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Questions: Do symptomatic female office workers perform computing tasks with higher cervical postural muscle loads (in terms of higher amplitudes and less muscular rest) and more discomfort compared with asymptomatic individuals? Are these differences in postural muscle loads consistent across bilateral (typing) and unilateral (mousing) conditions? Design: an experimental case-control study. Participants: 18 symptomatic female office workers and 21 asymptomatic female office workers. Intervention: Three conditions (typing, mousing, and type-and-mouse) were performed in random order. Outcome measures: Muscle load was measured as median amplitude and gap frequency using surface EMG of bilateral cervical erector spinae and upper trapezius. Discomfort was measured using a numerical rating scale. Results: The case group demonstrated 4.3% (95% CI 0.1 to 8.4) higher amplitude during typing and 3.5% (95% CI 0.1 to 6.9) higher amplitude during type-and-mouse in the right cervical erector spinae compared with the control group. There was a similar difference between groups in the left cervical erector spinae which also demonstrated a 1.2 gaps/min (95% CI -2.3 to 0.0) lower frequency during typing. The case group had significantly higher discomfort during all conditions compared with the control group. The case group demonstrated higher median amplitudes and lower gap frequencies than the control group during bilateral conditions (typing and type-and-mouse) compared with unilateral conditions (mousing) for both muscle groups. Conclusion: There was increased amplitude and decreased muscular rest in the cervical erector spinae of office workers performing typing and mousing tasks. These findings may represent a mechanism underlying computer-related musculoskeletal disorders. [ABSTRACT FROM AUTHOR]

Past research on work-related musculoskeletal disorders (WMSD) has frequently examined the activity of neck-shoulder muscles such as upper trapezius (UT) and cervical erector spinae (CES) during typing tasks. Increased electromyographic activity in these postural stabilising muscles has been consistently found in chronic neck pain patients under different physically stressful conditions. The present study compared muscle activity when female office workers with chronic neck pain (n=39) and asymptomatic controls (n=34) adopted two resting postures: (1) with hands on laps versus; and (2) hands on a keyboard. Resting hands on keyboard elicited significantly increased muscle activity in the right UT of subjects with high discomforts (n=22), similar to that observed during actual typing. In contrast, the asymptomatic controls showed no difference in muscle activity between the resting postures. This result suggested that altered muscle activation patterns were triggered by some anticipatory task demand associated with a task-specific position in some individuals. [ABSTRACT FROM AUTHOR]

Question: Is neck/shoulder pain in adolescents related to their sitting spinal posture, taking account of gender? Design: Cross-sectional survey and direct observation. Participants: 1597 adolescents from the 'Raine' birth cohort study (781 females, 816 males) with a mean age of 14.1 years (SD 0.2). Outcome measures: Neck/shoulder pain prevalence and gender was measured by survey. Spinal posture (7 angles) during sitting was measured from photographs. Results: Life, month, and point prevalence for neck/shoulder pain among adolescents were 47%, 29%, and 5% respectively. Life prevalence was 10% higher in females than in males and month prevalence was 12% higher. When looking straight ahead, females sat with 2 degrees (95% CI 1 to 3) less neck flexion, 2 degrees (95% CI 0 to 3) less craniocervical angle, 7 degrees (95% CI 6 to 8) less cervicothoracic angle, 13 degrees (95% CI 12 to 14) less trunk angle, 10 degrees (95% CI 8 to 12) less lumbar angle, and 9 degrees (95% CI 7 to 11) more anterior pelvic tilt than males. Adolescents with neck/shoulder pain sat with 2 degrees (95% CI 1 to 3) less trunk angle, and 1 degree (95% CI 0 to 2) less cervicothoracic angle than those without pain. After controlling for gender, OR for neck/shoulder pain ever predicted by any angle ranged from 0.99 to 1.00 (range of 95% CI 0.98 to 1.01). Conclusion: Neck/shoulder pain is highly prevalent in Australian adolescents. Sitting spinal posture differs between males and females and differs slightly between those with and without neck/shoulder pain. However, posture was not predictive of neck/shoulder pain ever after controlling for gender. [ABSTRACT FROM AUTHOR]

BACKGROUND: Increasing use of computers by children has raised concerns over the potential impact on their cognitive, social, educational, visual and physical development. Despite this concern, there are no large-scale studies relating the use of computers to specific health indicators in children as they reach school age. METHODS: A cross-sectional analysis of 1600 5-year-old Western Australian children participating in a longitudinal cohort study was conducted to ascertain their computer use, other activities (watching television and videos, playing electronic games, reading and looking at books, drawing on paper and moderate to vigorous physical activity), and specific health indicators. RESULTS: More than half (56%) of the children used computers each week. Computer use was significantly related to TV viewing (OR 1.97 weekday) and electronic game use (console games OR 2.48 weekday, 1.81 weekend; hand-held games OR 1.88 weekend) and negatively associated with vigorous physical activity on weekends (OR 0.72). Computer use was also significantly related to socio-economic indicators such as the mother being older (40+ years, OR 1.70 weekend, 1.73 weekday), tertiary educated (OR 1.63 weekend) and studying (OR 1.52 weekend, 1.41 weekday). Almost 1% children were reported to have complained of tired or sore muscles, and 2.2% had complained of tired or sore eyes, after watching television or using a computer. CONCLUSION: A substantial proportion of 5-year-old Western Australian children are using computers. Computer use was related to other sedentary activities and less vigorous activity. While musculoskeletal and vision problems are not widespread, their presence and the sedentary nature of computer use is of public health concern. [ABSTRACT FROM AUTHOR]

Prolonged static posture has been identified as a major risk factor for work-related neck and upper limb disorders (WRNULD) in computer users. Previous research has mainly examined working postures in healthy pain-free individuals. The present study examined whether symptomatic subjects exhibited the same kinematic patterns as asymptomatic controls during a prolonged computer task. In a Case--Control comparison, female office workers performed the same computer task using the same adjustable computer workstation for 1 h. Three-dimensional (3D) kinematics were measured in the head--neck, thorax and shoulder (upper arm) segments. Case Group subjects (n=21) displayed trends for increased head--neck flexion angles and greater ranges of movements than the Control Group (n=17). There were also small but significant differences between groups in side flexion and rotation angles of the head-neck region. The shoulder joints displayed significantly greater flexion and abduction angles on the right in both groups, although no group differences were observed. The increased neck flexion angles were associated with significantly higher activity in the upper trapezius muscle and with neck and shoulder discomfort. The individual differences in postural habits appeared to be independent of the physical environment. These results suggest motor control changes are associated with the presence of WRNULD. [ABSTRACT FROM AUTHOR]

Work-related neck and upper limb disorders (WRNULD) are common problems among office workers who use computers intensively and maintain prolonged static postures. These disorders have often been attributed to result from sustained muscle activity in the neck--shoulder musculature. The present study examined whether symptomatic subjects exhibited the same muscle activity patterns as asymptomatic controls when they performed a prolonged computer task under the same conditions. Surface electromyography (EMG) of four major neck--shoulder muscles were compared between a Case Group (n=23) and a Control Group (n=20) of female office workers. The Case Group had higher activity in the right upper trapezius (UT) while the Control Group had more symmetrical muscle activity between left and right UT. The Case subjects could also be differentiated into 'High Discomfort' and 'Low Discomfort' sub-groups based on their discomfort scores. The High Discomfort Group had significantly higher right UT activity compared to the Low Discomfort and Control Groups. Results suggested that symptomatic individuals had altered muscle recruitment patterns that persisted throughout the sustained occupational task, while discomfort increased with time-at-task. These findings indicate that altered muscle recruitment patterns observed in the symptomatic subjects preceded the onset of task discomfort, and this finding may have important implications for the etiology of WRNULD. [ABSTRACT FROM AUTHOR]

Teaching 'correct' lifting technique is common, with squat lifting generally recommended. However the available evidence is less clear about which technique should be favoured. The purpose of this paper was to present an accessible synthesis of the evidence to assist professionals in their decision about whether to teach a specific technique for lifting objects lying on or near the ground. Squat, stoop and semi-squat techniques are described and the psychophysical, physiological, biomechanical, psychological, performance and clinical evidence for each technique summarised. Evidence for other lifting guidelines is also presented. It is concluded that no one technique has clear evidence and that a work design approach should be the prime focus of intervention. Recommendations for correct lifting technique guidelines are given for where technique training must be provided. [ABSTRACT FROM AUTHOR]

Advice and training on techniques for lifting is frequently provided. The choice of which technique to use should be based on the evidence available on a number of criteria. Important criteria include: psychophysical, physiological, biomechanical, psychological, performance and clinical. However few professionals have the time to read all the original research required to understand the limitations of the available criteria. The purpose of this paper was to present an accessible synthesis of the criteria used to choose a specific technique. Each criterion is described and its validity discussed to provide the reader with a better understanding of the criteria, and thus the evidence available. [ABSTRACT FROM AUTHOR]

Background: Spinal pain is an important health issue for adolescents resulting in functional limitations for many and increasing the risk of spinal pain in adulthood. Whilst human and animal studies suggest nutrition could influence spinal pain, this has not been investigated in adolescents. The objective of this exploratory cross sectional study was to evaluate associations between diet and adolescent spinal pain.Methods: This study surveyed the spinal pain (neck and back) and nutrition (specific nutrients, broad food groups, diet quality and dietary pattern) of 1424 male and female adolescents at 14 years of age, in Western Australia.Results: Back or neck pain were experienced by around half of the adolescents, with females more likely to experience spinal pain. Nutrition differed between sexes and deviated from optimal intakes. Vitamin B12, eggs, cereals and meat consumption were related to spinal pain in sex specific multivariate analyses including primary carer education level and adolescent waist girth and smoking.Conclusions: The findings of this study suggest that certain aspects of diet may have an association with spinal pain in adolescence. [ABSTRACT FROM AUTHOR]

Background: Many children are reported to have insufficient physical activity (PA) placing them at greater risk of poor health outcomes. Participating in sedentary activities such as playing electronic games is widely believed to contribute to less PA. However there is no experimental evidence that playing electronic games reduces PA. There is also no evidence regarding the effect of different types of electronic games (traditional sedentary electronic games versus new active input electronic games) on PA. Further, there is a poor understanding about how characteristics of children may moderate the impact of electronic game access on PA and about what leisure activities are displaced when children play electronic games. Given that many children play electronic games, a better understanding of the effect of electronic game use on PA is critical to inform child health policy and intervention.Methods: This randomised and controlled trial will examine whether PA is decreased by access to electronic games and whether any effect is dependent on the type of game input or the child's characteristics. Children aged 10-12 years (N = 72, 36 females) will be recruited and randomised to a balanced ordering of 'no electronic games', 'traditional' electronic games and 'active' electronic games. Each child will participate in each condition for 8 weeks, and be assessed prior to participation and at the end of each condition. The primary outcome is PA, assessed by Actical accelerometers worn for 7 days on the wrist and hip. Energy expenditure will be assessed by the doubly labelled water technique and motor coordination, adiposity, self-confidence, attitudes to technology and PA and leisure activities will also be assessed. A sample of 72 will provide a power of > 0.9 for detecting a 15 mins difference in PA (sd = 30 mins).Discussion: This is the first such trial and will provide critical information to understand whether access to electronic games affects children's PA. Given the vital importance of adequate PA to a healthy start to life and establishing patterns which may track into adulthood, this project can inform interventions which could have a profound impact on the long term health of children.Trial Registration: This trial is registered in the Australia and New Zealand Clinical Trials Registry (ACTRN 12609000279224). [ABSTRACT FROM AUTHOR]

There is limited evidence on heterogenous co-developmental trajectories of internalizing (INT) and externalizing (EXT) problems from childhood to adolescence and predictors of these joint trajectories. We utilized longitudinal data from Raine Study participants ( n = 2393) to identify these joint trajectories from 5 to 17 years using parallel-process latent class growth analysis and analyze childhood individual and family risk factors predicting these joint trajectories using multinomial logistic regression. Five trajectory classes were identified: Low-problems (Low-INT/Low-EXT, 29%), Moderate Externalizing (Moderate-EXT/Low-INT, 26.5%), Primary Internalizing (Moderate High-INT/Low-EXT, 17.5%), Co-occurring (High-INT/High-EXT, 17%), High Co-occurring (Very High-EXT/High-INT, 10%). Children classified in Co-occurring and High Co-occurring trajectories (27% of the sample) exhibited clinically meaningful co-occurring problem behaviors and experienced more adverse childhood risk-factors than other three trajectories. Compared with Low-problems : parental marital problems, low family income, and absent father predicted Co-occurring and High Co-occurring trajectories; maternal mental health problems commonly predicted Primary Internalizing, Co-occurring , and High Co-occurring trajectories; male sex and parental tobacco-smoking uniquely predicted High Co-occurring membership; other substance smoking uniquely predicted Co-occurring membership; speech difficulty uniquely predicted Primary Internalizing membership; child's temper-tantrums predicted all four trajectories, with increased odds ratios for High Co-occurring (OR = 8.95) and Co-occurring (OR = 6.07). Finding two co-occurring trajectories emphasizes the importance of early childhood interventions addressing comorbidity.

Background: Digital technology is ubiquitous in the lives of many children and parents. To better understand any influence of technology use by infants, and mothers, on child development, technology use should be considered within the broader family system context in which children develop. This study aimed to investigate associations between infant and maternal technology use and infant 12-month development, taking into consideration other family factors., Methods: This cross-sectional study used data from ORIGINS participants, collected at 12-months of age: maternal and child technology use (TechU-Q), sociodemographic factors (e.g. child sex, household income), parental mental health (DASS-21), and child development (Ages and Stages Questionnaire). Linear regression was used for analyses., Results: When family factors were considered, higher infant mobile touchscreen device (MTSD) use was associated with poorer infant development for gross motor, problem-solving, and total ASQ-3 scores. In contrast there were no associations between infant television (TV) watching or maternal technology use and total ASQ-3 scores. Higher maternal technology use was associated with higher infant technology use. Poorer maternal and paternal mental health were associated with poorer infant development. Poorer maternal mental health was also associated with higher infant TV watching and higher maternal MTSD use., Conclusion: There is a complex relationship between technology use, parental mental health and other family factors that together influence infant development. To improve infant development outcomes, less focus should be on infant or maternal technology use, and more on supporting the family as a whole, and parental mental health in particular., (© 2024. The Author(s).)

Background: Higher educational attainment is important for economic wellbeing and associated with better health and longevity. Previous research focused on intelligence, socioeconomic status and mental health or individual risk behaviours as predictors of educational attainment, but the role of multiple domains of adolescent risk behaviours is less clear. This study examined the association between multiple domains of risk behaviour in adolescence and educational attainment by 22 years-of-age., Methods: Young people (Generation 2, Gen2) and their parents (Generation 1, Gen1) participating in the Raine Study completed questionnaires at years 1, 5, 8, 10 (Gen1 only), 14, 17 (both) and 22 (Gen2 only). The Raine Study is an ongoing longitudinal study initiated in Perth, Western Australia, between 1989 and 1991. The 1,102 Gen2 participants who responded to questions about highest educational attainment were included in this study. The association between Gen2 self-reported risk behaviours (including age at commencement of drinking alcohol, smoking, sexual intercourse and drug use) and educational attainment (defined as self-reported years of completed high school: ≤10, 11, 12 or tertiary education (> 12)) at year 22, after adjusting for mother's age and combined parental education level, participant sex, and family income, educational performance and adolescent mental health, was explored using ordinal regression models and presented as odds ratios (OR) with 95% confidence intervals (CI)., Results: Ordinal models suggested that never smoking or starting older than 18 compared with smoking before age 15 (OR 2.02, 95%CI: 1.28-2.14); first drinking alcohol between 15 and 17 years compared with younger than 15 (OR 1.52, 95%CI: 1.08-2.14); and, first sexual intercourse aged ≥ 18 years compared with under 15 (OR 1.67, 95%CI: 1.08-2.57) were associated with higher levels of educational attainment at 22-year follow-up. Additionally, lower ("better") behavioural scores increased the odds of higher levels of attainment., Conclusions: Absence of health risk behaviours at a younger age or later commencement was associated with higher educational attainment. Evidence-based interventions that address the societal influences underpinning risk behaviours in adolescents may support longer school retention., (© 2024. The Author(s).)

Background: Risk-taking behaviours are a major contributor to youth morbidity and mortality. Vulnerability to these negative outcomes is constructed from individual behaviour including risk-taking, and from social context, ecological determinants, early life experience, developmental capacity and mental health, contributing to a state of higher risk. However, although risk-taking is part of normal adolescent development, there is no systematic way to distinguish young people with a high probability of serious adverse outcomes, hindering the capacity to screen and intervene. This study aims to explore the association between risk behaviours/states in adolescence and negative health, social and economic outcomes through young adulthood., Methods: The Raine Study is a prospective cohort study which recruited pregnant women in 1989-91, in Perth, Western Australia. The offspring cohort (N = 2,868) was followed up at regular intervals from 1 to 27 years of age. These data will be linked to State government health and welfare administrative data. We will empirically examine relationships across multiple domains of risk (for example, substance use, sexual behaviour, driving) with health and social outcomes (for instance, road-crash injury, educational underachievement). Microsimulation models will measure the impact of risk-taking on educational attainment and labour force outcomes., Discussion: Comprehensive preventive child health programmes and policy prioritise a healthy start to life. This is the first linkage study focusing on adolescence to adopt a multi-domain approach, and to integrate health economic modelling. This approach captures a more complete picture of health and social impacts of risk behaviour/​states in adolescence and young adulthood.

Objective: The purpose of this study was to determine whether sagittal neck sitting posture subgroup membership in late adolescence was a risk factor for persistent neck pain (PNP) in young adults., Methods: There were 686 participants enrolled in the Raine Study at the 17- and 22-year follow-ups. At 17 years of age, posture was measured by photographs, and 4 subgroups of sitting neck posture were determined by cluster analysis. Height and weight were measured, and exercise frequency, depression, and PNP were assessed by questionnaire. At 22 years of age, participants answered questions about neck pain and occupation type. Logistic regression examined if neck posture subgroups at 17 years of age were a risk factor for PNP at 22 years of age, taking into account other factors., Results: Female sex (odds ratio [OR] = 1.75, 95% CI = 1.16-2.65) and PNP at 17 years of age (OR = 3.78, 95% CI = 2.57-5.57) were associated with PNP at 22 years of age. In females, neck posture subgroup at 17 years of age was a risk factor for PNP at 22 years of age. Compared with the upright subgroup, both the slumped thorax/forward head subgroup groups and the intermediate subgroup had decreased odds for PNP at 22 years of age (OR = 0.24, 95% CI = 0.08-0.76; OR = 0.38, 95% CI = 0.15-0.99, respectively). No association was found in males., Conclusion: After taking into account PNP at 17 years, sitting neck posture at 17 was not a risk factor for PNP at 22 years of age in males, whereas in females, more relaxed postures (slumped thorax/forward head and Intermediate postures) were protective of neck pain compared with upright posture., Impact: Females in late adolescence who sat in slumped thorax/forward head or intermediate posture rather than upright sitting posture had a lower risk of PNP as a young adult. The practice of generic public health messages to sit up straight to prevent neck pain needs rethinking., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Physical activity has been associated with physical and mental health across the life course, yet few studies have used group-based trajectory modeling to examine the effect of longitudinal patterns of physical activity during childhood and adolescence on adult health outcomes. The Raine Study data from Gen2 follow-ups at 8, 10, 14, 17, 20, and 22 years collected between 1998 and 2014 were used. Latent class analysis identified trajectories using parent-reported physical activity for ages 8 to 17. Associations between trajectories and physical and mental health outcomes at ages 20 and 22 were explored, adjusting for current physical activity and considering sex interactions. Analysis in 2019 identified three trajectories: low (13%), mid (65%) and high (22%) physical activity (n = 1628). Compared to the low-activity trajectory, those in the high-activity trajectory had lower adiposity, insulin, HOMA-IR and fewer diagnosed disorders, higher HDL-cholesterol, and faster cognitive processing. For example, those in the high-activity trajectory had lower percent body fat at age 20 compared to those in the mid-activity (-4.2%, 95%CI: -5.8, -2.7) and low-activity (-9.5%, 95%CI: -11.7, -7.2) trajectories. Physical activity trajectories showed different associations between sexes for self-reported physical and mental health, BMI, systolic blood pressure, and depression symptoms. Being in the high- or mid-activity trajectory was associated with a more favorable cardiometabolic and mental health profile in young adulthood. Strategies are needed to help less active children to increase physical activity throughout childhood and adolescence to improve young adult health outcomes., Competing Interests: Declaration of competing interest EKH, JAM, JZ, ALS, RSB, TAM, LJB, LMS have no COIs to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Competing Interests: Competing interests: For the avoidance of doubt, WvM wishes to declare that he is a non-executive board member of Arbo Unie B.V. WvM and AvdB are director-shareholders of Vrije University Medical Center (VUmc) spin-off company Evalua Nederland B.V. Both Arbo Unie and Evalua operate in the Dutch occupational healthcare market. There are no conflicts of interest reported by the other authors.

This study aimed to examine prospective associations of mobile touch screen device (i.e. smartphone, tablet) use and patterns of use with musculoskeletal symptoms and visual health among adolescents. A representative sample of 1691 adolescents in Singapore (51% girls; 10-19 years) completed an online questionnaire at baseline and one-year follow-up. After adjusting for potential confounders, prospective associations were found between baseline smartphone use and follow-up neck/shoulder (OR = 1.61(95%CI = 1.06-2.44)) and low back (OR = 1.86(1.10-3.14)) symptoms; tablet use was also associated with neck/shoulder, low back and arms symptoms (OR = 1.33(1.04-1.71)to1.52(1.18-1.95)). No associations were observed between the duration of smartphone/tablet use and symptoms. Baseline patterns of use (bout length, certain types of activities, multitasking) were associated with follow-up musculoskeletal symptoms. Smartphone/tablet use was not related to visual outcomes (visual symptoms, wearing glasses/contact lenses, myopia) at follow-up. These findings suggest that patterns of smartphone/tablet use (though not the duration of use) can pose a prospective risk for musculoskeletal symptoms., Competing Interests: Declaration of competing interest The authors declare that they have no competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Current guidelines suggest too little sleep, too little physical activity, and too much sedentary time are associated with poor health outcomes. These behaviours may also influence academic performance in school children. The primary purpose of this study was to examine the relationships between sleep, physical activity, or sedentary behaviours and academic performance in a school with a well-developed and integrated technology use and well-being program., Methods: This was a cross-sectional survey of students (n = 934, Grades 5-12) in an Australian school with a bring-your-own device (tablet or laptop computer) policy. Students reported sleep, physical activity, and sedentary (screen and non-screen) behaviours. Academic performance was obtained from school records. Linear regressions were used to test the association between behaviours and academic performance outcomes., Results: Seventy-four percent of students met sleep guidelines (9 to 11 h for children 5-13 years and 8 to 10 h for 14-17 year olds), 21% met physical activity guidelines (60 min of moderate-to-vigorous physical activity every day), and 15% met screen time guidelines (no more than 2 h recreational screen time per day); only 2% met all three. There were no associations between meeting sleep guidelines and academic performance; however later weekend bedtimes were associated with poorer academic performance (- 3.4 points on the Average Academic Index, 95%CI: - 5.0, - 1.7, p < .001). There were no associations between meeting physical activity guidelines and academic performance. Meeting screen guidelines was associated with higher Average Academic Index (5.8, 95%CI: 3.6, 8.0, p < .001), Maths 7.9, 95%CI: 4.1, 11.6, p < .001) and English scores (3.8, 95%CI: 1.8, 5.8, p < .001) and higher time in sedentary behaviours was associated with poorer academic performance, including total sedentary behaviours in hrs/day (5.8 points on Average Academic Index, 95%CI: 3.6, 8.0, p < .001. Meeting at least two of the three behaviour guidelines was associated with better academic performance., Conclusions: Sleep and sedentary behaviours were linked to academic performance. School communities should emphasize comprehensive wellness strategies to address multiple behaviours to maximize student health and academic success.

Introduction: Eye diseases and visual impairment more commonly affect elderly adults, thus, the majority of ophthalmic cohort studies have focused on older adults. Cohort studies on the ocular health of younger adults, on the other hand, have been few. The Raine Study is a longitudinal study that has been following a cohort since their birth in 1989-1991. As part of the 20-year follow-up of the Raine Study, participants underwent a comprehensive eye examination. As part of the 27- and 28-year follow-ups, eye assessments are being conducted and the data collected will be compared with those of the 20-year follow-up. This will provide an estimate of population incidence and updated prevalence of ocular conditions such as myopia and keratoconus, as well as longitudinal change in ocular parameters in young Australian adults. Additionally, the data will allow exploration of the environmental, health and genetic factors underlying inter-subject differential long-term ocular changes., Methods and Analysis: Participants are being contacted via telephone, email and/or social media and invited to participate in the eye examination. At the 27-year follow-up, participants completed a follow-up eye screening, which assessed visual acuity, autorefraction, ocular biometry and ocular sun exposure. Currently, at the 28-year follow-up, a comprehensive eye examination is being conducted which, in addition to all the eye tests performed at the 27-year follow-up visit, includes tonometry, optical coherence tomography, funduscopy and anterior segment topography, among others. Outcome measures include the incidence of refractive error and pterygium, an updated prevalence of these conditions, and the 8-year change in ocular parameters., Ethics and Dissemination: The Raine Study is registered in the Australian New Zealand Clinical Trials Registry. The Gen2 20-year, 27-year and 28-year follow-ups are approved by the Human Research Ethics Committee of the University of Western Australia. Findings resulting from the study will be published in health or medical journals and presented at conferences., Trial Registration Number: ACTRN12617001599369; Active, not recruiting., 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.)

Early life stress (ELS) can significantly influence biological pathways associated with nociception, increasing vulnerability to future heightened pain sensitivity and subsequent risk of pain events. However, very little human research has investigated the association of ELS, measured across multiple domains, with future pain sensitivity. Data from Gen1 and Gen2 of the Raine Study were used to assess the association between a wide range of early life stressors, including antenatally, and pressure and cold pain sensitivity at young adulthood. Participants were classified into 2 groups according to their cold pain sensitivity. In addition, the interaction between ELS, pain sensitivity, and pain experience (based on Örebro Musculoskeletal Pain Questionnaire) at age 22 years was examined. Analysis was performed using both a complete case and multiple imputation approach, adjusting for contemporaneous 22-year correlates, with comparable results in each model. More problematic behaviour at age 2 years was associated with less pressure pain sensitivity at 22 years (13.7 kPa, 95% CI: 1.0-27.0, P = 0.037), with no interaction between problematic behaviour and pain experience at 22 years. For those reporting a moderate/high pain experience at 22 years, poor family functioning increased the odds ratio for high cold pain sensitivity (3.0, 95% CI: 1.6-5.6), but for those reporting no/low pain experience, it did not (OR:1.2, 95% CI: 0.8-1.8). This study provides the most comprehensive investigation of the relationship between ELS and pressure and cold pain sensitivity in young adults supporting early life as a critical period of development influencing future nociceptive processing.

Young children are increasingly using mobile technology, with potential for positive and negative developmental consequences. Parents are responsible to guide children in their use of technology based on recommendations and guidelines. Guidelines for screen use in young children have been based on little empirical information on contemporary screen use. This study surveyed parents of young children ( n  = 96, mean child age 3.0, SD 1.0 years) from three settings (Australia, United States) to test the reliability and validity of a new tool to capture richer data on technology use within a techno-microsystem. The TechU-Q demonstrated reasonable test-retest reliability and face and construct validity. Young children averaged more than 60 min per day of total technology use, mostly using TV, tablet computers, and mobile phones. The primary purposes for child use were educational and watching videos. Parental attitudes towards technology and parent use were associated with their child's use. Future guidelines should utilize detailed descriptions of technology use by device and purpose to provide more relevant advice on technology use for young children., Competing Interests: Conflict of InterestThe authors declare that they have no conflict of interest., (© Springer Science+Business Media, LLC, part of Springer Nature 2020.)

Background: The prevalence of musculoskeletal symptoms among sedentary workers is high. Interventions that promote occupational standing or walking have been found to reduce occupational sedentary time, but it is unclear whether these interventions ameliorate musculoskeletal symptoms in sedentary workers., Objectives: To investigate the effectiveness of workplace interventions to increase standing or walking for decreasing musculoskeletal symptoms in sedentary workers., Search Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, OSH UPDATE, PEDro, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal up to January 2019. We also screened reference lists of primary studies and contacted experts to identify additional studies., Selection Criteria: We included randomised controlled trials (RCTs), cluster-randomised controlled trials (cluster-RCTs), quasi RCTs, and controlled before-and-after (CBA) studies of interventions to reduce or break up workplace sitting by encouraging standing or walking in the workplace among workers with musculoskeletal symptoms. The primary outcome was self-reported intensity or presence of musculoskeletal symptoms by body region and the impact of musculoskeletal symptoms such as pain-related disability. We considered work performance and productivity, sickness absenteeism, and adverse events such as venous disorders or perinatal complications as secondary outcomes., Data Collection and Analysis: Two review authors independently screened titles, abstracts, and full-text articles for study eligibility. These review authors independently extracted data and assessed risk of bias. We contacted study authors to request additional data when required. We used GRADE considerations to assess the quality of evidence provided by studies that contributed to the meta-analyses., Main Results: We found ten studies including three RCTs, five cluster RCTs, and two CBA studies with a total of 955 participants, all from high-income countries. Interventions targeted changes to the physical work environment such as provision of sit-stand or treadmill workstations (four studies), an activity tracker (two studies) for use in individual approaches, and multi-component interventions (five studies). We did not find any studies that specifically targeted only the organisational level components. Two studies assessed pain-related disability. Physical work environment There was no significant difference in the intensity of low back symptoms (standardised mean difference (SMD) -0.35, 95% confidence interval (CI) -0.80 to 0.10; 2 RCTs; low-quality evidence) nor in the intensity of upper back symptoms (SMD -0.48, 95% CI -.096 to 0.00; 2 RCTs; low-quality evidence) in the short term (less than six months) for interventions using sit-stand workstations compared to no intervention. No studies examined discomfort outcomes at medium (six to less than 12 months) or long term (12 months and more). No significant reduction in pain-related disability was noted when a sit-stand workstation was used compared to when no intervention was provided in the medium term (mean difference (MD) -0.4, 95% CI -2.70 to 1.90; 1 RCT; low-quality evidence). Individual approach There was no significant difference in the intensity or presence of low back symptoms (SMD -0.05, 95% CI -0.87 to 0.77; 2 RCTs; low-quality evidence), upper back symptoms (SMD -0.04, 95% CI -0.92 to 0.84; 2 RCTs; low-quality evidence), neck symptoms (SMD -0.05, 95% CI -0.68 to 0.78; 2 RCTs; low-quality evidence), shoulder symptoms (SMD -0.14, 95% CI -0.63 to 0.90; 2 RCTs; low-quality evidence), or elbow/wrist and hand symptoms (SMD -0.30, 95% CI -0.63 to 0.90; 2 RCTs; low-quality evidence) for interventions involving an activity tracker compared to an alternative intervention or no intervention in the short term. No studies provided outcomes at medium term, and only one study examined outcomes at long term. Organisational level No studies evaluated the effects of interventions solely targeted at the organisational level. Multi-component approach There was no significant difference in the proportion of participants reporting low back symptoms (risk ratio (RR) 0.93, 95% CI 0.69 to 1.27; 3 RCTs; low-quality evidence), neck symptoms (RR 1.00, 95% CI 0.76 to 1.32; 3 RCTs; low-quality evidence), shoulder symptoms (RR 0.83, 95% CI 0.12 to 5.80; 2 RCTs; very low-quality evidence), and upper back symptoms (RR 0.88, 95% CI 0.76 to 1.32; 3 RCTs; low-quality evidence) for interventions using a multi-component approach compared to no intervention in the short term. Only one RCT examined outcomes at medium term and found no significant difference in low back symptoms (MD -0.40, 95% CI -1.95 to 1.15; 1 RCT; low-quality evidence), upper back symptoms (MD -0.70, 95% CI -2.12 to 0.72; low-quality evidence), and leg symptoms (MD -0.80, 95% CI -2.49 to 0.89; low-quality evidence). There was no significant difference in the proportion of participants reporting low back symptoms (RR 0.89, 95% CI 0.57 to 1.40; 2 RCTs; low-quality evidence), neck symptoms (RR 0.67, 95% CI 0.41 to 1.08; two RCTs; low-quality evidence), and upper back symptoms (RR 0.52, 95% CI 0.08 to 3.29; 2 RCTs; low-quality evidence) for interventions using a multi-component approach compared to no intervention in the long term. There was a statistically significant reduction in pain-related disability following a multi-component intervention compared to no intervention in the medium term (MD -8.80, 95% CI -17.46 to -0.14; 1 RCT; low-quality evidence)., Authors' Conclusions: Currently available limited evidence does not show that interventions to increase standing or walking in the workplace reduced musculoskeletal symptoms among sedentary workers at short-, medium-, or long-term follow up. The quality of evidence is low or very low, largely due to study design and small sample sizes. Although the results of this review are not statistically significant, some interventions targeting the physical work environment are suggestive of an intervention effect. Therefore, in the future, larger cluster-RCTs recruiting participants with baseline musculoskeletal symptoms and long-term outcomes are needed to determine whether interventions to increase standing or walking can reduce musculoskeletal symptoms among sedentary workers and can be sustained over time., (Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Restless legs syndrome has been associated with serum iron deficiency in clinical studies. However, studies investigating this relationship have had inconsistent results and there are no studies in young adults. Therefore, we investigated the relationship between serum measures of iron stores and restless legs syndrome in young adults in the community. Participants in the Western Australian Pregnancy Cohort (Raine) Study answered questions on restless legs syndrome (n = 1,100, 54% female) at age 22 years, and provided serum measures of iron stores (ferritin and transferrin saturation) at ages 17 and 22 years. Restless legs syndrome was diagnosed when four International RLS Study Group criteria were met (urge to move, dysaesthesia, relief by movement, worsening during evening/night) and these symptoms occurred ≥5 times per month. Logistic regression was used to assess associations between serum iron stores and restless legs syndrome, adjusting for potential confounders. The prevalence of restless legs syndrome at age 22 years was 3.0% (n = 33, 70% female). Among those who provided restless legs syndrome and iron data at age 22 years (n = 865), the median (interquartile range) ferritin was not different between the restless legs syndrome (55 [29.5-103.5] µg L -1 ) and the non-restless legs syndrome group (65.0 [35.0-103.3] µg L -1 , p = 0.2), nor were there differences in iron deficiency prevalence (p = 0.36). There was no association between restless legs syndrome (22 years) and iron stores (17, 22 years) before or after adjustment for potential confounders. There was no association between restless legs syndrome at 22 years and iron stores at 17 or 22 years in this cohort. Serum iron stores may not be a useful indicator of restless legs syndrome risk in young adults in the community., (© 2018 European Sleep Research Society.)

Background: This study sought to explore factors in adults with cystic fibrosis (CF) that predicted whether (i) someone was engaged in full-time paid work, and (ii) those engaged in paid work reported problems with absenteeism and/or presenteeism., Methods: Adults with cystic fibrosis who live in Western Australia completed absenteeism and presenteeism questions from the World Health Organization's Health Performance Questionnaire. The participants were grouped by work status (full time vs part time or unemployed) and by self-reported absenteeism and presenteeism (evidence of vs no evidence of). We explored whether factors such as air-flow obstruction, level of education, health-related quality of life (measured by using the Cystic Fibrosis Questionnaire-Revised), and treatment adherence predicted group membership., Results: Of the 50 participants for whom data were available (median [interquartile range] age 30 [25-36] y; mean ± SD FEV 1 % predicted, 60 ± 18%); 34 (68%) worked full time. A higher education level increased the odds of working full time (odds ratio 1.74, 95% CI 1.36-1.89). Among the employed participants, problems with absenteeism and presenteeism were reported by 20 (47%) and 7 (16%), respectively. Both those who reported problems with absenteeism or presenteeism were characterized only by lower scores on the role domain of the Cystic Fibrosis Questionnaire-Revised ( P = .02)., Conclusions: In this study, the majority of adults with cystic fibrosis worked full time and a low percentage of the sample reported problems with absenteeism and presenteeism., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2019 by Daedalus Enterprises.)

This study aimed to describe contemporary technology use, especially smartphones and tablets (mobile touch screen devices), and examine associations with musculoskeletal symptoms and visual health among adolescents in Singapore. A representative sample of 1884 adolescents (50.4% girls) from grades primary 5 to post-secondary (10-18 years old), recruited from 13 schools, completed an online questionnaire in class. Total technology use was high, with smartphone duration being highest (mean = 264 [SD = 243] min/day). Patterns of use, including multitasking and bout length, were influenced by gender, school level, type of device and activities. Musculoskeletal discomfort and visual symptoms were commonly reported. After adjusting for potential confounders, more hours/day of smartphone use was associated with increased risk of neck/shoulders, upper back, arms and wrist/hand discomfort (OR = 1.04[95%CI = 1.01-1.07] to 1.07[1.03-1.10]) and visual symptoms (OR = 1.05[1.02-1.08]), but was associated with decreased odds of myopia (OR = 0.97[0.94-0.99]). No significant associations were found for tablet use. Practitioner Summary: 1884 adolescents in Singapore completed an in-depth questionnaire regarding their use of technology. The smartphone was the device with the highest usage, and greater smartphone use was associated with increased odds of musculoskeletal and visual symptoms. High use of smartphones has physical health implications for adolescents.

Objectives: The purpose of this study was to identify early life factors that were associated with childhood and adolescent organized sport participation trajectories., Design: Participants were in the Raine Study, a pregnancy cohort in Western Australia recruited from 1989 to 1991., Methods: Three organized sport trajectories over ages 5-17years were previously identified for girls (n=824: consistent participators, dropouts, and non-participators in sport) and boys (n=855: consistent participators, dropouts, joiners - those who joined sport in adolescence). Physical, psychological and social factors were measured from birth to age 5., Results: For girls and boys, children who were breastfed, were taller, did not have behavior problems, and attended childcare were more likely to consistently participate. Girls who had a previous injury (Relative risk ratio 1.55: 95% confidence interval 1.05, 2.29 vs never been injured) or who had parents who had worries about their child's health (1.56: 1.00, 2.42 vs no worries) were more likely to be in the dropout trajectory. Boys born preterm (2.00, 2.06, 3.76 vs full-term), did not have a previous injury (0.72, 0.53, 0.97 those with injury vs never been injured), had more difficult temperament (1.63, 1.02, 2.60 vs easy temperament), and higher family dysfunction (1.49, 1.06, 2.08) were more likely to be in the dropout trajectory., Conclusions: Early life factors were associated with membership in sport trajectories. Physical, psychological, and social factors may serve as early warning signs for parents and practitioners that children may be at higher risk of dropping out of sports., (Copyright © 2018. Published by Elsevier Ltd.)

Background: Excess weight is a major risk factor for chronic diseases. In Australia, over 60% of adults are overweight or obese. The overconsumption of energy-dense nutrient-poor (EDNP) foods and low physical activity (PA) levels are key factors contributing to population obesity. New cost-effective approaches to improve population diet and PA behaviors are needed., Objective: This 1-year randomized controlled trial (6-month intervention and 6-month follow-up) aims to investigate whether a tailored intervention using mobile technology can improve diet and PA behaviors leading to weight loss in adults (aged 18-65 years) who are overweight or obese and recruited through a social marketing campaign (LiveLighter)., Methods: All eligible participants will provide data on demographics and lifestyle behaviors online at baseline, 6 months, and 12 months. Using two-stage randomization, participants will be allocated into one of three conditions (n=200 per group): tailored feedback delivered via email at seven time points, informed by objective dietary (mobile food record app) and activity (wearable activity monitor) assessment; active control receiving no tailored feedback, but undergoing the same objective assessments as tailored feedback; and online control receiving no tailored feedback or objective assessments. Primary outcome measures at 6 and 12 months are changes in body mass, EDNP food and beverage consumption, and daily moderate-to-vigorous PA (measured via accelerometry). Secondary outcomes include change in fruit and vegetable consumption, daily sedentary behaviors, and cost effectiveness., Results: Enrolment commenced in August 2017. Primary outcomes at 12 months will be available for analysis from September 2019., Conclusions: Tailored email feedback provided to individuals may deliver a cost-effective strategy to overcome existing barriers to improving diet and PA. If found to be successful and cost effective, upscaling this intervention for inclusion in larger-scale interventions is highly feasible., Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617000554369; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=371325&isReview=true., International Registered Report Identifier (irrid): DERR1-10.2196/12782., (©Rhiannon E Halse, Charlene L Shoneye, Christina M Pollard, Jonine Jancey, Jane A Scott, Iain S Pratt, Satvinder S Dhaliwal, Richard Norman, Leon M Straker, Carol J Boushey, Edward J Delp, Fengqing Zhu, Amelia J Harray, Maria A Szybiak, Anne Finch, Joanne A McVeigh, Barbara Mullan, Clare E Collins, Syed Aqif Mukhtar, Kieran N Edwards, Janelle D Healy, Deborah A Kerr. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 25.02.2019.)

Background: The use of mobile touch screen devices, e.g. smartphones and tablet computers, has become increasingly prevalent among adolescents. However, little is known about how adolescents use these devices and potential influences on their use. Hence, this qualitative study explored adolescents' perceptions on their patterns of use and factors influencing use, and perceptions and concerns from parents., Methods: Semi-structured interviews were conducted with adolescents (n = 36; 11 to 18 years) and their parents/caregivers (n = 28) in Singapore recruited to represent males and females across a range of ages from different socioeconomic groups. Prompts covered weekday and weekend use patterns, types of activities, perspectives on amount of use, parental control measures and concerns. Interviews were recorded and transcribed. Transcripts were coded and thematic analysis was carried out., Results: Smartphone was the most common mobile device owned and used by many of the adolescents, while only some used a tablet. Many adolescents and their parents felt that adolescents' MTSD use was high, frequent and ubiquitous, with frequent checking of device and multitasking during use. Reported influences of use included functional, personal and external influences. Some of the influences were irresistibility of mobile devices, lack of self-control, entertainment or relaxation value, and high use by peers, family and for schoolwork that contributed to high use, or school/parental control measures and lack of internet availability that limited use. Most adolescents were generally unconcerned about their use and perceived their usage as appropriate, while most parents expressed several concerns about their adolescents' use and perceived their usage as excessive., Conclusions: This study has provided rich insights into the patterns and influences of contemporary mobile device use by adolescents. Mobile device use has become an integral part of adolescents' daily routines, and was affected by several functional, personal and external influences which either facilitated or limited their use. There also seemed to be a strong inclination for adolescents to frequently check and use their mobile devices. There is an urgent need to understand the implications of these common adolescent behaviours to inform advice for wise mobile device use by adolescents.

Objectives: To investigate the cross-sectional associations between musculoskeletal pain experience and measures of pressure and cold pain sensitivity in young adults from the Western Australian Pregnancy Cohort (Raine) Study., Participants and Methods: In total, 917 participants were eligible for analysis if they provided data pertaining to musculoskeletal pain status at the 22-year follow-up and had data for at least 1 valid pain sensitivity test. Standardized protocols were used to assess pressure pain threshold (4 sites: lumbar spine, tibialis anterior, upper trapezius, and wrist) and cold pain threshold (wrist). Four pain experience groups ("No pain" [n=562, 61.3%], "Low" [n=84, 9.2%], "Medium" [n=147, 16.0%], "High" [n=124, 13.5%]) were determined by latent class analysis using parameters of pain chronicity, frequency, intensity, and number of pain areas. Variables considered as confounders included sex, age, ethnicity, waist-hip ratio, psychological symptoms, sleep quality, physical activity, sedentary behavior, smoking, and income., Results: There were no associations between pain experience and pressure pain sensitivity after adjusting for confounders. The "Medium" and "High" pain experience groups demonstrated heightened cold pain sensitivity compared with the "No pain" group (P=0.023), adjusted for sex and smoking., Discussion: This study provides the most extensive investigation of the relationship between musculoskeletal pain experience and pressure and cold pain sensitivity in young adults. Heightened cold pain sensitivity in those classified as "Medium" and "High" pain experience may suggest altered nociceptive processing and has implications for clinical management.

Aim: The Animal Fun program, a universal early intervention program that aims to promote the motor skills and social-emotional development of young children, has shown to improve overall motor proficiency and social and behavioural outcomes. The aim of the current study was to evaluate the program's impact on children's aiming and catching, and balance skills., Methods: A cluster randomised control trial was employed, with six intervention and six control (following normal curriculum) schools. A total sample of 511 children (257 boys and 254 girls), aged 4-6 years presented at pre-test. Children were tested across three time points, pre-test, post intervention (six months later) and follow-up (18 months after pre-test), using the Movement Assessment Battery for Children-2 Aiming and Catching, and Balance tasks. The study also tested for potential moderators including pre-test motor proficiency, age, gender, and cognitive performance., Results: Participation in Animal Fun improved children's one leg balance at post-test and follow-up compared to control children, regardless of pre-test motor proficiency, age, gender, or pre-test cognitive performance. Participation in Animal Fun also improved throwing skills for those children with poorer motor proficiency compared to the controls with poorer motor performance. Interestingly, it was found that the control group's catching skills improved more than the intervention group at follow up., Conclusions: The study provides some promising results regarding the efficacy of the Animal Fun program in improving one-leg balance for all children, and throwing skills for those children with poorer motor proficiency, while also suggesting potential confounding factors, such as maturational issues and other individual factors (e.g., a child's participation in extracurricular activity)., (Copyright © 2018 Elsevier Ltd. All rights reserved.)