Motivations for participation in weight loss clinical trials

Males are under-represented in weight loss clinical trials, usually comprising fewer than one-quarter of participants. Our study aimed to investigate people's motivations for participating in weight loss trials and determine any relationship with gender. Eighty individuals from an existing registry for weight loss trials were contacted, of whom 24 (9 males, 15 females) agreed to participate in a 20-min semi-structured interview around their expectations and motivations for volunteering. Interviews were audio-recorded and transcribed in Zoom. A transcript of each interview was uploaded into NVivo for preliminary thematic analysis. Improved health was a common motivation for pursuing weight loss in all subjects regardless of gender. Male recruitment to weight loss trials was often influenced by advice from a healthcare professional to lose weight for the prevention of obesity-related comorbidities, whereas family and aesthetic expectations (e.g., clothes and fashion) were key elements of female participation. Identification of gender differences in motivations for volunteering in weight loss trials will help improve tailoring of recruitment strategies and interventions to enhance male participation in the future.

Gambling, fast food and alcohol sponsorship in elite sport - perspectives from Australian sporting fans

BACKGROUND

Public health bodies in Australia remain concerned about marketing of unhealthy commodities; namely unhealthy food, alcohol and gambling products. Children are particularly susceptible to the influence of unhealthy commodity marketing. This study explored adults' perceptions of unhealthy commodities sponsorship in elite sport and policies to restrict them.

METHODS

Four focus groups of 7-8 frequent sport spectators were recruited, including parents and non-parents, and located in inner and outer suburbs of Sydney, Australia. Results were analysed thematically.

RESULTS

Participants identified the contradictions of healthy messages of sport and unhealthy commodities, while highlighting the commercial value of sport sponsorship to sporting clubs. There is concern around children's exposure to effective and integrated marketing techniques when viewing sport, which encouraged unhealthy habits. Support for restricting sponsorship related to perceived product harm, with gambling viewed as having the greatest health impact. Participants were supportive of policies that reduced exposure of unhealthy commodities to children, but were concerned about the financial risk to sporting clubs. Governments and sports associations were identified as holding responsibility for enacting changes.

CONCLUSION

A number of options were identified for advocates to gain public and political traction to reduce unhealthy commodity sponsorship. There is potential for shifts away from unhealthy sponsorship by both governments and sports associations.

Differences in weight loss outcomes for males and females on a low-carbohydrate diet: A systematic review

It has been widely demonstrated that there are a broad range of individual responses to all weight management regimens, often masked by reports of the mean. Identifying features of responders and non-responders to weight loss regimens enables a more tailored approach to the provision of weight management advice. Low-carbohydrate diets are currently popular, and anecdote suggests that males are more successful at losing weight using this approach. This is feasible given the physiological and socio-psychological differences between the genders. We analysed the extent and variation in weight change for males and females separately through a systematic search for all low-carbohydrate diet trials published since 1985. Very few studies compared weight loss outcomes by gender and, of those that did, most lacked supporting data. The majority of studies reported no gender difference but when a gender difference was found, males were more frequently reported as losing more weight than females on a low-carbohydrate diet. The lack of gender stratification in weight loss trials is concerning, as there are a range of gender-based factors that affect weight loss outcomes. This study highlights the importance of examining weight change for males and females separately, since as failure to do so may mask any potential differences, which, if detected, could assist with better weight loss outcomes.

A Comparison of the Australian Dietary Guidelines to the NOVA Classification System in Classifying Foods to Predict Energy Intakes and Body Mass Index

NOVA classification distinguishes foods by level of processing, with evidence suggesting that a high intake of ultra-processed foods (UPFs, NOVA category 4) leads to obesity. The Australian Dietary Guidelines, in contrast, discourage excess consumption of “discretionary foods” (DFs), defined according to their composition. Here, we (i) compare the classification of Australian foods under the two systems, (ii) evaluate their performance in predicting energy intakes and body mass index (BMI) in free-living Australians, and (iii) relate these outcomes to the protein leverage hypothesis of obesity. Secondary analysis of the Australian National Nutrition and Physical Activity Survey was conducted. Non-protein energy intake increased by 2.1 MJ (p < 0.001) between lowest and highest tertiles of DF intake, which was significantly higher than UPF (0.6 MJ, p < 0.001). This demonstrates that, for Australia, the DF classification better distinguishes foods associated with high energy intakes than does the NOVA system. BMI was positively associated with both DFs (−1. 0, p = 0.0001) and UPFs (−1.1, p = 0.0001) consumption, with no difference in strength of association. For both classifications, macronutrient and energy intakes conformed closely to the predictions of protein leverage. We account for the similarities and differences in performance of the two systems in an analysis of Australian foods.

Cracked Tooth Syndrome: Assessment, Prognosis and Predictable Management Strategies

Cracked tooth syndrome (CTS) is a common presentation in general practice. The diagnosis and management of teeth with CTS may be difficult due to the unknown extent of the crack. This article reviews the aetiology, diagnosis, management and prognosis of teeth with CTS. A thorough examination is required to effectively assess CTS. Intervention should aim to relieve symptoms and brace the remaining tooth structure effectively against further flexion. Restored teeth with CTS have a guarded prognosis due to the risk of further crack propagation, but the chances of survival at 5-years is acceptable (74.1-96.8%).

Physical activity in the management of obesity in adults: A position statement from Exercise and Sport Science Australia

This Position Statement examines the evidence for physical activity in weight and adiposity loss, prevention of weight and adiposity gain, and in weight regain in adults, and provides guidance on implications for exercise practitioners. Research evidence indicates that >150 min but preferably 300 min per week of aerobic activity of at least moderate intensity is required to prevent weight and adiposity gain, and at least the upper end of this range of activity to prevent weight regain after weight loss. For meaningful weight and total adiposity loss, a minimum of 300-420 min per week of aerobic activity of at least moderate intensity is required. The evidence around the volume of aerobic physical activity required to reduce central adiposity is emerging, and research suggests that it may be substantially less than that required for weight loss. The impact of high-intensity physical activity and resistance exercise for weight management is uncertain. During consultations for weight management, exercise practitioners should advise that metabolic and cardiovascular health benefits can be achieved with physical activity at any weight, and irrespective of weight change.

Cracked Tooth Syndrome: Assessment, Prognosis and Predictable Management Strategies

Cracked tooth syndrome (CTS) is a common presentation in general practice. The diagnosis and management of teeth with CTS may be difficult due to the unknown extent of the crack. This article reviews the aetiology, diagnosis, management and prognosis of teeth with CTS. A thorough examination is required to effectively assess CTS. Intervention should aim to relieve symptoms and brace the remaining tooth structure effectively against further flexion. Restored teeth with CTS have a guarded prognosis due to the risk of further crack propagation, but the chances of survival at 5-years is acceptable (74.1-96.8%).

Digital health screening tool for identification of elder mistreatment

PURPOSE

It is estimated that 15.7% of people aged 60 years and older were subjected to some form of Elder Mistreatment (EM) globally (Yon et al., 2017). In the USA, as many as 1 in 24 EM cases are left unidentified by professionals, with a 300% increased mortality risk for older adults who do not receive help (National Center on Elder Abuse, n.d.; Dong, 2009). Current methods of screening tend to miss less obvious signs of EM and may discourage older adults from disclosing EM, due to either a lack of understanding of what constitutes mistreatment or fear of retaliation from the perpetrator.

METHOD

Our approach shifts the focus of EM identification to the older adults themselves through an automated tablet-based tool. The Virtual cOaching in making Informed Choices on Elder Mistreatment Self-Disclosure (VOICES) tool includes various multimedia components such as videos, audio, and animations designed to educate and enhance screening. Patients screened as positive are guided through a Brief Negotiated Interview (BNI) utilizing motivational interviewing to assist in self-identification (recognize that they are experiencing elder mistreatment) or self-disclosure (inform others about their elder mistreatment experiences). During tool development, we conducted a qualitative study to evaluate the perceived value and likelihood of adopting a tablet-based approach to facilitate screening and self-disclosure of EM in the ED. We held 3 focus groups with stakeholders, including 24 adults 60 years or over, 2 social workers, 2 caregivers, and 2 ED clinicians. We used the findings from the focus groups and User-Centered Design approach (UCD) to develop the tablet-based screening tool. Once the tool was ready, we tested its usability and acceptability with 14 older adults.

RESULTS AND DISCUSSION

Focus group participants supported use of a tablet-based tool to screen for EM, indicating that digital screening benefits from feelings of privacy and anonymity. On a 7-point Likert scale ranging from "1=Very Comfortable" to "7=Very Uncomfortable", older adults scored 2.8 on average for whether they would feel comfortable using a tablet device to screen for EM. Prominent suggestions made by older adults included using a female voice for the tool narrator, larger font size, more multimedia, headphones for privacy; and having someone available during screening for assistance if needed. Participants indicated that it is difficult for older adults experiencing EM to ask for help and that any type of mistreatment screening would be helpful. They also highlighted the need to explain community resources available to older adults once EM is disclosed, especially resources offering help to the caregiver. Participants of the usability evaluation rated the tool a mean score of 86.6 (median= 88.8, iQR =18.1) on the System Usability Scale (SUS), far above the benchmark SUS score of 68, which indicates that the system is "good" or "acceptable" (Bangor et al., 2008). Shifting the focus from the provider to the older adult may encourage self-disclosure of EM by addressing major barriers to traditional screening processes. In summary, this study supported the use of self-administered automated tablet-based screening for EM. Participants generally believed that the use of digital health tools to facilitate the screening process would be beneficial in the ED setting.

National policies to prevent obesity in early childhood: Using policy mapping to compare policy lessons for Australia with six developed countries

Interventions for obesity prevention in early childhood (first 5 years of life) are likely to have a significant preventive health impact. This mapping review identified recommended policy options for the Australian Federal Government (AFG) by comparing countries with similar population, income, and language to Australia. Policies were mapped in six countries using two matrices. The first matrix examined policy context, describing obesity prevention governance. The second matrix examined policy content, compared with global recommendations. Policies were grouped into downstream (healthcare), midstream (lifestyle and settings), and upstream (determinants of health, including food and built environments). Results identified variance in obesity governance across the six countries including policy coherence, leadership, institutional drivers, and overlapping responsibility across different levels of government. While countries tended to have more downstream or midstream policies, upstream policies were more likely when countries had invested in system-wide approaches to obesity such as developing a national obesity strategy, having separate food/nutrition and physical activity plans, and a dedicated preventive health agency. This study recommends a range of initiatives for the AFG to strengthen policies for the prevention of obesity in early childhood, including prioritising the development of a national food/nutrition strategy.

Ultra-processed foods and recommended intake levels of nutrients linked to non-communicable diseases in Australia: evidence from a nationally representative cross-sectional study

OBJECTIVE

This study aimed to describe the consumption of ultra-processed foods in Australia and its association with the intake of nutrients linked to non-communicable diseases (NCDs).

DESIGN

Cross-sectional study.

SETTING

National Nutrition and Physical Activity Survey (2011-2012).

PARTICIPANTS

12,153 participants aged 2+ years.

MAIN OUTCOME MEASURES

Average dietary content of nutrients linked to NCDs and the prevalence of intake outside levels recommended for the prevention of NCDs.

DATA ANALYSIS

Food items were classified according to the NOVA system, a classification based on the nature, extent and purpose of industrial food processing. The contribution of each NOVA food group and their subgroups to total energy intake was calculated. Mean nutrient content of ultra-processed food and non-ultra-processed food fractions of the diet were compared. Across quintiles of the energy contribution of ultra-processed foods, differences in the intake of nutrients linked to NCDs as well as in the prevalence of intakes outside levels recommended for the prevention of NCDs were examined.

RESULTS

Ultra-processed foods had the highest dietary contribution (42.0% of energy intake), followed by unprocessed or minimally processed foods (35.4%), processed foods (15.8%) and processed culinary ingredients (6.8%). A positive and statistically significant linear trend was found between quintiles of ultra-processed food consumption and intake levels of free sugars (standardised β 0.43, p<0.001); total (β 0.08, p<0.001), saturated (β 0.18, p<0.001) and trans fats (β 0.10, p<0.001); sodium (β 0.21, p<0.001) and diet energy density (β 0.41, p<0.001), while an inverse relationship was observed for dietary fibre (β -0.21, p<0.001) and potassium (β -0.27, p<0.001). The prevalence of non-recommended intake levels of all studied nutrients increased linearly across quintiles of ultra-processed food intake, notably from 22% to 82% for free sugars, from 6% to 11% for trans fat and from 2% to 25% for dietary energy density, from the lowest to the highest ultra-processed food quintile.

CONCLUSION

The high energy contribution of ultra-processed foods impacted negatively on the intake of non-ultra-processed foods and on all nutrients linked to NCDs in Australia. Decreasing the dietary share of ultra-processed foods would substantially improve the diet quality in the country and help the population achieve recommendations on critical nutrients linked to NCDs.

Increasing the sensitivity of terahertz split ring resonator metamaterials for dielectric sensing by localized substrate etching

We demonstrate a significant enhancement in the sensitivity of split ring resonator terahertz metamaterial dielectric sensors by the introduction of etched trenches into their inductive-capacitive gap area, both through finite element simulations and in experiments performed using terahertz time-domain spectroscopy. The enhanced sensitivity is demonstrated by observation of an increased frequency shift in response to overlaid dielectric material of thicknesses up to 18 µm deposited on to the sensor surface. We show that sensitivity to the dielectric is enhanced by a factor of up to ∼2.7 times by the incorporation of locally etched trenches with a depth of ∼3.4 µm, for example, and discuss the effect of the etching on the electrical properties of the sensors. Our experimental findings are in good agreement with simulations of the sensors obtained using finite element methods.

Use of The Global Alliance for Musculoskeletal Health survey module for estimating the population prevalence of musculoskeletal pain: findings from the Solomon Islands

Background

Musculoskeletal (MSK) conditions are common and the biggest global cause of physical disability. The objective of the current study was to estimate the population prevalence of MSK-related pain using a standardized global MSK survey module for the first time.

Methods

A MSK survey module was constructed by the Global Alliance for Musculoskeletal Health Surveillance Taskforce and the Global Burden of Disease MSK Expert Group. The MSK module was included in the 2015 Solomon Islands Demographic and Health Survey. The sampling design was a two-stage stratified, nationally representative sample of households.

Results

A total of 9214 participants aged 15–49 years were included in the analysis. The age-standardized four-week prevalence of activity-limiting low back pain, neck pain, and hip and/or knee pain was 16.8, 8.9, and 10.8%, respectively. Prevalence tended to increase with age, and be higher in those with lower levels of education.

Conclusions

Prevalence of activity-limited pain was high in all measured MSK sites. This indicates an important public health issue for the Solomon Islands that needs to be addressed. Efforts should be underpinned by integration with strategies for other non-communicable diseases, aging, disability, and rehabilitation, and with other sectors such as social services, education, industry, and agriculture. Primary prevention strategies and strategies aimed at self-management are likely to have the greatest and most cost-effective impact.

Electronic supplementary material

The online version of this article (10.1186/s12891-018-2198-0) contains supplementary material, which is available to authorized users.

Management of Musculoskeletal Conditions in Rural South Australia: A Randomised Controlled Trial

With age, the prevalence of musculoskeletal conditions increases markedly. This rural-based study determined the benefits of two approaches for managing musculoskeletal conditions: a multiple-component 'Self-management Plus' intervention, and usual care. The intervention combined self-management education with physical activity and health professional support. 6-month outcomes included: Clinical Global Impression-Improvement Scale (CGI-IS) and Quality of Life (QoL). A total of 145 people were recruited; mean (SD) age was 66.1 (11.1) and 63.3 (10.9) years for intervention and control groups respectively. The intervention resulted in greater improvements in global functioning (CGI-IS mean (SD) = 3.2 (1.3)) than usual care (CGI-IS mean (SD) = 4.2 (1.5)). There was no difference in QoL improvement between study groups. A multiple-component 'Self-management Plus' intervention had a positive effect on physical functioning for older adults with musculoskeletal conditions. However, recruitment and retention of participants was problematic, which raises questions about the intervention's feasibility in its current form.

Identification of factors contributing to successful self-directed weight loss: a qualitative study

BACKGROUND

Despite the number of weight management programmes and their wide promotion, most overweight and obese individuals tend to lose weight on their own. The present study aimed to understand the characteristics and strategies of those who successfully engage in self-directed weight loss, which could empower other overweight and obese individuals with information and strategies to manage their weight on their own.

METHODS

Men and women who had lost at least 5% of their body weight without direct interaction with professionals or weight management programmes were recruited. Demographic data were collected by questionnaire and participants' weight-loss experiences were explored using semi- structured interviews to elicit in-depth individual experiences and perspectives. Iterative thematic method data analysis was used to generate themes describing contributing factors to the success of self-directed weight loss identified by participants.

RESULTS

Most characteristics of those who successfully self-managed their weight loss were in line with those reported by successful weight losers participating in professional-led projects. However, strategies such as early embedding of new lifestyle behaviours into daily routine, the ability to learn from previous weight-loss experiences, and not requiring social support were identified as distinctive factors that contributed to the success of self-directed weight loss by participants of the present study.

CONCLUSIONS

Overweight or obese individuals with strong internal motivation, problem-solving skills and self-reliance are more likely to be successful at achieving self-directed weight loss. The patients identified with these characteristics could be encouraged to self-manage their weight-loss process, leaving the places available in more resource-intensive professional-led programmes to those individuals unlikely to succeed on their own.

A Systematic Review of Research into the Impact of Loose Parts Play on Children's Cognitive, Social and Emotional Development

Loose parts play (LPP) interventions introduce moveable materials and equipment to children’s play spaces to facilitate unstructured, child-led play. Meta-analysis of previous school-based research has shown significant benefits of LPP for physical activity. In the current paper, we review the scope and quality of the quantitative evidence relating to cognitive, social and emotional outcomes. We conducted a systematic search of the literature on LPP interventions for primary school-aged children which used quantitative outcome indicators for cognitive, social and/or emotional development. Studies were screened for inclusion by two independent researchers and reviewed for content, relevant outcomes and quality indicators. Five studies met the review inclusion criteria. Two studies used a randomised controlled trial design, two studies used quasi-experimental design, and one used an observational design. Outcomes measured focused mainly on social development. With the exception of enjoyment, school satisfaction and self-esteem, emotional outcomes were almost entirely absent. No measures of cognitive or academic outcomes were found. For the studies using control groups, few differences between groups were reported, although one study found increased happiness at school and increased odds of reporting being pushed/shoved at playtime associated with intervention. Null results were found for peer acceptance, relational bullying, social competence, social skills, peer group size and psychosocial quality of life. In the non-controlled study, there were observed increases in co-operative play. There is insufficient high-quality, quantitative, empirical evidence available to determine whether or not LPP interventions have an impact on children’s cognitive, social and emotional development. We conclude our review with some recommendations which we hope will assist future research in this promising field.

Obesity, arterial function and arterial structure - a systematic review and meta-analysis

OBJECTIVE

Obesity is an established risk factor for cardiovascular disease. The mechanisms by which obesity affects cardiovascular risk have not been fully elucidated. This paper reports a comprehensive systematic review and meta-analysis on obesity and two key aspects of vascular health using gold-standard non-invasive measures - arterial endothelial function (brachial flow-mediated dilatation) and subclinical atherosclerosis (carotid intima-media thickness).

METHODS

Electronic searches for 'Obesity and flow-mediated dilatation' and 'Obesity and intima-media thickness' were performed using Ovid Medline and Embase databases. A meta-analysis was undertaken for brachial flow-mediated dilatation and carotid intima-media thickness to obtain pooled estimates for adults with obesity and those with healthy weight.

RESULTS

Of the 5,810 articles retrieved, 19 studies on flow-mediated dilatation and 19 studies on intima-media thickness were included. Meta-analysis demonstrated that obesity was associated with lower flow-mediated dilatation (-1.92 % [95% CI -2.92, -0.92], P = 0.0002) and greater carotid intima-media thickness (0.07 mm [95% CI 0.05, 0.08], P < 0.0001).

CONCLUSIONS

Obesity is associated with poorer arterial endothelial function and increased subclinical atherosclerosis, consistent with these aspects of vascular health at least partially contributing to the increased risk of cardiovascular events in adults with obesity. These estimated effect sizes will enable vascular health benefits in response to weight loss treatment to be put in greater perspective, both in the research setting and potentially also clinical practice.

Validity of short food questionnaire items to measure intake in children and adolescents: a systematic review

BACKGROUND

Short food questions are appealing to measure dietary intakes.

METHODS

A review of studies published between 2004 and 2016 was undertaken and these were included in the present study if they reported on a question or short item questionnaire (≤50 items, data presented as ≤30 food groups) measuring food intake or food-related habits, in children (aged 6 months to 18 years), and reported question validity or reliability. Thirty studies met the inclusion criteria.

RESULTS

Most questions assessed foods or food groups (n = 29), with the most commonly assessed being fruit (n = 22) or vegetable intake (n = 23), dairy foods and discretionary foods (n = 20 studies each). Four studies assessed food habits, with the most common being breakfast and meal frequency (n = 4 studies). Twenty studies assessed reliability, and 25 studies determined accuracy and were most commonly compared against food records. Evaluation of question performance relied on statistical tests such as correlation.

CONCLUSIONS

The present study has identified valid and reliable questions for the range of key food groups of interest to public health nutrition. Questions were more likely to be reliable than accurate, and relatively few questions were both reliable and accurate. Gaps in repeatable and valid short food questions have been identified that will provide direction for future tool development.

Television advertising, not viewing, is associated with negative dietary patterns in children

BACKGROUND

Children's exposure to unhealthy food marketing is a contributor to poor diets and weight gain. Television food advertising, in particular, has been the focus of research and policy discussions.

OBJECTIVES

We aimed to quantify the specific impact of television advertising, as distinct from television viewing generally, on children's usual diet. Methods Four hundred seventeen Australian children aged 10-16 participated in an online survey, which assessed television viewing habits and consumption of 12 frequently advertised unhealthy foods/drinks. Consumption of these foods/drinks was dichotomized (less weekly, weekly or more) and summed (1 point for each item consumed weekly or more) to give cumulative consumption scores.

RESULTS

After adjusting for age and socioeconomic status, there was strong evidence of an increase in unhealthy food score (P < 0.001), drink score (P = 0.002) and food/drink combined score (P < 0.001), with increasing commercial television viewing.

CONCLUSIONS

The link between television viewing and poor diet was strongest for children who watched the most commercial television, and those who were actually exposed to advertisements embedded within programs. This association between advertisement exposure and poor diet emphasizes the need for public policy intervention to reduce children's food advertising exposures.

Typical food portion sizes consumed by Australian adults: results from the 2011-12 Australian National Nutrition and Physical Activity Survey

Considerable evidence has associated increasing portion sizes with elevated obesity prevalence. This study examines typical portion sizes of commonly consumed core and discretionary foods in Australian adults, and compares these data with the Australian Dietary Guidelines standard serves. Typical portion sizes are defined as the median amount of foods consumed per eating occasion. Sex- and age-specific median portion sizes of adults aged 19 years and over (n = 9341) were analysed using one day 24 hour recall data from the 2011–12 National Nutrition and Physical Activity Survey. A total of 152 food categories were examined. There were significant sex and age differences in typical portion sizes among a large proportion of food categories studied. Typical portion sizes of breads and cereals, meat and chicken cuts, and starchy vegetables were 30–160% larger than the standard serves, whereas, the portion sizes of dairy products, some fruits, and non-starchy vegetables were 30–90% smaller. Typical portion sizes for discretionary foods such as cakes, ice-cream, sausages, hamburgers, pizza, and alcoholic drinks exceeded the standard serves by 40–400%. The findings of the present study are particularly relevant for establishing Australian-specific reference portions for dietary assessment tools, refinement of nutrition labelling and public health policies.

A snapshot of the scope of obesity prevention practice in Australia

Community-based initiatives (CBIs) that build capacity and promote healthy environments hold promise for preventing obesity and non-communicable disease, however their characteristics remain poorly understood and lessons are learned in isolation. This limits understanding of likely effectiveness of CBIs; the potential for actively supporting practice; and the translation of community-based knowledge into policy. Building on an initial survey (2010), an online survey was launched (2013) with the aim to describe the reach and characteristics of Australian CBIs and identify and evaluate elements known to contribute to best practice, effectiveness and sustainability. Responses from 104 CBIs were received in 2013. Geographic location generally reflected population density in Australia. Duration of CBIs was short-term (median 3 years; range 0.2–21.0 years), delivered mostly by health departments and local governments. Median annual funding had more than doubled since the 2010 survey, but average staffing had not increased. CBIs used at least two strategy types, with a preference for individual behaviour change strategies. Targeting children was less common (31%) compared with the 2010 survey (57%). Logic models and theory were used in planning, but there was low use of research evidence and existing prevention frameworks. Nearly, all CBIs had an evaluation component (12% of budget), but dissemination was limited. This survey provides information on the scope and varied quality of the current obesity prevention investment in Australia. To boost the quality and effectiveness of CBIs, further support systems may be required to ensure that organizations adopt upstream, evidence-informed approaches; and integrate CBIs into systems, policies and environments.

A map of community-based obesity prevention initiatives in Australia following obesity funding 2009-2013

Abstract

Objective:

Obesity is the single biggest public health threat to developed and developing economies. In concert with healthy public policy, multi-strategy, multi-level community-based initiatives appear promising in preventing obesity, with several countries trialling this approach. In Australia, multiple levels of government have funded and facilitated a range of community-based obesity prevention initiatives (CBI), heterogeneous in their funding, timing, target audience and structure. This paper aims to present a central repository of CBI operating in Australia during 2013, to facilitate knowledge exchange and shared opportunities for learning, and to guide professional development towards best practice for CBI practitioners.

Methods:

A comprehensive search of government, non-government and community websites was undertaken to identify CBI in Australia in 2013. This was supplemented with data drawn from available reports, personal communication and key informant interviews. The data was translated into an interactive map for use by preventive health practitioners and other parties.

Results:

We identified 259 CBI; with the majority (84%) having a dual focus on physical activity and healthy eating. Few initiatives, (n=37) adopted a four-pronged multi-strategy approach implementing policy, built environment, social marketing and/or partnership building.

Conclusion:

This comprehensive overview of Australian CBI has the potential to facilitate engagement and collaboration through knowledge exchange and information sharing amongst CBI practitioners, funders, communities and researchers.

Implications:

An enhanced understanding of current practice highlights areas of strengths and opportunities for improvement to maximise the impact of obesity prevention initiatives.

Digital junk: food and beverage marketing on Facebook

OBJECTIVES

We assessed the amount, reach, and nature of energy-dense, nutrient-poor (EDNP) food and beverage marketing on Facebook.

METHODS

We conducted a content analysis of the marketing techniques used by the 27 most popular food and beverage brand Facebook pages in Australia. We coded content across 19 marketing categories; data were collected from the day each page launched (mean = 3.65 years of activity per page).

RESULTS

We analyzed 13 international pages and 14 Australian-based brand pages; 4 brands (Subway, Coca-Cola, Slurpee, Maltesers) had both national and international pages. Pages widely used marketing features unique to social media that increase consumer interaction and engagement. Common techniques were competitions based on user-generated content, interactive games, and apps. Four pages included apps that allowed followers to place an order directly through Facebook. Adolescent and young adult Facebook users appeared most receptive to engaging with this content.

CONCLUSIONS

By using the interactive and social aspects of Facebook to market products, EDNP food brands capitalize on users' social networks and magnify the reach and personal relevance of their marketing messages.

The use of granulocyte colony-stimulating factors in a Canadian outpatient setting

BACKGROUND

Data on real-life utilization of granulocyte colony-stimulating factors (g-csfs) in Canada are limited. The objective of the present study was to describe the reasons for, and the patterns of, g-csf use in selected outpatient oncology clinics in Ontario and Quebec.

METHODS

In a retrospective longitudinal cohort study, a review of medical records from 9 Canadian oncology clinics identified patients being prescribed filgrastim (fil) and pegfilgrastim (peg). Patient characteristics, reasons for g-csf use, and treatment patterns were descriptively analyzed.

RESULTS

Medical records of 395 patients initiating g-csf therapy between January 2008 and January 2009 were included. Of this population, 80% were women, and breast cancer was the predominant diagnosis (59%). The most commonly prescribed g-csf was fil (56% in Ontario and 98% in Quebec). The most frequent reason for g-csf use was primary prophylaxis (42% for both fil and peg), followed by secondary prophylaxis (37% fil, 41% peg). Those proportions varied by tumour type and chemotherapy regimen. Delayed g-csf administration (more than 1 day after the end of chemotherapy) was frequently observed for fil, but rarely reported for peg, and that finding was consistent across tumours and concurrent chemotherapy regimens.

CONCLUSIONS

The use of g-csf varies with the malignancy type and the provincial health care setting. The most commonly prescribed g-csf agent was fil, and most first g-csf prescriptions were for primary prophylaxis. Delays were frequently observed for patients receiving fil, but were rarely reported for those receiving peg.

Shiftworking, nutrition and obesity: implications for workforce health- a systematic review

BACKGROUND

Shiftworking has long been unrecognised as an occupational health hazard up until now.

METHODS

Electronic databases were searched using OVID host as the main search engine for Medline, PUBMED and CINHAL during the years 1990-December 2010. Combinations of the keywords yielded 35 full papers and ab-stracts, of which 16 articles were relevant. One paper was not in English, leaving 15 included in this review after final reconsideration. Studies were categorised into two main titles: studies assessing the association between shift working and obesity and/or BMI (n=8) and studies assessing the association between shift working and nu-tritional/dietary patterns (n=7). Type of study was also considered as a part of the search strategy.

RESULTS

In total, one interventional, nine cross-sectional and five cohort studies were retrieved. Seven cross-sectional studies and one cohort study showed a higher BMI/obesity prevalence in shiftworks. Interventional, one cross-sectional and three cohort studies showed higher frequency of meal intake or poor nutrition quality/habits in the shift workers compared with the day-shift workers. Another cross-sectional study showed no difference between workers.

CONCLUSION

In terms of obesity or high BMI, majority of cross-sectional studies indicate that shiftwork increases weight gain and the prevalence of obesity. On the other hand, half of cohort studies show higher frequency of meal intake and/or poor nutrition quality in the shift workers. Generally, it is indicated that shift working negatively impacts on health and nutritional status of workforces.

Interactions of protamine with the marine bacterium, Pseudoalteromonas sp. NCIMB 2021

Pseudoalteromonas sp. NCIMB 2021 (NCIMB 2021) was grown in synthetic seawater (SSW) containing pyruvate, in the presence (SSW(++) ) and absence (SSW(-) ) of divalent cations. Cultures contained single cells. Addition of the cationic antibacterial peptide (CAP), protamine, did not inhibit, but rather increased, the growth of NCIMB 2021 in SSW(++) and caused the bacteria to grow in chains. Bacterial growth was assessed using turbidity, cell counts and the sodium salt of resazurin. In SSW(-) , NCIMB 2021 was no longer resistant to protamine. The minimum inhibitory concentration (MIC) was 5 mg ml(-1) .

SIGNIFICANCE AND IMPACT OF THE STUDY

Protamine is a cationic antimicrobial peptide (CAP), which is active against a variety of bacteria. This is the first in-depth study of the interaction of protamine with a marine bacterium, Pseudoalteromonas sp. NCIMB 2021. Our results show that protamine is only active in seawater in the absence of divalent cations. In the presence of the divalent cations, Mg(2+) and Ca(2+) , protamine enhances the growth of Pseudoalteromonas sp. NCIMB 2021 and produces chains rather than individual cells. These are important considerations when deciding on applications for protamine and in terms of understanding its mechanism of action.

Misreporting of energy intake in the 2007 Australian Children's Survey: differences in the reporting of food types between plausible, under- and over-reporters of energy intake

BACKGROUND

Misreporting is common when collecting dietary intake data, although relatively little is known about the types of foods misreported among children. The present study aimed to identify differences in the reporting of food types between plausible and misreporters of energy intake in a national nutrition survey of Australian children.

METHODS

Dietary data were collected using a 24-h recall from 4826 children aged 2-16 years who were participating in the 2007 Australian National Children's Nutrition and Physical Activity Survey. Misreporters of energy intake were classified using the Goldberg criteria. Differences in the reporting of a range of food types were examined between plausible, under- and over-reporters.

RESULTS

Compared with plausible reporters, under-reporters reported less frequent consumption and smaller quantities of consumption of both core and noncore foods. Older children (self-report) under-reported a larger selection of noncore foods than younger children (parental report). Over-reporters reported similar percentages of consumption of many core and noncore foods, with some exceptions. The quantities consumed by over-reporters were generally much larger and this was evident in younger and older children. Compared with plausible reporters, under-reporters had significantly higher intakes of protein and starch but lower intakes of sugar and fat, as percentage energy, than plausible reporters, whereas over-reporters had higher fat and lower carbohydrate intakes.

CONCLUSIONS

Differences in the reporting of food types were common between plausible, under- and over-reporters of energy intake by children (or their parents) and were not restricted to noncore foods.

Shifting curves? Trends in thinness and obesity among Australian youth, 1985 to 2010

OBJECTIVE

To describe 25-year trends in the prevalence of ≤Grade 2 thinness and obesity among Australian children by sex, age and socioeconomic (SES) background.

METHODS

Cross-sectional surveys of New South Wales school-aged children aged 6.0-16.9 years conducted in 1985-1997-2004-2010 (n = 19 434). Height/weight were measured, and thinness and obesity were defined by international standards. SES was derived from children's residential postcode using the Australian Bureau of Statistics' Index of Relative Socioeconomic Disadvantage, most proximal to the survey year.

RESULTS

Since 1985, the prevalence of thinness has not varied by survey year. Age was not associated with thinness; however, thinness was lower among middle SES boys, compared with high SES (OR: 0.45, 95%CI: 0.21, 0.97). The prevalence of obesity trebled between 1985 and 1997 (1.7% vs. 5.1% P = 0.000); however, since 1997, obesity prevalence has not significantly changed. Since 1997, obesity was higher among younger compared with older girls (OR: 2.11, 95%CI: 1.48, 3.00) and SES was inversely associated with obesity in boys (OR: 2.05, 95%CI: 1.44, 2.92) and girls (OR: 1.86, 95%CI: 1.27, 2.74).

CONCLUSIONS

The apparent plateau in child obesity is a welcome finding; however, the SES gradients are of concern. If the obesity stabilization is associated with the impact of multiple lifestyle behavioural interventions, the findings suggest obesity programmes have done 'no harm', but potentially the dose/delivery of interventions has not been sufficient or appropriate to reduce child obesity levels.