ABSTRACT Background Hysteroscopy is a common minor gynaecological procedure that is increasingly being performed in an outpatient setting. There is currently no effective evidence‐based strategy for managing pain in women undergoing hysteroscopy. It is anticipated that most people will experience mild to moderate pain; however, the literature reports varying numbers of women, up to 40%, who experience severe pain during outpatient hysteroscopy. Aim This paper reports the qualitative results of interviews with 10 participants in a single‐centre mixed‐methods cohort study in New Zealand to understand women's experiences of hysteroscopy. Methods Data from semi‐structured interviews were analysed using Qualitative Description. Results Three themes describe the participants' experiences of hysteroscopy. Should it hurt? Expectations of the procedure; I did not realize that was an option: control of pain; and right information, at the right time. Conclusions Although women experience varying levels of pain during hysteroscopy, their experience of the procedure may be influenced by their expectations of pain, their perception of control over their pain management, and how and when they receive information. Providing information in a range of formats prior, during, and after the procedure may help reduce anxiety and set more accurate expectations. Considering a range of pain relief options during hysteroscopy, including non‐pharmacological methods, and ensuring they are readily available in the procedure room may help women better manage their pain or actively participate in pain management and distraction strategies, ultimately enhancing their sense of control.
Abstract We develop a theory of policy advice that focuses on the relationship between the competence of the advisor (e.g., an expert bureaucracy) and the quality of advice that the leader may expect. We describe important tensions between these features present in a wide class of substantively important circumstances. These tensions point to the presence of a trade‐off between receiving advice more often and receiving more informative advice. The optimal realization of this trade‐off for the leader sometimes induces her to prefer advisors of limited competence—a preference that, we show, is robust under different informational assumptions. We consider how institutional tools available to leaders affect preferences for advisor competence and the quality of advice they may expect to receive in equilibrium.
ABSTRACT Objective This case study describes the contributions made by the Broken Hill University Department of Rural Health (BHUDRH) to improving child health care access and health outcomes over almost three decades. Background Compared to their metropolitan counterparts, rural and remote children experience persistent inequities in health, development, and education, exacerbated by environmental and service access challenges. Methods A retrospective synthesis of program documentation, evaluation reports, and peer‐reviewed literature relating to four major BHUDRH‐supported initiatives: lead management programs, the Allied Health in Outback Schools Program, School Health Hubs, and the School‐Based Primary Health Care Registered Nurse initiative was undertaken. Findings The BHUDRH contributed to the development and delivery of child health services through investments in program development; research and evaluation; workforce development; and service delivery. The BHUDRH used its intellectual capital to help guide these developments through leadership and cross sector collaboration; governance and oversight; and securing funding for infrastructure development. Outcomes included a 75% reduction in average blood lead levels; access to allied health services for approximately 150 school children annually; establishment of $4.7M School Health Hub infrastructure across seven primary schools; and creation of a new workforce of school‐embedded primary health care nurses. Conclusion This case study demonstrates how UDRHs act as catalysts for sustained, system‐level change in response to community‐identified health priorities. Lessons from Broken Hill highlight the value of university‐community partnerships, research translation, and cross‐sector governance in addressing complex rural health inequities. These contributions highlight the significant contributions made by UDRHs in rural contexts beyond health workforce parameters.
ABSTRACT Background Epidemiological studies have reported an association between advanced paternal age at conception and an increased risk of neurodevelopmental disorders in offspring, such as autism spectrum disorder. Evidence suggests that DNA methylation alterations in spermatozoa of older men may be transmitted to the feto‐placental unit and associated with offspring brain development and behavioral differences later in childhood. Objective We aimed to assess the association of advanced paternal age with DNA methylation alterations in the human placenta and compare the results to previous findings in spermatozoa. Methods For this study, 64 placenta samples from the Design, Develop, and Discover (3D) prospective birth cohort study were categorized based on paternal age at conception. DNA methylation of the placenta was interrogated using the Illumina 850K array. There were no differentially methylated sites found to be statistically significant after correction for multiple comparisons, therefore sites with significant nominal p values < 0.05 were assessed and used to define differentially methylated regions (DMRs) associated with genes. Results Advanced paternal age was associated with DNA methylation alterations in the placenta at up to 688 genes, with a predominance of hypomethylation (65%), including at eight imprinted loci. About 7% of genes with age‐associated DNA methylation changes in placenta overlapped with genes previously reported to show altered DNA methylation in spermatozoa of older men; seven genes common to placenta and spermatozoa had previously been identified in association with susceptibility to autism spectrum disorder. Among loci most affected, we found evidence of sex‐specific hypermethylation at genes linked to neurodevelopment ( GRM7 , EBF3 , FOXG1 ). Conclusion Our findings suggest that advanced paternal age at conception correlates with altered DNA methylation at a small number of loci in the human placenta, notably affecting genes involved in neurodevelopment. This study highlights the use of the placenta DNA methylome as a surrogate marker for the potential impact of advanced paternal age on the child.
ABSTRACT Background The nasoseptal flap is commonly used in the reconstruction of the anterior skull base following sinonasal tumor resection, but has limitations in its use. Methods A retrospective case series at a quaternary referral center involved 13 consecutive anterior skull base resections reconstructed with a pericranial flap. Data collection included patient demographics, type of resection (endoscopic/open/combined), length of stay, follow‐up and complications. The primary outcome was the cerebrospinal fluid (CSF) leakage rate and the secondary outcome was the overall complication rate. Results The median age was 64 years (range: 32–75 years), and median follow‐up was 24.8 months. Four patients (30.8%) had prior radiotherapy, and 10 patients (76.9%) had adjuvant radiotherapy. Eight patients (61.5%) underwent pure endoscopic resection, while the remaining five (38.5%) had a combined endoscopic resection with an open approach required for an orbital exenteration. None of the patients had an open craniotomy. Post‐operative CSF leakage was 7.7% ( n = 1) and the overall complication rate was 23.1% ( n = 3). In addition to the CSF leak, one patient (7.7%) experienced a tension pneumocephalus and another (7.7%) had a delayed presentation of an ascending intracranial infection. Conclusions The pericranial flap is a useful extranasal pedicled flap for reconstruction of the anterior skull base when the nasoseptal flap is not available or inadequate. Complications such as CSF leakage, tension pneumocephalus and ascending intracranial infections are uncommon, though they can be adequately managed when present.