1
|
Marsh R, Gill S, Lowry N, Hayden G, Ryan M, Gwini SM, Allender S, Stella J. Childhood obesity in the ED: A prospective Australian study. Emerg Med Australas 2024. [PMID: 38649794 DOI: 10.1111/1742-6723.14414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To determine (i) the prevalence of overweight and obesity among children presenting to all EDs in a large regional Australian city and (ii) whether age, sex, socioeconomic status (SES) or hospital setting (public vs private) were associated with overweight and obesity. METHODS This prospective observational study included children aged ≥2 and <18 years who presented to any of three EDs over an 18 month period who had their height and weight measured. Age, sex and residential postcode were collected. Weight category was determined by sex and age standardised body mass index (BMI) z-score. Weight category was assessed by sex, age, SES and hospital setting with chi-squared tests, and ordinal logistic regression with cluster sandwich error estimators. Results were reported using odds ratios (OR) with 95% confidence intervals (CI). RESULTS Data were collected for 3827 children, of which 11.6% were obese and 19.8% overweight. The prevalence of obesity was highest in those aged 8-14 years and in those from lower SES postcodes. The likelihood of obesity was higher in the public than the private hospitals (OR 0.66, 95% CI 0.51-0.86), whereas the likelihood of overweight was similar (OR 1.00, 95% CI 0.83-1.22). CONCLUSIONS Almost one-third of children who presented to EDs were overweight or obese. Obesity was particularly high in those aged 8-14 years and those from lower SES postcodes. In the evolving obesity crisis, the high proportion of children presenting to EDs above a healthy weight might represent an opportunity for EDs to identify and refer children for body weight and lifestyle management.
Collapse
Affiliation(s)
- Rachel Marsh
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Stephen Gill
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
- Deakin University Faculty of Health, Barwon Centre for Orthopedic Research and Education (B-CORE), Geelong, Victoria, Australia
| | - Nicole Lowry
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Georgina Hayden
- St John of God Geelong Hospital, Geelong, Victoria, Australia
| | - Matthew Ryan
- Emergency Department, Epworth Geelong, Geelong, Victoria, Australia
| | | | - Steven Allender
- Deakin University Global Obesity Centre, Geelong, Victoria, Australia
| | - Julian Stella
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| |
Collapse
|
2
|
Hore-Lacy F, Gwini S, Glass DC, Dimitriadis C, Jimenez-Martin J, Hoy RF, Sim MR, Walker-Bone K, Fisher J. Psychometric properties of the Perceived Stress Scale (PSS-10) in silica-exposed workers from diverse cultural and linguistic backgrounds. BMC Psychiatry 2024; 24:181. [PMID: 38439053 PMCID: PMC10913222 DOI: 10.1186/s12888-024-05613-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/15/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND The Perceived Stress Scale (PSS-10) has been used in a range of occupational cohorts, but only recently in stone benchtop workers undergoing screening for silicosis. The aim of this study was to compare psychometric properties of the PSS-10 in stone benchtop workers amongst those born overseas or who used an interpreter. METHODS Stone benchtop workers in Melbourne, Australia completed the PSS-10 as part of their occupational screening for silicosis. Internal consistency was assessed with Cronbach's α for the total score and the positive and negative subscales. Validity was assessed using confirmatory factor analysis (CFA). Analysis was performed for the total group and for subgroups according to sex, interpreter use, overseas-born, and language spoken at home. RESULTS The results of 682 workers with complete PSS-10 scores were included in analysis. Most participants were male (93%), with mean age 36.9 years (SD 11.4), with just over half (51.6%) born in Australia, 10.1% using an interpreter, and 17.5% using a language other than English at home. Cronbach's α for the overall group (α = 0.878) suggested good internal consistency. DISCUSSION CFA analysis for validity testing suggested PSS-10 performance was good for both sexes, moderate for country of birth and language spoken at home categories, but poorer for those who used an interpreter. Whilst professional interpreters provide a range of benefits in the clinical setting, the use of translated and validated instruments are important, particularly in cohorts with large numbers of migrant workers. CONCLUSION This study describes the psychometric properties of the PSS-10 in a population of stone benchtop workers, with good internal consistency, and mixed performance from validity testing across various subgroups.
Collapse
Affiliation(s)
- Fiona Hore-Lacy
- Monash University, Melbourne, Australia.
- Alfred Health, Melbourne, Australia.
| | | | | | | | | | - Ryan F Hoy
- Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | | | | | | |
Collapse
|
3
|
Hildebrand-Burke C, Davey C, Gwini S, Catania L, Kazantzis N. Therapist competence, homework engagement, and client characteristics in CBT for youth depression: A study of mediation and moderation in a community-based trial. Psychother Res 2024; 34:41-53. [PMID: 37963351 DOI: 10.1080/10503307.2023.2267166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 09/19/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE Prior studies of Cognitive Behavioral Therapy (CBT) have focused on the quantity and quality of clients' homework completion and only rarely have considered the role of therapist competence. METHODS The present study examined (a) therapist competence across the entire process of integrating homework into CBT, including the review, design, and planning of tasks; (b) homework engagement, including client appraisals of the difficulty and obstacles encountered in task completion using the Homework Rating Scale - Revised (HRS-II); (c) pre-post symptom reduction as the index of outcome; and (d) considered client factors such as suicide risk in a community-based trial for adolescent depression. Trained independent observers assessed therapist competence and engagement with homework at two consecutive sessions of CBT for N = 80 young people (Mage = 19.61, SD = 2.60). RESULTS Significant complementary mediation effects were obtained; there was an indirect mediation effect of HRS-II Beliefs (b = 1.03, SE B = 0.42, 95% BCa CI [0.35, 2.03]) and HRS-II Perceived Consequences on the Competence-Engagement relationship (b = 0.85, SE B = 0.31, 95% BCa CI [0.39, 1.61]). High levels of suicidal ideation were also shown to moderate this relationship. CONCLUSIONS The present findings contribute to the growing body of CBT process research designed to examine the complex interrelationships of client and therapist variables, in a manner that reflects the actual process of therapy, and advances beyond studies of isolated predictors of symptom change.
Collapse
Affiliation(s)
- Craig Hildebrand-Burke
- Cognitive Behavior Therapy Research Unit, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
| | | | - StellaMay Gwini
- Cognitive Behavior Therapy Research Unit, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
| | - Lisa Catania
- University of Melbourne, Melbourne, VIC, Australia
| | - Nikolaos Kazantzis
- Cognitive Behavior Therapy Research Unit, Melbourne, VIC, Australia
- Beck Institute for Cognitive Behavior Therapy, Philadelphia, PA, USA
| |
Collapse
|
4
|
Woode ME, Wong K, Reid CM, Stowasser M, Russell G, Gwini S, Young MJ, Fuller PJ, Yang J, Chen G. Cost-effectiveness of screening for primary aldosteronism in hypertensive patients in Australia: a Markov modelling analysis. J Hypertens 2023; 41:1615-1625. [PMID: 37466447 DOI: 10.1097/hjh.0000000000003513] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Primary aldosteronism affects 3-14% of hypertensive patients in the primary care setting and up to 30% in the hypertensive referral units. Although primary aldosteronism screening is recommended in patients with treatment-resistant hypertension, diagnosis at an earlier stage of disease may prevent end-organ damage and optimize patient outcomes. METHODS A Markov model was used to estimate the cost-effectiveness of screening for primary aldosteronism in treatment and disease (cardiovascular disease and stroke) naive hypertensive patients. Within the model, a 40-year-old patient with hypertension went through either the screened or the unscreened arm of the model. They were followed until age 80 or death. In the screening arm, the patient underwent standard diagnostic testing for primary aldosteronism if the screening test, aldosterone-to-renin ratio, was elevated above 70 pmol/l : mU/l. Diagnostic accuracies, transition probabilities and costs were derived from published literature and expert advice. The main outcome of interest was the incremental cost effectiveness ratio (ICER). RESULTS Screening hypertensive patients for primary aldosteronism compared with not screening attained an ICER of AU$35 950.44 per quality-adjusted life year (QALY) gained. The results were robust to different sensitivity analyses. Probabilistic sensitivity analysis demonstrated that in 73% of the cases, it was cost-effective to screen at the commonly adopted willingness-to-pay (WTP) threshold of AU$50 000. CONCLUSION The results from this study demonstrated that screening all hypertensive patients for primary aldosteronism from age 40 is cost-effective. The findings argue in favour of screening for primary aldosteronism before the development of severe hypertension in the Australian healthcare setting.
Collapse
Affiliation(s)
- Maame Esi Woode
- Centre for Health Economics, Monash Business School, Monash University, Caulfield East
- Victorian Heart Institute, Monash University
| | - Kristina Wong
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research
- Department of Medicine, Monash University, Clayton, Victoria
| | - Christopher M Reid
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia
- Department of Epidemiology, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Princess Alexandra Hospital, Brisbane, Queensland
| | - Grant Russell
- Department of General Practice, Monash University, Clayton
| | - StellaMay Gwini
- Department of Epidemiology, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria
- University Hospital Geelong, Barwon Health, Geelong
| | - Morag J Young
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research
- Department of Medicine, Monash University, Clayton, Victoria
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Caulfield East
| |
Collapse
|
5
|
Divakaran P, Hong JS, Abbas S, Gwini SM, Nagra S, Stupart D, Guest G, Watters D. Failure to Rescue in Major Abdominal Surgery: A Regional Australian Experience. World J Surg 2023; 47:2145-2153. [PMID: 37225931 PMCID: PMC10208200 DOI: 10.1007/s00268-023-07061-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Failure to rescue (FTR) is increasingly recognised as a measure of the quality care provided by a health service in recognising and responding to patient deterioration. We report the association between a patient's pre-operative status and FTR following major abdominal surgery. METHODS A retrospective chart review was conducted on patients who underwent major abdominal surgery and who suffered Clavien-Dindo (CDC) III-V complications at the University Hospital Geelong between 2012 and 2019. For each patient suffering a major complication, pre-operative risk factors including demographics, comorbidities (Charlson Comorbidity Index (CCI)), American Society of Anaesthesiology (ASA) Score and biochemistry were compared for patients who survived and patients who died. Statistical analysis utilised logistic regression with results reported as odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS There were 2579 patients who underwent major abdominal surgery, of whom 374 (14.5%) suffered CDC III-V complications. Eighty-eight patients subsequently died from their complication representing a 23.5% FTR and an overall operative mortality of 3.4%. Pre-operative risk factors for FTR included ASA score ≥ 3, CCI ≥ 3 and pre-operative serum albumin of < 35 g/L. Operative risk factors included emergency surgery, cancer surgery, greater than 500 ml intraoperative blood loss and need for ICU admission. Patients who suffered end-organ failure were more likely to die from their complication. CONCLUSION Identification of patients at high risk of FTR should they develop a complication would inform shared decision-making, highlight the need for optimisation prior to surgery, or in some cases, result in surgery not being undertaken.
Collapse
Affiliation(s)
- Pranav Divakaran
- Department of Surgery, University Hospital Geelong, Barwon Health 272-322 Bellarine Street and Ryrie Street, Geelong, VIC, 3220, Australia.
| | - Joshua Sungho Hong
- Warrnambool Base Hospital, Southwest Healthcare, 25 Ryot Street, Warrnambool, VIC, 3280, Australia
| | - Saleh Abbas
- Department of Surgery, University Hospital Geelong, Barwon Health 272-322 Bellarine Street and Ryrie Street, Geelong, VIC, 3220, Australia
- Geelong Clinical School, Deakin University School of Medicine, Little Malop Street, Geelong, VIC, 3220, Australia
| | - Stella-May Gwini
- Biostatistics Support Service, Level 2 Kitchner House, University Hospital Geelong, Barwon Health 272-322 Bellarine Street and Ryrie Street, Geelong, VIC, 3220, Australia
| | - Sonalmeet Nagra
- Department of Surgery, University Hospital Geelong, Barwon Health 272-322 Bellarine Street and Ryrie Street, Geelong, VIC, 3220, Australia
- Geelong Clinical School, Deakin University School of Medicine, Little Malop Street, Geelong, VIC, 3220, Australia
| | - Douglas Stupart
- Department of Surgery, University Hospital Geelong, Barwon Health 272-322 Bellarine Street and Ryrie Street, Geelong, VIC, 3220, Australia
- Geelong Clinical School, Deakin University School of Medicine, Little Malop Street, Geelong, VIC, 3220, Australia
| | - Glenn Guest
- Department of Surgery, University Hospital Geelong, Barwon Health 272-322 Bellarine Street and Ryrie Street, Geelong, VIC, 3220, Australia
- Geelong Clinical School, Deakin University School of Medicine, Little Malop Street, Geelong, VIC, 3220, Australia
| | - David Watters
- Department of Surgery, University Hospital Geelong, Barwon Health 272-322 Bellarine Street and Ryrie Street, Geelong, VIC, 3220, Australia
- Geelong Clinical School, Deakin University School of Medicine, Little Malop Street, Geelong, VIC, 3220, Australia
| |
Collapse
|
6
|
Cheng CT, Gwini S, Craig G. A quantitative analysis of spectral computed tomography characteristics of osseous metastases. J Med Imaging Radiat Oncol 2023; 67:595-601. [PMID: 37186505 DOI: 10.1111/1754-9485.13528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/26/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Spectral detector computed tomography (SDCT) is a recent advancement that enables elemental material decomposition which could improve the detection of osseous metastases in the oncologic patient. METHODS Sixteen patients who underwent oncologic staging SDCT as well as WBBS with Technetium-99 m hydroxydiphosphonate (Tc99m HDP) were included in this retrospective study. A total of 50 osseous metastases were identified and confirmed on bone scintigraphy. Quantitative ROI-based measurements of each lesion and a similar region of normal bone were performed, and the acquired spectral data were used for comparison. These parameters included effective atomic number (Zeff ), electron density (%EDW) and calcium suppression (HU). Receiver operating characteristic (ROC) analysis was performed. RESULTS In comparison to normal bone, osseous metastases showed statistically significantly elevated values in effective atomic number, electron density and calcium suppression. ROC analysis demonstrated outstanding discrimination with area under the curve (AUC) values of 0.934 and 0.915 for effective atomic number and electron density, and excellent discrimination with an AUC value of 0.884 for calcium suppression. Threshold values of effective atomic number (Zeff ) >9.7, electron density >115% EDW and calcium suppression values >0 HU were demonstrated to be able to differentiate an osseous lesion from normal bone with a sensitivity of 82%, 82% and 84% and a specificity of 86%, 92% and 88% respectively. CONCLUSION Spectral analysis of osseous metastases demonstrated significantly elevated values in effective atomic number, electron density and calcium suppression as compared to normal bone which would be useful adjunct quantitative parameters in CT imaging to increase diagnostic confidence.
Collapse
Affiliation(s)
- Chris-Tin Cheng
- University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - StellaMay Gwini
- University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Giles Craig
- University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| |
Collapse
|
7
|
Hoy RF, Dimitriadis C, Abramson M, Glass DC, Gwini S, Hore-Lacy F, Jimenez-Martin J, Walker-Bone K, Sim MR. Prevalence and risk factors for silicosis among a large cohort of stone benchtop industry workers. Occup Environ Med 2023; 80:439-446. [PMID: 37328266 PMCID: PMC10423513 DOI: 10.1136/oemed-2023-108892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/30/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES High silica content artificial stone has been found to be associated with silicosis among stone benchtop industry (SBI) workers. The objectives of this study were to determine the prevalence of and risk factors for silicosis among a large cohort of screened SBI workers, and determine the reliability of respiratory function testing (RFT) and chest x-ray (CXR) as screening tests in this industry. METHODS Subjects were recruited from a health screening programme available to all SBI workers in Victoria, Australia. Workers undertook primary screening, including an International Labour Office (ILO) classified CXR, and subject to prespecified criteria, also underwent secondary screening including high-resolution CT (HRCT) chest and respiratory physician assessment. RESULTS Among 544 SBI workers screened, 95% worked with artificial stone and 86.2% were exposed to dry processing of stone. Seventy-six per cent (414) required secondary screening, among whom 117 (28.2%) were diagnosed with silicosis (median age at diagnosis 42.1 years (IQR 34.8-49.7)), and all were male. In secondary screening, silicosis was associated with longer SBI career duration (12 vs 8 years), older age, lower body mass index and smoking. In those with silicosis, forced vital capacity was below the lower limit of normal in only 14% and diffusion capacity for carbon monoxide in 13%. Thirty-six (39.6%) of those with simple silicosis on chest HRCT had an ILO category 0 CXR. CONCLUSION Screening this large cohort of SBI workers identified exposure to dry processing of stone was common and the prevalence of silicosis was high. Compared with HRCT chest, CXR and RFTs had limited value in screening this high-risk population.
Collapse
Affiliation(s)
- Ryan F Hoy
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Christina Dimitriadis
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael Abramson
- School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Deborah C Glass
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - StellaMay Gwini
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Fiona Hore-Lacy
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Javier Jimenez-Martin
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Karen Walker-Bone
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Malcolm R Sim
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
8
|
Ng E, Gwini S, Libianto R, Choy KW, Fuller P, Shen J, Yang J. RF32 | PSUN49 To Repeat or Not to Repeat: The Question of Aldosterone and Renin Variability. J Endocr Soc 2022. [PMCID: PMC9624878 DOI: 10.1210/jendso/bvac150.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Plasma aldosterone concentration (PAC), renin levels and aldosterone-renin ratio (ARR) are used to screen for primary aldosteronism (PA). A recent study (Yozamp et al. Hypertension 2021) reported substantial intraindividual variability of PAC and ARR (using plasma renin activity) in the context of usual antihypertensive therapy. The intraindividual variability of PAC and direct renin concentration (DRC), a more widely used measurement of renin, in the absence of interfering medications is unknown but important where a single ARR is used to screen for PA. The aim of this study was to evaluate the intraindividual variability of PAC, DRC and ARR in a cohort of patients with and without PA. Patients who attended an Endocrine Hypertension Service from May 2017 to July 2021 with at least two ARR measurements off interfering medications were retrospectively evaluated. While the measurements were performed at several hospital and community laboratories, the same analyser was used. PA was confirmed using the seated saline suppression test following an abnormal ARR >70 pmol/L: mU/L. PAC and DRC variability was calculated as coefficient of variation (CV=standard deviation/mean×100) and percent difference (PD=difference between highest and lowest values/mean×100). A total of 223 patients were analysed (55% female, median age 52 years), including 162 with PA (25% with unilateral disease). Significant variability in both PAC and DRC was observed in the PA group (CV: 24%, 41%; PD: 46%, 76% respectively) and non-PA group (CV: 22%, 40%; PD: 38%, 65% respectively), which was higher than the assays’ analytical variability. The ARR was also highly variable within individuals, in both the PA group (CV: 42%; PD: 74%) and non-PA group (CV: 37%; PD: 61%). Variability was not significantly different between PA subtypes, and persisted irrespective of age, gender and degree of hypertension. Sixty-two patients (39%) with PA could have had a missed diagnosis if the ARR had not been repeated, i.e., had at least one ARR <70 pmol/L: mU/L, while 28 (46%) without PA had at least one abnormal ARR > 70. Intraindividual variability in PAC, DRC and ARR occurs in a significant number of patients being investigated for PA. These results support the need for at least two ARR on separate occasions before PA is excluded or further investigated. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Monday, June 13, 2022 1:06 p.m. - 1:11 p.m.
Collapse
|
9
|
Abstract
PURPOSE Orbital fractures are common facial fractures that can be challenging to repair and require careful attention to avoid unacceptable ophthalmic complications. Customized implants that are unique to an individual patient, or patient-specific implants (PSIs), have been increasingly used to repair orbital wall fractures. This systematic review summarizes the current evidence regarding custom-made orbital wall implants. METHODS A keyword search of published literature from January 2010 to September 2021 was performed using Ovid MEDLINE, PubMed, and the Cochrane Library databases. Original articles that included more than 3 human subjects with an orbital fracture repaired with a PSI were included. The search results were reviewed, duplicates were removed and relevant articles were included for analysis. RESULTS Fifteen articles meeting the inclusion criteria. The articles were categorized into 3 separate groups based on the method of PSI fabrication: manual molding of a PSI on a 3D-printed orbital model (53%), directly from a 3D printer (27%), or via a template fabricated from a 3D printer (20%). Three primary postoperative outcomes were assessed: rates of diplopia, enophthalmos, and orbital volume. Postoperative rates of diplopia and enophthalmos improved regardless of the PSI technique, and postoperative orbital volumes were reduced compared with their preoperative state. When PSIs were compared to conventional implants, patient outcomes were comparable. CONCLUSIONS This review of existing PSI orbital implant literature highlights that while PSI can accurately and safely repair orbital fractures, patient outcomes are largely comparable to orbital fractures repaired by conventional methods, and PSI do not offer a definitive benefit over conventional implants.
Collapse
Affiliation(s)
- Dominic I Maher
- Department of Ophthalmology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Anthony J Hall
- Department of Ophthalmology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - StellaMay Gwini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elad Ben Artsi
- Department of Ophthalmology, Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
10
|
Yang J, Gwini S, Beilin LJ, Schlaich M, Stowasser M, Young MJ, Fuller PJ, Mori T. The Relationship Between the Aldosterone-to-Renin Ratio and Blood Pressure in Young Adults: A Longitudinal Study. J Endocr Soc 2021. [PMCID: PMC8089744 DOI: 10.1210/jendso/bvab048.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background: Hypertension tracks throughout childhood into adulthood. Aldosterone excess, or primary aldosteronism, has been reported as the most common secondary cause of hypertension in adults. Elevated aldosterone in the setting of low renin predicts incident hypertension in normotensive adults. However, the relationship between aldosterone and blood pressure in adolescents and young adults is unclear. Objectives: To evaluate the relationship between aldosterone, renin and the aldosterone:renin ratio (ARR) and blood pressure (BP) at age 17y as well as BP at age 27y in a community-based population. Methods: This is a prospective birth cohort study. Young adult offspring (Gen2) of women enrolled during pregnancy into the Raine Study, with 1239 at age 17y and 1006 at age 27y, were evaluated. Females taking hormonal contraception and participants without BP data were excluded from the current analysis. A generalised linear model was used to examine the relationship between BP and aldosterone, renin and ARR over time. The median aldosterone, renin and ARR was compared between sexes using quantile regression. Results: At 17y, females had similar aldosterone (349 vs 346 pmol/L, p=0.833) but significantly lower renin (20.6 vs 25.7 mU/L, p<0.001) and thus a higher ARR (18.3 vs 13.5, p<0.001) compared to males. However, they had lower systolic BP (109 vs 118 mmHg, p< 0.001) versus males. A significant correlation between ARR and systolic BP was detected in 17y males when adjusted for alcohol consumption, physical activity, urinary sodium and body mass index. This was true when the ARR was expressed as a continuous variable (β-coefficient 0.1, p=0.009) or categorical variable (highest quartile, β-coefficient 3.15, p=0.003). A similar correlation was not observed in females at 17y. However, the ARR at 17y was significantly associated with both systolic (β-coefficient 0.15, p=0.009) and diastolic BP (β-coefficient 0.14, p=0.003) at 27y in females, but not males. Conclusion: A relationship between ARR and BP are observed at both 17 and 27 years but with distinct age-related sex differences. Further evaluation of the relationship between ARR and surrogate markers of cardiovascular disease such as vascular reactivity will improve our understanding of aldosterone as a cardiovascular risk factor young people.
Collapse
Affiliation(s)
- Jun Yang
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | | | | | | | | | - Morag J Young
- Baker Heart and Diabetes Institute, Melborne, Australia
| | | | - Trevor Mori
- The University of Western Australia, Perth, Australia
| |
Collapse
|
11
|
Fuscaldo G, Gwini SM, Larsen R, Venkataramani A. Do Health Service staff support the implementation of Voluntary Assisted Dying at their workplace? Intern Med J 2021; 51:1636-1644. [PMID: 33710752 DOI: 10.1111/imj.15285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 01/31/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND On 29 November 2017, the Victorian Parliament passed the Voluntary Assisted Dying (VAD) Act 2017, which came into effect from 19 June 2019. AIM To investigate whether staff from a large regional health service support the legalisation of Voluntary Assisted Dying (VAD) and the implementation of VAD at their workplace. METHODS Staff were invited to complete an anonymous online survey comprising both closed and open-ended questions. RESULTS 38% of the workforce (n = 1624) responded to the survey. Most participants supported the legalisation of VAD (88%), the provision of eligibility assessment and/or the administration of VAD within the health service (80%). There were negligible differences in support for VAD by role, however, specialist doctors were significantly less supportive (65%). Approximately half of the respondents expressed concern about monitoring (49%) or implementation (53%) of VAD. Concerns were also raised about assessment of eligibility, support for staff involved in VAD and pressure on both patients and staff to participate. Nearly three quarters (71%) of participants agreed that if the health service offers VAD services, a special unit or facility should be available. CONCLUSION This study found that health workers have concerns about the implementation of VAD at their workplace but are generally supportive. This paper provides information for health services considering the implementation of VAD, about staff concerns and issues that need to be addressed for the successful introduction of VAD. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- G Fuscaldo
- University Hospital Geelong Barwon Health, Geelong, Australia, 3220.,Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill, Australia, 3128
| | - S M Gwini
- University Hospital Geelong Barwon Health, Geelong, Australia, 3220.,iMPACT, Faculty of Health, Deakin University, Geelong, Australia, 3220
| | - R Larsen
- University Hospital Geelong Barwon Health, Geelong, Australia, 3220
| | - A Venkataramani
- University Hospital Geelong Barwon Health, Geelong, Australia, 3220
| |
Collapse
|
12
|
Abstract
Egg freezing (EF) technology has improved significantly over the last decade, giving women more choice over their reproductive futures. Despite this advance, EF brings forth contentious ethical and regulatory issues. Policies controlling access to EF vary around the world and there is a lack of consensus about who should have access and what criteria are relevant in making these decisions. This study aimed to identify views of women about access to EF for both "medical" and "non-medical" risks to infertility. An online survey was administered to women aged between 18 and 60 years in Victoria, Australia between April and May 2018. A total of 1,066 individuals initiated the survey. The median age of the participants was 28 years and 81% were <40 years old. Almost all participants (98%) supported access to medical EF in situations where treatments (e.g. chemotherapy) or illnesses threaten fertility. Support for access to EF for non-medical indications was lower; 75% supported EF for "lack of suitable partner", followed by "financial insecurity to raise a child" (72%) and "career/educational advancement" (65%). Older respondents (aged ≥40 years) were less likely than their younger counterparts to support all indications for non-medical EF. Our findings indicate broad support for EF. However, the variation in support between indications for non-medical EF suggests that individuals do not think about access to EF simply in terms of medical necessity. To reflect public views, future policy may need to consider access to EF beyond the medical/non-medical distinction.
Collapse
Affiliation(s)
- Molly Johnston
- PhD candidate, Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia, 3168
| | - Giuliana Fuscaldo
- Associate Professor, Eastern Health Clinical School, Monash University, Box Hill, Australia; University Hospital Geelong, Australia
| | - Nadine Maree Richings
- Teaching Associate, Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - StellaMay Gwini
- Adjunct Lecturer, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; University Hospital Geelong, Australia; Centre for Innovation in Mental and Physical Health and Clinical Treatment (IMPACT), School of Medicine, Deakin University, Geelong, Australia
| | - Sally Catt
- Senior Lecturer, Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| |
Collapse
|
13
|
Ostaszkiewicz J, Dunning T, Hutchinson A, Wagg A, Gwini S, Dickson-Swift V. The development and validation of instruments to measure dignity-protective continence care for care-dependent older people in residential aged care facilities: A study protocol. Neurourol Urodyn 2020; 39:1363-1370. [PMID: 32227651 DOI: 10.1002/nau.24343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/10/2020] [Accepted: 03/18/2020] [Indexed: 12/29/2022]
Abstract
AIMS To develop and validate two instruments to measure dignity-protective continence care for care-dependent older people in residential aged care facilities: one instrument to be completed by care recipients and another for healthcare professionals. METHODS The first phase of the project will involve a review of literature to identify the attributes of "dignity-protective continence care" for older people, which will be used to design the initial drafts of the instruments. Thereafter the Delphi survey technique will be used to establish the face and content validity of the draft instruments with three purposive samples; (a) care recipients (care-dependent older people with decisional capacity), (b) formal carers (nurses and personal care workers from residential aged care facilities, and (c) healthcare professionals with gerontological expertize in the management of incontinence. After instrument development, a large cross-sectional survey of care recipients and formal carers will be conducted to establish the internal consistency and construct validity of the instruments. This will be followed by a series of tests to establish their test-retest reliability. CONCLUSION The completed research will result in two reliable and valid instruments that will support broader efforts to ensure that care practices in residential aged care facilities do not violate the dignity of care-dependent older people with continence care needs, and allow care partners and providers to act upon the results.
Collapse
Affiliation(s)
- Joan Ostaszkiewicz
- Centre for Quality and Patient Safety Research-Barwon Health Partnership, Institute for Healthcare Transformation, Deakin University, Geelong, Victoria, Australia
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
- National Ageing Research Institute, Parkville, Victoria, Australia
| | - Trisha Dunning
- Centre for Quality and Patient Safety Research-Barwon Health Partnership, Institute for Healthcare Transformation, Deakin University, Geelong, Victoria, Australia
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Alison Hutchinson
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research-Monash Health Partnership, Institute for Healthcare Transformation, Deakin University, Geelong, Victoria, Australia
| | - Adrian Wagg
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - StellaMay Gwini
- Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
- iMPACT Institute, Deakin University, Geelong, Victoria, Australia
| | - Virginia Dickson-Swift
- Centre for Quality and Patient Safety Research-Barwon Health Partnership, Institute for Healthcare Transformation, Deakin University, Geelong, Victoria, Australia
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
14
|
Yang J, Menezes S, Kaur A, Narayan O, Gwini S, Shen J, Fuller P, Young M. SAT-056 Primary Aldosteronism Has a Distinctive Twenty-four Hour Blood Pressure Profile. J Endocr Soc 2019. [PMCID: PMC6552459 DOI: 10.1210/js.2019-sat-056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Primary aldosteronism (PA) has a reported prevalence of up to 30% in cases of resistant hypertension and is associated with worse cardiovascular outcomes than BP-matched essential hypertension (EH), but is substantially under-diagnosed due to the lack of specific symptoms and signs. Ambulatory blood pressure monitoring (ABPM) provides a non-invasive method for evaluating circadian BP variations, offers valuable prognostic information and may help to differentiate PA from EH in patients referred with non-specific hypertension for investigation. Aims: To compare AMBP parameters in hypertensive patients with established PA and those without, and correlate these parameters with cardiovascular outcomes. Methods: AMBP readings were evaluated retrospectively in 453 patients assessed at Monash Heart (the largest cardiology service in Victoria, Australia). Patient demographics, screening aldosterone and renin concentrations and medications were retrieved from medical records. 414 hypertensive patients with presumed EH and 39 PA patients were identified and their cardiovascular events (myocardial infarction, left ventricular hypertrophy, coronary artery disease, atrial fibrillation) were recorded. All parameters are reported as the median [interquartile range], unless stated otherwise. Statistical significance was set at p<0.05. Results: Compared to hypertensive patients who are presumed to have EH, PA patients were significantly younger (55 yr [50, 66] vs 63 yr [53, 72]), had higher systolic (149 mmHg [134, 156] vs 133 mmHg [124, 145]) and diastolic BP readings (87 mmHg [82, 92] vs 75 mmHg [68, 82]) with similar patterns observed for average daytime and night-time BP. BP load (% daytime and night-time SBP/DBP readings over 135/85 and 120/70 mmHg, respectively) was significantly higher for both systolic and diastolic in PA (83% [61, 92] and 57% [35, 76]) compared with the non-PA group (48% [23, 75] and 14% [5, 35]). 77% of patients with PA (30/39) had loss of physiological nocturnal BP dipping compared with 44% of the non-PA group (184/414). Rates of cardiovascular events were similar in both groups but may be confounded by the retrospective nature of this study and lack of long-term follow-up. Conclusion: In our study, PA is associated with a distinctive 24-hour BP profile, including a significant increase in BP load and loss of nocturnal BP dipping which are known risk factors for adverse cardiovascular events. A prospective study is needed to better define AMBP parameters in PA and evaluate their ability to unveil underlying PA amongst hypertensive patients.
Collapse
Affiliation(s)
- Jun Yang
- Hudson Institute of Medical Research, Clayton, Victoria, , Australia
| | - Serena Menezes
- Hudson Institute of Medical Research, Clayton, Victoria, , Australia
| | - Amrina Kaur
- Hudson Institute of Medical Research, Clayton, Victoria, , Australia
| | - Om Narayan
- Monash Heart, Clayton, Victoria, , Australia
| | | | - Jimmy Shen
- Hudson Institute of Medical Research, Clayton, Victoria, , Australia
| | - Peter Fuller
- Monash Med Ctr, Hudson Institute of Medical Research, Clayton, Victoria, , Australia
| | - Morag Young
- Hudson Institute of Medical Research, Clayton, Victoria, , Australia
| |
Collapse
|
15
|
Jun Y, Menezes S, Narayan O, Gwini S, Shen J. A12864 Ambulatory Blood Pressure Monitoring May Unveil Primary Aldosteronism. J Hypertens 2018. [DOI: 10.1097/01.hjh.0000548883.43340.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
16
|
Hashimura H, Shen J, Fuller PJ, Chee NYN, Doery JCG, Chong W, Choy KW, Gwini S, Yang J. Saline suppression test parameters may predict bilateral subtypes of primary aldosteronism. Clin Endocrinol (Oxf) 2018; 89:308-313. [PMID: 29873811 DOI: 10.1111/cen.13757] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND The saline suppression test (SST) serves to confirm the diagnosis of primary aldosteronism (PA) whilst adrenal vein sampling (AVS) is used to determine whether the aldosterone hypersecretion is unilateral or bilateral. An accurate prediction of bilateral PA based on SST results could reduce the need for AVS. AIM We sought to identify SST parameters that reliably predict bilateral PA. METHODS The results from 121 patients undergoing SSTs at Monash Health from January 2010 to January 2018 including screening blood tests, imaging, AVS and histopathology results were evaluated. Patients were subtyped into unilateral or bilateral PA based on AVS and surgical outcomes. RESULTS Of 113 patients with confirmed PA, 33 had unilateral disease whilst 42 had bilateral disease. In those with bilateral disease, plasma aldosterone concentration (PAC) was significantly lower post-SST, together with a significant fall in the aldosterone-renin ratio (ARR). The combination of PAC < 300 pmol/L and a reduction in ARR post-SST provided 96.8% specificity in predicting bilateral disease. Eighteen of 39 patients (49%) with bilateral PA could have avoided AVS using these criteria. CONCLUSION A combination of PAC < 300 pmol/L and a lower ARR post-SST could reliably predict bilateral PA. An independent cohort will be needed to validate these findings.
Collapse
Affiliation(s)
- Hikaru Hashimura
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
| | - Jimmy Shen
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic., Australia
| | - Peter J Fuller
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic., Australia
| | - Nicholas Y N Chee
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
| | - James C G Doery
- Department of Pathology, Monash Health, Clayton, Vic., Australia
- Department of Medicine, Monash University, Clayton, Vic., Australia
| | - Winston Chong
- Department of Imaging, Monash Health, Clayton, Vic., Australia
| | - Kay Weng Choy
- Department of Pathology, Monash Health, Clayton, Vic., Australia
| | - StellaMay Gwini
- School of Public Health and Preventative Medicine, Monash University, Clayton, Vic., Australia
- University Hospital Geelong - Barwon Health, Geelong, Vic., Australia
| | - Jun Yang
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic., Australia
- School of Clinical Sciences, Monash University, Clayton, Vic, Australia
| |
Collapse
|
17
|
Abstract
BACKGROUND Diverticular disease is a common, chronic inflammatory disease of the bowel. This study investigates the differences in body composition between patients with diverticular disease and those without. METHODS Appropriate patients were identified using a search of the radiology database. Demographic and disease information was gathered using scanned medical records. Body composition analysis was performed at level L3 using single-slice computed tomography techniques. RESULTS Two hundred seventy-one patients were included in this study: 83 controls, 93 with diverticulosis and 95 with diverticulitis. Diverticulitis and diverticulosis were associated with a significantly higher visceral fat area (VFA), than the control group (p < 0.001, p < 0.001). Diverticulitis and diverticulosis were associated with a significantly higher visceral fat area to subcutaneous fat area ratio (VFA:SCFA), than the control group (p = 0.005, p = 0.019). Only diverticulosis was associated with increased levels of extramyocellular fat, when compared to the control group (p = 0.001). CONCLUSION Diverticular disease is associated with a higher amount and a higher proportion of visceral fat than seen in controls without diverticular disease.
Collapse
Affiliation(s)
- Julia Freckelton
- School of Clinical Sciences, Monash University, 246 Clayton Rd, Clayton, VIC, 3168, Australia.
| | - Darcy Holt
- Clinical Nutrition and Metabolism Unit, Monash Health, 246 Clayton Rd, Clayton, VIC, 3168, Australia
| | - Adina Borsaru
- Clinical Nutrition and Metabolism Unit, Monash Health, 246 Clayton Rd, Clayton, VIC, 3168, Australia
| | - StellaMay Gwini
- Department of Epidemiology and Preventive Medicine, Monash University, 246 Clayton Rd, Clayton, VIC, 3168, Australia
| | - Daniel Croagh
- School of Clinical Sciences, Monash University, 246 Clayton Rd, Clayton, VIC, 3168, Australia.,Department of Surgery, Monash Health, 246 Clayton Rd, Clayton, VIC, 3168, Australia
| | - Gregory Moore
- School of Clinical Sciences, Monash University, 246 Clayton Rd, Clayton, VIC, 3168, Australia.,Department of Gastroenterology and Hepatology, Monash Health, 246 Clayton Rd, Clayton, VIC, 3168, Australia
| |
Collapse
|
18
|
Bennett CJ, Walker RE, Blumfield ML, Gwini SM, Ma J, Wang F, Wan Y, Dickinson H, Truby H. Interventions designed to reduce excessive gestational weight gain can reduce the incidence of gestational diabetes mellitus: A systematic review and meta-analysis of randomised controlled trials. Diabetes Res Clin Pract 2018; 141:69-79. [PMID: 29698713 DOI: 10.1016/j.diabres.2018.04.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 03/12/2018] [Accepted: 04/04/2018] [Indexed: 01/18/2023]
Abstract
AIMS To (i) evaluate the global impact of interventions designed to prevent excessive gestational weight gain (eGWG) on the incidence of gestational diabetes (GDM), and (ii) examine whether the effects differ by pre-conception body mass index (BMI) or ethnicity. METHODS A systematic search of randomised controlled trials (RCTs) with a primary or secondary aim to reduce eGWG was conducted in seven international and three Chinese databases without date limits. Meta-analysis data are reported as relative risk (RR) for GDM incidence for interventions including: diet, physical activity (PA), and lifestyle (diet and PA). RESULTS Forty-five studies were included, 37 in the meta-analyses. Diet and PA interventions reduced GDM risk by 44% (RR: 0.56, 95% CI: 0.36-0.87) and 38% (RR: 0.62, 95% CI: 0.50-0.78), respectively. Lifestyle interventions and BMI didn't significantly alter GDM risk. PA interventions from Southern-Europe reduced GDM risk by 37% (RR: 0.63, 95% CI: 0.50-0.80). Whereas, diet and lifestyle interventions conducted in Asia reduced GDM risk by 62% (RR: 0.38, 95% CI: 0.24-0.59) and 32% (RR: 0.68, 95% CI: 0.54-0.86), respectively. CONCLUSION Diet and PA interventions designed to reduce GWG are more effective than standard care in reducing the incidence of GDM, although the effect varies by region and BMI. The 'one size fits all' approach is not supported.
Collapse
Affiliation(s)
- Christie Jane Bennett
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Ruth Elizabeth Walker
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Michelle Louise Blumfield
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Stella-May Gwini
- Biostatistics Platform, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Jianhua Ma
- Institute of Nutrition and Food Hygiene, School of Public Health, Lanzhou University, China
| | - Fenglei Wang
- Department of Food Science and Nutrition, Zhejiang University, Hangzhou, China
| | - Yi Wan
- Department of Food Science and Nutrition, Zhejiang University, Hangzhou, China
| | - Hayley Dickinson
- The Richie Centre, Translational Research Facility, Hudson Institute of Medical Research, Clayton, Vic., Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Vic., Australia
| | - Helen Truby
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
| |
Collapse
|
19
|
Sehgal A, Allison BJ, Gwini SM, Menahem S, Miller SL, Polglase GR. Vascular aging and cardiac maladaptation in growth-restricted preterm infants. J Perinatol 2018; 38:92-97. [PMID: 29120452 DOI: 10.1038/jp.2017.135] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/10/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess arterial morphology and mechanics in preterm infants with fetal growth restriction (FGR) compared with those appropriate for gestational age (AGA) in the early neonatal period. STUDY DESIGN This observational study involved 20 preterm FGR infants (28 to 32 weeks) of gestational age (GA) and birth weight (BW) <10th centile and 20 preterm AGA infants. Vascular ultrasound was performed to measure aortic properties. RESULTS GA and BW of FGR and AGA infants were 29.8±1.3 vs 30±0.9 weeks (P=0.78) and 923.4±168 vs 1403±237 g (P<0.001), respectively. At 10.5±1.3 (s.d.) days after birth, blood pressure (systolic 51±3 vs 46±4 mm Hg, P<0.001) and maximum aorta intima-media thickness (621±76 vs 479±54 μm; P<0.001) were significantly higher in FGR infants. Arterial wall stiffness and peripheral resistance were also increased in the FGR infants (2.36±0.24 vs 2.14±0.24, P=0.008 and 22.2±5 vs 13.7±2.3 mm Hg min ml-1, P<0.001), respectively. Significant correlations between vascular mechanics and cardiac function were observed (resistance vs E/E', r=0.7 and Tei index, r=0.79). CONCLUSION Maladaptive arterial-ventricular coupling was noted. Early detection may aid in early therapeutic strategies such as afterload reduction.
Collapse
Affiliation(s)
- A Sehgal
- Monash Newborn, Monash Children's Hospital, Melbourne, VIC, Australia.,Department of Pediatrics, Monash University, Melbourne, VIC, Australia
| | - B J Allison
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - S M Gwini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - S Menahem
- Paediatric and Fetal Cardiac Units, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
| | - S L Miller
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - G R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
20
|
Gwini SM, Kelsall HL, Sim MR, Ikin JF, McFarlane AC, Forbes AB. Stability of symptom patterns in Australian Gulf War veterans: 10-year longitudinal study: Table 1. Occup Environ Med 2016; 73:195-8. [DOI: 10.1136/oemed-2015-103169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/30/2015] [Indexed: 11/03/2022]
|
21
|
Gwini S, MacFarlane E, Del Monaco A, McLean D, Pisaniello D, Benke GP, Sim MR. Cancer Incidence, Mortality, and Blood Lead Levels Among Workers Exposed to Inorganic Lead. Ann Epidemiol 2012; 22:270-6. [DOI: 10.1016/j.annepidem.2012.01.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 12/13/2011] [Accepted: 01/07/2012] [Indexed: 10/14/2022]
|