Objective: To assess the factors that contributed to the successful completion of recruitment for the largest clinical trial ever conducted in Australia, the Aspirin in Reducing Events in the Elderly (ASPREE) study.

Research on health inequalities and health disparities has grown exponentially since the 1960s, but this expansion has not been matched by an associated sense of progress. Criticisms include claims that too much research addresses well-trodden questions and that the field has failed to gain public and policy traction. Qualitative studies have found researchers partly attribute these challenges to fragmentation resulting from disciplinary and methodological differences. Yet, empirical investigation (‘research on research’) is limited. This study addresses this gap, employing mixed-methods to examine, at scale, how and why this field is defined by insular research clusters. First, bibliometric analysis identifies and visualizes the 250 most-connected authors. Next, an algorithm was used to identify clustering via citation links between authors. We used researcher profiling to ascertain authors' geographical and institutional locations and disciplinary training, examining how this mapped onto clusters. Finally, causes of siloing were investigated via semi-structured interviews with 45 researchers. The resulting ‘atlas’ of health inequalities and health disparities research identifies eight clusters of authors with varying degrees of connectedness. No single factor neatly describes observed fragmentation, health equity scholars exhibit a diverse disciplinary backgrounds, and geographical, institutional, and historical factors appear to intersect to explain siloed citation patterns. While the configuration of research activity within clusters potentially helps render questions scientifically manageable, it affirms perceptions of the field as fragmented. We draw on Thomas Kuhn and Sheila Jasanoff to position results within theoretical pictures of scientific progress. Newcomers to the field can use our findings to orient themselves within the many streams of health equity scholarship, and existing health equity scholars can use the atlas to move beyond existing geo-disciplinary networks. However, although stronger cross-cluster engagement would be likely to improve insights, the complex nexus of factors underlying the field's structure will likely make this challenging in practice.

Key Points Question Which cognitive measure among global cognition, memory, processing speed, and verbal fluency is most useful in assessing risk of future dementia when combined with gait decline? Findings In this cohort study of 16 855 relatively healthy older people in Australia and the US, a dual decline in gait and cognitive function compared with nondecliners was significantly associated with increased risk of dementia. This risk was highest in those with both gait and memory decline. Meaning These results highlight the importance of gait in dementia risk assessment and suggest that dual decline in gait speed and a memory measure may be the best combination to assess future dementia.

Objectives Age and female sex are risk factors for dementia, and menopause is associated with cognitive dysfunction. Previous work largely considered the effects of sex and menopause as being independent of age. We studied whether age interacts with sex or menopause in explaining imaging biomarkers of dementia during midlife. Methods In this cross-sectional study of UK Biobank participants with brain magnetic resonance imaging (MRI), we explored the interaction of age with sex or menopausal status in explaining total brain (TBV), grey matter (GMV), white matter (WMV), white matter hyperintensities (WMHV), regional cortical, and subcortical volumes. Results Data were available for 1827 postmenopausal women, 230 pre/perimenopausal women and 2165 men (median age 63.3 years). There was a significant interaction between age and sex (p=0.024) for TBV, where the inverse association age with TBV was steeper in women (β=-5.35 ml/year) than in men (β=-4.77 ml/year). Similar age-sex interactions were also observed for GMV and WMV. In women, there was a significant interaction between age and menopausal status (p=0.007) where the inverse association of age with TBV was steeper in postmenopausal (β=-5.89 ml/year) than in pre/perimenopausal women (β=-1.61 ml/year). Similar age-menopause interactions were found in predicting lower GMV and higher WMHV. Differences in the direction of these age-sex and age-menopause interactions were found for regional cortical and subcortical brain volumes. Conclusion Sex and menopause both interact with age during midlife in explaining MRI biomarkers of dementia. Further work is required to understand the mechanisms driving these interactions to develop strategies for delaying dementia.

BackgroundMelbourne, Australia, successfully halted exponential transmission of COVID-19 via two strict lockdowns during 2020. The impact of such restrictions on healthcare-seeking behaviour is not comprehensively understood, but is of global importance. We explore the impact of the COVID-19 pandemic on acute, subacute and emergency department (ED) presentations/admissions within a tertiary, metropolitan health service in Melbourne, Australia, over two waves of community transmission (1 March to 20 September 2020).MethodsWe used 4 years of historical data and novel forecasting methods to predict counterfactual hospital activity for 2020, assuming absence of COVID-19. Observed activity was compared with forecasts overall, by age, triage category and for myocardial infarction and stroke. Data were analysed for all patients residing in the health service catchment area presenting between 4 January 2016 and 20 September 2020.ResultsED presentations (n=401 805), acute admissions (n=371 723) and subacute admissions (n=15 676) were analysed. Substantial departures from forecasted presentation levels were observed during both waves in the ED and acute settings, and during the second wave in subacute. Reductions were most marked among those aged >80 and <18 years. Presentations persisted at expected levels for urgent conditions, and ED triage categories 1 and 5, with clear reductions in categories 2–4.ConclusionsOur analyses suggest citizens were willing and able to present with life-threatening conditions during Melbourne’s lockdowns, and that switching to telemedicine did not cause widespread spill-over from primary care into ED. During a pandemic, lockdowns may not inhibit appropriate hospital attendance where rates of infectious disease are low.

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Introduction To determine whether slowed gait and weakened grip strength independently, or together, better identify risk of cognitive decline or dementia. Methods Time to walk 3 meters and grip strength were measured in a randomized placebo‐controlled clinical trial involving community‐dwelling, initially cognitively healthy older adults (N = 19,114). Results Over a median 4.7 years follow‐up, slow gait and weak grip strength at baseline were independently associated with risk of incident dementia (hazard ratio [HR] = 1.44, 95% confidence interval [CI]: 1.19–1.73; and 1.24, 95% CI: 1.04–1.50, respectively) and cognitive decline (HR = 1.38, 95% CI: 1.26–1.51; and 1.04, 95% CI: 0.95–1.14, respectively) and when combined, were associated with 79% and 43% increase in risk of dementia and cognitive decline, respectively. Annual declines in gait and in grip over time showed similar results. Discussion Gait speed and grip strength are low‐cost markers that may be useful in the clinical setting to help identify and manage individuals at greater risk, or with early signs, of dementia, particularly when measured together. Highlights Grip strength and gait speed are effective predictors and markers of dementia. Dementia risk is greater than cognitive decline risk with declines in gait or grip. Decline in gait speed, more so than in grip strength, predicts greater dementia risk. Greater risk prediction results from combining grip strength and gait speed.

Message framing has been used as a strategy for promoting physical activity (PA) in university students, but the effectiveness of gain-framed (GF), or loss-framed (LF) messages is variable. This study aims to investigate the effects on motivation and PA behaviour of framed messaging on social media in university students. Gain- and loss-framed messages communicated the mental health outcomes of PA. A three-arm feasibility study (n = 148) collected pre-post intervention online questionnaire responses to assess motivation for PA, exercise, active travel, and PA levels, in response to the messaging intervention on Facebook. Both GF and LF messages effectively increased average motivation for PA in comparison to controls (GF by 0.3 (on a 7-point Likert scale), 9% [95% CI: 3–17%], p = 0.007, LF by 0.3, 10% [CI: 3–18%], p = 0.005). Average motivation for exercise increased in comparison to controls (GF by 0.6, 16% [95% CI: 6–26%], p = 0.001, LF by 0.5, 14.6% [95% CI: 5–26%], p < 0.001). Average motivation for active travel increased in comparison to controls (GF by 0.7, 18% [95% CI: 8–29%], p < 0.001, LF by 0.6, 19% [95% CI: 8–30%], p < 0.001). No meaningful differences between GF or LF messages were observed. Framed messages regarding mental health outcomes of PA delivered via social media could be effective for increasing PA motivation in university students. However, based on our results there is no gain- or loss-framed advantage.