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Chlamydia screening
Seventy-nine women developed pain that interfered with work and were referred to an orthopedic surgeon for an orthoneurologic exam. Sacroiliac joint dysfunction, symphysiolysis, muscular insufficiency, sciatica, lumbago, and thoracic pain were the diagnoses made. Unilateral pelvic pain was most common with sacroiliac joint dysfunction. A trochanteric belt helped 39 of the 54 women for whom it was prescribed; 65% of the women with debilitating pain continued to have low back pain in the postpartum period for a mean of four months.
Chlamydia Screening Trachtenberg A, Washington AE, Halldorson S: A Cost-Based Decision Analysis for Chlamydia Screening in California Family Planning Clinics. OBSTET GYNECOL 71(1):101-108, 1988. The article presents a decision model using medical care costs to determine total costs of a program to screen all women with the Microtrak system versus not screening. Another purpose of the study was to determine the prevalence of infection required for screening to pay for itself. Seventy percent of women with chlamydia are entirely asymptomatic, although clinically detectable PID will occur in 25% of women left untreated. A study in Seattle family planning clinics showed an overall prevalence of the disease of 9.3%. The California clinics in thii study examine 400,000 patients per year with a 9.8% prevalence of chlamydia. Using probabilities for the outcomes of chlamydia and direct costs for components of the screening program, the authors project a net savings of six million dollars in the first year of a universal screening program, with savings increasing to over $13 million in a few years from prevention of chlamydiaassociated PID and its long-term sequelae. The authors conclude that if a population has a prevalence rate of only 2% or
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more, such screening will pay for itself or be “cost-effective.” The authors offer a copy on floppy disk of the spread sheet model they used.
Maternal Smoking Kuhnett BR, Kuhnert PM, Zarlingo TJ: Associations Between Placental Cadmium and Zinc and Age and Parity in Pregnant Women Who Smoke. OBSTETGYNECOL 71(1):6770, 1988. Previous research indicates that infants of older smokers are at greater risk of IUGR than those of young smokers; no explanation of these findings had been discovered. This study was done to examine the relationship between the toxic element cadmium, a byproduct of smoking, and the essential element zinc in placentas of smokers and nonsmokers. It is postulated that zinc becomes depleted with increasing parity. In addition, cadmium has a vey long half-life in the body and accumulates in tissue with increasing age. As the zinc/cadmium ratio decreases, less zinc is available for fetal growth. Placentas and a blood sample taken within an hour of delivery were examined in 98 smokers and 151 nonsmokers at Cleveland Metropolitan General. The plasma was analyzed for thiocyanate to verify smoking status; passive smokers were considered nonsmokers unless thiocyanate exceeded 60 in their sample. There was no significant effect from age alone on the amount of cadmium in placentas. However, the interactive effect of parity and smoking on placental cadmium was significant. Placental zinc decreased slightly with parity in both smokers and nonsmokers. It also decreased significantly with maternal age. The zinc/cadmium ratio was significantly affected by age, but not by parity. The ratio was always higher in nonsmokers; even the oldest nonsmoker had a mean higher than the youngest smoker. The authors suggest that the need to orally supplement zinc in older pregnant smokers should be investigated.
Estrogen Replacement Luciano AA, Turksoy R, Carleo J. Hendriz JW Clinical and Metabolic Responses of Menopausal Women to Sequential versus Continuous Estrogen and Progestin Replacement Therapy. OBSTET GYNECOL 71( 1): 39-43, 1988. This prospective study blindly and randomly assigned 20 postmenopausal women with intact uteri and symptoms of estrogen deficiency to two groups. The first group received the standard sequential regimen of estrogen on days l-25 and progesterone on days 16-25. The second group received both estrogen and progesterone on a daily basis. Half of each group received 1.25 mg Premarin and the other half received 0.625 mg; all women received 10 mg of ProVera. The women kept a calendar of symptoms for one week before the study began and for the 12 weeks of the study. They also had a lipid profile drawn before the study and in the 12th week. Each woman also had an endometrial biopsy in the 12th week of the study. The 10 patients receiving sequential therapy all developed cyclic bleeding; one of these women dropped out of the study because she could not tolerate the resumption of menstruation. Histology results of these women indicated stimulated endomeiria. Of the 10 patients receiving continuous therapy, four were amenorrheic and six had acyclic spotting. Histology of all 10 women indicated atrophic endomeiria. Lipid profiles changed somewhat in both groups. With sequential therapy, there was no change in total cholesterol, a slight increase in HDL, and a decrease in LDL. With continuous therapy, total cholesterol decreased, and both HDL and LDL decreased slightly. In conclusion, the authors recommend the continuous use of the combined hormones since it will relieve menopausal symptoms, decrease the frequency of uterine bleeding by inducing endometrial atrophy, and decrease total serum cholesterol.
Journal of Nurse-Midwifery 0 Vol. 33, No. 3,
May/June 1988
Chlamydia Screening Trachtenberg A, Washington AE, Halldorson S: A Cost-Based Decision Analysis for Chlamydia Screening in California Family Planning Clinics. OBSTET GYNECOL 71(1):101-108, 1988. The article presents a decision model using medical care costs to determine total costs of a program to screen all women with the Microtrak system versus not screening. Another purpose of the study was to determine the prevalence of infection required for screening to pay for itself. Seventy percent of women with chlamydia are entirely asymptomatic, although clinically detectable PID will occur in 25% of women left untreated. A study in Seattle family planning clinics showed an overall prevalence of the disease of 9.3%. The California clinics in thii study examine 400,000 patients per year with a 9.8% prevalence of chlamydia. Using probabilities for the outcomes of chlamydia and direct costs for components of the screening program, the authors project a net savings of six million dollars in the first year of a universal screening program, with savings increasing to over $13 million in a few years from prevention of chlamydiaassociated PID and its long-term sequelae. The authors conclude that if a population has a prevalence rate of only 2% or
146
more, such screening will pay for itself or be “cost-effective.” The authors offer a copy on floppy disk of the spread sheet model they used.
Maternal Smoking Kuhnett BR, Kuhnert PM, Zarlingo TJ: Associations Between Placental Cadmium and Zinc and Age and Parity in Pregnant Women Who Smoke. OBSTETGYNECOL 71(1):6770, 1988. Previous research indicates that infants of older smokers are at greater risk of IUGR than those of young smokers; no explanation of these findings had been discovered. This study was done to examine the relationship between the toxic element cadmium, a byproduct of smoking, and the essential element zinc in placentas of smokers and nonsmokers. It is postulated that zinc becomes depleted with increasing parity. In addition, cadmium has a vey long half-life in the body and accumulates in tissue with increasing age. As the zinc/cadmium ratio decreases, less zinc is available for fetal growth. Placentas and a blood sample taken within an hour of delivery were examined in 98 smokers and 151 nonsmokers at Cleveland Metropolitan General. The plasma was analyzed for thiocyanate to verify smoking status; passive smokers were considered nonsmokers unless thiocyanate exceeded 60 in their sample. There was no significant effect from age alone on the amount of cadmium in placentas. However, the interactive effect of parity and smoking on placental cadmium was significant. Placental zinc decreased slightly with parity in both smokers and nonsmokers. It also decreased significantly with maternal age. The zinc/cadmium ratio was significantly affected by age, but not by parity. The ratio was always higher in nonsmokers; even the oldest nonsmoker had a mean higher than the youngest smoker. The authors suggest that the need to orally supplement zinc in older pregnant smokers should be investigated.
Estrogen Replacement Luciano AA, Turksoy R, Carleo J. Hendriz JW Clinical and Metabolic Responses of Menopausal Women to Sequential versus Continuous Estrogen and Progestin Replacement Therapy. OBSTET GYNECOL 71( 1): 39-43, 1988. This prospective study blindly and randomly assigned 20 postmenopausal women with intact uteri and symptoms of estrogen deficiency to two groups. The first group received the standard sequential regimen of estrogen on days l-25 and progesterone on days 16-25. The second group received both estrogen and progesterone on a daily basis. Half of each group received 1.25 mg Premarin and the other half received 0.625 mg; all women received 10 mg of ProVera. The women kept a calendar of symptoms for one week before the study began and for the 12 weeks of the study. They also had a lipid profile drawn before the study and in the 12th week. Each woman also had an endometrial biopsy in the 12th week of the study. The 10 patients receiving sequential therapy all developed cyclic bleeding; one of these women dropped out of the study because she could not tolerate the resumption of menstruation. Histology results of these women indicated stimulated endomeiria. Of the 10 patients receiving continuous therapy, four were amenorrheic and six had acyclic spotting. Histology of all 10 women indicated atrophic endomeiria. Lipid profiles changed somewhat in both groups. With sequential therapy, there was no change in total cholesterol, a slight increase in HDL, and a decrease in LDL. With continuous therapy, total cholesterol decreased, and both HDL and LDL decreased slightly. In conclusion, the authors recommend the continuous use of the combined hormones since it will relieve menopausal symptoms, decrease the frequency of uterine bleeding by inducing endometrial atrophy, and decrease total serum cholesterol.
Journal of Nurse-Midwifery 0 Vol. 33, No. 3,
May/June 1988