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PubMed1994

Smoking, obesity, alcohol consumption, and the risk of rheumatoid arthritis.

There is some evidence that sex hormones may influence the incidence of rheumatoid arthritis. Obesity has been found to increase endogenous estrogens, particularly among postmenopausal women. Although the association of endogenous hormones with smoking and alcohol use is less clear, we examined the relation of these three factors with rheumatoid arthritis in women. We conducted a population-based case-control study of rheumatoid arthritis in King County, WA, and Group Health Cooperative of Puget Sound. We compared 349 incident cases of rheumatoid arthritis with 1,457 controls selected by random digit dialing or by random selection from the enrollment files of Group Health Cooperative. We conducted personal interviews to collect data on weight, smoking, alcohol history, reproductive variables, and other demographic variables. Women with 20 or more pack-years of smoking had a relative risk of 1.5 [95% confidence interval (CI) = 1.0-2.0] compared with never-smokers. Post-menopausal women who averaged more than 14 alcoholic drinks per week had a reduced risk of rheumatoid arthritis (relative risk = 0.5; 95% CI = 0.2-1.7). Women in the highest quartile of body mass index had a risk of 1.4 (95% CI = 1.0-2.0) relative to women with lowest body mass index.

Adolescent↗
PubMed1994

Risk factors for menopausal hot flashes.

OBJECTIVE: To find predictors of hot flashes at natural menopause. METHODS: A cross-sectional sample of 334 black and white, naturally menopausal women was selected from a control group in a population-based study of reproductive cancers in central North Carolina. Women reported whether they had experienced hot flashes at the time of menopause. Life-style factors and reproductive histories of those with and without hot flashes were compared. RESULTS: Compared to women who were older at menopause, those reporting natural menopause before age 52 years had a significantly increased probability of having hot flashes (prevalence ratio 1.5, P = .04). Less than a high school education was significantly related to an increased probability of hot flashes (prevalence ratio 1.4, P = .20). There was significant interaction between cigarette smoking and body mass index (BMI), so that thin women who smoked in the premenopausal period were most likely to experience hot flashes (prevalence ratio 1.9, P = .03). Among non-smokers, BMI appeared to have no effect on the probability of hot flashes. Alcohol use, although not statistically significant, suggested a positive relation with hot flashes over and above that incurred from smoking. In addition, menarche before the age of 12 (prevalence ratio 0.6, P = .08) and a history of irregular menstrual cycles (prevalence ratio 0.6, P = .08) were marginally related to a decreased prevalence of hot flashes. Race, parity, and age at first and last pregnancy had no relation to hot flashes. CONCLUSION: Socioeconomic factors and those related to the decline of estrogen production are related to the occurrence of hot flashes at the time of menopause.

Adult↗
PubMed1994

Trends in cohort fertility of the Dariusleut Hutterite population.

A church book containing vital information on Dariusleut Hutterite families enabled us to trace the life course of individual women. We conducted a retrospective cohort study on the women born in the Dariusleut sect for the period 1901-1965, focusing on their marriage and reproductive histories. The subjects were grouped into 5-year birth cohorts from 1901-1905 to 1961-1965. The marital age-specific fertility rate (MASFR) increased from the 1901-1905 cohort to the 1926-1930 cohort and then began to decrease, particularly at the ages of 30-39 years. The initial increase in MASFR was not reflected directly in the cohort mean of the total number of children per woman because of a concurrent delay in age at marriage. Marriage delay, however, could not explain the drastic decrease, which started in the 1931-35 cohort, in the total number of children per woman; the decrease in MASFR at the ages of 30 years and older was considered a major reason for the recent changes in Hutterite fertility. The causes of the recent fertility decrease of Hutterites at higher ages remain to be investigated.

Adult↗
PubMed1993

Prevention and screening for breast cancer.

Breast cancer is the most common cancer among women in both Europe and the U.S. It is the second leading cause of cancer deaths for women in the U.S., but the first in Poland. Age, family history, reproductive factors, proliferative breast disease, and radiation are established risk factors. Diet may account for differences in international incidence rates; however, the majority of women who get breast cancer do not have identifiable risk factors other than age and being female. Primary prevention of breast cancer is unknown. Control relies on secondary prevention aimed at suppression of clinically occult disease, mammographic screening, and early detection of palpable disease through physical examination and breast self-examination. Dietary and medical prevention strategies are being tested in the U.S. Screening mammography has demonstrated effectiveness in reducing mortality in women over 50. The "Partnerships in Healthcare" program aims to enhance the early detection of breast cancer in Poland by providing mammography units, training for technicians and nurses, and incentives to develop multidisciplinary approaches to diagnosis and treatment.

Adult↗
PubMed1994

Vulvar vestibulitis syndrome: an exploratory case-control study.

OBJECTIVE: To assess the prevalence of genital bacterial infection among women with vulvar vestibulitis syndrome and to evaluate the association of several potential risk factors with the occurrence of the syndrome. METHODS: Fifty-seven women referred for dyspareunia who satisfied Friedrich's criteria and had symptoms for at least 6 months were recruited as cases. Controls included 173 patients without dyspareunia seen at a private clinic. Cases and controls were aged 18-35 years and were not pregnant. RESULTS: Among cases, the prevalences were low for genital infection with gonorrhea (0%), Chlamydia (0%), Trichomonas (0%), Mycoplasma (0%), Gardnerella (14%), and Candida (8.8%). Ureaplasma was detected in the Bartholin glands of ten affected women (17.5%). Human papillomavirus DNA was detected in only three cases (5.3%) based on polymerase chain reaction assays on vestibular biopsies. The relative risk (RR) of the syndrome was related to some aspects of sexual and reproductive history. In particular, the RR in women who had used oral contraceptives (OCs) early (before age 17) reached 11.0 (95% confidence interval [CI] 1.3-97.1) relative to those who had never used OCs. Women who had first intercourse at age 15 or earlier had a 3.3-fold increase in RR (95% CI 1.4-8.0) compared to those who had first intercourse at age 16 or later. CONCLUSION: Our data provide little support for the idea that infection causes the vulvar vestibulitis syndrome. Hormonal factors such as early OC use may be involved in the etiology of this condition.

Adolescent↗
PubMedDate not supplied

A computerized record chart for the study of chronic daily headache.

A comprehensive record chart for the study of chronic daily headache (CDH) is presented. The record chart contains 11 parts (232 items) concerning: sociodemographic data, physiological history, female reproductive life history, family history, pathological history, drug abuse, headache history, headache clinical features, prophylactic therapy, instrumental investigations, and physical and neurological examination. Furthermore, three attached special charts are illustrated which concern, respectively, the cervical spine examination, oromandibular function examination and the assessment of analgesic use.

Chronic Disease↗
PubMed1993

Human sperm fertilizing potential in vitro is correlated with differential expression of a head-specific mannose-ligand receptor.

OBJECTIVE: To determine whether different patterns of surface expression of mannose-ligand binding sites are correlated with capacitation and predictive of the ability of human sperm to recognize and fertilize eggs in vitro. DESIGN: Analysis of motile sperm populations (from fertile donors, males presenting for routine semen analysis, and men undergoing IVF) before and after incubation in capacitating media. SETTING: Patients from an infertility practice at a major university hospital. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The mannose ligand-binding capacity of sperm populations were initially assayed by solid-phase mannosylated polyacrylamide bead binding studies. Sperm surface D-mannose binding sites thus detected were localized and visualized by fluorescence microscopy after reaction with a mannosylated fluorescein isothiocyanate-labeled neoglycoprotein probe. Results were correlated with acrosomal status, reproductive histories, and IVF outcomes. RESULTS: The percent of sperm with head-directed surface expression of a mannose-specific receptor was increased in fertile donors and males exhibiting normal fertilization in IVF after incubation in albumin-supplemented Ham's F-10 medium (GIBCO Laboratories, Grand Island, NY). In normospermic males exhibiting zona binding failure in IVF, mannose-specific receptor was observed over the head surface of few incubated sperm. CONCLUSIONS: The appearance of D-mannose-ligand binding sites on the surface of heads of human spermatozoa is associated with zona binding ability in IVF and is a putative determinant in human gamete recognition and fertilization.

Acrylic Resins↗
PubMed1993

Determinants of estrogen replacement therapy use in northern Italy.

Socio-demographic characteristics, general lifestyle habits and menstrual and reproductive history were compared in 83 women aged 45 years or more who had at some time used estrogen replacement therapy (ERT) and 1759 never users interviewed as control subjects in the framework of a large case-control survey on risk factors for gynecological neoplasms conducted in Northern Italy. ERT use was strongly related to social class and level of education. The odds ratio of "ever" use was 3.0 (95% confidence interval, CI, 1.8-5.1) for women with 12 or more years of education, compared with those with less than 7 years. No relationship emerged between marital status and ERT use, but parous women tended to be less frequently ever users than nulliparous, and ERT use decreased with increasing number of births (chi 2 1 trend = 10.51, p. = 0.001). Post-menopausal women reported more frequent ERT use than peri-menopausal ones, and among post-menopausal subjects the use was more frequent in those reporting earlier age at menopausal (chi 2 1 trend = 5.33, p = 0.02). There was no association between smoking habits and ERT use, but Quetelet's index was inversely related to the use of ERT.

Aged↗
PubMed1993

Breast cancer risk: the role of the nurse practitioner.

Information about breast cancer risk is confusing to many patients. This paper focuses on some of the more important risk factors for breast cancer: age, benign breast disease, diet, hormone replacement therapy at menopause, and family and reproductive history. Some of the social factors that can influence receptivity to risk information are briefly mentioned. With their experience in educating patients and families, NPs are ideally suited to provide information about breast cancer risk.

Adult↗
PubMed1996

Impact of the loop electrosurgical excision procedure on future fertility.

OBJECTIVE: The loop electrosurgical excision procedure (LEEP) is a popular and effective method of conservatively treating premalignant lesions of the cervix in reproductive-age women. While the safety and effectiveness of LEEP has been documented, few data have been collected on the long-term effect of LEEP of the cervix on subsequent fertility. The purpose of this study was to determine that effect. STUDY DESIGN: A retrospective, cohort study with chart review and telephone or mail-in survey. One hundred fifty-eight women seen in the colposcopy clinic at New Hanover Regional Medical Center for abnormal cervical cytologic smears from January 1991 through December 1992 were surveyed concerning their reproductive history since undergoing colposcopy. The study group consisted of 79 women who had been treated with LEEP after demonstrating abnormalities on colposcopically directed cervical biopsy. The control group consisted of 79 women who underwent colposcopy and cervical biopsy without subsequent LEEP of the cervix. RESULTS: One hundred eleven women responded to the survey. In this study group, 11 of the 12 women who desired pregnancy actually became pregnant in the in interval between treatment and completion of the survey. All 17 patients in the control group who desired pregnancy became pregnant. CONCLUSION: In our patient population there appeared to be no significant detrimental effect of LEEP on future fertility. These preliminary findings are reassuring, however, due to the small sample size, the study lacked sufficient power for us to draw definitive conclusions.

Adult↗
PubMed1997

Communicating about chromosomes: patients, providers, and cultural assumptions.

Field-based anthropological research on the social impact and cultural meaning of prenatal diagnosis suggests four factors that contribute to multicultural patient-provider miscommunication. These are: 1) the detection of fetal mental retardation, particularly Down syndrome, is not always an appropriate reason to test; 2) the statistical information on age-related risk rates for chromosome abnormality may appear small when compared to more pressing vulnerabilities faced by poor and/or immigrant pregnant women and their families; 3) variation in individual reproductive histories and social values strongly shape acceptance and rejection of the test; and 4) most controversially, not everyone accepts the burdens of individual choice.

Attitude to Health↗
PubMed1997

[Female sterilization in Burkina Faso. Report of 142 cases].

Through a transversal study over a twelve month period, the authors report 142 cases of female sterilization (FS) in Burkina Faso. The aims of this study were to determine the profile of women undergoing FS and to precise the indications and the immediate outcome. The study took place in the two main gynecologic and obstetric units of the country. Various data about the socio-demographic characteristics of the women, their reproductive history, the indications for the FS and the short term follow up were recorded. The woman undergoing tubal ligation (TL) is 36 years old, gravida 7 para 7 with 5 children (3 boys for 2 girls). Her occupation is housewifery, she is married and is illiterate in 84.4% of the cases. This woman has no prior history of contraceptive use in 71% of the cases. FS was performed for medical reasons in 50% of the cases whereas economic reason was invoked by only 5% of the couples. Prior to the TL oral informed consent was obtained from both the woman and her husband. The TL was performed during caesarean section in 55.6%, in the postpartum period in 34.5% of the cases. Two wound abscesses occurred. With a follow up ranging from 2 to 14 months, no pregnancy has been reported. To give a chance to FS to be popular in Burkina Faso, the authors made some suggestions.

Adult↗
PubMed1997

[Incidence and outcome of pregnancies with contraception].

In 1992, 1531 women aging 25-45 years from 5 urban and rural regions were interviewed about infertility and subfecundity within the German part of a study by the European community. 1248 of them had a positive reproductive history with 3018 pregnancies. 400 (= 13.25%) occurred during contraception. This affected 296 women (= 19.6% of all women). Smoking seems to have a promotion effect. The risk of ectopic pregnancies seems to be higher in contraceptive users. The highest fetal loss was found in women using an IUD. There were no differences in the course and outcome of pregnancy between users and nonusers of contraceptives. About 40% of the women in the corresponding group reported an irregular application of the contraceptive technique.

Adult↗
PubMed1996

[Etiological epidemiology of colorectal tumors].

We reviewed the main results of colon cancer (CC) epidemiologic studies, according to data published in the 1973-1994 period, with a particular mention to dietary factors and to differences with Italian findings. Meat (mostly, red meat), animal fats and high energy intake not counterbalanced by sufficient physical activity seem to be the most consistent risk factors for CC. On the contrary, the vegetarian based diet seems to reduce the risk of CC. Although interestingly, the relevance to CC of other life-style and diet-related factors (alcohol intake, smoking habits, processing and cooking methods, occupation, drugs, personal medical and reproductive history) must be better defined and requests further investigations. More recently, genetic studies are clarifying the hereditary risk of CC. Several colon carcinogenesis hypotheses have been proposed, but general agreement on the most reliable is still lacking. Authors argue that in the next future, new acquirements could emerge from metabolic polymorphism studies, possibly reconciling the biological significance of individual susceptibility and environmental factors to CC incidence.

Alcohol Drinking↗
PubMed1976

Thyroid function in human pregnancy. IX. Development or retardation of 7-year-old progeny of hypothyroxinemic women.

Progeny of women, whose thyroid function was studied gestationally, had psychological and/or neurologic examinations at 8 months, 4 years and 7 years of age. In more than 100 pregnancies (at least 3 per cent of total pregnancies) hypothyroxinemia occurred and was treated adequately or inadequately. Children were delivered after uncomplicated pregnancies (except hypothyroxinemia), had birth weights of at least 2,500 grams, and were excluded when postnatal insults intervened. At 8 months and 4 years progeny of inadequately treated hypothyroxinemic women had the lowest psychological scores. Now 246 7-year-old children have been examined psychologically and neurologically (earlier data on only 101). Definite trends and a few statistically lower psychological scores of progeny of inadequately treated hypothyroxinemic pregnant women are compared with better psychological scores of 7-year-old children born to euthyroid and adequately treated hypothyroxinemic women. In six sibling sets outcome was better when hypothyroxinemic women were treated with adequate thyroid replacement therapy. If a woman has a poor reproductive history, early in a subsequent gestation, thyroid status should be examined and adequate thyroid medication considered seriously.

Adolescent↗
PubMed1997

[Induced abortion in a Swiss canton from 1990 to 1993: implications for epidemiological surveillance].

BACKGROUND: To describe abortion utilization in the Canton of Vaud (Switzerland) and to identify desirable changes in the data collection system to improve the epidemiologic monitoring METHODS: Retrospective survey of the 5600 abortion requests to the Canton Health Authority for resident women between 1990 and 1993. RESULTS: Nine women out of 1000 residents requested an abortion, but the abortion rate was higher among women of foreign origin compared to Swiss women (17/1000 vs. 6/1000, p < 0.0001). The proportion of terminated recognized conceptions was 127/1000, and the ratio of IVG to livebirths was 0.18. The abortion rate was lower during adolescence (6/1000) or after 40 years of age (1.8/1000), whereas the proportion of terminated conceptions was highest at these ages (527/1000 and 312/1000). Abortion utilization in Canton of Vaud is among the lowest. CONCLUSIONS: Although these indicators do reflect a satisfactory accessibility and use of family planning services, improvements could be made. A better knowledge of the causes (motives, contraceptive method, reproductive history) and of the consequences of abortion (psycho-social implications, medical complications) would allow to design more focused prevention strategies and to fit health services to current needs. Updating the 1942 Swiss legislation is also desirable.

Abortion, Induced↗
PubMed1998

The risk for recurrence of premature births to African-American and white women.

Preterm birth rates are higher for African Americans than for whites, but the risk for recurrence is not well defined. We tested the hypothesis that the base and recurrence rates for premature births are higher for African Americans than for whites. We recruited a cohort of African-American and white women giving birth to singleton infants between 1988 and 1993 at Perinatal Network, a Midwest urban teaching hospital. These women had known reproductive history, delivered two or more singletons, and had no planned abortions, miscarriages, or induced preterm labor. Premature infants were born at less than 37 completed weeks of gestation. The total preterm birth rate among African Americans was 24.5%, significantly higher than the 11.1% for whites (relative risk, 2.22; confidence interval, 1.79 to 2.75). The preterm birth rate among African Americans for the second pregnancy was 30.6%, significantly higher than the rate of 18.2% for the first pregnancy and 24.5% for the third and fourth pregnancies. The preterm birth rates for whites were 11.7% for the first pregnancy, 9.8% for the second, and 12.9% for the third and fourth pregnancies, which were not significantly different from each other. Considering only the first two pregnancies, recurrence accounted for 32.6% of all premature births for both African Americans and whites. After the second pregnancy, 68% of African-American and 41.7% of white premature babies were born to women who had previous preterm infants. We conclude that preterm births are relatively common for African Americans and whites in the first two pregnancies. Women, particularly African-American women with a previous preterm birth at either the first or second pregnancy, require more specific management to prevent recurrence of preterm birth.

Birth Rate↗