WOMEN'S HEALTH
Director of CDC Calls for Applying Knowledge About Women's Health
At an "Infectious Diseases and Women" conference held in Atlanta, Ga., Feb. 27-29, Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, announced that sexually transmitted diseases (STDs) and certain other infections disproportionately affect women. She noted that 60 to 70 percent of women infected with gonorrhea and chlamydia are unaware of infection. Compared to men, women are four times more vulnerable to STDs, including HIV infection. She also said that women disproportionately suffer from poverty, widespread and persistent discrimination, and complications of pregnancy. She cited lack of scientific knowledge and failure to apply what is known as being responsible for increasing the burden of disease on women.
Kaiser Report Notes Disparities and Access Problems Among Women
Kaiser Family Foundation has two new reports. One, "Racial and Ethnic Disparities in Women's Health Coverage and Access to Care," notes differences between women of color and white women in insurance coverage, communication with health providers, use of care, and perceived quality of care. The second, "Health Coverage and Access Challenges for Low-Income Women," examines the experiences of low-income women in gaining access to health care, as they are three times more likely to be uninsured and to forgo care. For more information, go to http://www.kff.org/womenshealth/whp031004pkg.cfm.
Fatigue, Shortness of Breath Can Presage a Heart Attack in Women
Dr. Jean C. McSweeney, a professor in the College of Nursing at the University of Arkansas for Medical Sciences, knows that women experience heart problems differently than men. In a landmark study published in November Circulation, several unusual early warning signs were identified that appear to presage acute myocardial infarction among women. About 95 percent of study participants reported experiencing new or different symptoms a month or so before their heart attack that went away after the attack. The most common symptoms were unusual fatigue (71 percent), sleep disturbances (48 percent), shortness of breath (42 percent), indigestion (39 percent), and anxiety (35 percent). She noted that this is the first time we have been able to get a typical picture of women with heart disease. For women, stress testing is generally a better diagnostic tool than an electrocardiogram. Nuclear stress testing, which includes an imaging component, is even better.
SOURCE: Women's Early Warning Symptoms of Acute Myocardial Infarction. Circulation 2003; 108:2619.
Women Get Less Aggressive Heart Treatment
According to a presentation at a recent meeting of the American College of Cardiology (ACC), women with serious heart conditions are getting less aggressive treatment in U.S. hospitals than men. Dr. Andra Blomkalns of the University of Cincinnati reported at the ACC's Annual Scientific Session that despite being at higher risk, women who arrive at the hospital with symptoms of a heart attack were less likely to receive recommended medications and procedures than men. Heart disease is the No. 1 killer of both men and women in the United States. According to the American Heart Association, 267,000 American women die of heart disease each year.
The analysis of CRUSADE data measured adherence to the ACC/American Heart Association (ACC/AHA) treatment guidelines for patients with cardiac conditions known as non-ST-segment elevation acute coronary syndrome (NSTE ACS). These NSTE ACS account for more than 1.4 million hospitalizations each year. This analysis is important, because research indicates that those treated according to NSTE ACS guidelines are more likely to survive than those who are not. In the analysis presented, men were more likely to receive recommended therapies in the hospital setting, with blood-thinning agents such as heparin or other treatments such as glycoprotein (GP) IIb-IIIa inhibitors (80 percent women vs. 84 percent men for heparin; 29 percent vs. 39 percent for GP). Women were less likely than men to undergo cardiac procedures and receive certain recommended medications upon discharge. For catheterization, this was particularly strong with 60 percent vs. 71 percent.
CRUSADE data (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC and AHA Guidelines) was analyzed by the University of Cincinnati Medical Center, with its affiliate, The University Hospital, and is one of more than 400 hospitals participating in the nationwide quality improvement initiative. Led by Duke Clinical Research Institute, CRUSADE, a retrospective analysis of 35,000 patients, has gathered clinical data from U.S. hospitals since 2000.
In their analysis of the medical data of 35,835 patients (41 percent of whom were female) in the CRUSADE initiative, researchers found that female patients were significantly less likely to receive medications such as heparin or GP IIb-IIIa inhibitors, even when adjusting for differences in patient and hospital characteristics. Similarly, female patients were less likely to undergo diagnostic catheterization (60.1 percent vs. 71.1 percent) or percutaneous coronary intervention (31.4 percent vs. 40.4 percent).
Although the women tended to be older and more medically compromised, women had an increased unadjusted in-hospital mortality (5.6 percent of women vs. 4.3 percent of men), and an increase in other health complications as well. Women dentists can assist their male colleagues and patients in understanding that women are less likely to demonstrate "classic" symptoms of acute coronary syndrome, so education about women's symptoms is very important. For additional information, go to http://www.womenshealth.org/ 0javascripts/dropinnav.htm?/sbb/news.htm.
Web sites for Women's Health Resources
- Medline Women's Health — http://www.nlm.nih.gov/medlineplus/womenshealth.html
- National Women's Health Network — http://www.nwhn.org/
- National Women's Health Resource Center — http://www.healthywomen.org/
- Journal of Women's Health — http://www.liebertpub.com/JWH/default1.asp
- Harvard Women's Health Watch — http://www.health.harvard.edu/hhp/publication/view.do?name=W
- Journal of American Medical Women's Association — http://jamwa.amwa-doc.org/
- Women's Health Research — http://www4.od.nih.gov/orwh/
- Mayo Clinic Women's Health Center — http://www.mayoclinic.com/findinformation
- iVillage Women's Health Information — http://www.ivillage.com/topics/health/0,10707,412465,00.html
- Woman Dentist Journal — www.wdjournal.com
ORAL HEALTH MATTERS
Checklist and Workbook Available From OSAP
A comprehensive checklist for infection control in dentistry is available in the January edition of Infection Control in Practice at http://www.osap.org/resources/members/index.htm. The checklist is helpful before plowing through the dense 63-page document from the Centers for Disease Control and Prevention "Guidelines for Infection Control in Dental Health-Care Settings — 2003" published in December. OSAP also has a workbook titled "From Policy to Practice: OSAP's Guide to the Guidelines." With 10 hours of continuing education, the workbook contains additional checklists and shows various techniques to enhance infection control in the dental office.
Evidence for Managing Pain by NSAIDs
Differential response to pain has been noted among women, when compared to men. Women tend to be more responsive to the kappa opioids than men. Although no gender analysis was available, there is a new review of the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for postoperative dental pain. This evidence-based approach evaluated the clinical studies on the safe use of these drugs in dental patients.
SOURCE: Maximizing the Safety of Nonsteroidal Anti-inflammatory Drug Use for Postoperative Dental Pain: An Evidence-Based Approach. Ong KS, Seymore RA. Anesthesia Progress 50 (2).
[May be downloaded from http://www.dentalzzz.com/NSAIDEBM.pdf.]
Detection of Oral Bacteria Implicated in Gingivitis by Sensors
Proteases are critical to the inflammatory process in gingivitis. New Protector Proteins™ have been developed that can inhibit these proteases. These can be applied to multiple oral care products such as dental floss, toothbrushes, toothpaste, or oral rinses.
ECI has also developed ExpressDetect™ sensors, which change color in the presence of harmful pathogens and can be applied to oral care products, including floss or oral rinses, quickly detecting the presence of proteases that lead to gingivitis. For more information, go to www.ecibiotech.com.
Cochrane Collaboration Meeting in October
With the theme "Bridging the Gaps," the focus of the 12th Cochrane Colloquium on Oct. 2-6, 2004, in Ottawa, Canada, will highlight gaps between practitioners and users of health-care information. Since methodology for oral health is somewhat different than general health, methodologists and reviewers will also be available to discuss this gap. Cochrane Collaboration has released oral health reports. Contact: International Conference Services, 640 - 850 West Hastings Street, Vancouver, BC V6C 1E1 CANADA. Phone: +1-604-681-2153 or Fax: +1-604-681-1049 or email [email protected].
For Cochrane analyses, especially the one that peaked interest last year on manual vs. powered toothbrushing, go to http://www.cochrane.org/index2.htm.
Guide Available for Dental Offices on Responding to Terrorist Acts
A new guide, "Getting Ready: Company Primer on Preparedness and Response Planning for Terrorist and Bioterrorist Attacks," is available from the Business Executives for National Security. The short document contains a discussion of types of terrorist threats and types of attacks, an overview of bioterrorism agents, a background on governmental emergency response, procedures for responding to events including ventilations, security procedures, and maintaining business functions in the event of attack. A critical checklist includes risk assessment, facility preparation and response, insurance issues, and risk communication, as well as business interruption procedures.
Be sure that your team members have ready access to phone numbers for the police, fire, and public health departments. Go to http:www.bens.org for more information.
Some other key Web sites:
- Building Safety — http://www.cdc.gov/niosh/bldvent/2002-139E.html
- Emergency Preparedness for Business — http://www.cdc.gov/niosh/topics/prepared?prepared_contact.html
- Emergency Management Guide for Business and Industry — http:www.fema.gov/library/bizindex.shtm
- Business and Industry Guide — http:www.redcross.org/services/disaster/beprepared/busi?industry.html
UPCOMING CONFERENCES
AAPD (American Academy of Pediatric Dentistry) — May 27-31, 2004; San Francisco Marriott; San Francisco, Calif.; www.aapd.org; (312) 337-2169
AAWD (American Association of Women Dentists) — July 8-11, 2004; Anaheim Marriott; Anaheim, Calif.; www.aawd.org; (800) 920-2293
AGD (Academy of General Dentistry) — July 8-11, 2004; Anaheim Convention Center; Anaheim, Calif.; www.agd.org; (888) 243-3368
NDA (National Dental Association) — July 30-Aug. 4, 2004; Century Plaza; Los Angeles, Calif.; www.ndaonline.org; (202) 588-1697
ADA (American Dental Association) — Sept. 30-Oct. 3, 2004; Orange County Convention Center; Orlando, Fla.; www.ada.org; (312) 440-2500
AOS (American Orthodontic Society) — Oct. 21-24, 2004; Westin Riverwalk; San Antonio, Texas; www.orthodontics.com; (813) 264-6677
GNYDM (Greater New York Dental Meeting) — Nov. 26-Dec. 1, 2004; Jacob K. Javitz Center; New York, N.Y.; www.gnydm.com; (212) 398-6922
KUDOS!
- to Dr. Janet Hatcher Rice for being inducted as the first female president of the Academy of Laser Dentistry.
- to the Osteopathic Heritage Foundation of Columbus, Ohio, which gave a total of $317,135 for dental services to women during pregnancy and for six months after giving birth. This is a three-year project.
