ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo estimate the incidence and regression rates of uterine leiomyomata and polyps in a cohort of asymptomatic, premenopausal women.METHODSSaline infusion sonography was performed twice, 2.5 years apart, in a cohort of 64 initially asymptomatic women. Subjects completed a questionnaire that assessed the development of abnormal uterine bleeding.RESULTSThe mean age of women (at second ultrasound) was 44 years. In four of seven women with polyps at the original ultrasound, their polyps regressed. Polyps that regressed tended to be smaller than polyps that persisted. Ten women had endometrial polyps at the second ultrasound for a point prevalence of 16% and a cumulative incidence rate of 12% per 2.5 years. A higher percentage of women with uterine polyps had complaints of abnormal uterine bleeding than women with no uterine abnormalities (70% versus 33%,P= .04). Six leiomyomata in four women were no longer detected in the second ultrasound. Leiomyomata that regressed were in older premenopausal women and were smaller than leiomyomata that persisted. The point prevalence and incidence rates of leiomyomata were 27% and 13% per 2.5 years, respectively. Leiomyomata grew an average of 1.2 cm per 2.5 years, but great variation in growth rates were noted.CONCLUSIONSmall uterine polyps frequently regressed spontaneously, whereas larger polyps were more likely to persist and were associated with the development of abnormal bleeding. Smaller leiomyomata in older premenopausal women also regressed whereas larger leiomyomata tended to grow while often remaining asymptomatic.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo systematically review the literature on the surgical and nonsurgical management of uterine leiomyomata.DATA SOURCESPublished literature in English on the management of uterine leiomyomata published from 1975 through 2000 was identified in MEDLINE, CINAHL, CancerLit, EMBASE, HealthSTAR, and the Cochrane Database of Systematic Reviews. Search terms included “leiomyomata,” “fibroids,” “hysterectomy,” and “myomectomy.”STUDY SELECTIONStudy designs considered included controlled trials, prospective trials with historical controls, prospective or retrospective cohort studies, and series with at least 20 cases. Original research studies or relevant reviews were included if the study population included women with uterine leiomyomata, and data were provided relevant to one or more of nine prespecified research questions.TABULATION, INTEGRATION, AND RESULTSInconsistency in reporting of severity of symptoms, uterine anatomy, and response to therapy prevented meaningful comparison of studies in most cases, and prevented performance of meta-analysis in all cases. This was true of both surgical and nonsurgical treatments.CONCLUSIONThe available evidence on the management of uterine leiomyomata is of poor quality. Patients, clinicians, and policymakers do not have the data needed to make informed decisions about appropriate treatment. Given the prevalence of this condition and its substantial impact on women's lives, obtaining these data should be a high research priority.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo describe self-reported prevalence of the use of alternative therapies for menopause symptoms and subject characteristics associated with their use.METHODSA telephone survey of 886 women aged 45–65 years (87.2% response rate) was conducted at Group Health Cooperative in Washington state. Women were asked about eight alternative therapies and their use for menopause symptoms.RESULTSThe proportion of women who used each therapy was 76.1% for any therapy, 43.1% for stress management, 37.0% for over-the-counter alternative remedies, 31.6% for chiropractic, 29.5% for massage therapy, 22.9% for dietary soy, 10.4% for acupuncture, 9.4% for naturopath or homeopath, and 4.6% for herbalists. The proportion of women who used it to manage menopause symptoms was 22.1% for any therapy, 9.1% for stress management, 13.1% for over-the-counter alternative remedies, 0.9% for chiropractic, 2.6% for massage therapy, 7.4% for dietary soy, 0.6% for acupuncture, 2.0% for naturopath or homeopath, and 1.2% for herbalists. Among women who used these therapies, 89–100% found them to be somewhat or very helpful. A history of breast cancer was associated with a six-fold increase in use of dietary soy for menopause symptoms (odds ratio 6.23, 95% confidence limits 2.54, 15.28). Current users of hormone replacement therapy were half as likely to use alternative remedies or providers (odds ratio 0.48, 95% confidence limits 0.29, 0.77) as were never users. Sleep disturbances were associated with a four-fold increase in the use of body work, a three-fold increase in the use of stress management, and more than doubled the use of dietary soy products to manage menopause symptoms.CONCLUSIONThe use of alternative therapies for menopause symptoms is common, and women who use them generally find them to be beneficial. Physicians should routinely ascertain perimenopausal women's use of alternative therapies.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo describe the odds of femicide (homicide of females) for women abused during pregnancy.METHODSA ten-city case-control design was used with attempted and completed femicides as cases (n= 437) and randomly identified abused women living in the same metropolitan area as controls (n= 384). The attempted and completed femicide cases were identified from police and medical examiner records. Interviews of attempted femicide victims and a proxy for the femicide victim were compared with data from abused controls, identified via random digit dialing in the same ten cities.RESULTSAbuse during pregnancy was reported by 7.8% of the abused controls, 25.8% of the attempted femicides, and 22.7% of the completed femicides. Five percent of the femicide victims were murdered while pregnant. After adjusting for significant demographic factors, such as age, ethnicity, education, and relationship status, the risk of becoming an attempted/completed femicide victim was three-fold higher (adjusted odds ratio 3.08, 95% adjusted confidence interval 1.86, 5.10) for women abused during pregnancy. Black women had more than a three-fold increase in risk (adjusted odds ratio 3.6, 95% adjusted confidence interval 2.4, 5.5) as compared with white women. Compared with women not abused during pregnancy, controls and attempted/completed femicide victims abused during pregnancy reported significantly higher levels of violence.CONCLUSIONFemicide is an important, but often unreported, cause of maternal mortality. This is the first report of a definite link between abuse during pregnancy and attempted/completed femicide. This research documents the immediate need for universal abuse assessment of all pregnant women.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVEFew studies have investigated risk factors that predispose males to be involved in teen pregnancies. To provide new information on such factors, we examined the relationships of eight common adverse childhood experiences to a male's risk of impregnating a teenager.METHODSWe conducted a retrospective cohort study using questionnaire responses from 7399 men who visited a primary care clinic of a large health maintenance organization in California. Data included age of the youngest female ever impregnated; the man's own age at the time; his history of childhood emotional, physical, or sexual abuse; having a battered mother; parental separation or divorce; and having household members who were substance abusers, mentally ill, or criminals. Odds ratios (ORs) for the risk of involvement in a teen pregnancy were adjusted for age, race, and education.RESULTSAt least one adverse childhood experience was reported by 63% of participants, and 34% had at least two adverse childhood experiences; 19% of men had been involved in a teen pregnancy. Each adverse childhood experience was positively associated with impregnating a teenager, with ORs ranging from 1.2 (sexual abuse) to 1.8 (criminal in home). We found strong graded relationships (P< .001) between the number of adverse childhood experiences and the risk of involvement in a teen pregnancy for each of four birth cohorts during the last century. Compared with males with no adverse childhood experiences, a male with at least five adverse childhood experiences had an OR of 2.6 (95% confidence interval [CI] 2.0, 3.4) for impregnating a teenager. The magnitude of the ORs for the adverse childhood experiences was reduced 64–100% by adjustment for potential intermediate variables (age at first intercourse, number of sexual partners, having a sexually transmitted disease, and alcohol or drug abuse) that also exhibited a strong graded relationship to adverse childhood experiences.CONCLUSIONAdverse childhood experiences have an important relationship to male involvement in teen pregnancy. This relationship has persisted throughout four successive birth cohorts dating back to 1900–1929, suggesting that the effects of adverse childhood experiences transcend changing sexual mores and contraceptive methods. Efforts to prevent teen pregnancy will likely benefit from preventing adverse childhood experiences and their associated effects on male behaviors that might mediate the increased risk of teen pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo estimate the effect of epidural analgesia on the Friedman labor curve.METHODSThis study was a secondary analysis of a previously reported randomized trial of the effects of patient-controlled epidural analgesia during labor compared with patient-controlled meperidine on cesarean delivery rate. All subjects had a singleton, cephalic, nonanomalous fetus at or beyond 37 weeks' gestation. This secondary analysis was limited to women who had cervical dilatation commencing of at least 3 cm (ie, active phase of labor).RESULTSA total of 459 women were randomized. Twenty-five women were excluded for a cervix less than 3 cm dilated, leaving 220 women allocated to patient-controlled epidural analgesia and 214 to patient-controlled intravenous meperidine available for analysis. There were no significant demographic differences between the two groups, including age, race, gestational age, and cervix on admission. The active phase of labor was 1 hour longer in the epidural-treated group (6.0 ± 3.2 hours versus 5.0 ± 3.2 hours,P< .001). The rate of cervical dilation was significantly less with epidural analgesia (1.4 cm/h versus 1.6 cm/h,P< .002). The duration of the second stage tended to be longer in the epidural group (1.1 ± 1.5 hours versus 0.9 ± 1.0 hours,P= .079).CONCLUSIONEpidural analgesia prolonged the active phase of labor by 1 hour compared with Friedman's original criteria.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo assess the diagnostic accuracy of amniotic fluid Δ OD 450 values in the second and third trimesters of D-alloimmunized pregnancies.METHODSWe searched our database for singleton D-alloimmunized pregnancies with nonhydropic fetuses, where amniocentesis was performed within 4 days of first fetal blood sampling. Amniotic fluid Δ OD 450 values were plotted on an extrapolated Liley's chart. Sensitivity and specificity were calculated for two commonly used cutoff levels, Liley's zone 3 and the upper third of Liley's zone 2. Severe fetal anemia was defined as a hemoglobin concentration of more than 5 standard deviations below the normal mean for corresponding gestational age.RESULTSSeventy-nine pregnancies met our inclusion criteria. Overall accuracy of the extrapolated Liley's curve in predicting severe fetal anemia was 75% (95% confidence interval [CI] 64, 84) for zone 3 and 86% (95% CI 77, 93) when the upper third of zone 2 was included. Sensitivity of Δ OD 450 values in Liley's zone 3 or the upper third of Liley's zone 2 was 95% (95% CI 74, 100) before and 98% (95% CI 89, 100) after 27 weeks.CONCLUSIONLiley's extrapolated curve predicts severe fetal anemia with reasonable accuracy and high sensitivity.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo estimate the association of preoperative CA 125 levels with outcome in primary ovarian cancer patients.METHODSOne hundred forty-two patients with epithelial ovarian cancer, who had a serum CA 125 level drawn before surgery, were retrospectively evaluated. The relationship of preoperative CA 125 levels and various preoperative and postoperative variables was evaluated. CA 125 levels were determined using a solid-phase immunoassay.RESULTSThe median CA 125 value for all patients was 582 U/mL (range 7–52,930 U/mL). Preoperative CA 125 values did not correlate with increasing age (P= .40), but were found to be significantly associated with serous histology compared with other histology (median CA 125 of 870 versus 334 U/mL,P= .02), high-stage (III/IV) compared with low-stage (median CA 125 of 893 versus 174 U/mL,P< .001), high tumor grade (3) compared with grade 1 or 2 (median CA 125 of 928 versus 323 U/mL,P< .001), and the presence of ascites compared with absence of ascites (median CA 125 of 893 versus 220 U/mL,P< .001). Suboptimal cytoreduction (more than 1 cm residual) was associated with significantly higher CA 125 levels (1067 U/mL) compared with individuals with optimal cytoreduction (399 U/mL,P< .001). Preoperative CA 125 values less than 500 U/mL had a positive predictive value for optimal cytoreduction of 82%, but a poor negative predictive value of 48%. After adjusting for covariates, there was a significant association between CA 125 levels and disease-specific survival. As preoperative CA 125 levels increased, the risk of death increased except at the highest values of CA 125.CONCLUSIONPreoperative CA 125 is an independent risk factor for death due to disease in ovarian cancer, but not a reliable predictor of optimal cytoreduction.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID