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UC researchers say early puberty in girls may be the new big...

Wed, July 10, 2019

CINCINNATI—Adolescent girls who reach puberty at an earlier age may also have a greater chance of developing migraine headaches, according to new research from investigators at the University of Cincinnati (UC) College of Medicine. “We know that the percentage of girls and boys who have migraine is pretty much the same until menstruation begins,” says Vincent Martin, MD, professor in the Division of General Internal Medicine and director of the Headache and Facial Pain Center at the UC Gardner Neuroscience Institute. “When the menstrual period starts in girls, the prevalence goes way up, but what our data suggests is that it occurs even before that.” The findings will be presented by Martin at the American Headache Society 61st Annual Scientific Meeting Saturday, July 13, in Philadelphia. Nationally, about 10 percent of school age children suffer from migraine, according to the Migraine Research Foundation (MRF). As adolescence approaches, the incidence of migraine increases rapidly in girls, and by age 17, about 8 percent of boys and 23 percent of girls have experienced migraine, the MRF reports. Martin and a team of researchers were part of a longitudinal study looking at 761 adolescent girls from sites in Cincinnati, New York and the San Francisco Bay area. The girls ranged in age from 8 to 20 and study took place over a 10-year period beginning in 2004. Girls enrolled in the study at age 8-10 were examined during study visit every six to 12 months. Researchers determined when they showed initial signs of thelarche (breast development), pubarche (pubic hair growth) and menarche (start of menstrual periods). Girls answered a headache questionnaire to find out if they suffered from migraine headache, no migraine or probable migraine—the latter is defined as meeting all the diagnostic criteria for migraine except one. The average age at which they completed the survey was 16. Of those surveyed, 85 girls (11 percent) were diagnosed with migraine headache while 53 (7 percent) had probable migraine and 623 (82 percent) had no migraine, according to Martin, also a UC Health physician specializing in migraine. Researchers found that girls with migraine had an earlier age of thelarche (breast development) and the onset of menarche (menstrual periods) than those with no migraine. On average breast development occurred four months earlier in those with migraine while menstruation started five months earlier. There was no difference in the age of pubarche (pubic hair development) between those with migraine and no migraine. “There was a 25 percent increase in the chance of having migraine for each year earlier that a girl experienced either thelarche or menarche,” says Susan Pinney, PhD, professor in the UC Department of Environmental Health and lead investigator on the study. “This suggests a strong relationship between early puberty and the development of migraine in adolescent girls.” The age of onset of thelarche, pubarche or menarche did not differ between those with probable migraine and no migraine, says Pinney. Previous research suggests that migraine often starts with the onset of menstrual cycles during menarche in adolescent girls. But this study looks at earlier stages of puberty such as thelarche and pubarche, explains Martin. “To suggest the origins of migraine may occur actually before menstrual periods begin is pretty novel,” says Martin. “At each of these stages, different hormones are starting to appear in girls. During pubarche, testosterone and androgens are present, and during thelarche, there is the very first exposure to estrogen. Menarche is when a more mature hormonal pattern emerges. Our study implies that the very first exposure to estrogen could be the starting point for migraine in some adolescent girls. It may be the Big Bang Theory of migraine.” So is there anything that one can do to prevent an early puberty? “Studies suggest that childhood obesity is associated with early puberty,” says Martin, who is also president of the National Headache Foundation. “Keeping your weight down might prevent the early onset of puberty. Future studies will need to be done to determine if strategy will decrease also the likelihood of developing migraine.” Other co-investigators in the study include Frank Biro, MD, UC professor in the Department of Pediatrics and Cincinnati Children’s pediatrician, Jun Ying, PhD, professor in the UC Department of Environmental Health, and Hao Yu, biostatistician, UC Department of Environmental Health. Funding for this research came grant U01ES026119 from the National Institute of Environmental Health Sciences and grant 1R03HD094236 of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

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UC researchers say early puberty in girls may be the new big...

Wed, July 10, 2019

CINCINNATI—Adolescent girls who reach puberty at an earlier age may also have a greater chance of developing migraine headaches, according to new research from investigators at the University of Cincinnati (UC) College of Medicine. “We know that the percentage of girls and boys who have migraine is pretty much the same until menstruation begins,” says Vincent Martin, MD, professor in the Division of General Internal Medicine and director of the Headache and Facial Pain Center at the UC Gardner Neuroscience Institute. “When the menstrual period starts in girls, the prevalence goes way up, but what our data suggests is that it occurs even before that.” The findings will be presented by Martin at the American Headache Society 61st Annual Scientific Meeting Saturday, July 13, in Philadelphia. Nationally, about 10 percent of school age children suffer from migraine, according to the Migraine Research Foundation (MRF). As adolescence approaches, the incidence of migraine increases rapidly in girls, and by age 17, about 8 percent of boys and 23 percent of girls have experienced migraine, the MRF reports. Martin and a team of researchers were part of a longitudinal study looking at 761 adolescent girls from sites in Cincinnati, New York and the San Francisco Bay area. The girls ranged in age from 8 to 20 and study took place over a 10-year period beginning in 2004. Girls enrolled in the study at age 8-10 were examined during study visit every six to 12 months. Researchers determined when they showed initial signs of thelarche (breast development), pubarche (pubic hair growth) and menarche (start of menstrual periods). Girls answered a headache questionnaire to find out if they suffered from migraine headache, no migraine or probable migraine—the latter is defined as meeting all the diagnostic criteria for migraine except one. The average age at which they completed the survey was 16. Of those surveyed, 85 girls (11 percent) were diagnosed with migraine headache while 53 (7 percent) had probable migraine and 623 (82 percent) had no migraine, according to Martin, also a UC Health physician specializing in migraine. Researchers found that girls with migraine had an earlier age of thelarche (breast development) and the onset of menarche (menstrual periods) than those with no migraine. On average breast development occurred four months earlier in those with migraine while menstruation started five months earlier. There was no difference in the age of pubarche (pubic hair development) between those with migraine and no migraine. “There was a 25 percent increase in the chance of having migraine for each year earlier that a girl experienced either thelarche or menarche,” says Susan Pinney, PhD, professor in the UC Department of Environmental Health and lead investigator on the study. “This suggests a strong relationship between early puberty and the development of migraine in adolescent girls.” The age of onset of thelarche, pubarche or menarche did not differ between those with probable migraine and no migraine, says Pinney. Previous research suggests that migraine often starts with the onset of menstrual cycles during menarche in adolescent girls. But this study looks at earlier stages of puberty such as thelarche and pubarche, explains Martin. “To suggest the origins of migraine may occur actually before menstrual periods begin is pretty novel,” says Martin. “At each of these stages, different hormones are starting to appear in girls. During pubarche, testosterone and androgens are present, and during thelarche, there is the very first exposure to estrogen. Menarche is when a more mature hormonal pattern emerges. Our study implies that the very first exposure to estrogen could be the starting point for migraine in some adolescent girls. It may be the Big Bang Theory of migraine.” So is there anything that one can do to prevent an early puberty? “Studies suggest that childhood obesity is associated with early puberty,” says Martin, who is also president of the National Headache Foundation. “Keeping your weight down might prevent the early onset of puberty. Future studies will need to be done to determine if strategy will decrease also the likelihood of developing migraine.” Other co-investigators in the study include Frank Biro, MD, UC professor in the Department of Pediatrics and Cincinnati Children’s pediatrician, Jun Ying, PhD, professor in the UC Department of Environmental Health, and Hao Yu, biostatistician, UC Department of Environmental Health. Funding for this research came grant U01ES026119 from the National Institute of Environmental Health Sciences and grant 1R03HD094236 of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Cincinnati Enquirer speaks with UC College of Medicine...

Wed, June 26, 2019

The Cincinnati Enquirer highlighted a $1.7 million National Institute of Drug Abuse (NIDA) grant awarded over a three-year period to Jason Blackard, PhD, to conduct an omics analysis of synthetic opioids and HIV. Blackard, an associate professor in the UC Department of Internal Medicine’s Division of Digestive Diseases, says opioids and HIV encourage one another and not in a good way. Jennifer Brown, PhD, associate professor of psychiatry, a co-investigator on the study, also spoke with the Enquirer. You can read the full news release here.

UC researcher examines impact opioids and HIV have on each other

Tue, June 11, 2019

A University of Cincinnati (UC) College of Medicine researcher is trying to determine how opioids interact with HIV and the medications used to manage it in the search for new therapies to better assist individuals battling addiction and living with HIV. Jason Blackard, PhD, associate professor in the UC Department of Internal Medicine’s Division of Digestive Diseases, has secured a $1.7 million National Institute of Drug Abuse (NIDA) grant awarded over a three-year period to conduct an omics analysis of synthetic opioids and HIV. “This is a complex issue. We have a very poor understanding of how HIV impacts opioids or how opioids impact HIV. We don’t know if current therapies will work as well as they normally do,” says Blackard, whose translational research laboratory studies virus-virus and virus-host interactions. “What is the interaction between these synthetic opioids that are commonly found in high-risk individuals and some of the infections that might be associated with drugs of abuse like HIV or Hepatitis C virus?” In 2017, an estimated 1.7 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers and 652,000 suffered from a heroin use disorder, according to NIDA. About 47,000 Americans that same year died as a result of opioid overdose—a statistic that includes the use of prescription opioids, heroin and illegally manufactured synthetic opioids such as fentanyl, per NIDA. Drug users often share needles when using injectable opioids, an action that increases the risk of contracting HIV and Hepatitis C virus. A key advantage of this project is its multi-disciplinary approach. Co-investigators involved in the study include UC faculty and UC Health clinicians: Michael Lyons, MD, associate professor of emergency medicine, and Jennifer Brown, PhD, associate professor of psychiatry. They will help Blackard in bridging the divide between basic and clinical science that this translational research project is designed to address. Blackard says the research project will include an observational study in humans as well as ex vivo experiments using blood samples manipulated and exposed to HIV and/or synthetic opioids in the laboratory. As part of the clinical trial, Blackard will work closely with clinicians and health professionals to enroll 25 patients annually over the grant period who come to UC Medical Center’s emergency room as a result of drug overdose. When patients presenting with opioid-related overdose are seen by an emergency physician, blood is drawn to determine what substance is present in their bodies. Many of these individuals may already know their HIV status, while others may require additional testing for HIV, explains Blackard. Blackard says the observational study focuses on individuals with HIV so he is looking for patients who are HIV positive and battling addiction. “What we will do is measure their viral load; it is the measure of how much virus is in the body. It also tells us how well HIV treatments are working and provides important information about disease progression,” he explains. “There are a whole bunch of markers of HIV disease we can measure. What is it doing to the cells that are infected in the first place? We know that people with opioid use disorders relapse quite frequently. We know that people who are relapsing may not adhere to their HIV medications or they may chose not to take them or they may not work,” says Blackard. “So, we have to take this relatively holistic approach to saying, you know what we probably need is new medications or additional medications to treat opioid use disorder in the context of HIV or some other chronic infection because these two things are synergetic, but they are helping each other along in a bad way.” Ex vivo experiments also yield important information for the research study, says Blackard. “In my lab we grow HIV, Hepatitis C, Hepatitis B and we take something we grow in a petri dish and add it to blood sample that we took from a patient,” says Blackard. “We do the same measure of replication; how well does HIV grow in the presence of an opioid? “It helps us determine what medications we should use or how we intervene,” says Blackard. “If we know the drugs of abuse promote HIV replication then maybe we need to have a discussion about pre-exposure prophylaxis.” Pre-exposure prophylaxis (PrEP) involves using antiviral drugs in people not yet exposed to HIV/AIDS to prevent infection. PrEP is sometimes offered to subpopulations deemed at high risk of HIV infection. “Maybe we need to look at what specific combinations of drugs work the best for reducing HIV replication for people that are injecting versus those that don’t,” says Blackard. “Perhaps a certain recognition there are certain types of drugs that may not be appropriate for injection drug users, but they might be appropriate for other subpopulations at risk for HIV.” “At the end of the day, we are really limited in what we have to treat substance abuse in people that have something else,” says Blackard. “Even though we talk about how we treat the HIV, which we do reasonably well, we do a poor job of also treating the substance abuse.” This research was supported by National Institutes of Health NIDA grant 1R61DA048439-01.

Two Bearcats honored for LGBTQ activism

Thu, June 6, 2019

A public health graduate student and a second-year medical student were honored recently by the University of Cincinnati (UC) LGBTQ Center for their efforts aimed at building community ties and improving the health of the LGBTQ community at the university and beyond. Ryan Anderson, a 2019 graduate of the master’s in public health program, and Haidn Foster, a medical student finishing his second year, received the LGBTQ Bridge Builder Award, and the LGBTQ Student Activist Award, respectively, during the Lavender Graduation Ceremony held April 25. The LGBTQ Bridge Builder Award celebrates any UC student or organization for excellence and commitment in building connections between the LGBTQ community and broader student life at UC. The LGBTQ Student Activist Award recognizes any UC student for excellence in leadership or service to the LGBTQ community at UC. Both honors reflect a commitment to diversity and inclusion and the urban impact platform of UC’s strategic direction, Next Lives Here. Anderson: Educating and social norming Anderson, a former graduate student worker in the UC Student Wellness Center, was nominated for the award by Lori Bishop-Ley, his former boss and assistant director of the Student Wellness Center. She says she was impressed by Anderson’s work implementing programs across the campus that tackle sexual health, gender-based violence and alcohol, tobacco and drug education along with mental health. Anderson, who majored in gender studies and film at Miami University, spearheaded a new social norming campaign at UC funded by the Ohio Department of Higher Education. The campaign focused on bystander intervention and ways to prevent sexual violence and was titled “Togetherto100UC.” “On social media Ryan created posts that encouraged students to be more active bystanders when they see or hear acts of gender-based violence,” says Bishop-Ley. “Ryan would highlight different situations on campus where students could interrupt problematic or violent behaviors. He then would offer different ways one could safely respond if they saw that situation.” Anderson created inclusive marketing materials such as flyers and newsletters to encourage students to understand potentially problematic situations with a new perspective, explains Bishop-Ley. Assessment tools he developed for this project also will help inform future campaigns. Bishop-Ley says Anderson helped organize monthly HIV testing services for the Student Wellness Center and worked closely with Caracole, a longtime partner of the center and Greater Cincinnati’s non-profit AIDS service organization. He educated students waiting for HIV testing about the test itself and offered information about other sexually transmitted infections and discussed safer sexual health practices, explains Bishop-Ley. Anderson was a Pride Ambassador with the UC LGBTQ Center and this role allowed him to align his values with his passion and build meaningful connections with LGBTQ students, explains Bishop-Ley. “The Wellness Center gave me so many opportunities and put a lot of trust in me,” says Anderson. “During my third week I was teaching alone for our sanction classes for alcohol and drugs. I really appreciated that they had that much trust in me.” Anderson hopes that as a recent graduate he can continue his work advancing HIV and sexually transmitted infection prevention and has his sights on a fellowship with the U.S. Centers for Disease Control and Prevention or the National Institutes of Health. “There are so many students doing powerful work all over campus so to be selected for such a great award was really amazing,” says Anderson. Foster: Redefining patient experiences Foster, a medical student who is interested in becoming an oncologist, launched the nonprofit online publication Pride in Practice earlier this year to offer more comprehensive LGBTQ health care education for medical students, residents, physicians and other health care workers. He was nominated by Sarah Pickle, MD, an associate professor of family medicine and associate division director, medical education, for the student activism award. Foster, a 31-year-old native of Seattle, has a special interest in LGBTQ health. He graduated with undergraduate and master’s degrees in English from the University of Washington and ran a marketing company for several years before going back to Portland State University for a Bachelor of Science degree in preparation for starting medical school. An experience with a chronic medical condition that caused severe pain, but was ultimately treated successfully, left him curious about his body and how physicians managed to cure him. His publication serves a resource on LGBTQ health care and includes articles written by UC faculty, staff and students as well as community activists and physicians from across the country. Recently, Pride in Practice became a registered 501(c)(3) public charity. One of Foster’s new initiatives on Pride in Practice is a provider resource portal with guides and clinical resources that medical professionals can easily share and print for use in the clinic. Resources currently in the portal include a physician guide to gender pronouns and a list of crisis hotlines for LGBTQ patients. Pickle says she is amazed Foster has time to serve as editor-in-chief of Pride in Practice. He also advances LGBTQ health care policy through his involvement in the American Medical Association. “Medical school is an extremely challenging time for future physicians,” says Pickle, also a UC Health physician. “They spend four years learning every aspect of the human body and the human experience. They memorize millions of facts, chemical models, medications and disease pathways. For most medical students, they spend most of their time studying, having clinical experiences, and many volunteer in the community. “Haidn Foster, in the midst of the academic rigor of his first two years of medical school, decided to become a CEO and author,” says Pickle. “So in the midst of learning about how to care for patients, Haidn is redefining how the medical community should care for persons across the spectrums of gender and sexuality.” Foster says receiving the award was pretty exciting. “I didn’t know I had been nominated, and a notification just came into my inbox one day that I had been selected for this award,” says Foster, who later learned Pickle had nominated him. “Dr. Pickle has been a tremendous mentor to me. She was my preceptor, and we have worked closely together on events such as the Transgender Day of Visibility in downtown Cincinnati. I’m so grateful to her and the UC LGBTQ Center for helping to highlight the importance of LGBTQ-inclusive health care.”

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