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The suburbs located on the metropolitan edges of Australian cities are popular residential locations, but concerns have been raised about social isolation in these developing communities. This paper explores residents’ lived experiences of community in an outer-suburb of Melbourne using a phenomenological approach and photo-elicited interviews. Nine participants photographed positive and less favourable aspects of their suburb and these images were used to guide in-depth interviews. Findings indicated that participants’ views on what it meant to be a community and how they went about making social connections did not align exclusively with concepts of community saved, lost or liberated, but included broad aspirations around community building, helping and being helped by strangers and online place-based relationships. Overall, residents’ experiences were complex suggesting researchers, government and developers alike need to pay closer attention to how residents themselves create community in new ...

ObjectiveTo quantify associations of the dietary share of ultra-processed foods (UPF) with the overall diet quality of First Nations peoples.DesignA cross-sectional analysis of data from the First Nations Food, Nutrition and Environment Study, designed to contribute to knowledge gaps regarding the diet of First Nations peoples living on-reserve, south of the 60th parallel. A multistage sampling of communities was conducted. All foods from 24 h dietary recalls were categorized into NOVA categories and analyses were performed to evaluate the impact of UPF on diet quality.SettingWestern and Central Canada.SubjectsFirst Nations participants aged 19 years or older.ResultsThe sample consisted of 3700 participants. UPF contributed 53·9 % of energy. Compared with the non-UPF fraction of the diet, the UPF fraction had 3·5 times less vitamin A, 2·4 times less K, 2·2 times less protein, 2·3 times more free sugars and 1·8 times more Na. As the contribution of UPF to energy increased so did the overall intakes of energy, carbohydrate, free sugar, saturated fat, Na, Ca and vitamin C, and Na:K; while protein, fibre, K, Fe and vitamin A decreased. Diets of individuals who ate traditional First Nations food (e.g. wild plants and game animals) on the day of the recall were lower in UPF.ConclusionsUPF were prevalent in First Nations diets. Efforts to curb UPF consumption and increase intake of traditional First Nations foods and other fresh or minimally processed foods would improve diet quality and health in First Nations peoples.

Awareness among people of reproductive age about the factors that influence fertility and reproductive outcomes, including medically assisted reproduction outcomes, is generally low. To improve awareness about the potentially modifiable factors that affect fertility and reproductive outcomes, ‘Your Fertility’, a fertility health promotion programme funded by the Australian Government, was established in 2011. This paper describes the development and evaluation of the reach of the Your Fertility programme from its inception in 2011 to June 2016. Systematically recorded outcomes for the programme’s key focus areas and Google Analytics data were collated. Key achievements include developing and maintaining an internationally renowned website that experiences high growth and demand for fertility-related information; by 2016, over 5 million users had viewed more than 10 million webpages, and over 96,000 users had engaged in programme messages across social media. Programme messages have reached more than 4 million Australian social media users, and a potential audience of 150 million through media coverage across more than 320 media features. More than 4200 education and health professionals have completed online learning modules, and external partnerships have been established with 14 separate organizations. Data collected over 5 years indicate that the Your Fertility programme meets a need for targeted, evidence-based, accessible fertility-related information., Highlights • Most people have inadequate knowledge about fertility and its limitations • To address this a novel fertility health promotion program was launched in 2011 • In the first 5 years more than 5 million people accessed the program’s website • Data indicate that the program meets a need for fertility-related information.

Anna Maria Martinez-Sagi is a largely forgotten but immensely evocative voice in the liberal-progressive press of nineteen-thirties’ Spain. In particular, she is remarkable for being one of very few female writers of the time who were also active sportswomen, as well as being fiercely Catalanist and pro-women, in an inclusive sense. This article looks at her contribution to the debate on physical culture in Catalonia at the time, with reference to other writers concerned with the subject, and aims to capture in some small way the energy and humour which characterized her columns and reports.

Background Optimal parental preconception health benefits reproductive outcomes. However, preconception health promotion is not routinely offered in primary health care settings to people of reproductive age. The aim was to gauge the planned preconception health behaviours and attitudes towards being asked about pregnancy intention by a general practitioner (GP) among people of reproductive age in Australia. Method The research was conducted on a single wave of Australia’s first and only probability-based online panel, Life in Australia™. Members of the Life in Australia™ panel are Australian residents aged 18 years or over. All active members between the ages of 18 and 45 years were eligible to participate. Eligible panel members were invited to complete a survey about fertility and childbearing. Data were collected from 18 February to 4 March 2019. Results In all 965 female and male members of Life in Australia™ aged between 18 and 45 years were invited to complete the survey. Of these, 716 (74.2%) agreed. Most respondents indicated that if they were planning to have a child they would try to optimise their preconception health by adopting a healthier diet (80%), seeing a GP for a health check-up (78%), reducing alcohol consumption (78% of those consuming alcohol), getting fitter (73%), and stopping smoking (70% of smokers). Three in four (74%) stated that they would not mind if their GP asked them about their pregnancy intentions. Conclusion Findings suggests that routinely asking people of reproductive age about their pregnancy intentions and advising those who are planning pregnancy about what they can do to ensure optimal preconception health would be acceptable to most people and may improve reproductive outcomes.

Background Although implicit and explicit learning approaches have been well investigated in healthy populations, there is less evidence regarding the relative benefits of each approach in clinical practice. Studies in stroke typically investigate single elements of an implicit learning approach (ILA; eg, reduced quantity feedback or an external focus of attention) within controlled environments. These studies predominantly evaluate performance, with few measuring this over time (ie, learning). The relevance and transferability of current research evidence into stroke rehabilitation is therefore limited. Objective The objective of this study was to compare the ILA with standard care in the acute phase following stroke, to generate data and insights to inform the design of a definitive trial, and to understand patient and therapist perceptions of the ILA. Methods This is a multicenter, assessor-blind, cluster randomized controlled pilot trial with nested qualitative evaluation. Stroke units (clusters) will be randomized to either ILA (intervention) or standard care (control) arms. Therapy teams at the intervention sites will be trained in the ILA and provided with an intervention manual. Those at the control sites will have minimal input from the research team, other than for data collection. Consent will be provided at the individual participant level. Once enrolled, participants will receive rehabilitation that focuses on lower limb recovery, using the designated approach. Measures will be taken at baseline, every 2 weeks until the point of discharge from hospital, and at 3 months post stroke onset. Measures include the Fugl Meyer Assessment (motor leg subsection), modified Rivermead Mobility Index, Swedish Postural Adjustment in Stroke Scale, and achievement of mobility milestones. Fidelity of the treatment approach will be monitored using observational video analysis. Focus groups and interviews will be used to gain insight into the perceptions of trial participants and clinical teams. Results The first site opened to recruitment in February 2019. The opening of a further 5 sites will be staggered throughout 2019. Results are expected in early 2021. Conclusions The findings from this mixed methods pilot study will be used to inform the design of a definitive study, comparing the ILA with standard care in acute stroke rehabilitation. Trial Registration ClinicalTrials.gov NCT03792126; https://clinicaltrials.gov/ct2/show/NCT03792126 International Registered Report Identifier (IRRID) DERR1-10.2196/14222

Background: Research has suggested that bone fractures can hinder the health status of patients’ life. However, limited research has examined the impact that the healing process of a fracture has on the physical health and psychological state of individuals, particularly in considering the short- and long-term impact of having a fracture that fails to heal and drops into a non-union. The aim of this systematic review is to better understand the impact of fracture non-union to physical health and to respective psychological outcomes. Methods: Electronic databases ‘PubMed’, ‘Cochrane’, ‘PsycInfo’, ‘Medline’, ‘Embase’, ‘Web of Science’, and ‘CINAHL’ were used. Search terms used were nonunion OR non-union OR “non union” OR “long bone” OR “delayed union” AND “quality of life” OR qol OR depression OR anxiety OR psycholog* OR PTSD OR “post-traumatic stress disorder”. Studies published in the years 1995 to 2018 were included. Two independent reviewers carried out screening and data extraction. Studies were included if (1) participants were adult (human) patients with a traumatic non-union secondary to fracture/s; (2) outcomes measured included physical health and psychological wellbeing (e.g., PTSD, psychological trauma, depression, anxiety, etc.). Studies received emphasis if they compared those outcomes between: (1) The “non-union” group to a normative, matched population and (2) the “non-union group” to the same group after union was achieved. However, studies that did not use comparison groups were also included. Results: Out of the 1896 papers identified from our thorough literature search, 13 met the inclusion criteria. Quality assessment was done by the Methodological Index for Non-Randomized Studies (MINORS). Findings suggested that non-unions had a detrimental impact on physical health, and psychological difficulties often after recovery. Conclusions: Patients who experience a long bone non-union are at risk of greater psychological distress and lower physical health status. There is a need for early identification of psychological distress in patients with fracture non-unions and psychological provision should become part of the available treatment.

Background Research suggests that young people are much less comfortable than their older counterparts with the topic of dying and death in a variety of different ways (Dying Matters Coalition, 2016). Engagement with the local college identified a gap in talking to young people about death, particularly in the context of students responsible for having ‘good death conversations’ within their chosen profession. Aims To create/facilitate the development of a safe space for students of health and social care and those going into public services, to explore the subject of death and how to have difficult conversations. The dialogue may be different for each group, but how you feel when talking to families may be similar. Methods Pilot project launched April – June 2019, 1 × 2 hours per month, non-compulsory, with coffee and cake (mandatory). Course tutors attended and college counsellors notified in case further support required. Sessions were student led but focussed on key topics, and they chose the project name ‘Dead Chatty’, as it reflected the open nature of the discussions. Results of evaluation 28 students; attended up to three sessions – 12 evaluated. Distance travelled calculation based on questionnaire, shown as percentage improvement. (No change=3); 0%–9%=2; 10%–19%=2; 20%–29%=4; 30%–39%=1 Conclusions It was difficult to get students together (short project, exam times, work placements etc.) better scheduling might help, as would running over the whole academic year. There were tangible changes within the group on the subject matter, confidence grew and humour developed. What did you like best? People sharing experiences Open discussions No judgement of opinions. What could be improved? Nothing More sessions. A space where students can ask questions, be supported and tackle the taboo of death and dying has been created.

Background Increasing numbers of women ≥40 years old are accessing assisted reproductive technology (ART) due to age-related infertility. There is limited population-based evidence about the impact on the cumulative live birth rate (CLBR) of women aged ≥40 years using their own oocytes, compared to women of a similar age, using donor oocytes. Aims To compare the CLBR for women ≥40 years undergoing ART using autologous oocytes and women of similar age using donor oocytes. Materials and methods This population-based retrospective cohort study used data from all women aged ≥40 years undergoing ART with donated (n = 987) or autologous oocytes (n = 19 170) in Victoria, Australia between 2009 and 2016. A discrete-time survival model was used to evaluate the CLBR following ART with donor or autologous oocytes. The odds ratio, adjusted for woman's age; male age; parity; cause of infertility; and the associated 95% confidence intervals (CI), were calculated. The numbers needed to be exposed (NNEs) were calculated from the adjusted odds ratio (aOR) and the CLBR in the autologous group. Results The CLBR ranged from 28.6 to 42.5% in the donor group and from 12.5% to 1.4% in the autologous group. The discrete-time survival analysis with 95% CI demonstrated significant aOR on CLBR across all ages (range aOR: 2.56, 95% CI: 1.62-4.01 to aOR: 15.40, 95% CI: 9.10-26.04). Conclusions Women aged ≥40 years, using donor oocytes had a significantly higher CLBR than women using autologous oocytes. The findings can be used when counselling women ≥40 years about their ART treatment options and to inform public policy.

In clomiphene-citrate-resistant anovulatory women with polycystic ovary syndrome (PCOS) and no other infertility factors, either metformin combined with clomiphene citrate or gonadotrophins could be used as a second-line pharmacological therapy, although gonadotrophins are more effective. Gonadotrophins could also be used as a second-line pharmacological therapy in anovulatory women with PCOS and clomiphene-citrate-failure. Laparoscopic ovarian surgery can also be used as a second-line therapy for ovulation induction in anovulatory women with clomiphene-citrate-resistant PCOS and no other infertility factors. The usefulness of letrozole as a second-line pharmacological treatment for ovulation induction in clomiphene-citrate-resistant women with PCOS requires further research. In terms of improving fertility, both pharmacological anti-obesity agents and bariatric surgery should be considered an experimental therapy in anovulatory women with PCOS and no other infertility factors. Where first- or second-line ovulation induction therapies have failed, in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI) could be offered as a third-line therapy in women with PCOS in the absence of an absolute indication for IVF/ICSI. For women with PCOS undergoing IVF/ICSI treatment, the gonadotropin-releasing hormone (GnRH) antagonist protocol is preferred and an elective frozen embryo transfer strategy could be considered. In assisted conception units with sufficient expertise, in-vitro maturation (IVM) of oocytes could be offered to women with PCOS.

We examined the feasibility of linear programming (LP) to develop diets that were economical, included traditional (cultural, non-market) foods and met the dietary reference intakes (DRI) in a Canadian Indigenous population. Diet optimisation using LP is a mathematical technique that can develop food-based dietary guidelines for healthy eating in Indigenous populations where food insecurity, availability and cost are important considerations. It is a means of developing nutritionally optimal food combinations that are based on economical and culture-specific foods. Observed food consumption data were derived using 24-h food recalls from the First Nations Food, Nutrition and Environment Study. The LP models were constructed to develop diets meeting DRI, cost and food constraints. Achieving the recommended food intake was not feasible in a model meeting all nutrient requirements. Models that met most nutrient requirements at reduced cost were designed for men and women, separately. In women, it was necessary to increase energy intake to meet most nutrient requirements. Nutrient requirements could not be met for fibre, linoleic and linolenic acids, vitamin D, Ca and K in both sexes, P in women, and Mg and vitamin A in men. Using LP to develop optimal diets for First Nations people, we found simultaneous achievement of all DRI was difficult, suggesting that supplementation might be necessary which goes against recommendations for individuals to meet their nutrient needs through healthy eating patterns. Additionally, to make diets feasible, programmes to reduce market food costs and to support First Nations people in traditional food harvesting are recommended.

BACKGROUND Although implicit and explicit learning approaches have been well investigated in healthy populations, there is less evidence regarding the relative benefits of each approach in clinical practice. Studies in stroke typically investigate single elements of an implicit learning approach (ILA; eg, reduced quantity feedback or an external focus of attention) within controlled environments. These studies predominantly evaluate performance, with few measuring this over time (ie, learning). The relevance and transferability of current research evidence into stroke rehabilitation is therefore limited. OBJECTIVE The objective of this study was to compare the ILA with standard care in the acute phase following stroke, to generate data and insights to inform the design of a definitive trial, and to understand patient and therapist perceptions of the ILA. METHODS This is a multicenter, assessor-blind, cluster randomized controlled pilot trial with nested qualitative evaluation. Stroke units (clusters) will be randomized to either ILA (intervention) or standard care (control) arms. Therapy teams at the intervention sites will be trained in the ILA and provided with an intervention manual. Those at the control sites will have minimal input from the research team, other than for data collection. Consent will be provided at the individual participant level. Once enrolled, participants will receive rehabilitation that focuses on lower limb recovery, using the designated approach. Measures will be taken at baseline, every 2 weeks until the point of discharge from hospital, and at 3 months post stroke onset. Measures include the Fugl Meyer Assessment (motor leg subsection), modified Rivermead Mobility Index, Swedish Postural Adjustment in Stroke Scale, and achievement of mobility milestones. Fidelity of the treatment approach will be monitored using observational video analysis. Focus groups and interviews will be used to gain insight into the perceptions of trial participants and clinical teams. RESULTS The first site opened to recruitment in February 2019. The opening of a further 5 sites will be staggered throughout 2019. Results are expected in early 2021. CONCLUSIONS The findings from this mixed methods pilot study will be used to inform the design of a definitive study, comparing the ILA with standard care in acute stroke rehabilitation. CLINICALTRIAL ClinicalTrials.gov NCT03792126; https://clinicaltrials.gov/ct2/show/NCT03792126 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/14222

We report the synthesis and structural characterization of a neutral PV Lewis acid, P(OC6 F5 )5 , and salts containing the six-coordinate anions [P(OC6 F5 )5 F]- and [P(OC6 F5 )6 ]- . The latter anion exhibits a rare example of F-πarene interactions in both the solid and the solution phase, which has been quantitatively studied by variable-temperature (VT) NMR spectroscopy. The Lewis acid strength of P(OC6 F5 )5 has been assessed through experimental fluoride ion competition experiments and quantum-chemical calculations of its fluoride ion affinity (FIA) and global electrophilicity index (GEI). Our findings highlight the importance of considering solvent effects in electrophilicity calculations, even when neutral Lewis acids are involved, and show a rare divergence between FIA and GEI trends. The coordinating abilities of the [P(OC6 F5 )6 ]- and [P(OC6 F5 )5 F]- anions towards the trityl cation, as a prototypical electrophile, have been assessed.

© 2019 Objective: To study the impact of the donor's and recipient's age on the cumulative live-birth rate (CLBR) in oocyte donation cycles. Design: A population-based retrospective cohort study. Setting: Not applicable. Patient(s): All women using donated oocytes (n = 1,490) in Victoria, Australia, between 2009 and 2015. Intervention(s): None. Main Outcome Measure(s): The association between the donor's and recipient's age and CLBR modeled by multivariate Cox proportional hazard regression with the covariates of male partner's age, recipient parity, and cause of infertility adjusted for, and donor age grouped as

Global cities research is a lively field. It may well benefit from an ‘engaged pluralism’, though such a call still suggests a tolerance of difference by those who remain in positions of power to admit or reject such a challenge and to shape its form as well as to judge its veracity. This response argues further that in this case the ‘straw man’ – or the postcolonial woman – has not been adequately registered, heard or adequately responded to.

Some potentially modifiable factors adversely affect fertility and pregnancy health. To inform a fertility health promotion programme, this study investigated fertility knowledge and information-seeking behaviour among people of reproductive age. This was a qualitative study involving six focus group discussions with women and men who intended to have children in the future and eight paired interviews with couples who were actively trying to conceive. Participants (n = 74) themselves generally claimed 'low' to 'average' levels of knowledge about fertility. Most of them overestimated women's reproductive lifespan and had limited knowledge about the 'fertile window' of the menstrual cycle. The Internet was a common source of fertility-related information and social media was viewed as a potential effective avenue for dissemination of messages about fertility and how to protect it. Most participants agreed that primary health care providers, such as general practitioners (GPs), are well placed to provide information regarding fertility and pregnancy health. This study identified several gaps in knowledge among people of reproductive age about factors that influence fertility and pregnancy health negatively. Addressing these knowledge gaps in school curricula, primary care and health promotion would assist people to realize their reproductive goals and reduce the risk of infertility and adverse obstetric outcomes.

Living in the suburbs is founded on mobility, as residents move to the periphery of the city, commute to work and travel for shops, schools and leisure. While there have been numerous studies raising critical questions on the vulnerability of outer suburban residents to loneliness, financial and mortgage stress, the actual experiences and challenges posed by the dependence of suburban life on mobility is rarely singled out for attention. Through purposive sampling and then snowballing, eight outer suburban residents participated in photo-elicited interviewing to detail their lifeworlds and mobility experiences. Problems ranged from getting to work to accessing schools, shops and even neighbourhood services as the suburban car culture was embraced but also constrained patterns of movement. However, there was also an array of positive experiences and alternatives to these patterns, including the pleasures to be found in traffic jams and the suburban environment and local actions to establish new pat...

La Susi en el vestuario blanco (2003) is a fictional chronicle of life in the Real Madrid locker room, a privileged insight into the sanctum sanctorum of the world's richest soccer team. The hiring of Susi as glamour coach ostensibly aims to boost the competitive advantage of the galacticos in foreign as well as local markets (reflecting the reality of the club at the time). In Mendicutti's homoeroticizing gaze, it also serves to uncover the homophobic substrate reportedly still common in male team sports and teases at the anxieties of the players. This article explores the peculiar function of Susi as she sets the comic tone of the work and engages with the varied virilities before her. It examines the notions of “glamour” and “identification” both as tongue-in-cheek team objectives and as phenomena with wider relevance for the way spectators relate to sport and players relate to the world around them.

Purpose – The purpose of this paper is to examine a gap in knowledge about the interaction between mentalizing skills and social inclusion activity immediate after completing an intensive mentalization-based treatment (MBT) program. Design/methodology/approach – Lived experience was explored through the use of timelines, repeated cycles of audio-recorded focus groups and inductive thematic analysis. Findings – Destructive cycles between self-hatred and social-exclusion were first disrupted by MBT because people felt understood. Being understood reduced self-hatred which was an essential precursor for attempting new forms of mentalizing in social interactions. This process was challenging but continued as a virtuous cycle after treatment finished. Research limitations/implications – The sample was limited because at three, it was small. However, the study was co-produced between professional and service users at all stages. Lived experience was carefully explored in depth and triangulated between three people. The authors acknowledge too that they have reflected on experience within only one to three years after MBT finished. Future studies might usefully replicate the methodology to trace experience up to the eight year follow up point undertaken by Bateman and Fonagy (2008). Practical implications – There is a great sense of loss for service users when therapy ends and that ending needs to be managed on both sides. Service users start to acquire powerful new skills and thought processes at the end of therapy. While this may not be overwhelming, they will not be used to them and so it helps when therapists help service users think about their plans and ideas for things they want to do or changes they might make in their lives. Originality/value – While supporting quantitative data about the outcome of therapy, this study offers the type of qualitative detail about how the psychological and social interact post-therapy, which can inform the successful management of those processes by those involved.

One of the many trends that have recently proliferated across the Western world has been the embrace of neo-liberalism. Accompanying moves towards the privatization of public space and social servi...

The Eeyouch are a First Nations (Cree) population that live above 49.6°N latitude in Eeyou Istchee in northern Quebec. Eeyouch rely on traditional foods (TF) hunted, fished or gathered from the land. The overarching aim of this study was to achieve an understanding of the factors associated with TF intake among Eeyouch. Data were from 465 women and 330 men who participated in the Nituuchischaayihtitaau Aschii Multi-Community Environment-and-Health (E&H) study. The relationship between TF consumption and dietary, health, sociodemographic and food sovereignty (i.e. being a hunter or receiving Income Security to hunt, trap or fish) variables was examined using linear and logistic regression. Analyses were stratified by sex because of the male/female discrepancy in being a hunter. Among respondents, almost all (99.7%) consumed TF, 51% were hunters and 10% received Income Security. Higher intake of TF was associated with lower consumption of less nutritious ultra-processed products (UPP). In women, TF intake increased with age, hunting and receiving Income Security, but decreased with high school education. In men, TF intake increased with age and speaking only Cree at home. The findings suggest that increased food sovereignty would result in improved diet quality among Eeyouch through increased TF intake and decreased UPP intake.

To describe exposure to methylmercury among Cree, focusing on women of childbearing age, we used data from 2 studies. Multiple regression was employed to examine associations between blood and hair mercury concentrations and consumption of locally harvested fish. Approximately 9.9% of non-pregnant women aged 15–44 y and 3.9% of pregnant women required follow-up according to Health Canada’s blood mercury guidance value of 40 nmol/L. 8% of hair mercury observations in the non-pregnant women and 2.5% among pregnant women exceeded the equivalent threshold of 10 nmol/g. The geometric mean blood mercury concentration was 12.7 nmol/L in 1,429 persons aged 8 and over, and 17.7 nmol/L in adults aged 18 and older. The proportion of hair mercury concentrations greater than 12.5 nmol/g decreased in all age-sex groups when comparing the 2002–2009 data to published values for 1993–1994. Among women of childbearing age, local fish consumption was associated with increased blood and hair mercury concentrations. While over 90% of women of childbearing age in this population have acceptable levels of mercury, ongoing intake of mercury suggests that their consumption of fish with known high mercury content be minimised. Reducing consumption of fish known to be high in mercury content needs to be balanced with promoting ongoing connection to Cree culture and land-based activities that are also important determinants of health.

Study question What are the fertility and childbearing concerns and related information needs and preferences of women with polycystic ovary syndrome (PCOS)? Summary answer Women with PCOS have concerns about fertility and childbearing mainly because they believe that it will be difficult for them to conceive, and identify a need for evidence-based information and preconception care so that they can make informed decisions about having children and achieve their reproductive goals. What is known already Women with chronic conditions seek reproductive health information from a range of sources, including their healthcare provider, the internet, other women with the condition, patient associations and support groups, and scientific publications. Little is known about the fertility concerns and information needs of women with PCOS or their preferences for how and when to receive information about the effect of their condition and its treatment on fertility and childbearing. Study design, size, duration A qualitative study of 13 women of reproductive age with self-reported PCOS living in Australia participated in an online discussion group conducted from May to June 2018. Women were recruited via targeted advertisements on social media. Participants/materials, setting, methods In a closed-group moderated discussion, participants responded to questions about fertility concerns and the related information needs and preferences of women with PCOS. Non-identifiable demographic information was sought via a separate online anonymous survey. The discussion transcript was analysed thematically. Main results and the role of chance Women identified a number of concerns about childbearing including whether they could become pregnant, how to prepare for pregnancy and what they should do before trying to conceive given their PCOS. Women reported seeking information about fertility and PCOS from a range of sources, and views about the most useful types and sources of fertility information for women with PCOS varied. Limitations, reasons for caution Due to the small sample size and recruitment of participants via advertisements on Facebook, women who participated in the study may not be representative of women with PCOS in the general population. Women currently contemplating childbearing or who have recently had children or fertility difficulties may also have been more likely to participate in the study. Women in this study self-reported PCOS, and this may not necessarily reflect a confirmed diagnosis of PCOS. No formal diagnostic criteria were used to confirm their PCOS status. Wider implications of the findings Women with PCOS would benefit from evidence-based information in a range of formats to help them make informed decisions about childbearing and achieving their reproductive goals. Preconception care, including counselling and information about appropriate interventions and self-management strategies to optimise health and improve chances of conception, may be of particular assistance to women with PCOS. STUDY FUNDING/COMPETING INTEREST(S) The Victorian Assisted Reproductive Treatment Authority (VARTA) commissioned researchers at Monash University to generate evidence to guide the development of resources to assist women with PCOS make informed fertility and childbearing decisions and achieve their reproductive goals. The authors have no conflict of interests to declare. Trial registration number Not applicable.

Indigenous people worldwide have a greater disease burden than their non-aboriginal counterparts with health challenges that include increased obesity and higher prevalence of diabetes. We investigate the relationships of dietary patterns with nutritional biomarkers, selected environmental contaminants and measures of insulin resistance in the Cree (Eeyouch) of northern Québec Canada.The cross-sectional 'Nituuchischaayihitaau Aschii: A Multi-Community Environment-and-Health Study in Eeyou Istchee' recruited 835 adult participants (≥18 y) from 7 communities in the James Bay region of northern Québec. The three dietary patterns identified by principal component analysis (PCA) were: inland and coastal patterns with loadings on traditional foods, and a junk food pattern with high-fat and high-sugar foods. We investigated dietary patterns scores (in quantiles) in relation with nutritional biomarkers, environmental contaminants, anthropometry, blood pressure, fasting plasma glucose and insulin, and insulin resistance. Homeostatic model assessment (HOMA-IR) was used as surrogate markers of insulin resistance. ANCOVA ascertained relationships between dietary patterns relationship and outcomes. Greater scores for the traditional patterns were associated with higher levels of n-3 fatty acids, mercury and polychlorinated biphenyls (PCBs) (P trend0.001). Higher scores for the junk food pattern were associated with lower levels of PCBs and Vitamin D, but higher fasting plasma insulin and HOMA-IR.Our results suggest that poor diet quality accompanied greater insulin resistance. Impacts of diet quality on insulin resistance, as a sign of metabolism perturbation, deserve more attention in this indigenous population with high rates of obesity and diabetes.

We investigated the food types consumed by 3276 First Nations citizens from the First Nations Food Nutrition and Environment Study (FNFNES) living on-reserve in Canada. Data from 24-h dietary recalls were classified into NOVA categories: fresh or minimally processed foods (MPF), processed culinary ingredients, processed foods, and ultra-processed foods (UPF). Individuals were classified as traditional food (TF) eaters if they ate MPF of their First Nations culture. UPF accounted for 54.0% of energy intake; 23% of participants ate TF. Increasing age and household size, living in British Columbia and TF eating were associated with a lower intake of energy from UPF. Eating TF appeared to be protective against intake of UPF.

In this concluding chapter we provide a revised periodisation of planning in Australia based on its impact on Aboriginal and Torres Strait Islander peoples. The result is a quite different framing of the Australian planning story from that told byn standard planning histories have told. We argue that this is a crucial early step for the discipline to grapple with what it will mean to decolonise planning on the terms of Indigenous peoples. The chapter also scopes some initial implications of our analysis for planning practice, discussing what planners might need to do differently in the future if the discipline is to be able to come to a more just relationship with Aboriginal and Torres Strait Islander peoples.

This chapter presents four case studies that profile different ways Aboriginal communities are building and contributing to a body of alternative planning work. The case of Redfern, in Sydney, provides an early example of the direct action and alliance-building necessary to assert and claim a presence in the middle of Australia’s foremost city. In Victoria’s south-west, the Gunditjmara have gained historic outcomes in environment and land management through their strategic use of court action and cultural heritage protection. In Broome, the Yawuru people have become a major planning stakeholder in this important regional city through their successful native title claim. In Perth, the settlement of the Noongar people’s claim will deliver a historic if controversial package of benefits. Each of these cases reveals the dilemmas associated with actions that seek to settle outstanding claims with the state, some of which present difficult compromises for Aboriginal communities.

ObjectiveTo assess associations between three diet quality indices and metabolic syndrome (MetS) in the Cree (Eeyouch) of northern Québec, Canada, as well as to evaluate their pertinence in this Indigenous context.DesignThe alternative-Healthy Eating Index 2010 (aHEI-2010), the Food Quality Score (FQS) and the contribution of ultra-processed products (UPP) to total daily dietary energy intake using the NOVA classification were calculated from 24 h food recalls. MetS was determined with the latest harmonized definition. Logistic regressions assessed the relationship between quintiles of dietary quality scores with MetS and its components.SettingStudy sample from the 2005–2009 cross-sectionalNituuchischaayihititaau AschiiEnvironment-and-Health Study.SubjectsEeyouch (n811) from seven James Bay communities (≥18 years old).ResultsMetS prevalence was 56·6 % with 95·4 % abdominal adiposity, 50·1 % elevated fasting plasma glucose, 43·4 % hypertension, 38·6 % elevated TAG and 44·5 % reduced HDL cholesterol. Comparing highest and lowest quintiles of scores, adjusted OR (95 % CI) of MetS was 0·70 (0·39, 1·08;P-trend=0·05) for aHEI-2010, 1·06 (0·63, 1·76;P-trend=0·87) for FQS and 1·90 (1·14, 3·17;P-trend=0·04) for the contribution of UPP to total daily dietary energy intake.ConclusionsAlthough diet quality indices have been associated with cardiometabolic risk, only the dietary intake of UPP was significantly associated with MetS in the Eeyouch. Indices tailored to the food environment of northern communities are essential to further understand the impact of diet quality in this context.

Background Many factors influence the chance of having a baby with assisted reproductive technologies (ART). A 2016 Australian Competition and Consumer Commission (ACCC) investigation concluded that ART clinics needed to improve the quality of information they provide about chance of ART success. Aim To evaluate changes in the quality of information about success rates provided on the websites of ART clinics in Australia and New Zealand before and after the ACCC investigation. Materials and Method Desktop audits of websites of ART clinics in Australia and New Zealand were conducted in 2016 and 2017 and available information about success rates was scored using a matrix with eight variables and a possible range of scores of 0–9. Results Of the 54 clinic websites identified in 2016, 32 had unique information and were eligible to be audited. Of these, 29 were also eligible to be audited in 2017. While there was a slight improvement in the mean score from 2016 to 2017 (4.93–5.28), this was not statistically significantly different. Of the 29 clinics, 14 had the same score on both occasions, 10 had a higher and five a lower information quality score in 2017. Conclusions To allow people who consider ART to make informed decisions about treatment they need comprehensive and accurate information about what treatment entails and what the likely outcomes are. As measured by a scoring matrix, most ART clinics had not improved the quality of the information about success rates following the ACCC investigation.

In 1823, William Hazlitt published his erotic memoir, Liber Amoris, and a polemic against royalism, “On the Spirit of Monarchy.” This essay assesses the sadomasochistic nature of the royalist imagination in “Monarchy” and the psychological violence of Liber Amoris in order to illuminate Hazlitt's theory of the imagination, which, I demonstrate, posited that the expansive imagination, though driven by antisocial impulse, as a regulating force that enables sociability in a society held together by print culture.

STUDY QUESTION What are the expectations and experiences of anonymous gamete donors about contact with their donor offspring? SUMMARY ANSWER Rather than consistently wanting to remain distant from their donor offspring, donors' expectations and experiences of contact with donor offspring ranged from none to a close personal relationship. WHAT IS KNOWN ALREADY Donor conception is part of assisted reproduction in many countries, but little is known about its continuing influence on gamete donors' lives. STUDY DESIGN, SIZE, DURATION A qualitative research model appropriate for understanding participants' views was employed; semi-structured interviews were conducted during January–March 2013. PARTICIPANTS/MATERIALS, SETTING, METHODS Before 1998, gamete donors in Victoria, Australia, were subject to evolving legislation that allowed them to remain anonymous or (from 1988) to consent to the release of identifying information. An opportunity to increase knowledge of donors' expectations and experiences of contact with their donor offspring recently arose in Victoria when a recommendation was made to introduce mandatory identification of donors on request from their donor offspring, with retrospective effect. Pre-1998 donors were invited through an advertising campaign to be interviewed about their views, experiences and expectations; 36 sperm donors and 6 egg donors participated. MAIN RESULTS AND THE ROLE OF CHANCE This research is unusual in achieving participation by donors who would not normally identify themselves to researchers or government inquiries. Qualitative thematic analysis revealed that most donors did not characterize themselves as parents of their donor offspring. Donors' expectations and experiences of contact with donor offspring ranged from none to a close personal relationship. LIMITATIONS, REASONS FOR CAUTION It is not possible to establish whether participants were representative of all pre-1998 donors. WIDER IMPLICATIONS OF THE FINDINGS Anonymous donors' needs and desires are not homogeneous; policy and practice should be sensitive and responsive to a wide range of circumstances and preferences. Decisions made to restrict or facilitate contact or the exchange of information have ramifications for donors as well as for donor-conceived people. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the Victorian Department of Health. The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER Not applicable.

Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility in women of reproductive age. Lifestyle change is considered the first line treatment for the management of infertile anovulatory women with PCOS, and weight loss for those who are overweight or obese. First line medical ovulation induction therapy to improve fertility outcomes is letrozole, whilst other less efficacious ovulation induction agents, such as clomiphene citrate, metformin, and metformin combined with clomiphene citrate, may also be considered. Metformin combined with clomiphene citrate is more effective than clomiphene citrate alone. In obese women with PCOS, clomiphene citrate could be used in preference to metformin alone whilst clomiphene citrate could be added to metformin alone in order to improve reproductive outcome in all women with PCOS. Gonadotrophins, which are more effective than clomiphene citrate in therapy naïve women with PCOS, can be considered a first line therapy in the presence of ultrasound monitoring, following counselling on the cost and the potential risk of multiple pregnancy.

STUDY QUESTION How do gamete donors who presumed they could remain anonymous respond to proposed legislation to retrospectively remove anonymity? SUMMARY ANSWER A little more than half of the donors opposed the recommendation to introduce legislation to remove donor anonymity with retrospective effect. WHAT IS KNOWN ALREADY An increasing proportion of parents disclose their origins to their donor-conceived children and growing numbers of donor-conceived adults are aware of how they were conceived. Research indicates that access to information about the donor is important to donor-conceived people. However, worldwide most donor-conceived people are unable to find any identifying information about the donor because of the practice of anonymous gamete donation. STUDY DESIGN, SIZE, DURATION This study adopted a qualitative research model using semi-structured interviews with gamete donors that included open questions. Interviews with 42 volunteers were conducted between December 2012 and February 2013. PARTICIPANTS/MATERIALS, SETTING, METHODS Before 1998 gamete donors in Victoria, Australia, were able to remain anonymous. Pre-1998 donors were invited through an advertising campaign to be interviewed about their views on a recommendation that legislation mandating retrospective release of identifying information be introduced. MAIN RESULTS AND THE ROLE OF CHANCE Donors were almost evenly split between those who supported and those who rejected the recommendation to introduce legislation to remove donor anonymity with retrospective effect. About half of the donors who rejected the recommendation suggested the compromise of persuading donors voluntarily to release information (whether identifying or non-identifying) to donor-conceived people. These donors were themselves willing to supply information to their donor offspring. The findings of this study informed the Victorian Government's response to the proposed legislative change. While acknowledging donor-conceived people's right of access to information about their donors, the Government decided that identifying information should be released only with the consent of donors and that donors should be encouraged to allow themselves to be identifiable to their donor offspring. LIMITATIONS, REASONS FOR CAUTION There is no way of knowing whether participants were representative of all pre-1998 donors. WIDER IMPLICATIONS OF THE FINDINGS The balancing of donors' and donor-conceived people's rights requires utmost sensitivity. All over the world, increasing numbers of donor-conceived people are reaching adulthood; of those who are aware of their mode of conception, some are likely to have a strong wish to know the identity of their donors. Legislators and policy-makers in jurisdictions permitting anonymous gamete donations will need to respond when these desires are expressed, and may choose to be guided by the model of consultation described in this paper. STUDY FUNDING/COMPETING INTERESTS The study was funded by the Victorian Department of Health. The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER Not applicable.

Government policy in many countries encourages migration to regional centres to relieve pressure on major cities and to boost economic development. Migrants are more likely to remain in a new location if they have meaningful work and establish social connections there. This article explores how organisations and groups in a regional city provide newcomers with access to social capital resources which migrants can use to forge social connections. Past research has shown that migrants require a mix of linking, bridging and bonding social capital to form an effective primary social contract with their new home. This research suggests that regional cities – such as Geelong, Victoria – which are proactive in assembling diverse social capital resources and making them accessible to migrants, are more likely not only to receive more newcomers but also more likely to retain migrants and a skilled workforce. The findings have relevance to other regional centres.

La trilogia de memòries de Llorenç Villalonga (1897-1980) proposada per Miquel López Crespí, narrades per l'alter ego de Villalonga, Salvador Orlan, planteja preguntes sobre la motivació i el lloc d'aquesta literatura pseudomemorialística, tant en el context local de Mallorca con en l'espai testimonial de manera més general. El segon dels dos volums publicats fins ara, Les vertaderes memòries de Salvador Orlan (2012), fa servir escrits autobiogràfics i pseudobiogràfics de Villalonga per a presentar una narrativa en primera persona exculpatòria i a vegades malhumorada els defectes estilístics de la qual ja fan poc probable que el subjecte es pugui guanyar l'afecte del lector. Aquest assaig estudia per què Villalonga, mitjançant la seva pròpia tradició del desconcert, podria semblar lliurar-se a la reescriptura però no a l'empatia, i suggereix que posicionar-lo com a cap de turc o víctima que encara ha de fer la reparació per la seva lleialtat a la Guerra Civil és èticament problemàtic i pragmàticament fútil. Conclou que aquesta contribució a la cultura de la memòria històrica respon en la mateixa mesura al mercat que a l'exigència política o a la necessitat de recordar.

Rapid development, including the building of hydroelectric projects and roads in remote areas of Northern Quebec, Canada, has led to concerns about the contamination of traditional foods (TF) and a transition to a diet characterized by increased commercial food intake. A cross-sectional study of 850 Cree adults, aged ≥19 years, from 7 of the 9 Eeyouch communities was conducted during the spring and summer seasons of 2005–2008. Anthropometric measures were collected. TF and dietary intake were assessed using food-frequency questionnaires (FFQs) and 24-h recalls. Obesity was high, with 77% of the women and 64% of the men classified as obese. Past-year TF consumption was 100%, and 41% of participants reported eating TF on the 24-h recall. TF intake as reported on both the FFQs and the 24-h recalls was higher in individuals aged >50 years of age and in men, relative to younger adults and women, respectively. TF consumption increased protein, vitamin D, iron, and magnesium in all individuals, and energy, cholesterol, magnesium, sodium, and zinc in men aged 19–50 years; it decreased vitamin C in men and women aged ≥51 years. Participants reported drinking a mean daily 0.78 ± 1.34 cans of soft drinks or other high-sugar beverages per day or 5.28% ± 8.92% of total energy. It is important to identify behaviours that are contributing to obesity and its health consequences in this population and to find culturally appropriate ways to promote the consumption of TF and to reduce the consumption of energy-dense and nutrient-poor beverages and food items.

Objective To explore knowledge about the effects on fertility of age, obesity, smoking, and timing of intercourse among Australians of reproductive age. Design Telephone survey of a representative sample of Australians. Setting Not applicable. Patient(s) Australians aged 18 to 45 years who wish to have a child or another child now or in the future. Intervention(s) None. Main Outcome Measure(s) Knowledge about the effect on fertility of age, obesity, smoking, and timing of intercourse. Result(s) A total of 462 interviews were conducted. The majority of respondents underestimated, by about 10 years, the age at which male and female fertility starts to decline. Only one in four correctly identified that female fertility starts to decline before age 35, and one in three identified that male fertility starts to decline before age 45. Most (59%) were aware that female obesity and smoking affect fertility, but fewer recognized that male obesity (30%) and smoking (36%) also influence fertility. Almost 40% of respondents had inadequate knowledge of when in the menstrual cycle a woman is most likely to conceive. Conclusion(s) Considerable knowledge gaps about modifiable factors that affect fertility were identified. These are targeted in a national education campaign to promote awareness of factors that influence fertility.

Increasingly individuals are preferring to die at home, eliciting an increased need for good communication, forward planning is more crucial than ever. We need to be better equipped for difficult conversations and more confident in sharing our wishes with others. The ‘Everything in Place’ project raises the profile of these taboo subjects, reducing barriers by encouraging conversations and advocates the need to take responsibility for informed decision making. Six sessions included: The last taboo Wills Powers of Attorney Advance decisions for health and care Funeral planning/poverty A strong soul/organ donation. The project is delivered through local community centres, housing organisations, workplaces and communities of interest. Initially presentations were made to gauge interest, dispel myths, and demonstrate the mass of practical evidence surrounding what constitutes a good death. Once venues were established the project was promoted through posters, leaflets, newspaper and radio, a work book was designed to help with decision making and record thoughts and plans. Six sessions were delivered in five venues (monthly), five people attended during week one and overall we delivered the equivalent of 82 individual sessions, results below: Attendance rates might suggest the uncomfortable nature of death, however results would confirm that in the main discussions were beneficial. We believe the project is making an impact and continue our work to make this information accessible.

Intergenerational projects are a cornerstone of community development. Through sharing information and experiences young people can engage a different perspective and experience situations that they might not usually be exposed to. It is in transforming the perceptions of our young people that we can initiate culture change. We worked with a local youth project to approach four local schools, targeting ‘A’ level Art students. Three declined stating that it was inappropriate for their young people to come into the hospice, the remaining school circulated information to students and five young people came forward. Students came into the hospice (extra curricula), talked to day guests about memories, and planned a series of art installations in the hospice grounds to support our Dying Matters week collaborations. Some of the conversations challenged the young people, but the situation was managed by the team, without specialist support services. The aim for students was to understand life, death, grief and loss, gaining an understanding that death is part of life and should be embraced. The art was robust and weatherproofed, objects suspended in the trees and walkways for an afternoon picnic. Our day guests were excited to share their memories, and the final exhibition proved emotional as the artwork resonated with many of the visitors. Exhibits included small pictures in glass jars, a globe, and a film in the following areas: Wedding Picnic Beach Coronation Family ribbon tree Railways World travel RAF Hiking Horse racing Washing line. The timing of the event was difficult for the young people as it led into exam time – students found this difficult. Overall it was a successful event, students commented on the wisdom of older people and how life has changed, but most of all we now have a solid foundation with the school to build future relationships and learning.

Objective: An evidence based Clinical Decision Rule (CDR) was developed from a systematic review and epidemiological study to identify burns due to child maltreatment (abuse or neglect). Prior to an implementation evaluation, we aim to explore clinicians’ views of the CDR, the likelihood that it would influence their management, and factors regarding its acceptability.Methods: A semi-structured questionnaire exploring demographics, views of the CDR and data collection proforma, ability to recognize maltreatment, and likelihood of following CDR recommended child protection (CP) action, was administered to 55 doctors and nurses in 8 Emergency Departments and 2 burns units. Recognition of maltreatment was assessed via four fictitious case vignettes.Analysis: Fisher’s exact test and variability measured by coefficient of unalikeability.Results: The majority of participants found the CDR and data collection proforma useful (45/55 = 81.8%). Only 5 clinicians said that they would not take the action recommended by the CDR (5/54, 9.3%). Lower grade doctors were more likely to follow the CDR recommendations (P=0.04) than any other grade, while senior doctors would consider it within their decision making. Factors influencing uptake include: brief training, background to CDR development and details of appropriate actions.Conclusions: It is apparent that clinicians are willing to use a CDR to assist in identifying burns due to child maltreatment. However, it is clear that an implementation evaluation must encompass the influential variables identified to maximize uptake.