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Biomedical subjects

C Westhoff

Publications and source records attributed to C Westhoff.

At least 19 recordsLinked to original sources
PubMed1998

Depressive symptoms and Norplant contraceptive implants.

Women enrolled in a multicenter prospective study were evaluated to identify any possible relationship between depressive symptoms and the use of contraceptive implants. Women choosing Norplant implants (n = 910) were evaluated before starting this contraceptive and were reinterviewed at 6 months and 2 years. Women who continued the method had lower depressive symptom scores before initiating Norplant implants than did the women who discontinued the method or who were lost to follow up. Among the continuing Norplant implant users, the mean scores were similar before starting Norplant and at 6 months (7.9 vs 7.7). The strongest overall predictor of the depressive symptom score was relationship satisfaction. At 24 months, the subgroup of continuing users with decreased relationship satisfaction had an increase in depressive symptom score, but those with stable or improved relationships had stable depressive symptom scores. The subjects with the highest (i.e., worst) scores at enrollment demonstrated improved scores during follow-up. These results are reassuring for women who are concerned that Norplant use may adversely affect their mood.

Adolescent↗
PubMed1998

Depressive symptoms and Depo-Provera.

Women enrolled in a multicenter prospective study were evaluated to identify any possible relationship between depressive symptoms and the use of contraceptives. Women choosing Depo-Provera (n = 495) were evaluated before starting these contraceptives and were reinterviewed 1 year later. Women who continued the method had lower depressive symptom scores at baseline than did the women who discontinued the method or who were lost to follow-up. Among the continuing Depo-Provera users, the depressive symptom scores improved slightly at 1 year (7.4 vs 6.7). Those subjects with the highest (i.e., worst) scores at enrollment demonstrated improved scores at follow-up.

Adolescent↗
PubMed1998

Genital chlamydial disease in an urban, primarily Hispanic, family planning clinic.

BACKGROUND AND OBJECTIVES: Although chlamydia is a well-studied disease, little is known about the rates of genital chlamydial disease among female Hispanics in urban family planning clinics. GOALS: To determine the prevalence of women with chlamydia in two clinic populations during 1994. We also sought to describe previously identified and novel risk factors for chlamydial disease in this unique population. STUDY DESIGN: We conducted a retrospective case-control analysis in two community clinics in the Washington Heights section of New York City. RESULTS: In 1994, 4,190 screening tests were done for Chlamydia trachomatis in these clinics, and the prevalence of positive tests was 5.4% (227/4,190). The mean age of the women screened was 19.2 years and most were of Hispanic origin (76%), students (51%), and received Medicaid (61%). Risk factors found to be associated with C. trachomatis infection included young age; earlier age at first coitus; pregnancy at the time of chlamydia screening; concurrent gonorrheal infection; and the clinical findings of cervical abnormalities, vaginal discharge, and adnexal tenderness. Hormonal contraception appeared to be protective against chlamydial infection (odds ratio, 0.36%; confidence interval, 0.17-0.77). CONCLUSION: Sexually transmitted diseases were common in our population because 5.4% of the women screened had chlamydial infection and 1.5% had concurrent gonorrheal infection. Our study confirmed risk factors established in other populations. These data support the need for enhanced screening efforts for chlamydia to decrease the prevalence of disease in our population.

Adolescent↗
PubMed1997

Endometrial adenocarcinoma--lack of correlation between treatment delay and tumor stage.

OBJECTIVE: The objective was to examine why a proportion of patients with endometrioid adenocarcinoma (EMC) presents with advanced stage disease and whether the duration of bleeding prior to hysterectomy (treatment delay) is predictive of stage. STUDY DESIGN: A retrospective clinicopathologic study of 182 patients treated for EMC at Columbia-Presbyterian Medical Center in New York City between 1988 and 1996 was performed. RESULTS: Ninety percent of patients with EMC presented with abnormal uterine bleeding. The median time interval from onset of bleeding to biopsy diagnosis was 2.5 months (range, 2 weeks to 60 months) and 3 weeks from biopsy to hysterectomy. No correlation between the duration of symptoms and tumor stage was found (P = 0.87). There was, however, significant correlation between poor tumor differentiation and the advanced stage of the disease (P = 0.0001). CONCLUSIONS: Stage at presentation in patients with EMC correlates with tumor differentiation but not with time interval from bleeding to definitive therapy.

Adenocarcinoma↗
PubMed1997

Does creatinine adjustment of urinary pregnanediol glucuronide reduce or introduce measurement error?

Correlation between urinary pregnanediol and serum progesterone measurements and the influence of age, race, smoking and urinary creatinine adjustment was determined during the luteal phase of the menstrual cycle in 175 volunteers. A decline in serum progesterone was observed with increasing age. Mean baseline urinary creatinine declined with increasing age in non-smokers and was not affected by race or baseline weight. An excellent correlation between urinary pregnanediol glucuronide and serum progesterone levels existed except when urinary pregnanediol concentrations were adjusted using creatinine measurements in older individuals. Adjustment of urinary pregnanediol glucuronide concentration using creatinine measurement is therefore discouraged.

Adult↗
PubMed1996

Predictors of ovarian steroid secretion in reproductive-age women.

During the baseline period (1985-1988) of a prospective study, midcycle and luteal-phase estrogens and progestins were measured in 175 healthy women aged 21-36 years with spontaneous, cyclic menses in Brooklyn, New York. Subjects contributed daily first-morning urine specimens and three blood specimens during a single menstrual cycle monitored by basal body temperature. Hormone levels were compared according to age, race, and levels of known or suspected breast cancer risk factors. Late age at menarche was associated with increased urinary and serum progestin levels. Increased body weight was associated with decreased progestin levels, even in ovulatory women. Neither weight nor age at menarche was related to estrogen levels. Cigarette smoking was associated with decreased midcycle and luteal-phase estradiol levels. No other factors were associated with differences in any of the hormones measured either midcycle or during the luteal phase, despite good statistical power to detect moderate differences. Sources of individual variability in ovarian steroid levels remain unexplained. These data do not support hypotheses that breast cancer risk factors act through an effect on ovarian hormones during the middle reproductive years.

Adult↗
PubMed1996

Asbestos exposure and ovarian fiber burden.

Epidemiologic studies suggest increased risk of epithelial ovarian cancer in female asbestos workers and increased risk of malignancy in general in household contacts of asbestos workers. Ovaries were studied from 13 women with household contact with men with documented asbestos exposure and from 17 women undergoing incidental oophorectomy. Ovarian tissue was examined by analytic electron microscopy. Significant asbestos fiber burdens were detected in 9 out of 13 women with household asbestos exposure (69.2%), and in 6 out of 17 women who gave no exposure history (35%). Three exposed women had asbestos counts over 1 million fibers per gram wet weight (23%), but only 1/17 women without an exposure history had a count that high (6%). Although asbestos has been documented as a contaminant of some older cosmetic talc preparations, the chrysotile and crocidolite types of asbestos we detected are more indicative of background and/or occupational exposure. This study demonstrates that asbestos can reach the ovary. Although the number of subjects is small, asbestos appears to be present in ovarian tissue more frequently and in higher amounts in women with a documentable exposure history.

Asbestos↗
PubMed1996

The relationship between perineal cosmetic talc usage and ovarian talc particle burden.

OBJECTIVE: Epidemiologic studies support the hypothesis of a dose-related risk of epithelial ovarian cancer with perineal talc usage exposure. Frequency and duration of talc has not been previously correlated with ovarian talc content. STUDY DESIGN: Ovaries were studied from 24 women undergoing incidental oophorectomy who were interviewed regarding talc usage. Twelve subjects reported frequent perineal talc applications; the twelve controls reported no use. Ovarian tissue blocks were digested and analyzed by polarized light microscopy and analytic electron microscopy to identify and quantify talc. RESULTS: Talc was identified in all 24 cases by either light or electron microscopy. Talc particle counts were completely unrelated to reported levels of perineal talc exposure. CONCLUSIONS: The detection of talc in all ovaries demonstrates that it can reach the upper genital tract. Widespread exposure to talc during diapering may contribute to the ubiquitous presence of talc in ovarian tissue.

Adult↗
PubMed1996

Ovarian cancer.

Ovarian cancer incidence rates are highest and stable in white populations; in Asia previously low incidence rates may be increasing. Most cases present with disseminated disease, and mortality rates remain high despite the use of aggressive polychemotherapy. Mortality among younger women has decreased, which has been attributed to widespread use of oral contraceptives. Studies consistently show a protective effect of oral contraceptives that increases with duration of use; no dose effect has been identified to date. Risk decreases substantially with increasing numbers of pregnancies; periods of lactation are relatively less protective. Periods of oral contraceptive use are less protective than equal periods of pregnancy. These factors may protect against ovarian cancer due to inhibition of ovulation or due to suppression of another aspect of ovarian function. Hysterectomy and tubal ligation are both protective, perhaps by preventing the ascent of environmental carcinogens that are as yet unidentified. A positive family history substantially increases risk; mutations in the BRCA1 gene may be responsible for about 5% of cases. No other exposures have been consistently associated with disease risk. Whether risk is modified by ovarian damage mediated by dietary galactose is being evaluated; studies to date have conflicting results. The effect of infertility and its treatments on ovarian cancer risk is controversial; two studies suggest that infertility treatments increase risk.

Female↗
PubMed1996

Depot medroxyprogesterone acetate contraception. Metabolic parameters and mood changes.

This review summarizes the existing literature regarding metabolic parameters and mood changes in women using depot medroxyprogesterone acetate (DMPA). MEDLINE and additional bibliographic sources were searched to identify English-language articles describing clinical trials and cross-sectional studies of DMPA published during the last 20 years. DMPA has little or no effect on glucose tolerance, but insulin levels may increase. An increase in low-density lipoprotein cholesterol and a decrease in high-density lipoprotein cholesterol have been observed in cross-sectional and longitudinal studies; however, there are no data to indicate whether the observed lipid alterations lead to adverse clinical events. There is some evidence suggesting decreased bone density in long-term DMPA users. Longitudinal data regarding bone density changes are needed to assess changes both during and after use. Most cross-sectional and longitudinal studies show increased mean weight or weight gain in DMPA users. Controlled studies of weight change that evaluate subgroups and effects of confounding variables are also needed to provide constructive advice to patients. Data regarding depression or mood changes in DMPA users are scanty and do not support a causal relationship between use of this contraceptive and affective disorders. For all of these parameters, case reports indicating adverse clinical outcomes are nearly absent from the literature despite widespread long-term international use of DMPA.

Affect↗
PubMed1995

Depression in users of depo-medroxyprogesterone acetate.

Prevalence of depression is high among poor, young, Hispanic inner city women. Depot-medroxyprogesterone acetate (DMPA) is a popular contraceptive choice in this group. DMPA labelling suggests that depression may worsen with use. In order to identify any association of DMPA use with worsening depression, we surveyed an English-speaking subset of DMPA users in a Title-X funded family planning clinic. Eighty women completed the CES-D scale on two occasions: once about four weeks after a DMPA injection when the subject would have been exposed to the highest blood levels, and once immediately prior to an injection when recent blood levels of the drug would be somewhat lower (or absent preceding the first injection). The median CES-D score was 14. The scores were not related to timing of the test (pre- or post-injection). The depression scores were somewhat higher among those women receiving their first DMPA injection during the study period (i.e., unexposed women) and among those women who had received four or more injections. Scores were unrelated to age or parity, but were somewhat higher in women who reported fewer years of education or a recent adverse pregnancy outcome. These data provide little evidence of increasing depression with long-term use of DMPA and no evidence of a short-term effect of dose (within the contraceptive range) on mood. Women at risk of depression should not be denied DMPA as a contraceptive choice.

Adolescent↗
PubMed1994

Current status of screening for ovarian cancer.

Many women are requesting tests to screen for ovarian cancer. Extensive media coverage of this disease probably stimulates demand for these tests. Published reports from ovarian cancer screening programs have not yet demonstrated any benefit of screening. Existing programs have largely reported only the number of cancers detected during a single round of screening. Among 36,000 screened subjects reported on, 29 ovarian cancers have been detected; 12 of these were Stage I. All programs report that considerable surgery for benign disease has occurred among subjects. Follow-up, thus far, has been brief, and no control groups are included. Several new screening programs include only women with a family history of ovarian cancer. These programs also lack control groups and have little follow-up to date. A prospective, randomized trial of ovarian cancer screening to include 74,000 postmenopausal women has been initiated by NCI as part of the PLCO trial. Results from this trial should quantify the risks and benefits of screening; however, results will not be available for many years. Until there are data to show that screening reduces mortality from ovarian cancer, clinicians should not suggest these tests are beneficial, and they should avoid performing these tests outside of research protocols.

CA-125 Antigen↗
PubMed1994

Use of Norplant implants in a New York City clinic population.

Two-hundred-eight women attending family planning clinics in New York City who received the Norplant contraceptive system during the first sixteen months of Norplant implants insertions were evaluated. Within this clinic population, Norplant implants were a popular contraceptive choice and were removed from 64 of the 208 recipients. Reasons for removal included bleeding, weight gain, and headache, and were consistent with those found in the clinical trials. Prior satisfaction with oral contraceptives did not predict success or failure with Norplant implants. The rate of follow-up visits to the family planning clinics was low. However, evidence exists that these women did not lose contact with the medical center and continued to receive health care.

Adult↗