In Touch
A Publication of the
Jacobs Institute of Women's Health

December 1996 - Volume 4, Number 4

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Health Effects of Stress Emphasized, Countermeasures Highlighted

Twenty percent of women will be diagnosed with depression at some point in their lives, according to Marilyn Martin, MD, MPH, who engaged the full house at the third 1996 Breakfast Seminar, "The Stressless Woman: An Oxymoron," held by the Jacobs Institute on October 10. Dr. Martin is a psychiatric consultant with the Community Institute of Behavioral Services in Baltimore, Md. She believes it is incumbent on health care providers to aid women in dealing stress and in understanding its impact on their lives, because the literature shows that stress, especially when handled in unhealthy ways, can be a health hazard.

"Stess is a very personal experience," Dr. Martin pointed out. She defined stress as the result of any demand on the body, and the effect may be mental or physical, as she illustrated with several studies of the effects of stress on cardiovascular health, and the specific effects on women's health (eg, as related to the perimenstrual period).

Women, she joked, are supposed to act like a lady, think like a man, and work like a dog. So they need to find ways to handle stress both at home--as partners and mothers--and at work. Although work can be a source of pointed out that it can actually increase self-esteem and independence, alleviating elements of stress from other sources. "Motherhood," said drily, "is rarely associated in studies with psychological stress. At home, as at work, the reasons are the same: little control, great responsibility, a certain recipe for stress. Dr. Martin drew on her own family to illustrate some points. "In fact," Dr. Martin told the audience, "there is such a thing as a stressless woman; but, unfortunately, the only time a woman is truly stressless is when she's passed on."

So what can women do to alleviate stress? According to Dr. Martin, there are two options: "We can eliminate the stressor or change our response to it." She recommends that all women have an individual management plan, which requires overcoming socialization patterns that tell women that self shouldn't come first. She points out that self-care lies on the continuum between selfishness and selflessness. Specific techniques for alleviating some elements of stress include physical activity, since exercise eases stress; prioritization instruments such as choosing what to do if one had 6 months to live or what to include in a feature film of one's life.

Control, however, is the real key to alleviating stress. She suggested techniques such as the serenity prayer (to identify what you can accept and what you must change), learning to say no (to others as well as herself), and an exercise she calls "mini's." To demonstrate, she led the audience in the exercise, asking them to imagine that they were wearing tight jeans, then to take a deep breath and expand their stomachs as if they were trying to pop off the top button, then relax.

The goal at Dr. Martin's clinic is to empower women to develop their own programs to control stress in their lives. Her 2-year-old daughter, she pointed out, already understood that there are certain things one must be able to do to alleviate stress. Using her baby photos, Dr. Martin illustrated several of them:

  • You need exercise.
  • You need to get angry sometimes and express it.
  • You need to learn to say 'no.'
  • You need to have a way to relax.
  • You need to have some element of spirituality or connectedness in your life.
  • You need a support network.
  • You need to know how to soothe yourself.
  • You need to be able to crawl in someone's lap and get a hug.
  •  

In response to questions from attendees, Dr. Martin agreed that here will always be elements of stress that one can't change completely, as, for example, not being able to afford to quit a high-stress job. In such circumstances, Dr. Martin suggested prioritizing, delegating, and sharing responsibility, and she emphasized the importance of being able to ask for assistance in career decisions.

In response to The 1996 breakfast seminar series is sponsored by The Monsanto Company and G.D. Searle. Audiocassettes are available for $12 plus $3.50 shipping and handling. Resource packets on stress are also available for $15 plus $3.50 shipping and handling. For more information, call the Jacobs Institute at 202-863-4990 or e-mail .   up_arrow.gif (847 bytes)


View from the Board

The Jacobs Institute's Board of Governors appointed two new members this year. Joining the Institute's volunteer leadership are William Cook Andrews, MD, past president of The American College of Obstetricians and Gynecologists (ACOG), and Roderick L. Mackenzie, chairman of the board of Gynetics, Inc. "We originally conceived of the board as multidisciplinary," says Bonnie Flood Chez, RNC, MSN, chairperson of the Committee on Board Development. "We have been expanding that scope to make the board even more representative, encompassing all aspects of women's health. Board members come from business organizations. "With the addition of Dr. Andrews and Mr. Mackenzie, we continue in that direction, bringing expertise to the board that we previously did not have. In addition to being an experienced clinician, Dr. Andrews brings a national specialty perspective to the board. Mr. Mackenzie brings a pharmaceutical industry perspective. Both are extremely well known and well connected to major players in the disciplines affecting women's health."

Dr. Andrews, of Norfolk, Virginia, is past president of ACOG and an ob-gyn in private practice. He received his degree from Johns Hopkins University School of Medicine and completed his internship at the New York Hospital and in the U.S. Navy. Dr. Andrews has served on the Food and Drug Administration's Fertility and Maternal Drugs Advisory Committee and the Obstetrical and Gynecological Device Panel, and is a member of the Scientific Advisory Committee of the Alan Guttmacher Institute. Dr. Andrews is also past president of the American Fertility Society, where he subsequently served as executive director for several years.

Roderick L. Mackenzie of Bonita Springs, Florida, is chairman of the board of Gynetics, Inc., a pharmaceutical and medical products development and marketing company dedicated to advancing women's health. He was for many years chairman of the board of GynoPharma Inc., the pharmaceutical company that introduced and marketed the copper T 380A intrauterine device in the United States. Mr. Mackenzie has served as president in several arms of the Johnson & Johnson family of companies, including Ortho Pharmaceutical. Mr. Mackenzie is a member of the Scientific Advisory Board of the Consortium for Industrial Collaboration in Contraceptive Research.

The expansion of the Board strengthens the Insitute's volunteer leadership. The addition of Dr. Andrews and Mr. Mackenzie will help the Institute sharpen its programmatic focus and build its resource development program.  up_arrow.gif (847 bytes)


Our Annual Report: Continuing, Expanded, and New Programs Mark 1996

Many aspects of women's health care continue to draw increased attention from consumers, health care providers, and policy makers. In the last year, the public's attention has been drawn to various ethical issues in assisted reproduction, the health care needs of the growing number of women in the military, and increasingly to concerns about the impact of managed care on the health care of women.. Never has the need been greater for accurate and timely information to inform public discourse on women's access to and use of health care services. The Jacobs Institute of Women's Health plays an important role in this process by fostering research, disseminating information, and analyzing trends in women's health care. The Institute continues to grow and expand its programs, projects, and publications thanks to the support of its many generous members and donors.

Most significant among the Institute's new programs this year is its 2-year initiative, "Women's Health and Managed Care: Defining the Issues and Monitoring the Trends," which will for the first time assess information about the ways in which managed care may improve or hinder women's ability to obtain timely and appropriate health services. The first in a series of background papers looks at the clinical and provider impacts of providing comprehensive primary care for women in managed care settings, and a symposium in January will bring together a panel of experts to consider the implications of those impacts. Project support was provided by The Commonwealth Fund, the Henry J. Kaiser Family Foundation, Wyeth-Ayerst Laboratories, and Eli Lilly & Company. The initiative is guided by an external advisory committee, chaired by Carol S. Weisman, PhD. Julie Gonen, who joined the Institute this year as Research Associate, serves as primary staff.

Women's Health Issues, the Institute's official, peer-reviewed journal edited by Warren H. Pearse, MD, FACOG, and Associate Editor Carol S. Weisman, PhD, expanded from quarterly to bimonthly publication. The new schedule provides increased editorial pages and increased value to members. Special issues in 1996 included the proceedings from the Jacobs Institute's "Women's Health and Managed Care" conference, the National Advisory Board of Ethics and Reproduction conference on ethics in reproduction, and the United States Uniformed Health Services conference on health challenges facing women in the military, as well as many other ground-breaking and informative articles and papers.

The Institute's Washington Breakfast Seminar series was generously supported again in 1996 by The Monsanto Company and by new sponsor G.D. Searle. Topics included living well despite chronic illness or disability, women and stress, exercise and women's health, and the Women's Health Initiative at the National Institutes of Health. Attendance averages 100 people per breakfast, and audiotapes and resource packets from each briefing are available.

The third Mammography Attitudes and Usage Survey (MAUS III) was completed with support from The American Cancer Society. The results of the nationwide telephone interviews with nearly 1,000 women were published in the July/August 1996 Women's Health Issues.

Last January, Barbara A. Bartman, MD, MPH, of the University of Maryland was named the second Jacobs Institute Ortho Pharmaceutical Scholar in Women's Health for her project on racial differences in estrogen use among middle-age and older women. The $30,000 annual award was established with the generous support of the Ortho Pharmaceutical Company.

Also announced last January was the $500 award in the manuscript competition on women and exercise. Diane Gill, PhD, MS, and colleague KathleenWilliams, PhD, MS, won for their study "Physical Activity and Psychological Well-Being in Older Women." For next year, the award has been increased to $1,000 and is supported by the Jacobs Institute Leadership Fund.

Founded by the past presidents of ACOG, under the direction of Richard S. "Pete" Hollis, MD, and Harry S. Jonas, MD, the 1996 Leadership Fund raised over $6,500 in support of this important competition, focusing this year on developing new models of primary women's health care. The winner of the first annual Leadership Award will be announced in January 1997.

The Resource Development Committee, under the guidance of Board Secretary-Treasurer C.E. Gibbs, MD, embarked in October on its first Annual Fund Campaign. Because membership dues alone do not cover the cost of programs, projects, and publications, the Board of Governors solicited the Institute's many constituencies for help to ensure the Institute's continued financial stability. The Board illustrated its commitment through its members' generous gifts to the Board Annual Appeal, which raised over $9,000 in unrestricted support. Three new members joined the Board: Mary K. Chung, executive director, National Asian Women's Health Organization, San Francisco, CA; Deborah I. Dingell, president, General Motors Foundation; and Constance M. Ryan, president, Streck Laboratories. The current roster of 10 physicians, lawyers, nurses, researchers, and industry and organizational professionals with an interest in women's health reflects the Institute's diverse constituencies.

The Jacobs Institute's membership also reflects that diversity. Members in 1997 can receive the managed care initiative background papers, in addition to the Institute's regular publications, for the low price of only $55 per year; over 60% off the price of individual issues of Women's Health Issues. The Institute is here to serve members in their work and interest in women's health, but its efforts are made possible only through the contributions of its supporters. This support allowed the Institute to continue to serve as a premier source of accurate and relevant information about women's health for as large and as diverse an audience as possible this year. The coming year promises new challenges and further growth. To renew your membership, or become a member of the Institute, please use the form on page 3.

The Institute would like to thank the corporations, foundations, organizations, and individuals listed on pages 4 and 5 who supported this mission of advancing the knowledge, practice, and understanding of health care for all women at the intersection of the social and the medical sciences. Please take a moment to read over the list and acknowledge any friends or colleagues you may see. It is their support that will secure the future of the Institute into 1997 and beyond.  up_arrow.gif (847 bytes)