While cognitive impairment is a core feature of psychosis, significant heterogeneity in cognitive and clinical outcomes is observed.

The aim of this study was to identify cognitive and clinical subgroups in first-episode psychosis (FEP) and determine if these profiles were linked to functional outcomes over time.

A total of 323 individuals with FEP were included. Two-step hierarchical and k-means cluster analyses were performed using baseline cognitive and clinical variables. General linear mixed models were used to investigate whether baseline cognitive and clinical clusters were associated with functioning at follow-up time points (6–9, 12 and 15 months).

Three distinct cognitive clusters were identified: a cognitively intact group (N = 59), a moderately impaired group (N= 77) and a more severely impaired group (N= 122). Three distinct clinical clusters were identified: a subgroup characterised by predominant mood symptoms (N = 76), a subgroup characterised by predominant negative symptoms (N= 19) and a subgroup characterised by overall mild symptom severity (N = 94). The subgroup with more severely impaired cognition also had more severe negative symptoms at baseline. Cognitive clusters were significantly associated with later social and occupational function, and associated with changes over time. Clinical clusters were associated with later social functioning but not occupational functioning, and were not associated with changes over time.

Baseline cognitive impairments are predictive of both later social and occupational function and change over time. This suggests that cognitive profiles offer valuable information in terms of prognosis and treatment needs.

To investigate the intake of iodine in mother-infant pairs.

An exploratory, cross-sectional study. Iodine intake was estimated using Nutritics nutritional analysis software, following 24-hour dietary recall. Iodine-rich foods were grouped and compared between those women who met the UK RNI for iodine (140 µg/day) and those who did not.

Online and telephone questionnaires.

Self-selecting caregivers of infants aged 6-12 months.

Ninety-one mother-infant pairs with a mean (SD) age of 33.2 (4.1) years and 8.4 (1.3) months, respectively, were included. Most mothers were exclusively breast feeding (54.9%). The estimated maternal median iodine intake from food and supplements (median 140.3 µg/day, just meeting the UK RNI for women of reproductive age, but not the WHO or BDA recommendations for lactating women (250 µg/day and 200 µg/day, respectively). Forty-six (50.5%) of mothers met the UK RNI. Estimated intakes of fish, eggs, cow’s milk, and yoghurt/cream/dairy desserts were significantly greater, whilst intakes of plant-based milk alternative drinks were significantly less in mothers who met the RNI for iodine (P<0.05) compared with those who did not. Infant iodine intake from food was positively correlated with maternal; total iodine intake, iodine intake from all food, and iodine intake from dairy foods (Spearman’s rho=0.243, 0.238, 0.264 respectively; P<0.05).

Women in the UK may not consume enough iodine to meet the demands of lactation. Guidance on iodine-containing foods, focussed on intake before and during pregnancy and lactation, and mandatory fortification of plant-based milk-alternatives could all serve to avoid deficiency.

Patients with schizophrenia experience accelerated aging, accompanied by abnormalities in biomarkers such as shorter telomere length. Brain age prediction using neuroimaging data has gained attention in schizophrenia research, with consistently reported increases in brain-predicted age difference (brain-PAD). However, its associations with clinical symptoms and illness duration remain unclear.

We developed brain age prediction models using structural magnetic resonance imaging (MRI) data from 10,938 healthy individuals. The models were validated on an independent test dataset comprising 79 healthy controls, 57 patients with recent-onset schizophrenia, and 71 patients with chronic schizophrenia. Group comparisons and the clinical associations of brain-PAD were analyzed using multiple linear regression. SHapley Additive exPlanations (SHAP) values estimated feature contributions to the model, and between-group differences in SHAP values and group-by-SHAP value interactions were also examined.

Patients with recent-onset schizophrenia and chronic schizophrenia exhibited increased brain-PAD values of 1.2 and 0.9 years, respectively. Between-group differences in SHAP values were identified in the right lateral prefrontal area (false discovery rate [FDR] p = 0.022), with group-by-SHAP value interactions observed in the left prefrontal area (FDR p = 0.049). A negative association between brain-PAD and Full-scale Intelligence Quotient scores in chronic schizophrenia was noted, which did not remain significant after correction for multiple comparisons.

Brain-PAD increases were pronounced in the early phase of schizophrenia. Regional brain abnormalities contributing to brain-PAD likely vary with illness duration. Future longitudinal studies are required to overcome limitations related to sample size, heterogeneity, and the cross-sectional design of this study.

Loneliness has emerged as a pervasive public health challenge. Understanding loneliness and its associated risk factors is crucial for developing interventions to address this issue effectively. This study aimed to investigate loneliness among adults living in Australia, comparing different age cohorts.

This study used 10,815, 11,234, 14,670 and 15,049 records with loneliness measurements taken at 2006, 2010, 2014 and 2018, respectively, from the Household, Income and Labour Dynamics in Australia (HILDA) survey. A supervised machine learning algorithm, CatBoost, was employed to predict loneliness. Model predictions were explained using SHapley Additive exPlanations (SHAP) and partial dependence plots across five age-based subgroups to capture life stage variations.

Mental well-being, having a life partner, social connectedness and social fulfilment were the most important predictors of loneliness at the whole-population level. Among young adults, the level of friendship fulfilment, financial satisfaction and health status were relatively strong predictors of loneliness, while loneliness in older adults was more strongly associated with spare time fulfilment, community satisfaction and the loss of loved ones. Youth who reported that they did not have a lot of friends were predicted to have a 46.5% (95% CI: 45.9%–47.2%) chance of experiencing loneliness. Seniors have a 44.9% (95% CI: 43.9%–45.8%) chance of experiencing loneliness if they were almost always not fulfilled in their spare time.

This study underscores the need to recognise the heterogeneity of loneliness across the lifecourse and the importance of both targeted strategies and efforts to improve broader social cohesion.

The objectives of study 1 were to use expert opinion to identify the limitations of the Health Anxiety Inventory – Short Version (SHAI) for administration in medical populations and to develop an adapted version for medical populations. The objective of the second study was to evaluate the psychometric properties of the adapted measure. A three-round Delphi study method was used in study 1. Eight experts with experience of living with a physical health condition and four experts by profession working within physical health were invited to review the SHAI. Study 2 employed a cross-sectional mixed methods questionnaire design. Individuals with multiple sclerosis (n=115), myalgic encephalomyelitis/chronic fatigue syndrome (n=84) and chronic pain (n=116) were invited to complete a battery of questionnaires via an online survey. The adapted version of the SHAI for Medical Populations (HAI-M) consisted of 12 items scoring from 0 to 3, reaching high consensus (75% agreement) for administration in medical populations. All groups rated the HAI-M as more acceptable than the SHAI and no significant differences were found on HAI-M scores between clinical groups. The HAI-M demonstrated high internal consistency (.875), good test–retest reliability (.812) and convergent validity (.801). Divergent validity was also acceptable (.515). This study provides preliminary evidence for a psychometrically sound health anxiety screening tool for use in medical populations.

1. (1) To gain insights into the presentation of health anxiety in medical conditions.

2. (2) To consider the validity and reliability of using questionnaire measures developed using analogue sample norms, and how this may affect measurement when used in different context and settings.

3. (3) The process of systematically adapting, developing and testing standardised measures for use in special subgroups.

This review provides an overview of patient-reported outcome measure (PROMs) utilized to assess the impact of advance care planning (ACP) among older adults and evaluates their psychometric properties.

The inclusion criteria were as follows: (1) studies that targeted older adults; (2) studies using of any type of measurement tools that measure patient-reported ACP program outcomes; and (3) studies published in English or Korean. Following PRISMA guidelines, a systematic review was conducted, encompassing electronic searches across 5 databases including PubMed, EMBASE, Cochrane Library, CINHAL, and PsycINFO and manual searches of umbrella reviews on ACP interventions. General characteristics of the selected measures were extracted, and their methodological quality was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist.

Out of 19,503 studies initially identified, 74 met the inclusion criteria, reporting on a total of 202 measures. These measures were categorized into 4 domains reflecting the targets of ACP interventions: process (n = 56), action (n = 18), process and action (n = 16), quality of care (n = 63), and health status (n = 49). Despite the breadth of measures identified, none fully met all recommended psychometric properties outlined in the checklist.

While this review aids in the selection of measures for both practical and research purposes, it underscores the necessity for further validation of PROMs in assessing ACP outcomes in older adults, advocating for rigorous psychometric evaluations and adherence to standards like the COSMIN checklist to ensure reliable and valid data. It suggests the need for shortened versions and researcher assistance to address the challenges older adults face with self-reported PROMs and improve participation rates.

To characterise children’s lunchbox contents for food, waste and packaging.

A cross-sectional study was conducted. Lunchboxes were photographed at two time points on the same day: before first morning break to capture food and packaging and post-lunch break to capture food waste. Contents were coded using an audit tool developed using REDCap.

Twenty-three sites across metropolitan Adelaide, South Australia including fourteen preschools and nine primary schools in low (n 8), medium (n 7) and high (n 8) socioeconomic areas.

Preschool (ages 3–5 years) to Grade 7 primary school (ages 6–13 years) students.

673 lunchboxes were analysed. Grain foods dominated (with at least half of them being discretionary varieties), with 92 % of lunchboxes having at least one item from that category, followed by fruits (78 %), snacks (62 %), dairy (32 %) and vegetables (26 %). Lunchboxes of preschool children contained more fruits (92 % v. 65 %; χ2(1) = 73·3, P < 0·01), vegetables (36 % v. 16 %; χ2(1) = 34·0, P < 0·01) and dairy items (45 % v. 19 %; χ2(1) = 53·6, P < 0·01), compared to lunchboxes of primary school children. Snack foods were more prevalent in primary school (68 %) than preschool (55 %; χ2(1) = 11·2, P < 0·01). Discretionary foods appeared more frequently, and single-use packaging accounted for half (53 %) of all packaging in lunchboxes, primarily from snacks and grain foods. Preschool children had less single-use packaging but more food waste. Vegetables were the most wasted food group.

Sandwiches, fruits and various snacks are typical lunchbox foods, often accompanied by single-use packaging. Considering both health and environmental factors in lunchbox choices could benefit children and sustainability efforts in schools.

This systematic review aims to synthesize evidence from current literature to describe how Electronic Medical Record (EMR) primary care data have been used for antimicrobial stewardship activities internationally.

Systematic literature review.

We searched Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Embase, Scopus, and Web of Science from January 1, 2013 to September 23, 2023 to retrieve studies that included concepts of “antimicrobial stewardship,” “primary care,” and “electronic medical records.” We used narrative synthesis to classify and interpret results. Data were grouped and tabulated by similar themes and concepts, including strengths, facilitators, barriers, and limitations for antimicrobial stewardship.

A total of 265 articles were identified from the initial search, of which 34 full-text articles from 10 countries met all criteria and were included in the review. Six categories of EMR data use were identified from the studies, these were for: assessing antimicrobial prescribing quality, measuring the effectiveness of an intervention, analyzing antimicrobial prescribing trends, assessing patient and provider characteristics in prescribing, evaluating novel tools or measures, and measuring specific conditions and outcomes. Facilitators of use of EMR data were generally well-described across the studies reviewed; however, barriers were not. Barriers described were centered around EMR system design and technical challenges in data extraction. Completeness of EMR data was the most consistently described limitation.

Our study highlights the range of uses of EMR data in supporting AMS in primary care internationally, and its strengths, facilitators, and barriers to use.

Various committees provide health technology assessment (HTA) recommendations to the Australian government on health technology subsidization. All committees include consumer members, but operations vary across committees. To support the committee’s consumer members and facilitate consumer input, the Consumer Evidence and Engagement Unit (CEEU) was launched in 2019. The CEEU aims to enhance inclusion of consumer input in Commonwealth HTA processes.

The CEEU operates within the Australian Government Department of Health and Aged Care in a hybrid format. The core functions of the CEEU include secretariat support for the HTA Consumer Consultative Committee (CCC), which comprises consumer members from all HTA committees. The CEEU also summarizes consumer input for the HTA committees. In 2022, the CEEU launched the Conversations for Change series, which was developed through a range of different consultation activities. As a result, an ongoing “Changing Conversations” mandate is in place, to build and sustain relational, non-transactional partnerships in a true collaborative style.

The HTA committees and subcommittees operate across cycles with overlapping timelines, requiring consumer input to be gathered at different timepoints for different purposes. The CEEU has launched materials, including the Consultation Hub and HTA Engage, and is developing a Consultation Toolkit to raise awareness and facilitate these processes. The role of the HTA CCC is evolving as a forum to enable consumer committee members to share experiences and receive CEEU support. Improvements in consultation processes have enabled the CEEU to provide consumer comments to consumer committee members to facilitate genuine representation of consumer and other external stakeholder views.

Managing consumer input can be resource intensive, however there is increasing recognition of the importance of consumer engagement in Australian HTA. The CEEU expects continued growth and a wider remit from 2024, as new processes and changes occur. Additional materials are planned to support consumer committee members and to build capacity among consumers and consumer organizations.