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Health care workers unprepared for magnitude of climate change

An epidemic of chronic kidney disease that has killed tens of thousands of agricultural workers worldwide, is just one of many ailments poised to strike as a result of climate change, according to researchers at the University of Colorado Anschutz Medical Campus.

“Chronic kidney disease is a sentinel disease in the era of climate change,” said

Dr. Cecilia Sorensen
Dr. Cecilia Sorensen, lead author of the article in the New England Journal of Medicine.

Cecilia Sorensen, MD, of the Colorado School of Public Health and the University of Colorado School of Medicine. “But we can learn from this epidemic and choose a wiser path forward.”

The article was published today in the New England Journal of Medicine.

Lead author Sorensen and her colleague, Ramon Garcia-Trabanino, MD, said chronic kidney disease of unknown origin or CKDu is now the second leading cause of death in Nicaragua and El Salvador. The death toll from the disease rose 83% in Guatemala over the past decade.

The exact cause of the disease, which hits agricultural workers in hot climates especially hard, remains unknown. It doesn’t align with typical chronic kidney disease which is usually associated with diabetes and hypertension.

“What we do know for certain is that CKDu is related to heat exposure and dehydration,” Sorensen said, adding that exposure to pesticides, heavy metals, infectious agents and poverty may also play a role.

Sugar cane workers in Central America, who often toil in 104-degree heat in heavy clothing, are often victims of the illness.  Sorensen said there is evidence that constant exposure to high temperatures can result in chronic kidney damage.

“They can’t say it’s too hot, they don’t want to go work in the fields,” she said. “If they don’t work, they don’t eat that night.”

The disease is also showing up in the U.S. in places like Florida, California and Colorado’s San Luis Valley.

And the hotter it gets, Sorensen said, the more likely it will increase along with other diseases.

“When it gets hotter, we see more people in emergency rooms with cardiovascular disease,” said Sorensen, who is an emergency department physician at CU Anschutz and a member of the CU Consortium for Climate Change & Health. “We are seeing average global temperatures gradually creep up but one of the biggest risks are heat waves.”

She said U.S. public health officials are not prepared for the kinds of heat waves seen in Europe in 2003 that killed over 70,000 people.

“We are way behind the curve on this compared to Europe,” she said. “We are also seeing Lyme disease in places we never saw it before because the winters are no longer cold enough to kill off the ticks that carry it.”

She said the mosquitos that carry diseases like Zika, dengue fever and Chikungunya are now showing up in the U.S.

“If we are to address both the CKDu and other climate-related diseases, we will have to integrate environmental information into clinical and public health practice and build robust early-warning systems focused on vulnerable communities and climate-sensitive diseases…so we can respond rapidly,” she said. “We believe physicians have the opportunity to change the course of the future.”

 

 

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Greater prevalence of congenital heart defects in areas with high intensity of oil and gas well activity

Mothers living near more intense oil and gas development activity have a 40-70% higher chance of having children with congenital heart defects (CHDs) compared to those living in areas of less intense activity, according to a new study from researchers at the Colorado School of Public Health.

“We observed more children were being born with a congenital heart defect in areas with the highest intensity of oil and gas well activity,” said the study’s senior author Lisa McKenzie, PhD, MPH, of the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus.  At least 17 million people in the U.S. and 6% of Colorado’s population live within one mile of an active oil and gas well site.

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

The study was published today in the peer-reviewed journal Environment International.

The researchers studied 3,324 infants born in Colorado from 2005-2011. They looked at infants with several specific types of CHDs.

Researchers estimated the monthly intensity oil and gas well activity at mother’s residence from three months prior to conception through the second month of pregnancy.  This intensity measure accounted for the phase of development (drilling, well completion, or production), size of well sites, and production volumes.

They found mothers living in areas with the most intense levels of oil and gas well activity were about 40-70% more likely to have children with CHDs. This is the most common birth defect in the country and a leading cause of death among infants with birth defects. Infants with a CHD are less likely to thrive, more likely to have developmental problems and more vulnerable to brain injury.

Animal models show that CHDs can happen with a single environmental exposure during early pregnancy. Some of the most common hazardous air pollutants emitted from well sites are suspected teratogens – agents that can cause birth defects – known to cross the placenta.

The study builds on a previous one that looked at 124,842 births in rural Colorado between1996-2009 and found that CHDs increased with increasing density of oil and gas wells around the maternal residence. Another study in Oklahoma that looked at 476,000 births found positive but imprecise associations between proximity to oil and gas wells and several types of CHDs.

Those studies had several limitations including not being able to distinguish between well development and production phases at sites, and they did not confirm specific CHDs by reviewing medical records.

The limitations were addressed in this latest study. Researchers were able to confirm where the mothers lived in the first months of their pregnancy, estimate the intensity of well activity and account for the presence of other air pollution sources. The CHDs were also confirmed by a medical record review and did not include those with a known genetic origin.

“We observed positive associations between odds of a birth with a CHD and maternal exposure to oil and gas activities…in the second gestational month,” the study researchers said.

The study data showed higher levels of CHDs in rural areas with high intensities of oil and gas activity as opposed to those in more urban areas. McKenzie said it is likely that other sources of air pollution in urban areas obscured those associations.

Exactly how chemicals lead to CHDs is not entirely understood. Some evidence suggests that they may affect the formation of the heart in the second month of pregnancy. That could lead to birth defects.

McKenzie said the findings suggested but did not prove a causal relationship between oil and gas exploration and congenital heart defects and that more research needs to be done.

“This study provides further evidence of a positive association between maternal proximity to oil and gas well site activities and several types of CHDs,” she said. “Taken together, our results and expanding development of oil and gas well sites underscore the importance of continuing to conduct comprehensive and rigorous research on health consequences of early life exposure to oil and gas activities.”

The study co-authors include William Allshouse, PhD, BSPH and Stephen Daniels, MD, PhD, both of the University of Colorado Anschutz Medical Campus.  The study was funded by a grant from the American Heart Association.

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Women dominate OBGYN field but make less money than male counterparts

While women outnumber men as OB-GYN practitioners, they still make significantly less money and the pay gap extends to subspecialties like reproductive endocrinology and infertility (REI), according to researchers at the University of Colorado Anschutz Medical Campus.

“It’s interesting that the OB-GYN field is dominated by women and yet this gender inequality in pay persists,” said the study’s senior author Malgorzata Skaznik-Wikiel, MD, assistant professor of obstetrics and gynecology at the University of Colorado School of Medicine. “Why the discrepancy?”

The study was published on-line this month in the journal Fertility and Sterility.

It showed that even after adjusting for variables like hours worked, years in practice, location, academic vs. private practice, female reproductive endocrinology and infertility subspecialists make on average $67,000 less than male REIs per year.

Pay inequity among physicians in well-documented. According to Doximity, an online social network for health care professionals, women doctors make about 27.7 percent less than male physicians or about $105,000.

Dr. Skaznik-Wikiel | CU ARM
Malgorzata Skaznik-Wikiel, MD, assistant professor of obstetrics and gynecology at the University of Colorado School of Medicine.

A recent commentary in the journal Obstetrics and Gynecology noted that 82 percent of those going into OB-GYN were women, yet the field is the fourth worst of 18 specialties in pay inequity among the sexes. Skaznik-Wikiel and her colleagues sent surveys to 796 board-certified or board-eligible Society for Reproductive Endocrinology and Infertility members. Of those, 215 responded, an above average response for such surveys.

The study noted that although women were more likely to practice less than five days per week, there were no significant differences in the number of hours they spent per week seeing patients, doing research or being involved in other academic activities.

The researchers reviewed a number of reasons given for the pay gap – women working fewer hours, taking more personal leave, practicing in specialties that pay less or practicing in academia rather than privately.

Yet they found little to substantiate these suggestions.

For example, the study said it’s unlikely that a woman taking more personal leave, like maternity leave, would affect a base salary. Also, they said, more and more men are taking paternity leave as well.

One possible culprit is `salary compression.’ That’s when the market rate for a job outpaces pay increases for those already in those positions. New hires may get bigger salaries.

“There is some evidence that men switch jobs more often than women and sometimes new jobs will pay more to attract new employees,” Skaznik-Wikiel said.

She also said women are often reluctant to negotiate hard over salary for fear of being seen as overly aggressive, traits many do not associate with men who do the same thing.

Ultimately, Skaznik-Wikiel said, there is no good reason for the discrepancy.

“The first step in addressing the gender gap is acknowledging it exists,” she said. “Ignorance of this issue is no longer acceptable.”

The second step is opening a frank and honest discussion about income, salary negotiations and implementation of academic institutional and private practice policies addressing potential gender biases, the study said.

Salaries, raises and bonuses should be more transparent, said Skaznik-Wikiel.

“Women also need to step into mentorship roles now more than ever,” she said. “An opportunity exists for practitioners in the field of obstetrics and gynecology and its subspecialties to lead by example in establishing new transparent norms and better policies that create an environment of equity in pay.”

The study co-authors include: Sara Babcock Gilbert, MD, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology at the CU School of Medicine and Amanda Allshouse, MS, Department of Biostatistics and Informatics at the Colorado School of Public Health at CU Anschutz.

 

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Women dominate Ob/Gyn field but make less money than male counterparts

Pregnant patient

While women outnumber men as Ob/Gyn practitioners, they still make significantly less money and the pay gap extends to subspecialties like reproductive endocrinology and infertility (REI), according to researchers at the University of Colorado Anschutz Medical Campus.

“It’s interesting that the Ob/Gyn field is dominated by women and yet this gender inequality in pay persists,” said the study’s senior author Malgorzata Skaznik-Wikiel, MD, assistant professor of obstetrics and gynecology at the University of Colorado School of Medicine. “Why the discrepancy?”

The study was published on-line this month in the journal Fertility and Sterility.

It showed that even after adjusting for variables like hours worked, years in practice, location, academic vs. private practice, female reproductive endocrinology and infertility subspecialists make on average $67,000 less than male REIs per year.

Pay inequity among physicians in well-documented. According to Doximity, an online social network for health care professionals, women doctors make about 27.7 percent less than male physicians or about $105,000.

Dr. Skaznik-Wikiel | CU ARM
Malgorzata Skaznik-Wikiel, MD, assistant professor of obstetrics and gynecology at the University of Colorado School of Medicine.

A recent commentary in the journal Obstetrics and Gynecology noted that 82 percent of those going into Ob/Gyn were women, yet the field is the fourth worst of 18 specialties in pay inequity among the sexes.  Skaznik-Wikiel and her colleagues sent surveys to 796 board-certified or board-eligible Society for Reproductive Endocrinology and Infertility members. Of those, 215 responded, an above average response for such surveys.

The study noted that although women were more likely to practice less than five days per week, there were no significant differences in the number of hours they spent per week seeing patients, doing research or being involved in other academic activities.

The researchers reviewed a number of reasons given for the pay gap – women working fewer hours, taking more personal leave, practicing in specialties that pay less or practicing in academia rather than privately.

Yet they found little to substantiate these suggestions.

For example, the study said it’s unlikely that a woman taking more personal leave, like maternity leave, would affect a base salary. Also, they said, more and more men are taking paternity leave as well.

One possible culprit is `salary compression.’ That’s when the market rate for a job outpaces pay increases for those already in those positions. New hires may get bigger salaries.

“There is some evidence that men switch jobs more often than women and sometimes new jobs will pay more to attract new employees,” Skaznik-Wikiel said.

She also said women are often reluctant to negotiate hard over salary for fear of being seen as overly aggressive, traits many do not associate with men who do the same thing.

Ultimately, Skaznik-Wikiel said, there is no good reason for the discrepancy.

“The first step in addressing the gender gap is acknowledging it exists,” she said. “Ignorance of this issue is no longer acceptable.”

The second step is opening a frank and honest discussion about income, salary negotiations and implementation of academic institutional and private practice policies addressing potential gender biases, the study said.

Salaries, raises and bonuses should be more transparent, said Skaznik-Wikiel.

“Women also need to step into mentorship roles now more than ever,” she said. “An opportunity exists for practitioners in the field of obstetrics and gynecology and its subspecialties to lead by example in establishing new transparent norms and better policies that create an environment of equity in pay.”

The study co-authors include: Sara Babcock Gilbert, MD, Division of Reproductive Endocrinology and Infertility, Dept. of Obstetrics and Gynecology at the CU School of Medicine and Amanda Allshouse, MS, Dept. of Biostatistics and Informatics at the Colorado School of Public Health at CU Anschutz.

 

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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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Researchers discover a genetic defect linked to pediatric liver disease

Researchers from the University of  Colorado Anschutz Medical Campus, in collaboration with several other institutions, have discovered a genetic defect linked to Biliary atresia (BA), the most common pediatric cause of end-stage liver disease, and the leading indication for liver transplantation in children.

Their findings were published January in the journal Hepatology.

Ronald Sokol, MD
Ronald Sokol, MD

“We don’t know the cause of Biliary atresia, which interferes with our ability to treat affected children,” said study co-author Ronald Sokol, MD, a pediatric gastroenterologist and hepatologist at Children’s Hospital Colorado and Director of the Colorado Clinical and Translational Sciences Institute (CCTSI) at CU Anschutz.

By identifying a genetic mutation linked to the disease, Sokol, along with researchers from Emory University, University of Utah, Children’s Hospital of Philadelphia, Washington University at St. Louis, and others, may finally determine the cause of this devastating condition. The group used next-generation gene sequencing to discover that a genetic defect of the gene PKD1L1 was linked to BA in a subset of patients.

Some children with BA also have splenic abnormalities and cardiac malformations called biliary atresia splenic malformation syndrome or BASM. Researchers hypothesized that the genetic factors causing an asymmetric position of organs in the body could also cause the development of BA in BASM patients, and that the genes involved could be discovered using whole exome sequencing.

So they sequenced DNA specimens from 67 subjects with BASM, including 58 patient-parent trios. Researchers looked at 2,016 genes – a subset of the full genome – that were associated with proteins that were candidates to cause a disease like BA. The study found five patients who had two copies of mutations in the gene PKD1L1 and three additional patients who had one mutation in the gene.

“The importance of this is that researchers have never identified a gene, when mutated, that causes BA,” Sokol said. “This is the first time it has been found.”

The CCTSI’s Pediatric Clinical and Translational Research Center played a key role in the study. The patients who were participants came from a liver disease research network, which Dr. Sokol chairs, the Childhood Liver Disease Research Network (ChiLDReN). This network has been funded by the NIH for 15 years and includes 14 centers across the nation, Canada and the UK.

The gene that was identified may be the first of other genes to be found to be linked with BASM or BA. Understanding what causes BA is a breakthrough that could lead to new therapeutic approaches that would ultimately avoid liver transplantation.

In the first analysis of the data, researchers looked at more than 2,000 genes. Now that they have the data from the whole exome sequencing, researchers can go back and analyze the other 18,000 genes for other genetic causes of BA.

“What we learn about what causes the disease could translate into new therapeutic targets and strategies,” Sokol said.

Guest contributor: Wendy Meyer, Colorado Clinical and Translational Sciences Institute

 

 

 

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Researchers find genetic clues to high rates of asthma in those of African ancestry

In the largest study of its kind, researchers at the University of Colorado Anschutz Medical Campus have found new clues into the parts of the human genome associated with the higher rates of asthma in those of African ancestry.

The study was published today in the journal Nature Communications.

Using advanced new technology, scientists were able to identify loci or locations on a specific chromosome that may put those of African descent at a higher risk of asthma.

Kathleen Barnes, PhD, director of the Colorado Center for Personalized Medicine at CU Anschutz.
Kathleen Barnes, PhD, director of the Colorado Center for Personalized Medicine at CU Anschutz.

They also discovered four chromosomal regions usually found in whites and Asians associated with asthma. One of those chromosomal areas is known as the 17q12 – 21 region.

Despite the high incidence of asthma among those of African ancestry, it has been historically underrepresented in genome-wide association studies (GWAS) even though the African genome is the most diverse on earth.

“In the largest GWAS of asthma in African ancestry populations to date, we found strong evidence for association at four previously reported asthma loci whose discovery was driven largely by non-African populations, and we also identified two novel loci on chromosome 8 that may be specific to asthma risk in African ancestry populations,” said the study’s first author Michelle Daya, PhD, assistant professor in the division of Biomedical Informatics and Personalized Medicine at the CU School of Medicine.

According to Kathleen Barnes, PhD, the senior author on the study and director of the Colorado Center for Personalized Medicine at CU Anschutz, those of African ancestry in the Americas and elsewhere suffer a disproportionate burden of disability, disease and death from common chronic illnesses like asthma and diabetes. Yet the group has been understudied.

Michelle Daya, PhD, assistant professor in the division of Biomedical Informatics and Personalized Medicine.
Michelle Daya, PhD, assistant professor in the division of Biomedical Informatics and Personalized Medicine.

To better understand this population and its genetic impact, Barnes worked with the National Institutes of Health’s National Heart, Lung and Blood Institute (NHLBI) to create the `Consortium on Asthma among African-ancestry Populations in the Americas’ or CAAPA.

They sequenced the genome of 642 people of African ancestry from 15 North, Central and South American and Caribbean populations plus Yoruba-speaking individuals from Ibadan, Nigeria.

“NHLBI has been promoting basic research to understand the genetic contribution to asthma disparities across racial and ethnic groups, and the CAAPA is one of our major investments in this area,” said James Kiley, director of the Division of Lung Diseases at NHLBI and the NIH.

In this latest study, researchers looked at 7,009 asthma cases and 7,645 controls.

“From this study we can say chromosome 17q is important for the development of asthma not just in populations of European or Asian ancestry, but also those of African ancestry,” Barnes said. “This is a big step forward in untangling what is happening at this loci.”

The researchers were able to make these findings due to new technology like the development of the African Diaspora Power Chip in partnership with Illumina Inc. which allows for improved tagging and coverage of African ancestry genetic variation.

“We need to understand what is driving asthma in these populations,” Barnes said. “Now we have a much better genetic foundation for pursuing this.”

Daya agreed.

“Ultimately, we hope that a better understanding of the genetic risk factors for asthma in African ancestry populations will lead to the development of better therapeutic interventions,” she said.

 

 

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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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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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Among heart attack survivors, drug reduces chances of second heart attack or stroke

In a clinical trial involving 18,924 patients from 57 countries who had suffered a recent heart attack or threatened heart attack, researchers at the University of Colorado Anschutz Medical Campus and fellow scientists around the world have found that the cholesterol-lowering drug alirocumab reduced the chance of having additional heart problems or stroke.

The study was published today in The New England Journal of Medicine.

Gregory Schwartz MD, PhD, professor of medicine at the University of Colorado School of Medicine.
Gregory Schwartz MD, PhD, co-author of the study and professor of medicine at the University of Colorado School of Medicine.

Alirocumab is in the class of drugs called PCSK9 antibodies.

“It works by increasing receptors on the liver that attract particles of LDL cholesterol from the blood and break them down. The result is that blood levels of LDL or ‘bad’ cholesterol decrease by approximately 50 percent, even when patients are already taking a statin,” explained Gregory Schwartz MD, PhD, co-author of the study and professor of medicine at the University of Colorado School of Medicine.

The trial looked at patients who were at least 40-years-old, had been hospitalized with a heart attack or threatened heart attack (unstable angina), and had levels of LDL cholesterol of at least 70 mg per deciliter despite taking high doses of statins.

Half of the patients received alirocumab by self-injection under the skin every two weeks, and the other half received placebo injections. The patients were followed for an average of nearly three years. During that time, LDL cholesterol levels averaged 40 to 66 mg per deciliter in patients given alirocumab, compared with 93 to 103 mg per deciliter with placebo. Death from coronary heart disease, another heart attack or episode of unstable angina, or a stroke occurred in 903 patients given alirocumab, compared with 1052 patients given the placebo, corresponding to a 15% reduction in risk.

“Statins have been the main cholesterol-lowering drugs for heart patients for more than 30 years, and they are very effective,” Schwartz said. “Now we know that we can improve the outcomes after a heart attack by adding alirocumab to statins in selected patients.”

In the trial, alirocumab was safe and generally well-tolerated. The only common side effect with alirocumab was itching, redness, or swelling at the injection site which was usually mild. It occurred in 3.8 percent of those given alirocumab, compared with 2.1 percent of patients who received the placebo.

Alirocumab was approved by the Food and Drug Administration in 2015 as a treatment for high cholesterol, but it has only now been shown to also reduce the risk of heart disease events and stroke.

The study was funded by Sanofi and Regeneron Pharmaceuticals. Dr. Schwartz co-chaired the study with Philippe Gabriel Steg, MD, from Hôpital Bichat, Assistance Publique Hôpitaux de Paris in Paris, France.

 

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