Janneke Berecki-Gisolf

Transitions into informal caregiving and out of paid employment of women in their 50s.

Data from the Australian Longitudinal Study on Womens Health were used to study the order of events leading to informal caregiving and changes in labour force participation in mid-aged women, taking into account health and socioeconomic status. This analysis included 9857 women who responded to the third (2001) and fourth (2004) surveys and provided data for the caring and employment variables used. Caring was defined as providing care for an ill, frail or disabled person at least 7h/wk. Between 2001 and 2004, the proportion of women caring increased from 12 to 14%. Paid employment participation decreased from 67 to 62% in 2004. Logistic regression model results show that taking up caring between 2001 and 2004 was not statistically significantly associated with employment status in 2001. Among women who took up caring, however, hours spent in paid employment in 2001 was negatively associated with hours spent caring in 2004. Amongst women working in 2001, taking up caring between 2001 and 2004 was associated with reduced participation in paid employment. In conclusion, among mid-aged women, transitions into caregiving were irrespective of time spent in paid employment, but were followed by a decrease in labour force participation. Policies could aim to support continuing labour force participation during caregiving by creating flexible working arrangements; re-employment programs could support women who quit work in getting back to paid employment after a period of caregiving.

Symptoms reported by women in midlife: Menopausal transition or aging?

Objective: The aim of this study was to determine which symptoms commonly reported by women at midlife are associated with the menopausal transition, after adjusting for aging, life events, sociodemographics, and lifestyle factors. Methods: Middle-aged women participating in the Australian Longitudinal Study on Womens Health between 1996 (survey 1, ages 45-50 y) and 2007 (survey 5) were included in the analyses if natural menopause status could be determined at any survey (n = 8,649 of 13,716 participants). Natural menopause status was determined from reported menstruation patterns. A survival function describing age at menopause was computed. Logistic regression models for repeated measures were used to estimate the association between menopausal stage and symptom prevalence. Results: There were 6,814 (79%) women who reached natural menopause before 2007. The median age at menopause was 52 years. Compared with the premenopausal phase, menopause was associated with hot flushes (odds ratio, 8.6 [95% CI, 7.5-9.9]), night sweats (odds ratio, 5.5 [95% CI, 4.8-6.3]), and, to a lesser extent, stiff or painful joints (odds ratio, 1.6 [95% CI, 1.4-1.8]), difficulty sleeping (odds ratio, 1.4 [95% CI, 1.2-1.6]), and poor/fair self-rated health (odds ratio, 1.6 [95% CI, 1.3-1.9]), after controlling for confounders. Prevalence of some symptoms was still raised more than 7 years after menopause. Headaches/migraines were negatively associated with aging, and urinary incontinence was positively associated with aging. Conclusions: Treatment such as hormone therapy should be targeted to vasomotor symptoms, which are most strongly associated with menopause rather than to less specific symptoms related to aging per se.

Work disability after road traffic injury in a mixed population with and without hospitalisation

BACKGROUND Studies addressing work disability after road traffic injury are generally aimed at seriously injured hospital patients, and less is known about the disability burden associated with injuries not requiring hospitalisation. The aim of this study was to describe the distribution and determinants of work disability outcomes for patients with musculoskeletal and orthopaedic traffic injuries, including those not sufficiently severe to require hospitalisation. METHODS Persons injured in road traffic accidents in 2005-2007 claiming compensation via the Transport Accident Commission (Victoria, Australia) were included if they had compensated time off work, and their most serious injury was musculoskeletal or orthopaedic (n=5970). Work disability outcomes were determined from income compensation payments over 17 months following the accident. Logistic regression models were used relating demographic and injury characteristics to work disability. RESULTS Of the injuries, 59% required hospitalisation; 15% required hospitalisation of >1 week. Long-term work disability was common with 32% of injuries resulting in work disability ≥6 months after the accident. The duration of work disability increased markedly with length of hospital stay. Those with no hospital stay accounted for 27% of all work disability days; those with ≤7 days in hospital (including no hospital stay) accounted for 71%. Female sex, age ≥35 years and early opioid prescriptions were also risk factors for work disability ≥6 months after the accident. CONCLUSION The majority of work disability days were among patients with one week or less in hospital. Because (short) hospitalisation was relatively common after traffic accidents, the relative work disability burden of non-hospitalised injury is not as great as in a mixed injury aetiology population.

What Is a Healthy Body Mass Index for Women in Their Seventies? Results From the Australian Longitudinal Study on Women’s Health

BACKGROUND This study examines the relevance of the World Health Organization (WHO) optimal range for body mass index (BMI) of 18.5-25 kg/m(2) to morbidity in older women. METHODS Data were from 11,553 women who completed five mailed surveys at 3-year intervals between 1996 (age 70-75 years) and 2008 (age 82-87 years). Incidence and prevalence of diabetes mellitus (DM), hypertension, heart disease, and osteoporosis; hospital admissions; and mortality were assessed. The association between BMI in 1996 and each outcome was examined using logistic regression models with repeated measures and a proportional hazards model for survival. RESULTS There were consistent associations between increasing BMI and increasing incidence and prevalence of DM, hypertension, and heart disease and between increasing BMI and decreasing risk of osteoporosis. The association with hospital admission was J shaped and lowest for BMI of 22-24 kg/m(2), whereas the association with mortality was U shaped, being lowest for BMI of 25-27 kg/m(2). These associations were not affected by excluding women with cancer or excluding the first 5 years of follow-up. CONCLUSIONS These results illustrate the complexity of determining the optimal BMI range for women who survived to age 70-75 years. Although the WHO recommendation is appropriate for DM, hypertension, heart disease, and hospitalization, a slightly higher BMI range may be optimal for osteoporosis and mortality.

Adherence to bisphosphonate treatment by elderly women

Objective: The aim of this study was to evaluate the relationship between adherence to bisphosphonate treatment by postmenopausal women and demographic, health, and lifestyle factors before treatment in a country with universal subsidies for pharmaceutical costs. Design: Older women participating in the Australian Longitudinal Study on Womens Health who consented to linkage to Pharmaceutical Benefits Scheme claims data were included if they filled a bisphosphonate prescription between 2002 and 2005 after a medication-free interval of 180 days (N = 788). A Cox proportional hazards model was used to assess the association of baseline variables with duration of adherence to bisphosphonate treatment. Results: The median time until discontinuation of bisphosphonate treatment was 170 days (95% CI: 154-186). Accounting for socioeconomic status, the baseline variables that were associated with adherence failure were use of acid-related medications (hazard ratio = 1.25, 95% CI: 1.01-1.55) and smoking (hazard ratio = 1.82, 95% CI: 1.26-2.64); reporting high levels of physical activity was associated with better adherence (HR = 0.69, 95% CI: 0.52-0.92). Conclusions: Overall adherence to bisphosphonate treatment among older Australian women with a fracture history was poor. Inquiring about acid-related disorders and health behavior such as smoking and lack of physical activity could help the prescribing physician to identify women at risk of nonadherence.

Angina Symptoms Are Associated With Mortality in Older Women With Ischemic Heart Disease

Background— Angina symptoms have been reported to predict mortality in men. The aim of this study was to investigate the association between angina symptoms and mortality in women. Methods and Results— In 2004, 873 older participants in the Australian Longitudinal Study on Women’s Health with self-reported ischemic heart disease participated in a nested substudy. Women were 77 to 83 years of age; 165 (19%) died during the 4.5-year follow-up. Angina symptoms were established with Seattle Angina Questionnaire (SAQ) scores for physical limitation, angina frequency, angina stability, and disease perception. Proportional hazards modeling was used to examine the relationship of SAQ score differences with mortality. Physical limitation scores were associated with mortality, with hazard ratios of 1.1, 1.9, and 3.4 for mild, moderate, and severe versus minimal limitations, respectively (P<0.001). Angina frequency scores were also associated with death, with hazard ratios of 1.2, 1.2, and 4.8 for mild, moderate, and severe versus minimal angina frequency, respectively (P<0.001). Age (hazard ratio 1.1, 95% confidence interval 1.0 to 1.2), pulmonary disease (hazard ratio 1.6, 95% confidence interval 1.2 to 2.3), and kidney disease (hazard ratio 1.7, 95% confidence interval 1.1 to 2.5) were statistically significantly associated with mortality in a multivariable model of clinical predictors. In a combined model with SAQ scores and clinical predictors, SAQ scores for physical limitation and angina stability remained statistically significantly associated with mortality. Conclusions— In older women with ischemic heart disease, angina symptoms assessed by use of SAQ scores for physical limitations and angina frequency were associated with mortality; SAQ scores may therefore prove to be a useful tool for risk assessment in this patient group.

Identifying Cardiac Syncope Based on Clinical History: A Literature-Based Model Tested in Four Independent Datasets

Background We aimed to develop and test a literature-based model for symptoms that associate with cardiac causes of syncope. Methods and Results Seven studies (the derivation sample) reporting ≥2 predictors of cardiac syncope were identified (4 Italian, 1 Swiss, 1 Canadian, and 1 from the United States). From these, 10 criteria were identified as diagnostic predictors. The conditional probability of each predictor was calculated by summation of the reported frequencies. A model of conditional probabilities and a priori probabilities of cardiac syncope was constructed. The model was tested in four datasets of patients with syncope (the test sample) from Calgary (n=670; 21% had cardiac syncope), Amsterdam (n=503; 9%), Milan (n=689; 5%) and Rochester (3877; 11%). In the derivation sample ten variables were significantly associated with cardiac syncope: age, gender, structural heart disease, low number of spells, brief or absent prodrome, supine syncope, effort syncope, and absence of nausea, diaphoresis and blurred vision. Fitting the test datasets to the full model gave C-statistics of 0.87 (Calgary), 0.84 (Amsterdam), 0.72 (Milan) and 0.71 (Rochester). Model sensitivity and specificity were 92% and 68% for Calgary, 86% and 67% for Amsterdam, 76% and 59% for Milan, and 73% and 52% for Rochester. A model with 5 variables (age, gender, structural heart disease, low number of spells, and lack of prodromal symptoms) was as accurate as the total set. Conclusion A simple literature-based Bayesian model of historical criteria can distinguish patients with cardiac syncope from other patients with syncope with moderate accuracy.

The impact of the Thai motorcycle transition on road traffic injury: Thai Cohort Study results.

Objectives The aim of this study was to investigate the impact of motorcycle to car transitioning and urbanisation on traffic injury rates in Thailand. Design Analysis of two consecutive surveys of a large national cohort study. Setting Thailand. Participants The data derived from 57,154 Thai Cohort Study (TCS) participants who provided relevant data on both the 2005 and 2009 surveys. Primary and secondary outcome measures Motorcycle and car traffic crash injury self-reported in 2009, with twelve months’ recall. Results In 2009, 5608(10%) participants reported a traffic crash injury. Most crashes involved a motorcycle (74%). Car access increased and motorcycle use decreased between 2005 and 2009. Among those who used a motorcycle at both time points, traffic injury incidence was 2.8 times greater compared to those who did not use a motorcycle at either time point. Multivariable logistic regression models were used to test longitudinal and cross sectional factors associated with traffic crash injury: in the adjusted model, cars were negatively and motorcycles positively associated with injury. Living in an urban area was not injury protective in the adjusted model of traffic crash injury. Conclusions Ongoing urbanisation in Thailand can be expected to lead to further reductions in road traffic injuries based on transition from motorcycles to cars in urban areas. Cities, however, do not provide an intrinsically safer traffic environment. To accommodate a safe transition to car use in Thailand, traffic infrastructural changes anticipating the growing car density in urban areas is warranted.

The Effect of Injuries on Health Measured by Short Form 8 among a Large Cohort of Thai Adults

Introduction We investigate the links between health and injury in Thailand. This is important because of the high burden of injury in transitional countries and limited information for public health. Methods We analyse 2005 baseline and 2009, 4-year follow-up data from distance learning students of Sukhothai Thammathirat Open University residing nationwide (n = 60569). Injury was reported for the past year in both periods. Medical Outcome Study Short-Form (SF-8™) health status was reported and Physical and Mental Component Summary Scores (PCS and MCS) were calculated. Analyses used covariate-adjusted multivariate linear regression. Results In 2009, increasing numbers of traffic injuries (0, 1, 2, 3, 4+) associated with declining PCS scores (49.8, 48.4, 46.9, 46.2, 44.0), along with a similar monotonic decline for MCS scores (47.6, 46.0, 44.2, 42.7, 40.6). A similar (but smaller) dose-response gradient was found between non-traffic injuries and SF-8 scores. Longitudinal analyses showed those with incident injury (no injury 2005, injury 2009) had lower PCS and MCS scores compared to those with no injury in both periods. Individuals with reverting injury status (injury 2005, no injury 2009) reported improvement in PCS and MCS scores over the four-year period. Conclusion We found significant and epidemiologically important associations between increasing injury frequency and worse health in the past year, especially traffic injuries. Longitudinal 2005–2009 results were supportive and revealed statistically significant adverse 4-year effects of incident injury on health. If injury reverted over four years, low initial scores improved greatly. Findings highlight the importance of injury prevention as a public health priority.

Prescription opioid dispensing and prescription opioid poisoning: Population data from Victoria, Australia 2006 to 2013

Objective: To describe recent trends in opioid prescribing and prescription opioid poisoning resulting in hospitalisation or death in Victoria, Australia.