Comparison of two HRT regimens with bimonthly and monthly progestin administration in postmenopause

OBJECTIVES: Here we report the results of a study in which natural estrogens were given transdermally cyclically and continuously for 1 year, and a progestin of the latest generation, namely nomegestrol acetate, was given for 10 days every month and for 15 days every 2 months. METHODS: The patients were a group of 34 post-menopausal women (51-56 years), 18 of whom (group A) were treated with continuous transdermal estradiol (50 micrograms/day) and cyclic oral nomegestrol at a dose of 5 mg/day for 15 days every 2 months for 1 year. The other 16 women (group B) were treated with cyclic transdermal estradiol for 3 weeks with oral nomegestrol for 10 days (12-21)/month. Endometrial thickness was evaluated by transvaginal ultrasonography before and after treatment. At the end of treatment, an endometrial biopsy was performed. Serum total cholesterol, HDL, LDL and triglycerides were assessed at baseline and every 4 months. The characteristics of the cycle were deduced from the diary cards recorded by the women. RESULTS: No significant differences were found in the mean interval between the last dose of nomegestrol and the start of bleeding or in the duration of bleeding. The total number of days of bleeding per year was significantly lower in group A than group B (27 +/- 12 vs. 52 +/- 18; P < 0.01). Total serum cholesterol and LDL significantly decreased after 1 year of treatment in both groups, HDL-cholesterol and triglycerides were found increased at most of the time points studied. CONCLUSIONS: The present protocol involving continuous transdermal administration of estrogen combined with oral progestin every 2 months gave good control of the menstrual cycle, did not increase the risk of endometrial pathology and met with good patient compliance.     

Bleeding patterns in recent postmenopausal outpatients with uterine myomas: comparison between two regimens of HRT

Objectives: To evaluate and to compare the bleeding patterns obtained with two regimens of hormone replacement therapy given to early postmenopausal women with asymptomatic uterine leiomyomas. Methods: In this randomised prospective 1-year study 50 early postmenopausal women with one to four asymptomatic uterine leiomyomas were enrolled into two study-groups to take two regimens of hormone replacement therapy for 12 28-day cycles: (A) Tibolone, 2.5 mg/day; (B) conjugated equine estrogens (CEE), 0.625 mg/day plus medroxyprogesterone acetate (MPA), 5 mg/day. The bleeding patterns and the changes in uterine volume of the 47 outpatients who completed the study were evaluated and compared. Results: Amenorrhea incidence was higher in group A (75.0% of the cycles) than in group B (65.6% of the cycles), while irregular bleeding and irregular spotting incidences were higher in group B (29.7 and 4.7% of the cycles, respectively) compared to group A (22.6 and 2.4% of the cycles, respectively). The mean bleeding and spotting lengths were not statistically different between patients in group A and those in group B. Finally, at the end of the study period transvaginal ultrasonography showed no significant change in leiomyoma size. Conclusions: The results demonstrate that, in early postmenopausal patients with asymptomatic uterine leiomyomas, Tibolone treatment seems to be preferable compared to CEE–MPA continuous combined treatment in relation to the lesser occurrence of irregular bleeding. Furthermore, neither Tibolone nor CEE–MPA therapy, at the doses used here, promote fibroid growth.     

Hysteroscopic findings in postmenopausal abnormal uterine bleeding: a comparison between HRT users and non-users

Objectives: The aim of our study was to investigate hysteroscopic findings in a sample of 410 menopausal women (hormonal replacement therapy, HRT users n=219 and HRT non-users n=191) and to evaluate the relationship between the presence of intrauterine disease, the use of HRT and the presence of AUB. Methods: Two hundred and nineteen women on HRT underwent standard office hysteroscopy by means of the Hamou hysteroscope (in 94 cases for abnormal uterine bleeding (AUB) and in 125 cases for periodic endometrium monitoring). One hundred and ninety-one women who had never received HRT were submitted to office hysteroscopy (154 for AUB and 37 for other reasons). Results: Intrauterine diseases are more frequent in patients who do not use HRT (P=0.02). Endometrial polyps is a frequent disease present in 30% of the sample (23.7% of HRT users and 30.8% of HRT non-users). Myomas were present in 8.7% of all patients examined (6.8% of HRT users and 11% of HRT non-users). Irregular bleeding in menopause is often associated with endouterine abnormalities: in symptomatic patients the frequency of endouterine diseases was 41% while in asymptomatic patients was 28% (P=0.003). In patients taking HRT (n=219) endouterine disease is demonstrated in 37% with AUB and in 26% without AUB (P=0.07). Conclusion: Benign intrauterine diseases (endometrial polyps and submucous myomas) are more frequent in postmenopausal women who do not use HRT. In patients taking HRT irregular bleeding is associated with intrauterine diseases; however, the absence of AUB does not exclude the presence of endometrial polyps or myomas.     

Assessment of the QoL in Italian menopausal women: comparison between HRT users and non-users

Objectives: The aim of this cross-sectional study was to describe QoL in a large sample of women attending menopause centres and compare untreated postmenopausal women and matched HRT users by employing the Women's Health Questionnaire (WHQ) and two generic instruments, the SF-36 and the EQ-5D. Methods: Overall, 2906 women were recruited by 64 menopause centres throughout Italy, of whom 2160 filled in the questionnaire (1093 on HRT and 1067 not on HRT; response rate: 74%). Results: HRT users tended to be younger, healthier and with shorter menopause duration as opposed to non users, while no major socio-economic differences were present. At multivariate analysis, the presence of chronic diseases, low socio-economic status and living in Southern Italy represented the most important predictors of poor QoL. Furthermore, HRT users showed a lower probability of reporting problems in usual activities and pain/discomfort (EQ-5D), role limitations due to emotional problems (SF-36) and anxiety/fears (WHQ). HRT users also showed highly significant better outcomes in those areas that are more directly attributable to hormonal changes of mid age, namely vasomotor symptoms and sexual problems. Conclusions: Although QoL is mainly influenced by socio-economic and cultural factors, HRT has the potential for improving not only symptoms, but also more general aspects of physical and psychological well-being of symptomatic postmenopausal women.     

Prevention of perinatal transmission of hepatitis B virus (HBV): a comparison of two prophylactic schedules

Perinatal transmission of hepatitis B virus (HBV) from HBsAg carrier mothers who were HBeAg+, antiHBe+, or negative for both HBe markers, was interrupted using either 4 doses of vaccine, or one dose of hepatitis B immunoglobulin (HBIG) at birth, combined with 4 doses of vaccine. In those infants who received HBIG at birth, the antiHBs titre was significantly higher at 1 and 2 months old, but at 6, 9, and 18 months old, there was no significant difference. Among the infants of carrier mothers who did not display HBeAg (i.e., were antiHBe+, or negative for both HBe markers), a transient subclinical infection would have been expected in around 10% had there been no intervention. No evidence of such infection was detected, and no difference in outcome was found between the two treatment groups. Amongst infants born to HBeAg+ carrier mothers, infection occurred in 1 out of 8 who had received HBIG and vaccine, and in 3 of 8 who had received vaccine only. The difference in outcome was not statistically significant, but the numbers analysed were small. The infections which occurred in spite of prophylaxis may be attributable to in utero infection, poor response to vaccine by the infant, or to the mother having a particularly high HBV-DNA level. HBIG given at birth to infants of HBeAg+ carrier mothers may enhance the protection of infants who are destined to be poor responders to vaccine.     

Uterine positions and schedules of urination: correlates of differential maternal anogenital stimulation

Lactating Mongolian gerbils, like lactating Norway rats, reliably lick some pups in their litters more than they lick others. Male gerbil pups are licked more by their dams than are their sisters and some males and some females within each litter are licked more often than are their sibs of the same sex. In the present article, we explore the characteristics of same-sex littermates that are correlated with elicitation of extreme amounts of maternal anogenital licking. We found that both the male pup and the female pup in a litter of gerbils that received the most maternal anogenital licking: (1) released greater quantities of urine and (2) exhibited longer latencies to begin to urinate in response to artificial anogenital stimulation than did the male pup and the female pup in a litter that received the least amount of maternal anogenital licking. We also found that foster mothers rearing Caesarean-delivered litters spent more time licking the anogenital areas of: (1) those male pups that, as fetuses, had occupied uterine locations adjacent to relatively few females and (2) those female pups that, as fetuses, had occupied uterine locations adjacent to relatively many males. We discuss implications of these findings for understanding of how maternal behavior may mediate hormonal effects on the development of young gerbils.     

Uterine adenomyoma with uterus-like features: a report of two cases

Two uterine adenomyomas with unusual features are presented. Case 1 was a 43-year-old woman who had a 1-year history of menorrhagia and dysmenorrhea. The uterus showed a 3-cm-sized mass attached to the posterior wall of the lower uterine segment. On section, there was a well-circumscribed, submucosal cystic mass with a thick muscular wall. Histologically, the cavities were lined by well-developed secretory-phase endometrium and surrounded by smooth muscle, like a small uterus. Case 2 was a 52-year-old woman who visited the hospital because of itching sensation on the vulva. On physical examination, the mass was found on the left side of the pelvis. The enlarged uterus had an 8-cm-sized protruding mass from the left side of the lower uterine segment. On section, the mass was cystic and solid. Histologically, the cysts were lined by thin basalis-type endometrial glands and stroma, and the solid portion was composed of smooth muscle and fat cells.     

Longitudinal associations between depressive and anxiety disorders: a comparison of two trait models

BACKGROUND: Depression and anxiety are highly co-morbid disorders. Two latent trait models have been proposed to explain the nature of the relationship between these disorders. The first posits that depressive and anxiety disorders are both manifestations of a single internalizing factor. The second model, based on a tripartite model proposed by Clark & Watson [Journal of Abnormal Psychology (1991) 100, 316-336], proposes that depressive and anxiety disorders reflect a combination of shared and disorder-specific factors. METHOD: We directly compared the two models in a sample of 891 individuals from the Oregon Adolescent Depression Project who participated in up to four diagnostic assessments over approximately 15 years. Structural equation models were used to examine the relationship between depressive and anxiety disorders across different developmental periods (<14, 14-18, 19-23, 24-30 years of age). RESULTS: The one- and three-factor models were hierarchically related. Thus, a direct comparison between the one- and three-factor models was possible using a chi2 difference test. The result found that the three-factor model fit the data better than the one-factor model. CONCLUSIONS: The three-factor model, positing that depressive and anxiety disorders were caused by a combination of shared and disorder-specific factors, provided a significantly better fit to the data than the one-factor model postulating that a single factor influences the development of both depressive and anxiety disorders.     

Bronchial allergen challenge: comparison between two different methods of provocation

Bronchial allergen challenge was performed twice in ten well-defined stable asthmatic patients. On each provocation day the allergen was administered either by a standard method at tidal volume breathing or by a dosimeter method. Ten-fold increasing concentrations of allergen were administered with an interval of 10 min. Total amount of allergen of 9, 90, 900, 9000 and 90000 SQ units using the standard method, whereas the corresponding amount by the dosimeter method was 0.5, 5, 50, 500, and 5000 SQ units. The bronchial response was determined by forced expiratory volume in the first second (FEV₁) and by total resistance to breathing (R_t) measured by an opening interrupter method. The provocation was stopped when a decrease of at least 20% of the post-saline FEV₁ and a 4O% increase in post-saline R_t, was observed. A PC₂₀-FEV₁ and a PC₄₀-R_t was calculated by interpolation on the log dose-response curve. The late reaction was recorded and defined as a 20% reduction in peak expiratory flow (PEF) occurring during the 24-hr period after challenge. The comparability of PC₂₀-FEV₁ and PC₄₀-R_t obtained with the standard method and with the dosimeter was high. r= 0.89 and r= 0.88. Furthermore, no significant difference was found by comparing Δ FEV₁ and Δ R_t during provocation by either method as well as the occurrence and magnitude of the late reaction. We conclude that there exists a high comparability of the bronchial response to an allergen challenge performed either by a standard method at tidal volume breathing by continuous inhalation of the allergen aerosol or by a dosimeter method of inhalation despite the difference in the total allergen doses inhaled.     

Analgesics: a comparison of therapeutic knowledge and inter-professional liaison between general practitioners and community pharmacists.

The aim of this study was to ascertain general practitioners' (GPs') and pharmacists' knowledge of analgesics, to establish professional opinion on their use, and to assess the extent of pharmacist input into the prescribing of analgesics. Pharmacists displayed a better knowledge of analgesics than their colleagues in general practice, but had little input into the prescribing decisions made by GPs. Pharmacists' knowledge is not being put to best use in contributing to the preparation of practice formularies, and links between these two health professional groups need to be developed further.     

Interpersonal control in psychotherapy: a comparison of two definitions

This study compared the two definitions used to study therapist interpersonal control: The relational coding scheme of Ericson and Rogers (1973) and the topic initiation/topic following schema of Tracey and Ray (1984), as they apply to actual therapy dyads. All interactions of three psychotherapy dyads was coded independently according to each control coding schema and then correlated to examine the overlap and to assess whether each yielded similar results. It was found that both schemata were moderately correlated, which indicates marginal convergent validity, but the two models attributed control to different participants. The Ericson and Rogers model yielded results with the client in control, whereas the opposite result was obtained when the topic initiation/topic following schema was used. The results are discussed with respect to the different assumptions used in each method of operationalizing control and as an indication of the subtlety and complexity of the construct of control in psychotherapy.     

Clinical information technology in hospitals: a comparison between the state of Iowa and two provinces in Canada

Despite the growing interest in adopting information technology (IT) in healthcare, the degree of technology sophistication varies among healthcare organizations. Changes in the health care sector and continuous pressure to improve the quality of care have driven the evolution of IT in hospitals. This paper provides an overview of clinical IT sophistication in a sample of U.S. hospitals, and compares clinical IT capacities in this sample with a sample of Canadian hospitals. The instrument used for the comparison measures three clinical dimensions of IT sophistication: functional sophistication, technological sophistication and integration level. Clinical areas that were considered include patient management, patient care activities and clinical support activities. The comparison between hospitals in Iowa and Canada shows differences in clinical IT sophistication between the two settings. Hospitals in Iowa appear to have more technologies but fewer computerized processes and integration of patient management activities. Technological sophistication however, was low in both samples. Our findings confirm the construct validity of the measurement instrument and show initial evidence of its generalizability. More initiatives using the instrument would lead to enhancement in IT assessment tools that can be used for evaluation of IT in relation to patient management and quality outcomes.     

Circle-elipse discrimination in monkeys: comparison of titration schedules with the method of limits

In order to make a direct comparison, psychometric functions were derived from two titration schedules and from the method of limits. Three vervet monkeys were reinforced with food pellets for choosing a response key with a back-projected circle from among 7 keys with identical elipses. Elipse ratios from 0.400 to 0.985 were available in 18 discrete steps. The schedules were tested in this sequence: (1) a titration schedule with different up-and-down transformed response rules. Training began with a rule of 3:1 indicating that after three correct responses the next trial presented elipse ratios one step higher. A change to a lower ratio occurred after one incorrect response. Subsequently, up-and-down rules from 1:3 to 9:1 were tested, one rule per session. (2) the method of limits. One elipse ratio was tested per session first in a sequence of increasing then of decreasing ratio. (3) a titration schedule with sequential likelihood ratio tests. A target probability of correct responses was approached by deciding after each trial whether to change to a larger or to a smaller elipse ratio. Psychometric functions derived from schedules 1 and 2 coincided. Schedule 3 produced oscillations in the difficulty of the presented stimuli. The conclusion is that discrete trial titration schedules with different up-and-down transformed response rules provided reliable measures of threshold in a visual shape discrimination. Performance was more stable and the programming simpler with this schedule than with the sequential likelihood ratio test.     

Histamine inhalation challenge in children: a comparison of two methods

Airway reactivity in children is often assessed using a histamine inhalation challenge test. The bronchoconstrictor agents are usually delivered by five slow inspiratory capacity (IC) maneuvers, the IC method. We compared the IC method with a tidal breathing (TB) method in 30 children; 11 were normal, six were under investigation for asthma and 13 were known asthmatics. None of the normal children responded to either method, whereas 18 out of the 19 (95%) known or suspected asthmatics responded to the TB method while only 13 out of 19 (68%) showed a significant reduction in FEV1 when the IC method was used. The concentration of histamine necessary to cause a 20% reduction in FEV1 was less for the TB method, suggesting that in children the TB method will produce airway reactivity more quickly than the IC method.     

The Child Behaviour Checklist and the Rutter Parental Questionnaire: a comparison between two screening instruments

In order to carry out an epidemiological survey of child psychiatric disorders in a community sample, the Child Behaviour Checklist was chosen as a parental questionnaire for screening in the first stage of the study. A French version of this instrument was developed and a pilot study of the scale was completed on a clinical sample (N = 127). As a criterion to gauge its validity, the Rutter scale was used as a concurrent measure. The correlation coefficient between the total scores of the two scales is 0.79, and ranges between 0.22 and 0.96 for individual items. A linear regression analysis, using the total score of the Rutter scale as an independent variable, predicts a value of 41 as the optimal cut-off to be used for the Child Behaviour Checklist. Comparative properties (reliability and time of completion) of the two scales are presented and discussed.