University of Western Australia

Research on the health literacy of parents with children with intellectual disability is limited. Understanding parents' healthcare skills and needs is essential for improving children's health and developing effective support. In this study we aimed to (1) explore the health literacy skills of parents that enabled them to support the health needs of their child with intellectual disability and the factors influencing these skills, and (2) identify opportunities to support parent health literacy. A qualitative study was carried out using interviews with 24 parents of children and young people with intellectual disability. A directed content analysis was completed, guided by the nine domains included in the Health Literacy Questionnaire. Participants demonstrated strong health literacy skills; however, there was diversity in their strengths and needs across different domains of health literacy. Navigating healthcare systems was the key area where participants faced challenges and required further support. Participants described factors including educational levels, professional expertise, experiences over time, and relationships with healthcare professionals which influenced their health literacy. Opportunities to improve health literacy were identified, addressing parents, healthcare professionals, and healthcare and disability services. Developing and maintaining health literacy is critical to parents supporting the health of children with intellectual disability. These results provide insight into how health literacy interventions can be designed to support parent health literacy. The study provides participants' recommendations for how healthcare professionals can support parent health literacy. These recommendations relate to the health literacy responsiveness of the professional and service.

In ectotherms such as sea turtles, energy acquisition requires a combination of sufficient food resources and access to suitable temperatures. Leatherback turtles (Dermochelys coriacea) , though partially endothermic, are highly migratory and little is known about their energy acquisition. Existing knowledge is based on a few studies of juvenile leatherbacks in captivity that remained relatively small and did not reach sexual maturity while under observation. To bridge this gap, relevant physiological data have been extrapolated to the full lifecycle using Dynamic Energy Budget (DEB) theory. DEB theory provides the basis of mechanistic modeling presented here to (i) predict functional and life history traits for Northwest Atlantic (NWA) leatherback turtles, (ii) elucidate the effects of food availability and sea temperature on those traits, and (iii) use the model to predict traits for another (East Pacific, EP) population of leatherback turtles. Model simulations with warmer temperatures and more abundant food conditions (f≥0.882) led to younger age at puberty, larger size, and higher reproductive potential. Scaled food availability lower than f = 0.882, corresponding to a resource limitation of >15%, resulted in insufficient energy for leatherbacks to attain sexual maturity. Resource limitation hypothesized for the EP population was simulated as a 5% reduction in food availability, which, combined with a 1 °C warmer temperature possibly experienced by leatherbacks in the Pacific, successfully reproduced the observed data pattern. Namely, the model predicted that, under these conditions and while sharing the same physiological parameters as the NWA leatherbacks, the EP individuals would mature slightly earlier and at a similar size, would grow less after puberty (resulting in a smaller ultimate size), and would have a similar (seasonal) reproductive output as the NWA leatherbacks. Our findings highlight the need for a deeper understanding of the specific food and temperature conditions that individuals encounter along their migratory routes.

Brain network architecture is anticipated to influence future grey matter loss in individuals at Clinical High Risk (CHR) for psychosis. However, existing studies on grey matter structural network properties in CHR are scarce and constrained by small sample sizes. Here, we examined network topology differences comparing a) CHR versus healthy controls (HC); b) CHR who transitioned to psychosis (CHR-T) versus those who did not (CHR-NT); and c) different subsyndromes. We included structural scans from 1842 CHR individuals and 1417 HC individuals from 31 sites within the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) consortium. At the global level, CHR individuals exhibited lower structural covariance (q < 0.001; Cohen's d = 0.164) and less optimal structural network configuration than HC (lower global efficiency and clustering coefficient, d = 0.100,0.087, qs <= 0.027). Though no global difference between CHR-T and CHR-NT, network distinctiveness of the frontal and temporal surface area networks was higher in CHR-T than CHR-NT (d = 0.223,0.237) and HC (d = 0.208,0.219) (qs < 0.001). Network distinctiveness of the frontal cortical thickness network was lower in CHR-T (d = 0.218, q < 0.001) than CHR-NT and HC (d = 0.165, q < 0.001). Importantly, higher network distinctiveness was associated with worse positive symptoms in CHR-NT (frontal surface area, q = 0.008, R2 = 0.013) and at trend with worse negative symptoms in CHR-T (frontal thickness, q = 0.063, R2 = 0.049). Further, the brief intermittent psychotic syndrome subgroup showed more severe network alterations. Together, brain structural networks inform symptoms and the risk of transition to psychosis in CHR individuals.

This study investigated relationships between sleep quality, sleep apnoea and depression during pregnancy, focusing on their associations and potential bidirectional effects. Data from 193 pregnant women enrolled in a longitudinal study across pregnancy and postpartum were included. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Sleep apnoea was measured using home sleep studies (Apnoea-Hypopnoea Index, AHI≥5). Depressive symptoms were evaluated using the Edinburgh Postnatal Depression Scale (EPDS ≥ 13). Repeat assessments of sleep quality, apnoea and depressive symptoms were undertaken in early and late pregnancy. Clinical depression was diagnosed using the Structured Clinical Interview for DSM in early pregnancy and six months postpartum. Women with depression diagnosed in early-mid pregnancy had poorer self-reported sleep quality, higher self-reported depressive symptoms and increased incidence of postnatal depression. Depression in early pregnancy was associated with poorer sleep quality concurrently (OR: 1.25 [1.10-1.41]) and in late pregnancy (OR: 1.19 [1.04-1.36]). Cross-lagged panel modelling showed early depressive symptoms predicted poorer sleep in late pregnancy, but not vice versa. Sleep apnoea (severity or diagnosis) was not associated with depression or depressive symptoms. Depressive symptoms in early pregnancy predicted poorer self-reported sleep quality in later pregnancy, but not the reverse. Treating depression early in pregnancy may improve subsequent sleep. Sleep apnoea and depression may require distinct management approaches. Persistent sleep issues in pregnant women with depression or depressive symptoms should prompt screening for underlying sleep disorders, with sleep-focused interventions or medication adjustments considered if none are identified.

The predictive value of PromarkerD tests for incident diabetic kidney disease or rapid decline in estimated glomerular filtration rate was evaluated in 1010 non-Aboriginal and 71 Aboriginal adults with diabetes. Areas under the receiver operating characteristic curves were not significantly different (P ≥ 0.081) for first- (non-Aboriginals 0.890 (95% confidence interval 0.864 to 0.915) and Aboriginals 0.769 (0.624 to 0.915)) and second-generation (0.890 (0.862 to 0.917) and 0.711 (0.543 to 0.878)) tests. PromarkerD has potential renal prognostic value in Aboriginals with diabetes.

To compare the anatomical and functional outcomes of internal limiting membrane (ILM) flap and conventional ILM peeling in idiopathic full-thickness macular holes (FTMHs). Retrospective cohort study of all eyes treated with vitrectomy and ILM peeling (ILM-P) with or without ILM flap (ILM-F) for primary idiopathic FTMH repair in the Australian and New Zealand Society of Retinal Specialists (ANZSRS) Registry between 2006 and 2023. Propensity score weighting and multivariable regression analysis adjusted for baseline characteristics and covariates, including surgeon grade, lens status, and follow-up duration, were used to evaluate hole closure rate and best corrected visual acuity (BCVA) change at 3 months. Two thousand nine hundred ninety eyes of 2905 patients were included (mean age 69 ± 9 years). One Hundred Ninety-nine eyes underwent ILM-F and 2871 underwent ILM-P. On weighted multivariable regression analysis, ILM-F showed higher odds of hole closure compared to ILM-P (OR = 2.97, 95% CI: 1.08-8.20, p = 0.04). The adjusted closure rate was > 95% across all hole sizes in the ILM-F group, while only falling below 90% for X-large + holes (> 550 μm) in the ILM-P group. No significant difference in BCVA gain was observed between the two groups at 3 months (p = 0.08). The effects of ILM-F compared to ILM-P were consistent across all hole sizes. Although the ILM-F technique was more effective in idiopathic FTMH closure, visual acuity outcomes were comparable to conventional ILM peeling. These findings suggest that ILM-F is not required for the treatment of small and medium FTMHs.