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S Rozenberg

Publications and source records attributed to S Rozenberg.

At least 19 recordsLinked to original sources
PubMed2006

Safety of hormone therapy after breast cancer: a qualitative systematic review.

BACKGROUND: This qualitative review systematically analyses the safety of hormone therapy (HT) in breast cancer (BC) patients. METHODS: We systematically searched studies reporting the use of HT in BC patients. We selected 20 studies in which we evaluated the methodology, characteristics of the studied populations and outcomes in terms of mortality and recurrence rates (RRs). RESULTS: Many studies evaluating HT were uncontrolled and retrospective. Ten prospective and two randomized studies were found. These were characterized by heterogeneity in populations, tumour characteristics, prognostic factors and treatments. Two studies reported a reduced RR, and two reported lowered BC mortality rates in HT users. One randomized study reported an increased rate of new BC events in HT users. CONCLUSIONS: There are currently no reassuring data indicating the absence of a harmful effect of HT. Further studies should analyse whether some regimens are safer than others. There is a need for randomized trials assessing the safety of these regimens. In the meantime, patients should be informed about the absence of safety data.

Breast Neoplasms↗
PubMed2006

ART outcome in HIV-infected patients.

BACKGROUND: To assess assisted reproductive technique (ART) outcome in couples affected by human immunodeficiency virus (HIV). METHODS: Intrauterine insemination (IUI), IVF and ICSI were performed in 85 couples affected by HIV between January 2000 and June 2005. RESULTS: In 33 of the 85 couples, women were HIV positive-the clinical pregnancy rate (CPR) and cancellation rate (CR) after 34 IUI cycles were, respectively, 25 and 18%. The CPR after 26 IVF and 30 ICSI cycles were, respectively, 37.5 and 18.8% with CRs of 38.5 and 46.7%, respectively. In 38 couples, men were infected-the CPR and CR after 85 IUI cycles were, respectively, 14.7 and 20%; 62 ICSI cycles were performed leading to CPR of 23.4% with a CR of 25%. In 14 couples, the two partners were infected: none of the four IUI cycles carried out was successful (CR, 20%); the CPR and CR after 35 ICSI cycles were, respectively, 12.5% with 31%. All children born had a negative HIV test. CONCLUSION: In couples affected by HIV, an acceptable pregnancy rate was obtained. The worst results were obtained when both partners were infected. The CR was elevated among HIV-infected couples.

Adult↗
PubMed2006

Fear-avoidance beliefs about back pain in patients with subacute low back pain.

The fear-avoidance beliefs of patients with subacute low back pain (LBP) considered at risk for chronic disabling LBP are not well known. The objectives of this cross-sectional descriptive survey, conducted in secondary care practice, were to assess fear-avoidance beliefs about back pain in patients with subacute LBP and to seek an association between physician or patient characteristics and level of fear-avoidance beliefs. A total of 286 rheumatologists completed a self-administered questionnaire assessing physicians' demographic, professional data, personal history of back pain, and back pain fear-avoidance beliefs (on the Fear-Avoidance Belief Questionnaire [FABQ]) and 443 patients with sLBP completed one on pain, perceived handicap and disability (Quebec Back Pain Disability Scale), anxiety and depression (Hospital Anxiety Depression questionnaire), and back pain beliefs (FABQ). Mean FABQ scores for rheumatologists for physical activities (FABQ Phys) and occupational activities (FABQ Work) were 9.2+/-4.4 (range 0-21) and 16.7+/-6.9 (range 2-37), respectively, and patient scores were 16.7+/-5.2 and 19.3+/-12.4, respectively. A total of 68% of patients and 10% of physicians had a high rating on the FABQ Phys (>14). Patients' fear-avoidance beliefs about physical activity were associated with low level of education (odds ratio [OR] 4.19; 95% confidence interval [CI] 1.83-9.57), patients' perceived disability (OR 1.05; CI 1.03-1.07), and physicians' high FABQ Phys score (OR 5.92; CI 1.31-26.32). Here we show that fear-avoidance beliefs about back pain were high in patients with subacute LBP and their rheumatologists.

Acute Disease↗
PubMed2005

Outcome of subacute low back pain: influence of patients' and rheumatologists' characteristics.

OBJECTIVES: To assess the outcome of subacute low back pain, to identify the characteristics of patients and physicians which were related to outcome and to evaluate the influence of rheumatologists' beliefs about back pain on their following the guidelines for physical and occupational activity. METHODS DESIGN: a longitudinal descriptive survey. SETTING: a secondary care practice in France. PARTICIPANTS: 266 rheumatologists; 440 patients with subacute low back pain. OUTCOME MEASURES: the main outcome measure was persistence of back pain 3 months after baseline evaluation. A self-administered questionnaire for physicians assessed attitudes and beliefs about back pain [Fear-Avoidance Beliefs Questionnaire (FABQ)], and one for patients assessed pain, perceived handicap and disability (Quebec Scale), anxiety and depression (Hospital Anxiety Depression Questionnaire), and beliefs about back pain (FABQ). RESULTS: Forty per cent of patients had persistent low back pain at 3 months; 5.5% of these had sciatica. A total of 10% of rheumatologists and 68% of patients at baseline had a high FABQ physical score (phys; >14). Determinants of outcomes were work-related back pain [odds ratio (OR) = 3.37; 95% confidence interval (CI) 1.08-5.17], anxiety (OR = 2.41; 95% CI 1.44-4.09), sex (female OR = 2.03; 95% CI 1.30-3.18) and patients' beliefs about back pain at work (OR = 1.02; 95% CI 1.00-1.05). Physicians with high FABQ physical scores were less likely to follow guidelines on prescribing rest and occupational activity for back pain. CONCLUSION: Back pain commonly persists 3 months later in patients with subacute low back pain. Patients and rheumatologists still have negative beliefs about back pain. Rheumatologists' beliefs influence their following guidelines on physical and occupational activities. National education programmes about low back pain are needed in France.

Acute Disease↗
PubMed2005

Measuring the contribution of pharmacological treatment to advice to stay active in patients with subacute low-back pain: a randomised controlled trial.

PURPOSE: In clinical guidelines for acute and subacute low-back pain, pharmacological treatment is recommended for short-term symptomatic relief. The objective was to study the effect of the guidelines' advise to remain active, alone and with the addition of the drug adenosine tri-phosphate (ATP), in patients with subacute low-back pain. METHODS: A drug-guidelines effectiveness trial was undertaken simultaneously to an experimental drug efficacy placebo controlled trial in subacute (4-12 weeks) non-specific low-back pain patients. The 132 participating primary care physicians across France were randomised to participate to either trial. In the drug-guidelines trial, all physicians received a quick consultation card containing the key elements of the clinical guidelines and a brochure that gave their patients practical tips to remain active. Patients were then randomised to receive Atepadene, containing 90 mg of ATP by mouth daily for 30 days (guidelines plus ATP group), or nothing beside the rescue drug that was made available to all patients (guidelines alone group). The principal outcome was functional improvement on the Roland-Morris Disability Questionnaire (RDQ) at 90 days. RESULTS: In the drug-guidelines effectiveness trial, 157 patients were randomised. The rate of improvement in the RDQ over the 90 days of follow-up was superior in the group guidelines plus ATP (8.3 points, 95% confidence interval (CI): 7.3-9.3) than in the group guidelines alone (6.5 points, 95%CI: 5.3-7.7) (p = 0.02). In terms of probability of improving between two to five points on the RDQ at 90 days this difference translated in a 2 to 13 times higher probability compared to the group guidelines alone (odds ratios ranging from 2.1, 95%CI: 0.9-5.0 to 12.9, 95%CI: 1.6-103.4). Patients in the group guidelines plus ATP were also three times less likely to report a condition that had worsened or remained unimproved at 90 days (p = 0.02). CONCLUSION: This drug-guidelines effectiveness trial showed a modest advantage of combined specific pharmacologic and non-pharmacological treatments on absolute improvement on the RDQ. A threefold reduction in the risk of chronicity was observed, an important goal in low-back pain guidelines.

Adenosine Triphosphate↗
PubMed2005

Primary osteoarthritis of hip, knee, and hand in relation to occupational exposure.

AIM: To identify occupations with excess prevalence of osteoarthritis of the knee, hip, and hand in a nationwide survey and to compare occupations with and without excess prevalence with regard to biomechanical stresses and severity of osteoarthritis. METHODS: Patients presenting with osteoarthritis of the knee, hip, or hand were recruited throughout France by their treating physician who collected information on history, including age at onset, occupation, and occupational stresses to joints. Severity was assessed using joint specific functional status questionnaires: Lequesne for the hip and knee and Dreiser for the hand. The distribution of osteoarthritis patients by occupation was compared with the distribution of occupations in all workers in France to obtain prevalence rate ratios. RESULTS: Occupations with the greatest prevalence rate ratio were female cleaners (6.2; 95% CI 4.6 to 8.0), women in the clothing industry (5.0; 95% CI 3.9 to 6.3), male masons and other construction workers (2.9; 95% CI 2.6 to 3.3), and agriculture male and female workers (2.8; 95% CI 2.5 to 3.2). A twofold greater prevalence rate was observed within certain occupations between self-employed and salaried workers. Early onset of osteoarthritis was seen in the more heavy labour jobs with almost 40% of patients reporting their first symptoms before the age of 50. CONCLUSION: The early onset and severity of osteoarthritis in certain occupations warrants an urgent need for occupation specific studies for the development and evaluation of preventive strategies in this leading cause of disability in Western countries.

Adult↗
PubMed2004

Cesarean section scar evaluation by saline contrast sonohysterography.

OBJECTIVE: To investigate the frequency of images suggesting the existence of a dehiscence at the site of the uterine scar after Cesarean section. METHODS: Thirty-three women with a past history of Cesarean section who were planning a further pregnancy were involved in the study. Saline contrast sonohysterography (SCSH) was performed a minimum of 3 months following Cesarean section. The thickness of the residual myometrium, the thickness of the myometrium bordering the scar and the depth of the filling defect in the scar (i.e. the 'niche', defined as a triangular, anechoic area at the presumed site of incision) were recorded in each case. A 'dehiscence' was defined as a niche whose depth was at least 80% of the anterior myometrium. RESULTS: In 19/33 (57.5%) patients a niche with a depth of 4.2 +/- 2.5 (range, 1.2-11.7) mm was identified. In these patients the residual myometrium measured 6.5 +/- 2.7 (range, 0-10.9) mm vs. 8.9 +/- 2.0 (range, 6.9-13.9) mm in the remaining 14 patients without a niche. Within the 19 niches, two dehiscences were identified. CONCLUSION: Niches can be identified by SCSH following a Cesarean section in about 60% of patients. The prevalence of scar dehiscence (in the present series 2/33 or 6%) is much higher than the reported risk of uterine rupture (0.4%).

Adult↗
PubMed2003

Epidural corticosteroid injections for sciatica: a randomised, double blind, controlled clinical trial.

OBJECTIVE: To determine the efficacy of epidural corticosteroid injections for sciatica. METHODS: Three epidural injections (two day intervals) of 2 ml prednisolone acetate (50 mg) or 2 ml isotonic saline were administered to patients with sciatica presumably due to a disk herniation lasting 15-180 days. Self evaluation was the main judgment criterion at day 20. Patients who recovered or showed marked improvement were considered as success. Pain measured by VAS, the SLR test, Schober's test, Dallas pain questionnaire, and the Roland-Morris index were evaluated at days 0, 5, 20, and 35. Only analgesics were authorised, patients requiring non-steroidal anti-inflammatory drugs (NSAIDs) before day 20 were considered as failure. RESULTS: 42 patients were included in the control group (CG), 43 in the steroid group (SG). On an intention to treat analysis 15/42 (36%) in the CG and 22/43 (51%) in the SG (p=0.15) were considered as success (difference 15.5%, 95% CI (-5.4 to 36.3)). Among the 48 failures, 14 patients (6 CG, 8 SG) required NSAIDs, 3 (2 CG, 1 SG) required surgery, and 7 (3 CG, 4 SG) other treatments. On analysis according to protocol, in 74 remaining patients 12/35 (34%) in the CG and 22/39 (56%) in the SG (p=0.057) were considered as success (difference 22.1%, 95% CI (0.0 to 44.2)). For all secondary end points intragroup improvement with time was significant, but intergroup differences were not. CONCLUSION: The efficacy of isotonic saline administered epidurally for sciatica cannot be excluded, but epidural steroid injections provide no additional improvement.

Adult↗
PubMed2003

Primary osteoarthritis and occupations: a national cross sectional survey of 10 412 symptomatic patients.

AIMS: To describe the age standardised prevalence of symptomatic osteoarthritis (OA) in a nationwide cross sectional survey of 10 412 patients in France, and their functional and work limitations. METHODS: Cases in the survey were compared with their expected counterpart by age, gender, and occupational groupings using data from the 1998 French National Survey on Health Impairment and Disability. RESULTS: Women represented 66.2% of the sample; mean age was 66.2 years. One third of patients had OA of the knee, 16% of the hip, and 12% of the hand; a third had multiple joint OA. Peak prevalence of symptomatic OA was in the 60-69 year category in women and in the 70-79 year category in men. Agricultural workers showed a significant excess prevalence of OA, with an observed to expected (O/E) ratio of 1.7 in women and 2.3 in men. Linear trends in prevalences between white collar, "mixed" collar, and blue collar workers were also significant, with odds ratios respectively of 1.0, 2.9, and 2.6 in women and 1.0, 1.2, and 1.7 in men. Specific excess prevalence was found in women among housekeepers (O/E 4.4), and in men among unskilled labour workers (O/E 10.3) and truck drivers (O/E 6.7). Total work disability was highest among blue collar workers and partial disability among agricultural workers. CONCLUSION: Results contribute to the mounting evidence that OA is potentially aetiologically linked to occupation in a sizeable segment of the population and that OA can no longer be considered an inevitable disease of ageing.

Adult↗
PubMed2002

[Estrogen replacement therapy: for whom, why and how?].

Symptoms may appear during the perimenopause, but it is often difficult to treat them at that time. Progestins are used to treat abnormal bleeding. Low dose hormone replacement therapy (HRT) or oral contraception are often used also. HRT can be used to maintain the bone density even in elderly women. Nevertheless, the treatment is often not taken for sufficient time. In order to improve compliance, a number of low dose HRT have been developed. For most patients these medications will preserve the bone mass, but data showing a fracture protection are missing. The exact role of HRT on cardiovascular pathologies is controversial. Observational data indicated a protective effect on atherosclerosis. But randomised studies contradicted these results: the latest randomised trial involving a continuous combined regimen of estrogen and progestin reported an increased risk in cardiovascular events as compared to placebo. It is still possible that estrogen decreases atheromatosis but that it increases the risk of thrombosis. SERM (Selective Estrogen Receptor Modulators) have agonistic and antagonistic proprieties to estrogens on selective tissues. They have a proven protective effect on bone and possibly also on cardiovascular system. Nevertheless, the risk of thrombosis seems to be similar to that of estrogens. The risk of breast cancer seems to be increased in long term HRT users but this subject is also controversial since discordant results have been reported. Furthermore, breast cancer mortality in HRT users seems to be lower than in non users.

Breast Neoplasms↗
PubMed2001

A survey of physicians' attitude towards women with postmenopausal bleeding.

OBJECTIVE: To study how gynaecologist manage postmenopausal bleeding in women not using HRT. The impact on the physicians' attitude of risk factors for endometrial cancer and of the endometrial thickness was essentially accounted for. METHODS: Two different case-types were defined by modifying the risk level of developing endometrial cancer. Also the level of endometrial thickness, assessed by ultrasound, was made to vary. In total four case-types were constructed. One case-type was sent at random to each Belgian gynaecologist (n=970). RESULTS: Response rate: 55%. The proportion of physicians who would not investigate the patients' endometrium varied between 2% (high-risk patient with abnormal ultrasound) and 34% (low risk patient, normal ultrasound). Significant differences were observed in relation to the level of risk factors for endometrial cancer and in relation to endometrial thickness. No significant relationship was found between the choice of the method of endometrial investigation and the risk situation or the ultrasound result. CONCLUSIONS: The attitude of Belgian gynaecologists towards postmenopausal bleeding is modified by the presence of risk factors and by the level of endometrium thickness. About one third of physicians would not further investigate the endometrium of a patient with a low risk profile and a normal endometrium as assessed by ultrasound.

Aged↗
PubMed2001

Aerodiol versus the transdermal route: perspectives for patient preference.

OBJECTIVE: to compare the efficacy, tolerability and user preference of Aerodiol intranasal and transdermal patch administration of 17 beta-estradiol for climacteric symptoms. METHODS: an open-label, multicenter, crossover trial in which recently postmenopausal women were randomized to receive either Aerodiol 300 microg daily (n=176), or transdermal 17 beta-estradiol (reservoir patches delivering 50 microg/day), 2 patches per week (n=185), for 12 weeks, followed by 4 weeks of the alternative treatment. Efficacy was assessed primarily by the Kupperman index at the end of each treatment period. User satisfaction was assessed by questionnaire at weeks 12 and 16, and at week 16 the women chose which treatment they preferred to use for a further 40-week period. RESULTS: Aerodiol and transdermal patch therapy produced marked and similar reductions in the Kupperman index and the incidence of hot flushes at weeks 12 and 16. The reduction in the Kupperman index at week 12 was statistically equivalent for the two treatments. The tolerability of both treatments was good, with similar numbers of emergent adverse events reported in both groups. The incidence of moderate or severe mastalgia, however, was significantly lower with Aerodiol (P=0.02). Significantly more women chose to continue treatment with Aerodiol than with the transdermal patch (66 vs. 34%, P<0.001). When all women had experienced both treatments, reported levels of satisfaction were significantly higher with Aerodiol than with transdermal therapy (P<0.001 for all six categories assessed). CONCLUSIONS: Aerodiol and transdermal patch treatments were of similar efficacy and tolerability. Levels of user preference and satisfaction, however, were higher with Aerodiol, which should contribute towards good long-term compliance with this therapy.

Administration, Cutaneous↗
PubMed2001

Opinion survey towards hormone replacement therapy in the prevention of coronary heart disease.

BACKGROUND: Observational and experimental data underscore the cardioprotective effects of hormone replacement therapy (HRT). On the other hand, the randomised trial available, the 'Heart and Estrogen/Progestin Replacement Study (HERS)', showed no reduced risk of coronary heart disease (CHD), using HRT. AIM: Opinion survey on the effect of HRT on CHD risk. SETTING: Identification of articles on the related topic using a Medline search. Written survey of the authors' opinion towards HRT in relation to CHD. RESULTS: Thirty-seven of the 108 principal authors responded. Among them, respectively, 16 (43%) and seven (19%) found that HRT has favourable effects on primary and secondary prevention, two (5%) and five (14%) that it had no effect, none (0%) and four ( 11%) that it had an unfavourable effect, seven (19%) and nine (25%) that it had both favourable and unfavourable effects, and nine (25%) and ten (27%), thought that there are not enough data. Considering a risk modification superior to 20% as clinically relevant, then 57% thought that HRT has a beneficial effect of on primary prevention and 30% on secondary prevention, while none of the responders considered that HRT has unfavourable effects on primary prevention and only 2% on secondary prevention of CHD. CONCLUSION: Despite the negative results of the HERS study, about one-half of the responders still think that HRT has a beneficial effect on primary prevention of CHD and almost one-third on secondary prevention.

Attitude of Health Personnel↗