Biomedical subjects

Susan D Reed

Publications and source records attributed to Susan D Reed.

12 recordsLinked to original sources

PubMed2006

Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo: a randomized trial.

BACKGROUND: Herbal supplements are widely used for vasomotor symptoms. OBJECTIVE: To test the efficacy of 3 herbal regimens and hormone therapy for relief of vasomotor symptoms compared with placebo. DESIGN: 1-year randomized, double-blind, placebo-controlled trial conducted from May 2001 to September 2004. SETTING: Group Health, Washington State. PARTICIPANTS: 351 women age 45 to 55 years with 2 or more vasomotor symptoms per day; 52% of the women were in menopausal transition and 48% were postmenopausal. MEASUREMENTS: Rate and intensity of vasomotor symptoms (1 = mild to 3 = severe), and Wiklund Vasomotor Symptom Subscale. INTERVENTIONS: 1) Black cohosh, 160 mg daily; 2) multibotanical with black cohosh, 200 mg daily, and 9 other ingredients; 3) multibotanical plus dietary soy counseling; 4) conjugated equine estrogen, 0.625 mg daily, with or without medroxyprogesterone acetate, 2.5 mg daily; or 5) placebo. RESULTS: Vasomotor symptoms per day, symptom intensity, Wiklund Vasomotor Symptom Subscale score did not differ between the herbal interventions and placebo at 3, 6, or 12 months or for the average over all the follow-up time points (P > 0.05 for all comparisons) with 1 exception: At 12 months, symptom intensity was significantly worse with the multibotanical plus soy intervention than with placebo (P = 0.016). The difference in vasomotor symptoms per day between placebo and any of the herbal treatments at any time point was less than 1 symptom per day; for the average over all the follow-up time points, the difference was less than 0.55 symptom per day. The difference for hormone therapy versus placebo was -4.06 vasomotor symptoms per day for the average over all the follow-up time points (95% CI, -5.93 to -2.19 symptoms per day; P < 0.001). LIMITATIONS: The trial did not simulate the whole-person approach used by naturopathic physicians. Differences between treatment groups smaller than 1.5 Vasomotor symptoms per day cannot be ruled out. CONCLUSION: Black cohosh used in isolation, or as part of a multibotanical regimen, shows little potential as an important therapy for relief of vasomotor symptoms. CLINICAL TRIALS REGISTRATION NUMBER: NCT00169299.

Cimicifuga↗

PubMed2006

Pregnancy outcomes in women with rheumatoid arthritis in Washington State.

OBJECTIVE: To determine whether rheumatoid arthritis (RA) is associated with increased adverse obstetric or neonatal outcomes. STUDY DESIGN AND SETTING: Washington State birth records and hospital discharge data between 1987 and 2001 identified a cohort of women with rheumatoid arthritis and a comparison group of women without rheumatoid arthritis. Pregnancy and neonatal outcomes were compared using general linear models for common outcomes, calculating approximate relative risks and 95% confidence intervals. RESULTS: There were 243 women with rheumatoid arthritis and 2,559 controls. Infants of women with rheumatoid arthritis had increased risk of cesarean delivery (adjusted approximate relative risk, aRR=1.66, 95% CI (1.22, 2.26)), prematurity (aRR=1.78, 95% CI (1.21, 2.60)), and longer birth hospitalization (aRR=1.86, 95% CI (1.32, 2.60)) compared to those born to women without rheumatoid arthritis. CONCLUSIONS: We speculate that the increased risks for cesarean delivery, prematurity, and longer hospitalization at birth among infants born to women with rheumatoid arthritis may be due to the pathophysiologic changes associated with rheumatoid arthritis or medications used to treat the disease.

Adult↗

PubMed2006

Targeted prenatal herpes simplex virus testing: can we identify women at risk of transmission to the neonate?

OBJECTIVE: Potential strategies to prevent neonatal herpes include herpes simplex virus (HSV) serologic testing and counseling of pregnant women and rapid HSV polymerase chain reaction (PCR) testing of maternal genital secretions at delivery. The cost-effectiveness of these interventions would be improved if high-risk pregnancies could be easily identified for targeted testing. STUDY DESIGN: Washington State birth certificate data for all singleton live births from 1987 through 2002 were linked with infant death and hospital discharge data for birth and subsequent hospitalizations in a population-based case-control study of risk factors for neonatal herpes. A case was defined as an infant with a discharge diagnosis of HSV infection (International Classification of Diseases 9th edition [ICD-9] code 054.X) from birth admission or readmission within 30 days of life. Five controls per case were frequency matched to cases by year of birth. RESULTS: Ninety-one neonatal HSV cases were identified (8.4/100,000 live births). Risk factors for infection included maternal age younger than 25 years (adjusted odds ratio [aOR] = 1.9, 95% CI 1.1-3.3) and paternal age younger than 20 years or unknown (aOR = 1.7, 95% CI 0.7-3.7). Testing couples with either risk factor would require testing 36% of couples and could potentially prevent up to 60% of cases. Maternal history of genital herpes, fever during labor, and premature rupture of membranes were also associated with neonatal disease; using all risk factors identifiable at delivery would require screening 60% of pregnancies and identifying 84% of cases. CONCLUSION: Targeted HSV testing would miss a substantial proportion of neonatal herpes.

Case-Control Studies↗

PubMed2006

The incidence of repeat uterine surgery following myomectomy.

OBJECTIVE: To determine the incidence of subsequent leiomyoma surgery following myomectomy in a population-based cohort. METHODS: All women, ages 20-75 years, enrolled in a large HMO in Washington State, identified by CPT and ICD-9 codes as having a myomectomy between January 1, 1993, and December 31, 2002, were eligible for the study. The follow-up period was 0.1-11 years. Automated enrollment and inpatient, outpatient, pathology, and procedure data were linked. Age-adjusted hazard ratios (HR) and 95% confidence intervals (CI) using Cox proportional hazard models, age-specific Kaplan Meier estimates of cumulative risk, and incidence of uterine surgery after myomectomy were calculated. RESULTS: Among 628 eligible women, 127 (21.8%) had a second surgery, 95 (74.8%) of which were hysterectomies. The cumulative incidence of a second surgery was 23.5% at 5 years and 30% at 7 years. During 2766.5 woman-years of follow-up, the annual incidence of a subsequent myoma surgery was 4.6%. Compared with women aged 40-44, women >or=50 had a 50% decreased risk for subsequent surgery (HR = 0.5, 95% CI 0.3-0.9). CONCLUSIONS: The incidence of subsequent surgery for leiomyomas following myomectomy is high, almost 5% per year.

Adult↗

PubMed2005

The Herbal Alternatives for Menopause (HALT) Study: background and study design.

We designed a randomized double-blind randomized trial to examine the short and long-term effects of alternative approaches commonly used to manage menopause symptoms. Women were randomly assigned to: (1) black cohosh 160 mg daily; (2) multibotanical (50 mg black cohosh, alfalfa, chaste tree, dong quai, false unicorn, licorice, oats, pomegranate, Siberian ginseng, boron) four capsules daily; (3) multibotanical plus telephone counseling to increase dietary soy; (4) conjugated equine estrogen 0.625 mg +/- 2.5 mg medroxyprogesterone acetate; or (5) placebo. Working with a skilled CAM provider helped us choose interventions that reflected naturopathic practices worthy of study. Mass mailing, with careful tracking and rapid responses to recruitment rates, was an effective and cost-effective recruitment strategy. Creativity was necessary to construct methods for blinding capsules and the dietary soy intervention. Independent testing of herbal products was vital to confirming their constituents. The Data and Safety and Monitoring Committee, and project officers at the funding agency, were critical partners in designing responses to unanticipated Women's Health Initiative findings published during the HALT trial. Careful monitoring of adverse events may provide much needed information about side effects of herbal products and supplements. Despite inherent challenges, the study of alternative therapies for menopause symptoms is a rewarding and important area deserving of further inquiry.

Cimicifuga↗

PubMed2005

Increased risk of adverse pregnancy outcome among Somali immigrants in Washington state.

OBJECTIVE: The purpose of this study was to compare maternal and neonatal morbidity among Somali immigrants, US-born blacks and whites in Washington state. STUDY DESIGN: Washington state birth certificate data was linked to hospital discharge records comparing singleton deliveries among Somali immigrants with US-born blacks and whites between 1993 and 2001, in a 1:3 ratio. Outcomes were compared using unconditional multiple logistic regression models calculating odds ratios (ORs), and 95% confidence intervals (95% CIs). RESULTS: Five hundred seventy-nine pregnancies from Somali women were compared with 2384 and 2435 pregnancies from black and white women, respectively. Nulliparous Somali women were more likely to have a cesarean delivery than black or white control women, OR 1.6 (95% CI, 1.1-2.3) and 2.0 (95% CI, 1.4-2.8), respectively. Among all women who had cesarean deliveries, Somali women more commonly had cesarean deliveries associated with fetal distress and failed induction of labor. They were 9 times more likely than both control groups to deliver after 42 weeks gestation, and 4 times more likely than black women and 8 times more likely than white women to have oligohydramnios. Somali women were more likely to have gestational diabetes and significant perineal lacerations, and less likely to smoke. Newborns of Somali women were at increased risk for prolonged hospitalization, lower 5-minute Apgar scores, assisted ventilation, and meconium aspiration. CONCLUSION: Pregnancy outcomes should be evaluated within ethnically and culturally unique groups; Somali immigrants are a high-risk subpopulation.

Black or African American↗

PubMed2004

Dose of progestin in postmenopausal-combined hormone therapy and risk of endometrial cancer.

OBJECTIVE: We studied the impact of progestin dose on this risk. The pattern and number of days per month that progestin is given in postmenopausal combined hormone therapy appears to affect endometrial cancer risk. We assessed the impact of progestin dose on this risk. STUDY DESIGN: A population-based, case-control study included 647 cases with endometrial cancer and 1209 controls. RESULTS: Among users of estrogen with medroxyprogesterone acetate (MPA) 10 to 24 days/month, women who took >100 mg/month had an endometrial cancer risk that was equal to that of hormone nonusers (95% CI 0.6-1.7). The corresponding relative risk was 0.8 (95% CI 0.5-1.5) in those who used a lower monthly MPA dose for 10 to 24 days/month. Among users of a continuous combined hormone regimen, the risk of endometrial cancer was low relative to hormone nonusers, regardless of MPA dose. CONCLUSION: Among the combined hormone regimens most commonly used by postmenopausal women today, MPA monthly dose bears little or no relation to endometrial cancer risk.

Aged↗

PubMed2004

Indications for hormone therapy: the post-Women's Health Initiative era.

Information from the Women's Health Initiative (WHI) trial has given physicians valuable tools for counseling women aged 50 to 79 years about the short-term risks of hormone therapy (HT). Unanswered questions remain, particularly on the risks and benefits of discontinuing HT among long-term users. The decision to discontinue HT should be carefully considered, because stopping and re-starting after several months may "reset the clock" for risks associated with changes in hepatic protein synthesis. The current authors recommend low-dose transdermal hormonal formulations,but no large-scale randomized trials exist to confirm the veracity of this recommendation. It has been suggested that starting HT in the menopausal transition would alleviate the HT risks observed withWHI. Until additional data are available to counsel women in the menopausal transition, however, the conservative counseling approach is to apply those figures available from the WHI, particularly because women aged 50 to 59 years using estrogen-progestin therapy have an unfavorable risk-benefit ratio, similar to that seen in older women.

Aged↗

PubMed2004

The sex ratio of pregnancies complicated by hospitalisation for hyperemesis gravidarum.

OBJECTIVE: To evaluate the sex ratio among pregnancies complicated by first trimester hyperemesis gravidarum and extend previous findings to include a measure of severity. DESIGN: Population-based case control study. SETTING: All non-federal hospitals in Washington State. POPULATION: Two thousand and one hundred and ten pregnant women hospitalised for hyperemesis gravidarum and 9783 pregnant women without hyperemesis gravidarum. METHODS: The infant sex ratio for pregnant women admitted to the hospital for hyperemesis gravidarum was evaluated using the Washington State hospital discharge database linked to the birth certificate database for years 1987-1996. Cases were pregnant women hospitalised for hyperemesis gravidarum (International Classification for Diseases-9th edition [ICD-9] diagnosis code 643) in the first trimester. Controls were women who experienced a singleton live birth and were not hospitalised for hyperemesis in Washington State during the same time period. Regression analysis with general estimating equations was used to calculate an odds ratio (OR) and 95% confidence interval (CI) to assess the association of hyperemesis gravidarum with infant sex ratio. MAIN OUTCOME MEASURE: Infant sex ratio. RESULTS: Pregnant women hospitalised for hyperemesis gravidarum in the first trimester had a 50% increased odds of having a female infant compared with controls (OR 1.5, 95% CI 1.4, 1.7). Women hospitalised for three or more days had the greatest odds of having a female infant compared with control women (OR 1.8, 95% CI 1.5, 2.0). CONCLUSION: Hyperemesis gravidarum is associated with an increase in female live births and may be a marker for high oestrogen levels in utero.

Adolescent↗

PubMed2003

Longitudinal changes in bone density in relation to oral contraceptive use.

The primary aim of this 36-month prospective cohort study was to evaluate the association between use of oral contraceptives (OCs) and bone mineral density in reproductive-age women. The 36-month bone density (g/cm2) at the spine, hip and whole body and percent change from baseline (measured at 6-month intervals) were evaluated among 245 women 18-39 years of age; 89 were using OCs (median duration: 3.7 years at study entry) and 156 were not using any hormonal contraception. Before and after adjustment for covariates (baseline bone density, age, race, ever pregnant, exercise, body mass and calcium intake), women using OCs did not differ significantly from comparison women in percent change in bone density over 36 months or in absolute bone density at 36 months. All p-values for between-group differences were >0.55. In conclusion, within the limitations of this study, OCs did not appear to impact bone density over time in this cohort of reproductive-age women.

Adolescent↗

PubMed2003

Intracervical sonographic-pathologic correlation: preliminary results.

OBJECTIVE: To determine whether current-generation endoluminal ultrasonic transducer technology could visualize dysplastic and malignant cervical lesions. METHODS: Inclusion criteria for patients enlisted in the study were abnormal Papanicolaou test results, an abnormality seen at colposcopy, and consent for a cone biopsy. In addition, we included 4 women who were undergoing hysterectomy but had no evidence of cervical abnormalities at the time of surgery, for a total of 28 women. We used a 20-MHz annular array intravascular transducer. We correlated all sonographic and pathologic results with regard to being normal or abnormal using the Pearson product moment correlation coefficient, and we evaluated interobserver variation by having 5 blinded sonologists interpret each examination and calculating kappa statistics. RESULTS: We performed intracervical sonography on 24 women with abnormal Papanicolaou test results and on 4 women without abnormalities. Nineteen of the 24 women with proven disease had abnormal sonographic images. Five women with pathologically proven cervical intraepithelial neoplasia I had normal sonographic images. Lesions ranged in size from 0.3 to 7 mm. Two carcinomas (5 and 7 mm diameter), multiple nabothian cysts, cervicitis, and 2 giant cell foreign body reactions were visible on sonography. The correlation coefficient for abnormal sonographic and pathologic findings was 0.87 (P < .005). We obtained a kappa value of 0.75 for interobserver variation. CONCLUSIONS: Intracervical sonography was able to visualize dysplastic lesions and carcinomas as hypoechoic defects with surrounding echogenic areas of glandular cervical mucosa. Lesions were shown with sufficient resolution and interobserver variation to suggest that the technique may be clinically applicable, particularly for planning surgical therapy. However, design of a transducer that can be easily sterilized between examinations, similar to current endovaginal probes, would be necessary to make intracervical sonography a clinically feasible examination.

Colposcopy↗

PubMedDate not supplied

Postmenopausal estrogen and progestogen therapy and the risk of uterine leiomyomas.

OBJECTIVE: Leiomyomas are common benign neoplasms. Although hormone therapy is the most common and effective treatment for menopausal symptoms, little is known about its effect on leiomyomas. We examined the risk of a first diagnosis of leiomyomas in peri- and postmenopausal women associated with prior use of estrogen and progestogen therapy (EPT). DESIGN: A case-control study was conducted among enrollees from a nonprofit health plan. Cases had a first diagnosis of leiomyomas confirmed by surgery or ultrasound. Controls were women of the same age range without a diagnosis of leiomyomas selected at random from membership and outpatient files. Participants were interviewed regarding prior use of exogenous hormones, medical history, and reproductive history. This analysis was restricted to cases (n = 256) and controls (n = 276) who were peri- or postmenopausal and more than 40 years of age. Adjusted odds ratios (OR) and 95% CIs were estimated using logistic regression models. RESULTS: EPT use for more than 5 years was associated with a 1.7-fold increased risk of leiomyomas (95% CI, 0.9-3.3). Associations with EPT use were only present among women with a body mass index less than 24 kg/m; OR (ever-use), 2.3 (95% CI, 1.2-4.3); and OR (>or= 5 years use), 4.0 (95% CI, 1.6-10.3). CONCLUSION: Among peri- and postmenopausal women, prior EPT use was associated with an increased risk of a subsequent leiomyomas. This association seemed limited to the subset of women with low body mass index. Exogenous sources of estrogen and progestin in the setting of low adiposity may contribute to the development of leiomyomas.

Adult↗