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Grafton, New Zealand

Rush E.C.,Auckland University of Technology | Bristow S.,Auckland University of Technology | Plank L.D.,University of Auckland | Rowan J.,National Womens Health
European Journal of Clinical Nutrition | Year: 2013

Background/Objectives:Bioimpedance analysis (BIA) is a simple, convenient and widely used tool for the measurement of body composition in population surveys and surveillance. Prediction equations based on BIA applicable to preschool children are available but are based on total body water estimation and have not been developed across multiple ethnic groups. Our aim was to develop a BIA-based equation in a multi-ethnic sample of 2-year old using fat-free mass (FFM) from dual-energy X-ray absorptiometry (DXA) as criterion measure.SUBJECTS/METHODS:Single-frequency hand-to-foot BIA (model BIM4, Impedimed) and whole-body DXA measurements were carried out in 77 (35 boys, 42 girls; 27 European, 20 Polynesian, 30 Asian and other) healthy preschool children (age range 22-38 months). Body mass index s.d. scores were 0.41±1.23 for boys and 0.61±1.09 for girls. The performance of published equations applicable to this age group was assessed. The predicted residual sum of squares method was used to develop and cross-validate a multiple regression equation relating FFM to BIA measures.RESULTS:Published equations performed poorly for estimating FFM in this group of children. The prediction equation developed in all 77 children was: FFM (kg)=0.367 height(cm) 2 /resistance+0.188 weight (kg)+0.077 height (cm)+0.273 sex (male=1, female=0)-2.490, R 2 =0.89, standard error of estimate=0.50 kg. Ethnicity and age did not add significantly to the model.CONCLUSIONS:We have developed an equation that may have application for prediction of FFM in 2-3-year-old children, which does not require determination of hydration factors. Further work should be carried out using DXA scanning to extend the applicable age range. © 2013 Macmillan Publishers Limited All rights reserved.

Crofts J.F.,University of Bristol | Winter C.,North Bristol NHS Trust | Sowter M.C.,National Womens Health
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2011

Improving maternal and perinatal care is a global priority. Practical simulation training for maternity care might prevent many of these deaths. There have been numerous evaluation studies published on the effectiveness of simulation training for obstetric emergencies, with increasing evidence that it is associated with improvement in clinical outcomes. Evidence has begun to move from subjective assessment of participants' experiences towards objective assessment of clinical outcomes. However, the results are not entirely consistent and, at present, all of the evidence associating training with improvements in clinical outcomes relates to neonatal outcomes. This review summarises recent progress in the evaluation of the effectiveness of simulation training for maternity care in both high- and low-resource settings, and presents a vision for ensuring that practical simulation training for maternity care can become an effective tool to reduce global maternal and perinatal morbidity and mortality. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

Kadir R.A.,Haemophilia Center and Thrombosis Unit | McLintock C.,National Womens Health
Seminars in Thrombosis and Hemostasis | Year: 2011

Pregnancy is associated with physiological and pathological changes in platelet numbers and function, which can be of clinical concern because of risks for maternal and fetal or neonatal bleeding. Thrombocytopenia in pregnancy is frequently encountered and may be due to increased platelet turnover and plasma dilution, immune-mediated mechanisms, or a complication of a more severe underlying pregnancy-related disorder such as preeclampsia. Inherited defects in platelet function and number may also manifest during pregnancy with the risk of bleeding dependent on the underlying problem. In some women, the diagnosis of thrombocytopenia will precede pregnancy but in others, the problem is first identified when routine pregnancy blood tests are performed. An accurate diagnosis and risk assessment in the antenatal period are essential for developing specific plans for any antenatal interventions and for management of delivery and the postpartum periods, and the neonate. Management of pregnant women with platelet disorders requires a multidisciplinary approach and close collaboration between the obstetric and hematology teams. © 2011 by Thieme Medical Publishers, Inc.

McLintock C.,National Womens Health
Thrombosis Research | Year: 2011

The choice of anticoagulant agent for pregnant women with mechanical prosthetic heart valves introduces a clinical dilemma for women and the clinicians caring for them. Options include continuing oral anticoagulants (OAC) such as warfarin throughout pregnancy, switching from warfarin to unfractionated heparin or low molecular weight heparin (LMWH) in the first trimester then back to warfarin until close to delivery or taking unfractionated heparin or LMWH throughout pregnancy. The dilemma is that warfarin is the most effective a preventing maternal thromboembolic complications but causes significant fetal morbidity and mortality; unfractionated heparin and in particular LMWH have good fetal outcomes but the risk of thromboembolic complications is high. What is considered to be an "acceptable level" of risk to mother and infant may differ from one clinician to another and of equal importance, it may also differ from one woman to the next. An unbiased discussion of the pros and cons of each option is required to allow women to make and informed and confident choice in this very difficult clinical situation. © 2010 Elsevier B.V. All rights reserved.

Long-term anticoagulation is required in all patients with mechanical prosthetic heart valves to prevent complications with valve thrombosis and valve failure or systemic thromboembolism. The prothrombotic environment of pregnancy further increases the risks of these complications. Anticoagulant choices for pregnant women include oral vitamin K antagonists such as warfarin, or heparin-either unfractionated heparin (UFH) or low molecular weight heparin (LMWH). None of the options is without risk for the mother or her baby. Warfarin crosses the placenta and is associated with warfarin embryopathy and fetopathy but is very effective at preventing thromboembolic complications. The dose of warfarin may play a role in the risk of some, but not all fetal complications. Heparin does not cross the placenta but is less effective at preventing thrombosis and LMWH may be more effective than UFH. The optimal dose and target anti-Xa levels for LMWH have not been established. Measurement of trough anti-Xa levels in addition to peak anti-Xa levels may be important. © 2013 Elsevier Ltd. All rights reserved.

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