Compliance In Women Research Articles

Postpartum Glucose Follow-up Screening Among Women With Gestational Diabetes Mellitus: A Retrospective Cohort Study

Abstract Objective To evaluate the impact of pre-gestational and gestational characteristics on postpartum glucose follow-up screening (PGFS) compliance in women diagnosed with gestational diabetes mellitus (GDM) in southwest China. Methods This retrospective cohort study was conducted in West China Second Hospital, Sichuan University. Pre-gestational and gestational factors were extracted from hospital records and compared between women who completed PGFS and those who did not. The screening method chosen was the 75g oral glucose tolerance test (OGTT), performed 4–12 weeks postpartum. Univariate analysis, logistic regression analysis, and Cochran-Armitage test were used to assess associations between maternal characteristics and PGFS compliance. Results A total of 3047 women with GDM were included, with a PGFS completion rate of 47.2%. Of those who completed PGFS, 430 women (29.9%) presented abnormal results: 1.8% with impaired fasting glucose (IFG), 24.1% with impaired glucose tolerance (IGT), 2.2% with both IFG and IGT 2.2%, and 1.8% with suspected diabetes. Independent factors associated with non-compliance to PGFS included higher pre-gestational BMI (odds ratio (OR): 0.952; 95% confidence interval (CI): 0.922, 0.984), multipara (OR: 0.721; 95% CI: 0.593, 0.877), use of assisted reproduction technology (ART) (OR: 1.427; 95% CI: 1.080, 1.885), excessive gestational weight gain (OR: 0.956; 95% CI: 0.936, 0.977), elevated fasting plasma glucose (FPG) prior to delivery (OR: 0.909; 95% CI: 0.835, 0.988), and undergoing cesarean section (OR: 1.232; 95% CI: 1.017, 1.492) were independent influencing factors of failing to PGFS. PGFS completion rates significantly decreased with increasing pre-gestational BMI and earlier gestational age (P < 0.001). Conclusions Establishing dedicated postpartum follow-up teams and targeting women with higher pre-gestational BMI, multiparity, ART use, excessive gestational weight gain, elevated pre-delivery FPG, and those undergoing cesarean section are critical to improving postpartum GDM management.

0531 Excessive mask leak and its association with poor PAP compliance in women. A secondary analysis of the AWARE study

Abstract Introduction Studied have shown that continuous positive airway pressure(CPAP) adherence is lower in women. However, understanding of the specific challenges faced by woman when starting therapy remains poor. Specifically, is there any relationship between leak and women’s characteristics that could influence adherence? Methods The AWARE-study is a longitudinal pilot-study with the objective to identify in women modifiable barriers to initiating/adhering to treatment over 3-months. Adherence was considered when using CPAP for a minimum 4-hours 70% of the nights. But, is there any association between leak, mask type and other patient’s characteristics that could influence adherence in women? This is a secondary analysis looking at leak as a consequence of poor adherence in women within the AWARE-study. We gathered data directly from the PAP-data-base and evaluated adherence within the first 3-months after starting therapy and usage at-present-time. We investigated leakage (>25 L/min) and gathered information about severity of OSA, age, BMI, and race. Our aims: to evaluate for leak as a cause of poor adherence and to identify characteristics that could potentiate leak in women. Results Data from 49 women from the AWARE-study between the ages of 28-85, with a recent diagnosis of OSA who started CPAP was analyzed. Adherence, leakage, age, OSA severity, and mask type was gathered. Chi-squared test of independence suggests a relationship between leakage and present adherence, Chi2(1)=11.34, p=0.001. Of those women experiencing high leakage, 83% were non-adherent to therapy. Logistic regression was run to compute an odds ratio with 95% CI. Those experiencing high leakage have about 92% times lower odds to still be compliant than those not experiencing high leakage [OR=0.08, 95% CI: 0.007, 0.478]. Overall, mask type relates to adherence, 72% of nasal mask wearers were still being adherent versus 38% when using facial masks. The prediction of adherence from leakage does not significantly differ across mask type. Age was found to be related to adherence; 57% of women under 50-years were not adherent to CPAP versus 26% in women over 50-years. Conclusion This information could guide us in suggesting strategies for better mask choosing and possibly to implement more specific strategies that can increase adherence in women. Support (if any)

Young Healthy Men and Women Have Similar Arterial Stiffness at Rest and Post‐Acute Inflammation

The cardioprotective effects of estrogen on arterial function and inflammation are well‐documented; however, it is unclear whether arterial stiffness and compliance vary between healthy premenopausal women and age‐matched men following an acute inflammation. The objective of the current study was to evaluate central and local arterial stiffness and compliance at rest and in response to an acute inflammatory stimulus, specifically, when estrogen levels are thought to be similar between young healthy women and men. It was hypothesized that sustained effects of estrogen throughout the lower‐hormone phase of a natural menstrual or oral contraceptive pill cycle would induce lower central and local stiffness and higher compliance in women as compared to men at rest and in response to an acute inflammatory stimulus. Concentrations of interleukin‐6 (IL‐6) and assessments of central and local arterial stiffness and compliance were obtained from 29 young healthy adults (21±3 y; female, n=15) at baseline (BL), and 24‐ (24H) and 48‐hours (48H) following administration of a seasonal influenza vaccine. To capture the lower‐hormone phases of female participants, women were assessed within the early follicular phase if naturally menstruating or the placebo pill phase if using oral contraceptives. Central stiffness was assessed via carotid‐to‐femoral pulse wave velocity (cfPWV) and local stiffness was measured using ultrasonography at the carotid artery to obtain β‐stiffness, elastic modulus (Ep) and arterial compliance (AC). IL‐6 concentrations were expressed as change‐values from BL and were compared between sexes and timepoints (24H‐BL vs. 48H‐BL). Indices of central and local stiffness and AC were compared between sexes and individual timepoints (BL vs. 24H vs. 48H). Men and women exhibited similar changes in concentrations of IL‐6 (effect of sex: P=0.60), with significant elevations at 24H‐BL as compared to 48H‐BL (effect of time: P=0.0002), indicating that the influenza vaccine successfully induced an acute inflammatory response in both groups. However, there were no effects of sex or time on cfPWV, β‐stiffness or Ep (P>0.05 for all). While men displayed greater AC as compared to women at BL (1.09±0.25 vs. 0.88±0.17 mm2/kPa, P=0.01), there were no sex‐differences at 24H and 48H (P=0.10 and 0.70, respectfully), suggesting that the women were able to compensate for their lower resting AC values when exposed to an acute inflammatory stimulus. In conclusion, when estrogen levels are similar between young healthy women and men, there are no sex‐differences in central or local arterial stiffness at rest nor in response to an acute inflammatory stimulus.

Compliance with post-cesarean section thromboprophylaxis recommendations. A cross sectional study in 233 women

Cesarean section increases four times the risk of venous thromboembolism compared to vaginal delivery. The Royal College of Obstetricians and Gynecologists guidelines are used at our service. A written alert was designed to stratify patients at high, intermediate or low risk making a suggestion for thromboprophylaxis. To assess the compliance with the guidelines and to evaluate the impact of a written alert in the thromboprophylaxis compliance in women subjected to caesarean section. Review of medical records of 233 women aged 19 to 32 years, subjected to a caesarean section in a Gynecology Service, between 2016-2017. Compliance with recommendations was observed in 29% of patients (68/233), 86% in the low-risk group, 26% in the intermediate risk group and 100% in the high risk group. In 41/233 (18%) of patients, a written alert was included in the medical record. Compliance with recommendations in the presence of the written alert was 61% (25/41 women) compared to 22% (43/192) in those lacking the alert (p < 0.01). In women whose emergency caesarean section was the only risk factor, the compliance with the recommendation was 8%, compared with 30% among those who had at least one thrombotic risk factor associated with caesarean section (p < 0.01). In this cross-sectional study, we observed a low compliance with thromboprophylaxis guidelines in cesarean women. We observed that the use of a written alert improved the compliance with thromboprophylaxis.

Metabolic PCOS Features Are Ameliorated by Mitochondrial Uncoupler BAM15 in a PCOS Mouse Model

Polycystic ovary syndrome (PCOS) is a prevalent endocrine condition characterized by endocrine, reproductive and metabolic dysfunction. At present, there is no cure for PCOS and current treatments are suboptimal. Obesity and adverse metabolic features are prevalent in women with PCOS, with weight loss having a beneficial effect on PCOS features. The use of dietary interventions aimed at weight loss have low long-term compliance in women suffering from PCOS. Recent data from animal studies has shown that a small molecule mitochondrial uncoupler, BAM15, is an effective method to pharmacologically treat obesity and metabolic diseases. Therefore, the aim of this study was to investigate the efficacy of BAM15 to ameliorate PCOS-traits in a hyperandrogenic PCOS mouse model. As expected, exposure of female mice to dihydrotestosterone (DHT) induced the PCOS metabolic features of increased body weight (P<0.05), lean mass (P<0.001), increased parametrial and mesenteric fat pad weights (both P<0.05) and adipocyte hypertrophy (P<0.05). Additionally, DHT-induced PCOS mice exhibited insulin resistance measured by HOMA-IR, increased cholesterol and fasting triglyceride levels and hepatic steatosis (all P<0.05). In contrast, DHT-induced PCOS females treated with BAM15 displayed body weights which were comparable with controls, a significant decrease in parametrial and mesenteric fat depot weights (P<0.05) and reduced adipocyte hypertrophy. Furthermore, BAM15 treatment decreased insulin resistance, cholesterol and fasting triglyceride levels, as well as the degree of hepatic steatosis observed in PCOS females, to levels comparable with controls. PCOS mice presented the reproductive PCOS traits of irregular cycles and ovulatory dysfunction, however BAM15 did not improve these PCOS traits. These findings demonstrate that the pharmacologic mitochondrial uncoupler BAM15 is able to ameliorate metabolic PCOS features in a hyperandrogenic PCOS mouse model. These data provide compelling evidence to support BAM15 as a potential innovative and viable therapeutic approach to manage metabolic traits associated with PCOS.

Low Bladder Compliance in Women: A Clinical Overview

(Abstracted from Female Pelvic Med Reconstr Surg 2020;26:263–269) The ability of a normally functioning bladder to accommodate large volumes of urine is termed bladder compliance. Both the viscoelastic properties of the bladder wall and neural responses influence bladder storage.

Activity Rest Prescription and Compliance in Women With Short Cervix [03K

INTRODUCTION: Despite lack of evidence to support efficacy, activity restriction is one of the most common prescribed interventions used for the prevention of preterm birth. With short cervix being one of the risk factors for preterm birth, the purpose of our study was to determine if women with short cervix are prescribed activity rest and if they are compliant. METHODS: This is a single-center retrospective cohort study of women identified with short cervix (&lt;25 mm) prior to 28 weeks gestation of pregnancy who delivered between January 2018 and February 2019. The verified cohort was contacted by phone and administered a questionnaire to identify details regarding activity rest (work restrictions, pelvic rest, lifting restrictions or bed rest) during pregnancy. The primary outcome is rate of activity restriction in women and compliance of prescribed rest. RESULTS: Of women questioned, 37% of women with short cervix were placed on activity rest and 83% of these women were placed on rest by an obstetrician. 100% of women reported compliance with prescribed activity rest. 41% of women were prescribed pelvic rest separately from other forms of activity rest. Average gestational age at delivery was comparable for women on activity rest and those not on activity rest (31.2 vs 31.7 weeks gestation). CONCLUSION: Women with short cervix are being prescribed activity rest almost exclusively by obstetricians and are strictly compliant. Women consider activity rest and pelvic rest separate entities. Education to physicians may be needed to reduce unnecessary activity rest in pregnancy as it does not improve preterm birth rate.

Resistance and compliance in women’s academic identity work in the Global South

AbstractThe aim of this study is to explore women academic's identity work in the context of the Global South (Indonesia). This is done by examining how the interplay between macro‐level social, cultural and political influences and micro‐processes produce moments of compliance and resistance. To this end, the following research question is posed: What is the nature of identity work among women academics in higher education institutions of the Global South where there are shifting and conflicting social and cultural conditions? This study contributes by illuminating the ways in which women comply with or resist traditional and contemporary organisational and occupational structures that produce gender inequality. It also contributes to understanding how the interplay of power and resistance influences women's academic identity work in developing nations.

Long-term compliance of vaginal pessaries: Does stress urinary incontinence matter?

Vaginal pessary treatment for pelvic organ prolapse (POP) is relatively safe and cost-effective. Since long-term use is an important key to keep the benefit of pessary treatment, we would like to investigate the factors which might affect the compliance of vaginal pessaries. In this retrospective study, 65 women were included, and we found poor compliance in women with severe stress urinary incontinence (SUI) after reduction (1-hour pad test >10 gm vs ≦10 gm, 57.1% vs. 84.3%, P = .027). Besides, women younger than 60 years-old also had poor compliance (age ≦60-year-old vs >60-year-old, 58.3% vs 83.0%, P = .04). Other factors such as POP stage, history of hysterectomy, and types of pessaries, did not show significant influence on the long-term compliance in this study. Therefore, to evaluate the severity of SUI after reduction before providing pessary treatment is important to predict long-term compliance. Meanwhile, long-term pessary treatment seems to be more acceptable to elderly patients.

NOSOLOGICAL STRUCTURE OF ACUTE CORONARY EVENTS AT ADMISSION AND AT DISCHARGE, PATIENT COMPLIANCE AND NEAREST FORECAST (DATA OF THE RACSMI-UZ REGISTER)

Introduction. Basing on the data of the “RACSMI-UZ” register, the article provides comparative analysis of the structure and transformation of diagnoses during acute coronary conditions in the dynamics (at admission and discharge), assesses patients' adherence to drug therapy depending on gender and also describes analysis of its effect on the short-term prognosis.Material and methods. The study material included 449 patients with ACS/AMI hospitalized to relevant health care facilities of the experimental district of Tashkent. Two groups of patients were distinguished depending on the gender: group 1 included 243 male patients, and group 2 consisted of 206 female patients. Results. The registration showed that ACS/AMI was more often observed in men than in women (54.1% vs. 45.9%, respectively). Male patients proved to be younger than female ones (p &lt;0.05); obesity of different degree prevailed in women (48.0% in women vs. 29.6% in men, p &lt;0.05). In the male population, AMI at admission was registered in 43 (17.7%) patients but the number of patients with this diagnosis increased at discharge (61 subjects, or 25.1%). Out of 243 men, 3.7% died and the largest number of deaths occurred in patients with initial diagnosis of unstable angina. In the female population, the incidence of AMI both with and without Q at admission was recorded 2 times less frequent than that at discharge from the hospital (8.7% of cases at admission and 17.5% of cases at discharge), which shows low vigilance of healthcare professionals in diagnostics of AMI in women. Mortality from ACS/ AMI in women was 3.4% with the largest number of deaths being associated with the initial diagnosis of AMI without Q. Compliance in females was somewhat higher than in males; men were prone to taking more medications (Mc’s), though there were no significant differences between men and women by the proportion of Mc’s taken. The direct correlation was found between the patients’ compliance level and the time interval: from admission to death of the respondent (p&gt; 0.05).Conclusion. ACS / AMI was more often recorded in men than in women, while the age of men was younger (p&lt;0.05). Alertness of primary care physicians in ACS / AMI was low, especially for women. Compliance in women was higher than in men. Thus, the higher was the patient adherence to therapy, the more stable the body appeared to cardio stress.

Low Bladder Compliance in Women: A Clinical Overview.

Bladder compliance refers to the ability of the bladder to accommodate large volumes of urine. Patients with low bladder compliance may present with persistent urinary incontinence and/or evidence of upper tract damage. Clinicians often may not consider low bladder compliance in their differential for patients complaining of bothersome lower urinary tract symptoms. In this article, we aim to provide further guidance in the management of women with low bladder compliance given the lack of information on this topic in the medical literature.

Vascular compliance in women with polycystic ovary syndrome treated with spironolactone.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age in the United States and has been associated with several diseases including cardiovascular disease, obesity, and glucose intolerance. In this study, systolic blood pressure, diastolic blood pressure, pulse pressure (vascular compliance), large artery elasticity, systemic vascular resistance (SVR), total vascular impedance (TVI), and body mass index (BMI) were measured before and after treatment with spironolactone in 10 women with PCOS. Systolic BP, diastolic BP, and BMI were similar prior to treatment and after treatment. Pulse pressure decreased slightly post-treatment compared to pretreatment but not to significance (P=0.07). The results show that after treatment with spironolactone, there was a statistically significant increase in large artery elasticity (P=0.047), while there was a statistically significant decrease in SVR and TVI (P=0.0005 and P=0.03). This study indicates that treatment with spironolactone improves large artery elasticity and reduces systemic vascular resistance without any change in small artery elasticity.

Arterial Wall Properties in Men and Women: Hemodynamic Analysis and Clinical Implications.

The properties of arterial walls are dictated by their underlying structure, which is responsible for the adequate perfusion of conduit branching arteries and their vascular beds. Beginning with the mechanobiology of arteries in terms of their composition and individual contributions to overall viscoelastic behavior in men and women, pressure-flow relations are analyzed and noted in terms of sex differences. Hemodynamic function in terms of indices of vascular stiffness-such as pressure-strain elastic modulus, pulse wave velocity, augmentation index, and cardio-ankle vascular index-are evaluated. They all showed differences between the sexes, and these differences also were shown among people of different cultures. Recent studies also showed, in heart failure patients, a comparatively greater increase in peripheral resistance and a greater decreased arterial compliance in women. Wave separation into forward and reflected waves allows elucidation of mechanical and drug-treated similarities and differences in induced hypertension. This may provide insight into treatment strategy in terms of improving mechanobiology and designing drug therapy for the sexes. Finally, modeling studies are useful in identifying how arterial compliance and its pressure dependence can be better used in differentiating aging- and hypertension-induced changes that differentially affect the sexes.

Safety and effectiveness of alveolar recruitment maneuvers and positive end-expiratory pressure during general anesthesia for cesarean section: a prospective, randomized trial

IntroductionDuring cesarean section, the supine position reduces functional residual capacity and worsens lung compliance. We tested the hypothesis that alveolar recruitment maneuvers and positive end-expiratory pressure improve lung compliance in women undergoing general anesthesia for cesarean section. MethodsNinety women undergoing cesarean section were randomly assigned to one of two groups in a prospective, double-blind trial. In the alveolar recruitment maneuver group, pressure-control ventilation was used and inspiratory time was increased to 50% after delivery; positive end-expiratory pressure was increased to 20cmH2O and peak airway inspiratory pressure gradually increased to 45–50cmH2O. Volume-control ventilation was then used with low tidal volumes (6mL/kg) and positive end-expiratory pressure was reduced stepwise to 8cmH2O. In the control group, alveolar recruitment maneuvers were not used. Data were collected before and 3, 10 and 20min after the alveolar recruitment maneuver, before extubation and postoperatively at 10 and 20min. ResultsDynamic compliance, peak airway inspiratory pressure, PaO2 and PaO2/FiO2 were significantly different in the alveolar recruitment maneuver group compared to controls at all time points during surgery except at baseline. Oxygen saturation was significantly greater in the alveolar recruitment maneuver group at 10 and 20min and before extubation. Dynamic compliance was 29.7–42.5% higher and peak airway inspiratory pressure 3.6–10.2% lower in the alveolar recruitment maneuver group compared to controls. The PaO2, PaO2/FiO2 and oxygen saturation were higher (9.4–12%, 10.3–11.9% and 0.4–1.3%, respectively) in the alveolar recruitment maneuver group. Postoperatively, PaO2 and oxygen saturation were significantly higher in the alveolar recruitment maneuver group compared to controls (PaO2 9.2% at 10min and 8.4% at 20min, oxygen saturation 0.8% at 10min and 1.1% at 20min). There were no significant differences in hemodynamic stability or adverse events between groups. ConclusionCompared to standard care, the alveolar recruitment maneuver with positive end-expiratory pressure and low tidal volumes appears safe and effective in improving lung compliance and both intraoperative and postoperative oxygenation in women undergoing general anesthesia for elective cesarean section.

Systematic development of an evidence-based website on preconception care

Introduction: In February 2015, the Flemish Minister of Welfare, Public Health and Family launched a website on preconception care: ‘gezondzwangerworden.be’. The website was developed in response to the lack of comprehensive communication on preconception care and the inadequate intake of folic acid among Flemish women. Despite the international recommendation to take 400 μg folic acid on a daily basis one month before conception until 12 weeks of pregnancy, studies show a lack of compliance in women wanting to become pregnant.Procedure: A compilation of evidence was made through reviewing well-established guidelines on preconception and prenatal care. The quality of guidelines was assessed by means of AGREE II. The topics included in the website were selected by an internal committee of 5 experts and an external committee of 16 experts. Content validation was carried out by 40 experts in preconception care or related topics.Results: The above-described procedure resulted in an evidence-based website with a selection of relevant, validated information for both women and men who plan a pregnancy and professionals who are consulted by these people.Evaluation and recommendation: The website is currently attracting a constant number of 100 to 200 visitors a day. The information on folic acid is among the most requested, which is an important finding with regard to the policy objectives on preconception care. More research is needed in order to evaluate the use and effect of the website more thoroughly.

The relationship between maternal self-efficacy, compliance and outcome in a trial of vitamin D supplementation in pregnancy.

The relationship between self-efficacy (the belief that one can carry out a behaviour), compliance with study protocol and outcome was explored within a randomised, double-blind, placebo-controlled trial of vitamin D supplementation in pregnancy. In the Maternal Vitamin D Osteoporosis Study (MAVIDOS) trial, women with circulating plasma 25(OH)-vitamin D of 25-100nmol/l in early pregnancy were randomised to either 1000IU cholecalciferol/day or matched placebo from 14weeks until delivery. Circulating 25(OH)-vitamin D concentrations were assessed at 14 and 34weeks' gestation. A sequential sub-sample completed Schwarzer's General Self-Efficacy Scale at 14 and 34weeks and the Problematic Experiences of Therapy Scale at 34weeks. Women were interviewed about their experiences of the trial and interview transcripts analysed thematically. In 203 women, those with higher self-efficacy were less likely to experience practical problems taking the study medication (odds ratio (OR) 0.81 (95% confidence interval (CI) 0.69-0.95), p = 0.01). Over half reported practical problems associated with poorer compliance with the protocol requiring women to take the medication daily. Compliance in women who experienced practical problems was 94% compared with 98% for those with no problems (p < 0.001). Poorer compliance was also associated with lower concentrations of 25(OH)-D in late pregnancy in the treatment group (β = 0.54nmol/l (95% CI 0.18-0.89), p = 0.003). Thematic analysis suggested common difficulties were remembering to take the medication every day and swallowing the large capsules. These findings suggest that differences in self-efficacy influence trial outcomes. Such information may help clinicians anticipate responses to routine vitamin D supplementation in pregnancy and identify those who may need more support to comply. ISRCTN82927713, registered 11/04/2008.

Improved Efficacy of Low-Dose Spironolactone and Metformin Combination Than Either Drug Alone in the Management of Women With Polycystic Ovary Syndrome (PCOS): A Six-Month, Open-Label Randomized Study

To improve the treatment outcomes in women with polycystic ovary syndrome (PCOS), various drugs like glitazones, oral contraceptive pills, or antiandrogens have been combined with metformin. The aim of the study was to compare the efficacy of the combination of low-dose spironolactone and metformin with either drug alone in the management of women with PCOS. The present study was an open-label, randomized study conducted at a tertiary care referral center. Of 204 women who met the 2006 Androgen Excess-PCOS criteria for PCOS, 198 were randomized into 3 equal groups to receive metformin (1000 mg/d), low-dose spironolactone (50 mg/d), or a combination of both drugs for a period of 6 months. A total of 169 subjects (n = 56 metformin, 51 spironolactone, 62 combination) completed the study. Menstrual cycle pattern, Ferriman-Gallwey score, body mass index (BMI), waist-hip ratio, blood pressure, LH, FSH, total T, glucose and insulin sensitivity indices were measured at baseline (0 mo) and 3 and 6 months after the intervention. Recording of adverse events and drug compliance was assessed at each of the visits. The 3 groups had comparable mean age and BMI at baseline. By 6 months, menstrual cycles/y increased, whereas Ferriman-Gallwey score, serum total T, and area under the curve-glucose and -insulin decreased significantly (P < .05) in the combination group as compared to either drug alone. There was no significant change in body weight, BMI, waist-hip ratio, and blood pressure in any of the 3 groups. The combination group had better compliance than either drug alone, and the adverse event rate was not higher. The combination of low-dose spironolactone with metformin seems superior to either drug alone in terms of clinical benefits and compliance in women with PCOS.

Altered Arterial Compliance in Hypertensive Pregnant Women Is Associated with Preeclampsia

Vascular alterations are present in pregnant women affected by preeclampsia. In this study, we assessed arterial compliance in women affected by hypertensive disorders of pregnancy. We hypothesized that arterial compliance is reduced in women affected by preeclampsia. Forty-three hypertensive pregnant women undergoing evaluation for preeclampsia were studied. Clinical data about each patient and pregnancy were collected. Large (C1) and small (C2) artery compliance were assessed by radial tonometry, while the patients underwent laboratory tests to diagnose preeclampsia. At the time of delivery, gestational age and newborn data were recorded. Eighteen women were diagnosed with preeclampsia. C2 levels were lower among preeclamptic versus hypertensive aproteinuric women (mean ± SD, 4.5 ± 1.3 vs 5.9 ± 2.3 mL/mm Hg · 100, P = 0.013, 95% confidence interval [CI] of difference 0.32-2.55), whereas C1 levels did not differ. In the preeclampsia group, C2 levels correlated with urine total protein concentrations measured the same day (Spearman ρ = -0.49, P = 0.047, upper 95% CI -0.01) and with gestational age at first occurrence of hypertension (Spearman ρ = 0.59, P = 0.010, lower 95% CI 0.17). Among singleton gestations, C2 also correlated with newborn birth weight measured at delivery (Spearman ρ = 0.43, P = 0.009, lower 95% CI 0.11). Women who were hypertensive but aproteinuric at the time of compliance assessment, but who subsequently developed preeclampsia (n = 6), had C2 levels similar to those with an early diagnosis of preeclampsia (mean difference 0.37 mL/mm Hg · 100, 95% CI -2.42 to 1.67) and lower C2 levels than women diagnosed with gestational hypertension (P = 0.019, 95% CI 0.33-4.42 mL/mm Hg · 100). The noninvasive assessment of arterial elasticity may contribute toward characterization of the nature of the pathophysiology in pregnancy-induced hypertensive disorders. The vascular alterations of the small arteries, as assessed by C2, may reflect the extent of vascular alterations present with preeclampsia.

Follow-up Frequency and Compliance in Women with Probably Benign Findings on Breast Magnetic Resonance Imaging

Six-month short-interval follow-up is recommended for probably benign findings on breast magnetic resonance imaging (MRI). We wanted to examine patient adherence to follow-up recommendation for Breast Imaging-Reporting and Data System (BI-RADS) category 3 lesions at a tertiary care medical center. We performed a retrospective review of frequency and adherence rates to follow-up recommendation for women with an initial BI-RADS 3 breast MRI between 2005 and 2007. A total of 132 women with BI-RADS 3 breast MRI recommendations were included. Ninety-six of 132 (72.7%) women adhered to the first follow-up recommendation or elected to have tissue diagnosis; 78/132 (59.1%) had follow-up MRI and 18/132 (13.6%) had tissue diagnosis. Thirty-six of 132 (27.3%) women did not return for follow-up. Nine of nine (100%) of BRCA carriers returned for follow-up or had tissue diagnosis, compared to 87/123 (70.7%) of non-BRCA carriers. A total of 35/41 (85.4%) of patients with a prior history of breast cancer returned for follow-up or had tissue diagnosis, compared to 61/91 (67%) of patients without a history of breast cancer. Only 5/15 (33%) of patients undergoing MRI for symptom alone adhered to follow-up recommendations. Adherence to BI-RADS category 3 follow-up recommendation is often low. Women with a history of breast cancer or who were BRCA carriers were significantly more likely to adhere to follow-up recommendation than women without a history of breast cancer or women undergoing MRI for symptoms alone. Strategies to improve adherence should be developed.

Reduction of urinary levels of N-telopeptide correlates with treatment compliance in women with postmenopausal osteoporosis receiving alendronate

The aim of this study was to assess the factors associated with the effectiveness of treatment with alendronate (ALN) quantified by a reduction in urinary excretion of N-telopeptide (NTx). The study is an observational, prospective, multicenter trial, with a 6-month follow-up. Postmenopausal osteoporotic women (densitometric criteria), who initiated treatment with ALN (70 mg/weekly) without previous treatment with antiresorptive agents (12 month) and calcitonin (6 month), were included. The assessment of NTx levels (nmol bone collagen equivalents/mmol creatinine) in the urine was performed at baseline and after completion of follow-up. A logistic regression model included "achieving a reduction in urinary NTx of at least 30% (minimal clinically significant change [MCSC])" as a dichotomous dependent variable and the following as independent variables: baseline urinary NTx levels, treatment compliance, years since diagnosis of menopause, ALN treatment duration, and treatment with calcium and vitamin D. Treatment compliance was assessed as the percentage of days of medication prescribed as a function of the time between the beginning and end of treatment. Good compliance was defined as a percentage between 80% and 120%. The variables that reached statistical significance were baseline urinary NTx values (odds ratio, 1.052; 95% CI, 1.025-1.079) and compliance (odds ratio, 3.9; 95% CI, 1.5-10.1). Therefore, the women with good treatment compliance were almost 4 times more likely to achieve an MCSC in NTx levels, and the raise in one unit of urinary NTx baseline values increased by 5% of the probability of achieving MCSC. Treatment with ALN (70 mg/week) in women with postmenopausal osteoporosis effectively reduces the urinary excretion of the bone turnover biomarker NTx. The probability of achieving a clinically significant reduction is greater in those women with higher baseline levels of NTx and in women who comply with treatment.