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PubMed1999

Assessing the need for faculty development in women's health among internal medicine and family practice teaching faculty. The Women's Health Education Working Group (WHEWG).

Women's health education is an emerging interdisciplinary field that has recently received national attention. The American Board of Internal Medicine and the American Academy of Family Practice recently have published competencies in women's health for their residents, with increased attention to gynecological and mental health issues. Increasing women's health in the curricula of internal medicine (IM) and family practice (FP) residents will certainly require faculty development among IM and FP teaching faculty. We report a multiinstitution needs assessment among IM and FP teaching faculty for continuing medical education (CME) in multidisciplinary women's health topics. The survey (n = 100) asked whether faculty desired CME in 30 women's health topics. It also requested rates of referral to specialists for breast and menstrual problems and performance of tests commonly carried out in the care of women (e.g., endometrial biopsy, colposcopy, skin biopsy, and sigmoidoscopy) as measures of possible need for CME. Of the 69 respondents, 37% were IM physicians and 63% were FP physicians. Among the 30 women's health topics listed, breast cancer treatment alternatives, infertility for primary care providers, cervical dysplasia, medical treatment in pregnancy, vulvar disease, indications for pelvic ultrasound/endometrial biopsy, and menstrual disorders were of highest interest. The ranking of desirability of topics by IM and FP faculty correlated by .54 (Spearman rank, df = 28, p < 0.01). Analysis of variance revealed a significantly higher interest overall by IM than FP physicians, 58% vs. 42% (F = 4.1, df = 1, 50, p < 0.05). None of the IM teaching faculty performed endometrial biopsy or colposcopy compared with 57% of FP physicians, and only 12.5% of internists performed skin biopsy and sigmoidoscopy compared with 70% of FP physicians (F = 33, df = 1, 38, p < 0.001). We conclude that faculty development in women's health would benefit resident training in IM and FP, and topics of interest are identifiable. The correlation in interests between the IM and FP teaching faculty might make joint programs successful, although gynecological skills and knowledge clearly are needed more by IM teaching faculty. Obstetrics and gynecology (OB/GYN) faculty could be instrumental in improving women's health education among their IM and FP colleagues.

Education, Medical, Continuing↗
PubMed2001

Autoimmune thyroid disease in pregnancy and the postpartum period: relationship to spontaneous abortion.

The aim of this study was to determine the prevalence of autoimmune thyroid disease and the risk of miscarriage in autoimmune thyroid antibody (ATA)-positive women. Eight hundred seventy-six subjects completed the study, and 12.3% were thyroid antibody-positive (4.5% tested positive for both thyroid peroxidase antibody [TPO-Ab] and thyroglobulin autoantibody [Tg-Ab], 4.79% were TPO-Ab-positive only, and 3.1% were Tg-Ab-positive only). Fifty percent of the ATA-positive women and 14.1% of the ATA-negative group had a history of spontaneous abortion. Forty-eight of the ATA-positive women developed postpartum autoimmune thyroid dysfunction (PATD). Of these, 50% had hypothyroidism alone, 31.3% had transient hyperthyroidism followed by hypothyroidism, and 18.8% had transient thyrotoxicosis alone. Of the 48 PATD subjects, 12.5% developed persistent hypothyroidism. None of the ATA-negative women developed any form of thyroid dysfunction. The thyroid-stimulating hormone (TSH) levels in the ATA-positive group were significantly higher than those in the ATA-negative group, and only the ATA-positive women with a history of abortion had significantly higher TSH and lower free thyroxine (FT4) concentrations than the other subgroups. The results revealed a 5.5% prevalence rate for PATD in the study population. In addition to TPO-Ab, Tg-Ab is a useful marker for autoimmune thyroiditis.

Abortion, Spontaneous↗
PubMed1995

[A measurement scale for the Type A behavior pattern in women: the development of the Everyday Behavior Questionnaire].

A new 23-item scale, the Everyday Behavior Questionnaire (EDBQ) was developed to assess the Type A behavior pattern in women. Nurses (N = 139) in an university hospital participated in the validation study. Factor analysis of the 23 items revealed a four-factor structure. The four factors were anger/impatience, competitiveness/hard-driving, speed, and eagerness/interest. Internal consistency reliability estimates of four factors were adequate. Concurrent validity assessed by the relationship between the EDBQ and the Jenkins Activity Survey was significantly high. The four-factor structure and the relationship between the factors and psychological/physical symptoms adequately demonstrated Type A characteristics, as well as the uniqueness of the new questionnaire. These results suggested that the construct validity was in the desired direction. Further reliability and validity researches with the EDBQ in various samples were suggested.

Adult↗
PubMed2005

Very long-term follow-up of girls with early and late menarche.

Short- and long-term psychosocial effects of precocious or early normal puberty are probably more important for individuals than the moderate losses in final height they experience. Despite this, pediatric endocrinologists have focused much more on final height than psychosocial outcomes. As a surrogate for long-term follow-up studies of girls with precocious puberty, we have reviewed the results of a very long-term study of physical and psychosocial development of girls with normal early puberty. Results revealed that at age 15-16, girls with menarche before age 11 (early) were more norm-breaking, including being delinquents. In addition, they had earlier advanced sexual experiences. By adult age, there were no differences in psychosocial adjustment between the early- and late-developed women. Thus, the effects of early pubertal timing for psychosocial problems seem to be adolescent-limited. At ages 27 and 43, early-developed women had lower academic education. Regarding somatic development, at age 43, women with early menarche were shorter and heavier, had worse physical fitness and dieted more frequently compared to other women. There was no difference in quality of life. In searching for reasons for the antisocial behaviors in adolescence and the lower educational levels among early developers, early heterosexual relations seem to be the most crucial.

Adolescent↗
PubMedDate not supplied

Effect of pregnancy on development of seizures.

Some women develop seizures or experience increased seizure frequency during pregnancy. Although the reason for this increased susceptibility during pregnancy has not been established, hormonal changes have been hypothesized to be a factor. This study compared the rates of kindling in rats kindled during the first, second, or third trimester and female controls during diestrus. No significant differences in kindling rate were found between the controls and the pregnant rats. Although some differences in kindling rate were seen when the animals were separated into groups depending on stage of pregnancy kindled, these did not reach statistical significance. Using this model, seizure susceptibility was not significantly altered during pregnancy.

Animals↗
PubMed1993

The importance of thyroid microsomal antibodies in the development of elevated serum TSH in middle-aged women: associations with serum lipids.

OBJECTIVE: We assessed the relative risk of both serum TSH and antithyroid antibody concentrations with regard to progression of thyroid failure and studied the lipid profiles of individuals with elevated TSH levels. DESIGN, PATIENTS AND MEASUREMENTS: In a randomly selected group of 427 women aged 40-60 (mean 55) years volunteering in an epidemiological survey in Zoetermeer, TSH and thyroid microsomal antibodies (TMA) were determined. Ten years after the initial survey only TSH was measured and the lipid profiles of the individuals with elevated serum TSH levels were studied and compared with a reference group. RESULTS: During follow-up, four of 427 women were treated with thyroxine. Seventeen of 423 women initially had elevated serum concentrations of TSH (> 4.2 mU/l), 11 of whom were TMA positive. In the group of 406 women with initially a normal TSH, nine out of 37 (24%) TMA-positive women developed elevated serum levels of TSH over 10 years. In contrast only 10 of 369 (3%) TMA-negative women had elevated serum TSH levels 10 years after the initial survey (P < 0.001). Altogether, at the end of the observation period, 40% of TMA-positive subjects had elevated serum TSH concentrations, compared to 3% in the TMA-negative group (P < 0.01). TSH levels in the upper part of the normal range also appeared to have a predictive value: if those both with TSH levels between 2.0 and 4.2 and with a positive TMA status were contrasted with those without antibodies and low TSH, the crude relative risk was 71.5 (31.0-164.3), whereas the crude relative risk of presence versus absence of TMA was only 36.3 (18.8-70.3). Women with elevated TSH levels did not show changes in serum concentrations of total cholesterol (7.4 +/- 1.1 mmol/l), apo-A, (4.7 +/- 1.0 mmol/l) and apo-B (3.1 +/- 0.7 mmol/l) lipoproteins, compared with control individuals (7.2 +/- 1.3, 4.7 +/- 0.8 and 3.0 +/- 0.7 mmol/l, respectively). CONCLUSIONS: The determination of serum TMA in middle-aged women can identify an important group of women at risk of developing an elevated serum TSH. TMA measurement is of potential use in the prevention of cardiovascular disease. An elevated serum TSH, however, in our study-group does not seem to be accompanied by an abnormal lipid profile, as reported by others.

Adult↗
PubMedDate not supplied

Progression of abnormal MIB-1 staining patterns of reserve cells in cervical smears from women ultimately developing high grade squamous intraepithelial lesions.

OBJECTIVE: To assess, in a longitudinal study in women diagnosed with high grade squamous epithelial lesion (HSIL), the progression over time of proliferative activity in reserve cells using population screening cervical cytology specimens. STUDY DESIGN: Twenty consecutive, unselected patients with HSIL lesions were part of the national cervical screening program. From the archives, for each patient, the last prior normal population screening smear was included in the study. Concurrent sets of cervical smears from 80 age-matched women without pathology formed the controls. The original slides were stained using MIB-1 monoclonal antibody. The fraction of MIB-1-positive reserve cells was assessed using systematic random sampling and running progressive means assessment to ensure a sufficient sample size. RESULTS: The proliferation fraction in reserve cells of HSIL patients was significantly raised (mean, 65.0%; range, 53.5-94.1%; p < 0.01) as compared with that in concurrent controls (mean, 12.8%; range, 1.9-45.4%). Prior smears from HSIL patients, although without morphologic abnormalities, had abnormally high proliferation fractions (mean, 59.1%; range, 1.0-94.7%), significantly raised over those from concurrent controls (mean, 9.4%; range CONCLUSION: In population-based cervical smear screening, HSIL patients already have abnormally raised proliferation fractions of reserve cells, even without morphologic changes in squamous cells, 1-5 (mean, 3.6) years prior to diagnosis.

Biomarkers, Tumor↗
PubMed1997

Monitoring of early human fetal development in women exposed to large doses of chemicals.

The toxicological in-patient hospital in Budapest is responsible for the care of chemically poisoned persons from a population of 3 million. A population-based prospective epidemiological study of all pregnant women admitted from 1985 to 1993 was used to evaluate effects of large doses of chemicals on human fetal development. Of 559 self-poisoned pregnant women identified, two died from the poisoning. A total of 213 fetuses were in the first month of their postconception development. Of these, 126 had evaluated pregnancy outcomes: 111 ended in very early loss, 3 ended in clinical miscarriage, and 12 survived to delivery. (In addition 73 pregnancies were terminated and one pregnant woman died.) The 12 liveborn infants had two congenital abnormalities that were probably not related to their mother's self-poisoning. Though based on small numbers, these findings are consistent with an "all-or-nothing" effect of chemical poisoning very early in human gestation.

Abortion, Spontaneous↗
PubMed1996

The clinical spectrum of postpartum thyroid disease.

The clinical and biochemical features of postpartum thyroid disease were analysed in 152 antithyroid peroxidase antibody-positive (anti-TPO+ve) women and compared with 239 anti-TPO-ve age-matched control postpartum women. All were assessed monthly for up to 12 months postpartum. Seventy three anti-TPO+ve women developed postpartum thyroiditis (PPT): 19.2% hyperthyroid alone, 49.3% hypothyroid alone, and 31.5% characterized by hyper- followed by hypothyroidism. None of the antibody-negative women developed any thyroid dysfunction. A significant increase in many of eleven symptoms of hypothyroidism and some of eight symptoms of hyperthyroidism compared to control women was observed in all anti-TPO+ve women, independent of thyroid status. This was particularly seen in women who later developed PPT when they were euthyroid, but was also observed in euthyroid anti-TPO+ve women who showed no decline of thyroid function during the postpartum period. Although PPT is usually transient, this condition, and the euthyroid antibody-positive state, may be associated with significant symptomatology, including an increased incidence of minor to moderate depression. Early recognition of this syndrome by antenatal screening of thyroid antibodies may contribute to improved management of women during the postpartum period.

Adult↗