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At least 1,243 records · Page 69Linked to original sources
PubMed2000

Fertility after ectopic pregnancy. Effects of surgery and expectant management.

OBJECTIVE: To evaluate the effects of different management strategies for ectopic pregnancy on fertility. STUDY DESIGN: Retrospective cohort study of 180 consecutive patients who were diagnosed with ectopic pregnancy between September 1988 and December 1995. The fertility rate after ectopic pregnancy treated with surgery was compared with that after expectant treatment. Statistical analysis took into consideration the following confounding variables: history of sterility, infertility, ectopic pregnancy, use of intrauterine device, endometriosis, pelvic inflammatory disease or pelvic surgery prior to ectopic pregnancy, and type of therapy for ectopic pregnancy. RESULTS: Of the 180 women enrolled in the study, 97 desired conception. The intrauterine conception rate was similar in those initially treated expectantly as in those allocated to primary surgery (63% [31/49] vs. 51% [19/37], P = .37). Successful completion of expectant management was associated with rates of subsequent intrauterine pregnancy similar to those of surgical treatment (including primary surgery and surgery after failure of expectant management) (65% [22/34] vs. 54% [28/52], P = .44). Women undergoing delayed surgery due to failure of expectant management had rates of subsequent intrauterine conception similar to those who underwent primary surgery (9/15 vs. 19/37, P = .79). Several anamnestic factors had a significant and adverse effect on reproductive outcome: history of infertility (P = .01), history of ectopic pregnancy (P = .02) and previous pelvic surgery (P = .001). CONCLUSION: Expectant and surgical management of ectopic pregnancy had similar subsequent intrauterine conception rates, even when failure of expectant management led to secondary surgery. Gynecologic history can identify the subgroup of patients at higher risk of a poor reproductive outcome.

Cohort Studies↗
PubMedDate not supplied

The aging brain: the cognitive reserve hypothesis and hominid evolution.

Compared to other primates, humans live a long time and have large brains. Recent theories of the evolution of human life history stages (grandmother hypothesis, intergenerational transfer of information) lend credence to the notion that selection for increased life span and menopause has occurred in hominid evolution, despite the reduction in the force of natural selection operating on older, especially post-reproductive, individuals. Theories that posit the importance (in an inclusive fitness sense) of the survival of older individuals require them to maintain a reasonably high level of cognitive function (e.g., memory, communication). Patterns of brain aging and factors associated with healthy brain aging should be relevant to this issue. Recent neuroimaging research suggests that, in healthy aging, human brain volume (gray and white matter) is well-maintained until at least 60 years of age; cognitive function also shows only nonsignificant declines at this age. The maintenance of brain volume and cognitive performance is consistent with the idea of a significant post- or late-reproductive life history stage. A clinical model, "the cognitive reserve hypothesis," proposes that both increased brain volume and enhanced cognitive ability may contribute to healthy brain aging, reducing the likelihood of developing dementia. Selection for increased brain size and increased cognitive ability in hominid evolution may therefore have been important in selection for increased lifespan in the context of intergenerational social support networks.

Aging↗
PubMed2004

Positive selection at reproductive ADAM genes with potential intercellular binding activity.

Many genes with a role in reproduction, including those implicated in fertilization and spermatogenesis, have been shown to evolve at a faster rate relative to genes associated with other functions and tissues. These survey studies usually group a wide variety of genes with different characteristics and evolutionary histories as reproductive genes based on their site of expression or function. We have examined the molecular evolution of the ADAM (a disintegrin and metalloprotease) gene family, a structurally and functionally diverse group of genes expressed in reproductive and somatic tissue to test whether a variety of protein characteristics such as phylogenetic clusters, tissue of expression, and proteolytic and adhesive function can group fast evolving ADAM genes. We found that all genes were evolving under purifying selection (d(N)/d(S) < 1), although reproductive ADAMs, including those implicated in fertilization and spermatogenesis, evolved at the fastest rate. Genes with a role in binding to cell receptors in endogenous tissue appear to be evolving under purifying selection, regardless of the tissue of expression. In contrast, positive selection of codon sites in the disintegrin/cysteine-rich adhesion domains was detected exclusively in ADAMs 2 and 32, two genes expressed in the testis with a potential role in sperm-egg adhesion. Positive selection was detected in the transmembrane/cytosolic tail region of ADAM genes expressed in a variety of tissues.

ADAM Proteins↗
PubMed1997

Oral contraceptives, reproductive factors and p53 gene expression in colorectal cancer.

Protective effects of oral contraceptives and high parity on the development of colorectal cancer have been hypothesized. However, the epidemiological data are inconsistent. This inconsistency may be due in part to the biological heterogeneity of colorectal tumors. A recent investigation of hepatocellular carcinoma demonstrated an association between lack of p53 expression and oral contraceptive use. We investigated the relationship between oral contraceptive use and other reproductive factors with p53 over-expression in 64 post-menopausal women, 45-86 years of age, with non-familial colorectal adenocarcinoma. Fifty per cent (32/64) of colorectal tumors displayed nuclear over-expression of p53 protein. Women with a history of oral contraceptive use were significantly less likely to have p53 positive (+) tumors than women who never used oral contraceptives (P = 0.02). In contrast, tumors from women who had never been pregnant were more likely to be p53 + compared to tumors from parous women (P = 0.10). These data suggest that oral contraceptive use and pregnancy are associated with a p53 independent pathway in the development of colorectal cancer.

Aged↗
PubMed2004

Independent of body adiposity, breast-feeding has a protective effect on glucose metabolism in young adult women.

The objective of the present study was to determine if any associations between reproductive experience and anthropometric or sub-clinical metabolic alterations of glucose metabolism exist. Sixty-seven women were recruited from the University of Brasilia Hospital and were evaluated at 12-18 months postpartum. Demographic, socio-economic, physical activity, anthropometric and health history (biochemical, reproductive) data were obtained. After a 12 h overnight fast, a 2 h oral glucose tolerance test was performed. Blood samples were collected at several points: at baseline, after intake of d-glucose solution (750 g/l; 100 ml) and every 30 min thereafter. Blood glucose and lipids were measured by enzymic assays. Blood insulin was measured by RIA. In multiple regression analysis four dependent logarithmically transformed (logt) variables (increased area under the glucose curve (IAUGC), increased area under the insulin curve (IAUIC), insulin peak (IP), homeostasis model of assessment (HOMA)) were adjusted for parity, age, lactation index, BMI, percentage body fat (PBF), waist circumference, superior skinfold thickness sum:inferior skinfold thickness sum ratio and oral contraceptive use. PBF was positively associated with logt-IAUIC (P=0.004) and IP (P=0.006). However, the lactation index was negatively associated with logt-IAUIC (P=0.02). IAUGC and HOMA did not present significant associations. We conclude that during the postnatal period, independent of parity, body adiposity accumulation is associated with initial alterations in insulin secretion. Furthermore, independent of body adiposity, breast-feeding has a long-lasting protective effect on insulin response.

Adipose Tissue↗
PubMed2005

Factors influencing persistent organic pollutant concentrations in the Atlantic white-sided dolphin (Lagenorhynchus acutus).

Assessing the trends of persistent organic pollutants (POPs) in cetaceans is difficult because of age and gender influences on accumulation. Persistent organic pollutants bioaccumulate and are poorly metabolized; hence, concentrations may increase with age in males while females reduce their POP burden through parturition and lactation. Age and gender effects on contaminant concentrations are species specific because of life history and reproductive strategies. These influences must be understood in order to elucidate and assess lifetime POP exposure. The objectives of this study were to determine baseline POP concentrations in blubber samples from the Atlantic white-sided dolphin (Lagenorhynchus acutus) and to investigate life history and other influences, such as metabolism, on these concentrations. Forty-seven L. acutus blubber samples collected from mass stranding events in Massachusetts, USA (1993-2000), and archived in the National Marine Mammal Tissue Bank at the National Institute of Standards and Technology (Gaithersburg, MD, USA) were analyzed for 55 polychlorinated biphenyl congeners (PCB; 55 congeners), five polybrominated diphenyl ether (PBDE) congeners, and organochlorine pesticides (toxaphene, DDT and metabolites, mirex, dieldrin, chlordanes, hexachlorocyclohexanes, hexachlorobenzene, and endosulfans) by gas chromatography/mass spectrometry (GC-MS). Ages for 19 animals were determined from growth layer groups on decalcified, stained thin tooth sections. Total PCBs (sigmaPCB; sum of 55 congeners) were the contaminants present in the highest concentrations in all age classes (0.5-63 microg/g wet mass) followed by sum of DDTs (0.50-43 microg/g wet mass), toxaphene (0.055-31 microg/g wet mass), chlordanes (0.30-24 microg/g wet mass), and PBDEs (0.12-4.0 microg/g wet mass). Body length had a greater statistical influence than age on contaminant burdens in L. acutus. Contaminant burdens decreased with length in both male and female L. acutus, suggesting metabolic elimination and/or growth dilution in males and off-loading via lactation in females.

Adipose Tissue↗
PubMed1994

Obstetric and gynaecological profile in patients with primary Sjögren's syndrome.

OBJECTIVE: To describe the effects of Sjögren's syndrome (SS) on the fertility, parity and sexual activity as well as investigating the aetiopathology of dyspareunia in female patients. METHODS: Fifty one female patients with primary SS (pSS) and 57 healthy controls were interviewed concerning their past gynaecological, obstetric and sexual history and underwent a complete gynaecological examination. Punch biopsy of the vagina was performed in six patients and one healthy individual. In addition, the vaginal tissue was evaluated following hysterectomy in two patients with pSS. RESULTS: No differences were observed in fertility, parity or reproductive success rate between patients and controls. Atrophy of the external genitalia and production of cervical mucus in both patients and controls correlated with age and menopause, but not with other clinical or serological pSS manifestations. Dyspareunia was observed in 40% of the patients during the premenopause period compared with 3% observed in controls. Half of the patients, however, had an obvious aetiology for dyspareunia (trauma or inflammation) not related to pSS. The histological picture of the patients' vaginal tissue revealed perivascular infiltration. Finally, pSS patients appeared to have a similar intercourse frequency with the controls. However, unlike that observed in controls, the intercourse frequency did not diminish with age nor with the presence of dyspareunia. CONCLUSION: The fertility, parity and sexual activity of pSS patients does not appear to differ from that of the healthy population. Dyspareunia is a frequent symptom in these patients and local perivascular in these patients and local perivascular inflammation may contribute to the expression of this manifestation.

Adult↗
PubMed1999

Risk factors for pelvic endometriosis in women with pelvic pain or infertility. Gruppo Italiano per lo Studio dell' endometriosi.

OBJECTIVE: The objective of the study was to analyse the relationship between selected characteristics and risk of pelvic endometriosis. STUDY DESIGN: Eligible for the study were 817 women with primary or secondary infertility or pelvic pain requiring laparoscopy. Of these, 393 were included for infertility and 424 for pelvic pain. RESULTS: A total of 345 (42.2%) had a diagnosis of endometriosis and 472 did not have the disease. Multiparous women had endometriosis less frequently than nulliparous, the estimated odds ratios (OR) were respectively 0.9 (95% confidence interval, CI, 0.5-1.6) and 0.4 (95% CI 0.2-0.7) in women reporting one and two or more births. In comparison with women reporting no spontaneous abortion, the estimated OR was 0.3 (95% CI 0.2-0.5) in those who reported > or =1 miscarriage. In comparison with women reporting menstrual cycles lasting > or =25 days subjects with totally irregular menstrual cycles had a reduced risk of endometriosis (OR 0.6, 95% CI 0.3-0.9). No significant association emerged between smoking, age at menarche and risk of endometriosis. CONCLUSIONS: this study confirms, with a different methodological approach to previously published studies, that multiparity, a history of abortion and lifelong irregular menstrual pattern decrease the risk of endometriosis in women with pelvic pain and infertility.

Adult↗
PubMed2004

[Risk factors for hysterectomy among Brazilian women].

A case-control study was conducted to investigate risk factors for hysterectomy among women using the public health system in Northeast Brazil. The cases were 373 women aged 30-54 years that had undergone elective hysterectomy for benign pelvic conditions. Controls were 742 women with preserved uterus selected from public health clinics. Data were collected through a review of medical records and a personal interview using a structured, pre-tested questionnaire. Unconditional multiple logistic regression was applied in the analysis. Women at greater risk for hysterectomy were those with a higher per capita family income, zero to three children, a history of medical consultation for menstrual problems, hospitalization for gynecological problems, or tubal ligation before age 30 years. Menopause and a history of stillbirth appeared as protective factors in the statistical analysis.

Adult↗
PubMed1996

The "epidemic" of breast cancer in the U.S.--determining the factors.

Breast cancer incidence rates in the United States rose by 24% between 1973 and 1991. Mortality during this period, however, remained stable. Both the 5-year relative survival rate and the rates of in situ and stage I breast cancers have been increasing, while the incidence of later-stage cancers has been decreasing. Increased mammography screening may explain the documented jump in breast cancer incidence rates during the mid-1980s. Differences in the distribution of breast cancer risk factors may account, in part, for the temporal trends in breast cancer incidence. In particular, breast cancer risk factors may vary by birth cohort, including age at menarche, age at first birth, physical activity, obesity, diet, alcohol intake, estrogen therapy, and exposure to environmental organochlorines. After decades of epidemiologic research, a preventive approach to breast cancer that focuses on the physiologic effects of the sex steroid hormones, and their potential interactions with family history, is being carefully formulated.

Adult↗
PubMed2005

Prediction of preterm delivery in the second trimester.

OBJECTIVE: The aim of this study was to estimate the probability of spontaneous delivery at 34 weeks or less according to cervical assessment by transvaginal scan associated with previous obstetric history. METHODS: Ultrasound transvaginal cervical length and presence of funneling were evaluated in 1,958 singleton pregnancies between 21 and 24 weeks of gestation. For the prediction of preterm delivery, the results of cervical assessment were analyzed in association with the previous obstetric history of preterm delivery, spontaneous miscarriage, and curettage. Sensitivity, specificity, and positive and negative predictive values for the various cutoff cervical lengths in the groups with or without previous history of preterm delivery were calculated. Multivariable regression analysis was used to identify the predictive factors for preterm delivery at 34 weeks or less. RESULTS: The incidence of spontaneous delivery at gestational age of 34 weeks or less was 3.4%. The mean cervical length was 30.1 mm (standard deviation 10.1 mm) in the group with previous history of prematurity (n = 180) and 35.8 mm (standard deviation 7.9 mm) in the group without previous history of prematurity (P < .001). The mean cervical length in the group of patients who delivered at or before 34 weeks was 23.8 mm, and for patients who delivered after 34 weeks it was 35.6 mm (P < .001). The mean gestational age at delivery was significantly lower in the group with funneling compared with the group without funneling (33.5 weeks versus 38.8 weeks, P < .001). Logistic regression analysis demonstrated that cervical length, funneling, and history of previous preterm delivery were independent contributors for preterm delivery. CONCLUSION: Ultrasound cervical assessment may be useful in the prediction of preterm delivery, but it should also be considered in association with the obstetric history of prematurity.

Adult↗
PubMedDate not supplied

The exclusion of never-married women from Chinese fertility surveys.

Never-married women have been regularly excluded in official national surveys of fertility in China, even in light of evidence of increasing premarital sexual activity. Likewise, never-married women in the United States were consistently excluded from national fertility surveys prior to 1982 because of the perceived sensitivity of questions about contraceptive use and sexual activities. Data on sexual and fertility behavior from all women of reproductive age, regardless of marital status, can provide direct measures of sexual activity and unintended pregnancies, as well as facilitate modeling of social networks underlying the sexual transmission of diseases. China's need for such information, however sensitive, will become more difficult to ignore given increasing pressures to attend to the health needs of their never-married but sexually active population.

Adolescent↗