The impact of anti-mould prophylaxis on Aspergillus PCR blood testing for the diagnosis of invasive aspergillosis.

BACKGROUND: The performance of the galactomannan enzyme immunoassay (GM-EIA) is impaired in patients receiving mould-active antifungal therapy. The impact of mould-active antifungal therapy on Aspergillus PCR testing needs to be determined. OBJECTIVES: To determine the influence of anti-mould prophylaxis (AMP) on the performance of PCR blood testing to aid the diagnosis of proven/probable invasive aspergillosis (IA). METHODS: As part of the systematic review and meta-analysis of 22 cohort studies investigating Aspergillus PCR blood testing in 2912 patients at risk of IA, subgroup analysis was performed to determine the impact of AMP on the accuracy of Aspergillus PCR. The incidence of IA was calculated in patients receiving and not receiving AMP. The impact of two different positivity thresholds (requiring either a single PCR positive test result or ≥2 consecutive PCR positive test results) on accuracy was evaluated. Meta-analytical pooling of sensitivity and specificity was performed by logistic mixed-model regression. RESULTS: In total, 1661 (57%) patients received prophylaxis. The incidence of IA was 14.2%, significantly lower in the prophylaxis group (11%-12%) compared with the non-prophylaxis group (18%-19%) (P < 0.001). The use of AMP did not affect sensitivity, but significantly decreased specificity [single PCR positive result threshold: 26% reduction (P = 0.005); ≥2 consecutive PCR positive results threshold: 12% reduction (P = 0.019)]. CONCLUSIONS: Contrary to its influence on GM-EIA, AMP significantly decreases Aspergillus PCR specificity, without affecting sensitivity, possibly as a consequence of AMP limiting the clinical progression of IA and/or leading to false-negative GM-EIA results, preventing the classification of probable IA using the EORTC/MSGERC definitions.

Interlaboratory evaluation of Mucorales PCR assays for testing serum specimens: A study by the fungal PCR Initiative and the Modimucor study group.

Interlaboratory evaluations of Mucorales qPCR assays were developed to assess the reproducibility and performance of methods currently used. The participants comprised 12 laboratories from French university hospitals (nine of them participating in the Modimucor study) and 11 laboratories participating in the Fungal PCR Initiative. For panel 1, three sera were each spiked with DNA from three different species (Rhizomucor pusillus, Lichtheimia corymbifera, Rhizopus oryzae). For panel 2, six sera with three concentrations of R. pusillus and L. corymbifera (1, 10, and 100 genomes/ml) were prepared. Each panel included a blind negative-control serum. A form was distributed with each panel to collect results and required technical information, including DNA extraction method, sample volume used, DNA elution volume, qPCR method, qPCR template input volume, qPCR total reaction volume, qPCR platform, and qPCR reagents used. For panel 1, assessing 18 different protocols, qualitative results (positive or negative) were correct in 97% of cases (70/72). A very low interlaboratory variability in Cq values (SD = 1.89 cycles) were observed. For panel 2 assessing 26 different protocols, the detection rates were high (77-100%) for 5/6 of spiked serum. There was a significant association between the qPCR platform and performance. However, certain technical steps and optimal combinations of factors may also impact performance. The good reproducibility and performance demonstrated in this study support the use of Mucorales qPCR as part of the diagnostic strategy for mucormycosis.

Within-species relationship of patchiness to both abundance and occupancy, as exemplified by seagrass macrobenthos.

For the first time, intraspecific relationships between the macroecological metrics patchiness (P) and both abundance (A) and occupancy (O) were investigated in a faunal assemblage. As a companion study to recent work on interspecific P, A and O patterns at the same localities, intraspecific patterns were documented within each of the more dominant invertebrates forming the seagrass macrobenthos of warm-temperate Knysna estuarine bay (South Africa) and of sub-tropical Moreton Bay (Australia). As displayed interspecifically, individual species showed strong A-O patterns (mean scaling coefficient - 0.76 and mean R2 > 0.8). All P-O relations were negative and most (67%) were statistically significant, although weaker (mean R2 0.5) than A-O ones; most P-A ones were also negative but fewer (43%) achieved significance, and were even weaker (mean R2 0.4); 33% of species showed no significant interrelations of either O or A with P. No species showed only a significant P-A relationship. Compared with interspecific P-A-O data from the same assemblages, power-law scaling exponents were equivalent, but R2 values were larger. Larviparous species comprised 70% of the total studied, but 94% of those displaying significant patchiness interrelationships; 5 of the 9 showing no P-A or P-O relationships, however, were also larviparous. At Knysna, though not in Moreton Bay, larviparous species also showed higher levels of occupancy than non-larviparous ones, whilst non-larviparous species showed higher levels of patchiness. Dominant Moreton Bay species, but not those at Knysna, exhibited homogeneously sloped P-O relationships.

Low-flow apnoeic oxygenation for laryngeal surgery: a prospective observational study.

Laryngeal surgery requires a shared airway and close collaboration between surgeon and anaesthetist in order to optimise operating conditions. Apnoeic oxygenation uses the principle of aventilatory mass flow to maintain oxygenation of pulmonary capillary blood under apnoeic conditions while minimising laryngeal movement. Concerns regarding accumulation of carbon dioxide and resultant acidaemia have limited the use of the technique. We performed a prospective study of low-flow apnoeic oxygenation for patients undergoing microlaryngoscopy under general anaesthesia in order to evaluate the ability of the technique to maintain oxygenation and determine the resultant rate of carbon dioxide accumulation. Sixty-four patients undergoing microlaryngoscopy under general anaesthesia were studied between November 2016 and December 2018. Intra-operative oxygenation was provided via a 10-French oxygen catheter placed into the trachea delivering oxygen at 0.5-1.0 l.min-1 . Data regarding apnoea time, peripheral oxygen saturation and venous blood gas concentrations were recorded. The mean (SD) duration of apnoea was 18.7 (7.2) min. Apnoeic oxygenation allowed successful completion of the surgical procedure in 62/64 patients. Mean (SD) rate of rise of the venous partial pressure of carbon dioxide was 0.15 (0.10) kPa.min-1 . Operating conditions were recorded qualitatively as being adequate in all cases. No adverse effects were reported. Low-flow intra-tracheal apnoeic oxygenation is a simple, effective and inexpensive technique to maintain oxygenation for laryngeal surgery.

Supporting individuals with intellectual and developmental disability during the first 100 days of the COVID-19 outbreak in the USA.

BACKGROUND: It is unknown how the novel Coronavirus SARS-CoV-2, the cause of the current acute respiratory illness COVID-19 pandemic that has infected millions of people, affects people with intellectual and developmental disability (IDD). The aim of this study is to describe how individuals with IDD have been affected in the first 100 days of the COVID-19 pandemic. METHODS: Shortly after the first COVID-19 case was reported in the USA, our organisation, which provides continuous support for over 11 000 individuals with IDD, assembled an outbreak committee composed of senior leaders from across the health care organisation. The committee led the development and deployment of a comprehensive COVID-19 prevention and suppression strategy, utilising current evidence-based practice, while surveilling the global and local situation daily. We implemented enhanced infection control procedures across 2400 homes, which were communicated to our employees using multi-faceted channels including an electronic resource library, mobile and web applications, paper postings in locations, live webinars and direct mail. Using custom-built software applications enabling us to track patient, client and employee cases and exposures, we leveraged current public health recommendations to identify cases and to suppress transmission, which included the use of personal protective equipment. A COVID-19 case was defined as a positive nucleic acid test for SARS-CoV-2 RNA. RESULTS: In the 100-day period between 20 January 2020 and 30 April 2020, we provided continuous support for 11 540 individuals with IDD. Sixty-four per cent of the individuals were in residential, community settings, and 36% were in intermediate care facilities. The average age of the cohort was 46 ± 12 years, and 60% were male. One hundred twenty-two individuals with IDD were placed in quarantine for exhibiting symptoms and signs of acute infection such as fever or cough. Sixty-six individuals tested positive for SARS-CoV-2, and their average age was 50. The positive individuals were located in 30 different homes (1.3% of total) across 14 states. Fifteen homes have had single cases, and 15 have had more than one case. Fifteen COVID-19-positive individuals were hospitalised. As of 30 April, seven of the individuals hospitalised have been discharged back to home and are recovering. Five remain hospitalised, with three improving and two remaining in intensive care and on mechanical ventilation. There have been three deaths. We found that among COVID-19-positive individuals with IDD, a higher number of chronic medical conditions and male sex were characteristics associated with a greater likelihood of hospitalisation. CONCLUSIONS: In the first 100 days of the COVID-19 outbreak in the USA, we observed that people with IDD living in congregate care settings can benefit from a coordinated approach to infection control, case identification and cohorting, as evidenced by the low relative case rate reported. Male individuals with higher numbers of chronic medical conditions were more likely to be hospitalised, while most younger, less chronically ill individuals recovered spontaneously at home.

Efficacy and safety of point-of-care ultrasound-guided intra-articular corticosteroid joint injections in patients with haemophilic arthropathy.

INTRODUCTION AND OBJECTIVES: Intra-articular corticosteroid injections are standard of care for managing joint pain secondary to osteoarthritis or rheumatoid arthritis but are rarely used in haemophilic arthropathy. We have introduced and evaluated the efficacy and safety of ultrasound-guided corticosteroid injections for pain relief in patients with haemophilic arthropathy. PATIENTS AND METHODS: Ultrasound-guided intra-articular injections performed on haemophilia patients at UCSD between March 2012 and January 2016 were analysed. Needle placement and injection (40 mg triamcinolone; 3-5 mL lidocaine) were performed with musculoskeletal ultrasound and Power Doppler. Analysis included patient demographics, joint-specific parameters such as tissue hypervascularity and effusions, pain relief, and procedure-associated complications. RESULTS: Forty-five injections (14 ankles, 13 elbows, 18 knees) were administered in 25 patients. Advanced arthropathy with hypervascularity and/or effusions was present in 91% and 61% of joints, respectively. Ninety-one per cent of injections resulted in pain relief which was significant in 84% (>30% reduction). Median pain score was reduced from 7 of 10 to 1 of 10 (P < 0.001), usually within 24 h. Median duration of pain relief was 8 weeks (range 1-16 weeks). Haemophilia B patients experienced longer periods of relief, and high Pettersson scores were associated with shorter duration of relief. There were no procedure-associated complications. Repeat ultrasound of eight joints within 4 weeks of injection demonstrated nearly complete resolution of hypervascularity. CONCLUSIONS: Point-of-care ultrasound enabled intra-articular corticosteroid injections that provided highly effective, safe, and relatively long-lasting pain relief in haemophilic arthropathy. This approach should be used to improve pain management in haemophilic arthropathy.

Words will never hurt me? Preferred terms for describing obesity and binge eating.

OBJECTIVE: This study evaluated individuals' language preferences for discussing obesity and binge eating. METHOD: Participants (N = 817; 68.3% female) were an online community sample. They rated the desirability of terms related to obesity and binge eating, and also completed psychometrically established eating-disorder measures. In addition to examining participants' preferences, analyses explored whether preferences differed by socio-demographic variables, weight status and binge-eating status. RESULTS: Preferred obesity-related terms were weight and BMI, although women rated undesirable obesity-related terms even lower than did men. Participants with obesity and binge eating rated weight, BMI, unhealthy BMI and large size as less desirable than participants with obesity but not binge eating. Binge-related terms were generally ranked neutrally; preferred descriptions were kept eating even though not physically hungry and loss of control. CONCLUSIONS: Preferred terms were generally consistent across sex, weight status and binge-eating status. Using terms ranked more preferably and avoiding terms ranked more undesirably may enhance clinical interactions, particularly when discussing obesity with women and individuals reporting binge eating, as these groups had stronger aversion to some non-preferred terms. Findings that the selected binge-related descriptions were rated neutrally on average provide support for their use by clinicians.

Progression of diabetic retinopathy after bariatric surgery.

AIM: To assess the impact of bariatric surgery on the progression of diabetic retinopathy in patients with Type 2 diabetes. METHOD: We conducted a retrospective, observational study of patients with Type 2 diabetes who underwent bariatric surgery between 1 January 2001 and 31 December 2012 and had hospital-based retinal screening records. Data were collected from four surgical centres. Those who had pre-operative retinal screening and at least one post-operative retinal screen were eligible for analysis. A generalized linear mixed model was used to explore significant clinical predictors on the post-operative grade severity over time, controlling for important baseline characteristics. RESULTS: Three hundred and eighteen patients were eligible for analysis. Of these, 68.6% had no diabetic retinopathy pre-operatively compared with 18.9%, 8.5% and 4% with a diabetic retinopathy grade of minimal, mild or moderate and higher, respectively. First post-operative retinal screening results showed that after surgery 73% had no change in their diabetic retinopathy grade, 11% regressed and 16% progressed. The probability of having a diabetic retinopathy grade of moderate or higher over time post surgery was significantly associated with the magnitude of HbA1c reduction from pre-surgery HbA1c levels, a shorter post-operative retinal screening duration, more severe pre-operative retinal screening grade, male gender and non-Maori/Pacific ethnicity. CONCLUSIONS: A higher pre-operative diabetic retinopathy grade, and a large decrease in HbA1c post surgery warrant closer monitoring of diabetic retinopathy after bariatric surgery. Further prospective, randomized studies are required to investigate the gender and ethnic differences found.

Older adults' outdoor walking and the built environment: does income matter?

BACKGROUND: Our aim was to examine the association between Street Smart Walk Score® and self-reported outdoor walking among older Canadians, and to determine whether socioeconomic status modifies this association. METHODS: We linked objective walkability data with cross-sectional survey data from the Canadian Community Health Survey Healthy-Aging 2008-2009 Cycle for a sample of 1309 British Columbians aged ≥ 65 years. We examined associations between Street Smart Walk Score and meeting physical activity guidelines (≥150 min of moderate to vigorous activity/week) through self-reported outdoor walking using multivariable logistic regression, and tested for significant interactions with household income. RESULTS: A ten point higher Street Smart Walk Score was associated with a 17 % higher odds of meeting physical activity guidelines through walking outside (95 % CI: 1.07,1.27). In addition, older adults living in neighbourhoods categorised as Walker's Paradise were over three times more likely to meet guidelines than those living in Car-dependent/Very car dependent neighbourhoods. We found no evidence that household income moderated the effect of Walk Score on walking outside. CONCLUSIONS: Neighbourhood design may be one avenue whereby physical activity levels of older people can be enhanced through outdoor walking, with benefit across socioeconomic strata.

Uca cryptica Naderloo, Türkay & Chen, 2010 (Crustacea: Brachyura:Ocypodidae) is no longer cryptic.

Uca cryptica Naderloo, Türkay & Chen, 2010, was originally described from four male specimens found in museum collections without any information regarding the site of collection. We present the first recorded field observations of this species and new morphological features. Specimens were observed and collected in the Wakatobi National Park, on the island of Kaledupa, Sulawesi Tenggara, Indonesia. Colouration of both males and females is described and ecology and distribution are noted. Uca cryptica has been seen coexisting with nine other species; one of the highest recorded numbers of Uca species living in sympatry.

Randomized clinical trial of selective versus routine preoperative duplex ultrasound imaging before arteriovenous fistula surgery.

BACKGROUND: Anatomical suitability for arteriovenous fistula (AVF) formation was formerly determined by clinical examination alone. There are potential benefits from imaging to assess anatomical suitability. Existing studies examined the role of routine preoperative ultrasonography versus clinical examination alone. The role of a selective duplex ultrasound imaging policy is unknown. This study aimed to compare a policy of selective versus routine ultrasound assessment before AVF formation. METHODS: All patients referred for fistula formation were assessed for inclusion. Suitable patients were randomized to either routine or selective preoperative ultrasound imaging; selective imaging was performed only when clinical criteria were not met. The primary outcome measures were site of AVF formation and 30-day primary failure rate, and secondary outcome measures included the rate of complications. RESULTS: A total of 106 patients were assessed, and 94 were randomized: 47 to selective and 47 to routine duplex ultrasonography. The groups were well matched for age, co-morbidities and medications. The primary failure rate (29 per cent overall) was not significantly different between the selective and routine imaging groups: 36 per cent (14 of 39) and 21 per cent (8 of 38) respectively (P = 0·144). There were no significant differences in the sites of AVF formation or complication rates. CONCLUSION: Routine preoperative ultrasound vessel imaging did not significantly reduce early failure rates, influence the site of AVF formation or reduce complications. If clinical evaluation detects anatomy suitable for AVF formation, duplex imaging may not be needed. REGISTRATION NUMBER: NCT01004627 (http://www.clinicaltrials.gov).

Clinical and economic burden of invasive fungal diseases in Europe: focus on pre-emptive and empirical treatment of Aspergillus and Candida species.

Invasive fungal diseases (IFDs) have been widely studied in recent years, largely because of the increasing population at risk. Aspergillus and Candida species remain the most common causes of IFDs, but other fungi are emerging. The early and accurate diagnosis of IFD is critical to outcome and the optimisation of treatment. Rapid diagnostic methods and new antifungal therapies have advanced disease management in recent years. Strategies for the prevention and treatment of IFDs include prophylaxis, and empirical and pre-emptive therapy. Here, we review the available primary literature on the clinical and economic burden of IFDs in Europe from 2000 to early 2011, with a focus on the value and outcomes of different approaches.

Ruptured AAA: suitability for endovascular repair is associated with lower mortality following open repair.

OBJECTIVES: Perioperative mortality of open repair of ruptured abdominal aortic aneurysms (rAAA) remains unacceptably high: 30-day mortality ≈ 40 %. This study aimed to assess, quantify, and determine the consequences of anatomic suitability for endovascular repair of rAAA. DESIGN: A retrospective analysis of the prospectively maintained database identified patients with rAAA. METHODS: Preoperative CT scans were assessed for anatomic suitability for emergency EVAR and precluding factors recorded. Demographic information was collected and analysed for all patients. RESULTS: A total of 141 patients underwent open surgical repair of rAAA. Forty-six patients had preoperative CT scans suitable for reconstruction. Morphological measurements indicated that 41 % would have been anatomically suitable for EVAR. Suitability was associated with lower mortality rates than unsuitability: 0, 11, and 20 % (24 h, 30 days, and 1 year respectively) versus 11, 33, and 59 % (statistically significant at 1 year; p = 0.02). The groups were comparable excepting diabetes incidence, which was higher in those suitable for EVAR (p = 0.003). CONCLUSIONS: A minority of patients with ruptured AAA are anatomically suitable for EVAR. Anatomical suitability appears to identify patients at low risk from open surgery. Whether this is due to technically less demanding open surgery is unknown. This may be resolved by the IMPROVE trial results, which are eagerly awaited.

Microscale dispersion of intertidal seagrass macrofauna.

Previous studies of dispersion of intertidal seagrass-associated macrobenthos in subtropical Moreton Bay, Queensland, showed that patchiness characterised its assemblage abundance with scale-invariant magnitude across areas ranging from >8000 to 0.1 m2. Those studies were here continued across the smaller scales (down to 0.014 m2) arguably more relevant to the dominant 2-10 mm long animals, using 16 replicate blocks of 5x5 contiguous 0.0024 m2 cores nested within the previously studied site. At microscales ≥0.09 m2, the earlier congruence of conclusions derived from patchiness indices and spatial autocorrelation broke down. At >0.014 m2, adjacent points (cores) no longer together formed larger spatial units of related abundance (i.e. showed no autocorrelation), but point abundances were still highly disparate (as reflected in patchiness indices). Congruent indications of patchiness only manifested at 0.014 m2 spatial scales. Assemblage dispersion pattern was partly consequent on one microgastropod (Pseudoliotia) occurring superabundantly in scattered 0.0024 m2 hotspots.

Firearm Access and Gun Violence Exposure Among American Indian or Alaska Native and Black Adults.

Importance: American Indian or Alaska Native and Black adults experience elevated rates of firearm injury and death, but both groups are severely underrepresented in research on firearm exposure and behaviors. Objective: To explore geodemographic differences in firearm behaviors and violence exposure among American Indian or Alaska Native and Black adults in the US. Design, Setting, and Participants: In this survey study, nationally representative samples of American Indian or Alaska Native and/or Black adults recruited from KnowledgePanel were surveyed cross-sectionally. Surveys were administered online between April 12 and May 4, 2023. Main Outcomes and Measures: Firearm access, storage, and carrying behaviors and lifetime firearm violence exposure were the primary outcomes. Demographic factors such as age, geographic location, and political affiliation were considered. Data were weighted to geodemographic distributions from the US Census Bureau's 2022 Current Population Survey. Results: Of 3542 participants, 527 (14.9%) were American Indian or Alaska Native (280 [53.1%] female) and 3015 (85.1%) were Black (1646 [54.6%] female). Both groups exhibited high firearm access rates (American Indian or Alaska Native adults: 238 [45.4%; 95% CI, 39.4%-51.7%]; Black adults: 909 [30.4%; 95% CI, 28.0%-32.9%]), predominantly owning handguns for home protection. The groups demonstrated similar firearm storage patterns, and a substantial proportion endorsed always or almost always carrying firearms outside the home (American Indian or Alaska Native adults: 18.9%; Black adults: 15.2%). Self-protection was a common reason for carrying a firearm (American Indian or Alaska Native adults: 104 [84.9%; 95% CI, 74.1%-91.7%]; Black adults: 350 [88.3%; 95% CI, 82.3%-92.4%]), and a minority of participants cited lack of faith in the police (American Indian or Alaska Native adults: 19 [15.2%; 95% CI, 8.2%-26.7%]; Black adults: 61 [15.4%; 95% CI, 10.3%-21.2%]), indicating potential shifts in public safety dynamics. Conclusions and Relevance: In this survey study of American Indian or Alaska Native and Black US adults, a substantial percentage of both groups reported living in homes with firearms, storing firearms loaded and unlocked, frequently carrying firearms outside the home, and having been exposed directly and indirectly to gun violence. These findings underscore the need for nuanced public health campaigns and policies and highlight challenges for law enforcement in contexts of racial disparities and changing legal frameworks.

The use of a pre-hospital questionnaire expedited the acute management of patients with ischemic stroke in a comprehensive stroke center.

BACKGROUND: Delays in intravenous thrombolysis (IVT) treatment for acute ischemic stroke decrease the benefit of treatment. Difficulties determining a patient's clinical eligibility for IVT is a frequent cause of treatment delays. OBJECTIVE: We aimed to assess the effectiveness of the "PROVIDENCE" datasheet, a pre- hospital assessment of contraindications for IVT use applied by emergency medical services personnel. METHODS: We performed a single-center cohort study comparing IVT decision and treatment times between patients with PROVIDENCE datasheets and those without. Patients were eligible if they were over 18 years old and presented to our comprehensive stroke center from the field with stroke-like symptoms with onset within 4.5 hours. RESULTS: We identified 465 records and included 166 records in our final analysis (54 in the study group and 112 in the control group). A subgroup of 85 patients received IVT (30 in the study group patients and 55 in the control group). The PROVIDENCE datasheet was associated with a faster median time by five minutes from the patient's initial presentation at the emergency department to the final decision regarding IVT eligibility (p = 0.032) and a faster time between the first encounter with a neurology provider and the decision regarding IVT administration by six minutes (p = 0.002) for the entire sample. In the subgroup that received IVT, the PROVIDENCE datasheet decreased the median decision time by seven minutes (p = 0.044) There was no significant difference in door-to-needle times between groups. CONCLUSION: Using the PROVIDENCE datasheet, first responders can quickly identify potential contraindications for IVT treatment in patients with stroke-like symptoms. This tool expedited decision-making and led to faster IVT administration process at a comprehensive stroke center.

Predictors of large and small for gestational age birthweight in offspring of women with gestational diabetes mellitus.

AIM: To identify predictors of large and small for gestational age in women with gestational diabetes mellitus. METHODS: A retrospective audit of clinical data analysed for singleton births in women diagnosed with gestational diabetes by Australasian Diabetes in Pregnancy Society guidelines from 1994 to 2009. Exclusions were: incomplete data, delivered at < 36 weeks gestation and/or last recorded weight > 4 weeks pre-delivery. We assessed: pre-pregnancy BMI, ethnicity, total maternal weight gain, weight gain before and after treatment initiation for gestational diabetes, HbA(1c) at gestational diabetes presentation and treatment modality (diet or insulin) and smoking. Birthweight was assessed using customized percentile charts (large for gestational age > 90th; small for gestational age < 10th percentile). Multiple regression analyses were undertaken; statistical significance was p < 0.05. RESULTS: There were 1695 women first seen at (mean ± sd) 28.1 ± 5.3 weeks gestation (range 6-39). Ethnic mix was South-East Asian 36.7%, Middle Eastern 27.6%, European 22.4%, Indian/Pakistani 8.6%, Samoan 1.9%, African 1.5% and Maori 1.1%. Therapy was diet 69.1% and insulin 30.9%. Mean total weight gain was 12.3 ± 6.1 kg, the majority (10.6 ± 6.0 kg), gained before dietary intervention. There were 7.9% small for gestational age and 15.2% large for gestational age births. Significant independent large for gestational age predictors were: weight gain before intervention, pre-pregnancy BMI, weight gain after intervention and treatment type, but not HbA1c or smoking. Significant small for gestational age predictors were: weight gain before intervention, weight gain after intervention, but not pre-pregnancy BMI, HbA(1c) or smoking. CONCLUSION: Conventional treatment for gestational diabetes mellitus concentrates on management of blood glucose levels. The trends identified here emphasize the need to also address pregnancy weight gain stratified by pre-pregnancy BMI.

Does neighbourhood walkability moderate the effects of mass media communication strategies to promote regular physical activity?

BACKGROUND: Mass media campaigns are widely used in Australia and elsewhere to promote physical activity among adults. Neighbourhood walkability is consistently shown to be associated with walking and total activity. Campaigns may have different effects on individuals living in high and low walkable neighbourhoods. PURPOSE: The purpose of this study is to compare pre- and post-campaign cognitive and behavioural impacts of the Heart Foundation's Find Thirty every day® campaign, in respondents living in high and lower walkable neighbourhoods. METHODS: Pre- and post-campaign cross-sectional survey data were linked with objectively measured neighbourhood walkability. Cognitive and behavioural impacts were assessed using logistic regression stratified by walkability. RESULTS: Cognitive impacts were significantly higher post-campaign and consistently higher in respondents in high compared with lower walkable neighbourhoods. Post campaign sufficient activity was significantly higher and transport walking significantly lower, but only in residents of lower walkable areas. CONCLUSIONS: Cognitive impacts of mass media physical activity campaigns may be enhanced by living in a more walkable neighbourhood.