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Biomedical subjects

I Milsom

Publications and source records attributed to I Milsom.

At least 37 records · Page 2Linked to original sources
PubMed2000

A longitudinal cohort study of elderly women with urinary tract infections.

AIMS: the prevalence of urinary tract infections (UTI), urinary incontinence (UI), estrogen-use and overall mortality in a cohort of elderly women who had been treated for UTI in 1985-86 was re-assessed 10 years later. MATERIAL AND METHODS: a random sample of 6000 women from the birth cohorts 1900, 1905, 1910, 1915 and 1920 were invited in 1986 to complete a questionnaire about UTI, UI and estrogen use (response rate 70%; n = 4206). Treatment with antibiotics for UTI during 1985-86 was reported by 688 (17%) women. In 1995 a similar questionnaire was sent to the women from this group who were still alive (n = 434). Mortality in the women with a history of UTI was compared with an aged-matched control group of women who did not have UTI during 1985-86. RESULTS: the questionnaire was completed and returned by 361 (83%) women. Treatment for at least one UTI during the last 9 years was reported by 219 (61%) women. The number of episodes varied: 35% had one to two UTI, 28% had three to four UTI, 27% five to ten UTI and 10% had had more than 10 UTI. In 1986, the prevalence of UI was higher in women with a history of UTI than in the total population sample (30 vs. 17%; P < 0.001). The prevalence of UI had increased from 30% in 1986 to 33% in 1995 (P < 0.05). Mortality in the women with a history of UTI was higher than in the aged-matched control group (37 vs. 28%; P < 0.001). A total of 162 (45%) women had received estrogen therapy at some time after the age of 60 years and 140 (39%) reported that they were currently taking low potency estrogens. CONCLUSION: elderly women with a history of UTI had a continued high occurrence of UTI and UI, and overall mortality was higher in these women than in an age-matched control group of women from the total population.

Age Factors↗
PubMed2000

Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding: is it always necessary to perform an endometrial biopsy?

OBJECTIVE: This study was undertaken to evaluate whether it was possible to abstain from performing an endometrial biopsy when endometrial thickness according to transvaginal ultrasonography was </=4 mm in women with postmenopausal bleeding or irregular bleeding during hormone replacement therapy. STUDY DESIGN: Transvaginal ultrasonography was performed in 361 women aged >/=50 years who were referred because of postmenopausal bleeding or irregular bleeding during hormone replacement therapy. If endometrial thickness was </=4 mm, a Papanicolaou cervical smear was performed and the woman was reexamined with transvaginal ultrasonography after 4 and 12 months. Subjects were also instructed to return if they had recurrent bleeding, in which case transvaginal ultrasonography was performed and an endometrial biopsy specimen was obtained. Women with an endometrial thickness >/=5 mm underwent either curettage or endometrial biopsy. RESULTS: One hundred sixty-three women had an endometrial thickness </=4 mm. In this group one endometrial cancer that was missed by ultrasonography was diagnosed by cervical cytologic examination and two adnexal malignancies were diagnosed by ultrasonography. Endometrial malignancy was diagnosed in 0.6% of the women with an endometrial thickness </=4 mm. Endometrial biopsy was performed because of recurrent bleeding in 6.1% of cases and because of endometrial thickening in 8.1%. No cancer or hyperplasia was subsequently diagnosed among the women with an endometrial thickness </=4 mm. Endometrial cancer was diagnosed in 18.7% of the women with an endometrial thickness >/=5 mm. The corresponding figure when atypical hyperplasia and endometrial metastases were included was 20. 2%. CONCLUSION: If the false-negative rate of endometrial biopsy techniques is taken into account, then the combination of transvaginal ultrasonography and cervical cytologic examination is an adequate form of management for women with postmenopausal bleeding or irregular bleeding during hormone replacement therapy as long as endometrial thickness is </=4 mm. A randomized prospective study is necessary to verify this finding.

Biopsy↗
PubMed2000

Acute effects of transdermal estrogen in postmenopausal women with coronary artery disease. Using a clinically relevant estrogen dose and concurrent antianginal therapy.

In the present study the acute anti-ischemic effect of clinically relevant doses of transdermal estradiol during concurrent antianginal therapy was investigated in 14 postmenopausal women with stable coronary artery disease. Plasma estradiol was significantly increased, but no significant effects on time to angina, time to 1 mm S--T depression, total exercise time, maximum rate-pressure product, maximum S--T depression or maximum workload were found. However, resting diastolic blood pressure was significantly decreased due to estrogen.

Administration, Cutaneous↗
PubMed2000

Prevalence and risk factors for prelabor rupture of the membranes (PROM) at or near-term in an urban Swedish population.

AIMS: To determine the prevalence, recurrence rate and to identify risk factors for prelabor rupture of the membranes (PROM) after 34 completed weeks in an urban Swedish population. METHODS: In a retrospective cohort study a sample of 2880 women aged 25-41 years, resident in the city of Göteborg, was randomly selected from the population register. According to information from the national Medical Birth Register (MBR), 1507 of these 2880 women had given birth 2736 times. 2270 of these deliveries had occurred in hospitals in the city of Göteborg and case records for 2242 of these deliveries were found. The case records were systematically analyzed for the occurrence of PROM and potential risk factors for PROM. 2208 of these deliveries occurred after 34 weeks of gestation. The further analyses were based on these 2208 deliveries. RESULTS: The prevalence of PROM after 34 week of gestation in this urban Swedish population was 12.9% and about 20% of the women in the population had experienced PROM at least once. In the multiple stepwise regression analysis, risk factors for PROM were primiparity, premature contractions, PROM in a previous pregnancy and bleeding in the first trimester. CONCLUSIONS: PROM is a common complication at or near term. The risk factors for PROM found in this representative study are difficult to influence and thus provide no guidance about how pregnancies should be managed to reduce the occurrence of PROM in the future.

Adult↗
PubMed2000

Factors associated with climacteric symptoms and the use of hormone replacement therapy.

BACKGROUND: To investigate factors associated with climacteric symptoms and the use of hormone replacement therapy (HRT). METHODS: A random sample of women aged 46, 50, 54, 58 and 62 years resident in Goteborg, Sweden (n=5,990) were invited by letter to complete a postal questionnaire concerning the menopause and HRT use. RESULTS: The response rate was 76% (n=4,504). Women with a higher education, who exercised regularly and who had regular spare-time activities felt better and had fewer climacteric complaints (p<0.001) compared to lower educated women, women who exercised infrequently and women who had no spare-time activities. Climacteric symptoms were associated with dryness symptoms (dry eyes, skin, hair and mouth), bilateral salpingo-oophorectomy (SOE), use of psychotropical drugs and use of alternative remedies, previous hysterectomy and full-time occupation. Stepwise multiple regression analysis showed significant correlations between vasomotor symptoms and various dryness symptoms, no menstrual periods and use of alternative remedies. Current HRT-users (13%) had used estrogens for 4.0 years and past users (14%) for 4.3 years. A correlation (p<0.005) was found between HRT use and previous use of contraceptive pills, use of alternative remedies and hysterectomy. Education, occupation and the frequency of exercise did not influence the prevalence of HRT use. CONCLUSIONS: This study has shown that the experience of climacteric symptoms and well-being is associated with many different factors. Women with a higher education and those who exercised regularly were more often symptom-free. HRT use was associated with previous use of contraceptive pills, use of alternative remedies and hysterectomy.

Climacteric↗
PubMed2000

The prevalence of urinary incontinence.

Urinary incontinence is one of the most important health problems confronting modern society. More than 50 million men and women throughout the world are afflicted. Population studies have demonstrated that approximately 10% of all women suffer from urinary incontinence. Prevalence figures increase with increasing age and in women aged > or = 70 years more than 20% of the female population are affected. Urinary incontinence not only causes considerable personal suffering for the individual afflicted but is also of immense economic importance for the health service. The annual cost of urinary incontinence in Sweden in 1990 accounted for 2% of the total health care costs.

Adult↗
PubMed2000

The prevalence of overactive bladder.

Overactive bladder (OAB) is a disorder that encompasses frequency, urgency, and urge incontinence, singly or in combination. It often has a significant individual impact on quality of life and on limitations to activities, yet most individuals with OAB do not seek medical care. Therefore, it is not possible to estimate the prevalence and, more generally, the societal impact of OAB based on medical encounter data. With few exceptions, most epidemiologic studies have focused on urge incontinence, the most severe form of OAB. The prevalence of OAB increases with age and is more common in women than men. However, prevalence estimates vary considerably among studies, ranging from 3% to 43%. The variation in estimates from epidemiologic studies is the result in part of differences in the criteria used to define a case of urge incontinence among studies. This problem is attributable in part to the lack of a standardized, validated, and operational definition. Nonetheless, consensus exists regarding the significant individual and societal impact of urge incontinence and the recognition that it is underdiagnosed and undertreated. Frequency and urgency, the other 2 symptoms of OAB, have not received the same level of attention as urge incontinence, yet the societal impact of these symptoms of OAB may be considerably greater. Overall, frequency and urgency are considerably more common symptoms than urge incontinence, especially between 35 and 55 years of age, the period of peak productivity for most workers. Recent evidence indicates that a substantial proportion of individuals with frequency and urgency report a diminished quality of life and interference with activities in a number of roles, including work. Efforts are under way to more accurately describe the prevalence of frequency and urgency, using a validated and standardized epidemiologic case definition to determine the individual impact of each symptom of OAB and to estimate societal costs.

Adult↗
PubMed1999

Factors influencing vaginal fetal fibronectin concentrations during pregnancy.

In order to evaluate factors influencing fetal fibronectin concentrations during pregnancy a total of 312 vaginal samples for fetal fibronectin measurements and microbiological culture were collected and later included in a stepwise regression analysis. Preterm premature rupture of membranes, a modified Bishop score >/=6 (p < 0.0001), a low vaginal polymorphonuclear leukocyte count (p < 0. 002), the presence of Enterococcus faecalis (p < 0.0001), Prevotella species (p < 0.05), a bacterial vaginosis-associated flora (p < 0. 05), and a non-lactobacilli-dominated vaginal flora (p < 0.05) were associated with an elevated vaginal fetal fibronectin concentration.

Adult↗
PubMed1999

Oral contraceptives and thrombosis. From risk estimates to health impact.

OBJECTIVE: The scientific debate on oral contraceptives (OCs) and thrombotic diseases continues unabated. The aim of this survey was to evaluate available scientific data on OCs and thrombotic diseases and to make tentative prescription recommendations of OCs to women with and without various thrombotic risk factors. CONSENSUS: In women 15-29 years old, venous thromboembolism is about twice as common as arterial complications. In women between 30 and 44 years, the number of arterial complications exceeds venous diseases by about 50%. The mortality from arterial diseases is 3.5 times higher than the number of deaths from venous diseases in women below 30 years, and 8.5 times higher in women 30-44 years old. A significant disability is more frequent in women suffering and surviving an arterial complication than in women with venous thromboembolism. Although many important scientific issues still have to be addressed, the available scientific data suggests a differential influence of OCs with second and third generation progestagens on the risk of venous and arterial diseases. OCs with second generation progestagens seem to confer a smaller increase in the risk of venous diseases and a higher increase in risk of arterial complications, compared with OCs containing third generation progestagens. The possible difference on the venous side seems to be smaller than primarily anticipated. RESULTS: Young women without any known risk factor for thrombotic diseases may use any low-dose OC. If OCs are prescribed to women with known risk factors for arterial thrombotic disease; e.g. smoking, diabetes, controlled hypertension, migraine without aura, family disposition of acute myocardial infarction (AMI) or thrombotic stroke, a low-dose pill with a third generation progestagen may have an advantage. If OCs are considered for women with risk factors for venous disease such as severe obesity, varicose veins, family history of VTE or with factor V Leiden mutation, a low-dose combined pill with a second generation progestagen may be preferable. In women above 30 years, OCs with third generation progestagens generally seem to confer less overall thrombotic morbidity, mortality and disability than OCs with second generation progestagens. These women should reconsider, however, the indication of combined OCs in the presence of significant risk factors of thrombotic diseases.

Adolescent↗
PubMed1999

The prevalence of urinary incontinence and its influence on the quality of life in women from an urban Swedish population.

OBJECTIVES: To assess the prevalence of urinary incontinence and its influence on the quality of life. MATERIAL AND METHODS: A random sample of every fourth woman aged > or =20 years resident in a primary health care district of the city of Göteborg was obtained from the population register (n=2911). The women were invited by letter to complete a questionnaire concerning urinary incontinence. The women were also requested to assess their quality of life using a visual analogue scale. RESULTS: The overall response rate was 77%. The prevalence of urinary incontinence increased (p<0.001) in a linear fashion from 3% in the cohort 20-29 years to 32 % in the cohort of women aged > or =80 years. The proportion of women suffering from stress incontinence decreased (p<0.001) with increasing age, while the proportion of women suffering from urge and mixed incontinence increased (p<0.01) with increasing age. Women with stress incontinence had a greater body weight and had given birth to a greater number of children compared to continent women. There was, however, in this respect no difference between women with urge incontinence and continent women. Women with urinary incontinence reported a poorer quality of life compared to continent women (p<0.01). Women with urge incontinence and women with mixed incontinence reported a poorer quality of life compared to women with stress incontinence (p<0.05). Only 6% of the women from this population had sought medical attention for urinary incontinence. CONCLUSIONS: Although urinary incontinence was a prevalent condition, particularly among the elderly and had a negative influence on the quality of life, only a small number of women had sought medical care.

Adult↗
PubMed1998

Perforations with intrauterine devices. Report from a Swedish survey.

This survey comprised 50 consecutive perforations occurring with intrauterine devices (IUD) reported to the National Patient Insurance Scheme Register during 1990 to 1993. All 50 women were parous and > 20 years of age at the time of IUD insertion. Forty-two (84%) of the IUD were inserted by a midwife and eight by a gynecologist. A total of 45 women (90%) had their IUD inserted < 1 year after a full-term pregnancy and 31 women (62%) had their IUD inserted < or = 12 weeks after delivery. Of the 50 women, 27 (54%) reported that they were breastfeeding at the time of IUD insertion. No particular IUD was overrepresented in relation to its share on the market. In 31 cases (62%), severe pain at insertion and during the first 24 h was recorded. In 14 women (28%), the perforation was diagnosed early (i.e., within 1 month of insertion) and in 36 women (72%), the perforation was diagnosed > 1 month after insertion. Lower abdominal pain was the most frequent symptom at early diagnosis but in two cases, the main symptom was heavy bleeding. Among the 36 women in whom the perforation was discovered more than 1 month after insertion, the diagnosis was made when an unexpected pregnancy occurred in 20 women (56%). In 15 cases, the IUD strings were not visible during pelvic examination at a routine check-up, which led to efforts to locate the IUD. Thirty-two women (64%) underwent laparotomy for removal. We conclude that lactating women seem to be a risk group for perforation and that a national register of IUD perforations could provide a better means of quality control.

Abdominal Pain↗
PubMed1998

Transdermal oestrogen reduces daytime blood pressure in hypertensive women [see comment].

The aim of this study was to investigate the acute effects of transdermally administered 17-beta-oestradiol on ambulatory blood pressure (BP) in hypertensive, postmenopausal women. Thirteen postmenopausal women with ongoing treatment for hypertension were included in this placebo-controlled, double-blind cross-over study. Ambulatory recordings of BP and heart rate were performed during 24 h on two occasions, separated by at least 1 week, after application of a patch containing either 100 microg per 24 h 17-beta-oestradiol or placebo. Serum oestradiol was increased (P<0.001) during active treatment (139.2 +/- 21.1 pg/ml) compared with the baseline postmenopausal levels recorded during placebo (40.5 +/- 2.2 pg/ml). No rise in BP was found in office BP or during ambulatory recordings. Daytime BP pressure was acutely reduced by approximately 3 mm Hg during the 24 h of treatment with oestrogen (SBP n.s., DBP P<0.05), without any change in heart rate. Nocturnal dipping in SBP and DBP was present during placebo conditions, and there were no signs of an increase in dipping during treatment with 17-beta-oestradiol. This study supports previous evidence that hormone replacement therapy is safe in hypertensive women. The data in the present study also imply an acute, but small reduction of daytime BP due to transdermal oestrogen in hypertensive, postmenopausal women. Furthermore oestrogen did not blunt or increase the dipping phenomena during the night in these women.

Administration, Cutaneous↗
PubMed1998

An evaluation of multidisciplinary intervention governed by functional independence measure (FIMSM) in incontinent stroke patients.

Patients with acute hemispheric stroke and ensuring urinary incontinence were randomly allocated to a ward using conventional methods of rehabilitation (n = 13) or to a ward practicing rehabilitation governed by Functional Independence Measure (FIM) (n = 21). All patients were assessed on admission and on discharge using the Katz activities of daily living (ADL) index, the psychological general well-being index, item G of the FIM index (FIM-G), and a mobility score. Patients admitted to the ward utilizing FIM were additionally evaluated using the total FIM on admission, repeatedly during the rehabilitation period and on discharge. An individual rehabilitation programme based on the latest FIM score was used throughout rehabilitation. There were no differences on admission between groups regarding clinical and demographic characteristics, ADL, mobility and mood. Twenty patients in the intervention group regained continence before discharge compared to 3 (p < 0.01) in the control group. There was also a greater improvement in well-being in the intervention group compared to the control group (p < 0.01). This study has indicated that rehabilitation governed by the use of FIM reduced urinary incontinence and enhanced well-being better than conventional methods of rehabilitation. The results warrant a larger study to further investigate rehabilitation of incontinent stroke patients using FIM.

Activities of Daily Living↗
PubMed1998

Factors influencing the presence of uterine cavity fluid in a random sample of asymptomatic postmenopausal women.

AIMS: To assess possible endometrial pathology and other factors influencing the presence of uterine cavity fluid in postmenopausal women. STUDY DESIGN: A random sample of 559 asymptomatic postmenopausal women, recruited from the total population, were examined by transvaginal sonography (TVS) for the presence of uterine cavity fluid. Women with uterine cavity fluid who had an endometrial thickness of > or = 8 mm (including fluid) were admitted for hysteroscopy and a dilatation and curettage (D & C), and those with <8 mm underwent a new TVS examination one year later. A medical history, including details regarding previous minor gynecological surgery, was taken from the women and from an age-matched control-group of women from the same population. RESULTS: Uterine cavity fluid was found in 8.9% (50/559) of the women. In four women with an endometrium measuring > or = 8 mm, curettage revealed polyps in three women and atrophy with a pyometra in one woman. At the one-year follow-up, 22 women who originally had an endometrial thickness<8 mm had an endometrial thickness of<5 mm; 11 women had no cavity fluid and in the remaining 11 the cavity fluid had decreased. In 17 women, endometrial thickness measured > or = 5 mm and subsequent histology showed 11 endometrial biopsies with atrophy, four endometrial polyps and two cervical polyps. The prevalence of uterine cavity fluid increased with increasing age (p<0.0001) and was increased in smokers (p<0.013) but was unaltered by the presence or absence of hormone replacement therapy (HRT). CONCLUSION: There were no indications that uterine cavity fluid was associated with malignancy. The prevalence of uterine cavity fluid increased with increasing age and was higher in smokers. We could not demonstrate an increased prevalence of fluid in HRT-users.

Age Factors↗
PubMed1998

Increased circulating concentrations of asymmetric dimethyl arginine (ADMA), an endogenous inhibitor of nitric oxide synthesis, in preeclampsia.

OBJECTIVES: To study endogenous nitric oxide (NO) synthesis inhibitors in preeclampsia by measuring asymmetric dimethyl arginine (ADMA) and arginine. STUDY DESIGN: Blood samples for measurement of plasma concentrations of ADMA and arginine were obtained antepartum (range 32-39 weeks gestation), 3-5 days postpartum and 3 months postpartum from 12 pregnant women with severe preeclampsia and from a normotensive pregnant control group (n=12). RESULTS: During the third trimester, plasma ADMA was elevated (p<0.05) in the preeclampsia patients (0.55+/-0.02 micromol/l) compared to the normotensive pregnant controls (0.36+/-0.01 micromol/l). Since plasma arginine levels did not differ between preeclamptic and normotensive control women (80.7+/-5.8 micromol/l) and 74.5+/-3.8 micromol/l respectively), the plasma arginine/ADMA ratio was lower (p<0.05) in the preeclamptic group (145.6+/-10.5) compared to the normotensive controls (211.0+/-14.3). Three days post partum there was an increase (p<0.05) in plasma ADMA in both the preeclamptic (0.67+/-0.03 micromol/l) and the normotensive control group (0.64+/-0.03 micromol/l). This was accompanied by a rise (p<0.05) in plasma arginine levels in both the preeclamptic patients (112.9+/-10.5 micromol/l) and the normotensive control group (121.7+/-9.6 micromol/l). At this time point there was no difference in plasma arginine/ADMA ratio between the groups. Three months postpartum, plasma ADMA levels were slightly lower in both groups compared to the postpartum values (preeclampsia: 0.56+/-0.03 micromol/l, normotensive pregnant control: 0.52+/-0.03 micromol/l). CONCLUSION: Elevated circulating ADMA concentrations in combination with low plasma arginine levels may be of pathophysiological importance in pregnancies complicated with preeclampsia.

Arginine↗
PubMed1998

Swedish gynecologists' and general practitioners' views on the climacteric period: knowledge, attitudes and management strategies.

AIMS: To investigate attitudes, knowledge and management strategies concerning hormone replacement therapy (HRT) among gynecologists and general practitioners (GPs) in Sweden. MATERIAL AND METHODS: In 1996 a questionnaire was sent to all Swedish gynecologists (n=1323) and every third general practitioner (GP) (n=1397) regarding indications, contraindications, treatment regimens and their own (or their wives') use of estrogens. RESULTS: Answers were received from 53% of the GPs and from 80% of the gynecologists. Fifteen per cent of the GPs often considered it difficult to evaluate the advantages and disadvantages of hormone replacement therapy compared to 2% of the gynecologists (p<0.001). Almost 100% of the physicians considered hot flushes, night sweats and osteoporosis to be indications for HRT. Significantly more GPs compared to gynecologists (50% vs 24%) stated that estrogen increased the risk of developing a deep vein thrombosis. Significantly more GPs performed measurements of blood pressure, weight, lipoproteins and palpated the breasts before starting treatment and at the follow-up visits. Significantly more gynecologists performed pelvic examination, vaginal sonography, endometrial biopsy and mammography. Among the female doctors who were either postmenopausal or had climacteric symptoms 72% of the GPs and 88% of the gynecologists were current users of HRT (p<0.01). Corresponding figures for the wives were 68% vs 86% (p<0.001). CONCLUSION: As earlier contraindications to HRT nowadays have turned into indications it is reasonable that more GPs compared to gynecologists consider it difficult to evaluate advantages and disadvantages of HRT and more gynecologists than GPs took the first initiative to discuss HRT with their patients. The information that far more female doctors and doctors' wives, compared to the Swedish female population, were using HRT is important information when discussing HRT compliance with patients.

Adult↗