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Biomedical subjects

B G Wren

Publications and source records attributed to B G Wren.

At least 37 records · Page 2Linked to original sources
PubMed1992

A cost-effectiveness analysis of hormone replacement therapy in the menopause.

OBJECTIVE: To evaluate the cost-effectiveness of hormone replacement therapy in the menopause with particular reference to osteoporotic fracture and myocardial infarction. DESIGN: The multiple-decrement form of the life table was the mathematical model used to follow women of age 50 through their lifetime under the "no hormone replacement" and "hormone replacement" assumptions. Standard demographic and health economic techniques were used to calculate the corresponding lifetime differences in direct health care costs (net costs in dollars) and health effects ("net effectiveness" in terms of life expectancy and quality, in "quality-adjusted life-years"). This was then expressed as a cost-effectiveness ratio or the cost ($) per quality-adjusted life-year (QALY) for each of the chosen hormone replacement regimens. SETTING AND PATIENTS: All women of age 50 in New South Wales, Australia (n = 27,021). RESULTS: The analysis showed that the lifetime net increments in direct medical care costs were largely contributed by hormone drug and consultation costs. Hormone replacement was associated with increased quality-adjusted life expectancy, a large percentage of which was attributed to a relief of menopausal symptoms. Cost-effectiveness ratios ranged from under 10,000 to over a million dollars per QALY. Factors associated with improved cost-effectiveness were prolonged treatment duration, the presence of menopausal symptoms, minimum progestogen side effects (in the case of oestrogen with progestogen regimens), oestrogen use after hysterectomy and the inclusion of cardiac benefits in addition to fracture prevention. CONCLUSIONS: Hormone replacement therapy for symptomatic women is cost-effective when factors that enhance its efficiency are considered. Short-term treatment of asymptomatic women for prevention of osteoporotic fractures and myocardial infarction is an inefficient use of health resources. Cost-effectiveness of hormone replacement in asymptomatic women is dependent on the magnitude of cardiac benefits associated with hormone use and the treatment duration.

Cost-Benefit Analysis↗
PubMed1992

HRT and the cardiovascular system.

Oestrogen is cardioprotective for women. Not only does it have a beneficial effect on the circulating blood lipid fractions, but it is now established that oestrogen has a positive influence in preventing the deposit of cholesterol in the arterial endothelium. It also induces vasodilation, increases peripheral blood flow and leads to a fall in blood pressure. The use of oestrogen to reduce cardiovascular disease far outweighs any potential adverse changes.

Arteriosclerosis↗
PubMed1991

Compliance with hormonal replacement therapy.

One hundred post-menopausal women given HRT were reviewed 12 months after their first visit to determine their compliance with treatment. Sixty-one percent continued to take the therapy while 27% ceased. Most often the reason for ceasing HRT was return of bleeding but a number of women expressed fear of developing cancer or other long term complications.

Attitude to Health↗
PubMed1986

A double-blind trial with clonidine and a placebo to treat hot flushes.

A double-blind crossover study that compared clonidine and a placebo, which were administered to 19 postmenopausal women who were suffering from hot flushes, failed to demonstrate any statistical reduction in the number of hot flushes. Therefore, clonidine is not recommended as a treatment drug for this symptom.

Clinical Trials as Topic↗
PubMed1986

Limitations of forearm bone densitometry as an index of vertebral or femoral neck osteopenia.

Osteoporosis of the spine and femoral neck is a major problem in aging populations, but detection prior to a fracture remains a challenge. Forearm bone mineral content has been advocated as a useful screening test in this situation. We have examined the correlation between distal forearm bone mineral content, by single photon absorptiometry, and lumbar vertebral and femoral neck bone mineral density, by dual photon absorptiometry. Eighty women aged 20 to 76 years were studied and significant correlations (p less than .001) were found between the measurements on the forearm and at the two axial sites (r = 0.66 and 0.69, respectively). However, forearm bone mineral content was an unreliable predictor of axial bone mineral density. For prediction of lumbar spine osteopenia with a sensitivity of 88%, the false positive rate was 91%. Conversely, to achieve a specificity of 82%, the false negative rate was 65%. Similarly, for prediction of femoral neck osteopenia at a sensitivity of 92%, the false positive rate was 87%, and at a specificity of 90%, the false negative rate was 33%. These data demonstrate that forearm bone densitometry cannot be used as a screening procedure for osteopenia of the lumbar spine or femoral neck.

Adult↗
PubMed1983

The effect of type and dose of oestrogen on the blood pressure of post-menopausal women.

Evidence from two groups of post-menopausal women who were randomly allocated to be treated with either conjugated equine oestrogens or piperazine oestrone sulphate demonstrates that the two oestrogens produce markedly different effects on blood pressure. The conjugated equine oestrogens appear to produce no significant change in either systolic or diastolic blood pressure whereas piperazine oestrone sulphate produced a significant fall in both systolic and diastolic blood pressure. This finding is discussed in relationship to the known causes for a change in cardiovascular response to oestrogen and several hypotheses are put forward.

Antihypertensive Agents↗
PubMed1982

Differential clinical response to oestrogens after menopause.

An analysis of vasomotor, psychological, and physical symptoms of 136 women who were receiving piperazine oestrone sulphate (Ogen) and conjugated equine oestrogens (Premarin) after menopause has shown differences in responses which can be explained only if it is accepted that the two oestrogenic compounds have differing effects on various parts of the body. Premarin (0.625 mg) was found to be more potent at inducing withdrawal bleeding than Ogen (1.25 mg), whereas Ogen was more effective than Premarin in alleviating hot flushes and some psychological symptoms. A hypothesis involving metabolism of oestrone to the catecholamine, 2-hydroxyoestrone, is postulated, which explains why these differences occur. It is further suggested that better selection of oestrogens to suit particular postmenopausal symptoms should be encouraged when prescribing oestrogen for women after menopause.

Estrogens↗
PubMed1982

Induction of estrogen sulfotransferase in the human endometrium by progesterone in organ culture.

It has been established that progesterone will induce 17 beta-estradiol (E2) dehydrogenase in the human endometrium. Whether it plays a similar role in the induction of estrogen sulfotransferase is not known, although this is likely, since estrone sulfate is the main metabolite of E2 when incubated with secretory, but not proliferative, human endometrium. We have now examined the influence of progesterone on both enzymes in endometrial tissue in organ culture. Estrogen sulfotransferase activity was not detectable in the cytosol of proliferative tissue when cultured in the absence of hormone, but was induced by culture in the presence of progesterone to a value (mean +/- SEM) of 19.7 +/- 5.3 pmol E2-3-sulfate h-1 mg cytosol protein-1. A significant (P less than 0.05) induction of E2 dehydrogenase activity was also observed in the same tissues [from 3.7 +/- 1.9 to 10.4 +/- 2.7 (mean +/- SEM) nmol estrone h-1 mg microsomal protein-1]. Corresponding values for secretory endometrium, when cultured under identical conditions in the absence of progesterone, were 20.3 +/- 11.6 pmole h-1 mg-1 and 31.1 +/- 25.1 nmol h-1 mg-1 for estrogen sulfotransferase and E2 dehydrogenase, respectively. Values not significantly different from these were obtained when progesterone was present in the cultures. These data indicate that progesterone secretion during the luteal phase is responsible for the induction of both E2 dehydrogenase and sulfotransferase activities in the endometrium. It is likely that these enzymes are closely coupled, resulting in the rapid metabolism of E2 by formation and excretion of estrone sulfate.

Chromatography, Thin Layer↗
PubMed1981

Blood pressure changes: oestrogens in climacteric women.

An analysis of data from a prospective study which compared the effect of conjugated equine oestrogens (Premarin) with that of piperazine oestrone sulphate (Ogen) demonstrated that postmenopausal women who received conjugated equine oestrogens had a higher rate of a rise in blood pressure and development of hypertension than women who received piperazine oestrone sulphate. Conversely, a greater proportion of women who took oestrone sulphate had a fall in blood pressure than those who took equine oestrogens. A hypothesis to account for these differences, based on the known potent biological action of equine oestrogen, is developed.

Adult↗
PubMed1981

Minimal dose combined hormonal replacement therapy for menopausal women.

The problem of managing postmenopausal women with hormonal replacement therapy is reviewed. A case is clearly made for using progestogen in every instance when women receive oestrogen in the menopause. By this means the incidence of carcinoma is reduced to at least the rate found in non-treated patients and perhaps even lower. The biochemical changes leading to this reduction are summarized, and a suggestion is made regarding the optimal dosage of progestogen. This paper presents evidence to suggest that minimal doses of progestogen given for at least ten days in each month will protect endometrial target cells.

Biopsy↗
PubMed1981

The value of endometrial cell sampling in the management of post-menopausal women.

The value of performing endometrial cytology on women receiving hormonal replacement therapy is discussed. Evidence is presented which shows that when this is routinely performed prior to beginning therapy, some 2% of women are found to have an abnormality ranging from polyps to carcinoma. When minimal dose combined oestrogen plus progestogen replacement therapy is used together with a monitoring procedure which involves routine annual Mimark endometrial sampling and curettage for abnormal cytology or bleeding, the risk of endometrial abnormality is reduced to a minimum. The benefits to be gained and the problems which detract from the use of endometrial cytology are discussed. It is recommended that every woman should have a routine cytological endometrial screening performed by a doctor experienced in the use of endometrial sampling equipment when she receives hormonal replacement therapy in the post-menopausal phase.

Cytodiagnosis↗
PubMed1978

Counselling the hysterectomy patient.

The problem of psychosexual disorders following hysterectomy is reviewed. A search of the current literature suggests that a large number of women who have post-hysterectomy depression, loss of libido, or other neuroses have a previous history of depression and neurosis, that they have a generally poor knowledge of their own anatomy and physiology, or that they have received poor counselling and explanation from their own doctor. The fact that the decision to perform a hysterectomy may have been incorrect has also been suggested as a possible cause for regret for the loss of their uterus in some women, whilst in others it is often related to the concept that the uterus is the source of a woman's femininity and the loss of this organ makes her less than a woman. A regime of counselling and the use of an explanatory pamphlet is proposed for all women who are to have a hysterectomy.

Adult↗
PubMed1978

Sexual counselling--a dual counselling approach.

A technique has been described which utilises a dual counselling approach to handle problems of a sexual nature. The methods used to structure counselling sessions are discussed as well as the benefits and the drawbacks of using a male and female counsellor to assist people who have some failure in their sexual lifestyle.

Counseling↗