Asthma's Inner World
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SPECIAL REPORT: INDIA’s dowRY VIOLENCE • CAMP FUN • BEYOND BIKINI SCIENCE nonprofit organization u.s. postage paid permit #7175 615 N. Wolfe Street, E2132 Baltimore, md Baltimore, MD 21205 Change Service Requested INAUGURAL SYMPOSIUM FALL 2013 THE MAGAZINE OF THE JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH WWW.JHSPH.EDU Wendy Klag Center for Autism and Developmental Disabilities October 15, 1 to 5:30 p.m. Sheldon Hall, W1214 10TH ANNIVERSARY SCIENTIFIC SYMPOSIUM & CELEBRATION Meatless Monday October 17, 4 to 5:45 p.m. Feinstone Hall, E2030 MAGAZINE IDEAS? SUGGESTIONS? 50% Total Recycled Fiber Contact editor Brian W. Simpson at [email protected]. 20% Post-consumer Fiber Asthma’s Inner World NEXT ISSUE FOOD RESEARCHERS FOLLoW The dISeASe’S RooTS NOT TO THE LUNGS, BUT TO THE GUT What’s in a public health magazine’s food issue? Think industrial agriculture, MRSA, allergies, ethics, caffeinated foods, Nepalese nutrition, urban gardens, oyster aquaculture, famine, faith and a full menu of all things edible— and a few inedible—all around the globe. (And Cheetos, too.) Pakistani children sharing naan / Shehzad Noorani 14 JOHNS HOPKINS PUBLIC HEALTH / FALL 2013 BEYOND BIKINI SCIENCE A band of scientists expands women’s health research beyond its traditional reproductive focus Story Jackie Powder Illustration Jody Hewgill In 2003, Judy O’Neill had her first “spell”— “ We know there are mechanisms impacting was formed in 1990, women’s health was intense chest pain, shortness of breath, a health differently for the sexes, and this really viewed as ‘bikini medicine,’” says shooting pain in her left arm and vomiting. makes it important to study health in Janine Clayton, MD, director of the Office It marked the beginning of seven years women as well as men.” of Women’s Health Research at NIH, of regular trips to the emergency room, —Karen Bandeen-Roche explaining that decades of women’s health countless tests and procedures—and, at research often led by men focused primarily times, dismissive attitudes from her doctors. on the areas of the body covered by a bikini. Eventually, the 69-year-old O’Neill Medicine, this band of scientists seeks It wasn’t until 1990 that Congress reached cardiologist Pamela Ouyang, MD. to discover the health implications of mandated that women be adequately Ouyang, director of the Johns Hopkins fundamental sex-based differences and to represented in NIH-supported research. Women’s Cardiovascular Health Center, better understand health issues unique to Until then most clinical trials only enrolled diagnosed coronary vasospasm (a coronary women. men, assuming that the findings applied artery constriction). “Our group represents diversity—from equally to both sexes—when the reality was More common in women, the condition policy and behavior to cancer, immunology, quite different. causes some of the classic symptoms of infectious disease and other aspects of Morgana Mongraw-Chaffin, PhD ’13, heart disease, but tests don’t necessarily women’s health,” says Sabra Klein, PhD, MPH, a cardiovascular epidemiologist and show severe coronary artery atherosclerosis MS, an associate professor in Molecular WHRG member, says she has benefited causing obstruction to blood flow, which is Microbiology and Immunology. Klein’s from the WHRG’s collective experience and more often found in men. own investigations into the ways that male support. She wants to see sex-based research It’s not uncommon for clinicians to and female hormones affect susceptibility to evolve from its status as a growing field to fail to recognize that women can experience infection have gained national attention. standard practice. heart disease—and many other medical The group’s interests include reframing “My hope is that at the end of every talk conditions—differently than men. This pregnancy as an opportunity to shape a I go to, I won’t have to raise my hand and fact highlights the need for research with a woman’s long-term health, diagnosing and say, ‘That’s great, but did you look at the women’s health focus, say members of the preventing frailty, and discovering how basic differences between men and women,’” says Women’s Health Research Group (WHRG) physiological sex differences affect diseases Mongraw-Chaffin. “It should be as standard at Johns Hopkins. Ouyang and her WHRG of the immune system. as any of the other research methods we use.” colleagues are committed to bridging the WHRG’s research reflects the slow WHRG members investigate a wide research gaps in women’s health. From evolution of women’s health science beyond range of issues related to women’s health. the schools of Public Health, Nursing and a reproductive focus. “When our office Following are some examples. JOHNS HOPKINS PUBLIC HEALTH / FALL 2013 15 Look for Depression Early to Prevent It Later Can Pregnancy Lead to a Healthier Life? Taking Care of Mom, Too During puberty and adolescence, young For WHRG director Wendy Bennett, MD, Depression in a new mother can disrupt a people transition from the highly structured MPH, the postpartum period is a “window child’s well-being from the earliest days of childhood years to the exhilarating and of opportunity” to motivate women to make life. Mothers who suffer from the disorder sometimes frightening first years of smart choices about food, exercise and may be overly anxious, reserved emotionally independence. The transformation brings healthy behaviors, particularly women who and less likely to play with their babies— challenges and occasional turbulence. Social experienced complicated pregnancies. all factors that can impact a child’s early relationships, concerns with body image There’s an increasing recognition that development. and self-identity begin to take on increasing preeclampsia, gestational diabetes or other “If a mom is depressed it’s really importance for the young. pregnancy-related conditions put women at difficult for her to be present and responsive Recent research indicates that it’s also greater risk for developing chronic diseases to an infant,” says Tamar Mendelson, PhD, a time when girls begin to show increasing later in life, says Bennett, an assistant an associate professor in Mental Health. rates of depressive symptoms, says Donna professor in General Internal Medicine with Based on recent findings by Mendelson Strobino, PhD, a professor in Population, a joint appointment in PFRH. and her research partners, a group- Family and Reproductive Health (PFRH). “It’s not just a matter of telling women, format, mental health program to prevent Until puberty, the rates for depression are ‘You delivered your baby, you’re fine.’ We postpartum depression—the Mothers and similar for both sexes, says Strobino. need to discuss ways to prevent diabetes and Babies Course—shows promise in helping A greater understanding of this early heart disease,” she says. pregnant women and new mothers at risk of vulnerability could prove valuable in the Bennett and her colleagues are depression. In a randomized trial led by S. prevention, diagnosis and treatment of designing a pilot project, based at Johns Darius Tandon, PhD, an associate professor depression in young women, a group that Hopkins Bayview Medical Center, to better in the School of Medicine, the cognitive- experiences higher rates of the disorder than understand how to broaden postpartum behavioral intervention was delivered to low- men. care. Researchers plan to recruit women income women receiving home-visitation “Recognizing the divergence gives us a from East Baltimore to receive postpartum services. window into identifying risk and identifying care that not only includes the relevant Researchers showed that the inter- it really early,” says Strobino. “Early medical care, but offers additional health vention could be effective in the context identification is particularly important screenings and education. of home-visiting programs and reported a because one of the strongest risk factors “It’s not just thinking about a one-time significant reduction in depressive symptoms for major depressive disorder in adults and intervention,” says Bennett, “but how to among women in the study group. Equally postpartum is a history of depression.” influence the next stage in life.” important, the women showed continued progress at a six-month follow-up. 16 JOHNS HOPKINS PUBLIC HEALTH / FALL 2013 Planning for Safety Comparing Apples to Pears Holding Back Frailty Family planning clinics offer a range of When it comes to matters of the heart, Geriatricians have long known what services to women—access to contraceptives, cardiovascular disease is not created equal. frailty looks like: hunched posture, halting cervical cancer screenings and HIV testing, “Heart disease in men and women movements, a slow gait and the loss of to name a few. looks different, and we’re not sure why,” says muscle mass. Michele Decker, ScD, MPH, assistant Morgana Mongraw-Chaffin. However, instead of viewing frailty as professor in PFRH, is exploring whether the While pain is a common heart attack separate symptoms, the Women’s Health clinics can also serve as effective entry points symptom in both sexes, for example, women and Aging Study (WHAS) team defined it to educate women about physical and sexual are more likely to experience atypical as a syndrome and developed precise metrics abuse and link them with support services. symptoms, including abdominal stress, back (a frailty assessment) to identify it. “Evidence increasingly shows that pain or shortness of breath—sometimes in WHAS research, conducted at young women bear the brunt of partner the absence of chest discomfort. Hopkins from 1991 to 2011, has important violence, and violence is associated with “The way women put on fat is implications in caring for a rapidly aging unintended pregnancy as well as other subcutaneous, whereas men put on fat population—particularly for women aspects of poor sexual and reproductive more viscerally,” reflected in the traditional who are disproportionately affected by health,” she says. apple and pear shapes in men and women, frailty, says Karen Bandeen-Roche, PhD, In a pilot study at four Northern explains Mongraw-Chaffin, whose research Biostatistics chair.