Maternal pre-pregnancy BMI influences the associations between bisphenol and phthalate exposures and maternal weight changes and fat accumulation.

BACKGROUND: Bisphenols and phthalates are two classes of endocrine-disrupting chemicals (EDCs) thought to influence weight and adiposity. Limited research has investigated their influence on maternal weight changes, and no prior work has examined maternal fat mass. We examined the associations between exposure to these chemicals during pregnancy and multiple maternal weight and fat mass outcomes. METHODS: This study included a sample of 318 women enrolled in a Canadian prospective pregnancy cohort. Second trimester urinary concentrations of 2 bisphenols and 12 phthalate metabolites were quantified. Self-reported and measured maternal weights and measured skinfold thicknesses were used to calculate gestational weight gain, 3-months and 3- to 5-years postpartum weight retention, late pregnancy fat mass gain, total postpartum fat mass loss, and late postpartum fat mass retention. Adjusted robust regressions examined associations between chemicals and outcomes in the entire study population and sub-groups stratified by pre-pregnancy body mass index (BMI). Bayesian kernel machine regression examined chemical mixture effects. RESULTS: Among women with underweight or normal pre-pregnancy BMIs, MBzP was negatively associated with weight retention at 3- to 5-years postpartum (B = -0.04, 95%CI: -0.07, -0.01). Among women with overweight or obese pre-pregnancy BMIs, MEHP and MMP were positively associated with weight retention at 3-months and 3- to 5-years postpartum, respectively (B's = 0.12 to 0.63, 95%CIs: 0.02, 1.07). DEHP metabolites and MCNP were positively associated with late pregnancy fat mass gain and late postpartum fat mass retention (B's = 0.04 to 0.18, 95%CIs: 0.001, 0.32). Further, the mixture of EDCs was positively associated with late pregnancy fat mass gain. CONCLUSION: In this cohort, pre-pregnancy BMI was a key determinant of the associations between second trimester exposure to bisphenols and phthalates and maternal weight changes and fat accumulation. Investigations of underlying physiological mechanisms, windows of susceptibility, and impacts on maternal and infant health are needed.

Maternal exposure to bisphenols, phthalates, perfluoroalkyl acids, and trace elements and their associations with gestational diabetes mellitus in the APrON cohort.

The increasing global prevalence of gestational diabetes mellitus (GDM) has been hypothesized to be associated with maternal exposure to environmental chemicals. Here, among 420 women participating in the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study, we examined associations between GDM and second trimester blood or urine concentrations of endocrine disrupting chemicals (EDCs): bisphenol-A (BPA), bisphenol-S (BPS), twelve phthalate metabolites, eight perfluoroalkyl acids (PFAAs), and eleven trace elements. Fifteen (3.57%) of the women were diagnosed with GDM, and associations between the environmental chemical exposures and GDM diagnosis were examined using multiple logistic and LASSO regression analyses in single- and multi-chemical exposure models, respectively. In single chemical exposure models, BPA and mercury were associated with increased odds of GDM, while a significant inverse association was observed for zinc. Double-LASSO regression analysis selected mercury (AOR: 1.51, CI: 1.12-2.02), zinc (AOR: 0.017, CI: 0.0005-0.56), and perfluoroundecanoic acid (PFUnA), a PFAAs, (AOR: 0.43, CI: 0.19-0.94) as the best predictors of GDM. The combined data for this Canadian cohort suggest that second trimester blood mercury was a robust predictor of GDM diagnosis, whereas blood zinc and PFUnA were protective factors. Research into mechanisms that underlie the associations between mercury, zinc, PFUnA, and the development of GDM is needed.

Sex-Specific Associations between Prenatal Exposure to Di(2-ethylhexyl) Phthalate, Epigenetic Age Acceleration, and Susceptibility to Early Childhood Upper Respiratory Infections.

Di(2-ethylhexyl) phthalate (DEHP) is a common plasticizer that can affect immune system development and susceptibility to infection. Aging processes (measured as epigenetic age acceleration (EAA)) may mediate the immune-related effects of prenatal exposure to DEHP. This study's objective was to examine associations between prenatal DEHP exposure, EAA at three months of age, and the number of upper respiratory infections (URIs) from 12 to 18 months of age using a sample of 69 maternal-child pairs from a Canadian pregnancy cohort. Blood DNA methylation data were generated using the Infinium HumanMethylation450 BeadChip; EAA was estimated using Horvath's pan-tissue clock. Robust regressions examined overall and sex-specific associations. Higher prenatal DEHP exposure (B = 6.52, 95% CI = 1.22, 11.81) and increased EAA (B = 2.98, 95% CI = 1.64, 4.32) independently predicted more URIs. In sex-specific analyses, some similar effects were noted for boys, and EAA mediated the association between prenatal DEHP exposure and URIs. In girls, higher prenatal DEHP exposure was associated with decreased EAA, and no mediation was noted. Higher prenatal DEHP exposure may be associated with increased susceptibility to early childhood URIs, particularly in boys, and aging biomarkers such as EAA may be a biological mechanism. Larger cohort studies examining the potential developmental immunotoxicity of phthalates are needed.

Maternal Pre-Pregnancy BMI and Gestational Weight Gain Are Associated with Preschool Children's Neuropsychological Outcomes in the APrON Cohort.

This study examined the associations between maternal pre-pregnancy BMI and gestational weight gain (GWG) and children's neuropsychological outcomes at 3 to 5 years of age. A total of 379 women and their children from the Alberta Pregnancy Outcomes and Nutrition (APrON) study participated. Covariate-adjusted robust regressions examined associations between maternal pre-pregnancy BMI, GWG class, interaction terms, and child outcomes. Each unit increase in maternal BMI was linked to a 0.48-point decrement (95% CI: -0.75 to -0.21) in children's Full Scale IQ. Higher pre-pregnancy BMI was related to poorer performance on the other intelligence indexes (B = -0.35 to -0.47, 95% CIs: -0.75, -0.02) and lower performance on measures of language (B = -0.08 to -0.09, 95% CIs: -0.16, -0.02), motor skills (B = -0.08 to -0.11, 95% CIs: -0.18, -0.01), and executive function (B = -0.09 to -0.16, 95% CIs: -0.26, -0.01). GWG below the recommended range was associated with a 4.04-point decrement (95% CI: 7.89, -0.11) in Full Scale IQ, but better performance on a spatial working memory test (B = 0.27, 95% CI: 0.02, 0.52). GWG above the recommended range was associated with lower language (B = -0.79, 95% CI: -1.52, -0.06) and memory scores (B = -0.93, 95% CI: -1.64, -0.22). Interactions were found between pre-pregnancy BMI and GWG on measures of intelligence and executive function. Maternal pre-pregnancy BMI and GWG are related to children's performance in various neuropsychological domains and may interact to predict outcomes. Optimizing maternal health and weight prior to conception and during pregnancy may enhance children's neuropsychological outcomes.

Exploring post-stroke fatigue from the perspective of stroke survivors: what strategies help? A qualitative study.

PURPOSE: Post-stroke fatigue is a research priority for stroke survivors and health professionals but there is limited evidence to guide management. We aimed to explore (1) the experience of post-stroke fatigue from the perspective of stroke survivors and their caregivers and (2) fatigue management strategies that are used. MATERIALS AND METHODS: This was a qualitative study using semi-structured interviews. People with self-reported post-stroke fatigue and caregivers were recruited using maximum variation sampling. Analysis was done via the framework approach. RESULTS: We recruited 17 stroke survivors, nine male (53%), most under 65 years (n = 12, 76%), and greater than 1-year post-stroke (n = 16, 94%, range 10-months to 22-years). One-third of participants self-reported having aphasia (n = 5, 36%). We also recruited eight caregivers, most of whom were female (n = 7, 88%). We identified four themes: (1) fatigue is unexpected after stroke and symptoms vary; (2) the individual experience of fatigue is complex, influenced by multifactorial and biopsychosocial factors; (3) learning to adapt and accept fatigue; and (4) Strategies to manage fatigue and personal approaches to rest. CONCLUSIONS: Post-stroke fatigue experience varies presenting cognitively, physically, and psychologically according to a complex interplay of biopsychosocial factors and personal triggers. Self-management strategies are individualised and include organisation, medications, lifestyle modifications, and peer support.Implications for rehabilitationPost-stroke fatigue is a complex individual experience involving biopsychosocial factors, and stroke survivors need assistance to identify their triggers and support from family, peers, and the stroke community to live well with fatigue.Fatigue is not commonly discussed by health professionals and stroke survivors need simple, practical advice over the long-term to reduce fear and distress.There are a range of strategies that may be helpful. Stroke survivors may benefit from adopting problem-solving approaches, trial pacing, lifestyle modifications and planning, and find forms of rest that work for them.

Associations between the chemical exposome and pregnancy induced hypertension.

Exposure to environmental chemicals has been linked to an increased risk of pregnancy-induced hypertension (PIH). This prospective cohort study examined the associations between PIH and maternal chemical exposure to four classes of chemicals (i.e., phthalates, bisphenols, perfluoroalkyl acids, non-essential metals and trace minerals). Participants included 420 pregnant women from the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort who had data available on diagnosed PIH and environmental chemical exposure. Twelve phthalate metabolites, two bisphenols, eight perfluoroalkyl acids and eleven non-essential metals or trace minerals were quantified in maternal urine or blood samples collected in the second trimester of pregnancy. Associations between the urinary and blood concentrations of these chemicals and PIH were assessed using multiple logistic and LASSO regression analyses in single- and multi-chemical exposure models, respectively. Thirty-five (8.3%) participants were diagnosed with PIH. In single chemical exposure models, two phthalate metabolites, mono-methyl phthalate (MMP) and monoethyl phthalate (MEP), three perfluoroalkyl acids, perfluoroheptanoic acid (PFHpA), perfluorononanoic acid (PFNA), and perfluorodecanoic acid (PFDA), and one metal, manganese, were associated with increased odds of PIH. The metabolites of di (2-ethylhexyl) phthalate (DEHP) and the molar sum of these metabolites, as well as antimony, displayed trend associations (p < 0.10). In multi-chemical exposure models using LASSO penalized regressions and double-LASSO regressions, MEP (AOR: 1.43, 95% CI: 1.09-1.88, p = 0.009) and PFNA (AOR: 2.03, 95% CI: 1.01-4.07, p = 0.04) were selected as the chemicals most highly associated with PIH. These findings suggest that maternal levels of phthalates and perfluoroalkyl acids may be associated with the diagnosis on PIH. Future research should consider both individual and multi-chemical exposures when examining predictors of PIH and other maternal cardiometabolic health disorders, such as preeclampsia, eclampsia, HELLP syndrome, and gestational diabetes.

Using Presurgical Biopsychosocial Features to Develop an Advanced Clinical Decision-Making Support Tool for Predicting Recovery Trajectories in Patients Undergoing Total Knee Arthroplasty: Protocol for a Prospective Observational Study.

BACKGROUND: Following total knee arthroplasty (TKA), 10% to 20% of patients report dissatisfaction with procedural outcomes. There is growing recognition that postsurgical satisfaction is shaped not only by the quality of surgery but also by psychological and social factors. Surprisingly, information on the psychological and social determinants of surgical outcomes is rarely collected before surgery. A comprehensive collection of biopsychosocial information could assist clinicians in making recommendations in relation to rehabilitation, particularly if there is robust evidence to support the ability of presurgical constructs to predict postsurgical outcomes. Clinical decision support tools can help identify factors influencing patient outcomes and support the provision of interventions or services that can be tailored to meet individuals' needs. However, despite their potential clinical benefit, the application of such tools remains limited. OBJECTIVE: This study aims to develop a clinical decision tool that will assist with patient stratification and more precisely targeted clinical decision-making regarding prehabilitation and rehabilitation for TKA, based on the identified individual biopsychosocial needs. METHODS: In this prospective observational study, all participants provided written or electronic consent before study commencement. Patient-completed questionnaires captured information related to a broad range of biopsychosocial parameters during the month preceding TKA. These included demographic factors (sex, age, and rurality), psychological factors (mood status, pain catastrophizing, resilience, and committed action), quality of life, social support, lifestyle factors, and knee symptoms. Physical measures assessing mobility, balance, and functional lower body strength were performed via video calls with patients in their home. Information related to preexisting health issues and concomitant medications was derived from hospital medical records. Patient recovery outcomes were assessed 3 months after the surgical procedure and included quality of life, patient-reported knee symptoms, satisfaction with the surgical procedure, and mood status. Machine learning data analysis techniques will be applied to determine which presurgery parameters have the strongest power for predicting patient recovery following total knee replacement. On the basis of these analyses, a predictive model will be developed. Predictive models will undergo internal validation, and Bayesian analysis will be applied to provide additional metrics regarding prediction accuracy. RESULTS: Patient recruitment and data collection commenced in November 2019 and was completed in June 2022. A total of 1050 patients who underwent TKA were enrolled in this study. CONCLUSIONS: Our findings will facilitate the development of the first comprehensive biopsychosocial prediction tool, which has the potential to objectively predict a patient's individual recovery outcomes following TKA once selected by an orthopedic surgeon to undergo TKA. If successful, the tool could also inform the evolution rehabilitation services, such that factors in addition to physical performance can be addressed and have the potential to further enhance patient recovery and satisfaction. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/48801.

Maternal co-exposure to mercury and perfluoroalkyl acid isomers and their associations with child neurodevelopment in a Canadian birth cohort.

BACKGROUND: Perfluoroalkyl acids (PFAAs) within the broader class of per- and polyfluoroalkyl substances (PFAS) are present in human serum as isomer mixtures, but epidemiological studies have yet to address isomer-specific associations with child development and behavior. OBJECTIVES: To examine associations between prenatal exposure to 25 PFAAs, including perfluorooctane sulfonate (PFOS) and perfluorooctanoate (PFOA) isomers, and child neurodevelopment among 490 mother-child pairs in a prospective Canadian birth cohort, the Alberta Pregnancy Outcomes and Nutrition (APrON) study. To consider the influence of a classic neurotoxicant, total mercury (THg), based on its likelihood of co-exposure with PFAAs from common dietary sources. METHODS: Maternal blood samples were collected in the second trimester and child neurodevelopment was assessed at 2 years of age using the Bayley Scales of Infant and Toddler Development, 3rd Edition (Bayley-III). Linear or curvilinear multiple regression models were used to examine associations between exposures and neurodevelopment outcomes. RESULTS: Select PFAAs were associated with lower Cognitive composite scores, including perfluoroheptanoate (PFHpA) (ß = -0.88, 95% confidence interval (CI): -1.7, -0.06) and perfluorododecanoate (PFDoA) (ß = -2.0, 95% CI: -3.9, -0.01). Non-linear relationships revealed associations of total PFOS (ß = -4.4, 95% CI: -8.3, -0.43), and linear-PFOS (ß = -4.0, 95% CI: -7.5, -0.57) and 1m-PFOS (ß = -1.8, 95% CI: -3.3, -0.24) isomers with lower Language composite scores. Although there was no effect modification, including THg interaction terms in PFAA models revealed negative associations between perfluorononanoate (PFNA) and Motor (ß = -3.3, 95% CI: -6.2, -0.33) and Social-Emotional (ß = -3.0, 95% CI: -5.6, -0.40) composite scores. DISCUSSION: These findings reinforce previous reports of adverse effects of maternal PFAA exposure during pregnancy on child neurodevelopment. The unique hazards posed from isomers of PFOS justify isomer-specific analysis in future studies. To control for possible confounding, mercury co-exposure may be considered in studies of PFAAs.

Sex-specific associations between maternal phthalate exposure and neurodevelopmental outcomes in children at 2 years of age in the APrON cohort.

BACKGROUND: There is inconsistent evidence regarding the sex-specific associations between prenatal phthalate exposure and children's neurodevelopment. This could be due to differences in the phthalate exposures investigated and the neurodevelopmental domains assessed. OBJECTIVE: To evaluate the associations between prenatal phthalate exposure and sex-specific outcomes on measures of cognition, language, motor, executive function, and behaviour in children 2 years of age in the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort. METHODS: We evaluated the associations between prenatal phthalate exposure and sex-specific neurodevelopmental outcomes in children at 2 years of age using data from 448 mothers and their children (222 girls, 226 boys). Nine phthalate metabolites were measured in maternal urine collected in the second trimester of pregnancy. Children's cognitive, language, and motor outcomes were assessed using the Bayley Scales of Infant Development - Third Edition (Bayley-III). Parents completed questionnaires on children's executive function and behavior, the Behavior Rating Inventory of Executive Function- Preschool Version (BRIEF-P) and Child Behavior Checklist (CBCL), respectively. Sex-stratified robust multivariate regressions were performed. RESULTS: Higher maternal concentrations of ΣDEHP and its metabolites were associated with lower scores on the Bayley-III Cognitive (ß's from -11.8 to -0.07 95% CI's from -21.3 to -0.01), Language (ß's from -11.7 to -0. 09, 95% CI's from -22.3 to -0.02) and Motor (ß's from -10.9 to -0.07, 95% CI from -20.4 to -0.01) composites in boys. The patterns of association in girls were in the opposite direction on the Cognitive and Language composites; on the Motor composite they were in the same direction as boys, but of reduced strength. Higher concentrations of ΣDEHP and its metabolites were associated with higher scores (i.e., more difficulties) on all measures of executive function in girls: inhibitory self-control (B's from 0.05 to 0.11, 95% CI s from -0.01 to 0.15), flexibility (B's from 0.04 to 0.11, 95% CI s from 0.01 to 0.21) and emergent metacognition (B's from -0.01 to 0.06, 95% CIs from -0.01 to 0.20). Similar patterns of attenuated associations were seen in boys. Higher concentrations of ΣDEHP and its metabolites were associated with more Externalizing Problems in girls and boys (B's from 0.03 to 6.82, 95% CIs from -0.08 to 12.0). Two phthalates, MMP and MBP, had sex-specific adverse associations on measures of executive function and behaviour, respectively, while MEP was positively associated with boys' cognitive, language, and motor performance. Limited associations were observed between mixtures of maternal phthalates and sex-specific neurodevelopmental outcomes. CONCLUSIONS: Maternal prenatal concentrations of DEHP phthalates were associated with sex specific difference on measures of cognition and language at 2 years of age, specifically, poorer outcomes in boys. Higher exposure to DEHP was associated with poorer motor, executive function, and behavioural outcomes in girls and boys but the strength of these associations differed by sex. Limited associations were noted between phthalate mixtures and child neurodevelopment.

Fluoride exposure during pregnancy from a community water supply is associated with executive function in preschool children: A prospective ecological cohort study.

BACKGROUND: On May 19, 2011, Calgary, Canada stopped fluoridating its drinking water. This prospective ecological study examined if maternal exposure to fluoride during pregnancy from drinking water that was fluoridated at the recommended level of 0.7 mg/L was associated with children's intelligence and executive function at 3-5 years of age. METHODS: Participants were 616 maternal-child pairs enrolled in the Calgary cohort of the Alberta Pregnancy Outcomes and Nutrition (APrON) study between 2009 and 2012. Maternal-child pairs were classified as fully exposed to fluoridated drinking water throughout pregnancy (n = 295); exposed to fluoridated drinking water for at least part of the pregnancy plus an additional 90 days (n = 220); or not exposed to fluoridated drinking water during pregnancy plus the 90 days prior to pregnancy (n = 101). Children's Full Scale IQs were assessed using the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition: Canadian (WPPSI-IVCDN). Children's executive functions were also assessed: working memory (WPPSI-IVCDN Working Memory Index), inhibitory control (Gift Delay, NEPSY-II Statue subtest), and cognitive flexibility (Boy-Girl Stroop, Dimensional Change Card Sort (DCCS)). RESULTS: No associations were found between exposure group and Full Scale IQ. However, compared to no exposure, full exposure to fluoridated drinking water throughout pregnancy was associated with poorer performance on the Gift Delay (B = 0.53, 95 % CI = 0.31, 0.93). Sex-specific analyses revealed that girls in the fully exposed (AOR = 0.30, 95 % CI = 0.13, 0.74) and partially exposed groups (AOR = 0.42, 95 % CI = 0.17, 1.01) performed more poorly than girls in the not exposed group. Sex effects were also found on the DCCS; girls in the fully exposed (AOR = 0.34, 95 % CI = 0.14, 0.88) and partially exposed groups (AOR = 0.29, 95 % CI = 0.12, 0.73) performed more poorly. CONCLUSION: Maternal exposure to drinking water throughout pregnancy fluoridated at the level of 0.7 mg/L was associated with poorer inhibitory control and cognitive flexibility, particularly in girls, suggesting a possible need to reduce maternal fluoride exposure during pregnancy.

Associations between maternal folate status and choline intake during pregnancy and neurodevelopment at 3-4 years of age in the Alberta Pregnancy Outcomes and Nutrition (APrON) study.

Folate and choline are methyl donor nutrients that may play a role in fetal brain development. Animal studies have reported that prenatal folate and choline supplementation are associated with better cognitive outcomes in offspring and that these nutrients may interact and affect brain development. Human studies that have investigated associations between maternal prenatal folate or choline levels and neurodevelopmental outcomes have reported contradictory findings and no human studies have examined the potential interactive effect of folate and choline on children's neurodevelopment. During the second trimester of pregnancy, maternal red blood cell folate was measured from blood samples and choline intake was estimated using a 24-h dietary recall in 309 women in the APrON cohort. At 3-5 years of age, their children's neurodevelopment was assessed using the Wechsler Preschool and Primary Scales of Intelligence - Fourth EditionCND, NEPSY-II language and memory subtests, four behavioral executive function tasks, and the Movement Assessment Battery for Children - Second Edition. Adjusted regressions revealed no associations between maternal folate and choline levels during pregnancy and most of the child outcomes. On the Dimensional Change Card Sort, an executive function task, there was an interaction effect; at high levels of choline intake (i.e., 1 SD above the mean; 223.03 mg/day), higher maternal folate status was associated with decreased odds of receiving a passing score (ß = -0.44; 95%CI -0.81, -0.06). In conclusion, maternal folate status and choline intake during the second trimester of pregnancy were not associated with children's intelligence, language, memory, or motor outcomes at 3-4 years of age; however, their interaction may have an influence children's executive functions.

Emotion socialization parenting interventions targeting emotional competence in young children: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Although emotion socialization parenting interventions are supported by a growing body of literature, their effects have yet to be systematically examined. The present systematic review and meta-analysis assesses the evidence for emotion socialization parenting interventions for parents of young children. METHODS: Six electronic databases were systematically searched from inception to October 5th, 2022. We conducted random effects meta-analyses of randomized controlled trials of emotion socialization interventions delivered to parents of children aged 18 months to 6 years 11 months. RESULTS: Twenty-six studies which reported data from 15 individual trials met the inclusion criteria. Interventions had a positive effect on positive and negative emotion socialization parenting practices (g's = 0.50) and child emotional competence (g = 0.44). Interventions also had a positive effect on positive (g = 0.74) and negative parenting behaviors (g = 0.25), parent psychological well-being (g = 0.28), and child behavioral adjustment (g = 0.34). Findings remained significant after considering potential publication bias and conducting sensitivity analyses. Two significant moderating factors emerged. CONCLUSIONS: Emotion socialization parenting interventions are effective for improving emotion socialization parenting practices and child emotional competence. Additional methodologically rigorous trials are needed to buttress the current evidence and provide evidence for additional moderating factors.

Management of post-stroke fatigue: an Australian health professional survey.

PURPOSE: Evidence for post-stroke fatigue management is limited. We aimed to explore how Australian health professionals assess and assist fatigue management. Our objectives were to identify fatigue assessment tools and interventions used, explore clinician's confidence managing fatigue and explore whether management of post-stroke fatigue differs from management of fatigue related to other conditions. MATERIALS AND METHODS: An online cross-sectional survey was completed by Australian health professionals (n = 60) providing services to people with fatigue. Analysis of open-ended questions identified common interventions and descriptive statistics were calculated for closed and dichotomized questions. RESULTS: Routine use of formal fatigue assessment tools was low (17%, n = 10). Most respondents reporting use of the Fatigue Impact Scale, Fatigue Assessment Scale and Fatigue Severity Scale. To address fatigue, respondents reported providing energy optimization strategies, education, and exercise interventions in clinical practice. Less frequently reported interventions were strategies to adapt tasks, sleep hygiene, psychology, nutrition, and pharmacology interventions. Respondents were "moderately" confident managing post-stroke fatigue. Respondents did not report differences between how they manage post-stroke fatigue and fatigue present in other conditions. CONCLUSIONS: Few Australian health professionals formally assess post-stroke fatigue. Management is multidisciplinary and based on evidence from fatigue management in other conditions.Implications for rehabilitationMost health professionals are not routinely using formal assessment tools for fatigue, possibly due to a lack of consensus on best practice in research.Common strategies recommended by health professionals include energy optimisation strategies, education and exercise.Comprehensive guidelines for post-stroke fatigue management are yet to be established.Health professionals should assess post-stroke fatigue using a validated tool to ensure an individualised approach to management based on the current available clinical guidelines.

Maternal sensitivity moderates the association between maternal history of childhood maltreatment and child executive function.

BACKGROUND: Experiences of childhood maltreatment are associated with a variety of negative outcomes throughout individuals' lives as well as disadvantaged cognitive and socioemotional development among their offspring. The mechanisms through which some children show resilience against the intergenerational transmission of risk, however, are less well understood. OBJECTIVE: The current study focuses on a proximal parental factor that plays a central role in children's early cognitive development - maternal sensitivity - and examines whether it moderates the association between maternal history of childhood maltreatment and child executive function (EF). PARTICIPANTS AND SETTING: Data were collected from a community sample of 139 mothers and their infants (51 % female) recruited from urban areas in Ontario, Canada. METHODS: Maternal maltreatment history was assessed via self-report at child age 3 months. Maternal sensitivity was assessed observationally at child age 8 months, and child executive function was assessed using performance-based measures at child age 3 years. Hypotheses were tested through multiple regression models. RESULTS: In the current sample, maternal maltreatment history was not associated with child EF on average. However, results were consistent with a moderation model, indicating that maternal maltreatment history was associated with lower levels of child EF only when mothers were relatively insensitive. CONCLUSIONS: The findings indicate the importance of considering sensitive parenting practices as a protective factor for children's cognitive development in the context of more distal risk factors such as mothers' history of childhood maltreatment.

Adolescent Experience With Dating Violence in Relation to Virginity Status: Findings From a Jamaican Sample.

The association between adolescents' involvement in sexual intercourse and their experiences with adolescent dating violence (ADV) is an understudied topic. This study examined this relationship for 178 Jamaican adolescents in Grades 9-11. The expectation that adolescents who reported having had sexual intercourse would report greater victimization and greater perpetration than adolescents who had not had intercourse was consistent only for sexual abuse. Analyses also showed that sexually experienced males perpetrated and experienced more psychological abuse compared to males who were not so experienced. These results suggest different experiences based on adolescents' sex and so support others' calls for ADV research to do more examinations by sex. Also, it endorses the importance of doing research on both victims and perpetrators of intimate abuse. Implications of these findings for sexual and relationship education of adolescents are discussed.

Prenatal exposure to phthalates and peripheral blood and buccal epithelial DNA methylation in infants: An epigenome-wide association study.

BACKGROUND: Prenatal exposure to phthalates has been associated with adverse health and neurodevelopmental outcomes. DNA methylation (DNAm) alterations may be a mechanism underlying these effects, but prior investigations of prenatal exposure to phthalates and neonatal DNAm profiles are limited to placental tissue and umbilical cord blood. OBJECTIVE: Conduct an epigenome-wide association study (EWAS) of the associations between prenatal exposure to phthalates and DNAm in two accessible infant tissues, venous buffy coat blood and buccal epithelial cells (BECs). METHODS: Participants included 152 maternal-infant pairs from the Alberta Pregnancy Outcomes and Nutrition (APrON) study. Maternal second trimester urine samples were analyzed for nine phthalate metabolites. Blood (n = 74) or BECs (n = 78) were collected from 3-month-old infants and profiled for DNAm using the Infinium HumanMethylation450 (450K) BeadChip. Robust linear regressions were used to investigate the associations between high (HMWPs) and low molecular weight phthalates (LMWPs) and change in methylation levels at variable Cytosine-phosphate-Guanine (CpG) sites in infant tissues, as well as the sensitivity of associations to potential confounders. RESULTS: One candidate CpG in gene RNF39 reported by a previous study examining prenatal exposure to phthalates and cord blood DNAm was replicated. The EWAS identified 12 high-confidence CpGs in blood and another 12 in BECs associated with HMWPs and/or LMWPs. Prenatal exposure to bisphenol A (BPA) associated with two of the CpGs associated with HMWPs in BECs. DISCUSSION: Prenatal exposure to phthalates was associated with DNAm variation at CpGs annotated to genes associated with endocrine hormone activity (i.e., SLCO4A1, TPO), immune pathways and DNA damage (i.e., RASGEF1B, KAZN, HLA-A, MYO18A, DIP2C, C1or109), and neurodevelopment (i.e., AMPH, NOTCH3, DNAJC5). Future studies that characterize the stability of these associations in larger samples, multiple cohorts, across tissues, and investigate the potential associations between these biomarkers and relevant health and neurodevelopmental outcomes are needed.

Prenatal Folate and Choline Levels and Brain and Cognitive Development in Children: A Critical Narrative Review.

Women's nutritional status during pregnancy can have long-term effects on children's brains and cognitive development. Folate and choline are methyl-donor nutrients and are important for closure of the neural tube during fetal development. They have also been associated with brain and cognitive development in children. Animal studies have observed that prenatal folate and choline supplementation is associated with better cognitive outcomes in offspring and that these nutrients may have interactive effects on brain development. Although some human studies have reported associations between maternal folate and choline levels and child cognitive outcomes, results are not consistent, and no human studies have investigated the potential interactive effects of folate and choline. This lack of consistency could be due to differences in the methods used to assess folate and choline levels, the gestational trimester at which they were measured, and lack of consideration of potential confounding variables. This narrative review discusses and critically reviews current research examining the associations between maternal levels of folate and choline during pregnancy and brain and cognitive development in children. Directions for future research that will increase our understanding of the effects of these nutrients on children's neurodevelopment are discussed.

Emotion regulation moderates between maternal adverse childhood experiences (ACEs) and oxytocin response.

Exposure to adverse childhood experiences (ACEs) is associated with oxytocin dysregulation in women, such as decreased peripheral oxytocin concentrations, but little is known about vulnerability markers for oxytocin dysregulation in mothers exposed to ACEs. Identifying vulnerability markers may help inform future targets for prevention and intervention programmes. This study provided a preliminary examination of emotion regulation as a potential moderator of the association between maternal ACEs and peripheral oxytocin levels. The current study included a sample of 38 postpartum women. Women completed questionnaires on exposure to ACEs and difficulties with emotion regulation. At a clinic visit at 9 months postpartum, women provided plasma and salivary oxytocin samples anchored around a mother-infant interaction. Associations between maternal ACEs, three dimensions of difficulties with emotion regulation, and peripheral oxytocin concentrations were examined. Linear regression analyses showed that greater difficulties engaging in goal-directed behaviour (ß = - 0.50, p = 0.01) and more limited access to effective emotion regulation strategies (ß = - 0.68, p < 0.001) were related to reduced plasma oxytocin concentrations in postpartum women. Furthermore, in postpartum women reporting greater exposure to ACEs, higher levels of nonacceptance of emotional responses (ß = - 0.55, p = 0.01) and more limited access to effective emotion regulation strategies (ß = - 0.54, p = 0.01) were associated with reduced salivary oxytocin response (i.e. decreased change in oxytocin concentrations from baseline) following mother-infant interaction. Difficulties with emotion regulation may serve as a vulnerability marker for oxytocin dysregulation in postpartum women exposed to ACEs, and this suggests that emotion regulation may be an important target for future clinical interventions. Future research is recommended which replicates these preliminary results and which examines how emotion regulation and peripheral oxytocin levels in mothers exposed to ACEs are associated with parenting and child development outcomes.

What do stroke survivors' value about participating in research and what are the most important research problems related to stroke or transient ischemic attack (TIA)? A survey.

BACKGROUND: Recruitment to stroke clinical trials is challenging, but consumer registers can facilitate participation. Researchers need to understand the key factors that facilitate trial involvement and improve consumer partnerships to identify what research topics important to stroke and transient ischemic attack (TIA) survivors and their carers. We aimed to examine i) the experience of being involved in a stroke research register, and ii) the priorities for stroke research from the perspective of stroke survivors. METHODS: Online and paper-based surveys were sent directly to members of a stroke register and disseminated online. Multiple choice questions were reported as counts and percentages and open-ended questions were thematically analysed using Braun and Clarke's 6-stage process. RESULTS: Of 445 survey respondents, 154 (38%) were a member of the Stroke Research Register. The most frequently reported reason for research participation was to help others in the future. Respondents reported they were less likely to take part in research if the research question was not relevant to them, if transport was an issue, or because they lacked time. The most important research problems reported were targeting specific impairments including recovery of movement, fatigue, and aphasia, improvement of mental health services, and increased support for carers. CONCLUSIONS: Recruitment to trials may be improved by research registers if an inclusive research culture is fostered, in which consumers feel valued as members of a community, have direct and timely access to research findings and the opportunity to be meaningfully involved in research around the problems that consumers find most important.