The Fatty Liver Assessment in Germany (FLAG) cohort study identifies large heterogeneity in NAFLD care.

BACKGROUND & AIMS: NAFLD is a growing health concern. The aim of the Fatty Liver Assessment in Germany (FLAG) study was to assess disease burden and provide data on the standard of care from secondary care. METHODS: The FLAG study is an observational real-world study in patients with NAFLD enrolled at 13 centres across Germany. Severity of disease was assessed by non-invasive surrogate scores and data recorded at baseline and 12 months. RESULTS: In this study, 507 patients (mean age 53 years; 47% women) were enrolled. According to fibrosis-4 index, 64%, 26%, and 10% of the patients had no significant fibrosis, indeterminate stage, and advanced fibrosis, respectively. Patients with advanced fibrosis were older, had higher waist circumferences, and higher aspartate aminotransferase and gamma-glutamyltransferase as well as ferritin levels. The prevalence of obesity, arterial hypertension, and type 2 diabetes increased with fibrosis stages. Standard of care included physical exercise >2 times per week in 17% (no significant fibrosis), 19% (indeterminate), and 6% (advanced fibrosis) of patients. Medication with either vitamin E, silymarin, or ursodeoxycholic acid was reported in 5%. Approximately 25% of the patients received nutritional counselling. According to the FibroScan-AST score, 17% of patients presented with progressive non-alcoholic steatohepatitis (n = 107). On follow-up at year 1 (n = 117), weight loss occurred in 47% of patients, of whom 17% lost more than 5% of body weight. In the weight loss group, alanine aminotransferase activities were reduced by 20%. CONCLUSIONS: This is the first report on NAFLD from a secondary-care real-world cohort in Germany. Every 10th patient presented with advanced fibrosis at baseline. Management consisted of best supportive care and lifestyle recommendations. The data highlight the urgent need for systematic health agenda in NAFLD patients. LAY SUMMARY: FLAG is a real-world cohort study that examined the liver disease burden in secondary and tertiary care. Herein, 10% of patients referred to secondary care for NAFLD exhibited advanced liver disease, whilst 64% had no significant liver scarring. These findings underline the urgent need to define patient referral pathways for suspected liver disease.

The impact and importance of place on health for young people of Pasifika descent in Queensland, Australia: a qualitative study towards developing meaningful health equity indicators.

BACKGROUND: Health equity is a priority in the global sustainable development agenda. Available health equity indicators often focus on health outcomes, access to healthcare, risk factors and determinants such as income, education, and gender. Less attention has been given to other social determinants, including those related to place and ethnicity. Measures such as income, education, and gender, however, may not provide policy-makers with sufficient information to redress inequities. In this paper, we begin to develop health equity indicators for young Pasifika peoples in Logan, Queensland, Australia. While health data on Pasifika young people in Queensland is scant, available data suggests significant inequalities. The purpose of the study was to develop an understanding of the drivers of these disparities through the lens of the social determinants of health, to create health equity indicators. METHODS: Following meetings with community stakeholders to develop respectful and collaborative partnership processes, we took a youth participatory action research approach. Six peer researchers (3 male, 3 female) were recruited from the Logan area for the project. Following training, the peer researchers undertook 31 qualitative interviews with young Pasifika (16-24 years old). Data was manually analysed, coded and grouped into themes to develop the draft indicators. Interviews used the culturally appropriate Talanoa storytelling approach. RESULTS: Six key themes were identified from the interviews and were used to develop example indicators related to: spiritual and socio-cultural dimensions, place, access to culturally responsive services, economic and material dimensions and political dimensions. The results demonstrate health inequities experienced by Pasifika populations are strongly linked to place and their economic, social and cultural position. CONCLUSIONS: This study emphasises the need to understand the multiplicity of place-based factors that interact in complex ways to shape health inequities for young Pasifika peoples. It highlights health equity indicators must go beyond healthcare services, outcomes and a limited number of objective determinants, to include a more holistic focus. Starting to measure health and wellbeing via the lens of the social determinants of health will help to identify where policy-makers and programmes can intervene to begin to more adequately address inequities.

'Hey, We Are the Best Ones at Dealing with Our Own': Embedding a Culturally Competent Program for Maori and Pacific Island Children into a Mainstream Health Service in Queensland, Australia.

OBJECTIVE: We present the results of one component of an external evaluation of Good Start Program (GSP), a community-based program for the prevention of chronic disease among Maori and Pacific Island (MPI) communities living in the state of Queensland, Australia. DESIGN: An evaluation of the GSP was undertaken using a mixed methods approach. This paper reports on the qualitative component where interview and focus group data was collected, using Talanoa, a culturally tailored research methodology. Respondents included school students, community groups, teachers and parents, as well as the Good Start implementation team. RESULT(S): The five broad themes that emerged from this evaluation related to (i) components of cultural-competence and (ii) perceived impact of the program. The views of all participants reinforced the importance of culturally appropriate programs and highlighted how the multicultural health workers (MHWs) contributed to the program's perceived success. The challenges in understanding restrictions of the mainstream health service framework were noted indicating the need for it to be flexible in incorporating culturally appropriate components if a program was to be embraced. CONCLUSION: The qualitative evaluation of the GSP suggests that culturally tailored programs, delivered by MHWs, have the potential to impact positively on community-level behavioural changes that improve health. These findings, supported by studies from other countries, contribute to the evidence that cultural-tailoring of programs is critical for ensuring that culturally appropriate initiatives are embedded in health care systems that support multicultural communities. Embedding includes the development of culturally appropriate policies, a culturally competent workforce and long-term funding to support culturally competent initiatives.

Perspectives of key stakeholders and experts in infant feeding on the implementation of the Australian National Breastfeeding Strategy 2010-2015.

Breastfeeding is widely accepted as an important public health issue for babies and their mothers. Yet, despite this, Australia continues to struggle with reaching global targets for breastfeeding indicators. In 2007, the Best Start Parliamentary Inquiry Report was released and set the stage for the Australian National Breastfeeding Strategy [2010-2015), which was announced in November 2009, with the vision to increase Australia's breastfeeding rates of infants at 6 months of age and beyond. The aim of this research project was to explore the perspectives of key stakeholders in the field of infant feeding in Australia on the implementation of the strategy, barriers and enablers to its successful implementation and actions that were still needed. Using qualitative research methods of in-depth, semi-structured interviews and thematic analysis, this study identifies main themes of these perceptions about the strategy implementation and some recommendations for future strategies and further research. The main themes identified were initial opinions of the strategy as a blueprint for action, the strategy as a driver for action, lessons learned and recommendations for the future. For success in improving implementation of national breastfeeding strategies, it is recommended that Australia establish an independent breastfeeding/infant feeding committee, increase the political prioritisation of issues surrounding infant feeding and strengthen the regulation of the marketing of breastmilk substitutes.

Charting Availability of Processed and Unprocessed Foods in School Neighbourhood Nutrition Environments in an Urban Australian Setting.

School Neighbourhood Nutrition Environments (SNNEs) can facilitate or impede healthy eating. This study describes the SNNEs surrounding 6 Good Start Program (GSP) schools in 5 suburbs in Logan, Queensland. Relative density of healthy and unhealthy food outlets was calculated for SNNEs surrounding GSP (6) and non-GSP (10) schools within the 5 suburbs. Relative accessibility of minimally processed and highly processed food and drink in SNNEs of the 6 GSP schools was determined using shelf measurements of snack foods. Unhealthy outlets greatly outnumber healthy outlets (mean relative density 15.6%, median 19.1%). The majority of outlets stock predominantly highly processed food and drink. Study areas are dominated by unhealthy food outlets and highly processed food.

Dietary habits of Samoan adults in an urban Australian setting: a cross-sectional study.

OBJECTIVE: To describe key characteristics of the dietary habits of Samoans residing in Logan, Queensland and to compare these characteristics with comparable populations. DESIGN: Dietary intake was measured using a self-administered structured questionnaire between December 2012 and March 2013. Demographic characteristics included age and sex. Questionnaire results were compared with data from samples of Brisbane residents of similar social and economic characteristics and Pacific Islanders in New Zealand. The association between demographic characteristics and diet was investigated. SETTING: Logan, Queensland, Australia. SUBJECTS: Samoans aged 16 years and older. RESULTS: A total of 207 Samoans participated, ninety-six (46 %) of whom were male. Of the participants, seventy-nine (38 %) were aged 16-29 years, sixty-three (30 %) were aged 30-49 years and sixty-five (31 %) were aged ≥50 years. Younger adults were significantly more likely to eat hamburgers, pizza, cakes, savoury pastries, potato crisps, sweets and soft drinks (all variables P<0·001). Among Samoans, 44·7 % consumed two or more pieces of fruit daily, compared with 43·8 % of comparable Brisbane residents (relative risk=1·0; 95 % CI 0·8, 1·2). Three or more servings of vegetables each day were consumed by 9·2 % of Samoans compared with 36·6 % of comparable Brisbane residents (relative risk=3·8; 95 % CI 2·5, 6·0). CONCLUSIONS: Samoans are consuming significantly fewer vegetables and more discretionary foods than other populations. Socio-economic factors, length of stay in Australia and cultural practices may impact upon Samoans' diets. Further comprehensive studies on Samoans' dietary habits in Australia are recommended.

Breastfeeding experiences of Aboriginal and Torres Strait Islander mothers in an urban setting in Brisbane.

STUDY AIM: This study examined urban Aboriginal and Torres Strait Islander mothers' breastfeeding experiences to inform support for mothers and their families. STUDY DESIGN: The research took a strengths approach, using qualitative methodology. Twenty semi-structured in-depth face-to-face interviews were conducted and analysed thematically. SETTING AND PARTICIPANTS: Indigenous mothers of infants 3 to 12 months were recruited through a Brisbane Indigenous health service. KEY FINDINGS: All mothers recounted considerable physical and emotional energy invested in breastfeeding. Although early introduction of formula made sense for some mothers under stressful circumstances, timely pro-breastfeeding support from family and health professionals facilitated continued breastfeeding. Professional and social/family contacts play key roles in steering infant feeding outcomes. CONCLUSIONS: Mothers' experiences strongly influence infant feeding strategies. Aboriginal and Torres Strait Islander community strengths are underutilised in supporting breastfeeding mothers. FUTURE IMPLICATIONS: Indigenous mothers, family and community strengths present points for engagement in future breastfeeding promotion and support initiatives.