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Biomedical subjects

M Vessey

Publications and source records attributed to M Vessey.

At least 55 records · Page 3Linked to original sources
PubMed1992

Trends in hospital discharge rates for pelvic inflammatory disease in Scotland, 1975-1985.

This paper describes trends in hospitalisation for pelvic inflammatory disease in Scotland between 1975 and 1985. The age-standardised hospital discharge rate per 100,000 for all pelvic inflammatory disease in women aged 15-44 rose from 100.1 in 1975 to 143.8 in 1985. Rates of acute pelvic inflammatory disease increased by 58%, from 66.3/100,000 in 1975 to 104.5/100,000 in 1985, but the rate of discharge for chronic disease rose only slightly from 33.8/100,000 to 39.3/100,000. About one quarter of acute cases underwent surgery which enabled confirmation of the diagnosis, and there was no major change in this proportion between 1975 and 1985. The use of laparoscopy steadily increased, but this tended to replace other forms of surgery which could confirm the diagnosis. The percentage of chronic cases which were surgically confirmed increased steadily over the time period studied. A marked decrease in the mean duration of stay--from 9.2 days in 1975 to 4.9 days in 1985--meant that the total number of bed days used by patients with pelvic inflammatory disease fell by 16% between 1975 and 1985 despite the increase in the total number of cases.

Adolescent↗
PubMed1991

The association of oral contraception with kidney cancer, colon cancer, gallbladder cancer (including extrahepatic bile duct cancer) and pituitary tumours.

This paper reviews the evidence for a relationship between oral contraceptive use and certain neoplasms: cancers of the kidney, colon and gallbladder (including the extrahepatic bile ducts) and tumours (benign or malignant) of the pituitary. Special reference is made to controlled epidemiological studies, both case-control and cohort. There is no convincing evidence that oral contraceptive use is causally related, either negatively or positively, to any of the tumours studied.

Bile Duct Neoplasms↗
PubMed1991

Is oral contraceptive use still associated with an increased risk of fatal myocardial infarction? Report of a case-control study.

OBJECTIVE: To investigate the association between fatal myocardial infarction and use of modern low-dose oral contraceptives. DESIGN: A case-control study. SETTING: General practices throughout England and Wales. SUBJECTS: 161 women aged under 40 dying from myocardial infarction during 1986-1988. Living controls (2 per case), matched for age and marital status, were chosen from general practice lists. Information was collected during structured interviews with general practitioners, and from postal questionnaires sent to surviving partners of the cases and to control women. MAIN OUTCOME MEASURES: Mortality from myocardial infarction in relation to many risk factors, notably oral contraception, as measured by relative risk. RESULTS: After allowing for the confounding effects of medical risk factors and for surgical sterilization, the overall relative risk associated with both current and past use of oral contraceptives was estimated to be 1.9 (95% CI 0.7 to 4.9, and 1.0 to 3.5 respectively). The relative risk associated with current use of preparations containing 50 micrograms of oestrogen, however, was estimated to be 4.2 (0.5 to 39.2). At least some of the relative risk associated with oral contraceptive use is likely to be attributable to the confounding effect of cigarette smoking, but it is impossible to estimate how much from the available data. CONCLUSIONS: If there was an increased risk of fatal myocardial infarction associated with oral contraceptive use in 1986-1988 it is likely to have been less than two-fold; in this study risks were slightly, but not significantly, elevated with both current and previous use. It may be that any increase in risk is associated solely with the older combined preparations containing 50 micrograms of oestrogen.

Adult↗
PubMed1990

The prevalence of subfertility: a review of the current confusion and a report of two new studies.

The difficulties inherent in measuring the prevalence of subfertility are discussed. Four subtypes of subfertility are defined, enabling comparisons to be made between the widely different approaches previously reported. A detailed assessment was made of the prevalence of subfertility in two different samples of British women aged 25 to 44 years, using interviews, postal questionnaires, and medical record searches. Data were collected on 872 women from a general practice and 702 hospital patients. The combined data showed that 24% of all women attempting to conceive experience an episode of subfertility at some stage in their reproductive life. Thirteen percent experience this in attempting to conceive their first child, and 17% when attempting to conceive a subsequent child. Three percent of women are involuntarily childless and 6% of parous women are not able to have as many children as they would wish.

Adult↗
PubMed1990

Mortality in a cohort of long-term users of hormone replacement therapy: an updated analysis.

OBJECTIVE: To reexamine the mortality experience of a cohort of long-term users of hormone replacement therapy (HRT) in comparison with that reported previously for the same cohort of women, paying particular attention to cardiovascular mortality, deaths from breast and endometrial cancer, and deaths attributed to suicide or suspected suicide. DESIGN: Longitudinal cohort of 4544 long-term users of HRT amongst whom mortality is being monitored prospectively in comparison with expected rates in the female population of England and Wales (taking account of age and calendar period). SUBJECTS: 4544 women, all of whom were recruited from specialist menopause clinics around Britain and had taken at least one year's continuous HRT at the time of recruitment to the study. MAIN OUTCOME MEASURES: All cause mortality, cardiovascular mortality, deaths from female cancers, deaths attributed to suicide or suspected suicide. RESULTS: Overall mortality (based on 236 deaths over the entire study period from recruitment to December 1988) remained significantly lower than expected on the basis of national rates (relative risk (RR) 0.56, 95% confidence limits (CL) 0.47-0.66). When specific causes were considered, the only mortality ratios greater than unity were for injury, poisoning and violence (1.54, 95% CL 1.02-2.06), and for suicide and suspected suicide ('suicide') (2.40, 95% CL 1.68-3.11). Comparison of the ratios for the 112 additional deaths with those obtained in our previous analysis revealed that one of the few ratios to show any increase was that for breast cancer mortality. This rose from a significant deficit of 0.55 (95% CL 0.28-0.96) in the earlier period to 1.00 (95% CL 0.55-1.45) in the later period. There was also a suggestion of an increase in breast cancer risk with increasing duration since first use of HRT. Most of the other cause-specific ratios were very similar over the two periods. The ratio of death from all circulatory diseases was notably lower in the later analysis (RR 0.37, 95% CL 0.15-0.58) than in the earlier analysis (0.51, 95% CL 0.36-0.69), as were all of the subcategories of cardiovascular death. The mortality ratio for cancer of the ovary and uterine adnexa fell from 1.12 in the previous analysis to 0.63 (95% CL 0-1.41). The mortality ratio for 'suicide' also decreased, but was only slightly lower in the later period. As before, however, there was evidence of a relatively high prevalence of prior psychiatric problems amongst the recent 'suicide' deaths, suggesting that the excess of deaths from 'suicide' may be a manifestation of selection. CONCLUSION: These data are consistent with a beneficial effect of HRT on cardiovascular diseases, although updated information comparing progestogen-opposed and -unopposed treatment is not available. The increase in breast cancer mortality contrasts with the pattern for all other specific causes examined; taken together with the suggestion of an increase in breast cancer mortality with increasing interval since first exposure to HRT, this finding is somewhat worrying.

Breast Neoplasms↗
PubMed1990

Epidemiology of pelvic inflammatory disease in parous women with special reference to intrauterine device use.

Up to the end of 1989, 206 parous women in the Oxford Family Planning Association contraceptive study had been referred to hospital with a first episode of pelvic inflammatory disease. Of these, 65 suffered from definite disease described as acute, 81 from definite disease not described as acute and 60 from 'other disease'. Considering all forms of disease together, referral was less common in those aged 25-29 and in those aged 45 or more than in those aged 30-44. Referral was more common in those of low social class, in those who smoked and in those who married young. All these factors were taken into account in analyses considering the effects of contraceptive methods. In these analyses, women currently using the contraceptive pill, the diaphragm, the sheath, female sterilization or an intrauterine device (IUCD) were compared with those currently using other methods or no method of contraception. IUCD ex-users were, however, placed in a separate category, irrespective of their current method of contraception. The relative risks obtained in these analyses, with 95% CI, were as follows: contraceptive pill 0.5 (0.2-0.9), diaphragm 0.6 (0.3-1.2), sheath 1.2 (0.6-2.4), female sterilization 0.7 (0.3-1.5), non-medicated IUCD 3.3 (2.3-5.0), medicated IUCD 1.8 (0.8-4.0), IUCD ex-users 1.3 (0.7-2.3). These data suggest that oral contraceptives, the diaphragm and female sterilization protect against pelvic inflammatory disease and that IUCDs increase the risk. Medicated devices, however, appear to carry only about half the risk of non-medicated devices, and the elevation of risks in IUCD ex-users appears to be small. Special analyses examined the risk associated with use of a Dalkon Shield. Among women currently using an IUCD (of any kind), those who had used a Dalkon Shield (at any time) had nearly five times as great a risk of hospital referral for pelvic inflammatory disease as those who had never used a Dalkon Shield (relative risk 4.7, 95% CI 2.1-9.0).

Acute Disease↗
PubMed1989

The reliability of surrogate information about oral contraceptive use, smoking, height and weight collected from men about their wives.

Ninety-nine female hospital patients and their husbands were asked to complete separate questionnaires about the woman's history of using oral contraceptives as well as her height, weight and cigarette smoking habits. The questionnaires were completed in the presence of a research nurse to ensure that there was no discussion. Reports of height, weight and smoking status showed a good agreement between the women and their husbands. Husbands usually reported accurately on whether the woman was a current or past user of oral contraceptives, but most of them were unable to name the brand of oral contraceptive that was used, or give an estimate of the duration of use.

Adult↗
PubMed1989

Carcinoma of the cervix and oral contraceptives: epidemiological studies.

The relationship between squamous carcinoma of the cervix and oral contraceptive use has been examined in a substantial number of epidemiological studies. On balance there is reasonably convincing evidence that prolonged oral contraceptive use slightly increases the risk of the disease, but some doubt remains as to whether or not confounding factors have been controlled adequately in the studies reporting positive findings. The data are too few at present for any reasoned comment to be made about the possible relationship between oral contraceptives and adenocarcinoma of the cervix.

Adenocarcinoma↗
PubMed1989

Alcohol, cigarette smoking and breast cancer.

The results of two case-control studies of breast cancer which included questions on exposure to tobacco and alcohol are reported. One study included 998 hospital cases and a like number of matched hospital controls while the other included 118 cases identified during mammographic screening and a like number of matched normal screenees. Both studies used the same questionnaires and the same methods to obtain information. The results with regard to cigarette smoking differed between the two studies. The hospital-based study showed a decreased risk of breast cancer with increasing amounts smoked (relative risk for 15 or more cigarettes per day was 0.82, 95% confidence interval 0.60-1.13) while the screening study showed an increased risk (relative risk for 15 or more cigarettes per day was 2.90, 95% confidence interval 1.16-7.25). Evidence is presented that both results may be attributable to bias in the selection of cases and controls. It is concluded that reliable results on the relationship between smoking and breast cancer are only likely to come from population-based studies. These studies, in general, have found no relationship. Neither study produced any hint of an association between alcohol consumption and breast cancer. From this, it appears that bias in subject selection may not be such a significant factor in interpretation of studies of alcohol and breast cancer as it is in studies of smoking and the disease. A number of other difficulties in the interpretation of studies of alcohol and breast cancer are considered, including the great variation in the amount of alcohol consumed. It is concluded that the assertion that alcohol is a risk factor for breast cancer remains unproven.

Adult↗
PubMed1989

Epidemiology and trends in hospital discharges for pelvic inflammatory disease in England, 1975 to 1985.

Hospital Inpatient Enquiry data were analysed to determine trends in hospital discharges for pelvic inflammatory disease in England from 1975 to 1985. Cases where the disease was thought to be related to another condition, e.g. appendicitis, were excluded from the analysis. Discharge rates for both acute and chronic disease increased over the review period and there was a 28% increase in the discharge rate for total disease. Women in their 20s were most likely to be involved and this group showed the greatest increase in the discharge rate, both for acute and chronic disease. In the 20-24-year age group the rate of discharge for acute disease rose by 50%, from 125.6/100,000 in 1975 to 189.0/100,000 in 1985. Patients with a diagnosis of chronic pelvic inflammatory disease tended to be older than those with acute disease. Women who were divorced were more at risk of both acute and chronic forms of the disease than single or married women. Increase in the use of surgery to confirm the diagnosis occurred only for those with chronic disease. About a quarter of patients with acute disease had the diagnosis confirmed surgically, and this proportion did not change in the period studied, although laparoscopy increased as laparotomy decreased.

Acute Disease↗
PubMed1989

Histopathology of breast cancer in young women in relation to use of oral contraceptives.

A detailed review was made of the histopathology of 227 tumours taken from 261 women under 45 years of age with breast cancer. The tumours were classified as follows: whether oral contraceptives had been used at any time; and whether oral contraceptives had been used before first term pregnancy. All analyses were adjusted for the effects of age. Overall, 201 (88.5%) of tumours were infiltrating ductal in type, 19 (8.4%) were infiltrating lobular, and seven (3.1%) were in situ ductal. Of the infiltrating ductal tumours, 28 (14%) were grade I 88 (44%) grade II, and 84 (42%) grade III. Various other tumour characteristics were also examined (per cent of carcinoma in situ, lymphatic permeation, necrosis, lymphoplasmocytic reaction and tumour edge). None of the histopathological features assessed showed any significant association with oral contraceptive use. Some characteristics of the areas of breast tissue adjacent to the tumours were also studied. The degree of cyst formation was considerably less pronounced in those using oral contraceptives before first term pregnancy than in those not doing so.

Breast↗
PubMed1989

Pyridoxine (vitamin B6) and the premenstrual syndrome: a randomized crossover trial.

A randomized double-blind crossover trial was conducted to study the effects of pyridoxine (vitamin B6) at a dose of 50 mg per day on symptoms characteristic of the premenstrual syndrome. Sixty three women aged 18-49 years, identified by means of a general practice based survey of menstrual patterns in the community, entered the trial. All of the women had noticed moderate to severe premenstrual symptoms during the previous year. The women kept a daily menstrual diary which graded the severity of nine individual symptoms from zero to three. After completing a diary for an initial month the women were randomized to receive either drug or placebo for three months, after which the treatments were crossed over for a further three months. Thirty two women completed the full seven months of the study. In these women a significant beneficial effect (P less than 0.05) of pyridoxine was observed on emotional type symptoms (depression, irritability and tiredness). No significant effect was observed on premenstrual symptoms of any other type.

Adolescent↗
PubMed1988

Do British women undergo too many or too few hysterectomies?

Hysterectomy is performed much less frequently in Britain than in North America, Australia and some European countries. Various theories have been advanced to explain this lower rate of surgery. These include: fewer health care resources (hospital beds, surgeons); much less fee-for-service medicine; differences in the attitudes of surgeons; differences in health care organisation, in particular the gatekeeping role of general practitioners; and differences in patients' expectations. This paper reviews the evidence on sources of variation and examines the extent to which hysterectomy rates vary between countries, and between small areas and social groups within Britain. Following an examination of national trends, evidence is presented from studies carried out in the Oxford region to illustrate the extent of variation in the rate at which hysterectomy is carried out and to explore the possible reasons for the differences. The article considers the health policy implications of an apparent increase in demand for hysterectomy and argues the case for a thorough evaluation of the impact of this operation on quality of life.

Adult↗
PubMed1988

Benign ovarian teratomas: a population-based case-control study.

We attempted to identify all cases of benign ovarian teratoma which occurred in two health districts in the UK during a 56 month period. The crude incidence was 8.9 cases/100,000 women. One hundred and twenty cases and 119 age-matched controls were interviewed to identify risk factors for this disease. In addition, 137 mothers completed postal questionnaires. Cases were older at leaving school, had higher social class occupations, were more often unmarried or married late, and had fewer children than controls. Oral contraceptive use was similar for both. Cases reported more exercise at all ages, and more alcohol consumption 1 year before diagnosis. Cases' mothers reported slightly less nausea during pregnancy than controls' mothers, and none of the mothers reported exogenous hormone exposure during the index pregnancy. In this study benign ovarian teratomas strongly resemble testicular cancer in their age distribution in the population. They also resemble testicular cancer in their association with educational status and marital status. There was, however, no similarity regarding prenatal hormone exposure. The increased risks associated with exercise and alcohol use were unexpected; we need further information about how these exposures affect the ovary, and whether they affect the testis.

Adult↗