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Women still left out of much medical research

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Your sex matters when it comes to your health, yet women may still be an afterthought in research studies.

Despite policies and grant requirements to include females in research studies, many researchers still don’t analyze their data by sex, a new study found. If researchers don’t look at their results by sex, it’s impossible to know if diseases, drugs or vaccines might impact each sex differently.

“Sex influences health and disease in multiple organ systems. It’s not just related to the reproductive tract. By not considering by sex in research, it’s a harm to women’s health,” said study author Nicole Woitowich.

“We need this information. Right now, we’re trying to put a puzzle together and we don’t have all the pieces. By including both sexes in research, we can improve the health of all people,” she explained. Woitowich is the associate director of the Women’s Health Research Institute at Northwestern University Feinberg School of Medicine, in Chicago.

Why does this make such a difference? Woitowich noted that in a recent study of a type of brain tumor where researchers analyzed their data by sex, they found differences in the response to treatment by sex.

Kathryn Schubert, president and CEO of the Society for Women’s Health Research, said, “Women need to be included in studies. When you think about diseases that affect women and men, like cardiovascular disease, symptoms may be different by sex, treatment may be different. If you haven’t thought about the differences between males and females in your research, it’s almost not worth it. You have to include the other half of the population.”

Schubert’s organization notes that 90 percent of women with sleep apnea aren’t diagnosed because their symptoms may differ from men’s. And 80 percent of people with osteoporosis are women.

Erin Mulcahy Stein, executive director of Maria Shriver’s Women’s Alzheimer’s Movement, pointed out that two-thirds of people with Alzheimer’s disease are women, making it important to understand what role sex plays in that condition.

Many diseases strike women differently

“Women have at least three or four life stages that men don’t have — menstruation, pregnancy, perimenopause and menopause — and all of these can affect how a disease develops in women. If we don’t have full understanding of these stages because we’ve left out 51 percent of the population, there’s a real risk there that we might miss something. We’ve seen it in heart disease when women were dropping dead of heart attacks because doctors thought women would have symptoms the same way men did with crushing chest pain, but that’s not how women present with the disease,” Stein said.

And, she explained, there are similar differences with Alzheimer’s. Women performed better on tests that were used to diagnose Alzheimer’s for many years, which meant they were diagnosed later. Now, those tests have been adjusted to account for those sex differences.

Historically, women were left out of research because researchers were concerned that the variability of female hormones — due to menstruation — might affect study results.

Woitowich said, “It was assumed that there was no difference between males and females outside of the reproductive tract, and it was just easier and cheaper to use one set of animals in research, and those tended to be male.”

And, she noted that it wasn’t until 2016 that basic science researchers were required to use animals of both sexes in research to get grants from the U.S. National Institutes of Health (NIH).

The current research included more than 700 studies from nine areas of biological research. The investigators looked at whether studies used male, female or both sexes, and whether or not they reported and analyzed the data by sex.

The good news is that more studies were including both male and female subjects — just 28 percent had both males and females in 2009 compared to 49 percent in 2019. Despite that increase in inclusion, the researchers didn’t find an increase in the number of studies that analyzed their data by sex during that time.

Only 4 percent of the published studies provided a reason why they didn’t use both sexes or why they didn’t separate the data by sex. Of those that provided a reason, many said it was to limit the influence of female hormones.

Scientists break out results by sex

In some cases, researchers also failed to detail how many males or females were studied. This is a big problem if another research team is trying to replicate the study’s findings, Woitowich said.

“One of the things I found most worrisome was that close to one-third of those who used both males and females didn’t report the numbers of each sex. The ability to repeat studies is so important. And, if I don’t have that information when I repeat the study and I get a different result, that leaves me confused,” she said.

So what can be done to change this? Woitowich said the NIH took the first step in 2016 by requiring scientists to consider both sexes.

“But that’s not the whole solution. In this study, the literature was all peer-reviewed. Editors of journals need to require information on sex. And, other funders besides the NIH need to make inclusion of both sexes a requirement, or if you’re studying just one sex, explain why. If you are including both sexes, describe why you’re not doing sex-based analysis,” she said.

Woitowich said cost likely isn’t a major factor because researchers can still use the same number of animals in their studies.

Of the current study, Schubert said, “It’s exciting to see that there is change happening, but there’s a lot more work to be done.”

Schubert added, “In order to help make [sex-based research analysis] the norm, not only do universities need to ensure that sex-based research policies are being implemented, researchers need to understand that sex is an important biological variable.”

Stein noted that “it’s taken quite a bit of time for [women’s health research] to start to catch up, but we’re still not there yet. There’s an increased awareness that’s come from the aggressive and unapologetic drumbeat from organizations like ours that ask, ‘How could we possibly know as much as we need to know about diseases like Alzheimer’s if women aren’t included in the research?'”

The study was published online June 9 in the journal eLife.

More information

Learn more about sex differences in health from the U.S. Office on Women’s Health.

Copyright 2020 HealthDay. All rights reserved.



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Common meds linked to faster mental decline in seniors

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A group of widely used medications might speed up older adults’ mental decline — especially if they are at increased risk of dementia, a new study hints.

The medications in question are called anticholinergics, and they are used to treat a diverse range of conditions — from allergies, motion sickness and overactive bladder to high blood pressure, depression and Parkinson’s disease.

The drugs are known to have short-term side effects such as confusion and fuzzy memory.

But studies in recent years have turned up a more troubling connection: a heightened risk of dementia among long-term users.

The new findings, published Sept. 2 in Neurology, add another layer: Healthy older adults on these medications had an increased risk of developing mild cognitive impairment. That refers to subtler problems with memory and thinking that may progress to dementia.

And the link, researchers found, was strongest among two groups of people already at heightened risk of Alzheimer’s disease: those who carry a gene variant that raises the odds of the disease, and people with certain biological “markers” of the disease in their spinal fluid.

The results do not prove anticholinergic drugs are to blame, cautioned Heather Snyder, vice president of medical and scientific relations at the Alzheimer’s Association.

“This study shows an association in a very specific population, but it does not prove causation,” said Snyder, who was not involved in the research.

However, it is biologically plausible that the drugs could increase dementia risk, said Dr. Allison Reiss, an associate professor at NYU Long Island School of Medicine.

The medications, she said, block a chemical called acetylcholine, which transmits messages among nerve cells. Acetylcholine is involved in memory and learning, and is typically low in people with Alzheimer’s.

“The preponderance of evidence suggests it’s better to avoid these medications in older adults,” said Reiss, who is also an advisory board member at the Alzheimer’s Foundation of America.

That’s especially true, she added, when alternatives exist.

Many medications sold for allergies, colds and coughs have anticholinergic properties — and are available over-the-counter. So it’s important, Reiss said, that older adults be aware that non-prescription drugs are not automatically “safe.”

“You don’t want to add any medications that aren’t necessary,” said Reiss, who had no role in the study.

Meanwhile, certain prescription drugs for depression, high blood pressure, Parkinson’s disease and schizophrenia have anticholinergic properties, as do medications for overactive bladder and urinary incontinence.

Reiss said that people with questions about their prescriptions should talk to their doctor.

For the new study, researchers led by Lisa Delano-Wood, from the University of California, San Diego, followed 688 older adults who initially had no problems with memory or thinking skills. One-third said they’d been regularly taking anticholinergic drugs for more than six months — usually far more than one.

In fact, they were taking an average of almost five medications per person.

Over the next 10 years, people on anticholinergics were more likely to develop mild cognitive impairment, which was gauged through yearly tests. Over half — 51% — developed the condition, versus 42% of older adults not taking anticholinergics.

The researchers did consider other factors that affect dementia risk — such as people’s education levels and history of heart disease or stroke. And after adjusting for those factors, older adults on anticholinergics were still 47% more likely to develop mild impairment.

The link was even stronger among people who carried a gene variant that raises Alzheimer’s risk: Anticholinergic use more than doubled their risk of impairment. A similar pattern was seen among study participants with Alzheimer’s-linked proteins in their spinal fluid.

That, Reiss said, suggests the medications might have “accelerated a process that was already in place.”

Snyder said the results “illustrate that we need better treatments — not only for Alzheimer’s and other dementias, but for other common conditions associated with aging.”

More information

The University of British Columbia has more on anticholinergic drugs.

Copyright 2020 HealthDay. All rights reserved.



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Even ‘social smokers’ up their odds of death from lung disease

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Even light smokers are much more likely to die of lung disease or lung cancer than nonsmokers, a new study warns.

“Everyone knows that smoking is bad for you, but it’s easy to assume that if you only smoke a little, the risks won’t be too high,” said study co-leader Pallavi Balte, of Columbia University Irving Medical Center, in New York City.

The new study shows how wrong that thinking can be. It included nearly 19,000 people in the United States, average age 61, who were followed for an average of 17 years. During that time, nearly 650 died of lung disease (such as emphysema) and 560 died of lung cancer.

Among nonsmokers, less than 2% died from lung disease and less than 1% died from lung cancer. But among social smokers (fewer than 10 cigarettes a day), those numbers were over 3% and close to 5%, respectively.

Not surprisingly, heavy smokers (more than 20 cigarettes a day) fared worst, with more than 10% dying from lung disease and about 13% from lung cancer, the study found.

After accounting for other potential factors — such as age, sex, race, level of education and body weight — the researchers concluded that social smokers were 2.5 times more likely to die of lung disease and 8.6 times more likely to die of lung cancer than nonsmokers.

Social smokers had around half the rate of death from lung disease as heavy smokers, but their rate of lung cancer death was two-thirds that of heavy smokers, according to the study.

The results were scheduled for presentation at a virtual meeting of the European Respiratory Society. Data and conclusions presented at meetings should be considered preliminary until peer-reviewed.

The findings show that cutting down on smoking is no substitute for quitting, the researchers concluded.

“Previous research suggests that people are cutting down on smoking. For example, in the U.S.A., the proportion of smokers smoking less than 10 cigarettes per day has increased from 16% to 27%,” Balte said in a society news release.

“You might think that if you only smoke a few cigarettes a day you are avoiding most of the risk. But our findings suggest that social smoking is disproportionately harmful,” Balte said.

If you don’t want to die of lung cancer or respiratory disease, the best action is to quit completely, she added.

More information

The U.S. Centers for Disease Control and Prevention offers a guide for quitting smoking.

Copyright 2020 HealthDay. All rights reserved.



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Antidepressant use rising in U.S., mostly in women, CDC says

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Sept. 4 (UPI) — Nearly 18% of all adult women in the United States used antidepressant medication between 2015 and 2018, compared to just over 8% of men, according to data released Friday by the Centers for Disease Control and Prevention.

Overall, during the decade between 2009-2010 and 2017-2018, antidepressant use increased to 14% from 11%, the agency found. Use increased more for women — to 19% from 14% — than for men — to 9% from 7%.

In 2018, slightly more than 7% of adults in the United States said they suffered from a “major depressive episode,” the agency said.

The findings are based on an analysis of data from the National Health and Nutrition Examination Survey for the 10-year period between 2009 and 2018.

Depression is a mental health disorder in which sufferers experience a persistent depressed mood or loss of interest in activities, causing significant impairment in daily life, according to the National Institute of Mental Health.

Antidepressant medications are used to reduce the symptoms of depression, and include selective serotonin reuptake inhibitors, or SSRIs, and serotonin and norepinephrine reuptake inhibitors, or SNRIs.

From 2015 through 2018, antidepressant use increased with age and was highest among women aged 60 and over, at slightly more than 24%, the CDC found.

In addition, use of the drugs was higher among non-Hispanic White adults, at 17%, compared with non-Hispanic Black adults, at 8%, and non-Hispanic Asian adults, at 3%.

Adults with at least some college education were more likely to use antidepressants than those with a high school education or less, the agency said.



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