Medicine (Western Health) - Research Publications
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ItemInteractions between age, sex and visceral adipose tissue on brain ageing(WILEY, 2024-06-20)AIM: To examine the associations between visceral adipose tissue (VAT) and brain structural measures at midlife and explore how these associations may be affected by age, sex and cardiometabolic factors. METHODS: We used abdominal and brain magnetic resonance imaging data from a population-based cohort of people at midlife in the UK Biobank. Regression modelling was applied to study associations of VAT volume with total brain volume (TBV), grey matter volume (GMV), white matter volume, white matter hyperintensity volume (WMHV) and total hippocampal volume (THV), and whether these associations were altered by age, sex or cardiometabolic factors. RESULTS: Complete data were available for 17 377 participants (mean age 63 years, standard deviation = 12, 53% female). Greater VAT was associated with lower TBV, GMV and THV (P < .001). We found an interaction between VAT and sex on TBV (P < .001), such that the negative association of VAT with TBV was greater in men (β = -2.89, 95% confidence interval [CI] -2.32 to -10.15) than in women (β = -1.32, 95% CI -0.49 to -3.14), with similar findings for GMV. We also found an interaction between VAT and age (but not sex) on WMHV (P < .001). The addition of other cardiometabolic factors or measures of physical activity resulted in little change to the models. CONCLUSIONS: VAT volume is associated with poorer brain health in midlife and this relationship is greatest in men and those at younger ages.
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ItemInsulinoma: Metastatic Recurrence 38 Years Following Initial Diagnosis in Pregnancy.(The Endocrine Society, 2024-02)A case of recurrent insulinoma spanning 4 decades is described. Following a delayed diagnosis, hyperinsulinemic hypoglycemia was confirmed in a 24-year-old woman during early pregnancy. Initial surgery, culminating in subtotal pancreatectomy, was noncurative. A 1-cm insulinoma was subsequently resected from the head of the pancreas postpartum, with postoperative resolution of hypoglycemia. However, 32 years later, the patient experienced a recurrence of hypoglycemic symptoms. Eventually, a subcentimeter extrapancreatic lesion was identified anterior to the pancreatic head on gallium-68 DOTA-Exendin-4 positron emission tomography/computed tomography. In 2022, a third operation was performed, with excision of a 4 × 3 mm tumor adjacent to the pancreatic head, and histology confirming insulinoma. She was again cured of symptoms.
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ItemCo-designing asthma health literacy with culturally and linguistically diverse (CALD) communities(Wiley, 2023-11)Background and Aims: In the 2016 thunderstorm asthma outbreak in Victoria, CALD communities were over-represented in deaths from asthma and hospital admissions. Given this, we conducted co-design workshops with participants from CALD communities to identify elements that should be incorporated into an existing, early intervention nurse-programme which has been shown to improve asthma control and health literacy.1 We describe the key findings from these workshops: specifically, issues related to health literacy, poor clinic attendance, yet frequent emergency presentations. Methods: Participants with asthma from 3 CALD communities, and staff providing health care to patients with asthma were enrolled into a separate, and then a combined focus group workshop. Data were collated with a view to integrating the key findings into the current model of care. Results: 18 patients with asthma from Vietnamese, Indian and Sri Lankan communities and staff members were recruited. Key findings include language and communication barriers (despite interpreters), poor understanding of asthma, for example, no specific descriptors/terminology for asthma, and poor cultural support (other than interpreters). Other issues include poor trust in the hospital system, access and affordability to General Practice, specialist clinics and hospital. Conclusion: Based on these findings, our model of care has been modified to include bicultural health care educators, who support a patient's transition from hospital to home, amongst other measures. This model of care is currently under evaluation.
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ItemNegative back beliefs are associated with increased odds of low back pain and disability: a 10-year cohort study in men.(Oxford University Press (OUP), 2023-11-08)OBJECTIVE: Although negative back beliefs are associated with high-intensity low back pain (LBP)/disability, whether they influence incident high-intensity LBP/high-disability over the long-term is unknown. This study aimed to investigate whether negative back beliefs were associated with developing high-intensity LBP and/or high-disability over 10 years in men. METHODS: Men with no or low-intensity LBP and/or disability attending the Geelong Osteoporosis Study between 2006-2010 were included. Data on age, body mass index, mobility, education, back beliefs (Back Beliefs Questionnaire), LBP and disability (Graded Chronic Pain Scale) were collected between 2006-2010. Beliefs, LBP and disability were re-assessed in 2016-2021. Binary logistic regression was used to examine the association between negative back beliefs and incident high-intensity pain and/or high-disability, adjusting for age, body mass index, mobility, and education. RESULTS: At baseline, 705 participants (mean age 53.8 years) had no or low LBP and no or low-disability; 441 (62.6%) participants completed a 10-year follow-up. Of these, 37 (8.4%) developed high-intensity pain and/or high-disability. In multivariate analyses, participants with more negative back beliefs at baseline were more likely to develop high-intensity pain and/or high-disability (Odds ratio 1.05, 95% CI 1.00-1.11). Developing more negative back beliefs was also associated with incident high-intensity pain and/or high-disability (Odds Ratio 1.20, 95% CI 1.12-1.30). CONCLUSION: In a male community-based population, negative beliefs regarding the consequences of LBP were associated with an increased likelihood of developing high-intensity pain and/or high-disability. Addressing negative back beliefs in the community may reduce the incidence of high-intensity pain and/or high-disability over 10 years in men.
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ItemNo Preview AvailableThe practicality of using bone impact microindentation in a population-based study of women: A Geelong-Osteoporosis Study.(Elsevier BV, 2024-03)Impact microindentation (IMI) is a minimally invasive technique that allows the assessment of bone material strength index (BMSi) in vivo, by measuring the depth of a micron-sized, spherical tip into cortical bone that is then indexed to the depth of the tip into a reference material. In this study, we aimed to assess the practicality of its application in 99 women aged 42-84 yr from the Geelong Osteoporosis Study. Impact microindentation was performed in the mid-shaft of the right tibia using the OsteoProbe. Immediately following measurement, each participant was requested to rate on a Visual Analogue Scale [0-10] the level of discomfort anticipated and experienced, any initial reluctance towards the measurement and whether they were willing to repeat the measurement. Of 99 potential participants who attended this assessment phase, 55 underwent IMI measurement. Reasons for non-measurement in 44 women were existing skin conditions (n = 8, 18.2 %) and excessive soft tissue around mid-tibial region (n = 32, 72.2 %). An additional four (9.1 %) participants did not provide any reasons for declining. For 55 participants who had underwent IMI, the expectation for pain when briefed about the procedure was low (2.28 ± 2.39), as was pain experienced during the measurement (0.72 ± 1.58). Participants were not reluctant to undergo the measurement (0.83 ± 1.67), and all indicated a willingness to repeat the measurement. Results of this study showed that the IMI technique is well tolerated and accepted by women participating in the Geelong Osteoporosis Study, suggesting that the technique shows promise in a research or clinical setting.
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ItemAdditional Insights on the Osteoporosis Care Gap(Wiley, 2023-04-01)
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ItemOutcome of reduction of paediatric forearm fracture by emergency department clinicians(Wiley, 2023-04)OBJECTIVES: Paediatric forearm fractures are common. Anecdotally, there is a trend towards ED reduction of selected fractures under procedural sedation. We aimed to determine the rate of subsequent operative intervention for fracture re-displacement. METHODS: Retrospective observational study of children with a forearm/wrist fracture undergoing fracture reduction in ED. Outcome of interest was operative intervention for fracture re-displacement within 6 weeks. RESULTS: Among 176 patients studied, operative intervention occurred in nine patients (5.1%, 95% confidence interval 2.7-9.4%). CONCLUSION: Reduction of paediatric forearm fractures under procedural sedation by ED clinicians is increasingly common and results in a low rate of subsequent operative intervention.
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ItemNo Preview AvailableThe Women’s Healthy Ageing Project: A pattern of cognitive decline after brain injury(Wiley, 2021-12)Abstract Background It is well recognised that damage sustained by traumatic brain injury (TBI) initiate injury mechanisms that continue to develop long after insult. Increasing evidence suggests TBI may lead to chronic cognitive decline and the development of dementia later in life. However, due to the low rate of TBI in the general community, there is a paucity of data on the impact of cognitive decline in community TBI. We examined longitudinal cognitive changes over a 12‐year period to determine if there was any relationship with community reported TBI. Method The Women’s Healthy Aging Project is an ongoing longitudinal cohort study of community‐dwelling Australian women. Assessments included an extensive range of measures, including neuropsychological testing of multiple cognitive domains and questions relating to head injury. In total, 110 women had complete neuropsychological testing at all three time points; from 2002, 2012 and 2014. Of these women, nine (aged 56‐65 in 2002) had a history of moderate to severe TBI. Composite cognitive scores were compared to 18 healthy controls randomly selected from the complete dataset individually matched for age, education, and APO4‐genotype. Analyses were conducted in five datasets drawn from the complete dataset and results were averaged. Result Median scores for executive function were similar for both the TBI group and healthy controls in 2002, lower in the TBI group by 2012 and this difference increased further in 2014. Median scores for verbal episodic memory were slightly lower in the TBI group than controls in 2002 and 2012, and this difference increased in 2014. Although this initial pilot study with small samples in mid‐aged healthy women did not show statistically significant results, the observed relationships were constant over the five datasets, warranting further exploration. Conclusion In our small pilot study, we observed greater rate of decline of both executive function and verbal episodic memory in women with a history of TBI. Findings warrant a need for larger studies to explore this relationship as it indicates that community‐based reported TBI may impact cognitive performance even in early ageing. Further work will continue to explore cognitive trajectories in women with a mean age 80 at next follow‐up.