Catherine M. Bennett

HbA1c as a screening tool for detection of Type 2 diabetes: a systematic review

Aim  To assess the validity of glycated haemoglobin A1c (HbA1c) as a screening tool for early detection of Type 2 diabetes.

Risk factors for female sexual dysfunction in the general population: exploring factors associated with low sexual function and sexual distress.

INTRODUCTION No previous population-based studies have used validated instruments to measure female sexual dysfunction (FSD) in Australian women across a broad age range. AIM To estimate prevalence and explore factors associated with the components of FSD. MAIN OUTCOME MEASURES Sexual Function Questionnaire measured low sexual function. Female Sexual Distress Scale measured sexual distress. Methods. Multivariate analysis of postal survey data from a random sample of 356 women aged 20-70 years. RESULTS Low desire was more likely to occur in women in relationships for 20-29 years (odds ratio 3.7, 95% confidence intervals 1.1-12.8) and less likely in women reporting greater satisfaction with their partner as a lover (0.3, 0.1-0.9) or who placed greater importance on sex (0.1, 0.03-0.3). Low genital arousal was more likely among women who were perimenopausal (4.4, 1.2-15.7), postmenopausal (5.3, 1.6-17.7), or depressed (2.5, 1.1-5.3), and was less likely in women taking hormone therapy (0.2, 0.04-0.7), more educated (0.5, 0.3-0.96), in their 30s (0.2, 0.1-0.7) or 40s (0.2, 0.1-0.7), or placed greater importance on sex (0.2, 0.05-0.5). Low orgasmic function was less likely in women who were in their 30s (0.3, 0.1-0.8) or who placed greater importance on sex (0.3, 0.1-0.7). Sexual distress was positively associated with depression (3.1, 1.2-7.8) and was inversely associated with better communication of sexual needs (0.2, 0.05-0.5). Results were adjusted for other covariates including age, psychological, socioeconomic, physiological, and relationship factors. CONCLUSIONS Relationship factors were more important to low desire than age or menopause, whereas physiological and psychological factors were more important to low genital arousal and low orgasmic function than relationship factors. Sexual distress was associated with both psychological and relationship factors.

What is the "true" prevalence of female sexual dysfunctions and does the way we assess these conditions have an impact?

INTRODUCTION A wide range of prevalence estimates of female sexual dysfunctions (FSD) have been reported. AIM Compare instruments used to assess FSD to determine if differences between instruments contribute to variation in reported prevalence. MAIN OUTCOME MEASURES Sexual Function Questionnaire combined with Female Sexual Distress Scale (SFQ-FSDS) was our gold standard, validated instrument for assessing FSD. Alternatives were SFQ alone and two sets of simple questions adapted from Laumann et al. 1994. Methods. A postal survey was administered to a random sample of 356 Australian women aged 20 to 70 years. RESULTS When assessed by SFQ-FSDS, prevalence estimates (95% confidence intervals) of hypoactive sexual desire disorder, sexual arousal disorder (lubrication), orgasmic disorder, and dyspareunia were 16% (12% to 20%), 7% (5% to 11%), 8% (6% to 12%), and 1% (0.5% to 3%), respectively. Prevalence estimates varied across alternative instruments for these disorders: 32% to 58%, 16% to 32%, 16% to 33%, and 3% to 23%, respectively. Compared with SFQ-FSDS alternative instruments produced higher estimates of desire, arousal and orgasm disorders and displayed a range of sensitivities (0.25 to 1.0), specificities (0.48 to 0.99), positive predictive values (0.01 to 0.56), and negative predictive values (0.95 to 1.0) across the disorders investigated. Kappa statistics comparing SFQ-FSDS and alternative instruments ranged from 0 to 0.71 but were predominantly 0.44 or less. Changing recall from previous month to 1 month or more in the previous year produced higher estimates for all disorders investigated. Including sexual distress produced lower estimates for desire, arousal, and orgasm disorders. CONCLUSIONS Prevalence estimates of FSD varied substantially across instruments. Relatively low positive predictive values and kappa statistics combined with a broad range of sensitivities and specificities indicated that different instruments identified different subgroups. Consequently, the instruments researchers choose when assessing FSD may affect prevalence estimates and risk factors they report.

ORIGINAL RESEARCH—EPIDEMIOLOGY: What can Prevalence Studies Tell Us about Female Sexual Difficulty and Dysfunction?

INTRODUCTION Many recent studies have investigated the prevalence of female sexual difficulty/dysfunction. AIM Investigate female sexual difficulty/dysfunction using data from prevalence studies. METHODS We reviewed published prevalence studies excluding those that had not included each category of sexual difficulty (desire, arousal, orgasm, and pain), were based on convenience sampling, or had a response rate <50% or a sample size <100. Main Outcome Measures. For each study we used the prevalence of any sexual difficulty as the denominator and calculated the proportion of women reporting each type of difficulty. For each category of sexual difficulty we used the prevalence of that difficulty lasting 1 month or more as the denominator and calculated the proportion of difficulties lasting several months or more and 6 months or more. RESULTS Only 11 of 1,248 studies identified met our inclusion criteria. These studies used different measures of sexual dysfunction, so generating a simple summary prevalence was not possible. However, we observed consistent patterns in the published data. Among women with any sexual difficulty, on average, 64% (range 16-75%) experienced desire difficulty, 35% (range 16- 48%) experienced orgasm difficulty, 31% (range 12-64%) experienced arousal difficulty, and 26% (range 7-58%) experienced sexual pain. Of the sexual difficulties that occurred for 1 month or more in the previous year, 62-89% persisted for at least several months and 25-28% persisted for 6 months or more. Two studies investigated distress. Only a proportion of women with sexual difficulty were distressed by it (21-67%). CONCLUSIONS Desire difficulty is the most common sexual difficulty experienced by women. While the majority of difficulties last for less than 6 months, up to a third persist for 6 months or more. Sexual difficulties do not always cause distress. Consequently, prevalence estimates will vary depending on the time frame specified by researchers and whether distress is included in these estimates.

ORIGINAL RESEARCH—EPIDEMIOLOGYORIGINAL RESEARCH—EPIDEMIOLOGY: What can Prevalence Studies Tell Us about Female Sexual Difficulty and Dysfunction?

INTRODUCTION Many recent studies have investigated the prevalence of female sexual difficulty/dysfunction. AIM Investigate female sexual difficulty/dysfunction using data from prevalence studies. METHODS We reviewed published prevalence studies excluding those that had not included each category of sexual difficulty (desire, arousal, orgasm, and pain), were based on convenience sampling, or had a response rate <50% or a sample size <100. Main Outcome Measures. For each study we used the prevalence of any sexual difficulty as the denominator and calculated the proportion of women reporting each type of difficulty. For each category of sexual difficulty we used the prevalence of that difficulty lasting 1 month or more as the denominator and calculated the proportion of difficulties lasting several months or more and 6 months or more. RESULTS Only 11 of 1,248 studies identified met our inclusion criteria. These studies used different measures of sexual dysfunction, so generating a simple summary prevalence was not possible. However, we observed consistent patterns in the published data. Among women with any sexual difficulty, on average, 64% (range 16-75%) experienced desire difficulty, 35% (range 16- 48%) experienced orgasm difficulty, 31% (range 12-64%) experienced arousal difficulty, and 26% (range 7-58%) experienced sexual pain. Of the sexual difficulties that occurred for 1 month or more in the previous year, 62-89% persisted for at least several months and 25-28% persisted for 6 months or more. Two studies investigated distress. Only a proportion of women with sexual difficulty were distressed by it (21-67%). CONCLUSIONS Desire difficulty is the most common sexual difficulty experienced by women. While the majority of difficulties last for less than 6 months, up to a third persist for 6 months or more. Sexual difficulties do not always cause distress. Consequently, prevalence estimates will vary depending on the time frame specified by researchers and whether distress is included in these estimates.

Paracetamol use in early life and asthma: prospective birth cohort study

Objective To determine if use of paracetamol in early life is an independent risk factor for childhood asthma. Design Prospective birth cohort study. Setting Melbourne Atopy Cohort Study. Participants 620 children with a family history of allergic disease, with paracetamol use prospectively documented on 18 occasions from birth to 2 years of age, followed until age 7 years. Main outcome measures The primary outcome was childhood asthma, ascertained by questionnaire at 6 and 7 years. Secondary outcomes were infantile wheeze, allergic rhinitis, eczema, and skin prick test positivity. Results Paracetamol had been used in 51% (295/575) of children by 12 weeks of age and in 97% (556/575) by 2 years. Between 6 and 7 years, 80% (495/620) were followed up; 30% (148) had current asthma. Increasing frequency of paracetamol use was weakly associated with increased risk of childhood asthma (crude odds ratio 1.18, 95% confidence interval 1.00 to 1.39, per doubling of days of use). However, after adjustment for frequency of respiratory infections, this association essentially disappeared (odds ratio 1.08, 0.91 to 1.29). Paracetamol use for non-respiratory causes was not associated with asthma (crude odds ratio 0.95, 0.81 to 1.12). Conclusions In children with a family history of allergic diseases, no association was found between early paracetamol use and risk of subsequent allergic disease after adjustment for respiratory infections or when paracetamol use was restricted to non-respiratory tract infections. These findings suggest that early paracetamol use does not increase the risk of asthma.

Effect of a partially hydrolyzed whey infant formula at weaning on risk of allergic disease in high-risk children: A randomized controlled trial

BACKGROUND Partially hydrolyzed whey formula (pHWF) has been recommended for infants with a family history of allergic disease at the cessation of exclusive breast-feeding to promote oral tolerance and prevent allergic diseases. OBJECTIVE To determine whether feeding infants pHWF reduces their risk of allergic disease. METHODS A single-blind (participant) randomized controlled trial was conducted to compare allergic outcomes between infants fed a conventional cows milk formula, a pHWF, or a soy formula. Before birth, 620 infants with a family history of allergic disease were recruited and randomized to receive the allocated formula at cessation of breast-feeding. Skin prick tests to 6 common allergens (milk, egg, peanut, dust mite, rye grass, and cat dander) were performed at 6, 12, and 24 months. The primary outcome was development of allergic manifestations (eczema and food reactions) measured 18 times in the first 2 years of life. RESULTS Follow-up was complete for 93% (575/620) at 2 years and 80% (495/620) at 6 or 7 years of age. There was no evidence that infants allocated to the pHWF (odds ratio, 1.21; 95% CI, 0.81-1.80) or the soy formula (odds ratio, 1.26; 95% CI, 0.84-1.88) were at a lower risk of allergic manifestations in infancy compared with conventional formula. There was also no evidence of reduced risk of skin prick test reactivity or childhood allergic disease. CONCLUSION Despite current dietary guidelines, we found no evidence to support recommending the use of pHWF at weaning for the prevention of allergic disease in high-risk infants.

Walking to school and traffic exposure in Australian children

Abstract: Daily patterns of pedestrian activity in young children have important health implications, primarily because of the risk of road traffic injury, but also because they may reflect the commencement of exercise habits with long–term consequences. A cross–sectional survey in two Australian cities, Melbourne and Perth, aimed to collect, by parent self–administered questionnaire, population–based data on modes of travel, numbers of street crossings (both accompanied and unaccompanied by an adult), and sociode–mographic factors for six– and nine–year–old children. Results indicate that 35 per cent (95 per cent confidence interval (CI) 31 to 39 per cent) and 31 per cent (CI 28 to 34 per cent) walk to school in Melbourne and Perth respectively, while over 60 per cent are driven to school by car, with very small proportions riding bicycles or taking public transport. A higher level of walking was associated with lower levels of several indicators of socioeconomic status. Logistic regression analysis showed that the strongest predictor of walking activity was school type (government versus independent), and after adjusting for this, lesser car ownership, non–English–speaking background and lower occupational category were associated with walking to school, while a different set of predictors–age, sex and maternal education–was associated with the unaccompanied crossing of streets. There was litde difference in overall walking levels between boys and girls, but boys were significandy more likely to cross streets unaccompanied (adjusted odds ratio 1.41, CI 1.14 to 1.72), providing a partial explanation of documented sex differences in injury rates.

Do boys do the atopic march while girls dawdle

BACKGROUND The atopic march hypothesis suggests that infants with eczema are at increased risk of asthma. Others argue that eczema is not a risk factor for asthma unless there is also sensitization or early wheezing. OBJECTIVE To examine the role of infantile eczema as a predictor of risk of childhood asthma, while allowing for the effects of early wheeze, sensitization, and sex, both as independent effects and possible effect modifiers. METHODS A total of 620 infants with a family history of allergic disease was recruited. Eczema and wheeze was prospectively documented to 2 years of age. Sensitization was determined by skin prick tests at 6, 12, and 24 months to 6 common food and inhalant allergens. Interviews were conducted at 6 and 7 years to ascertain current asthma. RESULTS Sufficiently complete data were available for 403 children. Eczema within the first 2 years of life was clearly associated with an increased risk of childhood asthma in boys (adjusted odds ratio, 2.45; 95% CI, 1.31-4.46) but not in girls (odds ratio, 0.88; 95% CI, 0.43-1.77; P for interaction = .031) even with adjustment for the effects of early allergic sensitization and wheeze. If these relationships are causal, an intervention to prevent eczema in boys might reduce the incidence of childhood asthma by as much as 28%. CONCLUSION Eczema in the first 2 years of life is associated with an increased risk of childhood asthma in boys, but there is no evidence of this in girls.

The temporal sequence of allergic sensitization and onset of infantile eczema

Background Eczema is commonly associated with sensitization in infants, but the causative role of sensitization in the development of eczema has been questioned.