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'.

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.

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.

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.

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.

Adult preferences for influenza vaccines with lower likelihood of side effects.

BACKGROUND: Concerns about possible side effects are a well-recognized barrier to influenza vaccination and emerging data indicate rates of reactogenicity for inactivated influenza vaccines may vary by manufacturer. We surveyed adults to assess their preference for hypothetical influenza vaccines with equivalent efficacy but differing rates of serious and minor adverse events. RESULTS: The response rate was 94% (1006/1071); 44% of respondents reported receiving influenza vaccine at least once in the past. Seventy-two percent of respondents expressed a preference for vaccines that provided the same level of protection, but were less likely to produce serious side effects, and 55% expressed a preference for vaccines less likely to produce minor side effects. No significant differences by prior influenza vaccination history, age group or gender were identified. CONCLUSIONS: A substantive proportion of adults have a strong preference for influenza vaccine formulations less likely to produce even minor side-effects, such as injection site reactions. Identifying influenza vaccines with equivalent efficacy but lower reactogenicity is important because experience with side effects may negatively impact future vaccine uptake. METHODS: Computer assisted telephone interviews were conducted as part of a population-based survey using a stratified random sample drawn from the residential White Pages® telephone directory.

Associations between childhood obesity and the availability of food outlets in the local environment: a retrospective cross-sectional study.

PURPOSE: Examine whether individual-level childhood obesity is related to residential availability of fast food and healthy food outlets. DESIGN: Retrospective cross-sectional study. SETTING: Perth, Western Australia. SUBJECTS: A total of 1850 children aged 5 to 15 years in 2005-2010 who participated in the Western Australian Health and Wellbeing Surveillance System survey. MEASURES: Geographical Information Systems were used to calculate a range of measures of fast food and healthy food outlet access and availability. For example, distance to nearest and access and density measures within 800 m and 3 km of each child's residence were all tested. ANALYSIS: Multivariate logistic regression analysis, controlling for individual-level sociodemographic factors and lifestyle behaviors. RESULTS: An increasing number of healthy food outlets within 800 m of a child's home was associated with a significantly reduced risk of being overweight/obese in all models tested. After controlling for age, physical activity, time spent sedentary, weekly takeaway consumption, area disadvantage, and count of fast food outlets, each additional healthy food outlet within 800 m was associated with a 20% decrease in the likelihood of a child being overweight or obese (odds ratio: .800, 95% confidence intervals: .686-.933). CONCLUSION: The local food environment around children's homes has an independent effect on child weight status. These findings highlight the importance of the built environment as a potential contributor towards child health, which should be considered when developing community health promotion programs.

Lifestyle factors, medication use and risk for ischaemic heart disease hospitalisation: a longitudinal population-based study.

BACKGROUND: Lifestyle factors have been implicated in ischaemic heart disease (IHD) development however a limited number of longitudinal studies report results stratified by cardio-protective medication use. PURPOSE: This study investigated the influence of self-reported lifestyle factors on hospitalisation for IHD, stratified by blood pressure and/or lipid-lowering therapy. METHODS: A population-based cohort of 14,890 participants aged 45+ years and IHD-free was identified from the Western Australian Health and wellbeing Surveillance System (2004 to 2010 inclusive), and linked with hospital administrative data. Adjusted hazard ratios for future IHD-hospitalisation were estimated using Cox regression. RESULTS: Current smokers remained at higher risk for IHD-hospitalisation (adjusted HR=1.57; 95% CI: 1.22-2.03) after adjustment for medication use, as did those considered overweight (BMI=25-29 kg/m(2); adjusted HR=1.28; 95% CI: 1.04-1.57) or obese (BMI of ≥30 kg/m(2); adjusted HR=1.31; 95% CI: 1.03-1.66). Weekly leisure-time physical activity (LTPA) of 150 minutes or more and daily intake of 3 or more fruit/vegetable servings reduced risk by 21% (95% CI: 0.64-0.97) and 26% (95% CI: 0.58-0.96) respectively. Benefits of LTPA appeared greatest in those on blood pressure lowering medication (adjusted HR=0.50; 95% CI: 0.31-0.82 [for LTPA<150 mins], adjusted HR=0.64; 95% CI: 0.42-0.96 [for LTPA>=150 mins]). IHD risk in smokers was most pronounced in those taking neither medication (adjusted HR=2.00; 95% CI: 1.41-2.83). CONCLUSION: This study confirms the contribution of previously reported lifestyle factors towards IHD hospitalisation, even after adjustment for antihypertensive and lipid-lowering medication use. Medication stratified results suggest that IHD risks related to LTPA and smoking may differ according to medication use.

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.

The impact of the built environment on health across the life course: design of a cross-sectional data linkage study.

INTRODUCTION: The built environment is increasingly recognised as being associated with health outcomes. Relationships between the built environment and health differ among age groups, especially between children and adults, but also between younger, mid-age and older adults. Yet few address differences across life stage groups within a single population study. Moreover, existing research mostly focuses on physical activity behaviours, with few studying objective clinical and mental health outcomes. The Life Course Built Environment and Health (LCBEH) project explores the impact of the built environment on self-reported and objectively measured health outcomes in a random sample of people across the life course. METHODS AND ANALYSIS: This cross-sectional data linkage study involves 15 954 children (0-15 years), young adults (16-24 years), adults (25-64 years) and older adults (65+years) from the Perth metropolitan region who completed the Health and Wellbeing Surveillance System survey administered by the Department of Health of Western Australia from 2003 to 2009. Survey data were linked to Western Australia's (WA) Hospital Morbidity Database System (hospital admission) and Mental Health Information System (mental health system outpatient) data. Participants' residential address was geocoded and features of their 'neighbourhood' were measured using Geographic Information Systems software. Associations between the built environment and self-reported and clinical health outcomes will be explored across varying geographic scales and life stages. ETHICS AND DISSEMINATION: The University of Western Australia's Human Research Ethics Committee and the Department of Health of Western Australia approved the study protocol (#2010/1). Findings will be published in peer-reviewed journals and presented at local, national and international conferences, thus contributing to the evidence base informing the design of healthy neighbourhoods for all residents.

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.

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.

Cerebrotendinous xanthomatosis (CTX): an association of pulverulent cataracts and pseudo-dominant developmental delay in a family with a splice site mutation in CYP27A1--a case report.

PURPOSE: A 15-year-old boy with developmental delay presented to the pediatric ophthalmology clinic with bilateral pulverulent cataracts. The family was examined for developmental delay, cataracts and systemic problems. METHODS: The parents were consanguineous and originally from Bangladesh. All the children were born in the UK. The mother and 5 children had developmental delay. Three children had global developmental delay, diarrhea and pulverulent cataracts. Two children had microcephaly, developmental delay, constipation and no cataracts. The mother did not have microcephaly, cataracts or gastrointestinal problems. Linkage analysis via autozygosity testing was performed for detection of loci and candidate genes. The patients with cataracts were segregated with homozygous mutations in the CYP27A1 (G to A substitution at position +1 of intron 6). RESULTS: The complex nature of this family's findings suggested that it had an unusual autosomal dominant condition with variable expression. Autozygosity testing demonstrated that three members had Cerebrotendinous xanthomatosis (CTX), which is inherited in an autosomal recessive manner. The aetiology of the developmental delay in other family members remains unknown. CONCLUSIONS: Cerebrotendinous xanthomatosis is a rare autosomal recessive condition that can result in neurological deficits and early death if left untreated. In view of the reversible nature of the condition with appropriate treatment, there needs to be a high level of suspicion of CTX for any child with cataracts and developmental delay even if the pattern of inheritance is not straightforward at initial assessment.

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).