Medicine (Western Health) - Research Publications
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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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ItemUndercarboxylated osteocalcin and ibandronate combination ameliorates hindlimb immobilization-induced muscle wasting(WILEY, 2023-05)Immobilization leads to muscle wasting and insulin resistance, particularly during ageing. It has been suggested that undercarboxylated osteocalcin (ucOC) improves muscle mass and glucose metabolism. Bisphosphonates, an anti-osteoporosis treatment, might protect muscle wasting independent of ucOC. We hypothesize that the combination of ucOC and ibandronate (IBN) treatments has superior protective effects against immobilization-induced muscle wasting and insulin resistance than either treatment alone. C57BL/6J mice were hindlimb-immobilized for two weeks, with injections of vehicle, ucOC (90 ng/g daily) and/or IBN (2 μg/g weekly). Insulin/oral glucose tolerance tests (ITT/OGTT) were performed. Immediately after immobilization, muscles (extensor digitorum longus (EDL), soleus, tibialis anterior, gastrocnemius and quadriceps) were isolated and measured for muscle mass. Insulin-stimulated glucose uptake (EDL and soleus) was examined. Phosphorylation/expression of proteins in anabolic/catabolic pathways were examined in quadriceps. Primary human myotubes derived from older adult muscle biopsies were treated with ucOC and/or IBN, then signalling proteins were analysed. Combined treatment, but not individual treatments, significantly increased the muscle weight/body weight ratio in immobilized soleus (31.7%; P = 0.013) and quadriceps (20.0%; P = 0.0008) muscles, concomitant with elevated p-Akt (S473)/Akt ratio (P = 0.0047). Combined treatment also enhanced whole-body glucose tolerance (16.6%; P = 0.0011). In human myotubes, combined treatment stimulated greater activation of ERK1/2 (P = 0.0067 and 0.0072) and mTOR (P = 0.036), and led to a lesser expression of Fbx32 (P = 0.049) and MuRF1 (P = 0.048) than individual treatments. These findings suggest a potential therapeutic role for the ucOC and bisphosphonates combination in protecting against muscle wasting induced by immobilization and ageing. KEY POINTS: It has been suggested that undercarboxylated osteocalcin (ucOC) improves muscle mass and glucose metabolism. Bisphosphonates, an anti-osteoporosis treatment, might protect against muscle wasting independent of ucOC. The combination treatment of ucOC and ibandronate was shown to exert a greater therapeutic effect against immobilization-induced muscle wasting, and led to greater activation of anabolic pathway and less expression of catabolic signalling proteins in myotubes derived from older adults, compared with individual treatments. The combination treatment was found to improve whole-body glucose tolerance. Our findings suggest a potential therapeutic role for the ucOC and bisphosphonates combination in protecting against muscle wasting induced by immobilization and ageing.