Pivot to prevent bowel cancer: Reflections on adapting an Aboriginal bowel cancer screening awareness program to a digital call to action-A commentary.

ISSUE ADDRESSED: The Sydney Local Health District (SLHD) Health Promotion Unit was awarded a Cancer Institute NSW grant to raise awareness of bowel cancer and promote the National Bowel Cancer Screening Program (NBCSP) among Aboriginal communities in SLHD. The COVID-19 pandemic thwarted initial plans for face-to-face workshops and plans pivoted to digital products and dissemination of messages on a range of communication platforms. DISCUSSION: The coronavirus (COVID-19) pandemic provided staff with the freedom, flexibility, and ability to be creative in ways not possible prior to the pandemic and ultimately ended up with a superior product with a reach further than anticipated. A more comprehensive suite of digital resources addressing barriers to bowel cancer screening in the Aboriginal community was produced that is able to be used more broadly. These resources have reached a much larger population group through websites, social media, as well as TV and radio advertisements, and have the potential to be used and adapted in other local health districts and states across Australia. CONCLUSION: Adapting an Aboriginal bowel cancer screening awareness program to a digital platform is a promising approach. SO WHAT?: COVID-19 provided an opportunity to create new long-lasting partnerships and to be creative beyond the scope of the original grant. This in turn produced a product with a reach further than anticipated that can also be built on and sustained.

Health promotion programs for middle-aged adults that promote physical activity or healthy eating and involve local governments and health services: A rapid review.

BACKGROUND: Noncommunicable diseases can be prevented or delayed through health promotion programs. Little is known about programs delivered by partnership organisations that address lifestyle behaviours. The study's purpose was to review the literature on physical activity or healthy eating health promotion programs, delivered in partnership by the local government and local health services, to describe characteristics of programs and their impact on physical activity, healthy eating or related health outcomes among middle-aged adults. METHODS: This rapid review was conducted from November 2021 to June 2022, informed by the Cochrane Rapid Reviews Methods guidance for conducting rapid reviews. Articles published in English since 2000 were identified in Medline, Embase, CINAHL, AgeLine and Scopus databases. A narrative synthesis was performed. RESULTS: Ten articles involving 19 802 participants were identified from a total of 4847 articles identified from the search. The primary role of the partnership was providing funds. Other roles were facilitating stakeholder involvement, program development, delivery and recruitment. Positive outcomes were likely if programs were developed by collaborative stakeholder partnerships, informed by previous research or a behaviour change framework. The heterogeneity of study designs and reported outcomes did not permit meta-analysis. CONCLUSION: This review highlights the lack of evidence of local government-health service partnerships delivering physical activity or healthy eating health promotion programs for middle-aged adults. Programs designed collaboratively with an evidence base or a theory base are recommended and can guide future work investigating strategies for partnership development. SO WHAT?: Physical activity or healthy eating health promotion programs need early stakeholder collaborative input designed with a theory/evidence base. This can guide future work for investigating strategies for partnership development.

Effects of telephone support or short message service on body mass index, eating and screen time behaviours of children age 2 years: A 3-arm randomized controlled trial.

BACKGROUND: Few randomized controlled trial (RCT) interventions targeted children's early risk behaviours using telephone or short message service (SMS) support. OBJECTIVE: To evaluate the effectiveness of telephone or SMS early intervention focusing on mothers' behaviours starting from late pregnancy to improve BMI, and eating and screen time behaviours of children aged 2 years in comparison with the control group. METHODS: A 3-arm RCT was conducted in Australia, 2017-2019. Two arms involved the interventions using nurse-led telephone or SMS support, delivered in nine stages from late pregnancy to age 2 years. The third arm was control. The primary outcome was children's objectively measured BMI and BMI z-score at 2 years. Secondary outcomes included child eating and screen time behaviours as reported by parents at 2 years. RESULTS: At 2 years, 797 mother-child dyads (69%) completed the telephone survey with 666 (58%) completing weight and height measurements. The study found no statistically significant difference in BMI between the groups. The mean BMI for telephone support was 16.93 (95% CI: 16.73 to 17.13), for SMS 16.92 (95% CI: 16.73 to 17.11) or for control 16.95 (95% CI: 16.73 to 17.16) with a difference of -0.02 (95% CI: -0.31 to 0.27, p = 0.907) in telephone versus control, and a difference of -0.03 (95% CI: -0.30 to 0.24, p = 0.816) in SMS versus control. Telephone support was associated with higher odds of no bottle at bedtime (adjusted odds ratio [AOR]: 2.99; 95% CI: 2.01 to 4.47), family meals (AOR: 2.05; 95% CI: 1.26 to 3.33), drinking from a cup (AOR: 1.89; 95% CI: 1.24 to 2.88), less screen time (<1 h/day) (AOR: 1.56; 95% CI: 1.10 to 2.23) and not eating dinner in front of the TV (AOR: 1.50; 95% CI: 1.09 to 2.06). SMS support was also associated with higher odds of no bottle at bedtime (AOR 2.30, 95% CI: 1.58 to 3.33) than the control. CONCLUSION: The telephone or SMS support intervention had no significant effects on BMI, but was effective in increasing no bottle use at bedtime. Telephone support showed more effects than SMS on reducing screen time and eating behaviours.

Culturally tailored tobacco control: Aboriginal community perspectives in Sydney, Australia.

INTRODUCTION: A community-based project was developed to support quit attempts and denormalise smoking in Aboriginal communities. This qualitative study evaluates the effectiveness of project strategies, messages and the partnership process, and explores impacts observed by Aboriginal community members, complementing findings from a quantitative evaluation. METHODS: The study comprised five focus groups (40 participants) and 14 in-depth interviews (with 15 community members). Data were analysed thematically by manual and NVivo software methods. RESULTS: Results demonstrate that the project attracted community attention, was well recalled and messages were considered convincing and persuasive. Participants reported being more likely to quit and to discuss smoking with family and friends, and noticed that many people were quitting. Participants observed an increase in asking people not to smoke in the home and fewer people smoking at events, but noted that many smokers struggled to stay quit. The partnership and participation of Aboriginal Health Workers were viewed as crucial. CONCLUSION: The qualitative findings reinforce quantitative evaluation findings suggesting that the project contributed to denormalising smoking and motivating quit attempts. SO WHAT: The evaluation provided insight into how the project changed attitudes and motivated community members to make quit attempts and provided ideas to meet the ongoing challenge.

Effects of Telephone and Short Message Service Support on Infant Feeding Practices, "Tummy Time," and Screen Time at 6 and 12 Months of Child Age: A 3-Group Randomized Clinical Trial.

Importance: There is limited information as to whether telephone or short message service (SMS) support is effective in improving infant feeding practices and tummy time and reducing screen time. Objective: To determine the effectiveness of either nurse-led telephone or SMS support in improving infant feeding practices and tummy time and reducing screen time. Design, Setting, and Participants: This study was part of a 2-year, 3-group parallel, randomized clinical trial conducted from February 23, 2017, to November 30, 2018, among 1155 women in the third trimester of pregnancy in New South Wales, Australia. It reports the main outcomes at 6 and 12 months of child age. All analyses were conducted on an intention-to-treat principle. Interventions: The intervention consisted of staged information booklets mailed to the intervention groups, each followed by either a nurse-led telephone support session or SMS intervention, antenatally and at 1, 3, 5, 7, and 10 months after birth. Main Outcomes and Measures: The primary outcomes were infant feeding practices at both 6 and 12 months and tummy time at 6 months. The secondary outcome was screen time at 12 months. Results: Of 1155 mothers, 947 (82%; mean [SD] age, 32.5 [5.0] years) completed follow-up surveys at 6 months; 920 mothers (80%) completed follow-up surveys at 12 months. Compared with the control group, telephone support led to higher odds of appropriate timing of introducing solid foods (adjusted odds ratio [AOR], 1.68 [95% CI, 1.22-2.32]), cup use (AOR, 1.54 [95% CI, 1.12-2.13]), and early-start tummy time (AOR, 1.63 [95% CI, 1.18-2.25]) at 6 months and higher odds of having no screen time (AOR, 1.80 [95% CI, 1.28-2.53]) and no bottle at bedtime (AOR, 1.73 [95% CI, 1.23-2.42]) at 12 months. Use of SMS also led to higher odds than the control group of having no screen time (AOR, 1.28 [95% CI, 1.08-1.52]) and having no bottle at bedtime (AOR, 1.29 [95% CI, 1.10-1.51]) at 12 months. No significant differences were found in breastfeeding rates between the telephone support, SMS support, and control groups. Conclusions and Relevance: Both the nurse-led telephone support and SMS interventions were effective in reducing screen time and bottle use at bedtime. Telephone support was also effective in promoting the appropriate timing of the introduction of solid foods, early-start tummy time, and cup use. Trial Registration: http://anzctr.org.au Identifier: ACTRN12616001470482.

Evaluating an Aboriginal tobacco social marketing project in Sydney, Australia.

INTRODUCTION: A partnership between three Aboriginal Community Controlled Organisations and a mainstream health service was formed to develop, implement and evaluate a comprehensive and culturally appropriate social marketing project which aimed to encourage smokers to quit smoking. The project also supported quit attempts and promoted denormalisation of smoking. METHODS: The project was evaluated through baseline (n = 427) and follow-up (n = 611) surveys carried out face-to-face with Aboriginal and/or Torres Strait Islander participants 18 years and older recruited through convenience sampling at community events and venues during 2010-2011 and 2015. RESULTS: The proportion of participants who had made one or more quit attempts increased significantly between baseline and follow-up surveys (54%, 101 out of 187; vs 64%, 189 out of 297; P < 0.05). Participants who had intended to quit within 6 months (AOR, 3.29; 95% CI 1.90-5.68; P < 0.01); and participants disagreeing with the statement "I don't mind if people smoke inside my home" (AOR, 1.74; 95% CI 1.06-2.84; P < 0.05) were significantly more likely to have made one or more quit attempts compared to the respective reference groups. CONCLUSION: Study findings demonstrate that the project was associated with increased quit attempts. Intention to quit and attitude were found to be the predictors of making a quit attempt. SO WHAT?: Many studies suggest the need to denormalise smoking; this study demonstrated both change in attitudes and an increase in quit attempts. It is recognised that many quit attempts may be needed for long-term smoking cessation.

Linking two randomised controlled trials for Healthy Beginnings©: optimising early obesity prevention programs for children under 3 years.

BACKGROUND: Beginning in 2017 we have conducted a 3-arm randomised controlled trial (RCT) to determine the effectiveness of an early obesity intervention in the first two years of life using either telephone or Short Message Service (SMS) support for mothers. The trial recruited 1155 mothers from their third trimester of pregnancy. This protocol is for a new trial to build on the existing trial using the mother-child dyads retained at 24 months for recruitment to the new RCT. The aim of this new trial is to test whether use of a combination of telephone and SMS interventions is effective in promoting healthy eating and physical activity, as well as reducing child body mass index (BMI) at 3 years of age. METHODS: We will conduct a parallel RCT with an estimated sample of 750 mother-child dyads retained from the existing trial at 24 months. Mothers who completed the 24 months survey, including a telephone survey and measurement of child's height and weight will be invited to participate in the new trial. Informed consent will be obtained at the 24 months survey. The participating mother-child dyads will then be randomly allocated to the intervention (combined telephone and text messaging intervention) or the control group. The intervention will comprise three staged telephone consultations and text messages after each of the three intervention booklets is mailed to mothers at specific time-points between two and three years of child age. The main trial outcome measures include a) BMI and BMI z-score measured at 36 months, b) diet, physical activity and screen time c) cost-effectiveness, and d) feasibility and acceptability of the intervention. DISCUSSION: This unique opportunity to link two studies will expedite project start up time, utilise existing research infrastructure and systems to run the study, and optimise the use of an already engaged population of study participants. It can address a significant knowledge gap regarding early obesity prevention for children aged 2 to 3 years. The feasibility and effectiveness of the combined telephone and SMS intervention will indicate whether this is a scaleable, broad-reach and low-cost early obesity intervention. TRIAL REGISTRATION: The trial was registered with the Australian Clinical Trial Registry ( ACTRN12618001571268 ) on 20/09/2018.

Twitter tweets and twaddle: twittering at AHPA. National Health Promotion Conference.

UNLABELLED: ISSUE ADDRESSED This paper explored the first-time use of Twitter by the Australian Health Promotion Association (AHPA) at its 2013 National Health Promotion Conference. METHODS: The @AHPA_AU Twitter account and #AHPA2013 hashtag were established and included in the conference program. Attendees were encouraged throughout the conference to use it. A total of 748 tweets were captured under the hashtag #AHPA2013 in chronological order from 16-19 June 2013. Tweets with photos and more than one hashtag were recorded. A thematic analysis of tweets was conducted. RESULTS: Thirteen broad themes were identified, with each of the 748 tweets allocated to one of the themes. Tweets about keynote sessions made up 38% of all tweets, followed by 14% for concurrent sessions. A photo was included in 11% of tweets, and 25% were sent to more than one hashtag. There were 96 tweeters; 75% of them posted five or less tweets and ~9%, including a professional blogger, posted greater than 20 tweets. At the Aboriginal and Torres Strait Islander pre-conference workshop there was a relatively high level of Twitter engagement. CONCLUSION: Twitter could potentially be useful for promoting conference content and activities, but what it adds in value to a health promotion conference cannot be determined by this study. SO WHAT? This paper highlights the engagement of tweeters with conference content and activities and suggests that tweeting benefited from the engagement of a professional health blogger.

Somatostatin receptor expression in thyroid disease.

Somatostatin analogues are commercially available and used for the management of acromegaly and neuroendocrine tumours, but the expression of the receptors as a target in thyroid disease has not been explored. To assess somatostatin (SST) and somatostatin receptor (SSTR1-5) expression in both normal and thyroid disorders, as a potential target for somatostatin analogue therapy, 67 thyroid tissue specimens were reviewed: 12 differentiated thyroid carcinomas, 14 follicular adenomas, 17 multinodular goitres, 14 Graves disease, 10 Hashimotos thyroiditis specimens and five normal thyroids. Tissue was immunostained for SST and SSTR1-5. Positivity and the degree of positivity were recorded by double-blinded observers. Somatostatin receptor expression was highly expressed in normal tissue for SSTR1, 3, 4 and 5 (5 of 5, 4 of 5, 4 of 5 and 5 of 5 respectively) whilst SST and SSTR 2a and b were not expressed at all. The commonest receptor expressed for all pathological subtypes grouped together was SSTR2b (63 specimens). The commonest receptors expressed in differentiated thyroid cancer were SSTR5 (11 of 12 specimens) and SSTR2b (10 of 12 specimens). The commonest receptor expressed in benign disease was SSTR2b (53 of 55 specimens). SSTR5 was significantly under-expressed in Graves disease (P < 0.05). This study illustrates that SSTR 1, 3, 4 and 5 are highly expressed in normal, benign and malignant thyroid tissue. SSTR 2a and 2b appear absent in normal tissue and present in benign and malignant thyroid tissue (P < 0.02). This suggests that focussed SSTR2 treatment may be a potential therapeutic target.

Pale body-like inclusion formation and neurodegeneration following depletion of 26S proteasomes in mouse brain neurones are independent of α-synuclein.

Parkinson's disease (PD) is characterized by the progressive degeneration of substantia nigra pars compacta (SNpc) dopaminergic neurones and the formation of Lewy bodies (LB) in a proportion of the remaining neurones. α-synuclein is the main component of LB, but the pathological mechanisms that lead to neurodegeneration associated with LB formation remain unclear. Three pivotal elements have emerged in the development of PD: α-synuclein, mitochondria and protein degradation systems. We previously reported a unique model, created by conditional genetic depletion of 26S proteasomes in the SNpc of mice, which mechanistically links these three elements with the neuropathology of PD: progressive neurodegeneration and intraneuronal inclusion formation. Using this model, we tested the hypothesis that α-synuclein was essential for the formation of inclusions and neurodegeneration caused by 26S proteasomal depletion. We found that both of these processes were independent of α-synuclein. This provides an important insight into the relationship between the proteasome, α-synuclein, inclusion formation and neurodegeneration. We also show that the autophagy-lysosomal pathway is not activated in 26S proteasome-depleted neurones. This leads us to suggest that the paranuclear accumulation of mitochondria in inclusions in our model may reflect a role for the ubiquitin proteasome system in mitochondrial homeostasis and that neurodegeneration may be mediated through mitochondrial factors linked to inclusion biogenesis.

Pregnant smokers are receptive to smoking cessation advice and use of nicotine replacement therapy.

Pregnant women who identified themselves as smokers were surveyed to ascertain their attitudes towards and likelihood of using nicotine replacement therapy (NRT) if it were to be provided free of charge at antenatal clinics. Smokers were asked to participate in a brief anonymous survey to identify current levels of smoking, nicotine dependence, attitudes towards cessation, use of cessation aids and whether they would use free NRT if it were provided with support at antenatal clinics. The majority of women were supportive of NRT being offered to pregnant smokers (87%), and 64% reported they would be very likely to use NRT if it were offered free from the antenatal clinic. These results provide strong support for a comprehensive cessation strategy implemented in antenatal clinics.

The expression of somatostatin receptors 3, 4 and 5 in laryngeal pathology.

Conventional chemotherapy has no role to play in the curative treatment of laryngeal carcinoma, yet the mortality rate from advanced disease has improved little over the last 20 years. Somatostatin is a naturally occurring peptide, which exerts anti-proliferative and anti-angiogenic effects via 5 membrane-bound receptor subtypes (SSTRs 1-5). We have previously studied the expression of SSTRs 1 and 2 and demonstrated loss of SSTR2 in laryngeal carcinoma. This study was therefore undertaken to study the expression of the remaining SSTR subtypes in laryngeal pathology. The expression of SSTRs 3, 4 and 5 was studied in benign (Reinke's oedema), pre-malignant and malignant laryngeal specimens using immunohistochemistry. There was very little expression of SSTR3, with low to moderate levels detected in just 1/6 (17%) benign and pre-malignant specimens and 3/12 (25%) malignant laryngeal tumours. A variable degree of SSTR4 expression was detected across the three groups, with low to moderate levels in 3/6 (50%) benign specimens, compared to only 1/6 (17%) pre-malignant specimens but 8/12 (67%) malignant laryngeal tumours. The majority of all specimens, however, demonstrated moderate to high levels of expression of SSTR5. This receptor was detected in 4/6 (67%) benign, all pre-malignant (100%) and 10/12 (83%) malignant cases. All the laryngeal carcinomas studied expressed either SSTR4 or SSTR5, with 60% expressing both, but very few expressing SSTR3. Somatostatin receptors warrant further investigation to determine whether they have a therapeutic role in carcinoma of the larynx.

Vascular endothelial growth factor (VEGF), VEGF receptors expression and microvascular density in benign and malignant thyroid diseases.

Angiogenesis is critical for the growth and metastatic spread of tumours. Vascular endothelial growth factor (VEGF) is the most potent inducer of neovasculature, and its increased expression has been related to a worse clinical outcome in many diseases. The purpose of this study was to evaluate the relation between VEGF, its receptors (VEGFR-1 and VEGFR-2) and microvessel density (MVD) in thyroid diseases. Immunostaining for VEGF and VEGF receptors was performed in 66 specimens of thyroid tissue, comprising 17 multinodular goitre (MNG), 14 Graves' disease, 10 follicular adenoma, 8 Hashimoto's thyroiditis, 7 papillary carcinoma and 10 normal thyroid specimens. Thyrocyte positivity for VEGF and VEGF receptors was scored 0-3. Immunohistochemistry for CD31, and CD34 on the same sections was performed to evaluate MVD. Immunohistochemical staining of VEGF in thyrocytes was positive in 92% of all the thyroid tissues studied. Using an immunostaining intensity cut off of 2, increased thyrocyte staining was seen in follicular adenoma specimens, MNG and normal thyroids compared with Hashimoto's thyroiditis and Graves' disease (P < 0.05). Similarly, VEGF thyrocyte expression in Graves' disease was less than other pathologies (P < 0.05). VEGFR-1 expression and the average MVD score did not differ between the different thyroid pathologies. VEGF expression was lower in autoimmune pathologies compared to autonomous growth processes. Conversely, both VEGFR-1 and VEGFR-2 were widely expressed in benign and neoplastic thyroid disease, suggesting that the up-regulation of VEGF and not its receptors occurs as tissue becomes autonomous. There was no clear relationship between MVD measurement and thyroid pathology.

Neuropilin-1 and VEGF correlate with somatostatin expression and microvessel density in ovarian tumours.

Vascular endothelial growth factor (VEGF), is an angiogenic growth factor, expressed more highly in malignant than benign ovarian tumours. Neuropilin-1, which can act as a VEGF receptor has been shown to be associated with tumour angiogenesis in some cancer systems. Somatostatin (SST), a potentially anti-angiogenic factor, acts via somatostatin receptors that are expressed in ovarian cancer. We used immunohistochemistry to demonstrate expression of Neuropilin-1 in 63 malignant and 35 benign ovarian tumours and compared it to VEGF, Flt, Flk, SST expression and tumour microvessel density (MVD). Neuropilin-1 was expressed in 34/63 malignant and 22/35 benign lesions. VEGF, Flt, Flk and SST were expressed more highly in the epithelium of malignant and the vessels of benign lesions. VEGF expression correlated with SST expression in the epithelium (p<0.001) and the vessels (p<0.001), this co-expression was confirmed by dual immunostaining. The MVD for malignant lesions was higher than benign (p<0.001) and positively correlated to epithelial VEGF expression (p=0.001) and negatively correlated to vascular VEGF expression (p=0.025). These results show that Neuropilin-1 is expressed in ovarian tumours and also show that VEGF and SST are co-expressed in the same tissue compartments raising the intriguing possibility that SST may be important in angiogenesis in ovarian cancer.

Development of a DNA Macroarray for Detection and Monitoring of Economically Important Apple Diseases.

Short DNA gene sequences (oligonucleotides) from the ribosomal spacer regions of bacterial and fungal pathogens were used to identify and monitor economically important apple diseases. The oligonucleotides or probes were attached to a nylon membrane by an amine modified linker arm and arranged in a precise pattern to form an array for detecting five pathogens corresponding to five apple diseases. Initially the specificity of the probes was determined by hybridizing pure cultures of the pathogens to the probes. The DNA array correctly identified Botrytis cinerea, Penicillium expansum, Podosphaera leucotricha, Venturia inaequalis, and Erwinia amylovora and eliminated closely related species. When the array was used to monitor V. inaequalis ascospores collected from spore traps located in orchards, it confirmed the presence of ascospores as predicted by the disease forecasting model. Preliminary tests to quantify P. leucotricha populations using grayscale values was effective to 20 conidia per leaf disk. The DNA array is a promising new detection system for accurate identification of several pathogens in a single test with the potential for being a new tool for epidemiological studies.

Effect of Preharvest Application of Cyprodinil on Postharvest Decay of Apples Caused by Botrytis cinerea.

Dry-eye rot and gray mold of apple are important diseases caused by Botrytis cinerea. Fungicides available for their control are lacking, and this study was conducted to determine if cyprodinil (Vangard) could be used for this purpose. The mean EC50 value of cyprodinil for 32 Botrytis spp. isolates (27 from apple) was 0.02 µg ml-l, indicating that apple isolates are generally very sensitive. Some of the isolates (19%) were less sensitive and had EC50 values greater than 0.03 µg ml-l, and one isolate from 'Gala' apple was considerably less sensitive at 0.095 µg ml-l. Bloom sprays of cyprodinil alone in 1998 and 1999 or in combination with myclobutanil or metiram in 1998 reduced Botrytis spp. infection on developing fruit. Postharvest application of cyprodinil in 1998 indicated that cyprodinil protected apples from gray mold for 3 months. Cyprodinil applied 2 to 3 weeks before harvest in 1999 reduced lesion diameters 68 and 62% on 'Jonagold' and 'Gala' apples, respectively, that had been wounded and inoculated with B. cinerea after storage at 1°C for 6 months. In similar trials on 'Gala' apples in 2000 and 2001, preharvest applications of cyprodinil consistently reduced gray mold incidence and lesion diameter on inoculated apples stored for 6 months. New preharvest use patterns for cyprodinil are discussed for control of postharvest diseases caused by B. cinerea.