The reporting and diagnosis of uterine fibroids in the UK: an observational study.

BACKGROUND: Uterine fibroids (UFs) are the most common benign tumour in women, and many undergo hysterectomy or uterus-preserving procedures (UPPs) to manage their symptoms. We aimed to validate the recording of UFs in a primary care database, The Health Improvement Network (THIN), and to determine the incidence of UFs in the UK. METHODS: In this observational study, women in THIN aged 15-54 years between January 2000 and December 2009 with no previous record of UFs, hysterectomy or UPPs were identified. Individuals were followed up until there was a Read code indicating UFs, they reached 55 years of age or died, or the study ended. Among those without a UF code, women were identified with a code for hysterectomy, UPPs or heavy menstrual bleeding (HMB). Anonymized patient profiles from each category were randomly selected and reviewed. Subsequently, primary care physicians were asked to complete questionnaires to verify the diagnosis for a randomly selected subgroup. RESULTS: In total, 737,638 women were identified who met the initial inclusion criteria. The numbers of women with a code for UFs, hysterectomy, UPPs and HMB were 9380, 11,002, 3220 and 60,915, respectively; the proportions of confirmed cases of UFs were 88.8, 29.7, 57.7 and 15.9 %. The estimated number of women with UFs was 23,140 (64.0 % without a recorded UF diagnosis). The overall incidence of UFs was 5.8 per 1000 woman-years. CONCLUSIONS: UFs were confirmed in a high proportion of women with UF Read codes. However, almost two-thirds of cases were identified among women with a code for hysterectomy, UPPs or HMB. These results show that UFs are under-recorded in UK primary care, and suggest that primary care physicians tend to code the symptoms of UFs more often than the diagnosis.

The continuation rates of long-acting reversible contraceptives in UK general practice using data from The Health Improvement Network.

PURPOSE: The purpose of this study was to determine the continuation rates of new users of long-acting reversible contraceptive (LARC) methods in the UK, using data from general practice. METHODS: We conducted an observational study using a general practitioner (GP) database, The Health Improvement Network (THIN). The methods studied were copper intrauterine devices (Cu-IUDs), levonorgestrel-releasing intrauterine system (LNG-IUS), progestogen-only implants and progestogen-only injections. The study population comprised women in THIN aged 18-44 years during the period 2004-2009 who had been registered with their GP for at least 5 years, with a computerized prescription history of at least 1 year. Using computer algorithms, the database was searched for the Read and Multilex codes for each LARC method. New LARC users were identified and followed until there was a record indicating termination of use or the study period ended. RESULTS: The proportion of women who discontinued use during the same year of administration was 7.5% for Cu-IUDs, 10.6% for LNG-IUS, 13.2% for progestogen-only implants and 54.4% for progestogen-only injections. By the end of the study, a higher proportion of Cu-IUD and LNG-IUS users (21.1 and 18.6%, respectively) undertook consecutive use of the same method than progestogen-only implant users (10.7%). Manual review of computerized profiles demonstrated the validity of this approach. CONCLUSIONS: In the UK, the continuation rates of LARCs are high, and approximately one fifth of women chose to have a second intrauterine device fitted after expiry of the first device. A validation step demonstrated the reliability of the methodology and computer algorithms used.

Study of long-acting reversible contraceptive use in a UK primary care database: validation of methodology.

OBJECTIVES To develop and validate algorithms to identify new users of long-acting reversible contraceptives (LARCs) in a primary care database, The Health Improvement Network (THIN). METHODS Women in THIN aged 12 to 49 years in 2005 were studied. THIN was searched using Read and MULTILEX codes to identify new users of copper intrauterine devices (Cu-IUDs), the levonorgestrel-releasing intrauterine system (LNG-IUS) and progestogen-only implants. Validation was undertaken for a randomly selected sample of 398 LARC users, in which their primary care physicians were asked to complete a questionnaire detailing LARC use. RESULTS Questionnaires were received for 379 patients (95%), confirming 316 (83%) as new LARC users. Confirmation rates for Cu-IUDs, the LNG-IUS and progestogen-only implants were 64%, 94% and 89%, respectively. The use of Read codes alone had the lowest confirmation rate, particularly for Cu-IUD users. Confirmation rates increased by using MULTILEX codes when available, or by examination of computerised medical records. CONCLUSIONS Computer algorithms were used to identify new LARC users. While THIN is a useful resource for studying LARC uptake, steps to gather additional information are necessary to ensure the validity of LARC classification.

Use of long-acting reversible contraceptives in the UK from 2004 to 2010: analysis using The Health Improvement Network Database.

OBJECTIVES: To determine the use of long-acting reversible contraceptives (LARCs) in the UK over the period 2004 to 2010, using the general practice database The Health Improvement Network (THIN). METHODS: Women in THIN, aged 18 to 44 years during 2004 to 2010, who had been registered with their general practitioner for at least five years, with a prescription history of at least one year were included. THIN was searched using the Read and MULTILEX codes for: copper intrauterine devices (Cu-IUDs), the levonorgestrel releasing-intrauterine system (LNG-IUS), progestogen-only implants, and progestogen-only injections. RESULTS: The prevalence of progestogen-only implant use rose from 0.5 to 3.4%, and that of the LNG-IUS from 3.1 to 5.2%. The annual incidence and prevalence of progestogen-only implant use increased for all age groups but was most marked in younger women, whereas the use of the LNG-IUS augmented with increasing age. For all women, there was a small decrease in the prevalence of use of Cu-IUDs (from 5.4 to 4.8%) and progestogen-only injections (from 3.6 to 3.2%). CONCLUSIONS: Uptake of progestogen-only implants and the LNG-IUS increased over the period 2004 to 2010 in the UK, but LARC use in young women remains low.

Depression in Swedish women: relationship to factors at birth.

Depression is a common and serious disorder that may have developmental origins. Birth-related factors have been related to childhood and adult occurrence of somatic as well as psychiatric disorders, but studies on the relationship between birth-related factors and depression are few and show mixed results. In addition, varying methods have been used to assess depression. Standardized clinical criteria to diagnose depression, combined with birth data collected from midwife records have not been used in most studies. Participants in the Prospective Population Study of Women in Sweden (803 women), born 1914, 1918, 1922 and 1930, provide information on birth factors and depression. Women participated from 1968 at mid-life ages of 38-60 years, to 2000, when they were age 78-92 years. Original birth records containing birth weight, length, head circumference, and gestational time, as well as social factors were obtained. Lifetime depression was diagnosed via multiple information sources. Symptoms were assessed using the Comprehensive Psychopathological Rating Scale and diagnoses were based on DSM-III-R criteria. Over their lifetime, 44.6% of women in this sample experienced depression. Birth weights ≤ 3500 g [odds ratio (OR), age-adjusted = 1.72; 95% CI 1.29-2.28, P < 0.001] and shorter gestational time (OR, age-adjusted = 1.13; 95% CI 1.04-1.24, P = 0.005) were independently associated with a higher odds of lifetime depression in a logistic regression model adjusted for age. Lower than median birth weights and shorter gestational time were related to lifetime depression in women. Both neurodevelopmental and environmental contributions to lifetime depression may be considered.

Incidence of urinary tract infection in patients with type 2 diabetes. Experience from adverse event reporting in clinical trials.

PURPOSE: Diabetes mellitus has long been widely considered to be associated with an increased risk of urinary tract infection (UTI), but information on incidence rates are scarce and risk factor data have been conflicting. The aim was to estimate UTI incidence and evaluate potential risk factors for UTI in patients with type 2 diabetes included in recent clinical trials. METHODS: Type 2 diabetes patients from 10 AstraZeneca phase III diabetes clinical trials (n=6016, mean 57.4 years, 50.7% female) conducted during 2004-2007 were included. Patients free of UTI at baseline were followed for up to 6 months after inclusion in the trials. UTI was considered present if any term sorting under the MedDRA high-level term "UTIs" was recorded as an adverse event. RESULTS: In all, 142 patients had an adverse event for UTI, corresponding to an incidence of 59.5/1000 person-years for all patients (91.5/1000 in women, 28.2/1000 in men) and a cumulative incidence of 2% during 6 months. Female gender was associated with an increased incidence [relative risk (RR) 3.4; 95% confidence interval (CI) 2.3-5.1] and also higher age (RR 2.5 [95% CI 1.4-4.8] for ages ≥ 70 years vs. 40-49 years). No increased incidence was associated with body mass index (25-29, 30+ vs. <25 kg/m(2) ), HbA1c (<8% vs. >8%), race (Black, Oriental vs. Caucasian) or drug treatment (study drug, comparator vs. placebo). A history of immune system disorder conveyed a twofold higher risk for UTI. CONCLUSION: UTI is common among female patients with type 2 diabetes and older patients of both genders.

Dietary plant sterols and cholesterol metabolism.

Plant sterols, naturally occurring in foods of plant origin, reduce cholesterol absorption. Experimental studies show plant sterols to be an important part of the serum-cholesterol lowering effect of certain diets and dietary components. Epidemiological data show that individuals with higher intakes of plant sterols from their habitual diets have lower serum-cholesterol levels. To date, the role of naturally occurring plant sterols for lowering serum cholesterol has probably been underestimated. The consumption of dietary plant sterols should be a part of dietary advice to patients with hypercholesterolemia and the general public for the prevention and management of coronary heart disease.

The incidence of hysterectomy, uterus-preserving procedures and recurrent treatment in the management of uterine fibroids.

OBJECTIVE: To determine the incidence of hysterectomy and uterus-preserving procedures (UPPs) among women with uterine fibroids (UFs) and the incidence of further procedures after a UPP. STUDY DESIGN: This was an observational study using a primary care database, The Health Improvement Network (THIN). Women in THIN with UFs aged 15-54 years between January 2000 and December 2009 were eligible for study. The UPPs examined were myomectomy, endometrial ablation (EA) and uterine artery embolization (UAE). Using Read codes, women were followed up until one of the following was met: there was a record of hysterectomy or UPPs, they died or the study ended (end of 2010). RESULTS: The cumulative incidence of hysterectomy or UPPs was 23.6% at 1 year, and 40.9% after the follow-up period (median 3.6 years). At the end of the follow-up period, the cumulative incidences of hysterectomy, myomectomy, EA and UAE were 33.0%, 3.9%, 6.4% and 1.9%, respectively. For women initially treated with a UPP, the cumulative incidence of second procedures was 11.5% at 1 year. At the end of the follow-up period (median 2.7 years), the cumulative incidence of further procedures was 26.1%, and the cumulative incidences of women undergoing hysterectomy, myomectomy, EA and UAE were 19.0%, 4.3%, 3.4% and 1.4%, respectively. CONCLUSIONS: Women considering UPPs for the management of UFs should be made aware that the incidence of further treatments is high, with hysterectomy being the most frequent procedure undergone.

Incidence of genital infection among patients with type 2 diabetes in the UK General Practice Research Database.

The objective of this population-based study was to evaluate the incidence of vaginitis (females) and balanitis (males) among a cohort of type 2 diabetes patients and compare this risk to patients without diabetes. The study population included 125,237 female patients and 146,603 males identified from GPRD. All patients were followed for 1-year from their study index date for the first record of an infection or a censored event. Among patients with diabetes the incidence of vaginitis was 21.0/1000PY (95% CI 19.8-22.1) with the risk being 1.81 (95% CI 1.64-2.00) greater that patients without diabetes. The incidence of balanitis among diabetes patients was 8.4/1000PY (95% CI 7.8-9.1) with a relative risk of 2.85 (2.39-3.39) compared to patients without diabetes. Additional analyses were performed by HbA1c level. Results from this large population-based study indicate that patients with diabetes are at an increased risk of being diagnosed with infections of the genital tract and patients with poorly controlled diabetes have higher risks.

Incidence of urinary tract infection among patients with type 2 diabetes in the UK General Practice Research Database (GPRD).

The objective of this observational study was to quantify the incidence of urinary tract infections (UTI) among diabetes patients and compare this risk to patients without diabetes. Type 2 diabetes patients and a matched sample of patients without diabetes were identified from GPRD. Patients were followed for 1-year from their study index date until the first record of a UTI or a censored event. The incidence of UTI was 46.9 per 1000 person-years (95% confidence interval (CI) 45.8-48.1) among diabetes patients and 29.9 (95% CI 28.9-30.8) for patients without diabetes. Compared to the non-diabetes patients, the risk of UTI was 1.53 (95% CI 1.46-1.59) for all diabetes patients; and 2.08 (95% CI 1.93-2.24) for patients with previously diagnosed diabetes. In general practice, across gender and age, the risk of developing a UTI is higher for patients with type 2 diabetes compared to patients without diabetes.

Weight and length at birth and their relationship to diabetes incidence and all-cause mortality--a 32-year follow-up of the population study of women in Gothenburg, Sweden.

OBJECTIVE: The purpose of the study was to explore the relationship of weight and length at birth to diabetes in adult life and to all-cause mortality. Special attention was taken to potential confounding factors as age, family history, education, socio-economic group, physical inactivity, smoking, blood pressure, serum lipids and obesity. RESEARCH DESIGN AND METHODS: A longitudinal population study consisting of a representative sample of 1381 women aged 38-54 started in Gothenburg, Sweden, in 1968-1969 monitoring for diabetes mellitus and overall mortality over 32 years. Original delivery records were retrieved for 61.2% of the women. Death certificates were obtained for 99.3% the women who died during the 32-year follow-up period. RESULTS: We observed an inverse statistically significant relationship between birth weight and 32-year diabetes incidence independent of age, the highest incidence 16.3% in the lowest quartile of birth weight compared to 9.2% in the highest quartile. The relationship remained when controlling for the following covariates: education, socio-economic group, physical activity, smoking, systolic blood pressure, adult body mass index (BMI), waist-hip ratio, serum triglycerides and cholesterol. When overweight women (BMI> or =25) were excluded from the statistical analyses birth weight was even stronger related to the incidence of diabetes, 12.8% in lowest quartile and 5.7% in the highest quartile of birth weight independent of birth length, education, socio-economic group, physical activity, smoking, systolic blood pressure, body mass index, waist-hip ratio, blood glucose, serum triglycerides and cholesterol. Length at birth was a predictor for diabetes independent of age plus adult body mass index (BMI) and smoking but not independent of age only. No significant associations were observed between birth factors as birth weight and birth length and overall mortality during the 32-year of follow-up. CONCLUSIONS: A low birth weight seems to be a risk factor for diabetes in adult women independent of age and most of the established risk factors for diabetes.