Gender and Ethnic Medicine Project: Cardio-vascular Health

Video 1: Click the picture above to listen to Dr Núñez giving the rationale why you should learn about cardiovascular health issues related to gender and ethnicity..	Video 2: Click the picture above to see Dr Núñez perform an Interview with emphasis on Cardio-vascular Health ...	Video 3: Click the picture above to see Drs Núñez and Lee discuss Cardio-vascular Health issues related to Gender, Ethnicity, and more... NEW: You might subscribe to the GEM discussions in iTunes, and listen to them on your iPod

Links:

1. The Heart Truth (extensive resources, pbl case, lecture materials and additional resources)
   http://womenshealth.gov/hearttruth
   
   
2. DHHS Office of Womens Health
   http://4woman.gov
   
   
3. Agency for Healthcare quality and research
   http://Ahrq.gov
   
   
4. DHHS Office of Minority Health
   http://omh.gov
   
   
5. HRSA
   http://www.hrsa.gov/culturalcompetence/curriculumguide/default.htm

Goals:

Delineate unique and different aspects of heart health risk, clinical presentation, diagnosis, treatment and outcomes for women as compared to men and to describe the impact of subcultural differences in outcomes for diverse women.

Knowledge, Attitudes and Skills Objectives by domain:

Risk Factors and Predictive Tools

• Cite prevalence and incidence data of cardiovascular disease (CVD), and identify racial and gender differences in CVD prevalence and incidence
  
  
• Identify known CVD risk factors in women
  
  
• Identify gender and racial differences in the relative importance of the CVD risk factors for women
  
  
• Define the concept of CVD risk stratification
  
  
• Identify risk reduction strategies, including those involving lifestyle behavioral changes
  
  
• Summarize the current state of knowledge of how menopause and hormone therapy affect a woman’s risk for developing CVD
  
  
• Calculate BMI
  
  
• Identify common (typical) presentations of CVD and identify gender differences in presentation
  
  
• Calculate a woman’s 10-year risk for CVD events using the Framingham criteria

Clinical Presentation, Diagnosis and Testing for Disease

• Describe the pathophysiology of stable and unstable coronary syndromes
  
  
• Recognize the range of common clinical presentations for stable and
  unstable coronary syndromes in women and contrast these with those of
  men
  
  
• Describe testing modalities for diagnosing coronary heart disease and explain differences in test sensitivity and specificity for common tests by gender
  
  
• List appropriate initial diagnostic tests (those usually performed in the emergency department) for a female patient presenting with possible acute coronary syndrome

Behavior Change

• Cite the “Five A’s” for behavioral counseling in smoking cessation
  
  
• Identify evidence-based patient education resources to support primary
  and secondary prevention and treatment of heart disease
  
  
• Apply behavioral change theories and strategies to clinical situations
  
  
• Identify stage of change readiness for the standardized patient and
  understand how this impacts her ability to modify lifestyle habits and
  behaviors
  
  
• Identify the patient’s barriers to change
  
  
• Develop a plan to manage barriers and to move the patient toward a
  higher stage of readiness

Attitudinal Issues

• State what biases may lead to the failure to diagnose CVD in women
  
  
• Identify psychosocial factors that influence, interfere with or delay women seeking treatment and early evaluation for symptoms suggestive of CVD
  
  
• Recognize that gender-specific and culture-specific communication styles may impact the clinician-patient interaction

Resources:

Prevention of Cardiovascular Disease in Women

• Evidence-based Guidelines for Cardiovascular Disease Prevention in Women  http://circ.ahajournals.org/cgi/content/full/109/5/672
  
  
• Coronary heart disease incidence, by sex—United States 1971-1987. MMWR 1992; 41:526-529.
  
  
• Carr MC, Kim KH, Zambon A, et al. Changes in LDL density across the menopausal transition. J Investig Med 2000; 48: 245-250.
  
  
• Grundy, SM, Cleeman JI, Daniels SR et al. Diagnosis and management of metabolic syndrome: an American Heart Association/National Heart, Lung and Blood Institute scientific statement. Accessed at http://www.circulationaha.org on October 25, 2005
  
  
• Mosca L, Appel LJ, Benjamin EJ, et al. Evidence-based guidelines for cardiovascular disease prevention in women. Circulation 2004; 109:672-693.
  
  
• Nohria A, VaccarinoV, Krumholz HM. Gender differences in coronary artery disease in women: gender differences in mortality after myocardial infarction: why women fare worse than men. Cardiol Clin 1998; 16:45-57.
  
  
• Charney P. Presenting symptoms and diagnosis of coronary heart disease in women. J Cardiovasc Risk 2002; 9:303-307.
  
  
• Zimmerman GL, Olsen CG, Bosworth MF. A ‘stages of change’ approach to helping patients change behavior. Am Fam Physician 2000; 61:1409-1416.

Diagnostic Testing

• Mieres JH, Shaw LJ, Arai A, et al.
  Role of noninvasive testing in the clinical evaluation of women with suspected coronary artery disease: consensus statement from the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association.Circulation. 2005; 8;111:682-96. http://circ.ahajournals.org/cgi/content/full/111/5/682
  
  
• Gibbons RJ, Balady GJ, Bricker JT, et al.
  ACC/AHA 2002 guidelines update for exercise testing: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). J Am Coll Cardiol 2002;40:1531-1540. http://www.acc.org/clinical/guidelines/exercise/exerciseclean.pdf
  
  
• Cheitlin MD, Armstrong WF, Aurigemma GP, et al.
  ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). J Am Soc Echocardiogr 2003; 16:1091-1110. http://www.acc.org/clinical/guidelines/echo/index.pdf

Cultural Issues in Care and Women’s Health

• Berlin EA. & Fowkes WC, Jr.: A teaching framework for cross-cultural health care--Application in family practice, In Cross-cultural Medicine.
  
  
• West J. Med. 1983, 12: 139, 93~98
  
  
• Núñez AE. Transforming cultural competence into cross-cultural efficacy in women's health education. Academic Medicine. 75(11):1071-80, 2000 Nov.
  
  
• Association of American Medical Colleges, Tools for Assessing Cultural Competence, 2000 http://www.aamc.org/meded/tacct/start.htm
  
  
• Institute of Medicine. Exploring the Biological Contributions to Human Health: Does Sex Matter? 2001
  http://www.iom.edu/CMS/3740/5437.aspx
  
  
• Office of Minority Health, National Standards on Culturally and Linguistically Appropriate Services (CLAS), 2001. http://www.omhrc.gov/templates/browse.aspx?lvl=2&lvlID=15
  
  
• California Endowment P r i n c i p l e s a n d R e c o m m e n d e d S t a n d a r d s f o r C u l t u r a l C o m p e t e n c e E d u c a t i o n o f  H e a l t h C a r e P r o f e s s i o n a l s, 2001.
  http://www.calendow.org/reference/publications/pdf/cultural/TCE0215-2003_Principles_and.pdf
  
  
• Núñez AE. Robertson, CJ. Multicultural Issues for Women’s Health. Medical Clinics of North America. 87(2003) 939-954.
  
  
• Agency for Healthcare Research and Quality. National Health Care Health Disparities Report 2006 http://www.ahrq.gov/qual/nhdr06/nhdr06.htm
  
  
• Transforming the Face of Health Professions Through Cultural & Linguistic Competence Education:  The Role of the HRSA Centers of Excellence Appendix A Toolbox, 2002.
  http://www.hrsa.gov/culturalcompetence/curriculumguide/AppendixA.htm
  
  
• Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.2002.  http://www.iom.edu/CMS/3740/4475.aspx

Tools and Additional Web Resources:

• Absolute CHD Risk Calculator.
  http://www.nhlbi.nih.gov/guidelines/cholesterol
  
  
• 10-year CHD Risk Assessment Tool:
  http://hin.nhlgi.nih.gov/atpiii/riskcalc.htm
  
  
• Body Mass Index Calculator for Palm OS and Pocket PC 2003:
  http://hin.nhlbi.nih.gov/bmi_palm.htm
  
  
• ATPIII Cholesterol Management Implementation Tool for Palm OS:
  http://hin.nhlbi.nih.gov/atpiii/atp3palm.htm
  
  
• JNC 7 Application for Palm OS and Pocket PC. 2003:
  http://hin.nhlbi.nih.gov/jnc7/jnc7pda.htm
  
  
• “Act in Time to Heart Attack Signs” Physician Quick Reference for Palm OS:
  http://hin.nhlbi.nih.gov/haacpalm/haacpalm.htm
  
  
• A Family Physician’s Guide to Cultural Competency
  https://cccm.thinkculturalhealth.org/

Compilation by A.Núñez, 2007