Women want to see the same health provider during pregnancy, birth and beyond
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Hazel Keedle, Western Sydney University and Hannah Dahlen, Western Sydney University
In theory, pregnant women in Australia can choose the type of health provider they see during pregnancy, labour and after they give birth. But this is often dependent on where you live and how much you can afford in out-of-pocket costs.
While standard public hospital care is the most common in Australia, accounting for 40.9% of births, the other main options are:
- GP shared care, where the woman sees her GP for some appointments (15% of births)
- midwifery continuity of care in the public system, often called midwifery group practice or caseload care, where the woman sees the same midwife of team of midwives (14%)
- private obstetrician care (10.6%)
- private midwifery care (1.9%).
Given the choice, which model would women prefer?
Our new research, published BMC Pregnancy and Childbirth, found women favoured seeing the same health provider throughout pregnancy, in labour and after they have their baby – whether that’s via midwifery group practice, a private midwife or a private obstetrician.
Assessing strengths and limitations
We surveyed 8,804 Australian women for the Birth Experience Study (BESt) and 2,909 provided additional comments about their model of maternity care. The respondents were representative of state and territory population breakdowns, however fewer respondents were First Nations or from culturally or linguistically diverse backgrounds.
We analysed these comments in six categories – standard maternity care, high-risk maternity care, GP shared care, midwifery group practice, private obstetric care and private midwifery care – based on the perceived strengths and limitations for each model of care.
Overall, we found models of care that were fragmented and didn’t provide continuity through the pregnancy, birth and postnatal period (standard care, high risk care and GP shared care) were more likely to be described negatively, with more comments about limitations than strengths.
What women thought of standard maternity care in hospitals
Women who experienced standard maternity care, where they saw many different health care providers, were disappointed about having to retell their story at every appointment and said they would have preferred continuity of midwifery care.
Positive comments about this model of care were often about a midwife or doctor who went above and beyond and gave extra care within the constraints of a fragmented system.
The model of care with the highest number of comments about limitations was high-risk maternity care. For women with pregnancy complications who have their baby in the public system, this means seeing different doctors on different days.
Some respondents received conflicting advice from different doctors, and said the focus was on their complications instead of their pregnancy journey. One woman in high-risk care noted:
The experience was very impersonal, their focus was my cervix, not preparing me for birth.
Why women favoured continuity of care
Overall, there were more positive comments about models of care that provided continuity of care: private midwifery care, private obstetric care and midwifery group practice in public hospitals.
Women recognised the benefits of continuity and how this included informed decision-making and supported their choices.
The model of care with the highest number of positive comments was care from a privately practising midwife. Women felt they received the “gold standard of maternity care” when they had this model. One woman described her care as:
Extremely personable! Home visits were like having tea with a friend but very professional. Her knowledge and empathy made me feel safe and protected. She respected all of my decisions. She reminded me often that I didn’t need her help when it came to birthing my child, but she was there if I wanted it (or did need it).
However, this is a private model of care and women need to pay for it. So there are barriers in accessing this model of care due to the cost and the small numbers working in Australia, particularly in regional, rural and remote areas, among other barriers.
Women who had private obstetricians were also positive about their care, especially among women with medical or pregnancy complications – this type of care had the second-highest number of positive comments.
This was followed by women who had continuity of care from midwives in the public system, which was described as respectful and supportive.
However, one of the limitations about continuity models of care is when the woman doesn’t feel connected to her midwife or doctor. Some women who experienced this wished they had the opportunity to choose a different midwife or doctor.
What about shared care with a GP?
While shared care between the GP and hospital model of care is widely promoted in the public maternity care system as providing continuity, it had a similar number of negative comments to those who had fragmented standard hospital care.
Considering there is strong evidence about the benefits of midwifery continuity of care, and this model of care appears to be most acceptable to women, it’s time to expand access so all Australian women can access continuity of care, regardless of their location or ability to pay.
Hazel Keedle, Senior Lecturer of Midwifery, Western Sydney University and Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Oxygen Advantage – by Patrick McKeown
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You probably know to breathe through your nose, and use your diaphragm. What else does this book have to offer?
A lot of the book is aimed at fixing specific problems, and optimizing what can be optimized—including with tips and tricks you may not have encountered before. Yet, the offerings are not bizarre either; we don’t need to learn to breathe through our ears while drinking a glass of water upside down or anything.
Rather, such simple things as improving one’s VO₂Max by occasionally holding one’s breath while walking briskly. But, he advises specifically, this should be done by pausing the breath halfway through the exhalation (a discussion of the ensuing physiological response is forthcoming).
Little things like that are woven throughout the book, whose style is mostly anecdotal rather than hard science, yet is consistent with broad scientific consensus in any case.
Bottom line: if you’ve any reason to think your breathing might be anything less than the best it could possibly be, this book is likely to help you to tweak it to be a little better.
Click here to check out The Oxygen Advantage, and get yours!
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You’ve Got Questions? We’ve Got Answers!
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From Cucumbers To Kindles
Q: Where do I get cucumber extract?
A: You can buy it from BulkSupplements.com (who, despite their name, start at 100g packs)
Alternatively: you want it as a topical ointment (for skin health) rather than as a dietary supplement (for bone and joint health), you can extract it yourself! No, it’s not “just juice cucumbers”, but it’s also not too tricky.
Click Here For A Quick How-To Guide!
Q: Tips for reading more and managing time for it?
A: We talked about this a little bit in yesterday’s edition, so you may have seen that, but aside from that:
- If you don’t already have one, consider getting a Kindle or similar e-reader. They’re very convenient, and also very light and ergonomic—no more wrist strain as can occur with physical books. No more eye-strain, either!
- Consider making reading a specific part of your daily routine. A chapter before bed can be a nice wind-down, for instance! What’s important is it’s a part of your day that’ll always, or at least almost always, allow you to do a little reading.
- If you drive, walk, run, or similar each day, a lot of people find that’s a great time to listen to an audiobook. Please be safe, though!
- If your lifestyle permits such, a “reading retreat” can be a wonderful vacation! Even if you only “retreat” to your bedroom, the point is that it’s a weekend (or more!) that you block off from all other commitments, and curl up with the book(s) of your choice.
Q: Any study tips as we approach exam season? A lot of the productivity stuff is based on working life, but I can’t be the only student!
A: We’ve got you covered:
- Be passionate about your subject! We know of no greater study tip than that.
- Find a willing person and lecture them on your subject. When one teaches, two learn!
- Your mileage may vary depending on your subject, but, find a way of studying that’s fun to you!
- If you can get past papers, get as many as you can, and use those as your “last minute” studying in the week before your exam(s). This will prime you for answering exam-style questions (and leverage state-dependent memory). As a bonus, it’ll also help ease any anxiety, because by the time of your exam it’ll be “same old, same old”!
Q: Energy drinks for biohacking, yea or nay?
A: This is definitely one of those “the dose makes the poison” things!
- Caffeine, in and of itself, can be healthy in moderation for most people.
- Taurine has assorted benefits at safe dosages:
- Other ingredients often have health benefits too.
But… The generally agreed safe dose of taurine is around 3g/day for most people; a standard Red Bull contains 1g.
That math would be simple, but… if you eat meat (including poultry or fish), that can also contain 10–950mg per 100g. For example, tuna is at the high end of that scale, with a standard 12oz (340g) tin already containing up to 3.23g of taurine!
And sweetened carbonated beverages in general have so many health issues that it’d take us a full article to cover them.
Short version? Enjoy in moderation if you must, but there are definitely better ways of getting the benefits they may offer.
Q: Best morning routine?
A: The best morning routine is whatever makes you feel most ready to take on your day!
This one’s going to vary a lot—one person’s morning run could be another person’s morning coffee and newspaper, for example.
In a nutshell, though, ask yourself these questions:
- How long does it take me to fully wake up in the morning, and what helps or hinders that?
- When I get out of bed, what do I really need before I can take on my day?
- If I could have the perfect morning, what would it look like?
- What can evening me do, to look after morning me’s best interests? (Semi-prepare breakfast ready? Lay out clothes ready? Running shoes? To-Do list?)
Q: I’m curious how much of these things you actually use yourselves, and are there any disagreements in the team? In a lot of places things can get pretty heated when it’s paleo vs vegan / health benefits of tea/coffee vs caffeine-abstainers / you need this much sleep vs rise and grinders, etc?
A: We are indeed genuinely enthusiastic about health and productivity, and that definitely includes our own! We may or may not all do everything, but between us, we probably have it all covered. As for disagreements, we’ve not done a survey, but if you take an evidence-based approach, any conflict will tend to be minimized. Plus, sometimes you can have the best of both!
- You could have a vegan paleo diet (you’d better love coconut if you do, though!
- There is decaffeinated coffee and tea (your taste may vary)
- You can get plenty of sleep and rise early (so long as an “early to bed, early to rise” schedule suits you!)
Interesting note: humans are social creatures on an evolutionary level. Evolution has resulted in half of us being “night owls” and the other half “morning larks”, the better to keep each other safe while sleeping. Alas, modern life doesn’t always allow us to have the sleep schedule that’d suit each of us best individually!
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154 million lives saved in 50 years: 5 charts on the global success of vaccines
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We know vaccines have been a miracle for public health. Now, new research led by the World Health Organization has found vaccines have saved an estimated 154 million lives in the past 50 years from 14 different diseases. Most of these have been children under five, and around two-thirds children under one year old.
In 1974 the World Health Assembly launched the Expanded Programme on Immunization with the goal to vaccinate all children against diphtheria, tetanus, pertussis (whooping cough), measles, polio, tuberculosis and smallpox by 1990. The program was subsequently expanded to include several other diseases.
The modelling, marking 50 years since this program was established, shows a child aged under ten has about a 40% greater chance of living until their next birthday, compared to if we didn’t have vaccines. And these positive effects can be seen well into adult life. A 50-year-old has a 16% greater chance of celebrating their next birthday thanks to vaccines.
What the study did
The researchers developed mathematical and statistical models which took in vaccine coverage data and population numbers from 194 countries for the years 1974–2024. Not all diseases were included (for example smallpox, which was eradicated in 1980, was left out).
The analysis includes vaccines for 14 diseases, with 11 of these included in the Expanded Programme on Immunization. For some countries, additional vaccines such as Japanese encephalitis, meningitis A and yellow fever were included, as these diseases contribute to major disease burden in certain settings.
The models were used to simulate how diseases would have spread from 1974 to now, as vaccines were introduced, for each country and age group, incorporating data on increasing vaccine coverage over time.
Children are the greatest beneficiaries of vaccines
Since 1974, the rates of deaths in children before their first birthday has more than halved. The researchers calculated almost 40% of this reduction is due to vaccines.
The effects have been greatest for children born in the 1980s because of the intensive efforts made globally to reduce the burden of diseases like measles, polio and whooping cough.
Some 60% of the 154 million lives saved would have been lives lost to measles. This is likely due to its ability to spread rapidly. One person with measles can spread the infection to 12–18 people.
The study also found some variation across different parts of the world. For example, vaccination programs have had a much greater impact on the probability of children living longer across low- and middle-income countries and settings with weaker health systems such as the eastern Mediterranean and African regions. These results highlight the important role vaccines play in promoting health equity.
Vaccine success is not assured
Low or declining vaccine coverage can lead to epidemics which can devastate communities and overwhelm health systems.
Notably, the COVID pandemic saw an overall decline in measles vaccine coverage, with 86% of children having received their first dose in 2019 to 83% in 2022. This is concerning because very high levels of vaccination coverage (more than 95%) are required to achieve herd immunity against measles.
In Australia, the coverage for childhood vaccines, including measles, mumps and rubella, has declined compared to before the pandemic.
This study is a reminder of why we need to continue to vaccinate – not just against measles, but against all diseases we have safe and effective vaccines for.
The results of this research don’t tell us the full story about the impact of vaccines. For example, the authors didn’t include data for some vaccines such as COVID and HPV (human papillomavirus). Also, like with all modelling studies, there are some uncertainties, as data was not available for all time periods and countries.
Nonetheless, the results show the success of global vaccination programs over time. If we want to continue to see lives saved, we need to keep investing in vaccination locally, regionally and globally.
Meru Sheel, Associate Professor and Epidemiologist, Infectious Diseases, Immunisation and Emergencies Group, Sydney School of Public Health, University of Sydney and Alexandra Hogan, Mathematical epidemiologist, UNSW Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Sarah Raven’s Garden Cookbook – by Sarah Raven
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Note: the US Amazon site currently (incorrectly) lists the author as “Jonathan Buckley”. The Canadian, British, and Australian sites all list the author correctly as Sarah Raven, and some (correctly) credit Jonathan Buckley as the photographer she used.
First, what it’s not: a gardening book. Beyond a few helpful tips, pointers, and “plant here, harvest here” instructions, this book assumes you are already capable of growing your own vegetables.
She does assume you are in a temperate climate, so if you are not, this might not be the book for you. Although! The recipes are still great; it’s just you’d have to shop for the ingredients and they probably won’t be fresh local produce for the exact same reason that you didn’t grow them.
If you are in a temperate climate though, this will take you through the year of seasonal produce (if you’re in a temperate climate but it’s in for example Australia, you’ll need to make a six-month adjustment for being in the S. Hemisphere), with many recipes to use not just one ingredient from your garden at a time, but a whole assortment, consistent with the season.
About the recipes: they (which are 450 in number) are (as you might imagine) very plant-forward, but they’re generally not vegan and often not vegetarian. So, don’t expect that you’ll produce everything yourself—just most of the ingredients!
Bottom line: if you like cooking, and are excited by the idea of growing your own food but are unsure how regularly you can integrate that, this book will keep you happily busy for a very long time.
Click here to check out Sarah Raven’s Garden Cookbook, and level-up your home cooking!
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Dating apps could have negative effects on body image and mental health, our research shows
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Around 350 million people globally use dating apps, and they amass an estimated annual revenue of more than US$5 billion. In Australia, 49% of adults report using at least one online dating app or website, with a further 27% having done so in the past.
But while dating apps have helped many people find romantic partners, they’re not all good news.
In a recent review, my colleagues and I found using dating apps may be linked to poorer body image, mental health and wellbeing.
Dikushin Dmitry/Shutterstock We collated the evidence
Our study was a systematic review, where we collated the results of 45 studies that looked at dating app use and how this was linked to body image, mental health or wellbeing.
Body image refers to the perceptions or feelings a person has towards their own appearance, often relating to body size, shape and attractiveness.
Most of the studies we included were published in 2020 onwards. The majority were carried out in Western countries (such as the United States, the United Kingdom and Australia). Just under half of studies included participants of all genders. Interestingly, 44% of studies observed men exclusively, while only 7% included just women.
Of the 45 studies, 29 looked at the impact of dating apps on mental health and wellbeing and 22 considered the impact on body image (some looked at both). Some studies examined differences between users and non-users of dating apps, while others looked at whether intensity of dating app use (how often they’re used, how many apps are used, and so on) makes a difference.
More than 85% of studies (19 of 22) looking at body image found significant negative relationships between dating app use and body image. Just under half of studies (14 of 29) observed negative relationships with mental health and wellbeing.
The studies noted links with problems including body dissatisfaction, disordered eating, depression, anxiety and low self-esteem.
Dating apps are becoming increasingly common. But could their use harm mental health? Rachata Teyparsit/Shutterstock It’s important to note our research has a few limitations. For example, almost all studies included in the review were cross-sectional – studies that analyse data at a particular point in time.
This means researchers were unable to discern whether dating apps actually cause body image, mental health and wellbeing concerns over time, or whether there is simply a correlation. They can’t rule out that in some cases the relationship may go the other way, meaning poor mental health or body image increases a person’s likelihood of using dating apps.
Also, the studies included in the review were mostly conducted in Western regions with predominantly white participants, limiting our ability to generalise the findings to all populations.
Why are dating apps linked to poor body image and mental health?
Despite these limitations, there are plausible reasons to expect there may be a link between dating apps and poorer body image, mental health and wellbeing.
Like a lot of social media, dating apps are overwhelmingly image-centric, meaning they have an emphasis on pictures or videos. Dating app users are initially exposed primarily to photos when browsing, with information such as interests or hobbies accessible only after manually clicking through to profiles.
Because of this, users often evaluate profiles based primarily on the photos attached. Even when a user does click through to another person’s profile, whether or not they “like” someone may still often be determined primarily on the basis of physical appearance.
This emphasis on visual content on dating apps can, in turn, cause users to view their appearance as more important than who they are as a person. This process is called self-objectification.
People who experience self-objectification are more likely to scrutinise their appearance, potentially leading to body dissatisfaction, body shame, or other issues pertaining to body image.
Dating apps are overwhelmingly image-centric. Studio Romantic/Shutterstock There could be several reasons why mental health and wellbeing may be impacted by dating apps, many of which may centre around rejection.
Rejection can come in many forms on dating apps. It can be implied, such as having a lack of matches, or it can be explicit, such as discrimination or abuse. Users who encounter rejection frequently on dating apps may be more likely to experience poorer self-esteem, depressive symptoms or anxiety.
And if rejection is perceived to be based on appearance, this could lead again to body image concerns.
What’s more, the convenience and game-like nature of dating apps may lead people who could benefit from taking a break to keep swiping.
What can app developers do? What can you do?
Developers of dating apps should be seeking ways to protect users against these possible harms. This could, for example, include reducing the prominence of photos on user profiles, and increasing the moderation of discrimination and abuse on their platforms.
The Australian government has developed a code of conduct – to be enforced from April 1 this year – to help moderate and reduce discrimination and abuse on online dating platforms. This is a positive step.
Despite the possible negatives, research has also found dating apps can help build confidence and help users meet new people.
If you use dating apps, my colleagues and I recommend choosing profile images you feel display your personality or interests, or photos with friends, rather than semi-clothed images and selfies. Engage in positive conversations with other users, and block and report anyone who is abusive or discriminatory.
It’s also sensible to take breaks from the apps, particularly if you’re feeling overwhelmed or dejected.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. The Butterfly Foundation provides support for eating disorders and body image issues, and can be reached on 1800 334 673.
Zac Bowman, PhD Candidate, College of Education, Psychology & Social Work, Flinders University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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NADᐩ Against Aging
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Nicotinamide adenine dinucleotide, or “NAD” to its friends, is a coenzyme produced in the human body (amongst other places), and it is critical for cellular energy metabolism, but there’s more to it than that.
Today we’ll be looking mostly at NAD+, of which the + indicates the positive formal charge of one of its nitrogen atoms. We won’t get too much into the chemistry of this, but we will mention that it’s a cofactor with NADH—the former accepting electrons and the latter donating electrons.
Both NAD+ and NADH are critical to good health, but we’re going to focus on NAD+ for the simple reason that it gets depleted with aging.
Note: it gets depleted with aging.
Chronological age is not so important here, but there is a direct relationship between biological aging and NAD+ depletion.
For example, healthy centenarians tend not to have depleted NAD+ levels. Further, its depletion (in those in whom it is depleted) is then a causal factor for many age-related diseases:
❝Remarkably, ageing is accompanied by a gradual decline in tissue and cellular NAD+ levels in multiple model organisms, including rodents and humans.
This decline in NAD+ levels is linked causally to numerous ageing-associated diseases, including cognitive decline, cancer, metabolic disease, sarcopenia and frailty.
Many of these ageing-associated diseases can be slowed down and even reversed by restoring NAD+ levels.❞
~ Dr. Rosalba Perrone et al.
Read in full: NAD+ metabolism and its roles in cellular processes during ageing
As for restoring those NADᐩ levels, that does help in interventional trials, whether by supplementing directly, or with NAD precursors*:
❝NAD+ levels steadily decline with age, resulting in altered metabolism and increased disease susceptibility.
Restoration of NAD+ levels in old or diseased animals can promote health and extend lifespan, prompting a search for safe and efficacious NAD-boosting molecules that hold the promise of increasing the body’s resilience, not just to one disease, but to many, thereby extending healthy human lifespan.❞
~ Dr. David Sinclair et al.
Read more: Therapeutic Potential of NAD-Boosting Molecules: The In Vivo Evidence
*There are actually also other NAD-boosting molecules besides NAD itself and its precursors. For example, the liver will not produce NADᐩ unless it has aminocarboxymuconate-semialdehyde decarboxylase (or “ACMSD”, to its friends), which limits the production of NADᐩ. Why, you ask? The theory is that it is a kind of evolutionary conservativism, much like not lighting a fire without the ability to put it out. In any case, taking ACMSD-blockers will thus result in an increased endogenous production of NADᐩ.
You can read about this here:
De novo NAD+ synthesis enhances mitochondrial function and improves health
Nor is taking supplements or drugs the only way to get more of it; there’s an enzyme nicotinamide phosphoribosyltransferase (“NAMPT”, to its friends) involved in the synthesis of NADᐩ, and exercise boosts levels by 127% (i.e., it more than doubles the levels), based on a modest three-week exercise bike regimen:
Skeletal muscle NAMPT is induced by exercise in humans
And to underline that point, another study found that resistance training (so, a different kind of exercise from that of the previous study) boosts levels of NADᐩ itself by the same 127%:
One way to get more out of NADᐩ
We’ll get straight to the point: it works very well paired with a senolytic agent, i.e. something that kills aging cells so that they get recycled sooner:
NAD+, Senolytics, or Pyruvate for Healthy Aging?
To read more about senolytics, check out:
Fisetin: The Anti-Aging Assassin
Want to try some?
We don’t sell it, but here for your convenience is an example product on Amazon 😎
Enjoy!
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