Recent Publications by CFE Educators

CONTEXT

Although studies have examined U.S. pill users' patterns of discontinuation, little is known about pill discontinuation, and the effects of partner influence, among Hispanics.

METHODS

Follow-up data on pill use were collected from 213 predominantly Hispanic women who requested the pill in an urban family planning clinic in 2000. Logistic regression analyses were conducted to assess the association between a range of factors, including partner and relationship variables, and the odds of discontinuation within one month.

RESULTS

The overall discontinuation rate within one month was 23%. Women who reported that their partner was unaware of their planned pill use had significantly elevated odds of discontinuing use (odds ratio, 3.4). Other variables that were independently associated with increased odds of early pill discontinuation were not taking the first pill during the clinic visit (3.0), feeling happy about the prospect of a pregnancy in the next six months (2.4) and intending to use the pill for one year or less (2.3). Age, which was assessed as a continuous variable, was negatively associated with the odds of early discontinuation (0.9).

CONCLUSIONS

Male partners' awareness of planned pill use may be a marker for the level of communication and commitment in the relationship. Women may choose to disclose their planned pill use to supportive partners, and this may be beneficial to the relationship and the couple's contraceptive use. However, clinicians should take women's circumstances and needs into account before counseling them to tell a partner that they intend to use the pill.

Coronary microvascular damage can occur in the presence of myocardial ischemia even if epicardial vessels are patent, a phenomenon known as "no-reflow." Estrogens have favorable effects on coronary conductance and resistance arteries, and may have therapeutic value in ischemic syndromes. Myocardial contrast echocardiography (MCE) is a promising method for evaluating microvascular damage. In this study, the authors hypothesized that acute intracoronary 17beta-estradiol administration can reduce postischemic microvascular damage, which is evaluated by MCE, in a porcine model. Sixteen male pigs were randomized into 2 groups: the treatment group (n = 9) received intracoronary estradiol in increasing doses, and the control group (n = 7) received intracoronary vehicle (dimethylsulfoxide, DMSO). Microvascular damage was induced by balloon catheter occlusion followed by reperfusion of the left circumflex coronary artery (LCX). MCE using Levovist with harmonic imaging was performed before and during 15-minute balloon occlusion of the proximal LCX to determine perfusion areas of the left anterior descending artery (LAD) and LCX. MCE was performed immediately postocclusion and after each injection of estradiol (1, 10, and 100 nmol/L) or DMSO. Videodensitometry measurements were performed as a quantitative marker for myocardial microvascular damage. Videodensitometry results were expressed as peak intensity ratios. Intracoronary estradiol induced a significant reduction in myocardial microvascular damage after ischemic episode by videodensitometry measurements when compared to intracoronary DMSO. The authors conclude that intracoronary injection of estradiol reduces postischemic microvascular damage measured by MCE in a porcine model.

OBJECTIVE

The purpose of this study was to determine whether rates of hypertensive disorders of pregnancy increase beyond 37 weeks of gestation and to address how best to analyze these rates.

STUDY DESIGN

This was a retrospective cohort study of all women delivered beyond 37 weeks' gestational age from 1995 to 1999 at all Kaiser Permanente Medical Care Program delivery hospitals in Northern California. Rates of gestational hypertension, preeclampsia, and eclampsia were calculated by use of both pregnancy delivered (PD) and ongoing pregnancy (OP) as the denominator. Bivariate and multivariate analyses were conducted with use of P.05 to indicate statistical significance.

RESULTS

Among the 135,560 women in this cohort, the rates of gestational hypertension, preeclampsia, and eclampsia were the same or decreased from 37 to 43 weeks' gestation using PD, but all three increased when calculated according to OP (P.01).

CONCLUSION

We found that among complications of pregnancy that are diagnosed ante partum, use of a different denominator led to contradictory conclusions. When hypertensive disorders of pregnancy are analyzed, ongoing pregnancies should be used as the denominator.

Mouse genetics has contributed significantly to our understanding of molecular mechanisms underlying tissue and nerve injury-induced persistent pain. To create a highly reproducible, relatively noninvasive model of neuropathic pain in the mouse, we examined the behavioral consequences of sparing each of the 3 distal branches of the sciatic nerve in wild-type mice after a model originally described in the rat. Sparing the tibial branch but sparing neither of the other branches produced robust mechanical allodynia while leaving heat sensibility intact. To assess the topographic organization of the IB4 population of afferents from each branch and to compare anatomic consistency across injury models, we examined loss of thiamine monophosphatase staining in the superficial dorsal horn after peripheral nerve injury. We found that each of the sciatic branches targets a distinct mediolateral location in inner lamina II and that each of the spared nerve injury models produced a more reproducible pattern of thiamine monophosphatase staining loss than did partial tight ligation. These results improve on previous nerve injury models in mouse, demonstrate similar behavioral changes as in rat, and provide novel information on the topographic organization of small diameter peripheral afferents in the mouse spinal cord.

Jails are a unique setting for health education. The Tuberculosis (TB) Prevention Project was designed to improve completion of care for latent TB infection in released inmates. As part of an ongoing clinical trial to improve rates of completion, educators provided TB-focused educational sessions to 1,027 inmates. This article describes the educational sessions and illustrates some of the barriers to working in a jail setting and strategies to overcome them. The nature of the jail itself, inmate characteristics, the characteristics of educators, and the educational sessions themselves interacted in different ways to enhance or impair the interaction. Jail is a setting in which the population is at high risk for a number of health problems and health education is increasingly important.

PURPOSE

To determine which clinical and radiologic findings are independently associated with a pathologic diagnosis of usual interstitial pneumonia (UIP).

METHODS

We recently reported, using a prospective, multicenter study of patients suspected of having idiopathic interstitial pneumonia (IIP), that a confident diagnosis of UIP made by experienced radiologists was correct in 95% of cases. In the current article, we further analyzed data from this study. Ninety-one patients were entered into the study. Clinical, physiologic, chest radiographic, and CT features were prospectively recorded, and analyzed using univariate and multivariate logistic regression analysis to compare the patients with a histologic diagnosis of UIP with those who received other pathologic diagnoses.

RESULTS

Fifty-four of 91 patients (59%) received a pathologic diagnosis of UIP. The following features recorded at the referring clinical centers were associated with a pathologic diagnosis of UIP on multivariate analysis: lower-lobe honeycombing on high-resolution CT (HRCT) [odds ratio, 11.45], radiographic findings consistent with UIP (odds ratio, 5.73), elevated ratio of FEV(1) to FVC (odds ratio, 4.8), and absence of smoking history (odds ratio, 0.19). On multivariate analysis of specific HRCT features recorded by four experienced chest radiologists, lower-lung honeycombing (odds ratio, 5.36) and upper-lung irregular lines (odds ratio, 6.28) were the only independent predictors of UIP. Using only these two factors, a diagnosis of UIP could be established with a sensitivity of 74%, a specificity of 81%, and a positive predictive value of 85%.

CONCLUSION

In patients presenting with a clinical syndrome suggestive of IIP, CT findings of lower-lung honeycombing and upper-lung irregular lines are most closely associated with a pathologic diagnosis of UIP.

Bronchiolitis is increasingly recognized as an important clinical syndrome that encompasses the broad spectrum of histopathologic processes which show some degree of inflammation, narrowing, or obliteration of the small conducting airways. It has an extremely variable clinical course, etiology, and histologic appearance. Understanding of this entity has been limited because until recently only case reports described this lesion in several diverse clinical settings. In addition, there has been considerable confusion as a result of the different terminologies applied to the many syndromes. This article reviews the clinical, radiographic, and histopathologic findings of the bronchiolar syndromes that are secondary to inhalation of chemicals or organic dust, that are secondary to infection, that are drug-induced, and that have no known etiology (idiopathic).

CONTEXT

The value of exercise testing in women has been questioned.

OBJECTIVE

To determine the prognostic value of exercise testing in a population-based cohort of asymptomatic women followed up for 20 years.

DESIGN AND SETTING

Near-maximal Bruce-protocol treadmill test data from the Lipid Research Clinics Prevalence Study (1972-1976) with follow-up through 1995.

PARTICIPANTS

A total of 2994 asymptomatic North American women, aged 30 to 80 years, without known cardiovascular disease.

MAIN OUTCOME MEASURES

Cardiovascular and all-cause mortality.

RESULTS

There were 427 (14%) deaths during 20 years of follow-up, of which 147 were due to cardiovascular causes. Low exercise capacity, low heart rate recovery (HRR), and not achieving target heart rate were independently associated with increased all-cause and cardiovascular mortality. There was no increased cardiovascular death risk for exercise-induced ST-segment depression (age-adjusted hazard ratio, 1.02; 95% confidence interval [CI], 0.57-1.80; P =.96). The age-adjusted hazard ratio for cardiovascular death for every metabolic equivalent (MET) decrement in exercise capacity was 1.20 (95% CI, 1.18-1.30; P.001); for every 10 beats per minute decrement in HRR, the hazard ratio was 1.36 (95% CI, 1.19-1.55; P.001). After adjusting for multiple other risk factors, women who were below the median for both exercise capacity and HRR had a 3.5-fold increased risk of cardiovascular death (95% CI, 1.57-7.86; P =.002) compared with those above the median for both variables. Among women with low risk Framingham scores, those with below median levels of both exercise capacity and HRR had significantly increased risk compared with women who had above median levels of these 2 exercise variables, 44.5 and 3.5 cardiovascular deaths per 10 000 person-years, respectively (hazard ratio for cardiovascular death, 12.93; 95% CI, 5.62-29.73; P.001).

CONCLUSION

The prognostic value of exercise testing in asymptomatic women derives not from electrocardiographic ischemia but from fitness-related variables.