32 research outputs found

    A systematic review of the effectiveness of self-management interventions in people with multiple sclerosis at improving depression, anxiety and quality of life.

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    BACKGROUND: Self-management interventions have become increasingly popular in the management of long-term health conditions; however, little is known about their impact on psychological well-being in people with Multiple Sclerosis (MS). PURPOSE: To examine the effectiveness of self-management interventions on improving depression, anxiety and health related quality of life in people with MS. METHOD: A structured literature search was conducted for the years 2000 to 2016. The review process followed the PRISMA guidelines, and is registered with PROSPERO (no. CRD42016033925). RESULTS: The review identified 10 RCT trials that fulfilled selection criteria and quality appraisal. Self-management interventions improved health-related quality of life in 6 out of 7 studies, with some evidence of improvement in depression and anxiety symptoms. CONCLUSION: Although the results are promising more robust evaluation is required in order to determine the effectiveness of self-management interventions on depression, anxiety and quality of life in people with MS. Evaluation of the data was impeded by a number of methodological issues including incomplete content and delivery information for the intervention and the exclusion of participants representing the disease spectrum. Recommendations are made for service development and research quality improvement

    Maternal body mass index, gestational weight gain, and the risk of overweight and obesity across childhood : An individual participant data meta-analysis

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    Background Maternal obesity and excessive gestational weight gain may have persistent effects on offspring fat development. However, it remains unclear whether these effects differ by severity of obesity, and whether these effects are restricted to the extremes of maternal body mass index (BMI) and gestational weight gain. We aimed to assess the separate and combined associations of maternal BMI and gestational weight gain with the risk of overweight/obesity throughout childhood, and their population impact. Methods and findings We conducted an individual participant data meta-analysis of data from 162,129 mothers and their children from 37 pregnancy and birth cohort studies from Europe, North America, and Australia. We assessed the individual and combined associations of maternal pre-pregnancy BMI and gestational weight gain, both in clinical categories and across their full ranges, with the risks of overweight/obesity in early (2.0-5.0 years), mid (5.0-10.0 years) and late childhood (10.0-18.0 years), using multilevel binary logistic regression models with a random intercept at cohort level adjusted for maternal sociodemographic and lifestylerelated characteristics. We observed that higher maternal pre-pregnancy BMI and gestational weight gain both in clinical categories and across their full ranges were associated with higher risks of childhood overweight/obesity, with the strongest effects in late childhood (odds ratios [ORs] for overweight/obesity in early, mid, and late childhood, respectively: OR 1.66 [95% CI: 1.56, 1.78], OR 1.91 [95% CI: 1.85, 1.98], and OR 2.28 [95% CI: 2.08, 2.50] for maternal overweight; OR 2.43 [95% CI: 2.24, 2.64], OR 3.12 [95% CI: 2.98, 3.27], and OR 4.47 [95% CI: 3.99, 5.23] for maternal obesity; and OR 1.39 [95% CI: 1.30, 1.49], OR 1.55 [95% CI: 1.49, 1.60], and OR 1.72 [95% CI: 1.56, 1.91] for excessive gestational weight gain). The proportions of childhood overweight/obesity prevalence attributable to maternal overweight, maternal obesity, and excessive gestational weight gain ranged from 10.2% to 21.6%. Relative to the effect of maternal BMI, excessive gestational weight gain only slightly increased the risk of childhood overweight/obesity within each clinical BMI category (p-values for interactions of maternal BMI with gestational weight gain: p = 0.038, p <0.001, and p = 0.637 in early, mid, and late childhood, respectively). Limitations of this study include the self-report of maternal BMI and gestational weight gain for some of the cohorts, and the potential of residual confounding. Also, as this study only included participants from Europe, North America, and Australia, results need to be interpreted with caution with respect to other populations. Conclusions In this study, higher maternal pre-pregnancy BMI and gestational weight gain were associated with an increased risk of childhood overweight/obesity, with the strongest effects at later ages. The additional effect of gestational weight gain in women who are overweight or obese before pregnancy is small. Given the large population impact, future intervention trials aiming to reduce the prevalence of childhood overweight and obesity should focus on maternal weight status before pregnancy, in addition to weight gain during pregnancy.Peer reviewe

    Epigenome-wide meta-analysis of blood DNA methylation in newborns and children identifies numerous loci related to gestational age

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    Background Preterm birth and shorter duration of pregnancy are associated with increased morbidity in neonatal and later life. As the epigenome is known to have an important role during fetal development, we investigated associations between gestational age and blood DNA methylation in children. Methods We performed meta-analysis of Illumina's HumanMethylation450-array associations between gestational age and cord blood DNA methylation in 3648 newborns from 17 cohorts without common pregnancy complications, induced delivery or caesarean section. We also explored associations of gestational age with DNA methylation measured at 4-18 years in additional pediatric cohorts. Follow-up analyses of DNA methylation and gene expression correlations were performed in cord blood. DNA methylation profiles were also explored in tissues relevant for gestational age health effects: fetal brain and lung. Results We identified 8899 CpGs in cord blood that were associated with gestational age (range 27-42 weeks), at Bonferroni significance, P <1.06 x 10(- 7), of which 3343 were novel. These were annotated to 4966 genes. After restricting findings to at least three significant adjacent CpGs, we identified 1276 CpGs annotated to 325 genes. Results were generally consistent when analyses were restricted to term births. Cord blood findings tended not to persist into childhood and adolescence. Pathway analyses identified enrichment for biological processes critical to embryonic development. Follow-up of identified genes showed correlations between gestational age and DNA methylation levels in fetal brain and lung tissue, as well as correlation with expression levels. Conclusions We identified numerous CpGs differentially methylated in relation to gestational age at birth that appear to reflect fetal developmental processes across tissues. These findings may contribute to understanding mechanisms linking gestational age to health effects.Peer reviewe

    Meta-analysis of epigenome-wide association studies in neonates reveals widespread differential DNA methylation associated with birthweight

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    Birthweight is associated with health outcomes across the life course, DNA methylation may be an underlying mechanism. In this meta-analysis of epigenome-wide association studies of 8,825 neonates from 24 birth cohorts in the Pregnancy And Childhood Epigenetics Consortium, we find that DNA methylation in neonatal blood is associated with birthweight at 914 sites, with a difference in birthweight ranging from -183 to 178 grams per 10% increase in methylation (P-Bonferroni <1.06 x 10(-7)). In additional analyses in 7,278 participants,Peer reviewe

    Gestational weight gain charts for different body mass index groups for women in Europe, North America and Oceania

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    Background: Gestational weight gain differs according to pre-pregnancy body mass index and is related to the risks of adverse maternal and child health outcomes. Gestational weight gain charts for women in different pre-pregnancy body mass index groups enable identification of women and offspring at risk for adverse health outcomes. We aimed to construct gestational weight gain reference charts for underweight, normal weight, overweight, and grade 1, 2 and 3 obese women and compare these charts with those obtained in women with uncomplicated term pregnancies.Methods: We used individual participant data from 218,216 pregnant women participating in 33 cohorts from Europe, North America and Oceania. Of these women, 9,065 (4.2%), 148,697 (68.1%), 42,678 (19.6%), 13,084 (6.0%), 3,597 (1.6%), and 1,095 (0.5%) were underweight, normal weight, overweight, and grade 1, 2 and 3 obese women, respectively. A total of 138, 517 women from 26 cohorts had pregnancies with no hypertensive or diabetic disorders and with term deliveries of appropriate for gestational age at birth infants. Gestational weight gain charts for underweight, normal weight, overweight, and grade 1, 2 and 3 obese women were derived by the Box-Cox t method using the generalized additive model for location, scale and shape. Results: We observed that gestational weight gain strongly differed per maternal pre-pregnancy body mass index group. The median (interquartile range) gestational weight gain at 40 weeks was 14.2 kg (11.4-17.4) for underweight women, 14.5 kg (11.5-17.7) for normal weight women, 13.9 kg (10.1-17.9) for overweight women, and 11.2 kg (7.0-15.7), 8.7 kg (4.3-13.4) and 6.3 kg (1.9-11.1) for grade 1, 2 and 3 obese women, respectively. The rate of weight gain was lower in the first half than in the second half of pregnancy. No differences in the patterns of weight gain were observed between cohorts or countries. Similar weight gain patterns were observed in mothers without pregnancy complications.Conclusions: Gestational weight gain patterns are strongly related to pre-pregnancy body mass index. The derived charts can be used to assess gestational weight gain in etiological research and as a monitoring tool for weight gain during pregnancy in clinical practice

    Stakeholder engagement in water policy:Lessons from peri-urban irrigation

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    In highly urbanised Australia many cities and towns demand may have exceeded existing water supply. In peri-urban areas this can lead to conflict over access to supplies with priority often given to urban users. In an effort to resolve potential conflicts, water management planning often seeks to engage ‘community stakeholders’ in an attempt to produce a ‘harmonised’ strategic plan. In this paper we focus on the process of developing one such plan for sustainable water management in a peri-urban area with complex and conflicting stakeholder interests. We subject data from a series of planning meetings and ‘stakeholder’ workshops to a critical review and analysis against the project's stated aims for this stage of the process of: engaging key stakeholders, developing a common vision, and deciding research priorities. We conclude that the approach was unable to achieve these strategic outcomes. In discussion we explore how this analysis reflects barriers in the engagement process, which highlight more general concerns about this widely accepted model for stakeholder engagement in resource issues

    From knowing it all to learning to engage – Experiences from Australian interventions in agricultural research and development in Vietnam

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    The Australian Assistance in Development organisation (AusAID) funded three projects over the last ten years as part of the Collaboration for Agriculture and Rural Development Program (CARD) with the initial objective to introduce Integrated Pest Management (IPM) based on mineral spray oil into citrus production in Vietnam. This objective later evolved from IPM to a broader Integrated Crop Management (ICM) approach and eventually to the introduction of procedures for Good Agricultural Practice (GAP). In this paper we discuss the evolution of the collaborative approaches in the consecutive projects, departing from making Vietnamese researchers introduce a preconceived, externally developed concept in their local socio‐economic and natural environments, to gradually facilitating the local partners to review potential innovations, test and adapt them, and develop management systems that suit the local conditions. This process resulted in linkages and interactions amongst local and international experts across disciplinary boundaries and between local stakeholders themselves. The final outcome of 15 years of collaborative work extended far beyond IPM, ICM and GAP resulting in the improved capacity of all stakeholders including farmers, extension and technical personnel from government organisations, non‐government organisations and private industry, scientists from research institutes and universities and representatives of local governments to respond to the local specific needs of farmers and the policy requirements of agricultural and rural development in Vietnam. The major outcome for Australian researchers was the realisation that humans (farmers) with their culture, habits and behaviours are a crucial part of the system in which our knowledge and technologies are to be utilised

    Mineral oils and their use : sustainable pest management and green agriculture

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    Litter decomposition and nitrogen mineralisation of soils in subtropical plantation forests of southern China, with special attention to comparisons between legumes and non-legumes

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    Litter decomposition and nitrogen mineralization were investigated in subtropical plantation forests in southern China. The CO2 –C release from incubated litter and the forest floor of Acacia mangium, Acacia auriculaeformis, Eucalyptus citriodora, Pinus elliotii and Schima superba stands were used to estimate relative rates of litter decomposition. Decomposition was not positively correlated with litter nitrogen. E. citridora litter decomposed most rapidly and A. mangium litter most slowly, both with and without the addition of exotic nitrogen. Aerobic incubation and intact soil core incubation at 30 °C over a period of 30 days were used to assess nitrogen mineralization of six forest soils. Although there were differences in results obtained using the two methods, patterns between legume and non-legume species were the same regardless of method. All soils had pH values below 4.5, but this did not prevent nitrification. The dominant form of mineral nitrogen was nitrate for legume species and ammonium for non-legume species. The nitrogen mineralization potential was highest for soils in which legumes were growing
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