Changes in attitudes, knowledge and hormone replacement therapy use: a comparative study in two random samples with 6-year interval

OBJECTIVES: To study changes in: (i) the prevalence of hormone-replacement therapy (HRT) and (ii) women's attitudes and knowledge about the climacteric. Design. Cross-sectional comparison was performed on two populations of women both aged 46-62 years and resident in the same urban Swedish population over a period of 6 years. MATERIAL AND METHODS: In 1992, a random sample of 5990 women, from five birth cohorts, 46, 50, 54, 58, and 62 years in the city of G?teborg, were assessed using a postal questionnaire technique. In 1998, the same technique was used and a similar questionnaire was sent to another cohort of women (n=5411) of the same ages, resident in the city of G?teborg. The overall response rate was 76%. Information was obtained regarding climacteric symptoms, HRT use, and attitudes and knowledge. RESULTS: The prevalence of HRT use with medium-potency estrogens had increased from 13% (1992) to 31% (1998). The highest prevalence was reported in women 54 years of age (46%). The most common reasons why women started HRT were: hot flushes and sweats, depression/irritability, sleeping disturbances, and vaginal dryness. Forty-four percent of the women in this study were prepared to consider extended HRT if the treatment was free from withdrawal bleedings (35%, 1992). Eighty percent believed that the risk of osteoporosis decreased during HRT use (61%, 1992) and 68% thought that the risk of breast cancer increased (58%, 1992). CONCLUSIONS: A marked increase in the use of HRT was reported between 1992 and 1998. Women's attitudes to HRT were more positive in 1998 compared to 1992. Knowledge about HRT among women had increased during the same 6-year period.     

A comparative study of raw and prepared semen samples from two consecutive days.

OBJECTIVE: To study and compare raw and prepared semen samples from two consecutive days by conventional sperm parameters, various motility characteristics of spermatozoa determined by computer-aided sperm analysis and calcium ionophore-induced acrosome reaction. STUDY DESIGN: Semen samples of male partners in couples undergoing 81 cycles of double intrauterine insemination were studied. The first sample was produced after abstinence of 2-7 days and the second, 24 hours after the first. Both samples were processed by isolate sperm separation medium. RESULTS: Semen volume, sperm concentration and total motile spermatozoa were significantly reduced in day 2 raw and prepared samples, whereas normal morphology, motility characteristics and percentage of acrosome-reacted spermatozoa increased significantly in day 2 inseminated samples as compared to day 1. Oligospermic, asthenospermic and teratozoospermic samples showed a significant improvement in concentration, various motility characteristics and normal morphology of spermatozoa in day 2 samples as compared to day 1. CONCLUSION: Men with normal samples showed improvements in normal morphology and acrosome-reacted spermatozoa, whereas those with subnormal semen samples from day 1 showed a significant improvement in concentration, various spermatozoal velocities and normal morphology on day 2.     

Smoking-associated fetal morbidity among older gravidas: a population study

BACKGROUND: We set out to assess the influence of advanced maternal age on fetal morbidity associated with smoking during pregnancy in a population-based retrospective study of 7 792 990 singleton live births between 1995 and 1997 in the United States with documented maternal smoking habit. METHODS: The study group consisted of infants born to mothers aged>or=40 years (older mothers). Two maternal age categories (20-29, "younger mothers"; 30-39, "mature mothers") were constructed as comparison groups. Adjusted odds ratios (ORs) generated from logistic regression models were used to compare fetal morbidity indices associated with smoking across maternal age categories. Main outcome measures included preterm, very preterm, and small for gestational age (SGA). RESULTS: The prevalence of smoking was 13.1%, and decreased with increasing maternal age. Regardless of maternal age, the risk for fetal morbidity was significantly elevated if the mother smoked. The risks for preterm and SGA associated with smoking were significantly higher among older gravidas as compared to younger mothers while mature mothers had risk estimates comparable to those of older mothers. Among smoking mothers only, the risk pattern for fetal morbidity was J-shaped, with babies of older smokers having significantly higher fetal morbidity indices, while those of mature smokers showed lower levels of risk as compared to younger mothers. CONCLUSION: In an era of relatively lower prevalence of smoking during pregnancy, advanced maternal age still increases the risk of smoking-associated fetal morbidity. Our findings reveal new information of elevated risk for very preterm births among older smoking mothers.     

Fatigue in pregnancy: a comparative study.

The objective of this study was to use validated scales to determine if fatigue is increased during the first trimester of pregnancy compared to nonpregnant women with similar demographic characteristics. Women between 6 and 12 weeks' gestation were invited to complete a demographics questionnaire and the Numerical Rating Scale for Fatigue (NRS-F), State Trait Anxiety Inventory (STAI), and Beck Depression Index (BDI-II). Nonpregnant women were also invited to participate. Statistical analysis was performed using Mann-Whitney U, Fisher's exact, Spearman correlation, and Monte Carlo tests where appropriate; significance was assumed at p <0.05. Twenty pregnant and 15 nonpregnant patients were enrolled. There was no difference in age, parity, BMI, race, marital status, education, income or hours worked outside the home between pregnant and nonpregnant subjects. Pregnant women reported greater number of hours spent sleeping each day (8 [7-10] vs. 7 [6-9], p = 0.03). There was no significant difference in BDI-II, STAI-S, or STAI-T scores, but pregnant women had significantly higher scores on the NRS-F test (72.5 [20-88] vs. 36 [18-94], p <0.05). Women in the first trimester of pregnancy experience significantly greater fatigue compared to a similar group of nonpregnant women.     

5-year survival of endometrial carcinoma in the experience of the Gynaecological Clinic of Padua University: quality of life.

We have considered 414 cases of endometrial carcinoma from 1963 to 1990, with particular attention to 5-year survival and quality of life. The results show an increase of survival rate and of patients always NED- rate, from the first decades (63-70) to the last period (81-90). Similarly, the percentage of patients treated just with surgical therapies increases too, showing the effectiveness of personalized therapeutical strategies.     

Gynaecological surgical training in the operating room: an exploratory study

Objective

One of the challenging goals of gynaecological education is preparing trainees for independent practice of surgery. Research, however, on how to acquire surgical skills in the operating room safely, effectively and efficiently is scarce. We performed this study to explore trainers’ and trainees’ mutual expectations concerning operative training, to identify key aspects for improving learning and teaching in the operating theatre.

Study design

We conducted a focus group study in different teaching hospitals in The Netherlands. Three focus groups were composed of gynaecology consultants representing over half of the training hospitals in The Netherlands. Four groups were composed of gynaecology trainees at different stages of training, from university and non-university hospitals and of both sexes. The interviews were recorded, transcribed verbatim and entered into qualitative data analysis software and two researchers performed a thematic analysis.

Results

Teaching and learning in the operating theatre are complicated by the dynamics of trainer-trainee interaction, which are fraught with potentially conflicting interests. Trainer and trainee have to consider each other's interests, while their primary concern must be patient safety. Trainers want to feel in control and trainees want to be given a free hand within a safe atmosphere. Structuring of the teaching and learning process appears to hold the key to creating positive dynamics between trainer, trainee and their responsibility towards the patient. Structuring can be achieved before, during and after an operation. Before the operation both trainer and trainee can take the initiative to talk about learning objectives, plan of action, and task allocation. During the operation, the trainee can verbalise actions before actually performing them. This makes trainee actions predictable, enhances trainer confidence and thus may increase the trainee's chance of actually performing (a portion of) a procedure. After the operation, both trainer and trainee can initiate an evaluation the trainee's performance.

Conclusion

Interaction between trainer and trainee is complicated by their shared responsibility towards the patient. Structured interactions before, during and after operations appear to offer opportunities for improving learning and teaching in the operating theatre.     

Laparoscopic sacrocolpopexy: impact of the learning curve. Historic retrospective comparative study between two series of 93 and 169 patients

Genital prolapse is one of the most frequent reasons for gynaecologic consultations. Laparoscopic sacrocolpopexy (LSC) became the gold standard since laparoscopy was developed. We retrospectively compared two groups of patients: 82 who undergone LSC from January 1996 to December 2002 (group A) and 169 from January 2002 to December 2009 (group B), always by the same team. Suspension was reinforced with two strips of synthetic mesh. Laparoscopy was performed in 93 women of group A and 169 of group B. They all had symptomatic uterine prolapse. Conversion to laparotomy because of technical difficulties was significantly lower in the second than the first period (1 vs. 11, p?<?0.001). We performed less culdoplasty, levator myorrhaphy and Burch colposuspension (p?<?0.001) but more associated cure of urinary stress incontinence in the second period. Peri-operative complications (7.3% vs. 1.8%, p?=?0.006), post-operative complications (21% vs. 5%), and surgical length decreased (231 to 191?min, p?<?0.001). Six patients (7%) in group A had re-intervention, 15 (9%) in group B. LSC is a reproducible technique. A learning curve shortens the length of intervention and operative and post-operative complications and rate of conversion to laparotomy.     

Associations between sleep habits and interference of premenstrual symptoms in athletic performance in Japanese adolescent athletes: a cohort study over a 2-year period

Abstract

Premenstrual symptoms are common problems among female high-school and college athletes. This prospective study investigated associations between sleep habits and interference of premenstrual symptoms in athletic performance among Japanese adolescent athletes. A school-based survey on menstruation and school life was conducted among 623 female high-school students in 2015 and 2016, and data from the two surveys were connected. In total, 262 students completed the questionnaire in both years. We recruited 108 of those students who were athletes with regular menstrual cycles. Participants completed a questionnaire about their premenstrual symptoms and lifestyle habits. The prevalence of short sleep duration (<8?h) was high (95.4%). The difference in premenstrual symptom severity in individual students between the first and second years was not significant (p?>?.05). Premenstrual symptoms were less associated with disturbance in ‘athletic performance in training or competition’ in the second year than the first. ‘Longer sleeping time’ in the first year was associated with lower risk of increased interference of premenstrual symptoms in athletic performance in the second year (odds ratio 0.982, 95% confidence interval: 0.970–0.994). Shorter sleep duration may therefore have an effect on premenstrual symptoms’ interference with athletic performance among Japanese adolescents.     

Background factors and management of ectopic pregnancy in Sweden. Changes over a decade

Hospital records of all women operated on for ectopic pregnancy (EP) in four Swedish towns during 1970-72 and 1980-82 were elaborated. The gynecological and obstetrical background was noted and the clinical picture and management was recorded and analysed. The incidence of EP more than doubled between the two periods. There was no major change in classical background factors between the periods, but the proportion of IUCD users rose from 4 to 16 percent. The use of hCG assays, curettage and ultrasound in establishing the diagnosis increased markedly and the proportion of women with ruptured tubes and heavy intra-abdominal bleeding decreased. Moreover there was a clear tendency towards a more conservative surgical approach in the latter period.     

Gynecological cancer incidence in a hospital population in Saudi Arabia: the effect of foreign immigration over two decades

Aim:  To determine if the incidence of female genital malignancies changed with foreign immigration.
Methods  Retrospective analysis of histopathology records of women with primary genital tract cancers attending a referral gynecological hospital over two decades from 1985 to 2004. Incidence rates for the combined population of foreign migrants and Saudi nationals were compared to rates among Saudi nationals alone. Outcome measures were incidence rates and incidence rate ratios.
Results:  The incidence of cervical cancer for the combined migrant and local Saudi population was 48.4%, while for Saudi nationals alone it was 33.5% (incident rate ratio [IRR]= 1.44, 95% CI 1.17–1.88, P  < 0.001). For vulvar cancer, the incidence was 1.2% versus 0.5% (IRR = 2.4, 95% CI 2.03–2.79, P  < 0.001). Endometrial cancer rate was lower in the combined population than in Saudi nationals alone (11.7% vs 18.0%, IRR = 0.65, 95% CI 0.27–1.02, P  < 0.04). There were no differences in incidence for gestational trophoblastic neoplasia, uterine corpus sarcoma, ovarian, and vaginal cancer. Incidence rate ratios differed between decades for cervical cancer (1.1/1.9, 0.58, 95% CI 0.21–0.89, P  < 0.001), vulvar cancer (4.2/1.8, 2.33, 95% CI 1.68–3.07, P  < 0.001), gestational trophoblastic neoplasia (1.4/1.0, 1.4, 95% CI 1.09–2.13, P  < 0.04), and uterine sarcoma (0.3/1.0, 0.03, 95% CI 0.012–0.041, P  < 0.02).
Conclusion:  The incidence of cervical and vulvar cancer increased among women presenting with gynecological malignancies. For cervical and vulvar cancer, uterine corpus sarcoma, and gestational trophoblastic neoplasia, incidence varied over time.     

Retrospective,observational study on the effects and tolerability of flutamide in a large population of patients with acne and seborrhea over a 15-year period

The long-term effects and tolerability of flutamide (Flu) in women with acne and seborrhea were evaluated. Over the 15-year period, which spans from January 1991 to January 2006, a total of 230 Caucasian women with acne, 211 of which also with seborrhea, received yearly reducing doses (250, 125, and 62.5?mg/day) of Flu alone or combined with oral contraceptive for a period varying from 3 to 6 years and more. Clinical and endocrine evaluations were performed half-yearly and yearly, respectively, in the first 3 years of the study, and yearly in the following years. Liver function evaluations were performed quarterly. Both the groups of patients under Flu therapy showed a similar, marked decrease in acne and seborrhea scores after 6 months of treatment compared with basal values. The maximum drug effect was observed after 1 year, and it was maintained during the following years of treatment. Androgens were strongly suppressed during treatment. During the first year of treatment with 250?mg/day, 4.8% of patients interrupted the study due to hepatic disorders. During the following years on the 125 and 62.5?mg/day doses, no transaminase elevation was observed. The study supports very low-dose Flu as a first-line therapy for women with acne and seborrhea.     

A comparison between laser surgery and electrosurgery for bilateral hydrosalpinx: a 2-year follow-up

The overall pregnancy rate after salpingostomy in women with complete bilateral terminal tubal occlusions was 26.9%. No difference was found in the intrauterine pregnancy rate and the surgery-conception interval between salpingostomy with the CO2 laser or the microdiathermy needle at a 2-year follow-up. The advantage of the CO2 laser in other reproductive surgery remains to be seen.     

Vasoepididymostomy to the head of the epididymis: a comparative study of two microsurgical techniques in the rabbit

In an experimental animal study, two different microsurgical techniques of vasoepididymostomy to the caput epididymidis are compared: an end-to-side anastomosis with the epididymal tubule and an end-to-end anastomosis with a section of a cluster of the epididymal tubule. The patency rates are respectively 50 per cent and 26.3 per cent, as controlled by deferentography and histology. Examination with scanning electron microscopy, shows that the superiority of the first method is due to the better apposition of both mucosas .