Antenatal care (ANC) is vital for optimum maternal care and could provide an opportunity to prevent acute respiratory infection (ARI) in early childhood, particularly in low-resource settings; however, its impact on ARI remains underexplored. This study examined the association between ANC utilisation and ARI in Ethiopian infants, including stratified analyses by key socio-demographic factors. A total of 4,154 mother-infant pairs were analysed, using data from the Performance Monitoring for Action Ethiopia panel surveys conducted from 2019 to 2021 and from 2021 to 2023. At least one ANC visit, adequate ANC visits, and timely initiation of ANC were the exposures, and ARI among infants was the outcome. Generalised linear mixed models (GLMMs) were fitted using STATA 17 to estimate odds ratios (ORs) with 95% confidence intervals (CIs). Stratified analysis was conducted by maternal education, family wealth status, and administrative regions. Adequate ANC visits (≥4 ANC visits) were associated with significantly lower odds of ARI (aOR = 0.47; 95% CI: 0.24, 0.90). The protective effect was more pronounced among infants of mothers with higher education (aOR = 0.15; 95% CI: 0.04, 0.56), from wealthier households (aOR = 0.31; 95% CI: 0.14, 0.67), and those residing in agrarian regions (aOR = 0.44; 95% CI: 0.22, 0.88). At least one ANC visit showed a reduction in odds, but only among infants of educated mothers (aOR = 0.20; 95% CI: 0.05, 0.79). Adequate ANC visits significantly reduced the odds of ARI, especially among infants of educated mothers, wealthier families, and in agrarian regions. In contrast, just one visit or early initiation alone showed no benefit. Ensuring quality ANC access and targeting women in poverty with limited transport, income, and health literacy needs to be the focus of maternal and child health programs if we are to improve child health outcomes in low-resource settings like Ethiopia.

BackgroundAlthough perceived distance is a key factor in deciding and reaching healthcare, its impact on antenatal care (ANC) utilisation remains underexplored.ObjectiveThis study aims to examine the effect of perceived distance on ANC uptake, stratified by key maternal characteristics.DesignCross-sectional analysis based on demographic and health survey data (DHS).MethodsThis study analysed the demographic and health survey data of 26 sub-Saharan African countries, comprising 186,873 women who had given birth within the five years preceding the surveys. The exposure variable was perceived distance to a healthcare facility, categorised as "a big problem" or "not a big problem." Whereas the outcome variable was the number of ANC contacts, classified as no, one to three, four to seven and eight or more contacts. A Generalised Structural Equation Model (GSEM) with a multinomial logit link was employed to examine the association. Analyses were further stratified by socio-demographic characteristics.ResultsThe analysis revealed that women who perceived the distance as a major problem had 15% higher odds of receiving only 1-3 contacts (aOR = 1.15, 95% CI: 1.05, 1.25, p = 0.002), and 51% higher odds of receiving no ANC (aOR = 1.51, 95% CI: 1.35, 1.66, p < 0.001), compared to those receiving eight or more contacts. These associations were particularly pronounced among women with lower educational status (aOR=1.48, 95%CI: 1.29, 1.64), rural residents (aOR=1.55, 95%CI: 1.37, 1.74), low household income (aOR=1.47, 95%CI: 1.27,1.68), and younger age (aOR=1.55, 95%CI: 1.31, 1.80).ConclusionPerceived distance remains a significant barrier to the utilisation of antenatal care services in resource-limited settings. Strengthening health system responsiveness and addressing structural barriers, such as transportation infrastructures, through innovations like mobile antenatal care is vital to improving maternal health outcomes and advancing global health equity.

BACKGROUND:Existing trajectory studies have emphasised large-airway indices, but chronic obstructive pulmonary disease (COPD) might originate in smaller airways. This study aimed to investigate mid-to-small-airway function trajectories, their associated factors, and COPD risk. METHODS:In this prospective cohort study, probands (referred to throughout as offspring) were recruited to the Tasmanian Longitudinal Health Study from local schools across Tasmania, Australia at age 7 years. Pre-bronchodilator mean forced expiratory flow between 25% and 75% of the forced vital capacity (FEF25-75%) of offspring was measured at age 7 years as a proxy measure of mid-to-small-airway function. Parents completed a comprehensive respiratory health survey on themselves and their offspring. Offspring were followed up at mean ages of 13, 18, 45, 50, and 53 years. Follow-up included pre-bronchodilator spirometry, demographic surveys, lifestyle factors, respiratory symptoms, and illnesses. Post-bronchodilator spirometry was measured at mean ages of 45 and 53 years. Parents were later approached to complete the 2010 Tasmanian Longitudinal Health Study Parents Postal Survey, which collected information on parental preconception factors, including exposures during their own childhood and adolescence. Group-based trajectory modelling was used to identify FEF25-75% trajectories. Regression models were used to assess associations of FEF25-75% trajectories with childhood and parental preconception factors, and with COPD risk by age 53 years. FINDINGS:Between Feb 23, 1968, and Nov 8, 2016, 2314 offspring from the Tasmanian Longitudinal Health Study were included. Six FEF25-75% trajectories were identified: persistently low (144 [6·2%]); early normal-reduced growth-rapid decline (168 [7·3%]); early below average-reduced growth (740 [32·0%]); early low-accelerated growth (80 [3·5%]); average (976 [42·2%]; reference); and persistently high (206 [8·9%]). Three impaired trajectories across the lifespan were associated with COPD: persistently low (adjusted odds ratio 112 [95%CI 42-304]), early normal-reduced growth-rapid decline (41 [15-112]), and early below average-reduced growth (3·1 [1·0-9·2]) trajectories. Factors associated with impaired trajectories included no breastfeeding, the presence of asthma or wheeze, allergic rhinitis, and pneumonia or pleurisy during childhood, maternal asthma or wheeze, and parental smoking before conception. The persistently high trajectory was associated with parental preconception microbial-related exposures (ie, fathers sharing a childhood bedroom with three or more siblings and maternal cat keeping before completing puberty). INTERPRETATION:FEF25-75% across the life course, particularly from early life, could be more relevant to COPD than previously recognised. Several childhood and novel parental preconception factors were associated with FEF25-75% trajectories, although causality cannot be inferred due to no clear temporality of these associations. Our findings on the relationship between FEF25-75% and COPD should be interpreted as life-course associations rather than as predictive. As COPD was rare in the average trajectory, the magnitude of effect estimates could be inflated. FUNDING:National Health and Medical Research Council of Australia; The University of Melbourne; Clifford Craig Medical Research Trust; the Victoria, Queensland, and Tasmania Asthma Foundations; The Royal Hobart Hospital Research Foundation; Helen MacPherson Smith Trust; GlaxoSmithKline; China Scholarship Council.

Background and objective:Paternal passive smoke exposure before 15 years of age was associated with offspring childhood asthma, but its association with asthma beyond childhood had not been investigated. We aimed to investigate such long-term association. Methods:Data were from 1078 father-offspring and 1537 mother-offspring pairs from the Tasmanian Longitudinal Health Study. Offspring (probands of the original cohort) completed asthma surveys at age 7, 13, 18, 30, 43, 50 and 53 years. Life-course asthma trajectories were developed using group-based trajectory modelling. Parents self-reported their own passive smoke exposure before 15 years of age. Multinomial logistic regressions assessed associations between parental passive smoke exposure and offspring asthma trajectories. Active parental smoking, offspring sex, childhood respiratory illnesses and subsequent active smoking were evaluated for mediations and interactions. Results:Paternal passive smoke exposure before 15 years of age was associated with an early-onset adult-remitting asthma trajectory (adjusted multinomial odds ratio (aMOR) 2.53, 95% CI 1.09-5.85) in offspring, but not persistent asthma trajectories. Maternal passive smoke exposure before 15 years of age was associated with an early-onset adult-remitting asthma trajectory in offspring who were also exposed to childhood passive smoke (aMOR 4.30, 95% CI 1.01-18.40; p-interaction=0.044). The observed associations were partly mediated through active parental smoking or offspring childhood respiratory illnesses (each <10%). Conclusions:This study identified a novel association between parental passive smoke exposure before 15 years of age and an early-onset adult-remitting asthma trajectory in offspring, which is related to subsequent COPD. These findings suggest that in parents inevitably exposed to passive smoke during childhood/puberty, asthma risk in future generations associated with such exposure may be lower if parents avoid smoking around children.

Culturally and linguistically diverse (CALD) communities remain underrepresented in health research despite experiencing substantial health inequities. Community advisory panels are increasingly recommended to strengthen community engagement, cultural responsiveness, and research relevance; however, there is limited guidance on how to systematically establish, implement, and sustain advisory panels in CALD research contexts. This study aimed to develop and establish the content validity of an implementation framework to guide the implementation of culturally responsive advisory panels in CALD research settings. A two-phase study was undertaken. First, a scoping-informed best-fit framework synthesis integrated concepts from five complementary frameworks spanning Indigenous governance, culturally grounded co-design, cross-cultural research, multicultural health research, and inclusive patient and public involvement. Framework development was supported by concept-to-source mapping and an audit trail documenting adaptation decisions. Second, a two-round modified Delphi study involving experts in multicultural health, implementation science, community engagement, public health, health service delivery, and consumer involvement was conducted to refine the framework and establish content validity through expert consensus. Participants rated framework components on a 9-point Likert scale and provided qualitative feedback to refine it. Framework synthesis identified five interconnected domains underpinning advisory panel implementation: (1) Foundational Principles of Cultural Partnership; (2) Community-Centred Panel Composition and Setup; (3) Culturally Responsive Engagement and Co-Design Processes; (4) Structural Supports and Resources for Implementation; and (5) Iterative Reflexivity, Evaluation, and Knowledge Translation. Most components achieved consensus in Round (1) Components relating to recruitment pathways, remuneration and recognition, and institutional support were refined following participant feedback and achieved consensus in Round (2) The framework conceptualises advisory panels as implementation strategies intended to strengthen acceptability, appropriateness, feasibility, fidelity, and sustainability of research conducted with CALD communities. An implementation checklist was developed to support practical application. The CALD Advisory Panel Implementation Framework provides an implementation-focused approach to establishing, evaluating, and sustaining advisory panels in multicultural research contexts. By operationalising cultural partnership, co-design, power-sharing, and implementation support processes, the framework offers practical guidance for researchers, institutions, and funders seeking to strengthen meaningful community engagement and reduce tokenistic involvement. Future research should evaluate implementation, feasibility, and effectiveness across diverse settings.

BACKGROUND/OBJECTIVE:Antibiotic exposure by 2 years is linked to increased childhood overweight/obesity risk, mainly in cross-sectional studies. Few longitudinal studies exist in high-risk populations, and none examined BMI trajectories up to 18 years. Our study is the first to investigate the association between early antibiotic exposure and BMI trajectories in a high allergy-risk cohort. METHODS:We analysed data from 428 participants in the Melbourne Atopy Cohort Study from birth to 18 years. Antibiotic use < 2 years was categorized as "ever versus never" and according to seven antibiotic classes. Number of courses (7 days) and the spectrum of antibiotics (broad versus narrow) were defined for each antibiotic class. Logistic regression models estimated associations between antibiotic use (any/specific), courses (0, 1, 2, and ≥ 3), and previously defined BMI trajectories from 4 weeks to 18 years: very low catch-up, low average, stable average (reference), average increasing to very high (AIVH), and persistently high (PH). RESULTS:We found consistent evidence of a relationship between antibiotic exposure by 2 years and increased risk of belonging to AIVH and PH trajectories, with magnitudes of effect differing by antibiotic spectrum and frequency. Notably, exposure to ≥ 3 courses of broad-spectrum antibiotic was associated with the AIVH (aOR = 3.36 [95% CI: 1.03, 10.87]) and PH trajectories (aOR = 3.29 [95% CI: 1.03, 10.53]). CONCLUSION:These findings may have important clinical implications, but further large-scale studies are required.

This study examines the direct and indirect effects of maternal folic acid (FA) supplementation on childhood metabolic outcomes, including blood pressure (BP), insulin resistance (HOMA-IR), and insulin sensitivity (QUICKI), with body mass index (BMI), waist circumference (WC), and skinfold thickness as mediators. This cross-sectional study analyzed data from 2577 children (9-13 years) from the Healthy Growth Study (2007-2009, Greece). Maternal FA intake was reported via parental questionnaires. BMI, WC, and skinfold thickness were measured using standardized protocols. BP, fasting glucose, and insulin were assessed to compute HOMA-IR and QUICKI. Structural equation modeling evaluated direct and indirect effects, adjusting for maternal, pregnancy, and child-related confounders. FA supplementation had no direct effect. However, indirect effects via WC were associated with lower SBP (β = -0.69, p = 0.036) and DBP (β = -0.36, p = 0.041), improved insulin sensitivity (QUICKI: β = 0.0018, p = 0.044), and reduced insulin resistance (HOMA-IR: β = -0.1099, p = 0.047). Skinfold thickness also mediated BP reductions. BMI was not a significant mediator (all p > 0.05). Maternal FA intake may indirectly influence childhood metabolic health via adiposity markers, emphasizing the need for targeted maternal nutrition interventions to improve childhood metabolic outcomes.

BACKGROUND AND OBJECTIVE:While short-term weight changes are known to influence obstructive sleep apnoea (OSA), the impact of body mass index (BMI) changes over the life course has been poorly documented. We examined the association between BMI trajectories from childhood to middle age and adult OSA, 10 years later. METHODS:Five BMI trajectories were previously identified in the population-based cohort Tasmanian Longitudinal Health Study (TAHS), using eight time-point BMI from age 5 to 43 years. The primary outcome was probable OSA at 53 years, defined using STOP-Bang questionnaire, with Berlin and OSA-50 questionnaires used to ensure consistency of findings. Clinically significant diagnosed OSA was defined as self-reported medical diagnosis or mild OSA with symptoms or moderate-to-severe OSA, using type-4 sleep studies. Associations were examined using multivariable logistic regression. RESULTS:Compared with the average BMI trajectory, the child average-increasing (aOR = 5.28, 95% CI 3.38-8.27) and persistently high trajectories (aOR = 3.73, 2.06-6.74) were associated with increased risk of probable OSA. These associations were consistent when using clinically significant diagnosed OSA (child average-increasing trajectory: aOR = 2.95, 1.30-6.72; high trajectory: aOR = 2.23, 0.82-6.09). Individuals belonging to the low trajectory were less likely than the average trajectory to have OSA. Notably, the child high-decreasing trajectory was not associated with OSA. CONCLUSION:Physicians and the public should be aware of the potential risk of OSA in middle-aged adults when BMI is high or continuously increasing from childhood to mid-40s. Obese children who subsequently lose weight were not at higher risk of OSA in middle age-a novel and key finding.

Background: Antenatal care (ANC) offers a valuable opportunity to reduce the risk of acute respiratory infections (ARIs) in children under five; however, its impact remains less understood and has not been comprehensively synthesised. This systematic review aimed to assess evidence on the association between ANC utilisation and ARIs in children under five. Methods: A systematic search was conducted in PubMed, CINAHL, Scopus, Web of Science, and Google Scholar for studies published between 2000 and 2025. PRISMA 2020 guidelines were followed in reporting. A qualitative synthesis was performed for all ARI outcomes, and a meta-analysis was conducted for pneumonia. Results: Eleven observational studies assessed the association between ANC utilisation and ARIs. Three ARI-related outcomes were identified: pneumonia (n = 4), pertussis (n = 2), and general ARIs (n = 5). ANC attendance was generally associated with reduced odds of respiratory infections across studies. The pooled analysis of two case–control studies (n = 2; total n = 956) showed a non-significant association between ANC attendance and pneumonia in children (pooled OR = 1.46; 95% CI: 0.91, 2.35; I2 = 0%). Conclusion: Our review suggests a potential protective effect of ANC, though evidence from the pneumonia-focused meta-analysis was inconclusive. Improving access to quality ANC may reduce respiratory infections, but more studies are needed across different populations.

INTRODUCTION:Psychological factors are linked to pain and function in various musculoskeletal conditions, but their impact on hallux valgus is unclear. Health-related quality of life declines with increasing severity of hallux valgus, affecting not only foot pain and physical function, but also general health, vitality and mental health. Previous studies have reported inconsistent associations between psychological factors, such as anxiety and depression, and surgical outcomes, which might relate to variability in measurement approaches. Understanding the associations between psychological factors, including anxiety, depression, pain catastrophizing and kinesiophobia, and hallux valgus-related pain and function may inform more holistic pre-operative care. Therefore, we aimed to assess these associations in adults with hallux valgus pre-surgery. METHODS:A pre-operative cross-sectional study was conducted with 41 adults scheduled for hallux valgus surgery. Participants completed questionnaires measuring continuous psychological variables: depression, anxiety and stress (Depression Anxiety Stress Scale-21, a tool for general psychological distress), kinesiophobia (Tampa Scale for Kinesiophobia, which assesses fear of movement associated with pain) and pain catastrophizing (Pain Catastrophizing Scale, a tool used to evaluate maladaptive pain-coping strategies). Continuous outcomes were evaluated using the Manchester-Oxford Foot Questionnaire for foot function, pain and social interaction. Multiple linear regressions explored the associations between these psychological factors and the outcomes. RESULTS:When all exposure variables were considered simultaneously, pain catastrophizing emerged as a significant predictor of foot pain and foot function. A one-unit increase in the pain catastrophizing score was associated with a 1.41-point increase in foot pain (β = 1.41, 95% confidence intervals (CIs) 0.73-2.09 and p < 0.001) and a 1.83-point increase in worse foot function (β = 1.83, 95% CI 1.12-2.54 and p < 0.001). CONCLUSION:Assessing pain catastrophising pre-operatively is recommended for individuals with hallux valgus, although more structured education may be needed to support health professionals in assessing psychological factors. Future research should evaluate the longitudinal impact of pain catastrophizing on post-operative outcomes and explore other contributing factors, such as comorbidities, lifestyle variables and sex differences, to refine screening and treatment strategies.

ABSTRACTBackground and ObjectiveThe impact of lifetime body mass index (BMI) trajectories on adult lung function abnormalities has not been investigated previously. We investigated associations of BMI trajectories from childhood to mid‐adulthood with lung function deficits and COPD in mid‐adulthood.MethodsFive BMI trajectories (n = 4194) from age 5 to 43 were identified in the Tasmanian Longitudinal Health Study. Lung function outcomes were defined using spirometry at 45 and 53 years. Associations between these BMI trajectories and lung function outcomes were investigated using multivariable regression.ResultsCompared to the average BMI trajectory, the child's average‐increasing BMI trajectory was associated with greater FVC decline from 45 to 53 years (β = −178 mL; 95% CI −300.6, −55.4), lower FRC, ERV and higher TLco at 45 years, lower FVC (−227 mL; −345.3, −109.1) and higher TLco at 53 years. The High BMI trajectory was also associated with lower FRC, ERV and higher TLco at 45 years, while spirometric restriction (OR = 6.9; 2.3, 21.1) and higher TLco at 53 years. The low BMI trajectory was associated with an obstructive picture: lower FEV1 (−124 mL; −196.4, −51.4) and FVC (−91 mL; −173.4, −7.7), and FEV1/FVC (−1.2%; −2.2, −0.1) and higher ERV and lower TLco at 45 and 53 years. A similar pattern was found at 53 years. No associations were observed with spirometrically defined COPD.ConclusionOur findings revealed contrasting lung function abnormalities were associated with high, subsequently increasing, and low BMI trajectories. These results emphasise the importance of tracking changes in BMI over time and the need to maintain an average BMI trajectory (BMI‐Z‐score 0 at each time point) throughout life.

BACKGROUND AND OBJECTIVE:The evidence around occupation-related chronic cough is conflicting and current definitions of chronic cough cannot capture its heterogeneity. Using our recently characterised novel cough subclasses, we aimed to identify subclass-specific occupational risks. METHODS:Using data from the Tasmanian Longitudinal Health Study (TAHS), occupational exposures up to age 53 years were coded using the ALOHA+ Job Exposure Matrix, into ever-exposure (no, only-low, ever-high) and cumulative exposure. People belonging to six previously identified cough subclasses among 2213 current coughers at age 53 years were compared to non-coughers (n = 1396). Associations with occupational exposures were assessed using multinomial logistic regression for these cough subclasses and logistic regression for standard definitions (chronic cough, chronic phlegm, and chronic bronchitis) after adjusting for potential confounders. RESULTS:Biological dust was associated with "cough with allergies" (cumulative: adjusted multinomial odds ratio [aMOR] = 1.06, 95% CI: 1.02-1.10, per 10 exposure-year increase). Aromatic solvents were associated with "chronic dry cough" (cumulative: aMOR = 1.15, 95% CI: 1.02-1.29). Other solvents were associated with "chronic productive cough" (ever-high: aMOR = 2.81, 95% CI: 1.26-6.2); "intermittent productive cough" (cumulative: aMOR = 1.06, 95% CI: 0.98-1.16), chronic bronchitis (ever-high: aOR = 2.48, 95% CI: 1.01-6.06); and chronic phlegm (ever-high: aOR = 2.26, 95% CI: 1.14-4.51). Herbicides (cumulative) were also associated with "intermittent productive cough" (aOR = 1.09, 95% CI: 1.00-1.77) and chronic phlegm (aOR = 1.07, 95% CI: 1.00-1.15). CONCLUSION:Novel cough subclasses had distinct associations with specific occupational exposures, suggesting different pathophysiology. Aromatic solvents were associated with dry cough; biological dust with allergic cough; herbicides and other solvents with productive cough. Using novel cough subclasses was superior to standard definitions in uncovering these associations.

Involuntarily, circumstantially and voluntarily childless women are constructed as deviating from pronatalist mothering norms, placing them at risk of social exclusion driven by unequal gender relations. This research examines associations between age, childlessness type and the probability of impaired social exclusion indicators in the social domain of life (social networks, social support, subjective social support and social interaction), social exclusion drivers (stigmatisation and stereotyping) and perceived exclusion due to not having children. Data were collected via self-administered questionnaire from 789 women aged 25 to 64 years living in Australia. Generalised additive models and general linear models stratified by childlessness type and controlling for education, employment, income and relationship status, assessed associations between age, childlessness type and dependent variables. Age was non-linearly associated with impaired social networks, with different patterns for circumstantially compared to involuntarily and voluntarily childless women. Associations between age and impaired social support and subjective social support were observed among voluntarily childless women. Among circumstantially childless women, there were associations between age and perceived exclusion from social interaction due to not having children. Age was associated with stigma consciousness and stereotyping, with different peak ages for circumstantially compared to involuntarily and voluntarily childless women. Different age-related patterns among childlessness types may relate to nuanced stigmatisation of involuntarily, circumstantially and voluntarily childless women, and its shifting salience over women's reproductive and postreproductive years.

Iron supplementation is recommended to reduce low birth weight (LBW) but its impact in Africa is underexplored. This study examines factors that may modify the effects of maternal iron supplementation on LBW in sub-Saharan Africa. Health Survey data from 26 sub-Saharan countries, including 149,346 woman-infant pairs, were analyzed. LBW (< 2500 g) was the outcome, and iron supplementation (yes/no) and its duration (none, < 90 days, or ≥ 90 days) were exposures. A regression modeling framework was used to assess associations, adjusting for potential confounders and stratification by country income level. Family income, mother's education, maternal age, and partner's education were assessed as potential effect modifiers. The prevalence of LBW was 10.36%. Maternal iron supplementation adherence was 37.34%, but lower among poor and young women (31.43%). Not taking iron supplements during pregnancy increased the odds of LBW (aOR 1.19; 95%CI: 1.09, 1.30). Longer duration (more than 90 days) reduced the odds of LBW (aOR 0.84; 95%CI: 0.76, 0.93). These impacts were greater among poor women (aOR 0.74; 95%CI: 0.64, 0.84), women/partner with no education (aOR 0.79; 95%CI: 0.67, 0.92), and younger age (aOR 0.72; 95%CI: 0.54, 0.97). Taking iron supplements longer during pregnancy contributes to lowering LBW in sub-Saharan countries. Younger mothers from poor areas with no education, along with those whose partners lack education, appear more vulnerable and may benefit from access to supplements. Enhancing adherence and addressing these disparities are key to addressing LBW in these settings.

Background: While the importance of folic acid supplementation during pregnancy in the prevention of neural tube defects in offspring is well established, its potential role in pediatric asthma development remains unclear, with limited evidence to date. Objective: To identify perinatal and environmental factors that modify the association between maternal folic acid intake and pre-adolescent asthma. Methods: Cross-sectional analysis of the Healthy Growth Study that consisted of 2332 pre-adolescents (mean age 11 years; asthma n = 451); 50% boys attending elementary schools in Greece. Questionnaires were used to collect data on sociodemographic, perinatal, and environmental characteristics as well as asthma prevalence and maternal folic acid supplementation during pregnancy (trimesters 1, 2, and 3). Logistic regression models explored the association between maternal folic acid supplementation and pre-adolescent asthma, accounting for perinatal and environmental exposures. Results: Adjusted regression models showed that maternal folic acid supplementation during the third trimester was associated with 34% increased odds of pre-adolescent asthma. Stratified analyses per perinatal and environmental factors revealed significantly higher asthma odds with folic acid supplementation during the second and third trimesters among pre-adolescents born < 37 weeks; non-smoking mothers; in pre-adolescents attending schools of low socioeconomic level; and in neighborhoods having less traffic and more parks. Contrastingly, in appropriate for gestational age (AGA), an infant’s first-trimester supplementation increased asthma odds. Conclusions: Maternal folic acid supplementation, particularly in later trimesters, was modestly associated with increased odds of pre-adolescent asthma, modified by perinatal and environmental factors. Future research should explore whether continued folic acid supplementation beyond the first trimester carries differential risks or benefits in asthma.

Background and objectives While adult chronic cough has high burden, its phenotypes, particularly those without aetiologically related underlying conditions, are understudied. We investigated the prevalence, lung function and comorbidities of adult chronic cough phenotypes. Methods Data from 3608 participants aged 53 years from the Tasmanian Longitudinal Health Study (TAHS) were included. Chronic cough was defined as cough on most days for >3 months in a year. Chronic cough was classified into “explained cough” if there were any one of four major cough-associated conditions (asthma, COPD, gastroesophageal reflux disease or rhinosinusitis) or “unexplained cough” if none were present. Adjusted regression analyses investigated associations between these chronic cough phenotypes, lung function and non-respiratory comorbidities at 53 years. Results The prevalence of chronic cough was 10% (95%CI 9.1,11.0%) with 46.4% being “unexplained”. Participants with unexplained chronic cough had lower FEV1/FVC (coefficient: -1.2% [95%CI:-2,3, -0.1]) and increased odds of comorbidities including obesity (OR=1.6 [95%CI: 1.2, 2.3]), depression (OR=1.4 [95%CI: 1.0, 2.1]), hypertension (OR=1.7 [95%CI: 1.2, 2.4]) and angina, heart attack or myocardial infarction to a lesser extent, compared to those without chronic cough. Participants with explained chronic cough also had lower lung function than both those with unexplained chronic cough and those without chronic cough. Conclusions Chronic cough is prevalent in middle-age and a high proportion is unexplained. Unexplained cough contributes to poor lung function and increased comorbidities. Given unexplained chronic cough is not a symptom of major underlying respiratory conditions it should be targeted for better understanding in both clinical settings and research.

BACKGROUND:Globally, many pollen monitoring networks provide the community with daily pollen information, but there are limited data on health consumer uses and benefits. This research investigated why individuals in the community access pollen information, how they use it, and the perceived benefits. METHODS:In- and post-pollen season surveys (2017-2018 and 2018-2019) enquired about symptoms, diagnoses, symptom management, access, benefits and usefulness of pollen information provided by the AusPollen Partnership. Open text responses were examined by thematic analysis. Theme frequency and quantitative data were compared across pollen seasons, within and after the season, and between respondents with and without access to AusPollen information. RESULTS:Surveys were completed 4044 times by 3604 individuals who predominantly self-reported severe and frequent allergic rhinitis symptoms. Local AusPollen information was accessible to 84.6% of participants, and was reportedly used for preparation and planning (34.6%), guiding activities (32.9%), and medication decisions (28.2%). When asked how pollen information helped, similar themes were evident; but 16.1% also mentioned safety for themselves and others. However, secondary analysis of survey responses indicated that self-reported medication use did not differ between those with or without access to pollen information or between time points surveyed. Suggestions for improvement included extended duration (16.4%), wider geographic range (13.5%), and information on other taxa (17.2%). CONCLUSION:There was a perceived need for localised, detailed and timely pollen information by people with pollen allergy. Whilst responses suggested this helped inform behaviours linked to allergen avoidance, further education strategies on allergic rhinitis control are needed to support patients who self-manage their condition.

Background The Australian Government introduced a major policy change tightening regulations regarding the access to nicotine containing e-cigarettes in October 2021. We assessed general practitioners’ (GPs) knowledge, attitudes, beliefs and intentions to prescribe nicotine containing e-cigarettes for smoking cessation. We compared baseline data near the time of policy change with data collected from these GPs 12-months later. Methods GPs were invited to complete a repeated cross-sectional survey based on the Theory of Planned Behaviour between December 2021 and March 2022 (T1) and again, between January and April 2023 (T2). Survey questions assessed knowledge, attitudes, beliefs and intention to prescribe e-cigarettes for smoking cessation. Results A total of 264 GPs completed the baseline (T1) survey and 94 provided responses at follow-up (T2). Over half of responders were female (T1 n = 170, 64.4%, T2 n = 57, 60.6%) and roughly one third were aged between 30 and 39 years (T1 n = 80, 37.2%, T2 n = 28, 29.8%). Participants who agreed e-cigarettes were suitable smoking cessation aids were more willing to recommend e-cigarettes to patients at T1 and T2 (T1 n = 29, 87.9%, vs. T2 n = 20, 100%). Knowledge about e-cigarettes was limited and did not change between T1 and T2. Participants who had greater confidence in their ability to talk to and answer patient questions about e-cigarettes were more likely to recommend them for smoking cessation at both T1 and T2 (T1 n = 24, 70.6% vs. T2 n = 17, 85.0%). Conclusion Since tightening the regulation of nicotine containing e-cigarettes, there has been little change in Australian GPs’ perceptions of e-cigarettes as smoking cessation aids. Australian GPs are poorly educated about vaping and knowledge about e-cigarettes remained limited, however, GPs at follow-up were more confident in their ability to discuss e-cigarettes with their patients. The findings from this survey may help guide policy and develop strategies to support the implementation of smoking cessation guidelines that incorporate the use of e-cigarettes as smoking cessation aids in Australia.

Narrow fitting footwear is a modifiable risk factor for the development of hallux valgus (HV). Despite this, the pressure that footwear exerts at the medial forefoot has not been fully evaluated in people with HV. Therefore, the objective of this study was to determine whether the toe box of footwear habitually worn by women with HV is associated with pressure exerted on the medial forefoot. In-shoe peak pressure and maximum force at the medial forefoot (distal and proximal sites) were recorded from 28 women (mean age 60.7 years, SD 10.7) with moderate or severe HV using the pedar pad pressure system (Novel GmbH, Germany). The shape (width and area) of the participants' most symptomatic foot and toe-box of their usual footwear was determined using an INFOOT 3D laser scanner (I-Ware Laboratory, Japan) and hand tracing, respectively. The difference between the foot and corresponding footwear measurements as well as differences in the magnitude and timing of peak pressure and maximum force between the proximal and distal forefoot were determined using independent t-tests. Correlations between forefoot pressures with toe-box differential were determined using Spearman's ρ analyses. Peak pressure and maximum force were significantly greater (mean difference [MD] = 33.0 ± 15.4 kPa; p < 0.001 and 12.8 ± 7.3 N; p = 0.001) and occurred slightly later in the stance phase at the distal forefoot compared to the proximal forefoot (MD = 6.0 ± 6.9%; p = 0.083 and 6.9 ± 6.8%; p = 0.045, respectively). There were no significant correlations between toe-box differential and medial forefoot pressures, with all correlations less than 0.35 (p > 0.05). Toe-box shape and fit of footwear typically worn by older women with painful HV was not associated with increased medial forefoot pressures in this study sample. Therefore, changing the toe-box width and area of the usual footwear worn by older women with painful, moderate or severe HV may not necessarily reduce medial forefoot pressures where footwear does not appear to play a role.

STUDY OBJECTIVES:The impact of household air pollution (HAP) on obstructive sleep apnoea (OSA) was unclear from the literature. We aimed to investigate the associations between HAP exposure over 10 years and OSA in middle-aged adults. METHODS:Using the Tasmanian Longitudinal Health Study (TAHS), seven longitudinal HAP profiles were previously identified using information on household heating, cooking, mould, active and passive smoking exposure collected at two ages spanning 10 years (at mean ages 43 and 53 years). Probable OSA was only measured at 53 years using validated STOP-Bang, Berlin and OSA-50 questionnaires. Medically diagnosed OSA was self-reported. Multivariable logistic regression was used to assess the associations between HAP profiles and each definition of OSA, adjusting for age, sex, socioeconomic status and ambient air pollution. RESULTS:Compared with the "Least exposed" profile, characterised by reverse-cycle air conditioning, electric cooking and no smoking exposure, the "Wood and gas heating/gas cooking/smoking" profile was associated with both probable OSA defined using OSA-50 (aOR = 2.39, 95 %CI 1.61-3.53) and medically diagnosed OSA (aOR = 2.31, 1.06-5.05). The "All gas" and "Wood heating/smoking" profiles were associated with OSA-50-defined probable OSA (aOR = 1.35, 1.01-1.79; aOR = 1.47, 1.10-1.96 respectively). Additionally, the "All gas" profile was associated with incident medically diagnosed OSA (aOR = 2.15, 1.06-4.38). CONCLUSIONS:Sustained exposure to wood and gas heating and gas cooking especially when combined with tobacco smoke increased the risk of OSA over 10 years in middle age. Our study strengthens the rationale for including the potential adverse effects of HAP on mid-life OSA within public educational programs and guidelines.