Large and forgotten in rural Australia: assessment, attitudes and possible approaches to losing weight in young adult males.

BACKGROUND: Young Adult Males (YAMs) in rural Australia are poorly studied with respect to overweight and obesity. Firstly, we explored the feasibility of recruiting 17-25 year old YAMs to obtain baseline data on overweight and obesity rates, socio-demographics, nutrition, exercise and mobile phone usage. Secondly, we explored the views of YAMs with a waist measurement over 94 cm about using mobile phone text messages to promote weight loss and incentives to promote healthy lifestyles. METHODS: A two-staged, mixed-methods approach was used to study obesity and overweight issues in Dubbo, a regional city in New South Wales, Australia. In Phase I, socio-demographic, health behaviour and mobile phone usage data were collected using a questionnaire and anthropometric data collected by direct measurement. In Phase II, YAMs' views were explored by focus group discussion using a semi-structured questionnaire. RESULTS: Phase I (145 participants): mean Body Mass Index (BMI) 25.06±5.01; mean waist circumference 87.4±15.4 cm. In total, 39.3% were obese (12.4%) or overweight (26.9%) and 24.1% had an increased risk of metabolic complications associated with obesity. 135 (93.1%) owned a mobile phone and sent on average 17±25 text messages per day and received 18±24. Phase II (30 participants): YAMs acknowledged that overweight and obesity was a growing societal concern with many health related implications, but didn't feel this was something that affected them personally at this stage of their lives. Motivation was therefore an issue. YAMs admitted that they would only be concerned about losing weight if something drastic occurred in their lives. Text messages would encourage and motivate them to adopt a healthy lifestyle if they were individually tailored. Gym memberships, not cash payments, seem to be the most favoured incentive. CONCLUSION: There is a clear need for an effective health promotion strategy for the almost 40% overweight or obese Dubbo YAMs. The high rate of text message usage makes it feasible to recruit YAMs for a prospective study in which personalized text messages are used to promote healthy behaviours. It may be important to target motivation specifically in any weight-related intervention in this group with incentives such as gym membership vouchers.

Endotracheal tube cuff pressure before, during, and after fixed-wing air medical retrieval.

Abstract Background. Increased endotracheal tube (ETT) cuff pressure is associated with compromised tracheal mucosal perfusion and injuries. No published data are available for Australia on pressures in the fixed-wing air medical retrieval setting. Objective. After introduction of a cuff pressure manometer (Mallinckrodt, Hennef, Germany) at the Royal Flying Doctor Service (RFDS) Base in Dubbo, New South Wales (NSW), Australia, we assessed the prevalence of increased cuff pressures before, during, and after air medical retrieval. Methods. This was a retrospective audit in 35 ventilated patients during fixed-wing retrievals by the RFDS in NSW, Australia. Explicit chart review of ventilated patients was performed for cuff pressures and changes during medical retrievals with pressurized aircrafts. Pearson correlation was calculated to determine the relation of ascent and ETT cuff pressure change from ground to flight level. Results. The mean (± standard deviation) of the first ETT cuff pressure measurement on the ground was 44 ± 20 cmH2O. Prior to retrieval in 11 patients, the ETT cuff pressure was >30 cmH2O and in 11 patients >50 cmH2O. After ascent to cruising altitude, the cuff pressure was >30 cmH2O in 22 patients and >50 cmH2O in eight patients. The cuff pressure was reduced 1) in 72% of cases prior to take off and 2) in 85% of cases during flight, and 3) after landing, the cuff pressure increased in 85% of cases. The correlation between ascent in cabin altitude and ETT cuff pressure was r = 0.3901, p = 0.0205. Conclusions. The high prevalence of excessive cuff pressures during air medical retrieval can be avoided by the use of cuff pressure manometers. Key words: cuff pressure; air medical retrieval; prehospital.

Association of urinary sex hormones with mood and behavior changes in a community adolescent cohort.

OBJECTIVE: To examine the contribution of variation in sex hormone excretion to mood and behavioral changes in adolescent females and males. DESIGN: Prospective, longitudinal observational cohort study. METHODS: Participants were 342 volunteers aged 10-12 years living in rural Australia. Urinary estradiol and testosterone levels measured by liquid chromatography-mass spectrometry were obtained at three-month intervals for three years. Integrated measures (area-under-curve) of urinary steroid excretion summarised as absolute and variability during each 12-month period of the study. Psychosocial data were gathered annually with the primary outcome of depressive symptomatology. Secondary outcomes were the other subscales of the Youth Self-Report, impulsive-aggression, sleep habits, and self-harm. RESULTS: 277 (158 male) participants contributed data over the full duration of the study and could be included in the analyses. In females, analyses of absolute urine hormone levels found no relationship between estradiol and any outcome, but higher testosterone was significantly associated with depression and poorer sleep. Greater variability of both urine estradiol and testosterone was associated with lower total psychopathology, anxious/depressed and social problems scores. Greater variability in urine estradiol was associated with lower attention problems and impulsive aggression in females. In males, higher testosterone and estradiol levels were associated with rule-breaking, and poorer sleep, and no associations were found for gonadal hormone variability for males. CONCLUSIONS: Longitudinal measurement of both iso-sexual and contra-sexual gonadal hormones contributes to a more nuanced view of the impact of sex steroids on mood and behavior in adolescents. These findings may enlighten the understanding of the impact of sex steroids during normal male and female puberty with implications for hormone replacement therapies as well as management of common mood and behavioral problems.

The study design and methodology for the ARCHER study--adolescent rural cohort study of hormones, health, education, environments and relationships.

BACKGROUND: Adolescence is characterized by marked psychosocial, behavioural and biological changes and represents a critical life transition through which adult health and well-being are established. Substantial research confirms the role of psycho-social and environmental influences on this transition, but objective research examining the role of puberty hormones, testosterone in males and oestradiol in females (as biomarkers of puberty) on adolescent events is lacking. Neither has the tempo of puberty, the time from onset to completion of puberty within an individual been studied, nor the interaction between age of onset and tempo. This study has been designed to provide evidence on the relationship between reproductive hormones and the tempo of their rise to adult levels, and adolescent behaviour, health and wellbeing. METHODS/DESIGN: The ARCHER study is a multidisciplinary, prospective, longitudinal cohort study in 400 adolescents to be conducted in two centres in regional Australia in the State of New South Wales. The overall aim is to determine how changes over time in puberty hormones independently affect the study endpoints which describe universal and risk behaviours, mental health and physical status in adolescents. Recruitment will commence in school grades 5, 6 and 7 (10-12 years of age). Data collection includes participant and parent questionnaires, anthropometry, blood and urine collection and geocoding. Data analysis will include testing the reliability and validity of the chosen measures of puberty for subsequent statistical modeling to assess the impact over time of tempo and onset of puberty (and their interaction) and mean-level repeated measures analyses to explore for significant upward and downward shifts on target outcomes as a function of main effects. DISCUSSION: The strengths of this study include enrollment starting in the earliest stages of puberty, the use of frequent urine samples in addition to annual blood samples to measure puberty hormones, and the simultaneous use of parental questionnaires.

Exploring rural patients' understanding of the types, risk factors and measures to prevent healthcare-associated infections in Australia.

BACKGROUND: In Australia, there are approximately 165,000 healthcare-associated infections (HAIs) per year. Improving patient knowledge on HAIs and actively involving them in infection prevention is essential. This study assessed patient knowledge on types of and risk factors for HAIs and their perceptions of HAI information provision and hospital infection control practices in rural New South Wales, Australia. METHODS: Medical and surgical ward patients in three rural hospitals completed a questionnaire between February and March 2019. Open ended responses were grouped under categories, decided upon by two researchers, one of which is an infection prevention and control nurse. Descriptive analysis was completed. RESULTS: A total of 153 patients completed the survey. Most (n = 126, 82%) participants were previously aware of HAIs, with common sources of education/information being family/friends (n = 55, 36%), television (n = 28, 18%), newspapers (n = 27, 18%), and previous experience of a HAI (n = 20, 13%). Satisfaction with infection control measures and hospital cleanliness was high. Over half (n = 83, 54%) of participants thought they received too little information on HAIs, and only 35% (n = 21) of those that had surgery reported receiving information. Participants suggested that more education for the general public (n = 117, 76%) and patients (n = 110, 72%) in both written form and verbally from hospital staff, and education outside of the hospital in various mediums, could help reduce the risk and rates of HAI. CONCLUSION: Awareness of HAIs amongst respondents was high, however, education appeared to be lacking. More can be done to inform patient, family and general public education programs in rural and regional Australian hospitals.

Serial measurement of mood via text messaging in young people.

BACKGROUND: To support longitudinal research into mood in adolescents we sought to assess the feasibility of collecting mood data via Short Message Service (SMS) over 3 years, and to investigate the relationship between SMS data and self-report measures of depression. METHODS: Prospective cohort study of young people aged 9 to 14 years at baseline. Participants completed Short Mood and Feelings Questionnaire (SMFQ) and the Youth Self Report Anxious/Depressed ((YSR)/AD) and Withdrawn/Depressed (YSR/WD) scales at baseline and annually for 3 years. In addition, at 3 monthly intervals they responded to an SMS asking them to rate their mood from 0 to 9 (9 highest). RESULTS: 277 young people (43% female) completed all four waves of the survey. There was a 87% response rate to requests for SMS Mood ratings. Mean SMS Mood decreased over time for females (p = 0.006) but not males (p = 0.45). We found an inverse association between SMS Mood and the SMFQ, YSR/AD and YSR/WD, scales in females and the SMFQ and YSR/WD scales in males. 45% of participants reported at least one SMS Mood rating score below 5, while 5% reported clusters of low SMS scores. Clusters of low SMS Mood scores were associated with SMFQ scores in the clinical range at 24 (OR = 4.45) and 36 months (OR = 4.72), and YSR/WD in the clinical range at 36 months (OR = 4.61). CONCLUSIONS: SMS Mood ratings represent a feasible means to augment but not replace assessment of mood obtained using standard instruments.

Foot Length Growth as a Novel Marker of Early Puberty.

Foot growth is part of overall pubertal growth but its relation to other anthropometric and hormonal changes is unclear. Our objective was to determine how foot length changes relate to changes in other growth parameters (height and weight), Tanner stage, and serum hormones. Adolescents (n = 342) were recruited to a 3-year longitudinal cohort study, underwent annual anthropometric assessments (height, weight, and foot length), and provided self-rated Tanner staging. They also provided blood samples that were analyzed using liquid chromatography-tandem mass spectrometry for serum testosterone and estradiol and classified as pre-pubertal or pubertal based on circulating hormone levels. Average annual percent increase in foot length was greater for pre-pubertal adolescents compared with pubertal. Increased foot length was associated with increases in height, weight, Tanner stage, and serum hormones in males and pre-menarcheal females but not post-menarcheal females. Foot length offers a novel, noninvasive, cost-effective, and easily demonstrable marker of early pubertal changes.

Self-rated Tanner stage and subjective measures of puberty are associated with longitudinal gonadal hormone changes.

Introduction In large community-based studies of puberty, Tanner staging by a clinician is often not possible. We compared self-rated Tanner staging and other subjective ratings of pubertal development with serum hormone levels measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) to reassess the utility of self-rated pubertal stage using highly sensitive and specific hormone analysis. Methods Adolescents and their parents enrolled in the Adolescent Rural Cohort study of Hormones and health, Education, environments and Relationships (ARCHER) answered annual survey questions on pubertal development. Annually, adolescents provided blood samples for serum testosterone and estradiol measured by LC-MS/MS. Results Longitudinally, self-rated Tanner stage was positively associated with serum testosterone and estradiol levels in both sexes. Confirmation by adolescent and parent that puberty had commenced was associated with higher gonadal hormone levels in both sexes. Parent and adolescent responses demonstrated 'fair' to 'moderate' agreement. Conclusions Over a 3-year follow-up, self-rated Tanner staging and simple questions regarding pubertal onset and development are positively associated with adolescent gonadal hormone concentrations in serum measured by mass spectrometry. Thus, self-report of puberty stage still has a role in large community-based studies where physical examination is not feasible.

Ghrelin and Peptide YY Change During Puberty: Relationships With Adolescent Growth, Development, and Obesity.

Context: Pubertal adolescents show strong appetites. How this is mediated is unclear, but ghrelin and peptide YY (PYY) play potentially important roles. Objective: To measure ghrelin and PYY change in relation to pubertal growth. Design: Three-year prospective cohort study. Setting: Australian regional community. Participants: Eighty healthy adolescents (26 girls; 54 boys) recruited at 10 to 13 years. Main Outcome Measures: Fasting circulating total ghrelin, total PYY, IGF-1, insulin, leptin (via radioimmunoassay), estradiol and testosterone (via mass spectrometry), anthropometry, and body composition (via bioelectrical impedance). Results: Adolescents exhibited normal developmental change. Mixed models revealed positive associations for ghrelin to age2 (both sexes: P < 0.05), indicating a U-shaped trend over time. Ghrelin was also inversely associated with IGF-1 (both sexes: P < 0.05), leptin in girls (P < 0.01), and insulin in boys (P < 0.05) and negatively correlated with annual height and weight velocity (both sexes: P ≤ 0.01). PYY showed no age-related change in either sex. Neither ghrelin nor PYY were associated with Tanner stage. Weight subgroup analyses showed significant ghrelin associations with age2 in healthy-weight but not overweight and obese adolescents (7 girls; 18 boys). Conclusions: Adolescents showed a U-shaped change in ghrelin corresponding to physical and biochemical markers of growth, and no change in PYY. The overweight and obesity subgroup exhibited an apparent loss of the U-shaped ghrelin trend, but this finding may be attributed to greater maturity and its clinical significance is unclear. Further research on weight-related ghrelin and PYY trends at puberty is needed to understand how these peptides influence growth and long-term metabolic risk.

Insights into Facebook Pages: an early adolescent health research study page targeted at parents.

Facebook has been used in health research, but there is a lack of literature regarding how Facebook may be used to recruit younger adolescents. A Facebook Page was created for an adolescent cohort study on the effects of puberty hormones on well-being and behaviour in early adolescence. Used as a communication tool with existing participants, it also aimed to alert potential participants to the study. The purpose of this paper is to provide a detailed description of the development of the study Facebook Page and present the fan response to the types of posts made on the Page using the Facebook-generated Insights data. Two types of posts were made on the study Facebook Page. The first type was study-related update posts and events. The second was relevant adolescent and family research and current news posts. Observations on the use of and response to the Page were made over 1 year across three phases (phase 1, very low Facebook use; phase 2, high Facebook use; phase 3, low Facebook use). Most Page fans were female (88.6%), with the largest group of fans aged between 35 and 44 years. Study-related update posts with photographs were the most popular. This paper provides a model on which other researchers could base Facebook communication and potential recruitment in the absence of established guidelines.

Defining the rest interval associated with the main sleep period in actigraph scoring.

Actigraphy is increasingly used for sleep monitoring. However, there is a lack of standardized methodology for data processing and analysis, which often makes between study comparisons difficult, if not impossible, and thus open to flawed interpretation. This study evaluated a manual method for detection of the rest interval in actigraph data collected with Actiwatch 2. The rest interval (time in bed), defined as the bedtime and rise time and set by proprietary software, is an essential requirement for the estimation of sleep indices. This study manually and systematically detected the rest interval of 187 nights of recording from seven healthy males and three females, aged 13.5±0.7 (mean ± standard deviation) years. Data were analyzed for agreement between software default algorithm and manual scoring. Inter-rater reliability in manual scoring was also tested between two scorers. Data showed consistency between default settings and manual scorers for bedtime and rise time, but only moderate agreement for the rest interval duration and poor agreement for activity level at bedtime and rise time. Manual detection of rest intervals between scorers showed a high degree of agreement for all parameters (intraclass correlations range 0.864 to 0.995). The findings demonstrate that the default algorithm on occasions was unable to detect rest intervals or set the exact interval. Participant issues and inter-scorer issues also made difficult the detection of rest intervals. These findings have led to a manual detection protocol to define bedtime and rise time, supplemented with an event diary.

Urinary Sex Steroids and Anthropometric Markers of Puberty - A Novel Approach to Characterising Within-Person Changes of Puberty Hormones.

BACKGROUND/AIMS: The longitudinal relationships of within-individual hormone and anthropometric changes during puberty have not ever been fully described. The objectives of this study were to demonstrate that 3 monthly urine collection was feasible in young adolescents and to utilise liquid chromatography-tandem mass spectrometry assay methods for serum and urine testosterone (T), estradiol (E2) and luteinizing hormone (LH) in adolescents by relating temporal changes in urine and serum hormones over 12 months to standard measures of pubertal development. METHODS: A community sample of 104 adolescents (57 female) was studied over 12 months with annual anthropometric assessment, blood sampling and self-rated Tanner staging and urine collected every 3 months. Serum and urine sex steroids (T, E2) were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and LH by immunoassay. RESULTS: A high proportion (92%) of scheduled samples were obtained with low attrition rate of 6.7% over the 12 months. Urine hormone measurements correlated cross-sectionally and longitudinally with age, anthropometry and Tanner stage. CONCLUSION: We have developed a feasible and valid sampling methodology and measurements for puberty hormones in urine, which allows a sampling frequency by which individual pubertal progression in adolescents can be described in depth.

Text messaging is a useful reminder tool.

INTRODUCTION: Longitudinal studies of adolescents must be 'adolescent-friendly', to collect data and to encourage maintenance in the study cohort. Text messaging may offer a feasible means to do both. METHODS: Adolescents in the Adolescent Rural Cohort, Hormones and Health, Education, Environments and Relationships (ARCHER) study (n=342) are sent automated text messages every 3 months, prompting biological specimen collection. RESULTS: A total of 99.2% of participants (or their parents) owned a mobile phone, of which 89.1% of participants responded to text messages and 97.3% of intended urine samples were collected. The average time to provide a urine sample after prompting correlated with time to reply to Short Message Service (SMS). CONCLUSIONS: This study shows SMS can be used effectively in longitudinal research involving adolescents and is feasible and useful as a reminder tool for regular biological specimen collection.