Preconception Care - Issues Paper

The evidence for the link between maternal risk factors (including smoking, obesity, alcohol use and maternal mental health) and perinatal morbidity and mortality rates among Australian women is clear. There is also a growing body of evidence that Indigenous women are significantly more likely than their non-Indigenous counterparts to be impacted by these risk factors. Risk factors originate from genetic, environmental and behavioural factors. In alignment with the Health and Social Policy Branch’s Strategic Plan, Healthy, Safe and Well, the purpose of this paper is to focus on those risk factors that have a behavioural element and can, therefore, be modified, or impacted by strategies to minimise associated harms. Smoking in pregnancy has been highlighted as the most significant preventable cause of morbidity and death among women and infants. The risk of smoking increases among Indigenous and other disadvantaged women. A combination of policy and social marketing interventions involving comprehensive bans on advertising and sponsorship, tobacco price increases, bans on smoking in work and public places, health warnings on packs, mass media, QUIT telephone coaching and monitoring by a physician have been found to be most effective. Trends in nutrition, physical activity and obesity suggest a need for greater awareness and education of women in their reproductive years, prior to conception. Given women who are overweight or obese at conception are at increased risk of excessive gestational weight gain, parenting education and the setting of weight management goals have had some traction in antenatal care, however, the success of such programs relies on regular attendance and health practitioner skill. Although targeted health promotion interventions have increased acceptance of the importance of a healthy diet and exercise, many health practitioners lack skills to manage the problem, and evidence of the efficacy of such interventions in achieving reductions in obesity at the population level is lacking. Aboriginal women are at increased risk of obesity and government support for culturally appropriate programs targeting lifestyle behaviours and supporting health eating and physical activity in local communities have the potential to impact positively. Alcohol consumption among young women and pregnant women in NSW represents a significant risk factor potentially impacting the unborn fetus. Whilst the proportion of women engaged in heavy drinking in pregnancy is low, the adverse outcomes (including FASD) of heavy gestational alcohol consumption and the lack of evidence around safe levels of consumption highlight the issue as a high public health priority. Mandatory labelling of alcohol products and training of health professionals have been proposed as best practice interventions, in combination with addressing issues of pricing and taxation and advocating abstinence from drinking during pregnancy. The estimated prevalence of harmful drinking in Indigenous populations is twice that of non-Indigenous populations and the normalisation of harmful consumption highlights the need to target Indigenous populations, Aboriginal Medical Services (AMS) and Aboriginal clinicians to give health practitioners the skills and resources needed to advocate for reduced alcohol consumption in pre-pregnancy. Key components of effective interventions targeting Aboriginal women and health practitioners in contact with women in preconception and pregnancy are interactive community-based education, culturally appropriate printed resources and ongoing community engagement. Maternal mental health issues are estimated to affect 10-15% of women in high income countries during the perinatal period. Policy frameworks in NSW reflect recognition of the need for greater awareness of maternal mental health and the requirement to integrate programs that provide support for women’s well-being in the antenatal and postnatal phase into policy, planning and delivery of health services. An evidence-based health home visiting program called Sustaining NSW Families, developed for the identification and treatment of women at risk of antenatal and postnatal depression, has been found to be effective as an early intervention tool. Factors impacting the health and well-being of Aboriginal people include spirituality, the relationship with family, land and culture and these factors are all intertwined. Programs targeting these women need to be culturally appropriate, driven by the community and run by a workforce who understands the psycho-social risks resulting from intergenerational trauma.Health and Social Policy Branch, NSW Ministry of Healt

Australian consumer perspectives, attitudes and behaviours on antibiotic use and antibiotic resistance: A qualitative study with implications for public health policy and practice

© 2017 The Author(s). Background: Consumers receive over 27 million antibiotic prescriptions annually in Australian primary healthcare. Hence, consumers are a key group to engage in the fight against antibiotic resistance. There is a paucity of research pertaining to consumers in the Australian healthcare environment. This study aimed to investigate the perspectives, attitudes and behaviours of Australian consumers on antibiotic use and antibiotic resistance, to inform national programs for reducing inappropriate antibiotic consumption. Method: Semi-structured interviews with 32 consumers recruited via convenience and snowball sampling from a university population in South East Queensland. Interview transcripts were deductively and inductively coded. Main themes were identified using iterative thematic analysis. Results: Three themes emerged from the analysis, to elucidate factors affecting antibiotic use: (a) prescription type; (b) consumer attitudes, behaviours, skills and knowledge; and (c) consumer engagement with antibiotic resistance. Consumers held mixed views regarding the use of delayed antibiotic prescriptions, and were often not made aware of the use of repeat antibiotic prescriptions. Consumers with regular general practitioners were more likely to have shared expectations regarding minimising the use of antibiotics. Even so, advice or information mediated by general practitioners was influential with all consumers; and helped to prevent inappropriate antibiotic use behaviours. Consumers were not aware of the free Return of Unwanted Medicines service offered by pharmacies and disposed of leftover antibiotics through household waste. To engage with mitigating antibiotic resistance, consumers required specific information. Previous public health campaigns raising awareness of antibiotics were largely not seen by this sample of consumers. Conclusions: Australian consumers have specific information needs regarding prescribed antibiotics to enable appropriate antibiotic use behaviours. Consumers also have expectations for high quality general practice consults conducted in a manner that increases consumer confidence in the treatment decision, regardless of whether an antibiotic is prescribed. To reduce inappropriate consumption of antibiotics and to more fully engage Australian consumers in mitigating antibiotic resistance, changes in health policy and practice are required

Supporting research translation through partnership

This paper provides a brief introduction to research translation in health care and three essential building blocks that support the process of using evidence to inform health policy and practice: partnerships, system readiness and diversity of evidence. We then describe a ‘live’ example of research translation currently underway between a research group and policy makers working together to support maternity care in NSW, and the important facilitating role of a shared knowledge broker.NSW Population Health and Health Services Research Support Program (PHHSRSP) gran

Efficacy and Tolerability of Malartin and Sulphadoxine-Pyrimethamine Combination against Uncomplicated Falciparum Malaria in Dibanda, Southwest Cameroon

Artemisinin derivatives are now the most potent and rapidly acting antimalarials. The aim of this study was to assess the in vivo efficacy and tolerability of a combination of Malartin (an artesunate) and sulphadoxine-pyrimethamine (SP) in the treatment of uncomplicated falciparum malaria in Dibanda, Cameroon. A total of 197 subjects were recruited into the study and administered Malartin for 3 days and SP as a single dose on day 0. Only 174 of the subjects were successfully followed up on days 3, 7, and 14. The overall success rate of the drug combination was 92.53%. Parasite density decreased during the follow-up period in different age groups, sexes, and social classes. The prevalence of anaemia decreased from 22.99% at enrolment to 9.77% on day 14, and the difference was significant (P < 0.05) on all days of followup. The drug combination did not give rise to any serious side effects

Thermally Activated Dynamics of the Capillary Condensation

This paper is devoted to the thermally activated dynamics of the capillary condensation. We present a simple model which enables us to identify the critical nucleus involved in the transition mechanism. This simple model is then applied to calculate the nucleation barrier from which we can obtain informations on the nucleation time. We present a simple estimation of the nucleation barrier in slab geometry both in the two dimensional case and in the three dimensional case. We extend the model in the case of rough surfaces which is closer to the experimental case and allows comparison with experimental datas.Comment: 6 pages, 3 figures, Submitted to J. Phys. : Condens. Matter, Proceedings of the IV Liquid Matter Conference - Grenada(Spain) july 199

Plasma exosome microRNAs are indicative of breast cancer

Table containing the clinicopathological features of the patient-derived xenograft (PDX) mice used in this study. (DOCX 13 kb

The impact of sound field systems on learning and attention in elementary school classrooms

Purpose: An evaluation of the installation and use of sound field systems (SFS) was carried out to investigate their impact on teaching and learning in elementary school classrooms. Methods: The evaluation included acoustic surveys of classrooms, questionnaire surveys of students and teachers and experimental testing of students with and without the use of SFS. Students ’ perceptions of classroom environments and objective data evaluating change in performance on cognitive and academic assessments with amplification over a six month period are reported. Results: Teachers were positive about the use of SFS in improving children’s listening and attention to verbal instructions. Over time students in amplified classrooms did not differ from those in nonamplified classrooms in their reports of listening conditions, nor did their performance differ in measures of numeracy, reading or spelling. Use of SFS in the classrooms resulted in significantly larger gains in performance in the number of correct items on the nonverbal measure of speed of processing and the measure of listening comprehension. Analysis controlling for classroom acoustics indicated that students ’ listening comprehension score

Fluctuations of water near extended hydrophobic and hydrophilic surfaces

We use molecular dynamics simulations of the SPC-E model of liquid water to derive probability distributions for water density fluctuations in probe volumes of different shapes and sizes, both in the bulk as well as near hydrophobic and hydrophilic surfaces. To obtain our results, we introduce a biased sampling of coarse-grained densities, which in turn biases the actual solvent density. The technique is easily combined with molecular dynamics integration algorithms. Our principal result is that the probability for density fluctuations of water near a hydrophobic surface, with or without surface-water attractions, is akin to density fluctuations at the water-vapor interface. Specifically, the probability of density depletion near the surface is significantly larger than that in bulk. In contrast, we find that the statistics of water density fluctuations near a model hydrophilic surface are similar to that in the bulk

DRAM-3 modulates autophagy and promotes cell survival in the absence of glucose

Macroautophagy is a membrane-trafficking process that delivers cytoplasmic constituents to lysosomes for degradation. The process operates under basal conditions as a mechanism to turnover damaged or misfolded proteins and organelles. As a result, it has a major role in preserving cellular integrity and viability. In addition to this basal function, macroautophagy can also be modulated in response to various forms of cellular stress, and the rate and cargoes of macroautophagy can be tailored to facilitate appropriate cellular responses in particular situations. The macroautophagy machinery is regulated by a group of evolutionarily conserved autophagy-related (ATG) proteins and by several other autophagy regulators, which either have tissue-restricted expression or operate in specific contexts. We report here the characterization of a novel autophagy regulator that we have termed DRAM-3 due to its significant homology to damage-regulated autophagy modulator (DRAM-1). DRAM-3 is expressed in a broad spectrum of normal tissues and tumor cells, but different from DRAM-1, DRAM-3 is not induced by p53 or DNA-damaging agents. Immunofluorescence studies revealed that DRAM-3 localizes to lysosomes/autolysosomes, endosomes and the plasma membrane, but not the endoplasmic reticulum, phagophores, autophagosomes or Golgi, indicating significant overlap with DRAM-1 localization and with organelles associated with macroautophagy. In this regard, we further proceed to show that DRAM-3 expression causes accumulation of autophagosomes under basal conditions and enhances autophagic flux. Reciprocally, CRISPR/Cas9-mediated disruption of DRAM-3 impairs autophagic flux confirming that DRAM-3 is a modulator of macroautophagy. As macroautophagy can be cytoprotective under starvation conditions, we also tested whether DRAM-3 could promote survival on nutrient deprivation. This revealed that DRAM-3 can repress cell death and promote long-term clonogenic survival of cells grown in the absence of glucose. Interestingly, however, this effect is macroautophagy-independent. In summary, these findings constitute the primary characterization of DRAM-3 as a modulator of both macroautophagy and cell survival under starvation conditions

Linking cohort-based data with electronic health records: a proof-of-concept methodological study in Hong Kong.

OBJECTIVES: Data linkage of cohort-based data and electronic health records (EHRs) has been practised in many countries, but in Hong Kong there is still a lack of such research. To expand the use of multisource data, we aimed to identify a feasible way of linking two cohorts with EHRs in Hong Kong. METHODS: Participants in the 'Children of 1997' birth cohort and the Chinese Early Development Instrument (CEDI) cohort were separated into several batches. The Hong Kong Identity Card Numbers (HKIDs) of each batch were then uploaded to the Hong Kong Clinical Data Analysis and Reporting System (CDARS) to retrieve EHRs. Within the same batch, each participant has a unique combination of date of birth and sex which can then be used for exact matching, as no HKID will be returned from CDARS. Raw data collected for the two cohorts were checked for the mismatched cases. After the matching, we conducted a simple descriptive analysis of attention deficit hyperactivity disorder (ADHD) information collected in the CEDI cohort via the Strengths and Weaknesses of ADHD Symptoms and Normal Behaviour Scale (SWAN) and EHRs. RESULTS: In total, 3473 and 910 HKIDs in the birth cohort and CEDI cohort were separated into 44 and 5 batches, respectively, and then submitted to the CDARS, with 100% and 97% being valid HKIDs respectively. The match rates were confirmed to be 100% and 99.75% after checking the cohort data. From our illustration using the ADHD information in the CEDI cohort, 36 (4.47%) individuals had ADHD-Combined score over the clinical cut-off in the SWAN survey, and 68 (8.31%) individuals had ADHD records in EHRs. CONCLUSIONS: Using date of birth and sex as identifiable variables, we were able to link the cohort data and EHRs with high match rates. This method will assist in the generation of databases for future multidisciplinary research using both cohort data and EHRs