Women Of Different Ages Research Articles

Endometrial Assessment: When is it Necessary?

BackgroundEndometrial cancer is the fourth most common cancer among women and the most common malignant neoplasm of the female genital tract in the USA. The onset is usually after the age of 50 and prognosis depends on the stage of disease at diagnosis. We aimed at determining the prevalence of high-risk endometrial lesions in women of different ages to establish a protocol for the indication of invasive diagnostic procedures.MethodsA retrospective study was conducted based on the descriptive and statistical analysis of histopathological records of 2,931 patients who underwent uterine curettage between January 2001 and December 2011 at our institution.ResultsThe risk of endometrial malignancy was about 10 times higher in patients aged 50 years or older than that in younger women. However, women with abnormal uterine bleeding had a higher prevalence of high-risk conditions, regardless of age.ConclusionAtypical and complex endometrial hyperplasia and carcinoma can affect women of all ages, but are more common in patients 50 years of age or older. Thus, endometrial sampling is recommended as a routine procedure for all women 50 years of age or older with clinical indications of the disease and as a screening procedure for those undergoing hysterectomy.

Dissimilarity of femur aging in men and women from a Nationwide Survey in Korea (KNHANES IV)

In light of the differences in hip fracture rates between men and women of different ages, age-related changes in bone structure that lead to bone fragility might differ depending on both age and gender. To investigate age-related bone loss and geometric deterioration of the femur, hip scans of 1,504 men and 2,076 women aged 19-92years acquired during the Fourth Korean National Health and Nutrition Examination Survey (KNHANES IV) using dual-energy X-ray absorptiometry (DXA) were analyzed with a structural analysis program. Cross-sectional area and cortical thickness with bone mineral density in men started to decline from the third decade and continued to decline at a constant rate. However, in women, these parameters remained nearly constant until the fifth decade and then declined at a more rapid rate than that seen in men. Consequently, changes in the buckling ratio, earlier onset, and continuation of increase over the lifetime were observed in men. A relatively later onset with a greater acceleration with aging was observed in women. Taken together, there were obvious gender and age differences in structural trends with age. Bone aging, i.e., bone loss and geometric deterioration, actually begins at a young age, especially in men, and osteoporosis prevention strategies should target not only the elderly but also younger individuals.

Complex impact of remoteness on the incidence of myocardial infarction in Aboriginal and non‐Aboriginal people in Western Australia

To determine the impact of remoteness on Aboriginal and non-Aboriginal myocardial infarction incidence rates in men and women of different ages. Descriptive study. Western Australia. Incident cases of myocardial infarction in Western Australia from 2000-2004 identified from person-linked files of hospital and mortality records. Analysis was undertaken for Aboriginal and non-Aboriginal populations, separately and combined, by broad age group, sex and remoteness. Incidence of myocardial infarction. In the combined analysis, age-standardised incidence was significantly higher for men in very remote areas (rate ratio 1.31: 95% confidence interval (CI), 1.19-1.45) and in women in both regional (rate ratio 1.12: 95% CI, 1.01-1.20) and very remote (rate ratio 2.05: 95% CI, 1.75-2.41) areas. Aboriginal rates were substantially higher than non-Aboriginal rates in all substrata. Compared with metropolitan people, regional Aboriginal men and very remote non-Aboriginal men aged 25-54 years had significantly higher incidence rates. For the remaining rural strata, there was either no geographical disadvantage or inconclusive findings. Non-metropolitan disadvantage in myocardial infarction rates is confirmed in regional areas and women in very remote areas. This disadvantage is partly explained by the high rates in Aboriginal people. Non-metropolitan dwellers are not uniformly disadvantaged, reflecting the interplay of the many factors contributing to the complex relationship between myocardial infarction incidence and sex, age, Aboriginality and residence. Aboriginal Western Australians in all regions and young non-Aboriginal men living in very remote areas need to be targeted to reduce disparities in myocardial infarction.

Midlife Crisis Perceptions, Experiences, Help-Seeking, and Needs Among Multi-Ethnic Malaysian Women

In the present study, researchers explored attitudes toward midlife crises, experience with midlife crises, help-seeking, and needs among multi-ethnic Malaysian women. A total of 14 focus group discussions were conducted with 89 Malaysian women of different ages and socioeconomic backgrounds. Women expressed concern over physical aging and decline in their physical functional health. Having a midlife crisis was frequently reported. Issues that were frequently reported to trigger a midlife crisis, such as empty nest syndrome, impact of aging on sexual and reproductive function, extended parenthood, caring for aging or ill parents, and career challenges were noted by the study participants (listed here in order of most to least frequently reporting of these themes across the group discussions). Overall, these issues were associated with attitudes about aging. A comparatively less open attitude toward sexual attitudes and help-seeking for sexual problems were found among the Malay and Indian women. This may imply that intervention to increase positive attitudes concerning both sexuality and help-seeking intentions should be culturally specific. The use of religious coping for comfort and consolation was frequently reported; therefore, those providing midlife crisis prevention and intervention programs should consider involving faith-based interventions in the Malaysian setting.

Potential lifetime cost-effectiveness of catheter-based renal sympathetic denervation in patients with resistant hypertension

Recent studies have demonstrated the safety and efficacy of catheter-based renal sympathetic denervation (RDN) for the treatment of resistant hypertension. We aimed to determine the cost-effectiveness of this approach separately for men and women of different ages. A Markov state-transition model accounting for costs, life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness was developed to compare RDN with best medical therapy (BMT) in patients with resistant hypertension. The model ran from age 30 to 100 years or death, with a cycle length of 1 year. The efficacy of RDN was modelled as a reduction in the risk of hypertension-related disease events and death. Analyses were conducted from a payer's perspective. Costs and QALYs were discounted at 3% annually. Both deterministic and probabilistic sensitivity analyses were performed. When compared with BMT, RDN gained 0.98 QALYs in men and 0.88 QALYs in women 60 years of age at an additional cost of €2589 and €2044, respectively. As the incremental cost-effectiveness ratios increased with patient age, RDN consistently yielded more QALYs at lower costs in lower age groups. Considering a willingness-to-pay threshold of €35 000/QALY, there was a 95% probability that RDN would remain cost-effective up to an age of 78 and 76 years in men and women, respectively. Cost-effectiveness was influenced mostly by the magnitude of effect of RDN on systolic blood pressure, the rate of RDN non-responders, and the procedure costs of RDN. Renal sympathetic denervation is a cost-effective intervention for patients with resistant hypertension. Earlier treatment produces better cost-effectiveness ratios.

The age- and sex-specific occurrence of bothersome neck pain in the general population – results from the Stockholm public health cohort

BackgroundNeck pain is very common but the occurrence of bothersome neck pain is not well described. Therefore our objective was to report on the prevalence and incidence of, as well as the rate of recovery from, bothersome neck pain in men and women of different ages in the general population.MethodsWe used data from a recently conducted population-based cohort study, comprising 23,794 individuals in Stockholm County, Sweden. Study participants were surveyed with a self-administered questionnaire in 2002/2003 and 2007, and information on episodes of neck pain was gathered at baseline and at follow-up. We then measured bothersome neck pain in 2005 and 2006 retrospectively in 2007 using the follow-up questionnaire.ResultsThe one-year prevalence of bothersome neck pain for at least seven consecutive days was 25% (95% confidence interval (CI): 24–25) among women and 16% (95% CI: 15–16) among men, peaking in individuals aged 30–59 years. The one-year incidence proportion of bothersome neck pain was 7% (95% CI: 6–7) among women, and 4% (95% CI: 4–5) among men. Women recovered more infrequently than men. The one-year incidence proportion of recovery (of at least one year duration) was 11% (95% CI: 10–12) among women and 14% (95% CI: 12–16) among men.ConclusionBothersome neck pain is most common in middle-aged individuals. Women are more likely than men to have and to develop bothersome neck pain, and less likely to recover from such pain. Younger men and women have a higher incidence, but recover more often from bothersome neck pain than older individuals.

Abstract 319: Potential Lifetime Cost-Effectiveness of Catheter-Based Renal Sympathetic Denervation in Patients with Resistant Hypertension

Aims - Recent studies have demonstrated the safety and efficacy of catheter-based renal sympathetic denervation (RD) for the treatment of resistant hypertension. We aimed to determine the cost-effectiveness of this approach separately for men and women of different ages. Methods and results - A Markov state-transition model accounting for costs, survival, quality of life, and incremental cost-effectiveness was developed to compare RD with best medical therapy (BMT). The model ran from age 30 to 100 years or death, with a Markov cycle length of 1 year. All patients entered the model with elevated systolic blood pressure (SBP, 180 mmHg), but free from prior cardiovascular disease (CVD) events. Patients could remain in this disease-free state or could have one of the following primary CVD events: myocardial infarction, angina, stroke or heart failure. After an event, patients transitioned into chronic disease states and/or could suffer from secondary CVD events. In the base case scenario, RD resulted in a sustained SBP reduction of 20 mmHg and in a corresponding relative risk reduction of adverse CVD events and death. The cost analysis was conducted from a health care payer perspective. Effectiveness was expressed as quality-adjusted life-years (QALY) gained. Costs and effects were discounted at 3% per annum, respectively. Deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness of the results. As compared with BMT, RD gained 0.99 QALYs in men and 0.91 QALYs in women 60 years of age at an additional cost of $3,265 and $2,594, respectively. As the incremental cost-effectiveness ratio increased with patient age, RD consistently yielded more QALYs at lower costs in lower age groups. Considering a willingness to pay threshold of $50,000/QALY, there was a 95% probability that RD would remain cost-effective up to an age of 82 and 80 years in men and women, respectively. Cost-effectiveness was influenced most by the extent of SBP lowering by RD, the rate of RD non-responders, and the costs associated with the RD procedure. Conclusion - RD offers a cost-effective treatment option for the prevention of CVD events in patients with resistant hypertension. An earlier intervention produces better cost-effectiveness ratios.

Finnish Girlhood in the Twentieth Century: Public Representations and Private Stories

Abstract This article focuses on change and continuity in the meanings of girlhood and adolescence in Finland during the twentieth century. There is an emphasis on the time period from the 1960s to the 1990s, but the article also includes a historical summary of early twentieth-century debates on girlhood and education, based on earlier research. In the article, public, normative views of girlhood are contrasted with the private experiences of girls and linked with an overview of the changing social and cultural ideals of femininity. Two main data sets will be drawn from: firstly, advice books for girls from the 1960s to the 1990s, and secondly, autobiographical stories written by girls and women of different ages in the mid-1990s. The analysis of the texts has been inspired by feminist poststructuralist theory, narrative analysis, and discourse analysis. In the course of the article, it is shown that Finnish girls’ position as individuals and citizens has constantly been questioned. Their sexuality has been seen as particularly vulnerable, and their relationship to parents has often been full of tension. However, towards the end of the twentieth century, positions invested with more agency were gradually opening up for girls and young women in Finland, especially in relation to the neo-liberal individualist discourses that had become more and more prominent during that time.

Stress-Induced Cardiomyopathy in Sweden: Evidence for Different Ethnic Predisposition and Altered Cardio-Circulatory Status

Background: In this paper, we report about new insights regarding clinical course, long-term outcome, ethnic/genetic predisposition and cardio-circulatory status in the large stress-induced cardiomyopathy (SIC) cohort from Sweden. Methods and Results: We have included 115 consecutive SIC patients between January 2005 and January 2010 at Sahlgrenska University Hospital in Gothenburg. Hemodynamic status and sympathetic nerve activity were evaluated and compared with those of healthy controls. Mean age was 64, and 14% were males. Thirty-day and 3-year mortality was 6 and 10%, respectively. Eleven percent had ischemic heart disease, 3% developed thromboembolic complications, 6% had cardiac arrest and 14% developed cardiogenic shock. The great majority of SIC patients (93%) were ethnic Swedes. In three families, several close relatives developed SIC. Fourteen percent developed two or more episodes of SIC. Hemodynamic evaluation has shown subnormal systemic vascular resistance, 22% lower sympathetic activity and preserved cardiac output in SIC patients. Conclusions: SIC affects both men and women of different ages and is associated with significant short- and long-term mortality. There is a strong signal for the presence of ethnic/genetic predisposition to develop SIC. Sympathetic activity and systemic vascular resistance are lower in SIC patients, suggesting that SIC is a cardio-circulatory phenomenon.

Influence of age on the association between lifestyle factors and risk of hypertension

BackgroundAlthough hypertension is a highly prevalent disease in older populations, risk factors for developing hypertension have been studied primarily in younger cohorts. We sought to determine whether the strength of traditional hypertensive risk factors varied with age. MethodsWe analyzed the prospective association between five modifiable risk factors and hypertension incidence among 78,590 initially nonhypertensive women of different ages in the Nurses’ Health Study I cohort over 26 years. ResultsOlder age attenuated the association between incident hypertension and four of five risk factors associated with hypertension in younger women. Persons aged 50 years and younger who were low risk for all five risk factor behaviors had a hazard ratio (HR) for incident hypertension of 0.13 (95% confidence interval [CI], 0.03–0.52) compared with others in this age group. In women 61 and older, the HR was 0.62 (95% CI, 0.51–0.75). However, the hypothetical number needed to treat (the number of women needed to join the low-risk-factor group for a 10-year period to prevent one hypertension case) was similar between the age groups. ConclusionThe fraction of incident hypertension attributable to modifiable lifestyle factors decreases with age. Because the incidence of hypertension is higher in older persons, however, lifestyle modification would hypothetically prevent similar numbers of hypertension cases in younger and older populations.

A reduction in public funding for fertility treatment - an econometric analysis of access to treatment and savings to government

BackgroundAlmost all assisted reproductive technology (ART) and intrauterine insemination (IUI) treatments performed in Australia are subsidized through the Australian Government’s universal insurance scheme, Medicare. In 2010 restrictions on the amount Medicare paid in benefits for these treatments were introduced, increasing patient out-of-pocket payments for fresh and frozen embryo ART cycles and IUI. The aim of this study was to evaluate the impact of the policy on access to treatment, savings in Medicare benefits and the number of ART conceived children not born.MethodsPooled quarterly cross-sectional Medicare data from 2007 and 2011 where used to construct a series of Ordinary Least Squares (OLS) regression models to evaluate the impact of the policy on access to treatment by women of different ages. Government savings in the 12 months after the policy was calculated as the difference between the predicted and observed Medicare benefits paid.ResultsAfter controlling for underlying time trends and unobserved factors the policy change reduced the number of fresh embryo cycles by almost 8600 cycles over 12 months (a 16% reduction in cycles, p < 0.001). The policy effect was greatest on women aged 40 years and older (38% reduction in cycles, p < 0.001). Younger women engaged in relatively more anticipatory behaviour by bringing forward their fresh cycles to 2009. Frozen embryo cycles, which are approximately one quarter of the cost of a fresh cycle, were only marginally impacted by the policy. Utilisation of IUI cycles were not impacted by the policy. After adjusting for anticipatory behaviour, $76 million in Medicare benefits was saved in the 12 months after the policy change (0.47% of annual Medicare benefits). Between 1200 and 1500 ART conceived children were not born in 2010 as a consequence of the policy.ConclusionsThe introduction of the policy resulted in a significant reduction in fresh ART cycles in the first 15 months after its introduction. Further evaluation on the long term impact of the policy with regard access to treatment and on clinical practice, particularly the number of embryos transferred, is crucial to ensuring equitable access to fertility treatment and the health and welfare of ART children.

The mutable identities of women in public relations

The notion that contemporary society as a knowledge economy is undergoing profound transformation has implications for the occupation of public relations, as well as the professional and personal identities of public relations practitioners. With the increasing erosion of once clear demarcations between people, time, space and communication technologies, public relations practitioners experience increasing tensions in their encounters between self and other, private and public, economic and cultural factors. We are interested in how women in public relations undertake identity work as a way of responding to these pressures, notably at the point where their home and work lives intersect. In interviews and focus groups conducted in Perth, Western Australia, women of different ages and career backgrounds related their experiences of juggling multiple roles including worker, mother, partner, friend, parent or grandparent. The findings reveal a set of complex identity constructions that indicate that some women are successful in separating professional and personal identities, while others are unable to resist work as an all-encompassing activity and as the marker of a meaningful identity. To develop as a public relations practitioner involves not only the social expectations of what it means to be a professional coupled with an individual’s presentation of themselves in public relations. It also involves a changeable relationship that expands over the whole life situation, including career trajectories and family life stages. A recognition of this set of circumstances prompts further research questions in relation to public relations and its specific influence on gendered, identity and relationship practices, and has significant implications for the profession more broadly.

The influence of individual personality traits on heart rate variability in women of different age under emotional stress

We have studied the autonomic regulation of the heart rate under the effect of emotional stress in women 30–60 years old. For physiological monitoring of the subject’s state during emotional tests, the variation pulsemetry based on the analysis of heart rate variability (time and spectral HRV) has been used. Negative emotions in introverts and subjects with intropunitive response have induced similar changes of HRV parameters in comparison to the original state: SDNN, RMSSD, triangular index, and power in HF range have decreased, and Baevsky stress index has increased. This is the evidence that autonomic balance shifts towards activation of the sympathoadrenal system, the decrease in efficiency of baroreflex regulation, and activation of regulatory systems of the body in those people. The described changes in HRV have been found to be similar to age-related changes. Our results help to reveal some of the mechanisms involved in development of neurogenic disorders during prolonged emotional stress.

Low predictability of anthropometric indicators of obesity in metabolic syndrome (MS) risks among elderly women

While diagnostic criteria for MS may vary depending on ethnicity, obesity remains a key risk factor in its development. In Taiwan, the incidence of obesity and MS among women has been increasing; however cut-off values for defining obesity for the diagnosis of MS among different groups of women have not been clearly established. The goal of this research was to examine the suitability of various anthropometric indicators of obesity in predicting the presence of MS criteria and to determine appropriate cut-off values of these indicators for women of different age and menstrual status. The sample was derived from the 2002 “Taiwan Three High Prevalence Survey” database. Women were divided into three groups based on age and menstrual status. Receiver-operating characteristic (ROC) curves was applied to the anthropometric indicators of obesity including, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), to ascertain its value in predicting MS. 2848 cases were included. It was found that most MS component values were worse with age and following menopause. Obesity indicators showed poor predictability for MS risks in post-menopausal women over 65 years, but good predictability in women under 65 years; our study revealed the following as ideal cut-off values for non-menopausal female: WHtR<0.49, WC<78cm, WHR<0.79, BMI<24kg/m2; for menopausal women, WHtR<0.54, WC<83cm, WHR<0.84, BMI<24.4kg/m2. It was concluded that obesity alone is not a reliable predictor of MS risks in women over the age of 65, and cut-off values for obesity indicators need to be further reduced in non-menopausal women.

Human papillomavirus infections in women with clinical gynaecological diseases in southwest China

The aim of this study was to determine the prevalence of human papillomavirus (HPV) infections in women with different gynaecological diseases (GDs) and ages in southwest China. With the assay of reverse dot blot, a total of 5544 cervical samples, including 1008 normal and 4536 abnormal specimens from women with GDs, were assayed for HPV detection. For the normal group, 20.2% (204/1008) tested positive for HPV, of which 40.2% (82/204) were high-risk (HR-HPV) genotypes. In the 4536 abnormal samples, 1569 women (34.6%) tested positive for HPV: 73.5% (1153/1569) had a single infection, 17.7% (277/1569) dual infection and 8.8% (138/1569) multiple HPV infection. Of 1569 HPV-positive specimens, 58.7% (921/1569) were infected with only HR-HPV genotypes. Significant differences in HPV infections were found among women of different ages (P < 0.01), number of pregnancies (P < 0.01), GDs (P < 0.01) and age at first sex (P < 0.01). In the present study, we found a high prevalence of HPV infection in women with GDs in southwest China. In addition to HPV types 16 and 18, a significant proportion of other HR-HPV genotypes were detected in this population.

Differences in the implementation of preventive services for reproductive health protection of women of different ages

Objective. The preservation and improvement of reproductive health of women is a significant segment of public health policy in each country. Factors affecting the reproductive health of women are numerous: the sociodemographic, sexual behavior and lifestyle, and health care factors. The aim of this study was to examine differences in socodemographic characteristics, application of methods of contraception and prevention practices are important to protect reproductive health of women of different age. Methods. This study represents a secondary data analysis of the 2006 National Health Survey of the population of Serbia (without data about Kosovo-Metohija), which was performed as a cross-sectional study on a randomly selected representative population sample of 14,522 people aged 20 and more. In this study, we focused on the characteristics of 3,575 women aged 20 to 49. Results. With our study we have shown that there are significant differences both in the application of methods of contraception, as well as preventive gynecological practice in order to protect the reproductive health of women young and middle age. The subjects mean age, as a method of contraception more frequently applied IUU (OR=3,56, 95% CI 2,02 - 6,28) and the method of the fertile days (OR=1,48, 95% CI 1,17 - 1,87); less likely to use condoms (OR=0,36, 95% CI 0,30- 0,45). In terms of preventive gynecological practice, middle-aged respondents, compared to younger, less likely to leave the control gynecological examinations (OR=2,13, 95% CI 1,78-2,54) more likely to do breast selfexamination (OR=1,23, 95% CI 1,05-1,45), Pap test usually work for a period of over three years (OR=7,27, 95% CI 3,34 to 15,84). Conclusion. Our study showed that women of different ages not sufficiently concerned about protecting their reproductive health, resulting in the low fertility rate.

Microneurographic research in women

This article reviews microneurographic research on sympathetic neural control in women under both physiological and pathophysiological conditions across the lifespan. Specifically, the effects of sex, age, race, the menstrual cycle, oral contraceptives, estrogen replacement therapy, and normal pregnancy on neural control of blood pressure in healthy women are reviewed. In addition, sympathetic neural activity during neurally mediated (pre)syncope, the Postural Orthostatic Tachycardia Syndrome (POTS), obesity, the Polycystic Ovary Syndrome (PCOS), gestational hypertension, and preeclampsia, chronic essential hypertension, heart failure, and myocardial infarction in women are also reviewed briefly. It is suggested that microneurographic studies provide valuable information regarding autonomic circulatory control in women of different ages and in most cases, excessive sympathetic activation is associated with specific medical conditions regardless of age and sex. In some situations, sympathetic inhibition or withdrawal may be the underlying mechanism. Information gained from previous and recent microneurographic studies has significant clinical implications in women's health, and in some cases could be used to guide therapy if more widely available.

Pain and daily activities in rheumatoid arthritis

Aim: The aim of this study was to describe experiences of pain and its relationship to daily activities in people with rheumatoid arthritis (RA). Method: Seven semi-structured focus group discussions were conducted with 33 men and women of different ages with RA. Data were analysed with content analysis. Results: Pain affected everyday life and may be a barrier to perform valued activities. Regarding the impact of pain on participation and independence, personal factors and the social environment were found to be important. It could be a struggle to find the right activity balance, since it was easy to be overactive, triggering subsequent elevation of pain levels. However, the participants also described activities as a mediator of pain and a distraction from it. Conclusion: The relationship between pain and daily activities in RA was complex. Pain as an impairment was expressed to be related to activity limitations and participation restrictions, as well as to contextual factors. These findings highlight the clinical importance of paying attention to the complexity of pain and its relation to daily activities and participation.Implications for RehabilitationPain in RA needs to be comprehensively analyzed and treated in the context of the patients’ perspective and needs.The relation between pain and performance of activities in RA highlights the importance of rehabilitative interventions to reduce pain in order to facilitate daily activity.The complexity of pain implies the need for multimodal approach in rehabilitation.

Risk perception and social participation among women exposed to manganese in the mining district of the state of Hidalgo, Mexico

ObjectiveTo analyze the importance attributed to manganese (Mn) in the health-disease-death process and possibilities for participation in risk management of women from two communities who live near the plant in the Molango mining district. Materials and methodsQualitative study based on 6 focus groups with women of different ages. Audio recordings were made of the sessions, after verbal informed consent, and were transcribed with a word processor. The analysis was conducted according to theme, taking into account the age group and community to which the women belonged, using the Atlas-ti (v.5.0) program. ResultsThe youngest women from Chiconcoac attribute the cause of headaches and chest pain to manganese, while women from the Tolago community believe it exacerbates disease in general. Women between 31 and 40years old from Chiconcoac attribute the cause of “brain” pain, burning eyes and coughs to manganese, and those in Tolago report that it causes memory problems. The oldest women in Tolago believe Mn causes learning difficulties and affects children's growth and development. The women of all ages in Tolago believe that Mn has decreased the production of fruit and vegetables in the region. Some of the obstacles to participation in risk management are: women are not allowed to attend meetings at which men discuss the Mn problem and they perceive the mine as a source of employment for the community. ConclusionsThe women perceive Mn to have serious effects on health and the local environment and have fewer opportunities than men to participate in risk management. Some of the health consequences attributed to Mn are consistent with those reported by neurological studies, nevertheless, other risks are overestimated. Spaces for communication need to be created to listen to the women's interests and concerns and empower them to participate in the risk management plan.

Clinical/pathologic features and patient outcome in early onset endometrial carcinoma: A population based analysis and an institutional perspective from the Detroit metropolitan area, Michigan

ObjectiveAnalyze tumor characteristics and outcomes in patients with endometrial carcinoma (EC)<40years of age and compare them to the characteristics of patients≥40years of age. Methods10,700 patients (305 patients <40years of age) diagnosed between 1988 and 2007 with EC from the Metropolitan Detroit Cancer Surveillance System (MDCSS), and 884 patients (42 patients <40years of age) diagnosed between 1996 and 2008 with EC from our institutional database were identified. Differences in clinical and demographic variables by age (<40 vs. ≥40) were assessed for statistical significance by chi-square tests. Cox proportional hazards models were used to calculate adjusted hazard ratios (HR) and their 95% confidence intervals (95% CI) to assess the risk of death from all causes. ResultsMDCSS based analysis: Patients<40 were more likely to present with low grade tumors (p<0.0001) and endometroid histology (p=0.0004) but less likely to undergo surgery (p=0.0007) or radiotherapy (p=0.0007). A multivariate analysis confirmed the significance of age, grade, and stage in all patients, and that of histologic type, surgery, and race in patients≥40 as independent prognostic factors for overall survival. Institution based analysis: Patients<40 had a higher proportion of patients with BMI≥30 (p=0.04), and presented with a higher frequency of well differentiated (p=0.04) endometrioid tumors (p=0.004) that are less prone to have deep myometrial invasion (p=0.008). ConclusionThis study supports the hypothesis of a disease that is biologically and genetically heterogeneous among women of different ages and ethnicities.