What is the most relevant standard of success in assisted reproduction? Assessing the BESST index for reproduction treatment.
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It has been proposed that use of performance indicators for assisted reproduction treatment (ART) should be revised to better reflect the burden of treatment endured by a couple, and to place greater emphasis on the desired outcome of healthy babies. Recently, the BESST (birth emphasizing a successful singleton at term) score as a routine measurement for use in ART has been suggested. We applied the BESST index to a sample of ART patients and found that the BESST score was sensitive to the effects of patient age and extremes in the number of embryos transferred. However, the statistical properties of the index placed great weight on the effective implantation rate, which when applied to a time series in which implantation rates were improving, showed BESST scores to increase simultaneously with multiple pregnancy rates. This limits the completeness of the summary score as an expression of benefits compared to risks. A modified BESST index, not including cycles of initiated treatment as a denominator, indicated that the ART births contained a substantially lower proportion of BESST babies when compared to the entire population of births. (+info)
An outreach intervention to implement evidence based practice in residential care: a randomized controlled trial [ISRCTN67855475].
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BACKGROUND: The aim of this project was to assess whether outreach visits would improve the implementation of evidence based clinical practice in the area of falls reduction and stroke prevention in a residential care setting. METHODS: Twenty facilities took part in a randomized controlled trial with a seven month follow-up period. Two outreach visits were delivered by a pharmacist. At the first a summary of the relevant evidence was provided and at the second detailed audit information was provided about fall rates, psychotropic drug prescribing and stroke risk reduction practices (BP monitoring, aspirin and warfarin use) for the facility relevant to the physician. The effect of the interventions was determined via pre- and post-intervention case note audit. Outcomes included change in percentage patients at risk of falling who fell in a three month period prior to follow-up and changes in use of psychotropic medications. Chi-square tests, independent samples t-test, and logistic regression were used in the analysis. RESULTS: Data were available from case notes at baseline (n = 897) and seven months follow-up (n = 902), 452 residential care staff were surveyed and 121 physicians were involved with 61 receiving outreach visits. Pre-and post-intervention data were available for 715 participants. There were no differences between the intervention and control groups for the three month fall rate. We were unable to detect statistically significant differences between groups for the psychotropic drug use of the patients before or after the intervention. The exception was significantly greater use of "as required" antipsychotics in the intervention group compared with the control group after the pharmacy intervention (RR = 4.95; 95%CI 1.69-14.50). There was no statistically significant difference between groups for the numbers of patients "at risk of stroke" on aspirin at follow-up. CONCLUSIONS: While the strategy was well received by the physicians involved, there was no change in prescribing patterns. Patient care in residential settings is complex and involves contributions from the patient's physician, family and residential care staff. The project highlights challenges of delivering evidence based care in a setting in which there is a paucity of well controlled trial evidence but where significant health outcomes can be attained. (+info)
Involvement in civil society groups: Is it good for your health?
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STUDY OBJECTIVE: To determine the involvement in civil society groups (CSGs) and the impact of this on health. DESIGN: Case study, cross sectional, self completion questionnaire, and semi-structured interviews. SETTING: Residents in two suburbs in Adelaide, South Australia. PARTICIPANTS: Every household (1038) received a questionnaire asking the adult with the next birthday to complete it. A total of 530 questionnaires were returned. Sixteen questionnaire respondents were also interviewed. MAIN RESULTS: 279 (53%) questionnaire respondents had been involved in a CSG in the past 12 months, 190 (36%) in locally based CSGs, and 188 (35%) in CSGs outside the area. Eleven of the 16 interviewees had been involved in a CSG. A path analysis examined the relation between demographic variables, CSG involvement, and mental and physical health, as measured by the SF-12. Physical health was negatively associated with CSG involvement and older age, and positively associated with working full time or part time and higher education level. Mental health was positively associated with older age, working full time or part time, and higher income but negatively associated with having a child under 18, speaking a language other than English and higher education level. Very few interviewees made a direct link between CSGs and positive individual health outcomes, though some positive community level outcomes were noted. More consistent were reports of the detrimental effects of CSG involvement on mental and physical health. CONCLUSIONS: Involvement in CSGs was significant but not always positive for health. It is possible that CSG involvement is good for a community but not necessarily for the individual. (+info)
Developmental allometry of pulmonary structure and function in the altricial Australian pelican Pelecanus conspicillatus.
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Quantitative methods have been used to correlate maximal oxygen uptake with lung development in Australian pelicans. These birds produce the largest altricial neonates and become some of the largest birds capable of flight. During post-hatching growth to adults, body mass increases by two orders of magnitude (from 88 g to 8.8 kg). Oxygen consumption rates were measured at rest and during exposure to cold and during exercise. Then the lungs were quantitatively assessed using morphometric techniques. Allometric relationships between body mass (M) and gas exchange parameters (Y) were determined and evaluated by examining the exponents of the equation Y=aM(b). This intraspecific study was compared to interspecific studies of adult birds reported in the literature. Total lung volume scales similarly in juvenile pelicans (b=1.05) as in adult birds (b=1.02). However, surface area of the blood-gas barrier greatly increases (b=1.25), and its harmonic mean thickness does not significantly change (b=0.02), in comparison to exponents from adult birds (b=0.86 and 0.07, respectively). As a result, the diffusing capacity of the blood-gas tissue barrier increases much more during development (b=1.23) than it does in adult birds of different sizes (b=0.79). It increases in parallel to maximal oxygen consumption rate (b=1.28), suggesting that the gas exchange system is either limited by lung development or possibly symmorphic. The capacity of the oxygen delivery system is theoretically sufficient for powered flight well in advance of the bird's need to use it. (+info)
Dietary composition of pregnant women is related to size of the baby at birth.
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The fetal origins theory of adult disease suggests that term infants who are small for their gestational age have an increased susceptibility to chronic disease in adulthood as a consequence of physiologic adaptations to undernutrition during fetal life. Consistent evidence for an influence of women's dietary composition during pregnancy on growth of their babies is lacking, despite robust effects in animal experiments. We undertook a prospective observational study of 557 women aged 18-41 y, living in Adelaide, South Australia. Diet was assessed in early and late pregnancy using an FFQ. In early pregnancy, medians for energy intake, the proportion of energy derived from protein and from carbohydrate were 9.0 MJ, 17 and 48%, respectively. In late pregnancy the corresponding medians were 9.2 MJ, 16 and 49%. In early pregnancy, the percentage of energy derived from protein was positively associated with birth weight (P = 0.02) and placental weight (P = 0.07), independently of energy intake and weight gain during pregnancy, and after adjustment for potential confounders, including maternal age, parity, and smoking. Effects were stronger among women (n = 429) who had reliable data, based on prespecified criteria including the plausibility of dietary data when referenced against estimated energy expenditure. In addition, for this subgroup, the percentage of energy from carbohydrate in early and late pregnancy was negatively associated with ponderal index of the baby, and a specific effect of protein from dairy sources was identified. These data support the proposition that maternal dietary composition has an effect on fetal growth. Maternal diet in Western societies may therefore be important for the long-term health of the child. (+info)
Dimensions of oral health related quality of life measured by EQ-5D+ and OHIP-14.
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BACKGROUND: The aims of the study were to compare the dimensions of oral-health-related quality-of-life measured by a generic health state measure, the EuroQol, and a specific oral health measure, the Oral Health Impact Profile. METHODS: Data were collected in 2001-02 from a random sample of South Australian dentists using mailed self-complete questionnaires. Dentists recorded the diagnosis of dental problems and provided patients with self-complete questionnaires to record the nature, severity and duration of symptoms using the EuroQol (EQ-5D+) and 14-item version of the Oral Health Impact Profile (OHIP-14) instruments. RESULTS: Data were available from 375 patients (response rate = 72%). The EuroQol items of mobility, self care and usual activities formed a separate cluster of variables, as did anxiety/depression and cognition, while pain clustered with items from the OHIP physical pain subscale. OHIP items tended to form clusters consistent with the subscales of social disability, physical disability, physical pain, functional limitation and psychological discomfort. The OHIP handicap items clustered between the OHIP social disability and physical disability subscales. The OHIP psychological disability items split between the social disability and psychological discomfort subscales. CONCLUSIONS: The observed clusters of variables empirically supported most of the conceptual dimensions of the OHIP. Both instruments covered symptom experience of pain indicating overlapping domains. However there was partial separation of the generic and specific items, EuroQol covered daily activities such as self-care and usual activities and OHIP covered oral health-specific aspects of functional limitation and physical disability as well as psychological and social aspects of disability and handicap. (+info)
The behavior and routes of lead exposure in pregrasping infants.
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Understanding the routes of lead exposure in a very young infant is an essential precursor to identifying effective strategies for minimizing blood-lead (PbB) levels throughout infancy. The present study integrated observational data, lead-loading data, and household airborne particulate levels <10 microm (PM(10)) to understand the broad patterns of lead exposure in infants from Port Pirie, South Australia. Seven, 2-19-week-old infants were observed between three and six times, for 3-9 h per visit, at intervals of 1-9 weeks. Household lead-loading and PM(10) data were collected for five of the families. Eight objects were observed in an infant's mouth, but only the infant's fingers, pacifier, and nipple of the mother's breast or teat of a bottle were observed in an infant's mouth for an average of more than 1% of an observation day. The objects most frequently put in an infant's mouth were their own fingers or their pacifier. Synthesizing our data on behavioral frequency, lead loading, and the surface area of contact, and using estimates of dose response, and sampling, transfer, and absorption efficiencies, the results suggest that a 4-month-old infant could absorb up to 4 microg of lead a day (equivalent to a PbB level of up to about 2.4 microg/dl) by mouthing their fingers, about two-thirds of all exposure routes identified in this study. Estimates also suggest that lead uptake via inhalation accounts for about 0.5-3% of an infant's PbB at 5 microg/dl. If our estimates reflect real routes and values, the majority of the average PbB level of 6-month-old infants in Port Pirie during 2002 could potentially be accounted for by the normal infant and family behaviors observed in this study. While the current level of concern is 10 microg/dl, recent studies indicate no safe threshold for Pb exposure, and so interventions for reducing chronic low-level exposure are useful. We suggest that home-based interventions for reducing Pb exposure should focus on maintaining low Pb loadings on objects that are directly associated with an infant, and outside objects that have few transfer steps to the infant. (+info)
Flexible teaching and learning in general practice.
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BACKGROUND: Changing general practice workforce characteristics, with fewer people prepared to work excessive hours, mean that both teachers and learners need greater flexibility in their approach. OBJECTIVE: This article describes the strategies one practice has used in aiming for optimum and stimulating medical education. Issues such as finding the right match between learner and teacher, and enriching the learning environment are discussed. Personal, professional and workforce boundaries are examined, as is the maintenance of identity and integrity. DISCUSSION: Flexible teaching and learning needs to involve vertical and horizontal integration. Mentors who are thriving personally should lead by example. A nonclinical agenda is paramount. Appropriate accreditation within the training program and acknowledgment of the differences between rural and metropolitan general practice training needs further work. (+info)