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Background: Regular contact with specialist care has been linked to better diabetes outcomes for young people with type 1 diabetes (YPwT1D), but evidence is limited to population‐based service usage and outcomes. Aims: This observational 5‐year study sought to capture YPwT1D living in the study catchment area (covering metropolitan, regional and rural Australia) as they transitioned to adult‐based diabetes healthcare services and to describe their glycaemic control and complication rates, service usage and associated factors. Methods: Records between 2010 and 2014 in a public healthcare specialist diabetes database were extracted, care processes and outcomes were described, and associations were sought between episodes of care (EOC) and potentially predictive variables. Results: Annual cohort numbers increased yearly, but without significant differences in demographic characteristics. Each year around 40% had no reported planned specialist care, and the average number of planned EOC decreased significantly year on year. Overall, mean HbA1c levels also reduced significantly, but with higher values recorded for those living in non‐metropolitan than metropolitan areas (achieving significance in 3 out of 5 years). Diabetes complication assessments were only reported in 37–46%, indicating one in five with retinopathy and hypertension affecting one in three to five young people. Conclusions: Findings highlight the importance of investment to address the specific needs of adolescents and young adults and demonstrate the need for better support during these vulnerable early years, particularly for non‐metropolitan residents. This will entail changes to funding mechanisms, the health workforce and infrastructure, and new models of care to provide equity of access and quality of specialist care. [ABSTRACT FROM AUTHOR]

Objectives: The Future Proofing Study (FPS) was established to examine factors associated with the onset and course of mental health conditions during adolescence. This paper describes the design, methods, and baseline characteristics of the FPS cohort. Methods: The FPS is an Australian school‐based prospective cohort study with an embedded cluster‐randomized controlled trial examining the effects of digital prevention programs on mental health. Data sources include self‐report questionnaires, cognitive functioning, linkage to health and education records, and smartphone sensor data. Participants are assessed annually for 5 years. Results: The baseline cohort (N = 6388, M = 13.9 years) is broadly representative of the Australian adolescent population. The clinical profile of participants is comparable to other population estimates. Overall, 15.1% of the cohort met the clinical threshold for depression, 18.6% for anxiety, 31.6% for psychological distress, and 4.9% for suicidal ideation. These rates were significantly higher in adolescents who identified as female, gender diverse, sexuality diverse, or Aboriginal and/or Torres Strait Islander (all ps < 0.05). Conclusions: This paper provides current and comprehensive data about the status of adolescent mental health in Australia. The FPS cohort is expected to provide significant insights into the risk, protective, and mediating factors associated with development of mental health conditions during adolescence. [ABSTRACT FROM AUTHOR]

Summary: Consuming a greater proportion of total energy intake earlier in the day rather than in the evening is proposed to positively influence weight loss and health, potentially due to greater synchronization of human body circadian rhythms. This systematic review provides an update on existing evidence regarding earlier distributed eating patterns in weight loss interventions. Using a robust search strategy in five electronic databases, nine randomized controlled trials investigating the impact of energy intake distribution on weight loss were identified. Following critical appraisal, a random‐effects meta‐analyses found that, in the context of an energy‐reduced diet, distributing energy intake with a focus on earlier intake resulted in significantly greater weight loss (−1.23 kg; 95% CI 2.40, −0.06, p = 0.04). Improvements in HOMA‐IR, fasting glucose, and LDL cholesterol were also seen. The current study provides a timely update on the evidence linking distribution of total daily energy intake and health, showing that a focus on earlier intakes can result in greater short‐term weight loss compared with later intakes. Future studies are needed to elucidate the impact that earlier intakes may have on weight management and metabolic health. [ABSTRACT FROM AUTHOR]

Background: Public involvement in health research and its translation is well recognized to improve health interventions. However, this approach is insufficiently practised and evidenced in relation to young people. This paper presents an analysis of the process of co‐producing a framework, partnership model and a growing network of young people informing and guiding an adolescent health research community of practice. Methods: A Living Lab is a participatory research approach that brings together a broad range of stakeholders in iterative cycles of research, design, development, pilot‐testing, evaluation and delivery to implement effective responses to complex phenomena. The geographical setting for this study was Sydney, NSW, Australia, and involved both youth and adult stakeholders from this region. The study spanned three phases between July 2018 and January 2021, and data collection included a range of workshops, a roundtable discussion and an online survey. Results: The co‐production process resulted in three key outputs: first, an engagement framework to guide youth participation in health research; second, a partnership model to sustain youth and adult stakeholder collaboration; third, the growth of the public involvement of young people with a range of projects and partners. Conclusions: This study investigated the process of co‐producing knowledge with young people in an adolescent health community of practice. A reflexive process supported youth and adult stakeholders to collaboratively investigate, design and pilot‐test approaches that embed young people's engagement in adolescent health research. Shared values and iterative methods for co‐production can assist in advancing mutual learning, commitment and trust in specific adolescent health research contexts. Public Contribution: Young people guiding and informing an adolescent health research community of practice were involved in this study, and one of the participants is a paper co‐author. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to explore the feasibility and potential benefits of deploying virtual reality (VR) for adolescents in the ED. Methods: This multi‐centre study was undertaken in paediatric and adult EDs in two university teaching hospitals. Twenty‐six participants who had voluntarily attended the ED received the VR intervention. Pre‐ and post‐measures assessing changes in state anxiety, stress and affect, and physical biomarkers were obtained. Results: The use of VR intervention was associated with significant reductions in distress (Short State Stress Questionnaire – Distress Subscale; t = 4.55, P < 0.001) and negative affect (the International Positive and Negative Affect Scale – Short Form version; t = 4.99, P < 0.001). Most participants chose 'Netflix' as their content of choice. The technology was well received by the participants with subjective reports indicating that receiving VR intervention was 'insanely cool', 'takes you away from what's actually happening' and some participants felt 'privileged to get this experience in a hospital'. Conclusions: VR technology can effectively be used in EDs to assist adolescents and young adults better manage their distress and take steps towards activating more self‐control mechanisms that will in turn allow for more meaningful engagements to be established with health clinicians. This technology has broad implications for reducing distress in adolescents in a variety of clinical contexts. Virtual reality technology can effectively be used in EDs to assist adolescents and young adults better manage their distress and take steps towards activating more self‐control mechanisms that will in turn allow for more meaningful engagements to be established with health clinicians. This technology has broad implications for reducing distress in adolescents in a variety of clinical contexts. [ABSTRACT FROM AUTHOR]

Aim: Emerging evidence suggests that pubertal tempo, that is rate of passage through puberty, has relevance to adolescent mood and behaviour. However, its wider health and developmental significance remain unclear. This systematic review sought to clarify the relationship of pubertal tempo to indicators of health and development, and to document tempo definitions and pubertal durations reported in the literature.Methods: Eight electronic databases were searched from earliest record to July 2018. Study eligibility: healthy participants; age 8-21 years; ≥2 longitudinal measures of puberty; analysis of tempo against a health or developmental indicator.Results: Thirty-eight studies met eligibility, and these reported on diverse tempo definitions and seven health- and development-related domains. Data sets with varying tempo definitions converged on an association of rapid pubertal progression to: (a) higher adiposity during childhood and adolescence in both sexes; and (b) lower psychosocial well-being in adolescent males. Later thelarche unanimously predicted faster progression to menarche in females, but this compensation was largely undetected when alternate definitions of pubertal timing and/or tempo were used. Duration of puberty ranged from 2.5-4.1 years.Conclusion: Pubertal tempo may be clinically relevant when considering trajectories of adiposity and psychosocial well-being among adolescents, especially males. Consensus on the definition of tempo would facilitate between-study comparisons. [ABSTRACT FROM AUTHOR]

Aim: A large proportion of young people with chronic health conditions are surviving into adulthood. They face the same challenges as their healthy peers and are at increased risk of mental health problems. Psychosocial assessment is a crucial aspect of clinical care. Interviews using the internationally used and accepted HEEADSSS (home environment, education/employment, eating, peer-related activities, drugs, sexuality, suicide/depression, and safety) framework require trained clinicians, rapid interpersonal engagement, time and manual documentation. HEEADSSS-derived digital self-report surveys can be initiated by non-trained staff. This study compares the utility and information recorded using both methods.Methods: A retrospective analysis comparing documentation from HEEADSSS guided face-to-face interview and a digital survey tool was conducted using 146 records collected by the Trapeze transition service across the two locations of the Sydney Children's Hospital Network (NSW, Australia) between 2013 and 2016. A panel of four experts used an iterative process to identify 29 data verification points, falling into seven categories. Wilcoxon signed-rank tests were used to compare category scores.Results: The digital survey took an average of 15 min and showed a significantly higher rate of disclosure across all psychosocial categories, particularly in the sensitive areas of emotions, drug use, sex and safety, compared to electronic medical record documentation of interview.Conclusions: Digital survey provided a time-efficient psychosocial screening tool that was self-administered, able to be introduced by non-trained staff, had a consistent record of responses, and elicited a substantially higher disclosure rate for important areas of strength and risk that may otherwise be avoided or not recorded. [ABSTRACT FROM AUTHOR]

Introduction: The challenges of becoming a mature adult may distract young adults with type 1 diabetes from disease self‐management, increasing risks for premature morbidity and mortality. Despite the importance of young adults with type 1 diabetes engaging with preventative diabetes‐related health care services, few studies report health care professionals' experiences and perceptions of the support that is available, including during the period of transition. This study sought to determine these factors across diverse contexts in one health jurisdiction. Methods: This qualitative study was undertaken in New South Wales, Australia. Recruitment was based on a snowball sampling technique, which began with members of an established diabetes service group. Data were collected by individual semistructured interviews with 16 health care professionals, most of whom were registered nurses (75%), working at differing levels of expertise and responsibility across metropolitan and regional/rural areas. Data were analysed using thematic analyses. Results: Participants overwhelmingly recognized the time and care needed to support young adults with type 1 diabetes to prepare them for adult self‐management and to work with adult diabetes services, and the importance of youth‐friendly services. They reported shortfalls and inequitous distribution in services for these young adults. Two themes, addressing the present and future possibilities, expressed their perceptions of services for this population: working with what is available and mapping a route to better services. Conclusion: Findings identify opportunities for development in the planning and provision of specialist multidisciplinary health care support for this population. New ideas are needed for policy and practice innovation and for the infrastructure to facilitate this, to ensure that young adults with type 1 diabetes have access to consistent and coordinated diabetes health care services, particularly in nonmetropolitan settings. [ABSTRACT FROM AUTHOR]

Aim: Recruiting young women to weight management research programs is difficult. The purpose of this study was to gain insights into the barriers and motivators that influence participation and to explore effective methods of recruitment from the perspective of young women with obesity living in both urban and regional areas. Methods: Semi‐structured interviews were used to elicit information from focus groups. The interviews were transcribed, coded and analysed qualitatively. Eight focus groups, which included a total of 27 women, were conducted. Participants had a mean age of 29.1 (±5.1) years and a mean body mass index of 35.8 (±2.9) kg/m2. Results: The barriers to participation were multifaceted and largely similar across urban and regional participants. Fear of judgement and uncertainty about the process were major psychosocial barriers. A lack of tailoring of program content was an important program‐related barrier. Physical barriers such as time commitment, cost and access were discussed extensively, particularly in urban groups. The provision of incentives and the use of positive language that focusses on the benefits of the intervention were viewed positively. Physical and virtual methods of recruitment were identified as potentially effective provided they were presented in media that this group is likely to use and can access in a private location. Conclusions: The results of this study provide a greater understanding of the challenges faced by young women in relation to participation in weight management programs and some of the potential methods that could be utilised to facilitate participation. [ABSTRACT FROM AUTHOR]

The authors discuss their study that aims to further understand management of adolescents and young adults (AYAs) with chronic illnesses from an emergency department (ED) clinician's perspective. Topics mentioned include the challenge of managing parents' expectations, confusion caused by adult ED age policies governing admission, and lack of training in adolescent health.

Objective: To evaluate population trends in presentations for mental health problems presenting to emergency departments (EDs) in New South Wales during 2010-2014, particularly patients presenting with suicidal ideation, self-harm, or intentional poisoning.Design, Setting and Participants: This was a retrospective, descriptive analysis of linked Emergency Department Data Collection registry data for presentations to NSW public hospital EDs over five calendar years, 2010-2014. Patients were included if they had presented to an ED and a mental health-related diagnosis was recorded as the principal diagnosis.Main Outcome Measures: Rates of mental health-related presentations to EDs by age group and calendar year, both overall and for the subgroups of self-harm, suicidal ideation and behaviour, and intentional poisoning presentations.Results: 331 493 mental health-related presentations to 115 NSW EDs during 2010-2014 were analysed. The presentation rate was highest for 15-19-year-old patients (2014: 2167 per 100 000 population), but had grown most rapidly for 10-14-year-old children (13.8% per year). The combined number of presentations for suicidal ideation, self-harm, or intentional poisoning increased in all age groups, other than those aged 0-9 years; the greatest increase was for the 10-19-year-old age group (27% per year).Conclusions: The rate of mental health presentations to EDs increased significantly in NSW between 2010 and 2014, particularly presentations by adolescents. Urgent action is needed to provide better access to adolescent mental health services in the community and to enhance ED models of mental health care. The underlying drivers of this trend should be investigated to improve mental health care. [ABSTRACT FROM AUTHOR]

Aim: More than 26 000 Australians aged 12-24 years experience homelessness, yet data on the health status of homeless youth remain limited. The aim of this study was to describe the health of young people attending a youth health service in Western Sydney who were experiencing homelessness.Methods: Retrospective case note review for clients aged 12-25 years attending Youth Health Services in Western Sydney. Extracted data included: homelessness status; demographics; physical health issues; mental health issues; involvement with juvenile justice; and disengagement from education or employment.Results: Just under half of the 180 clients attending a Youth Health Service in Western Sydney were homeless, and an additional 15 young people who were not currently homeless nominated homelessness as a presenting issue. In comparison with currently domiciled young people, homeless youth were less likely to have a regular general practitioner and more likely to nominate a physical health concern as a presenting issue, although there was no difference between groups in terms of diagnosed mental or physical health conditions. Considered as a whole, the sample showed high rates of acute physical symptoms, physical trauma, psychological distress and self-harm.Conclusions: Youth homelessness is associated with risk of both poor physical and mental health. As much of youth homelessness is hidden, health-care providers need to ensure that they inquire about homelessness status, and have an awareness of potentially complex multi-morbidities in the physical and mental health of young marginalised people presenting to health services. [ABSTRACT FROM AUTHOR]

Objective Age-related policies allow adolescents to access paediatric and adult EDs. Anecdotally, paediatric and adult EDs report challenges when caring for older and younger adolescents, respectively. Our aim was to describe the characteristics of an adolescent population attending an adult ED, co-located with a tertiary paediatric ED. Methods The Westmead Hospital ED database was accessed for 14.5-17.9 years old presentations between January 2010 and December 2012. Patient diagnosis coding ( SNOMED) was converted to ICD-10. De-identified data were transferred into Microsoft Excel with analysis performed using spss V22. Results There were 5718 presentations made to the Westmead Hospital, Sydney, Australia ED by 4450 patients, representing 3.3% (95% CI 3.2-3.4) of total visits from all patients 14.5 years and above. The mean age of the sample was 16.6 years (male 51.8%). Presentations triaged as level 4 or 5 represented 61.0% (95% CI 58.7-61.3) of visits. The proportion of patients who did not wait to receive care was 13.8% (95% CI 12.9-14.7), which was significantly higher than adult rates ( P < 0.01). There were 279 unscheduled return visits (visits made <72 h of discharge) representing 4.9% (95% CI 4.4-5.8) of all presentations. Injury was the most common diagnosis (30.2%, 95% CI 28.8-31.6). Chronic physical illness and alcohol-related visits comprised 2.1% (95% CI 1.7-2.5) and 0.8% (95% CI 0.6-1.0) of adolescent presentations, respectively. Conclusion Contrary to reported staff perceptions, adolescent chronic physical illness presentations were not a major burden. Alcohol was likely under-recorded as a contributing factor to presentations. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives Use of continuous subcutaneous insulin infusion therapy in type 1 diabetes management is high. However, the incorporation of this technology into self-care is not without challenges, and the support of an appropriately skilled health care team is recommended. This study aimed to examine the support context for patients using continuous subcutaneous insulin infusion therapy from the health care professional perspective, as well as contextual influences for health care professionals and their patients. Methods This ethnographic qualitative study was undertaken in New South Wales, Australia. Recruitment occurred using a snowball sampling technique, beginning with members of an established diabetes service group. Data were collected through the use of semistructured interviews undertaken by telephone and analysed using thematic analysis. Results Data were obtained from 26 interviews with staff from diverse professional backgrounds. An overarching theme of difficulties, disconnections, and disarray emerged, with findings indicating that participants perceived difficulties in relation to shortages of health care professional continuous subcutaneous insulin infusion-related expertise, and disconnected and disarrayed service structures and process, with barriers to access to these devices. Individual health care professionals were left to manage somehow or opted not to engage with related care. Conclusions Findings provide insights from health care professionals' perspectives into the complexity of providing support for patients using continuous subcutaneous insulin infusion therapy across diverse contexts, and provide a platform for further research and service development. The need for consistent and coordinated care, and the infrastructure to facilitate this, flags an opportunity to drive integration of care and teamworking across as well as within settings and disciplines. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives Continuous subcutaneous insulin infusion (CSII; insulin pump) use is increasing. However, there is little information about how this technology is used compared with other insulin delivery methods (ie, injections) by young people with type 1 diabetes mellitus in Australia. This study explored young people's attitudes, perceptions, and experiences with diabetes management comparing those using with those not using CSII, and proportions likely to transition to adult services requiring initiation and/or support for CSII use. Methods A survey was undertaken of young people (aged 12 to 18 years) with type 1 diabetes mellitus and their parents/guardians living in Hunter New England, Australia, using a questionnaire designed to collect quantitative, descriptive, and demographic data. Most questions were based on previously developed and validated instruments. In total, 107 respondents returned partially or fully completed questionnaires. Results Respondents had positive attitudes and perceptions of their self-efficacy and diabetes management, but were moderately disturbed by their diabetes and reported experiencing suboptimal management outcomes. Patterns of associations were demonstrated between knowledge, attitudes, and experiences of diabetes modeled by regression analysis. There were no statistically significant differences in responses between users and nonusers of CSII. Over 40% indicated their intention to use the technology as adults. Conclusions Opportunities for enhanced diabetes service support were clear, and CSII did not appear to be used to its full potential. Service redesign could enhance support for this young population using all preferred insulin delivery methods and should align to patients' goals and preferences to maximize service and patient gain. [ABSTRACT FROM AUTHOR]

Background Requests for assistance in menstrual management and menstrual suppression are a common, emotive and sometimes controversial aspect of adolescent disability care. Aims To review the uptake and outcomes of menstrual suppression among adolescent patients with developmental delay. Methods A retrospective review of the medical records of adolescent females with intellectual disability referred for menstrual management to the Paediatric and Adolescent Gynaecology Clinic, Children's Hospital at Westmead, Sydney, for the three-year period between January 1, 2010 and January 1, 2013. Results Eighty adolescent patients with developmental delay were identified. A third ( n = 28) of the patients were pre-menarcheal at first review with parent/caregivers seeking anticipatory advice. Of the post-menarcheal patients, the median age of menarche was 12 years (range 10-15 years). First and second line interventions were documented as were reasons for change where applicable. The combined oral contraceptive pill ( COCP) was the most frequently used therapy (67%), and 19 patients in total had a levonorgestrel releasing intrauterine system ( LNG- IUS) inserted (31%). Our study population differs from similar previously published groups in the marked absence of the use of depot medroxyprogesterone acetate or the subdermal etonogestrel releasing device. Conclusion As a paediatrician, it is important to address menstrual management issues and allay caregiver concerns with appropriate advice. Our study supports the use of the COCP as sound first line management in achieving menstrual suppression. The LNG- IUS appears to be a favourable second line option. Further investigation into longer-term outcomes and potential complications of device insertion is recommended. [ABSTRACT FROM AUTHOR]

Objectives To describe the characteristics, diagnoses and outcomes of older adolescents, aged 16-19 years, presenting to a paediatric ED. Methods A retrospective review of total ED presentations by older adolescents to a tertiary paediatric hospital between 2010 and 2012, inclusive, was undertaken to determine if behavioural or mental health problems were common. Results A total of 1184 ED presentations by 730 older adolescents were identified. Injury and abdominal pain were the most common complaints for presentations by older adolescents to the ED. The median length of stay in ED was 241 (range: 0-3873) min. More than 60% of the older adolescent ED presentations were triaged urgent or semi-urgent, and 39% of all these presentations resulted in hospital admission. Two-thirds of these older adolescents had a chronic illness, which accounted for 77% of all ED presentations by older adolescents. The history of chronic illness was considered related or relevant in the evaluation and management of over 80% of older adolescents. Of all the ED presentations by older adolescents with chronic illness, only one quarter had transition planning documentation. Conclusions A high prevalence of chronic illness was found in older adolescents attending the paediatric ED. There was no evidence that behavioural and mental health issues dominated. These findings reflect admission policy. [ABSTRACT FROM AUTHOR]

Objective Individuals with Prader-Willi syndrome (PWS) are commonly restricted to 60-75% of height-appropriate calorie intake because they rapidly become obese on a normal diet. This study measured changes in energy expenditure, glucose and lipid homeostasis, and metabolic flexibility in response to a meal in PWS adults. Methods 11 adults with PWS were compared with 12 adiposity-matched and 10 lean subjects. Indirect calorimetry was conducted at baseline and 210 min after a standardized 600 kCal breakfast to assess energy expenditure and substrate utilization. Circulating glucose, insulin, C-peptide, glucagon, nonesterified fatty acids, and triglycerides were measured up to 240 min. Insulin sensitivity and insulin secretion rate were assessed by HOMA-IR and C-peptide deconvolution, respectively. Body composition was determined by dual-energy X-ray absorptiometry. Results The PWS group had lower lean mass than the obesity control group. Corrected for lean mass, there were no differences between the PWS and obesity groups in resting metabolic rate or metabolic flexibility. Total and abdominal fat mass, insulin sensitivity, and insulin secretion rate were also similar between these groups. Conclusions This study did not detect an intrinsic metabolic defect in individuals with PWS. Rather, lower lean mass, combined with lower physical activity, may contribute to weight gain on an apparent weight-maintenance diet. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to review the operation of a specialist adolescent drug and alcohol consultation liaison service in a tertiary paediatric hospital. Method: A retrospective review of patient records was conducted to identify patient characteristics and assess service utilisation. Results: Two hundred adolescents were referred over 4 years. Most presented during mid-adolescence (14-16 years). Alcohol, cannabis and nicotine were the most frequently reported substances, and almost half of referrals involved polysubstance use. Mental health diagnoses and behavioural problems were commonly reported. Almost two-thirds (63.5%) attended an appointment for drug and alcohol assessment and intervention (n = 92) or were referred to appropriate services (n = 35). Adolescents more likely to engage and attend an appointment with the specialist adolescent addiction medicine service included those with amphetamine use, polysubstance use, chronic illness, any mental health diagnosis and mood disorder. Indigenous Australians and those with a history of aggression were more difficult to engage. Conclusions: Adolescents present to paediatric health settings with drug- and alcohol-related issues, including associated harms. These comprise, but are not limited to, physical and sexual assault, family conflict, mood and behavioural concerns (including psychosis), and forensic issues. Early intervention aims to reduce long-term risks such as dependence in adulthood. Specialist adolescent drug and alcohol services may assist in identifying and engaging these high-risk and often complex young people in developmentally appropriate treatment. [ABSTRACT FROM AUTHOR]

Context Individuals with Prader- Willi syndrome ( PWS) have a high cardiovascular risk, the mechanism of which is unclear. There may be dysfunction in the autonomic nervous system ( ANS) in PWS. Objective To measure, as indicators of cardiac autonomic function, postprandial heart rate variability ( HRV) and arterial stiffness in adults with PWS. Methods Ten adults with PWS were compared with 11 matched healthy obese subjects and 9 healthy lean subjects. Electrocardiographic traces and arterial stiffness were recorded over a period of 10 minutes at −60, 0, 30, 60, 120 and 240 minutes after consumption of a standardized 600- kCal breakfast. Frequency domain analysis was performed using fast Fourier transform to estimate power spectral density in the full spectrum and in low-frequency (LF 0·04-0·15 Hz) and high-frequency (HF 0·15-0·40 Hz) bands. Results ANCOVA revealed a reduced LF HRV meal response in adults with PWS compared with obese controls, with no differences in HF HRV, LF/ HF ratio, heart rate, total power or arterial stiffness meal responses. Conclusions This study assessed cardiac autonomic function in adults with PWS compared with matched obese and lean subjects in response to a meal. Results suggest impaired postprandial ANS responsiveness in PWS, which could contribute to both the known increased cardiovascular risk and obesity. [ABSTRACT FROM AUTHOR]

We sought to discover adolescents' thoughts about participation in longitudinal research and identify recruitment and retention strategies that were meaningful to them. We conducted seven focus groups with 10-15-year-olds in two large rural centers in New South Wales, Australia, and all focus groups were digitally recorded, transcribed, and analyzed. Adolescents discussed factors salient to their involvement in focus groups, as well as factors that may influence involvement in a longitudinal study. At the outset of the focus groups, adolescents had a positive view of 'research,' but were reluctant to engage in research that involved biologic samples. Effective recruitment of adolescents requires an appreciation of motivators, and time and resources to extend potential participants' understanding. [ABSTRACT FROM AUTHOR]

Aim: To report our experiences with recruiting overweight and obese 13- to 16-year-olds for the Loozit® weight management randomised control trial (RCT) and to identify effective strategies for recruiting adolescents from the community to a treatment trial. Methods: The Loozit RCT is a two-arm, community-based, lifestyle intervention that aims to evaluate the effect of additional therapeutic contact provided via telephone coaching and electronic communications as an adjunct to the Loozit group programme. Strategic areas that were targeted to recruit adolescents included media, schools, health professionals and community organisations. The programme aimed to recruit a cohort of 12-16 adolescents (body mass index z-score range 1.0-2.5) aged 13-16 years every 3 months over 3 years. Information regarding recruitment and eligibility to participate was initially assessed during a telephone screen. The relative cost effectiveness of recruitment strategies was determined based on recruitment rates and costs including administrative costs and research assistant time. Results: Out of 474 enquiries, 32% resulted in an enrolment to the RCT. Newspaper articles and school newsletters accounted for nearly 60% of enquiries and enrolments and were the most cost-effective recruitment strategies. Common reasons for ineligibility for inclusion in the RCT were adolescents being too young (21%) and parents consenting but adolescents refusing to participate (17%). Conclusions: The most successful recruitment strategies for the Loozit RCT were local newspapers and school newsletters. Future studies should consider involving a Public Relations department and other potentially cost-effective strategies such as peer recruitment. [ABSTRACT FROM AUTHOR]

Objective: To document diabetes health services use and indices of glycaemic management of young people with type 1 diabetes from the time of their first contact with adult services, for those living in regional areas compared with those using city and state capital services, and compared with clinical guideline targets.Design, Setting and Subjects: Case note audit of 239 young adults aged 18-28 years with type 1 diabetes accessing five adult diabetes services before 30 June 2008 in three geographical regions of New South Wales: the capital (86), a city (79) and a regional area (74).Main Outcome Measures: Planned (routine monitoring) and unplanned (hospital admissions and emergency department attendance for hypoglycaemia or hyperglycaemia) service contacts; recorded measures of glycated haemoglobin (HbA(1c)), body mass index (BMI), and blood pressure (BP).Results: Routine preventive service uptake during the first year of contact with adult services was significantly higher in the capital and city. Fewer regional area patients had records of complications assessment and measurements of HbA(1c), BMI and BP across all audited years of contact (HbA(1c): 73% v 94% city, 97% capital; P < 0.001). Across all years, regional area patients had the highest proportion of HbA(1c) values > 8.0% (79% v 62% city, 56% capital) and lowest proportion < 7% (4% v 7%, 22%) (both P < 0.001). Fewer young people made unplanned use of acute services for diabetes crisis management in the capital (24% v 49% city, 50% regional area; P < 0.001). In the regional area, routine review did not occur reliably even annually, with marked attrition of patients from adult services after the first year of contact.Conclusion: Inadequate routine specialist care, poor diabetes self-management and frequent use of acute services for crisis management, particularly in regional areas, suggest service redesign is needed to encourage young people's engagement. [ABSTRACT FROM AUTHOR]

Aim: With increasing survival rates for chronic childhood illness, there has been an increasing focus on the transition of clinical care from paediatric to adult services. Data regarding patient numbers are essential for strategic planning and for optimal management. We report on a data collection exercise from the New South Wales Greater Metropolitan Clinical Taskforce Transition Program. Methods: Data were collected between August 2004 and October 2005 through face-to-face interviews with over 200 clinicians in 68 clinical services in tertiary paediatric hospitals in New South Wales, providing information on approximately 4200 patients. Results: Sixty-eight services kept a database on patients with chronic illness but less than half were electronic. Eight services (12%) could specifically identify patients in the active phase of transition on their databases. The five most prevalent clinical groups requiring transition to adult specialist health care (excluding cerebral palsy and developmental disability) were diabetes, other endocrinology, neurology, spina bifida and gastroenterology. Conclusions: There are large numbers of young people with chronic illness and disability who need effective transition to long-term adult care. This study has enabled the identification of paediatric aspects of the transition process that require attention. [ABSTRACT FROM AUTHOR]

Aim: To evaluate a community-based weight management program for overweight and obese adolescents aged 13–16 years. Methods: The present study was a group-based intervention over five months conducted in Australian community health centres. Program evaluation questionnaires were completed by adolescents and their parents. Seven semi-structured group sessions were held for adolescents: weekly for four weeks and then at two, four and five months. The program sessions focused on healthy eating, increasing physical activity, decreasing sedentary behaviour and increasing self-esteem. Adolescents' anthropometry, blood pressure and fasting blood biochemistry were measured. Adolescents completed validated questionnaires on diet, physical activity and self-esteem. Results: Twenty-two overweight and obese adolescents were recruited with a median body mass index (BMI) z-score 2.30. Recruitment strategies were identified and a high retention rate (91%) was achieved. The program was well received by adolescents. Parents reported their adolescents were making healthier food choices and increasing physical activity. At treatment end there were clinically significant improvements in self-perception scores for physical appearance and romantic appeal ( P < 0.05), waist circumference (median 100.1 cm vs 97.1 cm; P < 0.0001) and HDL cholesterol (median 1.10 mmol/L vs 1.20 mmol/L; P = 0.02), but not BMI or BMI z-score. Conclusions: The Loozit weight management intervention is one of the first to involve adolescents in the evaluation of the program and to operate at a sustainable intensity in an accessible community setting. The present study provides valuable insights into the elements of a program that is acceptable to adolescents. [ABSTRACT FROM AUTHOR]

Objective Prader–Willi syndrome (PWS) is a genetic obesity syndrome characterized by hyperphagia, behavioural disturbance and intellectual disability. PWS appears to be associated with a high incidence of sudden death, suspected to be cardiopulmonary in origin. We therefore sought to provide an assessment of cardiac and vascular structure and function in patients with PWS. Patients Nine patients with genetically confirmed PWS, mean age 28 years, body mass index (BMI) 42 kg/m2, were compared with nine age- and gender-matched lean controls. Measurements Lipid parameters, high-sensitivity C-reactive protein (hs-CRP) and fasting glucose and insulin were measured. To assess cardiac structure and function, a resting electrocardiogram (ECG), exercise stress test, 24-h continuous ECG monitoring, and echocardiogram were obtained. Patients and control subjects also underwent comprehensive noninvasive vascular assessment, including venous-occlusion forearm plethysmography, brachial artery flow-mediated dilatation (FMD), radial artery tonometry and carotid intima–media thickness (IMT) measurements. Results All patients with PWS had significantly elevated hs-CRP (> 3·0 mg/l) (mean 11·5 mg/l, median 11·47, interquartile range: 4·48–15·8 mg/l), compared with controls ( P < 0·001). Five of nine patients with PWS had subnormal exercise capacity (< 4 mets on exercise stress testing). Twenty-four-hour ECG monitoring revealed prolonged sinus pauses in one patient, up to 4·8 s, requiring pacemaker insertion . Microvascular function as assessed by peak hyperaemic flow response was decreased in PWS (6·1 ± 1·0 times baseline flow vs. controls 13·5 ± 1·6 times baseline flow, P = 0·01). Other measures were similar between PWS and controls. Conclusions This group of PWS patients had significantly raised levels of the inflammatory marker hs-CRP and evidence of microcirculatory dysfunction, both of which are associated with coronary artery disease and early sudden death. The sinus node dysfunction may in itself be a risk factor for sudden cardiac death. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to describe the accessibility, quality and readability of web base content on the Internet for childhood obesity management from a parental viewpoint. As more than 25% of Australian children are overweight or obese, it is likely that parents access the Internet for advice on obesity management for their child. Design: Links to websites were generated using three search engines and three phrases. The first 10 website links were selected from each of nine searches. Ten aspects of obesity management were identified for the analysis of childhood obesity and related websites. The Fry readability graph was used to assess content readability. Data analysis: The data were analysed usingspss Version 10, Minitab and Microsoft Excel 2000.anova was used to compare clinical criteria between website type. Results: A total of 90 links were generated with 60 relevant for analysis. In total, 30 were specific to childhood obesity and 47 websites were either obesity-specific or weight-related. Childhood obesity websites were community-based or commercial. Most websites relevant to childhood obesity management came at no cost, in comparison with general weight-related sites. Childhood obesity websites scored generally high on accuracy of content. Overall, website readability was at an undergraduate level. Conclusions: There appears to be a paucity of accessible information on the Internet related to childhood weight management, which parents could access. Childhood obesity management websites should ideally include clinically approved management guidelines and follow e-health codes of ethical practice. [ABSTRACT FROM AUTHOR]

A correction to the article "Postprandial Metabolism in Adults with Prader-Willi Syndrome" by Louise Purtell, Alexander Viardot, Lisa Sze, and colleagues is presented.