Trends in body mass index and obesity prevalence in Western Australian adults, 2002 to 2015.

ISSUE ADDRESSED: Continued increases in overweight and obesity across most parts of the world in recent decades have seen maintaining or reaching a healthy weight become a major public health priority. This study reports on body mass index (BMI) and obesity prevalence trends in Western Australian adults between 2002 and 2015. METHODS: Self-reported height and weight were collected from Western Australian adults (16+ years) via 81 867 computer-assisted telephone interviews conducted between 2002 and 2015 as part of the WA Health and Wellbeing Surveillance System. Linear and quadratic trends in annual mean BMI and obesity prevalence estimates were generated from self-report data. These trends were subject to sequential sum of squares analysis to examine whether annual increases in mean BMI and obesity prevalence estimates diminished or were maintained over the 2002 to 2015 period. RESULTS: The analyses showed a preference for a quadratic model (with plots suggesting diminishing increases between 2002 and 2015) in mean BMI for males, 25- to 64-year-olds and across all adults, and in obesity prevalence estimates across all adults. CONCLUSIONS: The results suggest the rate at which mean BMI and obesity prevalence are increasing may be slowing overall and within specific groups in WA. SO WHAT?: The findings are potentially a positive news story for health in Western Australia. Even so, 2-thirds of the population are overweight or obese and there remains a strong need for sustained obesity prevention action.

The influence of estradiol on muscle damage and leg strength after intense eccentric exercise.

PURPOSE: To examine the influence of estradiol on muscle damage and leg strength after intense eccentric exercise. METHODS: Eight men (MEN), eight normally menstruating women (WomenNM), and eight women using oral contraceptives (WomenOC) participated in this study. Subjects performed 240 maximal-effort bilateral eccentric contractions of the quadriceps muscle groups designed to elicit exercise-induced muscle damage (EiMD). Serum creatine kinase (CK), myoglobin (Mb), and fatty acid-binding protein (FABP) concentrations were measured before (pre-) EiMD, as well as 0, 6, 24, and 48 h post-EiMD. Peak isometric quadriceps torque (i.e., leg strength) was measured pre-EiMD, as well as 24 and 48 h post-EiMD. RESULTS: The increases in CK, Mb, and FABP concentrations from pre- to post-EiMD were greater in MEN (10-fold, 15-fold, and fourfold, respectively) and WomenOC (sevenfold, 11-fold, and ninefold) compared with WomenNM (five-, six-, and threefold; p < 0.05). The decline in leg strength was about 10 % pre- to 24 h post-EiMD in all groups and decreased a further 10-15 % by 48 h post-EiMD in the MEN and WomenOC only. CONCLUSION: Our findings suggest an important role of estradiol in blunting the muscle damage response to intense eccentric exercise and preserving muscle function after EiMD.

Antenatal care provider's advice is the key determinant of influenza vaccination uptake in pregnant women.

BACKGROUND: Although influenza vaccination is an important component of antenatal care and is recommended and funded by the Australian government, vaccination uptake has been low. AIMS: This study compared seasonal influenza vaccination uptake among pregnant Western Australian (WA) women and identified factors associated with vaccination uptake. MATERIALS AND METHODS: Adult women who were pregnant during the 2012 and 2013 influenza vaccination seasons were selected at random and invited to complete a computer-assisted telephone interview survey about whether they received influenza vaccination during pregnancy. Data analyses were weighted to the age distribution of women of reproductive age in WA. Multivariate logistic regression was used to identify factors associated with vaccination uptake. RESULTS: Between 2012 and 2013, the proportion of WA women whose antenatal care provider recommended influenza vaccination increased from 37.6 to 62.1% and vaccination uptake increased from 23.0 to 36.5%. The antenatal care provider's advice to have influenza vaccine was the single most important factor associated with vaccination (OR 11.1, 95% CI 7.9-15.5). Most women (63.7%) were vaccinated in general practice, 18.8% in a public hospital antenatal clinic and 11.0% at their workplace. Wanting to protect their infant from infection (91.2%) and having the vaccine recommended by their GP (60.0%) or obstetrician (51.0%) were commonly reported reasons for vaccination; worrying about side effects was a common reason for nonvaccination. CONCLUSIONS: To optimise maternal and infant health outcomes, Australian antenatal care providers and services need to incorporate both the recommendation and delivery of influenza vaccination into routine antenatal care.

The effect of prior eccentric exercise on heavy-intensity cycling: the role of gender and oral contraceptives.

PURPOSE: To determine if gender and/or the use of oral contraceptives alter cycling performance with exercise-induced muscle damage (EiMD). METHODS: Nine male adults (MEN), nine normally menstruating female adults (WomenNM), and nine female adults using oral contraceptives (WomenOC) participated. Gas exchange and time to exhaustion were measured during continuous cycling performed at three distinct power outputs before (pre) and 48 h after (post) 240 maximal effort eccentric contractions of the quadriceps muscles designed to induce muscle damage (i.e., EiMD). RESULTS: The change in muscle damage (i.e., range of motion about the knee joint and serum creatine kinase activity) from pre- compared to post-EiMD was greater in MEN and WomenOC compared to the WomenNM. Time to exhaustion decreased after EiMD in MEN (5.19 ± 4.58 min, p = 0.01) and in WomenOC (2.86 ± 2.83 min, p = 0.02) but did not change in WomenNM (0.98 ± 2.28 min, p = 0.43). Accordingly, the slow component of O2 uptake, expressed relative to time to exhaustion (i.e., % min(-1)), was greater in post- compared to pre-EiMD for MEN (p = 0.02) and the WomenOC (p = 0.03), but not for the WomenNM (p = 0.12). CONCLUSION: The preservation of exercise tolerance during heavy-intensity cycling performed after intense eccentric exercise is improved in women compared to men. Furthermore, the preservation of exercise tolerance is exclusive to 17ß-estradiol and cannot be replicated with an exogenous synthetic estrogen replacement delivered in an oral contraceptive.

The carbon footprint of health care delivery in Western Australia's public health system.

Background: Health systems have a dual imperative to take action on climate change. First, they must develop climate resilient health services in response to the direct and indirect impacts of climate change on health. Second, they must reduce their own carbon footprint since health systems are a significant contributor to global greenhouse gas emissions. Methods: An environmentally-extended multi-region input-output analysis was carried out, incorporating National Accounts data for Australia and annual expenditure data from WA Health for financial year 2019-20. Expenditure data were categorised to one of 344 economic sectors and by location of the provider of goods or services purchased. Findings: WA Health contributes 8% of WA's total carbon footprint, driven by expenditure on chemicals (23.8% of total), transport (20.2% of total), and electricity supply (19.7% of total). These 3 sectors represent 63.7% of WA Health's carbon footprint, but only 10.8% of its total expenditure. Interpretation: Reducing emissions related to health service provision in WA will require a holistic approach that leverages carbon footprinting insights and integrates them into organisational decision-making across all health programs. The high carbon-intensity of the transport and chemicals sectors supports previous research calling for a reduction in unnecessary pathology testing and the transition to delivery of non-urgent health care via sustainable models of telehealth. The impact of WA's size and location presents challenges, with a predominantly non-renewable energy supply and reliance on transport and supply chains from other states adding significantly to emissions. Funding: The study received funding from the Australian Research Council, The University of Sydney, and the WA Department of Health. The full list of funding information can be found in Acknowledgements.

The management of acute complete ruptures of the ulnar collateral ligament of the thumb.

Aims: Complete ruptures of the ulnar collateral ligament (UCL) of the thumb are a common injury, yet little is known about their current management in the UK. The objective of this study was to assess the way complete UCL ruptures are managed in the UK. Methods: We carried out a multicentre, survey-based cross-sectional study in 37 UK centres over a 16-month period from June 2022 to September 2023. The survey results were analyzed descriptively. Results: A total of 37 centres participated, of which nine were tertiary referral hand centres and 28 were district general hospitals. There was a total of 112 respondents (69 surgeons and 43 hand therapists). The strongest influence on the decision to offer surgery was the lack of a firm 'endpoint' to stressing the metacarpophalangeal joint (MCPJ) in either full extension or with the MCPJ in 30° of flexion. There was variability in whether additional imaging was used in managing acute UCL injuries, with 46% routinely using additional imaging while 54% did not. The use of a bone anchor was by far the most common surgical option for reconstructing an acute ligament avulsion (97%, n = 67) with a transosseous suture used by 3% (n = 2). The most common duration of immobilization for those managed conservatively was six weeks (58%, n = 65) and four weeks (30%, n = 34). Most surgeons (87%, n = 60) and hand therapists (95%, n = 41) would consider randomizing patients with complete UCL ruptures in a future clinical trial. Conclusion: The management of complete UCL ruptures in the UK is highly variable in certain areas, and there is a willingness for clinical trials on this subject.

Effect of long-term oral contraceptive use on determinants of endurance performance.

We examined the effect of long-term oral contraceptive (OC) use on endurance performance in recreationally active women. Eight women using OC (OC group) and 8 women who were nonusers (CON group) performed a test to determine the peak oxygen uptake for cycling (V[Combining Dot Above]O2peak) and to estimate the anaerobic threshold (AT). Subjects also completed a continuous submaximal cycling test across 3 work stages (two 6-minute work stages below AT, and 1 above AT performed to exhaustion). Pulmonary gas exchange, heart rate (HR), blood pressure (BP), blood lactate concentration ([La]), and ratings of perceived exertion were measured throughout, and cycling economy was calculated. Physical characteristics were comparable between the groups (p > 0.05). Peak oxygen uptake (CON group: 2.59 ± 0.50 L·min; OC group: 2.13 ± 0.20 L·min) and oxygen uptake at the AT (CON group: 1.47 ± 0.27 L·min; OC group: 1.18 ± 0.15 L·min) were significantly different (p < 0.05) between the groups. Expired minute ventilation, HR, BP, [La], and cycling economy for all constant-load work stages were not significantly different (p > 0.05) between the groups. Furthermore, time to exhaustion for severe-intensity cycling was similar (p > 0.05) between the CON and OC groups. The results of the present study suggest that long-term OC use negatively affects peak V[Combining Dot Above]O2 and V[Combining Dot Above]O2 at the AT but does not alter endurance exercise performance.

Predictors of uptake of influenza vaccination--a survey of pregnant women in Western Australia.

BACKGROUND: Pregnant women are at increased risk of complications following influenza infection. Vaccination is the most effective preventive strategy. This survey aimed to determine the levels of uptake of influenza vaccine in pregnant women in Western Australia (WA), the proportion of women offered vaccination as part of antenatal care, and women's attitudes toward influenza vaccination in pregnancy. METHODS: Computer assisted telephone interviews were conducted with 416 randomly selected women who were pregnant during the 2012 influenza vaccination season. RESULTS: Influenza vaccination coverage was 23%. Predictors of vaccination included believing that vaccination is safe for the infant, having been recommended vaccination by an antenatal care provider, and attending a general practitioner for most antenatal care. The majority (74%) of unvaccinated women reported that they would have the vaccine if their antenatal care provider recommended it. DISCUSSION: General practitioners lead the way in antenatal influenza vaccination in WA. Vaccination coverage can be improved if recommending and offering influenza vaccination becomes a routine part of antenatal care.

Acute and chronic loading of sodium bicarbonate in highly trained swimmers.

In the present study, 200-m swim time in highly trained male swimmers was measured on two consecutive days (Trial 1 and Trial 2) and under three conditions [(1) acute loading, AcL; (2) chronic loading, ChL; (3) Placebo, PLA]. No sodium bicarbonate (NaHCO(3)) was administered between Trial 1 and Trial 2 under each condition. Blood lactate concentration ([La(-)]), base excess of extracellular fluid (BE(ecf)), plasma bicarbonate concentration ([HCO(3) (-)]) and pH were determined before and after capsule administration as well as at 0, 3, 5, 15 and 30 min after each 200-m swim trial. Swim time was not different among AcL, ChL or PLA for Trial 1 or 2 and we observed no change in 200-m swim time from Trial 1 to 2 under any condition (F = 0.48, P = 0.80). [HCO(3) (-)], pH and BE(ecf) measured after capsule administration was higher during AcL and ChL when compared with PLA (P < 0.05). We did not observe any difference in blood [La(-)] between the three conditions at any stage post-exercise (P > 0.05). The results indicate that acute and chronic loading of NaHCO(3) does not improve 200-m swim time in highly trained male swimmers.

Wait and transfer, curate and prosume: Women's social experiences of birth spaces architecture.

BACKGROUND: The birth environment can help or hinder physiological birth and influence a woman's level of satisfaction with birth. AIM: This paper gives new theoretical insights into how spatial architecture influences birthing women and their birth processes. It builds the architectural awareness of midwives/ designers need by linking design regulations/recommendations and experiential aspects of birth spaces architecture. METHODS: Two qualitative methods were used: (1) a regulation/policy document critique, and (2) childbearing women's spatial experiences explored in semi-structured interviews with drawing methods (24 mothers in a case study location in the north of England, UK). Themes emerged from semiotic (documents/visual data) and thematic (transcripts) analysis, and their relationships explored. FINDINGS: The regulatory documents revealed four spatial categorization concepts: (1) medical risk; (2) a tripartite clinical approach; (3) single-function birth space; and (4) a woman-centered approach. In contrast, women experience birth spaces architecture as an amalgam of all the spaces they use and in affective, interpersonal. Two patterns of spatial use emerged from the interviews: (1) 'wait and transfer' (more common in healthcare buildings); and (2) 'curate and prosume' (more common in women's homes). Women gave greater positive descriptions of the 'curate and prosume' pattern. CONCLUSIONS: The influence of building regulations on hospital settings and women's prior experiences of such spaces through appointments and antenatal education, shape women's spatial experiences of childbirth. This new evidence can act as a catalyst to evolve birth space design towards delivering woman-centered and personalized care in spaces designed for women to 'curate and prosume'.

Seromic analysis of antibody responses in non-small cell lung cancer patients and healthy donors using conformational protein arrays.

Analysis of antibody responses to self-antigens has driven the development of the field of tumor immunology, with the identification of many protein targets found in cancer but with limited expression in normal tissues. Protein microarray technologies offer an unprecedented platform to assay the serological response of cancer patients to tumor antigens in a comprehensive fashion, against many proteins simultaneously. We developed an array containing 329 full-length proteins, originally identified as antigenic in various cancer patients by serological expression cloning (SEREX), that were immobilized as folded, functional products accessible for antibody binding. To validate the use of these microarrays, we selected 31 sera from non-small cell lung cancer patients previously known to react to the following antigens by ELISA: LAGE-1/CTAG2, MAGEA4, TP53, SSX and SOX2. These sera were compared with 22 sera from healthy donors for reactivity against a series of antigens present on microarrays. The sensitivity and specificity of the arrays compared favorably with standard ELISA techniques (94% concordance). We present here a stringent strategy for data analysis and normalization that is applicable to protein arrays in general, and describe findings suggesting that this approach is suitable for defining potential antigenic targets for cancer vaccine development, serum antibody signatures with clinical value, characterization of predictive serum markers for experimental therapeutics, and eventually for the serological definition of the cancer proteome (seromics).

Water disinfection by-products and pre-labor rupture of membranes.

The causes of term pre labor rupture of membranes (term PROM) remain poorly defined. The authors conducted a record-based prevalence study to explore a possible relation between disinfection by-products in drinking water and term PROM in an Australian community with spatially variable trihalomethane and nitrate levels. A multilevel statistical model was used to examine the relation between factors operating at the levels of the individual, district, and water distribution zone and the prevalence of PROM at term among 16,229 women in Perth, Western Australia (2002-2004). Adjusted odds ratios for term PROM increased with increasing tertiles of nitrate exposure (moderate exposure: odds ratio = 1.23, 95% confidence interval: 1.03, 1.52; high exposure: odds ratio = 1.47, 95% confidence interval: 1.20, 1.79), but there was no significant relation with exposure to trihalomethanes. This study raises the possibility that water contaminants may promote the development of PROM at term.

A study of the structural correlates of affinity maturation: antibody affinity as a function of chemical interactions, structural plasticity and stability.

Mutations introduced in an antibody germline sequence as a result of somatic hypermutation could cause its derivatives to have an altered affinity for its target. Affinity maturation favors the selection of the antibodies which exhibit increased affinity. The mutations in 80 high affinity anti-thyroid peroxidase sequences derived from six germlines were analysed in terms of the physicochemical properties of the replacement residues, namely hydrophilicity, size and polarizability, and charge and polarity, in the context of its position and probable solvent accessibility. The effects of these substitutions were evaluated in terms of the resultant increased chemical interactivity potential of the affinity-matured antibodies relative to the germline. The results of the analysis would be useful in the rational design of antibodies and of other proteins for improved binding properties.

Oral contraceptives augment the exercise pressor reflex during isometric handgrip exercise.

We sought to determine whether oral contraception alters the gender-related differences observed in the exercise pressor reflex during isometric handgrip exercise. Fifteen men, fifteen normally menstruating women (WomenNM), and fifteen women taking monophasic oral contraceptives (WomenOC) completed two trials of a 3-min isometric handgrip exercise protocol performed at 30% of their maximal voluntary contraction: (1) where arterial occlusion was applied to the previously exercising arm during a 3-min recovery period (Occlusion trial); (2) where no arterial occlusion was applied during recovery (Control trial). Handgrip exercise elicited greater increases in mean arterial pressure (MAP) in MEN compared to both female groups (P < 0.05), and in WomenOC compared to WomenNM in both trials (P = 0.01, P = 0.03). After 3 min of recovery, sBP was 12% (P = 0.01) and 9% (P = 0.02) higher in the Occlusion trial when compared to the Control trial for MEN and WomenOC. Conversely, arterial occlusion in recovery from handgrip did not sustain elevated sBP in the Occlusion trial, and sBP returned to recovery levels not different to the Control trial, in WomenNM (P = 0.41). These data indicate that gender-related differences in the metaboreflex during isometric handgrip exercise exist between men and normally menstruating women, but are blunted when men are compared to women taking oral contraceptives. We conclude that the suppression of 17ß-estradiol and/or progestogen in women via the administration of oral contraceptives attenuates sex-related differences in the metaboreflex during isometric handgrip exercise.

Physical Activity and Survival among Long-term Cancer Survivor and Non-Cancer Cohorts.

Evidence suggests physical activity improves prognosis following cancer diagnosis; however, evidence regarding prognosis in long-term survivors of cancer is scarce. We assessed physical activity in 1,589 cancer survivors at an average 8.8 years following their initial diagnosis and calculated their future mortality risk following physical activity assessment. We also selected a cancer-free cohort of 3,145 age, sex, and survey year group-matched cancer-free individuals from the same source population for comparison purposes. Risks for cancer-specific mortality and all-cause mortality in relation to physical activity levels were estimated using Cox regression proportional hazard regression analyses within the cancer and non-cancer cohorts. Physical activity levels of 360+ min per week were inversely associated with cancer-specific mortality in long-term cancer survivors [hazard ratios (HR) = 0.30 (95% confidence intervals (CI) 0.13-0.70)] and participants without prior cancer [HR = 0.16 (95% CI 0.05-0.56)] compared with no reported physical activity. Physical activity levels of 150-359 and 360+ min were inversely associated with all-cause mortality in long-term cancer survivors [150-359 min; HR = 0.55 (95% CI 0.31-0.97), 360+ min; HR = 0.41 (95% CI 0.21-0.79)] and those without prior cancer [150-359 min; HR = 0.52 (95% CI 0.32-0.86), 360+ min; HR = 0.50 (95% CI 0.29-0.88)]. These results suggest that meeting exercise guidelines of 150 min of physical activity per week were associated with reduced all-cause mortality in both long-term cancer surviving and cancer-free cohorts. Exceeding exercise oncology guidelines (360+ min per week) may provide additional protection in terms of cancer-specific death.

Neonatal development of the corneal stroma in wild-type and lumican-null mice.

PURPOSE: Between days 8 and 14 of neonatal development, the corneal stroma of the mouse undergoes critical changes in tissue thickness, cell density, and light scattering. The authors investigate the stromal matrix structure in wild-type and lumican-deficient corneas in this developmental phase. METHODS: Wild-type (n = 44) and lumican-deficient (n = 42) mouse corneas at neonatal days 8, 10, 12, and 14 were investigated by synchrotron x-ray diffraction to establish the average collagen fibril spacing, average collagen fibril diameter, and level of fibrillar organization in the stromal matrix. RESULTS: Collagen interfibrillar spacing in the normal mouse cornea became more closely packed between days 8 and 14, though not significantly so. In lumican-null mice, interfibrillar spacing was significantly elevated at days 8, 10, and 12, but not day 14, compared with that in wild-type mice. At all stages investigated, collagen fibrils were, on average, marginally thinner than normal in lumican-null mutants, and the spatial distribution of the fibrils was less well organized. CONCLUSIONS: Transient thickening of the corneal stroma of the normal mouse at eye opening is probably not caused by widespread, homogeneous rearrangement of collagen fibrils but more likely by a temporary increase in cell or stromal "lake" volume. Lumican, structurally influential in adult mouse corneas, is also a key molecule in the neonatal development of the stromal matrix.

The lymphatic phenotype in Noonan and Cardiofaciocutaneous syndrome.

The RASopathies, which include Noonan syndrome (NS) and Cardiofaciocutaneous syndrome (CFC), are autosomal dominant disorders with genetic heterogeneity associated with germline mutations of genes in the Ras/mitogen-activated protein kinase (MAPK; RAS-MAP kinase) pathway. The conditions overlap and are characterised by facial dysmorphism, short stature and congenital heart disease. NS and CFC, in particular, are known to be associated with lymphatic problems, but this has not been well characterised to date. We describe 11 patients with Noonan or CFC syndrome with significant, persistent and progressive lymphatic dysplasia. The lymphatic disorders in Noonan and CFC syndrome are rare, but have a characteristic pattern with bilateral lower limb lymphoedema, genital swelling with chylous reflux and frequent systemic involvement, including intestinal lymphangiectasia and chylothoraces, which may be progressive. Lymphoscintigraphy demonstrates reflux and/or rerouting of lymphatic drainage associated with incompetent veins on the venous duplex scans.

Lumican regulates corneal inflammatory responses by modulating Fas-Fas ligand signaling.

PURPOSE: The authors have previously shown that apoptosis of stromal cells is downregulated in the lumican-null mouse and that this may be due to disruption of Fas-Fas ligand (FasL) signaling. The present study was undertaken to investigate the role of lumican in regulating Fas and its impact on inflammation and healing of corneal injuries. METHODS: Apoptosis was determined by measuring caspase-3/7 activity in corneal extracts. Protein and RNA levels of Fas were estimated by immunoblot analysis and RT-PCR, respectively. Circular and incisional stromal wounds were exposed to Pseudomonas aeruginosa LPS, and healing was assessed by (1) observing wound closure with fluorescence and bright-field microscopy, (2) histology to quantify inflammatory infiltrates by immunostaining for macrophages (F4/80) and neutrophils (NIMP-R14), (3) measuring myeloperoxidase (MPO) levels by ELISA to quantify neutrophils, and (4) measuring proinflammatory cytokines by ELISA. RESULTS: Lum-/- -injured corneas showed significantly lower caspase-3/7 activity (apoptosis). Lum-/- -wounded corneas showed delayed healing, reduced recruitment of macrophages and neutrophils, lower MPO levels, and no induction of the proinflammatory cytokines TNFalpha and IL1beta. The Fas protein level, before and after wounding, was dramatically lower in Lum-/- - compared with Lum+/+-injured cornea. However, Fas mRNA levels were comparable in both genotypes, suggesting regulation of Fas at the protein level. Moreover, a solid-state binding assay and coimmunoprecipitation of FasL and lumican suggested binding of FasL to lumican. CONCLUSIONS: The data suggest that lumican binds FasL and facilitates induction of Fas. Poor signaling through Fas-FasL in lumican deficiency leads to impaired induction of inflammatory cytokines and corneal healing.