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2.
Pediatr Dent ; 42(1): 28-39, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-32075707

RESUMO

Purpose: Fisher-Owens et al. described the diverse family-level factors influencing children's oral health, but few studies have investigated these relationships using longitudinal data. This study investigated the association between family and child oral health using the Longitudinal Study of Australian Children (LSAC), a cross-sequential dual cohort study. Methods: A total of 10,090 children were recruited at baseline, and seven waves of data are available. Children's parents or guardians reported experiences of dental caries and injury. Data were used to model family-level predictors with generalized estimating equations. Results: In the final model, predictors of dental caries over time were younger mothers (odds ratio [OR] equals 1.37, 95 percent confidence interval [95% CI] equals 1.01 to 1.87) and lower parental education (OR equals 1.24, 95% CI equals 1.10 to 1.39). Other significant factors were poor parental health, parents smoking, English as the main language, and Indigenous parents. Parents with consistent parenting styles protected against caries. Predictors of dental injury included socioeconomic status and parental age. Conclusions: This study highlighted a number of significant family-level constructs that predict dental caries and injury. Understanding the influence of family provides evidence to warrant investigation into tailored interventions targeting young mothers, common health risk factors, and parenting styles.


Assuntos
Cárie Dentária , Austrália , Criança , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Poder Familiar , Pais
3.
J Dent Educ ; 84(2): 166-175, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32043589

RESUMO

Various preclinical methodologies have been adopted by dental and oral health programs to develop student competence in administering dental local anesthetics (LA). Student-to-student practice is the most common preclinical training method. However, manikin simulation models have been introduced to avoid possible complications and ethical concerns with student-to-student injections. In 2017, the methodology was changed in the Bachelor of Oral Health program at The University of Sydney School of Dentistry in Australia from student-to-student practice to manikin simulation models. The aim of this study was to compare the students' learning experience, perceived confidence, and anxiety in giving their first injections to patients in these two preclinical training methods. A mixed-methods cohort design was used to compare the 2016 (n = 42) and 2017 (n = 32) oral health students' experiences and perceptions and evaluate students' clinical experience after commencing LA practice on patients. Students completed a questionnaire about their perceived level of confidence and anxiety before and after their first LA to a child and an adult for both infiltration and inferior alveolar nerve b lock (IANB) injections. Focus groups were conducted to further investigate the students' experience. The results showed that the perceived confidence and anxiety of the two cohorts did not differ significantly from each other. Although students found it difficult to transition into clinical practice without having experienced LA themselves, the manikin simulation practice provided a safe learning platform that avoided ethical and legal concerns. These findings support the use of manikin simulation models as an alte rnative method for dental local anesthetic preclinical training.


Assuntos
Anestésicos Locais , Estudantes de Odontologia , Adulto , Anestesia Local , Austrália , Criança , Competência Clínica , Humanos , Injeções , Ensino
4.
Medicine (Baltimore) ; 99(6): e18904, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028398

RESUMO

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neurodegenerative disorder of the human motor system. Neuroinflammation appears to be an important modulator of disease progression in ALS. Specifically, reduction of regulatory T cell (Treg) levels, along with an increase in pro-inflammatory effector T cells, macrophage activation and upregulation of co-stimulatory pathways have all been associated with a rapid disease course in ALS. Autologous infusion of expanded Tregs into sporadic ALS patients, resulted in greater suppressive function, slowing of disease progression and stabilization of respiratory function. Tecfidera (dimethyl fumarate) increases the ratio of anti-inflammatory (Treg) to proinflammatory T-cells in patients with relapsing remitting multiple sclerosis and rebalances the regulatory: inflammatory axis towards a neuroprotective phenotype. Consequently, the aim of this study was to assess the efficacy, safety, and tolerability of Tecfidera in sporadic ALS. METHODS: The study is an investigator led Phase 2 multi-center, randomized, placebo controlled, double blind clinical trial assessing the efficacy and safety of Tecfidera in patients with sporadic ALS. The study duration is 40 weeks, with a 36-week study period and end of study visit occurring at 40 weeks or at early termination/withdrawal from study. The TEALS study has been registered with the Australian and New Zealand Clinical Trials registry (ANZCTR) under the trials registration number ACTRN12618000534280 and has been approved by the Human Research Ethics Committee and Research Governance Office at the lead site (Westmead Hospital) with the ethics number HREC/17/WMEAD/353. The participating sites have obtained site specific ethics and governance approvals from the local institution. RESULTS: The primary endpoint is slowing of disease progression as reflected by the differences in the ALS Functional Rating Score-Revised (ALSFRS-R) score at Week 36. The secondary endpoints will include effects in survival, lower motor neuron function, respiratory function, quality of life and safety. CONCLUSION: This Phase 2 multi-center, randomized, placebo controlled, double blind clinical trial will provide evidence of efficacy and safety of Tecfidera in sporadic ALS.


Assuntos
Esclerose Amiotrófica Lateral/tratamento farmacológico , Fumarato de Dimetilo/uso terapêutico , Fármacos Neuroprotetores/uso terapêutico , Austrália , Fumarato de Dimetilo/administração & dosagem , Progressão da Doença , Método Duplo-Cego , Humanos , Fármacos Neuroprotetores/administração & dosagem , Nova Zelândia , Qualidade de Vida , Projetos de Pesquisa
5.
N Engl J Med ; 382(1): 20-28, 2020 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-31893513

RESUMO

BACKGROUND: Excessive alcohol consumption is associated with incident atrial fibrillation and adverse atrial remodeling; however, the effect of abstinence from alcohol on secondary prevention of atrial fibrillation is unclear. METHODS: We conducted a multicenter, prospective, open-label, randomized, controlled trial at six hospitals in Australia. Adults who consumed 10 or more standard drinks (with 1 standard drink containing approximately 12 g of pure alcohol) per week and who had paroxysmal or persistent atrial fibrillation in sinus rhythm at baseline were randomly assigned in a 1:1 ratio to either abstain from alcohol or continue their usual alcohol consumption. The two primary end points were freedom from recurrence of atrial fibrillation (after a 2-week "blanking period") and total atrial fibrillation burden (proportion of time in atrial fibrillation) during 6 months of follow-up. RESULTS: Of 140 patients who underwent randomization (85% men; mean [±SD] age, 62±9 years), 70 were assigned to the abstinence group and 70 to the control group. Patients in the abstinence group reduced their alcohol intake from 16.8±7.7 to 2.1±3.7 standard drinks per week (a reduction of 87.5%), and patients in the control group reduced their alcohol intake from 16.4±6.9 to 13.2±6.5 drinks per week (a reduction of 19.5%). After a 2-week blanking period, atrial fibrillation recurred in 37 of 70 patients (53%) in the abstinence group and in 51 of 70 patients (73%) in the control group. The abstinence group had a longer period before recurrence of atrial fibrillation than the control group (hazard ratio, 0.55; 95% confidence interval, 0.36 to 0.84; P = 0.005). The atrial fibrillation burden over 6 months of follow-up was significantly lower in the abstinence group than in the control group (median percentage of time in atrial fibrillation, 0.5% [interquartile range, 0.0 to 3.0] vs. 1.2% [interquartile range, 0.0 to 10.3]; P = 0.01). CONCLUSIONS: Abstinence from alcohol reduced arrhythmia recurrences in regular drinkers with atrial fibrillation. (Funded by the Government of Victoria Operational Infrastructure Support Program and others; Australian New Zealand Clinical Trials Registry number, ACTRN12616000256471.).


Assuntos
Abstinência de Álcool , Consumo de Bebidas Alcoólicas/efeitos adversos , Fibrilação Atrial/prevenção & controle , Idoso , Fibrilação Atrial/etiologia , Austrália , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Prevenção Secundária
6.
J Zoo Wildl Med ; 50(4): 861-867, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31926516

RESUMO

Antioxidants have a crucial role in protecting the body from oxidative stress, which would otherwise result in cellular damage and possibly predispose animals to disease. The antioxidant capacity of koalas (Phascolarctos cinereus) and its association with health or disease status is currently unknown. Ascorbate, a dietary antioxidant, has previously been identified in a few eucalypt species eaten by koalas. This study aimed to determine 1) differences between the antioxidant capacity of healthy and diseased koalas, and 2) concentration of the antioxidant ascorbate in Eucalyptus spp. leaves eaten by koalas. To determine differences in antioxidant capacity of koalas, plasma samples from clinically healthy koalas in Kangaroo Island, South Australia (SA) (n = 23), euthanized koalas with oxalate nephrosis from Mount Lofty Ranges, SA (n = 11), and euthanized koalas with chlamydiosis from Moggill, Queensland (n = 11) were analyzed for the three antioxidants α-tocopherol, ascorbate, and retinol and for two measures of antioxidant capacity, ferric reducing ability of plasma (FRAP), and trolox equivalent antioxidant capacity (TEAC). The thiobarbituric acid reactive substance (TBARS) measured formation of oxidants, and an oxidative stress index (OSI) was calculated by TBARS/(TEAC + FRAP). Ascorbate concentration was measured in dietary eucalypt leaves from Mount Lofty Ranges and Moggill. Results showed that in diseased Mount Lofty Ranges and Moggill koalas, plasma α-tocopherol concentrations were significantly lower, and ascorbate, TBARS, and OSI was significantly higher compared with clinically healthy koalas from Kangaroo Island. Ascorbate was high in eucalypt leaves, particularly young leaves from the Mount Lofty Ranges. This study showed that disease was associated with some measures of poor antioxidant capacity in koalas and also found that ascorbate is high in the dietary eucalypts of koalas.


Assuntos
Antioxidantes/química , Ácido Ascórbico/química , Eucalyptus/química , Phascolarctidae , Folhas de Planta/química , Animais , Austrália
7.
J Zoo Wildl Med ; 50(4): 937-946, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31926526

RESUMO

Listed as near-threatened by the International Union for Conservation of Nature (IUCN), the southern hairy-nosed wombat (SHNW, Lasiorhinus latifrons) faces threats such as drought, habitat degradation and loss, disease, and persecution because of competition with agriculture. To assist with evaluation of wombat health, this study reports serum biochemical reference intervals (RIs) for wild-caught SHNW from South Australia established from 126 apparently healthy SHNW using a Beckman Coulter AU480® Automated Chemistry Analyzer using RefVal Advisor. Partitioning of RIs for male and female wombats and for the two methods of sampling was performed as appropriate, and additional significant differences (P < 0.05) in biochemical profiles were identified across age class and season examined. A number of differences were observed between male and female wombats, most notably higher creatinine, urea, and sodium in females. Subadult and juvenile wombats had significantly lower total protein, globulin, and ALT activity, and significantly higher ALP activity than adults. Wombats sampled in winter and spring had significantly higher total protein, albumin, potassium, bicarbonate, and enzyme activities (ALP, ALT, AST, GGT, GLDH, lipase), and significantly lower glucose and creatinine when compared to individuals sampled in summer and autumn. Differences in CK activity and anion gap observed between the two methods of sampling likely reflect delay and handling of animals between capture and blood collection. The serum biochemical RIs documented here are considered representative of a population of healthy SHNW, providing a tool for health assessment and monitoring of SHNW health in South Australia and elsewhere.


Assuntos
Marsupiais/sangue , Envelhecimento , Animais , Animais Selvagens , Austrália , Análise Química do Sangue/veterinária , Feminino , Testes Hematológicos/veterinária , Masculino , Valores de Referência , Estações do Ano
8.
J Zoo Wildl Med ; 50(4): 966-971, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31926529

RESUMO

Determining the causes of mortality in endangered species is essential to understanding the possible reasons behind their decline and to facilitating the implementation of mitigating steps. The southern bent-winged bat (Miniopterus orianae bassanii) is a critically endangered Australian bat whose population numbers have decreased over the past 50 years. As part of a larger investigation to determine if disease could be a contributing factor to the decline, 27 southern bent-winged bats and one closely related eastern bent-winged bat (Miniopterus orianae oceanensis) that died during the study were necropsied and examined histologically. Trauma was the most common cause of death in the southern bent-winged bats, which mostly occurred at one site where fencing and other infrastructure was positioned around a key breeding cave. In response to these findings, management actions have been implemented to reduce this infrastructure-associated mortality of southern bent-winged bats. The single eastern bent-winged bat examined had a severe dermatitis caused by the mite Notoedres muris.


Assuntos
Quirópteros , Espécies em Perigo de Extinção , Ferimentos e Lesões/veterinária , Animais , Austrália , Causas de Morte , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/patologia
10.
N Engl J Med ; 382(4): 318-327, 2020 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-31971677

RESUMO

BACKGROUND: The meningococcal group B vaccine 4CMenB is a new, recombinant protein-based vaccine that is licensed to protect against invasive group B meningococcal disease. However, its role in preventing transmission and, therefore, inducing population (herd) protection is uncertain. METHODS: We used cluster randomization to assign, according to school, students in years 10 to 12 (age, 15 to 18 years) in South Australia to receive 4CMenB vaccination either at baseline (intervention) or at 12 months (control). The primary outcome was oropharyngeal carriage of disease-causing Neisseria meningitidis (group A, B, C, W, X, or Y) in students in years 10 and 11, as identified by polymerase-chain-reaction assays for PorA (encoding porin protein A) and N. meningitidis genogroups. Secondary outcomes included carriage prevalence and acquisition of all N. meningitidis and individual disease-causing genogroups. Risk factors for carriage were assessed at baseline. RESULTS: A total of 237 schools participated. During April through June 2017, a total of 24,269 students in years 10 and 11 and 10,220 students in year 12 were enrolled. At 12 months, there was no difference in the prevalence of carriage of disease-causing N. meningitidis between the vaccination group (2.55%; 326 of 12,746) and the control group (2.52%; 291 of 11,523) (adjusted odds ratio, 1.02; 95% confidence interval [CI], 0.80 to 1.31; P = 0.85). There were no significant differences in the secondary carriage outcomes. At baseline, the risk factors for carriage of disease-causing N. meningitidis included later year of schooling (adjusted odds ratio for year 12 vs. year 10, 2.75; 95% CI, 2.03 to 3.73), current upper respiratory tract infection (adjusted odds ratio, 1.35; 95% CI, 1.12 to 1.63), cigarette smoking (adjusted odds ratio, 1.91; 95% CI, 1.29 to 2.83), water-pipe smoking (adjusted odds ratio, 1.82; 95% CI, 1.30 to 2.54), attending pubs or clubs (adjusted odds ratio, 1.54; 95% CI, 1.28 to 1.86), and intimate kissing (adjusted odds ratio, 1.65; 95% CI, 1.33 to 2.05). No vaccine safety concerns were identified. CONCLUSIONS: Among Australian adolescents, the 4CMenB vaccine had no discernible effect on the carriage of disease-causing meningococci, including group B. (Funded by GlaxoSmithKline; ClinicalTrials.gov number, NCT03089086.).


Assuntos
Portador Sadio/prevenção & controle , Infecções Meningocócicas/prevenção & controle , Vacinas Meningocócicas/imunologia , Neisseria meningitidis Sorogrupo B/isolamento & purificação , Neisseria meningitidis/isolamento & purificação , Adolescente , Austrália/epidemiologia , Portador Sadio/epidemiologia , Feminino , Humanos , Masculino , Neisseria meningitidis/genética , Razão de Chances , Prevalência , Fatores de Risco , Sorogrupo , Método Simples-Cego
11.
Lancet ; 395(10219): 165, 2020 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-31954441
12.
Epidemiol Psychiatr Sci ; 29: e94, 2020 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-31973775

RESUMO

AIMS: Previous studies analysing blood alcohol concentration (BAC) at the time of suicide have primarily focused on sociodemographic factors. Limited research has focused on psychosocial factors and co-ingestion of other substances to understand the mechanisms of how alcohol contributes to death by suicide. The aim was to examine time trends, psychosocial factors related to acute alcohol use and co-ingestion of alcohol and other substances before suicide. METHODS: The Queensland Suicide Register in 2004-2015 was utilised and analysed in 2019. The cut-off point for positive BAC was set at ⩾0.05 g/dl. Substances were categorised as medicines, illegal drugs and other. Medicines were coded by the Anatomical Therapeutic Chemical (ATC) classification system. Joinpoint regression, univariate odds ratios, age and sex-adjusted odds ratios and Forward Stepwise logistic regression were performed. RESULTS: BAC information was available for 6744 suicides, 92% of all cases in 2004-2015. The final model showed that independent factors distinguishing BAC+ from BAC- were: age group 25-44 years, Australian Indigenous background, being separated or divorced, hanging, diagnosis of substance use, lifetime suicidal ideation, relationship and interpersonal conflict, not having psychotic and other psychiatric disorder, and no nervous system drugs or any other substances in blood at the time of suicide. CONCLUSIONS: Our findings suggest that people who die by suicide while under the influence of alcohol are more likely to be under acute stress (e.g. separation) and not have earlier psychiatric conditions, except substance use. This highlights the importance of more strict alcohol policies, but also the need to improve substance use treatment.


Assuntos
Consumo de Bebidas Alcoólicas/sangue , Concentração Alcoólica no Sangue , Sistema de Registros/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Adulto , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Austrália/epidemiologia , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Suicídio/psicologia
14.
Intern Med J ; 50(1): 15-16, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31943615
15.
J Environ Manage ; 257: 109979, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31989959

RESUMO

Aquaponics, the combined rearing of fish and hydroponic horticulture, has great potential for sustainable food production. Despite increasing research and investments in commercial scale systems, aquaponics is not yet a successful industry and most businesses report negative returns. Aquaponic produce is thought to contain added value to the consumer, and the environment. As most consumers are unaware of aquaponics and their benefits, little is known of its potential market. The present study addresses this gap by analysing willingness to consume aquaponic produce at different price levels in Israel and Australia. We used econometric tools to study the effects of pricing and other factors on revenues in each country. Cluster analysis was used to define groups of potential consumers. The results indicate that 17-30% of the population in both Israel and Australia would prefer to consume aquaponic produce once informed of their added value. Revenues at a given premium would be higher in Israel than in Australia, and higher for a leafy green, than for fish. Different segments of the population differed in their willingness to consume aquaponic produce, as well as in their stated motivations when purchasing food. Conclusions highlight the importance of case-specific research on consumer preferences and economic considerations preceding commercial investment in aquaponics.


Assuntos
Aquicultura , Nitrogênio , Animais , Austrália , Comportamento do Consumidor , Israel
16.
J Environ Manage ; 256: 109971, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31989987

RESUMO

Wetland ecosystems have a disproportionally large influence on the global carbon cycle. They can act as carbon sinks or sources depending upon their location, type, and condition. Rehabilitation of wetlands is gaining popularity as a nature-based approach to helping mitigate climate change; however, few studies have empirically tested the carbon benefits of wetland restoration, especially in freshwater environments. Here we investigated the effects of passive rehabilitation (i.e. fencing and agricultural release) of 16 semi-arid rain-filled freshwater wetlands in southeastern Australia. Eight control sites were compared with older (>10 year) or newer (2-5 year) rehabilitated sites, dominated by graminoids or eucalypts. Carbon stocks (soils and plant biomass), and emissions (carbon dioxide - CO2; and methane - CH4) were sampled across three seasons, representing natural filling and drawdown, and soil microbial communities were sampled in spring. We found no significant difference in soil carbon or greenhouse gas emissions between rehabilitated and control sites, however, plant biomass was significantly higher in older rehabilitated sites. Wetland carbon stocks were 19.21 t Corg ha-1 and 2.84 t Corg ha-1 for soils (top 20 cm; n = 137) and plant biomass (n = 288), respectively. Hydrology was a strong driver of wetland greenhouse gas emissions. Diffusive fluxes (n = 356) averaged 117.63 mmol CO2 m2 d-1 and 2.98 mmol CH4 m2 d-1 when wet, and 124.01 mmol CO2 m2 d-1 and -0.41 mmol CH4 m2 d-1 when dry. Soil microbial community richness was nearly 2-fold higher during the wet phase than the dry phase, including relative increases in Nitrososphaerales, Myxococcales and Koribacteraceae and methanogens Methanobacteriales. Vegetation type significantly influenced soil carbon, aboveground carbon, and greenhouse gas emissions. Overall, our results suggest that passive rehabilitation of rain-filled wetlands, while valuable for biodiversity and habitat provisioning, is ineffective for increasing carbon gains within 20 years. Carbon offsetting opportunities may be better in systems with faster sediment accretion. Active rehabilitation methods, particularly that reinstate the natural hydrology of drained wetlands, should also be considered.


Assuntos
Ecossistema , Áreas Alagadas , Austrália , Dióxido de Carbono , Metano , Chuva , Solo
17.
Arch Dis Child Fetal Neonatal Ed ; 105(1): 50-55, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31123055

RESUMO

OBJECTIVE: Higher rates of neonatal morbidity and mortality at term combined with earlier spontaneous delivery have led to the hypothesis that babies born to South Asian born (SA-born) women may mature earlier and/or their placental function decreases earlier than babies born to Australian and New Zealand born (Aus/NZ-born) women. Whether babies born to SA-born women do better in the preterm period, however, has yet to be evaluated. In this study we investigated respiratory outcomes, indicative of functional maturity, of preterm babies born to SA-born women compared with those of Aus/NZ-born women to explore this hypothesis further. STUDY DESIGN AND SETTING: This retrospective cohort study was conducted at Monash Health. PATIENTS: Data were collected from neonatal and birth records of moderate-late preterm (32-36 weeks) infants born between 2012 and 2015 to SA-born and Aus/NZ-born women. OUTCOME MEASURES: Rates of nursery admissions and neonatal respiratory outcomes were compared. RESULTS: Babies born to Aus/NZ-born women were more likely to be admitted to a nursery (80%) compared with SA-born babies (72%, p=0.004). Babies born to SA-born mothers experienced significantly less hyaline membrane disease (7.8%), required less resuscitation at birth (28.6%) and were less likely to require ventilation (20%) than babies born to Aus/NZ-born mothers (18%, 42.2%, 34.6%; p<0.001). There was no difference in the duration of ventilation or length of stay in hospital. CONCLUSIONS: Moderate-late preterm babies born to SA-born women appear to have earlier functional maturity, as indicated by respiratory outcomes, than Aus/NZ-born babies. Our findings support the hypothesis of earlier fetal maturation in SA-born women.


Assuntos
Grupo com Ancestrais do Continente Asiático , Grupo com Ancestrais do Continente Europeu , Doença da Membrana Hialina/epidemiologia , Nascimento Prematuro , Ressuscitação/estatística & dados numéricos , Adulto , Ásia Sudeste/etnologia , Austrália , Peso ao Nascer , Índice de Massa Corporal , Estudos de Coortes , Feminino , Glucocorticoides/uso terapêutico , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Mães , Nova Zelândia , Admissão do Paciente/estatística & dados numéricos , Cuidado Pré-Natal , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos
18.
BJOG ; 127(3): 345-354, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31749274

RESUMO

OBJECTIVES: To describe the population of women having bariatric surgery and compare the pregnancy outcomes for women having bariatric surgery with a non-bariatric surgery population having a first and second pregnancy. DESIGN: Population-based record linkage study. SETTING: New South Wales (NSW), Australia. POPULATION: All women aged 15-45 years with a hospital record in NSW (2002-2014) and all women giving birth in NSW (1994-2015; n = 1 606 737 women). METHODS: Pregnancy and birth outcomes were compared between first and second pregnancies using repeated-measures logistic regression and paired Student's t-tests. Bariatric and non-bariatric groups were also compared. MAIN OUTCOME MEASURES: Maternal diabetes, preterm birth (<37 weeks of gestation) and large for gestational age. RESULTS: There was a 13-fold increase in hospitalisations for primary bariatric surgery during 2002-2014. Compared with the general birthing population, women who had bariatric surgery experienced higher rates of hypertension, diabetes, and preterm birth. Among women who had bariatric surgery between a first and second pregnancy, there were reduced rates of hypertension (OR 0.39, 95% CI 0.29-0.53), spontaneous preterm birth (OR 0.37, 95% CI 0.16-0.86), infants that were large for gestational age (OR 0.63, 95% CI 0.44-0.88), and the admission of infants to a special care nursery or neonatal intensive care (OR 0.64, 95% CI 0.46-0.90) in the second pregnancy. Rates for small-for-gestational age and gestational diabetes following surgery were 8.3 and 11.4%, respectively CONCLUSIONS: Bariatric surgery between a first and second pregnancy was associated with reductions in obesity-related adverse pregnancy outcomes. Bariatric surgery performed for the management of obesity in accordance with current clinical criteria is associated with improved pregnancy outcomes in a subsequent pregnancy. TWEETABLE ABSTRACT: Bariatric surgery for obesity may improve pregnancy and birth outcomes in a subsequent pregnancy.


Assuntos
Cirurgia Bariátrica , Diabetes Gestacional , Obesidade , Nascimento Prematuro/epidemiologia , Sistema de Registros/estatística & dados numéricos , Adulto , Austrália/epidemiologia , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/estatística & dados numéricos , Peso ao Nascer , Cesárea/estatística & dados numéricos , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Recém-Nascido , Armazenamento e Recuperação da Informação , Obesidade/epidemiologia , Obesidade/cirurgia , Paridade , Gravidez , Resultado da Gravidez/epidemiologia
19.
J Sports Sci ; 38(1): 38-45, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31613185

RESUMO

To help inform strategies aimed at increasing muscular fitness levels, we examined factors associated with childhood muscular fitness (strength and power) that preceded the recently observed secular decline. Data were available from a nationally representative sample of Australian children aged 7-15 years in 1985 (n = 8469). Muscular fitness measures included strength (right and left grip, shoulder extension and flexion, and leg strength) and power (standing long jump distance). Anthropometric (adiposity, fat-free mass), cardiorespiratory fitness (CRF), flexibility, speed capability, physical activity (individual and parental), dietary quality and intake (fruit, vegetable, protein) and sociodemographic (area-level socioeconomic status (SES), school type) data were available. Statistical analyses included sex-stratified linear regression. Of all examined factors, measures of adiposity, fat-free mass, CRF, flexibility and speed capability were associated with muscular fitness at levels that met Cohen's threshold for important effects (r-squared = 0.02 to 0.28). These findings highlight the multifactorial relationship between muscular fitness and its determinants. Collectively, these factors were powerful in explaining muscular strength (females: r-squared = 0.32; males: r-squared = 0.41) and muscular power (females: r-squared = 0.36; males: r-squared = 0.42). These findings highlight modifiable and environmental factors that could be targeted to increase childhood muscular fitness.


Assuntos
Força Muscular/fisiologia , Músculo Esquelético/fisiologia , Aptidão Física/fisiologia , Adiposidade/fisiologia , Adolescente , Austrália , Índice de Massa Corporal , Aptidão Cardiorrespiratória/fisiologia , Criança , Estudos Transversais , Dieta , Meio Ambiente , Exercício/fisiologia , Feminino , Humanos , Masculino , Fenótipo , Classe Social
20.
Water Res ; 169: 115257, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31726396

RESUMO

Stormwater biofilters have great potential to treat stormwater for harvesting and reuse, but their variable performance in pathogen removal requires further optimisation prior to widespread uptake. This paper provides the first evidence that real time control (RTC) of stormwater biofilters can mitigate the impact of operational characteristics that result in poor microbial removal. We developed two RTC strategies and validated them using long-term laboratory experiments, utilising biofilters with a raised outlet pipe that creates a submerged zone. The first RTC strategy focuses on delivering the best water quality for harvesting and reuse or for recreational waterways. It has two components which ensure adequate treatment (microbial die-off): (1) it retains water in the biofilter for at least two days before allowing any further inputs into the system, and (2) the input volume is restricted to the submerged zone's pore volume. This strategy was effective and significantly improved water quality in the biofilter effluent. However, since the system favours bypassing influent to ensure good quality effluent, only 28.4% of the stormwater was treated. This still resulted in a 62.3% reduction in the influent E. coli load because the system was effective at removing E. coli under controlled conditions. The second RTC strategy builds upon the first strategy, and focuses on delivering a balance between good water quality for harvesting and protecting the environment (i.e., lower bypass). Three hours before the next rainfall event begins, the water that has remained in the biofilter's submerged zone for at least two days is drained and collected for harvesting through a bottom pipe. When stormwater inflow begins, the bottom pipe is closed and the biofilter operates without control, with water leaving the biofilter to the environment via the raised outlet pipe. The harvested effluent of this RTC strategy met the Australian stormwater harvesting guideline requirements for dual reticulation with indoor and outdoor use and irrigation of commercial food crops. Although only 5.4% of stormwater was collected for harvesting in this strategy, the environment was better protected because of a significantly reduced bypass volume. Our experiments also showed that the nutrient and sediment removal was high for both RTC strategies. This study presents the first stepping stone toward RTC of stormwater biofilters, demonstrating that these systems can deliver safe stormwater for harvesting and reuse, and for active recreational uses.


Assuntos
Filtração , Purificação da Água , Austrália , Escherichia coli , Chuva , Qualidade da Água
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