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PubMed2000

Depression and anxiety in early pregnancy and risk for preeclampsia.

OBJECTIVE: To examine whether depression and anxiety in early pregnancy are associated with preeclampsia in an unselected nulliparous population. METHODS: In this prospective population-based study during pregnancy at outpatient maternity clinics in the Helsinki metropolitan area, depression was assessed by a Finnish modification of the short form of the Beck Depression Inventory and anxiety by one established question. Preeclampsia was defined as elevated blood pressure (BP) (more than 140/100 mmHg) and proteinuria (0.3 g during 24 hours or more). Age, smoking, alcohol consumption, marital status, socioeconomic status, and bacterial vaginosis were analyzed as potentially confounding factors in a multiple logistic regression analysis. RESULTS: Six hundred twenty-three consecutive nulliparous women with singleton pregnancies were studied at ten to 17 (median 12) weeks' gestation and at delivery. Of them, 28 (4.5%) women developed preeclampsia. Depression (mean Beck score 4.5, range 3-17) was observed in 185 (30%), women and anxiety was observed in 99 (16%) in early pregnancy. In multivariate analysis, after adjustment for potentially confounding factors, depression was associated with increased risk (odds ratio [OR] 2.5; 95% confidence interval [CI] 1.1, 5.4) for preeclampsia, as was anxiety (OR 3.2; 95% CI 1.4, 7.4). Either depression or anxiety, or both, were associated with increased risk (OR 3.1; 95% CI 1.4, 6.9) for preeclampsia. Bacterial vaginosis together with depression was associated with increased risk (OR 5.3; 95% CI 1.8, 15.0) for preeclampsia. CONCLUSION: Depression and anxiety in early pregnancy are associated with risk for subsequent preeclampsia, a risk further increased by bacterial vaginosis.

Adolescent↗
PubMed2001

Physical activity and breast cancer risk: the Women's Health Study (United States).

OBJECTIVE: It is biologically plausible for physical activity to decrease breast cancer risk; however, epidemiologic studies have yielded inconsistent findings. We therefore examined physical activity and breast cancer risk in the Women's Health Study. METHODS: We assessed physical activity among 39,322 apparently healthy women, aged > or = 45 years, and prospectively followed them for an average of 48 months. Four hundred eleven women developed breast cancer, with 222 positive for both estrogen and progesterone receptors. RESULTS: Among all women the multivariate relative risks of all breast cancer associated with < 840, 840-2519, 2520-6299, and > or = 6300 kJ/week expended on recreational activities and stair climbing were 1.00 (referent), 1.04 (95% confidence interval, 0.77-1.40), 0.86 (0.64-1.17), and 0.80 (0.58-1.12), respectively; p-trend = 0.11. However, among postmenopausal women there was a significant inverse trend for all breast cancer; the corresponding relative risks were 1.0 (referent), 0.97 (0.68-1.4), 0.78 (0.54-1.1), and 0.67 (0.44-1.0), respectively; p-trend = 0.03. Physical activity was unrelated to breast cancers positive for both estrogen and progesterone receptors either among all or postmenopausal women (p-trend = 0.50 and 0.26, respectively). When we assessed only vigorous recreational activity, requiring > or = 6 METs or multiples of resting metabolic rate, we observed no significant associations with all or steroid hormone receptor positive breast cancer, either among all or postmenospausal women. CONCLUSIONS: These data suggest that physical activity during middle age and older is not uniformly associated with decreased breast cancer risk. Among postmenopausal women only, higher levels of physical activity may decrease the risk of breast cancer. This study, however, had limited statistical power to detect small effects.

Age Distribution↗
PubMed2001

Colorectal cancer complicating Crohn's disease.

Some earlier studies have indicated that patients with inflammatory bowel disease, especially those with long-standing and extensive ulcerative colitis, have an increased risk of colorectal cancer. Moreover, others in tertiary care centres have suggested that patients with Crohn's disease also have a higher risk of colorectal cancer. Canadian data on colorectal cancer in Crohn's disease appear to be limited. For this investigation, a single clinician database of 877 patients with Crohn's disease was used. Altogether, there were six patients with colorectal cancer (ie, overall rate of 0.7%). All of these patients were men with an initial diagnosis of Crohn's disease established at a mean age of approximately 28 years, with either ileocolonic disease or colonic disease alone, but not with ileal disease alone. Although there was a predominance of women in the overall study population (ie, 56.1%), no women developed colorectal cancer. The clinical behaviour of Crohn's disease was classified as nonstricturing in all six patients with colorectal cancer, but in two patients, Crohn's disease was complicated by a perirectal abscess or a fistula. All cancers were located in the rectum and were diagnosed 30 years, 22 years, seven years, 18 years, 20 years and 40 years after Crohn's disease was initially diagnosed. In three patients, the cancer was detected in a residual rectal stump after a partial colon resection at least 10 years earlier. In five patients, localized extension of disease through the serosa, nodal or distant metastases (ie, liver, lung) was found at the time of cancer diagnosis; two patients have since died. The present study confirms that Crohn's disease involving the colon may be a possible risk factor for the development of colorectal cancer, at least in younger men, but, in this study, not in women. However, part of this increased risk in men may have been related to the presence of a rectal stump, rather than to Crohn's disease per se.

Adenocarcinoma↗
PubMed1985

Characteristics and prognosis of lone atrial fibrillation. 30-year follow-up in the Framingham Study.

In 30 years of follow-up of 5,209 participants in the Framingham Study, 193 men and 183 women developed atrial fibrillation (AF). Among this group, "lone" AF occurred in 32 men and 11 women free of coronary heart disease, congestive heart failure, rheumatic heart disease, and hypertensive cardiovascular disease. To determine the characteristics and prognosis of lone AF, each case was matched to controls in the remaining Framingham sample. Comparisons indicated that levels of several risk factors associated with coronary heart disease were similar between the two groups. Atrial fibrillation cases, however, had significantly higher rates of preexisting nonspecific T- or ST-wave abnormalities and intraventricular block as determined by electrocardiograms. Follow-up for new cardiovascular events indicated similar rates of coronary heart disease and congestive heart failure, but the rate of strokes was significantly greater in the lone AF group. Findings suggest that subjects with lone AF, despite similar cardiovascular risk profiles to normal controls, have a distinct preponderance of preexisting electrocardiographic abnormalities. Furthermore, contrary to general belief, lone AF is not a benign condition; it has a serious prognosis, indicating a greater need for detection and treatment.

Adult↗
PubMed2002

Risk factors for progression of squamous cell cervical carcinoma in-situ to invasive cervical cancer: results of a multinational study.

OBJECTIVE: Human papillomaviruses (HPVs) are probably necessary causes of cervical carcinoma, but few infected women develop invasive cervical cancer, suggesting a role for cofactors. The purpose of this study was to identify cofactors associated with progression of carcinoma in-situ to invasion. METHODS: Data from in-person interviews of women included in a multinational, hospital-based case-control study of in-situ and invasive squamous cell cervical carcinoma were analyzed. In-situ cases and controls were compared to identify risk factors for carcinoma in-situ, and invasive and in-situ cases were compared to identify risk factors for progression to invasive disease. RESULTS: Risk of invasion was decreased in women with a history of cytologic screening, and in relation to other variables that likely represent enhanced opportunities for screening or clinical evaluation of symptomatic disease. No other risk or protective factors for progression were convincingly demonstrated. Risk of progression was not associated with multiple incidences of promiscuous sexual behavior, or use of steroid contraceptives, although there was a possible association with high parity. CONCLUSIONS: Possible cofactors that have been considered in this study alter the carcinogenicity of an HPV infection primarily prior to the development of cervical carcinoma in-situ. Women with a history of this condition need not avoid use of steroid contraceptives.

Adult↗
PubMed1998

Increased serum concentrations of interleukin-2 receptor in the first trimester in women who later developed severe preeclampsia.

BACKGROUND: To determine the concentration of cytokines having an immunomodulating effect in the first trimester in women who subsequently developed preeclampsia. METHODS: The serum concentrations of IL-10, TNFalpha, IL-6 and IL-2R were determined in ten women who later developed severe preeclampsia and in ten healthy controls. The groups were compared with the Mann-Whitney U test. RESULTS: The IL-2R concentration was significantly higher in the women who later developed preeclampsia than in normal patients (p = 0.028). No significant differences were detected between the groups with respect to the other evaluated cytokines. CONCLUSION: Elevated IL-2R concentrations in maternal serum as early as in the first trimester may be a sign of immunological maladaptation and might be associated with a disturbance of trophoblastic invasion.

Adult↗
PubMed2002

Alcohol consumption and risk of ischemic stroke: The Framingham Study.

BACKGROUND AND PURPOSE: Stroke is a major cause of death in the United States. The association between alcohol consumption and ischemic stroke (IS) remains controversial. METHODS: We used data collected on participants in the Framingham Study to assess the association between total alcohol intake and type of alcoholic beverage and development of IS, overall and according to age. RESULTS: A total of 196 men and 245 women developed IS during three 10-year follow-up periods. In the categories of never drinkers, drinkers of 0.1 to 11, 12 to 23, and > or =24 g/d of ethanol (a "typical drink" is approximately 12 g of ethanol), and former drinkers of 0.1 to 11 and > or =12 g/d, crude incidence rates of IS were 6.5, 5.9, 4.9, 5.0, 6.7, and 17.8 cases per 1000 person-years, respectively, for men and 5.9, 4.1, 4.1, 4.3, 8.3, and 7.1, respectively, for women. Overall, compared with never drinkers in a multivariate Cox regression, current alcohol consumption was not related significantly to IS in either sex. Former drinking of > or =12 g/d of alcohol was associated with a 2.4 times higher risk of IS among men but not among women. When stratified by age, alcohol intake was associated with lower risk of IS among subjects aged 60 to 69 years. In beverage-specific analysis, only wine consumption was related to a decreased risk of IS. CONCLUSIONS: Our data showed no significant association between total alcohol and IS overall but showed a protective effect of alcohol among subjects aged 60 to 69 years.

Age Distribution↗
PubMed1997

Incidence of ovarian cancer after hysterectomy: a nationwide controlled follow up.

OBJECTIVE: To estimate the risk of developing ovarian cancer after abdominal (total or subtotal) hysterectomy on benign indication. DESIGN: Prospective historical cohort study with 12.5 years of follow up. SETTING: Denmark, nationwide. POPULATION: All Danish women (aged 0 to 99 years) having undergone hysterectomy with conservation of at least one ovary for a benign indication from 1977 to 1981 (n = 22,135). Follow up was conducted from 1977 to 1991. The reference group included all Danish women who had not undergone hysterectomy, age-standardised according to the hysterectomy group (n = 2,554,872). METHODS: Registry data derived from the Danish National Register of Patients (diagnoses and operation codes) and the Civil Registration System (information about general population, including time of death). MAIN OUTCOME MEASURES: Incidence rate of ovarian cancer, lifetime risk of ovarian cancer, relative risk of ovarian cancer. RESULTS: Seventy-one women developed ovarian cancer on average 7.0 years after hysterectomy and 10,659 women in the reference group had ovarian cancer diagnosed after on average 6.4 years. The incidence rate of ovarian cancer was 0.27 per 1000 person-years in the group that had undergone hysterectomy and 0.34 per 1000 person-years in the general population (age-standardised). The extrapolated lifetime risk of developing ovarian cancer was 2.1% after hysterectomy and 2.7% in the general population (RR 0.78; 95% CI 0.60-0.96). CONCLUSIONS: The risk of ovarian cancer is lower among women who have undergone hysterectomy compared with those who have not. The protection seems to decrease with time.

Adolescent↗
PubMed2000

Umbilical endometriosis after unprotected removal of uterine pieces through the umbilicus.

We reviewed the frequency of umbilical endometriosis after laparoscopic-assisted subtotal hysterectomy with unprotected removal of uterine segments through the umbilical incision. Retrospective analysis of surgical records was followed by recall and clinical examination of 10 patients. Two women developed umbilical endometriosis. One was the only patient operated during menstruation. The other was one of two women operated in the late luteal phase and with subsequent adequate exposure to endogenous or exogenous estrogens. From 1976-1997, 22 reports of umbilical endometriosis were published: 18 cases were spontaneous, 2 occurred after ring sterilization, and 2 after diagnostic laparoscopy. These data lend support to the concept that implantation and the potential development of menstrual endometrium are increased after surgery. It is speculated that procedures that expose menstrual endometrial cells to nonepithelialized areas could be associated with an increased risk of endometriosis.

Adult↗
PubMed1995

Nonmelanoma skin cancer in Japanese ethnic Hawaiians in Kauai, Hawaii: an incidence report.

BACKGROUND: Incidence reports of nonmelanoma skin cancer (NMSC) in Japanese persons are limited. Most studies have relied primarily on hospital records or voluntary reporting systems. OBJECTIVE: Our purpose was to determine the incidence of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and Bowen's disease (BD) in a defined Japanese population. METHODS: A prospective 5-year population-based incidence study was conducted on the island of Kauai, Hawaii from 1983 through 1987. RESULTS: Thirty Japanese Kauai residents, 12 men and 18 women, developed BCC during the 5-year study period. At the same time, 24 Japanese, 6 men and 18 women, were identified with SCC, and 11 had BD, three men and eight women. When standardized to the Japanese population in Japan, the annual BCC incidence rate was 30 per 100,000 Japanese Kauai residents with an average patient age of 75 years. More than 80% of these BCCs were localized to the head and neck. New BCCs developed in four patients with BCC, but none was a recurrence of a previously treated lesion. Five patients with BCC had SCC or BD concurrently or at other times. The SCC incidence was 23 per 100,000 Japanese Kauai residents with an average patient age of 80 years. The head and neck were again the most common anatomic sites. New SCCs subsequently occurred in two patients, in one of whom a localized recurrence also developed. Five patients with SCC had BCC simultaneously or at other times. The incidence of BD was 13 per 100,000 Japanese Kauai residents with an average patient age of 74 years. The extremities were the most common anatomic sites. One patient later had a new BD lesion and a recurrent BD lesion. Two patients had BCC or SCC at other times. CONCLUSION: We report incidence rates of BCC, SCC, and BD at least 45 times higher in the Japanese population in Kauai, Hawaii than rates for the Japanese population in Japan. Kauai's intense UV radiation and emphasis on outdoor activities may contribute. More Japanese women had NMSC than men, a sex difference not observed in Japan.

Aged↗
PubMed2004

The metabolic syndrome and incident diabetes: assessment of four suggested definitions of the metabolic syndrome in a Chinese population with high post-prandial glucose.

AIMS: To assess the sensitivity and specificity of the four definitions of the metabolic syndrome for incident diabetes in both men and women. METHODS: The screening survey for type 2 diabetes was conducted in 1994. A follow-up study on 627 high-risk non-diabetic individuals at baseline was carried out in 1999 in Beijing area. 70 men and 76 women developed diabetes during the five-year follow-up. Sensitivity and specificity of four definitions of the metabolic syndrome based on the NCEP, WHO, EGIR and AACE recommendations were compared by McNemar's test. RESULTS: The metabolic syndrome based on all four definitions identified men at a 3.7-4.5-fold and women at a 1.6-2.8-fold risk of developing diabetes during 5-year follow-up. The AACE definition had the highest sensitivity for predicting diabetes (men: 0.61; women: 0.58) and lowest specificity (men: 0.71; women: 0.70). The WHO definition identified 53 % of male and 42 % female incident diabetes. The NCEP definition of adiposity as waist girth > 102 cm was the least sensitive, detecting only 27 % of incident diabetes in men; however, it was the most specific (0.91). The EGIR definition identified the lowest number of female cases (28 %) and fewer male cases (28 %) of incident diabetes, but was specific (women: 0.87; men: 0.91). CONCLUSIONS: Further studies on definition of the metabolic syndrome should focus on the potential ethnic differences in insulin resistance and anthropometric indicators for obesity.

Blood Glucose↗
PubMed1975

Neonatal risk following late gestational genital herpesvirus hominis infection.

Five women developed genital herpesvirus hominis (herpes simplex virus) infection beyond 32 week's gestation. Two of the women had fresh vesicular lesions at parturition. The five infants were delivered per vaginum at term and escaped subsequent overt herpesvirus hominis infection, although a scalp lesion in one infant was dismissed as inconsequential and disappeared without virologic study. Examination of the infants two months to four years after birth failed to detect sequelae of possible subclinical infection.

Child, Preschool↗
PubMed1994

Great expectations: challenges for women as mental health administrators.

Although women have made many strides in the area of leadership, stereotypes still exist that limit their power. Traditional concepts of femininity have not typically been associated with strength and competence. This article describes an inpatient unit at San Francisco General Hospital, University of California, San Francisco, which is led by a group of women. The unit houses a women-focused treatment team specializing in treating women who have serious mental illness with histories of severe trauma, including poverty and violence. The article describes the challenges and rewards available to women leaders in this type of setting. Four areas of women's leadership are explored: the stereotypes women have about each other as leaders, the expectations and biases of staff and trainees, the projections of patients onto women leaders, and women's leadership in relation to department administration. Strategies for addressing biases in these areas and developing women's leadership conclude the article.

Female↗
PubMed1979

Menstrual patterns and women's attitudes following sterilization by Falope rings.

Follow-up data on 147 women sterilized by laparoscopic Falope ring application were analyzed for changes in menstrual patterns, postoperative complications, patient feelings about surgery, and incidence of regret. Twelve to twenty-eight months after surgery, there were no consistent changes in interval, length, or amount of menstrual flow, and only 4% of women developed transient episodes of dysfunctional uterine bleeding. Analysis of feelings after sterilization showed that 90% of women were satisfied with the sterilization, 3% were unhappy, and 7% were ambivalent. Feelings of regret were not associated with postoperative complications and appeared to be related to the reasons for sterilization. Individual counseling not only helped to identify the population at risk for regret but also served to reduce the incidence of poststerilization ambivalent feelings.

Adult↗
PubMed1998

Medical risks for women who drink alcohol.

OBJECTIVE: To summarize for clinicians recent epidemiologic evidence regarding medical risks of alcohol use for women. METHODS: MEDLINE and PsychINFO, 1990 through 1996, were searched using key words "women" or "woman," and "alcohol." MEDLINE was also searched for other specific topics and authors from 1980 through 1996. Data were extracted and reviewed regarding levels of alcohol consumption associated with mortality, cardiovascular disease, alcohol-related liver disease, injury, osteoporosis, neurologic symptoms, psychiatric comorbidity, fetal alcohol syndrome, spontaneous abortion, infertility, menstrual symptoms, breast cancer, and gynecologic malignancies. Gender-specific data from cohort studies of general population or large clinical samples are primarily reviewed. MAIN RESULTS: Women develop many alcohol-related medical problems at lower levels of consumption than men, probably reflecting women's lower total body water, gender differences in alcohol metabolism, and effects of alcohol on postmenopausal estrogen levels. Mortality and breast cancer are increased in women who report drinking more than two drinks daily. Higher levels of alcohol consumption by women are associated with increased menstrual symptoms, hypertension, and stroke. Women who drink heavily also appear to have increased infertility and spontaneous abortion. Adverse fetal effects occur after variable amounts of alcohol consumption, making any alcohol use during pregnancy potentially harmful. CONCLUSIONS: In general, advising nonpregnant women who drink alcohol to have fewer than two drinks daily is strongly supported by the epidemiologic literature, although specific recommendations for a particular woman should depend on her medical history and risk factors.

Alcohol Drinking↗
PubMed2000

Testosterone supplemental therapy after hysterectomy with or without concomitant oophorectomy: estrogen alone is not enough.

Hysterectomy has the potential for generating serious consequences in terms of health, including two to seven times greater incidence and prevalence of cardiovascular disease, and quality of life, including loss of sexual libido and pleasure. More than a half-million American women undergo hysterectomy every year. Both in premenopausal women and in postmenopausal women, the ovaries are a critical source not only of estrogen but also of testosterone. Even in instances where ovaries have been spared on removal of the uterus, their function may be compromised. Today, women for whom estrogen replacement therapy is not contraindicated are routinely given supplemental estrogen following hysterectomy/oophorectomy. Many women develop and suffer symptoms of testosterone deficiency that go unrecognized and untreated. Testosterone supplemental therapy for women following hysterectomy not only can improve the quality of their lives in terms of sexual libido, sexual pleasure, and sense of well-being but also can--as does supplementary estrogen--contribute to the prevention of osteoporosis. Most importantly, an increasing body of evidence suggests that testosterone may be cardiovascular protective. As testosterone, the most potent anabolic steroid, has some anabolic effect on virtually every tissue in the body, it is likely that supplementing testosterone to physiological levels contributes to health maintenance in as yet undefined ways and that testosterone deficiency in women may be costing more in morbidity and mortality than we know at present.

Female↗
PubMed1997

Contraceptive practices before and after an intervention promoting condom use to prevent HIV infection and other sexually transmitted diseases among women--selected U.S. sites, 1993-1995.

Because heterosexual contact is the most common mode of human immunodeficiency virus (HIV) transmission among women, development of effective strategies to reduce sexually transmitted HIV infection is critical. In addition, because most women at risk for HIV infection are reproductive aged (14-44 years), effective use of contraceptives is important to prevent unintended pregnancies. Latex condoms used by males, when used consistently and correctly, are highly effective at reducing the risk for HIV infection and other sexually transmitted diseases (STDs); however, hormonal contraceptive methods or surgical sterilization are more effective for preventing pregnancy. One possible effect of encouraging women to use condoms for HIV/STD prevention with their male partners is that women may discontinue use of hormonal contraceptive methods. To assess whether encouraging women to use condoms for HIV/STD prevention affects their contraceptive practices, CDC analyzed longitudinal data on contraceptive methods and condom use for HIV/STD prevention that were collected as part of a randomized trial evaluating HIV-counseling methods during August 1993-June 1995. This report summarizes the findings of the analysis, which indicate that, among reproductive-aged women who were encouraged to use condoms for HIV/STD prevention, consistent condom use for HIV/STD prevention increased among women using each contraceptive method studied. In addition, most women using hormonal contraceptive methods continued to use them after the intervention, and the overall proportion of women protected against pregnancy increased.

Adolescent↗
PubMed2004

The natural history of maternal immunization against foetal platelet alloantigens.

Foetomaternal alloimmune thrombocytopenia (FMAIT) occurs when maternal antibodies of an antigen-negative mother cause destruction of sensitized foetal platelets. In Caucasian populations, 6-12% of human platelet antigen (HPA)-1a-negative women develop anti-HPA-1a, and the incidence of clinically affected cases is estimated to be 10-20% of immunized women. This study was performed in order to elucidate the rate of maternal immunization, incidence of FMAIT and the likely outcome of the condition in Asians. Excluding two or more pregnancies during the period, serum samples from 24 630 pregnant women, mainly Japanese, were screened for antibodies against platelet alloantigens by means of mixed passive haemagglutination (MPHA) (Anti-HPA-MPHA, Olympus, Tokyo). Antibodies were detected in 0.91% (223/24 630) of the women's samples and the immunization rate was correlated with the number of pregnancies. Antibody specificity included anti-HPA-4b (49), anti-HPA-5a (three), anti-HPA-5b (168), anti-HPA-4b + 5b (one) and anti-Nak(a) (CD36) (two). No alloimmunization was observed within the HPA-1, HPA-2, HPA-3 or HPA-6 systems. Among HPA-4b- or HPA-5b-negative women, 24% or 14% estimated, respectively, had antibodies and 26% (10/38) or 10% (12/125) of neonates, respectively, born to these mothers developed thrombocytopenia. Two neonates born to mothers having anti-HPA-4b developed generalized purpura. No cases of intracranial bleeding or death due to FMAIT were recorded. Generalized purpura due to FMAIT occurs in one in 9359 (95% CI: 1 in 77 519-1 in 2591) pregnancies solely because of HPA-4b incompatibility.

Antigens, Human Platelet↗