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This study aimed to ascertain frequency rates and predictors of six problematic online behaviors (POBs) in an Australian sample. Participants (N = 1626) completed instruments measuring problematic online gaming, cyberchondria, problematic cybersex, problematic online shopping, problematic use of social networking sites, problematic online gambling, anxiety, depression and attention deficit/hyperactivity disorder (ADHD). Each POB was presumed to be present based on the cut-off score on the corresponding instrument and at least one indicator of interference with functioning. Generalized linear model analyses were used to determine socio-demographic and psychopathological predictors of each POB. The most common POB was problematic online shopping (12.2%), followed by problematic online gambling (11.4%), problematic use of social networking sites (6.0%), problematic cybersex (5.3%), problematic online gaming (5.2%) and cyberchondria (4.6%). Age group 27-36 had the highest rates of POBs. The intensity of ADHD symptoms predicted all POBs, whereas younger age predicted all POBs except for problematic cybersex and online gambling. Female gender predicted lower scores on the measures of problematic online gaming and cybersex. These findings have implications for age- and gender-adapted education, prevention and treatment efforts and suggest that specific POBs should be investigated separately instead of lumping them together under the umbrella terms such as "Internet addiction".

The early complement components have emerged as mediators of pro-oncogenic inflammation, classically inferred to cause terminal complement activation, but there are limited data on the activity of terminal complement in cancer. We previously reported elevated serum and tissue C9, the terminal complement component, in esophageal adenocarcinoma (EAC) compared to the precursor condition Barrett's Esophagus (BE) and healthy controls. Here, we investigate the level and cellular fates of the terminal complement complex C5b-9, also known as the membrane attack complex. Punctate C5b-9 staining and diffuse C9 staining was detected in BE and EAC by multiplex immunohistofluorescence without corresponding increase of C9 mRNA transcript. Increased C9 and C5b-9 staining were observed in the sequence normal squamous epithelium, BE, low- and high-grade dysplasia, EAC. C5b-9 positive esophageal cells were morphologically intact, indicative of sublytic or complement-evasion mechanisms. To investigate this at a cellular level, we exposed non-dysplastic BE (BAR-T and CP-A), high-grade dysplastic BE (CP-B and CP-D) and EAC (FLO-1 and OE-33) cell lines to the same sublytic dose of immunopurified human C9 (3 µg/ml) in the presence of C9-depleted human serum. Cellular C5b-9 was visualized by immunofluorescence confocal microscopy. Shed C5b-9 in the form of extracellular vesicles (EV) was measured in collected conditioned medium using recently described microfluidic immunoassay with capture by a mixture of three tetraspanin antibodies (CD9/CD63/CD81) and detection by surface-enhanced Raman scattering (SERS) after EV labelling with C5b-9 or C9 antibody conjugated SERS nanotags. Following C9 exposure, all examined cell lines formed C5b-9, internalized C5b-9, and shed C5b-9+ and C9+ EVs, albeit at varying levels despite receiving the same C9 dose. In conclusion, these results confirm increased esophageal C5b-9 formation during EAC development and demonstrate capability and heterogeneity in C5b

AIM: We aimed to describe health-related out-of-pocket (OOP) expenses incurred by Australian families living with children with chronic and complex diseases. METHODS: A prospective pilot study of OOP expenses in families with children with tuberous sclerosis (TS) or mitochondrial disorders (MD) in 2016-2017. An initial survey assessed the family's financial situation, child's health functioning and estimated previous 6 months' and lifetime OOP expenses. Thereafter, families completed a survey each month for 6 months, prospectively tracking OOP expenses. RESULTS: Initial surveys were completed by 13 families with 15 children; median age 7 years (range: 1-12); 5 with MD, 10 with TS. All families reported OOP expenses: 38% paid $2000 per annum, more than double the annual per-capita OOP costs reported for Australia by the Organisation for Economic Co-operation and Development. Eight families estimated $5000-$25 000 in OOP expenses over their child's lifetime and 62% of mothers reduced or stopped work due to caring responsibilities. Eleven families paid annual private health insurance premiums of $2000-$5122, but 72% said this was poor value-for-money. Prospective tracking by eight families (9 children) identified the median OOP expenditure was $863 (range $55-$1398) per family for 6 months. OOP spending was associated with visits to allied health professionals, non-prescription medicines, special foods, supplements and disposable items. Eight families paid for 91 prescription medications over 6 months. CONCLUSION: All families caring for children with TS or MD reported OOP expenses. A larger study is needed to explore the affordability of health care for children living with a broader range of chronic diseases.

The validity of the constructs of problematic Internet or smartphone use and Internet or smartphone addiction has been extensively debated. The spectrum hypothesis posits that problematic online behaviors (POBs) may be conceptualized within a spectrum of related yet distinct entities. To date, the hypothesis has received preliminary support, and further robust empirical studies are still needed. The present study tested the spectrum hypothesis of POBs in an Australian community sample (n = 1,617) using a network analysis approach. Psychometrically validated self-report instruments were used to assess six types of POBs: problematic online gaming, cyberchondria, problematic cybersex, problematic online shopping, problematic use of social networking sites, and problematic online gambling. A tetrachoric correlation matrix was computed to explore relationships between online activities and a network analysis was used to analyze relationships between POBs. Correlations between online activities were positive and significant, but of small magnitude (0.051 ≤ r ≤ 0.236). The community detection analysis identified six distinct communities, corresponding to each POB, with strong relationships between items within each POB and weaker relationships between POBs. These findings provide further empirical support for the spectrum hypothesis, suggesting that POBs occur as distinct entities and with little overlap.

The validity of the constructs of problematic Internet or smartphone use and Internet or smartphone addiction has been extensively debated. The spectrum hypothesis posits that problematic online behaviors (POBs) may be conceptualized within a spectrum of related yet distinct entities. To date, the hypothesis has received preliminary support, and further robust empirical studies are still needed. The present study tested the spectrum hypothesis of POBs in an Australian community sample (n = 1,617) using a network analysis approach. Psychometrically validated self-report instruments were used to assess six types of POBs: problematic online gaming, cyberchondria, problematic cybersex, problematic online shopping, problematic use of social networking sites, and problematic online gambling. A tetrachoric correlation matrix was computed to explore relationships between online activities and a network analysis was used to analyze relationships between POBs. Correlations between online activities were positive and significant, but of small magnitude (0.051 ≤ r ≤ 0.236). The community detection analysis identified six distinct communities, corresponding to each POB, with strong relationships between items within each POB and weaker relationships between POBs. These findings provide further empirical support for the spectrum hypothesis, suggesting that POBs occur as distinct entities and with little overlap.

For 27 years, national prospective data on selected rare childhood diseases have been collected monthly by the Australian Paediatric Surveillance Unit (APSU) from paediatricians and other clinical specialists who report cases in children aged up to 16 years. We report here the annual results of APSU surveillance in 2020 for ten rare communicable diseases and complications of communicable diseases, namely: acute flaccid paralysis (AFP); congenital cytomegalovirus (CMV) infection; neonatal herpes simplex virus (HSV) infection; perinatal exposure to human immunodeficiency virus (HIV); paediatric HIV infection; severe complications of seasonal influenza; juvenile onset recurrent respiratory papillomatosis (JoRRP); congenital rubella syndrome; congenital varicella syndrome; and neonatal varicella infection. We describe the results for each disease in the context of the total period of study, including demographics, clinical characteristics, treatment and short-term outcomes. Despite challenges presented by the coronavirus disease 2019 (COVID-19) pandemic in 2020, more than 1,400 paediatricians reported regularly to the APSU and an overall monthly reporting rate of > 90% was achieved. The minimum AFP target of 1 case per 100,000 children aged less than 15 years was achieved and there were few cases of vaccine-preventable diseases (JoRRP, rubella, varicella). However, high cases of congenital CMV, neonatal HSV and perinatal exposure to HIV persist. There were no severe complications of seasonal influenza reported for the first time in 13 years. This is consistent with other surveillance data reporting a decline of influenza and other communicable diseases in 2020, and likely reflects the wider effects of public health measures to reduce transmission of SARS-CoV-2 in the Australian community.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a significant disease burden in obesity. Liver fibrosis is an important prognostic factor in NAFLD, and detection is vital. The pathophysiological changes of obesity can alter the accuracy of non-invasive NAFLD tests. We aimed to review current evidence for common non-invasive tests for NAFLD-related fibrosis in obesity. METHODS: We systematically searched for studies assessing the diagnostic accuracy of 11 biomarker panels and elastography techniques for NAFLD-related fibrosis in obesity. Meta-analyses were performed where possible. RESULTS: Thirty-eight studies were identified assessing the selected tests in obese populations. Simple biomarker panels (e.g. NAFLD fibrosis score) were the most validated. Evidence showed better accuracy of complex biomarker panels (NAFLD fibrosis score: summary receiver operator characteristic [SROC] 0.795-0.813 vs. enhanced liver fibrosis: SROC 0.962); however, these were poorly validated in obesity. Elastography techniques were better studied and had high diagnostic accuracy (transient elastography: SROC 0.859; magnetic resonance elastography: SROC 0.965) but were limited by BMI-dependent failure. Limited evidence was found to validate the accuracy of any test in exclusively obese populations. CONCLUSION: In obese subjects, complex biomarker panels and elastography have been reasonable to good accuracy for NAFLD-related fibrosis; however, these methods have not been well validated. Further study in this high-risk population is needed.

OBJECTIVE: To clarify the prognostic role of tumour protein 53 (TP53) mutations in patients with oesophageal adenocarcinoma (OAC) as there is a need for biomarkers that assist in guiding management for patients with OAC. DESIGN: A systematic review was conducted using MEDLINE, Embase, PubMed and Current Contents Connect to identify studies published between January 1990 and February 2015 of oesophageal cancer populations (with OAC diagnoses >50% of cases) that measured tumoural TP53 status and reported hazard ratios (HR), or adequate data for estimation of HR for survival for TP53-defined subgroups. Risk of bias for HR estimates was assessed using prespecified criteria for the appraisal of relevant domains as defined by the Cochrane Prognosis Methods Group including adherence to Grading of Recommendations, Assessment, Development and Evaluation and REporting recommendations for tumor MARKer prognostic studies guidelines, as well as assay method used (direct TP53 mutation assessment vs immunohistochemistry) and adjustment for standard prognostic factors. A pooled HR and 95% CI were calculated using a random-effects model. RESULTS: Sixteen eligible studies (11 with OAC only and 5 mixed histology cohorts) including 888 patients were identified. TP53 mutations were associated with reduced survival (HR 1.48, 95% CI 1.16 to 1.90, I2=33%). A greater prognostic effect was observed in a sensitivity analysis of those studies that reported survival for OAC-only cohorts and were assessed at low risk of bias (HR 2.11, 95% CI 1.35 to 3.31, I2=0%). CONCLUSIONS: Patients with OAC and TP53 gene mutations have reduced overall survival compared with patients without these mutations, and this effect is independent of tumour stage.

Background: The question of whether certain anxiety disorders are especially related to a cognitive style characterized by an exaggerated perception of threat and appraisal of the future as excessively unpredictable (general anxiety-prone cognitive style) remains open. Objectives: This study aimed to compare patients with generalized social anxiety disorder (SAD), generalized anxiety disorder (GAD), panic disorder with agoraphobia (PDA), and panic disorder without agoraphobia (PD) in terms of the levels of general anxiety-prone cognitive style when the severity of general distress and psychopathology is controlled for and to ascertain whether a co-occurring depressive disorder contributes substantially to the levels of this cognitive style. Methods: The Anxious Thoughts and Tendencies Scale, a measure of a general anxiety-prone cognitive style, and Symptom Checklist 90 - Revised were administered to 204 patients with various anxiety disorders who attended an outpatient anxiety disorders clinic and were diagnosed based on a semistructured diagnostic interview. Results: Patients with principal diagnoses of SAD and GAD had a more prominent general anxiety-prone cognitive style than patients with principal diagnoses of PD and PDA when the severity of general distress and psychopathology was controlled for. The presence or absence of a co-occurring depressive disorder had no bearing on this finding. Conclusions: The general cognitive component characterizes SAD and GAD more than it does PD and PDA, and a co-occurring depressive disorder does not affect this finding. These results have implications for distinguishing between various anxiety disorders. © 2012 Elsevier Inc.

Background: The question of whether certain anxiety disorders are especially related to a cognitive style characterized by an exaggerated perception of threat and appraisal of the future as excessively unpredictable (general anxiety-prone cognitive style) remains open. Objectives: This study aimed to compare patients with generalized social anxiety disorder (SAD), generalized anxiety disorder (GAD), panic disorder with agoraphobia (PDA), and panic disorder without agoraphobia (PD) in terms of the levels of general anxiety-prone cognitive style when the severity of general distress and psychopathology is controlled for and to ascertain whether a co-occurring depressive disorder contributes substantially to the levels of this cognitive style. Methods: The Anxious Thoughts and Tendencies Scale, a measure of a general anxiety-prone cognitive style, and Symptom Checklist 90 - Revised were administered to 204 patients with various anxiety disorders who attended an outpatient anxiety disorders clinic and were diagnosed based on a semistructured diagnostic interview. Results: Patients with principal diagnoses of SAD and GAD had a more prominent general anxiety-prone cognitive style than patients with principal diagnoses of PD and PDA when the severity of general distress and psychopathology was controlled for. The presence or absence of a co-occurring depressive disorder had no bearing on this finding. Conclusions: The general cognitive component characterizes SAD and GAD more than it does PD and PDA, and a co-occurring depressive disorder does not affect this finding. These results have implications for distinguishing between various anxiety disorders. © 2012 Elsevier Inc.