Women's Health

Nursing Week: Women's health advocate Sheila Tlou on breaking barriers in the fight for global health equity

siddiq22 — Mon, 08 May 2023 14:15:02 +0000

Nursing Week: Women's health advocate Sheila Tlou on breaking barriers in the fight for global health equity

siddiq22 Mon, 05/08/2023 - 10:15

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Sheila Tlou, Botswana's former minister of health, will give a keynote address on May 9 as part of National Nursing Week at the Lawrence S. Bloomberg Faculty of Nursing (supplied image)

Rebecca Biason

Topic

Global Lens

Africa

AIDS

Lawrence S. Bloomberg Faculty of Nursing

Nursing

United Nations

Women's Health

World Health Organization

The ��Ƶ's Lawrence S. Bloomberg Faculty of Nursing will mark National Nursing Week with a keynote address by Sheila Tlou, Botswana's former minister of health.

Over the past few decades, Tlou – a professor, nurse, HIV prevention advocate and artist – has merged her talents as a leader in health policy and community theatre to bring about lasting change in health outcomes in eastern and southern Africa.

“Nurses are a formidable and passionate force, and I say to all the young nurses out there, 'We can make an impact anywhere and everywhere we go,'” Tlou says.

Tlou will speak on May 9 at Innis College, sharing stories of her own experience as a changemaker in global health through her work with the World Health Organization (WHO), UNAIDS and the International Council of Nurses (ICN), where she has tackled issues around HIV transmission and prevention – particularly in women and children.

Of her many accomplishments, which have included being a member of parliament for the Republic of Botswana and director of a WHO nursing and midwifery initiative for anglophone Africa, Tlou says that she is most proud of her work saving the lives of children and their mothers by significantly lowering rates of HIV transmission in communities in Botswana.

When Tlou first became Botwana's minister of health in 2004, the rate of mother-to-child HIV transmission was very high. To address this urgent issue, Tlou created a comprehensive HIV/AIDS prevention strategy that included engaging with community members and leaders prior to rolling out an education and awareness campaign focused on HIV testing for pregnant women, as well as treatment with antiretrovirals.

By speaking with women and those supporting them in child-rearing – including partners and mothers-in-law – Tlou and her team of nurses, nurse practitioners and midwives were able to change the stigma around HIV and encourage early testing, shifting the community’s perspective and focus onto efforts that helped women birth healthy babies.

This community-engaged approach successfully reduced the rate of mother-to-child transmission of the disease from 30 per cent in 2003 to 8 per cent in 2008.

“This success was really saying to the world, 'Look at what can be achieved in a resource-limited area through the intervention of nurses,'” Tlou says. “Now the rate of transmission is less than 1 per cent, and the stigma is so low that many women continue to get tested. However the rates of infection of HIV among women remain very high, and that is still something that needs to be addressed.”

Tlou's advocacy has always been centered around issues of gender and empowering women to improve their health through education. Before she became a nurse, Tlou was passionate about theatre, originally planning to become an actor or interpreter for the United Nations because of her love of languages.

However, with only health sciences scholarships available to her as a young university student, Tlou entered the nursing program at Dillard University in New Orleans, opting to take public health and theatre as electives to foster her knack for engaging with people.

After completing her master’s degree in nursing education and instruction from Columbia University in New York City, Tlou returned to Botswana to teach community-health nursing and also co-directed a travelling theatre group that performed plays – some which imparted health-focused messages about family planning and spacing out pregnancies.

“Being able to take this practical public-health message out into the communities and villages was uplifting for the nursing students involved, because they could see the impact of community engagement from a nursing perspective,” Tlou says.

Though now retired, Tlou – who taught at the University of Botswana for decades – continues to work as a consultant on health promotion strategy for organizations such as the African Union, the United Nations and the WHO on efforts to reduce deaths from malaria, in addition to her work on HIV/AIDS.

During Nursing Week and beyond, Tlou wants nurses around the world to remember the importance not just of bedside care, but of community impact – and the ability of nurses to break down barriers that contribute to inequity in health care.

“My advice to current and future nurses is to look at the UN Sustainable Development Goals in your region, meet with nursing associations and find your niche,” Tlou says.

“As nurses, we need to make ourselves visible – and that includes in how we mentor the next generation."

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National Nursing Week

More awareness needed to improve heart health in women: U of T researcher

Christopher.Sorensen — Thu, 23 Feb 2023 18:07:24 +0000

More awareness needed to improve heart health in women: U of T researcher

Christopher.Sorensen Thu, 02/23/2023 - 13:07

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(iStock)

Rebecca Biason

Topic

Our Community

Lawrence S. Bloomberg Faculty of Nursing

Women

Women's Health

Cardiovascular disease is one of the leading causes of death in women – and the mortality rate has been steadily increasing since 2017 in Canada and the United States.

Monica Parry

That’s why Monica Parry, an associate professor at the ��Ƶ’s Lawrence S. Bloomberg Faculty of Nursing, uses her program of research to raise awareness about women’s heart health.

Much of Parry’s work is aligned with four of the UN’s Sustainable Development Goals – which includes enabling healthy lives and reducing inequalities – in addition to The Lancet commission’s target of reducing cardiovascular disease in women around the world by 2030.

“Globally, one woman still dies every 16 minutes of heart disease and many factors affecting women’s risk of heart disease are often gender-based,” says Parry.

“It is imperative we address the gaps in research and care for women with cardiovascular disease.”

Women are more likely to be caregivers, Parry adds, and this can contribute to them delaying seeking care for symptoms or focusing on themselves. Research has also shown that symptoms of heart disease in women manifest differently than in men and may be mistaken for other health conditions.

“Many women are simply unaware of their risk factors or symptoms, and this is further complicated by the fact that most guidelines for heart health and previous clinical trials have been focused on men and men’s anatomy,” says Parry.

In recognition of heart month and the goal to increase awareness about cardiovascular disease in women, writer Rebecca Biason recently spoke to Parry about how she plans to address gaps in the care and management of women’s heart health – and her efforts to empower women to help them manage their disease.

How does gender affect the risk of heart disease in women?

Women have non-traditional risk factors for heart disease – some of these are societal and based on gender and some are biological. Diseases associated with an increased risk of negative heart health such as obesity, diabetes and hypertension affect women differently as do other life events such as pregnancy, where the risks from preeclampsia and eclampsia can heighten a woman’s risk of developing chronic heart conditions later in life.

Societally, however, women are often positioned in roles of caregiving or are in lower economic status positions, and that can add to their stress level, further increasing their risk factors. Some of my current research is examining the role of unpaid caregivers and their mental health in Canada, 54 per cent of whom are women. In addition to wanting to gather more data about women who are of diverse ethnic backgrounds, I am also interested in learning more about the intersection of risks, especially for conditions like Takotsubo syndrome, which is a heart condition that can be caused by stress.

How does your work aim to improve cardiovascular health in women?

Self-management of symptoms – especially if women can distinguish them from other chronic conditions – can be lifesaving. With support from the Canadian Institutes of Health Research (CIHR) and an AMS Healthcare Fellowship, I have been working to develop and pilot a web-based app that uses a progressive algorithm and chatbot called “Holly” to screen women for heart-related symptoms. We know women often delay seeking treatment for their symptoms and that can be further complicated if they are unaware of whether their symptoms are related to their cardiovascular condition or not.

Holly asks women a series of questions about their last heart event, which is stored as an event profile. On subsequent logins, Holly asks women for a heart check, a series of questions to determine if they are experiencing acute cardiac symptoms and assigns them a risk profile: green (no risk) yellow (some risk) or red (severe risk), based on their answers. A user is then encouraged to seek further health assessment by her primary care provider or call 911 and go to the ER depending on her risk profile.

Working with our patient partners, we have also uncovered the need to create new body maps as part of the app to help women locate and identify their pain when identifying their symptoms for Holly. Most body maps are based on the male anatomy and in women we found that heart-related pain and discomfort can be found in regions that include the legs, such as in Kounis syndrome, an acute coronary syndrome associated with allergies and hypersensitivity reactions.

Holly also offers a library of resources for women to gain greater knowledge about their condition – another finding that arose as a result of our collaboration with patient partners. Many of the women in our focus groups indicated they wanted to have access to peer-reviewed and well-sourced materials about specific aspects of their heart condition.

How might education of future health-care providers help advance women’s heart health?

Awareness and education are key, both for women and for health-care providers. As a nurse practitioner who has worked on the cardiac unit, I have seen first-hand how women recover more poorly or have slower rates of recovery after cardiac surgery. In our education program at Bloomberg Nursing, we are incorporating a focus on symptoms of heart disease in women. I am a co-investigator with the CIHR-funded CANadian Consortium of Clinical Trial TRAINing platform that aims to enhance national clinical research capability and quality into clinical research education and good clinical practice, and also a co-principal investigator with the CIHR-funded training program titled “Maximize Your Research on Obesity and Diabetes” (myROaD), a national training platform aimed to train the next generation of researchers in obesity, diabetes and cardiometabolic health. Both training programs focus on the intersections of sex, gender, race and ethnicity.

My PhD students at Bloomberg Nursing are all focused on addressing aspects of heart disease in women – from young South Asian women with low physical activity and increased heart health risk to understanding the intersections of race and gender in Black Canadian women who have had a hypertensive disorder of pregnancy. Through their work we will continue to bring a diverse perspective and awareness to cardiovascular disease in women and move this research into the future.

U of T researcher helps develop online training program on Indigenous women’s reproductive health

Christopher.Sorensen — Tue, 24 Sep 2019 19:47:57 +0000

U of T researcher helps develop online training program on Indigenous women’s reproductive health

Christopher.Sorensen Tue, 09/24/2019 - 15:47

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U of T's Lisa Richardson co-led a team of Ontario researchers who developed a training program to teach health-care providers about the experiences of Indigenous women (photo by Nick Purdon)

Topic

Research & Innovation

Truth and Reconciliation

Women's Health

A new tool, created by researchers at the ��Ƶ and other Ontario institutions, seeks to educate health-care professionals about the biases Indigenous women face when it comes to navigating their reproductive health.

The online training program – part of a research study involving U of T, the Northern Ontario School of Medicine, Lakehead University and the Thunder Bay Regional Health Research Institute – is designed to help health-care professionals across Canada learn more about the social determinants of Indigenous women’s reproductive health.

It will officially be launched at an Oct. 1 event at U of T’s St. George campus in downtown Toronto.

“We’ve got a crisis in Canada when it comes to overcoming barriers that Indigenous women, and all Indigenous Peoples, face in accessing equitable health care,” says Dr. Lisa Richardson, strategic advisor, Indigenous health at U of T’s Faculty of Medicine, who assisted with the development of the training program.

“There is a long, long way to go.”

Naana Jumah, an an obstetrician-gynecologist and assistant professor at the Northern Ontario School of Medicine, says the program is designed for health-care providers, but encourges anyone who might provide care to Indigenous women to use it (photo courtesy of Northern Ontario School of Medicine)

The training program was created to teach health-care providers about the experiences of Indigenous women and communicate with learners in Indigenous women’s own voices. The initiative was led by Richardson, who is also an associate professor in U of T’s department of medicine, and Dr. Naana Jumah, an obstetrician-gynecologist at the Thunder Bay Regional Health Sciences Centre and assistant professor at the Northern Ontario School of Medicine.

Both doctors led a research team of seven people to develop the curriculum, the majority of whom were Indigenous women.

“This is designed for health-care providers, like doctors, nurses, social workers and first responders. But anyone else who might provide care to Indigenous women is encouraged to use it,” says Jumah.

“We’re also hoping that other staff members working at health-care organizations will take part, like receptionists and administrative workers. These people are typically the first person a patient interacts with, and they have a critical role in how a patient forms their first impressions of the organization.”

The training program, called “Hearing Our Voices,” incorporated feedback from 11 organizations from across Canada – many of them Indigenous women’s organizations, including Ka Ni Kanichihk, Kenhtè:ke Midwives, Native Women’s Association of Canada, Newfoundland Aboriginal Women’s Network, Pauktuutit Inuit Women of Canada, Rona Sterling Consulting and the Centre for Addiction and Mental Health.

Health-care providers and other Canadians are being invited to try out the online training program and share their feedback.

Richardson says the development of the curriculum reflects overall educational shifts that were highlighted as necessary in the Truth and Reconciliation Commission of Canada’s Calls to Action and the Final Report of the National Inquiry into Missing and Murdered Women and Girls.

Earlier this year, Richardson told the House of Commons Standing Committee on Health about the “ongoing evidence of the mistreatment of our peoples within health care,” including forced sterilizations that occurred.

“It’s appalling,” she says. “This training program is an important resource that all health-care providers should be aware of.”

Jumah agrees.

“Our hope is that if people take part in education, it will result in fewer discriminatory practices, and better skills among health-care providers,” she says. “We also hope it will lead to better relationships with Indigenous patients and a greater ability to address Indigenous patients’ needs.”

Doing the devil’s work: How U of T's Elizabeth Bagshaw became a pioneer in women's health

Christopher.Sorensen — Tue, 20 Aug 2019 16:35:49 +0000

Doing the devil’s work: How U of T's Elizabeth Bagshaw became a pioneer in women's health

Christopher.Sorensen Tue, 08/20/2019 - 12:35

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Dr. Elizabeth Bagshaw packs her medical bag before making house calls in Hamilton in 1976 (photo by the Hamilton Spectator, courtesy of the Hamilton Historical Collection)

Topic

Subheadline

The local bishop called her a heretic. The Criminal Code deemed her work illegal. But Dr. Bagshaw was more concerned with helping women at Canada's first birth control centre.

In September of 1901, 19-year-old Elizabeth Bagshaw came to the ��Ƶ to register for studies in medicine. She had just arrived in the city the day before from her family farm near Cannington, Ont. When she entered the registration area, she noticed most of the women were in the line to enrol for arts courses. She joined the queue that was almost entirely men – to register for medicine. One young man tried to redirect her. I’ll stay here, she said. The reaction of the men was one of amused disbelief.

“They just laughed,” Bagshaw said in the National Film Board of Canada movie Doctor Woman: The Life and Times of Dr. Elizabeth Bagshaw.

It was the beginning of a life of defying expectations for Bagshaw who, after earning her medical degree from U of T in 1905, would set up a successful practice – exceedingly rare for a woman in the early 20th century. She became medical director of Canada’s first and illegal birth control clinic in 1932 and spent more than three decades at the centre empowering women to control their reproductive health and plan the size of their own families.

During her years at U of T, Bagshaw thrived under the challenge of medical school. Many of her classes were held at the Ontario Medical College for Women and she was particularly adept at dissection – her professor praised her proficiency at dissecting cadavers – likely due to her steady, level-headed nature and ambidexterity. She and the other women did, of course, face gender discrimination: classes such as obstetrics and dissection were segregated, teasing from male classmates occurred and women were pushed into the field of obstetrics or pediatrics.

“I’d [have] liked to have gone through for a surgeon, but in those days there was no chance,” she said in Doctor Woman. “They wouldn’t have trusted a woman in those days to be a surgeon.”

After moving to Hamilton, Ont., to begin her career, Bagshaw (photo, right, courtesy U of T Archives) found that maternity work was the mainstay of her practice. Many of her patients were recent immigrants, often Italian, raised in the tradition of midwifery – and this made them much more comfortable with a female doctor. In the early days, Bagshaw rented a horse and buggy from a livery to make house calls during the day; at night, she would bike to homes to deliver babies. So successful was she at maternity work that for three years in a row she signed more birth certificates than any other doctor in Hamilton.

Like every doctor of the time, she also ministered to patients suffering from life-threatening illnesses such as tuberculosis, smallpox and typhoid – in the days before the necessary antibiotics and immunizations existed. Bagshaw herself caught the Spanish flu – which killed tens of millions throughout the world from 1918 to 1920 – but made a full recovery. It was not possible, however, to make a full recovery from her personal losses: In the summer before her final year of medical school, her father had died in an accident on the farm, falling off a ladder and breaking his neck. Then, during the First World War, her suitor, Lou Honey, was killed in the line of duty. Before he had enlisted as a soldier, Honey had given her a diamond ring. He died in 1915. For many years, a picture of him in uniform remained on Bagshaw’s wall.

It was against the hardscrabble backdrop of the Great Depression that Bagshaw’s pioneering work with Canada’s first birth control clinic began. One day in 1932, a woman named Mary Hawkins paid a visit to her office. Hawkins – who did much volunteer work with women and children – had opened the clinic on March 3, 1932, to offer contraceptives and information on family planning. However, the doctor they hired resigned three weeks in, and Hawkins had come to implore Bagshaw to sign on as medical director.

The stakes for those involved in the clinic were extremely high: It was an indictable offence – liable to two years in prison – to sell or advertise contraceptives or to instruct people on how to use them. One clause in the code offered hope: if one could prove “public good” was served by their actions, they could avoid conviction. But no one wanted to be put in the position of a long, expensive trial or risk being jailed.

Bagshaw initially turned down the position of medical director. It was not out of legal concerns: She was not one to back away from a fight. But she was time-constrained as a doctor with a thriving practice and a young adopted son to raise.

Then, she changed her mind. As a physician, she had borne witness to the hardships that many large families faced, and the physical problems women suffered from bearing many children. Now, in addition, there was the relentless poverty caused by the Great Depression: husbands on relief, great numbers of children that couldn’t be fed or cared for. In the 1930s, the maternal death rate in Canada was high. Many women also died trying to perform abortions on themselves, or while undergoing the procedure illegally. Bagshaw believed informing and helping women in the arena of family planning was the right thing to do – for them and their families. “I had so many patients who were having babies nearly every year or two years, and their husbands were out of work, and they hadn’t enough to eat. Why should they go on having more children?” she said, pragmatically, in the book Elizabeth Bagshaw, by Marjorie Wild.

And so, almost every Friday afternoon for the next 34 years, Bagshaw would work in the clinic: She would fit women for diaphragms, instruct them on the proper use and then have them come in for a followup. She did not receive a salary – only a small honorarium fluctuating between $100 and $200 a year. The number of women who sought her help was well beyond the clinic’s predictions: In the first year, they expected about 60 women. Almost 400 came.

Dr. Elizabeth Bagshaw, CM, receiving the Governor General's award for the Persons Case (photo courtesy of the Government of Canada)

In retrospect, this likely didn’t shock them. The clinic provided the first opportunity most women ever had to learn about their own bodies and control their reproductive destinies. Prior to the clinic, men were the gatekeepers to women’s health in Canada. Men headed the educational and medical systems that controlled knowledge about birth control. They helmed the pulpits that made the religious creeds against using contraceptives. They ran the courts that judged birth control as unlawful, and spoke loudest in the court of public opinion that deemed it immoral. The women who ran the clinic cut through this socially constructed shame, countering that birth control was “about as immoral as a good day’s washing is immoral.”

“The challenges that [Bagshaw] faced during the Depression are similar to challenges that doctors in many countries face today, whether it is in countries where bias against women prevails or in countries where sexuality is not understood as a natural and important part of life,” says U of T’s Rebecca Cook, a professor emerita at U of T’s Faculty of Law and co-director of the Reproductive and Sexual Health Law Program. “Her legacy continues to motivate doctors today. She understood that neglecting health care that only women need contributes to their subordination.”

One of the clinic’s staunchest opposers was the Roman Catholic Church. Bishop J.T. McNally of Hamilton incessantly attacked Hawkins and Bagshaw at the pulpit, referring to them as “devils and whores,” and birth control policies as “blasphemous, degrading, dehumanizing.”

“The bishop always warned the [nursing] graduates not to come near the [clinic] because it was run by heretics and devils,” said Bagshaw in Doctor Woman. “I was the devil. I didn’t worry about it.”

“It was the best advertising we had,” she added. “It was against the law to advertise, therefore we couldn’t say anything, but he advertised it – then I’d tell the nurses, ‘Be sure to be on time, don’t be late at the next two or three clinics because we’ll have a number of Roman Catholics there.’ And we always did.”

In September 1936, a trial brought the issue of the legality of distributing and advising on birth control to a head. Dorothea Palmer, a nurse with the Parents’ Information Bureau in Ottawa, was charged with advertising birth control after visiting women in their homes to teach them about family planning. After a tense 20 days of trial, a verdict was reached: she was not guilty. The magistrate found that Palmer had, indeed, acted for the “public good.” The case was appealed. She won again.

After that, the most stressful, worrisome years were over for the clinic. The fear of being charged or imprisoned had dissipated. But it wasn’t until 1969 – three years after Bagshaw retired from the clinic, that the birth control law was officially changed.

Bagshaw didn’t retire from her own practice until the age of 95 in 1976, which made her the oldest physician practising in Canada. (At that time, she had about 50 patients all over the age of 80.) She died at the age of 100. For her pioneering work, she had been inducted into the Canadian Medical Hall of Fame, invested into the Order of Canada and had an elementary school in Hamilton named in her honour. Bagshaw had greatly advanced the concept of health-care equality: Regardless of what opinions one held, society was not entitled to impose them in a way that impeded the health of another.

“In addition to her courage in facing prejudice and stigma, her work contributed to our understanding of health equity. She understood that health-care services need to be provided in an equitable way to all women, in a way that attends to their sex-specific health-care needs,” says Cook. “Now, international human rights law recognizes that for women to be equal, in fact, their sex-specific health-care needs have to be accommodated.”

Female athletes in team sports need 50 per cent more protein than non-active males: U of T study

ullahnor — Thu, 30 Nov 2017 20:53:41 +0000

Female athletes in team sports need 50 per cent more protein than non-active males: U of T study

ullahnor Thu, 11/30/2017 - 15:53

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The Varsity Blues women's volleyball team at a game (photo by Martin Bazyl)

Topic

Macronutrients are an athlete’s best friend.

Carbohydrates and fat provide athletes with fuel and energy, but protein is what allows their bodies to recover from the physical demands of sports and exercise. So, how much protein do active females need to recover from exercise?

A new study from U of T’s Faculty of Kinesiology and Physical Education (KPE), the Hospital for Sick Kids and Ajinomoto Co. suggests it’s 50 per cent more than men who are not active. The study was published last month in the American College of Sports Medicine's Medicine & Science in Sports & Exercise.

The current recommended dietary allowance for protein is set at 0.8 grams per kilogram per day for the general population, however these guidelines don’t take into account the effect of regular exercise on minimum protein requirements. The American College of Sports Medicine recommends that athletes should consume between 1.2 to 2.0 g/kg of protein per day, but the broad range may not capture the specific needs of different athletes in light of their unique exercise demands.

”These recommendations are primarily based on athletes performing exclusively weightlifting or endurance exercises, which lie on opposite ends of the strength-endurance continuum of exercise,” says Daniel Moore, an assistant professor at KPE. “This leaves team sport athletes, such as basketball, hockey or soccer players, who have to have high levels of endurance but also perform stops and starts with high muscle forces, trying to guess what their optimal protein intake may be.”

To further complicate matters, studies examining the protein requirements of different active populations almost exclusively study males, which may limit the ability to translate these findings to active females.

“Despite the fact that females are just as active as males, existing studies primarily address the nutrient needs of males, and in particular strength and endurance athletes,” Moore says. “The purpose of this study was to determine a recommended daily allowance for protein in females engaged in team sports, which typically have elements of both endurance and resistance exercise.”

The study participants, six healthy active young women, performed a modified version of the Loughborough Intermittent Shuttle Test, which simulates the stop-and-go activity in soccer.

Following the exercise, they each consumed a series of meals containing a tracer, a protein building block, which is an amino acid that's a little bit heavier than those naturally occurring in our bodies.

If the tracer appears in the breath after it has been ingested, that’s a sign that we haven’t used it to build new body proteins. By tracking it in the breath and urine samples of the study participants, the researchers were able to determine how much of the protein in their diet was being used to build new protein, which is important for athletes to help them recover from demanding exercise.

The study demonstrated that variable-intensity exercise, like soccer, increases the safe protein intake in female athletes to 1.71g/kg/day, which is above the current daily recommendation of 0.8 g/kg/day for the general population and the 0.93 to 1.2 g/kg/day range for non-exercising males, but within the upper range of 1.2 to 2.0g/kg/day recommended for athletes by the American College of Sports Medicine.

“The study results will serve to provide a more refined athlete-specific recommendation for females engaged in team sports, which is especially significant given the tendency of female athletes to eat less than their male counterparts and in the case of some female soccer players, to consume protein below the present recommendations,” Moore says.

More broadly, he says, this shows the importance for dietary protein requirements to be population-specific.

Next up, the group of researchers will study the protein requirements of female athletes versus male athletes in team sports and in weightlifting.

The study was supported by an Ajinomoto Innovation Alliance Program Award for Moore.

Interested in publicly funded research in Canada? Learn more at UofT’s #supportthereport advocacy campaign

Three U of T faculty land on Canada's top 40 under 40 list

Christopher.Sorensen — Thu, 29 Jun 2017 21:17:53 +0000

Three U of T faculty land on Canada's top 40 under 40 list

Christopher.Sorensen Thu, 06/29/2017 - 17:17

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Patrick Gunning, a cancer researcher at U of T Mississauga, at work in the lab (photo by Paul Orenstein)

Chris Sorensen

Sharon Aschaiek

Author legacy

Sharon Aschaiek and Chris Sorensen

Topic

Three ��Ƶ faculty members – all working on critical health research – made Canada’s celebrated Top 40 Under 40 list this year.

Patrick Gunning, a medicinal chemistry professor at U of T Mississauga; Nav Persaud, an assistant professor at U of T’s department of family and community medicine and Aristotle Voineskos, an associate professor in U of T’s department of psychiatry, were all honoured on the annual list of 40 innovators in Canada’s private, public and not-for-profit sectors.

“It’s an honour to be named to a list of such distinguished people,” said Gunning of the list, which was started in 1995 by the Toronto-based global executive search firm Caldwell Partners.

“It’s important to me to do science that can help patients and make a positive contribution to health care.”

The Scottish-born Gunning, who holds a Canada Research Chair in Medicinal Chemistry, works on developing new drugs to battle aggressive blood, brain and breast cancers. His approach involves developing molecular compounds that more effectively target cancer-associated proteins and cause fewer side effects.

Gunning and his 35-member team test medicinal compounds that can disrupt protein-protein interactions – hubs of protein activity in the body that contribute to cells becoming cancerous.

U of T researcher looks into why dementia and depression hit women hardest

ullahnor — Mon, 13 Mar 2017 16:33:50 +0000

U of T researcher looks into why dementia and depression hit women hardest

ullahnor Mon, 03/13/2017 - 12:33

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Gillian Einstein’s work is breaking new ground in how researchers think about biological and social factors and the ways they relate to health (photo courtesy of Gillian Einstein)

Jovana Jankovic

Author legacy

Jovana Jankovic

Topic

Global Lens

Women's Health

Faculty of Arts & Science

Dalla Lana School of Public Health

Health

Aging

Subheadline

Gillian Einstein is the holder of the inaugural Wilfred and Joyce Posluns chair in women’s brain health and aging

Why is the incidence of depression, stroke, dementia and Alzheimer's significantly higher in women than men?

Women’s health – and women’s brain health, in particular – is something “distinct in itself”, says ��Ƶ researcher Gillian Einstein, the holder of the inaugural Wilfred and Joyce Posluns chair in women’s brain health and aging.

Yet the majority of research into women’s health has so far focused mainly on reproductive health, rather than on other systems like the nervous, musculoskeletal, cardiovascular and immune systems and the ways in which they’re influenced by hormones like estrogen.

Einstein is an associate professor of psychology in the Faculty of Arts & Science and the Dalla Lana School of Public Health. With the support of the Posluns chair – $1 million over five years – Einstein is keen to look into a number of key mysteries surrounding women’s brain health.

“Women are subjected to different life conditions than men,” she says. “A big mystery is why more women have Alzheimer’s disease than men.”

Einstein says with women living longer that could explain the discrepancy. But it could also be that women are subjected to “different life conditions than men.”

There have not been many studies trying to understand if gendered life experiences – like having one's ovaries removed – might affect the prevalence of Alzheimer’s disease, she says. Reports indicate that those who have their ovaries removed have a higher incidence of dementia.

“One of the things that the Posluns Chair will allow us to do,” says Einstein, “is to study the trajectory of brain changes from having one’s ovaries removed to, say, 13 years later. When do the brain changes start? Are they getting worse over time? Which brain regions are most affected?”

The significance of the Posluns chair being awarded to a researcher from U of T is not lost on Einstein. She points to the calibre of research and the culture of teamwork here.

“My research program wouldn’t be possible without the kind of collaboration of excellent scientists that exists here. There isn’t any project in my lab that doesn’t have at least three or four people who are collaborating on it.”

In addition to pursuing her own research, Einstein is passionate about encouraging students who are interested in studying sex, gender and brain health.

“One of the goals of the chair is to provide graduate students in psychology and neuroscience who are studying the brain and cognition extra financial support if they’re interested in adding sex differences to their studies or adding females or women to their research,” says Einstein. Having more researchers thinking about sex differences and gender and how to incorporate these considerations into their studies would enhance the rigour and relevance of brain and cognition research.

”There are a lot of expectations about the way that women are supposed to be, and sometimes we only research those things,” says Einstein. “Women bear children so we focus enormous energy and time on reproductive health. This chair allows us to study some surprising things that might not be expected.”

There are many examples of sex and gender bias in scientific studies. For example, males and females have both estrogens and androgens and both mediate important biological mechanisms, but there’s a lack of study about testosterone in women or estrogen in men, she says.

“We have actually gendered those hormones as ‘male’ or ‘female’ and then we study them in the sex we think they belong in,” explains Einstein.

The Wilfred and Joyce Posluns chair is an initiative of the late Wilfred Posluns' Family Foundation and the Women's Brain Health Initiative. It is supported through a partnership between the foundation, the Canadian Institutes of Health Research, the Alzheimer Society of Canada and the Ontario Brain Institute.

U of T physician pushes for Pap tests for immigrant women and those living in low-income neighbourhoods

ullahnor — Tue, 07 Feb 2017 18:03:11 +0000

U of T physician pushes for Pap tests for immigrant women and those living in low-income neighbourhoods

ullahnor Tue, 02/07/2017 - 13:03

Cutline

Dr. Aisha Lofters: “Rates of this disease are much lower in Canada than the rest of the world, but there are still big disparities here especially among people who are foreign-born” (photo courtesy of Institute for Clinical Evaluative Sciences)

Jim Oldfield

Author legacy

Jim Oldfield

Topic

Dalla Lana School of Public Health

Subheadline

The two groups of women are less likely to get screened for cervical cancer than other Canadians

Cervical cancer is highly curable if it’s caught early. But across Canada, screening rates for the disease vary wildly. Recent immigrants and women who live in low-income neighbourhoods are much less likely to get screened than other Canadians. Why?

That’s one question that drives Dr. Aisha Lofters, an assistant professor at U of T's Faculty of Medicine and Dalla Lana School of Public Health and a scientist at the Li Ka Shing Knowledge Institute at St. Michael’s Hospital.

Lofters has studied immigrant health and health equity for 10 years. She spoke with U of T's Jim Oldfield about her interest in health disparities, why demographic data on patients is critical, and what can be done to improve cervical cancer screening in women most at risk.

What inspired you to study cervical cancer screening?

As a practising family physician, a core part of my discipline is preventing illness before it happens. Some cancers you can’t predict, but some would be drastically reduced with ideal screening levels. Cervical cancer is a strong case in point – the literature says that with full screening we could virtually eliminate it. Rates of this disease are much lower in Canada than the rest of the world, but there are still big disparities here especially among people who are foreign-born. And, it doesn’t have to be that way.

Which groups aren't getting screened regularly in Canada?

We’ve known for some time that recent immigrants are less likely to be screened, but that's a pretty broad group. So a few years ago, my colleagues at St. Michael's and I began looking at this issue more closely. We found that screening rates vary by race/ethnicity, age and where a person lives. Whether a woman has a family doctor is also a factor. So for example, a woman living in a high-income neighbourhood in Toronto is about four times more likely to have up-to-date screening than a recent immigrant of South Asian descent who is over 50 and doesn't have a general practitioner. That's a pretty striking disparity.

What are the reasons for that disparity?

Well, many women in lower income countries have never been screened due to limited budgets for public health and prevention. Our data suggest that patterns of low screening persist for many of these women after they arrive here, for several reasons.

Sometimes, they aren’t aware that screening is an option. Competing priorities can be a factor especially among low-income women. They may have chronic mental or other types of illness to deal with for example so screening for cervical cancer is not a priority for them.

Cost can come into play as well – some women face transportation and child care expenses when seeking care so they will avoid those costs unless they have acute illness. There can also be issues with doctor-patient communication and whether a doctor is male or female, which can affect a women’s comfort level with testing.

How do you address those issues to improve screening?

It's important to know which groups of women are facing these barriers, and that's what my research has been trying to determine. We now have data in Ontario that gives us a good picture of the problem, and we're starting to test interventions.

Education for health care providers, women and family members can all make a difference. I'm working on a study in Peel region with family physicians who have many patients of South Asian descent. Volunteers, also of South Asian descent, work with these doctors and patients to talk about cancer screening in the office or call patients at home who are overdue for screening. The volunteers can often speak to patients in their own languages. In one doctor’s office, 30 to 40 per cent of patients contacted came in within six months for screening, which is encouraging.

You've done volunteer work in Jamaica on screening for cervical cancer. Can you talk about that?

Cervical cancer is the second-leading cause of cancer-related death for women in Jamaica. Screening rates are a big problem, but several efforts are underway to change that.

I've been there twice, most recently this past November with Medicine in Action. I travelled with a team that provided primary care to women, men and children in remote areas. Most rural Jamaicans have limited access to health care. Many women have never had a Pap test or other cancer screening. But a lot of the women we met were quite open to testing, so the issue was less about privacy and modesty, and more about education, cost and access. Hopefully these and other efforts such as HPV vaccination are having an impact.

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U of T physician pushes for Pap tests for immigrant women and those living in low-income neighbourhoods