What shapes the continuum of reproductive isolation? Lessons from Heliconius butterflies.

The process by which species evolve can be illuminated by investigating barriers that limit gene flow between taxa. Recent radiations, such as Heliconius butterflies, offer the opportunity to compare isolation between pairs of taxa at different stages of ecological, geographical, and phylogenetic divergence. Here, we report a comparative analysis of existing and novel data in order to quantify the strength and direction of isolating barriers within a well-studied clade of Heliconius Our results highlight that increased divergence is associated with the accumulation of stronger and more numerous barriers to gene flow. Wing pattern is both under natural selection for Müllerian mimicry and involved in mate choice, and therefore underlies several isolating barriers. However, pairs which share a similar wing pattern also display strong reproductive isolation mediated by traits other than wing pattern. This suggests that, while wing pattern is a key factor for early stages of divergence, it may become facultative at later stages of divergence. Additional factors including habitat partitioning, hybrid sterility, and chemically mediated mate choice are associated with complete speciation. Therefore, although most previous work has emphasized the role of wing pattern, our comparative results highlight that speciation is a multi-dimensional process, whose completion is stabilized by many factors.

Differential effects of air conditioning type on residential endotoxin levels in a semi-arid climate.

Residential endotoxin exposure is associated with protective and pathogenic health outcomes. Evaporative coolers, an energy-efficient type of air conditioner used in dry climates, are a potential source of indoor endotoxins; however, this association is largely unstudied. We collected settled dust biannually from four locations in homes with evaporative coolers (n=18) and central air conditioners (n=22) in Utah County, Utah (USA), during winter (Jan-Apr) and summer (Aug-Sept), 2014. Dust samples (n=281) were analyzed by the Limulus amebocyte lysate test. Housing factors were measured by survey, and indoor temperature and relative humidity measures were collected during both seasons. Endotoxin concentrations (EU/mg) were significantly higher in homes with evaporative coolers from mattress and bedroom floor samples during both seasons. Endotoxin surface loads (EU/m2 ) were significantly higher in homes with evaporative coolers from mattress and bedroom floor samples during both seasons and in upholstered furniture during winter. For the nine significant season-by-location comparisons, EU/mg and EU/m2 were approximately three to six times greater in homes using evaporative coolers. A plausible explanation for these findings is that evaporative coolers serve as a reservoir and distribution system for Gram-negative bacteria or their cell wall components in homes.

Divergence in brain composition during the early stages of ecological specialization in Heliconius butterflies.

During speciation across ecological gradients, diverging populations are exposed to contrasting sensory and spatial information that present new behavioural and perceptive challenges. These challenges may be met by heritable or environmentally induced changes in brain function which mediate behaviour. However, few studies have investigated patterns of neural divergence at the early stages of speciation, inhibiting our understanding of the relative importance of these processes. Here, we provide a novel case study. The incipient species pair, Heliconius erato and H. himera, are parapatric across an environmental and altitudinal gradient. Despite ongoing gene flow, these species have divergent ecological, behavioural and physiological traits. We demonstrate that these taxa also differ significantly in brain composition, in particular in the relative levels of investment in structures that process sensory information. These differences are not explained solely by environmentally-induced plasticity, but include heritable, nonallometric shifts in brain structure. We suggest these differences reflect divergence to meet the demands of contrasting sensory ecologies. This conclusion would support the hypothesis that the evolution of brain structure and function play an important role in facilitating the emergence of ecologically distinct species.

Risk of Injury According to Attention Deficit Hyperactivity Disorder, Comorbid Mental Illness, and Medication Therapy.

INTRODUCTION: We identify the risk of selected types of injuries among patients with ADHD or ADHD and comorbid mental illness. We also assess whether selected medications used by patients with ADHD increase the risk of comorbid mental illness or influence the association between ADHD and injury. METHODS: A retrospective cohort study design was conducted using medical claims data from the Deseret Mutual Benefit Administrators (DMBA). ADHD diagnosis, injury, medication, and demographic data were extracted from claims files during 2001-2013. Rate ratios were adjusted for age, sex, and calendar year. RESULTS: Patients with ADHD were 7.9 (95% CI 7.6-8.2) times more likely to have psychosis, 5.5 (3.9-7.8) times more likely to have alcohol- or drug-induced psychosis, and 6.0 (5.9-6.2) times more likely to have neurotic or personality disorder. Therapy with amphetamine was positively associated with neurotic or personality disorder (rate ratio=1.08, 1.02-1.15); methylphenidate was negatively associated with neurotic or personality disorder (0.90, 0.84-0.97); and atomoxetine was positively associated with psychosis (1.33, 1.21-1.46), alcohol- or drug-induced psychosis (2.38, 1.04-5.43), and neurotic or personality disorder (2.38, 1.04-5.43). ADHD was associated with an increased risk of injury, with ADHD and comorbid mental illness having a stronger increased risk of injury. Psychostimulants ameliorated the increased risk of injury for patients with ADHD. CONCLUSION: Patients with ADHD have an increased risk of injury, significantly more so for those with ADHD and comorbid mental illness. Psychostimulants can lower the risk of injury among patients with ADHD.

The diversification of Heliconius butterflies: what have we learned in 150 years?

Research into Heliconius butterflies has made a significant contribution to evolutionary biology. Here, we review our understanding of the diversification of these butterflies, covering recent advances and a vast foundation of earlier work. Whereas no single group of organisms can be sufficient for understanding life's diversity, after years of intensive study, research into Heliconius has addressed a wide variety of evolutionary questions. We first discuss evidence for widespread gene flow between Heliconius species and what this reveals about the nature of species. We then address the evolution and diversity of warning patterns, both as the target of selection and with respect to their underlying genetic basis. The identification of major genes involved in mimetic shifts, and homology at these loci between distantly related taxa, has revealed a surprising predictability in the genetic basis of evolution. In the final sections, we consider the evolution of warning patterns, and Heliconius diversity more generally, within a broader context of ecological and sexual selection. We consider how different traits and modes of selection can interact and influence the evolution of reproductive isolation.

Ecological and genetic factors influencing the transition between host-use strategies in sympatric Heliconius butterflies.

Shifts in host-plant use by phytophagous insects have played a central role in their diversification. Evolving host-use strategies will reflect a trade-off between selection pressures. The ecological niche of herbivorous insects is partitioned along several dimensions, and if populations remain in contact, recombination will break down associations between relevant loci. As such, genetic architecture can profoundly affect the coordinated divergence of traits and subsequently the ability to exploit novel habitats. The closely related species Heliconius cydno and H. melpomene differ in mimetic colour pattern, habitat and host-plant use. We investigate the selection pressures and genetic basis underlying host-use differences in these two species. Host-plant surveys reveal that H. melpomene specializes on a single species of Passiflora. This is also true for the majority of other Heliconius species in secondary growth forest at our study site, as expected under a model of interspecific competition. In contrast, H. cydno, which uses closed-forest habitats where both Heliconius and Passiflora are less common, appears not to be restricted by competition and uses a broad selection of the available Passiflora. However, other selection pressures are likely involved, and field experiments reveal that early larval survival of both butterfly species is highest on Passiflora menispermifolia, but most markedly so for H. melpomene, the specialist on that host. Finally, we demonstrate an association between host-plant acceptance and colour pattern amongst interspecific hybrids, suggesting that major loci underlying these important ecological traits are physically linked in the genome. Together, our results reveal ecological and genetic associations between shifts in habitat, host use and mimetic colour pattern that have likely facilitated both speciation and coexistence.

Racial/ethnic differences in the use of surgery for ovarian cancer in the United States.

PURPOSE: This study provides an assessment of patterns of both hysterectomy and other surgeries among ovarian cancer patients in the United States according to race/ethnicity. METHODS: Analyses are based on data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program, 2002 through 2006. RESULTS: About 75% of ovarian cancer patients received surgery, with most undergoing unilateral or bilateral (salpingo-) oophorectomy with omentectomy or debulking (cytoreductive surgery). Black and Hispanic patients were significantly less likely to receive surgery after adjusting for age, marital status, and tumor stage and grade at diagnosis. Among cases aged 15-44 with localized disease, 35% selected fertility-conservative management. The percentage receiving fertility-conservative management fell from 57% in ages 15-29 to 12% in ages 40-44. There was no significant difference among women of childbearing age across racial/ethnic classifications in their use of fertility-conservative management. Among the 88% of patients aged 45 years or older at diagnosis, treatment with surgery was generally high: 90% for ages 45-59, 81% for ages 60-69, 68% for ages 70-79, and 38% for ages 80 and older. CONCLUSION: Black and Hispanic patients are less likely to receive surgery, but in women of childbearing age with locally staged disease there is no difference among racial/ethnic groups in fertility-conservative management.

Employee weight management through health coaching.

OBJECTIVE: This study will evaluate the effectiveness of an interactive health coaching intervention at lowering weight. METHODS: The study involved 5405 overweight or obese employees aged 18-85, who entered the program sometime during 2001-2008. RESULTS: Average body mass index (BMI) significantly decreased from 32.1 at baseline to 31.4 at 3 months, 31.0 at 6 months, and 30.6 at 12 months. Decreasing BMI was more pronounced in older age groups and among women, those using weight loss medication, those with higher BMI, and those with higher motivation and confidence to make behavior changes. When the effects of these variables on the decreasing trend in BMI were simultaneously estimated, only baseline classifications of BMI, health status, and confidence remained significant. Change in BMI through 12 months was -0.7% for those with normal weight, -2.0% for overweight, -3.6% for obese, and -7.1% for morbidly obese individuals at baseline. Among morbidly obese individuals, decrease in BMI through 12 months was -7.6% for those with "high" confidence to lose weight at baseline vs -4.4% for those with low confidence. Better health status at baseline was also related to more pronounced weight loss. CONCLUSION: Interactive health coaching significantly lowered BMI among participants through 3, 6, and 12 months of follow-up.

Factors associated with attrition and success in a worksite wellness telephonic health coaching program.

OBJECTIVES: This study identifies factors associated with attrition and improvements in body mass index (BMI) in a telephonic health coaching program. METHODS: A cohort study design was used with 6,129 employees aged 21-88 years, enrolled in telephonic health coaching sometime during 2002 through 2008. RESULTS: Attrition through 3, 6 and 12 months of follow-up was 13%, 17% and 36%, respectively. Those currently making changes in physical activity or nutrition had the highest BMI (kg/m2), lowest levels of exercise and the poorest overall health at baseline. They were also most likely to continue with health coaching through 12 months. Those not ready to make changes at this time or having maintained an appropriate level of physical activity or nutrition for more than six months were least likely to continue with health coaching through 12 months. They also had the lowest BMI, highest levels of exercise and the best overall health. Among those continuing with health coaching through 12 months, the percent decrease in BMI between baseline and 12 months was: 1.5% for normal weight, 2.7% for overweight, 4.1% for class I & II obesity and 7.2% for class III obesity; 4.3% for high confidence to lose weight, 3.5% for medium confidence to lose weight and 3.1% for low confidence to lose weight; and 3.8% for very good or good general health, 4.5% for average general health and 6.8% for poor/very poor general health. CONCLUSIONS: Attrition in the telephonic health coaching program is greatest among those least in need of behavior change. Of those who continued in the program, the greatest decrease in BMI occurred in those in greatest need for behavior change. KEYWORDS: Behavior change, BMI, interactive health coaching, readiness to change, self-efficacy, weight.

Sectors of the Russian economy that would benefit from reduced cigarette sales.

BACKGROUND: Cigarette companies argue that tobacco control measures will harm the Russian economy. Research in other countries has refuted this claim. OBJECTIVE: To identify how current and former smokers would (or did) spend their cigarette money if (or when) they quit smoking. METHODS: A nationwide face-to-face survey of 1599 participants aged 18 years and older in 128 cities was conducted in Russia during May 2008 by the Russian Levada Analytical Center. RESULTS: In all, 10% of respondents were former smokers and 33% were current smokers. Respondents indicated that they would spend their cigarette money on selected items if they quit. These items, from most to least common are groceries, recreation, housing, clothing, transportation, healthcare and savings. The ways that cigarette money would be spent in the absence of smoking significantly differed according to smoking status, gender, age, education, income, rural versus urban residency and geographic region. CONCLUSIONS: Tobacco control may benefit the Russian economy by producing healthier workers and because the money that would have been used for cigarettes would be shifted primarily to groceries, recreation, housing and clothing.

Attention deficit hyperactivity disorder and increased risk of injury.

PURPOSE: This study describes the influence of attention deficit hyperactivity disorder (ADHD) on the incidence rates of selected injuries. METHODS: A retrospective cohort study design was employed using medical claims data from the Deseret Mutual Benefit Administrators (DMBA), a health insurance company for employees of the Church of Jesus Christ of Latter-day Saints (LDS) and their spouses and dependent children. ADHD diagnosis, injury, medication, and demographic data were extracted from claims files during 1998-2005 for all enrollees aged 0-64 years. RESULTS: Incidence rates of ADHD were 1.83 (95% CI 1.68-2.00) times greater in males than females and highest in the age group 5-9 years and income group $80,000 or greater. ADHD increased the risk of selected injuries. The most common injuries involved sprains and strains of joints, then open wounds of the head, neck and trunk, and upper/lower limb, and then fractures of the upper/lower limb. Medication did not significantly protect against injury in ADHD patients. The rate of severe injury (i.e., fracture of skull, neck and trunk; intracranial injury excluding those with skull fracture; and injuries to nerves and spinal cord) was 3.07 (95% CI 2.37-3.98) times more common in ADHD enrollees compared with non-ADHD enrollees. Those with 1, 2, 3, or 4 or more injuries were 1.67 (1.50-1.86), 2.11 (1.75-2.56), 2.63 (1.80-3.84), and 2.94 (1.47-5.87) times more likely to have ADHD, respectively. CONCLUSIONS: ADHD is positively associated with injuries. More severe injuries have a significantly stronger associated with ADHD than less severe injuries.

Perceived effectiveness of counselling patients about smoking among medical students in Amman, Jordan.

We identified the prevalence of smoking and perceived effectiveness of physicians counselling patients about smoking among 340 1st and 4th year medical students in Amman, Jordan. Smoking prevalence was 26% for males and 7% for females, similar to that of their peers in the general population. Smokers and male students were less likely to believe it is wrong for physicians to smoke in front of patients or that smoking policy or physician interaction with patients can influence smoking practices. Students believed that physicians can more effectively prevent smoking than influence patients to stop smoking. Student training on how to effectively counsel patients about smoking prevention and cessation is warranted.

The effects of an intensive lifestyle modification program on sleep and stress disorders.

BACKGROUND: To determine if a lifestyle change program can modify behavior to reduce sleep and stress disorders. METHODS: Analyses are based on 2,624 individuals aged 30 to 80 years from the Rockford, Illinois metropolitan area who completed a lifestyle evaluation at baseline and again after four weeks, following participation in a 40-hour educational course given over a four-week period. Participants receive instruction on the importance of making better lifestyle choices related to making long-term improvements in nutrition and physical activity and they learn ways to improve sleep and reduce stress in their lives. RESULTS: Significant percent decreases were observed in the number experiencing selected sleep or stress disorders from baseline to four weeks later for "sleeps restlessly" (-59%), "suffers from insomnia" (-64%), "feels under pressure" (-37%), "easily emotionally upset" (-52%), and "feels fearful or depressed" (-61%). Experiencing a selected sleep or stress disorder after four weeks among those who had the disorder at baseline was significantly more likely in those not physically active and/or not having lowered their BMI after four weeks. Changes in alcohol consumption and smoking did not significantly contribute to changes in the disorders. Those who failed to lower their coffee/tea use after four weeks were significantly more likely to have a sleep disorder and be easily emotionally upset. CONCLUSIONS: Changes in lifestyle behaviors after attending an educational program significantly reduced sleep and stress disorders in as little as four weeks, primarily explained by decreasing BMI and/or increasing exercise.

Sit to stand transfer: performance in rising power, transfer time and sway by age and sex in senior athletes.

OBJECTIVE: To observe the differences in performance variables of the sit to stand transfer (as measured on the NeuroCom Balance Master) in a population of senior athletes. METHOD: A convenience sample of 173 subjects aged 50 years and older. Data were obtained from voluntary participation in a health fair offered at the annual Huntsman World Senior Games in St George, Utah, USA. All sit to stand tests were performed on the NeuroCom Balance Master. The measured parameters were weight transfer time (WTT), rising power (force exerted to rise), and centre of gravity sway (COG sway) during the rising phase. RESULTS: A significant difference was found between stratified age groups (50-64 and 65+ years) on rising power. There was also a sex difference in rising power. No significant differences were found in weight transfer time or COG sway. CONCLUSION: While rising power decreases with increasing age in senior athletes, WTT and COG sway remain similar regardless of age or sex. The maintenance of these other two variables (WTT and COG sway) may be attributable to physical activity and/or participation in sport.

Trends in tobacco smoking among adolescents in Lyon, France.

To provide information that may promote more effective cancer prevention, we identified factors associated with regular smoking among adolescents in Lyon, France. School grades where these factors began to influence regular smoking were also identified. Seven consecutive cross-sectional anonymous surveys were conducted in three public schools, beginning in grade 6ème (average age 11.5 years) in 1993 and ending in grade Terminale (average age 17.4 years) in 1999. All classes in each respective grade were surveyed, with 3650 completed questionnaires for all years combined. Prevalence of current regular smoking is presented according to school grade for 17 variables identified as significantly related to regular smoking in a multivariate logistic regression analysis. Important factors associated with regular smoking were identified as early as grade 6ème and included not viewing the taking care of one's health as important, not eating breakfast regularly, associating with groups where smoking occurs, having a best friend who smokes, and having a brother and/or sister who smokes. Not regularly reading was first associated with an increased risk of regular smoking in grade 5ème. Not living with both parents, alcohol drinking, episodes of drunkenness, illicit drug use, and sexual relationships were positively associated with regular smoking in the middle and later grades, when these questions were first asked. Not playing sports and not playing with computers were initially associated with an increased risk of regular smoking in grade 3ème.

Measuring the public health burden of cancer in the United States through lifetime and age-conditional risk estimates.

PURPOSE: Effects of an aging population in the United States on lifetime and age-conditional risk estimates of developing site-specific cancers are identified and the potential role these statistics play in monitoring disease burden discussed. METHODS: Risk estimates were derived by applying cross-sectional population-based incidence rates of cancer and mortality rates from other causes to a hypothetical cohort. The cohort was aged through a double decrement life table to determine the expected proportion of the population that would develop the disease. RESULTS: Despite black men having higher invasive cancer incidence rates than white men, and black and white women having similar rates, because of the better life expectancy among whites lifetime risk estimates of developing cancer are higher for whites than blacks: 45.5% in white men, 40.4% in black men, 39.2% in white women, and 32.4% in black women based on 1995-97 data. White men experience higher 10-year cancer risk than black men in only bladder cancer, non-Hodgkin's lymphomas (NHL), and leukemia. White women tended to show a greater risk than black women for cancers of the breast, corpus uteri, ovary, NHL, and leukemia. For both whites and blacks, the 10-year risk of lung cancer ranks first among men aged 40, ranks second to prostate cancer for men aged 50, 60, and 70, and ranks second to breast cancer for women aged 40, 50, 60, and 70. CONCLUSIONS: Lifetime and age-conditional risk measures reflect both changes in the disease incidence rates and age distribution over calendar time such that they are useful for monitoring the disease burden in the population. Even if cancer rates remain stable or fall, it is possible for the cancer burden, as reflected by lifetime and age-conditional risk estimates, to increase due to the aging population.

Comparison of two methods based on cross-sectional data for correcting corpus uterine cancer incidence and probabilities.

BACKGROUND: Two methods are presented for obtaining hysterectomy prevalence corrected estimates of invasive cancer incidence rates and probabilities of the corpus uterine. METHODS: The first method involves cross-sectional hysterectomy data from the Utah Hospital Discharge Data Base and mortality data applied to life-table methods. The second involves hysterectomy prevalence estimates obtained directly from the Utah Behavior Risk Factor Surveillance System (BRFSS) survey. RESULTS: Hysterectomy prevalence estimates based on the first method are lower than those obtained from the second method through age 74, but higher in the remaining ages. Correction for hysterectomy prevalence is greatest among women ages 75-79. In this age group, the uncorrected rate is 125 (per 100,000) and the corrected rate based on the life-table method is 223 using 1995-97 data, 243 using 1992-94 data, and 228 from the survey method. The uncorrected lifetime probability of developing corpus uterine cancer is 2.6%; the corrected probability from the life-table method using 1995-97 data is 4.2%, using 1992-94 data is 4.5%; and based on prevalence data from the survey method is 4.6%. CONCLUSIONS: Both methods provide reasonable hysterectomy prevalence estimates for correcting corpus uterine cancer rates and probabilities. Because of declining trends in hysterectomy in recent decades, corrected estimates from the life-table method are less pronounced than those based on the survey method. These methods may be useful for obtaining corrected uterine cancer rates and probabilities in areas of the world that do not have sufficient years of hysterectomy data to directly compute prevalence.

Demographics and health-related factors of men receiving prostate-specific antigen screening in Utah.

BACKGROUND: Identifying who is pursuing prostate-specific antigen (PSA) screening for prostate cancer is prerequisite to effectively influencing participation in PSA screening and educating people about potential screening implications and personal risk. This paper describes the relationship between select demographic and health-related factors with PSA screening. METHODS: Analysis was based on 1,293 men age 40 years or older who responded to a cross-sectional random telephone survey involving 12 health districts in the state of Utah from June 1 to August 31, 1996. Independent variables were current age, race, marital status, education, household income, medical insurance, level of physical activity, intake of fruits and vegetables, receipt of psychiatric help, religious preference, church attendance, general health status, and employment. RESULTS: Forty-eight percent of respondents reported having had a PSA in the past year. PSA screening in the previous year significantly increased and leveled off with age: 23.9% for ages 40-49, 51.4% for ages 50-59, 67.4% for ages 60-69, and 67.0% for ages 70+. After adjusting for age, only marital status and medical insurance were significantly related to PSA screening, with medical insurance having the largest effect. Approximately 50.6% married men and 33.5% unmarried men had a PSA in the past year. Percentages for insured and uninsured men were 49.4 and 16.6%, respectively. CONCLUSION: A substantial portion of elderly men, particularly those who are married and medically insured, have had a PSA test in the past year. This information makes it possible to more effectively influence participation in PSA screening and educate people about potential screening implications and personal risk.

Religious preference, church activity, and physical exercise.

BACKGROUND: Utah has the highest percentage of physically active adults in the United States. It also has a high percentage of religiously active people. About 90% of the adult population has a religious preference and 62% of those individuals attend church weekly. This study evaluates the relationship between religious preference, church attendance, and physical activity. METHODS: Analysis is based on 6,188 adult respondents ages 18 years and older to a cross-sectional random telephone survey involving 12 health districts in the state of Utah from June 1 to August 31, 1996. RESULTS: Within religious groups, those attending church weekly were more likely to exercise than individuals attending church less than weekly. About 70% of Utah consists of members of the Church of Jesus Christ of Latter-day Saints (LDS). LDS attending church less than weekly were least physically active in Utah. The percentages of those exercising vigorously at least 20 min three times per week were 52.3% (LDS who attend church weekly), 44.5% (LDS who attend church less than weekly), 57.6% (non-LDS who attend church weekly), 54.3% (non-LDS who attend church less than weekly), and 53.1% (no religious preference) (P = 0.0070). When adjustment was made for age, smoking status, education, marital status, and general health, differences in exercise between church activity levels within religious groups became insignificant. Smoking and general health have the greatest influences on the relationship between religious preference, church attendance, and exercise. LDS were significantly less physically active than non-LDS in the adjusted model. CONCLUSIONS: Although differential smoking levels and general health status explained differences between church activity levels within religious groups, lower levels of exercise among LDS versus non-LDS could not be explained and require further study.

Prevalence corrected hysterectomy rates and probabilities in Utah.

PURPOSE: A life table method is used for correcting hysterectomy rates and probabilities for prevalent cases of hysterectomies in the population. Both corrected and conventional hysterectomy rates and probabilities are reported. METHODS: Hysterectomy prevalence estimates are derived from cross-sectional hysterectomy and mortality using a life table method. Analysis is based on the Utah Hospital Discharge Data Base and State death certificates. RESULTS: Hysterectomy rates are strongly influenced by age, reaching 150 per 10,000 for ages 45-49 years. The corresponding corrected hysterectomy rate is 196. Differences between the corrected and uncorrected cause-specific hysterectomy rates tend to be most pronounced at their peaks, particularly later in life where the prevalence of hysterectomy is greatest. Probability of hysterectomy approaches slightly above 35% over the life span, whereas the corrected hysterectomy probability approaches 43%. Probability of hysterectomy in the next 10 years is 12.9% for women aged 35 years and 11.7% for women aged 45 years. Corresponding corrected hysterectomy probabilities are 14.3 and 15.1. Higher prevalence of hysterectomy in later ages explains the reverse in magnitude of the rates when the correction is applied to the hysterectomy rates. CONCLUSIONS: Conventional hysterectomy rates are underestimated, particularly in older age groups. A prevalence correction of the rates and probabilities is necessary to fully understand the potential health related consequences and impact of this medical procedure in the population.