Utilization of bone mineral density testing among breast cancer survivors in British Columbia, Canada

Breast cancer survivors are at high osteoporosis risk. Bone mineral density testing plays a key role in osteoporosis management. We analyzed a historical utilization of bone mineral density testing in breast cancer survivors. The utilization remained low in the 1995-2008 period. Lower socio-economic status and rural residency were associated with lower utilization.

INTRODUCTION

To evaluate the utilization of bone mineral density (BMD) testing for female breast cancer survivors aged 65+ surviving ≥ 3 years in British Columbia, Canada.

METHODS

A retrospecitve population-based data linkage study. Trends in proportion of survivors with ≥ 1 BMD test for each calendar year from 1995 to 2008 were evaluated with a serial cross-sectional analysis. Associations between factors (socio-demographic and clinical) and BMD testing rates over the period 2006-2008 for 7625 survivors were evaluated with a cross-sectional analysis and estimated as adjusted prevalence ratios (PR_adj) using log-binomial models.

RESULTS

Proportions of survivors with ≥ 1 BMD test increased from 1.0% in 1995 to 10.1% in 2008. The BMD testing rate in 2006-2008 was 26.5%. Socio-economic status (SES) and urban/rural residence were associated with BMD testing rates in a dose-dependent relationship (p for trend< 0.01). Survivors with lower SES (PR_adj = 0.66-0.78) or rural residence (PR_adj = 0.70) were 20-30% less likely to have BMD tests, compared with survivors with the highest SES or urban residence. BMD testing rates were also negatively associated with older age (75+) (PR_adj = 0.47; 95% CI = 0.42, 0.52), nursing home residency (0.05; 0.01, 0.39), recent osteoporotic fractures (0.21; 0.14, 0.32), and no previous BMD tests (0.26; 0.23, 0.29).

CONCLUSION

Utilization of BMD testing was low for breast cancer survivors in BC, Canada. Lower SES and rural residence were associated with lower BMD testing rates.

IMPLICATION FOR CANCER SURVIVORS

Female breast cancer survivors, especially those with lower SES or rural residence, should be encouraged to receive BMD tests as recommended by Canadian guidelines.

Defining migration and its health impact in China

The scale and rapid expansion of urbanization resulting from socio-economic transformation in China at the beginning of the 21st century has accelerated rural-urban migration. Public health concerns from this increasing internal population mobility are now receiving attention from researchers. The health problems from internal migration pose particular demands on healthcare systems and relate to its demographic characteristics, with many younger and older people being left behind in the rural countryside. A review of literature, census, policy reports, government documents and media was undertaken to look at the classification system and health characteristics of China's internal migrants. It suggests that public health bears the consequences of political and economic decisions made elsewhere in society.

The community prevalence of chronic pelvic pain in women and associated illness behaviour

BACKGROUND

Chronic pelvic pain has often been described as a major women's health issue, but no information exists on the extent of the problem in the United Kingdom.

AIM

To investigate the community prevalence of chronic pelvic pain and its effect on the lives of consulting and non-consulting women.

DESIGN OF STUDY

Postal questionnaire survey.

SETTING

Women aged 18 to 49 (n = 3916) randomly selected from the Oxfordshire Health Authority Register.

METHOD

The questionnaire response rate (adjusted for non-deliveries) was 74% (2304/3106). Chronic pelvic pain was defined as recurrent or constant pelvic pain of at least six months' duration, unrelated to periods, intercourse, or pregnancy. Case subgroups comprised recent consulters, past consulters, and non-consulters. Women who reported dysmenorrhoea alone formed a comparison group.

RESULTS

The three-month prevalence of chronic pelvic pain was 24.0% (95% CI = 22.1% to 25.8%). One-third of women reported pain that started more than five years ago. Recent consulters (32% of cases) were most affected by their symptoms in terms of pain severity, use of health care, physical and mental health scores, sleep quality, and pain-related absence from work. Non-consulters (41% of cases) did not differ from women with dysmenorrhoea in terms of symptom-related impairment. Irrespective of consulting behaviour, a high rate of symptom-related anxiety was found in women with chronic pelvic pain (31%) compared with women with dysmenorrhoea (7%).

CONCLUSIONS

This study showed a high community prevalence of chronic pelvic pain in women of reproductive age. Cases varied substantially in the degree to which they were affected by their symptoms. The high symptom-related anxiety in these women emphasises the need for more information about chronic pelvic pain and its possible causes.

Chronic pelvic pain in the community--symptoms, investigations, and diagnoses

OBJECTIVES

This study was undertaken to investigate the overlap between chronic pelvic pain, dysmenorrhea, dyspareunia, irritable bowel syndrome, and genitourinary symptoms in the community and also to examine associated investigations and diagnoses.

STUDY DESIGN

A postal questionnaire was used to survey 3916 women aged 18 through 49 randomly selected from the Oxfordshire Health Authority Register. The number of responders was 2304 (74% of 3106 questionnaire recipients). Chronic pelvic pain was described as recurrent or constant pelvic pain of > or =6 months' duration unrelated to periods, intercourse, or pregnancy. Case patients (n = 483) were subgrouped as follows: (1) chronic pelvic pain only, (2) chronic pelvic pain and irritable bowel syndrome, (3) chronic pelvic pain and genitourinary symptoms, and (4) chronic pelvic pain, genitourinary symptoms, and irritable bowel syndrome.

RESULTS

Half the women with chronic pelvic pain also had either genitourinary symptoms or irritable bowel syndrome, or both. Prevalences of dysmenorrhea and dyspareunia were higher among women with chronic pelvic pain (81% and 41%, respectively) than among women without chronic pelvic pain (58% and 14%, respectively); rates did not differ among the chronic pelvic pain subgroups. Irritable bowel syndrome and stress were the most common diagnoses received by patients with chronic pelvic pain, but 50% had never received a diagnosis.

CONCLUSIONS

There is substantial overlap between chronic pelvic pain and other abdominal symptoms in the community. Despite a high prevalence of chronic pelvic pain, many women have never had the condition diagnosed.

Prevalence and incidence of chronic pelvic pain in primary care: evidence from a national general practice database

OBJECTIVES

To estimate the prevalence and incidence in primary care of chronic pelvic pain in women in the UK.

DESIGN

Cross-sectional analysis of MediPlus UK Primary Care Database.

SETTING

One hundred and thirty-six general practices in the UK.

POPULATION

From 284,162 women aged 12-70 who were registered on the database and who had a general practice contact in 1991, 24,053 chronic pelvic pain cases were identified between 1991 and 1995.

METHODS

Chronic pelvic pain was defined as pelvic pain lasting for at least six months, and cases were identified on the basis of contacts with general practice. Pain due to malignancy, chronic inflammatory bowel diseases or pregnancy, or which occurred only during menstruation or sexual intercourse, was excluded.

MAIN OUTCOME MEASURES

Prevalence and incidence rates of chronic pelvic pain in primary care by age and region.

RESULTS

Monthly prevalence and incidence rates of chronic pelvic pain were 21.5/1000 and 1.58/1000, respectively, with an annual prevalence of 38.3/1000. Monthly prevalence rates increased significantly with age (P < 0.001) from 18.2/1000 in 15-20 year olds to 27.6/1000 in women older than 60, as symptoms persisted longer in older women. Prevalence and incidence rates varied significantly between regions (P < 0.001), with the lowest monthly prevalence in Scotland (16.0/1000) and the highest in Wales (29.4/1000).

CONCLUSIONS

Chronic pelvic pain is a common condition in the UK, with a prevalence in primary care comparable to migraine, back pain, and asthma. Its prevalence in the general population is likely to be considerably higher.

Patterns of diagnosis and referral in women consulting for chronic pelvic pain in UK primary care

OBJECTIVES

To describe duration of symptoms and patterns of diagnosis and referral in women with chronic pelvic pain.

DESIGN

Retrospective cohort analysis of the MediPlus UK Primary Care Database.

SETTING

One hundred and thirty-six general practices in the UK.

STUDY GROUP

A cohort of 5051 incident cases of chronic pelvic pain.

METHODS

The cohort was followed up from the start of their symptoms in 1992 until the end of the chronic pelvic pain episode or the end of 1995.

MAIN OUTCOME MEASURES

Duration of symptoms, frequency of diagnoses and referral rates.

RESULTS

A third of women had symptoms persisting for more than two years. Duration of symptoms increased significantly with age (P < 0.001) from a median of 13.7 months in 13-20 year olds to 20.2 months in women over the age of 60. Irritable bowel syndrome and cystitis were the most common diagnoses at all ages. Twenty-eight percent of women never received a diagnosis during three to four years of follow up after first consultation, and 60% of women had no evidence of a specialist referral. Women aged 21-50 and women whose final diagnosis was endometriosis received the largest number of diagnoses and had the highest referral rates.

CONCLUSIONS

The numbers and types of diagnosis given to a woman with chronic pelvic pain and the likelihood of specialist referral depend on her age, as well as on the duration of symptoms. Women seen in secondary care for chronic pelvic pain are a highly selected group and are likely to represent only the tip of the iceberg.

The prevalence of chronic pelvic pain in women in the United Kingdom: a systematic review

OBJECTIVE

To obtain a prevalence estimate for chronic pelvic pain in women in the United Kingdom by analysing published data.

DESIGN

Systematic review of published papers.

SETTING

The general population or hospitals in the United Kingdom.

POPULATION

Women participating in relevant community surveys or control women participating in hospital-based studies.

METHODS

Papers were retrieved by systematically searching the databases MEDLINE, EMBASE and PsycLit, and by hand searching. Studies were included if they 1. were community-based and reported prevalence rates of chronic pelvic pain, dyspareunia, dysmenorrhoea, or abdominal pain, or 2. referred to a clinical population but reported prevalence rates in a disease-free control group.

MAIN OUTCOME MEASURES

Prevalence rates for chronic pelvic pain including any overlap with dyspareunia, dysmenorrhoea and abdominal pain.

RESULTS

No community-based study has been performed that provides an estimate of the prevalence of chronic pelvic pain in the general UK population. A rate of 39% was reported in women undergoing laparoscopy for sterilisation or investigation of infertility in the single study from the United Kingdom investigating chronic pelvic pain unrelated to menstruation or intercourse. Prevalence rates for dyspareunia, dysmenorrhoea, and abdominal pain found in UK community-based studies were 8%, 45% to 97%, and 23% to 29%, respectively, but definitions used varied greatly.

CONCLUSIONS

Because chronic pelvic pain can reduce the quality of life and general wellbeing, there is a need for a community-based study into the prevalence of chronic pelvic pain and its effect upon the lives of women in the UK.

Patterns of maternal weight gain in pregnancy

A retrospective study of 1145 pregnant women showed that trends in mean maternal weight gain from the time of booking until delivery were not linear. Statistically significant lower rates of maternal weight gain were seen before 16 weeks, after 36 weeks and between 28 and 32 weeks gestation (P less than 0.05). The mean maternal weight gain was 10.71 kg (SD 4.3) and the mean weekly weight gain was 0.38 kg (SD 0.16). A wide variation of maternal weight gain was seen in women with a normal outcome. The mean weight gain in heavy (greater than 68 kg) and light (less than 55.4 kg) women was less than that in women whose weight was in the third quartile (60-68 kg, P less than 0.05). The mean maternal weight gain was less in young (less than 20 years) women than in older women (greater than 25 years; P less than 0.05), less in parous than in primigravid women from week 37 onwards (P less than 0.05), less in smokers than in non-smokers from 20 weeks onwards (P less than 0.05), and greater in hypertensive women (BP less than 140/90) than in normotensive women (P less than 0.05) from week 24 onwards. The mean weight gain in women who had small for gestational age (SGA) infants was not significantly different from that in women who had infants that were of appropriate size for gestational age. After taking into account infant and placental weight using multiple regression analysis, the factors that were associated with statistically significant differences in average weekly weight gain were parity, body mass index, smoking habit and raised blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Repeated measurement of maternal weight during pregnancy. Is this a useful practice?

A retrospective study of 1092 pregnant women showed that the use of a centile chart of maternal weight gain was not effective at detecting women who give birth to small for gestational age (SGA) infants. Multiple regression analysis showed that of the various weight measurements recorded, weekly weight gain and maternal size at booking were the only factors which had a significant association with infant birthweight after taking into account maternal gestation, age, smoking habit and parity. Low maternal booking weight (less than 51 kg) was the most effective maternal weight measurement for antenatal detection of SGA infants (positive predictive value 20.0%). Low average weekly maternal weight gain (less than 0.20 kg) had a positive predictive value of only 12.9% for detecting these pregnancies. Weight loss or failure to gain weight over a 2-week interval occurring in the third trimester was observed in 46% of all women studied. Maternal smoking had a positive predictive value of 16.3% in antenatal detection of SGA infants. Maternal weight need be recorded only at booking, with the exception of patients in whom nutrition is of concern. The subsequent routine weighing of patients may produce unnecessary anxiety and should cease.

Obesity in a Somerset town: prevalence and relationship to morbidity

Body mass index was determined for 953 subjects, randomly selected from the electoral roll of a town in south-west England. Morbidity was estimated using a questionnaire.The prevalence of obesity (body mass index < 28) was 21 per cent for males and 22 per cent for females. Overall morbidity was significantly increased in obese females. The three main disease groups that were more prevalent in both the obese males and females were hypertension, cardiovascular disease and musculoskeletal disorders.