Jo-Anne Rayner

Oestrogen treatment for tall stature in girls: estimating the effect on height and the error in height prediction

Objective  To determine the effect of oestrogen treatment on attenuating the growth of tall girls after adjusting for error in height prediction.

Identifying risk factors for very preterm birth: A reference for clinicians

OBJECTIVE to provide an accessible list of individual and population-based risk factors associated with very preterm birth to assist care providers in planning appropriate pregnancy care. DESIGN a population-based case-control study. SETTING Victoria, Australia. PARTICIPANTS women were recruited from April 2002 to 2004. Cases had a singleton birth between 20 and 31+6 weeks gestation and controls were a random selection of women having a birth of at least 37 weeks gestation in the same time period as the cases. MEASUREMENTS AND FINDINGS structured interviews were conducted within a few weeks postpartum with 603 cases and 796 controls. Data were collected on sociodemographic factors; obstetric and gynaecological history; and maternal health problems, both pre-existing and occurring during the index pregnancy. Risk factors were calculated. KEY CONCLUSIONS when correlated, risk factors were grouped as either lifestyle or maternal health factors. The majority of the risks were obstetric or gynaecological factors. Risks occurring in pregnancy may precipitate preterm birth. IMPLICATIONS FOR PRACTICE knowing the risk factors for very preterm birth is likely to be helpful for pregnancy care providers. The development of a risk factor checklist based on the findings presented here may enable more informed planning of care and timely intervention.

Intracervical procedures and the risk of subsequent very preterm birth: a case–control study

Abstract  Objective. To investigate the relation of prior intracervical procedures with very preterm birth. Design. A population‐based case–control study. Setting. The study was conducted in Australia between 2002 and 2004. Sample. Three hundred and forty‐five women having a medically indicated and 236 having a spontaneous singleton birth between 20 and 31 weeks of gestation and 796 women selected randomly from all those giving birth at ≥37 weeks of gestation. Methods. Interview data were analysed using logistic regression. Main outcome measure. Very preterm birth. Results. Very preterm birth was significantly associated with having any intracervical procedure [adjusted odds ratio (AOR) 2.07; 95% confidence interval (CI) 1.6–2.7], in particular curettage associated with abortion (AOR 1.80; 95% CI 1.2–2.6). Assisted reproductive technology procedures were significantly associated with medically indicated very preterm birth (AOR 3.07; 95% CI 1.8–5.3) and treatments for precancerous cervical changes were significantly associated with spontaneous very preterm birth, as follows: conization/cone biopsy (AOR 3.33; 95% CI 1.8–6.2) and cauterization/ablation (AOR 2.27; 95% CI 1.4–3.8). Suction aspiration for abortion, abnormal Pap smear without treatment and abortion without instrumentation were not associated with very preterm birth. Conclusions. Intracervical procedures are associated with very preterm birth. Notably, curettage rather than any other procedure associated with abortion appears to be implicated in the risk. The introduction of infection during cervical procedures may be the common link with risks found. Changing clinical practice in the management of abortion and human papillomavirus vaccination may lead to lowering the risks of very preterm birth.

Use of complementary and alternative medicine in residential aged care.

OBJECTIVES There is increasing evidence of the use of complementary and alternative medicine (CAM) by older people living in the community; however, little is known about the use of CAM in residential aged-care facilities (RACF). This review examined the literature on the use of CAM in RACF, focusing on prevalence, motivations, and support for use. METHODS A search of multiple databases between 2000 and 2010 was conducted. Articles were analyzed under five key themes: prevalence of CAM use, CAM user profile, motivations for use, expectations for and satisfaction with CAM use, and institutional and/or staff support for CAM use. RESULTS Only five articles were found that met the inclusion criteria. The review highlights the absence of evidence regarding the use of CAM by older people in RACF. CONCLUSIONS To inform policy and improve clinical practice in line with the aging of the population, nationally representative, population-based studies are required.

Modelling prior reproductive history to improve prediction of risk for very preterm birth

In published studies of preterm birth, analyses have usually been centred on individual reproductive events and do not account for the joint distributions of these events. In particular, spontaneous and induced abortions have often been studied separately and have been variously reported as having no increased risk, increased risk or different risks for subsequent preterm birth. In order to address this inconsistency, we categorised women into mutually exclusive groups according to their reproductive history, and explored the range of risks associated with different reproductive histories and assessed similarities of risks between different pregnancy histories. The data were from a population-based case-control study, conducted in Victoria, Australia. The study recruited women giving birth between April 2002 and April 2004 from 73 maternity hospitals. Detailed reproductive histories were collected by interview a few weeks after the birth. The cases were 603 women who had had a singleton birth between 20 and less than 32 weeks gestation (very preterm births including terminations of pregnancy) and the controls were 796 randomly selected women from the population who had had a singleton birth of at least 37 completed weeks gestation. All birth outcomes were included. Unconditional logistic regression was used to assess the association of very preterm birth with type and number of prior abortions, prior preterm births and sociodemographic factors. Using the complex combinations of prior pregnancy experiences of women (including nulligravidity), we showed that a history of prior childbirth (at term) with no preterm births gave the lowest risk of very preterm birth. With this group as the reference category, odds ratios of more than two were associated with all other prior reproductive histories. There was no evidence of difference in risk between types of abortion (i.e. spontaneous or induced) although the risk increased if a prior preterm birth had also occurred. There was an increasing risk of very preterm birth associated with increasing numbers of abortions. This method of data analysis reveals consistent and similar risks for very preterm birth following spontaneous or induced abortions. The findings point to the need to explore commonalities rather than differences in regard to the impact of abortion on subsequent births.

Looking back in time: conducting a cohort study of the long-term effects of treatment of adolescent tall girls with synthetic hormones

ObjectivePublic health research is an endeavour that often involves multiple relationships, far-reaching collaborations, divergent expectations and various outcomes. Using the Tall Girls Study as a case study, this paper will present and discuss a number of methodological, ethical and legal challenges that have implications for other public health research.ApproachThe Tall Girls Study was the first study to examine the long-term health and psychosocial effects of oestrogen treatment for tall stature.ResultsIn undertaking this study the research team overcame many hurdles: in maintaining collaboration with treating clinicians and with the women they had treated as girls - groups with opposing points of view and different expectations; using private practice medical records to trace women who had been patients up to forty years earlier; and exploring potential legal issues arising from the collection of data related to treatment.ConclusionWhile faced with complex challenges, the Tall Girls Study demonstrated that forward planning, ongoing dialogue between all stakeholders, transparency of processes, and the strict adherence to group-developed protocols were keys to maintaining rigour while undertaking pragmatic research.ImplicationsPublic health research often occurs within political and social contexts that need to be considered in the planning and conduct of studies. The quality and acceptability of research findings is enhanced when stakeholders are engaged in all aspects of the research process.

Modelling sequence of prior pregnancies on subsequent risk of very preterm birth

The prevalence and intractability of preterm birth is known as is its association with reproductive history, but the relationship with sequence of pregnancies is not well studied. The data were from a population-based case-control study, conducted in Victoria, Australia. The study recruited women giving birth between April 2002 and April 2004 from 73 maternity hospitals. Detailed reproductive histories were collected by interview a few weeks after the birth. The cases were 603 women having a singleton birth between 20 and <32 weeks gestation (very preterm births including terminations of pregnancy). The controls were 796 randomly selected women from the population having a singleton birth of at least 37 completed weeks gestation. Unconditional logistic regression was used to assess the association of very preterm birth with sequence of pregnancies defined by their outcome (prior abortion - spontaneous or induced, and prior preterm or term birth) with adjustment for sociodemographic factors. The outcomes of each prior pregnancy, stratified by pregnancy order, and starting with the pregnancy immediately before the index or control pregnancy, were categorised as one of abortion, preterm birth or term birth. We showed that each of these prior pregnancy events was an independent risk of very preterm birth. This finding does not support the hypothesis of a neutralising effect of a term birth after an abortion on the subsequent risk for very preterm birth and is further evidence for the cumulative or increasing risk associated with increasing numbers of prior abortions or preterm births.

Women’s use of complementary medicine to enhance fertility: The views of fertility specialists in Victoria, Australia

The increasing use of complementary medicine (CM) by Australians cannot be ignored: in 2006, 69% used some form of CM, including over-the-counter purchases of nonprescribed medicines and supplements and 44% visited a CM practitioner; CM is commonly used concurrently with conventional medicine without the knowledge of medical practitioners; and is supported financially by private health insurance rebates. Women are the primary users: 75% reported CM use in 2006, and their use during pregnancy, including self-medication is well documented. While there is evidence to support the use of acupuncture in infertility treatment, little remains known about women’s use of CM to enhance fertility. In 2008, with ethical approval from La Trobe University (FHEC08 ⁄ 21), fertility specialists listed with the Victorian Infertility Treatment Authority (n = 55) were sent an invitation to participate in an anonymous survey along with a covering letter, a copy of the survey and a reply paid envelope. The survey sought their opinions on the safety, usefulness and effectiveness of CM for fertility enhancement. Five invitations were returned to sender and nine specialists completed the survey, a response fraction of 18% (9 ⁄ 50). The respondents, four females and five males, were aged between 37 and 69 years and all had undertaken medical education in Australia. All respondents practised in metropolitan Melbourne and had been in clinical practice for 12 to 46 years. Only one respondent reported personal use of CM. Respondents reported that a considerable proportion of women who consult them also use CM (range 25–80%); few routinely asked women about their CM use (two always and four sometimes); and six reported that they

Older australian women use complementary fertility care : A practice audit

Australian women of reproductive age are frequent users of complementary and alternative medicine (CAM), consulting practitioners and self-medicating with over-thecounter and Internet-derived supplements.However, there are gaps in knowledge about the use of CAM for fertility enhancement.6–8 We undertook a retrospective audit of all new clients attending a CAM practice in Melbourne, Australia during September 2008. The practice specializes in fertility enhancement, offering an array of modalities. The audit aimed to describe new clients seeking fertility advice and to test the feasibility of recruiting research participants in this environment. Anonymous data abstracted from records included limited demographic information, reason for attending, the modality of practitioner consulted, and use of assisted reproductive technology (ART). A random sample of new clients was also invited to complete a simple anonymous survey indicating willingness to participate in research and to select their ideal recruitment method from a list of choices provided.

I Wouldn't Mind Trying It. I'm in Pain the Whole Time: Barriers to the Use of Complementary Medicines by Older Australians in Residential Aged-Care Facilities.

Older people living in the community use complementary medicine (CM) to manage the symptoms of chronic illness; however, little is known about CM use by older people living in care settings. Using focus groups and individual interviews, this study explored the use of CM from the perspective of 71 residents, families, and health professionals from six residential aged-care facilities in Victoria, Australia. Residents used CM to manage pain and improve mobility, often covertly, and only with the financial assistance of their families. Facility policies and funding restrictions constrained CM use at the individual and facility level. An absence of evidence to support safety and efficacy coupled with the risk of interactions made doctors wary of CM use in older people. These findings have relevance for the large number of CM using “baby-boomers” as they move into residential aged-care.