Obstetrics and Gynaecology - Research Publications
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ItemCompliance with screening for and recommended management of maternal group B streptococcus carriage in pregnancy(WILEY, 2019-12)BACKGROUND: Universal screening of pregnant women at 35-37 weeks gestation is recommended for detection of anogenital group B streptococcus carriage. Intrapartum chemoprophylaxis is prescribed to carriers to prevent transmission to babies, reducing early-onset neonatal group B streptococcal sepsis. AIMS: To review compliance with, and the effects of education on group B streptococcus screening and intrapartum chemoprophylaxis practices at The Royal Women's Hospital, Melbourne, Australia. MATERIALS AND METHODS: A retrospective audit of women delivering in February 2016 and February-March 2017 was conducted. In February 2017, updated early-onset group B streptococcal disease prevention guidelines were released and promoted with targeted education of clinical staff. Compliance was considered appropriate if practices followed up-to-date local protocols. RESULTS: Screening rate for group B streptococcus was 84.4% (599/710) and carriage rate 19.5% (109/558), while intrapartum antibiotic prophylaxis was optimal in 83% of those labouring greater than four hours (39/47). There was no significant difference in compliance between 2016 and 2017. Of 113 women with unknown group B streptococcal status at delivery, only five of 33 (15%) with clinical risk factors for early-onset neonatal disease received intrapartum prophylaxis. CONCLUSIONS: Compliance remained stable, with no change during or after implementation of new protocols. Compliance with protocols was low for cases with unknown group B streptococcal status at delivery but with the presence of one or more clinical risk factors for early-onset group B streptococcal sepsis.
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ItemDeterminants of bone mineral density in young Australian women; results from the Safe-D study (vol 28, pg 2619, 2017)(SPRINGER LONDON LTD, 2017-11)
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ItemUsing Mobile Technology to Improve Bone-Related Lifestyle Risk Factors in Young Women With Low Bone Mineral Density: Feasibility Randomized Controlled Trial.(JMIR Publications Inc., 2019-02-25)BACKGROUND: Poor bone health in adolescent and young adult females is a growing concern. Given the widespread use of mobile phones in this population, mobile health (mHealth) interventions may help improve health behaviors related to bone health in young women. OBJECTIVE: The goal of the study was to determine the acceptability and feasibility of an mHealth intervention called Tap4Bone in improving health behaviors associated with the risk of osteoporosis in young women. METHODS: The Tap4Bone mHealth intervention comprised the use of mobile phone apps, short messaging service (text messaging), and Web emails to encourage health behavior changes. The education group received osteoporosis prevention education leaflets. Changes in the bone health-related behaviors exercise, smoking, and calcium intake were assessed. User experiences and acceptance of the app were collected through focus group interviews. RESULTS: A total of 35 (22 completed, mean age 23.1 [SD 1.8] years) were randomized to either the mobile phone (intervention n=18) or education (control n=17) group. Although there were trends toward improvement in calcium intake, sports activity, and smoking behaviors in the mHealth intervention group compared to the education group, these were not statistically significant. CONCLUSIONS: The Tap4Bone mHealth intervention was shown to be acceptable and feasible in subsets of the participants. The intervention should be improved upon using participant feedback to improve functionality. Findings from this study may aid in the development and modification of health care apps to reduce participant attrition.
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ItemExploring the facilitators and barriers to using an online infertility risk prediction tool (FoRECAsT) for young women with breast cancer: a qualitative study protocol.(BMJ Journals, 2020-02-10)INTRODUCTION: As cancer treatments may impact on fertility, a high priority for young patients with breast cancer is access to evidence-based, personalised information for them and their healthcare providers to guide treatment and fertility-related decisions prior to cancer treatment. Current tools to predict fertility outcomes after breast cancer treatments are imprecise and do not offer individualised prediction. To address the gap, we are developing a novel personalised infertility risk prediction tool (FoRECAsT) for premenopausal patients with breast cancer that considers current reproductive status, planned chemotherapy and adjuvant endocrine therapy to determine likely post-treatment infertility. The aim of this study is to explore the feasibility of implementing this FoRECAsT tool into clinical practice by exploring the barriers and facilitators of its use among patients and healthcare providers. METHODS AND ANALYSIS: A cross-sectional exploratory study is being conducted using semistructured in-depth telephone interviews with 15-20 participants each from the following groups: (1) premenopausal patients with breast cancer younger than 40, diagnosed within last 5 years, (2) breast surgeons, (3) breast medical oncologists, (4) breast care nurses (5) fertility specialists and (6) fertility preservation nurses. Patients with breast cancer are being recruited from the joint Breast Service of three affiliated institutions of Victorian Comprehensive Cancer Centre in Melbourne, Australia-Peter MacCallum Cancer Centre, Royal Melbourne Hospital and Royal Women's Hospital, and clinicians are being recruited from across Australia. Interviews are being audio recorded, transcribed verbatim and imported into qualitative data analysis software to facilitate data management and analyses. ETHICS AND DISSEMINATION: The study protocol has been approved by Melbourne Health Human Research Ethics Committee, Australia (HREC number: 2017.163). Confidentiality and privacy are maintained at every stage of the study. Findings will be disseminated through peer-reviewed scholarly and scientific journals, national and international conference presentations, social media, broadcast media, print media, internet and various community/stakeholder engagement activities.
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ItemBasal Temperature Measurement Using a Multi-Sensor Armband in Australian Young Women: A Comparative Observational Study(JMIR PUBLICATIONS, INC, 2015-10-05)BACKGROUND: The menstrual cycle is a key marker of health in women of reproductive age. Monitoring ovulation is useful in health studies involving young women. The upward shift in basal body temperature, which occurs shortly after ovulation and continues until the next menses, is a potentially useful marker of ovulation, which has been exploited in clinical and research settings. OBJECTIVE: We investigated the utility of BodyMedia SenseWear (BMSW) in monitoring ovulation in young women by analyzing the correlation and agreement of basal temperatures measured using BMSW and a digital oral thermometer. METHODS: Kappa statistics were used to determine the agreement in ovulation detection between the two devices, for each participant, under each form of analysis. Participants also completed an online questionnaire assessing the acceptability of both devices. RESULTS: We recruited 16 participants with 15 of them providing analyzable data (11 OCP non-users, 4 OCP users). Weak to moderate correlations were observed between thermometer and BMSW temperature measurements averaged over 5 different time intervals. However, no agreement between methods was observed using Bland-Altman plots. There was a significant difference in the range of temperatures that each device recorded (thermometer: 35.3-37.2°C, BMSW: 29.7-36.7°C) with BMSW temperatures significantly lower than thermometer temperatures: mean 34.6°C (SD 1.2) versus 36.4°C (SD 0.3) respectively, P<.001. Poor agreement was observed between devices under quantitative analysis of ovulation while fair agreement was observed under visual analysis. Under both quantitative and visual analysis, there was 0% agreement for evidence of ovulation. CONCLUSIONS: This study demonstrated the importance of evaluating biomeasures collected using mobile monitoring devices by comparison with standard methods. It revealed a relatively poor correlation between BMSW and oral thermometer temperature readings and suggested that BMSW is unlikely to detect an upward shift in basal body temperature. Participant behavior suggested poor compliance in the use of BMSW for basal temperature measurement and that the basal body temperature method may not be suitable for use in unselected samples of young women. There is a need for research tools for monitoring ovulation that are simple, self-administered, and inexpensive, yet appealing to young women.
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ItemNo Preview AvailablePolycystic ovarian syndrome: Prevalence and impacton the wellbeing of Australian women aged 16-29years(WILEY, 2018-04)BACKGROUND: Polycystic ovarian syndrome (PCOS) is the most common condition among reproductive-aged women. However, its exact prevalence is unknown. AIMS: To determine the prevalence of PCOS in Australian women aged 16-29 years using the National Institutes of Health (NIH) criteria compared to self-reported PCOS, to compare co-morbidities between the groups and to determine the most distressing aspect of a diagnosis of PCOS for these young women. MATERIALS AND METHODS: Participants were recruited from the Young Female Health Initiative (YFHI) and Safe-D studies. Participants completed questionnaires, physical examinations and blood tests from 2012 to 2016. In March 2016, two supplementary questionnaires were distributed: the first, comprising questions on reproductive health and impact of diagnosis, was sent to participants who self-reported having PCOS in the original studies. The second, comprising general reproductive health questions, was sent to the remainder. RESULTS: The prevalence of PCOS, according to the NIH criteria, was 12% (31/254), while the prevalence of self-reported PCOS was 8% (23/300). Only 35% (8/23) of those with self-reported PCOS actually fulfilled the NIH criteria for PCOS. Comorbidities were relatively similar among groups. Finally, approximately 65% (15/23) were unhappy or worried about their initial PCOS diagnosis, with 72% (13/18) stating fertility concerns were the most distressing aspect of their diagnosis. CONCLUSIONS: The lack of consistent and accurate diagnosis of PCOS in young women potentially leads to over-diagnosis. This creates unnecessary fears of health complications, particularly infertility. Therefore, we recommend the development of standardised criteria with set parameters that allow for better diagnosis of PCOS.
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ItemDeterminants of bone mineral density in young Australian women; results from the Safe-D study(SPRINGER LONDON LTD, 2017-09)UNLABELLED: The study aimed to explore determinants of bone parameters in young women. Most bone parameters were associated with height and lean mass. Bone parameters were not associated with vitamin D status. Future research should address whether interventions aimed at improving lean mass are beneficial to bone health in young women. INTRODUCTION: The implementation of prevention strategies during young adulthood may be crucial for osteoporosis prevention in later life, yet literature examining the determinants of bone health in premenopausal women is limited. We aimed to assess determinants of bone health, including serum 25-hydroxyvitamin D (25OHD), in females aged 16-25 years, living in Victoria, Australia, recruited through Facebook advertising. METHODS: Serum 25OHD was measured by liquid chromatography-tandem mass spectrometry and bone health was measured using dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT) in 326 participants. RESULTS: Mean (± standard deviation) serum 25OHD was 69 ± 28 nmol/L and the prevalence of vitamin D deficiency (serum 25OHD <50 nmol/L) was 26%. Seven percent of participants (n = 23) reported taking a vitamin D supplement. Two percent of participants had low lumbar spine bone mineral density (Z-score <-2.0), 5% at the hip and 7% at the femoral neck. Serum 25OHD levels were not associated with DXA bone parameters, nor with pQCT bone parameters. Most bone parameters were positively associated with height and lean mass. CONCLUSION: Vitamin D status was not associated with bone health in young women in the current study. Our findings suggest that targeting other modifiable factors, such as lean body mass, is likely to be beneficial to bone health in young women. Longitudinal studies examining the association between vitamin D status and bone health in young women are necessary to confirm our findings. In addition, whether raising 25OHD levels is advantageous for young women's bone health is yet to be determined.
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ItemNo Preview AvailablePrevalence and severity of dysmenorrhoea, and management options reported by young Australian women(ROYAL AUSTRALIAN COLLEGE GENERAL PRACTITIONERS, 2016-11)BACKGROUND: Little is known about the severity of dysmenorrhoea and attitudes towards its management in young females. OBJECTIVE: The aim of this study was to evaluate the prevalence and severity of dysmenorrhoea in women aged 16-25 years. METHODS: Participants were recruited via targeted Facebook advertising and asked to complete an online questionnaire covering medications, menstruation and lifestyle-related themes. A follow-up questionnaire on dysmenorrhoea was also administered. RESULTS: The prevalence of dysmenorrhoea was 88% (n = 247, mean age 21.5 years, SD 2.6). Only 34% of participants reported consulting a healthcare provider about their pain, whereas 86% consulted other sources. Pain medication was used by 58% of the participants. Dysmenorrhoea was associated with interference with daily activities (P DISCUSSION: Dysmenorrhoea is highly prevalent among these women, with most indicating moderate to severe pain and a significant adverse impact on daily activities. Most women did not obtain information about dysmenorrhoea from healthcare providers, indicating the need for general practitioners to provide accurate information about dysmenorrhoea to young females.
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ItemImproving Vitamin D Status and Related Health in Young Women: The Safe-D study - Part B(JMIR PUBLICATIONS, INC, 2016-05-10)BACKGROUND: Vitamin D deficiency is highly prevalent and associated with increased risk of a number of chronic health conditions including cardiovascular disease, poor bone and muscle health, poor mental health, infection, and diabetes. Vitamin D deficiency affects millions of Australians, potentially causing considerable suffering, economic loss, and mortality. OBJECTIVE: To measure the effectiveness of a (1) mobile-based app (behavioral) and (2) pharmacological intervention to increase circulating 25-hydroxyvitamin D (serum 25 OHD) levels and health outcomes over 4 months of intervention compared with usual care in a cohort of young women with suboptimal serum 25 OHD levels (25-75 nmol/L). METHODS: Participants with 25 OHD levels 25 to 75 nmol/L are invited to participate in this study. Participants are randomized to one of three groups in 1:1:1 ratio: a mobile phone-based application, vitamin D supplementation (1000 IU/day), and a control group. Data collection points are at baseline, 4, and 12 months post baseline with the major endpoints being at 4 months. A wide-range of information is collected from participants throughout the course of this study. General health, behavioral and demographic information, medications, smoking, alcohol and other substance use, health risk factors, nutrition, eating patterns and disorders, and mental health data are sourced from self-administered, Web-based surveys. Clinical data include anthropometric measurements, a silicone skin cast of the hand, cutaneous melanin density, bone mineral density, and body composition scans obtained through site visits. Main analyses will be conducted in two ways on an intention-to-treat (ITT) basis using the last observation carried forward approach as an imputation for missing data, and on a per protocol basis to compare the intervention arms against the control group at 4 and 12 months. RESULTS: Publication of trial results is anticipated in 2017. CONCLUSIONS: The study will allow assessment of the effects of a mobile-based app behavioral intervention and vitamin D supplementation on vitamin D status and will evaluate the effects of improving vitamin D levels on several health outcomes.