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PubMed2004

[Syphilis positivity in puerperal women: still a challenge in Brazil].

OBJECTIVE: To investigate the factors associated with positive syphilis serology results in puerperal women who were receiving care at 24 health centers accredited by Brazil's National Program on Sexually Transmitted Diseases and AIDS. METHODS: This cross-sectional study included a probabilistic random sample of 3047 puerperal women. The eligibility criterion was being admitted for delivery or curettage in the selected centers. After an interview to collect demographic and clinical information, a blood sample was taken and then examined with the Venereal Disease Research Laboratory (VDRL) slide test. With positive VDRL results, the fluorescent treponemal antibody-absorption test (FTA-Abs) was used for confirmation. The event considered for analysis was positivity on the VDRL test, with confirmation by the FTA-Abs. For the statistical analysis, odds ratios and 95% confidence intervals were calculated. The model fit was assessed using the Hosmer-Lemeshow test. RESULTS: The prevalence of syphilis among the women studied was 1.7%. Multivariate analysis showed that increased risk for positive VDRL and FTA-Abs results was associated with the following characteristics: family income below one minimum wage, age < 17 years at first sexual intercourse, age < or = 14 years at first pregnancy, history of syphilis or of other sexually transmitted diseases prior to the current pregnancy, treatment for syphilis during the current pregnancy, partner having been tested for syphilis, having a positive HIV test result or having no HIV test result on record, previous preterm delivery, and stillbirth as an outcome of pregnancy. Only 43% of the women had had six or more prenatal visits, and only 3% had had one VDRL test during the first trimester of pregnancy and another VDRL test during the third trimester, as is recommended by Brazil's national Ministry of Health. CONCLUSIONS: This study shows that the problem of congenital syphilis is far from being solved in Brazil. It is necessary to provide adolescents with family planning services as well as guidance on sexual issues, to improve prenatal follow-up, and to research the history of sexually transmitted diseases in both the pregnant woman and her sexual partner.

Adolescent↗
PubMed1994

Risk factors for breast cancer in younger women.

Epidemiologic studies of breast cancer that have included younger, premenopausal women in their populations have found that factors that predict altered risk of breast cancer after menopause can have different or even reversed effects before menopause. We have reviewed the literature on risk factors for breast cancer and their associations with breast cancer in general, and compared the risks for younger women with those for women diagnosed at older ages. Race, parity, and large body size are factors that may have opposite effects on breast cancer risk in younger and older women. Other factors of particular significance in the etiology of early-onset breast cancer include a late age at first birth, never having lactated, oral contraceptive use at early ages or of long duration, a family history of breast cancer, and a history of proliferative benign breast disease.

Adult↗
PubMed1998

Sociodemographic characteristics, smoking, medical and family history, and breast cancer.

The relationship between sociodemographic characteristics, lifestyle, family history of cancer, medical history, and reproductive factors and breast cancer was investigated in a population-based case-control study of French Canadians in Montreal. In this study, a total of 414 French-Canadian cases and 429 age- and language-matched population controls were interviewed. Ever-married women showed significantly lower risk (OR: 0.64 [0.45-0.92]) for breast cancer, as did smokers (OR: 0.73 [0.55-0.98]), particularly of nonfilter cigarettes (OR: 0.36 [0.17-0.72]). Weight history, both for the year before the diagnosis of breast cancer and 10 years previously, was associated with risk for the disease. A strong inverse relationship was found between the number of full-term pregnancies (OR: 0.48 [0.28-0.82]) and the risk of breast cancer, while the p trend for late age at first pregnancy (p = 0.02) and menopause (p = 0.004) was statistically significant. A history of breast problems (OR: 1.87 [1.34-2.60]) and a history of breast cancer in relatives (OR: 2.95 [1.63-5.34]) were strongly associated with risk. This study confirms the risk factors of late age at first full-term pregnancy, nulliparity, late age at menopause, and positive family history of breast cancer in the etiology of this disease. Perhaps the protective effect of smoking against breast cancer could be due to its antiestrogenic influence.

Adult↗
PubMed2002

A prospective study of clinico-pathological features of epithelial ovarian cancer in Pakistan.

BACKGROUND: Although geographic and racial differences in the incidence of cancer are well recognized, information regarding any dissimilarity in clinico-pathological behavior of cancers is scarce. In particular, information from the developing countries regarding clinico-pathologic features of even some of the common cancers such as ovarian cancer is lacking. METHODS: Information was prospectively collected on all patients with epithelial ovarian cancer referred to the National Cancer Institute, Karachi, Pakistan between January 1, 1993 and June 30, 1998. Information was obtained directly from the patients and a close relative. Medical records were reviewed and radiologic and pathologic re-evaluation was done when necessary. RESULTS: Two hundred and eighty six patients were accrued. Mean age was 49.5 (+/- 13) years. Most of the well defined risk factors such as early menarche, late menopause, nulliparity, lack of lactation were uncommonly observed. Twenty percent of the patients had a positive family history of cancer. Most of these relatives were young (46.1 years), first degree (68%) and had breast or ovarian cancer. Clinical presentation, histologic features and stage of disease were similar to the North American or European women with epithelial ovarian cancer. CONCLUSION: Younger age at presentation and higher frequency of positive family history are two unusual features of Pakistani patients with epithelial ovarian cancer. This suggests a more significant role played by the genetic factors in these patients. Further work is needed.

Adult↗
PubMed1999

Reproductive characteristics and the age at inception of the perimenopause in a British National Cohort.

Data from a British national cohort of women born in 1946 were used to investigate the hypothesis that the rate of depletion of oocyte numbers is associated with the age at which a woman reaches the inception of the perimenopause. Menopausal status was obtained using an annual questionnaire, sent to the cohort since the age of 47 years, and risk factor information from contacts with the survey throughout earlier life. Parous women entered the perimenopause later than nulliparous women. Those with the most children had the latest perimenopause, where the estimated hazard ratio for women having four or more children compared with those having none was 0.56 (95% confidence interval 0.39-0.81). Women who had a unilateral oophorectomy reached perimenopause earlier then those who had not (hazard ratio = 1.96, 95% confidence interval 1.15-3.35). There was some evidence that early age at menarche and short menstrual cycles were associated with an earlier perimenopause. No relation was observed with oral contraceptive pill use. Results provided some support for the hypothesis under consideration, while estimates of the median age at inception of the perimenopause due to these factors ranged from 46 to 50 years, which is an important variation with respect to later health.

Adult↗
PubMedDate not supplied

Profile of familial breast cancer in Alexandria, Egypt.

Nearly two thirds of the cancers which will appear in the next 25 years will occur due to unawareness of the public. In a population genetic study in Alexandria, Egypt, we found that the parents of 20% of the population are first degree cousins. Out of 9,587 female cancer cases registered in the last 10 years by the Alexandria Cancer Registry, 3250 (33%) were breast cancer. Twelve percent of breast cancer patients had a positive first-degree relative family history of cancer. Familial breast cancer (FBC) occurred at a younger age, ranging from 23-74 years, with a median equal to 46.5 years compared to 35-76 years, with a median of 54.5 years, in non-familial cases. The aim of this work was to show how familial cancer registries can produce useful data, helping to develop a data base of familial cancer, for the primary care program to control the morbidity of breast cancer in females by identification of those with a positive family history of cancer who are at a high risk of developing breast cancer.

Adult↗
PubMed1997

Levels and determinants of gynecological morbidity in a district of south India.

This article presents the results of an assessment of gynecological morbidity among 385 women with young children residing in a district of Karnataka State, South India. All three main modes of assessment (clinical examination, laboratory tests, and self-reports) reveal a high burden of reproductive tract infections. The two most common conditions, identified by laboratory tests, were bacterial vaginosis and mucopurulent cervicitis. Approximately one-fourth of the women had clinical evidence of pelvic inflammatory disease, cervical ectopy, and fistula. The contribution of sexually transmitted diseases to overall gynecological morbidity appears to be relatively modest; 10 percent were so diagnosed. Associated conditions of anemia and chronic energy deficiency were common. Severe anemia was found in 17 percent of cases and severe chronic energy deficiency in 12 percent. These results indicate that radical improvements in women's health in India will require far more than the diagnosis and treatment of reproductive tract infections.

Comorbidity↗
PubMed1994

Employment and the use of birth control by sexually active single Hispanic, black, and white women.

Previous studies of the use of birth control by sexually active single women tend to emphasize family background and aspirations, and restrict their attention to teenagers. We elaborate this framework by considering how labor market experiences might shape the birth control practices of women in their late teens and twenties. Data from the National Longitudinal Survey of Labor Force Experiences--Youth Cohort provide evidence that employment histories and wages influence birth control practices, net of the effects of family background, aspirations, and educational attainment. Several pronounced racial and ethnic differences are found.

Adult↗
PubMed1999

A history of placental dysfunction and risk of placental abruption.

In a population-based historic cohort study, we assessed the possible association of fetal growth retardation, preterm birth and pregnancy-induced hypertension in the immediately preceding pregnancy with placental abruption in the current pregnancy, which would suggest a shared aetiological factor. We also assessed whether chronic hypertension, diabetes mellitus and a history of Caesarean section are associated with placental abruption. Preterm birth and small-for-gestational-age (SGA) in the immediately preceding delivery were associated with an increased risk of placental abruption with unadjusted odds ratios (ORs) of 2.1 [95% CI = 1.9, 2.4] and 1.6 [95% CI = 1.5, 1.8] respectively. Women with a history of an SGA preterm birth in the immediately preceding delivery and an appropriate-for-gestational-age infant in the current had an adjusted OR of 3.2 [95% CI = 2.3, 4.5]. The adjusted odds ratio of placental abruption in women who had pregnancy-induced hypertension in the previous pregnancy, but not in the current, was 1.4 [95% CI = 1.2, 1.7]. Women who delivered a preterm or SGA infant in the previous delivery and had chronic hypertension or diabetes mellitus in the current had adjusted ORs of 2.3-5.7 and 2.5-6.0 respectively. Caesarean section in the previous delivery increased the risk of placental abruption by 40%. These results suggest that pregnancy-induced hypertension, intrauterine growth retardation, preterm delivery and placental abruption share an aetiological factor or represent different clinical expressions of recurring placental dysfunction. Chronic hypertension and diabetes mellitus may cause or aggravate such dysfunction thus causing placental abruption. A history of Caesarean section is associated with an increased risk of placental abruption.

Abruptio Placentae↗
PubMed1994

Determinants of basal follicle-stimulating hormone levels in premenopausal women.

The (basal) level of FSH measured during early menses is emerging as a predictor of ovarian competence. In this study, correlates of basal FSH were examined in 222 premenopausal women who were not using oral contraceptives and selected from either the general population or a clinic for women with family histories of ovarian cancer. Using analysis of variance, the effect on FSH by age, smoking history, and reproductive variables was examined. Dietary galactose (as a potential oocyte toxin) was estimated, and red cell activity of galactose-1-phosphate uridyl transferase (GALT) was measured. Qualitative features of GALT were described by its electrophoretic or molecular genetic patterns. Possession of GALT polymorphisms previously linked with low GALT activity, including the Q188R mutation of classic galactosemia or N314D mutation of the Duarte galactosemia variant, was associated with significantly higher FSH, even in the heterozygous state. Other factors significantly influencing FSH included age, smoking history, cycle length, and cycle regularity. No effect of current galactose consumption was found, and GALT activity was only weakly correlated (inversely) with FSH. Applying multiple linear regression, variables independently predictive of high FSH were age of 40 yr or more, current smoking, and possession of a GALT polymorphism.

Adult↗
PubMed1994

Antenatal screening: its use in assessing obstetric risk factors in Zimbabwe.

STUDY OBJECTIVE: To assess the predictive utility of obstetric risk factors for identifying before the onset of labour those women at high risk of obstetric complications in a developing world setting, where home deliveries predominate and emergency transport is scarce. DESIGN: Risk factors derived from two population based, case-control studies (one of cephalopelvic disproportion and one of post partum haemorrhage), carried out in Zimbabwe were used to construct weighted and unweighted scores, a variety of screening algorithms, and sets of probabilities estimated from logistic regression models. These screening tests were evaluated for sensitivity, specificity, positive predictive value, and "cost" (the proportion of the population testing positive). Each complication was evaluated separately and the two were then pooled. PARTICIPANTS: All were Harare residents with singleton, vertex deliveries and spontaneous onset of labour. A total of 201 experienced cephalopelvic disproportion, 150 had post partum haemorrhage, and 299 had normal, unassisted deliveries. MEASUREMENTS AND MAIN RESULTS: Largely because of the very low incidence of the two complications studied (1% or less), positive predictive values were low (less than 7%). Holding "cost" constant at 10%, a screening test for cephalopelvic disproportion could predict 42.3% of cases compared with only 35.0% of those with post partum haemorrhage. Weighted scores had little advantage over unweighted ones, and probabilities from the logistic regression models did not differentiate cases from controls very well. CONCLUSIONS: With simple algorithms based on maternal height, parity, and obstetric history, more than one third of women at risk for potentially fatal complications could be identified at relatively small cost to themselves or the health care system.

Adult↗
PubMed2000

High frequency of sub-optimal semen quality in an unselected population of young men.

Male reproductive function seems to have deteriorated considerably during the past 4-5 decades. However, studies of the reproductive function in unselected populations have not previously been reported. As the large majority of young men in Denmark are subjected to a compulsory medical examination for military service, this provided a unique opportunity to study the reproductive function in an unbiased population. Altogether 891 young men delivered a blood sample in which reproductive hormones were measured. From 708 of these men data were also obtained on semen quality and testis size. The median sperm concentration was 41 x 10(6)/ml (mean 57.4 x 10(6)/ml). Men with ejaculation abstinence above 48 h had slightly higher sperm concentrations (median 45 x10(6)/ml, mean 63.2 x 10(6)/ml), but even in this subgroup, 21 and 43% respectively had sperm counts below 20 x 10(6)/ml and 40 x 10(6)/ml. Among men with no history of reproductive diseases and a period of abstinence above 48 h, as many as 18 and 40% respectively had concentrations below 20 and 40 x 10(6)/ml. Sperm counts were positively correlated with testis size, percentage normal spermatozoa and inhibin B, and negatively correlated with percentage immotile spermatozoa and follicle stimulating hormone. Possible causes for this high frequency of young men with suboptimal semen quality are obscure and need to be explored. Whether these findings apply for young male populations of comparable countries remains to be seen.

Analysis of Variance↗
PubMed1999

Predictive value of history and physical examination in patients with suspected ectopic pregnancy.

STUDY OBJECTIVE: To identify historical and physical examination findings that are predictive of ectopic pregnancy (EP) in pregnant patients with abdominal pain or bleeding. METHODS: This study was conducted in an urban academic emergency department as a prospective observational study of consecutive patients from August 1, 1991, to August 31, 1992, who had abdominal pain or vaginal bleeding and a positive beta-human chorionic gonadotropin level. Patients were excluded if they had a diagnostic ultrasound during a previous visit, or if the uterine size was larger than 12 weeks by pelvic examination. Data were analyzed using chi2 with a P value less than. 05 identified as significant. Odds ratios were determined for significant variables. A classification and regression tree analysis was then performed using the predictive variables to derive a decision tree. RESULTS: Four hundred forty-one patients were enrolled, 57 of whom (13%) had an EP. Factors by history that increased the risk of EP included pain that was described as moderate to severe, lateral, or sharp. Pain located in the midline decreased the risk of EP. A history of previous intrauterine device use, infertility, prior pelvic surgery, or tubal ligation were each found to be predictive. On physical examination, the presence of peritoneal signs, cervical motion tenderness, or lateral or bilateral abdominal or pelvic tenderness increased the risk of EP. A uterine size larger than 8 weeks by pelvic examination decreased the risk of EP. Combinations of predictive variables identified subsets of patients with either an increased or decreased frequency of EP, but in no case was a combination identified that would confirm or exclude this diagnosis with a high degree of certainty. CONCLUSION: History and physical examination findings predictive of EP were identified. However, no constellation of findings could confirm or exclude this diagnosis with a high degree of reliability.

Abdominal Pain↗
PubMed1994

Health and behavioral predictors of success in an intensive smoking cessation program for women.

Cigarette smoking is the major addiction of women, the leading cause of women's death, and maternal smoking has substantial negative health effects on children. The majority of smokers quit on their own, but women are more likely than men to seek help, and some prefer women-only programs. Multi-component programs combining cessation techniques with counselling, skills training, and emotional support show the highest quit rates. In this clinical study of a multi-component, eight week cessation program for women, sixty-two percent completed the program and stopped smoking. Over half of these were abstinent six months later, which compares favorably with other women's-only programs in Canada. Based on the literature, we hypothesized that factors related to personal health status, family drug history, current lifestyle and social environment would be the best predictors of program outcome: dropping out of the program, completing the program and quitting smoking, and being abstinent at six months. Over 400 measures of personal and family history, health status, health behavior and social environment were gathered. A multiple regression model using four variables with additive variance and stable parameters explained 48% of the variance in program outcome. These were client's history of asthma, smoking status of the mother when the client was a child, weekly consumption of chocolate and candy, and the number of children the client had. These results identify issues that need to be taken into account when assisting women to quit smoking.

Asthma↗
PubMed2006

[Constipation in postmenopausal women].

OBJECTIVES: To investigate the prevalence and factors associated with constipation in postmenopausal women and evaluate the level of agreement between different diagnostic criteria. METHODS: A cross-sectional study was conducted with 100 postmenopausal women more than 45 old. The Rome II criteria, stool frequency per week and patient self-evaluation were the diagnostic criteria applied. Social demographic and clinical characteristics with their descriptive analysis were assessed. Subsequently, kappa (ê) statistics was used to assess the level of agreement between diagnostic criteria. The association between constipation and its possible determinants was studied by bivariate and multivariate analyses, using the prevalence ratio (PR). The confidence interval was set at 95% (95% CI). RESULTS: The mean age of participants was 58.9+/-5.9 years (range, 46-76 years). The prevalence of constipation was 47%, 37% and 26%, according to patient self-evaluation, the Rome II criteria and < 3 bowel movements per week, respectively. The best agreement found was between patient self-evaluation and the Rome II criteria (k: 0.63; 95% CI: 0.48-0.78). After multivariate analysis, the history of perianal surgery (PR: 2.69; 95% CI: 1.03-7.01), according to the Rome II criteria; the presence of hemorrhoids, according to stool frequency (PR: 2.53; 95% CI: 1.16-5.51) and patient self-evaluation (PR: 1.78; 95% CI: 1.01-3.15) were associated with constipation. CONCLUSIONS: Prevalence of constipation in postmenopausal women was high. Agreement between diagnostic criteria ranged from moderate to good. History of perianal surgery and presence of hemorrhoids were associated with constipation.

Aged↗
PubMed1998

Correlation between beta 2-glycoprotein antibodies and antiphospholipid antibodies in patients with reproductive failure.

PROBLEM: Antiphospholipid antibodies (APAs) are important in the etiology of reproductive failure. Studies have shown that binding proteins are necessary for the detection of APAs. One of these, beta 2-glycoprotein, has been shown to be necessary for detection of anticardiolipin antibodies. It is felt that some APAs may be directed to the binding protein itself, or to a combination of the binding protein and phospholipid. METHOD OF STUDY: In this study, a comparison of APAs vs. anti beta 2-glycoprotein antibodies was performed on the sera of 123 women younger than 40 years of age with a history of reproductive failure. Antibodies to six phospholipid epitopes, cardiolipin, phosphatidyle-thanolamine, phosphatidylserine, phosphatidylinositol, phosphatidic acid, phosphatidylglycerol, and phosphatidylserine, were measured. RESULTS: Of the 123 women tested, 33 had one or more positive immunoglobulin (Ig)G antibodies to phospholipids, of which 9 were to cardiolipin. However, only 1 of 123 women had IgG antibodies to beta 2-glycoprotein and she was APA negative. Thirty-eight of 123 women had one or more IgM antibodies to phospholipids, with none directed to cardiolipin IgM. In contrast, only 8 of the 123 women had IgM antibodies to beta 2-glycoprotein. Five of the eight patients had IgM APA; 4 of 5 had IgM antibodies to PE, 1 to PI. CONCLUSIONS: There is no correlation between beta 2-glycoprotein antibodies and APA status in this population. To date, our most sensitive test for detecting phospholipid autoimmune-mediated in vitro fertilization failure still appears to be the ELISA assay for APA.

Adult↗
PubMed2004

Ectopic pregnancies in a Caesarean scar: review of the medical approach to an iatrogenic complication.

Implantation of a pregnancy within a Caesarean fibrous tissue scar is considered to be the rarest form of ectopic pregnancy and a life-threatening condition. We conducted a computer search of the English literature of all studies since 2002 to gather updated data on the outcome of such pregnancies. Sixty-six new cases were reported since 2002, possibly reflecting the increasing number of Caesareans currently being performed as well as the more widespread use of the transvaginal scan allowing their earlier detection. Analysis of these women's obstetric history revealed that those at risk for pregnancy in a Caesarean scar appear to have a history of dilatation and curettage, placental pathology, ectopic pregnancy, and IVF. Twenty-one out of 39 for which this information was available (54%) had undergone multiple (> or =2) Caesareans and 13 had previous dilatation and curettage, which might also be an associated factor. We review and discuss the features of contemporary work-ups, including a high index of awareness, a detailed history and a skillful ultrasound examination for an early and accurate diagnosis. Healthcare professionals should be familiar with the possibility of untoward sequelae and how a modern work-up can help in guiding conservative options, thus reducing morbidity and preserving fertility.

Cesarean Section↗
PubMedDate not supplied

Risk factors for primary breast cancer in Japan: 8-year follow-up of atomic bomb survivors.

BACKGROUND: Findings from the Life Span Study (LSS) of the health effects of exposure to atomic bomb radiation have documented a strong dose-response relation between radiation exposure and breast cancer incidence. PURPOSE: We analyzed data from the LSS cohort to identify nonradiation risk factors for breast cancer and to determine whether these factors were independent of the effects of radiation on breast cancer occurrence. METHODS: Breast cancer incidence was ascertained among a cohort of 22,200 residents of Hiroshima and Nagasaki, Japan, who had completed a mail survey between 1979 and 1981 to study nonradiation risk factors for disease. During the subsequent follow-up period (average 8.31 years), 161 cases of primary breast cancer were identified through population-based tumor registries in the two cities. RESULTS: The risk of breast cancer was inversely related to age at menarche and weakly positive in relation to age at menopause and years of menstruation. A significant negative association of full-term pregnancy against breast cancer was observed, although the number of pregnancies beyond the first was not related to the rate of breast cancer in the cohort. Women having their first full-term pregnancy before age 30 were at decreased risk of breast cancer relative to older women, but there was no trend. A nonsignificant, positive trend in risk was associated with increasing weight and body mass (kg/m2). The risk of breast cancer among women with a history of estrogen use was 1.64 (95% confidence interval 1.02-2.64) and with diabetes 2.06 (95% confidence interval 1.27-3.34). It was not possible to distinguish among additive and multiplicative models of the joint association of radiation dose and various non-radiation-related exposures (age at menarche, full-term pregnancy, female hormone preparations) identified in this analysis. CONCLUSIONS: Nonradiation risk factors for breast cancer among Japanese atomic bomb survivors were consistent with those identified among other populations of women, although the prevalence of common risk factors was low. Reproductive factors and hormone use appear to act independently of radiation exposure on the risk of breast cancer among this population.

Aged↗