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Practicalities and Research Considerations for Conducting Childhood Obesity Prevention Interventions with Families
No full text© 2016 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access
article distributed under the terms and conditions of the Creative Commons Attribution
(CC-BY) license (http://creativecommons.org/licenses/by/4.0/).Internationally, childhood obesity is a major public health concern. Given the established difficulties in treating obesity, designing and evaluating effective obesity prevention interventions are research priorities. As parents play a crucial role in establishing positive health behaviours in children, they are a key target for child obesity prevention programs. However, recruiting and engaging parents in such interventions can be a considerable challenge for researchers and practitioners. Members of the ‘Parenting, Child Behaviour and Well-being’ stream of the Australasian Child and Adolescent Obesity Research Network (ACAORN) have considerable and varied expertise in conducting such interventions and can provide insights into addressing these challenges. This paper aims to highlight considerations regarding the design, implementation, and evaluation of obesity prevention interventions with families and provide practical insights and recommendations for researchers and practitioners conducting family-based research in this area. Case studies of three family-based interventions conducted by ACAORN members are highlighted to provide examples and contextualise the recommendations proposed
Metformin and dietary advice to improve insulin sensitivity and promote gestational restriction of weight among pregnant women who are overweight or obese: the GRoW Randomised Trial
No full textThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background
Obesity is a significant global health problem, with approximately 50% of women entering pregnancy having a body mass index greater than or equal to 25 kg/m2. Obesity during pregnancy is associated with a well-recognised increased risk of adverse health outcomes both for the woman and her infant. Currently available data from large scale randomised trials and systematic reviews highlight only modest effects of antenatal dietary and lifestyle interventions in limiting gestational weight gain, with little impact on clinically relevant pregnancy outcomes. Further information evaluating alternative strategies is required.
The aims of this randomised controlled trial are to assess whether the use of metformin as an adjunct therapy to dietary and lifestyle advice for overweight and obese women during pregnancy is effective in improving maternal, fetal and infant health outcomes.
Methods
Design: Multicentre randomised, controlled trial.
Inclusion Criteria: Women with a singleton, live gestation between 10+0-20+0 weeks who are obese or overweight (defined as body mass index greater than or equal to 25 kg/m2), at the first antenatal visit.
Trial Entry & Randomisation: Eligible, consenting women will be randomised between 10+0 and 20+0 weeks gestation using an online computer randomisation system, and randomisation schedule prepared by non-clinical research staff with balanced variable blocks. Stratification will be according to maternal BMI at trial entry, parity, and centre where planned to give birth.
Treatment Schedules: Women randomised to the Metformin Group will receive a supply of 500 mg oral metformin tablets. Women randomised to the Placebo Group will receive a supply of identical appearing and tasting placebo tablets. Women will be instructed to commence taking one tablet daily for a period of one week, increasing to a maximum of two tablets twice daily over four weeks and then continuing until birth. Women, clinicians, researchers and outcome assessors will be blinded to the allocated treatment group.
All women will receive three face-to-face sessions (two with a research dietitian and one with a trained research assistant), and three telephone calls over the course of their pregnancy, in which they will be provided with dietary and lifestyle advice, and encouraged to make change utilising a SMART goals approach.
Primary Study Outcome: infant birth weight >4000 grams.
Sample Size: 524 women to detect a difference from 15.5% to 7.35% reduction in infants with birth weight >4000 grams (p = 0.05, 80% power, two-tailed).
Discussion
This is a protocol for a randomised trial. The findings will contribute to the development of evidence based clinical practice guidelines
Terrestrial freshwater lenses in stable riverine settings: Occurrence and controlling factors
Get PDFPublished version made available following 6 months embargo from date of publication (13 May 2016) in accordance with publisher copyright.Rivers in arid and semiarid regions often traverse saline aquifers, creating buoyant freshwater lenses in the adjoining riparian and floodplain zones. The occurrence of freshwater lenses where the river is otherwise gaining saline groundwater appears counterintuitive, given that both hydraulic and density forces act toward the river. In this paper, an analytical solution is presented that defines the extent of a stable, sharp-interface terrestrial freshwater lens (in cross section) in a riverine environment that otherwise contains saline groundwater moving toward the river. The method is analogous to the situation of an island freshwater lens, except in the riverine setting, the saltwater is mobile and the lens is assumed to be stagnant. The solution characterizes the primary controlling factors of riverine freshwater lenses, which are larger for situations involving lower hydraulic conductivities and rates of saltwater discharge to the river. Deeper aquifers, more transmissive riverbeds, and larger freshwater-saltwater density differences produce more extensive lenses. The analytical solution predicts the parameter combinations that preclude the occurrence of freshwater lenses. The utility of the solution as a screening method to predict the occurrence of terrestrial freshwater lenses is demonstrated by application to parameter ranges typical of the South Australian portion of the River Murray, where freshwater lenses occur in only a portion of the neighboring floodplains. Despite assumptions of equilibrium conditions and a sharp freshwater-saltwater interface, the solution for predicting the occurrence of riverine freshwater lenses presented in this study has immediate relevance to the management of floodplains in which freshwater lenses are integral to biophysical conditions
Strongyloidiasis: A Disease of Socioeconomic Disadvantage
Get PDFThis is an open access article distributed under the Creative Commons Attribution License (CC BY) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Abstract: Strongyloidiasis is a disease caused by soil transmitted helminths of the Strongyloides
genus. Currently, it is predominately described as a neglected tropical disease. However, this
description is misleading as it focuses on the geographical location of the disease and not the primary
consideration, which is the socioeconomic conditions and poor infrastructure found within endemic
regions. This classification may result in misdiagnosis and mistreatment by physicians, but more
importantly, it influences how the disease is fundamentally viewed. Strongyloidiasis must be first and
foremost considered as a disease of disadvantage, to ensure the correct strategies and control measures
are used to prevent infection. Changing how strongyloidiasis is perceived from a geographic and
clinical issue to an environmental health issue represents the first step in identifying appropriate
long term control measures. This includes emphasis on environmental health controls, such as
better infrastructure, sanitation and living conditions. This review explores the global prevalence
of strongyloidiasis in relation to its presence in subtropical, tropical and temperate climate zones
with mild and cold winters, but also explores the corresponding socioeconomic conditions of these
regions. The evidence shows that strongyloidiasis is primarily determined by the socioeconomic
status of the communities rather than geographic or climatic conditions. It demonstrates that
strongyloidiasis should no longer be referred to as a “tropical” disease but rather a disease of
disadvantage. This philosophical shift will promote the development of correct control strategies for
preventing this disease of disadvantage
Reorganization of the primary motor cortex following lower-limb amputation for vascular disease: a pre-post-amputation comparison
Get PDFThis author accepted manuscript is made available following 12 months embargo from date of publication (December 2016) in accordance with the publisher’s copyright policyPurpose: This study compared bilateral corticomotor and intracortical excitability of the primary motor cortex (M1), pre- and post-unilateral transtibial amputation.
Method: Three males aged 45, 55, and 48 years respectively who were scheduled for elective amputation and thirteen (10 male, 3 female) healthy control participants aged 58.9 (SD 9.8) were recruited. Transcranial magnetic stimulation assessed corticomotor and intracortical excitability of M1 bilaterally. Neurophysiological assessments were performed 10 (SD 7) days prior to surgery and again at 10 (SD 3) days following surgery. Data were analyzed descriptively and objectively compared to 95% confidence intervals from control data.
Results: Prior to amputation, all three patients demonstrated stronger short-latency intracortical inhibition evoked from M1 ipsilateral to the affected limb and reduced long-latency intracortical inhibition evoked from M1 contralateral to the affected limb compared to control subjects. Following amputation, short-latency intracortical inhibition was reduced in both M1s and long-latency intracortical inhibition was reduced for the ipsilateral M1. Single-pulse motor evoked potential amplitude and motor thresholds were similar pre-to-post amputation.
Conclusions: Modulation of intracortical excitability shortly following amputation indicates that the cortical environment may be optimized for reorganization in the acute post-amputation period which might be significant for learning to support prosthetic mobility.
Implications for Rehabilitation
Amputation of a lower-limb is associated with extensive reorganization at the level of the cortex.
Reorganization occurs in the acute post-amputation period implying a favorable cortical environment for recovery.
Rehabilitation or brain interventions may target the acute pre-prosthetic post-amputation period to optimize recovery
α-Conotoxin Vc1.1 inhibits human dorsal root ganglion neuroexcitability and mouse colonic nociception via GABAB receptors
Get PDFThis is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/ licenses/by-nc/4.0/Objective α-Conotoxin Vc1.1 is a small disulfide-bonded peptide from the venom of the marine cone snail Conus victoriae. Vc1.1 has antinociceptive actions in animal models of neuropathic pain, but its applicability to inhibiting human dorsal root ganglion (DRG) neuroexcitability and reducing chronic visceral pain (CVP) is unknown.
Design We determined the inhibitory actions of Vc1.1 on human DRG neurons and on mouse colonic sensory afferents in healthy and chronic visceral hypersensitivity (CVH) states. In mice, visceral nociception was assessed by neuronal activation within the spinal cord in response to noxious colorectal distension (CRD). Quantitative-reverse-transcription-PCR, single-cell-reverse-transcription-PCR and immunohistochemistry determined γ-aminobutyric acid receptor B (GABABR) and voltage-gated calcium channel (CaV2.2, CaV2.3) expression in human and mouse DRG neurons.
Results Vc1.1 reduced the excitability of human DRG neurons, whereas a synthetic Vc1.1 analogue that is inactive at GABABR did not. Human DRG neurons expressed GABABR and its downstream effector channels CaV2.2 and CaV2.3. Mouse colonic DRG neurons exhibited high GABABR, CaV2.2 and CaV2.3 expression, with upregulation of the CaV2.2 exon-37a variant during CVH. Vc1.1 inhibited mouse colonic afferents ex vivo and nociceptive signalling of noxious CRD into the spinal cord in vivo, with greatest efficacy observed during CVH. A selective GABABR antagonist prevented Vc1.1-induced inhibition, whereas blocking both CaV2.2 and CaV2.3 caused inhibition comparable with Vc1.1 alone.
Conclusions Vc1.1-mediated activation of GABABR is a novel mechanism for reducing the excitability of human DRG neurons. Vc1.1-induced activation of GABABR on the peripheral endings of colonic afferents reduces nociceptive signalling. The enhanced antinociceptive actions of Vc1.1 during CVH suggest it is a novel candidate for the treatment for CVP
Re-framing ‘counterfeit from a public health perspective’: A case for fraudulent medicine
No full textAuthor version made available in accordance with publisher copyright policy.“Black market” counterfeiters operating outside of authorised industry are often framed as the perpetrators of dangerous and defective medicines within legal pharmaceutical markets. However the assumption that all medicines which deliberately violate regulatory standards and quality specifications have black market origins is ill conceived, as poor medicine quality can occur regardless of who the manufacturer of the medicine may be. This paper proposes a reframing of all pharmaceutical products which intentionally, or negligently, fail to comply with regulatory standards and which are then fraudulently depicted as being of standard, from “counterfeit” to “fraudulent medicines”. This proposal is reinforced with examples from Australian law, where Australian pharmaceutical companies, who deliberately violated regulatory standards and produced defective and dangerous medicines, have been prosecuted using legislation designed to capture poor-quality, counterfeit drugs. The paper argues that these corporate crimes should not be framed as “counterfeiting” but as “frauds”, thus containing acts of “counterfeiting” to existing intellectual property (IP) law and providing due recognition for all acts which defraud and cause harm to the consumer
Communities for Children Final Report: The use of Communities for Children programs to improve the Social Determinants of health outcomes in Western Adelaide.
No full textRecurrent mutation in the crystallin alpha A gene associated with inherited paediatric cataract
No full text© 2016 Javadiyan et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License
(http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium,
provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/
publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Cataract is a major cause of childhood blindness worldwide. The purpose of this study was to determine
the genetic cause of paediatric cataract in a South Australian family with a bilateral lamellar paediatric cataract
displaying variable phenotypes.
Case presentation: Fifty-one genes implicated in congenital cataract in human or mouse were sequenced in an
affected individual from an Australian (Caucasian) family using a custom Ampliseq library on the Ion Torrent Personal
Genome Machine. Reads were mapped against the human genome (hg19) and variants called with the Torrent Suite
software. Variants were annotated to dbSNP 137 using Ion Reporter (IR 1.6.2) and were prioritised for validation if they
were novel or rare and were predicted to be protein changing. We identified a previously reported oligomerization
disrupting mutation, c.62G > A (p.R21Q), in the Crystallin alpha A (CRYAA) gene segregating in this three generation
family. No other novel or rare coding mutations were detected in the known cataract genes sequenced. Microsatellite
markers were used to compare the haplotypes between the family reported here and a previously published family
with the same segregating mutation. Haplotype analysis indicated a potential common ancestry between the two
South Australian families with this mutation. The work strengthens the genotype-phenotype correlations between
this functional mutation in the crystallin alpha A (CRYAA) gene and paediatric cataract.
Conclusion: The p.R21Q mutation is the most likely cause of paediatric cataract i
Lupus anti-ribosomal P autoantibody proteomes express convergent biclonal signatures
No full textLupus-specific anti-ribosomal P (anti-Rib-P) autoantibodies have been implicated in the pathogenesis of neurological complications in systemic lupus erythematosus (SLE). The aim of the present study was to determine variable (V)-region signatures of secreted autoantibody proteomes specific for the Rib-P heterocomplex and investigate the molecular basis of the reported cross-reactivity with Sm autoantigen. Anti-Rib-P immunoglobulins (IgGs) were purified from six anti-Rib-P-positive sera by elution from enzyme-linked immunosorbent assay (ELISA) plates coated with either native Rib-P proteins or an 11-amino acid peptide (11-C peptide) representing the conserved COOH-terminal P epitope. Rib-P- and 11-C peptide-specific IgGs were analysed for heavy (H) and light (L) chain clonality and V-region expression using an electrophoretic and de-novo and database-driven mass spectrometric sequencing workflow. Purified anti-Rib-P and anti-SmD IgGs were tested for cross-reactivity on ELISA and their proteome data sets analysed for shared clonotypes. Anti-Rib-P autoantibody proteomes were IgG1 kappa-restricted and comprised two public clonotypes defined by unique H/L chain pairings. The major clonotypic population was specific for the common COOH-terminal epitope, while the second shared the same pairing signature as a recently reported anti-SmD clonotype, accounting for two-way immunoassay cross-reactivity between these lupus autoantibodies. Sequence convergence of anti-Rib-P proteomes suggests common molecular pathways of autoantibody production and identifies stereotyped clonal populations that are thought to play a pathogenic role in neuropsychiatric lupus. Shared clonotypic structures for anti-Rib-P and anti-Sm responses suggest a common B cell clonal origin for subsets of these lupus-specific autoantibodies