Richard Hockey

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.

Weighted multimorbidity indexes predicted mortality, health service use, and health-related quality of life in older women

OBJECTIVE To develop indexes of multimorbidity, based on self-reported data, to predict mortality, health service use, help with activities of daily living (ADL), and health-related quality of life (HRQOL) in older women. STUDY DESIGN AND SETTING Cross-sectional survey of 10,434 women, aged 73-78 years, in the Australian Longitudinal Study of Womens Health in 1999, with mortality follow-up to 2005. For analysis, the sample was equally split into a development and validation sample. Weighted and unweighted multimorbidity indexes were developed and tested. RESULTS Outcomes ranged from 14% for mortality to 47% for specialist doctor visits. Mortality was predicted by heart disease, stroke, low iron, diabetes, cancer (nonskin), bronchitis/emphysema, and Alzheimers disease. Different patterns of morbidities were associated with the other outcomes. Weighted and unweighted multimorbidity index scores were linearly related to increasing risk of each outcome. For each outcome, the weighted scores fitted the data better and had a wider range of possible values. CONCLUSION These multimorbidity indexes predict mortality, health service use, help with ADL, and HRQOL in older women. The indexes could be used as covariates in research with weighted scores having a better chance of discriminating between patient groups than unweighted scores.

Gastroschisis: can prenatal sonography predict neonatal outcome?

Gastroschisis is associated with significant neonatal morbidity, and occasionally mortality. Previous studies looking at ways to prognosticate this condition by antenatal ultrasound have shown conflicting results. The aim of this study was to evaluate the usefulness of prenatal sonographic parameters to predict neonatal outcome of gastroschisis.

Cohort Profile Update: Australian Longitudinal Study on Women’s Health

In 1996 the Australian Longitudinal Study on Womens Health recruited a nationally representative sample of more than 40,000 women in three age cohorts, born in 1973-78, 1946-51 and 1921-26. At least six waves of 3-yearly surveys have been completed. Although the focus remains on factors affecting the health and well-being of women and their access to and use of health services across urban, rural and remote areas of Australia, the study has now been considerably expanded by linkage to other health data sets. For most women who have ever participated in the study, linked records are now available for: government-subsidized non-hospital services (e.g. all general practitioner visits); pharmaceutical prescriptions filled; national death index, including codes for multiple causes of death; aged care assessments and services; cancer registries; and, for most states and territories, hospital admissions and perinatal data. Additionally, a large cohort of women born in 1989-95 have been recruited. The data are available to approved collaborators, with more than 780 researchers using the data so far. Full details of the study materials and data access procedures are available at [http://www.alswh.org.au/].

Physical activity, Body Mass Index and health care costs in mid-age Australian women

Objective: This study examined the relationships between combined categories of physical activity (PA) and Body Mass Index (BMI) with health care costs in women and assessed the potential cost savings of improving PA and BMI in sedentary mid‐age women.

Childhood poisoning in Queensland: An analysis of presentation and admission rates

Objective: To determine the presentation rates for paediatric poisoning by ingestion and the determinants of hospital admission.

Effects of Having a Baby on Weight Gain

BACKGROUND Women often blame weight gain in early adulthood on having a baby. PURPOSE The aim was to estimate the weight gain attributable to having a baby, after disentangling the effects of other factors that influence weight change at this life stage. METHODS A longitudinal study of a randomly selected cohort of 6458 Australian women, aged 18-23 years in 1996, was conducted. Self-report mailed surveys were completed in 1996, 2000, 2003, and 2006, and data were analyzed in 2008. RESULTS On average, women gained weight at the rate of 0.93% per year (95% CI=0.89, 0.98) or 605 g/year (95% CI=580, 635) for a 65-kg woman. Over the 10-year study period, partnered women with one baby gained almost 4 kg more, and those with a partner but no baby gained 1.8 kg more, than unpartnered childless women (after adjustment for other significant factors: initial BMI and age; physical activity, sitting time, energy intake (2003); education level, hours in paid work, and smoking). CONCLUSIONS Having a baby has a marked effect on 10-year weight gain, but there is also an effect attributable to getting married or living with a partner. Social and lifestyle as well as energy balance variables should be considered when developing strategies to prevent weight gain in young adult women.

Recruitment via the Internet and social networking sites: the 1989-1995 cohort of the Australian Longitudinal Study on Women's Health.

Background Faced with the challenge of recruiting young adults for health studies, researchers have increasingly turned to the Internet and social networking sites, such as Facebook, as part of their recruitment strategy. As yet, few large-scale studies are available that report on the characteristics and representativeness of the sample obtained from such recruitment methods. Objective The intent of the study was to describe the sociodemographic and health characteristics of a national sample of young Australian women recruited mainly through the Internet and social networking sites and to discuss the representativeness of their sociodemographic, health, and lifestyle characteristics relative to the population. Methods A cohort of 17,069 women (born between 1989 and 1995) was recruited in 2012-13 for the Australian Longitudinal Study on Women’s Health. Sociodemographic characteristics (percentages, means, and 95% confidence intervals) from the online survey data were compared with women aged 18-23 years from the 2011 Australian Census. Sample data were compared by age and education level with data from the 2011-13 Australian Health Survey (AHS). Results Compared to the Australian Census data, study participants were broadly representative in terms of geographical distribution across Australia, marital status (95.62%, 16,321/17,069) were never married), and age distribution. A higher percentage had attained university (22.52%, 3844/17,069) and trade/certificate/diploma qualifications (25.94%, 4428/17,069) compared with this age group of women in the national population (9.4% and 21.7% respectively). Among study participants, 22.05% (3721/16,877) were not in paid employment with 35.18% (5931/16,857) studying 16 or more hours a week. A higher percentage of study participants rated their health in the online survey as fair or poor (rather than good, very good, or excellent) compared with those participating in face-to-face interviews in the AHS (18.77%, 3203/17,069 vs 10.1%). A higher percentage of study participants were current smokers (21.78%, 3718/17,069 vs 16.4%) and physically active (59.30%, 10,089/17,014 were classified as sufficiently active vs 48.3%) but alcohol consumption was lower (59.58%, 9865/16,558 reported drinking alcohol at least once per month vs 65.9% in the AHS). Using self-reported height and weight to determine body mass index (BMI, kg/m2), 34.80% (5901/16,956) of the cohort were classified as overweight or obese (BMI of 25 or more), compared with 33.6% respectively using measured height and weight in the AHS. Conclusions Findings indicated that using the Internet and social networking sites for an online survey represent a feasible recruitment strategy for a national cohort of young women and result in a broadly representative sample of the Australian population.

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.

The long-term relationship between duration of treatment and contracture resolution using dynamic orthotic devices for the stiff proximal interphalangeal joint: A prospective cohort study

STUDY DESIGN Descriptive design with a prospective cohort. INTRODUCTION Little is known about the long-term relationship between the duration of treatment using dynamic orthoses (splints), and contracture resolution in the stiff proximal interphalangeal (PIP) joint. PURPOSE OF THE STUDY To examine the long-term relationship between weeks of treatment using dynamic orthoses and contracture resolution, in both flexion and extension deficits of the PIP joint. METHODS Forty-one participants were treated with a dynamic orthotic device (splint) for either a flexion or extension deficit of the PIP joint (n=48 joints). The relationship between contracture resolution and weeks of treatment was examined controlling for baseline range of motion (ROM), weekly total end range time, pretreatment joint stiffness, time since injury, and diagnosis. Outcome was measured via change in torque and active ROM. RESULTS Outcome with orthotic use was significantly associated with the weeks of treatment (p<0.001). ROM increased in a linear fashion although faster progress was observed when treatment was aimed at improving flexion rather than extension. Flexion deficits appeared to maximize gains with orthotic treatment after 12 weeks. However, extension deficits continued to demonstrate slow and continuous improvement beyond the 17 weeks of recorded data. Less treatment duration (in weeks) was needed to restore flexion than extension. CONCLUSIONS The duration of orthotic use (weeks of treatment) is significantly associated with the extent of contracture resolution. Slower recovery of ROM and a longer duration of orthotic use may be expected when the treatment goal is to improve extension rather than flexion. LEVEL OF EVIDENCE 2b.