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PubMed1996

Anthropometric measures and metabolic rate in association with risk of breast cancer (United States).

To investigate whether cancer risk-reduction seen in calorie-restricted animals also applies to breast cancer in women, we have analyzed data from the first National Health and Nutrition Examination Survey in the United States and subsequent follow-up surveys. During the follow-up of one to 155 months, 182 out of 7,622 women developed breast cancer. Due to biased under-reporting of dietary intake, the analysis did not examine calorie intake as an exposure variable, but rather focused on anthropometric measures and metabolic rate as biomarkers of nutritional balance. Multiple Cox regression analysis showed elevated odds ratios (OR) for height, elbow width, and skinfolds among postmenopausal women. ORs for the fifth quintile were 2.0 (95 percent confidence interval [CI] = 1.0-3.8), 2.3 (CI = 1.2-4.7), and 2.0 (CI = 1.0-4.0), respectively. Weight (OR = 2.5, CI = 1.2-5.1) and resting metabolic rate (OR = 2.0, CI = 1.0-4.0) were significant relative to the second quintile. Bitrochanteric breadth, sitting height, body fat, body mass index, or combination variables were not associated with cancer risk. It was concluded that in the analysis of breast cancer data, skeletal measures ought to be considered as routine potential confounders, and that using measured rather than estimated metabolic rates may improve risk prediction.

Adipose Tissue↗
PubMed2002

Breast cancer screening in women previously treated for Hodgkin's disease: a prospective cohort study.

PURPOSE: Young women who are exposed to chest irradiation for Hodgkin's disease (HD) are at increased risk of breast cancer; this study investigated patient awareness of breast cancer risk and patient screening behavior and assessed the utility of mammographic screening in HD survivors. PATIENTS AND METHODS: This is a prospective cohort study of 90 female long-term survivors of HD who had been treated > or = 8 years previously with mantle irradiation (current age, 24 to 51 years). Participants completed surveys of their perceptions of breast cancer risk and screening behaviors and received written recommendations for breast examinations and mammography. Annual follow-up was conducted through medical records, telephone, and/or mailed questionnaires. RESULTS: At baseline, women were often unaware of their increased risk of breast cancer; 40% (35 of 87) reported themselves to be at equal or lower risk than women of the same age. Only 47% (41 of 87) reported having had a mammogram in the previous 24 months. Women who had received information from an oncologist were more likely to assess correctly their risk than women who received information from other sources (P <.001). Ten women developed 12 breast cancers (ductal carcinoma-in-situ [n = 2], invasive ductal carcinoma [n = 10]) during the study; two were diagnosed at study entry, and 10 during follow-up (median, 3.1 years). All cancers were evident on mammogram, and eight of 10 invasive cancers were node negative. CONCLUSION: Practitioners who care for women after HD therapy need to educate patients regarding their risks and begin early screening. Screening by mammography can detect small, node-negative breast cancers in these patients.

Adult↗
PubMed2001

Risk of new-onset urinary incontinence after forceps and vacuum delivery in primiparous women.

OBJECTIVE: We sought to determine the incidence of new-onset urinary incontinence after forceps and vacuum delivery compared with spontaneous vaginal delivery. STUDY DESIGN: We performed a prospective study in primiparous women delivered by forceps (n = 90), vacuum (n = 75), or spontaneous vaginal delivery (n = 150). Follow-up for urinary incontinence was at 2 weeks, 3 months, and 1 year after delivery. RESULTS: The incidence of urinary incontinence was similar in the 3 groups at 2 weeks after delivery. The proportion of women developing new-onset urinary incontinence decreased significantly over time in the spontaneous vaginal (P =.003) and vacuum delivery groups (P =.009) but not in the forceps group (P =.2). No relationship of urinary incontinence with vaginal lacerations, epidural anesthesia, length of second stage of labor, or infant birth weight was seen. CONCLUSIONS: In primiparous women, urinary incontinence after forceps delivery is more likely to persist compared with spontaneous vaginal or vacuum delivery.

Adult↗
PubMed2004

Recent advances and problems in primary therapy for cervical cancer in Taiwan.

Cervical cancer is a serious health problem in Taiwan, with nearly 2700 women developing the disease each year. The estimated incidence of this disease from 1993 to 1997 was 21.8 per 100,000 woman-years. The lack of effective Papanicolaou smear screening systems was the major cause of the high prevalence rate before 1995. Surgery and radiotherapy are the standard treatments for early stage cervical cancer. For women with advanced stage cervical cancer, external-beam pelvic radiation followed by intracavitary radiotherapy is the treatment of choice. Although randomized clinical trials have shown that concurrent chemoradiotherapy should be regarded as the standard treatment for locally advanced cervical cancer (stage IIB to IVA), the impact of the complications associated with this treatment have not been evaluated in Taiwanese studies. Localized bulky (stage IB2 or bulky IIA) tumors are commonly treated with various combinations of chemotherapy, surgery and radiotherapy, despite unresolved concerns about the morbidity and effectiveness of this approach compared with definitive radiotherapy or radical surgery. Although about 60% of Taiwanese women with cervical cancer receive primary surgical treatment, about 20% do not receive treatment or receive non-standard therapies. Efforts are needed to increase the screening rate, to improve access to medical care, and to provide public education for patients to reduce the occurrence and mortality of cervical cancer in Taiwan.

Female↗
PubMed1990

[Routine breast examination and early detection of hypertension and diabetes mellitus by primary care physicians ].

Breast cancer is the leading cause of cancer mortality among women is Israel. On average, 1 in every 12 women develops the disease. While breast self-examination has not proved effective, and routine mass mammography is at present unavailable to the population at large, regular routine breast examination by primary care physicians can effectively screen a large fraction of this country's population. In order to do so, full acceptance of the procedure by women and their physicians is required. This study examines the attitudes and practice of primary care physicians with regard to routine breast examination, and compares them with routine detection of hypertension and diabetes mellitus. A structured questionnaire was distributed to all 97 Kupat Holim (workers' federation sick fund) primary care physicians in the Negev. They included 40 family physicians (FP), board-certified or completing specialization, and 57 general practitioners (GP), not board-certified. There was no difference in response rate between the 2 groups (47%). Nearly all physicians perform routine examinations for detection of hypertension (100% of the FP and 96% of the GP) and diabetes mellitus (91% and 74%, respectively). Of the FP, 96% consider routine breast examination as the task of the primary care physician, versus only 68% of the GP. Accordingly, 92% of the FP stated that they routinely perform the procedure, but only 52% of the GP. Being an FP was positively related with the performance of breast examination, while seeing a large number of patients per clinic session and low job satisfaction were negatively associated with it.

Attitude of Health Personnel↗
PubMed2001

Management of accidental dural puncture in labour with intrathecal catheters: an analysis of 10 years' experience.

The records of 15030 labour epidural blocks were analysed. Seventy-two accidental dural punctures (ADP) were recognised at the time of the procedure. In 34 women an epidural catheter was inserted intrathecally through the Tuohy needle and continuous spinal analgesia provided. In a further 37 women the primary management of ADP was to resite an epidural catheter. One woman who received a microspinal catheter later in labour was excluded from analysis. There were no significant differences in maternal characteristics, quality of labour analgesia and anaesthesia, or mode of delivery between the groups. Three repeat ADPs occurred during attempts to resite the epidural. Two women developed high blocks after epidural resiting, one of whom required intubation and ventilation. There was one high block in the intrathecal catheter group. The incidence of postdural puncture headache was 71% in the intrathecal catheter group compared with 81% in the non-intrathecal catheter group (P = 0.45). Epidural blood patch was performed on 50% of women managed with intrathecal catheters compared with 73% of those managed without (P = 0.08). Following ADP in labour an intrathecal catheter is a simple and effective alternative to resiting an epidural. Recognition of ADP is important as it allows appropriate management avoiding possible complications of administering epidural top-ups in the presence of a dural tear.

Journal Article↗
PubMedDate not supplied

Working women's breastfeeding experiences.

PURPOSE: To describe the breastfeeding experiences of women who returned to work after childbirth. DESIGN AND METHODS: Descriptive, using questionnaires with 50 women. Content analysis of data obtained from women who responded to open-ended questionnaires at 16 weeks postpartum. Three procedures were used: coding data, categorizing text units, and refining the emerging themes. RESULTS: Four categories emerged from the data:support, attitude, strategic plan, and psychological distress. The women expressed a need for support such as an accepting environment, spatial issues, modeling, and time allowance. They needed to maintain a positive attitude so they could commit to and accomplish their breastfeeding goals. The women developed strategic plans to help prevent breastfeeding problems as well as continue breastfeeding successfully. Finally, they described psychological distress as a conflict between the demands of work and the breastfeeding process. Associated feelings included guilt, stress, or having to sacrifice. CLINICAL IMPLICATIONS: These findings can help nurses and other healthcare professionals in providing anticipatory guidance to women who plan to continue breastfeeding after returning to work. Further research should investigate the relationship between psychological distress, work productivity, family functioning, and breastfeeding activities of working women who breastfeed.

Adaptation, Psychological↗
PubMed1997

The effect of a desogestrel-containing oral contraceptive on glucose tolerance and leptin concentrations in hyperandrogenic women.

Ovarian hyperandrogenism can be associated with insulin resistance, hyperinsulinemia, glucose intolerance, and obesity. High levels of the lipostatic hormone, leptin, have also been reported in this condition. The purpose of the present study was to examine the effect of an oral contraceptive (OC) of low androgenicity containing desogestrel on glucose tolerance in hyperandrogenic women and the impact of changes in androgenic/estrogenic status on leptin concentrations. Sixteen nondiabetic hyperandrogenic women, aged 29 +/- 1 yr with a body mass index (BMI) of 36.8 +/- 1.8 kg/m2, underwent an oral glucose tolerance test before and after 6 months of therapy with the OC. Free testosterone decreased and sex hormone-binding globulin increased after therapy (P < 0.001). Glucose tolerance deteriorated significantly, and two women developed diabetes. Body weight, BMI, and leptin did not change significantly. Leptin correlated with BMI before (r = 0.56; P = 0.02) and after (r = 0.51; P = 0.04) treatment, but not with glucose, insulin, total and free testosterone, or sex hormone-binding globulin before or after treatment. In conclusion, 1) glucose tolerance should be monitored in hyperandrogenic women using OC, even those of low androgenicity; and 2) changes in androgenic/estrogenic status had no effect on the leptin concentration, suggesting that its sexual dimorphism is not related to sex steroids.

Adult↗
PubMed1999

Sonographic assessment of the endometrium in osteopenic postmenopausal women treated with idoxifene.

Idoxifene is a novel selective estrogen receptor modulator that has shown beneficial effects on bone turnover and lipid metabolism in clinical studies. Preclinical studies have demonstrated that idoxifene has estrogen antagonist activities on the endometrium. This paper describes the results of a double-blind, placebo-controlled, and dose ranging study involving 331 osteopenic postmenopausal women who were treated with either placebo or idoxifene (2.5, 5, or 10 mg/day) for 12 weeks. In these women, endometrial assessment was carried out by transvaginal sonography and endometrial biopsy on selected patients at baseline and on all women at the end of treatment. Women with an endometrial thickness greater than 10 mm were excluded from the study. Aspiration endometrial biopsy was performed on women with an endometrial thickness between 6 and 10 mm at baseline and on all women after treatment. Of the 298 biopsies performed in the subjects at the end of treatment, 99% of the women were reported to have either a benign or atrophic endometrium (85%) or insufficient tissue for diagnosis (14%). Proliferative histologic features were reported in two cases (1%) (2.5 mg idoxifene) and atypical hyperplasia in one placebo patient. Even though idoxifene use was associated with a dose related increase in endometrial thickness as evaluated by transvaginal sonography, no relationship was established between endometrial histologic features and change in endometrial thickness. On histologic analysis, the increase in endometrial thickness seen on transvaginal sonography was not associated with proliferative or hyperplastic change in the epithelial (glandular) endometrial tissue. In 48 patients (16% of total) transvaginal sonography showed endometrial thickening of 5 mm or more over the study period. The endometrial histologic features were benign in all these patients. Nineteen percent of women developed intraluminal fluid, even though endometrial thickness was normal and unchanged and histologic features were normal. Our data show that after 3 months of treatment, no significant pathologic changes of the endometrium were observed. Our data indicate that measurements of endometrial thickness by transvaginal sonography may falsely suggest the presence of endometrial pathologic changes in some postmenopausal women treated with idoxifene. Additional testing using saline infusion sonohysterography is an important part of the transvaginal sonography protocol in equivocal or abnormal cases to exclude focal lesions such as polyps. In addition, our data indicate that pathologic changes of the endometrium are extremely rare in the treated group, indicative of its short term safety. Continued investigation such as this will be needed to establish long term safety.

Aged↗
PubMed1999

[Comprehensive treatment of ileofemoral thrombosis at the end of pregnancy with cesarean section in combination with thrombectomy].

Acute deep ileofemoral thrombosis was treated at the end of pregnancy in four pregnant women. A multidisciplinary approach was selected. During a single anaesthesia the team of obstetricians and neonatologists made a Caesarean section followed by thrombectomy with a Fogarty catheter. This operation was performed by a team of specialists in cardiovascular surgery. Two women developed rethrombosis: one woman on the following day, the second one two weeks after surgery. In both instances repeated thrombectomy was performed. In one woman the cause of ileofemoral thrombosis was malignant disease of the uterine cervix II and this woman is, after oncological treatment, in a serious condition due to the basis disease. The remaining three women were repeatedly subjected to phlebographic examinations and complete patency of the deep vascular system was found. These women are free from subjective and objective complaints and can look after their children. Pregnant women where a serious ileofemoral thrombosis was diagnosed had high fibrinogen and thrombocyte levels. In two women an AT III deficiency was found. There was also a high cholesterol level and positive antiphospholipid antibodies. Thrombectomy has according to the authors' experience very good results when the operation is implemented within 72 hours after initial symptoms. This procedure reduces the risk of chronic venous insufficiency.

Adult↗
PubMedDate not supplied

[Integrated attention of epileptic women].

INTRODUCTION: The treatment of epileptic seizures is only one aspect of the integrated treatment of epileptic women. DEVELOPMENT: Treatment should take into account, apart from the control of seizures, the short and long term side effects of antiepileptic drugs (AEDs), the effect of sex hormones on seizures, the effect of epilepsy and the AEDs on reproductive well being, and the social and psychological problems of these patients. Integrated attention of these patients should give epileptic women information and education so that they may participate effectively in matters affecting them. CONCLUSION: In this paper we review the special characteristics of treatment of epileptic women and summarize several different guidelines regarding this.

Anticonvulsants↗
PubMed2003

Osteoporosis in 5 elderly women with pubic osteolysis.

5 elderly women developed pubic osteolysis after spontaneous fracture of the pubic bone. Radiographs showed gradual progression of the osteolysis, followed by callus formation, and bone union after 4-5 months. Bone mineral density was low in all patients. White blood cell count, erythrocyte sedimentation rate, and C-reactive protein were normal. Urine deoxypyridinoline was high, but serum osteocalcin normal. Elderly women with spontaneous fractures and osteolysis of the pubic bone should be considered for evaluation of osteoporosis and treatment.

Aged↗
PubMed1984

Breast cancer developing in four women cured of Hodgkin's disease.

Four patients developed breast cancer 11 to 17 years after treatment for Hodgkin's disease. Three patients received radiotherapy only, and one received radiation plus chemotherapy. This study is in keeping with the report by Nelson and associates that with duration of follow-up exceeding 10 years, there is an increase of breast cancer in women treated for Hodgkin's disease that is similar to or greater than the risk of breast cancer in women treated with radiation for benign breast disease and is probably independent of chemotherapy.

Adolescent↗
PubMed2001

Sjogren's syndrome.

Sjogren's syndrome is a chronic progressive autoimmune disorder manifested predominately by xerostomia (dry mouth) and keratoconjunctivitis sicca (dry eyes). It can also affect many body systems. Up to 5% of people over the age of 60 years have primary Sjogren's syndrome, and approximately one third of patients present with extraglandular (systemic) manifestations. This disease is seen mostly in middle-aged women, with a small but significant proportion of these women developing lymphoid neoplasia. The exact etiology is still unknown. This autoimmune disorder is characterized by B-cell activation, the production of numerous auto-antibodies, and the loss of immune tolerance. Salivary gland biopsy remains the most helpful diagnostic test. Treatment is aimed at moisture replacement, which alleviates the discomfort and slows the destructive process. Because of its prevalence in older women, the obstetrician-gynecologist must be aware of the diagnostic and therapeutic approach to Sjogren's syndrome.

Journal Article↗
PubMed1996

Screening primiparous women and newborns for fetal/neonatal alloimmune thrombocytopenia: a prospective comparison of effectiveness and costs. Immune Thrombocytopenia Working Group.

A prospective study was conducted in three maternity wards to compare the medical outcomes and the costs of two screening strategies for the detection of fetal/neonatal alloimmune thrombocytopenia (FMAIT). A total of 2066 primiparas and 6081 newborns were included. Fifty-two primiparous women with HPA-1b phenotype were found, and 45 were followed during pregnancy. Four women developed antibodies, and two fetuses exhibited FMAIT; therefore, the prevalence of anti-HPA-1a was 2 per 1000, and the prevalence of FMAIT 1 per 1000. Forty-eight thrombocytopenic newborns were found out of a total of 5632 blood samples. Five were HPA-1a children whose mothers were HPA-1b. The cost-effectiveness of screening all primiparous women was $45,000 and of screening all newborns is $18,000-per anti-HPA-1a alloimmunization diagnosed. Costs per fetal death or disability averted were $500,000 for the primiparous strategy and $225,000 for the newborn strategy. In conclusion, screening newborns for neonatal alloimmune thrombocytopenia is more cost-effective than screening primiparous women.

Antigens, Human Platelet↗
PubMed1997

Determinants of bone mineral density in postmenopausal white Iowans.

BACKGROUND: Osteoporosis is a major health problem for older individuals. For women, development of osteoporosis is a function of the accretion of "peak" bone mass in the third decade, age at menopause, and rate of bone loss with aging. Low bone mineral density (BMD) is a major risk factor for osteoporosis and fracture. The purpose of this study was to identify life style, nutritional, medical, and genetic predictors of low BMD in postmenopausal Iowa women. METHODS: One hundred thirty-four postmenopausal White women ranging in age from 57 to 81 years were included in this case-control study. Bone mineral density was measured at the femoral neck, using dual photon X-ray absorptiometry (Hologic 2000 QDR). Sixty-six women with BMD measurements below 0.68 g/cm2 (the bottom quartile of the BMD distribution in the population from which participants were recruited), and 68 women with values at or above 0.83 g/cm2 (the top quartile of the BMD distribution in the same population) were included. Information about environmental, nutritional, medical, and life style modifiers of BMD was obtained by written questionnaire and telephone interview. To assess familial factors that might influence BMD, we obtained a detailed family history for each participant. In addition, we tested the hypothesis that allelic variation at the Vitamin D receptor (VDR), and the type I collagen gene (COL1A1 and COL1A2) loci influence BMD. RESULTS: Weight, loss of height, age, and age at menopause were strong predictors of BMD in our population. After adjustment for these differences, we found no effect of genotype at the COL1A1, COL1A2, and VDR loci on BMD. CONCLUSIONS: Bone mineral density is a complex trait that is influenced by several different modifiers; in the present study, weight was the best predictor of postmenopausal BMD. While several studies suggest that VDR genotype is an important determinant of BMD, we did not find this association in our population, nor did we identify an association between allelic variation at the type I collagen gene loci and BMD. Identification of genes that determine body mass index may provide additional insight into risk factors for low BMD, and osteoporotic fractures.

Aged↗
PubMed2003

C-reactive protein and the risk of developing hypertension.

CONTEXT: Although it has been hypothesized that hypertension is in part an inflammatory disorder, clinical data linking inflammation with incident hypertension are scarce. OBJECTIVE: To examine whether C-reactive protein levels, a marker of systemic inflammation, are associated with incident hypertension. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study that began in 1992 of 20 525 female US health professionals aged 45 years or older who provided baseline blood samples with initially normal levels of blood pressure (BP) (systolic BP <140 mm Hg and diastolic BP <90 mm Hg, and no history of hypertension or antihypertensive medications) and then followed up for a median of 7.8 years for the development of incident hypertension. Plasma C-reactive protein levels were measured and baseline coronary risk factors were collected. MAIN OUTCOME MEASURE: Incident hypertension, defined as either a new physician diagnosis, the initiation of antihypertensive treatment, or self-reported systolic BP of at least 140 mm Hg or a diastolic BP of at least 90 mm Hg. RESULTS: During follow-up, 5365 women developed incident hypertension. In crude models, the relative risks (RRs) and 95% confidence intervals (CIs) of developing hypertension from the lowest (referent) to the highest levels of baseline C-reactive protein were 1.00, 1.25 (95% CI, 1.14-1.40), 1.51 (95% CI, 1.35-1.68), 1.90 (95% CI, 1.72-2.11), and 2.50 (95% CI, 2.27-2.75) (linear trend P<.001). In fully adjusted models for coronary risk factors, the RRs and 95% CIs were 1.00, 1.07 (95% CI, 0.95-1.20), 1.17 (95% CI, 1.04-1.31), 1.30 (95% CI, 1.17-1.45), and 1.52 (95% CI, 1.36-1.69) (linear trend P<.001). C-reactive protein was significantly associated with an increased risk of developing hypertension in all prespecified subgroups evaluated, including those with very low levels of baseline BP, as well as those with no traditional coronary risk factors. Similar results were found when treating C-reactive protein as a continuous variable and controlling for baseline BP. CONCLUSION: C-reactive protein levels are associated with future development of hypertension, which suggests that hypertension is in part an inflammatory disorder.

Biomarkers↗