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Background The prevalence of diabetes, heart disease, and stroke multimorbidity (co-occurrence of two or three of these conditions) has increased rapidly. Little is known about how the three conditions progress from one to another sequentially through the life course. We aimed to delineate this progression in middle-aged women and to determine the roles of common risk factors in the accumulation of diabetes, heart disease, and stroke multimorbidity. Methods and findings We used data from 13,714 women aged 45-50 years without a history of any of the three conditions. They were participants in the Australian Longitudinal Study on Women's Health (ALSWH), enrolled in 1996, and surveyed approximately every 3 years to 2016. We characterized the longitudinal progression of the three conditions and multimorbidity. We estimated the accumulation of multimorbidity over 20 years of follow-up and investigated their association with both baseline and time-varying predictors (sociodemographic factors, lifestyle factors, and other chronic conditions). Over 20 years, 2,511 (18.3%) of the women progressed to at least one condition, of whom 1,420 (56.6%) had diabetes, 1,277 (50.9%) had heart disease, and 308 (12.3%) had stroke; 423 (16.8%) had two or three of these conditions. Over a 3-year period, the age-adjusted odds of two or more conditions was approximately twice that of developing one new condition compared to women who did not develop any new conditions. For example, the odds for developing one new condition between Surveys 7 and 8 were 2.29 (95% confidence interval [CI], 1.93-2.72), whereas the odds for developing two or more conditions was 6.51 (95% CI, 3.95-10.75). The onset of stroke was more strongly associated with the progression to the other conditions (i.e., 23.4% [95% CI, 16.3%-32.2%] of women after first onset of stroke progressed to other conditions, whereas the percentages for diabetes and heart disease were 9.9% [95% CI, 7.9%-12.4%] and 11.4% [95% CI, 9.1%-14.4%], respectively). Being separated, divorced, or widowed; being born outside Australia; having difficulty managing on their available income; being overweight or obese; having hypertension; being physically inactive; being a current smoker; and having prior chronic conditions (i.e., mental disorders, asthma, cancer, osteoporosis, and arthritis) were significantly associated with increased odds of accumulation of diabetes, heart disease, and stroke multimorbidity. The main limitations of this study were the use of self-reported data and the low number of events. Conclusions Stroke was associated with increased risk of progression to diabetes or heart disease. Social inequality, obesity, hypertension, physical inactivity, smoking, or having other chronic conditions were also significantly associated with increased odds of accumulating multimorbidity. Our findings highlight the importance of awareness of the role of diabetes, heart disease, and stroke multimorbidity among middle-aged women for clinicians and health-promotion agencies., Author(s): Xiaolin Xu *, Gita D. Mishra, Annette J. Dobson, Mark Jones Introduction The prevalence of diabetes, heart disease, and stroke multimorbidity (co-occurrence of two or three from these conditions) [...]

Background/Objectives: Decreases in physical performance are associated with multiple negative health outcomes. The objective of this study was to examine whether high plasma homocysteine and low serum vitamin B12 are independent risk factors for lower physical performance, both cross-sectionally and longitudinally. Subjects/Methods: This study was performed in persons aged ≥ 65 years of the LASA (Longitudinal Aging Study Amsterdam), an ongoing cohort study. Blood was collected in 1995/1996 (n = 1352). Physical performance was assessed in 1995/1996 and in 1998/1999 using three tests: the walking test, the chair stands test and the tandem stand (n = 901-1155). Results: After adjustment for confounding, women in the highest quartile of homocysteine had a significantly lower physical performance than did those in the lowest quartile in the cross-sectional analyses (β = -0.93, s.e. = 0.34, P Conclusions: High plasma homocysteine is an independent risk factor for lower physical performance in older women. The association between vitamin B12 and physical performance is less clear. European Journal of Clinical Nutrition (2012) 66, 174-181; doi: 10.1038/ejcn.2011.151; published online 24 August 2011 Keywords: homocysteine; older people; physical performance; vitamin B12, Introduction Homocysteine levels increase and vitamin B12 levels decrease with aging (Jacques et al., 1999; Refsum et al., 2004; Allen, 2009). In the LASA (Longitudinal Aging Study Amsterdam), a representative [...]

Background/Objectives: Several nutrients affect bone turnover. Dietary patterns may provide insights into which foods are important and how nutrition affects bone health. The aim of this study was to investigate the associations between dietary patterns, bone turnover and bone mineral density (BMD). Subjects/Methods: This cross-sectional study examined 3236 Scottish women age 50-59 years, who were members of the Aberdeen Prospective Osteoporosis Screening Study. They had hip and spine BMD measurements (dual-energy X-ray absorptiometry) and provided samples for bone turnover markers. Diet was assessed by a validated food frequency questionnaire encompassing 98 foods, from which 35 food groups were systematically created. Dietary patterns were defined by principal components analysis. The bone measures were regressed onto the dietary pattern and adjusted for potential confounders. Results: Five dietary patterns were identified, three of which were associated with bone health. The 'healthy' pattern was associated with decreased bone resorption (r = 0.081, Po 0.001). Two other patterns (processed foods and snack food) were associated with lower BMD (femoral neck r =-0.056, r =-0.044, Po0.001, respectively). Conclusions: Dietary pattern may influence bone turnover and BMD. A healthy dietary pattern with high intakes of fruit and vegetables may lead to less bone resorption, and a poor dietary pattern rich in processed foods is associated with a decrease in BMD. This study confirms that a healthy diet is required for strong bones, and highlights that a nutrient-poor diet is a risk factor for osteoporosis. European Journal of Clinical Nutrition (2011) 65, 378-385; doi: 10.1038/ejcn.2010.264; published online 22 December 2010 Keywords: dietary patterns; osteoporosis; fruit and vegetables; bone resorption; principal components analysis, Introduction It has been estimated that one in two women and one in five men in the United Kingdom over the age of 50 years will have an osteoporotic fracture [...]

Midlife African American women are at risk for HIV related to higher prevalence of infection among African Americans and concurrent sexual partnerships. In this grounded theory study, we explored the context of decision making related to concurrent sexual partnerships among 36 African American women between the ages of 40 and 65 years. Qualitative data from semi-structured interview and focus group schedules collected between fall 2003 and summer 2006 are the basis for analysis. Transcripts were analyzed using constant comparison to develop concrete and abstract categories, and member checking used to verify findings. Women reported that partner concurrency and competition for acceptable men partners, 'Man-Sharing,' among midlife African American women influenced sexual decision-making, potentially resulting in greater risk for HIV infection. Future research focusing on the power differential in heterosexual relationships, inter-racial dating, and limiting the risks associated with partner concurrency may be fruitful. KEYWORDS African American, HIV, midlife, prevention, women DOI: 10.1080/03630242.2010.520253

The case of a 62-year-old woman with nausea, vomiting, diarrhea and fever is discussed to better understand the problems associated with diagnosis of L. monocytogenes infection. The need for extraordinary vigilance in the case of patients being treated with TNF inhibitors present with symptoms suggestive of infection is highlighted.

The article discusses the vital role that a healthy diet plays in reducing the incidence of hypertension as well as maintaining a healthy blood pressure level. The case of a 57-year-old woman with hypertension is highlighted to show how a healthy diet can help maintain goo vlood pressure levels and prevent hypertension.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jada.2009.10.001 Byline: Noriko Sudo, Courtney Perry, Marla Reicks Abstract: Mailed food records have been suggested as a means to acquire useful food intake data from a large number of participants with minimal effort. The purpose of this cross-sectional study was to explore whether education level and weight status of midlife women affected adequacy of information about dietary intake derived from a self-administered mailed 1-day food record. Adequacy was defined as the ability to describe and record intake with sufficient detail for entry into a computerized diet analysis program without missing data. From October 2007 through March 2008, 100 women (49[+ or -]5 years), recruited by education level, were mailed a food record booklet and a 16-page actual-size two-dimensional food model booklet with instruction to describe foods, amounts consumed, and preparation methods/recipes. Women returned the completed food record booklet by mail. Between 3 and 13 days later, a registered dietitian called the participants to review missing details, clarify amounts, and probe for omissions. Six categories of missing data included: "omission of portion size," "inaccurate portion size," "insufficient description of portion size," "insufficient description of food," "omission of ingredients," and "insufficient or no preparation method." The percentage of foods with missing data did not differ by education level; however, higher percentages of missing data regarding "insufficient description of food," were observed in obese compared to overweight women. Adequacy of information from the mailed food record was dependent on weight status but not education level. Additional study is needed to determine how to revise instructions for mailed food records in future studies according to weight status of midlife women. Article History: Accepted 3 April 2009

The author discusses the new recommendation given by the U.S. Preventive Services Task Force, which emphasizes on the delay of the routine screening mammography for older women. The various risks and advantages of the screening procedure are explained.

The article discusses the case of 52-year-old woman with peripheral neuropathy due to diabetes for the last 8 years, in order to better understand the diagnosis and different treatment methodologies for neuropathy. The most important point to keep in mind is the need for the patient to keep ones diabetes under control to avoid further complications.

The case study of a middle-aged female teacher with a history of hypertension approaching urgent care with symptoms of chest pressure and light-headedness is analyzed. Relevant pathological tests were carried out and the condition was diagnosed as apical ballooning syndrome which closely resembles the symptoms of myocardial infarction.

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-9566.2009.01175.x Byline: Laura Hurd Clarke, Alexandra Korotchenko Keywords: suntanning; older women; risk; health; appearance Abstract: Abstract This paper examines older women's experiences and perceptions of sunbathing, sun avoidance, and suntanned appearances. Using data from in-depth interviews with 36 women aged 71 to 94, we elucidate the motivations behind the women's sunbathing practices. Specifically, we explore how the women responded to the health and appearance risks associated with exposure to and avoidance of ultraviolet radiation as well as extant feminine beauty norms. The majority of women put their experiences of sunbathing in an emergent historical context. Although most of the women suggested that suntanned appearances were indicative of health and beauty, sunbathers tended to downplay their health risks by distancing themselves from those they considered to be most at risk, namely tanning bed users and individuals who acquired overly dark suntans. Sunbathers also emphasised the benefits of sun exposure for adequate vitamin D absorption. In contrast, the women who did not suntan tended to have experienced negative health and appearance consequences from their past sunbathing practices. Thus, these women emphasised the importance of future health over immediate appearance dividends. We discuss our findings in relation to the extant research on suntanning and the literature pertaining to health, risk, and beauty work. Article note: Address for correspondence: Laura Hurd Clarke, School of Human Kinetics, The University of British Columbia, Vancouver, British Columbia, V6T 1Z2, Canada, e-mail: laura.hurd.clarke@ubc.ca

A clinical case study of a 52-year old female manifesting an ulcer on the ankle with a problem of varicose veins is presented. The management and treatment of the condition is discussed.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jada.2009.02.009 Byline: Candice A. Rideout, Susan I. Barr Abstract: In an effort to control body weight, many women diet or adopt a restrained approach to eating. Although common, dieting and dietary restraint remain poorly understood. Clarification of their association with health-related factors, such as body weight and overeating, is required. In this study, we explored how dieting and dietary restraint were associated with body mass index (BMI; calculated as kg/m.sup.2) and disinhibition (tendency to overeat) in a sample of 1,071 postmenopausal women aged 45 to 75 years. In a survey of dietary attitudes and body image, we asked about current dieting status and measured restrained eating and disinhibition. Self-reported height and weight were used to calculate BMI, which was confirmed in a subset. Participants were classified by dieting status (yes/no) and level of dietary restraint (high/low by median split).We examined the independent effects of dieting and restrained eating on BMI and disinhibition. More than half of the sample (53%) reported current dieting. Dieting and dietary restraint showed opposite associations with BMI. Among dieters, BMI was 4.1 higher (95% confidence interval: 3.6 to 4.6) than among nondieters. In contrast, BMI of restrained eaters was 1.0 lower (95% confidence interval: -1.6 to -0.5) than unrestrained eaters. Dieters had higher scores for disinhibition, but disinhibition scores of restrained eaters did not differ from those of unrestrained eaters. Our results suggest that dieting and dietary restraint are not equivalent. Finding that dietary restraint is associated with lower BMI (when considered independently of dieting) suggests that restrained eating, rather than dieting, may contribute to successful weight management. Article History: Accepted 9 September 2008

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jada.2009.02.008 Byline: Vanessa A. Farrell, Margaret Harris, Timothy G. Lohman, Scott B. Going, Cynthia A. Thomson, Judith L. Weber, Linda B. Houtkooper Abstract: It is important to identify the role of nutrition in the treatment and prevention of osteoporosis. The goal of this study was to compare the equivalency of nutrient intakes assessed by diet records and the Arizona Food Frequency Questionnaire and the associations of these nutrients with bone mineral density (BMD). This is a secondary analysis of cross-sectional data that was analyzed from six cohorts (fall 1995 to fall 1997) of postmenopausal women (n=244; 55.7[+ or -]4.6 years) participating in a 12-month, block-randomized, clinical trial. One-year dietary intakes were assessed using 8 days of diet records and the Arizona Food Frequency Questionnaire. Participants' BMD was measured at the lumbar spine (L2-L4), femur trochanter, femur neck, Ward's triangle, and total body using dual-energy x-ray absorptiometry. Linear regression analyses (P[less than or equal to]0.05) were adjusted for the effects of exercise, hormone therapy use, body weight at 1 year, years post menopause, and total energy intake. Significant correlations (r=0.30 to 0.70, P[less than or equal to]0.05) between dietary assessment methods were found with all dietary intake variables. Iron and magnesium were consistently and significantly positively associated with BMD at all bone sites regardless of the dietary assessment method. Zinc, dietary calcium, phosphorous, potassium, total calcium, and fiber intakes were positively associated with BMD at three or more of the same bone sites regardless of the dietary assessment method. Protein, alcohol, caffeine, sodium, and vitamin E did not have any similar BMD associations. Diet records and the Arizona Food Frequency Questionnaire are acceptable dietary tools used to determine the associations of particular nutrients and BMD sites in healthy postmenopausal women. Article History: Accepted 21 November 2008

Estrogen and body fat content are important predictors of bone mineral density (BMD) in postmenopausal women, but their association with BMD in premenopausal women is less clear. Mounting evidence suggests that dietary fats can have detrimental effects on bone health. In a cross-sectional sample of healthy 30- to 40-y-old women (n = 242), we investigated the predictors of BMD at the hip and spine by multilevel multiple regression analyses. Predictor variables in the models included dietary intake of various fats, serum concentrations of sex steroids, blood chemistries and markers of metabolic syndrome, anthropometric variables, and ethnicity. Among these premenopausal women, lean body mass was the strongest independent predictor (P < 0.0001) and African-American ethnicity (P < 0.05) was another positive independent predictor of BMD at the hip and spine. Dietary fats were not independent predictors of BMD of hip and spine. Lean body mass and being African-American explained 33% of the variance in hip BMD. Lean body mass, African-American ethnicity, and serum concentrations of triglycerides (a negative predictor, P = 0.0001) explained 28% of the variance in spine BMD. In contrast, luteal phase serum concentrations of estradiol, progesterone, and testosterone were not predictors of BMD. It remains to be determined whether efforts to increase lean body mass in premenopausal women with normal levels of endogenous estrogen may be an effective preventive strategy to preserve bone health.

Objectives. We examined the association between health behaviors and socioeconomic status (SES) in childhood and adult life. Methods. Self-reported diet, smoking, and physical activity were determined among 3523 women aged 60 to 79 years recruited from general practices in 23 British towns from 1999 through 2001. Results. The most affluent women reported eating more fruit, vegetables, chicken, and fish and less red or processed meat than did less affluent women. Affluent women were less likely to smoke and more likely to exercise. Life course SES did not influence the types of fat, bread, and milk consumed. Adult SES predicted consumption of all foods considered and predicted smoking and physical activity habits independently of childhood SES. Childhood SES predicted fruit and vegetable consumption independently of adult SES and, to a lesser extent, predicted physical activity. Downward social mobility over the life course was associated with poorer diets and reduced physical activity. Conclusions. Among older women, healthful eating and physical activity were associated with both current and childhood SES. Interventions designed to improve social inequalities in health behaviors should be applied during both childhood and adult life. (Am J Public Health. 2009;99:320-327. doi:10.2105/ AJPH.2007.129288)

The increasing use of prescription and over-the-counter drugs by older adults in the U.S. is investigated. The results indicate that the elderly tended to use prescription and non-prescription drugs together, creating a major risk of drug--drug interaction.

Objectives. We sought to determine prospective changes in health-related quality of life (HRQoL) measures and subsequent mortality in middle-aged and older women. Methods. We obtained data from 40337 healthy women from the Nurses' Health Study aged 46 to 71 years in 1992. We used Cox proportional hazards regression to evaluate associations of changes in self-assessed physical and mental component summary (PCS and MCS) scores from the Short Form 36 Health Survey between 1992 and 1996 and between 1996 and 2000, with all-cause mortality through 2004. Results. Women with low HRQoL (PCS and MCS scores) and the greatest HRQoL declines had higher mortality than did women with stable scores. Change in PCS score predicted mortality across the range of 4-year change: severe decline (relative risk [RR]=3.32; 95% confidence interval [CI]=2.45, 4.50), moderate decline (RR=1.44; 95% CI=1.16, 1.79), slight decline (RR=1.35; 95% CI=1.12, 1.63), no change (reference category), improvement (RR=0.72; 95% CI=0.56, 0.91; continuous P

Objective: Examine whether (1) childhood maltreatment is associated with subsequent obesity and depression in middle-age; (2) maltreatment explains the associations between obesity and depression; and (3) hinge eating or body dissatisfaction mediate associations between childhood maltreatment and subsequent obesity. Methods: Data were obtained through a population-based survey of 4641 women (mean age = 52 years) enrolled in a large health plan in the Pacific Northwest. A telephone survey assessed child sexual and physical abuse, obesity (BMI [greater than or equal to] 30), depressive symptoms, binge eating, and body dissatisfaction. Data were analyzed using logistic regression models incorporating sampling weights. Results: Both child sexual and physical abuse were associated with a doubling of the odds of both obesity and depression, although child physical abuse was not associated with depression for the African American/Hispanic/American Indian subgroup. The association between obesity and depression (unadjusted OR = 2.82; 95% CI = 2.20-3.62) was reduced somewhat after controlling for sexual abuse (adjusted OR = 2.54; 1.96-3.29) and for physical abuse (adjusted OR = 2.63; 2.03-3.42). Controlling for potential mediators failed to substantially attenuate associations between childhood maltreatment and obesity. Conclusions: This study is the first to our knowledge that compares associations of child abuse with both depression and obesity in adults. Although the study is limited by its cross-sectional design and brief assessments, the fact that child abuse predicted two debilitating conditions in middle-aged women indicates the potential long-term consequences of these experiences. Keywords: Child abuse Obesity Depression Binge eating Body dissatisfaction

Objectives. This study examined the effects of arthritis-related stress and chronic life stress on depressive symptoms among African Americans and Whites with arthritis. Methods. Participants included 175 African American and White women (aged 45-90) who completed structured questionnaires assessing arthritis-related stress (i.e., pain, functional impairment, perceived stress), chronic life stress (i.e., discrimination, financial stress, life stressors), and well-being (i.e., depressive symptoms). Results. African Americans reported more functional impairment and lower perceived arthritis stress, but more life stressors, financial stress, and discrimination, than Whites. Arthritis-related stress accounted for similar proportions of variance in depressive symptoms across African Americans ([DELTA][R.sup.2] = .16, p < .001) and Whites ([DELTA][R.sup.2] = .24, p < .001). However, chronic life stressors explained significantly more variance among African Americans ([DELTA][R.sup.2] = .20, p < .001, vs [DELTA][R.sup.2] = .06, p < .05). Discussion. Findings demonstrate the importance of considering contextual factors influencing women's health and well-being, particularly for those women with a chronic illness, including arthritis. Although arthritis-related stressors may be the predominant factors affecting well-being for Whites with arthritis, well-being in African Americans with arthritis is also closely tied to broader life stressors. Results suggest the importance of looking beyond illness-specific stressors when studying aging and health. Key Words: Arthritis-related Stress--Chronic Life Stress--Racial Differences--Depressive Symptoms.

Objectives: The aim of this study was to examine the variation of enterolactone from fasting and non-fasting blood of middle-aged healthy women eating a normal diet to determine the usefulness of a single sample in epidemiological studies. Subjects and methods: Twenty-six women born between 1940 and 1950 were recruited within the Malmo Diet and Cancer cohort. Three non-fasting and two overnight fasting samples were collected from each individual during a 5-week period. Twenty-one participated in all measurements. Enterolactone concentrations were analyzed by time-resolved fluoroimmunoassay. Results: The within-subject and between-subject variations (coefficient of variations, CV) were estimated to 59 and 89% respectively for fasting samples and 71 and 67% for non-fasting samples. The intraclass correlation coefficients (ICC) were estimated to 0.66 (95% confidence interval (CI) 0.35-0.84) for fasting and 0.48 (95% CI, 0.22-0.72) for non-fasting samples. Conclusions: Although the estimated ICC for blood samples was moderate, it indicates that enterolactone levels of both fasting and non-fasting blood samples should be useful in future projects within the Malmo Diet and Cancer cohort. doi:10.1038/sj.ejcn.1602811; published online 30 May 2007 Keywords: enterolactone; serum; lignans; biomarker; time-resolved fluoroimmunoassay, Introduction Lignans, found in seeds, legumes, berries and cereals (Milder et al., 2005; Penalvo et al., 2005a), may have health benefits and possibly protect, or indicate protection against chronic diseases [...]

Objective: This study examined the relationships between combined categories of physical activity (PA) and Body Mass Index (BMI) with health care costs in women and assessed the potential cost savings of improving PA and BMI in sedentary mid-age women. Methods: Cross-sectional analysis of 2001 survey data linked to health service use data for the same year from 7,004 mid-age women (50-55 years) participating in the Australian Longitudinal Study on Women's Health. Results: The mean (median; interquartile range) annual cost of Medicare-subsidised services was $542 (355; 156-693) per woman. Costs were 17% higher in obese than in healthy-weight women and 26% higher in sedentary than in moderately active women. For sedentary obese women, mean costs were 43% higher than in healthy weight, moderately active women. After adjustment for potential confounders, the relative risk of 'high' claims ([greater than or equal to]15 claims per year) for overweight women who reported 'moderate' or 'high' PA were lower than for women with healthy BMI who reported no PA. Conclusions and Implications: Lower PA and higher BMI are both associated with higher health care costs, but costs are lower for overweight active women than for healthy-weight sedentary women. At the population level these data suggest that there would be significant cost savings if all sedentary mid-age women could achieve at least 'low' levels of PA (60-150 minutes a week). Key words: Exercise; body weight; health expenditure; obesity; Australian Medicare. doi: 10.1111/j.1753-6405.2008.00192.x