Parental role-modeling on 24-hour movement behaviors among preschoolers during the COVID-19 pandemic.

INTRODUCTION: Little is known about the association between parents' and children's 24-h movement behaviors during the pandemic. This cross-sectional study examined the association between the 24-h movement behaviors of parents and their preschoolers and investigated sex differences in this association. METHODS: A total of 1740 preschoolers (4.5 ± 0.8 years old, 50.3% boys) and their parents (35.4 ± 4.9 years old, 24.3% males) in China participated in this study and provided valid and complete data. Parents completed an online survey or a written questionnaire in the period between October and December 2020. Preschoolers' and parents' movement behaviors (physical activity [PA], sedentary behavior [SB], screen time, and sleep) and demographic information were reported by the parents. Generalized linear models and logistic regression models were performed. RESULTS: Positive associations were found between parents' and preschoolers' moderate-to-vigorous intensity PA (ß = 0.28; 95% confidence interval [CI]: 0.20, 0.36), total PA (ß = 0.21; 95% CI: 0.17, 0.24), and sleep (ß = 0.05; 95% CI: 0.03, 0.06) with no apparent sex difference. No significant association was found between parents' and preschoolers' SB or screen time. Girls were more likely to meet all three 24-h movement guidelines when their parents met them (odds ratio = 2.38; 95% CI: 1.42, 4.01), but the relationship was not significant for boys. CONCLUSIONS: Parental role-modeling was positively associated with children's PA and sleep. This finding suggests that supporting parents' movement behaviors has the potential to promote a healthy lifestyle among preschoolers.

A qualitative study of career decision making among African and Asian international medical students in China: process, challenges, and strategies.

China hosts around 68,000 international medical students (IMSs) primarily from lower income countries in Africa and Asia, who have the potential to contribute to international medical services. Understanding how these IMSs make career decisions can help better address the issue of global medical workforce shortage. However, such research is limited. Our study aims to explore the career decision-making process of China-educated IMSs, the challenges they experienced and the strategies they employed.In this exploratory qualitative study, we conducted semi-structured interviews with IMSs educated in China in 2022 using purposeful sampling. Twenty virtual one-on-one interviews were conducted, and data were analysed through directed qualitative content analysis. Cognitive Information Processing (CIP) theory was applied as the guiding framework for organising and analysing the data.The career decision-making process of the participants generally followed the stages of decision-making cycle in CIP theory, with a combination of urgent migration decisions and specialisation considerations adding layers of complexity to their career trajectories. Identified challenges encompassed lack of knowledge about oneself and career options, lack of decision-making skills, concerns of contextual complexities that limited the career decision-making process, low motivation and negative thoughts. Specific challenges due to their role as IMSs arose, which were related to career information access, self-capability evaluation, degree accreditation, employment competitiveness and mental states. Participants' proposed strategies were categorised into personal and institutional aspects, providing insights into addressing these challenges.This study substantiates and expands the application of the CIP theory within the sphere of the particular cultural and educational context of IMSs educated in China. It highlights the significance of integrating migration decision-making into career guidance for IMSs, and contributes to the literature by proposing an evidence-based tiered career intervention programme for IMSs.

Physical activity, screen time and dietary behaviours in New Zealand adolescents prior to and following the onset of the COVID-19 pandemic.

BACKGROUND: Insufficient physical activity, high screen time, and unhealthy dietary patterns among adolescents may have worsened during the pandemic, but data are lacking. This study compared physical activity, screen time and fruit and vegetable intake in adolescents from Dunedin, New Zealand, 5-6 years before (Study 1) and during (Study 2) the COVID-19 pandemic. METHODS: Adolescents completed an online survey as part of the Built Environment and Active Transport to School (BEATS) studies in 2014/2015 (Study 1; n = 1,266; age: 15.3 ± 1.4 years; 54.6% female) and 2021/2022 (Study 2; n = 819; age: 15.2 ± 1.4 years; 47.4% female). The proportion of adolescents meeting guidelines for physical activity (≥ 60 min/day of moderate-to-vigorous physical activity), outside school screen time (≤ 2 h/day) and fruit and vegetable intake (> 1 serving/day for both fruit and vegetables) was calculated. Data were analysed using multivariable linear and logistic regression modelling. RESULTS: Few adolescents met recommended health behaviour guidelines. Compared to Study 1, significantly greater proportions of adolescents at Study 2 met guidelines for physical activity (16.7% vs. 23.1%; p < 0.001) and outside school screen time (13.3% vs. 18.3%; p < 0.001) while fruit and vegetable intake was not different (29.6% vs. 27.0%; p = 0.322). Compared to Study 1, average outside school screen time at Study 2 was lower on both weekdays (5.0 ± 2.9 vs. 4.6 ± 2.9; p < 0.001) and weekend days (6.9 ± 3.5 vs. 6.1 ± 3.6 h/day; p < 0.001). Reported frequency of consuming sweets was higher and soft drinks lower at Study 2 versus Study 1. CONCLUSIONS: Despite observed higher levels of physical activity and lower levels of outside school screen time during the pandemic compared to the pre-pandemic levels, few adolescents met health behaviour guidelines at both time points. Therefore, comprehensive health promotion that aims to improve physical activity levels, screen time and dietary patterns for adolescents is still necessary to prevent chronic health conditions adulthood.

Intense and problematic social media use and sleep difficulties of adolescents in 40 countries.

INTRODUCTION: Social media has become a ubiquitous part of everyday life; however, evidence suggests patterns of social media use can affect sleep health in children and adolescents. This study aimed to examine the associations of intense and problematic social media use (SMU) with sleep-onset difficulties in adolescence. METHODS: We analysed data from 212,613 adolescents aged 11-15 years (51.1% girls) from 40 European and North American countries that participated in the 2017/2018 Health Behaviour in School-aged Children survey. Intense SMU assessed how often respondents had online contact through social media, and problematic SMU was assessed by symptoms of addiction to social media. Sleep-onset difficulties were assessed using a self-reported item. Multilevel mixed-effects logistic regression was used to obtain the estimates. RESULTS: Sleep-onset difficulties were more common among girls than boys (27.1% vs 20.8%). Intense SMU was significantly associated with sleep-onset difficulties in boys in 17 countries and in girls in 25 countries, while problematic SMU was significantly associated in most of the participating countries. Overall, exposure to problematic SMU alone was highly associated with sleep-onset difficulties both in girls (OR 2.20, 2.04-2.38) and boys (OR 1.88, 1.73-2.04), while the association estimates for intense SMU were smaller and comparable across gender (Girls: OR 1.27, 1.23-1.31; Boys: OR 1.22, 1.18-1.27). Sensitivity analyses supported the above findings. CONCLUSIONS: Intense and/or problematic SMU were associated with sleep-onset difficulties across gender with associations being higher for problematic compared to intense SMU. Prospective research with objective measures is needed to understand the causal mechanisms underlying these relationships.

Physical activity and sedentary behaviour among south Asian immigrants in Australia.

ISSUE ADDRESSED: South Asians make up the second-largest group of immigrants in Australia and experience a higher burden of chronic diseases compared with non-immigrants. Most chronic diseases are associated with insufficient physical activity (PA) and sedentary behaviour (SB); however, studies involving PA and SB in immigrants are limited. This study aimed to explore PA and SB and associated factors among South Asian immigrants in Australia. METHODS: South Asian adult immigrants in Australia were surveyed online (from November 2020 to March 2021) about PA, SB, knowledge and barriers to PA. Logistic regressions were used to examine factors associated with insufficient PA (<150 minutes/week) and a high sitting time (>8 hours/day). RESULTS: A total of 321 participants provided complete data. Approximately 76% of participants reported insufficient PA and 27% reported high sitting time. Only 6% of participants walked or bicycled. The main reported barriers to PA were lack of time, costs, transport facilities, skills, and culturally appropriate resources. Around 52% of participants were not aware of the importance of PA. Participants with self-reported poor health and who used motorized travel were more likely to have inadequate PA. High sitting time was more common among middle-aged, overweight/obese, and middle-income participants. CONCLUSIONS: Most South Asian immigrants are insufficiently active with a lack of socio-economically appropriate PA facilities identified as a major challenge. A stronger collaboration between policymakers and community is required for sustainable solutions. SO WHAT?: Affordable and appropriate PA facilities in neighbourhoods could overcome major barriers. Also, information about PA should incorporate cultural expectations in the general recommendations to encourage participation.

Integration of Mendelian randomisation and systems biology models to identify novel blood-based biomarkers for stroke.

Stroke is the second largest cause of mortality in the world. Genome-wide association studies (GWAS) have identified some genetic variants associated with stroke risk, but their putative functional causal genes are unknown. Hence, we aimed to identify putative functional causal gene biomarkers of stroke risk. We used a summary-based Mendelian randomisation (SMR) approach to identify the pleiotropic associations of genetically regulated traits (i.e., gene expression and DNA methylation) with stroke risk. Using SMR approach, we integrated cis-expression quantitative loci (cis-eQTLs) and cis-methylation quantitative loci (cis-mQTLs) data with GWAS summary statistics of stroke. We also utilised heterogeneity in dependent instruments (HEIDI) test to distinguish pleiotropy from linkage from the observed associations identified through SMR analysis. Our integrative SMR analyses and HEIDI test revealed 45 candidate biomarker genes (FDR < 0.05; PHEIDI > 0.01) that were pleiotropically or potentially causally associated with stroke risk. Of those candidate biomarker genes, 10 genes (HTRA1, PMF1, FBN2, C9orf84, COL4A1, BAG4, NEK6, SH2B3, SH3PXD2A, ACAD10) were differentially expressed in genome-wide blood transcriptomics data from stroke and healthy individuals (FDR < 0.05). Functional enrichment analysis of the identified candidate biomarker genes revealed gene ontologies and pathways involved in stroke, including "cell aging", "metal ion binding" and "oxidative damage". Based on the evidence of genetically regulated expression of genes through SMR and directly measured expression of genes in blood, our integrative analysis suggests ten genes as blood biomarkers of stroke risk. Furthermore, our study provides a better understanding of the influence of DNA methylation on the expression of genes linked to stroke risk.

Efficacy of a school-based education intervention on the consumption of fruits, vegetables and carbonated soft drinks among adolescents.

OBJECTIVES: To evaluate the efficacy of a school-based education intervention on the consumption of fruit, vegetables and carbonated soft drinks among adolescents. DESIGN: Cluster-randomised controlled trial. SETTING: Eight secondary schools from Dhaka, Bangladesh, participated in this trial and were randomly allocated to intervention (n 160) and control groups (n 160). PARTICIPANTS: A total of 320 students from 8th to 9th grades participated and completed the self-reported questionnaires at baseline, and at 8 and 12 weeks. The intervention included weekly classroom-based nutrition education sessions for students and healthy eating materials for students and parents. Repeated measures ANCOVA was used to assess the effects of the intervention. RESULTS: Daily fresh fruit intake was more frequent in the intervention (26 %) compared to the control group (3 %) at 12 weeks (p = 0·006). Participants from the intervention group also reported a significantly (P < 0·001) higher (49 %) proportion of fresh vegetable intake compared to the control group (2 %) at 12 weeks. Frequency of daily carbonated soft drinks intake decreased (25 %) in the intervention group at 12 weeks compared to baseline, while it remained unchanged in the control group; the interaction effect was observed significant (P = 0·002). CONCLUSION: Our school-based education intervention increased the daily frequency of fresh vegetables and fruit intake and decreased carbonated soft drink consumption among adolescents in the intervention group. There is a need for scaling up the intervention to engage students and empower them to develop healthy dietary habits.

Different types of screen time are associated with low life satisfaction in adolescents across 37 European and North American countries.

AIMS: Prolonged screen time (ST) is a potential concern for poor wellbeing. This study aimed to examine the associations of different types of ST with life satisfaction among adolescents. METHODS: Data were from 380,446 adolescents (aged 11-15 years, 51% girls) across 37 European and North American countries who completed the 2010 and 2014 Health Behaviour in School-Aged Children surveys. Participants reported h/day during free time spent on television, electronic games, and computer/other devices. Life satisfaction was assessed using a 10-point scale (low life satisfaction ⩽5). RESULTS: Generalized additive modelling showed non-linear associations for each ST type, with low life satisfaction increasing monotonically for >1 h/day of electronic gaming or computer/other device and >2 h/day of watching television. Multilevel multivariable modelling showed that >4 h/day of watching television was associated with 26% higher odds for boys (OR 1.26; 95% CI:1.21-1.32) and 52% higher odds for girls (1.52; 1.46-1.59) of low life satisfaction than for ⩽1 h/day of television. Electronic gaming >4 h/day was associated with low life satisfaction with odds 42% higher in boys (1.42, 1.36-1.48) and 69% higher in girls (1.69, 1.61-1.76). A similar association was found for >4 h/day of computer/other device for boys (1.43, 1.37-1.49) and girls (1.71, 1.65-1.77). CONCLUSIONS: Low levels of ST may be beneficial; however, prolonged periods are associated with low life satisfaction among adolescents, in particular among girls. Results support ⩽2 h/day restriction of ST and highlight research is needed to understand underlying mechanisms of ST and wellbeing, which may not reflect active versus passive content.

The prevalence of chronic diseases in international immigrants: a systematic review and meta-analysis.

AIMS: The purpose of this study is systematically to review and synthesise available prevalence data of major chronic diseases in international immigrants. METHODS: Four electronic databases were searched to retrieve peer-reviewed original articles published in English between January 2000 and December 2020. Cross-sectional, cohort, or longitudinal studies that reported the prevalence of cardiovascular disease, any type of cancer, chronic obstructive pulmonary disease, and type 2 diabetes among immigrant adults were included. We calculated pooled prevalence using random-effects meta-analyses. RESULTS: Of 13,363 articles retrieved, 24 met the eligibility criteria. The pooled prevalence of diabetes was 9.0% (95% confidence interval (CI) 7.6-10.4) with a higher prevalence in North American countries 11.1% (95% CI 8.0-14.1) than in the other destination countries: 6.6% (95% CI 5.1-8.1) including Italy, Sweden, The Netherlands, Australia, and Israel. The pooled prevalence of cardiovascular diseases and respiratory diseases was 7.7% (95% CI 5.7-9.6) and 6.5% (95% CI 2.3-10.7), respectively. Only two articles reported the prevalence of cancers (2.7% and 3.8%). We found high heterogeneity among all studies regardless of the disease. CONCLUSIONS: The prevalence of diabetes was higher than other chronic diseases in international immigrants. There is a strong need to enhance health information systems to understand the magnitude of chronic diseases among different immigrant subgroups.

Bullying Experiences of South Asian Immigrants in Australia: a Mixed-Method Study.

Bullying is a pervasive problem faced by immigrants that negatively impacts their health and well-being. Understanding the factors that contribute to bullying and the prevalence of bullying victimisation may help to develop strategies to prevent bullying. Using a mixed-method approach, this study explored the perceptions and prevalence of bullying of South Asian immigrants living in Australia. Five focus group discussions (FGDs) were conducted to explore bullying experiences and to inform an online survey. The online survey included the California Bullying Victimisation Scale-Retrospective (CBVS-R) to measure prevalence, types, and places of bullying victimisation. Data collected from FGDs were thematically analysed while survey data were examined to identify factors associated with bullying. The main contributing factors reported by participants during FGDs were ethnic attire (clothing), religion, accent, workplace achievement, skin colour, and body shape. The online survey collected responses from 313 participants that included females (44%) and males (56%) with a mean age of 41.0 (SD ± 10.3) years. Almost 31% of participants surveyed experienced multiple bullying incidents per month with no differences observed between gender (32% in males, 31% in females). Males were mostly bullied (63%) in their workplaces while females were mostly bullied (56%) at bus or train stations. Country of birth, employment status, educational qualification, and English proficiency significantly associated with bullying experience (p < 0.001). These findings show that bullying affects male and female immigrants in different forms and settings; therefore, a large national assessment is needed to evaluate the magnitude of bullying and its consequences on immigrant health and well-being.

Excessive Smartphone Use is Associated with Depression, Anxiety, Stress, and Sleep Quality of Australian Adults.

Problematic smartphone use has been associated with poorer mental health in different population groups; however, little is known about how levels of smartphone use were associated with mental health outcomes of adults in Australia. Using data from a cross-sectional survey among Australian adults aged 18-59 years (n = 655, Mean = 24.55 [SD = 5.59] years; 66% female), the current study aimed to examine association between problematic smartphone use and different psychological outcomes. Participants completed measures of problematic smartphone use with Mobile Phone Problem Use Scale (MPPUS), mental health outcomes with Depression, Anxiety, and Stress Scale (DASS-21), and Pittsburgh Sleep Quality Index (PSQI), in addition to some socio-demographics. Smartphone use was categorised into three groups: low-moderate, moderate-high, and high-severe. A total of 160 adults (24.4%) reported high-severe smartphone use. Multivariable linear regression analyses showed that smartphone use was inversely associated with psychological outcomes in a dose-dependent manner with high-severe smartphone uses having the most adverse effects. Compared to low-moderate use, average depression score was 3.5 points higher for moderate-high smartphone use (ß = 3.51, 95% CI: 1.63-5.40) and 6.9 points higher for high-severe smartphone use (ß = 6.91, 95% CI: 4.74-9.07). Similarly, average stress score was 3.4 points higher for moderate-high smartphone use (ß = 3.40, 95% CI: 1.75-5.06) and 7.0 points higher for high-severe smartphone use (ß = 7.02, 95% CI: 5.11-8.93). Similar association estimates were found for anxiety and sleep quality. Reducing smartphone use has the potential to optimise depression, anxiety, stress, and sleep quality; however, longitudinal research is warranted to establish directionality of the association.

Report card grades on physical activity for children and adolescents from 18 Asian countries: Patterns, trends, gaps, and future recommendations.

Background: Physical inactivity is a persistent and worsening population health concern in Asia. Led by the Active Healthy Kids Global Alliance, Global Matrix (GM) initiative provides an opportunity to explore how regional and cultural differences across 18 Asian countries relate to physical activity (PA) participation among children and adolescents. Objectives: To synthesize evidence from the GM2.0 to GM4.0 (2016-2022) in Asian countries. Methods: Report Card grades on behavioral/individual and sources of influence indicators were reported from 18 Asian countries. Letter grades were converted into numerical values for quantitative analyses. Based on this, cross-sectional and longitudinal analyses were conducted to investigate patterns and trends. Qualitative evidence synthesis was performed based on Report Card grades and published papers to identify gaps and suggest future recommendations. Results: In total, 18 countries provided grades for at least one round of GM, 12 countries provided grades for at least two rounds, and seven countries provided grades for all three GMs. Of possible grades, 72.8%, 69.2%, and 76.9% of the grades were assigned from GM 2.0 to GM 4.0, respectively. In terms of the Report Card grades, there was a slight decrease in behavioral/individual indicators from "D+" in GM 2.0 to "D-" in GM 3.0 but this reverted to "D" in GM 4.0. For the sources of influence, a "C" grade was given in all three rounds of GM. Longitudinal observation of seven Asian countries that provided grades in all three rounds of GM revealed that grades are generally stable for all indicators with some country-specific fluctuations. In future GM initiatives and research, considerations should be made to provide more accurate and rich data and to better understand contextual challenges in evaluating certain indicators such as Active Transportation, Active Play, and Physical Fitness in particular. Further, macro level factors such as socioeconomic/cultural disparities and gender-specific barriers, ideology, or climate change should also be proactively considered in future research as these factors are becoming increasingly relevant to indicators of GM and United Nation's Sustainable Development Goals. Conclusions: Participation from Asian countries in GM has increased over the years, which demonstrates the region's enthusiasm, capacity, and support for global PA promotion efforts. The efforts to promote a physically active lifestyle among children and adolescents should be a collective interest and priority of the Asia region based on the gaps identified in this paper.

Adolescent screen time: associations with school stress and school satisfaction across 38 countries.

This study examined associations of watching television, electronic games, computer uses with school stress, and satisfaction among adolescents. Nationally representative data from 38 European and North American countries that participated in the 2014 Health Behaviour in School-aged Children (HBSC) survey were analysed. School stress and school satisfaction were each assessed using a 4-point self-reported item and then dichotomised. Participants reported discretional time spent on different screen-based activities. Of the 191,786 participants (age 13.6 [1.6] years; 51% girls), 35% reported high levels of school stress, while 30% reported high satisfaction with their school. Multilevel multivariable logistic regression modelling showed that adolescents reporting watching television > 4 h/day (≤ 1 h/day as reference) had 31% higher odds of school stress (OR 1.31; 95% CI: 1.27-1.35) and 36% less odds of school satisfaction (OR 0.64; 95% CI: 0.62-0.67). Prolonged electronic gaming (> 4 h/day) increased the odds of school stress by 26% (OR 1.26; 95% CI: 1.22-1.30) and decreased the odds of school satisfaction by 37% (OR 0.63; 95% CI: 0.61-0.65). Adolescents with prolonged computer use had 46% higher odds of school stress (OR 1.46; 95% CI: 1.42-1.50) and 39% lower odds of school satisfaction (OR 0.61; 95% CI: 0.59-0.63). Association estimates were more evident among younger adolescents than their older counterparts with no apparent gender differences. CONCLUSION: Prolonged screen use, irrespective of type, was positively associated with school stress and inversely associated with school satisfaction with high computer use showing the highest adverse associations. Prospective research is needed to understand directionality and mechanisms of these relationships. WHAT IS KNOWN: • Screen-based activities are adversely associated with various health and wellbeing indicators in adolescents.. • The relation between screen time and school-related outcomes is yet to understand fully. WHAT IS NEW: • Prolonged screen time is associated with increased school stress and decreased school satisfaction in adolescents. • Computer use showed higher adverse associations than watching television or playing electronic games.

The burden of chronic diseases and patients' preference for healthcare services among adult patients suffering from chronic diseases in Bangladesh.

BACKGROUND: Low- and middle-income countries (LMICs) have a disproportionately high burden of chronic diseases, with inequalities in health care access and quality services. This study aimed to assess patients' preferences for healthcare services for chronic disease management among adult patients in Bangladesh. METHODS: The present analysis was conducted among 10,385 patients suffering from chronic diseases, drawn from the latest Household Income and Expenditure Survey 2016-2017. We used the multinomial logistic regression to investigate the association of chronic comorbid conditions and healthcare service-related factors with patients' preferences for healthcare services. RESULTS: The top four dimensions of patient preference for healthcare services in order of magnitude were quality of treatment (30.3%), short distance to health facility (27.6%), affordability of health care (21.7%) and availability of doctors (11.0%). Patients with heart disease had a 29% significantly lower preference for healthcare affordability than the quality of healthcare services (relative risk ratio [RRR] = 0.71; 0.56-0.90). Patients who received healthcare services from pharmacies or dispensaries were more likely to prefer a short distance to a health facility (RRR = 6.99; 4.80-9.86) or affordability of healthcare services (RRR = 3.13; 2.25-4.36). Patients with comorbid conditions were more likely to prefer healthcare affordability (RRR = 1.39; 1.15-1.68). In addition, patients who received health care from a public facility had 2.93 times higher preference for the availability of medical doctors (RRR = 2.93; 1.70-5.04) than the quality of treatment in the health facility, when compared with private service providers. CONCLUSIONS: Patient preferences for healthcare services in chronic disease management were significantly associated with the type of disease and its magnitude and characteristics of healthcare providers. Therefore, to enhance service provision and equitable distribution and uptake of health services, policymakers and public health practitioners should consider patient preferences in designing national strategic frameworks for chronic disease management. PATIENT OR PUBLIC CONTRIBUTION: Our research team includes four researchers (co-authors) with chronic diseases who have experience of living or working with people suffering from chronic conditions or diseases.

The Contribution of Onsite Physiotherapy to an Integrated Model for Managing Work Injuries: A Follow Up Study.

Purpose As part of an integrated system to manage work injuries, some organisations utilise the skills of an onsite physiotherapist. Onsite physiotherapy can provide benefits for the workers and organisation when delivered as part of an early intervention injury prevention program (IPP) at a poultry meat processing plant. However, once established, the sustainability of this service on work injury and compensation outcomes without ongoing physiotherapy contribution is unknown. Methods Through analysis of two large secondary datasets of workplace injuries and compensation claims, outcome measures of injury rates, cost per workers' compensation claim and duration of work absence were compared over a 36-month period where onsite physiotherapy contributed to the IPP and was later removed. Results 3951 injuries and their 781 resultant compensation claims were analysed within a 36-month analysis period. A small but non-significant rise in injury rates and duration of work absence was associated with the removal of onsite physiotherapy. There was also a shift towards more compensations claims with work absence after physiotherapy was removed. However, there was a significant reduction in adjusted mean costs per claim of $847 for all injury types (p < 0.001) and $930 for musculoskeletal disorders (p < 0.001) after the removal of onsite physiotherapy. Conclusions Once an IPP was embedded within an organisation, onsite physiotherapy services were able to be discharged without significantly and negatively impacting demonstrated benefits and injury outcomes. There was also cost savings to the insurer through reduced mean claim costs and to the employer by not funding the onsite physiotherapy service.

Clustering of lifestyle risk factors for non-communicable diseases in 304,779 adolescents from 89 countries: A global perspective.

The precursors of non-communicable diseases (NCDs) are often manifested during childhood and adolescence with little knowledge about co-occurrence of their related lifestyle risk factors. To address this deficit, we estimated the prevalence and clustering of six major NCD-risk factors in adolescents around the world. Data from the Global School-based Student Health Survey, collected between 2007 and 2016, were analysed in 304,779 adolescents aged 11-17 years (52.2% females) from 89 countries. We compared the observed (O) to expected (E) prevalence ratios of 64 possible combinations of six risk factors to determine their clustering patterns. Overall, 82.4% (95% CI 82.1-82.7) of adolescents had ≥2 risk factors, while 34.9% (34.6-35.3) had ≥3. Adolescents aged 16-17 years, compared to those aged 11-13 years, had higher odds (OR 1.33; 95% CI 1.31-1.36) of reporting ≥3 risk factors. Risk factors clustered in multiple combinations and differed by sex. The clustering of physical inactivity and low fruit and vegetable intake was evident in both males (O/E 1.10; 95% CI 1.07-1.12) and females (1.08; 1.06-1.10). The co-occurrence of cigarette smoking, alcohol drinking, physical inactivity, and low fruit and vegetable intake was 165% greater in females (2.65; 2.28-3.07) and 110% greater in males (2.10; 1.90-2.32) than expected. Globally, adolescents exhibit multiple modifiable risk factors for future development of NCDs. Early gender-specific prevention strategies targeting clusters of lifestyle risk factors should be prioritised to help mitigate future burden of NCDs globally. Periodical collection of behavioural risk factor data should be encouraged to facilitate a sustainable global surveillance.

Low physical activity and high sedentary behaviour are associated with adolescents' suicidal vulnerability: Evidence from 52 low- and middle-income countries.

AIM: To examine the relationships of physical activity (PA) and sedentary behaviour (SB) with suicidal thoughts and behaviour among adolescents in low- and middle-income countries (LMICs). METHODS: Global School-based Student Health Survey data from 206 357 students (14.6 ± 1.18 years; 51% female) in 52 LMICs were used. Students reported on suicidal ideation, suicide planning, suicide attempts, PA, leisure-time SB and socio-demographic characteristics. Multilevel mixed-effects generalised linear modelling was used to examine the associations. RESULTS: High leisure-time SB (≥3 hours/day) was independently associated with higher odds of suicidal ideation, suicide planning and suicide attempts for both male and female adolescents. Insufficient PA (<60 mins/day) was not associated with higher odds of ideation for either sex; however, it was associated with planning and attempts for male adolescents. The combination of insufficient PA and high SB, compared with sufficient PA and low SB, was associated with higher odds of suicidal ideation and suicide planning for both male and female adolescents, and suicide attempts for male adolescents. CONCLUSION: High SB may be an indicator of suicidal vulnerability among adolescents in LMICs. Low PA may be a more important risk for suicidal thoughts and behaviours among male, than female, adolescents. Promoting active lifestyle should be integrated into suicide prevention programmes in resource-poor settings.

Prevalence and correlates of depressive symptoms in secondary school children in Dhaka city, Bangladesh.

Objectives: Depression is a leading contributor to the global burden of disease, and often starts at a young age. Depression in young people can increase the risk of unhealthy lifestyle behaviour and can lead to substantial disability, social problems, poor health, and suicide. Other research has examined depressive symptoms among adult populations in Bangladesh, but little is known about other age groups. The aim of this study was to assess the prevalence and socio-demographic correlates of depressive symptoms among secondary school children of Dhaka city, Bangladesh.Design: A self-completed questionnaire was administered to 898 students from eight secondary schools of Dhaka, the capital City of Bangladesh. Of the respondents, 755 (372 males, 383 females; average age 14.26 years; SD 1.15) completed the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). A score of 10 or more was used to indicate depressive symptoms. Parents completed a separate questionnaire to provide individual and household/family-level data. Generalized Estimating Equations (GEE) was used to assess sociodemographic and lifestyle factors associated with adolescent depressive symptoms.Results: Among the responding adolescents, 25% reported depressive symptoms with prevalence more common among females than males (30% vs. 19%). Factors significantly associated with symptoms of depression included being female, aged 15-16 years, self-perception of non-normal weight, feeling unsafe at school, sleep disturbance, low life satisfaction, high intake of sugary drinks, and regularly skipping breakfast.Conclusion: Depressive symptoms are prevalent among secondary school children in urban Bangladesh. Interventions for adolescents with depressive symptoms could focus on lifestyle practices such as weight management, personal safety, sleep hygiene and healthy eating.

A multisite longitudinal evaluation of patient characteristics associated with a poor response to non-surgical multidisciplinary management of low back pain in an advanced practice physiotherapist-led tertiary service.

BACKGROUND: Non-surgical multidisciplinary management is often the first pathway of care for patients with chronic low back pain (LBP). This study explores if patient characteristics recorded at the initial service examination have an association with a poor response to this pathway of care in an advanced practice physiotherapist-led tertiary service. METHODS: Two hundred and forty nine patients undergoing non-surgical multidisciplinary management for their LBP across 8 tertiary public hospitals in Queensland, Australia participated in this prospective longitudinal study. Generalised linear models (logistic family) examined the relationship between patient characteristics and a poor response at 6 months follow-up using a Global Rating of Change measure. RESULTS: Overall 79 of the 178 (44%) patients completing the Global Rating of Change measure (28.5% loss to follow-up) reported a poor outcome. Patient characteristics retained in the final model associated with a poor response included lower Formal Education Level (ie did not complete school) (Odds Ratio (OR (95% confidence interval)) (2.67 (1.17-6.09), p = 0.02) and higher self-reported back disability (measured with the Oswestry Disability Index) (OR 1.33 (1.01-1.77) per 10/100 point score increase, p = 0.046). CONCLUSIONS: A low level of formal education and high level of self-reported back disability may be associated with a poor response to non-surgical multidisciplinary management of LBP in tertiary care. Patients with these characteristics may need greater assistance with regard to their comprehension of health information, and judicious monitoring of their response to facilitate timely alternative care if no benefits are attained.

Combined Effects of Physical Inactivity and Sedentary Behaviour on Psychological Distress Among University-Based Young Adults: a One-Year Prospective Study.

Insufficient physical activity (PA) and prolonged sedentary behaviour (SB) may have deleterious psychological health consequences. Using one-year prospective data, this study examined the combined effects of PA and SB on psychological distress among university-based young adults in Dhaka, Bangladesh. During Wave 1 (September-December 2015), total 573 undergraduate students (mean age: 20.7 ± 1.35 years; 45% females) completed a self-administered survey on PA, SB, psychological distress, health and lifestyle factors and sociodemographics. During Wave 2 (October-November 2016), 395 students (retention rate = 69%) completed a sub-set of Wave 2 survey with items on PA, SB and psychological distress. PA and SB were assessed using the Global Physical Activity Questionnaire and distress with the Kessler 6 Psychological Distress scale. Generalized Estimating Equations with Gaussian family and identity link under exchangeable correlation structure was used to examine the relationships. Multivariable modeling showed that participants with insufficient PA (<150 min/week) and high SB (≥480 min/day) or insufficient PA + low SB had more distress [ß: 3.07 (95% CI: 2.12-4.01) and 2.77 (1.86-3.67), respectively] than those who had sufficient PA + low SB, after controlling for gender, sleep difficulties, perceived health, fast food and fresh fruit intake. There was no statistically significant difference for the level of distress between other PA and SB groups. In this one-year prospective study, irrespective of SB, insufficient PA was associated with high psychological distress in university-based young adults in Bangladesh. The protective role of PA should be considered in intervention programs to improve psychological health of young adults.