Gender differences in cardiovascular disease risk: Adolescence to young adulthood.

BACKGROUND AND AIMS: Gender differences in cardiovascular disease (CVD) have been well documented but rarely for young adults and the extent to which gender related lifestyle differences may contribute to gender differences in CVD risk experienced by young adults have not been reported. METHODS AND RESULTS: Data are from a long-running cohort study, the Mater-University of Queensland Study of Pregnancy (MUSP). We track gender differences in CVD related behaviours at 21 and 30 years (consumption of a Western Diet/Health-Oriented Diet, cigarette smoking, vigorous physical exercise, heavy alcohol consumption). At 30 years we compare males and females for CVD risk, and the extent to which lifestyle behaviours at 21 and 30 years contribute to CVD risk. At both 21 and 30 years of age, males more frequently consume a Western Diet and less often a Health Oriented Diet. By contrast, males are also much more likely to report engaging in vigorous physical activity. On most CVD markers, males exhibit much higher levels of risk than do females at both 21 and 30 years. At 30 years of age males have about five times the odds of being at high risk of CVD. Some lifestyle behaviours contribute to this additional risk. CONCLUSION: Young adult males much more frequently engage in most CVD related risk behaviours and males have a higher level of CVD risk. Gender differences in CVD risk remain high even after adjustment for CVD lifestyles, though dietary factors independently contribute to CVD risk at 30 years.

Do tobacco and cannabis use and co-use predict lung function: A longitudinal study.

BACKGROUND: Use of tobacco and cannabis is common and has been reported to predict lung function. Less is known about co-use of tobacco and cannabis and their impact on changes in lung function to early adulthood. RESEARCH QUESTION: The study examines whether cigarette smoking or cannabis use and co-use are each associated with lung function in a population sample of young adults. STUDY DESIGN AND METHODS: Data are from a prospective cohort study of cigarette smoking, cannabis use and co-use at 21 and 30 years of age and lung function (FVC, FEV1, FEV1/FVC) measured at 30 years. Lung function results are transformed using Global Lung Function Formulae. Subjects are the children of pregnant women who were recruited into the cohort study over the period 1981-3. Respondents were administered a spirometry assessment at 21 and 30 years of age. These respondents completed a smoking and cannabis use questionnaire at 21- and 30-year follow-ups. RESULTS: Cigarette smoking (with or without cannabis use) is associated with reduced airflow. There is no consistent association between cannabis use and measures of lung function. The co-use of tobacco and cannabis appears to entail no additional risk to lung function beyond the risks associated with tobacco use alone. INTERPRETATION: Persistent cigarette smoking is associated with reduced airflow even in young adults. Cannabis use does not appear to be related to lung function even after years of use.

Does Childhood Maltreatment Lead to Low Life Success? Comparing Agency and Self-Reports.

BACKGROUND: The long-term mental and physical health consequences of childhood maltreatment have been well documented. Less known are the longer-term consequences of childhood maltreatment, specifically the extent to which childhood maltreatment predicts adult life success. OBJECTIVES: To prospectively assess the extent to which childhood experiences of physical, sexual, emotional abuse and childhood neglect predict life success at 30 years of age. PARTICIPANTS AND SETTING: Data are from the Mater-University of Queensland Study of Pregnancy (MUSP), a pre-birth cohort study which follows children from conception to 30 years of age. METHODS: Details of childhood maltreatment are from two sources; child safety agency notifications (and substantiations) linked to the survey data with self-reports of childhood experiences of maltreatment obtained at the 30-year follow-up using the Child Trauma Questionnaire (CTQ). Life success is a 9-item composite measure (alpha = 0.76) obtained at the 30-year follow-up. We use logistic regression models (with control for covariates) to examine the association between overall as well as specific forms of childhood maltreatment on adult life success. We further test these models using different cut-offs and propensity analyses to adjust for loss to follow-up. RESULTS: Childhood maltreatment whether measured by agency report or self-report predicts overall low life success; agency substantiation OR = 1.88(1.14,3.08) & self-report OR = 2.60 (2.10,3.25). Self-report physical abuse, OR = 2.37(1.72,3.28); sexual abuse, OR = 2.85(2.05,3.96); emotional abuse, OR = 2.53(1.85,3.45) and neglect, OR = 2.36(1.83,3.03) all predict higher levels of low life success. CONCLUSIONS: Our findings suggest that the long-term consequences of childhood maltreatment extend to a wide range of day-to-day circumstances and extend into mid- to later life.

Do adversities experienced over the early life course predict mental illness and substance use behaviour in adulthood: A birth cohort study.

A range of adult health outcomes have been linked to early childhood adversities. These early adversities include parental marital breakdown and family economic disadvantage. Childhood experiences of maltreatment have also been linked to a variety of adult health outcomes. As both childhood adversities and child maltreatment often co-occur, we examine whether childhood adversities at 3 stages of the child's early life course predict any of nine adult mental health outcomes controlling for past experiences of child trauma (maltreatment). Data are from a long running birth cohort study, the Mater-University of Queensland Study of Pregnancy (MUSP). We use bivariate and multinomial logistic regression with adjustment for confounding, to predict adult outcomes. Experiences of recent life events in pregnancy appear to be unrelated to adult mental health. Recent life events experienced at the 5-year follow-up independently predicts lifetime ever depression and cannabis use disorder. Experiences of recent life events at 14-years of age predict lifetime ever depression, cannabis and amphetamine use in adulthood. Our findings support early childhood interventions which should be supplemented with a focus on later childhood and the adolescent period of development. Interventions should also focus on the broader social and demographic context within which children are born. Efforts to reduce the occurrence and consequences of childhood maltreatment should be given primary attention in order to reduce the childhood factors contributing to adult mental illness.

Predicting Child Maltreatment over the Early Life Course: A Prospective Study.

A large number of early life exposures predict child maltreatment. Using data from a 30-year birth cohort study we examine 12 early life course risk factors of four types of self-reported childhood maltreatment recalled at the 30-year follow-up. Of the 7223 children in the sample at birth, 2425 responded to the Child Trauma Questionnaire at the 30-year follow-up. On adjusted analysis being a teenage mother predicts childhood physical and sexual abuse, as well as child neglect. More numerous maternal marital partner changes in the 5 years after the birth predict offspring experiences of emotional abuse, sexual abuse and childhood neglect. Policy responses should focus on the broad social context in which children are reared as the most effective approach to reducing the high level of childhood abuse and neglect.

Long term impact of the WHI studies on information-seeking and decision-making in menopause symptoms management: a longitudinal analysis of questions to a medicines call centre.

BACKGROUND: While women are taking a greater role in decisions about menopause symptom management, the legacy of the Women's Health Initiative (WHI) studies persist. Despite hormone therapy (HT) being effective in reducing all-cause mortality, many women seeking relief of menopausal symptoms exaggerate HT harms and overstate the perceived benefits or ignore the risks of alternative therapies. We aimed to explore the longitudinal impact of the widely-publicised WHI 2002 study on women's information-seeking and describe determinants of decision-making about managing menopausal symptoms. METHODS: In a longitudinal analysis of both quantitative and qualitative data, we explored consumer questions about menopause-related medicines received by two Australian medicines call centres (1996-2010) before, during, and after WHI 2002. We analysed calls by age and gender of caller and patient, their relationship, postcode, enquiry type, and motivation to help-seek. We compared calls regarding HT and herbal medicines (HM) with the rest of calls, and thematically analysed question narratives across the three time-periods. RESULTS: There were 1,829 menopause-related calls received of over this time-period, with a call surge, primarily from women in their mid-fifties, in the two months after the WHI 2002 publication. Two in three calls were motivated by negative media reports as women sought support for decision-making, primarily reassurance to cease HT. While HT safety concerns persisted for eight years post-publication, the nature of information-seeking changed over time. Callers subsequently sought reassurance to use menopause treatments together with their other medicines; and pursued HT substitutes, including HM, in response to HT product discontinuation. CONCLUSIONS: Women sought information or reassurance to support a decision, based on dynamic changes in internal (symptom or risk intolerance, attitude towards menopause and treatment preferences) and external factors (perceived source trust and changes in treatment availability). In assessing HT benefit versus risk, women tend to overestimate risk with HT safety concerns persisting over time. Decision-making in managing menopause symptoms is complex and dynamic. Reassurance to reach or justify decisions from a perceived trusted source can support informed decision-making.

Does the millennial generation of women experience more mental illness than their mothers?

BACKGROUND: There is concern that rates of mental disorders may be increasing although findings disagree. Using an innovative design with a daughter-mother data set we assess whether there has been a generational increase in lifetime ever rates of major depressive disorder, generalised anxiety disorder, panic disorder, and post-traumatic stress disorder (PTSD) experienced prior to 30 years of age. METHODS: Pregnant women were recruited during 1981-1983 and administered the Composite International Diagnostic Interview (CIDI) at the 27-year follow-up (2008-11). Offspring were administered the CIDI at the 30-year follow-up (2010-2014). Comparisons for onset of diagnosis are restricted to daughter and mother dyads up to 30 years of age. To address recall bias, disorders were stratified into more (≥12 months duration) and less persistent episodes (< 12 months duration) for the purposes of comparison. Sensitivity analyses with inflation were used to account for possible maternal failure to differentially recall past episodes. RESULTS: When comparing life time ever diagnoses before 30 years, daughters had higher rates of persistent generalised anxiety disorder, and less persistent major depressive disorder, generalised anxiety disorder and PTSD. CONCLUSIONS: In the context of conflicting findings concerning generational changes in mental disorders we find an increase in generational rates of persistent generalised anxiety disorders and a range of less persistent disorders. It is not clear whether this finding reflects actual changes in symptom levels over a generation or whether there has been a generational change in recognition of and willingness to report symptoms of mental illness.

Gender Differences in Intimate Partner Violence in Current and Prior Relationships.

Although much available research indicates that intimate partner violence (IPV) is male perpetrated, growing recent evidence suggests a gender symmetry model of family violence. This article examines gender differences in IPV in current and prior relationships reported by young adults. Data comprised 2,060 young adults (62.1% females) who participated in the 30-year follow-up of the Mater Hospital and University of Queensland Study of Pregnancy (MUSP) in Brisbane, Australia. The Composite Abuse Scale was used to measure IPV during the last 12 months in the respondents' most recent relationship. Similar proportions of males and females reported leaving their prior relationships. Both males and females who were not currently in a relationship reported experiencing much higher rates of IPV than those who were in a relationship. There were no differences in the past experience of IPV between males and females who were not currently in a relationship, but males in a current relationship reported they experienced most forms of IPV more often than did females. IPV typically involves both male and female perpetrators and victims. It does appear that the majority of relationships involving higher rates of IPV were dissolved. IPV was more likely to have occurred in relationships that ended than in relationships that persisted. Males more often remain in an abusive relationship and report experiencing higher rates of IPV in their current relationships compared with females.

Poverty over the early life course and young adult cardio-metabolic risk.

OBJECTIVES: There is little known about whether exposure to family poverty at specific periods of the early life course independently contributes to coronary heart disease risk beyond the contribution of concurrent poverty. METHODS: Children were recruited in early pregnancy and additional survey data obtained during the pregnancy and at the 5-, 14- and 30-year follow-ups. Fasting blood samples were also obtained at the 30-year follow-up. Analyses are multinominal logistic regressions stratified by gender and with adjustments for confounding. RESULTS: For male offspring, family poverty at different stages of the early life course was not associated with measures of cardio-metabolic risk. For females early life course, poverty predicted obesity, homeostatic model assessment of insulin resistance (HOMA-IR) and total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C), as well as concurrent family poverty associated with obesity, HOMA-IR, TC/HDL-C, HDL-C and increased systolic and diastolic blood pressure. CONCLUSIONS: Family poverty in the early life course independently predicts increased levels of cardio-metabolic risk of females. The primary finding, however, is that concurrent poverty is independently and strongly associated with increased cardio-metabolic risk levels in young adulthood.

Illicit drug use by mothers and their daughters in Australia: A comparison of two generations.

BACKGROUND: While recent decades have witnessed an increase in the use of illicit drugs in Australia, the extent to which the types of drugs used has changed over a generation of young women has not been documented. METHODS: Data are from a prospective birth cohort study. Mothers were recruited in early pregnancy (1981-83) and then they and their child were followed up, with mothers interviewed 27 years (2008-2011), and daughters 30 years (2010-14), after the birth. At these most recent interviews both mothers and daughters were administered the Composite International Diagnostic Interview (CIDI III). Comparisons are for mothers and daughters separated by a 25 year period. For this study, we compare levels of lifetime use of a range of illicit drugs and drug use disorders reported by mothers and their daughters (N = 998 mother/daughter pairs) with adjustment for family income, marital status, education and occupation. RESULTS: There has been a generational increase in the use of illicit substances and prevalence of substance use disorders experienced by Australian women. Mothers' use of illicit drugs was generally restricted to cannabis. By contrast the majority of daughters report lifetime use of an illicit drug with cannabis, club drugs and stimulants the most common. Compared to the mothers, daughters used club drugs 50 times, cocaine 19 times and inhalants 20 times more often. Daughters report experiencing 12 times the rate of cocaine use disorders, 9 times the rate of stimulant disorders and 7 times the rate of cannabis use disorders compared to their mothers. CONCLUSIONS: Mothers of the current generation of 30 year old Australian women rarely used illicit drugs and few experienced a drug use disorder. The current generation of young women report commonly using one or more illicit drugs with a substantial minority experiencing a drug use disorder. It is unlikely that the use of illicit drugs by young women in Australia will be reversed in the foreseeable future. Government policies and treatment practices need to be calibrated to the reality of the much greater contact with illicit drugs being exhibited by younger women.

Intimate partner violence and subsequent depression and anxiety disorders.

PURPOSE: The current longitudinal study examines the temporal association between different types of intimate partner violence (IPV) at early adulthood (21 years) and subsequent depression and anxiety disorders in young adulthood (30 years). METHODS: Participants were from the Mater-University of Queensland Study of Pregnancy. A cohort of 1529 was available for analysis. IPV was measured using the Composite Abuse Scale at 21 years. At the 21 and 30-year follow-ups, major depression disorder and anxiety disorders were measured using the Composite International Diagnostic Interview. RESULTS: We found a temporal relationship between almost all forms of IPV at 21 years and females' new cases of major depression disorder at 30 years. This association was not found for females who had previously been diagnosed with depression disorder. IPV did not predict the onset of new anxiety disorders, but it had a robust association with anxiety disorders in females with a previous anxiety diagnosis. We observed no significant link between IPV and males' subsequent major depression disorder. Interestingly, the experience of emotional abuse was a robust predictor of new cases of anxiety disorders but only for males. CONCLUSION: Our results suggest the need for sex-specific and integrated interventions addressing both IPV and mental health problems simultaneously. IPV interventions should be informed by the extend to which pre-existing anxiety and depression may lead to different psychological responses to the IPV experience. Increased risk of anxiety disorders predicted by emotional abuse experienced by males challenges beliefs about invulnerability of men in the abusive relationships and demands further attention.

Income, Gender, and Forms of Intimate Partner Violence.

Poverty and socioeconomic disadvantage place demands on intimate relationships and provide fertile ground for disagreements and conflicts. It is not known whether poverty also leads to intimate partner violence (IPV). This study investigates the association between income and forms of IPV victimization for both males and females. We also examine whether income inequalities are related to IPV and whether the gender balance of household income contributes to IPV victimization. Data are from a cohort of 2,401 young offspring (60.3% females) who participated at the 30-year follow-up of the Mater-University of Queensland Study of Pregnancy in Brisbane, Australia. Participants completed questionnaires including their income details and the Composite Abuse Scale. Within low-income families, both partners experience higher levels of IPV. Females' income is not independently related to experiencing IPV either for females or males. Females and males experience a higher rate of IPV when the husband earns a low income. When considering partners' relative income, families in which both partners earned a low income experienced higher levels of almost all forms of IPV. Income (im)balance in which females earn more or partners both have higher income was less often associated with the experience OF IPV IPV appears to be mutually experienced in the setting of the poverty. Objective economic hardship and scarcity create a context which facilitates IPV for both partners in a relationship.

Intimate partner violence in emerging adulthood and subsequent substance use disorders: findings from a longitudinal study.

AIMS: To examine the temporal association between the experience of different types of intimate partner violence (IPV) in early adulthood (21 years) and substance use disorders in young adulthood (30 years). DESIGN: Prospective birth cohort study using data from the Mater-University of Queensland Study of Pregnancy (MUSP). SETTING: Brisbane, Australia. PARTICIPANTS: A total of 1353 people (822 females and 531 males). MEASUREMENTS: IPV was measured using the Composite Abuse Scale (CAS) and alcohol, substance and nicotine use disorders were assessed using the Composite International Diagnostic Interview (CIDI). FINDINGS: In females, the experience of different forms of IPV at 21 years remained a robust risk factor for subsequent alcohol use disorder [adjusted odds ratios (aORs) ranged from 1.6 to 2.6 (all P < 0.05)], substance use disorder [aORs ranged from 2.1 to 4.0 (all P < 0.001)] and nicotine use disorder [aORs ranged from 2.0 to 2.4 (all P < 0.05)] at 30 years, even after controlling for antecedent substance disorders. However, in males only physical and emotional abuse (but not harassment) were significant in predicting alcohol use disorder [aORs ranged from 1.4 to 1.8 (all P < 0.05)] and drug use disorder [aORs ranged from 1.6 to 2.0 (all P < 0.05)] in the fully adjusted model. CONCLUSION: Intimate partner violence (IPV) in early adulthood is robustly associated with alcohol, substance and nicotine use disorders in women, whereas in men the association is clear for only some forms of IPV and types of disorder.

Maternal intimate partner violence victimization and child maltreatment.

There is some limited evidence of an association between maternal intimate partner victimization (IPV) and children's experience of maltreatment. Using data from a longitudinal study, we examine whether this relationship is independent of range of potential confounders including socio-economic, familial and psychological factors. Data were taken from the 14 and 30-year follow-ups of the Mater-University of Queensland Study of Pregnancy (MUSP) in Australia. A subsample of 2064 mothers and children (59.0% female) whose data on maternal IPV and child maltreatment was available, were analysed. In families with maternal IPV, two in five children reported being maltreated, compared to one in five children maltreated in families without maternal IPV. Except for sexual maltreatment which was consistently higher in female offspring, there was no gender differences in experiencing different types of maltreatment in families manifesting maternal IPV. Although both males and females were at increased risk of child maltreatment in families where mothers were victimized by their male partners, male children were more likely to be emotionally maltreated. The main associations were substantially independent of measured confounders, except for father's history of mental health problems which attenuated the association of maternal IPV victimization and male offspring's physical abuse. Our findings confirm that there is a robust association between maternal IPV and child maltreatment. Both maternal IPV victimization and child maltreatment co-occur in a household characterized by conflict and violence. Consequences of IPV go beyond the incident and influence all family members. Efforts to reduce child maltreatment may need to address the greater level of IPV associated with the cycle of family violence.

Does leaving an abusive partner lead to a decline in victimization?

BACKGROUND: This paper investigates gender differences in persistence of intimate partner violence (IPV), for those remaining or leaving an abusive relationship. We followed a sample of males and females to examine whether leaving an abusive partner may alter the continuity of victimization. METHODS: Data were taken from the 21 and 30-year follow-ups of the Mater Hospital and University of Queensland Study of Pregnancy (MUSP) in Australia. A cohort of 1265 respondents, including 874 females and 391 males, completed a 21-item version of the Composite Abuse Scale. RESULTS: We found proportionally similar rates of IPV victimization for males and females at both the 21 and 30 year follow-ups. Females who reported they had an abusive partner at the 21 year follow-up were more likely to subsequently change their partner than did males. Harassment and then emotional abuse appeared to have a stronger association for females leaving a partner. For males, a reported history of IPV was not significantly associated with leaving the partner. There was no significant association between leaving (or not) a previous abusive relationship and later victimization, either for male or female respondents. CONCLUSION: Changing a partner does not interrupt the continuity of victimization either for male or female respondents, and previous IPV victimization remained a determining factor of re-abuse, despite re-partnering.

The inter- and intra- generational transmission of family poverty and hardship (adversity): A prospective 30 year study.

BACKGROUND: Children exposed to family poverty have been found to have higher morbidity and mortality rates, poorer mental health and cognitive outcomes and reduced life chances across a wide range of life domains. There is, however, very little known about the extent to which poverty is experienced by children over their early life course, particularly in community samples. This study tracks changes in family poverty and the main factors that predict family poverty (adverse life experiences) over a 30-year period since the birth of the study child. METHODS: Data are from a prospective, longitudinal, birth cohort study conducted in Brisbane, Australia. Consecutive families were recruited at the mothers' first obstetrical visit at one of two major obstetrical hospitals in Brisbane. Data are available for 2087 families with complete data at the 30-year follow-up. Poverty was measured using family income at each time point (adjusted for inflation). FINDINGS: Poverty affects about 20% of families at any time point. It is common for families to move in and out of poverty, as their circumstances are affected by such adversities as unemployment and marital breakdown. Over the period of the study about half the families in the study experienced poverty on at least one occasion. Only a very small minority of families experienced persistent poverty over the 30-year duration of the study. Logistic regressions with time lag show that family poverty predicts subsequent adversities and adverse events predict subsequent poverty. CONCLUSIONS: Experiences of poverty and adversity are common and may vary greatly over the child's early life course. In assessing the health consequences of poverty, it is important to distinguish the timing and chronicity of early life course experiences of poverty and adversity.

The bidirectional relationship between vasomotor symptoms and depression across the menopausal transition: a systematic review of longitudinal studies.

OBJECTIVE: To explore the nature of the bidirectional relationship between vasomotor symptoms (VMS) and depression, and to determine whether hot flashes and night sweats differentially affect the association between VMS and depression through their effect on sleep disruption. METHODS: Multiple databases were searched from 1961 until July 31, 2016, and a manual search of reference lists of identified articles was conducted. Sixteen articles that involved 10,008 participants were identified and analyzed. RESULTS: The methods of analyses and measurement of VMS and depression varied across the studies. Two studies explored the bidirectional association, but only one was significant in both directions (odds ratio [OR] depression to VMS 3.06, 95% confidence interval [CI] 1.43-6.58; OR VMS to depression 8.88, 95% CI 2.57-30.68). In both cases, the association between VMS leading to depressive symptoms was stronger than the opposite. Eleven studies examined VMS leading to depression, but only five showed a significant effect (OR 1.57-1.81, P ≤ 0.02). Treating VMS and depressive symptoms as continuous variables (n = 3) diminished the relationship. Three studies showed a significant association of depression leading to VMS (OR 1.62-1.94, P ≤ 0.01). We found little evidence for a specific effect of night sweats on the association between VMS and depressive symptoms. The effect might not be related to sleep disruption. CONCLUSIONS: There is a bidirectional association between VMS and depressive symptoms. The menopausal transition appears to increase the risk of recurrent episodes of depression that might not be explained only by VMS. Further investigation is needed to explain the differential effect of night sweats and hot flashes on depression.

The Use of a Brochure to Enable CAM-with-Chemotherapy Patient Education.

The majority of cancer patients receiving chemotherapy will consider taking complementary and alternative medicine (CAM) during their treatment. As biologically-active CAM may detrimentally interfere with chemotherapy treatment, cancer patients require evidence-based information on chemotherapy-CAM integration consequences. This study aimed to assess if the availability of a purpose-designed brochure within a cancer service aided doctors' discussions with their patients on CAM use and helped patients understand the effects of CAM during their chemotherapy treatment. Cancer care doctors consulting in an adult day unit completed a structured post-intervention feedback survey form (n = 17), and cancer patients receiving chemotherapy treatment were provided the brochure and completed the local health service consumer testing feedback form (n = 30). All cancer care doctors perceived a need for the brochure and recommended the brochure to their patients. All doctors thought the brochure made it easier for them to discuss CAM with their patients, and 59 % believed that it saved them time during patient consultations. Ninety percent of cancer patients reported the brochure had enough information to answer their CAM questions, and all patients thought the information was easy to read and understand. An evidence-based CAM-with-chemotherapy patient brochure was perceived to have enabled cancer care doctors to discuss CAM with their patients and to have answered patients' CAM questions.

Psychological health and menopause-specific quality of life of Malaysian women with type 2 diabetes.

Anxiety and depression are more common among females and those experiencing diabetes and menopause. Menopausal symptoms experienced by women can vary tremendously from population to population; therefore, there is a need to investigate these symptoms and associated risk factors in different communities. This study investigated the differences in psychological health and menopause-specific quality of life (MENQOL) between women with and without diabetes type 2 (T2DM) in Malaysia. Women with T2DM (n=320) were matched by age range to controls without T2DM (n=320). Data were collected from March 2012 to January 2013. Delusions Symptoms States Inventory (DSSI) instrument was used to identify symptoms of depression and anxiety. Women with diabetes had higher depressive (11.8% versus 8.4%) and anxiety (8.4% versus 6.6%) symptoms compared to women without diabetes. In both groups, the most common menopausal symptom was aches (muscles and joints). Women without diabetes had significantly higher scores for the sexual domain compared to women with diabetes (4.20 versus 3.21, p=0.001). The odds that a postmenopausal woman with diabetes was depressed or anxious on the DSSI scale increased significantly when the MENQOL score on the physical, vasomotor, and psychosocial domains increased by one unit. Both diabetes and psychological problems have negative impact on MENQOL. Our findings support the view of screening postmenopausal women with diabetes for depressive and anxiety, to improve overall quality of life.

Complementary and alternative medicine use by patients receiving curative-intent chemotherapy.

AIM: To determine which types of complementary and alternative medicine (CAM) are being used by cancer patients commencing curative-intent chemotherapy, whether the CAM taken has the potential to affect treatment efficacy, the reasons for patients' decisions to use CAM and whether these patients would like information on CAM safety with chemotherapy. METHODS: Seventy-five solid tumor malignancy patients receiving curative-intent treatment attending a cancer care day unit were interviewed about their CAM use on the day of receiving their first dose of chemotherapy. RESULTS: Sixty percent of study participants were using CAM at the start of chemotherapy treatment. Biologically active CAM assessed as having potential to interact with prescribed chemotherapy was ingested by 27% of patients, all of whom had routinely used CAM prior to cancer diagnosis. CAM was used by 51% of patients for supportive care reasons and by 28% of patients with the intention of treating their cancer. Patients' CAM decision-making was influenced by advice from family and friends, practitioners and casual acquaintances. Thirteen percent of patients were told by a CAM advice-giver not to have chemotherapy. The majority of patients (84%) would have liked to receive information on which CAM is safe to use with chemotherapy before treatment commenced. CONCLUSIONS: Patients being treated with curative intent, particularly those with a history of CAM use, may be taking biologically active CAM with potential to compromise their chemotherapy treatment. These patients want cancer-care health professionals to provide them evidence-based information on safe CAM use with chemotherapy and may be contending with alternative health advice to not have chemotherapy.