Jacobs Institute of Women's Health
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Isoflavones and changes in body weight and severe hot flashes in postmenopausal women: A secondary analysis of a randomized clinical trial
No full textOBJECTIVE: Severe hot flashes have been associated with an increased risk of cardiovascular disease and diabetes. This secondary analysis assessed associations between isoflavone intake, body weight, and severe hot flashes in postmenopausal women. METHODS: Participants (n = 84) were randomly assigned to a low-fat vegan diet supplemented with soybeans (n = 42) or a control group who made no changes to their diet (n = 42) for 12 weeks. Three-day diet records were analyzed using the Nutrition Data System for Research software. A repeated measures analysis of variance, Spearman correlations, and a linear regression model were used for statistical analyses. RESULTS: Daidzein intake increased in the vegan group (effect size: +34.4 mg/day [95 % CI +28.1 to +40.8], p \u3c 0.001). Similarly, genistein and glycitein increased in the vegan group (effect sizes: +34.8 mg/day [95 % CI +27.7 to +42.0], p \u3c 0.001; and +4.2 mg/day [95 % CI +3.2 to +5.2], p \u3c 0.001, respectively). Mean body weight decreased by 3.6 kg in the vegan group and by 0.2 kg in the control group (effect size: -3.4 kg [95 % CI -4.5 to -2.3], p \u3c 0.001). Severe hot flashes were reduced by 92 % (from 1.3/day to 0.1/day) in the vegan group (p \u3c 0.001) and did not change significantly in the control group (between-group p = 0.02). The increased consumption of each of the three isoflavones was associated with weight loss (r = -0.67, p \u3c 0.001 for daidzein; r = -0.67, p \u3c 0.001 for genistein; and r = -0.66, p \u3c 0.001 for glycitein), but not with the reduction in severe hot flashes. There was no significant association between weight loss and a reduction in severe hot flashes (r = +0.20, p = 0.12). Controlling for energy intake and changes in body mass index, the main independent predictor of a reduction in severe hot flashes was the increased intake of daidzein (p = 0.04). Controlling for fiber and fat intake did not change the results. CONCLUSIONS: These findings suggest that the mechanisms by which a low-fat vegan diet supplemented with soybeans reduces the frequency of severe hot flashes include the increased consumption of daidzein, among other potential factors. Confirmatory trials are needed. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04587154, registered on Oct 14, 2020
Detailed Mapping of the Cerebellar Dentate Nucleus Using Ultra-High Field (7T) Susceptibility-Weighted Imaging
No full textThe current study presents a novel method for imaging the cerebellar dentate nucleus, combining ultra-high field (7T) and quantitative susceptibility mapping (QSM) to enhance tissue boundary identification and segmentation. After assessing segmentation reliability, we assessed validity by evaluating volume and resting state functional connectivity (FC) of the dorsal vs. ventral dentate subregions. Neurotypical adults (n = 30, 15 females) completed 7T susceptibility-weighted imaging (SWI) and resting state fMRI. QSM maps were used to segment the dentate (whole, dorsal, ventral subregions). Reliability of the segmentation protocol was established across three raters (inter-rater) and one rater who performed the segmentations twice (intra-rater) using the Dice coefficient (d). Dorsal and ventral dentate volumes were calculated, and whole-brain seed-to-voxel FC patterns were assessed from the whole dentate, dorsal, and ventral subregions. Group-level contrasts for each subregion and between subregions were thresholded at voxel-level p \u3c.005, with a cluster-level FDR-correction of p \u3c.05. Segmentation reliability was high (inter-rater d = 0.89, intra-rater d = 0.93), and the dorsal subregion was significantly smaller than the ventral (p \u3c.001). The dorsal dentate showed greater FC with regions involved in sensorimotor processing (cerebellar vermis I-V, IX-X, lobules VIII-IX, fusiform, cuneus), and the ventral dentate showed greater FC with regions involved in cognitive processing (cerebellar lobule VII, angular gyrus, middle and superior frontal gyri, middle and superior temporal gyri, temporal pole). We present an innovative, reliable, and valid method for imaging the dentate. Dentate volumes and FC were consistent with anatomical mapping from animal and human studies. Future directions include application to clinical populations with anomalous cerebellar development and injury
How COVID-19 Treatment in Pregnancy Reflects Healthcare Utilization During a Pandemic: A Two-Stage Individual Participant Data Meta-Analysis Combining Case-Based Registries
No full textPURPOSE: To describe an international response to the COVID-19 pandemic by estimating the prevalence of medication use for COVID-19 treatment in pregnancy, stratified by hospitalization, trimester of pregnancy, and country. METHODS: We conducted a two-stage individual participant data meta-analysis of proportions from primary data on medications used to treat COVID-19 during pregnancy. A common data model was developed to pool the data from single-country and international registries. Data from pregnant individuals with COVID-19 between February 2020 and October 2022 were included in study platforms across 9 data sources. Patient information was abstracted from medical records. RESULTS: Among 24 937 pregnant individuals, the pooled prevalences of individuals receiving medications to treat COVID-19 were: 34.7% heparin, 9.8% antibiotics, 4.9% corticosteroids, 2.2% antivirals, 0.8% antimalarials, 0.3% convalescent plasma, 0.2% immunosuppressants, and 0.02% monoclonal antibodies. Prevalence of medication use was higher in hospitalized individuals than in non-hospitalized individuals: 58.4% versus 17.9% for heparin, 26.9% versus 5.7% for antibiotics, 17.5% versus 1.3% for corticosteroids, 10.3% versus 0.3% for antivirals, and 4.5% versus 0.1% for antimalarials. The prevalence of corticosteroid use was lower in the first trimester (0.1%) compared with the second (7.2%) and third (4.9%) trimesters of pregnancy. The prevalence of medications differed widely across countries. CONCLUSION: Medication to treat COVID-19 was more frequently used in pregnant individuals hospitalized for COVID-19. Corticosteroids were used less in the first trimester of pregnancy. The differences in use between countries could reflect differences in the clinical management and access to medications for this population at risk of severe disease
Is the Risk Perception Attitude Framework Associated with the Accuracy of Self-Reported vs Actual Cardiometabolic Risk and Physical Activity in Young Adults with Overweight/Obesity?
No full textWe examined the accuracy of perceived vs actual cardiometabolic risk and physical activity within the Risk Perception Attitude Framework (RPA). We analyzed baseline data from 343 young adults (23.3 ± 4.4 years) participating in a weight management clinical trial. Cardiometabolic risk factors were measured according to standard clinical procedures. A cardiometabolic risk score was created from five biomarkers according to whether or not a standard clinical risk cut point was exceeded. Physical activity was determined by ActiGraph and self-report. Perceived risk and physical activity self-efficacy were assessed by validated measures. The Proactive cluster (low perceived risk/high self-efficacy) was most accurate regarding actual vs perceived risk awareness (54%), while the Responsive cluster (high perceived risk/high self-efficacy) was the least accurate (16%). All RPA clusters underestimated their actual physical activity, self-reporting less than half the moderate-to-vigorous physical activity that was captured via accelerometry. The RPA Framework can identify young adults unlikely to be aware of their cardiometabolic risk. Given the growing prevalence of metabolic syndrome, efforts early in adulthood to increase knowledge and awareness of cardiometabolic risk, and behaviors necessary to reduce that risk, can have substantial impact on future health
Stronger Than Sickle Cell
No full textSickle Cell Disease (SCD) is an inherited blood disorder that predominantly affects people of color. Our program, Stronger Than Sickle Cell, is focused on raising awareness and promoting community engagement while collecting resources to support Sickle Cell Disease research and treatment. The program will take place during the National Sickle Cell Awareness Month and will include a fundraiser called “Change for Change”, an awareness campaign with school assemblies and posters, and a blood drive in partnership with the American Red Cross. Volunteers, including students and community members will be trained to help lead this work in schools. We will measure impact through pre/post-survey, the amount of blood donated, and total money raised. In our research, we were unable to identify current programs, specifically targeting high school students in regarding this issue. Therefore, through our initiative we aim to address gaps in awareness and engagement, ensuring youth in underserved communities in Washington D.C. have access to education and opportunities that support better health.https://hsrc.himmelfarb.gwu.edu/dchapp/1025/thumbnail.jp
ACR-ACNM-ARS-SNMMI Practice Parameter for the Performance of Therapy With Radium-223 Dichloride
No full textOBJECTIVES: This practice parameter was revised collaboratively by the American College of Radiology (ACR), the American College of Nuclear Medicine (ACNM), the American Radium Society (ARS), and the Society of Nuclear Medicine and Molecular Imaging (SNMMI). The document represents an update of the radium-223 therapy practice parameter developed by the societies in 2019. METHODS: This practice parameter was revised according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters-Nuclear Medicine and Molecular Imaging of the ACR Commissions on Nuclear Medicine and Molecular Imaging and the Committee on Practice Parameters-Radiation Oncology of the ACR Commission on Radiation Oncology, in collaboration with the ACNM, the ARS, and the SNMMI. Reports available since the publication of the initial document in 2019 were collected and reviewed. RESULTS: Since the publication of the initial radium-223 practice parameter in 2019, there has been significant investigation of the agent in the management of numerous metastatic cancer sites, in addition to additional studies of its use in metastatic hormone-resistant prostate cancer. This updated document considers physical properties of the agent, current and investigative indications, qualifications and responsibilities of personnel, specifications of the evaluation exam and treatment, the therapeutic use of unsealed radiopharmaceutical sources, radiation safety, and quality control. CONCLUSIONS: This updated practice parameter is intended to guide appropriately trained and credentialed physicians performing therapy with radium-223 dichloride. All aspects of patient and radioisotope management are considered, as are current indications and ongoing investigations
The health burden and racial-ethnic disparities of air pollution from the major oil and gas lifecycle stages in the United States
No full textThe United States has one of the world\u27s largest oil and gas (O&G) industries, yet the health impacts and inequities from pollutants produced along the O&G lifecycle remain poorly characterized. Here, we model the contribution of major lifecycle stages (upstream, midstream, downstream, and end-use) to air pollution and estimate the associated chronic health outcomes and racial-ethnic disparities across the contiguous US in 2017. We estimate lifecycle annual burdens of 91,000 premature deaths attributable to fine particles (PM), nitrogen dioxide (NO), and ozone, 10,350 PM-attributable preterm births, 216,000 incidences of NO-attributable childhood-onset asthma, and 1610 lifetime cancers attributable to hazardous air pollutants (HAPs). Racial-ethnic minorities experience the greatest disparities in exposure and health burdens across almost all lifecycle stages. The greatest absolute disparities occur for Black and Asian populations from PM and ozone, and the Asian population from NO and HAPs. Relative inequities are most extreme from downstream activities, especially in Louisiana and Texas
Do Primary Care Providers\u27 Medicaid Panels Represent the Communities They Serve?
No full textDisparities in primary care access among Medicaid enrollees may be driven by differences in provider acceptance of Medicaid, yet the extent to which primary care provider (PCP) panels reflect the racial and ethnic diversity of local Medicaid populations is unknown. : To quantify the alignment between the racial/ethnic composition of PCP Medicaid panels and the underlying Medicaid population in their service areas. : We conducted a cross-sectional analysis of 2019 Transformed Medicaid Statistical Information System Analytic Files from 44 states focusing on non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic enrollees. We calculated a panel representation ratio (PRR) for each PCP (physicians, nurse practitioners, and physician associates) as the proportion of a racial/ethnic group in their panel divided by that group\u27s proportion in the county Medicaid population. PRRs \u3e 1 indicate overrepresentation; PRRs \u3c 1, underrepresentation. Analyses were stratified by provider specialty, rurality, and Health Professional Shortage Area (HPSA) status. : The study sample included 372,320 PCPs from the following professions: nurse practitioners (NPs) and physician associates (PAs), along with physicians from the following specialties: family physicians (FPs), internal medicine physicians (IM), obstetrician gynecologists (ObGyn), and pediatricians (Peds). In the full sample, PRR was 1.28 for NHW enrollees, but less than one for NHB (0.98) and Hispanic (0.82) enrollees. Across provider specialties and professions, NHW enrollees were overrepresented in both rural and urban areas. In rural areas, NHB enrollees were overrepresented, but Hispanic enrollees remained underrepresented regardless of Health Professional Shortage Area (HPSA) status. In urban areas, both NHB and Hispanic enrollees were underrepresented in provider panels. : Medicaid PCP panels do not reflect the racial/ethnic diversity of local Medicaid populations, particularly for NHB and Hispanic enrollees in urban settings. Efforts to improve equitable access to primary care must address these disparities in provider panel composition
Paediatric difficult intubations and the impact of timing of weekend versus weekday cases: an analysis of the Pediatric Difficult Intubation registry
No full textBACKGROUND: Off-hours presentation has been shown to be independently associated with tracheal intubation-related adverse events in patients with predicted difficult airway. The comparison of the complication rates of paediatric difficult intubations on weekends vs weekdays is unknown. The primary objective of this retrospective review is to determine the complication rates for paediatric difficult intubation cases that occur on a weekend vs a weekday. METHODS: We performed a retrospective review of data from the Pediatric Difficult Intubation registry, with service dates June 8, 2012 to May 9, 2023, to compare complication rates (total complications, hypoxaemia, non-hypoxaemia complications, and first-attempt success rate) during paediatric difficult intubations that occurred on the weekends vs weekdays. Research electronic data capture was used to standardise data collection across institutions. RESULTS: We reviewed a total of 8031 cases of difficult paediatric intubations. Two hundred and eighty-five (3.5%) were performed on the weekend, and 7746 (96.5%) were performed on a weekday. Complication rates with paediatric difficult intubations (total complications, hypoxaemia, and non-hypoxaemia complications) were significantly higher on weekends compared with weekdays. The odds of any complication were more than two times higher on the weekends compared with weekdays (odds ratio 2.13, 95% confidence interval 1.49-3.07, P\u3c0.0001). CONCLUSIONS: This study supports paediatric anaesthetists\u27 clinical decision-making to postpone nonurgent paediatric procedures in children with a history of a difficult airway from weekend to weekday to decrease risk of airway management complications and improve patient safety and quality of care
Atypical alpha oscillatory EEG dynamics in children with Angelman syndrome
No full textOBJECTIVES: Biomarkers of atypical brain development are crucial for advancing clinical trials and guiding therapeutic interventions in Angelman syndrome (AS). Electroencephalography (EEG) captures well-characterized developmental changes in peak alpha frequency (PAF) that reflect underlying neural circuit maturation and may provide a sensitive metric for mapping atypical neural trajectories in AS. METHOD: We analyzed 159 EEG recordings from 95 children with AS (ages 1-15 years) and 185 age-matched typically developing (TD) controls. PAF was quantified using a well-established curve-fitting method applied to 1/f-corrected power spectra. To validate robustness, we further evaluated PAF using an alternative prominence-based peak detection approach across varying detection thresholds. RESULTS: Significant disruptions in PAF were evident in children with AS. While over 90% of EEGs from TD children exhibited a clear alpha peak, fewer than 50% of EEGs from children with AS showed a detectable PAF. Furthermore, when PAF was present, its frequency was significantly lower in AS children and did not show the typical age-related increases observed in TD children. Validation analyses confirmed consistently lower rates of PAF detection in AS across varying sensitivity thresholds, demonstrating the robustness of these results. CONCLUSIONS: The absence and lower frequency of alpha peaks in Angelman syndrome indicate that PAF is a developmentally sensitive marker of disrupted neural maturation in this population. Further research is needed to clarify how PAF emergence and shifts relate to longitudinal developmental trajectories and specific clinical phenotypes. Nonetheless, PAF shows promise as an objective, quantitative biomarker of neural circuit dynamics that can enhance clinical-trial endpoints by indexing underlying brain function. Future analyses will examine inter-individual variability in PAF among AS participants to uncover mechanistic pathways that may inform targeted therapeutic strategies