Transcript Women’s Health Update 2002 - Department of Health Home

Women’s Health 2004:
Across the Life Span
Pamela D. Dodge, RN, MSN
Director Ambulatory Care
Magee-Womens Hospital
Pittsburgh, PA
Changing Definitions of
Women’s Health
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Setting priorities for women’s health
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Healthy People 2002
Proposed Office of Women’s Health
Racial and ethnic disparities
Gender differences/research/clinical
care
Aging of America
Poverty Rates
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Females
Males
Total
Population Distribution
100
90
80
70
60
50
40
30
20
10
0
Females
Males
Total
Recognizing the Health
Disparities that Exist
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Black women live fewer years than white
women
Breast cancer is diagnosed later with higher
mortality
The majority of women and children infected
with HIV diseases are black
Recognizing the Health
Disparities that Exist
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Heart disease at younger ages
A heart attack is more likely to be fatal
Twice as many cases of high blood pressure
as whites
Recognizing the Health
Disparities that Exist
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Nearly 50% of are overweight
More likely to smoke, and less likely to quit
than white women
Higher rates of sexually transmitted infections
and pelvic inflammatory disease
Over 50% have been beaten, raped or
survived incest.
Gender-based Issues
Example: medications
Varying rate of metabolism-liver enzymes more
active in women
Amount of drug getting to cells can vary partly
due to differences in drug-transport
mechanisms
Anatomy-women have lower body weight,
smaller organ size, reduced blood flow, higher
proportion of fat
Hormonal activity differences effect processing,
absorption, clearance from the body
Gender-based Issues
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Most patients and physicians are not aware of
differences and that sex matters when drugs
are prescribed
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Are there known sex or gender differences in how
the drug works?
Benefits, common, rare and serious side effects
Safer alternatives?
Interactions with other drugs
Interference with effectiveness of other drugs
Aging Women
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A women’s health issue
Older women are more likely to be poor and
live alone, spend significantly more years
being disabled
More likely than men to have arthritis,
osteoporosis, diabetes, urinary incontinence
Need to have risk factor reduction, early dx
and tx and prevention of chronic diseases
Quality of care for chronic conditions needs to
be improved
Women’s Wellness
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Regular screening according to age and
risk factors
Balanced diet
Exercise
Stress management
Vitamins, minerals, herbs
Teen Morbidity and Mortality
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Injury
Violence
Accidents
Homicides
Suicides
Accidents
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Motor vehicles
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Drinking and driving
Driving with someone who has been
drinking
Not using seatbelts
Riding motorcycles without a helmet
Homicides and Violence
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More males than females
Murder with guns
Carrying weapons: guns, knives, clubs
Suicides
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Increasing among teens
More males complete the suicidal act
Rate of suicide attempts is unknown
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More females attempt suicide
Suicidal ideation is common in adolescents
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25% of high school students have thought
about suicide
17% have made a suicide plan
Behavioral Health
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Depression, panic disorders, phobias
are more common in females
Girls are more vulnerable to depression
during periods of transition such as
entering puberty or changing schools,
family changes.
Tobacco Use
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Smoking among teens is on the rise
Ages 11-15 start of smoking behavior
Girls
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Smoke to look cool
To keep from gaining weight
Boys use smokeless tobacco: chew and
snuff
Alcohol
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Experimentation is common
First use of alcohol often before 13
years old
Regular use of alcohol is prevalent in
ages 15-18
Daily use and heavy drinking more
common in males
Drug Use
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Marijuana use is common
Heroin is cheap and pure-snorting
Inhalants
Hallucinogens
Use of cocaine and crack cocaine is low
Injecting drugs is not a usual risk
behavior
Sexual Behavior
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By age 17, 50% of teens have engaged
in sexual intercourse
Consistent use of contraception is on
the increase
Condom use is up
Sexually Transmitted
Infections
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Chlamydia
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Gonorrhea
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Human papilloma
virus
Herpes
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Syphilis
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HIV/AIDs
Adolescents and STIs
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67% do not consider themselves to be at risk
for an STI
57% have not discussed issue with a health
care provider
59% have not discussed with a partner
One act of unprotected sex with infected
partner
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HIV risk=1%
Genital herpes risk=30%
Gonorrhea risk=50%
PA
Incidence
U.S.
AIDS
9.8
12.6
Gonorrhea
108.6
140.3
Syphilis
1.5
5.8
Chlamydia
323.7
290.3
Safer Sex
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You can’t tell by looking
Condoms-use them
Influence of drugs and alcohol
Microbicides
Oral sex
Emphasize detection and treatment in older
population-over 50s
Gay and lesbian partners
Family Planning
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Access to care and coverage
Abstinence
Emergency contraception
Birth control pills/
Patch
DepoProvera
IUD
Tubal ligation, Essure, vasectomy
Exercise, Diet and Weight
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At least one physical activity each week
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Most do not eat five or more servings:fruits
and vegetables daily
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Decreases as teens get older
High fat content: french fries, hot dogs,
hamburgers, sweets
Meals are on the run and not planned
1/3 think they are overweight and are trying
to lose weight
Preconception Counseling
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Family History-MOB and FOB
Genetics
Medications-Accutane
Environmental and occupational exposures
Use of drugs, alcohol and tobacco
Folic acid-400 mcg/day
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OJ, green leafy vegetables, fortified breakfast
cereals
Risk Factors for Infant
Mortality
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African American
Hx of fetal or infant death, 2nd trimester loss,
preterm delivery
Unplanned pregnancy
MOB was preterm
Maternal infections
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STIs
Bacterial vaginosis
UTIs
Risk Factors for Infant
Mortality
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Close interpregnancy interval
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No or late prenatal care
Cocaine use
Smoking during pregnancy
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<18 months
50%
Exposure to secondhand smoke
SIDS
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Back to Sleep
Pregnancy Care
Early and Comprehensive
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Walk-in pregnancy testing
Presumptive eligibility
Healthy Beginnings Plus
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Physical, psychological and social
Transportation
Education/Long term home visiting
Care coordination, linkages
Nutritional counseling, smoking cessation, genetics
counseling, substance abuse referrals
Heart Disease Deaths
per 100,000
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Number one killer of
American women
Studies
predominately in
non-minority
populations
Nurses Health
Study-94% white,
2% each AA, Asian,
Hispanic
400
350
300
250
Female
Males
Total
200
150
100
50
0
PA
US
Heart Disease
1 in 9 women ages 45-64 have some
form of heart or blood vessel disease
1 in 3 by age 65
Nearly twice as many women die from
heart disease and stroke than from all
forms of cancer
Heart Disease and African
American Women
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Highest mortality rates
Highest rates of smoking???
Highest rates of hypertension
Highest prevalence of obesity among
minority women
Major Risk Factors for Heart
Disease
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Smoking
Hypertension
Diabetes
High cholesterol
Family history
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Obesity
Inactivity
Stress
Age
Nutrition
Heart Attack
Multiple, non-traditional symptoms
 Nausea, weakness, anxiety, fainting,back pain
 May or may not have chest pain
Treatment may be less aggressive, men may
advocate better for themselves
Diagnostic tests may not be as sensitive, breast
tissue may obscure results, may not get EKG,
clot-busting drugs delayed, less cardiac
catheterization
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Cancers
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Lung Cancer-#1
cancer
300
250
200
Females
Males
150
100
50
0
PA
US
Smoking Incidence
30
25
20
Females
Males
15
10
5
0
PA
US
Lung Cancer and Smoking
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Rates are due to
increased smoking
Mortality rate has
declined for men but
not women over
past 10 years
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Aggressively screen
Provide counseling
about impact on health
Recommend stopping
on each visit
Information on
programs
Nicotine replacement
Actions
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Increase awareness of the impact
Expose and counter the tobacco industry’s
deliberate targeting of women
Advocacy support and publicize that most
women are nonsmokers
Build science base on gender-specific
outcomes and how to reduce disparities
among women
Support efforts to reduce smoking-behavioral
and pharmacologic approaches
Enact comprehensive statewide tobacco
control programs
Breast Cancer
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Risk increases with age
Monthly self-breast exams
Yearly clinical breast exams
Yearly mammograms beginning at age
40
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Rates of screening for 20% relative risk
reduction with mammograms
Breast Cancer
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Pennsylvania
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Mammography in past 2 years ages 50-69
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82%
In US 81%
White women have higher incidence
than AA, Hispanic, A/PI & AI
AA have a higher mortality rate
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31.0/100,00 vs. 24.3/100,000
Breast Cancer Interventions
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Financial Support
 Reimbursement
 Healthy Woman program
 Public education
 Coalitions/partnerships
 Professional education
 Screening, tracking,
follow-up, case
management
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Government
Regulatory Oversight
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Mammography Quality
Standards Act- MQSA
FDA annual inspections
Public Reporting
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Quality measures
Hospital and physician
performance
Websites
www.medicalconsumers.org
www.healthcarechoices.org
Colorectal Cancer
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Third leading cause of cancer death in
women
Regular screening-hemoccult,
colonoscopy at 50
Diet low in fat and high in fiber
Regular exercise
Aspirin, vitamins
Cervical Cancer
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Every 2 of 100 women
Incidence and death rates have declined by
40% since 1970
Healthy Woman program
American Cancer Society recommendations
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Age, risk
Thin prep
HPV
Colposcopy, cryo, LEEP
Ovarian Cancer
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No reliable screening or diagnostic
testing
Usually asymptomatic until diagnosed,
late stages
Family history
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OCPs
Melanoma
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Women under 40, fastest growing
incidence
Prevalence
Risk factors
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Severe sunburn at early age
Light color hair and eyes
Family history
Moles and freckles, irregular borders
Skin Cancer Prevention
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Limit sun exposure
Periodic skin checks
Sunscreen
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Use on cloudy days too
Reapply often
Avoid tanning booths
Car windows
Daily UV index
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Special fabrics
Long sleeves
Hats
Diabetes
30
25
20
Females
Males
15
10
5
0
PA
US
Diabetes Risk Factors
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Smoking
Obesity
Physical Activity
Eating Disorders
Depression
Cardiovascular
disease
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Pregnancy
Poverty
Genetics
Eating Disorders
Depression
Strategies for Prevention
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Access and increased funding-regardless of
ability to pay or coverage
Improve patient self-management
techniques-patient education, support groups,
reimbursement for patient ed and supplies
Guidelines for healthy eating and exercise
Start in adolescent years-increased physical
activity, nutrition and prevention curriculum,
policy on management and tx of diabetic
students
Strategies for Prevention
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ID women at risk during reproductive years,
during pregnancy management of diabetes
with motivational support for tight glucose
and nutritional control
Worksite policies to encourage healthy eating,
physical activity, health days for screenings
Educate seniors on lifestyle changes that
prevent and treat diabetes, provide
transportation for visits and support activities.
Affordable and appropriate care access
Menopause
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Controversy continues with recent results
from the Women’s Health Initiative
Long-term hormone therapy in healthy
postmenopausal women increases the risk of
breast cancer, cardiovascular disease and
stroke.
One type of drug in one study
New package insert-shortest possible
duration, do not use to prevent CVD and
consider other treatments to prevent
osteoporosis
Menopause
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In prescribing hormone therapy,
consideration of the individual is critical:
Each woman experiences menopause
uniquely and may or may not be a
candidate for hormone therapy. If she
is one would expect that she would
respond uniquely to a given regimen of
hormone therapy.
Osteoporosis
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An adolescent disease-poor calcium
intake
1.5 million hip, wrist, vertebrae and
other bone fractures per year
25% of women with hip fracture die
within one year
Risk Factors for Osteoporosis
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Female
Smokers
Small-boned
Small frame
White or Asian
Calcium-poor
Non-weight bearing
Medications-anti-seizure, steroids
Early estrogen deficiency
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Menopause-natural or surgical,
amenorrhea
Prevention Strategies
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Calcium
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1000mg/day-adults
1200-1500mg/day11 to 17 years
1500mg/daypostmenopausal
No Smoking
Limit Alcohol
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Vitamin D
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Rx medications
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400 IU/day
Raloxifene
HRT
Exercise
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weight-bearing
Health Problems of Older
Women
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Osteoarthritis
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Alzheimer’s Disease
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Sensory Deficits
Osteoarthritis
Alzheimer’s Disease
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Total # of existing
cases somewhat
higher in women
May progress more
slowly, may survive
longer
Caregivers may be
vulnerable to
depression
Sensory Deficits
Women and Mental Health
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Depression-2:1 female to male ratio
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Multiple roles in home and work
Poverty
Risk for violence and abuse
Raising children alone
Raise the risk for suicide
Postpartum Depression
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Onset is within 4 weeks of delivery
Serious disorder where hormonal changes
after childbirth combined with psychosocial
stresses prove to be disabling
Increased awareness about and demand for
treatment, strikes 1-2 out of ten women
Women are not educated about the
symptoms and potential severity of PPD
Drugs and therapy
Behavioral Health
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Anxiety and panic disorders
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Women outnumber men except for OCD
and social phobia
OCD, PTSD, phobias
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PTSD- rape, criminal assault, war, child abuse,
natural disasters, serious accidents
Nightmares, flashbacks, emotional numbing,
depression, anger, irritability, distraction, easily
startled.
Mental Health
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Eating Disorders-anorexia, bulimia,
binge-eating
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Often co-occur with depression, substance
abuse, anxiety disorders
Comprehensive treatment plan-medical
care and monitoring, psychotherapy,
nutritional counseling and medication
management
Alcohol
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1/3 of 14 million alcohol abusing or
dependant users in US are women
Women become intoxicated on less alcohol
than men b/c of lower body water content
and more fatty tissue
Women have lower levels of gastric alcohol
dehydrogenase-allows more alcohol to be
available
Fluctuating hormone levels effect metabolism
Safe Alcohol Consumption
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One 12 ounce beer
One 5 ounce glass of wine
One ounce of alcohol
Drug Use
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Marijuana
Cocaine
Heroin
Ecstacy
Oxycontin
Lifetime Incidence of Abuse
40
35
30
25
20
3-D Column 1
15
10
5
0
CA
SA
IPV
AnyAbuse
Violence and Abuse
Web Sites
National Women’s Health
Information Center:
www.4women.gov
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Postpartum Support
International:
www.chs.iup.edu/postpartum
National Foundation for
Depressive Illness .Inc
www.depression .org
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National Institute of Health
www.nimh.nih.gov
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National alliance for the
Mentally Ill
www.swpa.nami.org
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National Mental Health
Association
www.nmha.org
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Women’s Behavioral
HealthCARE
www.womensbehavioralhealth.org
Web Sites for Her
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www.4woman.gov
www.menopause.org
www.americanheart.org
www.nof.org
www.womens-health.org
www.nimh.nih.gov