The detection of isolated tumor cells in bone marrow comparing bright-field immunocytochemistry and multicolor immunofluorescence.

Background: The detection of isolated tumor cells in bone marrow by immunocytochemistry (ICC) has been reported to predict progression of early-stage breast cancer. The most common staining procedure uses bright-field ICC with cytokeratin (CK) antibodies to label isolated tumor cells. However, this method can result in false-positive staining events.

A varying-coefficient Cox model for the effect of age at a marker event on age at menopause.

It is of recent interest in reproductive health research to investigate the validity of a marker event for the onset of menopausal transition and to estimate age at menopause using age at the marker event. We propose a varying-coefficient Cox model to investigate the association between age at a marker event, defined as a specific bleeding pattern change, and age at menopause, where both events are subject to censoring and their association varies with age at the marker event. Estimation proceeds using the regression spline method.

Incidence of stillbirth and perinatal mortality and their associated factors among women delivering at Harare Maternity Hospital, Zimbabwe: a cross-sectional retrospective analysis.

BACKGROUND: Death of an infant in utero or at birth has always been a devastating experience for the mother and of concern in clinical practice. Infant mortality remains a challenge in the care of pregnant women worldwide, but particularly for developing countries and the need to understand contributory factors is crucial for addressing appropriate perinatal health. METHODS: Using information available in obstetric records for all deliveries (17,072 births) at Harare Maternity Hospital, Zimbabwe, we conducted a cross-sectional retrospective analysis of a one-year data, (1997-1998) to assess demographic and obstetric risk factors for stillbirth and early neonatal death.

Sentinel lymph node biopsy in breast cancer.

Sentinel lymph node biopsy techniques have evolved in a short period of time to become a highly accurate method for the pathologic staging of clinically node-negative breast cancers. Multiple single and multi-institutional studies have confirmed a high accuracy of pathologic staging (95-100%) with reasonable false-negative rates (0-15%). The use of vital blue dyes, radioactive isotopes, or a combination of the two are the most commonly employed techniques used for this procedure.

Prerandomization Surgical Training for the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-32 trial: a randomized phase III clinical trial to compare sentinel node resection to conventional axillary dissection in clinically node-negative breast cancer.

Objective: To train surgeons in a standardized technique of sentinel lymph node biopsy and to prepare them for the requirements of a prospective randomized surgical trial.

Summary Background Data: The NSABP B32 trial opened to accrual in May 1999. A significant component of this trial was a prerandomization training phase of surgeons performed by a group of core surgical trainers.

Risk factors for prematurity at Harare Maternity Hospital, Zimbabwe.

Background: Prematurity remains the main cause of mortality and morbidity in infants and a problem in the care of pregnant women world-wide. This preliminary study describes the socio-demographic, reproductive, medical, and obstetrical risk factors for having a live pre-term delivery (PTD) in Zimbabwe.

Methods: This case-control study examined risk factors for PTD, at Harare Maternity Hospital between March and June 1999.

Racial/ethnic differences in the prevalence of depressive symptoms among middle-aged women: The Study of Women's Health Across the Nation (SWAN).

Objectives: We examined racial/ethnic differences in significant depressive symptoms among middle-aged women before and after adjustment for socioeconomic, health-related, and psychosocial characteristics.

Methods: Racial/ethnic differences in unadjusted and adjusted prevalence of significant depressive symptoms (score >/= 16 on the Center for Epidemiologic Studies Depression [CES-D] Scale) were assessed with univariate and multiple logistic regressions.

Results: Twenty-four percent of the sample had a CES-D score of 16 or higher.

Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection.

Sex workers have long been considered a high-risk group for HIV infection, but to date little quantitative research has explored the association between HIV risk and exchange of sex for material gain by women in the general population. The objective of this study was to estimate the prevalence of such transactional sex among women attending antenatal clinics in Soweto, South Africa, to identify demographic and social variables associated with reporting transactional sex, and to determine the association between transactional sex and HIV serostatus. We conducted a cross-sectional study of women seeking antenatal care in four Soweto health centres who accepted routine antenatal HIV testing.

Prevalence and patterns of gender-based violence and revictimization among women attending antenatal clinics in Soweto, South Africa.

Gender-based violence is a key health risk for women globally and in South Africa. The authors analyzed data from 1,395 interviews with women attending antenatal clinics in Soweto, South Africa, between November 2001 and April 2002 to estimate the prevalence of physical/sexual partner violence (55.5%), adult sexual assault by nonpartners (7.

Birthweight-adjusted Dubowitz methods: reducing misclassification of assessments of gestational age in a Zimbabwean population.

Objective: To evaluate the performance and the utility of using birthweight-adjusted scores of the Dubowitz method of estimating gestational age in a Zimbabwean population.

Design: A validation study.

Setting: Harare Maternity Hospital, from October to December 1999.

Risk factors for low bone mineral density and the 6-year rate of bone loss among premenopausal and perimenopausal women.

Risk factors that are associated with lower bone mineral density (BMD) may not necessarily be associated with increased bone loss among premenopausal and perimenopausal women. We determined risk factors for lower premenopausal and perimenopausal BMD while simultaneously determining risk factors for increased 6-year rate of bone loss among women aged 24-50 years within a population-based prospective cohort study. BMD of the lumbar spine and femoral neck, reported as t scores, were measured five times within the 6-year study among 614 women who were between the ages of 24 and 44 in 1992/1993.

A new statistical approach demonstrated menstrual patterns during the menopausal transition did not vary by age at menopause.

Objective: To describe population mean, variance, and correlation of cycle length across the life span and by age at menopause and age at menarche using a new statistical approach.

Study Design And Setting: Data from the Tremin Trust (n=997), a prospective menstrual diary study, was analyzed. Marginal models with generalized estimating equations were used to describe changes in menstrual parameters across the reproductive life span.

Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa.

Background: Gender-based violence and gender inequality are increasingly cited as important determinants of women's HIV risk; yet empirical research on possible connections remains limited. No study on women has yet assessed gender-based violence as a risk factor for HIV after adjustment for women's own high-risk behaviours, although these are known to be associated with experience of violence.

Methods: We did a cross-sectional study of 1366 women presenting for antenatal care at four health centres in Soweto, South Africa, who accepted routine antenatal HIV testing.

Science-based trade disputes: a new challenge in harmonizing the evidentiary systems of law and science.

In November 2001, the University of Michigan hosted one of the first dialogues among international trade law scholars and scientists in the field of risk assessment with the goal of identifying critical areas of misunderstanding between the two fields. This article discusses key issues that need to be addressed in order to better harmonize the scientific and legal systems of evidence within the context of trade disputes and trade law and presents the recommendations that emerged from the Michigan meeting.

Change in estradiol and follicle-stimulating hormone across the early menopausal transition: effects of ethnicity and age.

Serum reproductive hormone concentrations were measured longitudinally in a community-based, multiethnic population of midlife women to assess whether ethnic differences exist in the patterns of change in estradiol (E2) and FSH and, if so, whether these differences are explained by host characteristics. We studied 3257 participants from seven clinical sites in the Study of Women's Health Across the Nation (SWAN) who were aged 42-52 yr at baseline and self-identified as African American (28.2%), Caucasian (47.

Sampling strategies for prospective studies of menstrual function.

Little information is available about optimal sampling strategies for prospective studies of menstrual function. Sample size and study duration for menstrual studies have often been driven as much by feasibility and cost as by statistical principles, with follow-up lasting 6 months to 2 years and sample size ranging from 100 to 500 women. Whether these studies are sufficiently powered to address common study objectives has not been adequately evaluated, and sample size estimates rarely account for the repeated nature of menstrual cycle data.

NSABP-32: Phase III, randomized trial comparing axillary resection with sentinal lymph node dissection: a description of the trial.

The NSABP-32 trial is a randomized, phase III clinical trial to compare sentinel node (SN) resection to conventional axillary dissection in clinically node-negative breast cancer patients. The primary aims of the trial are to determine if removal of only SNs provides survival and regional control equivalent to those of axillary dissection, while diminishing the magnitude of surgically related side effects. In order to ensure consistency of the outcomes for this trial, a standardized method of SN surgery has been utilized for all cases.

Staging reproductive aging: a comparison of proposed bleeding criteria for the menopausal transition.

Objective: A staging system for female reproductive aging has recently been proposed. Bleeding criteria are an important component of a staging system, as bleeding patterns are readily observable. Several different bleeding criteria have been proposed, but their concordance and validity have not been evaluated.

Incidence of and socio-demographic risk factors for stillbirth, preterm birth and low birthweight among Zimbabwean women.

Data on birth outcomes are important for planning maternal and child health care services in developing countries. Only a few studies have examined frequency of birth outcomes in Zimbabwe, none of which has jointly examined the spectrum of poor birth outcomes across important demographic subgroups. We assessed delivery patterns and birth outcomes in 17 174 births over a one-year period from October 1997 to September 1998 at Harare Hospital, Zimbabwe.

Age at natural menopause in a sample of Puerto Rican women.

Objectives: To characterize the distribution of age at menopause in a sample of Puerto Rican women and to evaluate the differences in demographic, health and lifestyle factors associated with menopausal state.

Background: Age at natural menopause may be an important marker of a woman's long-term risk of chronic disease. Understanding which factors influence the timing of menopause remains limited and while ethnic differences in age at menopause have been reported, little data are available for Puerto Rican women.

Current status of sentinel node surgery in breast cancer.

Sentinel node surgery potentially increases the accuracy of identifying lymph nodes that contain breast cancer and decreases morbidity compared to conventional axillary lymph node resection. However, no long-term comparisons of the two modalities have been carried out, and the survival benefit associated with one protocol vs the other remains unknown. Although sentinel node surgery is not expected to increase the cure rate of breast cancer patients, a significant reduction in the incidence of permanent side effects associated with axillary node resection will be a considerable advance.