The Association of Polycystic Ovary Syndrome and Gestational Hypertensive Disorders in a Diverse Community-Based Cohort.

PURPOSE: To examine the association of polycystic ovary syndrome (PCOS) and pregnancy-induced hypertension (PIH) within a large population of pregnant women in an integrated healthcare system. METHODS: This retrospective study utilized a source cohort of 1023 women with PCOS and 1023 women without PCOS who had a delivered pregnancy within Kaiser Permanente Northern California. Preexisting hypertension was defined by hypertension diagnosis, treatment, or elevated blood pressure prior to 20 weeks of gestation. The development of PIH, including gestational hypertension, preeclampsia/eclampsia, or HELLP (hemolysis, elevated liver enzymes, and low platelet count), was ascertained by chart review. Among women without preexisting hypertension who had a singleton pregnancy, the association of PCOS and PIH was examined using multivariable logistic regression. RESULTS: Among 1902 women (910 PCOS) with singleton pregnancy, 101 (11.1%) PCOS and 36 (3.6%) non-PCOS women had preexisting hypertension and were excluded. Of the remaining 1765 women, those with PCOS (compared to non-PCOS) were slightly older (mean age 31.2 versus 30.7), more likely to be obese (39.6% versus 15.1%), nulliparous (63.8% versus 43.4%), and conceive with fertility treatment (54.1% versus 1.9%); they also had a higher incidence of PIH (10.8% versus 6.6%), including gestational hypertension (5.8% versus 3.6%) and preeclampsia or HELLP (4.9% versus 3.0%; all p<0.05). PCOS was associated with increased odds of PIH (odds ratio, OR 1.7, 95% confidence interval, CI 1.2-2.4), remaining significant after adjusting for age, race/ethnicity, nulliparity, and fertility treatment; however, findings were attenuated and no longer significant after adjusting for weight status (OR 1.1, CI 0.7-1.7). Maternal PCOS was also associated with preeclampsia/HELLP in unadjusted but not adjusted (OR 1.0, CI 0.5-1.9) analyses. Nulliparity and higher prepregnancy BMI were associated with PIH in both groups. CONCLUSION: Compared to women without PCOS, women with PCOS are at higher risk for PIH but this association was not independent of weight status.

Application of therapeutic harp sounds for quality of life among hospitalized patients.

CONTEXT: Hospitalized patients experience symptoms including pain and anxiety that may negatively affect their well-being and overall quality of life (QOL), even when medical interventions are deemed successful. OBJECTIVES: The objective of the study was to assess the efficacy of prescriptive live therapeutic harp sounds on patient symptoms and QOL. METHODS: The study was a two-period, two-treatment arm crossover, randomized clinical trial. Individuals were randomized to harp music and standard care for the first 24 hours of the hospital stay, followed by 24 hours of only standard care, or vice versa. The harp intervention was 30-40 minutes of prescriptive live therapeutic harp sounds in the form of solo harp pieces and improvisations. Patients recorded well-being and symptom scores on linear analogue scales. Entry criteria included at least 18 years and a score of 3 or below on a 1-5 linear analogue scale indicating compromised overall QOL. RESULTS: Ninety-two eligible patients participated in the clinical trial. All the QOL variables had significantly higher percentages of patients with improvements during the harp treatment than during standard care. Five symptoms--fatigue, anxiety, sadness, relaxation, and pain--were significantly improved following therapeutic harp treatment. Approximately 30% to 50% of patients showed a significant increase in the QOL measures after harp treatment. CONCLUSION: There is evidence of strong positive effects on the QOL of hospitalized patients who received therapeutic harp sound treatment along with standard care.

Management of osteoporosis in geriatric populations.

The incidence of osteoporotic fractures increases with advancing age and is associated with significant health care expenditures, particularly related to hip fractures and loss of quality of life. Unfortunately, few studies have included subjects 80 years of age and older to help guide management of elderly patients who are living in the community or in long-term care facilities. Treating this age group encompasses the same general measures and pharmacologic therapies as in younger adults. Focusing on fall prevention and adequate vitamin D is essential. All prevention strategies in the elderly for fracture risk reduction should include simple vitamin D and calcium supplementation. However, for those at high risk of fracture, adding pharmacologic therapy should be considered. This article reviews recent research findings of general measures and pharmacologic therapy that are applicable to managing osteoporosis in the elderly.

Bone mineral density in postmenopausal Caucasian, Filipina, and Hispanic women.

BACKGROUND: Previous bone mineral density (BMD) studies have suggested Asian women have lower BMD and Hispanic women have similar or higher BMD compared with Caucasian women, partially explained by ethnic differences in body size. This study compared the effect of different variables representing body size on BMD in postmenopausal women aged 50-69 years from three ethnic groups in San Diego County, CA: 354 Caucasians, 285 Filipinas, and 164 Hispanics. METHODS: In all three groups, BMD was measured by DXA (Hologic 2000) at the hip, lumbar spine, and total body. Lifestyle variables and anthropometric measures were assessed by standard methodology; medication and supplement use were validated by a nurse. RESULTS: Regardless of the variables used to represent body size in the regression modelling, either body mass index or lean and fat tissue mass, ethnic differences were minimal across the three groups. The only significant differences observed using the two fully adjusted models (age, height, body mass index or lean and fat tissue mass, smoking, alcohol, exercise, current oestrogen and calcium supplement use, and osteoarthritis) were at the total body BMD site where Filipinas had significantly higher BMD than the Caucasians or Hispanics, whose total body BMD was similar to one another. The independent variables in the fully adjusted models explained approximately 20-40% of the variation in BMD at each of the four sites. Income or occupation did not help explain BMD differences, but a pattern of increased BMD among those with some college education in all three groups was observed. CONCLUSIONS: Accounting for body size using either body mass index or fat and lean tissue mass along with height and other lifestyle variables minimizes ethnic differences and explains a considerable amount of variation in mean BMD among older ethnic minority and Caucasian women.

Insomnia. Safe and effective therapy for sleep problems in the older patient.

Insomnia is a problem in all stages of life but is particularly common after age 65. A number of factors--including advanced age, psychosocial influences, medical illness, and the use of medications and alcohol--may disturb sleep architecture. Evaluation of insomnia in the older patient requires a careful history and physical examination, supplemented by a sleep diary. Treatment of underlying conditions and nonpharmacologic improvements in sleep hygiene are first-line therapy, but pharmacologic agents such as benzodiazepines, nonbenzodiazepine hypnotics, or antidepressants may be needed. Nonbenzodiazepines with rapid elimination may offer a lower side-effect profile than other hypnotic agents when used for insomnia in the older population.

Alendronate improves bone mineral density in elderly women with osteoporosis residing in long-term care facilities. A randomized, double-blind, placebo-controlled trial.

BACKGROUND: Many elderly female residents of long-term care facilities have osteoporosis and could benefit from intervention to increase bone density. OBJECTIVE: To examine the efficacy and safety of alendronate for treatment of osteoporosis in elderly female residents of long-term care facilities. DESIGN: Multicenter, randomized, double-blind, placebo-controlled 2-year study. SETTING: 25 long-term care facilities. PATIENTS: 327 elderly women with osteoporosis. INTERVENTION: Patients were randomly assigned to receive alendronate, 10 mg/d, or placebo. All patients also received vitamin D, 400 IU/d, and some patients received supplemental calcium (total intake, approximately 1500 mg/d). MEASUREMENTS: Bone mineral density (BMD) of the spine and hip and biochemical markers of bone turnover. RESULTS: Alendronate produced significantly greater increases in BMD than did placebo (24-month differences: spine, 4.4% [95% CI, 3.3% to 5.5%]; femoral neck, 3.4% [CI, 2.3% to 4.4%]). Alendronate produced greater decreases from baseline in biochemical markers of bone turnover than did placebo (P < 0.001). CONCLUSION: Alendronate increased BMD at both the spine and hip in elderly female residents of long-term care facilities.

Alendronate reduces the risk of multiple symptomatic fractures: results from the fracture intervention trial.

OBJECTIVES: To evaluate the effect of alendronate on the occurrence rate of multiple svmptomatic fractures and on the risk of multiple symptomatic fractures (likelihood of having more than one fracture diagnosed because of the symptoms the fractures caused over the study period) among women with osteoporosis. DESIGN: Primary analysis of data from a randomized, placebo-controlled, double-blind trial. SETTING: Eleven community-based clinical research centers. PARTICIPANTS: Subset of women enrolled in the Fracture Intervention Trial: aged 55 to 81 and having at least one morphometric vertebral fracture at baseline (n=2,027) or having no vertebral fracture but meeting prevailing World Health Organization bone mineral density criteria for osteoporosis (T-score < or =2.5 at the femoral neck)(n = 1,631). INTERVENTION: All participants reporting calcium intake of 1,000 mg/day or less received a supplement of 500 mg calcium and 250 IU cholecalciferol. Participants were randomly assigned to placebo or alendronate sodium (5 mg/day for 2 years and 10 mg/day for the remainder of the study). Average total follow-up was 4.3 years. MEASUREMENTS: Symptomatic fractures were diagnosed by personal physicians and confirmed by review of radiological data by an expert committee blinded to treatment assignments. RESULTS: Eighty-six of 1,817 women receiving placebo experienced multiple symptomatic fractures during the follow-up period, compared with 51 of 1,841 receiving alendronate. Reduction of risk for multiple symptomatic fractures combined was 42% (relative risk (RR) = 0.58, 95% confidence interval (CI) = 0.41, 0.81) and for multiple symptomatic vertebral fractures was 84% (RR = 0.16,95% Cl = 0.05, 0.42). Cumulative incidence curves showed divergence after as little as 3 months of treatment, with a statistically significant (P = .044) reduction at 6 months for multiple symptomatic vertebral fractures. When all fractures over the follow-up period were included, the occurrence rates of all symptomatic fractures and symptomatic vertebral fractures were 34% and 63% lower, respectively, with alendronate than with placebo. These reductions were sustained during the follow-up period. All reductions in risk were consistent across predefined subgroups: age (<75 vs > or =75), morphometric vertebral fracture(present vs absent), prior clinical fracture since age 45 (yes vs no), and whether the subject had fallen in the 12 months before randomization. CONCLUSIONS: These data demonstrate that treatment with alendronate reduces the risk of multiple symptomatic fractures during a treatment period averaging 4.3 years. The reductions were consistent across prespecified sub-groups. This effect is evident early in treatment and is sustained.