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Meretsky CR, Plitt VE, Friday BL, Schiuma AT, Ajebli M. A Comparative Analysis of the Efficacy of Local Anesthetics and Systemic Anesthetics in the Red-Headed Versus Non-Red-Headed Patient Population: A Comprehensive Review. Cureus 2024; 16:e61797. [PMID: 38975446 PMCID: PMC11227258 DOI: 10.7759/cureus.61797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
Researchers have found that individuals with red hair often require higher doses of anesthetic medications to achieve the same level of pain relief or sedation compared to people with other hair colors. This review investigates the effects of local and systemic anesthetics in individuals with red hair compared to the general population. Focusing on both local and systemic anesthesia, this research aims to elucidate any distinctive responses or complications among the red-haired demographic. Utilizing a systematic review approach, we analyzed a wide array of previous research papers published over the last two decades to gather relevant data. Our findings suggest that people with red hair may exhibit variations in their response to both local and systemic anesthesia compared to non-red-haired individuals, indicating the necessity for tailored anesthetic approaches in clinical settings. Previous studies have found that individuals with red hair, as well as those with the corresponding melanocortin-1 receptor (MC1R) mutations, exhibit a greater resistance to the effects of systemic and local anesthetics. This review provides valuable insights that could help healthcare professionals optimize anesthetic management and improve patient outcomes, particularly for those with red hair.
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Affiliation(s)
| | - Victoria E Plitt
- Obstetrics and Gynecology, St. George's University School of Medicine, Great River, USA
| | - Brooke L Friday
- Medicine, St. George's University School of Medicine, Great River, USA
| | | | - Mohammed Ajebli
- Biological Sciences, Faculty of Sciences and Technologies, Moulay Ismail University, Errachidia, MAR
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Augustinsson A, Franze E, Almqvist M, Warrén Stomberg M, Sjöberg C, Jildenstål P. Red-Haired People's Altered Responsiveness to Pain, Analgesics, and Hypnotics: Myth or Fact?-A Narrative Review. J Pers Med 2024; 14:583. [PMID: 38929804 PMCID: PMC11204720 DOI: 10.3390/jpm14060583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Red hair has been linked to altered sensitivity to pain, analgesics, and hypnotics. This alteration may be impacted by variants in the melanocortin-1 receptor (MC1R) gene, which are mainly found in redheads. The aim of this narrative review was to explore and present the current state of knowledge on red hair and its plausible associations with altered responsiveness to pain, analgesics, and hypnotics. Structured searches in the PubMed, CINAHL Complete, and Scopus electronic databases were conducted. Evidence suggests that women with red hair have an increased sensitivity to pain. Conversely, data also indicate a higher pain tolerance in homozygous carriers of MC1R variant alleles. Varied responses to analgesia have been reported, with both increased analgesic responsiveness in homozygous carriers of MC1R variant alleles and less analgesia in redheads. Data indicate an increased need for hypnotics in redheads. However, failed attempts to find statistical associations between red hair and altered responsiveness to hypnotics are also evident. Even though there seems to be an association between red hair and an altered responsiveness to pain, analgesics, and/or hypnotics, the results of this narrative review are inconclusive. Further research studies with larger populations and MC1R testing are needed.
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Affiliation(s)
- Annelie Augustinsson
- Care in High Technological Environments, Department of Health Sciences, Lund University, 221 00 Lund, Sweden
| | - Elisabeth Franze
- Care in High Technological Environments, Department of Health Sciences, Lund University, 221 00 Lund, Sweden
| | - Martina Almqvist
- Care in High Technological Environments, Department of Health Sciences, Lund University, 221 00 Lund, Sweden
| | - Margareta Warrén Stomberg
- Care in High Technological Environments, Department of Health Sciences, Lund University, 221 00 Lund, Sweden
| | - Carina Sjöberg
- Care in High Technological Environments, Department of Health Sciences, Lund University, 221 00 Lund, Sweden
| | - Pether Jildenstål
- Care in High Technological Environments, Department of Health Sciences, Lund University, 221 00 Lund, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Department of Anesthesia and Intensive Care, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Department of Anesthesiology, Surgery and Intensive Care, Sahlgrenska University Hospital, 405 83 Gothenburg, Sweden
- Department of Anesthesiology and Intensive Care, Örebro University Hospital and School of Medical Sciences, Örebro University, 701 85 Örebro, Sweden
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Surgeons Beware: Some Red Heads Have Increased Requirements for Inhalation, Infiltration, and Topically Administered Anesthetic Agents. J Oral Maxillofac Surg 2021; 79:958-959. [PMID: 33610489 DOI: 10.1016/j.joms.2020.12.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 11/21/2022]
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The relative effects of dexmedetomidine and propofol on cerebral blood flow velocity and regional brain oxygenation: A randomised noninferiority trial. Eur J Anaesthesiol 2018; 34:732-739. [PMID: 28891839 DOI: 10.1097/eja.0000000000000662] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dexmedetomidine constricts cerebral blood vessels without a concomitant reduction in cerebral metabolic oxygen consumption. Its safety as a sedative in patients with neurological diseases thus remains uncertain. OBJECTIVE Our primary objective was to test the hypothesis that dexmedetomidine is noninferior to propofol as regards cerebral blood flow (CBF) velocity and brain oxygenation. DESIGN Unblinded randomised trial. SETTING Cleveland Clinic Hospital, Cleveland, from November 2010 to July 2013. PATIENTS Forty-four patients scheduled for insertion of a deep-brain stimulating electrodes. INTERVENTIONS Patients were randomised to receive either dexmedetomidine or propofol sedation during deep-brain stimulating electrode insertion. MAIN OUTCOME MEASURES Intraoperative CBF velocity was measured with transcranial Doppler, and brain oxygenation was assessed with near-infrared spectroscopy. Noninferiority of dexmedetomidine to propofol was defined as a less than 20% difference in means. RESULTS Twenty-three patients were given dexmedetomidine and 21 propofol. Baseline characteristics and operative management were similar in each group. Dexmedetomidine was noninferior to propofol on both CBF and brain oxygenation, confirming our primary hypothesis. For cerebral flood flow, the estimated ratio of means (dexmedetomidine/propofol) was 0.94 [90% CI: 0.84 to 1.05], P = 0.011 for noninferiority. For brain oxygenation, the estimated ratio of means was 0.99 [90% CI: 0.96 to 1.02], P < 0.001 for noninferiority. Superiority was not found for either primary outcome. Dexmedetomidine provided deeper sedation than propofol, with a difference of medians of 1 [90% CI: 0 to 2], P < 0.001 on the Observer's Assessment of Alertness/Sedation scale. No significant differences were observed in pulsatility index, cerebral perfusion pressure, number of hypertensive or apnoeic episodes. CONCLUSION Regional brain oxygenation and CBF velocity are comparably preserved during dexmedetomidine and propofol sedation. Thus, the use of dexmedetomidine in patients with movement disorders appears reasonable. TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov (NCT 01200433).
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Kouba DJ, LoPiccolo MC, Alam M, Bordeaux JS, Cohen B, Hanke CW, Jellinek N, Maibach HI, Tanner JW, Vashi N, Gross KG, Adamson T, Begolka WS, Moyano JV. Guidelines for the use of local anesthesia in office-based dermatologic surgery. J Am Acad Dermatol 2016; 74:1201-19. [PMID: 26951939 DOI: 10.1016/j.jaad.2016.01.022] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/19/2015] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
Abstract
There are an increasing number and variety of dermatologic surgical procedures performed safely in the office setting. This evidence-based guideline addresses important clinical questions that arise regarding the use and safety of local anesthesia for dermatologic office-based procedures. In addition to recommendations for dermatologists, this guideline also takes into account patient preferences while optimizing their safety and quality of care. The clinical recommendations presented here are based on the best evidence available as well as expert opinion.
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Affiliation(s)
- David J Kouba
- Toledo Clinic Facial Plastics and Dermatology, Toledo, Ohio
| | - Matteo C LoPiccolo
- Toledo Clinic Facial Plastics and Dermatology, Toledo, Ohio; Department of Dermatology, Henry Ford Health System, Detroit, Michigan; Dermatology Specialists of Shelby, Shelby, Michigan
| | - Murad Alam
- Department of Dermatology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Bernard Cohen
- Department of Dermatology-Pediatrics, Johns Hopkins Children's Center, Baltimore, Maryland
| | - C William Hanke
- Laser and Skin Surgery Center of Indiana PC, Carmel, Indiana
| | - Nathaniel Jellinek
- Department of Dermatology, Brown University, East Greenwich, Rhode Island
| | - Howard I Maibach
- Department of Dermatology, UCSF School of Medicine, San Francisco, California
| | - Jonathan W Tanner
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neelam Vashi
- Department of Dermatology and Center for Ethnic Skin, Boston University School of Medicine, Boston, Massachusetts
| | | | - Trudy Adamson
- Department of Nursing, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Wendy Smith Begolka
- Department of Science, Quality and Practice, American Academy of Dermatology, Schaumburg, Illinois
| | - Jose V Moyano
- Department of Science, Quality and Practice, American Academy of Dermatology, Schaumburg, Illinois.
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Gradwohl SC, Aranake A, Abdallah AB, McNair P, Lin N, Fritz BA, Villafranca A, Glick D, Jacobsohn E, Mashour GA, Avidan MS. Intraoperative awareness risk, anesthetic sensitivity, and anesthetic management for patients with natural red hair: a matched cohort study. Can J Anaesth 2015; 62:345-55. [PMID: 25681040 DOI: 10.1007/s12630-014-0305-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 12/16/2014] [Indexed: 01/28/2023] Open
Abstract
PURPOSE The red-hair phenotype, which is often produced by mutations in the melanocortin-1 receptor gene, has been associated with an increase in sedative, anesthetic, and analgesic requirements in both animal and human studies. Nevertheless, the clinical implications of this phenomenon in red-haired patients undergoing surgery are currently unknown. METHODS In a secondary analysis of a prospective trial of intraoperative awareness, red-haired patients were identified and matched with five control patients, and the relative risk for intraoperative awareness was determined. Overall anesthetic management between groups was compared using Hotelling's T(2) statistic. Inhaled anesthetic requirements were compared between cohorts by evaluating the relationship between end-tidal anesthetic concentration and the bispectral index with a linear mixed-effects model. Time to recovery was compared using Kaplan-Meier analysis, and differences in postoperative pain and nausea/vomiting were evaluated with Chi square tests. RESULTS A cohort of 319 red-haired patients was matched with 1,595 control patients for a sample size of 1,914. There were no significant differences in the relative risk of intraoperative awareness (relative risk = 1.67; 95% confidence interval 0.34 to 8.22), anesthetic management, recovery times, or postoperative pain between red-haired patients and control patients. The relationship between pharmacokinetically stable volatile anesthetic concentrations and bispectral index values differed significantly between red-haired patients and controls (P < 0.001), but without clinical implications. CONCLUSION There were no demonstrable differences between red-haired patients and controls in response to anesthetic and analgesic agents or in recovery parameters. These findings suggest that perioperative anesthetic and analgesic management should not be altered based on self-reported red-hair phenotype.
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Affiliation(s)
- Stephen C Gradwohl
- Department of Anesthesiology, Washington University in Saint Louis, School of Medicine, Campus Box 8054, 660 S. Euclid Ave., Saint Louis, MO, 63110, USA
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Bispectral index dynamics during propofol hypnosis is similar in red-haired and dark-haired subjects. Anesth Analg 2013; 116:319-26. [PMID: 23302977 DOI: 10.1213/ane.0b013e31827533b4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND We have previously shown that red hair is associated with increased desflurane requirement for immobility, compared with dark hair. The effect of red hair on IV anesthetic requirement remains unknown. We tested the hypothesis that the propofol concentration in the effect site associated with half maximal electroencephalogram response, Ce50, is at least 50% higher in subjects with red hair. METHODS We modeled the propofol concentration versus electroencephalogram response relationship using a 2-step approach in 29 healthy dark- and red-haired volunteers receiving a propofol infusion to produce loss of consciousness. Bispectral Index (BIS) was the measure of drug effect. The parameters of a 3-compartment pharmacokinetic model were fit to measured arterial propofol concentrations. The relationship between effect-site propofol concentration (Ce) and BIS was characterized using a sigmoid Emax model. Model performance and accuracy of the estimated parameters were evaluated using accepted metrics and bootstrap resampling. The effect of hair color on the Ce50 for BIS response in the final model was assessed using a threshold of 6.63 (P<0.01) in reduction of -2 log likelihood. The influence of body weight on the model was also assessed. RESULTS The inclusion of hair color as a model covariate did not improve either the pharmacokinetic or the pharmacodynamic model. A separate analysis for the dark- and red-haired subjects estimated a median (95% confidence interval) Ce50 BIS of 2.71 μg/mL (2.28-3.36 μg/mL) and 2.57 μg/mL (1.68-3.60 μg/mL), respectively. Body weight was a significant covariate for the CL1 and V1. CONCLUSIONS Red hair phenotype does not affect the pharmacokinetics or pharmacodynamics of propofol.
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Roberts DJ, Haroon B, Hall RI. Sedation for critically ill or injured adults in the intensive care unit: a shifting paradigm. Drugs 2012; 72:1881-916. [PMID: 22950534 DOI: 10.2165/11636220-000000000-00000] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
As most critically ill or injured patients will require some degree of sedation, the goal of this paper was to comprehensively review the literature associated with use of sedative agents in the intensive care unit (ICU). The first and selected latter portions of this article present a narrative overview of the shifting paradigm in ICU sedation practices, indications for uninterrupted or prolonged ICU sedation, and the pharmacology of sedative agents. In the second portion, we conducted a structured, although not entirely systematic, review of the available evidence associated with use of alternative sedative agents in critically ill or injured adults. Data sources for this review were derived by searching OVID MEDLINE and PubMed from their first available date until May 2012 for relevant randomized controlled trials (RCTs), systematic reviews and/or meta-analyses and economic evaluations. Advances in the technology of mechanical ventilation have permitted clinicians to limit the use of sedation among the critically ill through daily sedative interruptions or other means. These practices have been reported to result in improved mortality, a decreased length of ICU and hospital stay and a lower risk of drug-associated delirium. However, in some cases, prolonged or uninterrupted sedation may still be indicated, such as when patients develop intracranial hypertension following traumatic brain injury. The pharmacokinetics of sedative agents have clinical importance and may be altered by critical illness or injury, co-morbid conditions and/or drug-drug interactions. Although use of validated sedation scales to monitor depth of sedation is likely to reduce adverse events, they have no utility for patients receiving neuromuscular receptor blocking agents. Depth of sedation monitoring devices such as the Bispectral Index (BIS©) also have limitations. Among existing RCTs, no sedative agent has been reported to improve the risk of mortality among the critically ill or injured. Moreover, although propofol may be associated with a shorter time to tracheal extubation and recovery from sedation than midazolam, the risk of hypertriglyceridaemia and hypotension is higher with propofol. Despite dexmedetomidine being linked with a lower risk of drug-associated delirium than alternative sedative agents, this drug increases risk of bradycardia and hypotension. Among adults with severe traumatic brain injury, there are insufficient data to suggest that any single sedative agent decreases the risk of subsequent poor neurological outcomes or mortality. The lack of examination of confounders, including the type of healthcare system in which the investigation was conducted, is a major limitation of existing pharmacoeconomic analyses, which likely limits generalizability of their results.
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Affiliation(s)
- Derek J Roberts
- Departments of Surgery, Community Health Sciences (Division of Epidemiology) and Critical Care Medicine, University of Calgary and the Foothills Medical Centre, Calgary, AB, Canada
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What is the connection between red hair and Tourette syndrome? Med Hypotheses 2009; 73:849-53. [DOI: 10.1016/j.mehy.2009.03.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 02/23/2009] [Accepted: 03/27/2009] [Indexed: 11/17/2022]
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Sessler CN, Wilhelm W. Analgesia and sedation in the intensive care unit: an overview of the issues. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 12 Suppl 3:S1. [PMID: 18495052 PMCID: PMC2391267 DOI: 10.1186/cc6147] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Analgesic and sedative medications are widely used in intensive care units to achieve patient comfort and tolerance of the intensive care unit environment, and to eliminate pain, anxiety, delirium and other forms of distress. Surveys and prospective cohort studies have revealed wide variability in medication selection, monitoring using sedation scales, and implementation of structured treatment algorithms among practitioners in different countries and regions of the world. Successful management of analgesia and sedation incorporates a patient-based approach that includes detection and management of predisposing and causative factors, including delirium; monitoring using analgesia and sedation scales and other instruments; proper medication selection, with an emphasis on analgesia-based drugs; and incorporation of structured strategies that have been demonstrated to reduce likelihood of excessive or prolonged sedation.
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Affiliation(s)
- Curtis N Sessler
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Virginia Commonwealth University Health System, Richmond, Virginia 23298, USA.
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Höhener D, Blumenthal S, Borgeat A. Sedation and regional anaesthesia in the adult patient. Br J Anaesth 2008; 100:8-16. [PMID: 18070783 DOI: 10.1093/bja/aem342] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This review discusses sedation for regional anaesthesia in the adult population. The first section deals with general aspects of sedation and shows that the majority of patients receiving sedation for regional anaesthesia are satisfied and would choose it again. Methods of assessing the level of sedation are discussed with emphasis on clinical measures. The pharmacology of the drugs involved in sedation is discussed, with propofol and remifentanil appearing to be the combination of choice for sedation in regional anaesthesia. The techniques for administering sedation are discussed and replacement of the traditional repeated boluses or continuous infusion with pharmacokinetic and patient-controlled systems is supported. Patient satisfaction studies suggest that patient-controlled systems are preferred.
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Affiliation(s)
- D Höhener
- Department of Anaesthesiology, Orthopedic University Clinic Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland
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Missmer SA, Spiegelman D, Hankinson SE, Malspeis S, Barbieri RL, Hunter DJ. Natural hair color and the incidence of endometriosis. Fertil Steril 2006; 85:866-70. [PMID: 16580366 DOI: 10.1016/j.fertnstert.2005.12.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2005] [Revised: 12/05/2005] [Accepted: 12/05/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate a previously hypothesized relation between natural hair color and endometriosis. DESIGN Prospective cohort study. SETTING Nurses' Health Study II with 10 years of follow-up. PARTICIPANT(S) A total of 90,065 women, 25-42 years old, who had never been diagnosed with endometriosis, infertility, or cancer at baseline in 1989. MAIN OUTCOME MEASURE(S) Incidence of laparoscopically confirmed endometriosis according to natural hair color. RESULT(S) During 379,422 person-years of follow-up, 1,130 cases of laparoscopically confirmed endometriosis were reported among women with no past infertility. After adjusting for age, calendar time, parity, race, and body mass index at age 18, we observed no association overall. However, compared with women with any other hair color, we observed an increased rate of endometriosis among women with naturally red hair who had never been infertile (incidence rate = 1.3, 95% confidence interval [CI] = 1.0-1.7), but a decreased rate among women with naturally red hair among women who were infertile (incidence rate = 0.4, 95% CI = 0.2-1.2); P value, test for heterogeneity = .03. CONCLUSION(S) Overall, we did not observe a significant relation between red hair color and the rate of endometriosis, however this prospective cohort study suggests that the relation may differ by infertility status.
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Affiliation(s)
- Stacey A Missmer
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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