Mechanism of chlorpropamide antidiuresis in diabetes insipidus.
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Adult↗
Biomedical subjects
B Ettinger
Publications and source records attributed to B Ettinger.
Excretion of triamterene and its metabolite in triamterene stone patients.
As triamterene users may form kidney stones containing deposits of triamterene and its metabolites, we studied urinary excretion to detect any altered metabolism of triamterene in these patients. We found no significant differences between patients and matched control subjects in total recovery, hourly excretion patterns, and concentrations of triamterene and its sulfate metabolite. Approximately half of all subjects tested revealed urine concentrations of the sulfate metabolite that exceeded the observed solubility limit.
Adult↗
Quantitative computed tomography for spinal mineral assessment: current status.
Quantitative CT (QCT) is an established method for the noninvasive assessment of bone mineral content in the vertebral spongiosum and other anatomic locations. The potential strengths of QCT relative to dual photon absorptiometry (DPA) are its capability for precise three-dimensional anatomic localization providing a direct density measurement and its capability for spatial separation of highly responsive cancellous bone from less responsive cortical bone. The extraction of this quantitative information from the CT image, however, requires sophisticated calibration and positioning techniques and careful technical monitoring.
Adult↗
Diagnosis of symptomatic postmenopausal women by traditional Chinese medicine practitioners.
OBJECTIVE: To learn more about the way that practitioners of traditional Chinese medicine (TCM) diagnose women who have menopausal symptoms. DESIGN: We assembled a cohort of 23 postmenopausal women who had hot flushes and were otherwise healthy. Each woman was examined independently by nine practitioners of TCM on the same day. Examination consisted of medical history and physical examination. Diagnoses were recorded and counted. RESULTS: The most frequent diagnosis made by the practitioners of TCM was kidney yin deficiency, which was the diagnosis made after 168 of 207 visits (81%); 23 women seen by nine TCM practitioners. Practitioners showed good agreement regarding presence of kidney yin deficiency: in 12 women (52%), this diagnosis was made by eight of nine practitioners; in 16 women (70%), seven of nine practitioners made this diagnosis; and in all 23 women (100%), at least five of nine practitioners made this diagnosis. CONCLUSIONS: Practitioners of TCM who diagnose postmenopausal women with vasomotor symptoms are likely to make a diagnosis that includes kidney yin deficiency.
Adult↗
The North American Menopause Society 1998 menopause survey: Part II. Counseling about hormone replacement therapy: association with socioeconomic status and access to medical care.
OBJECTIVE: The purpose of this study was to examine two predictors of women's obtaining hormone replacement therapy (HRT) counseling: socioeconomic status and access to health care. DESIGN: During May-July 1998, by means of random-digit telephone dialing, 749 postmenopausal women who were living in the United States and aged 50-65 years were interviewed. On average, they were 56.8 years and 11.8 years postmenopausal. Most (86.0%) were Caucasian, and their median annual income was approximately $40,000. Nearly all (90.8%) had medical insurance coverage; 47.6% of those insured received care from a managed care organization. Access to medical care was evidenced by 92.3% being under the care of a primary care physician, 92.3% ever having had a mammogram, 96.9% ever having had a pelvic examination, and 91.1% ever having had a serum cholesterol determination. RESULTS: Of these 749 women, 75.4% reported that they had received counseling about post-menopausal HRT from healthcare providers. Both level of education and level of income were associated with an increased likelihood that HRT counseling would be obtained. Having a personal physician, and particularly receiving care from a gynecologist, increased the likelihood that counseling would be available. There were no substantial differences in counseling frequency between women in managed care plans and those having other types of health insurance. In a multivariate model, adjusted odds ratios for receiving HRT counseling were 2.9 (95% confidence interval [CI] = 1.7-4.8) for having an annual income of $50,000 or more versus less than $30,000, 2.8 (95% CI = 1.7-4.5) for receiving care from a gynecologist versus other primary care physician, 1.9 (95% CI = 1.1-3.2) for being Caucasian versus not, and 1.5 (95% CI 1.0-2.2) for having a hysterectomy versus not. CONCLUSIONS: Three quarters of a sample of US postmenopausal women aged 50-65 years reported that they had been counseled about HRT. However, women of lowest socioeconomic status and those who did not have a primary care physician were least likely to have received counseling. No differences were observed in prevalence of counseling between women in managed care settings and those with other types of health insurance. The findings suggest that special efforts are necessary to provide menopause education and counseling to underserved women.
Counseling↗
Long-term compliance with estrogen replacement therapy in surgical postmenopausal women: benefits to bone and analysis of factors associated with discontinuation.
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Confounding Factors, Epidemiologic↗
Postmenopausal hormonal support: discontinuation of raloxifene versus estrogen.
OBJECTIVE: To determine possible differences in continuation among women initiating treatment with the selective estrogen receptor modulator raloxifene, versus those initiating treatment with estrogen-containing regimens. DESIGN: A pharmacy prescription database search for refill patterns. The study subjects were members of Kaiser Foundation Health Plan, a large health maintenance organization; 1,394 women age >or=60 years who filled index prescriptions for either raloxifene (n = 331) or systemic estrogens (n = 1,063) between April 1998 and March 1999. The main outcome measure was discontinuation based on prescription refill patterns through December 2000. RESULTS: At 24 months, the probabilities of discontinuing were 56% for women starting raloxifene compared to 72% for women starting estrogens. The likelihood of discontinuation was significantly less among women starting raloxifene than among those starting estrogen (hazard ratio = 0.75; 95% confidence interval = 0.64-0.88). Adjustments for age and prescriber specialty did not affect the risk. CONCLUSIONS: We conclude that discontinuation of estrogen by women well beyond the age of menopause is high; more than two-thirds discontinue within 2 years of starting. Women starting therapy with raloxifene are 25% percent less likely to discontinue their medication than those starting estrogen, providing some promise that long-term benefits of raloxifene may be more easily achieved than those of estrogen.
Aged↗
Reversal by medical treatment of endometrial hyperplasia caused by estrogen replacement therapy.
OBJECTIVE: Endometrial hyperplasia, an entity considered a precursor to endometrial carcinoma, frequently develops in women receiving unopposed estrogens. Progestins used concomitantly with estrogens can largely prevent endometrial hyperplasia and carcinoma. However, the ability of progestins to reverse endometrial hyperplasia induced by estrogens is less well recognized. The purpose of this study was to assess the medical reversal rate of endometrial hyperplasia that develops in women receiving unopposed estrogen replacement therapy (ERT). DESIGN: Review of recent literature (1990-2000). RESULTS: Based on four large series, more than 90% of endometrial hyperplasia caused by ERT can be reversed by medical treatment. Discontinuation of estrogen and oral administration of 10 mg/day of medroxyprogesterone acetate continuously for 6 weeks or cyclically for 3 months (2 weeks of each month) are the two regimens most widely used. Other progestins also have been shown to be effective. CONCLUSIONS: Progestins are highly successful in reversing endometrial hyperplasia caused by ERT.
Clinical Trials as Topic↗
Differences in calcium metabolism between black and white men and women.
To determine whether environmental factors influence racial differences in calcium metabolism, the authors evaluated the influence of three factors (season, length of sunlight exposure, and diet) on calciotropic hormones, renal calcium excretion, and markers of bone turnover in an ambulatory population aged 25-36 years. Included were 109 black men, 114 white men, 95 black women, and 84 white women. Compared with white subjects, black subjects of both genders showed lower levels of serum 25-hydroxyvitamin D (25-OHD) and higher levels of serum 1,25-dihydroxyvitamin D [1,25(OH)(2)D]. The mean winter levels of 25-OHD were 19 to 29% lower than the summer levels in all groups. The urinary calcium excretion was 26% lower in black men than in white men and was 36% lower in black women than in white women. The parathyroid hormone levels were 29% higher in black women than in white women, but no statistically significant racial differences in parathyroid hormone levels were seen in men. Bone turnover markers (serum osteocalcin, bone-specific alkaline phosphatase, urinary pyridinoline cross-link excretion) did not show consistent racial differences. Racial and gender differences in calcium excretion did not significantly correlate with differences in lifestyle or with levels of the calciotropic hormones. Environmental factors such as diet and sunlight exposure do not appear to influence racial differences in the levels of the calciotropic hormones or renal calcium excretion.
Adult↗
Health-related quality of life in economic evaluations for osteoporosis: whose values should we use?
OBJECTIVE: To determine whether the source of preference scores has an impact on the cost-effectiveness of osteoporosis interventions. METHODS: Three groups of subjects aged > or =50 years--199 women without fractures and 183 women with osteoporotic fractures-were studied at two major medical centers. Medical history and comorbidity data were obtained from review of medical records. Health status was measured using the Medical Outcomes Study SF-36. Two preference-classification systems (i.e., quality of well-being scores estimated from SF-36 subscales and the Health Utilities Index) were also used. Preferences for current health and for hypothetical health states were assessed using a time tradeoff and implemented with a computer-based utility instrument (U-Titer). Wilcoxon's rank-sum and signed-rank tests were used to compare preferences for current health among women with osteoporotic fractures with 1) directly assessed preferences for osteoporosis health states delineated by outcome descriptions and 2) preference scores obtained from the preference-classification systems. The potential impact of the source of the preference scores was estimated using a Markov state-transition model. RESULTS: The preference scores for hypothetical osteoporosis health states of the non-fracture subjects were approximately 50% lower than those of the women who had actually experienced the health state. Differences of this magnitude would change the estimated cost-effectiveness of a 15-year intervention (which for approximately $280 per year prevents hip fracture about as well as hormone-replacement therapy) from $25,000 per QALY gained when non-fracture subjects' preferences were used to $94,000 per QALY gained when fracture subjects' preferences were used. Preferences estimated using the Health Utilities Index and those directly measured in fracture subjects using the time tradeoff did not differ significantly. CONCLUSIONS: The Health Utilities Index preference-classification system may provide an efficient and inexpensive alternative to direct utility assessment in this patient group. However, there are important differences in the valuation of health states by women who have experienced osteoporotic fractures compared with women who have not. Cost-utility analyses based solely on fracture patients' preferences for osteoporotic health states may undervalue prevention.
Aged↗
Estrogen supplements in menopause.
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Aged↗
Use of low-dosage 17 beta-estradiol for the prevention of osteoporosis.
Osteoporosis is a major health problem in postmenopausal women. Although estrogen replacement in adequate dosage can slow or even prevent bone loss, only a small percentage of postmenopausal women receive such therapy; many who do fail to comply with the prescribed regimen because of the fear of cancer and the occurrence of withdrawal bleeding, irregular bleeding, or both, and other side effects. Use of lower estrogen dosages has been suggested as a means of improving compliance and enhancing safety without compromising efficacy. Compared with standard therapy, low-dosage estrogen may minimize the increased risk of both endometrial hyperplasia and endometrial cancer. Most women find low-dosage estrogen more acceptable than higher dosages because they experience less bleeding and are more likely to become amenorrheic. Low-dosage estrogen along with sufficient calcium intake effectively maintains bone density in postmenopausal women. In the recent study of unopposed estrogen therapy described here, micronized 17 beta-estradiol in the range of 0.5 to 2.0 mg, given with dietary and supplemental calcium to ensure a minimum of 1500 mg/day, effectively maintained spinal trabecular bone density. None of the women who received the lowest dosage of 0.5 mg/day micronized 17 beta-estradiol experienced vaginal bleeding, and after 18 months the incidence of endometrial hyperplasia in this dosage group (17%) tended to be lower than those in the 1.0-mg and 2.0-mg dosage groups (29% and 22%, respectively). There was a trend toward fewer vasomotor symptoms among women who received the 0.5-mg and 1.0-mg dosages of micronized 17 beta-estradiol compared with those who received placebo. The 2.0-mg dosage group had a significantly lower incidence of vasomotor symptoms (P = 0.02) than the placebo group. Micronized 17 beta-estradiol (0.5 mg/day) with an adequate intake of dietary or supplementary calcium (1500 mg/day) is an appropriate choice for postmenopausal women in whom low-dosage estrogen therapy is indicated. This regimen, while proving efficacious in the prevention of bone loss, may be especially helpful for women who wish to minimize the bleeding that accompanies usual-dosage hormone-replacement regimens and should enhance compliance with the prescribed therapy.
Calcium, Dietary↗