Women’s Health

Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21670

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Pregnancy Augments the Vasoactive, Metabolic, and Inflammatory Functions of Uterine Perivascular Adipose Tissue
(2018-03-14) Goulopoulou, Styliani; Osikoya, Oluwatobiloba
Introduction: Perivascular adipose tissue (PVAT) is functionally different from other adipose depots and has vasoactive effects that vary with anatomic location and disease state. Healthy pregnancy involves remodeling of the vessels that supply blood flow to the uteroplacental unit (i.e. uterine arteries) and increases adipose tissue metabolic and inflammatory functions. The main objective of this study was to examine whether pregnancy changes the function of PVAT surrounding the uterine arteries (utPVAT). Hypothesis: Healthy pregnancy augments the vasoactive, metabolic, and inflammatory functions of utPVAT. Methods: Pregnant (gestational day 16, term=22-23 days) and aged-matched non-pregnant rats were used. To evaluate the effects of utPVAT on endothelium-dependent dilation in uterine artery, we performed concentration-response curves to acetylcholine (ACh) in the presence or absence of utPVAT using wire myography. A proteome adipokine profiler and reverse transcription polymerase chain reaction (RT-PCR) were used to assess protein and gene expression of utPVAT adipocytokines, respectively. Results: Incubation of uterine arteries from pregnant rats with utPVAT reduced ACh-induced relaxation responses following constriction with 60 mM potassium chloride solution [pEC50, +PVAT (n=5): 6.25 ± 0.12 vs. –PVAT (n=5): 6.66 ± 0.18, p = 0.02] or 10-6 M phenylephrine [pEC50, +PVAT (n=9): 6.86 ± 0.10 vs. –PVAT (n=9): 7.61 ± 0.17, p=0.0004]. This effect was not seen in arteries from non-pregnant animals. Uterine PVAT from pregnant rats (n=3) had reduced mRNA expression of peroxisome proliferator-activated receptor gamma (PPAR-γ) by 5.7 fold compared to utPVAT from non-pregnant rats (n=4). Leptin mRNA expression was reduced by 6.4 fold and protein expression was increased in utPVAT from pregnant rats compared to utPVAT from non-pregnant rats. Interleukin (IL)-10, IL-6, and monocyte chemoattractant protein (MCP)-1 mRNA expression in utPVAT did not differ between groups but protein expression of these adipocytokines was increased in utPVAT from pregnant rats. Conclusion: In pregnancy, utPVAT reduces endothelium-dependent relaxation in uterine arteries. In addition, pregnancy regulates metabolic and inflammatory adipocytokines in utPVAT at the level of protein translation. Future studies will determine the functional role of the vasoactive and molecular changes in utPVAT and their impact on uterine blood flow and fetal growth.
Current Physical Activity Levels may Not be a Protective Factor for Cognitive Decline in Women Ages 55 to 64
(2018-03-14) Hatfield, Lauren; Valdez, Blessie; Hartos, Jessica; Hassan-Hussein, Amber
Purpose: Physical activity could help prevent or slow deficits in cognition as an individual age; however, little is known about this relationship in females ages 55 to 64. The purpose of this study was to assess the relationship between physical activity levels and cognitive decline in females ages 55 to 64. Methods: This cross sectional analysis used 2015 data from the Behavioral Risk Factor Surveillance System (BRFSS) for females ages 55 to 64 in Connecticut, Montana, and Oregon. Logistic regression was used to assess the relationship between physical activity levels and cognitive decline while controlling for health and demographic factors. Results: Across states, few participants reported cognitive decline (10-14%), and only one-fifth reported being inactive (18-29%), while twice as many reported being highly active (34-48%). Adjusted results indicated that cognitive decline was not found to be significantly related to physical activity levels in any state, but cognitive decline was significantly related to number of health conditions, mental health, and substance use (all with moderate to large effect sizes) in two or three of three states. Conclusion: Across states, cognitive decline was not related to physical activity levels in females ages 55 to 64. The measurement for cognitive decline provided a limited scope of the condition and this study was unable to control for menopause and hormone replacement therapy, which may affect the outcome. Primary providers should not screen for physical activity levels related to cognitive decline in this population, but should screen for cognitive decline, multiple health conditions, current mental health issues, and substance use, if symptoms present for any of these in this target population. Providers should educate patients about the overall benefits of physical activity, but should focus on concurrently managing health conditions and discontinuing tobacco use as related to cognitive decline in females ages 55 to 64.
For General Health, does General, Mental, and Physical Health differ by Healthcare Access for Middle-aged Females?
(2018-03-14) Gilchrist, Naomi; Schultz, Jared; Samuels, Kenya; Hartos, Jessica; Wrzesinski, Derek
Introduction: General health and healthcare access, defined as coverage and cost, have been shown to be related in previous research, but these studies did not focus on middle-aged females (1). Therefore, the purpose of this study was to determine whether general, mental, and physical health differed by healthcare access in middle-aged females. Methods: This cross-sectional analysis used 2015 BRFSSS data for middle-aged females aged 35-54 from Alabama, Arkansas, Louisiana, and Mississippi. Multiple logistic regression analysis assessed the relationship separately for good general health, good mental health, and good physical health with healthcare access (coverage and cost) while controlling for routine checkup, high cholesterol, age, ethnicity/race, education, income, metropolitan status, and veteran status. Results: For females aged 35-54, the majority of participants reported having good general health (73-79%), mental health (54-58%), and physical health (54-59%). Most participants reported having healthcare coverage (82-92%), and that cost did not preclude them from provider visits in the past year (74-82%). The results of adjusted analysis indicated: •Healthcare cost (moderate to large effect sizes) related to good general and physical health in three of four states. •High cholesterol (moderate to large effect sizes) related to good general, mental, and physical health in three of four states. •Income level of over $25,000 (moderate to large effect sizes) related to good general, mental, and physical health in three of four states. Conclusion: Overall, good general health and physical health were related to healthcare cost while healthcare coverage was not significant for good general, mental, or physical health in any state. The results of this study may generalize to middle-aged female patients in primary care practice. Limitations to this study include a lack of information on the extent of cost as a barrier. Healthcare services should consider a patient’s ability to manage costs of treatment, medications, and chronic health management.
Voluntary Blood Donations: A Path to Adequate Blood Supply and Fewer Maternal Deaths in Nigeria
(2018-03-14) Raines-Milenkov, Amy; Chukwudebe, Olisaemeka
Purpose Maternal mortality in Nigeria represents a substantial fraction of the burden of pregnancy-related deaths globally. Obstetric hemorrhage is a major cause of maternal death in Nigeria. The prompt transfusion of safe blood could save many women with obstetric hemorrhage. The World Health Organization (WHO) recommends national blood bank systems that are exclusively supplied by voluntary donors. Blood donors in Nigeria include relatives of transfusion recipients, commercial suppliers, and altruistic donors. This review examines global experiences with blood donation and the applicability of WHO recommendations in Nigeria for improved maternal outcomes. Methods The WHO recommendation for voluntary blood donation and its justification were examined in scientific literature and grey literature. The search terms ‘blood donation,’ ‘voluntary,’ and ‘Nigeria,’ were used in PubMed to locate 24 publications spanning the last 10 years. Successful experiences with WHO recommendations in 4 developing countries were reviewed. An analysis of Nigerian studies was conducted to identify prevalent attitudes and practices related to blood donation. Results The WHO recognizes voluntary blood donations as a viable means of collecting safe blood for clinical use. Nicaragua, Iran, and China are developing countries that have recorded notable success with blood systems exclusively supplied by voluntary donors. Between 2002 and 2016, in the African country Mauritius, total blood supply increased as the proportion of voluntary donations rose from 60 to 82.5%. Despite a good level of knowledge that could facilitate blood donation in certain segments of the Nigerian population, voluntary donations are unsatisfactory. Nigerians with a favorable attitude to donation report inadequate opportunities and a lack of prompting. Additional barriers to voluntary donations in Nigeria could be classed into the categories of fear and policies. Potential donors report fear of needle pricks, negative health effects, HIV detection, and the inappropriate use of donated blood. A policy environment that is insufficiently supportive of blood donations is reflected in absent legislation. Conclusion A national blood bank system underpinned by voluntary donations is desirable and achievable in Nigeria. Strategic leadership, education that dispels fears surrounding blood donation, infrastructural investments, and collaborative partnerships with domestic and international stakeholders are required for improvements in Nigeria’s blood transfusion system. By improving the availability of safe blood for transfusion, the burden of maternal deaths in Nigeria could be reduced.
A Case of Ovarian Torsion in the 3rd Trimester of Pregnancy
(2018-03-14) Nguyen, Bao-Quyen; Combs, Shanna
Background Ovarian torsion is a rare occurrence during pregnancy, especially in the third trimester. It is a gynecological emergency and needs to be promptly reversed in order to preserve ovarian function. Unfortunately, ovarian torsion is difficult to diagnose due to non-specific abdominal symptoms. It is especially difficult to diagnose in pregnancy due to the enlarged uterus which leads to trouble visualizing anatomy as well as similar symptom presentation that occurs in pregnancy. Case Information An unusual case of ovarian torsion in the third trimester presented with late onset of abdominal pain and non-reassuring fetal heart tones. The ovarian torsion was unable to be clearly visualized with ultrasound and was found upon emergent Cesarean delivery that was performed due to non-reassuring fetal heart tones. The ovary was found to be necrotic and a right salpingo-oophorectomy was performed. Conclusion It is rare for ovarian torsion to occur in pregnancy and even more rare to have an effect on the fetal status as presented in this case. Upon review of the literature, this case was found to be truly unique in the rarity of occurrence of ovarian torsion late in pregnancy, as well as the effect on the fetal status. Only 2 other case reports of intra-abdominal inflammatory conditions in the third trimester were identified to have caused fetal distress, resulting in an emergent Caesarian delivery.
Survival sex, drug use, and reproductive autonomy: a study of hysterectomy rates among high-risk reproductive aged women.
(2018-03-14) Nguyen, Bao-Quyen; Tod, Nicole; Felini, Martha; Mirochnitchenko, Alissa
Purpose: Marginalized and high-risk groups often present with health outcomes that differ from the general population. The aim of the current study was to compare hysterectomy rates in a large sample of reproductive aged truck stop and street sex workers with the general population, and to explore the social and medical variables underlying this difference. Methods: Using a multi-sector community partnership with law enforcement, we accessed hard to reach, migratory truck stop and street sex workers moving through transportation corridors. Unique to this partnership was provision of immediate resources directly on the street and a safe exit strategy. Women choosing to exit were immediately diverted to treatment services with long-term wraparound services. In a follow-up cancer prevention study, we collected survey and clinical data from 1167 women aged 18-78 years at Nexus Recovery Center in Texas (2014-2016). Hysterectomy status was collected by self-report and confirmed by clinical examination. Results: Of the 1167 women participating in the study, 67% reported physical and sexual trauma, 55% prior incarceration, 28% traded sex for drugs, and 34% self-identified as minority race. Of the 81 (6.9%) hysterectomies, 48 (60%) occurred among women from 25-44 years, of whom 3 (6%) were never pregnant. There was no association between race and hysterectomy status (OR=0.80, 95% CI= 0.49-1.30). Conclusions: Women with complex trauma histories, co-occurring disorders, and history of trading sex for survival needs had higher hysterectomy rates than the general population (3%). The high prevalence of hysterectomy among reproductive aged women has significant implications for reproductive autonomy, and may be indicative of limited access to information about medical procedures and alternatives. Communication with healthcare professionals may be hindered by stigmatization. These marginalized groups are present globally, many hidden in plain sight. This multi-sector street based initiative has been replicated in other settings and casts a wide net to also reach trafficked women with trauma-informed care.
High Risk Anal and Cervical HPV Infections among Sexual Minority Women
(2018-03-14) Felini, Martha; Combs, Shanna; Forner, Elizabeth
Purpose: To examine anal and cervical high-risk HPV (hr-HPV) infections among women having sex with women, and women having sex with men and women. Methods: We conducted a cross-sectional study of women ages 18-70 in treatment at the largest substance use disorders center in North Texas who participated in a cancer prevention program providing well woman exams. Demographics, past trauma, sexual practices, and risky behaviors were collected using self-administered questionnaires. Chi-square tests and adjusted logistic regression controlling for age (AOR) were used to compare hr-HPV infection prevalence rates by sexual minority status. Results: A total of 757 women with histories of trauma were included in this study; 84% were smokers, 53% self-reported previous incarceration and 25% traded sex for drugs. Nearly one-quarter reported having oral, vaginal, or anal sex with women only, or with men and women. Among this sexual minority group, 40% tested positive for anal hr-HPV vs 34% of heterosexual women (P=.18). Cervical hr-HPV was present in 31% of sexual minority women and 27% of heterosexual women (P=.20). Sexual minority status was not significantly associated with anal hr-HPV (AOR 1.23 95% CI .85-1.77) or cervical hr-HPV (AOR 1.09 95% CI .76-1.55) compared to heterosexual women. Cervical hr-HPV was significantly associated with anal hr-HPV among both groups (P Conclusion: These findings inform providers about HPV infections among sexual minority women, and the appropriateness of anal pap and HPV co-testing exams in this population.
Marital Status and Cervical Screenings Among a Vulnerable Population
(2018-03-14) Dokpesi, Philip; Bakre, Sulaimon; Ukpaka, Kelechi; Felini, Martha F.; Gallagher, Sarah
Introduction: The CDC’s Healthy People 2020 goal is that 93% of eligible women receive a cervical cancer screening by 2020. Evidence based strategies for increasing completion rates include doctor recommendation and reminders by telephone and mail. Other strategies such as educating husbands on the importance of cervical cancer screenings for their wives has had success in underserved, vulnerable populations, such as refugees. However, there is little evidence whether these strategies work among women at highest risk of cervical cancer as they move in and out of the criminal justice system and sell sex for mere survival needs. Given the political and social dynamics on the street, we hypothesized that marital status would not have the same positive effect that we observe in the general population or in other underserved populations. Methods: We performed a cross-sectional analysis on data collected from 1172 women who were in substance abuse treatment at Nexus Recovery Center from 2012–2016 and participated in the CPRIT funded Sound Mind, Sound Body Project. Women who received a well-woman exam through this cancer prevention project and declared a marital status at enrollment (married, divorced, widowed, in a relationship, single) were included in the final study population (n=744). Outcomes assessed were high-risk HPV screening results and STI results. Bivariate analysis was performed using Statistical Analysis Software to calculate chi-square p values (α Results: Our study population had an average age of 33.4 years; 37% minority race; 26% with less than a high school diploma. Nearly half were currently (n=85) or previously (n=253) married. The odds ratios for cervical HPV and cervical chlamydia were close to the null (AOR=1.02, 95% CI:0.60-1.74; AOR=0.77, 95% CI:0.23-2.56, respectively). Similarly, the association between marriage and anal screenings was also statistically insignificant (anal HPV: AOR=0.69, 95% CI:0.41-1.19; anal chlamydia: AOR=1.20, 95% CI:0.45-3.21). Conclusion: Marriage did not offer positive benefits in cervical cancer screenings among vulnerable populations with complex needs and addictions. Findings serve to highlight both the need for multi-sector strategies that could ensure adherence to needed cancer screenings and a critical need to inform healthcare providers how self-reported marital status is determined on the street, in order to provide best cancer prevention recommendations.
Analysis of Maternal Mortality Review in the UnitedStates
(2018-03-14) Fadeyi, Oluwatosin; Ghosh, Shanalyn
Analysis of Mortality Maternal Review in the United States Abstract Background: Maternal mortality has been a persistent concern locally, nationally, and globally. The maternal mortality rate in Texas has been rising since 2010 and is one of the worst rates in the U.S. In fact, the Texas rate is almost double that of the U.S. The Texas Maternal Mortality and Severe Morbidity Task Force (MMMTF) was set up within the Department of State Health Services (DSHS) to study and review cases of pregnancy-related causes of maternal mortality and severe morbidity. Other states have conducted similar reviews prior to Texas’ MMMTF. They have seen improvements in maternal mortality from the implementation of their recommendations. Objective: To compare and contrast previous maternal mortality and morbidity reviews of other states and determine its impact on the rate of maternal mortality because of the review. The results of these reviews can be used to guide the implementation of appropriate interventions to reduce the rate of maternal morbidity and mortality in Texas. Methodology: A review of literature and “grey” literature was conducted. Studies were selected based on the following criteria: state/city review, case definition of maternal mortality, year maternal mortality review was implemented, type of review (only medical records, family interviews, etc.), recommended/implemented interventions, and composition of the taskforce. Inclusion criteria consisted of publication period between 2007 and 2017, search terms “death review” and “maternal mortality”, and reviews within the United States. Exclusion criteria was comprised of countries outside of the U.S., and infant or other mortality reviews. Results: The review revealed that a maternal mortality surveillance system helps to identify interventions and recommendations unique to the needs of each State, making it difficult to compare effective practices across regions. However, evidence-based practices that have been successful with populations and infrastructures similar to Texas are worth considering. Conclusion: A state level review of maternal death allows in-depth analyses of the problem of maternal mortality. It allows for a richer, more nuanced picture than what would otherwise result from analysis of vital statistics. These conclusions can help establish a surveillance system and also have the potential to give rise to recommendations to address maternal morbidity and mortality.
Protective Potential of Hormone Replacement Therapy in Post-Menopausal Women
(2018-03-14) Cunningham, Rebecca; Duong, Phong; Trieu, Jenny
Purpose: Menopause is the cessation of a woman’s menstrual cycle, generally diagnosed after 12 months of amenorrhea. Due to hormonal changes, women often undergo physical and behavioral changes: including hot flashes, mood lability, and sleep disturbances. The first line of treatment for menopausal symptoms is hormonal replacement therapy (HRT). HRT use does have risks, such as cardiovascular disease and breast cancer. Younger postmenopausal women had reduced risks compared to older postmenopausal women. Aging is linked with oxidative stress (OS), and thus OS may be a mediating factor in HRT risk. Previously, we showed HRT given prior to OS insult is neuroprotective. If given after OS insult, HRT is neurotoxic in dopaminergic neurons. Therefore, we will determine if OS and HRT interactions is a general phenomenon applicable to all cell types or specific to neurons. Further, we will determine if either the estrogen receptor or the androgen receptor mediate OS and HRT interactions. Materials and Methods: We utilized 1RB3AN27 (N27) neuronal cells derived from female fetal mesencephalic tissue, human embryonic kidney cells (HEK), and C6 glial cells. Cells were grown in their preferred media supplemented with L-glutamine, penicillin-streptomycin and fetal bovine serum. Prior to experimentation, media was switched to charcoal stripped serum to remove hormones. To model post-menopause, hormone-deficient cells were exposed to OS using hydrogen peroxide (H2O2). Three different HRTs were examined: testosterone, 17-beta estradiol, and membrane impermeable dihydrotestosterone (DHT-BSA). An estrogen receptor inhibitor (ICI-182,780) and androgen receptor degrader will be included to explore the hormonal pathways. Cell viability was assessed with MTT assays. Results: Testosterone, estradiol, and DHT-BSA had different effects, which were dependent on the presence of OS. Both testosterone and estradiol were protective when given prior to OS, but DHT-BSA was not protective. Conversely, all HRTs given after OS exacerbated OS-induced cell loss. Conclusion: Based on our results, HRT's protective effects against subsequent OS damage is predominantly due to estrogen hormonal pathways. Activation of androgen pathways may not be neuroprotective and could be damaging. Currently, post-menopausal women are mainly using estradiol-based HRT. However, an increasing trend for off-label use of testosterone-based HRTs has been noted in post-menopausal women to improve libido.
For CAD, Does Mental Health Differ by Ethnicity/Race in Post-MI Females 50 Years and Older?
(2018-03-14) Lutes, Danielle; Norman, Kara; Hartos, Jessica; Thornton, Caitlin
Purpose: Older males and females have similar incidence of coronary artery disease (CAD); however, there is limited research surrounding how mental health in post-myocardial infarction (MI) patients differs by ethnicity. Therefore, the purpose of this study was to determine whether mental health differs by ethnicity in post-MI older adult females with CAD. Methods: This cross-sectional analysis used 2015 BRFSS data for females 50 years of age and older from Arkansas, Kentucky, and Tennessee. Multiple logistic regression analysis was used to assess the relationship between mental health and ethnicity/race while controlling for age, education level, income level, marital status, physical activity, and depression. Results: The majority of women reported 30 good days of mental health in the last month (56-58%); and 73-80% reported their race as white. After controlling for demographic factors, physical activity and depression, mental health did not differ significantly by ethnicity/race in any of the three states. However, mental health was significantly related to age in two of three states and depression across all states. Conclusion: Mental health did not differ significantly by ethnicity in post-MI older adult females with CAD. However, within this target population, good mental health was significantly related to those aged 65 and older and to those with a previous diagnosis of depression. Although there was no information regarding mental health progression following a myocardial infarction, primary care providers and cardiologists should screen all post-MI female patients, despite their ethnicity, for poor mental health, especially those who are aged 50-64 or who have a previous diagnosis of depression. Mental health education and a referral to a mental health professional, as necessary, should be provided to post-MI older adult females of all ethnicities.
She’s Healthy and Empowered: Optimizing Social Network and Improving Health
(2018-03-14) Velarde, Elizabeth; Cantu Anguiano, Katherine; Spence-Almaguer, Emily; Chhetri, Shlesma
Purpose: Developed through community-based participatory research (CBPR) approach, SHE Tribe aims to promote healthy lifestyles among women. The program encourages women to utilize their supportive social networks and work towards making meaningful behavior changes through five program gatherings. During each gathering, a peer facilitator motivates their tribe to set individual goals, do actions needed to achieve those goals, and reflect on factors that may aid or hinder successful completion of those goals. The purpose of this study was to assess changes in the overall well-being of SHE Tribe participants. Methods: Participants were asked to complete a baseline assessment before commencing the program followed by a post-assessment upon completion. The questions included in the assessment package were utilized to generate customized feedback on five health domains: me (general well-being), mind (mental health), matter (what we consume), move (physical activity), and meet (social support). To standardize the measurements, the total score for each domain was converted into a 100-point scale. Paired t-tests were conducted to assess change in the respective areas of health before and after participants’ enrollment in the program. Results: A total of 39 women have enrolled in the program. Among 29 women with complete pre-post data, 93% showed improvement in at least one of the five domains. Additionally, 90% displayed progress in two or more domains and 55% enhanced more than three areas of their health. Paired t-tests showed significant improvement in areas such as me, mind, move, and matter (p meet category as well. However, the change was not statistically significant. Conclusions: SHE Tribe participants showed improvement in several areas of health. This study highlights the success of a social network based peer-led model in empowering women and promoting healthy lifestyle choices. Furthermore, programs fostering intrinsic motivation and self-efficacy such as SHE Tribe show promise with improving health.

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