Australian Government Department Research Articles

Associations Between Regularity of General Practitioner Contacts and Adherence to Statin Therapy

IntroductionResearch has demonstrated continuity and regularity of general practitioner (GP) contacts to be associated with reduced hospitalisations and emergency department (ED) presentations. Opportunities for improved medication management are often cited as a potential causal mechanism, but little research has directly addressed this.
 Objectives and ApproachTo determine associations between continuity of primary care and adherence with statin medications amongst individuals at risk of cardiovascular disease outcomes, taking statins through the exposure period of July 2011 - June 2012. We used self-report and administrative data from 267,153 participants of the 45 and Up Study conducted in New South Wales, Australia from 2006-2009. Medicare Benefits Schedule and Pharmaceutical Benefits Scheme data, from the Australian Government Department of Human Services, were linked to survey, hospital and death data by the NSW Centre for Health Record Linkage. Exposures were the Usual Provider of Care (UPC) index, i.e. the proportion of visits made to the usual GP; and a regularity index assessing whether patients were visiting the GP on a regular basis. Cox regression estimated associations between these exposures and time to cessation of statin medication, defined as a 30-day period without supply.
 ResultsPreliminary findings amongst a cohort of approximately 48,000 indicated that increases in both regularity and continuity of primary care were associated with reduced likelihood of statin cessation. After controlling for socio-demographic and health status indicators the hazard ratio for cessation in the most regular quintile (baseline least) was 0.84 (95%CI 0.80 – 0.87) and in the highest continuity quintile was 0.93 (95%CI 0.89 – 0.96).
 Conclusion / ImplicationsPrevious work assessed relationships between continuity of care and downstream hospital and ED outcomes. This work complements existing literature by assessing intermediate outcomes, aiding understanding of potential causal pathways. These findings are relevant given adherence to statin medication is often sub-optimal.

Re: Integrated Immune Dynamics Define Correlates of COVID-19 Severity and Antibody Responses

SARS-CoV-2 causes a spectrum of illness, ranging from asymptomatic to severe COVID-19. As the immunological basis for severity remains ill-defined, we analysed 78 SARS-CoV-2-infected individuals at acute and/or convalescent timepoints, up to 102 days post-symptom onset, quantifying 184 innate and adaptive immunological parameters. Acute COVID-19 in hospitalised patients was associated with high levels of IL-6, IL-18 and IL-10, elevated neutrophil-to-lymphocyte and neutrophil-to-T cell ratios, and high proportions of activated CD38+ neutrophils, CD38+ eosinophils, CD38+ HLA-DRlo monocytes, CD38+CD56dim NK cells, CD38+ γδ T cells, antibody-secreting cells, CD38+ICOS+ circulating T follicular helper (cTFH) cells, CD38+HLA-DR+CD4+ T cells, effector CD27-CD45RA+ and CD38+ CD8+ T cells. During convalescence, elevated seroconversion and neutralising antibodies were prominent and correlated with acute CXCR3+ cTFH cell activation. Strikingly, intensive care unit (ICU) patients with severe COVID-19 displayed higher levels of soluble IL-6R, IL-18, and hyperactivation of innate, adaptive and myeloid compartments than ward patients with moderate disease. Our analyses provide a comprehensive map of longitudinal immunological responses in COVID-19 patients during acute and convalescent phases of SARS-CoV-2 infection, and integrate key cellular pathways of complex perturbed immune networks that underpin severe COVID-19, providing important insights into potential biomarkers and immunotherapies.Funding: This work was supported by the Australian National Health and Medical Research Council (NHMRC) Leadership Investigator Grant to KK (#1173871), NHMRC Program Grant to DLD (#1132975), Research Grants Council of the Hong Kong Special Administrative Region, China (#T11-712/19-N) to KK, the Jack Ma Foundation to KK, KS, DIG and AWC, the a2 milk foundation to KS, the Victorian Government MRFF award (#2002073) to SJK, DIG and AKW, MRFF Award (#1202445) to KK, NHMRC program grant 1149990 (SJK), NHMRC project grant 1162760 (AKW), NHMRC Program Grant (#1071916) to KK and DCJ, NHMRC Program Grant (1113293) to DIG, the Merridew Foundation to NJCK. KK is supported by NHMRC Senior Research Fellowship (1102792), DLD by a NHMRC Principal Research Fellowship (#1137285), KS by an NHMRC Investigator grant (#1177174), SYCT by a NHMRC Career Development Fellowship (#1145033), DIG by an NHMRC Senior Principal Research Fellowship (#1117766) and SJK by NHMRC Senior Principal Research Fellowship (#1136322). SRL is supported by an NHMRC program grant (#1149990) and practitioner fellowship (#1135851). LH and WZ are supported by the Melbourne International Research Scholarship (MIRS) and the Melbourne International Fee Remission Scholarship (MIFRS) from The University of Melbourne. XJ is supported by China Scholarship Council-University of Melbourne joint Scholarship. CES has received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement (#792532). JRH and WZ are supported by the Melbourne Research Scholarship from The University of Melbourne. TMA and FM-W are International Society for Advancement of Cytometry Marylou Ingram Scholars. GHP is supported by the Australian Government Research Training Program (RTP) Scholarship. JAJ is supported by an NHMRC Early Career Fellowship (ECF) (#1123673). EBC. is supported by a NHMRC Peter Doherty Fellowship (#1091516). KK and AC were supported by the University of Melbourne Dame Kate Campbell Fellowship. The Melbourne WHO Collaborating Centre for Reference and Research on Influenza is supported by the Australian Government Department of Health. Conflict of Interest: The authors declare no conflict of interest.Ethical Approval: The study was approved by the Alfred Hospital (#280/14), Melbourne Health (HREC/17/MH/53), Monash Health (HREC/15/MonH/64/2016.196), The University of Melbourne (#2056689, #2056761, #1442952, #1955465 and #1443389) and James Cook University (H7886) Human Research Ethics Committees.

Determinants of usefulness in professional behaviour change interventions: observational study of a 15-year national program

ObjectiveEducational, and audit and feedback interventions are effective in promoting health professional behaviour change and evidence adoption. However, we lack evidence to pinpoint which particular features make them most effective....

A national study on prescribed medicine use in Australia on a typical day.

To describe Australians' prescribed medicine use on a typical day (September 25, 2018). We conducted a cross-sectional study using nationally representative dispensing claims data using the Australian Government Department of Human Services random 10% sample of all Australians eligible for prescription medicines subsidised through the Australian Pharmaceutical Benefits Scheme (PBS). Our main outcome measures were the number and proportion of people using at least one prescribed medicine and the specific medicine groups and classes on the day. We estimated the proportion of Australians using these medicines using the mid-year Australian population as the denominator. We quantified multiple medicine use by calculating the number and proportion of people experiencing polypharmacy (the use of 5 or more unique medicines) and hyper-polypharmacy (the use of 10 or more unique medicines). We found that 9.0 million Australians used at least one PBS medicine on September 25, 2018; equating to 27.5 million medicines in use across Australia. "Cardiovascular system", "nervous system" and "alimentary tract and metabolism" medicines comprised the top three medicine groups. Over 1.8 million people experienced polypharmacy on the day, accounting for 13.6 million dispensed medicines. 1 022 590 (45%) people aged ≥70 years old experienced polypharmacy and 188 930 (8%) experienced hyper-polypharmacy. Rates of polypharmacy were high, particularly in the people most susceptible to polypharmacy-related harm. Strategies to optimise the risk-benefit ratio of medicines and to reduce polypharmacy through "choosing wisely" and "de-prescribing" in this age group are needed. Australia's national data provides a benchmark to inform global medicine utilisation practices.

Atrial Fibrillation in Indigenous Australians: A Multisite Screening Study Using a Single-Lead ECG Device in Aboriginal Primary Health Settings

Circulatory diseases continue to be the greatest cause of mortality for Australian Aboriginal and Torres Strait Islander people, and a major cause of persistently lower life expectancy compared with non-Aboriginal Australians. The limited information that exists on atrial fibrillation (AF) prevalence in Aboriginal and Torres Strait Islander communities is mostly based on hospital admission data. This shows AF as principal or additional admission diagnosis was 1.4 times higher compared to non-Aboriginal Australians, a higher incidence of AF across the adult life span after age 20 years and a significantly higher prevalence among younger patients. Our study estimates the first national community prevalence and age distribution of AF (including paroxysmal) in Australian Aboriginal people. A handheld single-lead electrocardiograph (ECG) device (iECG), known to be acceptable in this population, was used to record participant ECGs. This co-designed, descriptive cross-sectional study was conducted in partnership with 16 Aboriginal Community Controlled Health organisations at their facilities and/or with their services delivered elsewhere. The study was also conducted at one state community event. Three (3) Australian jurisdictions were involved: New South Wales, Western Australia and the Northern Territory. Study sites were located in remote, regional and urban areas. Opportunistic recruitment occurred between June 2016 and December 2017. People <45 years of age were excluded. Thirty (30) of 619 Aboriginal people received a 'Possible AF' and 81 an 'Unclassified' result from a hand-held smartphone ECG device. A final diagnosis of AF was made in 29 participants (4.7%; 95%CI 3.0-6.4%), 25 with known AF (five paroxysmal), and four with previously unknown AF. Three (3) of the four with unknown AF were aged between 55-64 years, consistent with a younger age of AF onset in Aboriginal people. Estimated AF prevalence increased with age and was higher in those aged >55 years than the general population (7.2% compared with 5.4%). Slightly more men than women were diagnosed with AF. This study is a significant contribution to the evidence which supports screening for AF in Aboriginal and Torres Strait Islander people commencing at a younger age than as recommended in the Australian guidelines (>65 years). We recommend the age of 55 years. Consideration should be given to the inclusion of AF screening in the Australian Government Department of Health annual 'Aboriginal and Torres Strait Islander Health Assessment'. ACTRN12616000459426.

Self-esteem, Bullying Perpetration/Victimization and Perceived Parental Support in a Nationally Representative Sample of Australian Students

The purpose of this study was to explore the inter-relationships among students’ self-esteem, bullying victimization/perpetration behaviours, and perceived parental support, with a focus on how self-esteem mediates the association of parental support and bullying behaviours and how bullying mediates the association of parental support and self-esteem. We employed structural equation modelling to analyse the secondary data collected in “Young Minds Matter: The Second Australian Child and Adolescent Survey of Mental Health and Wellbeing” funded by the Australian Government Department of Health. Analyses were performed on 431 adolescent students selected from 2967 adolescents aged 11-17 years. Our findings revealed that parental support has a direct positive association with self-esteem and a direct negative association with bullying behaviours. This study highlights the importance of parental support in both lowering bullying perpetration/victimization and enhancing student’s self-esteem. Findings of this study could improve anti-bullying programs.

Evaluation of Residues in Hen Eggs After Exposure of Laying Hens to Water Containing Per- and Polyfluoroalkyl Substances.

Per- and polyfluoroalkyl substances (PFAS) have been used in aqueous film-forming foams used in firefighting, resulting in soil and groundwater contamination and leading to human exposure via animal products grown in contaminated areas. The present study reports the relationship between PFAS intake by hens and the PFAS concentrations in the edible parts of eggs. Laying hens were exposed via drinking water to different concentrations of 4 PFAS compounds (perfluorooctane sulfonate [PFOS], perfluorohexane sulfonate [PFHxS], perfluorooctanoic acid [PFOA], and perfluorohexanoic acid) over 61 d. Egg PFAS residues were assessed for a further 30 d after exposure ceased. The target concentrations of PFAS were 0, 0.3, 3, 30, and 300 µg/L for the treatment groups T1-T5, respectively; and PFAS residues were determined from the eggs collected every second day. There was a linear correlation between the PFAS concentrations in the drinking water of hens and those detected in the egg, which could be useful in estimating PFAS concentrations in the egg by measuring water concentrations. Exposure of hens to drinking water with PFAS concentrations below the Australian Government Department of Health limits (PFOS and PFHxS, 0.07 µg/L; PFOA, 0.56 µg/L), and with no other sources of PFAS exposure, is unlikely to result in egg PFAS concentrations that would exceed the 10% limit set by Food Standards Australia New Zealand for human consumption. Environ Toxicol Chem 2021;40:735-743. © 2020 SETAC.

168-LB: Prediction for Risk-Stratified Care for Women with Gestational Diabetes: The PeRSonal GDM Study

Objective: To develop and validate a prediction model for adverse pregnancy outcomes at the time of gestational diabetes (GDM) diagnosis to stratify care. Research Design and Methods: A prediction model development and validation study was conducted on data from a retrospective population-based study. The outcome to be predicted was a composite for adverse pregnancy outcome: hypertensive disorder of pregnancy, large-for-gestational (LGA) age neonate, neonatal hypoglycaemia requiring intravenous therapy, shoulder dystocia, perinatal death, neonatal bone fracture and nerve palsy. Results: Predictors of the composite adverse pregnancy outcome were: fasting and 1 hour glucose from the diagnostic OGTT, gestational age of GDM diagnosis, previous macrosomia, previous pre-eclampsia or eclampsia, previous LGA, ethnicity, weight at GDM diagnosis and parity. The apparent performance of the model was reasonable: c-statistic was 0.691 (95% CI, 0.662 - 0.720) and the calibration plot showed near perfect agreement between predicted and observed risks (Figure 1). Conclusions: A promising prediction model for adverse pregnancy outcomes in women with GDM was developed. Model estimation using the Least Absolute Shrinkage and Selection Operator method is currently underway to correct for over-optimism. External validation and decision curve analysis will determine suitability for clinical application. Disclosure S. Cooray: None. J. Boyle: None. G. Soldatos: None. J. Zamora: None. B.M. Fernandez-Felix: None. J. Allotey: None. S. Thangaratinam: None. H. Teede: Other Relationship; Self; Roche Diagnostics France. Funding National Health and Medical Research Council of Australia (APP1151242); Australian Academy of Science; Diabetes Australia Research Program; Medical Research Future Fund of Australia; Australian Government Department of Education and Training (7167_2019)

National Study of Adult Oral Health 2017–18: Study design and methods

The National Study of Adult Oral Health (NSAOH) is Australia's third national oral examination survey of a representative sample of Australian adults. The study was undertaken primarily to describe levels of oral health in the population and to describe trends since the first survey, conducted in 1987-88. The aim of the study was to complete 7,200 examinations, necessitating approximately 15,200 completed interviews. Survey participants were selected using a multi-stage probability sampling design that began with the sampling of postcodes within states/territories in Australia. Individuals within selected postcodes were then selected by the Australian Government Department of Human Services (DHS) from the Medicare database. Following an initial opt-out period, participants were given the option to either complete the questionnaire online or to complete the questionnaire via a computer-assisted telephone interview. Participants were asked a series of questions about their oral health and dental service use and those who reported having one or more of their own natural teeth were invited to undergo a standardised oral examination. Examinations were conducted by state/territory dental practitioners who underwent prior training and calibration in survey procedures by the Australian Research Centre for Population Oral Health (ARCPOH), The University of Adelaide.

Guest Editorial.

This Special Issue of the Australian Dental Journal coincides with an unprecedented health event in the 21st century: the COVID-19 pandemic. Given the social and economic consequences of the disease, the vivid debate about the most effective public health measures to tackle the epidemic and the global spread of the epidemic,1 people worldwide are becoming familiar with words such as ‘epidemiology’, ‘epidemic curve’, ‘fatality rate’, ‘surveillance systems’ ‘prediction’, ‘modelling’, among other. However, what is epidemiology? Epidemiology has been conceptualised as ‘the study of the occurrence and distribution of health-related events, states, and processes in specified populations, including the study of the determinants influencing such processes, and the application of this knowledge to control relevant health problems’. Two central assumptions support this definition and, therefore, Epidemiology itself: (i) the diseases, health conditions, and their determinants are not randomly distributed in a population; (ii) the knowledge of these factors has practical implications for the control and prevention of diseases and health problems.2 This Special Issue of the Australian Dental Journal is about epidemiology, more precisely about oral epidemiology, the branch of epidemiology dedicated to oral diseases and disorders its socioeconomic, behavioural and health services related factors. It describes the state of oral health and use of dental services of the Australian adult population using information from the National Study of Adult Oral Health (NSAOH) 2017–18.3 The NSAOH 2017–18 was conducted by the Australian Research Centre for Population Oral Health (ARCPOH) at the University of Adelaide in partnership with the Australian Government Department of Health and State/Territory health departments and dental services with support from the National Health and Medical Research Council (NHMRC). This national study involved collection of interviews from over 15,000 adults across Australia, with clinical oral epidemiological examinations performed on over 5,000 people. NSAOH 2017–18 is only the third national oral examination survey of adults in Australia. It follows from the second National Survey of Adult Oral Health conducted in 2004–06,4 and the initial National Oral Health Survey of Australia 1987–88.5 The purpose of this Special Issue is to provide a descriptive ‘snapshot’ of oral health in the adult population of Australia and to describe their use of dental services. The findings provide up-to-date evidence that can contribute to the development of oral health policies and programs in Australia. Such evidence continues to be essential because oral diseases represent a considerable burden on the health of the public. This calls for information about the distribution of oral disease and provision of dental care among relevant subgroups of the Australian population. This report also includes some comparisons of results with the first two surveys, evaluating trends in oral disease and dental care that have occurred over the past 30 years. These trends provide insights into historical influences on dental care and likely trends in oral health status. The first set of papers deal with the methods involved in relation to sampling, data collection, weighting of the data and representativeness. Following these methods papers are a set of papers that describe oral health status for outcomes such as tooth loss, caries and periodontal disease. Other important oral conditions such as fluorosis and xerostomia are also presented. The final set of papers includes impacts of oral conditions, use of dental services and dental behaviours. Together the information in these papers reflects a valuable national resource that demonstrates the widespread nature of oral diseases in the Australian population, the impacts of these oral diseases, the groups within our society that suffer the greatest burden from oral diseases and the importance of access to dental services for Australians.

Pre-Pregnancy Diet Quality and Its Association with Offspring Behavioral Problems

Abstract Objectives To examine the relationship between pre-pregnancy diet quality and offspring behavioral problems among children aged 5–12 years. Methods 1554 mother-child dyads with mothers from the Australian longitudinal study on women's health (ALSWH) and children from the mothers and their children's health Study (MatCH). The healthy eating index (HEI-2015) score was used to explore maternal diet quality before pregnancy. Childhood total behavioral difficulties, internalizing (emotional and peer) and externalizing problems (hyperactivity and conduct) were assessed using the strengths and difficulties questionnaire (SDQ). Multivariable logistic regression analyses were used to examine the association between maternal diet quality and offspring behavioral problems. Results 211 children experienced a greater score on total behavioral difficulties (13.6%) among the 1554 children. Better pre-pregnancy diet quality was associated with lower odds of offspring total behavioral difficulties after adjustment for potential confounders, highest vs lowest tertile (AOR = 0.52, 95% CI: 0.32, 0.85) at P = 0.009. Greater adherence to the HEI-2015 score before pregnancy was also inversely associated with odds of offspring externalizing problems (AOR = 0.64, 95% CI: 0.43, 0.94). Among the four subscales, hyperactivity and peer problems were negatively associated with better diet quality, (AOR = 0.67, 95% CI: 0.47, 0.96) and (AOR = 0.63, 95% CI: 0.42, 0.96), respectively. Conclusions We found that mothers who recorded the better quality of diets before pregnancy had children with a lower risk of behavioral disorders in childhood. Further well-powered prospective studies are warranted to confirm the findings. Funding Sources The research on which this paper is based was conducted as part of the Australian Longitudinal Study on Women's Health by the University of Queensland and The University of Newcastle. We are grateful to the Australian Government Department of Health for funding and to the women who provided the survey data. Gete is supported by the UQ Research Training Scholarship. Mishra holds the Australian Health and Medical Research Council Principal Research Fellowship APP1121844.

Use of health and support services by people living with dementia in the community setting.

To determine the access to and use of health-care services by people with dementia in the community. A retrospective cross-sectional analysis of the Australian Government Department of Veterans' Affairs (DVA) administrative claims data was conducted. Veterans and their spouses with one or more dementia claims between 1 January 2000 and 30 June 2016, who were aged ≥45years at the time of the claim and who were still alive and living in the community on 30 June 2017, were included. We assessed the proportions of people with dementia who received medical, pharmacy and medicines, allied health services, and home care supports from 1 July 2016 to 30 June 2017. A total of 10171 people with dementia were included. They had a median age of 89years, 60% were female, and 63% lived in a major city. Over the one-year study period, 98% visited the GP and 99% had medicines dispensed at a pharmacy. Eighty-two per cent saw a specialist, and 19% saw a geriatrician. Thirty-one per cent received a DVA-funded dose administration aid to support medication administration, and 19% received a home medicines review. Less than half had claims for occupational therapist services (48%), community nursing (48%), physiotherapists (41%) or dentist visits (33%). Fifty-eight per cent received home care supports, for example domestic assistance. Many people living with dementia in the community do not access all of the health-care or support services available to them. Ensuring that people with dementia and their carers are supported to access the services available to assist them live in the community setting for as long as possible is important.

Use of analgesics following rescheduling of codeine in Australia: An interrupted time series analysis in the veteran population

BackgroundThe Australian medicines regulator, the Therapeutic Goods Administration (TGA), rescheduled all codeine-containing medicines to be available only on prescription on 1 February 2018. This study was conducted to determine whether use of analgesics changed following codeine re-scheduling to prescription only status, and whether there was a change in the use of codeine preparations and a therapeutic shift to stronger opioids or other analgesics in the Australian veteran population following the change. MethodsInterrupted time series analysis using Repatriation Pharmaceutical Benefits Scheme (RPBS) claims data from the Australian Government Department of Veterans’ Affairs (DVA) for clients with dispensing of opioid and non-opioid analgesics between January 2015 and April 2019. Trends in the monthly rate of analgesic dispensings (opioid and non-opioid) were compared for the period between January 2015 and January 2018 with the period February 2018 to April 2019. ResultsParacetamol with codeine 8mg was the only analgesic with an increased rate of dispensing following the February 2018 codeine scheduling changes. Prior to codeine re-scheduling, the rate of dispensing of paracetamol with codeine 8mg was decreasing by 0.9% each month. Immediately after the scheduling changes, dispensing of paracetamol with codeine 8mg increased by 45% (95%CI=1.282-1.676, p<0.001) and in the fifteen month period thereafter (February 2018 to April 2019), the rate of dispensing increased by 4% each month (95%CI=1.027-1.054, p<0.001). Therapeutic shift from over-the-counter codeine products to other opioids was not observed, with no increase in the rate of dispensing of any of the other opioid (or non-opioid) analgesics following the codeine scheduling changes. ConclusionA significant increase in prescription use of paracetamol with codeine 8mg was observed after the February 2018 codeine re-scheduling. Therapeutic shift to stronger opioid analgesics was not observed in the study population.

In the frame, road map for Australian sport on an uncertain journey through COVID-19

In the frame, road map for Australian sport on an uncertain journey through COVID-19

Reducing medicine-induced deterioration and adverse reactions (ReMInDAR) trial: study protocol for a randomised controlled trial in residential aged-care facilities assessing frailty as the primary outcome

IntroductionMany medicines have adverse effects which are difficult to detect and frequently go unrecognised. Pharmacist monitoring of changes in signs and symptoms of these adverse effects, which we describe as...

Twin enzymes, divergent control: The cholesterogenic enzymes DHCR14 and LBR are differentially regulated transcriptionally and post‐translationally

Cholesterol synthesis is a tightly regulated process, both transcriptionally and post‐translationally. Transcriptional control of cholesterol synthesis is relatively well understood. However, post‐translational regulation has only been examined for a few of the ~20 enzymes in cholesterol biosynthesis. Two of the four sterol reductases, DHCR14 and LBR, share evolutionary ties with a high level of sequence homology, and they uniquely share the same delta‐14 reductase activity in cholesterol biosynthesis. However, the post‐translational regulation of these twin enzymes is poorly understood. Using CHO‐7 cells stably expressing epitope tagged DHCR14 or LBR, we investigated the post‐translational regulation of these enzymes. We found that DHCR14 and LBR undergo differential post translational regulation, with DHCR14 being rapidly turned over, triggered by cholesterol and other sterol intermediates while LBR remained stable. DHCR14 is degraded via the ubiquitin‐proteasome system and via mass‐spectrometry we identified several E3 ligases that modulate basal DHCR14 levels. Significantly, we found that gene expression across an array of human tissues showed an inverse relationship between the C14‐sterol reductases; one enzyme or the other tends to be predominantly expressed in each tissue. Overall, our findings indicate that while LBR tends to be the constitutively active delta‐14 reductase, DHCR14 levels are tuneable, responding to the local cellular demands for cholesterol.Support or Funding InformationThis work was supported by Australian Research Council Grant DP170101178. PhD Candidates were funded by the Research Training Program from the Australian Government Department of Education.

Efforts to control air pollution in the Asia-Pacific region.

Efforts to control air pollution in the Asia-Pacific region.

Impact of a diagnosis of polycystic ovary syndrome on diet, physical activity and contraceptive use in young women: findings from the Australian Longitudinal Study of Women's Health.

Do diet, physical activity and contraceptive use change after receiving a diagnosis of polycystic ovary syndrome (PCOS)? Using longitudinal data 12months apart, young women newly diagnosed with PCOS were more likely to stop using contraception but did not change their physical activity or vegetable intake. Diagnostic criteria for PCOS have widened to capture more women, despite limited evidence of the benefits and harms. Possible benefits of a PCOS diagnosis are that it may help women with family planning and motivate them to implement healthy lifestyle changes to reduce the reproductive, metabolic and cardiovascular risks associated with PCOS. However, there are no empirical studies investigating how women respond to a diagnosis of PCOS with respect to their health behaviour, and longitudinal population-based studies are lacking. This is a longitudinal analysis of two waves of data collected 12months apart from the cohort born 1989-1995 in the Australian Longitudinal Survey on Women's Health, a population-based cohort study. Women in this cohort were first surveyed in 2012-2013, aged 18-23 years. Women who responded to the 2014 survey (aged 19-24, n= 11 344) and 2015 survey (aged 20-25, n= 8961) were included. Using logistic regression, multinomial logistic regression and linear regression, change in vegetable intake, physical activity and contraceptive use were compared for women newly diagnosed with PCOS to women not reporting a diagnosis of PCOS. Changes in psychological distress and BMI were also examined. Young women reporting a new diagnosis of PCOS were no more likely to increase their vegetable intake or physical activity than women not reporting a PCOS diagnosis. Women newly diagnosed with PCOS were 3.4 times more likely to stop using contraception during the 12-month study period than women without PCOS (14% versus 4%, 95% CI = 2.3 to 5.1, P< 0.001). This difference remained significant after controlling for demographics, chronic conditions associated with PCOS, endometriosis, BMI and psychological distress (P< 0.001). All data was self-reported including PCOS diagnosis, assessment of diet quality was limited to vegetable intake only. The exact timing of diagnosis within the 12-month period and whether the women intended to conceive are unknown. The number of women reporting a new diagnosis of PCOS was also relatively small. These findings suggest that a diagnosis of PCOS may not produce short-term benefits by way of improving health behaviour. The observed reduction in contraception use suggests some women may be at increased risk of unplanned pregnancies, highlighting the importance of counselling about contraceptive needs. Both potential benefits and harms must be considered when determining the appropriateness of a PCOS diagnosis. The Australian Longitudinal Study on Women's Health is funded by the Australian Government Department of Health. BWM reports consultancy for ObsEva, Merck, Merck KGaA and Guerbet. No further competing interests exist. N/A.

Age at natural menopause and development of chronic conditions and multimorbidity: results from an Australian prospective cohort.

Is age at natural menopause (ANM) associated with the development of multiple chronic conditions (multimorbidity) in postmenopausal life? Women with premature menopause experience increased odds of developing individual chronic conditions and multimorbidity. ANM is considered as a marker of age-related morbidity and mortality in postmenopausal life. Multimorbidity affects more than 60% of older women and has been recognized as the most common 'chronic condition'. Few studies have examined the association between ANM and the development of multimorbidity. A prospective national cohort study of 11 258 Australian women, aged 45-50years in 1996. Women were followed from 1996 to 2016. Information about ANM and 11 chronic conditions (diabetes, hypertension, heart disease, stroke, arthritis, osteoporosis, asthma, chronic obstructive pulmonary disease, depression, anxiety and breast cancer) were estimated approximately every 3years. Multimorbidity is defined as 2 or more of these 11 conditions. Generalized estimating equations were used to link the categorical ANM with individual chronic conditions and multimorbidity. Among 5107 women reporting ANM, 2.3% experienced premature menopause (≤40years) and 55.1% developed multimorbidity. Compared with women who experienced menopause at age 50-51years, women with premature menopause had twice the odds of experiencing multimorbidity by age 60 (OR = 1.98, 95% CI 1.31 to 2.98) and three times the odds of developing multimorbidity in their 60s (OR = 3.03, 95% CI 1.62 to 5.64). Women with premature menopause also experienced higher incidence of most individual chronic conditions. The main limitation of this study was the use of self-reported data, but with repeated assessments from prospective study design and the validity of most of the chronic conditions from hospital data, the potential for non-differential misclassification is minimized. To our knowledge, this is the first study to assess the association of premature menopause and development of multimorbidity in a larger national cohort of mid-aged women. Health professionals should consider comprehensive screening and assessment of risk factors for multimorbidity when treating women who experienced premature menopause. The Australian Longitudinal Study on Women's Health was supported by the Australian Government Department of Health. X.X. is funded by an International Postgraduate Research Scholarship from the Australian government and a UQ Centennial Scholarship from The University of Queensland. G.D.M. is supported by the National Health and Medical Research Council Principal Research Fellowship (APP1121844). None of the authors has any conflicts of interest to declare.

A prospective quasi-experimental controlled study evaluating the use of dynamic elastomeric fabric orthoses to manage common postpartum ailments during postnatal care.

Objective:To evaluate the effectiveness of a postnatal dynamic elastomeric fabric orthoses to manage postpartum pain, improve functional capacity and enhance the quality of life arising from postnatal ailments immediately to an 8-week postpartum, compared with patients who did not wear dynamic elastomeric fabric orthoses.Method:A total of 51 postpartum women were recruited (day 0 to 10 days post-delivery) from hospitals and community-based health clinics to participate in a prospective quasi-experimental controlled study using parallel groups without random allocation. The subgroup of the compression shorts group wore SRC recovery shorts and received standard postnatal care. The comparison group received standard postnatal care alone. Wear compliance was monitored throughout the study. Primary outcome measure, Numeric Pain Rating Scale, and secondary outcome measures, Roland Morris Disability Questionnaire, Pelvic Floor Impact Questionnaire–7, and Short Form (SF-36) were assessed fortnightly over 8 weeks for both groups.Results:The compression shorts group reported a larger reduction in mean (SD) Numeric Pain Rating Scale score (−3.09 (2.20)) from baseline to 8 weeks, compared to the comparison group (−2.00 (1.41)). However, there was insufficient evidence of a statistical difference in Numeric Pain Rating Scale score at 8 weeks when comparing the compression shorts group and comparison group (−1.17; 95%CI: (−2.35, −0.01), R2 = .19, p = .050). The compression shorts group met the wear compliance of the dynamic elastomeric fabric orthoses and reported an average wear of the dynamic elastomeric fabric orthoses as 9 out of 14 days for 11 h per day (SD 4.8 h) between the fortnightly timepoints.Conclusion:The use of dynamic elastomeric fabric orthoses may be considered during postnatal care as a non-pharmacological therapeutic intervention to manage pain resulting from common postpartum ailments. While the dynamic elastomeric fabric orthoses was clinically well accepted by participants with high wearing compliance, future research with larger population samples are needed to enable statistical conclusions on the effectiveness of a dynamic elastomeric fabric orthoses in postnatal care to be made.Registration:Trial registration was not required as per the Australian Government Department of Health, Therapeutic Goods Administration.