Domestic violence is a leading risk factor in default from colposcopy services.

AIM: Domestic violence is common in women and is associated with poorer health-care outcomes. However, no causal pathway has been identified to explain this observation. We have followed a cohort of women to determine whether poorer outcomes can be explained by high rates of default and loss to follow-up. MATERIAL AND METHODS: A prospective cohort study was performed. Institutional ethics approval was obtained. Participants were consecutive patients attending colposcopy clinics at a major metropolitan hospital in Australia. Following ascertainment of domestic violence status, appointment outcomes for colposcopy services were tracked for a 3-year period. Multivariate analysis was undertaken to determine demographic factors associated with default from care and loss to follow-up. RESULTS: Of 581 women approached, consent was obtained from 574 women (99%). Domestic violence status was obtained from 566 women, of whom 187 (33%) had a recent history of exposure. Women exposed to violence were more likely to default from colposcopy once (26.2% vs 7.4%; P < 0.0001), twice (11.2% vs 3.2%, P = 0.0001), or thrice (10.7% vs 2.4%, P < 0.0001). They were more likely to be lost to follow-up (8.0% vs 1.1%, P < 0.0001). In multivariate analysis, exposure to domestic violence remained significantly associated with default and loss to follow-up. CONCLUSION: Domestic violence is a risk factor for default from attendance and loss to follow-up at colposcopy services. This may explain the mechanism behind adverse health-care outcomes seen. Screening and targeted appointment intervention programs may improve clinical compliance.

Prevalence and associations of domestic violence at an Australian colposcopy clinic.

OBJECTIVE: Domestic violence is associated with significant mortality and morbidity including gynecological morbidity. We report the prevalence and associations of domestic violence in an Australian colposcopy service. MATERIALS AND METHODS: A prospective study was performed from consecutive patients attending colposcopy clinics at a major metropolitan hospital in Australia. Key outcomes were the prevalence of intimate partner violence and its key demographic associations. RESULTS: Consent was obtained from 574 and domestic violence status was ascertained in 566 of 581 women approached. Overall, 33% of responders reported violence within 12 months. In 14.5%, the female reported being sole recipient of violence; in a further 16.6%, violence was bidirectional, and in 1.9% of cases, a woman was the sole perpetrator. Key associations of violence were younger age at presentation (32 vs 35 y; p = .01), higher rates of smoking (51.3% vs 38.2%; p = .0004), higher rates of housing instability (32.2% vs 12.2%; p < .0001), a positive Beck Depression Inventory screen (50.0% vs 24.6%; p < .0001), and higher rates of default to initial attendance (15.5% vs 4.7%, p < .0001). CONCLUSIONS: Domestic violence is common in women presenting to colposcopy services and may be associated with poor housing stability and higher default rates.

Can individualized rehabilitation improve functional independence in elderly patients with COPD?

STUDY OBJECTIVES: The aims of this study were to establish whether pulmonary rehabilitation (PR) improves domestic function and daily activity levels in COPD and whether individually targeted exercise is more effective than general exercise. DESIGN: Prospective randomized, controlled trial. SETTING: Outpatient PR program in secondary care. PARTICIPANTS: One-hundred eighty patients (mean [+/-SD] age, 68.3 +/- 8.6 years; FEV1, 0.95 +/- 0.4 L; FEV1/FVC ratio, 0.51 +/- 0.15; 111 male patients; 69 female patients) with stable COPD. One hundred twenty-one patients completed the study. INTERVENTIONS: Patients were randomized to a conventional 7-week general exercise program ([GEP] n = 90) or an individually targeted exercise program ([ITEP] n = 90). MEASUREMENT AND RESULTS: Daily activity was measured using ambulatory activity monitors (Z80 -32k V1 Int; Gaehwiler Electronics; Hombrechtikon, Switzerland). These were lightweight devices, which contained a uniaxial accelerometer. Domestic function was assessed by the Canadian Occupational Performance Measure (COPM). Exercise performance was assessed by the incremental shuttle walk test (ISWT) and the endurance shuttle walk test and health status by the chronic respiratory questionnaire-self-reported. Activity monitor counts increased by 29.18% (95% confidence interval [CI], 3.19 to 55.17; p = 0.03) for the GEP and 40.63% (95% CI, 7.42 to 73.83; p = 0.02) for the ITEP. Mean COPM performance scores increased by 1.71 (95% CI, 1.37 to 2.05; p = 0.0001) for the GEP and 1.46 (95% CI, 1.05 to 1.87; p = 0.0001) for the ITEP. Mean COPM satisfaction scores increased by 2.27 (95% CI, 1.74 to 2.81; p = 0.0001) for the GEP and 2.04 (95% CI, 1.56 to 2.52; p = 0.0001) for the ITEP. ISWT scores increased by 81.72 m (range, 63.83 to 99.62) for the GEP and by 85.52 m (range, 67.62 to 103.42) for the ITEP. No statistically significant difference was found between the general exercise group and the individually targeted exercise group for any outcome measure. CONCLUSIONS: Pulmonary rehabilitation improves domestic function and physical activity. This study also demonstrates that general exercise training is as effective as individually targeted training.

Transcriptome profiling of female alates and egg-laying queens of the Formosan subterranean termite.

Termites are known to have an extraordinary reproductive plasticity and capacity, but the underlying genetic patterns of termite reproductive biology are relatively understudied. The goal of this study was to identify genes for which expression levels differ between dealated precopulatory females (virgins) and egg-laying queens of the Formosan subterranean termite, Coptotermes formosanus Shiraki. We constructed a normalized polyphenic expressed sequence tag (EST) library that represents genomic material from most of the castes and life stages of the Formosan subterranean termite. Microarrays were designed using probes from this EST library and public genomic resources. Virgin females and queens were competitively hybridized to these microarrays and differentially expressed candidate genes were identified. Differential expression of eight genes was subsequently confirmed via reverse transcriptase quantitative PCR (RT-QPCR). When compared to virgins, queens had higher expression of genes coding for proteins related to immunity (gram negative binding protein), nutrition (e.g., termite-derived endo-beta-1,4-glucanase), protein storage, regulation of caste differentiation and reproduction (hexamerin, juvenile hormone binding protein). Queens also had higher transcript levels for genes involved in metabolism of xenobiotics, fat, and juvenile hormone (glutathione-S-transferase-like proteins, and cytochrome P450), among others. In particular, hexamerin, juvenile hormone binding protein, and a cytochrome P450 from the 4C subfamily are likely to be involved in initiating the inactive period during the reproductive cycle of the queen. Vice versa, virgins had higher expression than queens of genes related to respiration, probably due to recent flight activity, and several genes of unknown function.