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OBJECTIVE: With increasing rates of non-communicable disease, there is a need for implementing population-wide, evidence-based interventions for improving behavioural risk factors. Telephone-based interventions provide one option. This study reports on the evaluation of the Australia's Get Healthy Information and Coaching Service(R), to improve lifestyle behaviours, amongst a population-wide sample who completed the 6-month coaching programme. METHODS: Using a pre-post design, New South Wales participants who completed telephone-based coaching between February 2009 and December 2011 were included. Outcomes comprised self-reported weight, waist circumference, height, physical activity and dietary behaviours. Matched pair analyses and multivariate modelling were performed to assess behavioural changes. RESULTS: Participants (n=1440) reported statistically significant improvements in weight (-3.9kg (5.1)); waist circumference (-5.0cm (6.0)); and Body Mass Index (-1.4 BMI units (1.8)); number of walking and moderate-vigorous physical activity sessions of >=30min per week; number of vigorous physical activity sessions of >=20min per week and servings of vegetables; fruit; take-away meals and sweetened drinks (all p<0.001). Improvements in weight, waist, moderate physical activity, fruit and vegetable and take-away meals consumption remained significant after adjusting for socio-demographic characteristics. CONCLUSIONS: These results support the effectiveness of replicating an evidence-based intervention in improving population risk factors for chronic disease. [ABSTRACT FROM AUTHOR]

Many health organisations seek social media engagement through their online health promotion campaigns, but there is little understanding of what engagement means in relation to the uptake of health messages. To understand the relevance of social media engagement, we need to look at the reasons why people engage with health content via social media. This exploratory study examined people's motivations for engaging with health content through a case study of the Healthy Lunch Box campaign. Data was collected via online focus groups (n = 7), with participants being a convenience sample of people who had seen or engaged with the Healthy Lunch Box resources (n = 24). The discussions covered reasons for engaging with the Healthy Lunch Box campaign, and more broadly with health content on social media in general. The data was analysed using a reflexive approach to thematic analysis, with themes developed inductively. The study found that some of the reasons for engagement aligned with the paradigm of social media engagement being an intermediary step in the process towards health behaviour change. However, people also described other reasons, such as alignment with their personal values, consideration of their online presentation, or as a way of curating the content they wanted to be shown on social media. These results demonstrate that people's decision to engage with health-related social media content involves more than consideration about the usefulness of the content, suggesting the need for a deeper examination of the assumptions made about the value of social media engagement in health campaign evaluations., (© The Author(s) 2023. Published by Oxford University Press.)

Importance: To counteract infection with phage, bacteria have evolved a myriad of molecular defense systems. Some of these systems initiate a process called abortive infection, in which the infected cell kills itself to prevent phage propagation. However, such systems must be inhibited in the absence of phage infection to prevent spurious death of the host. Here, we show that the cyclic oligonucleotide based anti-phage signaling system (CBASS) accomplishes this by sensing intracellular folate molecules and only expressing this system in a group. These results enhance our understanding of the evolution of the seventh Vibrio cholerae pandemic and more broadly how bacteria defend themselves against phage infection., Competing Interests: The authors declare no conflict of interest.

Issue Addressed: Australia has smoking prevalence of less than 15% among adults, but there are concerns that the rates of decline have stabilised. Sustained mass media campaigns are central to decreasing prevalence, and the emotions evoked by campaigns contribute to their impact. This study investigates the association between potential exposure to campaigns that evoke different emotions on quitting salience (thinking about quitting), quitting intentions and quitting attempts., Methods: Data on quitting outcomes were obtained from weekly cross-sectional telephone surveys with adult smokers and recent quitters between 2013 and 2018. Campaign activity data were collated, and population-level potential campaign exposure was measured by time and dose., Results: Using multivariate analyses, a positive association between potential exposure to 'hope' campaigns and thinking about quitting and intending to quit was noted, but no association was seen with quit attempts. Potential exposure to 'sadness' evoking campaigns was positively associated with quitting salience and negatively associated with quit attempts, whereas those potentially exposed to campaigns evoking multiple negative emotions (fear, guilt and sadness) were approximately 30% more likely to make a quit attempt., Conclusions: This study suggests a relationship between the emotional content of campaigns, quitting behaviours. Campaign planners should consider campaigns that evoke negative emotions for population-wide efforts to bring about quitting activity alongside hopeful campaigns that promote quitting salience and quitting intentions. The emotional content of campaigns provides an additional consideration for campaigns targeting smokers and influencing quitting activity. SO WHAT?: This study demonstrates the importance of balancing the emotional content of campaigns to ensure that campaign advertising is given the greatest chance to achieve its objectives. Utilising campaigns that evoke negative emotions appear to be needed to encourage quitting attempts but maintaining hopeful campaigns to promote thinking about quitting and intending to quit is also an important component of the mix of tobacco control campaigns., (© 2022 The Authors. Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

The efficacy of lifestyle interventions for reduced gestational weight gain (GWG) is established, but evidence of their effectiveness is limited. The Get Healthy in Pregnancy (GHiP) program is a telephone health coaching program supporting healthy GWG delivered state-wide in New South Wales, Australia. This evaluation explores the impact of GHiP on behavioural outcomes and GWG, analysing GHiP participant data (n = 3702 for 2018-2019). We conducted McNamar's tests to explore within-individual change for behavioural outcomes and logistic regression to assess associations between demographic characteristics, participant engagement and behavioural and weight outcomes for women who completed the program. Participants who completed ten coaching calls made significant improvements (all p < 0.001) in more health-related behaviours (walking, vigorous physical activity, vegetable consumption, takeaway meals and sweetened drink consumption) than those who completed fewer calls. Among women with valid weight change data (n = 245), 31% gained weight below, 33% gained weight within, and 36% gained weight above GWG guidelines. Pre-pregnancy BMI was the only factor significantly associated with meeting GWG guidelines. Women with pre-pregnancy overweight and obesity had lower odds than those with a healthy weight of having GWG within the guidelines. The majority of these women did not gain weight above the guidelines. A higher proportion of women with pre-pregnancy obesity gained weight below the guidelines (33.8%) than above the guidelines (28.5%). GHiP has the potential to support all pregnant women, including those with pre-pregnancy obesity, to achieve a healthier pregnancy.

Introduction: While social media are commonly used in public health campaigns, there is a gap in our understanding of what happens after the campaign is seen by the target audience. This study aims to understand how the Shisha No Thanks campaign video was received by the Facebook audience by analyzing Facebook comments posted to it. Specifically, this study aims to determine whether the Facebook audience accepted or rejected the campaign's message., Methods: A sample of the Facebook comments was extracted, and the study team, which included cultural support workers, developed content categories consistent with the research question. Each comment was then coded by three team members, and only assigned a category if there was agreement by at least two members., Results: Of the 4990 comments that were sampled, 9.1% (456) accepted the campaign message, 22.9% (1144) rejected the message, 21.8% (1089) were unclear, and 46.1% (2301) contained only tagged names. Of the sample, 2.8% (138) indicated the commenter took on board the campaign message by expressing an intention to stop smoking shisha, or asking a friend to stop smoking shisha. Of the comments that showed rejection of the campaign, the majority were people dismissing the campaign by laughing at it or expressing pro-shisha sentiments., Conclusions: This study demonstrates that conducting content analyses of social media comments can provide important insight into how a campaign message is received by a social media audience., Competing Interests: The authors have each completed and submitted an ICMJE form for disclosure of potential conflicts of interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. L. Chan reports that since the initial planning of the work received a scholarship from Prevention Research Support Program, New South Wales Ministry of Health, provision of study materials and in-kind support of staff time for analysis from the Western Sydney Local Health District, technical advice in accessing data from Sydney Infomatics Hub and provision of cultural support workers from South Eastern Sydney Local Health District and Sydney Local Health District Cultural Support Program. B. Freeman reports that in the past 36 months received payment from Cancer Council NSW and payment to her Institution from Cancer Council NSW, Healthway WA, VicHealth, Ian Potter Foundation, and NSW Health. Furthermore, she received consulting fees from the World Health Organization and Heart Foundation NSW, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Department of Health The Government of Hong Kong Special Administrative Region, the USA FDA, BMJ Tobacco Control, and support for attending meetings and/or travel from Oceania Tobacco Control Conference, and Australia Public Health Association Conference. Finally she reports that she was an expert advisor (unpaid) at the Cancer Council - Tobacco Issues Committee, an expert member (paid for time) at NHMRC Electronic Cigarettes Working Committee and advisor (unpaid) at Cancer Institute - Vaping Communications Advisory Panel., (© 2022 Chan L. et al.)

The current circulating pandemic El Tor biotype of Vibrio cholerae has persisted for over sixty years and is characterized by its acquisition of two unique genomic islands called the Vibrio Seventh Pandemic Islands 1 and 2 (VSP-I and VSP-II). However, the functions of most of the genes on VSP-I and VSP-II are unknown and the advantages realized by El Tor through these two islands are not clear. Recent studies have broadly implicated these two mobile genetic elements with phage defense. Still, protection against phage infection through these islands has not been observed directly in any V. cholerae El Tor biotype. Here we report the isolation of a circulating phage from a cholera patient stool sample and demonstrate that propagation of this phage in its native host is inhibited by elements in both VSP-I and VSP-II, providing direct evidence for the role of these genomic islands in phage defense. Moreover, we show that these defense systems are regulated by quorum sensing and active only at certain cell densities. Finally, we have isolated a naturally occurring phage variant that is resistant to the defense conferred by the VSP islands, illustrating the countermeasures used by phages to evade these defense mechanisms. Together, this work demonstrates a functional role for the VSPs in V. cholerae and highlights the key regulatory and mechanistic insights that can be gained by studying anti-phage systems in their native contexts., Competing Interests: The authors have declared that no competing interests exist.

Co-production in health literature has increased in recent years. Despite mounting interest, numerous terms are used to describe co-production. There is confusion regarding its use in health promotion and little evidence and guidance for using co-produced chronic disease prevention interventions in the general population. We conducted a scoping review to examine the research literature using co-production to develop and evaluate chronic disease prevention programs. We searched four electronic databases for articles using co-production for health behaviour change in smoking, physical activity, diet, and/or weight management. In 71 articles that reported using co-production, co-design, co-create, co-develop, and co-construct, these terms were used interchangeably to refer to a participatory process involving researchers, stakeholders, and end users of interventions. Overall, studies used co-production as a formative research process, including focus groups and interviews. Co-produced health promotion interventions were generally not well described or robustly evaluated, and the literature did not show whether co-produced interventions achieved better outcomes than those that were not. Uniform agreement on the meanings of these words would avoid confusion about their use, facilitating the development of a co-production framework for health promotion interventions. Doing so would allow practitioners and researchers to develop a shared understanding of the co-production process and how best to evaluate co-produced interventions.

Background: Waterpipe (shisha) is becoming increasingly popular worldwide, particularly among young people; and in some countries, it is one of the few forms of tobacco use that is increasing. While there is a growing body of evidence of the harms of waterpipe smoke, there is a scarcity of research of interventions to address this form of tobacco consumption., Methods: The Shisha No Thanks project was a co-design social marketing campaign that aimed to raise awareness of the harms of waterpipe smoking among young people from an Arabic speaking background in Sydney, Australia. The campaign distributed material through social media and community events. We evaluated the project through an SMS community panel using a longitudinal study design. The cohort were sent questions before and after the project asking about their awareness of messages of harms, attitudes, intention to reduce waterpipe smoking, and awareness of support services. Data was analysed as matched pre- post- data., Results: The evaluation recruited 133 people to the panel. There was a significantly greater proportion of people who reported seeing, hearing or reading something about the harms of waterpipe smoking after the campaign (67.5%) compared with before (45.0%) (p=0.003). Post-campaign, there were higher proportions of people who strongly agreed that waterpipe smoking causes damage, and that it contains cancer-causing substances, but these increases were not statistically significant. There was low awareness of waterpipe cessation services at baseline and post campaign (22.5%)., Conclusions: The Shisha No Thanks project increased awareness of messages about the harms of waterpipe smoking. Although this is a small study, the longitudinal evaluation findings have international relevance and make a useful contribution to the understanding of the impact such interventions can have in addressing one of the few forms of tobacco use that is growing in both developed and developing countries., (© 2022. The Author(s).)

During the COVID-19 pandemic many traditional methods of data collection, such as intercept surveys or focus groups, are not feasible. This paper proposes that establishing community panels through SMS text messages may be a useful method during the pandemic, by describing a case study of how an innovative SMS text message community panel was used for the "Shisha No Thanks" project to collect data from young adults of Arabic-speaking background about their attitudes on the harms of waterpipe smoking. Participants were asked to complete an initial recruitment survey, and then subsequently sent 1 survey question per week. The study recruited 133 participants to the SMS text message community panel and the mean response rate for each question was 73.0% (97.1/133) (range 76/133 [57.1%] to 112/133 [84.2%]). The SMS text message community panel approach is not suited for all populations, nor for all types of inquiry, particularly due to limitations of the type of responses that it allows and the required access to mobile devices. However, it is a rapid method for data collection, and therefore during the COVID-19 pandemic, it can provide service providers and policymakers with timely information to inform public health responses. In addition, this method negates the need for in-person interactions and allows for longitudinal data collection. It may be useful in supplementing other community needs assessment activities, and may be particularly relevant for people who are considered to be more difficult to reach, particularly young people, culturally and linguistically diverse communities, and other groups that might otherwise be missed by traditional methods., (©Lilian Chan, Nouhad El-Haddad, Becky Freeman, Blythe J O'Hara, Lisa Woodland, Ben Harris-Roxas. Originally published in JMIR Formative Research (https://formative.jmir.org), 03.11.2021.)

It is now well appreciated that members of pathogenic bacterial populations exhibit heterogeneity in growth rates and metabolic activity, and it is known this can impact the ability to eliminate all members of the bacterial population during antibiotic treatment. It remains unclear which pathways promote slowed bacterial growth within host tissues, primarily because it has been difficult to identify and isolate slow growing bacteria from host tissues for downstream analyses. To overcome this limitation, we have developed a novel variant of TIMER, a slow-folding fluorescent protein, named DsRed42, to identify subsets of slowly dividing bacteria within host tissues. The original TIMER folds too slowly for fluorescence accumulation in quickly replicating bacterial species (Escherichia coli, Yersinia pseudotuberculosis), however DsRed42 accumulates red fluorescence in late stationary phase cultures of E. coli and Y. pseudotuberculosis. We show DsRed42 signal also accumulates during exposure to sources of nitric oxide (NO), suggesting DsRed42 signal detects growth-arrested bacterial cells. In a mouse model of Y. pseudotuberculosis deep tissue infection, DsRed42 signal was detected, and primarily accumulates in bacteria expressing markers of stationary phase growth. There was no significant overlap between DsRed42 signal and NO-exposed subpopulations of bacteria within host tissues, suggesting NO stress was transient, allowing bacteria to recover from this stress and resume replication. This novel DsRed42 variant represents a tool that will enable additional studies of slow-growing subpopulations of bacteria, specifically within bacterial species that quickly divide., Competing Interests: The authors have declared that no competing interests exist.

Competing Interests: None declared.

Objectives: To examine the relationship between school playground size and total physical activity (PA), fitness and fundamental movement skills (FMS) of primary school students., Design: Cross-sectional ecological analysis., Setting: 43 primary schools in New South Wales, Australia., Participants: Data were from 5238 students, aged 5 to 12 years, participating in the Schools Physical Activity and Nutrition Survey., Outcome Measures: Self (for age ≥11 years) and parent (for age <11 years) report of PA (meeting PA recommendations and number of days meeting recommendations), objectively measured FMS and cardiorespiratory and muscular fitness., Results: Associations between playground space and measures of PA and fitness were mostly non-linear and moderated by loose equipment. Students in schools with no loose equipment showed a weak association between space and meeting PA recommendations (self-report). In schools with equipment, students' predicted probability of meeting PA recommendations increased sharply between 15 m 2 and 25 m 2 per student from 0.04 (95% CI: 0.01 to 0.08) to 0.30 (95% CI: 0.14 to 0.46), but at 30 m 2 returned to levels comparable to students in schools with no equipment (0.18, 95% CI: 0.07 to 0.28). For cardiorespiratory fitness, in schools with no loose equipment, probabilities for being in the healthy cardiovascular fitness zone varied between 0.66 and 0.77, showing no consistent trend. Students in schools with loose equipment had a predicted probability of being in the healthy fitness zone of 0.56 (95% CI: 0.41 to 0.71) at 15 m 2 per student, which rose to 0.75 (95% CI: 0.63 to 0.86) at 20 m 2 per student. There was no relationship between space and FMS., Conclusions: School space guidelines need to incorporate sufficient playground space for students. Our study provides evidence supporting better PA outcomes with increasing space up to 25 m 2 per student, and access to loose equipment, however further research is required to determine precise thresholds for minimum space. Intersectoral planning and cooperation is required to meet the needs of growing school populations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Weight-loss maintenance and lifestyle behaviour necessary to manage weight are undisputedly challenging. We evaluated a secondary prevention weight-loss maintenance programme for participants (n = 490) with weight-related chronic disease in the Australian private health insurance setting. This study investigated the impact of the maintenance programme on anthropometric and lifestyle risk behaviour changes after 6 and 12 months, and trends in weight-loss maintenance after 1 year. Using a pre- and post-test design, data were analysed with generalized linear mixed models for repeated measures to determine the effect of the programme on weight loss and lifestyle behaviour outcomes. After initially losing a clinically significant amount of weight (mean 9.1 kg), maintenance-programme participants maintained clinically significant weight loss (mean 7.6 kg) at 12 months. Rates of discontinuation in the programme were high (47% at 6 months and 73% at 12 months). Weight-loss maintenance was achieved by 76% of participants at 3 months and 62% at 6 months, stabilizing at 55% and 56% at 9 and 12 months, respectively. Greater initial weight loss was associated with weight-loss maintenance at 12 months. Participants <55 years demonstrated consistent weight-loss maintenance over this time but the odds for successful weight-loss maintenance for those ≥55 years continued to decrease over time. At maintenance-baseline, 68.3% of participants had sufficient physical activity for health; 61.4% and 19.8% met recommended fruit and vegetable consumption, respectively. All lifestyle risk behaviours were maintained at 12 months. A programme extending support strategies for maintaining weight-related behaviour shows promise to successfully support these changes over 12 months. There is a potentially important opportunity for targeted intervention at 6 to 9 months., (© 2020 World Obesity Federation.)

Objective: The Live Life Well @ School program aims to establish, reinforce and support primary school students (aged 5-11 years) and their families to adopt healthy eating and physical activity behaviours through the implementation of an evidence-based program that focuses on the school curriculum, the school food and physical activity environment, and teacher professional development. This paper examines Live Life Well @ School monitoring data to provide practical insights into program adoption and changes in primary school environments across NSW, particularly in schools characterised as disadvantaged. Type of program: The Live Life Well @ School program provides a universally delivered, state-wide approach to childhood obesity prevention in the primary school setting. The program is a joint initiative between health and education sector agencies., Methods: The program includes health promotion strategies for primary schools relating to physical activity and nutrition. Adoption of the program is indicated by achievement of evidence-based desirable practices, which are monitored routinely by local health promotion staff using a purpose-built online Population Health Information Management System. Monitoring data are used to provide feedback to schools and identify a staged approach to achieving more desirable practices. Health promotion staff tailor support locally to suit school and community needs, and have additional funding to support socio-economically disadvantaged schools., Results: The program has achieved high reach to schools (82.7%percnt; of the 2570 schools in New South Wales, Australia). Adoption of desirable practices within schools participating in 2017 was 72.9%percnt;. Equitable reach was achieved for schools in areas of socio-economic disadvantage, schools in remote areas and schools with a high propotion of Aboriginal students, who are likely to have higher rates of childhood overweight and obesity. Curriculum-based strategies were more frequently adopted; environmental changes and teacher professional development components were less well adopted., Lessons Learnt: The desirable practice approach allows health promotion officers to tailor support by building on school strengths and taking a staged approach to change. Ongoing monitoring of the program provides useful insights that inform quality improvements to the program and implementation process, as well as information on progress towards outcomes. State-wide program targets were adjusted to strengthen impact and focus on desirable practices that were less well achieved. Intentional targeting and tailoring in areas of disadvantage are required to achieve equitable adoption of such a universal health promotion program. Strong relationships at the local level between school champions (teachers and principals) and health promotion staff characterise success., Competing Interests: The NSW Ministry of Health provides funding to support LLW@S.

Background: Childhood obesity is an important public health issue. Approximately 20% of 2-4 year olds are overweight or obese, meaning 1 in 5 Australian children start school above a healthy weight. In the state of New South Wales (NSW) the combined prevalence of childhood overweight and obesity is significantly higher among children from low socioeconomic status backgrounds and children from regional, rural and remote areas. This paper describes implementation of a healthy eating and active play program ( Munch & Move ) for center-based early childhood education and care (ECEC) services aimed at influencing healthy behaviors in young children in NSW, Australia. It shows changes over time including a focus on disadvantaged, Aboriginal and remote communities. It also discusses the challenges and future opportunities for the program. Methods: Routine data in relation to service delivery (reach) and implementation indicators are collected by Local Health District staff. Fifteen implementation indicators (known as practices) were introduced to monitor the implementation of Munch & Move (six related to promoting and encouraging healthy eating, four related to improving physical activity, two related to small screen recreation; and three related to quality of service delivery). Results: As of 30 June 2017, 88.4% of ECEC services have staff trained in Munch & Move . Of the 15 practices related to promoting and encouraging healthy eating, increasing physical activity and improving the quality of service delivery 13 practices saw significant improvements between 2012 and 2017. This was consistent for services with a high proportion of Aboriginal children and for services in disadvantaged and remote communities. There has been a statistically significant increase in the proportion (37.6-81.0%, p < 0.0001) and type of ECEC services (preschools 36.1-81.3%, p < 0.0001, long day care 38.6-81.0%, p < 0.0001, and occasional care 34.0-74.6%, p < 0.0001) that have implemented the program since 2012 as well as in services with a high proportion of Aboriginal children (33.6-85.2% p < 0.0001), services in disadvantaged communities (37.4-83.3% p < 0.001), and services in remote communities (27.8-59.4% p < 0.0139). Discussion: This paper demonstrates that Munch & Move has seen large improvements in the delivery of training, practice achievements and program adoption in ECEC services across NSW including services in disadvantaged and remote communities and that have a higher proportion of Aboriginal children., (Copyright © 2020 Green, Mihrshahi, Innes-Hughes, O'Hara, McGill and Rissel.)

Qualitative evidence of participants' experiences of real-life weight loss maintenance programs is important for ongoing participant engagement and can inform program improvements. The purpose of this study was to understand how participants account for their engagement with a weight loss maintenance program and the role of the program in their weight management. A qualitative study using semi-structured interviews with 17 participants of a weight loss maintenance program was conducted; common themes were identified using a thematic inductive approach. Many participant narratives incorporated recurrent descriptions of their program experiences as a weight management journey. Our analysis generated four themes: returning to real life as a threat, the personal responsibility imperative, the program supporting agency and the program supporting self-regulation. The program, which provides external support and strategies, overlapped with the context of returning to real life and the personal responsibility imperative. Participant accounts of their journey at this intersection include the program supporting both agency and self-regulation which influences ongoing weight management. The interplay between themes identified and the maintenance program services allows compatibility between participants' sense of personal responsibility and the program components to help participants to 'stay on track' or 'get back on track'. In providing sufficient structure, opportunities to revisit successful strategies, and accountability, participants are empowered to overcome real-life threats and make positive health choices., Competing Interests: The authors declare no conflict of interest. Luke Lawler is CEO and Scientific Director of Prima Health Solutions, which delivers the Healthy Weight for Life program. He has no commercial or financial relationship with any co-authors.

Objectives: We examine survey reporting of Medicare coverage of the older population by evaluating discordance between survey responses and administrative records. Method: We link data from the 2014 Current Population Survey Annual Social and Economic Supplement (CPS ASEC) and 2014 Medicare Enrollment Database to evaluate the extent to which individuals misreport Medicare coverage in the CPS ASEC. Using regression analyses, we assess factors associated with misreporting. Results: We find the CPS ASEC undercounts the population aged 65 years and older with Medicare by 4.5%. Misreporting of Medicare coverage is associated with citizenship status, immigration year of entry, employment, coverage of other household members, and imputation of Medicare responses. Adjusting for misreporting, Medicare coverage among older individuals increases from 93.4% to 95.6%. Discussion: The CPS ASEC underestimates Medicare coverage for the older population. Administrative records may be useful to evaluate and improve survey imputation of Medicare coverage when missing.

Background: Australian private health insurers are increasingly involved in the delivery of chronic disease management programmes to their members, recognising the importance of decreasing and managing lifestyle risk factors and the impact such factors have on health service utilisation. One such secondary prevention programme is the Healthy Weight for Life programme, an intensive weight loss and lifestyle modification programme that has been designed for overweight and obese private health insurance members in Australia. Together with the insurer, the Healthy Weight for Life service provider developed and implemented a long-term maintenance programme that supports participants who complete the Healthy Weight for Life programme to maintain the weight loss they achieved during the programme. Various studies have shown that evidence-based weight management programmes can be effective; however, the results may vary in different contexts., Objective: This article presents the evaluation rationale and framework designed to assess the process and impact of the long-term maintenance programme on weight loss maintenance, other health-related benefits and participants' experience with the programme., Methods: The evaluation will comprise a number of inter-related sub-studies balancing evaluation of programme effectiveness and implementation. The maintenance programme presented a unique opportunity for researchers to partner with private health insurance and a service provider to assess a real-world programme in the under-researched area of weight loss maintenance in this setting and emphasises the importance of evaluating such programmes given the potential the private health insurance context has in the future delivery of health care., Competing Interests: Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: L.L. is the CEO and Scientific Director of Prima Health Solutions, which delivers the Healthy Weight for Life programme. The remaining authors have no conflicting interests to disclose.

Age-related tendon degeneration (tendinosis) is characterized by a phenotypic change in which tenocytes display characteristics of fibrochondrocytes and mineralized fibrochondrocytes. As tendon degeneration has been noted in vivo in areas of decreased tendon vascularity, we hypothesized that hypoxia is responsible for the development of the tendinosis phenotype, and that these effects are more pronounced in aged tenocytes. Hypoxic (1% O 2 ) culture of aged, tendinotic, and young human tenocytes resulted in a mineralized fibrochondrocyte phenotype in aged tenocytes, and a fibrochondrocyte phenotype in young and tendinotic tenocytes. Investigation of the molecular mechanism responsible for this phenotype change revealed that the fibrochondrocyte phenotype in aged tenocytes occurs with decreased Rac1 activity in response to hypoxia. In young hypoxic tenocytes, however, the fibrochondrocyte phenotype occurs with concomitant decreased Rac1 activity coupled with increased RhoA activity. Using pharmacologic and adenoviral manipulation, we confirmed that these hypoxic effects on the tenocyte phenotype are linked directly to the activity of RhoA/Rac1 GTPase in in vitro human cell culture and tendon explants. These results demonstrate that hypoxia drives tenocyte phenotypic changes, and provide a molecular insight into the development of human tendinosis that occurs with aging., (© 2019 The Authors. Aging Cell published by the Anatomical Society and John Wiley & Sons Ltd.)

Objective: To identify the behavioral economics (BE) conceptual underpinnings of lifestyle financial incentive (FI) interventions., Data Source: A mapping review of peer-reviewed literature was conducted by searching electronic databases., Study Inclusion and Exclusion Criteria: Inclusion criteria were real-world FI interventions explicitly mentioning BE, targeting individuals, or populations with lifestyle-related behavioral outcomes. Exclusion criteria were hypothetical studies, health professional focus, clinically oriented interventions., Data Extraction: Study characteristics were tabulated according to purpose, categorization of BE concepts and FI types, design, outcome measures, study quality, and findings., Data Synthesis and Analysis: Financial incentives were categorized according to type and payment structure. Behavioral economics concepts explicitly used in the intervention design were grouped based on common patterns of thinking. The interplay between FI types, BE concepts, and outcome was assessed., Results: Seventeen studies were identified from 1452 unique records. Analysis showed 76.5% (n = 13) of studies explicitly incorporated BE concepts. Six studies provided clear theoretical justification for the inclusion of BE. No pattern in the type of FI and BE concepts used was apparent., Conclusions: Not all FI interventions claiming BE inclusion did so. For interventions that explicitly included BE, the degree to which this was portrayed and woven into the design varied. This review identified BE concepts common to FI interventions, a first step in providing emergent and pragmatic information to public health and health promotion program planners.

Physical inactivity is a major contributor to non-communicable disease and people of low socioeconomic status (SES) are more likely to be insufficiently active. Physical activity mass media campaigns aim to increase physical activity participation, but little is known about their impact on low SES groups. We reviewed the published literature from 1990 to June 2016 to identify reports of physical activity mass media campaigns. We documented evaluation/study design, target population, campaign outcomes assessed, SES measures used and analysed the results of the SES comparisons. A total of 23 papers were reviewed, reporting on 17 physical activity campaigns and 12 campaigns compared SES differences for 85 outcomes: 45 comparisons showed no difference between lowest and highest SES groups, 20 showed a better outcome for the lowest SES group and 20 showed a worse outcome. Some campaigns found inconsistent results, but seven found only equal and/or better results for low SES groups. Post-campaign physical activity behaviour most commonly showed no SES differences, but no other patterns were seen. Our review found that physical activity mass media campaigns have mostly equitable or better impacts for low SES groups, but to reduce inequalities these campaigns need to be maximally effective for low SES populations.

Sensing and responding to environmental changes is essential for bacteria to adapt and thrive, and nucleotide-derived second messengers are central signaling systems in this process. The most recently identified bacterial cyclic dinucleotide second messenger, 3', 3'-cyclic GMP-AMP (cGAMP), was first discovered in the El Tor biotype of Vibrio cholerae The cGAMP synthase, DncV, is encoded on the VSP-1 pathogenicity island, which is found in all El Tor isolates that are responsible for the current seventh pandemic of cholera but not in the classical biotype. We determined that unregulated production of DncV inhibits growth in El Tor V. cholerae but has no effect on the classical biotype. This cGAMP-dependent phenotype can be suppressed by null mutations in vc0178 immediately 5' of dncV in VSP-1. VC0178 [renamed as cGAMP-activated phospholipase in Vibrio (CapV)] is predicted to be a patatin-like phospholipase, and coexpression of capV and dncV is sufficient to induce growth inhibition in classical V. cholerae and Escherichia coli Furthermore, cGAMP binds to CapV and directly activates its hydrolase activity in vitro. CapV activated by cGAMP in vivo degrades phospholipids in the cell membrane, releasing 16:1 and 18:1 free fatty acids. Together, we demonstrate that cGAMP activates CapV phospholipase activity to target the cell membrane and suggest that acquisition of this second messenger signaling pathway may contribute to the emergence of the El Tor biotype as the etiological agent behind the seventh cholera pandemic., Competing Interests: The authors declare no conflict of interest., (Copyright © 2018 the Author(s). Published by PNAS.)

Objectives and importance of study: Low program completion rates can undermine the public health impact of even the most effective program. Participant experiences with lifestyle programs are not well reported, but are important for program improvement and retention. The purpose of this study was to understand participant perceptions of the Get Healthy Information and Coaching Service (GHS), a 6-month telephone-based health coaching program to promote lifestyle change. We were particularly interested in participants' initial expectations, their actual experience and, for those who did not complete the program, what influenced their withdrawal., Study Type: The study included qualitative semistructured interviews and a quantitative sociodemographic survey., Methods: A random sample of GHS participants (n = 59) was recruited to take part in semistructured interviews about their perceptions and experiences of the coaching program. Researchers conducted independent thematic analysis of the interview transcripts. Sociodemographic details were obtained from a quantitative survey of all GHS participants., Results: Participants expected that coaching would provide support, information and motivation, and would hold them accountable. Coach support was the most valued aspect of the participants' experience. Despite high attrition rates, participants were mostly positive about their coaching experience. Service structure or individual circumstances, rather than the program itself, were the main reasons for withdrawal., Discussion: A positive coaching experience was underpinned by good participant-coach rapport, which facilitated participant adherence and motivation to achieve their goals and complete the program. It is possible that participants who start to achieve their goals are motivated to continue with the program, and that their motivation moves from relying on their coach to being more intrinsically motivated. Reasons for high attrition provide insights into the coaching structure and process, and suggest that ensuring an individualised coaching approach and flexibility with follow-up calls (including alternative communication methods) are changes that could be used to improve practice and retain more participants for the duration of the program., Conclusions: Notwithstanding high attrition rates, participants were mostly positive about their coaching experience. Barriers to participants completing the program could be used to shape service redesign., Competing Interests: None declared

Introduction and Aims: Previous studies on smoking quitlines have focused on service effectiveness and usage, describing client characteristics, referral sources and service utilisation. There is a lack of qualitative research examining callers' perspectives on service quality. The analysis aimed to describe the factors which underpin quitline callers' descriptions of their satisfaction with the service., Design and Methods: We conducted qualitative interviews with 46 callers to the NSW Quitline's English and multilingual lines. We used an iterative, inductive, thematic approach to identify common patterns within interviewees' descriptions of what informed their level of satisfaction with the service., Results: Interviewees evaluated the Quitline service format (frequency, duration and convenience of call-backs), call content and advisor competence in terms of whether these components conveyed care, developed rapport and demonstrated a general professionalism (polite, reliable and convenient service). Satisfaction rested on callers finding advice and resources personally relevant and matching prior expectations, although many did not have an accurate idea of Quitline's services prior to calling. These themes were evident across age, gender, language background and quitting status., Discussion and Conclusions: 'Satisfaction' with Quitline is complex and not wholly dependent on achieving cessation. Evaluations emerged out of dynamic interactions between callers' preconceived notions and needs of smoking cessation services and the particular service experience of the caller. While callers' descriptions of the Quitline were predominantly positive, developing specialised modules for long-term smokers and those with a strong sense of personal responsibility for quitting may broaden the utility of the service., (© 2017 Australasian Professional Society on Alcohol and other Drugs.)

Background: Health insurers worldwide implement financial incentive schemes to encourage health-related behaviours, including to facilitate weight loss. The maintenance of weight loss is a public health challenge, and as non-communicable diseases become more prevalent with increasing age, mid-older adults could benefit from programs which motivate weight loss maintenance. However, little is understood about their perceptions of using financial incentives to maintain weight loss., Methods: We used mixed methods to explore the attitudes and views of participants who had completed an Australian weight loss and lifestyle modification program offered to overweight and obese health insurance members with weight-related chronic diseases, about the acceptability and usefulness of different types of financial incentives to support weight loss maintenance. An online survey was completed by 130 respondents (mean age = 64 years); and a further 28 participants (mean age = 65 years) attended six focus groups., Results: Both independent samples of participants supported a formalised maintenance program. Online survey respondents reported that non-cash (85.2%) and cash (77%) incentives would be potentially motivating; but only 40.5% reported that deposit contracts would motivate weight loss maintenance. Results of in-depth discussions found overall low support for any type of financial incentive, but particularly deposit contracts and lotteries. Some participants expressed that improved health was of more value than a monetary incentive and that they felt personally responsible for their own health, which was at odds with the idea of financial incentives. Others suggested ongoing program and peer support as potentially useful for weight loss maintenance., Conclusions: If financial incentives are considered for mid-older Australian adults in the health insurance setting, program planners will need to balance the discordance between participant beliefs about the individual responsibility for health and their desire for external supports to motivate and sustain weight loss maintenance.

Fibrous pseudotumors are rare benign lesions that originate within the paratesticular tissues. Local excision is the preferred method of treatment of these tumors over radical orchiectomy, however a definitive diagnosis must be made beforehand given the similarity of these tumors to malignant entities. We present a case of fibrous pseudotumor of the tunica vaginalis and cauda epididymis. A diagnosis of fibrous pseudotumor could not be established despite the use of intraoperative frozen section, therefore necessitating radical orchiectomy.

Purpose: This study investigated whether participants in a 6-month telephone-based coaching program, who set physical activity, nutrition, and weight loss goals had better outcomes in these domains., Design: Quasi-experimental design., Setting: The Australian Get Healthy Information and Coaching Service (GHS), a free population-wide telephone health-coaching service that includes goal setting as a key component of its coaching program., Participants: Consenting GHS coaching participants who had completed coaching between February 2009 and December 2012 (n = 4108)., Measures: At baseline, participants select a goal for the coaching program, and sociodemographic variables are collected. Self-reported weight, height, waist circumference, physical activity, and nutrition-related behaviors are assessed at baseline and 6 months., Analysis: Descriptive analysis was performed on key sociodemographic variables, and the relationship between goal type and change in health outcomes was assessed using a series of linear mixed models that modeled change from baseline to 6 months., Results: Participants who set goals in relation to weight management and physical activity achieved better results in these areas than those who set alternate goals, losing more than those who set alternate goals (1.5 kg and 0.9 cm in waist circumference) and increasing walking per week (40 minutes), respectively. There was no difference in food-related outcomes for those that set nutrition-related goals., Conclusion: Goal setting for weight management and increasing physical activity in the overweight and obese population, undertaken in a telephone-based coaching program, can be effective.

Background: Traditional in-person cardiac rehabilitation has substantial benefits for cardiac patients, which are offset by poor attendance. The rapid increase in social media use in older adults provides an opportunity to reach patients who are eligible for cardiac rehabilitation but unable to attend traditional face-to-face groups. However, there is a paucity of research on cardiac patients' experiences and perspectives on using social media to support their health., Objective: The aim of this study was to describe cardiac rehabilitation patients' experiences in using social media in general and their perspective on using social media, particularly Facebook, to support their cardiac health and secondary prevention efforts., Methods: A mixed-methods study was undertaken among cardiac rehabilitation patients in both urban and rural areas. First, this study included a survey (n=284) on social media use and capability. Second, six focus group interviews were conducted with current Facebook users (n=18) to elucidate Facebook experience and perspectives., Results: Social media use was low (28.0%, 79/282) but more common in participants who were under 70 years of age, employed, and had completed high school. Social media users accessed Web-based information on general health issues (65%, 51/79), medications (56%, 44/79), and heart health (43%, 34/79). Participants were motivated to invest time in using Facebook for "keeping in touch" with family and friends and to be informed by expert cardiac health professionals and fellow cardiac participants if given the opportunity. It appeared that participants who had a higher level of Facebook capability (understanding of features and the consequences of their use and efficiency in use) spent more time on Facebook and reported higher levels of "liking," commenting, or sharing posts. Furthermore, higher Facebook capability appeared to increase a participants' willingness to participate in a cardiac Facebook support group. More capable users were more receptive to the use of Facebook for cardiac rehabilitation and more likely to express interest in providing peer support. Recommended features for a cardiac rehabilitation Facebook group included a closed group, expert cardiac professional involvement, provision of cardiac health information, and ensuring trustworthiness of the group., Conclusions: Cardiac health professionals have an opportunity to capitalize on cardiac patients' motivations and social media, mostly Facebook, as well as the capability for supporting cardiac rehabilitation and secondary prevention. Participants' favored purposeful time spent on Facebook and their cardiac health provides such a purpose for a Facebook intervention. The study results will inform the development of a Facebook intervention for secondary prevention of cardiovascular disease., (©Stephanie R Partridge, Anne C Grunseit, Patrick Gallagher, Becky Freeman, Blythe J O'Hara, Lis Neubeck, Sarah Due, Glenn Paull, Ding Ding, Adrian Bauman, Philayrath Phongsavan, Kellie Roach, Leonie Sadler, Helen Glinatsis, Robyn Gallagher. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 15.09.2017.)

Background: Non-communicable chronic diseases in Australia contribute to approximately 85% of the total burden of disease; this proportion is greater for Aboriginal communities. The Get Healthy Service (GHS) is effective at reducing lifestyle-based chronic disease risk factors among adults and was enhanced to facilitate accessibility and ensure Aboriginal cultural appropriateness. The purpose of this study is to detail how formative research with Aboriginal communities was applied to guide the development and refinement of the GHS and referral pathways; and to assess the reach and impact of the GHS (and the Aboriginal specific program) on the lifestyle risk factors of Aboriginal participants., Methods: Formative research included interviews with Aboriginal participants, leaders and community members, healthcare professionals and service providers to examine acceptability of the GHS; and contributed to the redesign of the GHS Aboriginal program. A quantitative analysis employing a pre-post evaluation design examined anthropometric measures, physical activity and fruit and vegetable consumption of Aboriginal participants using descriptive and chi square analyses, t-tests and Wilcoxon signed-rank tests., Results: Whilst feedback from the formative research was positive, Aboriginal people identified areas for service enhancement, including improving program content, delivery and service promotion as well as ensuring culturally appropriate referral pathways. Once these changes were implemented, the proportion of Aboriginal participants increased significantly (3.2 to 6.4%). There were significant improvements across a number of risk factors assessed after six months (average weight loss: 3.3 kg and waist circumference reduction: 6.2 cm) for Aboriginal participants completing the program., Conclusions: Working in partnership with Aboriginal people, Elders, communities and peak bodies to enhance the GHS for Aboriginal people resulted in an enhanced culturally acceptable and tailored program which significantly reduced chronic disease risk factors for Aboriginal participants. Mainstream telephone based services can be modified and enhanced to meet the needs of Aboriginal communities through a process of consultation, community engagement, partnership and governance.

Vibrio cholerae-specific bacteriophages are common features of the microbial community during cholera infection in humans. Phages impose strong selective pressure that favors the expansion of phage-resistant strains over their vulnerable counterparts. The mechanisms allowing virulent V. cholerae strains to defend against the ubiquitous threat of predatory phages have not been established. Here, we show that V. cholerae PLEs (phage-inducible chromosomal island-like elements) are widespread genomic islands dedicated to phage defense. Analysis of V. cholerae isolates spanning a 60-year collection period identified five unique PLEs. Remarkably, we found that all PLEs (regardless of geographic or temporal origin) respond to infection by a myovirus called ICP1, the most prominent V. cholerae phage found in cholera patient stool samples from Bangladesh. We found that PLE activity reduces phage genome replication and accelerates cell lysis following ICP1 infection, killing infected host cells and preventing the production of progeny phage. PLEs are mobilized by ICP1 infection and can spread to neighboring cells such that protection from phage predation can be horizontally acquired. Our results reveal that PLEs are a persistent feature of the V. cholerae mobilome that are adapted to providing protection from a single predatory phage and advance our understanding of how phages influence pathogen evolution.

Compared with other racial/ethnic groups, American Indians and Alaska Natives (AIANs) have higher uninsured rates and worse health outcomes. Using data from the 2010-2014 American Community Survey, we employ logistic regression techniques to assess the characteristics associated with Indian Health Service (IHS) coverage among working-age AIANs who have health insurance or are uninsured. Across all insurance categories, geographic residence is a factor in IHS coverage. Among the uninsured, those with and without IHS coverage are more dissimilar than similar across socioeconomic characteristics. When controlling for confounding characteristics, people who are uninsured or have Medicaid have a much higher IHS coverage rate compared with those with employer-sponsored insurance. This indicates IHS coverage is an important component for the uninsured and it complements Medicaid services. This work identifies a need for increased outreach to eligible AIANs about IHS programs, particularly those without comprehensive care.

Mass media campaigns aimed at influencing lifestyle risk factors are one way that governments are attempting to address chronic disease risk. In Australia, a national campaign aimed at encouraging Australians to make changes in lifestyle-related behaviors was implemented from 2008 to 2011. The first phase, Measure Up (2008-2009), focused on why lifestyle changes are needed by increasing awareness of the link between waist circumference and chronic disease risk. The second phase, Swap It, Don't Stop It (2011), emphasized how adults can change their behaviors. Cross-sectional telephone surveys (after the campaign) were undertaken in July and November 2011 to evaluate the Swap It, Don't Stop It campaign and included measures of campaign awareness and lifestyle-related behavior change. Survey participants (N = 5,097) were similar across the two survey periods. Prompted campaign awareness was 62% (16% for unprompted awareness); females, younger respondents (18-44 years), those in paid employment, and those who spoke English at home were more likely to report prompted/unprompted campaign awareness. Moreover, 16% of survey respondents reported any swapping behavior in the previous 6 months, with the majority (14%) reporting only one swap; younger respondents and those in paid employment were significantly more likely to report having implemented a swapping behavior. The campaign achieved modest population awareness but demonstrated limited effect in terms of nudging behaviors. This evaluation indicates that encouraging swapping behaviors as a prelude to lifestyle change may not result from a mass media campaign alone; a comprehensive multicomponent population approach may be required.