ObjectivesTo examine the validity and reliability of the Fitbit Flex against direct observation for measuring steps in the laboratory and against the Actigraph for step counts in free-living conditions and for moderate-to-vigorous physical activity (MVPA) and activity energy expenditure (AEE) overall.MethodsTwenty-five adults (12 females, 13 males) wore a Fitbit Flex and an Actigraph GT3X+ during a laboratory based protocol (including walking, incline walking, running and stepping) and free-living conditions during a single day period to examine measurement of steps, AEE and MVPA. Twenty-four of the participants attended a second session using the same protocol.ResultsIntraclass correlations (ICC) for test-retest reliability of the Fitbit Flex were strong for walking (ICC = 0.57), moderate for stair stepping (ICC = 0.34), and weak for incline walking (ICC = 0.22) and jogging (ICC = 0.26). The Fitbit significantly undercounted walking steps in the laboratory (absolute proportional difference: 21.2%, 95%CI 13.0–29.4%), but it was more accurate, despite slightly over counting, for both jogging (6.4%, 95%CI 3.7–9.0%) and stair stepping (15.5%, 95%CI 10.1–20.9%). The Fitbit had higher coefficients of variation (Cv) for step counts compared to direct observation and the Actigraph. In free-living conditions, the average MVPA minutes were lower in the Fitbit (35.4 minutes) compared to the Actigraph (54.6 minutes), but AEE was greater from the Fitbit (808.1 calories) versus the Actigraph (538.9 calories). The coefficients of variation were similar for AEE for the Actigraph (Cv = 36.0) and Fitbit (Cv = 35.0), but lower in the Actigraph (Cv = 25.5) for MVPA against the Fitbit (Cv = 32.7).ConclusionThe Fitbit Flex has moderate validity for measuring physical activity relative to direct observation and the Actigraph. Test-rest reliability of the Fitbit was dependant on activity type and had greater variation between sessions compared to the Actigraph. Physical activity surveillance studies using the Fitbit Flex should consider the potential effect of measurement reactivity and undercounting of steps.

Support for current beneficial breast-feeding practices and promotion of nutrient-dense complementary foods, need to be embedded in initiatives for improved family food security. Good nutrition in early life can reduce the disparity in health, education and economic status between Aboriginal and Torres Strait Islander peoples and other Australians.

Objective: To examine the prevalence of dementia and problems associated with ageing in the Torres Strait. Methods: The study was conducted across all 18 island and 5 mainland communities in the Torres Strait and Northern Peninsula Area of Far North Queensland.Participants underwent a comprehensive health assessment and a Geriatrician assessment, which were used to establish consensus diagnoses. Results: A total of 276 Torres Strait residents aged between 45 and 93 participated in the study. The prevalence of dementia in the sample was 14.2%, which was 2.87 times higher than the wider Australian population. Conclusion: Torres Strait Islander peoples share the increased risk of dementia seen

ObjectivesTo investigate the suitability of the German version of the Manchester Triage System (MTS) as a potential tool to redirect emergency department (ED) patients to general practitioner care. Such tools are currently being discussed in the context of reorganisation of emergency care in Germany.DesignProspective cohort study.SettingSingle centre University Hospital Emergency Department.ParticipantsAdult, non-surgical ED patients.ExposureA non-urgent triage category was defined as a green or blue triage category according to the German version of the MTS.Primary and secondary outcome measuresSurrogate parameters for short-term risk (admission rate, diagnoses, length of hospital stay, admission to the intensive care unit, in-hospital and 30-day mortality) and long-term risk (1-year mortality).ResultsA total of 1122 people presenting to the ED participated in the study. Of these, 31.9% (n=358) received a non-urgent triage category and 68.1% (n=764) were urgent. Compared with non-urgent ED presentations, those with an urgent triage category were older (median age 60 vs 56 years, p=0.001), were more likely to require hospital admission (47.8% vs 29.6%) and had higher in-hospital mortality (1.6% vs 0.8%). There was no significant difference observed between non-urgent and urgent triage categories for 30-day mortality (1.2% [n=4] vs 2.2% [n=15]; p=0.285) or for 1-year mortality (7.9% [n=26] vs 10.5% [n=72]; p=0.190). Urgency was not a significant predictor of 1-year mortality in univariate (HR=1.35; 95% CI 0.87 to 2.12; p=0.185) and multivariate regression analyses (HR=1.20; 95% CI 0.77 to 1.89; p=0.420).ConclusionsThe results of this study suggest the German MTS is unsuitable to safely identify patients for redirection to non-ED based GP care.Trial registration numberU1111-1119-7564; Post-results

ObjectiveTo explore self reported knowledge and attitudes to insulin treatment among a group of adults with poorly controlled diabetes in the Torres Strait islands.DesignCross‐sectional survey in 2014, interviews with 29 adults with HbA1c ≥ 8.5% (69 mmol mol−1) and not taking insulin, using Insulin Treatment Appraisal Scale (ITAS) and Barriers to Insulin Treatment Questionnaire (BITQ) scores.SettingFive remote Torres Strait Island communities in the Torres Strait region.ParticipantsPoorly controlled insulin‐naïve type 2 diabetics.Main outcome measures BITQ and ITAS scores on items related to knowledge and attitudes to insulin treatment, clinical and demographic measures.ResultsOverall, 34% of the cohort had poor glycaemic control. Compared to those with HbA1c ≥ 8.5% and taking insulin (n = 37), the 29 insulin‐naïve participants were more obese, more likely to smoke and drink alcohol, have lower mean HbA1c and fewer years with diabetes. Among the insulin‐naïve group, those reporting higher ‘barriers’ (BITQ scores) were older and with lower formal education than those reporting fewer barriers. Torres participants consistently scored low on ‘knowledge’ items in the ITAS, especially those which would guide insulin initiation (insulin improves glucose control and prevents complications).ConclusionCompared to other published studies, the Torres participants had higher scores for BITQ ‘barrier’ items and lower ‘knowledge’ scores. This suggests better education around glycaemic control with medication and discussion of perceptions and exchange of experiences with peers who are taking insulin might improve the uptake of insulin in this high‐risk group.

BackgroundTraumatic brain injury (TBI) is a leading cause of disability worldwide. Previous studies have shown that males have a higher incidence than females, and Indigenous populations have a higher rate than non-Indigenous. To date, no study has compared the incidence rate of TBI between Indigenous and non-Indigenous Australians for any cause. Here we add to this rather sparse literature.MethodsRetrospective analysis of data from North Queensland Emergency Departments between 2007 and 2015 using Australian Bureau of Statistics population estimates for North Queensland residents aged 15–64 years as denominator data. Outcome measures include incidence rate ratios (IRR) for TBI presentations by Indigenous status, age, sex, year of presentation, remoteness, and socio-economic indicator.ResultsOverall incidence of TBI presentations per 100,000 population was 97.8. Indigenous people had an incidence of 166.4 compared to an incidence in the non-Indigenous population of 86.3, providing an IRR of 1.93 (95% CI 1.77–2.10; p < 0.001). Males were 2.29 (95% CI 2.12–2.48; p < 0.001) times more likely to present than females. Incidence increased with year of presentation only in the Indigenous male population.ConclusionsThe greater burden of ED presentations for TBI in the Indigenous compared with the non-Indigenous population is of concern. Importantly, the need to provide quality services and support to people living with TBI in remote and very remote areas, and the major role of the new National Disability Insurance Scheme is discussed.

Objective: Early childhood anaemia affects health and neurodevelopment. This study describes anaemia among Aboriginal and Torres Strait Islander children of Far North Queensland.Methods: This retrospective cohort study used health information for children born between 2006 and 2010 and their mothers. We describe the incidence of early childhood anaemia and compare characteristics of children and mothers where the child had anaemia with characteristics of children and mothers where the child did not have anaemia using bivariate and multivariable analysis, by complete case (CC) and with multiple imputed (MI) data.

This paper examines the relationship between Strongyloides stercoralis infection and eosinophilia in an endemic community, and suggests that eosinophilia is not a reliable screening test for excluding S Stercoralis infection in this setting. The relationship between T2DM, Strongyloides infection and eosinophilia is elaborated.