Sex, Dementia, and Long-Term Care: Public Perspectives

The current mixed methods study utilized an ecological framework to examine public perspectives toward sexual behaviors among long-term care residents with dementia. Analyzing attitudes of the public is an integral component of understanding the entire ecological system that affects the development and overall well-being of a long-term care resident. Attitudes were examined using a multiple segment factorial vignette with a probability sample of 329 respondents from a southern state. Results indicate that attitudes were not statistically affected by sex or the elapsed time since diagnosis, and age, spousal disposition, and degree of intimacy predicted attitudes. A respondent’s education level also predicted attitudes across segments; those who attained higher levels of education were consistently more accepting of sexual behaviors, less likely to expect staff intervention in adulterous relationships, and were supportive of the healthy spouse beginning a new relationship. An ecological perspective provided a framework for guiding and informing future research on the influences of long-term care on sexual development and, in turn, for the development of relevant long-term care policy

Translating Policy, Systems, and Environmental Change for Use in the Family Context

Theorists argue that emphasizing changes to the policies, systems, and environments in which individuals live has more economical and sustainable impact on human health than interventions targeted directly to individuals (Kegler et al., 2015). We believe, however, that the ecology of the family remains an essential context for influencing individual behavior and contend it crucial that family life educators acknowledge the impact of family-level health-improvement initiatives. As such, we propose a behavior-change model for the family context that reflects the impact of interconnected family rules (policy), family relationships (systems), and the home (environment) on individual behavior, and acknowledge the underlying philosophical values that influence decisions about development, well-being, and health (see Figure 1; Bates & Yelland, 2018). Although the four framework concepts are interrelated, each can be conceptualized and operationalized uniquely. Future research will delineate techniques for evaluating how changes to family rules, family relationships, and the home impact human health

Developing a tool for obtaining maternal skinfold thickness measurements and assessing inter-observer variability among pregnant women who are overweight and obese

Extent: 6p.Background: It is estimated that between 34% and 50% of Australian women entering pregnancy are overweight and obese, which is associated with an increased risk in complications for both the woman and her infant. Current tools used in clinical and research practice for measuring body composition include body mass index (BMI), waist circumference and bioimpedance analysis. Not all of these measures are applicable for use during pregnancy due to a lack of differentiation between maternal and fetal contributions. While skinfold thickness measurement (SFTM) is increasingly being used in pregnancy, there is limited data and a lack of a standard tool for its use in overweight and obese pregnant women. Methods: We developed a standard tool for evaluating SFTM among women with a BMI ≥ 25 kg/m2. Forty-nine women were measured as part of a prospective cohort study nested within a multicentre randomised controlled trial (The LIMIT Randomised Controlled Trial). Two blinded observers each performed 2 skinfold measurements on the biceps, triceps and subscapular of each woman. Intraclass correlation coefficients (ICC) and standard error of measurement (SEM) were used to analyse SFTM, body fat percentage (BF%) and inter-observer variability. Results: The ICC for inter-observer variability in measurements were considered moderate for biceps SFTM (ICC = 0.56) and triceps SFTM (ICC = 0.51); good for subscapular SFTM (ICC = 0.71) and BF% (ICC = 0.74); and excellent for arm circumference (ICC = 0.97). The standard error of measurements ranged from 0.53 cm for arm circumference to 3.58 mm for the subscapular SFTM. Conclusion: Our findings indicate that arm circumference and biceps, triceps and subscapular SFTM can be reliably obtained from overweight and obese pregnant women to calculate BF%, using multiple observers, and can be used in a research setting.Lavern M Kannieappan, Andrea R Deussen, Rosalie M Grivell, Lisa Yelland and Jodie M Dod

Importance of adequate sample sizes in fatty acid intervention trials

Abstract not availableLisa N. Yelland, Maria Makrides, Andrew J. McPhee, Julie Quinlivan, Robert A. Gibso

Managing shoulder pain in general practice: The value of academic detailing

Copyright © Royal Australian College of General Practitioners Copyright to Australian Family Physician. Reproduced with permission. Permission to reproduce must be sought from the publisher, The Royal Australian College of General Practitioners.After low back pain and neck pain, shoulder pain is the third musculoskeletal reason for presentation to general practice, with a self reported prevalence of 16-26%. Approximately 1% of the adult population is expected to visit a general practitioner annually for shoulder pain. Shoulder complaints are more common in women and despite the fact that 50% of acute shoulder pain resolves in 8-10 weeks, many patients present with the anticipation of being referred for imaging.Norman A. Broadhurst, Christopher A. Barton, Lisa N. Yelland, David K. Martin and Justin J. Beilb

Comparison of dichotomized and distributional approaches in rare event clinical trial design: a fixed Bayesian design

Accepted 14 July 2016This research was motivated by our goal to design an efficient clinical trial to compare two doses of docosahexaenoic acid supplementation for reducing the rate of earliest preterm births (ePTB) and/or preterm births (PTB). Dichotomizing continuous gestational age (GA) data using a classic binomial distribution will result in a loss of information and reduced power. A distributional approach is an improved strategy to retain statistical power from the continuous distribution. However, appropriate distributions that fit the data properly, particularly in the tails, must be chosen, especially when the data are skewed. A recent study proposed a skew-normal method. We propose a three-component normal mixture model and introduce separate treatment effects at different components of GA. We evaluate operating characteristics of mixture model, beta-binomial model, and skew-normal model through simulation. We also apply these three methods to data from two completed clinical trials from the USA and Australia. Finite mixture models are shown to have favorable properties in PTB analysis but minimal benefit for ePTB analysis. Normal models on log-transformed data have the largest bias. Therefore we recommend finite mixture model for PTB study. Either finite mixture model or beta-binomial model is acceptable for ePTB study.Yang Lei, Susan Carlson, Lisa N. Yelland, Maria Makrides, Robert Gibson and Byron J. Gajewsk

Does n-3 LCPUFA supplementation during pregnancy increase the IQ of children at school age? Follow-up of a randomised controlled trial

Introduction Despite recommendations that pregnant women increase their docosahexaenoic acid (DHA) intake to support fetal brain development, a recent systematic review found a lack of high-quality data to support the long-term effects of DHA supplementation on children's neurodevelopment. Methods and analysis We will assess child neurodevelopment at 7 years of age in follow-up of a multicentre double-blind randomised controlled trial of DHA supplementation in pregnancy. In 2010–2012, n=2399 Australian women with a singleton pregnancy <21 weeks’ gestation were randomised to receive 3 capsules daily containing a total dose of 800 mg DHA/day or a vegetable oil placebo until birth. N=726 children from Adelaide (all n=97 born preterm, random sample of n=630 born at term) were selected for neurodevelopmental follow-up and n=638 (preterm n=85) are still enrolled at 7 years of age. At the 7-year follow-up, a psychologist will assess the primary outcome, IQ, with the Wechsler Abbreviated Scale of Intelligence, Second Edition. Specific measures of executive functioning (Fruit Stroop and the Rey Complex Figure), attention (Test of Everyday Attention for Children), memory and learning (Rey Auditory Verbal Learning Test), language (Clinical Evaluation of Language Fundamentals, Fourth Edition) and basic educational skills (Wide Range Achievement Test, Fourth Edition) will also be administered. Caregivers will be asked to complete questionnaires measuring behaviour and executive functioning. Families, clinicians and research personnel are blinded to group assignment with the exception of families who requested unblinding prior to the follow-up. All analyses will be conducted according to the intention-to-treat principal. Ethics and dissemination All procedures will be approved by the relevant institutional ethics committees prior to start of the study. The results of this study will be disseminated in peer-reviewed journal publications and academic presentations. Trial registration numbers ACTRN12605000569606 and ACTRN12614000770662.Jacqueline F Gould, Karli Treyvaud, Lisa N Yelland, Peter J Anderson, Lisa G Smithers, Robert A Gibson, Andrew J McPhee, Maria Makride

A statewide review of postnatal care in private hospitals in Victoria, Australia

<p>Abstract</p> <p>Background</p> <p>Concerns have been raised in Australia and internationally regarding the quality and effectiveness of hospital postnatal care, although Australian women receiving postnatal care in the private maternity sector rate their satisfaction with care more highly than women receiving public maternity care. In Victoria, Australia, two-thirds of women receive their maternity care in the public sector and the remainder in private health care sector. A statewide review of public hospital postnatal care in Victoria from the perspective of care providers found many barriers to care provision including the busyness of postnatal wards, inadequate staffing and priority being given to other episodes of care; however the study did not include private hospitals. The aim of this study was replicate the review in the private sector, to explore the structure and organisation of postnatal care in private hospitals and identify those aspects of care potentially impacting on women's experiences and maternal and infant care. This provides a more complete overview of the organisational structures and processes in postnatal care in all Victorian hospitals from the perspective of care providers.</p> <p>Methods</p> <p>A mixed method design was used. A structured postal survey was sent to all Victorian private hospitals (n = 19) and key informant interviews were undertaken with selected clinical midwives, maternity unit managers and obstetricians (n = 11). Survey data were analysed using descriptive statistics and interview data analysed thematically.</p> <p>Results</p> <p>Private hospital care providers report that postnatal care is provided in very busy environments, and that meeting the aims of postnatal care (breastfeeding support, education of parents and facilitating rest and recovery for women following birth) was difficult in the context of increased acuity of postnatal care; prioritising of other areas over postnatal care; high midwife-to-woman ratios; and the number and frequency of visitors. These findings were similar to the public review. Organisational differences in postnatal care were found between the two sectors: private hospitals are more likely to have a separate postnatal care unit with single rooms and can accommodate partners' over-night; very few have a policy of infant rooming-in; and most have well-baby nurseries. Private hospitals are also more likely to employ staff other than midwives, have fewer core postnatal staff and have a greater dependence on casual and bank staff to provide postnatal care.</p> <p>Conclusions</p> <p>There are similarities and differences in the organisation and provision of private postnatal care compared to postnatal care in public hospitals. Key differences between the two sectors relate to the organisational and aesthetic aspects of service provision rather than the delivery of postnatal care. The key messages emerging from both reviews is the need to review and monitor the adequacy of staffing levels and to develop alternative approaches to postnatal care to improve this episode of care for women and care providers alike. We also recommend further research to provide a greater evidence-base for postnatal care provision.</p