The purpose of this study was to assess the prevalence of psychological distress in employees in the metalliferous mining industry in Australia, and to examine associated demographic, health, and ...workplace characteristics. A cross sectional survey was conducted among 1,799 participants from four metalliferous mines. Psychological distress was measured by the Kessler Psychological Distress Scale (K10), alongside other measures of personal demographics, health history, health behaviour, and workplace characteristics. Univariate and multivariate statistical methods were used to examine associations between psychological distress and personal and workplace characteristics. Levels of moderate to very high psychological distress were significantly higher in this sample (44.4%) compared to the general population (27.2%). Moderate to very high psychological distress was significantly associated with younger age; individual health factors (a prior history of depression, anxiety, or drug/alcohol problems); health behaviours (using illicit drugs in the last month); and a range of workplace factors (concern about losing their job; lower satisfaction with work; working shifts of over 12 hours duration; working in mining for financial reasons and social factors (poorer social networks). The identification of a number of social, personal and workplace factors associated with high psychological distress present useful targets to inform the development of tailored workplace interventions to reduce distress in metalliferous mine employees.
Smoking tobacco, poor nutrition, risky alcohol use, and physical inactivity (SNAP) behaviors tend to cluster together. Health benefits may be maximized if interventions targeted multiple health risk ...behaviors together rather than addressing single behaviors. The internet has wide reach and is a sustainable mode for delivery of interventions for multiple health behaviors. However, no systematic reviews have examined the long-term effectiveness of internet-based interventions on any combination of or all SNAP behaviors in adults aged 18 years or older.
This systematic review examined, among adults (aged ≥18 years), the effectiveness of internet-based interventions on SNAP behaviors collectively in the long term compared with a control condition.
The electronic databases Medline, PsycINFO, Embase, CINAHL, and Scopus were searched to retrieve studies describing the effectiveness of internet-based interventions on ≥2 SNAP behaviors published by November 18, 2019. The reference lists of retrieved articles were also checked to identify eligible publications. The inclusion criteria were randomized controlled trials or cluster randomized controlled trials with adults examining an internet-based intervention measuring the effect on ≥2 SNAP behaviors at least 6 months postrecruitment and published in English in a peer-reviewed journal. Two reviewers independently extracted data from included studies and assessed methodological quality using the Quality Assessment Tool for Quantitative Studies. A robust variance estimation meta-analysis was performed to examine the long-term effectiveness of internet-based interventions on all 4 SNAP risk behavior outcomes. All SNAP outcomes were coded so they were in the same direction, with higher scores equating to worse health risk behaviors.
The inclusion criteria were met by 11 studies: 7 studies measured the effect of an internet-based intervention on nutrition and physical activity; 1 study measured the effect on smoking, nutrition, and physical activity; and 3 studies measured the effect on all SNAP behaviors. Compared with the control group, internet-based interventions achieved an overall significant improvement across all SNAP behaviors in the long term (standardized mean difference -0.12 improvement as higher scores = worse health risk outcomes, 95% CI -0.19 to -0.05; I
=1.5%, P=.01). The global methodological quality rating was "moderate" for 1 study, while the remaining 10 studies were rated as "weak."
Internet-based interventions were found to produce an overall significant improvement across all SNAP behaviors collectively in the long term. Internet-based interventions targeting multiple SNAP behaviors have the potential to maximize long-term improvements to preventive health outcomes.
Background
Web-based interventions targeting parents with health and parenting support frequently report high rates of attrition. The SMS4dads text messaging program, developed in Australia, has ...delivered texts to over 10,000 fathers. The brief text messages, which are sent 3 times per week from 16 weeks of gestation to 48 weeks after birth, include regular reminders that participants can leave the program by texting back “STOP” to any message. Although acceptance of the program is high, almost 1 in 5 ask it to be removed. Analyzing the factors influencing attrition from digital parenting programs such as SMS4dads may assist in developing more effective interventions.
Objective
This study aimed to examine factors associated with attrition in a text-based intervention targeting fathers.
Methods
Demographic characteristics, requests to complete a psychological scale, individual message content, participant feedback, and automatically collected data registering clicks on links embedded in the texts were examined to identify attrition factors among 3261 participants enrolled in SMS4dads from 4 local health districts in New South Wales, Australia, between September 2020 and December 2021.
Results
Participants who were smokers, recorded risky alcohol consumption, had a lower education level, or signed up prenatally had 30% to 47% higher hazard of dropout from the program, whereas participant age, Aboriginal or Torres Strait Islander status, rurality, and psychological distress score (as Kessler Psychological Distress Scale K10 category) were not associated with dropout. Primary reasons for dropping out reported by 202 of 605 respondents included “other reasons” (83/202, 41.1%), followed by “not helpful” (47/202, 23.3%) and “too busy” (44/202, 21.8%). Program features such as repeated requests to complete a psychological scale (K10) and the content of individual messages were not linked to increased dropout rates. Analysis of a sample (216/2612) of inactive participants who had not engaged (clicked on any embedded links) for at least 10 weeks but who had not opted out identified a further 1.5% of participants who would opt to leave the program if asked.
Conclusions
Identifying which features of the participant population and of the program are linked to dropout rates can provide guidance for improving program adherence. However, with limited information from feedback surveys of those exiting early, knowing which features to target does not, by itself, suggest ways to increase engagement. Planning ahead to include robust measures of attrition, including more detailed feedback from participants, could provide more effective guidance. A novel element in this study was seeking feedback from inactive participants to estimate dropout from this group and thereby provide an overall dropout rate of 20%. The retention rate of 80%, relatively high compared with other web-based parenting programs for fathers, suggests that tailoring the content to specifically address fathers’ role may be an important consideration in reducing fathers’ disengagement.
Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease in which circulatory biomarkers have the potential for guiding management in clinical practice. We assessed the prognostic role of ...serum biomarkers in three independent IPF cohorts: Australian Idiopathic Pulmonary Fibrosis Registry (AIPFR), Trent Lung Fibrosis (TLF) and Prospective Observation of Fibrosis in the Lung Clinical Endpoints (PROFILE).
In the AIPFR cohort, candidate proteins were assessed by ELISA as well as in an unbiased proteomic approach. LASSO (least absolute shrinkage and selection operator) regression was used to restrict the selection of markers that best accounted for the progressor phenotype at 1 year in the AIPFR cohort, and subsequently prospectively selected for replication in the validation TLF cohort and assessed retrospectively in the PROFILE cohort. Four significantly replicating biomarkers were aggregated into a progression index model based on tertiles of circulating concentrations.
189 participants were included in the AIPFR cohort, 205 participants from the TLF cohort and 122 participants from the PROFILE cohort. Differential biomarker expression was observed by ELISA and replicated for osteopontin, matrix metallopeptidase-7, intercellular adhesion molecule-1 and periostin for those with a progressor phenotype at 1 year. Proteomic data did not replicate. The progression index in the AIPFR, TLF and PROFILE cohorts predicted risk of progression, mortality and progression-free survival. A statistical model incorporating the progression index demonstrated the capacity to distinguish disease progression at 12 months, which was increased beyond the clinical GAP (gender, age and physiology) score model alone in all cohorts, and significantly so within the incidence-based TLF and PROFILE cohorts.
A panel of circulatory biomarkers can provide potentially valuable clinical assistance in the prognosis of IPF patients.
The transition to parenthood can be a challenging time, in which both mothers and fathers experience increased risk of distress and depression. Mothers are more likely than fathers to engage with ...services and have their mental health monitored and attended to during the perinatal period. The present study aimed to explore whether smartphone technology could be used to address fathers' needs across their transition to fatherhood.
A corpus of messages, including linked information and mood tracking software, was designed to support and enhance paternal relationships with their babies, their partners and themselves across the perinatal period. Messages were sent to project participants (N = 520) from 12-weeks' gestation to 24-weeks after birth.
Of those fathers enrolled (N = 520), 21.5% scored >13 on K6 and completion rate (85%) was similar between these and other fathers. Most fathers (63.1%) clicked at least one link and responses were received for 20.5% of mood tracker questions. The probability of reporting worse mood scores decreased over time. Fathers completing post study surveys (N = 101) reported that messages helped them in their experience of becoming a new dad (92.8%), as well as helping them develop a strong relationship with their new child (54.9%), and in their relationship with their partner (79%).
The present study has demonstrated that it is both feasible and acceptable to support new fathers with SMS4dads, a relationship-focused messaging system designed to be delivered to smartphones across fathers' transition to parenthood.
Digital health interventions (DHIs) are effective in improving poor nutrition, physical inactivity, overweight and obesity. There is evidence suggesting that the impact of DHIs may be enhanced by ...improving user engagement. However, little is known about the overall effectiveness of strategies on engagement with DHIs.
This study aims to assess the overall effectiveness of strategies to improve engagement with DHIs targeting nutrition, physical activity, and overweight or obesity and explore associations between strategies and engagement outcomes. The secondary aim was to explore the impact of these strategies on health risk outcomes.
The MEDLINE, Embase, PsycINFO, CINAHL, CENTRAL, Scopus, and Academic Source Complete databases were searched up to July 24, 2023. Eligible studies were randomized controlled trials that evaluated strategies to improve engagement with DHIs and reported on outcomes related to DHI engagement (use or user experience). Strategies were classified according to behavior change techniques (BCTs) and design features (eg, supplementary emails). Multiple-variable meta-analyses of the primary outcomes (usage and user experience) were undertaken to assess the overall effectiveness of strategies. Meta-regressions were conducted to assess associations between strategies and use and user experience outcomes. Synthesis of secondary outcomes followed the "Synthesis Without Meta-Analysis" guidelines. The methodological quality and evidence was assessed using the Cochrane risk-of-bias tool, and the Grading of Recommendations Assessment, Development, and Evaluation tool respectively.
Overall, 54 studies (across 62 publications) were included. Pooled analysis found very low-certainty evidence of a small-to-moderate positive effect of the use of strategies to improve DHI use (standardized mean difference=0.33, 95% CI 0.20-0.46; P<.001) and very low-certainty evidence of a small-to-moderate positive effect on user experience (standardized mean difference=0.29, 95% CI 0.07-0.52; P=.01). A significant positive association was found between the BCTs social support (effect size ES=0.40, 95% CI 0.14-0.66; P<.001) and shaping knowledge (ES=0.39, 95% CI 0.03-0.74; P=.03) and DHI use. A significant positive association was found among the BCTs social support (ES=0.70, 95% CI 0.18-1.22; P=.01), repetition and substitution (ES=0.29, 95% CI 0.05-0.53; P=.03), and natural consequences (ES=0.29, 95% CI 0.05-0.53; P=.02); the design features email (ES=0.29, 95% CI 0.05-0.53; P=.02) and SMS text messages (ES=0.34, 95% CI 0.11-0.57; P=.01); and DHI user experience. For secondary outcomes, 47% (7/15) of nutrition-related, 73% (24/33) of physical activity-related, and 41% (14/34) of overweight- and obesity-related outcomes reported an improvement in health outcomes.
Although findings suggest that the use of strategies may improve engagement with DHIs targeting such health outcomes, the true effect is unknown because of the low quality of evidence. Future research exploring whether specific forms of social support, repetition and substitution, natural consequences, emails, and SMS text messages have a greater impact on DHI engagement is warranted.
PROSPERO CRD42018077333; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=77333.
To maximise their potential health benefits, school-based physical activity policies need to be implemented at scale. This paper describes the third in a sequence of trials that sought to optimise an ...effective strategy (PACE) to assist schools' implementation of a physical activity policy. Specifically, it aimed to determine the probability that a multi-strategy intervention adapted to reduce in-person contact (Adapted PACE) was "as good as" the original intervention (PACE) in increasing the weekly minutes of structured physical activity implemented by classroom teachers. A noninferiority cluster randomised controlled trial was undertaken with 48 primary schools in New South Wales, Australia. Schools were randomised to receive PACE or a model with adaptations made to the delivery modes (Adapted PACE). Teachers' scheduled minutes of weekly physical activity was assessed at baseline (Oct 2018-Feb 2019) and 12-month follow-up (Oct-Dec 2019). The noninferiority margin was set at - 16.4 minutes based on previous data and decision panel consensus. A linear mixed model analysed within a Bayesian framework was used to explore noninferiority between the two PACE models. A cost minimisation analysis was conducted from the health service provider perspective, using the Australian dollar (AUD). The posterior estimate for the between group difference at follow-up was - 2.3 minutes (95% credible interval = - 18.02, 14.45 minutes). There was an estimated 96% probability of Adapted PACE being considered noninferior (only 4% of the posterior samples crossed the noninferiority margin of - 16.4 minutes). That is, the minutes of physical activity implemented by teachers at Adapted PACE schools was not meaningfully less than the minutes of physical activity implemented by teachers at PACE schools. The mean total cost was AUD$25,375 (95% uncertainty interval = $21,499, $29,106) for PACE and AUD$16,421 (95% uncertainty interval = $13,974, $19,656) for Adapted PACE; an estimated reduction of AUD$373 (95% uncertainty interval = $173, $560) per school. It is highly probable that Adapted PACE is noninferior to the original model. It is a cost-efficient alternative also likely to be a more suitable approach to supporting large scale implementation of school physical activity policies.
Objectives:
Low education and unhealthy lifestyle factors such as obesity, smoking, and no exercise are modifiable risk factors for disability and premature mortality. We aimed to estimate the ...individual and joint impact of these factors on disability-free life expectancy (DFLE) and total life expectancy (TLE).
Methods:
Data (
n
= 22,304) were from two birth cohorts (1921–26 and 1946–51) of the Australian Longitudinal Study on Women’s Health and linked National Death Index between 1996 and 2016. Discrete-time multi-state Markov models were used to assess the impact on DFLE and TLE.
Results:
Compared to the most favourable combination of education and lifestyle factors, the least favourable combination (low education, obesity, current/past smoker, and no exercise) was associated with a loss of 5.0 years TLE, 95% confidence interval (95%CI): 3.2–6.8 and 6.4 years DFLE (95%CI: 4.8–7.8) at age 70 in the 1921–26 cohort. Corresponding losses in the 1946–51 cohort almost doubled (TLE: 11.0 years and DFLE: 13.0 years).
Conclusion:
Individual or co-ocurrance of lifestyle risk factors were associated with a significant loss of DFLE, with a greater loss in low-educated women and those in the 1946–51 cohort.
Globally, there has been a renewed focus on addressing gestational weight gain (GWG). In Australia, the Department of Health pregnancy care guidelines recommend women be offered routine weighing and ...receive brief nutritional and physical activity support during antenatal care visits. Women gaining weight outside the Institute of Medicine (IOM)'s weight gain reference values are further recommended to be referred to a dietitian. However, professional and organizational barriers, including an absence of weight gain referral pathways and limited workforce resources, exist with the translation and scaling of these recommendations into practice. This study aimed to explore patterns of GWG among a cohort of Australian pregnant women and to determine if pregnancy weight gains of above or below 2 kg or 5 kg in the second and third trimester can be used to predict total GWG outside recommendations. Sensitivity, specificity, negative, and positive likelihood ratios were calculated. The most predictive time point was 24 weeks' gestation using the minimum weight change parameter of +/-2 kg, demonstrating reasonable sensitivity (0.81, 95% CI 0.61-0.83) and specificity (0.72, 95% CI 0.61-0.83), resulting in 55% (
= 72/131) of the cohort qualifying for dietetic referral. Given the current health service constraints, a review of dietetic services within maternity care is warranted.
The need for better end-of-life care for people with dementia has been acknowledged. Existing literature suggests that people dying with dementia have less access to palliative care, yet little is ...known about the care provided to people with dementia at the end of life. This study aimed to establish evidence related to end-of-life care for people dying with dementia in hospital compared to other settings.
A retrospective clinical audit of people who had a diagnosis of dementia and had accessed services within a local health district, who died between 2015 and 2019, was conducted. A total of 705 people were identified, and a subset of 299 people randomly selected for manual audit. Chi-square p-values were used to compare the place of death, and a t-test or non-parametric test was used to assess the significance of the difference, as appropriate. Measures of functional decline within one month of death were assessed using mixed effects logistic regression models.
The characteristics of people differed by place of death, with people who died in hospital more likely to be living at home and to not have a spouse. Less than 1 in 5 people had advance care directives or plans. Many were still being actively treated at the time of death: almost half of people who died in hospital had an investigation in their final 72 hours, less than half of people were coded as receiving palliative care at death, and more than 2 in 3 people did not get access to specialist palliative care. Declining function was associated with the terminal phase.
This study provides novel insights for those providing end-of-life care for people with dementia. Healthcare professionals and policy makers should consider how demographic characteristics relate to the places people with dementia receive end-of-life care. The care provided to people with dementia in the last year of their life highlights the need for more support to prepare advance care documentation and timely consideration for palliative care. Changes in markers of nutritional status and function in people with advanced dementia may help with identification of terminal phases.
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