Research Publications and Outputs

Associations between parental engagement with health professionals and child health behaviours

2026-07-10T05:23:08Z

Associations between parental engagement with health professionals and child health behaviours House, Eve T; Xu, Huilan; Baur, Louise A; Denney-Wilson, Elizabeth; Taki, Sarah; Wen, Li Ming Background: Health professionals are an important source of infant feeding advice in the first year of life. However, little is known about the impact of such advice provided as part of routine child health services on feeding practices and other child health behaviours. This study aimed to examine the association between parental engagement with health professionals for breast and formula feeding advice during the first 6 months of life and child health behaviours at 6, 12 and 24 months of the child's age. Methods: Cross-sectional and longitudinal analyses of survey data from a randomised controlled trial in Australia were conducted. At 6 months, parents were asked what sources of information regarding breast and formula feeding they used; at 6, 12 and 24 months, they were asked about their child's nutrition, feeding and movement behaviours. Cross-sectional and longitudinal multiple logistic regression models examined the association between engagement with health professionals in the first 6 months of life and child health behaviours at 6, 12 and 24 months of age. Results: A total of 1155 mothers completed the baseline survey, 947 (82%), 920 (80%) and 797 (69%) completed the 6-, 12- and 24-month surveys. Longitudinal modelling indicated that seeking health professional advice regarding infant feeding was associated with a lower likelihood of current breastfeeding (adjusted odds ratio = 0.54, 95% confidence interval = 0.41-0.71, p < 0.001). After adjustment for confounders, engagement with health professionals in the first 6 months of life was not associated with any other child health behaviours based on cross-sectional analyses. Conclusions: These findings suggest that parental engagement with health professionals for infant feeding support may be a response to significant breastfeeding challenges or transitions in infant feeding, pointing to an opportunity to support more routine health promotion in child healthcare settings before such challenges arise.

Considerations of eating disorder risk during obesity treatment in Australia: Current practice, attitudes and barriers

2026-07-09T06:01:38Z

Considerations of eating disorder risk during obesity treatment in Australia: Current practice, attitudes and barriers Kwok, Cathy; Forward, Victoria; Lister, Natalie B; Garnett, Sarah P; Baur, Louise A; Jebeile, Hiba Introduction People with obesity are vulnerable to eating disorders. It has been suggested that screening for eating disorder risk be part of obesity care. However, it is unclear what current practice entails. Objective To explore considerations of eating disorder risk during treatment of obesity, including assessment and intervention strategies used in clinical practice. Materials and Methods An online (REDCap) cross-sectional survey was distributed to health professionals working with individuals with obesity in Australia through professional societies and social media. The survey had three sections: 1. Characteristics of Clinician/Practice, 2. Current Practice, 3. Attitudes. Data were summarised using descriptive statistics and free-text comments were independently coded in duplicate to identify themes. Results 59 health professionals completed the survey. Most were dietitians (n = 29), identified as women (n = 45) and worked within a public hospital (n = 30) and/or private practice (n = 29). Overall, 50 respondents reported assessing for eating disorder risk. Most reported that having a history of, or risk factors of eating disorders should not preclude obesity care but emphasised the importance of treatment modification including using a patient-centred approach involving a multidisciplinary team and promoting healthy eating behaviours, with less emphasis on calorie restriction or bariatric surgery. Management approaches did not differ for those with eating disorder risk factors or a diagnosed eating disorder. Clinicians identified the need for additional training and clear referral pathways. Conclusion Individualised care, balancing models of care for eating disorders and obesity and further access to training and services will be important in improving care of patients with obesity.

Additional Support Needs of Adolescents with Obesity During an Obesity Treatment Trial: Fast Track to Health

2026-07-09T03:29:05Z

Additional Support Needs of Adolescents with Obesity During an Obesity Treatment Trial: Fast Track to Health Kwok, Cathy; Lister, Natalie B; House, Eve T; Baur, Louise A; Garnett, Sarah P; Jebeile, Hiba; Fast Track to Health study team Background: Treatment-seeking adolescents with obesity may have diverse dietetic, psychological, or medical needs that require support during obesity treatment. Objectives: To characterize initial referral reasons, content, and outcome of support visits provided in addition to protocolized visits during an obesity treatment trial. Methods: The Fast Track to Health trial was a 52-week multi-site randomized trial conducted between 2018 and 2023 in Australia, comparing intermittent and continuous energy restricted dietary interventions delivered as part of an intensive behavioral intervention in adolescents with obesity and ≥1 obesity-related complications. Alongside protocolized mental health screening and medical and dietetic reviews, additional support was provided by the study dietitian, pediatrician or psychologist if needed or requested by families. Two reviewers independently coded deidentified clinical notes for each additional support visit to identify referral reasons, content and outcome of each visit. Results: Of 141 adolescents enrolled, 51 (36.2%) attended at least one additional support session, with most (n = 31) having one visit. Most referrals were initiated by a clinician (n = 34) and included requests for dietetic review (n = 16), motivation and/or support during COVID-19 lockdowns (n = 15), general psychological review (n = 14) and anxiety (n = 11). Conclusions: Understanding the diverse needs of adolescents with obesity is essential to inform obesity treatment interventions.

Progressing Cross-Sector Collaboration for People With Eating Disorders and Higher Weight: Priority Actions From an Expert Roundtable Using a Modified Nominal Group Technique

2026-07-03T05:37:48Z

Progressing Cross-Sector Collaboration for People With Eating Disorders and Higher Weight: Priority Actions From an Expert Roundtable Using a Modified Nominal Group Technique Jebeile, Hiba; Brennan, Leah; Burrows, Tracy; de la Piedad Garcia, Xochitl; Ralph, Angelique F; Saluja, Supreet; Atlantis, Evan; Garnett, Sarah P; Harrison, Carmel J; House, Eve T; Lister, Natalie B; Moran, Lisa; Piya, Milan K; Rieger, Elizabeth; Smith, Evelyn; Hay, Phillipa; Trobe, Sarah Introduction Eating disorders are more prevalent in people with higher weight than those with low weight. However, contention between the fields of obesity and eating disorders has prevented meaningful progress in research, prevention, identification and coordinated clinical services for people with co-occurring conditions. In Australia, public health approaches and provision of treatment services for people with eating disorders and clinical obesity are siloed, often resulting in contradictory messaging. To address this, a roundtable meeting was held in November 2024 in Sydney, Australia, with 28 experts in one or both of these fields, including researchers, clinicians and service leaders working across paediatric and adult care, and individuals with lived experience. Guided by the National Eating Disorders Collaboration stepped system of care framework, participants identified key challenges and possible solutions, and established five priority actions. Main Recommendations The priority actions across sectors are: Health Campaigns focused on raising awareness of eating disorders at higher weight, using appropriate language and reducing weight stigma; improved Screening and Assessment using standardised protocols across healthcare settings; supporting Primary Healthcare and improving the use of Medicare items; Tailored Treatment Pathways including integrated care models; and building Workforce Capacity to upskill professionals to provide safe, person-centred care. Changes in Management as a Result of the Statement These actions aim to promote improved cross-sector collaboration and effective, safe, coordinated and integrated approaches to prevention, identification and treatment across the fields of obesity and eating disorders. They address the complex medical and psychological needs of those with co-occurring eating disorders and higher weight or clinical obesity through a skilled workforce and improved access to care. Effective integration, collaboration and coordination across services is essential for long-term recovery support.

Socio-Demographic, Self-Control, Bullying, Parenting, and Sleep as Proximal Factors Associated with Food Addiction among Adolescents

2026-07-03T00:27:45Z

Socio-Demographic, Self-Control, Bullying, Parenting, and Sleep as Proximal Factors Associated with Food Addiction among Adolescents Leary, Mark; Pursey, Kirrilly M; Verdejo-Garcia, Antonio; Smout, Scarlett; McBride, Nyanda; Osman, Bridie; Champion, Katrina E; Gardner, Lauren A; Jebeile, Hiba; Kelly, Erin V; Thornton, Louise; Teesson, Maree; Burrows, Tracy L Adolescence is considered an important period of neurodevelopment. It is a time for the emergence of psychosocial vulnerabilities, including symptoms of depression, eating disorders, and increased engagement in unhealthy eating behaviours. Food addiction (FA) in adolescents is an area of study where there has been substantial growth. However, to date, limited studies have considered what demographic characteristics of adolescents may predispose them to endorse greater symptoms of FA. Studies have found a variety of factors that often cluster with and may influence an adolescent’s eating behaviour such as sleep, level of self-control, and parenting practices, as well as bullying. Therefore, this study investigated a range of socio-demographic, trait, mental health, and lifestyle-related profiles (including self-control, parenting, bullying, and sleep) as proximal factors associated with symptoms of FA, as assessed via the Yale Food Addiction Scale for Children (YFAS-C) in a large sample of Australian adolescents. Following data cleaning, the final analysed sample included 6587 students (age 12.9 years ± 0.39; range 10.9–14.9 years), with 50.05% identifying as male (n = 3297), 48.5% as female (n = 3195), 1.02% prefer not to say (n = 67), and 0.43% as non-binary (n = 28). Self-control was found to be the most significant predictor of total FA symptom score, followed by female gender, sleep quality, and being a victim of bullying. Universal prevention programs should therefore aim to address these factors to help reduce the prevalence or severity of FA symptoms within early adolescent populations.

Mindful and Intuitive Eating Imagery on Instagram: A Content Analysis

2026-07-03T00:23:55Z

Mindful and Intuitive Eating Imagery on Instagram: A Content Analysis Hoare, Johanna K; Lister, Natalie B; Garnett, Sarah P; Baur, Louise A; Jebeile, Hiba Non-dieting approaches, including mindful/intuitive eating, to health improvement are of increasing interest, yet little is known about young adults' social media exposure to them. Therefore, this study aimed to describe the imagery related to mindful/intuitive eating which is visible to young adult Instagram users. Images categorized under the hashtags 'mindfuleating' and 'intuitiveeating' were searched in September 2021 using the 'top posts' view. Screen captures of 1200 grid-view images per hashtag were used to construct coding frameworks and to determine saturation. Sample sizes for #mindfuleating and #intuitiveeating were 405 and 495 images, respectively. Individual images were coded collaboratively. Almost half of each sample depicted food or drink, of which 50-60% were healthy foods. Approximately 17% were single-person images, of which the majority were young, female adults with healthy weight. Approximately one-third of text suggested credibility through credentials, profession, or evidence. Messaging was similar for both hashtags, encompassing mindful/intuitive eating (~40%), nutrition/eating behaviours (~15%), physical/mental health (~20%), disordered eating (~12%), and body-/self-acceptance (~12%). Differences were observed between hashtags for weight-related concepts (20%/1%) and anti-diet/weight-neutral approaches (10%/35%). The representation on Instagram of mindful and intuitive eating portrays healthy lifestyles without a focus on weight but lacks demographical and body-type diversity. Instagram holds the potential for health professionals to disseminate culturally/demographically inclusive, evidence-based health/nutrition information to youth.

The Effectiveness of Different Diet Strategies to Reduce Type 2 Diabetes Risk in Youth

2026-07-03T00:18:28Z

The Effectiveness of Different Diet Strategies to Reduce Type 2 Diabetes Risk in Youth Gow, Megan L; Garnett, Sarah P; Baur, Louise A; Lister, Natalie B Type 2 diabetes in children and adolescents has become a prominent clinical issue in recent decades. Increasing numbers of young people have risk factors for type 2 diabetes, particularly obesity, indicating the need for effective type 2 diabetes prevention strategies. The aim of this review was to identify specific dietary strategies that optimize improvements in risk factors for type 2 diabetes in youth and hence reduce the risk of type 2 diabetes development. Our review of the current literature indicates that dietary interventions lead to weight loss when intervention adherence is high. However, in addition to weight loss, a diet that is reduced in carbohydrates may optimize improvements in other type 2 diabetes risk factors, including insulin resistance and hyperglycemia. While further research is needed to confirm this finding, reduced carbohydrate diets may include a very low-carbohydrate diet, a very low-energy diet, a lower-glycemic-index diet, and/or an intermittent fasting diet. This array of dietary strategies provides a suite of intervention options for clinicians to recommend to young people at risk of type 2 diabetes. However, these findings are in contrast to current guidelines for the prevention of type 2 diabetes in adults which recommends a low-fat, high-carbohydrate diet.

Efficacy, safety and acceptability of a very-low-energy diet in adolescents with obesity: a fast track to health sub-study

2026-07-03T00:15:56Z

Efficacy, safety and acceptability of a very-low-energy diet in adolescents with obesity: a fast track to health sub-study Gow, Megan; Jebeile, Hiba; House, Eve T; Alexander, Shirley; Baur, Louise A; Brown, Justin; Collins, Claire E; Cowell, Chris T; Day, Kaitlin; Garnett, Sarah P; Grunseit, Alicia; Inkster, Mary-Kate; Kwok, Cathy; Lang, Sarah; Paxton, Susan J; Truby, Helen; Varady, Krista A; Lister, Natalie B The aim of this study was to determine the efficacy, safety and acceptability of a 4-week very-low-energy diet (VLED) program for adolescents with obesity. Adolescents (13–17 years) with obesity and ≥1 obesity-related complication were Fast Track to Health 52-week randomized controlled trial participants. Adolescents undertook a 4-week micronutrient-complete VLED (800 kcal/day), with weekly dietitian support. Anthropometric data were recorded at baseline and week-4 and side-effects at day 3–4, week-1, -2, -3 and -4. Adolescents completed an acceptability survey at week-4. A total of 134 adolescents (14.9 ± 1.2 years, 50% male) had a 5.5 ± 2.9 kg (p < 0.001) mean weight loss at week-4: 95% experienced ≥1 and 70% experienced ≥3 side-effects during the VLED program, especially during the first week. Hunger, fatigue, headache, irritability, loose stools, constipation and nausea were most common. Reporting more side-effects at day 3–4 correlated with greater weight loss at week-4 (r = −0.188, p = 0.03). Adolescents reported ‘losing weight’ (34%) and ‘prescriptive structure’ (28%) as the most positive aspects of VLED, while ‘restrictive nature’ (45%) and ‘meal replacement taste’ (20%) were least liked. A dietitian-monitored short-term VLED can be implemented safely and is acceptable for many adolescents seeking weight loss, despite frequent side-effects. Investigating predictors of acceptability and effectiveness could determine adolescents most suited to VLED programs

Antenatal diet quality and perinatal depression: the Microbiome Understanding in Maternity Study (MUMS) cohort

2026-07-03T00:08:42Z

Antenatal diet quality and perinatal depression: the Microbiome Understanding in Maternity Study (MUMS) cohort Gow, Megan L; Lam, Yei W I; Jebeile, Hiba; Craig, Maria E; Susic, Danielle; Henry, Amanda Background: Previous findings from research investigating the role of antenatal nutrition in preventing postpartum depression (PPD) are inconsistent. Our primary aim was to investigate the association between pregnancy diet quality and PPD. Our secondary aim was to investigate associations between (a) diet quality and depression during pregnancy and (b) depression during pregnancy and PPD. Methods: This analysis represents data from 73 women participating in the Microbiome Understanding in Maternity Study (MUMS) cohort in Sydney, Australia, which followed women from Trimester 1 of pregnancy to 1-year postpartum (PP). Participants' diet quality was assessed using the Australian Eating Survey at Trimester 1 and 3 to calculate diet quality, known as the Australian Recommended Food Score (lower diet quality defined as score <39; higher diet quality ≥39). Depression was assessed using the Edinburgh Depression Scale at Trimesters 1, 2, 3 and 6 weeks PP (defined as score ≥11). Results: Depression scores during pregnancy were significantly associated with depression score 6 weeks PP (Trimester 1: r = 0.66, Trimester 2: r = 0.69, Trimester 3: r = 0.67; all p < 0.001). Diet quality during pregnancy was not significantly correlated with 6-week PPD score. In unadjusted analysis, diet quality during pregnancy was not associated with pregnancy depression scores. When adjusted for age, parity and Trimester 1 body mass index, Trimester 1 physical activity levels and gestational weight gain, higher Trimester 3 diet quality was associated with reduced Trimester 3 depression only. Conclusions: Depression scores during pregnancy were positively associated with PPD, highlighting the importance of screening for depression during pregnancy and postnatally. Larger longitudinal prospective studies may elucidate the association between diet quality and PPD.

Opportunities to advance research, intervention, and policy on stigma, eating disorders, and body image

2026-07-03T00:01:22Z

Opportunities to advance research, intervention, and policy on stigma, eating disorders, and body image Pearl, Rebecca L; Austin, S. Bryn; Jebeile, Hiba; D'Adamo, Laura; Wilfley, Denise E Stigma involves assigning labels and negative character traits (or stereotypes) to individuals who are viewed as “different.” This labeling is used to justify mistreatment and exert power over stigmatized individuals through diminished social status, discrimination, and overall devaluation as human beings [1]. Decades of research studies have documented stigmatization of people on the basis of body weight and other aspects of appearance. Weight stigma typically involves ascribing negative stereotypes to individuals with a high body weight or larger body [2]. Individuals with low body weight may also be viewed negatively and assumed to have eating disorders, which in turn are linked to stereotypes as well [3]. Stigmatization of persons with psychiatric disorders more generally can also extend to those with eating disorders. Due to misconceptions that body weight and eating disorder symptoms are entirely within an individual’s control, blame is rampant. This Special Issue aims to bring increased attention to stigma related to eating disorders, weight, and body image, including intersections with other forms of stigma, health impacts, and promising avenues for intervention.

New anti-obesity medications: Considerations and future directions in people with concurrent eating disorders

2026-07-02T23:54:36Z

New anti-obesity medications: Considerations and future directions in people with concurrent eating disorders Sharp, Gemma; Girolamo, Teresa; Hay, Phillipa; Mitchison, Deborah; Cooper, Kelly; Sumithran, Priya; Jebeile, Hiba People with both obesity and eating disorders have complex medical needs requiring multidisciplinary care. Improved linkages and referral pathways between obesity and eating disorders are strongly needed to facilitate effective concurrent treatment of both conditions.

Participant recruitment for paediatric research using social media: A practical ‘how-to’ guide for researchers

2026-07-02T23:48:41Z

Participant recruitment for paediatric research using social media: A practical ‘how-to’ guide for researchers Lang, Sarah; Day, Kaitlin; Gallagher, Emma; Jebeile, Hiba; Collins, Clare E; Baur, Louise A; Truby, Helen Aim: Social media platforms are being increasingly used to support participant recruitment into paediatric health-related research. This study aimed to develop a multi-phase approach for using social media as a recruitment strategy for paediatric research studies. Methods: The process was informed by the authors' prior experiences recruiting for paediatric obesity-related research studies, expertise in social media marketing and digital participant/ patient recruitment. Reflection on these experiences resulted in the iterative creation of a draft process which was further refined. A narrative literature review using a structured search was conducted to refine and augment the content and finalise the process. Results: A six-phase recruitment approach was developed that includes: (i) plan for social media use as a recruitment strategy, (ii) explore relevant ethical considerations to protect the wellbeing of potentially vulnerable groups and create an ethical management plan, (iii) identify and understand the different target audiences and develop the advertising strategy, (iv) develop and design campaign content, (v) implement, monitor and iteratively refine the recruitment campaign, (vi) evaluate the campaign success. Potential activities and key considerations relevant for paediatric research are presented within each phase. Conclusion: Due to the widespread use and diverse characteristics of social media users, social media has the potential to disseminate details of research opportunities to community members who may otherwise not hear about, engage with, and potentially benefit from research participation. Researchers should collaborate with communication experts and target audiences to generate relevant and effective recruitment campaigns. Researchers should implement processes to protect vulnerable audiences' wellbeing at each stage of the process. Recruitment via social media may support wider community participation in research studies designed to improve young people's health.

Eating disorder risk during behavioral weight management in adults with overweight or obesity: A systematic review with meta-analysis

2026-07-02T23:44:06Z

Eating disorder risk during behavioral weight management in adults with overweight or obesity: A systematic review with meta-analysis Jebeile, Hiba; Libesman, Sol; Melville, Hannah; Low-wah, Timothy; Dammery, Genevieve; Seidler, Anna L; Jones, Rebecca A; McMaster, Caitlin M; Paxton, Susan J; Hill, Andrew J; Ahern, Amy L; Garnett, Sarah P; Braet, Caroline; Wilfley, Denise E; Baur, Louise A; Lister, Natalie B This systematic review examined change in eating disorder risk during weight management interventions. Four databases and clinical trials registries were searched in March and May 2022, respectively, to identify behavioral weight management intervention trials in adults with overweight/obesity measuring eating disorder symptoms at pre- and post-intervention or follow-up. Random effects meta-analyses were conducted examining within group change in risk. Of 12,023 screened, 49 were eligible (n = 6337, mean age range 22.1 to 59.9 years, mean (SD) 81(20.4)% female). Interventions ranged from 4 weeks to 18 months, with follow-up of 10 weeks to 36 months post-intervention. There was a within group reduction in global eating disorder scores (20 intervention arms; Hedges' g = -0.27; 95% CI -0.36, -0.17; I2 67.1%) and binge eating (49 intervention arms; -0.66; 95% CI -0.76, -0.56; I2 82.7%) post-intervention, both maintained at follow-up. Of 14 studies reporting prevalence or episodes of binge eating, all reported a reduction. Four studies reported eating disorder symptoms, not present at baseline, in a subset of participants (0%-6.5%). Overall, behavioral weight management interventions do not increase eating disorder symptoms for most adults; indeed, a modest reduction is seen post-intervention and follow-up. A small subset of participants may experience disordered eating; therefore, monitoring for the emergence of symptoms is important.

Dietary restraint, binge eating and adherence to an adolescent intensive behavioural weight management intervention: a Fast Track to Health sub-study

2026-07-01T02:30:28Z

Dietary restraint, binge eating and adherence to an adolescent intensive behavioural weight management intervention: a Fast Track to Health sub-study House, Eve T; Lister, Natalie B; Baur, Louise A; Garnett, Sarah P; Gow, Megan L; Kwok, Cathy; Jebeile, Hiba Purpose Dietary restraint often increases or remains unchanged following adolescent weight management interventions. It is unknown whether dietary restraint change in such interventions is associated with binge eating risk or intervention adherence. This study examined associations between (1) dietary restraint, measured using the Eating Disorder Examination Questionnaire (EDE-Q) and Dutch Eating Behaviour Questionnaire (DEBQ); (2) changes in dietary restraint and binge eating; and (3) changes in dietary restraint, anthropometry, and adherence throughout a weight management intervention. Methods Secondary data analysis of a clinical trial of behavioural weight management interventions involving adolescents (13–17 years) with obesity and related complications. Associations between dietary restraint, binge eating, and BMI z-score were examined using Pearson or Spearman’s rank correlation. Differences in dietary restraint change between adherers and non-adherers were examined by independent samples t-tests or Mann–Whitney U tests. Results 141 adolescents (14.8 years, 49.6% female) were recruited; 136 had baseline, 130 week-4, 120 week-16, and 92 week-52 data included in analyses. EDE-Q and DEBQ restraint scores were correlated at all timepoints (r = 0.442–0.579, all p < 0.001). Changes in dietary restraint and binge eating from baseline to week-4 and week-16 were not correlated. Week-52 change in DEBQ dietary restraint was associated with change in binge eating (r = 0.347, p < 0.001). Correlations between changes in dietary restraint and BMI z-score and differences in change in dietary restraint between adherers and non-adherers were not significant. Conclusion The findings do not provide robust evidence of dietary restraint as a marker of adherence or binge eating risk during a behavioural weight management intervention.

Dieting Practices of Adolescents Seeking Obesity Treatment

2026-07-01T02:31:53Z

Dieting Practices of Adolescents Seeking Obesity Treatment Jebeile, Hiba; House, Eve T; Baur, Louise A; Kwok, Cathy; Collins, Clare E; Garnett, Sarah P; Lister, Natalie B Background: Adolescents with obesity participate in self-directed weight loss attempts, and these may be associated with disordered eating. This study aimed to understand prior engagement with a dietitian and previous dieting practices of adolescents presenting for obesity treatment. Additionally, we aimed to understand the association between prior dieting and eating disorder risk, binge eating, weight bias internalisation and body image. Methods: This cross-sectional study included 141 adolescents (median [IQR] age: 14.8 [13.8-15.7] years) with BMI 35.28 (31.99-38.57) kg/m2 and ≥1 related complication presenting for a prescriptive dietary intervention. Adolescents were asked whether they had previously seen a dietitian (yes/no) and/or previously trialled any other diets for weight management. Associations between reported diets and the Eating Disorder Examination Questionnaire (EDE-Q), the Binge Eating Scale, the Weight Bias Internalisation scale and Body Appreciation Scale scores were assessed using multiple one-way ANOVAs. Results: A total of 68 (48.2%) adolescents had previously seen a dietitian and 106 (75.2%) had trialled at least one diet. Most adolescents had used one diet type (n = 74; 52.5%), and 29 (20.6%) had used two or three different diets. Most adolescents reported following a healthy eating pattern (n = 76; 53.9%), with 11 trying a low-carbohydrate diet (7.8%) or a specific eating plan, e.g., low sugar, vegetarian (n = 11; 7.8%). There were no associations between dieting attempts and scores of measures of disordered eating, weight bias or body appreciation. Conclusions: Many adolescents presenting for obesity treatment will have trialled diets, with or without the support of a dietitian. Clinicians providing nutrition education and prescribing dietary interventions should be aware of this and the potential influence on adolescent perceptions of dieting practices.

Facets of Dietary Restraint Associated With Disordered Eating Behaviors Among Children and Adolescents With Higher Weight

2026-07-01T01:34:23Z

Facets of Dietary Restraint Associated With Disordered Eating Behaviors Among Children and Adolescents With Higher Weight D'Adamo, Laura; Christian, Caroline; Jebeile, Hiba; Wilfley, Denise E; Eddy, Kamryn T; Boutelle, Kerri; Zucker, Nancy; Peterson, Carol B; Celio-Doyle, Angela; Le Grange, Daniel; Goldschmidt, Andrea B Objective: Self-directed dietary restraint (i.e., outside of evidence-based weight management programs) has been associated with disordered eating in youth. This study examined associations between maladaptive facets of dietary restraint and disordered eating among youth with higher weight. Methods: Participants (N = 529; mean age = 10.8 ± 2.08; BMI ≥ 85th percentile) self-reported dietary restraint (restraint over eating, avoidance of eating, food avoidance, desire for an empty stomach, and dietary rules) and disordered eating behaviors (i.e., objective and subjective binge eating, driven exercise, and vomiting) over the past 3 months. Network analysis estimated partial correlations between restraint factors and disordered eating behaviors. Results: The restraint item most strongly associated with disordered eating behaviors was "dietary rules," which was associated with "driven exercise" and "subjective binge eating." The disordered eating behavior most strongly connected to restraint was "subjective binge eating," which was positively associated with "dietary rules," "desire for an empty stomach," and "food avoidance." Conclusions: Trying to follow definite dietary rules may be associated with disordered eating behaviors in youth with higher weight. Prospective research is needed to examine causality among youth undergoing weight management interventions, which could inform screening and monitoring of restraint prior to and during weight management.

The recruitment of adolescents with obesity to a randomised controlled trial: A Fast Track to Health sub-study

2026-07-01T01:15:06Z

The recruitment of adolescents with obesity to a randomised controlled trial: A Fast Track to Health sub-study House, Eve T; Ghouri, Hamna; Baur, Louise A; Collins, Clare E; Gow, Megan L; Truby, Helen; Jebeile, Hiba; Lister, Natalie B Aims: Behavioural weight management interventions facilitate short to medium-term weight and cardiometabolic improvements in adolescent obesity. However, recruiting adolescents to trials of such interventions is challenging. This study describes strategies used to recruit adolescents with obesity into the Fast Track to Health (Fast Track) trial, conducted at two tertiary paediatric centres in Australia. Methods: Fast Track (HREC/17/SCHN/164) was a randomised controlled trial that recruited 13-17-year-olds with obesity and ≥ 1 cardiometabolic complication, from December 2017 to March 2022. Families underwent phone screening, followed by in-person screening appointments. Recruitment strategies were grouped and enrolment yield by strategy was calculated. Results: Of 308 inquiries received, 141 (45.8 %) adolescents were recruited. The most successful strategy was referral from specialists at participating centres (21.2 % enrolment yield), followed by referrals from family/friends (6.5 %), other doctors/general practitioners (3.6 %), and social media (3.6 %). Social media was used for 11 months only (enrolment yield - 8.5 %). Recruitment strategies with low yield were study flyers/posters (1.6 %), digital/print media (1.3 %), and the study website (1.0 %). Of 137 adolescents excluded at phone screening, most were due to disinterest in participation or inability to make contact (60.6 %). Of 171 adolescents attending in-person screening, 30 did not meet inclusion criteria (n = 7 of those excluded had no metabolic complications, n = 7 were outside the BMI range). Conclusion: Connecting with medical specialists may be important to support the engagement of treatment-seeking adolescents with obesity in clinical trials. Further research is needed to identify methods of enhancing clinical trial recruitment in primary care, community settings, and online.

Identifying Eating Disorders in Adolescents and Adults Living With Higher Weight: An Updated Systematic Review of Questionnaire Diagnostic Accuracy

2026-07-01T01:10:56Z

Identifying Eating Disorders in Adolescents and Adults Living With Higher Weight: An Updated Systematic Review of Questionnaire Diagnostic Accuracy House, Eve T; McMaster, Caitlin M; Lister, Natalie B; Jardine, Isabelle R.; Lorien, Sasha J; Seidler, Anna Lene; Jebeile, Hiba Objective To update the evidence regarding the diagnostic accuracy of eating disorder (ED) questionnaires in adolescents and adults with higher weight. Method Five databases were systematically searched from 2020 to November 2025 (CRD420251186115). Included studies reported on the diagnostic accuracy of self-report questionnaires against a clinical interview to identify EDs and disordered eating behaviors (DEBs) in adolescents and adults with higher weight. Narrative synthesis was conducted, and findings from new studies were synthesized alongside previously identified studies. Results Thirty-two studies (5 new) were included, reporting on the diagnostic accuracy of 13 questionnaires in adults and 5 in adolescents. The diagnostic accuracy of questionnaires was examined to identify any ED (5 questionnaires in adults, 0 adolescents), binge-eating disorder (8 adult, 2 adolescent), DEBs (e.g., binge eating, purging) (4 adult, 1 adolescent), loss-of-control eating (1 adult, 2 adolescent), bulimia nervosa, atypical anorexia nervosa, purging disorder, and night eating syndrome (each n = 1 adult, 0 adolescent). The Eating Disorder Examination Questionnaire (7 studies; sensitivity 0.16–0.88; specificity 0.54–1.0), Binge Eating Scale (6 studies; sensitivity 0.37–0.98; specificity 0.48–0.96), and Questionnaire on Eating and Weight Patterns (6 studies; sensitivity 0.07–1.0; specificity 0.0–1.0) were most used. Discussion Progress in evaluation of the diagnostic accuracy of ED questionnaires in people with higher weight has been limited. There remains a lack of evidence regarding the diagnostic accuracy of questionnaires in adolescents and a lack of sufficiently sensitive questionnaires to identify EDs other than binge-eating disorder. Assessing the diagnostic accuracy of questionnaires in people with higher weight remains a research priority. Summary Eating disorders and higher weight commonly co-occur; eating disorder screening and assessment is recommended as part of care for people seeking support with weight loss; however, recommendations on which tools to use are lacking. Thirty-two studies have been identified that report on the diagnostic accuracy of self-reported eating disorder questionnaires, with the majority focused on identifying binge-eating disorder or binge-eating behaviors. To date, the diagnostic accuracy of the Binge Eating Scale has been most extensively assessed to identify binge-eating disorder in adults, generally demonstrating good sensitivity. Diagnostic accuracy studies of eating disorder questionnaires for adolescents with higher weight are lacking. Assessment of the diagnostic accuracy of existing questionnaires or development of tailored questionnaires to identify restrictive eating disorders in adolescents and adults with higher weight is needed.

The Prevalence of Eating Disorders and Disordered Eating in Adults Seeking Obesity Treatment: A Systematic Review With Meta-Analyses

2026-06-30T23:43:12Z

The Prevalence of Eating Disorders and Disordered Eating in Adults Seeking Obesity Treatment: A Systematic Review With Meta-Analyses Melville, Hannah; Lister, Natalie B; Libesman, Sol; Seidler, Anna Lene; Cheng, Hoi Yuk; Kwan, Yuen Lam; Garnett, Sarah P; Baur, Louise A; Jebeile, Hiba Objective: To estimate the prevalence of eating disorders and disordered eating in adults seeking obesity treatment. Method: Databases, MEDLINE, Embase, and PsycINFO, were searched to 20th March 2025. Studies reporting the prevalence of eating disorders or disordered eating at presentation to obesity treatment in adults (≥ 18 years) with overweight (BMI 25 to< 30 kg/m 2) or obesity (BMI ≥ 30 kg/m 2), with ≥ 325 participants to ensure a representative sample, were included. A random-effects model was used to pool prevalence estimates of eating disorders and disordered eating. Results: 85 studies were included (n = 94,295, 75.9% female, median (IQR) age 44 (5) years, BMI 46 (10) kg/m 2). When assessed by clinical interview, the pooled prevalence of binge-eating disorder (Diagnostic and Statistical Manual of Mental Disorders-5) was 14% (95% CI: 7 to 22, prediction interval [PI]%: 0 to 43, k = 10, n = 8534), and bulimia nervosa 1% (95% CI: 0 to 1, PI%: 0 to2, k = 9, n = 9448, τ 2 = 0). When assessed using the Binge Eating Scale, the prevalence of self-reported moderate severity binge eating was 26% (95% CI: 23 to 28, PI%: 18 to 33, k = 12, n = 8113, τ 2 = 0.001) and severe binge eating was 12% (95% CI: 8 to 16, PI%:0 to 31, k = 18, n = 12,136, τ 2 = 0.01). Discussion: Obesity and eating disorders or disordered eating do co-occur. There was variability between studies and between the prevalence of eating disorders and disordered eating in adults presenting for obesity treatment. It is critical that clinicians are well resourced to effectively identify individuals with eating disorders and disordered eating and provide appropriate treatment pathways.

Pilot evaluation of early childhood health promotion training for primary health professionals in Australia

2026-07-10T01:23:40Z

Pilot evaluation of early childhood health promotion training for primary health professionals in Australia House, Eve T; Kerr, Erin; Taki, Sarah; Denney-Wilson, Elizabeth; Baur, Louise A; Cheng, Heilok; Vlahos, Sharlene; Wen, Li Ming Issue Addressed: This study evaluated the feasibility, acceptability and effectiveness of an online continuing professional development (CPD) program for primary health professionals (PHPs) regarding early childhood nutrition and associated health behaviours. Methods: An action research approach was used. Process evaluation included webinar observation to identify behaviour change and adult learning techniques used and post-webinar acceptability surveys. Impact evaluation examined changes in knowledge, attitudes, practices and self-efficacy using online surveys before and 1 month following webinars. Interviews with PHPs and facilitators informed process and impact evaluation. Results: Thirty-six webinars were delivered from 2022–24, 1246 PHPs registered, and 463 attended live. Facilitation style reflected adult learning principles and incorporated behaviour change techniques targeting knowledge and skill improvement. Facilitators and attendees valued the national scope of the program but highlighted challenges achieving national reach and meeting the needs of a broad audience. Over 90% of attendees provided positive feedback in acceptability surveys; this was reflected in qualitative feedback: attendees enjoyed the practical, interactive content and opportunity to review program material. There was low uptake of effectiveness surveys. In qualitative interviews, PHPs reported intent to change practice; however, the extent of implementation of program content into clinical practice varied. Conclusions: CPD regarding early childhood health promotion and obesity prevention was well received by PHPs. Future pro-grams should consider incorporating comprehensive impact evaluation. So What? Findings should inform future program design, including the need for interactive and practical education. Reach and sustainability of future programs may be enhanced through integration into existing education services for PHPs.

Misaligned Attitudes and Perceptions Among Adolescents Living With Obesity, Caregivers and Healthcare Professionals: ACTION Teens Australia Survey Study

2026-06-30T07:05:14Z

Misaligned Attitudes and Perceptions Among Adolescents Living With Obesity, Caregivers and Healthcare Professionals: ACTION Teens Australia Survey Study Kwok, Cathy; Bentley, Nicholas; Curran, Jacqueline; Lister, Natalie; Truby, Helen; Baur, Louise A Aims: To explore perceptions, attitudes, behaviours and barriers relating to adolescent weight management in Australia.Methods: ACTION Teens was a cross-sectional, survey-based study. Adolescents with high body mass index (BMI), caregiversand healthcare professionals (HCPs) from 10 countries completed an online survey in 2021. This analysis was limited to partici-pants in Australia. Adolescents (N = 298) were aged 12–< 18 years with BMI ≥ 95th percentile for age and sex. Caregivers (N = 276)lived with an eligible adolescent and were involved in healthcare decisions. HCPs (N = 137) had ≥ 2 years' clinical experience andsaw/treated ≥ 10 adolescents with high BMI per month. Outcomes included perceptions of high BMI, weight loss (history, bar-riers, definition of success), weight-management information sources, and history/assessment of weight-related conversations.Results: Most adolescents believed their health was good/very good/excellent (83%) but worried about weight impacting their fu-ture health (69%). More caregivers indicated their adolescent's health was good/very good/excellent (92%). More adolescents thancaregivers agreed weight loss was entirely the adolescent's responsibility (72% vs. 28%), reported a recent weight-loss attempt bythe adolescent (52% vs. 21%) and believed initiating weight-related discussions with HCPs was the adolescent's responsibility(62% vs. 51%). Only 42% of adolescents had recently discussed weight with an HCP; although 66% of this subset trusted theirHCP's advice, the adolescents reported both positive (73%) and negative (44%) feelings following discussions.Conclusions: To improve adolescent obesity care in Australia, improved communication between adolescents and caregivers/HCPs is needed. We recommend HCPs raise the topic of weight with adolescents in a sensitive manner.ClinicalTrials.gov identifier: NCT05013359.

Components of Adolescent Behavioural Interventions With Eating Disorder Outcomes: Systematic Review With Intervention Mapping

2026-06-30T07:00:52Z

Components of Adolescent Behavioural Interventions With Eating Disorder Outcomes: Systematic Review With Intervention Mapping Lister, Natalie B; Khalid, Rabia; Jardine, Isabelle R; Pryde, Samantha; Melville, Hannah; Seidler, Anna L; Hunter, Kylie E; Ahern, Amy L; Baur, Louise A; Braet, Caroline; Garnett, Sarah P; Hill, Andrew J; Maguire, Sarah; Nicholls, Dasha; Paxton, Susan J; Piya, Milan K; Sainsbury, Amanda; Steinbeck, Katharine; Wilfley, Denise E; Cooper, Kelly; Dammery, Genevieve; Grunseit, Alicia M; Heeren, Faith Anne N; Jones, Rebecca A; Kyle, Theodore K; Quigley, Fiona; Robbins, Molly; Yourell, Jacqlyn; Bean, Melanie K; Bonham, Maxine P; Boutelle, Kerri N; Cardel, Michelle I; Darling, Katherine E; Dordevic, Aimee L; Eichen, Dawn M; Epstein, Leonard H; Goldschmidt, Andrea B; Jelalian, Elissa; Lofrano-Prado, Mara Cristina; Naets, Tiffany; Prado, Wagner L; Skjåkødegård, Hanna F; Danielsen, Yngvild Sørebø; Stein, Richard I; Tanofsky‐Kraff, Marian; Van Eyck, Annelies; Vidmar, Alaina P; Yanovski, Jack A; Johnson, Brittany J; Jebeile, Hiba Objective To understand delivery features and intervention strategies of adolescent weight management interventions which may influence eating disorder risk. Methods Systematic searches in four databases and two trial registries to identify randomised controlled trials in adolescents with overweight/obesity measuring eating disorder risk pre‐ and post‐intervention. Delivery features and intervention strategies were coded from published descriptions using a project‐specific codebook, validated by trial investigators and narratively synthesised. Results Of 11 860 records screened, 23 trials, with 54 intervention arms, were included in the analysis. Most interventions focused on weight loss and maintenance (54%) and were informed by a cognitive behavioural framework (43%). Interventions commonly targeted an individual with a support person (70%). Median intervention duration was 26 weeks, with weekly (35%) or staged (e.g., weekly, then monthly) visit (41%) frequency. Interventions had a mean (SD) of 30 (16.1) intervention strategies. Most included healthy eating education (89%), physical activity education (89%) and problem‐solving barriers to dietary change (80%). Few included mental health strategies (17%). Interventions included ‘dietary prescription’ (65%), and 78% promoted ‘healthful/helpful eating behaviours’. Conclusion Weight management interventions are complex and vary in delivery approach and strategies used to change behaviors. Characterising interventions is a critical first step to understanding how weight management interventions' influence eating disorder risk.

Changes in Psychosocial Outcomes Reported in Behavioral Intervention Trials for Children and Adolescents with Overweight and Obesity: A Scoping Review

2026-07-15T23:40:57Z

Changes in Psychosocial Outcomes Reported in Behavioral Intervention Trials for Children and Adolescents with Overweight and Obesity: A Scoping Review Kwok, Cathy; Sacco, Sabrina; Lister, Natalie B; Alberga, Angela S; Baur, Louise A; Booij, Linda; Carrière, Kimberly; Garnett, Sarah P; Jebeile, Hiba Background: Pediatric obesity is associated with co-occurring psychosocial conditions, which may be impacted by obesity treatment. Past systematic reviews have shown positive effects for specific psychosocial outcomes following behavioral interventions. This review aimed to extend these findings by mapping patterns of change for the totality of psychosocial outcomes reported. Methods: We conducted a scoping review following published guidelines. We searched 11 databases to identify behavioral intervention trials for children and adolescents living with overweight or obesity that measured at least one psychosocial outcome pre–post. Outcomes were grouped into categories thematically, and data were synthesized based on the timepoint (post-intervention, latest follow-up), intervention arm (active, no-intervention control), and type of change reported (difference between arms, change over time). Results: Of 1172 articles screened, 197 articles (169 trials) met the inclusion criteria, with a combined sample of 18,694 children and adolescents. A total of 372 outcomes were identified and grouped into eight constructs. Across all outcomes and timepoints, many trials reported no difference or a difference favoring the active intervention arm over the no-intervention control arm. Likewise, most active intervention arms showed improvements or no change over time, though five of 169 trials reported worsening in a psychosocial outcome at post-intervention. Most no-intervention control arms showed no change over time. Conclusions: Behavioral interventions are associated with improvements or no change in psychosocial health across a broad range of outcomes assessed. Consensus on core psychosocial outcomes is needed to reduce heterogeneity and ensure outcomes are relevant to children and adolescents living with obesity.

Eating Disorders In weight-related Therapy (EDIT) Collaboration: Rationale and study design

2026-06-30T06:34:59Z

Eating Disorders In weight-related Therapy (EDIT) Collaboration: Rationale and study design Lister, Natalie B; Baur, Louise A; Paxton, Susan J; Garnett, Sarah P; Ahern, Amy L; Wilfley, Denise; Maguire, Sarah; Sainsbury, Amanda; Steinbeck, Katharine; Braet, Caroline; Hill, Andrew; Nicholls, Dasha; Jones, Rebecca A; Dammery, Genevieve; Grunseit, Alicia; Cooper, Kelly; Kyle, Theodore K; Heeren, Faith N; Hunter, Kylie E; McMaster, Caitlin M; Johnson, Brittany J; Seidler, Anna Lene; Jebeile, Hiba The cornerstone of obesity treatment is behavioural weight management, resulting in significant improvements in cardio-metabolic and psychosocial health. However, there is ongoing concern that dietary interventions used for weight management may precipitate the development of eating disorders. Systematic reviews demonstrate that, while for most participants medically supervised obesity treatment improves risk scores related to eating disorders, a subset of people who undergo obesity treatment may have poor outcomes for eating disorders. This review summarises the background and rationale for the formation of the Eating Disorders In weight-related Therapy (EDIT) Collaboration. The EDIT Collaboration will explore the complex risk factor interactions that precede changes to eating disorder risk following weight management. In this review, we also outline the program of work and design of studies for the EDIT Collaboration, including expected knowledge gains. The EDIT studies explore risk factors and the interactions between them using individual level data from international weight management trials. Combining all available data on eating disorder risk from weight management trials will allow sufficient sample size to interrogate our hypothesis: that individuals undertaking weight management interventions will vary in their eating disorder risk profile, based on personal characteristics and intervention strategies available to them. The collaboration includes the integration of health consumers in project development and translation. An important knowledge gain from this project is a comprehensive understanding of the impact of weight management interventions on eating disorder risk.

Psychosocial outcomes of the Fast Track to Health clinical trial in adolescents with obesity

2026-06-24T04:50:42Z

Psychosocial outcomes of the Fast Track to Health clinical trial in adolescents with obesity Lister, Natalie B; Baur, Louise A; Gow, Megan L; House, Eve T; Kwok, Cathy; Varady, Krista A; Jebeile, Hiba Introduction: Adolescent obesity requires effective and accessible treatment. Intensive dietary interventions may be used as adjunctive therapy to behavioral interventions, and lead to weight loss. The effects of behavioural interventions on psychosocial outcomes are mixed, and the impact of intensive interventions with shifts away from normal eating habits and social norms is not clear. Methods: Adolescents (13-17years) with obesity and ≥1 complication participated in a 52-week RCT, conducted 2018-2023 (ACTRN12617001630303). The intervention compared a 4-week very low energy diet followed by intermittent or continuous energy restriction (48weeks). Anthropometry and psychosocial health were assessed at baseline, weeks-4, -16, and -52 including Dutch Eating Behaviour Questionnaire (DEBQ), Rosenberg Self-Esteem Scale (RSE), Weight Bias Internalization Scale (WBIS), Body Appreciation Scale (BAS), and Depression Anxiety and Stress Scale (DASS). Intention to treat analysis using linear mixed models investigated changes over time between intervention groups. Results: 141 adolescents (70 female) were enrolled and 97 (48 female) completed the intervention. There were significant reductions in external eating (DEBQ, p<0.001), weight bias internalization (WBIS, p<0.001), anxiety (DASS, p<0.001), and stress (DASS, p=0.082), and significant increases in self-esteem (RSE, p<0.001) and body appreciation (BAS, p<0.001) in both groups. There were increases in dietary restraint (DEBQ, p=0.595), and decreases in emotional eating (DEBQ, p=0.645) and depression (DASS, p=0.381) which returned to baseline by the end of intervention. Reductions in BMIz were significantly associated with improvements in emotional eating (r=0.215, p=0.046, n=87) and body appreciation (r=-0.235, p=0.027, n=88). Conclusion: Intensive interventions incorporating dietary and behavioural components were associated with improvements in psychosocial health among adolescents with obesity associated complication

Submission on the Exposure Draft of the Children’s Online Privacy Code 2026

2026-07-02T23:01:30Z

Submission on the Exposure Draft of the Children’s Online Privacy Code 2026 Humphry, Justine; Gray, Joanne; Mrva-Montoya, Agata; Hutchinson, Jonathon; Ahmadpour, Naseem; Lal, Shalini; Peralta, Louisa; Egliston, Ben; Page Jeffery, Catherine The submission responds to the Exposure Draft of the Privacy (Children’s Online Privacy) Code 2026. The draft Code represents a meaningful step towards protecting children’s privacy online, including the best interests test, privacy-by-default requirements, the consent framework, transparency requirements, and the right to destruction of personal information. In this submission, we address a number of areas that can be further strengthened in relation to the sale or commercial transfer of children’s personal information, accessibility requirements for children with disabilities, operation of consent practices, privacy by design, just-in-time requirements for handling personal information, privacy safeguards for age assurance systems, and definitions that are flexible and fit for purpose. To address these issues and strengthen the Code, we have made nine recommendations for consideration.

Climate Change, Place and Mental Health Incubator Submission to the NSW Minimum Energy Efficiency Rental Standards Consultation 2026

2026-06-02T05:38:47Z

Climate Change, Place and Mental Health Incubator Submission to the NSW Minimum Energy Efficiency Rental Standards Consultation 2026 Bower, Marlee; Smout, Scarlett; Dawkins, Jacqueline; Sedgwick, Camilla; Haddad, Shamila; Brambilla, Arianna; Bryant, Gareth; Daniel, Lyrian; Lynch, A; Palmer, S; Cheung, A; K, C; Howard, Amanda; Jegasothy, Edward; McClellan, Jo; McGrath, Laura; O'Sullivan, Kimberley; Stapinski, Lexine; Swain, Jon; Teesson, Maree We are pleased to see that the NSW Department of Climate Change, Energy, the Environment and Water and NSW Fair Trading are seeking feedback on the introduction of minimum energy efficiency rental standards, and we welcome the opportunity to provide input. Our submission seeks to highlight the importance of considering mental health in the design, implementation, and evaluation of MEERS. The submission combines empirical evidence collated by the Investigator team with rich insights from the real-world experiences of the Lived Experience Advisory Group. Rather than being structured by consultation questions, the submission is organised by 1. The potential impacts of MEERS on mental health, 2. Other considerations for the design and implementation of MEERS, 3. Learnings from other jurisdictions, and a final note on measurement and evaluation.

Integrating rural community screening initiatives into general practice: a qualitative evaluation of the Care2U rural outreach pilot program

2026-05-14T03:03:48Z

Integrating rural community screening initiatives into general practice: a qualitative evaluation of the Care2U rural outreach pilot program Wong, Kam Cheong; Osuagwu, Uchechukwu Levi; Wenkart, Edweana; Bapat, Yash; McCrossin, Timothy; Mahns, David Diabetes and cardiovascular disease profoundly affect rural Australians. The Care2U program was proposed to integrate rural community-based screening with general practice systems. Its innovative feature is a closed-loop communication model between outreach teams and general practitioners (GPs), enabling systematic tracking of diagnoses, management and outcomes for screening-detected medical conditions. This study explored the acceptability, feasibility and sustainability of the proposed model from healthcare providers’ perspectives.

Designing a research room for a National Hybrid Particle Therapy Facility (protons, carbon and other ions) - white paper

2026-03-23T22:44:54Z

Designing a research room for a National Hybrid Particle Therapy Facility (protons, carbon and other ions) - white paper Ahern, Verity; Haworth, Annette Representatives from research institutes across Australia, international particle therapy centres, ANSTO and leading universities attended a workshop to examine how a dedicated research room at the proposed National Hybrid Particle Therapy Facility could complement existing programs and infrastructure, enable new scientific opportunities and support workforce development across nuclear science, health, space, accelerator physics and related fields. This white paper and supplementary material capture the workshop's findings.

Stakeholder Perspectives on the Term Time Toxicity to Describe Health Care Contact Time Associated With Cancer Treatments

2026-02-18T00:15:49Z

Stakeholder Perspectives on the Term Time Toxicity to Describe Health Care Contact Time Associated With Cancer Treatments Stevens, Samuel Xavier; El-Katateny, Ella; Gupta, Arjun; De Abreu Lourenço, Richard; Shaw, Joanne; Booth, Christopher M; Vardy, Janette L Purpose: The labeling of the time-opportunity costs of cancer care as time toxicity has stimulated research into the impact of treatment time on patients, yet stakeholder views on this potentially value-laden term remain unreported. Existing qualitative research highlights significant individual differences in the perception of burden from treatment-related time. The purpose of this study was to report patient, caregiver, and oncologist reactions to the term time toxicity. Methods: Semistructured interviews were conducted with purposively selected adults with advanced GI cancers and their caregivers from one metropolitan and one regional center, as well as GI oncologists recruited from participating sites, email, and social media advertising. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis tied to a framework approach. Results: Forty-five people, including patients (n = 20), caregivers (n = 10), and GI medical oncologists (n = 15) were interviewed. Thematic analysis identified three major themes: (1) Critiques of toxicity, (2) supportive perspectives, and (3) alternative terminology. Although some participants felt that describing time as a treatment-related toxicity was both accurate and provided a potential benefit to health systems optimization, many felt that the word toxicity conveyed an unhelpful value judgment on time invested for treatment and could overlook positive experiences of care. Alternative value-neutral or positive terms were suggested (eg, time commitment). Conclusion: We identified divergent perspectives on the terminology used to describe treatment-related health care contact time. These differences likely reflect subjective experiences of treatment time. Further research should explore this concept in more diverse populations.

Transmission and Non-transmission of Melanoma From Deceased Solid Organ Donors to Transplant Recipients: Risks and Missed Opportunities

2026-02-02T02:29:30Z

Transmission and Non-transmission of Melanoma From Deceased Solid Organ Donors to Transplant Recipients: Risks and Missed Opportunities Rosales, Brenda; Hedley, James; De La Mata, Nicole; Cavazzoni, Elena; Vajdic, Claire; Thompson, John; Kelly, Patrick; Wyburn, Kate; Webster, Angela Background. Biovigilance concerns are in tension with the need to increase organ donation. Cancer transmission risk from donor to recipient may be overestimated, as non-transmission events are rarely reported. We sought to estimate melanoma transmission risk in deceased organ donation and identify missed opportunities for donation in an Australian cohort with high melanoma prevalence. Methods. We used a population-based approach and linked deceased organ donors, transplant recipients, and potential donors forgone, 2010–2018, with the Central Cancer Registry (CCR), 1976–2018. We identified melanomas using ICD-O-3 classification, assessed the probability of transmission, and compared suspected melanoma history in potential donors forgone with melanoma notifications in the CCR. Results. There were 9 of 993 donors with melanoma in CCR; 4 in situ low-risk and 5 invasive high-to-unacceptable risk. Four were unrecognized before donation. Of 16 transplant recipients at risk, we found 0 of 14 transmission events (2 recipients had insufficient follow-up). Of 35 of 3588 potential donors forgone for melanoma risk alone, 17 were otherwise suitable for donation; 6 of 35 had no melanoma in CCR, 2 of 35 had in situ melanomas and 9 of 35 had thin invasive melanomas (localized, ≤0.8 mm thickness). Conclusions. Our findings contribute to current evidence that suggests donors with melanomas of low metastatic potential may provide an opportunity to safely increase organ donation and so access to transplantation.

Cancer mortality in kidney transplant recipients: An Australian and New Zealand population-based cohort study, 1980-2013

2026-02-02T01:06:34Z

Cancer mortality in kidney transplant recipients: An Australian and New Zealand population-based cohort study, 1980-2013 Rosales, Brenda; De La Mata, Nicole; Vajdic, Claire; Kelly, Patrick; Wyburn, Kate; Webster, Angela Cancer burden is increasing in kidney transplant recipients, but differences in mortality compared to the general population remain unclear. We sought to compare cancer mortality in paediatric and adult kidney transplant recipients with the general population and describe any differences, by site, age and sex, country and over time. We included kidney transplant recipients from the Australian and New Zealand Dialysis and Transplantation Registry, 1980–2013. Date of death and underlying cause of death were ascertained by data-linkage and classified using ICD10AM codes. Indirect standardisation was used to estimate standardised mortality ratios (SMR). There were 5,284 deaths in 17,628 kidney transplant recipients over 175,084 person-years of observation, including 1,061 (20%) cancer deaths. Relative cancer mortality was higher than the general population for all-site (SMR 2.9, 95% CI 2.7–3.1) cancer and highest for nonmelanoma skin cancer (SMR 50.9, 95% CI 43.5–59.6) and lymphoma (SMR 42.2, 95% CI 35.3–50.5). Relative cancer mortality decreased with increasing age in men (p < 0.001) and women (p = 0.001) but never reached parity with the general population. Relative mortality did not change with age for skin and lip, or colorectal cancers (p-value >0.1). Only relative colorectal cancer mortality increased over time (p = 0.002). Our study shows cancer mortality in kidney transplant recipients was higher than expected in the general population. The magnitude of excess mortality varied by cancer site, age and sex. Further evidence is needed to identify whether this variation is due to differences at diagnosis or access and effectiveness of cancer treatments in this population.

Decoding Surgical Complexity: Measuring the Impact of Operative Difficulty on Quality Outcomes Following Hepatectomy for Liver Cancer over Two Decades

2026-02-13T03:12:13Z

Decoding Surgical Complexity: Measuring the Impact of Operative Difficulty on Quality Outcomes Following Hepatectomy for Liver Cancer over Two Decades Patel, Meet; Daniel, Jonathan Ben; Bhimani, Nazim; Glover, Anthony R; Hugh, Thomas J Introduction: Operative time is commonly used as a surrogate marker for operative difficulty in liver resection, but the contribution of other intraoperative factors is less well understood. This study aimed to develop an objective, composite score to assess operative difficulty and evaluate its association with postoperative and oncological outcomes. Methods: A retrospective cohort study was conducted on patients who underwent liver resection for malignant disease between 1999 and 2023 at an Australian tertiary hospital, using a prospectively maintained database. Principal component analysis (PCA) was applied to operative time, estimated blood loss, total time of hepatic inflow occlusion and the number of packed red bloods transfused intraoperatively to derive a composite operative difficulty score. Patients were then stratified into low, moderate and high difficult groups using Gaussian mixture models (GMM). Comparison of textbook oncological outcomes (TOO) achievement and futile resection rates were assessed using Chi-squared analysis. Kaplan-Meier analysis was used to assess recurrence-free and overall survival in subgroup analysis. Results: Of 729 patients, 699 met the inclusion criteria. GMM identified three distinct operative difficulty groups: low (n=540), moderate (n=143), and high (n=16). TOO and non-futile resection rates declined with increasing difficulty: 77% and 58% (low), 47% and 52% (moderate), and 6% and 19% (high), respectively (p<0.001, p=0.004 respectively). Among patients with cholangiocarcinoma, median overall survival was inversely correlated with operative difficulty (40 months low, 16 months moderate, 7 months high, p=0.004). In patients with colorectal liver metastases, there was a trend towards worse overall survival and disease-free survival with increasing operative difficulty, however, this did not reach statistical significance. Conclusion: An objective intraoperative difficulty score was developed and demonstrated a significant inverse association with both quality and oncological outcomes. While external validation is required, these findings support the potential of operative difficulty assessment to enhance perioperative decision-making, inform patient counselling, and optimise postoperative care planning.

Non-Retrieval and Non-Utilisation of Deceased Donor Kidneys for Transplantation: An Australian Cohort Study

2026-04-29T00:09:11Z

Non-Retrieval and Non-Utilisation of Deceased Donor Kidneys for Transplantation: An Australian Cohort Study Cutting, Rachel; De La Mata, Nicole; Singla, Animesh; Hedley, James; Opdam, Helen; Clayton, Philip; Wyburn, Kate; Cavazzoni, Elena; Robertson, Paul; Pleass, Henry; Webster, Angela Background: An efficient organ donation programme must maximise transplantation following initiation of organ recovery procedures. Methods: We conducted a cohort study of deceased donors in Australia (2014-2021) using Australia and New Zealand Organ Donation Registry data to characterise kidney non-retrieval (post-incision) and non-utilisation (retrieved, not transplanted). Donor characteristics included kidney side (left/right), kidney-only procurement, kidney donor profile index (KDPI), cause of death, resuscitation, donation after circulatory/neurological determination of death (DCDD/DNDD) and donor criteria (standard SCD/extended ECD), year, age, sex, blood group, ethnicity, comorbidities, smoking, BMI, weight, remoteness, occupation and socioeconomic disadvantage. System characteristics included jurisdiction of donor hospital, retrieval team and recipient's hospital. Results: Among 7211 kidneys (3683 donors) accepted for retrieval, 675 (9%) were non-retrieved and 430 (7%) were non-utilised. Crude non-retrieval rates doubled from 5% to 10% between 2014 and 2021 (p = 0.01) while non-utilisation remained around 7% (p = 0.1). After adjustment, non-retrieval was greater among donors with KDPI ≥ 75 (OR: 4.28, 95% CI: 2.08-8.81, p < 0.001), diabetes (OR: 1.74, 95% CI: 1.25-2.43, p = 0.001) and in recent years (annual OR: 1.08, 95% CI: 1.03-1.55, p = 0.002), and lower for ECD DCDD (OR: 0.46, 95% CI: 0.26-0.81, p = 0.01). Non-utilisation was greater for SCD DCDD (OR: 1.90, 95% CI: 1.28-2.82, p < 0.001), blood group AB (OR: 2.05, 95% CI: 1.16-3.64, p = 0.03) and in recent years (annual OR: 1.08, 95% CI: 1.02-1.15, p = 0.01), and lower in Tasmania (OR: 0.28, 95% CI: 0.08-0.97) and Queensland (OR: 0.57, 95% CI: 0.36-0.92, p = 0.03). Documented reasons for non-utilisation lacked transparency but included poor perfusion (17%). Conclusion: Increasing utilisation of higher KDPI kidneys and enhancing perfusion could help maximise kidney transplantation.

Values, Preferences, and Risk Tolerance of People Waitlisted for a Kidney Transplant Regarding Potential Deceased Donor Organ Profiles: A Systematic Review

2026-01-27T04:35:53Z

Values, Preferences, and Risk Tolerance of People Waitlisted for a Kidney Transplant Regarding Potential Deceased Donor Organ Profiles: A Systematic Review Cutting, Rachel; Muscat, Danielle; Patel, Pinika; De La Mata, Nicole; Irish, Georgina; Wyld, Melanie; White, Sarah; Webster, Angela Background: Incorporating the views of people waitlisted for a kidney transplant is important when clinicians consider any donor kidney offer. Methods: We conducted a systematic review of quantitative and qualitative studies in adult patients on, or under assessment for, the kidney waitlist. We focused on views of extended criteria, increased viral (blood-borne virus), or increased cancer risk in deceased donor kidneys. We systematically searched databases and conference proceedings until April 2024, excluding studies of children, case reports, and commentaries. Studies were appraised using the Johanna Briggs Institute checklists and synthesized using a convergent segregated approach, incorporating narrative and thematic methods. Results: We included 25 studies (2630 participants) comprising quantitative surveys, questionnaires, conjoint analysis, and discrete choice experiments (n = 16; 64%) and qualitative semi-structured, in-depth interviews and focus groups (n = 9; 36%). Most studies were from the United States (n = 19; 76%) and focused on extended criteria and increased viral risk donors (n = 24; 96%), with 1 study considering general risks (4%). None focused on increased cancer-risk donors. We identified 4 themes and 2 subthemes: (1) I want to be free from dialysis, (2) I do not want more health problems, (3) I might not get another chance, (4) I desire shared decision-making but feel powerless to contribute, (4a) I need more information about my health status, prognosis and the transplant process, and (4b) I need more information about donor risk factors. Conclusion: Waitlist patients desired information and involvement in decision-making, yet individual prognoses were not fully understood. Integrating shared decision-making from pre- to post-offer will increase knowledge and enhance treatment satisfaction.

Advances in the Genetics and Pathology of Lewy Body Dementia

2026-04-28T23:39:18Z

Advances in the Genetics and Pathology of Lewy Body Dementia Scholz, Sonja W; Okubadejo, Njideka U; Prakash, Priya; Liddelow, Shane A; Ryten, Mina; Halliday, Glenda M Lewy body dementia is a heterogeneous disease that is underdiagnosed and poorly understood. Pathologically, Lewy body dementia is characterized by the accumulation of intraneuronal aggregates of misfolded α-synuclein, known as Lewy bodies and Lewy neurites. The genetic architecture of Lewy body dementia is complex, involving both common genetic variants with small risk effects and rare genetic variants with large effects. Alzheimer’s disease pathology frequently coexists with Lewy body pathology and influences the clinical presentation. A deeper understanding of the pathophysiological pathways, including mitochondrial dysfunction, lysosomal dysfunction, and neuroinflammation, can enhance disease modeling, and this knowledge will ultimately facilitate the development of therapeutic interventions. The biological relationships that Lewy body dementia shares with other neurodegenerative and psychiatric disorders may also prove crucial for the development of therapeutic strategies.

AcceSS and Equity in Transplantation (ASSET) New Zealand: protocol for a population-wide data linkage platform to investigate equity in access to kidney failure health services in New Zealand

2026-05-07T02:24:21Z

AcceSS and Equity in Transplantation (ASSET) New Zealand: protocol for a population-wide data linkage platform to investigate equity in access to kidney failure health services in New Zealand Cutting, Rachel; Webster, Angela; Cross, Nicholas; Dunckley, Heather; Beaglehole, Ben; Dittmer, Ian; Irvine, John; Walker, Curtis; Jones, Merryn; Wyld, Melanie; Kelly, Patrick; Wyburn, Kate; De La Mata, Nicole Background: Kidney transplantation is considered the ideal treatment for most people with kidney failure, conferring both survival and quality of life advantages, and is more cost effective than dialysis. Yet, current health systems may serve some people better than others, creating inequities in access to kidney failure treatments and health outcomes. AcceSS and Equity in Transplantation (ASSET) investigators aim to create a linked data platform to facilitate research enquiry into equity of health service delivery for people with kidney failure in New Zealand. Methods: The New Zealand Ministry of Health will use patients’ National Health Index (NHI) numbers to deterministically link individual records held in existing registry and administrative health databases in New Zealand to create the data platform. The initial data linkage will include a study population of incident patients captured in the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), New Zealand Blood Service Database and the Australia and New Zealand Living Kidney Donor Registry (ANZLKD) from 2006 to 2019 and their linked health data. Health data sources will include National Non-Admitted Patient Collection Data, National Minimum Dataset, Cancer Registry, Programme for the Integration of Mental Health Data (PRIMHD), Pharmaceutical Claims Database and Mortality Collection Database. Initial exemplar studies include 1) kidney waitlist dynamics and pathway to transplantation; 2) impact of mental illness on accessing kidney waitlist and transplantation; 3) health service use of living donors following donation. Conclusion: The AcceSS and Equity in Transplantation (ASSET) linked data platform will provide opportunity for population-based health services research to examine equity in health care delivery and health outcomes in New Zealand. It also offers potential to inform future service planning by identifying where improvements can be made in the current health system to promote equity in access to health services for those in New Zealand.

Outcomes of Foundational Learning in Research Methods Following Primary Medical Qualification on Surgical Research: A Retrospective Review

2026-01-12T22:34:38Z

Outcomes of Foundational Learning in Research Methods Following Primary Medical Qualification on Surgical Research: A Retrospective Review Patel, Meet; Sun, David; Starr, Maya Jane; Solanki, Dhaval; Upadhyay, Jeet; Edwards, Dominic J.A.; Raju, Arjun; Maouris, Thomas; Lombardo, Alexander; Wang, Daphne; Nagi, Karamveer; Bhimani, Nazim; Glover, Anthony R Introduction: Limited knowledge exists on how post-graduate surgical coursework programs impact surgical research outputs in Australia. This study evaluated the impact of university-based teaching in research methods and supervisor characteristics on research quality and short-term research output for students undertaking the Master of Surgery (MS) post-graduate coursework degree within Australia. Methods: A retrospective cohort analysis of students enrolled in the dissertation for The University of Sydney MS program between 2010-2020. Grades for the dissertation and research subjects were extracted from the central university analytics. PubMed and Web of Science were used to determine if the dissertation was published and identify other publications by the students. A Google search was completed to identify supervisor characteristics. Statistical analysis involved logistic regression, multiple linear regression and negative binomial regression. Results: 379 students were included in this study. Fifty-three percent of the students had an associated publication from their dissertation at a median of 18-months post-enrolment and median journal impact-factor 2.19. Students averaged 2.1 additional publications (range 0-30) two years post-dissertation completion. Students with a distinction/high distinction grade in the dissertation subject or ≥three journal publications prior were significantly more likely to publish their dissertation (OR 2.26, 95% CI=1.42-3.61, p<0.001; OR 3.35, 95% CI=1.90-5.92, p<0.001 respectively). Students who received a distinction/high distinction in the research methods subject had 64% more first-author publications within two years of finishing the dissertation (95% CI=1.20–2.23, p=0.002). Conclusion: Engagement in structured teaching in research methods and prior research experience significantly improves short-term research output amongst early surgical researchers.

Navigating complexity in liver resection: A narrative review of factors influencing intra-operative difficulty

2026-04-28T07:03:03Z

Navigating complexity in liver resection: A narrative review of factors influencing intra-operative difficulty Patel, Meet; Glover, Anthony; Hugh, Thomas J Background: Liver resection remains the cornerstone for curative management in primary liver malignancies. Liver surgery ranges from simple wedge resections to complex hepatectomies involving vascular or biliary reconstructions. The anatomical complexity of the liver and these varied surgical approaches create challenges in assessing operative difficulty. This literature review explores the key factors influencing operative difficulty in liver resection for primary liver malignancy across surgical techniques. Methods: A broad literature review was conducted to determine the factors that were associated with increased operative difficulty in liver resection using Embase, PubMed and Cochrane databases for studies published between 2000-2025. Results: This review identifies several patient, tumour, and surgical factors that influence operative difficulty in liver resection. Numerous difficult scoring systems were identified, yet their applicability across different operative approaches remains uncertain. Across open and minimally invasive techniques, tumour size and location are commonly used to determine complexity. However, debate remains regarding the optimal cut-off for tumour diameter. Other identified factors include extent of resection, patient-specific variables (e.g., cirrhosis, body mass index, previous surgeries), and surgical technique. Additionally, liver resection procedures classified based off the 2000 Brisbane terminology have been stratified into three groups of increasing difficulty. Conclusion: The ability to predict operative difficulty is useful for case selection, surgical planning, and risk stratification for meaningful shared decision making. Future research should focus on refining predictive models by integrating composite measures, including patient-reported outcomes and long-term survival. A unified, validated scoring system applicable across surgical techniques could enhance consistency in clinical practice and research to improve outcomes.

Health economic data collection tools for health care research and practice: Protocol for a systematic scoping review

2026-04-22T03:37:04Z

Health economic data collection tools for health care research and practice: Protocol for a systematic scoping review Szewczyk, Zoe; Creagh, Nicola; Belramoul, Emile; Smith, Ben; Phongsavan, Philayrath; Sarkies, Mitchell Background: Reliable cost and resource use data (hereafter referred to as cost data) forms the foundation of all economic evaluations and is essential for informing the implementation and scale-up of interventions found to be effective and efficient. Despite their importance, health intervention cost estimates are often missing, their methods of collection lack sufficient detail required for replication, and the quality of the tools used is seldom addressed in the literature. Cost data collection tools have been developed for a variety of contexts and study designs; however, none are widely adopted in practice. Aims: Undertake a systematic scoping review of scientific and grey literature to identify cost data collection tools for health services and public health research. Methods: A systematic scoping review of scientific (peer reviewed) literature and a scoping review of grey literature will be conducted in parallel. Both searches will be limited to tools available in English between January 2015 and December 2025. The tools must be publicly available (both free and for fee) for immediate use (requiring minimal adaptation). Discussion: The findings of this scoping review will provide researchers and health service staff cost data collection tools available for immediate use. This information is also intended to inform the development of future tools for cost data collection in health services and prevention research. Such a tool will facilitate collection of urgently needed cost and resource use data to inform investment decision making, policy and practice in health services and population health care.

How Important is Healthcare‑Contact Time to Systemic Treatment Decision‑Making in Advanced Gastrointestinal Cancers: Developing Attributes to Include in a Discrete Choice Experiment

2026-04-28T23:39:19Z

How Important is Healthcare‑Contact Time to Systemic Treatment Decision‑Making in Advanced Gastrointestinal Cancers: Developing Attributes to Include in a Discrete Choice Experiment Stevens, Samuel X; El-Katateny, Ella; Addo, Isaac Yeboah; Street, Deborah; Booth, Christopher; Shaw, Joanne; Vardy, Janette L.; De Abreu Lourenço, Richard Abstract Background People receiving treatment for advanced cancer invest substantial portions of their survival time receiving healthcare, labelled the ‘time toxicity’ of treatment. Although qualitative research has examined the impact of time burden on patients and their caregivers, its influence on treatment decision-making is unclear. Objective: Our objective was to explore treatment decision-making with patients with advanced gastrointestinal cancer, their caregivers, and oncologists, and unmask the role of time burden in those decisions. The objective was to inform the design of a subsequent discrete-choice experiment (DCE) investigating the importance of time burden in treatment decision-making. Methods: A two-step process was used. Factors relevant to treatment decision-making were discussed as part of semistructured interviews. Responses were analysed using thematic analysis with a focus on measurable themes relevant to the development of candidate attributes for a DCE. Second, we reviewed stated-preferences studies in the field of treatment decision-making in cancer and compared the results with the candidate attributes identified from interviews. Results: Interviews with 45 participants (20 patients, 10 caregivers,15 gastrointestinal oncologists; 53% metropolitan) revealed 4 themes and 6 candidate attributes: expected survival benefit of treatment, impact of physical side effects, effect on day-to-day functioning, route of administration, healthcare contact days, and planned length of the treatment course. Review of 45 published studies yielded no additional attributes. Conclusions: This study identified six candidate attributes for a forthcoming DCE on time burden in advanced cancer care. These findings support growing efforts to quantify and address time toxicity in cancer treatment decision-making.

“The Cancer is My Life”: patient and caregiver perceptions of the time toxicity of palliative systemic cancer treatments for advanced gastrointestinal cancers

2026-06-09T02:20:48Z

“The Cancer is My Life”: patient and caregiver perceptions of the time toxicity of palliative systemic cancer treatments for advanced gastrointestinal cancers Stevens, Samuel X.; El-Katateny, Ella; De Abreu Lourenço, Richard; Booth, Christopher M.; Shaw, Joanne; Vardy, Janette L. Purpose Treatment for advanced cancer entails substantial time commitments, which has been labelled the ‘time toxicity’ of treatment, though the perspectives of people affected by cancer are still being established. We aimed to establish patient and caregiver perspectives on the ‘time toxicity’ of palliative systemic treatments. Methods :Semi-structured qualitative interviews were conducted using an inductive approach. Purposively selected adults with advanced gastrointestinal cancers who had received palliative systemic therapy and caregivers were recruited from one metropolitan and regional site. Interviews were analysed using thematic analysis. Results: Twenty patients and ten caregivers participated. Eighty percent were Australian-born, 60% were 55–74 years old, 57% had colorectal cancer, 50% were female, and 50% were regionally situated. Five themes emerged: (1) treatment as work, (2) opportunity costs of receiving care, (3) treatment time as an investment, (4) time in treatment decision-making, and (5) tools for managing treatment time. Participants found it burdensome to organise their lives around treatment requirements. Perception of time burdens related to understandings of treatment benefit, experience of downsides, and psychological reactions to illness. Time spent coordinating and recovering from treatment had a substantial impact on participants’ lives outside of contact days. However, participants valued the potential benefits of treatment and described healthcare time as a modifier, rather than a driver, of treatment decision-making. Conclusion: This qualitative analysis contributes a foundational understanding of perceptions, sources, and impacts of healthcare time burdens in an Australian context. Further research will identify, assess, and address modifiable sources of time burdens in cancer care.

Phenomenology of humiliation: feeling injustice in healthcare

2025-12-17T04:49:55Z

Phenomenology of humiliation: feeling injustice in healthcare Subramani, Supriya In this paper, I show how humiliation, as a moral emotion, is a pervasive yet neglected dimension of medicine, health and ethics discourse. Although often conflated with shame, humiliation names a distinct self-conscious emotion: not an internalised sense of personal failure, but a relational harm imposed by others and institutions that undermines dignity and self-respect. Recently, medical humanities and ethics literature has attended extensively to shame and stigma, yet humiliation remains underexplored, despite its salience in patient accounts of dismissal, disrespect and degradation. I begin by explaining why it helps to have a conceptual distinction between humiliation and shame, showing how humiliation is an externally inflicted injury rather than a private moral lapse. Drawing on my ethnographic and phenomenological research in India and Zurich, in this conceptual paper, I illustrate how humiliation surfaces in healthcare encounters and spaces, where patients, especially those who are marginalised, are silenced or disregarded. I show that humiliation is diagnostic and has inherent moral insights and reveals injustice. Thus, in this paper, I argue that reclaiming humiliation as a moral and phenomenological category opens new ethical and analytical possibilities: it calls for reimagining medicine as a relational practice grounded in dignity, recognition and justice—one that acknowledges those once humiliated not as passive sufferers but as moral agents whose emotions reveal the truth of injustice.

Biological effects of pathologies in Lewy body diseases: why timing matters

2026-04-28T23:39:18Z

Biological effects of pathologies in Lewy body diseases: why timing matters Halliday, Glenda; Elie, Matar The emergence of promising biomarkers of α-synuclein Lewy pathology has led to new biological definitions and staging systems for Parkinson's disease and dementia with Lewy bodies. These research frameworks aim to enhance patient selection for studies of biomarkers and disease-modifying therapies. Building on approaches developed for Alzheimer's disease, these new frameworks focus on hallmark neuropathological findings in Lewy body diseases, including abnormal α-synuclein aggregates and neurodegeneration, particularly nigrostriatal dopaminergic loss. Understanding the temporal inter-relationships between Lewy pathology, Alzheimer's disease, and other co-pathologies and symptom manifestation is central to any biological staging system. Neuropathological and in vivo evidence demonstrates substantial temporal and biological heterogeneity in the progression of clinical and pathological events across Lewy body disorders, highlighting knowledge gaps. Staging systems must incorporate this evidence into a nuanced conceptual framework of biological progression. Such revision will be crucial for the appropriate selection of participants and correct timing of targeted interventions in clinical research.

Building readiness in community-based organisations to enable the implementation of public health interventions for adults and older adults: a scoping review

2025-11-24T22:01:30Z

Building readiness in community-based organisations to enable the implementation of public health interventions for adults and older adults: a scoping review Hassett, Leanne; Moseley, Anne M; Nettlefold, Lindsay; Pearce, Louise M N; Franke, Thea; Macdonald, Heather M; Tiedemann, Anne; McKay, Heather A Data and supplementary file from: 'Building readiness in community-based organisations to enable the implementation of public health interventions for adults and older adults: a scoping review' Background: A key challenge to implementing and scaling up evidence-based interventions (EBIs) into practice is organisational readiness; described as an organisation’s motivation, general capacities, and capabilities specific to the EBI. Building organisational readiness has been investigated in some health disciplines (e.g., mental health). However, the importance of building organisational readiness to effectively implement public health EBIs for adults and older adults in the community setting remains largely unexplored. Our aim was to examine how readiness was defined and measured, what strategies were used to build readiness, and the relationship between readiness-building strategies and implementation, service-level, and person-level outcomes. Methods: In this scoping review, we searched seven databases and conducted forward and backward citation tracking. From a pool of eight reviewers, combinations of two reviewers independently screened references for eligibility. A single reviewer extracted data, and a second reviewer checked data. Results for each implementation, service-level and person-level outcome in each study were extracted and categorised as favourable, nonsignificant, or unfavourable. Results: Twelve studies were included, which implemented a mix of different public health EBIs to almost 40,000 participants (n = 37,883; 54% women) across varied community settings. Only four studies defined readiness; all used different definitions. Five studies used five different instruments to assess readiness, all with poor psychometric properties. All studies used multiple strategies to build readiness (range 4–20 strategies per study), with all using strategies to assess, plan and monitor implementation of the EBI (i.e., ‘evaluative and iterative strategies’) and strategies to support collaboration between organisations delivering the EBI (i.e., ‘develop interest-holder interrelationships’). Three-quarters of the strategies focused on building the organisation’s capability to deliver the specific EBI (e.g., assessing readiness, conducting educational meetings) and were delivered by external support teams. Exploring the relationship between readiness-building strategies and study outcomes indicated more favourable than unfavourable outcomes, particularly for implementation and service-level outcomes (38/48; 79% favourable). Conclusions: Within this limited sample, the use of readiness-building strategies improved the implementation of public health EBIs in community organisations. However, consistency of definitions and terminology and more sophisticated testing of readiness-building strategies will help confirm how best to do this. Trial registration: Open Science Framework, May 5, 2024.

Dementia with Lewy bodies and Parkinson’s disease dementia – the same or different and is it important?

2026-04-28T23:39:18Z

Dementia with Lewy bodies and Parkinson’s disease dementia – the same or different and is it important? Halliday, Glenda; Fu, Yuhong Biological definitions of neurological diseases are now becoming a reality, although still in the research phase. This development will recategorize neurological diseases, providing objective diagnostics and the promise of therapeutics that target biological mechanisms - similar to the strategy that has proven successful in tumours and other conditions. In this Perspective article, we discuss this development for dementias with dominant Lewy pathology, as the availability of biological assays for this pathology has sparked new interest in a single disease diagnosis for all individuals positive for α-synuclein. On the basis of current evidence, we argue that an α-synuclein assay alone is unlikely to be a specific criterion for a spectrum of clinical syndromes with Lewy pathology or a definitive diagnostic marker for Lewy body dementia. We advocate that one biological assay will not reflect the complex spatiotemporal features of brain pathology. Diverse sequential mechanisms underpin the highly heterogeneous phenotypes and clinicopathological processes of Lewy body dementias. Disease modification, if possible, will be most effective when it targets the early underlying mechanisms, especially those leading to aggressive phenotypes.

Safe and Affirmed: Building and Evaluating Capacity to Support LGBTIQA+ Young People in Mental Health Services in New South Wales

2026-05-27T03:48:16Z

Safe and Affirmed: Building and Evaluating Capacity to Support LGBTIQA+ Young People in Mental Health Services in New South Wales Davies, Cristyn; Berger, Matthew N.; Mowbray, Ellen; Robinson, Kerry H.; Knox, Sara L.; Lum, Steph; Byron, Paul; McGowan, Natalie; Kang, Melissa; Marino, Jennifer L.; Skinner, S. Rachel Background: The Twenty-Ten Association Incorporated (Twenty-ten) is a New South Wales (NSW)-based not-for-profit organisation. This service provides housing, case management, psychosocial support, counselling, mental health, health, family and domestic violence and legal services for young people (aged 12-25 years) of diverse genders and sexualities, and those born with innate variations of sex characteristics, for their families and communities who support them. Lesbian, Gay, Bisexual, Transgender, Intersex, Queer/Questioning, Asexual, and other diverse gender and sexual identities (LGBTIQA+) young people can experience significant stigma and discrimination, leading to higher rates of mental health conditions compared to their heterosexual, cisgender and endosex peers. Healthcare systems that are cisgender-heteronormative and that privilege endosex individuals often exclude LGBTIQA+ young people. As a result, these young people may disengage from healthcare systems, resulting in poorer health and wellbeing. Some may turn to social media and online communities to help address their healthcare concerns. Effective and culturally safe LGBTIQA+ healthcare requires incorporating lived experiences of stakeholders, understanding health disparities, and practising respectful communication. Mental health professionals too often lack confidence and skills in providing affirming and culturally safe care to LGBTIQA+ clients. Connection to the community and access to culturally safe healthcare are critical protective factors for these young people. LGBTIQA+ affirming practice training is essential for reducing discrimination and improving care. Studies show that while healthcare professionals benefit from LGBTIQA+ training, there is limited access to such programs, and evidence weighing the effectiveness of that training is scarce. Improving culturally safe care and inclusivity through targeted training can significantly enhance the mental health and wellbeing of LGBTIQA+ young people. Aim and objectives: The overall aim was to evaluate the knowledge of mental health professionals about culturally safe healthcare for LGBTIQA+ young people pre- and post- the Safe and Affirmed program, presented through professional development workshops. Our objectives were to evaluate the program to determine if participants have (1) gained knowledge and skills to enhance clinical practices supporting LGBTIQA+ young people in managing family, carer, school, and social relationships, (2) improved system responsiveness and care experiences for LGBTIQA+ young people in mental health care settings, and (3) applied their learnings to clinical practice, advocacy, and affirmative care for LGBTIQA+ young people. Methods: A pre- and post-evaluation was conducted to assess the Safe and Affirmed LGBTIQA+ program for mental health professionals in NSW. The evaluation included pre- and post-surveys administered on the same day as the professional development workshop, and a follow-up survey conducted three to six months later. A sub-sample of consenting participants were invited to take part in semi-structured interviews, which were conducted online three- to six-months post-training. The professional development, provided by Twenty-ten, comprised face-to-face and online education sessions and was implemented across all NSW government and several private health services (i.e., not-for-profit organisations and private healthcare organisations). This program was designed to primarily support Child and Adolescent Mental Health Services (CAMHS). Eligible participants were mental health professionals (e.g., medical practitioners, nurses, social workers, occupational therapists, and peer workers) working in youth mental health services in NSW who completed the training. Recruitment strategies included engaging CAMHS services and disseminating flyers to potential participants. Quantitative data were analysed using paired t-tests to assess average changes in pre- and post-training survey scores. Descriptive statistics summarised demographic and professional characteristics, and the study was designed to detect score changes with statistical significance (p<0.05). All interviews were audio-recorded with participant consent and transcribed verbatim to ensure accuracy. Transcripts were then analysed thematically using both inductive and deductive approaches. This involved a systematic coding process to identify, analyse, and interpret key patterns and themes, drawing on both data-driven insights and pre-identified areas of interest related to the training objectives. Key findings: Three hundred and thirty-four (n=334) participants completed the pre-evaluation survey, and 271 completed the post-evaluation survey; thus, 18.9% (n=63) were lost to follow-up. Participants completing the post-evaluation survey were predominantly social workers (25.4%, n=66), psychologists (23.1%, n=60) and registered nurses (18.5%, n=48). Most participants practised in regional or rural locations (n=171, 65.8%), compared to metropolitan (30%, n=78) or remote (3.5%, n=9) locations. An insufficient number of participants completed the three- to six-month follow-up survey; therefore, this data could not be included in the analysis. The pre- and post-evaluation surveys highlight the significant improvements in participants' knowledge and confidence following their completion of the professional development. Participants reported significantly improved confidence in their knowledge and skills to provide gender affirming approaches for children, adolescents, and young people. Further, there was a marked improvement in participants' confidence in providing culturally safe mental health care to gender and sexuality diverse young people and those with innate variations of sex characteristics. Participants indicated an increased understanding of the co-occurrence of gender diversity with diagnoses such as eating disorders and neurodivergence. They also reported a better understanding of the co-occurrence of sexuality diversity with conditions like anxiety, depression, and post-traumatic stress disorder (PTSD). Participants demonstrated a significant improvement in their confidence in supporting and advocating for young people with an innate variation of sex characteristics. Pre-training 36.7% (n=95/260) of participants could name three unique needs of LGBTIQA+ young people when accessing mental health care services, compared to 94.2% (n=244/259) post-training. The ability to identify three barriers to accessing safe and equitable mental health care for LGBTQIA+ young people increased from 53.1% (n=138/260) pre-training to 97.7% (n=254/260) post-training. Awareness of the NSW LGBTIQ+ Health Strategy increased from 30.8% (n=80/260) pre-training to 96.5% (n=251/260) post-training. Awareness of the NSW Specialist Trans and Gender Diverse Health Service for young people under 25 increased from 48.1% (n=125/260) pre-training to 95.4% (n=248/260) post-training. Fifteen participants were interviewed three to six months after attending the workshop. Most identified as cisgender female (n=12, 80%), followed by cisgender male (n=2, 13.3%) and trans woman (n=1, 6.7%). Eleven participants identified as heterosexual (73.3%), three as gay or lesbian (20%), and one as bisexual (6.7%). The majority were working in regional or rural settings (n=10, 67.7%), with the remainder based in city or urban areas (n=5, 33.3%). Interviews underscored the importance of inclusive documentation in creating affirming healthcare environments for LGBTIQA+ young people. Participants highlighted small changes, such as including chosen names and pronouns on forms, that can significantly affirm identities and influence broader team culture. However, structural barriers, such as electronic medical records with binary gender options, were noted. In response, staff employed local solutions and emphasised the importance of team communication, training, and leadership. While the Safe and Affirmed professional development promoted inclusive values and critical reflection, participants emphasised the need for systemic reform, noting that lasting change requires a whole-of-setting approach that extends beyond individual efforts. Conclusion: These findings underscore the effectiveness of the Safe and Affirmed program in enhancing the participants' capabilities to support and provide culturally safe care for LGBTIQA+ young people. Continued investment in targeted and tailored professional development for mental health professionals providing care to LGBTIQA+ young people is required to build the knowledge and capacity of the health workforce. Quality training with a face-to-face component delivered by experts with lived experience enhanced the learning experience. Regional and rural health professionals must be included in quality face-to-face LGBTIQA+ culturally safe training opportunities.

The drivers of influenza vaccination in adults: Insights from a national Australian survey

2026-04-22T03:37:04Z

The drivers of influenza vaccination in adults: Insights from a national Australian survey Christou-Ergos, Maria; Sabahelzain, Majdi; Steffens, Maryke; Kaufman, Jessica; Bolsewicz, Katarzyna; Danchin, Margie; Leask, Julie Study: Influenza vaccination coverage is suboptimal in the Australian adult population. The National Vaccination Insights Project [1] was established in 2024 to annually measure the behavioural and social drivers of vaccination in the Australian population. Prior to this, while coverage data were used to monitor uptake, there was no systematic data collection to understand the reasons for coverage gaps. The inaugural survey of Australian adults used a globally standardized survey tool [2] adapted for the Australian context to measure constructs related to influenza vaccination within four domains (i) vaccination-related thoughts and feelings, (ii) social processes, (iii) motivation, and (iv) practical issues. This study provides a foundation for ongoing national monitoring of the drivers of influenza vaccination and will help tailor timely strategies to population needs. Dataset: A de-identified dataset from an online survey conducted in March 2024 with a nationally representative sample of 2,055 Australian adults recruited through an online panel [1] https://ncirs.org.au/our-work/national-vaccination-insights-project [2] Behavioural and social drivers of influenza vaccination: tools and practical guidance for achieving high uptake. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.

The multifaceted nature of impulsivity in Parkinson’s disease

2026-04-28T07:03:03Z

The multifaceted nature of impulsivity in Parkinson’s disease O'Callaghan, Claire This scientific commentary refers to "Mosley PE, Paliwal S, Robinson K, Coyne T, Silburn P, Tittgemeyer M, Stephan KE, Breakspear M, Perry A. The structural connectivity of discrete networks underlies impulsivity and gambling in Parkinson's disease. Brain. 2019 Dec 1;142(12):3917-3935. doi: 10.1093/brain/awz327. PMID: 31665241.

Cognition in Parkinson's disease

2026-04-28T07:03:03Z

Cognition in Parkinson's disease O'Callaghan, Claire Cognitive decline is now recognised as a common non-motor symptom of Parkinson’s disease, and it has been the subject of increasing research in recent decades. Cognitive deficits in Parkinson’s disease can be distinguished as dopaminergically-mediated executive dysfunction seen in the milder stages, versus a global dementia syndrome that can occur with disease progression. The neural basis of these deficits has been explored from the perspective of multimodal imaging techniques to measure the structural, functional and metabolic correlates of cognitive decline in Parkinson’s disease. Increasingly, changes in neurotransmitter systems beyond dopamine, including the noradrenergic, serotonergic and cholinergic systems, are being recognised for their contribution to cognitive decline. The impact of certain genetic variations on cognitive function has also been established, including links between cognitive decline and polymorphisms affecting COMT, MAPT, APOE and GBA genotypes. Although therapeutic options for cognitive decline are still far less established than for motor systems, both pharmacological and non-pharmacological strategies are continuing to develop.