Obstetrics and Gynaecology - Research Publications
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ItemShift work, hCLOCK T3111C polymorphism, and endometriosis risk(LIPPINCOTT WILLIAMS & WILKINS, 2008-05)BACKGROUND: Endometriosis, a dysplastic disease affecting approximately 5%-10% of US reproductive-age women, has been linked to exposures indicating high circulating estrogen levels. One such exposure may be night shift work, which has been associated with menstrual disruption and increased risk of 2 other estrogen-influenced diseases, breast cancer and adverse coronary events. METHODS: In this population-based case-control study, cases were 235 women aged 18 to 49 years who were enrolled in a large health-maintenance organization in the state of Washington, and who were first diagnosed with surgically-confirmed endometriotic disease between April 1, 1996 and March 31, 2001. Controls were 545 randomly selected women enrolled in the same program who did not have a history of endometriosis. Study participants were asked about night shift work in all paid full-time or part-time jobs they had worked from age 18 to the reference date. Genotypes for T3111C hCLOCK were determined for a subset of 218 cases and 456 controls. RESULTS: Any night shift work was associated with a 50% increase in risk of endometriosis (odds ratio = 1.48 [95% confidence interval = 0.96-2.29]), and working more than half of shifts on a job at night was associated with a nearly doubled disease risk (1.98 [1.01-3.85]). Changing sleep patterns on days off was associated with further increases in disease risk. T3111C hCLOCK polymorphism was unrelated to endometriosis status and did not modify the effect of shift work on endometriosis. CONCLUSIONS: These findings suggest that some aspects of night shift work may influence the development of endometriosis.
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ItemNo Preview AvailableUterine leiomyoma and menstrual cycle characteristics in a population-based cohort study(OXFORD UNIV PRESS, 2004-10)BACKGROUND: We examined the association of uterine leiomyoma with menstrual cycle characteristics in a population of non-care-seeking women. METHODS: This cross-sectional study uses data from the Seveso Women's Health Study (SWHS), a population-based cohort in Italy. Participants included 341 premenopausal women, 30-60 years old, who had an intact uterus and were not pregnant, lactating, or using oral contraception or intra-uterine devices. We examined the presence of any ultrasound-detected uterine leiomyoma in relation to self-reported menstrual cycle length, flow length and heaviness of flow. The association of leiomyoma number, volume, tissue layer location and axial position with menstrual cycle characteristics was also examined. RESULTS: Uterine leiomyomata were detected in 73 women (21.4%). After adjustment for covariates, the presence of a leiomyoma was not significantly related to menstrual cycle length, flow length or heaviness of flow [odds ratio (OR) for scanty flow =1.9, 95% confidence interval (CI) 0.8-4.3; OR for heavy flow =1.3, 95% CI 0.7-2.5; relative to moderate flow]. Number, volume, tissue layer location (subserosal or intramural) and axial position (anterior or posterior) of the leiomyoma were also not related to menstrual cycle characteristics. CONCLUSION: In this Italian population of women not seeking gynaecological care, menstrual characteristics are not related to leiomyoma.
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ItemNo Preview AvailableBurden of community-onset Escherichia coli bacteremia in seniors(UNIV CHICAGO PRESS, 2005-05-01)BACKGROUND: Although Escherichia coli is a well-recognized cause of urinary tract infection in seniors, little is known about the burden of invasive E. coli infection in this population. METHODS: We conducted a population-based cohort study of 46,238 noninstitutionalized Group Health Cooperative members>or=65 years of age to ascertain incidences of community-onset E. coli bacteremia and, for comparison, pneumococcal bacteremia, and we then performed a case-control study to identify risk factors for community-onset E. coli bacteremia. RESULTS: The overall rate of community-onset E. coli bacteremia in the study cohort was 150 cases/100,000 person-years, which was approximately 3 times higher than the rate of pneumococcal bacteremia. In the case-control study, urinary catheterization and urinary incontinence were the only factors associated with an increased risk of E. coli bacteremia in men (62 cases), whereas cancer, renal failure, congestive heart failure, coronary artery disease, and urinary incontinence were associated with an increased risk of E. coli bacteremia in women (119 cases). CONCLUSIONS: E. coli appears to be the leading cause of community-onset bacteremia in seniors, and, on the basis of these rates, we estimate that 53,476 cases occur in noninstitutionalized seniors each year in the United States. Community-onset E. coli bacteremia in seniors is, therefore, an infection of public health importance.
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ItemLifetime occupational history and risk of endometriosis(SCANDINAVIAN JOURNAL WORK ENVIRONMENT & HEALTH, 2009-05)OBJECTIVES: Endometriosis is the presence of functioning endometrial glands and stroma outside the uterine cavity, most often in the pelvic peritoneal cavity. Women with endometriosis commonly have dysmenorrhea, dyspareunia, pain, menorrhagia, and/or metrorrhagia. Disease complications can include adhesions, chronic pain, and infertility. In this exploratory case-control study, we investigated the relationship between lifetime occupational history and surgically confirmed endometriosis in a population-based sample. METHODS: We conducted interviews with participants, all reproductive-aged female members of a large health-maintenance organization who were first diagnosed with surgically confirmed endometriosis between April 1, 1996 and March 31, 2001. Interviews were also conducted with randomly selected controls, reproductive-aged female enrollees of the same organization from the same time period. Each reported job was coded using US Census Occupations and Industries codes, and classified into categories. We used unconditional logistic regression to compare having worked in a given job class with never having done so. RESULTS: Our study found that an increased risk of endometriosis was associated with having worked as a flight attendant, service station attendant, or health worker, particularly as a nurse or health aide (flight attendant: odds ratio (OR) 9.80, 95% CI 1.08-89.02; service station attendant: OR 5.77, 95% CI 1.03-32.43; health worker: OR 1.49, 95% CI 1.03-2.15). Income and education did not make a difference in the OR estimates for the occupations examined. CONCLUSIONS: This exploratory study suggested that there might be an associated risk of endometriosis for those women who have worked as a flight attendant, service station attendant, or health worker, particularly a nurse.
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ItemNo Preview AvailableMenopause.(Random House Australia, 2006-08)This book is designed to help you participate as an equal partner in your health care.