7 facts women should know to prevent and recognize stroke

stroke

It’s telling that although stroke is the third leading cause of death for women in the U.S., and that twice as many women die of stroke than of breast cancer, most women aren’t aware of these facts.

As is the case with heart attacks, stroke is often perceived as occurring mostly in men—even though women account for 51% of all people worldwide who have experienced a stroke.

That’s why neurologist Sarah Song, MD, MPH of the Rush Stroke Program says it’s essential for women to be savvy when it comes to stroke.

Understanding your risks empowers you to take steps to prevent a stroke. And being aware of the symptoms will enable you to get treatment faster if you do have a stroke, when every second counts.

Whether you’re a woman or have loved ones who are women, Song says knowing these facts can help save lives:

1. Don’t dismiss stroke symptoms

These symptoms are commonly identified with stroke in both men and women:

  • Numbness on one side of the body and/or face
  • Weakness on one side of the body and/or face
  • Loss of vision
  • Double vision
  • Vertigo, or room-spinning
  • Slurred speech
  • Difficulty speaking or understanding language

If you notice any of these symptoms in yourself or another person, call 911 immediately, even if the symptoms don’t cause pain or they go away.

Just remember that “time is brain.” If it is a stroke, the sooner you get treatment, the better your chance of surviving. Prompt treatment also improves your chances for successful rehabilitation and recovery.

2. Strokes in young women are on the rise

It’s true that strokes most often strike older women (and men). But the World Stroke Organization reports that 8% of all strokes—and 4% of all stroke-related deaths—occur in people under the age of 44.

One potential reason is thought to be the increase in obesity among younger women. Studies have shown that women who are obese or have gained more than 44 pounds since age 18 are about 2.5 times more likely to have a stroke than women who maintain a healthy weight.

While obesity is a stroke risk factor on its own, it also contributes to other significant risk factors, including high blood pressure, Type 2 diabetes and heart disease—all of which are increasingly common in women today.

Pregnancy and childbirth can also make young women, including transgender women, more vulnerable to stroke.

Most maternal strokes happen within the first few weeks after birth, triggered by blood loss or hormonal changes. Stroke is also associated with certain complications of pregnancy, including infections and preeclampsia. And, generally speaking, clotting activity is heightened during pregnancy; if clots form in the blood vessels of the veins, they can lead to a stroke.

3. Black and Hispanic women have a higher risk of stroke

According to the Office of Minority Health, part of the U.S. Department of Health and Human Services, Black women are twice as likely to have a stroke as white women—and more likely to die from a stroke than either white women or Hispanic women.

One reason? High blood pressure, diabetes and obesity—three of the biggest risk factors for stroke—are all more common in Black women than white women.

A lesser known risk factor: sickle cell disease, a genetic disease common in Black Americans (around 1 in 365 Black Americas is born with it). Twenty-five percent of adults with sickle cell disease will suffer a stroke by the age of 45.

Hispanic women, too, experience high blood pressure, diabetes and obesity at higher rates than non-Hispanic white women, putting them at increased risk of both stroke and stroke-related deaths.

Working to improve your weight, blood pressure and cholesterol with lifestyle changes and medications can help reduce the risk not only of stroke, but of heart disease and cancer.

4. Using birth control pills can potentially raise stroke risk

The American Stroke Association reports that women who take birth control pills may be twice as likely to have a stroke as those who don’t. Birth control pills (often referred to as “the pill”) can cause blood clots to develop. In some cases, blood clots can possibly travel to the brain, causing a stroke or heart attack.

Since the stroke risk for healthy young women is low to begin with, you don’t necessarily have to forgo the pill. Your doctor can help determine whether oral contraceptives or another form of birth control is best for you.

That means identifying your other risk factors. If you take oral contraceptives, any additional risk factors—especially smoking—will increase your potential for stroke even more. The risk of stroke related to oral contraceptives also increases with age.

5. There’s a link between migraines and stroke

These crippling headaches—far more common in women than men—have been associated with an increased risk of stroke when accompanied by a migraine aura.

The reasons for this association are not well understood. But from what we do know, aura (where you experience flashes of light, light or noise sensitivity, tingling in the hands or face, partial loss of vision or other symptoms) must be associated with the headache to increase stroke risk. It may also be associated with hormonal changes.

The American Stroke Association says women who experience migraines with aura are up to 10 times more likely to have a stroke, depending on their other risk factors. Smoking and using oral contraceptives, in particular, can increase your risk significantly.

6. Women should watch their waistlines

Studies have shown that postmenopausal women with a waist measuring more than 35.2 inches and a triglyceride (blood fat) level higher than 128 mg/dL have five times the risk of stroke.

And there are other serious health risks associated with an “apple” body shape in women, including heart disease and diabetes.

There are some stroke risk factors you can’t control, like your family history, ethnicity/race and age. So it is helpful instead to focus on the behaviors you can change.

That includes making time to exercise and eating a diet rich in fruits, vegetables and whole grains. Adopting a healthy lifestyle may help prevent stroke in women, especially if you have other stroke risk factors.

7. A transient ischemic attack, or “mini-stroke,” is a warning sign

A transient ischemic attack, also known as a TIA or “mini-stroke,” causes the same symptoms as a stroke but lasts only minutes to a few hours.

Even though there may not be lasting effects from a TIA, you should still seek immediate medical help. That includes talking to your doctor about how to prevent a full-blown stroke, because having a TIA puts you at greater risk for having a stroke. A TIA is an opportunity to look for stroke risk factors that could be better controlled.

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Women face unique risks for high blood pressure and stroke

blood pressure

Women have a lot on their plates, and sometimes important self-care can take a back seat to work, family and other obligations. In fact, nearly 50% of adult women have high blood pressure, and nearly three-quarters of those with high blood pressure don’t have it under control. Uncontrolled high blood pressure can significantly increase a woman’s risk for a stroke, but a few important steps can help reduce that risk and give women (and their loved ones) one less thing to worry about.

“High blood pressure is a leading cause of stroke and we know that one in five women will have a stroke and stroke kills more women than breast cancer,” according to Dr. Monik Jiménez, a volunteer with the American Heart Association / American Stroke Association and associate epidemiologist at Brigham and Women’s Hospital and assistant professor of Medicine at Harvard Medical School and Harvard T.H. Chan School of Public Health.

“While high blood pressure isn’t directly linked to gender, different health issues throughout a woman’s life, such as birth control, pregnancy, and menopause, can increase the risk of developing high blood pressure, which can increase the risk of stroke if left uncontrolled,” according to Jiménez.

Doctors and researchers have found a link between birth control pills and an increase in blood pressure among some women. They say that it is more likely to occur in women who are already overweight, have kidney disease or have a family history of high blood pressure. A combination of birth control pills and smoking can be very dangerous to women and is not recommended.

A woman’s health during pregnancy can be a preview of her health in the future. Women who had high blood pressure during pregnancy are at an increased risk for developing high blood pressure and having a stroke later in life.

The physical changes associated with menopause also increase a woman’s risk of developing high blood pressure.

Of note, women of Black and Hispanic ethnicity may develop high blood pressure at a younger age and have a higher average blood pressure than other racial groups, according to the Centers for Disease Control and Prevention.

Fortunately, 80% of strokes may be prevented and lowering high blood pressures reduces stroke risk. Women can measure their blood pressure at home regularly and let their doctors know if it’s normally above 120/80. In addition, lifestyle adjustments such as getting enough exercise, eating healthfully, maintaining a healthy weight, and not smoking can go a long way to reduce women’s disease risk from high blood pressure.

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Study helps unravel why pregnant women develop heart failure similar to older patients

pregnant women

Researchers at Penn Medicine have identified more genetic mutations that strongly predispose younger, otherwise healthy women to peripartum cardiomyopathy (PPCM), a rare condition characterized by weakness of the heart muscle that begins sometime during the final month of pregnancy through five months after delivery. PPCM can cause severe heart failure and often leads to lifelong heart failure and even death. The study is published today in Circulation.

PPCM affects women in one out of every 2,000 deliveries worldwide, with about a third of those women developing heart failure for life, and about five percent of them dying within a few years. Maternal mortality in the United States has doubled in the last 20 years, and PPCM is a leading cause of these deaths. Previously, the reasons behind why women developed PPCM remained a mystery until a 2016 study strongly suggested that some genetic mutations predispose women to the disease. Zoltan P. Arany, MD, PHD, the Samuel Bellet Professor of Cardiology in the Perelman School of Medicine at the University of Pennsylvania was also the senior author of that study. This newly released study shines a light on four more genetic variants that had not previously been associated with PPCM. It found that this genetic profile is highly similar to that found in patients with non-ischemic dilated cardiomyopathy (DCM), a very similar disease that typically impacts middle-aged men and women, and one that the medical community knows more about.

“This study provides the first extensive genetic and phenotype landscape of PPCM and has major implications for understanding how PPCM and DCM are related to each other,” said Arany. “It shows that predisposition to heart failure is an important risk factor for PPCM, suggesting that approaches being developed for DCM may also apply to patients with PPCM.”

For the study, Penn researchers identified nearly 470 women with PPCM, retrospectively, from several academic centers in the United States and abroad, and looked at clinical information and DNA samples. Then, they performed next-generation sequencing on 67 genes, including a gene known as TTN, which generates a large protein that controls how heart muscle cells contract and pump blood. 10.4 percent of the patients sampled showed shortened variants in the TTN gene, compared with just 1.2 percent of the reference population. Researchers also found overrepresentation of shortened variants in three other genes not previously associated with PPCM, but previously associated with DCM.

Researchers hope this will push for changes to allow physicians to follow similar, well-established genetic testing practices and counseling guidelines already used for patients with DCM, as well as gene-specific therapies.

“We believe this study shows how important genetic screening and counseling are for women who develop PPCM, something that isn’t currently common practice, and perhaps even for their female family members of child-bearing age,” Arany said. “As a physician, knowing you have a patient with PPCM who shows these genetic mutations would lead you to make changes in care, such as lowering the threshold for defibrillator use in the case of high-risk variants, or counseling family members on their risk of developing PPCM.”

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Women seeking help for unmet needs often overdue for cervical cancer screenings

More than half of cervical cancer cases in the United States occur in women who have not had timely Pap smears and/or HPV tests — screenings that allow for detection of precancerous or cancerous cells on the cervix. Encouraging low-income women in particular to participate in such screenings likely would improve cancer detection and save lives, but health-care professionals have been uncertain of how best to improve patient adherence to screenings and follow-ups involving abnormal results.

Women with low incomes sometimes skip Pap smears and other cancer prevention screenings because they are focused on more pressing needs such as housing, food and other necessary expenses. So, researchers at Washington University School of Medicine in St. Louis evaluated efforts to help such women obtain cervical cancer screenings.

The scientists studied a group of female callers in Missouri seeking assistance from a free and confidential phone service that helps people find basic resources. The researchers determined that many female callers were due for cervical cancer screenings but most did not schedule one, even with the support of a health navigator, an individual trained to help people access medical care. Their findings indicate a new, more involved approach is needed to achieve such screenings and, ultimately, lower the number of women treated for advanced cancer.

“Reasons for inadequate screening are many and often deeply rooted to social and structural determinants of health that drive health inequities,” said first author Lindsay Kuroki, MD, an assistant professor of obstetrics & gynecology. “We wanted to determine the need for cervical cancer screening among women seeking assistance with unmet basic needs and to assess different methods of encouraging callers to seek Pap screening. Connecting underserved women to cervical cancer-screening services and assisting them with barriers to access medical care can improve health equity and reduce cancer disparities.“

The findings are available online in the American Journal of Obstetrics & Gynecology.

Participants were recruited from June 2010 through June 2012 from among callers to United Way 2-1-1 Missouri, a telephone helpline for local health and social service resources. Most callers seek help with basic needs such as food, utility bills, shelter and unexpected expenses.

Of 932 callers, 211 were referred for cervical cancer screenings. Callers were randomized to one of three conditions: phone call only; phone call and a print reminder; or a phone call and a personal navigator. The researchers looked at how many women contacted a clinic to schedule a Pap test one month after receiving a referral.

Patients in need of Pap screening had multiple cervical cancer risk factors. These women had a mean age of 48.2 years, were predominantly non-white, poor and unemployed, not married, and actively smoking. Nearly all (94.7%) female callers, regardless of their need for Pap testing, had at least one unmet basic need, with callers reporting an average of two unmet needs.

Women in the group that was assigned health navigators reported higher rates of contacting Pap services (29.6%) than those given phone calls only (15.1%), or phone calls and tailored print reminders (13.4%). Health navigators tripled the likelihood that women made contact with Pap services, and this remained true even among women with multiple unmet needs. Nevertheless, only 41 of 211 (19.4%) women who were overdue for Pap testing and received a referral contacted the referred clinic to schedule cervical cancer screenings.

The scientists said future research is necessary to understand how unmet basic needs pose barriers to cervical screening and how effective interventions to meet basic needs may lead to improved access to cancer prevention services. Some of these interventions might include immediate help such as assisting women with transportation and childcare. Other interventions might focus on redesigning health systems and influencing social policy to provide women at risk for cervical cancer with secure homes free of hunger and tobacco.

“Women contacting 2-1-1 are likely to have health needs that greatly exceed those of the general population, in addition to lacking financial resources and social support required to seek cervical cancer screening,” said senior author Matthew Kreuter, PhD, the Kahn Family Professor of Public Health at the Brown School. “Continuing this line of research is critical to improving outcomes for low-income, medically underserved populations. No woman should die from a preventable cancer.”

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Why women may be better equipped to fight COVID

covid

When it comes to COVID-19, women seem to be the stronger sex, suffering severe disease at about half the rate as men, but the reason for this has been elusive.

Now, a chance experiment by an ophthalmology researcher at Duke Health has led to an insight: Women have more of a certain type of immune cell that fights infections in mucosal tissue, and these immune cells amass in the lungs, poised to attack the COVID virus.

“Better armed with these specialized immune cells, women appear to be more equipped to fight some of the most severe impacts of COVID-19, notably the respiratory infections that can become life-threatening,” said Daniel Saban, Ph.D., an associate professor in Duke’s Department of Ophthalmology and in the Department of Immunology.

Saban, who led the study that appears online in the Cell Press journal Med, said the investigation began last spring as COVID first spread and he was sidelined from his normal caseload studying eye diseases. A piece of equipment in his lab—a device that can perform 36-color flow cytometry—was sitting idle, so he decided to use it to examine blood samples from COVID patients.

“We didn’t start with a hypothesis,” Saban said. “It was a completely unbiased approach, where we asked our colleagues to provide blood and tissue samples from COVID patients as well as healthy people. We had no idea what we would find, if anything.”

Saban and the members of his lab, including Chen Yu, Ph.D. and Sejiro Littleton, quickly saw that a white blood cell called mucosal associated invariant T cells, or MAIT cell, circulated more abundantly in the blood from healthy women compared to healthy men. MAIT cells are highly specialized white blood cells that contribute to immune defenses in mucosal organs and tissues.

Among COVID patients, however, there were few MAIT cells circulating in the blood, even among women, where the population of MAIT cells radically fell off, leading the researchers to question where these cells had gone.

They found their answer in tissue samples from the lungs of COVID patients. Overall, there were an abundance of MAIT cells in the lung tissue of people with COVID, but upon closer inspection, they found night-and-day differences between the sexes.

“We first found this dichotomy in healthy blood,” Saban said. “Circulating MAIT cells in women expressed genes indicative of a robust profile poised for fighting an infection, but this was not the case in males. Then we looked in the tissue and were able to find evidence of this same pattern by sex.”

Saban said there are numerous examples of sexual differences in the immune responses to infections, noting those differences have been prevalent all along with COVID-19.

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Pandemic taking ‘massive toll’ as women fight depression

Denise Welch talks to depression sufferer for MHFA England

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Almost 60 percent of women feel more stressed or overwhelmed since the pandemic began, compared with 41 percent of men. The survey, commissioned by the British Association for Counselling and Psychotherapy (BACP), revealed that almost half of women (48 percent) now feel more depressed or hopeless, while only 38 percent of men feel the same way.

One in 10 women who accessed counselling services have done so for the first time in the past six months, and just over half of those said it was influenced by Covid-19.

BACP’s annual public perceptions survey was conducted as part of its Friends First campaign, which is urging meeting up as part of the “rule of six friends”.

This comes after the recent relaxing of restrictions, meaning groups of six can now meet outdoors.

The campaign also wants to help people spot the signs of deteriorating mental health and encourage loved ones to seek professional support if needed.

Some 87 percent have become more conscious of the mental health of friends and family since the pandemic and 37 percent of those who have never had counselling before said they would consider it if a friend or family member suggested it.

Lorraine Collins, a registered BACP counsellor based in London, said: “The onset of the pandemic brought a rapid emotional gear shift for women in the home that has seen a disproportionate effect on their mental health.

“Stress factors such as no longer having physical or mental space to decompress, coupled with expectations to manage everything under one roof while working and being the main care givers, has made a real impact.”

BACP’s Fiona Ballantine Dykes, a senior counsellor and supervisor, said: “While we recognise the important role that friends and family will play in the mental wellbeing of their loved ones, we are acutely aware that overcoming mental health obstacles requires professional help.

“It’s important that people try to spot the signs of where support is needed, such as someone retreating from conversations or not responding to messages.

“Equally as important is that friends do not become overwhelmed and give the wrong advice, however well meant.”

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Encouraging COVID vaccine results for children and pregnant women

vaccine

After being safely administered to millions of adults around the world, new data shows that the Pfizer/BioNTech vaccine is effective in teenagers as well. A US trial of more than 2,000 12-15 year olds found that the vaccine had an efficacy rate of 100% and produced a strong antibody response, according to a press release from Pfizer. That’s good news, as children will eventually need to be vaccinated to prevent infection, says pediatrician James B Wood.

These results follow earlier positive results relating to the efficacy of COVID-19 vaccines during and after pregnancy. A small study of pregnant and breastfeeding women who had been given the Pfizer and Moderna vaccines found they too produced a robust immune response, and that vaccinated mothers were also able to pass on immunity to their newborns. Immunologists Catherine Thornton and April Rees explain here how it works.

The Moderna and Novavax vaccines are due to arrive in the UK in the coming months, with the latter to be entirely produced and packaged domestically. This will provide hope for those who are still waiting for their first doses, say supply chain experts Liz Breen and Sarah Schiffling, and it will hopefully bolster the country’s slow emergence from lockdown.

In the US, 15 million doses of the Johnson & Johnson vaccine have been contaminated at a manufacturing site after ingredients were conflated with those destined for the AstraZeneca vaccine.

The boost for UK production of COVID-19 vaccines will take some of the heat out of disputes with the EU over the export of doses manufactured within the bloc. The World Health Organization has described the EU rollout as “unacceptably slow”, and the UK has claimed it has preferential access to AstraZeneca vaccines because it negotiated a better contract with the drugmaker. But that’s not strictly true, writes EU law professor Gareth Davies.

The UK prime minister, Boris Johnson, reportedly hailed the lightning-fast development of COVID-19 vaccines as a victory for “greed” and “capitalism,” but the free market has not proven effective in bringing the world new vaccines in the past, writes David Whyte. The real unsung hero of the pandemic, he says, is the publicly funded research sector.

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Women accumulate Alzheimer’s-related protein faster

alzheimers

Alzheimer’s disease seems to progress faster in women than in men. The protein tau accumulates at a higher rate in women, according to research from Lund University in Sweden. The study was recently published in Brain.

Over 30 million people suffer from Alzheimer’s disease worldwide, making it the most common form of dementia. Tau and beta-amyloid are two proteins known to aggregate and accumulate in the brain in patients with Alzheimer’s.

The first protein to aggregate in Alzheimer’s is beta-amyloid. Men and women are equally affected by the first disease stages, and the analysis did not show any differences in the accumulation of beta-amyloid. Memory dysfunction arises later, when tau starts to accumulate. More women than men are affected by memory problems due to Alzheimer’s, and it was for tau that the researchers found a higher rate of accumulation in women.

“Tau accumulation rates vary greatly between individuals of the same sex, but in the temporal lobe, which is affected in Alzheimer’s disease, we found a 75% higher accumulation rate in women as a group compared to men,” explains Ruben Smith, first author of the study.

The accumulation of tau is faster in patients who already have a pathological accumulation of beta-amyloid, and are in the early phase of the disease. The discovery that the accumulation rate of tau is higher in women remained even after adjusting for age and the levels of tau they had at the beginning. Together with data from three similar cohorts in the USA, the project contains 209 women and 210 men.

“The next step would be to examine why this accumulation is faster in women,” says Sebastian Palmqvist, the researcher responsible for the cognitive assessment of the patients.

The study did not investigate the reasons for the higher rate of tau accumulation in women.

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Non-O blood type may increase stroke risk among women who smoke, take oral contraceptives

contraception

Non-O blood type may increase the risk of stroke among women who smoke and take oral contraceptives, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2021.

According to the most recent comprehensive data (January 2020) from the Centers for Disease Control and Prevention (CDC), stroke is the fifth leading cause of death in the United States and a major contributor to long-term disability. Some risk factors for stroke, such as older age and family history, cannot be controlled. Fortunately, several risk factors can be controlled, including not smoking, maintaining a healthy body weight, eating a healthy diet, being physically active, controlling high cholesterol and diabetes, and avoiding excessive alcohol use.

Oral contraceptives can also increase stroke risk in some women, especially those who smoke. Due to this risk, women who smoke and are older than 35 should not take oral contraceptives. Previous research has shown that blood types, specifically non-O, (A, B, or AB) also may increase the risk of stroke.

“We sought to determine whether blood group, specifically non-O blood group, increases the risk for stroke among oral contraceptive users,” said study lead author Steven J. Kittner, M.D., professor of neurology at the University of Maryland School of Medicine in Baltimore, Maryland. “The results of our small study suggest that this might be the case, but more data from other studies are needed to support or refute our findings. We did find that smoking markedly increased the risk of stroke in young women, regardless of oral contraceptive use, and this finding has been supported by numerous other studies.”

Using information from another study of early-onset stroke, researchers compared the risk of stroke among women who smoked and used oral contraceptives, alongside a second analysis of women who only smoked or only took contraceptives. Study participants included 347 women who had experienced a stroke before the age of 50, and a comparison group of 383 women without a stroke. The average age in both groups was 42, and about half of the patients were African American, and half were white. All participants lived in the Baltimore-Washington, D.C., area and were enrolled in the Genetics of Early-onset Stroke study conducted at the University of Maryland School of Medicine between 1992-1996 or 2001-2003.

Researchers found:

  • Women who both smoked and took oral contraceptives were nearly five times as likely to have a stroke compared to women who did not smoke or take oral contraceptives.
  • Non-O blood type further increased the risk of early-onset stroke among women who both smoked and took oral contraceptives: compared to women with O type blood who did not smoke and did not take oral contraceptives, those with non-O type blood who did both were nearly twice as likely to have a stroke.
  • The findings persisted after adjusting for other factors, including race, age, high blood pressure, diabetes and migraine headaches.

Blood type did not significantly affect stroke risk among women who either smoked only or took oral contraceptives only:

  • Women who smoked only were three times more likely to have a stroke than those who did not smoke; and
  • women who took oral contraceptives only were nearly four times more likely to have a stroke compared to those who did not.

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Most women receive inappropriate treatment for urinary tract infections

antibiotic

Nearly half of women with uncomplicated urinary tract infections received the wrong antibiotics and almost three-quarters received prescriptions for longer than necessary, with inappropriately long treatment durations more common in rural areas, according to a study of private insurance claims data published today in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

“Inappropriate antibiotic prescriptions for uncomplicated urinary tract infections are prevalent and come with serious patient- and society-level consequences,” said Anne Mobley Butler, Ph.D., lead author of the study and assistant professor of medicine and surgery at Washington University School of Medicine, St. Louis. “Our study findings underscore the need for antimicrobial stewardship interventions to improve outpatient antibiotic prescribing, particularly in rural settings.”

Researchers studied insurance claims data for 670,400 women ages 18 to 44 who received an outpatient diagnosis of uncomplicated urinary tract infection between April 2011 and June 2015. They identified filled antibiotic prescriptions, assessed adherence to clinical guidelines, and compared rural and urban antibiotic usage patterns.

Rural patients were more likely to receive a prescription for an inappropriately long duration of therapy than urban patients, according to an analysis of geographic data from the claims database. While use of both inappropriate antibiotic choice and inappropriate duration of prescriptions declined slightly over the study period, inappropriate prescriptions continued to be common with 47% of prescriptions written for antibiotics outside guideline recommendations and 76% for an inappropriate duration, nearly all of which were longer than recommended.

“Accumulating evidence suggests that patients have better outcomes when we change prescribing from broad-acting to narrow-spectrum antibiotics and from longer to shorter durations,” Butler said. “Promoting optimal antimicrobial use benefits the patient and society by preventing avoidable adverse events, microbiome disruption, and antibiotic-resistant infections.”

Clinicians should periodically review clinical practice guidelines, even for common conditions, to determine the ideal antibiotic and treatment duration, Butler said. Auditing outpatient antibiotic prescribing patterns and periodic feedback to healthcare provider helps remind clinicians of the best practices and improves antibiotic prescribing. However, additional research should be performed to understand and ultimately improve rural outpatient antibiotic prescribing practices for urinary tract infections and other common conditions.

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