Amy Huebschmann, University of Colorado Anschutz Medical Campus and Judith Regensteiner, University of Colorado Anschutz Medical Campus

A simple difference in the genetic code – two X chromosomes versus one X chromosome and one Y chromosome – can lead to major differences in heart disease. It turns out that these genetic differences influence more than just sex organs and sex assigned at birth – they fundamentally alter the way cardiovascular disease develops and presents.

While sex influences the mechanisms behind how cardiovascular disease develops, gender plays a role in how health care providers recognize and manage it. Sex refers to biological characteristics such as genetics, hormones, anatomy and physiology, while gender refers to social, psychological and cultural constructs. Women are more likely to die after a first heart attack or stroke than men. Women are also more likely to have additional or different heart attack symptoms that go beyond chest pain, such as nausea, jaw pain, dizziness and fatigue. It is often difficult to fully disentangle the influences of sex on cardiovascular disease outcomes versus the influences of gender.

While women who haven’t entered menopause have a lower risk of cardiovascular disease than men, their cardiovascular risk accelerates dramatically after menopause. In addition, if a woman has Type 2 diabetes, her risk of heart attack accelerates to be equivalent to that of men, even if the woman with diabetes has not yet gone through menopause. Further data is needed to better understand differences in cardiovascular disease risk among nonbinary and transgender patients.

Despite these differences, one key thing is the same: Heart attack, stroke and other forms of cardiovascular disease are the leading cause of death for all people, regardless of sex or gender.

We are researchers who study women’s health and the way cardiovascular disease develops and presents differently in women and men. Our work has identified a crucial need to update medical guidelines with more sex-specific approaches to diagnosis and treatment in order to improve health outcomes for all.

Gender differences in heart disease

The reasons behind sex and gender differences in cardiovascular disease are not completely known. Nor are the distinct biological effects of sex, such as hormonal and genetic factors, versus gender, such as social, cultural and psychological factors, clearly differentiated.

What researchers do know is that the accumulated evidence of what good heart care should look like for women compared with men has as many holes in it as Swiss cheese. Medical evidence for treating cardiovascular disease often comes from trials that excluded women, since women for the most part weren’t included in scientific research until the NIH Revitalization Act of 1993. For example, current guidelines to treat cardiovascular risk factors such as high blood pressure are based primarily on data from men. This is despite evidence that differences in the way that cardiovascular disease develops leads women to experience cardiovascular disease differently.

In addition to sex differences, implicit gender biases among providers and gendered social norms among patients lead clinicians to underestimate the risk of cardiac events in women compared with men. These biases play a role in why women are more likely than men to die from cardiac events. For example, for patients with symptoms that are borderline for cardiovascular disease, clinicians tend to be more aggressive in ordering artery imaging for men than for women. One study linked this tendency to order less aggressive tests for women partly to a gender bias that men are more open than women to taking risks.

In a study of about 3,000 patients with a recent heart attack, women were less likely than men to think that their heart attack symptoms were due to a heart condition. Additionally, most women do not know that cardiovascular disease is the No. 1 cause of death among women. Overall, women’s misperceptions of their own risk may hold them back from getting a doctor to check out possible symptoms of a heart attack or stroke.

These issues are further exacerbated for women of color. Lack of access to health care and additional challenges drive health disparities among underrepresented racial and ethnic minority populations.

Sex difference in heart disease

Cardiovascular disease physically looks different for women and men, specifically in the plaque buildup on artery walls that contributes to illness.

Women have fewer cholesterol crystals and fewer calcium deposits in their artery plaque than men do. Physiological differences in the smallest blood vessels feeding the heart also play a role in cardiovascular outcomes.

Women are more likely than men to have cardiovascular disease that presents as multiple narrowed arteries that are not fully “clogged,” resulting in chest pain because blood flow can’t ratchet up enough to meet higher oxygen demands with exercise, much like a low-flow showerhead. When chest pain presents in this way, doctors call this condition ischemia and no obstructive coronary arteries. In comparison, men are more likely to have a “clogged” artery in a concentrated area that can be opened up with a stent or with cardiac bypass surgery. Options for multiple narrowed arteries have lagged behind treatment options for typical “clogged” arteries, which puts women at a disadvantage.

In addition, in the early stages of a heart attack, the levels of blood markers that indicate damage to the heart are lower in women than in men. This can lead to more missed diagnoses of coronary artery disease in women compared with men.

The reasons for these differences are not fully clear. Some potential factors include differences in artery plaque composition that make men’s plaque more likely to rupture or burst and women’s plaque more likely to erode. Women also have lower heart mass and smaller arteries than men even after taking body size into consideration.

Reducing sex disparities

Too often, women with symptoms of cardiovascular disease are sent away from doctor’s offices because of gender biases that “women don’t get heart disease.”

Considering how symptoms of cardiovascular disease vary by sex and gender could help doctors better care for all patients.

One way that the rubber is meeting the road is with regard to better approaches to diagnosing heart attacks for women and men. Specifically, when diagnosing heart attacks, using sex-specific cutoffs for blood tests that measure heart damage – called high-sensitivity troponin tests – can improve their accuracy, decreasing missed diagnoses, or false negatives, in women while also decreasing overdiagnoses, or false positives, in men.

Our research laboratory’s leaders,collaborators and other internationally recognized research colleagues – some of whom partner with our Ludeman Family Center for Women’s Health Research on the University of Colorado Anschutz Medical Campus – will continue this important work to close this gap between the sexes in health care. Research in this field is critical to shine a light on ways clinicians can better address sex-specific symptoms and to bring forward more tailored treatments.

The Biden administration’s recent executive order to advance women’s health research is paving the way for research to go beyond just understanding what causes sex differences in cardiovascular disease. Developing and testing right-sized approaches to care for each patient can help achieve better health for all.

Amy Huebschmann, Professor of Medicine, University of Colorado Anschutz Medical Campus and Judith Regensteiner, Professor of Medicine, University of Colorado Anschutz Medical Campus

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Trirupa Chakraborty, University of Pittsburgh; Aniruddh Sarkar, Georgia Institute of Technology, and Jishnu Das, University of Pittsburgh

Blood samples of patients infected with a parasitic worm that causes schistosomiasis contain hidden information that marks different stages of the disease. In our recently published research, our team used machine learning to uncover that hidden information and improve early detection and diagnosis of infection.

The parasite that causes schistosomiasis completes its life cycle in two hosts – first in snails and then in mammals such as people, dogs and mice. Freshwater worm eggs enter human hosts through the skin and circulate throughout the body, damaging multiple organs, including the liver, intestine, bladder and urethra. When these larvae reach blood vessels connecting the intestines to the liver, they mature into adult worms. They then release eggs that are excreted when the infected person defecates, continuing the transmission cycle.

Since diagnosis currently relies on detecting eggs in feces, doctors usually miss the early stages of infection. By the time eggs are detected, patients have already reached an advanced stage of the disease. Because diagnosis rates are poor, public health officials typically mass-administer the drug praziquantel to populations in affected regions. However, praziquantel cannot clear juvenile worms in early stages of infection, nor can it prevent reinfection.

Our study provides a clear path forward to improving early detection and diagnosis by identifying the hidden information in blood that signals active, early stage infection.

Your body responds to a schistosomiasis infection by mounting an immune response involving several types of immune cells, as well as antibodies specifically targeting molecules secreted by or present on the worm and eggs. Our study introduces two ways to screen for certain characteristics of antibodies that signal early infection.

The first is an assay that captures a quantitative and qualitative profile of immune response, including various classes of antibodies and characteristics that dictate how they communicate with other immune cells. This allowed us to identify specific facets of the immune response that distinguish uninfected patients from patients with early and late-stage disease.

Second, we developed a new machine learning approach that analyzes antibodies to identify latent characteristics of the immune response linked to disease stage and severity. We trained the model on immune profile data from infected and uninfected patients and tested the model on data that wasn’t used for training and data from a different geographical location. We identified not only biomarkers for the disease but also the potential mechanism that underlies infection.

Why it matters

Schistosomiasis is a neglected tropical disease that affects over 200 million people worldwide, causing 280,000 deaths annually. Early diagnosis can improve treatment effectiveness and prevent severe disease.

In addition, unlike many machine learning methods that are black boxes, our approach is also interpretable. This means it can provide insights into why and how the disease develops beyond simply identifying markers of disease, guiding future strategies for early diagnosis and treatment.

What still isn’t known

The schistosomiasis infection signatures we identified remain stable across two geographical regions across two continents. Future research could explore how well these biomarkers apply to additional populations.

Further, our work identifies a potential mechanism behind disease progression. We found that a particular immune response against a specific protein on the surface of the worm signals an intermediate stage of infection. Understanding how the immune system responds to this understudied antigen could improve diagnosis and treatment.

What’s next

Besides improving our understanding of how the immune system responds to different stages of infection, our findings identify key antigens that could pave the way for designing cost-effective and efficient approaches to diagnosis and treatments. Our next steps will include actually deploying these strategies in the field for early detection and management of disease.

The Research Brief is a short take about interesting academic work.

Trirupa Chakraborty, Ph.D. Candidate in Integrative Systems Biology, University of Pittsburgh; Aniruddh Sarkar, Assistant Professor of Biomedical Engineering, Georgia Institute of Technology, and Jishnu DasUniversity of Pittsburgh

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Kimber Wilkerson, University of Wisconsin-Madison

A growing number of students in public schools – right now, about 15% of them – are eligible for special education services. These services include specially designed instruction for students with autism, learning or physical disabilities, or traumatic brain injuries. But going into the current school year, more than half of U.S. public schools anticipate being short-staffed in special education. Dr. Kimber Wilkerson, a professor of special education and department chair at the University of Wisconsin-Madison, explains why there’s a shortage and what needs to be done to close the gap.

The Conversation has collaborated with SciLine to bring you highlights from the discussion, which have been edited for brevity and clarity.

Which students receive special education services?

Kimber Wilkerson: Students with a disability label receive special education services. They need these additional services and sometimes instruction in school so they can access the curriculum and thrive like their peers.

What is happening with staffing for special education?

Wilkerson: Since special education became a thing in the ’70s, there have always been challenges in filling all the special education positions.

In the past 10 years preceding the COVID-19 pandemic, those challenges started to increase. There were more open positions in special education at the beginning of each school year than in previous decades. In the 2023-24 school year, 42 states plus the District of Columbia reported teacher shortages in special education.

What is causing these shortages?

Wilkerson: One, there are fewer young people choosing teaching as a major in college and as a profession. And special education is affected by these lower rates more than other forms of education.

Also, there’s more attrition – people leaving their teaching job sooner than you might expect – not because they’re retiring, but because they are tired of the job.

They want to do something different. They want to go back to school. Sometimes it’s life circumstances, but the number of people leaving the job before retirement age has increased. And in our state, Wisconsin, about 35% of all educators leave the field before they hit their fifth year.

That number is even higher for special educators. About half of special educators are out of the profession within five years.

Why do special education teachers leave the profession?

Wilkerson: There’s not a national study that speaks to that reason. There are some localized studies, and people report things like too much paperwork or too many administrative tasks associated with the job. Sometimes they report the students’ behavioral challenges. Sometimes it’s a feeling of isolation, or a lack of support from the school.

How are students with disabilities affected when their school does not have enough special educators?

Wilkerson: In a school that’s one special educator short, the other special educators have to take over that caseload. Instead of having 12 students on their caseload, maybe now they have 20. So, the amount of individual attention given to each student with a disability decreases.

Also, when teachers with experience leave the profession, they leave behind a less experienced group of teachers. This means the students are losing out on the benefit of those years of wisdom and experience.

What are some strategies to recruit and retain more special education teachers?

Wilkerson: There’s a range of strategies that different universities, states and school districts have taken, like residency programs.

In these programs, the person who is learning to be a teacher, and who is referred to as a teaching resident, works alongside a mentor teacher for an entire year in a school, and they get paid to do so. They’re not the teacher of record, but they’re learning and getting paid, and they’re in that school community.

Can you tell us about your recent study on supporting new special education teachers?

Wilkerson: One thing that made a big difference is when the teachers in our study, which is now under review, had access to a mentor and a group of their peers. We called this facilitated peer-to-peer group of teachers a “community of practice.” Every other week, on Zoom, we’d get these new special education teachers from different school districts together, along with experienced teachers. And they would do some sort of work on problems, bringing in the things that were challenging, and work on possible solutions as a group.

We also used Zoom to do one-on-one mentoring. And what people liked about it was that they could talk to someone who wasn’t right in their building and right in their district who they could be open and vulnerable with.

Sometimes, special educators can be isolated because they’re not necessarily a part of a grade-level team. They work with kids across a lot of classrooms. This gave them an opportunity to have their own kind of community, and that made a difference.

We also surveyed their level of burnout and how good they felt about the job they did. And then we surveyed special education teachers who weren’t participating in our community of practice.

At the end of the year, those people who had that mentoring and the community of practice felt less burnt out, and they also felt more effective in the area of classroom management. And that’s critical, because burnout is one of the primary reasons people leave the profession.

So if we can make people feel like they’re better equipped to handle this challenging position, then that’s one strategy to increase the number of people wanting to stay in their job year after year.

Watch the full interview to hear more.

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Kimber Wilkerson, Professor of Special Education, University of Wisconsin-Madison

This article is republished from The Conversation under a Creative Commons license. Read the original article.