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Biomedical subjects

Ann J Brown

Publications and source records attributed to Ann J Brown.

8 recordsLinked to original sources
PubMed2006

Nonalcoholic steatohepatitis and nonalcoholic Fatty liver disease in young women with polycystic ovary syndrome.

CONTEXT: Nonalcoholic fatty liver disease and polycystic ovary syndrome (PCOS) are both associated with insulin resistance. Thus, women with PCOS may have an increased prevalence of nonalcoholic fatty liver disease, including nonalcoholic steatohepatitis (NASH). OBJECTIVE: The objective of the study was to determine the prevalence and characteristics of NASH and abnormal aminotransferase activity in women with PCOS. DESIGN: The study is a retrospective chart review. SETTING: The setting is an academic endocrinology clinic. PATIENTS: Patients were 200 women with PCOS, defined as irregular menses and hyperandrogenism. MAIN OUTCOME MEASURES: Biopsy-documented NASH and aminotransferase levels were the main outcome measures. RESULTS: Fifteen percent (29 of 200) had aspartate aminotransferase and/or alanine aminotransferase more than 60 U/liter. Women with aminotransferase elevations had lower high-density lipoprotein (HDL) (41 vs. 50 mg/dl, P = 0.006), higher triglycerides (174 vs. 129 mg/dl, P = 0.024), and higher fasting insulin (21 vs. 12 microIU/ml, P = 0.036) compared with women with normal aminotransferases. Six women (mean age 29 yr) with persistent aminotransferase elevations underwent liver biopsy. All six had NASH with fibrosis. Compared with the 194 of 200 PCOS women who did not undergo biopsy, women with biopsy-documented NASH had lower HDL (median 34 vs. 50 mg/dl, P < 0.001), and higher triglycerides (245 vs. 132 mg/dl, P = 0.025), fasting insulin (26 vs. 13 microIU/ml, P = 0.038), aspartate aminotransferase (144 vs. 22 U/liter, P < 0.001), and alanine aminotransferase (143 vs. 28 U/liter, P < 0.001). CONCLUSION: Abnormal aminotransferase activity is common in women with PCOS. Low HDL, high triglycerides, and high fasting insulin were associated with abnormal aminotransferase activity. Some women already had evidence of NASH with fibrosis. Further studies are needed to evaluate whether to screen PCOS women for liver disease at an earlier age than is currently recommended for the general population.

Adolescent↗
PubMed2005

Generation X: implications for faculty recruitment and development in academic health centers.

Differences and tensions between the Baby Boom generation (born 1945-1962) and Generation X (born 1963-1981) have profound implications for the future of academic medicine. By and large, department heads and senior faculty are Boomers; today's residents and junior faculty are Generation X'ers. Looking at these issues in terms of the generations involved offers insights into a number of faculty development challenges, including inadequate and inexpert mentoring, work-life conflicts, and low faculty morale. These insights suggest strategies for strengthening academic medicine's recruitment and retention of Generation X into faculty and leadership roles. These strategies include (1) improving career and academic advising by specific attention to mentoring "across differences"--for instance, broaching the subject of formative differences in background during the initial interaction; adopting a style that incorporates information-sharing with engagement in problem solving; offering frequent, frank feedback; and refraining from comparing today to the glories of yesterday; to support such improvements, medical schools should recognize and evaluate mentoring as a core academic responsibility; (2) retaining both valued women and men in academic careers by having departments add temporal flexibility and create and legitimize less-than-full-time appointments; and (3) providing trainees and junior faculty with ready access to educational sessions designed to turn their "intellectual capital" into "academic career capital."Given the trends discussed in this article, such supports and adaptations are indicated to assure that academic health centers maintain traditions of excellence.

Academic Medical Centers↗
PubMed2003

Women in academic medicine: a report of focus groups and questionnaires, with conjoint analysis.

BACKGROUND: The percentage of women graduating from U.S. medical schools has increased dramatically over the past 30 years, but the distribution of women and men across faculty ranks in academic medical centers has remained nearly unchanged. Women remain underrepresented in the senior ranks of academic medicine. The purpose of the study was to evaluate the work environment at Duke University Medical Center, with particular emphasis on gender climate. METHODS: An independent firm conducted structured focus groups and administered questionnaires, analyzed through conjoint analysis. Focus groups were stratified by rank and included the following groups of women: medical students, residents, fellows, junior faculty, senior faculty, and women in fields with few women. RESULTS: The conjoint analysis demonstrated that the women placed high value on the quality of their personal and work lives and rated these as more important than other traditional markers of career success, such as stature of their institution or earnings potential. Discussions during the focus groups elaborated on what "quality of personal and professional life" meant. They described a need for career efficiencies that allow individuals to excel professionally while also honoring their personal values and responsibilities. The discussions also suggested that similar problems have increasing importance for men. CONCLUSIONS: The results suggest that institutions should provide more alternative models of success and increase flexible work options. Future studies of women in academic medicine should explore the role of value conflict in career development in academic medicine and probe the idea that the priorities articulated by the women in these focus groups may reflect the values of a generation as much as they do gender.

Academic Medical Centers↗
PubMedDate not supplied

Number of children and risk of metabolic syndrome in women.

BACKGROUND: In the United States, there is a high prevalence of metabolic syndrome, as defined by The Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III). The relationship between reproductive factors and metabolic syndrome in women is unknown. METHODS: We examined the association of number of children and breastfeeding history with metabolic syndrome risk among women. We used nationally representative data from the Third National Health and Nutrition Examination Survey (NHANES III). A total of 4699 (age > or = 20) nonpregnant women were included in this report. Metabolic syndrome was defined according to ATP III. RESULTS: Overall, 22.6% of women were determined to have metabolic syndrome. The rate of metabolic syndrome was significantly higher with increasing numbers of children, demonstrating a dose-response relationship (p < 0.0001). After controlling for age, race/ethnicity, income, education, and other sociodemographic, reproductive, and behavioral risk factors, the odds of metabolic syndrome increased 13% (95% CI, 6%-20%) with each additional child. In a similarly controlled analysis in parous women, the odds of metabolic syndrome decreased 22% (95% CI, 1%-39%) in women with a history of breastfeeding for >1 month. However, both effects were no longer significant after inclusion of body mass index (BMI) categories. CONCLUSIONS: In a national sample of women, increasing number of children was associated with higher rates of metabolic syndrome, and history of breastfeeding was associated with decreased rates of metabolic syndrome. The strength of these relationships was decreased after additional adjustment for BMI, suggesting that weight or weight changes may be an important mediator of the effects of parity and breastfeeding on the risk of metabolic syndrome.

Adult↗
PubMedDate not supplied

Polycystic ovary syndrome and severe nonalcoholic steatohepatitis: beneficial effect of modest weight loss and exercise on liver biopsy findings.

OBJECTIVE: To report a case of biopsy-documented nonalcoholic steatohepatitis (NASH), which improved appreciably through moderate exercise and weight loss in a young woman with polycystic ovary syndrome (PCOS) and insulin resistance. METHODS: We present a detailed case report, including laboratory and pathologic findings. In addition, we review the recent literature regarding the association of insulin resistance with NASH and PCOS. RESULTS: A 24-year-old woman was referred to the Duke Gastroenterology Clinic for evaluation of long-term high serum aminotransferase levels. She also reported a history of chronically irregular menses, infertility, and hirsutism and was diagnosed with PCOS. Subsequent glucose tolerance testing suggested the presence of insulin resistance. Liver biopsy findings were consistent with severe nonalcoholic steatohepatitis. Under the supervision of her physician and an exercise physiologist, the patient initiated a diet and exercise program that resulted in an 11.5% weight loss during approximately 8 months and yielded normalization of her aminotransferase levels. A repeat liver biopsy done 13 months after the initial biopsy revealed a substantial decrease in steatosis and a reduction in inflammation. CONCLUSION: Women with PCOS and insulin resistance have an increased risk of developing many of the consequences of the dysmetabolic syndrome, including type 2 diabetes, hypertension, and hyperlipidemia. This case report suggests that fatty liver and NASH may be other important diseases to identify in such women. It also demonstrates the improvement in this condition with moderate exercise and weight loss.

Adult↗