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ABSTRACT Objective Design Setting Population Methods Main Outcome Measure Results Conclusion To identify whether maternal and pregnancy characteristics associated with stillbirth differ between preterm and term stillbirth.Secondary cohort analysis of the DESiGN RCT.Thirteen UK maternity units.Singleton pregnant women and their babies.Multiple logistic regression was used to assess whether the 12 factors explored were associated with stillbirth. Interaction tests assessed for a difference in these associations between the preterm and term periods.Stillbirth stratified by preterm (<37+0 weeks') and term (37+0–42+6 weeks') births.A total of 195 344 pregnancies were included. Six hundred and sixty‐seven were stillborn (3.4 per 1000 births), of which 431 (65%) were preterm. Significant interactions were observed for maternal age, ethnicity, IMD, BMI, parity, smoking, PAPP‐A, gestational hypertension, pre‐eclampsia and gestational diabetes but not for chronic hypertension and pre‐existing diabetes. Stronger associations with term stillbirth were observed in women with obesity compared to BMI 18.5–24.9 kg/m2 (BMI 30.0–34.9 kg/m2 term adjusted OR 2.1 [95% CI 1.4–3.0] vs. preterm aOR 1.1 [0.8–1.7]; BMI ≥ 35.0 kg/m2 term aOR 2.2 [1.4–3.4] vs. preterm aOR 1.5 [1.2–1.8]; p‐interaction < 0.01), nulliparity compared to parity 1 (term aOR 1.7 [1.1–2.7] vs. preterm aOR 1.2 [0.9–1.6]; p‐interaction < 0.01) and Asian ethnicity compared with White (p‐interaction < 0.01). A weaker or lack of association with term, compared to preterm, stillbirth was observed for older maternal age, smoking and pre‐eclampsia.Differences in association exist between mothers experiencing preterm and term stillbirth. These differences could contribute to design of timely surveillance and interventions to further mitigate the risk of stillbirth. [ABSTRACT FROM AUTHOR]

Introduction: Direct current cardioversion (DCCV) remains one of the recommended management strategies for symptomatic atrial fibrillation (AF). Antiarrhythmic drugs (AAD) are prescribed post procedure to maintain sinus rhythm (SR). Limited literature exists on the AAD prescribing practices and their efficacy, post‐DCCV in rural Australia. Objective: The primary aim was to determine the preferred AAD post‐DCCV and the factors affecting AAD prescribing practices. The secondary aim was to assess the efficacy of the AAD in maintaining SR. Design: A retrospective observational audit of patients with non‐valvular AF who underwent successful elective DCCV for symptomatic AF, during 2015–2020 at a regional hospital in New South Wales (NSW) (Dubbo Base Hospital). Patients were followed up for a duration of 12 months post‐DCCV. Results: 233 patients underwent successful DCCV during the study duration. Amiodarone was the preferred AAD of choice post‐DCCV followed by sotalol and flecainide, respectively (36.5% vs. 27.8% vs. 1.3%). 35.2% patients were not prescribed AAD. Amiodarone and sotalol had similar but modest efficacies and neither were superior to no AAD, in maintaining SR 12 months post‐DCCV (AF recurrence rate 61.5% vs. 68.2% vs. 71.6% respectively, p = 0.37). Antecedent cerebrovascular accident (CVA), pulmonary disease, smoking, prior treatment with digoxin, diuretics and left ventricular (LV) dysfunction were factors that influenced AAD prescribing practices. Conclusion: The study demonstrates equal efficacies of amiodarone, sotalol and no AAD in maintaining SR 12 months post‐DCCV. Prescribing practices post‐DCCV at Dubbo Base Hospital differ from observed national trends and guidelines. AAD prescription requires a multifaceted approach with a key consideration to prioritise safety over efficacy, being mindful of challenges in delivering optimal healthcare in a rural setting. [ABSTRACT FROM AUTHOR]

Background: There is no defined cause for cryptogenic stroke/embolic stroke of undetermined source (CS‐ESUS). As atrial fibrillation (AF) develops in a significant proportion of these patients, it has been suggested that left atrial (LA) myopathy may predispose to CS‐ESUS. We investigated alterations in echocardiographic measures of LA size and function in patients with CS‐ESUS. Methods: A systematic literature review and meta‐analysis was performed. PubMed, EMBASE, Cochrane Library, Web of Science and SCOPUS were searched for articles published between 1 January 1990 and 10 February 2023. All observational studies of adult CS‐ESUS patients with LA volume or function measurements performed by transthoracic echocardiogram were included. Individual random effects meta‐analyses were performed on LA measurements in the CS‐ESUS patients using subgroup analysis of comparator groups. Results: We included 29 articles with 3927 CS‐ESUS patients. Analysis of weighted mean differences showed CS‐ESUS patients had altered LA structure and function parameters, with a larger maximum indexed LA volume, reduced LA emptying fraction and/or LA reservoir strain, compared to healthy controls and noncardioembolic stroke patients. Conversely, CS‐ESUS patients had a smaller left atrium with better function, compared to cardioembolic stroke patients and CS‐ESUS patients who subsequently developed atrial fibrillation. Conclusions: LA volume and function are altered in CS‐ESUS patients compared to healthy controls and other stroke aetiologies. An underlying atrial myopathy in a subset of CS‐ESUS patients may be involved in both thrombogenesis and dysrhythmia (specifically AF). While LA functional assessment is not currently recommended following stroke, it may offer an opportunity for recurrent stroke risk stratification. [ABSTRACT FROM AUTHOR]

Breastfeeding is associated with reduced lifetime cardiometabolic risk, but little is known regarding the metabolic benefit in a subsequent pregnancy. The primary aim of this study was to investigate the association between breastfeeding duration and intensity and next pregnancy oral glucose tolerance test (OGTT) results. A retrospective cohort study was conducted from March 2020 to October 2022. All multiparous women who met inclusion criteria and gave birth during the study period were eligible for inclusion. Analysis was stratified by risk for gestational diabetes (GDM). High GDM risk criteria included previous GDM and BMI > 35 kg/m2. The association between breastfeeding duration and high-intensity breastfeeding (HIBF) and subsequent pregnancy OGTT were assessed with multivariate logistic models adjusted for statistically and clinically relevant covariables. There were 5374 multiparous participants who met the inclusion criteria for analysis. Of these, 61.7% had previously breastfed for >6 months, and 43.4% were at high risk for GDM. HIBF was associated with 47% reduced odds of an abnormal fasting glucose in a subsequent pregnancy OGTT (aOR 0.53; 95%CI 0.38–0.75; p < 0.01). There was no association between HIBF and other glucose results on the OGTT. Women who smoked were least likely to breastfeed at high intensity (aOR 0.31; 95%CI 0.21–0.47; p < 0.01). South Asian women had 65% higher odds of HIBF than women who identified as White/European (aOR 1.65; 1.36–2.00; p < 0.01). This study highlights the importance of exclusive breastfeeding to potentially reduce the prevalence of GDM and may also translate into long-term reduction of cardiometabolic risk. [ABSTRACT FROM AUTHOR]

The article presents the development of a case selection score (CSS) called the Endoscopic Mucosal Resection Case Selection Score (EMR-CSS) for endoscopists undergoing training in conventional colonic EMR. The CSS incorporates factors such as lesion size, morphology, and challenging location to predict the risk of technical failure or adverse events during the procedure. The study found that the EMR-CSS accurately identified high-risk lesions in the validation cohort, suggesting that it can be used to guide case selection and improve the accuracy of competency markers for EMR trainees. [Extracted from the article]

Background: On 9 June 2021, the Australian Technical Advisory Group on Immunisation and Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommended that pregnant women receive Comirnaty (Pfizer) messenger RNA vaccine at any stage of pregnancy. Aim: This multi‐centre study aimed to assess vaccine acceptance, reasons for hesitancy and determine if differences exist between health districts, to inform future policy strategies for COVID‐19 vaccination in pregnancy. Materials and methods: An online survey (developed based on the World Health Organization Behavioural and Social Drivers survey and modified for the pregnant population) was administered to a sample population of pregnant women attending antenatal clinics at two metropolitan hospitals (Westmead and Royal North Shore Hospital (RNSH)) in New South Wales between 15 September 2021 and 22 October 2021. Results: There were 287 pregnant women surveyed (Westmead 198 (69%), RNSH 66 (23%), no site 23 (8%)). There was a significantly lower Socio‐Economic Indexes for Areas score (5.66 vs 9.45, P = 0.001), fewer women born in Australia (37% vs 53%, P = 0.02) and higher number of children (0.77 vs 0.41, P = 0.01) among Westmead respondents. There was lower vaccination uptake (68% vs 86%, P = 0.01) and willingness to receive vaccine (68% vs 88% P = 0.01) at Westmead compared to RNSH. There was an increased proportion of respondents who were concerned that the vaccine could cause harm to the unborn baby at Westmead (38% vs 11%, P = 0.01). Conclusions: Along with healthcare provider recommendation for vaccination in pregnancy, materials should be targeted to specific safety concerns of pregnant women. [ABSTRACT FROM AUTHOR]

Perinatal mental health (PMH) conditions are associated with an increased risk of adverse perinatal outcomes including preterm birth. Midwifery caseload group practice (continuity of care, MCP) improves perinatal outcomes including a 24 % reduction of preterm birth. The evidence is unclear whether MCP has the same effect for women with perinatal mental health conditions. To compare perinatal outcomes in women with a mental health history between MCP and standard models of maternity care. The primary outcome measured the rates of preterm birth. A retrospective cohort study using routinely collected data of women with PMH conditions between 1st January 2018 – 31st January 2021 was conducted. We compared characteristics and outcomes between groups. Multivariate logistic regression models were performed adjusting for a-priori selected variables and factors that differ between models of care. The cohort included 3028 women with PMH, 352 (11.6 %) received MCP. The most common diagnosis was anxiety and depression (n = 723, 23.9 %). Women receiving MCP were younger (mean 30.9 vs 31.3, p = 0.03), Caucasian (37.8 vs 27.1, p < 0.001), socio-economically advantaged (31.0 % vs 20.2, p < 0.001); less likely to smoke (5.1 vs 11.9, p < 0.001) and with lower BMI (mean 24.3 vs 26.5, p < 0.001) than those in the standard care group. Women in MCP had lower odds of preterm birth (adjOR 0.46, 95 % CI 0.24–0.86), higher odds of vaginal birth (adjOR 2.55, 95 % CI 1.93–3.36), breastfeeding at discharge (adj OR 3.06, 95 % CI 2.10–4.55) with no difference in severe adverse neonatal outcome (adj OR 0.79, 95 % CI 0.57–1.09). This evidence supports MCP for women with PMH. Future RCTs on model of care for this group of women is needed to establish causation. [ABSTRACT FROM AUTHOR]

This article examines the relationship between ambient maximum daily temperature and mental health-related presentations to an emergency department in western Sydney from 2015 to 2019. The study analyzed data from the Patient Health Care Records dataset and meteorological data from two stations. The findings suggest that high temperatures may increase the risk of mental health presentations, particularly for women. The study highlights the importance of considering climate factors in mental health strategies and providing support during periods of extreme heat. However, the study has limitations, such as being based on data from one emergency department and not including certain factors in the analysis. [Extracted from the article]

Large (≥20 mm) nonpedunculated colorectal polyps (LNPCPs) may have synchronous LNPCPs in up to 18% of cases. The nature of this relationship has not been investigated. We aimed to examine the relationship between individual LNPCP characteristics and synchronous colonic LNPCPs. Consecutive patients referred for resection of LNPCPs over 130 months until March 2022 were enrolled. Serrated lesions and mixed granularity LNPCPs were excluded from analysis. Patients with multiple LNPCPs resected were identified, and the largest was labelled as dominant. The primary outcome was the identification of individual lesion characteristics associated with the presence of synchronous LNPCPs. There were 3149 of 3381 patients (93.1%) who had a single LNPCP. In 232 (6.9%) a synchronous lesion was detected. Solitary lesions had a median size of 35 mm with a predominant Paris 0-IIa morphology (42.9%) and right colon location (59.5%). In patients with ≥2 LNPCPs, the dominant lesion had a median size of 40 mm, Paris 0-IIa (47.6%) morphology, and right colon location (65.9%). In this group, 35.8% of dominant LNPCPs were non-granular compared with 18.7% in the solitary LNPCP cohort. Non-granular (NG)-LNPCPs were more likely to demonstrate synchronous disease, with left colon NG-LNPCPs demonstrating greater risk (odds ratio, 4.78; 95% confidence interval, 2.95–7.73) than right colon NG-LNPCPs (odds ratio, 1.99; 95% confidence interval, 1.39–2.86). We found that 6.9% of LNPCPs have synchronous disease, with NG-LNPCPs demonstrating a greater than 4-fold increased risk. With post-colonoscopy interval cancers exceeding 5%, endoscopists must be cognizant of an individual's LNPCP phenotype when examining the colon at both index procedure and surveillance. ClinicalTrials.gov , NCT01368289; NCT02000141; NCT02198729. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions Young offenders experience higher rates of neurodevelopmental and mental health disorders than the general population, and significant access barriers to health treatment. Treatment combining Cognitive Remediation Therapy (CRT) and Social Cognition Remediation Therapy (SCRT) has demonstrated benefits for functional improvements and social development. However, there is limited information regarding group treatment programs in custodial settings for young offenders. This pilot study explores the effectiveness and feasibility of a group treatment program for youth offenders with cognitive deficits and mental health concerns in youth detention.The School‐Link Advantage pilot study designed and tested a 10‐week group treatment program combining CRT and SCRT for young offenders in custody. The closed groups incorporated interactive activities focussed on emotional recognition and regulation skills, optimizing executive functioning, understanding values, exploring belief systems, improving relationships, and safety planning.Of the 22 male participants recruited in an Australian Youth Justice Centre, 12 completed all aspects of the treatment program, reflecting a 54.5% completion rate in a typically challenging to engage population cohort. Results demonstrated significant improvements in the ability to store and retrieve information, recognize information, and control emotions. Planning and organizing skills also showed considerable development.This pilot study suggests that a combined CRT and SCRT group treatment program has the potential to effectively target cognitive challenges associated with mental health disorders in young offenders in custody. These promising outcomes suggest exploring randomized controlled trials with increased cultural sensitivity for diverse populations. [ABSTRACT FROM AUTHOR]

Background and Aims: The efficacy of colorectal endoscopic mucosal resection (EMR) is limited by recurrence and the necessity for conservative surveillance. Margin thermal ablation (MTA) after EMR has reduced the incidence of recurrence at the first surveillance colonoscopy at 6 months (SC1). Whether this effect is durable to second surveillance colonoscopy (SC2) is unknown. We evaluated long-term surveillance outcomes in a cohort of LNPCPs that have undergone MTA., Methods: LNPCPs undergoing EMR and MTA from four academic endoscopy centres were prospectively recruited. EMR scars were evaluated at SC1 and in the absence of recurrence, SC2 colonoscopy was conducted in a further 12 months. A historical control arm was generated from LNPCPs that underwent EMR without MTA. The primary outcome was recurrence at SC2 in all LNPCPs with a recurrence-free scar at SC1., Results: 1152 LNPCPs underwent EMR with complete MTA over 90 months until October 2022. 854 LNPCPs underwent SC1 with 29/854 (3.4%) LNPCPs demonstrating recurrence. 472 LNPCPs free of recurrence at SC1 underwent SC2. 260 LNPCPs with complete SC2 follow-up formed the control arm from January 2012 to May 2016. Recurrence at SC2 was significantly less in the MTA arm versus controls (1/472 (0.2%) vs 9/260 (3.5%); p<0.001))., Conclusion: LNPCPs that have undergone successful EMR with MTA and are free of recurrence at SC1 are unlikely to develop recurrence in subsequent surveillance out to 2 years. Provided the colon is cleared of synchronous neoplasia, the next surveillance can be potentially extended to 3-5 years. Such an approach would reduce costs and enhance patient compliance., Competing Interests: Competing interests: MJB: Research Support: Olympus Medical, Cook Medical, Boston Scientific. GB: Research Support: Olympus Medical. The remaining authors have no financial, professional, or personal conflicts of interest to disclose., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Vaccine adjuvants are thought to work by stimulating innate immunity in the draining lymph node (LN), although this has not been proven in humans. To bridge the data obtained in animals to humans, we have developed an in situ human LN explant model to investigate how adjuvants initiate immunity. Slices of explanted LNs were exposed to vaccine adjuvants and revealed responses that were not detectable in LN cell suspensions. We used this model to compare the liposome-based AS01 with its components, monophosphoryl lipid A (MPL) and QS-21, and TLR ligands. Liposomes were predominantly taken up by subcapsular sinus-lining macrophages, monocytes, and DCs. AS01 induced DC maturation and a strong proinflammatory cytokine response in intact LN slices but not in dissociated cell cultures, in contrast to R848. This suggests that the onset of the immune response to AS01 required a coordinated activation of LN cells in time and space. Consistent with the robust immune response observed in older adults with AS01-adjuvanted vaccines, the AS01 response in human LNs was independent of age, unlike the response to R848. This human LN explant model is a valuable tool for studying the mechanism of action of adjuvants in humans and for screening new formulations to streamline vaccine development.

Introduction: Novel strategies are needed to address the rising burden of osteoporosis and fragility fractures. High-intensity resistance and impact (HiRIT) exercise has shown benefit in improving bone density in postmenopausal women with osteoporosis/osteopenia. Whether HiRIT can enhance the therapeutic effects of osteoporosis pharmacotherapy has not been established. ROLEX-DUO is a randomised controlled trial designed to assess the efficacy of romosozumab on various bone and muscle outcomes in combination with different exercise interventions in women with postmenopausal osteoporosis/osteopenia., Methods and Analysis: ROLEX-DUO is an 8-month randomised placebo-controlled trial conducted at two tertiary referral centres for patients with osteoporosis/osteopenia in Sydney, New South Wales, Australia. The study is implementing the combination of romosozumab or placebo with different forms of exercise in postmenopausal women with osteoporosis/osteopenia without recent fragility fracture (n=102). Eligible women will be randomised 1:1:1 into one of three groups: (1) romosozumab with supervised HiRIT, (2) romosozumab with unsupervised low-intensity exercise or (3) placebo with unsupervised low-intensity exercise. Co-primary outcomes are the mean percentage change in lumbar spine bone mineral density (BMD), and mean change in five times sit-to-stand test performance (seconds) at 8 months. Secondary/exploratory outcomes include BMD changes at the femoral neck, total hip and distal radius, three-dimensional dual-energy X-ray absorptiometry (DXA) hip outcomes, DXA-derived lean and fat mass, serum markers of bone turnover (procollagen type 1 peptide, C-telopeptide of type 1 collagen) and bone biomarkers (dickkopf-1), serum extracellular vesicle analyses, 36-Item Short Form Survey (SF-36) quality-of-life scores, Menopause-Specific Quality Of Life (MENQOL) Questionnaire menopause symptom burden scores, number of falls and fractures. Mixed-effects models will be performed to compare longitudinal outcome results between groups using intention-to-treat analysis., Ethics and Dissemination: The trial was approved by the Northern Sydney Local Health District Human Research Ethics Committee (2022/ETH01794, protocol V.8, dated 03 July 2024). Participants will provide written informed consent prior to inclusion. Findings will be disseminated via peer-reviewed journals, scientific conferences and summary reports to funding bodies., Trial Registration Number: ACTRN12623000867695., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/disclosure-of-interest/ and declare: all authors had financial support from Healthy Bones Australia, Australian New Zealand Bone and Mineral Society, Avant Mutual and NORTH Foundation for grant funding for the submitted work. Belinda R Beck is owner and director of The Bone Clinic (TBC) which is the licensee of the HiRIT programme being used in this study. All other authors declare no financial relationships with any organisations that might have an interest in the submitted work in the previous three years and no other relationships or activities that could appear to have influenced the submitted work., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)