How do we best engage young people in decision-making about their health? A scoping review of deliberative priority setting methods.

INTRODUCTION: International organisations have called to increase young people's involvement in healthcare and health policy development. We currently lack effective methods for facilitating meaningful engagement by young people in health-related decision-making. The purpose of this scoping review is to identify deliberative priority setting methods and explore the effectiveness of these in engaging young people in healthcare and health policy decision-making. METHODS: Seven databases were searched systematically, using MeSH and free text terms, for articles published in English before July 2021 that described the use of deliberative priority setting methods for health decision-making with young people. All titles, abstracts and full-text papers were screened by a team of six independent reviewers between them. Data extraction followed the Centre for Reviews and Dissemination guidelines. The results are presented as a narrative synthesis, structured around four components for evaluating deliberative processes: 1) representation and inclusion of diverse participants, 2) the way the process is run including levels and timing of participant engagement, 3) the quality of the information provided to participants and 4) resulting outcomes and decisions. FINDINGS: The search yielded 9 reviews and 21 studies. The more engaging deliberative priority setting tools involved young people-led committees, mixed methods for identifying and prioritising issues and digital data collection and communication tools. Long-term and frequent contact with young people to build trust underpinned the success of some of the tools, as did offering incentives for taking part and skills development using creative methods. The review also suggests that successful priority setting processes with young people involve consideration of power dynamics, since young people's decisions are likely to be made together with family members, health professionals and academics. DISCUSSION: Young people's engagement in decision-making about their health is best achieved through investing time in building strong relationships and ensuring young people are appropriately rewarded for their time and contribution. If young people are to be instrumental in improving their health and architects of their own futures, decision-making processes need to respect young people's autonomy and agency. Our review suggests that methods of power-sharing with young people do exist but that they have yet to be adopted by organisations and global institutions setting global health policy.

Young people's experiences of COVID-19 messaging at the start of the UK lockdown: lessons for positive engagement and information sharing.

BACKGROUND: To reduce COVID-19 infection rates during the initial stages of the pandemic, the UK Government mandated a strict period of restriction on freedom of movement or 'lockdown'. For young people, closure of schools and higher education institutions and social distancing rules may have been particularly challenging, coming at a critical time in their lives for social and emotional development. This study explored young people's experiences of the UK Government's initial response to the pandemic and related government messaging. METHODS: This qualitative study combines data from research groups at the University of Southampton, University of Edinburgh and University College London. Thirty-six online focus group discussions (FGDs) were conducted with 150 young people (Southampton: n = 69; FGD = 7; Edinburgh: n = 41; FGD = 5; UCL: n = 40; FGD = 24). Thematic analysis was conducted to explore how young people viewed the government's response and messaging and to develop recommendations for how to best involve young people in addressing similar crises in the future. RESULTS: The abrupt onset of lockdown left young people shocked, confused and feeling ignored by government and media messaging. Despite this, they were motivated to adhere to government advice by the hope that life might soon return to normal. They felt a responsibility to help with the pandemic response, and wanted to be productive with their time, but saw few opportunities to volunteer. CONCLUSIONS: Young people want to be listened to and feel they have a part to play in responding to a national crisis such as the COVID-19 epidemic. To reduce the likelihood of disenfranchising the next generation, Government and the media should focus on developing messaging that reflects young people's values and concerns and to provide opportunities for young people to become involved in responses to future crises.

Parental perspectives on negotiations over diet and physical activity: how do we involve parents in adolescent health interventions?

OBJECTIVE: To identify the ways in which parental involvement can be incorporated into interventions to support adolescent health behaviour change. DESIGN: Data from semi-structured interviews were analysed using inductive thematic analysis. SETTING: Southampton, Hampshire, UK. PARTICIPANTS: A convenience sample of twenty-four parents of adolescents. RESULTS: Parents consider themselves to play an important role in supporting their adolescents to make healthy choices. Parents saw themselves as gatekeepers of the household and as role models to their adolescents but recognised this could be both positive and negative in terms of health behaviours. Parents described the changing dynamics of the relationships they have with their adolescents because of increased adolescent autonomy. Parents stated that these changes altered their level of influence over adolescents' health behaviours. Parents considered it important to promote independence in their adolescents; however, many described this as challenging because they believed their adolescents were likely to make unhealthy decisions if not given guidance. Parents reported difficulty in supporting adolescents in a way that was not viewed as forceful or pressuring. CONCLUSIONS: When designing adolescent health interventions that include parental components, researchers need to be aware of the disconnect between public health recommendations and the everyday reality for adolescents and their parents. Parental involvement in adolescent interventions could be helpful but needs to be done in a manner that is acceptable to both adolescents and parents. The findings of this study may be useful to inform interventions which need to consider the transitions and negotiations which are common in homes containing adolescents.

Use of radioiodine in nuclear medicine-A brief overview.

Radioiodines have a long history in nuclear medicine. Herein, we discuss the production, properties and applications of these versatile iodine-based imaging and theragnostic agents. There are 38 isotopes of iodine (I) including one stable form (127 I). The most common radionuclides used in medical imaging and treatment, including Iodine-123 (123 I), Iodine-124 (124 I), Iodine-125 (125 I) and Iodine-131 (131 I), are discussed in this review.

Australian Football Athletes Lack Awareness of Current Sport Nutrition Guidelines.

Sports nutrition is an evolving field, but there is a lack of data on Australian athletes' knowledge of current sports nutrition guidelines. Additionally, several tools used to assess nutrition knowledge (NK) have not undergone adequate validation. The purpose of this study was to assess and compare the sports NK of elite and nonelite Australian football (AF) athletes using a newly validated questionnaire-The Nutrition for Sport Knowledge Questionnaire. Elite AF players (n = 46) were recruited directly from their club dietitian and nonelite AF players (n = 53) were invited to participate via e-mail from their club president or secretary. The mean NK score of elite and nonelite AF players was 46 ± 16% and 51 ± 11%, respectively (p = .041). In both groups, knowledge of macronutrients, weight management, and alcohol was better than knowledge of supplements, micronutrients, and sports nutrition. Nonelite athletes achieved statistically significantly higher scores on the questionnaire subsections testing weight management (elite: 48 ± 18; nonelite: 57 ± 19, p = .019), micronutrients (elite: 39 ± 19; nonelite: 50 ± 16, p = .004), and alcohol (elite: 52 ± 13; nonelite: 71 ± 17, p = .002). While overall NK of Australian athletes was poor, scores varied greatly among individuals (range: 10-70%) and across the six subsections (topics) being assessed. Professionals working with athletes should undertake an assessment of the athletes' NK so that they can provide targeted education programs.

Behaviour change interventions improve maternal and child nutrition in sub-Saharan Africa: A systematic review.

Evidence that nutrition-specific and nutrition-sensitive interventions can improve maternal and child nutrition status in sub-Saharan Africa is inconclusive. Using behaviour change theory and techniques in intervention design may increase effectiveness and make outcomes more predictable. This systematic review aimed to determine whether interventions that included behaviour change functions were effective. Six databases were searched systematically, using MeSH and free-text terms, for articles describing nutrition-specific and nutrition-sensitive behaviour change interventions published in English until January 2022. Titles, abstracts and full-text papers were double-screened. Data extraction and quality assessments followed Centre for Reviews and Dissemination guidelines. Behaviour change functions of interventions were mapped onto the COM-B model and Behaviour Change Wheel. PROSPERO registered (135054). The search yielded 1193 articles: 79 articles met inclusion criteria, ranging from low (n = 30) to high (n = 11) risk of bias. Many that applied behaviour change theory, communication or counselling resulted in significant improvements in infant stunting and wasting, household dietary intake and maternal psychosocial measures. Interventions with >2 behaviour change functions (including persuasion, incentivisation, environmental restructuring) were the most effective. We recommend incorporating behaviour change functions in nutrition interventions to improve maternal and child outcomes, specifically drawing on the Behaviour Change Wheel, COM-B model (SORT B recommendation). To enhance the designs of these interventions, and ultimately improve the nutritional and psychosocial outcomes for mothers and infants in sub-Saharan Africa, collaborations are recommended between behaviour change and nutrition experts, intervention designers, policy makers and commissioners to fund and roll-out multicomponent behaviour change interventions.

Characteristics, Treatment Patterns, and Clinical Outcomes of Chronic Hepatitis B Across 3 Continents: Retrospective Database Study.

INTRODUCTION: The prevalence of chronic hepatitis B virus (HBV) infection is high in many countries; however, robust, real-world epidemiological data are lacking. This study describes the prevalence, characteristics, treatment patterns, and long-term clinical outcomes of patients with chronic HBV infection in the US, Germany, and Taiwan. METHODS: This was a retrospective cohort analysis of three healthcare/insurance claims databases. Individuals were identified as patients with chronic HBV infection if their records contained HBV diagnostic codes from 1 January 2010 to 31 December 2012 (Germany and Taiwan) or 1 January 2013 (USA). Included patients were indexed on 1 January 2013. Patients' demographics, clinical characteristics, and healthcare utilisation were described. Treatment patterns and long-term clinical outcomes over follow-up (to 31 December 2016 or loss to follow-up) were estimated. RESULTS: The prevalence of chronic HBV infection was 0.10%, 0.17%, and 2.39% in the US, Germany, and Taiwan respectively. Prevalence was very low in children, increased rapidly in adulthood, and peaked in 50- < 65 year olds before declining in the elderly. More US (16.6%) and German (15.4%) patients were HIV ± HCV coinfected than in Taiwan (4.1%). Baseline clinical characteristics and healthcare utilisation were broadly similar between countries. In total, 19.2%, 11.1%, and 5.9% of non-coinfected adult patients received treatment at index in the US, Germany, and Taiwan, respectively; most frequently with nucleos(t)ide analogue monotherapy (94.4%, 97.2%, 99.8% of treated patients, respectively) and rarely with interferons (0.27%, 1.63%, and 0.06%, respectively). Untreated Taiwanese patients were more likely to remain untreated than elsewhere, and treated Taiwanese patients were less likely to persist with therapy. Generally, the cumulative incidence of long-term clinical outcomes was lowest in Germany. CONCLUSION: This study provides a contemporary, real-world, intercontinental snapshot of chronic HBV infection. Long-term sequelae occurred in all populations, and treatment levels were low, suggesting an unmet need for (or access to) effective treatments.

Patient Biochemistry and Treatment Need in Chronic Hepatitis B Virus Infection Across Three Continents: Retrospective Cross-Sectional Cohort Studies.

INTRODUCTION: Chronic hepatitis B virus (HBV) infection is associated with significant global morbidity and mortality. Low treatment rates are observed in patients living with HBV; the reasons for this are unclear. This study sought to describe patients' demographic, clinical and biochemical characteristics across three continents and their associated treatment need. METHODS: This retrospective cross-sectional post hoc analysis of real-world data used four large electronic databases from the United States, United Kingdom and China (specifically Hong Kong and Fuzhou). Patients were identified by first evidence of chronic HBV infection in a given year (their index date) and characterized. An algorithm was designed and applied, wherein patients were categorized as treated, untreated but indicated for treatment and untreated and not indicated for treatment based on treatment status and demographic, clinical, biochemical and virological characteristics (age; evidence of fibrosis/cirrhosis; alanine aminotransferase [ALT] levels, HCV/HIV coinfection and HBV virology markers). RESULTS: In total, 12,614 US patients, 503 UK patients, 34,135 patients from Hong Kong and 21,614 from Fuzhou were included. Adults (99.4%) and males (59.0%) predominated. Overall, 34.5% of patients were treated at index (range 15.9-49.6%), with nucleos(t)ide analogue monotherapy most commonly prescribed. The proportion of untreated-but-indicated patients ranged from 12.9% in Hong Kong to 18.2% in the UK; almost two-thirds of these patients (range 61.3-66.7%) had evidence of fibrosis/cirrhosis. A quarter (25.3%) of untreated-but-indicated patients were aged ≥ 65 years. CONCLUSION: This large real-world dataset demonstrates that chronic hepatitis B infection remains a global health concern; despite the availability of effective suppressive therapy, a considerable proportion of predominantly adult patients apparently indicated for treatment are currently untreated, including many patients with fibrosis/cirrhosis. Causes of disparity in treatment status warrant further investigation.

A Qualitative Investigation of Factors Influencing the Dietary Intakes of Professional Australian Football Players.

(1) Background: Many professional Australian Football (AF) players do not meet recommended sports nutrition guidelines despite having access to nutrition advice. There are a range of factors that can influence players' ability to meet their nutrition goals and awareness of the barriers players face is essential to ensure that dietary advice translates into practice. Therefore, this qualitative research study aimed to explore the factors influencing AF players' dietary intakes and food choice. (2) Methods: Semi-structured interviews were conducted with twelve professional male AF players. (3) Results: Less experienced players restricted their carbohydrate intake to meet body composition goals, particularly during preseason and surrounding body composition assessment. During the competition season players had a greater focus on performance and placed more emphasis on carbohydrate intake in the lead up to matches. Players felt nutrition goals were easier to achieve when dietary choices were supported by their families and peers. One-on-one consultations provided by a sports dietitian were players' preferred mode of nutrition intervention. Individualized nutrition advice is required for less experienced AF players who may be vulnerable to unsustainable dietary habits. Experienced AF players can support junior teammates by promoting positive team culture related to body composition, nutrition and performance.

How do we harness adolescent values in designing health behaviour change interventions? A qualitative study.

OBJECTIVES: Adolescent health behaviours do not support optimal development. Adolescents are reportedly difficult to engage in health behaviour improvement initiatives. Little is known about what adolescents value in relation to diet and physical activity or how best to target these in health interventions. This study explored adolescents' values in relation to diet and physical activity and how these values can inform health intervention design. DESIGN: Qualitative semi-structured interviews explored adolescents' lives, what they thought about diet and physical activity and what might support them to improve their health behaviours. METHODS: A total of 13 group interviews were conducted with 54 adolescents aged 13-14 years, of whom 49% were girls and 95% identified as White British. Participants were recruited from a non-selective secondary school in a large southern UK city. Inductive thematic analysis was used to identify key adolescent values. RESULTS: Adolescents valued being with their friends, doing what they enjoyed and were good at; being healthy was important to them but only if achievable without compromising other things that are important to them. The need to be healthy was not aligned with adolescents' basic psychological needs, nor their strongly held priorities and values. CONCLUSIONS: Health is not a motivating factor for adolescents; therefore, interventions designed solely to improve health are unlikely to engage them. Instead, interventions that align with the values and priorities specified by adolescents are more likely to be effective in supporting them to eat well and be more active.

Behaviour change interventions: getting in touch with individual differences, values and emotions.

Systematic reviews and meta-analyses suggest that behaviour change interventions have modest effect sizes, struggle to demonstrate effect in the long term and that there is high heterogeneity between studies. Such interventions take huge effort to design and run for relatively small returns in terms of changes to behaviour.So why do behaviour change interventions not work and how can we make them more effective? This article offers some ideas about what may underpin the failure of behaviour change interventions. We propose three main reasons that may explain why our current methods of conducting behaviour change interventions struggle to achieve the changes we expect: 1) our current model for testing the efficacy or effectiveness of interventions tends to a mean effect size. This ignores individual differences in response to interventions; 2) our interventions tend to assume that everyone values health in the way we do as health professionals; and 3) the great majority of our interventions focus on addressing cognitions as mechanisms of change. We appeal to people's logic and rationality rather than recognising that much of what we do and how we behave, including our health behaviours, is governed as much by how we feel and how engaged we are emotionally as it is with what we plan and intend to do.Drawing on our team's experience of developing multiple interventions to promote and support health behaviour change with a variety of populations in different global contexts, this article explores strategies with potential to address these issues.

Dietary Intakes of Professional and Semi-Professional Team Sport Athletes Do Not Meet Sport Nutrition Recommendations-A Systematic Literature Review.

Background: to develop sport-specific and effective dietary advice, it is important to understand the dietary intakes of team sport athletes. This systematic literature review aims to (1) assess the dietary intakes of professional and semi-professional team sport athletes and (2) to identify priority areas for dietetic intervention. METHODS: an extensive search of MEDLINE, Sports DISCUS, CINAHL, Web of Science, and Scopus databases in April-May 2018 was conducted and identified 646 studies. Included studies recruited team sport, competitive (i.e. professional or semi-professional) athletes over the age of 18 years. An assessment of dietary intake in studies was required and due to the variability of data (i.e. nutrient and food group data) a meta-analysis was not undertaken. Two independent authors extracted data using a standardised process. RESULTS: 21 (n = 511) studies that assessed dietary intake of team sport athletes met the inclusion criteria. Most reported that professional and semi-professional athletes' dietary intakes met or exceeded recommendations during training and competition for protein and/or fat, but not energy and carbohydrate. Limitations in articles include small sample sizes, heterogeneity of data and existence of underreporting. CONCLUSIONS: this review highlights the need for sport-specific dietary recommendations that focus on energy and carbohydrate intake. Further exploration of factors influencing athletes' dietary intakes including why athletes' dietary intakes do not meet energy and/or carbohydrate recommendations is required.

Dietary intakes of professional Australian football league women's (AFLW) athletes during a preseason training week.

OBJECTIVES: In 2016 the Australian football league introduced the first women's league, integrating part-time female athletes into the professional sporting environment. This study aims to assess the dietary intakes of professional Australian football league women's (AFLW) athletes to highlight key focus areas for nutrition and additionally provide nutrition recommendations for dietitians working with these athletes. DESIGN: Cross-sectional study. METHODS: Dietary intake data was collected from 23 players from the same club competing in the Australian football league women's, during a preseason week. Dietary intakes were assessed using three day estimated food records. RESULTS: Majority of athletes did not meet recommendations for carbohydrate (96%, n=22), iron (87%, n=20) and calcium (61%, n=14). In comparison, majority of athletes met protein (74%, n=17) and fat (78%, n=18) recommendations. No significant difference was found in energy intake on main training, light training and recovery days (p>0.05). Energy and carbohydrate intakes reported by AFLW athletes (1884±457kcalday-1 and 2.7±0.7gkg-1day-1) were consistent with values reported in previous studies that included professional female athletes. CONCLUSIONS: This research highlights that further exploration of the factors that influence dietary intake is required to support athletes to meet energy and carbohydrate recommendations required for desired training and performance outcomes.

Dietary intake of professional Australian football athletes surrounding body composition assessment.

BACKGROUND: Sports Dietitians aim to assist in improving performance by developing nutrition knowledge (NK), enhancing dietary intake and optimising body composition of athletes. In a high-pressure environment, it is important to identify factors that may compromise an athlete's nutrition status. Body composition assessments are regularly undertaken in sport to provide feedback on training adaptions; however, no research has explored the impact of these assessments on the dietary intake of professional athletes. METHODS: This cross-sectional study assessed dietary intake (7-day food diary), nutrition knowledge (Nutrition for Sport Knowledge Questionnaire) and body composition (Dual-energy X-ray absorptiometry) of 46 professional male Australian football (AFL) athletes during a 2017 pre-season training week (7 days) where body composition assessments were undertaken. Dietary intake was assessed against International Olympic Committee recommendations for professional athletes. RESULTS: Overall, no athlete met dietary their recommended energy intake (15 ± 1.1 vs. 9.1 ± 1.8 MJ, respectively) or carbohydrate recommendations (6-10 vs. 2.4 ± 0.9 g·kg-1·day-1). Only 54% met protein recommendations. Secondary analyses demonstrated significant associations between education status and energy intake (P < 0.04) and vegetable intake (P < 0.03), with higher levels of education being associated with higher intakes. A moderately positive association was observed between NK scores and meeting estimated energy requirements (r = 0.33, P = 0.03). NK scores were also positively associated with protein (r = 0.35, P = 0.02), fibre (r = 0.51, P = 0.001) and calcium intakes (r = 0.43, P = 0.004). CONCLUSIONS: This research identified that the dietary intake of professional AFL athletes during a pre-season training week where body composition assessments were undertaken did not meet current recommendations. Several factors may influence the dietary intake of AFL athletes, including lower education levels, poor NK and dietary intake restriction surrounding body composition assessment. Athletes may require support to continue with performance-based nutrition plans in periods surrounding body composition assessment.