Age-related differences in exercise and quality of life among breast cancer survivors

Purpose: Physical activity has become a focus of cancer recovery research as it has the potential to reduce treatment-related burden and optimize health-related quality of life (HRQoL). However, the potential for physical activity to influence recovery may be age-dependent. This paper describes physical activity levels and HRQoL among younger and older women after surgery for breast cancer and explores the correlates of physical inactivity. Methods: A population-based sample of breast cancer patients diagnosed in South-East Queensland, Australia, (n=287) were assessed once every three months, from 6 to 18 months post-surgery. The Functional Assessment of Cancer Therapy-Breast questionnaire (FACTB+4) and items from the Behavioral Risk Factor Surveillance System (BRFSS) questionnaire were used to measure HRQoL and physical activity, respectively. Physical activity was assigned metabolic equivalent task (MET) values, and categorized as < 3, 3 to 17.9 and 18+ MET-hours/weeks. Descriptive statistics, generalized linear models with age stratification (<50 years versus 50+ years), and logistic regression were used for analyses (p=0.05, two-tailed). Results: Younger women who engaged in 3 or more MET-hours/week of physical activity reported a higher HRQoL at 18 months compared to their more sedentary counterparts (p<0.05). Older women reported similar HRQoL irrespective of activity level and consistently reported clinically higher HRQoL than younger women. Increasing age, being overweight or obese, and restricting use of the treated side at six months post-surgery increased the likelihood of sedentary behavior (OR>3, p<0.05). Conclusions: Age influences the potential to observe HRQoL benefits related to physical activity participation. These results also provide relevant information for the design of exercise interventions for breast cancer survivors and highlights that some groups of women are at greater risk of long-term sedentary behavior.

Increased cardio-metabolic risk is associated with increased TV viewing time

Purpose: Television viewing time, independent of leisure-time physical activity, has cross-sectional relationships with the metabolic syndrome and its individual components. We examined whether baseline and five-year changes in self-reported television viewing time are associated with changes in continuous biomarkers of cardio-metabolic risk (waist circumference, triglycerides, high density lipoprotein cholesterol, systolic and diastolic blood pressure, fasting plasma glucose; and a clustered cardio-metabolic risk score) in Australian adults. Methods: AusDiab is a prospective, population-based cohort study with biological, behavioral, and demographic measures collected in 1999–2000 and 2004–2005. Non-institutionalized adults aged ≥ 25 years were measured at baseline (11,247; 55% of those completing an initial household interview); 6,400 took part in the five-year follow-up biomedical examination, and 3,846 met the inclusion criteria for this analysis. Multiple linear regression analysis was used and unstandardized B coefficients (95% CI) are provided. Results: Baseline television viewing time (10 hours/week unit) was not significantly associated with change in any of the biomarkers of cardio-metabolic risk. Increases in television viewing time over five years (10 hours/week unit) were associated with increases in: waist circumference (cm) (men: 0.43 (0.08, 0.78), P = 0.02; women: 0.68 (0.30, 1.05), P <0.001), diastolic blood pressure (mmHg) (women: 0.47 (0.02, 0.92), P = 0.04), and the clustered cardio-metabolic risk score (women: 0.03 (0.01, 0.05), P = 0.007). These associations were independent of baseline television viewing time and baseline and change in physical activity and other potential confounders. Conclusion: These findings indicate that an increase in television viewing time is associated with adverse cardio-metabolic biomarker changes. Further prospective studies using objective measures of several sedentary behaviors are required to confirm causality of the associations found.

Troubling Empowerment : A feminist critique of a rural women and communication technology project

Participatory research methodologies and interactive communication technologies (ICTs) are increasingly seen as offering ways of enhancing women’s empowerment and rural community development. However, some researchers suggest the need for caution about such claims. This book details findings from an evaluation of a feminist action research project that explored the impacts of ICTs for rural women in Queensland, Australia, in terms of personal, business and community development. Using praxis and poststructuralist feminist theories and methodologies, this innovative study presents a rigorous analysis and critique of women's empowerment and participation. This study demonstrates the value of adopting a critical yet pragmatic approach that takes diversity and difference, power-knowledge relations, and the contradictory effects of participation into account. This is argued to enable the development of more effective strategies for women’s empowerment, participation and inclusion. This book should be of particular interest to researchers, postgraduate students, and others working in the fields of communication, gender, and rural development, and feminist evaluation and ethnography.

Depression, anxiety and body image after treatment for invasive stage one epithelial ovarian cancer

Background: Diagnosis of epithelial ovarian cancer (EOC) in young women has major implications including those to their reproductive potential. We evaluated depression, anxiety and body image in patients with stage I EOC treated with fertility sparing surgery (FSS) or radical surgery (RS). We also investigated fertility outcomes after FSS.----- Methods: A retrospective study was undertaken in which 62 patients completed questionnaires related to anxiety, depression, body image and fertility outcomes. Additional information on adjuvant therapy after FSS and RS and demographic details were abstracted from medical records. Both bi and multivariate regression models were used to assess the relationship between demographic, clinical and pathological results and scores for anxiety, depression and body image.----- Results: Thirty-nine patients underwent RS and the rest, FSS. The percentage of patients reporting elevated anxiety and depression (subscores ≥ 11) were 27 % and 5% respectively. The median (inter quartile range) score for body image scale (BIS) was 6 (3-15). None of the demographic or clinical factors examined showed significant association with anxiety and BIS with the exception of ‘time since diagnosis’. For depression, post-menopausal status was the only independent predictor. Among those 23 patients treated by FSS, 14 patients tried to conceive (7 successful), resulting in 7 live births, one termination of pregnancy and one miscarriage.----- Conclusion: This study shows that psychological issues are common in women treated for stage I EOC. Reproduction after FSS is feasible and lead to the birth of healthy babies in about half of patients who wished to have another child. Further prospective studies with standardised instruments are required.

Glycaemic index and glycaemic load intake patterns in older Australian women

Aims: Dietary glycemic index (GI) and glycemic load (GL) have been associated with risk of chronic diseases, yet limited research exists on patterns of consumption in Australia. Our aims were to investigate glycemic carbohydrate in a population of older women, identify major contributing food sources, and determine low, moderate and high ranges. Methods: Subjects were 459 Brisbane women aged 42-81 years participating in the Longitudinal Assessment of Ageing in Women. Diet history interviews were used to assess usual diet and results were analysed into energy and macronutrients using the FoodWorks dietary analysis program combined with a customised GI database. Results: Mean±SD dietary GI was 55.6±4.4% and mean dietary GL was 115±25. A low GI in this population was ≤52.0, corresponding to the lowest quintile of dietary GI, and a low GL was ≤95. GI showed a quadratic relationship with age (P=0.01), with a slight decrease observed in women aged in their 60’s relative to younger or older women. GL decreased linearly with age (P<0.001). Bread was the main contributor to carbohydrate and dietary GL (17.1% and 20.8%, respectively), followed by fruit (15.5% and 14.2%), and dairy for carbohydrate (9.0%) or breakfast cereals for GL (8.9%). Conclusions: In this population, dietary GL decreased with increasing age, however this was likely to be a result of higher energy intakes in younger women. Focus on careful selection of lower GI items within bread and breakfast cereal food groups would be an effective strategy for decreasing dietary GL in this population of older women.

Glycaemic load is associated with insulin resistance in older Australian women

Background: Diets with a high postprandial glycemic response may contribute to long-term development of insulin resistance and diabetes, however previous epidemiological studies are conflicting on whether glycemic index (GI) or glycemic load (GL) are dietary factors associated with the progression. Our objectives were to estimate GI and GL in a group of older women, and evaluate cross-sectional associations with insulin resistance. Subjects and Methods: Subjects were 329 Australian women aged 42-81 years participating in year three of the Longitudinal Assessment of Ageing in Women (LAW). Dietary intakes were assessed by diet history interviews and analysed using a customised GI database. Insulin resistance was defined as a homeostasis model assessment (HOMA) value of >3.99, based on fasting blood glucose and insulin concentrations. Results: GL was significantly higher in the 26 subjects who were classified as insulin resistant compared to subjects who were not (134±33 versus 114±24, P<0.001). In a logistic regression model, an increment of 15 GL units increased the odds of insulin resistance by 2.09 (95%CI 1.55, 2.80, P<0.001) independently of potential confounding variables. No significant associations were found when insulin resistance was assessed as a continuous variable. Conclusions: Results of this cross-sectional study support the concept that diets with a higher GL are associated with increased risk of insulin resistance. Further studies are required to investigate whether reducing glycemic intake, by either consuming lower GI foods and/or smaller serves of carbohydrate, can contribute to a reduction in development of insulin resistance and long-term risk of type 2 diabetes.

Reempowering ourselves: Australian Aboriginal women

The arrival of the colonists, the invasion of Aboriginal lands and the subsequent colonization of Australia had a disastrous effect on Aboriginal women, including on-going dispossession and disempowerment. Aboriginal women’s lives and gendered realities were forever changed in most communities. The system of colonization deprived Aboriginal women of land and personal autonomy and restricted the economic, political, social, spiritual and ceremonial domains that had existed prior to colonization. It also involved the implementation of overriding patriarchal systems. This is why Aboriginal women may find understanding within the women’s movement and why feminism might offer them a source of analysis. There are some connections in the various forms of social oppression, which give women connection and a sharing on some issues. However, imperialism and colonialism are also part of the women’s movement and feminism. This essay demonstrates why attempts to engage with feminism and to be included in women-centred activities might result in the denial and sidelining of Aboriginal sovereignty and further oppression and marginalisation of Aboriginal women. Moreover, strategies employed by non-Indigenous feminists can result in the maintenance of white women’s values and privileges within the dominant patriarchal white society. By engaging in these strategies feminists can also act in direct opposition to Aboriginal sovereignty and Aboriginal women. This essay states clearly that women who do not express positions or opinions in outright support of these activities still benefit from their position by proxy and contribute to the cultural dominance of non-Indigenous women. I argue that Aboriginal women need to define what empowerment might mean to themselves, and I suggest re-empowerment as an act of Aboriginal women’s healing and resistance to the on-going processes and impacts of colonization.

From Sydney and Shanghai : Australian and Chinese women writing modernism

In the 1930s and 1940s, Australian women writers published novels, poems, and short stories that pushed the boundaries of their national literary culture. From their position in the Pacific, they entered into a dialogue with a European modernism that they reworked to invigorate their own writing and to make cross-continental connections. My interest in the work of Australian women prose writers of this period stems from an appreciation of the extent of their engagement with interwar modernism (an engagement that is generally under-acknowledged) and the realization that there are commonalities of approach with the ways in which contemporaneous Chinese authors negotiated this transnational cultural traffic. China and Australia, it has been argued, share an imaginative and literal association of many centuries, and this psychic history produces a situation in which ‘Australians feel drawn towards China: they cannot leave it alone.’1 Equally, Chinese exploration of the great southern land began in the fifteenth century, prior to European contact. In recent times, the intensity of Australia’s cultural and commercial connections with Asia has led to a repositioning of the Australian sense of regionalism in general and, in particular, has activated yet another stage in the history of its relationship with China. In this context, the association of Australian and Chinese writing is instructive because the commonalities of approach and areas of interest between certain authors indicate that Australian writers were not alone in either the content or style of their response to European modernism. This recognition, in turn, advances discussions of modernism in Australia and reveals an alternative way of looking at the world from the Pacific Rim through literature. The intent is to examine selective Australian and Chinese authors who are part of this continuous history and whose writing demonstrates common thematic and stylistic features via the vector of modernism. I focus on the 1930s and 1940s because these are the decades in which Australia and China experienced wideranging conflict in the Pacific, and it is significant that war, both forthcoming and actual, features as an ominous soundtrack in the writing of Chinese and Australian women. I argue that, given the immensity of cultural difference between Australia and China, there is an especially interesting juncture in the ways in which the authors interrogate modernist practices and the challenge of modernism. The process in which writing from the Pacific Rim jointly negotiates the twin desires of engaging with European literary form and representing one’s own culture may be seen as what Jessica Berman identifies as a geomodernism, one of the ‘new possible geographies’ of modernism.2 My discussion centres on the work of the Australian women, to which the Chinese material serves as a point of reference, albeit a critical one. The Chinese writing examined here is restricted to authors who wrote at least some material in English and whose work is available in translation.

Sustainability of a multimodal intervention to promote lifestyle factors associated with the prevention of cardiovascular disease in midlife Australian women : a 5-year follow-up

We evaluated sustainability of an intervention to reduce women’s cardiovascular risk factors, determined the influence of self-efficacy, and described women’s current health. We used a mixed method approach that utilized forced choice and open-ended questionnaire items about health status, habits, and self-efficacy. Sixty women, average age 61, returned questionnaires. Women in the original intervention group continued health behaviors intended to reduce cardiovascular disease (CVD) at a higher rate than the control group, supporting the feasibility of a targeted intervention built around women’s individual goals. The role of self-efficacy in behavior change is unclear. The original intervention group reported higher self-reported health.

Associations among body size dissatisfaction, perceived dietary control, and diet history in African American and European American women

European American (EA) women report greater body dissatisfaction and less dietary control than do African American (AA) women. This study investigated whether ethnic differences in dieting history contributed to differences in body dissatisfaction and dietary control, or to differential changes that may occur during weight loss and regain. Eighty-nine EA and AA women underwent dual-energy X-ray absorptiometry to measure body composition and completed questionnaires to assess body dissatisfaction and dietary control before, after, and one year following, a controlled weight-loss intervention. While EA women reported a more extensive dieting history than AA women, this difference did not contribute to ethnic differences in body dissatisfaction and perceived dietary control. During weight loss, body satisfaction improved more for AA women, and during weight regain, dietary self-efficacy worsened to a greater degree for EA women. Ethnic differences in dieting history did not contribute significantly to these differential changes. Although ethnic differences in body image and dietary control are evident prior to weight loss, and some change differentially by ethnic group during weight loss and regain, differences in dieting history do not contribute significantly to ethnic differences in body image and dietary control.

Comparison of multiple and novel measures of dietary glycemic carbohydrate with insulin resistant status in older women

BACKGROUND:Previous epidemiological investigations of associations between dietary glycemic intake and insulin resistance have used average daily measures of glycemic index (GI) and glycemic load (GL). We explored multiple and novel measures of dietary glycemic intake to determine which was most predictive of an association with insulin resistance.METHODS:Usual dietary intakes were assessed by diet history interview in women aged 42-81 years participating in the Longitudinal Assessment of Ageing in Women. Daily measures of dietary glycemic intake (n = 329) were carbohydrate, GI, GL, and GL per megacalorie (GL/Mcal), while meal based measures (n = 200) were breakfast, lunch and dinner GL; and a new measure, GL peak score, to represent meal peaks. Insulin resistant status was defined as a homeostasis model assessment (HOMA) value of >3.99; HOMA as a continuous variable was also investigated.RESULTS:GL, GL/Mcal, carbohydrate (all P < 0.01), GL peak score (P = 0.04) and lunch GL (P = 0.04) were positively and independently associated with insulin resistant status. Daily measures were more predictive than meal-based measures, with minimal difference between GL/Mcal, GL and carbohydrate. No significant associations were observed with HOMA as a continuous variable.CONCLUSION:A dietary pattern with high peaks of GL above the individual's average intake was a significant independent predictor of insulin resistance in this population, however the contribution was less than daily GL and carbohydrate variables. Accounting for energy intake slightly increased the predictive ability of GL, which is potentially important when examining disease risk in more diverse populations with wider variations in energy requirements.

National Aboriginal and Torres Strait Islander women's health strategy

The Strategy presented in this report was developed through the Australian Women’s Health Network Talking Circle in 2009-2010. Over 400 Aboriginal and Torres Strait Islander women were involved in the consultations. The Action Areas and Recommendations presented in this Strategy were raised and discussed by the women who contributed to the Talking Circle. This Strategy is not intended to replace any other national or state/territory identified priorities or needs. Instead, this Strategy supplements other work. Aboriginal and Torres Strait Islander women experience extremely poor health outcomes. They have a right to determine for themselves what their health system will look like. This Strategy is part of that process. If Aboriginal and Torres Strait Islander women continue to have their sense of identity marginalised and eroded, they will continue to have the poorest health of any group of women in Australian society.