Progress and priorities in the health of women and girls: a decade of advances and challenges.

OBJECTIVE: Following the initial wave of federal support to address women's health, there is a need to assess successes and determine the next priorities to advance the health of women. The objective of this study was to systematically collect expert opinion on the major advances in women's health in the past decade and priorities for women's health research and service in the coming decade. METHODS: We utilized a Delphi method to query the leadership from academic and community Centers of Excellence in Women's Health, as designated by the Department of Health and Human Services. Leaders from 36 of the 48 centers responded to a series of questions about the major advances and critical indicators to evaluate future needs in women's health. We utilized a social ecology model framework to organize the responses to each question. RESULTS: The experts identified increased health education for women and increased empowerment of women across multiple spheres as the major advances positively impacting the health of women. The experts selected the following areas as the most important indicators to measure the status of the health of women in the future: health education and promotion, rates and impact of interpersonal violence against women, and access to healthcare. The major advances and measures of the health of women did not focus on specific changes to individual women in illness management, clinical care, or individual behavioral change. CONCLUSIONS: As we move to address health reform, we must be able to recognize and incorporate a broad perspective on public health and policy initiatives critical to the health and wellness of women and girls and, therefore, central to the well-being of the nation.

The heart truth professional education campaign on women and heart disease: needs assessment and evaluation results.

BACKGROUND: Heart disease is the leading cause of death for women in the United States. Research has identified that women are less likely than men to receive medical interventions for the prevention and treatment of heart disease. METHODS AND RESULTS: As part of a campaign to educate healthcare professionals, 1245 healthcare professionals in 11 states attended a structured 1-hour continuing medical education (CME) program based on the 2004 AHA Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women and completed a pretest and posttest evaluation. We identified significant knowledge deficits in the pretest: 45% of attendees would initially recommend lifestyle changes alone, rather than statin therapy, for women diagnosed with coronary artery disease (CAD); 38% identified statin therapy as less effective in women compared with men for preventing CAD events; 27% identified Asian American women at low risk (rather than high risk) for type 2 diabetes mellitus (DM); and 21% identified processed meat (rather than baked goods) as the principal dietary source of trans fatty acids. Overall, healthcare professionals answered 5.1 of 8 knowledge questions correctly in the pretest, improving to 6.8 questions in the posttest (p < 0.001). Family physicians, obstetrician/gynecologists, general internists, nurse practitioners/physician assistants, and registered nurses all statistically significantly improved knowledge and self-assessed skills and attitudes as measured by the posttest. CONCLUSIONS: Significant knowledge deficits are apparent in a cross-section of healthcare providers attending a CME lecture on women and heart disease. A 1-hour presentation was successful in improving knowledge and self-assessed skills and attitudes among primary care physicians, nurse practitioners, physician assistants, and registered nurses.

The Centers for Disease Control and Prevention revised recommendations for HIV testing: reactions of women attending community health clinics.

The purpose of this study was to examine reactions to the Centers for Disease Control and Prevention revised recommendations for HIV testing by women attending community health clinics. A total of 30 women attending three community clinics completed semistructured individual interviews containing three questions about the recommendations. Thematic content analysis of responses was conducted. Results were that all agreed with the recommendation for universal testing. Most viewed opt-out screening as an acceptable approach to HIV testing. Many emphasized the importance of provision of explicit verbal informed consent. The majority strongly opposed the elimination of the requirement for pretest prevention counseling and spontaneously talked about the ongoing importance of posttest counseling. The conclusion was that there was strong support for universal testing of all persons 13 to 64 years old but scant support for the elimination of pretest prevention counseling. In general, respondents believed that verbal informed consent for testing as well as provision of HIV-related information before and after testing were crucial.

Faculty ownership of medical facilities: inappropriate conflict or an opportunity that benefits physicians and patients?

As a result of a confluence of issues, including faculty compensation in an academic health center (AHC), increasing awareness of conflict-of-interest issues, growing interest by faculty in entrepreneurial activities, and the creation of numerous new facilities and buildings associated with the AHC, the Indiana University School of Medicine (IUSM) in Indianapolis addressed the question of whether its faculty or even faculty groups could invest in any of these new entities, either as individuals or as groups. The dean of IUSM appointed a subcommittee of the school's standing Conflict of Interest Committee that included distinct groups of stakeholders and those without any fiduciary interests. As a result of meetings of this subcommittee, a new policy was set forth in a Points to Consider document to meet the emerging needs of the school to deal with such issues. The authors present the policy and the deliberations leading up to it as an example of how to address the issue of faculty ownership of medical facilities.

Improving breast health education for Hispanic women.

Hispanic women are less likely to receive screening mammograms than are white or African American women, even though breast cancer is the leading cause of cancer-related deaths in the population. Between 1990 and 2000, the Hispanic population of Indianapolis, Indiana (Marion County) grew by approximately 300%: from 8450 to 33 290. The present project was undertaken to provide educational outreach in Spanish to the new Hispanic residents of Indianapolis. A bilingual outreach coordinator visited community centers, churches, and health clinics and presented information to Hispanic women and men about a variety of cancers for which Hispanic women are at particularly high risk, including breast and cervical cancer. The number of Hispanic women obtaining mammograms rose by more than 200% during the first 6 months of the program. The authors conclude that culturally appropriate educational outreach presented by a Spanish-speaking woman using a Spanish-language videotape about mammography can improve breast cancer screening in Latinas.

Development of a comprehensive women's health program in an academic medical center: experiences of the Indiana University National Center of Excellence in Women's Health.

BACKGROUND: The IU National Cancer of Excellence (CoE) in Women's Health was funded by the Office on Women's Health, Department of Health and Human Services, in 1997 as part of the "second generation" of CoEs. The purpose of this paper is to describe the changes that the existence of this Center have wrought within the IU School of Medicine. METHODS: This paper describes the creation, mission, and function of the IU CoE, as well as some of its accomplishments to date. RESULTS: Through its missions targeting clinical care, research, education, community outreach, and leadership development, the IU CoE has significantly changed the delivery of care to and by women at this institution. CONCLUSIONS: The IU CoE has been responsible for major changes in the concepts of women's health from a clinical, research, education, and leadership perspective at the IU School of Medicine. Similar cases can be made for most of the other CoEs around the country. The challenges being faced continue to be sustained and sufficient funding for these valuable Centers.

Preliminary studies on the anti-angiogenic potential of pomegranate fractions in vitro and in vivo.

We previously showed pomegranate seed oil and fermented juice polyphenols to retard oxidation and prostaglandin synthesis, to inhibit breast cancer cell proliferation and invasion, and to promote breast cancer cell apoptosis. Here we evaluated the anti-angiogenic potential of these materials in several ways. We checked a possible effect on angiogenic regulation by measuring vascular endothelial growth factor (VEGF), interleukin-4 (IL-4) and migration inhibitory factor (MIF) in the conditioned media of estrogen sensitive (MCF-7) or estrogen resistant (MDA-MB-231) human breast cancer cells, or immortalized normal human breast epithelial cells (MCF-10A), grown in the presence or absence of pomegranate seed oil (SESCO) or fermented juice polyphenols (W). VEGF was strongly downregulated in MCF-10A and MCF-7, and MIF upregulated in MDA-MB-231, overall showing significant potential for downregulation of angiogenesis by pomegranate fractions. An anti-proliferative effect on angiogenic cells was shown in human umbilical vein endothelial cell (HUVEC) and in myometrial and amniotic fluid fibroblasts, and inhibition of HUVEC tubule formation demonstrated in an in vitro model employing glass carrier beads. Finally, we showed a significant decrease in new blood vessel formation using the chicken chorioallantoic membrane (CAM) model in vivo. 'In sum, these varied studies employing different models in different laboratories overall demonstrate for the first time an anti-angiogenic potential of pomegranate fractions, suggesting further in vivo and clinical investigations (for updates: info@rimonest.com).

HIV/STDs in minority women: educational and medical interventions to alter the spread.

HIV is but one form of sexually transmitted disease (STD). Many of the other STDs, especially those that produce ulcerating lesions, such as herpes simplex, syphilis, and chancroid, are associated with increased shedding of HIV if the individual is seropositive, and with increased risk of infection if a seronegative individual with that type of STD has unprotected intercourse with an HIV-positive partner. Thus, control and treatment of other STDs is very important in the management and prevention of the spread of HIV/AIDS.

Cevimeline for the treatment of xerostomia in patients with Sjögren syndrome: a randomized trial.

BACKGROUND: Cevimeline hydrochloride is a cholinergic agent with muscarinic agonist activity prominently affecting the M1 and M3 receptors prevalent in exocrine glands. We evaluated the safety and efficacy of cevimeline in the treatment of xerostomia in patients with Sjögren syndrome. METHODS: Seventy-five patients with Sjögren syndrome and associated salivary gland dysfunction were enrolled in a double-blind, randomized, placebo-controlled trial at 8 university- and office-based outpatient clinical facilities in the United States. Eligible study participants were randomized to receive 30 mg of cevimeline 3 times daily, 60 mg of cevimeline 3 times daily, or placebo for 6 weeks. Subjective responses were determined using global patient evaluation and visual analog scales. Salivary flow was measured objectively. RESULTS: Sixty-one participants completed the study. Patients in both cevimeline groups had significant improvements in dry mouth, as indicated by symptoms, salivary flow, and use of artificial saliva, compared with the placebo group. The drug was generally well tolerated, with expected adverse events resulting from the drug's muscarinic agonist action. Fourteen patients withdrew from the study because of adverse events, the most frequent being nausea. CONCLUSIONS: Therapy with cevimeline, 30 mg 3 times daily, seems to be well tolerated and to provide substantive relief of xerostomia symptoms. Although both dosages of cevimeline provided symptomatic improvement, 60 mg 3 times daily was associated with an increase in the occurrence of adverse events, particularly gastrointestinal tract disorders. Use of 30 mg of cevimeline provides a new option for the treatment of xerostomia in Sjögren syndrome.