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PubMed1992

Combined effects of body size, parity, and menstrual events on breast cancer incidence in seven countries.

A biologically motivated breast cancer incidence rate function was fit to data from a published case-control study conducted in countries whose incidence is high (Wales and the United States), moderate (Brazil, Greece, and Yugoslavia), and low (Japan and Taiwan). The data include personal characteristics of 3,925 breast cancer cases and 11,327 controls interviewed in selected hospitals in 1964-1968. Parameters in the function specify the dependence of age-specific breast cancer incidence rates on age at menarche, age at menopause, occurrence and timing of full-term pregnancies, and body mass. Parameters were estimated separately for high-, moderate-, and low-risk countries. Examination of residuals provided little evidence of inadequacy of the fitted function in describing combined effects of the characteristics studied. The following patterns were seen in all three risk groups: 1) Incidence rates jump to a higher level after first childbirth, but then increase with age more slowly thereafter. 2) Rates increase with age more slowly after menopause than before. 3) Rates change quadratically with body mass index among all women, although the main trend varies: Rates decrease with body mass among premenopausal women in high-risk countries, but increase with body mass in all other groups of women. Similarities of parameter estimates across countries suggest that reproductive events and body fat exert similar effects on all women, regardless of breast cancer rates in their country of residence.

Adult↗

PubMed2002

Influence of pelvic endometriosis and ovarian endometrioma on fertility.

We investigated the influence of pelvic endometriosis and ovarian endometrioma on pregnancy outcome in women associated with infertility. A total of 237 women with endometriosis were reviewed, and their fertility rate was assessed by both r-AFS staging and TOP classification as previously proposed by our group. There was no significant difference in pregnancy rate among r-AFS stages. However, the pregnancy rate was mostly affected by the tubal condition according to the TOP classification as follows: no adhesive lesion (T0), 53% (69/129); unilateral lesion (T1), 46% (18/39); bilateral lesion with at least one tube patent, (T2), 37% (10/27); bilateral tubal occlusion (T3), 0% (0/8) (p < 0.05, Mantel-Extension test). The absence (O0-O1) or co-existence (O2-O3) of ovarian endometrioma and different gradings of cul-de-sac obliteration (P2-P3) showed no significant differences in pregnancy rate. The resulting conception rate was also not affected by the size or location of ovarian endometrioma. In addition, the higher adhesion score of ovarian endometrioma involving the fallopian tube and as described in r-AFS classification had a significant detrimental effect on fertility. These observations suggest that our TOP classification describing individual tubal condition has a clinically predictive value in assessing the reproductive outcome of women with endometriosis.

Adult↗

PubMed2005

[The frequency and character of clinical manifestations of androgenization among adolescent girls].

By clinical examination of 700 adolescent girls aged 11-17 high frequency of androgen depended manifestations, such as acne, seborrhea, hypertrichosis or their combination was detected in prepubertal and pubertal periods (4.7%, 6.8%, 2.9% and 20.6%, 5.3%, 3.0% correspondingly). Above-mentioned signs developed as a result of activation of androgens secretion by adrenal glands and ovaries, which are physiological processes during pubertal period. The combination of these signs with hirsutism and menstrual disorders may be a manifestation of endocrine- reproductive disorders. Results of our data indicate to infirmity, expediency and importance of prophylactic examination among adolescent girls. Low rate of attendance to medical care among adolescents with clinical manifestations with probable endocrine and reproductive disorders indicates to the importance of their early diagnosis during adolescence and timely initiation of the treatment.

Acne Vulgaris↗

PubMed2006

[Differential-diagnostic features of clinical development of urogenital mycoplasmosis].

Every year urogenital mycoplasma draws the increasing attention, as serious pathological disease of women of reproductive age. During the urogenital mycoplasmosis, parameters of clinical semiology are expressed more significantly than without this disease. Among women with a reproductive pathology on a background of urogenital mycoplasmosis most often took place pathological discharge with a putrefactive smell, irritation, an itch and burning of genitals. Though frequency of such clinical symptoms as the painful sexual intercourse, pain conceded the pathological discharge. It is established, that during urogenital infections among pregnant women and women with a reproductive pathology the wide scale of specific symptoms are peculiar for the mycoplasmosis.

Adult↗

PubMed1991

On the excess of mental retardation and/or congenital malformations in apparently balanced reciprocal translocations. A critical review of the Leuven data 1966-1991.

In this report we review 286 reciprocal translocations (rcpt) diagnosed in Leuven in the period 1966, mid 1991. They were selected from a total number of 82,000 patients karyotyped for constitutional reasons. Special attention is paid to: (1) the phenotypic effect of de novo reciprocal chromosomal rearrangements and (2) the incidence of mental retardation/congenital malformations (MR/CM) in familial rcpt. Important conclusions of this study were: 1) The high incidence of MR/CM in de novo rcpt, not only in patients with complex chromosomal rearrangements (greater than 80%) but also in patients with classical two breaks rcpt (greater than 60%). In contrast, the phenotypic effect of normal/mosaic rcpt seems to be minimal. 2) The overall incidence of MR/CM in carriers of familial balanced rcpt was 6.4%. Interestingly, the incidence of MR/CM problems in rcpt carriers from families detected because of reproductive failure was not increased (2.3%). However, the risk to find MR/CM in a rcpt carrier was much higher (12.8%) if he/she belonged to a family in which the rcpt was detected in an index patient with MR/CM.

Congenital Abnormalities↗

PubMed1998

2,3,7,8-Tetrachlorodibenzo-p-dioxin plasma levels in Seveso 20 years after the accident.

In 1976, near Seveso, Italy, an industrial accident caused the release of large quantities of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) into the atmosphere, resulting in the highest levels of the toxicant ever recorded in humans. The contaminated area was divided into three zones (A, B, R) corresponding to decreasing TCDD levels in soil, and cohort including all residents was enumerated. The population of the surrounding noncontaminated area (non-ABR) was chosen as referent population. Two decades after the accident. plasma TCDD levels were measured in 62 subjects randomly sampled from the highest exposed zones (A and B) and 59 subjects from non-ABR, frequency matched for age, gender, and cigarette smoking status. Subjects living in the exposed areas have persistently elevated plasma TCDD levels (range = 1.2-89.9 ppt; geometric mean = 53.2 and 11.0 ppt for Zone A and Zone B, respectively). Levels significantly decrease by distance from the accident site (p = 0.0001), down to general population values (4.9 ppt) in non-ABR, thus validating the original zone classification based on environmental measurements. Women have higher TCDD levels than men in the entire study area (p = 0.0003 in Zone B; p = 0.007 in non-ABR). This gender difference persists after adjustment for location within the zone, consumption of meat derived from locally raised animals, age, body mass index, and smoking. There is no evidence for a gender difference in exposure, so variation in metabolism or elimination due to body fat or hormone-related factors may explain this finding. Elevated TCDD levels in women may contribute to adverse reproductive, developmental, and cancer outcomes.

Accidents, Occupational↗

PubMed1998

Epidemiology of repeat ectopic pregnancy: a population-based prospective cohort study.

OBJECTIVE: To study infectious pathology at index ectopic pregnancy and to determine what other factors predispose a woman to repeat ectopic pregnancy. METHODS: All women (n = 697) with their first (index) ectopic pregnancy histologically verified between January 1, 1978, and December 31,1993, at the only two hospitals in one Norwegian county were eligible. Included were permanent residents of the county who were 37 years of age or younger and who had not had tubal surgery before the index pregnancy. When the study closed on November 1, 1994, the participants had been observed prospectively for fertility events from approximately 1 to 17 years. Included in the final analyses were 353 women who had from one to five natural conceptions, for a total of 555 pregnancies. Chi-square test was used in univariate analysis, and the generalized estimating equations approach was used to analyze correlated responses and covariates that changed over time. RESULTS: Pregnancy order is the stronger correlate of subsequent ectopic pregnancy. The frequency of repeat ectopic pregnancy decreased by one-third for each pregnancy from the first to the third pregnancy. The odds of having another ectopic pregnancy were nearly three times higher for women with a diagnosis of infectious pathology than for women who had no infectious pathology. Other correlates of repeat ectopic pregnancy include age 24 years or younger at first ectopic pregnancy, history of repeat ectopic pregnancy, initiation of infertility work-up, and conception with an intrauterine device at index pregnancy. Method of surgery was not associated with repeat ectopic pregnancy. CONCLUSION: The most crucial reproductive event after first ectopic pregnancy is the first event to occur. Women who have experienced two ectopic pregnancies should be considered candidates for assisted reproduction.

Adult↗

PubMed1989

The effect of lactation and other factors on post-partum changes in body-weight and triceps skinfold thickness.

1. Mothers were followed from 1 month post-partum up to 12 months post-partum to measure changes in their body-weight and triceps skinfold thickness. 2. Overall there was a significant weight loss in the first few months but this levelled off by 7 months. 3. The triceps skinfold increased significantly up to 5 months post-partum and then decreased. 4. These changes in body-weight and skinfold were not affected by the duration of lactation, smoking or the educational achievement of the mothers, but were influenced by the initial body mass index and the desire to lose weight.

Adolescent↗

PubMed1994

Cost-effectiveness of levonorgestrel subdermal implants. Comparison with other contraceptive methods available in the United States.

The objective of this analysis was to evaluate and compare the cost-effectiveness of eight contraceptive methods: condoms, diaphragms, oral contraceptives, intrauterine devices, medroxyprogesterone acetate suspension, levonorgestrel subdermal implants, tubal ligation and vasectomy. Based on a comprehensive review of the literature and various additional data sources, this analysis identified, measured and compared direct costs of the methods, physician visits, treatment of adverse effects and cost of failure (i.e., mean cost for all types of deliveries or first-trimester abortion). Medical benefits (if any) resulting from each contraceptive method were calculated and considered in the analysis as cost savings. The cost of method failure proved to be the greatest influence on cost-effectiveness. Sterilization was identified as the most cost-effective method overall. Of the reversible methods, the intrauterine device was found to be the most cost-effective, followed by levonorgestrel implants.

Adult↗

PubMed2007

Comparison of smallpox outbreak control strategies using a spatial metapopulation model.

To determine the potential benefits of regionally targeted mass vaccination as an adjunct to other smallpox control strategies we employed a spatial metapopulation patch model based on the administrative districts of Great Britain. We counted deaths due to smallpox and to vaccination to identify strategies that minimized total deaths. Results confirm that case isolation, and the tracing, vaccination and observation of case contacts can be optimal for control but only for optimistic assumptions concerning, for example, the basic reproduction number for smallpox (R0=3) and smaller numbers of index cases ( approximately 10). For a wider range of scenarios, including larger numbers of index cases and higher reproduction numbers, the addition of mass vaccination targeted only to infected districts provided an appreciable benefit (5-80% fewer deaths depending on where the outbreak started with a trigger value of 1-10 isolated symptomatic individuals within a district).

Disease Outbreaks↗

PubMed1997

[A genetic-demographic study of the South Altaian population of the Mendur-Sokkon village (Altai Republic)].

The main demographic parameters of the population of South Altaians from the Mendur-Sokkon village, Ust'-Kanskii raion, Altai Republic, were studied. This population was classified as a growing one because the population's reproductive size was large (37%), the prereproductive part constituted the majority of the population (52%), and the average number of surviving children per spouse was 2.6. The population studied began to mix with other ethnic groups (mostly Russians and Kazakhs) only recently; therefore, the proportion of interethnic hybrids was only 5%. The tribal structure of the Mendur-Sokkon population was typical of all South Altaians and characterized by stringent observance of exogamous regulations. An ethnically pure core was preserved in the population. The degree of endogamy was 0.36; however, the population mostly exchanged marriage migrants within the Ust'-Kanskii raion. A study of postreproductive females revealed that the average number of surviving children and pregnancies per female was 4.9 and 5.3, respectively; these values were lower than those in indigenous northern Siberian populations studied earlier. The high value of the Crow's index of total selection (Itot = 0.63) was mainly accounted for by the differential fecundity component, I(f) = 0.40, whereas the prereproductive mortality component (Im = 0.16) was considerably lower than in northern Siberian populations (Nganasans, Forest and Tundra Nentsi, Evens, Asian Eskimos, etc.) and closer to the values characteristic of urban human populations.

Adolescent↗

PubMed1998

Epidemiology of sociodemographic characteristics, lifestyle, medical history, and colon cancer: a case-control study among French Canadians in Montreal.

Colon cancer is the second most common cancer in both men and women in North America and other developed countries. In a population-based case-control study of colon cancer among French Canadians in greater Montreal, a total of 402 cases and 668 controls were interviewed. The cancer cases were identified through the admission offices of five major Francophone teaching hospitals in Montreal from 1989 to 1993. The controls, matched by age, sex, place of residence, and language, were selected by a modified random digit dialing method. The results show that subjects who had ever been married had a lower risk for colon cancer (odds ratio [OR]: 0.58; 95% confidence interval [95% CI]: 0.48-0.84) than did individuals who had never been married. A significant association (OR: 1.90; p for trend = 0.003) was found between the height of subjects and the risk of colon cancer. The OR for individuals with a family history of colorectal cancer was 2.78 with a p value of 0.01. A direct and significant association (OR: 2.01) was found among constipation, use of laxatives (OR: 1.41), and the risk of colon cancer. Among women, a suggestive inverse association was detected between the number of full-term pregnancies and the risk of colon cancer in female subjects (the OR for five or more pregnancies was 0.58 with a p for trend of 0.08). There was also a suggestive linear trend (increased age-decreased risk) between age at menarche and the risk of colon cancer. No association was apparent between other sociodemographic characteristics and the risk of colon cancer. In conclusion, married individuals had lower risk for colon cancer, perhaps due to food habits or other characteristics of being single. Higher height and weight history 10 years before the diagnosis of cancer are risk factors for breast cancer, while both current weight and body mass index seem to be protective. Positive family history of colon cancer increased the risk of colon cancer significantly.

Adult↗

PubMedDate not supplied

Hemizona assay: evaluation of fertility potential in patients with vasectomy reversal.

Approximately 40 to 60% of men who undergo a successful vasovasostomy have "functional failure" or failure to conceive even though active sperm are present. Factors of this functional failure include sperm abnormalities (oligoasthenoteratospermia) and antisperm antibodies. Nine male patients 32 to 43 years of age who underwent vasovasostomy were included in the study group. These patients demonstrated ductal patency 3 to 6 months after surgery. After attempts at fertility with their spouses failed, the couples underwent urological and gynecological evaluation. Semen parameters were recorded and further evaluation was performed using immobilizing and agglutination antibodies as well as direct immunobead test and the hemizona assay (HZA). Semen parameters presented varying levels of sperm concentration, percent motility, and morphology (strict). Antisperm antibodies were present in 4 of the 9 patients. Three of 4 patients with antibodies and 4 of 5 patients without antibodies benefitted from hemizona assay results in that it either supported a desired therapy or gave objective data that would dictate more aggressive therapy. Six men had a hemizona index of > 35%, predictive of adequate zona bind capability. Using these individual situations combined with gynecologic findings, recommendations are made as to identifying realistic options and therapeutic recommendations.

Adult↗

PubMed1976

Comparison of in vitro methods to determine drug-induced cell lethality.

In proliferating cell populations, the inability to reproduce indefinitely is the only relevant criterion to assess cell lethality. The in vitro colony formation technique (CF) used to determine reproductive death is, however, too slow and has several technical limitations. For finding suitable, more rapid techniques that assessed drug-induced cell killing, a human lymphoma cell line was exposed in vitro to increasing concentrations of adriamycin, bleomycin, and 1,3-bis(2-chloroethyl)-1-nitrosourea for 1 hr. Survival was assayed immediately after treatment and at regular intervals thereafter. Data from CF were compared to those resulting from the following tests: doubling time, labeling index, dye exclusion, 51Cr release, and rate of [3H]thymidine uptake (scintillation index). Dye exclusion and 51Cr release failed to demonstrate any killing effect for the 3 drugs. The percentage of killing calculated from doubling time determinations, although dose dependent, failed to correlate with CF. Scintillation and labeling index values displayed similar temporal fluctuations but were not clearly dose dependent and did not correlate with CF. Thus, CF appears as the most reliable, dose-dependent index of cell lethality. Tests that measure metabolic death grossly overestimate or underestimate killing activity induced by 3 of the most effective antitumor drugs.

Antineoplastic Agents↗

PubMedDate not supplied

The 25-year health care costs of women who remain overweight after 40 years of age.

BACKGROUND AND PURPOSE: Previously published reports strongly suggest that being overweight is a risk factor for coronary heart disease, hypertension, diabetes, gallstones, and osteoarthritis in women. Substantial health care and medication costs are associated with these chronic health conditions. We used an incidence-based analysis to estimate the excess costs associated with women maintaining an overweight status during the 25-year period from age 40 to 65 years. METHODS: The health care costs of three hypothetical cohorts of 10,000 40-year-old women were extrapolated to age 65. The non-overweight cohort maintained a body mass index (BMI; weight [kg]/height [m2]) of 21 to 24.9; the moderately overweight cohort maintained a BMI of 25 to 28.9; the severely overweight cohort maintained a BMI of > or = 29. The number of fatal and nonfatal health outcomes in each cohort for heart disease, hypertension, diabetes mellitus, gallstones, and osteoarthritis was calculated with their associated costs. RESULTS: We estimated that when compared with the non-overweight cohort of 10,000 women, the cohort of 10,000 women who had a BMI of > or = 29 incurred excess costs of $53 million over a 25 year period (discounted at 3% per year) and 497 excess deaths. The cohort of 10,000 women who had a BMI of 25-28.9 incurred excess costs of $22 million (discounted at 3% per year) and 212 excess deaths, compared with the non-overweight cohort. CONCLUSIONS: The results of this study indicate that an estimated $16 billion will be spent during the next 25 years treating health outcomes associated with overweight in middle-aged women in the United States. Thus, a substantial health burden is associated with the increasing prevalence of overweight women in the United States. Preventing excess coronary heart disease, gall-stones, osteoarthritis, hypertension, and diabetes through prevention of weight gain, particularly among reproductive-aged women, may be a cost-effective strategy.

Adult↗

PubMed2004

Effect of the insulin sensitizer pioglitazone on insulin resistance, hyperandrogenism, and ovulatory dysfunction in women with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism, chronic anovulation, and insulin resistance; long-term consequences include diabetes mellitus type 2. The aim of this randomized, double-blind, controlled trial was to investigate whether the thiazolidinedione derivative pioglitazone diminishes insulin resistance and hyperandrogenism and enhances ovulation rates in women with PCOS. Forty premenopausal women with PCOS were randomly allocated to treatment with either pioglitazone (30 mg/d) or placebo for periods of 3 months. Administration of pioglitazone resulted in a remarkable decline in both fasting serum insulin levels (P < 0.02) and the area under the insulin response curve after an oral glucose load (P < 0.02). This represented an increase in insulin sensitivity and a decrease in insulin secretion (P < 0.05). Furthermore, pioglitazone increased serum SHBG (P < 0.05), resulting in a significant decrease in the free androgen index (P < 0.05 compared with placebo). Treatment with pioglitazone was also associated with higher ovulation rates (P < 0.02). Thus, pioglitazone significantly improved insulin sensitivity, hyperandrogenism, and ovulation rates in women with PCOS, thereby providing both metabolic and reproductive benefits.

Adult↗

PubMed1996

Women in the central highlands of Irian Jaya, Indonesia.

The weight, height and mid-upper-arm circumference (MUAC) were measured in 159 women of reproductive age between June and November 1991 in four remote valleys in the Eastern Central Highlands of Irian Jaya, Indonesia. The average weight was 42.3 +/- 5.2 kg and 26% weighed less than 40 kg. The average height was 141.3 +/- 9.1 cm and 30% were shorter than 140 cm. By the MUAC measurement, the nutritional status was considered to be inadequate (MUAC less than 23 cm) in 58% of the women. 8% of the women were observed to be visibly pregnant and 43% were lactating. In the same period 112 women in the Yamil valley were visited at home. They had given birth to 331 children, of whom 83 had died before the age of five years, i.e. a child mortality rate of 251 per 1000 births. Nearly half of the mortality (45%) occurred shortly after birth.

Adolescent↗

PubMed2001

Obesity and weight change related to parity and breast-feeding among parous women in Brazil.

OBJECTIVE: Studies on the independent role of parity in long-term body weight change in economically developing countries are scarce and inconclusive, and only a few studies have taken into account patterns of breast-feeding. This association was examined in a national cross-sectional survey representative of Brazilian parous women. DESIGN AND SETTING: The survey conducted in 1996 measured women's height and weight in the household and data on weight prior to the first pregnancy, parity and breast-feeding were recalled. SUBJECTS: A sample of 2338 parous women, 15 to 49 years of age, 29 months after last delivery on average, had current body mass index (BMI, in kg m(-2)) modelled through hierarchical multiple linear regression analysis. Explanatory variables included parity, days of predominant breast-feeding, BMI pre-pregnancy, socio-economic, geographic, demographic and other reproductive variables. RESULTS: Prevalences of overweight (BMI = 25.0-29.9 kg m(-2)) and obesity (BMI > or = 30.0 kg m(-2)) were 25.2% and 9.3%. The overall mean weight gain per year after the first pregnancy was 0.90 kg for an average time since first pregnancy of eight years. BMI pre-pregnancy modified the association between current BMI and parity. Therefore, weight change attributed to parity calculated for a woman of average height (1.56 m) was 0.60 kg greater for primiparous women with a BMI pre-pregnancy of 30 kg m(-2), compared with women with BMI pre-pregnancy of 25 kg m(-2). This greater weight retention among obese women was 1.21 kg for women with two children and 1.82 kg for women with three or more children. Parity reduced the effect of weight loss associated with lactation (1.75 kg for six months of lactation among primiparous women and 0.87 kg among women with three or more children). For the sub-sample of 793 primiparous women, a weight decrease of 300 g was associated with each month of predominant breast-feeding for all prior BMI levels. CONCLUSIONS: In this study, weight change associated to reproduction was highly dependent on BMI previous to pregnancy and the effects of parity and lactation were small.

Adolescent↗