ORCID Profile
0000-0003-1935-7627
Current Organisation
Monash University Department of Epidemiology and Preventive Medicine
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Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2013
Publisher: Wiley
Date: 2007
DOI: 10.1002/ART.22535
Abstract: To evaluate the effects of age, physical activity, and body mass index (BMI) on patella cartilage volume and defects and bone volume in middle-aged women without knee pain. Magnetic resonance imaging was performed in 176 healthy women, ages 40-67 years, without knee pain to measure patella cartilage and bone volume and patella cartilage defects. The effects of age, physical activity, BMI, smoking, and alcohol were analyzed to determine whether associations existed between these variables and patella cartilage and bone volume and cartilage defects. Patella cartilage volume decreased with age (P = 0.01) and BMI (P = 0.05) after adjusting for age and patella bone volume. Patella bone volume was positively associated with body height in both the univariate and multivariate models. Cartilage defects in the patellofemoral compartment were present in 36.4% of the study population. Age, weight, and BMI were positively associated with the presence of cartilage defects in the multivariate analysis. This study demonstrated that although age is positively associated with both patella bone volume and cartilage defects, it is inversely associated with patella cartilage volume in healthy in iduals. Moreover, BMI is inversely associated with both patella cartilage volume and patella bone volume in middle-aged women without knee osteoarthritis. Longitudinal studies will be required to determine whether avoiding a high BMI will reduce the risk of developing patellofemoral osteoarthritis.
Publisher: BMJ
Date: 14-07-2009
Abstract: Bone marrow lesions (BML) are important in established knee osteoarthritis, predicting pain and progression of disease. Whether BML are also associated with longitudinal changes in knee structure in an asymptomatic population is unknown. 148 healthy pain-free women in middle age with no history of knee injury or clinical knee osteoarthritis who had a magnetic resonance imaging (MRI) scan performed on their dominant knee at baseline, had another MRI 2 years later to assess whether having a BML present at baseline affected change in tibiofemoral cartilage defects and tibial cartilage volume. BML were present in 14.9% of women at baseline. The risk of progression of total tibiofemoral cartilage defects was significantly higher when a very large BML was present (odds ratio 5.55, 95% CI 1.04 to 29.6) compared with when no BML was present, after adjusting for potential confounders. In the lateral compartment, the rate of cartilage volume loss was significantly greater when a BML was present after adjusting for confounders (regression coefficient 39.2 mm(3), 95% CI 11.1 to 67.2, p = 0.007). In healthy women without pain at baseline, large BML were associated with both progression of cartilage defects in the whole tibiofemoral joint and more rapid lateral tibial cartilage loss. These data suggest that the relationship between BML and knee cartilage in healthy women is similar to that described in established osteoarthritis. It is possible that BML may predict an increased risk of knee osteoarthritis and facilitate the identification of novel interventions to prevent disease.
Publisher: Elsevier BV
Date: 02-2009
DOI: 10.1016/J.MATURITAS.2008.12.017
Abstract: The aim of this study was to document the age-specific prevalence of different types of urinary incontinence (UI) in women and to identify the risk factors associated with each type of UI. A detailed self-administered questionnaire was mailed to 542 community-dwelling women, aged 24-80 years. The questionnaire included a validated instrument, the Questionnaire for Urinary Incontinence Diagnosis (QUID), for the assessment of stress, urge and mixed UI. Five hundred and six of the 542 women provided data (93.4%). The overall prevalence of any UI was 41.7% [95% confidence interval (CI): 37.2-45.8%]. Of the 210 women reporting UI, 16% [95% CI: 12.9-19.3%] reported stress only 7.5% [95% CI: 5.2-9.8%] reported urge only and 18% [95% CI: 14.7-21.5%] reported a mixed pattern. Stress incontinence was most common amongst middle-aged women (25.3% of women aged 35-44 years), while urge incontinence was most common in women over the age of 75 years (24.2%). In logistic regression analyses, obesity (p<0.001) and being parous (p=0.019) were found to be significantly associated with stress incontinence, increasing age (p=0.002) with urge incontinence, and being overweight (p=0.035) or obese (p<0.001) and having had a hysterectomy (p=0.021) with mixed incontinence. UI is a highly prevalent condition in women living in the community. Stress, urge and mixed incontinence have different age distributions and risk factors. These data are important in understanding the etiology, management and possible prevention of these conditions.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2013
Publisher: Wiley
Date: 25-07-2013
DOI: 10.1111/J.1741-6612.2011.00553.X
Abstract: To investigate vitamin D status among older women and to explore relationships between vitamin D and fracture risk and vertebral fractures. A total of 267 general practitioners recruited 2466 women aged >70 years with no known osteoporosis or fragility fracture. Serum 25-hydroxy vitamin D (25(OH)D), bone mineral density by dual-energy X-ray absorptiometry (DXA) and vertebral fracture on thoracolumbar X-ray were determined. A total of 2368 women, median age 76 years, provided data and of these 13% were on vitamin D supplements. 25(OH)D levels were available for 907 (44.1%) of those not taking vitamin D. 88.3% of these had a level below 75 nmol/L. Serum 25(OH)D was negatively associated with age (P = 0.003) and body mass index (P < 0.001), and positively associated with lower latitude, femoral neck DXA T-score (P = 0.044) and being Caucasian (P < 0.001). The vitamin D status of community-dwelling older Australian women is inadequate, yet the use of supplements is low.
Publisher: Informa UK Limited
Date: 18-05-2020
Publisher: Elsevier BV
Date: 12-2009
DOI: 10.1016/J.SEMARTHRIT.2008.05.003
Abstract: Bone marrow lesions (BML) have been implicated in the pathogenesis of osteoarthritis, yet their exact role, etiology, and natural history remain unclear. The aim of this study was to examine the natural history of BML in a healthy population and identify risk factors associated with their persistence and incidence. One hundred forty-eight healthy middle-aged women had magnetic resonance imaging performed on their dominant knee at baseline and 2 years later to assess the presence, natural history, and risk factors for persistence and incidence of BML. Approximately 46% of BML present at baseline completely resolved over 2 years. "Large" BML had the potential to improve, while the majority of "very large" remained stable. In those women with no BML at baseline, approximately 9% developed a BML over 2 years, the majority in the medial compartment. There was a trend toward weight being a risk factor for the development of "very large" BML (P = 0.08). The natural history of BML may be different in healthy persons compared with diseased states. The trend for weight as a risk factor for development of a "very-large" BML suggests there is potential to identify modifiable risk factors for BML in asymptomatic people and warrants further investigation.
Publisher: Springer Science and Business Media LLC
Date: 2009
DOI: 10.1186/AR2873
Publisher: Wiley
Date: 17-09-2013
DOI: 10.1111/J.1445-2197.2012.06229.X
Abstract: There is no evidence of benefit in terms of survival or quality of life for intensive surveillance of women with early breast cancer (BC) and current guidelines reflect this. We have examined whether Victorian women, nearly 4 years from a diagnosis of localized BC, were being managed according to these guidelines. Participants are women in the BUPA Health Foundation Health and Wellbeing after Breast Cancer prospective cohort study. All participants completed an enrolment questionnaire within 12 months of diagnosis and then completed follow-up questionnaires every 12 months thereafter. In the third follow-up questionnaire, completed nearly 4 years from the time of diagnosis, women were asked about imaging tests they had in the previous 12 months. The analysis was completed on 673 women who were stage 1 at the time of diagnosis and had not reported evidence of recurrence or a new BC since diagnosis. Of the 673, 603 (89.5%) reported having had a mammogram in the previous 12 months and 319 (52.9% of those having a mammogram) reported a breast ultrasound. Seventy-one per cent of women reported no other imaging investigations in the previous 12 months. Our study shows that, nearly 4 years from diagnosis, Australian practitioners are generally adhering to guidelines about imaging surveillance of BC survivors. Practitioners could use the guidelines for the education of BC survivors about appropriate health surveillance.
Publisher: Mary Ann Liebert Inc
Date: 12-2008
Abstract: To report on the issues encountered in the recruitment of healthy naturally menopausal women in the community to a randomized placebo-controlled trial of dehydroepiandrosterone (DHEA) therapy for treatment of loss of sexual desire. Recruitment of women was achieved by advertising and media publicity. We have reported on the method by which women initially contacted us and the reasons for nonparticipation. Nine hundred and eighteen women contacted us about participating in the study 706 of these were telephoned screened, and 93 of these (10%) women were randomized to therapy. The main determinants for nonparticipation included ineligibility on phone screening (58%), withdrawal of interest either before or after screening (55%), and preexisting pathology after attending for screening (8%). Despite ongoing interest by women to participate in research for therapies to treat low libido, concerns about the use of any hormonal treatment and the time poverty experienced by many women at midlife present new barriers to recruitment and need to be considered in assessing the feasibility of studies in this field.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2007
DOI: 10.1097/GME.0B013E31802F316B
Abstract: Exercise has been strongly promoted for the prevention of the major diseases of aging in women, such as cardiovascular disease and osteoporosis. However, conflicting data exist as to whether exercise benefits joint health and thus helps protect against degenerative processes such as knee osteoarthritis. The aim of this study was to examine the cross-sectional relationship between exercise and knee joint cartilage in women at midlife. A total of 176 women aged 40 to 67 years with no clinical knee osteoarthritis or history of significant knee injury were recruited from the community and had magnetic resonance imaging performed on their dominant knee to assess tibial cartilage volume and defects. The women completed a questionnaire to determine fortnightly exercise participation and frequency. Fortnightly participation in exercise at an intensity that caused tachypnea and an increased pulse rate for at least 20 minutes was positively associated with the volume of the medial tibial cartilage (P=0.02). There was a tendency for the frequency of exercise at this intensity to be positively associated with medial tibial cartilage volume (P=0.07). Exercise participation was not significantly associated with the presence of knee cartilage defects. Participation in exercise that causes tachypnea and an increased pulse rate for at least 20 minutes was associated with greater medial tibial cartilage volume, but not knee cartilage defects in non-healthcare-seeking women at midlife. More frequent exercise also tended to be associated with greater medial tibial cartilage volume. Although our findings need to be confirmed longitudinally, they provide further support for a beneficial effect of regular exercise on diseases related to aging.
Publisher: Oxford University Press (OUP)
Date: 07-2009
DOI: 10.1111/J.1743-6109.2009.01289.X
Abstract: Although the efficacy of testosterone for the treatment of hypoactive sexual desire disorder is well established, the effect of testosterone therapy on breast cancer risk remains uncertain. The incidence of invasive breast cancer among past and current testosterone users. Retrospective cohort study of 631 women ever treated with testosterone between January 1989 and December 2007 in a clinical endocrinology practice. The incidence of invasive breast cancer since first exposure, and the standardized incidence rate ratio (IRR) calculated using Australian age-specific incidence rates for 2005. The mean age of the women at first exposure to testosterone therapy was 49.1 +/- 8.2 years, median treatment duration, 1.3 years, and mean follow-up of 6.7 +/- 4.6 years, providing 4,015 woman-years of follow-up. Twelve cases of invasive breast cancer occurred among 599 women breast cancer-free before treatment, giving an age adjusted IRR of 1.35 (95% confidence interval 0.76-2.38). There was no evidence of an independent effect of duration of exposure on breast cancer risk. In this study, testosterone use was not associated with a significant increase in breast cancer risk.
Publisher: Informa UK Limited
Date: 21-10-2014
DOI: 10.3109/13697137.2014.954997
Abstract: This study was undertaken to determine whether metformin would ameliorate insulin resistance, reduce weight and waist circumference and improve lipids in obese, but not morbidly obese, euglycemic women. Obese women (body mass index (BMI) ≥ 30 and 88 cm), aged 35-65 were randomized (1:1) to metformin 850 mg or identical placebo, twice daily for 26 weeks. The primary outcome was the change in insulin resistance determined by the homeostasis model of assessment (HOMA-IR). Secondary outcomes included fasting insulin, glucose, weight, waist circumference and BMI. Of the 125 women screened, 117 enrolled and 100 women, mean age 53 years, were included in the primary intention-to-treat analysis. Metformin resulted in statistically significant between-group difference in the change in HOMA-IR (change in median - 0.04 vs. placebo + 0.1, p = 0.018) and BMI (mean change - 1.00 kg/m(2) 95% confidence interval (CI) 1.37 to - 0.62 vs. placebo mean change 0.00 95% CI - 0.29 to 0.28, p < 0.001). Statistically significant reductions in HbA1c (p = 0.008) and fasting insulin (p = 0.03) and a borderline decrease in high density lipoprotein cholesterol (p = 0.07) were also observed for metformin, compared with placebo. No effects were seen for waist circumference, fasting glucose or other lipids. Treatment of euglycemic, obese, middle-aged women with metformin 1700 mg per day reduced insulin resistance and weight compared with placebo. Further studies are needed to determine whether the use of metformin will prevent the progression of insulin resistance to type 2 diabetes mellitus in obese women.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2008
DOI: 10.1097/GME.0B013E31816DDB6F
Abstract: There are currently no programs to assess ovarian health in postmenopausal women. The aim of this study was to describe the ovaries in healthy women at least 5 years after menopause by questionnaire, transvaginal ultrasonography, and blood ovarian cancer markers. A total of 515 women who were asymptomatic and at the Stages of Reproductive Aging Workshop +2 stage of menopause (>5 y postmenopause) were recruited by advertisement. Clinical history was obtained by questionnaire, and biophysical assessment by a transvaginal ultrasound investigation and biochemical assessment by serum CA-125 and inhibin were performed. Abnormal findings were confirmed and then reviewed. Both ovaries were identified by transvaginal ultrasonography in 71% of women. The right ovary was visualized in 86.3% of these volunteers, and the left ovary was visualized in 78%. The presence of small unilocular cysts and echogenic foci facilitated identification of the ovary in some women. Ovarian araovarian lesions were present in 12.6% of women. Abnormalities of the endometrium and uterus were also common, prompting surgery in 7.2% of the women. Total serum inhibin concentrations were normal for postmenopausal women, whereas serum CA-125 was elevated in two women. We find that the description and detection of postmenopausal ovaries by transvaginal ultrasonography allows the identification of both ovaries in most postmenopausal women. Ultrasonography-detected abnormalities of the ovary and/or the uterus/endometrium are common in women at this stage of life. The potential need for surgical intervention after the detection of such abnormalities needs to be carefully evaluated when considering transvaginal ultrasonography as a screening tool for ovarian cancer.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2006
Publisher: JMIR Publications Inc.
Date: 08-12-2022
Abstract: lcohol consumption is a major modifiable risk factor for female breast cancer, even in small amounts. However, awareness of this risk remains low. National breast screening programs are uniquely positioned to provide timely and targeted health information and behavior change strategies to improve alcohol literacy and reduce consumption. A breast screening service is a novel health care setting for brief alcohol intervention, with the potential for extensive reach. his study aimed to conduct a formative evaluation with breast screening service consumers to understand the need for, and acceptability of, brief alcohol intervention in the breast screening setting and collaboratively design a brief alcohol intervention (Health4Her) to test the effectiveness of Health4Her in improving knowledge of alcohol as a breast cancer risk factor (primary outcome), improving alcohol literacy, and reducing consumption among women attending a breast screening service and to examine the implementation strategy through process evaluation. his was a hybrid type II effectiveness-implementation trial comprising a randomized controlled trial (RCT) alongside a mixed methods program evaluation guided by applicable elements of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework and Consolidated Framework for Implementation Research. Formative evaluation comprised a retrospective analysis of alcohol consumption data (n=49,240), a web-based survey (n=391), and focus groups and interviews (n=31) with breast screening service consumers. Women attending routine mammography, drinking at any level, were recruited to the single-site, double-blind RCT (n=558), and completed a baseline assessment before randomization (1:1) to receive Health4Her (alcohol brief intervention + lifestyle information) or control (lifestyle information) via animation on an iPad. Follow-up assessments were performed 4 and 12 weeks after randomization. The process evaluation included evaluation of trial administrative data, participant quantitative (n=497) and qualitative feedback (n=30), and site staff qualitative feedback (n=11). his research was funded in March and May 2019. Data collection for the formative evaluation and trial recruitment occurred between January and April 2020 and February and August 2021, respectively, with finalization of follow-up data collection in December 2021. Quantitative process evaluation data were collected during trial implementation, and collection of participant and staff feedback was finalized in December 2021. Results of the retrospective analysis of alcohol consumption data from breast screening service consumers is anticipated to be published in March 2023 and the results of the RCT to be published in March 2023. his study is anticipated to generate new substantial knowledge on the alcohol consumption and literacy needs of women attending breast screening and the extent to which these can be addressed using a novel, tailored brief alcohol intervention. The study design permits the evaluation of the effectiveness and implementation of Health4Her to predict and facilitate uptake in breast screening services. linicalTrials.gov NCT04715516 t2/show/NCT04715516 R1-10.2196/44867
Publisher: Wiley
Date: 10-2006
Publisher: Informa UK Limited
Date: 2006
DOI: 10.1080/13697130600641282
Abstract: Factors that contribute to cognitive decline in women from midlife remain poorly understood. There are circumstantial data indicating a positive association between homocysteine and cognitive decline and that endogenous and exogenous estrogen may influence homocysteine levels. The aim of this review was to establish what is known of the relationships between cognitive change and homocysteine levels, and the impact of the menopause transition and exogenous estrogen on homocysteine levels. We reviewed the recent published literature from 1993 to 2005 pertaining to the current understanding of the relationship(s) between plasma homocysteine levels and cognitive functioning and endogenous hormone levels and exogenous estrogen use in women. Hyperhomocysteinemia is consistently associated with cognitive decline. Dietary supplementation with vitamins may assist in normalizing homocysteine levels however, there is no evidence that this results in favorable effects on cognition. Changes in endogenous estrogen levels are inversely associated with changes in serum homocysteine. Consistent with this, estrogen therapy is associated with reductions in plasma homocysteine, with the greatest effects reported in women with higher levels of homocysteine at baseline. Limited data indicate that tibolone is associated with little change in homocysteine. The use of raloxifene, the most studied selective estrogen receptor modulator, is associated with a modest reduction in homocysteine. There are data to suggest an underlying link between homocysteine levels and cognitive decline. There is also evidence for a link between both the menopause transition and use of exogenous estrogen therapy and homocysteine levels. Clinical data do not support a role for exogenous estrogen in the prevention of dementia in older women however, the 'window of opportunity' theory suggests that there is a need for randomized controlled trials to evaluate the role of estrogen in the early postmenopausal years to protect against cognitive decline in later life.
Publisher: Elsevier BV
Date: 08-2014
DOI: 10.1016/J.JOCA.2014.06.008
Abstract: There is evidence for an association between levels of urinary C-telopeptide fragments of type II collagen (uCTX-II) and risk of knee osteoarthritis (OA). The aim of this cohort study was to examine the association between uCTX-II levels and knee cartilage and bone changes in middle-aged women without clinical knee disease. 140 women, aged 40-67 years, with no significant knee pain, knee injury or any forms of arthritis, underwent knee magnetic resonance imaging (MRI) at baseline and 2 years later. Cartilage volume, cartilage defects, tibial plateau bone area and bone marrow lesions (BMLs) were measured using validated methods. Baseline uCTX-II was measured using enzyme-linked immunosorbent assay (ELISA). For every one unit (natural logarithm transformed) increase in baseline uCTX-II level, there was an increase in the prevalence of medial tibiofemoral cartilage defects (Odds ratio (OR) 4.36, 95% confidence interval (CI) 1.58-12.04), medial (80.2 mm(2), 95% CI 9.3-151.1) and lateral (86.0 mm(2), 95% CI 33.3-138.7) tibial plateau bone area, and the prevalence of lateral tibiofemoral BMLs (OR 10.62, 95% CI 1.82-61.85). Baseline uCTX-II levels were not significantly associated with baseline tibial cartilage volume or changes in knee cartilage volume or defects or bone area over 2 years, although there was a trend for the deterioration of medial tibiofemoral BMLs (P = 0.06). In middle-aged women without clinical knee disease, higher uCTX-II levels were associated with early detrimental structural changes at the knee (cartilage defects, tibial bone expansion and BMLs) at baseline but not over 2 years. Further work will be needed to determine its sensitivity to change and whether it predicts disease progression over longer time periods.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2013
Publisher: Informa UK Limited
Date: 22-07-2018
DOI: 10.1080/13697137.2018.1476968
Abstract: In this opinion piece, we discuss the issue of lack of reproducibility in medical research and the different approaches that are being taken to address this problem. One general approach involves much greater transparency including the pre-publication of a study protocol, analysis plan and analysis code as well as the ultimate sharing of data, doing away with the concept of the 'single wrap-up publication'. The other change required is to support the training and mentorship of young researchers and ensure that they are not working in isolation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2006
Publisher: Informa UK Limited
Date: 03-12-2011
DOI: 10.3109/13697137.2011.614026
Abstract: Cosmetic breast surgery is amongst the top five most commonly performed cosmetic surgical procedures. With breast cancer being the most common non-skin malignancy in women, the likelihood that a woman undergoing cosmetic breast surgery may have an occult breast cancer needs to be considered. Most of the available data pertaining to breast cancer diagnosis in the setting of cosmetic surgery are from studies of cosmetic breast surgery populations. We report on the prevalence of breast cancer as an incidental finding during cosmetic breast surgery in the context of women subsequently diagnosed with invasive breast cancer. The Bupa Health Foundation Health and Wellbeing after Breast Cancer Study is a prospective cohort study of 1684 women recruited within 12 months of their first diagnosis with invasive breast cancer. Participants completed an enrolment questionnaire and annual follow-up questionnaires for 5 years. At the second follow-up, 1.5% of women reported having undergone cosmetic breast surgery prior to being diagnosed with breast cancer, 16 had undergone breast reduction and seven had augmentations. Invasive breast cancer was diagnosed at the time of a cosmetic breast procedure in two women, in both an augmentation and a reduction procedure, which is 8.7% (95% confidence interval 23.5% to +20.9%) of the women in our study reporting a cosmetic breast procedure prior to diagnosis. Although prior cosmetic breast surgery was reported by few women, breast cancer was diagnosed in two women during the procedure. Surgeons performing elective breast surgery need to understand and apply consistent, reliable breast cancer screening practices.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2013
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.MATURITAS.2015.11.002
Abstract: To investigate the awareness of breast cancer (BCa) and BCa screening amongst women at midlife in Bangladesh. A nationally representative cross-sectional survey of women aged 30-59 years was conducted in 7 districts of the 7 isions in Bangladesh, using a multistage cluster s ling technique. The factors associated with the awareness of BCa and breast assessment of asymptomatic women were investigated separately, using multivariable logistic regression. Of the 1590 participants, mean age 42.3 (±8.0) years, 81.9% had ever heard of BCa and 64.2% of any methods of BCa screening, respectively. Awareness of BCa was associated with being aged 40-49 years (adjusted OR 2.04, 95% CI 1.46-2.84), aged 49-59 years (1.96, 1.32-2.91), being overweight (1.46, 1.07-2.01) and obesity (1.62, 1.01-2.62), while inversely associated with rural dwelling (0.37, 0.22-0.61), primary education (0.44, 0.27-0.70), having no education (0.23, 0.14-0.36) and parity (0.62, 0.44-0.87). Of the 750 women who were aware of clinical breast examination (CBE) or mammography, reasons provided for not undergoing screening included that they had no symptoms (92%) and that they did not know screening was needed (40%). 8% of women reported CBE. Women with no education were less likely to have undergone CBE (0.38, 0.141.04 p=0.059). Lack of understanding of the assessment of asymptomatic women is the key obstacle to BCa screening uptake in Bangladesh. Health education programs, especially BCa awareness programs, have the potential to increase BCa awareness and down-staging of the disease.
Publisher: Springer Science and Business Media LLC
Date: 13-04-2006
Abstract: By providing information on the relative merits and potential harms of the options available and a framework to clarify preferences, decision aids can improve knowledge and realistic expectations and decrease decisional conflict in in iduals facing decisions between alternative forms of action. Decision-making about prenatal testing for fetal abnormalities is often confusing and difficult for women and the effectiveness of decision aids in this field has not been established. This study aims to test whether a decision aid for prenatal testing of fetal abnormalities, when compared to a p hlet, improves women's informed decision-making and decreases decisional conflict. A cluster designed randomised controlled trial is being conducted in Victoria, Australia. Fifty General Practitioners (GPs) have been randomised to one of two arms: providing women with either a decision aid or a p hlet. The two primary outcomes will be measured by comparing the difference in percentages of women identified as making an informed choice and the difference in mean decisional conflict scores between the two groups. Data will be collected from women using questionnaires at 14 weeks and 24 weeks gestation. The s le size of 159 women in both arms of the trial has been calculated to detect a difference of 18% (50 to 68%) in informed choice between the two groups. The required numbers have been adjusted to accommodate the cluster design, miscarriage and participant lost – to – follow up. Baseline characteristics of women will be summarised for both arms of the trial. Similarly, characteristics of GPs will be compared between arms. Differences in the primary outcomes will be analysed using 'intention-to-treat' principles. Appropriate regression techniques will adjust for the effects of clustering and include covariates to adjust for the stratifying variable and major potential confounding factors. The findings from this trial will make a significant contribution to improving women's experience of prenatal testing and will have application to a variety of maternity care settings. The evaluation of a tailored decision aid will also have implications for pregnancy care providers by identifying whether or not such a resource will support their role in providing prenatal testing information.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2010
Publisher: Elsevier BV
Date: 11-2009
DOI: 10.1016/J.CONTRACEPTION.2009.03.021
Abstract: The study was conducted to perform a direct comparison of the satisfaction of intrauterine device (IUD) users and Implanon users after 6 months. Women were recruited to this study in the contraception clinics of Southern Health and Family Planning Victoria. Each woman completed a questionnaire at the time of starting her contraception with either an IUD or Implanon. Women were sent a follow-up questionnaire after 6 months to assess their satisfaction with their chosen method of contraception. A total of 439 participants were recruited for this non randomized cohort study 211 choosing an IUD and 228 choosing to use Implanon. The main reason patients in both groups chose their contraceptive method was recommendation by the doctor. Follow-up was achieved in over 84% in both groups. More than 50% of women in both groups reported at least one side effect. The most commonly reported side effect in both groups was abnormal bleeding and this was also the most common reason for having the contraceptive device removed. The IUD users reported a higher rate of satisfaction with their chosen method of contraception, although there was no difference between groups in the removal rate or whether the women would recommend the contraception to others. IUD users reported a higher level of satisfaction than did Implanon users at 6 months. Side effects in women using IUDs and Implanon are common. The range of likely side effects should be included in counseling women about long-term reversible contraception.
Publisher: Informa UK Limited
Date: 19-04-2012
DOI: 10.3109/13697137.2012.658461
Abstract: The prevalence of major depression disorder in women is double that seen in men, with the menopause transition being associated with increased vulnerability to depression. Selective serotonin reuptake inhibitors (SSRIs), which constitute 70-80% of antidepressant prescriptions, are associated with secondary sexual dysfunction in 35-70% of users. Different strategies for approaching sexual dysfunction secondary to SSRI medication have been investigated. Most interventions fail to show significant benefit on sexual function compared to placebo moreover, adjuvant therapies commonly result in side-effects and tolerability problems. While antidepressant-associated sexual dysfunction in women has been a concern for many years, there remains a need for more research into the optimal management of antidepressant-associated sexual dysfunction in women, including multidisciplinary approaches. Further randomized, controlled trials assessing multidisciplinary approaches are required before clinicians or patients can be confident of the benefits of any intervention. Despite the efficacy of testosterone in improving sexual function in non-depressed women, there is no information regarding the efficacy of testosterone in treating antidepressant-associated sexual dysfunction in women.
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.BREAST.2012.04.006
Abstract: This study explored factors associated with the likelihood of reconstruction after unilateral mastectomy and the wellbeing of women after reconstruction. Data were from a questionnaire completed on average 1.8 years after diagnosis by 1429 women in the BUPA Health and Wellbeing After Breast Cancer Study. Logistic regression was used to model factors associated with reconstruction. The Psychological General Wellbeing Questionnaire was used to assess wellbeing. A total of 25.4% of 366 women who had a unilateral mastectomy had undergone a reconstruction nearly two years after diagnosis. Being younger (p<0.001), educated beyond school (p<0.04), living in the metropolitan area (p<0.001), having private health insurance (p=0.003), not having dependent children (p=0.004) and not having radiotherapy (p<0.001) explained just over 40% of the variation in reconstruction status. There was a modest difference between women who did and did not have a reconstruction in terms of wellbeing. Demographic factors strongly influence the likelihood of reconstruction after mastectomy.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2015
Publisher: Elsevier BV
Date: 06-1986
DOI: 10.1016/S0140-6736(86)91662-4
Abstract: A radioimmunoassay for relaxin was developed in which a synthetic analogue of human relaxin was used as standard, tracer, and immunogen. Relaxin could not be measured in sera from men or non-pregnant women, but was measurable in pregnant women from the tenth week of gestation until term. Concentrations ranged from 0.19-1.18 ng/ml, with highest levels measured in the first trimester.
Publisher: Springer Science and Business Media LLC
Date: 28-05-2008
Publisher: Wiley
Date: 07-03-2011
DOI: 10.1002/PON.1949
Abstract: To explore the beliefs held by breast cancer (BC) survivors about the factors that contribute to the development of their BC. The BUPA Health Foundation Health and Well-being after Breast Cancer Study is a prospective cohort study of 1684 women recruited within 12 months of their first diagnosis with invasive BC. Participants completed an enrollment questionnaire (EQ), first follow-up questionnaire (FQ1) and a second follow-up questionnaire (FQ2), 12 months and 24 months post-EQ, respectively. In the FQ2, women were asked whether they believed anything contributed to the development of their BC and whether they had made lifestyle changes since the FQ1. Well-being was assessed at the FQ2 using the psychological general well-being index (PGWB). In total, 1496/1684 women completed the FQ2 and 43.5% reported belief in a factor that may have contributed to their developing BC. These women were more likely to be younger (p<0.0001) and educated beyond high school (p<0.0001). Stress (58.1%) was the most common reason given, followed by previous use of hormone therapy (17.0%) and a family history of any cancer (9.8%). Women who believed stress contributed to their BC had lower PGWB scores than other study participants (70.9 ± 16.1, n = 361 versus 77.3 ± 14.9, n = 1071, mean difference = 6.4, 95% CI: 4.6-8.2 p<0.0001) and were more likely to have made lifestyle changes since their BC diagnosis. Many women with BC believe that stress has contributed to their condition. Women who held this belief were more likely to adopt strategies to reduce stress than those who did not.
Publisher: Oxford University Press (OUP)
Date: 09-2009
DOI: 10.1111/J.1743-6109.2009.01381.X
Abstract: Dehydroepiandrosterone (DHEA) and its sulfate DHEAS, which are the most abundant steroids in women, decline with age. We have shown association between low sexual function and low circulating DHEAS levels in women. The aim of this study was to evaluate whether restoration of circulating DHEA levels in postmenopausal women to the levels seen in young in iduals improves sexual function. Ninety-three postmenopausal women not using concurrent estrogen therapy were enrolled in a 52-week randomized, double-blind, placebo controlled trial and received either DHEA 50 mg or placebo (PL) daily. Efficacy was assessed through 26 weeks. The main outcome measures were the change in total satisfying sexual events (SSE) and the change in the Sabbatsberg Sexual Self-Rating Scale (SSS) total score. Secondary measures were the Psychological General Well-Being Questionnaire (PGWB), and the Menopause-Specific Quality of Life Questionnaire (MENQOL). Hormonal levels, adverse events (AEs), serious adverse events (SAEs) and clinical labs were evaluated over 52 weeks. Eighty-five participants (91%) were included in the 26-week efficacy analysis. There were no significant differences between the DHEA and PL groups in the change in total SSE per month or the SSS, PGWB, and MENQOL change scores. Overall AE reports and number of withdrawals as a result of AEs were similar in both groups however more women in the DHEA group experienced androgenic effects of acne and increased hair growth. In this study treatment of postmenopausal women with low sexual desire with 50 mg/day DHEA resulted in no significant improvements in sexual function over PL therapy over 26 weeks.
Publisher: Wiley
Date: 2001
DOI: 10.1002/PD.153
Abstract: Forty percent of pregnant women aged 37 years and over do not have prenatal diagnosis despite being eligible for a free test. The present study aimed to determine how often, and which, untested women were making a choice about this, how many declined an offer and why. A questionnaire was given to untested women, aged 37 years and over, at no less than 24 weeks gestation. A total of 375 (81.5%) women declined, 72 (16%) were not offered a test and 13 presented too late antenatally. There was a three-fold increased likelihood (OR 3.10 95% CI 1.44, 6.65) of no offer for urban non-English speaking background women, compared with the reference group (metropolitan, English speaking). Unpartnered women were also significantly less likely to receive an offer (OR 3.18, 95% CI 1.19, 8.46). Risk to the baby was the main reason for declining. When offered non-invasive prenatal screening, most decliners of prenatal diagnosis accepted, even those who declined because they were opposed to abortion. We estimate that overall 33% of older pregnant women were being offered and declining amniocentesis and/or chorion villus s ling (CVS). Only 6% were not offered a test, but this small proportion is over-represented by minority groups who must be given equal opportunity to make this choice.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2009
DOI: 10.1097/GME.0B013E3181AA1C93
Abstract: We have previously reported on the point prevalence of ovarian lesions detected by transvaginal ultrasound (TVU) in 515 asymptomatic women at least 5 years postmenopause. The aims of this study were to report, in the same women, on the repeatability of visualization of the ovaries (TVU) and the natural history of ovarian lesions seen at baseline but not treated surgically and to assess whether any women developed new ovarian abnormalities 12 months later. The study involved a cohort of 515 postmenopausal women recruited from the community, at least 5 years past their last period. They were assessed at baseline and again after 12 months with TVU and serum levels of inhibin and CA-125. The right and left ovaries were seen on both occasions in 80% and 68% of women, respectively. Of the 49 women who had an ovarian lesion at baseline, did not undergo surgery at that time, and had a follow-up TVU, the lesion was unchanged 12 months later in 30 women. Four women developed a new ovarian lesion within the 12 months. None of the 14 women who underwent surgery on the basis of the ovarian appearance at baseline, or the 2 who had surgery on the basis of the ovarian appearance at follow-up, had an ovarian malignancy. The use of TVU in women at least 5 years after menopause is problematic because the ovaries cannot be visualized in all women and because TVU has the potential to identify many benign lesions that would otherwise remain undetected. These are important considerations in weighing up the risks and benefits of using TVU as a screening tool.
Publisher: Springer Science and Business Media LLC
Date: 26-08-2009
DOI: 10.1007/S00520-009-0726-Z
Abstract: The aim of this study was to document the psychological well-being of a group of women with invasive breast cancer (BC) on an average of nearly 2 years after their diagnosis. Participants were women in the Medical Benefits Fund Australia Limited Foundation Health and Wellbeing after Breast Cancer Study, a cohort study of 1,684 women recruited within 12 months of their diagnosis with invasive BC, who completed their first annual follow-up questionnaire. Psychological well-being was measured using the Psychological General Well Being Index questionnaire (PGWB) in women with BC. The PGWB questionnaire was completed by 1,589 women on an average of 92 weeks after their BC diagnosis, of whom 46 had evidence of active disease. PGWB total scores for all age groups of the BC cohort were lower than community-based norms (p or =70, 60-<70, 50-60 p = 0.002 for age group 40-<50 and p = 0.05 for age group <40). PGWB total scores for the BC cohort were positively associated with age (p < 0.001) and living with others (p < 0.01) and inversely associated with active disease (p < 0.001) and education beyond secondary school (p = 0.03). For the domain of anxiety, there was no statistically significant association with living with others but an inverse association with education beyond school. A higher level of education may be associated with increased anxiety and lower well-being. Social support is particularly important for women with BC who are known to live alone.
Publisher: Springer Science and Business Media LLC
Date: 02-05-2008
Publisher: Informa UK Limited
Date: 09-07-2021
DOI: 10.1080/13697137.2021.1936486
Abstract: This study aimed to explore Australian health-care providers' knowledge of menopause and its consequences, and their views about menopause-related health care. This was a cross-sectional qualitative study of Australian general practitioners (GPs), gynecologists (GYs) and pharmacists (PHs). Recruitment was ultimately achieved through professional networks and cold calling. There were equal numbers of GPs, GYs and PHs, and equal numbers of males and females in each group. All participants demonstrated sound understanding of menopause and its consequences. A strong theme was recognition of high usage of complementary and alternative medicines (CAMs) by women for menopausal symptoms. Most participants highlighted lack of efficacy evidence for most CAMs, but the majority of GPs and PHs considered CAMs to 'have a role'. Most supported menopausal hormone therapy (MHT) when symptoms impaired quality of life. Limitations to comprehensive care included knowledge gaps and lack of time. Australian health-care providers appeared knowledgeable about menopause, but uncertain about its management. MHT prescription appeared limited to women with severe symptoms despite lifestyle modification and a trial of CAMs. The upskilling of clinicians providing care for women at midlife, with respect to the indications for and prescribing of MHT, urgently needs to be addressed.
Publisher: Oxford University Press (OUP)
Date: 22-09-2013
Publisher: Oxford University Press (OUP)
Date: 11-2012
Publisher: Oxford University Press (OUP)
Date: 02-2010
Publisher: Springer Science and Business Media LLC
Date: 2008
DOI: 10.1186/AR2380
Publisher: Wiley
Date: 11-09-2012
DOI: 10.1111/J.1365-2265.2011.04301.X
Abstract: Sex hormone-binding globulin (SHBG) is a robust predictor of insulin resistance. Whether this is independent of circulating sex steroid levels remains uncertain. The aim of this study was to investigate the determinants of SHBG in postmenopausal women and whether the relationship between SHBG and insulin resistance is independent of oestrogen and androgen levels. A cross-sectional study of naturally and surgically menopausal women. Seven hundred and sixty three postmenopausal women not using any systemic hormone therapy, mean age 54·4 ± 5·8 years, recruited in the US, Canada, Australia, UK and Sweden between July 2004 and February 2005. Relationships between log-transformed (ln) SHBG and ln homoeostasis model assessment for insulin resistance (HOMA-IR) were explored, taking into account age, body mass index (BMI), blood pressure (BP) and circulating oestradiol, oestrone, testosterone and dihydrotestosterone. Taking into account age, race, years since menopause, menopause type, BMI, BP, prior postmenopausal hormone use and the sex steroids measured, 34·4% of the variation in SHBG could be explained by the model that included negative contributions by HOMA-IR, BMI and diastolic BP, and a positive contribution by total testosterone (P < 0·001). None of the sex steroids made independent contributions to HOMA-IR, which was best explained by the model that included BMI, SHBG, systolic BP and surgical menopause, with each variable being positively related to HOMA-IR (r(2) = 0·3152, P = 0·03). The relationship between SHBG and HOMA-IR, as an estimate of insulin resistance, is not explained by endogenous oestrogen and androgen levels and is, at least in part, independent of BMI in postmenopausal women.
Publisher: Wiley
Date: 04-2014
DOI: 10.1111/IMJ.12205
Abstract: Although there is evidence that minimal surveillance is compatible with an optimal outcome in women after early stage breast cancer, little is known of the surveillance that these women receive. To describe the intended clinical follow up and patterns of use of imaging modalities in low-risk breast cancer survivors who are at least 5 years from diagnosis. Participants in the Bupa Health Foundation Health and Wellbeing After Breast Cancer Study with stage 1 invasive breast cancer at diagnosis, who had survived free of recurrence or new primary breast cancer for at least 5 years, provided information for this analysis. The most common choice of physician follow up was with one doctor only (54%). Within this group, the most frequent choice was a general practitioner (GP) (63%) followed by medical oncologist (23%). Thirty-five per cent of women said that they intended to consult two doctors and within this group, the most common combination was a GP and a medical oncologist (45%). This was despite two out of three women reporting being advised that there was no need to consult a medical oncologist. Over 90% of women reported having a mammogram with, or without, breast ultrasound in the previous 12 months. There was a low rate of use of other imaging tests in the absence of clear indications. Minimising unnecessary medical consultations by women with breast cancer at low risk of recurrence 5 years from diagnosis will require education about the benefits of a minimal surveillance strategy.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2015
Publisher: The Endocrine Society
Date: 07-2005
DOI: 10.1210/JC.2005-0212
Abstract: Context: Changes in androgen levels across the adult female life span and the effects of natural menopause and oophorectomy have not been clearly established. Objective: The objective of this study was to document the effects of age on androgen levels in healthy women and to explore the effects of natural and surgical menopause. Design, Setting, and Participants: A cross-sectional study was conducted of 1423 non-healthcare-seeking women, aged 18–75 yr, randomly recruited from the community over 15 months. Main Outcome Measures: Serum levels by age of total testosterone (T), calculated free T, dehydroepiandrosterone sulfate, and androstenedione in a reference group of women free of confounding factors. Women in the reference group had no usage of exogenous steroid therapy no history of tubal ligation, hysterectomy, or bilateral oophorectomy and no hyperprolactinemia or polycystic ovarian syndrome. The effects of natural and surgical menopause on sex steroid levels were also examined. Results: In the reference population (n = 595), total T, calculated free T, dehydroepiandrosterone sulfate, and androstenedione declined steeply with age (P & 0.001), with the decline of each being greater in the earlier than the later decades. Examination of serum androgen levels by year in women aged 45–54 yr showed no independent effect of menopausal status on androgen levels. In women aged 55 yr or older, those who reported bilateral oophorectomy and were not on exogenous steroids had significantly lower total T and free T levels than women 55 yr or older in the reference group. Conclusions: We report that serum androgen levels decline steeply in the early reproductive years and do not vary because a consequence of natural menopause and that the postmenopausal ovary appears to be an ongoing site of testosterone production. These significant variations in androgens with age must be taken into account when normal ranges are reported and in studies of the role of androgens in women.
Publisher: Wiley
Date: 05-05-2014
DOI: 10.1111/CEN.12459
Abstract: The aim of this study was to examine the effects of testosterone on verbal learning and memory in postmenopausal women. Randomized, placebo-controlled trial in which participants were randomized (1:1) to transdermal testosterone gel 300 mcg/day, or identical placebo, for 26 weeks. Ninety-two postmenopausal women aged 55-65 years, on no systemic sex hormone therapy. The primary outcome was the score for the International Shopping List Task (ISLT) of CogState. Secondary outcomes included other CogState domains, the Psychological General Well-Being Index (PGWB) and safety variables. Eighty-nine women, median age 60 years, were included in the primary analysis. Testosterone treatment resulted in statistically significantly better performance for the ISLT (improved verbal learning and memory) compared with placebo, adjusted for age and baseline score (mean difference 1·57 95%CI 0·13, 3·01) P = 0·03). There were no significant differences for other CogState domains or the PGWB scores. At 26 weeks, the median total testosterone was 1·7 nm (interquartile range (IQR) 1·1, 2·4) in the testosterone group and 0·4 nm (IQR 0·3, 0·5) in the placebo group. The small but statistically significant effect of testosterone treatment on verbal learning and memory in postmenopausal women provides the basis for further clinical trials.
Publisher: Wiley
Date: 04-01-2023
DOI: 10.1111/CEN.14874
Abstract: To explore the associations between endogenous testosterone blood concentrations and muscle mass, strength and performance in community dwelling women. Online databases, including Ovid MEDLINE, EMBASE and Web of Science, were searched for observational studies, with at least 100 female participants, reporting associations between endogenous testosterone blood concentrations and muscle mass, strength and performance. The findings were synthesized in a narrative review. Heterogeneity in study design and analysis precluded a meta‐analysis. Of the 36 articles retrieved for full‐text review, 10 met the inclusion criteria. Eight studies were cross‐sectional, 1 longitudinal and 1 provided both cross‐sectional and longitudinal data. Testosterone was measured by liquid chromatography‐tandem mass spectrometry in two studies and by immunoassay in 8. An association between total testosterone and muscle mass, strength or performance in women was not found. The studies of calculated free or bioavailable testosterone and lean muscle mass reported a positive association, but no association was reported for muscle strength or performance. Each included study was limited by a high risk of bias in at least one assessed domain. This review does not support an association between testosterone and muscle mass, strength or performance in women. This, together with the reported associations between free or bioavailable testosterone and muscle mass should be interpreted cautiously due to the predominant use of immunoassay and the inaccuracy of calculated variables. Additionally, biological significance of nonprotein bound testosterone has not been established. Further studies examining the relationship between precisely measured testosterone and muscle mass and function in women are required.
Publisher: Wiley
Date: 08-01-2019
Abstract: The aim of this study was to investigate mammographic density in a s le of Victorian women and explore a possible association between mammographic density and ethnicity. Categories of mammographic density, using Volpara Density Grade, were reported using two editions of Volpara automated software in a data set of women attending two Victorian sites for mammographic screening. The variables available for analysis were age, self-reported exposure to menopausal hormone therapy (MHT) and ethnicity based on country of birth. Data from 16,943 women were available for analysis. Using the VDG 4th edition, 40% of women were classified in the higher two categories (42% for the 5th edition) and 76.9% of women were in the same VDG category using both systems. In the s le, 87.7% of women were in the age range currently invited for screening in Victoria (50-74 years). Of the total group, 82.5% could be classified on the basis of country of birth. In multivariable logistic regression analyses examining factors associated with higher VDG, age (protective), use of MHT (risk factor) and being born in a country with predominantly Asian ancestry (risk factor) were all statistically significant at P < 0.001 for both editions irrespective of whether the reference category was the lowest two or three VDG categories. Mammographic density as assessed by VDG was positively associated with ever exposure to MHT and inversely associated with age. Being born in a country with predominantly Asian ancestry was associated with higher VDG when controlled for age and MHT exposure.
Publisher: Springer Science and Business Media LLC
Date: 24-02-2013
DOI: 10.1007/S00520-013-1763-1
Abstract: The aim of this work was to study the incidence and prevalence of self-reported lymphedema in breast cancer survivors between 2 and 4 years following diagnosis, the factors associated with the development of lymphedema and the impact of lymphedema on psychological well-being. We assessed self-reported lymphedema in the BUPA Health Foundation Health and Wellbeing After Breast Cancer Study, a questionnaire-based study of 1,683 women newly diagnosed with their first episode of invasive breast cancer in Victoria, Australia. Psychological well-being was assessed using the Psychological General Well-being Index. Two years after diagnosis, nearly 20 % of women reported lymphedema and this proportion remained above 18 % 2 years later. However, self-reported lymphedema was a dynamic phenomenon, with the condition resolving in some women and others reporting onset for the first time up to 4 years from diagnosis. Lymphedema 2 years from diagnosis was positively associated with the number of nodes removed at initial surgery, although this variable only explained a small proportion of the likelihood of reporting lymphedema. The presence of lymphedema was associated with lower psychological general well-being. Lymphedema after breast cancer treatment frequently has a dynamic pattern and may emerge as an issue for women several years after their initial treatment. It is associated with a lower level of general well-being.
Publisher: Informa UK Limited
Date: 04-05-2021
Publisher: Springer Science and Business Media LLC
Date: 17-02-2009
DOI: 10.1007/S10689-009-9236-X
Abstract: To document the prevalence of family history of breast cancer (BC) amongst women newly-diagnosed with invasive BC and to explore the relationship between family history and cancer size and stage. A cross-sectional analysis was conducted on baseline questionnaire data from a cohort study of 1,684 women diagnosed with invasive BC within the previous 12 months and recruited between 2004 and 2006 in Victoria, Australia. Women with affected first degree relative(s) were more likely to have a smaller BC (odds ratio for <or=10 mm 1.74, 95% CI: 1.32-2.29) and stage I BC (odds ratio 1.31, 95% CI: 1.01-1.70) at diagnosis than women with no affected relatives. There was no significant difference in BC size and stage between women with only affected second degree relatives and women with no affected relatives. Women with a first degree relative with BC had smaller, earlier stage cancers at diagnosis, possibly reflecting more diligent use of breast screening amongst women who considered themselves at increased risk of developing the disease.
Publisher: Oxford University Press (OUP)
Date: 20-11-2015
DOI: 10.1634/THEONCOLOGIST.2015-0235
Abstract: Cervical cancer (CCa) is the second most common cancer among women in Bangladesh. The uptake of CCa screening was less than 10% in areas where screening has been offered, so we investigated the awareness of CCa and CCa screening, and factors associated with women's preparedness to be screened. A nationally representative, cross-sectional survey of women aged 30–59 years was conducted in 7 districts of the 7 isions in Bangladesh, using a multistage cluster s ling technique. Factors associated with the awareness of CCa and screening uptake were investigated separately, using multivariable logistic regression. On systematic questioning, 81.3% and 48.6% of the 1,590 participants, whose mean age was 42.3 (±8.0) years, had ever heard of CCa and CCa screening, respectively. Having heard of CCa was associated with living in a rural area (adjusted odds ratio [OR]: 0.42 95% confidence interval [CI]: 0.26–0.67), being 40–49 years old (OR: 1.59 95% CI: 1.15–2.0), having no education (OR: 0.25 95% CI: 0.16–0.38), and being obese (OR: 2.04 95% CI: 1.23–3.36). Of the 773 women who had ever heard of CCa screening, 86% reported that they had not been screened because they had no symptoms and 37% did not know screening was needed. Only 8.3% had ever been screened. Having been screened was associated with being 40–49 years old (OR: 2.17 95% CI: 1.19–3.94) and employed outside the home (OR: 3.83 95% CI: 1.65–8.9), and inversely associated with rural dwelling (OR: 0.54 95% CI: 0.30–0.98) and having no education (OR: 0.29 95% CI: 0.10–0.85). Lack of awareness of CCa and of understanding of the concept of screening are the key barriers to screening uptake in women at midlife in Bangladesh. Targeted educational health programs are needed to increase screening in Bangladesh with the view to reducing mortality.
Publisher: Informa UK Limited
Date: 27-10-2015
DOI: 10.3109/13697137.2014.937689
Abstract: To systematically review published articles for the prevalence of menopausal symptoms in Asian women. A comprehensive and systematic literature search was performed using MEDLINE, EMBASE, PsycINFO, CINAHL, SCOPUS and Google scholar in June 2013 to retrieve all English-language studies that included information on the prevalence of menopausal symptoms in women living in Asian countries. Risk of bias of included studies was assessed using a risk-of-bias tool explicitly designed for the systematic review of prevalence studies. Twenty-three independent studies met our inclusion criteria. Physical symptoms were the most prevalent symptoms compared to psychological, vasomotor and sexual symptoms. There was a wide variation in the prevalence of all symptoms across the menopausal stages due to the differences in modes of recruitment, study design, s ling procedures, the time frame over which symptoms were assessed and use of different diagnostic or screening tools. A high level of bias was observed for both external and internal validity for most studies. Although there is a wide variation in the reported prevalence of menopausal symptoms, physical symptoms predominate, followed by psychological symptoms, vasomotor symptoms and sexual symptoms. Further studies of representative s les are necessary to understand whether the variations in prevalence reporting are a function of methodological issues or due to ethnic, cultural or other socioeconomic differences.
Publisher: The Endocrine Society
Date: 02-2015
DOI: 10.1210/JC.2014-4264
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2009
DOI: 10.1097/GME.0B013E31817E5CE0
Abstract: Although low back pain is characterized by both pain and disability, there is a paucity of studies that have concurrently examined risk factors for these features in community-dwelling women. We aimed to investigate the prevalence and identify factors associated with both back pain and disability. A questionnaire was mailed to 542 women from a community-based research database. Detailed demographic data were collected, including participants' menopause, relationship, and employment status. Point and period prevalence estimates for back pain were derived. Participants were classified based on pain intensity and disability scores calculated from the Chronic Pain Grade Questionnaire, and factors associated with high levels of pain and disability were examined. A total of 506 (93.4%) women completed the questionnaire. More than 90% of participants had experienced low back pain, with 75.1% and 22.5% reporting pain in the past 12 months and currently, respectively. Seven percent of women reported a high level of disability and 16% reported high-intensity pain. Women with higher levels of disability were more likely to have a higher body mass index and to have pain currently, whereas those with greater pain intensity were more likely to be younger, have a higher body mass index, not be employed outside the home, drink alcohol, and have current pain. Low back pain is a common problem for community-based women. A high body mass index and current pain were factors independently associated with both high pain intensity and disability. Longitudinal investigation is required to determine the predictive nature of these factors and their potential role in preventing pain and disability.
Publisher: Wiley
Date: 05-2003
DOI: 10.1046/J.1445-5994.2003.00346.X
Abstract: Background : The parenteral administration of oestradiol acutely protects against exercise‐induced myocardial ischaemia in women, but whether this effect is sex specific is not known. Aims : The effects of acutely administered conjugated equine oestrogen on exercise‐induced myocardial ischaemia in men with established coronary heart disease were investigated in a randomized, placebo‐controlled, double‐blind cross‐over trial. Methods : Twenty men, aged 62 ± 11.6 years, with reproducible exercise‐induced myocardial ischaemia were treated with either intravenous conjugated equine oestrogen (25 mg) or saline prior to undergoing an exercise stress test. Primary end‐points were total exercise time and time to 1 mm ST‐segment depression. Results : All participants completed the protocol. Total exercise time exceeded the baseline value in 17 of the 20 men following saline, and in 17 of the 20 men following oestrogen pretreatment. Time to 1 mm ST‐segment depression exceeded the baseline value in 14 of the 19 men following saline, and following oestrogen administration, exceeded baseline in 13 of the 19 men. There was no significant difference between the two treatments in either time to 1 mm ST‐segment depression or total exercise time. A period effect was apparent for total exercise time ( P = 0.05) but not for time to ST‐segment depression. Conclusion : Acute parenteral oestrogen therapy did not increase total exercise time or time to the onset of electrocardiographic changes of ischaemia in men with chronic stable coronary artery disease. These findings contrast the favourable effects of oestrogen in women in comparable studies and indicate a sex specificity for the acute cardiovascular effects of oestrogen. (Intern Med J 2003 33: 221−224)
Publisher: Informa UK Limited
Date: 2009
DOI: 10.1080/13697130802635645
Abstract: To examine the relationships between well-being and different levels of both low back pain intensity and disability in women living in the community. A detailed, self-administered questionnaire was mailed to 542 community-dwelling women, aged 24-80 years. Participants provided demographic data and completed the Chronic Pain Grade Questionnaire and Psychological General Well-being Index (PGWB). A total of 506 participants (93.4%) returned completed questionnaires. Multivariate analysis revealed associations between lower total PGWB scores and both low (odds ratio (OR) -5.53 95% confidence interval (CI) -9.01, -2.06) and high pain intensity (OR -8.36 95% CI -13.8, -2.92) compared with no pain intensity, after adjusting for confounders. Lower total scores on the PGWB were also associated with low (OR -4.72 95% CI -9.04, -0.41) and high disability (OR -9.26 95% CI -15.2, -3.30), compared with no disability. There were also statistically significant associations between lower scores on the PGWB subdomains and low and high pain intensities, and low and high disabilities. We found that it is not only women with high pain intensity and disability who experience reduced well-being, but also those with low levels of pain and disability. Longitudinal investigation is needed to investigate the predictive nature of both low and high levels of pain and disability in determining poor well-being in community-based women.
Publisher: Elsevier BV
Date: 12-2004
DOI: 10.1016/J.SEMARTHRIT.2004.07.007
Abstract: There is some observational evidence to suggest an effect of hormones on osteoarthritis (OA), especially in perimenopausal women. To review the epidemiological evidence for an effect of estrogen replacement therapy (ERT) on the incidence and prevalence of OA, especially radiological OA, and the effect of ERT on articular cartilage in women. The literature relating to these questions was reviewed using OVID Medline (1966 to March 2003). Some studies which have suggested a protective effect of ERT on the incidence and prevalence of OA. However, many of the confidence intervals include unity. Although a protective effect also was seen on articular knee cartilage in long-term users of ERT compared with never users, no difference in change in cartilage was seen over 2 years. There is weak epidemiological evidence suggesting a role for estrogen therapy in joint health in postmenopausal women. The data are more suggestive of an effect on large joint OA than small joint OA.
Publisher: American Association for Cancer Research (AACR)
Date: 12-2012
Publisher: Wiley
Date: 09-02-2007
DOI: 10.1111/J.1365-2265.2007.02771.X
Abstract: The aim of this study was to evaluate whether subclinical thyroid disease is associated with impaired health-related quality of life and a more adverse cardiovascular disease risk profile. A community-based cross-sectional study. A total of 1423 non-healthcare-seeking women, aged 18-75 years were randomly recruited from the community via the electoral roll from April 2002 to August 2003. These were the scores for the Short-Form 36 (SF-36), the Psychological General Well-being Index (PGWI), thyroid hormone levels, serum lipids and high sensitivity C-reactive protein (hsCRP). Subclinical hypothyroidism (SCH) and subclinical hyperthyroidism (SCHyper) were defined as serum TSH > 4.0 mIU/l and < 0.5 mIU/l, respectively, with a normal free thyroxine (free T4) level. Evaluable data were available for all participants. 10.7% of all women had an abnormal TSH value. The prevalence of a low TSH level by age group ranged from 1.2% to 6.4%, whereas the prevalence of an elevated TSH level ranged from 2.8% to 9.2% and increased with age (P = 0.002). There were no significant differences between women with SCH or SCHyper and age-matched controls for the total PGWI score or the Mental and Physical Component Scores of the SF-36. Women with SCH were no different from controls for serum lipids or hsCRP. Using linear regression, SCH vs. euthyroidism did not make an independent contribution to variation in either total cholesterol or triglycerides, with or without adjustment for age +/- age(2) +/- BMI. Our data indicate that subclinical thyroid disease in women in the community is not associated with lower well-being or impaired health-related quality of life and SCH is not associated with increased serum markers of CVD risk.
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.MATURITAS.2011.08.006
Abstract: To explore the effects of testosterone on cognitive performance in healthy postmenopausal women. Open-label pilot study. Nine postmenopausal women on non-oral hormone replacement therapy, aged 47-60 years received transdermal testosterone spray for 26 weeks. A control group of 30 women provided normative data for comparison. Scores from a computerized cognitive test battery performed pre- and post treatment, at 0 and 26 weeks. There were no differences between treatment/normative groups in any parameter at baseline. At week 26 scores for the International Shopping list task including delayed recall (verbal learning and memory) and the continuous paired associate learning task (visual learning and memory) were significantly higher in the treatment group as compared to the normative group (p<0.05). Significant improvements from baseline were observed for the International Shopping list delayed recall (verbal learning and memory) and Groton Maze recall tasks (visual learning and memory) for the treatment group (both p<0.05), after 26 weeks. There were no significant differences between baseline and week 26 in the normative group. In the regression analysis which modeled the score at week 26, and which included a bootstrapping approach, the beta coefficient for the treatment group was statistically significant when age and baseline score were taken into account for the International Shopping list task including delayed recall (both p<0.02). Testosterone improved cognitive performance in the domain of verbal learning and memory in a pilot study of healthy postmenopausal women and is worthy of further exploration in a randomized placebo controlled study.
Publisher: Elsevier BV
Date: 08-2007
DOI: 10.1016/J.SEMARTHRIT.2006.12.008
Abstract: To evaluate the relationship between serum testosterone (T), preandrogens and sex hormone binding globulin (SHBG), and the knee structure in middle-aged women without knee pain. One hundred and thirty-nine healthy women without knee pain, aged 40 to 67 years, underwent magnetic resonance imaging of their dominant knee to measure tibial and patella cartilage volumes and defects, respective bone area and volume, and bone marrow lesions. The serum level of T, preandrogens, and SHBG were analyzed using linear regression to determine whether associations existed between these hormones and knee structure. Free T and total T showed no association with cartilage volume or bone structures in the knee. SHBG showed a statistically positive association with patella bone volume after adjusting for confounders (P = 0.02). Our study suggests there are no associations between serum levels of T or the preandrogens and knee structure in women. The observed positive association between SHBG and patella bone volume may reflect a favorable effect of estrogen exposure on patella bone volume.
Publisher: Elsevier BV
Date: 12-2003
Publisher: Elsevier BV
Date: 2010
DOI: 10.1016/J.NEUROPSYCHOLOGIA.2009.10.013
Abstract: Mental rotation is a task known to activate the parietal cortical regions. The present study aimed to investigate whether there is differential activation of regions within the parietal lobe and to reveal functional subspecialisation of this region by examining the effects of increasing angle of rotation. Functional magnetic resonance imaging was performed in nine healthy female subjects whilst undertaking a parametric mental rotation task. The task comprised 6 alphanumeric characters presented in their normal or mirror-reversed orientation. Behaviourally, subjects showed increased reaction times with increased angle of rotation, with differential effects between the alphanumeric characters numbers having greater reaction times than letters. BOLD signal increase was observed bilaterally in the middle occipital gyrus and medial frontal gyrus, in the right superior and inferior parietal lobules and in the left superior temporal gyrus. Parametric increases in activation with increasing angle of rotation were observed bilaterally in the superior and inferior parietal lobules and in the right medial frontal gyrus, with greater parametric effects in the superior parietal lobules compared to the inferior parietal lobules. Our findings suggest subspecialisation of the posterior parietal lobules during mental rotation, with differential responses in the superior and inferior regions.
Publisher: Informa UK Limited
Date: 04-12-2015
DOI: 10.3109/13697137.2014.978754
Abstract: Our aim was to systematically review published articles for the prevalence of persistent estrogen depletion symptoms among women aged 65+ years. A systematic literature search of English-language publications was performed using MEDLINE, EMBASE, CINAHL, and PsycINFO. Twenty-three studies that included information on the prevalence of vasomotor and/or urogenital atrophy symptoms among older women (65 + years) met our inclusion criteria. Risk of bias of the included studies was assessed using a risk-of-bias tool explicitly designed for the systematic review of prevalence studies. The available data suggest that vasomotor symptoms are experienced by a considerable proportion of older women, that symptoms of urogenital atrophy including urinary incontinence are widespread, and that women remain sexually active well into later life. A high degree of variability was observed for the prevalence of estrogen deficiency symptoms for women age 65+ years. Discrepancies in modes of recruitment, s ling procedures, time frames over which symptoms were assessed and use of different and non-validated assessment tools contributed to the inconsistencies across the published studies. Larger and appropriately s led studies, employing validated questionnaires, are still needed to establish the prevalence of persistent estrogen depletion symptoms in women aged 65+ years.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2005
DOI: 10.1097/00042192-200512020-00016
Abstract: Although natural menopause is associated with loss of ovarian estrogen production, this life phase is followed by a significant increase in estrogen-related cancers, namely breast and endometrial cancer. These tissues, as well as adipose, skeletal, and vascular tissues and the brain are important sites of postmenopausal estrogen production. Circulating C19 steroid precursors are essential substrates for extragonadal estrogen synthesis however, the levels of these androgenic precursors decline markedly with advancing age. This implies an increase in capacity for extragonadal tissues to produce estrogen with age. To explore this, and the effects of the menopause transition and postmenopausal estrogen therapy on extragonadal estrogen biosynthesis, we have compared the expression of the aromatase gene and estrogen (ER) and androgen receptors (AR) in subcutaneous abdominal and gluteal fat taken from premenopausal (group 1: n = 11), postmenopausal (group 2: n = 10), and postmenopausal women taking estrogen therapy (group 3: n = 10). All subjects were of normal body mass index, euglycemic, and normolipemic. The postmenopausal women were older (group 1, 43.1 +/- 5.0 vs groups 2 and 3, 57.9 +/- 7.4 years, P < 0.001 and 56.1 +/- 4.5 years, P < 0.001, respectively) and had lower serum estradiol levels (group 2, 22.2 +/- 3.2 vs group 1, 442.5 +/- 248.2 pmol/L, P < 0.05), which were restored to premenopausal levels with estrogen therapy. Expression analysis revealed that levels of transcripts encoding aromatase were greater in gluteal than abdominal depots in each group in postmenopausal versus premenopausal women (P < 0.05). Use of hormone therapy did not influence aromatase gene expression in either depot. No differences were detected in the expression of ER or AR between groups of between tissue depots. Thus, the capacity of adipose tissue to produce estrogen seems to increase significantly with age at the time of menopause and to be unaltered by exogenous estrogen therapy. This difference in extragonadal estrogen production with age may play a pivotal role in the increase in estrogen-dependent malignancies in the postmenopausal years.
Publisher: Informa UK Limited
Date: 26-05-2020
Publisher: Informa UK Limited
Date: 04-07-2022
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2006
DOI: 10.1097/01.GME.0000227333.50867.4E
Abstract: To explore whether inhibition of the conversion of testosterone to estradiol modifies the effects of testosterone on cognition in 61 healthy, estrogen-treated postmenopausal women. Seventy-six postmenopausal women using transdermal estrogen for at least 8 weeks, with a serum total testosterone less than 1.2 nmol/L participated in a single-center, double-blind, randomized, placebo-controlled study. All participants received transdermal testosterone, 400 muL of a 0.5% testosterone gel, daily and were randomized to receive either letrozole 2.5 mg/day or an identical placebo tablet. The main outcome measure was cognition, evaluated using a comprehensive battery of standardized neuropsychological tests, at baseline and week 16. Thirty women in each group completed the study. Free testosterone increased from baseline in both groups, with no difference between groups. Free testosterone levels achieved were below the 90th centile for young women in 80% of the participants at week 16. Serum estradiol and sex hormone-binding globulin levels did not differ from baseline or between groups during the study. No clinically significant effects of testosterone treatment were seen for attention and working memory, psychomotor speed, or executive function. Significant improvements were seen for immediate and delayed visual and verbal memory and for simple concentration with testosterone therapy, all of which were unaffected by the aromatase inhibitor. We did not observe any effects of aromatase inhibition on cognition in healthy, estrogen-treated postmenopausal women treated with testosterone. This may be due to insufficient study power or a true lack of effect. However, our findings highlight that the detection of subtle changes in cognition in well women require the development of sensitive instruments and large randomized, controlled trials.
Publisher: Oxford University Press (OUP)
Date: 2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2013
DOI: 10.1097/GME.0B013E3182610CAB
Abstract: The aim of this study was to investigate the extent of discontinuation of oral adjuvant endocrine therapy (OAET) in women nearly 4 years from the diagnosis of their first episode of invasive breast cancer and the reasons for such discontinuation. We used a large, prospective cohort study of women who had been diagnosed with their first episode of invasive breast cancer between 2004 and 2006, recruited through a state-based cancer registry. All participants completed an enrollment questionnaire (EQ) within 12 months of diagnosis and annual follow-up questionnaires (FQs) thereafter. The data in this report were obtained from the EQ and the first three FQs. A total of 1,370 women with hormone receptor-positive disease completed the EQ. At the completion of the third FQ nearly 4 years from diagnosis, 1,193 women remained in the study. Use of OAET peaked by 2 years postdiagnosis. At nearly 4 years from diagnosis, 18% of the 1,193 women remaining in the study were not taking OAET. Of these women, just more than half had ceased therapy mainly owing to a range of adverse effects, predominantly estrogen deficiency symptoms, but the remainder (8% of women remaining in the study) had never used OAET. Our study confirms that early discontinuation of OAET due to estrogen deficiency symptoms remains an important issue despite calls for strategies to address this problem. The number of women potentially suitable for OAET but not receiving it was almost as great as the number of those who have discontinued therapy.
Publisher: Mary Ann Liebert Inc
Date: 12-2009
Abstract: The aim of this study was to investigate the level of understanding in women with newly diagnosed invasive breast cancer of the key clinical features of their disease that are important determinants in treatment decision making. The 1684 women aged between 26 and 88 years at diagnosis enrolled in a 5-year cohort study were asked by questionnaire about their estrogen receptor (ER) and progesterone receptor (PR) status and about their past or current treatment with adjuvant endocrine therapy. Information was linked with their ER and PR status determined from the histopathology report. Logistic regression analysis was used to explore the relationship between age and education status and the likelihood of being able to correctly report hormone receptor status, as well as the relationship between the likelihood of receiving adjuvant endocrine therapy and knowledge of hormone receptor status in women who were ER or PR positive. Not being able to correctly report hormone receptor status was associated with being older and having a lower level of education. Of women who were ER positive or PR positive or both and were at least 40 weeks from diagnosis, having received some form of endocrine therapy was significantly associated with self-identification as being ER or PR positive (OR=1.82, 95% CI 1.24-2.68, p=0.002), even when age was taken into account. That self-knowledge of hormone receptor status was independently associated with likelihood of receiving endocrine therapy suggests that the methods of helping women understand the nature of their breast cancer are worthy of review.
Publisher: The Endocrine Society
Date: 03-2008
DOI: 10.1210/JC.2007-2128
Abstract: It has been proposed that dehydroepiandrosterone and dehydroepiandrosterone sulfate (DHEAS) exert neuroprotective effects in the brain, yet evidence of associations between the endogenous levels of these steroids and measures of cognitive function is lacking. The objective of the study was to investigate whether circulating levels of DHEAS independently contribute to aspects of cognitive function in women in the community. This was a community-based, cross-sectional study. Two hundred ninety-five women, aged 21-77 yr, were recruited from a community-based data set and participated between September 2003 and December 2004. Women were excluded if they reported any health condition that might potentially adversely affect cognitive function. The in idual scores of a comprehensive battery of tests of cognitive function and the serum level of DHEAS (square root transformed) were measured. In the multiple linear regression analysis, the DHEAS term made a significant independent positive contribution to the Controlled Oral Word Association Test score, a measure of executive function. In addition, women with a DHEAS level in the highest tertile who also had more than 12 yr of education performed better on both Digit Span Forward and Digit Span Backward tests, which are tests of simple concentration and working memory, respectively. Higher endogenous DHEAS levels are independently and favorably associated with executive function, concentration, and working memory.
Publisher: Wiley
Date: 08-2004
Publisher: Oxford University Press (OUP)
Date: 04-04-2008
DOI: 10.1093/RHEUMATOLOGY/KEN244
Abstract: Although cartilage loss occurs with advancing age and is a hallmark of OA, the factors that affect cartilage change are not well established. The aim of this study was to explore the determinants of change in patella cartilage volume over 2 yrs among healthy middle-aged women with no clinical knee OA. One hundred and forty-eight women with no clinical knee OA were recruited from a previous population-based cross-sectional study of healthy women aged 40-67 yrs. MRI was performed at baseline and at 2 yrs, to assess patella cartilage and bone volume. Self-reported exercise was assessed by questionnaire. Annual loss of patella cartilage volume was 1.6% (95% CI 1.2, 1.9). Age was positively associated with patella cartilage volume loss after adjustment for confounders (P = 0.05). For every 1 mm(3) increase in patella bone volume at baseline, annual cartilage loss was reduced by 8.05 mm(3) (95% CI 12.91, 3.19 P < 0.001). Fortnightly participation in exercise promoting an increased heart and respiratory rate for at least 20 min also tended to be associated with a reduced rate of patella cartilage volume loss (P = 0.09). Among middle-aged women with no clinical knee OA, advancing age expedites the rate of patella cartilage volume loss, while increased patella bone volume and exercise participation tends to be associated with a reduction in the rate of patella cartilage volume loss. Interventions targeting modifiable factors, such as physical activity, warrant further investigation as they may help to prevent patellofemoral OA.
Publisher: AMPCo
Date: 2012
DOI: 10.5694/MJA11.11476
Abstract: No. Breast cancer researchers Robin Bell and Robert Burton believe that screening can result in overdiagnosis.
Publisher: Elsevier BV
Date: 12-2012
Publisher: Elsevier BV
Date: 12-2005
DOI: 10.1016/J.FERTNSTERT.2005.05.058
Abstract: To evaluate the clinical usefulness for the measurement of testosterone (T) values in the "low" female range with a direct radioimmunoassay (RIA) for total T by comparing total T values measured by this assay with values determined by conventional RIA after organic solvent extraction/column chromatography. Cross-sectional study. Victoria, Australia. Two hundred fifty-nine healthy women, aged 18-75 years, recruited from the community. Fasting serum s les were obtained and stored at -80 degrees C. Total T measurement. Total T was measured by the direct RIA method using antibody-coated tubes and iodine-labeled T tracer. For comparison, total T levels were also measured using the conventional RIA method after organic solvent (ethyl acetate:hexane [3:2]) extraction and celite column partition chromatography before RIA. The mean T level by direct RIA was 0.76 nmol/L (median, 0.70 SD, 0.54 minimum, 0.10 maximum, 3.2). The mean difference between the two measurements (direct RIA - conventional RIA) was -0.28 (SD, 0.3). The direct RIA value was 63% (95% confidence interval, 26%-155%) of the conventional RIA estimate. For the classification of values at the lower end of the range, there was very good agreement beyond chance (kappa = 0.68-0.74) for values in approximately the lowest 10th-40th percentiles. The direct RIA is a clinically useful assay for the study of the issue of "low" T within the female population.
Publisher: Oxford University Press (OUP)
Date: 12-2013
Publisher: Springer Science and Business Media LLC
Date: 19-04-2012
Publisher: Wiley
Date: 08-01-2008
DOI: 10.1111/J.1471-0528.2007.01576.X
Abstract: To evaluate the effectiveness of a decision aid for prenatal testing of fetal abnormalities compared with a p hlet in supporting women's decision making. A cluster randomised controlled trial. Primary health care. Women in early pregnancy consulting a GP. GPs were randomised to provide women with either a decision aid or a p hlet. The decision aid was a 24-page booklet designed using the Ottowa Decision Framework. The p hlet was an existing resource available in the trial setting. Validated scales were used to measure the primary outcomes, informed choice and decisional conflict, and the secondary outcomes, anxiety, depression, attitudes to the pregnancy/fetus and acceptability of the resource. Outcomes were measured at 14 weeks of gestation from questionnaires that women completed and returned by post. Women in the intervention group were more likely to make an informed decision 76% (126/165) than those in the control group 65% (107/165) (adjusted OR 2.08 95% CI 1.14-3.81). A greater proportion of women in the intervention group 88% (147/167) had a 'good' level of knowledge than those in the control group 72% (123/171) (adjusted OR 3.43 95% CI 1.79-6.58). Mean (SD) decisional conflict scores were low in both groups, decision aid 1.71 (0.49), p hlet 1.65 (0.55) (adjusted mean difference 0.10 95% CI -0.02 to 0.22). There was no strong evidence of differences between the trial arms in the measures of psychological or acceptability outcomes. A tailored prenatal testing decision aid plays an important role in improving women's knowledge of first and second trimester screening tests and assisting them to make decisions about screening and diagnostic tests that are consistent with their values.
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.FERTNSTERT.2015.09.017
Abstract: To determine the prevalence and severity of vasomotor symptoms (VMS) and sexual symptoms in community-dwelling older women, and to explore factors associated with VMS. Population-based cross-sectional study. Not applicable. A total of 1,548 women aged 65-79 years. None. The presence and self-rated severity of VMS (hot flashes, night sweats, or sweating), and sexual symptoms (intimacy, desire, and vaginal dryness) were determined with the use of the Menopause Quality of Life (MenQOL) questionnaire. All items of the vasomotor and the sexual MenQOL domains were completed by 1,532 and 1,361 of the study participants, respectively. Menopausal hormone therapy (MHT) use was reported by 6.2% of the women, and 6.9% reported using vaginal estrogen. Among the 1,426 women not using MHT, at least 1 VMS was reported by 32.8%. The prevalence of VMS rated as moderately to severely bothersome was 3.4%. A total of 54.4% of currently partnered women had sexual symptoms, and 32.5% reported vaginal dryness during intercourse in the past month. In the multivariate analysis, factors significantly associated with VMS were age, obesity, being a caregiver for another person, and bilateral oophorectomy. VMS and vaginal atrophy symptoms are common in community-dwelling older women, but they are predominantly untreated. The degree of distress caused by sexual symptoms among older women needs further exploration.
Publisher: Oxford University Press (OUP)
Date: 10-2009
DOI: 10.1111/J.1743-6109.2009.01406.X
Abstract: The extent to which low sexual function or sexual dissatisfaction in women impacts on well-being remains uncertain, yet this is a critical issue in the controversy as to the benefits of pharmacotherapy for women seeking treatment for female sexual dysfunction. Aim. To explore the relationship between well-being and self-perceived satisfaction with sexual function in women and to determine if there is an independent effect of menopausal status or age. A community-based cross-sectional study. A total of 421 women, aged 18 to 65 years were recruited from the community. Women were required to self-identify at study outset as being either satisfied or dissatisfied with their sexual life and be premenopausal or postmenopausal. Scores from the Psychological General Well-Being Index (PGWB), the Beck Depression Index (BDI) and a daily diary of sexual function. A group of 349 women were included in the analysis. Total PGWB and domain scores of positive well-being and vitality were lower in dissatisfied women compared to satisfied women. PGWB total and domain scores of depressed mood, positive well-being and vitality were higher in older women. Menopause did not have an independent effect on well-being. Women who self-identify as having sexual dissatisfaction have lower psychological general well-being. These findings reinforce the importance of addressing sexual health and well-being in women as an essential component of their health care.
Publisher: Informa UK Limited
Date: 08-07-2020
Publisher: Oxford University Press (OUP)
Date: 05-2008
DOI: 10.1111/J.1743-6109.2008.00780.X
Abstract: Satisfaction with sexual function in community-based women has not been well-described, and little is known of differences in sexual function between pre-(PreM) and postmenopausal (PM) women. The aim of this article was to describe sexual function in PreM and PM women who self-identify as being satisfied or dissatisfied with their sexual life. A cross-sectional questionnaire study was conducted among 349 sexually active community-based women, aged 20-65 years, who self-identified as being either satisfied or dissatisfied with their sexual life. Scores from a daily diary of sexual function for 4 weeks, examining the frequency of sexual thoughts, interest, and activity. One hundred and eighty-four women (53%) were PreM, and 165 (47%) were dissatisfied with their sexual life. The median number of days with sexual activity or events per month for all women was 8 (ranges 2-28 days 2-57 events). Ninety-two percent of reported events involved a partner, 86% involved intercourse, and in 40% the woman initiated the activity. Women satisfied with their sexual life had higher frequencies of sexual thoughts, interest, events, and initiation of activity than dissatisfied women (P < 0.0001). PreM satisfied women had higher frequencies of sexual thoughts, numbers of days with sexual activity, and events per month than PM satisfied women (P < 0.05). PreM oral contraceptive pill (OCP) users had significantly lower average frequencies of sexual thoughts, interest, and days of sexual activity per month (P < 0.05), whereas PM women hormone therapy (HT) users had higher frequencies of sexual thoughts and sexual interest (P = 0.04 and P = 0.05, respectively) compared to nonusers. There were no differences in sexual function between PreM and PM women who were sexually dissatisfied. Sexual activity mostly involved a partner, partner initiation, and intercourse. Sexually satisfied women reported more sexual thoughts, interest, events, and initiation of sexual activity than dissatisfied women. PreM sexually satisfied women reported more sexual thoughts, days with sexual activity, and sexual events per month compared to PM satisfied women. OCP and HT use appeared to have contrasting effects on sexual function.
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.MATURITAS.2015.06.004
Abstract: The extent to which menopause influences wellbeing is unclear. We investigated the association between moderate-severely bothersome vasomotor symptoms (VMS) and psychological general wellbeing in women, aged 40-65 years, taking into account socio-demographic and lifestyle factors. This was a cross-sectional survey of 2020 Australian women, aged 40-65 years, recruited from the community between July 2013 and March 2014. Wellbeing was assessed by the Psychological and General Wellbeing questionnaire (PGWB) and VMS by the Menopause-specific Quality of Life Questionnaire. Moderate-severely bothersome VMS had a strong significant negative association with psychological general wellbeing [regression coefficient (β)=-8.17, 95% confidence interval (CI) -10.90 to -5.45]. Socio-demographic factors associated with lower wellbeing included being un-partnered (β=-2.80, 95% CI -4.74 to -0.86), obese (β=-5.46, 95% CI -7.24 to -3.68) and a smoker (β=-3.47, 95% CI -6.10 to -0.84). Older age (β=0.29, 95% CI 0.06-0.42) and participation in paid and/or volunteer work (β=2.72, 95% CI 0.61-4.82) were positively associated with wellbeing. For those with insecure housing, being a carer was associated with better wellbeing. Moderate-severely bothersome VMS are significantly and independently negatively associated with psychological general wellbeing in women at midlife. This is an important consideration when assessing psychological wellbeing in women during this life phase.
Publisher: Springer Science and Business Media LLC
Date: 04-11-2008
Publisher: Springer Science and Business Media LLC
Date: 31-10-2014
DOI: 10.1007/S00198-014-2945-5
Abstract: Minimal-trauma fracture is an important issue in breast cancer survivors, especially rib fracture. The likelihood of fracture is affected by menopausal status and a diagnosis of osteoporosis prior to breast cancer. Most women reported at least one assessment of bone mineral density. We have investigated the self-reported frequency and pattern of minimal-trauma fracture (MTF) in breast cancer (BC) survivors at least 5 years from diagnosis, along with the use of bone mineral density (BMD) assessment. This study was carried out within the Bupa Health Foundation Health and Wellbeing After Breast Cancer Study which is a questionnaire-based prospective cohort study of 1683 women diagnosed with their first invasive breast cancer between 2004 and 2006 and followed for at least 5 years. One thousand two hundred and five women, who remained free of recurrence or new breast cancer, completed the fifth annual follow-up. One hundred sixty-four (13.6%) reported at least one MTF. Rib fracture was the most common (52 fractures in 46 women). Compared with women who remained pre- eri-menopausal, either being postmenopausal at diagnosis (OR 3.53, 95% Confidence Interval (CI) 1.09-11.44, p=0.036) or changing from pre- to postmenopausal during follow-up (OR 3.97, 95% CI 1.21-13.10, p=0.023) was associated with a higher likelihood of fracture, as was having a diagnosis of osteoporosis at the time of diagnosis (OR 1.74, 95% CI 1.00-2.99, p=0.047). Most women (64.9%) reported at least one BMD assessment. Overall MTF is a problem for breast cancer survivors, with rib fracture a particular issue for women in our study. Both pre-existing osteoporosis and being postmenopausal are risk factors for subsequent MTF in women treated for breast cancer. Clinicians need to be mindful of fracture prevention medication in these groups.
Publisher: Georg Thieme Verlag KG
Date: 04-2006
Abstract: Androgen receptors are present in numerous tissues throughout the female body, and knowledge of the specific actions of androgens at different sites is increasing, along with the understanding of their contribution to various pathophysiological states. This article reviews the physiology of androgens (testosterone and dihydrotestosterone) and immediate androgen precursors (dehydroepiandrosterone [DHEA], dehydroepiandrosterone sulfate [DHEAS], and androstenedione), with specific reference to the androgen receptor, production and metabolism of C- (19) steroids, circulating androgen concentrations, and androgen actions. In addition, the evidence for physiological modulation of androgens including circadian variation, cyclical variation, age, and natural menopause is reviewed.
Publisher: Informa UK Limited
Date: 07-04-2003
Publisher: Elsevier BV
Date: 12-2007
DOI: 10.1016/J.JOCA.2007.04.010
Abstract: Bone marrow lesions (BMLs) have been shown to be associated with pain and progression of knee osteoarthritis (OA) in those with disease. The natural history of BMLs in a healthy population and their role in the pathogenesis of OA are unknown. The aim of this study was to determine the risk factors for BMLs in healthy subjects and the association of BMLs with knee structure. One hundred and seventy-six healthy, adult women with no history of knee injury, or clinical knee OA had magnetic resonance imaging performed on their dominant knee to assess BMLs, tibiofemoral cartilage defects, tibial cartilage volume and bone area. Thirteen percent of subjects had knee BMLs. The prevalence was higher in the medial tibiofemoral compartment. There was a significant positive association between BMLs and cartilage defects after adjusting for the potential risk factors: age, height, weight and cartilage volume [odds ratio (OR) 1.78 (95% confidence interval [CI] 1.12, 2.82), P=0.01]. BML was positively associated with tibial plateau bone area in the lateral compartment [OR 1.67 (95% CI 1.02, 2.71), P=0.04]. There was no significant association between BMLs and cartilage volume. Independent risk factors for BMLs after adjustment were increasing height [OR 1.18 (95% CI 1.02, 1.36), P=0.02 for lateral compartment] and weight [OR 1.04 (95% CI 1.01, 1.08), P=0.005 for total knee]. These data support that BMLs are present in a similar distribution to tibiofemoral knee OA. Their presence is associated with risk factors (height and weight) for knee OA, and the early structural changes of knee OA in subjects without knee pain and thus no clinical disease. Longitudinal studies will clarify whether BMLs relate to the pathogenesis of clinical knee OA.
Publisher: JMIR Publications Inc.
Date: 02-04-2014
DOI: 10.2196/44867
Abstract: Alcohol consumption is a major modifiable risk factor for female breast cancer, even in small amounts. However, awareness of this risk remains low. National breast screening programs are uniquely positioned to provide timely and targeted health information and behavior change strategies to improve alcohol literacy and reduce consumption. A breast screening service is a novel health care setting for brief alcohol intervention, with the potential for extensive reach. This study aimed to conduct a formative evaluation with breast screening service consumers to understand the need for, and acceptability of, brief alcohol intervention in the breast screening setting and collaboratively design a brief alcohol intervention (Health4Her) to test the effectiveness of Health4Her in improving knowledge of alcohol as a breast cancer risk factor (primary outcome), improving alcohol literacy, and reducing consumption among women attending a breast screening service and to examine the implementation strategy through process evaluation. This was a hybrid type II effectiveness-implementation trial comprising a randomized controlled trial (RCT) alongside a mixed methods program evaluation guided by applicable elements of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework and Consolidated Framework for Implementation Research. Formative evaluation comprised a retrospective analysis of alcohol consumption data (n=49,240), a web-based survey (n=391), and focus groups and interviews (n=31) with breast screening service consumers. Women attending routine mammography, drinking at any level, were recruited to the single-site, double-blind RCT (n=558), and completed a baseline assessment before randomization (1:1) to receive Health4Her (alcohol brief intervention + lifestyle information) or control (lifestyle information) via animation on an iPad. Follow-up assessments were performed 4 and 12 weeks after randomization. The process evaluation included evaluation of trial administrative data, participant quantitative (n=497) and qualitative feedback (n=30), and site staff qualitative feedback (n=11). This research was funded in March and May 2019. Data collection for the formative evaluation and trial recruitment occurred between January and April 2020 and February and August 2021, respectively, with finalization of follow-up data collection in December 2021. Quantitative process evaluation data were collected during trial implementation, and collection of participant and staff feedback was finalized in December 2021. Results of the retrospective analysis of alcohol consumption data from breast screening service consumers is anticipated to be published in March 2023 and the results of the RCT to be published in March 2023. This study is anticipated to generate new substantial knowledge on the alcohol consumption and literacy needs of women attending breast screening and the extent to which these can be addressed using a novel, tailored brief alcohol intervention. The study design permits the evaluation of the effectiveness and implementation of Health4Her to predict and facilitate uptake in breast screening services. ClinicalTrials.gov NCT04715516 t2/show/NCT04715516 RR1-10.2196/44867
Publisher: AMPCo
Date: 08-2015
DOI: 10.5694/MJA14.01723
Abstract: To document the prevalence of, and factors associated with, the use of complementary and alternative medicines (CAMs) for vasomotor symptoms (VMS) and other symptoms of menopause in Australian women aged 40-65 years. Cross-sectional questionnaire-based study of Australian women aged 40-65 years living independently in the community. Women able to complete a questionnaire in English were recruited by telephone between October 2013 and March 2014 from a large, representative, national, continually refreshed database derived from the electoral roll. Use of CAMs for VMS and other menopausal symptoms (eg, arthralgia, depression and sleep disturbance), assessed using the Menopause-Specific Quality of Life questionnaire. Of 5850 women contacted, 2911 agreed to participate, and 2020 eligible women returned completed questionnaires (response rate, 34.53%). Most of the women were postmenopausal (54.90%), resided in metropolitan areas (62.70%) and were born in Australia (80.43%). The prevalence of use of CAMs for VMS was 13.22%. Phytoestrogens were most commonly used for VMS (6.29%), followed by evening primrose oil (3.91%) and ginseng (1.73%). Compared with premenopausal women, perimenopausal women (odds ratio [OR], 2.09 95% CI, 1.42-3.06) and early postmenopausal women (OR, 1.83, 95% CI, 1.21-2.76) were more likely to use any CAM for VMS. The prevalence of use of CAMs for other symptoms was 32.23% being postmenopausal and older were the factors associated with this use. Australian women at midlife are using CAMs that are known to be ineffective for managing VMS. Health care providers need to be more involved in guiding women in the treatment of VMS and other menopausal symptoms. More judicious use of supplements such as fish oil and glucosamine, particularly by older women, is needed until their efficacy and safety profiles are better understood.
Publisher: Wiley
Date: 12-1999
DOI: 10.1046/J.1369-6513.1999.00064.X
Abstract: OBJECTIVES: To determine the effect of a consumer-directed information c aign to increase knowledge of folate for the prevention of neural tube defects among women of child-bearing age, and to measure women's recall of sources of information and knowledge about folate. DESIGN: A community randomized trial. SETTING: Three matched pairs of geographically distinct Local Government Areas in the state of Victoria, Australia. INTERVENTION: Printed information recommending folate intake to decrease the risk of neural tube defects was disseminated to women of child-bearing age in three of the Local Government Areas selected randomly. MAIN OUTCOME MEASURE: The proportion of women aware of the association between folate and spina bifida. RESULTS: Of 1197 women interviewed prior to the intervention, 12.4% (adjusted for the cluster and population s ling unit) were aware of folate and neural tube defects. After the intervention, there was not only a significant background increase of 3.4% (P=0.02) in folate awareness since the pre-intervention survey (n=603), but also a significant additional increase of 4.0% (P=0.04) owing to the intervention itself (n=603). Only 70% of women who were aware of folate knew the correct timing. CONCLUSIONS: The provision of printed educational material can increase folate awareness among women of child-bearing age. A comprehensive, long-term and ongoing health promotion c aign including such material, together with initiatives by relevant health service providers and the food industry, could best address the current low levels of folate awareness among women of child-bearing age.
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.1016/J.MATURITAS.2016.02.003
Abstract: It has been hypothesised that vasomotor symptoms (VMS), the hallmark of menopause, may affect women's workplace performance. The aim of this study was to investigate the association between VMS and self-reported work ability, taking into account socio-demographic characteristics. Study design/Main Outcome measures: A national cross-sectional survey of women, aged 40-65 years, was conducted between October 2013 and March 2014. Participants provided socio-demographic and lifestyle factors and completed the Menopause Specific Quality of Life Questionnaire (MENQOL) and the Work Ability Index (WAI). Of 2020 women who comprised the study s le, 1274 were in paid employment and 1263 completed the WAI. The WAI score was good-excellent for 81.5% of women and poor-moderate for 18.5%. After adjustment for socio-demographic characteristics, having any VMS was associated with greater likelihood of poor-moderate work ability [odds ratio (OR)=2.45, 95% CI 1.69-3.54]. Poorer work ability was significantly and independently associated with being un-partnered, obese or overweight, smoking, being carer and having insecure housing finance, but not with age. Overall, most women functioned well at work. We observed an association suggesting a relationship not only between menopausal VMS and personal wellbeing, but also between VMS and self-assessed work ability. Although 4 in 5 women functioned well at work, recognition of the association with VMS may improve wellbeing and work performance of working women at midlife.
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.MATURITAS.2013.11.007
Abstract: There is a high incidence of depression in women presenting to menopause clinics. The aim of this review was to determine if there is an association between depressive symptoms or major depressive disorder (MDD) and vasomotor symptoms (VMS). A systematic review of the literature was conducted according to PRISMA guidelines. 33 relevant publications were found, 12 from three large studies. Overall, we found that there is a bidirectional association between VMS and depressive symptoms. This has been established in well-conducted, large observational studies. There does not appear to be a relationship between VMS and MDD. However, studies examining VMS and MDD were prone to bias making it difficult to draw any conclusions.
Publisher: Elsevier BV
Date: 12-2021
Publisher: Wiley
Date: 26-02-2008
DOI: 10.1111/J.1442-2042.2007.01976.X
Abstract: Urinary incontinence in women is common and has a significant impact on the physical, psychological and socio-economic aspects of life. The aims of this study were to review the published reports on the prevalence and incidence of urinary incontinence in Australian women and to examine the methodological issues associated with these studies. Electronic searches of Medline, EMBASE and the Current Index to Nursing and Allied Health Literature databases were undertaken using 'Medical Subject Heading' terms and 'free text' words. We retrieved papers that investigated the prevalence and/or incidence of urinary incontinence in Australian women and were published in English after 1980. Methodological data from each study were tabulated. Seven studies were identified which examined the prevalence of urinary incontinence and two studies that reported its incidence. The prevalence of urinary incontinence varied between 12.8% and 46.0%. Study heterogeneity was a consequence of response rates, the inclusion of women in institutional care, the method of data collection, the questions used to identify different types of urinary incontinence and the way these questions were reported, the period over which the urinary incontinence had occurred and the severity of the incontinence. Two studies which examined incidence provided evidence that urinary incontinence can be a transient phenomenon. Research into the incidence and prevalence of urinary incontinence in Australian women exhibits significant heterogeneity in the findings due to methodological limitations. There is a need for future studies to employ validated instruments and give careful attention to the selection of participants and the reporting of age-specific data.
Publisher: American Medical Association (AMA)
Date: 02-11-2005
Publisher: Informa UK Limited
Date: 11-11-2023
DOI: 10.1080/13697137.2022.2139600
Abstract: This review was conducted to explore the association between endogenous testosterone blood concentrations and cognitive performance among community dwelling postmenopausal women. We searched Ovid MEDLINE, EMBASE, PsycINFO and Web of Science databases for observational studies with at least 100 postmenopausal participants. The results were categorized by study design, reporting of total or free testosterone and risk of bias assessments, narratively. Ten of the 26 articles retrieved for full-text review met the inclusion criteria, six provided cross-sectional data, seven provided longitudinal data and one provided case-control data. Cognitive performance tests differed between studies. Eight studies measured testosterone by immunoassay, one by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and one did not specify their methodology. Eleven different cognitive domains were tested by 37 different instruments. Irrespective of the study design, the findings were inconsistent and inconclusive. Both positive and inverse associations were reported for each of global cognition and immediate and delayed verbal recall. The majority of studies reported no association between total or free testosterone and cognitive performance. Although this review did not demonstrate an association between testosterone and cognitive performance in postmenopausal women, the findings should be considered inconclusive due to the imprecision of testosterone measurement and the methodological heterogeneity of the included studies.
Publisher: Springer Science and Business Media LLC
Date: 05-08-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2008
DOI: 10.1097/GME.0B013E318174F16E
Abstract: Oral estrogen therapy suppresses insulin like growth factor I (IGF-I) levels, whereas conventional dose transdermal estradiol (E2) does not. However, it has been proposed that if sufficiently high serum E2 levels are achieved, nonoral E2 will also suppress serum IGF-I. The aim of the study was to investigate the effects of intranasal E2 with norethisterone (E2/NET) versus oral E2/NET acetate on IGF-I, IGF binding protein 3, and insulin resistance in postmenopausal women. This was a randomized, multicenter, double-blind, double-dummy trial. Postmenopausal women were randomized to receive either daily intranasal E2/NET (175 microg/275 microg) as a spray and a placebo tablet (n = 41) or oral E2/NET acetate (1 mg/0.5 mg) plus placebo intranasal spray (n = 41) for 1 year. Fasting plasma concentrations of IGF-I, IGF binding protein 3, glucose and insulin, glucose and insulin at 120 minutes post-glucose challenge, and the homeostasis model assessment for insulin resistance were assessed at baseline and after 52 weeks of treatment. The two groups were well matched for all clinical and biochemical parameters at baseline. There were no significant between-group differences for fasting and 120-minute glucose, insulin, homeostasis model assessment for insulin resistance, and IGF binding protein 3. The mean IGF-I level at week 52 was significantly lower for women treated with oral versus intranasal therapy (116 +/- 21 [SD] versus 134 +/- 33 [SD], P = 0.005) and the mean difference in change over 52 weeks in IGF-I was significantly different between groups (-19, 95% CI:-37 to -1, P = 0.04). In healthy postmenopausal women, intranasal E2 at a dose that results in serum levels that exceed the proposed threshold for growth hormone and IGF-I effects, does not alter IGF-I levels. This suggests that the effect of exogenous estrogen on IGF-I is a function of the method of administration rather than being dose related.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2010
DOI: 10.1097/GME.0B013E3181D991DD
Abstract: Our aim was to document patterns of consultation with alternative practitioners, use of complementary and alternative medicine (CAM) commonly used to alleviate menopausal symptoms, and lifestyle changes made by women in the first 2 years after their diagnosis with invasive breast cancer. A total of 1,588 women in the MBF Foundation Health and Wellbeing After Breast Cancer Study completed both the enrollment questionnaire and the first follow-up questionnaire (FQ1), on average, 41 and 92 weeks after diagnosis, respectively. The Menopause Quality of Life Questionnaire and the Psychological General Wellbeing Index were included in the FQ1. Logistic regression analysis was used to examine characteristics associated with consulting a CAM practitioner or using CAMs. At the time of completion of the FQ1, 16.4% of women had consulted a CAM practitioner and 10.6% reported using at least one CAM commonly used to alleviate menopausal symptoms. Women who consulted a CAM practitioner and women who were using at least one CAM at the time of completion of the FQ1 were, on average, younger and more educated and had a higher Menopause Quality of Life Questionnaire score than did women who did not. Of the women, 33.6% reported having made a dietary change, and the most common lifestyle change was an increase in physical activity, which was reported by 29.0% of women. The frequency of use of CAMs in common usage for menopausal symptoms by women with breast cancer was lower than anticipated, increased with time from diagnosis, and is associated with more severe menopausal symptoms.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2008
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2016
DOI: 10.1097/GME.0000000000000615
Abstract: The aim of the study was to document the prevalence of menopausal symptoms and the extent to which women are bothered by vasomotor symptoms (VMS) and joint pain in Bangladesh. A total of 1,590 women, aged 30 to 59 years, participated in a cross-sectional, questionnaire-based study between September 2013 and March 2014. The main outcome measures were moderate to severely bothersome VMS and joint pain, measured by the Menopause-Specific Quality of Life questionnaire. Of participants, 59.4% were premenopausal, 8.4% perimenopausal, and 32.3% postmenopausal. Approximately all women reached menopause by the age of 50 years. The prevalence of moderate to severely bothersome VMS was 4.1% in premenopausal, 33.3% in perimenopausal, and 28.2% in postmenopausal women. Factors associated with moderate to severely bothersome VMS were being perimenopausal (odds ratio [OR] 46.34, 95% CI 13.29-161.56 P 0.001) or postmenopausal (OR 19.15, 95% CI 5.63-65.11 P 0.001) and obesity (OR 2.20, 95% CI 1.03-4.71 P = 0.042). The prevalence of moderate to severely bothersome joint pain was 40.3% in postmenopausal, 36.2% in perimenopausal, and 15.3% in premenopausal women. Moderate to severely bothersome joint pain was more likely both in perimenopausal (OR 2.64, 95% CI 1.63-4.29 P 0.001) and postmenopausal women (OR 2.96, 95% CI 2.06-4.24 P 0.001). Moderate to severely bothersome joint pain was also more likely in women with no education compared with women having education beyond secondary school (OR 2.38, 95% CI 1.02-2.32 P 0.001). No women reported prescription therapy for menopausal symptoms. This study demonstrates that a high proportion of Bangladeshi women experience moderate to severely bothersome VMS and joint pain. Despite the considerable symptom prevalence, no women reported treatment, suggesting that menopause remains neglected in Bangladesh.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2014
Publisher: Wiley
Date: 07-11-2003
DOI: 10.1002/UOG.885
Abstract: To evaluate the measurement of the fetal abdominal fat layer (FFL), cardiac interventricular septum (IVS) and abdominal circumference (AC) percentile in the early third trimester as predictors of macrosomia at birth in the fetuses of women with gestational diabetes. Ninety patients attending the hospital's special diabetic clinic were recruited prospectively. FFL and IVS were measured in addition to the routine biometry in the early third trimester. AC was measured routinely and AC percentile was determined from established antenatal charts. These measurements were then assessed as predictors of macrosomia. A fetal fat layer of >/=5 mm was the most useful predictor of macrosomia at term as assessed using the likelihood ratio. An AC >/=90th percentile, however, had a better sensitivity. The usefulness of routine FFL measurement in the early third trimester in the management of diabetic pregnancies is worthy of further evaluation.
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1016/J.MATURITAS.2015.12.012
Abstract: To assess the prevalence, and factors associated with, pelvic floor disorders in a representative s le of community-dwelling older Australian women. 1548 women, aged 65-79 years, were recruited to this cross-sectional study between April and August 2014. Pelvic floor disorders, including urinary incontinence (UI), fecal incontinence (FI), and pelvic organ prolapse (POP), were assessed using validated questionnaires. Multivariable logistic regression was used to assess factors associated with each, and having one or more pelvic floor disorders. Among 1517 women (mean age=71.5 ± 4.1 SD years), 47.2% (95% CI, 44.7-49.7%) of women had one or more pelvic floor disorders, with 36.2% (95% CI, 33.8-38.6%) having UI, 19.8% (95% CI, 17.8-21.9%) having FI, and 6.8% (95% CI, 5.6-8.2%) having POP. Of the women with POP, 53.4% had UI, 33% had FI and 26.2% had both. The proportion of women with one or more pelvic floor disorders increased with parity from 34.6% (95% CI, 7.8-11.7%) for nulliparous women, to 45.3% (95% CI, 40.3-59.1%) for 1-2 births, and 52.1% (95% CI, 48.3-55.8%) for ≥ 3 births. Obese women were more likely to have at least one pelvic floor disorder (OR=1.77 95% CI, 1.36-2.31, p<0.01). Pelvic floor disorders are common in older women. Physicians caring for older women should be mindful that older women presenting with symptoms of one pelvic floor disorder are likely to have another concurrent pelvic floor problem.
Publisher: Wiley
Date: 03-2002
DOI: 10.1046/J.1369-6513.2002.00155.X
Abstract: To assess women's concerns when interviewed about the association between folate and neural tube defects (NTDs) and to determine how this is affected by time, being folate aware, having seen folate promotional material or being pregnant. As part of a community randomized trial outcomes evaluation, independent cross-sectional follow-up surveys were carried out in 1997 and 2000. Six local government areas in the state of Victoria, Australia 2431 women aged between 15 and 44 years. Whether or not women knew of the association between folate and NTDs (i.e. were folate aware), whether or not women had been concerned by seeing folate/NTD information and if an interview about folate and NTDs had raised any concerns for them. In the 1997 survey, 36% of women said that the interview had raised concerns and this decreased to 26% in 2000. Women who were folate aware were significantly less likely to have raised concerns than women who were not folate aware (OR(adj) = 0.38, 95% CI 0.24-0.60). In general, women who had seen promotional material were less likely to feel concern about the interview than those who had not, although this varied with whether or not the promotional material had raised concerns. These effects were greater in women who were pregnant. Women had increased concerns having seen folate promotional material and after being interviewed about it. These results are consistent with the proposition that an initial emotional response to sensitive health information is part of an adaptive response appropriate to the process of health-related behaviour change.
Publisher: Wiley
Date: 2013
DOI: 10.1111/J.1445-5994.2012.02930.X
Abstract: Recently, the dual-energy X-ray absorptiometry (DXA) diagnostic cut-off (T-score) for Australian Pharmaceutical Benefits Scheme (PBS) supported primary fracture prevention therapy with alendronate for older women (>70 years) has been changed from -3.0 to -2.5. To examine the impact of the expanded criteria for PBS-supported fracture prevention therapy in older women on case finding and cost. One thousand, nine hundred and eighty-three women, median age 76 years, not previously known to have low bone mineral density by DXA or a vertebral fracture underwent DXA scanning and a thoracolumbar X-ray. A woman was considered eligible for fracture prevention therapy if she had a T-score ≤-2.5 at the femoral neck and/or the lumbar vertebrae (two to four) or at least one vertebral fracture of ≥20% deformity. Seven hundred and forty-six women (37.6%) met the new criteria as a case for PBS-subsidised fracture prevention therapy. Four hundred and thirty-one (21.7%) had a T-score ≤-2.5 on DXA compared with 10.6% (n = 210) with a T-score ≤-3.0. Four hundred and eighty-three (24.4%) had at least one vertebral fracture. Only 8.5% (n = 168) had both a T-score ≤-2.5 and a prevalent vertebral fracture. The cost per case found by DXA equated to $460 compared with $398 for screening by thoracolumbar X-ray. The use of either DXA or X-ray will identify approximately two-thirds of women aged 70 years and over who would be eligible for fracture prevention. The use of X-ray would identify a marginally larger number of women and at lower financial cost but involve substantially greater radiation exposure.
Publisher: Elsevier BV
Date: 06-2016
Publisher: Elsevier BV
Date: 10-2013
DOI: 10.1016/J.BREAST.2013.05.013
Abstract: This study examined pregnancy-associated breast cancer (PABC) and pregnancy following treatment for breast cancer. We analysed data from a questionnaire-based, prospective study of women diagnosed with breast cancer. Timing of diagnosis in relation to pregnancy was self-reported in the enrolment questionnaire. Women reported subsequent pregnancies in annual follow-up questionnaires, up to at least 5 years from diagnosis. Women with PABC made up 3.3% of women <48 years at diagnosis and 14.3% of women aged <35 years at diagnosis. Nine of 46 (19.6%) women who were aged <40 years at diagnosis, and had either no children, or only one child, became pregnant subsequent to their diagnosis, and 8 experienced a live birth. As the number of women with PABC was small, conclusions from this study are limited. However, young women should be alert to PABC, especially in the post-partum period. Some women, with incomplete families at diagnosis, are choosing to have one or more pregnancies following treatment.
Publisher: Springer Science and Business Media LLC
Date: 09-04-2011
DOI: 10.1007/S00520-011-1150-8
Abstract: Smoking and alcohol consumption after breast cancer diagnosis have received little attention. The aim of this study was to describe the change in smoking and alcohol consumption of women in the BUPA Health Foundation Health and Wellbeing After Breast Cancer Study in the first 2 years after diagnosis. We documented cigarette and alcohol use at diagnosis in a prospective cohort study of 1,588 Australian women with invasive breast cancer in an enrolment questionnaire and again 2 years later (follow-up questionnaire, FQ1). Twelve percent of participants smoked at diagnosis. Nearly one third of these had quit by FQ1 and of those continuing, 1 in 4 were smoking fewer cigarettes per day. Smoking more at diagnosis was significantly associated with smoking at FQ1.Over 70% of women reported consuming alcohol in each questionnaire. The proportion of women consuming more than four alcoholic drinks per occasion at least weekly dropped between the time of diagnosis and FQ1, although by FQ1, 1 in 12 women still reported this drinking pattern. Smoking and alcohol consumption are important health issues for women with breast cancer. Health care providers should consider using evidence-based interventions to reduce smoking and drinking in this group.
Publisher: Springer Science and Business Media LLC
Date: 23-08-2013
DOI: 10.1007/S11764-013-0306-6
Abstract: The aim of our study was to establish the prevalence of breast pain persisting 5 years after the initial treatment of breast cancer (BC) and the relationship between those persistent symptoms and general well-being. The study involved women from Victoria, Australia, who had survived at least 5 years from diagnosis, remained free from recurrence or new BC and completed the fifth annual follow-up questionnaire. Analysis involved both multivariable logistic and linear regression. Of 1,205 women, 45 % reported breast pain which persisted for at least 3 months following initial treatment, and of these, 80 % reported pain persisting for at least 5 years. The factor contributing most to the likelihood of persistent breast pain was current lymphedema however, a full multivariable model explained <10 % of the likelihood of breast pain persisting for 5 years. The presence of breast pain at 5 years was associated with only a modest reduction in general well-being. Breast pain persisting for at least 5 years after treatment for BC is common. As the pain is largely unexplained by factors associated with the characteristics of the cancer or its treatment, the contribution of patient expectations to persistent breast pain may be considerable. Where persistent pain occurs, referral for the management of pain and, where appropriate, lymphedema is warranted.
Publisher: American Medical Association (AMA)
Date: 06-07-2005
Abstract: It has been proposed that low sexual desire and sexual dysfunction are associated with low blood testosterone levels in women. However, evidence to support this is lacking. To determine whether women with low self-reported sexual desire and sexual satisfaction are more likely to have low serum androgen levels than women without self-reported low sexual desire and sexual satisfaction. A community-based, cross-sectional study of 1423 women aged 18 to 75 years, who were randomly recruited via the electoral roll in Victoria, Australia, from April 2002 to August 2003. Women were excluded from the analysis if they took psychiatric medication, had abnormal thyroid function, documented polycystic ovarian syndrome, or were younger than 45 years and using oral contraception. Domain scores of the Profile of Female Sexual Function (PFSF) and serum levels of total and free testosterone, androstenedione, and dehydroepiandrosterone sulfate. A total of 1021 in iduals were included in the final analysis. No clinically significant relationships between having a low score for any PFSF domain and having a low serum total or free testosterone or androstenedione level was demonstrated. A low domain score for sexual responsiveness for women aged 45 years or older was associated with higher odds of having a serum dehydroepiandrosterone sulfate level below the 10th percentile for this age group (odds ratio [OR], 3.90 95% confidence interval [CI], 1.54-9.81 P = .004). For women aged 18 to 44 years, having a low domain score for sexual desire (OR, 3.86 95% CI, 1.27-11.67 P = .02), sexual arousal (OR, 6.39 95% CI, 2.30-17.73 P<.001), and sexual responsiveness (OR, 6.59 95% CI, 2.37-18.34 P<.001) was associated with having a dehydroepiandrosterone sulfate level below the 10th percentile. No single androgen level is predictive of low female sexual function, and the majority of women with low dehydroepiandrosterone sulfate levels did not have low sexual function.
Publisher: Wiley
Date: 28-07-2014
DOI: 10.1002/ART.38651
Abstract: The increased prevalence of osteoarthritis (OA) in postmenopausal women suggests that changes in either circulating sex steroid concentrations or the tissue response to sex steroids may have a role in the pathogenesis of OA. The aim of this study was to examine whether circulating sex steroid concentrations are associated with the incidence of total knee and total hip replacement for OA. Study subjects (n = 2,621 all women) were recruited in 1990-1994 from the Melbourne Collaborative Cohort Study (MCCS). Circulating sex steroid concentrations were measured in blood s les obtained from the women at the time of recruitment. The incidence of total knee and total hip replacement for OA during 2001-2011 was determined by linking the MCCS records to the Australian Orthopaedic Association National Joint Replacement Registry. During the followup period, 115 women had undergone total knee replacement and 99 had undergone total hip replacement for OA. Greater log-transformed concentrations of estradiol were associated with a lower incidence of knee replacement (hazard ratio [HR] 0.70, 95% confidence interval [95% CI] 0.50-0.96), and greater log-transformed concentrations of androstenedione were associated with a lower incidence of hip replacement (HR 0.70, 95% CI 0.52-0.93). In contrast, greater log-transformed concentrations of sex hormone binding globulin (SHBG) were associated with a higher incidence of hip replacement (HR 1.70, 95% CI 1.05-2.77). A lower estradiol concentration is a risk factor for knee OA, while a lower androstenedione concentration and higher SHBG concentration are risk factors for hip OA in women. These findings suggest that circulating sex steroids have a role in the pathogenesis of OA, and that modifying these steroid concentrations may provide a potential strategy for the prevention and treatment of knee and hip OA.
Publisher: Wiley
Date: 06-2004
Publisher: Informa UK Limited
Date: 10-12-2012
DOI: 10.3109/13697137.2012.746656
Abstract: The profound estrogen depletion caused by aromatase inhibitors (AIs) is associated with musculoskeletal symptoms, but the underlying pathophysiology remains unclear. To assess the effects of AI therapy on structural changes in knee cartilage and subchondral bone over 2 years in postmenopausal women. Setting and participants Thirty women with breast cancer, mean age 58.5 (standard deviation ± 5.6) years and 62 healthy controls, mean age 56.5 (standard deviation ± 4.6) years. Annualized changes in tibial cartilage volume and subchondral bone area, and worsening of tibiofemoral cartilage defects from paired knee magnetic resonance imaging 2 years apart were compared between the two groups. The AI-treated women had significantly greater expansion of the tibial plateau than the control group. The mean annualized differences, after adjusting for age, body mass index and baseline bone area, were 22.1 mm(2) (95% confidence interval (CI) 7.6-36.6, p = 0.003) for the medial tibial plateau and 19.1 mm(2) (95% CI 9.6-28.5, p < 0.001) for the lateral tibial plateau. The annual change in tibial cartilage volume and the worsening of cartilage defects did not differ between women taking AI therapy and controls. AI therapy is associated with knee subchondral bone expansion knee with no effect on knee cartilage in postmenopausal women without pre-existing joint symptoms. This suggests the effect of severe estrogen depletion on knee is on bone, with the tibial bone expansion most likely a response to mechanical load in the setting of bone loss. Whether this then results in an increased risk of knee osteoarthritis will need to be determined.
Publisher: Oxford University Press (OUP)
Date: 11-2008
DOI: 10.1111/J.1743-6109.2008.00967.X
Abstract: A validated questionnaire to assess the nature and quality of the recent female sexual experience and that can be employed to evaluate acute therapeutic effects does not exist. To validate an instrument with which researchers can evaluate the nature and quality of the female sexual experience within 24 hours of a sexual event. A cross-sectional questionnaire study in 349 sexually active community-based women, aged 20-65 years, who self-identified as being either satisfied or dissatisfied with their sexual life. Scores from the Monash Women's Health Program Female Sexual Satisfaction Questionnaire (MFSSQ), completed within 24 hours of sexual activity, on two occasions. Participants were 349 women who were sexually active at least once per fortnight, but not necessarily partnered. Almost equal groups of self-identified satisfied, dissatisfied, premenopausal, and postmenopausal women participated. Three hundred forty-five women (99%) completed one MFSSQ, and 326 women (94%) completed two separate questionnaires, each within 24 hours of a sexual event. Missing responses were few, good inter-item correlation was seen, and excellent reliability was demonstrated for most items, based on test-retest data. The questionnaire was able to discriminate well between sexually satisfied and dissatisfied women. The MFSSQ is a 12-item questionnaire specifically designed to assess the quality and nature of a recent sexual experience. It is easy and quick to administer, is reliable and valid, and has the potential to be used to assess the efficacy of acute interventions in the area of female sexual dysfunction.
Publisher: Informa UK Limited
Date: 16-09-2014
DOI: 10.3109/13697137.2014.956718
Abstract: The aim of this review was to examine the benefits and harms of organized screening mammography, with particular reference to data from Australia. Published literature was examined relating to the impact of screening mammography on breast cancer-specific mortality, the trends in use of adjuvant treatments for breast cancer, the effectiveness of adjuvant treatment in terms of breast cancer-specific mortality, the impact of breast cancer treatment on non-breast cancer mortality and the magnitude of the issue of over-diagnosis. Most of the recent reduction in breast cancer-specific mortality is explained by use of adjuvant therapy rather than screening mammography. The impact of screening mammography in countries where women present with early disease and have access to adjuvant treatment is modest. There is a wide range of estimates for the magnitude of over-diagnosis. All-cause mortality (rather than breast cancer-specific mortality) should be used when assessing the impact of mammographic screening as otherwise the harm of breast cancer treatment in women who are over-diagnosed will be missed. The benefits and harms of screening mammography are finely balanced. The impact of screening mammography is at best neutral but may result in overall harm. Women should be informed of the issue of over-diagnosis. It is time to review whether organized mammographic screening programs should continue.
Publisher: Springer Science and Business Media LLC
Date: 09-03-2010
DOI: 10.1007/S12672-010-0011-0
Abstract: Exposure to postmenopausal hormone therapy (HT) may affect the stage, histological type, and hormone receptor (HR) status of invasive breast cancer at the time of diagnosis. One thousand six hundred eighty-four women with newly diagnosed first invasive breast cancer were recruited to the "MBF Foundation Health and Wellbeing after Breast Cancer Study." Women using systemic HT estrogen (E) or E combined with progesterone (P) at the time of diagnosis of breast cancer were compared with those not using HT. Breast cancer tumor data were obtained from the Victorian Cancer Registry. Regression analysis was used to determine the associations between HT use or not at the time of diagnosis and tumor histology (ductal vs lobular), stage (I vs II, III, IV), HR status (ER+ or PR+ or both vs ER- or PR-). Of 1,377 women included in the analysis, 226 (16%) were using HT at the time of diagnosis. Of HT users, 20.4% had lobular breast cancer, 50% were stage I, and 85.8% had HR-positive tumors. Of non-users, 13.6% had lobular breast cancer, 48.2% were stage I, and 82.4% had HR-positive tumors. Use of systemic HT was associated with increased odds of having lobular compared with ductal breast cancer (OR = 1.75, 95% CI = 1.14-2.69, p = 0.01). There were no associations between HT use and either breast cancer stage or HR status. Women using systemic HT at the time of diagnosis were more likely to have lobular rather than ductal breast cancer compared with women not on HT.
Publisher: Wiley
Date: 06-2004
Publisher: Springer Science and Business Media LLC
Date: 29-09-2012
DOI: 10.1007/S10549-011-1794-6
Abstract: There has been a 28% reduction in age-standardised breast cancer mortality in Australia since 1991 when the free national mammographic program (BreastScreen) began. Therefore, a comparative study between BreastScreen participation and breast cancer age specific mortality trends in Australia was undertaken for two time periods between 1991 and 2007, where women aged 50-59 and 60-69 years, who were invited to screen, were compared to women aged 40-49 and 70-79 years who were not invited, but who did have access to the program. There were mortality reductions in all four age groups between 1991-1992 and 2007, resulting in 5,849 (95% CI 4,979 to 6,718) fewer women dying of breast cancer than would have otherwise been the case. Women aged 40-49 years, who had the lowest BreastScreen participation (approximately 20%), had the largest mortality reduction: 44% (95% CI 34.8-51.2). Women aged 60-69 years, who had the highest BreastScreen participation (approximately 60%), had the smallest mortality reduction: 19% (95% CI 10.5-26.9). As BreastScreen participation by invited women aged 50-69 years only reached a maximum of about 55-60% in 1998-1999, a decline in mortality in Australian women cannot be attributed to BreastScreen prior to this time. Thus, almost 60% of the Australian decline in breast cancer mortality since 1991 cannot be attributed to BreastScreen. Therefore, mammographic screening cannot account for most of the reductions in breast cancer mortality that have occurred in Australian women since 1991 and may have contributed to over-diagnosis. Most, if not all, of the reductions can be attributed to the adjuvant hormonal and chemotherapy, which Australian women have increasingly received since 1986.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2006
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2014
Publisher: Informa UK Limited
Date: 2004
DOI: 10.1080/01443610400007885
Abstract: This questionnaire-based study in Victoria, Australia, examined the responses of pregnant women, aged 37 years and over, to a question about what they expected prenatal testing (screening and/or diagnosis) for birth defects to tell them about their pregnancy. Content analysis showed that, of the 432 tested women, 61.3% mentioned Down syndrome, chromosomal abnormalities or trisomies. Women undergoing both screening and diagnosis were more likely than those having one or other test to mention Down syndrome (adjusted OR = 1.6, P = 0.06), having adjusted for age, marital status, education, residence and parity. Similarly, those from an English-speaking background were more likely to mention Down syndrome, etc. compared to women from a non-English-speaking background (adjusted OR = 3.5, P < 0.001). Down syndrome, a fundamental piece of information about prenatal tests, was not mentioned in nearly 40% of women's responses. This suggests that pregnant women need clearer information about prenatal testing, including the conditions that might be detected.
Publisher: Elsevier BV
Date: 07-2005
DOI: 10.1016/J.MATURITAS.2004.08.013
Abstract: Changes in the hormonal milieu at the menopause are associated with an increase in total adiposity and a more android pattern of fat distribution, with the latter associated with an increased risk of the metabolic syndrome. The aim of this study was to explore potential mechanisms that might contribute to the changes in body composition associated with the menopause transition. Using real-time PCR analysis, we have compared the expression of various factors involved in fat metabolism in subcutaneous abdominal and gluteal fat in premenopausal (Group 1 n=11), postmenopausal (Group 2 n=10) and postmenopausal women taking estrogen therapy (Group 3 n=10). All subjects were of normal body mass index, euglycemic and normolipemic. The postmenopausal women were older (Group 1, 43.1+5.0 versus Groups 2 and 3, 57.9+/-7.4 years, P<0.001 and 56.1+/-4.5 years, P<0.001, respectively). Expression analysis revealed that levels of transcripts encoding adiponectin, peroxisome proliferator-activated receptor gamma and fatty acid transporter, each associated with insulin sensitivity, were significantly greater in gluteal fat from estrogen deplete postmenopausal women than in fat from the other two groups (P<0.05). In contrast, levels of transcripts for acetyl CoA carboxylase alpha, long chain acyl CoA dehydrogenase and hormone sensitive lipase were significantly greater in abdominal fat from premenopausal women than either postmenopausal groups (P<0.05). These findings indicate both aging and the menopause transition are associated with changes in fat metabolism, which may contribute to the accumulation of body fat after menopause.
Publisher: Wiley
Date: 29-02-2016
DOI: 10.1111/AJO.12453
Abstract: A clinical practice audit was undertaken to share an Australian experience of the use of micronised progesterone (mP) 100 mg daily as part of menopausal hormone therapy (MHT). Ninety-nine women attending a single practitioner were offered the option of mP as a component of MHT, under the Australian Authorised Prescriber Scheme, over 2.5 years. Each of their files was independently audited. The mean age at commencement was 55.0 (SD 6.6) years. Of the 93 postmenopausal women, 7 were lost to follow-up, 18 discontinued and treatment was ongoing for 68. The mean duration of treatment for those ongoing was 1.7 (SD 0.5) years, and for those who discontinued, 0.6 (SD 0.6) years. The most common side effect was unscheduled bleeding, which was also the most common reason for discontinuation (5/18 women). None of the 15 women who had a transvaginal ultrasound examination had an endometrial thickness >5 mm. Of the 41 women who had at least one blood progesterone measurement performed, the median value was 11.3 (range 0.7-138) nmol/L. This audit indicates that mP is well tolerated when prescribed as MHT. Although there was no evidence of endometrial hyperplasia, further research is needed to establish the safety of mP for continuous combined MHT use.
Publisher: Elsevier BV
Date: 08-2008
DOI: 10.1016/J.JOCA.2007.11.011
Abstract: Although vastus medialis and vastus lateralis are important muscular determinants of patellofemoral joint function, it is unclear how these muscles relate to the structure of the patellofemoral joint. The aim of this cross-sectional study was to determine the relationship between the vasti muscles and patella cartilage volume and defects and patella bone volume. One hundred and seventy-five women, aged 40-67 years, with no knee pain or clinical lower-limb disease had magnetic resonance imaging (MRI) of their dominant knee. The cross-sectional areas of the distal vastus medialis and lateralis were measured 37.5mm superior to the quadriceps tendon insertion at the proximal pole of the patella. Patella cartilage volume and defects and patella bone volume were measured from these images using validated methods. There was no significant association between the distal vastus medialis cross-sectional area and patella cartilage volume. For every 1mm(2) increase in the distal vastus medialis cross-sectional area, there was an associated increased risk of patella cartilage defects [odds ratio (OR): 1.2 95% confidence interval (CI) 1.004, 1.5 P=0.05], and an associated increase in patella bone volume (OR: 3.9 95% CI 2.0, 5.8 P<0.001) after adjustment for potential confounders. There was no significant relationship between vastus lateralis cross-sectional area and measures of patella cartilage or bone. An increased cross-sectional area of the distal portion of the vastus medialis muscle is associated with an increased risk of patella cartilage defects, and an increase in patella bone volume among healthy women. Although these results need to be confirmed in longitudinal studies, they suggest that an increase in the distal vastus medialis cross-sectional area is associated with structural change at the patellofemoral joint.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2007
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2011
DOI: 10.1097/GME.0B013E3181FEE03B
Abstract: The aim of this study was to document the age-specific prevalence of fecal incontinence (FI), as well as its relationship to childbirth and urinary incontinence (UI), in a community-based s le of Australian women. A total of 444 women aged 26 to 82 years, originally recruited from a community-based research database, completed a self-administered study questionnaire. Prevalence of FI was assessed using the Pelvic Floor Distress Inventory, and UI and its subtypes were determined using the Questionnaire for Urinary Incontinence Diagnosis. Univariate (Pearson's χ tests) and multivariate logistic regression analyses were used to assess the relationship between FI type and UI adjusting for age and body mass index (BMI). Data were analyzed for 442 women. The overall prevalence of any FI was 20.7% (95% CI, 16.9%-24.5%). Loose FI was reported by 91 of 442 women, yielding a prevalence of 20.7% (95% CI, 16.9%-24.5%). Well-formed FI was reported by 20 of 442 women, yielding a prevalence of 4.5% (95% CI, 2.6%-6.4%). All the women with well-formed FI also reported problems of loose FI. The prevalence of FI increased with age up to 75 years for both types of FI. FI was not related to parity (P = 0.9). The highest proportion of any FI (24.4%) occurred in women with a parity of four or greater however, 20.3% of nulliparous women reported FI. Within parous women, there was no significant association found between FI and history of self-reported instrumental delivery (P = 0.4). About two thirds of the women with loose and well-formed FI also reported coexisting UI. Loose FI was significantly associated with any UI (odds ratio, 2.8 95% CI, 1.7-4.8) after adjusting for age and BMI (P < 0.001). Well-formed FI was not significantly associated with any UI after adjusting for age and BMI. FI is a common condition affecting one in five adult women in the community. In our study, women with loose FI, but not well-formed FI, were more likely to have UI independent of their age and BMI. Being parous was not associated with an increased risk of any FI.
Publisher: Springer Science and Business Media LLC
Date: 29-01-2015
DOI: 10.1007/S00198-015-3046-9
Abstract: This study establishes a profile for women at midlife, referred for a dual energy X-ray absorptiometry (DXA), most likely to have osteoporosis, and from this, a pre-DXA screening tool has been developed. These findings inform much needed evidence-based guidelines for targeted and effective screening for osteoporosis and osteoporotic fracture prevention in women at midlife. There is no consensus as to whether women at midlife should undergo screening dual energy X-ray absorptiometry (DXA) to identify osteoporosis (T-score < -2.5). We investigated the prevalence of osteoporosis in women, aged 40-65 years, referred to 42 community-based Australian radiology centres, and identified the characteristics that best predict osteoporosis in women having a screening DXA. One thousand four hundred and two women completed the study questionnaire and had DXA reports available. After excluding women with an established indication for a DXA (58 %), users of bone-specific medication (10.5 %) and cancer (7.6 %), 466 women were classified as having a screening DXA. Forty of these women had osteoporosis at the lumbar spine (n = 32, 6.9 %) or femoral neck (n = 17, 3.6 %). Three predictors of osteoporosis (postmenopausal, nonuse of hormonal therapy and body mass index) were identified and incorporated into the Monash Osteoporosis Risk Score for women at midlife (MORS). In the screened study population, the MORS had a sensitivity of 70 % and specificity of 66 %, with a positive predictive value of 16.2 % and negative predictive value of 95.9 % for osteoporosis. Very few women referred for a screening DXA scan will be found to have osteoporosis. The MORS, a simple decision tool, would have identified 70 % of the women in our screening DXA study population and would have eliminated over 60 % of the screening DXA studies. Hence, use of the MORS may reduce unnecessary DXA scans and facilitate identification of the majority of cases of osteoporosis in women aged 40 to 65 years.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2011
DOI: 10.1016/J.JURO.2010.11.080
Abstract: We determined the incidence and resolution rates of different types of urinary incontinence in Australian women and examined the course of urinary incontinence with or without treatment. A total of 506 women originally recruited from a community based research database completed a baseline questionnaire in 2006 and a followup questionnaire in 2008. Urinary incontinence incidence and resolution were assessed using the Questionnaire for Urinary Incontinence Diagnosis. The Bristol Female Lower Urinary Tract Symptoms questionnaire was used to assess the impact of urinary incontinence on quality of life. At baseline and followup 442 women provided data. Mean ± SD age was 59.28 ± 12.1 years at followup. The total incidence of any new urinary incontinence was 17% (95% CI 12.4-21.6) in unaffected women and the total resolution rate was 16.8% (95% CI 11.4-22.2) in women with urinary incontinence during 2 years regardless of receiving treatment for urinary incontinence. There was also movement of women among the diagnoses of stress only, urge only and mixed urinary incontinence during followup. A total of 34 women reported having received treatment for urinary incontinence and 5 experienced resolution of the condition. All types of urinary incontinence were associated with impaired quality of life (p <0.001) and adversely impacted daily activity. A negative impact on quality of life (p = 0.02) was also observed in incident cases at followup compared with baseline. Our study shows that urinary incontinence is a highly dynamic clinical condition with movement among diagnostic subtypes of stress only, urge only and mixed urinary incontinence, and periods of resolution. Any urinary incontinence is significantly associated with impaired quality of life.
Publisher: Informa UK Limited
Date: 24-07-2020
Publisher: Elsevier BV
Date: 07-2009
DOI: 10.1016/J.MATURITAS.2009.03.020
Abstract: The aim of this study was to evaluate the safety of 52 weeks of DHEA 50mg daily oral dose given to postmenopausal women with low libido to improve sexual function. 93 postmenopausal women were enrolled in a 52-week randomised, double-blind, placebo-controlled trial and received either DHEA 50mg or placebo (PL) daily. The effects of DHEA versus placebo on lipid profile, insulin-glucose homeostasis and the endomentrium were assessed over 52 weeks. Oral DHEA, 50mg/day, was not associated with any effects on blood lipids or insulin resistance. The pattern of breakthrough bleeding did not substantially differ between the DHEA and PL groups and no significant adverse endometrial effects were apparent. The use of 50mg oral DHEA did not significantly alter lipid profile, insulin sensitivity or adversely affect the endometrium in postmenopausal women.
Location: Australia
No related grants have been discovered for Robin Bell.