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BACKGROUND AND OBJECTIVE:Adults with bronchiectasis often present with altered body composition and muscle strength, yet prognostic value of peripheral muscle strength are not well understood. This study compared body composition and muscle function between adults with bronchiectasis and healthy controls and examined whether peripheral muscle strength estimates one-year clinical outcomes. METHODS:Adults with HRCT-confirmed bronchiectasis and controls underwent assessments including DXA (body composition), dynamometry (leg and shoulder strength), and core endurance tests. Participants with bronchiectasis were classified as having retained or impaired leg strength based on the 10th percentile of control values and were reassessed after one year for exacerbations, dyspnoea, quality of life, anxiety and depression, and exercise capacity. RESULTS:Seventy-one participants with bronchiectasis and 92 controls were included; 43 bronchiectasis participants completed follow-up. Females with bronchiectasis had lower appendicular muscle index (p = 0.018) and both sexes had lower bone mineral density compared to their control counterparts (p < 0.001). Osteopenia was 3 times more prevalent in females with bronchiectasis compared to their counterparts (54% versus 18%). Females with bronchiectasis have poorer lateral core endurance than those without (p ≤ 0.003). Leg strength was reduced in bronchiectasis compared to controls, regardless of sex (mean difference [95% CI] for males -25 [-50; -1] Kg and females -18 [-29; -7] Kg). Reduced leg strength is associated with worse dyspnoea, health related quality of life, and functional capacity over one year, explaining up to 33% of the variance (p ≤ 0.001). CONCLUSION:Individuals with bronchiectasis exhibit impaired muscle function and bone health, with leg strength showing a significant association with clinical outcomes over one year.
Schools provide an ideal context for developing students' leadership skills; however, most leadership opportunities (e.g., serving as class president) are typically offered to students who already demonstrate leadership qualities. The aim of our study was to evaluate the effects of a school-based leadership program, implemented through a peer-led fundamental movement skills intervention, on the leadership abilities of student leaders (10-12 years) and the physical and psychological development of their younger peers (8-10 years). We conducted a cluster randomized controlled trial to assess the impact of the Learning to Lead program in 20 elementary schools in New South Wales, Australia (N = 1898 students). Leader outcomes included teacher-rated leadership effectiveness (the primary outcome), leadership ability, leadership self-efficacy, wellbeing, and observed time on-task in the classroom. Peer outcomes included school-based physical activity (accelerometers), object control motor competence (Test of Gross Motor Development-3), perceived motor competence, cardiorespiratory fitness (20-meter multi-stage fitness test), and muscular power (standing long jump). We observed statistically significant group-by-time effects for Leaders' leadership effectiveness, wellbeing, and time spent ontask in the classroom. Statistically significant improvements in Peers' perceived motor competence, school-based physical activity, and cardiorespiratory fitness were also found. Our study demonstrated that a school-based leadership intervention has extensive benefits for the students delivering the program and those they taught. In addition to improvements in students' leadership skills, the Learning to Lead program produced spillover effects on students' well-being and time on task in the classroom.
OBJECTIVES:To examine the early effect of a world first national policy (Social Media Minimum Age Act 2024, which established a national minimum age of 16 years for holding accounts on designated social media platforms) on adolescent social media use, and to describe adolescent use of social media platforms subject to the Act, experience of age verification strategies, any efforts to circumvent them, and any perceived behavioural substitution or displacement. DESIGN:Observational study. SETTING:Community based study conducted across Australia. PARTICIPANTS:Australian adolescents aged between 12 and <17 years at the time of implementation of the age restrictions. INTERVENTION:The Australian Government's Online Safety Amendment (Social Media Minimum Age Act 2024), which requires designated social media platforms to implement reasonable measures to prevent users under 16 years of age from holding accounts. MAIN OUTCOME MEASURES:Data were collected immediately before (baseline) and approximately three months after introduction of the Act. Co-primary outcomes were adolescents' self-reported use of social media in the previous seven days (every day versus not every day) and time spent using social media per day. A sharp regression discontinuity design was used to evaluate the impact of the Act on social media use. Differences in outcomes at each side of the age threshold were estimated using local linear regression with triangular kernel function. RESULTS:Follow-up data were available from 408 of the 436 adolescents recruited at baseline. More than 85% of participants aged under 16 years reported using social media platforms subject to the Act at follow-up, predominately via use of their own accounts (54-68%), 66% of whom reported exposure to platform age verification, most commonly self-declared age (24-39%) or uploading of a picture ("selfie") (13-27%). Efforts to circumvent restrictions, such as use of a "fake" account (15-19%) or social media access via a private browser (6-11%) were also reported. Between baseline and follow-up, daily social media use was stable among 12-13 year olds; reduced somewhat among those aged 14-15 years (from 78% to 69%), and increased for those aged >16 years (from 80% to 89%). Time spent per day using social media was relatively stable between baseline and follow-up for 12-13 year olds and those aged >16 years but was lower at follow-up for those aged 14-15 years (from 3.40 to 3.13 units on an ordinal scale). In regression discontinuity design analyses, insufficient evidence was available to support a discontinuity in social media use on these primary outcomes (P≥0.60). CONCLUSIONS:Despite the intent of the Social Media Minimum Age Act 2024 to delay access to social media platforms and reduce the potential for online harms, little evidence was found of immediate substantive reductions in reported social media use by adolescents under 16 years. TRIAL REGISTRATION:Australian New Zealand Clinical Trials Registry ACTRN12625001056482.
The introduction of immune checkpoint inhibitor (ICI) therapy has improved cancer outcomes but at the cost of adverse events, mainly related to the immune system. Cardiovascular (CV) toxic effects, and especially myocarditis, are of particular concern and are the subject of this position statement by the International Cardio-Oncology Society with representation of experts from oncology, hematology, and cardiology. CV toxic effects of ICI therapies include inflammation-associated diseases, such as myocarditis, pericarditis, and vasculitis, as well as the aggravation of chronic inflammatory conditions, such as atherosclerosis with acute ischemic complications (myocardial infarction and stroke). Patients taking ICI therapies can also develop cardiac dysfunction, stress-induced cardiomyopathy (Takotsubo or apical ballooning syndrome), and heart failure without inflammatory cell infiltration of the myocardium. Atrial and ventricular arrhythmias can emerge in the setting of a systemic inflammatory milieu, myocarditis, or ischemia. Of all potential CV adverse effects, myocarditis remains of highest concern, although fatality rates have declined over time with a broadening spectrum of presentations ranging from troponin elevation of uncertain significance to smoldering, nonsevere, and severe or fulminant myocarditis. Concerns for myocarditis continue to dominate the spectrum of CV toxic effects in patients receiving ICI therapy. Recommendations for management vary according to severity. Multidisciplinary collaborations remain key for managing acute toxic effects and future cancer treatment decisions, including ICI rechallenge. Ischemic heart disease constitutes the main differential diagnosis in these patients, while pericarditis can be concomitantly present, and atrial and ventricular arrhythmias can also complicate the clinical picture. Several gaps in knowledge are identified and require further research.
Background: Optimal evidence-based dietary recommendations for dietary fiber have not been established. Objectives: This study aims to conduct a systematic review of fiber and gut motility (laxation) in noninfants with normal bowel function. Methods: We searched PubMed, Embase, and CINAHL from inception through 4 March, 2025, and existing systematic review reference lists. We included randomized controlled trials (RCTs) in the general population without bowel dysfunction that compared fiber amounts or types and assessed stool consistency, fecal weight, fecal frequency, or gut transit time. We categorized fibers according to their solubility, viscosity, and fermentability and performed hierarchical Bayesian regression models and spline analyses across reported total and added fiber intake doses, with subanalyses by fiber type. We assessed study risk of bias and strength of evidence (SoE). Results: We identified 113 eligible trials, with low or moderate risk of bias. Models provided moderate SoE that increasing fiber intake (per g/d total fiber) yields softening stool consistency [0.013 units, 95% credible interval (CrI): 0.009, 0.016 on the Bristol Stool Scale], increasing total fecal weight (1.76 g/d, 95% CrI: 1.58, 1.94) and dry fecal weight (0.47 g/d, 95% CrI: 0.42, 0.51), increasing fecal frequency (0.053 additional bowel movements/wk, 95% CrI: 0.042, 0.065), and shortening gut transit times (- 0.24 h, 95% CrI:-0.36,-0.12). Associations between fiber intake and outcomes varied across fiber doses and type. Low-solubility and low-fermentability fibers had the strongest associations with laxation outcomes, with low to medium SoE. However, findings are indirect, based on models, and there is insufficient evidence in specific subpopulations. Conclusions: RCTs support small to modest effects of dietary fiber on laxation in generally healthy people with normal bowel function. Low-solubility and low-fermentability fibers yielded the strongest effects. Future studies should better characterize fiber properties, assess wider ranges of fiber doses, and comprehensively report participants' total and background fiber intake. This study was registered at PROSPERO as CRD42024522380.
