Impact of sleep on educational outcome of Indigenous Australian children: A systematic review.

INTRODUCTION: The association between quality sleep and improved cognition is well reported in literature. However, very few studies have been undertaken to evaluate the impact of poor sleep on educational outcomes in Indigenous Australian children. OBJECTIVES: The objective of this review was to explore the association between sleep and educational outcomes of Indigenous children. METHODS: For this systematic review, a literature search covering research articles in academic databases and grey literature sources was conducted to retrieve studies published until March 2022. Eight online e-databases (PubMed, Ovid MEDLINE, CINAHL, SCOPUS, HealthinfoNet, PsycINFO, Cochrane and Google Scholar) were searched for data extraction and two appraisal tools (NIH and CREATE) were used for quality assessment. Studies that explored any aspect of sleep health in relation to educational/academic outcomes in school going Indigenous Australian children aged 5-18 were included in this study. All review articles and studies that focused on physical/ mental disabilities or parent perceptions of sleep and educational outcomes were excluded. A convergent integrated approach was used to collate and synthesize information. RESULTS: Only three studies (two cross-sectional and one longitudinal) met the eligibility criteria out of 574 articles. The sample size ranged from 21-50 of 6 to 13 year old children. A strong relationship was indicated between sleep quantity and educational outcomes, in two of the three studies. One study related the sleep fragmentation/shorter sleep schedules of short sleep class and early risers with poorer reading (B = -30.81 to -37.28, p = 0.006 to 0.023), grammar (B = -39.79 to -47.89, p = 0.012-0.013) and numeracy (B = -37.93 to -50.15, p = 0.003 to 0.022) skills compared with long sleep and normative sleep class whereas another reported no significant relation between sleep and educational outcomes. CONCLUSION: The review highlights the need for more research to provide evidence of potentially modifiable factors such as sleep and the impact these may have on academic performance.

Discharge against medical advice in rural and remote emergency departments: views of healthcare providers.

INTRODUCTION: The aim of the study was to explore, in one remote hospital, emergency department healthcare providers' experience and perceptions of the factors surrounding a patient's decision to discharge against medical advice (DAMA). The secondary objective was to gain insight into staff experiences of the current protocols for managing DAMA cases and explore their recommendations for reducing DAMA incidence. METHODS: This was a cross-sectional study involving a survey and semi-structured interviews exploring healthcare providers' (n=19) perceptions of factors perceived to be influencing DAMA, current practice for managing DAMA and recommendations for practice improvements. Health professionals (doctors, nurses, Aboriginal Health Workers) all worked in the emergency department of a remote community hospital, Queensland, Australia. Responses relating to influencing factors for DAMA were provided on a three-point rating scale from 'no influence/little influence' to 'very strong influence'. DAMA management protocol responses were a three-point rating scale from 'rarely/never' to 'always'. Semi-structured interviews were conducted after the survey and explored participants' perceptions in greater detail and current DAMA management protocol. RESULTS: Feedback from the total of 19 participants across the professions presented four prominent yet interconnected themes: patient, culture, health service and health provider, and health literacy and education-related factors. Factors that were perceived to have a strong influence on DAMA events included alcohol and drug abuse (100%), a lack of culturally sensitive healthcare services (94.7%), and family commitments or obligations (89.5%). Healthcare provider recommendations for preventing DAMA presented themes of right communication, culturally safe care (right place, right time) and the right staff to support DAMA prevention. The healthcare providers described the pivotal role the Indigenous Liaison Officer (ILO) plays and the importance of this position being filled. CONCLUSION: DAMA is a multifaceted issue, influenced by both personal and hospital system-related factors. Participants agreed that the presence of ILO and/or Aboriginal Health Workers in the emergency department may reduce DAMA occurrences for Indigenous Australians who are disproportionately represented in DAMA rates, particularly in rural and remote regions of Australia.

Trajectories of dietary patterns from pregnancy to 12 years post-pregnancy and associated maternal characteristics: evidence from the Avon Longitudinal Study of Parents and Children.

PURPOSE: Dietary patterns (DPs) during pregnancy have been well researched. However, little is known about maternal diet after pregnancy. The aim of the study was to explore maternal DPs longitudinally, examine trajectories over 12 years after pregnancy and identify associated factors. METHODS: Of 14,541 pregnant women enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC) complete dietary information was available for 5336 women. Principal components analysis (PCA) was used to derive DPs. DP scores at each time point were used to create DP trajectories using group-based trajectory modelling (GBTM). Multinomial logistic regression assessed the association with maternal factors. RESULTS: A total of six distinct DPs were identified over time with different numbers of DPs at each time point. The "healthy" and "processed" DPs persisted over the 12-year post-pregnancy. Three trajectories of "healthy" and "processed" DPs were identified from GBTM. Half the women were on the moderately healthy DP trajectory with 37% on the lower trajectory and 9% on the higher healthy DP trajectory. 59% of women were on the lower processed DP trajectory with 38% on the moderate trajectory and 3.3% on the higher processed DP trajectory. Low educational attainment, low social class and smoking in pregnancy were independently associated with being on a less favourable DP trajectory over the 12 years. CONCLUSION: Health professionals should provide support on smoking cessation along with healthy eating advice during ante-natal counselling. Continued support on eating healthily after pregnancy would be beneficial for mothers and families.

Time trends, projections, and spatial distribution of low birthweight in Australia, 2009-2030: Evidence from the National Perinatal Data Collection.

INTRODUCTION: Infants with low birthweight (LBW, birthweight <2500 g) have increased in many high-resource countries over the past two decades. This study aimed to investigate the time trends, projections, and spatial distribution of LBW in Australia, 2009-2030. METHODS: We used standard aggregate data on 3 346 808 births from 2009 to 2019 from Australia's National Perinatal Data Collection. Bayesian linear regression model was used to estimate the trends in the prevalence of LBW in Australia. RESULTS: Wefound that the prevalence of LBW was 6.18% in 2009, which has increased to 6.64% in 2019 (average annual rate of change, AARC = +0.76%). If the national trend remains the same, the projected prevalence of LBW in Australia will increase to 7.34% (95% uncertainty interval, UI = 6.99, 7.68) in 2030. Observing AARC across different subpopulations, the trend of LBW was stable among Indigenous mothers, whereas it increased among non-Indigenous mothers (AARC = +0.81%). There is also an increase among the most disadvantaged mothers (AARC = +1.08%), birthing people in either of two extreme age groups (AARC = +1.99% and +1.53% for <20 years and ≥40 years, respectively), and mothers who smoked during pregnancy (AARC = +1.52%). Spatiotemporal maps showed that some of the Statistical Area level 3 (SA3) in Northern Territory and Queensland had consistently higher prevalence for LBW than the national average from 2014 to 2019. CONCLUSION: Overall, the prevalence of LBW has increased in Australia during 2009-2019; however, the trends vary across different subpopulations. If trends persist, Australia will not achieve the Sustainable Development Goals (SDGs) target of a 30% reduction in LBW by 2030. Centering and supporting the most vulnerable subpopulations is vital to progress the SDGs and improves perinatal and infant health in Australia.

Anaemia in women of reproductive age in low- and middle-income countries: progress towards the 2025 global nutrition target.

Objective: To examine trends in, and projections of, the prevalence of anaemia in women of reproductive age in low- and middle-income countries at national and subpopulation levels. Methods: We used nationally representative data from repeated cross-sectional Demographic and Health Surveys (DHS) on 1 092 512 women of reproductive age (15-49 years) from 15 low- and middle-income countries. We defined anaemia as haemoglobin < 11 g/dL for pregnant women and < 12 g/dL for non-pregnant women. We analysed data using Bayesian linear regression analyses. Findings: During 2000-2018, the prevalence of anaemia in women of reproductive age decreased in nine countries, with the highest decrease in Malawi (-2.5%), and increased in six countries, with the highest increase in Burundi (10.9%). All countries are projected to have a prevalence of anaemia ≥ 15% in 2025, with the highest level in Burundi (66.8%). The prevalence of anaemia and projection of prevalence varied between and within countries. Women's education, family wealth and place of residence had the highest impact on the current and projected prevalence rates of anaemia. Seven countries had a prevalence of anaemia ≥ 40%, which we defined as a severe public health problem, in the earliest and latest DHS and this prevalence is projected to persist in 2025. Conclusion: None of the 15 countries is likely to meet the global nutrition target of a 50% reduction in the prevalence of anaemia in women of reproductive age by 2025. Global and country leaders should reconsider nutrition policies and reallocate resources targeting countries and communities at risk.

Why patients attend emergency department for primary care type problems: views of healthcare providers working in a remote community.

INTRODUCTION: Emergency department (ED) utilisation continues to increase, particularly for primary care presentations that do not require high level ED services. The reasons for this are complex, and research has focused on patient perspectives in choosing where to seek care rather than those of ED and general practitioner (GP) providers. This study aimed to address this gap by exploring the views of ED and GP providers regarding ED utilisation for primary care type health conditions in a small, remote Australian city with perhaps unique population demographics and service configuration. METHODS: Service providers from the ED and general practice clinics were invited to participate in focus groups and semi-structured interviews exploring their views on ED utilisation for primary-care-type health presentations. The data were analysed using thematic content analysis. RESULTS: In total, 24 healthcare providers (five GPs, seven ED practitioners, seven community nurse navigators, four Aboriginal and Torres Strait Islander Health Workers and one Indigenous Liaison Officer) participated in focus groups discussion and interviews. The analysis identified three themes: access and logistic barriers, rational decision-making and self-perceived urgency. While there was some overlap in the healthcare providers' perceptions, there were also strong differences between ED and GP groups. In particular, the ED group believed that GP services are less accessible for urgent appointments, whereas GPs believed that such arrangements were in place. Both groups agreed on the need for clear communication between the ED and general practice. CONCLUSION: ED and GP providers demonstrate similarities and differences in understanding patients' reasons for choosing which service to access. The differences may stem from ED providers' focus on offering a rapid resolution of acute presentations and GP providers' focus on offering comprehensive and continuing care. Effective communication between general practice and the ED services and clearer referral pathways may help in reducing ED utilisation for less urgent primary-care-type problems.

Shift work is associated with increased risk of COVID-19: Findings from the UK Biobank cohort.

Despite the strong evidence on circadian rhythm disruption in shift workers and consequent increased vulnerability for infection, longitudinal association between shift work and COVID-19 infection is unexplored. In this study, data from UK Biobank participants who were tested for COVID-19 infection (16 March to 7 September 2020) were used to explore the link between shift work and COVID-19 infection. Using the baseline occupational information, participants were categorised as non-shift workers, day shift workers, mixed shift workers and night shift workers. Multivariable regression models were used to assess the association between shift work and COVID-19 infection. Among the 18,221 participants (9.4% positive cases), 11.2% were health workers, and 16.4% were involved in shift-work-based jobs. Ethnic minorities (18%) and people in night-shift-based jobs (18.1%) had a significantly higher prevalence of COVID-19 infection than others. Adjusted logistics regression model suggest that, compared with their counterparts, people employed in a night-shift-based job were 1.85-fold (95% CI: 1.42-2.41) more likely to have COVID-19 infection. Sensitivity analysis focusing on people working in a non-healthcare setting suggests that people in shift-work-based jobs had 1.81-fold (95% CI: 1.04%-3.18%) higher odds of COVID-19 infection than their counterparts. Shift workers, particularly night shift workers, irrespective of their occupational group, seem to be at high risk of COVID-19 infection. If similar results are obtained from other studies, then it would mandate to revisit the criteria for defining high-risk groups for COVID-19 and implementing appropriate interventions to protect people in shift-based jobs.

Geographical variation and temporal trend in anemia among children aged 6-59 months in low- and middle-income countries during 2000-2018: forecasting the 2030 SDG target.

OBJECTIVE: To examine geographical variations, trends and projections in the prevalence of childhood anemia at national and subpopulation levels. DESIGN: Repeated cross-sectional Demographic and Health Survey (DHS) conducted during 2000-2018. SETTING: Fifty-three low- and middle-income countries (LMIC). PARTICIPANTS: Totally, 776 689 children aged 6-59 months. RESULTS: During the latest DHS rounds between 2005 and 2018, the prevalence of child anemia was > 20 % in fifty-two out of fifty-three countries and ranged from 15·9 % in Armenia in 2016 to 87·8 % in Burkina Faso in 2010. Out of thirty-six countries with at least two surveys during 2000-2018, the prevalence of child anemia decreased in twenty-two countries, highest in Zimbabwe (-4·2 %) and increased in fourteen countries, highest in Burundi (5·0 %). Based on the trend, eleven and twenty-two out of thirty-six countries are projected to experience, respectively, moderate and severe public health problem according to the WHO criteria (moderate problem: 20-39·9 % and severe problem: ≥ 40 %) due to child anemia in 2030, with the highest prevalence in Liberia (87·5 %, 95 % credible interval 52·0-98·8 %). The prevalence of child anemia varied across the mother's education and age, child sex, wealth quintiles, and place of residence, with the highest rate of child anemia among the poorest, rural and low-educated mothers. These scenarios are projected to continue. The probability of reducing child anemia at < 0·5 % by 2030 is 0 % for all study countries. CONCLUSIONS: The prevalence of child anemia varied between and within countries. None of the thirty-six LMIC is likely to eradicate child anemia by 2030.

Drivers of general practice-type presentations to the emergency department in a remote outback community.

OBJECTIVE: To estimate the number of general practice-appropriate attendances in a remote emergency department and explore the reasons for patients' choice of service. DESIGN: A four-step case study approach was adopted, focusing on hospital emergency department (ED) attendances that were potentially manageable in general practice. SETTING: A large, remote community with substantial populations of Indigenous peoples and fly-in, fly-out mining industry workers. The ED is experiencing rapid growth in demand for services for lower urgency. PARTICIPANTS: Patients attending the emergency department with lower urgency problems. INTERVENTIONS: ED attendance data for 2016 were reviewed to identify lower urgency presentations. Patient records for 400 randomly selected presentations were subject to deeper analysis. A prospective survey was conducted over 6 months of 369 ED patients with lower urgency presentations. MAIN OUTCOME MEASURES: The proportion of patients attending the ED with GP-appropriate problems and influences on their decisions to attend the ED. RESULTS: About 48% of all attendances met the agreed definition of GP-appropriate problems. About half of presentations were during the normal work hours and about half of patients stated that GP services were unavailable. Younger age, lack of information about local GP services, and perceptions of convenience contributed significantly to seeking ED care. CONCLUSION: Increasing the availability of GP services alone is unlikely to be sufficient to change service utilisation. Strategies should include raising community awareness of how and when to utilise the appropriate service, understanding different models of care, and the need to register with a general practice.

Late bedtime and body mass index gain in indigenous Australian children in the longitudinal study of indigenous children.

AIM: To explore sleep patterns in indigenous Australian children and assess the role of sleep timing in longitudinal changes in body mass index (BMI). METHODS: Latent profile analysis was conducted with the Australian Longitudinal Study of Indigenous Children (LSIC) cohort data (wave 5), to determine distinct patterns of bed and wake timing, taking account of weekday sleep duration, weekday and weekend bedtimes, and weekday wake times. Multilevel models with a random intercept were used to investigate the role of baseline sleep pattern in predicting longitudinal changes in BMI. RESULTS: Baseline data for 1258 children (50.7% males), mean age 6.32 ± 1.52 years, indicated the presence of five classes of sleep patterns: early/long sleepers (4.5%), normative sleepers (25.5%), late sleepers (49.9%), consistent late sleepers (11.1%) and early risers (9%). Late sleeping was significantly associated with longitudinal gains in BMI. Compared with early sleepers, consistent late sleepers experienced 1.03 unit gain in BMI at follow-up (95% CI: 0.001-2.05, P = .05). CONCLUSION: This study underscores the importance of looking beyond sleep duration and highlights the positive outcomes of early bedtimes in children. As sleep timing is modifiable, this offers the opportunity for improvement in sleep and protecting against future weight gain in indigenous children.

Are primary healthcare services culturally appropriate for Aboriginal people? Findings from a remote community.

This study explored the views of key stakeholders on cultural appropriateness of primary health care (PHC) services for Aboriginal people. A total of 78 participants, including healthcare providers, administrative team members (n=24, ~30% of study sample) and Aboriginal community members (n=54, ~70% of study sample) living in remote North West Queensland participated in the study. Outcome measures were assessed by administering survey questionnaires comprising qualitative questions and various subscales (e.g. provider behaviours and attitudes, communication, physical environment and facilities, and support from administrative staff). Descriptive statistics were used to present quantitative findings, whereas inductive thematic analysis was used for qualitative data. In contrast to the views of PHC providers, a significant number of Aboriginal people did not perceive that they were receiving culturally appropriate services. Although PHC providers acknowledged cultural awareness training for familiarising themselves with Aboriginal culture, they found the training to be general, superficial and lacking prospective evaluation. PHC providers should understand that culturally inappropriate clinical encounters generate mistrust and dissatisfaction. Therefore, a broad approach involving culturally respectful association between PHC providers, Aboriginal consumers and administrative staff is required to bring sustainable changes at the practice level to improve the health of Aboriginal people.

Exploring Gender Difference in Sleep Quality of Young Adults: Findings from a Large Population Study.

OBJECTIVES: To explore if gender difference in sleep quality is due to higher prevalence of depression in females, and whether socio-demographic and lifestyle factors have a differential effect on sleep quality in males and females. METHODS: Youth self-reports and the Pittsburgh Sleep Quality Index were used to assess sleep quality and associated risk factors. Logistic regression analyses were used to analyze the association between various risk factors and poor sleep quality. RESULTS: Reports from 3,778 young adults (20.6±0.86 years) indicate a higher prevalence of poor sleep quality in females than males (65.1% vs. 49.8%). It seems that gender difference in poor sleep is independent of depression, socio-demographics, and lifestyle factors, since the higher odds of poor sleep quality in females was robust to adjust for depression, socio-demographics, and lifestyle factors (OR: 1.53, 95% CI: 1.23-1.90). Lifestyle factors (eg, smoking) (OR 1.91; 95% CI 1.05-3.46) were associated with sleep quality in only males. CONCLUSION: Our findings indicate that female vulnerability to poor sleep quality should be explored beyond psycho-social disparities. Perhaps, exploring if the female predisposition to poor sleep quality originates at the biological level could lead to the answer.

Parent and adolescent reports in assessing adolescent sleep problems: results from a large population study.

AIM: To compare parent and adolescent reports in exploring adolescent sleep problems and to identify the factors associated with adolescent sleep problem disclosures. METHODS: Parent (n = 5185) and adolescent reports (n = 5171, age=13.9 ± 0.3 years), from a birth cohort were used to explore adolescent sleep problems. Kappa coefficients were used to assess the agreement, whereas, conditional agreement and disagreement ratios were used to identify the optimal informant. Logistic regression analysis was used to determine the factors affecting adolescent sleep problem disclosure. RESULTS: Parental reports identified only about one-third of the sleep problems reported by adolescents. Whereas adolescent reports identified up to two-thirds of the sleep problems reported by parents. Combined reports of parents and adolescent did not show any considerable difference from the adolescent report. Adolescent and parent health, maternal depression, and family communication were significantly associated with adolescents sleep problem disclosures. CONCLUSION: Adolescent reports could be used as the preferred source to explore adolescent sleep problems. Parental reports should be used when parents as observers are more reliable reporters, or where adolescents are cognitively unable to report sleep problems. Additionally, the impact of poor health, maternal depression and family communication on sleep problems disclosure should be considered for adolescent sleep problem diagnosis.

Epidemiology of Caesarean section on maternal request in Australia: A population-based study.

OBJECTIVE: To explore the trends, determinants, and short-term maternal and neonatal health outcomes of Caesarean section on maternal request (CSMR). DESIGN: Population-based record linkage study. SETTING: Birth registry data for all births in Queensland, Australia, from 2008 to 2017. PARTICIPANTS: Pregnancies resulting in live or intrapartum stillbirth with >=20 gestational weeks and/or >=400 gm birth weight were the study population. The analytic sample was restricted to low-risk pregnancies by excluding preterm, non-cephalic pregnancies with medical risk factors. MEASUREMENTS: CSMR was defined as a first-time C-section in singleton, term pregnancies with an ICD-10-AM code of O-82/O-47. CSMR trend was reported in age-standardised rate using a join-point regression model. The determinants and perinatal outcomes of CSMR were tested against Spontaneous vaginal births (VBs) and planned VBs including assisted VBs and emergency C-sections in this group. The generalised estimating equation technique was used for regression analysis and reported in the odds ratio (OR) at a 95% Confidence Interval (CI). FINDINGS: Of total C-sections (n = 204,863), the average annual change in CSMR rate was 4.4% (95% CI: 2.1-6.7%, p<0.01) for the total pregnancies (N=613,375) Of the analytic sample (N=365568), nulliparous women with age ≥35 years (OR: 2.32,95% CI: 2.09-2.57), delivered at private hospitals (OR:4.90; 95% CI: 4.65-5.18); with mood disorders (OR: 2.15; 95% CI: 1.88-2.43) were positive and midwives birth attendant (OR 0.28; 95% CI: 0.26 to 0.30) was negative influencing factors for CSMR. In a propensity score matched sample; CSMR observed an increasedrisk of anaesthetic complications (OR: 8.00; 95% CI:1.95-32.82) and slightly reduced odds of birth asphyxia (OR:0.20;95%CI:0.06-0.60)against planned VBs while the overall incidence of birth-asphyxia was low (1.29%) However, neonatal morbidities (OR:1.61; 95% CI:1-2.59) and special care admission (OR:2.15; 95% CI:1.03-4.5) were higher after CSMR in comparison to SVBs CONCLUSION: Despite being linked with adverse perinatal health outcomes, the incidence of CSMR increased 1.75-fold during the past 10 years. Maternal educational interventions to provide adequate information, including the long-term risks and benefits of C-sections, can help reduce the growing rates of CSMR.

Geographical variation in the association between physical violence and sleep disturbance among adolescents: A population-based, sex-stratified analysis of data from 89 countries.

OBJECTIVE: To examine geographical variations in involvement in physical violence and sleep disturbance among adolescents. DESIGN: Cross-sectional study. SETTING: Eighty-nine low- to middle-income and high-income countries PARTICIPANTS: Adolescents 13-17 years of age. MEASUREMENTS: Multiple binary logistic regression analyses and meta-analyses were performed to assess the link between physical violence (number of physical fights) and sleep disturbance ("mostly" or "always" experienced worry-induced sleep loss). RESULTS: Among 296,212 adolescents, 8.9% reported sleep disturbance (male: 7.5%, female: 9.6%), with the highest prevalence among adolescents from the Eastern Mediterranean region (14.1%) and high-income countries (14.1%). Overall, sleep disturbance prevalence increased gradually with the increased episodes of physical violence. Adolescents who were involved in physical violence once, 2-3 times, and 4+ times were respectively 18%, 26%, and 77% more likely than their counterparts to experience sleep disturbance (1 time: OR 1.18, 95% CI 1.13-1.24; 2-3 times: 1.26, 1.20-1.34; 4+ times: 1.77, 1.66-1.88). The association between physical violence and sleep disturbance was observed in all regions and country-income groups, with the highest odds of sleep disturbance among adolescents experiencing 4+ times of physical violence in the European region (2.34, 1.17-4.67) and upper-middle-income countries (1.91, 1.73-2.11). The association of physical violence with sleep disturbance by sex was significant in all regions and country-income groups, except the European region. CONCLUSIONS: Exposure to physical violence is associated with increased odds of sleep disturbances in adolescents. School and community-level interventions, vigilance, and programs to promote violence-free environments may improve the sleep health of adolescents exposed to physical violence.

Connecting the health of country with the health of people: Application of "caring for country" in improving the social and emotional well-being of Indigenous people in Australia and New Zealand.

Emerging evidence from the western literature suggests an increasing focus on applying nature-based interventions for mental health improvements. However, in Indigenous communities, caring for country has always been central to the Indigenous way of life. Knowing that nature-based interventions effectively improve mental health outcomes, this review collated evidence on the application of caring for country in improving social and emotional well-being (SEWB) of Indigenous peoples in Australia and New Zealand. Three studies from Australia and one from New Zealand, explored the role of country or whenua (land) in the lives of Indigenous people. Participation in caring-for country activities was associated with lower levels of psychological distress and strengthened guardianship relationship with country, which positively affected SEWB. This systematic review offers preliminary evidence on the role of caring for country activities in improving the SEWB of Indigenous peoples and highlights the need for strengths-based approaches to improve the SEWB of Indigenous peoples. Funding: None.

Geographical variations in the prevalence of traditional and cyberbullying and its additive role in psychological and somatic health complaints among adolescents in 38 European countries.

OBJECTIVES: To explore geographical variations in the prevalence of traditional and cyberbullying and their individual and additive role on psychological and somatic health issues of adolescents. METHODS: We used cross-sectional data from 188,003 adolescents (50.9% females; mean age 13.6 years) from the nationally representative Health Behaviour in School-aged Children 2014 survey in 38 European countries. Multivariable linear regression analyses were conducted to explore the role of bullying on health outcomes whilst meta-analyses were conducted to generate pooled regression coefficients. RESULTS: Overall, the prevalence of traditional bullying was 26.9%, ranges from 8.8% in Armenia to 49.7% in Latvia, and cyberbullying was 15.8%, ranges from 5.8% in Greece to 38.3% in Greenland. 1 in 10 (8.4%) adolescents reported experiencing both forms of bullying, with the prevalence ranging from 2.5% (Greece) to 21.0% (Greenland). Meta-analytic estimates suggest a significant role of both traditional and cyberbullying in poor somatic and psychological health issues. The additive effect of both forms of bullying was more prominent on psychological health issues (ß 0.70, 95% CI 0.66-0.74) than on somatic health issues (ß 0.50, 95% CI 0.47-0.53). These associations varied across countries. CONCLUSION: The prevalence of traditional and cyberbullying varied significantly across European countries while their individual and additive links with an increased risk of poor psychological and somatic health issues remain common in majority countries. To ensure both forms of bullying are prevented, a multifaceted approach and particular attention to mental health issues in bullying victims are needed in countries with high prevalence of bullying.

The myth and reality of familial resemblance in dietary intake: a systematic review and meta-analysis on the resemblance of dietary intake among parent and offspring.

Background: There is a strong societal belief that parents are role models for their child's dietary behaviours in early life that may persist throughout the life course. Evidence has shown inconclusive dietary resemblance in parent-child (PC) pairs. This systematic review and meta-analysis aimed to examine dietary resemblance between parent and children. Methods: We systematically searched for studies on PC dietary resemblance, via six electronic databases (PubMed, Ovid MEDLINE, Embase, APA PsycNet, CINAHL, and Web of Science) and other grey sources of literature between 1980 and 2020. We performed quality effect meta-analysis model on transformed correlation coefficients (z) to examine the resemblance in dietary intakes including nutrient intakes, food group intakes and whole diet. Finally, the Fisher's transformed coefficient (z) was used for meta-regression analysis to identify potential moderators. Heterogeneity and inconsistency were examined using the Q and I2 statistic. The study is registered on PROSPERO, CRD42019150741. Findings: A total of 61 studies met the inclusion criteria for systematic review, 45 were included in the meta-analysis. Pooled analyses showed weak to moderate PC dietary intake associations for energy: (r: 0.19; 95% CI: 0.16, 0.22), fat (% energy): (r: 0.23; 95% CI: 0.16, 0.29), protein (% energy): (r: 0.24; 95% CI: 0.20, 0.27), carbohydrate (% energy): (r: 0.24; 95% CI: 0.19, 0.29), fruits and vegetable (g/d): (r: 0.28; 95% CI: 0.25, 0.32), confectionary food (g/d): (r: 0.20; 95% CI: 0.17, 0.23), and whole diet (r: 0.35; 95% CI: 0.28, 0.42). Dietary intakes associations by study characteristics, including population, study year, dietary assessment method, person reporting dietary intake, quality of the study, and study design were highly variable, but associations were similar between PC pairs. Interpretation: The resemblance among parent-child pairs was weak to moderate for most aspects of dietary intakes. These findings challenge the social myth that parental dietary intake behaviour shapes their child's dietary intake. Funding: None.

Sleep health and its implications in First Nation Australians: A systematic review.

Understanding the state of sleep health in First Nations Australians offers timely insight into intervention and management opportunities to improve overall health and well-being. This review explored the determinants and burden of poor sleep in First Nations Australians. A systematic search was conducted to identify studies published until August 2020 in First Nations Australian adults. Nine studies (n = 2640) were included, three in community settings, six in clinical populations. Across studies compared with non-Indigenous people, 15-34% of First Nations Australians experience less than recommended hours (<7 h/night), 22% reported fragmented, irregular, and unrefreshing sleep with a high prevalence of OSA in clinical populations (39-46%). Findings show First Nations Australians are significantly more likely to report worse sleep health than Non-Indigenous Australians in all measured domains of sleep. Co-designed sleep programs and service delivery solutions are necessary to ensure timely prevention and management of sleep issues in First Nations communities which to date have been underserved. FUNDING: No external funding was provided for this work.

Multigenerational transmission of obesity: A systematic review and meta-analysis.

There is a strong link between parental and offspring obesity status. However, the state of epidemiological evidence on multigenerational transmission of overweight/obesity, such as from grandparents to grandchildren, is relatively unknown. This systematic review collates and appraises existing evidence on multigenerational transmission of overweight/obesity and uses meta-analytic estimates for quantitative synthesis. Six electronic databases were searched for publications reporting the relationship between grandparents and their grandchildren overweight/obesity status. A total of 25 studies from 17 countries with a combined population of 238,771 study participants met the inclusion criteria. About 60% (15) of the reviewed studies reported a positive association between grandparent-grandchild (GP-GC) overweight/obesity, out of which 11 were statistically significant. Seven studies reported odds ratios of GP-GC overweight/obesity associations and were included in the meta-analysis. The pooled estimates showed a significant GP-GC association in overweight/obesity status (odds ratio [OR]: 1.79, 95% confidence interval [CI]: 1.01-2.57). Thus, the current research evidence shows that grandchildren's overweight/obesity status is associated with their grandparents' overweight/obesity status, indicating a multigenerational transmission of obesity. However, more studies, especially from developing countries, are required to assess the robustness of these findings. Future studies should also focus on the mechanisms through which this transmission occurs.