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Biomedical subjects

A MacLennan

Publications and source records attributed to A MacLennan.

At least 19 recordsLinked to original sources
PubMed2001

Oral oestrogen replacement therapy versus placebo for hot flushes.

BACKGROUND: Hot flushes and night sweats are common symptoms experienced by menopausal women. Hormone replacement therapy (HRT), containing oestrogens alone or oestrogens together with progestogens in a cyclic or continuous regimen, is often recommended for their alleviation. OBJECTIVES: To examine the effect of oral HRT compared to placebo on these vasomotor symptoms and the risk of early onset side-effects. SEARCH STRATEGY: As developed by the Menstrual Disorders Group and Subfertility group of the Cochrane Collaboration. SELECTION CRITERIA: Double-blind, randomised, placebo-controlled trials of oral HRT therapy for at least three months duration. DATA COLLECTION AND ANALYSIS: Study quality and outcome data were assessed independently. Random effects models were considered appropriate due to the variety of trial methodologies. The meta-analyses were explored for sensitivity to trial quality and therapy duration. Symptom frequency and severity were assessed separately, together with withdrawals and side-effects. Frequency data were analysed using the Weighted Mean Difference (WMD) between treatment and placebo outcomes. For severity data, odds ratios were estimated from the proportional odds model. From 99 references originally identified, 21 trials meeting the selection criteria were included in the review. Study participants totalled 2,511. Trial duration ranged from three months to three years. MAIN RESULTS: There was a significant reduction in the weekly hot flush frequency for HRT compared to placebo (WMD -17.46, 95% CI -24.72, -10.21). This was equivalent to a 77% reduction in frequency (95% CI 58.2, 87.5) for HRT relative to placebo. Symptom severity was also significantly reduced compared to placebo (OR 0.13, 95% CI 0.08, 0.22). Withdrawal for lack of efficacy occurred significantly more often on placebo therapy (OR 17.25, 95% CI 8.23, 36.15). Withdrawal for adverse events, commonly breast tenderness, oedema, joint pain and psychological symptoms, was not significantly increased for HRT therapy (OR 1.38, 95% CI 0.87, 2.21). In women who were randomised to placebo treatment, a 50.8% (95% CI 41.7, 58.5) reduction in hot flushes was observed between baseline and end of study. REVIEWER'S CONCLUSIONS: Oral HRT is highly effective in alleviating hot flushes and night sweats. Therapies purported to reduce such symptoms must be assessed in blinded trials against a placebo or a validated therapy. Withdrawals due to side-effects were only marginally increased in the HRT groups despite the inability to tailor HRT in these fixed dose trials. Comparisons of hormonal doses, product types or regimens require analysis of trials with these specific "within study" comparisons.

Administration, Oral↗
PubMed2001

Immersion in water in the first stage of labor: a randomized controlled trial.

BACKGROUND: Current forms of analgesia often have significant side effects for women in labor. Bathing in warm water during labor has been reported to increase a woman's comfort level and cause a reduction in painful contractions. The objective of this trial was to compare immersion in warm water during labor with traditional pain management for a range of clinical and psychological outcomes. METHODS: A prospective randomized controlled trial of 274 pregnant women, who were free from medical and obstetric complications and expecting a singleton pregnancy at term, was conducted at the Women's and Children's Hospital, a maternity tertiary referral center in Adelaide, South Australia. Women in labor were randomized to an experimental group who received immersion in a bath or to a nonbath group who received routine care. Pharmacological pain relief was the primary outcome that was measured, and secondary outcomes included maternal and neonatal clinical outcomes, factors relating to maternal and neonatal infectious morbidity, psychological outcomes, and satisfaction with care. RESULTS: The use of pharmacological analgesia was similar for both the experimental and control groups; 85 and 77 percent, respectively, used major analgesia. No statistical differences were observed in the proportion of women requiring induction and augmentation of labor or in rates of perineal trauma, length of labor, mode of delivery, or frequency of cardiotocographic trace abnormalities. Neonatal outcomes (birthweight, Apgar score, nursery care, meconium-stained liquor, cord pH estimations) revealed no statistically significant differences. Infants of bath group women required significantly more resuscitation than routine group women. Routine group women rated their overall experience of childbirth more positively than bath group women. Psychological outcomes, such as satisfaction with care or postnatal distress, were the same for both groups. CONCLUSION: Bathing in labor confers no clear benefits for the laboring woman but may contribute to adverse effects in the neonate.

Analgesia, Obstetrical↗
PubMed2001

Oral estrogen replacement therapy versus placebo for hot flushes: a systematic review.

OBJECTIVE: To examine the effectiveness of oral hormone replacement therapy (HRT) with regard to hot flushes and night sweats, which are vasomotor symptoms commonly experienced by menopausal women. METHODS: Double-blind, randomized, placebo-controlled trials of oral HRT for at least 3 months' duration and reporting vasomotor outcomes were identified using a search strategy developed by the Menstrual Disorders Group and Subfertility Group of the Cochrane Collaboration. Twenty-one trials meeting the selection criteria were included in the review. Study participants totalled 2511. Trial duration ranged from 3 months to 3 years. RESULTS: There was a significant reduction in the weekly hot flush frequency for HRT compared with placebo (weighted mean difference -17.46, 95% confidence interval (CI) -24.72 to -10.21). This was equivalent to a 77% reduction in frequency (95% CI 58.2-87.5) for HRT relative to placebo. Symptom severity was also significantly reduced compared with placebo (odds ratio (OR) 0.13, 95% CI 0.08-0.22). Withdrawal for lack of efficacy occurred significantly more often with placebo therapy (OR 17.25, 95% CI 8.23-36.15). Withdrawal for adverse events, commonly breast tenderness, edema, joint pain and psychological symptoms, was not significantly increased for HRT (OR 1.38, 95% CI 0.87-2.21). In women who were randomized to placebo treatment, a 50.8% (95% CI 41.7-58.5) reduction in hot flushes was observed between baseline and the end of the study. CONCLUSIONS: Oral HRT is highly effective in alleviating hot flushes and night sweats. Owing to the marked effect seen with placebo treatment, it is important to compare therapies purported to alleviate vasomotor symptoms with a placebo or an established therapy.

Administration, Oral↗
PubMed2001

Men and osteoporosis.

BACKGROUND: While strict criteria have been developed for defining osteoporosis in women (bone mineral density measurements more than 2.5 standard deviations below the mean for young adult normal women, i.e. t-score value < -2.5), there still remains a controversy regarding the definition in men. Spinal fractures occur in 5% and hip fractures in 6% of men older than 50 years. There are significant differences between men and women with respect to the pathogenesis of osteoporosis, underlying medical conditions and postfracture sequelae. OBJECTIVE: To provide an overview of the pathogenesis, diagnosis and prevention of osteoporosis in men. DISCUSSION: Osteoporosis is increasingly recognised. Data from the Dubbo Osteoporosis Epidemiology Study suggests that 30% of men in Australia aged over 60 years will suffer from an osteoporotic fracture. It is estimated that 30-60% of men presenting with spinal fractures will have another illness contributing to their bone loss. Osteoporotic fractures in men are associated with higher morbidity and mortality than in women. Lifestyle changes together with daily calcium supplementation should be implemented and vitamin D3 should be considered in men with osteopenia.

Bone Density↗
PubMed2001

Guidelines for treatment of osteoporosis in men.

BACKGROUND: Osteoporosis is associated with significant morbidity and mortality in men. Published randomised controlled trials assessing the benefits of therapy in men with osteoporosis are limited, but those available need to be used to develop management guidelines. OBJECTIVE: To present evidence based guidelines for the treatment of osteoporosis in men. DISCUSSION: It is estimated that 30-60% of men presenting with spinal fractures have another illness contributing to their bone disease. Therefore assessment and treatment of coexisting medical conditions is a vital part of management of osteoporosis. While primary prevention of fractures remains crucial, treatment to ensure further fractures do not occur is equally important. Alendronate is the treatment of choice for men with osteoporosis and fractures, with cyclical etidronate an appropriate alternative and testosterone replacement therapy is indicated in hypogonadal men presenting with osteoporosis.

Calcitriol↗
PubMed2001

Corticosteroid induced osteoporosis. Guidelines for treatment.

BACKGROUND: Last year, Australian Family Physician published 'Guidelines for Management of Postmenopausal Osteoporosis', which were developed by Osteoporosis Australia. Recently, significant advances in our understanding of the treatment of corticosteroid osteoporosis have occurred. OBJECTIVE: The following guidelines, also developed by Osteoporosis Australia, and supported by the National Asthma Campaign, are to help general practitioners identify those patients at risk of this problem and to provide information about current treatment strategies. DISCUSSION: Corticosteroids are widely used and effective agents for the control of many inflammatory diseases. Corticosteroid osteoporosis is a common problem associated with the long term high dose use of these medications.

Adrenal Cortex Hormones↗
PubMed2000

Postmenopausal osteoporosis treatment guidelines.

BACKGROUND: Several years ago, Osteoporosis Australia published Guidelines for the management of osteoporosis. Since then significant advances in our understanding of the treatment of osteoporosis have been published. The importance of this is heightened as early diagnosis is now possible with precise methods of bone density measurement. OBJECTIVE: This article presents updated guidelines developed on behalf of Osteoporosis Australia for the treatment of postmenopausal osteoporosis to help general practitioners identify those women at risk and to review current treatment strategies. DISCUSSION: Osteoporosis and its associated problems are major health concerns in Australia, especially with an ageing population. While important principles of management are still considered to be maximising peak bone mass and prevention of postmenopausal bone loss by oestrogen therapy, new clinical trial data about drugs such as raloxifene and the bisphosphonates have recently become available and the relative role of various agents is gradually becoming clearer.

Accidental Falls↗
PubMed1997

Osteoporosis. Menopause and beyond.

Preventive strategies for osteoporosis must be integrated with the total health care of the menopausal woman. After attention to lifestyle factors all women should be fully informed and assessed for indications for hormone replacement therapy (HRT). Hormone replacement therapy is the optimal strategy for both the prevention and the treatment of osteoporosis.

Aged↗
PubMed1996

Novel asymmetric photosensitizers: an in vitro study.

A series of compounds based on an asymmetrical protoporphyrin molecule have been examined. The paired groups of sensitizers differed in terms of the presence or absence of a permanent positive charge, in the alkyl side chain length and in having either a primary or secondary amine substituent. The effects of these variables on drug uptake, partition coefficient and photodynamic cell kill were tested. Drug uptake and partition coefficient were shown to be correlated. Differences in gross uptake were found within paired groups of sensitizers although cell-associated uptake alone did not correlate with clonogenic cell survival. Of the compounds tested it was the sensitizers with alkyl side chains, rather than the permanently positively charged compounds, which resulted in the greatest degree of clonogenic cell kill.

Cell Survival↗
PubMed1993

Continuous low-dose oestrogen and progestogen hormone replacement therapy: a randomised trial.

OBJECTIVE: To establish the efficacy and acceptability of combined continuous low-dose oestrogen and low-dose progestogen therapy, to determine whether any of three commercially available progestogens had any advantages or disadvantages in these circumstances and whether use of the lowest clinically effective oestrogen dose affected other outcomes being measured. DESIGN: A 12-month, prospective, open label, single centre, randomised trial. PATIENTS AND METHODS: Seventy-five postmenopausal women already receiving hormone replacement therapy in the form of conjugated equine oestrogens (CEE) (0.625 mg daily) and cyclical medroxyprogesterone acetate (10 mg) and experiencing withdrawal bleeding were changed to a continuous daily regimen of 0.3 mg CEE and a random allocation of one of three low-dose progestogens (medroxyprogesterone acetate 2.5 mg, levonorgestrel 30 micrograms or norethisterone 350 micrograms). Return to a dose of 0.625 mg CEE was permitted if required to control menopausal symptoms with separate analysis of this group when appropriate. OUTCOMES MEASURED: Menopausal symptom score, clinical bleeding pattern, endometrial biopsy results, forearm bone density and content, serum lipids and side effects. RESULTS: Fifteen women withdrew from the trial, five because of irregular bleeding. In the remainder, amenorrhoea was achieved in 53% by three months, in 67% by six months and in 93% by 12 months. Endometrial biopsy showed atrophic endometrium by 12 months in all but one patient, in whom minimal proliferative activity was seen. Twenty-seven women chose to return to a dose of 0.625 mg CEE. In all groups, final control of menopausal symptoms improved. All regimens were bone sparing and the lipid profile was unchanged. Minimal side effects were experienced by the patients. There was little difference in outcome between the three progestogens except that norethisterone therapy was associated with a greater prevalence of amenorrhoea at six months than was seen in the levonorgestrel and medroxyprogesterone acetate groups. CONCLUSIONS: These low-dose continuous oestrogen and progestogen regimens appear an appropriate option for the postmenopausal woman wishing to eliminate withdrawal bleeding and reduce both hormonal side effects and menopausal symptoms. The long term benefits of these regimens with regard to the prevention of osteoporotic fractures, cardiovascular disease and endometrial cancer need to be further assessed over time.

Bone Density↗
PubMed1993

The prevalence of hysterectomy in South Australia.

OBJECTIVE: To ascertain the prevalence of hysterectomy in the South Australian community. DESIGN AND SETTING: Data were collected as part of the South Australian Health Omnibus Survey which involved a self-weighting, multistage, systematic, representative area cluster sample of 4608 households in metropolitan and country South Australia. One thousand and forty-seven women over the age of 40 were personally interviewed by trained data collectors. OUTCOME MEASURES: Demographic characteristics, selected medical descriptive variables and the prevalence of hysterectomy. RESULTS: 27.9% of the respondents over 40 had undergone a hysterectomy. The prevalence rose from 18.9% in the 40-44 age group to 31.4% in women aged between 55 and 64 years. There were no statistically significant associations with country of birth, educational attainment or income. Significantly more women who had undergone a hysterectomy were current or past users of oestrogen replacement therapy and they also visited their general practitioner more frequently. Elevated body mass index and the prevalence of diabetes also approached statistical significance. CONCLUSION: At current rates nearly a third of South Australian women will have a hysterectomy during their lifetime.

Adult↗
PubMed1993

The prevalence of oestrogen replacement therapy in South Australia.

OBJECTIVE: To ascertain the prevalence of the use of oestrogen replacement therapy in the South Australian community. DESIGN AND SETTING. Data was collected as part of the South Australian Health Omnibus Survey which involved a clustered, self-weighting, multi-stage, systematic representative area sample of 4608 households in metropolitan and country South Australia. One-thousand and forty-seven women over the age of 40 were personally interviewed by trained data collectors. OUTCOME MEASURES: Demographic characteristics, prevalence of current or past oestrogen use, type of oestrogen used, period of use and reasons for using, stopping or never using therapy. RESULTS: Current use of oestrogen replacement therapy is 13.6% and ever use was 24.3%. The highest prevalence of use was in the age group 45-54 years. Use of oestrogen replacement therapy associated with women born in the UK or Ireland, middle income earners, intermediate education, recent visits to a general practitioner, a current relationship, previous hysterectomy and smoking. The commonest period of use for current users was 1-5 years and the longest 30 years. In contrast many past users had stopped within 6 months, usually because of side effects. The commonest reasons for oestrogen use were to alleviate symptoms, 'following hysterectomy' and to prevent osteoporosis. Only 4.3% took oestrogen to reduce the risk of heart attack or stroke. Reasons for not taking therapy were often due to the woman being premenopausal, having no symptoms or ignorance of the therapy. CONCLUSION: Nearly one quarter of women over the age of 40 have used oestrogen replacement therapy. In general there is a perception only of the short term benefits amongst the current users and there is misinformation amongst the non-users. Therapy is often stopped after a very short time because of minor side effects.

Adult↗