Variation in mortality following hip fracture across the Asia Pacific region: Systematic review and proportional meta-analysis.

OBJECTIVE: To determine country/region-specific mortality (in-hospital, 30-day and 1-year) following hip fracture across the Asia Pacific region. METHODS: Five databases MEDLINE, PUBMED, EMBASE, Web of Science and the Cochrane Library were searched to identify studies that reported mortality following hospitalisation for low-trauma hip fracture in adults aged ≥50 years with data from 2010 to 30 September 2021. There were no restrictions on study design or language. Pooled mortality estimates for countries/regions with ≥2 studies were calculated using random-effects models. RESULTS: In total 244 studies were included in the meta-analysis. 123 studies (1,382,810 patients, 13 countries/regions) reported in-hospital mortality which ranged from 1.4 % in Japan [95 %CI 1.2-1.7], Singapore [95 %CI 1.0-1.6], China [95 %CI 0.8-2.3] and Hong Kong SAR [95 %CI 0.8-2.6] to 5.5 % [95 %CI 4.1-7.2] in New Zealand. 92 studies (628,450 patients, 13 countries/regions) reported 30-day mortality which ranged from 1.2 % in Japan [95 %CI 0.9-1.5] and Thailand [95 %CI 0.7-2.0] to 7.4 % [95 %CI 7.0-7.8] in Australia. 142 studies (1,139,752 patients, 14 countries/regions) reported 1-year mortality which ranged from 10.8 % [95 %CI 9.6-12.1] in Singapore to 23.3 % [95 %CI 22.3-24.5] in Australia and 23.8 % in New Zealand. CONCLUSION: There is substantial variation in mortality across the Asia Pacific region. Short-term mortality rates in Asian countries, notably Japan and Singapore, are up to four-fold lower than for Australia and New Zealand. This difference, although less marked, is sustained at 1-year with a two-fold lower mortality rate in Asia. This meta-analysis is the first to delineate these differences, further studies are required to understand the reasons for this variation.

The Perception of Art among Patients and Staff on a Renal Dialysis Unit.

This study investigated the purpose and effectiveness of giving outpatients an opportunity to engage in art activities while receiving dialysis treatment. A mixed method study was conducted. 21 semi-structured interviews were conducted with outpatients attending the dialysis unit and 13 surveys of clinicians were completed. The principle reasons to partake in the art activity programme included: to pass time, to relieve boredom, to be creative, to try something new, distraction from concerns, to stay positive and to achieve something new. Patients who did not participate in the programme pass their time primarily by watching TV or sleeping. All staff who partook in the survey were satisfied with the programme and wanted it to continue. Our findings indicate that the creative arts programme is viewed positively by staff and patients alike, and might be useful in other hospital departments. Further in depth qualitative research would be useful to interrogate the potential effect of engagement in art on positive mental health and quality of life for patients with chronic conditions.

Barriers and gateways: a study of nursing students' utilisation of learning support resources.

Many first year nursing students require additional academic support from both their lecturers and learning resources. Anecdotal evidence at an Australian university suggested that 'at risk' students did not follow up lecturer referral. This study identified what learning resources were accessed and what factors influenced students' decisions to follow up or not to follow up lecturer referral. First-year nursing students (n =150) were surveyed towards the end of their second semester regarding their use of learning support services. Twelve students were randomly selected and interviewed regarding their use of learning support and their first year learning experience. Demographic data were analyzed using descriptive statistics. Qualitative data were subjected to content analysis. Results revealed learning support utilisation was related to age and publicity but unrelated to gender or culture. Older students entering through non-traditional entry modes displayed a tendency to self refer to learning support. Younger students (<25 years) often lacked effective learning strategies and were reluctant to access on-campus learning support. For all students positive on and off campus support led to positive outcomes. Faculty and learning support lecturers need to foster integration of learning support for all students and encourage peer-learning partnerships within the foundation subjects.

Withdrawal of synthetic hormones during the perimenopause: a case study.

A single case study was used to explore the experiences of a perimenopausal woman following withdrawal of synthetic hormones. The respondent, aged 51 years, had experienced severe physiologic, affective and cognitive dysfunction following withdrawal of synthetic hormones. She was approached while attending a family planning clinic in regional New South Wales, Australia. Information was obtained through a retrospective chart review and in-depth interview. The findings suggest that affective and cognitive dysfunction may be triggered by the sudden withdrawal of artificial hormones in perimenopausal women. Practitioners should be aware that some women, especially those unable to produce sufficient natural hormones, might experience severe physiologic, affective and cognitive dysfunction when hormone supplements are withdrawn. Detailed history-taking and close monitoring following the withdrawal or introduction of hormones may alert practitioners to the incidence of withdrawal symptoms or side-effects. Moving beyond the scientific interpretations, future research should address these concerns and investigate the potential for addiction when hormones are prescribed.

A comparison of adult and teenage mother's self-esteem and satisfaction with social support.

OBJECTIVE: To investigate the similarities and differences between teenage and adult mothers and their level of self-esteem and satisfaction with social support at six weeks and six months postpartum. DESIGN: A two group comparative study. SETTING: Maternal child health, immunisation and midwives' clinics in New South Wales, Australia. PARTICIPANTS: 173 adult mothers and 72 adolescent mothers who had experienced a normal pregnancy, labour and delivery and delivered a healthy baby near term. MEASUREMENTS AND FINDINGS: Rosenberg's Self-esteem Scale, Brown's Support Behavior Inventory and a personal information form were used. Irrespective of age, breast-feeding rates and satisfaction with social support decreased significantly during the early months postpartum. Furthermore, a significant inverse relationship was noted between maternal age and satisfaction with support and a positive relationship was identified between maternal age and self-esteem. KEY CONCLUSIONS AND CLINICAL IMPLICATIONS: Maternal self-esteem may be challenged by the demands of motherhood and dissatisfaction with social support could contribute to the decline in breast-feeding practices. Developing a postnatal support plan, including fathers in education programmes and offering courses and workshops designed to enhance self-esteem and parentcraft may assist mothers to assume baby care responsibilities and increase their satisfaction with support.

Investigating the relationship between satisfaction with social support and functional status after childbirth.

PURPOSE: To explore the relationship between satisfaction with support and functional status after childbirth. DESIGN: Prospective longitudinal survey design. METHODS: Two hundred new mothers who had experienced a healthy pregnancy, normal delivery and puerperium, and delivered a healthy infant between 37 and 42 weeks gestation were approached while attending primary healthcare maternal-child health centers and immunization clinics in New South Wales, Australia. Measurement tools included the Inventory of Functional Status After Childbirth and the Support Behavior Inventory, and were administered at 6 weeks, 3 months and 6 months. RESULTS: Significant increases in total mean functional scores, scores for household responsibilities, social activities, and self-care were noted. Although no significant correlation was found between satisfaction with social support and functional status after childbirth, satisfaction with support from one's partner decreased significantly during the 6-month survey period, as did satisfaction with support from others. CLINICAL IMPLICATIONS: It could be that providers need to assess the social support needs of their clients. A postnatal support plan could be used by mothers to negotiate the long-term involvement of others in household tasks and selected aspects of infant care.

Comparison of the effects of injections of nortestosterone phenylpropionate at single and multiple sites in cattle on the detection of its residues in plasma, urine and bile.

The synthetic androgen 17 beta-19-nortestosterone (beta-NT) has been used illegally as a growth promoter in cattle production in the European Union. The elimination of beta-NT and its metabolites in plasma and urine was studied in cattle which had received intramuscular injections of its phenylpropionate ester (NTPP) at either single or multiple sites at a dose rate of 1 mg/kg bodyweight. In both groups, the plasma concentrations of beta-NT, measured by enzyme immunoassay, were consistently greater than the assay's limit of quantification (0.24 ng/ml) during days 1 to 7 of the study. The mean (sd) maximum plasma concentration (Cmax) was significantly greater in the multiply injected animals (4.4 [0.48] v 2.7 [0.15] ng/ml), but other plasma pharmacokinetic parameters, AUC, CL, T1/2 beta, Tmax and MRT, were not significantly different in the two groups. The equivalent urinary concentrations exceeded the limit of quantification of the assay (4.5 ng/ml) for up to 24 days after injection. In a second study, the biliary concentrations of beta-NT and its 17 alpha-epimer (alpha-NT) were measured by gas chromatography-high resolution mass spectrometry after cattle were injected intramuscularly at either single or multiple sites with NTPP. Only alpha-NT was detected in bile for up to 62 days after injection at concentrations above the limit of quantification of the assay (0.7 ng/ml). It is concluded that in some animals, intramuscular injections of NTPP at several sites may decrease the period after injection during which free beta-NT and its metabolites are detectable in plasma and urine. After the injection of NTPP, alpha-NT was detected in bile for longer than it was detected in plasma or urine.

Plasma, urinary and biliary residues in cattle following intramuscular injection of nortestosterone laurate.

The synthetic androgen 19-nortestosterone (beta-NT) has been used illegally as a growth promoter in cattle production in the European Union. Elimination of beta-NT and its metabolites in plasma, urine and bile was studied in three cattle with cannulated gallbladders following intramuscular injection at a single site of 500 mg of the laurate ester (NTL) containing 300.5 mg beta-NT. Using enzyme immunoassay quantification, plasma Cmax of free beta-NT was 0.5 +/- 0.15 microgram/L (mean +/- SEM). Concentrations of free beta-NT in plasma were consistently greater than the assay limit of quantification (0.12 microgram/L) for 32.7 +/- 13.42 days. Mean residence time for the beta-NT in plasma was 68.5 +/- 20.75 days. Following sample preparation by immunoaffinity chromatography, high-resolution GC-MS was used to quantify beta-NT and alpha-NT in urine and bile. beta-NT was detected irregularly in urine from two of the three animals post injection. The principal metabolite present in the urine, alpha-NT, was detected for 160.3 +/- 22.67 days post injection. Cmax for alpha-NT in urine was 13.7 +/- 5.14 micrograms/L. Mean urinary AUC0-183 days for alpha-NT was 845.7 +/- 400.90 (microgram h)/L. In bile, alpha-NT was the only metabolite detected for 174.3 +/- 8.67 days post treatment. Cmax for alpha-NT in bile was 40.8 +/- 12.70 micrograms/L and mean biliary AUC0-183 days for alpha-NT was 1982.6 +/- 373.81 (microgram h)/L. Concentrations of alpha-NT in bile samples were greater than those in urine samples taken at the same time. The mean ratio of biliary:urinary AUC0-183 days was 3.0 +/- 0.72. It is concluded that bile is a superior fluid for detection of alpha-NT following injection of NTL, owing to the longer period during which residues may be detected after administration.

Biliary elimination of endogenous nortestosterone by pregnant cows.

A temporal study of the biliary elimination of endogenous 19-nortestosterone during two successive pregnancies was made in three cows with cannulated gall bladders. Bile samples were analysed for 17 beta-19-nortestosterone (beta-NT) and the 17 alpha-epimer (alpha-NT) by using high resolution gas chromatography and mass spectroscopy. No beta-NT was detected in any of the samples analysed. However, alpha-NT was detected from around 120 days of gestation in each of the cows. Peak concentrations were observed in the last week before calving and ranged from 9.5 to 36.7 ng/ml. After parturtion, the concentrations of alpha-NT declined rapidly and were undetectable by seven days after calving, and it was not detected again until after 120 days of gestation. The biliary concentrations of alpha-NT detected subsequently were similar to those observed in cattle several weeks after an exogenous injection of the synthetic ester beta-NT phenylpropionate.

Functional status after childbirth in an Australian sample.

OBJECTIVE: To investigate changes in functional status after childbirth from 6 weeks to 6 months post-delivery. DESIGN: Prospective, longitudinal survey. SETTING: Maternal-child health centers and immunization clinics in regional New South Wales, Australia. PARTICIPANTS: Two hundred Australian mothers from culturally diverse backgrounds, ages 20-35 years, who had experienced normal pregnancies, labors, and deliveries and delivered healthy singleton infants between 37 and 42 weeks gestation. MAIN OUTCOME MEASURES: The Inventory of Functional Status After Childbirth. RESULTS: Significant increases in functional status were noted in household (t = -6.871, df = 311, p = .0001), social (t = -5.856, df = 311, p = .0001), and self-care activities (t = -3.469, df = 313, p = .0006). However, none of the mothers had achieved full functional status by 6 months postdelivery. CONCLUSIONS: A gradual resumption of past role-related activities may reflect the normal adjustments required when a woman becomes a mother. Mothers not only resume most aspects of previous roles, but also add to their multiple role demands by assuming primary responsibility for infant care. Further investigations are required to identify why aspects of certain roles are resumed and others are discarded either temporarily or permanently.

Residues of nortestosterone esters at injection sites. Part 1. Oral bioavailability.

Injectable esters of 17 beta-19-nortestosterone (beta-NT) have been used illegally for growth promotion in European Union (EU) cattle production. There are no data on oral bioavailability of free beta-NT from beta-NT esters. Adult non-pregnant female Landrace pigs (n = 4) were fitted with jugular vein cannulae and were treated as follows with an appropriate 'flushing out' period between each treatment: an intravenous bolus of beta-NT at 0.1 mg kg-1 body weight (NTi.v.), 300 mg nortestosterone phenylpropionate (NTPP) in oil of arachis administered per os (NTPPoil) and 300 mg NTPP in aqueous suspension administered per os (NTPPaq). Blood samples were taken for up to 24 h and analysed for free beta-NT by enzyme immunoassay. Calculation of the area under the plasma time concentration curve (AUC), allowed absolute bioavailability estimations for both oral treatments. Mean bioavailability of beta-NT following NTPPaq was 0.35% (range 0.25-0.41%) compared to 2.25% (range 0.86-2.85%) for NTPPoil. Mean +/- standard error of mean time of maximum plasma concentration (Tmas) of free beta-NT occurred earlier (2.3 +/- 0.6 h) with NTPPoil compared to NTPPaq (10.3 +/- 1.03 h) and the maximum plasma concentration (Cmax) was also greater for NTPPoil compared to NTPPaq (36.1 +/- 6.49 vs. 3.2 +/- 0.31 micrograms l-1). It is concluded that the presence of arachis oil enhances the absorption of NTPP. Notwithstanding the possible effects that cooking and other food processing may have on such injection site residues, extrapolation of these results to man suggests that consumption of NTPP-containing injection sites may result in peak plasma concentrations of free beta-NT which are significantly greater than those observed following injection of NT esters.

Residues of nortestosterone esters at injection sites. Part 2. Behavioural effects.

Anecdotal evidence in man suggests that abuse of anabolic androgenic steroids (AAS) is linked with increased aggression. In order to test the hypothesis that administration of nortestosterone (beta-NT) esters may increase aggression, behavioural effects following beta-NT phenylpropionate (NTPP) administration were assessed in male mice using the isolation-induced aggression paradigm. Mice (n = 80) were individually caged and randomly assigned to 'resident' or 'intruder' status. Residents received one of four treatments: subcutaneous (s/c) injection of oil of arachis (OILINJ), s/c injection of NTPP in oil of arachis (NTINJ), oil of arachis per os (OILOS) and NTPP in oil of arachis per os (NTOS). After treatment, weight-matched intruders were introduced into each resident's cage and the encounter was videotaped to allow the frequency (f) and duration (d) of social, non-social, offensive and defensive behaviours displayed by residents and intruders to be measured. The latency of bite attack for residents was significantly shorter in NTOS compared to OILOS. There was no difference in either f or d of aggressive behaviours between NTINJ and OILINJ. Because OILINJ residents demonstrated similar levels of aggression to NTOS, it is possible that the aggression in NTOS mice may be mediated by a different biochemical pathway. Extrapolation of these results indicate that ingestion of beta-NT esters may have a role in the induction of aggression in consumers.

Motherhood experiences from the perspective of first-time mothers.

This study explored the early motherhood experiences of 79 first-time mothers. All women reported normal pregnancies and deliveries, delivered healthy infants at term, and were surveyed at 6 weeks postpartum using the Inventory of Functional Status After Childbirth. Mothers' written comments were subjected to a content analysis, and much of their commentary revolved around the "conspiracy of silence" that appeared to exist about the realities of motherhood. Most commented that no one had prepared them for the unrelenting demands of infant care, the level of fatigue they would experience, the loss of personal time and space, and the realities of 24-hour-a-day infant care. The women also cited their partners as their main support person during the early weeks of motherhood. Although maternal child health nurses and midwives are well placed to offer prenatal education and long-term professional support postpartum, perhaps what is needed is active, anticipatory preparation for motherhood that begins long before the first pregnancy becomes a reality.

Functional status after childbirth: a comparison of Australian women from English and non-English speaking backgrounds.

A survey was used to explore the relationship between English speaking versus non-English speaking backgrounds (NESB) and functional status after childbirth. Women were recruited (n = 132) from a culturally diverse population and allocated to sub-groups based on their dominant language background. All had experienced an uncomplicated pregnancy, delivery and delivered a healthy infant between 37 and 42 weeks gestation. Mothers were contacted while attending maternal child health centres and surveyed at 6 weeks post delivery using the Inventory Of Functional Status After Childbirth (Fawcett, Tulman, & Myers, 1988). Functional status scores were not significantly different based on dominant language background, however significantly fewer women of NESB (Mean 2 = 7.03, df 1, p = 0.02) breast fed their infant.

An Australian study of functional status after childbirth.

OBJECTIVE: To identify key predictive variables of functional status after childbirth. DESIGN: An investigative survey design. SETTING: Primary health care maternal child health centres in one large city in Victoria, Australia. PARTICIPANTS: 200 mothers selected from a culturally diverse population. All were aged 20 to 35 years, had experienced normal pregnancies, labours, deliveries and delivered a healthy baby between 37 and 42 weeks' gestation. MEASURES AND FINDINGS: The Inventory of Functional Status After Childbirth (IFSAC) (Fawcett Tulman & Myers 1988) was used as the main outcome measure. Three variables predictive of functional status after childbirth were identified, namely, satisfaction with level of stamina and well-being, sleep pattern at night and perceived lack of support following childbirth. KEY CONCLUSIONS: Return to full functional status as measured by IFSAC takes longer than physiological recovery after childbirth. Women who experience diminished well-being, interrupted sleep patterns and lacked support, appeared to be at greater risk of role congestion, overload and dysfunction. IMPLICATIONS FOR PRACTICE: To help women avoid the additive nature of assuming the motherhood role while also resuming past role responsibilities, practitioners could encourage pregnant women to develop a postnatal support plan. Women need to be proactive in negotiating specific and ongoing support from others with household responsibilities and some aspects of baby care.

Menopause and healthy aging: a pilot project.

Twenty-three women drawn from a culturally diverse community participated in a pilot health promotion project on menopause and healthy aging. The participants offered information about their usual information sources, menopausal experiences and health promotional practices. Their comments suggest that mid-aged women are frustrated by the lack of accurate and up-to-date information available to them, many found that their concerns about menopause were trivialised by their medical practitioners, most did not practice breast self-examination or have regular Pap smears, and some voiced concerns about the accessibility and affordability of appropriate health care. For some women, common medical therapies did not appear to control the symptoms they attributed to menopause. They expressed a desire to be active in health promotion and wanted to be more involved in the decision making process when consulting health care professionals. Suggestions for improving the quality of health promotion programs include the development of peer support groups and professional partnerships aimed at meeting the education, information and support needs of aging women.