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Biomedical subjects

J Lumley

Publications and source records attributed to J Lumley.

At least 73 records · Page 4Linked to original sources
PubMed1997

Women's views of different models of antenatal care in Victoria, Australia.

BACKGROUND: This study assessed women's views of care in pregnancy, contrasting the experiences and satisfaction of women using different models of care in Victoria, Australia. METHODS: A statewide postal survey of women who gave birth during a 2-week period in 1993 was carried out 6 to 7 months after birth. RESULTS: Of 1336 women, 62.5 percent responded, and of these, 62.4 percent rated their antenatal care as very good, 27.7 percent as good, 8.2 percent as mixed, and 1.8 percent as poor or very poor. Although social factors, obstetric factors, and model of care had significant associations with satisfaction in univariate analyses, only model of care, mother's country of birth, and medical risk remained significant in a multivariate analysis using logistic regression. Women were most likely to be satisfied when antenatal care was provided by an obstetrician in private practice or a birth center. When comparisons were restricted to options available to women without private health insurance, using public hospital clinics as the baseline in a multivariate analysis, women were significantly more likely to be satisfied with birth center care, and significantly less likely to be satisfied with shared care. Contributing factors were waiting times, staff seeming rushed, and lack of continuity of caregiver. CONCLUSION: The expansion of shared antenatal care has not succeeded in improving satisfaction with antenatal care for women in the public health care sector.

Adolescent↗
PubMed1996

The 'new' risk factors for SIDS: is there an association with the ethnic and place of birth differences in incidence in Victoria, Australia?

Home interviews and assessments of infant development were carried out in a project examining the family environments of four groups of women and their infants with different risks of sudden infant death syndrome (SIDS): a reference group of 200 Australian-born (Anglo-Celtic) women (SIDS incidence, 2.04/1000), 101 women born in Asia (0.97/1000) and 56 women born in Southern Europe (0.58/1000) whose infants have a very low risk of SIDS and 102 women who chose to give birth at home whose infants have a high risk of SIDS (8.9/1000). As these differences are not explained by the classic social and perinatal risk factors, it was possible that they might be attributable to the 'new' risk factors: prone sleeping position, not fully breast feeding, exposure to cigarette smoke and bed sharing. Analysis of the data did not show this expected association: there were no significant differences between the groups in the use of the prone position; although only two Asian-born women smoked, infant exposure to cigarette smoke was similar in the other three groups; choice of infant feeding method did not fit the expected pattern--homebirth infants were fully breast fed almost exclusively while this was so for only about 50% of infants in both low risk groups; more than 50% of homebirth families slept with their infants, but bed sharing was also significantly more common in the Asian-born group than in the reference group.

Asia↗
PubMed1996

Critically ill parturient women and admission to intensive care: a 5-year review.

Thirty-nine parturient women were admitted to a general intensive care unit (ICU) from April 1989 to March 1994 and of these four were readmitted (total 43 admissions). Twelve women were admitted to the obstetric unit from peripheral hospitals in different regions, but no requirement for intensive care was perceived on referral. Six women were transfered directly into the intensive care unit from different hospitals in the region. The incidence of obstetric patients requiring ICU admission, excluding direct transfers, was 0.64%. The majority (85%) were postpartum, and 64% were primiparous. Morbidity was caused primarily by hypertensive disorders (33%) and haemorrhage (33%). The remainder included medical disorders (21%)[ sepsis (13%) and surgical problems (5%). Associated major complications were acute renal failure, coagulopathies and adult respiratory distress syndrome. A multidisciplinary approach to management is practised and specialist interventions included haemofiltration and haemodialysis (18%) and radiological arterial embolisation (10%). Ventilatory and inotropic support were given in 38% and 41% of patients respectively. Only one patient died on the intensive care unit, this was from multiorgan failure secondary to sepsis.

Journal Article↗
PubMed1996

Competing or complementary? Ethical considerations and the quality of randomized trials.

The ethical principles of beneficence (doing the best for one's patients and clients), nonmaleficence (doing no harm), autonomy, justice, and equity, are positively associated with the quality of a trial rather than being opposed to it. Ethical considerations involve such important questions as appropriate design and documentation, participation rates, withdrawals or losses to follow-up, careful monitoring of safety and efficacy, timely completion, generalizability, and publication and dissemination of findings. When conflicts between ethical considerations and the trial's scientific quality do occur, the ethical considerations must be paramount.

Ethics Committees↗
PubMed1996

Visits to medical practitioners in the first 6 months of life.

OBJECTIVE: To assess the use of medical practitioners' services by mothers and their babies in the 6 months following childbirth. METHODOLOGY: Aggregated Medicare data detailing medical practitioner services provided to a random sample of 650 Victorian babies born between 1 March and 31 May 1993 and their mothers were obtained from the Health Insurance Commission. This provided data on services provided between March and December of 1993 to the selected cohort. Services provided by the public hospital system to mothers and babies are not included. RESULTS: Mothers and babies in the sample used 6404 medical practitioner services in the 6 months following birth; 57% of services were to babies, 43% to mothers. Of the 6404 medical practitioner services 5042(79%) were provided by general practitioners (GP), 804(12%) by paediatricians, 319(5%) by obstetricians and 239(4%) by 'other' specialists. The mean number of visits to a GP by mothers was 3.5 and by babies was 4.2 in the 6 months following birth. General practitioners were more likely to be vocationally registered and there were differences in the item numbers charged between those who were vocationally registered and those who were not. The length of GP consultation differed significantly between mothers' and babies' visits. CONCLUSIONS: A previously undocumented level of postnatal use of medical practitioner services is presented. It suggests a significant level of postnatal maternal and infant morbidity that requires further study.

Family Practice↗
PubMed1996

Mothers' knowledge of the risk factors and anxiety about SIDS.

OBJECTIVE: To assess the impact on mothers' knowledge and anxiety of the 1991-92 health promotion campaign on Sudden Infant Death Syndrome (SIDS) risk factors. METHODOLOGY: A telephone survey of a population based sample of 339 mothers in Victoria, Australia, conducted 1992-94. RESULTS: Recall by mothers of the risk factors for SIDS was as follows: not breast-feeding, 15%; smoking, 46%; overheating, 48%; and prone sleeping, 84%. Recall rate increased as the campaign progressed. Receiving the campaign pamphlet was associated with an increased recall of all risk factors. Discussion of the pamphlet with a health professional was rare (9%). One-third of all mothers reported being very worried about cot death when caring for their babies. Self-reported worry was significantly more common among mothers whose babies were born at the time of the campaign introduction. CONCLUSIONS: The campaign pamphlets were effective in increasing knowledge of the risk factors. The limited discussion with health professionals suggests that future campaigns need increased professional involvement to address problems, including anxiety among new mothers.

Anxiety↗
PubMed1995

Breast and ovarian cancer incidence after infertility and in vitro fertilisation.

Concern has been expressed that exposure to fertility drugs might be associated with a risk of ovarian cancer. We have examined the incidence of breast and ovarian cancer in a cohort of 10,358 women referred for in-vitro fertilisation (IVF) treatment in Victoria, Australia, between 1978 and 1992. The "exposed" group (n = 5564) had had ovarian stimulation to induce multiple folliculogenesis and the "unexposed" group (n = 4794) had been referred for IVF but were untreated or had had "natural cycle" treatment without ovarian stimulation. Duration of follow-up ranged from 1 to 15 years. Cases of cancer were determined by record linkage with data from population-based cancer registries. 34 cases of invasive breast cancer and 6 of invasive ovarian cancer were observed. A comparison with the expected numbers, derived by applying age-standardised general population rates to the cohort gave standardised incidence ratios (SIR) for breast cancer of 0.89 (95% CI 0.55-1.46) in the exposed group and 0.98 (0.62-1.56) in the unexposed group, and for ovarian cancer SIRs were 1.70 (0.55-5.27) and 1.62 (0.52-5.02), respectively. Rates of all cancers were not significantly different from general population rates. The relative risk (RR) of cancer, adjusted for age and infertility type, was, in the treated group compared with the untreated group, 1.11 (95% CI 0.56-2.20) for breast cancer and 1.45 (0.28-7.55) for ovarian cancer. The risk of body of uterus cancer was increased in the exposed and unexposed groups combined (SIR 2.84 [1.18-6.81]). Women with unexplained infertility, independent of IVF exposure, had significantly increased risks of ovarian cancer (RR = 19.19 [2.23-165.0]) and body of uterus cancer (RR = 6.34 [1.06-38.0]) compared with women with known causes of infertility. This relatively short-term follow-up suggests that ovarian stimulation with IVF is not associated with an increased risk of breast cancer. Although there was no significantly increased risk of ovarian cancer after ovarian stimulation with IVF the small number of cases limits the conclusions that can be drawn. Longer-term follow-up of large cohorts of women who have been in IVF programmes will be necessary.

Adult↗
PubMed1995

Comparison of women who do and do not have amniocentesis or chorionic villus sampling.

Even in areas where prenatal diagnostic testing is offered at no cost to women over a certain age, uptake of testing is not complete. We have studied the factors that affect uptake in Victoria, Australia. In 1988-92, 43% of 37-39-year-old women and 29% of those 40 years and over had no diagnostic testing despite their eligibility for a free test. We compared the characteristics of untested women (n = 3074) with those of tested women (2462 amniocentesis, 1575 chorionic villus sampling) by use of record-linkage between the Victorian birth register and fetal diagnosis data collection. The indication for testing was maternal age alone. Women who had had 3 or more previous births were less likely than those of lower parity to undergo testing (odds ratio 0.54 [95% CI 0.46-0.63], p < 0.001), whereas those who had had a previous termination of pregnancy were more likely to be tested than those who had not (1.52 [1.26-1.83], p < 0.001). Women born in non-English-speaking countries and women who lived in rural areas were less likely to be tested. Women who gave birth in private hospitals were more likely to be tested than those who gave birth in any public hospital or at home. These data help to distinguish between issues of choice and access to diagnostic testing. Factors that hinder testing of rural women and of those from non-English-speaking backgrounds should be addressed.

Abortion, Induced↗
PubMed1995

New estimates of Down syndrome risks at chorionic villus sampling, amniocentesis, and livebirth in women of advanced maternal age from a uniquely defined population.

Current measures of livebirth prevalence of Down syndrome are derived from data obtained up to 20 years ago, before the introduction of the prenatal diagnostic tests amniocentesis and chorionic villus sampling (CVS). For women aged 36-52 years, but who were not tested prenatally, we proposed to make a direct estimate of current livebirth prevalence of Down syndrome. We could also determine prevalence at the time of CVS and amniocentesis in women of the same age undergoing prenatal testing. Differences in these prevalences allow an estimation of the relative loss of Down syndrome during pregnancy. In Victoria, Australia, we identified 3041 women having CVS, 7504 having amniocentesis, and 13,139 having no test. Smoothed regression estimates of age-specific livebirth prevalence were found to be higher than in the early studies. The estimate of spontaneous loss was 17 per cent between the time of CVS and amniocentesis, and 18 per cent after the time of amniocentesis. The latter figure is lower than previous estimates and may be explained by a greater likelihood of a Down syndrome fetus surviving to be liveborn, given the modern approach to early obstetric intervention. These current risk estimates of livebirth may be useful updates for genetic counselling, but perhaps more importantly, may be used as precise maternal age-related risk figures, necessary in the design and implementation of prenatal screening programmes for Down syndrome.

Adult↗
PubMed1995

How midwives identify women as aboriginal or Torres Strait Islanders.

At the present time no reliable information is available about how midwives actually decide to record a person as Aboriginal or Torres Strait islander on the Perinatal Morbidity Statistics form. In 1993, Koori Health in the Department of Health and Community Services asked the Perinatal Data Collection Unit to undertake a study to determine how midwives make this decision. The study was conducted in seven country and city hospitals and two universities from August to December 1993. The hospitals ranged in size from 149 to 2359 births per year. During a routine education session the midwives were invited to take part in a focus group discussing 'Aboriginality'. Fifty-four midwives were involved in the study. Most mothers were not asked if they identified as 'Aboriginal or Torres Strait Islanders'. Midwives did ask women who they thought were 'Aboriginal' by appearance. Most midwives did not ask about 'Aboriginality' because they felt uncomfortable asking. They felt uncomfortable because they felt that both Aboriginal and non-Aboriginal women would feel ill at ease when asked if they identified as Aboriginal or Torres Strait Islanders. There were many reasons for this but they included negative perceptions of Aboriginal women. Some midwives made discriminatory comments. The conclusions of the study are that midwives need to know the reasons why they are requested to ask all women if they identify as Aboriginal or Torres Strait Islanders. Major barriers are often based on poor knowledge and understanding of definitions and issues. There was strong evidence of the existence of underlying beliefs and perceptions about Aboriginal people which 'inhibit' midwives from complying with the Data Collection Unit's explicit advice on the collection of this information.

Attitude of Health Personnel↗
PubMed1995

Method for cohort and nested case-control studies: the prevalence, timing and effectiveness of obstetric ultrasound, Victoria 1991-1992.

The study was designed to assess the effectiveness of obstetric ultrasound in the diagnosis of congenital malformations and to establish its prevalence of use and timing. Statewide data were collected in 138 of the 141 obstetric hospitals in Victoria over a 12-month period during 1991-1992. Within the final cohort of 55,226 mothers providing responses, a nested case-control study group was formed. This group comprised 719 cases (infants born with one or more malformations potentially diagnosable at 16-20 weeks) and 703 controls (non-malformed infants). The cases for the group were extracted from the Victorian Congenital Malformations Register; controls were randomly selected from the Victorian Perinatal Data Collection Unit's database. Of the 1422 in the study group, 1328 medical records were validated in 100 hospitals. The design, method, procedure, sample and outcome are described for the cohort and nested case-control studies. At the conclusion of the study it was established that major variations between the cohort and missing data were confined to mothers less likely to have had a spontaneous vaginal delivery or to those with poor perinatal outcome. There was no significant selective loss of cases or controls in the nested case-control study group.

Case-Control Studies↗
PubMed1995

Follow-up validation study of the Victorian Congenital Malformations Register.

OBJECTIVE: To determine whether there has been an improvement in ascertainment of malformations in the Victorian Congenital Malformations Register (VCMR). METHODOLOGY: The medical records of 500 children under 4 years of age admitted consecutively to two paediatric teaching hospitals in Victoria in 1992 were viewed to determine whether these cases had been notified to the Register. RESULTS: Over three-quarters of the defects recorded had been notified to VCMR. There was 100% ascertainment of chromosomal anomalies and a high proportion of major structural malformations were notified. CONCLUSION: This study repeats the validation study completed in 1986 and shows marked improvement in ascertainment of malformations in the VCMR by 1992.

Child, Preschool↗