To examine academic outcomes among children hospitalised with a chronic health condition.
Population-level birth cohort.
New South Wales, Australia.
397 169 children born 2000-2006 followed up to ...2014.
Hospitalisations with a chronic condition.
Academic underperformance was identified as 'below the national minimum standard' (BNMS) in five literacy/numeracy domains using the national assessment (National Assessment Program-Literacy and Numeracy) data. Multivariable logistic regression assessed the adjusted ORs (aORs) of children performing BNMS in each domain at each grade (grades 3, 5 and 7, respectively).
Of children hospitalised with a chronic condition prior to National Assessment Program-Literacy and Numeracy (NAPLAN) (16%-18%), 9%-12% missed ≥1 test, with a maximum of 37% of those hospitalised ≥7 times, compared with 4%-5% of children not hospitalised. Excluding children who missed a NAPLAN test, more children hospitalised with a chronic condition performed BNMS across all domains and grades, compared with children not hospitalised (eg, for BNMS in reading at grade 3: n=2588, aOR 1.35 (95% CI 1.28 to 1.42); for BNMS in numeracy at grade 3: n=2619, aOR 1.51 (95% CI 1.43 to 1.59)). Increasing frequency and bed-days of hospitalisation were associated with 2-3 fold increased odds of performing BNMS across all domains and grades. Children hospitalised with mental health/behavioural conditions had the highest odds of performing BNMS across all domains at each grade.
Children hospitalised with a chronic condition underperform academically across literacy/numeracy domains at each school grade. Health and educational supports are needed to improve these children's academic outcomes.
To examine the associations between adolescents’ intake of sugar‐sweetened beverages (SSBs) with oral health impacts (OHI) and weight status.
Cross‐sectional health survey with anthropometry and ...self‐report OHI (toothache and avoiding some foods because of oral problems) and SSB intake (fruit juice, flavoured water, soft, diet, sports and energy drinks) collected in 2015.
A total of 3,671 adolescents participated (50% girls; mean age 13.2 years ±1.7). Drinking ≥1cup/day of SSBs was consistently associated with higher odds of OHI compared with drinking <1cup/day: diet soft drinks (AOR, 5.21 95%CI 2.67, 10.18); sports drinks (AOR 3.60 95%CI 1.93, 6.73); flavoured water (AOR 3.07 95%CI 1.55, 6.06); and energy drinks (AOR 2.14 95%CI 1.44, 3.19). Daily SSB intake was not consistently associated with weight status. The odds of overweight/obesity (AOR 1.27 95%CI 1.01, 1.59) and obesity (AOR 1.61 95%CI 1.01, 2.57) were higher for energy drink consumption, compared with not drinking energy drinks; and the odds of abdominal obesity were twice as high among adolescents who drank ≥1cup/day of sports drinks, compared with <1cup/day intake.
Daily consumption of SSBs is prevalent among adolescents and is consistently associated with higher odds of OHI. The most popular SSBs among adolescents were energy drinks. Different types of SSB were differentially associated with OHI and weight status.
Different types of SSBs were differentially associated with OHI and weight status in adolescents. Diet soft drinks and new generation SSBs such as energy and sport drinks and flavoured water had a greater impact on adolescents’ OHI compared with soft drinks and fruit juice.
To evaluate the diagnosis and management of reflux and gastro-oesophageal reflux disease (GORD) in infants aged <1 year presenting to general practitioners (GPs).
A nationally representative, ...prospective, cross-sectional survey of GP activity in Australia, 2006-2016 (Bettering the Evaluation And Care of Health Study). Annually, a random sample of around 1000 GPs recorded details for 100 consecutive visits with consenting, unidentified patients.
Diagnoses of reflux and GORD and their management including prescribing of acid-suppressant medicines (proton pump inhibitors (PPIs) and histamine receptor antagonists (H2RAs)) and counselling, advice or education.
Of all infants' visits, 512 (2.7%) included a diagnosis of reflux (n=413, 2.2%) or GORD (n=99, 0.5%). From 2006 to 2016, diagnostic rates decreased for reflux and increased for GORD. Prescribing of acid suppressants occurred in 43.6% visits for reflux and 48.5% visits for GORD, similar to rates of counselling, advice or education (reflux: 38.5%, GORD: 43.4% of visits). Prescribing of PPIs increased (statistically significant only for visits for reflux), while prescribing of H2RAs decreased.
Overprescribing of acid suppressants to infants may be occurring. In infants, acid-suppressant medicines are no better than placebo and may have significant negative side effects; however, guidelines are inconsistent. Clear, concise and consistent guidance is needed. GPs and parents need to understand what is normal and limitations of medical therapy. We need a greater understanding of the influences on GP prescribing practices, of parents' knowledge and attitudes and of the pressures on parents of infants with these conditions.
Maternal mortality is too rare in high income countries to be used as a marker of the quality of maternity care. Consequently severe maternal morbidity has been suggested as a better indicator. Using ...the maternal morbidity outcome indicator (MMOI) developed and validated for use in routinely collected population health data, we aimed to determine trends in severe adverse maternal outcomes during the birth admission and in particular to examine the contribution of postpartum haemorrhage (PPH).
We applied the MMOI to the linked birth-hospital discharge records for all women who gave birth in New South Wales, Australia from 1999 to 2004 and determined rates of severe adverse maternal outcomes. We used frequency distributions and contingency table analyses to examine the association between adverse outcomes and maternal, pregnancy and birth characteristics, among all women and among only those with PPH. Using logistic regression, we modelled the effects of these characteristics on adverse maternal outcomes. The impact of adverse outcomes on duration of hospital admission was also examined.
Of 500,603 women with linked birth and hospital records, 6242 (12.5 per 1,000) suffered an adverse outcome, including 22 who died. The rate of adverse maternal outcomes increased from 11.5 in 1999 to 13.8 per 1000 deliveries in 2004, an annual increase of 3.8% (95%CI 2.3-5.3%). This increase occurred almost entirely among women with a PPH. Changes in pregnancy and birth factors during the study period did not account for increases in adverse outcomes either overall, or among the subgroup of women with PPH. Among women with severe adverse outcomes there was a 12% decrease in hospital days over the study period, whereas women with no severe adverse outcome occupied 23% fewer hospital days in 2004 than in 1999.
Severe adverse maternal outcomes associated with childbirth have increased in Australia and the increase was entirely among women who experienced a PPH. Reducing or stabilising PPH rates would halt the increase in adverse maternal outcomes.
Aim
To determine survival of infants with major congenital anomalies (CA) and assess the effect of co‐existing anomalies and gestational age.
Methods
All liveborn infants with major CA born in New ...South Wales (NSW), Australia, 2004–2009 were identified from the NSW Register of Congenital Conditions. Deaths were identified via record linkage to death registrations and five‐year survival was estimated using Kaplan–Meier methods.
Results
There were 8521 liveborn infants with CA of whom 617 (7.2%) died within the first five years of life. Half of deaths occurred in the first week of life. The overall five‐year survival rate was 92.8% (95%CI: 92.2–93.3) and 83.2% (95%CI: 79.0–87.4) for syndromes, 83.4% (95%CI: 80.9–85.9) for multiple, 85.1% (95%CI: 82.6–87.5) for chromosomal, 95.3% (95%CI: 94.8–95.8) for isolated and 96.2% (95%CI: 94.3–98.1) for non‐Q chapter anomalies. Five‐year survival for chromosomal, syndromes and sub‐groups was higher for isolated compared with multiple anomalies ranging from 77.5% to 98.9% and 68.6% to 89.5%, respectively. Survival was lower for preterm (79.4%; 95%CI: 77.5‐81.4) than for term infants (95.8%; 95%CI: 95.3–96.3).
Conclusion
Nine in ten infants with major CA survive up to five years, although there is variability in survival across CA groups. Survival of infants with major congenital anomalies has improved in recent years.
Like other teens in conservative religious environments, LGBTQ+ teens raised in the Church of Jesus Christ of Latter‐day Saints (CJCLDS) likely experience unique microaggressions. Furthermore, like ...other conservatively religious parents of LGBTQ+ teens, active Latter‐day Saint (LDS) parents who openly support their LGBTQ+ teens likely both witness microaggressions toward their teens and may personally experience microaggressions. The present study sought to understand parents' and teens' experiences of microaggressions in conservative religious contexts by focusing specifically on the microaggressions experienced by (a) LGBTQ+ teens raised in the CJCLDS and (b) their active LDS parents. Thematic analysis of separate interviews with 19 dyads of LGBTQ+ teens and their active LDS parents (38 total interviews) revealed various ways in which they experienced verbal, nonverbal, and environmental microaggressions. We highlight parents' and teens' shared experiences of microaggressions that may be uniquely related to their religious contexts, such as assumptions that LGBTQ+ teens or their parents are not faithful and exclusionary Church policies. Additionally, we identified microaggressions that specifically targeted parents of LGBTQ+ teens, such as comments suggesting parents should limit their support for their teens. Finally, we found that parents had vicarious experiences with microaggressions through witnessing or learning about microaggressions that targeted their teens. Findings highlight the ways that the religious contexts in which microaggressions occur can influence the way that microaggressions are communicated to and experienced by LGBTQ+ teens – and their parents.
Fifteen weeks of dietary n-3 PUFA deprivation increases coefficients of conversion of circulating α-linolenic acid (α-LNA; 18:3n-3) to docosahexaenoic acid (DHA; 22:6n-3) in rat liver but not brain. ...To determine whether these increases reflect organ differences in enzymatic activities, we examined brain and liver expression of converting enzymes and of two of their transcription factors, peroxisome proliferator-activated receptor α (PPARα) and sterol-regulatory element binding protein-1 (SREBP-1), in rats fed an n-3 PUFA “adequate” (4.6% α-LNA of total fatty acid, no DHA) or “deficient” (0.2% α-LNA, no DHA) diet for 15 weeks after weaning. In rats fed the deficient compared with the adequate diet, mRNA and activity levels of Δ5 and Δ6 desaturases and elongases 2 and 5 were upregulated in liver but not brain, but liver PPARα and SREBP-1 mRNA levels were unchanged. In rats fed the adequate diet, enzyme activities generally were higher in liver than brain. Thus, differences in conversion enzyme expression explain why the liver has a greater capacity to synthesize DHA from circulating α-LNA than does the brain in animals on an adequate n-3 PUFA diet and why liver synthesis capacity is increased by dietary deprivation. These data suggest that liver n-3 PUFA metabolism determines DHA availability to the brain when DHA is absent from the diet.
The renal diseases most frequently associated with myeloma include amyloidosis, monoclonal immunoglobulin deposition disease, and cast nephropathy. Less frequently reported is light chain proximal ...tubulopathy, a disease characterized by κ-restricted crystal deposits in the proximal tubule cytoplasm. Light chain proximal tubulopathy without crystal deposition is only loosely related to the typical light chain proximal tubulopathy, and little is known about this entity. A search was performed of the 10 081 native kidney biopsy samples processed by our laboratory over the past 2 years for cases that had light chain restriction limited to the proximal tubule cytoplasm. A total of 10 cases of light chain proximal tubulopathy without crystal deposition were found representing 3.1% of light chain-related diseases. Nine of these 10 showed λ-light chain restriction. Only three cases of light chain proximal tubulopathy with crystals were found accounting for 0.9% of light chain-related diseases. Two of these three were κ subtype. Plasma cell dyscrasia was unsuspected in seven of the 10 patients with light chain proximal tubulopathy without crystals at the time of renal biopsy. After the biopsy was reported, follow-up was available on 9/10 patients with 9/9 showing a plasma cell dyscrasia including 8/9 with multiple myeloma. We found that light chain proximal tubulopathy without crystal formation, despite being rarely described in the literature, is over three times more common than light chain proximal tubulopathy with crystal formation in our series. And given that it is often associated with previously unrecognized myeloma, it is a critically important diagnosis.
Summary
Administrative or population health data sets (PHDS), such as birth and hospital discharge data, are used increasingly to evaluate maternity care. Use of PHDS requires reliable identification ...of diagnoses and procedures. The aim of this study was to determine the accuracy and reliability of the reporting of diagnoses and procedures related to childbirth in both individual and linked, birth and ICD10‐coded hospital discharge data. Data from a population‐based validation study of 1200 women provided the ‘gold standard’ for labour and delivery events and were compared with the hospital discharge and birth databases. Reporting characteristics (sensitivity, specificity, positive and negative predictive values) were determined for: induction, augmentation and obstruction of labour, modes of delivery (including failed instrumental delivery), episiotomy, perineal tears and repairs, and manual removal of the placenta. Differences in reporting by mode of delivery were also examined.
Of the 1184 records available for review, 25% had labour induced, 25% had labour augmented and, of those who laboured, 17% had obstructed labour reported. Fourteen per cent had an elective/planned caesarean section (CS) including 2% that went into labour prior to the planned date, and 11% had an emergency, unplanned CS including 2% who had no labour. With the exception of augmentation and obstruction of labour, failed instrumental delivery and manual removal, there were high levels of accuracy for reporting of diagnoses and procedures during labour and delivery. There were no significant differences in reporting by mode of delivery. The findings suggest that PHDS‐reported induction of labour, mode of delivery, and 3rd and 4th degree tears and repairs can be reliably used to evaluate maternity care. Consistency in reporting in birth and hospital discharge data from different countries and over time suggests the findings are likely to be generalisable to high‐income countries.
Male rat pups at weaning (21 days of age) were subjected to a diet deficient or adequate in n-3 polyunsaturated fatty acids (n-3 PUFAs) for 15 weeks. Performance on tests of locomotor activity, ...depression, and aggression was measured in that order during the ensuing 3 weeks, after which brain lipid composition was determined. In the n-3 PUFA-deprived rats, compared with n-3 PUFA-adequate rats, docosahexaenoic acid (22:6n-3) in brain phospholipid was reduced by 36% and docosapentaenoic acid (22:5n-6) was elevated by 90%, whereas brain phospholipid concentrations were unchanged. N-3 PUFA-deprived rats had a significantly increased (P = 0.03) score on the Porsolt forced-swim test for depression, and increased blocking time (P = 0.03) and blocking number (P = 0.04) scores (uncorrected for multiple comparisons) on the isolation-induced resident-intruder test for aggression. Large effect sizes (d > 0.8) were found on the depression score and on the blocking time score of the aggression test. Scores on the open-field test for locomotor activity did not differ significantly between groups, and had only small to medium effect sizes. This single-generational n-3 PUFA-deprived rat model, which demonstrated significant changes in brain lipid composition and in test scores for depression and aggression, may be useful for elucidating the contribution of disturbed brain PUFA metabolism to human depression, aggression, and bipolar disorder.
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