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Predictors of and reasons for pacifier use in first-time mothers: an observational study

2013-05-13T02:10:33Z

Title: Predictors of and reasons for pacifier use in first-time mothers: an observational study Authors: Mauch, Chelsea E; Scott, Jane Anne; Magarey, Anthea Margaret; Daniels, Lynne Allison Abstract: This study confirms the findings of earlier studies that the use of a pacifier is widespread in Australia and that the early introduction, and frequent use, of a pacifier is associated with shorter breastfeeding duration. Furthermore, it identifies an opportunity for educating new mothers and their support network, particularly grandmothers, with regards to potential risks associated with the early and frequent use of a pacifier, and alternative methods for soothing their infant, in order to reduce the use of pacifiers and the potentially negative effect associated with their use on breastfeeding duration.

A 3-year follow-up study of inpatients with lower limb ulcers: evidence of an obesity paradox?

2013-05-13T02:10:31Z

Title: A 3-year follow-up study of inpatients with lower limb ulcers: evidence of an obesity paradox? Authors: Miller, Michelle Deanne; Delaney, Christopher; Penna, Deanna; Liang, Lilian; Thomas, Jolene Marie; Puckridge, Phillip; Spark, J Ian Abstract: Objectives: To determine whether body composition is related to long-term outcomes amongst vascular inpatients with lower limb ulcers. Design: Prospective study with 3 years follow-up. Materials and methods: Body mass index (BMI), fat, and fat-free mass were measured and associations with readmission to hospital (number, cause, length of stay) and all-cause mortality were explored. Results: Thirty patients (22 men, 8 women) participated in the study. Ten patients (33%) had a BMI ≥ 30 kg/m2. 18/20 (90%) patients with a BMI < 30 kg/m2 and 9/10 (90%) patients with a BMI ≥ 30 kg/m2 were admitted to hospital in the 3 years of follow-up. Patients with a BMI < 30 kg/m2 were admitted more frequently, earlier and for longer compared to those with BMI ≥ 30 kg/m2 but these did not reach statistical significance. The 3 year mortality rate for patients with BMI ≥ 30 kg/m2 was 20% (n = 2/10) compared to 70% (n = 14/20) with a BMI <30 kg/m2, P = 0.019. Conclusion: This preliminary study suggests that higher BMI may have a protective effect against mortality in vascular patients with lower limb ulcers. These findings contradict the universal acceptance that obesity leads to poor health outcomes. Further work is required to confirm these findings and explore some of the potential mechanisms for this effect.

Assessment of wound healing: validity, reliability and sensitivity of available instruments

2013-05-13T02:10:06Z

Title: Assessment of wound healing: validity, reliability and sensitivity of available instruments Authors: Pillen, H; Miller, Michelle Deanne; Thomas, Jolene Marie; Puckridge, Phillip; Sandison, Sheralee; Spark, J Ian Abstract: Objectives: If wound assessment instruments are to be used in the periodic assessment of wound healing, they must prove to be valid, reliable and sensitive measures of wound healing. Thus, this systematic literature review aims to examine available wound healing instruments in terms of these parameters. Method: Only instruments able to measure changes in wound healing were included in this review and not those used to predict healing, classify wounds, or measure wound characteristics per se. All wound types were suitable for inclusion. Results: A total of 20 articles were found, evaluating the validity of 10 instruments used to monitor wound healing. No instrument satisfied all criteria required for instrument validation. Instruments used to assess pressure ulcers, notably the Pressure Ulcer Scale for Healing (PUSH) and Pressure Sore Status Tool (PSST), had been validated to the greatest extent, whilst those describing healing in leg ulcers and general or surgical wounds tended to lack comprehensive and quality evaluation. Conclusion: This review identified substantial gaps in the literature with regard to validation of existing wound healing instruments. Future studies are needed to comprehensively validate these instruments.

BMI: a simple, rapid and clinically meaningful index of under-nutrition in the oldest old?

2013-05-13T02:09:47Z

Title: BMI: a simple, rapid and clinically meaningful index of under-nutrition in the oldest old? Authors: Miller, Michelle Deanne; Thomas, Jolene Marie; Cameron, Ian D; Chen, Jian Sheng; Sambrook, Philip; March, Lyn M; Cumming, Robert G; Lord, Stephen R Abstract: BMI is commonly used as a sole indicator for the assessment of nutritional status. While it is a good predictor of morbidity and mortality among young and middle-aged adults, its predictive ability among the oldest old remains unclear. The objective of the present study was to investigate the relationship between BMI and risk of falls, fractures and all-cause mortality among older Australians in residential aged care facilities. One thousand eight hundred and forty-six residents of fifty-two nursing homes and thirty hostels in northern Sydney, Australia, participated in the present study. Baseline weight and height were measured and BMI (kg/m2) calculated. For 2 years following the baseline measurements, incidence and date of all falls and fractures were recorded by research nurses who visited the facilities regularly and date of death was documented based on the participants’ records at each facility. Cox proportional hazards regression models were calculated to determine the relationship between baseline BMI and time to fall, fracture or death, within 2 years following the baseline measures taken to be the censoring date. After adjustments were made for age, sex and level of care, low BMI (,22 kg/m2) increased the risk of fracture by 38% (hazard ratio ¼ 1·38, 95% CI 1·11, 1·73) and all-cause mortality by 52% (hazard ratio ¼ 1·52, 95% CI 1·30, 1·79). The magnitude of this effect was only slightly reduced when adjustments were further made to incorporate cognition, number of medications, falls and fracture in the subsequent 2-year period. In conclusion, BMI has predictive ability in the area of fracture and all-cause mortality for residents of aged care facilities. It is a simple and rapid indicator of nutritional status rendering it a useful nutrition screen and goal for nutrition intervention.