A call to action for evidence‐based safer conception interventions for HIV‐affected couples desiring children in Sub‐Saharan Africa

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135487/1/ijgo73.pd

Moving Toward Patient‐Centered Care: Women's Decisions, Perceptions, and Experiences of the Induction of Labor Process

Background Patient preferences and clinician practices are possible causative factors to explain the increase in induction of labor, but scientific studies that demonstrate this link are limited. The purpose of this study is to identify factors that influence inductions from the perspective of women. Methods A qualitative investigation using grounded theory methodology was conducted. Women were interviewed preinduction and postinduction. Analysis of the interviews was conducted using constant comparison to identify codes, categories, and themes. Through this process the complex intersection between women, their clinician, and the application of evidence‐based care in clinical practice was explored. Results Five major themes from the preinduction interview were identified; safety of baby, women's trust in their clinician, relief of discomfort and/or anxiety, diminish potential or actual risk, and lack of informed decision making. Five major themes were identified from the postinduction interview; lack of informed decision making, induction as part of a checklist, women's trust in their clinician, happy with induction, and opportunities to improve the experience. Conclusions Lack of informed decision making was cited as a barrier to optimal care. This study has important implications for patient‐centered research and clinical care, requiring the inclusion of women and the salient concepts of care that they identify.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107354/1/birt12080.pd

Respiratory and atopic conditions in children two to four years after the 2014 Hazelwood coalmine fire

Objective: To evaluate associations between exposure during early life to mine fire smoke and parent-reported indicators of respiratory and atopic illness 2-4 years later. Design, setting: The Hazelwood coalmine fire exposed a regional Australian community to markedly increased air pollution during February - March 2014. During June 2016 - October 2018 we conducted a prospective cohort study of children from the Latrobe Valley. Participants: Seventy-nine children exposed to smoke in utero, 81 exposed during early childhood (0-2 years of age), and 129 children conceived after the fire (ie, unexposed). Exposure: Individualised mean daily and peak 24-hour fire-attributable fine particulate matter (PM2.5) exposure during the fire period, based on modelled air quality and time-activity data. Main outcome measures: Parent-reported symptoms, medications use, and contacts with medical professionals, collected in monthly online diaries for 29 months, 2-4 years after the fire. Results: In the in utero exposure analysis (2678 monthly diaries for 160 children exposed in utero or unexposed), each 10 μg/m3 increase in mean daily PM2.5 exposure was associated with increased reports of runny nose/cough (relative risk [RR], 1.09; 95% CI, 1.02-1.17), wheeze (RR, 1.56; 95% CI, 1.18-2.07), seeking health professional advice (RR, 1.17; 95% CI 1.06-1.29), and doctor diagnoses of upper respiratory tract infections, cold or flu (RR, 1.35; 95% CI, 1.14-1.60). Associations with peak 24-hour PM2.5 exposure were similar. In the early childhood exposure analysis (3290 diaries for 210 children exposed during early childhood, or unexposed), each 100 μg/m3 increase in peak 24-hour PM2.5 exposure was associated with increased use of asthma inhalers (RR, 1.26; 95% CI, 1.01-1.58). Conclusions: Exposure to mine fire smoke in utero was associated with increased reports by parents of respiratory infections and wheeze in their children 2-4 years later.This investigation was funded by the Victorian Department of Health and Human Services. The article presents our views, not those of the department. Our work was also supported by the Commonwealth Specialist Training Program and the Australian National University Master of Applied Epidemiology progra

Overweight and obesity in Australia: the 1999-2000 Australian Diabetes, Obesity and Lifestyle Study (AusDiab)

Objective:To measure the prevalence of obesity in Australian adults and to examine the associations of obesity with socioeconomic and lifestyle factors.Design:AusDiab, a cross-sectional study conducted between May 1999 and December 2000, involved participants from 42 randomly selected districts throughout Australia.Participants:Of 20 347 eligible people aged &gt; 25 years who completed a household interview, 11 247 attended the physical examination at local survey sites (response rate, 55%).Main outcome measures:Overweight and obesity defined by body mass index (BMI; kg/m2) and waist circumference (cm); sociodemographic factors (including smoking, physical activity and television viewing time).Results:The prevalence of overweight and obesity (BMI &gt; 25.0 kg/m2; waist circumference &gt; 80.0 cm [women] or &gt; 94.0 cm [men]) in both sexes was almost 60%, defined by either BMI or waist circumference. The prevalence of obesity was 2.5 times higher than in 1980. Using waist circumference, the prevalence of obesity was higher in women than men (34.1% v 26.8%; P &lt; 0.01). Lower educational status, higher television viewing time and lower physical activity time were each strongly associated with obesity, with television viewing time showing a stronger relationship than physical activity time.Conclusions:The prevalence of obesity in Australia has more than doubled in the past 20 years. Strong positive associations between obesity and each of television viewing time and lower physical activity time confirm the influence of sedentary lifestyles on obesity, and underline the potential benefits of reducing sedentary behaviour, as well as increasing physical activity, to curb the obesity epidemic.<br /

Exposure to air pollution during the first 1000 days of life and subsequent health service and medication usage in children

Background: Evidence of health effects following early life exposure to short-to-medium duration of high pollution levels is extremely limited. Objectives: We aimed to evaluate the associations between: 1. intrauterine exposure to fine particulate matter (PM2.5) from coal mine fire emissions and the frequencies of general practitioner attendances and dispensations of prescribed asthma inhalers, steroid skin creams, and antibiotics during the first year of life; 2. infant exposure and those outcomes during the year following the fire. Methods: All participants were recruited from the Latrobe Valley of Victoria, Australia. Participants' 24-h average and hourly peak mine fire-specific PM2.5 exposures from 09/02/2014 to 31/03/2014 were estimated using chemical transport modelling. Outcome data were obtained from the Australian Medicare Benefits Schedule and Pharmaceutical Benefits Scheme from each child's birth to 31/12/2016. We used negative binomial and logistic regression models to independently assess risks of the outcomes associated with every 10 and 100 μg m−3 increase in average or peak PM2.5 exposure, respectively, while adjusting for potential confounders. Results: We included 286 of 311 children whose parents consented to be linked, comprising 77 with no exposure, 88 with intrauterine exposure and 121 with exposure in infancy. 10- and 100- μg m−3 increases in average and peak PM2.5 exposure during infancy were associated with greater incidence of antibiotics being dispensed during the year following the fire: the adjusted incidence rate ratios were 1.24 (95% CI 1.02, 1.50, p = 0.036) and 1.14 (1.00, 1.31, p = 0.048) respectively. No other significant associations were observed. Conclusion: Exposure to coal mine fire emissions during infancy was associated with increased dispensing of antibiotics. This could reflect increased childhood infections or increased prescriptions of antibiotics in the year following the fire

Early life exposure to coal mine fire smoke emissions and altered lung function in young children

Background and objective Long‐term respiratory risks following exposure to relatively short periods of poor air quality early in life are unknown. We aimed to evaluate the association between exposure to a 6‐week episode of air pollution from a coal mine fire in children aged <2 years, and their lung function 3 years after the fire. Methods We conducted a prospective cohort study. Individual exposure to 24‐h average and peak concentrations of particulate matter with an aerodynamic diameter <2.5 μm in diameter (PM2.5) during the fire were estimated using dispersion and chemical transport modelling. Lung function was measured using the forced oscillation technique (FOT), generating standardized Z‐scores for resistance and reactance at a frequency of 5 Hz (Rrs5 and Xrs5), and area under the reactance curve (AX). We used linear regression models to assess the associations between PM2.5 exposure and lung function, adjusted for potential confounders. Results Of the 203 infants originally recruited, 84 aged 4.3 ± 0.5 years completed FOT testing. Median (interquartile range, IQR) for average and peak PM2.5 were 7.9 (6.8–16.8) and 103.4 (60.6–150.7) μg/m3, respectively. The mean ± SD Z‐scores for Rrs5, Xrs5 and AX were 0.56 ± 0.80, –0.76 ± 0.88 and 0.72 ± 0.92, respectively. After adjustment for potential confounders including maternal smoking during pregnancy, a 10 μg/m3 increase in average PM2.5 was significantly associated with worsening AX (β‐coefficient: 0.260; 95% CI: 0.019, 0.502), while the association between a 100‐μg/m3 increase in peak PM2.5 and AX was borderline (0.166; 95% CI: −0.002, 0.334). Conclusion Infant exposure to coal mine fire emissions could be associated with long‐term impairment of lung reactance

Associations between respiratory and vascular function in early childhood

Background and objective The link between respiratory and vascular health is well documented in adult populations. Impaired lung function is consistently associated with thicker arteries and higher incidence of cardiovascular disease. However, there are limited data on this relationship in young children and the studies that exist have focussed on populations at high risk of cardiorespiratory morbidity. We determined if an association exists between respiratory and cardiovascular function in young children and, if so, whether it is confounded by known cardiorespiratory risk factors. Methods Respiratory and vascular data from a prospective cohort study established to evaluate the health implications 3 years after coal mine fire smoke exposure in children aged 3–5 years were used. Respiratory function was measured using the forced oscillation technique and included resistance at 5 Hz (R5), reactance at 5 Hz (X5) and area under the reactance curve (AX). Vascular health was measured by carotid intima-media thickness (ultrasound) and pulse wave velocity (arterial tonometry). Regression analyses were used to examine the relationship between the respiratory Z-scores and cardiovascular measures. Subsequent analyses were adjusted for potential confounding by maternal smoking during pregnancy, maternal education and exposure to fine particulate matter <2.5 μm in aerodynamic diameter (PM2.5). Results Peripheral lung function (X5 and AX), but not respiratory system resistance (R5), was associated with vascular function. Adjustment for maternal smoking, maternal education and early life exposure to PM2.5 had minimal effect on these associations. Conclusion These observations suggest that peripheral lung stiffness is associated with vascular stiffness and that this relationship is established early in life