Biomedical subjects

J E Byles

Publications and source records attributed to J E Byles.

At least 19 recordsLinked to original sources

PubMed2005

Trends in health service use for women in Australia with diabetes.

OBJECTIVE: To describe the health, health service use and use of recommended guidelines for care for women in Australia with diabetes. METHODS: Analysis of survey data 1996-99 from the Australian Longitudinal Study on Women's Health, linked with Medicare data for 1997-2001. Participants were 12,338 mid-age women aged 45-50 years in 1996 (1.9% with diabetes) and 10,421 older women aged 70-75 years at Survey 1 in 1996 (8.1% with diabetes). The outcome measures were number of general practice and specialist visits and use of glycosylated haemoglobin (HbAlc), lipids and microalbuminuria tests. RESULTS: Women with diabetes at Survey 1, and those diagnosed by Survey 2, were more likely to have hypertension, heart disease and eyesight problems, have high rates of polypharmacy (four or more medications: mid age 32%, older 64%) and more consultations with general practitioners and specialists than women without diabetes. During 1997-2001, there was a trend for a greater percentage of women with diabetes to have an HbA1c test at least annually (mid age 44%-52%, older age 46%-58%). Rates of testing microalbuminuria and lipids also increased but were far from conforming to guidelines. Having more frequent consultations with a general practitioner was significantly associated with having all three recommended tests. CONCLUSIONS: There is an increasing use of services by women with diabetes, in part due to an increase in compliance with guidelines for the management of diabetes. IMPLICATIONS: Linked health and administrative data provide a means to monitor health service utilisation, adherence to principles for best practice care and issues of equity in care.

Adolescent↗

PubMed2003

Medication use among older Australian veterans and war widows.

This study aimed to review the medications used by a group of Australian war veterans and widows, to identify type and number of medications used and potential inappropriate prescribing. Label details of 4304 medications used by 887 participants were recorded and classified according to the Anatomical Therapeutic Chemical code. The median number of regular medications being used was four (interquartile range 2-7), with a median of one other medication (interquartile range 1-2) being taken as needed. Over half (53%) the participants were taking four or more regular medications. There were 26 potential interactions among 25 people. Polypharmacy was a considerable problem for this group of older Australians.

Aged↗

PubMed2001

Determinants of general practitioner use among women in Australia.

This study investigates the use of general practitioner services by women in Australia. Although there is a universal health insurance system (Medicare) in Australia, there are variations in access to services and out of pocket costs for services. Survey data from 2350 mid-age (45-50 years) and 2102 older (70-75 years) women participating in the Australian Longitudinal Study on Women's Health were linked with Medicare data to provide a range of individual and contextual variables hypothesised to explain general practitioner use. Structural equation modelling showed that physical health was the most powerful explanatory factor of general practitioner use. However, after adjusting for self-reported health, out of pocket cost per consultation was inversely associated with use of services. The out of pocket cost was generally lower for women with low socioeconomic status but cost was also directly related to geographical remoteness. Women living in more remote areas had higher out of pocket costs and poorer access to services. Women who reported better access to care were more likely to be satisfied with their most recent general practice consultation and less likely to be sceptical of the value of medical care. These results show the need for health policies that improve the equitable use of general practitioner services in Australia.

Aged↗

PubMed2001

Health services research using linked records: who consents and what is the gain?

OBJECTIVE: To assess consent to record linkage, describe the characteristics of consenters and compare self-report versus Medicare records of general practitioner use. METHOD: Almost 40,000 women in the Australian Longitudinal Study on Women's Health were sent a request by mail for permission to link their Medicare records and survey data. RESULTS: 19,700 women consented: 37% of young (18-23 years), 59% of mid-age (45-50 years) and 53% of older women (70-75 years). Consenters tended to have higher levels of education and, among the older cohort, were in better health than non-consenters. Women tended to under-report the number of visits to general practitioners. CONCLUSIONS: Record linkage of survey and Medicare data on a large scale is feasible. The linked data provide information on health and socio-economic status which are valuable for understanding health service utilisation. IMPLICATIONS: Linked records provide a powerful tool for health care research, particularly in longitudinal studies.

Adolescent↗

PubMed2000

Factors associated with hysterectomy among women in Australia.

This study was to identify hysterectomy prevalence across urban, rural and remote areas of Australia and across states, to separate geographic variation from the effect of sociodemographic influences, and also to compare the quality of life of women who have and have not had hysterectomy. Data were collected from 14,072 women aged 45-50 years participating in the baseline survey of the Australian Longitudinal Study on Women's Health. The estimated prevalence of hysterectomy was 22%. Factors significantly associated with hysterectomy included living in a rural or remote area, state of residence, having private health insurance, lower levels of education, being married and having more than two children, having had other gynaecological and non-gynaecological surgical procedures, and more visits to general practitioners. Compared with women who had not had hysterectomy, women who had had hysterectomy had significantly poorer physical and mental health as measured by the SF-36 quality of life profile (adjusted mean PCS=45.7 vs 49.3, p<0.0001; adjusted mean MCS=46.9 vs 48.2, p<0.0001).

Australia↗

PubMed2000

A thorough going over: evidence for health assessments for older persons.

OBJECTIVE: To review published randomised controlled trials of health assessments for older people; consider the effects of assessments in maintaining health and quality of life for older people; and identify those factors associated with more successful health assessment programs. METHODS: A systematic literature search and methodological review of published studies of health assessments for people aged 65 years and over, living in the community. RESULTS: Twenty-one trials were identified. They were widely heterogeneous in terms of methodological quality, assessment content and outcome variables. While the studies' results are inconsistent, the majority of the more methodologically sound studies report improvements in health. The studies reporting positive health outcomes were not specifically targeted to particular groups at high need, but were applied to all people in the source population who had reached a set age, usually 75 plus. In the majority of studies reviewed, the assessments were conducted by non-medical personnel (nurse, lay interviewer/volunteer or office staff). CONCLUSIONS: Health assessments have been associated with improved health outcomes for older people. An evidence base for specific components to be included in the assessments is yet to be derived. IMPLICATIONS: In November 1999, new Medicare items to provide for health assessments for persons in Australia aged 75 years and over were introduced. The acceptability, adoption and effectiveness of these items needs careful monitoring.

Aged↗

PubMed2000

Access and equity in the provision of general practitioner services for women in Australia.

OBJECTIVE: To assess geographical equity in the availability, accessibility and out-of-pocket costs of general practitioner (GP) services for women in Australia. METHOD: Data on general practice consultations during 1995 and 1996 for women aged 18-23 years (n = 5,260), 45-50 years (n = 7,898) and 70-75 years (n = 6,542) in the Australian Longitudinal Study on Women's Health were obtained from the Health Insurance Commission. A sub-study of 4,577 participants provided data on access to health services. RESULTS: Older women were more likely to have no out-of-pocket costs for their GP consultations, but in all age groups, the proportion was lower in rural areas than in urban areas (older age: 60% rural areas, 76% capital cities; mid-age: 24% rural areas, 40% capital cities; young age: 35% rural areas, 52% capital cities). Among mid-aged women, the median out-of-pocket cost per consultation ranged from $2.11 in capital cities to $6.48 in remote areas. Women living in rural and remote areas gave lower ratings for the availability, accessibility and affordability of health services than women living in urban areas. CONCLUSIONS: This study has shown a striking gradient in financial and nonfinancial barriers to health care associated with area of residence. IMPLICATIONS: The geographical imbalance in the supply and distribution of GP services in Australia has long been recognised but inequities in the affordability of services must also be addressed. Longitudinal survey data and Health Insurance Commission data provide a means to evaluate policies designed to improve access to health services in rural and remote areas.

Adolescent↗

PubMed2000

A general practice-based recruitment strategy for colorectal cancer screening.

OBJECTIVE: To determine whether a screening recruitment strategy for first degree relatives of people with colorectal cancer is effective in enabling eligible relatives to request screening from their general practitioner (GP) and to assess acceptability to GPs and patients. METHODS: Thirty GPs, from 26 practices, and 303 of their patients aged over 50 who were first degree relatives of a person with colorectal cancer, participated in a randomised controlled trial of a GP-based recruitment strategy, in the Newcastle Area of New South Wales, Australia. RESULTS: The proportion of relatives requesting screening was statistically significantly higher in the intervention group than in the control group (18% compared to 4%, respectively; p = 0.01). CONCLUSIONS: Interest in the study by GPs was low, however for GPs who were involved, the recruitment strategy did prompt first degree relatives to discuss screening. The strategy may be even more effective when combined with other interventions such as a media campaign. The results may be generalizable to feasibility studies of general population screening for colorectal cancer in Australia. IMPLICATIONS: The results of this work are potentially informative to public health practice in Australia given the ensuing pilot programs of colorectal cancer screening.

Aged↗

PubMed2000

'Is anybody listening?' The experiences of widowhood for older Australian women.

This paper discusses preliminary findings from participants in the baseline survey of the Australian Longitudinal Study on Women's Health (Women's Health Australia: WHA) who reported their marital status as widowed. A total of 12,624 women, aged 70-75 years, completed a self-administered 260-item questionnaire, and 4335 of these women were widowed. Many of these women provided additional qualitative comments about their health, social and financial circumstances after the death of their spouse. This paper presents a thematic analysis of the qualitative comments and builds on the findings of the quantitative analysis of baseline data. The aims of this part of the study are to examine the short- and long-term effects of widowhood on the health and wellbeing of older women and to explore the process of change they experience after the death of a spouse. Preliminary findings suggest that, as a key life event, widowhood has an initial negative impact on the health and wellbeing of older women, but in the long term it may be accompanied by a positive shift into a new life phase.

Aged↗

PubMed1999

Factors relating to cervical screening in New South Wales, Australia.

The aims of this paper were to describe the geographical variation in Pap smear screening rates, standardised for age and adjusted for rates of hysterectomies and to assess the sociodemographic and health care factors associated with the variation. The data used in the study were the percentage of women who had had Pap smears between the years 1990 and 1992 based on the records of the Australian Health Insurance Commission (HIC). The best predictors of screening extracted from the model were the Index of Economic Resources and the proportion of women within each region who were born in non-English speaking countries.

Adolescent↗

PubMed1999

Tyranny of distance? The health of mid-age women living in five geographical areas of Australia.

Over 14,000 women aged 45-50 are participating in the Australian Longitudinal Study on Women's Health, which is designed to track the health of Australian women for 20 years, and to understand lifestyle and healthcare factors that influence women's health. The study deliberately overrepresents women from rural and remote areas. This analysis of baseline data from the study compares the responses of women living in urban areas (capital city, other metropolitan), large rural centres, small rural centres, other rural areas and remote areas (remote centres, other remote areas) of Australia. The data show that while women in this age group who live in rural and remote areas have similar levels of self-rated health, they have significantly fewer visits to general practitioners and specialists (P < 0.001) and more visits to alternative healthcare providers than women living in urban areas. Rural and remote area women were also more likely to undergo gynaecological surgery than women living in urban areas (P < 0.001). Other results suggest that being overweight is more common among women from rural and remote areas, and that these women also report lower levels of stress than women from urban areas (P < 0.001). Further follow up will allow any divergence in health and healthcare equity to be explored as these women get older.

Australia↗

PubMed1999

Women's Health Australia: on the progress of the main cohort studies.

More than 41,000 women aged 18-23, 45-50, and 70-75 years in 1996 are participating in the Australian Longitudinal Study on Women's Health (Women's Health Australia). Baseline surveys were conducted for all three cohorts in 1996, and the first follow-up survey of the mid-age group in 1998 has achieved a response rate exceeding 90%. The main findings so far reflect the large differences in the life experiences of the three cohorts. The young women report high levels of stress. The physical and mental health of those with young children is worse than for those without children, but confounding by sociodemographic characteristics may account for the differences. Two thirds of young women in the healthy weight or underweight range would like to weigh less, and early onset of dieting is associated with poorer physical and mental health. Most of the women in the mid-age group have multiple roles--in paid work, home duties, and caring for children and other dependents. The potential of the study to investigate the long-term impact of such busy lives on health outcomes is considerable. At this stage, the main health issues for these women relate to tiredness, weight gain, and menopause. The older cohort presents a picture of positive aging. These women are heavier users of health services than the mid-age and younger women, and they are also more satisfied with these services. Although their physical health is poorer, their mental health is better, and they report less stress than women in the other two cohorts. The follow-up survey of this group, planned for 1999, will focus on the coping strategies used by these women. An overall goal of the project is to understand the interactions among social roles, life events, and women's health in order to provide a basis for improved health policies and services. Analysis of these interactions, which relies on both quantitative and qualitative data, poses many challenges that will be addressed as the longitudinal data become available.

Adult↗

PubMed1999

Association of Helicobacter pylori infection with gastric carcinoma: a meta-analysis.

OBJECTIVE: As conflicting studies have recently been published, we aimed to determine if Helicobacter pylori (H. pylori) infection is associated with gastric adenocarcinoma. METHODS: This was a meta-analysis of observational epidemiological studies. RESULTS: A total of 42 studies met the selection criteria and were categorized by the type of study design: eight cohort and 34 case-control studies. The pooled odds ratio for H. pylori in relation to gastric carcinoma was 2.04 (95% CI: 1.69-2.45). Both patient age (OR 0.77, 95% CI: 0.68-0.89) and intestinal type cancers (OR 1.14, 95% CI: 1.05-1.25) were independent effect modifiers. Analysis of other effect modifiers showed no relationship with female gender (OR 0.76, 95% CI: 0.64-0.89), stage of cancer (advanced %) (OR 1.12, 95% CI: 0.88-1.43), anatomical location (cardia %) (OR 1.54, 95% CI: 0.32-7.39) or cohort (nested case-control) studies (OR 1.72, 95% CI: 0.32-9.17). There was significant heterogeneity among the studies (tau2 = 149; p < 0.001). The quality of the studies varied considerably, with the majority of excellent studies producing positive results and the very poor to moderate studies producing mixed results. CONCLUSIONS: H. pylori infection is associated with a 2-fold increased risk of developing gastric adenocarcinoma.

Adenocarcinoma↗

PubMed1999

For richer, for poorer, in sickness and in health: older widowed women's health, relationships and financial security.

AIM: This study contrasts the health and social needs of widowed older women with needs of married older women. METHOD: 12,624 women aged 70-75 years across Australia completed baseline questionnaires for the Australian Longitudinal Study on Women's Health: 34.5% of the women were widowed, and 13.5% of these widowed women had lost their spouse within the past 12 months (recently widowed). RESULTS: Recently widowed women had particular physical and mental health needs as well as financial and practical needs relating to managing on their income. They had the lowest self-rated health, were most likely to report they were stressed about their health, and scored significantly lower than married women on all 8 sub-scales of the SF-36. Women were more likely to say they make their own decisions about their life if they were widowed than if they were married. However, stress with relationships with children or other family members was more likely to be reported by widows than other women.

Aged↗

PubMed1998

Women's satisfaction with general practice consultations.

OBJECTIVE: To determine women's satisfaction with general practice services. DESIGN: Cross-sectional postal questionnaire conducted during April to September 1996 (part of the baseline survey of the Australian Longitudinal Study on Women's Health). PARTICIPANTS: Women aged 18-22 (n = 14,739), 45-49 (n = 14,013) and 70-74 (n = 12,941) years, randomly selected from the Medicare database, with oversampling of women from rural and remote areas. MAIN OUTCOME MEASURES: Frequency of use of general practice services; satisfaction with the most recent visit to a general practitioner (GP); prevalence of selected symptoms; preference for a female doctor. RESULTS: The most recent visit to a GP was rated overall as good, very good or excellent by more than 80% of women, with increasing levels of satisfaction with increasing age of the women. However, satisfaction was lower for waiting room time and cost of the visit. A third of the young and middle-aged women living in rural and remote areas were dissatisfied with the cost of the visit. Young women were more likely to prefer a female doctor, and many were dissatisfied with their GP's skills at explaining their problem and giving them a chance to give an opinion and ask questions. The most prevalent symptoms for all women included headaches and tiredness, and may were not satisfied with the health services available to help them deal with these symptoms. CONCLUSIONS: Australian women have high levels of satisfaction with GP consultations. However, more effective strategies may be needed to improve communication with younger women, and there is an unmet need for services to help all women deal with some common symptoms. Dissatisfaction with cost of services and women's preference for female doctors have implications for future health policy.

Adolescent↗

PubMed1998

Colorectal cancer screening: discussions with first degree relatives.

Screening by faecal occult blood test and colonoscopy is recommended for first degree relatives of people with colorectal cancer. While it is known that screening participation among relatives is low, relatives' beliefs and attitudes towards screening have not been explored at an in-depth level. In this study, four focus group discussions with first degree relatives of people with colorectal cancer were held. Discussions were audio-taped, transcribed verbatim and the data were independently coded and analysed by the authors. Three main themes were identified: risk, understanding, and screening. Perceived risk was determined by family history, age and gender. Of concern, there was limited understanding of the asymptomatic nature of screening with most relatives initially 'screened' after consulting a doctor with colorectal symptoms. These findings need to be considered in screening programs.

Attitude to Health↗

PubMed1998

Women's Health Australia: recruitment for a national longitudinal cohort study.

The Women's Health Australia (WHA) project is a longitudinal study of several cohorts of Australian women, which aims to examine the relationships between biological, psychological, social and lifestyle factors and women's physical health, emotional well-being, and their use of and satisfaction with health care. Using the Medicare database as a sampling frame (with oversampling of women from rural and remote areas), 106,000 women in the three age groups 18-23, 45-50 and 70-75 were sent an invitation to participate and a 24-page self-complete questionnaire. Reminder letters, a nation-wide publicity campaign, information brochures, a freecall number for inquiries, and the option of completing the questionnaire by telephone in English or in the respondent's own language, were used to encourage participation. Statutory regulations precluded telephone follow-up of non-respondents. Response rates were 41% (N = 14,792), 54% (N = 14,200) and 36% (N = 12,614) for the three age groups. Comparison with Australian census data indicated that the samples are reasonably representative of Australian women in these age groups, except for a somewhat higher representation of women who are married or in a defacto relationship, and of women with post-school education. The most common reason for non-participation was lack of interest or time. Personal circumstances, objections to the questionnaire or specific items in it, and concerns about confidentiality were the other main reasons. Recruitment of three representative age-group cohorts of women, and the maintenance of these cohorts over a number of years, will provide a valuable opportunity to examine associations over time between aspects of women's lives and their physical and emotional health and well-being.

Adult↗

PubMed1997

'It would be good to know you're not alone': the health care needs of women with menstrual symptoms.

OBJECTIVES: We aimed to explore how menstrual symptoms affect women, women's health care needs, and their expectations and experiences when seeking care; to identify ways to assist women in having their needs met. METHODS: Qualitative research using focus group methodology was carried out. Identification of women experiencing menstrual symptoms through a random community survey of 200 women aged 30-50 years in the Hunter region of New South Wales. Focus group discussions were recorded and transcripts were analysed. RESULTS: All women attending focus groups had sought medical advice for their menstrual problems. Having one doctor with whom they felt comfortable was important. Women expressed difficulties asking questions and were concerned that symptoms may not be taken seriously or may be dismissed as psychological. There was widespread acceptance of alternative 'natural' therapies. CONCLUSIONS: Interactions between doctors (particularly GPs) and women with menstrual symptoms are central to how women perceive the care they receive. There is a need for doctors to demonstrate empathy. For many women, what they needed most from their doctors was to be understood and 'to know they weren't alone'.

Adult↗