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J Wactawski-Wende

Publications and source records attributed to J Wactawski-Wende.

13 recordsLinked to original sources
PubMed2001

Risk factors for uterine fibroids among women undergoing tubal sterilization.

Uterine leiomyomas are reported to be the most common benign gynecologic tumors affecting premenopausal women, and they are often associated with considerable morbidity. The purpose of this study was to identify risk factors for uterine fibroids among women undergoing tubal sterilization. Cases comprised women aged 17-44 years whose uterine fibroids were first visualized at the time of tubal sterilization (1978-1979 or 1985-1987) or who reported a history of uterine fibroids (n = 317). Controls were randomly selected from women with no laparoscopic evidence of or history of fibroids (n = 1,268). Adjusted odds ratios were estimated using unconditional logistic regression separately for White (n = 1,235) and African-American (n = 350) women. Risk factors for White women included: age 40-44 years (odds ratio (OR) = 6.3; 95% confidence interval (CI): 3.5, 11.6), > or =5 years since last delivery (OR = 1.9; 95% CI: 1.1, 3.1), lifetime cigarette smoking of > or =1 pack/day (OR = 1.6; 95% CI: 1.1, 2.3), menstrual cycle length of >30 days (OR = 1.6; 95% CI: 1.1, 3.3), and menstrual bleeding for > or =6 days (OR = 1.4; 95% CI: 1.0, 2.0). Parous women were at reduced risk compared with nulliparous women (OR = 0.2; 95% CI: 0.1, 0.3). Advancing age was the only significant risk factor for African-American women (ages 40-44 years, OR = 27.5; 95% CI: 5.6, 83.6). Current oral contraceptive use and elective abortion were not associated with fibroids.

Adolescent↗
PubMed2001

Periodontal diseases and osteoporosis: association and mechanisms.

There is increasing evidence that osteoporosis, and the underlying loss of bone mass characteristic of this disease, is associated with periodontal disease and tooth loss. Periodontitis has long been defined as an infection-mediated destruction of the alveolar bone and soft tissue attachment to the tooth, responsible for most tooth loss in adult populations. Current evidence including several prospective studies supports an association of osteoporosis with the onset and progression of periodontal disease in humans. The majority of studies have shown low bone mass to be independently associated with loss of alveolar crestal height and tooth loss. However studies that focus on the relation of clinical attachment loss and osteoporosis are less consistent. To date, the majority of studies on the relationship between periodontal disease and osteoporosis have been hindered by small sample sizes, limited control of other potential confounding factors, varying definitions of both periodontal disease and osteoporosis, and few prospective studies where the temporality of the association can be established. Potential mechanisms by which host factors may influence onset and progression of periodontal disease directly or indirectly include underlying low bone density in the oral cavity, bone loss as an inflammatory response to infection, genetic susceptibility, and shared exposure to risk factors. Systemic loss of bone density in osteoporosis, including that of the oral cavity, may provide a host system that is increasingly susceptible to infectious destruction of periodontal tissue. Studies have provided evidence that hormones, heredity, and other host factors influence periodontal disease incidence and severity. Both periodontal disease and osteoporosis are serious public-health concerns in the United States. Prevalence of both osteoporosis and tooth loss increase with advancing age in both women and men. Understanding the association between these common diseases and the mechanisms underlying those associations will aid health professionals to provide improved means to prevent, diagnose, and treat these very common diseases. This paper reviews the current evidence on the association between periodontal disease and osteoporosis.

Adult↗
PubMed2000

The relationship between bone mineral density and periodontitis in postmenopausal women.

BACKGROUND: Systemic bone loss has been proposed as a risk factor for periodontal disease; however, the relationship between these two diseases is still not clear. The objective of this study was to assess the relationship between systemic bone mineral density and periodontal disease, controlling for known confounders. METHODS: The study population included 70 postmenopausal Caucasian women aged 51 to 78 (mean +/- SD: 62.10 +/- 7.1 years). Skeletal bone mineral density (BMD) was assessed by dual energy x-ray absorptiometry (DXA) at the neck, trochanter, intertrochanter, Ward's triangle, and total regions of the femur, and from the anterior-posterior view of the lumbar spine. Periodontal disease severity was represented by clinical attachment loss (CAL) and interproximal alveolar bone loss (ABL). Other measures of periodontal status included probing depth (PD), supragingival plaque, gingival bleeding on probing, and calculus. DXA and oral examinations were performed by calibrated examiners. Partial correlation coefficients (r) were obtained from multiple linear regression analysis adjusting for age, age at menopause, estrogen supplementation, cigarette smoking, body mass index, and supragingival plaque. RESULTS: Mean ABL was significantly correlated with BMD of the trochanter (r =- 0.27), Ward's triangle (r = -0.26), and total regions of the femur (r = -0.25). Mean CAL appeared to be related to BMD consistently at all regions of the skeleton, although the association did not reach statistical significance. CONCLUSIONS: We can conclude that skeletal BMD is related to interproximal alveolar bone loss and, to a lesser extent, to clinical attachment loss, implicating postmenopausal osteopenia as a risk indicator for periodontal disease in postmenopausal Caucasian women.

Absorptiometry, Photon↗
PubMed1998

Asymptomatic bacteriuria in human immunodeficiency (HIV)-infected women.

Objective: To determine the prevalence of bacteriuria in HIV- infected women versus healthy non-HIV-infected controls.Methods: A prospective cohort study was undertaken between January 1996 and March 1997. One hundred nineteen ambulatory, premenopausal women from the Women's HIV Clinic and 191 similar non-infected Gynecology Clinic controls were recruited. Information recorded from the medical record and patient questionnaire included: age, prior history of UTI, antibiotic usage, sexual frequency, diaphragm/spermicide use, and CD4 count. A clean catch urine culture was collected on all patients. Statistical analysis was via SPSSPC.Results: The mean age of HIV-infected women was 33 vs 26 for non-infected. The mean CD4 count was 341. A prior history of UTI (mean # per lifetime) was significantly higher for HIV women (2.8) vs controls (1.8) [P =.01]. The mean weekly sexual frequency was significantly higher in HIV-negative (2.1) vs HIV-infected (1.2) [P <.001]. Diaphragm/spermicidal use was uncommon but equal in both groups. The prevalence of any growth of uropathogens (>10(2) cfu/mL) was 30% in the HIV-infected vs 47% in controls. The percentage of asymptomatic bacteriuria for each range of uropathogen titer (cfu/mL) in urine was:Chronic antibiotic usage (39% of HIV-infected vs 4% of controls) was associated with a decreased prevalence of bacteriuria, but there was not a significant difference in prevalence of bacteriuria between groups. Regardless of titer ranges of uropathogens evaluated, the prevalence of bacteriuria was not different between CD4 counts of <200 and >/=200. As compared to controls, HIV-infected individuals demonstrated shifts toward nosocomial pathogens: Enterococcus, S. aureus and non-E. coli gram-negative rods.Conclusion: The prevalence of bacteriuria was not greater in HIV-infected women versus non-HIV-infected women versus HIV non-infected controls and was not significantly affected by antibiotic usage or CD4 count. Uropathogens responsible for asymptomatic bacteriuria in HIV-infected women are different from "healthy" controls and are more representative of nosocomial flora.

Journal Article↗
PubMed1998

Single-dose antibiotic prophylaxis during cesarean section.

Objective: To compare single-dose antibiotic prophylaxis (cefotetan 1 g vs cefoxitin 2 g) in various subpopulations based upon risk factors for postsurgical infection following cesarean section.Methods: Patients undergoing cesarean section from April 1993 through March 1994 were included in a retrospective analysis if either of the above antibiotics were administered, surgery was non-emergent, gestational age was less than 32 weeks, absence of fever or prior antibiotics therapy within 72 hours, and no history of organ transplantation or HIV. Cases classified as high risk for infection: IDDM, obesity, autoimmune disease, sickle cell disease, or corticosteroid use. Cases classified as high risk for endometritis (any 2 factors): labor >12 hours, >4 vaginal examinations, ruptured membranes >9 hours, and internal fetal monitor. Cases were separated into 4 groups: elective vs non-elective, low vs high surgical risk. A chi(2) analysis was used to test for differences in infection rates between groups (P <.05).Results: Of 1383 cesarean sections, 385 met criteria for inclusion. Non-elective cases accounted for 77% of cases. Postsurgical infection rate was greater in non-elective cases, 7.4%, vs elective cases, 3.0% (P =.056) as was the rate of endometritis (3.2% vs 1.2%, P =.185). No differences were noted based on antibiotic regimen. Postsurgical infection rate was greater for 28 cases at high risk for both surgical infection and endometritis (17.9%) when compared to all 357 other cases (4.5%), P =.003. No difference was noted for endometritis. Of the 28 cases 28.6% of patients treated with cefoxitin and 7.1% of cases treated with cefotetan developed postsurgical infection (P =.13).Conclusion: Overall cefoxitin and cefotetan provided equivalent clinical outcome. A small subset of patients with multiple risk factors for infection may benefit from cefotetan.

Journal Article↗
PubMed1998

Chorioamnionitis: the association between clinical and histological diagnosis.

Objective: To determine the association between clinical and histological diagnoses of chorioamnionitis.Methods: A retrospective 9-year review of hospital records for all perinatal deaths (N = 804) occurring at a Western New York regional perinatal center between 1988 and 1996 was conducted. Information concerning clinical indicators of chorioamnionitis were recorded including: maternal fever, leukocytosis, uterine tenderness, foul smelling discharge, and fetal tachycardia. Histological examination of the placenta was conducted in 797 of 804 perinatal deaths and staged by a standardized method. Type and number of clinical signs and symptoms were correlated with severity of histologic grade to determine their relation.Results: Chorioamnionitis was diagnosed either clinically or histologically in 243 (30.5%) of 797 perinatal deaths. Of these, 72 cases (23.5%) occurred in the 307 fetal deaths and 171 (34.9%) occurred in the 490 neonatal deaths. Five cases were diagnosed only on autopsy. In 51 of 243 cases (21%) there was histologic confirmation of chorioamnionitis without any clinical indicators present. In 13 of 243 cases (5.4%) there were 1 or more clinical indicators of chorioamnionitis without histologic confirmation. Sensitivity and specificity for 1 or more clinical indicators was 77.8% and 97.7%, respectively.Conclusion: Chorioamnionitis was present in 30.5% of perinatal deaths in this cohort. Identification of one or more clinical signs or symptoms was found to be both a sensitive and specific screening method for a presumptive diagnosis of chorioamnionitis when using histologic confirmation as the gold standard.

Journal Article↗
PubMed1996

The role of osteopenia in oral bone loss and periodontal disease.

Osteoporosis and periodontitis are diseases which affect a large number of women and men, with incidence increasing with advancing age. Osteopenia is a reduction in bone mass due to an imbalance between bone resorption and formation, favoring resorption, resulting in demineralization and leading to osteoporosis. Osteoporosis is a disease characterized by low bone mass and fragility and a consequent increase in fracture risk. Periodontitis is characterized by inflammation of the supporting tissues of the teeth, resulting in resorption of the alveolar bone as well as loss of the soft tissue attachment to the tooth and is a major cause of tooth loss and edentulousness in adults. The relationship of osteopenia to oral bone loss and periodontal disease has been addressed in a limited number of studies. A review of current knowledge regarding this relationship is presented. Interpretation of the literature is complicated by the variety of methods used to assess osteopenia, oral bone mass, and periodontitis, as well as varying definitions of outcomes of interest. Results of a previously unpublished study are presented which suggest that severity of osteopenia is related to loss of alveolar crestal height and tooth loss in post-menopausal women. The literature on the relationship among these disorders is limited and points to the need for additional studies which thoroughly evaluate the influence of potential confounding factors to further define the relationship between low bone mineral density and periodontal disease in larger populations. Clearer understanding of this relationship may aid health care providers in their efforts to detect and prevent osteoporosis and periodontal disease. Increased dialogue among medical and dental professional will be increasingly important in achieving and maintaining patients' optimal health.

Adult↗
PubMed1994

Chromosome aberrations in lymphocytes from women irradiated for benign and malignant gynecological disease.

Excess leukemias have occurred after partial-body radiotherapy for cervical cancer and benign gynecological disease (BGD). However, the level of risk is nearly the same in both groups, about twofold, despite a tenfold difference in average dose to active bone marrow (8 Gy vs 0.7 Gy, respectively). High-dose cell killing has been postulated as one explanation for this apparent inconsistency. To examine whether chromosome aberration rates observed in lymphocytes many years after exposure might serve as population markers of cancer risk, blood samples were taken from 60 women treated for BGD (34 with radiation) and cytogenetic data compared with previous results from 96 women irradiated for cervical cancer. Remarkably, the rate of stable aberrations, which reflects nonlethal damage in surviving stem cells, was only slightly higher among the cancer patients. Thus the lower-dose regimens to treat benign disorders resulted in much higher aberration yields per unit dose than those for cervical cancer. Assuming that the fraction of cytogenetically aberrant stem cells that survive radiotherapy contributes to the leukemogenic process, these data are then consistent with the epidemiological observations of comparable overall leukemia risks seen in these two irradiated populations. Accordingly, for patient populations given partial-body radiotherapy, stable aberrations at a long time after exposure appear to serve as biomarkers of effective risk rather than as biomarkers of radiation dose received.

Aged↗
PubMed1994

Bacterial interference in nasopharyngeal bacterial flora of otitis-prone and non-otitis-prone children.

The quantitative bacteriology of the adenoid was studied in 34 otitis-prone and 25 non-otitis prone children. Viridans streptococci appeared to be the predominant normal flora in children who are non-otitis prone. There was a significant decrease in viridans streptococci in the otitis-prone child compared to the non-otitis-prone child. There was a significant increase in nontypable Haemophilus influenzae (NTHI) in the otitis-prone child. The mechanisms responsible for this alteration of the microecology of bacteria of the nasopharynx may be related, in part, to bacterial interference or to the inappropriate use and over-use of antibiotics. In vitro inhibition of growth of NTHI was demonstrated with selective strains of viridans streptococci. A preliminary analysis of an inhibitory strain and a non-inhibitory strain of viridans streptococci are presented and their biochemical profiles and antibiotic sensitivities were entirely different. A possible mechanism for the inhibition on NTHI by viridans streptococci has been suggested. This mechanism may be related to an alteration of pH in the growth media or the possibility of the utilization of nutrients required for growth of NTHI.

Adenoids↗
PubMed1993

Micro-ecology of the nasopharyngeal bacterial flora in otitis-prone and non-otitis-prone children.

The quantitative bacteriology of the adenoid was studied in otitis-prone and non-otitis-prone children. alpha-hemolytic Streptococci (Viridans Streptococci) appeared to be predominant normal flora in the healthy nasopharynx. There was a decrease in alpha-hemolytic Streptococci in the otitis-prone child compared to the non-otitis-prone child. Concomitantly, there appears to be an increase in both nontypable Haemophilus influenzae (NTHI) and S. pneumoniae in the nasopharyngeal flora in the otitis-prone child. The mechanisms responsible for this alteration of the micro-ecology of bacteria of the nasopharynx may be related, in part, to factors that alter mucociliary function. These factors could be viral infection, allergy, local and systemic immunological deficiency and the indiscriminate use of antibiotics. An understanding of the relationship between the normal flora and the potential pathogens may be important in the understanding of both the pathogenesis of otitis media (OM) and possibly the treatment of this disease entity.

Child, Preschool↗
PubMed1993

Leukemia, lymphoma, and multiple myeloma after pelvic radiotherapy for benign disease.

The relationship between exposure to sparsely ionizing radiation and mortality due to cancers of hematopoietic and lymphopoietic tissues was studied among 12,955 women treated for benign gynecological disorders at any of 17 hospitals in New England or New York State and followed for an average of 25 years; 9770 women were treated by radiation (intracavitary 226Ra, external-beam X rays), while 3185 were treated by other methods, including curettage, surgery, and hormones. The average age at treatment was 46.5 years, and the mean dose to active bone marrow among irradiated women was 119 cGy. Forty deaths due to acute, myelocytic, or monocytic leukemia were observed among irradiated women. This number was 70% higher than expected based on U.S. mortality rates [standardized mortality ratio (SMR) = 1.7; 90% confidence interval (CI) 1.3-2.3]. A deficit was recorded among nonirradiated women, based on three observed deaths (SMR = 0.5; 90% CI 0.1-1.2). A well-defined gradient in the SMR with dose among exposed women was not detected. The SMR was highest within 5 years after irradiation but remained elevated even after 30 years. The temporal pattern differed by subtype of leukemia: excess mortality due to chronic myelocytic leukemia occurred almost exclusively within the first 15 years, whereas the SMR for acute leukemia, though also elevated, varied little over time. Cancers of lymphoreticular tissue occurred more often than expected based on U.S. mortality rates, but not appreciably differently for irradiated and nonirradiated women. There was little or no evidence of effects attributable to radiotherapy for chronic lymphocytic leukemia [relative risk (RR) = 1.1; 90% CI 0.5-3.0], Hodgkin's disease (RR = 0.9; 90% CI 0.3-3.2), non-Hodgkin's lymphoma (RR = 0.9; 90% CI 0.6-1.6), or multiple myeloma (RR = 0.6; 90% CI 0.3-1.4). These results corroborate previous findings indicating that acute and myelocytic leukemias are the most prominent malignancies after exposure to sparsely ionizing radiation, occurring in excess shortly after irradiation, and that lymphomas are either not caused by radiation or are induced only rarely.

Bone Marrow↗
PubMedDate not supplied

Serum estrogen and androgen levels following treatment for cervical cancer.

Endogenous sex hormones seem to influence the risk of several common and debilitating diseases. With a view toward better understanding the effects of surgical removal of the ovaries and high-dose pelvic radiotherapy on plasma sex hormone levels, we measured estrogen and androgen concentrations cross-sectionally among 147 women who had been treated for cervical cancer 0.3-18.5 years previously. Pelvic radiotherapy (mean dose to ovaries, 50 Gy) and bilateral ovariectomy were associated with similarly reduced hormone concentrations relative to levels among nonirradiated women with intact ovaries, most of whom had had early-stage disease and were treated by hysterectomy. There was little evidence that radiotherapy in addition to ovariectomy further lowered concentrations below levels associated with ovariectomy alone, such as might be expected if radiation was suppressing adrenal endocrine function. Among women age 50 years or older at the time of blood drawing, the removal or irradiation of the ovaries was associated with approximately 45% lower concentrations of estradiol (mean ratio [MR], 0.55; 95% confidence interval [CI], 0.32-0.95) and testosterone (MR, 0.57; 95% CI, 0.32-0.99), and 25-30% lower concentrations of estrone (MR, 0.69; 95% CI, 0.44-1.09) and androstenedione (MR, 0.76; 95% CI, 0.47-1.23), relative to the hysterectomy-only group. Among women younger than 50, ovariectomy and radiotherapy, alone or in combination, were associated with 83% lower estradiol concentrations (MR, 0.17; 95% CI, 0.09-0.31), 46% lower estrone concentrations (MR, 0.54; 95% CI, 0.37-0.81), 23% lower androstenedione concentrations (MR, 0.77; 95% CI, 0.57-1.04), and 14% lower testosterone levels (MR, 0.86; 95% CI, 0.64-1.15).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗