South African Menopause Society revised consensus position statement on menopausal hormone therapy, 2014

PKThe South African Menopause Society (SAMS) consensus position statement on menopausal hormone therapy (HT) 2014 is a revision of the SAMS Council consensus statement on menopausal HT published in the SAMJ in May 2007. Information presented in the previous statement has been re-evaluated and new evidence has been incorporated. While the recommendations pertaining to HT remain similar to those in the previous statement, the 2014 revision includes a wider range of clinical benefits for HT, the inclusion of non-hormonal alternatives such as selective serotonin reuptake inhibitors and serotonin noradrenaline reuptake inhibitors for the management of vasomotor symptoms, and an appraisal of bioidentical hormones and complementary medicines used for treatment of menopausal symptoms. New preparations that are likely to be more commonly used in the future are also mentioned. The revised statement emphasises that commencing HT during the ‘therapeutic window of opportunity’ maximises the benefit-to-risk profile of therapy in symptomatic menopausal women

Intention to breastfeed and awareness of health recommendations: findings from first-time mothers in southwest Sydney, Australia

<p>Abstract</p> <p>Background</p> <p>In 2001, the World Health Organisation (WHO) recommended exclusive breastfeeding for the first six months of life. The objectives of this study are to assess awareness of the WHO recommendation among first-time mothers (women at 24 to 34 weeks of pregnancy) and to explore the relationship between this awareness and mothers' intention to exclusively breastfeed for six months.</p> <p>Methods</p> <p>This study was part of the Healthy Beginnings Trial (HBT) conducted in southwest Sydney, Australia. We analysed cross-sectional baseline data of the trial conducted in 2008, including 409 first-time mothers at 24 to 34 weeks of pregnancy. The mothers' awareness of the recommended duration of exclusive breastfeeding and their intention to meet the recommendation were assessed through face-to-face interviews. Socio-demographic data were also collected. Factors associated with awareness of the recommendation, or the intention to meet the recommendation, were determined by logistic regression modeling. Log-binomial regression was used to calculate adjusted risk ratios (ARR).</p> <p>Results</p> <p>Sixty-one per cent of mothers knew the WHO recommendation of exclusive breastfeeding for six months. Only 42% of all mothers intended to meet the recommendation (breastfeed exclusively for six months). Among the mothers who knew the recommendation, 61% intended to meet the recommendation, compared to only 11% among those mothers who were not aware of the recommendation.</p> <p>The only factor associated with awareness of the recommendation was mother's level of education. Mothers who had a tertiary education were 1.5 times more likely to be aware of the recommendation than those who had school certificate or less (ARR adjusted for age 1.45, 95% CI 1.08, 1.94, p = 0.02). Mothers who were aware of the recommendation were 5.6 times more likely to intend to breastfeed exclusively to six months (ARR adjusted for employment status 5.61, 95% CI 3.53, 8.90, p < 0.001).</p> <p>Conclusion</p> <p>Awareness of the recommendation to breastfeed exclusively for six months is independently associated with the intention to meet this recommendation. A substantial number of mothers were not aware of the recommendation, particularly among those with low levels of education, which is of concern in relation to promoting breastfeeding. Improving mothers' awareness of the recommendation could lead to increased maternal intention to exclusively breastfeed for six months. However, whether this intention could be transferred into practice remains to be tested.</p> <p>Trial Registration</p> <p>HBT is registered with the Australian Clinical Trial Registry (ACTRNO12607000168459)</p

Early intervention of multiple home visits to prevent childhood obesity in a disadvantaged population: a home-based randomised controlled trial (Healthy Beginnings Trial)

<p>Abstract</p> <p>Background</p> <p>Studies have shown that a proportion of children as young as two years are already overweight. This indicates that obesity prevention programs that commence as early as possible and are family-focused are needed. This Healthy Beginnings Trial aims to determine the efficacy of a community-based randomized controlled trial (RCT) of a home visiting intervention in preventing the early onset of childhood overweight and obesity. The intervention will be conducted over the first two years of life to increase healthy feeding behaviours and physical activity, decrease physical inactivity, enhance parent-child interaction, and hence reduce overweight and obesity among children at 2 and 5 years of age in the most socially and economically disadvantaged areas of Sydney, Australia.</p> <p>Methods/design</p> <p>This RCT will be conducted with a consecutive sample of 782 first time mothers with their newborn children. Pregnant women who are expecting their first child, and who are between weeks 24 and 34 of their pregnancy, will be invited to participate in the trial at the antenatal clinic. Informed consent will be obtained and participants will then be randomly allocated to the intervention or the control group. The allocation will be concealed by sequentially numbered, sealed opaque envelopes containing a computer generated random number. The intervention comprises eight home visits from a specially trained community nurse over two years and pro-active telephone support between the visits. Main outcomes include a) duration of breastfeeding measured at 6 and 12 months, b) introduction of solids measured at 4 and 6 months, c) nutrition, physical activity and television viewing measured at 24 months, and d) overweight/obesity status at age 2 and 5 years.</p> <p>Discussion</p> <p>The results of this trial will ascertain whether the home based early intervention is effective in preventing the early onset of childhood overweight and obesity. If proved to be effective, it will result in a series of recommendations for policy and practical methods for promoting healthy feeding and physical activity of children in the first two years of life with particular application to families who are socially and economically disadvantaged.</p

South African Menopause Society revised consensus position statement on menopausal hormone therapy

The South African Menopause Society (SAMS) consensus position statement on menopausal hormone therapy (HT) 2014 is a revision of the SAMS Council consensus statement on menopausal HT published in the SAMJ in May 2007. Information presented in the previous statement has been re-evaluated and new evidence has been incorporated. While the recommendations pertaining to HT remain similar to those in the previous statement, the 2014 revision includes a wider range of clinical benefits for HT, the inclusion of non-hormonal alternatives such as selective serotonin reuptake inhibitors and serotonin noradrenaline reuptake inhibitors for the management of vasomotor symptoms, and an appraisal of bioidentical hormones and complementary medicines used for treatment of menopausal symptoms. New preparations that are likely to be more commonly used in the future are also mentioned. The revised statement emphasises that commencing HT during the 'therapeutic window of opportunity' maximises the benefit-to-risk profile of therapy in symptomatic menopausal women

Adherence to isoniazid preventive therapy in Indonesian children: A quantitative and qualitative investigation

<p>Abstract</p> <p>Background</p> <p>It is recommended that young child contacts of sputum smear positive tuberculosis cases receive isoniazid preventive therapy (IPT) but reported adherence is low and risk factors for poor adherence in children are largely unknown.</p> <p>Methods</p> <p>We prospectively determined rates of IPT adherence in children < 5 yrs in an Indonesian lung clinic. Possible risk factors for poor adherence, defined as ≤3 months prescription collection, were calculated using logistic regression. To further investigate adherence barriers in-depth interviews were conducted with caregivers of children with good and poor adherence.</p> <p>Results</p> <p>Eighty-two children eligible for IPT were included, 61 (74.4%) of which had poor adherence. High transport costs (OR 3.3, 95% CI 1.1-10.2) and medication costs (OR 20.0, 95% CI 2.7-414.5) were significantly associated with poor adherence in univariate analysis. Access, medication barriers, disease and health service experience and caregiver TB and IPT knowledge and beliefs were found to be important determinants of adherence in qualitative analysis.</p> <p>Conclusion</p> <p>Adherence to IPT in this setting in Indonesia is extremely low and may result from a combination of financial, knowledge, health service and medication related barriers. Successful reduction of childhood TB urgently requires evidence-based interventions that address poor adherence to IPT.</p

The development of an HIV-specific complexity rating scale

© The Author(s) 2019. As treatment for HIV improves, an ageing population is experiencing comorbidity which often leads to complex clinical presentations requiring an interdisciplinary care approach. This study sought to quantify clinician assessment of the level of clinical complexity, through the development of a rating scale for people living with HIV (PLHIV), to improve client care through an interdisciplinary care model. An existing alcohol and other drug complexity rating scale was selected and modified for use with PLHIV. HIV-specific items were included through consultation with an interdisciplinary team. A risk-prediction model was developed and validated using clinician ratings of clients attending The Albion Centre, a tertiary HIV clinic in Sydney, Australia, resulting in the development of the Clinical Complexity Rating Scale for HIV (CCRS-HIV). Multivariable logistic regression models identified eight characteristics based on clinician assessment of complexity in PLHIV: financial instability, social isolation, problematic crystal methamphetamine use, mental illness and/or other problematic substance use, cognitive/neurological impairment, polypharmacy, current hepatitis C infection and/or cancer, and other physical health comorbidity. A weighted risk-prediction model was developed and validated. The final model accurately predicted 85% of complex clients, with a sensitivity of 80% and specificity of 91%. This study developed an HIV-specific clinician-rated complexity scale. Further investigations are required to validate the CCRS-HIV with broader HIV populations. This simple complexity screening tool is a promising adjunct to clinical assessment to identify clients with complex physical and psychosocial needs who may benefit from interdisciplinary care interventions and allocation of resources

MECHANICAL PROPERTIES OF REINFORCED FOAMS.

The tensile elastic modulus of fiberglass reinforced high density polyester foams, the compression elastic modulus of particulate reinforced medium density polyurethane foams and their compressive creep behavior were investigated. The measured elastic properties were compared with predicted values based on the modified Kerner equation and the quasi-isotropic laminate theory. The compressive creep behavior was described by a power law and its temperature and load dependence by an Arrhenius type expression