Medications use among women with dementia: a cohort study.

BACKGROUND: Older population with dementia use huge range of medications. In this study, we aimed to determine the prevalence of commonly used medications a year before and after first recorded dementia diagnosis among older Australian women. METHODS: The study utilized Australian Longitudinal Study on Women's Health (ALSWH) data from 2090 women with known dementia, linked with administrative health datasets. The Pharmaceutical Benefits Scheme (PBS) data provided detailed information about prescribed medications. We applied latent class analysis (LCA) to the post-dementia data to identify patterns of medication use. Logistic regression model was used to explore the impact of potential predictors for medication utilization. RESULTS: Antipsychotic use increased from 5% before dementia to 19% after dementia, while antidementia medication use increased from < 1 to 28%. There was a modest increase in benzodiazepines and antidepressants. Post-dementia, four distinct groups were identified using LCA (names based on probabilities of medications use) as: "High Psychotropic-Low Cardiovascular" (16% of the sample); "Moderate Psychotropic-High Cardiovascular" (12%); "Low Psychotropic-High Cardiovascular" (27%); and "Low Psychotropic-Low Cardiovascular" (45%). Living in Residential Aged Care (RAC) and frailty were associated with increased odds of being in the higher psychotropic use groups. CONCLUSIONS: Substantial utilization of psychotropic medications by older people with dementia indicates a need for a careful review of the use of these medications. Appropriate alternative approaches to the management of dementia should be practiced with a special focus on RAC residents with frailty.

Patterns of contraceptive use among young Australian women with chronic disease: findings from a prospective cohort study.

BACKGROUND: Given chronic disease is increasing among young women and unintended pregnancies among these women are associated with poor maternal and fetal outcomes, these women would benefit from effective preconception care. However, there is a lack of understanding of how these women use or don't use contraception to inform such interventions. This study examined patterns of contraceptive use among an Australian cohort of young women and investigated the influence of chronic disease on contraceptive use over time. METHODS: Using data from 15,244 young women from the Australian Longitudinal Study on Women's Health (born 1989-1995), latent transition analysis was performed to identify distinct contraceptive patterns among women who were at risk of an unintended pregnancy. Multinomial mixed-effect models were used to evaluate the relationship between contraceptive combinations and chronic disease. RESULTS: Contraceptive use for women with cardiac and autoinflammatory diseases differed to women without chronic disease over the observation period. Compared to women without chronic disease using the pill, women with cardiac disease had double the odds of using 'other' contraception and condoms (OR = 2.20, 95% CI 1.34, 3.59) and a modest increase in the odds of using the combined oral contraceptive pill and condoms (OR = 1.39, 95% CI 1.03, 1.89). Compared to women without chronic disease who used the pill, women with autoinflammatory disease had increased odds of using LARC and condoms (OR = 1.58, 95% CI 1.04, 2.41), using 'other' contraception and condoms (OR = 1.69, 95% CI 1.11, 2.57), and using the combined oral contraceptive pill and condoms (OR = 1.38, 95% CI 1.09, 1.75). No differences in contraceptive patterns over the observation period were found for women with asthma or diabetes when compared to women without chronic disease. CONCLUSION: The findings identified a need for effective contraceptive counselling as part of routine chronic disease care and improved communication between health care providers and women with chronic disease to improve young women's contraceptive knowledge and agency in contraceptive choice, particularly for those with cardiac or autoinflammatory conditions. This may be the key to reducing high-risk unintended pregnancies among this vulnerable population.

Chronic disease is increasing among young women and unintended pregnancies among these women are associated with poor outcomes for both the mother and baby. To optimise outcomes, it is important for these women to plan pregnancies and use effective contraception until such time. However, there is a lack of understanding of how these women use or don't use contraception, particularly with respect to highly effective contraception. This study examined patterns of contraceptive use among an Australian cohort of young women (born 1989­1995) and investigated the influence of chronic disease on contraceptive use over time. We found differences in contraceptive use over time for women with cardiac disease and those with autoinflammatory diseases. Importantly, compared to women without chronic disease using the pill alone, women with cardiac disease had double the odds of using low efficacy contraception. While women with autoinflammatory disease were 69% more likely to use long-acting methods combined with condoms, these women were also 70% more likely to use low efficacy contraception, compared to women without chronic disease who used the pill only. Contraceptive patterns did not differ for women with asthma or diabetes from women without chronic disease. The findings identified a need for effective contraceptive counselling as part of routine chronic disease care and improved communication between health care providers and women with chronic disease to improve young women's contraceptive knowledge and contraceptive decision-making, particularly for those with cardiac or autoinflammatory conditions. This may be the key to reducing high-risk unintended pregnancies among this vulnerable population.

Utility estimations of health states of older Australian women with atrial fibrillation using SF-6D.

PURPOSE: To estimate SF-6D utility scores for older women with atrial fibrillation (AF); calculate and compare mean utility scores for women with AF with various demographic, health behaviours, and clinical characteristics; and develop a multivariable regression model to determine factors associated with SF-6D utility scores. METHODS: This study evaluated N = 1432 women diagnosed with AF from 2000 to 2015 of the old cohort (born 1921-26) of the Australian Longitudinal Study on Women's Health (ALSWH) who remained alive for at least 12 months post first recorded AF diagnosis. Self-reported data on demographics, health behaviours, health conditions, and SF-36 were obtained from the ALSWH surveys, corresponding to within three years of the date of the first record of AF diagnosis. Linked Pharmaceutical Benefits Scheme (PBS) data determined the use of oral anticoagulants and comorbid conditions, included in CHA2DS2-VA (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes, Stroke or TIA, Vascular disease and Age 65-74 years) score calculation, were assessed using state-based hospital admissions data. Utility scores were calculated for every woman from their SF-36 responses using the SF-6D algorithm with Australian population norms. Mean utility scores were then calculated for women with various demographic, health behaviours, and clinical characteristics. Ordinary Least Square (OLS) regression modelling was performed to determine factors associated with these utility scores. Two different scenarios were used for the analysis: (1) complete-case, for women with complete data on all the SF-36 items required to estimate SF-6D (N = 584 women), and (2) Multiple Imputation (MI) for missing data, applied to missing values on SF-36 items (N = 1432 women). MI scenario was included to gauge the potential bias when using complete data only. RESULTS: The mean health utility was estimated to be 0.638 ± 0.119 for the complete dataset and 0.642 ± 0.120 for the dataset where missing values were handled using MI. Using the MI technique, living in regional and remote areas ([Formula: see text]) and the use of oral anticoagulants ([Formula: see text] were positively associated with health utility compared to living in major cities and no use of anticoagulants, respectively. Difficulty to manage on available income [Formula: see text], no/low physical activity [Formula: see text], disability [Formula: see text], history of stroke ([Formula: see text] and history of arthritis [Formula: see text] were negatively associated with health utility. CONCLUSION: This study presents health utility estimates for older women with AF. These estimates can be used in future clinical and economic research. The study also highlights better health utilities for women living in regional and remote areas, which requires further exploration.

Low birth weight and its associated biopsychosocial factors over a 19-year period: findings from a national cohort study.

BACKGROUND: In Australia, 6.7% of babies (5.2% for singletons) are born low birth weight (LBW), and over the past decade, this figure has increased by 8%. Evidence regarding LBW has largely come from hospital-based cross-sectional studies, which are not representative, lack temporality and do not examine the potential predictors of LBW using a comprehensive theoretical framework. This study, therefore, examined predictors of LBW within a biopsychosocial framework, using a community-based representative prospective cohort with 19 years of data. METHODS: The study included 11 854 singleton babies born to 5622 women from the 1973 to 1978 cohort of the Australian Longitudinal Study on Women's Health. RESULTS: Among 5622 first births, 310 (5.5%) were reported as LBW. Maternal risk factors included pre-pregnancy underweight (aOR = 2.27, 95% CI: 1.43-3.62), chronic diabetes (aOR = 2.38, 95% CI: 1.14-4.95), gestational diabetes (aOR = 1.93, 95% CI: 1.27-2.94), chronic hypertension (aOR = 2.23, 95% CI: 1.50-3.33) and gestational hypertension (aOR = 2.44, 95% CI: 1.78-3.36). Among all births (N = 11 854), the overall LBW rate was 3.8% with a recurrence rate of 4.8%. Identified risk factors included menarche before 12 years (aOR = 1.57; 95% CI: 1.17-2.11), pre-pregnancy underweight (aOR = 2.25, 95% CI: 1.46-3.45), gestational diabetes (aOR = 1.74, 95% CI: 1.16-2.59), chronic hypertension (aOR = 2.01, 95% CI: 1.40-2.90) and gestational hypertension (aOR = 2.81, 95% CI: 2.05-3.84). LBW was less likely for second births (aOR = 0.39, 95% CI: 0.31-0.50) and third/above births (aOR = 0.49, 95% CI: 0.35-0.67) compared with the first births. CONCLUSION: Increased nutrition counselling/supplementation for underweight women and interventions aimed at chronic disease prevention and management by using a multi-sectoral approach may be the key to the prevention of LBW.

Delayed versus Immediate Cord Clamping in Preterm Infants.

BACKGROUND: The preferred timing of umbilical-cord clamping in preterm infants is unclear. METHODS: We randomly assigned fetuses from women who were expected to deliver before 30 weeks of gestation to either immediate clamping of the umbilical cord (≤10 seconds after delivery) or delayed clamping (≥60 seconds after delivery). The primary composite outcome was death or major morbidity (defined as severe brain injury on postnatal ultrasonography, severe retinopathy of prematurity, necrotizing enterocolitis, or late-onset sepsis) by 36 weeks of postmenstrual age. Analyses were performed on an intention-to-treat basis, accounting for multiple births. RESULTS: Of 1634 fetuses that underwent randomization, 1566 were born alive before 30 weeks of gestation; of these, 782 were assigned to immediate cord clamping and 784 to delayed cord clamping. The median time between delivery and cord clamping was 5 seconds and 60 seconds in the respective groups. Complete data on the primary outcome were available for 1497 infants (95.6%). There was no significant difference in the incidence of the primary outcome between infants assigned to delayed clamping (37.0%) and those assigned to immediate clamping (37.2%) (relative risk, 1.00; 95% confidence interval, 0.88 to 1.13; P=0.96). The mortality was 6.4% in the delayed-clamping group and 9.0% in the immediate-clamping group (P=0.03 in unadjusted analyses; P=0.39 after post hoc adjustment for multiple secondary outcomes). There were no significant differences between the two groups in the incidences of chronic lung disease or other major morbidities. CONCLUSIONS: Among preterm infants, delayed cord clamping did not result in a lower incidence of the combined outcome of death or major morbidity at 36 weeks of gestation than immediate cord clamping. (Funded by the Australian National Health and Medical Research Council [NHMRC] and the NHMRC Clinical Trials Centre; APTS Australian and New Zealand Clinical Trials Registry number, ACTRN12610000633088 .).

Better diet quality scores are associated with a lower risk of hypertension and non-fatal CVD in middle-aged Australian women over 15 years of follow-up.

OBJECTIVE: To explore if better diet quality scores as a measure of adherence to the Australian Dietary Guidelines (ADG) and the Mediterranean diet (MedDiet) are associated with a lower incidence of hypertension and non-fatal CVD. DESIGN: Prospective analysis of the 1946-1951 cohort of the Australian Longitudinal Study on Women's Health (ALSWH). The Australian Recommended Foods Score (ARFS) was calculated as an indicator of adherence to the ADG; the Mediterranean Diet Score (MDS) measured adherence to the MedDiet. Outcomes included hypertension and non-fatal CVD. Generalised estimating equations estimated OR and 95 % CI across quartiles of diet quality scores. SETTING: Australia, 2001-2016. PARTICIPANTS: 1946-1951 cohort of the ALSWH (n 5324), without CVD, hypertension and diabetes at baseline (2001), with complete FFQ data. RESULTS: There were 1342 new cases of hypertension and 629 new cases of non-fatal CVD over 15 years of follow-up. Multivariate analysis indicated that women reporting better adherence to the ARFS (≥38/74) had 15 % (95 % CI 1, 28 %; P = 0·05) lower odds of hypertension and 46 % (95 % CI 6, 66 %; P = 0·1) lower odds of non-fatal CVD. Women reporting better adherence to the MDS (≥8/17) had 27 % (95 % CI 15, 47 %; P = 0·0006) lower odds of hypertension and 30 % (95 % CI 2, 50 %; P = 0·03) lower odds of non-fatal CVD. CONCLUSIONS: Better adherence to diet quality scores is associated with lower risk of hypertension and non-fatal CVD. These results support the need for updated evidenced based on the ADG as well as public health nutrition policies in Australia.

Longitudinal inconsistency in responses to survey items that ask women about intimate partner violence.

BACKGROUND: Longitudinal research has demonstrated that experiences of abuse and adversity are not consistently reported over time; however, there is a paucity of available evidence regarding the consistency of reporting experiences of intimate partner violence (IPV) over time. This study aimed to investigate the consistency of self-reported IPV involving a partner or spouse. Differences in the health status of women according to consistency of IPV reporting was also investigated. METHODS: Survey data collected from the 1946-51 cohort of the Australian Longitudinal Study on Women's Health (ALSWH) between 1996 and 2016 were used (n = 13,715). Consistency of self-reported IPV was evaluated by responses to the question "Have you ever been in a violent relationship with a partner/spouse?" Demographic and health characteristics of consistent and inconsistent reporters of IPV were compared. Multinomial logistic regression was used to determine the strength of the association between demographic and health characteristics of the women and their consistency of longitudinal reporting of IPV. RESULTS: There were 10,966 women who answered IPV questions over six surveys, with 9610 women (87.6%) providing consistent responses. Inconsistent responses were provided by 1356 women (12.4%), of whom 258 (2.4%) reported IPV at all but one survey (Mainly IPV), 587 (5.3%) reported no IPV at all but one survey (Mainly no IPV), and 511 (4.7%) reported Mixed IPV responses over time. Women in the Mainly IPV group, and those in the Mixed IPV group were similar to those in the Consistent IPV group in demographic and health characteristics, whereas women in the Mainly no IPV group were similar to those in the Consistent never IPV group. CONCLUSIONS: IPV data collected at one time point may involve around 12% false negative or false positive responses. To increase reliability, IPV should be measured on more than one occasion, using different techniques and methods that account for intentional and unintentional over- and under-reporting.

Factors Influencing Web-Based Survey Response for a Longitudinal Cohort of Young Women Born Between 1989 and 1995.

BACKGROUND: With health research practices shifting toward rapid recruitment of samples through the use of online approaches, little is known about the impact of these recruitment methods on continued participation in cohort studies. OBJECTIVE: This study aimed to report on the retention of a cohort of young women who were recruited using an open recruitment strategy. METHODS: Women from the 1989-95 cohort of the Australian Longitudinal Study on Women's Health, recruited in 2012 and 2013 were followed up annually via Web-based surveys in 2014, 2015, and 2016. Prevalence ratios for survey response were calculated using log-binomial models with generalized estimating equations including demographic, health-related, and recruitment method characteristics examined as explanatory factors. RESULTS: Of the 17,012 women who completed the baseline survey (Survey 1) in 2012 to 2013, approximately two-thirds completed Survey 2 (2014), and just over half completed Surveys 3 (2015) and 4 (2016). Women demonstrated transient patterns of responding with 38.21% (6501/17,012) of women completing all 4 surveys. Although retention of young women was associated with older age, higher education, higher self-rated health status, and low engagement with adverse health behaviors, the method of recruitment was a key determinant of study participation in the multivariate model. Although women were more likely to be recruited into the cohort via social media (eg, Facebook), retention over time was higher for women recruited through traditional media and referral approaches. CONCLUSIONS: A balance must be obtained between achieving representativeness, achieving rapid cohort recruitment, and mitigating the pitfalls of attrition based on recruitment method in the new era of cohort studies, where traditional recruitment methods are no longer exclusively viable options.

Adverse Childhood Experiences and Healthcare Costs in Adult Life.

The current study aims to present the prevalence of adverse childhood experiences and examine the healthcare costs associated with primary, allied, and specialist healthcare services. The Australian Longitudinal Study on Women's Health is a general health survey of four nationally representative age cohorts. The current study uses 20 years of survey and administrative data (1996-2015) from the cohort born 1973-1978. Overall, 41% of women indicated at least one category of childhood adversity. The most commonly reported type of childhood adversity was having a household member with a mental illness (16%), with the most commonly reported ACES category being psychological abuse (17%). Women who had experienced adversity in childhood had higher healthcare costs than women who had not experienced adversity. The healthcare costs associated with experiences of adversity in childhood fully justify a comprehensive policy and practice review.

Pelvic floor functional outcomes after total abdominal vs total laparoscopic hysterectomy for endometrial cancer.

BACKGROUND: Pelvic floor functioning is an important concern for women requiring a hysterectomy for endometrial cancer. The incidence of pelvic floor symptoms has not been reported in women who have undergone a hysterectomy for early-stage endometrial cancer. OBJECTIVE: We sought to evaluate pelvic floor function in women who have had surgical treatment for early-stage endometrial cancer as part of the multinational Laparoscopic Approach to Cancer of the Endometrium trial and to compare patients' outcomes who had total abdominal vs total laparoscopic hysterectomy. STUDY DESIGN: A multinational, phase III, randomized noninferiority trial compared disease-free survival of patients who had total abdominal hysterectomy vs total laparoscopic hysterectomy. This substudy analyzes the results from a self-administered validated questionnaire on pelvic floor symptoms (Pelvic Floor Distress Inventory) administered preoperatively, and at follow-up visits 6, 18, 30, 42, and 54 months postoperatively. RESULTS: Overall, 381 patients with endometrial cancer were included in the analysis (total abdominal hysterectomy, n = 195; total laparoscopic hysterectomy, n = 186). At 6 months postsurgery both groups experienced an improvement in Pelvic Floor Distress Inventory scores compared to presurgical pelvic floor well-being (total abdominal hysterectomy: mean change -11.17; 95% confidence interval, -17.11 to -5.24; total laparoscopic hysterectomy: mean change -10.25; 95% confidence interval, -16.31 to -4.19). The magnitude of change from baseline in pelvic floor symptoms did not differ between both treatment groups up to 54 months postsurgery. CONCLUSION: These findings suggest that pelvic floor function in terms of urinary, bowel, and prolapse symptoms are unlikely to deteriorate following abdominal or laparoscopic hysterectomy and are reassuring for women undergoing hysterectomy for early-stage endometrial cancer.

Effect of Total Laparoscopic Hysterectomy vs Total Abdominal Hysterectomy on Disease-Free Survival Among Women With Stage I Endometrial Cancer: A Randomized Clinical Trial.

Importance: Standard treatment for endometrial cancer involves removal of the uterus, tubes, ovaries, and lymph nodes. Few randomized trials have compared disease-free survival outcomes for surgical approaches. Objective: To investigate whether total laparoscopic hysterectomy (TLH) is equivalent to total abdominal hysterectomy (TAH) in women with treatment-naive endometrial cancer. Design, Setting, and Participants: The Laparoscopic Approach to Cancer of the Endometrium (LACE) trial was a multinational, randomized equivalence trial conducted between October 7, 2005, and June 30, 2010, in which 27 surgeons from 20 tertiary gynecological cancer centers in Australia, New Zealand, and Hong Kong randomized 760 women with stage I endometrioid endometrial cancer to either TLH or TAH. Follow-up ended on March 3, 2016. Interventions: Patients were randomly assigned to undergo TAH (n = 353) or TLH (n = 407). Main Outcomes and Measures: The primary outcome was disease-free survival, which was measured as the interval between surgery and the date of first recurrence, including disease progression or the development of a new primary cancer or death assessed at 4.5 years after randomization. The prespecified equivalence margin was 7% or less. Secondary outcomes included recurrence of endometrial cancer and overall survival. Results: Patients were followed up for a median of 4.5 years. Of 760 patients who were randomized (mean age, 63 years), 679 (89%) completed the trial. At 4.5 years of follow-up, disease-free survival was 81.3% in the TAH group and 81.6% in the TLH group. The disease-free survival rate difference was 0.3% (favoring TLH; 95% CI, -5.5% to 6.1%; P = .007), meeting criteria for equivalence. There was no statistically significant between-group difference in recurrence of endometrial cancer (28/353 in TAH group [7.9%] vs 33/407 in TLH group [8.1%]; risk difference, 0.2% [95% CI, -3.7% to 4.0%]; P = .93) or in overall survival (24/353 in TAH group [6.8%] vs 30/407 in TLH group [7.4%]; risk difference, 0.6% [95% CI, -3.0% to 4.2%]; P = .76). Conclusions and Relevance: Among women with stage I endometrial cancer, the use of total abdominal hysterectomy compared with total laparoscopic hysterectomy resulted in equivalent disease-free survival at 4.5 years and no difference in overall survival. These findings support the use of laparoscopic hysterectomy for women with stage I endometrial cancer. Trial Registration: clinicaltrials.gov Identifier: NCT00096408; Australian New Zealand Clinical Trials Registry: CTRN12606000261516.

Stroke, Physical Function, and Death Over a 15-Year Period in Older Australian Women.

BACKGROUND AND PURPOSE: As populations age, an increasing number of older women are living with stroke. This study looks at long-term outcomes for women with stroke, comparing mortality rates for women with poor physical function (PF) and those with higher levels of function. The purpose is to understand not only how long women might live after a stroke, but also how long they live with physical disability. METHODS: The study uses 15 years of data on women from the Australian Longitudinal Study on Women's Health 1921 to 1926 cohort. The risk of stroke and the risk of stroke and poor PF were estimated using Cox proportional hazard model. Among women who reported a stroke during the study period, mortality risk was compared according to their physical functioning level after that stroke. RESULTS: Almost half of the women who had a stroke and poor PF survived past 10 years. The 10-year mortality rate was 37% for women with stroke and adequate PF and 51% for women with stroke and poor PF at the time of the stroke (hazard rate ratio, 1.52; 95% CI, 1.18-1.95; P=0.0015 adjusting for demographic and health covariates). CONCLUSIONS: This study provides evidence of the long-term outcomes of stroke among older women, with women living for many years with poor PF. This outcome has important implications for the women's quality of life during their later years and in understanding the burden of disability associated with stroke.

Obesity, polycystic ovary syndrome and breastfeeding: an observational study.

INTRODUCTION: Polycystic ovary syndrome (PCOS) affects 9-21% of reproductive-age women. The relations between PCOS, body mass index (BMI) and breastfeeding are unclear. Our aim was to examine breastfeeding in women with and without PCOS and the relation with BMI. MATERIAL AND METHODS: This is a cross-sectional study set in the general community. Participants are women, aged 31-36 years, from the Australian Longitudinal Study on Women's Health (ALSWH), a large community-based study. Data was analyzed from the first child of respondents to Survey five (2009) reporting at least one live born child. Logistic regression analysis was used to examine factors associated with breastfeeding. The main outcome measures studied were breastfeeding initiation and duration and the main explanatory variables included self-reported PCOS and BMI. RESULTS: Of the 4898 women, 6.5% reported PCOS (95% confidence interval 5.8-7.2%). Median duration of breastfeeding was lower in women reporting PCOS (6 months, range 2-10 months) than in women not reporting PCOS (7 months, range 3-12 months) (p = 0.001). On multivariable regression analysis, there was no association between PCOS and breastfeeding outcomes. However, being overweight or obese was associated with not initiating breastfeeding and with breastfeeding for less than 6 months, after adjusting for confounders. CONCLUSIONS: High BMI is negatively associated with breastfeeding, whereas PCOS status per se does not appear to be related to breastfeeding initiation and duration, after adjusting for BMI.

Lower preoperative quality of life increases postoperative risk of adverse events in women with endometrial cancer: results from the LACE trial.

OBJECTIVE: To examine the association between preoperative quality of life (QoL) and postoperative adverse events in women treated for endometrial cancer. METHODS: 760 women with apparent Stage I endometrial cancer were randomised into a clinical trial evaluating laparoscopic versus open surgery. This analysis includes women with preoperative QoL measurements, from the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire, and who were followed up for at least 6 weeks after surgery (n=684). The outcomes for this study were defined as (1) the occurrence of moderate to severe adverse events within 6 months (Common Toxicology Criteria (CTC) grade≥3); and (2) any serious adverse event (SAE). The association between preoperative QoL and the occurrence of AE was examined, after controlling for baseline comorbidity and other factors. RESULTS: After adjusting for other factors, odds of occurrence of AE of CTC grade≥3 were significantly increased with each unit decrease in baseline FACT-G score (OR=1.02, 95% CI 1.00-1.03, p=0.030), which was driven by physical well-being (PWB) (OR=1.09, 95% CI 1.04-1.13, p=0.0002) and functional well-being subscales (FWB) (OR=1.04, 95% CI 1.00-1.07, p=0.035). Similarly, odds of SAE occurrence were significantly increased with each unit decrease in baseline FACT-G score (OR=1.02, 95% CI 1.01-1.04, p=0.011), baseline PWB (OR=1.11, 95% CI 1.06-1.16, p<0.0001) or baseline FWB subscales (OR=1.05, 95% CI 1.01-1.10, p=0.0077). CONCLUSION: Women with early endometrial cancer presenting with lower QoL prior to surgery are at higher risk of developing a serious adverse event following surgery. FUNDING: Cancer Council Queensland, Cancer Council New South Wales, Cancer Council Victoria, Cancer Council, Western Australia; NHMRC project grant 456110; Cancer Australia project grant 631523; The Women and Infants Research Foundation, Western Australia; Royal Brisbane and Women's Hospital Foundation; Wesley Research Institute; Gallipoli Research Foundation; Gynetech; TYCO Healthcare, Australia; Johnson and Johnson Medical, Australia; Hunter New England Centre for Gynaecological Cancer; Genesis Oncology Trust; and Smart Health Research Grant QLD Health.

Agreement between self-reported perinatal outcomes and administrative data in New South Wales, Australia.

BACKGROUND: Many epidemiological studies that focus on pregnancy rely on maternal self-report of perinatal outcomes. The aim of this study was to evaluate the agreement between self-reported perinatal outcomes (gestational hypertension with or without proteinuria, gestational diabetes, premature birth and low birth weight) in a longitudinal study and linked to administrative data (medical records). METHODS: Self-reported survey data from the Australian Longitudinal Study on Women's Health was linked with the New South Wales Perinatal Data Collection. Agreement between the two sources was evaluated using percentage agreement and kappa statistics. Analyses were conducted at two levels by: i) the mother and ii) each individual child. RESULTS: Women reliably self-report their perinatal outcomes (≥ 87 % agreement). Gestational hypertension with or without proteinuria had the lowest level of agreement. Mothers' reports of perinatal outcomes were more reliable when evaluated by child. Restricting the analysis to complete and consistent reporting further strengthened the reliability of the child-specific data, increasing the agreement from >92 to >95 % for all outcomes. CONCLUSIONS: The present study offers a high degree of confidence in the use of maternal self-reports of the perinatal outcomes gestational hypertension, gestational diabetes, preterm birth and low birth weight in epidemiological research, particularly when reported on a per child basis. Furthermore self-report offers a cost-effective and convenient method for gathering detailed maternal perinatal histories.

Life space and mental health: a study of older community-dwelling persons in Australia.

OBJECTIVES: The ability of older people to mobilise within and outside their community is dependent on a number of factors. This study explored the relationship between spatial mobility and psychological health among older adults living in Australia. METHODS: The survey sample consisted of 260 community-dwelling men and women aged 75-80 years, who returned a postal survey measuring spatial mobility (using the Life Space Questionnaire) and psychological health (using the SF36 Health Related Quality of Life Profile). From the Life Space Questionnaire, participants were given a life-space score and multinomial regression was used to explore the potential effect of mental health on life-space score. RESULTS: The study found a significant association between mental health and life space. However, gender, physical functioning, and ability to drive were most strongly associated with the extent of life space and spatial mobility. Compared to men, older women are more likely to experience less spatial mobility and restricted life space, and hence are more vulnerable to social isolation. CONCLUSION: Mental health and life space were associated for the older people in this study. These findings have important implications for health policy and highlight the need to support older persons to maintain independence and social networks, and to successfully age in place within their community. This study also highlights the utility of the Life Space Questionnaire in terms of identifying older persons at risk of poorer mental health.

Retirement, age, gender and mental health: findings from the 45 and Up Study.

OBJECTIVES: To examine the relationships of retirement and reasons for retirement with psychological distress in men and women at the age of 45-79 years. METHOD: Data from 202,584 Australians participating in the large-scale 45 and Up Study was used. Psychological distress was measured by the Kessler psychological distress scale. Associations between different work status and reasons for retirement with psychological distress were assessed for men and women at different ages using logistic regression. RESULTS: Being fully retired or unemployed was associated with the high levels of psychological distress compared to being in paid work for men and women aged 45-64 (p < 0.0001), and for men aged 65-74 years (p ≤ 0.0014). At the age of 75-79 years, there was no difference in psychological distress between different work statuses. Among retirees, retirement due to ill health, being made redundant or caring duty was associated with the high level of psychological distress. CONCLUSION: The association between work and mental health underscores the importance of policies and strategies to encourage and enable people to continue in the workforce after age 55, particularly for men. Important reasons for retirement with worse mental health outcomes include redundancy, ill health and needing to care for family or a friend. These circumstances will affect whether a person can continue working and their risk of poor mental health, and both considerations should be addressed in developing approaches for maintaining older workers or assisting them with their retirement transition.

Prevalence correlates and impact of fecal incontinence among older women.

BACKGROUND: Fecal incontinence is a common problem that has been associated with anatomic, physiological, and medical conditions. There are very few data on the factors associated with fecal incontinence in elderly women. OBJECTIVES: We aimed to determine the factors associated with fecal incontinence via a population-based survey in a large cohort of elderly Australian women. DESIGN AND SETTING: Data from a large longitudinal population-based study of elderly Australian women aged 82 to 87 years were analyzed. PATIENTS: Participants were 5560 women (aged 82-87 years) who participated in the Australian Longitudinal Study on Women's Health; 4815 women responded to questions relating to fecal incontinence. MAIN OUTCOME MEASURES: Fecal incontinence was defined as leakage of liquid and/or solid stool at least once per month over the past 12 months. Self-reported medical conditions and lifestyle factors as well as demographic factors were recorded. RESULTS: The prevalence of fecal incontinence was 10.4% (95% CI, 9.6-11.3) (n = 510). The prevalence was significantly higher among institutional- versus community-dwelling women (14.1% vs 9.7%; p = 0.0002). Univariately, lifestyle factors including fruit intake and fluid intake, along with a range of comorbidities, were associated. However, independent factors for fecal incontinence among community-dwelling women included diabetes mellitus (OR, 1.51; 95% CI, 1.14-2.01; p = 0.004), depression (OR, 1.84; 95% CI, 1.30-2.62; p = 0.001), urinary incontinence (OR, 2.29; 95% CI, 1.83-2.86; p < 0.0001), and osteoarthritis (OR, 0.73; 95% CI, 0.57-0.94; p = 0.013). Among institutional-dwelling women, however, we found urinary incontinence (OR, 4.43; 95% CI, 2.83-6.93; p < 0.0001) and poorer general health (OR, 0.98; 95% CI, 0.97-0.99; p = 0.003) to be independently associated. LIMITATIONS: This is a cross-sectional study, which prevents making conclusions about the cause and effect of observed correlations. CONCLUSIONS: The independent factors associated with fecal incontinence in this population do not appear readily modifiable, and many previously identified risk factors may not be important in the elderly women with fecal incontinence.

Referral for management of emotional health issues during the perinatal period: does mental health assessment make a difference?

BACKGROUND: There exists little evidence that routine assessment of current or past mental health in the perinatal period positively impacts on rates of referral for emotional health issues. This study aimed to evaluate the impact of this early intervention approach on reported referrals for emotional health issues during pregnancy and the first postpartum year. METHOD: A subsample of women (N = 1,804) drawn from the Australian Longitudinal Study on Women's Health participated in the study. RESULTS: Multivariate analyses showed that predictors of being given a referral for emotional health issues during pregnancy and the postnatal period, respectively, included assessment of past mental health (Adjusted Odds Ratio [AOR] = 4.40, p < 0.001, and AOR = 5.69, p < 0.001), assessment of current mental health (AOR = 2.47, p < 0.001, and AOR = 2.72, p < 0.001), and reported experience of significant emotional distress (AOR = 2.58, p < 0.001, and AOR = 2.83, p < 0.001). The odds of receiving a referral were up to 16 times greater for women who were asked about both their past and current mental health than for women who did not receive any form of mental health assessment. CONCLUSIONS: This study highlights that enquiry into risk factors such as past history (in addition to current mental health) enhances initiation of referrals. Importantly, results suggest that enquiry about current mental health is associated with appropriate rates of referral rather than a nonspecific inflation of referrals. In line with Australia's Clinical Practice Guidelines for Perinatal Mental Health, the value of a comprehensive approach to mental health assessment to aid decision making around referral for further assessment or care is particularly evident.

Disparities in reported psychosocial assessment across public and private maternity settings: a national survey of women in Australia.

BACKGROUND: Psychosocial assessment and depression screening is now recommended for all women who are pregnant or have recently given birth in Australia. Existing studies which have examined the extent of participation by women in such population-based programs have been primarily concerned with depression screening rather than a more comprehensive examination of psychosocial assessment, and have not been sufficiently inclusive of the 30% of women whose maternity care is provided in the private sector. Whether there are disparities in equity of access to perinatal psychosocial assessment is also unknown. METHODS: A sub-sample of women (N = 1804) drawn from the Australian Longitudinal Study on Women's Health participated in the study. Overall rates of assessment across five psychosocial domains (current emotional health; mental health history; current level of support; current drug or alcohol use; experience of domestic violence or abuse), as well as receipt of mental health promotion information, were examined. Log binomial regression was performed to investigate whether there were socio-demographic or health system inequalities among women who are and are not assessed across each domain. RESULTS: Two-thirds of women (66.8%) reported being asked about their current emotional health in the antenatal period, increasing to 75.6% of women in the postnatal period. Rates decreased markedly for reported assessment of mental health history (52.9% during pregnancy and 41.2% postnatally). Women were least likely to be asked about their experience of domestic violence or abuse in both the antenatal and postnatal periods (in total, 35.7% and 31.8%, respectively).In terms of equity of access to psychosocial assessment, women who gave birth in the public hospital sector were more likely to report being assessed across all domains of assessment in the antenatal period, compared with women who gave birth in the private sector, after adjusting for other significant covariates. State of residence was associated with reported rates of assessment across all domains in both the antenatal and postnatal periods. Women from non-English speaking backgrounds and women with more than one child were less likely to be assessed across various domains. CONCLUSION: This study provides an important insight into the reported overall penetration of and access to perinatal psychosocial assessment among a sample of women in Australia. Opportunities to minimise the current shortfall in assessment rates, particularly in the private sector, and for ongoing monitoring of assessment activity at a national level are discussed.