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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.
BACKGROUND:Low back pain (LBP) is a common, disabling condition that often results in presentation to the emergency department (ED). There is currently a paucity of research examining how to optimise care for this patient group and concurrently improve service efficiency. We assessed the impact of a suite of co-designed strategies to improve the flow and reduce admission rate of people with LBP presenting to the ED. METHODS:A quasi-experimental implementation science study in a 30-bed ED at an Australian tertiary referral hospital. We implemented four improvement strategies: (1) co-design and development of a local ED guideline, (2) patient handout, (3) clinician education programme and (4) rapid-access physiotherapy follow-up clinic. We included all ED presentations from patients ≥16 years old, with a final diagnosis of LBP. Using an interrupted time series analysis, we compared a pre-implementation phase (July 2014-December 2019), a transition phase (July 2020-February 2021) and a post implementation phase (March 2021-November 2021). Our primary outcome was the proportion of patients admitted to hospital, in each phase. Secondary outcomes included ED length of stay (LOS), ED presentation cost, re-presentations within five days, admission LOS and outcome measures for those patients who attended the rapid-access physiotherapy clinic. RESULTS:There were 5301 LBP presentations pre-implementation, 752 during transition and 732 post implementation. The mean age of patients was 50.3 (20.1) years, 53% were female and 6.5% identified as Aboriginal and/or Torres Strait Islander. We observed a small reduction (2%) in the proportion of admissions per month (post implementation vs pre-implementation slope difference 0.98 ((95% CI 0.928 to 1.035), p=0.467) and a monthly decrease of 1.5 min in the average ED LOS for these patients (post implementation vs pre-implementation slope difference -1.5 ((95% CI -8.1 to 5.1), p=0.653) which was not statistically significant. 121 patients were referred to the follow-up physiotherapy clinic, and 41% attended an appointment. CONCLUSION:The improvement strategies did not significantly reduce admissions or LOS for people with LBP presenting to the ED, and based on the CIs, we cannot exclude that these increased.
OBJECTIVES:Many telephone-based Cancer Information and Support services (CIS) use distress screening tools. However, screening-based referral and repeat screening are less common. The Structured Triage And Referral by Telephone (START) trial implemented an evidence-informed co-designed model of structured-care. This study explored acceptability and integration of structured care into Australian Cancer Council telephone-based support services. METHODS:The START model for patient and caregiver callers supplemented existing Distress Thermometer (DT) use with Patient Health Questionnaire-4 (PHQ-4) screening, a structured referral pathway, and an outbound follow-up call with re-screening. Acceptability and integration of the model were assessed between April 2017 and March 2020 using interviews with Cancer Council consultants and analysis of call recordings. RESULTS:Analysis of 11 interviews identified seven themes relating to advantages and disadvantages of the START model. Perceived advantages were: clear framework to initiate discussion about distress; enhanced consultant confidence and understanding managing distress; and outbound calls providing continuity of care. Perceived disadvantages were: concerns about screening; necessity of screening; challenges introducing screening appropriateness for some callers; and workload. Staff reported satisfaction with the model becoming routine practice. Assessment of 107 call recordings found similar call length between usual care and START. The PHQ-4 was administered in 91.5% of START calls with some variation to standardised delivery and a significant increase in outbound calls relative to usual care (59.3% v 31.3%, p = 0.004). CONCLUSIONS:The systematic implementation of evidence-informed structured care protocols in CIS services is seen as acceptable and beneficial to service staff and callers. Further assessment is required to assess long-term integration of the model into care. IMPLICATIONS FOR PRACTICE:Introducing structured care represented significant changes to caller-driven practices. Ongoing monitoring and further evaluation are required for consistent implementation and to assess how variations in implementation affect caller experience and outcomes.
