RESUMEN
To examine whether exposure to oral contraceptives (OCs) is associated with bone mineral density (BMD) in young women, we studied, cross-sectionally and longitudinally, 216 white and 260 black women enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Spine, hip and whole body BMDs were measured by dual-energy X-ray absorptiometry (DXA) when the women were aged 25-37 years, and whole body BMD was remeasured in 369 of the women 3 years later. A comprehensive history of OC use, including dose of ethinyl estradiol (estrogen) and duration of use, was determined from an interviewer-administered questionnaire. After adjustment for other relevant variables, we found that cumulative estrogen from OCs (mg) explained 4.0% of the variation in spine BMD ( p = 0.024) among white women, but did not explain any of the variance in BMD in black women. Cumulative OC estrogen was associated with a decreased risk for low bone density (lowest quartile) at the spine, hip and whole body in white women. The odds ratios (95% CIs) comparing women in the highest quartile of cumulative OC estrogen with those in the lowest quartile were, at the spine: 0.08 (0.02, 0.46); at the hip: 0.23 (0.06, 0.87); and at the whole body: 0.37 (0.11, 1.26). OC exposure was not related to low bone density in black women. OCs did not predict longitudinal changes in whole body BMD in either race. These results suggest that exposure to the estrogen from OCs during the premenopausal years may have a small beneficial effect on the skeleton in white women. Benefit is proportional to the cumulative estrogen exposure, suggesting that previous cross-sectional studies that considered OC use as a dichotomous variable may have lacked the power to detect an association.
Asunto(s)
Población Negra , Densidad Ósea/efectos de los fármacos , Anticonceptivos Hormonales Orales/farmacología , Estradiol/farmacología , Población Blanca , Adulto , Antropometría , Densidad Ósea/fisiología , Estudios de Cohortes , Estudios Transversales , Femenino , Cuello Femoral/fisiología , Humanos , Oportunidad Relativa , Premenopausia/fisiología , Columna Vertebral/fisiologíaRESUMEN
OBJECTIVE: Results obtained with commercial testing kits for immunoglobulin M Toxoplasma antibodies may be inaccurate or may be inaccurately interpreted, which may influence whether a woman decides to terminate the pregnancy. This study was undertaken to determine whether confirmatory testing at a reference laboratory and communication of the results and an expert interpretation to the patient's physician would affect the rate of induced abortions among pregnant women with positive results of testing for immunoglobulin M Toxoplasma antibodies in outside laboratories. STUDY DESIGN: This was a retrospective cohort study of 811 consecutive pregnant women for whom the toxoplasma serologic profile was performed at a reference laboratory. Almost all the patients had been informed by their physicians that a result of a test for immunoglobulin M Toxoplasma antibodies performed in an outside laboratory was positive. Women were separated into those with a toxoplasma serologic profile result suggestive of a recently acquired infection (group 1) and those with a result suggestive of an infection acquired in the more distant past (group 2). Physician reports of induced abortions were used to determine rates of induced abortion in groups 1 and 2. RESULTS: Of the 811 women 321 (39.6%) were considered likely to have a recent infection (group 1) and 490 (60.4%) were considered likely to have a past infection (group 2). Physicians reported pregnancy outcomes for 433 (53.4%) of 811 women (65.1% and 45.7% in groups 1 and 2, respectively). Whereas 36 of 209 women in group 1 (17.2%) terminated the pregnancy, only 1 of 224 women in group 2 (0.4%) chose abortion (P <.001). CONCLUSION: Confirmatory serologic testing in a reference laboratory and communication of the results and their correct interpretation by an expert to the patient's physician decreased the rate of unnecessary abortions by approximately 50% among women for whom positive immunoglobulin M Toxoplasma test results had been reported by outside laboratories.
Asunto(s)
Aborto Inducido/estadística & datos numéricos , Anticuerpos Antiprotozoarios/sangre , Inmunoglobulina M/sangre , Complicaciones Infecciosas del Embarazo/parasitología , Toxoplasma/inmunología , Toxoplasmosis/diagnóstico , Adulto , Animales , Estudios de Cohortes , Femenino , Edad Gestacional , Humanos , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Estudios RetrospectivosRESUMEN
With the explosion of college-level Web-based courses, concern has arisen about the quality of online courses. Peer review of online courses is one method of ensuring that these courses meet the highest standards. Although numerous colleges and universities use peer review for classroom presentations, clinical experiences, and course materials, peer review of an online course may require a different type of expertise. This article describes the process for conducting a peer review of teaching in Web-based courses and explains how documentation of peer review of an online course can be used for faculty development, promotion and tenure decisions, curriculum decisions, and program review.
Asunto(s)
Instrucción por Computador/normas , Bachillerato en Enfermería/normas , Internet/normas , Sistemas en Línea/normas , Revisión por Pares/métodos , Enseñanza/normas , Curriculum/normas , Docentes de Enfermería , Guías como Asunto , Humanos , Relaciones Interprofesionales , Aprendizaje Basado en Problemas/normas , Estudiantes de Enfermería/psicologíaRESUMEN
This study was conducted to explore the use of interactive videodisc instruction (IVDI) with cooperative learning strategies. Baccalaureate students in their junior year were assigned to one of three types of groups based on prenursing grade point average: homogeneous average achievement, homogeneous high achievement, and heterogeneous mixed achievement students. Groups of three to five students viewed a lesson related to auscultation of heart sounds using IVDI and were videotaped throughout the lesson. There were no significant differences among the groups in their interaction frequencies, cooperativeness, or achievement on the group posttest completed immediately after viewing the lesson. Homogeneous high achievement students scored significantly higher than the other two groups on the individual posttests given 2 weeks after viewing the lesson. However, all three groups had very low scores. Several themes emerged related to management of the lesson. A majority of the students without previous IVDI experience had difficulty accessing and proceeding through the lesson: fill-in-the-blank questions posed by the lesson often were frustrating to the students, students in groups had difficulty reading the touch screen monitor, a large number of students attempted to locate the cardiac valves on themselves or other group members, and male students tended to distance themselves from each other. In this study, students needed more orientation to the computer equipment and to cooperative learning strategies. When using IVDI with inexperienced students, faculty should be certain that technical assistance is available throughout the lesson.