Factors related to declining luteal function in women during the menopausal transition

CONTEXT

Reproductive hormones are incompletely characterized during the menopause transition (MT).

HYPOTHESIS

Increased anovulation and decreased progesterone accompany progress through the MT.

DESIGN

The Daily Hormone Study (DHS) of the Study of Women's Health Across the Nation (SWAN) included 848 women aged 43-53 yr at baseline who collected daily urine for one cycle or up to 50 d annually for 3 yr.

MAIN OUTCOME MEASURES

LH, FSH, estrone conjugates, and pregnanediol glucuronide levels were assessed. Cycles were classified by presumed luteal (ovulatory) status and bleeding. Hormones were related to time in study, age, menopausal status, and selected variables.

RESULTS

Ovulatory-appearing cycles declined from 80.9% at baseline to 64.7% by the third assessment (H3). Cycles presumed anovulatory and not ending with bleeding by 50 d (anovulatory/nonbleeding) increased from 8.4 to 24% by H3 and were associated with progress to early perimenopause [odds ratio (OR) = 2.66; confidence interval (CI) = 1.17-6.04] or late perimenopause (OR = 56.21; CI = 18.79-168.12; P < 0.0001), African-American ethnicity (OR = 1.91; CI = 1.06-3.43), and less than high school education (OR = 3.51; CI = 1.62-7.62). Anovulatory cycles ending with bleeding remained at about 10% from baseline to H3; compared with ovulatory cycles, they were associated with obesity (OR = 4.68; CI = 1.33-16.52) and more than high school education (OR = 2.12; CI = 1.22-3.69; P = 0.02). Serum estradiol in both the highest and lowest categories was associated with anovulatory/nonbleeding collections. Pregnanediol glucuronide decreased 6.6% for each year on study. Insulin sensitivity measures did not relate strongly to menstrual cycle hormones.

CONCLUSIONS

Anovulation without bleeding represents progression of the MT. A small but detectable decrease in luteal progesterone excretion occurs as women progress through the MT.

Nonverbal Behavior of Vendors in Customer-Vendor Interaction

Two research questions were posed on the homophily theory of customer-vendor interactions: (a) do vendors show any nonverbal preference for Euro-American or African-American customers?; (b) do vendors demonstrate any nonverbal preference for customers with which they share racial homophily? The results supported the homophily theory for Euro-American customers in that there were significant interaction effects by race in facial expression ( F = 5.33, p < .05), amount of speaking ( F = 6.76, p < .01), tone of voice ( F = 7.62, p < .01), and touching ( F = 4.57, p < .05). Vendor behavior varied when the customer was Euro-American, with Euro-American vendors smiling more frequently ( M = 4.05) than African-American vendors ( M = 3.69), speaking more frequently ( M = 3.57) than African-American vendors ( M = 3.09), using a more friendly tone of voice ( M = 3.59, and engaging in more touching behaviors ( M = 1.81) than African-American vendors ( M = 1.48). There was no significant difference in the behavior of Euro-American and African-American vendors when the customer was African-American.

Fenofibrate and pioglitazone improve endothelial function and reduce arterial stiffness in obese glucose tolerant men

Obesity is a low grade inflammatory state associated with premature cardiovascular morbidity and mortality. Along with traditional risk factors the measurement of endothelial function, insulin resistance, inflammation and arterial stiffness may contribute to the assessment of cardiovascular risk. We conducted a randomised placebo controlled trial to assess the effects of 12 weeks treatment with a PPAR alpha agonist (fenofibrate) and a PPAR gamma agonist (pioglitazone) on these parameters in obese glucose tolerant men. Arterial stiffness was measured using augmentation index and pulse wave velocity (PWV). E-selectin, VCAM-1 and ICAM-1 were used as markers of endothelial function. Insulin sensitivity improved with pioglitazone treatment (p=0.001) and, in keeping with this, adiponectin increased by 85.2% (p<0.001). Pro-inflammatory cytokine levels (TNFalpha, IL-6 and IL-1 beta) fell with both treatments (p<0.01 for TNFalpha and IL-1 beta, p<0.001 for IL-6). VCAM-1 and ICAM-1 were reduced with both treatments (p<0.001 for VCAM-1, p<0.05 for ICAM-1) and E-selectin improved with pioglitazone treatment (p=0.05). Both treatments resulted in a fall in augmentation index. PWV fell by 17.4% with fenofibrate treatment (p<0.001) and 16.3% with pioglitazone treatment (p<0.001). Pioglitazone and fenofibrate treatment of obese, glucose tolerant men reduces inflammation, improves markers of endothelial function and reduces arterial stiffness. These results suggest that treatment with PPAR agonists has potential to reduce the incidence of premature cardiovascular disease associated with obesity.

JM, Partridge EE, Parham GP. Use of complementary and alternative medicine and spiritual practices among women with ovarian carcinoma in the southeastern United States

15048

Background: The use of complementary and alternative medicine (CAM) among women with gynecologic malignancies has been described in a number of studies from the Midwestern and Western United States. There is limited data on the use of CAM in women with gynecologic malignancies in the Southeastern United States. Therefore, we sought to evaluate the use of CAM and spiritual practices among women with ovarian carcinoma in the Southeastern United States. Methods: Women with the diagnosis of ovarian carcinoma undergoing chemotherapy were recruited from the gynecologic oncology clinic. Patients underwent a face-to-face interview by a research assistant regarding their use of CAM as well as their spiritual practices. Results: 39 women participated in the interview. 26 patients (67%) had used CAM since being diagnosed with cancer. CAM use was not affected by age, annual income, or number of treatments. The majority of women who used CAM had a college education or higher (69%). The most frequently used CAM therapies included mind-body techniques (44%), herbal therapy (38%), and dietary supplements (28%). The most common mind-body technique was music therapy (28%) followed by meditation (21%). The most common dietary supplement used was fish oil, and the most common herbal therapy was green tea (77%). 28% of patients had used an alternative health care provider, most commonly a chiropractor (13%). The most common reason for using CAM was relief of side-effects from treatment (28%). All patients reported some use of spiritual practices. 95% of patients pray with 90% having asked others to pray for their health. 82% had spoken to a religious figure and 26% had a religious sacrament performed for their health. 87% of patients would like their physician to pray with them. Conclusion: Patients with ovarian cancer in the Southeastern United States frequently use CAM including mind-body techniques, herbal therapy, and dietary supplements. The majority of patients believe that spirituality is an important aspect of their cancer therapy. Physicians should be aware of the number of patients who incorporate CAM and spirituality into their standard therapy.

No significant financial relationships to disclose.

Pulpal and periodontal temperature rise during KTP laser use as a root planing complement in vitro

OBJECTIVE

The purpose of this study was to define the optimal irradiation conditions of a KTP laser during root planing treatment.

METHODS

The surfaces of 60 single-root human teeth were scaled with conventional instruments before lasing. The pulpal temperature increase was measured by means of one thermocouple placed in the pulp chamber and a second one placed on the root surface at 1 mm from the irradiation site. The influence of variables of coloration by Acid Red 52 (photosensitizer), scanning speed, dentin thickness, and probe position was analyzed for a constant exposure time of 15 sec and 500 mw (spot size diameter, 0.5 mm). The pulpal temperature was below 3 degrees C for the adjustments.

RESULTS

The irradiation on one point of root surface had the following results: The application of photosensitizer on the root surface before lasing produced a 50% higher temperature rise within the pulp than in the case without the application of the photosensitizer. The temperature rise in the pulp chamber was below 3 degrees C with the following settings of 500 mw: PW = 10 msec and PRR < 35; or PW= 20 msec and PRR < 20 Hz. On the other hand, for the same irradiation conditions, the temperature rise on the surface of the root was always below 7 degrees C. However, the temperature increase became higher than 7 degrees C (on the surface of the root) in the case of P > 500 mw, PW > 50 msec and PRR > 10 Hz of root surface or a scanning speed of irradiation of 1 mm/sec for a linear irradiation of 4 mm.

CONCLUSION

The KTP laser may be used safely without thermal damage to pulp and periodontal tissue with respect to the biologically acceptable previously described parameters.

Changes in students' perceptions of interdisciplinary practice reaching the older adult through mobile service delivery

This study examined students' perceptions of interdisciplinary health care practice in a facilitated, community-based practicum experience. Students' perceptions of interdisciplinary practice relative to their own profession and other health disciplines were examined before and after involvement in mobile service delivery to the older adult in a collaborative team approach. The Interdisciplinary Education Perception Scale was used to collect data before and after planned and facilitated interdisciplinary experiences of students enrolled in health professional programs (nursing, dietetics, physical therapy, occupational therapy, pharmacy, health education, social work, and physician assistant). Univariate repeated-measures analysis of variance revealed significant pretest to posttest and discipline effects following the interdisciplinary interaction of students in the practicum experience. Univariate analysis revealed a significant change in students' perceptions of professional competence and autonomy, actual cooperation and resource sharing within and across professions, and understanding of the value and contributions of other professionals from pretest to posttest. The findings support the need for educators to facilitate communication through innovative interdisciplinary clinical opportunities for health professions students to influence perceptions that promote active participation in a team approach to care delivery in an increasingly complex health care system.

Safety parameters for pulp temperature during selective ablation of caries by KTP laser in vitro

OBJECTIVE

To define the optimal parameters of KTP laser irradiation during a selective caries removal.

MATERIALS AND METHODS

Twelve decayed human teeth, recently extracted were used. Their root canals were prepared for insertion of a thermocouple probe into the pulp chamber. The demineralized tissues were colored by Acid Red 52 before proceeding to different conditions of irradiation.

RESULTS

Pulpal temperature increases (below 3 degrees C) were found under the following parameters with 15 sec of continuous lasing: 400 mWatts, 0.10-msec pulse width, PRR <50 Hz for efficient caries removal. A resting time average of 70 sec was necessary to allow pulp temperature to get back to its baseline.

CONCLUSION

KTP laser can be used safely and without any pulp over-heating under certain irradiation conditions.

Restoration-enamel interface with argon laser and visible light polymerization of compomer and composite resin restorations: a polarized light and scanning electron microscopic in vitro study

This polarized light (PL) and scanning electron microscopic (SEM) in vitro study investigated the effect of argon laser (AL) and visible light (VL) polymerization on the interfaces between compomer and composite resin restorations and the enamel cavosurfaces. Surface topography by SEM revealed a smooth transition between the restorative materials and adjacent enamel surfaces with no microspaces between the restorations and enamel surfaces. The enamel surfaces showed relatively smooth surface coatings with AL curing compared with exposure of etched prism endings with VL curing. The restoration-enamel interface by PL showed an intimate relationship between the restorative materials and the cavosurface enamel. No differences were found between AL and VL polymerization. With the restoration-enamel interface by SEM, compomers and composite resins were adapted closely to the cavosurface enamel and tags of restorative material protruded into the adjacent cavosurface enamel. Both VL and AL polymerization of compomers and composite resin restorations in vitro produced closely adapted restorations with intimate restoration-enamel interfaces. Such restoration-enamel interfaces may provide a certain degree of resistance against secondary caries formation, and this may be enhanced by the caries protective effect of argon laser irradiation.

Increase of enamel fluoride retention by low fluence argon laser in vivo

BACKGROUND AND OBJECTIVES

The aim of this in vivo study was to investigate if argon laser irradiation of enamel can increase the retention of fluoride.

STUDY DESIGN/MATERIALS AND METHODS

Ninety-eight teeth in 12 patients were randomly divided into three groups: (1) EF group: 40 teeth were only treated by fluoride gel (application for 5 minutes followed by 1 minute rinsing with distilled water). (2) EFL group: 40 teeth were treated the same way as in the EF group but they were lased after fluoridation. (3) E group of 18 teeth were kept without any treatment and considered as reference. In order to quantify the fluoride content in the enamel samples, the teeth were analyzed by proton beam delivered by a tandem accelerator (PIgammaE, particle induced gamma-ray emission). The fluoride content of enamel surface is not homogeneous. Therefore, it is necessary to analyze the same enamel area after each treatment. Each tooth was maintained in a fixed tooth holder which was designed to analyze the tooth enamel surface at the same place (1 mm(2) and around 20 mum in depth) after various treatments. A low energy density of argon laser beam was used: 10.74 J/cm(2), 30 seconds of irradiation time and 340 m W of output power.

RESULTS

The results after 7 days showed that the lased enamel still retained 157.4 +/- 23.371 ppm or 42.29% of fluoride after fluoridation process whereas the unlased enamel retained 45.59 +/- 9.377 ppm or 12.25% of fluoride.

CONCLUSIONS

We concluded that the use of argon laser at low energy density (10.74 J/cm(2)) significantly increases the fluoride retention in lased enamel which had approximately three times more fluoride than the unlased enamel.

Primary tooth enamel surface topography with in vitro argon laser irradiation alone and combined fluoride and argon laser treatment: scanning electon microscopic study

PURPOSE

The purpose of this descriptive scanning electron microscopic study was to characterize surface alterations in primary tooth enamel after in vitro argon laser irradiation alone and combined with topical fluoride treatment either before or after argon laser irradiation.

METHODS

Twenty extracted or exfoliated primary teeth underwent soft tissue debridement and a fluoride-free prophylaxis. Buccal and lingual surfaces were determined to be caries-free by macroscopic examination (stereo-zoom binocular microscope, x16). Treatment groups were: (1) no-treatment control; (2) argon laser irradiation (ALI; 11.5 J/cm2); (3) 1.23% acidulated phosphate fluoride (APF before ALI); and (4) ALI before APF. Both buccal and lingual surfaces were evaluated following standard scanning electron microscopic preparation techniques.

RESULTS

With controls, enamel surfaces were relatively smooth with occasional enamel prism ends present on their surfaces. There were no areas with cavitations or surface defects. With ALI, the lased surfaces were roughened mildly to moderately irregular without cavitation of the enamel or exposure of enamel prism ends. The surfaces possessed adherent granules to globules, with most being <3 microm in greatest dimension. Only occasional fine cracks and porosities in the surface coatings were noted and these were typically less than 1 microm in width or diameter. With APF before ALI, the surfaces possessed an irregular contour, with numerous granules to globules varying in size from 1 to 3 microm in greatest dimension. With ALI before APF, a homogenous confluent surface was present that masked typical enamel surface markings. The previously noted adherent granules and globules with argon laser treatment alone or APF before ALI were not seen. The argon laser effects on the enamel surfaces were masked by the uniformity of these surface coatings.

CONCLUSIONS

Argon laser irradiation and combined APF and argon laser treatment of primary tooth enamel created surfaces that may provide a protective barrier against a cariogenic attack. The surface coatings associated with combined APF and argon laser treatment may contain fluoride-rich calcium and phosphate mineral phases that could act as reservoirs for fluoride, calcium, and phosphate and provide a certain degree of protection from a caries lesion challenge.

Surgical presentation of ischaemic hepatitis

Intestinal ischaemia typically presents with signs suggestive of an acute surgical abdomen. A raised serum lactate may substantiate the diagnosis. The first case of ischaemic hepatitis mimicking intestinal ischaemia is reported. The recognition of markedly deranged transaminases allows the clinician to differentiate the two diagnoses and potentially avoid the risks incurred with laparotomy.

MonoFIX-VF, a new mono-component factor IX concentrate: a single-centre continuous-infusion study

MonoFIX-VF, a monocomponent factor IX concentrate, has replaced the use of Prothrombinex-HT as the treatment of choice for patients with factor IX deficiency in Australia. The haemostatic effect of MonoFIX-VF, administered by continuous infusion, was assessed in four subjects being treated for 10 bleeding episodes including five surgical procedures. MonoFIX-VF was found to be a safe and effective treatment for patients with haemophilia B.

Psychologic distress and natural menopause: a multiethnic community study

OBJECTIVES

This study examined the association between psychologic distress and natural menopause in a community sample of African American, White, Chinese, Hispanic, and Japanese women participating in a national women's health study.

METHODS

A cohort of 16,065 women aged 40 to 55 years provided information on menstrual regularity in the previous year, psychosocial factors, health, and somatic-psychologic symptoms. Psychologic distress was defined as feeling tense, depressed, and irritable in the previous 2 weeks.

RESULTS

Rates of psychologic distress were highest in early perimenopause (28.9%) and lowest in premenopause (20.9%) and postmenopause (22%). In comparison with premenopausal women, early perimenopausal women were at a greater risk of distress, with and without adjustment for vasomotor and sleep symptoms and covariates. Odds of distress were significantly higher for Whites than for the other racial/ethnic groups.

CONCLUSIONS

Psychologic distress is associated with irregular menses in midlife. It is important to determine whether distress is linked to alterations in hormone levels and to what extent a mood-hormone relationship may be influenced by socioeconomic and cultural factors.

Relations among age, income, and knowledge of investments

This study examined consumers' interactions with financial advisors in terms of the age and income of the respondents. The respondents were 500 residents of Florida interviewed in a random telephone survey. The dependent variables for the analysis were (1) frequency of communication, (2) knowledge, and (3) confidence in investment. No significant differences were found for frequency of interaction, but differences were identified on both knowledge and confidence in investment. Older respondents had more knowledge about investment than did younger ones, and respondents of higher income had more knowledge and more confidence in their investments than did those of lower or middle income. The results are discussed in terms of immediacy theory. Investment issues would have more immediacy for higher income respondents since they would have more money available for investment. Similarly, immediacy would be higher for older respondents since they would have more time and interest to devote to investment issues.

Direct tissue stops for distal extension removable partial dentures

Supplemental impression++ strategies may be used to capture optimal registration of residual ridge tissues in distal extension-base RPDs. A procedure is described to adapt tissue stops in vivo and positively position the framework to the master cast when clinically using corrected impressions. This method is simple and cost-effective, and it promotes accurate prosthetic-tissue relationships during clinical and laboratory phase of RPD fabrication.

A capillary whole blood method for measuring the INR

This study describes a method of measuring the INR on native whole blood capillary samples using Innovin recombinant thromboplastin. Modification of the reagent was necessary to compensate for the nonoptimal level of calcium in the sample/reagent mixture. Ninety-five percent of results obtained by the capillary blood method were no more than 0.42 INR higher or 0.38 INR lower than the venous blood method. The effect of changes in haematocrit was minimal. Significant differences in results were found between the Innovin and Thrombotest capillary blood methods. Provided the reagent was properly stored, there was no reagent drift and satisfactory results were obtained on samples supplied by UKNEQAS (coagulation) from previous trials. The method described is a convenient, simple and accurate method of measuring the INR using native capillary whole blood and Innovin recombinant thromboplastin.

Equipment malfunctions and attribution of causality

The purpose of this study was to test whether individuals would be more likely to attribute the cause for the malfunction of a new piece of equipment as a manufacturing problem in the equipment or as an inability on their part to properly work with the equipment. The subjects were 600 residents of Florida, selected by a stratified random sample and interviewed in a statewide telephone survey. Subjects were more likely to attribute the cause to themselves rather than the machine. Overall, 71% attributed the cause to themselves, while only 24% said the machine was at fault. There was also an interaction effect in terms of income, with middle-income users more likely to blame the machine and upper-income users more likely to blame themselves. Further, there was also a significant relationship between attribution of cause and age, with older respondents being more likely to attribute cause to themselves. These results imply that attribution may differ when the potential object of attribution is a machine rather than another person.

Differential patterns of executive function in children with attention-deficit hyperactivity disorder according to gender and subtype

The present investigation examined differential patterns in executive functions of children with attention-deficit hyperactivity disorder (ADHD; no diagnosed comorbid disorders) according to subtype and gender, and identified instrumentation sensitive to executive function in children aged 6 to 12 years with ADHD. Data were obtained from 94 children diagnosed with ADHD (predominantly inattentive, n = 32, ADHD combined, n = 62), and from 28 controls. Participants with ADHD, who were unmedicated at the time of testing, were administered five tests of executive function (the Wisconsin Card Sorting Test, the Stroop Color-Word Test, the Matching Familiar Figures Test, the Trail Making Test, and the Tower of London). A two-way multivariate analysis of covariance with age as the covariate and subtype and gender as the independent variables was conducted on all of the tests administered. While children with ADHD predominantly inattentive and those with ADHD combined differed from controls, it was only the latter subtype that differed significantly in perseveration and response inhibition. The absence of diagnosed comorbidity in the children with ADHD at the time of test administration demonstrates that the impairments in executive function are clearly located in ADHD, particularly in the ADHD combined subtype, thus providing support for Barkley's proposed unifying theory of ADHD.

Spur cell anaemia and hepatic iron stores in patients with alcoholic liver disease undergoing orthotopic liver transplantation

BACKGROUND

Following orthotopic liver transplantation (OLT) histological examination of explant livers from patients with alcoholic liver disease (ALD) sometimes shows extensive iron deposits in a distribution suggestive of homozygous haemochromatosis.

AIMS

To use haemochromatosis gene (HFE) assays to distinguish between ALD with notable siderosis and hereditary haemochromatosis. To evaluate the possible influence of spur cell haemolytic anaemia on hepatic iron loading.

PATIENTS

Thirty seven patients with ALD were abstinent for at least six months prior to OLT. Twenty three patients had transferrin saturations greater than 55%, 16 also had increased serum ferritin (>350 micrograms/l). Eight of 37 (22%) explant livers had grade 3 or 4 hepatic iron deposition, predominantly in hepatocytes. Of these, four had a hepatic iron index greater than 1. 9 and most seemed to have spur cell haemolytic anaemia.

METHODS

Mutation analysis for C282Y and H63D mutations was performed on DNA extracts from peripheral blood or explant liver. Spur cell haemolytic anaemia was diagnosed when the haemoglobin was 105 g/l in the presence of notable acanthocytosis.

RESULTS

None of the eight patients with grade 3 or 4 hepatic iron had evidence of the C282Y mutation. Two of the eight were heterozygous for H63D. None of the remaining 28 patients tested showed homozygous HFE mutations. Spur cell anaemia was present in six of the eight patients with heavy iron deposition and only one of the remaining patients.

CONCLUSIONS

The HFE mutation was not present in these patients with advanced ALD and heavy iron loading. Spur cell haemolytic anaemia provides an alternative potential mechanism for the heavy iron loading.