Menopause and accelerated aortic stiffness.

BACKGROUND: The menopausal transition is widely believed to increase the risk of cardiovascular disease, based on the notion that estrogen is cardioprotective in women. While aortic stiffness is an independent predictor of cardiovascular disease, it has been unclear whether this risk increases during menopause. OBJECTIVE: This study aimed to determine the association between changes in menopausal status and aortic stiffness. MAIN OUTCOME MEASURES: Menopausal status was classified using the Stages of Reproductive Aging in Women criteria in a stratified random sample of Australian women aged 40-80 years, at three time-points over 14 years (n = 469 in 2001-02 and 2005, and n = 323 in 2014). Aortic stiffness was measured non-invasively via carotid-femoral pulse wave velocity at each time point. Mixed modeling was employed to determine the independent associations between menopausal status and aortic stiffness accounting for multiple covariates including age, systolic blood pressure, heart rate, medications, cholesterol, waist circumference, smoking and diabetes status. RESULTS: There was no evidence to support an association between the menopausal transition and an acceleration of aortic stiffness. However, there was an acceleration of aortic stiffness in the late (8+ years) postmenopause phase, after accounting for age and traditional cardiovascular risk factors (0.122 [95%CI: 0.106, 0.139] m/s/year; p < 0.001). CONCLUSIONS: The menopausal transition is not associated with major changes in aortic stiffness beyond normal age-related effects. However, the clinically significant acceleration in aortic stiffness observed in late postmenopause may contribute to greater cardiovascular risk in this later life phase. Study registered in the Australian and New Zealand Clinical Trials Registry, reference ACTRN12618000005257.

Association of change in fat and lean mass with incident cardiovascular events for women in midlife and beyond: A prospective study using dual-energy x-ray absorptiometry (DXA).

OBJECTIVE: To determine whether changes in fat and lean mass over time, quantified using dual-energy x-ray absorptiometry (DXA), are related to incident cardiovascular events. Previous studies using surrogate anthropometric methods have had inconsistent findings. STUDY DESIGN: Prospective, longitudinal observational study of women aged 40 to 80 randomly selected from the electoral roll and stratified into decades: 40-49, 50-59, 60-69 and 70-79 years. MAIN OUTCOME MEASURES: Changes in anthropometric measurements (body mass index and waist-to-hip ratio) and DXA-quantified fat mass and lean mass between the first and fifth years of the study. Incident cardiovascular events recorded from the sixth to the 12th year. RESULTS: In total 449 participants (87.9 %) were analyzed. A 10 % or greater decrease in total fat mass index was associated with a 67 % lower likelihood of any cardiovascular event (OR = 0.33, 95%CI 0.15-0.71); no association was observed for an increase. A 10 % or greater decrease in abdominal fat mass index was associated with a 62 % lower likelihood of incident stroke (OR = 0.38, 95%CI 0.16-0.91); no association was observed for an increase. A 10 % or greater decrease in appendicular lean mass index resulted in increased odds ratio of 2.91 for incident peripheral artery events (OR = 2.91, 95%CI 1.18-7.20). CONCLUSIONS: Reducing fat mass for women in midlife and beyond may decrease the risk of cardiovascular events. An increase in fat mass may not contribute to additional cardiovascular events. A reduction in limb muscle mass may provide an independent marker for cardiometabolic risk and peripheral artery disease. No independent association was found using anthropometric measurements and incident cardiovascular events.

Registry-Managed Care Coordination and Education for Patients With Co-occurring Diabetes and Serious Mental Illness.

OBJECTIVE: Longitudinal changes in health outcomes of patients with serious mental illness and co-occurring diabetes were examined after introduction of an intervention involving electronic disease management, care coordination, and personalized patient education. METHODS: This observational cohort study included 179 patients with serious mental illness and diabetes mellitus type 2 at a behavioral health home in Chicago. The intervention employed a care coordinator who used a diabetes registry to integrate services; patients also received personalized diabetes self-management education. Outcomes included glucose, lipid, and blood pressure levels as assessed by glycosylated hemoglobin, low-density lipoprotein, triglycerides, and systolic/diastolic values from electronic medical records and completion of specialty visits confirmed with optometrists and podiatrists. Interrupted time-series segmented random-effects regression models tested for level changes in the eight study quarters following intervention implementation compared with eight preimplementation study quarters, controlling for clinic site and preimplementation secular trends. RESULTS: Significant declines were found in levels of glucose, lipids, and blood pressure postimplementation. In addition, completed optometry referrals increased by 44% and completed podiatry referrals increased by 60%. CONCLUSIONS: Significant improvement in medical outcomes was found among patients of a behavioral health home who had comorbid diabetes and mental illness after introduction of a multicomponent care coordination intervention, regardless of which clinic they attended.

Comparison of obesity and metabolic syndrome prevalence using fat mass index, body mass index and percentage body fat.

BACKGROUND: Accurate obesity classification is important so that appropriate intervention can be instituted to modify metabolic risk factors. Commonly utilized body mass index (BMI) and percentage body fat (PBF) are influenced by lean mass whereas fat mass index (FMI) measures only body fat. This study compares the prevalence of obesity and metabolic risk factors with FMI, BMI and PBF using DXA (dual-energy x-ray absorptiometry). METHODS: 489 women randomly recruited from the electoral roll were stratified into 4 age groups; 40-49, 50-59, 60-69 and 70-79 years from 2000 to 2001. Clinical data and DXA body composition were obtained. Statistical analyses were performed using Medcalc v15 (Ostend, Belgium) with significance level at p = 0.05 (two-tailed). RESULTS: There was higher prevalence of obesity using PBF compared to BMI and FMI (p<0.001). This difference was greater from age 50-59 (p<0.05) which may be explained by age-related lean mass loss. PBF over-classified obesity in over 35% of normal and 95% of overweight categories compared to FMI and BMI. BMI has a sensitivity of 78.9% and specificity of 98.3% for obesity using FMI as the standard. BMI under-classified obesity in the overweight category by 14.9% compared to FMI. There was no difference in diabetes, dyslipidemia, hypertension and metabolic syndrome prevalence within the BMI-obesity and FMI-obesity categories (p>0.05). CONCLUSION: PBF classified more obesity than BMI and FMI because of its low pre-determined threshold. The greater difference with PBF compared to BMI and FMI from the 50-59 decade onwards can be attributed to age-related lean mass loss. BMI had the lowest sensitivity for obesity diagnosis. BMI under-classified obesity in the overweight category compared to FMI due to its inability to differentiate lean mass. However, there was no significant difference in the prevalence of metabolic risk factors between BMI and FMI-obesity categories indicating that fat location may influence metabolic dysregulation.

A 5-year longitudinal study of changes in body composition in women in the perimenopause and beyond.

OBJECTIVE: Most studies of the age-related changes in body composition are cross-sectional in design: there have been few longitudinal studies. The aim of this 5-year study was to document body composition changes in perimenopausal and older women. STUDY DESIGN: Prospective, longitudinal observational study. METHODS: 489 women were randomly selected from the electoral roll and stratified into 4 age groups by decade: 40-49, 50-59, 60-69 and 70-79 years. Dual-energy x-ray absorptiometry (DXA) was performed in the first and fifth years of the study. Total body mass (TBM), total fat mass (TFM), total lean mass (TLM), abdominopelvic fat mass, and appendicular fat and lean mass were determined. RESULTS: There were significant increases in TBM (p < 0.001), TFM (p < 0.01), TLM (p < 0.05), arm fat mass (p < 0.05), leg fat mass (p < 0.001) and leg lean mass (p < 0.05) within the 40-49 age decade. TBM, TFM and abdominopelvic fat started to decline from the 50-59 decade. Abdominopelvic fat reduction was significant from the 50-59 decade to the later decades (p = 0.05 to p < 0.001). Arm lean mass showed a significant reduction from the 50-59 decade (p < 0.01). Leg lean mass declined from the 60-69 decade, reaching significance in the 70-79 decade (p = 0.05). CONCLUSION: TFM and abdominopelvic fat declined from the 50-59 age decade, which is earlier than is suggested in the literature. Conversely, the decline in appendicular lean mass with age occurred later, from the 50-59 decade, with earlier and greater loss in the arms, which has implications for exercise strategies to maintain muscle mass from midlife on.

Psychosis in public mental health: Provider perspectives on clinical relationships and barriers to the improvement of services.

Whereas a growing literature has sought to understand challenges involved in the dissemination and implementation of specific evidence-based practices (EBP), few studies have centered on the perspectives of front-line community providers regarding best practices, clinical ideals and barriers to quality improvement for clients with psychosis. The goal of this project was to lay a foundation for future work aimed at improving the overall quality and impact of the multifaceted services typically provided to adults with psychosis served by the public mental health system. The findings reported here draw on a series of in-depth interviews and focus groups with 34 clinicians based at multiple inner-city community mental health sites. The project was participatory and service user co-led. Analyses focus on participant's perspectives concerning optimal services for clients with psychosis and perceived barriers to improving services. Providers strongly underscored the centrality of relationship quality versus mastery of specialized techniques and of deeper experiential engagement with the subjective meaning of the experience of psychosis. Asked about barriers to quality improvement, they described both macrolevel social forces, including chronic underfunding and overreliance on manualized approaches to distress, as well as cross-cutting clinical challenges not typically captured in the literature on more specific, targeted interventions. Our discussion focuses on the implications of these findings with respect to research and quality improvement and concludes with a call to increase investment and attention to the perspectives of front-line providers and the issue of workforce and organizational capacity vis-à-vis psychosis. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Cultural issues in menopause: an exploratory qualitative study of Macedonian women in Australia.

OBJECTIVE: This study explored the attitudes to, and experience of, menopause among Macedonian women living in Australia, including attitudes and responses to hormone therapy (HT) and complementary therapies, as well as related psycho-sexual, relationship and other midlife issues. METHODS: Using qualitative methodology, the study was based on seven unstructured, nondirective group discussions. Natural social groups were recruited, meeting wherever each group felt most at home. A total of 81 participants ranged in age from 45 to 75 years. The women included both first-generation immigrants and women born in Australia to Macedonian parents. A bilingual Macedonian researcher conducted the fieldwork. RESULTS: Participants typically claimed they lacked information about menopause in their native language, and their knowledge of HT was highly variable. Some women only felt comfortable approaching Macedonian doctors. Others reported an easing of symptoms when they revisited their homeland. Deeply religious participants claimed their faith helped them through this phase of life, and that they were as likely to consult a priest as a doctor. A recurring theme was that Macedonian men tended to regard their wives differently after menopause, sometimes treating them as "non-sexual." Women regarded this shift in male attitudes as a precipitating factor in domestic violence, extramarital affairs and divorce. Symptoms such as hot flashes and mood swings were associated with negative attitudes toward menopause. CONCLUSIONS: Culturally determined attitudes appear to affect the perception and experience of menopause. Other influencing factors include migration, women's roles, marital status, religion, use of herbal and traditional remedies, social situation, access to information, knowledge and experience of menopausal symptoms.

Health literacy training: A model for effective implementation and sustainability.

OBJECTIVE: Training the mental health workforce to provide health promotion and support to people using their services to manage comorbid conditions is essential if full integration of physical and mental health is to become a reality. We document how a training model was explicitly designed to extend curricula beyond the classroom in order to increase the frequency and quality of physical health interventions. We also show how implementation was supported by a strong project structure and a facilitative administration. METHOD: This article was informed by the workforce development literature, process observations, and key informant interviews. RESULTS: Passive dissemination cannot change practice. Buy-in and commitment from agency leaders facilitates collaboration between consultant-trainers and trainees. Organizations with strong implementation structures help ensure training uptake. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: When contracting with trainers, ensure that they understand the need for and are willing to commit to sustainability. Additionally, organizations will benefit by using lessons from implementation science when approaching workforce.

A Controlled Trial of Supported Employment for People With Severe Mental Illness and Justice Involvement.

OBJECTIVE: Employment is a key to participation in community life for people with severe mental illness, especially those who have been involved in the criminal justice system. Although the Individual Placement and Support (IPS) model of supported employment has been established as an evidence-based practice for helping people with severe mental illness attain competitive employment, little is known about whether IPS is effective for people with severe mental illness who have a history of arrest or incarceration. This study examined this question. METHODS: A randomized controlled trial examined competitive employment outcomes for 85 participants with severe mental illness and justice involvement who were assigned to IPS or to a comparison group that offered a job club approach with peer support. RESULTS: At one-year follow-up, a greater proportion of participants in the IPS group than in the comparison group had obtained competitive employment (31% versus 7%; p<.01). The IPS and comparison groups did not differ significantly during follow-up in rates of hospitalization (51% versus 40%) or justice involvement-either arrests (24% versus 19%) or incarceration (2% for both groups). CONCLUSIONS: Although IPS was shown to be an effective model for helping justice-involved clients with severe mental illness achieve employment, the outcomes were modest compared with those in prior IPS studies. The IPS model provided a useful framework for employment services for this population, but augmentations may be needed.

Carotid ultrasound pulsatility indices and cardiovascular risk in Australian women.

INTRODUCTION: Ultrasound-acquired internal carotid arterial (ICA) pulsatility indices (PI) have been demonstrated to be useful measures of cerebrovascular disease. The purpose of this cross-sectional study was to investigate the association between carotid artery PI, cardiovascular risk and ischaemic heart disease in aging women. METHODS: One hundred and fifty-eight female participants of the Longitudinal Assessment of Ageing in Women study, aged 48-85 years, were evaluated. The relationships between common carotid artery (CCA) and ICA Doppler PI to cardiovascular risk factors (age, body mass index, systolic and mean arterial blood pressure, smoking and diabetes), carotid-femoral (femPWV) and carotid-radial (radPWV) pulse wave velocities, and ischaemic heart disease (IHD) were assessed using Spearman's rank correlation (ρ), multiple regression and logistic regression. Dependent variables were Box-Cox transformed to meet linear regression assumptions. RESULTS: CCA and ICA PI were significantly correlated to femPWV (ρ = 0.414 and ρ = 0.544, respectively). Cardiovascular risk factors were significantly predictive of CCA PI (Adj R(2) = 0.176, P < 0.01); however, their relationship to ICA PI (Adj R(2) = 0.508, P < 0.01) was stronger. This result was comparable with the relationship between cardiovascular risk factors and femPWV (Adj R(2) = 0.561, P < 0.01). Age and systolic blood pressure were the dominant risk factors for IHD in this group. CONCLUSION: ICA PI is comparable with femPWV in its association with cardiovascular disease. PI does not improve the prediction of IHD over age and systolic blood pressure.

Targeting consumers in the early stages of substance use treatment: a pilot study.

OBJECTIVE: Engaging persons with co-occurring disorders in substance use treatment presents a significant challenge for public mental health service providers. Standardized, user-friendly guidelines may have great benefit for community mental health outreach staff working with individuals with co-occurring disorders. The purpose of this study is to describe the impact of a brief, structured goal development curriculum ("Fresh Start") on clinicians' motivational interviewing skills and to assess clinician and consumer satisfaction with the curriculum. METHOD: Four clinicians, each working with 3-4 consumer participants, were assessed with the Yale Adherence and Competency Scale prior to and during use of Fresh Start to determine improvements in motivational interviewing and goal setting. Consumer participants were assessed in brief qualitative interviews to assess satisfaction. Chart-review of routinely collected substance use data was used to assess reductions in use. RESULTS: Clinicians demonstrated high ratings in relational motivational interviewing skills at baseline which were maintained at study conclusion. Clinicians had lower technical motivational interviewing skills at baseline and made modest improvements in motivational interviewing techniques targeting increasing change talk. Fresh Start participants completed an average of 10 sessions (SD = 2.35). Among the 16 consumers who volunteered to participate in using the Fresh Start curriculum, 12 finished the program and 9 decided to reduce use and composed a sobriety plan. CONCLUSIONS AND IMPLICATION FOR PRACTICE: High rates of completion indicate acceptability of the curriculum and feasibility for implementing the program in a community setting. Short, goal-setting interventions are needed and under proper conditions may be teachable in vivo.

Partnering with mental health providers: a guide for services researchers.

BACKGROUND: There is a 20-year delay between the development of effective interventions for individuals with severe mental illness and widespread adoption in public mental health care settings. Academic-provider collaborations can shorten this gap, but establishing and maintaining partnerships entail significant challenges. AIMS: This paper identifies potential barriers to academic-provider research collaborations and provides guidelines to overcome these obstacles. METHOD: Authors from an academic institution and community mental health organization outline the components of their long-standing partnership, and discuss the lessons learned that were instrumental in establishing the collaborative model. Results Realistic resource allocation and training, a thorough understanding of the service model and consumer characteristics, systemic and bidirectional communication and concrete plans for post-project continuation are necessary at all project phases. CONCLUSIONS: A shared decision-making framework is essential for effective academic institution and community mental health agency collaborations and can facilitate long-term sustainability of novel interventions.

Towards validation of use of an Australian reference database for the diagnosis of osteoporosis with DXA.

INTRODUCTION: Bone densitometry in Australia uses the data from the Geelong Osteoporosis Study for conversion of bone mineral density (BMD) to T-scores to diagnose osteoporosis based on the World Health Organization (WHO) classification criteria. An underlying assumption is that the bone status of women in Geelong city is representative of the rest of Australia. The aim of this study is to compare the prevalence of normal BMD, osteopenia and osteoporosis of sample Brisbane women to Geelong, and to assess the validity of the Geelong reference database for Australia-wide application. METHODS: The subjects were recruited as part of a longitudinal assessment of age-related changes in a random sample of women from Brisbane. The sample consisted of 503 women, aged between 40 and 79 years. Each subject had BMD measured at the lumbar spine and femoral neck. RESULTS: Using the WHO osteoporosis classification criteria based on T-scores, and the BMD cut-offs from the Geelong Study, the prevalence of normal BMD, osteopenia and osteoporosis was determined for the following age groupings, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69 and 70-79, to match the Geelong Study for comparison. There were no systematic differences in the prevalence of normal BMD, osteopenia and osteoporosis in the Brisbane subjects compared to the Geelong Study. CONCLUSION: This finding supports the use of the Geelong data as the reference for the generation of T-scores for bone densitometry assessment for osteoporosis using dual-energy X-ray absorptiometry in Australia.

Intake of isoflavone and lignan phytoestrogens and associated demographic and lifestyle factors in older Australian women.

The purpose was to determine intake of phytoestrogens in a sample of older Australian women, and to investigate associated lifestyle factors. Subjects were an age-stratified sample of 511 women aged 40-80 y, randomly selected from the electoral roll and participating in the Longitudinal Assessment of Ageing in Women at the Royal Brisbane and Women's Hospital. A cross-sectional study was conducted to assess isoflavone and lignan intake over the past month from food and supplements using a 112-item phytoestrogen frequency questionnaire. Data were also collected on nutrient intakes, physical activity, smoking, alcohol, non-prescription supplements, hormone therapy, education and occupation. Logistic regression was used to evaluate associations between demographic and lifestyle variables and soy/linseed consumption while controlling for age. Isoflavone intakes were significantly higher in the younger compared to older age groups (p<0.001); there were no age-related differences in lignan intake. Forty-five percent of women consumed at least one serve of a soy and/or linseed item and were defined as a soy/linseed consumer. Median (range) intakes by consumers for isoflavones and lignans (3.9 (0-172) mg/d and 2.4 (0.1-33) mg/d) were higher than intakes by non-consumers (0.004 (0-2.6) mg/d and 1.57 (0.44-4.7) mg/d), respectively (p<0.001). Consumers had higher intakes of dietary fibre (p=0.003), energy (p=0.04) and polyunsaturated fat (p=0.004), and higher levels of physical activity (p=0.006), socio-economic position (p<0.001), education (p<0.001) and supplement use (p<0.001). Women who consumed soy or linseed foods differed in lifestyle and demographic characteristics suggesting these factors should be considered when investigating associations with chronic disease outcomes.

Age-related changes in heart function by serial echocardiography in women aged 40-80 years.

AIM: To determine if a defined set of echocardiographic parameters at entry and exit of a longitudinal study over 5 years showed changes with aging. METHODS: The cohort consisted of 484 randomly recruited women aged 40-80. They were examined by two echocardiography cardiologists, independent of the medical information for these women. RESULTS: Across the age decades (40-49, 50-59, 60-69, 70-79 years), body weight and body surface area (BSA) did not vary, and diastolic blood pressure (DBP) was stable; systolic blood pressure (SBP) progressively increased. There was gradual decline in left ventricular (LV) diastolic function, increase in LV muscle mass, and decrease in LV end-diastolic volume (LVEDV). The serial decrease in rate of change over 5 years in ejection fraction (ET) was small but significant across the four age decades. CONCLUSIONS: As expected, there were age-related changes in cardiac structure and function over time in women who showed no apparent cardiovascular disease (CVD) at entry to the study. The direction of these serial changes was toward the development of LV stiffness and likelihood of subsequent heart failure. The clinical significance of the decrease in rate of change in EF remains unclear.

Comparison of multiple and novel measures of dietary glycemic carbohydrate with insulin resistant status in older women.

BACKGROUND: Previous epidemiological investigations of associations between dietary glycemic intake and insulin resistance have used average daily measures of glycemic index (GI) and glycemic load (GL). We explored multiple and novel measures of dietary glycemic intake to determine which was most predictive of an association with insulin resistance. METHODS: Usual dietary intakes were assessed by diet history interview in women aged 42-81 years participating in the Longitudinal Assessment of Ageing in Women. Daily measures of dietary glycemic intake (n = 329) were carbohydrate, GI, GL, and GL per megacalorie (GL/Mcal), while meal based measures (n = 200) were breakfast, lunch and dinner GL; and a new measure, GL peak score, to represent meal peaks. Insulin resistant status was defined as a homeostasis model assessment (HOMA) value of >3.99; HOMA as a continuous variable was also investigated. RESULTS: GL, GL/Mcal, carbohydrate (all P < 0.01), GL peak score (P = 0.04) and lunch GL (P = 0.04) were positively and independently associated with insulin resistant status. Daily measures were more predictive than meal-based measures, with minimal difference between GL/Mcal, GL and carbohydrate. No significant associations were observed with HOMA as a continuous variable. CONCLUSION: A dietary pattern with high peaks of GL above the individual's average intake was a significant independent predictor of insulin resistance in this population, however the contribution was less than daily GL and carbohydrate variables. Accounting for energy intake slightly increased the predictive ability of GL, which is potentially important when examining disease risk in more diverse populations with wider variations in energy requirements.

Effect of lifestyle factors and hormone therapy on heart function by serial echocardiography in postmenopausal women.

BACKGROUND: There is conflicting information on the effects of oestrogen on the heart in women, especially those using postmenopausal hormone therapy. Whilst some studies reported a beneficial effect, others showed adverse outcomes. The interplay of lifestyle factors and type/timing of therapy remains to be clarified. AIM: The aim of this study was to determine the effects of lifestyle and hormone therapy on heart function and structure in postmenopausal women. METHOD: As part of a large longitudinal study of women randomly recruited from an urban population, the study assessed 410 suitable women by echocardiography in Year 1 and Year 5 of the study by two independent cardiologists. RESULTS: In lifestyle characteristics, the difference in age and body mass (as markers of cardiovascular risk) was in favour of never-users versus hormone therapy-users. Using an arbitrary cut-off > or =15% change for an effect, we found lifestyle factors had minimal effect on the two measured parameters - ejection fraction, left ventricular mass. Effects of hormone therapy were variable and mixed; greatest effect was found for an 'early start' of hormone therapy with oestrogen-only preparation - the risk of reduced ejection fraction was decreased [hazard ratio (HR) 0.42, confidence interval = 0.17-1.03, P = 0.06] and risk of increased left ventricular mass was increased (HR 2.21, 1.09-4.49, P = 0.03). CONCLUSION: Our findings add to the evidence that oestrogen given to postmenopausal women has a mixed effect on the heart, with effect best shown when started early.

A validated self-administered female pelvic floor questionnaire.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to validate a self-administered version of the already validated interviewer-administered Australian pelvic floor questionnaire. METHODS: The questionnaire was completed by 163 women attending an urogynecological clinic. Face and convergent validity was assessed. Reliability testing and comparison with the interviewer-administered version was performed in a subset of 105 patients. Responsiveness was evaluated in a subset of 73 women. RESULTS: Missing data did not exceed 4% for any question. Cronbach's alpha coefficients were acceptable in all domains. Kappa coefficients for the test-retest analyses varied from 0.64-1.0. Prolapse symptoms correlated significantly with the pelvic organ prolapse quantification. Urodynamics confirmed the reported symptom stress incontinence in 70%. The self and interviewer-administered questionnaires demonstrated equivalence. Effect sizes ranged from 0.6 to 1.4. CONCLUSIONS: This self-administered pelvic floor questionnaire assessed pelvic floor function in a reproducible and valid fashion and due to its responsiveness, can be used for routine clinical assessment and outcome research.

Australian pelvic floor questionnaire: a validated interviewer-administered pelvic floor questionnaire for routine clinic and research.

The aim of this study was to design and validate an interviewer-administered pelvic floor questionnaire that integrates bladder, bowel and sexual function, pelvic organ prolapse, severity, bothersomeness and condition-specific quality of life. Validation testing of the questionnaire was performed using data from 106 urogynaecological patients and a separately sampled community cohort of 49 women. Missing data did not exceed 2% for any question. It distinguished community and urogynaecological populations regarding pelvic floor dysfunction. The bladder domain correlated with the short version of the Urogenital Distress Inventory, bowel function with an established bowel questionnaire and prolapse symptoms with the International Continence Society prolapse quantification. Sexual function assessment reflected scores on the McCoy Female Sexuality Questionnaire. Cronbach's alpha coefficients were acceptable in all domains. Kappa coefficients of agreement for the test-retest analyses varied from 0.5 to 1.0. The interviewer-administered pelvic floor questionnaire assessed pelvic floor function in a reproducible and valid fashion in a typical urogynaecological clinic.

An interviewer-administered validated female pelvic floor questionnaire for community-based research.

OBJECTIVE: The aim of this study was to design and validate an interviewer-administered pelvic floor questionnaire suitable for community-dwelling women to assess female bladder, bowel, and sexual function; pelvic organ prolapse; and condition-specific quality-of-life issues. DESIGN: The questionnaire was developed and administered during interviews of 493 community-dwelling women aged 40 to 79 years originally recruited from an age-stratified random sample from the electoral roll who were involved in a longitudinal study of aging in women. Full psychometric testing was performed. To assess discriminant validity, 55 consecutive patients attending a tertiary referral urogynecology clinic served as a comparison group. RESULTS: Face validity: The interviewer-administered questionnaire was easily administered and missing data did not exceed 2%. Discriminant validity: The questionnaire clearly discriminated the community population from the urogynecology patients in all pelvic floor domains. Convergent validity: The bladder function domain score correlated with the validated short version of the Urogenital Distress Inventory score. Bowel function scores correlated highly with corresponding items in an established bowel questionnaire. Prolapse symptoms correlated significantly with the pelvic organ prolapse quantification. Sexual function score (n = 257) correlated with the validated McCoy Female Sexuality Questionnaire score. Reliability: Cronbach's alpha for the bladder, bowel, prolapse, and sexual function domains was adequate (alpha >or= 0.7). Kappa values in the test-retest analyses varied between 0.63 and 1.0 (test-retest reproducibility). CONCLUSIONS: The interviewer-administered questionnaire assesses all aspects of pelvic floor function including condition-specific quality-of-life issues in a reliable and valid fashion. It is suitable for researchers investigating pelvic floor function.