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Women's Health (women's + health)
Terms modified by Women's Health Selected AbstractsDeterminants of continuity and change over 10 years in young women's smokingADDICTION, Issue 3 2009Liane McDermott ABSTRACT Aims To examine prospectively continuity and change in smoking behaviour and associated attributes over a 10-year period. Design, setting and participants Participants (initially aged 18,23 years) in the Australian Longitudinal Study on Women's Health completed postal questionnaires in 1996, 2000, 2003 and 2006. The analysis sample was 6840 women who participated in all surveys and provided complete smoking data. Measurements Outcome variables were transitions in smoking behaviour between surveys 1 and 2, 2 and 3, 3 and 4 and 1 and 4. Attributes that differentiated continuing smokers from quitters, relapsers from ex-smokers and adopters from never smokers were examined for each survey period. Explanatory variables included previous smoking history, demographic, psychosocial, life-style risk behaviour and life-stage transition factors. Findings Over 10 years, 23% of participants either quit, re-started, adopted or experimented with smoking. Recent illicit drug use and risky or high-risk drinking predicted continued smoking, relapse and smoking adoption. Marriage or being in a committed relationship was associated significantly with quitting, remaining an ex-smoker and not adopting smoking. Living in a rural or remote area and lower educational attainment were associated with continued smoking; moderate and high physical activity levels were associated positively with remaining an ex-smoker. Conclusions Life-style and life-stage factors are significant determinants of young women's smoking behaviour. Future research needs to examine the inter-relationships between tobacco, alcohol and illicit drug use, and to identify the determinants of continued smoking among women living in rural and remote areas. Cessation strategies could examine the role of physical activity in relapse prevention. [source] Botanical Medicine for Women's HealthFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 4 2009E Ernst [source] The Association Between Obesity and the Frailty Syndrome in Older Women: The Women's Health and Aging StudiesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2005Caroline S. Blaum MD Objectives: To determine whether obesity is associated with the frailty phenotype and, if so, whether comorbid conditions or inflammatory markers explain this association. Design: Cross-sectional analysis of baseline data from the Women's Health and Aging Studies I (1992) and II (1994), complementary population-based studies. Setting: Twelve contiguous ZIP code areas in Baltimore, Maryland. Participants: Five hundred ninety-nine community-dwelling women aged 70 to 79 with a body mass index (BMI) greater than 18.5 kg/m2. Measurements: The dependent variables were the frailty syndrome, including prefrailty, defined as presence of one or two of five frailty indicators (weakness, slowness, weight loss, low physical activity, exhaustion), and frailty, defined as three or more indicators. Independent variables included BMI, categorized using World Health Organization criteria as normal (18.5 to <25 kg/m2), overweight (25 to <30 kg/m2), and obese (,30 kg/m2); chronic diseases; C-reactive protein; and serum carotenoids. Results: Being overweight was significantly associated with prefrailty, and obesity was associated with prefrailty and frailty. In all frail women, regardless of BMI group, a similar pattern of three defining frailty indicators was found: slowness, weakness, and low activity (with the addition of weight loss in the normal weight group.) In multinomial regression models, obesity was significantly associated with prefrailty (odds ratio (OR)=2.23, 95% confidence interval (CI)=1.29,3.84) and frailty (OR=3.52, 95% CI=1.34,9.13), even when controlling for covariates. Conclusion: Obesity is associated with the frailty syndrome in older women in cross-sectional data. This association remains significant even when multiple conditions associated with frailty are considered. Prospective studies are needed to confirm this finding. [source] Chronic Cytomegalovirus Infection and Inflammation Are Associated with Prevalent Frailty in Community-Dwelling Older WomenJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2005Heidi N. Schmaltz MDCM Objectives: To evaluate the association between asymptomatic chronic cytomegalovirus (CMV) infection and the frailty syndrome and to assess whether inflammation modifies this association. Design: Cross-sectional analysis. Setting: Women's Health and Aging Study I & II, Baltimore, Maryland. Participants: Seven hundred twenty-four community-dwelling women aged 70 to 79 with baseline measures of CMV, interleukin-6 (IL-6), and frailty status. Measurements: CMV serology and IL-6 concentrations were measured using enzyme-linked immunosorbent assay. Frailty status was based on previously validated criteria: unintentional weight loss, weak grip strength, exhaustion, slow walking speed, and low level of activity. Frail women had three or more of the five components, prefrail women had one or two components, and women who were not frail had none of the components. Multinomial logistic regression adjusted for potential confounders. Results: Eighty-seven percent of women were CMV seropositive, an indication of chronic infection. CMV was associated with prevalent frailty, adjusting for age, smoking history, elevated body mass index, diabetes mellitus, and congestive heart failure (CMV frail adjusted odds ratio (AOR)=3.2, P=.03; CMV prefrail AOR=1.5, P=.18). IL-6 interacted with CMV, significantly increasing the magnitude of this association (CMV positive and low IL-6 frail AOR=1.5, P=.53; CMV positive and high IL-6 frail AOR=20.3, P=.007; CMV positive and low IL-6 prefrail AOR=0.9, P=.73; CMV positive and high IL-6 prefrail AOR=5.5, P=.001). Conclusion: Chronic CMV infection is associated with prevalent frailty, a state with increased morbidity and mortality in older adults; inflammation enhances this effect. Further prospective studies are needed to establish a causal relationship between CMV, inflammation, and frailty. [source] Predictors of Health Resource Use by Disabled Older Female Medicare Beneficiaries Living in the CommunityJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2003Michael Weiner MD OBJECTIVES: To identify specific clinical factors that could best predict resource use by disabled older women. DESIGN: Cross-sectional. SETTING: Urban community in Baltimore, Maryland. PARTICIPANTS: One thousand two community-dwelling, moderately to severely disabled, female Medicare beneficiaries aged 65 and older, from the Women's Health and Aging Study I (WHAS). MEASUREMENTS: WHAS data were merged with participants' 1992,1994 Medicare claims data for the year after baseline evaluation, reflecting inpatient, outpatient, home-based, and skilled-nursing services. The independent contributions of factors hypothesized to predict health expenditures were assessed, using chi-square and regression analyses, with the logarithm of Medicare expenditures as the primary outcome. RESULTS: Demographic factors were not associated with Medicare expenditures. Factors associated with expenditures in bivariate analyses included heart disease (1.4x), chronic obstructive pulmonary disease (1.3x), diabetes mellitus (1.1x), smoking, comorbidity, and severity of disability, as well as low creatinine clearance, serum albumin, caloric expenditure, or skinfold thickness. Heart disease, diabetes mellitus, and low skinfold thickness remained significant after adjustment for other factors. CONCLUSION: Heart disease, diabetes mellitus, and low skinfold thickness are important independent predictors of 1-year Medicare expenditures by disabled older women. Many other variables that reflect disease, disability, nutrition, or personal habits have less predictive ability. Most demographic factors are not predictors of expenditures in this population. Focusing on the best predictors may facilitate more-effective risk adjustment and creation of related health policies. [source] Musculoskeletal Pain and Risk for Falls in Older Disabled Women Living in the CommunityJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2002Suzanne G. Leveille PhD OBJECTIVES: To determine whether musculoskeletal pain increased risk for falls in older women with disabilities. DESIGN: Prospective population-based cohort study. SETTING: The city and county of the eastern area of Baltimore. PARTICIPANTS: One thousand two women aged 65 and older, participants in the Women's Health and Aging Study, representing the one-third of older women who were living at home with disabilities, followed semiannually for 3 years beginning in 1991. MEASUREMENTS: Pain was categorized into four groups according to severity and location. Widespread pain was defined as pain in the upper and lower extremities and in the axial skeletal region, with moderate to severe pain in at least one region (, 4 on a 10-point numeric rating scale, 10 = excruciating pain). Moderate to severe lower extremity pain that did not meet criteria for widespread pain was the next category. The reference category was no pain or mild pain in one site. The additional category of "other pain" was pain that did not fit into the other three groups. The occurrence of falls and fall-related injuries were assessed at each interview. RESULTS: Of the 940 women who participated in at least one follow-up examination, 39% fell in first year; of the survivors, 36% fell in Year 2, and 39% in Year 3. After adjusting for several major risk factors for falls, women with widespread pain had an increased likelihood of falling during follow-up (adjusted odds ratio (AOR) = 1.66, 95% confidence interval (CI) = 1.25,2.21) compared with those with no or mild pain in only one musculoskeletal site. Women who had other musculoskeletal pain but not widespread pain or lower extremity pain also had an increased risk of falls (AOR = 1.36, 95% CI = 1.02,1.82). Among women with musculoskeletal pain, risk for falls was lower in those who used daily analgesic medication. Risk for recurrent falls and self-reported fractures due to falls was also elevated in women with musculoskeletal pain, most consistently in women with widespread pain. CONCLUSIONS: Musculoskeletal pain, particularly widespread pain, is a substantial risk factor for falls in older women with disabilities. These findings add an important dimension to our understanding of the multifactorial processes leading to falls in older persons. J Am Geriatr Soc 50:671,678, 2002. [source] Identifying women with severe angiographic coronary diseaseJOURNAL OF INTERNAL MEDICINE, Issue 1 2010C. Kreatsoulas Abstract., Kreatsoulas C, Natarajan MK, Khatun R, Velianou JL, Anand SS (McMaster University; CARING Network, McMaster University; Population Health Research Institute, McMaster University and Hamilton Health Sciences; Interventional Cardiology, Hamilton Health Sciences; Eli Lilly Canada,May Cohen Chair in Women's Health, McMaster University; Michael G. DeGroote-Heart and Stroke Foundation of Ontario Chair in Population Health Research, McMaster University; Population Genomics Program, McMaster University; McMaster University, Hamilton, ON, Canada). Identifying women with severe angiographic coronary disease. J Intern Med 2010; 268:66,74. Objectives., To determine sex/gender differences in the distribution of risk factors according to age and identify factors associated with the presence of severe coronary artery disease (CAD). Design., We analysed 23 771 consecutive patients referred for coronary angiography from 2000 to 2006. Subjects., Patients did not have previously diagnosed CAD and were referred for first diagnostic angiography. Outcome measures., Patients were classified according to angiographic disease severity. Severe CAD was defined as left main stenosis ,50%, three-vessel disease with ,70% stenosis or two-vessel disease including proximal left anterior descending stenosis of ,70%. Univariate and multivariate logistic regression was used to assess the association between risk factors and angina symptoms with severe CAD. Results., Women were less likely to have severe CAD (22.3% vs. 36.5%) compared with men. Women were also significantly older (69.8 ± 10.6 vs. 66.3 ± 10.7 years), had higher rates of diabetes (35.0% vs. 26.6%), hypertension (74.8% vs. 63.3%) and Canadian Cardiovascular Society (CCS) class IV angina symptoms (56.7% vs. 47.8%). Men were more likely to be smokers (56.9% vs. 37.9%). Factors independently associated with severe CAD included age (OR = 1.05; 95% CI 1.05,1.05, P < 0.01), male sex (OR = 2.43; CI 2.26,2.62, P < 0.01), diabetes (OR = 2.00; CI 1.86,2.18, P < 0.01), hyperlipidaemia (OR = 1.50; CI 1.39,1.61, P < 0.01), smoking (OR = 1.10; CI 1.03,1.18, P = 0.06) and CCS class IV symptoms (OR = 1.43; CI 1.34,1.53, P < 0.01). CCS Class IV angina was a stronger predictor of severe CAD amongst women compared with men (women OR = 1.82; CI 1.61,2.04 vs. men OR = 1.28; CI 1.18,1.39, P < 0.01). Conclusions., Women referred for first diagnostic angiography have lower rates of severe CAD compared with men across all ages. Whilst conventional risk factors, age, sex, diabetes, smoking and hyperlipidaemia are primary determinants of CAD amongst women and men, CCS Class IV angina is more likely to be associated with severe CAD in women than men. [source] An International Imperative for Gender-Sensitive Theories in Women's HealthJOURNAL OF NURSING SCHOLARSHIP, Issue 4 2001Eun-Ok Im Purpose: To propose gender-sensitive theories as a future direction for theoretical development of women's health. Few theories pertain to women's health and illness experiences, with gender issues embedded in social, cultural, and historical contexts. Organizing Construct: Significance, definition, and philosophical bases of gender-sensitive theories. Findings: Six major components should be incorporated in the development of gender-sensitive theories: (a) gender as a major feature, (b) women's own words and experiences, (c) nature of women's experiences, (d) theorists' perspectives, (e) contexts, and (f) guidelines for actions. Conclusions: We believe that the development of gender-sensitive theories in nursing could enable researchers to transcend androcentric and ethnocentric views on women's health, decrease gender inequity in health care, enhance women's well being, and ultimately contribute to knowledge development in nursing. [source] Smoking and Women's HealthJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 5 2010Article first published online: 4 AUG 2010 No abstract is available for this article. [source] Parish Nursing and Community Collaboration in Women's HealthJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 2 2010P. Ann Solari-Twadell No abstract is available for this article. [source] The AWHONN Near-Term Infant Initiative: A Conceptual Framework for Optimizing Health for Near-Term InfantsJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 6 2005Barbara Medoff-Cooper In June 2005, the Association of Women's Health, Obstetric and Neonatal Nurses launched a multiyear initiative to address the unique physiologic and developmental needs of near-term infants (NTIs) defined as those born between 34 and 37 weeks post-menstrual age. The Optimizing Care for the Near-Term Infant Conceptual Model integrates the concepts of neonatal physiologic functional status, nursing care practices, care environment, and the essential role of the family both in the hospital and beyond. The elements of the model will serve to guide program and resource development within the Near-Term Infant Initiative. Goals of the initiative are to raise awareness of the NTI population's unique needs, emphasize the need for research, encourage development and adoption of evidence-based guidelines to promote safe care, and provide resources that assist nurses and other health care professionals in risk-based assessment of NTIs. [source] Annotated Bibliography of NINR Findings on Women's Health in Pregnancy and Childbirth: 2005 UpdateJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 3 2005Human Services, National Institute of Nursing Research, National Institutes of Health, U.S. Department of Health First page of article [source] Smoking Cessation Counseling for Pregnant Women Who Smoke: Scientific Basis for Practice for AWHONN's SUCCESS ProjectJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 3 2004FAAN, Susan A. Albrecht PhD Objectives: To review the literature addressing smoking cessation in pregnant women. To develop the project protocol for the Association of Women's Health, Obstetric and Neonatal Nurse's (AWHONN) 6th research-based practice project titled "Setting Universal Cessation Counseling, Education and Screening Standards (SUCCESS): Nursing Care of Pregnant Women Who Smoke." To evaluate the potential of systematic integration of this protocol in primary care settings in which women seek care at the preconception, pregnant, or postpartum stages. Literature Sources: Computerized searches in MEDLINE and CINAHL, as well as references cited in articles reviewed. Key concepts in the searches included low-birth-weight infants and effects of prenatal smoking on the infant and the effects of preconception and prenatal smoking cessation intervention on premature labor and birth weight. Literature Selection: Comprehensive articles, reports, and guidelines relevant to key concepts and published after 1964 with an emphasis on new findings from 1996 through 2002. Ninety-eight citations were identified as useful to this review. Literature Synthesis: Tobacco use among pregnant women and children's exposure to tobacco use (secondhand smoke) are associated with pregnancy complications such as placental dysfunction (including previa or abruption), preterm labor, premature rupture of membranes, spontaneous abortions, and decreased birth weight and infant stature. Neonates and children who are exposed to secondhand smoke are at increased risk for developing otitis media, asthma, other respiratory disorders later in childhood; dying from sudden infant death syndrome; and learning disorders. The "5 A's" intervention and use of descriptive statements for smoking status assessment were synthesized into the SUCCESS project protocol for AWHONN's 6th research-based practice project. Conclusions: The literature review generated evidence that brief, office-based assessment, client-specific tobacco counseling, skill development, and support programs serve as an effective practice guideline for clinicians. Implementation and evaluation of the guideline is under way at a total of 13 sites in the United States and Canada. [source] The Status of Women's Health in the United StatesJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 4 2003Nancy K. Lowe Editor No abstract is available for this article. [source] Evaluating the Level of Evidence of Qualitative ResearchJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 6 2002Sandra Cesario RNC Guidelines for evaluating the levels of evidence based on quantitative research are well established. However, the same cannot be said for the evaluation of qualitative research. This article discusses a process members of an evidence-based clinical practice guideline development team with the Association of Women's Health, Obstetric and Neonatal Nurses used to create a scoring system to determine the strength of qualitative research evidence. A brief history of evidence-based clinical practice guideline development is provided, followed by discussion of the development of the Nursing Management of the Second Stage of Labor evidence-based clinical practice guideline. The development of the qualitative scoring system is explicated, and implications for nursing are proposed. [source] Annotated Bibliography of Recent National Institute of Nursing Research Findings on Women's Health: Pregnancy and ChildbearingJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 3 2002Division of Extramural Programs, National Institute of Nursing Research, National Institutes of Health First page of article [source] Women's Health in Post-Soviet Russia: The Politics of InterventionAMERICAN ANTHROPOLOGIST, Issue 2 2007SARAH PHILLIPS Women's Health in Post-Soviet Russia: The Politics of Intervention. Michele Rivkin-Fish. Indianapolis: University of Indiana Press, 2006. 253 pp. [source] Urinary incontinence across the lifespanNEUROUROLOGY AND URODYNAMICS, Issue 6 2003Yvette D. Miller Abstract Aims The objectives of the current study were (1) to measure type and severity of urinary leakage and (2) to investigate the association between these factors and age-related life events and conditions in three groups of Australian women with a history of urinary leakage. Methods Five hundred participants were randomly selected from women in the young (aged 18,22 in 1996), mid-age (45,50), and older (70,75) cohorts of the Australian Longitudinal Study of Women's Health (ALSWH) who had reported leaking urine in the 1996 baseline survey. Details about leaking urine (frequency, severity, situations) and associated factors (pregnancy, childbirth, body mass index [BMI]) were sought through self-report mailed follow-up surveys in 1999. Results & Conclusions Response rates were 50, 83, and 80% in the young, mid-age, and older women, respectively. Most women confirmed that they had leaked urine in the past month, and the majority of these were cases of "mixed" incontinence. Incontinence severity tended to increase with BMI for women of all ages, and increased severity scores were associated with having urine that burns or stings. Additional independent risk factors for increasing incontinence severity were heavy smoking in young women, past or present use of hormone replacement therapy in older women, and BMI and history of hysterectomy in mid-age women. Neurourol. Urodynam. 22:550,557, 2003. © 2003 Wiley-Liss, Inc. [source] Thinking Strategically About Women's Health A Dynamic Three-Part SeriesNURSING FOR WOMENS HEALTH, Issue 6 2001Jaynelle F. Stichler DNSc Editor's Note: In June 2000, Lifelines launched its first series on the business of women's health. As women's health continues to emerge as a "must-provide" services line for all types of health care organizations, Lifelines again asked widely recognized women's health services experts to revisit the notion of creating a women's health business model. Beginning in this issue, and continuing through the next two issues, we'll explore the strategies, marketing approaches and needed finance tools in developing a successful women's health business model. [source] Nonhuman Primate Models of Women's Health, Guest Edited by Carol A. Shively and Thomas B. ClarksonAMERICAN JOURNAL OF PRIMATOLOGY, Issue 9 2009Paul A. Garber Executive Editor No abstract is available for this article. [source] Older Australian women's use of dentists: A longitudinal analysis over 6 yearsAUSTRALASIAN JOURNAL ON AGEING, Issue 1 2010David W Sibbritt Aim:, To identify factors associated with dentist consultation by older Australian women. Methods:, Participants from the older cohort of the Australian Longitudinal Study on Women's Health which originally involved 12 432 older women. Results:, The percentage of women who consulted a dentist in the years 1999, 2002 and 2005 were 35%, 36% and 37%, respectively. Women were more likely to consult with a dentist if they lived in urban areas (RR = 1.26; 95% CI: 1.21, 1.32), were non-smokers (RR = 1.38; 95% CI: 1.21, 157), did not have diabetes (RR = 1.16; 95% CI: 1.08, 1.25), had better physical health (RR = 1.02 (95% CI: 1.01, 1.02). Women were less likely to consult with a dentist if they found it difficult to live on their income (RR = 0.90; 95% CI: 085, 0.95). Conclusion:, Access to dentists, cost of consultations and poor health appear to be significant factors influencing visits to a dentist by older Australian women. [source] Infertility in Australia circa 1980: an historical population perspective on the uptake of fertility treatment by Australian women born in 1946-51AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 6 2009Danielle L. Herbert Abstract Objective: To estimate the prevalence of lifetime infertility in Australian women born in 1946-51 and examine their uptake of treatment. Methods: Participants in the Australian Longitudinal Study on Women's Health born in 1946-51 (n=13,715) completed up to four mailed surveys from 1996 to 2004. The odds of infertility were estimated using logistic regression with adjustment for socio-demographic and reproductive factors. Results: Among participants, 92.1% had been pregnant. For women who had been pregnant (n=12738): 56.5% had at least one birth but no pregnancy loss (miscarriage and/or termination); 39.9% experienced both birth and loss; and 3.6% had a loss only. The lifetime prevalence of infertility was 11.0%. Among women who reported infertility (n=1511), 41.7% used treatment. Women had higher odds of infertility when they had reproductive histories of losses only (OR range 9.0-43.5) or had never been pregnant (OR=15.7, 95%CI 11.8-20.8); and higher odds for treatment: losses only (OR range 2.5-9.8); or never pregnant (1.96, 1.28-3.00). Women who delayed their first birth until aged 30+ years had higher odds of treatment (OR range 3.2-4.3). Conclusions: About one in ten women experienced infertility and almost half used some form of treatment, especially those attempting pregnancy after 1980. Older first time mothers had an increased uptake of treatment as assisted reproductive technologies (ART) developed. Implications: This study provided evidence of the early uptake of treatment prior to 1979 when the national register of invasive ART was developed and later uptake prior to 1998 when data on non-invasive ART were first collected. [source] Infertility, medical advice and treatment with fertility hormones and/or in vitro fertilisation: a population perspective from the Australian Longitudinal Study on Women's HealthAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2009Danielle L. Herbert Abstract Objective: To identify the factors associated with infertility, seeking advice and treatment with fertility hormones and/or in vitro fertilisation (IVF) among a general population of women. Methods: Participants in the Australian Longitudinal Study on Women's Health aged 28-33 years in 2006 had completed up to four mailed surveys over 10 years (n=9,145). Parsimonious multivariate logistic regression was used to identify the socio-demographic, biological (including reproductive histories), and behavioural factors associated with infertility, advice and hormonal/IVF treatment. Results: For women who had tried to conceive or had been pregnant (n=5,936), 17% reported infertility. Among women with infertility (n=1031), 72% (n=728) sought advice but only 50% (n=356) used hormonal/IVF treatment. Women had higher odds of infertility when: they had never been pregnant (OR=7.2, 95% CI 5.6-9.1) or had a history of miscarriage (OR range=1.5-4.0) than those who had given birth (and never had a miscarriage or termination). Conclusion: Only one-third of women with infertility used hormonal and/or IVF treatment. Women with PCOS or endometriosis were the most proactive in having sought advice and used hormonal/IVF treatment. Implications: Raised awareness of age-related declining fertility is important for partnered women aged ,30 years to encourage pregnancy during their prime reproductive years and reduce the risk of infertility. [source] Regional variation in the survival and health of older Australian women: a prospective cohort studyAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2009Dimitrios Vagenas Abstract Objective: Older people may act as sensitive indicators of the effectiveness of health systems. Our objective is to distinguish between the effects of socio-economic and behavioural factors and use of health services on urban-rural differences in mortality and health of elderly women. Methods: Baseline and longitudinal analysis of data from a prospective cohort study. Participants were a community-based random sample of women (n=12778) aged 70-75 years when recruited in 1996 to the Australian Longitudinal Study on Women's Health. Measures used were: urban or rural residence in Australian States and Territories, socio-demographic characteristics, health related behaviour, survival up to 1 October 2006, physical and mental health scores and use of medical services. Results: Mortality was higher in rural than in urban women (hazard ratio, HR 1.14; 95% CI, 1.03,-1.26) but there were no differences between States and Territories. There were no consistent baseline or longitudinal differences between women for physical or mental health, with or without adjustment for socio-demographic and behavioural factors. Rural women had fewer visits to general practitioners (odds ratio, OR=0.54; 95% CI, 0.48-0.61) and medical specialists (OR=0.60; 95% CI, 0.55-0.65). Conclusions: Differences in use of health services are a more plausible explanation for higher mortality in rural than urban areas than differences in other factors. Implications: Older people may be the ,grey canaries' of the health system and may thus provide an ,early warning system' to policy makers and governments. [source] Physical activity, Body Mass Index and health care costs in mid-age Australian womenAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2008Wendy J. Brown Abstract Objective: This study examined the relationships between combined categories of physical activity (PA) and Body Mass Index (BMI) with health care costs in women and assessed the potential cost savings of improving PA and BMI in sedentary mid-age women. Methods: Cross-sectional analysis of 2001 survey data linked to health service use data for the same year from 7,004 mid-age women (50-55 years) participating in the Australian Longitudinal Study on Women's Health. Results: The mean (median; interquartile range) annual cost of Medicare-subsidised services was $542 (355; 156-693) per woman. Costs were 17% higher in obese than in healthy-weight women and 26% higher in sedentary than in moderately active women. For sedentary obese women, mean costs were 43% higher than in healthy weight, moderately active women. After adjustment for potential confounders, the relative risk of ,high' claims (,15 claims per year) for overweight women who reported ,moderate' or ,high' PA were lower than for women with healthy BMI who reported no PA. Conclusions and Implications: Lower PA and higher BMI are both associated with higher health care costs, but costs are lower for overweight active women than for healthy-weight sedentary women. At the population level these data suggest that there would be significant cost savings if all sedentary mid-age women could achieve at least ,low' levels of PA (60-150 minutes a week). [source] Attrition in longitudinal studies: who do you lose?AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2006Anne F. Young Objective: To describe the risk factors for various types of attrition in three age cohorts of women in a longitudinal study and to discuss strategies to minimise attrition. Methods: Analysis of survey data from the Australian Longitudinal Study on Women's Health, collected by mailed questionnaire. In 1996, the study recruited and surveyed a national random sample of ,younger' (18,23 years, n=14,247), ,mid-age' (45,50 years, n=13,716), and ,older' women (70,75 years, n=12,432), and began a staggered cycle of mailed follow-up questionnaires: 1998 (mid-age), 1999 (older), 2000 (younger) and so on. Demographic, health and social risk factors for attrition were examined using multivariate analysis. Results: Attrition at survey 2 was highest among younger women (32%), mainly because of participants not being contactable (21%), and lower among the older (16%) and mid-age women (10%). At survey 1, the survey 2 non-respondents were more likely to report having less education, being born in a non-English-speaking country and being a current smoker, in all cohorts, and had poorer health (mid-age and older cohort) and more diffculty managing on their income (younger and mid-age). Conclusion: Although the magnitude of different types of attrition was found to differ by age, there were several risk factors for attrition that remained consistent. These fndings are important to inform future studies on ways to lessen or prevent systematic loss of participants. Implications: Recruitment and follow-up methods in longitudinal studies should be tailored to maximise retention of participants at higher risk of dropout. [source] Differences in mail and telephone responses to self-rated health: use of multiple imputation in correcting for response biasAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2005J. R. Powers Objectives: To estimate differences in self-rated health by mode of administration and to assess the value of multiple imputation to make self-rated health comparable for telephone and mail. Methods: In 1996, Survey 1 of the Australian Longitudinal Study on Women's Health was answered by mail. In 1998, 706 and 11,595 mid-age women answered Survey 2 by telephone and mail respectively. Self-rated health was measured by the physical and mental health scores of the SF-36. Mean change in SF-36 scores between Surveys 1 and 2 were compared for telephone and mail respondents to Survey 2, before and after adjustment for socio-demographic and health characteristics. Missing values and SF-36 scores for telephone respondents at Survey 2 were imputed from SF-36 mail responses and telephone and mail responses to socio-demographic and health questions. Results: At Survey 2, self-rated health improved for telephone respondents but not mail respondents. After adjustment, mean changes in physical health and mental health scores remained higher (0.4 and 1.6 respectively) for telephone respondents compared with mail respondents (-1.2 and 0.1 respectively). Multiple imputation yielded adjusted changes in SF-36 scores that were similar for telephone and mail respondents. Conclusions and Implications: The effect of mode of administration on the change in mental health is important given that a difference of two points in SF-36 scores is accepted as clinically meaningful. Health evaluators should be aware of and adjust for the effects of mode of administration on self-rated health. Multiple imputation is one method that may be used to adjust SF-36 scores for mode of administration bias. [source] HEALTH ISSUES AMONG FILIPINO WOMEN IN REMOTE QUEENSLANDAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 4 2001Margaret Kelaher ABSTRACT: This paper discusses health issues among Filipinas (women born in the Philippines) living in remote and rural environments in Queensland. The sample was recruited as part of the University of Queensland component of the Australian Longitudinal Study of Women's Health (ALSWH). Most of the women lived in an urban or semi-urban area (391), whereas 90 lived in rural or remote areas. Community perceptions had a much greater impact on health service utilisation in rural and remote areas than in urban areas. The transition between newcomer and old-timer is more difficult for Filipinas than for other rural women because they are visibly different from other members of the community and suffer from stigmatisation associated with perceptions of Filipinas as mail order brides. For these women, concerns about confidentiality and a reluctance to ask for support are major barriers to health service utilisation. The area of greatest concern is mental health, particularly in relation to parenting issues. Improving access may involve providing a greater awareness of what services are available and allowing women to access services in a way that does not require them to label themselves or be labelled by others. [source] Low serum selenium concentrations are associated with poor grip strength among older women living in the communityBIOFACTORS, Issue 1 2007Justine Beck Abstract Aging is associated with a loss of muscle strength, and, in turn, loss of muscle strength has been associated with increased risk of frailty, disability and mortality. The factors that contribute to loss of muscle strength with aging have not been well characterized. Selenium is important in normal muscle function because of its role in selenoenzymes that protect muscle against oxidative damage. We hypothesized that low serum selenium concentrations were associated with poor grip strength. We examined the association between serum selenium and hand grip strength among 676 moderately to severely disabled community-dwelling women in the Women's Health and Aging Study I in Baltimore, Maryland. After adjusting for age, race, body mass index, Mini-Mental Status Examination score, current smoking, hypertension, congestive heart failure and depression, serum selenium was associated with grip strength (P = 0.04). This study supports the idea that selenium is important to muscle strength in older women. [source] Joint Analysis of Time-to-Event and Multiple Binary Indicators of Latent ClassesBIOMETRICS, Issue 1 2004Klaus Larsen Summary. Multiple categorical variables are commonly used in medical and epidemiological research to measure specific aspects of human health and functioning. To analyze such data, models have been developed considering these categorical variables as imperfect indicators of an individual's "true" status of health or functioning. In this article, the latent class regression model is used to model the relationship between covariates, a latent class variable (the unobserved status of health or functioning), and the observed indicators (e.g., variables from a questionnaire). The Cox model is extended to encompass a latent class variable as predictor of time-to-event, while using information about latent class membership available from multiple categorical indicators. The expectation-maximization (EM) algorithm is employed to obtain maximum likelihood estimates, and standard errors are calculated based on the profile likelihood, treating the nonparametric baseline hazard as a nuisance parameter. A sampling-based method for model checking is proposed. It allows for graphical investigation of the assumption of proportional hazards across latent classes. It may also be used for checking other model assumptions, such as no additional effect of the observed indicators given latent class. The usefulness of the model framework and the proposed techniques are illustrated in an analysis of data from the Women's Health and Aging Study concerning the effect of severe mobility disability on time-to-death for elderly women. [source] | |||||||||||||||||||||||||||||||||||||