Biomedical subjects

Robert L Barbieri

Publications and source records attributed to Robert L Barbieri.

25 records · Page 2Linked to original sources

PubMed2004

Population density and teen pregnancy.

OBJECTIVE: The relationship between population density and the percentage of teens who electively terminate their pregnancy was the focus of this study. METHODS: The United States population density was determined for each state and each district of the American College of Obstetricians and Gynecologists (ACOG) from the 2000 US Census. The United States teenage pregnancy statistics for females aged 15 to 19 years in 1999 and 2000 were obtained from the Alan Guttmacher Institute. The main measures were the correlation between population density and teen pregnancy rate or teen abortion rate by state and ACOG district. RESULTS: In 2000 there was no significant correlation between population density and the percentage of teenage females who conceived when analyzed by ACOG district (correlation coefficient r = 0.063, P =.87). In contrast, there was a significant correlation between population density and the percentage of pregnant teens who electively terminated their pregnancy when analyzed by ACOG district (r = 0.85, P =.003). In regions of greatest population density the percentage of pregnant teens who electively terminated was about 50%. In regions of least population density the percentage of pregnant teens who electively terminated was about 25%. Similar results were observed when teen pregnancy and abortion data from 1999 were analyzed. CONCLUSION: In the United States population density is not associated with the percentage of teenage females who become pregnant, but it is positively correlated with the percentage of pregnant teens that electively terminate their pregnancy. In areas of low population density teens who become pregnant may prefer birth to pregnancy termination. Alternatively, the access to pregnancy termination services may be suboptimal for teens in geographic areas with low population density. LEVEL OF EVIDENCE: II-2

Abortion, Induced↗

PubMed2004

Reproductive history and endometriosis among premenopausal women.

OBJECTIVE: To clarify the temporal complexities of the relation between reproductive factors and endometriosis. METHODS: We analyzed 10 years of prospective data from the Nurses' Health Study II cohort. Information was obtained through questionnaires sent every 2 years to 116,678 women aged 25-42 years when enrolled in 1989. Cox proportional hazards models were used to adjust for age, calendar time, and confounding variables. RESULTS: During 726,205 woman-years of follow-up, 1,721 cases of laparoscopically confirmed endometriosis were reported among women with no past infertility. Greater incidence was observed among women with an earlier age at menarche (rate ratio of 1.3 comparing menarche at age < 10 to age 12 years; 95% confidence interval [CI] 1.0-1.8; P value, test for trend < .001) and shorter cycle length during late adolescence (rate ratio of 1.3 comparing < 26 days to 26-31 days; 95% CI 1.1-1.5). Time to cycle regularity was not associated with risk. Among parous women, a linear decrease in risk was observed with number of liveborn children (rate ratio of 0.5 comparing > 3 with 2 children; 95% CI 0.4-0.7; P value, test for trend < .001) and lifetime duration of lactation if time since last birth was less than 5 years (rate ratio of 0.2 comparing > 23 months with never; 95% CI 0.1-0.4; P value, test for trend < .001). CONCLUSION: Hormonal and anatomical changes associated with menstruation and pregnancy may affect the rate of laparoscopically confirmed endometriosis. Within this cohort, risk was greatest among nulliparous women with earlier age at menarche and shorter menstrual cycles. Among parous women, parity and lifetime duration of lactation were associated with decreased risk.

Adult↗

PubMed2004

Plasma adrenal androgens and risk of breast cancer in premenopausal women.

OBJECTIVES: Plasma DHEA and its sulfate (DHEA-S) are positively associated with breast cancer risk in postmenopausal women; but the relationships have not been studied in detail in premenopausal women. We prospectively evaluated relationships between plasma levels of DHEA and DHEA-S in blood samples provided by a group of primarily premenopausal women and subsequent breast cancer, by use of case-control sampling from the Nurses' Health Study cohort. METHOD: Blood samples were collected from 1989 to 1990. Among women who were not postmenopausal at blood collection, 302 were diagnosed with breast cancer between blood collection and June 1998. Two controls were selected per case and matched with respect to age, menopausal status, month and time of day of blood collection, and fasting status at blood collection. Statistical analyses using conditional logistic regression were done to adjust for potential confounders. RESULTS: At time of blood collection, the median age was 49 (10th to 90th percentiles 45 to 53). In multivariable analyses, the highest quartile of DHEA was associated with an odds ratio of breast cancer of 0.92 (95% confidence interval, 0.59-1.43) relative to the lowest quartile (P value for log-linear trend 0.11). A similar analysis revealed an odds ratio of 1.08 (0.69-1.69) for DHEA-S (P value for log-linear trend 0.83). No statistically significant interactions were noted according to certainty of menopausal status, age, or past oral contraceptive use. DISCUSSION: Our analysis did not reveal a relationship between DHEA or DHEA-S and subsequent breast cancer in middle-aged premenopausal women. In the future, this relationship should be studied in younger women.

Androgens↗

PubMed2003

Metformin for the treatment of polycystic ovary syndrome.

OBJECTIVE: To familiarize obstetrician-gynecologists with the use of metformin for the treatment of polycystic ovary syndrome (PCOS). DATA SOURCES: Using OVID, 94 English-language articles published after 1966 indexed with the key words "metformin" and "polycystic ovary syndrome" were identified. METHODS OF STUDY SELECTION: Studies were excluded if they did not have a control group, did not use the National Institutes of Health definition of PCOS, did not have a clinical outcome as an end point, and were not in the English language. Reviews were also excluded, leaving 21 articles for inclusion. TABULATION, INTEGRATION, AND RESULTS: Three clinical trials reported that for the treatment of anovulatory infertility caused by PCOS, metformin plus clomiphene is more effective than clomiphene alone in inducing ovulation. For the treatment of irregular menses caused by PCOS in women not attempting conception, metformin therapy may restore ovulatory menses in the majority of women. However, most women will require 4-6 months of metformin therapy before they achieve ovulatory menses. In obese women, metformin plus a low-calorie diet may be associated with more weight loss than a low-calorie diet alone. CONCLUSION: Polycystic ovary syndrome is a common gynecologic endocrine disorder. Obstetrician-gynecologists should be familiar with the indications and contraindications for the use of metformin in their practice.

Clinical Trials as Topic↗

PubMed2002

Does tubal sterilization influence the subsequent risk of menorrhagia or dysmenorrhea?

OBJECTIVE: To evaluate the relation between tubal ligation, change in menstrual cycle characteristics, and early follicular phase hormones. DESIGN: Cross-sectional analysis of women 36-44 years of age. SETTING: The greater Boston area. PATIENT(S): Nine hundred seventy-six premenopausal women with intact uteri. INTERVENTION(S): A comparison of women with and without a history of tubal ligation. MAIN OUTCOME MEASURE(S): Menstrual and reproductive histories were self-reported. Early follicular phase blood samples were obtained to assess FSH, LH, and E(2). We compared menstrual cycle changes from the first 5 years after menarche with completion of the baseline questionnaire in women with and without a prior history of tubal ligation. RESULT(S): Cycle length, cycle regularity, menses length, flow volume, dysmenorrhea, and hormone levels were similar in women with and without a history of tubal ligation. However, among parous women with a history of cesarean section, those with a tubal ligation >5 years ago experienced a marginal increase in volume of menstrual flow compared with women with no tubal ligation history. CONCLUSION(S): We found no significant change in menstrual cycle characteristics or hormone levels in women with or without a history of tubal ligation. However, tubal ligation may have a modest effect on the change in menstrual flow volume over time among parous women with a history of cesarean section.

Adult↗

PubMed2002

Diagnosis and management of chronic pelvic pain.

Chronic pelvic pain is difficult to diagnose and to treat [81] because of the multiple and often overlapping causes [82]. A systematic approach aids in the thorough evaluation and appropriate therapy. At the initial visit(s), a thorough history should be taken and complete physical examination performed. Screening for co-existing conditions, such as depression, narcotic dependency, and physical, sexual, or emotional abuse is crucial so these issues may be addressed immediately while additional causes for pelvic pain are evaluated. The relative likelihood of gastrointestinal, urologic, musculoskeletal, or gynecologic etiology must be considered to guide a more thorough initial evaluation. With gynecologic chronic pelvic pain, differentiation between hormonally responsive and nonresponsive conditions is helpful for diagnosis and treatment. Therapy can then be instituted or an appropriate referral made.

Chronic Disease↗

PubMed2002

Endometriosis and infertility: a cause-effect relationship?

Two major methodological problems that impact clinical research in endometriosis are the absence of a low-cost, highly reliable method for diagnosing endometriosis and the possibility that endometriosis is actually multiple different diseases that we have not yet been able to differentiate. Animal models of endometriosis clearly demonstrate that advanced endometriosis causes reduced fertility. In humans, endometriosis and infertility are commonly associated. However, few data from high-quality clinical trials demonstrate that endometriosis causes infertility in humans. Future research should focus on the implications of the observation that, in ovarian endometriosis cysts, the epithelium is monoclonal. This observation suggests that nonrandom somatic mutations cause ovarian endometriosis cysts. If somatic mutations cause ovarian endometriosis cysts, it is likely that a small number of genes can be identified that play a central role in pathogenesis of this disease.

Animals↗