Maternal Health Considerations: Highlighting and advancing opportunities for improved maternal health.

The special collection on Maternal Health Considerations offers a comprehensive exploration of critical issues surrounding maternal well-being across diverse contexts and disciplines. Recognising that maternal health extends beyond the physiological realm, this collection delves into the multifaceted dimensions of maternal well-being, including physical, mental, and socio-ecological factors. The collection comprises a series of interdisciplinary studies that investigate various facets of maternal health, from conception to postpartum stages. It addresses the complex interplay between biological, psychological, and socio-cultural determinants that influence maternal health outcomes. By adopting a holistic approach, the contributors shed light on the interconnectedness of maternal well-being. Key themes explored within this collection include the impact of prenatal care on maternal and neonatal health outcomes, as well as the role of mental health in shaping maternal experiences. In addition, the collection presents innovative recommendations to enhancing maternal well-being, such as community-based interventions, technological advancements, and future policy considerations. Furthermore, the special collection emphasises the significance of culturally sensitive care in promoting maternal health. It highlights the need for tailored interventions that respect the diversity of maternal experiences across different ethnic, racial, and socioeconomic groups. Contributors to this collection employ a range of methodologies, including qualitative and quantitative research case studies, which provide an intricate overview of the current state of maternal health research. The collection also offers valuable insights for policymakers, healthcare practitioners, researchers, and advocates working towards improving maternal health outcomes worldwide. It serves as a vital resource for contributing to our understanding of the complexities surrounding maternal well-being. It offers a platform for critical dialogue and collaborative efforts aimed at promoting holistic maternal health.

Evaluation of the HEAL™ing Mental Health program: A prospective cohort study of short-term changes from a physical activity and lifestyle education program for people with mental health disorders living in rural Australia.

This study aimed to evaluate short-term outcomes of the HEAL™ing Mental Health program, an 8-week intervention for change in functional, behavioural and physiological health and wellbeing designed for people living with mental health conditions in rural or regional areas of Australia. A prospective cohort study was completed, reporting on 19 items (pre-program) and 15 (post-participation change), organised across seven domains. Participants took part in an Accredited Exercise Physiologist/Nurse led supervised group exercise (60 minutes) and healthy lifestyle education program (60 minutes). Separate linear mixed models with restricted maximum likelihood were used to examine the primary research question considering the effect of the program on: walking (min/week); planned, incidental and total physical activity (min/week); sitting time; active days; fruit and vegetable intake; body mass index; waist circumference; blood pressure; 6 minute walk distance; 30 second sit-to-stand; psychological distress symptoms; and stage of behaviour change. There were 99 participants (31 males, 68 females) out of 117 participants completed more than 50% of program sessions. Twelve of 15 measures achieved their desired target change and a statistically significant change toward the desired outcome was reported for 14 of 15 measures. Positive results were obtained for participants completing more than 50% of sessions, suggesting that HEAL™ ing Mental Health program is effective to increase physical activity and healthy lifestyle choices in individuals who self-report a mental health disorder.

What are the most effective exercise, physical activity and dietary interventions to improve body composition in women diagnosed with or at high-risk of breast cancer? A systematic review and network meta-analysis.

BACKGROUND: Obesity has been recognized as a risk factor in the development and recurrence of breast cancer and is also associated with poor prognostic outcomes. This systematic review and network meta-analysis aimed to identify the most effective exercise, physical activity, and dietary interventions to reduce fat mass, body fat percentage and body weight as well as potentially increase lean mass in women diagnosed with or at high risk of breast cancer. METHODS: A systematic search of databases was performed up to May 2022. Eligible randomized controlled trials examined the effects of exercise, physical activity and/or dietary interventions on fat mass and lean mass in women diagnosed with or at high risk of breast cancer. A random-effects network meta-analysis was conducted to determine the effects of different interventions across outcomes when sufficient studies were available. RESULTS: Eighty-four studies (n = 6428) were included in this review. Caloric restriction and combined exercise + caloric restriction significantly reduced fat mass (range, -3.9 to -3.7 kg) and body weight (range, -5.3 to -4.7 kg), whereas physical activity + caloric restriction significantly reduced body fat percentage (-2.4%; 95% confidence interval [CI], -3.4% to -13%) and body mass index (-2.2 kg × m-2 ; 95% CI, -3.0 to -1.4 kg × m-2 ) in breast cancer patients. Resistance exercise was the most effective intervention to increase lean mass (0.7 kg; 95% CI, 0.5-1.0 kg) in breast cancer patients. CONCLUSION: Multimodal exercise and diet programs were the most effective interventions to reduce fat mass, body fat percentage, and body weight and increase and/or preserve lean mass.

Novel holistic pharmacokinetic model applied to plasma and urine concentrations of 2,5-dihydroxybenzene sulphonate following administrations of calcium dobesilate and etamsylate to exercised horses.

Calcium dobesilate (CD) is a synthetic venoactive drug used in veterinary medicine to treat equine navicular disease. Etamsylate is a haemostatic agent used in horses for the treatment of exercise-induced pulmonary haemorrhage. Both etamsylate and CD dissociate in the circulatory system with 2,5-HBSA as the active drug. The aim of the research was to be able to provide detection time (DT) advice from pharmacokinetic (PK) studies in Thoroughbred horses to better inform trainers, and their veterinary surgeons, prescribing these substances for treatment of Thoroughbred racehorses. Two (pilot study) and six (final study) horses were given 28 and 9 repeated dose of CD (3 mg/kg BID) respectively. Two horses were each given a single intravenous (IV) dose of etamsylate (10 mg/kg). Plasma and urine 2,5-HBSA concentrations were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The CD pilot study revealed that steady state could be reached with a few days and that 2,5-HBSA in plasma and urine shows instability during storage at -20°C but appears stable at -80°C. A novel holistic non-linear mixed-effects three-compartmental PK model was developed that described both plasma and urine concentrations of 2,5-HBSA, from either CD or etamsylate administration. Typical values for 2,5-HBSA clearance and bioavailability were 2.0 mL/min/kg and 28% respectively. Using the parameters obtained from this PK model, in conjunction with methodology developed by Toutain, afforded a possible screening limit (SL) that can regulate for a DT of 3 days in urine; however, a corresponding SL in plasma would be below current levels of detection. However, it is the responsibility of the individual racing authorities to apply their own risk management with regard to SLs and DTs.

Exercise medicine considerations for pregnancy-associated breast cancer: Characteristics, prognosis and treatment.

Breast cancer is the most prevalent cancer in women worldwide and is the most common cancer diagnosis made during pregnancy or in the postpartum period. When breast cancer is diagnosed either during pregnancy or in the first-year postpartum, it is referred to as pregnancy-associated breast cancer. The aim of this review is to assess existing literature regarding the recommendations and outcomes of participating in exercise for people with pregnancy-associated breast cancer. The occurrence of pregnancy-associated breast cancer is increasing as a growing number of women delay first pregnancies. Women undergoing treatment for pregnancy-associated breast cancer are dealing with both cancer and its treatment as well as a pregnancy or postpartum period, and often encounter symptoms associated with cancer diagnosis and treatment, such as nausea, pain and fatigue while simultaneously navigating a pregnancy or early motherhood. These experiences can be barriers to participating in exercise, despite exercise being associated with numerous benefits for both pregnancy health and breast cancer outcomes. Numerous studies report the benefits of exercising during breast cancer treatment in ameliorating associated symptoms, and some studies report that engaging in exercise can lead to healthier and lower risk pregnancies. However, there is a lack of consensus around appropriate exercise programmes for this specific population. Given the associated benefits of participating in exercise for both breast cancer patients and pregnant/postpartum women as separate groups, research into exercise medicine designed specifically for the pregnancy-associated breast cancer population is needed.

Adaptive Goal Processes and Underlying Motives That Sustain Mental Wellbeing and New Year Exercise Resolutions.

Exercise resolutions are the most common goals people set each New Year. However, research has rarely examined adaptive goal processes and motives that may maintain wellbeing and resolution pursuit. We therefore investigated if (1) personal goal flexibility and tenacity maintain mental wellbeing and adherence to New Year exercise resolutions and if (2) underlying intrinsic and extrinsic motives maintain wellbeing and sustained exercise resolution adherence. A community sample (N = 297) completed an online longitudinal study. At baseline, participants listed their most important exercise-related New Year resolution. Participants then completed measures to assess goal flexibility and tenacity, resolution motives, and mental wellbeing at baseline. At three follow-up surveys over a two-month period, participants completed self-report measures of wellbeing and adherence to their exercise resolution. As predicted, goal flexibility and tenacity each independently predicted wellbeing across time. Counter to prediction, neither goal flexibility nor tenacity predicted sustained exercise adherence. Notably, underlying intrinsic motives (but not extrinsic motives) maintained mental wellbeing and exercise adherence across time. Our findings indicate that goal flexibility and tenacity are beneficial in maintaining mental wellbeing and that pursuing resolutions for internalised motives is beneficial for one's mental wellbeing and exercise adherence.

Equine metabolism of the selective androgen receptor modulator YK-11 in urine and plasma following oral administration.

YK-11 is a steroidal selective androgen receptor modulator, a compound class prohibited in both equine racing and human sports because of their potentially performance enhancing properties. YK-11 is easily accessible via internet-based supplement vendors making this compound a possible candidate for doping; however, its phases I and II metabolism has not yet been reported in the horse. The purpose of this study was to investigate the in vivo metabolites of YK-11 in urine and plasma following oral administration with three daily doses of 50 mg to two Thoroughbred horses. In vitro incubations with equine liver microsomes/S9 were also performed for use as metabolite reference materials; however, this resulted in the formation of 79 metabolites with little overlap with the in vivo metabolism. In plasma, parent YK-11 and seven phase I metabolites were detected, with five of them also observed in vitro. They were present nonconjugated in plasma, with one metabolite also indicating some glucuronide conjugation. In urine, 11 phase I metabolites were observed, with four of them also observed in vitro and six of them also detected in plasma. Nine metabolites were excreted non-conjugated in urine, with two of them also indicating some sulfate conjugation. Two minor metabolites were detected solely as sulfate conjugates. The most abundant analytes in urine were a mono-O-demethylated breakdown product and di-O-demethylated YK-11. The most abundant analytes in plasma were two isomers of the breakdown product with an additional hydroxylation reaction, which also provided the longest detection time in both matrices.

Effects of a nurse-led Tai Chi programme on improving quality of life, mental wellbeing, and physical function of women with breast cancer: Protocol for a randomized controlled trial.

OBJECTIVES: Quality of life, mental wellbeing, and physical function deteriorate among women with breast cancer. Tai Chi is a moderate form of exercise that may be effective in improving the mental and physical wellbeing, therefore, the quality of life of women with breast cancer. This protocol paper outlines a trial to determine the therapeutic effects of a Tai Chi programme on breast cancer management. METHODS: The study will be an interventional, single-blind, double-armed, randomized, and controlled trial involving a 12-week Tai Chi programme for women with breast cancer. Forty participants aged 18 years and above who are diagnosed with breast cancer from the general community will be recruited. All participants will be randomized to either a Tai Chi programme or a waiting list control group. The Tai Chi programme will involve 12 weeks of group Tai Chi sessions, with 45 min per session, twice a week. The primary outcome will be potential improvements to the quality of life, and secondary outcomes will be potential improvements in mental wellbeing (anxiety and depression), and physical function (pain, flexibility, obesity, and vital signs). These outcomes will be assessed via self-administered online assessments and physical examinations pre-and post-intervention. Linear mixed modelling will be used to assess changes in outcomes. DISCUSSION AND DISSEMINATION: Tai Chi is a safe, easy to learn, inexpensive, and low-intensity exercise with increasing popularity worldwide. If the intervention improves the quality of life in women with breast cancer, this study will build research capacity and increase awareness of the potential for Tai Chi to empower patients and engage them in self-management of breast cancer symptoms. Research findings will be disseminated to the public, health professionals, researchers, and healthcare providers through conference presentations, lay summaries, and peer-reviewed publications.

She'll Be 'Right but Are They? An Australian Perspective on Women in High Performance Sport Coaching.

Participation and media coverage of women in high-performance sport has been steadily increasing in recent years throughout the world. While this increase in interest has led to many young women and girls becoming involved in grassroots sport, there has yet to be a significant change in the number of women in coaching roles, particularly at the high-performance level. This paper synthesizes and summarizes the current challenges facing women sport coaches in Australia, drawing from existing research, media and government reports to understand the barriers for women entering and progressing in these roles. We also present some of the more recent initiatives to increase opportunities for women in high performance coaching. Within Australia, there is a need to (1) understand the pipeline for women coaches, (2) examine the interacting contexts and constraints that women are subject to within sporting organizations, and (3) create a preliminary framework for future research, outreach, and education to address gender inequity within Australian sport coaching.

Reflections from the peer-supported writing and wellbeing program, Write Smarter Feel Better.

PURPOSE: This paper aims to provide an overview of a peer-supported writing and wellbeing pilot program for higher degree by research (HDR) students in Australia. It proposes a six-month program is a beneficial service to HDR students that improves not only their productivity and writing confidence but assists with their perceived mental wellbeing as well. DESIGN/METHODOLOGY/APPROACH: This paper offers a perspective of the piloted writing and wellbeing program for HDR students during the recovery period during the COVID-19 global pandemic. It includes generalized reflections of participation, content, and structure alongside future directions and further implementation. FINDINGS: This research includes generalized, anonymous data regarding the success of the writing and wellbeing pilot program for HDR students and components to improve upon. It suggests that the overwhelming response from participants was positive, especially during various COVID-19 related lockdowns and travel restriction measures. RESEARCH LIMITATIONS/IMPLICATIONS: As this paper involves a small cohort of preliminary impressions from the pilot study, results will lack generalizability. Therefore, it is acknowledged that further research will ensue to examine the program further. PRACTICAL IMPLICATIONS: The success, measured by adherence and wellbeing improvements, of the Write Smarter: Feel Better program can influence the way in which universities address and protect mental wellbeing of their HDR students. ORIGINALITY/VALUE: This paper fulfills an identified and growing need for mental wellbeing to be strengthened among HDR students.

In vitro and in vivo metabolism of the anabolic-androgenic steroid oxandrolone in the horse.

Oxandrolone is an anabolic-androgenic steroid with favourable anabolic to androgenic ratio, making it an effective anabolic agent with less androgenic side effects. Although its metabolism has been studied in humans, its phase I and II metabolism has not been previously reported in the horse. The purpose of this study was to investigate the in vitro metabolism of oxandrolone (using both equine liver microsomes and S9) and in vivo metabolism following oral administration (three daily doses of 50 mg of oxandrolone to a single Thoroughbred horse), using both gas and liquid chromatography-mass spectrometry techniques. The in vitro phase I transformations observed included 16-hydroxylated (two epimers), 17-methyl-hydroxylated and 16-keto metabolites. In addition to parent oxandrolone and these hydroxylated metabolites, the 17-epimer and a 17,17-dimethyl-18-norandrost-13-ene analogue were detected in biological samples following the administration. 16-keto-oxandrolone was only observed in urine. The 16- and 17-methyl-hydroxylated oxandrolone metabolites were predominantly excreted as sulfate conjugates in urine, whereas parent oxandrolone, its epimer and 17,17-dimethyl-18-norandrost-13-ene derivative were found predominantly in the unconjugated urine fraction. The most abundant analyte detected in both plasma and urine was parent oxandrolone. However, the longest detection period using the developed analytical method was provided by 17-hydroxymethyl-oxandrolone in both matrices. The results of this study provided knowledge of how best to detect the use of oxandrolone in regulatory samples.

Impact of COVID-19 lockdown on physical activity behaviours of older adults who participated in a community-based exercise program prior to the lockdown.

This study investigated the impact of the 2020 COVID-19 lockdown on community-dwelling older adults attending a community-based exercise program to seek strategies to keep them active during self-isolated situations. A two-phase mixed methods approach included a survey followed by in-person focus groups. Forty-eight participants, with 32 starting a community-based exercise program before the lockdown and 16 joining the program after the lockdown, completed a questionnaire survey about physical activities before and during the lockdown. This was followed by three focus groups (26 participants in total) to identify factors influencing physical activity behaviours found in the survey. The survey found that the COVID-19 lockdown had varied impact on exercise adherence of the older adults: 43% of the participants exercised less during the lockdown than pre-lockdown, but 26% exercised more. Interestingly, among the participants approximately 80% still achieved the recommended physical activity level by the WHO during the lockdown. The focus groups revealed that exercise behaviours before the lockdown directly affected the behaviours during the lockdown. Participants' recognition of the support from trustworthy people also influenced their motivation to perform exercises in an isolated environment. Remote exercise programs, such as digital and printed exercise materials, were found beneficial for the participants only when they came from the people the older adults trusted through their previous experience (i.e., the program). A sense of belonging to the exercise group was also essential for the participants to achieve self-managed exercise. It was concluded that older adults need connections to an exercise group and a trustworthy exercise instructor who could continuously support them to be physically active in isolated situations such as lockdowns, in addition to exercise knowledge and a better understanding of the benefits of exercise.

A Survey to Evaluate the Association of COVID-19 Restrictions on Perceived Mood and Coping in Australian Community Level Athletes.

Highlights: No differences in coping or well-being in Australian community athletes based on the level of support received during COVID-19 restrictions.Community level athletes had better coping when a training program was provided.No difference between individual or team community athletes for well-being or coping scores. Australian community level athletes faced unprecedented changes to their training and competition options as the global COVID-19 pandemic took a stronghold. This disruption was predicted to have a negative impact on emotional well-being as communities braced through periods of social isolation and physical distancing requirements. This study provides an Australian perspective on the emotional well-being of community level athletes and the extent to which they coped during the COVID-19 pandemic. Emotional well-being and coping were measured using the Brief Emotional Experience Scale and the 28-item Brief Cope Scale. Both instruments were administered along with other questions pertaining to participant demographics and training status via an online survey between April and June 2020. The survey was disseminated to community athletes through word-of-mouth and social media platforms. No significant differences in emotional well-being were observed between athlete groups as a result of COVID-19 and its associated restrictions. Coping scores also appeared to be preserved in Australian community athletes, which contrasts the impact expected as a result of the COVID-19 pandemic. While tentative, the observed preservation in coping may have buffered potential declines in emotional well-being, which has been documented in professional and semi-professional athletes and the general population. These unexpected findings and tentative suppositions warrant further investigation and highlight the importance of conducting a country- or region-specific approach to examining the impact of COVID-19 on community athletes, as responses to COVID-19 are undoubtedly not consistent throughout the world.