I AM SAMIA NOURSI.
EXECUTIVE SECRETARY OF THIS
COMMITTEE AND ASSOCIATE DIRECTOR
SM I WOULD LIKE TO CALL TO ORDER
THE NIH ADVISE RECOMMITTEE ON
RESEARCH ON WOMEN'S HEALTH.
THIS MEETING IS OPEN TO THE
PUBLIC VIA LIVE BROADCAST AND ON
THE NIH VIDEO NETWORK, VIDEOCAST
NETWORK, IT IS BEING RECORDED
FOR OUR ARCHIVES AND FOR FUTURE
ON DEMAND VIEWING BY THE PUBLIC.
IF YOU ARE A MEMBER OF THE
PUBLIC, PERTHE FEDERAL REGISTER
NOTICE, YOU MAY SUBMIT YOUR
QUESTIONS IN WRITING DIRECTLY TO
ME AT SAMIA.NOURSI @NIH.GOV.
THAT IS SAMIA.NOURSI @NIH.GOV.
YOU WILL RECEIVE AN ANSWER FROM
ME DIRECTLY.
WE ARE JOINING REMOTELY EVENT
PARTICIPANTS AND PRESENTER SAYS
ARE PRESENTING THROUGH ZOOM.
AS MEMBERS OF THE FEDERAL
ADVISORY COMMITTEE YOU ARE
SPECIAL GOVERNMENT EMPLOYEES, WE
CALL USGEs.
WHICH MEANS YOU ARE SUBJECT TO
THE SAME ETHIC RULES THAT APPLY
TO GOVERNMENT EMPLOYEES.
THESE RULES ARE DESCRIBED IN THE
PAMPHLET ENTITLED STANDARDS OF
ETHICAL CONDUCT OF EMPLOYEES FOR
THE EXECUTIVE BRANCH.
YOU WILL RECEIVE THE COPY OF
THIS DOCUMENT WHEN YOU WERE
APPOINTED.
AT EVERY MEETING WE LIKE TO
REVIEW THE STEPS WE TAKE AND THE
PROCESS WE FOLLOW TO IDENTIFY
AND ARK ADDRESS ANY CONFLICTS
BETWEEN YOU, YOUR PUBLIC, THE
RESPONSIBILITY AND YOUR PRIVATE
INTERESTS.
AS YOU KNOW BEFORE EVERY
MEETING, YOU PROVIDE US WITH A
GREAT DEAL OF INFORMATION ABOUT
YOUR PROFESSIONAL, PERSONAL AND
FINANCIAL INTERESTS.
WE USE THIS INFORMATION AS THE
FOUNDATIONS FOR ASSESSING
WHETHER YOU HAVE ANY REAL
POTENTIAL OR APPARENT CONFLICTS
OF INTEREST THAT COULD
COMPROMISE YOUR ABILITY TO BE
OBJECTIVE TO GIVE ADVICE DURING
COMMITTEE MEETINGS.
IF YOU THE NEED FOR INDIVIDUAL
SERVICES ARE IN PLACE OF A
POTENTIAL CONFLICTS OF INTEREST,
WE HAVE IDENTIFIED WE WOULD
ISSUE YOU A WAIVER OR RESCUE
YOU--RECUSE YOU--EXCUSE ME--FROM
A PARTICULAR PORTION OF MEETING.
WE USUALLY WAVE CONFLICTS OF
INTEREST FOR GENERAL MATTERS
BECAUSE WE BELIEVE YOUR ABILITY
TO BE OBJECTIVE WILL NOT BE
AFFECTED BY YOUR FINANCIAL
INTEREST.
WE ALSO RELY A GREAT DEAL ON
YOU.
YOU NEED TO BE ATTENTIVE DURING
MEETINGS TO THE POSSIBILITY THAT
AN ISSUE COULD ARISE THAT COULD
AFFECT OR APPEAR TO AFFECT YOUR
FINANCIAL INTEREST WITH RESPECT
TO A SPECIFIC PARTY OR MATTER.
IF THIS HAPPENS, YOU WILL BE
ASKED TO RECUSE YOURSELF FROM
THAT PORTION OF THE MEETING.
BEFORE INTRODUCTION, I WILL
BRIEFLY REVIEW BEST PRACTICES
FOR OUR ZOOM PARTICIPANTS.
YOU KNOW THIS BUT JUST A
REMINDER, PLEASE MUTE YOUR MIC
IF YOU ARE NOT SPEAKING.
WHEN SPEAKING STATE YOUR NAME
BEFORE MAKING COMMENTS, MOTIONS
OR RECOMMENDATIONS.
TRY TO USE THE HEAD SET WITH MIC
WHEN SPEAKING AND THAT WILL
PROVIDE THE LEAST AMOUNT OF
AUDIO FEEDBACK.
TURN OFF YOUR VIDEO IF YOU'RE
NOT SPEAKING TO PRESERVE
INTERNET BAND WIDTH.
IF YOU HAVE A QUESTION OR WOULD
LIKE TO MACK A COMMENT, PLEASE
UTILIZE THE CHAT FEATURE.
THE ZOOM SHAT WILL BE KEPT AS
PART OF THE OFFICIAL MEETING
RECORD.
WE WILL BE VOTING WITH THE ZOOM
POLLING FUNCTION.
DURING THE VOTE, MULTIPLE
SELECTIONS WILL DISPLAY ON THE
SCREEN, PLEASE SELECT YOUR
RESPONSE AND CLICK SUBMIT.
I WOULD LIKE TO WELCOME OUR
NEWEST ACRWH MEMBERS, DR. STEVEN
HIGGINS ISSUES PROFESSOR OF
PSYCHOLOGY AND PSYCHIATRIST AND
DREBLGHTOR OF VERMONT CENTER ON
BEHAVIOR AND HEALTH AT THE
UNIVERSITY OF VERMONT.
DR. ANDRIEA JONES PROFESSOR AND
EXECUTIVE DIRECTOR OF THE
HORIZONS PROGRAM IN THE
DEPARTMENT OF OBSTETRICS AND
GYNECOLOGY AT THE UNIVERSITY OF
NORTH CAROLINA AT CHAPEL HILL
SCHOOL OF MEDICINE.
DR. THELLIAL CELLS MA MIELENZ,
PROFESSOR OF MEDICAL AT CO
LUNLBIA UNIVERSITY.
DR. ALEXANDRA NOEL, UPON SCHOOL
OF VETERINARY MEDICINE LOUISIANA
STATE UNIVERSITY AND DR. PHILIS
SHARPS, Ph.D., MSN, RN AT THE
JOHNS HOPKINS UNIVERSITY.
WE LOOK FORWARD TO WORKING
CLOSELY WITH YOU IN THE COMING
YEARS AND WELCOME EVERYONE.
s AS I GO THROUGH THE ROSTER,
WHEN YOU HEAR YOUR NAME PLEASE
UNMUTE YOUR MIC AND INTRODUCE
YOURSELF BY NAME AND WHAT
INSTITUTION YOU REPRESENT.
DR. ANDERSON?
>>GOOD MORNING DR. ANDERSON
FROM THE FRED HUTCHISON CANCER
RESEARCH CENTER NTHANK YOU
DR. ANDERSON.
>>DR. [INDISCERNIBLE]
>>GOOD MORNING
DR. [INDISCERNIBLE] FROM THE
SOCIETY FOR WOMEN'S HEALTH
RESEARCH.
>>THANK YOU DOCTOR,
DR. BRUGALL?
>>THE DOCTOR HASN'T JOINED US
YET.
>>THANK YOU SARAH.
DR. HIGGINS.
>>HI, STEVE HIGGINS FROM THE
UNIVERSITY OF VERMONT, GLAD TO
BE WITH YOU.
>>DR. HOLGREN?
>>HI, EVERYBODY, SCOTT HOLGREN,
AT WASHINGTON UNIVERSITY IN
ST. LOUIS, DEPARTMENT OF
MOLECULAR BIOLOGY AND DIRECTOR
OF THE CENTER FOR WOMEN'S
INFECTIOUS DISEASE RESEARCH.
>>THANK YOU.
DR. JONES?
>>HI, DR. ANDREA JONES FROM THE
UNIVERSITY OF NORTH CAROLINA
CHAPEL HILL.
>>THANK YOU.
DR. [INDISCERNIBLE]
>>[INDISCERNIBLE] DIRECTOR FOR
CENTER FOR BIOETHICS AND SOCIAL
SCIENCES MEDICINE AT THE
UNIVERSITY OF MICHIGAN AND ABOUT
TO BECOME CHAIR OF RADIATION AND
ONCOLOGY AT EMORY UNIVERSITY.
>>THANK AND YOU
CONGRATULATIONS, DOCTOR.
>>DR. KLEIN.
>>HI, SABRA KLEIN JOHN HOPKINS
SCHOOL OF APPROXIMATE
UBIQUITINNATION LICK HELT,
PROFESSOR IN THE DEPARTMENT OF
MOLECULAR MICROBIOLOGY AND
IMMUNOLOGY AND CO DIRECTOR OF
THE JOHNS HOPKINS CENTER FOR
WOMEN'S HEALTH SEX AND GENDER
RESEARCH.
>>THANK YOU DR. KLEIN,
DR. Mc GREGOR?
>>DR. Mc GREGOR HASN'T JOINED
US YLT.
>>THANK YOU DR. MELENS.
>>I'M THELLIAL CELLS MA
MIELMENS, COLUMBIA SCHOOL OF
PUBLIC HEALTH.
>>THANK YOU DOCTOR, DOCTOR,
DR. NOEL?
>>GOOD MORNING EVERYONE, I'M
DR. ALEXANDRA NOEL, I AIVE IS
APT PROFESSOR IN THE DEPARTMENT
OF COMP PARAATIVE BIOMEDICAL
SCIENCES AT LOUISIANA STATE
UNIVERSITY.
>>THANK YOU
DR. [INDISCERNIBLE].
>>HI, I'M DOCTOR
[INDISCERNIBLE] AT UNIVERSITY OF
COLORADO AND DIRECTOR FOR THE
FAMILY AND WOMEN'S HEALTH
RESEARCH.
>>THANK YOU DR. ROBINSON?
, IN GOOD MORNING MICHELLE
ROBINSON, SENIOR ASSOCIATE DEAN
DID SPECIAL INTERIM DEAN AT
UNIVERSITY OF ALABAMA AT
BIRMINGHAM, SCHOOL OF DENTISTRY
AND SCHOOL OF HEDICATION.
>>THANK YOU DR. ROBINSON.
DR. [INDISCERNIBLE]
>>HELLO EYE AM
DR. [INDISCERNIBLE], DIRECTOR OF
THE McGEE WOMEN'S RESEARCH
INSTITUTE.
>>THANK YOU DOCTOR, DR. SHARPS?
>>DR. SHARPS HASPT JOIN USED US
YET TODAY.
>>DR. SIMON.
>>HI, IT'S MELISSA, OBGYN AT
NORTHWEST EXPERN LEAD THE CENTER
FOR HEALTH EQUITY
TRANSFORMATION.
>>THANK YOU.
AND DR. TEMPLE TON?
>>DR. TEMPLE TON HAS NOT JOINED
US YET.
>>DR. [INDISCERNIBLE] JOINED
US, WOULD YOU LIKE TO INTRODUCE
YOURSELF?
KREBS CYCLE?
OKAY, GOT IT.
THANK YOU.
THE DOCTOR IS HAVING CONNECTION
ISSUES BUT SHE IS IN THE MEETING
FOR THE RECORDS.
>>WE HAVE 1 MORE HOUSEKEEPING
ITEMS TO TAKE CARE OF BEFORE
MOVING ON WITH THE MEETING.
YOU WERE SENT THE MINUTES FROM
THE LAST MEETING ON APRIL 6,
2022 FOR YOUR REVIEW.
IS THERE A MOTION ON THE TABLE
TO ACCEPT THE APRIL 62022
MINUTES AS WRITTEN?
>>MOTION TO APPROVE.
>>SORRY CAN YOU STATE YOUR
NAME.
>>SABRAKLEIN.
>>THANK YOU DR. KLEIN HAS
SUBMITTED THE MOTION, DO I HEAR
A SECOND?
>>SECOND.
>>I'M SORRY?
>>SECOND.
>>DR. JAGSY.
>>THANK YOU VERY MUCH.
THE POLL HAS BEEN OPENED FOR YOU
TO RESPOND.
IF YOU ARE IN FAVOR, OPPOSE, OR
ABSTAIN, YOU WILL HAVE
30-SECONDS TO RESPOND.
>>HI, SARAH HAVE THE VOTES BEEN
RECORDED.
>>YES WITH 14 IN FAVOR.
>>THANK YOU.
THE APPROXIMATELY SIXTH 2022
MEETING MINUTES HAVE BEEN
ACCEPTED WITH 14 IN FAVOR.
DR. Mc GREGOR, YOU JUST
JOINED, WOULD YOU LIKE TO
INTRODUCE YOURSELF BEFORE WE
START?
>>SURE, YES, THANK YOU, ALLYSON
Mc GREGOR, PROFESSOR OF
MEDICINE AND ASSOCIATE DEAN AT
FACT OUTLETY AFFAIRS AND
DEVELOPMENT AT THE UNIVERSITY OF
SOUTH CAROLINA IN GREENVILLE.
>>THANK YOU DR. Mc GREGOR AND
NOW I WOULD LIKE TO INTRODUCE
THE CHAIR OF THIS COMMITTEE AND
THE DIRECTOR OF THE OFFICE OF
RESEARCH ON WOMEN'S HEALTH
DR. JANINE CLAYTON.
>>THANK YOU SO MUCH DR. NOURSI.
LET ME SHARE MY KREEN HERE AND
WE WILL--SCREEN HERE AND WE WILL
GET STARTED.
CAN SOMEONE PLEASE CONFIRM YOU
ARE SEEING THE CORRECT SCREEN.
>>YES,.
>>LOOKS GOOD.
>>AWESOME.
THANK YOU SO MUCH.
I AM SO EXCITED TO BE HERE WITH
YOU ALL HERE TODAY FOR AWE
57th MEETING.
HERE'S MY OUTLINE FOR TODAY, I
WILL COVER SO ORWH AND NIH
UPDATES, SOME UPDATES ON COVID,
SCIENTIFIC AND POLICY UPDATES,
TALK ABOUT FUNDING AND CAREERS
BEFORE I CLOSE.
SO WITH THAT, LET ME GO RIGHT
AHEAD AND I WILL START WITH AN
ANNOUNCEMENT THAT YOU ARE ALL
AWARE OF, DR. ANTHONY FAUCI
ANNOUNCED HIS INTENTION TO
RETIRE IN SEPTEMBER AND HE
PROVIDED INCREDIBLE ADVANCES IN
WOMEN'S HEALTH.
I WANTED TO HIGHLIGHT A FEW OF
THOSE.
FROM HIS GROUND BREAKING
RESEARCH ON GRANUE LO MATOSEIS,
TO UNDERSTANDING AND REGULATION
AND MECHANISMS OF ACTIONS OF
MANY OF THE IMMUNOSUPPRESSIVE
MEDICATIONS WE USE TODAY AND
THAT I PERSONALLY USE TO TREAT
WEGENER'S PATIENTS AND WE ARE
GRATEFUL FOR HIS INCREDIBLE WORK
IN THAT SPACE AND HIS LEADERSHIP
AT NIAID HAS RESULTED IN
INCREDIBLE ADVANCES RELATED TO
HIV, 1 OF THEM BEING PREVENTION
OF TRANSMISSION OF HIV FROM
MOTHER TO CHILD, SO THAT IS
BASICALLY SOMETHING'S WE TAKE
ALMOST FOR GRANTED NOW BUT WAS
NOT ALWAYS THE CASE, HIS
LEADERSHIP IN THAT SPACE LED TO
THESE ADVANCES WHERE WE CAN NOW
SAFELY HIV POSITIVE INDIVIDUALS
CAN NOW SAFELY HAVE A PREGNANCY
AND PREVENT MOTHER-CHILD
TRANSMISSION OF HIV.
IN ADDITION, THROUGH HIS WORK
AND OVERSIGHT OF INFLUENZA
CHALLENGE STUDIES, WORK THAT HAS
ADVANCED OUR UNDERSTANDING OF
SEX DIFFERENCES IN THE IMMUNE
RESPONSE TO INFLUENZA AND SO WE
KNOW THERE ARE SEX DIFFERENCES
IN IMMUNE RESPONSES.
THAT'S BEEN WELL RECOGNIZED AND
WE KNOW THAT INDIVIDUALS HAVE
BECOME PREGNANT HAVE INCREASED
RISKS RELATED TO INFLUENZA BUT
THESE RECENT CHALLENGE STUDIES
THAT WERE PUBLISHED LAST YEAR
HIGHLIGHT SOME OF THE UNDERLYING
MECHANISMS RELATED TO THAT AND
THE FACT THAT INHIBITION TITERS
WERE ASSOCIATED WITH THE SEX
DIFFERENCES THAT WE'RE SEEING
AND SO THAT GIVES US A CLUE AS
TO SOME OF THE MECHANISMS THAT
MAYBE EVEN MEET THE SEX
DIFFERENCES THAT HAVE BEEN
RECOGNIZED FOR SOMETIME.
AND THEN LASTLY INCLUES OF
PREGNANT PEOPLE IN COVID-19
RESEARCH, PREGNANT WOMEN AND
YOUNG CHILDREN ARE NOT INCLUDED
IN EARLY EXPERIMENTAL STUDIES
RELATED TO VACCINATIONS BUT I DO
APPLAUD NIAID FOR DEVELOPING THE
MOMMY VAX STUDY WHERE REGNANT
WOMEN ARE INCLUDED AND--PREGNANT
WOMEN ARE INCLUDED AND LOOKING
AT EFFECTS OF COVID-19 VACCINE
TO PREGNANTINANT PEOPLE AND
POSTPARTUM INDIVIDUALS AND WE
LOOK FORWARD TO THE RESULTS OF
THOSE STUDIES GOING FORWARD AND
ARE WE CONGRATULATE DR. FAUCI ON
HIS COMMITMENT TO WOMEN'S HEALTH
RESEARCH.
SO THAT'S THE WEGENER'S PAPER
FROM MANY YEARS AGO AND FROM
DR. FAUCI, RELATED TO HIV
TRANSMISSION, SOME INFLUENZA
VIRION LIKE PARTICLES AND THEN
JUST SOME MORE ON COVID-19.
SO AS I MOVE THIS OVER TO THE
UPDATE SECTION, I WANT TO SHARE
SOME NEWS WITH YOU.
FIRST WE HAVE A NEW ASSISTANT
DIRECTOR AT ORWH, MISS
[INDISCERNIBLE] IS OUR NEW
ASSISTANT DIRECTOR FOR
MANAGEMENT REPORTING OPERATIONS
AND COMMUNICATIONS SECTION.
WE STREAMLINED THAT AND WE
WELCOME HER SECOND AS YOU KNOW,
WE ARE CURRENTLY UNDERGOING THE
PROCESS OF UPDATING THE NIH WIDE
STRAY JECTORY STIGIC PLAN FOR
THE RESEARCH ON WOMEN AND OF
COURSE THERE HAVE BEEN RECENT
SIGNIFICANT HEALTH EEIVETS
INCLUDING THE COVID-19 PANDEMIC
THAT HAVE HAD AN OUTSIDE EFFECT
ON WOMEN, SEVERAL TOPICS
RELATIVE TO THE HEALTH OF WOMEN
WERE REVIEWED BY THE BY THE
COMMITTEE AT THE CONFERENCE LAST
YEAR, THAT WAS CONGRESSALLY
DIRECTED.
I WANT TO HIGHLIGHT THAT THE
FULL REPORT IS AVAILABLE ON OUR
WEBSITE.
THAT INFORMATION ALONG WITH
OTHER INFORMATION FROM A WIDE
RANGE OF STAKEHOLDERS WILL BEGIN
FORMING THE NEXT STRATEGIC PLAN
FOR THE HEALTH AND RESEARCH ON
WOMEN OR WE RECENTLY CLOSED OR
SOLICITED INPUT FROM A LARGE SET
OF THE PUBLIC AND BASICALLY
ANYONE WHO WANTED TO RESPOND TO
INFORM OUR NEXT STEPS.
SO THANK YOU VERY MUCH FOR YOUR
WORK ON THAT ACR WH AND STAY
TUNED FOR MORE.
NEXT, I WANT TO HIGHLIGHT FOR
YOU SOME CHANGES THAT NIH
REQUESTED RELATED TO THE
BIENNIAL REPORT.
THIS IS YOUR REPORT, THE TITLE,
OFFICIAL REPORT IS THE REPORT OF
THE ADVISE RECOMMITTEE ON
WOMEN'S HEALTH, RESEARCH ON
WOMEN'S HEALTH AND AS A RESULT
WE ARE PROPOSING TO SHORTEN THE
LENGTH OF THIS REPORT WITH A
TARGET PAGE COUNT OF FEWER THAN
A HUNDRED PAGES AND WITH A
SINGLE PAGE FOR EACH ICU AS A
STRATEGY, WE ARE SEEKING TO
LEVERAGE EXISTING DIGITAL
CONTENT AND DIGITAL CONTENT IN
GENERAL TO INSURE THAT THE
PUBLIC HAS ACCESS TO INFORMATION
THAT THEY NEED.
WE KNOW THAT THIS IMPORTANT
REPORT, IT HAS BEEN THE SOURCE
OF INFORMATION FOR MANY OTHER
STUDIES AND IT'S IMPORTANT FOR
US TO TRANSPARENTLY SHARE WITH
THE PUBLIC INFORMATION ABOUT
THEIR INVESTMENT IN WOMEN'S
HEALTH RESEARCH, FOR EXAMPLE,
RECENT NATIONAL ACADEMY'S REPORT
ON WOMEN ON UNDER REP
REPRESENTED GROUPS USED
INCLUSION DATA THAT WE REPORT IN
THE BIENNIAL REPORT TO DO THEIR
ANALYSIS.
WE WILL ALSO BE USING THE START
MODULE WHICH STANDS FOR
STRATEGIC PLAN TRACKING AND
REPORTING TOOL THAT THE OFFICE
OF EVALUATION, PERFORMANCE AND
REPORTING OF OE, PR IN DPC SI,
IS OVERSEEING TO BE ABLE TO
FACILITATE INFORMATION, GETTING
INFORMATION IN A CONSISTENT
MANNER ACROSS THE NIH ICOs AND
TO BE ABLE TO LEVERAGE DATA FROM
A VARIETY OF SOURCES AS WE MOVE
FORWARD.
SO YOU WILL BE--YOU WILL RECALL
ACRWH MEMBERS THAT YOU RESCREW
THE CONTENT FOR THE BIENNIAL
REPORT AND YOU WILL BE SEEING
THAT AGAIN IN EARLY 2023 ANDY
WOO WILL HAVE A NEW E-MAIL
ADDRESS THAT YOU WILL BE
RECEIVING INFORMATION FROM AND
TELL BE BIENNIAL REPORT
UNDERSCORE HELP OF WOMEN AT
NIH.GOV SO KEEP YOUR EYE OUT FOR
THAT AS WELL.
IN TERMS OF THE LEADERSHIP YOU
UPDATES DR. JIM ANDERSON WHO WAS
THE FORMER DEPUTY DIRECTOR FOR
PROGRAM ACCORD NATION PLANNING
AND STRATEGIC INITIATIVES HERE
AT NIH, HE RECENTLY RETIRED AND
WE ARE PLEASED TO SHARE WITH YOU
THAT THE ACTING DIRECTOR IS
DR. ROBERT EISINGER, HE WAS A
LONG-TERM DIRECTOR OF OHR, AND
WORKED THERE FOR MANY YEARS AND
WE'RE DELIGHTED TO BE WORKING
WITH HIM IN THIS NEW CAPACITY
AND I'M REALLY THRILLED TO SHARE
WITH YOU THAT DR. MONICA
BERTAGNOLLI, HAS RECENTLY FIRST
STARTED AS THE FIRST WOMAN
DIRECTOR OF THE NIH AND WE ARE
NOW UP TO 12 WOMEN IC DIRECTORS.
MISS ANDREA NORRIS IS RETIRING
AND SO SHE ANNOUNCED HER
INTENTION TO RETIRE IN DECEMBER,
AND I'M ALSO PLEASED TO SHARE
WITH YOU THAT DR. NINA SHORE HAS
BEEN APPOINTED DEPUTY DIRECTOR
FOR INTRAMURAL RESEARCH AND WE
ARE EXCITED ABOUT WORKING WITH
HER IN THAT CAPACITY AND
CONGRATULATION DR. MICHAEL
GOTTESMAN FOR HIS LONG-TERM
CAREER.
MR. KEVIN WILLIAMS IS NOW THE
NEW DIRECTOR OF THE OFFICE OF
EQUITY, DIVERSITY AND INCLUSION
AS WELL.
AND SO, I LOOK FORWARD TO
WORKING WITH ALL OF THESE NEW
LEADERS AT NE H IN THEIR NEW
CAPACITIES.
IN TERMS OF COVID-19 UPDATE, I
WANT TO SHARE WITH YOU, EACH OF
THESE MEETINGS WE'VE SHARED
COVID-19 DATA RELATIVE TO THE
HEALTH OF WOMEN AND THIS TIME I
WANT TO SHARE INFORMATION WITH
YOU ON A REVIEW ARTICLE THAT
LOOKED ACROSS ALL THE
PUBLICATIONS RELATED TO COVID-19
OVER THE LAST 2 YEARS.
THEY IEE, AUDIENCE DENTIFIED
OVER 4000 PUBLICATIONS THAT MET
THEIR CRITERIA, THEY WERE
SPECIFICALLY LOOKING FOR
PUBLICATIONS THAT REPORTED
OUTCOMES FOR SEX, BOY SEX.
AND UNFORTUNATELY, AND THEY WERE
LOOKING FOR, PUBLICATIONS THAT
LOOK AT COVID SEQUEL I AS WELL
AS LONG COVID SYNDROME AS THEY
PUBLISHED IN THIS PUBLICATION,
AND UNFORTUNATELY ON ONLY 23 OF
THESE OVER 4000 PUBLICATIONS
REPORTED RESULTS SEPARATELY FOR
MEN AND WOMEN AND THEY DID FIND
THAT WOMEN WERE MORE LIKELY TO
REPORT COVID SEQUEL I RELATED TO
ENT, PSYCHIATRIC, MOOD, AND
OTHERS, AND IN TERMS OF LONG
COVID SYNDROME, ONLY 12 OF THOSE
4000 PUBLICATIONS HAD
INFORMATION AVAILABLE
DISAGGREGATED BY SEX.
WOMEN WERE MORE LIKELY TO HAVE
LONG ASHING SYNDROME IN THIS
REVIEW, THIS LITERATURE REVIEW
AND SIGNIFICANTLY MORE LIKELY
AMONG WOMEN IN THE LONG COVID
SECTION INCLUDED GI,
NEUROLOGICAL AND DERMATOLOGICAL
COMPLIICATIONS AND AMONG MEMORY
RESPONSE ENDOCRINE COMPLICATIONS
IN LONG COVID IN ADDITION TO THE
RENAL COMPLICATIONS.
SO A FEW STUDIES, THIS REVIEW
SUMMARIZES FEW COVID-19 STUDIES
REPORTS SEX DISAGGREGATED DATA
UNDERSCORING THE NEED FOR BASED
SEX RESEARCH REPORTING.
AND I AM HIGHLIGHTING THIS STUDY
FROM ITALY.
ALTHOUGH THE STUDY IS SMALL, IT
PROSPECTIVELY LOOKED AT OUTCOMES
BY SEX AND FOUND THAT FEMALE SEX
ADVANCED AGE AND ACTIVE SMOKING
WERE LINKED TO HIGHER RISKS OF
LONG COVID ALTHOUGH DISPARITY
AND DISEASE WAS NOT.
SO APPLAUD THOSE INVESTIGATORS
FOR DOING THAT PROSPECTIVELY.
I DO WANT TO SHARE UPDATES IN
TERMS OF NIH INVESTMENTS IN THIS
SPACE, THE RECOVER STUDY OVER
SEARCHING COVID TO ENHANCE
RECOVERY IS LOOKING FOR SEX
OUTCOMES IN COVID-19 INFECTION
AS WELL AS P A SC AS WELL, AND
IT'S LOOKING INCLUDING A LARGE
NUMBER OF INDIVIDUALS, ADULTS
AND PEDIATRIC COHORTS ARE
INCLUDED AND LOOKING AT OVER
60 MILLION ELECTRONIC HEALTH
RECORDS.
THERE'S AN ACUTE INFECTION
COHORT MPLET THERE'S A PAST
COHORT THAT INCLUDES, WILL
INCLUDE OVER 200 PLUS PREGNANT
PERSONS AND OVER A THOUSAND
CHILDREN AND THERE'S THIS POST
ACUTE INFECTION COHORT THAT I
MENTIONED AND HAS BEEN IN A CASE
CONTROL DESIGN AND IT HAS
PROSPECTIVELY PLANNING TO LOOK
CAREFULLY AT SOME OF THESE
OUTCOMES BY SPECS.
HERE IS A BIT MORE INFORMATION
ON RECOVER AND THE PREGNANT
INDIVIDUALS THAT WILL BE
INCLUDED.
RECOVER IS LEVERAGING 2
PREGNANCY COHORTS, THE MFM U
UNITS LAZ AS PREGNANCY CORONA
VIRUS PREGNANCY AND OUTCOMES AND
WE LOOK TO THOSE TO HAVE
EVIDENCE TO INFORM TREATMENT
DECISIONS.
THE PROTOCOLS ARE COLLECTING
INFORMATION ABOUT PREGNANCY,
PREGNANCY RELATED OUTCOMES AS
WELL AS FEMALE SPECIFIC OUTCOMES
INCLUDING MENSTRUATION,
MENOPAUSE, SYMPTOMS, FERTILITY
AND SECTION FUNCTION.
TO GIVE YOU A BIT OF AN UPATE ON
SOME OF THE ORWH-LED RELATED
ACTESTIFIES, RELATED TO
COVID-19, WE FORMED A WORKING
GROUP THROUGH THE NIH
COORDINATING COMMITTEE OR CCRWH
FOR COVID-19 AND THE HEALTH OF
WOMEN.
THIS GROUP PERFORMED A PORTFOLIO
ANALYSIS LOOKING AT RESEARCH
GRANTS AWARDED OVER A SEVERAL
MONTH PERIOD, AND ACTUALLY
THIS--THAT SHOULD BE A 2 YEAR
PERIOD AND SO, THEY LOOKED WE
WERE TRYING TO ACCELERATE THE
EFFECTS ON SEC AND GENDER AND
THAT WAS THE GROUP'S GOAL AND
COLLABORATION.
I WILL SHOW YOU ON THE NEXT
SLIDE, A LITTLE BIT OF
INFORMATION RELATED TO THAT
PORTFOLIO ANALYSIS.
BUT IN TERMS OF THIS WORKING
GROUP, THEY HAD COMPLETED THE
ANALYSIS, THEY CREATED GUIDING
PRINCIPLES RELATED TO SEX AND
GENDER INFLUENCES IN THE HEALTH
AND WOMEN WHICH WE POSTED ON THE
ORWH OVER THE WEBSITE ON
COVID-19 AND WOMEN, ISSUED AN
RFI RELATED TO THE INTERSECTION
OF SARS-COV-2 INN FEKS AND THE
PANDEMIC AND THE HEALTH OF WOMEN
AND THAT RECENTLY CLOSED AND
CONTRIBUTED TO AN NHLBI LED THAT
ORWH PARTNERED ON LOOKING AT SEX
AND GENDER SPECIFIC COVID-19
OUTCOMES IN HEART, LUNG, BLOOD
AND SLEEP DISORDERS AND WORKING
ON A WHITE PAPER NOW.
HERA'S A HIGH LEVEL OF VIEW OF
THAT PORTFOLIO ANALIS OF OF OVER
A 2 YEAR PERIOD, 540 GRANTS
SUPPORTED BY 21 ICOs HAVE BEEN
ISSUED AND HERE ARE THE MAIN
TOPICS THAT HAVE BEEN COVERED TO
DATE, SO I LOOK FORWARD TO
SHARING MORE OF THIS INFORMATION
WITH YOU AND THERE WAS A
PRESENTATION MADE BY THE CO
CHAIRS OF THIS, WORKING GROUP
AND I WANT TO THANK THEM FOR
THIS WORK AND LOOK FORWARD TO
SHARING MORE OF THAT INFORMATION
WITH YOU IN THE FUTURE.
IN TERMS OF COVID-19 AND THE
HEALTH OF WOMEN, WE RECOGNIZED
EARLY INTERSECTION AND HELP
DEVELOP THE LECTURE SERIES
CALLED DIVERSE VOICES.
IN JULY WE HAD A SESSION ON
COVID-19, AND THEN, IN SEPTEMBER
WE HAVE A SESSION ON VIOLENCE
AND WOMEN, TRAUMA AND ADDICTION,
IMPACTS ON PREGNANT AND
POSTPARTUM PEOPLE.
SO IF YOU MISSED THAT, YOU CAN
GET THAT INFORMATION FROM OUR
WEBSITE.
ONE OF THE ACTIVITIES THAT NIH
HAS UNDERGONE THAT ADDRESSING
SOME OF THE HEALTH INIQUITIES
THAT WERE LAID THERE WITH THE
COVID-19 PANDEMIC INCLUDE A NEW
COMPASS INITIATIVE.
I AM PLEASED TO CO CHAIR THE
COMPASS WORKING GROUP WITH THE
DIRECTORS FROM NIH AND NICHD,
NINR AND THE TRIBAL HEALTH
RESEARCH OFFICE.
SO FOLKS IF THERE'S ANYONE SPEAK
FIGURE THEY COULD MUTE, THAT
WOULD BE GREAT.
COMPASS STANDS FOR COMMUNITY
PARTNERSHIPS TO ADVANCE SCIENCE
FOR SOCIETY.
AND IT'S A COMMON FUND PROGRAM.
THE COMMON FUND ADDRESSES AREAS
THAT CROSS BIOMEDICAL AND
BEHEAEVERRIAL RESEARCH THAT
INVOLVE MULTIPLE NIH INSTITUTES
AND CENTERS AND IS DESIGNED TO
SPUR RESEARCH THAT OTHERWISE
WOULD NOT BE POSSIBLE WITHOUT AN
INITIAL STRATEGIC INVESTMENT.
COMPASS' TRIPLE AIM AND TO
ADVANCE HEALTH EQUITY, IMPROVE
OUTCOMES AND REDUCE DIDIS
PARITIES.
THE PROGRAM GOALS INCLUDE
CATALYZING, DEPLOYING, AND
EVALUATING COMMUNITY LED HEALTH
STRUCTURE AT INTERVENTIONS THAT
EMPLOY MULTISECTOR
PARTNERSHIPPINGS TO REDUCE
HEALTH DISPARITIES.
THE PROGRAM SEEKS TO DEVELOP A
HEALTH EQUITY RESEARCH MODEL FOR
COMMUNITY LET MULTISECTOR
ADVANCE RESEARCH ACROSS NIH
INCLUDING OTHER FEDERAL
AGENCIES.
THERE ARE 2 FUNDING
OPPORTUNITIES THAT HAVE BEEN
RECENTLY LAUNCHED TO KICKOFF
COMPASS, THE COMMUNITY LED
HEALTH STRUCTURAL INTERVENTIONS
INITIATIVE AND THAT WILL BE
USING OTHER TRANSACTIONAL
AUTHORITY AND LETTER OF INTENT
IS DUE FROM COMMUNITY
ORGANIZATIONS ON
NOVEMBER 18th, SO HELP US GET
THE WORD OUT ABOUT THAT AND THE
COMMUNITY PARTNERSHIPS TO
ADVANCE SCIENCE FOR SOCIETY
ACCORD NATION CENTER AND THE RFA
IS RELEASED WITH A DUE DATE OF
JANUARY 27, 2023.
WE HAVE A VARIETY OF RESOURCES
AVAILABLE TO ASSIST YOU.
COUPLE OTHER POLICY AND
SCIENTIFIC UPDATES TO SHARE WITH
YOU.
RECENTLY, NIH UPDATED OUR
INSTRUCTION GUIDE FOR THE RPPR,
OR RESEARCH PERFORMANCE PROGRESS
REPORT.
PER THE NIH REVITALIZATION ACT
OF 1993, AND THE 21st CENTURY
CURES ACT THAT WENT INTO EFFECT
2016, WE REMINDED INDIVIDUALS
THAT RECEIVE NIH FUNDING FOR
PHASE 3 CLINICAL TRIALS THAT
THEY ARE REQUIRED TO REPORT THE
RESULTS OF VALID ANALYSIS BY SEX
OR GENDER RACE AND ETHNICITY FOR
NIH DEFINED PHASE 3 CLINICAL
TRIALS IN THE PROJECT OUTCOMES
SECTION OF THE RPPR AS WELL AS
TO CLINICAL TRIALS .GOV.
THIS INFORMATION WILL BE
AVAILABLE TO THE PUBLIC AND IS
AN IMPORTANT WAY TO GET THIS
INFORMATION OUT TO THE PUBLIC.
SO PLEASE HELP US DISSEMINATE
THAT TO THE INVESTIGATOR ABOUT
THEIR RESPONSIBILITY TO REPORT
THAT INFORMATION TO NIH PHASE 3
TRIALS IN THE RPPR.
HERE'S THE INFORMATION JUST TO
GIVE YOU EXACTLY WHERE IT IS IN
THE INSTRUCTIONS TO REMIND
INDIVIDUALS ABOUT THIS
REQUIREMENT WITH THE APPROPRIATE
CITATION.
IN TERMS OF POLICY, I'M
PRIVILEGED TO CO SHARE THE NIH
INCLUSION GOVERNANCE COMMITTEE
TD GEFULTS ARE INCLUDED AT VERY
HIGH LEVELS OF GOVERNMENT THAT
JOIN THE INCLUSION GOVERNANCE
COMPLITEE FOR THAT BRIEFING,
THAT BRIEFING, AND THAT REPORT
WAS IN RESPONSE TO A
CONGRESSIONAL CALL FOR THIS
STUDY TO BE CONDUBTED.
CONGRESS ASKED THAT THE NATIONAL
ACADEMIES EXAMINE THE LONG-TERM
MEDICAL AND ECONOMIC IMPACTS OF
A LACK OF INCLUSION OF WOMEN AND
UNDER REPRESENTED MINORITY
GROUPS AND CLINICAL RESEARCH AND
SUBSEQUENT WORK.
THE CHAIR WAS CHAIRED BY
DR. CHRISTEN BIBBINS-DOMINGO.
SOME OF THE STUDY USED THE LOOK
AT THE ELDERLY MODEL, TO LOOK AT
HOW LIFE EXPECTANCY DISPARITIES
IN ELDERLY PEOPLE.
IF DISPARITIES WERE ELIMINATED
DUE TO DIABETES, HEART DISEASE
AND HYPERTENSION.
THEY POSTULATED THAT WITH BETTER
REPRESENTATION IN CLINICAL
RESEARCH, THESE DISPARITIES
COULD BE ELIMINATED AND THEY
ARTICULATED THE ECONOMIC COST OF
THE HEALTH DISPARITIES IN THIS
WAY.
IF ALL LIFE EXPECTANCY
DISPARITIES WERE ELIMINATED FOR
THESE 3 CONDITIONS TOGETHER
COMBINED, DISEASE ISSUES
HYPERTENSION, THE VALUE WOULD BE
$11 TRILLION, THE VALUE FOR EVEN
A MODEST REDUCTION IN HEALTH
DISPARITIES WOULD BE WORTH
BILLIONS OF DOLLARS AND THEY
GIVE AN EXAMPLE THAT IF
1 PERCENT OF LELGT DISPARITIES,
JUST 1 PERCENT WERE ALLEVIATED
BY BETTER REPRESENTATION, IT
WOULD RESULT IN MORE THAN 40
BILLION DOLLARS FOR GAINS IN
DIABETES AND 60 BILLION DOLLARS
FOR HEART DISEASE.
THEY CONCLUDED THAT LARGE SWATHS
OF THE POPULATION, THOSE WHO
FACE THE GREATEST HEALTH
CHALLENGES WERE NOT ADEQUATELY
REPRESENTED IN RESEARCH AND THEY
LOOKED AT CLINICAL RESEARCH
ACROSS THE BOARD THAT IS FUNDED
BY MULTIPLE ENTITIES, THIS WAS A
VERY LARGE SCALE AND SCOPE.
THEY PUT FORWARD, THAT LITTLE
PROGRESS WAS MADE IN THE LAST 3
DECADES, FROM THEIR PERSPECTIVE
TO INCREASE PARTICIPATION AND
RACIAL AND ETHNIC MINORITY,
POPULATION GROUPS AND OTHER
GROUPS LIKE PREGNANT PEOPLE,
OLDER ADULTS, PEOPLE WITH
DISABILITIES AND THAT THE
UNDERREPRESENTATION COMPOUNDS
HEALTH DISPARITIES AND
COMPROMISES THE GENERALIZABILITY
OF RESEARCH.
THEY ALSO PUT FORWARD THAT THE
BENEFITS OF REPRESENTATION WOULD
BE REDUCING HEALTH DISPARITY AND
MORE INNOVATION WITH INCREASED
HETEROGENERATED AITY, AND
EXPANDINGAX ASSESSES AND
INCREASING TRUST IN SCIENCE AND
NEW THERAPIES, THEY HAVE A
VARIETY, A LARGE NUMBER NUMBER
OF RECOMMENDATIONS, I'M ONLY
HIGHLIGHTING A FEW HERE THAT ARE
RELEVANT TO NIH, 1 WAS THE
DEVELOPMENT OF A DHS TASK FORCE,
STANDARDIZATION OF DATA GRAPHIC
AND OTHER ELEMENTS OF CLINICAL
TRIALS .GOV REPORTING
INCORPORATING AND CRITERIA,
DEVELOPING GUIDANCE ON
PARTICIPANT AND CAREGIVER
COMPENSATION AND INVESTING IN
FUNDING COMMUNITY RESEARCH
INFRASTRUCTURE.
SO I DO WANT TO HIGHLIGHT THIS
REPORT FOR YOU AND PROVIDED THAT
URL FOR YOU FOR MORE FOR YOU TO
HAVE MORE DETAILED LOOK @ THAT
NATIONAL ACADEMIES REPORT.
TO JUST SHARE BROAFLY WITH YOU A
RECENT NATURE PUBLICATION THAT
LOOKED ACROSS VEARGS
STAKEHOLDERS WITH VARIOUS
OPINIONS ABOUT SABVAND VARIOUS
EXPERIENCES AND I WILL SHARE 1
QUOTE FROM DR. SUSAN CHENG AND
SHE'S REFERRING TO STUDIES THAT
LOOK AT THE CUT OFFS OF SYSTOLIC
BLOOD PRESSURE BY SEX THAT ARE
ASSOCIATED WITH INCREASED RISK
FOR COMPLICATION, THAT CUT OFF
IS 110-MILLIMETERS OF MERCURY
FOR WOMEN AS A RESULT OF THIS
STUDY, SHE SAID QUOTE FINDINGS
THAT MEN AND WOMEN DIFFER IN
RISK CUT-OFFS WAS ACTUALLY ARY
UEKA MOMENT.
IT WAS LIKE HOW DID WE NOT SEE
THIS BEFORE, SHE ASHES TRIBUTES
THE RESULTS TO THE NE H
CHALLENGE WHICH WAS AN NIH
FUNDING OPPORTUNITY TO LOOK FOR
SEX DIFFERENCES AND SAYS THEY
MADE IT ALL HAPPEN.
OF COURSE THERE ARE MANY
INDIVIDUALS AND STAKEHOLDERS IN
THIS SPACE AND WE RECOGNIZE THE
CONTRIBUTIONS OF SEX DIFFERENCES
RESEARCHERS FOR MANY YEARS AND
OTHER ASSOCIATIONS, PROFESSIONAL
SOCIETIES, AND SCIENTIFIC GROUPS
AND THAT THIS IS A JOURNEY THAT
WE'RE ALL ON TOGETHER TO
IMPRIEWEVER THE APPLICATION OF
SEX AND BIOLOGICAL VARIABLE.
AND FOR OUR SPACE, I'M DELIGHTED
TO SHARE WITH YOU THAT WE
REISSUED THE SPECIALIZED CENTERS
FOR RESEARCH IN EXCELLENCE RFA
EARLIER THIS YEAR, AND WE
RECENTLY GOT A RECEIVE DATE AND
OUR SCORE, NIH'S ONLY CENTER
LEVEL SEX DIFFERENCES FUNDING
OPPORTUNITY.
SO PLEASE STAY TUNED FOR MORE ON
THAT AND VERY RECENTLY WE JUST
REISSUED OUR SEX AND GENDER RO-1
AND NIH'S ONLY RO-1 FOCUSED ON
THE INTERSECTION OF SEX AND
GENDER INFLUENCES ON HEALTH AND
DISEASE, THE FIRST RECEIVE DATE
FOR THAT IS DECEMBER 19th OF
THIS YEAR.
SO WE'RE EXCITED ABOUT THE
CONTINUATION OF THESE AMAZING
PROGRAMS THAT ADDRESS SEX
DIFFERENCES AND WE WANT TO THANK
OUR ICO PARTNERS.
WE HAVE 10 ICs ARE THE SEX AND
GENDER RO-1 AND 8 PARTICIPATING
IN THE SEX AND GENDER STUDIES
ACTIVITIES.
I ALSO WANT TO HIGHLIGHT THE
ANNUAL SCORE MEETING THIS YEAR
AND WE WILL HAVE THE
EN--STRATEGIESITUTE OF GENDER
AND HEALTH DR. KAREN TANNENBAUM,
AND HER KEY NOTE WILL BE NEXT
GENERATION SEX AND GENDER
SCIENCE.
TELL BE AN AMAZING PRESENTATION
AND I'M REALLY LOOKING FORWARD
TO IT.
I WANT TO HEIGHT LIGHT ANOTHER
FUNDING OPPORTUNITY FROM THE
NATIONAL INSTITUTE ON AGING,
THAT'S INVESTIGATING SEX
DIFFERENCES ON MOLECULAR
DETERMINANTS OF ALZHEIMER'S
DISEASE RISK.
THEY'RE SEEKING ININTEGRATIVE
RESEARCH TO UNDERSTAND THE
IMPACT OF SEX DIFFERENCES ON THE
MOLECULAR DETERMINE NATION OF
ALZHEIMER'S DISEASE RISK AND
RESPONSIVENESS TO TREATMENT AND
THEY'RE SPECIFIC LYE LOOKING FOR
APPLICATIONS THAT APPLY CROSS
DISCIPLINEAR COMPETENT TEAM
SCIENCE APPROACHES, GAINING
COMPREHENSIVE MECHANISTIC
UNDERSTANDINGS OF THE IMPACT OF
SEX DIFFERENCES ON THE MOLECULAR
TRAJECTORIES OF BRAIN AGING AND
ON THE PHENOTYPES OF RISK AND
RESILIENCE AND UNDERLYING
RESPONSES TO PHARMAICOLOGGIC AND
NONPHARMAICOLOGGIC INTERVENTIONS
SOPHISTICATEDY WE KNOW THE SEX
DIFFERENCES IN ALZHEIMERS HAVE
BEEN WELL REPORTED AND CONTINUE
TO BE SOMETHING THAT IS UP FOR
EXPLOR IEGZ AND TRACTABLE AND WE
NEED TO EXPABD OUR
UNDERSTANDING.
THE EARLIEST SUBMISSION DATE IS
NOVEMBER 11th SO LET'S GET THE
WORD OUT ABOUT THIS IMPORTANT
FUNDING OPPORTUNITY AND I WANT
TO COMMEND THE NATIONAL
INSTITUTE ON AGING FOR ISSUING
THIS SPECIFIC SEX DIFFERENCES
FOA ON AN IMPORTANT AREA OF
PUBLIC INFORMATION.
DO WANT TO UPDATE YOU AS WELL,
THE NIH DIRECTORS ADVISORY
COMMITTEE TO THE DIRECTOR
WORKING GROUP ON ENHANCING RIG
OR, TRANSPARENCY AND
TRANSLATABILITY OF ANIMAL
RESEARCH I HAD THE PRIVILEGE OF
SERVING ON THAT GROUP AND THEIR
REPORT HAS BEEN ISSUED.
THAT REPORT IS SEEKING TO HAVE
AN OVERALL GOAL TO ALLOW STEAK
HOLDERS TO HAVE FULL CONFIDENCE
IN THE QUALITY AND APPLICABILITY
OF WERE FINDINGS, FROM ANIMAL
STUDIES AND TO,A SURE THAT
ANIMAL SUBJECTS ARE USED WITH
APPROPRIATE CONSIDERATION OF
ETHICS AND HARM BENEFIT
ANALYSIS.
AND THE OVERARCHING GOALS HERE
AS I MENTIONED ARE IN THE BOTTOM
LEFT, AND THE REPORT
RECOMMENDATION HAS 5 THEMES,
FIRST IMPROVING STUDY DESIGN AND
ANALYTIC RIGOR OF ANIMAL STUDIES
BY PROVIDING FOR EXAMPLE
STATISTICAL TRAINING TO STUDENTS
AND INVESTIGATORS, FACILITATING
COLLABORATIONS BETWEEN ANIMAL
RESEARCHERS AND STATISTICIANS.
THE SECOND AND ADDRESS BIAS AND
COMPLETE REPORTING AND
QUESTIONABLE RESEARCH PRACTICES,
HERE PERHAPS EXPLORING
PERSPECTIVE, STUDY PLANS AS
WELL.
THIRD IMPROVING THE RELEVANCE
AND USE OF ANIMAL MODELS, HERE
IS WHERE SEX COMES IN AND IN
PARTICULAR, AND ENCOURAGING THE
USE OF ARRIVE 2.0 IN THE
ESSENTIAL TECH CHECK LIST,
IMPROVE METHOD LOGIC AND RESULTS
REPORTING, AGAIN, SEX COMES IN
HERE IN TERMS OF SEX SPECIFIC
RESULTS REPORTING TO ENHANCE
RIGOR AND TRANSPARENCY AS WELL
AS TRANSLATABILITY, AND OF
COURSE, MEASURING AND EVALUATING
THE EFFECTIVE COST OF THIS WITH
MANY INTERVENTIONS.
SO IN REASON STUDY HIGHLIGHTS
HOW IMPORTANT THIS IS, THIS IS
IN BRAIN THIS YEAR AND IT SHOWED
FOR THE FIRST TIME THAT NEURONS
IN WOMEN'S SPINAL CORD PROCESS
PAIN DIFFERENTLY FROM MEN.
SEX DIFFERENCES IN MAIN
PROCESSING HAVE BEEN REPORTED
AND WE KNOW OF COURSE THIS IS
VERY IMPORTANT FOR POTENTIALLY
IMPROVING SEX AWARE TREATMENTS
FOR PAIN AND WITH THE ONGOING
OPIOID EPIDEMIC IN THIS COUNTRY
THIS IS DOUBLY IMPORTANT WE KNOW
THAT WOMEN EXPERIENCE PAIN
DIFFERENTLY MOST OF THE ANIMAL
RESEARCH RELATED TO PAIN
INVOLVES MALE RODENTS AND IN
THIS PARTICULAR STUDY THEY USED
FEMALE AND MALE FINE
SALIVA--SALIVA CORD TISSUE
EXVIVO FROM BOTH RODENTS AND
HUMANS AND THEY FOWBD THAT BRAIN
GROWTH FACTOR PLAYS A MAJOR ROLE
IN AMPLIFYING SPINAL CORD PAIN
SIGNAL NOTHING BOTH MALE HUMANS
AND MALE RATS BUT NOT IN FEMALE
HUMANS OR FEMALE RATS AND WHEN
FEMALE RATS WERE OVERETC.
MYSELF, THAT DIFFERENCE
DISAPPEARS HELPING TO PROVIDE
INFORMATION FOUNDATION ABOUT THE
UNDERLYING NECKIMISMS BEHIND SEX
DIFFERENCES AND PAIN PROCESSING
AND HIGHLIGHTING THE IMPORTANCE
OF LOOKING AT ANIMAL MODELS AND
SEX DIFFERENCES THERE AND HOW
THEY DO OR DO NOT RECAPITULATE
SEX DIFFERENCES IN HUMAN
DISEASE.
I'M GOING TO SHIFT GEARS HERE TO
TALK A LITTLE BIT ABOUT SOME
CLINICAL AND PUBLIC HEALTH
ISSUES AND I WANT TO BEGENERATED
BY SHOWING SOME DATA THAT ARE
VERY DISTURBING TO ME AND THESE
HIGHLIGHT CHANGES IN FEMALE LIFE
EXPECTANCY IN THE UNITED STATES
OVER A 2 YEERD PERIOD VERY
RECENTLY COMPARED TO HIGH--OTHER
HIGH INCOME COUNTRIES.
AND IF YOU LOOK AT THE SLIDE
HERE, YOU CAN SEE FROM
NUCLEOTIDES ZEALAND TO THE
UNITED STATES REDUCTION IN LIFE
EXPECTANCY.
THIS IS SCRUOF THE FOR FEMALES,
THE OVERALL U.S. FEMALE RATE IS
HERE WITH ALMOST A LITTLE OVER
BETWEEN 1 AND 2 YEAR REDUCTION
IN LIFE EXPECTANCY.
THIS IS ON TOP OF A PREVIOUS
TREND OF REDUCING LIFE
EXPECTANCY SLIDES I'VE SHOWN TO
YOU BEFORE BUT YOU CAN SEE WHEN
YOU BREAK THIS DOWN BY RACE AND
ETHNICITY, HISPANIC FEMALES AND
BLACK FEMALES WITH EVEN LARGER
REDUCTION IN LIFE EXPECTANCY
COMPARED TO PEER COUNTRIES HERE.
SO THAT'S THE BACK DROP FOR
THESE SLIDES.
NHLBI FUNDED RESEARCH THAT
LOOKED AT CARE OF INDIVIDUALS
EXPERIENCING BOTH ST SEGMENT AND
NONSTEMI, AND THESE SHOW THE
PROBABLE OF RECEIVING TIMELY
ANGIOGRAPHY DURING INDEX
ADMISSION.
HERE WITH MALE ANDS WITH
FEMALES.
AND WE SEE AN INCREASE IN BOTH
MALES AND FEMALES RECEIVING
TIMELY ANGIEOGRAPHY OVER TIME
FOR BOTH FOR BOTH TYPES OF MI,
HOWEVER WE SEE A PERSISTENCE GAP
BETWEEN MALES AND FEMALES.
WE ALSO SEE PERSISTENT GAP
BETWEEN WHITE AND OTHER
POPULATIONS IN TERMS OF
RECEIVING ANGIEOGRAPHY IN A
TIMELY MANNER.
SO ALTHOUGH THERE IS AN
INCREASING PROPORTION OF
PATIENTS RECEIVING GUIDELINE
RECOMMENDED INTERVENTIONS AND
THERE I WILL SHOW YOU IN THE
NEXT SLIDE, DECREASED MORTALITY
OVER THE STUDY PERIOD, WE STILL
SEE GAPS BY SEX AND RACE AND
ETHNICITY.
HERE'S THE SURVIVE AG, THE 1
YEAR SURVIVAL AND WE DO SEE A
NARROWING HERE, NOT HERE BUT
STILL SEE A GAP.
AND THESE--THIS IS 1 EXAMPLE, A
CHRONIC DISEASE CARDIOVASCULAR
CORONARY DISEASE AS 1 EXAMPLE OF
A CHRONIC DEBILITATING CONDITION
AND I WILL REMIND YOU THIS IS
ADDRESSED IN THE WOMEN'S HEALTH
CONFERENCE REPORT WHERE YOU AS
THE STAKEHOLDERS THAT SUPPORTED
AND PARTICIPATED IN THE MEETING
CALLED FOR A SPECIFIC FRAMEWORK
TO LOOK AT CHRONIC DISEASE IN
WOMEN TO BE ABLE TO ADDRESS
THESE PERSISTENT GAPS.
HERE'S ANOTHER EXAMPLE OF A
STUDY THAT LOOKED AT
RENAL--CHRONIC KIDNEY DISEASE
AND APPROXIMATE FOUND THAT WOMEN
WERE LESS LIKELY TO RECEIVE A
CHRONIC KIDNEY DISEASE
DIAGNOSTIC CODE, LESS LIKELY TO
BE REFERRED AND LESS LIKELY TO
RECEIVE MEDICATION, APPROPRIATE
MEDICATION FOR EXAMPLE, RASI AND
STATINS AT THE STUDY AND THEN
OVERTIME THEY WERE STILL LESS
LIKELY TO RECEIVE A CKD
DIAGNOSIS, REFERRED TO A
NEPHROLOGIST DESPITE ALBUT MIN
AND LESS LIKELY TO BE MONITORED
FOR THEIR KRE TINSA TINNINE AND
ALBIEWMINNURIA LEVELS.
AND THEY EXPECTING TO FIND SMALL
OR NO DISPARITIES IN HOW MEN AND
WOMEN WERE MANAGED BECAUSE
GUIDELINES DO NOT MAKE
DISTINCTIONS BY SEX ACCORDING TO
THEM.
IN INSTEAD WE OBSERVED PROFOUND
DIFFERENCES IN THE DETECTION
WORK UP AND MANAGEMENT OF
CHRONIC KIDNEY DISEASE
SUGGESTING SUBOPTIMAL CARE AMONG
WOMEN.
SO IN TERMS OF WHAT IT MAY BE
CRUCIATING TO THE DATA, IN
ADDITION TO COVID-19 IN TERMS OF
THE LIFE EXPECTANCY DATA I
SHOWED YOU, OF COURSE THE
COVID-19 PANDEMIC IS A CRITICAL
CONTRIBUTOR BUT WE ALSO HAVE TO
LOOK AT THESE OTHER FACTORS AND
I WILL END THIS LITTLE SECTION
WITH AN NICHD FUNDED STUDY THAT
LOOKED AT USING THE NURSES
HEALTH STUDY OVER 110,000 NURSES
FOLLOWED OVER 28 YEARS TO SEE
WHO GOT, AND IN HERE THEY WERE
LOOKING AT EN--STRATEGIES DENSE
OF STROKE AND THEY FOUND
INDIVIDUALS THAT HAD
LAPROSCOPICLY CONFIRMED
ENDOMETRIOSIS HAD A 34%
INCREASED RISK OF INCIDENCE
STROKE WHILE THE ABSOLUTE RISK
OF STROKE WAS SMALL, THIS IS AN
IMPORTANT SIGNAL SHOWING THAT
ENDOMETRIOSIS MAY INFLUENCE RISK
THROUGH A VARIETY OF FACTORS,
THROUGH ENDOGENOUS INFLAMMATION,
HORMONAL OR THE CONSEQUENCES OF
THE STREEMENT OF ENDOMETRIOSIS
AND THAT INFORMATION'S
HIGHLIGHTED HERE.
WE KNOW THAT HYPERTENSION, HIGH
CHOLESTEROL LEVELS, HORMONE
THERAPY USE, HYSTERECTOMY, AND
NEFF RECTIFIED ME WHICH SEVERAL
INDIVIDUALS WITH ENDOMETRIOSIS
HAVE AND THEY ARE ALSO
ASSOCIATED WITH STROKE RISK, SO
THIS IS A COMP LITLICATED
PICTURE BUT WE DO HIGHLIGHT THE
IMPORTANCE OF CONSIDERING FEMALE
SPECIFIC CARDIOVASCULAR RISKS
LIKE PREGNANCY INDUCED
HYPERTENSION, LIKE ENDOMETRIOSIS
AS WE THINK ABOUT CHRONIC
DISEASE DEVELOPMENT.
ONE OF THE WAYS WE ARE SEEKING
TO ADDRESS THESE CHALLENGES IS
TO GALVANIZE HEALTH EQUITY
THROUGH EDUCATION APPROXIMATE -
WE RECENTLY ANNOUNCED OUR NEW
GENDER 25, IT STANDS FOR
GALVANIZING HEALTH EQUITY
THROUGH NOVARTISET AND DIVERSE
EDUCATIONAL RESOURCES AND WOO
INTEND WITH THIS SEX RELATED
ACTIVITIES THAT COMPLEMENT OR
ENHANCE TRAINING OF A DIVERSE
WORKFORCE AND WE ARE LOOKING FOR
SKILLS DEVELOPMENT, CURRICULA,
METHODS DEVELOPMENT, WE ARE
THRILLED TO HAVE SO MANY
PARTNERING WITH US INCLUDING
SGMRO AND ROUND 1 APPLICATIONS
ARE DUE IN OCTOBER 27th WOO DO
WANT TO HIGHLIGHT THAT SEX IS
THE BIOLOGICAL VARIABLE BUT IT'S
BASED ON A CLEFT CHAL ROL AND
ANATOMICAL AND
PHYSIOLOGICALERATES THAT INCLUDE
ANATOMY, PHYSIOLOGY, DEN
GENETICS AND AS WELL AS GENDER
AND IDENTITY AND FORMS AND POWER
RELAYINGS AND QUALITY AND EQUITY
AS A SOCIAL AND CULTURAL
CONSTRUCT AND HAS MULTIPLE
DOMAINS, AND SO, BOTH OF THESE
ARE CRITICALLY IMPORTANT FOR
HEALTH OUTCOMES FOR PEOPLE AND
WE WANT TO--WOULD LIKE TO SEE
MORE RESEARCH THAT INCORPORATES
THEM AND WE WANT TO SUPPORT THE
METHODS DEVELOPMENT AND THE
NECESSARY INFRASTRUCTURE TO SEE
THAT IN THE FUTURE.
AND I WANT TO HIGHLIGHT FOR YOU
OUR LONG STANDING
INTERPROFESSIONAL HEALTH
EDUCATION WEBPAGE THAT HOSTS A
VARIETY OF COURSES THAT WE HAVE
DEVELOPED OUR BENCH TO BEDSIDE
FOR HUMAN HEALTH COURSE WAS
DEVELOPED IN COLLABORATION WITH
THE FDA'S OFFICE OF WOMEN'S
HEALTH.
YOU CAN NOW EARN UP TO 6 CME
CREDITS FREE, SO TAKE A LOOK AT
OUR WEBSITE THERE ANY WEB
CONNECTED HAVE A VARIETY OF
MATERIALS THAT ARE RELEVANT TO
ALL LEVELS INCLUDING AN SABB,
PRIMER AND INTRODUCTORY GUIDE AS
WELL AND TRAIN THE TRAINER
MATERIALS ARE NOW INCLUDED.IN
TERMS OF INFORMATION, CDC
UPDATED THEIR DATA AND THEY
FOUND THAT 4 OUT OF 5 U.S.
PREGNANCY AREYALATED DEATHS ARE
PREVENTIBLE AND AMONG AMERICAN
INDIAN OR ALASKA NATIVE PEOPLE,
93% OF DEATHS ARE PREVENTIBLE.
THIS IS BASED ON MMRC,
COMMITTEES FROM 36 STATES.
THEY REVIEWED DEATHS DURING
PREGNANCY, DAY OR WEEK OF
PREGNANCY AND YOU CAN SEE THE
BREAK DOWN HERE IN TERMS OF
PROPORTIONS, BUT FROM DAY 7 TO 1
YEAR OUT OVER HALF OF THESE
DEATHS OCCUR.
THEY HIGHLIGHT THE LEADING
CAUSES, THE LEADING CAUSE NOW IS
MENTAL HEALTH CONDITIONS
INCLUDING OVERDOSE AND THEY
FOUND THAT THE UNDERLYING CAUSES
VARY BY RACIAL GROUP WITH MENTAL
HEALTH CONDITIONS, THE LEADING
CAUSE FOR HISPANIC AND
NONHISPANIC WHITE WOMEN,
HEMORRHAGE FOR NONHISPANIC ASIAN
WOMEN AND HEART CONDITIONS, THE
LEADING CAUSE FOR NONHISPANIC
BLACK WOMEN.
ONE OF THE STEPS AT NIH WE'RE
TAKING TO ADDRESS THIS IS THE
PATHWAYS TO PREVENTION PROGRAM.
THIS 1 IS ENTITLED IDENTIFYING
RISKS AND INTERVENTIONS TO
OPTIMIZE POSTPARTUM HEALTH AND
WE WILL HAVE A WORKSHOP THAT IS
OPEN TO THE PUBLIC IN NOVEMBER.
LET SPEAKERS WILL DISCUSS THE
SCIENTIFIC EVIDENCE AVAILABLE
FOR PREDICKING OR PREVENTING
POORER OUTCOMES POSTPARTUM AND
ATTENDEES WILL HAVE THE
OPPORTUNITY TO SUBMIT QUESTIONS
AND COMMENTS AND AFTER THE
WORKSHOP, AN INDEPENDENT PANEL
WILL BE DRAFTING A REPORT
OUTLINING EVIDENCE GAPS AND
PRYERITYS FOR FUTURE RESEARCH.
YOU CAN REGISTER FOR THE
WORKSHOP, SO FAR OVER 5 HELPED
PEOPLE HAVE REGISTERED FOR THE
WORKSHOP.
THE 2 P2 PWORKSHOP QUESTIONS ARE
@ A BIRTHING PERSON'S ENTRY IS
INTO PRENATAL CARE WHAT
COMPLICATIONS OF RISK INDICATORS
HAVE THE GREATEST RISK IMPACT ON
POOR POSTPARTUM HEALTH OUTCOMES
AND TO WHAT EXTENT DO THOSE
PATTERNS VARY BY RACE AND
ETHNICITY.
AND TO WHAT EXTENT DO THEY VARY
BY RACE AND ETHNICITY AND THE
INDEPENDENT PANEL INCLUDES THIS
INPUT, INCLUDING NIH PORTFOLIO
ANALYSIS, ARK PANEL REPORT TO
GENERATE THEIR PANEL REPORT.
I ALSO WANT TO GIVE YOU AN
UPDATE ON THE NIH IMPROVE
INITIATIVE.
AND AN FY22, NIH RECEIVED 30
BILLION DOLLARS TO EXPAND
IMPEDIMENTS PROVE INITIATIVE, I
AM PLEASED TO CO CHAIR ALONG
WITH DR. DIANEA BI ANCY AND A
REPRESENTATIVE FROM NIH OD, THE
NIH PATERNAL MORTALITY TASK
FORCE THAT HAS OVERSEEN IMPROVE
TO DATE AND HERE ARE THE FY22
INITTIAIVE ITS THAT ALL LEAD TO
A NEW PROGRAM ON MATERNAL HEALTH
CENTERS OF EXCELLENCE.
THIS YEAR WE FUNDED AWARDS FOR
PATIENT IMPLEMENTATION NOSI,
SEEKING TO GENERATE EVIDENCE
BASED FINDINGS WITH EMPHASIS ON
STRATEGIES TO TEST EVIDENCE
BASED FINDINGS FOR EMPHASIS ON
STRATEGIES FOR POPULATIONS WITH
HEALTH DISPARITIES, COMMUNITY
PARTNERSHIPS CHALLENGE BUILDING
RESEARCH INFRASTRUCTURE AND
BARRIERS FOR COMMUNITY AND
ADVOCACY ORGANIZATIONS
CONDUCTING MATERNAL HEALTH
RESEARCH, A RAD-X MATERNAL
HEALTH CHALLENGE, TRYING TO
INFOIVATE ON POINT OF CARE AND
HOME BASED DIAGNOSISTICS THAT
PREDICT RISK FOR SEVERE MATERNAL
MORBIDITY AND MORTALITY
POSTPARTUM.
CONNECTING TO THE TOP, SEEKING
TO CONNECT ELECTRONIC HEALTH
RECORDS RELATING TO MOTHER AND
INFANT TO ADVANCE THEREFOREY AND
POSTPARTUM RESEARCH AND A
COMMUNITY IMPLEMENTATION PROGRAM
OR CIP FOR COMMUNITY ENGAGED
IMPLEMENTATION PROJECTS FOR
EVIDENCE-BASED COMMUNITIES AND
WHICH ARE INCREASING.
CENTERS OF EXCELLENCE, THESE ARE
ALL DESIGNED TO FEED INTO AND
SUPPORT AND INTEGRATE WITH THE
CENTERS OF EXCELLENCE FOA THAT
WE ALSO RELEASED THAT IS
DESIGNED TO CONDUCT BOTH WIDE
RANGING ACTIVITIES FROM
FOUNDATIONAL RESEARCH TO
IMPLEMENTATION SCIENCE TO
COMMUNITY PARTNERED RESEARCH TO
ULTIMATELY REDUCE PREGNANCY
ASSOCIATED AND PREGNANCY RELATED
DEATHS IN THE U.S.
I WANT TO JUST GIVE YOU A QUICK
SNAPSHOT ON ORWH FUNDING AS I DO
EACHIER.
EACH YEAR.
ON THE LEFT YOU CAN SEE THE
CURRENT TRENDS AND WE HAVE HAD
INCREASED FUNDING THAT HAS
ALLOWED TO US TO EXPAND THE
PROGRAMS HIGHLIGHTED FOR YOU.
OT RIGHT IS A BREAK DOWN OF OUR
RESEARCH PROGRAMS, OUR BIRCH
PROGRAM, SCORE PROGRAM, NEW
CAREER PROGRAMS LIKE THE
CONTINUITY SUPPLEMENTS OR IN
PREVIOUS PROGRAMS LIKE THE
REENTRY SUPPLEMENT THAT WAS
EXPANDED TO INCLUDE
REINTEGRATION AND SPECIFICALLY
ADDRESS INDIVIDUALS WHO HAVE
BEEN AFFECTED BOY UNLAWFUL
HARASSMENT INCLUDING SEXUAL
HARASSMENT AND PROVIDES AN
ONRAMP FOR THEM TO ESCAPE THAT
ENVIRONMENT.
OUR U3 PROGRAM, OUR SEX AND
GENDER RO-1 AND SEX AND GENDER
ADMIN SUPS AND WE WERE THE ICs
IN THEIR WOMEN'S HEALTH RESEARCH
AS WELL.
SO CAN YOU SEE THE BREAK DOWN
THERE.
ASK TO IMIF YOU MORE DETAIL ON
THE SEXUAL HARASSMENT AREA,
WE'VE EXPAND OUR ANTIHARASSMENT
ENFORCEMENT AND IN SECTION 213
OF THE CONSOLIDATED
APPROPRIATIONS ACT, WE
ARTICULATE THAT THE NIH DIRECTOR
WILL THEREAFTER REQUIRE
INSTITUTIONS THAT RECEIVE NIH
FUNDS THROUGH A GRANT OR A
COOPERATIVE AGREEMENT TO REPORT
TO NIH WHEN INDIVIDUALS
IDENTIFIED AS A PI OR AS A KEY
PERSONNEL, IN AN NIH NOTICE OF
AWARD ARE REMOVED FROM THEIR
POSITION OR OTHERWISE
DISCIPLINED DUE TO CONCERNS
ABOUT HARASSMENT, BULLYING,
RETALIATION OR HOSTILE WORK
CONDITIONS.
THAT MUST BE REPORTED WNCH 30
DAYS AND HERE IS A LITTLE BIT OF
INFORMATION, HERE'S THE GUIDE
NOTICE IN THE URL FOR THAT,
FAIRLY RECENTLY THE NATIONAL
ACADEMIES PUT OUT A NEW REPORT
ON EXPLORING SAIRVEGZS AND EARLY
INTERVENTIONS FOR FACULTY SEXUAL
HARASSMENT AND HIGHER EDUCATION,
AND THEY PUT FORWARD DATA THAT
38% OF WOMEN GRADUATE STUDENTS,
EXPERIENCE SEXUAL HARASSMENT
FROM FACULTY OR STAFF AND THESE
CHALLENGES THAT ARE BEING
EXPERIENCED IN ACADEMIA, INCLUDE
LACK OF ACCORD NATION AND
DOCUMMATION AND TRANSPARENCY
REPORTING AND ACCOUNTABILITY AND
THEY PERFORM IT ALSO THAT THERE
WAS NO READILY AVAILABLE GUIDE
FOR ADMINISTRATORS RELATED TO
SANCTIONING AND INTERVENING,
EXCUSE ME, AND CULTURAL RESEARCH
ON ACCORD NATION AS WELL.
--ACCORD NATION AS WELL, AND
THEN I WANT TO HIGHLIGHT 2 NIH
FUNDED GRANTS IN THIS PLACE.
WE WERE PLEASED TO COLLABORATE
WITH THE NATIONAL INSTITUTE OF
MEDICAL SCIENCES ON THEIR FOA ON
RESEARCH INTERVENTION THAT
PROMOTE THE INDIVIDUALS IN THE
RESEARCH SURPRISE THAT FOA HAS
SPECIFIC RESEARCH INVITING
APPLICATIONS RELATED TO
HARASSMENT AND SEXUAL HARASSMENT
AND THIS YEAR WE ARE PLEASED TO
FULLY FUND DR. SALAS'S AWARD AT
STANFORD AND CO FUND DR. STOCK
DALE'S AWARD AT INDIANA AT
PURDUE.
RIGHT AROUND THE CORNER IS
ORWH'S FIRST EVER GENDER AND
HEALTH WORKSHOP ENTITLED THE
IMPACTS OF STRUCTURAL SEXISM,
GENDER NORMS, RELAITIONZAL
POWER, DISCIPLINARY TISSUE AND
MACROPHAGESSICS AND GENDER
INEQUALITIES THAT'S ON
OCTOBER 26, WE HAVE AN ALL STAR
LINE UP FOR YOU IN TERMS OF OUR
PLENARY SPEAKERS HEADED BY
DR. NANCY KREIgE R,
DR. PATRICIA HOMAN, AND
DR. VIELKA, AND THEY ARE MANY
ICO PARTNERS LISTED BELOW, SO
PLEASE JOIN US THERE, THAT'S
AVAILABLE BY VIDEOCAST.
AND OUR SCORE MEETING OUR ANNUAL
SCORE MEETING IS NOVEMBER 1 WITH
THE KEY NOTE FROM DR. KAREN
DENNEN BAM AND OUR ANNUAL BIRCH
MEETING IS NOVEMBER 2nd AS
WELL AS OUR LEGACY LEADERSHIP
LECTURE WITH CATHY HATTER MAN
AND DR. JUDITH JAMES
RESPECTIVELY.
SO PLEASE JOIN US FOR THOSE.
AND AS I END HERE, I WILL
HIGHLIGHT THE WAYS THAT YOU CAN
CONNECT WITH US THROUGH OUR
QUARTERLY PUBLICATIONS CALLED
WOMEN'S HEALTH AND FOCUS AT NIH.
YOU CAN SIGN UP TO RECEIVE
THOSE, CAN YOU SIGN UP TO A
MONTHLY E-MAIL, AND TO RECEIVE
INFORMATION ABOUT OUR EVENTS,
PLEASE TAKE A ELECTRIC AT OUR
WOMEN'S SCIENCE AND THE IMPACT
OF COVID-19 URL, HIGHLIGHTING
HOW TO FOLLOW US ON SOCIAL
MEDIA,OT TOP RIGHT HERE AND OUR
ELEARNING COURSES.
AND WITH THAT I WILL PAUSE HERE
AND TAKE A LOOK AND SEE IF WE
HAVE TIME DR. NOURSI, FOR A FEW
QUESTIONS, MAYBE 1 QUESTION, I
HAVE 1 MINUTE BEFORE OUR 10:30.
DO WE HAVE TIME FOR 1 QUESTION.
>>YES, WE DO, BEFORE WE YOU
TAKE THE QUESTION, I WOULD LIKE
TO ACKNOWLEDGE DR. CLAYTON IF I
MAY, 2 MEMBERS WHO JOINED US IN
BETWEEN, DR. PHIL EPIGENETIC
SHARPS AND DR. KIM TEMPLE TON.
THANK YOU FOR JOINING US,
DR. CHARP'S WE LOOK FORWARD TO
WORKING WITH YOU FOR THE NEXT
FEW YEARS AND ALSO DR. CRISWELLS
NIAMILLIOS DIRECTOR WHO WILL BE
THE NEXT SPEAKER BUT DR. CLAYTON
YOU HAVE A FEW MINUTES FOR
QUESTIONS.
>>GREAT.
THANK YOU IF ANYONE WOULD LIKE
TO UNMUTE OR TURN YOUR VIDEO ON
TO ASK YOUR QUESTION, THAT WOULD
BE JUST FINE.
AND I WILL CHECK THE CHAT AS
WELL AND I'M SO THRILLED TO HAVE
YOU ALL HERE WITH ME TODAY.
>>THERE ARE NO QUESTIONS IN THE
CHAT BOX.
>>WE HAVE DR. CRISWELL AND IN
THE INTEREST OF TIME WE WILL GO
AHEAD AND MOVE ON, WE HAVE 2
DISCUSSION TIME SLOTS TODAY, A
MORNING DISCUSSION AND AN
AFTERNOON DISCUSSION SO I
WELCOME ECONOMIES AND COMMENTSA
THE THAT TIME BUT FOR NOW I WANT
TO GIVE A WARM WELCOME TO
DR. LINDSAY CRISWELL, OUR NEXT
PRESENTER.
SHE BECAME THE DIRECTOR OF NIAMS
IN FEBRUARY 2021.
PREVIOUSLY SHE SERVED AS VICE
CHANCELLOR OF RESEARCH AT THE
UNIVERSITY OF CALIFORNIA
SAN FRANCISCO AS WELL PROFESSOR
OF RHEUMATOLOGY AND ORAL
APPROXIMATE FACIAL SCIENCES.
HER RESEARCH FOCUSES ON THE
GENETICS AND EPIDEMIOLOGY OF
HUMAN AUTOIMMUNE DISEASES, A
TOPIC NEAR AND DEAR TO MY HEART
PARTICULARLY RHEUMATOID
ARTHRITIS AND [INDISCERNIBLE].
SHE HAS MENTORED MANY STUDENTS
TO INDEPENDENT FACULTY TO
INDEPENDENT RESEARCH CAREERS
SOMETHING OF UTMOST IMPORTANCE
TO ORWH AND OUR MISSION.
SHE RECEIVED BACHELOR'S IN
IMENETTICS AND MASTERS FROM UC
BERKELEY AND A DOCTOR OF
EPIDEMIOLOGY FROM THE
[INDISCERNIBLE] INSTITUTE FOR
HEALTH SCIENCES AND ROTTER DAM
AND HER MEDICAL DEGREE FROM
UCSF, SO DR. CRISWELL IS BOARD
CERT TIED IF INTERNAL MEDICINE
AND RHEUMATOLOGY AND MEMBER OF
ASSOCIATION AMERICAN PHYSICIANS,
WELCOME DR. LINDSAY CRISWELL.
WE ARE SO EXCITED TO HAVE YOU
WITH US TODAY.
>>THANK YOU SO MUCH DR. CLAYTON
AND IT'S A REAL PLEASURE TO BE
HERE WITH YOU ALL THIS MORNING.
SO I APPRECIATE THE OPPORTUNITY
TO DESCRIBE THE ACCELERATING
MEDICINE PARTNERSHIP OR AMP AND
YOU WILL HEAR ME REFER TO THIS
AS AMP AIM.
I WANT TO FOCUS BOTHOT EXCITING
SCIENCE THE PROGRAM SUPPORTS AS
WELL AS A NEW PARTNERSHIP WITH
ORWH.
THAT'S INTENDS AND AIMS TO
SUPPORT INVESTIGATOR WHO IS WISH
TO LEVERAGE THE AMP AIM
INFRASTRUCTURE TO DEVELOP THEIR
OWN CAREERS IN RESEARCH ON
IMPORTANT TOPICS AFFECTING
WOMEN'S HEALTH.
NEXT SLIDE, PLEASE.
SO FOR THOSE NOT FAMILIAR WITH
AMP, IT'S A PUBLIC PRIVATE
PARTNERSHIP THAT'S ORGANIZED BY
THE FOUNDATION FOR THE NIH OR
FNIH AND IT WAS LAUNCH INDEED
2014 AND IT CURRENTLY CONSISTS
OF 9 PROGRAMS, THAT ARE
SUPPORTED BY 28 INDUSTRY
PARTNERS, 15 NIH COMPONENTS, AND
NOW 29 NONPROFIT ORGANIZATIONS.
AND AS OF JUNE OF THIS YEAR,
772 MILLION-DOLLAR HAVE BEEN
INVESTED IN THE PROGRAM.
THE NEXT SLIDE, SHOWS THE
IMPORTANT CLINICAL TOPICS THAT
AMP IS ADDRESSING CURRENTLY.
THESE INCLUDE ALZHEIMER'S
DISEASE, TYPE 2 DIABETES, COMMON
METABOLIC DISORDERS, RHEUMATOID
ARTHRITIS AND LUNG RHEUMATOID
ARTHRITIS AND LUPUS, AS WELL AS
PARKINSON'S DISEASE,
SCHIZOPHRENIA, GENE THERAPY FOR
RARE DISEASES, AND HEART
FAILURE.
THE PROJECTS FOCUS ON THE
PRECOMPETITIVE PHASE AND INCLUDE
EFFORTS TO IDENTIFY DISEASE
MECHANISMS, BIOMARKERS DISEASE
PROGRESSION AND POTENTIAL
TEARGTS FOR INTERVENTION.
ON THE NEXT SLIDE, I WANT TO
PROVIDE A LITTLE HISTORY OF THE
AMP RHEUMATOID ARTHRITIS IN THE
[INDISCERNIBLE] PROGRAM WHICH
WAS THE PRECURSOR TO AMP AIM AND
I WILL REFER TO RHEUMATOID
ARTHRITIS AND SYSTEMIC LIEWPUS
AS R. A. AND FLE.
SO THIS IS 1 OF THE ORIGINAL
PROGRAMS LAUNCHED BACK IN 2015
AND IT FOCUSED ON IDENTIFYING
THE DISEASE MECH INFORMS FOR R.
A. AND LUPUS AND CORRECTED AN
INFRASTRUCTURE FOR COLLECTING
AND ANALYZING BLOOD AND SYNOVIAL
TISSUE FROM R. A. PEASHTS AND
BLOOD URINE, SKIN AND KIDNEY
TISSUE FROM PATIENTS WITH LUPUS.
THE INVESTIGATORS WORK TOGETHER
TO DEVELOP STANDARD OPERATING
PROCEDURES, TR TISSUE COLLECTION
AND ANALYSIS AND THEY APPLIED
SINGLE CELL TECHNOLOGIES TO
IDENTIFY BIOMARKERS, THERAPEUTIC
TARGETS AND STRATEGIES FOR THE
MOLECULAR CLASSIFICATION OF THE
DISEASE.
IMPORTANTLY, 1 OF THE MOST
SIGNIFICANT LEGACIES OF THE AMP
R. A. LUPUS PROGRAM IS THE RICH
DATA IT GENERATED AND NOW MADE
AVAILABLE TO THE BROADER
RESEARCH COMMUNITY.
NEXT SLIDE.
SO WHILE THE AMP R. A. LUPUS
PROGRAM FOCUSED ON
DECONSTRUCTION, THAT IS
IDENTIFYING THE CELL POPULATIONS
AND PATHWAYS THAT CHARACTERIZE
THE 2 DISEASES, AMP AIM REFEIGNS
AND EXTENDS THE SINGLE CELL
ANALYSIS OF TISSUE, TO
ADDITIONAL DISEASES, AND IT
EMPLOYS HIGH DIMENSIONAL MODEL
ANALYSTICS TO DISCOVER HOW THE
INNATE AND ADAPTIVE CELLS OF THE
IMMUNE SYSTEM AND THE TISSUE
CELLS WORK TOGETHER TO DRIVE
INFLAMMATION, INJURY, ABNORMAL
FUNCTION, AND ULTIMATELY
CLINICAL DISEASE.
THE NEXT SLIDE SHOWS A BIT MORE
ABOUT WE EXPECT THIS DISEASE
RECONSTRUCTION PROCESS TO TELL
US, THAT IS THE AMP AIM PROGRAM
THAT WAS JUST RECENTLY LAUNCHED.
SO NOT ONLY WILL
INVESTIGATORRING BE STUDYING
CELL-CELL BEHAVIORIAL
INTERACTIONS THEYAL ALSO MAP THE
PHYSICAL INTERACTIONS AND DEFINE
HOW CELLULAR AND MOLECULAR
PATHOLOGIES ARE SHARED ACROSS
DISEASES AND TISSUES.
THIS KNOWLEDGE WILL ADVANCE OUR
UNDERSTANDING OF HOW CELL-CELL
INTERACTIONS ACTIVATE DISEASE
CAUSING MECHANISMS AND
ACCELERATE THE DISCOVERY OF NEW
MEDIATORS OF DISEASES.
AT A SYSTEMS BIOLOGY LEVEL,
RESEARCH WILL USE THESE FINDINGS
AS A FOUNDATION UPON WHICH THEY
CAN IMPOSSIBLE TO BUILD GREAT
EPIGENETIC AND GENOMIC STUDIES
TO IDENTIFY TARGET MOLECULES IN
DISEASE CAUSING PATHWAYS.
NEXT SLIDE.
SO NOT ONLY DOES IT EXPAND THE
R. A. AND LUPUS STUDIES BUT IT
ALSO STUDIES SORTING
SIGNALSIATRIC AND SJOGREN'S
DISEASE, AND THAT IS
PARTICULARLY STRIKING FOR LUPUS
AND SJOGREN'S DISEASE.
A UNIQUE AIM WILL BE NOT ONLY
THEY STUDY THESE CONDITIONS
INDIVIDUALLY BUT THEY WILL ALSO
STRIVE TO DISCOVER SHARED
PATHOLOGIC MECHANISMS.
THE NEXT SLIDE SHOWS AT A VERY
HIGH LEVEL THE TOOLS AND
PROCESSES THAT THE 4-AMP AIM
DISEASE CHAINS, THE 3 SYSTEMS
BIOLOGY AND TISSUE REPOSITORY
CORES AND THE 2 TECHNOLOGY CORES
WE'LL USE.
THE AWARDS WERE MADE IN MARCH OF
THIS YEAR AND AT PRESENT
CONNECTICUT SORTIUM RESEARCHERS
ARE DEVELOPING THEIR INTEGRATED
RESEARCH PLAN.
ON THE OTHER SIDE I WANT TO
ACKNOWLEDGE THE MANY PARTNERS
SHOWN ON THIS SLIDE, INCLUDING
THE NIAID, THE NATIONAL INTUITY
OF CRANEIO AND DENTAL FACIAL
RESEARCH, THE NATIONAL EYE
INSTITUTE AND THE OFFICE OF
RESEARCH ON WOMEN'S HEALTH.
SO THESE ARE THE PARTNERS THAT
ARE SUPPORTING AMP AIM.
AND THERE'S A BROADER SET OF
PARTNERS THAT SUPPORTING OTHER
AMP PROGRAMS AS A MENTIONED AT
THE OUTSET.
THE NEXT SLIDE, HIGHLIGHTS THE
NEW PARTNERSHIP BETWEEN ORWH AND
NIAIMS.
DR. CLAYTON AND I ANNOUNCED THIS
NEW OPPORTUNITY LAST MONTH AT
THE ACCEPT NIAIMS ADVISORY
COUNCIL MEETING.
OUR GOAL IS TO TO DEDICATE WOMEN
HEALTH RESEARCH BY TRAINING
INVESTIGATORS IN THE SKILLS OF
TEAM, SCIENCE, LEADERSHIP AND
MENTORING.
LEVERAGING THE INFRASTRUCTURE OF
THE AMP AIM PROGRAM.
ONE LESSON LEARNED FROM THE AMP
R. A. LUPUS PROGRAM IS THE
IMPORTANCE IT PLAYED IN THE
CAREERS OF LESS ESTABLISHED
VRLGTS.
SO WE WANTED TO CAPITALIZE ON
RELATED OPPORTUNITIES THWARTED
BY AMP AIM.
THE NEXT SLIDE SHOWS OW NIAM'S
AND SHARED INTEREST IN WOMEN'S
HEALTH RESEARCH AND CAREER
DEVELOPMENT INTERSECT TO PROVIDE
AN ENVIRONMENT WHERE
INVESTIGATORS CAN GAIN
LEADERSHIP AND MENTORING
EXPERIENCE AS WELL AS LEARN TO
DEAL EFFECTIVELY WITH THE
COMPLEXITY OF BIG TEAM BASED
PROJECTS.
WE ENVISION THIS NEW PROGRAM
TARGETING MIDCAREER
INVESTIGATORS WHO AT A CAREER
STAGE HAD THE POTENTIAL MAKING
INNOVATIVE DISCOVERIES AND
CONNECTIONS BETWEEN IDEAS IS
HIGH.
I'M HAPPY TO ANNOUNCE THAT SINCE
THE PROGRAM'S LAUNCH, THE NIH
OFFICE OF DATA SCIENCE STRATEGY
HAS ENTHUSIASTICALLY AGREED TO
CONTRIBUTE FUNDS SOPHISTICATEDY
THAT WE CAN SUPPORT AN
ADDITIONAL PARTICIPANT.
AS SHOWN ON THE NEXT SLIDE, THE
PROGRAMS OVERALL GOAL IS TO
DEVELOP A CO SHORT OF WOMEN'S
HEALTH SCIENTISTS WHO CAN LEAD
HIGHLY COMPLEX, HIGH IMPACT
RESEARCH PROGRAMS IN ACADEMIA,
INDUSTRY, AND THE PUBLIC HEALTH
SECTORS.
IT WILL IMPROVE THE HEALTH OF
WOMEN BY SUPPORTING SCHOLARS WHO
SPECIALIZE IN WOMEN'S HEALTH
STUDIES IN AUTOIMMUNITY AND
IMMUNE RELATED DISEASES AND IN
RELATED SCIENTIFIC AND CLINICAL
TOPICS.
SCHOLARS WILL INTEGRATE THE WORK
WITH THE AMP AIM NETWORK WITH
THE SCIENTIFIC GOALS.
SO THE PROGRESS WILL ADDRESS
IMPORTANT SCIENTIFIC QUESTIONS
THAT ENHANCE AMP AIM'S RESEARCH
AND IMPACT AND THE PROJECT
SHOULD BENEFIT FROM THE
INVESTIGATORS INFRASTRUCTURE
CLINICAL INFORMATION, SAMPLES
AND DATA THAT AMP AIM IS
COLLECTING BUT SOME ALSO BRING A
UNIQUE QUESTION, APPROACH OR
OPPORTUNITY TO THE AMP AIM
NETWORK.
THESE NEW SCIENTIFIC QUESTIONS
AND,A PROACHS INCLUDING DATA
SCIENCE OPPORTUNITIES SHOULD
LEVERAGE AMP AIM INFRASTRUCTURE,
SAMPLES, COHORTS OR DATA TO
FURTHER ADVANCE OUTCOMES FOR
PEOPLE WITH AUTOIMMUNE AND
IMMUNE MEDIATED DISEASES.
THE SCHOLARS WILL DEVELOP TEEM
AND SKILLS SCIENCE THROUGH
IMMESSIVE CROSS SECTIONAL
COLLABORATIVE EXPERIENCES TO
ENABLE THEM TO BYE-BYE EFFECTIVE
LEADERS OF LARGE CONSORTIA AND
THEY WILL ENHANCE LEADERSHIP AND
MENTORSHIP EXPERIENCE BY
EXPANDING NETWORKS BEYOND THEIR
CURRENT PLACE OF EMPLOYMENT
ALLOWING THEM TO SERVE AS
EFFECTIVE MENTORS FOR FUTURE
GENERATIONS OF TEAM SCIENTISTS
WHO ARE FOCUSED ON IMPROVING
WOMEN'S HEALTH.
ON THE NEXT SLIDE, SO SOON WE
WILL INITIATE THE NATIONAL
SEARCH FOR OUR INITIAL COHORT OF
SCHOLARS.
AND WE'RE EXPECTING TO ENROLL 4
OR 5 SCHOLARS AND SUPPORTING
THEM FOR A PERIOD OF 2-3 YEARS.
WE ARE EXTREMELY GRATEFUL TO
ORWH FOR FUND THANKSGIVING PILOT
PROJECT AND I ALSO WANT TO
ACKNOWLEDGE THE WORK OF DR. LISA
BEG AT ORWH AND
DR. [INDISCERNIBLE] FOR THEIR
EFFORTS TO MAKE THIS PROGRAM A
REALITY AND I'M ALSO GREAT TOFUL
DR. SUSAN GOOD WHAT WHO IS THE
DIRECTOR OF ODSS FOR HER
ENTHUSIASTIC SUPPORT OF THEIR
PILOT PROGRAM.
AND ON THE NEXT SLIDE, I WOULD
LIKE TO THANK YOU ALL FOR YOUR
INTEREST IN HOW THE NIERK H CAN
ACCELERATE WOMEN'S HEALTH
RESEARCH AND ALLOW ALL AMERICANS
TO BENEFIT FROM OUR NATION'S
INVESTMENT IN BIOMEDICAL
RESEARCH AND IF THERE'S TIME, I
WOULD BE HAPPY TO TAKE ANY
QUESTIONS.
>>THANK YOU SO MUCH
DR. CRISWELL, FOR DESCRIBING
OWSH EXCITING PARTNERSHIP.
IT WAS MY DELIGHT FOR JOINING
YOU AT YOUR COUNSELS AND I WILL
THANK YOU FOR JOINING ME HERE.
ARE THERE QUESTIONS FROM THE
COMMITTEE MEMBERS OR COMMENTS?
WE LEARNLY WELCOME YOUR
FEEDBACK.
--CERTAINLY WELCOME YOUR
FEEDBACK.
LET ME GIVE THEM A MOMENT
BECAUSE THEY ARE NOT SHY.
IT IS SIGHTING TO SEE THE WORK
IN THE SJORGREN'S SPACE, IT
SOMETIMES GETS FORGOTTEN, IT'S
NOT 1 OF THE BIG AUTOIMMUNE
DISEASES BUT IT RESULTS IN MUCH
PAIN DISCOMFORT AND DISABILITY
AND POOR KAWLT OF LIFE FOR
INDIVIDUALS THAT ARE AFFECTED.
LET'S TAKE A LOOK.
--SUFFERING FROM THIS DISEASE
AND RESEARCH IN THIS AREA HAS
REALLY FALLEN BEHIND MANY OTHER
AUTOIMMUNE DISEASES SO I WAS SO
PLEASED TO SEE ITS INCLUSION IN
THIS NEW ITERATION OF THE
PROGRAM.
>>ABSOLUTELY.
ABSOLUTELY.
MAYBE I WILL JUST ASK A QUESTION
AS WE MOVE FORWARD HERE
DR. CRISWELL, YOU HIGHLIGHTED SO
NICELY THE PARTNERSHIPS THAT ARE
INTEGRAL TO AMP AND HOW
IMPORTANT THAT IS, MIGHT YOU
COMMENT ON KIND OF YOUR
PERSPECTIVE ON PARTNERSHIPS
GENERALLY AND HOW WE CAN TAKE
THEM TO THE NEXT LEVEL TO
ADVANCE RESEARCH, WHAT ARE YOUR
THOUGHTS?
>>YES, I GUESS I WILL START BY
SAYING THAT COLLABORATION AND
ULTIMATELY TEAM SCIENCE HAS BEEN
A VERY PROMINENT THEME OF MY
CAREER.
I THINK INCREASINGLY IN ORDER TO
ADDRESS THE CHALLENGING PROBLEMS
THAT WE FACE RELATED TO THE
HEALTH OF OUR COMMUNITY WE
ABSOLUTELY HAVE TO FOCUS ON TEAM
EFFORT AND COLLABORATIVE
RESEARCH.
NO 1 PERSON OR TEAM OR
INSTITUTION HAS ALL OF THE
REQUISITE IDEAS, RESOURCES, AND
PEOPLE TO EFFECTIVELY SOLVE
THESE PROBLEMS AND YOU KNOW THIS
GOES WELL BEYOND KIND OF
COLLABORATIONS IN TERMS OF
DIVERSITY OF SCIENCE, BUT AS YOU
POINTED OUT, THE PERSPECTIVES
THAT VOLUNTARY ORGANIZATIONS
BRING, THAT INDUSTRY PARTNERS
BRING, THEY PLAY A VERY
IMPORTANT ROLE IN THE
DEVELOPMENT OF NEW THERAPIES, OF
COURSE FOR THE PROBLEMS THAT WE
FACE, SO, NOW, HAVING SAID THAT,
THESE PARTNERSHIPS ARE
COMPLICATED AND THEY CAN BE
CHALLENGING TO DEVELOP, TO
COORDINATE, AND TO CONDUCT
SUCCESSFULLY AND IN THE CASE OF
AMP WHICH I AM NOW INCREASING LE
HOLDING UP AS A MODEL AND
SHINING STAR FOR HOW TO DO
COLLABORATIVE PUBLIC PRIVATE
PARTNERSHIP EFFORTS, I THINK THE
FOUNDATION FOR THE NIH HAS
PLAYED A CRITICAL ROLE IN YOU
KNOW BRINGING TOGETHER
INTERACTING WITH INDUSTRY
PARTNERS, UNDERSTANDING THEIR
GOALS, WHAT THEY CAN CONTRIBUTE
AND CONNECTING THEM WITH VARIOUS
INSTITUTES AND CENTERS AND
ACADEMIC INSTITUTIONS AROUND THE
COUNTRY SO THEY HAVE PLAYED A
REALLY CRITICAL ROLE IN MAKING
THIS EFFORT SUCCESSFUL AND THE
LAST PIECE OF THIS I WOULD LIKE
TO SHARE IS INCREASINGLY WE'RE
ALL RECOGNIZING THAT IT'S
ESSENTIAL TO INCLUDE NOT ONLY
PATIENT VOLUNTARY ORGANIZATIONS
BUT THE PATIENTS PERSPECTIVES,
THE PATIENTS THEMSELVES.
AND DR. CLAYTON AND OTHERS
YOU'RE PROBABLY WELL AWARE OF
THE MANY CONVERSATIONS ACROSS
THE NIH AND THE COUNTRY ABOUT
THE IMPORTANCE OF PATIENT
ENGAINLMENT AND UNDERSTANDING
THE PATIENT'S PERSPECTIVE AND I
THINK THAT'S ANOTHER DIMENSION
AND ELEMENT THAT I'M EAGER TO
SEE EXPANDED AS PART OF AMP
PROJECTS AND MORE GENERALLY AS
WE MOVE FORWARD PLANNING
RESEARCH TO SOLVE OUR CURRENT
PROBLEMS.
>>THANK YOU SO MUCH
DR. CRISWELL, MAB I WILL TAKE
ADVANTAGE OF YOU BEING WITH US
AND ASK MAYBE JUST 1 MORE
QUESTION ABOUT, IT'S BEEN GREAT
TO GET TO KNOW YOU AND WE'VE HAD
OUR CONVERSATIONS ABOUT THE
FUTURE OF WOMEN'S HEALTH
RESEARCH IN THE CONTEXT OF
NIAIMS MISSION AND YOUR VISION
FOR NIAMS GOING FORWARD AS YOU
ARE LEADING THIS INSTITUTE GOING
FORWARD, THERE'S SO MANY
DISEASES AND CONDITIONS,
VIRTUALLY EVERY 1 OF YOUR AREAS
IS A HEALTH RESEARCH FOR WOMEN'S
TOPIC.
HOW DO YOU WOMEN'S HEALTH BEING
INCORPORATED GOING FORWARD UNDER
YOUR LEADERSHIP.
>>WELL, AS YOU POINTED OUT,
IT'S A FUNDAMENTAL ASPECT OF OUR
WORK.
I MEAN, THE AUTOIMMUNE DISEASES,
ALMOST WITHOUT EXCEPTION, OTHER
CONDITIONS SUCH AS
OSTEOARTHRITIS EXHIBIT, YOU KNOW
GENDER AND SEX DIFFERENCES THAT
HAVE BEEN UNDERAPPRECIATED AND
CERTAINLY NOT FULLY EXPLORED AND
NOT YET FULLY UNDERSTOOD SO A
PARTNERSHIP WITH ORWH AND WILL
BE ABSOLUTELY CRITICAL TO OUR
SUCCESS AND I'M REALLY DELIGHTED
THAT YOU KNOW WE CAN LEVERAGE
THE EFFORTS OF YOUR STRATEGIC
PROCESS, NOW THAT WE'RE
INITIATING OURS AND WE
IDENTIFIED MANY WAYS IN WHICH WE
INTERSECT AND INCREASING
LOAMACYY WE SHOULD BE THINKING
OF EACH OTHER AS VERY
ENTHUSIASTIC PARTNERS TO HELP
SUPPORT OUR RESPECTIVE EFFORTS,
AND WE'RE SO GRATEFUL YOU
REACHED OUT WITH THIS PARTICULAR
OPPORTUNITY AND I THINK IT
ADDRESSES AN UNUSUAL NICHE WHICH
IS TRAINING WOMEN IN LEADERSHIP
ROLES IN TEAM SCIENCE, IT'S A
REALLY IMPORTANT ELEMENT THAT
HASN'T BEEN SPECIFICALLY
ADDRESSED BY OTHER PROGRAMS AND
MORE GENERALLY IN EMERGING ITS
OF PRIORITIES FOR NIAMS, AND AS
I SHARED LENIENTLY AT A MEETING
OF THE INSTITUTE CENTERS AND
DIRECTORS, I THINK THAT IF WE
THINK INCREASINGLY ABOUT
RESEARCH ECOSYSTEMS, THAT ARE BY
NECESSITY MULTIFACTORIAL WITH
DIFFERENT PERSPECTIVES,
SCIENTIFICALLY, DIFFERENT TYPES
OF DATA FROM OMICS TO SOCIAL
DETERMINANTS OF HEALTH, TO
PATIENT REPORTED OUTCOMES,
DIFFERENT--OR IMPORTANT SYSTEMS
BIOLOGY PERSPECTIVE WITH EFFORTS
TO INTEGRATE ALL OF THESE
DIFFERENT DATA TYPES AND THEN
IMPORTANTLY MAKE THE DATA
AVAILABLE TO THE REST OF THE
RESEARCH COMMUNITY AND ALONG
THOSE LINES I FULLY SUPPORT THE
NEW NIH DATA SHARING AND
MANAGEMENT PLANS WHICH ALTHOUGH,
YOU KNOW THEY WILL BE
CHALLENGING AND REQUIRE CULTURAL
CHANGE IN THE BROADER COMMUNITY
ABSOLUTELY ESSENTIAL FOR US TO
MAXIMIZE THE BENEFIT OF OUR
RESPECTIVE RESEARCH EFFORTS.
SO I'M FULLY SUPPORTIVE AND THAT
HAS BEEN AN IMPORTANT GOAL FOR
THE AMP PROGRAMS SINCE ITS
INCEPTION.
IT LOOKS LIKE THERE MAY BE A
QUESTION HERE.
>>THERE IS, DR. JONES, THANK
YOU SO MUCH FOR BEING WITH US, 1
OF OUR NEW MEMBERS.
>>THANK YOU SO MUCH FOR HAVING
ME AND THARVEG YOU DR. CRISWELL
FOR A REALLY GREAT PRESENTATION
AND INFORMATIVE AND I WAS
WONDERING IF YOU WOULD CARE TO
COMMENT ON HOW OR WHAT ARE THE
EFFORTS TO HELP SCIENTISTS
TRANSLATE AND COMMUNICATE AND
EDUCATE OUR POLICY MAKERS
BECAUSE I KNOW WHEN I WEPT TO
SCHOOL, NOBODY SHOWED ME HOW TO
DO THAT AND THAT IS--IT SEEMS TO
BE MORE AND MORE SO IMPORTANT
TAKEN--THEY WE ARE COMMUNICATING
PRACTICAL EVIDENCE-BASED
TRANSLATABLE EASY TO UNDERSTAND
FINDINGS FROM OUR RESEARCH.
SO WOULD LOVE TO HEAR YOUR
COMMENTS ON THAT.
THANK YOU.
>>WOW, I WISH I HAD A STRAIGHT
FORWARD ANSWER TO THAT QUESTION,
THAT'S AN INCREDIBLE LOAMACYY
IMPORTANT ISSUE AND OF COURSE,
YOU KNOW SOME OF THE
COMMUNICATION AND MISCOMMUNE
KAITIONZ OR MISUNDERSTANDINGS
THAT WE'RE SO PROMINENT AND
VISIBLE IN THE CONTEXT OF THE
LAST 2 YEARS AND THE COVID
PANDEMIC HIGHLIGHTED HOW
IMPORTANT THAT IS.
AND THE FIRST THING I WILL SAY
ABOUT THAT IS I HOPE THAT WHAT
WE OBSERVED OVER THE LAST COUPLE
OF YEARS, DID SNOT DISCOURAGE
YOUNG PEOPLE FROM PURSUING
CAREERS IN MEDICINE AND SCIENCE.
AND SOME OF YOU MAY BE AWARE
THAT DR. TONY FAUCI, WHO WILL BE
STEPPING DOWN FROM HIS NIH
LEADERSHIP ROLES AT THE END OF
THIS CALENDAR YEAR PLANS TO
FOCUS O THAT WITH 100% OF HIS
EFFORT ANDENERGY.
HE THINK IT'S A VERY IMPORTANT
AREA TO RESEARCH.
BUT MOOT ME SAY, THAT'S NOT
SOMETHING WE RECEIVE TRAINING IN
AND I THINK THAT'S WHERE
MENTORING COMES INTO PLAY AND
IT'S NOT SIMPLY YOUR SINGLE
PRIMARY MENTOR.
YOU CAN'T LOOK TO THAT PERSON TO
PROVIDE ALL OF THESE KIND OF
LIFE SKILLS THAT WE NEED TO BE
SUBASSESSESFUL RESEARCHERS AND
COMMUNICATORS BUT WE NEED TO BE
THINKING ABOUT MENTORING TEAMS,
CREATING SUPPORTIVE MENTORING
ENVIRONMENTS AND THEN LASTLY
THAT COMMUNICATION FOR THE
POLICY PIECE.
THERE IS A PROPOSED NEW COMMON
FUND EFFORT THAT WILL FOCUS ON
HEALTH OF INFORMATION
COMMUNICATION THAT MIGHT TOUCH
UPON THAT.
I'M NOT AWARE OF SPECIFIC PLANS
TO DEVELOP PROGRAMS ALONG THOSE
LINES BUT THERE CERTAINLY IS
RECOGNITION THAT'S CRITICALLY
IMPORTANT AND YOU MAY BE AWARE
THAT ALL OF THE INSTITUTES AND
CENTERS WORK WITH SPECIALISTS
WITHIN OUR INSTITUTES THAT HELP
US UNDERSTAND HOW BEST TO
COMMUNICATE TO POLICY MAKERS,
HOW TO UNDERSTAND WHAT WILL
RESONATE WITH THEM, YOU KNOW AND
HOW TO BE VERY CAREFUL POINTED
AND EFFECTIVE WITH OUR
COMMUNICATION.
SO THAT'S BEEN 1 OF THE THINGS I
FOUND MOST INTERESTING IN MY
ROLE, BUT OF COURSE, THAT
IS--THAT IS SUPPORT ASK
EXPERTISE THAT NOT ALL
RESEARCHERS AND SCIENTISTS HAVE
ACCESS TO, BUT YOU KNOW PERHAPS
DR. CLAYTON OR I SEE DR. WOYCHIK
CAN ADD TO COMMENTS ON THAT
IMPORTANT TOPIC.
>>THANKS SO MUCH FOR THAT GREAT
QUESTION DR. JONES.
CLEARLY AN IMPORTANT PART OF
WHAT WE DO ALL AS SCIENTISTS AS
PART OF THE RESEARCH ECOSYSTEM
IS IT BEING ABLE TO PLAIN WHAT
WE'RE DOING AND WHY WE DO IT TO
A BROAD AUDIENCE AND AS
DR. CRISWELL MENTIONED WE
INTERNALLY WORK WITH SPECIALISTS
THAT DO THAT AND I PERSONALLY
PAY CLOSE ATTENTION TO THE
COMMUNICATION THAT ORWL PUTS OUT
TO INSURE THAT IT'S IN AS PLAIN
LANGUAGE AS POSSIBLE BUT YOU
ASKED ABOUT SCIENTISTS AND THEIR
EDUCATION AND SO I THINK THIS IS
A GREAT EXAMPLE OF AN
OPPORTUNITY FOR MORE
COLLABORATION BETWEEN NIH AND
ACADEMIC INSTITUTIONS TO INSURE
THAT THOSE SCIENTISTS OF THE
FUTURE ARE GETTING THE EDUCATION
THEY NEED, TRAINING, MENTORING
CAREER DEVELOPMENT AS
DR. RCRISWELL MENTIONED AT THE
HIGHEST LEVEL AND SHARE SCIENCE
WITH ANY AUDIENCE TO PLAIN WHY
SCIENCE IS IMPORTANT BECAUSE THE
FUTURE OF SOCIETY, YOU KNOW,
FROM OUR PERSPECTIVE, DEPENDS ON
SCIENTIFIC SOLUTIONS AS PART OF
THE EQUATION, NOT THE WHOLE
EQUAWGZ BUT PART OF THE
EQUATION, AND SO, I THINK
THROUGH K12 AND OTHER EFFORTS
THEY MAY BE OPPORTUNITIES TO
IMPROVE THAT.
I DO KNOW THAT RESEARCH AMERICA
HAS A SPECIFIC FELLOWSHIP ON
SCIENCE COMMUNICATION AND SO
THAT MIGHT BE SOMETHING THAT YOU
MIGHT WANT TO LOOK INTO.
I AM NOT AWARE OF OTHER
SOCIETIES OR ASSOCIATIONS THAT
DO, THEY MAY, I'M JUST NOT AWARE
OF THEM BUT THAT ALSO SHOWS THAT
THE ECOSYSTEM, THE RESEARCH
ECOSYSTEM INCLUDES SO MANY
DIFFERENT STAKEHOLDERS.
AND SCIENCE COMMUNICATION IS
SOMETHING THAT IS IMPORTANT TO
ALL OF US AND SO IN ORDER FOR US
TO BE ABLE TO HAVE THE MOST
ROBUST RETURNOT INVESTMENTS,
WE'RE ALL MAKING THESE ARE
PUBLICLY FUNDED RESEARCH AND ALL
INVESTMENTS WE WANT TO MAKE SURE
THAT INFORMATION'S REPORTED.
I SHOWED A SLIDE ON THE PROJECT
OUTCOMES SECTION OF THE FINAL
PROGRESS REPORT, THAT IS PART OF
THAT SECTION, THE PROJECT
OUTCOMES HAS TO BE WRITTEN IN
PLAIN LANGUAGE AND IS AVAILABLE
TO THE PUBLIC.
AND THAT'S WHY IT'S SO IMPORTANT
FOR THEM TO UNDERSTAND OUR
INVESTIGATORS THAT THEY NEED TO
BE ABLE TO CONVEY FOR EXAMPLE,
WHAT THE DIFFERENCES WERE, VALID
ANALYSIS, NOT NECESSARILY
STATISTICAL, VALID ANALYSIS FOR
SEX OR GENDER, RACE OR ETHNICITY
FOR PHASE 3 CLINICAL TRIALS,
WHICH ARE THOSE TRIALS THAT
REALLY INFORM TREATMENT
DECISIONS.
SO THANK YOU SO MUCH FOR THAT
QUESTION.
WITH THAT--
>>DR. JANINE, IF I CAN MAKE A
COMMENT HERE.
>>YES.
>>IT HAS TO BE A PRIORITY FOR
SCIENTISTS TO LEARN HOW TO SPEAK
TO NONSCIENTIFIC AUDIENCES.
AND WHILE WE'VE NEVER BEEN
TRAINED TO DO THIS AND A
PRESENTATION TO CONGRESSIONAL
BREFFING OR A PRESENTATION TO A
LAY AUDIENCE, IS JUST VERY
DIFFERENT THAN A PRESENTATION TO
A SCIENTIFIC AUDIENCE.
SO LEARNING HOW TO DO THAT AND
LEARNING HOW TO CONVEY COMPLEX
SCIENTIFIC MESSAGES BUT IN THE
CONTEXT OF KEEPING ALL THE
SCIENCE, THE SUBSTANCE OF THE
SCIENCE WITHOUT THE JARGON IS A
REAL CHALLENGE.
SO LEARNING HO YOU TO DO THIS
IS, IT JUST HAS TO BE A
PRIORITY.
>>DR. TEMPLE TON WOULD YOU LIKE
TO MAKE ANOTHER COMMENT BEFORE
WE MOVE ON?
>>JUST REFLECTING ON WHAT I PUT
IN THE CHAT, I COMPLETELY AGREE
WITH THIS, SO I INITIALLY WORKED
WITH THE AMERICAN ACADEMY OF
ORTHOPEDIC SURGEONS TO DEVELOP
THE WASHINGTON HAD HEGHT POLICY
FELLOWSHIP AND THAT'S WHERE
RESIDENTS WOULD SPEND 6 WEEKS
DURING AN ACADEMIC YEAR WORKING
ON POLICY AND HOW TO COMMUNICATE
WITH POLICY MAKERS CROSS
LINKINGY PART OF THE TIME IS
SPENT IN YOUR WASHINGTON D. C.
OFFICE AND THEY SPEND A LOT OF
TIME ON CAPITAL HILL, I
DEVELOPED THEN SOMETHING SIMILAR
FOR A MEDICAL SCHOOL WHERE
MEDICAL STUDENTS WOULD SPEND 1
OF THEIR ELECT LIVE ROTATIONS IN
TOPEKA KANSAS WORKING WITH THE
STATE MEDICAL SOCIETY AND
WORKING WITH THE CAPITAL, AGAIN
LEARNING HOW TO COMMUNICATE WITH
POLICY MAKERS, SO BOG THE
ELECTIVE IS STILL EXISTENT
ALTHOUGH IT'S HARD TO GET
STUDENTS TO DO IT BECAUSE THEY
DON'T WANT TO BE AWAY FROM HOME.
THE AOS POLICY WAS AROUND FOR
MANY YEARS AFTER I WAS NO LONGER
LEADING THIS BUT UNFORTUNATELY
IT WENT AWAY BECAUSE OF LACK OF
FUNDING.
BUT PERHAPS SOMETHING SIMILAR TO
THIS WHERE YOU HAVE THOSE ININ
TRANSLATIONAL RESEARCHING SO YOU
CATCH THEM EARLY BUT STILL LATE
ENOUGH IN THE PROCESS THEY KNOW
WHAT THEY'RE TALKING ABOUT.
BUT WITH SUPERVISION FROM BOTH
THE HEALTHCARE PROFESSIONAL AND
SCIENCE SIDE BUT THEN SUPER
VISION FROM THE HEALTH POLICY
SIDE TO HELP THEM UNDERSTAND
THIS BETTER AND HAVE THIS BE
PART OF WHAT IT IS THAT THEY DO
AND PART OF THEIR LEXICON.
>>JUST ANOTHER QUICK COMMENT IS
THAT IF YOU'RE INTERESTED IN
SCIENCE COMMUNICATION, ALAN
ALDA, HAS TAKEN ON AS SCIENCE
COMMUNICATION IN A REALLY BIG
WAY, HE'S DOING THIS THROUGH
STONY BROOK UNIVERSITY, SO DO A
GOOGLE SEARCH ON ALAN ALDA, AND
IF YOU EVER LISTEN TO SCIENCE
FRIDAY, HIS PODCAST AS I DO, HE
WAS ON IT AND TALKED ABOUT THE
REALLY IMPORTANT THINGS THAT
NEED TO--REALLY IMPORTANT
STRATEGIES THAT SCIENTISTS NEED
TO TAKE TO COMMUNICATE THEIR
RESEARCH RESULTS.
>>THANKS FOR MENTIONING THAT
RICK, AND I FORGOT TO MENTION
TRIP AAAS, AND SO GREAT QUESTION
DR. JONES, SEE YOU ALREADY ARE
SHOWING US THAT WE MIDA GREAT
CHOICE WITH INCLUDING YOU AS A
NEW MEMBER OF THE GROUP, SO WE
ARE THINKING OF THING WE NEED TO
THINK OF.
AND WITH THAT I WANT TO THANK
DR. CRISWELL, PER JOINING US AND
PARTNERING WITH US AND LOOK
FORWARD TO BRINGING HER BACK TO
SHOW YOU THE GREAT RESULTS WE
GET IN SOME TIME.
SO THANK YOU LINDE FOR JOINING
US--LINDE FOR JOINING US TODAY,
WE APPRECIATE THAT.
>>MY PLEASURE, THANK YOU SO
MUCH.
>>ABSOLUTELY.
AND NOW WE HAVE THE PRIVILEGE OF
MOVING FORWARD WITH DR. RICK
WOYCHIK, I WOULD LIKE TO
INTRODUCE THE NEWEST DIRECTOR OF
NIEHS, WE WAS NAMED DIRECTOR IN
TWEBT 20 AND HE'S ALSO DIRECTOR
OF THE NATIONAL TOXICOLOGY
PROGRAM WITH RELATES TO DHHS
REPORTS, RELATES TO DHHS AT
TOXICOLOGY RESEARCH, AMONG
NIEHS, THE NATIONAL CENTER FOR
TOXICOLOGICAL RESEARCH AT FDA,
AND SOME CDC AREAS AS WELL.
SO HE'S GOT A BIG, BIG JOB
THERE, HE CAME TO NIH IN 2010
WHEN HE WAS NAMED DEPUTY
DIRECTOR OF NIEHS, BUT BEFORE
THAT, HE IS A MOLECULAR
GENETICIST WITH A Ph.D. IN
MOLECULAR BIOLOGY FROM CASE
WESTERN RESERVE UNIVERSITY AND
NEEDED HIS POST DOC WITH THE
LEADER AT HARVARD MEDICAL
SCHOOL.
HE SPENT 10 YEARS AT THE
ECOSYSTEMS RIDGE NATIONAL
LABORATORY AND WAS VICE CHAIR AT
PEDIATRICS IN CASE WESTERN AND
WORKED IN PHARMA FOR MANY YEARS
AS WELL AND THEN WAS A CEO OF
THE JACKSON LABS BEFORE HE CAME
TO NIEHS.
SO HE'S DISCOVERED MANY THINGS
I'LL JUST MENTION THE CANNED
WHAT AS 1 OF HIS LANDMARK
CONTRIBUTIONS IN THE FIELD OF
ENVIRONMENT WILL EPIGENETICS AND
MAMMALIAN GENETICS SO WITH THAT
DR. WOYCHIK, WE'RE DELIGHTED TO
HAVE YOU HERE TODAY.
SNR TEROFFIC.
OKAY, LET ME SEE MY SLIDES ARE
UP, THANK YOU FOR SHARING YOUR
SCREEN.
CAN EVERYONE HEAR ME OKAY, I
DON'T WANT TO START MY LECTURE
AND NO 1 CAN HEAR ME.
>>WE CAN HEAR YOU.
>>TERRIFIC.
LET ME JUST SAY FIRST OF ALL
THAT IT'S JUST WONDERFUL TO BE
HERE WITH YOU THIS MORNING AND
THANKS DR. CLAYTON FOR THIS
OPPORTUNITY TO PRESENT THE WORK
AND I WILL FOCUS ON TALKING
ABOUT SOME OF THE ISSUES
RELATING TO HOW CLIMATE CHANGE
AFFECTS WOMEN'S HEALTH WHICH IS
WHAT I INTEND TO DO AND IN THE
EXCHANGE YOU HAD WITH
DR. CRISWELL, IT'S A HIGHLY
COLLABORATIVE PROGRAM, THE
COLLABORATED ACROSS ALL OF NIH
AND OTHER HHS AGENCIES IT HAS TO
BE BECAUSE IT'S A BIG PROBLEM.
BUT I THOUGHT I WOULD ALSO TACK
A FEW MINUTES AND TALK ABOUT THE
WORK WE DO AT NIEHS, SO I HOPE
YOU DON'T MIND IF I DO THAT JUST
TO MAKE SURE THAT YOU AND STAFF
AT THE OFFICE OF RESEARCH AND
WOMEN'S HEALTH ARE FULLY AWARE
OF THE BROAD SPECTRUM OF
DIFFERENT THINGS WE DO AT NIEHS,
SO LET'S GO TO THE NEXT SLIDE,
PLEASE.
SO IN THIS DISCUSSION ABOUT
NIEHS, I WILL JUST SAY RIGHT UP
FRONT WHAT DIFFERENTIATES US
FROM THE 26 OTHERS ICs, AND
CENTERS AND OFFICES, ACROSS THE
NIH, OUR MISSION AND OUR VISION.
SO OUR MISSION IS TO DISCOVER
HOW THE ENVIRONMENT AFFECTS
PEOPLE IN ORDER TO PROMOTE
HEALTHIER LIVES, AND OUR VISION
IS TO PROVIDE GLOBAL LEADERSHIP
FOR INNOVATIVE RESEARCH FOR
PUBLIC HEALTH BY VERMEN INFECTED
VENTING DISEASE AND DISABILITY.
SO THE 2 ELEMENTS OF THE VISION
I WANT TO EMPHASIZE ARE THE
INNOVATION AND THE PREVENTION.
SO IN, IEHS AIMS TO PROVIDE AS
THE DEFINITIVE GLOBAL AND HEALTH
SCIENCENESS COMMUNITY AND WE
WANT TO PROMOTE THE TYPE OF
INNOVATIVE THINKING THAT WILL
KIEP THE ENVIRONMENTAL HEALTH
SCIENCES COMMUNITY AT THE
CUTTING EDGE OF ADVANCING HUMAN
HEALTH.
SO ADDITIONALLY AND PROBABLY
MOST IMPORTANT THE PRIMARY
PHOBEUS OF THE WORK AT NIEHS IS
ON THE PREVENTION OF ADVERSE
HEALTH EFFECTS.
SOPHISTICATEDY WE AIM TO DO THIS
CAREFULLY BY STUDYING THE
ENVIRONMENT AND FACTORS WITH THE
ENVIRONMENT THAT CAN NEGATIVELY,
YOU SHOULD THE TOXICOLOGY
FRAMEWORK BUT ALSO POSITIVELY
IMPACT HUMAN HEALTH SO IT'S
ABOUT BOTH OF THESE DIFFERENT
THINGS.
SO NEXT SLIDE; SO WHOOPS LET'S
GO BACK.
THERE WE ARE SO TO HELP YOU
UNDERSTAND WHAT WE DO AT NIEHS,
AGAIN I WILL BE RELATIVELY BRIEF
ON THIS I WANT TOUC ABOUT OUR
STRATEGIC PLAN, THERE ARE 3
THEMES OF OUR STRATEGIC PLAN AND
THE FIRST PLAN IS ABOUT
ADVANCING HEALTH SCIENCES AND IT
IS A BIG THEME AND INVOLVES
STUDYING HOW ENVIRONMENTAL
EXPOSURES IMPACT ALL LEVELS
BIOLOGICAL ORGANIZATION FROM THE
MOLECULAR AND BIOCHEMICAL
PATHWAY TO THE CELLULAR TISSUE
ORGAN, YOU KNOW SYSTEM SYSTEM
BASED MODEL ORGANISMS AT THE
INDIVIDUAL AND THE POPULATION
LEVELS.
AND WE ARE DOING THIS AT ALL
STAGES ACROSS THE LIFE SPAN FROM
PRECONCEPTION THROUGH OLD AGE.
SO IT'S A BIG THEME AND WE DO A
LOT OF WORK AND I WILL TALK MORE
SPECIFICALLY ABOUT THE WORK WE
DO AS IT RELATES TO WOMEN'S
HEALTH IN JUST A COUPLE OF
MINUTES.
SO THE SECOND THEME IS ABOUT
PROMOTING AND TRANSLATION, SO
DATA TO KNOWLEDGE TO ACTION.
SO THIS THEME RECOGNIZES THAT
THE VALUE OF ADVANCING HEALTH
SCIENCES CAN ONLY BE FULLY
REALIZED THROUGH THE TRANALATION
OF OUR SCIENCE SO IT CAN BE USED
BY THE PUBLIC, BY HEALTH
PROVIDERS, REGULATORS AND POLICY
MAKERS AND I'M HOPING THIS WILL
HELP TO INFORM THE DECISIONS
THEY MAKE.
SO IN THE CONTEXT OF OUR
DISCUSSION ABOUT COMMUNICATING
SCIENCE RESULTS, THIS SQUARELY
FITS WITHIN THE SECOND AIM OF
OUR STRATEGIC PLAN.
HOW DO WE COMMUNICATE THOSE
RESULTS IN A WAY THAT WE CAN
ACTUALLY HAVE AN IMPACT ON THE
HEALTH OF INDIVIDUALS WITHIN OUR
COMMUNITY.
I WILL TALK A BIT ABOUT THE WORK
THAT YOU'RE COSPONSORING WHICH I
WILL SPEAK ON IN A FEW MINUES.
SO THE THIRD THEME IS ADVANCING
SCIENCE THROUGH STEWARDSHIP AND
SUPPORT.
WE RECOGNIZE THAT THE SUCCESS OF
OUR MISSION REQUIRES THAT WE
CONTINUE TO PROVIDE STRONG
LEADERSHIP OF OUR HUMAN OR
FINANCIAL AND INSTRAY JECTORY
STRUCTURE RESOURCES.
SO INCLUDED IN THIS THIRD THEME
OF OUR PLAN IS ENGAGING
INVESTIGATORS FROM OUTSIDE
ENVIRONMENTAL HEALTH SCIENCES SO
THEY CAN BRING THEIR KNOWLEDGE
AND CAPABILITIES INTO THE
ENVIRONMENTAL HEALTH SCIENCES TO
HELP US ACHIEVE OUR MISSION.
SO HOPEFULLY YOU WILL RECOGNIZE
THAT WE DO TOXICOLOGY RESEARCH
AND I AS YOU'VE INDICATED
DR. CLAYTON THE DIRECTOR OF THE
NATIONAL TOXICOLOGY PROGRAM BUT
WE DO A LOT MORE THAN JUST
TOXICOLOGY SCIENCE AND WE WILL
UPDATE, BOY THE WAY I WANTED TO
COMMENT RELATIVE STRATEGIC
PLANS, WE WILL UPDATE OUR PLAN
THIS NEXT YEAR, SO STAY TUNED
WE'LL BE ISSUING AN RFI SOON AND
WILL BE WELCOMING ANY AND ALL
INPUT AS WE ABOUT FORWARD.
SO NEXT SLIDE.
TO GIVE YOU A SENSE OF THE
ENORMITY OF OUR CHALLENGE AND
STUDYING THE ENVIRONMENTS, SO
AGAIN, IT GOES WELL BEYOND JUST
TOXICOLOGY SCIENCE, OF COURSE WE
DO SOME TOXICOLOGY WORK, WE
DEFINE THE ENVIRONMENTAL
RESEARCH BROADLY TO INCLUDE A
WHOLE VARIETY OF DIFFERENT
ENVIRONMENTAL EXPOSURES THAT
YOU'RE SEEING ON THIS SLIDE.
SO THEY'RE ALL EXPOSURES THAT
CAN ULTIMATELY INFLUENCE HUMAN
HEALTH, WE SO STUDY CHEMICALS IN
PRODUCTS AND BUILDING MATERIALS,
WE STUDY PRODUCTS IN AIR, SOIL
AND WATER, AGRICULTURAL
CHEMICALS, WE STUDY SYNTHETIC
CHEMICALS PIF, AS, AND IT'S BEEN
IN THE NEWS RECEIPTLY AND IN
MANY OF YOU PROBABLY KNOW THESE
AS TEFLON AND SCOTCH GUARD.
YOU HAVE TO BE CAREFUL WHEN
YOU'RE SPRAYING YOUR HIKING
BOOTS WITH SCOTCH GUARD, YOU
DON'T WANT TO BROAGHT THAT
STUFF.
SO WE EVALUATE AND WE
RECOGNIZE,Y WE EVALUATE IT IS
HEALTH WITH COSMETICS AND
SUNSCREENS AND THE INFLUENCE OF
LIFESTYLE FACTORS SUCH AS
NUTRITION, SMOKING, VAPING
PSYCHOSOCIAL STRESS AND
EXERCISE, SO FOR EXAMPLE, WE'RE
STUDYING HOW GREEN FACES IN
URBAN ENVIRONMENTS CAN POSITIVE
IMPACT U MAN HEALTH OR LACK OF
GREEN SPACES CAN NEGATIVELY
IMPACT HUMAN HEALTH AND GRANTEES
WHO ARE STUDYING THE COMSUMPTION
OF FRUITS WITH POLYPHENOLS AND
OTHERS WITH OMEGA 3 FATTY ACID,
SO HOW DOES DIET BE POSITIVELY
IMPACING OUR HEALTH AND
POTENTIALLY NEUTRALIZING THOSE
EXPOSURES.
SO STRONG FOCUS AT THE WORK AT
NIEHS IS TO STUDY THE IMPACT OF
HEALTH DISPARITIES AND
STRUCTURAL RACISM AND MODEL
CITIZEN 1 OF OUR MORE RECENT
COUNCIL MEETINGS WE'VE COME TO
DEFINE THAT STRUCTURAL RACISM IS
ANA VERSE ENVIRONMENTAL EXPOSURE
AND IT ABSOLUTELY NEGATIVELY
AFFECTS HUMAN HEALTH.
SO THE BOTTOM LINE IS WE'RE
INTERESTED IN HOW A BROAD
ASSORTMENT OF ENVIRONMENTAL
EXPOSURES CAN AGAIN POSITIVELY
OR NEGATIVELY IMPACT HUMAN
HEALTH.
WELL, CLICK, PLEASE, SO PART OF
THE REASON WHY PART THE DOCTOR
SOPHISTICATED CHOSE ME AS THE
DEPUTY DIRECTOR OF NIEHS,
SOMEONE COME NOTHING WITH
BACKGROUND IN MAMMALIAN AND
HUMAN GENETICS, SO OUR WORK ALSO
INCREASINGLY INVOLVES STUDYING
DIFFERENCES IN THE WAY THAT EACH
OF US RESPHOND A GIVEN
ENVIRONMENTAL EXPOSURE, SO
DIFFERENT INDIVIDUALS I THINK AS
WE KNOW WITH THEIR OWN GENETIC
AND BIOLOGICAL MAKE UP RESPOND
TO THE ENVIRONMENT IN DIFFERENT
WAYS.
SO WHAT MAY BE DANGEROUS OR WHAT
MAY MAKE SOMEONE SICK OF A GIVEN
DOSE MAY NOT HAVE THE SAME
EFFECT ON SOMEONE ELSE.
SO CLICK IT AGAIN PLEASE.
SO WHAT'S EMERGE SUGGEST A
PRETTY EXCITING NEW CONCEPT IT'S
CALLED PRECISION ENVIRONMENTAL
HEALTH.
SO THIS IS WHERE WE STUDY THE
GENE-BIOENVIRONMENT EFFECTS SO
WE STUDY THE GENETICS BUT WE
ALSO STUDY THE EPIGENETIC AND
THE BIOLOGICAL BASIS FOR WHY
INDIVIDUALS HAVE DIFFERENT
RESPONSES TO ENVIRONMENTAL
EXPOSURES.
SO I FIRST BECAME AWARE OF THIS
WHEN 3 OF OUR GRANTEES PRESENTED
THIS AT NIEH STHEY DESCRIBED
ENVIRONMENTAL HELT IT
DOVETAILSINIZELY WITH THE
PRECISION HEALTH PROGRAM WHICH I
THINK MANY OF YOU ARE AWARE.
IT'S PRECISION MEDICINE IS ABOUT
GENETIC VARIATIONS THAT CONFER
DIFFERENTIAL RESPONSES TO
MEDICAL TREATMENTS.
SO, THE NEW PROGRAM AND
POSSESSION OF VOIRMTAL HEALTH
INCLUDES THE ENVIRONMENTAL
EXPOSURES AND EPIGENETIC AND
VARIATIONS THAT CAN ARISE AS A
CONSEQUENCE OF THOSE
ENVIRONMENTAL EXPOSURES AND THE
FACT IS THAT THEY'RE
ENVIRONMENTAL EXPOSURES THAT
MAKE PEOPLE SICK, SO YOU HAVE TO
FACTOR THOSE INTO THE EQUATION.
SO THE PRECISION ENVIRONMENTAL
HEALTH IS REALLY ALL ABOUT
TRYING TO IDENTIFY THOSE GENETIC
AND GENOMIC SIGNALS THAT
REGULATE OUR GENES AND REGULATE
HOW OUR GENES ARE EXPRESSED
THROUGHOUT THE LIFE COURSE.
SO ANDREA, SHERYL AND DANA
EXPLAIN THAD THIS IS ALL ABOUT
UNDERSTANDING INDIVIDUAL RISK TO
PREVENT DISEASE.
SO IN A NUT SHELL PRECISION
ENVIRONMENTAL HEALTH IS WORKING
AT THE INTERSECTION OF PRECISION
GENETICS AND ENVIRONMENTAL
SCIENCE, DATA MANAGEMENT IS A
BIG PART OF PRECISION
ENVIRONMENTAL HEALTH AND IT ALSO
INCLUDES BETTER UNDERSTANDING
WHY WOMEN RESPOND TO THE
ENVIRONMENT IN DIFFERENT WAYS
THAN MEN.
SO LET'S GO TO THE NEXT SLIDE.
SO AS FAR AS THE ENVIRONMENTAL
COMPONENT TO PRECISION AND
ENVIRONMENTAL HEALTH IS
CONCERNED, THE ENVIRONMENTAL
HEALTH SCIENCES COMMUNITY HAS
COME TO RECOGNIZE THAT IF WE
TRULY WANT TO UNDERSTAND THE
IMPACT OF THE ENVIRONMENT WE
HAVE TO GET BEYOND STUDYING 1
EXPOSURE AT A TIME.
IT CAN'T BE JUST ABOUT AIR
POLLUTION OR IT CAPTAIN BE JUDGE
UOF THE ABOUT PESTICIDES BECAUSE
WE'RE EXPOSED TO ALL OF THESE
THINGS CONTINUOUSLY AND IT'S
THIS COLLECTIVE EXPOSURE THAT
ULTIMATELY IMPACTS HUMAN HEALTH.
SO THE COMMUNITY HAS EMBRACED
WHAT YOU SEE ON THE SLIDE IS
EMBRACED THE IT'S CALLED THE
EXPOSE OHM FRAMEWORK AND THIS IS
ABOUT STUDYING THE TOTALITY OF
EXPOSURES OVER A LIFETIME.
YOU CAN SEE THE SLIDE NOT ONLY
INVOLVES PHYSICAL AND CHEMICAL
AGENTS THAT CAN INFLUENCE HUMAN
HEALTH BUT ALSO INCLUDES DIET AS
I MENTIONED EARLIER,
PSYCHOSOPHISTICATED SOCIAL
STRESS, ECONOMIC STATUS, AND
ENVIRONMENT JUSTICE AND THE
IMPACTS OF THE BUILT
ENVIRONMENT.
TD EXPOSE OHM ALSO MEASURES
FISCAL ACTIVITY, SLEEP,
BEHAVIOR, DRUG AND HOLE USE, AND
ABUSE.
AND THE EXPOSEEM FRAMEWORK IS
ALL ABOUT INTEGRATING ALL OF
THESE REAL WORLD EXPOSE IRBURES
IN A WAY WE CAN TRULY UNDERSTAND
THE IMPACT OF THE TOTALITY OF
THE ENVIRONMENT AND TO DO THIS
OVER THE LIFE COURSE SO WHILE
MANY OF US HAVE BEEN USING THE
EXPOSE OHM TERMINOLOGY SINCE
2005 WHEN IT WAS FIRST PROPOSED
BY CHRIS WILD WAS BECOMING
INCREASINGLY CLEAR IS WE NEED A
BETTER UNDERSTANDING OF HOW DO
YOU DO AN EXPERIMENT, RECENTLY
DR. COLLINS, ASKED ME, HE WAS
INTERESTED AND RICK, HOW DO I DO
AN EXPO STUDIES OF MULTIPLE
ENDOCRINICS EXPERIENCE?
SO WHAT'S CLEAR IS THAT THE
COMMUNITY IS LACKING IN THE
CLEAR EXPERIMENTAL SIDE OF HOW
TO CONDUCT AN EXPERIMENT IN
EXPOETIC SOMMICS AND MANY
MEMBERS OF THE ENVIRONMENTAL
COMMUNITY HAVE RIVEN TO THE CHAL
ERVELG AND THE CHALLENGE WAS
SPECIFICALLY TO DEFINE HOW TO
OPERATIONALIZE EXPOSOMICs, SO
ALONG THESE LINES NIEHS PROVIDED
THIS COURSE OVER LAST SUMMER AND
HOPEFULLY SOME OF YOUR COMMUNITY
PARTICIPATED IN THESE, I HOPE,
AND THIS WAS ALL ABOUT MAKING
THE PIVOTAL SHIFT FROM EXPOSING
THE EXPOETIC SOM TO THE DATA, TO
THE TOTALITY OVER THE LIFE
COURSE, IT WAS ENCOURAGING, 400
COLLEAGUES ACROSS THE BIOMEDICAL
COMMUNITY WERE JOINING FOR SOME
OR ALL OF THESE WORKSHOPS AND
THERE WERE 64 TOPICS THAT WERE
RAISED AND DISCUSSED AND WE'RE
NOW AT THE POINT WHERE WE'RE
ADDRESSING 5 MAJOR TOPICS.
WHAT DO WE MEASURE?
HOW DO WE MEASURE IT, HOW TO
SHARE INTERNATIONAL
CLASSIFICATION GRIT, HARMONIZE,
ANALYZE AND AND INTERPRET THE
DATA AND HOW DO WE TRANSLATE
EXPOETIC STUDIES OF MULTIPLE
ENDOCRINICS DATA IN A WAY THAT
IT'S USEFUL AND CO MAKE AN
IMPACT AND STUDYING THE TOTALITY
OF EXPOSURES IN THE ENVIRONMENT.
SO STAY TUNED, I AM ENCOURAGED
WE MADE A LOT OF PROGRESS AND
OPERATIONAL MODEL FOR CONDUCTING
AN EXPOSE STUDIES OF MULTIPLE
ENDOCRINICS EXPERIMENT.
I KNOW DR. CRISWELL, ALSO
HAPPENS TO BE VERY ABOUTED IN
DOING EXPOSOMICs EXPERIMENTS
SO LET'S GO TO THE NEXT SLIDE,
NOW I'M GOING TO COVER A LOT SO
I WILL GIVE YOU A BROAD
FRAMEWORK FOR NIEHSRKS I
APOLOGIZE COVERING A LOT OF
INFORMATION IN A REEL KEEPSAKES
TELEVISIONALLY SHORT PERIOD OF
TIME BUT LET ME TRANSITION MORE
INTO THE WORK THAT WE DO IN
SUPPORTED OF WOMEN'S HEALTH.
SO WOMEN'S SHELGT A ESSENTIAL
COMPONENT OF THE RESEARCH WE DO
AND IT'S BEEN PART OF OUR AGENDA
FOR QUITE SOMETIME AND SO I
CAN'T GO THROUGH AND DESCRIBE
EVERYTHING THAT WE DO, IN
WOMEN'S HEALTH IN THE LIMITED
TIME THAT I HAVE TODAY, BUT
SUFFICE IT TO SAY THAT THE
RESEARCHERS WE SUPPORT IN OUR
INTRAMURAL AND EXTRAMURAL
COMMUNITIES APPLY THE BROAD
BASED APPROACHES THAT I DESCRIBE
AND THE PREVIOUS FEW SLIDES AND
THEY--THEY SPECIFICALLY USE THIS
APPROACH TO INVESTIGATE THE
ENVIRONMENTAL, THE LIFESTYLE AND
THE BEHAVIORIAL FACTORS THAT CAN
ULTIMATE INFLUENCE WHETHER WOMEN
WILL DEVELOP HEALTH PROBLEMS
OVER THEIR LIFE COURSE.
I MEAN THROUGH OUR PRECISION AND
ENVIRONMENTAL HEALTH PROGRAM, WE
STUDY GENETIC FACTORS, BUT WE
ALSO STUDIED CHEMICAL EXPOSURES
IN THE AIR, TO WATER, SIEL, FOOD
AND CONSUMER PRODUCTS THAT ARE
USED BY WOMEN.
AND WE'RE ULTIMATELY INTERESTED
IN CONTRIBUTING MORTALITY IN
WOMEN, SPECIFICALLY WE STUDY THE
ENVIRONMENTAL STRESSES THAT ARE
ASSOCIATED WITH UTERINE
FIBROIDS, INFERTILITY, INCREASED
RISK OF A VARIETY OF DIFFERENT
CANCERS, METABOLIC DISORDERS,
LACTATION DEFECTS, SEX
APPROPRIATE GONAD DEVELOPMENT
AND MAJOR STUDY ON IPPED O KRIN
DISRUPTION IN THE NATIONAL
TOXICOLOGY PROGRAM AND IT'S IA
BIG AREA OF FOCUS FOR MANY OF
THE GRAPTEES THAT WE SUPPORT ON
NIEHS, THERE'S CHEMICALS ARE
VERY IMPORTANT FACTOR IN
INFLUENCING WOMEN'S HEALTH.
SO WE ALSO SPRPT A VARIETY OF
PROJECTS AND THIS IS TRUE IN OUR
INTRAMURAL RESEARCH DIVISION, SO
WE'RE BASICALLY STUDYING THESE
FUNDAMENTAL AND BIOLOGICAL
PATHWAYS THAT DRIVE WOMEN'S
HEALTH AND REPRODUCTION, SO OUR
CLINICAL DIRECTOR DR. JAN HALL
STUDIES THE MECHANISMS INVOLVED
IN THE INTEGRATED CONTROL OF THE
REPRODUCT EVALUATION PROCESS
SYSTEM IN WOMEN AND IT'S
DISRUPTION IN REPROUCT DIDDIVE
DISORDERS, SO THE RESEARCH
FOCUSES ON THE NEURAL
INTERACTIONS THAT GOVERN--THAT
GOVERN NORMAL REPRODUCTION AND
THE CHANGES THAT OCCUR WITH
AGING.
AND IT'S ACTUALLY REALLY
FASCINATING SHE REEBTLY
DESCRIBED TO ME, A SET OF
EXPERIMENTS WHERE SHE'S LOOKING
AT HYPOTHALAMIC AMEN OREA, WHICH
IS A CONDITION OF LOSS OF
REPRODUCTIVE CYCLES IN OTHERWISE
NORMAL WITHEM WHICH IS
ASSOCIATED WITH INCREASED
EXERCISE OR DIETARY RESTRICTION.
WE HAVE A DOCTOR FOCUSING ON
FISCHERIOLOGY AND DISEASE AND
OVARIAN STEROIDS, PROGESTERONE
AND ESTROGEN.
AND DR. WILLIAMS STUDY MOLECULAR
EVENTS SPECIFICALLY HOW THE
EMBRYO DEVELOPS WITHIN THE FIRST
FEW DAYS OF LIFE.
SO THEY COULD GIVE YOU A LECTURE
ON ANY 1 OF THESE AREAS BUT VERY
EXCITING STUFF AND IT'S A MAJOR
FOCUS ON REALLY UNDERSTANDING
FEMALE PHYSIOLOGY, FEMALE
BIOLOGY AND IMPACT OF
ENVIRONMENTAL EPTION POSURES ON
FEMALE BIOLOGY, HOW STRUCTURAL
SOURCES AND THEY ALL EXACERBATE
MA TERRAL HEALTH.
SEE WE ALSO COME TO RECOGNIZE
THAT THERE ARE WINDOWS WHEN AN
INDIVIDUAL IS SENSITIVE TO
ENVIRONMENTAL EXPOSURES AND FROM
THE STANDPOINT OF WOMEN'S
HEALTH, PREGNANCY REPRESENTS A
SENSITIVE WINDOW OF
SUSCEPTIBILITY AND WE UNDERSTAND
THAT THIS IS A TIME WHEN IN
WOMEN THERE ARE PHYSIOLOGICAL
CHANGES TO EVERY MAJOR ORGAN
SYSTEM THAT INCREASE SENSITIVITY
TO ENVIRONMENTAL EXPOSURES SO
FOR EXAMPLE, HYPER TENSIVE
DISORDER IS 1 AND WE STUDY THOSE
FOR PREECLAMPSIA, CHRONIC
HYPERTENSION, THESE ARE ALL
LEADING CAUSES OF MATERNAL
MORBIDITY AND WE'RE ON TOP OF
IT.
SO THE DIVISION OF TRANSLATIONAL
TOXICOLOGY, WE RECENTLY CHANGED
THE NAME TO DTT, SO WE FOUND
THAT AIR POLLUTION FROM TRAFFIC
EMISSIONS FOR EXAMPLE ARE
PRESUMED HAZARD FOR HYPER
TENSIVE DISORDERS OF WOMEN.
AND OUR NIEHS GRANTEES
ESTABLISHED THAT THERE'S
EXPOSURE TO CAD METRICS UMKC AND
OTHER HEAVY MEDALS TO PFAS,
THALLATES AND ALSO PREGNANCY.
SO NIEHS SUPPORTED WORK THAT
FALLS IN THIS CONTEXT FALLING
BROADLY UNDER THIS DEFINITION OF
IT'S CALLED DOUGH HEAD WHICH
STANDS FOR THE DEVELOPMENTAL
ORIGINS OF HEALTH AND DISEASE.
SO YOU KNOW OF THE EPIDEMIOIO
LOGICAL SUPPORTS NOT SUPPORTED
BY NIEHS BUT WERE DONE TO
CONNECT STARVATION DURING
PREGNANCY WITH THE
PREDISPOSITION TO AN INCREASED
RISK OF OBESITY LATER IN LIFE,
IN THOSE--IN OFFSPRING AND MORE
RECENTLY NIEHS SUPPORTED
INVESTIGATORS, THAT ARE
DISCOVERING THAT THERE ARE
EXPOSURES DURING PREGNANCY THAT
CAN PREDISPOSE TO A WHOLE
VARIETY OF ADVERSE HEALTH
EFFECTS MUCH LATER IN LIFE.
SO, AND WE'VE ALSO FOUND THAT
EXPOWZURES DURING CHILDHOOD AND
EARLY PUBERTY REPRESENT ANOTHER
WINDOW OF CONCERN SINCE THESE
ARE WHENNED BODY IS GROWING
RAPIDLY AND THE HORMONE SYSTEMS
ARE ACTIVE AND THOSE
ENVIRONMENTAL EXPOSURES CAN HAVE
NEGATIVE I AM NOT PACTS ON THE
CHANGING BIOLOGY.
IN FACT IT GIVES ME A CHANCE TO
TALK ABOUT WORK IN MY OWN LAB
VERY BRIEFLY.
WE'VE ACTUALITILY BEEN STUDYING
HOW CHEMICAL EXPOSURES DURING
EARLY DEVELOPMENT CAN INFLUENCE
HOW GENES ARE EXPRESSED MUCH
LATER IN LIFE, AND SO WE TREATED
PREGNANT MICE WITH THE CHEMICAL
PEST SIDE CHA WE STUDIED AT
GREAT LENGTH IT'S A NATURAL
PESTICIDE AND IT'S THE TRONS
PORT CHAIN AND WE TREATED THE
PREGNANT THIS OCCURRED AT
WEANING AND WE STOPPED EXPOSURE
AT WEANING AND WE SAW THE
EFFECTS AT WEANING AND 6 MONTHS
OF AGE AND AT 12 AND 18 MONTHS
OF AGE.
SO IT WAS WELL AFTER I MEAN
MONTHS AFTER THE EXPOSURE WAS
DONE.
SO THESE EPIGENETIC MODIFICATION
SAYS HAD THE POTENTIAL TO IMPACT
THE WHOLE SERIES OF NETWORKS
FROM MAP KINASE SIGNALING TO
HEPATOCELLULAR CARCINOMA SO THE
BOTTOM LINE IS THAT DEVELOPMENT
IS A HIGHLY SUSCEPTIBLE WINDOW
AND ENVIRONMENTAL EXPOSURES
DURING DIFFERENT WINDOWS CAN
CAUSE YOUR GENES TO MISBEHAVE
AND NOT OHM DURING TWEPMENT, BUT
ALSO MUCH, MUCH, LATER IN LIFE
THROUGH THESE EPIGENETIC
MECHANICANISMS SO IT'S A VERY
IMPORTANT AREA OF FOCUS FOR
NIEHS.
AND I WOULD SAY FOR A BROAD BASE
OF COMMUNITY THESE DAYS.
WELL THE'S GO TO THE NEXT SLIDE.
SO I ALSO WANT TO INCREASE THE
NUMBER OF EXAMS OUT THERE OUR
FOCUS ON ENVIRONMENTAL JUDGE
JUSTICE THAT WE'RE STUDYING HOW
ADVERSE ENVIRONMENTAL EXPOSURES
LIKELY CONTRIBUTE TO THE HEALTH
DISPARITIES ASSOCIATE WIDE THE
MORBIDITY AND MORTALITY OF
MINORITY POPULATIONS.
SO I BELIEVE WE ALL KNOW THAT
CHEMICAL AND NONCHEMICAL
EXPOSURES THAT ADVERSELY WOMEN'S
HEALTH ARE NOT RANDOMLY
DISTRIBUTED ACROSS THE
POPULATION.
SO MOST RACIAL AND ETHNIC
MINORITIES LIVE IN LARGELY
DIFFERENT PHYSICAL AND SOCIAL
ENVIRONMENTS COMPARED TO THE
MAJORITY WIDE POPULATION AND
INVESTIGATORS SUPPORTED BY NIEHS
DISCOVERED THAT RACIAL
DIFFERENCES AND EXPOSSESSURE TO
ENVIRONMENTAL STRESSORS LEAD TO
DIFFERENTIAL RISK ACROSS THE
LIFE SPAN.
--SO RECENTLY AS YOU CAN SEE ON
SLIDE, WE RECENTLY HAD A
WORKSHOP ENTITLED ENVIRONMENTAL
IMPACTS ON WOMEN'S HEALTH
DISPARITIES AND PREPRODUCTIVE
HEALTH AND WE LEARNED THAT WE
NEED TO CREATE EQUAL ACCESS TO
TOOLS AND OPPORTUNITIES TO
IMPROVE HEALTH EQUITY AND WE
ALSO LEARNED THAT WE NEED TO
SHIFT TO TRANSAALATIONAL AND
ENVIRONMENTAL EPIDEMIOLOGIC
RESEARCH FRAMEWORKS WE NEED TO
DEVELOP TRANSDISCIPLINARY
COMMUNITY DRIIVE AND
COMPREHENSIVE RESEARCH PROGRAMS
THAT LEAD TO ACTION AND TO
INFORMED POLICY AND INTEGRATED
OF COURSE IS LEARNING HOW TO
TALK ABOUT THE WORK THAT WE DO
AND SO THAT THEY UNDERSTAND THE
WORK WE'RE CONDUCTING.
NEXT SLIDE, PLEASE.
AND AS I MENTIONED
DR. [INDISCERNIBLE] AT NIEHS HAS
DONE REMARKABLE WORK TO SPONSOR
WORKSHOPS TO IMPLEMENT WORKSHOPS
TO DISTEMINATE KNOWLEDGE ON
WOMEN'S HEALTH INTO THE
COMMUNITY.
ESPECIALLY COMMUNITIES OF COLOR.
SO THIS IS IN SUPPORT OF OUR
SECOND THEM OF OUR PLAN AND
HAVING IMPACT ON THE PUBLIC
HEALTH SO DR. CANNED WHAT
MANAGES THE WOMEN'S HEALTH
AWARENESS INITIATIVE AT NIEHS
AND AS YOU CAN SEE ON THIS
SLIDE, IT HAS A MISSION TO
INFORM AND EMPOWER WOMEN TO TAKE
RESPONSIBILITY FOR THEIR HEALTH,
TO UNDERSTAND THEIR HEALTH
OPTIONS AND TO IDENTIFY SERVICES
THEREBY INCREASING ACCESS TO
SERVICES, RESOURCES AND PRODUCTS
THAT BEST HELP THEM PREVENT AND
REDUCE POOR HEALTH.
SO THIS INITIATIVE BRINGS
EDUCATION ENVIRONMENTAL HEALTH
LITERACY TO THE WOMEN ACROSS
NORTH CAROLINA FOR THE PURPOSE
OF PROMOTING HEALTHIER LIVES BY
PROMOTING AWARENESS OF
ENVIRONMENTAL SAFER HOMES AND
COMMUNITY.
SO I ALMS WANT TO POINT OUT THAT
JOAN IS MANAGING A PROJECT
CALLED WOMEN'S HEALTH AWARENESS,
COMMUNITY RESILIENCY AND
ENVIRONMENTAL ACTION AND
COLLABORATIONS FOR HEALTH, IT'S
CALLED THE REACH EQUITY PROGRAM.
IT'S TO IDENTIFY PREDISPOSING
FACTORS AND COVID-19 RELATED
FACTORS IN WOMEN WITH THEIR
FAMILIES.
SO THE OVERALL GOAL SPECIAL TO
DEVELOP PREVENTIONS WITH DISEASE
PREVENTION, CONTROL AND
MANAGEMENT FOR DISEASE RECOVER
EXPE UNDERREPORPTED AND
UNDERSTUDIED WOMEN POST
COVID-19.
SO I WILL NOTE THE PROJECTS SO
DR. CLAYTON WE SPREESHT THE
COSPONSORSHIP OF THIS PROGRAM.
I LOOK FORWARD, I UPON IS YOU
LOOK FORWARD ALSO TO THE VERY
EXCITING RESULTS THAT WILL BE
COMING OUT OF THIS PROGRAM.
SO BEFORE I CONTINUE, I WANT TO
HEAR MORE ABOUT THE WORK THAT'S
BEING DONE IN THE VEERMTAL
HEALTH SCIENCES BY DRS. SANDLER,
HARMON AND UPSON, AND I THINK
THAT WILL HAPPEN LATER ON TODAY,
IT'S PART OF A PANEL DISCUSSION
OR PANEL PRESENTATION ENTITLED
EPIDEMIOLOGIC CONTRIBUTIONS TO
UNDERSTANDING THE ENVIRONMENTAL
IMPACTS ON WOMEN'S HEALTH.
SO DR. CHRISTEN UPSON IS 1 OF
OUR POST DOCTORAL FELLOWS AT
NIEHS, SHE IS A PROFESSOR OF
EMDEEMIOLOGY AND BIOSTATISTICS
AT MICHIGAN STATE AND SHE WILL
DESCRIBE HER WORK ON STUDYING
FACTORS THAT INFLUENCE THE RISK
OF DEVELOPING ENDOMETRIOSIS, SO
SHE IS USING THE WREN COHORT AND
WILL SHOW HOW ORGAN O CHLORINE
PEST TIDES PC Bs, THALLATES
AND BPA AND SOY IN FORMULA
FEEDING AS WELL AS DEHS AND
DEVELOP ENDOMEET RIONOSEIS.
AND DR. QUAKER HARMON IS AN
INVESTIGATOR IN OUR DIVISION OF
INTRAMURAL RESEARCH.
SHE WILL DISCUSS THE WORK SHE'S
BEEN DOING ON THE SELF-COHORT
HAD IS A COLLECTION OF ABOUT
1693 WOMEN WHO SELF-IDENTIFIED
AS BLACK OR AFRICAN AMERICAN,
AGES 23-35 FROM THE DETROIT
MICHIGAN AREA.
SO SHE'S USING THE TO HOTTER TO
STUDY THE ENVIRONMENTAL LIFE
SOMETIME FACTORS THAT INFLUENCE
THE DEVELOPMENT OF UTERINE
FIBROIDS.
AS YOU PROBABLY KNOW UTERINE
FOOTBALL ROADWAYS ARE HORMONAL
BENIGN TUMORS IN THE MUSCLE AND
THEY DEVELOP IN PREMENSTRUAL
WOMEN SO THEY ARE THE LEADING
INDICATION FOR--SORRY
PREMENOPAUSAL WOMEN.
OKAY THAT MAKES A LOT MORE
SENSE, SO THEY'RE THE LEADING
INDICATION FOR UTERINE FIBROIDS
AND SHE IS WORKING ON MED
KAILINGSS FOR THIS CONDITION.
AND FINALLY DR. DALE SANDLER
WILL WORK ON THE REMARK
ALGORITHMS SISTER STUDY.
SHE WILL TELL YOU A LOT MORE
ABOUT THIS.
SO IT'S A COHORT OF ABOUT 50,000
WOMEN FROM ACROSS THE UNITED
STATES AND PUERTO RICO WHO WERE
BETWEEN THE AGES OF 35-74 AND
WHOSE SISTER HAD BREAST CANCER.
AND BECAUSE OF THEIR SHARED
ENVIRONMENT, GENES AND
EXPERIENCES DR. SANDLER AND HER
COLLEAGUES FOUND THAT STUDYING
SISTERS PROVIDES A GREATER
CHANCE OF TEASING OUT THOSE RISK
FACTORS THAT PREDISPOSE TO
BREAST CANCER.
SO THEY'VE BEEN ABLE TO USE THIS
UNIQUE COHORT TO STUDY THE
ENVIRONMENTAL AND EPIGENIC
FACTORS AND THE DEVELOPMENT OF
BREAST CANCER AS WELL AS A
NUMBER OF OTHER ADVERSE HEALTH
EFFECTS SO I'M SURE YOU WILL BE
VERY GOD IN HEARING FROM THESE 3
DIFFERENT INVESTIGATORS.
SO LET'S MOVE TO THE NEXT SLIDE.
LET ME SET THE STAGE THR THIS
DISCUSSION IN THE CLIMATE CHANGE
FOR WOMEN'S HEALTH.
AND TO ADDRESS THIS I WANT TO
REFERENCE THE UN SECRETARY
GENERAL WHO SAID WE'RE
EXPERIENCING CODE RED FOR
HUMANITY.
SO CLIMATE CHANGE EXACERBATES
CHRONIC AND CONTAGIOUS DISEASE
AND WORSENS FOOD AND WATER
SHORTAGES AND INCREASES THE RISK
OF PANDEMICS AND AGGRAVATES MASS
DISPLACEMENT AND WE'RE SEEING
INCREASED SEVERITY AND FREQUENCY
OF WEATHER RELATED DISASTERS
COSTING OVER A BILLION DOLLARS,
IN 2020 ALONE WE SAW 22 SUCH
EVENTS COSTING A TOTAL OF 450
BILL WHEREON AND GOD ONLY KNOWS
WHAT IT WILL BE WITH THE RECENT
DISASTERS IN PUERTO RICO AND
FLORIDA WITH HURRICANE IAN.
SO WHILE IT'S CLEAR WE ARE AT A
POINT WHERE WE NEED TO BETTER
UNDERSTAND THE LONG IMPACTS OF
CLIMATE CHANGE WE ALSO NEED TO
UNDERSTAND THE HEALTH IMPACTS
WITH THESE SEVERE WEATHER
EEIVETS.
NEXT SLIDE.
SO LET SEA SEE CLICK PLIES, SO
CLIMATE CHANGE RESULTS IN
INCREASED GLOBAL TEMPERATURE AS
YOU CAN SEE ON THE SLIDE,
EXTREME WEATHER EVENTS
PRECIPITATION EXTREMES, SEA
LEVEL RISE AND CHANGES IN LAND
USE.
SO CLICK AGAIN PLEASE, THERE WE
ARE.
REDUCED FOOD AND WATER QUALITY
AND INCHANGE IN DISEASE AND SO
THESE RELATE IN HEAT RELATED
ILILLUMINATENESS, CARDIOVASCULAR
DISEASE, OTHER CHRONIC
CONDITIONS AND DEATH.
THEY ALSO RESULT IN NEUROLOGICAL
DISORDERS, VECTOR BORNE DISEASE
AND RESPIRATORY DISEASE AND
ASTHMA.
SO NEXT SLIDE.
HERE WE ARE, SUBMITTING THE
HEALTH EFFECTS THAT I JUST
DESCRIBED FALL GENERALLY INTO
THE CATEGORY OF DIRECT EFFECTS
BUT IT'S REALLY IMPORTANT TO
RECOGNIZE THAT THERE ARE ALSO
MANY INDIRECT EFFECTS OF CLIMATE
CHANGE ON HUMAN HEALTH.
THROUGH POPULATION DISPLACEMENT,
CHAIMPLES IN AIR, WATER, FOOD,
QUALITY, AND QUANTITY,
POPULATIONS DISPLACEMENT ISSUES
INTERRUPTIONS TO HEALTHCARE,
DISRUPTIONS TO THE
INFRASTRUCTURE AND SUPPLY CHAIN
FOR HEALTHCARE THEREFOREY AS
WELL AS ECONOMIC IMPACTS, FOR
EXAMPLE, MORE PEOPLE ARE GOING
TO BE LIVING IN POVERTY AS A
CONSEQUENCE OF CLIMATE CHANGE.
NEXT SLIDE.
I ALSO WANT TO STATE RIGHT UP
FRONT THAT WE RECOGNIZE THAT THE
HEALTH IMPACTS OF CLIMATE CHANGE
ARE DISPROPORTIONATELY BORNE BY
THE MOST VULNERABLE AMERICANS
AND WOULD INCLUDE DISPARITIES,
EXPOSED WORKERS, PERSONS WITH
DISABILITIES THOSE WHO ARE
VULNERABLE BY LIFE STAGE, FOR
EXAMPLE DURING PREGNANCY OR
MEDICAL CONDITIONS AND IT'S ALSO
CLEAR THAT POPULATIONS IN LOW
AND MIDDLE INCOME COUNTRIES WITH
HIGHER RATES OF EXISTING
DISEASES, NUTRITION AND EXTREME
POVERTY ARE ALSO
DISPROPORTIONATELY IMPACTED BY
CLIMATE CHANGE.
NEXT SLIDE.
SO THERE AIAN LOT ON THIS SLIDE
BUT I WANT TO FOCUS ON THE FACT
THAT CLIMATE CHANGE AFFECTS
WOMEN DIFFERENTLY.
BUT I WILL COMMENT ON THOSE IN A
MINUTE BUT YOU WITH SEE ON THE
SLIDE, EXTREME HEAT, WATER
QUALITY, VECTOR BORN DISEASES,
WATER AND FOOD, THEY CAUSE
INCREASE PORBIDDITY AND
MORTALITY IN WOMEN, INCREASED
RESPIRATORY AND HEART DISEASE,
MORE BIRTH COMPLICATIONS SO
CHRONIC EXPOSURE TO OZONE IN
PARTICULATE MATTER AND EXPOSURE
DURING PREGNANCY OR ASSOCIATED
WITH INCREASED MISTARRAGE AND
STILL BIRTHS.
AND THEN PRECONCEPTION STUDY, IT
WAS FOUND OUT OF EXPOSURE TO AIR
POLLUTION WITH REDUCED
ACCOUNTABILITY.
AND ANOTHER STUDY, WAS CLEAR
THAT EXPOSURE AIR PLUT ANTS
DURING PREGNANCY WAS ASSOCIATED
WITHNYONATAL RESPIRATORY
COMPLICATIONS.
NEXT SLIDE, PLEASE.
THE DIRECT EFFECT OF INCREASED
TEMPERATURES THAT INCREASED
TEMPERATURES CAUSED BY CLIM 8
CHANGE ALSO IMPACTS WOMEN'S
HEALTH.
SO IN THIS STUDY, SMALL CHANGES
IN TEMPERATURE, DURING THE WEEK
BEFORE DELIVERY WERE ASSOCIATED
WITH AN INCREASED CARDIOVASCULAR
RISK FOR MOTHERS DURING LABOR OR
DELIVERY.
SO THIS WAS MORE IN NONHISPANIC
BLACK WOMEN, THEY WERE SOARNTED
WITH LOW BIRTH WAY.
COULD I HAVE THE NEXT SLIDE,
PLEASE.
SO THE NEXT STUDY WITH THE
BIRTHS IT WAS CLEAR ACROSS THE
UNITED STATES THAT HIGH AMBIENT
TEMPERATURES, SO IT WAS CLEAR
THAT HIGH AMBIENT TEMPERATURES
ACROSS PREGNANCY IS ASSOCIATE
WIDE THE HIGHER RISK AS WHAT IS
REFERRED TO TERMED SMALL FOR
GUESTATIONAL AGE AND LOWER BIRTH
WAY.
SO THESE INCREASED RISKS APPEAR
TO BE MOST PRONOUNCED DURING THE
SECOND AND THIRD TRIMESTERS OF
PREGNANCY.
NEXT SLIDE.
AND ANOTHER SET OF STUDIES
DETERMINE AMBIENT CAPACITY AND
TEMPERATURES.
SO THEY USE THE TEST TO EVALUATE
OVARIAN RESERVE CALLED THE AFC.
SO THEY USE THE PERSPECTIVE
COHORT DESIGN, STUDY DESIGN WITH
631 PATIENTS FROM THE MASS
GENERAL HOSPITAL FERTILITY
CENTER, THEY STUDIED DAILY
TEMPERATURE AT THE WOMEN'S
REDENTIAL ADDRESS FOR 90 DAYS
BEFORE THEIR AFC MEASUREMENT,
THEY EVALUATED ASSOCIATIONS
BETWEEN TEMPERATURE AND AFC AND
THEY ADJUSTED FOR RELATIVE
HUMANITY, WITH PARTICULAR MATTER
EXPOSURE, AGE, EDUCATION,
SMOKING STATUS, DIAGNOSIS OF
DIMINISHED OVARIAN RESERVE FOR
OVULATION DISORDERS SO WHAT THEY
FOUND IS A 1 DEGREE CENTIGRADE
INCREASE IN MAXIMUM TEMPERATURE
WAS SOABT WTD A 1.6% LOWER AFC.
SO I GUESS THIS SUGGESTS THAT
HIGHER EXPOSURE TO HIGHER
TEMPERATURES CAN LEAD TO LOWER
OVARIAN RESERVE IN HUMANS THAT
RAISES CONCERN THAT THIS MAY
RESULT IN ACCELERATED
REPRODUCTIVE AGING IN WOMEN.
NEXT SLIDE, PLEASE.
SO IN THE CONTEXT OF INDIRECT
CLIMATE CHANGE, STUDIES HAVE
SHOWN THAT WOMEN, CHILDREN,
TEENS AND YOUNG ADULTS ARE MORE
VULNERABLE TO THE POST-TRAUMATIC
STRESS AFTER TSUNAMIS AND THAT
CHILDREN WITH CHRONIC HEALTH
CONDITIONS AND THOSE THAT MAY
NEED MENTAL HEALTHCARE
ULTIMATELY EXPERIENCE HEALTHCARE
DISRUPTIONS AND IMPACT THEIR
UNMET CARE AFTER HURRICANES.
SO IT'S ALSO BEEN FOUND THAT
THOSE CAUGHT MY CLIMATE CHANGE
EXPERIENCE MORE LONGER TERM
PROBLEMS CONTROLLING AGGRESSION
NEXT SLIDE, PLEASE.
>>I'M GETTING MY SLIDES MIXED
UP HERE, LET'S GO ON TO THE NEXT
SLIDE, PLEASE.
OKAY SO ANOTHER SET OF STUDIES
SHOWED THAT WEGINANT WOMEN
DELIVERED WITHIN 40 WEEKS AFTER
HURRICANE HARVEY, THEY HAD
HIGHER MATERNAL MORBIDITY AND
50% HAYER NEONATAL MORBIDITY.
WOMEN OF LOW SOCIAL ECONOMIC
STATUS WERE MOST AFFECTED.
SO IN THIS CASE, IN ANOTHER SET
OF STUDIES IT WOULD DETERMINE
THAT WOMEN WITH BREAST CANCER
THAT LIVED THROUGH HURRICANE
KATRINA, HAD A 15% INCREASED
RISK OF MORTALITY.
SO THE SAME WAS IN COLORECTAL
CANCER BUT THE IMPACT WAS MOST
LIKELY CAUSED BY THE DISRUPTION
IN HEALTHCARE DELIVERY SO AS CAN
YOU SEE ON THE RIGHT HAND SIDE
OF THE SLIDE, MISSING EVEN 1
WEEK OF CHEMO THERAPY HAS
SIGNIFICANT EFFECTS ON
MORTALITY.
NEXT SLID, AND JUST FINALLY,
IT'S THE--THERE ARE NUMBER OF
ADDITIONAL INDIRECT IMPACTS OF
WOMEN'S HEALTH CAUSED BY CLIMATE
CHANGE AND THEY'RE LIST OFFICE
OF DIVERSITY THIS SLIDE.
SO CLIMATE RELATED EVENTS,
DESTROY HEALTHCARE
INFRASTRUCTURE, AND THEY CAN
LEAD TO POWER OUTAGES, STAFF
SHORTAGES, AND TRANSPORTATION
DISRUPTIONS AND WE'VE SEEN THIS
MOST RECENTLY IN FLORIDA AND
PUERTO RICO, SO CLIMATE RELATED
EVENTERRINGS CAN OVERWHELM
HEALTH SYSTEMS, CAN RESULT IN
LOSS OF MEDICAL RECORDS,
PROBLEMS ACCESSING OR STORING
MEDICATIONS CAUSING DISRUPTIONS
IN MEDICAL SUPPLY CHANGE AND CAN
DISRUPT RESEARCH INFRASTRUCTURE
THAT IMPACTS CLINICAL TRIALS.
SO NEXT SLIDE, PLEASE.
SO IT'S CLEAR IS THAT CLIMATE
CHANGE IS IMPACTING HUMAN HEALTH
IN A NUMBER OF REMARKABLE WAYS
AND IT'S AFFECTING WOMEN'S
HEALTH IN A NUMBER OF DIRECT AND
INDIRECT WAYS SO WHAT ARE WE
DOING ABOUT ALL OF THIS AT THE
NIH.
SO YOU MAY RECALL THAT BACK IN
2021, PRESIDENT BIDEN ISSUED
EXECUTIVE ORDER 14008 AND HE
POINTED TO THE NIH TO TAKE TAKE
ON THE CHALLENGES OF ADDRESSING
THE HEALTH EFFECTS ASSOCIATED
WITH CLIMATE CHANGE.
SO WE'RE READY FOR THIS
CHALLENGE BECAUSE STUDYING THE
HEALTH EFFECTS OF CLIMATE CHANGE
IS AT A MODEST LEVEL AT LEAST
WAS WITH US FOR QUITE SOMETIME
SO THIS IS ESPECIALLY TRUE FOR
NIEHS, BUT WE RECOGNIZE THAT
ADDITIONAL MONEY WILL HELP TO
CATALYZE A MUCH LARGER EFFORT
THAT AND WE NEEDED ADDITIONAL
FUNDING TO UNDERTAKE THE
CHALLENGES ASSOCIATED, THE BIG
CHALLENGES ASSOCIATED WITH
CLIMATE CHANGE ASK HEMGHT.
SO THEREFORE WE WERE ENCOURAGED
WHEN WE LEARNED THAT CONGRESS
AND THE PRESIDENT WITH BUDGET
PROPOSAL RANGING FROM 10 TO
$100 MILLION CLEARLY RECOGNIZE
THAT THE HEALTH EFFECTS OF
CLIMATE CHANGE HAS TO BE A
PRIORITY FOR FY23.
SO WE'RE NOT SURE THAT WE WILL
ACTUALLY GET THE MONEY,
NEVERTHELESS, WE'VE STARTED
WORKING TO DEVELOP AN NIH WIDE
STRATEGY FOR CLIMATE CHANGE AND
HEALTH, AND WE ARE DOING THIS IN
A SCALE BECAUSE IT'S CLEAR THIS
TOPIC MUCH BIGGER THAN WHAT ANY
SINGLE IC CAN ACCOMPLISH ON ITS
OWN AND IT'S ALSO THREER THERE
ARE MANY INSTITUTES AND CENTERSA
THE NIH THAT HAVE A CLEAN
INTEREST IN THIS AREA OF
RESEARCH AND HOPEFULLY I'VE
CONVINCED YOU THAT THERE ARE
MANY CHALLENGES, SPECIFICALLY
THAT RELATE TO WOMEN'S HEALTH.
SO THEREFORE I'VE TAKEN THE LEAD
TO REACH OUT TO DOCTORS BIANCHI,
AT NICHD, DR. GIBBONS,
DR. GLASS, DR. GORDON, THE MIMH,
DR. PEREZ-STABLE AT NIMHD AND
DR. ZENK AT THE NINR AND
TOGETHER WE ARE FORMING WHAT WE
CALL THE EXECUTIVE COMMITTEE ON
CLIMATE CHANGE AND HEALTH.
SO TOGETHER WE HAVE REENERGIZED
A WORKING GROUP ACROSS ALL ICs
OF THE NIH AND THE WORKING GROUP
AND CO CHAIRED BY AWBRY MILLER
AT NIEHS AND JOSH ROSEN AT
FOGARTY.
SO OUR OWN GWEN IS ON THE ZOOM
SESSION THIS MORNING IS
PROVIDING THE COORDINATION TO
KEEP ALL MOVING FORWARDS WORKING
IN SYNCHRONY WITH EACH OTHER.
AND WE HAVE I STEERING GROWM
WITH DESIGNATED APPOINTEINGS ON
THE EXECUTIVE COMMITTEE AND THE
STEERING COMMITTEE, WOOING WITH
DOCTORS MILLER AND ROSEN THAT
YOU WILL TO MAKE SURE THE GOALS
OF THE WORKING GROUP ARE
ACHIEVED AND THE WORKING GROUP
AS BEEN VERY BIEWS EXPE WORKING
ON MANY DIFFERENT PROJECTS AND
INCLUDING MOST NOTABLY, THE
DEVELOPMENT OF AN NIH WIDE STRAY
JECTORY EDGE TOOIC FRAME WOR ARE
CLIMATE CHANGER AND HEALTH.
NEXT SLIDE.
OKAY, SO THE STRATEGIC FRAMEWORK
AND JUDGE, ANINE, I HAVE AN
HOUR, RIGHT?
I WANT TO CHECK, I HAVE ABOUT 20
MINUTES.
>>YOU'RE GOOD, YOU'RE GOOD.
SOUNDS GOOD.
OKAY.
SO I'M WINDING UP HERE.
SO THE STRATEGIC FRAMEWORK WAS
DEVELOPED USING SEVERAL SOURCES
AND IT'S SHOWN ON THIS SLIDE
HERE, THERE WERE SEVERAL SOURCES
OF INPUT DATA AND THIS INCLUDED
A PORTFOLIO ANALYSIS OF THINGS
THAT WE DO NOT JUST AT NIEHS,
BUT ACROSS THE NIH, THERE WAS
ALSO A STRATEGIC WHITE BOARDING
SESSION WITH MEMBERS OF THE
WORKING GROUP, THERE WAS A
LANDSCAPE ANALYSIS AND THERE
WERE 180 SUBSTANTIVE RESPONSES
FROM AN RFI THAT THE WORKING
GROUP ISSUED IN AUGUST OF 20
TWOON.
THE FRAMEWORK IS ILLUSTRATED
WITH WHAT WE CALL THE COG OR THE
CENTERPIECE OF THE DIAGRAM.
AS YOU CAN SEE THE FRAMEWORK IS
BASED ON 4 DIFFERENT CORE
ELEMENTS WHICH INCLUDE HEALTH
EFFECTS RESEARCH, HEALTH EQUITY,
TRAINING AND KASP A R PASTY
BUILDING AND--CAPACITY BUILDING
AND INTERVENTION AND SCIENCE AND
THE CENTER IS FOCUSED ON
MULTIDISCIPLINARY TRANSFORMATIVE
RESEARCH AND WHICH REINFORCES
THOSE COMMENTS BY DR. CRISWELL,
WHICH MEANS WOO VERMEN INFECTED
TO WORK TOGETHER IN A REALLY BIG
WAY TO MAKE THE HEALTH EFFECTS
OF CLIMATE CHANGE WORK HAPPEN.
SO THE WORK WILL BE CONDUCTED
WITH GLOBAL CROSS SECTION
INTERAGENCY AND COMMUNITY
PARTNERSHIP EXPTION THE CONS ON
THE PERIPHERY AND THE
CIRCUMFERENCE OF THE DIAGRAM,
ARE REALLY MEANT TO ILLUSTRATE
THE TYPES OF SCIENCE THAT WE
NEED TO BE COB DUCTED TO SUPPORT
THE FRAMEWORK.
SO AS CAN YOU SEE THE RESEARCH
AREAS ARE TRULY
MULTIDISCIPLINARY IN NATURE, AND
THEY RANGE FROM BASIC
MECHANISTIC RESEARCH TO
BEHAVIORIAL SOCIAL SCIENCE
RESEARCH, EMDEEMIOLOGY AND
PREDICTIVE MODELING TO
ADAPTATION RESEARCH.
I ALSO WANT TO MENTION THAT THE
SCIENTIFIC DIRECTOR FROM NIEHS,
DR. DARYL ZELDON IS WORKING WITH
A GROUP OF DIRECTORS ACROSS THE
NIH PUT TOGETHER A MODEST SIZE
CO EMPLOY ELEMENTARY EFFORT
WITHIN THE RESEARCH PROGRAM AND
SO IT'S ABOUT ALL OF US NOT ONLY
THE EXTRAMURAL PROGRAM BUT ALSO
INTRAMURAL SCIENTISTS AS WELL.
SO YOU WILL SEE HERE IN THE
LOWER LEFT HAND CORNER WE
DEVELOPED A WEBSITE FOR CLIMATE
CHANGE AND HEALTH, IT'S
WWW.NIH.GOV/CLIMATEANDHEALTH.
ONE WORD.
SO LOOK IF YOU'RE INTERESTED AND
STAY TUNED WE WILL WORK TO BUILD
SUFFICIENT SUPPORT PERHAPS THAT
HUNDRED MILLION DOLLARS IN THE
PRESIDENT'S BUDGET WILL BE
ALLOCATED BY CONGRESS IN FY23
AND AGAIN, IT'S THE OLD STRATEGY
WELL IT'S IN THE NIEHS BUDGET,
THE WHOLE STRATEGY TO TO
DISTRIBUTE THIS ACROSS THE NIERK
HR.
SO NEXT SLIDE, SO I JUST WANT TO
POINT OUT HERE, IT'S--AND YOU
WILL HAVE ACCESS TO THESE
SLIDES, SO USING THE STRATEGIC
FRAMEWORK WE COME UP WITH
SEVERAL EXAMPLES OF RESEARCH
THAT IS NEEDED TO ADDRESS THE
HEGHT EFFECTS OF CLIMATE CHANGE
AND I DON'T HAVE TIME NOW TO GO
OVER ALL OF THESE BUT SUFFICE IT
TO SAY WE NEED TO STUDY, IESHES
DENTIFY NEW AND ENERNLGING MELGT
RISKS FROM CLIMATE CHANGE AND WE
NEED TO BETTER UNDERSTAND AND
FOCUS ON THOSE POPULATIONS THAT
ARE MOST AT RISK AND WHAT'S
CLEAR AND HOPEFULLY I'VE GIVEN
YOU PLENTY OF EXAMPLES, WOMEN
ESPECIALLY DURING PREGNANCY ARE
AT INCREASED RISK FOR CLIMATE
CHANGE SO LET ME SKIP OVER ALL
THE WAY TO THE LAST POINT ON THE
RIGHT, WE ALSO NEED TO BETTER
UNDERSTAND HOW COMMUNITIES ARE
GOING TO ADAPT TO A CHANGE IN
CLIMATE.
SO WE BELIEVE THAT THE 27
EN--STRATEGIESITUTES AND CENTERS
OF THE NIH ARE UNIQUELY
POSITIONED TO CONDUCT THE
NECESSARY RESEARCH, PROVIDE
EVIDENCE AND THEN TO CONVEY THIS
KNOWLEDGE TO POLICY MAKERS IN A
WAY THAT WE CAN ULTIMATELY HELP
BUILD RESILIENCY AND COMMUNITIES
ACROSS AMERICA AND ACROSS THE
DPLOAB.
NEXT SLIDE, PLEASE.
BUT WE'RE NOT WAITING FOR
CONGRESS TO ALLOCATE NEW
APPROPRIATIONS IN FY23.
SO ALL MEMBERS OF THE EXECUTIVE
COMMITTEE TOGETHER WITH DOCTORS
TABAK AND SCHWETZ, ALONG WITH
DOCTORS GOTTESMAN AND SHORE, IN
THE OFFICE FOR INTERNATIONAL
CLASSIFICATIONA RAMURAL
RESEARCH, THEY PROVIDED START UP
FUNDING FROM THE FY22 OR PART OF
THEIR FY23 ALLOCATIONS BUT WE'RE
USING THIS MONEY FOR A NUMBER OF
INITIATIVES THAT ACROSS THE
INTRAMURAL AND EXTRAMURAL
PROGRAMS AT THE NIH.
THESE INCLUDE BRIEFLY HERE A
RESEARCH COORDINATING CENTER
THAT WILL HELP TO MANAGE THE
DATA BUILD RESEARCH CAPACITY AND
ADVANCE THE PRIORITIES
ESTABLISHED BY THE NIH CLIMATE
CHANGE AND HEALTH STRATEGIC
FRAMEWORK THAT I SHOW TD YOU A
COUPLE SLIDES AGO.
SO ADDITIONALLY WE FOUND START
UP FUNDING TO SUPPORT THE
ALLIANCE FOR COMMUNITY
ENGAGEMENT FOCUSED ON CLIMATE
CHANGE AND HEALTH.
WE'RE CALLING THIS THE ACCH.
SO THIS ALLIANCE WILL ALLOW THE
NIH TO ENGIJ COMMUNITIES THAT
ARE MOST IMPACTED BY CLIMATE
CHANGE.
THESE OF COURSE WOULD BE
UNDERSERVED AND RACIAL AND
ETHNIC MINORITY AND RURAL
POPULATIONS SO THE ACCH BUILDS
OFF A SUCCESSFUL PROGRAM THAT
WAS ESTABLISHED AT NHLBI AND
NIMHD TO DESCREASES THE HEALTH
DISPARITIES RESEARCH ASSOCIATE
WIDE COVID-19 TESTING.
SO THE ACCH WILL WORK IN CLOSE
COLLABORATION WITH COMMUNITY
PARTNER PRS PROMOTE ENCLIEWGZ,
IN THE CCH RESEARCH FRAMEWORK OF
THE UNDERSERVED AND RACIAL
ETHNIC MINORITY AND RURAL
POPULATIONS AND WE WILL DEVELOP
EFFECTIVE MESSAGING TO WORK TO
COUNTER MISINFORMATION.
AGAIN, BA BEING TO SOME OF THOSE
POINTS WE RAISED WITH
DR. CRISWELL, WE HAVE TO LEARN
TO COMMUNICATE IN WAY WE CAN
COUNTER MISINFORMATION AND IN
THE END WE HOPE THAT THE ACCH
WILL BUILD TRUST IN THOSE
UNDERSERVED AND RURAL
COMMUNITIES.
SO ADDITIONALLY MEMBERS OF THE
CCH WORKING GROUP HAD BEEN
ENGAGING WITH THE ICs TO GET
THE WORD OUT THAT THERE'S
INTEREST IN SUPPORTING
INVESTIGATOR INITIATED
PROPOSALS.
FOCUSED ON THE HEALTH EFFECTS OF
CLIMB 8 CHANGE AND AS FAR AS
THIS, THERE WILL BE NOSIs THAT
ARTICULATE THE RELEVANCE FOR
ADOPTING PRACTICAL TECHNOLOGIES
FOR CAPTURING THE HEALTH EFFECTS
OF CLIMATE CHANGE IN SBIR
APPLICATIONS.
NEXT SLIDE, PLEASE.
AND INCLUDED IN OUR NEW PROGRAM,
IT IS THE NIH CLIMATE AND HEALTH
SCHOLARS PROGRAM, SO THIS WILL
BRING THOSE WORKING IN CLIMATE
CHANGE AND HEALTH ON CAMPUS AND
TO WORK WITH STAFF AT THE NIH
AND THOSE INVOLVED IN THE NIH
ACCH INITIATIVE.
THESE SCHOLARS WILL BE INVITED
TO COLLABORATE WITH NIH STAFF ON
1 OR MORE ACTIVITIES RELATED TO
RESEARCH, TRAINING AND POLICY,
AND IT WILL BE IN A UNIQUE
OPPORTUNITY FOR SCIENTISTS FROM
OUTSIDE OF U.S. FEDERAL
GOVERNMENT TO SHARE KNOWLEDGE,
INTEREST AND PASSION AROUND
CLIMATE CHANGE AND HEALTH AND TO
DO THIS WITH NIH LABORATORIES,
PROGRAM OFFICERS, OTHERS ACROSS
THE NIESH H.
SO DID TAILS ON THE PROGRAM ARE
AT NIH.GOV/CLIMAT EAND AND
HEALTH.
SO IN THE INTEREST OF TIME,
THERE'S A LOT OF INTEREST IN
STUDYING HEGHTS OF CLIMATE
CHANGE WITHIN OUR INTRA MIEWR
WILLA RESEARCH PROGRAM.
SO YOUR SCIENTIFIC DIRECTORS ARE
WORKING TOGETHER WITH DR. ZELDAN
TO PUT TOGETHER A NUMBER OF
INITIATIVES SO IT WILL BE A
MODEL EFFORT INVOLVING OUR
INTRAMURAL PROGRAMS AND THAT
WILL BE COMPLEMENTING THE
EFFORTS IN OUR EXTRAMURAL
PROGRAMS.
SO NEXT SLIDE.
SO JUST TO SUMMARIZE IT ALL,
AGAIN, VISIT THE CLIMATE AND
HEALTH WEBSITE, IF YOU WANT MORE
INFORMATION AND WE'LL BE HOSTING
ANY FUNDING OPPORTUNITIES IF
THEY EXIST AND WE GET THOSE
ADDITIONAL DOLLARS COMING FROM
CONGRESS IF FY23, AND WE ALSO
WANT TO POINT OUT THAT WE
CONTINUE TO SUPPORT A PUBLIC
SEMINAR SERIES AND DON'T FORGET
ABOUT THE CLIMATE CHANGE IN
HEALTH LITERATURE PORTAL, SO THE
PORTAL IS A SEARCHABLE DATABASE
WITH EASY ACCESS TO THE MOST
RELEVANT SCIENTIFIC LITERATURE
THAT RELATE TO HEALTH IMPACTS OF
CLIMATE CHANGE.
SOPHISTICATEDY LET ME STOP AT
THIS POINT AND I THINK I'VE
GIVEN TIME FOR ANY QUESTIONS
THAT YOU MAY HAVE OR MEMBERS OF
YOUR ADVISORY GROUP MAY HAVE
RELATIVE TO WORK ON CLIMATE
CHANGE IN WOMEN'S HEALTH OR WORK
AT NIEHS, SO THANK YOU.
>>THANK YOU SO MUCH RICK FOR
THAT WHIRL WIND.
YOU COVERED SO MANY AREAS OF THE
WORK THAT NIEHS LEADS AND THAT
YOU LEAD AND ENDING WITH THE
CLIMATE CHANGE WHICH IS THE
TOPIC I REALLY WANTED TO HEAR
FROM YOU AND PRESENTED SOME VERY
COMPELLING DATA AROUND WHAT WE
ALREADY KNOW AND SO, THERE IS 1
QUESTION ALREADY FROM AN
ADVISORY COMMITTEE MEMBER IN THE
CHAT, DR. HIGGINS DO YOU WANT TO
UNMUTE AND TURN YOUR VIDEO - ON
AND I WOULD INVITE ANY OF THE
MEMBERS WHO WOULD LIKE TO ASK A
QUESTION, FEEL FREE TO TURN YOUR
VIDEO ON AS WELL.
DR. HIGGINS?
>>YEAH, THANKS, THANKS FOR THE
REALLY STIMULATING PRESENTATION,
I ENJOYED IT.
AND I WAS WONDERING IF YOU COULD
COMMENT ON AND ONGOING RESEARCH
OR ANY KNOWLEDGE YOU MIGHT HAVE
REGUARDING MATERNAL SMOKING AS A
RISK FACTOR FOR THE ADVERSE
EFFECTS OF EBS POSURES,
POLLUTANT EXPOSURES BUT ALSO
CLIMATE CHANGE ON PREGNANCY
OUTCOMES?
>>YEAH, WELL, LET ME--IN FACT I
WILL ASK DOCTOR COLEMAN, WHERE
IS SHE HERE, GWEN IF YOU COULD
JUST TURN ON YOUR CAMERA HERE I
WILL JUST COMMENT THAT SMOKING
OF COURSE IS ASSOCIATED WITH
THAT PARTICULATE MATTER THAT IS
ALSO A COMPONENT OF AIR
POLLUTION.
SO I'M NOT--GWEN ARE YOU
FAMILIAR WITH ANY SPECIFIC
STUDIES?
AND YOU MAY BE INVOLVED WITH
STUDIES INVOLVING SMOKING AS A
RISK FACTOR AND CLIMATE CHANGE
AND PREGMANCY OUTCOMES.
SO GO AHEAD.
>>SO THANKS FOR GIVING ME THE
OPPORTUNITY.
SO IN OUR INTRAMURAL PROGRAM,
DR. HIGGINS WE HAVE A CONSORTIUM
CALLED THE PACE CONSORTIUM
THAT'S RUNED BY DR. STEPHANIE
LONDON WHO BROUGHT TOGETHER
STUDIES FROM ALL AROUND THE
WORLD AND WERE ABLE TO USE
BIOLOGICAL SAMPLES THAT WERE
COLLECTED IN THESE BIRTH
COHORTS, AND THEY LOOKED AT
MATERNAL SMOKING AND EPIGENETIC
MARKS IN THOSE SPECIMENS.
AND BACK IN 2013 WERE ABLE TO
PUBLISH AN ANALYSIS SHOWING THAT
THERE WERE DIRECT CHANGES DM
METHYLATION ASSOCIATE WIDE
MATERNAL SMOKING.
BUT I DO LIKE THE WAY YOU PUT
YOUR QUESTION IN THE CONTEXT OF
THE MULTIPLE EXPOSURES THAT
WOMEN ARE ASSOCIATED WITH DURING
THEIR PREGNANCY AND RICK DID
TALK EARLIER ABOUT THE EXPOSE
OME CONCEPT SO I'M NOT SURE OF A
MORE CURRENT PUBLICATIONS THAT
MIGHT SHOW THE INTERACTIONS BUT
1 WOULD IMAGINE THE BIOLOGICAL
TARGETS FOR A VARIETIES OF THESE
EXPOSURES WERE IN THE SAME
PATHWAYS, YOU MIGHT SAN
FRANCISCO SEE SOME SYNERGISTIC
RESPONSES.
>>I APPRECIATE THAT
INFORMATION.
I HADN'T THOUGHT ABOUT IT
PREVIOUSLY BUT I HAVE AN ONGOING
CONCERN THAT WE UNDERTREAT
SMOKING DURING PREGNANCY AND
THIS KIND OF INFORMATION WHICH
AGAIN, I HADN'T REALLY THOUGHT
ABOUT BEFORE, BUT I THINK IT'S
LIKELY THAT THERE WOULD BE
INTERACTIONS AND THE MORE WE CAN
SHOW THE HARMING, ASSOCIATED
WITH MATERNAL SMOKING, THE MORE
I THINK WE COULD GET THE SUPPORT
WE NEED TO BETTER TREAT THE
PROBLEM.
SO THANK YOU VERY MUCH.
>>SORRY, I GUESS I
MISUNDERSTOOD YOUR QUESTION, I
THOUGHT THIS WAS DIRECTLY
RELATED TO THE CLIMATE CHANGE IN
PREGNANCY OUTCOMES, BUT GWEN'S
RIGHT, WE HAVE--IF YOUR VERY
INTERESTED IT'S A WONDERFUL
EPIDEMIOLOGICAL STUDY AND THERE
ARE SPECIFIC METHYLATION SITES
ON THE GENOMES THAT ARE
INFLUENCED BY SMOKING DURING
PREGNANCY.
>>YEAH, NO, I WAS HOPING THAT
THERE MIGHT BE SOME INFORMATION
ON THE CLIMATE CHANGE IMPACTS AS
WELL, THE MORE AS I WAS JUST
SUGGESTING, THE MORE WE KNOW
ABOUT SMOKING DURING PREGNANCY
AS A COMPLICATING FACTOR, AND I
NEVER THOUGHT ABOUT CLIMATE
CHANGE BEFORE THIS PRESENTATION,
BUT IT VERY WELL MAY BE 1, THE
MORE I THINK WE COULD GET
IMPROVE THE SUPPORT TO DO BETTER
WITH SMOKING CESSATION DURING
PREGNANCY.
SO THANK YOU VERY MUCH.
>>WELL SMOKING 2.5 SO I AM GLAD
THIS WAS HELPFUL FOR YOU.
TERRIFIC.
THANK YOU OKAY, LET'S SEE I
THINK WE HAVE--IS THERE ANOTHER
QUESTION.
>>YES DR. KLEIN HAS A QUESTION.
>>THANK YOU SO MUCH IF ARE THIS
FAP TAFTIC DISCUSSION, MUCH OF
WHAT YOU TALKED ABOUT WITH
REGARD TO HOW CLIMATE CHANGE
MIGHT BE AFFECTING PREGNANT
WOMEN TO ALTER OFFSPRING
OUTCOMES REALLY RESONATED WITH
ME.
I WORK WITH INFECTIOUS DISEASES
AND WE DO WORK IN HUMANS BUT WE
ALSO THEN TRY TO TURN TO SOME OF
OUR ANIMAL MODELS TO TRY TO MORE
MECHANISTICALLY INVESTIGATE HOW
INFECTION DURING PREGNANCY
ALTERS OFFSPRING OUTCOMES AND
WHETHER IT'S BEEN ZEKEA,
INFLUENZA, MORE RECENTLY WORK
WE'RE DOING WITH SARS-COV-2 A
LOT OF WHAT YOU DESCRIBE CAN
SMALL GUESTATIONAL AGE, WE
OBSERVE NEURAL BEHAVIORIAL
DEFICITS IN OUR ANIMAL MODELS,
WE'RE EVEN SEEING DEFICITS IN
IMMUNITY TO CHILDHOOD VACCINES
IN OUR ANIMAL MODELS WHEN
OFFSPRING HAVE BEEN EXPOSED TO
THESE INFECTIONS.
SO I GUESS I'M JUST LOOKING FOR,
YOU KNOW A COMMENT OR SOME KIND
OF INSIGHT.
I STARTED TO WONDER, YOU KNOW
DOES CLIMATE CHANGE ADD THIS 1-2
PUNCH?
DO WE START TO SEE THAT THIS
IMPACT OF INFECTION AND WE'VE
KNOWN THIS AND THIS WAS
DOCUMENTED EVENT DURING THE 1918
FLU PANDEMIC HAS SOME OF THESE
ADVERSE PREGNANCY OUTCOMES, BUT
WHEN YOU START TO SEE MORE OF
THIS AS A RESULT OF CLIMATE
CHANGE, FURTHER ADDING TO THIS
COMPLICATION OF INFECTION AND OF
COURSE I'M THINKING ABOUT IT
BECAUSE WE'VE JUST COME OUT OF A
PANDEMIC.
>>WELL THATIA A MULTIFACETED
QUESTION.
SO OF COURSE WITH CLOIMATE
CHANGE YOU'RE GOING TO BE SEEING
INCREASED INCIDENCE OF CERTAIN
INFECTIONS FROM VIRUSES AND
BACTERIA, INFECTIONS OF THINGS
THAT MAY NOT BE ASSOCIATED WITH
CERTAIN PARTS OF THE COUNTRY BUT
AIDATIONALLY, WITH CLIMATE
CHANGE, YOU HAVE VARIATIONS AND
ENVIRONMENTAL EXPOSURES, THERE
MAY BE DISTRIBUTIONS OF
ENVIRONMENTAL EXPOSURES AND FOR
EXAMPLE, SOME OF OUR
INVESTIGATORS HAVE DETERMINED
THAT PFAS, AND PFAS DESCROWKS IS
A RESULT OF A WEATHER RELATED
COMMENT EVENT CAN SUPPRESS THE
IMMUNE SYSTEM.
AND SO THEY COULD COMPROMISE THE
ABILITY TO AMOUNT A POSITIVE
RESPONSE TO A VACCINATION EVENT.
SO THERE ARE JUST LOTS OF THINGS
GOING ON, DO YOU HAVE GENE
ENVIRONMENT EEIVELGTS YOU HAVE
INCREASED TRANSMISSION OF
INFECTIOUS AGENTS AND THIS
INTERACTION WITH THE
ENVIRONMENTAL EXPOSURES THAT
WOULD BE WORKING SINNER GESTICLY
WITH THE ENVIRONMENT OF THE
INFECTIOUS AGENTS, SO THERE'S A
MULTIFASCINATING QUESTION BUT
DOES THIS GET TO THE POINT OF
ARE ADDRESSING WHAT YOU ARE
ASKING.
>>YEAH, IT'S JUST, YOU KNOW I
GUESS I'M EVEN WONDERING ARE
THERE INVESTIGATORS LOOKING AT
HOW SOME OF THESE CHANGES IN
ENVIRONMENTAL EXPOSURES AS A
RESULT OF CLIMATE CHANGE
INTERSECT WITH INFECTION TO
FURTHER ALTER PREGNANCY OUTCOMES
INCLUDING LONG-TERM OUTCOMES ON
OFFSPRING.
>>YEAH, I SEE THAT GWEN HAS
JUST UNMUTED HERSELF, SO GO
AHEAD.
>>MY ANSWER TO QUESTION IS IT
THERE ARE THERE ARE NOT ENOUGH
AND I THINK YOU'VE IDENTIFIED
SOME VERY RELEVANT INTERSECTING
HYPOTHESIS WE THINK ABOUT THIS
IN THE SYSTEMS AND EVERYTHING
YOU DESCRIBE INTERACTS WITH EACH
OTHER, SO COMMUNITIES THAT MOST
AT RISK FOR ONGOING IMPACTS OF
CLIMATE AND NEED TO CONSIDER
WHAT THE FUTURE CLIMATE IMPACTS
MIGHT BE ALL HAVE ENVIRONMENTAL
EXPOSURES, ENVIRONMENTAL JUSTICE
PROBLEMS PEOPLE WHO HAVE
CORMORBID CONDITIONS THEY ALIGN
WITH LOTS OF COMMUNITIES THAT
WE'RE VULNERABLE DUE TO COVID,
SO, YEAH, WE NEED MORE PEOPLE TO
STUDY THIS AND OUR NOSI UP THERE
IS 1 WAY FOR US TO GET STARTED
LETTING THE COMMUNITY KNOW THAT
WE WOULD LOVE TO SEE MORE
APPLICATIONS ABOUT YOU WE ALSO
THINK IT'S PRETTY COMPLICATED
AND WILL PROBABLY NEED TO BRING
NEW PEOPLE TO THE TABLE LIKE
CLIMATE SCIENTISTS AND OTHER WHO
IS CAN REALLY WORK TOGETHER WITH
A TEAM,A PROACH AND HOPE TO BE
ABLE TO BUILD CENTERS OR OTHER
KINDS OF TEAM SCIENCE ACTIVITIES
IN THE FUTURE.
>>THANK YOU.
>>ALSO KEEP IN MIND, ALL THOSE
INDIRECT EFFECTS OF CLIMATE
CHANGE INCLUDING, I MEAN I CAN'T
IMAGINE THE PSYCHOSOCIAL STRESS
WITH THE FAMILIES AND
INDIVIDUALS IN PUERTO RICO, I
MEAN GOING, I DON'T KNOW, DO
THEY HAVE POWER YET?
I CAN'T EVEN IMAGINE WHAT THE
PSYCHOSOCIAL STRESS IS AND HOW
IT'S AFCING THEM AND HOW IT'S
COMPROMISING THEIR IMMUNE SYSTEM
WHICH CAN MAKE THEM MORE
SUSCEPTIBILITY TO INFECTIOUS
AGENTS.
SO IT'S SO MULTIFACTORIAL.
IT'S A COLLABORATIVE EFFORT AND
WE HAVE TO ADDRESS ALL OF THESE,
FROM SMOKING TO WILDFIRES,
HURRICANES, YOU KNOW NOT ONLY
WIND TISSUE CULTURE MEDIA BUT
THE FLOODING ASSOCIATED WITH
HURRICANES AND DISTRIBUTION,
THERE ARE--WHEN YOU LOOK AT
STATISTICS IT'S REMARKABLE HOW
MANY OF THESE SUPER FUN SITES
ARE LOCATED IN A PLACE WHERE
THEY'RE POTENTIALLY AT RISK OF
FLOODING AND THE DISTRIBUTING
SOME OF THESE AGENT INTOS THE
SURROUNDING COMMUNITIES AND THEN
OF COURSE THE NET EFFECT IN THE
END IS YOU HAVE NOW IN MANY
COMMUNITIES OF COLOR THAT DON'T
HAVE THE OPTION OF MOVING INTO A
NONFLOOD PLAIN AREA, YOU KNOW
THEIR HOMES ARE POTENT IMRALLY
GOING TO BE FULL OF MOLD AS A
RESULT OF FLOODING SO WE HAVE
STOD THESE EFFECTS SO LOTS OF
DIFFERENT THINGS SO THANKS FOR
YOUR QUESTION, IT WAS REALLY
APPRECIATED.
>>THANK YOU SABRA, LOOKS LIKE
DR. ROBINSON ALSO HAS A
QUESTION.
THERE SHE IS,.
>>YEAH, THANK YOU FOR A VERY
INFORM PFAATIVE PRESENTATION,
YOUR WORK CLEARLY CUTS ACROSS A
LOT OF WHAT MOST OF US DO SO MY
QUESTION IS A LITTLE BIT OF AN
EXTENSION OF SABRA'S QUESTION,
TYPICALLY WE LOOK AT DISEASE AND
OUTCOMES AND WE MOVE TO
PREVENTION BUT AT THE INDIVIDUAL
LEVEL, WHAT ARE THINGS THAT ARE
BEING DONE OR PRACTITIONERS CAN
ADVICE THEIR PATIENTINGS IN A
PREVENTION MODE BECAUSE
INDIVIDUALS CAN BE THE CONTROL
THE CLIMATE WE KNOW THERE ARE
FAR REACHING IMPACTS SO WHAT DO
WE TELL PEOPLE AT THE INDIVIDUAL
LEVEL, IS THERE WORK DONE THERE,
ARE THERE PREVENTION TECHNIQUES
WE CAN GIVE PATIENTS AND IS
THERE MORE WORK TO BE DONE IN
THAT AREA?
WELL, I WILL ASK FOR DR. COLLMAN
TO WEIGH IN HERE BUT AS A
COMMUNITY WHAT CAN WE DO TO
PROMOTE RESILIENCE WITHIN
COMMUNITIES, ALSO 1 OF THINGS
BROADLY ACROSS THE VIERPTAL
HEALTH SCIENCES IS GETTING
MESSAGING TO POSITIONS, WHAT DO
PHYSICIANS TELL THEIR PATIENTS,
FOR EXAMPLE, ABOUT FFAS, PFAS IS
IN THE NEWS SO WHAT DO WE TELL
PEOPLE, PATIENTS ABOUT FFAS
EXPOSURE, FOR EXAMPLE IF YOU ARE
MEG PRABT YOU DON'T WANT TO GO
SPRAYING THOSE PFAS CHEMICALS ON
YOUR HIKING BOOTS AND BREATHING
THOSE VAPORS IN, SO CREATING
THOSE MESSAGES ABOUT VIERMAL
EXPOSURES AND HEALTH IS THE
SECOND THEME OF OUR STRATEGIC
PLAN, BECAUSE PACKAGING UP THE
INFORMATION, THE HEALTH RISKS
THAT WE'RE AWARE OF, YOU KNOW
PREVENTION STRATEGIES THAT WE
CAN DEPLOY, AND THEN CREATING
MESSAGES FOR PHYSICIANS.
I MEAN 1 OF THE GREAT
FRUSTRATIONS I HAVE IS THAT MOST
PHYSICIANS NEVER ASK THEIR
PATIENTS WHERE DO YOU LIVE AND
WHERE DO YOU WORK.
SO WE NEED TO CHANGE THAT.
WE NEED TO START GETTING
PHYSICIANS TO ASK THE QUESTIONS
SO THAT THEY CAN BE MORE AWARE
OF POTENTIAL ENVIRONMENTAL
EXPOSURES THAT CAN IMPACT HUMAN
HEALTH.
NG WEENK I SEE YOU UNMUTED, DO
YOU WANT TO ADD TO THIS?
>>WELL, DOCTOR, I NOTICED THE
TIME HERE AND I WANT TO BE
RESPECTFUL OF YOUR AGENDA YOU
CAN DECIDE IF YOU WANT ANOTHER
ANSWER TO THEY--THE SO IF YOU
WANT TO MOVE ON.
>>THANKS SO MUCH GWEN IF WE
COULD LET THE DOCTOR ASK HER
QUESTION AND CLOSE OUT THIS
SECTION.
THANK YOU SO MUCH GWEN FOR YOUR
GRACE, THERE, DID YOU HAVE A
QUESTION?
>>YES, GOOD MORNING, EVERYBODY,
SO MY QUESTION IS, ACTUALLY PART
OF THE DISCUSSION THAT JUST TOOK
PLACE, I WAS WONDERING WHAT
NIEHS IS DOING ENCOURAGING
MEDICAL SCHOOLS, NURSING SCHOOLS
TO ACTUALLY TRAIN HEALTHCARE
PROVIDERS WHO ARE IN TRAINING,
YOU KNOW AND TRAIN THEM INTO
ENVIRONMENTAL HEALTH ISSUES?
BECAUSE I THINK AT THIS POINT
WHERE IT'S BECOMES ALMOST LIKE
EXSTENTIAL ISSUE FOR EVERYONE IN
THE WORLD ACTUALLY, IT'S REALLY
VERY IMPORTANT TO START TRAINING
OUR HEALTHCARE PROFESSIONALS
WHEN THEY ARE IN TRAINING.
SOY I WILL STOP HERE.
>>I WILL START OFF BY SAYING WE
HAVE SPECIFIC PROGRAMS, GWEN DO
YOU WANT TO CHIME IN HERE, WE
HAVE SPECIFIC PROGRAMS WHERE WE
GET IN AND TRAIN PEDIATRICIANS
AND HEALTHCARE PROFESSIONALS.
JUST OVER ALL INCREASING THE
AWARENESS THAT THE ENVIRONMENTAL
EXPOSURES MAKE PEOPLE 6.
AND IT'S NOT JUST THOSE GENE
VARIANTS THAT THEY INHERIT IN
THEIR PARENTS ALONG THE LINES OF
THE PRECISION MEDICINE PROGRAM,
BUT BRINGING BRINGING
ENVIRONMENTAL EXPOSURES AND
FACTORING IT INTO THE EQUATION,
SO IT'S BEEN A PASSION OF OURS
AND A PERSONAL PASSION OF MINE
IS REALLY BRINGING ENVIRONMENTAL
EXPOSURES INTO STUDYING THE
ETIOLOGY OF HUMAN DISEASE.
O GWEN DO YOU WANT TO TALK ABOUT
THESE SPECIFIC PROGRAMS?
>>SO ONLY THING I WOULD ADD IS
NIH LAUNCHED PEDEIATED RICK AND
REPRODUCTIVE FELLOWS PROGRAM,
SCHOLARS PROGRAM THAT IS TO
PROVIDE TRAINING AWARENESS.
WE WORK COLLABORATIVELY WITH THE
CDC AND EPA ON PEDIATRIC
ENVIRONMENTAL HEALTH SPECIALTY
UNITS WITH LONG STANDING WORK IN
THE CHILDREN'S ENVIRONMENTAL
HEALTH SPACE, IN MANY OF OUR
CENTERS PROGRAMS AT THE
INSTITUTE WE EMBED WITHIN THEM
THE OPPORTUNITY FOR PHYSICIANS
OR OTHER HEALTH PRACTITIONERS
NOT JUST PHYSICIANS, YOU KNOW
COMMUNITY HEALTH WORKERS,
[INDISCERNIBLE], NURSES, AND
EVEN PHARMACISTS, YOU KNOW IN
THIS WHOLE GAMUT OF BUILDING
AWARENESS.
SO WE SEE THAT AS IMPORTANT
STAKEHOLDERS AND INTEGRATED IN
THAT, AND OF COURSE WE HAVE
TRADITIONAL TRAINING GRANTS.
OFTEN TIMES WE DO HAVE
PHYSICIANS WHO ARE INTERESTED IN
THE RESEARCH TRAINING ASPECTS
AND MOVE HERE, BUT ACTUALLY LONG
TIME AGO, WE HAD A PROGRAM THAT
WAS SPECIFICALLY BUILDING
CURRICULA WITHIN MEDICAL SCHOOLS
AND YOU KNOW THAT WAS 20 YEARS
AGO.
SO MAYBE WE WERE AHEAD OF THE
CURVE, AND IN SOME OF THOSE
PROGRAMS, THESE THINGS HAVE
CONTINUED TO FLOURISH AND MORE
UNIVERSITIES HAVE REALIZED THE
PERSON OF ENVIRONMENTAL EXPHELGT
HAVE INCLUDED THEM IN THE
CURRICULA.
WE WORK CLOSELY WITH MEDICAL
SOCIETIES, PEDIATRICS ACADEMY
AND THE CLIMATE CHANGE SPACE,
THERE ARE QUITE A NUMBER OF
ORGANIZATIONS POPPING UP WITHIN
THESE AND IN BETWEEN THESE TO
REALLY WORK ON THE ISSUE OF
PHYSICIAN KNOWLEDGE BASE AND
THEM BEING RARE INFLUENCERS AND
PRACTITIONERS WHO CAN PUSH THE
SUSTAINABILITY GOALS AND CLIMATE
CHANGE AGENDA WITHIN THEIR
SPHERES OF INFLUENCE, SO, I
THINK IT'S--IT'S--WE'RE HAPPY
ABOUT THAT AND WE IN OUR CLIMATE
CHANGE PROGRAM ARE TRYING TO
LEVERAGE ALL OF THOSE
OPPORTUNITIES AND BUILD
PARTNERSHIPS WITH THOSE NEWLY
EMERGING GROUPS.
THANK YOU FOR YOUR WORK - AND WE
APPRECIATE THE SUPPORT THAT THE
ORWH HAS GIVEN TO OUR CLIMATE
CHANGE RECENTLY WITH THE AWARD
OF SUPPLEMENTS.
>>THANK YOU SO MUCH FOR JOINING
US DR. COLLMAN, AND RICK FOR AN
AMAZING WHIRL WIND PRESENTATION,
I DID ASK YOU TO COVER A LOT AND
YOU FOUND A WAY TO DO IT SO
THANK YOU SO MUCH FOR THAT.
WE ARE SO EXCITED THAT THIS
ACCESS ENVIRONMENT COMMITTEE
MEETING HAS ENVIRONMENTAL HEALTH
AS HAY THEME.
IT IS SO IMPORTANT AND BOTH OF
YOU OUGHT LINED WHY IT'S SO
IMPORTANT AND WE REAMLY LOOK
FORWARD TO EXPANDING OUR
COLLABORATION WITH YOU GOING
FORWARD.
WE HAVE A COUPLE IDEAS FROM
THESE QUESTIONS SO GWEN I WILL
BE FOLLOWING UP ON THOSE AND
THANK YOU RICK FOR JOINING US SO
MUCH, WE APPRECIATE YOU BOTH.
>>AGAIN, THANKS FOR THE
OPPORTUNITY.
IT'S MY PLEASURE.
WE LOOK FORWARD TO MORE
CLOOBERATIONS WITH YOU.
YOU ARE DOING A GREAT JOB BY THE
WAY.
I'M REALLY IMPRESSED WITH THE
LEADERSHIP YOU ARE BRINGING TO
THE OFFICE.
THANK YOU RICK, VERY KIND OF
YOU.
THANKS, GWEN.
>>THANKS EVERYONE.
>>BE WELL.
>>SO WITH THAT, WE HAVE A HALF
AN HOUR, LITTLE BIT LESS THAN A
HALF OUR LEFT FOR OPEN
DISCUSSION AND IN RESPONSE TO
YOUR FEEDBACK IN THE PAST WE
OPENED UP DISCUSSION SLOTS, BOTH
IN THE MORNING AND AFTERNOON AND
I WOULD ASK THAT OUR MEMBERS IF
YOU'RE ABLE TO GO AHEAD, I KNOW
WE TOLD YOU TO TURN OFF YOUR
CAMERAS, BUT WE ARE OKAY, IF YOU
WILL PUT YOUR CAMERAS ON FOR THE
DISCUSSION THAT WILL WOULD BE
GREAT TO BE ABLE TO SEE YOUR
BEAUTIFUL FACES, JUST TO BE ABLE
TO INTERACT A BIT MORE DIRECTLY.
SO THANK YOU SO MUCH.
JUST SO SO THRILLED TO SEE OUR
NEW MEMBERS, RETURNING MEMBERS,
YOU ARE ALL NOT SHRINKING
VIOLETS, SABRA WE WOULD NEVER
SAY YOU'RE A SHRINKING VIOLET OR
ANY OF YOU BECAUSE YOU'RE SO
COMMITTED TO THE WOMEN'S HEALTH
AND IN THE MISSION AREA OF YOUR
PARTICULAR DISCIPLINE AND YOUR
ORGANIZATION SO I KNOW THAT YOU
HAVE IDEAS AND THOUGHTS AND
WELCOME DR. SHARP'S DELIGHTED TO
HAVE YOU WITH US, SO THIS PERIOD
OF TIME IS OPEN.
FOR DIGS CUSHION, WE WANT TO
UNDERSTAND WHAT'S ON YOUR MIND,
WHAT YOU THINK ORWH SHOULD KNOW
ABOUT, AND THE CONTEXT OF OUR
MISSION AREAS, INCLUSION,
WOMEN'S HEALTH, SEX, GENDER,
CAREERS AND ANY TOPIC THAT'S A
TOPIC UNDER OUR MISSION IS OPEN.
SO WHO WOULD LIKE TO START?
>>I KNEW IT DR. KLEIN.
>>YOU KNOW I CAN BE THE
REMEMBER ALL OF THE INSTITUTES
WHO ARE ENGAGED IN ORWH PROGRAMS
SO COULD YOU CHOOSE TO REMIND US
IF NIEHS IS 1 OF THE SPONSORING
EN--STRATEGIESITUTES FOR THINGS
LIKE THE SCORE THE BIRCH, THE
RO-1, ANY OTHER OTHER WONDERFUL
OPPORTUNITIES THAT YOU REVIEWED
WITH UTR.
>>GREAT QUESTION AND I THINK
THE ANSWER IS NO FOR THE BIRCH,
AND THE SCORE.
>>I THINK IT'S NO AS WELL.
>>AND I'M JUST DOUBLE CHECKING
TO SEE IF THEY SIGNED ON THE SEX
AND GENDER RO-1 NO.
>>I THOUGHT THERE WAS 1 EXTRA
FOR THE RO-1 AND THE SCORE
AND/OR NIH AS SIGNED UP TO THE
RO-1, YES!
>>SO THATIA GOOD TO HEAR.
>>YEAH.
>>OKAY.
>>YES, RICK,.
>>YES, YOU SIGNED UP.
>>GREAT.
GOOD TO HEAR.
SO MAYBE THIS REALLY STARTS TO
FOSTER MORRESEARCH SPECIFIC IN
THIS AREA.
>>YEAH AND LET ME SABRA LET ME
INTERRUPT YOU BEFORE YOU GO
BECAUSE I JUST PULLED UP THE
DATA AND NIEHS ALSO SIGNED ON TO
THE NEW SCORE RFA.
>>THAT'S CORRECT.
>>YES.
>>YOU GET DOUBLE GOLD STARS.
>>WELL, WE'RE FOLLOWING YOUR
LEADERSHIP.
>>THANK YOU.
>>THANK YOU SABRA, DID YOU WANT
TO EXTEND THAT OR WAS YOUR
POINT-REAM LE THAT THESE
ISSUES--THERE ARE SO MANY ISSUES
THAT ISHT SECTIONAL ANALYSIS
BETWEEN ENVIRONMENTAL HEALTH AND
WOMEN'S HEALTH.
>>ABSOLUTELY.
>>I'M ENCOURAGED TO SEE
ENGAGEMENT WITH THE INSTITUTE TO
FOSTER MORE RESEARCH IN THESE
AREAS AND JUST TO KIND OF, YOU
KNOW SO THAT IT'S JUST NOT ORWH
AND NIEHS AND THAT YOU'RE
LIFTING ALL VOTES AND BRINGING
IN EXTRAMURAL INVESTIGATOR'S
INTO THIS DISCUSSION.
SO THAT WAS MY ONLY--SO,.
>>ABSOLUTELY.
AND AS YOU POINTED OUT EARLIER
WITH YOUR QUESTION, YOU KNOW IN
ORDER FOR PEOPLE TO HAVE THE
OPPORTUNITY TO EXPLORE SEX
DIFFERENCES IN THOSE AREAS,
THERE'S A NEED FOR THEIR TO BE A
FUNDING OPPORTUNITY FOR THEM TO
APPLY TO SO WE DO UNDERSTAND
THAT AND DO WANT TO THANK MY NIH
COLLEAGUES FOR NIEHS COLLEAGUES
FOR THAT AND ALSO, OUR ORWH
OUTREACH TO THEM, TO THEM BEING
THE PRIMARY LEAD FOR THEM ON
THAT END SO IT'S A 2 WAY STREET
AND WE'RE GRATEFUL TO BE WORKING
CLOSELY WITH THEM ON SOME OF
THESE ISSUES BECAUSE IT'S--THE
ISSUES ARE IMPORTANT.
AND SO I WILL MOVE ON TO
DR. HOLGREN WHO HAS HIS HAND UP
PLIGHTLY THERE.
SCOTT?
>>YOU'RE MUTED, SCOTT.
>>THANK YOU JANINE.
I WAS SO PLEASED FOR YOUR
BRINGING UP TONY FAUCI TODAY AND
ALL THE WORK HE'S DONE FOR
WOMEN'S HEALTH AND IT JUST
REMINDS ME OF 1 OF THE PURPOSES
OF MYSELF ON THIS BOARD AND
THAT'S TO CONSTANTLY REMIND THE
GROUP OF THE INTEGRATION BETWEEN
MICROBIOLOGY AND WOMEN'S HEALTH
AND STILL REMAINS RELATIVELY
UNEXPLORED.
I'M GLAD THAT YOU BROUGHT UP
COVID AS AN EXAMPLE.
CERTAINLY, THERE'S A WHOLE
LAUNDRY LIST OF EXAMPLES AFTER
COVID OF HOW INFECTIOUS DISEASE
IMPACTS TREMENDOUSLY IMPACTS
WOMEN'S HEALTH AND OF COURSE,
WITH STUDIES ON THE MICROBIOME,
I MEAN THERE'S MORE PAPERS
COMING OUT ON MICROBIOME THAN
SINCE RECOMBIN ANT DNA.
IT'S A HUGE BUDDING FIELD AND OF
COURSE WE HAVE THE GUT BRAIN
ACCESS, GUT BLADDER ACCESS,
GUT-LUNG, AND ALL OF THESE
THINGS WHEN YOU BRIG DOWN, YOU
CAN REALLY FIND INTRICATE
CONNECTIONS WITH WOMEN'S HEALTH.
FOR EXAMPLE, PATIENTS OF HISTORY
WITH RECURRENT UTI ARE WALKING
AROUND WITH DECREASED DIVERSITY
OF THE MIKE ROY BIOME AND 1 OF
THE IT PURPOSE EVER THE
MICROBIOME IS TO PREVENT
PATHOGENS FROM GETTING IN, SO
IT'S REALLY A SYNDROME,
NONAPOPTOTIC THE JUST--IT'S NOT
JUST--IT'S A SEPARATE SYNDROME
AND EVEN 1 OF THE SPEAKERS
BRINGING UP NEURODEGENERATIVE
DISORDERS, PARKINSONS AND SO
FORTH, THERE'S PAPER COMING OUT
DEMONSTRATING A LINK BETWEEN
BACTERIAIAL INFECTION AND THINGS
LIKE PARKINSONS BACTERIA MAKE
AMLLOYDS, THE SAME STRUCTURE AS
AMLLOYDS THAT IMPORTANT
NEURODEGENERATIVE
PATHOPHYSIOLOGY AND THERE'S
PAPERS COMING OUT SHOWING THAT
THOSE BACTERIAL AMLLOYDS IN THE
GUT CAN NUCLEATE AMLLOYDS AND
THEY CAN STRAFUL UP THE VAGUS
NERVE TO THE ENTERTAIN STEM AND
EXACERBATE PARKINSONS SYMPTOMS,
SO I DON'T KNOW MY GOOD FRIEND
STANLEY FAL, KREBS CYCLE O SAYS
THAT ALL THINGS COME DOWN TOIN
FECTIOUS DISEASE SO I WANT TO
COMMEND ORWH ON DOING A
WONDERFUL JOB OF SUPPORTING THIS
AREA AS YOU'VE DONE HAD
HISTORICALLY AND MY LITTLE THING
HERE IS JUST TO THANK YOU AND
REMIND EVERYBODY OF THE
OPPORTUNITY THERE.
>>THANKS SCOTT.
I THINK THE PANDEMIC HAS
UNFORTUNATELY REVEALED HOW MUCH
MORE WE DON'T KNOW THAN WE
THOUGHT WE DIDN'T KNOW ABOUT
INFECTIOUS ORGANISMS AND THEIR
ISHT ACTION WITH THE ENVIRONMENT
AND RICK PUT A COMMENT HO IN THE
CHAT ABOUT HOW ENVIRONMENTAL
IMPACTS AFFECT THE MICROBIOME AS
WELL.
AND YOU KNOW LINDSAY TALKED
EARLIER ABOUT HOW COMPLICATED
SOME OF THESE SYSTEMS ARE AND
THE FACT THAT WE REALLY MUST BE
DESIGNING AND DEVELOPING MUCH
MORE COMPLEX AND NUANCED
STRATEGIES TO BE ABLE TO
INCORPORATE AND EVALUATE MORE
DATA WHETHER IT'S SOCIAL
DETERINANTS OF HELT DATA OR
MICROBES OR EPIGENETIC
MOLDIFICATIONS OR INTERACTIONS
AT DIFFERENT STAGES OF THE LIFE
COURSE AND 1 OF THE REALS THAT
WE PLAY AND I WOULD LO OF TO
HEAR FEEDBACK FROM YOU ALL ON
THIS, BECAUSE PART OF OUR ROLE
IS INTEGRATING AND CONNECTING
THE DOTS ACROSS THE 27
INSTITUTES AND CENTERS HERE,
THAT ARE ALL DOING AMAZING WORK
IN WOMEN'S HEALTH IN THE CONTEXT
OF THEIR MISSION AREAS AND AS WE
MOVE FORWARD TO DEVELOP THE
STRATEGIC PLAN, YOU WILL SEE
FROM THE PRESENTATION THIS
AFTERNOON WE WANT TO HEAR FROM
YOU IN TERMS OF ALL OF THOSE
MANY TOPICS, WHICH OF THEM DO WE
NEED TO PRIORITIZE, OKAY?
BECAUSE THERE'S SO MUCH WORK TO
BE DONE WHICH ARE SPECIFIC
POISED TO MOVE FORWARD WITH
STRATEGIC FUNDING.
WE ARE COMPLIMENTARY TO THE
ICs, WE TROO TO BE CATALYTIC,
WE TRY TO ADDRESS AREAS THAT
FALL BETWEEN THE CRACKS, TOPICS
THAT CROSS ICs, SO I WOULD
LOVE TO HEAR YOUR FEEDBACK ON
THAT IF ANYONE HAS COMMENTS
ABOUT KIND OF THE POSTURE THAT
ORWH WILL BE TAKING AS WE MOVE
FORWARD THERE BECAUSE THESE
ISSUES ARE COMING AUTOPSY AS WE
RECEIVE RESPONSES FROM THE
REQUEST FOR INFORMATION TO AND
FOR THE NEXT STRATEGIC PLAN?
OTHER COMMENTS?
SO SABRA, I WILL ASK YOU TO GO
AHEAD SINCE YOU'RE--
>>WELL, JUST FOLLOWING OFF ON
SCOTT'S COMMENT, I'VE NOTED THAT
THE NATIONAL INSTITUTE OF ALLERG
EXPE INFECTIOUS DISEASES HAS NOT
TYPICALLY BEEN A FUNDER OVER THE
YEARS OF THESE INITIATIVES AND
KIND OF BUILDING ON YOUR
PRESENTATION AND YOUR COMMENTS
ABOUT WHAT THE COVID-19 PANDEMIC
HAS REVEALED.
IT MIGHT BE A VERY IMPORTANT
OPPORTUNITY TO ENGAGE OUR
COLLEAGUES THERE WHO HAVE FUNDED
THIS TYPE OF RESEARCH INCLUDING
MY OWN RESEARCH IN OTHER
CAPACITIES, OTHER CENTERS OF
EXCELLENCE, BUT, YOU KNOW, I SEE
AN OPPORTUNITY.
, RIGHT.
GREAT, GREAT POINT, NIAID
ACTUALLY HAS ROBUSTLY SUPPORTED
THE RO-1.
THE SEX AND GENDER RO-1 AND
DR. HUNTER IF YOU WANT TO WEIGH
IN ON THE CHAT, THAT'S PERFECTLY
FINE, SEVERAL IN THE FIRST
ROUND, BUT IT IS AN EMERGING
AREA AND I THINK THERE'S ROOM
FOR GROWTH FOR SURE, SO THANK
FOR THAT.
OTHER COMMENTS OR OTHER TOPICS
STILL HAVE TIME BEFORE LUNCH.
IS THAT YOUR OLD VIRTUAL HAND OR
NEW VIRTUAL HAND?
IT'S AN OLD VIRTUAL HAND.
>>IT'S A NEW VIRTUAL MACHINE
YELL HAND, OKAY, GO AHEAD.
>>REAL QUICKLY SINCE I TOOK A
LOT OF TIME TO ANSWER YOUR
QUESTION, I WOULD JUST ADVISE TO
CONTINUE TO ALWAYS TRY TO STAY
AHEAD OF THE CURVE, LIKE YOU'VE
ALWAYS DONE WHEN THESE STORE
SCORES FIRST CAME OUT ABOUT
HAVING TO HAVE A MIXTURE OF
CLINICAL AND BASIC SCIENCE, THAT
WAS AHEAD OF THE CURVE AND YOU
GUYS ARE--YOU HISTORICALLY
HAVE--WE NEED YOU BEHIND US TO
DO THAT, THAT'S GREAT.
AND WE'RE UP FOR THE CHALLENGE.
THE HEALTH OF WOMEN, I SHOWED
THAT DATA THAT REDUCTION AND
LIFE EXPECTANCY DATA, I DIDN'T
SHOW YOU THE OLD DATA BECAUSE
I'VE SHOWN IT TO YOU SO MANY
TIMES, I DON'T WANT TO KEEP
TAKING IT OUT ON MY TALKS BUT
IT'S JUST SO DISTURBING, YOU
KNOW, THE LIFE EXPECTANCY OF THE
U.S. WOMEN COMPARED TO PEER
COUNTRIES WAS ALREADY GOING
DOWN.
THE LAST 2 YEARS WITH COVID AND
THEN MATERNAL MORTALITY DATA,
YOU KNOW, IT JUST SPEAKS TO THE
NEED FOR DOING THINGS
DIFFERENTLY, BECAUSE, THERE'S
INCREDIBLE URGENCY AND THE PAPER
THAT A COUPLE OF MY COLLEAGUES
AND I HAVE WROTE IN THE
BEGINNING OF THE PANDEMIC CALLED
THE MATERNAL MORTALITY CRISIS
WITH THE COVID-19 CRISIS, A
COLLISION OF CRISIS AND IT SEEMS
THAT THERE'S STILL SO MUCH WORK
TO BE DONE THERE.
OTHER THOUGHTS ABOUT OTHER
TOPICS THAT WE HAVEN'T ADDRESSED
THUS FAR THAT YOU THINK SHOULD
BE ON OUR RADAR OR ANY FEEDBACK
ON ANY OF OUR PROGRAMS, THE NEW
PROGRAMS OR THOUGHTS, AND
DR. HUNTEDDER DID AND YOU WILL
ASSIGNED TO THE SEX AND GENDER
RO-1 AND THEY CO FUNDED SERL
APPLICATIONS WITH ORWH FR THE
LAST ROUND SO THEY'RE COMMENTS
ON QUESTIONS OR COMMENTS?
EMPLOY DID.
>>DR. ROBINSON HAS A QUESTION.
>>THANK YOU,.
>>DR. ROBINSON?
>>IT'S OKAY, THAIRNG YOU, I WAS
TRYING TO THINK IF YOU HAD SEEN
THIS TOPIC AND MAYBE IF I HAD
FOR THE BENEFIT OF THE NEW
MEMBERS, BUT SO MUCH HAS BEEN
TALKED ABOUT AROUND PERSONALIZED
HEALTH AND PRECISION MEDICINE
AND THE INTERSECTION THAT THAT
HAS WITH A LOT OF THE WORK WE
DO, I DON'T REMEMBER SEEING THAT
TOPIC SO DON'T KNOW IF THAT WAS
SOMETHING FOR THE RADAR FOR THE
FUTURE, THERE IS A LOT OF
DEVELOPMENTS THAT WILL BE
RELEVANT AND TELL BE SUCH AN
INTERESTING TALK.
>>THANK YOU SO MUCH ROCHELLE,
SO WHEN THE PRECISION MEDICINE
INITIATIVE FIRST STARTED SOME
ADMINISTRATIONS AGO, THERE WAS
INFORMATION ABOUT HOW SEX AND
GENDER SHOULD BE EMBEDDED INTO
PRECISION MEDICINE AND THE
INITIATIVES, SO AS WE MOVED
FORWARD THROUGH THE YEARS, THAT
HAS MORPHED INTO ALL OF US
PROGRAM, AND I'M PRIVILEGED TO
BE ON THE BRAIN TRUST FOR ALL OF
US AND SO PART OF THE GROUP OF
ICO DIRECTORS THAT HAVE THE
OPPORTUNITY TO COLLABORATE WITH
THE LEADERSHIP OF ALL OF US TO
CONTRIBUTE AND SO SEX AND GENDER
CONSIDERATIONS WE'VE BEEN
WORKING BEHIND THE SCENES TO GET
THOSE EMBEDDED INTO WHAT ALL OF
US HAS BEEN PUTTING FORWARD.
THE PHRASE THAT I USE IS THAT
CONSIDERATION OF SEX IS--SHOULD
BE THE FIRST STEP ON THE ROAD TO
PRECISION MEDICINE IT'S
PRETTY--IT'S AN OVERSIGHT TO
STEP OVER THAT STEP ON YOUR
JOURNEY TO THE GENETIC LEVEL SO
WHAT'S HAPPENING IN A PARTICULAR
GENE OR OTHER MICROLEVEL
ULTIMATE GOALERATION THAT CAUSES
DISEASE IS VERY LIKELY, MORE
LIKELY THAN NOT TO BE INFLUENCED
BY THE CHROMOSOMAL COMPLEMENT
SEX AND THE GENDERED EXPERIENCE
OF THAT INDIVIDUAL WE'RE MISSING
AN OPPORTUNITY TO BETTER
UNDERSTAND HOW THESE PRECISION
MEDICINE TARGETS PLAY OUT AND I
THINK AWLG THE PRESENTERS--ALL
THE PRESENTERS TODAY HAVE EACH
IN THEIR OWN WAY HIGHLIGHTED HOW
CRITICAL IT IS TO INTEGRATE ALL
OF THESE INPUTS INTO OUR HEALTH.
I MEAN RICK'S FIRST COUPLE
SLIDES, YOU KNOW AND HIS FIRST 5
MINUTES OF REMARKS WERE JUST, HE
ELOQUENTLY OUTLINED HOW ALL OF
THESE PIECES ARE AFFECTING OUR
HEALTH AT THE SAME TIME AND SO,
UNIDIMENSIONAL STRATEGIES WHERE
WE LOOK AT 1 AND THEN WE LOOK AT
ANOTHER AND WE LOOK OVER TIME
AND DO META-ANALYSIS, YOU KNOW
THEY'RE JUST NOT ENOUGH FOR THAT
INTEGRATION, SO MICHELLE,
APPLICATIONS ABSOLUTELY.
AND AND 1 OF THE STRATEGIES TO
ADVANCE THOSE CONVERSATIONS IN
THAT CONTEXT IS THROUGH
INVESTING IN THESE EDUCATIONAL
MATERIALS AND THE RESOIRSS.
YOU PROBABLY HAVE NOTICED
CALIFORNIA BE THERE AT SOMETIME
THAT EVERY TIME WE MEET, WE HAVE
A LITTLE BIT OF SOMETHING NEW TO
TELL YOU ABOUT---SO THE QUESTION
ABOUT EDUCATING MEDICAL STUDENTS
AND TRAINEES AND CLIMATE CHANGE
AND WOMEN'S HEALTH, THAT IS
SOMETHING WE MIGHT BE ABLE TO
ADDRESS THROUGH OUR
INTERPROFESSIONAL EDUCATIONAL
MATERIALS SO THAT WILL BE OTHER
THOUGHTS ON THAT?
FROM ANYONE?
AND RICK ALSO ADDED THE
PRECISION ENVIRONMENTAL HEALTH
ACTIVITIES AND NIEHS IS WORKING
WITH THE ALL OF US LEADERSHIP TO
BRING ENVIRONMENTAL EXPOSURES
INTO THE ALL OF US FRAMEWORK,
THANK YOU SO MUCH RICK AND THAT
WILL INCLUDE IMPACTS OF
ENVIRONMENTAL EXPOSURES ON
WOMEN'S HEALTH INCLUDING GENETIC
BACKGROUND.
SO YOU'RE ABSOLUTELY RIGHT AND I
APPRECIATE YOU BRINGING IT BACK
UP SO IT COULD BE TOP OF MIND AS
WE THINK GOING FORWARD
ESPECIALLY GOING FORWARD IN HOW
WE FORMULATE THE NEXT NIH WIDE
STRATEGIC PLAN FOR WOMEN'S
HEALTH.
OTHER COMMENTS?
>>I HAVE A QUICK COMMENT.
AND IT'S--YOU KNOW WHEN WE
STARTED THE Q&A, YOU MENTIONED
WE ARE LOOKING FOR ADVICE OR
COMMENTS ON WHAT ORWH POSTURE
SHOULD TAKE OR FOCUS SHOULD BE
ON AND HAVING BEEN ON THIS
AMAZING ADVISORY COMMITTEE FOR
SEVERAL YEARS NOW, I REMEMBER
THINKING IN THE BEGINNING, THAT
WAS WEARY TO GET TOO DILUTE AND
SO WHEN JANINE, YOU WERE
THINKING ABOUT WE SHOULD ALSO
THINK ABOUT WOMEN AS SCIENTISTS
AND I CAME INTO THIS WITH THE
SEX AND GENDER, YOU KNOW HELMET
ON AND THEN, YOU KNOW EVERY
TIME, I'M SEEING ALL OF
THESE--YOU KNOW ALL THESE
PRESENTATIONS TODAY IT'S REALLY,
REALLY AWESOME THAT IT'S
BECOMING SO INTEGRATED AND WE
ARE EMBRACING THE COMPLEXITY OF
IT AND SO, IT'S MORE OF A
COMMENT THAT I'M SO EXCITED TO
SEE THAT ALL OF THESE
PRESENTATIONS AND OTHER ICOs
ARE MICKING THIS PART OF WHAT
THEY'RE DOING AS WELL.
SO I THINK, WE SHOULD CONTINUE
TO PROMOTE THAT AS AS THE ORWH'S
STANDPOINT.
I'M SNOT SURE ABOUT
FOCUSING--I'M NOT SURE ABOUT
FOCUSING ANYTHING ANYMORE WHEN
WE FINALLY HAVE EVERYBODY
LOOKINGA THE IT, AT THEIR
SCIENCE THROUGH THIS LENS.
SO I JUST BRING THAT UP FOR
DISCUSSION.
THANKS ALLYSON AND I THINK THAT,
YOU KNOW THAT MAY PLAY OUT A BIT
AS WE MOVE FORWARD, WITH THE
NEXT BIENNIAL REPORT, I AM
ALWAYS, SO DELIGHTED AND I
LEARNED SO MUCH FROM THE
INSTITUTES WHEN THEY SUBMIT
THEIR REPORTS ON WOMEN'S HEALTH.
A BIT CONCERNED THAT WE WILL
ADAPT TO THAT FORM AT AS WE MOVE
FORWARD BUT YOU KNOW, IT'S
VARIABLE IN TERMS OF HOW EACH IC
ADDRESSING THIS, BECAUSE THE
SCIENCE THAT THEY'RE SUPPORTING
IS VARIABLE, THE PRYERITYS ARE
VARIABLE, THE INSTITUTE
DIRECTORS HAVE THEIR OWN
APPROACHES TO THEIR INSTITUTES
AND CENTERS ABOUT YOU I HAVE TO
SAY, IT'S A PLEASURE TO WORK
WITH EACH AND EVERY 1 OF THEM TO
BE ABLE TO ADVANCE WOMEN'S
HEALTH RESEARCH AND THERE ARE
MANY NEW INSTITUTE AND CENTER
DIRECTORS, SO EACH TIME WE MEET,
I SHARE THE PHOTOS OF THE NEWEST
THAT HAVE COME, AND SO WE'RE
ESPECIALLY EXCITED ABOUT THE NEW
NCI DIRECTOR, WHO IS--HAS A
RECORD OF BEING CONCERNED ABOUT
WOMEN'S SURGEONS AS WELL AS
WOMEN'S CANCERS AND HEALTH
DISPARITIES AND MANY OTHER
ASPECTS THAT ARE IMPORTANT TO
ORWH AND PART OF WHAT I GET TO
DO AND I FEEL IT'S A REAL
PRIVILEGE TO BE ABLE TO
HIGHLIGHT THE AMAZING WORK AT
THE INSTITUTES AND CENTERS ARE
DOING AS I'M OUTSPEAKING.
SO WE WILL CERTAINLY CONTINUE TO
DO THAT AND I THINK WITH THAT WE
CAN GO TO DR. SHARPS, WE'RE
DELIGHTED TO HAVE YOU DR. SHARPS
WITH US TODAY.
>>GOOD MORNING.
VERY PLEASED TO BE HERE AND THIS
IS MY FIRST MEETING AND WHILE
THERE CERTAINLY IS MORE RESEARCH
TO DO, IT'S IMPRESSIVE HOW MUCH
WE HAVE ALREADY LEARNED AND I
PARTICULARLY ENJOYED THE
CONVERSATION IN THINKING ABOUT
COMMUNICATION AND GETTING IT TO
POLICY MAKERS AND CLINICIANS BUT
PART OF DR. WOYCHIK'S
PRESENTATION TALKED ABOUT THE
WOMEN'S HEALTH AWARENESS CENTER
AND PROGRAM.
IT SOUNDS LIKE A COMMUNITY
OUTREACH AND ENGAGEMENT AND
CAPACITY BUILDING AND SO I THINK
THAT THAT'S AN IMPORTANT
STRATEGY TO THINK ABOUT.
WE'RE LEARNING A LOT OF THINGS
THAT INDIVIDUALS AND COMMUNITIES
AND WE KNOW ANOTHER BIG ROLE OF
WOMEN, I MEAN THEY'RE THE GATE
KEEPERS FOR FAMILY HEALTH,
COMMUNITY HEALTH, OFTEN SCHOOL
HEALTH AND SO, IF THERE'S A WAY
TO DEVELOP MECHANISMS THAT
SUPPORT NOT ONLY SCIENTISTS BUT
ALSO REALLY HAVING MEANINGFUL
AND EFFECTIVE ENGAGEMENT WITH
COMMUNITIES AND BUILDING THAT
CAPACITY TO GET THE INFORMATION
OUT AT THAT LEVEL, TOO, I THINK
IT'S SOMETHING WE COULD THINK
ABOUT OR IS IMPORTANT TO THINK
ABOUT.
THANK YOU.
>>THANK YOU SO MUCH DR. SHARPS,
ABSOLUTELY AGREE 100% WITH YOU.
AND WE HAVE SUPPORTED DR. P A
CKEMHAM'S OUTREACH FOR SEVERAL
YEARS AND ACTUALLY I SPOKE AT
HER PROGRAM MOST RECENTLY AND
SHE HAS INCREDIBLE LEVEL OF
ENGAGEMENT IN NORTH CAROLINA AND
PARTNERSHIPS WITH HBCUs AS
WELL AS FRATERNITIES AND
SORORITYS IN THE AREA SO SHE'S
HAS A MACHINE, A WELL OILED
MACHINE THERE THAT WAS LEVERAGED
AND GOT EVEN MORE ACTIVATED WITH
THE PANDEMIC SO THAT'S 1 WAY
THAT WE'RE DOING THAT.
OF COURSE, THERE'S ROOM FOR THAT
IN SO MANY PLACES AND SPACES AS
WELL.
>>I WAS SO EXCITED TO SHARE
WITH YOU THE INFORMATION ABOUT
THE COMPASS INITIATIVES IS IS
WHERE THE COMMUNITY ORGANIZATION
IS THE LEAD.
THEY SUBMIT THE APPLICATION.
THE FUNDING GOES DIRECTLY TO THE
COMMUNITY ORGANIZATION.
IT'S AROUND STRUCTURAL
INTERVENTIONS WHICH ARE SO
CRITICAL TO HEALTH AS WE'VE
LEARNED.
SO I THINK THAT THERE'S
DIFFERENT ASPECTS OF COMMUNITY
HEALTH AND HOW TO ENGAGE AND
WHAT IMPLEMENTATION SCIENCE
LOOKS LIKE AND WHAT COMMUNITY
BASED PARTICIPATORY RESEARCH
LOOKS LIKE BUT THE PRINCIPLES OF
INVOLVING COMMUNITY AND TAKING
THAT AS SERIOUSLY AS ANY OTHER
PARTNER SO WE ARE RIGOROUS ABOUT
HOW WE DO THAT.
THAT WE CO-CREATE PROGRAMS
RATHER THAN AN ACADEMIC CENTER
AND THE COMPASS ORGANIZATION
WILL REACH OUT TO US.
AND WITH THAT OUR IMPROVED
COMMITTEE CHALLENGE IS VERY MUCH
LIKE THAT.
WE'LL HOPE TO BE ABLE TO
ANNOUNCE INFORMATION ABOUT THAT
SOON COMMUNITY ORGANIZATIONS
APPLIED FOR WAYS TO ADDRESS
MATERNAL MORTALITY THROUGH THE
IMPROVED COMMUNITY CHALLENGE.
BUT WE'RE NOW ONE MINUTE OVER.
I WANT TO BE RESPECTFUL OF TIME
AND WE NEED TO DO A PHOTO AND
YOU ALL NEED TO HAVE SOME LUNCH
SO LET ME TURN IT OVER TO
DR. NOURSI.
>>THANK YOU, DR. CLAYTON.
THANK YOU EVERYONE FOR THIS
GREAT MORNING WITH GREAT
DISCUSSION.
SO YES, WE WILL BE BACK AT 1:00.
PLEASE JOIN US AT 1:00 FOR A
STIMULATING PANEL ON
ENVIRONMENTAL HEALTH AS WELL.
WE WILL HAVE ALSO UPDATES TO
GIVE YOU ALL ON WHERE WE ARE
WITH OUR NEXT STRATEGIC PLAN AND
WE'LL HAVE ONE CONCEPT CLEARANCE
AND A DEMONSTRATION OF THE
MODULE.
BUT BEFORE YOU LOG OFF I ASK
THAT ALL COMMITTEE MEMBERS IF
YOU CAN STAY ON PUT YOUR CAMERA
ON SO WE CAN TAKE A GROUP PHOTO.
AND THEN WE'LL SEE I AFTER THAT
AT 1:00.
SO SARA IS OUR VIRTUAL
PHOTOGRAPHER.
>>THAT TOO.
SHE'S GOT MANY HATS.
SO IF YOU CAN KEEP YOUR CAMERA
ON FOR ALL MEMBERS AND SARA TELL
ME OR DR. ANDERSON -- I DON'T
SEE YOUR PICTURE.
>>THERE SHE IS.
GREAT TO SEE YOU.
OKIE DOKE.
I THINK WE HAVE EVERYONE, SARA,
RIGHT?
>>IF EVERYONE CAN SMILE FOR ME.
THREE, TWO, ONE.
GOTCHA.
>>ENJOY YOUR LUNCH WE'LL HAVE A
SLIDE ROTATOR DURING LUNCH IF
YOU TAKE A LOOK AT IT DURING
YOUR BREAK THAT WOULD BE GREAT
BUT WE'LL SEE YOU ALL BACK AT
1:00.
THANK YOU VERY MUCH.
IT'S 1:00 AND I'D LIKE TO
WELCOME YOU BACK AND HOPE YOU
ENJOYED YOUR LUNCH AND THE PHOTO
SLIDE SHOW.
I'D LIKE TO CALL INTO THE
MEETING THIS AFTERNOON AND HAND
IT OFF TO DR. REGINE DOUTHARD TO
INTRODUCE OUR NEXT SPEAKER.
>>THANK YOU VERY MUCH.
GOOD AFTERNOON, EVERYONE.
MY NAME IS REGINE DOUTHARD AND
IT'S MY PLEASURE TO INTRODUCE
DR. KRISTEN UPSON THE CHAIR OF
OUR PANEL AND THE PANEL IS
EPIDEMIOLOGIC CONTRIBUTION TO
UNDERSTANDING THE ENVIRONMENTAL
IMPACT ON WOMEN'S HEALTH.
SHE'S AN ASSISTANT PROFESSOR IN
THE DEPARTMENT OF EPIDEMIOLOGY
AND BIO STATISTICS IN THE
COLLEGE OF HUMAN MEDICINE AT
MICHIGAN STATE UNIVERSITY.
SHE IS AN EPIDEMIOLOGIST WHO'S
RESEARCH INTERSECTS
ENVIRONMENTAL HEALTH WITH HER
RESEARCH PROGRAM FOR
ENVIRONMENTAL STRUCTURES FOR
ENDOMETRIOSIS AND OTHER
DISEASES.
DR. UPSON RECEIVED HER Ph.D. IN
EPIDEMIOLOGY FROM THE UNIVERSITY
OF WASHINGTON AND POSTDOCTORAL
TRAINING AT THE NIH NATIONAL
INSTITUTE OF ENVIRONMENTAL
HEALTH SCIENCES.
SHE IS CURRENTLY THE PRINCIPAL
INVESTIGATOR OF AN NIH R00 FROM
THE STUDY FROM THE NATIONAL
INSTITUTE OF NURSING RESEARCH TO
INVESTIGATE TOXIC METALS AND
UTERINE FIBROID RISK AND WOMEN
THAT MAY INCREASE TOXIC METAL
BODY BURDEN.
DR. UPSON SERVED AS AN ASSOCIATE
EDITOR TO THE HUMAN REPRODUCTION
AND RECEIVED HER EARLY CAREER
RESEARCH EXCELLENCE AWARD FROM
THE MICHIGAN STATE UNIVERSITY
COLLEGE OF HUMAN MEDICINE.
DR. UPSON, WE ARE DELIGHTED TO
HAVE YOU HERE WITH US THIS
AFTERNOON AND THE FLOOR IS
YOURS.
>>THANK YOU VERY MUCH
DR. DOUTHARD FOR THE
INTRODUCTION.
I APPRECIATE THIS OPPORTUNITY TO
CHAIR THIS PANEL AND I'LL GO
AHEAD AND SHARE MY SLIDES.
I REALLY APPRECIATE THIS
OPPORTUNITY TO CHAIR THIS PANEL
ON THE EPIDEMIOLOGIC
CONTRIBUTION TO UNDERSTANDING
ENVIRONMENTAL IMPACT ON WOMEN'S
HEALTH.
ON THIS PANEL I'M JOINED BY
DR. QUAKER HARMON AND DALE
SANDLER FOCUS ON THE GYNECOLOGIC
CONDITIONS OF ENDOMETRIOSIS AND
UTERINE FIBOIDS AND WOMEN'S
HEALTH IN GENERAL.
EACH SPEAKER WILL PRESENT FOR 20
MINUTES FOLLOWED BY FIVE MINUTES
OF Q&A AFTER EACH TALK.
AFTER THE THREE TALKS, WE'LL
SYNTHESIZE THEMES FROM THE TALKS
AND HAVE ALLOWED 15 MINUTES FOR
A Q&A SESSION TO DISCUSS THE
GAPS AND IT WILL BE MODERATED BY
DR. REGINE DOUTHARD.
IN THE CASE OF ENDOMETRIOSIS AND
UTERINE FIBROID LANGUAGE IS
CIS-WOMAN RELATED TERMINOLOGY
BUT WOMEN NOT A UTERUS CAN HAVE
THESE CONDITION AND I'LL SHARE
THE RESULTS FROM OUR STUDY.
ENDOMETRIOSIS IS CHARACTERIZED
BY TISSUE RESEMBLING THE UTERINE
LINING APPEARING OUTSIDE THE
UTERUS USUALLY IN THE PELVIC
CAVITY.
WE CAN SEE LESIONS OVER THE
OVARIES AND DEEP LESIONS WHICH
CAN REPRESENT AS RECTAL VAGINAL
LESIONS AS WELL AS ADHESIONS.
INDIVIDUALS WITH ENDOMETRIOSIS
CAN REPORT CONSIDERABLE PAIN
SYMPTOMS INCLUDING CHRONIC
PELVIC PAIN, PAINFUL MENSTRUAL
PERIODS, PAINFUL BIO MOVEMENTS
AND URINATION AND THIS CAN
INTERFERE WITH DAILY ACTIVITY,
WORK PRODUCTIVITY AND SCHOOL
PERFORMANCE AND PERSONAL
RELATIONSHIPS.
DESPITE THIS, IT'S NOT WELL
UNDERSTOOD WHY IT DEVELOPS IN
SOME INDIVIDUALS BUT NOT OTHERS.
THE MOST WIDELY ACCEPTED THEORY
OF ENDOMETRIOSIS PATHOGENESIS IS
LINING OF THE UTERUS SHED WITH
EACH MENSES LEAD TO THE
IMPLANTATION OF TISSUE AND
ENDOMETRIOSIS.
ANOTHER THEORY IS IT MAY RESULT
FROM LOCAL TISSUE THAT UNDER
GOES CHANGES OR METAPLAGIA.
THE THIRD IS DURING INTRAUTERINE
DEVELOPMENT TISSUE IS MISPLACED
OUTSIDE THE UTERUS AND IT
RESULTING IN ENDOMETRIOSIS.
THOUGH SEVERAL THEORIES ARE
PROPOSED, ONE THEORY IS NOT ABLE
TO EXPLAIN ALL MANIFESTATIONS OF
ENDOMETRIOSIS.
IT'S BEEN SUGGESTS DIFFERENT
TYPES MAY ARISE FROM DIFFERENT
PROCESSES AND SOME FROM TISSUE
OVARIAN TRANSFORMATION.
OTHER FACTORS MAY BE INVOLVED IN
THE DEVELOPMENT ENDOMETRIOSIS
IT'S RECOGNIZED ESTROGEN IS
CENTRAL TO THE DEVELOPMENT OF
ENDOMETRIOSIS AS IT UNDER LIES
KEY PATHOLOGIC PROCESSES.
GIVEN THE DEVELOPMENT OF EST
ESTROGEN COULD BE AFFECTED BY
ENDOCRINE DISRUPTING.
IT'S DEFINED AS AN EXOGENOUS
CHEMICALS OR MIXTURES OF
CHEMICAL INTERFERE WITH ANY
ASPECT OF HORMONE ACTION.
IT'S TEMPTING TO THINK OF THE
SMOKESTACK FROM INDUSTRY.
HOWEVER, ENVIRONMENTAL CAN COME
FROM EVERY DAY PRODUCTS, FOOD I
AIR AND DUST IN OUR HOME
ENVIRONMENT.
FOR EXAMPLE, THE FOOD AND
BEVERAGES WE CONSUME COULD BE
CONTAMI
CONTAMINATED.
BPA IS USED IN CLEAR PLASTIC OF
REUSABLE FOOD AND BEVERAGE
CONTAINERS AND CAN LEACH INTO
FOOD AND WE CAN BE EXPOSED TO
THAT WILL PHTHALATES AND THEY
CAN BE USED AS FRAGRANCE
FIXATIVES AND CAN BE ADDED
FOREIGNING -- SOFTENING
MIXTURES AND IN FLOORS AND
COATINGS.
THIS IS A SNAPSHOT OF THE MANY
ENVIRONMENTAL CHEMICALS WE CAN
BE EXPOSED TO IN OUR DAY TO DAY
ENVIRONMENT.
AND THE GENERAL POPULATION IS
WIDELY EXPOSED TO ENVIRONMENTAL
CHEMICALS.
THIS FIGURE SHOWS IS THE NUMBER
OF ENVIRONMENTAL CHEMICALS
DETECTED IN BIOLOGIC SAMPLES
FROM A NATIONALLY REPRESENTATIVE
SAMPLE OF U.S. PREGNANT WOMEN.
STUDYING ENVIRONMENTAL EXPOSURE
AND ENDOMETRIOSIS IS
CHALLENGING.
ONE OF THE BIGGEST CHALLENGES IS
THAT ENDOMETRIOSIS CAN ONLY BE
DEFINITIVELY DIAGNOSED BY
SURGICAL VISUALIZATION BY A
PROCEDURE CALLED LAPAROSCOPY.
WE DON'T HAVE A WAY TO
NON-INVASIVELY SCREEN AND FOLLOW
INDIVIDUALS FOR THE DEVELOPMENT
COLLECT SAMPLES DURING THE
EXPOSURE WINDOWS PRIOR TO
DISEASE DEVELOPMENT SUCH AS AN
EPIDEMIOLOGIC PERSPECTIVE COHORT
STUDY.
THE CASE CONTROL STUDY DESIGN IS
FREQUENTLY USED.
THE APPROACH TO HOW PARTICIPANTS
ARE SELECTED IS IMPORTANT FOR
ROBUST RESULTS AND MINIMIZING
BIAS KNOWN AS SELECTION BIAS.
IDEALLY WE WANT TO FIRST
IDENTIFY THE STUDY POPULATION.
SECOND, IDENTIFY CASE ARE ARISE
FROM THE STUDY POPULATION.
THIRD, RANDOMLY SAMPLE FROM THE
UNDERLYING STUDY POPULATION TO
SELECT CONTROL.
THIS IS IMPORTANT AS CONTROLS
REPRESENT THE FREQUENCY OF
EXPOSURE FROM THE UNDERLYING
POPULATION THAT GIVE RISE TO
CASES.
HOWEVER, GIVEN SURGERY IS NEEDED
TO IDENTIFY CASES, MOST STUDIES
OF ENDOMETRIOSIS HAVE INSTEAD
FIRST IDENTIFIED ENDOMETRIOSIS
CASES AMONG PATIENTS UNDERGOING
SURGERY.
THEN THESE CASES ARE COMPARED TO
OTHER PATIENTS UNDERGOING
SURGERY WHO ARE NOT DIAGNOSED
WITH ENDOMETRIOSIS.
THE ISSUE WITH THIS APPROACH IS
SELECTING NON-CASES FROM
PATIENTS UNDERGOING SURGERY IS
THESE PATIENTS HAVE AN
INDICATION WARRANTING INCLUDING
MENSTRUAL IRREGULARITIES,
UTERINE FIBROIDS AND OVARIAN
CYSTS THAT MAY BE AFFECTED BY
ENDOCRINE-DISRUPTING CHEMICALS.
THIS GROUP OF PATIENTS WITHOUT
ENDOMETRIOSIS MAY NOT REPRESENT
THE FREQUENCY OF ENVIRONMENTAL
CHEMICAL EXPOSURE IN THE
UNDERLYING POPULATION THAT GIVE
RISE TO CASES.
THE RESULTING BIAS CAN OBSCURE
THE ABILITY TO UNDERSTAND THE
ASSOCIATION BETWEEN
ENDOMETRIOSIS AND STUDIES.
THIS IS WHERE THE WOMEN'S RISK
OF THE STUDY HAS MADE AN
IMPORTANT CONTRIBUTION TO THE
STUDY OF ENVIRONMENTAL RISK
FACTORS IN ENDOMETRIOSIS.
REN WAS A POPULATION-BASED CASE
CONTROL STUDY OF ENDOMETRIOSIS
THAT WAS CONDUCTED AMONG
ENROLLEES OF AN INTEGRATED
HEALTH CARE SYSTEM PROVIDING
BOTH INSURANCE COVERAGE AND
HEALTH CARE IN WASHINGTON STATE.
THIS ENTITY WAS KNOWN AS GROUP
HEALTH COOPERATIVE.
IT'S NOW KNOWN AS KAISER
PERMANENTE OF WASHINGTON.
IT WAS DESIGNED BY A PROFESSOR
EMERITUS AT THE UNIVERSITY OF
WASHINGTON.
THE STUDY WAS FUNDED BY AN R01
GRANT FROM NICHD.
FOLLOWING THE IDEAL APPROACH TO
SELECTING PARTICIPANTS IN THE
CASE CONTROL STUDY IN REN, THE
STUDY POPULATION WAS IDENTIFIED
FIRST.
PREMENOPAUSAL ENROLLEES 18 TO 49
WITH AN INTACT UTERUS AT LEAST
ONE OVARY AND NO PREVIOUS
HISTORY OF DIAGNOSIS AND
ENROLLED IN THE INTEGRATED
HEALTH SYSTEM FORMED THE STUDY
BASE.
ENDOMETRIOSIS CASES WERE
IDENTIFIED AND ENROLLEES WERE
DIAGNOSED FOR THE FIRST TIME
BETWEEN APRIL 1996 AND MARCH
2001.
THE DIAGNOSIS WAS CONFIRMED BY
MEDICAL RECORD REVIEW INCLUDING
OF OPERATIVE NODES AND PATHOLOGY
REPORT INDICATING ENDOMETRIOSIS
THROUGH DIRECT SURGICAL
VISUALIZATION.
FROM THE STUDY BASE, CONTROLS
WERE DIRECTLY AND RANDOMLY
SAMPLED FROM THE COMPUTERIZED
GROUP HEALTH ENROLLMENT
DATABASES THAT WERE FREQUENCY
MATCHED TO CASE IN FIVE-YEAR AGE
GROUPS.
IN REN THE STATE WAS NOT THE
DATE OF DIAGNOSIS BUT RATHER THE
DATE OF FIRST VISIT TO GROUP
HEALTH FOR SYMPTOMS LEADING TO
ENDOMETRIOSIS DIAGNOSIS.
IN REN, CASES ALSO NEEDED TO
MEET THE DEFINITION OF DEFINITE
FOR POSSIBLE ENDOMEETRY OTIC
DISEASE AND ENDOMETRIOSIS THAT
HAD PROGRESSED TO INCREASE THE
LIKELIHOOD OF OBSERVIING
OBSERVATIONS AND MINIMIZE SOME
CONTROLS.
THIS ALSO MEANT DATA WAS
AVAILABLE ON OVARIAN AND
NON-OVARIAN PELVIC ENDOMETRIOSIS
WHICH MAY HAVE SEPARATE
ETIOLOGIC PATHWAYS.
THE WREN STUDY INCLUDED
CONTROLS.
THE MAIN STUDY WAS AN IN-PERSON
STRUCTURED INTERVIEW CONDUCTED
BY A TRAINED FEMALE INTERVIEWERS
FROM THE FRED HUTCHINGSON CANCER
CENTER IN SEATTLE, WASHINGTON.
THE INTERVIEWS WERE AT THE
PARTICIPANT'S HOME OR FRED HUTCH
AND DATA WAS COLLECTED ON A
RANGE OF TOPICS FROM MENSTRUAL,
REPRODUCTIVE AND CONTRACEPTIVE
HISTORY TO EARLY LIFE FACTORS
AND OCCUPATIONAL EXPOSURES.
A VARIETY OF METHODS WERE USED
TO HELP PARTICIPANT RECALL.
A STUDY BY THE
U.S. ENVIRONMENTAL PROTECTION
AGENCY SUPPORT THE COLLECTION OF
BLOOD SAMPLES AND 34 NON-PCB
SERUM.
AS PART OF THE GRANT, URINE
SAMPLES WERE ALSO COLLECTED AND
ARCHIVED.
THE URINE SAMPLES WERE ANALYZED
FOR BPA FUNDED BY AN R03 GRANT
BY NIEHS AND METABOLITES FUNDED
AT THE UNIVERSITY OF WASHINGTON.
IN THE WREN STUDY, THE MEDIAN
AGE WAS 39 YEARS AND WAS SIMILAR
BETWEEN CASES AN CONTROLS SINCE
CONTROLS WERE FREQUENCY MATCHED.
THE STUDY POPULATION WAS
PREDOMINANTLY WHITE NON-HISPANIC
AND CASES CONTROLS WERE
GENERALLY SIMILAR ON SEVERAL
DEMOGRAPHIC FACTORS INCLUDING
EDUCATION, ANNUAL HOUSEHOLD
INCOME, BMI AND SMOKING.
HOWEVER, ENDOMETRIOSIS CASES
MORE FREQUENTLY REPORTED A
HISTORY OF NO PRIOR BIRTHS.
THE SOCIO DEMOGRAPHIC OF THE
WREN NEARED OF THAT THE
INTEGRATED HEALTH PLAN
POPULATION AND THE SURROUNDING
PUGET SOUND AREA.
I WANT TO POINT OUT MANY OF THE
ENVIRONMENTAL CHEMICALS MEASURED
IN WREN PARTICIPANTS WERE
DETECTABLE IN MANY IF NOT ALL
PARTICIPANTS.
BPA AND PHTHALATES ARE
NON-PERSISTENT CHEMICALS
SECRETED IN THE MATTER OF HOURS
AFTER EXPOSURE.
GIVEN HOW COMMONLY THEY WERE
DETECTED IN URINE SUGGESTS
CHRONIC EXPOSURE.
ORGANO CHLORINE PESTICIDE
PERSISTENT CHEMICALS THAT HAVE A
LONG HALF LIFE OF YEARS.
I'M GOING HIGHLIGHT A FEW OF THE
FINDINGS FROM ACROSS THE WREN
STUDIES.
WE OBSERVED THAT EXPOSURE STO
BETA HCH AND ORGANOCHLORINE
PESTICIDE WAS ASSOCIATED WITH
TWICE THE RISK OF ENDOMETRIOSIS
PRIMARILY OVARIAN ENDOMETRIOSIS.
BETA HCH IS TECHNICAL GRADE HCH
WAS AN INSECTICIDE IN THE UNITED
STATES UNTIL THE IS THE 80s.
AND WITH EACH INCREASE IN
NON-PCBTRATIONS IT WAS
ASSOCIATED WITH A 30% INCREASE
RISK OF ENDOMETRIOSIS.
PCBs WERE KNOWN IN COOLANTS AN
LUBRICANTS AND ELECTRICAL
EQUIPMENT LIKE TRANSFORMERS AND
UNTIL THEIR USE WAS BANNED IN
THE U.S. AND PCBs ACCUMULATE IN
THE FATTY TISSUE OF ANIMALS AND
HUMAN EXPOSURE PRIMARILY THROUGH
THE CONSUMPTION OF ANIMAL AND
DAIRY PRODUCTS.
EXPOSURE TO THE PHTHALATE
METABOLITE WAS ASSOCIATED WITH A
70% DECREASED RISK OF
ENDOMETRIOSIS.
THOUGH WE OBSERVED A DECREASED
RISK IT DOES NOT MEAN EXPOSURE
IS PROTECTIVE.
DEHP IS USED FOR SOFTENING AND
ADDING FLEXIBILITY TO PLASTIC
PRODUCTS AND THE EXHIBITED TOXIC
EFFECTS ON THE OVARIES INCLUDING
LOWERING HORMONES AND IT WAS
ASSOCIATED WITH THREE TIMES THE
RISK OF ENDOMETRIOSIS
PARTICULARLY NON-OVARIAN PELVIC
ENDOMETRIOSIS.
BPA IS USED TO MANUFACTURE CLEAR
HARD PLASTIC FOUND IN REUSABLE
FOOD AND BEVERAGE CONTAINERS AND
USED IN EPOXY RESIN THAT LINE
FOOD AND BEVERAGE CANS.
AND ENVIRONMENTAL EXPOSURE CAN
INCLUDE DIET, MEDICATION AND
OCCUPATIONAL EXPOSURES.
SOY FORMULA CONTAINS PHYTO
ESTROGENS.
IN WREN THE PARTICIPANT'S MOTHER
WAS CONTACTED AND ASKED WHETHER
THE PARTICIPANT WAS FED SOY
FORMULA AS AN INFANT.
WE OBSERVED THAT SOY FORMULA
DURING INFANCY WAS ASSOCIATED
WITH TWICE THE RISK OF
ENDOMETRIOSIS.
THE PARTICIPANT'S MOTHER WAS
ALSO ASKED ABOUT THE USE OF
HORMONE MEDICATION DES WHEN
PREGNANT WITH THE PARTICIPANT.
DES IS A POTENT ESTROGEN THAT
WAS PRESCRIBED TO WOMEN IN THE
U.S. FOR THE PREVENTION OF
MISCARRIAGE AND OTHER PREGNANCY
COMPLICATIONS UNTIL THE '70s
WHEN IT WAS FOUND TO INCREASE
THE RISK OF VAGINAL CANCER AND
IT WAS ASSOCIATED WITH TWICE THE
RISK OF ENDOMETRIOSIS.
NIGHT SHIFT WORK IS ONE CAUSE OF
CIRCADIAN DISRUPTION AND FOUND
TO ALTER ESTROGEN SECRETION AND
METABOLISM.
THEY WERE ASKED ABOUT EVERY JOB
HELD AND THE SHIFT WORKS FROM
18.
ANY NIGHT SHIFT WAS ASSOCIATED
WITH A 50% INCREASED RISK OF
ENDOMETRIOSIS RISK.
MOVING THE FIELD FORWARD
EXAMINEXAMINE
ING ENVIRONMENTAL CHEMICALS AND
ENDOMETRIOSIS RISK IS FOLLOWED
BY COLLECTION OF BIOLOGIC
SAMPLES AFTER DIAGNOSIS.
CASE OF A URINE SAMPLE TO LOOK
AT EXPOSURE TO NON-PERSISTENT
CHEMICALS.
THIS WAS CONDUCTED BEFORE THE
STATISTICAL METHODS FOR
EVALUATING EXPOSURE TO CHEMICAL
MIXTURES.
THE POTENTIAL FOR UNDIAGNOSED
DISEASE AMONG CONTROLS.
THOUGH WE ESTIMATE LESS THAN 2%
CONTROLS MAY HAVE HAD
UNDIAGNOSED ENDOMETRIOTIC
DISEASE.
THERE WAS A POPULATION-BASED
SAMPLING MINIMIZING HOW
PARTICIPANTS WERE SELECTED AND
WE HAD THE COLLECTION OF
BIOLOGIC SAMPLES FOR CHEMICAL
MEASUREMENTS AND SAMPLES THAT
WERE COLLECTED BEFORE AWARENESS
OF ENDOCRINE DISRUPTION
CHEMICALS CHANGING HABITS AFTER
DIAGNOSED.
WE HAD DATA ON OVARIAN AND
NON-OVARIAN PELVIC ENDOMETRIOSIS
WHICH MAY HAVE A DIFFERENT
RELATIONSHIP WITH ENVIRONMENTAL
EXPOSURES.
SEVERAL COMPREHENSIVE REVIEWS
WERE CONDUCTED ON ENVIRONMENTAL
CHEMICALS AND ENDOMETRIOSIS
INCLUDING A RECENT REVIEW FROM
2020.
A REPORT OF COMMON CONCLUSION.
THE RESULTS ACROSS STUDIES ARE
INCONCLUSIVE.
THE APPROACH TO STUDYING
POPULATION SAMPLING, THE USE OF
BIOLOGIC SAMPLES AND THE
APPROACH TO CAL OF STATISTICAL
ANALYSIS AND MANY LIKELY
CONTRIBUTED TO THE DISPARATE
RESULT.
IN THE PAST DECADE THERE'S BEEN
INNOVATIVE APPROACHES TO CONDUCT
POPULATION-BASED STUDIES OF
ENVIRONMENTAL CHEMICALS AND
ENDOMETRIOSIS YIELDING SOME
CONSISTENT RESULTS ACROSS
POPULATION STUDIES.
SO THIS LEADS KNOW MY FIRST
RECOMMENDATION OF FIVE
RECOMMENDATIONS TO MOVE THE
FIELD FORWARD.
FIRST, I RECOMMEND USING A VALID
EPIDEMIOLOGIC STUDY DESIGN FOR
REROBUST -- ROBUST RESULT BY
LARGE EPIDEMIOLOGIC COHORTS
MEASURING CHEMICALS OR COLLECTED
SAMPLES PROSPECTIVELY.
SECOND, I RECOMMEND MEASURING
EXPOSURE DURING THE RELEVANT
WINDOW OF THE DEVELOPMENT OF
ENDOMETRIOSIS.
AS THE WINDOWS COULD INCLUDE IN
UTERO AND INFANCY AND NOVEL
APPROACHES ARE NEEDED INCLUDING
THE USE OF EXISTING SAMPLES.
I'M THINKING NEWBORN DRY BLOOD
SPOTS COLLECTED AND BABY TEETH
LOSS CAN BE MEASURED FOR
ENVIRONMENTAL CHEMICALS AS WELL
AS LINKAGE WITH HISTORICAL DATA
SUCH AS AIR POLLUTION
MONITORING.
THIRD, I RECOMMEND
DISAGGREGATING ENDOMETRIOSIS AND
LOOKING AT DIFFERENT IDEOLOGIC
PATHWAYS.
FOURTH, I RECOMMEND
UNDERSTANDING FACTOR ARE COMMON
YET UNIQUE TO MEN STRATEAL
EXPOSURES AND THE ROLE OF
MENSTRUAL BLOOD LOSS ON CHEMICAL
EXCRETION AND CONTRACEPTIVE USE
AND USING TEAM SCIENCE WITH
EPIDEMIOLOGISTS, STATISTICIAN
AND COMMUNITY MEMBERS.
TO CONCLUDE I'D LIKE TO
ACKNOWLEDGE THE RESEARCHERS
INVOLVED IN THE WREN STUDY AND
THE FUNDING SOURCES THAT HAVE
MADE THIS RESEARCH POSSIBLE.
THANK YOU AND I'M HAPPY TO
ADDRESS ANY QUESTIONS YOU MAY
HAVE.
YOU CAN SUBMIT YOUR QUESTIONS BY
CHAT OR BY RAISING YOUR HAND AND
I'M HAPPY TO ADDRESS THEM.
WE HAVE ABOUT FIVE MINUTES FOR
THIS.
>>IF WE DON'T HAVE TIME FOR
THAT NOW KRISTEN WE CAN DO IT AT
THE END BUT IT LOOKS LIKE
DR. DOUTHARD HAS A QUESTION.
>>GREAT, THANK YOU.
DR. DOUTHARD.
>>THANK YOU VERY MUCH,
DR. UPSON FOR A VERY INFORMATIVE
PRESENTATION.
I THING YOU ANSWERED MY QUESTION
BECAUSE I WAS GOING TO SAY
SEVERAL STUDIES TALKED ABOUT
PHTHALATES AN AFFECT METABOLIC
PATHWAYS WITH STRESS AND AFFECT
ENDOMETRIOSIS.
YOU HAVE OTHER STUDIES OTHER
INVESTIGATIONS THAT COME UP WITH
DIFFERENT CONTRADICTORY
FINDINGS.
I WAS WONDERING ARE WE CLOSER TO
GETTING TO UNDERSTAND THE
CONTRADICTIONS AND I ASSUME THE
RECOMMENDATIONS YOU MADE COULD
DEFINITELY IMPROVE THE RESULTS
AND MINIMIZE OR DECREASE THE
RISK OF CONTRADICTORY RESULTS
FOR ASSOCIATION.
>>YES, I'M GLAD YOU'RE
HIGHLIGHTING THE DISPARATE
APPROACH AND WHEN IF YOU WANT TO
CHARACTERIZE SOMEONE'S EXPOSURE
WE NEED REPEAT URINARY SAMPLES
FROM THE SAME INDIVIDUAL TO
CHARACTERIZE THEIR EXPOSURE OVER
TIME.
IDEALLY WE'D LIKE TO
CHARACTERIZE THAT DURING AN
ETIOLOGICALLY SIMILAR WINDOW.
WHEN I COMPARED THE FINDINGS
FROM WREN USING A
POPULATION-BASED SAMPLING AS
WELL AS TWO FINDINGS FROM THE
NATIONAL HEALTH AND NUTRITION
EXEMPTION SURVEY A NATIONALLY
REPRESENTATIVIE IIE IIVE DATA
SAW THE ASSOCIATION BETWEEN THE
METABOLITES OF DPHP AND
DECREASED ENDOMETRIOSIS.
IT WAS NICE TO SEE WHEN WE HAD
SIMILAR POPULATION-BASED STUDY
DESIGNS THOUGH WE BOTH ONLY HAD
A SINGLE MEASURE OF URINARY
PHTHALATE IT WAS NICE TO SEE THE
CONSISTENCY BUT MOVE IT FORWARD
IT WOULD BE NICE TO HAVE
REPEATED MEASURES AND AT THE
ETIOLOGICALLY RELEVANT WINDOW.
>>MAYBE LATER WE CAN ADDRESS
MORE.
>>ABSOLUTELY.
WHY DON'T WE MOVE ON TO OUR NEXT
SPEAKER, I WOULD LIKE TO NOW
INTRODUCE MY FELLOW PANELIST
DR. QUAKER HARMON.
DR. HARMON IS A STAFF SCIENTIST
IN THE WOMEN'S HEALTH GROUP IN
THE EPIDEMIOLOGY BRANCH AT THE
NATIONAL INSTITUTE OF
ENVIRONMENTAL HEALTH SCIENCES.
IN THE THIS ROLE SHE WORKS TO
CONDUCT HER OWN RESEARCH AND
FACILITATE THAT OF OTHERS
LOOKING AT ENVIRONMENT,
LIFESTYLE AND FIBROIDS WITH
SELF.
IT'S A STUDY OF FIBROID
DEVELOPMENT IN THE DETROIT-BASED
COHORT OF BLACK WOMEN.
THE RACIAL ETHNIC GROUP THAT HAS
THE HIGHEST HEALTH BURDEN FROM
FIBOIDS.
HER RESEARCH HAS FOCUSSED ON
FIBROID OUTCOMES ASSOCIATED WITH
VITAMIN D AND THE USE OF
HORMONAL CONTRASEPTIVES AND
LOOKING AT GEOSPATIAL AND
ENVIRONMENTAL EXPOSURES AND HAS
INVESTIGATED CORRELATES AND
HEALTH IMPACTS OF MEASURED
TOXICANTS AND
ENDOCRINE-DISRUPTING CHEMICALS
AND LOOK AT VITAMIN D
ASSOCIATION WITH OVARIAN
HORMO
HORMONES.
SHE RECEIVED HER M.D. AT THE
UNIVERSITY OF TORONTO AND SHE IS
AN ADJUNCT FACULTY MEMBER AND
SERVED ON THE ADVISORY COMMITTEE
AT NIEHS AND ALL OF US WORKING
GROUP.
WELC
WELCOME, DR. HARMON.
>>THANK YOU.
LET ME SHARE MY SCREEN.
ARE YOU SEEING MY CORRECT SLIDE?
>>I AM AND I'M HEARING YOU
WELL.
>>THANK YOU.
THANK YOU FOR THAT INTRODUCTION
DR. UPSON.
TODAY I'LL TALK ABOUT THE STUDY
OF ENVIRONMENT, LIFESTYLE AND
FO
FIBROIDS.
THEY'RE SMOOTH MUSCLE TUMORS OF
THE UTERUS AND THIS SHOWS THEY
CAN OCCUR THROUGHOUT THE
MUSCULAR WALL OF THE UTERUS.
NOT ALL PEOPLE WITH FIBROIDS
KNOW THEY HAVE THEM AND IT'S THE
LARGER FIBROIDS THAT BECOME
SYSTEMATIC AND CAN IMPACT ALL
ASPECTS OF LIFE HERE
DEMONSTRATED WITH AN
ILLUSTRATION FROM THE NEW YORK
TIMES.
HEAVY MENSTRUAL BLEEDING IS
COMMON AND IT CAN BE SO HEAVY
THAT ANEMIA AND PAIN RESULT.
PAIN IS COMMON AND CAN MANIFEST
IN A NUMBER OF WAYS.
WITH LARGE FIBROIDS PEOPLE ALSO
EXPERIENCE A FEELING OF FULLNESS
IN THEIR ABDOMEN AND CAN PUSH ON
OTHER ORGANS WHICH CAN LEAD TO
SYMPTOMS ON BLADDER AND BOWELS.
SOME PEOPLE WITH FIBROIDS MAY
HAVE DIFFICULTY PREGNANT OR HAVE
COMPLICATIONS.
TREATMENT EXISTS INCLUDING
MEDICATION AND INTERVENTIONS
WHICH SPECIFICALLY TARGET
FIBROID.
HOWEVER, THEY FREQUENTLY COME
BACK AFTER TREATMENT.
THE ONLY DEFINITIVE TREATMENT IS
HYSTERECTOMY AND FIBROIDS ARE
THE LEADING CAUSE OF
HYSTERECTOMY IN THE UNITED
STATES.
IT'S A COMMON CONDITION WITH
MOST WOMEN HAVING A FIBROID BY
AGE 50 HOWEVER, THERE'S A HIGHER
PREVALENCE AMONG BLACK WOMEN.
HERE'S A PLOT FROM THREE STUDIES
EACH IN A DIFFERENT COLOR.
DATA FOR AFRICAN AMERICANS IN
SOLID LINES AND DATA FOR WHITES
IN DASHED LINES.
THIS BLUE LINE HERE SHOWS
AFRICAN AMERICAN HAVE A 10 YEAR
EARLY ONSET AND AFRICAN AMERICAN
WOMEN ARE MORE LIKELY TO HAVE A
FIBROID BY AGE 50 AND IT MEANS
THEY HAVE A LONGER TIME TO GROW,
BECOME SYSTEMATIC AND REQUIRE
TREATMENT.
NOW, THESE NUMBERS ARE SOMETIMES
SURPRISING TO PEOPLE WHO DON'T
THINK THEY KNOW ANYONE WITH A
FIBROID AND USING ULTRASOUND
SCREENING WE LEARNED ALMOST 50%
OF PREMENOPAUSAL WOMEN HAVE A
FIBROID ON ULTRASOUND THEY DON'T
KNOW ABOUT.
SO DESPITE THE BURDEN OF
DISEASE, RESEARCH AND RISK
FACTORS HAS BEEN SLOW.
THE STRONGEST RISK FACTORS AT
THE TOP OF THE SLIDE ARE MOSTLY
NON-MODIFIABLE.
EVIDENCE FOR MODIFIABLE RISK
FACTORS HAVE SHOWN WEAK
ASSOCIATIONS WHICH HAVE BEEN
INCONSISTENT ACROSS THE
LITERATURE.
THE EXCEPTION IS THE USE OF
DEPROPROVERA.
GIVEN THE COMMON CONDITION WHY
DON'T WE KNOW MORE?
THERE'S BEEN BENCH SCIENCE ON
FIBROID TISSUES AND IMPORTANT
STUDIES IN LABORATORY MICE AND
RATS BUT THE DATA FOR HUMANS HAS
LAGGED BEHIND.
ONE REASON WE'VE BEEN LIMITED IN
STUDYING FIBROIDS IS THE
STANDARD FIRST-LINE APPROACH TO
STUDYING CONDITIONS IS THE CASE
CONTROL STUDY.
AND THAT APPROACH REALLY DOES
NOT WORK WELL WITH A COMMON
DISEASE SUCH AS FIBROIDS
ESPECIALLY SINCE THERE'S NO
SYSTEMATIC SCREENING.
WHEN YOU PICK CASES HERE IN BLUE
FROM DIAGNOSED WOMEN AND THEN
YOU PICK NON-CASES IN GRAY FROM
UNDIAGNOSED WOMEN, YOU END UP
WITH A LOT OF MISCLASSIFICATION
BECAUSE A LOT OF THOSE
UNDIAGNOSED WOMEN ALREADY HAVE
FIBROIDS HERE MARK WITH AN X AND
THIS LEADS TO MISCLASSIFICATION
OF OUR CASES AND CONTROLS OR
NON-CASES.
THE OTHER ISSUE THAT ARISES IN
HUMAN STUDIES IS RELATED TO
TIMING.
WE KNOW FIBROIDS START WITH
ALTERATIONS TO A SINGLE CELL
UNTIL IT GROWS LARGE ENOUGH TO
BE SEEN AND MAY GROW LARGE TO
CAUSE SYSTEMS AND MAY BE
DIAGNOSED BY A CLINICIAN.
WHEN WE STUDY EXPOSURES IN
FIBROIDS WE CAN SEE OR
DIAGNOSED, WE MAY BE LOOKING AT
THE WRONG TIME POINT.
WE WANT TO KNOW THE EXPOSURE
EARLIER ON BEFORE THE FIBROID
AND THIS IS MISCLASSIFICATION OF
OUR EXPOSURE.
THE EXISTING HUMAN STUD Y OF
RISK FACTORS FOR FIBROIDS MOSTLY
DON'T HAVE THE DATA THAT ALLOW
TO US LEARN WITH THE DEVELOPMENT
OF FIBROIDS.
THEY MAY MISS IMPORTANT
EXPOSURES THAT MAY OCCUR BEFORE
FIBROIDS DEVELOP.
THE EXISTING STUDIES ARE
IMPORTANT BUT ISSUES WITH THE
STUDY DESIGN MEANING THEY'RE
HARD TO REPLICATE.
AND WITHOUT KNOWING THE EARLY
DEVELOPMENT OR NATURAL HISTORY
OF FIBROIDS IT CAN BE DIFFICULT
TO IDENTIFY IMPORTANT EXPOSURES
INCLUDING ENVIRONMENTAL
EXPOSURES.
TO ADVANCE OUR KNOWLEDGE OF RISK
FACTORS FOR FIBROIDS WE NEED
STRONG STUDY DESIGNS.
SO NOW I'M GOING TO TELL YOU
ABOUT THE STUDY OF ENVIRONMENT,
LIFESTYLE AND FIBROIDS.
DONNA BAIRD IS THE P.I. AND I'M
THE STAFF SCIENTIST.
SELF-RECRUITED YOUNG BLACK OR
AFRICAN AMERICAN WOMEN WHO LIVED
IN THE DETROIT, MICHIGAN AREA TO
BE PART OF THE STUDY.
THE CRITERIA WAS NO PRIOR
DIAGNOSIS OF FIBROIDS AND HERE'S
OUR WONDERFUL STUDY STAFF IN
NORTH CAROLINA AND AT OUR
PARTNER INSTITUTION HENRY FORD
HEALTH IN DETROIT.
SELF IS A FACE-IVE-YEAR PRODUCT
STUDY.
SELF-HAD HIGH RETENTION.
WE ENROLLED JUST UNDER 1700
PARTICIPANTS AND MORE THAN 90%
RETURNED TO THE FIVE-YEAR VISIT.
EXCUSE ME, AND EVERY VISIT WE
DID AN ULTRASOUND AND DID CLINIC
MEASURES AND BIO SPECIMEN.
WITH THIS STUDY DESIGN WE CAN
NOW DO A NUMBER OF THINGS THAT
WERE IMPOSSIBLE WITH PRIOR STUDY
DESIGNS.
WE CAN USE ULTRASOUND TO DETECT
NEW FIBROIDS WHEN THEY FIRST
APPEAR AND THIS ALLOWS US TO
CORRECTLY IDENTIFY CASES AND
NON-CASES.
WE CAN MEASURE THE GROWTH OF
INDIVIDUAL FIBROIDS WHICH ALLOWS
US TO STUDY FACTORS WHICH
INFLUENCE FIBROID GROWTH.
THIS DESIGN ALLOWS US TO MEASURE
EXPOSURES BEFORE THE FIBROIDS
DEVELOP OR EXPOSURES THAT CHANGE
OVER TIME SO WE CAN MINIMIZE
EXPOSURE IN THE CLASSIFICATION
AND IN ADDITION TO FIBROIDS,
SELF-WAS ABLE TO STUDY A WIDE
RANGE OF OUTCOMES WITH LESS
BIAS.
WHY'S THIS MATTER, KNOWING THE
NATURE HISTORY AND FOR THOSE WHO
DEVELOP AND KNOWING WHEN WE
SHOULD TREAT.
IF WE CAN FIND EXPOSURES WE
COULD DELAY THE NEED FOR
INVASIVE TREATMENTS.
AND IF WE IDENTIFY EXPOSURES
THAT INCREASE THE RISK OF NEW
FIBE FIBROIDS AND WE CAN
PRIORITIZE SCREENING.
NOW I'LL TALK ABOUT A COUPLE OF
STUDIES WE'VE DONE IN SELF.
AND WE LOOKED AT INFANT SOY
FORMULA AND I'LL SHARE SOME OF
WHAT WE LEARN ABOUT THE HISTORY
OF FIBROID DEVELOPMENT.
BEFORE DESCRIBING THE OUTCOMES
AND STATISTICAL MODELS I WANTED
TO GIVE YOU A SENSE OF THE
SELF-COHORT AND THE MEAN AGE WAS
29 YEARS AT ENROLLMENT.
IT HAS HIGH EDUCATIONAL
ATTAINMENT AND MOST WERE
CURRENCURRENT
LY EMPLOYED AND 45% HAD A
HOUSEHOLD INCOME BELOW $20,000.
60% HAD HAD A BIRTH.
THE FIBROID OUTCOMES I'LL BE
DISCUSSING ARE BASED ON
CONSECUTIVE VISITS OR INTERVALS
WITH AN ULTRASOUND AT EACH VISIT
HERE SHOWN AS A SCHEMATIC WITH A
LINE DRAWING OF A HUMAN UTERUS.
DIFFERENCES IN THE STATUS OR
CHARACTERISTICS AT EACH VISIT
ALLOWS US TO LOOK AT THE
OUTCOMES AND I'LL SHARE THE
DEVELOPMENT OF NEW FIBROIDS AND
FIBROID GROWTH.
SO SELF-DATA HAS BEEN USED TO
DESCRIBE THE NATURAL HISTORY OF
FIBROIDS WHICH HAS BEEN LACKING
PREVIOUSLY.
THIS WORK WAS CONDUCTED BY DONNA
BAIRD THE P.I. HERSELF.
WHEN LOOKING AT THE INCIDENTS OR
THE CHANCE A PARTICIPANT WILL
DEVELOP A FIBROID BY THE END OF
THE STUDY WE SEE INCREASING RISK
WITH AGE FROM 18% AMONG THOSE 23
TO 25 AT ENROLLMENT TO NEARLY
30% AMONG THOSE WHO WERE 32 TO
35.
WE'VE ALSO BEEN ABLE TO FOLLOW
THE GROWTH OF INDIVIDUAL
FIBROIDS IN MORE THAN 400
PARTICIPANTS.
AVERAGE GROWTH WAS 68% FOR 18
MONTHS AND FIBROID GROWTH
DECLINED STEEPLY INCREASING AGE.
SO NOW I'M GOING TO DISCUSS DMPA
A PROGESTERONE ONLY FORM OF
CONTRACEPTION GIVEN AS AN
INTRAMUSCULAR SHOT EVERY THREE
MONTHS.
THREE PREVIOUS STUDIES INCLUDING
CROSS-SECTIONAL ANALYSIS HAVE
SHOWN PROTECTIVE AGENTS FOR
FIBROIDS WITH ESTIMATED RELATIVE
RISK BELOW THE NUL VALUE OF 1.
HOWEVER, THE STUDIES HAVE A
NUMBER OF APPLIES BASED ON
DESIGN.
WE EXPLORED THE HYPOTHESIS WITH
OUR PROSPECTIVE DESIGN WITH
SCREENING.
WE LOOKED AT SELF-REPORTED USE
OF DMPA WITH ANY CHANGES AT USE
AT ANY FOLLOW-UP SHIFT TO
ESTIMATE THE TIME LAST USED OF
DMPA.
40% HAD EVER USED DMPA.
FOR OUR STATISTICAL ANALYSES AND
OTHER EXPOSURES WE USED THE SAME
INTERVALS I DESCRIBED EARLIER
AND EACH PARTICIPANT COULD HAVE
UP TO THREE OBSERVED INTERVALS.
WE USED SEPARATE STATISTICAL
MODELS.
HOWEVER, EXPOSURES AND
COVARIATES ARE UPDATED AT EVERY
VISIT AND ALL MODELS ACCOUNTED
FOR REPEATED MEASURES AT THE
LEVEL OF PARTICIPANT OR FIBROID
AND FOLLOWING INTERVENTION TO
TREAT FIBROIDS.
THE FIRST INCOME IS INCIDENT
FIBROIDS DEFINED AS A NEW
FIBROID CASE AMONG PARTICIPANTS
WITH NO PRIOR FIBROIDS OBSERVED
IN THE STUDY AND WE USED THE
TIME SCALE TO ESTIMATE THE
ADJUSTED HAZARD RATIOS.
ON TO THE RESULTS FOR INCIDENT
SHOWING THE HAZARD RATIO.
THE NUL VALUE OF NO ASSOCIATION
IS 1 SHOWN WITH THE VERTICAL
LINE, VALUES ABOVE 1 REPRESENT
AN INCREASED RISK AND VALUES
LESS THAN 1 ARE A NEGATIVE OR
PROTECTIVE ASSOCIATION.
AND THE COMPARISON GROUP IS
NEVER USED DMPA SHOWN BY THE
BLACK DOT AT THE NUL.
FOR INCIDENT FIBROIDS WE SEE OF
DMPA WITHIN TWO YEARS IS
ASSOCIATED WITH A 40% REDUCTION
IN FIBROID INCIDENTS WITH A
HAZARD RATIO OF 0.6 AS SHOWN BY
THE DOT AND THEN THE HORIZONTAL
LINE CAPTURES THE 95% CONFIDENCE
INTERVAL.
FIBROID GROWTH IS THE OTHER
OUTCOME WE STUDY AND GROWTH WAS
DEFINED AS A CHANGE IN VOLUME
BETWEEN VISITS AND TO ACCOUNT
FOR DIFFERENCE IN TIME BETWEEN
VISITS WE SCALE OUR OUTCOMES TO
18 MONTHS AND THIS ANALYSIS USED
FIBROIDS WHICH CAN BE MATCHED
AND A PARTICIPANT CAN HAVE
MULTIPLE MATCHED FIBROIDS.
WE USED LINEAR MIXED MODELS.
THESE ARE THE RESULTS FOR
FIBROID GROWTH AND I'M
ESTIMATING THE RELATIVE BIRTH
RATE OVER 18 MONTHS COMPARED
EXPOSED TO NEVER USERS.
WE SEE A STRONG ASSOCIATION FOR
REDUCED GROWTH FOR THOSE WHO
USED DMPA WITHIN TWO YEARS OF A
VISIT.
THE AVERAGE GROWTH RATE AMONG
THIS IS ABOUT 45% LOWER COMPARED
TO -- SO IN SUMMARY THOSE
EXPOSED TO DMPA WITHIN TWO YEARS
OF A VISIT HAVE A 40% REDUCTION
IN FIBROID INDENTS AND A 45%
REDUCTION IN FIBROID GROWTH.
AND THOUGH I DIDN'T SHOW THIS
RESULT, THIS REDUCTION IN GROWTH
IS RESULTING IN FIBROID
SHRINKAGE AND THE RECENT USERS
OF DMPA, 70% WERE MORE LIKELY TO
LOSE A FIBROID BETWEEN VISITS
DUE TO THE LOWER GROWTH.
THESE RESULTS POINT TO AN
IMPORTANT NON-CONTRACEPTIVE
BENEFIT OF DMPA WHICH HAS THE
POTENTIAL TO DELAY SYMPTOMS AND
THE NEED FOR INVASIVE TREATMENTS
HOWEVER, THE ASSOCIATIONS NEED
TO BE REPLICATED IN LARGER
POPULATIONS.
I'M NOW GOING TO DISCUSS SOY
INFANT FORMULA AND THE WORK WAS
DONE BY A POST-DOCTORAL FELLOW
IN OUR GROUP.
MANY PLANT HAVE PHYTO ESTROGENS
AND A TYPE THAT ARE FOUND IN
LEGUMES AND SOYBEANS IN SIMILAR
STRUCTURE TO ESTRADIOL.
IT CAN BIND TO THE ESTROGEN
RECEPTOR AND WHILE ISOFLAVONES
CAN ACT AS AN ENDOCRINE
DISRUPTOR.
EARLY LIFE EXPOSURE CAN ALTER
THE REPRODUCTIVE TRACT OF MICE
AND A RAT MODEL HAS IDENTIFIED
AN EPIDEMIOLOGIC PATHWAY BY
WHICH EARLY LIFE EXPOSURE LED TO
FIBROID DEVELOPMENT IN ADULT
RATS.
IT'S BEEN HYPOTHESIZED EXPOSURE
TO ESTROGEN LIKE COMPONENTS SUCH
AS SOY FORMULA DURING SENSITIVE
DEVELOPMENT WINDOWS MAY BEING
DETRIMENTAL TO THE DEVELOPING
REPRODUCTIVE TRACT INCLUDING THE
UTERUS.
SOY FORMULA IS CONSUMED BY ABOUT
12% INFANTS AND CONTAINS PHYTO
ESTROGENS AND WHEN IT'S THE ONLY
FOOD CONSUMED IT'S QUITE HIGH
AND SOY FORMULA FEEDING HAS BEEN
LINKED TO SEVERAL FEMALE
REPRODUCTIVE CONDITIONS
INCLUDING ENDOMETRIOSIS
DESCRIBED EARLIER BY DR. UPSON.
AND IN A HUMAN STUDY THAT
DEVELOPED THE DEVELOPMENT OF
ESTROGEN RECEPTIVE TISSUE IN
INFA
INFANTS, INFANTS HAD VAGINAL
CELL CHANGES IN THE LINING
RATHER THAN THOSE WITH COW
FORMULA.
WE GAVE A QUESTIONNAIRE STYLED
AS AN INTERVIEW AND 90% OF
PARTICIPANTS WERE ABLE TO
INTERVIEW THEIR MOTHERS AND 11%
TALKED TO RELATIVES OR OTHERS
INVOLVED IN THEIR INFANCY AND
HOW SOON THEY WERE SAID FORMULA
AND HOW MUCH AND WE CREATED A
VARIABLE WHERE PARTICIPANT
CHARACTERIZED WITH HIGHLY
EXPOSED, IF THEY WERE FED SOY
FORMULA IN THE FIRST TWO MONTHS
OF LIFE AND FOR A DURATION OF
FOUR MONTHS OR LONGER.
AND HERE ARE THE ADJUSTED HAZARD
RATIOS FOR FIBROID INCIDENTS.
WE'RE COMPARING THOSE FED SOY
FORMULA TO THOSE WHO NEVER
RECEIVED IT AND FIND
PARTICIPANTS WHO HAD SOY FORMULA
FEEDING WITHIN THE FIRST TWO
MONTHS OF LIFE HAD A 58%
INCREASE RISK OF INCIDENT
FIBROIDS.
IN THE STUDY WE OBSERVED IT WAS
ASSOCIATED WITH AN INCREASED
RISK OF ALL ULTRASOUND
IDENTIFIED FIBROIDS FOR THOSE
FED SOY FORMULA AFTER BIRTH AND
THIS IS CONSISTENT WITH
FINDINGS.
THEY NEED TO BE REPLICATED IN
OTHER POPULATIONS AN POINT TO
THE NEED TO STUDY SOY INFANT
FORMULA AND OTHER ESTROGEN
SENSITIVE OUTCOMES.
SO FINALLY, THERE'S BEEN
CONSISTENT EPIDEMIOLOGIC
EVIDENCE THAT THOSE WITH A BIRTH
ARE LESS LIKELY TO HAVE
FIBROIDS.
THIS ASSOCIATION IS DUE TO
POSTPARTUM CHANGES IN THE
UTERUS.
IN SELF WE'VE BEEN ABLE TO ADD
TO THE UNDERSTANDING OF THIS
ASSOCIATION BY LOOKING AT LIFE
TIME REPRODUCTIVE HISTORIES AND
BY EXAMINING ASSOCIATIONS WITH
SPECIFIC PREGNANCY
CHARACTERISTICS.
WE'RE STILL ANALYZING THE DATA
BUT AMONG THE FIRST TO BE ABLE
TO LOOK AT THE ASSOCIATION
BETWEEN BIRTH AND FIBROID
GROWTH.
AND HERE WE FIND THAT A BIRTH
WITHIN FIVE YEARS OF A VISIT
RESULTS IN ABOUT A 30% REDUCTION
IN FIBROID GROWTH AND THE
AFFECTS APPEAR TO BE STRONGER IF
THERE WAS BREAST FEEDING MORE
THAN SIX MONTHS FOLLOWING THE
BIRTH.
UNDERSTANDING THE STRONG
ASSOCIATIONS HAVE BEEN VERY
IMPORTANT IN OUR ABILITY TO
ANALYZE OTHER EXPOSURES.
SELF HAS MANY OTHER EXPOSURES
AND OUTCOMES WE'RE INVESTIGATING
AND HERE'S SOME OF THEM.
IN PARTICULAR, WE HAVE A NUMBER
OF ONGOING PROJECTS EXAMINING
THE USE OF PERSONAL CARE
PRODUCTS, SLEEP QUALITY AND
EARLY LIFE EXPOSURES.
WE'RE ALSO MEASURING SPECIFIC
EXPOSURES IN BLOOD OR URINE AND
OTHER ENDOCRINE DISRUPTING
CHEMICALS AND STARTED LOOKING AT
VITAMIN D.
I HOPE I'VE GIVEN A SENSE AS
STUDIES SUCH AS SELF CAN ADVANCE
SCIENCE IN WOMEN'S HEALTH AND
OUR DESIGN AND COHORT AND
COLLABORATIVE RESEARCH CAN SERVE
AS A MODEL FOR SIMILAR STUDIES
OF OTHER OUTCOMES.
WE'VE RECENTLY BEGAN EXPANDING
THE EXPOSURES IN OUR COHORT BY
USING GEOCODING TO LOOK AT
FACTORS, PROXIMITY TO TOXIC
CONTAMINATION SITES AND OTHER S.
BUT SELF IS A SMALL BEGINNING.
THERE'S NO PROSPECTIVE DATA FOR
HISPANICS, ASIAN AMERICANS OR
AND IT NEEDS TO BE REPLICATED IN
OTHER POPULATIONS WITH SIMILAR
DESIGNS.
FIBROIDS ALSO SERVE AS AN
EXAMPLE OF A LIFE COURSE DISEASE
AND LONG-TERM INVESTMENT WILL
PROVIDE OPPORTUNITIES FOR MORE
INNOVATIVE SCIENCE.
THE WORK IN SELF IS ONLY
POSSIBLE DUE TO INTRAMURAL
FUNDING FROM THE NIH AND
COLLABORATION BETWEEN NIE HS AND
SOME COLLABORATORS SOME OF WHOM
ARE PICTURED HERE.
WITH THAT I'LL TAKE A LITTLE BIT
OF TIME FOR QUESTIONS.
>>THANK YOU.
WE HAVE A FEW MINUTES FOR
QUESTION ABOUT DR. HARMON'S
PRESENTATION.
>>I SEE A HAND RAISED BY
DR. ROBINSON.
WE ALL KNOW SOMEONE WHO HAS
FIBROIDS.
IS THERE TALK OF PARALLEL
STUDIES IN OTHER PARTS AND I'VE
SEEN IT SUCCESSFUL FOR OTHER
DISEASES WHERE YOU HAVE THE SAME
EXACT STUDY AND TYPE OF COHORTS
THAT YOU'RE IDENTIFYING AND
LOOKING AT THE RESULTS ACROSS
THE DIFFERENT GROUPS.
>>THE ONLY ONE I'M AWARE OF IS
A STUDY DONE BY DR. ERICA MARSH
LOOKING AT HISPANIC WOMEN WITH A
SIMILAR PROTOCOL BUT I'M NOT
AWARE OF FUNDING TO LOOK AT
SIMILAR STUDIES IN OTHER
POPULATIONS AROUND THE UNITED
STATES.
I WILL NOTE THIS WAS FUNDED
INTRAMURALLY.
>>OKAY.
>>SOME OF THIS WORK ESPECIALLY
WORK ON THE NATURAL HISTORY OF
COMMON DISEASES IS VERY HARD IN
MY EXPERIENCE TO GET FUNDED
EXTRAMURALLY.
AND THAT IS ONE OF THE STRENGTHS
OF INTRAMURAL RESEARCH.
>>IN BOTH STUDIES WE HEARD
EXCELLENT DESIGNS AND STRONG
STUDY DESIGNS AND ANALYSIS AND I
APPRECIATE THAT.
I'M WONDERING HOW TO TAKE IT TO
THE NEXT LEVEL AND PARTICULARLY
I WAS WONDERING IF THERE'S AN
OPPORTUNITY TO BUILD INTO ALL OF
US?
I HAVEN'T TRACKED THE ALL OF US
COHORT THAT WELL IS THERE A
CHANCE TO ADD TO THE PROTOCOL TO
FILL OUT THE EXPOSOME ON ISSUES
RELATED TO WOMEN'S HEALTH?
>>ALL OF US IS RECRUITING WOMEN
UNFORTUNATELY THINGS LIKE
FIBROIDS IS HARD TO STUDY WHICH
IS WHAT WE'RE WE LYING ON FOR
HEALTH OUTCOMES AND SOME CAN BE
STUDYING ELECTRONIC HEALTH
RECORD.
FIBROID NOT ONE OF THEM.
THERE'S THE POTENTIAL TO DO
SUBSTUDIES WITHIN ALL OF US.
AND I THINK IT WOULD BE GOOD FOR
OUTCOMES WHERE E.H.R. IS A GOOD
SOURCE OF MEASURING YOUR
OUTCOME.
>>AN SOMEONE ANSWER A STUDY TO
THAT TO BE TAKEN A SUBSET OF
1,000 WOMEN AND DOING
ULTRASOUNDS?
>>I THINK ALL OF US IS IN THE
PROCESS OF BUILDING OUT THEIR
CAPACITY TO DEFINE AND DEAL WITH
ANCILLARY STUDIES.
>>OKAY.
>>THEY DO HAVE A RESEARCHER
WORK BENCH THAT ALLOWS
RESEARCHERS TO ACCESS THE
EXISTING DATA NOT NECESSARILY DO
ADDITIONAL WORK WITH A SUBCOHORT
BUT THERE IS A DASHBOARD WHERE
PEOPLE CAN ACCESS EXISTING DATA.
>>GREAT.
THANK YOU SO MUCH, DR. HARMON.
I THINK I WOULD LIKE TO NOW
INTRODUCE OUR FINAL PANELIST,
DR. DALE SANDLER.
HE IS A SENIOR INVESTIGATOR AND
CHIEF OF THE EPIDEMIOLOGY BRANCH
IN THE INTRAMURAL RESEARCH
PROGRAM OF THE NATIONAL
INSTITUTE OF ENVIRONMENTAL
HEALTH SCIENCES, WHERE SHE LEADS
THE CHRONIC DISEASE EPIDEMIOLOGY
GROUP AND RECEIVED HER B.A. FROM
BOSTON UNIVERSITY AND Ph.D. FROM
YALE UNIVERSITY AND Ph.D. IN
EPIDEMIOLOGY FROM JOHNS HOPKINS
UNIVERSITY.
SHE IS PRINCIPLE INVESTIGATOR OF
THE SISTER STUDY.
A U.S.-WIDE COHORT OF OVER
50,000 WOMAN WHO HAD A SISTER
DIAGNOSED WITH BREAST CANCER.
THE RESEARCH COVERS A RANGE OF
FACTORS RELATED TO BREAST CANCER
AND OTHER CHRONIC DISEASE RISK
INCLUDING EARLY LIFE EXPOSURES,
SOCIAL ENVIRONMENTAL AND
LIFESTYLE FACTORS AND THROUGH
COLLABORATIONS AT NIEHS AND
ELSEWHERE AND EPIDEMIOLOGIC
FACTORS AND CO-INVESTIGATOR OF
THE HEALTH STUDY LEADING EFFORTS
TO STUDY THE IMPACT OF
AGRICULTURAL EXPOSURES ON
NON-CANCER CHRONIC DISEASE AND A
COHORT OF PESTICIDE APPLICATORS
FOLLOWED SINCE 1987 AND THE GULF
LONG TERM STUDY A PROSPECTIVE
STUDY OF POTENTIAL HEALTH
EFFECTS IN INDIVIDUALS INVOLVED
IN CLEAN UP OF THE OIL SPILL
FOLLOWING THE GULF WATER
DISASTER IN THE GULF OF MEXICO.
WELCOME, DR. SANDLER.
>>YOU'RE ON MUTE.
>>THANK YOU FOR THE INVITATION
AND LOVELY INTRODUCTION AND WILL
TALK ABOUT THE SISTER STUDY
TODAY.
FOR MY PRESENTATION TODAY I'LL
GIVE AN OVERVIEW OF THE STUDY
AND THE BACKGROUND FOR
DEVELOPING THE COHORT, DESCRIBE
THE RESOURCE AND POTENTIAL TO
ADDRESS ENVIRONMENTAL HEALTH
CONCERNS AND I WASN'T ABLE TO
CHOOSE AMONG THE MANY RESEARCH
STUDIES WE'VE DONE IN THE COHORT
SO I MAY HAVE AN OVER ABUNDANCE
OF EXAMPLES AND CAN'T GO INTO
ANY ONE IN GREAT DEPTH.
AND END BY CONSIDERING
OPPORTUNITIES AND CHALLENGES FOR
THE FUTURE IN OUR COHORT AND
OTHER SIMILAR STUDIES.
SO THIS GRAPH SHOWS TRENDS IN
BREAST CANCER INCIDENTS AND
MORTALITY SINCE 1979.
THE INCIDENTS ROSE QUITE STEEPLY
UNTIL 2000 AND THE INCIDENTS
HAVE REMAINED HIGHER FOR WHITE
WOMEN THAN FOR BLACK WOMEN
WHEREAS THE MORTALITY RATES ARE
HIGHER IN BLACK WOMEN THAN WHITE
WOMEN.
YOU CAN ALSO SEE MORTALITY HAS
DECREASED OVER TIME IN PART DUE
TO THE UPTAKE OF SCREENING BUT
LARGELY DUE TO THE ADVANCES IN
TREATMENT.
THIS LED TO WIDESPREAD CONCERNS
ABOUT EXPOSURE TO ENVIRONMENTAL
CHEMICALS AND THEIR POTENTIAL
ASSOCIATIONS WITH INCREASED
BREAST CANCER ARE RISK.
A NUMBER OF ADVOCACY GROUPS
CALLED FOR MORE STUDIES.
THEY LOBBIED CONGRESS AND THE
NIEHS AND OTHER FUNDING
AGENCIES.
THERE WAS CONCERN THE EXISTING
STUDIES FOCUSSED ON LIFE STYLES,
HORMONES AND REPRODUCTIVE
FACTORS BUT NOT THE LARGER
ENVIRONMENT.
AND WE SEE A TREMENDOUS DECLINE
IN BREAST CANCER OR PRECIPITOUS
DECLINE IN BREAST CANCER
INCIDENTS FOR SOME GROUP.
BUT BREAST CANCER INCIDENTS
REMAIN HIGH AND RAISING AGAIN
AND THE LEADING TYPE OF CANCER
FOR WOMEN MORE THAN 280,000 NEW
CASES PREDICTED FOR 2021
REPRESENTING 30% OF ALL CANCERS
IN FEMALES.
IN 2012 AND 2013, SEVERAL
REPORTS WERE COMMISSIONED TO
DISCUSS THE POTENTIAL RESEARCH
THAT NEEDED TO BE DONE TO
IDENTIFY ENVIRONMENTAL CAUSES OF
BREAST CANCER.
AND THESE REPORTS SUGGESTED THAT
STUDIES SHOULD BE
MULTI-DISCIPLINARY AND SHOULD
CONSIDER GENOMICS AND GENE
ENVIRONMENT INTERACTIONS AND
TAKE A LIFE COURSE APPROACH.
THE SISTER STUDY HAD JUST
COMPLETED ENROLLMENT AT THE TIME
OF THE REPORTS STARTED WERE
COMMISSIONED AND WE'RE WELL
POSITIONED TO MEET THESE NEEDS
AND CONSIDER NEW APPROACHES SUCH
AS CHEMICAL MIXTURES AND THE
EXPOSOME.
CURRENT CONCERNS ABOUT THE
POTENTIAL HEALTH IMPACTS OF
CLIMATE CHANGE BRING NEW URGENCY
TO STUDIES OF ENVIRONMENT AND
ITS RELATIONSHIP TO BREAST
CANCER IN OTHER DISEASES.
SO OUR GOAL WITH THE SISTER
STUDY WAS TO ENROLL 50,000
VOLUNTEER WOMEN WHO HAD A SISTER
WITH BREAST CANCER TO PRIMARILY
ADDRESS THE CONCERNS WOMEN HAD
ABOUT THE RISKS ASSOCIATED WITH
ENVIRONMENTAL EXPOSURES AND
FOCUSSED ON SISTERS BECAUSE THEY
IS ABOUT TWICE THE RISK OF
DEVELOPING BREAST CANCER
THEMSELVES AND ALSO MAY HAVE A
HIGHER PREVALENCE OF RELEVANT
CHANGE OR EXPOSURES INCLUDING
THOSE THAT WEREN'T KNOWN TO US
AT THE TIME TO BE ASSOCIATED
WITH BREAST CANCER WHICH GIVES
US INCREASED POWER TO DETECT
ASSOCIATIONS.
FURTHERMORE, SISTERS WERE
POTENTIALLY HIGHLY MOTIVATED AND
WE EXPECTED THEIR RESPONSE RATES
IN THE STUDY OF SISTERS WOULD BE
HIGH.
OUR DESIGN WAS INTENDED TO
ADDRESS LIMITATIONS OF PRIOR
STUDIES IN BREEFT CANCER AND
GIVES US AN OPPORTUNITY TO STUDY
A RANGE OF HEALTH OUTCOMES AS
WELL AS TO CONTINUE TO FOLLOW
THESE WOMEN IN STUDY
ENVIRONMENTAL IMPACTS ON
SURVIVAL AND HEALTH OUTCOMES
AFTER A BREAST CANCER DIAGNOSIS.
OUR GOAL WAS TO ENROLL 50,000
WOMEN BETWEEN 34 AND 74 AND IT
CONSISTED OF MANY QUESTIONNAIRES
THAT AND TELEPHONE INTERVIEWS
AND SOME COMPLETED
QUESTIONNAIRES AS WELL AS A HOME
EXAM DURING WHICH WE MADE
MEASUREMENTS AND COLLECTED BLOOD
SAMPLES.
WOMEN HAD BEEN FOLLOWED EVERY
SINCE WITH ANNUAL HEALTH UPDATES
AND EVERY THREE YEARS A
COMPREHENSIVE QUESTIONNAIRE THAT
COLLECTS INFORMATION ON CHANGES
ON HEALTH AND CHANGES ON
EXPOSURES.
OUR RESPONSE RATES HAVE REMAINED
HIGH AT AROUND 90%.
IN 2003 WE LOOKED AT WOMEN WHO
DEVELOPED BREAST CANCER IN THE
INTERVENING YEARS AND SAMPLE OF
THE REST OF THE COHORT.
AND WOMEN DEVELOPED BREAST
CANCER AND OTHER HEALTH
CONDITIONS.
FOR THOSE WHO REPORT NEW
DIAGNOSIS IN BREAST CANCER OR
OVARIAN CANCER WE'VE BEEN
COLLECTING MEDICAL RECORDS IN
TUMOR TISSUE SAMPLES FOR OTHER
CANCERS WE COLLECT PATHOLOGY
REPORTS AND FOR OTHER CONDITIONS
WE CARRY OUT MEDICAL RECORD
VALIDATION AS NEEDED.
TODAY THROUGH OCTOBER 2020 OUR
MOST RECENT DATA RELEASE MORE
THAN 4,000 WOMEN HAVE REPORTED A
NEW DIAGNOSIS IN BREAST CANCER.
A LARGE NUMBER OF CASES WHICH
AGAIN IS TWICE WHAT WE WOULD
HAVE EXPECTED IN A RANDOM
POPULATION SAMPLE.
ALLOWS US TO STUDY SUB TYPES OF
BREAST CANCER AND POPULATION
SAMPLES.
OUR GOAL HAS BEEN TO ENROLL IN
DIVERSE COHORT BY GEOGRAPHY,
RATE, ETHNICITY AND EXPOSURES.
WE ENROLL PARTICIPANTS FROM
ACROSS THE UNITED STATES AND
PUERTO RICO.
WE WERE SUCCESSFUL IN THAT
REGARD.
THE COHORTS WERE LESS DIVERSE
AND 83% SELF-ALL RIREPORTED
NON-HISPANIC AND WE HAVE
HISPANIC WOMEN AND BLACK WOMEN
IN THE COHORT.
MORE THAN HALF THE COHORT
COMPLETED A COLLEGE DEGREE AND
THE AVERAGE INCOME PER PERSON
AND WE HAVE HOUSEHOLDS TWICE
THAT AND WE CAN BETTER
UNDERSTAND WHO WE DIDN'T INCLUDE
THROUGH MORTALITY LINKAGE AND
CANCER REGISTRY LINKAGE 3,000
WOMEN WHO DIDN'T FULLY COMPLETE
THE ENROLLMENT.
THIS IS JUST TO GIVE YOU AN IDEA
OF THE NUMBERS OF OTHER
DIAGNOSES THAT HAVE BEEN
REPORTED TO US DURING THE SISTER
STUDY WHICH ALLOW US TO STUDY
THE FULL COMPLEMENT OF HEALTH
INFLUENCE.
AROUND WE LOOKED AT
SUSCEPTIBILITY FROM FETAL
EXPOSURES TO EXPOSURES DURING
ESPECIALLY DURING THE TIME OF
PUBERTY AND REPRODUCTIVE YEARS
AND AROUND PERI MENOPAUSE.
OUR QUESTIONNAIRES COVER A RANGE
OF EXPOSURES AND AT FOLLOW-UP WE
UPDATE MANY OF THE EXPOSURE
QUESTIONS AS WELL AS UPDATE
HEALTH STATUS.
SO THE SOURCES OF ENVIRONMENTAL
DATA IN THE COHORT ARE VARIED.
IN ADDITION TO THE
QUESTIONNAIRES WHICH ALLOW US TO
LOOK AT CURRENT AND PAST
EXPOSURES, WE CAN MEASURE
EXPOSURES IN BIOLOGIC SAMPLES OR
HOUSEHOLD DUST FROM SAMPLES WE
COLLECTED IN THE COHORT AND HAVE
BEEN MAKING INCREASING USE OF
WIDELY AVAILABLE OR INCREASING
NUMBERS OF DATABASES FOR
ENVIRONMENTAL EXPOSURES THAT CAN
BE GEOGRAPHICALLY LINKED TO THE
RESIDENCES OF STUDY
PARTICIPANTS.
WE'VE CONSIDERED MAKING DIRECT
EXPOSURE MONITORING OR INVITING
PARTICIPANTS TO WEAR PERSONAL
MONITORING DEVICES BUT THIS IS
CHALLENGING IN THE STUDY AS
LARGE AS OURS.
MEASUREMENTS DON'T REALLY SCALE
UP AND ONLY CAPTURE CURRENT
EXPOSURES.
AND WE LOOKED AT EXPOSOME
STUDIES FOR SAMPLES IN THE
COHORT AND ALSO EPIGENETIC
MECHANISMS ARE AFFECT EARLY
DEVELOPMENT AND AGING AND ALSO
AFFECTED BY ENVIRONMENTAL LIFE
TIME EXPOSURES AS WE
DEMONSTRATED IN OUR COHORT.
MANY CPGs AND METHLATION-BASED
MARKERS OF ENVIRONMENTAL EXCUSE
ME, OF AGE ACCELERATION HAS BEEN
LINKED TO EXPOSURES IN THE
COHORT AND THE GOAL IS TO
IDENTIFY METHYLATION BASED
SIGNATURES AND EXPOSURE AS HAS
BEEN DONE FOR SMOKING.
OUR RESEARCH HAS BEEN WIDE
RANGING WE FOCUS ON A NUMBER OF
DISEASES BESIDES BREAST CANCER
AND WE DO THIS WORK INTERIM --
INTRAMURALLY AND IN OUR BRANCH
AND LOOKING SPECIFICALLY FOR
CANCER AS WELL AS CONE --
CONSORTIA OF RISK DISEASES.
WE CARRIED OUT A NUMBER OF
COLLABORATIVE STUDIES ACROSS THE
NIH WITHIN EXTRAMURAL COLLEAGUES
AND STUDENTS AND TO DATE MORE
THAN 270 PAPERS HAVE BEEN
WRITTEN USING THE SISTER STUDY
AND WE'VE BEEN THE BASIS FOR 17
EXTRAMURAL GRANTS.
SO NOW I WANT TO TURN TO SOME
EXAMPLES FOR THIS STUDY.
I'M GOING START WITH EXPOSURES
DURING CHILDHOOD.
THERE'S A LOT OF INTEREST IN THE
POSSIBILITY THAT AIR POLLUTION
IS ASSOCIATED WITH BREAST CANCER
RISK AND WE WONDERED IF EARLY
LIFE EXPOSURE TO AIR POLLUTION
WAS A PROBLEM.
AND AIR POLLUTION DATA BEFORE
1990 ARE QUITE LIMITED AND MOST
OF OUR PARTICIPANTS WERE BORN
BEFORE 1970.
SO WE HAD TO LOOK AT THIS USING
SELF-REPORTED DATA ON ROADS AND
TRAFFIC AT THE LONGEST CHILDHOOD
RESIDENCE AND WERE ABLE TO
DEMONSTRATE BREAST CANCER RISK
WAS ASSOCIATED WITH NEAR A
ROADWAY OF HEAVY TRAFFIC WHICH
IS A MARKER OF AIR POLLUTION.
WE ALSO LOOKED AT PHYSICAL
ACTIVITY IN CHILDHOOD AND THOSE
THAT ADHERE TO THE HHS GUIDELINE
FOR ACTIVITY OF SEVEN OR MORE
HOURS A WEEK OF EXERCISE HAVE A
REDUCED CASE OF BREAST CANCER.
CIGARETTE SMOKING HAS BEEN AN
ELUSIVE EXPOSURE IN RELATION TO
BREAST CANCER RISK AND
INCONSISTENT IN TERMS OF ACTIVE
RISK SMOKING AND TO PASSIVE
SMOKING WE DID NOT DEMONSTRATE
AN INCREASED RISK FOR ADULT
PASSIVE RISK EXPOSURE BUT DID
SEE A SMALL SUGGESTIVE INCREASE
IN RISK FOR BREAST CANCER
ASSOCIATED WITH INCREASING
LEVELS OF EXPOSURE TO
ENVIRONMENTAL TOBACCO SMOKE IN
CHILDHOOD AND IN UTERO.
SOMETHING THAT'S BEEN A LONG
STANDING INTEREST OF OURS AND
MOTIVATED BY THE HEALTH EFFECTS
ASSOCIATED WITH THE USE OF
PERSONAL CARE PRODUCTS.
MANY OF THESE PRODUCTS CONTAIN
ENDOCRINE DISRUPTING AND TOXIC
CHEMICALS.
WE ADMINISTERED A QUESTIONNAIRE
AND ENROLLMENT THAT FOCUSSED ON
PERSONAL CARE PRODUCT USE AT THE
AGES BETWEEN 10 AND 13 AROUND
THE TIMING OF PUBERTY AND 12
MONTHS BEFORE ENROLLMENT.
WE CONSIDERED FREQUENT USE OF
HAIR STRAIGHTENERS AND IN TERMS
OF ADOLESCENCE TWO FOLD HIGHER
RISK OF BREAST CANCER RISK AMONG
THOSE WHO FREQUENTLY USED HAIR
STRAIGHTENERS.
AND WE ALSO FOUND AN ASSOCIATION
WITH FREQUENT USE OF THESE
CHEMICAL HAIR STRAIGHTENERS IN
THE YEAR BEFORE ENROLLMENT.
50% INCREASE IN THE RISK SHOWN
HERE.
OF NOTE, THE USE OF CHEMICAL
STRAIGHTENERS IS FAR MORE COMMON
AMONG BLACK WOMEN AND U.S. AS A
WHOLE BUT THE ASSOCIATIONS WERE
SIMILAR REGARDING RACE.
WE ALSO FOUND THOUGH I'M NOT
SHOWING IT BREAST CANCER RISK
WAS HIGHER IN ASSOCIATION WITH
USE OF PERMANENT HAIR DYES AND
THE RISK WAS SLIGHTLY STRONGER
IN THIS CASE.
I ALSO WANTED TO POINT OUT THAT
STRAIGHTENERS HAVE ALSO BEEN
ASSOCIATED WITH OTHER HORMONE
MEDIATED CANCERS IN OUR COHORT
AND WITH OUT -- UTERINE CANCER
IN A REPORT THAT JUST CAME OUT
THIS WEEK.
THERE'S BEEN A LOT OF INTEREST
IN AIR POLLUTION AND BREAST
CANCER AND IN TERMS OF EXPOSURE
DURING ADULTHOOD CO2 HAS BEEN
ASSOCIATED WOMAN -- WITH A SMALL
INCREASE AND USING AIR POLLUTION
MONITORING DATA AND LAND USE
REGRESSION MODELS WE IN THE
SISTER STUDY WE FOUND
ASSOCIATIONS BETWEEN AIR
POLLUTION AND BREAST CANCER.
IN 2015 WE REPORTED NO2 WAS
ASSOCIATED WITH A 10% INCREASE
IN BREAST CANCER RISK ESPECIALLY
ER POSITIVE BREAST CANCER BUT
FOUND NO ASSOCIATION WITH PM2.5.
A FEW YEARS LATER IN 2019 WITH A
LONGER FOLLOW-UP WE AGAIN FOUND
IN A SMALL INCREASE IN RISK
ASSOCIATED WITH NO2 AND HERE WE
STARTED TO SEE THE SUGGESTION OF
A RISK ASSOCIATED WITH PN2.5.
ONE REASON THAT STUDIES OF PM2.5
MAY HAVE NOT CONSISTENTLY
DEMONSTRATED RISK IS THAT
PARTICULATE MATTER VARIES ACROSS
THE UNITED STATES.
IT'S NOT ONE SINGLE THING AND
GEOGRAPHIC HETEROGENEITY IN THE
CHEMICAL COMPOSITION MAY MAKE A
SENSE AND THE AIR POLLUTION
SOURCES VARY GEOGRAPHICALLY AND
WE DID DEMONSTRATE IN A STUDY
THAT WAS LED BY MY COLLEAGUE
ALEXANDER WHITE THAT THE PM2.5
IS ASSOCIATED WITH BREAST CANCER
RISK IN THE WESTERN U.S. BUT NOT
ELSEWHERE.
MANY OF THE LARGE COHORT STUDIES
FOCUSSED ON BREAST CANCER AND
OTHER DISEASES IN WOMEN HAVE
BEEN FOCUSSED ON DIET.
MOST OF THESE STUDIES HAVE
LOOKED AT INDIVIDUAL DIET
CONSTITUENTS AND NUTRIENTS BUT
PEOPLE DON'T EAT A SINGLE FOOD
AT A TIME, EXCUSE ME, THEY DON'T
EAT A SINGLE FOOD OR NUTRIENT SO
FOCUSSING ON PATTERNS MAY BE
MORE INFORMATIVE.
WE CONSIDERED A NUMBER OF
HEALTHY EATING INDICES USED ON
U.S. GUIDELINES FOR EATING AND
SHOWING THE U.S. FOOD PYRAMID,
AN EXAMPLE OF THE FOOD PYRAMID
AND HAVE SHOWN SEVERAL OF THESE
DIETS OR ALL THE ONES WE LOOKED
AT WERE ASSOCIATED WITH REDUCED
RISK OF BREAST CANCER FOR WOMEN
WHO EAT A HEALTHY DIET.
WE'VE BECOME INTERESTED IN MORE
MECHANISTIC DIETS HOWEVER, AND
THESE ARE BASED ON A PRESUMED
YO -- BIOLOGIC COMBINATIONS OF
FOODS AND CONSUMING A
PRO-INFLAMMATORY DIET WAS
ASSOCIATED WITH INCREASED RISK
OF ESTROGEN NEGATIVE AND TRIPLE
NEGATIVE BREAST CANCER.
AND SIMILARLY AN ANTI-OXIDANT
DIET WAS ASSOCIATED WITH A
NEGATIVE RESULT AND INVERSE
REACTIONS AND WE LOOKED AT
EXPOSURE TO AMBIENT LIGHT AT
NIGHT IN RELATION TO OBESITY.
I'LL TURN NOW TO LOOKING AT THE
FACTORS OTHER THAN BREAST
CANCER.
SELF-REPORTED EXPOSURE TO ANY
INDOOR LIGHT BUT ESPECIALLY
SLEEPING WITH THE LIGHT OR TV ON
WAS ASSOCIATED WITH INCREASED
OBESITY AT ENROLLMENT AS WELL AS
DURING FOLLOW-UP AS SHOWN.
IT WAS ASSOCIATED WITH INCIDENT
WEIGHT GAIN AND MEASURES OF
OBESITY AT THE TIME OF
FOLLOW-UP.
SLEEPING WITH THE LIGHT OR TV ON
IN THE ROOM IS ALSO ASSOCIATED
WITH PREVALENCE OF HYPERTENSION
OUTDOOR LIGHT AT NIGHT COLLECTED
MEASURES USING SATELLITE DATA
WAS ASSOCIATED WITH INCIDENT
HYPERTENSION ONLY AMONG THOSE
THAT REPORTED OUTDOOR LIGHT WAS
GETTING IN THE ROOM WHILE
SLEEPING.
FINALLY, TO BRING US BACK TO
BREAST CANCER WE SAW SLEEPING
WITH A LIGHT OR TV ON WAS
ASSOCIATED WITH AN INCREASED
RISK OF BREAST CANCER.
WE CONSIDERED A NUMBER OF
EXPOSURES IN RELATION TO
HYPERTENSION AND ONE THING ABOUT
HYPERTENSION IS WE HAVE A GOOD
MEASURE AND WE MEASURED THIS AT
ENROLLMENT AS PART OF THE HOME
EXAM.
WE SHOWED A NUMBER OF AIRBORNE
POLLUTANTS RELATED TO FOSSIL
FUEL AND COMBUSTION PRODUCTS
WERE ASSOCIATED WITH AN
INCREASED RISK OF HYPERTENSION.
WE USED DATA FROM SOMETHING
CALLED THE NATIONAL AIR TOXIC
ASSESSMENT THAT IS MODELLED
POLLUTION DATA FROM THE EPA AS
WELL AS USING MONITOR DATA AND
THE MIXTURE OF THESE NINE
CHEMICALS THAT WE LOOKED AT WAS
ASSOCIATED WITH A SMALL INCREASE
IN HYPERTENSION RISK AND RISK
THAT WAS GREATER AMONG
PARTICIPANTS.
WE DIDN'T WANT TO FORGET THE
SOCIAL ENVIRONMENT WE THINK IS
MORE IMPORTANT IN CANCER RISK.
WE EVALUATED NEIGHBORHOOD SOCIO
ECONOMIC FACTORS USING THE AREA
DEPRIVATION INDEX AND EVEN IN
OUR COHORT WHERE MOST OF THE
PEOPLE DO NOT LIVE IN
NEIGHBORHOODS THAT HAVE A HIGH
LEVEL OF NEIGHBORHOOD
DEPRIVATION, THE INCREASING
LEVELS ASSOCIATED WITH INCREASED
HYPERTENSION RISK.
THIS MEASURE WAS ALSO ASSOCIATED
WITH VARIOUS ACCELERATED
BIOLOGIC AGE.
I WANT TO POINT OUT MANY OF
THESE HAVE BEEN ASSOCIATED WITH
INCREASED BREAST CANCER RISK IN
OUR STUDY AND NOT TO END ON A
TOTALLY NEGATIVE NOTE WE'RE ONLY
LOOKING AT THINGS THAT ARE BAD
FOR YOU WE HAVE BEEN
COLLABORATING WITH COLLEAGUES
FROM THE EPA TO CONSIDER THE
IMPACT OF GREEN SPACE WHICH
MIGHT BE BENEFICIAL IN TERMS OF
HEALTH RISKS AND HERE I'M
SHOWING AN EXAMPLE OF ONE OF
THESE STUDIES WHERE WE SHOWED
OVER ALL THERE'S A SMALL
REDUCTION IN DEPRESSIVE SYMPTOMS
AMONG PEOPLE WHO LIVE IN AREAS
WITH MORE TREE CANOPY AND WHAT'S
INTERESTING HERE IS THE
ASSOCIATIONS WERE FAR STRONGER
AMONG WOMEN WHO LIVED IN
NEIGHBORHOODS WHO WERE
HISTORICALLY RED LINED
SUGGESTING A SMALL INVESTMENT IN
GREENERY AND THESE HISTORICALLY
RED LINED NEIGHBORHOODS MAYBE
BENEFICIAL FOR HEALTH.
I HOPE I'VE CONVINCED YOU
PROSPECTIVE COHORT STUDIES ARE
IMPORTANT FOR STUDYING
ENVIRONMENTAL EXPOSURES IN
RELATION TO HEALTH OUTCOMES.
I THINK ONE THING THAT'S NEEDED
FOR THE FUTURE IS MORE DIVERSE
COHORTS.
THE NEW TECHNOLOGIES THAT ARE
AVAILABLE HAVE EXPANDED OPTION
FOR EXPOSURE ASSESSMENT AND I
WANT TO REMIND QUESTIONNAIRES
ARE THE BEST WAY TO CAPTURE
PERSONAL OR HISTORICAL EXPOSURES
BUT WHERE POSSIBLE WE NEED TO BE
VALIDATING THESE MEASURES WITH
G.I.S. DATA AND MONITORING BIO
MARKER STUDIES.
STUDYING THE IMPACTS OF MULTIPLE
EXPOSURES TOGETHER IS
INCREASINGLY OF INTEREST.
CHEMICAL MIXTURES ARE IMPORTANTA
AS WELL AS THE EXTERNAL AND
INTERNAL EXPOSOME.
WE DON'T WANT TO OVERLOOK THE
SOCIAL AND COMMUNITY ENVIRO
ENVIRONMENT.
WE'VE ALSO STARTED TO IN OUR
STUDY AND THIS IS ESPECIALLY
IMPORTANT IN THE TRENDS FOR
BREAST CANCER TO FOCUS ON HEALTH
DISPARITIES IN RELATION TO BOTH
THE EXPOSURE OPPORTUNITIES AND
DISEASE RISKS.
AGAIN, I WANT TO MENTION WE NEED
TO BE INCREASINGLY FOCUSSED ON
AFFECTS OF CLIMATE CHANGE WHICH
IS SOMETHING WE'RE DOING NOW IN
OUR STUDY.
SO SORRY I WENT A LITTLE BIT
OVER AND GLAD TO TAKE ANY
QUESTIONS.
>>THANK YOU, SO MUCH,
DR. SANDLER.
WHAT WE'LL DO NOW IS TURN IT
OVER TO DR. QUAKER HARMON WHO
WILL PROVIDE ADDITIONAL
RECOMMENDATIONS BASED ON OUR
TALKS AND SET THE STAGE FOR THE
Q&A SESSION.
DR. HARMON.
>>THANK YOU.
SO BEFORE WE IDENTIFY
RECOMMENDATIONS, WE'D LIKE TO
PROVIDE A BRIEF OVERVIEW OF THE
OUTCOMES WE DISCUSSED TODAY AND
HOW IMPORTANT DIFFERENCES IN
THESE OUTCOMES RELATE TO OUR
ABILITY TO STUDY ENVIRONMENTAL
EXPOSURES.
SO STARTING WITH ENDOMETRIOSIS,
THERE ARE REALLY IMPORTANT
CHALLENGES IN DIAGNOSES WHICH
CURRENTLY REQUIRE SURGERY AND
THIS MAKES IT DIFFICULT TO STUDY
ENDOMETRIOSIS IN POPULATIONS.
AND GIVEN THIS DIFFICULTY, WE
STILL DON'T KNOW MUCH ABOUT
ENDOMETRIOSIS AND IN FACT WHEN
WE SEARCH PUB MED WE FOUND FEWER
THAN 3,000 PUBLICATIONS AND MANY
PEOPLE DON'T KNOW ABOUT
ENDOMETRIOSIS AS A HEALTH
OUTCOME.
THERE'S A RIBBON CAMPAIGN TO
RAISE AWARENESS AND RESEARCH
FUNDS BUT IT'S NOT A HIGH
PROFILE CONDITION AND GIVEN HOW
MUCH WE DON'T KNOW ABOUT
ENDOMETRIOSIS AND THE DIFFICULTY
IN MAKING A DIAGNOSIS IT BECOMES
VERY CHALLENGING TO STUDY
ENVIRONMENTAL EXPOSURES.
UTERINE FIBROIDS INVOLVE OUR
NEXT STAGE OF PROGRESSION IN
TERMS OF KNOWLEDGE.
WE CAN USE ULTRASOUND AND
STUDIES SUCH AS SELF ARE
POSSIBLE BUT THE ABILITY TO
DIAGNOSE FIBROIDS HAS BEEN
SLOWLY TRANSLATED TO HOW MUCH IS
KNOWN AND WE FOUND FEWER THAN
2,000 SCIENTIFIC PUBLICATIONS.
FIBROIDS THOUGH COMMON HAVE VERY
LOW PUBLIC AWARENESS.
I WAS UNABLE TO FIND A RIBBON
CAMPAIGN FOR FIBROIDS.
HOWEVER, THERE ARE INCREASING
PUBLIC AWARENESS AND SUPPORT
GROUPS AND HERE I'M HIGHLIGHTING
THE WHITE DRESS PROJECT.
AS WE LEARN MORE ABOUT THE
NATURAL HISTORY OF FIBROIDS IT
BECOMES EASIER TO IDENTIFY
IMPORTANT ENVIRONMENTAL
EXPOSURES BUT WE MUST PRIORITIZE
STRONG STUDY DESIGNS.
BREAST CANCER REPRESENTS AN
OUTCOME WHERE THE SCIENCE HAS
ADVANCED AND THE KNOWLEDGE ABOUT
THE RISK FACTORS FOR BREAST
CANCER HAS BEEN TRANSLATED TO A
ROBUST SCREENING PROGRAM AND THE
SISTER STUDY WHICH RECRUITED
WOMEN BASED ON FAMILY HISTORY.
BREAST CANCER HAS MORE THAN
40,000 PUBLICATIONS REPRESENTING
AN EXTENSIVE RESEARCH PROGRAM.
BREAST CANCER HAS A WIDELY
RECOGNIZED RIBBON CAMPAIGN AND
AN AWARENESS MONTH WE'RE IN
RIGHT NOW AND THE HISTORY AND
PRESENCE OF A ROBUST SCREENING
AND REPORTING SYSTEM MAKES IT
LESS CHALLENGING TO STUDY THE
EFFECTS OF ENVIRONMENTAL
EXPOSURES.
SO AS YOU THINK OF WAYS TO
ADVANCE SCIENCE ON THE
ENVIRONMENTAL IMPACTS OF WOMEN'S
HEALTH, SOLUTIONS WILL VARY
DEPENDING ON WHERE ON THE
SPECTRUM A CONDITION FALLS.
AND THE DIFFERENCES IN THE STATE
OF KNOWLEDGE ARE REFLECTED IN
THE FUND OF THE OUTCOMES.
DR. CHANDLER AT NSU PLOTTED DATA
FROM A 2019 PUBLICATION SHOWING
THAT FEMALE DOMINATED CONDITIONS
IN RED ARE OFTEN UNDER FUNDED
COMPARED TO MALE DOMINATED
OUTCOMES IN BLUE WHICH HAVE
SIMILAR DISEASE BURDEN.
ENDOMETRIOSIS AND FIBROIDS IN
PARTICULAR HAVE LOW FUNDING IN
RELATION TO THEIR DISEASE
BURDEN.
SO ONE OF OUR FIRST
RECOMMENDATION TO INCREASE THE
FOCUS AND FUNDING ON THE
NON-FATAL CONDITIONS THAT AFFECT
QUALITY OF LIFE.
WE MOSTLY PRESENTED ON
CONDITIONS THAT ARE EXCLUSIVELY
SEEN IN WOMEN, THERE ARE OTHER
IMPORTANT CONDITIONS TO
CONSIDER.
AMONG THE TOP CAUSES OF IN
FEMALES, HEART DISEASE AND
CANCER MAY HAVE DIFFERENT AND
UNIQUE RISK FACTORS AND CLINICAL
PRESENTATIONS.
THE NEXT CAUSES OF DEATH,
STROKE, ALZHEIMER'S AND CHRONIC
RESPIRATORY DISEASE ARE MORE
COMMON IN FEMALES COMPARED TO
MALES AND STUDIES NEED TO
INCLUDE MORE WOMEN AND
IMPORTANTLY ADDRESS EXPOSURES
THAT MAY BE UNIQUE OR MORE
COMMON IN WOMEN.
FOR EXAMPLE, GENDERED AND
RACIALIZED BEAUTY STANDARDS
RESULT IN DIFFERENCES IN RESULTS
IN PERSONAL CARE PRODUCTS.
IN ADDITION TO THESE THREE
RECOMMENDATIONS, WE'D LIKE TO
HIGHLIGHT THE NEED TO PROMOTE
STUDIES WITH STRONG
EPIDEMIOLOGIC DESIGNS WHICH WILL
RESULT IN ROBUST RESULTS.
THERE'S AN URGENT NEED TO
UNDERSTAND THE BASIC
EPIDEMIOLOGY OF UNDER STUDIED
CONDITIONS TO MAKE PROGRESS ON
MAJOR RISK FACTORS.
SUPPORT FOR THE DEVELOPMENT OF
NON-INVASIVE DIAGNOSTIC TOOLS TO
ADVANCE CLINICAL CARE AND
RESEARCH.
MANY CONDITIONS DEVELOP OVER THE
LIFE COURSE AND LIFE COURSE
STUDIES REQUIRE INNOVATION AND
UNIQUE FUNDING MECHANISMS.
WOMEN FACE IMPORTANT AND UNIQUE
SOCIAL DETERMINATES OF HEALTH
WHICH INFLUENCE THEIR EXPOSURES.
THESE SOCIAL DETERMINATES MUST
BE MEASURED IN ANY STUDY OF
OTHER RISK FACTORS.
AND ALL OF THIS IS ONLY POSSIBLE
USING TEAM SCIENCE APPROACHES
WHICH NECESSITATE DIVERSITY AND
SCIENTIFIC EXPERTISE AND LIVED
EXPERIENCES.
>>THANK YOU.
I'LL NOW TURN IT OVER TO
DR. REGINE DOUTHARD TO MODERATE
OUR Q&A.
>>I WANT TO THANK ALL OF OUR
PANELISTS FOR INVISIGHTFUL
PRESENTATION.
ALL THE PRESENTATIONS AND NOW
I'LL TRANSITION TO THE Q&A
SESSION.
PLEASE INCLUDE YOUR QUESTIONS IN
THE CHAT BOX AND TO WHICH
PANELIST THE QUESTION IS
ADDRESSED AND YOU CAN ALSO RAISE
YOUR HAND AND INVITE TO YOU ASK
YOUR QUESTION.
I DON'T SEE ANY HAND RAISED --
>>DR. SIMON HAD A QUESTION IN
THE CHAT.
DR. SIMON, WOULD YOU LIKE TO
STATE YOUR QUESTION AND IF YOU
DON'T MIND?
>>I WAS WONDERING WHEN A
PRESENTER WAS TALKING ABOUT
PROGESTERONE AND INSTEAD OF A
REFORMATION FOR PROGESTERONE FOR
CONTRACEPTION PERHAPS IS
REINVIGORATING THE OTHER
RESEARCH.
AND MY SECOND QUESTION I HAVEN'T
HEARD MUCH ABOUT STRUCTURAL
RACISM AND HOW THAT
NEIGHBORHOODS WERE CREATED AND
GET HIGHER LEVELS OF THE
ENVIRONMENTAL EXPOSURES REALLY
DRIVES A LOT OF THE RESEARCH AND
I'D LIKE TO SEE THE ADDITIONAL
ELEMENT ADDED TO FUTURE RESEARCH
AND THAT DOES INCLUDE WHAT WAS
SAID AT THE LAST RECOMMENDATION
AND TEAM SCIENCE AND TRANS
DISCIPLINARY EQUITY RESEARCHERS
GETTING ON BOARD.
>>WE WERE ONLY ABLE TO LOOK AT
DEPRO-PROVERA.
WE'RE CURRENTLY LOOKING AT THE
USE OF HORMONAL IUDs IN FIBROID
DEVELOPMENT.
IT LOOKS LIKE SOME ARE SWITCHING
TO THE USE OF THIS CONTRACEPTION
AND WE'RE WONDERING IF IT IS
ALSO ASSOCIATED WITH FIBROID
INCIDENTS AND GROWTH AND WE'LL
BE REPORTING THOSE RESULTS WHEN
IT IS DONE.
WE CERTAINLY AGREE WITH THE
ISSUES OF STRUCTURAL RACISM.
IN SELF WE'RE CHALLENGED BECAUSE
WE'RE NOT LOOKING AT A
HOMOGENOUS POPULATION BUT
CONSTRAINED POPULATION WITHIN
DETROIT AND THE ISSUES BLACK
WOMEN IN PARTICULAR IN DETROIT
MAY BE DIFFERENT THAN OTHER
PARTS OF THE COUNTRY.
IT'S CERTAINLY A PRIORITY AT
NIEHS TO START INCREASING
FUNDING IN THE SOCIAL
DETERMINATES OF HEALTH AND
THINKING HOW TO MEASURE AND HOW
TO INCLUDE MEASURES OF
STRUCTURAL RACISM INTO STUDIES
OF THE ENVIRONMENT.
>>I'D LIKE TO ADD SOMETHING TO
THAT.
AND STUDIES NEED TO INCREASINGLY
STRUCTURAL RACISM AND WHEN WE
LOOK AT A SOCIAL ENVIRONMENT
MEASURE BASED ON SOCIO ECONOMIC
FACTORS WHAT WE'RE CONSIDERED IS
WHAT ARE THE LONG-TERM
IMPLICATIONS FROM HISTORICAL AND
CURRENT STRUCTURAL RACISM.
PEOPLE WHO LIVE IN NEIGHBORHOODS
THAT ARE UNDER RESOURCED AND
LOOKING AT ENVIRONMENTAL
CONTAMINATES.
IT NEEDS TO BE CONSIDERED IN
EVERYTHING WE DO.
WE STARTED TO DO THIS AND ARE
LOOKING AT MORE.
>>WE HAVE ANOTHER QUESTION.
CAN YOU COMMENT ON THE
ASSOCIATION BETWEEN
ENDOCRINE-DISRUPTING CHEMICALS
AND OTHER ENVIRONMENTAL
EXPOSURES AND HORMONAL
CONTRACEPTION.
MOST PREMENOPAUSAL WOMEN HAVE
USED HORMONE CONTRACEPTION AND
IT ALSO CONFERS ANDI RISK AND
ASSOCIATED WITH ENDOMETRIOSIS
AND FIBROIDS AND BREAST CANCER.
>>I'M HAPPY DIVE IN AND TALK
ABOUT HORMONAL CONTRACEPTIVE AND
ENVIRONMENTAL EXPOSURE.
I PUBLISHED A PAPER IN
ENVIRONMENTAL HEALTH
PERSPECTIVES WITHIN THE SELF
COHORT LOOKING AT THE USE OF
DEPRO-PROVERA AND WE KNOW THAT
DEPRO CAN CONFER SKELETAL
EFFECTS AND IT'S STORED IN OUR
SKELETON WITH THE INCREASED BONE
TURNOVER AND LOSS OF DENSITY WE
HAVE A CONTROVERSY OF WHAT WAS
STORED IN BONE BEING SENT INTO
THE CIRCULATING SYSTEM AND
CIRCULATING INTO ORGANS.
THAT'S BEEN MY WORK LOOKING
WITHIN HORMONAL CONTRACEPTIVE
AND THINKING THROUGH THE BONE
PATHWAY WITH THAT REGARD.
>>I THINK WE HAVE ONE MINUTE
LEFT.
I DON'T SEE ANOTHER QUESTION IN
THE CHAT BOX SO MAYBE I CAN AND
CAN I ASK ONE LAST QUESTION?
>>GO AHEAD, REGINE, TAKE
ANOTHER TWO MINUTES.
>>YOU SHED INFORMATION ON THE
FUNDING STUDIES OF
FEMALE-DOMINANT CONDITIONS.
WHAT DO YOU THINK HAVE BEEN THE
BARRIERS TO FUNDING AND THAT'S
TO ALL OF OUR PANELISTS.
>>FINDING A STUDY SECTION WITH
THE EPIDEMIOLOGIC EXPERTISE AND
THE INTEREST AND EXPERTISE IN
PARTICULAR WOMEN'S HEALTH
OUTCOMES.
I THINK THAT HAS BEEN A BARRIER
IS FINDING A HOME FOR THE
STUDIES AND FINDING STUDY
SECTIONS INTERESTED AND CAPABLE
OF EVALUATING AND FINDING THE
BEST STUDIES.
>>AND I WOULD LIKE TO FURTHER
ADD, I THINK HISTORICALLY WE'VE
HAD AN ISSUE WHERE WOMEN
PRESENTING WITH HEAVY MENSTRUAL
BLEEDING AND MENSTRUAL PAIN HAVE
BEEN DISMISSED IN THE CLINICAL
SETTING HISTORICALLY AND HAVING
DISMISSED IN TERMS OF HAVING
PERIODS AND HAVING A GREATER
AWARENESS THE DISRUPTION OF
HEAVY MENSTRUAL BLEEDING AND
PAIN IN THE ACTIVITIES OF DAILY
LIVING WARRANT THE IMPORTANCE OF
THINKING ABOUT THESE CONDITIONS
IN TERMS OF QUALITY OF LIFE AND
WARRANTS FUNDING INTO THESE
CONDITIONS.
>>THANK YOU VERY MUCH.
SO NOW THAT WE REACHED THE END
OF THE Q&A SESSION SO PLEASE
JOIN ME IN THANKING ALL OF OUR
PANELISTS, DR. UPSON, DR. HARMON
AND SANDLER FOR THEIR
PARTICIPATION AND INFORMATIVE
PRESENTATIONS AND ENRICHING
DISCUSSION THIS AFTERNOON.
I'LL TURN IT TO DR. NOURSI.
>>THANK YOU, DR. DOUTHARD AND
TO ALL THE PRESENTERS.
I'D LIKE TO GO TO THE NEXT
SESSION AND FOR THIS ONE I WILL
PUT ON MY HAT AS THE ASSOCIATE
DIRECTOR FOR SCIENCE POLICY,
PLANNING AND ANALYSIS AT ORWH.
I WOULD LIKE TO INTRODUCE FOR
THIS SESSION TWO OF MY
COLLEAGUES WHO WILL BE
PRESENTING WITH ME.
DOCTORS KELLY CHANDLER AND
DR. CHING-YI PRESENTING THE NEXT
ONE.
DR. CHANDLER IS THE SECOND HALF
OF THE DOCTOR CHANDLER WHO WAS
MENTIONED A FEW MINUTES AGO.
SHE IS A HEALTH SCIENCE POLICY
ANALYST AT ORWH.
SHE COORDINATED THE
CONGRESSIONALLY MANDATED
DIRECTORS MEETING AND
COORDINATES THE STRATEGIC PLAN
ON THE HEALTH OF WOMEN AND
SUPPORTS EFFORTS RELATED TO
SCIENCE POLICY FOR THE HEALTH OF
WOMEN AT ORWH.
DR. CHANDLER COMPLETED HER Ph.D.
IN MOLECULAR PHYSIOLOGY AND BIO
PHYSICS AT VANDERBILT UNIVERSITY
WHERE HER RESEARCH FOCUSSED ON
MAPPING ANCIENT LONG RANGE
ENHANCERS OF DEVELOPMENTALLY
RELATED GENES USING TRANSGENIC
MOUSE MODEL.
SHE COMPLETED A POST-DOCTORAL
FELLOWSHIP AT THE
U.S. ENVIRONMENTAL PROTECTION
AGENCY WHERE SHE WAS A PART OF
TOXICAST TEAMS BUILDING
PREDICTIVE MODELS OF
DEVELOPMENTAL TOXICITY.
PRIOR TO JOINING ORWH THIS YEAR,
DR. CHANDLER WAS ENGAGED WITH
MULTIPLE STRATEGIC PLANNING AND
POLICY EFFORTS ACROSS THE NIH
AND HHS AND LED THE
INTERPRETATION AND REVIEW OF
GOVERNMENT-WIDE REGULATIONS IN
THE OFFICE OF POLICY, PLANNING,
EVALUATION AT THE NATIONAL
INSTITUTE OF ENVIRONMENTAL
HEALTH SCIENCES.
THE SECOND TEAM MEMBER IS
DR. CHING-YI SHIEH A HEALTH
POLICY ANALYST AND STATISTICIAN
WITH ORWH AND HER DUTIES INCLUDE
RESEARCH METHOD COMPUTATION AND
PORTFOLIO ANALYSIS AND
CONGRESSIONALLY BUDGET
REPORTING.
SHE ALSO LEADS THE TRANS-NIH
MANUAL CATEGORIZATION SYSTEM
WOMEN'S HEALTH REPORTING
INITIATIVE.
BEFORE TRANSITIONING TO THE
EXTRAMURAL SETTING, DR. SHIEH
WAS A RESEARCH ASSOCIATE AT THE
NIH CLINICAL CENTER
REHABILITATION MEDICINE
DEPARTMENT AND HER RESEARCH IS
THE DEMOGRAPHY OF AGING AND
SOCIOLOGY OF WORK AND FAMILY AND
SOCIAL DETERMINATES OF HEALTH
AND LIFE COURSE TRANSITION.
TRAINED IN QUANTITATIVE ARE
RESEARCH METHODS, SHE'S
PROFICIENT IN LONGITUDINAL
MODELLING AND CLINICAL STUDY
DESIGN AND METHODOLOGY AND
FEDERAL INITIATIVE DATA ANALYSIS
AND COMPLEX DATA LINKING.
SHE RECEIVED HER Ph.D. IN
SOCIOLOGY FROM THE UNIVERSITY OF
MARYLAND.
DR. CHANDLER AND CHING-YI.
I'D LIKE TO TURN TO THE SLIDE
PRESENTATION AND HERE WE'D LIKE
TO PROVIDE YOU WITH AN UPDATE ON
WHERE WE ARE WITH THE 2024, 2028
NIH STRATEGIC PLAN ON RESEARCH
ON THE HEALTH OF WOMEN AND BY
THE END OF THIS SHORT
PRESENTATION, WE WILL SHARE WITH
YOU THE DRAFT OF THE MAIN TOPICS
THAT WE CAME UP WITH IN THE LAST
TWO MONTHS.
THE OVERARCHING GOAL OF THIS
STRATEGIC PLAN IS TO PROVIDE A
ROAD MAP TO GUIDE NIH-WIDE
RESEARCH ON THE HEALTH OF WOMEN
AND NOW WE ARE IN THE MIDST OF
PLANNING FOR THE NEXT ONE WHICH
WILL BE LAUNCHED IN JANUARY OF
2024.
SO WHO DID WE INVOLVE IN THIS
PROCESS?
AND WE'RE STILL IN THE MIDDLE OF
IT.
WE INVOLVED ALL OF OUR I.C.s,
THE ICOs AND INSTITUTE CENTERS
AND OFFICES WITHIN THE NIH
THROUGH VARIOUS MECHANISMS.
AND WE INVOLVED MANY OF THE
FEDERAL AGENCIES THAT HAVE
INTERESTS AND FOCUS ON WOMEN'S
HEALTH AND,000 HERE ON THIS
SLIDE.
WE ALSO INVOLVED PUBLIC, PRIVATE
AND NON-PROFIT AND ADVOCACY
GROUPS THROUGH THE RFI
DR. CLAYTON MENTIONED WE HAD A
REQUEST FOR INFORMATION OUT ON
THE STREET SEVERAL MONTHS AND WE
RECEIVED INPUT MORE THAN 200
INPUTS FROM THESE GROUPS WE WILL
SHARE WITH YOU.
SO WE REALLY TRIED TO CAST A
WIDE NET OF WELCOMING SOLICITING
INPUT TO THIS SO WE CAN TRY TO
MAKE IT AS COMPREHENSIVE AS
POSSIBLE.
AS YOU RECALL, WE CREATED A
WORKING GROUP WITH MEMBERS OF
YOU OF THIS COMMITTEE.
THE ACRWH WORKING GROUP WAS
CREATED AND IT IS CO-CHAIRED BY
DR. ALLISON McGREGOR WHO IS HERE
WITH US TODAY.
SHE'S THE CO-CHAIR OF THIS
WORKING GROUP.
AND THE CHALLENGE OF THE WORKING
GROUP IS TO ADDRESS THE CURRENT
STATE OF SCIENCE ON THE HEALTH
OF WOMEN RESEARCH GAPS AND
IDENTIFY GOALS AND OBJECTIVES
ORWH NEEDS TO PRIORITIZE FROM
2024 TO 2028.
WE HAVE MET AND HAD A KICKOFF
MEETING THAT INVOLVED THE
MEMBERS OF THE WORKING GROUP AND
THIS WORKING GROUP INCLUDED
MEMBERS FROM NIH AND THE FEDERAL
AGENCY I MENTIONED EARLIER.
DURING THE MEETING WE ALSO
REVIEWED THE IMPLEMENTATION OF
THE 2019 TO 2023 THE CURRENT
STRATEGIC PLAN ON THE RESEARCH
OF HEALTH OF WOMEN.
WHAT WE WILL DO TODAY IS REVIEW
WHAT WE HAVE DONE SINCE THE
KICKOFF MEETING WHICH WE HAD
UNTIL NOW.
SO I WOULD LIKE TO TURN IT AND
WE SPLIT THE IT UP IN A WAY I
GAVE THE BACK, I'D LIKE TO TURN
IT TO MY COLLEAGUE,
DR. CHANDLER, TO TALK ABOUT THE
PROCESS AND THEN DR. SHIEH WILL
SHOW THE RESULTS.
WITH THAT I'LL TURN IT TO
DR. CHANDLER.
KELLY.
>>THANK YOU, DR. NOURSI.
ORWH ENGINEERED A PROCESS MODEL
FOR KEY STEPS FOR THE NEXT
NIH-WIDE STRATEGIC PLAN ON
RESEARCH ON THE HEALTH OF WOMEN.
THIS PROCESS BEGIN WITH
COLLECTING AND ANALYZING DATA
FROM A VARIETY OF ACTIVITIES
ALONG SIDE ACRWH.
WE THEN ESTABLISHED A STRATEGIC
PLAN WORKING GROUP LED BY
DOCTORS McGREGOR AND NOURSI AND
REPRESENTATIVES AND MEMBERS AND
FEDERAL PARTNERS.
INITIAL FINDINGS FROM THE DATA
ANALYSIS WERE PRESENTED TO THE
STRATEGIC PLAN WORKING GROUP AND
THE KICKOFF MEETING WAS HELD
JUNE 30 AND FEEDBACK WAS
OBTAINED FROM THE STRATEGIC PLAN
WORKING GROUP DURING THE MEETING
AS WELL AS THROUGH OUTREACH
EFFORTS AFTER THE MEETING.
TODAY WE'LL BE PRESENTING THE
PROPOSED STRATEGIC PLAN CONTENT
AREAS DEVELOPED DURING THE
KICKOFF MEETING AS WELL AS AN
RFI, I.C. DIRECTORS MEETINGS,
INTERNAL ORWH MEETINGS AND
MEETING HERE WITH YOU ALL TODAY.
ONCE THE CONTENT IS APPROVED
WE'LL RECUSE THINK TANK GROUPS
FROM THE COORDINATING COMMITTEE
AND RESEARCH ON WOMEN'S HEALTH
AND THE ICO SUBJECT MATTER
EXPERTS AND THE EVALUATION
REPRESENTATIVE AT NIH AND
WORKING GROUP MEMBERS AS WELL AS
FEDERAL PARTNERS.
THEY'LL WORK TOGETHER TO DEVELOP
THE STRATEGIC GOALS AND
STRATEGIC OBJECTIVES AND METRICS
FOR EACH OF THE GOALS.
ORWH WILL THEN DRAFT THE
STRATEGIC PLAN WHICH WILL BE
PUBLISHED IN JANUARY OF 2024
FOLLOWED BY AN IMPLEMENTATION
AND EVALUATION GUIDE WHICH WILL
THEN BE PUBLISHED SIX MONTHS
LATER.
SO TODAY, WE ARE HERE IN THE
PROCESS OF DEVELOPING THE
STRATEGIC PLAN.
WE'RE EXCITED TO SHARE THE DRAFT
CONTENT AREAS FOR YOUR
CONSIDERATION.
THEY WERE DEVELOPED WITH ORWH
GENERATING INTENTIONAL SYNERGY
FOR THE ACTIVITIES TO PROVIDE
DATA THAT COULD BE ANALYZED
QUALITATIVELY AND LEVERAGED TO
BUILD THE CONTENT AREAS.
WE DO VALUE YOU'RE TIME AND
INPUT AND MADE SIGNIFICANT
ANALYTICAL EFFORTS IN A SHORT
PERIOD OF TIME TO PRESENT THIS
DATA TO YOU TODAY.
SO JUST TO PUT IT IN
PERSPECTIVE, WITH ALMOST HALF
THE RFI RESPONSES SUBMITTED IN
THE TENTH AND FINAL WEEK ON THE
STREET, THE LION'S SHARE OF THE
ANALYZE HAD TO BE CONDUCTED IN A
SHORT PERIOD OF TIME.
LIKEWISE ALMOST THREE-QUARTERS
OF THE DIRECTORS MEETING
OCCURRED THROUGH AUGUST AND
SEPTEMBER.
WE WORKED HARD TO ENSURE WE HAVE
THE DATA AND CAN MAKE AN
EVIDENCE-BASED DECISION
REGARDING THE CONTENT AREAS.
THE CONTENT ANALYSIS DATA
COLLECTION WAS CONDUCTED ACROSS
FOUR DIFFERENT ACTIVITIES, WHICH
I'LL WALK YOU THROUGH NOW.
THE FIRST WAS THE STRATEGIC PLAN
WORKING GROUP KICKOFF MEETING
HELD IN JUNE.
SO ANALYSES ACROSS MULTIPLE DATA
SOURCES WERE PERFORMED BY ACWH
MEMBERS AND STAFF PRIOR TO THE
MEETING AND SUBSEQUENTLY
PRESENTED TO THE GROUP FOLLOWED
BY GUIDED DISCUSSION.
TO REALLY MAXIMIZE PARTICIPANT
INPUT WORKING GROUP NUMBERS WERE
PROVIDED TO GUIDE THE DISCUSSION
QUESTIONS IN ADVANCE OF THE
MEETING.
THIS RESULTED IN 29 INPUTS WHICH
WERE RECEIVED VIA COMMUNICATION
DURING THE MEETING ITSELF AND
THEN AFTER THE KICKOFF MEETING.
THE NEXT SOURCE I WANT TO TALK
ABOUT IS THE ICO DIRECTORS
MEETINGS.
THEY'RE MANDATED BY THE 21st
CENTURY CURES ACT WHEREBY THEY
MUST MEET ANNUALLY TO ENSURE THE
HEALTH OF WOMEN IS CAPTURED IN
THEIR RESPECTIVE STRATEGIC
PLANS.
AGAIN, ORWH WAS STRATEGIC IN
LEVERAGING THESE MEETINGS TO
OBTAIN INPUT ON NEXT NIH-WIDE
STRATEGIC PLAN ON THE RESEARCH
ON THE HEALTH OF WOMEN.
DIRECTORS WERE PROVIDED GUIDED
QUESTIONS AND ONE ASKED THE
DIRECTORS TO SHARE WHAT THEY HAD
IDENTIFIED AS THE MOST CRITICAL
WOMEN'S HEALTH TOPICS WITHIN THE
CONTEXT OF THEIR ORGANIZATION'S
MISSIONS.
ALL BUT FIVE ICO DIRECTORS
PARTICIPATED WITH THE REMAINING
DIRECTORS SCHEDULED FOR EARLY
NOVEMBER.
IN TOTAL THE MEETINGS RESULTED
IN 32 INPUTS FROM DIRECTORS AND
SENIOR LEVEL STAFF WHO
PARTICIPATED IN THE MEETINGS.
SO IN CONJUNCTION WITH YOU ALL,
ORWH PUBLISHED A REQUEST FOR
INFORMATION TO SOLICIT COMMENTS
FROM SCIENTISTS, ADVOCACY AND
COMMUNITIES AND THE GENERAL
PUBLIC.
RFI CLOSED SEPTEMBER 29 WITH
ANALYZATION OF 20 COMMENTS AND
ENSURE THE PERSPECTIVES WERE
AVAILABLE TO YOU ALL AND THEY
GATHERED TO LOOK AT INPUTS
CONTRIBUTING TO THE CONTENT
AREAS YOU'LL HEAR ABOUT NOW FROM
MY COLLEAGUE, DR. SHIEH.
>>THANK YOU DR. CHANDLER.
THEY ASKED AMONG SO MANY TOPICS
RELEVANT TO THE HEALTH OF WOMEN
WHAT ARE THE ESSENTIAL TOPICS
FOR NIH TO FOCUS ON IN THE NEXT
ROUND OF THE STRATEGIC PLAN.
WE CONDUCTED QUALITATIVE DATA
ANALYSIS TO SUMMARIZE THIS INPUT
AND PROVIDE CODING ASSESSMENT TO
RECONCILE THE INCONSISTENCIES.
WE GENERATED DRAFT CONTENT AREAS
AND WELCOME YOUR FURTHER
COMMENTS TODAY.
BECAUSE SOME RECOMMENDATIONS
INVOLVE MULTIPLE CONCEPT, THE
DRAFT AREAS MAY NOT BE MUTUALLY
EXCLUSIVE.
MOREOVER, SINCE THE AREAS GO TO
INFORM THE DEVELOPMENT OF THE
NIH STRATEGIC PLAN, WE SHOULD
IDENTIFY BROADER RESEARCH TO
GUIDE NIH-WIDE SCIENTIFIC
EFFORTS INSTEAD OF TARGETING
SPECIFIC DISEASES OR HEALTH
CONDITIONS.
ALIGN WITH THEIR MISSIONS,
INDIVIDUAL ICOs HAVE THE
EXPERTISE TO DECIDE WHAT TYPE OF
HEALTH CONDITIONS THEY WANT TO
OCCASION ON AND OPERATIONALIZE
THEIR STUDY DESIGNS.
NOW, WE WILL PRESENT THE TOP
FIVE DRAFT CONTENT AREAS.
THE FIRST DRAFT CONTENT AREA IS
CONSIDERED HOW THEIR
INTERSECTION OF ASSOCIATION AND
BIOLOGICAL FACTORS AFFECT THE
HEALTH OF WOMEN.
THIS BRINGS INTERSECTION
TOGETHER AND SIGNIFIES THAT AND
TO CHARACTERIZE THE HEALTH OF
WOMEN MORE HOLISTICALLY.
AND THE DRAFT CONTENT AREA WE
WILL STUDY THE HEALTH OF WOMEN
IN CONTEXT AND EXAMINE HEALTH
CONDITIONS ACROSS THE LIFE
COURSE AS A CONTINUUM.
WE ADDRESSED MINORITY HEALTH
HEALTH DISPARITY AND HEALTH
EQUITY.
ASSESS MULTI-DIMENSIONAL
INFERENCES SUCH AS THE AFFECT OF
GENDER NORMS, STRUCTURAL RACISM
AND POLICY CHANGE.
AND WE LOOK AT THE INTERSECTION
OF SOCIAL DEMOGRAPHIC,
BEHAVIORAL AND ENVIRONMENTAL AND
BIOLOGICAL FACTORS.
AND THE DRAFT CONTENT AREAS SUCH
AS NIH-SUPPORTED DEVELOPMENT OF
DATA SCIENCE IN RESEARCH METHODS
AND MEASUREMENTS AND WE LOOK AT
BIG DATA ANALYSIS AND THE
SOPHISTICATED MODELLING METHODS
AS WELL AS ARTIFICIAL
INTELLIGENCE AND THE MACHINE
LEARNING RESEARCH.
WE USE REPEATED MEASUREMENT AND
LONGITUDINAL DATA TO ASSESS
HEALTH OVER TIME AND FACILITATE
SCREENING AND DIAGNOSIS AND
TREATMENT.
ALSO, WE WILL URGE SCIENTIST TO
RECRUIT ENOUGH WOMEN
PARTICIPANTS TO SUPPORT CLINICAL
STUDIES SO THAT THE RESEARCH
FINDINGS WILL HAVE A SOLID
EVIDENCE BASE.
OUR THIRD DRAFT CONTENT AREA IS
SUPPORT BIO MEDICAL WORKFORCE
TRAINING AND PROMOTE WOMEN
SCIENTIST CAREER DEVELOPMENT TO
ADVANCE THE HEALTH OF WOMEN.
WE WILL CONTINUE MAKING EFFORTS
TO DEVELOP A WELL-TRAINED AND
DIVERSE SCIENTIFIC WORKFORCE,
INCREASE THE REPRESENTATION OF
WOMEN SCIENTIST IN THE
WORKFORCE, ADDRESS ISSUES IN
RELATION TO WOMEN SCIENTIST AND
RETENTION AND PROMOTION AND
SUGGESTION ACTION TO ENHANCE
FUNDING EQUITY.
THE FOURTH CONTENT AREA IS
ADVANCE BASIC SCIENCE AND
TRANSLATIONAL RESEARCH TO
IMPROVE THE HEALTH OF WOMEN.
WE WILL CONTINUE TO PROMOTE
EFFORTS AND EVALUATE
IMPLEMENTATION OUTCOMES.
EXAMINE THE UNDERLYING
MECHANISMS TO LOOK AT DIAGNOSIS
AND TREATMENT.
LIKEWISE, WE NEED TO IMPROVE
TRANSLATIONAL RESEARCH OUTCOMES
IN PARTICULAR DO OUR BEST TO
ENSURE PRECLINICAL STUDY AND THE
ANIMAL MODEL INTO HUMAN SUBJECT
RESEARCH.
THE FIFTH DRAFT AREA IS
ENCOURAGE COMMUNITY ENGAGEMENT
AND PROMOTE IMPLEMENTATION
SCIENCE FOR THE HEALTH OF WOMEN
WHICH INCLUDES APPLIED STUDY
RESULT TO REAL WORK AND LOOK AT
CULTURALLY COMPETENT
INTERVENTIONS, COLLABORATE WITH
COMMUNITIES AND ORGANIZATIONS TO
IMPROVE HEALTH CARE DELIVERY
OUTCOMES.
WE DEVELOPED GUIDANCE AND
PROVIDE THE REQUIRED EDUCATION
AS WELL AS PROVIDE COMMUNITY
ENGAGEMENT IS SUSTAINABLE.
WE ALSO IDENTIFIED SEVERAL
TOPICS THAT COHORT SCIENTIFIC
INVESTIGATIONS.
SOME OF THEM ARE MORE
CROSS-CUTTING FOR INSTANCE,
STUDY COMORBIDITY AND
MULTI-MORBIDITY.
OTHERS ARE MORE SPECIFIC SUCH AS
HEALTH CONDITIONS AFFECTING
WOMEN AND GIRLS INCLUDING BUT
NOT LIMITED TO AUTOIMMUNE
DISEASES AND MENOPAUSE AND
RESEARCH IS COMPLEX AND
IMPOSSIBLE TO INCLUDE EVERYTHING
ON OUR LIST HOWEVER, THE KEY
POINTS EMBEDDED IN THE FIVE
RECOMMENDED DRAFT AREAS CAN
GUIDE VARIOUS RESEARCH.
FOR EXAMPLE, SCIENTISTS CAN
SOMEONE WOMEN'S MENTAL HEALTH
ISSUES FROM A CAREER DEVELOPMENT
AND WORK PERSPECTIVE USING BASIC
SCIENCE OR CLINICAL RESEARCH
DESIGN OR COMBINATION OF THESE.
WE BELIEVE ALL THESE EFFORTS ARE
IMPORTANT TO HELP US UNDERSTAND
THE HEALTH OF WOMEN.
NEXT LET ME TURN IT TO
DR. NOURSI.
THANK YOU.
>>THANK YOU.
THANK YOU, DOCTORS CHANDLER AND
SHIEH.
IN ADDITION TO WHAT HAS BEEN
PRESENTED SO FAR THERE WERE OVER
ARCHING PRINCIPLES THAT CAME
THROUGHOUT THE DATA WE GATHERED
AND THE INPUT WE RECEIVED AND
THEY ARE THE THREE THAT ARE
LISTED HERE TO ENCOURAGE
CROSS-NIH ICO PARTNERSHIP AND
COLLABORATION BETWEEN THE NIH
COMMUNITY AND PRIORITIZE
INTERDISCIPLINARY RESEARCH AND
CONSIDER THE GOALS OF NIH
DIVERSITY, EQUITY, INCLUSION AND
ACCESSIBILITY.
THOSE WERE OVER ARCHING
PRINCIPLES THAT CAME TO US AND
WE'LL KEEP THEM IN MIND AS THE
PLAN IS BEING DEVELOPED.
THE NEXT IS TO TAKE QUESTIONS
FROM EVERYONE.
I'D LIKE TO ASK DR. SHIEH AND
CHANDLER TO COME BACK ON CAMERA
AND SEE IF WE HAVE QUESTIONS
FROM THE MEMBERS BEFORE WE MOVE
ON TO THE VOTE.
DR. RIGENSTEINER, DID YOU HAVE A
QUESTION?
>>YES.
TWO THINGS.
FIRST OF ALL THIS WAS REALLY
INTERESTED AND WELL PRESENTED
BUT I HAD A COUPLE THINGS I
DIDN'T HEAR SAID I THINK NEED TO
BE AT LEAST DISCUSSED.
ONE WAS GENDER.
RESEARCH MORE IN GENDER.
I SAW SABB WELL REPRESENTED AND
THAT'S IMPORTANT BUT MORE AND
MORE ISSUES OF GENDER AS WELL
SEX.
THAT'S ONE THING.
THE OTHER THING IS I SAW
CONDITIONS THAT MOSTLY AFFECT
WOMEN AND GIRLS WHICH IS AGAIN
INCREDIBLY IMPORTANT BUT I
DIDN'T SEE CHRONIC COMORBID
CONDITIONS WE IDENTIFIED WHICH
ARE DISEASES SUCH AS HEART
DISEASE THAT AFFECT BOTH MEN AND
WOMEN BUT AFFECTS WOMEN IN
UNIQUE WAYS.
I WANT TO MAKE SURE THESE
DISEASES AND GENDER ARE NOT
FORGOTTEN AND IF I MISSED IT, I
APOLOGIZE BUT I THINK IT'S TOO
IMPORTANT TO MENTION.
>>THANK YOU.
I BELIEVE GENDER WILL BE COVERED
BY CONTAIN THE AREA.
THAT IS -- IT'S ENCOMPASSING THE
DEFINITION OF WHAT GENDER MEANS
AND ENVIRONMENTAL FACTORS AND
SOCIAL FACTORS AS WELL.
THAT WILL BE TAKEN CARE OF.
THOSE ARE THE OVER ALL CONTENT
AREAS BUT YOUR COMMENTS ARE VERY
WELL TAKEN AND WE'LL MAKE SURE
WE ADDRESS THAT SO IS THE SECOND
AREA OF DEBILITATING HEALTH
CONDITIONS.
THANK YOU SEARCH.
>>WHERE WAS THAT?
>>THE FIRST ONE.
THE GENDER WAS IN THE FIRST ONE.
>>NO --
>>THE DEBILITATING WILL BE
INCLUDED BUT IT'S NOT LISTED
HERE.
AGAIN, THOSE ARE THE MAJOR AREAS
BUT NOT SPECIFIC AREAS THAT WILL
BE ADDRESSED LATER.
DR. SIMON AND THEN TEMPLETON AND
THEN SUDOWSKI.
>>TWO MINOR COMMENTS AND ONE
SUGGESTION.
PLEASE, CAN WE IN THE USE
CULTURAL COMPETENCE.
NO ONE CAN EVER BE COMPETENT IN
EVERYONE'S CULTURE.
CAN WE CONSIDER CULTURALLY
RESPONSIVE FOR CULTURAL
HUMILITY.
SOMETHING LIKE THAT?
THE OTHER THING IS I DON'T SEE
THE DEFINITION OF WOMEN'S HEALTH
AND HOW TO CAPTURE THAT TO
BETTER DELINEATE THE PROPORTION
OF NIH FUNDS SPENT ON WOMEN'S
HEALTH.
THE THIRD IS I DON'T SEE THE "A"
WORD, ABORTION AND THIS IS A
HUGE ISSUE AND WE AS THE OFFICE
OF RESEARCH IN WOMEN'S HEALTH
ADVISORY COMMITTEE SHOULD NOT
SHY AWAY FROM THE "A" WORD.
ABORTION CARE IS EVIDENCE-BASED
THEY'RE SAFER THAN CAESAREAN
SECTIONS AND A THIRD OF OUR
PREGNANT PERSONS IN THIS COUNTRY
GET A CAESAREAN AND BLACK AND
INDIGENOUS AND NATIVE AMERICAN
WOMEN THIS IS ALARMING AND WITH
DR. CLAYTON'S INITIAL
PRESENTATION THIS MORNING WITH
THE FOUR OUT OF FIVE MATERNAL
DEATHS COULD BE PREVENTED,
ABORTION CARE ACCESS IS ACTUALLY
ONE OF THOSE PREVENTIBLE DEATHS.
-- STRATEGIES.
IT NEEDS TO BE HERE AND NEEDS TO
BE SAID AND SPOKEN OUT LOUD.
THANKS.
>>I WANT TO ASK IF DR. CLAYTON
WANTS TO RESPOND TO THAT.
>>IN REPRODUCTIVE CARE AND
HEALTH CARE NEEDS TO BE INCLUDED
FOR SURE AND I GREATLY
APPRECIATE YOUR COMMENTS AND WHY
WHERE YOU'RE COMING FROM AND
THIS IS WHY WE HAVE THIS TIME
TOGETHER TO HEAR DIRECTLY FROM
YOU ALL AND THANK YOU SO MUCH.
WE REALLY APPRECIATE THAT.
>>DR. TEMPLETON.
>>THIS IS GREAT WORK.
MY COMMENTS WOULD BE TO WORK
WITH DR. RIGENSTEINER AND SIMON.
I DIDN'T FIND WOMEN'S HEALTH BUT
WE DIDN'T DEFINE CHRONIC HEALTH
CONDITIONS AND AS WE DISCUSSED
AT THE MEETING LAST YEAR, THAT'S
ONE OF THE BIGGEST ISSUES IS
WHAT IS A CHRONIC HEALTH
CONDITION OF WOMEN UNLESS WE
DEFINE IT WE DON'T KNOW WHAT
WE'RE LOOKING FOR WHEN WE'RE
LOOKING AT WHAT TO FUND AND HOW
MUCH IS BEING FUNDED.
DR. RIGENSTEINER MENTIONED
CARDIOVASCULAR DECEASE AND
MUSCULOSKELETAL DISEASES ARE IN
JUST ABOUT EVERYBODY.
IF WE CAN AT LEAST HAVE A
DEFINITION OF WHAT A CHRONIC
CONDITION IN A WOMAN IS AND HOW
WHETHER THAT'S SOMETHING THAT'S
EXCLUSIVELY IN WOMEN OR WOMEN
AND MEN BUT JUST DIFFERENT IN
WOMEN SO WE KNOW WHAT WE'RE
LOOKING FOR.
AND MY OTHER COMMENT AND ONE OF
THE PRIORITY IS WOMEN BEING
HIRED AND SUPPORTING THEIR
CAREERS AND BURNOUT.
I CONSIDER WE PUTTING A MENTION
ON CAREER RE-ENTRY CONSIDERING
THE NUMBER OF PEOPLE THAT LEFT
THE WORKFORCE ESPECIALLY WOMEN
DURING THE PANDEMIC AND ARE
ANTICIPATED TO LEAVE IN THE NEXT
COUPLE OF YEARS, WOMEN IN
PARTICULAR BECAUSE OF OUR
SOCIETAL GENDERED EXPECTATIONS
AT HOME MAY HAVE MORE ISSUES
RE-ENTERING THE WORKFORCE AND
WHILE WE NEED TO CONTINUE TO
TRAIN WOMEN IN SCIENCE CAREERS,
IT'S ALMOST A FASTER TRACK TO
RETRAIN WOMEN AND SUPPORT THEM
TO GET THEIR CAREERS BACK ON
TRACK.
SO I WOULD ASK WE ALSO CONSIDER
THAT AS ANOTHER AREA WHERE WE
WANT TO TRY TO SUPPORT WOMEN AND
SCIENCES.
>>THANK YOU.
>>THANK YOU, DR. TEMPLETON.
DR. SUDOWSKI.
>>THE REPORT IS CREATE AND THE
DISCUSSION WAS INSIGHTFUL.
ONE OF THE THINGS I LIKE THE
MOST ABOUT THE OVER ALL APPROACH
IS THE DIMENSIONALITY.
THE PROPOSED STUDIES REALLY
FOCUS ON ANYTHING AND FOCUS MORE
ON THE PREGNANCY AREA BECAUSE
THIS IS THE ONE AREA I
CONTRIBUTED MORE TO AND
EVERYTHING MORE FROM COMMUNITY
HEALTH CARE TO HOSPITAL LABOR
AND DELIVERY AND PREGNANCY TO
THE POSTPARTUM PERIOD AND DOW
DOULAS AND NURSES AND GOING FROM
BASIC TO TRANSLATION TO RESEARCH
CLINICAL RESEARCH AND ONE PLACE
WHERE IT'S READ AND THERE'S
RESEARCH OPPORTUNITIES.
ON PAGE 49 THERE'S RESEARCH
OPPORTUNITIES DISCUSSION FOR
THREE MAJOR AREAS, CERVICAL
CANCER, CHRONIC DISEASES AND
MATERNAL MORBIDITY, MORTALITY,
IT DID NOT INCLUDE BASIC AND
TRANSLATIONAL RESEARCH, THE
OTHER TWO DID.
I KNOW BASIC TRANSLATIONAL
RESEARCH IS VERY GOOD BUT IN THE
PLACE OF RECOMMENDATION FOR SOME
REASON BASIC AND TRANSLATIONAL
RESEARCH IN MATERNAL HEALTH WAS
OMITTED.
I'M NOT SURE WHY.
IT'S IMPORTANT TO HAVE SOME
CONDITIONS THAT CAN REALLY BE
OPTIMALLY ADDRESSED BY BASIC
RESEARCH.
>>THANK YOU.
I WILL SUMMARIZE ALL THE
COMMENTS I HEARD BUT I WANTED TO
PUT IN FRONT OF YOU ALL THE
CROSS-CUTTING TOPICS BECAUSE
SOME OF THE TOPICS PEOPLE ARE
ASKING ABOUT ARE SPECIFICALLY
HERE LISTED.
THIS DID COME UP AND THEY'LL BE
CONSIDERED FOR SURE.
I THINK DR. HIGGINS, I SAW YOUR
COMMENT AND YOU CAN SEE
SUBSTANCE USE AND MISUSE IS
RIGHT HERE.
DR. AMENIA.
>>THANK YOU, I WANTED TO DO A
BRIEF INCLUSION BECAUSE I KNOW
THE FIRST BULLET WHEN WE TALK
ABOUT DISEASES THAT AFFECT AND
ALSO HEALTH CONDITIONS.
I THINK ABOUT MENOPAUSE THAT
DIDN'T HIT THE PRIORITY AREAS
I'D LOVE TO MAKE SURE IS
ADDRESSED.
>>GREAT.
THANK YOU.
DO I SEE A HAND UP AGAIN?
>>TALK ABOUT PHRASES THAT
BECAME FAMOUS DURING COVID,
YOU'RE ON MUTE IS A BIG ONE.
SO, HERE'S WHERE I DIFFERED FROM
WHAT WAS SAID.
IT SAYS DISEASES THAT
PREDOMINANTLY AFFECT WOMEN AND
GIRLS.
OF COURSE WE NEED TO STUDY THOSE
DISEASES BUTTING SHOULD BE
PHRASED DISEASES THAT
PREDOMINANTLY AFFECT OR SOMEHOW
PUT IN THERE IT'S NOT JUST
DISEASE PREDOMINANTLY AFFECT
WOMEN AND GIRLS BUT ALSO
DISEASES THAT MAY UNIQUELY
AFFECT WOMEN AND GIRLS LIKE
ORTHOPEDIC ISSUES AND I'M
COMFORTED BY THE WORDING OF
THAT.
>>OKAY.
WELL TAKEN.
DR. JONES.
>>ONE OF THE THINGS I HAVEN'T
SEEN REPRESENTED HERE THAT I
JUST INVITE US TO THINK ABOUT IS
THE DIAD.
THE BIRTHING PERSON WOMAN AND
CHILD.
AND THEY'RE LIKELY TO HAVE
HEALTHY NEXT GENERATION.
IS THERE SOME WAY THAT THAT
COULD BE REPRESENTED BECAUSE I
THINK OFTEN WE JUST FOCUS ON THE
INDIVIDUAL AND YOU CAN'T HAVE A
BABY WITHOUT A PERSON AND ADULT
THERE.
I INVITE US TO THINK HOW THAT
MIGHT BE WOVEN IN.
>>OKAY.
ANY OTHER COMMENTS BEFORE I
SUMMARIZE WHAT I'VE HEARD?
CHRONIC DEBILITATING CONDITIONS
TO BE INCLUDED.
ALSO NOT DISEASES BUT AREAS SUCH
AS MENOPAUSE, ABORTION TOPIC AND
DISEASES THAT ARE SPECIFIC TO
WOMEN NOT JUST DOMINANTLY WOMEN
DR. SIMON, YOU HAVE ONE MORE?
>>I'M SORRY.
WE KEEP SAYING HOW IT AFFECTS
THE HEALTH OF WOMEN AND I JUST
WANT TO PIGGY BACK ON WHAT
DR. JONES JUST SAID.
IT'S NOT JUST THE HEALTH OF
WOMEN AND THE BABY THAT SHE'S
CARRYING BUT THE HEALTH OF
SOCIETY.
AND THE COMMUNITY FAMILY AND
SOCIETY.
IF THERE'S A WAY TO DO THAT TOO
BECAUSE WHEN WE STOP DEBATING ON
THINGS LIKE THE "A" WORD WHEN
IT'S NOT SO POLITICALLY CHARGED,
IT BECOMES, IF WE CAN FRAME
WOMEN'S HEALTH IN THE BENEFIT TO
THE GREATER GOOD I THINK IT WILL
HELP THE STRATEGIC PLAN AND THE
NORTH STAR.
>>I GOT IT.
DID I MISS ANYTHING?
I JUST WANT TO MAKE SURE I MAKE
IT VERY CLEAR THIS INPUT
RECEIVED IS INPUT THAT CAME FROM
ALL THESE INFORMANTS.
WE GATHERED ALL THIS
INFORMATION.
THIS IS THE RESULT OF HEARING SO
MANY PEOPLE.
THE TOPICS THAT ARE COMING RIGHT
NOW WERE HEARD BUT PROBABLY WERE
NOT HEARD WHEN WE HAD THE
KICKOFF MEETING MAYBE.
WE HAVE DIFFERENT MEMBERS.
I JUST WANT TO MAKE SURE THIS IS
NOT SOMETHING DR. SHIEH AND
DR. CHANDLER PUT TOGETHER, IT'S
A RESULT OF ALL THE INFORMATION
GATHERED BUT ALL YOUR COMMENTS
ARE TAKEN INTO CONSIDERATION.
THIS IS A DRAFT OF THE AREAS.
THOSE ARE NOT THE GOALS OR
OBJECTIVES.
THESE ARE THE MAIN AREAS FROM
THE INPUT RECEIVED SO FAR.
SO ALL YOUR COMMENTS ARE WELL
TAKEN.
WE'LL TAKE THEM INTO ENSURING
THOSE AREAS ARE INCORPORATED
INTO THE BIG TOPICS THAT WE ARE
PUTTING IN FRONT OF OUR THINK
TANKS TO DEVELOP THE GOALS AND
OBJECTIVES MOVING FORWARD.
>>DR. NOURSI, TO SUMMARIZE THE
TOPICS YOU DID NOT SUMMARIZE
WHAT I SAID ABOUT BASIC AND
TRANSLATIONAL RESEARCH.
>>THANK YOU.
THERE'S SOMETHING I MISSED IS
ALL GOING TO BE IN OUR COMMENT
IN THE SUMMARY AND RECORDING OF
THE MEETING.
>>THANK YOU ALL.
THANK YOU, FOR LEADING THAT.
I WANT TO THANK EVERYONE FOR
YOUR INPUT.
IT'S VERY IMPORTANT AND HELPFUL
TO US.
THANK YOU, SAMIA.
>>WITH TAKING INTO
CONSIDERATION ALL THE COMMENTS,
I WOULD LIKE TO MOVE ON TO VOTE
TO BECAUSE WITH THAT WE CAN MOVE
TO THE AREA OF MOVING FORWARD TO
WORKING ON THOSE AND POLISHING
THEM UP.
AT THIS TIME I WOULD LIKE TO
VOTE ON APPROVING THOSE TOPIC
AREAS WITH THE COMMENTS THAT
WERE RECEIVED THAT WILL BE
INCORPORATED INTO THE REVISIONS
THAT WE WILL BE PUTTING FORWARD.
AND WE ARE ADDING AND THERE'S A
POLL OPENING RIGHT NOW.
>>WE NEED TO HAVE A MEMBER MAKE
THE MOTION.
>>WE WOULD LIKE TO HAVE A
MOTION ON THE TABLE TO APPROVE
THE DRAFT CONTENT AREA FOR THE
2024, 2028, NIH-WIDE STRATEGIC
PLAN ON THE RESEARCH ON THE
HEALTH OF WOMEN.
DO WE HAVE A MOTION?
>>A MOTION TO ADOPT THE DRAFT
PLAN.
>>DO I HAVE A SECOND.
THANK YOU.
WE'RE OPENING THE POLL.
IF YOU'RE IN FAVOR, OPPOSE OR
ABSTAIN.
ENTER YOUR RESPONSE AND WE'LL
HAVE 30 SECONDS TO RESPOND.
>>THANK YOU WE APPRECIATE YOUR
LIVELY DISCUSSION AND COMMENTS
AND WE HAVE A GREAT TEAM HERE AT
ORWH THAT WILL ENSURE ALL YOUR
COMMENTS ARE TAKEN INTO
CONSIDERATION AND OUR STRATEGIC
PLAN SPECIFIC AREAS TO MOVE
FORWARD TO THE THINK TANKS ARE
ADDRESSED.
WITH THAT, I WOULD LIKE TO
WELCOME DR. SARAH TEMPKIN TO
INTRODUCE OUR NEXT SPEAKER.
>>THANK YOU SO MUCH,
DR. NOURSI.
I'M SO HAPPY TO PRESENT AND
INTRODUCE DR. ELIZABETH BARR WHO
WILL BE OUR NEXT PRESENTER.
SHE'S A SOCIAL AND BEHAVIORAL
SCIENCE ADMINISTRATOR AT ORWH.
DR. BARR COORDINATES OUR ORWH
INTERPROFESSIONAL EDUCATION
EFFORTS AND CO-LEADS THE DIVERSE
VOICES SPEAKER SERIES AND
SUPPORTS EFFORTS RELATED TO
GENDER VARIABLES IN HEALTH
RESEARCH.
HER BACKGROUND IS IN
COMMUNITY-CENTERED RESEARCH, HIV
TREATMENT, REPRODUCTIVE JUSTICE
AND GENDER-BASED VIOLENCE.
DR. BARR COMPLETED HER Ph.D. IN
COMMUNICATION WITH TRAINING AND
SCIENCE AND TECHNOLOGY STUDIES
AT THE UNIVERSITY OF WISCONSIN
MADSON AND HER MASTER'S DEGREE
IN WOMEN'S AND GENDER STUDIES AT
TOWSON UNIVERSITY.
PRYOR TO JOINING ORWH IN 2019,
DR. BARR LED INTERDISCIPLINARY
AND CROSS-PROJECTS TO INFECTIOUS
WOMEN'S ENGAGEMENT IN CLINICAL
RESEARCH AND SERVED ON THE
FACULTY AT UMBC AND TOWSON
UNIVERSITY.
WELCOME, DR. BARR.
>>THANK YOU.
I WANT TO RESPOND TO A QUESTION
RAISED EARLIER REGARDING
COMMUNITY-DRIVEN RESEARCH.
WITH ORWH'S R35 PROGRAM HOPES TO
RECEIVE APPLICATIONS FROM
COMMUNITY-BASED ORGANIZATION
NONPROFITS AND ADVOCACY GROUPS
AND ENCOURAGE PROJECTS FOCUS ON
ADVOCACY AND COMMUNITY-BASED
EDUCATION SO I WANTED TO MAKE
THAT QUICK NOTE.
WE KNOW BIOLOGY, SOCIETY AND
POLICY INFLUENCE HEALTH,
CONSIDERATION OF GENDER IN
RESEARCH IS CRITICAL TO
ADVANCING THE NIH MISSION OF
INCREASING HEALTH AND SEX AND
GENDER ARE OFTEN USED THEY
DESCRIBE UNIQUE HEALTH IMPACTS
AND USING THE TERMS
INTERCHANGEABLY CONTRIBUTES TO
CONFUSION AND SEX IS A CONSTRUCT
BASED ON A SET OF TRAITS
DESCRIBED AS SEX TRAITS THAT
INCLUDE ANATOMY, PHYSIOLOGY,
GENETICS AND HORMONES.
ALL ANIMALS INCLUDING HUMANS
HAVE A SEX.
WHILE MALE OR FEMALE DESCRIBED
SEX VARIATIONS OCCUR IN WHICH
SEX TRAITS DO NOT CORRESPOND TO
A BIOLOGICAL SEX.
THE LANDMARK 2016 SEX AS A
BIOLOGICAL VARIABLE POLICY HAS
THE EXPECTATION THAT SEX AS A
BIOLOGICAL VARIABLE BE FACTORED
INTO RESEARCH DESIGN, ANALYSIS
AND REPORTING IN HUMAN AND
VERTEBRATE ANIMAL STUDIES.
GENDER IS A SOCIAL AND CULTURAL
VARIABLE THAT ENCOMPASSES
DOMAINS EACH OF WHICH INFLUENCE
GENDER IDENTITY AND EXPRESSION
AND NORMS AND STRUCK USUAL
SEXISM, POWER AND EQUITY.
GENDER SOCIALIZATION AND NORMS
OF MASCULINITY INFLUENCE BOYS'
AND MEN'S BEHAVIORS AND CAN
CONTRIBUTE TO HEALTH INEQUITY.
OTHER SOCIAL VARIABLES INCLUDING
RACE, ETHNICITY AND SOCIO
ECONOMIC STATUS, STATE AND
FEDERAL POLICIES MAY
ADDITIONALLY INTERACT WITH
GENDER HIGHLIGHTING THE
IMPORTANCE OF AN INTERAGENCY
APPROACH AND THERE'S WAYS TO
ADDRESS THE VARIABLES IN
RESEARCH.
THE CANADIAN INSTITUTES OF
HEALTH RESEARCH HAS A SEX AND
GENDER-BASED ANALYSIS PLUS
POLICY WHICH CAME INTO AFFECT IN
JULY OF 2009.
IT'S TO ADDRESS HOW FACTORS LIKE
DISABILITY AND SEXUAL
ORIENTATION AND CULTURAL
BACKGROUND AND MIGRATION STATUS
AND GEOGRAPHIC LOCATION INTERACT
AND INTERSECT WITH BROADER
SYSTEMS OF POWER.
THE EUROPEAN COMMISSION WHICH IS
THE E.U.'S KEY FUNDING PROGRAM
FOR INNOVATION DESCRIBES THE
GENDER DIMENSION IN RESEARCH IS
A REQUIREMENT BY DEFAULT.
DISENTANGLED THE SEX AND GENDER
IN HEALTH HAS BEEN LIMITED TO
DATE.
THE CURRENT NIH REQUIREMENT FOR
RESEARCH ON HUMAN SUBJECTS IS
REFLECTION OF ONE VARIABLE, SEX
WHETHER SELF-REPORTED BY
PARTICIPANTS OR EXTRACTED FROM
MEDICAL RECORDS HAS BEEN THE
VARIABLE AND SEX AND GENDER
SHOULD BE COLLECTED AND STUDIED
APPROPRIATELY.
AND PRACTICES EXIST TO MEASURE
GENDER PHENOMENON IN HEALTH
RESEARCH AND ADDITIONAL RESEARCH
TO VALIDATE INSTRUMENTS IN THE
COLLECTION OF INFORMATION ABOUT
GENDER IS NEEDED.
EVOLVING SOCIAL NORMS HAVE
SHIFTED DEFINITIONS AND
UNDERSTANDINGS OF SEX AND GENDER
AND FEW TOOLS TO MEASURE AND
GENDER HAVE BEEN AVAILABLE AND
VALIDATED.
IN THIS CONTEXT, NIH
COMMISSIONED THE NATIONAL
ACADEMIES OF SCIENCES,
ENGINEERING AND MEDICINE TO
CONVENE A PANEL OF EXPERTS TO
REVIEW THE MEASUREMENT OF SEX,
GENDER IDENTITY AND SEXUAL
ORIENTATION TO MAKE
RECOMMENDATIONS FOR SPECIFIC
MEASURES AND TO PROVIDE GUIDANCE
FOR THEIR USE.
THIS EFFORT WAS LED BY THE
SEXUAL AND GENDER MINORITY
RESEARCH OFFICE AND SUPPORTED BY
18 ADDITIONAL INSTITUTE CENTERS
AND OFFICES INCLUDING THE ORWH.
ACCURATE DEFINITIONS AN
APPROPRIATE TERMINOLOGY ARE
ESSENTIAL TO RESEARCH AND THE
TWO-STEPS IS CONSIDERED BEST.
STEP ONES ASKED ABOUT CURRENT
GENDER IDENTITY AND INCLUDES A
VARIETY OF OPTIONS TO CHOOSE
FROM AND STEP TWO ASKS ABOUT SEX
ASSIGNED AT BIRTH.
THIS IS WIDELY UTILIZED ACROSS
NIH AND THE EXTRAMURAL
COMMUNITY.
FOR EXAMPLE, NIAID DEVELOPED
GUIDANCE FOR THEIR HIV CLINICAL
TRIALS NETWORK TO HAVE
RECOMMENDED MEASURES AND THE ALL
OF US RESEARCH PROGRAM UTILIZE
THE TWO-STEP METHOD.
THE REPORT INCLUDED RECOMMENDED
MEASURES FOR SEX ASSIGNED AT
BIRTH AND CURRENT GENDER
IDENTIFY SHOWN HERE.
WHILE THE NAS EM REPORT SAYS IT
USES SEX TERMS TO CAPTURE
IDENTITY THERE'S A LACK OF DATA
USING TERMINOLOGY TO COLLECT
CURRENT GENDER IDENTITY.
THIS HAS BEEN ADDED BUT THE
REPORT DOES INDICATE IN THE
ABSENCE OF OTHER EVIDENCE THE
PANEL'S RECOMMENDATION OF
FEMALE/MALE TERMINOLOGY FOR
CURRENT GENDER IS IN KEEPING
WITH OPENINGS USING THE CURRENT
MEASURES.
THEY USED EXPLICIT TEST OF
GENDER TERMINOLOGY OR GENDER
IDENTITY RESPONSES IN THE NASEM
REPORT.
STRATEGIC GOAL TWO OF THE 2019
THROUGH 2023 TRANS-NIH STRATEGIC
PLAN FOR WOMEN'S HEALTH RESEARCH
IS TO DEVELOP METHODS AND
LEVERAGE DATA SOURCES TO
CONSIDER SEX AND GENDER
INFLUENCES THAT ENHANCE RESEARCH
FOR THE HEALTH OF WOMEN,
OBJECTIVE 2.2 IS TO DEVELOP AND
ADAPT RELIABLE AND VALID
MEASURES RELEVANT TO THE HEALTH
OF WOMEN.
IN ALIGNMENT WITH OBJECTIVE 2.2
OF THE 2019 THROUGH 2023
STRATEGIC PLAN, TODAY WE PRESENT
FOR CLEARANCE A CONCEPT ON
GENDER AND MEASUREMENT WITH
TESTING GENDER TERMINOLOGY,
WOMEN, MAN, NON BINARY AND
CAPTURE SEX ASSIGNED AT BIRTH
AND GENDER IDENTITY.
AND CENTERS AND OFFICES HAVE
EXPRESSED INTEREST IN THE
CONCEPT INCLUDING THE SEXUAL AND
GENDER MINORITY RESEARCH OFFICE
AND THE NATIONAL LIBRARY OF
MEDICINE AND THE NATIONAL
INSTITUTE OF AGING, THE EUNICE
KENNEDY SHRIVER HEALTH AND HUMAN
DEVELOP.
AND OFFICE OF HUMAN AND
BEHAVIORAL SCIENCES RESEARCH.
WE'RE EXCITED TO SHARE AN
OPPORTUNITY FOR ADDITIONAL
DIALOGUE WHICH WILL TAKE PLACE
NEXT WEDNESDAY AND DR. CLAYTON
MENTIONED EARLIER THE SCIENTIFIC
WORKSHOP TITLED GENDER AND
HEALTH IMPACT STRUCTURAL GENDER
NORMS AND POWER DYNAMICS AND
INEQUITIES FOLLOWING THE OPEN
PLENARIES IN THE MORNING FROM
THE SPEAKERS THE AFTERNOON WILL
FEATURE SESSIONS INCLUDING ONE
FOCUSSED ENTIRELY ON ISSUES OF
MEASUREMENT AND METHODS.
THAT WILL FEATURE PRESENTATIONS.
AND WE INVITE YOU TO VIEW THAT
EVENT VIA VIDEOCAST IF YOU HAVE
NOT ALREADY REGISTERED.
AND WITH THAT, I AM HAPPY TO
ANSWER QUESTIONS AND THANK YOU
FOR YOUR ATTENTION.
>>WE DON'T COLLECT DATA WITH
RACIAL AND SOME ETHNIC
MINORITIES.
WE DON'T COLLECT DATA ON SEXUAL
MINORITIES.
IT'S BEEN TREATED SOMEWHAT LIKE
A TABOO TOPIC.
IT WOULD BE BETTER IF WE WERE
ABLE TO COLLECT DATA WITHOUT
BEING FEARFUL BUT HOW CAN WE
ADEQUATELY STUDY THESE THINGS
WITHOUT COLLECTING DATA?
IT'S AN IMPORTANT QUESTION AND
SEX ASSIGNED AT BIRTH PER GENDER
IDENTITY DISTINCT FROM SEXUAL
ORIENTATION WHICH AFTER
SOMEBODY'S GENDERED EXPOSURE AND
SOMEONE WHO IS A WOMAN MAY OR
MAY NOT HAVE BIOLOGICAL
ATTRIBUTES THAT WOULD BE
ASSIGNED WITH FEMALE SEX AND
BOTH VARIABLES ARE RELEVANT WITH
A HOST OF OTHER DEMOGRAPHIC
VARIABLES.
IT'S IMPORTANT TO USE PRECISE
AND ACCURATE TERMINOLOGY
THROUGHOUT.
>>OUR OFFICE IN POUGHKEEPSIE IS
DIVING INTO THE DOMAIN OF
ORIENTATION AND ONE THAT IS
IMPORTANT TO HEALTH AND TRYING
TO THINK THROUGH STRATEGIES FOR
AS YOU SAID INTEGRATING IT IN A
WAY THAT IS MEANINGFUL AND
CLINICALLY RELEVANT AND ALLOWS
PEOPLE TO FEEL COMFORTABLE
REPORTING THAT INFORMATION IN
THE CONTEXT OF IT BEING
IMPORTANT FOR THEIR HEALTH AND
SO SGMRO, WE WORKED CLOSELY WITH
THEM AND WE HAVE SUPPORTED SOME
OF THEIR EFFORTS AS WELL AS WE
MOVE THROUGH THE EVOLVING
CONCEPTS ALWAYS IN THE SERVICE
OF IMPROVING THE HEALTH OF
EVERYONE.
>>QUESTIONS?
DR. BARR.
DR. TEMPLETON.
>>A WONDERFUL PRESENTATION.
WITH THE PREVAILING POLITICAL
WINDS IN THE COUNTRY WHERE SOME
STATES ARE ALLOWING ONLY LOOKING
AT BIOLOGIC SEX INDICATING
THAT'S ALL THAT EXISTS AND
IGNORING THE FACT THAT GENDER
MAY BE DIFFERENT.
WHAT CAN WE DO OR ARE THERE
PLANS IN LOOKING AT EDUCATION OF
POLICY MAKERS TO LET THEM KNOW
THAT ACTUALLY GENDER IS A THING
AND NOT THE SAME AS SEX AND MAY
CORRELATE AND MAY NOT BUT I
WORRY ESPECIALLY WITH PEOPLE
WORKING IN STATE-SPONSORED
ACADEMIC INSTITUTIONS SOME MAY
BE HANDICAPPED IN NOT BEING ABLE
TO FULLY EXPLORE THIS IMPORTANT
AREA OF SCIENCE BECAUSE OF THE
POLITICAL INFLUENCES AT THE SATE
LEVEL.
>>DR. CLAYTON, WOULD I LIKE TO
RESPOND TO THAT?
>>DR. TEMPLETON, YOUR
HIGHLIGHTING VERY IMPORTANT
ISSUES THAT AFFECT US IN OUR
TODAY.
OUR PART IS TO PROVIDE
INFORMATION TO SUPPORT DATA,
GENERATION OF EVIDENCE AND THAT
NEEDS TO ALWAYS BE DONE IN THE
MOST RIGOROUS PAY POSSIBLE.
AS WE LEARN MORE ABOUT THE
CONCEPTS, WE EXPAND AND THINK
ABOUT THEM AS PER SCIENCE.
WE HAVE INVESTED IN A WIDE
VARIETY OF INTEREDUCATIONAL TOOL
TO HAVE THEM FREELY AVAILABLE TO
THE PUBLIC AND DIRECTED TOWARDS
VARIOUS AUDIENCES AT DIFFERENT
LEVELS AND WE HAVE AN
INTRODUCTORY COURSE NOW AND EVEN
TO THE TRAIN THE TRAINER
MATERIALS.
AND DR. BARR IS A WONDERFUL
LEADER IN THE INTERPROFESSIONAL
EDUCATIONAL EFFORTS AS WELL AS
THE CONTENT WE DISSEMINATE
PUBLICLY.
WE SEEK TO HAVE THAT ALWAYS BE
DATA DRIVEN AND EVIDENCE
DERIVED.
AGAIN IN THE SPIRIT OF INCLUDING
THE HEALTH OF EVERYONE.
THE OFFICE HAS A SPECIFIC FOCUS
ON THE HEALTH OF WOMEN AS YOU
KNOW AND WE DO PROVIDE
INFORMATION THROUGH MEDIA
INTERVIEWS, THROUGH WEB CONTENT,
THROUGH REPORTING PUBLICATIONS.
WE PUSH OUT A LOT OF CONTENT TO
MAKE IT AVAILABLE AND RECOGNIZE
IT'S A COMPLEX SPACE WITH MANY
STAKEHOLDERS AND MANY OBJECTIVES
AND AGENDAS OF DIFFERENT
STAKEHOLDERS.
SO WE ARE COMMITTED TO
GENERATING THAT EVIDENCE AND
MAKING SURE THAT EVIDENCE IS
AVAILABLE AND WITH THIS CONCEPT
DR. BARR JUST PRESENTED TO YOU,
WE'RE HOPING TO REFINE SOME OF
THE DIFFICULTIES OF THOSE AROUND
GENDER AND IMPROVE THE METHODS
AND MEASUREMENTS, MAYBE WE CAN
MAKE SOME STEPS FORWARD TOGETHER
AS A SOCIETY TO BE ABLE TO
ADDRESS THIS IMPORTANT ASPECT OF
HEALTH.
SO I KNOW THAT MAY NOT BE
ANSWERING EVERYTHING YOU ASKED,
BUT WE'RE TRYING TO DO OUR PART.
>>I WANT TO FRAME THIS AND
THERE'S A CONSENSUS STUDY I'M
PART OF DRIVING RACIAL AND
ETHNIC HEALTH DISPARITIES AND
PART OF WHAT I ALWAYS HEAR IN
TERMS OF RESEARCH AND IMPACTS OF
WOMEN'S HEALTH AND YOUR FIRST
SLIDE, DR. BARR, THAT I LOVE.
WAY WANT TO MAKE SURE WE DO IS
WHEN WE THINK ABOUT POLICY AND
RESEARCH AND HOW THOSE
INTERTWINE AND IMPACT HEALTH OR
DETRACT FROM HEALTH, WHAT DO WE
HAVE TO DE-IMPLEMENT BECAUSE IN
THE WORLD OF IMPLEMENTATION
SCIENCE AND THIS RESEARCH THAT
GOES ON WHETHER IT'S A TRIAL
THAT GOES INTO CLINICAL PRACTICE
AND WHEN NEW RESEARCH COMES OUT
WE FORGET WE HAVE TO ACTIVELY
DE-IMPLEMENT THE STUFF WE'VE
BEEN DOING AND THERE'S LESS
RESEARCH AND STUDY HOW TO
DE-IMPLEMENT SOMETHING WHILE
YOU'RE TRYING TO IMPLEMENT A NEW
THING.
THIS IS REALLY IMPORTANT FOR HOW
GENDER AND RACE AND ALL THOSE
OTHER INTERSECTIONAL IDENTITIES
PLAY OUT IN THIS SPACE.
SO DE-IMPLEMENTATION IS AN
IMPORTANT PART OF THE RESEARCH
TOO.
>>IF I CAN JUST RESPOND BRIEFLY
I KNOW WE'RE NEAR TIME.
THE DIVISION OF AIDS OVER AT
NIAID HAS DONE A LOT OF
FOUNDATIONAL WORK THROUGH THEIR
HIV NETWORKS AND SOME OF THEIR
GUIDANCE AROUND IMPLEMENTING A
TWO-STEP METHOD OF DATA
COLLECTION THEY ALSO REALLY
STRESSED THE IMPORTANCE OF STAFF
TRAINING AND RECOGNIZING THAT
NOT ALL STAFF AND THERE'S A
SHARED BASELINE LEVEL OF
UNDERSTANDING OF THE LANGUAGE
AND THE ISSUES.
I THINK THERE ARE POCKETS AND
EFFORTS EXISTING AND I FULLY
AGREE IT'S IMPORTANT TO AMPLIFY
THOSE.
>>ANYONE ELSE?
ANY QUESTIONS?
THANK YOU.
HAVE YOU FOR YOUR ENGAGEMENT.
I'D LIKE TO MOVE ON TO THE NEXT
STEP WITH THIS AND TO APPROVE
THE GENDER AND MEASUREMENT
CONCEPT CLEARANCE.
IS THERE A MOTION ON THE TABLE
TO APPROVE THE GENDER AND MER --
MEASUREMENT CONCEPT CLEARANCE.
>>I'LL MAKE THE MOTION.
PLEASE ENTER YOUR RESPONSES NOW
AND YOU HAVE 30 SECONDS.
>>THANK YOU.
WE HAVE 14 IN FAVOR AND ONE
OPPOSED.
>>THANK YOU VERY MUCH.
THE GENDER AND MEASUREMENT
CONCEPT CLEARANCE HAS BEEN
ACCEPTED WITH 14 IN FAVOR AND
ONE OPPOSED.
THANK YOU, DR. BARR.
AND PLEASE DO STAY ON BECAUSE
I'M GOING TURN IT TO YOU TO
INTRODUCE OUR NEXT PRESENTER.
>>THANK YOU.
I'M HAPPY TO STAY WITH YOU FOR
THE NEXT PRESENTATION AND TO BE
JOINED BY EMILY GERRICKE AND
WILL YOU BE SHARING YOUR SCREEN?
PERFECT.
WE CAN SEE YOUR SCREEN BUT
YOU'RE NOT IN PRESENTER MODE.
PERFECT.
AS MENTIONED SHE WILL PROVIDE AN
OVERVIEW OF OUR E LEARNING
COURSES AND WILL GIVE A LIVE
DEMONSTRATION.
THE AUDIENCE IS VERY FAMILIAR
WITH THE NEED FOR THE QUOTE
SHOWN HERE UNDER SCORES THE
SIGNIFICANT GAPS THAT EXIST IN
CURRENT TRAINING IN AUDIT
MEDICAL SCHOOLS CURRICULA FOUND
LESS THAN ONE-QUARTER OF
TRAINING RELATED TO SEX AND
GENDER.
AND JUST 8% INCLUDE IN DEPTH
DISCUSSION OF THE IMPORTANT
CONCEPTS.
DESPITE THE RELEVANCE OF BOTH
SEX AND GENDER TO HEALTH, THE
CONCEPTS ARE PERSISTENTLY UNDER
EXPLORED IN HEALTH RELATED
TRAINING MAKING IT DIFFICULT TO
REACH A TARGET STATE WHERE THIS
POPULATION IS INTEGRATED INTO
RESEARCH AND IT'S CRITICAL IN
BRINGING THE TARGET STATE AND
THE OFFICE HAS SUPPORTED A
EDUCATION TRAINING PROGRAM TO
REACH ALL THAT INTERACTION
INCLUDING CLINICIANS,
RESEARCHERS, VETERINARIANS,
PHARMACISTS, DATA SCIENTISTS,
JOURNAL EDITORS AND MORE.
SO WITH THAT SAID OUR GOALS ARE
TO PROVIDE OVERVIEW OF THE
COURSE OFFERINGS AS WELL AS THE
UNDERSTANDING OF THE KEY
AUDIENCES OF THE COURSES
FOLLOWED BY A LIVE DEMO.
JUST SOME HIGH LEVEL METRICS AS
OF SEPTEMBER OVER 200,000
INDIVIDUALS REGISTERED FOR THE
COURSE AND OR THE INTRODUCTORY
TRAINING AND OVER 1200
INDIVIDUALS ADD THE END OF
SEPTEMBER STARTED OR COMPLETE
THE MODULE OF BED TO BEDSIDE AND
750 COMPLETED A MODULE SO
THERE'S HIGH INTERESTED AS SHOWN
BY LEARNERS' REPORTED
AFFILIATION IN 56 COUNTRIES.
A GLOBAL REACH NOR -- FOR THE
PROGRAM AND I'LL TURN IT TO
EMILY WHO WILL WALK US THROUGH
THE REST OF THE RELATION.
>>I WON'T SPEND TOO MUCH TIME
ON THIS SLIDE BECAUSE WE HAVE A
GREAT RESOURCE.
OUR COURSE GUIDE PDF IS A
DOWNLOADABLE RESOURCE FROM OUR
WEBSITE AND I THINK DR. BARR CAN
PUT THE LINK TO IT IN THE CHAT
THAT HAS AN OVERVIEW OF THE
COURSE OFFERINGS AND WHAT TO
EXPECT FROM EACH COURSE AND THE
MODULES AND A BIT ABOUT WHO
THEY'RE FOR BUT I'LL GO OVER IN
BRIEF, THE BENCH TO BEDSIDE
COURSE IS A THOROUGH
UNDERSTANDING OF SEX AND GENDER
INFLUENCES AND HEALTH AND
DISEASE AND AS DR. BARR
MENTIONED EARLIER WE'RE TRYING
TO REACH ANYONE WHO WOULD
INTERACT AND INTERFACE WITH THE
HEALTH ECO SYSTEM WITH THIS
COURSE.
AND THERE'S CMEs AVAILABLE FOR
THIS AND IT WAS DEVELOPED IN
PARTNERSHIP WITH THE FDA.
THE SUPPLEMENT COURSE IS ABOUT
DEMONSTRATING HOW TO CONSIDER
SABBs IN ALL STAGES OF MEDICAL
RESEARCH TO CLARIFY POLICY AND
HOW TO PLY IT AND THE TRAIN THE
TRAINER COURSE PROVIDES
STRATEGIES AND BEST PRACTICES
HOW TO TEACH THE SAB POLICIES
AND CONCEPT TO OTHERS AND IT'S A
GREAT INTRODUCTORY RESOURCE AND
BREAKS DOWN SEX AND GENDER AND
HOW TO APPLY IT IN CLINICAL CARE
AND A RESEARCH AND IT PROVIDED
FUNDING FOR THE SABV PRIMARY
SUPPLEMENT.
THIS IS TO NOTE THERE'S A PRE
TEST WE ADMINISTER BEFORE YOU
CREATE AN ACCOUNT BEFORE THEY'RE
ABLE TO ACCESS COURSES WHICH
ALLOWS US TO ASSESS LEARNING
AFTER TAKING THE COURSES.
YOU WON'T SEE THIS IN THE DEMO
BECAUSE I ALREADY LOGGED IN BUT
WE WANTED TO FLAG IT SO YOU'RE
AWARE.
THE BENCH TO BEDSIDE COURSE,
WHEN WE TALK ABOUT WHO IT'S FOR
AS MENTIONED EARLIER ANYONE WHO
INTERFACES WITH THE HEALTH ECO
SYSTEM FROM CLINICIANS TO HEALTH
PROFESSIONALS TO POLICY MAKERS
AND RESEARCHERS AND STUDENTS
FROM AN ADVANCED UNDERGRADUATE
LEVEL TO GRADUATE AND
PHARMACEUTICAL AND OTHER
PROFESSIONAL SCHOOLS.
AS WELL AS ALL INTERESTED
LEARNERS.
SO THE SIX MODULESS COVER
IMMUNO
IMMUNOLOGY, CARDIOVASCULAR
DISEASE, ENDOCRINOLOGY AND
MENTAL HEALTH.
THIS IS PROBABLY THE MOST
IMPORTANT SLIDE WE WANTED TO
TAKE A MOMENT TO SHOW DURING THE
DEMONSTRATION.
THERE MANY WAYS WE THINK OF AND
PROBABLY OTHERS WE HAVEN'T
THOUGHT OF FOR APPLYING THE
BENCH TO BEDSIDE COURSE AS WELL
AS OTHER COURSES BUT THIS IS TO
SHOW YOU WHAT WE HAD IN MIND IN
CREATING THE RESOURCES.
ONE IS INCORPORATING INTO
ACADEMIC COURSES OR
INCORPORATING AS TRAINING FOR
LAB MEMBERS PROVIDING AN EXTRA
CREDIT OPTION FOR STUDENT AND
SHARING SCHOOL LIBRARIES AND
SHARING WITH PROFESSIONALS AND
WHAT THEY CAN LINK TO OR IN
PRINT RESOURCES THAT WE HAVE
LIKE A COURSE GUIDE TO BE SHARED
WITH DEPARTMENT FACULTY AND
NETWORKS AND WE ALWAYS VALUE
ANYONE WHO HAS TAKEN THE COURSE
SHARING AND THEIR EXPERIENCES
WITH COLLEAGUES AND FRIENDS
THROUGH THEIR E-MAIL OR SOCIAL
MEDIA PLATFORMS OR IN
CONSULTATION WITH COLLEAGUES.
AND WITH THAT I'LL MOVE TO THE
BENCH TO BEDSIDE DEMOS.
I'M GOING TO ASK ELIZABETH TO
CONFIRM FOR ME SHE CAN STILL
SEE -- CAN YOU SEE MY BROWSER
SCREEN?
>>YES.
>>GREAT.
THIS IS A FEW OF WHAT YOU'D SEE
BEFORE YOU LOG INTO THE --
BEFORE YOU CREATE AN ACCOUNT AND
LOG INTO E-LEARNING.
YOU CAN FIND IT UNDER THE CAREER
DEVELOPMENT AND EDUCATION TAB ON
THE WEBSITE.
YOU CAN GET TO THE MAIN COURSE
COLUMN BY CLICKING E-LEARNING
AND THAT WILL TAKE YOU HERE AND
EACH OF THE COURSES HAVE A
COURSE PAGE WHERE YOU CAN FIND
MORE DETAILS ABOUT THE COURSES
AND YOU CAN ALSO FIND MORE
INFORMATION ABOUT THE AUTHORS,
REVIEWERS AND LEADERSHIP FOR THE
COURSES AS WELL.
NOW I'LL MOVE TO ANOTHER BROWSER
WHERE I ALREADY SIGNED IN TO MY
ACCOUNT ON THE ACCOUNT.
ONCE YOU LOG IN YOU'LL BE ABLE
TO ACCESS ALL THE COURSES.
YOU CAN BEGIN MULTIPLE COURSES
AT ONE TIME OR TAKE THEM ONE AT
A TIME.
IT'S UP TO YOU.
IF I WERE TO EXPAND THIS COURSE
FOR THE BENCH TO BEDSIDE, WHICH
IS WHAT WE'RE LOOKING AT TODAY,
IT WILL SHOW YOU THE MODULES,
WHICH ONES YOU'VE BEGUN AND
WHICH ONES YOU'VE COMPLETED AND
THE DATE COMPLETED AS RELEVANT.
YOU'LL NOTE HERE IT'S SHOWING
I'VE ALREADY TAKEN THE PRETEST
SO IT'S ALLOWING KNOW NOW ACCESS
THE COURSE.
EACH MODULE WILL PRESENT TO YOU
WITH LEARNING OBJECTIVES AT THE
BEGINNING OF THE MODULE BUT
BECAUSE I'M JUMPING TO THE
MIDDLE OF THE COURSE YOU WON'T
SEE THE LEARNING OBJECTIVES AT
THE BEGINNING.
THIS IS JUMPING US INTO THE
MIDDLE OF THE IMMUNOLOGY MODULE
OF THE BENCH TO BEDSIDE COURSE.
AS WE NOTED THERE'S SIX
DIFFERENT MODULES WITH DIFFERENT
HEALTH AND DISEASE AREAS.
THE AUDIO FOR THIS PAGE HAS
ALREADY PLAYED BUT I'M HOPING IF
I ADVANCE TO THE NEXT SLIDE YOU
CAN GET A LITTLE BIT OF A TASTE
OF THE AUDIO.
SO HOPEFULLY THAT WILL PLAY FOR
US IN A MOMENT.
>>MALES AND FEMALES ARE NOT THE
SAME.
HERE ARE SOME OF THE WAYS IN
WHICH SEX MATTERS IN ACHIEVING
PERSONALIZED MEDICINE.
>>AS YOU CAN SEE THE COURSE IS
DYNAMIC AS USERS MOVE THROUGH
THE COURSE THEY EXPLORE THE
MATERIAL AT THEIR OWN PACE AND
REMAIN ENGAGED.
I'M GOING CONTINUE --
>>ADDITIONALLY -- WE CAN
CONTINUE THROUGH THE
DEMONSTRATION.
ALL THE MODULES ARE INTERACTIVE
WITH AUDIO, VIDEO AND CLICKABLE
ELEMENTS.
I'M GOING KEEP THE AUDIO MUTED
TO CONTINUE THROUGH THE
DEMONSTRATION.
THIS PORTION ILLUSTRATES AN
EXAMPLE OF HOW THE MOTH PROVIDES
SCIENTIFIC GRAPHICS WITH HELPFUL
INFORMATION AND SUITABLE FOR
THOSE WHO DO WHILE BEING HELPFUL
TO THOSE WHO MAY NOT BE AS
FAMILIAR.
AND I'LL POINT OUT THE GLASS
GLOSSARY TOOL WHICH IS ANOTHER
WAY WE'RE TRYING TO MAKE IT
ACCESSIBLE EVEN TO THOSE WHO ARE
NOT NECESSARILY CLINICIANS AND
HAVE A STRONG SCIENTIFIC
BACKGROUND TO KNOW THE TERMS.
THIS NEXT PORTION HAS AN
INTERACTIVE ELEMENT.
I'VE CLICKED THROUGH EVERYTHING
HERE BUT THIS ALLOWS LEARNERS TO
SELECT WHAT THEY WOULD EXPECT TO
SEE IN THE INFLAMMATORY RESPONSE
BASED ON SEX DIFFERENCES AND
PROGRESSION THROUGH THE LIFE
COURSE.
IF I HADN'T CLICKED THROUGH
EVERYTHING, IT WON'T ALLOW ME TO
ADVANCE YET AND THAT ALLOWS
USERS -- YOU CAN DO IT AS MANY
TIMES AS YOU WANT GOING BACK AND
FORTH AND GOING THROUGH PREVIOUS
PARTS OF THE COURSE AND DO THE
ELEMENT AGAIN.
EACH SECTION OF THE COURSE IS
UNIQUE IN HOW IT DISPLAYS THE
INFORMATION TO REMAIN ENGAGING.
THIS BREAKS DOWN THE GENETIC AND
HORMONE INFLUENCE AND ECOLOGICAL
FACTORS.
CHECK MARKS INDICATE I VIEWED
THE CONTENTS IN THE ELEMENT BUT
IF I HADN'T I WOULDN'T CHECK AND
YOU WON'T HAVE TO WORRY ABOUT
MISSING CONTENT.
WE ADVANCE TO THE KNOWLEDGE TAB
AT THE END OF EACH SECTION AND
YOU WILL BE PROVIDED INFORMATION
ABOUT WHETHER YOUR ANSWER IS
CORRECT AND WHY OR WHY NOT AND
THAT CONCLUDES OUR
DEMONSTRATION.
I KNOW IT'S A SHORT
DEMONSTRATION BUT WE HOPE IT'S
GIVEN YOU A SENSE FOR THE
QUALITY OF THE VALUE AND DEPTH
OF THESE RESOURCES OFFERED AND
PERHAPS SOME IDEAS HOW YOU MIGHT
BE ABLE TO DISSEMINATE OR
INCORPORATE THESE RESOURCES INTO
DIFFERENT WORK THAT HAVE YOU OR
COLLEAGUES YOU MIND MAY BE
INTERESTED.
I'LL REMIND YOU THE CMEs ARE
AVAILABLE JUST FOR THE BENCH TO
BEDSIDE COURSE BUT THEY OFFER A
CERTIFICATE AT THE END.
THANK YOU FOR YOUR TIME AND
ATTENTION AND HOPEFULLY THIS
GIVES YOU A GLIMPSE INTO THE
GREAT RESOURCES THAT ARE
AVAILABLE ON OUR E-LEARNING HOME
PAGE.
WITH THAT I'LL TURN IT BACK TO
DR. NOURSI.
>>THANK YOU, EMILY AND
ELIZABETH.
DR. CLAYTON, WE ARE SHARING NOW
THE CORRECTED SLIDE FOR YOUR
COMMENT.
>>PERFECT, THANK YOU.
DR. NOURSI.
>>I WANTED TO MAKE A CORRECTION
ON ONE OF THE SLIDES FROM THE
LUNCH BREAK.
THIS QUOTE WAS MISATTRIBUTED.
THE CORRECT ATTRIBUTION IS
REBECCA SHANSKI'S LAB POSTED ON
TWITTER AND WHAT WAS PREVIOUS
POSTED WAS A RE-POSTING.
THIS IS THE ORIGINAL TWEET AND
THE ORIGINAL TWEET'S OFFER.
WE APOLOGIZE FOR ANY MISTAKES
AND FOR MAKING THAT MISTAKE IN
THAT ATTRIBUTION.
THANK YOU SO MUCH FOR MAKING
THAT CORRECTION FOR US.
AT THIS POINT WE HAVE A BIT OF
TIME FOR OPEN DISCUSSION, OUR
AFTERNOON OPEN DISCUSSION IN
RESPONSE TO YOUR FEEDBACK TO
MAKE SURE WE HAD TIME ON THE
AGENDA THROUGHOUT FOR ENGAGEMENT
WITH YOU ALL AS ADVISORY
COMMITTEE MEMBERS.
I INVITE YOU TO TURN ON YOUR
CAMERAS AND BRING UP ANY ISSUES
OR TOPICS THAT YOU WOULD LIKE TO
SHARE YOUR THOUGHTS ABOUT
ESPECIALLY ANYONE WHO HAS NOT
CONTRIBUTED YET AND CONTRIBUTE
IN THE CHAT IF YOU PREFER BUT
LET ME JUST OPEN THE FLOOR TO
HEAR FROM YOU ALL AS ADVISORY
COMMITTEE MEMBERS.
AND YOUR INPUT IS SO IMPORTANT
TO US AND SO WOULD LIKE TO HEAR
ANY OTHER THOUGHT OR FEEDBACK OR
COMMENTS ON ORWH PROGRAMMING.
WHO WOULD LIKE TO START?
>>CAN YOU ASK TO YOU COMMENT
BRIEFLY ON THE IMPORTANCE OF
TRAUMA AND VIOLENCE IN WOMEN AND
WHAT WE SHOULD BE THINKING ABOUT
AS WE MOVE FORWARD?
THAT'S A TOPIC THAT'S BEEN VERY
IMPORTANT TO ORWH OVER THE YEARS
AND WE HAVE MADE SUBSTANTIAL
INVESTMENTS IN THE PATH WITH
COLLABORATING WITH HHS AND
ACROSS THE OPERATING DIVISIONS
TO PUT FORWARD SOME RESEARCH
QUESTIONS.
IT'S A CROSS-CUTTING TOPIC THAT
WE BELIEVE DOES DESERVE SOME
INCREASED ATTENTION BUT I WOULD
LIKE TO HEAR FROM OTHERS AND
YOUR OUTSTANDING WORK IN THE
SPACE IS WHY I'M CALLING FOR YOU
TO GET US STARTED ON THAT.
>>WHAT IS INTERESTING IS I
THINK THE CDC REPORT YOU
REFERENCED EARLIER ABOUT PRE
PREVENTIBLE DEATHS DURING
PREGNANCY.
WE KNOW THERE'S A HIGH RATE OF
PREGNANCY ASSOCIATED OF KILLING
WOMEN AND INJURY AND THE RESULT
OF INTIMATE PARTNER VIOLENCE.
I THINK IT'S A CROSS-CUTTING
TOPICS THAT HAS BEEN MENTIONED
SEVERAL TIMES BECAUSE WE KNOW
FEMALE CHILDREN AND I DON'T DO
CHILD ABUSE AND WE KNOW FEMALE
CHILDREN ARE EXPOSED ACROSS THE
LIFE SPAN.
IT CAN BEGIN IN INFANCY,
ADOLESCENT DATING, YOUNG ADULT
WOMEN AND ON AND I'VE DONE SOME
WORK WITH OLDER WOMEN AND
VIOLENCE.
IT'S THROUGH THROUGHOUT THE LIFE
TIME FOR MOST WOMEN AND WE KNOW
MANY PEOPLE CONCENTRATE ON THE
ACUTE INCIDENTS OF THE BATTERING
OR THE INJURY OR THE E.R. VISIT
BUT THERE'S OTHER RESEARCH AND
WORK I'VE DONE WITH DR. JACKIE
CAMPBELL THERE'S LIFELONG
EFFECTS WHICH PROBABLY I THINK
YOU COULD LOOK AT IN TERMS OF
CHRONIC CONDITIONS DISABLING
CONDITIONS AND SOME OF OUR
EARLIER WORK LINKED SOME
EXPOSURE TO HYPERTENSION AND
CARDIAC DISEASE.
I ALWAYS THINK OF MY Ph.D.
ADVISER ABOUT WHAT IS SEXY AND
WE HAVE PERIODS AND THINGS ARE
IMPORTANT THAT ARE NOT IMPORTANT
AND THINGS THAT FIT HIGH
PRIORITY AND WE'RE IN ACROSS THE
INSTITUTES WE'RE SHYING AWAY
FROM VIOLENCE AND THE IMPACT ON
HEALTH BUT WE KNOW IT'S THERE
AND NEED TO CONTINUE
TRAUMA-INFORMED WHEN YOU LOOK AT
THE DISEASES YOU WERE TALKING
ABOUT OR CONDITIONS FOR YOUR NEW
STRATEGIC PLAN AND MENTAL
HEALTH, SUBSTANCE ABUSE WE KNOW
ARE LONG-TERM CONSEQUENCES OF
EXPOSURE TO VIOLENCE AND WHEN WE
THINK ABOUT WOMEN AND THE HIGHER
RATES OF MENTAL HEALTH AND
DEPRESSION AND PARTICULARLY IN
VULNERABLE COMMUNITIES AND OFTEN
THOSE WOMEN ARE NOT -- THEY'RE
NOT SURE IT'S DEPRESSION OR HAVE
HAD THAT LABEL.
I THINK WE HAVE TO CONTINUE AND
CERTAINLY WE ARE ALSO SEEING THE
IMPACT OF VIOLENCE AGAINST WILL
HAVES AROUND GENDER STUDIES.
AND HOW DO WE LOOK AT THAT AND
HOW DO WE STUDY THAT
PARTICULARLY IN YOUNGER COHORTS
OF YOUNG WOMEN AND PERHAPS
INFLUENCE GENDERED INDIVIDUALS.
I THINK IT'S IMPORTANT THAT
ISSUE CONTINUES AND WE KNOW THAT
THAT PREGNANCY RELATED DEATHS
AND MATERNAL MORTALITY -- MORE
WOMEN ARE GOING TO BE EXPOSED TO
THAT THAN SOME OF THE OTHER
MEDICAL CONDITIONS THAT WE STUDY
AND I THINK IT'S A PERVASIVE AND
I THINK WE'RE SEEING THE
PANDEMIC HAS INCREASED MANY
WOMEN'S VULNERABILITY TO
PARTICULARLY INTIMATE PARTNER
VIOLENCE.
>>THANK YOU SO MUCH FOR SHARING
YOUR THOUGHTS.
ANYBODY ELSE WANT TO PICK UP ON
THAT OR ADD TO THAT BEFORE WE
MOVE ON TO ANOTHER TOPIC?
THANK YOU, DR. SHARPS.
I APPRECIATE THAT.
I WONDER IF I CAN GET A COMMENT
ON CANCER AND WOMEN AND IT'S
SOMETHING IMPORTANT TO US IN THE
WOMEN'S HEALTH CONFERENCE REPORT
WE TALKED ABOUT STALLED CERVICAL
CANCER SURVIVOR RATES.
WE HAVE A NEW NCI DIRECTOR
COMING.
SHE'S HERE, ACTUALLY.
GETTING ON HER CALENDAR.
I WOULD LIKE TO HEAR IF THERE'S
SPECIFIC THOUGHTS FOR US AS WE
GO INTO THE PERIOD OF HAVING THE
THINK TANKS THAT WILL INFORM OUR
STRATEGIC GOALS GOING FORWARD.
>>I'M SUPER EXCITED ABOUT
MONICA BECOMING HEAD OF THE NCI
AND SHE IS EXTRAORDINARY AND SO
I'M LOOKING FORWARD TO SEE WHAT
CHANGES OCCUR.
I THINK THAT ONE REALLY
INTERESTING THING AS PART OF THE
LANCET COMMISSION ON BREAST
CANCER WHICH IS A CONDITION THAT
DISPROPORTIONATELY AFFECTS WOMEN
AND BEING A TRACER CONDITION WE
CAN USE TO HELP TO HIGHLIGHT
WAYS THAT WOMEN CAN BE EMPOWERED
MORE GENERALLY AND WE'RE LOOKING
AT THE LITERATURE ON BREAST
CANCER RIGHT NOW AND LOOKING
ACROSS HIGH-INCOME AND LOW AND
MIDDLE-INCOME COUNTRY SETTING
AND THE OPTIONS ARE VERY
DIFFERENT IN DIFFERENT SETTINGS
YET THERE IS ALWAYS A CHOICE AND
CONSISTENT TRUTH WHICH IS GENDER
OF THE INDIVIDUAL IS SOMETHING
THAT DISADVANTAGES AND BEING A
WOMAN DISADVANTAGES YOU
REGARDLESS OF WHETHER YOU'RE IN
A HIGH-INCOME OR LOW-INCOME
COUNTRY AND THAT EXTENDS FROM
THE IMPACT OF THE DOBBS DECISION
HERE TO OTHER SETTINGS.
WE HAVE THE GENDER SPECIFIC
CANCERS AND THE ONES THAT AFFECT
PEOPLE WHO HAVE UTERUSES AND
AFFECT WOMEN LIKE BREAST CANCER
AND OBVIOUSLY ALL GENDERS HAVE
BREAST BUT IT'S MUCH MORE COMMON
IN WOMEN AND HOW CAN WE
POTENTIALLY LEVERAGE EFFORTS TO
COMBAT THOSE SPECIFIC DISEASES
TO INFORM AND ELEVATE WOMEN'S
RIGHT AND JUSTICE MORE GENERALLY
AND I THINK THERE'S ALSO ROOM
FOR US TO CONTINUE TO SEX AS A
BIOLOGICAL VARIABLE AND
INCLUSION OF WOMEN IN RESEARCH
FOR NON-SEX DISTRIBUTED CANCERS.
AND FIGURE OUT WAYS WE CAN USE
THIS MOMENT TO NEVERTHELESS
ADVANCE THE HEALTH OF WOMEN.
>>I APPRECIATE THAT.
>>OTHER THOUGHTS IN THE GROUP?
>>JUST A QUICK THOUGHT.
THESE ARE ALL REALLY IMPORTANT
INCREDIBLE PROBLEMS FOR US.
SOMETIMES IT'S OVERWHELMING.
I THINK WHEN WE PRESENT THESE
PROBLEMS I THINK WE HAVE TO ASK
OURSELVES WHAT'S THE
DELIVERABLES?
.
YOU GOT THIS PROBLEM, WHAT'S THE
DELIVERABLE?
HOW CAN IT BE FACED IN A WAY
THAT'S GOING TO LEAD TO
SOMETHING, YOU KNOW WHAT I MEAN?
JUST LIKE WHEN YOU WRITE A
GRANT, YOU HAVE TO PROVIDE WHAT
ARE YOU GOING GET OUT OF THE
GRANT?
WHAT'S THE DELIVERABLE.
THAT'S WHAT I WANTED TO SAY.
>>SCOTT, KEEPING US ON POINT.
THE QUESTION I ASKED MYSELF IS
TO WHAT END.
THAT'S HOW I FORCE MYSELF TO
THINK ABOUT WELL, WHY ARE YOU
DOING THIS?
WE HAVE EXTREMELY LIMITED
RESOURCES TO DO A LOT.
SAID IT CAN BE OVERWHELMING, THE
NEEDS ARE OVERWHELMING.
THE NEEDS OF WOMEN ARE OV
OVERWHELMING BECAUSE WE HAVE
GAPS IN KNOWLEDGE BECAUSE OF THE
WAY WE HISTORICALLY CONDUCTED
OUR RESEARCH AND NOT ALWAYS
HAVING PATHWAYS TO ADDRESS THE
ARTICULATED NEEDS OF ALL WOMEN
WITH THEIR LIVED EXPERIENCES AND
UNIQUE PERSPECTIVES.
BECAUSE THIS IS EVOLVING.
AND WE'VE ONLY BEEN AROUND AELT
A LITTLE OVER 30 YEARS.
-- A LITTLE OVER 30 YEARS.
IT'S IMPORTANT TO THINK TO WHAT
END AND TO THINK ABOUT WHICH OF
THE -- WHAT SCIENCE IS POISED TO
MOVE FORWARD NOW AND WHAT THINGS
MIGHT NEED INFRASTRUCTURE
INVESTMENT NOW TO BE ABLE TO DO
WHAT'S NEEDED IN THE FUTURE TO
BE ABLE TO THINK ABOUT THAT ALL
AT THE SAME TIME AND IN A
COMPLEX SYSTEM THAT HAS CHANGE
BEING PARTS.
SOMETIMES YOU FEEL LIKE THE
FLOOR'S MOVING UNDER YOU.
I THINK WE ALL FEEL THAT WAY.
I AM TOTALLY STEADY HOWEVER, BY
THE NEED TO PUT SCIENCE TO WORK
FOR ALL WOMEN AND WHY I'M HERE
AND ALL ORWH IS HERE.
WE REALIZE THAT WE CAN'T DO IT
ALL ALONE.
SO PARTNERSHIPS AND
COLLABORATIONS YOU SEE HOW WE
CONNECT WITH OUR PARTNERS.
I HEAR YOU SCOTT.
TO WHAT END.
>>WELL SAID, THANK YOU.
>>THAT'S THE WAY I THINK ABOUT
IT.
LET'S GO TO DR. McGREGOR AND
DR. SIMON.
>>I LOVE HEARING YOU SAY THAT,
THAT'S WONDERFUL.
A QUICK THING TO DISCUSS IS THE
BENCH TO BEDSIDE.
IT KIND OF OF THE RECENT COMMENT
HOW CAN WE MAKE THAT QUICKER?
I KNOW THE R35 GENDER GRANTS
HAVE TO DO WITH EXTRA CURRICULUM
AND RIGOR AND I'M SPREADING THAT
FAR AND WIDE BUT WHEN THERE ARE
SO MANY THINGS WHEN IT IS SO
OVERWHELMING AND WE'RE SEEING
ALL THE GREAT RESEARCH HAPPENING
NOW, ARE THERE WAYS THAT WE CAN
START TO ALSO THINK ABOUT HOW TO
IMPLEMENT THIS IN PATIENT CARE?
IT TAKES FOREVER?
ALL THIS AMAZING THINGS I'M
HEARING AND I GO TO MY SHIFT AN
IT'S NOT IMPLEMENTED AT ALL.
THAT'S WHERE I GET DOWN TRODDEN.
HOW CAN WE MAKE THIS A QUICKER
TRANSLATION?
>>THAT'S VERY HELPFUL, ALLISON,
YOU'RE RIGHT.
WE'VE BEEN TALKING ABOUT
ELECTRONIC HEALTH RECORDS COULD
BE DECISION SUPPORT TOOLS
BECAUSE WHEN WE HAVE THE
EVIDENCE THAT THERE ARE
DIFFERENCES, FOR EXAMPLE, IN
PARTICULAR LABORATORY BLOOD
VALUES OR HOW YOU SHOULD BE
ORDERING TESTS YOU SHOULD BE
GIVING OR ARE YOU DIAGNOSING
CHRONIC KIDNEY DISEASE AND SO
OPPORTUNITIES I'M HEARING FROM
YOU IS I'M HEARING OPPORTUNITIES
TO SUPPORT THE AM SELL --
ACCELERATION OF THE EVIDENCE WE
ALREADY HAVE TO GET TO WOMEN
FASTER AND AFFECT THE
CLINIC-PATIENT-CLINICIAN
INTERACTION AS WELL.
>>AND THANKS FOR WHAT YOU SAID
ABOUT NEEDING SCIENCE TO WORK
FOR ALL.
ALL PEOPLE WHO IDENTIFY AS WOMEN
AND THAT'S GREAT.
FOR THE COMMENT ON NOT ONLY WHAT
IS THE DRIVELIVERABLE WE TO THI
ABOUT WHAT BROUGHT US HERE IN
THE FIRST PLACE.
WHY ARE THINGS HAPPENING THE WAY
THEY ARE FOR SOME PEOPLE AND
OTHER WAYS FOR OTHER PEOPLE.
HEALTH INEQUITIES AS A RESULT OF
SOME THINGS AND THEY'RE DAUNTING
PROBLEMS BUT IF YOU LOOK UNDER
THE HOOD OF THE CAR AND
STRUCTURES THAT CAUSED US TO BE
HERE, THAT'S WHERE WE NEED TO
GO, UP STREAK AND ROOT CAUSE.
NOT JUST WHAT'S THE DELIVERABLE
BUT WHAT BROUGHT US HERE AND
WHAT ARE THE PHENOTYPES WE SEE
AS IS?
AND THE BENCH TO BEDSIDE IS
SUPER IMPORTANT BUT IT BECOMES
MORE TRANSLATABLE.
THE TRANSLATIONAL SCIENCE
BECOMES MORE TRANSLATABLE
ARGUABLY CONSISTENTLY WHEN WE
INVOLVE COMMUNITY AND CENTER
COMMUNITY AND NOT JUST ENGAGE
COMMUNITY ON THE SIDE LIKE AN
ADVISORY BOARD BUT WHEN WE
CENTER THE VOICES OF PEOPLE WHO
IDENTIFY AS WOMEN IN WOMEN'S
HEALTH RESEARCH AND CENTER
COMMUNITIES THAT ARE MORE OFTEN
BEARING THE BRUNT OF THE
DISPARITIES WE ACTUALLY CAN
TRANSLATE FASTER.
AND THE IMPLEMENTATION AND SCALE
ACTUALLY GOES A BIT BETTER.
THE EXAMPLE OF THE
IMPLEMENTATION SCIENCE HUB RFA
FOR THE IMPROVE INITIATIVE IS A
WONDERFUL EXAMPLE OF PUTTING
FUNDING ANNOUNCEMENTS OUT FOR
CENTERS AND THEN HAVING NOT ONLY
A DATA SCIENCE HUB BUT ALSO AN
IMPLEMENTATION DATA SCIENCE HUB
TO SUPPORT THE CENTERS.
THAT'S A GREAT EXAMPLE AND I
APPRECIATE YOUR LEADERSHIP,
DR. CLAYTON AND TEAM, ORWH TEAM
FOR THINKING OF THAT AND DOING
THAT.
SO THANK YOU.
>>THANK YOU.
WE CAN'T TAKE ALL THE CREDIT FOR
THAT.
NHLBI HAS A MATERNAL HEALTH
COMMUNITY IMPLEMENTATION
PROGRAM.
I KNOW YOU KNOW ABOUT IT AND I
WANT TO SHARE THAT WITH THE
GROUP THOUGH AND THRILLED WE
WERE ABLE TO SUPPORT TWO OF
THOSE PROGRAMS TO EXPAND THEIR
REACH THIS FISCAL YEAR TO TWO
STATES IN THE SOUTH.
SO WORKING ACROSS OUR PARTNERS
WHEN THEY CREATE SOMETHING THAT
CAN BE LEVERAGED TO ADDRESS WHAT
WE'VE IDENTIFIED ARE CRITICAL
HEALTH NEEDS FOR WOMEN IS A
STRATEGY AND WE'RE LOOKING
FORWARD TO THE FEEDBACK ON THAT
AND MOSTLY YOU COMMENTED ON
STRUCTURAL FACTORS WHICH WE SAW
PRESENTATIONS TODAY THAT SHOWED
INCREASING THE GREEN CANOPY IN
FORM -- IN FORMERLY RED LINED
AREAS IS ACTIONABLE BY OUR
COLLEAGUES AND OTHER
STAKEHOLDERS IN THE SPACE.
WE REALIZE WE'RE NOT THE ONLY --
WE'RE A BIG PLAYER BUT NOT THE
ONLY PLAYER IN THE SPACE BECAUSE
SO MANY THINGS AFFECT OUR
HEALTH.
>>I'M IN THE PROCESS OF PACKING
UP AFTER 16 YEARS AT THE
UNIVERSITY OF MICHIGAN AND I
DON'T KNOW IF YOU CAN SEE MY
OFFICE AND THERE'S BOXES WHERE
EVER AND A HAD OCCASION TO DIG
THROUGH OLD FILES BECAUSE I'M A
PACK RAT AND I PUT THESE ASIDE
BECAUSE I THOUGHT YOU'D ENJOY
THIS AS MUCH AS I DID.
I HAVE ALL THESE OLD PRESS
RELEASES FROM THE EARLY 1990 AND
RESEARCH FOR MEN ONLY AND
DOCTORS USE FOR TREAT WITH AND
VIVIENNE PIN HAS BEEN CHOSEN TO
HEAD THE OFFICE AT WOMEN'S
HEALTH AND IT UNDER SCORES FOR
ME WHEN I FEEL DAUNTED BY THE
MAGNITUDE OF WHAT WE HAVE YET TO
ACCOMPLISH, IT GIVES ME A SENSE
OF GRATITUDE TO BE WHERE WE ARE
AND ACCOMPLISHMENT TO SEE HOW
MUCH HAS BEEN STUDIED AND HOW
MUCH MORE WE KNOW NOW THAN WE
DID THEN AND JUST A PACK RAT AND
THIS IS FROM 1990s.
>>ABSOLUTELY.
IF YOU THINK ABOUT WHERE WE WERE
AND YOU'VE RIGHT, WE'VE COME A
LONG WAY.
IT DOESN'T MEAN WE DON'T HAVE
MORE TO GO BECAUSE THIS GROUP IS
EXTREMELY AWARE OF THE
INCREDIBLE NEEDS OF ALL WOMEN
ACROSS THE LIFE COURSE AND WE
HEARD A TOUCH ON MENOPAUSE
EARLIER.
DIDN'T HEAR MUCH MORE ABOUT THAT
BUT THAT'S REALLY IMPORTANT TO
US AS WELL.
AND I DIDN'T KNOW IN THE LAST
MINUTE WE HAVE ONE MINUTE, I DID
WANT TO GIVE DR. ANDERSON A
MOMENT TO COMMENT ON WHETHER SHE
WANTED TO MAKE ANY REMARKS ABOUT
MENOPAUSE RESEARCH.
>>THANK YOU.
THAT'S A LOT OF WORK ON THE
BIOLOGICAL EFFORT TO UNDERSTAND
THE SYMPTOMS ASSOCIATED WITH IT
AND TO REALLY HONE IN ON THE
TREATMENT.
THERE'S A LOT OF CONFUSION ABOUT
WHAT THE RESULTS OF THE WOMEN'S
CONFERENCE HAS PROVIDED AND
RETRENCHMENT IN THE USE OF
HORMONES AND I THINK WE NEED TO
BETTER UNDERSTAND THIS AND SO I
THINK ADDITIONAL RESEARCH EVEN
ON HORMONE THERAPY ITSELF IS
REALLY IMPORTANT.
>>THANK YOU SO MUCH,
DR. ANDERSON.
DR. NOURSI, BEFORE WE CLOSE I'LL
MAKE SOME CLOSING REMARKS IF
THAT'S OKAY IN A MINUTE BUT
BEFORE WE CLOSE I JUST WANT TO
THANK ALL THE AMAZING PRESENTERS
WHO ARE PARTICIPATING IN TODAY'S
MEET.
WE REALLY APPRECIATE DEEPLY THE
SUPPORT THAT WE HAVE AND FOR THE
ORWH MEMBERS GIVE TO US IN
RESPONDING TO OUR QUERIES,
WEIGHING IN ON INFORMATION WE
ASK YOU TO TALK ABOUT AND I WANT
TO THANK THE SCIENCE POLICY
PLANNING AND ANALYSIS SECTION
THAT LEADS THE ACRWH AND
DR. NOURSI WITH THE FEARLESS
EXEC SEC I ASKED HER TO SUB FOR
THIS LIKE OVER A YEAR AND A HALF
AGO.
HE'S TAKEN US TO THE NEXT LEVEL.
THANK YOU FOR YOUR LEADERSHIP IN
THAT SPACE.
EVERY AT TEAM ORWH THERE'S A LOT
OF WORK THAT HAPPENS BEHIND THE
SCENES TO DO THE ANALYSIS AND
GET THE INFORMATION TO YOU IN A
TIMELY MANNER.
THANK YOU.
SARAH HELMAN IS HER RIGHT HAND
ON ALL THINGS TEAM ORWH AND
THANK YOU ALL AND OUR FOLKS WHO
MAKE SURE WE LOOK GOOD WHEN WE
ARE OUT HERE CHAMPIONING WOMEN'S
HEALTH, FIGHTING THE GOOD FIGHT
FOR ALL WOMEN AND SO I WILL END
WITH AN INTEGRATING WAY TO THINK
ABOUT THE HEALTH OF WOMEN.
SO YOU'VE SEEN OUR
MULTI-DIMENSIONAL FRAMEWORK
WHICH HAS THE LIFE COURSE AND
EVERYTHING THAT HAPPENED BEFORE
CAN AFFECT THE HEALTH OF A WOMAN
TODAY EVEN IN UTERO.
YOU HEARD PREFERENCES TO
EPIGENETIC MODIFICATION AND
INTERNAL FACTORS LIKE SEX AND
GENETIC ANCESTRY AND EXTERNAL
FACTORS LIKE THE ENVIRONMENT WE
LIVE IN WHETHER IT'S A TOXIC
EXPOSURE, HAIR DYE, OR A TOXIC
RELATIONSHIP WITH A WOMAN BEING
AT THE HIGHEST RISK OF INTIMATE
PARTNER VIOLENCE IN HER LIFE
WHEN SHE'S PREGNANT.
A PERSON WHO IS PREGNANT IS THE
HIGHEST RISK IN YOUR LIFE OF
INTIMATE PARTNER VIOLENCE.
SO INTERNAL FACTORS, EXTERNAL
FACTORS, EVERYTHING THAT
HAPPENED BEFORE YOUR LIFE
COURSE, YOUR TRAJECTORY, YOUR
INTERACTION BETWEEN YOUR GENES
AND THE ENVIRONMENT, THE
POLICIES AROUND YOU AND WHERE
YOU, WHAT YOU HAVE ACCESS TO AND
WHAT YOU DO NOT HAVE ACCESS TO.
AND YOUR ENTIRE TRAJECTORY OF
YOUR LIFE COURSE WHETHER YOU'RE
PARTICIPATING IN THE LABOR
WORKFORCE, WHETHER YOU HAVE LEFT
THE LABOR WORKFORCE BECAUSE YOU
EXPERIENCED SEXUAL HARASSMENT OR
TRAUMA.
WE KNOW IT'S HAPPENING MORE AND
MORE.
ALL THOSE ARE OUR CONCERNS AND
THE STRATEGY WE'VE USED TO TRY
TO BE ABLE TO IMPROVE THAT
THROUGH THE RESEARCH CONTINUUM
IS TO INTENTIONALLY INTEGRATE
CONSIDERATIONS OF SEX AS A
BIOLOGICAL VARIABLE FROM THE
MOST BASIC STUDIES WHERE WE WERE
EXPLORING A BIOLOGIC PHENOMENON
THROUGH THAT PRE-CLINICAL WORK
GOING INTO AN ANIMAL MODEL WHICH
IS MODELLING HUMAN DISEASE THAT
AFFECTS MEN AND WOMEN PERHAPS OR
AFFECTS FEMALES ONLY TO CONSIDER
SEX VERY INTENTIONALLY AS WE
SELECT OUR RESEARCH QUESTION AS
WE DESIGN OUR EXPERIMENTS AND
USE FACTORIAL DESIGN TO GET
INFORMATION THAT SEX IS
DISAGGREGATED OR RELEVANT OR NOT
AND AS WE GO FIRST IN HUMAN AND
WHAT THAT MIGHT MEAN IN TERMS OF
DIFFERENT DOSAGES AND LIKELIHOOD
OF ADVERSE AFFECTS WHETHER
THAT'S A NEW IMMUNIZATION OR A
NEW COMPOUND THAT IS WORKING ON
A NEW TARGET.
SO THROUGH THAT TRANSLATION AND
THE GENDERED AFFECTS THAT ALL
AFFECT OUR HEALTH TODAY.
SO IF WE CAN INTEGRATE
CONSIDERATIONS OF SEX AND GENDER
ON THAT BASIC PRE CLINICAL,
TRANSLATIONAL APPLIES
IMPLEMENTATION, EDUCATION,
EVERYONE IN THE SPACE,
DR. JOHNSON THE ORAL HEALTH AND
DENTISTS.
WE DIDN'T GET TO THAT MENTION
THAT BUT ORAL HEALTH IS AN
IMPORTANT PART OF HEALTH.
MENTAL HEALTH IS A PART OF
HEALTH.
IF WE CAN DO THAT AND INFORM
POLICIES AND INFORM PRACTICES,
INFORM HOW HEALTH CARE'S
DELIVERED IN THE FUTURE AND GO
BACK AND START AGAIN WE MAY BE
ABLE TO INFORM AND IMPROVE THE
HEALTH OF ALL WOMEN.
SO THAT IS THE INTEGRATING
FRAMEWORK THAT I USE TO APPROACH
THE WORK THAT WE DO AND TO SHOW
EVERYONE THAT THERE'S A PLACE
FOR YOU HERE THAT WE PROMOTE
INNOVATION AND PROMOTE EQUITY
AND PROMOTE RIGOR WHEN WE
CONSIDER SEX AND GENDER THE
BIOMEDICAL RESEARCH CONTINUUM
AND WE'RE HERE TO INFORM AND
IMPROVE THE HEALTH OF WOMEN AND
WHY WE'RE HERE AND WOMEN WERE
NOT INCLUDED.
THE FINDINGS FOR MEN WERE
APPLIED TO WOMEN.
CERTAINLY THAT'S NOT RIGOROUS.
THERE WAS A DIFFERENT
UNDERSTANDING.
WE KNOW BETTER NOW SO WE CAN DO
THINGS BETTER.
WE HAVE EVOLVING SENSE OF WHAT
SEX AND GENDER ARE, HOW THEY'RE
RELATED TO EACH OTHER AND HOW
THEY'RE EACH IMPORTANT EXTERNAL
AND INTERNAL FACTOR IMPORTANT
AND NEED TO CONSIDER UNDER
SERVED, UNDER STUDIED WOMEN IN
EVERYTHING WE DO AND HOW
IMPROVING HEALTH FOR THOSE WHO
NEED IT MOST WILL IMPROVE HEALTH
OF EVERYONE AND DR. SIMON HOW AS
WOMEN MAKING 80% OF HEALTH
DECISIONS THE ECONOMIC IMPACT OF
THE HEALTH OF WOMEN, THE
SOCIETAL IMPACT WILL IMPROVE THE
FAMILY AND WILL IMPROVE THE
LABOR PARTICIPATION AND
EDUCATION AND IMPROVE EVERYONE'S
HEALTH.
THE DATA IS WELL DOCUMENTED
INVESTING IN WOMEN'S HEALTH IS A
SMART INVESTMENT FOR SOCIETY.
SO THANK YOU ALL FROM THE BOTTOM
OF MY HEART FOR YOUR COMMITMENT,
CONTINUED COMMITMENT TO WOMEN'S
HEALTH.
WE NEED YOU AND WOMEN NEED YOU
AND WE'RE DELIGHTED TO HAVE YOU
ON OUR TEAM AND YOUR ADVICE AND
COUNCIL AND THIS ADVISORY
COMMITTEE ARE SUPER IMPORTANT TO
THE FUTURE AND I WANT TO AGAIN
THANK TEAM ORWH FOR ALL YOU'VE
DONE AND OUR PARTNERS AND
COLLABORATORS ACROSS THE
RESEARCH ECO SYSTEM.
WE'VE GOT A LOT OF WORK TO DO
BUT WE ARE UP FOR THE CHALLENGE
REGARDLESS.
WE'RE UP FOR THE CHALLENGE AND
WE'LL BE THERE SO THANK YOU VERY
MUCH FOR YOUR ASSISTANCE AND
YOUR SUPPORT.
WE ARE ADJOURNED.
THANK YOU, DR. NOURSI.
>>BYE, EVERYBODY.