Research article Quantifying physical resilience after knee or hip surgery in older Australian women based on long term physical functioning trajectories.

INTRODUCTION: To improve outcomes after knee or hip surgery, better insight is needed in long-term recovery patterns in the context of ageing-related decline. We examined long-term trajectories of physical functioning (PF) in older women with and without hip and knee surgery, and described profiles of cases with higher and lower resilience after surgery. METHODS: This observational study used data from 10,434 women (73-79 yrs) who completed survey 2 of the Australian Longitudinal Study on Women's Health. Data were used from surveys 2 (1999) to 6 (2011). Covariable-adjusted linear mixed models were run to examine the surgery-by-time (-12 to +12 yrs) interaction in association with PF (SF-36 subscale). The differences between observed and expected PF were calculated, with positive/negative values reflecting higher/lower resilience, respectively. RESULTS: Women with hip surgery (n=982) had lower PF than those without surgery (n=8117) (p<0.001). Among hip surgery patients, the decline was more rapid pre-surgery than post-surgery (Δslope=-0.7, p<0.001). Women with knee surgery (n=1144) had lower PF than those without surgery (n=7971), but with a slower rate of decline (p=0.01). Among knee surgery patients, the rate of decline was similar pre- and post-surgery (Δslope =-0.3, p=0.25). Both in hip and knee patients, women with higher resilience had fewer comorbidities and symptoms, and were more often physically active and independent in daily activities than those with lower resilience (all p<0.05). CONCLUSION: Compared with women without surgery, PF was lower and declined more rapidly around the time of hip surgery, but not for knee surgery. Women with better long-term recovery after surgery, had fewer health problems and were more independent around the time of surgery.

Adherence to 24-h movement behaviour guidelines in families with multiple children.

BACKGROUND: In 2019, the World Health Organization (WHO) launched the first global movement guidelines for children that combined sleep, physical activity and screen time. Our previous research showed that adherence to age-specific guidelines for screen time was challenging for families with children in different age groups. We aimed to determine whether families with children in different age-based movement guideline categories have poorer adherence to the broader 24-h movement guidelines than those with all children in the same age category. METHODS: Data were from the 1973-1978 cohort of the Australian Longitudinal Study on Women's Health (seventh survey, 2015) and the women's three youngest children (aged ≤12) (Mothers and their Children's Health sub-study, 2016/2017). The sample was 1787 women (families) with 4064 children (mean age 7.2 [SD 2.9]). Whether children in the family were in the same or different age-based category was determined by matching children's ages in a family against age-based guideline categories for the 24-h movement behaviours. The association between children in the family being in the same or different age-based guideline category on adherence to 24-h movement guidelines, both collectively and individually, was analysed by adjusted logistic regression (binary and multinomial). RESULTS: Families with children in the same age guideline categories had double the odds of having all children meet 24-h movement guidelines (adjusted odds ratio [OR] 1.95 [95% confidence interval, CI: 1.32, 2.86]). Families with children in the same age categories on the screen guideline had higher odds of all children meeting (2.25 [1.73, 2.93]) and lower odds of some meeting/some failing the screen guideline (0.18 [0.14, 0.25]), than families with all children in different age categories. Families with children in the same age categories on the physical activity guideline had lower odds of all children meeting (0.57 [0.43, 0.75]) or some meeting/some failing the physical activity guideline (0.08 [0.06, 0.12]). No associations were found for sleep guidelines. CONCLUSIONS: Families with multiple children may need practical advice and strategies on how to adhere to guidelines when children span age categories. This could form part of public health strategies that raise awareness of the guidelines and may improve guideline adherence.

Is being childless associated with a woman's risk of overweight and obesity? Results from a national longitudinal study.

AIM: To examine the association between motherhood status (mothers, voluntarily childless, involuntarily childless) and overweight and obesity over 22 years. METHODS: A total of 4092 women aged 18-23 years were followed from 1996 to 2018. Motherhood status was defined by women's reports on their fertility, attempts to conceive, use of in vitro fertilisation and fertility hormones, and number of biological children. Associations between motherhood status and overweight and obesity were examined using generalised estimating equations models, adjusting for socio-demographic characteristics, lifestyle factors, depressive symptoms, early life factors, and polycystic ovary syndrome (PCOS). RESULTS: At age 40-45 years, 12% of women were voluntarily childless and 5% were involuntarily childless. The prevalence of overweight and obesity increased with age and women who were voluntarily or involuntarily childless had higher prevalence of obesity than mothers in all surveys. After adjusting for covariates, compared with mothers, women who were voluntarily childless had higher odds of being overweight (odds ratio [OR], 95% confidence interval [CI]: 1.29, 1.09-1.52) and obese (OR, 95% CI: 1.65, 1.29-2.12). Involuntary childlessness was not associated with being overweight (OR, 95% CI: 1.05, 0.82-1.33), and its association with obesity was attenuated after adjusting for PCOS in the final model (OR, 95% CI: 1.40, 0.99-1.98). CONCLUSIONS: Around one in nine Australian women remained voluntarily childless by their late reproductive years. On average, they had higher odds of being overweight and obese than mothers, suggesting that overweight and obesity prevention programs should consider tailoring their advice by motherhood status.

Do mothers or females without children have better health-related quality of life across their reproductive years?

PURPOSE: To compare health-related quality of life (HRQoL) between mothers and females who were voluntarily or involuntarily childless, across their reproductive years. METHODS: 4100 females born in 1973-78 from the Australian Longitudinal Study on Women's Health were followed for 22 years. Motherhood status was defined by females' reports in Survey 8 (2018, 40-45 years) on their fertility, attempts to conceive, use of in vitro fertilization and fertility hormones, and number of children. HRQoL was assessed in each survey using the 36-Item Short Form Survey (SF-36). Linear mixed models were used to assess the associations between motherhood status and HRQoL. RESULTS: Over 22 years, compared with females who were voluntarily childless, mothers on average had better HRQoL (shown by scores 1.5 to 3.4 points higher on five of the eight SF-36 subscales), while females who were involuntarily childless scored 2.2 to 3.0 points lower on three of eight SF-36 subscales. Compared with females who were voluntarily childless, teen mothers (age at first birth < 20 years) scored lower on role limitations due to physical problems subscale (b = -5.5, 95% CI: -9.3, -1.6), while females with either two, or three or more children scored 1.6 to 4.8 points higher on seven of eight SF-36 subscales. CONCLUSIONS: Females who were childless had poorer HRQoL than mothers. Further research is needed to understand the underlying mechanisms, which could inform policymakers on how to reduce the health disparities and improve long-term health outcomes for females.

History of pre-pregnancy maternal symptoms of binge eating and childhood behavioral problems in girls and boys.

OBJECTIVE: To explore whether children of mothers with pre-pregnancy binge eating (BE) symptoms have more behavioral difficulties compared with those without and whether associations are moderated by ED symptoms and other maternal health and social factors measured during childhood. METHOD: Pre-pregnancy BE symptoms were collected by the Australian Longitudinal Study on Women's Health at Survey 1 (in 1996) and/or at Survey 2 (in 2000) using questions mapped to DSM BE criterion 1. In 2016/7, 2180 women from the 1973-78 cohort provided data on externalizing and internalizing behavior, measured by Strengths and Difficulties Questionnaire, on 4054 of their children (2-12 years) in the Mothers and their Children's Health study. Covariates were markers of other ED symptoms, sociodemographic, social support, and mental health factors collected proximally to the child outcomes. Hierarchical multivariable regression models, using generalized estimating equations accounting for clustering of children within mothers, were used. RESULTS: Pre-pregnancy BE symptoms were associated with child behavior, with associations only moderated after adjustment for proximal markers of ED (girls internalizing behavior, b (95%CI) .30 (-.02, .61); boys externalizing behavior .34 (-.04, .73)) or social support (girls externalizing behavior 0.26 (-.08, .61)). Pre-pregnancy BE symptoms were not associated with boys internalizing behavior (-.27 (-.02, 0.57)). DISCUSSION: Studies with repeated ED measures should test hypotheses that these associations vary by timing of ED measurement. Identification of young women at risk of BE symptoms pre-pregnancy, as well as when children are older, may enable health services, treatment programs, and supports to minimize longer term effects on children. PUBLIC SIGNIFICANCE STATEMENT: A history of binge eating symptoms up to 10 years pre-pregnancy in mothers is associated with behavior problems in their girls and boys at average age of 7. However, the association is moderated by behaviors of eating disorders and social support in the mothers during childhood. Identification of ED symptoms prior to pregnancy, and then after childbirth, might enable health services to intervene to maximize child and mother outcomes.

Maternal factors associated with interbirth intervals in Australia: Results from a population-based longitudinal study.

BACKGROUND AND OBJECTIVE: Short and long intervals between successive births are associated with adverse birth outcomes, especially in low-income and middle-income countries, yet the birth intervals in high-income countries remain relatively understudied. The aim was to examine maternal factors associated with birth intervals in Australia. METHODS: The sample comprised 6130 participants in the Australian Longitudinal Study on Women's Health who were born in 1973-1978, had two or more births, and responded to regular surveys between 1996 and 2018. Interbirth interval (IBI) was defined as the time between successive live births. Maternal factors were examined using accelerated failure time models. RESULTS: For women with only two births (n = 3802), the median time to the second birth was 34.0 months (IQR 23.1, 46.2) with shorter IBI associated with higher socioeconomic status (eg, university education (31.9 months), less income stress (31.1)), and longer IBI associated with age over 35 (39.7), fair/poor health (43.0), untreated fertility problems (45.5), miscarriage (39.4), or abortion (41.0). For women with three or more births (n = 2328), the median times to the second and third births were 31.2 months (19.9, 42.1) and 36.5 months (25.3, 50.1), respectively; some factors were consistent between the first IBI and second IBI (eg, university education and being married were associated with shorter IBI), whereas income stress was associated with longer first IBI but not with second IBI. CONCLUSIONS: Understanding maternal factors associated with birth intervals in a high-income country like Australia may enable more nuanced tailoring of guidelines for prepregnancy care.

Rheumatoid arthritis is a preventable disease: 11 ways to reduce your patients' risk.

New evidence shows that up to 40% of rheumatoid arthritis (RA) cases are attributable to exposure to potentially modifiable factors. We can now identify people at higher risk of RA (pre-RA) through their family history, risk factors, autoantibodies and symptoms. Counselling these patients to act to modify factors known to be associated with RA risk could prevent the development of RA, and evidence shows that informing individuals of their risk and of ways to reduce it leads to positive behavioural change and is not harmful. This consumer-focussed narrative review is targeted at primary care providers and physicians to describe 11 changes that can be made, based on current evidence linking potentially modifiable factors to RA risk. These evidence-based recommendations are: (i) cease smoking; (ii) reduce exposure to inhaled silica, dusts and occupational risks; (iii) maintain a healthy weight; (iv) increase leisure time physical activity; (v) maintain good dental hygiene; (vi) maximise breastfeeding if able; (vii) maximise dietary quality and avoid high-salt diets; (viii) consume high levels of omega-3 fatty acids and fish; (ix) reduce consumption of sugar-sweetened soft drinks; (x) consume moderate levels of alcohol; and (xi) remain vitamin D replete.

Generational differences in the prevalence of postpartum depression among young Australians: a comparison of two cohorts born 17 years apart.

Whether there has been an increase in postpartum depression (PPD) over the generation remains unknown. This study aimed to compare the prevalence in two cohorts of young Australian women born 17 years apart and identified the factors associated with any generational differences. Participants were from the Australian Longitudinal Study on Women's Health, who gave birth between ages 18 and 27 (born in 1973-78 and 1989-95). PPD prevalence was calculated as the percentage of births associated with PPD. Both the prevalence of PPD diagnoses (among 1,610 births) and PPD symptoms (among 953 births) were compared. Relative risks (RRs) and 95% confidence intervals (CIs) were used to report generational differences in the prevalence for PPD diagnoses; Hazard ratios (HRs) and 95% CIs used for PPD symptoms. Factors that differed between cohorts and were associated with PPD diagnoses or PPD symptoms were adjusted. The prevalence of both PPD diagnoses (21.4% vs 10.3%; crude RR: 2.03, 95% CI: 1.59-2.60) and symptoms (20.1% vs 13.3%; crude HR: 1.60, 95% CI: 1.15-2.34) were higher in the 1989-1995 cohort than the 1973-1978 cohort. Generational differences in PPD diagnoses persisted after controlling for potential contributors (RR: 1.53, 95% CI: 1.15-2.04), while generational differences in PPD symptoms were attenuated (HR: 0.98, 95% CI: 0.64-1.49). Of all contributing factors, a history of depression explained most of the generational differences, especially in PPD symptoms (49%), to the extent that when the study sample was stratified by history of depression, no generational differences were detected (without prior depression, HR: 0.65, 95% CI: 0.20-2.08; with prior depression, HR: 1.18, 95% CI: 0.71-1.96). The higher prevalence of PPD in the recent generation was mainly due to the high prevalence of depression. Strategies that well manage pre-existing depression may benefit the prevention of PPD for the current young generation. Further research is warranted to inform detailed prevention approaches.

Screen time and child behaviour and health-related quality of life: Effect of family context.

This study investigated family contextual effects on the association between screen time, behaviour and health-related quality of life (HRQOL) in child siblings. Data were from 1772 participants in the Australian Longitudinal Study of Women's Health 1973-78 cohort and their three youngest children (N = 4010 siblings) aged two to 12, collected in Mothers and their Children's Health cross-sectional sub-study (2016/17). The exposure was average daily recreational screen time (televisions, computers, tablets, mobile phones, electronic games). Outcomes were child overall behaviour and prosocial behaviour, and psychosocial and physical HRQOL. Multilevel models were used to test 1) the absolute effect of screen time, and 2) change in the child's outcomes when their own screen time changes relative to their siblings (within-family contextual effects) and change in the child's outcomes when the sibling average screen time changes (between-family contextual effects). The children were average 7.37 years (SD 2.76). There was an absolute effect of screen time on behaviour and HRQOL. Between-family effects were found for child total behaviour (0·22 (95%CI, 0.06, 0.37)) and prosocial behaviour (-0.10 (-0.17, -0.04)), but there were no within-family effects. For HRQOL, within-family effects were found for psychosocial (-0.97 (-1.91, -0.02)) and physical (-1.32 (-2.25, -0.39)) HRQOL, but no between-family effects were found. In conclusion, the higher the average screen time by all children in the family, the worse the child's behaviour, while the greater the deviation of the child's screen time from their siblings, the poorer their HRQOL. Family contextual factors should be considered in screen time research and screen time recommendations.

Associations between feeding practices in infancy and fruit and vegetable consumption in childhood.

A diet rich in fruits and vegetables may reduce the risk of chronic diseases. However, in many countries, the majority of children do not eat the recommended quantities of fruits and vegetables. The present study aimed to understand associations between feeding practices in infancy (breast-feeding and first complementary food) and fruit and vegetable consumption in childhood (frequency and variety). Data were from the national, observational, cross-sectional Mothers and their Children's Health study conducted in 2016/2017, a sub-study of the national Australian Longitudinal Study on Women's Health. Mothers completed a written survey on feeding practices in infancy (breast-feeding duration, use of formula, first complementary food) and children's fruit and vegetable frequency (number of times eaten) and variety (number of different types eaten) in the past 24 h, using the Children's Dietary Questionnaire. Children (n 4981, mean 7·36 (sd 2·90) years) ate vegetables 2·10 (sd 1·11) times and fruits 2·35 (sd 1·14) times and ate 3·21 (sd 1·35) different vegetables and 2·40 (sd 1·18) different fruits, on average. Compared with breast-feeding for <6 months, breast-feeding for ≥6 months was associated with higher vegetable variety. Compared with cereal as the first complementary food, fruits or vegetables were associated with higher vegetable frequency and variety, and higher fruit frequency. Overall, infancy is a window of opportunity for dietary intervention. Guidance to parents should encourage the use of fruits and vegetables at the beginning of complementary feeding.

Maternal preconception weight trajectories are associated with offsprings' childhood obesity.

OBJECTIVES: This study aimed to examine the associations between (1) mothers' preconception body mass index (BMI) trajectories over 6-7 years and offspring childhood BMI, and (2) mothers' BMI changes between first and second pregnancy and the second-born child's BMI. METHODS: We used data (1606 mothers with 2733 children with mean age 7.7 years, SD 2.9) from the Australian Longitudinal Study on Women's Health and the Mothers and their Children's Health study. Preconception BMI trajectories were identified using latent class growth modeling. Children were categorized as underweight, normal, overweight or obese based on age and sex-specific BMI cut-off points for children. Multinomial and binary logistic regression were used for analyses. RESULTS: We identified three preconception BMI trajectories, named as 'normative' (61.2%), 'chronically overweight' (30.7%), and 'chronically obese' (8.1%). Children born to 'chronically overweight' and 'chronically obese' mothers were more likely to be overweight than normal weight relative to children born to women with a 'normative' BMI trajectory. The corresponding adjusted relative risk ratios (RRRs) (95% confidence interval [CI]) of childhood overweight were 1.75 (1.33, 2.31) for chronically overweight mothers and 2.48 (1.65, 3.73) for chronically obese mothers. Similarly, we found a much stronger association between 'chronically overweight' and 'chronically obese' BMI trajectories and childhood risk of obesity; RRR (95% CI), 2.49 (1.41, 4.40) and 6.65 (3.40, 13.01), respectively. Second-born children of mothers with high interpregnancy weight gain (≥4 BMI units) were also at higher risk of being overweight or obese (OR = 2.20, 95% CI: 1.02, 4.75) compared with children of mothers with stable interpregnancy weight (gain or loss of 1 BMI unit or less). CONCLUSIONS: In this population-based prospective cohort study, we found strong dose-response associations between preconception BMI trajectories and offsprings' childhood BMI.

Adult Pre-pregnancy Weight Change and Risk of Developing Hypertensive Disorders in Pregnancy.

BACKGROUND: While the association of pre-pregnancy body mass index (BMI) and hypertensive disorders in pregnancy (HDP) is well documented, little is known about the relationship between pre-pregnancy weight change and HDP. We examined the impact of adult pre-pregnancy weight change on the development of HDP. METHODS: We included 2914 women, surveyed about every three years since 1996, from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health. Women without hypertension or HDP were followed-up between 2003 and 2012. Generalised estimating equations were used to assess the effect of baseline BMI (mean age 20 years) and pre-pregnancy weight change on the incidence of HDP. RESULTS: Over 9 years of follow up, 301 incident HDP cases (6.3%) were reported from 4813 pregnancies. Overweight and obese women at the baseline survey were 1.67 (95% CI 1.3, 2.2) and 2.15 (95% CI 1.4, 3.3) times more likely to develop HDP than normal weight women, respectively. Compared with stable weight women, women with small (>1.5-2.5%) or moderate/high (>2.5%) annual weight gain had elevated risk of HDP (RR 1.67 95% CI 1.3, 2.2; RR 2.31, 95% CI 1.8, 3.0, respectively). Women who reported annual weight loss (>1.5%) between baseline and the average age of 24 years were 46% (95% CI 0.4, 0.8) less likely to develop HDP. CONCLUSIONS: Pre-pregnancy weight gain is associated with an increased risk of HDP, whereas early adult weight loss is associated with lower risk of HDP.

Social patterning of overeating, binge eating, compensatory behaviours and symptoms of bulimia nervosa in young adult women: results from the Australian Longitudinal Study on Women's Health.

OBJECTIVE: To study social patterning of overeating and symptoms of disordered eating in a general population. DESIGN: A representative, population-based cohort study. SETTING: The Australian Longitudinal Study on Women's Health (ALSWH), Survey 1 in 1996 and Survey 2 in 2000. SUBJECTS: Women (n 12 599) aged 18-23 years completed a questionnaire survey at baseline, of whom 6866 could be studied prospectively. RESULTS: Seventeen per cent of women reported episodes of overeating, 16 % reported binge eating and 10 % reported compensatory behaviours. Almost 4 % of women reported symptoms consistent with bulimia nervosa. Low education, not living with family, perceived financial difficulty (OR=1·8 and 1·3 for women with severe and some financial difficulty, respectively, compared with none) and European language other than English spoken at home (OR=1·5 for European compared with Australian/English) were associated with higher prevalence of binge eating. Furthermore, longitudinal analyses indicated increased risk of persistent binge eating among women with a history of being overweight in childhood, those residing in metropolitan Australia, women with higher BMI, smokers and binge drinkers. CONCLUSIONS: Overeating, binge eating and symptoms of bulimia nervosa are common among young Australian women and cluster with binge drinking. Perceived financial stress appears to increase the risk of binge eating and bulimia nervosa. It is unclear whether women of European origin and those with a history of childhood overweight carry higher risk of binge eating because of genetic or cultural reasons.

High education and increased parity are associated with breast-feeding initiation and duration among Australian women.

OBJECTIVE: Breast-feeding is associated with positive maternal and infant health and development outcomes. To assist identifying women less likely to meet infant nutritional guidelines, we investigated the role of socio-economic position and parity on initiation of and sustaining breast-feeding for at least 6 months. DESIGN: Prospective cohort study. SETTING: Australia. SUBJECTS: Parous women from the Australian Longitudinal Study on Women's Health (born 1973-78), with self-reported reproductive and breast-feeding history (N 4777). RESULTS: While 89 % of women (83 % of infants) had ever breast-fed, only 60 % of infants were breast-fed for at least 6 months. Multiparous women were more likely to breast-feed their first child (~90 % v. ~71 % of primiparous women), and women who breast-fed their first child were more likely to breast-feed subsequent children. Women with a low education (adjusted OR (95 % CI): 2·09 (1·67, 2·62)) or a very low-educated parent (1·47 (1·16, 1·88)) had increased odds of not initiating breast-feeding with their first or subsequent children. While fewer women initiated breast-feeding with their youngest child, this was most pronounced among high-educated women. While ~60 % of women breast-fed their first, second and third child for at least 6 months, low-educated women (first child, adjusted OR (95 % CI): 2·19 (1·79, 2·68)) and women with a very low (1·82 (1·49, 2·22)) or low-educated parent (1·69 (1·33, 2·14)) had increased odds of not breast-feeding for at least 6 months. CONCLUSIONS: A greater understanding of barriers to initiating and sustaining breast-feeding, some of which are socio-economic-specific, may assist in reducing inequalities in infant breast-feeding.

Body mass index and socioeconomic position are associated with 9-year trajectories of multimorbidity: A population-based study.

Multimorbidity is a growing public health problem and is more common in women than men. However, little is known about multimorbidity trajectories, in terms of the accumulation of disease over time, or about the determinants of these trajectories. We sought to identify lifestyle and socioeconomic factors related to multimorbidity trajectories in mid-aged women. Participants were from the Australian Longitudinal Study on Women's Health, a nationally representative population-based study. We included 4865 women born 1946-51, without chronic disease in 1998, followed triennially for 12 years. We used latent class growth analysis to identify 9-year multimorbidity trajectories and multinomial regression to calculate relative risk ratios (RRRs) for associations between baseline lifestyle and socioeconomic factors and trajectories. We identified five multimorbidity trajectories: 'no morbidity, constant'; 'low morbidity, constant'; 'moderate morbidity, constant'; 'no morbidity, increasing'; and 'low morbidity, increasing'. Overweight and obesity were associated with an increased risk of the 'no morbidity, increasing' (RRR 1.70, 95% CI 1.16 to 2.50 and 2.69, 95% CI 1.69 to 4.28, respectively) and the 'low morbidity, increasing' (RRR 2.57, 95% CI 1.56 to 4.24 and 4.28, 95% CI 2.41 to 7.60, respectively) trajectories, as compared to the 'no morbidity, constant' group. Low education and difficulty managing on income were also associated with trajectories of poorer health. Among mid-aged women, overweight/obesity and lower socioeconomic status are major risk factors for trajectories characterised by accumulation of chronic disease. These highlight key target areas for preventive approaches aimed at reducing the risk of accumulation of morbidities in mid-aged women.

Moderate agreement between self-reported stroke and hospital-recorded stroke in two cohorts of Australian women: a validation study.

BACKGROUND: Conflicting findings on the validity of self-reported stroke from existing studies creates uncertainty about the appropriateness of using self-reported stroke in epidemiological research. We aimed to compare self-reported stroke against hospital-recorded stroke, and investigate reasons for disagreement. METHODS: We included participants from the Australian Longitudinal Study on Women's Health born in 1921-26 (n = 1556) and 1946-51 (n = 2119), who were living in New South Wales and who returned all survey questionnaires over a defined period of time. We determined agreement between self-reported and hospitalised stroke by calculating sensitivity, specificity and kappa statistics. We investigated whether characteristics including age, education, area of residence, country of birth, language spoken at home, recent mental health at survey completion and proxy completion of questionnaire were associated with disagreement, using logistic regression analysis to obtain odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Agreement between self-report and hospital-recorded stroke was fair in older women (kappa 0.35, 95% CI 0.25 to 0.46) and moderate in mid-aged women (0.56, 95% CI 0.37 to 0.75). There was a high proportion with unverified self-reported stroke, partly due to: reporting of transient ischaemic attacks; strokes occurring outside the period of interest; and possible reporting of stroke-like conditions. In the older cohort, a large proportion with unverified stroke had hospital records of other cerebrovascular disease. In both cohorts, higher education was associated with agreement, whereas recent poor mental health was associated with disagreement. CONCLUSION: Among women who returned survey questionnaires within the period of interest, validity of self-reported stroke was fair to moderate, but is probably underestimated. Agreement between self-report and hospital-recorded stroke was associated with individual characteristics. Where clinically verified stroke data are unavailable, self-report may be a reasonable alternative method of stroke ascertainment for some epidemiological studies.

Multimorbidity patterns are differentially associated with functional ability and decline in a longitudinal cohort of older women.

BACKGROUND: we aimed to identify multimorbidity patterns and relate these patterns to functional ability and decline. METHODS: we included 7,270 participants of the older cohort of the Australian Longitudinal Study on Women's Health, who were surveyed every 3 years from 2002 to 2011. We used factor analysis to identify multimorbidity patterns from 31 self-reported chronic conditions among women aged 76-81 in 2002. We applied a linear increments model to account for attrition and related the multimorbidity patterns to functional ability and decline at subsequent surveys, as measured by activities of daily living (ADL) and instrumental activities of daily living (IADL). For each pattern, we determined mean ADL and IADL scores in the middle and highest third of factor score in comparison to a reference group. RESULTS: we identified three multimorbidity patterns, labelled musculoskeletal/somatic (MSO), neurological/mental health (NMH) and cardiovascular (CVD). High factor scores for NMH, MSO and CVD were associated with significantly higher mean ADL and IADL scores (poorer functional ability) in 2005 compared with the reference group of low factor scores for all three factors. The CVD pattern was associated with the greatest decline in ADL between 2005 and 2011, whereas the NMH pattern was associated with the greatest decline in IADL. CONCLUSIONS: distinct multimorbidity patterns were differentially associated with functional ability and decline. Given the paucity of studies on multimorbidity patterns, future studies should seek to assess the reproducibility of our findings in other populations and settings, and investigate the potential implications for improved prediction of functional decline.

Socioeconomic factors associated with trajectories of caring by young and mid-aged women: a cohort study.

BACKGROUND: The health and socioeconomic outcomes from being a caregiver are well described. In contrast, the long-term trajectories of caring undertaken by women, and the demographic, socioeconomic status, health status and health behaviour characteristics associated with these trajectories is not well known. METHODS: The data were from the Australian Longitudinal Study on Women's Health. Participants were 14,202 women born 1973-78 followed for 13 years, and 12,282 women born 1946-1951 followed for 9 years. Latent class analyses and multinomial logistic regression were used. RESULTS: Five distinct trajectories of caring were identified for the younger women: these represented 'ongoing', 'starting', 'never' and 2 types of 'transitional' caring. While traditional indicators of poorer socioeconomic status were associated with trajectories representing 'ongoing' and 'starting' caring, they were not associated with 'transitional' caring trajectories. Three distinct trajectories of caring were identified for the mid-age women: these represented 'ongoing', 'starting' and 'never' caring. For the mid-age women, poorer socioeconomic status indicators were associated with the 'ongoing' caring, but not 'starting' caring. CONCLUSIONS: Women in the 1973-78 cohort showed more varying and transitional caring trajectories compared to those in the 1946-51 cohort, and these trajectories were not associated with traditional socioeconomic indicators. An 'opportunity cost' theory for who become carers does not support young transitional carers or mid-aged women beginning new caring. Health policies, education and awareness campaigns for women carers need to target outside previously identified populations.

Educational mobility and weight gain over 13 years in a longitudinal study of young women.

BACKGROUND: Limited evidence exists about the role of education and own educational mobility on body weight trajectory. A better understanding of how education influences long term weight gain can help us to design more effective health policies. METHODS: Using random effects models, the association between i) highest education (n = 10 018) and ii) educational mobility over a 9 year period (n = 9 907) and weight gain was analysed using five waves of data (over 13 years) from the Australian Longitudinal Study on Women's Health 1973-78 cohort (from 18-23 years to 31-36 years). RESULTS: Highest educational attainment was inversely associated with weight at baseline and weight gain over 13 years. Compared to high educated women, those with a low (12 years or less) or intermediate (trade/certificate/diploma) education, respectively, weighed an additional 2.6 kg (95% CI:1.9 to 3.1) and 2.5 kg (95% CI:1.9 to 3.3) at baseline and gained an additional 3.9 kg (95% CI:2.6 to 5.2) and 3.1 kg (95% CI:2.6 to 3.9) over 13 years. Compared to women who remained with a low education, women with the greatest educational mobility had similar baseline weight to the women who already had a high education at baseline (2.7 kg lighter (95% CI:-3.7 to -1.8) and 2.7 kg lighter (95% CI:-3.4 to -1.9), respectively) and similarly favourable weight gain (gaining 3.1 kg less (95% CI:-4.0 to -2.21) and 4.2 kg less (95% CI:-4.8 to -3.4) over the 13 years, respectively). CONCLUSIONS: While educational attainment by mid-thirties was positively associated with better weight management, women's weight was already different in young adult age, before their highest education was achieved. These findings highlight a potential role of early life factors and personality traits which may influence both education and weight outcomes.