Health symptoms during midlife in relation to menopausal transition: British prospective cohort study

Objective To characterise symptoms experienced by women during the transition into natural menopause, to classify women into distinct symptom profiles or trajectories, and to relate these profiles to sociodemographic factors and health behaviours

Compensating for Missing Data from Longitudinal Studies Using WinBUGS

Missing data is a common problem in survey based research. There are many packages that compensate for missing data but few can easily compensate for missing longitudinal data. WinBUGS compensates for missing data using multiple imputation, and is able to incorporate longitudinal structure using random effects. We demonstrate the superiority of longitudinal imputation over cross-sectional imputation using WinBUGS. We use example data from the Australian Longitudinal Study on Women's Health. We give a SAS macro that uses WinBUGS to analyze longitudinal models with missing covariate date, and demonstrate its use in a longitudinal study of terminal cancer patients and their carers.

Food patterns associated with blood lipids are predictive of coronary heart disease : the Whitehall II study

Analysis of the epidemiological effects of overall dietary patterns offers an alternative approach to the investigation of the role of diet in CHD. We analysed the role of blood lipid-related dietary patterns using a two-step method to confirm the prospective association of dietary pattern with incident CHD. Analysis is based on 7314 participants of the Whitehall II study. Dietary intake was measured using a 127-item FFQ. Reduced rank regression (RRR) was used to derive dietary pattern scores using baseline serum total and HDL-cholesterol, and TAG levels as dependent variables. Cox proportional hazard regression was used to confirm the association between dietary patterns and incident CHD (n 243) over 15 years of follow-up. Increased CHD risk (hazard ratio (HR) for top quartile: 2&middot;01 (95 % CI 1&middot;41, 2&middot;85) adjusted for age, sex, ethnicity and energy misreporting) was observed with a diet characterised by high consumption of white bread, fried potatoes, sugar in tea and coffee, burgers and sausages, soft drinks, and low consumption of French dressing and vegetables. The diet-CHD relationship was attenuated after adjustment for employment grade and health behaviours (HR for top quartile: 1&middot;81; 95 % CI 1&middot;26, 2&middot;62), and further adjustment for blood pressure and BMI (HR for top quartile: 1&middot;57; 95 % CI 1&middot;08, 2&middot;27). Dietary patterns are associated with serum lipids and predict CHD risk after adjustment for confounders. RRR identifies dietary patterns using prior knowledge and focuses on the pathways through which diet may influence disease. The present study adds to the evidence that diet is an important risk factor for CHD. <br /

Which aspects of socioeconomic status are related to obesity among men and women?

OBJECTIVE: This study aimed to investigate the relationships between body weight and fat distribution, and four empirically derived domains of socioeconomic status: employment, housing, migration status and family unit. DESIGN: A population-based study was used. PARTICIPANTS: A total of 8667 randomly-selected adults (4167 men; 4500 women) who participated in the 1995 Australian National Health and Nutrition Surveys provided data on a range of health factors including objective height, weight and body fat distribution, and a range of sociodemographic indicators. RESULTS: Results demonstrated associations for women, after controlling for age, between the employment domain, and body mass index and waist-to-hip ratio. Low status employed women were 1.4 times as likely to be overweight as high status employed women. There were less consistent relationships observed among these factors for men. Relationships between family unit and indicators of body weight and body fat distribution were observed for both men and women, with those who were married, particularly men (OR=1.6, 95% CI 1.4-2.0), at higher risk of overweight. The migration and housing socioeconomic status domains were not consistently associated with body mass index or waist-to-hip ratio. CONCLUSIONS: These findings indicate that different components of socioeconomic status may be important in predicting obesity, and thus should be examined separately. Future research would benefit from investigating the underlying mechanisms governing the relationships between socioeconomic status domains further, particularly those related to employment and family unit and obesity<br /

Education, sex, and risk of stroke: a prospective cohort study

To determine whether the association between highest educational attainment and stroke differed by sex and age; and whether potential mediators of observed associations differ by sex.Prospective cohort study.Population based, New South Wales, Australia.253 657 stroke-free participants from the New South Wales 45 and Up Study.First-ever stroke events, identified through linkage to hospital and mortality records.During mean follow-up of 4.7 years, 2031 and 1528 strokes occurred among men and women, respectively. Age-standardised stroke rate was inversely associated with education level, with the absolute risk difference between the lowest and highest education group greater among women than men. In relative terms, stroke risk was slightly more pronounced in women than men when comparing low versus high education (age-adjusted HRs: 1.41, 95% CI 1.16 to 1.71 and 1.25, 95% CI 1.07 to 1.46, respectively), but there was no clear evidence of statistical interaction. This association persisted into older age, but attenuated. Much of the increased stroke risk was explained by modifiable lifestyle factors, in both men and women.Low education is associated with increased stroke risk in men and women, and may be marginally steeper in women than men. This disadvantage attenuates but persists into older age, particularly for women. Modifiable risk factors account for much of the excess risk from low education level. Public health policy and governmental decision-making should reflect the importance of education, for both men and women, for positive health throughout the life course

Comparative study of nifepidine and isoxsuprine in suppression of preterm labour

Background: A prospective study was conducted to compare the efficacy of nifedipine against isoxsuprine in preventing preterm labour and also to evaluate maternal side effects and neonatal outcome.Methods: This was a randomized prospective comparative study done at MGM hospital and research center, Patna, Bihar between 15/03/2014 to 15/02/2016. 75 antenatal women with gestational age between 28 to 36 weeks were selected who fulfilled the inclusion criteria for the study, were given nifedipine and were monitored throughout the course of treatment.Results: Groups were compared with mean prolongation of delivery, side effects, neonatal outcome, parity, cervical effacements. Nifedipine was twice more effective than isoxsuprine hydrochloride as a uterine tocolytic agent while side effects were comparable with fewer side effects in nifedipine group. Neonatal outcome was better with nifedipine in comparison to isoxsuprine.Conclusions: There is a high incidence of preterm labour in India. The present study found that nifedipine has better tocolytic efficacy, less side effects and better tolerability as compared to isoxsuprine.

Estimating the prevalence of dementia using multiple linked administrative health records and capture–recapture methodology

Obtaining population-level estimates of the incidence and prevalence of dementia is challenging due to under-diagnosis and under-reporting. We investigated the feasibility of using multiple linked datasets and capture-recapture techniques to estimate rates of dementia among women in Australia.This work is based on the Australian Longitudinal Study on Women's Health. A random sample of 12,432 women born in 1921-1926 was recruited in 1996. Over 16\ua0years of follow-up records of dementia were obtained from five sources: three-yearly self-reported surveys; clinical assessments for aged care assistance; death certificates; pharmaceutical prescriptions filled; and, in three Australian States only, hospital in-patient records.A total of 2534 women had a record of dementia in at least one of the data sources. The aged care assessments included dementia records for 79.3% of these women, while pharmaceutical data included 34.6%, death certificates 31.0% and survey data 18.5%. In the States where hospital data were available this source included dementia records for 55.8% of the women. Using capture-recapture methods we estimated an additional 728 women with dementia had not been identified, increasing the 16\ua0year prevalence for the cohort from 20.4 to 26.0% (95% confidence interval [CI] 25.2, 26.8%).This study demonstrates that using routinely collected health data with record linkage and capture-recapture can produce plausible estimates for dementia prevalence and incidence at a population level

Dietary patterns of Australian adults and their association with socio-economic status: results from the 1995 national nutrition survey

Objective: To describe dietary patterns among men and women in the Australian population, and to explore how these varied according to socioeconomic status (SES).Design: A cross-sectional self-report population survey, the 1995 Australian National Nutrition Survey (NNS), was used.Setting: Private dwelling sample, covering urban and rural areas across Australia.Subjects: Data provided by 6680 adults aged 18-64 who participated in the NNS were used in the analyses.Methods: Factor analyses were used to analyse data from a Food Frequency Questionnaire (FFQ) completed by participants. Associations between SES and dietary pattens were assessed using ANOVA.Results: Separate factor analyses of the FFQ data for men and women revealed 15 factors, accounting for approximately 50% of the variance in both men\u27s and women\u27s dietary patterns. Several gender and SES differences in food patterns were observed. Lower SES males more frequently consumed \u27tropical fruits\u27, \u27protein foods\u27, and \u27offal and canned fish\u27, while high SES males more often ate \u27breakfast cereals\u27 and \u27wholemeal bread\u27. Lower SES females more often ate \u27traditional vegetables\u27, \u27meat dishes\u27 and \u27pasta, rice and other mixed foods\u27, while high SES females more frequently ate \u27ethnic vegetables\u27 and \u27breakfast cereal/muesli\u27.Conclusions: These findings contribute to a better understanding of the dietary patterns that underscore gender-specific SES differences in nutrient intakes. Analyses of the type employed in this study will facilitate the development of interventions aimed at modifying overall eating patterns, rather than specific components of the diet.<br /

Müllerian duct cyst misdiagnosed as ovarian cyst: a rare case report

The Müllerian duct cyst is a remnant of the caudal ends of the fused embryologic paramesonephric ducts (or Müllerian ducts). Preoperative distinction of ovarian cyst from a Müllerian duct cyst is important and is based on visualization of the ipsilateral ovary separate from the mass. Müllerian duct cysts may also be mistaken as paratubal, paraovarian or peritoneal inclusion cysts and hydrosalpinx. Thus, preoperative diagnosis of Müllerian cyst of the uterus can be very challenging. However, with increased awareness, preoperative diagnosis of this condition should be possible by sonography. Laparoscopy is useful as a minimally invasive treatment to diagnose as well as resect the cyst at the same time. We present a rare case of Müllerian duct cyst misdiagnosed as ovarian cyst pre-operatively and managed laparoscopically. A 32 year old multiparous female presented with the complaint of lump and dull aching pain in lower abdomen since three months. A cystic mobile mass measuring 6X7 cm with smooth surface which corresponded to 16 weeks gravid uterus size was palpated arising from pelvis. Her pelvic ultrasonography revealed a 7X7 cm unilocular thin walled simple cyst in right ovary suggestive of serous cystadenoma. Her CA-125 was 5.3 IU/ml. She was taken up for laparoscopic ovarian cystectomy. Intra-operatively, a 7X7 cm cyst was seen arising from right lateral wall of uterus. Histopathology showed the cyst wall features consistent with a Müllerian duct cyst