Preventive Measures For Women Research Articles

Effectiveness of Prophylactic Mastectomy

Introduction: The growing incidence and recurrence rate of breast cancer has influenced multiple strategies such as surgical interventions that serve as preventive measures for women at high risk. Prophylactic mastectomy seems to be the most effective tool in the primary prevention of breast cancer, but opinions are not uniform, especially among specialists. The goal of this presentation is to examine the effect of risk-reducing mastectomy, including breast cancer incidence, breast cancer mortality, disease-free survival, physical morbidity, and psychosocial outcomes in cohort of patients who underwent prophylactic mastectomy. Materials and Methods: We retrospectively reviewed the outcomes of 20 years of experience with prophylactic mastectomies performed at the department from 1999 to 2019. In this study were included patients who underwent bilateral prophylactic mastectomy with no breast cancer, and patients with breast cancer, if they underwent contralateral risk-reducing mastectomy, however, only the prophylactic side was considered in the analysis. Patients with bilateral breast cancer were excluded. Results: A total of 749 risk-reducing prophylactic mastectomy in 545 patients were performed at our department from 1999 to 2019. Bilateral prophylactic mastectomies were performed in 204 patients (37,4%), and 341 (62,6%) underwent a unilateral risk-reducing mastectomy secondary to cancer in the contralateral breast. Overall, 243 patients with BRCA1 mutations and 113 with BRCA2 mutations were included. Conclusion: Prophylactic mastectomy is highly preventive against breast cancer. Although further clinical studies are needed to determine the effectiveness of prophylactic mastectomies in individual indications. With the effectiveness of prophylactic mastectomy should also be taken into consideration the quality of life after the immediate breast reconstruction, and the associated complications.

Monkeypox virus infection in women and non-binary people: uncommon or neglected?

Monkeypox virus infection in women and non-binary people: uncommon or neglected?

Лікувально-профілактичні заходи, спрямовані на зниження частоти гестаційних ускладнень у жінок із поєднаною безплідністю в анамнезі

The purpose - to substantiate the principles of prevention and treatment of major gestational complications in women with a history of combined infertility. Materials and methods. The patients were divided into the groups, depending on the prescribed treatment regimen: the group 1 - 52 pregnant women with a history of combined infertility who received basic therapy with a positive urinary test for pregnancy (dydrogesterone 10 mg 2 times a day for up to 12 weeks, folic acid - 400 mcg per day up to 14 weeks of pregnancy). The group 2 - 50 pregnant women with combined infertility who received our improved regimen (5-methyltetrahydrofolate - 600 mg, iodine - 200 mcg, micronized progesterone - 200 mg, cardioaspirin - 150 mg, calcium with vitamin D3, omega-3, -6, -9 polyunsaturated fatty acids - 1000 mg, magnesium with vitamin В6). Statistical processing of data was performed by the methods of variation statistics. Results. More often, gestational complications in the trimester II were in pregnant women of the group 1, who took the basic treatment regimen, than in patients of the group 2, who used the therapeutic complex improved by us. Thus, polyhydramnios was detected almost 2.5 times more often in patients of the group 1 (11.5%) versus 4% of pregnant women of the group 2; and oligohydramnios was confirmed 3 times more often in women of the group 1 (7.7%), while in pregnant women of the group 2 only in 2%. Isthmic-cervical insufficiency developed in every 5 women (21.2%) in the group 1 and almost three times less often - in 8% of women in the group 2. Anomalies of placental attachment, namely: placenta previa and its low location occurred 2.5 times more often in women of the group 1 (15.4%) compared with pregnant women of the group 2 (in 6%). Premature maturation of the placenta, which was manifested by structural changes in it on ultrasound, was manifested almost three times more often in women of the group 1 - in 17.3% versus 6% of pregnant women in the group 2. Gestational anemia was found in women of the group 1 (19.2%), which is half as often as in the group 2 (12%). Gestational diabetes was also half as common in women of the group 1 (30.8%) compared to the group 2 (20%). Exacerbation of chronic pyelonephritis was almost twice as common in women of the group 1 (7.7%) compared with the group 2 (4%). But pregnant women of the group 1 (23.1%) had vaginitis 4 times more often than the group 2 (6%). Conclusions. The use of the monitoring algorithm developed by us and a set of therapeutic and preventive measures in women with a history of infertility has significantly improved the results of their pregnancies. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

The Influence of Early Exercise Postpartum on Pelvic Floor Muscle Function and Prevalence of Pelvic Floor Dysfunction 12 Months Postpartum

There is limited knowledge on how exercise impacts the pelvic floor muscles (PFM) and prevalence of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) postpartum. The purpose of this study was to investigate whether early onset of general exercise postpartum negatively affects the PFM and/or increases the risk of SUI and POP 12months postpartum. This study used a prospective cohort design. At 6weeks postpartum, 57 women classified as exercisers (exercising ≥3 times at ≥30min/wk) were compared with 120 nonexercisers (mean age=29 years, SD=4.3). Manometry was used to measure vaginal resting pressure, PFM strength, and PFM endurance, and symptoms of SUI and POP were assessed using questionnaires. Data were presented as standardized beta coefficients (B) and odds ratios (OR). No differences were found between exercisers (n=57) and non-exercisers (n=120) at 6weeks postpartum on vaginal resting pressure (B=-0.04 [95% CI=-3.4 to 2.1]), PFM strength (B=0.03 [95% CI=-4.7 to 7.4]), PFM endurance (B=-0.02 [95% CI=-59 to 46]), or symptoms of SUI (OR=0.51 [95% CI=0.25 to 1.1]) or POP (OR=0.62 [95% CI=0.26 to 1.5]) measured at 12months postpartum. Adjusting for covariates, women with body mass index between 25 and 29.9 and>30 were more likely to report SUI 12months postpartum (OR=2.2 [95% CI=1.0 to 4.7] and OR=3.3 [95% CI=1.2 to 9.4], respectively). Women with physically strenuous occupations were more likely to report POP 12months postpartum (OR=3.0 [95% CI = 1.2 to 7.3]). This study suggests that regular exercise 6weeks postpartum has no negative effect on PFM function or on SUI or POP. Being overweight, however, was associated with more SUI, and women with physically strenuous occupations reported more POP. Results from this study suggest that first-time mothers should be encouraged to start general exercise within the first 6weeks after giving birth. Women at risk for PFD should be advised accordingly and potentially modifiable risk factors should be addressed prior to delivery. First-time mothers are encouraged to talk with a physical therapist about starting regular general exercise in the early postpartum weeks. Health care providers should advise patients on possible preventive measures for women at risk for PFD.

Knowledge, Attitudes and Practices of Women in the Southern Region of Saudi Arabia Regarding Cervical Cancer and the Pap Smear Test

Background:The main barrier for women to receive Papanicolaou (Pap) smear tests and immunization is lack of knowledge about the disease’s signs and symptoms, women’s attitudes toward prevention programs and cultural myths and beliefs. Therefore, the main objective of this study is to measure women’s knowledge, attitudes and practices about cervical cancer and the Pap smear test in the southern region of Saudi Arabia and to assess the findings in relation with women’s demographics. Methods:A cross sectional survey was conducted at the Armed Forces Hospital Southern Region Obstetrics and Gynecology Clinic using a self-administered questionnaire with a sample size of 255 women between the ages of 15 and 65 years. Results:Forty-three percent of the women in this region are aware of cervical cancer, but do not recognize its risk factors, implications, timing or main cause, which is Human papillomavirus (HPV). In fact, the primary source of information was obtained through social media. Only two women conducted Pap smear test and that was based on doctor’s referral, where women’s main reason from not conducting the test was feeling good and no need. Conclusions:There is a need, therefore, to create awareness programs for cervical cancer, its causes and risk factors, as well as its preventive measures for women in the southern region of Saudi Arabia.

Level of awareness among trained Accredited Social Health Activist workers in the field of women's health and child development – A survey

BACKGROUND: Currently, the Government of India is providing comprehensive integrated health care to the rural people under the umbrella of National Rural Health Mission. A village level community health worker “Accredited Social Health Activist (ASHA)” acts as an interface between the community and the public health system. A time-to-time assessment of the knowledge of ASHAs is essential as the success of government's health programs in rural areas depends on them, and hence, this research is conducted to identify the knowledge that ASHA has in the field of preventive women's health and childcare. SETTINGS AND DESIGN: A cross-sectional study was done at Panvel Taluka in Raigad District of Maharashtra. The study participants were Trained ASHA workers. MATERIALS AND METHODS: A cross-sectional study was conducted in rural field practice area of the department of preventive and community physiotherapy. The study participants were trained ASHA workers. All 100 ASHA workers were included as per the eligibility criteria. After obtaining prior consent, all ASHAs were interviewed using a self-designed, semi-structured questionnaire. STATISTICAL ANALYSIS USED: Data were analyzed in Excel and valid result and conclusion were drawn. RESULTS: Majority of ASHA workers had correct knowledge about problems faced by women during breastfeeding (91%), breastfeeding positions (97%), and delivery positions (96%). They were lacking in knowledge about pelvic floor problems such as uterine prolapse and urinary incontinence. This research is conducted to identify the knowledge that ASHA has in the field of preventive women's health and childcare. CONCLUSION: Despite the training given to ASHA workers, they are hardly aware about preventive measures for women's health and child development.

Prophylactic mastectomy for the prevention of breast cancer: Review of the literature.

The high incidence and recurrence rate of breast cancer has influenced multiple strategies such as early detection with imaging, chemoprevention and surgical interventions that serve as preventive measures for women at high risk. Prophylactic mastectomy is one of the growing strategies of breast cancer risk reduction that is of a special importance for breast cancer gene mutation carriers. Women with personal history of cancerous breast lesions may consider ipsilateral or contralateral mastectomy as well. Existing data showed that mastectomy effectively reduces breast cancer risk. However, careful risk estimation is necessary to wisely select individuals who will benefit from preventing breast cancer.

Pathogenetic therapeutic and preventive measures in women of risk group of isthmicocervical incompetence

The article considers the problem of isthmicocervical incompetence (ICI) as one of the leading factors in the genesis of premature termination of pregnancy. As noted, the frequency of this pathology in the population among pregnant women reaches 15%. The results of the study are presented, the purpose of which was to study the clinical effectiveness of the use of the drug Biolectra Magnesium Fortissimum in preconception prevention of ICI in women with undifferentiated connective tissue dysplasia on the background of a magnesium deficiency.The study involved 50 women at risk of ICI (hypomagnesemia, decrease in the index of resistance in the small arteries of cervix uteri (CU), ultrasound signs of connective tissue dysplasia). The age of women ranged from 20 to 40 years. Most subjects had clinical symptoms of magnesium deficiency: tachycardia occurred in 28%, sleep disorders in 24%, general fatigue in 20%, constipation in 18%, paresthesia in 36%, muscle spasms in 18% of cases.The mean magnesium concentration in the blood plasma of the patients was 0.74 ± 0.03 mmol/l. The conducted studies showed a significant decrease in the index of resistance in small arteries of CU in 86% of women, which indicated the presence of morphofunctional deficiency of CU. Also, in 78% of women, echographic examination revealed the presence of collagenopathy.To correct the magnesium deficiency in the pregestation period, women were prescribed the drug Biolectra Magnesium Fortissimum (Hermes Arzneimittel GmbH, Germany) for 1 effervescent tablet once a day for 10 days with a break of 2 weeks for 3–4 months. After completion of the course of treatment, in most cases there was a lack or decrease in the frequency and intensity of symptoms of magnesium deficiency symptoms. The gradient of magnesium level increase after a 3-month therapy was 0.14 ± 0.03 mmol/l. Residual phenomena of paresthesia occurred only in 10% of women, muscle cramps – in 8%. In 60% of women, there was an approximation of the blood flow resistance in the small arteries of CU (RI 0.63 ± 0.03) and in 64% of cases the ultrasonic examination of CU revealed an increase in the reflectivity of the organ, which indicating stabilization of collagen structures, changes in the morphofunctional state of CU, normalization of hemodynamic processes in the organ.Thus, the use of drug Biolectra Magnesium Fortissimum in magnesium deficiency provided an effective correction of hypomagnesemia, positively influenced the morphofunctional state of CU, which helped prevent the complication of pregnancy in 80% of cases.

Comprehensive primary prevention of cardiovascular disease in women

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality in women. Historically, medical research has focused on male patients, and subsequently, there has been decreased awareness of the burden of ASCVD in females until recent years. The biological differences between sexes and differences in societal expectations defined by gender roles contribute to gender differences in ASCVD risk factors. With these differing risk profiles, risk assessment, risk stratification, and primary preventive measures of ASCVD are different in women and men. In this review article, clinicians will understand the risk factors unique to women, such as preeclampsia, gestational diabetes, and those that disproportionately affect them such as autoimmune disorders. With these conditions in mind, the approach to ASCVD risk assessment and stratification in women will be discussed. Furthermore, the literature behind the effects of primary preventive measures in women, including lifestyle modifications, aspirin, statins, and anticoagulation, will be reviewed. The aim of this review article was to ultimately improve ASCVD primary prevention by reducing gender disparities through education of physicians.

Cardiovascular risk and history of gestational hypertension in women of reproductive age

In recent years, gestational hypertension, defined in accordance with the classification of the European Society of Cardiology (2011) as hypertension induced by pregnancy, occurring with or without proteinuria, developing after 20 weeks of pregnancy and resolving up to 42 days after delivery, is considered as a adverse prognostic factor in respect of development of cardiovascular diseases in the future and cardiovascular mortality. This review presents the results of various studies on the relationship of history of gestational hypertension with risk factors for cardiovascular disease, target organ damage, associated clinical conditions and cardiovascular risk in women, including those of reproductive age. Determination of the individual cardiovascular risk in women, especially in young women, is difficult due to the low sensitivity and specificity of the tests in this category of patients. In spite of the conducted studies and obtained experience regarding issues on the relationship of history of hypertension during pregnancy with cardiovascular risk, until now the origin and the contribution of the various forms of hypertensive disorders during pregnancy, including gestational hypertension, to the development of future cardiovascular disease is still unclear. Detection of the history of gestational hypertension will allow to more accurately assess the individual cardiovascular risk and administer an adequate range of therapeutic and preventive measures for women, including those of reproductive age, at an earlier stage.

Комплекс лікувально-профілактичних заходів для жінок з неалкогольною жировою хворобою печінки на етапі підготовки до програм допоміжних репродуктивних технологій

The objective: To evaluate the effectiveness of complex therapeutic and preventive measures for women with non-alcoholic fatty liver disease in preparation for ART programs. Materials and methods. To evaluate the effectiveness of therapeutic and preventive measures on the basis of the prediction algorithm in women with infertility and non-alcoholic fatty liver disease (NAFLD) identified 60 women with a high risk of inefficiencies ART. The method of randomization, patients were divided into: basic group - 30 women with a recommended set of preparations for the holding of ART, the comparison group - 30 women with preparations for ART according to the Ministry of Health protocols. Results. Application reference system in women with infertility and NAFLD, which includes forecasting inefficiency ART and additional therapeutic and preventive measures to include gepatoprotektors, acid ursodeoxycholicum drugs, L-arginine, щ-3 fatty acids and probiotics, helped to improve the overall condition of the woman, a liver condition, cardiovascular regulation reduce symptoms of dysbiosis, hormonal status and reproductive system, as a result, increase the effectiveness of ART programs to population-wide level (pregnancy occurred in 36.7% of women). Conclusions. Prove safety and high efficiency of complex therapeutic and preventive measures for women with infertility and NAFLD can be recommended for implementation in practice of reproductive medicine clinics, which will increase the effectiveness of ART, to preserve a woman’s health. Key words: infertility, assisted reproductive technologies, non-alcoholic fatty liver disease, treatment.

Predicting formation of adhesions after gynaecological surgery: development of a risk score.

PurposeRisk factors for post-surgical adhesions following gynaecological surgery have been identified, but their relative importance has not been precisely determined. No practical tool exists to help gynaecological surgeons evaluate the risk of adhesions in their patients. The purpose of the study was to develop an Adhesion Risk Score to provide a simple tool that will enable gynaecological surgeons to routinely quantify the risk of post-surgical adhesions in individual patients.MethodsA group of European gynaecological surgeons searched the literature to identify the risk factors and the surgical operations reported as carrying a risk of post-surgical adhesions. Through consensus process of meetings and communication, a four-point scale was then used by each surgeon to attribute a specific weight to each item and collective agreement reached on identified risk factors and their relative importance to allow construct of a useable risk score.ResultsTen preoperative and 10 intraoperative risk factors were identified and weighed, leading to the creation of two sub-scores to identify women at risk prior to and during surgery. The Preoperative Risk Score can range from 0 to 36, and the Intraoperative Risk Score from 3 to 31. Several thresholds between these limits may be used to identify women with low, medium, and high risk of post-surgical adhesions.ConclusionsGynaecological surgeons are encouraged to use this Adhesion Risk Score to identify the risk of adhesions in their patients. This will allow better informed use of available resources to target preventive measures in women at high risk of post-surgical adhesions.

Optimal age to start preventive measures in women with BRCA1/2 mutations or high familial breast cancer risk

Women from high-risk families consider preventive measures for breast cancer including screening. Guidelines on screening differ considerably regarding starting age. We investigated whether age at diagnosis in affected relatives is predictive for age at diagnosis. We analyzed the age of breast cancer detection of 1,304 first- and second-degree relatives of 314 BRCA1, 164 BRCA2 and 244 high-risk participants of the Dutch MRI-SCreening study. The within- and between-family variance in the relative's age at diagnosis was analyzed with a random effect linear regression model. We compared the starting age of screening based on risk-group (25 years for BRCA1, 30 years for BRCA2 and 35 years for familial risk), on family history, and on the model, which combines both. The findings were validated in 63 families from the UK-MARIBS study. Mean age at diagnosis in the relatives varied between families; 95% range of mean family ages was 35-55 in BRCA1-, 41-57 in BRCA2- and 44-60 in high-risk families. In all, 14% of the variance in age at diagnosis, in BRCA1 even 23%, was explained by family history, 7% by risk group. Determining start of screening based on the model and on risk-group gave similar results in terms of cancers missed and years of screening. The approach based on familial history only, missed more cancers and required more screening years in both the Dutch and the United Kingdom data sets. Age at breast cancer diagnosis is partly dependent on family history which may assist planning starting age for preventive measures.

Abstract P4-11-05: Optimal age to start preventive measures in women with BRCA1/2 mutations or high familial breast cancer risk

Abstract Background: Women from high risk breast cancer families consider preventive measures including screening. Guidelines on screening differ considerably regarding starting age. We investigated whether age at diagnosis in affected family members is predictive for age at diagnosis of a relative. Methods: We analyzed the age of breast cancer detection of 1304 first and second degree relatives of 314 BRCA1, 164 BRCA2 and 244 high-risk participants of the Dutch MRI-SCreening study. The within and between family variance in age at diagnosis was analyzed with a random effect linear regression model. We compared the starting age of screening based on risk-group (25 years for BRCA1, 30 years for BRCA2 and 35 years for familial risk), on family history, and on the model, which combines both. The findings were validated in 63 families from the UK- MARIBS study. Results: Mean age at diagnosis in the family varied between families; 95% range of mean family ages was 35–55 in BRCA1−, 41–57 in BRCA2− and 44–60 in high-risk families.14% of the variance in age at diagnosis was explained by family history, 7% by risk group. Approaches to determining start of screening based on the model and on risk-group were similar in terms of cancers missed and years of screening. The approach based on familial history only, missed more cancers and required more screening years in both the Dutch and UK datasets. Conclusion: Age at breast cancer diagnosis is in part dependent on family history which may assist planning starting age for preventive measures. Keywords: BRCA1, BRCA2, breast cancer, prevention, age at onset Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-11-05.

150 Optimal Age to Start Preventive Measures in Women with BRCA1/2 Mutations or High Familial Breast Cancer Risk

150 Optimal Age to Start Preventive Measures in Women with BRCA1/2 Mutations or High Familial Breast Cancer Risk

A “usual occurrence:” Stress incontinence among reproductive aged women in Sri Lanka

Stress urinary incontinence (SUI) is a common condition among women of all ages, often with devastating consequences, such as depression, anxiety and reduced quality of life. Researchers have largely focused on its prevalence and clinical management, particularly in highly industrialized country settings. In this article, drawing on epidemiological, clinical and qualitative research undertaken in Sri Lanka, we discuss how stress incontinence affects women's lives and how they personally manage the problem. Quantitative data derive from a community-based descriptive cross-sectional study, conducted in 2006-2007 with 1718 ever-married women, aged 15-49, of whom 9.8% reported problems of stress incontinence. Six focus group discussions, eight key informant interviews and five case studies with women with SUI were also undertaken to gain insight and depth. Although incontinence affected outdoor activities, sexual life, and sense of wellbeing, women did not consider it a health problem, rarely discussed it with others, and rarely sought treatment. Barriers to help seeking included fear of vaginal examination, shame and embarrassment, and belief that SUI was a natural consequence of aging and childbirth. Women's reluctance to seek advice on their own initiative about managing incontinence indicates the importance for health providers to pay greater attention to the condition and introduce appropriate preventive measures for women. This might include creating greater public awareness of SUI as preventable and treatable, ensuring a clinical environment conducive to discussing problems related to bodily functions.

A “usual occurrence:” Stress incontinence among reproductive aged women in Sri Lanka

Stress urinary incontinence (SUI) is a common condition among women of all ages, often with devastating consequences, such as depression, anxiety and reduced quality of life. Researchers have largely focused on its prevalence and clinical management, particularly in highly industrialized country settings. In this article, drawing on epidemiological, clinical and qualitative research undertaken in Sri Lanka, we discuss how stress incontinence affects women's lives and how they personally manage the problem. Quantitative data derive from a community-based descriptive cross-sectional study, conducted in 2006-2007 with 1718 ever-married women, aged 15-49, of whom 9.8% reported problems of stress incontinence. Six focus group discussions, eight key informant interviews and five case studies with women with SUI were also undertaken to gain insight and depth. Although incontinence affected outdoor activities, sexual life, and sense of wellbeing, women did not consider it a health problem, rarely discussed it with others, and rarely sought treatment. Barriers to help seeking included fear of vaginal examination, shame and embarrassment, and belief that SUI was a natural consequence of aging and childbirth. Women's reluctance to seek advice on their own initiative about managing incontinence indicates the importance for health providers to pay greater attention to the condition and introduce appropriate preventive measures for women. This might include creating greater public awareness of SUI as preventable and treatable, ensuring a clinical environment conducive to discussing problems related to bodily functions.

Cardiovascular disease in women: Sex differences in presentation, risk factors, and evaluation

Cardiovascular disease (CVD) is the leading cause of mortality in women. Pathophysiology, risk factors, clinical presentation, and outcomes of coronary artery disease (CAD) differ in women, and a better understanding of the sex differences in these factors will potentially lead to a slowing of this epidemic in women. Often forgotten, women have higher complication rates post revascularization and higher in-hospital mortality post myocardial infarction compared with men despite a smaller burden of disease in women. Though overall women share the same risk factors as men in the development of CAD, certain risk factors appear to be particularly ominous, such as the presence of diabetes mellitus, low values of high-density lipoprotein cholesterol, high triglycerides, and psychologic depression. Disease detection in advanced CAD is more accurate with stress echocardiography (ECG) and perfusion single-photon emission computed tomography imaging in women than with stress ECG. Subclincial atherosclerotic disease detection with carotid artery intima media thickness assessment provides an opportunity to target preventive measures in women. This article focuses on some of the sex-specific differences.

Changes in hip fracture epidemiology: redistribution between ages, genders and fracture types.

After several reports of increasing hip fracture incidence some studies have suggested a trend-break. In a previous study of hip fractures we forecast a 70% increase in the total number of fractures from 1985 up to year 2000. We therefore studied the incidence trend for the last 15 years and supply a new prognosis up to year 2010. We recorded all incident hip fractures treated in the county of Ostergötland, Sweden (approximately 400,000 inhabitants) 1982-96. A total of 11,517 hip fractures in men and women aged 50 years and above were included in the study after cross-validation between a computerized register of radiologic investigations and the hospital records. The projected number of fractures up to year 2010 was estimated by a Poisson regression model, considering both age and year of fracture in every single year 1982-96 for the respective fracture type and gender, and applied to the projected population. The annual number of hip fractures increased by 39% in men and 25% in women during the study period. Amongst men, the age-adjusted incidence of cervical fractures increased from 188 to 220/100,000 and of trochanteric fractures from 138 to 170/100,000. In women the incidence of cervical fractures decreased from 462/100,000 to 418/100,000 and of trochanteric fractures from 407/100,000 to 361/100,000. Cervical/trochanteric fracture incidence rate ratio leveled off, and also the female/male fracture rate ratio declined. A prognosis assuming that the incidence development will continue as during 1982-96, and a population in agreement with the forecast, predicts that the total age- and sex-adjusted number of hip fractures will decrease by 11% up to year 2010 compared with 1996. In women and men, however, a decrease of 19% and an increase of 7% respectively were projected. If the age- and sex-specific incidence remains at the same level as at the end of the study period, no significant change in the total numbers will occur. A trend-break was thus found in hip fracture incidence for women but not for men. Whether this is due to therapeutic and/or preventive measures in women is unknown. According to the most probable scenario a substantial increase in male trochanteric fractures (36%) is expected up to 2010, while all other hip fractures in both genders will decrease by 4-32% resulting in a total reduction of 11%.

Multiple Marker Second Trimester Serum Screening for Pre-eclampsia

There are indications that circulating levels of both free β-human chorionic gonadotropin (β-hCG) and inhibin A are increased in pregnant women who later develop pre-eclampsia. Results with α-fetoprotein (AFP) are inconsistent, but one study suggested that women who later develop preeclampsia have lower levels of unconjugated estriol (uE 3 ). The goal of this study was to learn whether an appropriate combination of these markers might be an effective screening tool for preeclampsia in the second trimester. Nineteen women with preeclampsia (increased systolic and diastolic blood pressures [30 and 20 mm Hg, respectively]; proteinuria exceeding 100 mg/liter; and plasma uric acid of at least 357 μmol/liter) had estimates of the four putative markers in 32 serum samples. For each study sample, three control samples were collected from women with uneventful pregnancies, matched with the study patients for maternal age and gestational age. Levels of free β-hCG and inhibin A were significantly increased in the preeclamptic pregnancies, whereas concentrations of uE 3 were reduced. The differences between preeclamptic and unaffected pregnancies were most marked after 19 weeks' gestation. The median inhibin A value was 1.7 multiples of the median for unaffected pregnancies, and the median free β-hCG level was 2.1 multiples of the control median. The median uE 3 in preeclamptic pregnancies was 0.8 multiples of the median 2 weeks or more before the onset of proteinuria. There were no substantial differences in AFP. Combining inhibin A, free β-hCG, and uE 3 as a screening measure would detect an estimated 55% of affected pregnancies with 5% false-positive results. The screening performance of these markers can be estimated from the means, standard deviations, and correlations between the markers. This small-scale study suggests that inhibin A, free β-hCG, and uE 3 all are associated with the subsequent development of preeclampsia. Because levels of the markers are not highly correlated in unaffected pregnancies, each of them provides independent predictive information. It would be of interest to utilize screening in controlled trials of preventive measures in women at high risk of preeclampsia.