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Women Younger (woman + younger)
Selected AbstractsHigh frequency of multiple HPV types in cervical specimens from Danish womenAPMIS, Issue 2 2009NINA MEJLHEDE Genital human papillomavirus infection (HPV) is common and usually harmless. However, chronic cervical infection with high-risk HPV types can cause cell changes that may eventually lead to cancer. To determine the frequency of individual HPV types among mixed infections, we examined the type distribution among cervical specimens from more than 1000 Danish women. We also examined the HPV type distribution and the frequency of single and multiple HPV types for specimens from 113 women who underwent conization and were diagnosed with cervical intraepithelial neoplasia grade II or worse (CIN2+). Using microarray technology, we found that 49% of the HPV-positive patients were infected with multiple HPV types. Among the CIN2+ diagnosed women, this frequency was 41%. The most frequently found high-risk HPV type was HPV-16, which was found in 25% of the HPV-positive cervical specimens. Among the HPV positive CIN2+ diagnosed women, 48% were HPV-16 positive. Women younger than 30 years of age had a higher frequency of multiple infections (61%) than women older than 30 years (39%). We conclude that cervical infection with multiple HPV types is common among women in all age groups and among women with or without the diagnosis of CIN2+. [source] Rise in maternal mortality in the NetherlandsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2010JM Schutte Please cite this paper as: Schutte J, Steegers E, Schuitemaker N, Santema J, de Boer K, Pel M, Vermeulen G, Visser W, van Roosmalen J, the Netherlands Maternal Mortality Committee. Rise in maternal mortality in the Netherlands. BJOG 2009;117:399,406. Objective, To assess causes, trends and substandard care factors in maternal mortality in the Netherlands. Design, Confidential enquiry into the causes of maternal mortality. Setting, Nationwide in the Netherlands. Population, 2,557,208 live births. Methods, Data analysis of all maternal deaths in the period 1993,2005. Main outcome measures, Maternal mortality. Results, The overall maternal mortality ratio was 12.1 per 100 000 live births, which was a statistically significant rise compared with the maternal mortality ratio of 9.7 in the period 1983,1992 (OR 1.2, 95% CI 1.0,1.5). The most frequent direct causes were (pre-)eclampsia, thromboembolism, sudden death in pregnancy, sepsis, obstetric haemorrhage and amniotic fluid embolism. The number of indirect deaths also increased, mainly caused by an increase in cardiovascular disorders (OR 2.5, 95% CI 1.4,4.6). Women younger than 20 years and older than 45 years, those with high parity or from nonwestern immigrant populations were at higher risk. Most substandard care was found in women with pre-eclampsia (91%) and in immigrant populations (62%). Conclusions, Maternal mortality in the Netherlands has increased since 1983,1992. Pre-eclampsia remains the number one cause. Groups at higher risk for complications during pregnancy should be better identified early in pregnancy or before conception, in order to receive preconception advice and more frequent antenatal visits. There is an urgent need for the better education of women and professionals concerning the danger signs, and for the training of professionals in order to improve maternal health care. [source] Atypical glandular cells of undetermined significance (AGUS): Clinical considerations and cytohistologic correlationDIAGNOSTIC CYTOPATHOLOGY, Issue 3 2002Joseph F. Nasuti M.D. Abstract The diagnoses of atypical glandular cells of undetermined significance (AGUS) made upon evaluation of cervical/vaginal (Pap) smears is examined to ascertain salient clinical and cytologic features that may lead to better characterization of the true nature of these lesions. Prior history of squamous dysplasia, age of the patient, and the occurrence of abnormal microbiopsy tissue fragments are investigated to determine their value in the proper evaluation of AGUS specimens. Of the 86,234 Pap smears submitted to our laboratory during a period of 2 yr, 187 (0.2%) were diagnosed as AGUS. Available follow-up in 128 (69%) cases revealed 54 (42%) significant tissue proven abnormalities, the majority (55%, 30 patients) of which were diagnosed as squamous intraepithelial lesions (SIL). Squamous dysplasia is significantly more common in women younger than 40 (15/18, 83%) and in patients with prior history of SIL (29/30, 97%). In addition, all nine patients diagnosed with endometrial lesions on subsequent histology were older than 40. Age, however, was not a discriminating factor in women proven to have endocervical glandular lesions. Additionally, certain tissue fragment cytomorphologic features were significantly more often observed on follow-up in specific histologic diagnostic categories. The Pap smears of patients diagnosed with SIL were noted to contain tissue fragments composed of both dysplastic squamous and benign glandular cells in 29 of 30 (97%). The presence of two distinct populations of glandular tissue fragments (typical and atypical) was found in the Pap smears of all nine women with endometrial abnormalities and in the smears of most women subsequently diagnosed with endocervical glandular lesions (87%, 13/15). These observations suggest that a more specific and clinically useful Pap smear interpretation other than AGUS is often possible by consideration of the patient's age and prior history along with the correct identification of the type of atypical cells observed in abnormal tissue fragments. Diagn. Cytopathol. 2002;26:186,190; DOI 10.1002/dc.10070 © 2002 Wiley-Liss, Inc. [source] Longitudinal Study of Changes in Hip Bone Mineral Density in Caucasian and African-American WomenJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2005Jane A. Cauley DrPH Objectives: To determine whether changes in hip bone mineral density (BMD) differ in Caucasian and African American women. Design: Longitudinal study of changes in hip BMD. Setting: Four U.S. clinical centers. Participants: Six thousand seven Caucasian (mean age 73) and 482 African-American (mean age 75) women enrolled in the Study of Osteoporotic Fractures. Measurements: Total hip and femoral neck BMD were measured an average of 3.5 years apart (Caucasian) and 2.0 years apart (African American). Annual absolute and percentage changes in BMD and bone mineral apparent density (BMAD) were calculated. Results: The multivariate adjusted annual percentage change in BMD was greater in Caucasian than African-American women at the total hip (,0.574%/y vs ,0.334%/y) and femoral neck (,0.515%/y vs ,0.203%/y) (both, P<.001). Similar findings were observed for BMAD. The average annualized rate of BMD loss was twice as high in women aged 75 and older as in women younger than 75 in both ethnic groups. The annual percentage loss in femoral neck BMD in nonusers versus hormone therapy users was (,0.57% vs ,0.22%) in Caucasians and (,0.35% vs 0.64%) in African Americans (interaction P=.03). Conclusion: The average rate of hip BMD loss is approximately twice as great in Caucasian as African-American women and increases with age in both groups. The hormonal and biochemical factors that contribute to ethnic differences and the increase in bone loss with advancing age need to be identified. [source] Sexual Healthcare Needs of Women Aged 65 and OlderJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2004Margaret R. H. Nusbaum DO Objectives: To compare prevalence and type of sexual concerns and interest in and experience with discussing these concerns with physicians for women younger than 65 and 65 and older. Design: Cross-sectional survey. Setting: Departments of Family Practice and Obstetrics and Gynecology at Madigan Army Medical Center, Tacoma, Washington. Participants: Of 1,480 women seeking routine gynecological care, 964 (65%) responded; 163 (17%) were aged 65 and older. Measurements: Self-reported sexual concerns and interest in and experience with discussing these concerns with their physicians. Results: Older women had a similar number of sexual concerns as younger women and were more likely to be concerned about their partner's sexual difficulties. Older women were less likely to have ever had the topic of sexual health raised during healthcare visits. Even though these women were more likely to report youthful-appearing physicians as hindering the topic of sexual health, the majority indicated that they would have discussed their concerns had the physician raised the topic and were interested in a follow-up appointment to do so. Conclusion: Although the types of sexual concerns vary in frequency, women aged 65 and older have a similar number of sexual concerns as younger women. Older women want physicians to inquire about their sexual health. This discussion should include inquiries about their partner's sexual functioning. To overcome age as a barrier to this discussion, younger physicians should be particularly attentive to initiating the topic of sexual health. [source] The FRAX tool in French women: How well does it describe the real incidence of fracture in the OFELY cohortJOURNAL OF BONE AND MINERAL RESEARCH, Issue 10 2010Elisabeth Sornay-Rendu Abstract The FRAX tool estimates an individual's fracture probability over 10 years from clinical risk factors with or without bone mineral density (BMD) measurement. The aim of our study was to compare the predicted fracture probabilities and the observed incidence of fracture in French women during a 10-year follow-up. The probabilities of fracture at four major sites (hip, clinical spine, shoulder, or wrist) and at the hip were calculated with the FRAX tool in 867 women aged 40 years and over from the Os des Femmes de Lyon (OFELY) cohort. The incidence of fracture was observed over 10 years. Thus 82 women sustained 95 incident major osteoporotic (OP) fractures including 17 fractures at the hip. In women aged at least 65 years (n,=,229), the 10-year predicted probabilities of fracture with BMD were 13% for major OP fractures and 5% for hip fractures, contrasting with 3.6% and 0.5% in women younger than 65 years (p,<,.0001). The predicted probabilities of both major OP and hip fractures were significantly higher in women with osteoporosis (n,=,77, 18% and 10%) and osteopenia (n= 390, 6% and 2%) compared with women with normal BMD (n,=,208, 3% and <1%; p,<,.0001. The predicted probabilities of fracture were two and five times higher in women who sustained an incident major OP fracture and a hip fracture compared with women who did not (p,<,.0001). Nevertheless, among women aged at least 65 years with low BMD values (T -score , ,1; n,=,199), the 10-year predicted probability of major OP fracture with BMD was 48% lower than the observed incidence of fractures (p,<,.01). A 10-year probability of major OP fracture higher than 12% identified more women with incident fractures than did BMD in the osteoporotic range (p,<,.05). In French women from the OFELY cohort, the observed incidence of fragility fractures over 10 years increased with age following a pattern similar to the predicted probabilities given by the FRAX tool. However, in women aged at least 65 years with low BMD, the observed incidence of fractures was substantially higher than the predicted probability. © 2010 American Society for Bone and Mineral Research. [source] First-trimester Down syndrome screening in women younger than 35 years old and cost-effectiveness analysis in Taiwan populationJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 5 2009Ching-Yu Chou MD Summary Objectives, Outcome of the first-trimester Down syndrome screening in younger population was less reported before. We present the outcome of this screening in Taiwanese women younger than 35 years old. We also test whether or not the first-trimester Down syndrome screening of women <35 years of age and women >35 years old routinely receiving amniocentesis is cost-effective compared with all pregnant women screened with this test in the setting of increased maternal age. Methods, From 1999 to 2007, the first-trimester Down syndrome screening including nuchal thickness, pregnancy-associated plasma protein A and free ,-hCG are provided to 10 811 singleton women <35 years of age with the cut-off of 1/270. A cost-effectiveness analysis of young women receiving this screening and older women undergo amniocentesis versus all women undergo this screening was performed in Taiwan population from 1987 to 2006, in which advanced age pregnancies increased from 2.8% to 11.6% of total pregnancies. Results, Detection rates of trisomy 21, trisomy 18, Turner syndrome and other chromosome anormalies in women <35 years of age are 87.5% (14/16), 50% (2/4), 80% (8/10) and 63% (12/19), respectively, with a false-positive rate of 5.5% (590/10 811). As advanced age pregnancies reached 11.6%, the average cost per one case averted for all women screened ranged from $77 204 to $98 421, while the cost ranged from $99 647 to $116 433 for only women <35 years of age receiving this screening. Conclusions, In an aging population, the first-trimester Down syndrome screening should be implemented for all pregnant women when it is available. [source] Parent-Child Relations Among Minor Females Attending U.S. Family Planning ClinicsPERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH, Issue 4 2005Rachel K. Jones CONTEXT: Relatively little is known about parent-child relations among minor females who use family planning clinics. Such information could inform the debate on parental involvement legislation and help clinics develop effective strategies to promote positive parental engagement. METHODS: Self-administered surveys were completed in 2003,2004 by 1,526 women younger than 18 attending 79 U.S. family planning clinics, providing measures of parent-child relations, perceived parental attitudes toward sex and birth control, and parental knowledge of the clinic visit. Associations between relationships with parents and parental knowledge of clinic visits were examined using t tests and logistic regression. RESULTS: Many adolescents had talked to parents about sexual issues (50,80%, depending on the topic) and reported high levels of connectedness with parents (68%). A substantial minority (19%) perceived that parents disapprove of their both having sex and using birth control. The majority (60%) reported that a parent knew of their clinic visit; such reports were most common among those who had high levels of connectedness to parents and communication with parents about sexual issues, and those who did not perceive parents to disapprove of sex and birth control. Adolescents aged 15 and younger were more likely than 17-year-olds to indicate that a parent knew they were at the clinic and to report that a parent suggested the clinic. CONCLUSIONS Overall, minors attending family planning clinics have good relations with parents. The youngest adolescents may be at family planning clinics specifically because parents are involved in their reproductive health decisions. [source] ,Blood On The Tracks' from corpora lutea to endometriomas,BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2009P Vercellini Objective, To detect a direct transition from a haemorrhagic corpus luteum to an endometriotic cyst by serial transvaginal ultrasonographic scans. Design, Prospective observational study. Setting, An academic tertiary care and referral centre for women with endometriosis. Population, One hundred and nine women younger than 40 years, with regular menstrual cycles, undergoing first-line surgery for endometriomas, and not wanting postoperative oral contraception. Methods, Three-monthly transvaginal ultrasonography during the luteal phase for 2 years after surgery. Main outcome measure, Sonographic identification of progression from a haemorrhagic corpus luteum to a recurrent endometriotic cyst. Results, A haemorrhagic corpus luteum was identified in 13 women. Serial ultrasonographic scans demonstrated transition to an endometriotic cyst in 11 (85%) instances and resorption in two. A unilateral endometriotic cyst without previous detection of a cystic corpus luteum was observed in 14 women. Conclusions, Bleeding from a corpus luteum appears to be a critical event in the development of endometriomas. [source] Maternal factors and the probability of a planned home birthBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2005S. Anthony Objectives In the Netherlands, approximately one-third of births are planned home births, mostly supervised by a midwife. The relationship between maternal demographic factors and home births supervised by midwives was examined. Design Cross-sectional study. Setting Dutch national perinatal registries of the year 2000. Population All women starting their pregnancy care under the supervision of a midwife, because these women have the possibility of having a planned home birth. Methods The possible groups of birth were as follows: planned home birth or short stay hospital birth, both under the supervision of a midwife, or hospital birth under the supervision of an obstetrician after referral from the midwife during pregnancy or birth. The studied demographic factors were maternal age, parity, ethnicity and degree of urbanisation. Probabilities of having a planned home birth were calculated for women with different demographic profiles. Main outcome measure Place of birth. Results In all age groups, the planned home birth percentage in primiparous women was lower than in multiparous women (23.5%vs 42.8%). A low home birth percentage was observed in women younger than 25 years. Dutch and non-Dutch women showed almost similar percentages of obstetrician-supervised hospital births but large differences in percentage of planned home births (36.5%vs 17.3%). Fewer home births were observed in large cities (30.5%) compared with small cities (35.7%) and rural areas (35.8%). Conclusions This study demonstrates a clear relationship between maternal demographic factors and the place of birth and type of caregiver and therefore the probability of a planned home birth. [source] Prognostic role of pregnancy occurring before or after treatment of early breast cancer patients aged <35 years,CANCER, Issue 22 2009A GET(N)A Working Group analysis Abstract BACKGROUND: Usual practices recommend waiting at least 2 years between diagnosis of early breast cancer (EBC) and pregnancy. Few data highlighted a harmful effect of an early pregnancy for low-risk patients. The authors analyzed retrospectively data from women younger than 35 years who became pregnant before or after treatment of EBC. METHODS: Between 1990 and 1999, 908 consecutive EBC patients were analyzed. The primary endpoint was to compare overall survival (OS) between pregnant and nonpregnant patients. The secondary endpoint was to establish a score index laying down the risk of distant recurrence. RESULTS: Within the year before the diagnosis, 105 (11.6%) patients became pregnant and 118 (13%) were pregnant after treatment. In a multivariate model, a pregnancy before the diagnosis was not predictive of death but of local relapse. A pregnancy subsequent to breast cancer therapy resulted in a 77% decrease of death (P < .001). In good-prognosis score index patients, the annual risk of relapse remained low. In patients having the higher score, recurrences occurred mainly during the first years after the treatment. Beyond 80 months, the annual risk of relapse seemed to be similar to those of lower-risk subgroups. CONCLUSIONS: In women aged younger than 35 years, a pregnancy occurring before or after the diagnosis of breast cancer was not an independent prognostic factor of death. In the subset of patients having a high risk of relapse, it may be preferable to postpone a pregnancy beyond 5 years after the breast cancer therapy. Cancer 2009. © 2009 American Cancer Society. [source] Pathologic features of endometrial carcinoma associated with HNPCCCANCER, Issue 1 2006A comparison with sporadic endometrial carcinoma Abstract BACKGROUND Endometrial carcinoma is a common malignancy in hereditary nonpolyposis colorectal carcinoma (HNPCC). Like colon carcinoma, endometrial carcinoma is diagnosed at an earlier age in women with HNPCC. In contrast to colon carcinoma, the pathologic features of endometrial carcinoma in HNPCC have not been studied in detail. It was the purpose of this study to pathologically characterize a series of HNPCC associated endometrial carcinomas. METHODS Fifty women with HNPCC and endometrial carcinoma were analyzed from four different hereditary cancer registries. H&E stained slides and pathology reports were reviewed for clinically important pathologic features of endometrial carcinoma. These results were compared with those for two different groups of sporadic endometrial carcinoma , women younger than age 50 years (n = 42) and women of all ages with tumors demonstrating microsatellite instability (MSI-high) secondary to methylation of MLH1 (n = 26). RESULTS Nearly one-fourth of HNPCC patients in this study had endometrial tumors with pathologic features that would require adjuvant therapy after hysterectomy. There was a trend toward the HNPCC patients having more nonendometrioid tumors; all of these patients were carriers of MSH2 mutations. Such nonendometrioid tumors were extremely rare in the MLH1 methylated group. A subset of MLH1 methylated sporadic tumors demonstrated a unique, ,undifferentiated' histology that was not observed in HNPCC or the young group. CONCLUSION Data suggest a genotype,phenotype relation in which microsatellite instability resulting from MLH1 methylation is almost exclusively associated with classical or ,undifferentiated' endometrioid tumors, whereas microsatellite instability secondary to MSH2 mutation can result in a more variable histologic spectrum of endometrial carcinoma. Cancer 2006. © 2005 American Cancer Society. [source] Histopathology of breast cancer among African-American women,CANCER, Issue S1 2003Lavinia P. Middleton M.D. Abstract Although the overall incidence of breast cancer in African-American women is lower than in white women, African-American women younger than 50 years old have a higher incidence of breast cancer than white women. African-American women with breast cancer have a poorer survival rate than white women and are more likely to die of breast cancer in almost every age group. To explain this disparity, we studied a substantial body of literature that reported a biologic difference in the tumors found in African-American and white women. Specifically, more aggressive histopathologic patterns have been described among African-American patients with breast cancer when compared with white women. In addition, there are data that support an ethnicity-related variation in the expression of breast tumor hormonal markers. The objective of this study was to critically evaluate the existing published data on the histologic features of breast cancer to determine whether breast cancer in African-American women is a histologically more aggressive disease than in white women. We conclude that the aggressive tumor histology reported in African-American women has not been analyzed carefully with respect to the age of the patient at the time of diagnosis and the stage of disease at presentation. Furthermore, there is a need for central pathology review using accepted, published criteria for diagnosis of uncommon and controversial histologic subtypes of breast cancer. Cancer 2003;97(1 Suppl):253,7. Published 2003 by the American Cancer Society. DOI 10.1002/cncr.11021 [source] Cost-effective mammography screening in Korea: High incidence of breast cancer in young womenCANCER SCIENCE, Issue 6 2009Soon Young Lee The epidemiological characteristics of breast cancer in Korean women are different from the characteristics reported in Western women. The highest incidence rate occurs in Korean women in their 40s. The purpose of this study was to determine the most cost-effective screening interval and target age range for Korean women from the perspective of the national healthcare system. A stochastic model was used to simulate breast cancer screenings by varying both the screening intervals and the age ranges. The effectiveness of mammography screening was defined as the probability of detecting breast cancer in the preclinical state and the cost was based on the direct cost of mammography screening and the confirmative tests. The age-specific mean sojourn times and the sensitivity of the mammography were applied in the stochastic model. An optimal cost-effectiveness was determined by the incremental cost-effectiveness ratio and lifetime schedule sensitivity. Sensitivity analyses were undertaken to assess parameter uncertainty. The selected cost-effective strategies were: (1) the current biennial mammography screenings for women who are at least 40 years old; (2) biennial screening for women between the ages of 35 and 75 years; and (3) a combination strategy consisting of biennial screening for women aged between 45 and 54 years, and 3-year interval screening for women aged between 40 and 44 years and 55 and 65 years. Further studies should follow to investigate the effectiveness of mammography screening in women younger than 40 years in Asia as well as in Korea. (Cancer Sci 2009; 100: 1105,1111) [source] | ||||||||||