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Biomedical subjects

I Milsom

Publications and source records attributed to I Milsom.

At least 19 recordsLinked to original sources
PubMed2003

Can ultrasound replace dilation and curettage? A longitudinal evaluation of postmenopausal bleeding and transvaginal sonographic measurement of the endometrium as predictors of endometrial cancer.

OBJECTIVE: The purpose of this study was to evaluate postmenopausal bleeding and transvaginal sonographic measurement of endometrial thickness as predictors of endometrial cancer and atypical hyperplasia in women whose cases were followed for > or =10 years after referral for postmenopausal bleeding. STUDY DESIGN: Women (n = 394) who had postmenopausal bleeding from November 1987 to October 1990 underwent transvaginal sonographic measurement of endometrial thickness and curettage. It was possible to assess the medical records (regarding recurrence of a postmenopausal bleeding, development of endometrial cancer, and death) in 339 of the 394 women (86%) > or =10 years after referral for postmenopausal bleeding. RESULTS: Thirty-nine of the 339 women (11.5%) had endometrial cancer, and 5 women (1.5%) had atypical hyperplasia. The relative risk of endometrial cancer in women who were referred for postmenopausal bleeding was 63.9 (95% CI, 46.0-88.8); the corresponding relative risk for endometrial cancer and atypical hyperplasia together was 72.1 (95% CI, 52.8-98.5) compared with women of the same age from the general population of the same region of Sweden. No woman with an endometrial thickness of < or =4 mm was diagnosed as having endometrial cancer. The relative risk of the development of endometrial cancer in women with an endometrial thickness of >4 mm was 44.5 (95% CI, 6.5-320.1) compared with women with an endometrial thickness of < or =4 mm. The reliability of endometrial thickness (cutoff value, < or =4 mm) as a diagnostic test for endometrial cancer was assessed: Sensitivity, 100%; specificity, 60%; positive predictive value, 25%; and negative predictive value, 100%. The incidence of endometrial cancer or atypical hyperplasia in women with an intact uterus whose cases had been followed for > or =10 years was 5.8% (15/257 women) compared with 22.7% (15/66 women) in women who had < or =1 episode of recurrent bleeding. No endometrial cancer was diagnosed in women with a recurrent postmenopausal bleeding who had an endometrial thickness of < or =4 mm at the initial scan. CONCLUSION: Postmenopausal bleeding incurs a 64-fold increase risk for endometrial cancer. There was no increased risk of endometrial cancer or atypia in women who did not have recurrent bleeding, whereas women with recurrent bleeding were a high-risk group. No endometrial cancer was missed when endometrial thickness measurement (cutoff value, < or =4 mm) was used, even if the women were followed up for < or =10 years. We conclude that transvaginal sonographic scanning is an excellent tool for the determination of whether further investigation with curettage or some form of endometrial biopsy is necessary

Aged↗
PubMed2002

Knowledge about the prevention of sexually transmitted diseases: a longitudinal study of young women from 16-23 years of age.

OBJECTIVES: To describe knowledge and attitudes regarding sexually transmitted diseases (STD) in the same women followed longitudinally for 7 years from teenage years to early adulthood, and to relate the findings to sexual behaviour. METHODS: A face to face interview and a questionnaire were completed by 79 young women when they were 16, 18, and 23 years old. RESULTS: The questionnaire, testing knowledge about the mode of transmission and prevention of STD, gave a total score of correct answers varying between 44% and 64%, with less knowledge about human papilloma (HPV) and herpes viruses than about chlamydia. Awareness of the possibility of asymptomatic transmission was low. The highest scores were obtained at the age of 18 years. Experience of many partners, a history of STD, smoking, and more frequent use of alcohol were associated with a higher level of knowledge. CONCLUSIONS: Knowledge was fairly good and consistent, but was more often incorrect regarding viral infections and the possibility of asymptomatic transmission, and in total did not ensure an adequate protective behaviour. A higher level of knowledge was associated with a more risky behaviour, indicating that information was best received by those who could identify with the problem.

Adolescent↗
PubMed2001

Knowledge, attitudes and management strategies in Scandinavia concerning hormone replacement therapy: a comparison between gynecologists in Denmark, Norway and Sweden.

OBJECTIVES: To describe and compare attitudes, knowledge and management strategies concerning the prescription of hormone replacement therapy (HRT) between gynecologists from three Scandinavian countries. DESIGN AND METHODS: In a cross-sectional study gynecologists in Denmark (n=386), Norway (n=475) and Sweden (n=1323) were invited by letter to complete and return an enclosed questionnaire. Then 1653 of the 2184 (76%) contacted gynecologists completed and returned the questionnaire. RESULTS: of the 1653 Scandinavian gynecologists, 42% offered HRT to all women provided there was no contraindication, while 58% recommended HRT to selected women after considering the advantages and disadvantages of HRT. In Norway and Sweden, the proportion of gynecologists routinely prescribing HRT for women without contraindications increased with age and in the oldest age group of gynecologists (>55 years) 49 and 56%, respectively, recommended HRT to all women. The gynecologists were unanimous in their choice of the type of HRT for perimenopausal women as 94% preferred cyclical or sequential combined (estrogen/progestogen) treatment or estrogen monotherapy (orally or transdermally) for hysterectomized women (95%). For postmenopausal women, 75% of the gynecologists offered continuous combined HRT while cyclical combined therapy was chosen by 15% of the gynecologists. No significant differences were found between physicians in the three countries regarding indications and contraindications to HRT. CONCLUSIONS: Scandinavian gynecologists are generally well informed concerning HRT and liberally recommend HRT for women without contraindications.

Adult↗
PubMed2001

Young women requesting emergency contraception are, despite contraceptive counseling, a high risk group for new unintended pregnancies.

Since its introduction in Sweden in 1994, emergency contraception has become a welcome addition to the campaign against unwanted pregnancy. In addition to an unplanned pregnancy, unprotected sexual intercourse may also involve the risk of contracting sexually transmitted diseases (STD). The aim of this study was to assess the short- and long-term risk of unintended pregnancy and to determine the frequency of chlamydia infections in women receiving emergency contraception. Between September 1998 and February 1999 young women aged 15-25 years had the opportunity to obtain emergency contraception (Yuzpe method) at a youth clinic in the city of Orebro where the opening hours were extended to include Saturdays and Sundays. A follow-up visit 3 weeks after treatment, which included contraceptive counseling, was offered to all participants. At both visits, a pregnancy test and a chlamydia test were performed, and the women completed a questionnaire. After the initial visit, the young women where monitored for new pregnancies during the following 12 months. One pregnancy occurred in the 134 young women who received emergency contraception during the study period. None of the women had a positive chlamydia test. Of those requesting emergency contraception, 54% did so because no contraception was used, 32% because of a ruptured condom, 11% because of missed oral contraceptives (OC), and 5% had mixed reasons. At long-term follow-up 1 year after the initial visit, 10 of the 134 young women had experienced an unplanned pregnancy that terminated in legal abortion in 9 women. All these women had either started and terminated OC or had never commenced the prescribed OC. Young women who request emergency contraception are, despite a planned follow-up with contraceptive counseling, a high risk group for new unintended pregnancies. In Sweden they do not seem to be a high risk group for STD.

Adolescent↗
PubMed2001

Incontinence aids in Sweden: users and costs.

OBJECTIVE: To study age- and sex-specific use and costs of incontinence aids distributed free of charge in Sweden. SUBJECTS AND METHODS: The study was conducted in the county of Jämtland, Sweden (132,000 inhabitants). The use and cost of incontinence aids for people living in their homes and the total cost of incontinence aids for residents of special accommodation (e.g. nursing homes, homes for the elderly and sheltered housing) was obtained from a central database constructed for the purpose. Individual usage of incontinence aids by those in special accommodation was studied in two districts of Jämtland, representing 18% of the population. RESULTS: Free incontinence products were used by 6.4% of all women and 2.4% of all men in the county. There was a sharp increase in usage from the age of 75 years. Of the users, 21% lived in special accommodation. If the data from Jämtland are extrapolated nationally, then 274,000 women and 93,000 men in Sweden (total population 8.8 million) are using free incontinence products. The total cost of incontinence aids for Jämtland during 1999 was 15.4 million Swedish krona (SK), and those in special accommodation accounted for 46% of these costs. This corresponds to an estimated total cost in Sweden of approximately 925 million SK. Although 75% of the users were women, women only contributed 61% of the total costs. The mean annual cost of incontinence aids for an incontinent man was twice that of an incontinent woman. More than half of the costs were attributable to those aged >or=80 years. CONCLUSIONS: The estimated national costs of free incontinence aids accounts for 0.5% of the total costs of Swedish healthcare, including the care and nursing of older and disabled people, and for 0.05% of the gross national product.

Adolescent↗
PubMed2001

How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study.

OBJECTIVE: To determine the prevalence of chronic and debilitating symptoms of the overactive bladder, defined here as the presence of chronic frequency, urgency and urge incontinence (either alone or in any combination), and presumed to be caused by involuntary detrusor contractions. Subjects and methods Data were collected using a population-based survey (conducted by telephone or direct interview) of men and women aged >/= 40 years, selected from the general population in France, Germany, Italy, Spain, Sweden and the United Kingdom, using a random stratified approach. The main outcome measures were: prevalence of urinary frequency (> 8 micturitions/24 h), urgency and urge incontinence; the proportion of participants who had sought medical advice for symptoms of an overactive bladder; and current or previous therapy received for these symptoms. RESULTS: In all, 16 776 interviews were conducted in the six European countries. The overall prevalence of overactive bladder symptoms in individuals aged >/= 40 years was 16.6%. Frequency (85%) was the most commonly reported symptom, followed by urgency (54%) and urge incontinence (36%). The prevalence of overactive bladder symptoms increased with advancing age. Overall, 60% of respondents with symptoms had consulted a doctor but only 27% were currently receiving treatment. Conclusion Symptoms of an overactive bladder, of which frequency and urgency are as bothersome as urge incontinence, are highly prevalent in the general population. However, only a few affected individuals currently receive treatment. Taken together, such findings indicate that there is considerable scope for improvement in terms of how physicians diagnose and treat this condition.

Activities of Daily Living↗
PubMed2001

Factors associated with endometrial thickness and uterine size in a random sample of postmenopausal women.

OBJECTIVE: The objective of this study was to investigate factors possibly associated with endometrial thickness and uterine size in a random sample of postmenopausal women. STUDY DESIGN: A random sample (n = 1000) of the total population of women 45 to 80 years of age, resident in the city of Göteborg, was invited to attend for a transvaginal sonography examination. Eight hundred twenty-seven women accepted the invitation and underwent a gynecologic and a transvaginal sonography examination with measurement of endometrial thickness and uterine size. The women's weight and height were measured and a blood sample for analysis of serum estradiol and follicle-stimulating hormone was taken. The women also provided information regarding previous medical and gynecologic history, possible medication, and smoking habits. RESULTS: Five hundred fifty-nine women were postmenopausal, and 183 (33%) of the postmenopausal women were taking some form of hormonal substitution. Factors associated with endometrial thickness and uterine size were analyzed by means of univariate and stepwise multiple regression analyses. The current use of hormone replacement therapy was the most important factor associated with both endometrial thickness and all the uterine size parameters studied. The presence of fibroids was also associated with endometrial thickness. Other factors shown to be associated with uterine size were age, parity, smoking, hypertension, and the presence of diabetes mellitus. CONCLUSIONS: Several of the known risk factors for endometrial cancer were shown to be associated with endometrial thickness and uterine size parameters.

Aged↗
PubMed2001

A population based study of Swedish women's opinions about antenatal, delivery and postpartum care.

OBJECTIVE: To investigate the views and experiences of Swedish women regarding antenatal, delivery and postpartum care. STUDY DESIGN: A random sample of women from the birth cohorts 1955, 1959, 1963, 1967 and 1971 resident in the city of Göteborg (n=2880) was invited by letter to complete a questionnaire regarding antenatal, delivery and postpartum care. RESULTS: The overall response rate was 73% and 1130 (54%) of the 2109 responders had given birth to at least one child. Eighty-one percent of parous women answered that checking blood and urine samples, fetal heart rate, and the measurement of fundal height were the most important procedures in antenatal care. A majority had a positive attitude towards the use of electronic fetal heart rate monitoring (parous 85%; nulliparous 84%). Sixty percent of parous women were aware that ultrasound examination was voluntary and a majority (90%) had a positive attitude towards ultrasound scanning. Forty-three percent of parous women wanted antenatal clinics to be open until 8.00 p.m. A minority of both parous (4%) and nulliparous (4%) women were interested in home delivery. There were more parous (33%) than nulliparous (12%) women who expressed no anxiety at all about the next delivery. Seventy-nine percent of the parous women reported that they would like to have a planned visit with a delivery ward midwife before the next delivery. About 80% reported that they would feel very safe if their partners were present at the delivery (nulliparous 79%; parous 84%). Eighty-five percent preferred a single room or a room together with only one other woman in the postnatal ward. Seventy-two percent of the women wanted to stay 72 hours or less in the postpartum ward and 24% thought there had been too many visitors during the postnatal period. Over 80% were very positive towards breast-feeding. Approximately 80% of all women considered regular contractions up to twelve hours to be acceptable before delivery. CONCLUSIONS: This study has provided some useful information about women's opinion regarding antenatal, delivery and postpartum care which may be taken into account when instigating changes in the maternity care system.

Analysis of Variance↗
PubMed2000

[Fertility and contraception in women older than 40 years].

Women in their later reproductive years constitute a large proportion of contraceptive users. Although increasing age is accompanied by a general decline in fecundity, each individual needs to know her own risk or possibility of becoming pregnant and when it is safe to stop using contraceptives. Women over 40 need special consideration since pregnancy and childbirth is sometimes associated with higher health risks both for mother and infant. Women over 40 are more likely than younger women to have medical problems, menstrual disorders and previous experience that may affect their choice and use of contraceptive methods. Recommendations for counselling, health screening and choice of contraceptive method in women in their later reproductive years are given.

Adult↗
PubMed2000

A longitudinal cohort study of elderly women with urinary tract infections.

AIMS: the prevalence of urinary tract infections (UTI), urinary incontinence (UI), estrogen-use and overall mortality in a cohort of elderly women who had been treated for UTI in 1985-86 was re-assessed 10 years later. MATERIAL AND METHODS: a random sample of 6000 women from the birth cohorts 1900, 1905, 1910, 1915 and 1920 were invited in 1986 to complete a questionnaire about UTI, UI and estrogen use (response rate 70%; n = 4206). Treatment with antibiotics for UTI during 1985-86 was reported by 688 (17%) women. In 1995 a similar questionnaire was sent to the women from this group who were still alive (n = 434). Mortality in the women with a history of UTI was compared with an aged-matched control group of women who did not have UTI during 1985-86. RESULTS: the questionnaire was completed and returned by 361 (83%) women. Treatment for at least one UTI during the last 9 years was reported by 219 (61%) women. The number of episodes varied: 35% had one to two UTI, 28% had three to four UTI, 27% five to ten UTI and 10% had had more than 10 UTI. In 1986, the prevalence of UI was higher in women with a history of UTI than in the total population sample (30 vs. 17%; P < 0.001). The prevalence of UI had increased from 30% in 1986 to 33% in 1995 (P < 0.05). Mortality in the women with a history of UTI was higher than in the aged-matched control group (37 vs. 28%; P < 0.001). A total of 162 (45%) women had received estrogen therapy at some time after the age of 60 years and 140 (39%) reported that they were currently taking low potency estrogens. CONCLUSION: elderly women with a history of UTI had a continued high occurrence of UTI and UI, and overall mortality was higher in these women than in an age-matched control group of women from the total population.

Age Factors↗
PubMed2000

Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding: is it always necessary to perform an endometrial biopsy?

OBJECTIVE: This study was undertaken to evaluate whether it was possible to abstain from performing an endometrial biopsy when endometrial thickness according to transvaginal ultrasonography was </=4 mm in women with postmenopausal bleeding or irregular bleeding during hormone replacement therapy. STUDY DESIGN: Transvaginal ultrasonography was performed in 361 women aged >/=50 years who were referred because of postmenopausal bleeding or irregular bleeding during hormone replacement therapy. If endometrial thickness was </=4 mm, a Papanicolaou cervical smear was performed and the woman was reexamined with transvaginal ultrasonography after 4 and 12 months. Subjects were also instructed to return if they had recurrent bleeding, in which case transvaginal ultrasonography was performed and an endometrial biopsy specimen was obtained. Women with an endometrial thickness >/=5 mm underwent either curettage or endometrial biopsy. RESULTS: One hundred sixty-three women had an endometrial thickness </=4 mm. In this group one endometrial cancer that was missed by ultrasonography was diagnosed by cervical cytologic examination and two adnexal malignancies were diagnosed by ultrasonography. Endometrial malignancy was diagnosed in 0.6% of the women with an endometrial thickness </=4 mm. Endometrial biopsy was performed because of recurrent bleeding in 6.1% of cases and because of endometrial thickening in 8.1%. No cancer or hyperplasia was subsequently diagnosed among the women with an endometrial thickness </=4 mm. Endometrial cancer was diagnosed in 18.7% of the women with an endometrial thickness >/=5 mm. The corresponding figure when atypical hyperplasia and endometrial metastases were included was 20. 2%. CONCLUSION: If the false-negative rate of endometrial biopsy techniques is taken into account, then the combination of transvaginal ultrasonography and cervical cytologic examination is an adequate form of management for women with postmenopausal bleeding or irregular bleeding during hormone replacement therapy as long as endometrial thickness is </=4 mm. A randomized prospective study is necessary to verify this finding.

Biopsy↗
PubMed2000

Acute effects of transdermal estrogen in postmenopausal women with coronary artery disease. Using a clinically relevant estrogen dose and concurrent antianginal therapy.

In the present study the acute anti-ischemic effect of clinically relevant doses of transdermal estradiol during concurrent antianginal therapy was investigated in 14 postmenopausal women with stable coronary artery disease. Plasma estradiol was significantly increased, but no significant effects on time to angina, time to 1 mm S--T depression, total exercise time, maximum rate-pressure product, maximum S--T depression or maximum workload were found. However, resting diastolic blood pressure was significantly decreased due to estrogen.

Administration, Cutaneous↗
PubMed2000

Prevalence and risk factors for prelabor rupture of the membranes (PROM) at or near-term in an urban Swedish population.

AIMS: To determine the prevalence, recurrence rate and to identify risk factors for prelabor rupture of the membranes (PROM) after 34 completed weeks in an urban Swedish population. METHODS: In a retrospective cohort study a sample of 2880 women aged 25-41 years, resident in the city of Göteborg, was randomly selected from the population register. According to information from the national Medical Birth Register (MBR), 1507 of these 2880 women had given birth 2736 times. 2270 of these deliveries had occurred in hospitals in the city of Göteborg and case records for 2242 of these deliveries were found. The case records were systematically analyzed for the occurrence of PROM and potential risk factors for PROM. 2208 of these deliveries occurred after 34 weeks of gestation. The further analyses were based on these 2208 deliveries. RESULTS: The prevalence of PROM after 34 week of gestation in this urban Swedish population was 12.9% and about 20% of the women in the population had experienced PROM at least once. In the multiple stepwise regression analysis, risk factors for PROM were primiparity, premature contractions, PROM in a previous pregnancy and bleeding in the first trimester. CONCLUSIONS: PROM is a common complication at or near term. The risk factors for PROM found in this representative study are difficult to influence and thus provide no guidance about how pregnancies should be managed to reduce the occurrence of PROM in the future.

Adult↗
PubMed2000

Factors associated with climacteric symptoms and the use of hormone replacement therapy.

BACKGROUND: To investigate factors associated with climacteric symptoms and the use of hormone replacement therapy (HRT). METHODS: A random sample of women aged 46, 50, 54, 58 and 62 years resident in Goteborg, Sweden (n=5,990) were invited by letter to complete a postal questionnaire concerning the menopause and HRT use. RESULTS: The response rate was 76% (n=4,504). Women with a higher education, who exercised regularly and who had regular spare-time activities felt better and had fewer climacteric complaints (p<0.001) compared to lower educated women, women who exercised infrequently and women who had no spare-time activities. Climacteric symptoms were associated with dryness symptoms (dry eyes, skin, hair and mouth), bilateral salpingo-oophorectomy (SOE), use of psychotropical drugs and use of alternative remedies, previous hysterectomy and full-time occupation. Stepwise multiple regression analysis showed significant correlations between vasomotor symptoms and various dryness symptoms, no menstrual periods and use of alternative remedies. Current HRT-users (13%) had used estrogens for 4.0 years and past users (14%) for 4.3 years. A correlation (p<0.005) was found between HRT use and previous use of contraceptive pills, use of alternative remedies and hysterectomy. Education, occupation and the frequency of exercise did not influence the prevalence of HRT use. CONCLUSIONS: This study has shown that the experience of climacteric symptoms and well-being is associated with many different factors. Women with a higher education and those who exercised regularly were more often symptom-free. HRT use was associated with previous use of contraceptive pills, use of alternative remedies and hysterectomy.

Climacteric↗