Health map for HealthGap: Defining a geographical catchment to examine cardiovascular risk in Victoria, Australia.

The HealthGap study aimed to understand cardiovascular risk among Indigenous Australians in Victoria using linked administrative data. A key challenge was differing spatial coverages of sources: state-level data for risk factors but cardiovascular outcomes for three hospitals. Catchments were defined based on hospital postcodes to estimate denominator populations for risk modelling: first- and second-order neighbours, and spatial distribution of outcomes ('spatial event distribution'). Catchment coverage was assessed through proportions of patients presenting to study hospitals from catchment postcodes. The spatial event distribution performed best, capturing 82% events overall (first-order:40%; second-order:64%) and 65% Indigenous (27% and 45%). No approach excluded proximal non-study hospitals. Spatial event distributions could help define denominator populations when geographic information on outcome data is available but may not avoid potential misclassification.

Ethics guidelines use and Indigenous governance and participation in Aboriginal and Torres Strait Islander health research: a national survey.

OBJECTIVES: To assess the use of NHMRC Indigenous research guidelines by Australian researchers and the degree of Aboriginal and Torres Strait Islander governance and participation in Indigenous health research. DESIGN, SETTING, PARTICIPANTS: Cross-sectional survey of people engaged in Indigenous health research in Australia, comprising respondents to an open invitation (social media posts in general and Indigenous health research networks) and authors of primary Indigenous health research publications (2015-2019) directly invited by email. MAIN OUTCOME MEASURES: Reported use of NHMRC guidelines for Indigenous research; reported Indigenous governance and participation in Indigenous health research. RESULTS: Of 329 people who commenced the survey, 247 people (75%) provided responses to all questions, including 61 Indigenous researchers (25%) and 195 women (79%). The NHMRC guidelines were used "all the time" by 206 respondents (83%). Most respondents (205 of 247, 83%) reported that their research teams included Indigenous people, 139 reported dedicated Indigenous advisory boards (56%), 91 reported designated seats for Indigenous representatives on ethics committees (37%), and 43 reported Indigenous health research ethics committees (17%); each proportion was larger for respondents working in Indigenous community-controlled organisations than for those working elsewhere. More than half the respondents reported meaningful Indigenous participation during five of six research phases; the exception was data analysis (reported as apparent "none" or "some of the time" by 143 participants, 58%). CONCLUSIONS: Indigenous health research in Australia is largely informed by non-Indigenous world views, led by non-Indigenous people, and undertaken in non-Indigenous organisations. Re-orientation and investment are needed to give control of the framing, design, and conduct of Indigenous health research to Indigenous people.

Interventions to support the mental health and well-being of front-line healthcare workers in hospitals during pandemics: an evidence review and synthesis.

OBJECTIVE: Pandemics negatively impact healthcare workers' (HCW's) mental health and well-being causing additional feelings of anxiety, depression, moral distress and post-traumatic stress. A comprehensive review and evidence synthesis of HCW's mental health and well-being interventions through pandemics reporting mental health outcomes was conducted addressing two questions: (1) What mental health support interventions have been reported in recent pandemics, and have they been effective in improving the mental health and well-being of HCWs? (2) Have any mobile apps been designed and implemented to support HCWs' mental health and well-being during pandemics? DESIGN: A narrative evidence synthesis was conducted using Cochrane criteria for synthesising and presenting findings when systematic review and pooling data for statistical analysis are not suitable due to the heterogeneity of the studies. DATA SOURCES: Evidence summary resources, bibliographic databases, grey literature sources, clinical trial registries and protocol registries were searched. ELIGIBILITY CRITERIA: Subject heading terms and keywords covering three key concepts were searched: SARS-CoV-2 coronavirus (or similar infectious diseases) epidemics, health workforce and mental health support interventions. Searches were limited to English-language items published from 1 January 2000 to 14 June 2022. No publication-type limit was used. DATA EXTRACTION AND SYNTHESIS: Two authors determined eligibility and extracted data from identified manuscripts. Data was synthesised into tables and refined by coauthors. RESULTS: 2694 studies were identified and 27 papers were included. Interventions were directed at individuals and/or organisations and most were COVID-19 focused. Interventions had some positive impacts on HCW's mental health and well-being, but variable study quality, low sample sizes and lack of control conditions were limitations. Two mobile apps were identified with mixed outcomes. CONCLUSION: HCW interventions were rapidly designed and implemented with few comprehensively described or evaluated. Tailored interventions that respond to HCWs' needs using experience co-design for mental health and well-being are required with process and outcome evaluation.

Rapid Design and Delivery of an Experience-Based Co-designed Mobile App to Support the Mental Health Needs of Health Care Workers Affected by the COVID-19 Pandemic: Impact Evaluation Protocol.

BACKGROUND: The COVID-19 pandemic has highlighted the importance of health care workers' mental health and well-being for the successful function of the health care system. Few targeted digital tools exist to support the mental health of hospital-based health care workers, and none of them appear to have been led and co-designed by health care workers. OBJECTIVE: RMHive is being led and developed by health care workers using experience-based co-design (EBCD) processes as a mobile app to support the mental health challenges posed by the COVID-19 pandemic to health care workers. We present a protocol for the impact evaluation for the rapid design and delivery of the RMHive mobile app. METHODS: The impact evaluation will adopt a mixed methods design. Qualitative data from photo interviews undertaken with up to 30 health care workers and semistructured interviews conducted with up to 30 governance stakeholders will be integrated with qualitative and quantitative user analytics data and user-generated demographic and mental health data entered into the app. Analyses will address three evaluation questions related to engagement with the mobile app, implementation and integration of the app, and the impact of the app on individual mental health outcomes. The design and development will be described using the Mobile Health Evidence Reporting and Assessment guidelines. Implementation of the app will be evaluated using normalization process theory to analyze qualitative data from interviews combined with text and video analysis from the semistructured interviews. Mental health impacts will be assessed using the total score of the 4-item Patient Health Questionnaire (PHQ4) and subscale scores for the 2-item Patient Health Questionnaire for depression and the 2-item Generalized Anxiety Scale for anxiety. The PHQ4 will be completed at baseline and at 14 and 28 days. RESULTS: The anticipated average use period of the app is 30 days. The rapid design will occur over four months using EBCD to collect qualitative data and develop app content. The impact evaluation will monitor outcome data for up to 12 weeks following hospital-wide release of the minimal viable product release. The study received funding and ethics approvals in June 2020. Outcome data is expected to be available in March 2021, and the impact evaluation is expected to be published mid-2021. CONCLUSIONS: The impact evaluation will examine the rapid design, development, and implementation of the RMHive app and its impact on mental health outcomes for health care workers. Findings from the impact evaluation will provide guidance for the integration of EBCD in rapid design and implementation processes. The evaluation will also inform future development and rollout of the app to support the mental health needs of hospital-based health care workers more widely. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/26168.

Fertility and pregnancy in the Fontan population.

BACKGROUND: Women with a Fontan circulation are deemed at significantly increased risk of maternal morbidity and mortality during pregnancy. Publications describe a small number of pregnancies worldwide and a high rate of miscarriage. We compiled the experience of women enrolled in the Australia and New Zealand Fontan (ANZ) Registry with regard to menarche, contraceptive use, pregnancy advice and pregnancy outcomes. METHODS: Women within the ANZ Fontan Registry were contacted and asked to consent to receiving sequential questionnaires. RESULTS: 156 women ≥ 18 years of age (including 4 deceased individuals) were identified, 101 women consented and 97 completed the initial questionnaire. Women were aged (median) 25 years (23-32); menarche occurred at a median 14 years (13-16). A wide variety of contraceptive methods was reported. 81% of women reported having received advice that pregnancy carried an increased risk or was inadvisable. Pregnancy was reported in a minority (n=27). Miscarriage (42.5%) and termination (7.5%) accounted for half the pregnancy outcomes and the babies were born early (median 31.5 weeks) and small (median 1350 g). Maternal complications of bleeding, arrhythmia and heart failure were reported with no early maternal mortality. CONCLUSIONS: In women with a Fontan circulation the fertility onset is delayed and pregnancy has a higher rate of miscarriage. Successful pregnancy resulted in small and premature babies. Significant maternal morbidity occurred. Whether pregnancy with its volume loading has an adverse effect on the long-term outcome of women with a single ventricle remains to be elucidated.

High Prevalence of Hypertension and End-Organ Damage Late After Coarctation Repair in Normal Arches.

BACKGROUND: To (1) determine the prevalence of hypertension late after coarctation repair in patients with normal-sized transverse arches, and (2) evaluate the potential for end-organ damage related to hypertension after coarctation repair. There are no studies specifically investigating end-organ damage and hypertension after coarctation repair using noninvasive techniques. METHODS: Eighty-two patients aged 10 years or greater with a coarctation repair and a normal-sized arch operated on between 1978 and 2010, underwent a transthoracic echocardiogram, 24-hour blood pressure (BP) monitoring, and retinal imaging. Median age at repair was 1 year (interquartile range, 0 to 6); 45% (37 of 82) were operated in the first year of life. RESULTS: After a follow-up of 24 ± 7 years, 27% (22 of 82) and 50% (41 of 82) suffered resting hypertension and resting prehypertension, respectively. On 24-hour BP monitoring, 61% (49 of 80) and 21% (17 of 80) suffered hypertension and prehypertension, respectively. Arch reobstruction (echo gradient > 25 mm Hg) was present in only 15% (12 of 82), and in only 15% (7 of 47) with 24-hour hypertension. Resting hypertension was associated with a smaller central retinal artery equivalent (average width of arterioles) and central retinal vein equivalent (average width of venules) (p = 0.0006 and p = 0.003, respectively). Left ventricular hypertrophy on echocardiography was present in 63% (31 of 49) with 24-hour hypertension compared with only 42% (13 of 31) with normal 24-hour BP (p = 0.06). CONCLUSIONS: There is a high rate of hypertension late after coarctation repair, even in patients with unobstructed arches. The presence of retinal imaging abnormalities and left ventricular hypertrophy signals the presence of end-organ damage in this young adult population. Regular follow-up with 24-hour BP monitoring is warranted.

Longitudinal associations between cyber-bullying perpetration and victimization and problem behavior and mental health problems in young Australians.

OBJECTIVES: To investigate associations between Grade 9 and 10 cyber-bullying perpetration and victimization and Grade 11 problem behavior and mental health problems after controlling for risk factors for these outcomes in the analyses. METHODS: The sample comprised 927 students from Victoria, Australia who completed a modified version of the self-report Communities That Care Youth Survey in Grades 9-11 to report on risk factors, traditional and cyber-bullying perpetration and victimization, problem behavior, and mental health. Complete data on over 650 participants were analyzed. RESULTS: Five per cent of Grade 9 and 10 students reported cyber-bullying perpetration only, 6-8% reported victimization only, and 8-9% both cyber-bullied others and were cyber-bullied. Results showed that cyber-bullying others in Grade 10 was associated with theft in Grade 11, cyber-victimization in Grade 10 was linked with Grade 11 depressive symptoms, and Grade 10 cyber-bullying perpetration and victimization combined predicted Grade 11 school suspension and binge drinking. CONCLUSIONS: Prevention approaches that target traditional and cyber-bullying, and established risk factors are necessary. Such multi-faceted programs may also reduce problem behavior and mental health problems.

Predictors of Traditional and Cyber-Bullying Victimization: A Longitudinal Study of Australian Secondary School Students.

The purpose of the present article is to compare the individual, peer, family, and school risk and protective factors for both traditional and cyber-bullying victimization. This article draws on data from 673 students from Victoria, Australia, to examine Grade 7 (aged 12-13 years) predictors of traditional and cyber-bullying victimization in Grade 9 (aged 14-15 years). Participants completed a modified version of the Communities That Care youth survey. There were few similarities and important differences in the predictors of traditional and cyber-bullying victimization. For Grade 9 cyber-bullying victimization, in the fully adjusted model, having been a victim of traditional bullying in Grade 7 and emotional control in Grade 7 were predictors. For Grade 9 traditional bullying victimization, predictors were Grade 7 traditional bullying victimization, association with antisocial peers, and family conflict, with family attachment and emotional control marginally statistically significant. The use of evidence-based bullying prevention programs is supported to reduce experiences of both traditional and cyber-bullying victimization, as is the implementation of programs to assist students to regulate their emotions effectively. In addition, traditional bullying victimization may be reduced by addressing association with antisocial friends, family conflict, and bonding to families.

Does school suspension affect subsequent youth nonviolent antisocial behavior? A longitudinal study of students in Victoria, Australia and Washington State, United States.

School suspension has been not only associated with negative behaviours but is predictive of future poor outcomes. The current study investigates a) whether school suspension is a unique predictor of youth nonviolent antisocial behaviour (NVAB) relative to other established predictors, and b) whether the predictors of NVAB are similar in Australia and the United States (U.S.). The data analysed here draws on two state-wide representative samples of Grade 7 and 9 students in Victoria, Australia and Washington State, U.S., resurveyed at 12-month follow-up (N = 3,677, 99% retention). School suspension did not uniquely predict NVAB in the final model. The predictors of NVAB, similar across states, included previous student NVAB; current alcohol and tobacco use; poor family management; association with antisocial friends; and low commitment to school. An implication of the findings is that U.S. evidence-based prevention programs targeting the influences investigated here could be trialled in Australia.

Longitudinal predictors of cyber and traditional bullying perpetration in Australian secondary school students.

PURPOSE: Cyberbullying perpetration (using communication technology to engage in bullying) is a recent phenomenon that has generated much concern. There are few prospective longitudinal studies of cyberbullying. The current article examines the individual, peer, family, and school risk factors for both cyber and traditional bullying (the latter is bullying that does not use technology) in adolescents. METHODS: This article draws on a rich data set from the International Youth Development Study, a longitudinal study of students in Victoria, Australia and Washington State, United States, which began in 2002. In this article, data from almost 700 Victorian students recruited in grade 5 are analyzed to examine grade 7 (aged 12-13 years) predictors of traditional and cyberbullying perpetration in grade 9 (aged 14-15 years). RESULTS: Fifteen per cent of students engaged in cyberbullying, 21% in traditional bullying, and 7% in both. There are similarities and important differences in the predictors of cyber and traditional bullying. In the fully adjusted model, only prior engagement in relational aggression (a covert form of bullying, such as spreading rumors about another student) predicted cyberbullying perpetration. For traditional bullying, previous relational aggression was also predictive, as was having been a victim and perpetrator of traditional bullying, family conflict, and academic failure. CONCLUSIONS: The use of evidence-based bullying prevention programs is supported to reduce experiences of all forms of bullying perpetration (cyber, traditional, and relational aggression). In addition, for traditional bullying perpetration, addressing family conflict and student academic support are also important.

Longitudinal consequences of adolescent bullying perpetration and victimisation: a study of students in Victoria, Australia.

AIMS: To examine the associations between self-reported bullying perpetration and victimisation in Years 7 and 10 and a range of psychosocial outcomes in Year 11. METHOD: This analysis draws on data from the International Youth Development Study, a longitudinal study of 5769 students from Victoria, Australia and Washington State, United States who were recruited through schools in Years 5, 7 and 9 in 2002. Data for the current results are taken from participants in the youngest (Year 5) Victorian cohort of the study. RESULTS: Rates of bullying victimisation exceeded 30% and up to one in five students had engaged in bullying. Adjusted logistic regression analyses revealed that bullying perpetration, and bullying victimisation in Year 7 did not significantly predict psychosocial outcomes in Year 11. Bullying perpetration in Year 10 was associated with an increased likelihood of theft, violent behaviour and binge drinking. Year 10 bullying victimisation was associated with an increased likelihood of Year 11 depressive symptoms. CONCLUSIONS: Prevention approaches that target bullying perpetration and victimisation are necessary. Programmes that lessen bullying may also have an impact on other proximally related behaviours, including binge drinking and depression.

Inhibition of Bak activation by VDAC2 is dependent on the Bak transmembrane anchor.

Bax and Bak are pro-apoptotic factors that are required for cell death by the mitochondrial or intrinsic pathway. Bax is found in an inactive state in the cytosol and upon activation is targeted to the mitochondrial outer membrane where it releases cytochrome c and other factors that cause caspase activation. Although Bak functions in the same way as Bax, it is constitutively localized to the mitochondrial outer membrane. In the membrane, Bak activation is inhibited by the voltage-dependent anion channel isoform 2 (VDAC2) by an unknown mechanism. Using blue native gel electrophoresis, we show that in healthy cells endogenous inactive Bak exists in a 400-kDa complex that is dependent on the presence of VDAC2. Activation of Bak is concomitant with its release from the 400-kDa complex and the formation of lower molecular weight species. Furthermore, substitution of the Bak transmembrane anchor with that of the mitochondrial outer membrane tail-anchored protein hFis1 prevents association of Bak with the VDAC2 complex and increases the sensitivity of cells to an apoptotic stimulus. Our results suggest that VDAC2 interacts with the hydrophobic tail of Bak to sequester it in an inactive state in the mitochondrial outer membrane, thereby raising the stimulation threshold necessary for permeabilization of the mitochondrial outer membrane and cell death.

Pubertal stage and the prevalence of violence and social/relational aggression.

OBJECTIVE: We examined associations between pubertal stage and violent adolescent behavior and social/relational aggression. METHODS: The International Youth Development Study comprises statewide representative student samples in grades 5, 7, and 9 (N = 5769) in Washington State and Victoria, Australia, drawn as a 2-stage cluster sample in each state. We used a school-administered, self-report student survey to measure previous-year violent behavior (ie, attacking or beating up another person) and social/relational aggression (excluding peers from the group, threatening to spread lies or rumors), as well as risk and protective factors and pubertal development. Cross-sectional data were analyzed. RESULTS: Compared with early puberty, the odds of violent behavior were approximately threefold higher in midpuberty (odds ratio [OR]: 2.87 [95% confidence interval (CI): 1.81-4.55]) and late puberty (OR: 3.79 [95% CI: 2.25-6.39]) after adjustment for demographic factors. For social/relational aggression, there were weaker overall associations after adjustment, but these associations included an interaction between pubertal stage and age, and stronger associations with pubertal stage at younger age were shown (P = .003; midpuberty OR: 1.78 [95% CI: 1.20-2.63]; late puberty OR: 3.00 [95% CI: 1.95-4.63]). Associations between pubertal stage and violent behavior and social/relational aggression remained after the inclusion of social contextual mediators in the analyses. CONCLUSIONS: Pubertal stage was associated with higher rates of violent behavior and social/relational aggression, with the latter association seen only at younger ages. Puberty is an important phase at which to implement prevention programs to reduce adolescent violent and antisocial behaviors.

Identification of an Xiap-like pseudogene on mouse chromosome 7.

The most thoroughly characterized mammalian IAP is XIAP/BIRC4, which can inhibit caspases 9, 3 and 7, but may also regulate apoptosis through interactions with other proteins such as Smac/DIABLO, HtrA2/Omi, XAF1, TAK1, cIAP1, and cIAP2.High throughput sequencing of the mouse genome revealed the existence of a gene resembling Xiap/Birc4 on mouse chromosome 7. To confirm the existence of this gene, and to determine its functional significance, we performed Southern and Northern blot analysis. This showed the presence of the Xiap-like gene in both wild-type and Xiap gene knock-out mice, but the corresponding mRNA was not detected in any tissues examined by Northern blot. Analysis of the gene sequence in all three possible reading frames predicts that expression of this gene would not give rise to a full-length protein, but only non-functional truncated polypeptides. Because its nucleotide sequence is 92% identical to Xiap, but it has no introns corresponding to those of Xiap, we conclude that Xiap-ps1 is a pseudogene generated by retro-transposition of a spliced Xiap message to chromosome 7.