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PubMed1997

One hundred consecutive cases of selective termination of an abnormal fetus in a multifetal gestation.

OBJECTIVE: To determine whether transabdominal selective termination of one or more abnormal fetuses in a multifetal pregnancy with dichorionic placentation is a safe and effective procedure. METHODS: One hundred consecutive selective termination procedures were performed by transabdominal injection of potassium chloride into the heart or umbilical vein of an anomalous fetus in a multifetal pregnancy. All of the abnormal fetuses were presumed to have dichorionic diamniotic placentas, based on an ultrasound evaluation before the procedure. Follow-up data were obtained for each patient regarding the development of postprocedural complications, laboratory or clinical evidence of a coagulopathy, maternal or neonatal morbidity, gestational age at delivery, and birth weight of the infants. RESULTS: Ninety-one sets of twins were reduced to singletons, six sets of triplets were reduced to twins, two sets of triplets were reduced to singletons, and one set of quadruplets was reduced to triplets. The anomalous fetus or fetuses were identified correctly and terminated in each case. Three patients spontaneously aborted, and one women electively terminated her pregnancy 2 weeks after the procedure. The mean gestational age at delivery of the 96 patients who delivered surviving infants was 36.8 weeks, and 85.4% delivered at 32 weeks or later. Three women developed laboratory evidence of a coagulopathy, but there were no cases of clinically evident disseminated intravascular coagulation. CONCLUSION: This procedure, performed at a single institution by a small number of operators using a common protocol, accomplished its objective in all cases, was accompanied by a low spontaneous loss rate, and resulted in the birth of healthy infants at or near term in the vast majority of cases. This series suggests that selective termination is a reasonable option to consider when one abnormal fetus is found in a multifetal pregnancy with dichorionic placentation.

Abortion, Eugenic↗
PubMed1998

Postmenopausal hormone use and risk for colorectal cancer and adenoma.

BACKGROUND: Accumulating evidence suggests that postmenopausal hormone use may decrease the risk for colorectal cancer. OBJECTIVE: To examine the relation of postmenopausal hormone therapy to colorectal adenoma and cancer. DESIGN: Prospective cohort and nested case-control studies. SETTING: Nurses' Health Study, a study of registered nurses recruited from 11 U.S. states. PARTICIPANTS: 59 002 postmenopausal participants in the Nurses' Health Study. MEASUREMENTS: Self-reported data on hormone use and cases of distal colorectal adenoma and colorectal cancer obtained from biennial questionnaires completed from 1980 to 1994. Cases of colorectal adenoma and cancer were confirmed by medical record review. RESULTS: 470 women developed colorectal cancer, and 838 developed distal colorectal adenomas. Current use of postmenopausal hormones was associated with a decreased risk for colorectal cancer (relative risk [RR], 0.65 [95% CI, 0.50 to 0.83]). This association was attenuated in past users (RR, 0.84 [CI, 0.67 to 1.05]) and disappeared 5 years after hormone use was discontinued (RR, 0.92 [CI, 0.70 to 1.21]). Longer duration of current use did not afford greater protection (RR with > or =5 years of use, 0.72 [CI, 0.53 to 0.96]). Even after exclusion of women who reported having screening sigmoidoscopy, the relative risk for colorectal cancer seen with current hormone use was 0.64 (CI, 0.49 to 0.82). This suggests that the apparent protection is unlikely to be due to more intensive screening among hormone users. Current users also had a lower risk for large (> or =1 cm) adenomas than did women who had never used hormones (RR, 0.74 [CI, 0.55 to 0.99]), although no overall material association was seen between colorectal adenoma and current hormone use (RR, 0.91 [CI,0.77 to 1.08]). CONCLUSIONS: The risk for colorectal cancer was decreased among women currently receiving postmenopausal hormone therapy, but the apparent reduction substantially diminished upon cessation of therapy. Hormone use was inversely associated with large colorectal adenomas but not small ones.

Adenoma↗
PubMed1998

Prospective evaluation of 618 pregnant women exposed to parvovirus B19: risks and symptoms.

OBJECTIVE: To assess the risk of maternal parvovirus B19 infection from exposure to various sources and the fetal morbidity of those infections. METHODS: We obtained demographic and occupational information about pregnant women exposed to sources of B19 and about the nature and duration of the exposures. We performed serologic testing 10-14 days after exposure using an indirect capture enzyme-linked immunosorbent assay. Women with immunoglobulin (Ig) M were examined with weekly ultrasound until 12 weeks after exposure, and the outcome of the pregnancy was ascertained from interviews with patients and their obstetricians. Logistic regression analysis was used to determine risk factors for maternal immunity and infection by B19. RESULTS: Of 618 pregnant women exposed, 307 (49.7%) were immune to B19, 259 remained susceptible after exposure, and 52 (16.7% of all susceptibles) contracted B19 infection. None of the 52 fetuses of infected women developed nonimmune hydrops, and there were no fetal deaths attributable to B19 in this group. The relative risk of maternal B19 infection was 2.8 if the source was a related child living in the household (95% confidence interval 1.7, 4.6; P < .001). No significant differences were found for maternal B19 infection in eight categories of maternal occupation. Maternal symptoms of polyarthralgia (46%), fever (19%), and nonspecific rash (38%) were significantly more common (P < .001) in IgM-positive patients than in noninfected women (4.1%, 2.8%, and 5.7%, respectively). Only 17 (33%) of the IgM-positive women were entirely asymptomatic. CONCLUSION: The risk of maternal B19 infection in pregnancy could not be predicted by a gravida's occupation, but it was significantly higher when the source of exposure was her own child. The fetal risk of nonimmune hydrops after maternal B19 infection must be very low. As a consequence, exclusion of pregnant women from the workplace during endemic periods with seasonal clusters of cases is not justified. Weekly fetal ultrasound evaluation in these cases carries a low yield.

Adult↗
PubMed2005

A weight gain chart for pregnant women designed in Chile.

The weight gain chart for pregnant women, developed by Rosso and Mardones (RM chart, 1997), is analysed and compared with other charts in terms of its usefulness for targeting nutritional interventions aimed at preventing low or high birth weights. The RM chart defines categories of maternal nutritional status in early gestation based on weight/height, expressed either as percentage of standard weight (PSW) or body mass index (BMI), and desirable gestational weight gains for each of these categories. Weight gain recommendations of the RM chart are proportional to maternal height. For underweight women the weight recommendation was derived from actual data, while for overweight and obese women it is based on data extrapolations. Since 1987 the Chilean National Health Service has used the RM chart as a standard in prenatal care in all its clinics, covering approximately 70% of the country's population, mostly middle and low income women. During the 1987-2001 period the proportion of underweight pregnant women and infants with birth weight < 3000 g decreased significantly and proportionally. Nevertheless, the proportion of obese pregnant women and infants with birth weight > or = 4000 g increased during this period. Multifactorial social changes including a decade of substantial economic growth in the country with improved family income, precludes the possibility of determining the efficacy of the RM chart in this group. However, the widespread use of the RM chart indicates that it is a helpful and easy-to-use instrument in the field. Further, by its clear graphical presentation of maternal nutritional status it helps draw the attention of health personnel to women who need special nutritional advice and support.

Adult↗
PubMed1996

Hypothalamic corticotropin-releasing hormone suppression during the postpartum period: implications for the increase in psychiatric manifestations at this time.

The third trimester of human pregnancy is characterized by a hyperactive hypothalamic-pituitary-adrenal axis, possibly driven by progressively increasing circulating levels of placental CRH and gradually decreasing levels of CRH-binding protein. The postpartum period, on the other hand, is characterized by an increased vulnerability to psychiatric manifestations (postpartum "blues," depression, and psychosis), a phenomenon compatible with suppressed hypothalamic CRH secretion. To investigate the hypothesis that the postpartum period is associated with suppression of hypothalamic CRH secretion, we studied prospectively 17 healthy euthymic women (mean +/- SE age, 32.0 +/- 1.1 yr) with no prior history of depression, starting at the 20th week of gestation. Psychometric testing was performed monthly during pregnancy and postpartum on day 2 and weeks 2, 3, 6, 8, 12, 16, and 20, whereas serial ovine (o) CRH tests were performed postpartum at 3, 6, and 12 weeks. While pregnant, all 17 subjects remained euthymic; in the postpartum period, 7 women developed the "blues," and 1 developed depression. Overall, the mean plasma ACTH response to an iv bolus of 1 microgram/kg oCRH was markedly blunted at 3 and 6 weeks, but normal at 12 weeks postpartum, whereas the mean plasma cortisol response was at the upper limit of normal at all 3 times. These data are compatible with a suppressed hypothalamic CRH neuron that gradually returns to normal while hypertropic adrenal cortexes are progressively down-sizing. When the postpartum ACTH responses to oCRH were analyzed separately for the euthymic women and the women who had the "blues" or depression, the blunting of ACTH was significantly more severe and long lasting in the latter group; this was observed at all 3 times of testing. We conclude that there is central suppression of hypothalamic CRH secretion in the postpartum, which might explain the increased vulnerability to the affective disorders observed during this period. The suppressed ACTH response to oCRH might serve as a biochemical marker of the postpartum "blues" or depression.

Adrenocorticotropic Hormone↗
PubMed2005

Pregnancy outcomes in women of very advanced maternal age.

OBJECTIVE: To assess outcomes for pregnancies progressing beyond 20 weeks' gestation in women of very advanced maternal age. DESIGN: Retrospective cohort study. SETTING: Two tertiary level obstetric hospitals. POPULATION: Women aged 45 years or more at the time of delivery over a 10-year period from 1 January 1992 to 31 December 2001. METHODS: Information regarding maternal, pregnancy and neonatal outcomes was obtained from the medical records. For comparison, routinely collected data from the obstetric database was obtained for women aged 20-29 years. RESULTS: Seventy-seven pregnancies in 76 women aged 45 years and over were registered in the 10-year period. There were 74 liveborn singletons, two sets of liveborn twins and one set of twins stillborn at 20 weeks' gestation. Sixteen women were primiparous. Eighty-four percent of pregnancies were conceived naturally and 53% underwent prenatal chromosomal determination; 53% of women had no pre-existing medical problems, 13% had hypertensive disorders of pregnancy and 8% of women developed gestational diabetes. There were 10 preterm and six post dates deliveries. The Caesarean section rate was 49%, compared to 23% in the 20-29 years age group (P < 0.001). Ten percent of neonates were small for gestational age, and 8% were large for gestational age. Seventeen percent required admission to the special care nursery and 6% had congenital abnormalities. CONCLUSIONS: Maternal and neonatal outcomes in this series were generally good. There was a significantly increased rate of Caesarean section. Overall, this study is reassuring for women aged 45 and over who have good general health and a chromosomally normal fetus.

Cesarean Section↗
PubMed2004

Recurrence of Sydenham chorea: implications for pathogenesis.

BACKGROUND: Sydenham chorea (SC), a major sign of rheumatic fever (RF), is related to systemic streptococcal infection and is treated with antibiotics. Recurrence usually occurs within a short interval following the initial event and is considered part of RF. OBJECTIVE: To evaluate the rate, nature, and course of recurrent SC during an extended follow-up period. DESIGN: Prospective assessment of a cohort of patients with SC who were admitted between 1985 and 2002. SETTING: General community hospital. METHODS: Diagnosis of RF was based on the revised Jones criteria. Other causes of chorea were excluded. Recurrence was defined as the development of new signs, lasting more than 24 hours and separated by a minimum of 2 months from the previous episode. Patients were observed from 1 to 14 years following the initial SC episode and for at least 1 year after recurrence. At recurrence, patients were assessed for RF clinical and laboratory activity, including change in cardiac involvement. RESULTS: Twenty-four patients had SC. In 19 patients (79%), the chorea was associated with other RF signs, and 5 suffered from pure chorea. Ten patients (42%, 7 women) developed 11 recurrent episodes of chorea 3 months to 10 years after the initial episode. Association of recurrent chorea with RF could be suspected in only 6 episodes: cessation of prophylactic antibiotic treatment or poor compliance in 4 patients and rise in antistreptolysin O titers in 2. In an 18-year-old woman, chorea recurred during her first pregnancy. At recurrence, chorea was the sole rheumatic sign in all 9 patients who had 1 recurrent episode. In the patient with 2 recurrent episodes, mitral regurgitation developed into mitral stenosis. No statistical differences in previous RF activity and rheumatic cardiac involvement between patients with recurrent SC and patients with a single episode could be found. CONCLUSIONS: In a significant subgroup of patients, SC recurrence might not be a true relapse of rheumatic fever. It might represent either a primary underlying abnormality that renders patients susceptible to developing such a movement disorder or the outcome of permanent subclinical damage to the basal ganglia following the initial SC episode.

Adolescent↗
PubMedDate not supplied

Preventive health services use, lifestyle health behavior risks, and self-reported health status of women in Ohio by ethnicity and completed education status.

This study assessed the health status and behavior of college-educated and non-college-educated African American women and European American women in Ohio. Analyses focused on health services utilization, health status, and life style/health behaviors from the 1998 Ohio Family Health Survey. College-educated African American women used more preventive health services and had better health status than non-college-educated African American women. Even so, college-educated African American women still had higher body mass index values, lower health status, and higher percent currently smoking than college-educated European American women. We conclude that college-educated African American women may face unique barriers to implementing all types of health-promoting behaviors available consequent to their higher education. Partnerships with respected community institutions, such as churches, may help these women develop good health practices in their entire community as well as in themselves.

Adult↗
PubMed2005

Magnesium intake and reduced risk of colon cancer in a prospective study of women.

A recent prospective study among Swedish women suggested an inverse association of dietary magnesium intake with incidence of colorectal cancer. The authors assessed this association in a cohort of 35,196 Iowa women initially free of cancer and aged 55-69 years in 1986. Intakes of magnesium and other nutrients were assessed by food frequency questionnaire at baseline. Over 17 years of follow-up through 2002, 1,112 women developed colorectal cancer. After adjustment for age, energy, other nutrients, and risk factors for colorectal cancer, the hazard ratios of colorectal cancer across quintiles of magnesium intake were 1.00, 0.96, 0.83, 0.87, and 0.80 (95% confidence interval: 0.62, 1.03; p(trend) = 0.06). The association was largely absent for rectal cancer but, for colon cancer, the hazard ratios were 1.00, 1.00, 0.88, 0.85, and 0.77 (95% confidence interval: 0.58, 1.03; p(trend) = 0.04). These findings offer further evidence that a diet high in magnesium may reduce the occurrence of colon cancer among women. If replicated by other observational studies, a clinical trial would be needed to determine whether it is magnesium, specifically, and not other aspects of the contributing foods, that may offer benefit.

Aged↗
PubMed1987

Epidemiology and prevention of cardiac failure: Framingham Study insights.

The prevalence, incidence, secular trends, precursors and prognosis of cardiac failure (CHF) is investigated over 3 decades of follow-up of 5209 subjects. Some 485 men and women developed first evidence of CHF. Annual incidence increased from 3 per 1000 at ages 35-64 years to 10 per 1000 at ages 65-94 years with a male predominance because of higher rates of coronary disease. Half developing CHF had coronary disease, but only 10% were free of concomitant hypertension. Appearance of coronary disease conferred an 8-fold increased risk of CHF. Hypertension is the dominant precursor of CHF, increasing risk 2-6 fold; 70% had antecedent hypertension. Systolic pressure was more predictive than diastolic. Non-specific S-T and T-wave changes, intraventricular conduction disturbances and left ventricular hypertrophy were powerful predictors, even taking blood pressure into account. Other independent risk factors include: low vital capacity, rapid heart rate, diabetes, cardiac enlargement, overweight (in women), serum cholesterol (in men under 65 years of age), cigarettes, proteinuria and hematocrit. Risk of CHF can be estimated over a 30-fold range from profiles made up of these independent risk factors. A preventive approach is essential. Despite potent glycosides, diuretics, vasodilators and antihypertensive treatment CHF continues to be a lethal end-stage of heart disease with a 50% 5 year mortality rate. Sudden death is a prominent terminal feature occurring at 9 times the general population rate.

Adult↗
PubMed1996

Physical activity, waist-to-hip ratio, and other risk factors for ovarian cancer: a follow-up study of older women.

We investigated the association of epithelial ovarian cancer with physical activity, waist-to-hip ratio, reproductive factors, and family history of cancer in a prospective cohort study of 31,396 postmenopausal women. Ninety-seven women developed incident epithelial ovarian cancer over 7 years. The number of livebirths was associated with lower risk (multivariate-adjusted relative risks for 1-2, 3-4, and > 4 livebirths compared with nulliparity were 0.64, 0.47, and 0.43, respectively). A family history of ovarian cancer in a first-degree relative was associated with a 2.5 times greater risk (95% confidence interval = 0.90-6.7). Multivariate-adjusted relative risks for the upper three quartiles of waist-to-hip ratio compared with the lowest quartile were 2.0, 1.6, and 2.3, respectively. Women with "moderate" and "high" levels of physical activity compared with those with "low" physical activity had relative risks of 1.4 and 2.1, respectively. Positive associations of physical activity and waist-to-hip ratio with ovarian cancer seem inconsistent with existing theories of ovarian cancer pathogenesis.

Aged↗
PubMed1993

Long acting methods of contraception.

Long acting methods of contraception have been developed and refined over the last 10 years. From the classical long acting progestogen-only depot preparations we now have a range of delivery systems including both combined and progestogen only injection systems and vaginal rings also containing either progestogen only or oestrogen and progestogen in combination. Subcutaneous implants at present containing only a progestogen, offer a range of durations from 2-5 years. The efficacy of these methods is high, with failure rates as low as 0.1 per 100 woman years. However, with progestogen only systems a significant proportion of women develop unpredictable menstrual bleeding, which with counselling is acceptable. The commonest reason for discontinuation still remains menstrual disorders and recent WHO workshops have investigated the cause of this bleeding and refined the reference periods of analysis. The method of action of progestogen-only systems is primarily cervical mucus blockade and prevention of sperm penetration. However, they also tend to produce a thinned atrophic endometrium. Ovarian effects ranging from complete anovulation to disordered luteal phase, persistent follicles and disorganised hormone production add to the contraceptive effect in more than half of the treatment cycles, but cause some of the menstrual disturbance. All these long acting methods are essential to family planning programmes, offering highly acceptable, and in some cases novel methods with high efficacy.

Administration, Intravaginal↗
PubMed1991

Does estrogen replacement therapy protect against rheumatoid arthritis?

The incidence of rheumatoid arthritis (RA) was compared in 2 cohorts of women aged 35-64. One consisted of 1,075 estrogen replacement therapy (ERT) users and the other was 3,251 women from general practice registers. Screening detected 32 cases; 8 postmenopausal control and 6 ERT women developed RA during the study period 1982-1986. This produced incidence rates of 19.7/10,000 and 12.3/10,000 years of observation for ERT and controls, respectively. The relative risks for ERT was 1.62 (95% CI 0.56-4.74) and reduced towards unity after adjustment for potential confounders. Despite the wide confidence interval, our data do not support the previous observation of a 4-fold reduction in RA incidence in ERT users. Indeed the incidence rate in the exposed group in this study exceeded current population estimates of RA incidence in postmenopausal women. We believe that the high incidence rates could be best explained by the self-selection for estrogen therapy at the menopause of those with undiagnosed joint symptoms. These findings underscore the difficulties in elucidating the relationship between ERT and RA.

Adult↗
PubMed1996

Acute fatty liver of pregnancy, hemolysis, elevated liver enzymes, and low platelets syndrome, and long chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency.

BACKGROUND: The similarity of the hepatic pathology in acute fatty liver of pregnancy (AFLP) to that seen in children with inherited disorders of intramitochondrial fatty acid oxidation (FAO) suggests that there may be a genetic basis for some cases of AFLP. OBJECTIVE: The purpose of this study was to examine patients with AFLP and their offspring to determine if there were women with AFLP who were heterozygous for the FAO defect, long chain 3-hydroxyacyl CoA dehydrogenase (LCHAD) deficiency. METHODS: We evaluated 12 women previously diagnosed with AFLP. Provocative fasting studies and skin biopsies for examination of their cultured skin fibroblasts were performed to search for a generalized defect in FAO both in vivo and in vitro. Cultured skin fibroblasts from AFLP patients, their children, and their husbands were also examined specifically for LCHAD activity. RESULTS: Of 12 women with a previous episode of AFLP, eight had reduced LCHAD activity consistent with being heterozygous for LCHAD deficiency. The eight heterozygotes had a total of nine pregnancies complicated by AFLP. In seven of those nine pregnancies, the women developed severe preeclampsia and hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. Of the nine offspring delivered from these pregnancies, four were confirmed to be affected with homozygous LCHAD deficiency. Three other deceased infants were presumed to be LCHAD-deficient based on clinical findings, postmortem examination, and confirmed heterozygote parents. The remaining two infants delivered after pregnancies complicated by AFLP had LCHAD activity in the heterozygous range and are healthy at 18 and 24 months of age. Consistent with the known autosomal recessive nature of this defect, five tested husbands of LCHAD heterozygous women with a history of AFLP and affected infants also showed reduced LCHAD activity. CONCLUSIONS: These studies indicate that a significant subgroup of women with AFLP are heterozygous for LCHAD deficiency and that careful observation of their offspring for signs of this disorder is warranted. Severe preeclampsia appears to increase the risk of AFLP in LCHAD heterozygous women.

3-Hydroxyacyl CoA Dehydrogenases↗
PubMed1987

Glucose and lipid metabolism with triphasic oral contraceptives in women with history of gestational diabetes.

The glucose and lipid metabolism in a group of women with previous history of gestational diabetes were evaluated before and after 6 months treatment with a low-dose triphasic oral contraceptives pill (TP). This group was compared with a control group of women, also with history of gestational diabetes, using intrauterine devices (IUD). In the TP group, 26.7% of the women developed impaired glucose tolerance which reverted to normal in all but one after cessation of the TP. The IUD group showed no change in glucose tolerance. The integrated insulin response to a 75g OGTT in the TP group increased by 48.3% at 6 months compared with an increase of 23.4% for the same period in the IUD group. In the TP group there was a significant decrease in serum total cholesterol without changes in HDL-cholesterol and triglycerides level. We conclude that even low-dose triphasic oral contraceptive pills can cause glucose intolerance in women with previous gestational diabetes mellitus.

Adult↗
PubMed1998

The social construction of the breast cancer epidemic.

The age-adjusted incidence of breast cancer among U.S. women rose by over 30% during the 1980s. Several population-based studies have concluded that most or all of this observed increase is an artifact of the lead time afforded by mammography screening rather than an indication of a true increase in the rate at which women develop the disease. We conducted a study of the social construction of breast cancer trends as a public health problem in popular U.S. magazines. We documented trends in popular magazine article coverage of breast cancer between 1980 and 1995. In addition, we analyzed the content of a convenience sample of 228 popular magazine articles published between 1987 and 1995, focusing on a subsample of articles (n = 91) that mention the increase in breast cancer incidence. Our results show that the increase in incidence is commonly portrayed as a mysterious, unexplained epidemic occurring primarily among young, professional women in their prime years. Many articles suggest that recent changes in women's behavior such as increases in delayed childbearing, nulliparity, the use of oral contraceptives, induced abortion, and the use of tobacco and alcohol are related to the recent upsurge in the disease. The portrayal of the breast cancer epidemic in the U.S. popular press reflects a strong social desire to create order and control over a frightening disease. In the process, a common message is that the behaviors and choices of young, nontraditional women especially those related to fertility control-have led to pathological repercussions within their bodies, which in turn may be responsible for great disorder and pathology at the societal level in the epidemic of breast cancer.

Body Image↗
PubMed2006

Plasma adiponectin levels and endometrial cancer risk in pre- and postmenopausal women.

BACKGROUND: Adiponectin, an adipocytokine secreted by adipose tissue, is decreased in obesity, insulin resistance, type 2 diabetes, and polycystic ovary syndrome, all of which are well-established risk factors for endometrial cancer. METHODS: We conducted a case-control study nested within the European Prospective Investigation into Cancer and Nutrition to examine the relation between prediagnostic plasma adiponectin levels and endometrial cancer risk. Among pre- and postmenopausal women who were not currently using exogenous hormones, 284 women developed incident endometrial cancer during an average of 5.1 yr of follow-up. Using risk set sampling, 548 control subjects were selected, matched on center, age, menopausal status, phase of menstrual cycle, time of blood draw, and fasting status. Conditional logistic regression models were used to estimate relative risks and 95% confidence intervals. RESULTS: Adiponectin levels were inversely associated with endometrial cancer risk [body mass index-adjusted relative risk for the top vs. bottom quartile = 0.56 (95% confidence interval 0.36-0.86), P(trend) = 0.006]. There was evidence of a stronger inverse association among obese women than among nonobese women (P(heterogeneity) = 0.03). The inverse association also appeared stronger for women who were postmenopausal or perimenopausal than premenopausal at baseline, but this was not statistically significantly heterogeneous (P(heterogeneity) = 0.51). The association remained statistically significant after separate adjustment for other obesity-related physiological risk factors such as C-peptide, IGF binding protein-1, IGF binding protein-2, SHBG, estrone, or free testosterone but only marginally statistically significant after simultaneous adjustment for these factors. CONCLUSIONS: High circulating adiponectin levels are associated with reduced endometrial cancer risk, largely independent of other obesity-related risk factors.

Adiponectin↗
PubMed2000

Psychiatric symptoms related to interferon therapy for chronic hepatitis C: clinical features and prognosis.

Psychiatric symptoms during interferon (IFN) therapy for viral hepatitis have been a crucial problem in consultation-liaison psychiatry. However, there have been few studies on psychiatric management for these symptoms and their prognosis. Among 943 patients who were treated with IFN for chronic hepatitis C between 1991 and 1995, 43 patients (4.6%) developed psychiatric symptoms during IFN treatment. Three patients (0.3%), with pre-existing psychiatric disorders showed aggravated symptoms and were excluded from the study. All three patients were able to finish the IFN therapy with psychiatric management. Forty patients (4.2%) manifested psychiatric symptoms induced by IFN. Thirteen patients (1.4%) were diagnosed as anxiety disorder and 21 patients (2.2%) revealed mood disorder with depressive features. There were other psychiatric disorders in six patients (0.6%), including psychotic disorder with delusions/hallucinations in four patients (0.4%), mood disorder with manic features in one patient (0.1%) and delirium in one patient (0.1%). Women developed psychiatric symptoms significantly more than men. Ten of 40 patients (25%) stopped IFN treatment because of manifesting psychiatric symptoms induced by IFN. Twelve patients (30%) required psychiatric treatment for more than 24weeks after ceasing IFN, and seven patients still had anxiety, insomnia and mild hypothymia at the end of the present study. Statistical analysis revealed that IFN-beta therapy and psychiatric manifestations including psychotic symptoms, delirium and manic symptoms were significantly related to long-term psychiatric problems. There are considerable numbers of patients who have required long-term psychiatric management even after cessation of IFN treatment.

Adult↗