Julia Shelley

Self-rated health: Biological continuum or social discontinuity?

Correlates of self-rated health among a randomly selected sample of 1863 Australian-born women 45-55 years of age were examined in two logistic regression analyses: one comparing a self-rated health of worse than ones peers with a self-rated health the same as ones peers; and, one comparing a self-rated health of better than ones peers with a self-rated health the same as ones peers. The final model for worse health was largely a reflection of the physical experience of ill health while that for better health was a more complex construct including not only the absence of illness but also markers of sociodemographic advantage and self-image. The two models had only three variables in common. Notably, the relationship between the outcome measures and one common variable, body mass index, differed markedly. It is suggested that previous analyses of self-rated health have had their power to adequately describe correlates and determinants of health status constrained. By assuming that the various self-rated health states are part of a continuum and employing statistical methods consistent with that assumption, previous studies have been unable to demonstrate the discontinuity among such states. In particular, it is suggested that self-rated health is at least in part a reflection of social role and as there is no basis for assuming that such roles form a continuum as the use of correlation-based analyses imply, then such analyses are inappropriate.

Quality of data on subsequent events in a routine Medical Birth Register

Background: The maintenance of health registers has become routine. The main prerequisite for their use is that registers be complete and that their contents correspond to reality. Methods: Data on all primiparous women who gave birth between 1987 and 1989 (N=73 009) and on their second (N=55 388) and third births (N=22 904) in the 1987-1998 period were retrieved from the Finnish Medical Birth Register (MBR). The consistency of the MBR data on reproductive history and on previous Caesarean section was investigated by comparing the records on subsequent births. Main results: In total 98.5% of the information on reproductive history corresponded with the previous data in the MBR. Data quality decreased over time and with increasing parity. There were problems with the registration of rare cases, e.g. several extrauterine pregnancies or stillbirths. The quality deteriorated in the late 1990s, because no data on previous induced abortions and extrauterine pregnancies were collected between 1991 and 1995. The quality of data on previous Caesarean section was poor in 1987-1990, a period when the data were collected by using ICD-9 codes, but the quality improved after the introduction of a check-box format in 1991. Conclusions: Changes in question formats may change the quality of register data significantly. Check-boxes seem to improve quality compared to open-ended questions. The data on reproductive history and previous Caesarean sections could be combined routinely to improve the quality of the MBR.

Relationship of Endogenous Sex Hormones to Lipids and Blood Pressure in Mid-Aged Women

PURPOSE The relationship between endogenous sex hormones and blood lipids was examined in a representative sample of 438 Australian-born women 45 to 56 years of age taking part in a longitudinal study of the menopausal transition. Data from 363 women who were taking neither exogenous hormones nor lipid-altering medications, were not diabetic, and who had provided blood samples were available for analysis. METHODS Multiple linear regression was used to examine the relationship between sex hormones and high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), triglycerides, and diastolic blood pressure (DBP), taking account of the effects of age, body mass index (BMI), smoking, alcohol intake, and exercise. RESULTS There was no significant relationship between estradiol and HDL, LDL, triglyceride, or DBP levels. Free androgen index was positively associated with LDL. However, BMI was an important predictor of all three lipid measures and DBP. HDL was positively associated with age and was highest among women with lowest BMI, high alcohol intake, and in nonsmokers. LDL increased with BMI, free androgen index, and age, but was lower amongst women who exercised more than two or three times per week. Triglyceride also increased with BMI, and was higher among smokers. DBP increased with BMI only. CONCLUSIONS The results do not support the view that endogenous sex hormones are strongly associated with cardiovascular risk factors around the time of menopause.

Sexual and Relationship Satisfaction Among Heterosexual Men and Women: The Importance of Desired Frequency of Sex

Little is known of the extent to which heterosexual couples are satisfied with their current frequency of sex and the degree to which this predicts overall sexual and relationship satisfaction. A population-based survey of 4,290 men and 4,366 women was conducted among Australians aged 16 to 64 years from a range of sociodemographic backgrounds, of whom 3,240 men and 3,304 women were in regular heterosexual relationships. Only 46% of men and 58% of women were satisfied with their current frequency of sex. Dissatisfied men were overwhelmingly likely to desire sex more frequently; among dissatisfied women, only two thirds wanted sex more frequently. Age was a significant factor but only for men, with those aged 35–44 years tending to be least satisfied. Men and women who were dissatisfied with their frequency of sex were also more likely to express overall lower sexual and relationship satisfaction. The authors’ findings not only highlight desired frequency of sex as a major factor in satisfaction, but also reveal important gender and other sociodemographic differences that need to be taken into account by researchers and therapists seeking to understand and improve sexual and relationship satisfaction among heterosexual couples. Other issues such as length of time spent having sex and practices engaged in may also be relevant, particularly for women.

PEAPS-Q: A QUESTIONNAIRE TO MEASURE THE PSYCHOSOCIAL EFFECTS OF HAVING AN ABNORMAL PAP SMEAR

We have developed the Psychosocial Effects of Abnormal Pap Smears Questionnaire (PEAPS-Q) which measures distress experienced by women undergoing follow-up investigation after an abnormal Pap smear result. A thorough literature review and qualitative research resulted in the development of a questionnaire which was tested on 350 women attending a Family Planning New South Wales (FPNSW) clinic. This sample included women at different stages of management after detection of a cervical abnormality: 93 first colposcopy clients and 257 follow-up colposcopy clients. Factor analysis identified four dimensions of distress: experience of medical procedures, beliefs/feelings about cervical abnormality and changes in perception of oneself, worry about infectivity and effect on sexual relationships. Repeatability of the PEAPS-Q was indicated by intra-class correlations of 0.88 overall and at least 0.60 for each scale. Internal consistency was shown by Cronbachs alpha of 0.84 overall and at least 0.72 for each scale. Validity was demonstrated by the correlation of scale scores with the 12-item General Health Questionnaire (GHQ) score of 0.32 (95% CI 0.22-0.41). The PEAPS-Q is a valid, reliable and multidimensional instrument for quantifying distress experienced by women with abnormal Pap smears.

A randomised trial of surgical, medical and expectant management of first trimester spontaneous miscarriage

Background:  Medical management and expectant care have been considered possible alternatives to surgical evacuation of the uterus for first trimester spontaneous miscarriage in recent years.

Cannabis Use and Sexual Health

INTRODUCTION Cannabis is the most commonly used illicit substance worldwide. Despite this, its impact on sexual health is largely unknown. AIM The aim of this article is to examine the association between cannabis use and a range of sexual health outcomes. MAIN OUTCOME MEASURES The main outcome measures include the number of sexual partners in the past year, condom use at most recent vaginal or anal intercourse, diagnosis with a sexually transmissible infection in the previous year, and the occurrence of sexual problems. METHODS Method used in this article includes a computer-assisted telephone survey of 8,656 Australians aged 16-64 years resident in Australian households with a fixed telephone line. RESULTS Of the 8,650 who answered the questions about cannabis use, 754 (8.7%) reported cannabis use in the previous year with 126 (1.5%) reporting daily use, 126 reported (1.5%) weekly use, and 502 (5.8%) reported use less often than weekly. After adjusting for demographic factors, daily cannabis use compared with no use was associated with an increased likelihood of reporting two or more sexual partners in the previous year in both men (adjusted odds ratio 2.08, 95% confidence interval 1.11-3.89; P = 0.02) and women (2.58, 1.08-6.18; P = 0.03). Daily cannabis use was associated with reporting a diagnosis of a sexually transmissible infection in women but not men (7.19, 1.28-40.31; P = 0.02 and 1.45, 0.17-12.42; P = 0.74, respectively). Frequency of cannabis use was unrelated to sexual problems in women but daily use vs. no use was associated with increased reporting among men of an inability to reach orgasm (3.94, 1.71-9.07; P < 0.01), reaching orgasm too quickly (2.68, 1.41-5.08; P < 0.01), and too slowly (2.05, 1.02-4.12; P = 0.04). CONCLUSIONS Frequent cannabis use is associated with higher numbers of sexual partners for both men and women, and difficulties in mens ability to orgasm as desired.

The Australian longitudinal study of health and relationships

BackgroundEnsuring the sexual and reproductive health of the population is essential for the wellbeing of a nation. At least three aspects of sexual and reproductive health are among the key policy issues for present Australian governments: maintaining and increasing the birth rate; reducing the abortion rate; and preventing and controlling Chlamydia infections.The overall aim of the Australian Longitudinal Study of Health and Relationships is to document the natural history of the sexual and reproductive health of the Australian adult population.Methods/designA nationally representative sample of Australian adults 16–64 years of age was selected in a two-phase process in 2004–2005. Eligible households were identified through random digit dialling. We used separate sampling frames for men and women; where there was more than one eligible person in a household the participant was selected randomly. Participants completed a computer-assisted telephone interview that typically took approximately 25 minutes to complete. The response rate was 56%. A total of 8,656 people were interviewed, of whom 95% (8243) agreed to be contacted again 12 months later. Of those, approximately 82% have been re-contacted and re-interviewed in 2006–07 (Wave Two), with 99% of those agreeing to be contacted again for Wave Three.DiscussionALSHR represents a significant advance for research on the linked topics of sexual and reproductive health. Its strengths include the large sample size, the inclusion of men as well as women, and the wide age range of the participants.

Knowledge of human papillomavirus (HPV) and the HPV vaccine in a national sample of Australian men and women

BACKGROUND Human papillomavirus (HPV) knowledge has rarely been investigated in the context of a national vaccination program. The present study investigated HPV knowledge after the introduction of a national HPV vaccination program in Australia using a national sample of men and women. METHODS Questions assessing HPV knowledge were part of a broader national study of health and relationships administered via a computer-assisted telephone interview. These findings are from wave four of the study, conducted between 2007 and 2008. Knowledge questions about HPV included its association with cervical cancer, genital warts and abnormal Pap tests. RESULTS A total of 2634 women and 2556 men between the ages of 18 and 70 were interviewed. Overall, 62.8% (95% confidence interval (CI): 60.8-64.7%) of women and 38.3% (95% CI: 36.3-40.4%) of men had heard of HPV. Of these, 66.0% (95% CI: 64.1-67.9%) correctly answered that HPV is associated with cervical cancer, 50.2% (95% CI: 48.2-52.1%) answered that HPV is associated with abnormal Pap tests and 44.5% (95% CI: 42.5-46.5%) answered that HPV causes warts. Predictors of good knowledge included being female, aged between 26 and 45, holding higher education levels and older age at first sex. Ever having a Pap test was also associated with awareness about HPV. CONCLUSION One of the highest levels of knowledge about HPV in Australia to date is reported in the present study. Knowledge about the association between HPV and cervical cancer was particularly high, especially when compared with knowledge of the association with genital warts. This appears to be a consequence of the marketing of the HPV vaccine as a vaccination against cervical cancer.

National prevalence of urogenital pain and prostatitis‐like symptoms in Australian men using the National Institutes of Health Chronic Prostatitis Symptoms Index

Study Type – Prognosis (cohort)
Level of Evidence 2a