Opportunities for primary and secondary prevention of excess gestational weight gain : General Practitioners’ perspectives

Background

The impact of excess gestational weight gain (GWG) on maternal and child health outcomes is well documented. Understanding how health care providers view and manage GWG may assist with influencing healthy gestational weight outcomes. This study aimed to assess General Practitioner's (GPs) perspectives regarding the management and assessment of GWG and to understand how GPs can be best supported to provide healthy GWG advice to pregnant women.
Methods

Descriptive qualitative research methods utilising semi - structured interview questions to assess GPs perspectives and management of GWG. GPs participating in shared antenatal care in Geelong, Victoria and Sydney, New South Wales were invited to participate in semi - structured, individual interviews via telephone or in person. Interviews were digitally recorded and transcribed verbatim. Data was analysed utilising thematic analysis for common emerging themes.
Results

Twenty eight GPs participated, 14 from each state. Common themes emerged relating to awareness of the implications of excess GWG, advice regarding weight gain, regularity of gestational weighing by GPs, options for GPs to seek support to provide healthy lifestyle behaviour advice and barriers to engaging pregnant women about their weight. GPs perspectives concerning excess GWG were varied. They frequently acknowledged maternal and child health complications resulting from excess GWG yet weighing practices and GWG advice appeared to be inconsistent. The preferred support option to promote healthy weight was referral to allied health practitioners yet GPs noted that cost and limited access were barriers to achieving this.
Conclusions

GPs were aware of the importance of healthy GWG yet routine weighing was not standard practice for diverse reasons. Management of GWG and perspectives of the issue varied widely. Time efficient and cost effective interventions may assist GPs in ensuring women are supported in achieving healthy GWG to provide optimal maternal and infant health outcomes.

A call for an expanded synthesis of developmental and evolutionary paradigms

Charney's target article continues a critique of genetic blueprint models of development that suggests reconsideration of concepts of adaptation, inheritance, and environment, which can be well illustrated in current research on infant attachment. The concepts of development and adaptation are so heavily based on the model of genetics and inheritance forged in the modern synthesis that they will require reconsideration to accommodate epigenetic inheritance.

Toxic marine microalgae and shellfish poisoning in the British isles : history, review of epidemiology, and future implications

The relationship between toxic marine microalgae species and climate change has become a high profile and well discussed topic in recent years, with research focusing on the possible future impacts of changing hydrological conditions on Harmful Algal Bloom (HAB) species around the world. However, there is very little literature concerning the epidemiology of these species on marine organisms and human health. Here, we examine the current state of toxic microalgae species around the UK, in two ways: first we describe the key toxic syndromes and gather together the disparate reported data on their epidemiology from UK records and monitoring procedures. Secondly, using NHS hospital admissions and GP records from Wales, we attempt to quantify the incidence of shellfish poisoning from an independent source. We show that within the UK, outbreaks of shellfish poisoning are rare but occurring on a yearly basis in different regions and affecting a diverse range of molluscan shellfish and other marine organisms. We also show that the abundance of a species does not necessarily correlate to the rate of toxic events. Based on routine hospital records, the numbers of shellfish poisonings in the UK are very low, but the identification of the toxin involved, or even a confirmation of a poisoning event is extremely difficult to diagnose. An effective shellfish monitoring system, which shuts down aquaculture sites when toxins exceed regularity limits, has clearly prevented serious impact to human health, and remains the only viable means of monitoring the potential threat to human health. However, the closure of these sites has an adverse economic impact, and the monitoring system does not include all toxic plankton. The possible geographic spreading of toxic microalgae species is therefore a concern, as warmer waters in the Atlantic could suit several species with southern biogeographical affinities enabling them to occupy the coastal regions of the UK, but which are not yet monitored or considered to be detrimental.

Indices for cashmere fleece competition and across farm comparisons: The role of staple length in identifying goats of higher cashmere production

A single focus on mean fibre diameter (MFD, μm) as the definition of cashmere quality overlooks the effects of fibre length, softness and fibre curvature on cashmere processing, textile quality and consumer acceptance. Many farmers overlook the importance of cashmere staple length (SL, cm) in their fleece assessments. We aimed to determine the importance of SL in comparison with MFD when evaluating cashmere production and to identify how across farm comparisons of cashmere fleeces can be objectively undertaken. A sample of 1244 commercial cashmere fleeces from goats originating from many Australian farms was used. Least squares models, relating the logarithm of clean cashmere production (CCMwt, g) to MFD and SL, were fitted. Six years of data from the Australian cashmere industry between farm fleece competitions were analysed to determine the relation between CCMwt and MFD. In the research flocks, adjusting CCMwt of individual goats across farms for MFD only accounted for 2% of the variance, whereas SL accounted for 39% of the variance. The least squares additive model involving only SL was: log10(CCMwt)=1.570+0.06010×SL. Thus CCMwt was proportional to: 100.06010×SL=1.1484SL. It was appropriate to adjust CCMwt for SL by a factor 1/1.1484(SL-SL0) where SL0 is a standard SL of 7.5cm. The between farm index for cashmere weight equals: cleancashmerestaplelengthindex=2.823×CCMwt/1.1484SL. For industry fleece competitions, regression analysis indicated that there was no association between cashmere production and MFD (P=0.81), similar to the research data. Adjusting CCMwt for MFD in across farm comparison and fleece competitions appears to be ineffective. For farm comparisons and in fleece competitions it is important to assess cashmere SL. The use of the Clean Cashmere Staple Length Index will provide a more robust comparison of cashmere productivity between farms as it is an indirect indicator of desirable skin secondary follicle development. The results have application in development projects where obtaining a cashmere MFD test is costly or unavailable. © 2013 Elsevier B.V.

Continuity of care in dual diagnosis treatment: definitions, applications, and implications.

OBJECTIVE: The goal of this work is to review the current literature on continuity of care in the treatment of people with dual diagnosis. In particular, this review set out to clarify how continuity of care has been defined, applied, and assessed in treatment and to enhance its application in both research and clinical practice. METHODS: To identify articles for review, the term "continuity" and combinations of "substance" and "treatment" were searched in electronic databases. The search was restricted to quantitative articles published in English after 1980. Papers were required to discuss "continuity" in treatment samples that included a proportion of patients with a dual diagnosis. RESULTS: A total of 18 non-randomized studies met the inclusion criteria. Analysis revealed six core types of continuity in this treatment context: continuity of relationship with provider(s), continuity across services, continuity through transfer, continuity as regularity and intensity of care, continuity as responsive to changing patient need, and successful linkage of the patient. Patient age, ethnicity, medical status, living status, and the type of mental health and/or substance use disorder influenced the continuity of care experienced in treatment. Some evidence suggested that achieving continuity of care was associated with positive patient and treatment-related outcomes. CONCLUSIONS: This review summarizes how continuity of care has been understood, applied, and assessed in the literature to date. Findings provide a platform for future researchers and service providers to implement and evaluate continuity of care in a consistent manner and to determine its significance in the treatment of people with a dual diagnosis.

Understanding ageing effects using complexity analysis of foot-ground clearance during walking

Ageing influences gait patterns which in turn can affect the balance control of human locomotion. Entropy-based regularity and complexity measures have been highly effective in analysing a broad range of physiological signals. Minimum toe clearance (MTC) is an event during the swing phase of the gait cycle and is highly sensitive to the spatial balance control properties of the locomotor system. The aim of this research was to investigate the regularity and complexity of the MTC time series due to healthy ageing and locomotors' disorders. MTC data from 30 healthy young (HY), 27 healthy elderly (HE) and 10 falls risk (FR) elderly subjects with balance problems were analysed. Continuous MTC data were collected and using the first 500 data points, MTC mean, standard deviation (SD) and entropy-based complexity analysis were performed using sample entropy (SampEn) for different window lengths (m) and filtering levels (r). The MTC SampEn values were lower in the FR group compared to the HY and HE groups for all m and r. The HY group had a greater mean SampEn value than both HE and FR reflecting higher complexity in their MTC series. The mean SampEn values of HY and FR groups were found significantly different for m = 2, 4, 5 and r = (0.1-0.9) × SD, (0.3-0.9) × SD and (0.3-0.9) × SD, respectively. They were also significant difference between HE and FR groups for m = 4-5 and r = (0.3-0.7) × SD, but no significant differences were seen between HY and HE groups for any m and r. A significant correlation of SampEn with SD of MTC was revealed for the HY and HE groups only, suggesting that locomotor disorders could significantly change the regularity or the complexity of the MTC series while healthy ageing does not. These results can be usefully applied to the early diagnosis of common gait pathologies.