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OBJECTIVE: An investigation of consumers' perceived barriers to access paediatric speech pathology services. DESIGN: Self-administered, mail-out questionnaire. SETTING: Rural and remote New South Wales (NSW). SUBJECTS: Three hundred and twenty-nine members of the NSW branch of the Isolated Children's and Parents' Association. RESULTS: Consumers living in rural and remote areas experience a number of barriers that affected their ability to access speech pathology services. These barriers include the lack, and limited choice, of speech pathologists in rural areas; long distances to travel to access services, expensive travel costs, lack of public transport; poor awareness of speech pathology services; and delays in treatment due to waiting lists. CONCLUSION: Barriers to access paediatric speech pathology services limit rural and remote consumers' usage of health services, regardless of need, indicating a possible inequity if compared to larger, more accessible urban areas. [ABSTRACT FROM AUTHOR]

Barriers inhibiting the equitable delivery of health services to rural and remote areas of Australia have been well documented. Yet the literature has not discussed health care consumers' proposed solutions to these barriers. This is especially the case when considering rural and remote speech pathology services. This paper reports on a study that investigated potential solutions to perceived barriers experienced by consumers when attempting to access paediatric speech pathology services in rural and remote New South Wales (NSW). The study consisted of a self-administered questionnaire mailed to members of the NSW branch of the Isolated Children's and Parents' Association (ICPA). Key findings from this study suggest consumer-based solutions to barriers to access in an attempt to maximize the effectiveness of sparse rural and remote speech pathology services, by matching the beliefs and expectations of consumers with the characteristics of services provided. [ABSTRACT FROM AUTHOR]

Context: Gestational diabetes mellitus (GDM) is a complex obstetric condition affecting localized glucose metabolism, resulting in systemic metabolic dysfunction., Objective: This cross-sectional study aimed to explore visceral adipose tissue (VAT) as an integral contributor to GDM, focusing on elucidating the specific contribution of obesity and GDM pathology to maternal outcomes., Methods: Fifty-six nulliparous pregnant women were recruited, including normal glucose tolerant (NGT) (n = 30) and GDM (n = 26) participants. Participants were subgrouped as nonobese (BMI <30 kg/m2) or obese (BMI ≥30 kg/m2). Metabolic markers in circulation, VAT, and placenta were determined. Morphological analysis of VAT and immunoblotting of the insulin signaling cascade were performed., Results: GDM participants demonstrated hyperinsulinemia and elevated homeostatic model assessment for insulin resistance (HOMA-IR) scores relative to NGT participants. The GDM-obese subgroup had significant VAT adipocyte hypoplasia relative to NGT-nonobese tissue. GDM-obese VAT had significantly lower insulin receptor substrate (IRS)-2 expression, with elevated ser312 phosphorylation of IRS-1, relative to NGT-nonobese. GDM-obese participants had significantly elevated circulating leptin levels and placental adipsin secretion, while GDM-nonobese participants had elevated circulating adipsin levels with reduced placental adiponectin secretion., Conclusion: These findings suggest that GDM-obese pregnancy is specifically characterized by inadequate VAT remodeling and dysfunctional molecular signaling, which contribute to insulin resistance and hinder metabolic health., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society.)

Purpose: The purpose of this study was to evaluate the success and barriers encountered by Connecticut medical clinicians providing and billing for infant oral health screenings and fluoride varnish., Methods: Clinicians trained and registered in providing oral health services were surveyed about practice demographics, training effectiveness, and implementation barriers., Results: Fifty-seven of 156 surveys (37 percent) were returned and analyzed. Most respondents were female (61 percent), worked at least 10 years (74 percent), and had at least 25 percent of their patients on Medicaid (79 percent). Respondents varied in how prepared they felt to offer services (P<.00). Sixty percent felt "well prepared" to provide oral screenings vs. 40 percent and 39 percent for fluoride varnish and billing services, respectively. Only 30 percent of respondents provided fluoride varnish. Clinicians were more likely to provide fluoride varnish and bill for the services if they felt well prepared after the training (P<.00). Referrals for an age one dental visit were not routine; 23 percent of clinicians did not refer, and 50 percent reported barriers., Conclusions: Few trained and registered clinicians provide fluoride varnish and bill for oral health services, despite feeling prepared to provide them. Additional support is required to help medical clinicians provide oral health services more consistently.

This paper describes the results of a survey that explored the experiences of carers when accessing rehabilitative services alongside their family member with a moderate-severe TBI. The 184 carers who completed these surveys reflected retrospectively on the care they received. The results of this study indicated that 61% of the carer respondents recollected accessing inpatient rehabilitation following their acute care. However, following inpatient discharge only 33% of carers reported receiving ongoing services. One quarter of carers stated they received inadequate information while transitioning through their healthcare journey and fewer than 20% of carers recollected receiving any formal support service. The results of this study showed that as carers transitioned through the healthcare journey with their family member with TBI, health services progressively declined. As this occurred, carers' satisfaction with services reduced, while their responsibilities for caring increased. This trend is concerning given the needs of carers have been shown to change over time and increase if not addressed. This paper describes both carer experience following TBI in Australia and encourages clinicians to advocate for carers needs when planning and providing rehabilitation services.

This paper investigates the continuum of care experienced by adults and their significant others following a moderate to severe traumatic brain injury (TBI) in Victoria, Australia. Clinical care guidelines exist defining best practice in TBI rehabilitation, but little is currently known about the experiences of those who sustain a TBI, their needs and the barriers they encounter when attempting to access services. This paper presents the journeys of 202 Victorians admitted for acute care following a moderate to severe TBI over 4 years. Results of this study indicate very few participants report receiving services in line with recommendations made in clinical care guidelines. In addition reported access to services was noted to vary according to allocated healthcare funding (i.e., compensable vs. private vs. public). Clinicians' consideration of healthcare consumers' experiences are essential if services provided are to match consumers' needs.

This review focuses on two factors that influence client access to care following head injury. These factors, namely the degree of rurality of a client's home town and the funding model to which they are allocated, are discussed in light of the results of the 'Head Injury Impact Project'. National and international publications, anecdotal reports and clinical experience illustrating current practices in care provision both nationally and internationally are then described. Finally, future research is proposed investigating perceived variations in access to services according to location, funding and other factors.

Background: The growing teratoma syndrome is a recognized complication of metastatic nonseminomatous germ cell tumors of the testis and is managed surgically. It may also occur in intracranial nongerminomatous germ cell tumors., Methods: The authors performed an English language computer search using the EMBASE data base (from January 1980 to December 1996) for pineal tumors, read all abstracts, and then selected all articles pertaining to germ cell tumors at this site., Results: The case history of a 19-year-old male who presented with a pineal nongerminomatous germ cell tumor, which was treated with chemotherapy, is reported. Despite normalization of raised tumor marker levels, the pineal mass enlarged during chemotherapy. This was excised and proved to be a mature teratoma. A review of the literature regarding this complication of intracranial germ cell tumors is also presented., Conclusions: The authors believe this to be the first reported case of growing teratoma syndrome in the pineal gland of an adult patient, two previously reported cases occurred in children. The authors conclude that the pineal gland is an unusual but important site in which to recognize the growing teratoma syndrome.

Antisera against 2-aminoimipramine covalently coupled to albumin have been raised in two rabbits. Both antisera bind imipramine and related tricyclic compounds as if to a single class of sites with high affinity and high titres. Displacement/inhibition assays showed that the affinities of various tricyclic compounds for the antisera showed a good correlation with the affinities of these drugs for the tricyclic antidepressant inhibitory sites on plasma-membrane 5-hydroxytryptamine carriers of human platelets and rat brain cortex. 5-Hydroxytryptamine and 5-hydroxytryptamine-uptake-selective drugs did not inhibit [3H]imipramine binding to antisera. The anti-imipramine antibodies were purified using imipramine-Sepharose affinity chromatography and were shown to be IgG class by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and protein A-Sepharose precipitation.

The widely-used food dye Erythrosin B inhibited ATP-dependent Ca2+ accumulation by rat brain microsomes, half-maximal inhibition requiring 1 microM dye. Addition of 0.5-20 microM dye to microsomes preloaded with Ca2+ did not cause any net Ca2+ release. 10 microM dye produced a constant inhibition of Ca2+ accumulation as the intravesicular free Ca2+ was lowered suggesting that, at low concentrations, it acts on the uptake system only. Ca2+ accumulation was ten-fold more sensitive to the dye than Erythrosin B-induced neurotransmitter release reported by others. Higher dye concentrations (100 microM) caused Ca2+ release.