ORCID Profile
0000-0002-8718-2753
Current Organisation
The University of Newcastle
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In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Economic Models and Forecasting | Reproduction | Health Economics | Applied Economics |
Market-Based Mechanisms | Child Health | Health Policy Economic Outcomes
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2003
DOI: 10.1097/00007435-200304000-00017
Abstract: The epidemiology of sexually transmitted infections (STIs) and HIV in Vanuatu is poorly defined. The goal was to determine the prevalence of laboratory-confirmed gonorrhea, chlamydia, trichomoniasis, syphilis seroreactivity, and HIV among pregnant women in Vila, Vanuatu. A cross-sectional survey of 547 pregnant women attending a first-visit antenatal hospital clinic in Vila. Laboratory testing included polymerase chain reaction on t ons for chlamydia, gonorrhea, and trichomoniasis testing of sera for syphilis with rapid plasmid reagin and enzyme-linked immunosorbent assay for HIV. The prevalence of trichomoniasis was 27.5% (150) of chlamydia, 21.5% (117) of gonorrhea, 5.9% (32) and of syphilis, 13 (2.4%). No HIV cases were detected 214 women (40%) had > or =1 STI. Young age and single marital status were both significantly associated with infection (P < 0.001). Chlamydial infection and trichomoniasis are hyperendemic among pregnant women in Vila. Young, single women are at greatest risk for infection.
Publisher: SAGE Publications
Date: 09-06-2016
Abstract: A lack of standard terminology or means to identify and define models of maternity care in Australia has prevented accurate evaluations of outcomes for mothers and babies in different models of maternity care. As part of the Commonwealth-funded National Maternity Data Development Project, a classification system was developed utilising a data set specification that defines characteristics of models of maternity care. The Maternity Care Classification System or MaCCS was developed using a participatory action research design that built upon the published and grey literature. The study identified the characteristics that differentiate models of care and classifies models into eleven different Major Model Categories. The MaCCS will enable in idual health services, local health districts (networks), jurisdictional and national health authorities to make better informed decisions for planning, policy development and delivery of maternity services in Australia.
Publisher: CSIRO Publishing
Date: 2011
DOI: 10.1071/AH10908
Abstract: Objective. To describe maternity services available to Australian women and, in particular, the location, classification of services and support services available. Design. A descriptive study was conducted using an online survey that was emailed to eligible hospitals. Inclusion criteria for the study included public and private maternity units with greater than 50 births per year. In total, 278 maternity units were identified. Units were asked to classify their level of acuity (Levels 2–6). Results. A total of 150 (53%) maternity units responded. Those who responded were reasonably similar to those who did not respond, and were representative of Australian maternity units. Almost three-quarters of respondents were from public maternity units and almost 70% defined themselves as being in a rural or remote location. Maternity units with higher birth rates were more likely to classify themselves as providing higher acuity services, that is, Levels 5 and 6. Private maternity units were more likely to have higher acuity classifications. Interventions such as induction of labour, either using an artificial rupture of membranes (ARM) and oxytocin infusion or with prostaglandins, were common across most units. Although electronic fetal monitoring (EFM) was also widely available, access to fetal scalp pH monitoring was low. Conclusion. Maternity service provision varies across the country and is defined predominately by location and annual birth rate. What is known about the topic? In 2007, over 99% of the 289 496 women who gave birth in Australia did so in a hospital. It is estimated that there are more than 300 maternity units in the country, ranging from large tertiary referral centres in major cities to smaller maternity units in rural towns, some of which only provide postnatal care with the woman giving birth at a larger facility. Geographical location, population and ability to attract a maternity workforce determine the number of maternity units within a region, although the means of determining the number of maternity units within a region is often unclear. In recent years, a large number of small maternity units have closed, particularly in rural areas, often due to difficulties securing an adequate workforce, particularly midwives and general practitioner obstetricians. There is a lack of understanding about the nature of maternity service provision in Australia and considerable differences across states and territories. What does this paper add? This paper provides a description of the geographic distribution and level of maternity services, the demand on services, the available obstetric interventions, the level of staffing (paediatric and anaesthetic) and support services available and the private and public mix of maternity units. The paper also provides an exploration of the different interventions and discusses whether these are appropriate, given the level of acuity and access to emergency Caesarean section services. What are the implications for practitioners? This study provides useful information particularly for policy-makers, managers and practitioners. This is at a time when considerable maternity reform is underway and changes at a broader level to the health system are planned. Understanding the nature of maternity services is critical to this debate and ongoing planning decisions.
Publisher: Springer Science and Business Media LLC
Date: 08-10-2015
Publisher: Informa UK Limited
Date: 07-2022
DOI: 10.1080/14647273.2020.1785643
Abstract: Multiple embryo transfer (MET) is associated with both an increased risk of multiple pregnancy and of live birth. In recent years, MET has become standard practice for most surrogacy arrangements. There is limited review of the use of MET versus single embryo transfer (SET) in surrogacy practice. The present review systematically evaluated the pregnancy outcomes of surrogacy arrangements between MET versus SET among gestational carriers. A systematic search of five computerized databases without restriction to the English language or study type was conducted to evaluate the primary outcomes: (i) clinical pregnancy (ii) live delivery and (iii) multiple delivery rates. The search returned 97 articles, five of which met the inclusion criteria. The results showed that clinical pregnancy (RR = 1.21, 95% CI: 1.06-1.39, n = 5, I
Publisher: Elsevier BV
Date: 09-2007
DOI: 10.1016/J.SOCSCIMED.2007.05.025
Abstract: This article draws on qualitative data to explore the beliefs through which decisions about caesarean birth are made and to consider how these might contribute to the increasing rate of caesarean birth. A total of 36 interviews were conducted in Australia, including 12 hospital-based midwives, 6 obstetricians, and 18 women who had experienced caesarean birth within the 2 years prior to the research interview. Data reveal a belief derived from the pervasive discourse of neo-liberalism that women are self-governing autonomous subjects in their birth experience, with entitlement to the consumption of birthing information and services, as guided by obstetricians. Feeding into this belief are coexisting discourses that serve to organise 'free choice' in terms of safe/unsafe, order/disorder, life/death and with ontological meanings, by structuring women's mothering identities as good/bad. The neo-liberal obligation to manage risk and pursue success for both mothers and babies means that women (and others) are obliged to choose what is set up as the most obvious and sensible option: safe, ordered caesareans. The structuring of discourses in this way shows how caesareans can be positioned as a preferential means of birth.
Publisher: Springer Science and Business Media LLC
Date: 03-01-2022
DOI: 10.1186/S40352-021-00162-6
Abstract: The rising rates of women in prison is a serious public health issue. Unlike men, women in prison are characterised by significant histories of trauma, poor mental health, and high rates of substance use disorders (SUDs). Reci ism rates of women have also increased exponentially in the last decade, with substance related offences being the most imprisoned offence worldwide. There is a lack of evidence of the effectiveness of post-release programs for women. The aim of this systematic review is to synthesise and evaluate the evidence on post-release programs for women exiting prison with SUDs. We searched eight scientific databases for empirical original research published in English with no date limitation. Studies with an objective to reduce reci ism for adult women (⩾18 years) with a SUD were included. Study quality was assessed using the revised Cochrane Risk of Bias tool for randomized trials (RoB2) and the Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tools. Of the 1493 articles, twelve ( n = 3799 women) met the inclusion criteria. Reci ism was significantly reduced in five (42%) programs and substance-use was significantly reduced in one (8.3%) program. Common attributes among programs that reduced reci ism were: transitional, gender-responsive programs provision of in idualised support providing substance-related therapy, mental health and trauma treatment services. Methodological and reporting biases were common, which impacted our ability to synthesize results further. Reci ism was inconsistently measured across studies further impacting the ability to compare results across studies. Reci ism is a problematic measure of program efficacy because it is inconsistently measured and deficit-focused, unrecognising of women’s gains in the post-release period despite lack of tailored programs and significant health and social disadvantages. The current evidence suggests that women benefit from continuity of care from prison to the community, which incorporated gender-responsive programming and in idualised case management that targeted co-morbid mental health and SUDs. Future program design should incorporate these attributes of successful programs identified in this review to better address the unique challenges that women with SUDs face when they transition back into the community.
Publisher: Mary Ann Liebert Inc
Date: 05-2014
Abstract: Breastfeeding has been reported to reduce the risk of postpartum anxiety and depression. However, little is known of the effects of breastfeeding on hospital admissions for postpartum mental disorders. This is a population-based longitudinal cohort study using linked data. All mothers who gave birth to a live infant between 2007 and 2008 in New South Wales, Australia were followed up for 1 year for hospital admissions with diagnoses of psychiatric and/or substance use disorders. There were 186,452 women who were reported as giving birth in New South Wales between 2007 and 2008. The "any breastfeeding" rate at the time of discharge was 87.1%. In total, 2,940 mothers were admitted to the hospital with psychiatric diagnoses within 12 months of birth. The first hospital admission for the diagnoses of overall mental illness was 32 days earlier for non-breastfeeding mothers compared with those with full breastfeeding. Mothers who did not breastfeed were more likely to be admitted to the hospital in the first year postpartum for schizophrenia (adjusted relative risk [ARR]=2.0 95% confidence interval [CI] 1.3, 3.1), bipolar affective disorders (ARR=1.9 95% CI 1.1, 3.5), and mental illness due to substance use (ARR=1.8 95% CI 1.3, 2.5) compared with full breastfeeding mothers. Breastfeeding is associated with a decrease in the risk of subsequent maternal hospital admissions for schizophrenia, bipolar affective disorders, and mental illness due to substance use, in the first postpartum year.
Publisher: Elsevier BV
Date: 06-2006
DOI: 10.1016/J.FERTNSTERT.2006.01.011
Abstract: The International Committee for Monitoring Assisted Reproductive Technology's 7th World Report for the year 2000 analyzes wide variations in live and multiple birth rates from 49 countries and six regions by type of assisted reproductive technology, age, number of embryos transferred, and multiple births. More than 460,157 procedures resulted in delivery rate per aspiration for conventional in vitro fertilization (IVF) of 18.6% for intracytoplasmic sperm injection (ICSI), 20.4% for egg donation, 32.3% per transfer and for frozen ET, 12.0% per transfer. Conventional IVF and ICSI twin rates were 26.9% and 26.2%, respectively, and triplet rates were 2.8% and 2.9%, respectively, for an estimated total of approximately 197,000 to 220,000 babies worldwide.
Publisher: Elsevier BV
Date: 06-2014
DOI: 10.1016/J.FERTNSTERT.2014.03.045
Abstract: Surveillance is a triennial worldwide compendium of national rules and regulations for assisted reproductive technology. It was last published in 2010.
Publisher: Springer Science and Business Media LLC
Date: 27-05-2012
DOI: 10.1007/S00737-012-0289-8
Abstract: This study aims to investigate hospital admission of major depressive disorders (MDD) before and after birth. Population data for all primiparous women admitted to the hospital with depressive disorders before and after birth were used. The comparison group consisted of 10 % of primiparous women not admitted to the hospital with a diagnosis of a psychiatric disorder or substance use. A total of 728 women had a first admission with depressive disorders (501 in the first postpartum year). The rate of first hospital admission for depressive disorders decreased during pregnancy and increased markedly in the first three months after birth (peaking in the second month with a rate of 10.74/1,000 person year and rate ratio of 12.56) compared with the 6 months prior to pregnancy. Admission remained elevated in the second postpartum year. Older maternal age, smoking, elective caesarian section and admission to a neonatal intensive care unit or special care nursery were associated with a higher rate of admission. Women born outside Australia and those most socioeconomically disadvantaged were less likely to be admitted to the hospital in the first postpartum year. Overall risk of hospital admission with depressive disorders rose significantly across the entire first postpartum year. This has significant implications for policy and service planning for women with mood disorders in the perinatal period.
Publisher: Springer Science and Business Media LLC
Date: 23-11-2015
Publisher: Wiley
Date: 14-11-2007
Publisher: Royal College of Psychiatrists
Date: 05-2016
DOI: 10.1192/BJPO.BP.116.002790
Abstract: Mental disorders of women during the postnatal period are a major public health problem. Compared with women's mental disorders, much less attention has been paid to men's mental disorders in the perinatal period. To date, there have been no reports in the literature describing secular changes of both maternal and paternal hospital admissions for mental disorders over the period covering the year before pregnancy (non-parents), during pregnancy (expectant parents) and up to the first year after birth (parents) based on linked parental data. The co-occurrences of couples' hospital admissions for mental disorders have not previously been investigated. To describe maternal and paternal hospital admissions for mental disorders before and after birth. To compare the co-occurrences of parents' hospital admissions for mental disorder in the perinatal period. This is a cohort study using paired parents' population data from the New South Wales (NSW) Perinatal Data Collection (PDC), Registry of Births, Deaths and Marriages (RBDM) and Admitted Patients Data Collection (APDC). The study included all parents ( n =196 669 couples) who gave birth to their first child in NSW between 1 January 2003 and 31 December 2009. The hospital admission rate for women with a principal mental disorder diagnosis in the period between the year before pregnancy and the first year after birth was significantly higher than that for men. Parents' mental disorders influenced each other. If a man was admitted to hospital with a principal mental disorder diagnosis, his wife or partner was more likely to be admitted to hospital with a principal mental disorder diagnosis compared with women whose partner had not had a hospital admission, and vice versa. Mothers' mental disorders after birth increased more significantly than fathers. However, fathers' mental disorders significantly impacted the co-occurrence of mothers' mental disorders.
Publisher: Wiley
Date: 06-2010
Publisher: Wiley
Date: 28-09-2010
DOI: 10.1111/J.1471-0528.2010.02731.X
Abstract: To assess the effect on the human sex ratio at birth by assisted reproductive technology (ART) procedures. Retrospective population-based study. Fertility clinics in Australia and New Zealand. The study included 13,368 babies by 13,165 women who had a single embryo transfer (SET) between 2002 and 2006. Logistic regression was used to model the effect on the sex ratio at birth of ART characteristics [in vitro fertilisation (IVF) or intracytoplasmic sperm insemination (ICSI) SET, cleavage-stage or blastocyst SET, and fresh or thawed SET] and biological characteristics (woman's and partner's age and cause of infertility). Proportion of male births. The crude sex ratio at birth was 51.3%. In idual ART procedures had a significant effect on the sex ratio at birth. More males were born following IVF SET (53.0%) than ICSI SET (50.0%), and following blastocyst SET (54.1%) than cleavage-stage SET (49.9%). For a specific ART regimen, IVF blastocyst SET produced more males (56.1%) and ICSI cleavage-stage SET produced fewer males (48.7%). The change in the sex ratio at birth of SET babies is associated with the ART regimen. The mechanism of these effects remains unclear. Fertility clinics and patients should be aware of the bias in the sex ratio at birth when using ART procedures.
Publisher: BMJ
Date: 2018
Publisher: Elsevier BV
Date: 11-2012
DOI: 10.1016/J.VACCINE.2012.09.033
Abstract: A universal newborn hepatitis B (HBV) vaccination program was introduced in the Northern Territory of Australia in 1990, followed by a school-based catch-up program. We evaluated the prevalence of hepatitis B infection in birthing women up to 20 years after vaccination and compared this to women born before the programs commenced. A cohort of birthing mothers was defined from Northern Territory public hospital birth records between 2005 and 2010 and linked to laboratory confirmed notifications of chronic HBV, based principally on a record of hepatitis B surface antigen detection. Prevalence of HBV was compared between women born before or after implementation of the newborn and catch-up vaccination programs. Among 10797 birthing mothers, 138 (1.3%) linked to a chronic HBV record. HBV prevalence was substantially higher in Aboriginal women compared to non-Indigenous women (2.4% versus 0.04% p<0.001). Among 5678 Aboriginal women, those eligible for catch-up and newborn HBV vaccination programs had a significantly lower HBV prevalence than older women born prior to the programs: HBV prevalence respectively 2.2% versus 3.5%, (OR 0.61, 95%CI 0.43-0.88) and 0.8% versus 3.5% (OR 0.21, 95%CI 0.11-0.43). This represents a risk reduction of respectively 40% and 80% compared to unvaccinated women. The progressively greater reduction in the prevalence of chronic HBV in adult Aboriginal women co-inciding with eligibility for catch-up and newborn vaccination programs is consistent with a significant impact from both programs. The use of data derived from antenatal screening to track ongoing vaccine impact is applicable to a range of settings globally.
Publisher: Wiley
Date: 16-01-2019
DOI: 10.1002/IJGO.12747
Abstract: To define current obstetric opinion and clinical practice regarding the prenatal diagnosis of vasa previa in Australia and New Zealand. A population-based cross-sectional survey of Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists was conducted from April to May, 2016. Descriptive analysis was used to define factors influencing opinion and practice regarding definition of vasa previa, attributable risk factors, and the value of screening. Overall, 453 respondents were included in the study. Two-thirds (304/453 67.1%) defined vasa previa as exposed fetal vessel(s) running over or within 2 cm of the internal os. A higher proportion of ultrasound specialists (30/65 46.2%) preferred a broader definition as compared with generalists (115/388 29.6% P<0.001). Overall, Fellows were supportive (342/430 79.5%) of both reporting ultrasound-based risk factors at the 20-week anomaly scan and targeted screening (298/430 69.3%). Only 77/453 (17.0%) respondents recognized all five "known" risk factors for vasa previa. There was a lack of consensus regarding the definition and diagnosis process for vasa previa. There was also a knowledge gap in risk factors for vasa previa that would inform a targeted screening policy. Nevertheless, support for targeted screening was strong from obstetricians who responded.
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.WOMBI.2017.01.005
Abstract: Without a standard terminology to classify models of maternity care, it is problematic to compare and evaluate clinical outcomes across different models. The Maternity Care Classification System is a novel system developed in Australia to classify models of maternity care based on their characteristics and an overarching broad model descriptor (Major Model Category). This study aimed to assess the extent of variability in the defining characteristics of models of care grouped to the same Major Model Category, using the Maternity Care Classification System. All public hospital maternity services in New South Wales, Australia, were invited to complete a web-based survey classifying two local models of care using the Maternity Care Classification System. A descriptive analysis of the variation in 15 attributes of models of care was conducted to evaluate the level of heterogeneity within and across Major Model Categories. Sixty-nine out of seventy hospitals responded, classifying 129 models of care. There was wide variation in a number of important attributes of models classified to the same Major Model Category. The category of 'Public hospital maternity care' contained the most variation across all characteristics. This study demonstrated that although models of care can be grouped into a distinct set of Major Model Categories, there are significant variations in models of the same type. This could result in seemingly 'like' models of care being incorrectly compared if grouped only by the Major Model Category.
Publisher: Wiley
Date: 05-2018
DOI: 10.1002/IJGO.12469
Publisher: Springer Science and Business Media LLC
Date: 14-03-2017
Publisher: Elsevier BV
Date: 02-2014
Publisher: Springer Science and Business Media LLC
Date: 05-12-2018
DOI: 10.1007/S10488-018-0911-9
Abstract: This paper helps to quantify the impact of the Australian National Perinatal Depression Initiative (NPDI) on postnatal inpatient psychiatric hospitalisation. Based on in idual hospital admissions data from New South Wales and Western Australia, we found that the NPDI reduced inpatient psychiatric hospital admission by up to 50% [0.9% point reduction (95% CI 0.70-1.22)] in the first postnatal year. The greatest reduction was observed for adjustment disorders. The NPDI appears to be associated with fewer post-birth psychiatric disorders hospital admissions this suggests earlier detection of psychiatric disorders resulting in early care of women at risk during their perinatal period.
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.CLBC.2017.06.016
Abstract: Improvements in local and systemic treatment, along with earlier diagnoses through breast awareness and screening, have led to increases in survival and a decline in breast cancer (BC) recurrence. To the best of our knowledge, no meta-analysis has yet focused on pregnancy outcomes after BC treatment. Hence, our research group explored the reproductive outcomes (pregnancy, miscarriage, termination of pregnancy, live births) after BC treatment. The Embase, MEDLINE, PubMed, and Scopus databases were searched. Studies were included that reported on pregnancy and reproductive outcomes after treatment of BC. A meta-analysis of 16 studies with subgroup analyses was conducted. In the matched cohort and case-control studies (n = 1287), subgroup analysis showed that women who had received systemic therapy after surgery had an overall pooled estimate of 14% (95% confidence interval [CI], 0.12-0.16 I
Publisher: Wiley
Date: 17-09-2014
Abstract: Studies in other developed countries have suggested that socioeconomic position may be a risk factor for poorer pregnancy outcomes. This analysis aimed to explore the independent impact of socioeconomic position on selected severe maternal morbidities among women in Australia. A case-control study using data on severe maternal morbidities associated with direct maternal death collected through the Australasian Maternity Outcomes Surveillance System. Australia. 623 cases, 820 controls. Logistic regression analysis to investigate differences in outcomes among different socioeconomic groups, classified by Socio-Economic Indexes for Areas (SEIFA) quintile. Severe maternal morbidity (amniotic fluid embolism, placenta accreta, peripartum hysterectomy, ecl sia or pulmonary embolism). SEIFA quintile was statistically significantly associated with maternal morbidity, with cases being twice as likely as controls to reside in the most disadvantaged areas (adjusted OR 2.00, 95%CI 1.29-3.10). Maternal age [adjusted odds ratio (aOR) 2.20 for women aged 35 or over compared with women aged 25-29, 95%CI 1.64-3.15] and previous pregnancy complications (aOR 1.30, 95%CI 1.21-1.87) were significantly associated with morbidity. A parity of 1 or 2 was protective (aOR 0.58, 95%CI 0.43-0.79), whereas previous caesarean delivery was associated with maternal morbidity (aOR 2.20 for women with one caesarean delivery, 95%CI 1.44-2.85, compared with women with no caesareans). The risk of severe maternal morbidity among women in Australia is significantly increased by social disadvantage. This study suggests that future efforts in improving maternity care provision and maternal outcomes in Australia should include socioeconomic position as an independent risk factor for adverse outcome.
Publisher: BMJ
Date: 08-2018
DOI: 10.1136/BMJOPEN-2017-021055
Abstract: To compare the management, maternal and perinatal outcomes of women with a body mass index (BMI) ≥60 kg/m 2 with women with a BMI –59.9 kg/m 2 . International collaborative cohort study. Binational study in the UK and Australia. UK: all pregnant women, and Australia: women who gave birth (birth weight ≥400 g or gestation ≥20 weeks) Data from the Australasian Maternity Outcomes Surveillance System and UK Obstetric Surveillance System. Management, maternal and infant outcomes were compared between women with a BMI ≥60 kg/m 2 and women with a BMI –59.9 kg/m 2 , using unconditional logistic regression. The sociodemographic characteristics and previous medical histories were similar between the 111 women with a BMI ≥60 kg/m 2 and the 821 women with a BMI –59.9 kg/m 2 . Women with a BMI ≥60 kg/m 2 had higher odds of thromboprophylaxis usage in both the antenatal (24% vs. 12% OR 2.25, 95% CI 1.39 to 3.64) and postpartum periods (78% vs. 66% OR 1.68, 95% CI 1.04 to 2.70). Women with BMI ≥60 kg/m 2 had nearly double the odds of pre-ecl sia/ecl sia (adjusted OR 1.83 (95% CI 1.01 to 3.30)). No other maternal or perinatal outcomes were statistically significantly different. Severe adverse outcomes such as perinatal death were uncommon in both groups thus limiting the power of these comparisons. The rate of perinatal deaths was 18 per 1000 births for those with BMI ≥60 kg/m 2 12 per 1000 births for those with BMI –59.9 kg/m 2 those with BMI ≥60 kg/m 2 had a non-significant increased odds of perinatal death (unadjusted OR 1.46, 95% CI 0.31 to 6.74). Women are managed differently on the basis of BMI even at this extreme as shown by thromboprophylaxis. The pre-ecl sia result suggests that future research should examine whether weight reduction of any amount prior to pregnancy could reduce poor outcomes even if women remain extremely obese.
Publisher: Wiley
Date: 19-09-2023
DOI: 10.1111/ADD.16339
Publisher: Springer Science and Business Media LLC
Date: 27-06-2014
Publisher: Springer Science and Business Media LLC
Date: 10-02-2012
Publisher: Wiley
Date: 04-2009
Publisher: Wiley
Date: 31-05-2019
DOI: 10.1111/BIRT.12435
Abstract: Rheumatic heart disease (RHD) is a preventable cardiac condition that escalates risk in pregnancy. Models of care informed by evidence-based clinical guidelines are essential to optimal health outcomes. There are no published reviews that systematically explore approaches to care provision for pregnant women with RHD and examine reported measures. The review objective was to improve understanding of how attributes of care for these women are reported and how they align with guidelines. A search of 13 databases was supported by hand-searching. Papers that met inclusion criteria were appraised using CASP/JBI checklists. A content analysis of extracted data from the findings sections of included papers was undertaken, informed by attributes of quality care identified previously from existing guidelines. The 43 included studies were predominantly conducted in tertiary care centers of low-income and middle-income countries. Cardiac guidelines were referred to in 25 of 43 studies. Poorer outcomes were associated with higher risk scores (detailed in 36 of 41 quantitative studies). Indicators associated with increased risk include anticoagulation during pregnancy (28 of 41 reported) and late booking (gestation documented in 15 of 41 studies). Limited access to cardiac interventions was discussed (19 of 43) in the context of poorer outcomes. Conversely, early assessment and access to regular multidisciplinary care were emphasized in promoting optimal outcomes for women and their babies. Despite often complex care requirements in challenging environments, pregnancy provides an opportunity to strengthen health system responses and address whole-of-life health for women with RHD. A standard set of core indicators is proposed to more accurately benchmark care pathways, outcomes, and burden.
Publisher: Wiley
Date: 05-2018
DOI: 10.1002/IJGO.12464
Publisher: Wiley
Date: 05-2018
DOI: 10.1002/IJGO.12463
Publisher: Hindawi Limited
Date: 24-03-2018
DOI: 10.1111/ECC.12682
Abstract: Gestational breast cancer (GBC) presents many challenges for women and the clinicians who care for them. The aim of this study was to explore the health care experiences of women diagnosed with GBC to inform and improve clinical care of women in this predicament. Semi-structured interviews were conducted with 17 women who had been diagnosed with GBC in the previous 5 years. The overarching themes for perceived quality of care were "communication" and "comprehensive care." "Communication" had two sub themes: "interdisciplinary communication" (the way health professionals from different disciplines communicated with each other about the management of the woman's care) and "patient communication" (how they communicated this to the woman). The "comprehensive care" theme incorporated three sub themes: "the spirit" (psychological care) "the mind" (information provision) and "the body" (management of treatment side effects). Women's own accounts of positive and negative experiences of GBC care provide unique and specific insights which improve understanding of their concerns and needs. The findings can inform advances in quality and efficacy of clinical care offer guidance for obstetricians, oncologists and allied health professionals about the needs of women diagnosed with GBC and how care can be optimised and inform the development of resources to assist women and their families.
Publisher: Wiley
Date: 05-2018
DOI: 10.1002/IJGO.12467
Publisher: Springer Science and Business Media LLC
Date: 08-06-2012
Publisher: Wiley
Date: 05-2018
DOI: 10.1002/IJGO.12466
Publisher: Wiley
Date: 05-2018
DOI: 10.1002/IJGO.12465
Publisher: American Medical Association (AMA)
Date: 11-1997
DOI: 10.1001/ARCHNEUR.1997.00550230060018
Abstract: To determine whether subjects older than 75 years are included in the randomized controlled trials of antiparkinsonian medications conducted during the last 30 years and to identify study characteristics that are associated with the exclusion of patients of advanced age. A systematic search was conducted on MEDLINE from January 1966 until September 1996 of all randomized controlled trials of drugs used to treat the motor symptoms of Parkinson disease. Articles were abstracted for the age of subjects date of publication, geographic location, drug class studied, stage of Parkinson disease of subjects, and the number of subjects in each trial. One hundred twelve articles met the inclusion criteria. The weighted mean (+/- SD) age for subjects in all trials was 62.2 +/- 3.9 years. Forty-two studies (37.5%) included subjects older than 75 years. However, in 31 articles (27.7%) it could not be determined if subjects older than 75 years were included. Among the 8 studies that provided the actual number of subjects within specific age groups, only 8 (5.5%) of 145 subjects were older than 75 years. Publication in the last decade was significantly associated with a decreased likelihood of including subjects older than 75 years (odds ratio, 0.19 95% confidence interval, 0.06-0.62). The relatively small number of subjects older than 75 years included in controlled trials of antiparkinsonian drugs seriously impedes our understanding of the efficacy and safety of these drugs in a large subgroup of frail patients for whom these products are prescribed. The tendency to exclude subjects of advanced age is highest in the most recently published articles that study new advances in pharmacotherapy. There is inadequate reporting of the age characteristics of subjects in clinical trials. This limitation hinders the synthesis of data regarding drug efficacy and toxicity relevant to older age groups.
Publisher: Wiley
Date: 06-12-2013
DOI: 10.1111/AJO.12020
Abstract: The Australasian Maternity Outcomes Surveillance System (AMOSS) conducts active, prospective surveillance of severe maternal conditions in Australia and New Zealand (ANZ). AMOSS captures greater than 96% of all births, and utilises an online, active case-based negative reporting system. To evaluate AMOSS using the United States Centres for Disease Control (MMWR 2001 50 (RR13): 1-35.) surveillance system evaluation framework. Data were gathered using multiple methods, including an anonymous online survey administered to 353 AMOSS data collectors, in addition to review of case data received during 2009-2011, documented records of project board and advisory group meeting minutes, publications, annual reports and the AMOSS database. AMOSS is a research system characterised by its simplicity and efficiency. The socio-demographic, risk factor and severe morbidity clinical data collected on rare conditions are not duplicated in other routine data systems. AMOSS is functioning well and has sustained buy-in from clinicians, stakeholders and consumers and a high level of acceptability to data collectors in ANZ maternity units. AMOSS is the only existing national system of surveillance for rare and severe maternal conditions in ANZ and therefore serves an important function, utilising data collected from reliable sources, in an effective, efficient and timely way.
Publisher: Oxford University Press (OUP)
Date: 13-11-2018
Abstract: Is perinatal mortality rate higher among births born following assisted reproductive technology (ART) compared to non-ART births? Overall perinatal mortality rates in ART births was higher compared to non-ART births, but gestational age-specific perinatal mortality rate of ART births was lower for very preterm and moderate to late preterm births. Births born following ART are reported to have higher risk of adverse perinatal outcomes compared to non-ART births. This population-based retrospective cohort study included 407 368 babies (391 952 non-ART and 15 416 ART)-393 491 singletons and 10 877 twins or high order multiples. All births (≥20 weeks of gestation and/or ≥400 g of birthweight) in five states and territories in Australia during the period 2007-2009 were included in the study, using National Perinatal Data Collection (NPDC). Primary outcome measures were rates of stillbirth, neonatal and perinatal deaths. Adjusted odds ratio (AOR) and 95% confidence interval (CI) were used to estimate the likelihood of perinatal death. Rates of multiple birth and low birthweight were significantly higher in ART group compared to the non-ART group (P < 0.01). Overall perinatal mortality rate was significantly higher for ART births (16.5 per 1000 births, 95% CI 14.5-18.6), compared to non-ART births (11.3 per 1000 births, 95% CI 11.0-11.6) (AOR 1.45, 95% CI 1.26-1.68). However, gestational age-specific perinatal mortality rate of ART births (including both singletons and multiples) was lower for very preterm (<32 weeks' gestation) and moderate to late preterm births (32-36 weeks' gestation) (AOR 0.61, 95% CI 0.53-0.70 and AOR 0.61, 95% CI 0.53-0.70, respectively) compared to non-ART births. Congenital abnormality and spontaneous preterm were the most common causes of neonatal deaths in both ART and non-ART group. Due to different cut-off limit for perinatal period in Australia, the results of this study should be interpreted with cautions for other countries. Australian definition of perinatal period commences at 20 completed weeks (140 days) of gestation and ends 27 completed days after birth which is different from the definition by World Health Organisation (commences at 22 completed weeks (154 days) of gestation and ends seven completed days after birth) and by Centers for Disease Control and Prevention (includes infant deaths under age 7 days and fetal deaths at 28 weeks of gestation or more). Preterm birth is the single most important contributing factor to increased risk of perinatal mortality among ART singletons compared to non-ART singletons. Further research on reducing early preterm delivery, with the aim of reducing the perinatal mortality among ART births is needed. Couples who access ART treatment should be fully informed regarding the risk of preterm birth and subsequent risk of perinatal death. There was no funding associated with this study. No conflict of interest was declared.
Publisher: Oxford University Press (OUP)
Date: 25-07-2018
Abstract: The global burden of rheumatic heart disease (RHD) is two-to-four times higher in women, with a heightened risk in pregnancy. In Australia, RHD is found predominantly among Aboriginal and Torres Strait Islander peoples. This paper reviews processes developed to identify pregnant Australian women with RHD during a 2-year population-based study using the Australasian Maternity Outcomes Surveillance System (AMOSS). It evaluates strategies developed to enhance reporting and discusses implications for patient care and public health. AMOSS maternity coordinators across 262 Australian sites reported cases. An extended network across cardiac, Aboriginal and primary healthcare strengthened surveillance and awareness. The network notified 495 potential cases, of which 192 were confirmed. Seventy-eight per cent were Aboriginal and/or Torres Strait Islander women, with a prevalence of 22 per 1000 in the Northern Territory. Effective surveillance was challenged by a lack of diagnostic certainty, incompatible health information systems and varying clinical awareness among health professionals. Optimal outcomes for pregnant women with RHD demand timely diagnosis and access to collaborative care. The strategies employed by this study highlight gaps in reporting processes and the opportunity pregnancy provides for diagnosis and re/engagement with health services to support better continuity of care and promote improved outcomes.
Publisher: Wiley
Date: 20-08-2008
Publisher: Wiley
Date: 24-02-2010
Publisher: Wiley
Date: 23-09-2004
Publisher: Springer Science and Business Media LLC
Date: 19-10-2016
Publisher: Oxford University Press (OUP)
Date: 04-10-2009
Abstract: Many definitions used in medically assisted reproduction (MAR) vary in different settings, making it difficult to standardize and compare procedures in different countries and regions. With the expansion of infertility interventions worldwide, including lower resource settings, the importance and value of a common nomenclature is critical. The objective is to develop an internationally accepted and continually updated set of definitions, which would be utilized to standardize and harmonize international data collection, and to assist in monitoring the availability, efficacy, and safety of assisted reproductive technology (ART) being practiced worldwide. Seventy-two clinicians, basic scientists, epidemiologists and social scientists gathered together at the WHO headquarters in Geneva, Switzerland in December, 2008. Several months in advance, three working groups were established which were responsible for terminology in three specific areas: clinical conditions and procedures, laboratory procedures and outcome measures. Each group reviewed the existing ICMART glossary, made recommendations for revisions and introduced new terms to be considered for glossary expansion. A consensus was reached on 87 terms, expanding the original glossary by 34 terms, which included definitions for numerous clinical and laboratory procedures. Special emphasis was placed in describing outcome measures such as cumulative delivery rates and other markers of safety and efficacy in ART. Standardized terminology should assist in analysis of worldwide trends in MAR interventions and in the comparison of ART outcomes across countries and regions. This glossary will contribute to a more standardized communication among professionals responsible for ART practice, as well as those responsible for national, regional and international registries.
Publisher: MDPI AG
Date: 27-03-2014
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Elsevier BV
Date: 09-2009
DOI: 10.1016/J.WOMBI.2009.02.002
Abstract: Death from pregnancy is rare in developed countries such as Australia but is still common in third world and developing countries. The investigation of each maternal death yields valuable information and lessons that all health care providers involved with the care of women can learn from. The aim of these investigations is to prevent future maternal morbidity and mortality. Obstetric haemorrhage remains a leading cause of maternal death internationally. It is the most common cause of death in developing countries. In Australia and the United Kingdom, obstetric haemorrhage is ranked as the 4th and 3rd most common cause of direct maternal death respectively. In a number of cases there are readily identifiable factors associated with the care that the women received that may have contributed to their death. It is from these identifiable factors that both midwives and doctors can learn to help prevent similar episodes from occurring. This article will identify some of the lessons that can be learnt from the recent Australian and UK maternal death reports. This paper presents an overview of the process and systems for the reporting of maternal death in Australia. It will then specifically focus on obstetric haemorrhage, with a focus on postpartum haemorrhage, for the 12-year period, 1994-2005. Vignettes from the maternal mortality reports in Australia and the United Kingdom are used to highlight the important lessons for providers of maternity care.
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1111/J.1753-6405.2012.00851.X
Abstract: To describe the Australian perinatal mental health reforms and explore ways of improving surveillance of maternal mental health morbidity and mortality in this context. We reviewed the Australian perinatal (defined as conception to one year postpartum) mental health reforms, in association with an appraisal of the population health methods that could be used for their evaluation. Despite the increasing focus of public health reforms on maternal mental health in the perinatal period, there is currently no national data available to evaluate these reforms or to provide an evidence base for improved health outcomes. National data development and linkage of relevant datasets would go a long way towards enabling such an endeavour. Inclusion of key mental health items in the Perinatal National Minimum Dataset and use of data linkage techniques will allow for monitoring of trends in maternal mental health morbidity and mortality in response to the Australian reforms. Once this is implemented, cost-benefit analyses can be undertaken.
Publisher: Springer Science and Business Media LLC
Date: 25-06-2022
DOI: 10.1038/S41598-022-15064-2
Abstract: Infertility affects millions of people globally. Although an estimated 1 in 6 couples in Australia are unable to conceive without medical intervention, little is known about the mental health impacts of infertility. This study investigated how infertility impacts the mental health of women. The study used nationally representative Australian Longitudinal Study on Women's Health (ALSWH) data. We analysed data from survey periods 2–8 conducted every three years between 2000 and 2018 for 6582 women born in 1973–78. We used a Generalised Equation Modelling (GEE) method to investigate the association of primary, secondary and resolved fertility status and psychological distress over time. Multiple measures were used to measure psychological distress: the (1) the mental health index subscale of the 36-item short form survey (SF-36), (2) the Center for Epidemiological Studies Depression Scale (CESD-10), (3) the Goldberg Anxiety and Depression Scale (GADanx) anxiety subscale and a (4) composite psychological distress variable. About a third (30%) of women reported infertility at any of the survey rounds a steady increase over 18 years from 1.7% at round 2 to 19.3% at round 8. Half of the women reporting primary or secondary infertility reported psychological distress, with the odds of having psychological distress was higher in women reporting primary (odds ratio (OR) 1.24, 95% confidence interval (CI) 1.06–1.45), secondary (OR 1.27, 95% CI 1.10–1.46) or resolved infertility (OR 1.15, 95% CI 1.05–1.26) compared to women reporting normal fertility status. Women with partners, underweight or higher BMI, smoking, and high-risk alcohol use had higher odds of psychological distress, whereas women in paid work had significantly lower odds of psychological distress ( p 0.001). Diabetes, high blood pressure, asthma, and other chronic physical illness were independently associated with higher odds of psychological distress. Infertility has a significant impact on mental health even after it is resolved. Frequent mental health assessment and a holistic approach to address the lifestyle factors should be undertaken during the treatment of infertility.
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/AH17118
Abstract: Objective To quantify total provider fees, benefits paid by the Australian Government and out-of-pocket patients’ costs of mental health Medicare Benefits Schedule (MBS) consultations provided to women in the perinatal period (pregnancy to end of the first postnatal year). Method A retrospective study of MBS utilisation and costs (in 2011–12 A$) for women giving birth between 2006 and 2010 by state, provider-type, and geographic remoteness was undertaken. Results The cost of mental health consultations during the perinatal period was A$17.5 million for women giving birth in 2007, rising to A$29 million in 2010. Almost 9% of women giving birth in 2007 had a mental health consultation compared with more than 14% in 2010. An increase in women accessing consultations, along with an increase in the average number of consultations received, were the main drivers of the increased cost, with costs per service remaining stable. There was a shift to non-specialist care and bulk billing rates increased from 44% to 52% over the study period. In 2010, the average total cost (provider fees) per woman accessing mental health consultations during the perinatal period was A$689, and the average cost per service was A$133. Compared with women residing in regional and remote areas, women residing in major cities where more likely to access consultations, and these were more likely to be with a psychiatrist rather than an allied health professional or general practitioner. Conclusion Increased access to mental health consultations has coincided with the introduction of recent mental health initiatives, however disparities exist based on geographic location. This detailed cost analysis identifies inequities of access to perinatal mental health services in regional and remote areas and provides important data for economic and policy analysis of future mental health initiatives. What is known about the topic? The mental healthcare landscape in Australia has changed significantly over the last decade, with the introduction of numerous policies aimed at prevention, screening and improving access to treatment. Several of these policies have been aimed at perinatal depression, which affects 15% of women giving birth. What does this paper add? This is the first population-based, cost analysis of mental health consultations during the perinatal period (pregnancy to end of the first postnatal year) in Australia. Almost 9% of women giving birth in 2007 had a mental health consultation funded though the MBS, compared with more than 14% in 2010. Over the same period there was a shift from psychiatric consultations to allied health and primary care consultations. In 2010, the total cost (provider fee) of these consultations was A$29 million, equating to an average cost per woman of A$689 and A$133 per service. Despite the changing policy environment, significant disparities exist in access to care according to geographic remoteness. What are the implications for practitioners? Recent policy initiatives have resulted in increasing access to mental health consultations for women around the time of childbirth. However, policies are needed that target women outside of major cities. Furthermore, evidence is needed on whether the increase in access has resulted in improved mental health outcomes for women at this vulnerable time. The cost data provided by this study are unique and will inform future mental health policy development and health economic evaluations.
Publisher: Wiley
Date: 13-06-2013
DOI: 10.1111/ACER.12138
Publisher: Springer Science and Business Media LLC
Date: 16-06-2016
Publisher: Wiley
Date: 06-2008
Publisher: Springer Science and Business Media LLC
Date: 27-04-2018
Publisher: Public Library of Science (PLoS)
Date: 12-11-2019
Publisher: Wiley
Date: 16-12-2019
DOI: 10.1111/AJO.13100
Abstract: Ecl sia is a serious consequence of pre-ecl sia. There are limited data from Australia and New Zealand (ANZ) on ecl sia. To determine the incidence, management and perinatal outcomes of women with ecl sia in ANZ. A two-year population-based descriptive study, using the Australasian Maternity Outcomes Surveillance System (AMOSS), carried out in 263 sites in Australia, and all 24 New Zealand maternity units, during a staggered implementation over 2010-2011. Ecl sia was defined as one or more seizures during pregnancy or postpartum (up to 14 days) in any woman with clinical evidence of pre-ecl sia. Of 136 women with ecl sia, 111 (83%) were in Australia and 25 (17%) in New Zealand. The estimated incidence of ecl sia was 2.2 (95% confidence interval (CI) 1.9-2.7) per 10 000 women giving birth. Aboriginal and Torres Strait Islander women were over-represented in Australia (n = 9 8.1%). Women with antepartum ecl sia (n = 58, 42.6%) were more likely to have a preterm birth (P = 0.04). Sixty-three (47.4%) women had pre-ecl sia diagnosed prior to their first ecl tic seizure of whom 19 (30.2%) received magnesium sulphate prior to the first seizure. Nearly all women (n = 128 95.5%) received magnesium sulphate post-seizure. No woman received prophylactic aspirin during pregnancy. Five women had a cerebrovascular haemorrhage, and there were five known perinatal deaths. Ecl sia is an uncommon consequence of pre-ecl sia in ANZ. There is scope to reduce the incidence of this condition, associated with often catastrophic morbidity, through the use of low-dose aspirin and magnesium sulphate in women at higher risk.
Publisher: Wiley
Date: 06-06-2013
DOI: 10.1111/AJO.12099
Publisher: Springer Science and Business Media LLC
Date: 22-10-2016
Publisher: Wiley
Date: 06-2009
Publisher: Wiley
Date: 16-05-2007
DOI: 10.1111/J.1471-0528.2007.01323.X
Abstract: To describe a 10-year trend in preterm birth. Population-based study. Australia. All women who gave birth during 1994-03. The proportion of spontaneous preterm births (greater than or equal to 22 weeks of gestation and less than 37 completed weeks of gestation) was calculated by iding the number of women who had a live spontaneous preterm birth (excluding elective caesarean section and induction of labour) by the total number of women who had a live birth after spontaneous onset of labour (excluding elective caesarean section and induction of labour). This method was repeated for the selected population of women at low risk. Preterm birth rates among the overall population of women preterm birth among all women with a spontaneous onset of labour and preterm birth in a selected population of women who were either primiparous or multiparous, non-Indigenous aged 20-40 years and who gave birth to a live singleton baby after the spontaneous onset of labour. Over the 10-year study period, the proportion of all women having a live preterm birth in Australia increased by 12.1% (from 5.9% in 1994 to 6.6% in 2003). Among women with a spontaneous onset of labour, there was an increase of 18.3% (from 5.7 to 6.7%). Among the selected population of low-risk women after the spontaneous onset of labour, the rate increased by 10.7% (from 5.6 to 6.2%) among first time mothers and by 19.2% (4.4-5.2%) among selected multiparous women. Over the 10-year period of 1994-03, the rate of spontaneous preterm birth among low-risk women having a live singleton birth has risen in Australia.
Publisher: Elsevier BV
Date: 05-1995
DOI: 10.1016/S0140-6736(95)90980-X
Abstract: 22 patients infected with fluoroquinolone-resistant Mycobacterium tuberculosis in New York City were identified between January, 1991, and November, 1993. In 16 patients resistance arose as a result of inadequate or inappropriate treatment. 6 patients had primary infection with fluoroquinolone-resistant organisms 5 acquired the organisms nosocomially. Seven distinct patterns of restriction-fragment length polymorphism were identified in isolates from 21 patients. Fluoroquinolones should be restricted to patients with multidrug-resistant disease or intolerance to other antituberculosis drugs. All patients with multidrug-resistant tuberculosis should be on directly observed therapy.
Publisher: Springer Science and Business Media LLC
Date: 10-09-2014
Publisher: Oxford University Press (OUP)
Date: 13-04-2010
Publisher: Mary Ann Liebert Inc
Date: 09-2016
Abstract: In Australia and New Zealand, there has not been a national systematic development of oncofertility services for cancer patients of reproductive age although many cancer and fertility centers have independently developed services. A number of barriers exist to the development of these services, including a lack of clear referral pathways, a lack of communication between clinicians and patients about fertility preservation, differences in the knowledge base of clinicians about the risk of cancer treatment causing infertility and fertility preservation options, a lack of national health insurance funding covering all aspects of fertility preservation, and storage costs and cultural, religious, and ethical barriers. The development of strategies to overcome these barriers is a high priority for oncofertility care to ensure that equitable access to the best standard of care is available for all patients. The FUTuRE Fertility Research Group led a collaborative consultation process with the Australasian Oncofertility Consumer group and oncofertility specialists to explore consumers' experiences of oncofertility care. Consumers participated in qualitative focus group meetings to define and develop a model of consumer driven or informed "gold standard oncofertility care" with the aim of putting together a Charter that specifically described this. The finalized Australasian Oncofertility Consortium Charter documents eight key elements of gold standard oncofertility care that will be used to monitor the implementation of oncofertility services nationally, to ensure that these key elements are incorporated into standard practice over time.
Publisher: Oxford University Press (OUP)
Date: 04-10-2007
Abstract: National assisted reproductive technology (ART) data collections that rely on practitioners' reports of birth defects have consistently reported lower proportions of children with birth defects than record linkage studies that link ART infants to birth and malformation registers. We compared the birth defect data reported to the national Australian Assisted Conception Data Collection (ACDC) by practitioners at three Western Australian ART clinics with the birth defect data identified on the Western Australian Birth Defects Registry (WABDR) through record linkage of all the pregnancies conceived at these clinics to the WABDR. Cases are reported to the WABDR by multiple statutory and voluntary sources. We found that the national ACDC significantly underestimated the prevalence of birth defects in WA-born ART infants. Less than one-third of ART children identified with a major birth defect on the WABDR were reported to the ACDC. Although national ART data collections provide valuable information on pregnancy rates and short-term pregnancy outcomes such as multiple birth and birth weight, we strongly recommend that birth defect information used for patient counselling is preferentially drawn from large studies that have used record linkage to high-quality birth defect registers.
Publisher: Informa UK Limited
Date: 23-07-2020
DOI: 10.1080/14647273.2020.1794062
Abstract: Understanding the likelihood of a live birth is important for fertility treatment planning, particularly when one cycle fails and further treatment may be contemplated. This study aims to estimate the chance of live birth among gestational surrogates undergoing altruistic surrogacy arrangements between 2009 and 2016 in Victoria, Australia. A total of 81 gestational surrogates with 170 embryo transfer cycles were included. Of the 170 embryo transfer cycles, the majority were single embryo transfers (SETs 97.1%), using frozen/thawed embryos (97.6%) which had been fertilized by intracytoplasmic sperm injection (77.6%). The cumulative live birth rate was 23.5% (95% CI, 15.6-33.8%) after the first cycle and increased to 50.6% (95% CI, 40.0-61.2%) after the sixth cycle. Of the 41 deliveries, 40 were singletons and one was a twin delivery. Two of the 42 deliveries were preterm, two were low birthweight and one was small for gestational age. The findings imply that surrogacy treatment can be offered up to six consecutive embryo transfer cycles to gestational surrogates. SET is encouraged in surrogacy practice to improve perinatal outcomes. These estimates can be used in counselling and decision-making for intended parents and gestational surrogates to continue a surrogacy treatment and informing public policy on assisted reproductive technology treatment.
Publisher: SAGE Publications
Date: 2017
Abstract: Drawing on in-depth interviews with incarcerated Aboriginal and Torres Strait Islander mothers in Western Australia, we report on the women’s use of violence in their relationships with others. Results reinforce that Aboriginal women are overwhelmingly victims of violence however, many women report also using violence, primarily as a strategy to deal with their own high levels of victimization. The “normalization” of violence in their lives and communities places them at high risk of arrest and incarceration. This is compounded by a widespread distrust of the criminal justice system and associated agencies, and a lack of options for community support.
Publisher: Oxford University Press (OUP)
Date: 06-1999
DOI: 10.1093/HER/14.3.315
Abstract: Beliefs about the extent to which health problems can be prevented reflect an understanding that preventive measures can reduce adverse health events and the level of control in iduals perceive that they hold over the factors that affect their health. A population survey of 1659 people conducted in 1995 in south western Sydney, Australia, found that only child drownings, tooth decay, skin cancer, and burns and scalds were considered all or mostly preventable by more than 50% of the s le. The majority of respondents did not believe that heart attacks, cervical cancer, high blood pressure, serious road injury, lung cancer and asthma deaths were all or mostly preventable. Logistic regression analysis showed that people born in an English speaking country, those with more than 10 years of education and men were significantly more likely to recognize a number of key conditions as highly preventable. The findings suggest that, in spite of the range of prevention efforts in Australia to date, these are not matched by strong beliefs within the community that prevention is possible. Communication of the opportunities and methods for prevention needs to be improved, particularly among certain population groups. The findings also indicate a need to examine social and environmental factors which are potentially reducing confidence, and subsequently and adoption of preventive behaviours.
Publisher: Springer Science and Business Media LLC
Date: 12-2017
Publisher: SAGE Publications
Date: 05-05-2015
Abstract: To evaluate the impact of the National Perinatal Depression Initiative on access to Medicare services for women at risk of perinatal mental illness. Retrospective cohort study using difference-in-difference analytical methods to quantify the impact of the National Perinatal Depression Initiative policies on Medicare Benefits Schedule mental health usage by Australian women giving birth between 2006 and 2010. A random s le of women of reproductive age enrolled in Medicare who had not given birth where used as controls. The main outcome measures were the proportions of women giving birth each month who accessed a Medicare Benefits Schedule mental health items during the perinatal period (pregnancy through to the end of the first postnatal year) before and after the introduction of the National Perinatal Depression Initiative. The proportion of women giving birth who accessed at least one mental health item during the perinatal period increased from 88 to 141 per 1000 between 2007 and 2010. The difference-in-difference analysis showed that while there was an overall increase in Medicare Benefits Schedule mental health item access as a result of the National Perinatal Depression Initiative, this did not reach statistical significance. However, the National Perinatal Depression Initiative was found to significantly increase access in subpopulations of women, particularly those aged under 25 and over 34 years living in major cities. In the 2 years following its introduction, the National Perinatal Depression Initiative was found to have increased access to Medicare funded mental health services in particular groups of women. However, an overall increase across all groups did not reach statistical significance. Further studies are needed to assess the impact of the National Perinatal Depression Initiative on women during childbearing years, including access to tertiary care, the cost-effectiveness of the initiative, and mental health outcomes. It is recommended that new mental health policy initiatives incorporate a planned strategic approach to evaluation, which includes sufficient follow-up to assess the impact of public health strategies.
Publisher: BMJ
Date: 09-2018
DOI: 10.1136/BMJOPEN-2018-022755
Abstract: Cardiac disease in pregnancy is a leading cause of maternal death in high-income countries. Evidence-based guidelines to assist in planning and managing the healthcare of affected women is lacking. The objective of this research was to produce the first qualitative metasynthesis of the experiences of pregnant women with existing or acquired cardiac disease to inform improved healthcare services. We conducted a systematic search of peer-reviewed publications in five databases to investigate the decision-making processes, supportive strategies and healthcare experiences of pregnant women with existing or acquired cardiac disease, or of affected women contemplating pregnancy. Identified publications were screened for duplication and eligibility against selection criteria, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We then undertook a thematic analysis of the data relating to women’s experiences extracted from each publication to inform new healthcare practices and communication. Eleven studies from six countries were included in our meta-synthesis. Four themes were revealed. Women with congenital and acquired heart disease identified situations where they had either taken charge of decision-making, lacked control or experienced emotional uncertainty when making decisions. Some women were risk aware and determined to take care of themselves in pregnancy while others downplayed the risks. Women with heart disease acknowledged the importance of specific social support measures during pregnancy and after child birth, and reported a spectrum of healthcare experiences. There is a lack of integrated and tailored healthcare services and information for women with cardiac disease in pregnancy. The experiences of women synthesised in this research has the potential to inform new evidence-based guidelines to support the decision-making needs of women with cardiac disease in pregnancy. Shared decision-making must consider communication across the clinical team. However, coordinated care is challenging due to the different specialists involved and the limited clinical evidence concerning effective approaches to managing such complex care.
Publisher: Wiley
Date: 18-05-2020
DOI: 10.1111/AJO.13179
Publisher: Wiley
Date: 12-07-2011
Publisher: Elsevier BV
Date: 11-2009
DOI: 10.1016/J.FERTNSTERT.2009.09.009
Abstract: Many definitions used in medically assisted reproduction (MAR) vary in different settings, making it difficult to standardize and compare procedures in different countries and regions. With the expansion of infertility interventions worldwide, including lower resource settings, the importance and value of a common nomenclature is critical. The objective is to develop an internationally accepted and continually updated set of definitions, which would be utilized to standardize and harmonize international data collection, and to assist in monitoring the availability, efficacy, and safety of assisted reproductive technology (ART) being practiced worldwide. Seventy-two clinicians, basic scientists, epidemiologists and social scientists gathered together at the World Health Organization headquarters in Geneva, Switzerland, in December 2008. Several months before, three working groups were established as responsible for terminology in three specific areas: clinical conditions and procedures, laboratory procedures, and outcome measures. Each group reviewed the existing International Committee for Monitoring Assisted Reproductive Technology glossary, made recommendations for revisions and introduced new terms to be considered for glossary expansion. A consensus was reached on 87 terms, expanding the original glossary by 34 terms, which included definitions for numerous clinical and laboratory procedures. Special emphasis was placed in describing outcome measures, such as cumulative delivery rates and other markers of safety and efficacy in ART. Standardized terminology should assist in analysis of worldwide trends in MAR interventions and in the comparison of ART outcomes across countries and regions. This glossary will contribute to a more standardized communication among professionals responsible for ART practice, as well as those responsible for national, regional, and international registries.
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.FERTNSTERT.2019.05.012
Abstract: To study the impact of the donor's and recipient's age on the cumulative live-birth rate (CLBR) in oocyte donation cycles. A population-based retrospective cohort study. Not applicable. All women using donated oocytes (n = 1,490) in Victoria, Australia, between 2009 and 2015. None. The association between the donor's and recipient's age and CLBR modeled by multivariate Cox proportional hazard regression with the covariates of male partner's age, recipient parity, and cause of infertility adjusted for, and donor age grouped as <30, 30-34, 35-37, 38-40, and ≥41 years, and recipient age as <35, 35-37, 38-40, 41-42, 43-44, and ≥45 years. The mean age of the oocyte donors was 33.7 years (range: 21 to 45 years) with 49% aged 35 years and over. The mean age of the oocyte recipients was 41.4 years (range: 19 to 53 years) with 25.4% aged ≥45 years. There was a statistically significant relationship between the donor's age and the CLBR. The CLBR for recipients with donors aged <30 years and 30-34 years was 44.7% and 43.3%, respectively. This decreased to 33.6% in donors aged 35-37 years, 22.6% in donors aged 38-40 years, and 5.1% in donors aged ≥41 years. Compared with recipients with donors aged <30 years, the recipients with donors aged 38-40 years had 40% less chance of achieving a live birth (adjusted hazard ratio 0.60 95% CI, 0.43-0.86) and recipients with donors aged ≥41 years had 86% less chance of achieving a live birth (adjusted hazard ratio 0.14 95% CI, 0.04-0.44). The multivariate analysis showed no statistically significant effect of the recipient's age on CLBR. We have demonstrated that the age of the oocyte donor is critical to the CLBR and is independent of the recipient woman's age. Recipients using oocytes from donors aged ≥35 years had a statistically significantly lower CLBR when compared with recipients using oocytes from donors aged <35 years.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2017
DOI: 10.1097/AOG.0000000000002198
Abstract: To estimate the incidence of women with vasa previa in Australia and to describe risk factors, timing of diagnosis, clinical practice, and perinatal outcomes. A prospective population-based cohort study was undertaken using the Australasian Maternity Outcomes Surveillance System between May 1, 2013, and April 30, 2014, in hospitals in Australia with greater than 50 births per year. Women were included if they were diagnosed with vasa previa during pregnancy or childbirth, confirmed by clinical examination or placental pathology. The main outcome measures included stillbirth, neonatal death, cesarean delivery, and preterm birth. Sixty-three women had a confirmed diagnosis of vasa previa. The estimated incidence was 2.1 per 10,000 women giving birth (95% CI 1.7–2.7). Fifty-eight women were diagnosed prenatally and all had a cesarean delivery. Fifty-five (95%) of the 58 women had at least one risk factor for vasa previa with velamentous cord insertion (62%) and low-lying placenta (60%) the most prevalent. There were no perinatal deaths in women diagnosed prenatally. For the five women with vasa previa not diagnosed prenatally, there were two perinatal deaths with a case fatality rate of 40%. One woman had an antepartum stillbirth and delivered vaginally and the other four women had cesarean deliveries categorized as urgent threat to the life of a fetus with one neonatal death. The overall perinatal case fatality rate was 3.1% (95% CI 0.8–10.5). Two thirds (68%) of the 65 neonates were preterm and 29% were low birth weight. The outcomes for neonates in which vasa previa was not diagnosed prenatally were inferior with higher rates of perinatal morbidity and mortality. Our study shows a high rate of prenatal diagnosis of vasa previa in Australia and associated good outcomes.
Publisher: Wiley
Date: 09-10-2020
Abstract: To describe the epidemiology of rheumatic heart disease (RHD) in pregnancy in Australia and New Zealand (A&NZ). Prospective population-based study. Hospital-based maternity units throughout A&NZ. Pregnant women with RHD with a birth outcome of ≥20 weeks of gestation between January 2013 and December 2014. We identified eligible women using the Australasian Maternity Outcomes Surveillance System (AMOSS). De-identified antenatal, perinatal and postnatal data were collected and analysed. Prevalence of RHD in pregnancy. Perinatal morbidity and mortality. There were 311 pregnancies associated with women with RHD (4.3/10 000 women giving birth, 95% CI 3.9-4.8). In Australia, 78% were Aboriginal or Torres Strait Islander (60.4/10 000, 95% CI 50.7-70.0), while in New Zealand 90% were Māori or Pasifika (27.2/10 000, 95% CI 22.0-32.3). One woman (0.3%) died and one in ten was admitted to coronary or intensive care units postpartum. There were 314 births with seven stillbirths (22.3/1000 births) and two neonatal deaths (6.5/1000 births). Sixty-six (21%) live-born babies were preterm and one in three was admitted to neonatal intensive care or special care units. Rheumatic heart disease in pregnancy persists in disadvantaged First Nations populations in A&NZ. It is associated with significant cardiac and perinatal morbidity. Preconception planning and counselling and RHD screening in at-risk pregnant women are essential for good maternal and baby outcomes. Rheumatic heart disease in pregnancy persists in First Nations people in Australia and New Zealand and is associated with major cardiac and perinatal morbidity.
Publisher: Elsevier BV
Date: 02-2015
DOI: 10.1016/J.FERTNSTERT.2014.11.004
Abstract: To analyze information on assisted reproductive technology (ART) performed worldwide, and trends in outcomes over successive years. Cross-sectional survey on access, efficiency, and safety of ART procedures performed in 55 countries during 2007. Not applicable. Infertile women and men undergoing ART globally. Collection and analysis of international ART data. Number of cycles performed, by country and region, including pregnancies, single and multiple birth rates, and perinatal mortality. Overall, >1,251,881 procedures with ART were reported, and resulted in 229,442 reported babies born. The availability of ART varied by country, from 12 to 4,140 treatments per million population. Of all aspiration cycles, 65.2% (400,617 of 614,540) were intracytoplasmic sperm injection. The overall delivery rate per fresh aspiration was 20.3%, and for frozen-embryo transfer (FET), 18.4%, with a cumulative delivery rate of 25.8%. With wide regional variations, single-embryo transfer represented 23.4% of fresh transfers, and the proportion of deliveries with twins and triplets from fresh transfers was 22.3% and 1.2%, respectively. The perinatal mortality rate was 19.9 per 1,000 births for fresh in vitro fertilization using intracytoplasmic sperm injection, and 9.6 per 1,000 for FET. The proportion of women aged ≥40 years increased to 19.8% from 15.5% in 2006. The international trend toward 40 years was a major component of ART services in some regions and countries.
Publisher: Springer Science and Business Media LLC
Date: 25-06-2019
Publisher: BMJ
Date: 10-2017
DOI: 10.1136/BMJOPEN-2017-017713
Abstract: Estimate the incidence of placenta accreta and describe risk factors, clinical practice and perinatal outcomes. Case–control study. Sites in Australia and New Zealand with at least 50 births per year. Cases were women giving birth (≥20 weeks or fetus ≥400 g) who were diagnosed with placenta accreta by antenatal imaging, at operation or by pathology specimens between 2010 and 2012. Controls were two births immediately prior to a case. A total of 295 cases were included and 570 controls. Data were collected using the Australasian Maternity Outcomes Surveillance System. Incidence, risk factors (eg, prior caesarean section (CS), maternal age) and clinical outcomes of placenta accreta (eg CS, hysterectomy and death). The incidence of placenta accreta was 44.2/100 000 women giving birth (95% CI 39.4 to 49.5) however, this may overestimated due to the case definition used. In primiparous women, an increased odds of placenta accreta was observed in older women (adjusted OR (AOR) women≥40 vs : 19.1, 95% CI 4.6 to 80.3) and current multiple birth (AOR: 6.1, 95% CI 1.1 to 34.1). In multiparous women, independent risk factors were prior CS (AOR ≥2 prior sections vs 0: 13.8, 95% CI 7.4 to 26.1) and current placenta praevia (AOR: 36.3, 95% CI 14.0 to 93.7). There were two maternal deaths (case fatality rate 0.7%). Women with placenta accreta were more likely to have a caesarean section (AOR: 4.6, 95% CI 2.7 to 7.6) to be admitted to the intensive care unit (ICU)/high dependency unit (AOR: 46.1, 95% CI 22.3 to 95.4) and to have a hysterectomy (AOR: 209.0, 95% CI 19.9 to 875.0). Babies born to women with placenta accreta were more likely to be preterm, be admitted to neonatal ICU and require resuscitation.
Publisher: Elsevier BV
Date: 07-2006
DOI: 10.1016/J.FERTNSTERT.2006.04.018
Abstract: The International Committee Monitoring Assisted Reproductive Technologies (ICMART) is an independent international nonprofit organization that has taken a leading role in the development, collection, and dissemination of worldwide data on assisted reproductive technology (ART). Information on availability, efficacy, and safety is provided to health professionals, health authorities, and the public. The glossary facilitates dissemination of ART data through a set of agreed-upon definitions, as seen in the most recent World Report on ART. It provides a conceptual framework for further international terminology and data development of ART.
Publisher: Wiley
Date: 22-06-2004
Publisher: Elsevier BV
Date: 1999
Abstract: Traditional tests for detection of syphilis are labour intensive and costly. Enzyme immunoassays (EIAs) are readily automated and cost effective if large numbers of tests are performed. Four experiments were devised to evaluate a syphilis EIA test kit where resources are limited: (1) testing antenatal patients (2) testing refugees (3) testing a high prevalence population and (4) testing "problem sera" (containing autoantibodies or antibodies to other infective agents). Forty-one available syphilitic sera from antenatal patients were tested to evaluate sensitivity. Specificity was determined through testing sera determined to be nonreactive with rapid plasma reagin and Treponema pallidum hemagglutination tests, calculating the s le size (456) on the confidence interval (CI) required. Two runs were performed on antenatal sera, giving sensitivities of 32% (95% CI: 20%, 47%) and 37% (95% CI: 24%, 52%) and specificities of 92% (95% CI: 89%, 94%) and 90% (95% CI 87%, 92%), respectively. We present a method to evaluate a serological test where resources are limited. Unexpectedly, the test kit performed poorly as a screening test. New serological tests need to be evaluated in-house prior to adoption.
Publisher: Springer Science and Business Media LLC
Date: 02-02-2017
Publisher: Cambridge University Press
Date: 2011
Publisher: Wiley
Date: 05-2018
DOI: 10.1002/IJGO.12499
Publisher: Informa UK Limited
Date: 23-06-2021
Publisher: Oxford University Press (OUP)
Date: 02-05-2014
Publisher: Ubiquity Press, Ltd.
Date: 2021
DOI: 10.5334/GH.1079
Publisher: Wiley
Date: 03-2001
DOI: 10.1046/J.1440-1843.2001.00300.X
Abstract: We have used record linkage analysis to describe the incidence of tuberculosis in a cohort of 24 652 predominantly south-east Asian refugees who arrived in Sydney, Australia during the period 1984 to 1994. Cases that had been registered with the State Department of Health were confirmed by examination of case records. After an average follow-up interval of 10.3 years there were 189 cases of tuberculosis, equivalent to an average incidence rate of 74.9 cases per 100 000 person-years. The highest incidence rate was in 40-49 year olds and 47% of cases were in women. One hundred and twenty seven cases (67%) were pulmonary and, of these, 64 (50%) were direct smear positive. The incidence of tuberculosis in this cohort is similar to that observed among Vietnamese migrants to Australia and the USA and substantially higher than the incidence among people born in Australia. It is important to maintain awareness of the diagnosis of tuberculosis, especially in countries such as Australia, where the incidence in the general population is low but where there are large populations of migrants and refugees in whom a higher incidence is expected.
Publisher: Wiley
Date: 30-09-2016
DOI: 10.1111/JPC.12742
Abstract: This article compares the severity of illness scoring systems clinical risk index for babies (CRIB)-II and score for neonatal acute physiology with perinatal extension (SNAPPE)-II for discriminatory ability and goodness of fit in the same cohort of babies of less than 32 weeks gestation and aims to provide validation in the Australian population. CRIB-II and SNAPPE-II scores were collected on the same cohort of preterm infants born within a 2-year period, 2003 and 2004. The discriminatory ability of each score was assessed by the area under the receiver operator characteristic curve, and goodness of fit was assessed by the Hosmer-Lemeshow (HL) test. The outcome measure was in-hospital mortality. A multivariate logistic regression model was tested for perinatal variables that might add to the risk of in-hospital mortality. Data for both scores were available for 1607 infants. Both scores had good discriminatory ability (CRIB-II area under the curve 0.913, standard error (SE) 0.014 SNAPPE-II area under the curve 0.907, SE 0.012) and adequate goodness of fit (HL χ Both severity of illness scores are ascertained during the first 12 h of life and perform similarly. Both can facilitate risk-adjusted comparisons of mortality and quality of care after the first post-natal 12 h. CRIB-II scores have the advantage of being simpler to collect and calculate.
Publisher: Springer Science and Business Media LLC
Date: 12-02-2011
Publisher: Springer Science and Business Media LLC
Date: 13-07-2018
Publisher: Wiley
Date: 17-06-2014
DOI: 10.1111/BIRT.12114
Publisher: Oxford University Press (OUP)
Date: 26-02-2013
Publisher: Oxford University Press (OUP)
Date: 04-12-2013
Abstract: Do singletons conceived following assisted reproduction technologies (ARTs) have significantly different hospital utilization, and therefore costs, compared with non-ART children during the first 5 years of life? ART singletons have longer hospital birth-admissions and a small increased risk of re-admission during the first 5 years of life resulting in higher costs of hospital care. ART singletons are at greater risk of adverse perinatal outcomes compared with non-ART singletons. Long-term physical and mental health outcomes of ART singletons are generally reassuring. There is a scarcity of information on health service utilization and the health economic impact of ART conceived children. A population cohort study using linked birth, hospital and death records. Perinatal outcomes, hospital utilization and costs, and mortality rates were compared for non-ART and ART singletons to 5 years. Adjustments were made for maternal age, parity, sex, birth year, socioeconomic status and funding source. Australian Diagnosis Related Groups cost-weights were used to derive costs. All costs are reported in 2009/2010 Australian dollars. All babies born in Western Australia between 1994 and 2003 were included 224 425 non-ART singletons and 2199 ART conceived singletons. Hospital admission and death records in Western Australia linked to 2008 were used. Overall, ART singletons had a significantly longer length of stay during the birth-admission (mean difference 1.8 days, P < 0.001) and a 20% increased risk of being admitted during the first 5 years of life. The average adjusted difference in hospital admission costs up to 5 years of age was $2490, with most of the additional cost occurring during the birth-admission ($1473). The independent residual cost associated with ART conception was $342 during the birth-admission and an additional $548 up to 5 years of age, indicating that being conceived as an ART child predicts not only higher birth-admission costs but excess costs to at least 5 years of age. This study could not investigate the impact of different ART practices and techniques on perinatal outcomes or hospital utilization, nor could it adjust for parental characteristics such as cause of infertility and treatment-seeking behaviour. This study related to ART treatment undertaken before 2003. Clinicians and patients should be aware of the risk of poorer perinatal outcomes and increased hospitalization of ART singletons compared with non-ART singletons. These differences are significant enough to affect health-care resource consumption, but are substantially and significantly less than those associated with ART multiple birth infants. Understanding the short- and long-term health services and economic impact of ART is important for setting the research agenda in ART, for informing economic evaluations of infertility and treatment strategies, and for providing an important input to clinical and administrative decision making. No specific funding was used to undertake this study and the authors report no conflicts of interest. A number of the authors receive Research Grants to their institutions from the Australian Government. G.M.C. receives grant support to her institution from the Australian Government, Australian Research Council (ARC) Linkage Grant No LP1002165 ARC Linkage Grant Partner Organisations are IVFAustralia, Melbourne IVF and Queensland Fertility Group. V.P.H. is employed as an Economics Research Associate on the same grant. NA.
Publisher: Wiley
Date: 24-09-2009
Publisher: Wiley
Date: 26-05-2022
DOI: 10.1111/HEX.13532
Abstract: Cardiac disease affects an estimated 1%–4% of all pregnancies and is a leading cause of maternal morbidity and mortality. There is a lack of data on the healthcare experiences of affected women to inform health service delivery and person‐centred care. This study sought to explore and understand the healthcare experiences of women with cardiac disease in pregnancy and postpartum. This qualitative study used semi‐structured interviews with women who had cardiac disease in pregnancy or the first 12 months postpartum. Data were analysed using thematic analysis. Participants were 25 women with pre‐existing or newly diagnosed acquired, genetic and congenital cardiac disease. Analysis of the interviews highlighted the discrepancy between care aspirations and experiences. The participants had a wide range of cardiac diseases and timing of diagnoses, but had similar healthcare experiences of being dismissed, not receiving the information they required, lack of continuity of care and clinical guidelines and of feeling out of place within a healthcare system that did not accommodate their combined needs as a mother and a cardiac patient. This study identified a lack of person‐centred care and responsiveness of the healthcare system in providing fit‐for‐purpose healthcare for women with complex disease who are pregnant or new mothers. In particular, cardiac and maternity care providers have an opportunity to listen to women who are the experts on their emergent healthcare needs, contributing to development of the knowledge base on the healthcare experiences of having cardiac disease in pregnancy and postpartum. Public and patient input into the value and design of the study was gained through NSW Heart Foundation forums, including the Heart Foundation's women's patient group.
Publisher: Wiley
Date: 08-10-2008
Publisher: AMPCo
Date: 11-2011
DOI: 10.5694/MJA10.11448
Abstract: To calculate cost savings to the Australian federal and state governments from the reduction in twin and triplet birth rates for infants conceived by assisted reproductive technology (ART) since 2002, and to determine the number of ART treatment programs theoretically funded by means of these savings. Costing model using data from the Australia and New Zealand Assisted Reproduction Database, the National Perinatal Data Collection and Medicare Australia on ART treatment cycles undertaken in Australia between 2002 and 2008. Annual savings in maternal and infant inpatient birth-admission costs resulting from the reduction in ART multiple birth rate theoretical number of ART treatment programs funded and infants born by means of these savings. The reduction in the ART multiple birth rate from 18.8% in 2002 to 8.6% in 2008 resulted in estimated savings to government of $47.6 million in birth-admission costs alone. Theoretically, these savings funded 7042 ART treatment programs comprising one fresh plus one frozen embryo transfer cycle, equating to the birth of 2841 babies. Fifty-five per cent of the increased use of ART services since 2002 has been theoretically funded by the reduction in multiple birth infants. Against a backdrop of supportive public funding of ART in Australia, a voluntary shift to single embryo transfer by fertility clinicians and ART patients has resulted in substantial savings in hospital costs. Much of the growth in ART use has been theoretically cross-subsidised by the move to safer embryo transfer practices.
Publisher: BMJ
Date: 10-2020
DOI: 10.1136/BMJOPEN-2020-039819
Abstract: In Australia, New South Wales (NSW), abortion has recently been removed from the criminal code. Previous research from Australia and other high-income countries has focused on adult women’s access to abortion services. This protocol describes a five-stage mixed-methods study to determine the care trajectories and experiences of adolescent females, aged 16–19 years, seeking an early induced abortion in NSW. The aims are to (1) explore the needs and perspectives of adolescent females seeking sexual and reproductive health services in NSW and (2) develop a framework for abortion service provision for adolescents in NSW. This study comprises: (1) semistructured qualitative interviews with key informants, in iduals with erse, in-depth experience of providing and/or supporting abortion care in NSW (2) a cross-sectional online survey of adolescent females residing in NSW (3) case study interviews with adolescents females who have accessed an abortion service in NSW (4) a co-design workshop with adolescents who took part in stage 3 to develop relevant knowledge and recommendations and (5) a knowledge dissemination forum with key stakeholders. Ethics approval has been received from the University of Technology Sydney Human Research Ethics Committee for this study. Data collection commenced in March 2019 and will continue until the end of 2020. This study aims to develop a deep understanding of adolescent abortion care trajectories and experiences of abortion services in NSW. The study will deliver co-produced recommendations to improve adolescent access to abortion information and services.
Publisher: Wiley
Date: 20-12-2012
Publisher: Oxford University Press (OUP)
Date: 20-11-2018
Publisher: Oxford University Press (OUP)
Date: 2019
Publisher: Springer Science and Business Media LLC
Date: 12-2012
Publisher: Mary Ann Liebert Inc
Date: 12-2018
Abstract: Improvements in cancer therapy for childhood and adolescent and young adult (AYA) survivors have increased in excess of 80% among pediatric patients and in excess of 85% among AYA cancer patients. Our research group explored the late effects consequences of cancer treatment on pregnancy and birth outcomes subsequent to a childhood (0-14 years) or AYA (15-25 years) diagnosis of cancer in female cancer survivors. Embase and Medline databases were searched. There were 17 review (n = 10 matched and n = 7 unmatched) studies that met the inclusion criteria. Subanalyses were conducted on 10 matched studies. The median age for all studies for patients at diagnosis and birth was 11 and 27 years, respectively. In matched cohort studies, female childhood and AYA cancer patients, who received chemotherapy alone, had a pooled estimated rate of 18% of experiencing a live birth compared with 10% of females who received radiotherapy alone and subsequently had a live birth. Females who received surgery alone reported higher pooled estimated rates of 44% for a live birth. For matched retrospective review studies, 79% (n = 973) of women experienced a live birth, of which 22% of these babies were born preterm. This meta-analysis found lower birth rates for survivors. Access to fertility-related information and discussions around fertility preservation options and oncofertility psychosocial support should be offered to all cancer patients and their families before starting cancer treatment.
Publisher: Springer Science and Business Media LLC
Date: 02-03-2018
Publisher: Wiley
Date: 22-07-2015
Publisher: BMJ
Date: 06-10-2010
DOI: 10.1136/BMJ.C5255
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.WOMBI.2018.08.161
Abstract: The Maternity Care Classification System is a novel system developed in Australia to classify models of maternity care based on their characteristics. It will enable large-scale evaluations of maternal and perinatal outcomes under different models of care independently of the model's name. To assess the accuracy, repeatability and reproducibility of the Maternity Care Classification System. All 70 public maternity services in New South Wales, Australia, were invited to classify three randomly allocated model case-studies using a web-based survey tool and repeat their classifications 4-6 weeks later. Accuracy of classifications was assessed against the correct values for the case-studies repeatability (intra-rater reliability) was analysed by percent agreement and McNemar's test between the same participants in both surveys and reproducibility (inter-rater reliability) was assessed by percent agreement amongst raters of the same case-study combined with Krippendorff's alpha coefficient for a subset of characteristics. The accuracy of the Maternity Care Classification System was high with 90.8% of responses correctly classified was repeatable, with no statistically significant change in the responses between the two survey instances (mean agreement 91.5%, p>0.05 for all but one variable) and was reproducible with a mean percent agreement across 9 characteristics of 83.6% and moderate to substantial agreement as assessed by a Krippendorff's alpha coefficient of 0.4-0.8. The results indicate the Maternity Care Classification System is a valid system for classifying models of care in Australia, and will enable the legitimate evaluation of outcomes by different models of care.
Publisher: Wiley
Date: 19-07-2011
DOI: 10.1111/J.1365-2702.2011.03765.X
Abstract: Background. Approximately 2% of women who give birth in Australia each year do so in a birth centre. A national study on birth centre procedures was conducted in 1997. There have been changes in the management of women in birth centres during the past 10 years and this may be due in part to changes in booking and transfer criteria. Aims. This study aimed to describe booking and transfer criteria and procedures available in birth centres in Australia in 2007 and to compare results with those of a previous national birth centre study undertaken in 1997. Design. Survey. Methods. Questionnaires were sent to 23 birth centres. Questions included: types of procedures, equipment and pain relief available and exclusion criteria for booking and transfer. Of the birth centres, 19 satisfied the inclusion criteria and 16 completed surveys. Results. Changes were noted in booking and transfer criteria and procedures for birth centres between 1997–2007. These included a decline in birth centres accepting postterm pregnancies, vaginal births after caesarean section and women who are obese. There were also reductions in the use of artificial rupture of membranes for augmentation of labour, forceps and opioids. Use of natural therapies was widespread in 2007. Increases in birth centres managing induction of labour and electronic fetal monitoring were also noted. Conclusions. The changes observed in birth centre practice reflect overall changes in maternity care in Australia from 1997–2007. Relevance to clinical practice. Findings of the study suggest that factors such as increasing obesity and limited admission for vaginal births after caesarean section may lead to proportionately more women being unable to access birth centres as their preferred place of birth.
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1111/J.1753-6405.2010.00565.X
Abstract: To establish baseline prevalence of neural tube defects (NTDs) prior to mandatory folic acid fortification in Australia. Retrospective population based study. Data from the Australian Congenital Anomalies Monitoring System, for 1998-2005 were used to calculate birth prevalence including live/stillbirths of at least 20 weeks gestation or 400 g birthweight. Total prevalence and trends of NTD including terminations of pregnancy (TOPs) before 20 weeks were established using data from South Australia, Victoria and Western Australia because of the incomplete ascertainment in other states. The birth prevalence of NTDs from 1998-2005, was 5/10,000 births. The total prevalence including TOPs was 13/10,000 births. A 26% declining trend in total prevalence was seen from 1992-2005, but the main decline occurred prior to 1998. Women who were Indigenous, socially disadvantaged, young, living in remote areas and had multiple gestations were more likely to give birth to babies with NTDs. The prevalence of NTD has been stable since 1998. Reporting of the birth prevalence alone underestimates the actual prevalence of NTD. From a public health perspective, future monitoring of NTD following implementation of fortification of bread-making flour with folic acid should include a mixed methods approach reporting birth prevalence on national data and total prevalence on tri-state data.
Publisher: Elsevier BV
Date: 06-2009
DOI: 10.1016/J.FERTNSTERT.2009.04.029
Abstract: To compare regulatory and economic aspects of assisted reproductive technologies (ART) in developed countries. Comparative policy and economic analysis. Couples undergoing ART treatment in the United States, Canada, United Kingdom, Scandinavia, Japan, and Australia. Description of regulatory and financing arrangements, cycle costs, cost-effectiveness ratios, total expenditure, utilization, and price elasticity. Regulation and financing of ART share few general characteristics in developed countries. The cost of treatment reflects the costliness of the underlying healthcare system rather than the regulatory or funding environment. The cost (in 2006 United States dollars) of a standard IVF cycle ranged from $12,513 in the United States to $3,956 in Japan. The cost per live birth was highest in the United States and United Kingdom ($41,132 and $40,364, respectively) and lowest in Scandinavia and Japan ($24,485 and $24,329, respectively). The cost of an IVF cycle after government subsidization ranged from 50% of annual disposable income in the United States to 6% in Australia. The cost of ART treatment did not exceed 0.25% of total healthcare expenditure in any country. Australia and Scandinavia were the only country/region to reach levels of utilization approximating demand, with North America meeting only 24% of estimated demand. Demand displayed variable price elasticity. Assisted reproductive technology is expensive from a patient perspective but not from a societal perspective. Only countries with funding arrangements that minimize out-of-pocket expenses met expected demand. Funding mechanisms should maximize efficiency and equity of access while minimizing the potential harm from multiple births.
Publisher: American Medical Association (AMA)
Date: 11-2014
DOI: 10.1001/JAMAPEDIATRICS.2014.1357
Abstract: The unprecedented increase in multiple births during the past 3 decades is a major public health concern and parallels the uptake of medically assisted conception. The economic implications of such births are not well understood. To conduct a comprehensive economic and health services assessment of the frequency, duration, and cost of hospital admissions during the first 5 years of life for singleton, twin, and higher-order multiple (HOM) children and to examine the contribution of assisted reproductive technology (ART) to the incidence and cost of multiple births. A retrospective population cohort study using in idually linked birth, hospital, and death records among 233,850 infants born in Western Australia between October 1993 and September 2003, and followed up to September 2008. Multiple-gestation delivery and ART conception. Odds of stillbirth, prematurity and low birth weight, frequency and length of hospital admissions, the mean costs by plurality, and the independent effect of prematurity on childhood costs. Of 226,624 singleton, 6941 twin, and 285 HOM infants, 1.0% of singletons, 15.4% of twins, and 34.7% of HOM children were conceived following ART. Compared with singletons, twins and HOMs were 3.4 and 9.6 times, respectively, more likely to be stillborn and were 6.4 and 36.7 times, respectively, more likely to die during the neonatal period. Twins and HOMs were 18.7 and 525.1 times, respectively, more likely to be preterm, and 3.6 and 2.8 times, respectively, more likely to be small for gestational age. The mean hospital costs of a singleton, twin, and HOM child to age 5 years were $2730, $8993, and $24,411 (in 2009-2010 US dollars), respectively, with cost differences concentrated in the neonatal period and during the first year of life. Almost 15% of inpatient costs for multiple births could have been avoided if ART twins and HOMs had been born as singletons. Compared with singletons, multiple-birth infants consume significantly more hospital resources, particularly during the neonatal period and first year of life. A significant proportion of the clinical and economic burden associated with multiple births can be prevented through single-embryo transfer. Increasing ART use worldwide and persistently high ART multiple-birth rates in several countries highlight the need for strategies that encourage single-embryo transfer. The costs from this study can be generalized to other settings.
Publisher: Springer Science and Business Media LLC
Date: 28-07-2017
Publisher: Springer Science and Business Media LLC
Date: 29-09-2014
Publisher: Emerald
Date: 17-12-2018
DOI: 10.1108/IJPH-12-2017-0059
Abstract: The rise in the incarceration of Aboriginal and Torres Strait Islander mothers is a major public health issue with multiple sequelae for Aboriginal children and the cohesiveness of Aboriginal communities. The purpose of this paper is to review the available literature relating to Australian Aboriginal women prisoners’ experiences of being a mother. The literature search covered bibliographic databases from criminology, sociology and anthropology, and Australian history. The authors review the literature on: traditional and contemporary Aboriginal mothering roles, values and practices historical accounts of the impacts of white settlement of Australia and subsequent Aboriginal affairs policies and practices and women’s and mothers’ experiences of imprisonment. The review found that the cultural experiences of mothering are unique to Aboriginal mothers and contrasted to non-Aboriginal concepts. The ways that incarceration of Aboriginal mothers disrupts child rearing practices within the cultural kinship system are identified. Aboriginal women have unique circumstances relevant to the concept of motherhood that need to be understood to develop culturally relevant policy and programs. The burden of disease and cycle of incarceration within Aboriginal families can be addressed by improving health outcomes for incarcerated Aboriginal mothers and female carers. To the authors’ knowledge, this is the first literature review on Australian Aboriginal women prisoners’ experiences of being a mother.
Publisher: Elsevier BV
Date: 2014
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1016/J.FERTNSTERT.2011.03.058
Abstract: To analyze information on assisted reproductive technologies (ART) performed globally. Data on access, efficacy, and safety of ART were collected for the year 2003 from 54 countries. National and regional ART registries globally. Patients undergoing ART globally. Collection and analysis of international ART registry data. Number of cycles performed in reporting countries and regions globally for different ART procedures with resulting pregnancy, live birth and multiple birth rates. A total of 433,427 initiated cycles reported in this registry resulted in 173,424 babies born. This corresponded to a delivery rate per aspiration of 22.4% for in vitro fertilization (IVF), 23.3% for intracytoplasmic sperm injection (ICSI), and a delivery rate per transfer of 17.1% for frozen embryo transfer. Although there is wide variation among countries and regions, the overall proportion of deliveries with twins and triplets from IVF and ICSI was 24.8% and 2.0%, respectively. There were wide variations in access, and compared with the previous report (year 2002), there was a 3.9% increase in the number of reported cycles and a minor increase in the delivery rate per aspiration. There was also a marginal decline in the mean number of embryos transferred and in the rate of multiple births. ART access, efficacy, and safety varies greatly globally. Collection and analysis of data over time will benefit ART patients, providers, and policy makers.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2007
Publisher: Oxford University Press (OUP)
Date: 12-06-2018
Abstract: What is the cumulative live birth rate following ICSI cycles compared with IVF cycles for couples with non-male factor infertility? ICSI resulted in a similar cumulative live birth rate compared with IVF for couples with non-male factor infertility. The ICSI procedure was developed for couples with male factor infertility. There has been an increased use of ICSI regardless of the cause of infertility. Cycle-based statistics show that there is no difference in pregnancy rates between ICSI and IVF in couples with non-male factor infertility. However, evidence indicates that ICSI is associated with an increased risk of adverse perinatal outcomes. A population-based cohort of 14 693 women, who had their first ever stimulated cycle with fertilization performed for at least one oocyte by either IVF or ICSI between July 2009 and June 2014 in Victoria, Australia was evaluated retrospectively. The pregnancy and birth outcomes following IVF or ICSI were recorded for the first oocyte retrieval (fresh stimulated cycle and associated thaw cycles) until 30 June 2016, or until a live birth was achieved, or until all embryos from the first oocyte retrieval had been used. Demographic, treatment characteristics and resulting outcome data were obtained from the Victorian Assisted Reproductive Treatment Authority. Data items in the VARTA dataset were collected from all fertility clinics in Victoria. Women were grouped by whether they had undergone IVF or ICSI. The primary outcome was the cumulative live birth rate, which was defined as live deliveries (at least one live birth) per woman after the first oocyte retrieval. A discrete-time survival model was used to evaluate the cumulative live birth rate following IVF and ICSI. The adjustment was made for year of treatment in which fertilization occurred, the woman's and male partner's age at first stimulated cycle, parity and the number of oocytes retrieved in the first stimulated cycle. A total of 4993 women undergoing IVF and 8470 women undergoing ICSI had 7980 and 13 092 embryo transfers, resulting in 1848 and 3046 live deliveries, respectively. About one-fifth of the women (19.0% of the IVF group versus 17.9% of the ICSI group) had three or more cycles during the study period. For couples who achieved a live delivery, the median time from oocyte retrieval to live delivery was 8.9 months in both IVF (range: 4.2-66.5) and ICSI group (range: 4.5-71.3) (P = 0.474). Fertilization rate per oocyte retrieval was higher in the IVF than in the ICSI group (59.8 versus 56.2%, P < 0.001). The overall cumulative live birth rate was 37.0% for IVF and 36.0% for ICSI. The overall likelihood of a live birth for women undergoing ICSI was not significantly different to that for women undergoing IVF (adjusted hazard ratio (AHR): 0.99, 95% CI: 0.92-1.06). For couples with a known cause of infertility, non-male factor infertility (female factor only or unexplained infertility) was reported for 64.0% in the IVF group and 36.8% in the ICSI group (P < 0.001). Among couples with non-male factor infertility, ICSI resulted in a similar cumulative live birth rate compared with IVF (AHR: 0.96, 95% CI: 0.85-1.10). Data were not available on clinic-specific protocols and processes for IVF and ICSI and the potential impact of these technique aspects on clinical outcomes. The reported causes of infertility were based on the treating clinician's classification which may vary between clinicians. This population-based study found ICSI resulted in a lower fertilization rate per oocyte retrieved and a similar cumulative live birth rate compared to conventional IVF. These data suggest that ICSI offers no advantage over conventional IVF in terms of live birth rate for couples with non-male factor infertility. No specific funding was received to undertake this study. There is no conflict of interest, except that M.B. is a shareholder in Genea Ltd. N/A.
Publisher: Wiley
Date: 06-11-2017
DOI: 10.1111/AJO.12744
Abstract: To study rheumatic heart disease health literacy and its impact on pregnancy, and to identify how health services could more effectively meet the needs of pregnant women with rheumatic heart disease. Researchers observed and interviewed a small number of Aboriginal women and their families during pregnancy, childbirth and postpartum as they interacted with the health system. An Aboriginal Yarning method of relationship building over time, participant observations and interviews with Aboriginal women were used in the study. The settings were urban, island and remote communities across the Northern Territory. Women were followed interstate if they were transferred during pregnancy. The participants were pregnant women and their families. We relied on participants' abilities to tell their own experiences so that researchers could interpret their understanding and perspective of rheumatic heart disease. Aboriginal women and their families rarely had rheumatic heart disease explained appropriately by health staff and therefore lacked understanding of the severity of their illness and its implications for childbearing. Health directives in written and spoken English with assumed biomedical knowledge were confusing and of limited use when delivered without interpreters or culturally appropriate health supports. Despite previous studies documenting poor communication and culturally inadequate care, health systems did not meet the needs of pregnant Aboriginal women with rheumatic heart disease. Language-appropriate health education that promotes a shared understanding should be relevant to the gender, life-stage and social context of women with rheumatic heart disease.
Publisher: Wiley
Date: 14-02-2018
DOI: 10.1111/JOG.13605
Abstract: The aim of this study was to identify the main contributors to cesarean section (CS) among women with and without diabetes during pregnancy using the Robson classification and to compare CS rates within Robson groups. A population-based cohort study was conducted of all women who gave birth in New South Wales, Australia, between 2002 and 2012. Women with pregestational diabetes (types 1 and 2) and gestational diabetes mellitus (GDM) were grouped using the Robson classification. Adjusted odd ratios (AOR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression. The total CS rate was 53.6% for women with pregestational diabetes, 36.8% for women with GDM and 28.5% for women without diabetes. Previous CS contributed the most to the total number of CS in all populations. For preterm birth, the contribution to the total was 20.5% for women with pregestational diabetes and 5.7% for women without diabetes. Compared to women without diabetes, for nulliparous with pregestational diabetes, the odds of CS was 1.4 (95% CI, 1.1-1.8) for spontaneous labor and 2.0 (95% CI, 1.7-2.3) for induction of labor. A history of CS was the main contributor to the total CS. Reducing primary CS is the first step to lowering the high rate of CS among women with diabetes. Nulliparous women were more likely to have CS if they had pregestational diabetes. This increase was also evident in all multiparous women giving birth. The high rate of preterm births and CS reflects the clinical issues for women with diabetes during pregnancy.
Publisher: Springer Science and Business Media LLC
Date: 14-06-2018
Publisher: Oxford University Press (OUP)
Date: 09-05-2006
Abstract: The International Committee Monitoring Assisted Reproductive Technologies (ICMART) is an independent, international non-profit organization that has taken a leading role in the development, collection and dissemination of worldwide data on ART. Information on availability, efficacy and safety is provided to health professionals, health authorities and the public. The glossary facilitates dissemination of ART data through a set of agreed definitions as seen in the most recent World Report on ART. It provides a conceptual framework for further international terminology and data development of ART.
Publisher: Wiley
Date: 13-10-2011
DOI: 10.1111/J.1471-0528.2010.02736.X
Abstract: To compare admissions to intensive care units (ICUs) with confirmed AH1N1v influenza in pregnancy in Australia, New Zealand and the UK. National cohort studies. ICUs in Australia, New Zealand and the UK. Fifty-nine women admitted to ICUs in Australia and New Zealand in June-August 2009, and 57 women admitted to ICUs in the UK in September 2009-January 2010. Comparison of cohort data. Incidence of ICU admission, comparison of characteristics and outcomes. There was a significantly higher ICU admission risk in Australia and New Zealand than in the UK (risk ratio 2.59, 95% CI 1.75-3.85). Indigenous women from Australia and women with Maori/Pacific Island backgrounds from New Zealand had the highest admission risk (29.7 admissions per 10 000 maternities, 95% CI 17.9-46.3). Women admitted in Australia and New Zealand were significantly more likely to have a pre-existing medical condition (51% versus 21%, P = 0.001), but were less likely to receive antiviral treatment (80% versus 93%, P = 0.038) than women admitted in the UK. Women admitted in the UK had a longer length of hospital stay (median 21 days, range 3-128 days) than women admitted in Australia and New Zealand (median 12 days, range 3-66 days), but there were no other differences in maternal or pregnancy outcomes. The difference in admission risk may reflect a second phase effect from successful clinical and public health interventions, as well as differences in population characteristics between the countries. The overall severity of the AH1N1v influenza infection in pregnancy is evident, and emphasises the importance of an ongoing immunisation programme in pregnant women in both northern and southern hemispheres.
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.VACCINE.2016.07.026
Abstract: Vaccination is one of the most significant and successful public health measures of recent times. Whilst the use of complementary medicine (CM) continues to grow, it has been suggested that CM practitioners hold anti-vaccination views. The objective of this critical review is to examine the evidence base in relation to CM practitioner attitudes to childhood vaccination alongside attitudes to vaccination among parents who visit CM practitioners and/or use CM products. A database search was conducted in MEDLINE, PubMed, CINAHL, EMBASE and AMED for research articles published between January 2000 and September 2015 that evaluated either CM practitioner or CM user attitudes and intention towards childhood vaccination. A total of 23 articles were found that detailed the attitudes of CM practitioners to vaccination. A further 16 papers examined the association between the use of CM products and visits to CM practitioners, and immunisation. The interface between CM and vaccination is complex, multi-factorial and often highly in idualised. The articles suggest that there is no default position on immunisation by CM practitioners or parents who use CM themselves, or for their children. Although CM use does seem positively associated with lower vaccination uptake, this may be confounded by other factors associated with CM use (such as higher income, higher education or distrust of the medical system), and may not necessarily indicate independent or predictive relationships. Although anti-vaccination sentiment is significant amongst some CM practitioners, this review uncovers a more nuanced picture, and one that may be more agreeable to public health values than formerly assumed.
Publisher: Wiley
Date: 25-02-2016
DOI: 10.1111/AJO.12451
Abstract: Information on gestational surrogacy arrangement and outcomes is limited in Australia. This national population study investigates the epidemiology of gestational surrogacy arrangement in Australia: treatment procedures, pregnancy and birth outcomes. A retrospective study was conducted of 169 intended parents cycles and 388 gestational carrier cycles in Australia in 2004-2011. Demographics were compared between intended parents and gestational carrier cycles. Pregnancy and birth outcomes were compared by number of embryos transferred. Over half (54%) intended parents cycles were in women aged <35 years compared to 38% of gestational carrier cycles. About 77% of intended parents cycles were of nulliparous women compared to 29% of gestational carrier cycles. Of the 360 embryo transfer cycles, 91% had cryopreserved embryos transferred and 69% were single-embryo transfer (SET) cycles. The rates of clinical pregnancy and live delivery were 26% and 19%, respectively. There were no differences in rates of clinical pregnancy and live delivery between SET cycles (27% and 19%) and double-embryo transfer (DET) cycles (25% and 19%). Five of 22 deliveries following DET were twin deliveries compared to none of 48 deliveries following SET. There were 73 liveborn babies following gestational surrogacy treatment, including 9 liveborn twins. Of these, 22% (16) were preterm and 14% (10) were low birthweight. Preterm birth was 13% for liveborn babies following SET, lower than the 31% or liveborn babies following DET. To avoid adverse outcomes for both carriers and babies, SET should be advocated in all gestational surrogacy arrangements.
Publisher: Elsevier BV
Date: 1998
DOI: 10.1016/S0736-4679(97)00242-4
Abstract: We identified 41 New York City residents who had been hospitalized at least overnight between January 1992 and September 1993 because of a toxic isoniazid (INH) exposure. Review of the available medical charts of 33 patients revealed that median age was 19 years, 27 (82%) were females, and 24 (83%) were taking INH chemoprophylaxis for tuberculosis infection. Twenty-two patients had seizures. Twenty-seven (82%) patients had attempted suicide using INH, and another three patients had intentionally misused INH by making up missed doses at one time. All patients survived. Physicians should be aware of the potential for INH toxicity and should assess their patients' current mental and psychosocial status when prescribing it. INH toxicity should be considered when young patients, particularly females, present with unexplained intractable seizures, and treatment with pyridoxine should be given.
Publisher: Wiley
Date: 02-2008
Publisher: Oxford University Press (OUP)
Date: 27-05-2009
Abstract: The International Committee for Monitoring Assisted Reproductive Technology's (ICMART) Eighth World Report analyzes assisted reproductive technology (ART) practice and results for the year 2002 from 53 countries by type of ART, women's age, number of embryos transferred and multiple births. Over 601,243 initiated cycles resulted in a delivery rate (DR) per aspiration of 22.4% for conventional IVF, 21.2% for ICSI and a DR per transfer of 15.3% for frozen embryo transfer. For conventional IVF and ICSI, there was an overall twin rate of 25.7% per delivery and a triplet rate of 2.5%. The number of babies born worldwide through ART in 2002 was estimated to range between 219,000 and 246,000. There were wide variations in availability, DRs and multiple birth rates across the countries. Compared with the previous report (year 2000), there was a large increase in the number of cycles and a slight increase in the DR. There was a marginal decline in the mean number of embryos transferred and in the multiple DRs.
Publisher: Wiley
Date: 07-2002
DOI: 10.1046/J.1365-2923.2002.01196.X
Abstract: Overseas-trained doctors (OTDs) have limited access and formal interaction with the Australian health care system prior to joining the Australian medical workforce. A pre-employment programme was designed to familiarize OTDs with the Australian health care system. All OTDs who had passed their Australian Medical Council (AMC) exams and were applying for a pre-registration year in New South Wales were invited to participate in the voluntary, free programme. A 4-week full-time programme was developed consisting of core group teaching and a hospital attachment. The curriculum included communication, health and workplace skills and sessions on culture shock and the role of junior doctors. A pilot programme was run in 1997. The programme was repeated in 1998 and 1999. The OTDs' confidence regarding the general duties of internship, and attitudes towards hospital workplace skills were examined. The 66 OTDs reported greater understanding of staff and communication issues and familiarization with the hospital environment. They reported a more realistic understanding of the role of a junior doctor, the need for separation of workplace and personal responsibilities and knowledge of pathways for future professional development. The course structure, with a focus on hospital attachments, establishment of a peer network, and workplace familiarization facilitated entry into the hospital workforce. The pre-employment programme enabled the OTDs to have a more equitable entry into the public hospital system, resulting in a more integrated, confident and functional workforce.
Publisher: Wiley
Date: 27-03-2006
Publisher: Oxford University Press (OUP)
Date: 18-10-2007
Abstract: Currently, about one-third of infants born after assisted reproductive technology (ART) worldwide are twins or triplets. This study compared the inpatient birth-admission costs of singleton and multiple gestation ART deliveries to non-ART deliveries. A cohort of 5005 mothers and 5886 infants conceived following ART treatment were compared to 245 249 mothers and 248 539 infants in the general population. Birth-admission costs were calculated using Australian Refined Diagnosis Related Groups and weighted national average costs (2003-2004 euro). ART infants were 4.4 times more likely to be low birthweight (LBW) compared with non-ART infants, translating into 89% higher birth-admission costs (euro2,832 and euro1,502, respectively). ART singletons were also more likely to be LBW compared with non-ART singletons, translating into 31% higher birth-admission costs (euro1,849 and euro1,415, respectively). After combining infant and maternal admission costs, the average cost of an ART singleton delivery was euro4,818 compared with euro13 890 for ART twins and euro54 294 for ART higher order multiples. Findings were not sensitive to changes in casemix. The poorer neonatal outcomes of ART singletons compared with non-ART singletons are significant enough to impact healthcare resource consumption. The high costs associated with ART multiple births add to the overwhelming clinical and economic evidence in support of single embryo transfer.
Publisher: Wiley
Date: 09-2012
DOI: 10.5694/MJA11.11331
Publisher: Springer Science and Business Media LLC
Date: 30-01-2012
Abstract: The Indigenous population of Australia was estimated as 2.5% and under-reported. The aim of this study is to improve statistical ascertainment of Aboriginal women giving birth in New South Wales. This study was based on linked birth data from the Midwives Data Collection (MDC) and the Registry of Births Deaths and Marriages (RBDM) of New South Wales (NSW). Data linkage was performed by the Centre for Health Record Linkage (CHeReL) for births in NSW for the period January 2001 to December 2005. The accuracy of maternal Aboriginal status in the MDC and RBDM was assessed by consistency, sensitivity and specificity. A new statistical variable, ASV, or Aboriginal Statistical Variable, was constructed based on Indigenous identification in both datasets. The ASV was assessed by comparing numbers and percentages of births to Aboriginal mothers with the estimates by capture-recapture analysis. Maternal Aboriginal status was under-ascertained in both the MDC and RBDM. The ASV significantly increased ascertainment of Aboriginal women giving birth and decreased the number of missing cases. The proportion of births to Aboriginal mothers in the non-registered birth group was significantly higher than in the registered group. Linking birth data collections is a feasible method to improve the statistical ascertainment of Aboriginal women giving birth in NSW. This has ramifications for the ascertainment of babies of Aboriginal mothers and the targeting of appropriate services in pregnancy and early childhood.
Publisher: Wiley
Date: 05-1996
DOI: 10.1111/J.1440-0960.1996.TB01078.X
Abstract: Skin phototype was assessed in 257 Asian Australians by self-reporting questionnaire. Minimal erythema dose, minimal melanogenic dose and minimal immediate pigment darkening dose were measured in a subgroup of 50 subjects. About 15% of Asian Australians in this study report that they have skin type I or II. Phototesting confirms that there is a UV-sensitive group and a wide spectrum of UV-sensitivity in this population. Whether Fitzpatrick's skin typing system adequately identifies this UV-sensitive group needs assessment by a larger study. The relationship between burning tendency and tanning capacity in Asians may differ from Caucasians.
Publisher: MDPI AG
Date: 08-05-2014
Publisher: SAGE Publications
Date: 02-2004
DOI: 10.1258/095646204322764316
Abstract: There is no routine prenatal screening for sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) in pregnancy in Samoa. Testing for chlamydial infection is not available. To gather information on pregnant women, a prevalence survey was conducted in Apia, Samoa, utilizing two prenatal hospital clinics. Pregnant ( n = 427) women were tested for Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis using polymerase chain reaction (PCR), and for syphilis ( n = 441) by rapid plasmid reagin (RPR) and HIV ( n = 441) by enzyme-linked immunosorbent assay (ELISA). Results were: chlamydia 30.9% (132) trichomoniasis 20.8% gonorrhoea 3.3% syphilis 0.5% and HIV 0%. Overall 42.7% had at least 1 STD. Young women aged years were three times more likely to have a STD than older women (odds ratio = 3.0, 95% confidence intervals 2.0, 4.5). The lack of inexpensive, reliable field diagnostics remain a barrier to sustainable STD control programmes for pregnant women living in developing countries.
Publisher: Wiley
Date: 24-08-2017
Abstract: Develop a core outcome set of international consensus definitions for severe maternal morbidities. Electronic Delphi study. International. Eight expert panels. All 13 high-income countries represented in the International Network of Obstetric Surveillance Systems (INOSS) nominated five experts per condition of morbidity, who submitted possible definitions. From these suggestions, a steering committee distilled critical components: ecl sia: 23, amniotic fluid embolism: 15, pregnancy-related hysterectomy: 11, severe primary postpartum haemorrhage: 19, uterine rupture: 20, abnormally invasive placentation: 12, spontaneous haemoperitoneum in pregnancy: 16, and cardiac arrest in pregnancy: 10. These components were assessed by the expert panel using a 5-point Likert scale, following which a framework for an encompassing definition was constructed. Possible definitions were evaluated in rounds until a rate of agreement of more than 70% was reached. Expert commentaries were used in each round to improve definitions. Definitions with a rate of agreement of more than 70%. The invitation to participate in one or more of eight Delphi processes was accepted by 103 experts from 13 high-income countries. Consensus definitions were developed for all of the conditions. Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process. These should be used in national registrations and international studies, and should be taken up by the Core Outcomes in Women's and Newborn Health initiative. Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process.
Publisher: Springer Science and Business Media LLC
Date: 12-11-2021
DOI: 10.1186/S40352-021-00153-7
Abstract: Women in prison are a vulnerable group, often with a history of abuse, out-of-home care, mental health problems and unemployment. Many are mothers when they become involved in the criminal justice system and their gender and parenting related needs are often not considered. The aim of this rapid review was to thematically synthesize the existing research on the needs and experiences of mothers while in, and following release from, prison in Australia. We conducted a rapid systematic search of electronic databases, search engines, the websites of key agencies, and contacted key agencies and researchers. Twenty-two publications from 12 studies met the inclusion criteria and were thematically synthesized in relation to the mothers, their children, family and community, and systems and services which mothers had contact with. We found that mothers in prison have a history of disadvantage which is perpetuated by the trauma of imprisonment. Release from prison is a particularly challenging time for mothers. In relation to their children, the included studies showed that the imprisonment of mothers impacts their maternal identity and role and disrupts the mother-child relationship. Specific strategies are needed to maintain the mother-child relationship, and to ensure the needs and rights of the child are met. In relation to family and community, we found that although family and social support is an important need of women in prison, such support may not be available. Moreover, the stigma associated with having been in prison is a significant barrier to transitions into the community, including finding employment and housing. In relation to systems and services, although limited services exist to support women in prison and on release, these often do not consider the parenting role. Evaluations of parenting programs in prison found them to be acceptable and beneficial to participants but barriers to access limit the number of women who can participate. Mothers have gender- and parenting-specific needs which should be considered in planning for corrective services in Australia. Any service redesign must place the woman and her children at the centre of the service.
Publisher: Wiley
Date: 14-11-2006
Publisher: Wiley
Date: 10-08-2015
Start Date: 11-2010
End Date: 01-2014
Amount: $315,000.00
Funder: Australian Research Council
View Funded Activity