Treatment Outcome In Women Research Articles

DNA methylation levels are associated with CRF1 receptor antagonist treatment outcome in women with post-traumatic stress disorder

BackgroundWe have previously evaluated the efficacy of the CRF1 receptor antagonist GSK561679 in female PTSD patients. While GSK561679 was not superior to placebo overall, it was associated with a significantly stronger symptom reduction in a subset of patients with probable CRF system hyperactivity, i.e., patients with child abuse and CRHR1 SNP rs110402 GG carriers. Here, we test whether blood-based DNA methylation levels within CRHR1 and other PTSD-relevant genes would be associated with treatment outcome, either overall or in the high CRF activity subgroup.ResultsTherefore, we measured CRHR1 genotypes as well as baseline and post-treatment DNA methylation from the peripheral blood in the same cohort of PTSD-diagnosed women treated with GSK561679 (N = 43) or placebo (N = 45). In the same patients, we assessed DNA methylation at the PTSD-relevant genes NR3C1 and FKBP5, shown to predict or associate with PTSD treatment outcome after psychotherapy. We observed significant differences in CRHR1 methylation after GSK561679 treatment in the subgroup of patients with high CRF activity. Furthermore, NR3C1 baseline methylation significantly interacted with child abuse to predict PTSD symptom change following GSK561679 treatment.ConclusionsOur results support a possible role of CRHR1 methylation levels as an epigenetic marker to track response to CRF1 antagonist treatment in biologically relevant subgroups. Moreover, pre-treatment NR3C1 methylation levels may serve as a potential marker to predict PTSD treatment outcome, independent of the type of therapy. However, to establish clinical relevance of these markers, our findings require replication and validation in larger studies.Trial registrationNCT01018992. Registered 6 November 2009.

Frontal Fibrosing Alopecia in Women: The Mayo Clinic Experience With 148 Patients, 1992-2016

ObjectiveTo characterize the clinicopathologic findings, comorbidities, and treatment outcomes of women with frontal fibrosing alopecia. Patients and MethodsRetrospective review of women with frontal fibrosing alopecia at Mayo Clinic from January 1, 1992, to February 22, 2016. The terms “scarring alopecia,” “lichen,” “planopilaris,” “fibrosing,” and “alopecia” were used for the search of female patients aged 1 to 100 years. A total of 686 patients were reviewed to confirm the diagnosis of frontal fibrosing alopecia. Patients were included if they met diagnostic criteria. ResultsA total of 148 women with frontal fibrosing alopecia were identified, with a mean age of 62 years; 60.1% presented with eyebrow loss; 67.6% and 27.7% described preceding or concurrent pruritus and trichodynia, respectively; 44.6% had a history of hypothyroidism; 13% had a history of surgical menopause; and 63.3% had a history of hormone replacement therapy. A total of 18.2% had lichen planus at other body sites, and 26.3% achieved disease stabilization, often requiring combination therapies. The mean time to remission was 1.8 years. ConclusionPatients with frontal fibrosing alopecia typically present with frontotemporal and eyebrow alopecia with preceding symptoms. Hypothyroidism and a history of hysterectomy may be more common than previously reported. Time to presentation, diagnosis, and stabilization is often months to years. Patients who lack treatment response may present with eyebrow loss, eyelash loss, and facial papules. Combination therapy is helpful in achieving slowing of disease progression or disease stabilization, although recurrence is common. Additional studies on treatment and efficacy are needed. Limitations to this study include the retrospective design and varied follow-up.

Disparities in Cardiac Care of Women: Current Data and Possible Solutions.

Cardiovascular disease remains the leading cause of death in women. The goal of this review is to address known disparities in cardiovascular care with regard to diagnosis and treatment of heart disease in women. Gender-specific differences in regard to the incidence, treatment, and outcomes of common cardiovascular pathology are increasingly recognized. Particular attention to ischemic heart disease, arrhythmia, congestive heart failure, and structural heart disease are reviewed in this article. There is a clear racial and ethnic discrepancy among women which is particularly concerning with a progressively diverse patient population. Medical and surgical treatment differences between men and women must be addressed by providers in order to optimize long-term outcomes among all patients. Understanding the unique cardiovascular risk profile and barriers to optimal treatment outcomes in women is imperative to eliminate the current disparities in cardiovascular disease.

Group therapy for women with substance use disorders: In-session affiliation predicts women's substance use treatment outcomes

In-session affiliation among members is a hypothesized mechanism of action of group therapy for women with substance use disorders (SUDs). We evaluated group affiliation as an independent predictor of SUD treatment outcome in women (n = 100), 18 years or older diagnosed with substance dependence, who were randomized to the single-gender Women's Recovery Group (WRG) or mixed-gender group therapy (Group Drug Counseling; GDC). Affiliative statements made by members in both groups were measured for 39 women in each treatment arm. We studied the relationship between frequency of affiliative statements categorized in quintiles and the trajectory of days of any drug use during 3 months treatment and 6 months post-treatment using a Poisson regression model with estimation via generalized estimating equations. Furthermore, we investigated whether the effect of affiliation on substance use was moderated by group therapy type. The relationship between amount of affiliation and substance use reduction was non-linear. At the end of the treatment phase (3 months), women who experienced the highest level of affiliation (>65 affiliative statements on average) were found to reduce substance use by about 1.75 days more (p-value = 0.02) than women who experienced the lowest level of affiliation (<26). The effects of affiliation persisted 6 months post-treatment and were moderated by therapy group, whereby women enrolled in the single-gender WRG appeared to benefit more from affiliation post-treatment. Training therapists to facilitate verbal affiliation may provide added therapeutic benefit to group therapy for women with SUDs.

Social support and one-year outcomes for women participating in prison-based substance abuse treatment programming

In recent decades, the number of women under criminal justice supervision has increased considerably, many of whom are serving time for drug offenses. Furthermore, women in prison are more likely than their non-institutionalized counterparts to suffer from a substance abuse disorder. While there is a growing body of research concerning women offenders’ drug abuse and treatment needs, few studies have examined the substance abuse treatment outcomes of women in the criminal justice system. Using data from Outcome Evaluation of the Forever Free Substance Abuse Treatment Program, this study compared women’s self-reported drug use twelve months after participation in high-intensity (n = 101) and low-intensity (n = 81) prison-based substance abuse treatment programming (N = 182). Women who perceived high levels of emotional social support were less likely to report substance use at 12-month follow-up. Furthermore, perceptions of emotional social support and treatment intensity interacted in their association with relapse, such that the protective effect of social support was strongest for women who participated in high-intensity programming. The results of the analyses highlight the importance of perceived social support for women with substance abuse disorders who are transitioning from prison-based substance abuse treatment programming to the community.

Treatment Outcomes for Women with Substance Use Disorders: a Critical Review of the Literature (2010–2016)

This review critically examines recent literature (2010–2016) on substance use outcomes in women-only treatment studies and gender differences in treatment outcomes in mixed-gender studies. We then focus on outcomes in three areas salient to women with substance use disorders (SUDs): treatment of comorbid post-traumatic stress disorder (PTSD), pregnancy and parenting interventions, and treatment for women in the criminal justice system. Favorable results were found for behavioral treatments for women including couples therapy and gender-responsive group therapy. When gender differences were observed in mixed-gender behavioral treatment, outcomes were more favorable in women than in men. However, when gender differences were observed in pharmacotherapy trial results, outcomes were worse for women. With regard to the three subgroups that we reviewed, most recent research on co-occurring PTSD and SUD has been secondary analysis studies which suggest that factors such as group attendance and co-occurring psychiatric disorders influence substance use outcomes. In contrast to the other two subgroups examined, behavioral treatments for pregnant women did not show superior outcomes when compared to control groups. However, buprenorphine was found to be safe and effective for use with pregnant women with an opioid use disorder. Finally, studies of treatment outcomes for women in the criminal justice system found preliminary evidence of efficacy for several behavioral treatments. Consistent with findings of previous reviews, gender alone did not necessarily predict treatment response; rather, interaction of gender and other factors affected outcomes. Evidence showing worse outcomes for women in pharmacotherapy trials, with the exception of buprenorphine with pregnant women, further reinforces the need for research to evaluate differential treatment outcomes for men and women.

Recent status of pregnant women with mental disorders at a Japanese perinatal center

Introduction: Recently, we have been providing comprehensive treatment for pregnant women with mental disorders involving specialists from multiple fields in cooperation with local administrative agencies. In this study, we examined the outcomes of treatment for women with perinatal mental disorders in our institute to evaluate the effect of our recent approach to improve perinatal mental health.Methods: We retrospectively compared the outcomes between pregnant women with mental disorders who delivered from April 2015 to March 2017 with those from April 2009 to March 2011. We examined the following: presence or absence of necessity of medication, self-interruption of medication, deterioration/relapse of mental disorders, and administrative support.Results: There was no significant difference in the rate of pregnant women with mental disorders between the two periods (3.2 versus 3.2%, respectively, p = .94). The rates of patients requiring medication and those with self-interruption of medication did not reach significance (p = .90 and .19, respectively) between the two periods; however, the rate of patients with deterioration/relapse of mental disorders decreased significantly during pregnancy and postpartum (20.3 versus 10.7 and 7.3 versus 1.7%, p = .04 and .03, respectively). On the other hand, the patients receiving administrative supports increased significantly over the total study period (p < .01).Conclusions: It was suggested that our recent active management of pregnant women with mental disorders might have contributed to prevent the deterioration/relapse of mental disorders during pregnancy and postpartum.

Change in attachment dimensions in women with binge-eating disorder following group psychodynamic interpersonal psychotherapy

Objective: To examine the role of attachment dimensions, including coherence of mind and reflective functioning, in developing and maintaining binge-eating disorder (BED) and in determining group psychotherapy outcomes for women with BED. We hypothesize that higher pre-treatment attachment dimension scores will predict better treatment outcomes for women with BED and will increase at follow-up. Method: Women with BED attended 16 sessions of group therapy and completed the Adult Attachment Interview (AAI) at pre-treatment. Participants completed outcome measures (i.e., binge-eating frequency and symptoms of depression) at pre-, post-, six months, and 12 months post-treatment. Treatment completers completed the AAI at six months post-treatment. Results: Treatment outcomes improved significantly from pre- to 12 months post-treatment. Greater Reflective Functioning scores at pre-treatment were related to greater decreases in binge eating across the four time points, whereas Coherence of Mind scores were not. For treatment completers, there were significant increases in Reflective Functioning at six months post-treatment, and about a third of treatment completers experienced clinically significant increases in both attachment dimensions at six months post-treatment. Conclusions: Greater reflective functioning at the outset is important for improvements in binge eating in the longer term and group psychotherapy can facilitate change in reflective functioning.

Psychological Impact of Cancer Diagnosis in Newly Diagnosed Breast Cancer Patients

Aim: The aim of the study was to examine the impact of cancer diagnosis on the psychological status of women with breast cancer, focusing on anxiety and psychological distress experienced by breast cancer patients. Materials and Method: A descriptive, cross-sectional study was conducted among 80 breast cancer patients after an initial cancer diagnosis by using purposive sampling. The study was conducted in a tertiary care hospital in South India. Data was collected by using Demographic and Clinical proforma, State-Trait Anxiety Inventory and Impact of Event Scale. Sample characteristics were analyzed using descriptive statistics, the influence of anxiety on psychological distress was tested with correlation and a chi-square test was used to test the association between anxiety and distress with demographic and disease-related variables. Results: The sample consisted of 80 women with a mean age of 48.1 years. 96% were married, and 90% of them were housewives. Half of the subjects were educatedupto primary school. 80% were in stage II of cancer with a duration of diagnosis of 2-4 weeks.48% of the subjects were suffering from a moderate range of distress and 16% had severe psychological distress. Similarly, 80% of subjects had moderate to high level of anxiety. Anxiety did not have any influence on psychological distress. And only duration of diagnosis was associated with psychological distress. Conclusion: Results of the study suggest that cancer diagnosis can cause moderate to severe distress in breast cancer patients. Recognizing distress and intervening it on time is pivotal to improve treatment outcomes of women with breast cancer.

Association Between Body Mass Index and Treatment Outcomes in Women Undergoing Breast Conservation: An Analysis of 3850 Women

Association Between Body Mass Index and Treatment Outcomes in Women Undergoing Breast Conservation: An Analysis of 3850 Women

Retrospective analysis of the survival benefit of chemotherapy for recurrent or advanced epithelial ovarian carcinoma in patients previously treated with paclitaxel plus platinum-based chemotherapy.

The outcomes of treatment for women with recurrent or advanced epithelial ovarian carcinoma previously treated with pacli- taxel plus platinum-based chemotherapy were analyzed. Retrospective analysis was performed in a total of 65 series of treatments provided for 35 patients with a history of paclitaxel plus platinum-based chemotherapy. The chemotherapy regimens used were classified into the following four types for analysis: conventional paclitaxel plus carboplatin therapy (TC arm), pegylated liposomal doxorubicin-containing regimens (PLD arm), CPT-11-containing regimens (CPT-11 arm), and others. Disease-control rates (DCRs) were compared and subjected to univariate analysis. Progression-free survival (PFS) was determined from the date of the first cycle of each chemotherapy with the Kaplan-Meier method, and comparisons were performed using the log-rank test. DCR was 80%, 71%, and 26% for the TC, PLD, and CPT-l arms, respectively. The median PFS was 286, 372, and 76 days for the TC, PLD, and CPT-11 arms, respectively. There was no discernible difference in PFS between the TC and the PLD arm. In contrast, PFS of the CPT- 11 arm was significantly shorter than that of the TC and PLD arms. In addition, three of seven (42.9%) treatments in the PLD arm maintained a progression-free period for longer than one year, while only one of 25 (4%) treatments in the TC arm maintained a progression-free period for more than one year. The PFS of PLD is similar to that of TC. PLD-containing regimens might have a potential benefit with a higher PFS over one year than the TC regimen.

Effect of thyroid autoimmunity per se on assisted reproduction treatment outcomes: A meta-analysis

ObjectiveThyroid autoimmunity (TA) is the most prevalent autoimmune disease in women of reproductive age and is often accompanied by subclinical hypothyroidism (SCH). Both TA and SCH have been associated with adverse pregnancy outcomes, but their relative influence is unclear. Therefore, we carried out a meta-analysis to evaluate the sole effect of TA on pregnancy outcomes in euthyroid women undergoing assisted reproductive technology. Materials and MethodsLiterature searches were conducted on Pubmed, EMBASE, and the Cochrane Controlled Trials Register Database from inception to May 2014. ResultsIn euthyroid women whose SCH status is unknown, those with positive antithyroid antibodies (ATA) had a higher miscarriage rate [pooled relative risk (RR) = 1.638; 95% confidence interval (CI), 1.228–2.185] and a lower delivery rate (pooled RR = 0.856; 95% CI, 0.759–0.965) than those with negative ATA. Clinical pregnancy rates were similar between groups. However, clinical pregnancy rate, miscarriage rate, and delivery rate were all comparable between ATA-positive and ATA-negative euthyroid women without SCH. ConclusionTA per se does not impair assisted reproductive treatment outcomes in women without SCH.

Comparison of psychological morbidity and perceived treatment outcome in women with breast cancer based on expected outcome of the mastectomy

Aim In the present study, the psychological morbidity compared with perceived treatment outcomes based on expected outcome of the mastectomy in women with breast cancer. Methods In the current study, 300 female patients with breast cancer were studied before and after mastectomy using the General Expectancy Outcome Incongruence and General Health questionnaire-12. Results The finding yielded that there was significant difference between patients with the high and low expected outcome of the mastectomy based on the psychological morbidity and perceived outcome of surgery. Similarly there is significant difference between the age, level of education, occupational status based on the psychological morbidity and perceived outcome of surgery. There was significant difference between elderly and non-elderly women psychological morbidity. Conclusions Results show the higher level of expectation of the surgery outcome can be useful in establishing primary social adjustment but lead to underestimate the negative effects of surgery and may disturb psychological adjustment. Thus, high expectancy of outcome of treatment indirectly plays a significant role in increasing problems after mastectomy and can be affect on patients' psychological morbidity and perceived treatment outcomes.

Patient factors associated with onabotulinum toxin A treatment outcome in women with detrusor overactivity.

To evaluate potential predictors of non-response to treatment with 200U onabotulinum toxin A (onaBoNTA) in women with refractory detrusor overactivity (DO). A secondary analysis of a randomized trial of 200U onaBoNTA versus placebo in women with refractory DO analyzed baseline and 6 week follow-up data. Univariate and multivariate logistic regression were used to assess demographic factors and baseline clinical parameters on non-response to treatment defined as 20% or less improvement in urinary urgency and leakage episodes, 10% or less in voiding frequency, not achieving continence, and "no change" or worse on PGI-I score at 6 weeks. One Hundred and twenty-two women were included. Twenty-nine (23.8%), 24 (19.7%), and 19 (15.6%) were non-responders to treatment for urgency, voiding, and leakage episodes, respectively. Fifty-nine (48.4%) failed to achieve continence, and 28 (23%) were non-responders on the PGI-I scale. Smoking status (OR: 2.89 95%CI 1.08, 7.73, P = 0.034) predicted non-response in urgency episodes, and higher baseline leakage episodes (OR: 1.17 95%CI 1.04, 1.31, P = 0.007) predicted non-response in achieving continence. Increasing age (OR 1.04, 95%CI 1.0, 1.09, P = 0.063) and body mass index (BMI) (OR 1.07, 95%CI 1.0, 1.16, P = 0.065) showed marginal associations with non-response on the PGI-I scale. onaBoNTA is an effective treatment for refractory DO, but some fail to respond. For identification of women at risk, our data indicate smokers should be advised of a lesser chance of successful treatment. Older women, those with high BMI and with more severe leakage also have a higher risk of failure. Neurourol. Urodynam. 36:426-431, 2017. © 2016 Wiley Periodicals, Inc.

In vitro fertilization in women under 35: counseling should differ by age.

The aim of this study is to evaluate the outcomes of in vitro fertilization (IVF), including cumulative live birth rate, among women <25 years, 25 to <30 years, and 30 to <35 years. A retrospective cohort study of all women 18 to <35 years of age at their first fresh-embryo, non-donor IVF cycle from January 1995 through December 2012 at a single center was conducted. A competing-risk regression model was used to estimate the cumulative probability and 95 % confidence interval (CI) of the first live birth in up to 6 cycles during the study period with IVF cycle number as the time metric. Among 7243 women who underwent 16,792 cycles, there were 163 (2.3 %) women <25 years, 1691 (23.3 %) women 25 to <30 years, and 5389 (74.4 %) women 30 to <35 years. Women <25 years had the lowest cumulative live birth rate after each cycle, followed by women 30 to <35 years. In both groups, the cumulative live birth rate after 6 cycles was significantly lower than that of women 25 to <30 years; these rates were 58 % (95 % CI 0.51-0.66) among women <25 years, 69 % (95 % CI 0.67-0.71) among women 25 to <30 years, and 64 % (95 % CI 0.63-0.65) among women 30 to <35 years. Our findings are consistent with other reports of less favorable IVF treatment outcomes in women <25 years of age following their first IVF cycle. This indicates that there are underlying factors in couples with a female <25 years of age that should lead to different treatment counseling when they attempt IVF.

Effect of body mass index (BMI) on oocyte quality in IVF cycles

Effect of body mass index (BMI) on oocyte quality in IVF cycles

Triclosan exposure and treatment outcomes in women undergoing in vitro fertilization

Triclosan exposure and treatment outcomes in women undergoing in vitro fertilization

Therapist-Aided Exposure for Women with Lifelong Vaginismus: Mediators of Treatment Outcome: A Randomized Waiting List Control Trial.

Therapist-aided exposure seems an effective treatment for lifelong vaginismus, but mechanisms of action have not yet been established. The purpose of the present study was to investigate whether treatment outcome of a therapist-aided exposure treatment was mediated by changes in positive and negative penetration beliefs or feelings of sexual disgust. Participants with lifelong vaginismus were allocated at random to a 3-month exposure (n = 35) or a waiting list control condition (n = 35). Full intercourse was assessed daily during 12 weeks. Secondary outcome measures (complaints about vaginismus and coital pain) were assessed at baseline and after 12 weeks. Possible mediators: penetration beliefs (catastrophic pain beliefs, genital incompatibility beliefs, perceived control beliefs) and feelings of sexual disgust were assessed at baseline and 6 weeks. Treatment outcome (coital frequency, symptoms of vaginismus, and coital pain) at 12 weeks was mediated by changes in negative and positive penetration beliefs at 6 weeks, in particular by more pronounced reduction of catastrophic pain penetration beliefs. No evidence was found that changes in feelings of sexual disgust mediated treatment outcome. The results strongly suggest that therapist-aided exposure affects negative penetration beliefs and that these changes in negative penetration beliefs mediate treatment outcome in women with lifelong vaginismus. Implications for treatment are discussed.

Periodontal treatment outcomes during pregnancy and postpartum.

This study was conducted to compare periodontal therapy outcomes during pregnancy and after delivery. One hundred nine pregnant women up to the 20th gestational week (GW) were randomized into two groups: the test group (comprehensive periodontal therapy during pregnancy) and the control group (comprehensive periodontal therapy after delivery). Periodontal examinations comprised plaque index (PI), gingival index (GI), periodontal probing depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), and gingival crevicular fluid (GCF) volume. After baseline examination, women in the test group received periodontal treatment up to the 24th GW. The final examination was performed at the 26th to the 28th GW. Women in the control group were treated 30days after delivery and reexamined 30days after treatment. Periodontal therapy significantly reduced periodontal inflammation in both groups. The mean percentage of sites with BOP was reduced from 49.14% (±22.49) to 11.10% (±7.84) and from 45.71% (±17.86) to 8.07% (±5.21) in the test and control groups, respectively (p = 0.95). No statistically significant differences were observed between groups concerning PI, GI, PPD, CAL, and GCF. The reduction in mean percentage of sites with BOP stratified for initial PPD ≥4mm was higher in the control group (p < 0.01), but no differences were seen regarding GCF in these sites. Hormonal changes during pregnancy do not interfere in treatment outcomes in women with widespread gingival inflammation and limited periodontal destruction. The role of these hormonal changes in pregnant women with different disease patterns remains uncertain. Periodontal health can be reestablished irrespective of the hormonal challenge that takes place during pregnancy.

Borderline ovarian tumor in women aged ≥65 years: impact on recurrence and survival

ObjectiveBorderline ovarian tumor (BOT) is uncommon in women with advanced age. The authors investigated the characteristics and treatment outcomes of women with BOT ≥65 years of age. Study DesignA hospital-based tumor registry was used to identify retrospectively patients with BOT who were treated between 1996 and 2011. Patients were divided into two cohorts: women aged <65 years and women aged ≥65 years. Recurrence and survival was examined using the Kaplan–Meier method. Multivariate Cox proportional hazards model was used to estimate hazard ratios with 95% confidence intervals (95% CI). ResultsIn total, 364 patients were identified, including 326 patients aged <65 years and 38 patients aged ≥65 years. The elderly patients had more comorbidities (P<0.001), larger tumor size at diagnosis (P=0.001), more perioperative complications (P=0.001), and longer postoperative hospital stay (P<0.001). In a multivariate model, the hazard ratios for recurrence and disease-related death in patients aged ≥65 years were 2.53 (95% CI, 1.03–6.23) and 7.66 (95% CI, 1.09–53.95), respectively. ConclusionsCharacteristics and survival of patients with BOTs aged ≥65 years differ distinctly from those of patients aged <65 years. Old age was an independent poor prognostic factor of recurrence and disease-related death.