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Biomedical subjects

Robin Bell

Publications and source records attributed to Robin Bell.

12 recordsLinked to original sources
PubMed2006

Evaluation of a decision aid for prenatal testing of fetal abnormalities: a cluster randomised trial [ISRCTN22532458].

BACKGROUND: By providing information on the relative merits and potential harms of the options available and a framework to clarify preferences, decision aids can improve knowledge and realistic expectations and decrease decisional conflict in individuals facing decisions between alternative forms of action. Decision-making about prenatal testing for fetal abnormalities is often confusing and difficult for women and the effectiveness of decision aids in this field has not been established. This study aims to test whether a decision aid for prenatal testing of fetal abnormalities, when compared to a pamphlet, improves women's informed decision-making and decreases decisional conflict. METHODS/DESIGN: A cluster designed randomised controlled trial is being conducted in Victoria, Australia. Fifty General Practitioners (GPs) have been randomised to one of two arms: providing women with either a decision aid or a pamphlet. The two primary outcomes will be measured by comparing the difference in percentages of women identified as making an informed choice and the difference in mean decisional conflict scores between the two groups. Data will be collected from women using questionnaires at 14 weeks and 24 weeks gestation. The sample size of 159 women in both arms of the trial has been calculated to detect a difference of 18% (50 to 68%) in informed choice between the two groups. The required numbers have been adjusted to accommodate the cluster design, miscarriage and participant lost--to--follow up. Baseline characteristics of women will be summarised for both arms of the trial. Similarly, characteristics of GPs will be compared between arms. Differences in the primary outcomes will be analysed using 'intention-to-treat' principles. Appropriate regression techniques will adjust for the effects of clustering and include covariates to adjust for the stratifying variable and major potential confounding factors. DISCUSSION: The findings from this trial will make a significant contribution to improving women's experience of prenatal testing and will have application to a variety of maternity care settings. The evaluation of a tailored decision aid will also have implications for pregnancy care providers by identifying whether or not such a resource will support their role in providing prenatal testing information.

Cluster Analysis↗
PubMed2006

Androgen physiology.

Androgen receptors are present in numerous tissues throughout the female body, and knowledge of the specific actions of androgens at different sites is increasing, along with the understanding of their contribution to various pathophysiological states. This article reviews the physiology of androgens (testosterone and dihydrotestosterone) and immediate androgen precursors (dehydroepiandrosterone [DHEA], dehydroepiandrosterone sulfate [DHEAS], and androstenedione), with specific reference to the androgen receptor, production and metabolism of C- (19) steroids, circulating androgen concentrations, and androgen actions. In addition, the evidence for physiological modulation of androgens including circadian variation, cyclical variation, age, and natural menopause is reviewed.

Adolescent↗
PubMed2005

Differential expression of factors involved in fat metabolism with age and the menopause transition.

OBJECTIVES: Changes in the hormonal milieu at the menopause are associated with an increase in total adiposity and a more android pattern of fat distribution, with the latter associated with an increased risk of the metabolic syndrome. The aim of this study was to explore potential mechanisms that might contribute to the changes in body composition associated with the menopause transition. METHODS: Using real-time PCR analysis, we have compared the expression of various factors involved in fat metabolism in subcutaneous abdominal and gluteal fat in premenopausal (Group 1; n=11), postmenopausal (Group 2; n=10) and postmenopausal women taking estrogen therapy (Group 3; n=10). RESULTS: All subjects were of normal body mass index, euglycemic and normolipemic. The postmenopausal women were older (Group 1, 43.1+5.0 versus Groups 2 and 3, 57.9+/-7.4 years, P<0.001 and 56.1+/-4.5 years, P<0.001, respectively). Expression analysis revealed that levels of transcripts encoding adiponectin, peroxisome proliferator-activated receptor gamma and fatty acid transporter, each associated with insulin sensitivity, were significantly greater in gluteal fat from estrogen deplete postmenopausal women than in fat from the other two groups (P<0.05). In contrast, levels of transcripts for acetyl CoA carboxylase alpha, long chain acyl CoA dehydrogenase and hormone sensitive lipase were significantly greater in abdominal fat from premenopausal women than either postmenopausal groups (P<0.05). CONCLUSIONS: These findings indicate both aging and the menopause transition are associated with changes in fat metabolism, which may contribute to the accumulation of body fat after menopause.

Acetyl-CoA Carboxylase↗
PubMed2005

Measurement of total testosterone in women: comparison of a direct radioimmunoassay versus radioimmunoassay after organic solvent extraction and celite column partition chromatography.

OBJECTIVE: To evaluate the clinical usefulness for the measurement of testosterone (T) values in the "low" female range with a direct radioimmunoassay (RIA) for total T by comparing total T values measured by this assay with values determined by conventional RIA after organic solvent extraction/column chromatography. DESIGN: Cross-sectional study. SETTING: Victoria, Australia. PATIENT(S): Two hundred fifty-nine healthy women, aged 18-75 years, recruited from the community. INTERVENTION(S): Fasting serum samples were obtained and stored at -80 degrees C. MAIN OUTCOME MEASURE(S): Total T measurement. Total T was measured by the direct RIA method using antibody-coated tubes and iodine-labeled T tracer. For comparison, total T levels were also measured using the conventional RIA method after organic solvent (ethyl acetate:hexane [3:2]) extraction and celite column partition chromatography before RIA. RESULT(S): The mean T level by direct RIA was 0.76 nmol/L (median, 0.70; SD, 0.54; minimum, 0.10; maximum, 3.2). The mean difference between the two measurements (direct RIA - conventional RIA) was -0.28 (SD, 0.3). The direct RIA value was 63% (95% confidence interval, 26%-155%) of the conventional RIA estimate. For the classification of values at the lower end of the range, there was very good agreement beyond chance (kappa = 0.68-0.74) for values in approximately the lowest 10th-40th percentiles. CONCLUSION(S): The direct RIA is a clinically useful assay for the study of the issue of "low" T within the female population.

Adolescent↗
PubMed2005

Adipose aromatase gene expression is greater in older women and is unaffected by postmenopausal estrogen therapy.

OBJECTIVE: Although natural menopause is associated with loss of ovarian estrogen production, this life phase is followed by a significant increase in estrogen-related cancers, namely breast and endometrial cancer. These tissues, as well as adipose, skeletal, and vascular tissues and the brain are important sites of postmenopausal estrogen production. Circulating C19 steroid precursors are essential substrates for extragonadal estrogen synthesis; however, the levels of these androgenic precursors decline markedly with advancing age. This implies an increase in capacity for extragonadal tissues to produce estrogen with age. DESIGN: To explore this, and the effects of the menopause transition and postmenopausal estrogen therapy on extragonadal estrogen biosynthesis, we have compared the expression of the aromatase gene and estrogen (ER) and androgen receptors (AR) in subcutaneous abdominal and gluteal fat taken from premenopausal (group 1: n = 11), postmenopausal (group 2: n = 10), and postmenopausal women taking estrogen therapy (group 3: n = 10). All subjects were of normal body mass index, euglycemic, and normolipemic. RESULTS: The postmenopausal women were older (group 1, 43.1 +/- 5.0 vs groups 2 and 3, 57.9 +/- 7.4 years, P < 0.001 and 56.1 +/- 4.5 years, P < 0.001, respectively) and had lower serum estradiol levels (group 2, 22.2 +/- 3.2 vs group 1, 442.5 +/- 248.2 pmol/L, P < 0.05), which were restored to premenopausal levels with estrogen therapy. Expression analysis revealed that levels of transcripts encoding aromatase were greater in gluteal than abdominal depots in each group in postmenopausal versus premenopausal women (P < 0.05). Use of hormone therapy did not influence aromatase gene expression in either depot. No differences were detected in the expression of ER or AR between groups of between tissue depots. CONCLUSION: Thus, the capacity of adipose tissue to produce estrogen seems to increase significantly with age at the time of menopause and to be unaltered by exogenous estrogen therapy. This difference in extragonadal estrogen production with age may play a pivotal role in the increase in estrogen-dependent malignancies in the postmenopausal years.

Adipose Tissue↗
PubMed2005

Protecting Medicare services: trials of a peer review scheme.

The Professional Services Review Scheme, established in 1994 under Pt VAA of the Health Insurance Act 1973 (Cth), is a unique attempt to apply peer standards to review of Medicare services. This article examines the evolution of the scheme in the light of extensive litigation.

Australia↗
PubMed2002

Antenatal and intrapartum antecedents of cerebral palsy: a case-control study.

AIM: To identify antenatal and intrapartum factors contributing to the aetiology of cerebral palsy (CP). METHODS: A case-control study using moderate/severe cases of cerebral palsy identified from the Victorian Cerebral Palsy Register and two controls per case identified through the Victorian Perinatal Data Collection Unit. RESULTS: A number of previously identified risk factors for CP were confirmed in our data. New observations were (in specific sub-groups): protective effects of mother's negative Rhesus status, cigarette smoking at the first visit and episiotomy and an increased risk of CP associated with an abnormal antenatal cardiotocograph. CONCLUSIONS: Although the result of the deliberate investigation of specific aspects of the antenatal and intrapartum period identified from a pilot study, our new findings must be interpreted with caution as they were not all based on specific a priori hypotheses, although some had been examined by other investigators. We would encourage their evaluation in other data sets.

Adult↗
PubMedDate not supplied

Climacteric symptoms among indigenous Australian women and a model for the use of culturally relevant art in health promotion.

OBJECTIVE: To evaluate climacteric symptoms among rural and remote, indigenous Australian women and to develop culturally relevant women's health midlife educational material. DESIGN: A cross-sectional pilot survey based on structured interviews of women older than 18 years of age who were available for interview and willing to participate. The study was conducted in the Kimberley region of Western Australia and southwestern Victoria between February and June 1999. Health issues central to the local community were identified by the structured survey. Development of culturally relevant information involved collaboration between indigenous women and indigenous artists, health workers, educators, and ourselves. Traditional health themes in art form were then linked with specific health issues to be addressed. Health messages were translated by Aboriginal women and health workers into both traditional language and vernacular, to target all women. RESULTS: Fifty-five women completed the survey. Thirty-eight were premenopausal, 4 were perimenopausal, and 13 were postmenopausal. The 4 perimenopausal women and 9 of the 13 postmenopausal women had climacteric symptoms, but none had been prescribed systemic or local hormonal therapy. Rates of obesity, diabetes mellitus, and hypertension were high. Midlife women's health booklets were produced in collaboration with Aboriginal elders and artists to communicate preventive health information in a visual context familiar to Aboriginal people of the Kimberley and surrounding communities. CONCLUSIONS: In contrast to the case in other non-Caucasian populations, climacteric symptoms seem to be common among Australian indigenous women and are apparently untreated. Aboriginal art and language has been employed in the development of culturally appropriate health promotion literature for Aboriginal communities in the Kimberley region of Western Australia. This process of collaboration provides a useful model for addressing women's health issues in other culturally diverse populations.

Adult↗