Purification and characterisation of hepatic glutathione transferases from a herbivorous marsupial, the brushtail possum (Trichosurus vulpecula)

In 1994, as part of their participation in the University of North Carolina Alumni Heart Study, 1101 women aged 45-51 years answered questions about their menopausal status and current use of hormone replacement therapy (HRT). Little is known about the use of HRT in younger women. We were interested in determining both patterns of HRT use and patient characteristics associated with HRT use in this cohort of women approaching the average age of menopause. After excluding women with breast, endometrial, and ovarian cancer, we studied 1080 women. These women identified themselves as: "There is no indication that I am near menopause" (stage 1, n = 326), "I think I may be close to or in the beginning stages of menopause but am not sure" (stage 2, n = 410), "I have begun menopause" (stage 3, n = 202), and "I have been through menopause" (stage 4, n = 142). The overall rate of HRT use was 22% (0% in stage 1, 8% in stage 2, 52% in stage 3, and 76% in stage 4). Both patterns of HRT use and patient characteristics associated with HRT use differed based on the woman's perception of her menopausal stage. In logistic regression models, where HRT use was the outcome variable, independent predictors of HRT use included stage of menopause, having had a hysterectomy, having had a bilateral oophorectomy, no family history of breast cancer, having had a pelvic examination in the last year, being married, and not participating regularly in physical exercise. A woman's perception of her stage in the process of reproductive aging correlates with her use of HRT. Informed decision making about HRT use should be tailored to the individual's perception of her menopausal stage.     

Endometrial cytology in normal postmenopausal women and during hormone replacement therapy

OBJECTIVE: To explore the possibility of endometrial cyopathologic examination as a method of monitoring endometrium during hormone replacement therapy (HRT) in postmenopausal women. METHODS: Endometrial cells were taken via tubal aspiration in 60 normal postmenopausal women (non-HRT group) and 41 with HRT for 3-18 months (HRT group). Their morphologic changes were observed and compared by cytopathologist. RESULTS: Atrophic endometrium was found in 51.7% of the non-HRT group. Its proportion increased with age and the time after menopause. Macrophages were seen in 68.3% of this group. However, in the HRT group the occurrence of atrophic type and macrophage (12.2%, 7.0% respectively) was significantly lower than that in the non HRT group (P < 0.05). Heterogeneity of endometrial cell type was shown both in non-HRT (38.3%) and HRT (65.8%) groups. CONCLUSIONS: Endometrial cells of postmenopausal women are not always atrophic in appearance. They change significantly during HRT. Endometrial cytological examination may be useful for monitoring during HRT.     

New autosomal recessive syndrome of severe microcephaly and skeletal anomalies including posterior rib-gap defects

A simultaneous comparison of human exposure to solar ultraviolet radiation at two locations was performed to study the effect of environmental factors and human attitudes on personal ultraviolet exposure. The study took place on 29 October 1996 in Toowoomba (27.5 degrees S, 151.9 degrees E) and Brisbane (27.4 degrees S, 153.1 degrees E), Queensland, Australia. From the data collected by calibrated ambient ultraviolet monitoring stations located in Toowoomba and Brisbane, Toowoomba received 68% more UVA (320-400 nm) and 61% more UVB (280-320 nm) than Brisbane from 07:00 to 10:00 Australian Eastern Standard Time (EST). From 10:00 to 17:00 EST Toowoomba received 5% more UVA and 20% less UVB than Brisbane. High ambient ultraviolet levels recorded by ultraviolet stations were reinforced by measurement of the personal ultraviolet exposure of human subjects wearing polysulfone dosimeters. Contrary to the common belief that the ultraviolet exposure to the human body is higher near the beach (i.e., coastal areas) than the inland area, the average erythemal weighted ultraviolet exposure on the chest and shoulder of each subject in the inland city of Toowoomba (127 km to the west of Brisbane) was 30% higher than in the coastal city of Brisbane from 07:00 to 17:00 EST. Evidence is also presented to suggest a relationship between altitude, climatic conditions, the human attitude, and the level of personal exposure to ultraviolet radiation.     

Carotid artery wall changes in estrogen-treated and -untreated postmenopausal women

OBJECTIVE: To investigate whether the thickness of the layers of the carotid artery (externa, media, and intima) are affected by menopause and its treatment with hormone replacement therapy (HRT). METHODS: One hundred twenty-nine postmenopausal women were recruited sequentially and classified into three groups. Forty-six were taking oral HRT, 32 had estradiol implants, and 51 had never taken HRT. The three layers of the externa wall of the carotid artery were identified and measured by high-resolution ultrasound. RESULTS: Women with implants had thicker carotid artery wall measurements (0.84 +/- 0.26 mm) than the other groups. The media (0.32 +/- 0.11 mm) was significantly thicker in the implant group. This layer has a high connective tissue component, including collagen type I, collagen type III, and elastin fibers. The intima layer was thinner (0.25 +/- 0.09 mm) in the oral HRT group compared with controls (0.29 +/- 0.1 mm). A statistically significant higher intima-media ratio (1.17 +/- 0.05) was calculated for the control group, compared with both the oral HRT (0.92 +/- 0.04) and implant groups (0.94 +/- 0.03). CONCLUSION: Our findings suggest that HRT given to postmenopausal women influences differentially the layers of the carotid artery. Hormones seem to encourage thickening of the layers with the highest connective tissue component (externa and media) and to delay thickening of the atheromatous intima layer. These effects on the vascular system may be partly responsible for the cardioprotection attributed to HRT.     

Defective expression of early activation genes in cartilage-hair hypoplasia (CHH) with severe combined immunodeficiency (SCID)

PURPOSE OF STUDY: To examine factors which may predispose to tooth fracture, and to assess the compressive strengths of foods and sweets which are associated with tooth fracture in vivo. POPULATION STUDIED: Consecutive dental patients presenting with one or more fractured posterior teeth at the surgeries of three general dental practitioners, over a four-month period. METHOD: A pro forma was designed to elicit information on the factors associated with tooth fracture and the nature and extent of such fractures. Three general dental practitioners were requested to complete a pro forma for each patient presenting with a fractured posterior tooth over a four-month period. Foods and sweets considered to be associated with tooth fracture were identified and their compressive strengths tested. FINDINGS: A total of 129 cases of fractured posterior teeth were recorded, of which 48% occurred in the mandibular arch and 52% in the maxillary arch. In the mandible, 75% of tooth fractures occurred in molars while in the maxillary arch 50% occurred in molars. In 57% of cases assessed, no identifiable causative item was noted. Forty-five per cent of fractures were in teeth which had been restored on three or more surfaces. Compressive forces of 0.16KN to 2.2KN were obtained for food items implicated in tooth fractures. CONCLUSION: As mesio-occlusodistal restorations were identified as a major predisposing factor to tooth fracture in this study, with mandibular first molar teeth particularly affected, placement of cuspal coverage restorations may be considered to be a justifiable preventative measure in teeth identified as being at risk.     

Hormone replacement and menopausal symptoms following hysterectomy

Hormone replacement therapy (HRT) is recommended for most women who experience surgical menopause following hysterectomy/oophorectomy for noncancerous conditions; it is also commonly prescribed for postmenopausal women. Beginning in 1992, 1,299 women undergoing hysterectomy in 28 hospitals throughout Maryland were interviewed prior to hysterectomy and were subsequently followed over a 2-year period. Interviews included questions about HRT use and symptoms associated with menopause. The majority of the women (66 percent) were white, 55 percent had a high school education or better, 49 percent were obese (body mass index > or =27.3), and 11 percent were postmenopausal. Over 40 percent of premenopausal women underwent bilateral oophorectomy. At 3 months posthysterectomy, 89 percent of these women were on HRT; this figure dropped to 85 percent at 24 months. Among postmenopausal women, 50 percent were on HRT both at 3 months and at 24 months posthysterectomy. Among premenopausal women who had unilateral oophorectomy, 21 percent were on HRT at 3 months, increasing to 35 percent at 24 months. Among premenopausal women who had no ovaries removed, 5 percent were on HRT at 3 months, increasing to 13 percent at 24 months. There were few within-group differences between HRT users and nonusers, except that among postmenopausal women, HRT users were younger and more likely to be white and had higher income and educational levels. Women who were postmenopausal or who underwent bilateral oophorectomy were less likely to have hot flashes if they were on HRT, but women with 0-1 ovary removed who were on HRT were more likely to have hot flashes than those not on HRT. Black women were significantly more likely to experience hot flashes than were white women, independent of HRT status and weight. Obese women were on HRT at approximately the same rates as nonobese women but were significantly more likely to have hot flashes, even when analyses controlled for HRT and race.     

The general practitioner's role in breast cancer screening: a survey in Otago-Southland

AIMS: To study the experience of general practitioners in Otago and Southland with the existing breast cancer screening programme and the reviews on future programmes. METHODS: A questionnaire was sent to all 210 general practitioners in Otago and Southland in June 1996. RESULTS: The response rate was 71%. All the 141 respondents except one encouraged eligible women to take part in the programme; this was done mainly during individual doctor-patient consultations, by pamphlets and posters, and in the work of the practice nurse. Ten percent of practitioners had a practice-based recall system for breast cancer screening. Seventy-five percent of general practitioners currently provide a list of eligible women to the programme, and of these, 52% check the list to exclude ineligible women. Only 24% of practitioners supplying a patient list to the programme reported that a patient had ever requested that their name be excluded from the list. Twenty-five percent of general practitioners providing lists had a notice in the waiting room stating that. Of those who did not provide lists, concerns about logistics, ethical issues and cost were raised, although 40% of these general practitioners intended to provide lists in the future. In a future programme, 57% of general practitioners felt they should be paid for supplying lists defined by age only and 82% felt they should be paid for supplying a list of women eligible by both age and medical history. Most general practitioners felt that general practitioner lists were the preferred source for invitations to the breast screening programme and that general practitioners had an important part in any future programme. Screening at the ages 50-64 (as currently proposed) is supported by 95% of general practitioners; in addition, 64% supported screening at ages 65-69. Only a minority of general practitioners supported screening at ages 40-49 or ages 70-74. Most general practitioners would offer screening to women under age 50 with either a strong or a weak family history, or even with a past history of a fibroadenoma. CONCLUSIONS: These results show that almost all general practitioners support breast cancer screening programmes and feel that they have an important role in future programmes. The majority support extension of the programme to ages 65-69, but not to ages 40-49. The majority support screening women with individual risk factors at ages under 50, although their responses show that better information on the importance of different risk factors is required.     

Insulin edema in diabetes mellitus associated with the 3243 mitochondrial tRNA(Leu(UUR)) mutation; case reports

OBJECTIVE: To determine the risk of breast cancer in relation to the use of combined estrogen and progestin hormone replacement therapy (HRT). DESIGN: A population-based case-control study. SETTING: The general female population of King County in western Washington State. PARTICIPANTS: Middle-aged (50 to 64 years) women, including 537 patients with incident primary breast cancer diagnosed between January 1, 1988, and June 30, 1990, who were ascertained through the Seattle-Puget Sound Surveillance, Epidemiology, and End Results cancer registry and 492 randomly selected control women without a history of breast cancer. MAIN OUTCOME MEASURE: Breast cancer risk in relation to use of menopausal hormones. RESULTS: Menopausal hormones of some type had been used by 57.6% of breast cancer cases and 61.0% of comparison women. The women who had ever taken combined estrogen-progestin HRT, representing 21.5% of cases and 21.3% of controls, were not at increased risk of breast cancer (relative odds [RO] = 0.9; 95% confidence interval [CI], 0.7 to 1.3). Compared with nonusers of menopausal hormones, those who used estrogen-progestin HRT for 8 or more years had, if anything, a reduced risk of breast cancer (RO = 0.4; 95% CI, 0.2 to 1.0). CONCLUSIONS: On the whole, the use of estrogen with progestin HRT does not appear to be associated with an increased risk of breast cancer in middle-aged women. Nonetheless, since the use of combined estrogen-progestin HRT has only recently become prevalent, future investigations must assess whether breast cancer incidence is altered many years after estrogen-progestin HRT has been initiated, particularly among long-term users.     

Immunophenotypic characteristics of the blast crisis in chronic myeloid leukemia

The objective of this study was to provide the Tamworth Rural Training Unit with a clear understanding and practical strategic directions for contributing to an equitable distribution of rural general practitioners in the New England Area Health Service. A survey was sent to all 139 general practitioners practising in this region. The best and worst features of rural practice, both professionally and personally, were surveyed, as well as ways to attract more general practitioners to rural areas. It was found that this region required an additional 46 full-time general practitioners in 1995 if equity and social justice principles were to be met. Projecting to the year 2005, the total shortfall of full-time general practitioners in the New England Area Health Service amounts to 90. It is recommended that this critical shortage of rural general practitioners be assessed within two distinct time frames, namely short-term strategies (1996-1998) and medium-term strategies (1999-2005).     

Mass screening of colorectal cancer by general practitioners in France: what is the real target population?

OBJECTIVES: People at high risk of colorectal cancer, due to familial or personal history, or to specific symptoms, are considered not to be concerned by mass screening by Haemoccult test. The aim of this study was to investigate people aged 50 to 74 with high risk of colorectal cancer among general practitioners' practices in the department of Calvados (France). METHODS: A random sample of 200 general practitioners were asked to systematically fill out a questionnaire on Haemoccult II proposal for 50-74 year-old patients for a whole week. RESULTS: Participation rate of general practitioners was 58.5%. According to our findings, 13% of 50-74 years patients are considered not be concerned by mass screening, due to familial or personal history, or to specific symptoms. CONCLUSIONS: Colorectal cancer screening protocol have to be fit to level of risk of colorectal cancer. Involvement of general practitioners in colorectal cancer mass screening allows identification of high risk people who can then be managed with a more suitable screening protocol.     

Patterns and correlates of hormone replacement therapy use among middle-aged Australian women

In this study, we examine the patterns of use of hormone replacement therapy (HRT) among women age 51 to 60 years and describe the characteristics of women who currently use HRT, previously used HRT, and have never used HRT. A brief postal survey of 800 women in this age range was used to determine HRT status. Telephone interviews were then conducted with 258 women (111 currently using HRT, 47 who previously used HRT, and 100 who had never used HRT) to determine characteristics of women who currently or previously used HRT or never used HRT, type of HRT used, duration of use, and reasons for use and nonuse. Nearly 40% of women were currently using HRT, 14% had previously used HRT, and 47% had never used HRT. Women currently using HRT were more likely than those not using HRT to have had a hysterectomy, attribute a greater number of symptoms to the climacteric, be in paid employment, and report a greater number of visits to the doctor over the past 12 months. HRT use among Australian women in their 50s is high and rising. Hysterectomy status, the attribution of symptoms to menopause, paid employment, and health care use were the most important correlates of HRT use. Few women specified long-term prevention of osteoporosis or heart disease as a reason for taking HRT.     

Mood disorders and menopause

Studies of depressive symptoms in menopausal women indicate that menopause is not associated with increased rates of depression, although mild mood and anxiety symptoms may occur in the few years prior to menopause. Women with previous affective disorders that are cyclic or that are associated with reproductive events may be at increased risk for depression at menopause. Because women presenting to menopause clinics are more likely to have affective disorders, the efficacy of estrogen for enhancing mood is an important question. Although some researchers suggest that estrogens have proven mood-elevating and antidepressant properties, others caution that the psychologic benefits of HRT deserve more systematic study before conclusions can be made. It has been suggested that minor psychologic symptoms at menopause or psychologic symptoms accompanied by vasomotor symptoms warrant a trial of HRT before considering psychotropic medication. If the psychologic symptoms do not respond to HRT, are not accompanied by vasomotor symptoms, or are clinically severe, antidepressant medication should be considered first or in addition to HRT. The psychologic effects of progesterone and androgens are less extensively studied than those of estrogen, and further research is needed.     

Role of endocrine factors in the development of stomach cancer

After the age of about 35, the natural cycle becomes less predictable. Oestrogen levels fluctuate, leading to some anovulatory cycles. Sometimes periods stop suddenly but more often become erratic and less frequent for a year or two before the final period (menopause). About 75% of women experience symptoms at the time of the menopause, which typically lasts 1-3 years and occurs at around the age of 50. Long-term effects of the menopause are a rapid decline in bone density and greater risk of heart disease. Useful life-style adjustments for menopausal women are to eat calcium-rich foods, stop smoking, restrict alcohol intake and exercise regularly, especially weight-bearing exercise such as walking, dancing or sports. Hormone replacement therapy (HRT) is effective in reducing menopausal symptoms and appears to reduce the long-term risks of osteoporosis and heart disease. Women may start taking HRT before periods cease if they have troublesome symptoms during the pre- and peri-menopausal stage. Women who have had a hysterectomy may use oestrogen on its own. Women who have a uterus need a combination of oestrogen and progestogen. Current evidence suggests that to take HRT for up to 5-8 years incurs no additional risk of breast cancer, although to take it for longer than 10 years seems to increase the risk slightly.     

High-intensity focused ultrasound (HIFU) in the treatment of benign prostatic hyperplasia (BPH)

The prevalence of antibiotic resistant Escherichia coli isolates from faecal samples from 110 veterinarians with different specialties (predominantly working with cattle, swine, poultry, or small animals or working as a non-practitioner, e.g. in government or industry) was investigated. In 22% and 13% of the veterinarians E. coli isolates showed a high level of resistance to oxytetracycline and ampicillin respectively. A significantly higher percentage of cattle practitioners had a high level of antibiotic resistance against ampicillin than did swine practitioners. Furthermore, a significantly higher percentage of poultry practitioners had a high level of antibiotic resistance against oxytetracycline than did swine practitioners and non-practitioners. A significantly higher percentage of practitioners recently (within last 6 months) used antibiotics for personal intake than did the group of non-practitioners. There was no evidence for a relationship between personal intake of antibiotics and the occurrence of a high level of resistance to ampicillin or oxytetracycline. The prevalence of E. coli isolates, that were resistant to several antibiotics was highest in cattle and poultry practitioners and the lowest in swine practitioners. A possible explanation for the observed differences in high level resistance to oxytetracycline and ampicillin between veterinary specialty groups is a difference in exposure to antibiotics during practice.     

The public and the help-giving professions in Australia.

The knowledge and use of the helping professions by the general public was examined with a concentration on psychology, medicine, psychiatry, religion, and social work. A questionnaire was given to 126 residents of Brisbane, Australia, Ss having been selected from 5 socioeconomic areas. The roles of medical doctor, clergy, and social worker were perceived to be known, whereas those of the clinical psychologist and psychiatrist were not as well understood. There was a difference in knowledge and anticipated use of services according to age, whereas no difference was found according to socioeconomic criteria. An education program for both professionals and the general public is suggested. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hormone replacement therapy: cardiovascular benefits for aging women

Observational studies suggest that hormone replacement therapy (HRT) reduces the risk of coronary artery disease by approximately 50%. This review focuses on possible mechanisms for this reduction in disease risk. HRT reverses many of the lipid and lipoprotein change associated with menopause, and the route of hormone delivery influences these changes. Oral HRT improves serum markers of clotting, although it may increase the risk of deep vein thrombosis. Endothelial function, particularly endothelium-dependent vasodilation, improves with estrogen. Central body fat appears to be reduced with oral HRT, possibly reducing the risk of coronary artery disease. Insulin sensitivity, which worsens after menopause, may be improved with HRT. Global systolic function, as measured by ejection fraction, may improve with oral HRT. Understanding how HRT regimens influence cardiovascular risk may allow physicians to make intelligent choices about HRT for particular patients.     

Does hormone replacement therapy inhibit coronary artery calcification?

OBJECTIVE: To determine the association between the use of hormone replacement therapy (HRT) and coronary calcium, in postmenopausal women who had no history of coronary artery disease by double helical computed tomography (CT). METHODS: We used CT to compare the prevalence and extent of coronary calcium in 41 postmenopausal women who were on HRT from the first year of menopause and 37 age-matched controls who had never used HRT. RESULTS: Both groups had a similar rate of smoking, hypertension, a positive family history, and hypercholesterolemia. Coronary calcification was observed in 28.2% of the 78 women studied. The prevalence of coronary calcium was significantly lower among HRT users: six of the 47 (14.6%), compared with 16 of the 37 nonusers (43.2%) (P < .01). The recorded risk factors had no effect on the prevalence of coronary calcium. Stepwise logistic regression analysis, including age, coronary risk factors, and HRT use as independent variables, yielded HRT as the only variable determining the presence of coronary calcium (odds ratio = 0.2; 95% confidence interval 0.06, 0.63; P = .006). CONCLUSION: The lower incidence of coronary calcium in the HRT users suggests that HRT is associated with decreased prevalence of the coronary calcification.