Association between long-term use of calcium channel blockers (CCB) and the risk of breast cancer: a retrospective longitudinal observational study protocol

INTRODUCTION

Calcium channel blockers (CCB), a commonly prescribed antihypertensive (AHT) medicine, may be associated with increased risk of breast cancer. The proposed study aims to examine whether long-term CCB use is associated with the development of breast cancer and to characterise the dose-response nature of any identified association, to inform future hypertension management.

METHODS AND ANALYSIS

The study will use data from 2 of Australia's largest cohort studies; the Australian Longitudinal Study on Women's Health, and the 45 and Up Study, combined with the Rotterdam Study. Eligible women will be those with diagnosed hypertension, no history of breast cancer and no prior CCB use at start of follow-up (2004-2009). Cumulative dose-duration exposure to CCB and other AHT medicines will be captured at the earliest date of: the outcome (a diagnosis of invasive breast cancer); a competing risk event (eg, bilateral mastectomy without a diagnosis of breast cancer, death prior to any diagnosis of breast cancer) or end of follow-up (censoring event). Fine and Gray competing risks regression will be used to assess the association between CCB use and development of breast cancer using a generalised propensity score to adjust for baseline covariates. Time-varying covariates related to interaction with health services will also be included in the model. Data will be harmonised across cohorts to achieve identical protocols and a two-step random effects individual patient-level meta-analysis will be used.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the following Human research Ethics Committees: Curtin University (ref No. HRE2022-0335), NSW Population and Health Services Research Ethics Committee (2022/ETH01392/2022.31), ACT Research Ethics and Governance Office approval under National Mutual Acceptance for multijurisdictional data linkage research (2022.STE.00208). Results of the proposed study will be published in high-impact journals and presented at key scientific meetings.

TRIAL REGISTRATION NUMBER

NCT05972785.

Device-measured physical activity and cardiometabolic health: the Prospective Physical Activity, Sitting, and Sleep (ProPASS) consortium

BACKGROUND AND AIMS

Physical inactivity, sedentary behaviour (SB), and inadequate sleep are key behavioural risk factors of cardiometabolic diseases. Each behaviour is mainly considered in isolation, despite clear behavioural and biological interdependencies. The aim of this study was to investigate associations of five-part movement compositions with adiposity and cardiometabolic biomarkers.

METHODS

Cross-sectional data from six studies (n = 15 253 participants; five countries) from the Prospective Physical Activity, Sitting and Sleep consortium were analysed. Device-measured time spent in sleep, SB, standing, light-intensity physical activity (LIPA), and moderate-vigorous physical activity (MVPA) made up the composition. Outcomes included body mass index (BMI), waist circumference, HDL cholesterol, total:HDL cholesterol ratio, triglycerides, and glycated haemoglobin (HbA1c). Compositional linear regression examined associations between compositions and outcomes, including modelling time reallocation between behaviours.

RESULTS

The average daily composition of the sample (age: 53.7 ± 9.7 years; 54.7% female) was 7.7 h sleeping, 10.4 h sedentary, 3.1 h standing, 1.5 h LIPA, and 1.3 h MVPA. A greater MVPA proportion and smaller SB proportion were associated with better outcomes. Reallocating time from SB, standing, LIPA, or sleep into MVPA resulted in better scores across all outcomes. For example, replacing 30 min of SB, sleep, standing, or LIPA with MVPA was associated with -0.63 (95% confidence interval -0.48, -0.79), -0.43 (-0.25, -0.59), -0.40 (-0.25, -0.56), and -0.15 (0.05, -0.34) kg/m2 lower BMI, respectively. Greater relative standing time was beneficial, whereas sleep had a detrimental association when replacing LIPA/MVPA and positive association when replacing SB. The minimal displacement of any behaviour into MVPA for improved cardiometabolic health ranged from 3.8 (HbA1c) to 12.7 (triglycerides) min/day.

CONCLUSIONS

Compositional data analyses revealed a distinct hierarchy of behaviours. Moderate-vigorous physical activity demonstrated the strongest, most time-efficient protective associations with cardiometabolic outcomes. Theoretical benefits from reallocating SB into sleep, standing, or LIPA required substantial changes in daily activity.

Sustained Hypothetical Interventions on Midlife Alcohol Consumption in Relation to All-Cause and Cancer Mortality: The Australian Longitudinal Study on Women's Health

No randomized controlled trial has evaluated the effect of long-term alcohol interventions on mortality. Results reported in existing observational studies may be subject to selection bias and time-varying confounding. Using data from the Australian Longitudinal Study on Women's Health 1946-1951 birth cohort, collected regularly from 1996-2016, we estimated all-cause and cancer mortality had women been assigned various alcohol interventions (in categories ranging from 0 to >30 g/day ethanol, or reduced to ≤20 g/day if higher) at baseline, and had they maintained these levels of consumption. The cumulative risks for all-cause and cancer mortality were 5.6% (10,118 women followed for 20 years) and 2.9% (18 years), respectively. For all-cause and cancer mortality, baseline ethanol up to 30 g/day showed lower risk and >30 g/day showed higher risk relative to abstention. Had women sustainedly followed the interventions, a similar relationship was observed for all-cause mortality. However, the negative association observed for intakes ≤30 g/day and positive association for intakes >30 g/day was not evident for cancer mortality. Our findings suggest that all-cause mortality could have been lower than observed if this cohort of women had consumed some alcohol (no more than 30 g/day) rather than no consumption, but cancer mortality might not.

A shared agenda for gender and COVID-19 research: priorities based on broadening engagement in science

While the acute and collective crisis from the pandemic is over, an estimated 2.5 million people died from COVID-19 in 2022, tens of millions suffer from long COVID and national economies still reel from multiple deprivations exacerbated by the pandemic. Sex and gender biases deeply mark these evolving experiences of COVID-19, impacting the quality of science and effectiveness of the responses deployed. To galvanise change by strengthening evidence-informed inclusion of sex and gender in COVID-19 practice, we led a virtual collaboration to articulate and prioritise gender and COVID-19 research needs. In addition to standard prioritisation surveys, feminist principles mindful of intersectional power dynamics underpinned how we reviewed research gaps, framed research questions and discussed emergent findings. The collaborative research agenda-setting exercise engaged over 900 participants primarily from low/middle-income countries in varied activities. The top 21 research questions included the importance of the needs of pregnant and lactating women and information systems that enable sex-disaggregated analysis. Gender and intersectional aspects to improving vaccine uptake, access to health services, measures against gender-based violence and integrating gender in health systems were also prioritised. These priorities are shaped by more inclusive ways of working, which are critical for global health as it faces further uncertainties in the aftermath of COVID-19. It remains imperative to address the basics in gender and health (sex-disaggregated data and sex-specific needs) and also advance transformational goals to advance gender justice across health and social policies, including those related to global research.

Changes in the food and drink consumption patterns of Australian women during the COVID-19 pandemic

OBJECTIVE

This paper uses data from the seventh fortnightly Coronavirus (COVID-19) Survey sent to women in the Australian Longitudinal Study on Women's Health to investigate the relationship between the COVID-19 pandemic and the food and drink consumption of women born in 1946-51, 1973-78 and 1989-95.

METHODS

A survey about changes in fruit, vegetable, discretionary food, takeaway and sugary drink consumption during the pandemic was emailed on 22 July 2020 to 28,709 women in three cohorts of the Australian Longitudinal Study on Women's Health. Thematic qualitative analysis was conducted on comments about changes in consumption, and basic quantitative analysis was included for context.

RESULTS

There were significant associations between age and all categories of food and drink consumption. Women wrote of lifestyle changes and choices during lockdowns, comfort and emotional eating, and access to food and drink changing their consumption behaviours.

CONCLUSIONS

The COVID-19 pandemic and interventions had both positive and negative impacts on the food and drink consumption behaviours of Australian women.

IMPLICATIONS FOR PUBLIC HEALTH

These findings can be used to directly influence practice around healthy food and drink consumption, highlighting enablers, including being at home, and barriers, including mental health, that should be considered.

The experience of delayed health care access during the COVID 19 pandemic in Australian women: A mixed methods exploration

Delayed health care access is a potential collateral effect of pandemic conditions, health rationing strategies and social distancing responses. We investigated experiences of delayed health care access in Australian women during COVID-19. A mixed methods study used quantitative and free-text data from the Australian Longitudinal Study on Women's Health COVID-19 survey 4 (health care access or delay). Logistic regression models were used to estimate factors associated with delaying access to general practitioners (GPs), specialists and allied health services. Free-text comments were analysed thematically, employing a process of constant comparison. COVID-19 survey 4 was completed by 8,200 women and 2,727 provided free-text comments. Of the women who needed the health service, 25% (1,268/5,071) delayed seeing their GP, 23.6% (570/1,695) delayed seeing a specialist and 45% (791/1,757) delayed use of an allied health service. Younger age was most significantly associated with delaying attendance. Women born 1989-95 were significantly more likely to delay compared to women born 1946-51 (OR (95% CI): GP = 0.28 (0.22, 0.35)); Specialist = 0.65 (0.45, 0.92; Allied Health = 0.59 (0.42, 0.82)). Women born 1973-78 were also likely to delay GP visits (0.69, (0.58, 0.83)). Four qualitative themes emerged including: (1) Challenges negotiating care during a pandemic; (2) Ongoing uncertainty towards accessing health care when a specialist delays an appointment; (3) Accessing health care (or not) using Telehealth and (4) Managing complex care needs. COVID-19 has had a significant effect on access to health care. Women delayed seeking help for cancer screening, mental health, and other health conditions involving chronic and complex needs for health and social care. While there is a need to rationalise and optimise health access during a pandemic, our outcomes suggest a need for public health campaigns that clarify how to access care, engage with telehealth and respond to missed appointments.

The Role of Child Diets in the Association between Pre-pregnancy Diets and Childhood Behavioral Problems: A Mediation Analysis

Objectives

To quantify the mediating role of childhood diets in the association between maternal diets before pregnancy and offspring behavioral problems.

Methods

This study included 1448 mother-child pairs from the Australian longitudinal study on women's health and its sub-study mothers and their children's health. The healthy eating index score was constructed using a semi-quantitative and validated 101-item food-frequency questionnaire. Childhood behavioral problems were assessed using the strengths and difficulties questionnaire. Three dietary patterns were identified using principal component analysis to explore childhood dietary patterns (high fats and sugar; prudent diets; and diary). A causal inference framework for mediation analysis was used to quantify the mediating role of childhood diets in the association between pre-pregnancy diets and the risk of offspring behavioral problems.

Results

We found a 20% of the total effect of the poor adherence to pre-pregnancy diet quality on the risk of offspring behavioral problems was mediated through childhood high consumptions of fats and sugar. No clear mediating effect through prudent, and diary childhood diets was observed.

Conclusions

This study suggests that childhood high fats and sugar consumption may contribute to the total effects of the pre-pregnancy diets on the risk of childhood behavioral problems.

Funding Sources

The ALSWH is funded by the Australian Government Department of Health. MatCH is funded by the National Health and Medical Research Council (NHMRC) project grant. Dereje Gete is supported by the University of Queensland Research Training Scholarship. Gita Mishra holds the Australian Health and Medical Research Council Principal Research Fellowship.

Improving the magnet alignment of undulator systems by laser interferometer

The issue of intrinsic-type misalignment errors arising from angular offsets between magnets in an undulator is addressed. A random tilt of the magnets or poles generates undesirable magnetic field components in both transverse and longitudinal directions and gives rise to errors in period lengths and amplitudes. These localized errors are carried to the entire undulator segments and are a cause of concern for precision field integral and phase error estimates. A laser interferometer has been designed to read the offsets and to fix the magnets to minimize the offsets.

Rheumatoid arthritis is a preventable disease: 11 ways to reduce your patients' risk

New evidence shows that up to 40% of rheumatoid arthritis (RA) cases are attributable to exposure to potentially modifiable factors. We can now identify people at higher risk of RA (pre-RA) through their family history, risk factors, autoantibodies and symptoms. Counselling these patients to act to modify factors known to be associated with RA risk could prevent the development of RA, and evidence shows that informing individuals of their risk and of ways to reduce it leads to positive behavioural change and is not harmful. This consumer-focused narrative review is targeted at primary care providers and physicians to describe 11 changes that can be made, based on current evidence linking potentially modifiable factors to RA risk. These evidence-based recommendations are: Cease smoking Reduce exposure to inhaled silica, dusts and occupational risks Maintain a healthy weight Increase leisure time physical activity Maintain good dental hygiene Maximise breastfeeding if able Maximise dietary quality, and avoid high salt diets Consume high levels of Omega-3 fatty acids and fish Reduce consumption of sugar-sweetened soft drinks Consume moderate levels of alcohol Remain Vitamin D replete This article is protected by copyright. All rights reserved.

260Smoking, body mass index, and risk of vasomotor symptoms: a pooled analysis of eight studies

Background

Vasomotor symptoms (VMS), including hot flushes and night sweats, are linked with adverse health outcomes. This study investigated the associations between smoking, body mass index (BMI), and their joint effects with the risk of VMS.

Methods

We pooled individual-level data on 21,460 midlife women from eight cohort studies in the InterLACE consortium. Frequency or severity of VMS were self-reported and categorised into four levels (from none to frequent/severe). Multinomial logistic regression models were used to estimate relative risk ratios (RRRs) and 95%CIs adjusted for within-study correlation and covariates.

Results

Nearly 60% of the women experienced some degree of VMS; 30% were overweight, 21% obese, and 17% current smokers. We found that smoking more cigarettes with longer duration and earlier initiation and being overweight or obese were all associated with more frequent/severe VMS. Never smokers who were obese had a 1.5-fold increased risk of frequent/severe VMS (RRR 1.52, 95%CI 1.35-1.73), compared with never smokers who were of normal-weight. Smoking strengthened the association because the risk of frequent/severe VMS was much greater among smokers who were obese (RRR 3.02, 95%CI 2.41-3.78). However, women who quit smoking before age 40 years had a similar level of risk as never smokers.

Conclusions

Cigarette smoking and overweight/obesity substantially increased women’s risk of frequent or severe VMS in a dose-response manner, and smoking intensified the effect of obesity.

Key messages

Quitting smoking before age 40 years and maintaining a normal weight before the menopausal transition may mitigate the excess risk of VMS in midlife.

1265Association between fruit and vegetable intake and depressive symptoms over 15 years in young women

Background

The role of higher intake of fruit and vegetables has been of particular interest as a novel approach to reduce the risk of depressive symptoms. This study examined the association between fruit and vegetable intake and depressive symptoms in the 1973-78 cohort in the Australian Longitudinal Study on Women’s Health.

Methods

A total of 4241 women with a mean age of 27.6 (SD 1.5) years were followed up at five surveys over 15 years starting from 2003. The Center for Epidemiologic Studies Depression-10 scale with a cut off > 10 indicated depressive symptoms. Fruit and vegetable intake was assessed using short questions. Multiple imputations with generalised estimating equations models were performed to estimate odds ratio of depressive symptoms according to fruit and vegetable intake.

Results

Fruit and vegetables were cross-sectionally associated with reduced odds of depressive symptoms. In longitudinal analysis, higher intake of fruit (> 4 servings) and vegetable (> 5 servings) was consistently associated with a reduced odds of depressive symptoms, with a 25% reduced odds (OR 0.75; 95% CI 0.57, 0.98, p = 0.032) and a 19% reduced odds (OR 0.81; 95% CI 0.70, 0.94, p = 0.008) respectively.

Conclusions

These findings suggest that a higher intake of fruit and vegetables was associated with a lower risk of depression symptoms over 15 years from a population-based prospective study of Australian women.

Key messages

Increasing intake of fruit and vegetables in the younger population may be a promising approach to reducing the risk of depressive symptoms in the long run.

1456Changes in dietary patterns from preconception to during pregnancy and its association with socio-demographic factors

Background

Little is known about the changes in dietary patterns from preconception to during pregnancy, nor of their association with socio-demographic and lifestyle factors. This study, therefore, examined dietary patterns changes from preconception to during pregnancy and their associations with socio-demographic and lifestyle factors.

Methods

This study used data from the Australian Longitudinal Study on Women’s Health (ALSWH), a population-based prospective cohort study. Women’s dietary patterns were assessed using Healthy Eating Index-2015 (HEI-2015) score and the four patterns obtained from the factor analysis (meats, high-fats, and sugar; vegetable and grains; traditional vegetable; and fruit patterns). Multivariable linear regression and repeated measures mixed-effect models were used.

Results

Women’s scores increased on the ‘HEI-2015’, ‘traditional vegetable’, and ‘fruit’ patterns while the ‘vegetable and grains’ decreased from preconception to during pregnancy. Women with higher education were more likely to increase their HEI-2015 score and fruit consumption from preconception to during pregnancy respectively (β = 2.31, 95%CI: 0.02, 4.60) and (β = 23.78, 95%CI: 4.58, 42.97), than those with lower educational status. Single women were more likely to increase the consumption of vegetables and grains compared to married women (β = 76.08, 95% CI: 20.83, 131.32). Women with higher income had a greater increase in the HEI-2015 score than those with lower income (β = 3.02, 95% CI: 0.21, 5.83).

Conclusion

The findings indicate that there have been marked dietary changes from preconception to during pregnancy. Changes in healthy dietary patterns were influenced by education, marital status, and income.

Key messages

Early shaping of adequate dietary behaviours before pregnancy is very important for the mothers and their children's health since pre-conception diets have a critical role in placental and foetal tissue developments.

352Postpartum diet quality: A cross-sectional analysis from the Australian longitudinal study on women’s health

Background

Reproductive-aged women are at high risk of developing obesity, and diet quality is a potential modifiable risk factor. There is limited research exploring postpartum diet quality.

Methods

Using data from the Australian Longitudinal Study on women’s Health of women, who reported having previously given birth, we investigated the association between time since childbirth and diet quality, and differences in energy, macronutrients, micronutrient intake, and diet quality assessed by the dietary guideline index (DGI) in women stratified by time from last childbirth, early (≤6 months; n = 558) and late (7–12 months; n = 547), and others (>12 months post childbirth; n = 3434).

Results

From this cohort, 4539 participants completed a food frequency questionnaire and were included in this analysis. Overall, diet quality was higher in early and late postpartum women (mean DGI score 89.8±10.5 and 90.0±10.2, respectively) compared to others (>12 months post childbirth), (85.2±11.7; p < 0.001). Factors positively associated with diet quality included higher education, physical activity, health provider support, and vitamin and/or mineral supplement use. Conversely, increasing time from childbirth (>12 months), smoking compared with non-smoking and medium income level compared with no income was negatively associated with diet quality.

Conclusions

A lower diet quality in women >12 months post childbirth may be reflective of increased pressures, balancing childrearing and return to work responsibilities. This highlights the need to support women beyond the postpartum period to improve modifiable factors associated with weight gain, including diet quality, to optimize health and reduce chronic disease risk.

Key messages

Diet quality; nutrition; obesity; prevention; postpartum; reproductive; women

Protocol for a case-control study investigating the clinical phenotypes and genetic regulation of endometriosis in Indian women: the ECGRI study

INTRODUCTION

Endometriosis is one of the common, gynaecological disorders associated with chronic pelvic pain and subfertility affecting ~10% of reproductive age women. The clinical presentation, etiopathogenesis of endometriosis subtypes and associated risk factors are largely unknown. Genome-Wide Association (GWA) Studies (GWAS) provide strong evidence for the role of genetic risk factors contributing to endometriosis. However, no studies have investigated the association of the GWAS-identified single-nucleotide polymorphism (SNPs) with endometriosis risk in the Indian population; therefore, one-sixth of the world's population is not represented in the global genome consortiums on endometriosis. The Endometriosis Clinical and Genetic Research in India (ECGRI) study aims to broaden our understanding of the clinical phenotypes and genetic risks associated with endometriosis.

METHODS AND ANALYSIS

ECGRI is a large-scale, multisite, case-control study of 2000 endometriosis cases and 2000 hospital controls to be recruited over 4 years at 15 collaborating study sites across India covering representative Indian population from east,north-east, north, central, west and southern geographical zones of India. We will use the World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonisation Project (WERF-EPHect) data collection instruments for capturing information on clinical, epidemiological, lifestyle, environmental and surgical factors. WERF-EPHect standard operating procedures will be followed for the collection, processing and storage of biological samples. The principal analyses will be for main outcome measures of the incidence of endometriosis, disease subtypes and disease severity determined from the clinical data. This will be followed by GWAS within and across ethnic groups.

ETHICS AND DISSEMINATION

The study is approved by the Institutional Ethics Committee of Indian Council of Medical Research-National Institute for Research in Reproductive Health and all participating study sites. The study is also approved by the Health Ministry Screening Committee of the Government of India. The results from this study will be actively disseminated through discussions with endometriosis patient groups, conference presentations and published manuscripts.

Pre-pregnancy Diet Quality Is Associated With Lowering the Risk of Offspring Obesity and Underweight: Finding From a Prospective Cohort Study

Objectives

To examine the association between maternal diet quality before pregnancy and childhood BMI in offspring.

Methods

We included 1936 mothers with 3391 children from the Australian Longitudinal Study on Women's Health (ALSWH) and the Mothers and their Children's Health study (MatCH). Maternal diet was assessed using a semi-quantitative and validated 101-item food-frequency questionnaire (FFQ). We used the healthy eating index (HEI-2015) score to explore maternal diet quality before pregnancy. Children over 2 years of age were categorized as underweight, normal, overweight, and obese based on age and sex-specific BMI classifications for children. Multinomial logistic regression with cluster-robust standard errors was used for analyses.

Results

Greater adherence to maternal diet quality before pregnancy was associated with a lower risk of offspring underweight after adjustment for potential confounders, highest vs lowest quartile (RRR = 0.68, 95% CI: 0.49, 0.96). Higher adherence to pre-pregnancy diet quality was also inversely associated with the risk of offspring obesity (RRR = 0.49, 95% CI: 0.24, 0.98). This association was, however, slightly attenuated by pre-pregnancy body mass index (BMI) in the full adjusted model. No significant association was observed between pre-pregnancy diet quality and offspring overweight.

Conclusions

This study suggests that better adherence to maternal diet quality before pregnancy is associated with a reduced risk of childhood underweight and obesity.

Funding Sources

The ALSWH is funded by the Australian Government Department of Health. MatCH is funded by the National Health and Medical Research Council (NHMRC) project grant. Dereje Gete is supported by the University of Queensland Research Training Scholarship. Gita Mishra holds the Australian Health and Medical Research Council Principal Research Fellowship.

Early life programming of adult ischemic heart disease within and across generations: The role of the socioeconomic context

BACKGROUND

The developmental origins of ischemic heart disease (IHD) have been widely documented but little is known about their persistence across more than one generation. This study aimed to investigate whether the effects of early life disadvantages on adult IHD have changed between generations and are mediated by adult socioeconomic circumstances, and further explore the transgenerational effects of grandparental and parental exposures to disadvantaged circumstances on adult offspring's IHD.

METHODS

We used register-based data from the Uppsala Multigenerational Study, Sweden. The study populations were the parents born 1915-1929 and their offspring born 1932-1972 with available obstetric data. The offspring were further linked to grandparents who had their socioeconomic and demographic data recorded. The outcome was incident IHD assessed at ages 32-75 during a follow-up from January 1, 1964 till December 31, 2008. The exposures included birthweight standardized-for-gestational age, ponderal index, gestational length, and parental socioeconomic position (SEP). Education and income were analyzed as mediators. Potential transgenerational associations were explored by linking offspring IHD to parents' standardized birthweight and gestational length, grandparental SEP, and to grandmothers' age, parity, and marital status at parental birth. All associations were examined in Cox proportional hazard regression models.

RESULTS

Lower standardized birthweight and lower parental SEP were found to be associated with higher IHD rates in both generations, with no evidence of effect modification by generation. Education and income did not mediate the association between standardized birthweight and IHD. Disadvantaged grandparental SEP, younger and older childbearing ages of grandmothers, and paternal preterm birth affected offspring's IHD independent of parental education, income, or IHD history.

CONCLUSIONS

The findings point to similar magnitudes of IHD inequalities by early life disadvantages across two historical periods and the existence of transgenerational effects on IHD. Epigenetic dysregulation involving the germline is a plausible candidate mechanism underlying the transgenerational associations that warrant further research.

Tracking the Development of Multimorbidity In the Australian Longitudinal Study on Women’s Health

IntroductionWith population ageing the prevalence of multi-morbidity (the co-occurrence of two or more chronic medical conditions) is increasing. Objectives and ApproachOur goal was to use data linkage to obtain clinically validated data on the incidence of a range of common chronic conditions developed by participants in the Australian Longitudinal Study on Women’s Health (57,000 women) and hence to track the cumulative incidence of multi-morbidity over time. ResultsThe major data sources differed for different conditions, e.g. the Pharmaceutical Benefits Scheme was important for identifying musculoskeletal conditions, whereas hospital admission data was crucial for identifying stroke. The most common combinations of conditions differed for women at different ages, e.g., mental health, musculoskeletal and respiratory conditions were most common for women born in 1989-95, whereas heart disease was a prominent part of multi-morbidity for women born in 1921-26. Among these older women about 50% had 3 or more chronic conditions in 2002 (when they were aged 76-81) and this increased to over 80% by 2015 (when they were 89-93). For comparison, among women born in 1973-78 fewer than 5% had 2 or more chronic conditions in 2002 (when they were aged 24-29) and this increased to about 15% in 2016 (when they were 38-43). Conclusion / ImplicationsRecord linkage from multiple data sources, repeated over a long time span, is a powerful method for studying the development of multi-morbidity patterns in cohorts.

Twenty Years of Data Linkage in The Australian Longitudinal Study on Women’s Health

IntroductionLinked health record collections, when combined with large longitudinal surveys, are a rich research resource to inform policy development and clinical practice across multiple sectors. Objectives and ApproachThe Australian Longitudinal Study on Women’s Health (ALSWH) is a national study of over 57,000 women in four cohorts. Survey data collection commenced in 1996. Over the past 20 years, ALSWH has also established an extensive data linkage program. The aim of this poster is to provide an overview of ALSWH’s program of regularly up-dated linked data collections for use in parallel with on-going surveys, and to demonstrate how data are made widely available to research collaborators. ResultsALSWH surveys collect information on health conditions, ageing, reproductive characteristics, access to health services, lifestyle, and socio-demographic factors. Regularly updated linked national and state administrative data collections add information on health events, health outcomes, diagnoses, treatments, and patterns of service use. ALSWH’s national linked data collections, include Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, the National Death Index, the Australian Cancer Database, and the National Aged Care Data Collection. State and Territory hospital collections include Admitted Patients, Emergency Department and Perinatal Data. There are also substudies, such as the Mothers and their Children’s Health Study (MatCH), which involves linkage to children’s educational records. ALSWH has an internal Data Access Committee along with systems and protocols to facilitate collaborative multi-sectoral research using de-identified linked data. Conclusion / ImplicationsAs a large scale Australian longitudinal multi-jurisdictional data linkage and sharing program, ALSWH is a useful model for anyone planning similar research.

Family history of non-communicable diseases and associations with weight and movement behaviours in Australian school-aged children: a prospective study

OBJECTIVE

To assess differences in weight status and movement behaviour guideline compliance among children aged 5-12 years with and without a family history of non-communicable diseases (NCDs).

DESIGN

Prospective.

SETTING AND PARTICIPANTS

Women born between 1973 and 1978 were recruited to the Australian Longitudinal Study on Women's Health (ALSWH) via the database of the Health Insurance Commission (now Medicare; Australia's universal health insurance scheme). In 2016-2017, women in that cohort were invited to participate in the Mothers and their Children's Health Study and reported on their three youngest children (aged <13 years). Data from children aged 5-12 years (n=4416) were analysed.

MEASURES

Mothers reported their children's height and weight, used to calculate body mass index (kg/m²), physical activity, screen time and sleep. In the 2015 ALSWH Survey, women reported diagnoses and family history of type 2 diabetes, heart disease and hypertension. Logistic regression models determined differences between outcomes for children with and without a family history of NCDs.

RESULTS

Boys with a family history of type 2 diabetes had 30% (95% CI: 0.51%-0.97%) and 43% lower odds (95% CI: 0.37%-0.88%) of meeting the sleep and combined guidelines, respectively, and 40% higher odds (95% CI: 1.01%- 1.95%) of being overweight/obese. Girls with a family history of hypertension had 27% lower odds (95% CI: 0.57%-0.93%) of meeting the screen time guidelines. No associations were observed for family history of heart disease.

CONCLUSIONS

Children who have a family history of type 2 diabetes and hypertension may be at risk of poorer health behaviours from a young age. Mothers with a diagnosis or a family history of these NCDs may need additional support to help their children develop healthy movement behaviours and maintain healthy weight.

Interleukin-10 gene promoter variants and susceptibility to diabetic nephropathy; a meta-analysis

Introduction: Diabetic nephropathy (DN) is a leading cause of chronic kidney disease (CKD) in diabetes patients. There is ample evidence that the inflammatory pathways are central to both diabetes and DN. Several studies that examined the link between the interleukin-10 (IL10) polymorphisms and DN risk yielded conflicting results. Objectives: The purpose of this meta-analysis is to evaluate the associations between IL10 promoter polymorphisms and DN risk. Methods: A bibliographic search was carried out on PubMed, Google scholar and Web of Science from the beginning until July 30, 2020. Association between IL10 promoter variants (-1082 A>G, -819 C>T and -592 C>A) and DN risk were assessed by considering diabetes without nephropathy (DWN) as well as healthy controls. Data were retrieved and the pooled odds ratio (OR) with 95% confidence interval (CI) was calculated. Results: For the IL10 -1082 A> G analysis, a total of 4 studies with DWN controls (682 cases and 529 controls) and 5 studies with healthy controls (1025 cases and 1625 controls) were considered. For the IL10 -819 C> T analysis, a total of three studies with DWN controls (9619 cases and 445 controls) and 5 studies with healthy controls (1005 cases and 1537 controls) were considered. For the IL10 -592 C> T analysis, a total of 5 studies with DWN controls (819 cases and 645 controls) and 5 studies with healthy controls (1005 cases and 1537 controls) were considered. In addition, there was no evidence of publication bias for IL10 promoter variants. No substantial association was observed between IL10 promoter variants and DN risk. Conclusion: Our study signifies that polymorphisms of IL10 -1082 A>G, -819 C>T and -592 C>A are not linked with DN risk.

Trajectories of socio-economic position over four time points and mortality: The role of gender

Background

Studies investigating the effect of social mobility on mortality in Sweden have used socioeconomic position (SEP) at only two time points and traditional methodological approaches. Our recent study has used SEP at four time points, but not employed latent class analyses when investigating the relationship between SEP trajectories and mortality in later life.

Methods

A cohort of 14,192 live births at Uppsala University Hospital between 1915-1929, of whom 97% were traced through parish records until routine registers became available in the 1960s. 5729 men and 5607 women were alive and living in Sweden in 1980. SEP was measured as social class of the head of household: at birth, in childhood (age 10, +/- five years), in adulthood (age 30-45, in the 1960 Census), and in later life (age 50-65, in the 1980 Census). Latent class analysis was employed to identify social class trajectories and Cox proportional hazard models used to estimate all-cause and cause-specific mortality (data from Causes of Death Register).

Results

Compared to men and women with stable high SEP trajectories, we found a higher risk of death from circulatory disease among men with stable low (HR 1.56, 95%CI 1.29-1.87), stable middle (HR 1.28, 95%CI 1.06-1.55) and upwardly mobile from low (HR 1.35, 95%CI 1.10-1.66) SEP trajectories, as well as in women with stable low or mobile from low to middle SEP trajectory (HR 1.27, 95%CI 1.02-1.59). SEP trajectories and total mortality showed similar, albeit, weaker associations in both genders. SEP trajectories were gender-specific and associations of SEP trajectories with circulatory disease mortality tended to be weaker in women.

Conclusions

Men's and women's socioeconomic position during childhood and over the life course affect their risk of late life all-cause mortality, and death from circulatory disease in particular. Improvements in social conditions at early stages of the life course are likely to contribute to reducing mortality at old age.

Key messages

Men’s and women’s socio-economic position during childhood and over the life course affect their risk of late life all-cause mortality and mortality from circulatory disease in particular. Trajectories of socioeconomic position across life course appear to be related to cause specific and total mortality in a gender specific pattern.

Pre-Pregnancy Diet Quality and Its Association with Offspring Behavioral Problems

Objectives

To examine the relationship between pre-pregnancy diet quality and offspring behavioral problems among children aged 5–12 years.

Methods

1554 mother-child dyads with mothers from the Australian longitudinal study on women's health (ALSWH) and children from the mothers and their children's health Study (MatCH). The healthy eating index (HEI-2015) score was used to explore maternal diet quality before pregnancy. Childhood total behavioral difficulties, internalizing (emotional and peer) and externalizing problems (hyperactivity and conduct) were assessed using the strengths and difficulties questionnaire (SDQ). Multivariable logistic regression analyses were used to examine the association between maternal diet quality and offspring behavioral problems.

Results

211 children experienced a greater score on total behavioral difficulties (13.6%) among the 1554 children. Better pre-pregnancy diet quality was associated with lower odds of offspring total behavioral difficulties after adjustment for potential confounders, highest vs lowest tertile (AOR = 0.52, 95% CI: 0.32, 0.85) at P = 0.009. Greater adherence to the HEI-2015 score before pregnancy was also inversely associated with odds of offspring externalizing problems (AOR = 0.64, 95% CI: 0.43, 0.94). Among the four subscales, hyperactivity and peer problems were negatively associated with better diet quality, (AOR = 0.67, 95% CI: 0.47, 0.96) and (AOR = 0.63, 95% CI: 0.42, 0.96), respectively.

Conclusions

We found that mothers who recorded the better quality of diets before pregnancy had children with a lower risk of behavioral disorders in childhood. Further well-powered prospective studies are warranted to confirm the findings.

Funding Sources

The research on which this paper is based was conducted as part of the Australian Longitudinal Study on Women's Health by the University of Queensland and The University of Newcastle. We are grateful to the Australian Government Department of Health for funding and to the women who provided the survey data.

Gete is supported by the UQ Research Training Scholarship. Mishra holds the Australian Health and Medical Research Council Principal Research Fellowship APP1121844.

Impact of a diagnosis of polycystic ovary syndrome on diet, physical activity and contraceptive use in young women: findings from the Australian Longitudinal Study of Women’s Health

STUDY QUESTION

Do diet, physical activity and contraceptive use change after receiving a diagnosis of polycystic ovary syndrome (PCOS)?

SUMMARY ANSWER

Using longitudinal data 12 months apart, young women newly diagnosed with PCOS were more likely to stop using contraception but did not change their physical activity or vegetable intake.

WHAT IS KNOWN ALREADY

Diagnostic criteria for PCOS have widened to capture more women, despite limited evidence of the benefits and harms. Possible benefits of a PCOS diagnosis are that it may help women with family planning and motivate them to implement healthy lifestyle changes to reduce the reproductive, metabolic and cardiovascular risks associated with PCOS. However, there are no empirical studies investigating how women respond to a diagnosis of PCOS with respect to their health behaviour, and longitudinal population-based studies are lacking.

STUDY DESIGN, SIZE, DURATION

This is a longitudinal analysis of two waves of data collected 12 months apart from the cohort born 1989–1995 in the Australian Longitudinal Survey on Women’s Health, a population-based cohort study. Women in this cohort were first surveyed in 2012-2013, aged 18-23 years.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Women who responded to the 2014 survey (aged 19–24, n = 11 344) and 2015 survey (aged 20–25, n = 8961) were included. Using logistic regression, multinomial logistic regression and linear regression, change in vegetable intake, physical activity and contraceptive use were compared for women newly diagnosed with PCOS to women not reporting a diagnosis of PCOS. Changes in psychological distress and BMI were also examined.

MAIN RESULTS AND THE ROLE OF CHANCE

Young women reporting a new diagnosis of PCOS were no more likely to increase their vegetable intake or physical activity than women not reporting a PCOS diagnosis. Women newly diagnosed with PCOS were 3.4 times more likely to stop using contraception during the 12-month study period than women without PCOS (14% versus 4%, 95% CI = 2.3 to 5.1, P &lt; 0.001). This difference remained significant after controlling for demographics, chronic conditions associated with PCOS, endometriosis, BMI and psychological distress (P &lt; 0.001).

LIMITATIONS, REASONS FOR CAUTION

All data was self-reported including PCOS diagnosis, assessment of diet quality was limited to vegetable intake only. The exact timing of diagnosis within the 12-month period and whether the women intended to conceive are unknown. The number of women reporting a new diagnosis of PCOS was also relatively small.

WIDER IMPLICATIONS OF THE FINDINGS

These findings suggest that a diagnosis of PCOS may not produce short-term benefits by way of improving health behaviour. The observed reduction in contraception use suggests some women may be at increased risk of unplanned pregnancies, highlighting the importance of counselling about contraceptive needs. Both potential benefits and harms must be considered when determining the appropriateness of a PCOS diagnosis.

STUDY FUNDING/COMPETING interest(s)

The Australian Longitudinal Study on Women’s Health is funded by the Australian Government Department of Health. BWM reports consultancy for ObsEva, Merck, Merck KGaA and Guerbet. No further competing interests exist.

TRIAL REGISTRATION NUMBER

N/A

Flexible age-period-cohort modelling illustrated using obesity prevalence data

Background

Use of generalized linear models with continuous, non-linear functions for age, period and cohort makes it possible to estimate these effects so they are interpretable, reliable and easily displayed graphically. To demonstrate the methods we use data on the prevalence of obesity among Australian women from two independent data sources obtained using different study designs.

Methods

We used data from two long-running nationally representative studies: seven cross-sectional Australian National Health Surveys conducted between 1995 and 2017–18, each involving 6000–8000 women; and the Australian Longitudinal Study on Women’s Health which started in 1996 and involves more than 57,000 women in four age cohorts who are re-surveyed at three-yearly intervals or annually. Age-period-cohort analysis was conducted using generalized linear models with splines to describe non-linear continuous effects.

Results

When analysed in the same way both data sets showed similar patterns. Prevalence of obesity increased with age until late middle age and then declined; increased only slightly across surveys; but increased steadily with birth year until the 1960s and then accelerated.

Conclusions

The methods illustrated here make the estimation and visualisation of age, period and cohort effects accessible and interpretable. Regardless of how the data are collected (from repeated cross-sectional surveys or longitudinal cohort studies), it is clear that younger generations of Australian women are becoming heavier at younger ages. Analyses of trends in obesity should include cohort, in addition to age and period, effects in order to focus preventive strategies appropriately.

The Association between Dietary Intake, Asthma, and PCOS in Women from the Australian Longitudinal Study on Women's Health

Dietary intake potentially modifies the prevalence or severity of asthma. The prevalence of asthma is higher in women with polycystic ovary syndrome (PCOS); it is not known if diet confounds or modifies the association between asthma and PCOS. The aims of this study were: (i) To determine if the association of PCOS and asthma is independent of dietary pattern and (ii) to determine if dietary pattern modifies the association between PCOS and asthma. Women in this study were from the Australian Longitudinal Study on Women's Health (ALSWH) cohort born between 1973 to 1978 and aged 18 to 23 years (n = 7382). Logistic regression was used to assess the association between PCOS and asthma, adjusting for the following: (i) Potential confounders identified a priori and (ii) dietary patterns (z-score) identified by principle component analysis. In the adjusted analysis, women with PCOS were more likely to have asthma than the women without PCOS (OR 1.35 and 95% CI, 1.02 and 1.78). This relationship was not altered by further adjustment for dietary patterns (non-core food, meats and takeaway, or Mediterranean-style pattern). In the interaction analysis, only the women consuming less than the median intake of non-core foods (i.e., lower intake of discretionary or unhealthy foods) and with PCOS were more likely to have asthma (OR 1.91 and 95% CI, 1.29 and 2.82). Dietary intake did not confound the relationship between PCOS and asthma. Other mechanistic pathways are likely responsible for the asthma and PCOS association, and further studies assessing factors such as oral contraceptive use and sex steroid hormones warrant investigation.

Naringenin mitigates antituberculosis drugs induced hepatic and renal injury in rats

Tuberculosis is one of the deadly diseases, which can be well treated by antituberculosis drugs (ATDs) i.e. isoniazid, rifampicin, pyrazinamide and ethambutol. These drugs also lead to severe hepatic and renal injury. The present study was designed to investigate efficacy of naringenin against ATDs induced hepato-renal injury. Rats were administered with ATDs for 8 weeks (3 day/week) followed by naringenin at three different doses (10, 20 and 40 mg/kg) conjointly for 8 weeks (3 days/week) orally. Silymarin (50 mg/kg) was used as positive control in the study. Hepatic and renal injury was measured by increased level of serological parameters such as aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, bilirubin, urea, uric acid and creatinine. The toxic effect of ATDs was also indicated by significant increase in lipid peroxidation along with decline in GSH, catalase and superoxide dismutase activity in liver and kidney tissues. Treatment with naringenin encountered ATDs induced injury as evident by significant reversal of biochemical indices towards their respective control in a dose dependent manner. Histopathological observations also supported biochemical findings. Assessment of TNF-α indicated therapeutic efficacy of naringenin at molecular level. Thus, results of this study clearly showed that naringenin possess protective role against ATDs induced hepato-renal injury and to take naringenin supplementation as food may be worthwhile to reduce ATDs induced hepato-renal injury.

Comparing different definitions of prediabetes with subsequent risk of diabetes: an individual participant data meta-analysis involving 76 513 individuals and 8208 cases of incident diabetes

Objective

There are currently five widely used definition of prediabetes. We compared the ability of these to predict 5-year conversion to diabetes and investigated whether there were other cut-points identifying risk of progression to diabetes that may be more useful.

Research design and methods

We conducted an individual participant meta-analysis using longitudinal data included in the Obesity, Diabetes and Cardiovascular Disease Collaboration. Cox regression models were used to obtain study-specific HRs for incident diabetes associated with each prediabetes definition. Harrell's C-statistics were used to estimate how well each prediabetes definition discriminated 5-year risk of diabetes. Spline and receiver operating characteristic curve (ROC) analyses were used to identify alternative cut-points.

Results

Sixteen studies, with 76 513 participants and 8208 incident diabetes cases, were available. Compared with normoglycemia, current prediabetes definitions were associated with four to eight times higher diabetes risk (HRs (95% CIs): 3.78 (3.11 to 4.60) to 8.36 (4.88 to 14.33)) and all definitions discriminated 5-year diabetes risk with good accuracy (C-statistics 0.79-0.81). Cut-points identified through spline analysis were fasting plasma glucose (FPG) 5.1 mmol/L and glycated hemoglobin (HbA1c) 5.0% (31 mmol/mol) and cut-points identified through ROC analysis were FPG 5.6 mmol/L, 2-hour postload glucose 7.0 mmol/L and HbA1c 5.6% (38 mmol/mol).

Conclusions

In terms of identifying individuals at greatest risk of developing diabetes within 5 years, using prediabetes definitions that have lower values produced non-significant gain. Therefore, deciding which definition to use will ultimately depend on the goal for identifying individuals at risk of diabetes.

Lifestyle and Psychological Factors Associated with Pregnancy Intentions: Findings from a Longitudinal Cohort Study of Australian Women

BACKGROUND

Preconception is a critical time for the establishment of healthy lifestyle behaviours and psychological well-being to reduce adverse maternal and offspring outcomes. This study aimed to explore relationships between preconception lifestyle and psychological factors and prospectively assessed short- (currently trying to conceive) and long-term (future parenthood aspirations) pregnancy intentions.

METHODS

Data from Wave 3 (age 25-30 years; n = 7656) and Wave 5 (age 31-36 years; n = 4735) from the Australian Longitudinal Study of Women's Health were used. Pregnancy intentions and parenthood aspirations were evaluated. Logistic regressions explored cross-sectional associations between demographic, lifestyle and psychological factors and pregnancy intentions/parenthood aspirations.

RESULTS

In multivariable models, parity and marital status were associated consistently with pregnancy intentions and parenthood aspirations. Few lifestyle behaviours and no psychological factors were associated with pregnancy intentions. Alcohol intake was the only behaviour associated with aspirations to have a first child. Aspirations for a second/subsequent child were associated negatively with physical activity, sitting time, diet quality, lower anxiety and higher stress.

CONCLUSIONS

It appears that women are not changing their behaviours when they form a decision to try to conceive. Interventions are needed that address women's preconception needs, to optimise lifestyle and improve health outcomes for women and their families.

Variation in menopausal vasomotor symptoms outcomes in clinical trials: a systematic review

BACKGROUND

There is substantial variation in how menopausal vasomotor symptoms are reported and measured among intervention studies. This has prevented meaningful comparisons between treatments and limited data synthesis.

OBJECTIVES

To review systematically the outcome reporting and measures used to assess menopausal vasomotor symptoms from randomised controlled trials of treatments.

SEARCH STRATEGY

We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from inception to May 2018.

SELECTION CRITERIA

Randomised controlled trials with a primary outcome of menopausal vasomotor symptoms in women and a sample size of at least 20 women per study arm.

DATA COLLECTION AND ANALYSIS

Data about study characteristics, primary vasomotor-related outcomes and methods of measuring them.

MAIN RESULTS

The search identified 5591 studies, 214 of which were included. Forty-nine different primary reported outcomes were identified for vasomotor symptoms and 16 different tools had been used to measure these outcomes. The most commonly reported outcomes were frequency (97/214), severity (116/214), and intensity (28/114) of vasomotor symptoms or a composite of these outcomes (68/214). There was little consistency in how the frequency and severity/intensity of vasomotor symptoms were defined.

CONCLUSIONS

There is substantial variation in how menopausal vasomotor symptoms have been reported and measured in treatment trials. Future studies should include standardised outcome measures which reflect the priorities of patients, clinicians, and researchers. This is most effectively achieved through the development of a Core Outcome Set. This systematic review is the first step towards development of a Core Outcome Set for menopausal vasomotor symptoms.

TWEETABLE SUMMARY

Menopausal hot flushes and night sweats have been reported in 49 different ways in clinical research. A core outcome set is urgently required.

Early menarche is associated with lower adult lung function: A longitudinal cohort study from the first to sixth decade of life

BACKGROUND AND OBJECTIVE

Early menarche is increasing in prevalence worldwide, prompting clinical and public health interest on its links with pulmonary function. We aimed to investigate the relationship between early menarche and lung function in middle age.

METHODS

The population-based Tasmanian Longitudinal Health Study (born 1961; n = 8583), was initiated in 1968. The 5th Decade follow-up data (mean age: 45 years) included age at menarche and complex lung function testing. The 6th Decade follow-up (age: 53 years) repeated spirometry and gas transfer factor. Multiple linear regression and mediation analyses were performed to determine the association between age at menarche and adult lung function and investigate biological pathways, including the proportion mediated by adult-attained height.

RESULTS

Girls reporting an early menarche (<12 years) were measured to be taller with greater lung function at age 7 years compared with those reporting menarche ≥12 years. By 45 years of age, they were shorter and had lower post-bronchodilator (BD) forced expiratory volume in 1 s (adjusted mean difference: -133 mL; 95% CI: -233, -33), forced vital capacity (-183 mL; 95% CI: -300, -65) and functional residual capacity (-168 mL; 95% CI: -315, -21). Magnitudes of spirometric deficits were similar at age 53 years. Forty percent of these total effects were mediated through adult-attained height.

CONCLUSION

Early menarche was associated with reduced adult lung function. This is the first study to investigate post-BD outcomes and quantify the partial role of adult height in this association.

SAT-206 Contemporary Risk of Menstrual and Reproductive Dysfunction in Women with Type 1 Diabetes: A Population-Based Study

Background: Type 1 diabetes mellitus (T1D) is historically associated with perturbations of the hypothalamic-pituitary ovarian axis, leading to hypogonadism, amenorrhea and infertility. Given modern therapies and aims for tighter glycaemic control, such reproductive disturbances may be ameliorated; however, few studies have evaluated this in women with T1D in a contemporary setting. Aims: To assess menstrual disturbance, contraceptive use, and reproductive outcomes in women of reproductive age with T1D, compared to age-matched women without T1D. Methods: A cross-sectional analysis was performed using data from the Australian Longitudinal Study on Women’s Health, a large community-based study. Women from two cohorts were included in this study: those aged 18-23 years old who participated in Survey 1 (2013) from the cohort born between 1989-1995, and those aged 34-39 years old who responded to Survey 6 (2012) from the cohort born between 1973-1978. Univariate analyses were performed to explore associations with menstrual disturbance, followed by multivariable logistic regression analyses adjusting for significant and clinically relevant covariates. Results: A total of 23,752 women were included, comprising 162 women with self-reported T1D and 23,590 non-diabetic, age-matched controls. There were no differences in mean age (25.3±7.7 vs. 25.8±7.8 years, p=0.37), body mass index (BMI) [25.9±6.3 vs. 25.0±5.9 kg/m², p=0.06], although a significant proportion of women in both groups had a BMI ≥ 25.0 kg/m² (43.0% vs 38.3%, p=0.25). Delay in menarche was not observed (12.8±1.9 vs. 12.8±1.5 years, p=0.59), however menstrual irregularity (47.2% vs. 34.6%, p=0.001) and polycystic ovarian syndrome (PCOS) [14.2% vs. 5.2%, p<0.001] was significantly increased in women with T1D. T1D, PCOS, thyroid dysfunction, younger age, increased BMI and hypertension were independently associated with menstrual irregularity, after adjustment. In women with prior pregnancies, those with T1D experienced significantly more miscarriages (45.9% vs 32.7%, p=0.04) and stillbirths (6.6% vs. 1.4%, p=0.01), despite no difference in pregnancy rates. Conclusions: Despite therapeutic advances in diabetes management, young women with T1D have persistently higher risk of menstrual and reproductive dysfunction compared to age-matched controls. Further evaluation of the aetiology of menstrual irregularity in this group, particularly distinguishing between oestrogen deficiency and PCOS, is necessary to guide management. Pre-conception optimization of care and counselling in reproductive-aged women with T1D is imperative to minimize complications in pregnancy.

Factors Influencing Web-Based Survey Response for a Longitudinal Cohort of Young Women Born Between 1989 and 1995

Background

With health research practices shifting toward rapid recruitment of samples through the use of online approaches, little is known about the impact of these recruitment methods on continued participation in cohort studies.

Objective

This study aimed to report on the retention of a cohort of young women who were recruited using an open recruitment strategy.

Methods

Women from the 1989-95 cohort of the Australian Longitudinal Study on Women’s Health, recruited in 2012 and 2013 were followed up annually via Web-based surveys in 2014, 2015, and 2016. Prevalence ratios for survey response were calculated using log-binomial models with generalized estimating equations including demographic, health-related, and recruitment method characteristics examined as explanatory factors.

Results

Of the 17,012 women who completed the baseline survey (Survey 1) in 2012 to 2013, approximately two-thirds completed Survey 2 (2014), and just over half completed Surveys 3 (2015) and 4 (2016). Women demonstrated transient patterns of responding with 38.21% (6501/17,012) of women completing all 4 surveys. Although retention of young women was associated with older age, higher education, higher self-rated health status, and low engagement with adverse health behaviors, the method of recruitment was a key determinant of study participation in the multivariate model. Although women were more likely to be recruited into the cohort via social media (eg, Facebook), retention over time was higher for women recruited through traditional media and referral approaches.

Conclusions

A balance must be obtained between achieving representativeness, achieving rapid cohort recruitment, and mitigating the pitfalls of attrition based on recruitment method in the new era of cohort studies, where traditional recruitment methods are no longer exclusively viable options.

Use of Online or Paper Surveys by Australian Women: Longitudinal Study of Users, Devices, and Cohort Retention

BACKGROUND

There is increasing use of online surveys to improve data quality and timeliness and reduce costs. While there have been numerous cross-sectional studies comparing responses to online or paper surveys, there is little research from a longitudinal perspective.

OBJECTIVE

In the context of the well-established Australian Longitudinal Study on Women's Health, we examined the patterns of responses to online or paper surveys across the first two waves of the study in which both modes were offered. We compared the following: differences between women born between 1946 and 1951 and between 1973 and 1978; types of device used for online completion; sociodemographic, behavioral, and health characteristics of women who responded online or using mailed paper surveys; and associations between mode of completion in the first survey and participation and mode of completion in the second survey.

METHODS

Participants in this study, who had responded to regular mailed surveys since 1996, were offered a choice of completing surveys using paper questionnaires or Web-based electronic questionnaires starting in 2012. Two groups of women were involved: an older cohort born between 1946 and 1951 aged in their 60s and a younger cohort born between 1973 and 1978 aged in their 30s when the online surveys were first introduced. We compared women who responded online on both occasions, women who responded online at the first survey and used the paper version of the second survey, women who changed from paper to online, and those who used paper for both surveys.

RESULTS

Of the 9663 women in their 60s who responded to one or both surveys, more than 50% preferred paper surveys (5290/9663, 54.74%, on the first survey and 5373/8621, 62.32%, on the second survey). If they chose the online version, most used computers. In contrast, of the 8628 women in their 30s, 56.04% (4835/8628) chose the online version at the first survey. While most favored computers to phones or tablets, many did try these alternatives on the subsequent survey. Many women who completed the survey online the first time preferred the paper version on the subsequent survey. In fact, for women in their 60s, the number who went from online to paper (1151/3851, 29.89%) exceeded the number who went from paper to online (734/5290, 13.88%). The online option was more likely to be chosen by better educated and healthier women. In both cohorts, women who completed paper surveys were more likely than online completers to become nonrespondents on the next survey. Due to the large sample size, almost all differences were statistically significant, with P<.001.

CONCLUSIONS

Despite the cost-saving advantages of online compared to paper surveys, paper surveys are likely to appeal to a different population of potential respondents with different sociodemographic, behavioral, and health characteristics and greater likelihood of attrition from the study. Not offering a paper version is therefore likely to induce bias in the distribution of responses unless weighting for respondent characteristics (relative to the target population) is employed. Therefore, if mixed mode (paper or online) options are feasible, they are highly likely to produce more representative results than if only the less costly online option is offered.

Abstract 127: Premenopausal Cardiovascular Disease is Associated With Early Natural Menopause

Introduction: Early menopause has been associated with an increased risk of cardiovascular disease (CVD), but few studies have examined the converse, i.e., whether CVD events that occurred before menopause were linked to early natural menopause.

Methods: Pooled participant-level data (177 131 women) from nine studies that contributed to the International collaboration for a Life course Approach to reproductive health and Chronic disease Events (InterLACE) consortium were included. We used multinomial logistic regression models to estimate multivariable relative risk ratios (RRR) and 95% confidence intervals (CI) for the associations between age at onset of non-fatal premenopausal CVD events (including coronary heart disease (CHD) and stroke events) and age at natural menopause. Age at menopause was categorised as <45 (early), 45-49, 50-51(reference), 52-53 and ≥54 years. Age at onset of premenopausal CVD events was grouped as <35, 35-39 and ≥40 years. Women who experienced no premenopausal CVD event were used as the reference group.

Results: Overall, there were 1561 (0.9%) non-fatal premenopausal CVD events (including 1130 CHD and 469 stroke events). The mean age at onset of premenopausal CVD was 41.3 years (standard deviation: 8.2 years, median 44.0 years). Compared with women without experiencing any premenopausal CVD events, women who experienced premenopausal CVD, CHD or stroke before age 35 years had 2-fold increased risk of experiencing early menopause (<45 years), with adjusted RRR (95%CI) of 1.92 (1.17, 3.14), 1.86 (1.01, 3.43), 2.17 (1.43, 3.30) respectively, whereas women with premenopausal CVD after age 40 years were more likely to experience normal menopause at age around 51 years. The associations remained after adjusting for smoking status, BMI, educational level, race/ethnicity, age at menarche, parity, hypertension status and family history of CVD.

Conclusions: In conclusion, women with premenopausal CVD events that occurred before age 35 years had twice the risk of having early menopause. Shared genetic and environmental factors, as well as compromised vasculature after CVD events may play a role.

Influence of food availability on mate-guarding behaviour of ladybirds

A recent study on ladybird, Menochilus sexmaculatus (Fabricius) demonstrates that males perform post-copulatory mate guarding in the form of prolonged mating durations. We investigated whether food resource fluctuation affects pre- and post-copulatory behaviour of M. sexmaculatus. It has not been studied before in ladybirds. For this, adults were subjected to prey resource fluctuations sequentially at three levels: post-emergence (Poe; 10 days), pre-mating (Prm; 24 h) and post-mating (Pom; 5 days; only female). The food resource conditions at each level could be any one of scarce, optimal or abundant. Pre-copulatory and post-copulatory behaviour, and reproductive output were assessed. Post-emergence and pre-mating nutrient conditions significantly influenced the pre-copulatory behaviour. Males reared on scarce post-emergence conditions were found to require significantly higher number of mating attempts to establish mating unlike males in the other two food conditions. Under scarce post-emergence and pre-mating conditions, time to commencement of mating and latent period were high but opposite result was obtained for mate-guarding duration. Fecundity and per cent egg viability were more influenced by post-mating conditions, with scarce conditions stopping oviposition regardless of pre-mating and post-emergence conditions. Present results indicate that pre- and post-copulatory behaviour of ladybird is plastic in nature in response to food resource fluctuations.

Menopause and diabetes: EMAS clinical guide

INTRODUCTION

Whether menopause increases the risk of type 2 diabetes mellitus (T2DM) independently of ageing has been a matter of debate. Controversy also exists about the benefits and risks of menopausal hormone therapy (MHT) in women with T2DM.

AIMS

To summarise the evidence on 1) the effect of menopause on metabolic parameters and the risk of T2DM, 2) the effect of T2DM on age at menopause, 3) the effect of MHT on the risk of T2DM, and 4) the management of postmenopausal women with T2DM.

MATERIALS AND METHODS

Literature review and consensus of experts' opinions.

RESULTS AND CONCLUSION

Metabolic changes during the menopausal transition include an increase in and the central redistribution of adipose tissue, as well as a decrease in energy expenditure. In addition, there is impairment of insulin secretion and insulin sensitivity and an increase in the risk of T2DM. MHT has a favourable effect on glucose metabolism, both in women with and in women without T2DM, while it may delay the onset of T2DM. MHT in women with T2DM should be administered according to their risk of cardiovascular disease (CVD). In women with T2DM and low CVD risk, oral oestrogens may be preferred, while transdermal 17β-oestradiol is preferred for women with T2DM and coexistent CVD risk factors, such as obesity. In any case, a progestogen with neutral effects on glucose metabolism should be used, such as progesterone, dydrogesterone or transdermal norethisterone. Postmenopausal women with T2DM should be managed primarily with lifestyle intervention, including diet and exercise. Most of them will eventually require pharmacological therapy. The selection of antidiabetic medications should be based on the patient's specific characteristics and comorbidities, as well on the metabolic, cardiovascular and bone effects of the medications.

Hysterectomy and incidence of depressive symptoms in midlife women: the Australian Longitudinal Study on Women's Health

AIMS

There is limited longitudinal research that has looked at the longer term incidence of depressive symptoms, comparing women with a hysterectomy to women without a hysterectomy. We aimed to investigate the association between hysterectomy status and the 12-year incidence of depressive symptoms in a mid-aged cohort of Australian women, and whether these relationships were modified by use of exogenous hormones.

METHODS

We used generalised estimating equation models for binary outcome data to assess the associations of the incidence of depressive symptoms (measured by the 10-item Centre for Epidemiologic Studies Depression Scale) across five surveys over a 12-year period, in women with a hysterectomy with ovarian conservation, or a hysterectomy with bilateral oophorectomy compared with women without a hysterectomy. We further stratified women with hysterectomy by their current use of menopausal hormone therapy (MHT). Women who reported prior treatment for depression were excluded from the analysis.

RESULTS

Compared with women without a hysterectomy (n = 4002), both women with a hysterectomy with ovarian conservation (n = 884) and women with a hysterectomy and bilateral oophorectomy (n = 450) had a higher risk of depressive symptoms (relative risk (RR) 1.20; 95% confidence interval (CI) 1.06-1.36 and RR 1.44; 95% CI 1.22-1.68, respectively). There were differences in the strength of the risk for women with a hysterectomy with ovarian conservation, compared with those without, when we stratified by current MHT use. Compared with women without a hysterectomy who did not use MHT, women with a hysterectomy with ovarian conservation who were also MHT users had a higher risk of depressive symptoms (RR 1.57; 95% CI 1.31-1.88) than women with a hysterectomy with ovarian conservation but did not use MHT (RR 1.17; 95% CI 1.02-1.35). For women with a hysterectomy and bilateral oophorectomy, MHT use did not attenuate the risk. We could not rule out, however, that the higher risk seen among MHT users may be due to confounding by indication, i.e. MHT was prescribed to treat depressive symptoms, but their depressive symptoms persisted.

CONCLUSIONS

Women with a hysterectomy (with and without bilateral oophorectomy) have a higher risk of new incidence of depressive symptoms in the longer term that was not explained by lifestyle or socio-economic factors.