Effect of two behavioural 'nudging' interventions on management decisions for low back pain: A randomised vignette-based study in general practitioners

Objective €Nudges' are subtle cognitive cues thought to influence behaviour. We investigated whether embedding nudges in a general practitioner (GP) clinical decision support display can reduce low-value management decisions. Methods Australian GPs completed four clinical vignettes of patients with low back pain. Participants chose from three guideline-concordant and three guideline-discordant (low-value) management options for each vignette, on a computer screen. A 2×2 factorial design randomised participants to two possible nudge interventions: €partition display' nudge (low-value options presented horizontally, high-value options listed vertically) or €default option' nudge (high-value options presented as the default, low-value options presented only after clicking for more). The primary outcome was the proportion of scenarios where practitioners chose at least one of the low-value care options. Results 120 GPs (72% male, 28% female) completed the trial (n=480 vignettes). Participants using a conventional menu display without nudges chose at least one low-value care option in 42% of scenarios. Participants exposed to the default option nudge were 44% less likely to choose at least one low-value care option (OR 0.56, 95%CI 0.37 to 0.85; p=0.006) compared with those not exposed. The partition display nudge had no effect on choice of low-value care (OR 1.08, 95%CI 0.72 to 1.64; p=0.7). There was no interaction between the nudges (OR 0.94, 95% CI 0.41 to 2.15; p=0.89). Interpretation A default option nudge reduced the odds of choosing low-value options for low back pain in clinical vignettes. Embedding high value options as defaults in clinical decision support tools could improve quality of care. More research is needed into how nudges impact clinical decision-making in different contexts

Predictors of chronic fatigue syndrome and mood disturbance after acute infection

Prospective cohort studies following individuals from acute infections have documented a prevalent post-infective fatigue state meeting diagnostic criteria for chronic fatigue syndrome (CFS) – that is, a post-infective fatigue syndrome (PIFS). The Dubbo Infection Outcomes Study (DIOS) was a prospective cohort following individuals from acute infection with Epstein-Barr virus (EBV), Ross River virus (RRV), or Q fever through to assessment of caseness for CFS designated by physician and psychiatrist assessments at 6 months. Previous studies in DIOS have revealed that functional genetic polymorphisms in both immunological (pro- and anti-inflammatory cytokines) and neurological (the purinergic receptor, P2X7) genes are associated with both the severity of the acute infection and subsequent prolonged illness. Principal components analysis was applied to self-report data from DIOS to describe the severity and course of both the overall illness and concurrent mood disturbance. Associations between demographics and acute infection characteristics, with prolonged illness course as well as the PIFS outcome were examined using multivariable statistics. Genetic haplotype-driven functional variations in the neuropeptide Y (NPY) gene previously shown to be associated with brain responses to stress, and to trait anxiety were also examined as predictors. The sample included 484 subjects (51% female, median age 32, IQR 19–44), of whom 90 (19%) met diagnostic criteria for CFS at 6 months. Participants with greater overall illness severity and concurrent mood disturbance in the acute illness had a more prolonged illness severity (HR = 0.39, 95% CI: 0.34–0.46, p 0.05). Severe acute infective illnesses predicted prolonged illness, prolonged mood disturbance and PIFS. These factors may facilitate early intervention to manage both PIFS and mood disturbances

Impact of a diagnosis of polycystic ovary syndrome on diet, physical activity and contraceptive use in young women: findings from the Australian Longitudinal Study of Women's Health

Study question: Do diet, physical activity and contraceptive use change after receiving a diagnosis of polycystic ovary syndrome (PCOS)? Summary answer: Using longitudinal data 12\ua0months apart, young women newly diagnosed with PCOS were more likely to stop using contraception but did not change their physical activity or vegetable intake. What is known already: Diagnostic criteria for PCOS have widened to capture more women, despite limited evidence of the benefits and harms. Possible benefits of a PCOS diagnosis are that it may help women with family planning and motivate them to implement healthy lifestyle changes to reduce the reproductive, metabolic and cardiovascular risks associated with PCOS. However, there are no empirical studies investigating how women respond to a diagnosis of PCOS with respect to their health behaviour, and longitudinal population-based studies are lacking. Study design, size, duration: This is a longitudinal analysis of two waves of data collected 12\ua0months apart from the cohort born 1989-1995 in the Australian Longitudinal Survey on Women's Health, a population-based cohort study. Women in this cohort were first surveyed in 2012-2013, aged 18-23 years. Participants/materials, setting, methods: Women who responded to the 2014 survey (aged 19-24, n\ua0= 11 344) and 2015 survey (aged 20-25, n\ua0= 8961) were included. Using logistic regression, multinomial logistic regression and linear regression, change in vegetable intake, physical activity and contraceptive use were compared for women newly diagnosed with PCOS to women not reporting a diagnosis of PCOS. Changes in psychological distress and BMI were also examined. Main results and the role of chance: Young women reporting a new diagnosis of PCOS were no more likely to increase their vegetable intake or physical activity than women not reporting a PCOS diagnosis. Women newly diagnosed with PCOS were 3.4 times more likely to stop using contraception during the 12-month study period than women without PCOS (14% versus 4%, 95% CI = 2.3 to 5.1, P\ua

Community awareness and use of anti-Müllerian hormone testing in Australia : a population survey of women

Funding This project was supported by a National Health and Medical Research Council (NHMRC) Centre for Research Excellence grant (1104136) and Program grant (1113532). T.C. is supported by an NHMRC Emerging Leader Research Fellowship (2009419).Peer reviewedPublisher PD

The Impact of the Chronic Disease Self-Management Program on Health Literacy: A Pre-Post Study Using a Multi-Dimensional Health Literacy Instrument.

This study assessed the impact of the Chronic Disease Self-Management Program (CDSMP) on different domains of health literacy using a pre-post study design. Participants aged over 16 years and with one or more self-reported chronic diseases were recruited for the CDSMP in western Sydney (a highly diverse area of New South Wales, Australia) between October 2014 and September 2018. Health literacy was assessed pre- and immediately post-intervention using the Health Literacy Questionnaire (HLQ), with differences in mean scores for each HLQ domain analysed using paired sample t-tests. A total of 486 participants were recruited into the CDSMP. Of those, 316 (65.0%) completed both pre- and post-intervention surveys and were included in the analysis. The median age of the participants was 68 years, the majority were female (62.5%), and most were born in a country other than Australia (80.6%). There were statistically significant (p < 0.001) improvements across all nine domains of the HLQ. This is the first study evaluating the potential impact of the CDSMP on improving different domains of health literacy amongst a diverse sample of participants with chronic diseases using a multi-dimensional instrument. The absence of a control population in this study warrants caution when interpreting the results

Australian Women’s Intentions and Psychological Outcomes Related to Breast Density Notification and Information

Objective To assess the effect of mammographic breast density notification and information provision on women’s intention to seek supplemental screening and psychological outcomes. Design, Setting, and Participants A 3-arm online randomized clinical trial was conducted from August 10 to 31, 2021. Data analysis was conducted from September 1 to October 20, 2021. Participants included Australian residents identifying as female, aged between 40 and 74 years, with no history of breast cancer who were residing in jurisdictions without existing breast density notification with screening mammograms. Interventions Women were randomized to receive 1 of the following hypothetical breast screening test result letters: screening mammogram result letter without breast density messaging (control), screening mammogram result letter with breast density messaging and an existing density information letter taken from a screening service in Australia (intervention 1), and screening mammogram result letter with breast density messaging and a health literacy–sensitive version of the letter adapted for people with lower health literacy (intervention 2). Main Outcomes and Measures Primary outcomes were intention to seek supplemental screening; feeling anxious (uneasy, worried, or nervous), informed, or confused; and having breast cancer worry

It's not just what you say, but also how you say it : exploring the auditory and visual properties of speech prosody

This thesis investigated the production and perception of prosodic cues for focus and phrasing contrasts from auditory and visual speech (i.e., visible face and head movements). This was done by examining the form, perceptibility, and potential functions of the visual correlates of spoken prosody using auditory and motion analysis and perception-based measures. The first part of the investigation (Chapters 2 to 3) consisted of a series of perception experiments conducted to determine the degree to which perceivers were sensitive to the visual realisation of prosody across face areas. Here, participants were presented with a visual cue (either from the upper or lower half of the face) to match (based on prosody) with another visual or auditory cue. Performance was much better than chance even when the task involved matching cues produced by different talkers. The results indicate that perceivers were sensitive to visual prosodic cues, that considerable variability in the form of these could be tolerated, and that different cues conveying information about the same prosodic type could be matched. The second part of the thesis (Chapters 4 to 8) reported on the construction of a multi-talker speech prosody corpus and the analysis and perceptibility of this production data. The corpus consisted of auditory and visual speech recording of six talkers producing 30 sentences across three prosodic conditions in two interactive settings (face-to-face and auditory-only), with face movements captured using a 3D motion tracking system and characterised using a guided principal components analysis. The analysis consisted of quantifying auditory and visual characteristics of prosodic contrasts separately as well as the relationship between these. Acoustically, the properties of the contrasts corresponded to those typically described in the literature (however, some properties varied systematically as a function of the interactive setting), and were also perceived as conveying the intended contrasts in subsequent perceptual tasks (reported in Chapter 6). Overall, the types of movements used to contrast narrow from broad focused utterances, and echoic questions from statements, involved the use of both articulatory (e.g., jaw and lip movement) and non-articulatory (e.g., eyebrow and rigid head movement) cues. Both the visual and the acoustic properties varied across talkers and interactive settings. The spatial and temporal relationship between auditory and visual signal modalities was highly variable, differing substantially across utterances. The final part of the thesis (Chapters 9 to 10) reported the results of a series of perception experiments using perceptual rating and cross-modal matching tasks on stimuli resynthesised from the motion capture data. These stimuli showed various combinations of visual cues, and when presented in isolation or combined with the auditory signal, these were perceived as conveying the intended prosodic contrast. However, no auditory-visual (AV) benefit was observed in the perceptual ratings, with the presentation of more cues failing to result in better cross-modal matching performance (suggesting there may be limitations in perceivers‟ ability to process multiple cues). In sum, the thesis showed that perceivers were sensitive to visual prosodic cues despite variability in production, and were able to match different types of cue. The construction of an AV prosody corpus permitted the characteristics of the auditory and visual prosodic correlates (and their relationship) to be quantified, and allowed for the synthesis of visual cues that perceivers subsequently used to successfully extract prosodic information. In all, the experiments reported in this thesis provide a strong case for the development of well-controlled and measured manipulations of prosody and warrants further examination of the visual cues to prosody