Publications

OBJECTIVE

To describe the experiences of postmenopausal women who try to stop hormone therapy and to identify characteristics associated with inability to stop.

METHODS

We conducted telephone interviews with 377 randomly selected female members of the Kaiser Foundation Health Plan, aged 50-69 years, who regularly used hormone therapy for at least 1 year before July 1, 2002 and had attempted to stop between July 2002 and March 2003.

RESULTS

Of the 377 women, 280 (74%) successfully stopped and 97 (26%) resumed taking hormone therapy. The major predictor of resuming hormone therapy use was the development of troublesome withdrawal symptoms (odds ratio 8.8; 95% confidence interval 4.9, 16.0). Report of hysterectomy, hormone therapy prescribed by a nongynecologist, and perception of high risk of hip or spine fracture were independently associated with a higher likelihood of unsuccessful stopping. Women with a hysterectomy who had used hormone therapy for 10 or more years and who started hormone therapy mainly for reasons other than health promotion were more likely (P <.001) to be unsuccessful in quitting (44%) compared with those with one or two (25%) or none (9%) of these three characteristics. Most successful stoppers (71%) stopped hormone therapy abruptly, but 29% tapered off hormone therapy; there was no difference in the incidence of troublesome withdrawal symptoms or successful quitting between these two groups.

CONCLUSION

Approximately one quarter of women who try to stop report that they are unable to discontinue postmenopausal hormone therapy, primarily because they develop troublesome withdrawal symptoms. Effective approaches to reducing hormone therapy withdrawal symptoms should be a priority for future research.

OBJECTIVE

To examine whether women who were using postmenopausal hormone therapy (HT) before publication of Women's Health Initiative findings about risks associated with HT had been informed about the findings once published; and to estimate how knowledge of these findings was associated with their decision to discontinue HT.

METHODS

We performed a telephone survey of 670 female members of a large health maintenance organization, aged 50-69 yr, who had regularly used HT from July 1, 2001, through June 30, 2002.

RESULTS

Most women (93%) reported hearing about the new findings; however, only 57% considered the quality of this information to be good, regardless of its source: mass media (21%), the health plan (32%), or a health care practitioner (34%). Women's knowledge of Women's Health Initiative findings was generally poor; 64% did not know what the findings were, 7% were unsure of their knowledge, 6% had incorrect knowledge, and 23% had correct knowledge of Women's Health Initiative findings. On a simple, five-question, true-or-false quiz about HT risks, 30% of respondents answered four to five questions correctly. Although not well informed, 56% reported attempting to discontinue HT in the 6 to 8 months after July 2002. Our multivariable model included five statistically significant predictors of attempting to stop HT: having been sent a letter about Women's Health Initiative findings (odds ratio [OR] 2.7; 95% confidence interval [CI] 1.8, 3.9), reporting good-quality information from media (OR 2.1; 95% CI 1.3, 3.3), having started HT for health promotion (OR 2.0; 95% CI 1.2, 3.3), using a lower-than-standard dosage of estrogen (OR 1.9; 95% CI 1.1, 3.1), and correctly answering four or more items on the HT quiz (OR 1.9; 95% CI 1.2, 2.8).

CONCLUSION

During the 6-8 months after publication of Women's Health Initiative trial findings, most regular postmenopausal HT users tried to stop using HT, despite not being well informed about the Women's Health Initiative findings.

BACKGROUND & AIMS

In the United States, upper gastrointestinal endoscopy is usually performed using intravenous sedation. Sedation increases the rate of both complications and costs of endoscopy. Unsedated esophagogastroduodenoscopy (EGD) using conventional 8-11-mm endoscopes is an alternative to sedated endoscopy but is generally perceived as unacceptable to many American patients. Unsedated EGD using ultrathin 5-6-mm endoscopes is better tolerated. A randomized trial comparing unsedated ultrathin EGD (UT-EGD) with sedated conventional EGD (C-EGD) in a diverse American population is needed.

METHODS

In this multicenter, randomized, controlled trial, 80 patients scheduled to undergo elective outpatient EGD were randomized to unsedated UT-EGD or sedated C-EGD. The study was carried out at San Francisco General Hospital, San Francisco Veterans Affairs Medical Center, and the Liver and Digestive Health Medical Clinic, San Jose.

RESULTS

Baseline characteristics of patients randomized to unsedated UT-EGD and sedated C-EGD were similar. Moreover, there were no significant differences in overall patient satisfaction and willingness to repeat endoscopy in the same manner among the 2 study groups. There was, however, a significant difference in median total procedure time between the 2 study groups of 1.5 hours (P < 0.0001). The mean (+/- SD) total procedure cost was 512.4 US dollars (+/- 100.8 US dollars) for sedated C-EGD and 328.6 US dollars (+/- 70.3 US dollars) for unsedated UT-EGD (P < 0.0001).

CONCLUSIONS

Patients undergoing unsedated UT-EGD are as satisfied as patients undergoing sedated C-EGD and are just as willing to repeat an unsedated UT-EGD. Unsedated UT-EGD was also faster, less costly, and may allow greater accessibility to this procedure.

The direct binding of Streptococcus mitis to human platelets is mediated in part by two proteins (PblA and PblB) encoded by a lysogenic bacteriophage (SM1). Since SM1 is the first prophage of S. mitis that has been identified and because of the possible role of these phage-encoded proteins in virulence, we sought to characterize SM1 in greater detail. Sequencing of the SM1 genome revealed that it consisted of 34,692 bp, with an overall G+C content of 39 mol%. Fifty-six genes encoding proteins of 40 or more amino acids were identified. The genes of SM1 appear to be arranged in a modular, life cycle-specific organization. BLAST analysis also revealed that the proteins of SM1 have homologies to proteins from a wide variety of lambdoid phages. Bioinformatic analyses, in addition to N-terminal sequencing of the proteins, led to the assignment of possible functions to a number of proteins, including the integrase, the terminase, and two major structural proteins. Examination of the phage structural components indicates that the phage head may assemble using stable multimers of the major capsid protein, in a process similar to that of phage r1t. These findings indicate that SM1 may be part of a discrete subfamily of the Siphoviridae that includes at least phages r1t of Lactococcus lactis and SF370.3 of Streptococcus pyogenes.