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V Ringa

Publications and source records attributed to V Ringa.

18 recordsLinked to original sources
PubMed2004

[Alternatives to hormone replacement therapy for menopause: an epidemiological evaluation].

OBJECTIVE: Recent results put into question the risks/benefits ratio of hormone replacement therapy and emphasize the importance of precise knowledge of the effects of other treatments that exist for postmenopausal symptoms or diseases. Our aim is to analyze their effect. METHODS: A review of randomized trials or epidemiological studies was undertaken. RESULTS: Bisphophonates, calcitonin, parathormone, strontium ranelate, calcium and vitamin D have specific effects on bone. The efficacy of bisphophonates for prevention and treatment of osteoporosis has been proven and parathormone and strontium ranelate seem promising. These treatments are useful for women at high risk of osteoporosis who do not suffer from menopausal symptoms. Tibolone, SERMs and phytoestrogens exert effects on various tissues. SERMs are very promising, but they do not improve climacteric symptoms and their long term effects are still unknown. Tibolone has beneficial effects on climacteric symptoms and on bone loss, but recent results concerning its effects on the risk of breast cancer call into question its interest. The beneficial effects of phytoestrogens on bone and on vasomotor symptoms need to be confirmed. CONCLUSION: At this time, none of the existing treatments for postmenopausal symptoms or diseases is ideal. The existence of several options for treatments of symptoms or diseases of the postmenopause is helpful as it affords several choices for physicians and for women who sometimes need to be treated for many years. However several questions remain unanswered concerning the long term effects of these treatments.

Climacteric↗
PubMed2003

[Compliance with hormone replacement therapy in menopausal women: results of a two-year prospective French study comparing transdermal treatment with fixed oral combination therapy].

OBJECTIVES: To evaluate rates of continuation with hormone replacement therapy (HRT) at 2 years in 2 cohorts of female patients, one of which was treated with a set combination of oral oestradiol valerate and medroxyprogesterone acetate and the other with percutaneous 17 beta-oestradiol gel combined with an oral progestogen selected by the prescribing doctor. PATIENTS AND METHODS: A prospective, randomised, open study, including 885 patients followed for 2 years whose 477 were in the oral HRT cohort and 408 were in the dermal cohort. Randomisation was done by group with prescription of the selected HRT for the cohort. The 2 treatment groups were compared using chi(2) tests and Fisher's exact test for qualitative variables, Student's t test or Wilcoxon's test for qualitative variables and Kaplan-Meier survival curves for continuation of HRT, with comparisons using the log-rank test. The prognostic value of baseline parameters on subsequent continuation of HRT was studied using the Cox model (Wald test, odds ratio). RESULTS; Among the 885 treated patients, 711 received the HRT assigned to their cohort (382 in the oral HRT cohort, 329 in the dermal HRT cohort). After 2 years, 77.9% of the patients in the oral HRT cohort and 73.4% of the patients in the dermal HRT cohort were continuing to take their prescribed HRT (P = 0. 076): 37.9% of patients in the oral HRT cohort and 20.2% of patients in the dermal HRT cohort (P < 0.001) continued taking their treatment without any modification. CONCLUSION: Although there was no significant difference in the level of compliance in the 2 groups, it is nonetheless worth noting that the HRT compliance with a sequential fixed estroprogestogen combination was, in this trial, at least equal to that with the free combination of a transdermal estrogen and a progestogen whose nature, dosage and sequence duration are selected by the prescriber. On the other hand, treatment modifications occurred more frequently in the cutaneous HRT group, which is logical as free combination affords to adapt the treatment to each patient.

Administration, Cutaneous↗
PubMed2000

Use of hormone replacement therapy: women's representations of menopause and beauty care practices.

OBJECTIVES: Hormone replacement therapy (HRT) during menopause has been shown to have beneficial effects on women's health, including preventing osteoporosis and probably reducing cardiovascular mortality and morbidity. However, these effects appear only after long use. Knowledge of factors influencing HRT use is a prerequisite for developing and assessing preventive actions. Most studies of user characteristics have focused on medical knowledge and socioeconomic characteristics, although social and cultural models of menopause may also play a role. Therefore, our study of the determinants of HRT use focused on representations of menopause and on beauty care. METHODS: Two scores, one concerning the level of beauty care and the other the representations of menopause, were calculated. In our population of 561 postmenopausal women from the GAZEL cohort in France, 409 (72.9%) had been using HRT for more than one year, and 152 (27.1%) had used it for less than three months, if ever. Associations between the study variables and HRT use were then analysed. RESULTS: No association was found between representations of menopause and HRT use. Beauty care and some beliefs about HRT (i. e. that it is useful for osteoporosis prevention, causes resumption of menstruation, and has anti-aging effects) were independently associated with HRT use. Moreover, the proportion of HRT users increased with socioeconomic status, with vasomotor symptoms in early menopause, and among hysterectomised women. CONCLUSIONS: The results suggest that the amount of attention women pay to beauty care plays a role, in determining HRT use.

Beauty↗
PubMed1994

Bone mass measurements around menopause and prevention of osteoporotic fractures.

The objective of this work is to try to answer the question: is it useful to recommend bone densitometry at the time of the menopause as a screening test for women at high risk of osteoporotic fractures? This analysis is based on a review of the literature for the period 1981-1993, considering published articles in English or French. Prospective studies demonstrate that low bone mass (BM) in women who have been menopausal for more than 10 years is actually a risk factor for fracture, with a fracture risk multiplied by about two for a decrease in BM of one standard deviation. At present no studies have shown this association when BM determinations have been realised at the age of 50 years. The use of BM measurements remains difficult in practice because there is no international consensus concerning the definition and the value of a threshold for a high fracture risk. Concerning the efficacy of preventive interventions applied following the identification of a low BM, i.e. hormonal replacement therapy (HRT), data are lacking concerning the magnitude of its efficacy on fracture prevention and in the presence of an already decreased BM. Moreover osteoporosis is not the only indication for HRT, which may be prescribed for other consequences of the menopause. There is not enough evidence for the screening, by BM measurements, of high risk fracture at the time of the menopause. These measurements may help women who hesitate to take HRT, but they do not seem to improve compliance with the treatment to a large extent. Knowledge concerning osteoporosis and its prevention remains a major determinant in the use of preventive measures.

Absorptiometry, Photon↗
PubMed1994

Determinants of hormone replacement therapy among postmenopausal women enrolled in the French GAZEL cohort.

Although the efficacy of hormonal replacement therapy (HRT) regarding numerous consequences of menopause is proven, its prevalence of use is low, as is compliance with the prescribed treatment. The aim of this work was to study the factors influencing a woman's decision to take HRT by analyzing the determinants of HRT use of at least 6 months' duration among post-menopausal women working for a French company and enrolled in a cohort study. Special attention was paid to the women's expectations of HRT. We compared two groups of women: 113 current HRT users who had been users for at least 6 months and 101 never users. Among the 113 current users, the most frequent treatment was a combination of oestrogen and progestin (86%). The determinants of HRT use for at least 6 months included a prior spinal radiograph, which showed a significant relationship with the use of hormone treatment (odds ratio (OR) 2.4; 95% confidence interval (CI) 1.2-4.7), a current marriage (OR 2.5; 95% CI 1.3-5.1) and previous hot flushes (OR 2.4; 95% CI 1.2-4.9). The strongest determinant was an expectation that HRT would prevent osteoporosis (OR 5.0; 95% CI 2.2-11.6). In this population concern about osteoporosis appears to be an important determinant of HRT use. Our results underline the importance of the diffusion of information among physicians and women about HRT's benefits, especially its efficacy in preventing osteoporosis.

Attitude↗
PubMed1994

Menopause and perceived health status among the women of the French GAZEL cohort.

The aim of this study was to evaluate the effect of menopause on women's quality of life. Women (1171) aged from 45-52 years who work for the French national gas and electricity company volunteered for this study (response rate 75%). They completed a self-administered questionnaire pertaining to general health. Quality of life was measured by the Nottingham Health Profile (NHP). Within this group 289 women were postmenopausal. After controlling for age, those women were more likely to show a lower quality of life than women still menstruating for 4 of the 6 sections of the NHP: social isolation (odds ratio 1.4; 95% confidence interval 1.1-1.9), pain, sleep and energy (odds ratios 1.5; 95% confidence intervals 1.1-2.0). Those alterations of quality of life are explained by the climacteric complaints the women report. Those findings suggest that the treatment of menopausal symptoms with medication of proven efficacy may prevent lowering of quality of life due to menopause.

Attitude to Health↗
PubMed1992

Determinants of hormonal replacement therapy in recently postmenopausal women.

Although the efficacy of hormonal replacement therapy (HRT) on the consequences of the menopause is not questioned, it appears that in Europe and in the USA only a small proportion of women are users of HRT. In this study, we examined the prevalence and the determinants of HRT among 1986 French menopausal women, aged 45 to 55 years, presenting to a preventive medicine centre. Overall, 8.1% of women reported current use of HRT. The estrogen preparation most commonly reported was transcutaneous 17 beta-oestradiol. The first determinant of current HRT was birth-place. Women born in France were nearly four times more likely to be on treatment than foreign-born women. A surgical menopause multiplied the probability of current HRT by 2, as did a high level of education. An age at first pregnancy of more than 20 and less than 4 children were also positively linked with HRT use. Even in this population of recently menopausal women, volunteering to undergo health evaluation, the prevalence of HRT was low. The reservations towards HRT may be partly due to the women themselves, and partly due to the physicians. It seems very important to inform the medical profession about the risks and benefits of HRT, and to understand more precisely the reasons why so few women use HRT.

Administration, Cutaneous↗
PubMed1992

[Post-menopausal osteoporosis. Epidemiologic aspects].

The purpose of this study is to point out the epidemiological features concerning the frequency and seriousness of post-menopausal osteoporosis, and concerning screening and prevention of osteoporotic fractures. Osteoporosis is a condition very widespread, characterised by fragility fractures. It has been estimated that in France one million of women suffer from vertebral fractures. Osteoporosis can alter the quality of life in various ways. Its cost is high, representing 4 billions francs a year in France only for hip fractures. The only preventive treatment that has been agreed on universally is oestrogen therapy. The fact that this treatment is not systematically recommended does not explain that only 8% among french menopausal women take oestrogen. The factors available at present to identify women at high risk of osteoporotic fractures are risk factors evaluated by clinical history, biological markers of bone formation and measurements of bone mass. None of these risk factors have enough sensibility and specificity to define accurately risks groups. Furthermore it is necessary to specify the effects of treatments associating oestrogens and progestogens prescribed in France, in particular effects on the risks of cardio-vascular diseases and breast cancer.

Absorptiometry, Photon↗
PubMed1990

Effect of maternal and fetal characteristics on diagnosis of intrauterine growth retardation.

We studied the fetal and maternal characteristics that affect the diagnosis of intrauterine growth retardation and lead to variations in the sensitivity, specificity and predictive values. The population comprised the 18,166 women who consulted and delivered in two teaching hospitals in Paris from 1978 to 1983. Specificity was lower when a child was born before 37 weeks, with a small weight-for-gestational age, and when the mother had experienced complications during either her obstetric history or current pregnancy. Conversely, sensitivity was higher when these maternal and fetal characteristics were present. Positive predictive values rose in the presence of a risk factor for small-for-dates, but the rise was smaller than would have been expected if sensitivity and specificity had remained at the levels observed in the low-risk group.

Birth Weight↗
PubMed1989

Ultrasound in obstetrics: do the published evaluative studies justify its routine use?

A review of surveys assessing the use of ultrasound in obstetrics was undertaken to determine why this examination has spread so rapidly. Seven randomized controlled trials (RCTs) published to date as well as 182 papers published in four obstetric journals between 1979 and 1984 were reviewed. The value of routine ultrasound scanning to improve the diagnosis of intrauterine growth retardation or gestational age was demonstrated in the RCTs, but the results of the RCTs measuring the effects on health of this screening procedure did not give strong evidence for its routine use. Of the 182 papers identified, 137 were related to the diagnostic assessment of ultrasound, 14 concerned the effects on medical practice and only nine papers studied the effects of ultrasound scanning on health. Most of these 137 papers came out in favour of this procedure. Thus the spread of ultrasound scanning was based mainly on evaluative surveys which assessed its diagnostic value.

Evaluation Studies as Topic↗
PubMed1989

The use of ultrasound examinations, intrapartum fetal heart rate monitoring and beta-mimetic drugs in France.

We conducted a survey of French obstetricians to document their attitudes towards routine ultrasound, intrapartum fetal monitoring and beta-mimetics in 1987. A questionnaire was sent to 582 obstetricians or gynaecologists who were members of two French medical associations. The response rate was 85%. Of the respondents 92% prescribed two or three routine ultrasound examinations; only one doctor did not use electronic fetal monitoring and 99% of the respondents prescribed beta-mimetics to prevent preterm delivery. Some obstetricians reported a decrease in their use of ultrasound and more dramatically in the use of beta-mimetics. Side-effects were reported to be the major reason for the change in beta-mimetic use. Obstetricians who read English language journals were more likely to have reduced their use of ultrasound and beta-mimetics than those who read only French language journals.

Female↗
PubMedDate not supplied

Consequences of misdiagnosis of intrauterine growth retardation for preterm elective cesarean section.

We studied the consequences of misdiagnosis of intrauterine growth retardation (IUGR) for preterm elective cesarean section among live singleton newborns in two teaching hospitals in Paris between 1978 and 1983. The population studied comprised the 16,540 babies who were normal for date, according to the 10th percentile of the reference curve established in this population. For 118 of these infants, IUGR had been diagnosed during pregnancy. The preterm elective cesarean section rate was 12.7% among newborns for whom IUGR was erroneously diagnosed, compared to 1.2% among those for whom IUGR was not diagnosed. The relationship between preterm cesarean section and misdiagnosis of IUGR still existed (odds ratio: 5.2, 95% CI: 2.1-12.9) after taking into account obstetric history and hypertension during pregnancy. Our results show that after diagnosis of IUGR, supplementary tests are essential to confirm fetal distress and consequently avoid unnecessary interventions.

Cesarean Section↗