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Allen A, Schembri M, Parvataneni R, Waetjen LE, Varon S, Salamat-Saberi N, Tassone S, Williams N, Kho KA, Jacoby VL. Pregnancy Outcomes After Laparoscopic Radiofrequency Ablation of Uterine Leiomyomas Compared With Myomectomy. Obstet Gynecol 2024; 143:612-618. [PMID: 38422502 DOI: 10.1097/aog.0000000000005548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/18/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To compare pregnancy outcomes after laparoscopic radiofrequency ablation and myomectomy. METHODS The ULTRA (Uterine Leiomyoma Treatment With Radiofrequency Ablation) study is an ongoing multicenter prospective cohort study with longitudinal follow-up up to 5 years comparing outcomes of radiofrequency ablation with myomectomy in premenopausal women older than age 21 years with symptomatic uterine leiomyomas. Participants were queried every 6 months after surgery to assess the incidence of pregnancy and pregnancy outcomes. RESULTS Among 539 women enrolled in ULTRA, a total of 37 participants (mean age at first pregnancy 35.0±4.7 years) conceived 43 times as of March 2023 (22 radiofrequency ablation, 21 myomectomy). The average length of follow-up time after all procedures was 2.5±1.0 years. The baseline miscarriage rate in the study population was 33.3%. In participants who underwent radiofrequency ablation, 9 of 22 pregnancies (40.9%, 95% CI, 20.3-61.5%) ended in first-trimester miscarriage, 11 resulted in live births (50.0%, 95% CI, 29.1-70.9%), one resulted fetal death at 30 weeks of gestation, and one resulted in uterine rupture during miscarriage treatment with misoprostol 10 weeks after radiofrequency ablation. Among the live births in the radiofrequency ablation group, 45.5% were by vaginal delivery. In the myomectomy group, 9 of 21 pregnancies (42.9%, 95% CI, 21.7-64.0%) ended in first-trimester miscarriage and 12 resulted in live births (57.1%, 95% CI, 36.0-78.3%). There were no significant differences in the likelihood of live birth or miscarriage between the study groups. CONCLUSION Full-term pregnancy and vaginal delivery are achievable after radiofrequency ablation of leiomyomas. However, in this interim analysis, the miscarriage rate in both radiofrequency ablation and myomectomy groups was higher than expected for women in this age group. Long-term data collection in the ongoing ULTRA study aims to further understand pregnancy outcomes after radiofrequency ablation compared with myomectomy. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov , NCT0210094.
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Affiliation(s)
- Antoinette Allen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, the Departments of Obstetrics and Gynecology, University of California, Los Angeles, University of California, Davis, University of California, San Diego, and University of California, Irvine, and the University of California Fibroid Network, California; Tassone Advanced ObGyn, Round Rock, Texas; the Gynecological Institute of Chicago, Chicago, Illinois; and the Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
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Huang AJ, Cummings SR, Ganz P, Schembri M, Raghunathan H, Vittinghoff E, Gibson CJ, Grady D. Efficacy of Continuous Transdermal Nitroglycerin for Treating Hot Flashes by Inducing Nitrate Cross-tolerance in Perimenopausal and Postmenopausal Women: A Randomized Clinical Trial. JAMA Intern Med 2023; 183:776-783. [PMID: 37273224 PMCID: PMC10242506 DOI: 10.1001/jamainternmed.2023.1977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/06/2023] [Indexed: 06/06/2023]
Abstract
Importance Due to the potential risks of long-term systemic estrogen therapy, many menopausal women are interested in nonhormonal treatments for vasomotor symptoms. Physiologic studies indicate that nitric oxide plays a key role in mediating hot flash-related vasodilation, suggesting that nonhormonal medications that induce nitrate tolerance in the vasculature may offer therapeutic benefit for vasomotor symptoms. Objective To determine whether uninterrupted administration of transdermal nitroglycerin (NTG) to induce nitrate cross-tolerance decreased the frequency or severity of menopause-related hot flashes. Design, Setting, and Participants This randomized, double-blinded, placebo-controlled clinical trial included perimenopausal or postmenopausal women reporting 7 or more hot flashes per day who were recruited from northern California by study personnel at a single academic center. Patients were randomized between July 2017 and December 2021, and the trial ended in April 2022 when the last randomized participant completed follow-up. Interventions Uninterrupted daily use of transdermal NTG (participant-directed dose titration from 0.2-0.6 mg/h) or identical placebo patches. Main Outcome Measures Validated symptom diaries assessing changes in any hot flash frequency (primary outcome) and moderate-to-severe hot flash frequency over 5 and 12 weeks. Results Among the 141 randomized participants (70 NTG [49.6%], 71 placebo [50.4%]; 12 [85.8%] Asian, 16 [11.3%] Black or African American, 15 [10.6%] Hispanic or Latina, 3 [2.1%] multiracial, 1 [0.7%] Native Hawaiian or Pacific Islander, and 100 [70.9%] White or Caucasian individuals), a mean (SD) of 10.8 (3.5) hot flashes and 8.4 (3.6) moderate-to-severe hot flashes daily was reported at baseline. Sixty-five participants assigned to NTG (92.9%) and 69 assigned to placebo (97.2%) completed 12-week follow-up (P = .27). Over 5 weeks, the estimated change in any hot flash frequency associated with NTG vs placebo was -0.9 (95% CI, -2.1 to 0.3) episodes per day (P = .10), and change in moderate-to-severe hot flash frequency with NTG vs placebo was -1.1 (95% CI, -2.2 to 0) episodes per day (P = .05). At 12 weeks, treatment with NTG did not significantly decrease the frequency of any hot flashes (-0.1 episodes per day; 95% CI, -1.2 to 0.4) or moderate-to-severe hot flashes (-0.5 episodes per day; 95% CI, -1.6 to 0.7) relative to placebo. In analyses combining 5-week and 12-week data, no significant differences in change in the frequency of any hot flashes (-0.5 episodes per day; 95% CI, -1.6 to 0.6; P = .25) or moderate-to-severe hot flashes (-0.8 episodes per day; 95% CI, -1.9 to 0.2; P = .12) were detected with NTG vs placebo. At 1 week, 47 NTG (67.1%) and 4 placebo participants (5.6%) reported headache (P < .001), but only 1 participant in each group reported headache at 12 weeks. Conclusions and Relevance This randomized clinical trial found that continuous use of NTG did not result in sustained improvements in hot flash frequency or severity relative to placebo and was associated with more early but not persistent headache. Trial Registration Clinicaltrials.gov Identifier: NCT02714205.
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Affiliation(s)
- Alison J. Huang
- Department of Medicine, University of California, San Francisco
| | - Steven R. Cummings
- Department of Medicine, University of California, San Francisco
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco
| | - Peter Ganz
- Department of Medicine, University of California, San Francisco
| | - Michael Schembri
- Department of Obstetrics and Gynecology, University of California, San Francisco
| | | | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Carolyn J. Gibson
- San Francisco VA Health Care System, San Francisco, California
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - Deborah Grady
- Department of Medicine, University of California, San Francisco
- Deputy Editor, JAMA Internal Medicine
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Chan LN, Chen LM, Goldman M, Mak JS, Bauer DC, Boscardin J, Schembri M, Bae-Jump V, Friedman S, Jacoby VL. Changes in Bone Density in Carriers of BRCA1 and BRCA2 Pathogenic Variants After Salpingo-Oophorectomy. Obstet Gynecol 2023; Publish Ahead of Print:00006250-990000000-00775. [PMID: 37290104 DOI: 10.1097/aog.0000000000005236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/23/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the effect of risk-reducing salpingo-oophorectomy (RRSO) on change in bone mineral density (BMD) in women aged 34-50 years with pathogenic variants in BRCA1 or BRCA2 (BRCA1/2). METHODS The PROSper (Prospective Research of Outcomes after Salpingo-oophorectomy) study is a prospective cohort of women aged 34-50 years with BRCA1 or two germline pathogenic variants that compares health outcomes after RRSO to a non-RRSO control group with ovarian conservation. Women aged 34-50 years, who were planning either RRSO or ovarian conservation, were enrolled for 3 years of follow-up. Spine and total hip BMD were measured by dual-energy X-ray absorptiometry (DXA) scans obtained at baseline before RRSO or at the time of enrollment for the non-RRSO group, and then at 1 and 3 years of study follow-up. Differences in BMD between the RRSO and non-RRSO groups, as well as the association between hormone use and BMD, were determined by using mixed effects multivariable linear regression models. RESULTS Of 100 PROSper participants, 91 obtained DXA scans (RRSO group: 40; non-RRSO group: 51). Overall, total spine, and hip BMD decreased significantly from baseline to 12 months after RRSO (estimated percent change -3.78%, 95% CI -6.13% to -1.43% for total spine; -2.96%, 95% CI -4.79% to -1.14% for total hip) and at 36 months (estimated percent change -5.71%, 95% CI -8.64% to -2.77% for total spine; -5.19%, 95% CI -7.50% to -2.87% for total hip. In contrast, total spine and hip BMD were not significantly different from baseline for the non-RRSO group. The differences in mean percent change in BMD from baseline between the RRSO and non-RRSO groups were statistically significant at both 12 and 36 months for spine BMD (12-month difference -4.49%, 95% CI -7.67% to -1.31%; 36-month difference -7.06%, 95% CI -11.01% to -3.11%) and at 36 months for total hip BMD (12-month difference -1.83%, 95% CI -4.23% to 0.56%; 36-month difference -5.14%, 95% CI -8.11% to -2.16%). Across the study periods, hormone use was associated with significantly less bone loss at both the spine and hip within the RRSO group compared with no hormone use (P<.001 at both 12 months and 36 months) but did not completely prevent bone loss (estimated percent change from baseline at 36 months -2.79%, 95% CI -5.08% to -0.51% for total spine BMD; -3.93%, 95% CI -7.27% to -0.59% for total hip BMD). CONCLUSION Women with pathogenic variants in BRCA1/2 who undergo RRSO before the age of 50 years have greater bone loss after surgery that is clinically significant when compared with those who retain their ovaries. Hormone use mitigates, but does not eliminate, bone loss after RRSO. These results suggest that women who undergo RRSO may benefit from routine screening for BMD changes to identify opportunities for prevention and treatment of bone loss. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT01948609.
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Affiliation(s)
- Leslie N Chan
- School of Medicine, the Department of Obstetrics, Gynecology and Reproductive Sciences, the Helen Diller Family Comprehensive Cancer Center, the Department of Medicine, and the Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, San Francisco, California; the Division of Gynecology Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and Facing Our Risk of Cancer Empowered, Tampa, Florida
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Huang AJ, Walter LC, Yaffe K, Vittinghoff E, Kornblith E, Schembri M, Chang A, Subak LL. TReating Incontinence for Underlying Mental and Physical Health (TRIUMPH): a study protocol for a multicenter, double-blinded, randomized, 3-arm trial to evaluate the multisystem effects of pharmacologic treatment strategies for urgency-predominant urinary incontinence in ambulatory older women. Trials 2023; 24:287. [PMID: 37085880 PMCID: PMC10122333 DOI: 10.1186/s13063-023-07279-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/27/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Urgency-type urinary incontinence affects one in four older community-dwelling women and overlaps with other common aging-associated health syndromes such as cognitive impairment, physical mobility impairment, and depression. Observational studies have raised concern about potentially higher rates of delirium and dementia in older adults taking anticholinergic bladder medications, but few prospective data are available to evaluate the effects of these and other pharmacologic treatments for urgency incontinence on cognition and other multisystem functional domains important to older women. METHODS The TRIUMPH study is a randomized, double-blinded, 3-arm, parallel-group trial comparing the multisystem effects of anticholinergic versus beta-3-adrenergic agonist bladder therapy and versus no active bladder anti-spasmodic pharmacotherapy in older women with urgency incontinence. Women aged 60 years and older (target N = 270) who have chronic urgency-predominant urinary incontinence and either normal or mildly impaired cognition at baseline are recruited from the community by investigators based in northern California, USA. Participants are randomized in equal ratios to take identically encapsulated oral anticholinergic bladder therapy (in the form of tolterodine 2 mg extended release [ER]), oral beta-3 adrenergic agonist bladder therapy (mirabegron 25 mg ER), or placebo daily for 24 weeks, with the option of participant-directed dose titration (to tolterodine 4 mg ER, mirabegron 50 mg ER, or matching placebo daily). Participants also receive patient-oriented information and instructions about practicing first-line behavioral management strategies for incontinence. The primary outcome is change in composite cognitive function over 24 weeks assessed by a comprehensive battery of cognitive tests, with a secondary exploration of the persistence of change at 36 weeks. Secondary outcomes include changes over 24 and 36 weeks in domain-specific cognitive function; frequency, severity, and impact of urgency-associated urinary symptoms; physical function and balance; sleep quality and daytime sleepiness; psychological function; and bowel function. DISCUSSION The TRIUMPH trial addresses the need for rigorous evidence to guide counseling and decision-making for older women who are weighing the potential multisystem benefits and risks of pharmacologic treatments for urgency incontinence in order to preserve their day-to-day functioning, quality of life, and independence in older age. TRIAL REGISTRATION ClinicalTrials.gov NCT05362292. Registered on May 5, 2022.
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Affiliation(s)
- Alison J Huang
- University of California San Francisco, San Francisco, USA.
| | | | - Kristine Yaffe
- University of California San Francisco, San Francisco, USA
| | | | - Erica Kornblith
- University of California San Francisco, San Francisco, USA
- San Francisco Veterans Affairs, San Francisco, USA
| | | | - Ann Chang
- University of California San Francisco, San Francisco, USA
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Rubio EM, Hilton JF, Bent S, Parvataneni R, Oberman E, Saberi NS, Varon S, Schembri M, Waetjen LE, Jacoby VL. Complementary and Alternative Medicine Use Among Women with Symptomatic Uterine Fibroids. J Womens Health (Larchmt) 2023; 32:546-552. [PMID: 37023398 DOI: 10.1089/jwh.2022.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Objective: The aim of this study is to examine complementary and alternative medicine (CAM) use among women with symptomatic uterine fibroids in the United States. Materials and Methods: In this cross-sectional analysis of baseline data from a multicenter, prospective cohort study of premenopausal women undergoing surgery for symptomatic fibroids and who enrolled in the Uterine Leiomyoma Treatment with Radiofrequency Ablation study from 2017 to 2019, we contrast women indicating use of at least one CAM modality specifically for fibroid symptoms against women using CAM for other reasons and CAM nonusers. Multivariable logistic regression models were performed to identify participant characteristics independently associated with CAM use for fibroids. Results: Among 204 women, 55% were Black/African American and the mean age was 42 (standard deviation 6.6) years. CAM use was common (67%), with 42% (95% confidence interval [CI]: 35%-49%) reporting use of CAM specifically to treat fibroid symptoms. Most commonly, CAM treatments used for fibroids were diet (62%) and herbs (52%), while CAM treatments for other reasons were exercise (80%) and massage (43%). On average, each participant who reported CAM use utilized three different types of CAM modalities. In a multivariable model, participants were more likely to use CAM for fibroids if they had pelvic pressure (odds ratio [OR] 2.50, 95% CI: 1.07-5.87, p = 0.04), a body-mass index lower than average (OR 0.76, 95% CI: 0.60-0.97, p = 0.03), and a lower health-related quality of life score (OR 0.61, 95% CI: 0.46-0.81, p = 0.001). Conclusions: In this diverse sample of women with symptomatic fibroids, CAM use was highly prevalent. Our findings highlight the need for providers to query patients about CAM use and understand the role of CAM in fibroid management. ClinicalTrials.gov Identifier: NCT02100904.
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Affiliation(s)
- Elia Marina Rubio
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Joan F Hilton
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Stephen Bent
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Ram Parvataneni
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California, USA
- University of California Fibroid Network, USA
| | - Erica Oberman
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California, USA
- University of California Fibroid Network, USA
| | - Naghmeh Salamat Saberi
- University of California Fibroid Network, USA
- Department of Obstetrics and Gynecology, University of California, Irvine, Irvine, California, USA
| | - Shira Varon
- University of California Fibroid Network, USA
- Department of Obstetrics and Gynecology, University of California, San Diego, San Diego, California, USA
| | - Michael Schembri
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
| | - L Elaine Waetjen
- University of California Fibroid Network, USA
- Department of Obstetrics and Gynecology, University of California, Davis, Davis, California, USA
| | - Vanessa L Jacoby
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- University of California Fibroid Network, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
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Oelsner EC, Krishnaswamy A, Balte PP, Allen NB, Ali T, Anugu P, Andrews H, Arora K, Asaro A, Barr RG, Bertoni AG, Bon J, Boyle R, Chang AA, Chen G, Coady S, Cole SA, Coresh J, Cornell E, Correa A, Couper D, Cushman M, Demmer RT, Elkind MSV, Folsom AR, Fretts AM, Gabriel KP, Gallo L, Gutierrez J, Han MLK, Henderson JM, Howard VJ, Isasi CR, Jacobs Jr DR, Judd SE, Mukaz DK, Kanaya AM, Kandula NR, Kaplan R, Kinney GL, Kucharska-Newton A, Lee JS, Lewis CE, Levine DA, Levitan EB, Levy B, Make B, Malloy K, Manly JJ, Mendoza-Puccini C, Meyer KA, Min YI, Moll M, Moore WC, Mauger D, Ortega VE, Palta P, Parker MM, Phipatanakul W, Post WS, Postow L, Psaty BM, Regan EA, Ring K, Roger VL, Rotter JI, Rundek T, Sacco RL, Schembri M, Schwartz DA, Seshadri S, Shikany JM, Sims M, Hinckley Stukovsky KD, Talavera GA, Tracy RP, Umans JG, Vasan RS, Watson K, Wenzel SE, Winters K, Woodruff PG, Xanthakis V, Zhang Y, Zhang Y, C4R Investigators FT. Collaborative Cohort of Cohorts for COVID-19 Research (C4R) Study: Study Design. Am J Epidemiol 2022; 191:1153-1173. [PMID: 35279711 PMCID: PMC8992336 DOI: 10.1093/aje/kwac032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/26/2022] [Accepted: 02/09/2022] [Indexed: 01/26/2023] Open
Abstract
The Collaborative Cohort of Cohorts for COVID-19 Research (C4R) is a national prospective study of adults comprising 14 established US prospective cohort studies. Starting as early as 1971, investigators in the C4R cohort studies have collected data on clinical and subclinical diseases and their risk factors, including behavior, cognition, biomarkers, and social determinants of health. C4R links this pre-coronavirus disease 2019 (COVID-19) phenotyping to information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and acute and postacute COVID-related illness. C4R is largely population-based, has an age range of 18-108 years, and reflects the racial, ethnic, socioeconomic, and geographic diversity of the United States. C4R ascertains SARS-CoV-2 infection and COVID-19 illness using standardized questionnaires, ascertainment of COVID-related hospitalizations and deaths, and a SARS-CoV-2 serosurvey conducted via dried blood spots. Master protocols leverage existing robust retention rates for telephone and in-person examinations and high-quality event surveillance. Extensive prepandemic data minimize referral, survival, and recall bias. Data are harmonized with research-quality phenotyping unmatched by clinical and survey-based studies; these data will be pooled and shared widely to expedite collaboration and scientific findings. This resource will allow evaluation of risk and resilience factors for COVID-19 severity and outcomes, including postacute sequelae, and assessment of the social and behavioral impact of the pandemic on long-term health trajectories.
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Affiliation(s)
- Elizabeth C Oelsner
- Correspondence to Dr. Elizabeth C Oelsner, MD MPH, Herbert Irving Associate Professor of Medicine, Division of General Medicine, Columbia University Irving Medical Center, 622 West 168 Street, PH9-105K New York, NY 10032 Tel: 917-880-7099
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Lia C, Farrugia B, Schembri M, Pace M, Said Huntingford I. 395 A case of uterine tumour resembling ovarian sex cord tumour. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Huang AJ, Chesney MA, Schembri M, Pawlowsky S, Nicosia F, Subak LL. Rapid Conversion of a Group-Based Yoga Trial for Diverse Older Women to Home-Based Telehealth: Lessons Learned Using Zoom to Deliver Movement-Based Interventions. J Integr Complement Med 2022; 28:188-192. [PMID: 35167358 PMCID: PMC8867109 DOI: 10.1089/jicm.2021.0268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This brief report describes the rapid conversion of a randomized trial of a Hatha-based yoga program for older women with urinary incontinence to a telehealth videoconference platform during the coronavirus disease 2019 (COVID-19) pandemic. Interim results demonstrate the feasibility of recruiting and retaining participants across a wide range of ages and ethnic backgrounds, but also point to potential obstacles and safety concerns arising from telehealth-based instruction. The investigators present lessons learned about the benefits and challenges of using telehealth platforms to deliver movement-based interventions and consider strategies to promote accessible and well-tolerated telehealth-based yoga programs for older and diverse populations. Clinical Trial Registration number: NCT03672461.
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Affiliation(s)
- Alison J. Huang
- Department of Medicine, University of California, San Francisco, California, USA
| | - Margaret A. Chesney
- Department of Medicine, University of California, San Francisco, California, USA
| | - Michael Schembri
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Sarah Pawlowsky
- Department of Physical Therapy, San Francisco State University, San Francisco, California, USA
| | - Francesca Nicosia
- Integrative Health Service, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, California, USA
| | - Leslee L. Subak
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California, USA
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Oelsner EC, Allen NB, Ali T, Anugu P, Andrews H, Asaro A, Balte PP, Barr RG, Bertoni AG, Bon J, Boyle R, Chang AA, Chen G, Cole SA, Coresh J, Cornell E, Correa A, Couper D, Cushman M, Demmer RT, Elkind MSV, Folsom AR, Fretts AM, Gabriel KP, Gallo L, Gutierrez J, Han MK, Henderson JM, Howard VJ, Isasi CR, Jacobs DR, Judd SE, Mukaz DK, Kanaya AM, Kandula NR, Kaplan R, Krishnaswamy A, Kinney GL, Kucharska-Newton A, Lee JS, Lewis CE, Levine DA, Levitan EB, Levy B, Make B, Malloy K, Manly JJ, Meyer KA, Min YI, Moll M, Moore WC, Mauger D, Ortega VE, Palta P, Parker MM, Phipatanakul W, Post W, Psaty BM, Regan EA, Ring K, Roger VL, Rotter JI, Rundek T, Sacco RL, Schembri M, Schwartz DA, Seshadri S, Shikany JM, Sims M, Hinckley Stukovsky KD, Talavera GA, Tracy RP, Umans JG, Vasan RS, Watson K, Wenzel SE, Winters K, Woodruff PG, Xanthakis V, Zhang Y, Zhang Y. Collaborative Cohort of Cohorts for COVID-19 Research (C4R) Study: Study Design. medRxiv 2021:2021.03.19.21253986. [PMID: 33758891 PMCID: PMC7987050 DOI: 10.1101/2021.03.19.21253986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The Collaborative Cohort of Cohorts for COVID-19 Research (C4R) is a national prospective study of adults at risk for coronavirus disease 2019 (COVID-19) comprising 14 established United States (US) prospective cohort studies. For decades, C4R cohorts have collected extensive data on clinical and subclinical diseases and their risk factors, including behavior, cognition, biomarkers, and social determinants of health. C4R will link this pre-COVID phenotyping to information on SARS-CoV-2 infection and acute and post-acute COVID-related illness. C4R is largely population-based, has an age range of 18-108 years, and broadly reflects the racial, ethnic, socioeconomic, and geographic diversity of the US. C4R is ascertaining severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 illness using standardized questionnaires, ascertainment of COVID-related hospitalizations and deaths, and a SARS-CoV-2 serosurvey via dried blood spots. Master protocols leverage existing robust retention rates for telephone and in-person examinations, and high-quality events surveillance. Extensive pre-pandemic data minimize referral, survival, and recall bias. Data are being harmonized with research-quality phenotyping unmatched by clinical and survey-based studies; these will be pooled and shared widely to expedite collaboration and scientific findings. This unique resource will allow evaluation of risk and resilience factors for COVID-19 severity and outcomes, including post-acute sequelae, and assessment of the social and behavioral impact of the pandemic on long-term trajectories of health and aging.
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Wang MT, Schembri M, Kok HK, Maingard J, Foo M, Lamanna A, Brooks M, Asadi H. Rendezvous endovascular common carotid artery stenting (RECCAS) technique for symptomatic steno-occlusive disease. CVIR Endovasc 2021; 4:17. [PMID: 33459863 PMCID: PMC7813902 DOI: 10.1186/s42155-020-00194-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/09/2020] [Indexed: 11/21/2022] Open
Abstract
This report describes a patient who presented with acute but transient right arm weakness and altered sensation secondary to severe stenosis of the left common carotid artery (CCA) origin. Endovascular stenting of the stenosed origin was achieved utilising a novel rendezvous technique through combined retrograde common carotid artery and anterograde transfemoral approaches. This technique has numerous potential advantages over traditional transfemoral endovascular and open retrograde common carotid artery approaches. It allows increased procedural control and success in traversing the stenosis and provides a smooth transition for the stent delivery catheter. An open cutdown procedure or open surgical technique is not required. Our patient recovered well from the procedure with no complications within the three-month follow up period.
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Affiliation(s)
- M T Wang
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Australia.
| | - M Schembri
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Australia
| | - H K Kok
- Interventional Radiology Service, Department of Radiology, Northern Health, Melbourne, Australia.,School of Medicine, Deakin University, Melbourne, Australia
| | - J Maingard
- School of Medicine, Deakin University, Melbourne, Australia.,Interventional Radiology and Neurointerventional Services, Department of Radiology, Monash Health, Melbourne, Australia
| | - M Foo
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Australia
| | - A Lamanna
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Australia
| | - M Brooks
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Australia.,School of Medicine, Deakin University, Melbourne, Australia
| | - H Asadi
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Australia.,School of Medicine, Deakin University, Melbourne, Australia.,Interventional Radiology and Neurointerventional Services, Department of Radiology, Monash Health, Melbourne, Australia
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11
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Schembri M, Pietropaolo A, Somani BK. Treatment of isolated small renal stones leads to resolution of symptoms and should be routinely offered to patients: retrospective outcomes from a university hospital. Scand J Urol 2020; 54:339-343. [PMID: 32686567 DOI: 10.1080/21681805.2020.1793810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Treatment of smaller renal stones and the symptomatic value it offers to patients is often debated. We wanted to analyse surgical outcomes for treatment of small renal stones and whether treatment resulted in symptom resolution. MATERIALS AND METHODS All patients who underwent ureterorenoscopy (URS) for isolated symptomatic small renal stones ≤10 mm over a 7-year period were retrospectively included and subdivided into those with stones of ≤7 mm (Group A) and stones of 8-10 mm (Group B). Patients with multiple renal stones, ureteric stones, or combined renal and ureteric stones were excluded. Based on the symptoms, the patient groups were those with pain, urinary tract infection (UTI) and haematuria. Resolution of symptoms was defined as no symptoms during the follow-up period. RESULTS A total of 109 patients with a single small renal stone ≤10 mm underwent URS and stone treatment, with mean age of 50 years and a male:female ratio of 1:1.2. The mean operative time was significantly longer in Group B (55.9 min vs 33.07 min, p = 0.001). In total, 97.2% (n = 70) of patients in Group A and 83.7% (n = 31) of patients in Group B were stone free (p = 0.017). Complete resolution of symptoms was seen in 63 (92.6%), 24 (85.7%) and 13 (100%) patients with pain, UTI and haematuria, respectively. There were no statistically significant differences in symptom resolution between patients with stones ≤7 mm and those with stones 8-10 mm in size. CONCLUSION Ureteroscopic treatment is a feasible option for small symptomatic stones, since it may lead to symptom resolution. Based on our study we would recommend that patients with symptomatic small renal stones are offered endoscopic treatment.
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Affiliation(s)
- M Schembri
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - A Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
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12
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Savoie MB, Lee KA, Subak LL, Hernandez C, Schembri M, Fung CH, Grady D, Huang AJ. Beyond the bladder: poor sleep in women with overactive bladder syndrome. Am J Obstet Gynecol 2020; 222:600.e1-600.e13. [PMID: 31836545 DOI: 10.1016/j.ajog.2019.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/23/2019] [Accepted: 12/01/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nocturnal bladder symptoms and sleep disruption commonly coexist in middle-aged and older women. Although sleep disruption is often attributed to nocturnal bladder symptoms in women with overactive bladder syndrome, nonbladder factors also may influence sleep in this population. Many women with overactive bladder are eager to identify nonpharmacologic strategies for both bladder symptoms and sleep disruption, given the potential adverse effects of sedative and anticholinergic bladder medications in this population. OBJECTIVES To provide greater insight into the complex relationship between nighttime overactive bladder symptoms and sleep disruption, and to evaluate the effects of a guided slow-paced respiration intervention on sleep outcomes in women with overactive bladder. STUDY DESIGN We conducted an ancillary study within a randomized trial of slow-paced respiration in women with overactive bladder symptoms. Ambulatory community-dwelling women who reported ≥3 episodes/day of urgency-associated voiding or incontinence were randomized to use either a portable biofeedback device (RESPeRATE; Intercure, Ltd) to practice guided slow-paced respiration exercises daily for 12 weeks (N=79) or an identical-appearing device programmed to play nonrhythmic music without guiding breathing (N=82). At baseline and after 12 weeks, bladder symptoms were assessed by voiding diary, sleep duration, and disruption were assessed by sleep diary corroborated by wrist actigraphy, and poor sleep quality was determined by a Pittsburgh Sleep Quality Index global score >5. RESULTS Of the 161 women randomized, 31% reported at least twice-nightly nocturia, 26% nocturnal incontinence, and 70% poor sleep quality at baseline. Of the 123 reporting any nighttime awakenings, 89% averaged 1 or more nighttime awakenings, and 83% attributed at least half of awakenings to using the bathroom. Self-reported wake time after sleep onset increased with increasing frequency of nocturnal bladder symptoms (P=.01 for linear trend). However, even among women without nocturia, average sleep quality was poor (Pittsburg Sleep Quality Index global score mean of 7.3; 95% confidence interval, 6.0-8.6). Over 12 weeks, women assigned to slow-paced respiration (N=79) experienced modest improvements in mean nocturnal voiding frequency (0.4 fewer voids/night), sleep quality (1.1 point score decrease), and sleep disruption (1.5% decreased wake time after sleep onset). However, similar improvements were detected in the music control group (N=81), without significant between-group differences. CONCLUSIONS Many women with overactive bladder syndrome experience disrupted sleep, but not all nocturnal awakenings are attributable to bladder symptoms, and average sleep quality tends to be poor even in women without nocturia. Findings suggest that clinicians should not assume that poor sleep in women with overactive bladder syndrome is primarily caused by nocturnal bladder symptoms. Guided slow-paced respiration was associated with modest improvements in nocturia frequency and sleep quality in this trial, but the results do not support clinician recommendation to use this technique over other behavioral relaxation techniques for improving sleep.
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Affiliation(s)
| | - Kathryn A Lee
- Department of Family Health Care Nursing, University of California San Francisco, CA
| | - Leslee L Subak
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA
| | - Cesar Hernandez
- Department of Medicine, University of California San Francisco, CA
| | - Michael Schembri
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California San Francisco, CA
| | - Constance H Fung
- Department of Medicine, University of California at Los Angeles, CA; VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Deborah Grady
- Department of Medicine, University of California San Francisco, CA
| | - Alison J Huang
- Department of Medicine, University of California San Francisco, CA
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Kanaya AM, Chang A, Schembri M, Puri-Taneja A, Srivastava S, Dave SS, Vijayakumar EN, Qamar Z, Naik HD, Siddiqui F, Kandula NR. Recruitment and retention of US South Asians for an epidemiologic cohort: Experience from the MASALA study. J Clin Transl Sci 2019; 3:97-104. [PMID: 31660232 PMCID: PMC6802417 DOI: 10.1017/cts.2019.371] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/28/2019] [Accepted: 04/09/2019] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION There are few longitudinal studies about South Asians (SAs) and little information about recruitment and retention approaches for this ethnic group. METHODS We followed 906 SAs enrolled in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort for 5 years. Surviving participants were invited for a second clinical exam from 2015 to 2018. A new wave of participants was recruited during 2017-2018. We assessed the yields from different methods of recruitment and retention. RESULTS A total of 759 (83%) completed the second clinical exam, and 258 new participants were enrolled. Providing a nearby community hospital location for the study exam, offering cab/shared ride reimbursement, and conducting home visits were the most effective methods for enhancing retention. New participant recruitment targeted women and individuals with lower socioeconomic status, and we found that participant referrals and active community engagement were most effective. Mailing invitational letters to those identified by electronic health records had very low yield. CONCLUSION Recruitment and retention strategies that address transportation barriers and increase community engagement will help increase the representation of SAs in health research.
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Affiliation(s)
- Alka M. Kanaya
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Ann Chang
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Michael Schembri
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | | | - Shweta Srivastava
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Swapna S. Dave
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Zubaida Qamar
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Family, Interiors, Nutrition and Apparel Department, San Francisco State University, San Francisco, California, USA
| | - Hemalatha D. Naik
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Faiza Siddiqui
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Namratha R. Kandula
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
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14
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Huang AJ, Chesney M, Lisha N, Vittinghoff E, Schembri M, Pawlowsky S, Hsu A, Subak L. A group-based yoga program for urinary incontinence in ambulatory women: feasibility, tolerability, and change in incontinence frequency over 3 months in a single-center randomized trial. Am J Obstet Gynecol 2019; 220:87.e1-87.e13. [PMID: 30595143 DOI: 10.1016/j.ajog.2018.10.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/25/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Because of the limitations of existing clinical treatments for urinary incontinence, many women with incontinence are interested in complementary strategies for managing their symptoms. Yoga has been recommended as a behavioral self-management strategy for incontinence, but evidence of its feasibility, tolerability, and efficacy is lacking. OBJECTIVE To evaluate the feasibility and tolerability of a group-based therapeutic yoga program for ambulatory middle-aged and older women with incontinence, and to examine preliminary changes in incontinence frequency as the primary efficacy outcome after 3 months. MATERIALS AND METHODS Ambulatory women aged 50 years or older who reported at least daily stress-, urgency-, or mixed-type incontinence, were not already engaged in yoga, and were willing to temporarily forgo clinical incontinence treatments were recruited into a randomized trial in the San Francisco Bay area. Women were randomly assigned to take part in a program of twice-weekly group classes and once-weekly home practice focused on Iyengar-based yoga techniques selected by an expert yoga panel (yoga group), or a nonspecific muscle stretching and strengthening program designed to provide a rigorous time-and-attention control (control group) for 3 months. All participants also received written, evidence-based information about behavioral incontinence self-management techniques (pelvic floor exercises, bladder training) consistent with usual first-line care. Incontinence frequency and type were assessed by validated voiding diaries. Analysis of covariance models examined within- and between-group changes in incontinence frequency as the primary efficacy outcome over 3 months. RESULTS Of the 56 women randomized (28 to yoga, 28 to control), the mean age was 65.4 (±8.1) years (range, 55-83 years), the mean baseline incontinence frequency was 3.5 (±2.0) episodes/d, and 37 women (66%) had urgency-predominant incontinence. A total of 50 women completed their assigned 3-month intervention program (89%), including 27 in the yoga and 23 in the control group (P = .19). Of those, 24 (89%) in the yoga and 20 (87%) in the control group attended at least 80% of group classes. Over 3 months, total incontinence frequency decreased by an average of 76% from baseline in the yoga and 56% in the control group (P = .07 for between-group difference). Stress incontinence frequency also decreased by an average of 61% in the yoga group and 35% in controls (P = .045 for between-group difference), but changes in urgency incontinence frequency did not differ significantly between groups. A total of 48 nonserious adverse events were reported, including 23 in the yoga and 25 in the control group, but none were directly attributable to yoga or control program practice. CONCLUSION Findings demonstrate the feasibility of recruiting and retaining incontinent women across the aging spectrum into a therapeutic yoga program, and provide preliminary evidence of reduction in total and stress-type incontinence frequency after 3 months of yoga practice. When taught with attention to women's clinical needs, yoga may offer a potential community-based behavioral self-management strategy for incontinence to enhance clinical treatment, although future research should assess whether yoga offers unique benefits for incontinence above and beyond other physical activity-based interventions.
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15
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Limb C, White A, Fielding A, Lunt A, Borrelli M, Alsafi Z, Schembri M, Fowler A, Agha R. Compliance of randomised controlled trials in general surgical journals with the CONSORT 2010 statement: A retrospective cohort study and review of the literature. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Huang AJ, Rowen TS, Abercrombie P, Subak LL, Schembri M, Plaut T, Chao MT. Development and Feasibility of a Group-Based Therapeutic Yoga Program for Women with Chronic Pelvic Pain. Pain Med 2018; 18:1864-1872. [PMID: 28419385 DOI: 10.1093/pm/pnw306] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective To develop a group-based therapeutic yoga program for women with chronic pelvic pain (CPP) and explore the effects of this program on pain severity, sexual function, and well-being. Methods A yoga therapy program for CPP was developed by a multidisciplinary panel of clinicians, researchers, and yoga consultants. Women reporting moderate to severe pelvic pain for at least six months were recruited into a single-arm trial. Participants attended twice weekly group classes focusing on Iyengar-based yoga techniques and were instructed to practice yoga at home an hour a week for six weeks. Participants self-rated the severity of their pelvic pain using daily logs. The impact of participants' pain on everyday activities, emotional well-being, and sexual function was assessed using an Impact of Pelvic Pain (IPP) questionnaire. Sexual function was further assessed using the Sexual Health Outcomes in Women Questionnaire (SHOW-Q). Results Among the 16 participants (age range = 31-64 years), average ratings of the severity of pain "at its worst," "at its best," and "on average" decreased by 29%, 32%, and 34%, respectively, from start to six weeks (P < 0.05 for all). Women demonstrated improvements in scores on IPP subscales for daily activities (1.8 ± 0.7 to 0.9 ± 0.7, P < 0.001), emotional well-being (1.7 ± 0.9 to 0.9 ± 0.7, P = 0.005), and sexual function (1.9 ± 1.1 to 1.0 ± 0.9, P = 0.04). Scores on the SHOW-Q "pelvic problem interference" scale also improved over six weeks (53 ± 23 to 27 ± 23, P = 0.002). Conclusions Findings provide preliminary evidence of the feasibility of teaching women with CPP to practice yoga to self-manage pain and improve quality of life and sexual function.
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Affiliation(s)
- Alison J Huang
- Department of Medicine.,Women's Health Clinical Research Center
| | - Tami S Rowen
- Department of Obstetrics, Gynecology, and Reproductive Sciences
| | | | - Leslee L Subak
- Women's Health Clinical Research Center.,Department of Obstetrics, Gynecology, and Reproductive Sciences
| | - Michael Schembri
- Women's Health Clinical Research Center.,Department of Obstetrics, Gynecology, and Reproductive Sciences
| | - Traci Plaut
- Department of Medicine.,Women's Health Clinical Research Center
| | - Maria T Chao
- Department of Medicine.,Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, California
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Vella-Baldacchino M, Vella Baldacchino M, Schembri M, Bugeja R. Bringing laparoscopy to your own home. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.11.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Galea LA, Mercieca A, Sciberras C, Gatt R, Schembri M. Evaluation of Sympathetic Vasomotor Fibres in Carpal Tunnel Syndrome Using Continuous Wave Doppler Ultrasonography. ACTA ACUST UNITED AC 2016; 31:306-10. [PMID: 16487634 DOI: 10.1016/j.jhsb.2005.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2005] [Revised: 12/19/2005] [Accepted: 12/21/2005] [Indexed: 02/07/2023]
Abstract
Sympathetic vasomotor fibres carried by the median nerve and ulnar nerve innervate their respective sensory territories. The sympathetic vasomotor fibres of the median nerve were evaluated in patients with carpal tunnel syndrome and in healthy volunteers using continuous wave Doppler ultrasonography. The pulsatility index of the radialis indicis artery and the radial palmar digital artery of the little finger were measured at baseline and after stimulation. The maximal increase in the pulsatility index of each artery was measured. This was significantly lower for the radialis indicis artery in the CTS group than in the healthy controls. However, there was no significant difference in the maximal increase in pulsatility index of the radial palmar digital artery of the little finger between both groups. Sympathetic vasomotor fibres of the median nerve are affected in carpal tunnel syndrome. Continuous wave Doppler ultrasonography is easy to use and should be investigated further as a possible diagnostic tool for the confirmation of carpal tunnel syndrome.
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Affiliation(s)
- L A Galea
- Department of Orthopaedics and Department of Surgery, St. Luke's Hospital, Guardamangia, Malta.
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19
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Huang AJ, Cummings SR, Schembri M, Vittinghoff E, Ganz P, Grady D. Continuous transdermal nitroglycerin therapy for menopausal hot flashes: a single-arm, dose-escalation trial. Menopause 2016; 23:330-4. [PMID: 26263283 PMCID: PMC4746109 DOI: 10.1097/gme.0000000000000520] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the efficacy and tolerability of continuous nitroglycerin for treatment of hot flashes. METHODS Perimenopausal and postmenopausal women reporting at least seven hot flashes per day were recruited into a single-arm, dose-escalation trial of continuous transdermal nitroglycerin. Participants were started on a generic 0.1 mg/hour nitroglycerin patch applied daily without patch-free periods. During 4 weeks, participants escalated dosage weekly to 0.2, 0.4, or 0.6 mg/hour as tolerated, then discontinued nitroglycerin during the final week. Changes in hot flash frequency and severity were assessed using symptom diaries. Paired t tests examined change in outcomes between baseline and maximal-dose therapy and after discontinuation of nitroglycerin. RESULTS Of the 19 participants, mean age was 51.4 (±4.3) years. Women reported an average 10.6 (±3.0) hot flashes and 7.1 (±3.8) moderate-to-severe hot flashes per day at baseline. Eleven women escalated to 0.6 mg/hour, three to 0.4 mg/hour, two to 0.2 mg/hour, and one remained on 0.1 mg/hour nitroglycerin. Two discontinued nitroglycerin before the first outcomes assessment. Among the remaining 17 women, the average daily frequency of hot flashes decreased by 54% and the average frequency of moderate-to-severe hot flashes decreased by 69% from baseline to maximum-dose therapy (P < 0.001 for both). After discontinuing nitroglycerin, participants reported an average 23% increase in frequency of any hot flashes (P = 0.041) and 96% increase in moderate-to-severe hot flashes (P < 0.001). CONCLUSIONS Continuous nitroglycerin may substantially and reversibly decrease hot flash frequency and severity. If confirmed in a randomized blinded trial, it may offer a novel nonhormonal hot flash treatment.
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Affiliation(s)
- Alison J Huang
- 1Department of Medicine, University of California, San Francisco, California 2San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California 3Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California 4Department of Epidemiology and Biostatistics, University of California, San Francisco, California
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20
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Jacoby VL, Kohi MP, Poder L, Jacoby A, Lager J, Schembri M, Rieke V, Grady D, Vittinghoff E, Coakley FV. PROMISe trial: a pilot, randomized, placebo-controlled trial of magnetic resonance guided focused ultrasound for uterine fibroids. Fertil Steril 2015; 105:773-780. [PMID: 26658133 DOI: 10.1016/j.fertnstert.2015.11.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/06/2015] [Accepted: 11/06/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the feasibility of a full-scale placebo-controlled trial of magnetic resonance-guided focused ultrasound for fibroids (MRgFUS) and obtain estimates of safety and efficacy. DESIGN Pilot, randomized, placebo-controlled trial. SETTING University medical center. PATIENT(S) Premenopausal women with symptomatic uterine fibroids. INTERVENTION(S) Participants randomized in a 2:1 ratio to receive MRgFUS or placebo procedure. MAIN OUTCOME MEASURE(S) PRIMARY OUTCOME change in fibroid symptoms from baseline to 4 and 12 weeks after treatment assessed by the Uterine Fibroid Symptom Quality of Life Questionnaire (UFS-QOL); secondary outcome: incidence of surgery or procedures for recurrent symptoms at 12 and 24 months. RESULT(S) Twenty women with a mean age of 44 years (±standard deviation 5.4 years) were enrolled, and 13 were randomly assigned to MRgFUS and 7 to placebo. Four weeks after treatment, all participants reported improvement in the UFS-QOL: a mean of 10 points in the MRgFUS group and 9 points in the placebo group (for difference in change between groups). By 12 weeks, the MRgFUS group had improved more than the placebo group (mean 31 points and 13 points, respectively). The mean fibroid volume decreased 18% in the MRgFUS group with no decrease in the placebo group at 12 weeks. Two years after MRgFUS, 4 of 12 women who had a follow-up evaluation (30%) had undergone another fibroid surgery or procedure. CONCLUSION(S) Women with fibroids were willing to enroll in a randomized, placebo-controlled trial of MRgFUS. A placebo effect may explain some of the improvement in fibroid-related symptoms observed in the first 12 weeks after MRgFUS. CLINICAL TRIAL REGISTRATION NUMBER NCT01377519.
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Affiliation(s)
- Vanessa L Jacoby
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California.
| | - Maureen P Kohi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Liina Poder
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Alison Jacoby
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
| | - Jeanette Lager
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
| | - Michael Schembri
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
| | - Viola Rieke
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Deborah Grady
- Department of Medicine, University of California, San Francisco, California
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Fergus V Coakley
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
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21
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Schembri M. Management of gallbladder stones – Are we delaying the inevitable? Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Leahey TM, Subak LL, Fava J, Schembri M, Thomas G, Xu X, Krupel K, Kent K, Boguszewski K, Kumar R, Weinberg B, Wing R. Benefits of adding small financial incentives or optional group meetings to a web-based statewide obesity initiative. Obesity (Silver Spring) 2015; 23:70-6. [PMID: 25384463 PMCID: PMC4448964 DOI: 10.1002/oby.20937] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 09/24/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine whether adding either small, variable financial incentives or optional group sessions improves weight losses in a community-based, Internet behavioral program. METHODS Participants (N = 268) from Shape Up Rhode Island 2012, a 3-month Web-based community wellness initiative, were randomized to: Shape Up+Internet behavioral program (SI), Shape Up+Internet program+incentives (SII), or Shape Up+Internet program+group sessions (SIG). RESULTS At the end of the 3-month program, SII achieved significantly greater weight losses than SI (SII: 6.4% [5.1-7.7]; SI: 4.2% [3.0-5.6]; P = 0.03); weight losses in SIG were not significantly different from the other two conditions (SIG: 5.8% [4.5-7.1], P's ≥ 0.10). However, at the 12-month no-treatment follow-up visit, both SII and SIG had greater weight losses than SI (SII: 3.1% [1.8-4.4]; SIG: 4.5% [3.2-5.8]; SI: 1.2% [-0.1-2.6]; P's ≤ 0.05). SII was the most cost-effective approach at both 3 (SII: $34/kg; SI: $34/kg; SIG: $87/kg) and 12 months (SII: $64/kg; SI: $140/kg; SIG: $113/kg). CONCLUSIONS Modest financial incentives enhance weight losses during a community campaign, and both incentives and optional group meetings improved overall weight loss outcomes during the follow-up period. However, the use of the financial incentives is the most cost-effective approach.
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Affiliation(s)
- Tricia M. Leahey
- University of Connecticut
- Alpert Medical School of Brown University
| | | | | | | | - Graham Thomas
- Alpert Medical School of Brown University
- The Miriam Hospital
| | | | | | | | | | | | | | - Rena Wing
- Alpert Medical School of Brown University
- The Miriam Hospital
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Corey SM, Epel E, Schembri M, Pawlowsky SB, Cole RJ, Araneta MRG, Barrett-Connor E, Kanaya AM. Effect of restorative yoga vs. stretching on diurnal cortisol dynamics and psychosocial outcomes in individuals with the metabolic syndrome: the PRYSMS randomized controlled trial. Psychoneuroendocrinology 2014; 49:260-71. [PMID: 25127084 PMCID: PMC4174464 DOI: 10.1016/j.psyneuen.2014.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 07/11/2014] [Accepted: 07/12/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Chronic stimulation and dysregulation of the neuroendocrine system by stress may cause metabolic abnormalities. We estimated how much cortisol and psychosocial outcomes improved with a restorative yoga (relaxation) versus a low impact stretching intervention for individuals with the metabolic syndrome. METHODS We conducted a 1-year multi-center randomized controlled trial (6-month intervention and 6-month maintenance phase) of restorative yoga vs. stretching. Participants completed surveys to assess depression, social support, positive affect, and stress at baseline, 6 months and 12 months. For each assessment, we collected saliva at four points daily for three days and collected response to dexamethasone on the fourth day for analysis of diurnal cortisol dynamics. We analyzed our data using multivariate regression models, controlling for study site, medications (antidepressants, hormone therapy), body mass index, and baseline cortisol values. RESULTS Psychosocial outcome measures were available for 171 study participants at baseline, 140 at 6 months, and 132 at 1 year. Complete cortisol data were available for 136 of 171 study participants (72 in restorative yoga and 64 in stretching) and were only available at baseline and 6 months. At 6 months, the stretching group had decreased cortisol at waking and bedtime compared to the restorative yoga group. The pattern of changes in stress mirrored this improvement, with the stretching group showing reductions in chronic stress severity and perseverative thoughts about their stress. Perceived stress decreased by 1.5 points (-0.4; 3.3, p=0.11) at 6 months, and by 2.0 points (0.1; 3.9, p=0.04) at 1 year in the stretching compared to restorative yoga groups. Post hoc analyses suggest that in the stretching group only, perceived increases in social support (particularly feelings of belonging), but not changes in stress were related to improved cortisol dynamics. CONCLUSIONS We found significant decreases in salivary cortisol, chronic stress severity, and stress perception in the stretching group compared to the restorative yoga group. Group support during the interactive stretch classes may have contributed to these changes.
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Affiliation(s)
- Sarah M Corey
- University of California, San Francisco, CA 94115, USA.
| | - Elissa Epel
- University of California, San Francisco, CA 94115, USA
| | | | | | - Roger J Cole
- Synchrony Applied Health Sciences, Del Mar, CA 92014, USA
| | | | | | - Alka M Kanaya
- University of California, San Francisco, CA 94115, USA
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Jacoby VL, Jacoby A, Learman LA, Schembri M, Gregorich SE, Jackson R, Kuppermann M. Use of medical, surgical and complementary treatments among women with fibroids. Eur J Obstet Gynecol Reprod Biol 2014; 182:220-5. [PMID: 25445104 DOI: 10.1016/j.ejogrb.2014.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 08/28/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the use of medical management, uterus-preserving surgery (UPS), and complementary treatments among women with uterine fibroids. STUDY DESIGN Prospective cohort study of 933 premenopausal women ages 31-54 years with symptomatic fibroids who participated in the Study of Pelvic Problems, Hysterectomy, and Intervention Alternatives (SOPHIA) for an average of 4.3 years (SD 2.5 years). Incident use of fibroid treatments was determined through annual interviews. Linear regression models were used to compare changes in fibroid-related symptoms among women who underwent UPS versus those who did not undergo surgery. RESULTS Participants were racially and ethnically diverse, with a mean age of 43 years. During study follow-up, 531 participants (57%) did not undergo UPS or hysterectomy, 250 (27%) had at least one UPS, and 152 (16%) underwent hysterectomy. Complementary and alternative treatments were commonly used, including exercise (45%), diet (34%), herbs (37%), and acupuncture (16%): participants reported significant symptom improvement and few side effects with these interventions. In multivariable linear regression models, women who did not undergo surgery during the study reported improvement in dyspareunia (p<.001), pelvic pain (p<.001), and menstrual cramps (p<.001). However, women who underwent UPS reported greater overall resolution of "pelvic problems" compared with women who did not have surgical treatment (difference in change score 1.18 on a four-point Likert scale, p<.001). CONCLUSION UPS are effective treatments for women with fibroids, but many women use hormonal or complementary treatments and report significant symptom improvement without surgical intervention.
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Affiliation(s)
- Vanessa L Jacoby
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 1635 Divisadero St, Suite 600, San Francisco, CA, USA.
| | - Alison Jacoby
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 1635 Divisadero St, Suite 600, San Francisco, CA, USA
| | - Lee A Learman
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, USA
| | - Michael Schembri
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 1635 Divisadero St, Suite 600, San Francisco, CA, USA
| | - Steven E Gregorich
- Medicine, University of California, San Francisco, CA, USA; Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, CA, USA
| | - Rebecca Jackson
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 1635 Divisadero St, Suite 600, San Francisco, CA, USA; Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 1635 Divisadero St, Suite 600, San Francisco, CA, USA; Epidemiology & Biostatistics, University of California, San Francisco, CA, USA; Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, CA, USA
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25
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Subak LL, Goode PS, Brubaker L, Kusek JW, Schembri M, Lukacz ES, Kraus SR, Chai TC, Norton P, Tennstedt SL. Urinary incontinence management costs are reduced following Burch or sling surgery for stress incontinence. Am J Obstet Gynecol 2014; 211:171.e1-7. [PMID: 24631433 DOI: 10.1016/j.ajog.2014.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/29/2014] [Accepted: 03/06/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of the study was to estimate the effect of Burch and fascial sling surgery on out-of-pocket urinary incontinence (UI) management costs at 24 months postoperatively and identify predictors of change in cost among women enrolled in a randomized trial comparing these procedures. STUDY DESIGN Resources used for UI management (supplies, laundry, dry cleaning) were self-reported by 491 women at baseline and 24 months after surgery, and total out-of-pocket costs for UI management (in 2012 US dollars) were estimated. Data from the 2 surgical groups were combined to examine the change in cost for UI management over 24 months. Univariate and bivariate changes in cost were analyzed using the Wilcoxon signed rank test. Predictors of change in cost were examined using multivariate mixed models. RESULTS At baseline mean (±SD) age of participants was 53 ± 10 years, and the frequency of weekly UI episodes was 23 ± 21. Weekly UI episodes decreased by 86% at 24 months (P < .001). The mean weekly cost was $16.60 ± $27.00 (median $9.39) at baseline and $4.57 ± $15.00 (median $0.10) at 24 months (P < .001), a decrease of 72%. In multivariate analyses, cost decreased by $3.38 ± $0.77 per week for each decrease of 1 UI episode per day (P < .001) and was strongly associated with greater improvement in Urogenital Distress Inventory and Incontinence Impact Questionnaire scores (P < .001) and decreased 24-hour pad weight (P < .02). CONCLUSION Following Burch or fascial sling surgery, the UI management cost at 24 months decreased by 72% ($625 per woman per year) and was strongly associated with decreasing UI frequency. Reduced out-of-pocket expenses may be a benefit of these established urinary incontinence procedures.
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Leahey TM, Thomas G, Fava JL, Subak LL, Schembri M, Krupel K, Kumar R, Weinberg B, Wing RR. Adding evidence-based behavioral weight loss strategies to a statewide wellness campaign: a randomized clinical trial. Am J Public Health 2014; 104:1300-6. [PMID: 24832424 DOI: 10.2105/ajph.2014.301870] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We determined the efficacy and cost-effectiveness of adding an evidence-based Internet behavioral weight loss intervention alone or combined with optional group sessions to ShapeUp Rhode Island 2011 (SURI), a 3-month statewide wellness campaign. METHODS We randomized participants (n = 230; body mass index = 34.3 ±6.8 kg/m(2); 84% female) to the standard SURI program (S) or to 1 of 2 enhanced programs: SURI plus Internet behavioral program (SI) or SI plus optional group sessions (SIG). The primary outcome was weight loss at the end of the 3-month program. RESULTS Weight losses differed among all 3 conditions (S: 1.1% ±0.9%; SI: 4.2% ±0.6%; SIG: 6.1% ±0.6%; Ps ≤ .04). Both SI and SIG increased the percentage of individuals who achieved a 5% weight loss (SI: 42%; SIG: 54%; S: 7%; Ps < .001). Cost per kilogram of weight loss was similar for S ($39) and SI ($35); both were lower than SIG ($114). CONCLUSIONS Although weight losses were greatest at the end of SURI with optional group sessions, the addition of an Internet behavioral program was the most cost-effective method to enhance weight losses.
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Affiliation(s)
- Tricia M Leahey
- Tricia M. Leahey, Graham Thomas, and Rena R. Wing are with Alpert Medical School of Brown University Department of Psychiatry and Human Behavior, The Miriam Hospital's Weight Control and Diabetes Research Center, Providence, RI. Joseph L. Fava and Katie Krupel are with The Miriam Hospital's Weight Control and Diabetes Research Center, Providence. Leslee L. Subak is with the University of California San Francisco, Department of Obstetrics, Gynecology, and Reproductive Science, San Francisco, CA. Michael Schembri is with University of California San Francisco, Women's Health Clinical Research Center, San Francisco. Rajiv Kumar is with ShapeUp Inc, Providence. Brad Weinberg is with Blueprint Health Inc, New York, NY
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Kanaya AM, Araneta MRG, Pawlowsky SB, Barrett-Connor E, Grady D, Vittinghoff E, Schembri M, Chang A, Carrion-Petersen ML, Coggins T, Tanori D, Armas JM, Cole RJ. Restorative yoga and metabolic risk factors: the Practicing Restorative Yoga vs. Stretching for the Metabolic Syndrome (PRYSMS) randomized trial. J Diabetes Complications 2014; 28:406-12. [PMID: 24418351 PMCID: PMC4004660 DOI: 10.1016/j.jdiacomp.2013.12.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 12/02/2013] [Accepted: 12/03/2013] [Indexed: 12/20/2022]
Abstract
AIMS Intensive lifestyle change prevents type 2 diabetes but is difficult to sustain. Preliminary evidence suggests that yoga may improve metabolic factors. We tested a restorative yoga intervention vs. active stretching for metabolic outcomes. METHODS In 2009-2012, we conducted a 48-week randomized trial comparing restorative yoga vs. stretching among underactive adults with the metabolic syndrome at the Universities of California, San Francisco and San Diego. We provided lifestyle counseling and a tapering series of 90-min group classes in the 24-week intervention period and 24-week maintenance period. Fasting and 2-h glucose, HbA1c, triglycerides, HDL-cholesterol, insulin, systolic blood pressure, visceral fat, and quality of life were assessed at baseline, 6- and 12-months. RESULTS 180 participants were randomized and 135 (75%) completed the trial. At 12 months, fasting glucose decreased more in the yoga group than in the stretching group (-0.35 mmol/L vs. -0.03 mmol/L; p=0.002); there were no other significant differences between groups. At 6 months favorable changes within the yoga group included reductions in fasting glucose, insulin, and HbA1c and an increase in HDL-cholesterol that were not sustained at 1 year except changes in fasting glucose. The stretching group had a significant reduction in triglycerides at 6 months which was not sustained at 1 year but had improved quality of life at both time-points. CONCLUSIONS Restorative yoga was marginally better than stretching for improving fasting glucose but not other metabolic factors.
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Affiliation(s)
| | | | | | | | | | | | | | - Ann Chang
- University of California, San Francisco
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28
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Corey S, Epel E, Schembri M, Pawlowsky S, Cole R, Araneta MR, Barrett-Connor E, Kanaya A. Effect of Restorative Yoga vs. Stretching on Salivary Cortisol and Psychosocial Outcomes in Individuals with the Metabolic Syndrome: The PRYSMS Randomized Controlled Trial. J Altern Complement Med 2014. [DOI: 10.1089/acm.2014.5053.abstract] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sarah Corey
- (1) University of California, San Francisco, CA, USA
- (2) San Francisco State University, San Francisco, CA, USA
- (3) Synchrony Applied Health Sciences, Del Mar, CA, USA
- (4) University of California, San Diego, CA, USA
| | - Elissa Epel
- (1) University of California, San Francisco, CA, USA
- (2) San Francisco State University, San Francisco, CA, USA
- (3) Synchrony Applied Health Sciences, Del Mar, CA, USA
- (4) University of California, San Diego, CA, USA
| | - Michael Schembri
- (1) University of California, San Francisco, CA, USA
- (2) San Francisco State University, San Francisco, CA, USA
- (3) Synchrony Applied Health Sciences, Del Mar, CA, USA
- (4) University of California, San Diego, CA, USA
| | - Sarah Pawlowsky
- (1) University of California, San Francisco, CA, USA
- (2) San Francisco State University, San Francisco, CA, USA
- (3) Synchrony Applied Health Sciences, Del Mar, CA, USA
- (4) University of California, San Diego, CA, USA
| | - Roger Cole
- (1) University of California, San Francisco, CA, USA
- (2) San Francisco State University, San Francisco, CA, USA
- (3) Synchrony Applied Health Sciences, Del Mar, CA, USA
- (4) University of California, San Diego, CA, USA
| | - Maria Rosario Araneta
- (1) University of California, San Francisco, CA, USA
- (2) San Francisco State University, San Francisco, CA, USA
- (3) Synchrony Applied Health Sciences, Del Mar, CA, USA
- (4) University of California, San Diego, CA, USA
| | - Elizabeth Barrett-Connor
- (1) University of California, San Francisco, CA, USA
- (2) San Francisco State University, San Francisco, CA, USA
- (3) Synchrony Applied Health Sciences, Del Mar, CA, USA
- (4) University of California, San Diego, CA, USA
| | - Alka Kanaya
- (1) University of California, San Francisco, CA, USA
- (2) San Francisco State University, San Francisco, CA, USA
- (3) Synchrony Applied Health Sciences, Del Mar, CA, USA
- (4) University of California, San Diego, CA, USA
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Hess R, Huang AJ, Richter HE, Ghetti CC, Sung VW, Barrett-Connor E, Gregory WT, Pinkerton JV, Bradley CS, Kraus SR, Rogers RG, Subak LL, Johnson KC, Arya LA, Schembri M, Brown JS. Long-term efficacy and safety of questionnaire-based initiation of urgency urinary incontinence treatment. Am J Obstet Gynecol 2013; 209:244.e1-9. [PMID: 23659987 DOI: 10.1016/j.ajog.2013.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 04/18/2013] [Accepted: 05/02/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective of the study was to determine the longer-term efficacy and safety of initiating treatment for urgency-predominant urinary incontinence (UUI) in women diagnosed using a simple questionnaire rather than an extensive evaluation. STUDY DESIGN Women completing a 12 week randomized controlled trial of fesoterodine therapy for UUI diagnosed by questionnaire were invited to participate in a 9 month, open-label continuation study. UUI and voiding episodes were collected using voiding diaries. Participant satisfaction was measured by questionnaire. Safety was assessed by the measurement of postvoid residual volume and adverse event monitoring; if necessary, women underwent a specialist evaluation. The longitudinal changes in UUI and voiding episodes were evaluated using linear mixed models adjusting for baseline. RESULTS Of the 567 women completing the randomized trial, 498 (87.8%) took at least 1 dose of medication during this open-label study. Compared with the baseline visit in the randomized trial, fesoterodine was associated with a reduction in total incontinence episodes per day and urgency incontinence episodes per day at the end of the open-label study (adjusted mean [SE], 4.6 [0.12] to 1.2 [0.13] and 3.9 [0.11] to 0.9 [0.11], respectively, P < .0001 for both). Most women were satisfied with treatment (89%, 92%, and 93% at 3, 6, and 9 months, respectively). Twenty-six women experienced 28 serious adverse events, 1 of which was considered possibly treatment related. Twenty-two women had a specialist evaluation: 5 women's incontinence was misclassified by the 3 Incontinence Questions; none experienced harm because of misclassification. CONCLUSION Using a simple validated questionnaire to diagnose and initiate treatment for UUI in community-dwelling women is safe and effective, allowing timely treatment by primary care practitioners.
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Camarano L, Alkon A, Nachtigall RD, Schembri M, Weiss S, Croughan MS. Preterm delivery and low birth weight in singleton pregnancies conceived by women with and without a history of infertility. Fertil Steril 2012; 98:681-686.e1. [PMID: 22633266 DOI: 10.1016/j.fertnstert.2012.04.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 03/30/2012] [Accepted: 04/19/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine predictors of low birth weight (LBW) and preterm delivery (PTD) in singleton pregnancies conceived by women with and without a history of infertility. DESIGN Retrospective cohort study. SETTING Eleven infertility clinics in northern California. PATIENT(S) Three groups of women who carried singleton pregnancies to ≥20 weeks' gestation: 542 infertile women who conceived after treatment, 441 infertile women who conceived spontaneously, and 1,008 fertile women for comparison. INTERVENTION(S) Chart review. MAIN OUTCOME MEASURE(S) Association of LBW or PTD with infertility treatment, maternal age, parity, obesity, or development of gestational diabetes. RESULT(S) Infertile women who conceived with treatment were more likely to be obese, develop gestational diabetes, and have ovarian, ovulatory, or male factor infertility than infertile women who conceived spontaneously. Infertile women who conceived after treatment had 1.61 times greater odds of having an LBW infant. Nulliparity was an independent predictor of LBW and PTD in all three groups after controlling for maternal age, history of infertility, infertility treatment, obesity, and gestational diabetes. CONCLUSION(S) Nulliparous women and women with a history of infertility who conceive a singleton after treatment may be at increased odds for having an LBW infant. Infertile women do not appear to be at increased odds for PTD.
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Affiliation(s)
- Loretta Camarano
- School of Nursing, Samuel Merritt University, San Mateo;; Fertility Physicians of Northern California, California 94402, USA.
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31
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Huang AJ, Hess R, Arya LA, Richter HE, Subak LL, Bradley CS, Rogers RG, Myers DL, Johnson KC, Gregory WT, Kraus SR, Schembri M, Brown JS. Pharmacologic treatment for urgency-predominant urinary incontinence in women diagnosed using a simplified algorithm: a randomized trial. Am J Obstet Gynecol 2012; 206:444.e1-11. [PMID: 22542122 DOI: 10.1016/j.ajog.2012.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 02/06/2012] [Accepted: 03/05/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate clinical outcomes associated with the initiation of treatment for urgency-predominant incontinence in women diagnosed by a simple 3-item questionnaire. STUDY DESIGN We conducted a multicenter, double-blinded, 12-week randomized trial of pharmacologic therapy for urgency-predominant incontinence in ambulatory women diagnosed by the simple 3-item questionnaire. Participants (N = 645) were assigned randomly to fesoterodine therapy (4-8 mg daily) or placebo. Urinary incontinence was assessed with the use of voiding diaries; postvoid residual volume was measured after treatment. RESULTS After 12 weeks, women who had been assigned randomly to fesoterodine therapy reported 0.9 fewer urgency and 1.0 fewer total incontinence episodes/day, compared with placebo (P ≤ .001). Four serious adverse events occurred in each group, none of which was related to treatment. No participant had postvoid residual volume of ≥ 250 mL after treatment. CONCLUSION Among ambulatory women with urgency-predominant incontinence diagnosed with a simple 3-item questionnaire, pharmacologic therapy resulted in a moderate decrease in incontinence frequency without increasing significant urinary retention or serious adverse events, which provides support for a streamlined algorithm for diagnosis and treatment of female urgency-predominant incontinence.
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Affiliation(s)
- Alison J Huang
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA.
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Eisenberg ML, Schembri M, Croughan MS, Walsh TJ. Fecundity and sex ratio of offspring in an infertile cohort. Fertil Steril 2011; 96:833-6. [DOI: 10.1016/j.fertnstert.2011.07.1141] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 07/19/2011] [Accepted: 07/25/2011] [Indexed: 11/16/2022]
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Bradley CS, Brown JS, Van Den Eeden SK, Schembri M, Ragins A, Thom DH. Urinary incontinence self-report questions: reproducibility and agreement with bladder diary. Int Urogynecol J 2011; 22:1565-71. [PMID: 21796472 DOI: 10.1007/s00192-011-1503-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 07/11/2011] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study aims to measure self-report urinary incontinence questions' reproducibility and agreement with bladder diary. METHODS Data were analyzed from the Reproductive Risk of Incontinence Study at Kaiser. Participating women reporting at least weekly incontinence completed self-report incontinence questions and a 7-day bladder diary. Self-report question reproducibility was assessed and agreement between self-reported and diary-recorded voiding and incontinence frequency was measured. Test characteristics and area under the curve were calculated for self-reported incontinence types using diary as the gold standard. RESULTS Five hundred ninety-one women were included and 425 completed a diary. The self-report questions had moderate reproducibility and self-reported and diary-recorded incontinence and voiding frequencies had moderate to good agreement. Self-reported incontinence types identified stress and urgency incontinence more accurately than mixed incontinence. CONCLUSIONS Self-report incontinence questions have moderate reproducibility and agreement with diary, and considering their minimal burden, are acceptable research tools in epidemiologic studies.
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Affiliation(s)
- Catherine S Bradley
- Comprehensive Access and Delivery Research and Evaluation Center, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.
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Thom DH, Brown JS, Schembri M, Ragins AI, Creasman JM, Van Den Eeden SK. Parturition events and risk of urinary incontinence in later life. Neurourol Urodyn 2011; 30:1456-61. [PMID: 21780171 DOI: 10.1002/nau.21166] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 05/09/2011] [Indexed: 01/14/2023]
Abstract
AIMS To examine the association between specific events during vaginal deliveries and urinary incontinence later in life. METHODS A retrospective cohort study of 1,521 middle-aged and older women with at least one vaginal delivery who were long-term members of an integrated health delivery system. Age, race/ethnicity, current incontinence status, medical, surgical history, pregnancy and parturition history, menopausal status, hormone replacement, health habits, and general health were obtained by questionnaire. Labor and delivery records, archived since 1948, were abstracted by professional medical record abstractors to obtain parturition events including induction, length of labor stages, type of anesthesia, episiotomy, instrumental delivery, and birth weight. The primary dependent variable was current weekly urinary incontinence (once per week or more often) versus urinary incontinence less than monthly (including no incontinence) in past 12 months. Associations of parturition events and later incontinence were assessed in multivariate analysis with logistic regression. RESULTS The mean age of participants was 56 years. After adjustment for multiple risk factors, weekly urinary incontinence significantly associated with age at first birth (P = 0.036), greatest birth weight (P = 0.005), and ever having been induced for labor (OR = 1.51; 95%CI = 1.06-2.16, P = 0.02). Risk of incontinence increased from OR = 1.35 (95%CI = 0.92-1.97, P = 0.12) for women with one induction to OR = 2.67 (95%CI = 1.25-5.71, P = 0.01) for women with two or more inductions (P = 0.01 for trend). No other parturition factors were associated with incontinence. CONCLUSIONS Younger age at first birth, greatest birth weight, and induction of labor were associated with an increased risk of incontinence in later life.
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Affiliation(s)
- David H Thom
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA.
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35
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Learman LA, Gregorich SE, Schembri M, Jacoby A, Jackson RA, Kuppermann M. Symptom resolution after hysterectomy and alternative treatments for chronic pelvic pain: does depression make a difference? Am J Obstet Gynecol 2011; 204:269.e1-9. [PMID: 21376168 DOI: 10.1016/j.ajog.2010.12.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Revised: 11/29/2010] [Accepted: 12/27/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether depression influences treatment outcomes and to identify predictors of symptom resolution among women with chronic pelvic pain (CPP). STUDY DESIGN Analysis of 701 women with CPP in the Study of Pelvic Problems, Hysterectomy and Intervention Alternatives prospective cohort study, which included 153 women (22%) with depression. We conducted multivariable analyses to evaluate the influence of depression on pre-/posttreatment differences in symptoms and health-related quality of life and to identify other predictors of symptom improvement. RESULTS CPP treatments included hysterectomy (9%), other surgical treatments (9%), hormonal medications (50%), narcotic analgesics (47%), physical therapy (12%), and nonprescription medications (93%). Depression predicted lower gains in health perception (P < .05) but not in symptom resolution, sexual functioning, or other aspects of health-related quality of life. Symptom resolution was predicted by hysterectomy (P < .001), entering menopause (P < .001), and pretreatment satisfaction with sex (P = .039). CONCLUSION Depression does not influence substantially treatment-related gains in CPP symptom resolution and health-related quality of life. Coexisting depression should not delay treatment for CPP.
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Doshi AM, Van Den Eeden SK, Morrill MY, Schembri M, Thom DH, Brown JS. Women with diabetes: understanding urinary incontinence and help seeking behavior. J Urol 2010; 184:1402-7. [PMID: 20727547 DOI: 10.1016/j.juro.2010.06.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE We examined the association of urinary incontinence with diabetes status and race, and evaluated beliefs about help seeking for incontinence in a population based cohort of women with vs without diabetes. MATERIALS AND METHODS We performed a cross-sectional analysis of 2,270 middle-aged and older racially/ethnically diverse women in the Diabetes Reproductive Risk factors for Incontinence Study at Kaiser. Incontinence, help seeking behavior and beliefs were assessed by self-report questionnaires and in-person interviews. We compared incontinence characteristics in women with and without diabetes using univariate analysis and multivariate models. RESULTS Women with diabetes reported weekly incontinence significantly more than women without diabetes (weekly 35.4% vs 25.7%, p <0.001). Race prevalence patterns were similar in women with and without diabetes with the most vs the least prevalence of incontinence in white and Latina vs black and Asian women. Of women with diabetes 42.2% discussed incontinence with a physician vs 55.5% without diabetes (p <0.003). Women with diabetes were more likely than those without diabetes to report the belief that incontinence is rare (17% vs 6%, p <0.001). CONCLUSIONS Incontinence is highly prevalent in women with diabetes. Race prevalence patterns are similar in those with and without diabetes. Understanding help seeking behavior is important to ensure appropriate patient care. Physicians should be alert for urinary incontinence since it is often unrecognized and, thus, under treated in women with diabetes.
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Affiliation(s)
- Ashmi M Doshi
- Women's Health Clinical Research Center, University of California-San Francisco School of Medicine, San Francisco, California 94115, USA.
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Thom DH, Brown JS, Schembri M, Ragins AI, Subak LL, Van Den Eeden SK. Incidence of and risk factors for change in urinary incontinence status in a prospective cohort of middle-aged and older women: the reproductive risk of incontinence study in Kaiser. J Urol 2010; 184:1394-401. [PMID: 20727544 DOI: 10.1016/j.juro.2010.05.095] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE Urinary incontinence is a dynamic condition that can progress and regress but few groups have examined risk factors for change in incontinence status. MATERIAL AND METHODS We used stratified random sampling to construct a racially and ethnically diverse, population based cohort of 2,109 women 40 to 69 years old. Data were collected by questionnaires and medical record review. A second survey approximately 5 years later was completed by 1,413 women (67%) from the original cohort. The frequency of urinary incontinence was categorized as less than weekly, weekly and daily. Change in incontinence status was defined as new onset incontinence, incontinence progression or regression between frequency categories and resolution of incontinence. Predictor variables were demographics, body mass index and other medical conditions. We used logistic regression to estimate the adjusted OR and 95% CI. RESULTS Compared to white nonHispanic women, black women were less likely to have incontinence progression (OR 0.46, 95% CI 0.24-0.88). New onset incontinence was more common in women with a higher body mass index at baseline (p = 0.006) and those who experienced increased body mass index (p = 0.03) or decreased general health (p = 0.007) during the study. Participants with chronic obstructive pulmonary disorder at baseline were more likely to report incontinence progression (OR 2.64, 95% CI 1.22-5.70). Baseline incontinence type was not significantly associated with the risk of change in continence status independent of frequency. CONCLUSIONS Identifying risk factors for change in incontinence status may be important to develop interventions to decrease the burden of incontinence in the general population.
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Affiliation(s)
- David H Thom
- Department of Family and Community Medicine, San Francisco General Hospital, University of California-San Francisco, San Francisco, California 94110, USA.
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West DS, Gorin AA, Subak LL, Foster G, Bragg C, Hecht J, Schembri M, Wing RR. A motivation-focused weight loss maintenance program is an effective alternative to a skill-based approach. Int J Obes (Lond) 2010; 35:259-69. [PMID: 20680012 PMCID: PMC2974962 DOI: 10.1038/ijo.2010.138] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objective Maintaining weight loss is a major challenge in obesity treatment. Individuals often indicate that waning motivation prompts cessation of effective weight management behaviors. Therefore, a novel weight loss maintenance program that specifically targets motivational factors was evaluated. Design Overweight women (N=338; 19% African American) with urinary incontinence were randomized to lifestyle obesity treatment or control and followed for 18 months. All participants in lifestyle (N=226) received the same initial six-month group behavioral obesity treatment and were then randomized to 1) a novel motivation-focused maintenance program (N=113) or 2) a standard skill-based maintenance approach (N=113). Main Outcome Measure Weight assessed at baseline, 6, and 18 months. Results Both treatment groups (motivation-focused and skill-based) achieved comparable 18-month weight losses (−5.48% for motivation-focused vs −5.55% in skill-based, p=0.98), and both groups lost significantly more than controls (−1.51%; p=.0012 in motivation-focused and .0021 in skill-based). Conclusions A motivation-focused maintenance program offers an alternative, effective approach to weight maintenance expanding available evidence-based interventions beyond traditional skill-based programs.
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Affiliation(s)
- D S West
- Department of Health Behavior and Health Education, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 7205, USA.
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Walsh TJ, Schembri M, Turek PJ, Chan JM, Carroll PR, Smith JF, Eisenberg ML, Van Den Eeden SK, Croughan MS. Increased risk of high-grade prostate cancer among infertile men. Cancer 2010; 116:2140-7. [PMID: 20309846 DOI: 10.1002/cncr.25075] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND It has been reported that fatherhood status may be a risk factor for prostate cancer. In the current study, the authors examined the subsequent occurrence of prostate cancer in a cohort of men evaluated for infertility to determine whether male infertility is a risk factor for prostate cancer. METHODS A total of 22,562 men who were evaluated for infertility from 1967 to 1998 were identified from 15 California infertility centers and linked to the California Cancer Registry. The incidence of prostate cancer was compared with the incidence in an age-matched and geography-matched sample of men from the general population. The risk of prostate cancer in men with and those without male factor infertility was modeled using a Cox proportional hazards regression model. RESULTS A total of 168 cases of prostate cancer that developed after infertility were identified. Men evaluated for infertility but not necessarily with male factors were not found to have an increased risk of cancer compared with the general population (standardized incidence ratio [SIR], 0.9; 95% confidence interval [95% CI], 0.8-1.1). This risk was found to be highest for men with male factor infertility who developed high-grade prostate cancer (SIR, 2.0; 95% CI, 1.2-3.0). On multivariate analyses, men with male factor infertility were found to be 2.6 times more likely to be diagnosed with high-grade prostate cancer (hazard ratio, 2.6; 95% CI, 1.4-4.8). CONCLUSIONS Men with male factor infertility were found to have an increased risk of subsequently developing high-grade prostate cancer. Male infertility may be an early and identifiable risk factor for the development of clinically significant prostate cancer.
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Affiliation(s)
- Thomas J Walsh
- Department of Urology, University of Washington School of Medicine, Seattle, Washington 98195-6510, USA.
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Morrill M, Doshi A, Van Den Eeden S, Schembri M, Thom D, Brown J. 1667 DO WOMEN WITH DIABETES AND WEEKLY INCONTINENCE SEEK CARE? J Urol 2010. [DOI: 10.1016/j.juro.2010.02.1491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Eisenberg M, Schembri M, Croughan M, Walsh T. 1926 GENDER RATIO AND INFERTILITY IN A PROSPECTIVE U.S. COHORT. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.1894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
BACKGROUND The risk of testicular cancer is thought to be higher among men seeking infertility treatment compared with the general population. Confirmation of this risk in a large US cohort of at-risk patients is lacking. This study explored the association between male infertility and subsequent development of testicular cancer in a US-based cohort. METHODS A total of 51 461 couples evaluated for infertility from 1967 to 1998 were recruited from 15 California infertility centers. We linked data on 22 562 identified male partners to the California Cancer Registry. The incidence of testicular cancer in this cohort was compared with the incidence in an age-matched sample of men from the general population using the Surveillance Epidemiology and End Results program. We analyzed the risk for testicular cancer in men with and without male factor infertility using a Cox proportional hazards regression model. RESULTS Thirty-four post-infertility-diagnosis cases of histologically confirmed testicular cancer were identified. Men seeking infertility treatment had an increased risk of subsequently developing testicular cancer (standardized incidence ratio, 1.3; 95% confidence interval, 0.9-1.9), with a markedly higher risk among those with known male factor infertility (2.8; 1.5-4.8). In multivariable analysis, men with male factor infertility were nearly 3 times more likely to develop testicular cancer compared with those without (hazard ratio, 2.8; 95% confidence interval, 1.3-6.0). CONCLUSION Men with male factor infertility have an increased risk of subsequently developing testicular cancer, suggesting the existence of common etiologic factors for infertility and testicular cancer.
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Affiliation(s)
- Thomas J Walsh
- Department of Urology, University of Washington, School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195-6510.
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Harris I, Purcell K, Schembri M, Adamson D. Characterization of the reduced pregnancy rates with IVF in Asian-Americans. Fertil Steril 2008. [DOI: 10.1016/j.fertnstert.2008.07.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lamb J, Schembri M, Johnstone E, Huddleston H, Sohn S, Fujimoto V. Asian ethnicity is associated with reduced pregnancy outcomes after IVF using a downregulated GnRH agonist suppression protocol. Fertil Steril 2008. [DOI: 10.1016/j.fertnstert.2008.07.1181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Walsh TJ, Croughan MS, Schembri M, Smith JF, Chan JM, Turek PJ. INFERTILE MEN MAY HAVE INCREASED RISK FOR NON-GERM CELL CANCERS: DATA FROM 51,318 INFERTILE COUPLES. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61910-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Walsh T, Schembri M, Turek P, Croughan M. Increased risk of testicular cancer among infertile men. Fertil Steril 2007. [DOI: 10.1016/j.fertnstert.2007.07.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kuppermann M, Learman LA, Schembri M, Gregorich S, Jacoby A, Jackson RA, Gates E, Wassel-Fyr C, Lewis J, Washington AE. Effect of Noncancerous Pelvic Problems on Health-Related Quality of Life and Sexual Functioning. Obstet Gynecol 2007; 110:633-42. [PMID: 17766611 DOI: 10.1097/01.aog.0000279153.56275.b5] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the effect of abnormal uterine bleeding and pelvic pain and pressure on health-related quality of life and sexual functioning and assess treatment satisfaction. METHODS This is a cross-sectional study of 1,493 sociodemographically diverse women who were seeking care for noncancerous pelvic problems and who had not undergone hysterectomy. Participants were asked about symptoms, attitudes, health-related quality of life, sexual functioning, and treatment satisfaction. Preference for current health was measured using the time tradeoff metric, which asked respondents to estimate the number of years of life they would be willing to trade off to not have a uterine condition. Multivariable logistic regression was used to identify determinants of treatment satisfaction. RESULTS Most (82.7%) participants reported a complete lack of or only partial symptom resolution, and 42.3% reported that their pelvic problems interfered with their ability to have and enjoy sex. Mean Short Form-12 Physical (43-49) and Mental (41-44) Component Summary scores were substantially lower than population norms for women aged 40-49 years. Mean current health time tradeoff scores ranged from 0.78 to 0.88. Satisfaction with Western medicines ranged from 31.3% (progestin intrauterine device) to 58.2% (opiates) and with uterine-preserving surgery from 20.0% (dilation and curettage) to 51.0% (myomectomy); 27.7 % of the women who used acupuncture were satisfied. Participants with lower educational attainment, greater symptom resolution, and less interference of pelvic problems with sex were more likely to be satisfied. CONCLUSION Noncancerous pelvic problems are associated with serious decrements in health-related quality of life and sexual functioning and low rates of treatment satisfaction. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Miriam Kuppermann
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California 94143-0856, USA.
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Purcell KJ, Schembri M, Telles TL, Fujimoto VY, Cedars MI. Bed rest after embryo transfer: a randomized controlled trial. Fertil Steril 2007; 87:1322-6. [PMID: 17362946 DOI: 10.1016/j.fertnstert.2006.11.060] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Revised: 10/03/2006] [Accepted: 11/15/2006] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine whether bed rest after embryo transfer leads to improved pregnancy rates (PR). DESIGN Randomized controlled trial. SETTING University reproductive health clinic. PATIENT(S) Women undergoing IVF. INTERVENTION(S) Patients undergoing 164 cycles of IVF were randomized to 30 minutes of bed rest after embryo transfer or immediate discharge from the clinic. MAIN OUTCOME MEASURE(S) Clinical PR defined by visualized fetal heart beat and ongoing PR defined by viable intrauterine gestation beyond 11 weeks. RESULT(S) The clinical and ongoing PR for both groups were 50% and 46.3%, respectively, with no statistically significant difference between the two groups. CONCLUSION(S) Thirty minutes of bed rest after embryo transfer does not improve PR.
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Affiliation(s)
- Karen J Purcell
- Fertility Physicians of Northern California, San Jose, California 95124, USA.
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Wu YW, Croen LA, Henning L, Najjar DV, Schembri M, Croughan MS. Potential association between infertility and spinal neural tube defects in offspring. ACTA ACUST UNITED AC 2006; 76:718-22. [PMID: 17022023 PMCID: PMC3407570 DOI: 10.1002/bdra.20313] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We examined the possible association between infertility and spinal neural tube defects (NTDs). METHODS This is a nested case-control study within the Kaiser Permanente Medical Care Program (KPMCP) in Northern California. Among a birth cohort of 110,624 singleton infants > or = 36 weeks gestation, 1994-1997, we electronically identified cases of spinal NTDs and confirmed the diagnosis by chart review. Controls (n = 1,608) were randomly selected from the birth population. History of infertility was defined as: (1) physician diagnosis of infertility; (2) prescription for an infertility medication noted in the KPMCP pharmacy; and/or (3) evaluation at 1 of 15 infertility clinics in Northern California. RESULTS Eighteen infants diagnosed with spinal NTDs (prevalence 1.6/10,000) included 13 with spina bifida cystica and 5 with spina bifida occulta. Case mothers were more likely to have a history of infertility (4/18 vs. 96/1,608, OR 4.3, 95% CI 1.01-14.0), and to have been prescribed clomiphene citrate within the window spanning 60 days before to 15 days after conception (3/18 vs. 32/1,608, OR 11.7, 95% CI 2.0-44.8). CONCLUSION This exploratory study suggests that infertility may be associated with an increased risk of spinal NTDs among liveborn, term infants.
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Affiliation(s)
- Yvonne W Wu
- Department of Neurology, University of California, San Francisco, California 94143-0137, USA.
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Croughan M, Schembri M, Bernstein D, Chamberlain N, Purcell N, Camarano L. O-9. Fertil Steril 2006. [DOI: 10.1016/j.fertnstert.2006.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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