Family violence across the life cycle

Aims to address clinical questions that general practitioners (GPs) may have in identifying and responding to patients experiencing family violence. Background Family violence covers a range of abuse including child abuse and neglect, intimate partner violence and elder abuse. Each form of abuse has a significant negative impact on health and wellbeing, and patients present to general practice with varying physical and psychological issues. General practice is unique in that it often works with an entire family, which can be challeng-ing and needs to be actively managed. Objective This article aims to address clinical questions that general practitioners (GPs) may have in identifying and responding to patients experiencing family violence. It takes into account the different types of abuse victims experience and how to respond to perpetrators. The recommendations in this article can also apply to same-sex relationships. Discussion Managing family violence requires a whole-of-practice approach to encourage a safe environment in which families can dis-close abuse and where GPs can respond appropriately. Abuse can be inter-generational and GPs have a role in identification, management and referral.   &nbsp

Who consults chiropractors in Victoria, Australia?: Reasons for attending, general health and lifestyle habits of chiropractic patients

Background COAST (Chiropractic Observational and Analysis STudy) reported the clinical practices of chiropractors. The aims of this study were to: 1) describe the chiropractic patient demographic and health characteristics; 2) describe patient-stated reasons for visiting a chiropractor; 3) describe chiropractic patient lifestyle characteristics; 4) compare, where possible, chiropractic patient characteristics to the general Australian population. Methods Fifty-two chiropractors in Victoria, Australia, provided information for up to 100 consecutive encounters. If patients attended more than once during the 100 encounters, only data from their first encounter were included in this study. Where possible patient characteristics were compared with the general Australian population. Results Data were collected from December 2010 to September 2012. Data were provided for 4464 encounters, representing 3287 unique individuals. The majority of chiropractic encounters were for musculoskeletal conditions or for wellness/maintenance. The majority of patient comorbidities were musculoskeletal, circulatory or endocrine/metabolic in nature. Eight hundred chiropractic patients (57 %, 95 % CI: 53–61) described their self-reported health as excellent or very good and 138 patients (10 %, 95 % CI: 8–12) as fair or poor. Seventy-one percent of adult male patients (18 years and older), and 53 % of adult female patients, were overweight or obese. Fourteen percent (n = 188, 95 % CI: 12–16) were current smokers and 27 % (n  = 359, 95 % CI: 24–31) did not meet Australian alcohol consumption guidelines. Less than half of the chiropractic patients participated in vigorous exercise at least twice per week. Approximately 20 % ate one serving of vegetables or less each day, and approximately 50 % ate one serve of fruit or less each day. Compared to the general Australian population, chiropractic patients were less likely to smoke, less likely to be obese and more likely to describe their health in positive terms. However, many patients were less likely to meet alcohol consumption guidelines, drinking more than is recommended. Conclusions In general, chiropractic patients had more positive health and lifestyle characteristics than the Australian population. However, there were a significant proportion of chiropractic patients who did not meet guideline recommendations about lifestyle habits and there is an opportunity for chiropractors to reinforce public health messages with their patients

Promoting EArly intervention with men's use of violence in ReLationships through primary care (PEARL study)

The PEARL study will address an evidence gap around early intervention with male perpetrators of domestic violence through primary care.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

Interventions in Health Settings for Male Perpetrators or Victims of Intimate Partner Violence

Background: Intimate partner violence (IPV) is common in patients attending health-care services and is associated with a range of health problems. The majority of IPV perpetrators are men, and a substantial minority of men are victims, yet health-care professionals have little evidence or guidance on how to respond to male patients who perpetrate or experience violence in their intimate relationships. Methods: We conducted a systematic review to determine the effectiveness of interventions for male perpetrators or victims of IPV in health settings. Online databases, reference lists, Google Scholar, and gray literature were searched, and inclusion/exclusion criteria were applied. Narrative synthesis methods were used due to the heterogeneity of study types and outcome measures. Results: Fourteen studies describing 10 interventions met our inclusion criteria: nine randomized controlled trials, four cohort studies, and one case-control study. Interventions were predominantly therapeutic in nature and many were conducted in alcohol treatment settings. Conclusion: Overall, the evidence for effectiveness of interventions in health-care settings was weak, although IPV interventions conducted concurrently with alcohol treatment show some promise. More work is urgently needed in health-care services to determine what interventions might be effective, and in what settings, to improve the response to male perpetrators or victims of IPV. </jats:sec

Androgen stimulates growth of mouse preantral follicles in vitro: Interaction with follicle-stimulating hormone and with growth factors of the TGFβ super family

Androgens are essential for the normal function of mature antral follicles but also have a role in the early stages of follicle development. Polycystic ovary syndrome (PCOS), the most common cause of anovulatory infertility, is characterized by androgen excess and aberrant follicle development that includes accelerated early follicle growth. We have examined the effects of testosterone and dihydrotestosterone (DHT) on development of isolated mouse preantral follicles in culture with the specific aim of investigating interaction with follicle-stimulating hormone (FSH), the steroidogenic pathway, and growth factors of the TGFβ superfamily that are known to have a role in early follicle development. Both testosterone and DHT stimulated follicle growth and augmented FSH-induced growth and increased the incidence of antrum formation among the granulosa cell layers of these preantral follicles after 72 hours in culture. Effects of both androgens were reversed by the androgen receptor antagonist flutamide. FSH receptor expression was increased in response to both testosterone and DHT, as was that of Star, whereas Cyp11a1 was down-regulated. The key androgeninduced changes in the TGFβ signaling pathway were down-regulation of Amh, Bmp15, and their receptors. Inhibition of Alk6 (Bmpr1b), a putative partner for Amhr2 and Bmpr2, by dorsomorphin resulted in augmentation of androgen-stimulated growth and modification of androgen-induced gene expression. Our findings point to varied effects of androgen on preantral follicle growth and function, including interaction with FSH-activated growth and steroidogenesis, and, importantly, implicate the intrafollicular TGFb systemas a keymediator of androgen action. These findings provide insight into abnormal early follicle development in PCOS

Effects of environmental pollutants on the reproduction and welfare of ruminants

Anthropogenic pollutants comprise a wide range of synthetic organic compounds and heavy metals, which are dispersed throughout the environment, usually at low concentrations. Exposure of ruminants, as for all other animals, is unavoidable and while the levels of exposure to most chemicals are usually too low to induce any physiological effects, combinations of pollutants can act additively or synergistically to perturb multiple physiological systems at all ages but particularly in the developing foetus. In sheep, organs affected by pollutant exposure include the ovary, testis, hypothalamus and pituitary gland and bone. Reported effects of exposure include changes in organ weight and gross structure, histology and gene and protein expression but these changes are not reflected in changes in reproductive performance under the conditions tested. These results illustrate the complexity of the effects of endocrine disrupting compounds on the reproductive axis, which make it difficult to extrapolate between, or even within, species. Effects of pollutant exposure on the thyroid gland, immune, cardiovascular and obesogenic systems have not been shown explicitly, in ruminants, but work on other species suggests that these systems can also be perturbed. It is concluded that exposure to a mixture of anthropogenic pollutants has significant effects on a wide variety of physiological systems, including the reproductive system. Although this physiological insult has not yet been shown to lead to a reduction in ruminant gross performance, there are already reports indicating that anthropogenic pollutant exposure can compromise several physiological systems and may pose a significant threat to both reproductive performance and welfare in the longer term. At present, many potential mechanisms of action for individual chemicals have been identified but knowledge of factors affecting the rate of tissue exposure and of the effects of combinations of chemicals on physiological systems is poor. Nevertheless, both are vital for the identification of risks to animal productivity and welfare

An externally validated age-related model of mean follicle density in the cortex of the human ovary

The population of non-growing follicles present in the ovary is defined as the ovarian reserve. This underpins the reproductive lifespan in women, with its depletion determining age at loss of fertility and the menopause. Data amassed from published results of indirect invasive and non-invasive procedures has resulted in the generation of predictive models which estimate the ovarian reserve from conception throughout adult life. The distribution of follicles in the ovary is not uniform, with the great majority of NGFs located in the cortex, which is the region normally biopsied and used for fertility preservation. Previous models have however analysed whole ovary NGF populations and ovarian volumes, but not cortical NGF density. In this study we compared mean non-growing follicle density values obtained from tissue samples from 13 ovarian cortical biopsies (16-37 years) against age- matched model-predicted values generated from population and ovarian volume models, taking into account the proportion of the ovary that is cortex. A mean non-growing follicle density was calculated for each patient by counting all follicles in a given volume of freshly biopsied ovarian cortical tissue. These values were compared to age-matched model generated densities and the correlation between data sets tested. Non-growing follicle density values obtained from fresh biopsied ovarian cortex samples closely matched model generated data with low mean difference, tight agreement limits and no proportional error between the observed and predicted results. These findings validate the use of the population and ovarian volume models to accurately predict mean follicle density in the ovarian cortex of adult women.Publisher PDFPeer reviewe