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New study shows hidden genes may underlie autism severity

Scientists at the University of Colorado Anschutz Medical Campus  have implicated a largely hidden part of the human genome in the severity of autism symptoms, a discovery that could lead to new insights into the disorder and eventually to clinical therapies for the condition.

James Sikela, PhD, professor in the Department of Biochemistry and Molecular Genetics at the CU School of Medicine.
James Sikela, PhD, professor in the Department of Biochemistry and Molecular Genetics at the CU School of Medicine.

The researchers found the critical genes are a part of the human genome that is so complex and difficult to study that it has been unexamined by conventional genome analysis methods.

In this case, the region encodes most copies of the Olduvai (formerly DUF1220) protein domain, a highly duplicated (~300 copies in the human genome) and highly variable gene coding family that has been implicated in both human brain evolution and cognitive disease.

The researchers, led by James Sikela, PhD, a professor in the Department of Biochemistry and Molecular Genetics at the University of Colorado School of Medicine, analyzed the genomes of individuals with autism and showed that, as the number of copies of Olduvai increased, the severity of autism symptoms became worse.

While the Sikela lab has shown this same trend previously, the discovery has not been pursued by other researchers due to the complexity of the Olduvai family.

“It took us several years to develop accurate methods for studying these sequences, so we fully understand why other groups have not joined in.” Sikela said. “We hope that by showing that the link with autism severity holds up in three independent studies, we will prompt other autism researchers to examine this complex family.”

Image result for genome

In order to provide more evidence that the association with autism severity is real, the Sikela lab used an independent population and developed a different, higher resolution measurement technique. This new method also allowed them to zero in on which members of the large Olduvai family may be driving the link with autism.

Though autism is thought to have a significant genetic component, conventional genetic studies have come up short in efforts to explain this contribution, Sikela said.

“The current study adds further support to the possibility that this lack of success may be because the key contributors to autism involve difficult-to-measure, highly duplicated and highly variable sequences, such as those encoding the Olduvai family, and, as a result, have never been directly measured in other studies of autism,” Sikela said.

The study was published today in the American Journal of Psychiatry, and included CU Anschutz co-authors Jonathan M. Davis, PhD and Ilea Heft, PhD. Work was performed in collaboration with Dr. Stephen Scherer of The Hospital for Sick Children (SickKids) and University of Toronto and used whole genome sequences generated by the Autism Speaks MSSNG Open Science project. The work was supported by grants from the National Institute for Mental Health (NIMH) and the Simons Foundation for Autism Research (SFARI).

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Vaccine-Preventable Infections Higher in Pediatric Transplant Patients

vaccine-preventable infections in children

Children who receive solid organ transplants are hospitalized due to vaccine-preventable infections at rates that are significantly higher than the general population, according to a newly published study by University of Colorado School of Medicine researchers.

The study, published today in JAMA Pediatrics, reviewed nearly 7,000 transplant recipients nationally over a seven-year period beginning Jan. 1, 2004, to determine how often they are hospitalized with infections that are typically prevented with vaccines.

Of the 6,980 transplant recipients in the study, 1,092 patients, or 15.6 percent, were hospitalized with a total of 1,490 cases of vaccine-preventable infections within five years after transplant surgery. At that rate, hospitalization among the transplant population was up to 87 times higher than in the general population.

“The huge burden of illness from vaccine-preventable infections that we show in this article should stress to all physicians the critical importance of ensuring that all transplant patients receive age-appropriate immunizations,” said the study’s lead author, Amy Feldman, MD, MSCS, assistant professor of pediatrics for the CU School of Medicine and program director for the liver transplant fellowship at Children’s Hospital Colorado on the CU Anschutz Medical Campus.

While other studies have looked at morbidity from certain types of infections, this study is the first to explore the burden of illness from all vaccine-preventable infections across the entire pediatric solid organ transplant population. The analysis included all patients younger than 18 years old who underwent a heart, lung, liver, kidney, intestine, or multivisceral transplant at any of the 45 U.S. not-for-profit tertiary care pediatric hospitals that report data to the Pediatric Health Information System of the Children’s Hospital Association.

Based on the findings, Feldman and her co-authors recommend further study to identify ways to improve the likelihood of vaccination among children who need transplant surgery. The goal is to reduce the costs of hospitalization and the rates of sickness and death due to infections that could be prevented by vaccination.

Feldman has received funding for her research from an award from the Children’s Hospital Colorado Research Institute and from a grant by the National Institutes of Health National Center for Advancing Translational Sciences.

Feldman’s co-authors are Brenda L. Beaty, MSPH; Donna Curtis, MD, MPH; Elizabeth Juarez-Colunga, PhD; and Allison Kempe, MD, MPH; all from the CU Anschutz Medical Campus.

Guest contributor: Mark Couch, CU School of Medicine

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Researchers raise bar for successful management of severe atopic dermatitis (eczema)

A team of investigators from the University of Colorado College of Nursing and National Jewish Health has identified comprehensive guidelines for managing severe atopic dermatitis (AD), the most common form of eczema.

The clinical management review was recently published in The Journal of Allergy and Clinical Immunology: In Practice.

“The FDA approval of biologic medication for treating moderate-to-severe AD has transformed the therapeutic landscape highlighting the need for comprehensive and clear guidelines,” said Noreen Nicol, PhD, RN, associate professor in the College of Nursing at the CU Anschutz Medical Campus. “Without comprehensive guidelines that analyze national and international findings, we risk clinicians skipping crucial conventional steps, such as wet-wrap therapy, that need to be utilized prior to initiating biologics.”

Life with severe AD is incredibly difficult

Atopic dermatitis affects up to 18 percent of children as well as seven percent of adults. As a chronic, relapsing disease, severe AD has a profound impact on the quality of life of patients and families. Recent studies reveal patients with severe cases report high itch frequency of up to 18 hours a day, sleep disturbance and borderline or abnormal quality of life scores.

Current guidelines for decision making about advancement to systemic therapy in severe AD are misunderstood or not used. Treatment has often been reactive with inappropriate use of systemic corticosteroids and unapproved systemic immunosuppressants – drugs that suppress, or reduce, the strength of the body’s immune response. Additionally, international guidelines for treatment differ widely among countries.

A new approach to treating patients

Algorithm for managing eczema
Annotated guidelines for the patient with severe atopic dermatitis.

In their clinical review, the researchers incorporate national and international guidelines to deliver a comprehensive algorithm to guide clinicians in treating AD patients, as seen in the chart.

The steps include:
-Making a proper diagnosis and defining the severity of AD
-Addressing the basics of AD care:

Appropriate skin hydration and use of moisturizers and topical medications
Identifying irritants and allergens
Treating bacterial, viral or fungal infections
Treating psychosocial aspects
Developing an action plan

-Consultations with an AD specialist
-Considering acute management with wet-wrap therapy
-Considering hospitalization, treatment with the systemic biologic dupilumab and phototherapy

“Life with severe atopic dermatitis can be incredibly difficult for our patients and their families, and it can be quite challenging to care for. It’s important to let our patients, caregivers, and healthcare providers know that we have entered a new and exciting era in the treatment of AD with a number of targeted therapies approved or being studied which are referenced in this clinical review,” said Mark Boguniewicz, MD, professor, Division of Allergy-Immunology and Department of Pediatrics at National Jewish Health and University of Colorado School of Medicine.

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Research initiative uses Big Data to improve patient care

Researchers at the University of Colorado College of Nursing are participating in an initiative to improve health care outcomes and efficiencies by using large clinical and administrative data in a pediatric acute care setting. The project was funded by a grant received from Data Science to Patient Value (D2V) from the CU School of Medicine.

D2V is a multidisciplinary research initiative that funds projects focusing on using technology and Big Data and their applications to health care through collaborations with multiple stakeholders, including providers, patients, health systems, payers and policy makers. Also playing key roles in the initiative are the CU College of Nursing and the Colorado School of Public Health (ColoradoSPH).

Using Big Data

The use of Big Data to improve health-care delivery is being studied by Principal Investigator John Welton, PhD, RN, FAAN, and Co-Investigators Marcelo Coca Perraillon, PhD, an assistant professor in the Department of Health, Systems, Management & Policy in the ColoradoSPH and Peggy Jenkins, PhD, RN, assistant professor in the College of Nursing. Their study focuses on developing a database warehouse called the Nursing Value Research Data Warehouse (NVRDW) that collects data for each nurse caring for each patient during hospitalization.

The PI for the study, Welton, states, “This is the largest database of its kind to date detailing the overall care delivered by individual nurses and provides exciting potential to better understand the factors leading to better hospital outcomes of care.”

‘This is the largest database of its kind to date detailing the overall care delivered by individual nurses.’ – John Welton, PhD, RN, FAAN

The NVRDW is a large “pool” of data collected from various sources within multiple organizations that can be used to improve patient outcomes or transform health-care systems and deliver quality care to patients. Additionally, it can be used by researchers as a resource to create innovative strategies that improve patient outcomes.

One of the products from the D2V study is the creation of a consortium of three schools of nursing including the University of Kansas and University of Minnesota to share expertise to collect Big Data across multiple institutions in the future and leverage the expertise developed from the D2V project to improve the quality of care and optimizing nursing care to lower health care costs.

“There is a distinct purpose for data stored in the warehouse, such as research or reporting to improve patient outcomes or transform health-care systems,” said Jenkins. “Because so much data are collected in health-care settings, it is important to resource teams working to standardize the data so it can be compared and used to inform innovation.”

Providing Quality Care

Playing a huge role in the future of health care, Big Data is becoming more important to measure the quality of care provided to patients. Jenkins believes that nurses are just one of many individual interprofessional providers of patient care who can help in improving the quality of health care.

Big Data’s impact on health care

With technology becoming more present in the delivery of health-care services, more data is being collected than ever before. From tracking vital signs to discover trends, charting patient care histories through electronic health records, or using multiple patients’ health histories to predict health conditions and create treatment plans, Big Data is being used to reduce costs, create innovative treatments and provide effective care in a timely manner.

“Interprofessional collaboration of data scientists, informaticians, nurse scientists, nurse leaders, academia, clinical practice sites, and industry is necessary to construct data warehouses,” she said.

Although not all hospitals and health-care settings have large database warehouses, the multidisciplinary work at the CU Anschutz Medical Campus is a step in the right direction. Problems such as incompatible data systems could make it hard to import data to use to improve quality of care. Patient confidentiality can also become an issue. With large amounts of data such as electronic health records being housed in one database, it can make patients’ information vulnerable to a security breech, so it is important to have clear protocols in place to make the data secure.

Additionally, Big Data can create higher-value care that is more efficient, effective, higher quality and more cost effective, which can improve the care patients receive from providers in all sectors of the health field. This is particularly essential to nursing care, Jenkins notes.

“Using new methods, nurses are viewed as unique providers of patient care, and the value of quality nursing care provided divided by costs can be measured,” she said. “There is much to be learned about nurse characteristics and processes contributing to quality patient outcomes.”

Welton adds, “We are at the start of our journey to better understand the inner workings of health care by examining the care of each provider. We know a lot about physician care, but we are just beginning to collect data at the individual nurse-patient unit of analysis.”

The foundational D2V project has started a national dialogue on how to use this work to collect increasingly larger datasets to complement the many efforts to improve future health-care systems.

Guest contributor: This story was written by freelance contributor Katherine Phillips

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Blood results revealed from contaminated water near Colorado Springs

Researchers at the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus and the Colorado School of Mines shared the preliminary blood results from a study on poly- and perfluoroalkyl substances (PFAS) found at high levels in groundwater wells associated with public drinking water systems near Colorado Springs in 2013. The contaminants are linked to firefighting foam used at nearby Peterson Air Force Base.

Researchers tested the blood of 220 residents in Security, Widefield, and Fountain, and discovered PFAS levels well above the national average. Dr. John Adgate, a professor at the Colorado School of Public Health, said blood samples show some chemicals at rates twice as high and up to 12 times as high as median levels found across the country.

Blood testing is just the first step in the study, which will look further at signs of immune function and other health markers among participants in the year to come.

For more information on the preliminary results, visit https://www.pfas-aware.org/

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Researchers find possible connection between cardiovascular disease indicators and living near oil and gas wells

Researchers at the Colorado School of Public Health have found a possible connection between the intensity of oil and gas exploration in an area and early indicators of cardiovascular disease among nearby residents.

In a pilot study of 97 people in Fort Collins, Greeley and Windsor, the scientists found that those who lived in areas of more intense oil and gas development showed early signs of cardiovascular disease (CVD), including higher blood pressure, changes in the stiffness of blood vessels, and markers of inflammation.

Lisa McKenzie, PhD, MPH, of the Colorado School of Public Health
Lisa McKenzie, PhD, MPH, Colorado School of Public Health

The study was published this month in the journal Environmental Research.

“We are not sure whether the responsible factor is noise or emissions from the well pads or something else, but we did observe that with more intense oil and gas activity around a person’s home, cardiovascular disease indicator levels increased,” said the study’s lead author Lisa McKenzie, PhD, MPH, of the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus.

From Oct. 2015 to May 2016, the researchers measured indicators of CVD in 97 men and women from Fort Collins, Greeley and Windsor who did not smoke tobacco or marijuana. The participants did not have jobs that exposed them to dust, fumes, solvents or oil or gas development activities.  None had histories of diabetes, chronic obstructive pulmonary disease or chronic inflammatory disease like asthma or arthritis.  CVD is the leading cause of mortality in the U.S. with more than 900,000 deaths in 2016.

“While behavioral and genetic factors contribute to the burden of CVD, exposure to environmental stressors, such as air pollution, noise and psychosocial stress also contribute to cardiovascular morbidity and mortality,” according to the authors.

John L. Adgate, PhD, MSPH, Colorado School of Public Health
John L. Adgate, PhD, MSPH, Colorado School of Public Health

One increasingly common source of these stressors is extraction of oil and gas in residential areas. Advances in fracking, horizontal drilling, and micro-seismic imaging have opened up many previously inaccessible areas for exploration. Some of those wells are in heavily populated areas. “More than 17.4 million people in the U.S. now live within one mile of an active oil and gas well,” McKenzie said.

Previous studies have shown that short and long-term exposure to the kind of particulate matter emitted from oil and gas operations may be associated with increases in cardiovascular disease and death. At the same time, noise levels measured in communities near these facilities have exceeded levels associated with increased risk of CVD and hypertension, the study said.

This study is the first to investigate the relationship between oil and gas development and CVD. But the results are consistent with an increase in the frequency of cardiology inpatient hospital admissions in areas of oil and gas activity in Pennsylvania.

“Our study findings support the use of these indicators of cardiovascular disease in future studies on oil and gas development in residential areas,” McKenzie said.

Those indicators included blood pressure, arterial stiffening and early markers of inflammation.

McKenzie acknowledged the limitations of the small sample size, saying that the results demonstrate the need for a much larger study.

The study co-authors include: John L. Adgate, Department of Environmental and Occupational Health, Colorado School of Public Health; James Crooks, Division of Biostatistics and Bioinformatics, National Jewish Health, Department of Epidemiology, Colorado School of Public Health; Jennifer L. Peel, Department of Environmental and Occupational Health, Colorado School of Public Health, Department of Epidemiology, Colorado School of Public Health, Department of Environmental and Radiological Health Sciences, Colorado State University; Benjamin D. Blair, Department of Environmental and Occupational Health, Colorado School of Public Health; Stephen Brindley, Department of Environmental and Occupational Health, Colorado School of Public Health; William B. Allshouse, Department of Environmental and Occupational Health,

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Hormone may preserve bone and muscle mass in older women

Women 55 and older have an increased risk of bone and muscle loss, but therapy with the hormone Dehydroepiandrosterone (DHEA) may help prevent bone loss and increase muscle mass in older women, according to a new study led by Catherine M. Jankowski, PhD, FACSM, an exercise physiologist and associate professor at the University of Colorado College of Nursing at the CU Anschutz Medical Campus.

The study was published online Nov. 27 in the journal Clinical Endocrinology and highlighted in Endocrinology Today.

Jankowski and colleagues analyzed data from four single-site, double-blinded, placebo-controlled, randomized clinical trials sponsored by the National Institute on Aging designed to assess the effects of oral DHEA therapy on bone mineral density (BMD) and body composition in women and men between the ages of 55 to 85 who were not using sex hormone therapy.

The dose of DHEA used in the studies increased circulating DHEA sulfate levels to that of young adults.

“Because age-related decreases in androgen and estrogen production contribute to the loss of bone and muscle mass in older adults, restoring DHEAS to youthful levels may be an effective strategy for maintaining bone and muscle,” said Jankowski.

In all four studies, dual-energy X-ray absorptiometry (DXA) was used to measure total body fat and lean (muscle) mass, and bone mineral density of the proximal femur, total hip, and lumbar spine at baseline and after 12 months of DHEA or placebo administration. Serum DHEA sulfate, estradiol, testosterone, sex hormone-binding globulin and insulin-like growth factor I concentrations were also measured at baseline and at 12 months. Researchers merged data from the four studies into a central database and compared the 12-month changes in BMD, body composition, circulating hormones, and growth factors in response to oral DHEA therapy versus placebo.

Of the 486 cases, 138 women and 98 men had low bone mass, and 29 women and 11 men had osteoporosis. The researchers found that DHEA therapy was associated with increased BMD of the lumbar spine, total hip and trochanter in women, but not in men. The increases in BMD in women were not as large as seen with other treatments such as bisphosphonates.

“Unlike some pharmaceutical trials targeting BMD, the DHEA trials we conducted did not target women with osteoporosis, which may have contributed to the modest increases in BMD,” said the researchers.

“It is possible that DHEA therapy could be a strategy to mitigate the decline in BMD in postmenopausal women who do not tolerate other treatments,” according to Jankowski. However, the authors also concluded that the safety of long-term DHEA therapy (more than one year) needs further research.

The investigators also found sex-specific results effects on fat-free mass (which includes muscle mass) in women and a decrease of 0.4 kg fat mass in men. None of the four trials controlled for exercise behaviors, which could have contributed to the increase in fat-mass of women taking DHEA.

“Combining DHEA therapy with resistance exercise that imparts mechanical strain to bone may promote greater increases in muscle mass and BMD compared to either intervention alone,” stated Jankowski. “The beneficial effects of DHEA replacement on body composition are to modestly increase fat-free mass in women and decrease fat mass in older men, a reversal of the usual age-related trends in muscle and fat.”

Jankowski and colleagues are currently conducting a randomized placebo-controlled trial to determine the independent and combined effects of bone-loading exercise and DHEA on BMD and muscle mass in postmenopausal women with low bone mass or moderate osteoporosis (NCT# 03227458).

Co-authors of the pooled analysis include: Wendy Kohrt, Pamela Wolfe, and Sarah J. Schmiege of the University of Colorado Anschutz Medical Campus, Aurora; K. Sreekumaran Nair, Sundeep Khosla, and Michael Jensen of the Mayo Clinic, Rochester, Minn.; Denise von Muhlen, Gail A. Laughlin, Donna Kritz-Silverstein, Jaclyn Bergstrom, and Richele Bettencourt of the University of California, San Diego; Edward P. Weiss currently of St. Louis University, St. Louis; and Dennis T. Villareal, currently of Baylor University and the Michael E. DeBakey Veterans Administration Medical Center in Houston.

Guest contributor: Dana Brandorff, director of Marketing & Communications, CU College of Nursing

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Talent behind the lab coats

“Ni hao.” “Namaste.” “As-Salaam-Alaikum.” “M’bolani.” “What’s up?”

At the recent Talent and Attire Show hosted by the Association of International Researchers (AIR), these were only a few of the responses to Ranjitha Dhanasekaran, PhD, president of AIR, who opened the show by directing the audience: “Say hello in your native tongue.”

The show in the Krugman Conference Hall, complete with international banquet catered by local restaurants, was the culmination of the nationwide International Education Week (IEW). “IEW is hosted by the State Department of the United States to recognize the importance of international education and cultural exchange,” said Michelle Larson-Krieg, JD, director of the International Student and Scholar Services (ISSS) with the Office of International Affairs at the CU Anschutz and CU Denver campuses.

One of the many volunteers who made the event possible, Daniela Santos, MD, said the annual event fosters both a sense of belonging and acceptance among international researchers on campus as well as an avenue to show pride in their heritage. “It’s a two-way exchange of ideas,” she said. For example, Santos elaborated, it changed her perspective seeing a Nigerian lab mate, who typically wears U.S. street clothes, donning traditional Nigerian apparel for the attire show. “It’s a way to learn about who he is and where he came from.”

Humor a theme of the night

Talent show Ironic
Jennifer Major, PhD, and her 6-year-old daughter Roxy perform a Canadian music tribute vis-à-vis Alanis Morissette’s “Ironic.”

Canada-born Jennifer Major, PhD, and Scotland-born John Peacock, PhD, postdoctoral fellows at the CU Anschutz Medical Campus, served as hosts and comedic relief for the event. “What’s the difference between the United States and Canada?” Peacock quipped to the audience. “The U.S. has a nice neighbor.” Off-stage, a more serious Peacock explained that as a scientist, it’s important to have interests other than science, and the event brings much-needed art and culture to the medical campus, which he feels can be a bit sterile at times. “There are many diversely talented people working here, and unless they have such a platform to show off these talents, few people will know this.”

In contrast to Peacock’s droll humor, Major, AIR’s vice president of communications, performed a Canadian music tribute while her 6-year-old daughter Roxy danced in accompaniment. While not intended as a comedy routine, Major’s rendition of Alanis Morissette’s “Ironic” was affected by a few sound glitches, causing her to improvise with an a cappella performance and lending some levity amidst the technical problems.

Global talent on a local stage

Talent show international
From left: Daniela Santos, 10-month-old Emmalina Sayem, Nabanita Mukherjee, PhD, and Ranjitha Dhanasekaran, PhD, president of the International Student and Scholar Services at the CU Anschutz Medical Campus. All women participated in the attire show.

The two-part talent show took a break for dinner, followed by the attire show. Over 100 international and domestic faculty, staff and students were in attendance, many with their children. Talents on display included singing, dancing, folklore and short comedy readings. “People embrace the opportunity to share their background, culture and talents,” said Larson-Krieg. “You can see the enthusiasm for the event in the volunteers, the people who participate, and the performers.”

Marveling at the diversity of the campus international community, director of the Postdoctoral Office and Career Development Office Bruce Mandt, PhD, joked, “Who knew there was so much talent hiding behind lab coats?” Mandt said events such as the talent show are important career-development opportunities. “Science is global,” Mandt insisted. “Our trainees need opportunities to understand that science transcends borders and at some point, regardless of whether they remain in academia or move into other industries, they will work with people from all over the world.”

Nabanita Mukherjee, PhD, wearing traditional ceremonial attire including a reed crown, performed Odissi, one of the oldest surviving Indian classical dance forms. Mukherjee explained that her performance began with a tribute to Mother Earth, then to the Almighty, to the Teacher/Guru and finally to the audience. In the past, Mukherjee frequently performed public dance routines; however, she took a break from dancing following the birth of her child. “It felt great to me personally to realize I can continue dancing,” she said.

One of the most striking performances of the night came when the song “The End of the World,” most notably performed by Skeeter Davis and featured in movies such as “Girl, Interrupted” and TV shows including “Mad Men” and “Lost,” was performed at the event by Yao Ke, PhD, who alternated singing in English and Mandarin Chinese. Given the familiarity of the tune, many in the audience sang in their native language, serving as a reminder that though songs may be translated into other languages, the melody remains the same. Likewise, at CU Anschutz, a community of researchers from diverse cultures and backgrounds are united by their passion for science.

Dhanasekaran added, “The Association for International Researchers is here to promote inclusivity and diversity.” Further elaborating, she quoted thought leader Verna Myers: “Diversity is being invited to the party. Inclusion is being asked to dance.”

Guest contributor: Story written by Shawna Matthews, a postdoc at CU Anschutz. Photos by Eseosa Enabulele, MPH

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Women in hospital medicine face major obstacles in pregnancy and returning to work

Women in hospital medicine face major obstacles during pregnancy, parental leave and returning to work, prompting a discussion about gender equity in medicine, according to a new study from researchers at the University of Colorado Anschutz Medical Campus.

Emily Gottenborg, MD, assistant professor in the division of Hospital Medicine at the University of Colorado School of Medicine
Emily Gottenborg, MD, assistant professor in the division of Hospital Medicine at the CU School of Medicine

The study, published recently in the Journal of Hospital Medicine, includes wide-ranging interviews with 10 female academic hospitalists from institutions around the country. They were asked about their experiences during pregnancy, parental leave and the challenges of returning to work including barriers to breastfeeding and diminished career opportunities.

“It is commonly thought that the medical profession is more enlightened around parental support than other professions, but it really isn’t,” said the study’s lead author Emily Gottenborg, MD, assistant professor in the division of Hospital Medicine at the University of Colorado School of Medicine. “We found a lack of paid leave policies in academic settings, difficulty in support for breastfeeding, and loss of career opportunities when new parents return to work.”

Gottenborg said hospital medicine is unique in that 47 percent of practitioners are women and 80 percent are under age 40, indicative of a large proportion of women entering the profession during a time in life when many want to start a family.

“The field poses known challenges to this population, including shift work, atypical schedules and unpredictable hours,” Gottenborg said. “Our goal was to both explore the challenges to undergoing this experience and discovering solutions to support female academic hospitalists.”

Most participants described inadequate paid parental leave that resulted in haggling with managers, human resources and administrative staff for time away from work with their newborns.

“All of my leave was unpaid…managed to finagle short-term disability into paying for it…the system was otherwise set up to screw me financially,” one research participant said.

All of the women described significant physical challenges when working during pregnancy.

“I used to lie on the floor of my office, take a little nap, wake up, write some notes, go home, take another nap, wake up, write some more notes,” a doctor reported.

Breastfeeding, extolled by the medical community for its long-term benefits to children, was an endless challenge, the study said. Privacy was often elusive.

“It’s two chairs that are behind a curtain in a women’s locker room in the basement of the hospital, that are tiny and gross,” said one physician.

Another said this:

“I would get to work, set up, and pump while chart reviewing. Then I would go and see people…and come back to my office and pump and write a few notes. And go out and see more patients, and then pump. I was like a cow.”

Some stopped breastfeeding early because of these difficulties.

Many of the physicians interviewed faced serious career challenges during this period. Sometimes they were left out of projects or not asked to participate.

“People feel they are missing out and their career suffers,” Gottenborg said. “One of the reasons women are not in more leadership positions in medicine is because of these big breaks in their lives.”

The study calls for a more generous paid leave policy that not only includes maternity leave but a flexible scheduling period before and after the leave to account for the challenges of pregnancy and new motherhood.

“Paid parental leave is rare in academic settings, but studies from other industries show that when women take paid leave, they are more likely to remain in the workforce 9-12 months afterward, work more weekly hours and feel more loyal to the organization,” the study said.

Ultimately, Gottenborg said, if academic medicine wants to continue to attract and retain women it needs to reexamine work-life policies that often feel antiquated.

“As medical professionals we should be in the forefront of this kind of change,” she said, “not lagging behind.”

The study co-authors include: Anna Maw, MD; Li-Kheng Ngov, MD; Marisha Burden, MD; Anastasiya Ponomaryova, BS and Christine Jones, MD, MS.

 

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