Now showing 1 - 10 of 85
  • Publication
    Journal Article
    Associations of gestational diabetes and type 2 diabetes during pregnancy with breastfeeding at hospital discharge and up to 6 months: the PANDORA study.
    (2020-09-10)
    Longmore DK
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    Barr ELM
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    Wilson AN
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    Barzi F
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    Kirkwood M
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    Simmonds A
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    Lee I-L
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    Hawthorne E
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    Van Dokkum P
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    ;
    Boyle JA
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    Zimmet P
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    O'Dea K
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    Oats J
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    McIntyre HD
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    Brown ADH
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    Shaw JE
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    AIMS/HYPOTHESIS: Women with gestational diabetes mellitus (GDM) and obesity experience lower rates of breastfeeding. Little is known about breastfeeding among mothers with type 2 diabetes. Australian Indigenous women have a high prevalence of type 2 diabetes in pregnancy. We aimed to evaluate the association of hyperglycaemia, including type 2 diabetes, with breastfeeding outcomes. METHODS: Indigenous (n = 495) and non-Indigenous (n = 555) participants of the Pregnancy And Neonatal Diabetes Outcomes in Remote Australia (PANDORA) cohort included women without hyperglycaemia in pregnancy (n = 222), with GDM (n = 684) and with type 2 diabetes (n = 144). The associations of hyperglycaemia in pregnancy and breastfeeding at hospital discharge, 6 weeks and 6 months post-partum were evaluated with logistic regression, after adjustment for maternal obesity, ethnicity, maternal and neonatal characteristics. RESULTS: Indigenous women were more likely to predominantly breastfeed at 6 weeks across all levels of hyperglycaemia. Compared with women with no hyperglycaemia in pregnancy, women with type 2 diabetes had lower odds for exclusive breastfeeding at discharge (adjusted OR for exclusive breastfeeding 0.4 [95% CI 0.2, 0.8] p = 0.006). At 6 weeks and 6 months, the relationship between type 2 diabetes and predominant breastfeeding was not statistically significant (6 weeks 0.7 [0.3, 1.6] p = 0.40, 6 months 0.8 [0.4, 1.6] p = 0.60). Women with gestational diabetes were as likely to achieve predominant breastfeeding at 6 weeks and 6 months as women without hyperglycaemia in pregnancy. CONCLUSIONS/INTERPRETATION: Indigenous women had high rates of breastfeeding. Women with type 2 diabetes had difficulty establishing exclusive breastfeeding at hospital discharge. Further research is needed to assess the impact on long-term breastfeeding outcomes. Graphical abstract.
      897
  • Publication
    Journal Article
    Birth outcomes in women with gestational diabetes managed by lifestyle modification alone: The PANDORA Study.
    (2019-10-03)
    Cheng E
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    Longmore D
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    Barzi F
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    Barr ELM
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    Lee I
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    ;
    Boyle JA
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    Oats J
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    McIntyre HD
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    Kirkwood M
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    Dempsey K
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    Zhang X
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    ; ;
    Zimmet P
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    Brown ADH
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    Shaw JE
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    To assess outcomes of women in the Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) cohort with gestational diabetes mellitus (GDM) managed by lifestyle modification compared with women without hyperglycaemia in pregnancy. Indigenous (n=97) and Europid (n=113) women managed by lifestyle modification were compared to women without hyperglycaemia (n=235). Multivariate linear and logistic regressions assessed whether GDM-lifestyle women had poorer outcomes compared to women without hyperglycaemia. Women with GDM-lifestyle had higher body mass index and lower gestational weight gain than women without hyperglycaemia. On univariate analysis, gestational age at delivery was lower and induction rates were higher in women with GDM-lifestyle than without hyperglycaemia. On multivariable regression, GDM-lifestyle was associated with lower gestational age at delivery (by 0.73 weeks), lower birthweight z-score (by 0.26, p=0.007), lower likelihood of large for gestational age (LGA) [OR (95% CI): 0.55 (0.28, 1.02), p=0.059], and greater likelihood of labour induction [2.34 (1.49, 3.66), p < 0.001] than women without hyperglycaemia CONCLUSION: Women with GDM managed by lifestyle modification had higher induction rates and their offspring had lower birthweight z-scores, with a trend to lower LGA than those without hyperglycaemia in pregnancy. Further studies are indicated to explore reasons for higher induction rates.
      4096
  • Publication
    Journal Article
    Improving postpartum screening after diabetes in pregnancy: Results of a pilot study in remote Australia.
    (2018-10-02)
    Kirkham R
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    MacKay D
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    Barzi F
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    Kirkwood M
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    Graham S
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    Van Dokkum P
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    McIntyre HD
    ;
    Shaw JE
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    Brown A
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    O'Dea K
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    Oats J
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    Zimmet P
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    Boyle JA
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    The postpartum period is a critical time to improve health outcomes for Aboriginal women, particularly for those who have chronic conditions. To assess enhanced support methods (for women following diabetes in pregnancy (DIP)) to improve completion rates of recommended postpartum health checks. Fifty-three Aboriginal women in the Northern Territory (NT) were contacted in the postpartum period to encourage medical check-ups. Messages were delivered through phone (call or text messages) or other methods (Facebook or email). The primary outcome was postpartum blood glucose testing (oral glucose tolerance testing (OGTT), random or fasting glucose and HbA1c). Establishing contact with women was difficult. Of 137 messages sent to 52 women, 22 responded (42%). Phone was the most common contact method with successful contact made from 16 of 119 (13%) attempts. Rates of postpartum OGTT completion were higher in the group successfully contacted (32% vs 7%). However, for any postpartum glucose testing (including OGTT and HbA1c) rates were 25 of 42 (60%) and neither success in making contact nor the contact method was associated with higher rates. The small sample size limits our conclusions; however, results highlight that engaging remote women postpartum is difficult. While rates of postpartum OGTT completion differed according to successful contacts, rates of any postpartum blood glucose testing did not. Further research is needed to explore feasible intervention methods to improve postpartum screening after a pregnancy complicated by diabetes.
      1401
  • Publication
    Journal Article
    The ASQ-TRAK: Validating a culturally adapted developmental screening tool for Australian Aboriginal children.
    (2021-12-01)
    Simpson S
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    Eadie T
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    Khoo ST
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    ; ;
    Thompson R
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    Wunungmurra A
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    Jeyaseelan D
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    Dunham M
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    D'Aprano A
    BACKGROUND: Developmental monitoring, performed using culturally relevant tools, is of critical importance for all young children. The ASQ-TRAK is the culturally and linguistically adapted Ages and Stages Questionnaire (ASQ-3), a developmental screening tool, for Australian Aboriginal children. While the ASQ-TRAK has been well received in practice, investigating its psychometric properties will enable professionals to make informed decisions about its use. AIMS: To conduct a rigorous validation study of the ASQ-TRAK by applying Kane's argument-based approach. SUBJECTS: The ASQ-TRAK, Bayley-III and/or BDI-2 were administered cross-sectionally to 336 Australian Aboriginal children aged 2-48 months across ten participating sites in the Northern Territory and South Australia. A sample of staff and caregivers completed feedback surveys about the ASQ-TRAK. RESULTS: ASQ-TRAK domain scores were moderately positively correlated with corresponding domain scores on the Bayley-III or BDI-2. Inter-rater and inter-instrument reliability were high. Sensitivity (83%), specificity (83%) and negative predictive value (99%) were acceptable. Staff and caregivers expressed high levels of satisfaction with the ASQ-TRAK. CONCLUSIONS: Regular developmental screening can provide important information about developmental vulnerability and the need for services. The ASQ-TRAK should be administered by trained Aboriginal community-based workers and the implementation approach carefully planned. Areas for future research include longitudinal follow-up of children, investigating existing norms and cut-off scores, and considering the appropriateness of the ASQ-TRAK with Aboriginal people from different locations. The ASQ-TRAK has the potential to fill an important gap by enabling better access to high-quality developmental monitoring and targeted early intervention.
      2649
  • Publication
    Journal Article
    New and emerging therapies for diabetic kidney disease.
    (2024-01-02)
    Correa-Rotter, Ricardo
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    Sahay, Rakesh
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    Tuttle, Katherine R
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    Ulasi, Ifeoma I
      682
  • Publication
    Journal Article
    Musculoskeletal health of Indigenous Australians.
    (2018-07-14)
    Zengin A
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    Brennan-Olsen S
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    Center JR
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    Eades S
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    Ebeling PR
    Research on non-communicable diseases (NCD) in Indigenous Australians has mostly focused on diabetes mellitus and chronic kidney or cardiovascular disease. Osteoporosis, characterised by low bone mass and structural deterioration of bone tissue, and sarcopenia, the age-related loss of muscle mass and strength, often co-exist with these common NCDs-the combination of which will disproportionately increase bone fragility and fracture risk and negatively influence cortical and trabecular bone. Furthermore, the social gradient of NCDs, including osteoporosis and fracture, is well-documented, meaning that specific population groups are likely to be at greater risk of poorer health outcomes: Indigenous Australians are one such group. This review summarises the findings reported in the literature regarding the muscle and bone health of Indigenous Australians. There are limited data regarding the musculoskeletal health of Indigenous Australians; however, areal bone mineral density (aBMD) measured by dual-energy X-ray absorptiometry (DXA) is reported to be greater at the hip compared to non-Indigenous Australians. Falls are the leading cause of injury-related hospitalisations in older Australians, particularly Indigenous Australians, with a great proportion suffering from fall-related fractures. Despite sparse data, it appears that Indigenous men and women have a substantially higher risk of hip fracture at a much younger age compared to non-Indigenous Australians. Data on more detailed musculoskeletal health outcomes are required in Indigenous Australians to better understand fracture risk and to formulate evidence-based strategies for fracture prevention and to minimise the risk of falls.
      1138
  • Publication
    Journal Article
    Exploring differences in perceptions of child feeding practices between parents and health care professionals: a qualitative study.
    (2021-07-23)
    Rohit A
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    Kirkham R
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    McCarthy L
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    Puruntatameri V
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    Brimblecombe J
    BACKGROUND: Evidence on child feeding practice is often based on the perspectives and experiences of parents and less that of health practitioners. In this study, we explored child feeding practice in Aboriginal communities in northern Australia from both the parents and health practitioners' perspectives with the aim of informing nutrition improvement programs. METHODS: Qualitative research methods were employed. Using semi-structured interviews, parents (n = 30) of children aged 2-5 years, and 29 service providers who were involved in the delivery of child health and nutrition programs in the same communities, were asked about child feeding attitudes and practices. Responses were analyzed through inductive and deductive analysis, recognizing that worldviews influence child feeding practices. RESULTS: Sharing food was a central practice within families. Parents highly valued development of child independence in food behavior but were conflicted with the easy access to unhealthy food in their communities. This easy access to unhealthy food and inadequate food storage and kitchen facilities for some families were major challenges to achieving optimal diets for children identified by Aboriginal families and service providers. The responsive style of parenting described by parents was often misunderstood by service providers as sub-optimal parenting when viewed through a dominant western lens. CONCLUSIONS: Approaches to support healthy feeding practices and optimal child nutrition require health-enabling food environments. Along with a community-based Aboriginal health workforce, it is paramount that the non-Aboriginal workforce be supported to be reflective of the impact of worldview on their practice, to ensure a culturally safe environment for families where parenting styles are understood and appropriately supported.
      1512
  • Publication
    Journal Article
    Glucagon-like peptide-1 receptor agonist (GLP1-RA) therapy in type 2 diabetes.
    (2022-07-01)
    Ng E
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    Shaw JE
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    Wood A
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    BACKGROUND: Type 2 diabetes (T2D) is a national health priority. Its rising prevalence is accompanied by a high burden of diabetes-related complications, many of which are preventable. Numerous glucose-lowering medications have been developed in recent years with growing evidence relating to their efficacy and safety. These advances have increased the complexity of prescribing decisions in T2D. OBJECTIVE: This review provides clinicians with relevant evidence and practical advice concerning glucagon-like peptide-1 receptor agonists (GLP1-RAs) in T2D. DISCUSSION: The Royal Australian College of General Practitioners recommends GLP1-RAs as an option for second-line therapy in T2D. GLP1-RAs contribute to weight loss and glycated haemoglobin reduction. GLP1-RAs also reduce incidence of cardiovascular events in selected populations, and available evidence suggests renoprotective effects. Common adverse effects include gastrointestinal symptoms, especially in the weeks following treatment initiation. GLP1-RAs should be considered for people with T2D at high cardiovascular risk or where weight loss is a priority.
      3561