Search

Objective: To determine whether maternal preeclampsia is an independent risk factor for poorer academic school performance in offspring, taking into account important perinatal and child factors., Study Design: A population-based cohort study using record-linkage of state-wide data was undertaken. We evaluated children born at 28+ weeks of gestation in New South Wales, Australia who had grade 3 record-linked education outcomes via the National Assessment Program-Literacy and Numeracy (NAPLAN) between 2009 and 2014. Children with in utero preeclampsia exposure were compared with those without exposure. Robust multivariable Poisson models were used to determine adjusted relative risks., Results: Crude models demonstrated an increased risk of scoring below the national minimal standard in all 5 domains (reading, writing, spelling, grammar and punctuation, and numeracy) for children exposed to preeclampsia, ranging from a relative risk (RR) of 1.13 (95% CI, 1.04-1.24) for reading to 1.19 (95% CI, 1.09-1.30) for numeracy. These differences were attenuated once adjusted for perinatal and child factors (RR, 1.07 [95% CI, 0.97-1.18] to 1.11 (95% CI, 0.99-1.22]), with combined perinatal and childhood factors mediating between 35.7% (writing) to 55.1% (spelling) of the association. Gestational age at birth was the most important perinatal factor, explaining 10.5% (grammar and punctuation) to 20.6% (writing) of the association between preeclampsia and poor school performance, followed by small for gestational age., Conclusion: The poorer educational performance experienced by children born to women with preeclampsia appears largely attributable to perinatal and childhood factors, suggesting an opportunity to improve school performance in children exposed to preeclampsia by optimizing these perinatal factors, particularly gestational age at birth., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: Diet and fluid management can reduce mortality, serious comorbidities, and debilitating symptoms in patients on hemodialysis, but restrictions may also be a major burden, and nonadherence remains high. We aimed to describe the perspectives and experiences of patients on hemodialysis regarding their dietary management to understand both facilitators and barriers to adherence and to identify strategies to improve care., Design and Methods: Semi-structured interviews were conducted with 35 people on maintenance hemodialysis from six dialysis units in New South Wales, Australia. Transcripts were thematically analyzed using principles of grounded theory., Results: We identified 5 major themes. Two themes reflect barriers to dietary change: exacerbating disruption (adding to treatment burden, contradicting healthy eating, confused by fragmented advice, conflicting cultural norms, changing appetite and palate, isolation from family and friends) and losing control (crises derailing discipline, frustrated by failure, combating bodily need for hydration). Three themes represent enablers for dietary change: attaining health benefits (avoiding medical catastrophes, enhancing benefits of dialysis, alleviating and managing symptoms, improving health), achieving treatment goals (building familiarity and acceptance, flexibility and moderation, taking personal responsibility), and succeeding withsupport (leaning on family for strength, trusting expert guidance, empowered with flexible and practical advice, relying on reminders and cues, motivation through shared experience)., Conclusions: Patients on hemodialysis believe dietary control helps to reduce symptom burden and enhance general health and well-being, but competing medical and social issues coupled with contradictory and/or irrelevant dietary advice prevents them from implementing diet and fluid restrictions. Interventions involving collaborative multidisciplinary care including clinicians with dietetic expertise, and consistent information that addresses cultural and personal circumstances, may support adherence to dietary recommendations and improve outcomes., (Copyright © 2018 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)