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Background The aim of this study was to determine the long-term effect of increasing water intake in patients with autosomal dominant polycystic kidney disease (ADPKD) on longitudinal changes in health-related quality of life (HRQoL) in the setting of a clinical trial. Methods Self-completed HRQoL (using the KDQoL-SF, v.1.3 questionnaire) was assessed annually in participants of a 3-year randomized controlled clinical trial (n  = 187), allocated (1:1) either to increase water intake to reduce urine osmolality to ≤270 mosmol/kg (implemented by dietetic coaching, self-monitoring tools, text messaging) or continue usual water intake. Results Overall, 96% and 81.8% of participants (n  = 187) completed the questionnaire at the baseline and final study visits, respectively. At baseline, the physical component summary score (PCS) and mental component summary score (MCS) were similar in the two groups (P > 0.05) and the five dimensions with the lowest scores in both groups were: energy and fatigue; general and overall health; sleep; emotional well-being; and pain. Within each group, there were no longitudinal changes over time. At the final visit, the PCS was higher in the increased water intake group (51.3 ± 7.6, mean ± standard deviation) compared to the usual water intake group 48.8 ± 9.3; P = 0.037) whereas the MCS was numerically similar. The improvement in the PCS was due to higher sub-scale values for physical functioning and pain (both P < 0.05). By multivariate analysis, only baseline PCS and height-corrected total kidney volume were associated with the final PCS (P < 0.05). Conclusion HRQoL scores remained stable over a 3 year period, and were not adversely affected by the intervention to increase water intake. Future studies should evaluate the clinical significance of the higher PCS in the increased water intake group. [ABSTRACT FROM AUTHOR]

Breastfeeding is associated with reduced lifetime cardiometabolic risk, but little is known regarding the metabolic benefit in a subsequent pregnancy. The primary aim of this study was to investigate the association between breastfeeding duration and intensity and next pregnancy oral glucose tolerance test (OGTT) results. A retrospective cohort study was conducted from March 2020 to October 2022. All multiparous women who met inclusion criteria and gave birth during the study period were eligible for inclusion. Analysis was stratified by risk for gestational diabetes (GDM). High GDM risk criteria included previous GDM and BMI > 35 kg/m2. The association between breastfeeding duration and high-intensity breastfeeding (HIBF) and subsequent pregnancy OGTT were assessed with multivariate logistic models adjusted for statistically and clinically relevant covariables. There were 5374 multiparous participants who met the inclusion criteria for analysis. Of these, 61.7% had previously breastfed for >6 months, and 43.4% were at high risk for GDM. HIBF was associated with 47% reduced odds of an abnormal fasting glucose in a subsequent pregnancy OGTT (aOR 0.53; 95%CI 0.38–0.75; p < 0.01). There was no association between HIBF and other glucose results on the OGTT. Women who smoked were least likely to breastfeed at high intensity (aOR 0.31; 95%CI 0.21–0.47; p < 0.01). South Asian women had 65% higher odds of HIBF than women who identified as White/European (aOR 1.65; 1.36–2.00; p < 0.01). This study highlights the importance of exclusive breastfeeding to potentially reduce the prevalence of GDM and may also translate into long-term reduction of cardiometabolic risk. [ABSTRACT FROM AUTHOR]

Objectives. Given the continuing COVID-19 pandemic and the associated prevention and control measures implemented, the psychological burden brought by the pandemic on citizens is expected to increase. This study is aimed at exploring the predictors of depressive symptoms among Hong Kong people during the epidemic, as well as factors that could potentially alleviate the negative effects of the epidemic. Methods. The third wave follow-up survey (December 2021 to January 2022) from a longitudinal prospective survey study conducted in Hong Kong was used for a cross-sectional analysis. The participants (n = 803) are adults aged 18 and above in Hong Kong. Logistic and linear regression were performed to test the predictors and moderating effects, respectively, with depression as the outcome variable. Results. With minimized confounding effects of demographic variables, higher levels of concern about infection, experience with COVID-19 infection and previous epidemics, hassles, and trust in authority increased the odds of being depressed, while a higher level of trust in medical professionals reduced the odds of depression. Moreover, greater trust in medical professionals, as a moderator, lessened the positive associations between the levels of depression and hassles and concern about infection. Conclusions. Even though the threats of COVID-19 seem to have lowered, this study shows that a few factors associated with the pandemic continue to threaten people's mental health. However, developing greater trust in medical experts may be an effective way to relieve psychological burden. [ABSTRACT FROM AUTHOR]

Background: The association of smoking with new‐onset cardiovascular disease, chronic lung disease, malignancy and mortality in dialysis is well‐known. The smoking prevalence and its association with clinical outcome was assessed. Methods: Multicentre cohort study using 'ANZDATA' Registry, 57 838 adults who commenced dialysis (>3 months) between 1990 and 2016 were included. Patients' demographics, initial dialysis modality, presence of comorbidities and smoking history are predictors. The primary outcome was all‐cause mortality. Secondary outcomes were smoking prevalence, cause‐specific mortality, non‐skin cancers, cardiovascular and chronic lung diseases. Results: Of the 57 838 patients, 56 512 (mean age of 58.9 ± 15.1 years, 40.1% female, 43% diabetic), had data on smoking history with 13.6% current, 40.7% former and 45.6% never smokers. Former and current smokers had 10% (HR 1.10; 95% CI: 1.08, 1.13) and 22%(HR 1.22; 95% CI: 1.18, 1.26) higher risk of all‐cause mortality. They were 13% (HR 1.13; 95% CI: 1.09, 1.18) and 23% (HR 1.23; 95% CI: 1.17, 1.29) for CVD mortality. Smoking was associated with higher mortality from respiratory failure (HR 1.59; 95% CI: 1.13, 2.23, p =.073 and HR 1.33; 95% CI: 1.01, 1.74, p =.042) for current and former smokers. Current and former smokers had higher risk for non‐skin cancer (HR 1.30; 95% CI: 1.19, 1.42 and HR 1.24; 95% CI: 1.17, 1.32). Smoking was associated with a higher rate of death from cancer (HR 1.26; 95% CI 1.19–1.33) and chronic lung disease (HR 1.48; 95% CI 1.15–1.92). Former and current smokers had a higher adjusted risk for de novo vascular disease (PVD, CVD), CAD (adjusted RR 1.1; 95% Cl: 1.09–1.12). Conclusions: In dialysis patients, smoking was associated with higher rates of all‐cause mortality, cardiovascular mortality, respiratory failure, chronic lung disease and malignancy along with higher risks of non‐skin cancers, de novo vascular disease and chronic lung disease. Summary at glance: Cigarette smoking is a very well‐known risk factor for mortality in dialysis patients. This is the first manuscript analysing hazardous effects of smoking by using the ANZDATA Registry. Besides well‐known negative impact on all‐cause mortality and chronic diseases, smoking trends in different age groups and time periods were reported in this study. This study underlines the negative impact of smoking in dialysis population. New guidelines and preventive measures should be designed according to different age groups. [ABSTRACT FROM AUTHOR]

Background: There is little information available to inform the cost‐effectiveness of eHealth interventions in improving patient health outcomes. A trial‐based economic evaluation was undertaken aiming to inform the feasibility of conducting a mobile phone text messaging programme targeting dietary behaviours in people receiving haemodialysis. Methods: A trial‐based economic evaluation from a health system perspective of a 6‐month pilot randomised controlled trial was undertaken. One hundred and thirty patients receiving haemodialysis from six dialysis units across Sydney, Australia, were enrolled into the KIDNEYTEXT study. Usual care (inperson dietary counselling) was compared with usual care plus three semi‐personalised dietary mobile phone text messages per week over a 6‐month period. The outcomes of this economic evaluation included: cost of intervention, cost‐effectiveness and marginal effects on total costs. Results: The cost of developing and maintaining the KIDNEYTEXT intervention was US $110 per participant. Total costs were US $1418 higher in the usual care arm compared to the intervention arm. The incremental benefits for quality‐adjusted life adjusted years were 0.01 [95% confidence interval (CI) = −0.03 to 0.06] and dietary adherence (i.e., adherent to three or more dietary guidelines at 6 months) being 0.04 (95% CI = −0.15 to 0.24). The largest component of total costs was related to unplanned admissions to hospital. Conclusions: Mobile phone text messages targeting dietary behaviours may be cost saving, at the same time as maintaining similar or improved dietary behaviours. A larger trial with a longer follow‐up time is warranted. Highlights: Mobile phone text messaging is a low‐cost intervention.Mobile phone text messaging targeting dietary behaviours shows potential in being cost saving and resulting in similar or improved dietary behaviours.This simple text messaging intervention may be used as an additional tool to enhance patients' nutrition care.There may be a cost‐saving for dialysis units in using text messages, in addition to individualised dietary counselling. [ABSTRACT FROM AUTHOR]

Background: There is a lack of evidence for pre‐eclampsia prophylaxis with aspirin in women with pre‐existing diabetes mellitus (DM). Aims: To examine the evidence for aspirin in pre‐eclampsia prophylaxis in women with pre‐existing DM. Material and Methods: An electronic search using Ovid MEDLINE, Embase, CinicalTrials.gov and the Cochrane CENTRAL register of controlled trials through to February 2021 was performed. Reference lists of identified studies, previous review articles, clinical practice guidelines and government reports were manually searched. Randomised controlled trials (RCTs) of aspirin vs placebo for pre‐eclampsia prophylaxis were included. Articles were manually reviewed to determine if cohorts included women with DM. The systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement. Data from included trials were extracted independently by two authors who also independently assessed risk of bias as per the Cochrane Handbook criteria version 5.1.0. Data were analysed using Rev‐Man 5.4. Results: Forty RCTs were identified, of which 11 included a confirmed subset of women with DM; however, data were insufficient for meta‐analysis. Meta‐analysis of 930 women with DM, from individual patient data included in a systematic review and unpublished data from one of the 11 RCTs, showed a non‐significant difference in the outcome of pre‐eclampsia in participants treated with aspirin compared to placebo (odds ratio 0.58; 95% CI 0.20–1.71; P = 0.33). Conclusions: Pre‐eclampsia risk reduction with aspirin prophylaxis in women with pre‐existing DM may be similar to women without pre‐existing DM. However, randomised data within this meta‐analysis were insufficient, warranting the need for further studies within this high‐risk group of women. [ABSTRACT FROM AUTHOR]

This research examined understandings of cultural competence of social workers in Hong Kong, their needs and challenges in serving culturally diverse groups, and their willingness and receptivity to receive cultural competence training by using constructivist grounded theory. Individual qualitative interviews were conducted with thirteen frontline and managerial practitioners and educators in training institutions in the social work profession. Data were analysed by identifying major themes. The findings show that social workers in Hong Kong tend to encounter language barriers and various forms of cultural shocks in serving ethnoculturally diverse clients. The professional code of practice is not sufficient in promoting culturally competent practice and there are institutional barriers to the enhancement of cultural competence of the social services. Mainstream social work units are generally not well prepared to provide services to non-Chinese communities. In response to these obstacles, professional training should provide future Hong Kong social workers with opportunities to interact with ethnoculturally diverse communities through service-learning. To tackle institutional racism, leaders should have cultural awareness and promote culturally inclusive practices. Inclusion of staff members from diverse cultural backgrounds would increase the capacity of the organisations to better serve clients of diverse needs. Anti-racism training should be made as an essential professional development component for social work students, practicum students, practitioners and managers. [ABSTRACT FROM AUTHOR]