Medicine and Health Sciences Commons^™

Community Perspectives On The Benefits And Risks Of Technologically Enhanced Communicable Disease Surveillance Systems: A Report On Four Community Juries, Christopher J. Degeling, Stacy M. Carter, Antoine M. Van Oijen, Jeremy Mcanulty, Vitali Sintchenko, Annette J. Braunack-Mayer, Trent Yarwood, Jane Johnson, Gwendolyn L. Gilbert

Illawarra Health and Medical Research Institute

Background Outbreaks of infectious disease cause serious and costly health and social problems. Two new technologies – pathogen whole genome sequencing (WGS) and Big Data analytics – promise to improve our capacity to detect and control outbreaks earlier, saving lives and resources. However, routinely using these technologies to capture more detailed and specific personal information could be perceived as intrusive and a threat to privacy. Method Four community juries were convened in two demographically different Sydney municipalities and two regional cities in New South Wales, Australia (western Sydney, Wollongong, Tamworth, eastern Sydney) to elicit the views of well-informed community members …

Diet Quality In Patients With End-Stage Kidney Disease Undergoing Dialysis, Lauren Roach, Kelly Lambert, Jane Holt, Barbara J. Meyer

Faculty of Science, Medicine and Health - Papers: part A

ACKGROUND: People on haemodialysis (HD) are at risk of consuming a poor quality diet. This includes inadequate intake of omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA). OBJECTIVE: This study aims to investigate diet quality, with a particular focus on n-3 LCPUFA intake, in a population of incentre HD patients. DESIGN: Dietary intake was measured using three 24 hour recalls; the Polyunsaturated food frequency questionnaire (PUFA FFQ) and the Total Diet Score (TDS). Dietary intake was also compared to evidence based practice guidelines (EBPG). Nutritional status was assessed using the Patient Generated Subjective Global Assessment (PG SGA). SUBJECTS: A total …

Beneficial Effects Of Increased Lysozyme Levels In Alzheimer's Disease Modelled In Drosophila Melanogaster, Linnea Sandin, Liza Bergkvist, Sangeeta Nath, Claudia Kielkopf, Camilla Janefjord, Linda Helmfors, Henrik Zetterberg, Kaj Blennow, Hongyun Li, Camilla Nilsberth, Brett Garner, Ann-Christin Brorsson, Katarina Kagedal

Illawarra Health and Medical Research Institute

Genetic polymorphisms of immune genes that associate with higher risk to develop Alzheimer's disease (AD) have led to an increased research interest on the involvement of the immune system in AD pathogenesis. A link between amyloid pathology and immune gene expression was suggested in a genome-wide gene expression study of transgenic amyloid mouse models. In this study, the gene expression of lysozyme, a major player in the innate immune system, was found to be increased in a comparable pattern as the amyloid pathology developed in transgenic mouse models of AD. A similar pattern was seen at protein levels of lysozyme …

Identifying Metabolic Syndrome In A Clinical Cohort: Implications For Prevention Of Chronic Disease, Allison Martin, Elizabeth Neale, Marijka Batterham, Linda C. Tapsell

Faculty of Science, Medicine and Health - Papers: part A

In the clinical setting, calculating cardiovascular disease (CVD) risk is commonplace but the utility of the harmonised equation for metabolic syndrome (MetS) (Alberti et al., 2009) is less well established. The aims of this study were to apply this equation to an overweight clinical cohort to identify risk factors for being metabolically unhealthy and explore associations with chronic disease. Baseline data were analysed from a lifestyle intervention trial of Illawarra residents recruited in 2014/2015. Participants were aged 25–54 years with a BMI 25–40 kg/m2. Data included MetS, CVD risk, insulin sensitivity, weight, body fat, diet, peripheral artery disease (PAD), physical …

Lipid Anti-Lipid Antibody Responses Correlate With Disease Activity In Systemic Lupus Erythematosus, Vojislav Jovanovic, Nurhuda Abdul Aziz, Yan Ting Lim, Amanda Ng Ai Poh, Sherlynn Jin Hui Chan, Eliza Ho Xin Pei, Fei Chuin Lew, Guanghou Shui, Andrew M. Jenner, Li Bowen, Eoin F. Mckinney, Paul A. Lyons, Michael D. Kemeny, Kenneth G.C. Smith, Markus R. Wenk, Paul A. Macary

Illawarra Health and Medical Research Institute

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disorder characterized by broad clinical manifestations including cardiovascular and renal complications with periodic disease flares and significant morbidity and mortality. One of the main contributing factors to the pathology of SLE is the accumulation and impaired clearance of immune complexes of which the principle components are host auto-antigens and antibodies. The contribution of host lipids to the formation of these autoimmune complexes remains poorly defined. The aim of the present study was to identify and analyze candidate lipid autoantigens and their corresponding anti-lipid antibody responses in a well-defined SLE patient cohort using …

Neurotrophin Signaling And Alzheimer's Disease Neurodegeneration - Focus On Bdnf/Trkb Signaling, Jenny Wong

Illawarra Health and Medical Research Institute

Neurotrophins are small proteins vital for neuronal growth, differentiation, survival, and plasticity. Members of the mammalian neurotrophin family include nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), and neurotrophin- 4/5 (NT-4/5). Their neurotrophic effects are mediated by the tropomyosin receptor kinase (Trk) receptors, membrane-bound receptor tyrosine kinases (NGF for TrkA, BDNF and NT4/5 for TrkB, and NT-3 for TrkC) which activate various cell signaling pathways linked to growth, differentiation, and survival. The importance of neurotrophin signaling in brain development is highlighted by findings showing that knockout mice for any one of the neurotrophins or their receptors are fatal …

Daedalic Dna Vaccination Against Self Antigens As A Treatment For Chronic Kidney Disease, Yuan Min Wang, Jimmy Jianheng Zhou, Ya Wang, Debbie Watson, Geoff Yu Zhang, Min Hu, Huiling Wu, Guoping Zheng, Yiping Wang, Anne M. Durkan, David Ch Harris, Stephen I. Alexander

Faculty of Science, Medicine and Health - Papers: part A

Chronic kidney disease (CKD) is a major cause of death and morbidity in Australia and worldwide. DNA vaccination has been used for targeting foreign antigens to induce immune responses and prevent autoimmune disease, viral infection and cancer. However, the use of DNA vaccination has been restricted by a limited ability to induce strong immune responses, especially against self-antigens which are limited by mechanisms of self-tolerance. Furthermore, there have been few studies on the potential of DNA vaccination in chronic inflammatory diseases, including CKD. We have established strategies of DNA vaccination targeting specific self-antigens in the immune system including co-stimulatory pathways, …

From Research To Policy In Chronic Disease Prevention: Mandatory Salt Reduction In South Africa, K Charlton, K Steyn, N Levitt, C Lombard

Faculty of Science, Medicine and Health - Papers: part A

Abstract of a poster that presented at 20th International Congress of Nutrition, Granada, Spain, September 15-20, 2013.

Patients Communicating With Their Primary Care Physician About Chronic Disease Treatment In Regional Australia: Is Health Literacy Important?, J Mullan, K Weston, A Bonney, C Magee, G Albert, B Gerges, Soheir Abadier, T Smith, V Bonney, B Dijkmans-Hadley, C Kielly-Carroll

Faculty of Science, Medicine and Health - Papers: part A

No abstract provided.

Deletion Of Abca7 Increases Cerebral Amyloid-Β Accumulation In The J20 Mouse Model Of Alzheimer's Disease, Woojin S. Kim, Hongyun Li, Kalani Ruberu, Sharon Chan, David A. Elliott, Jac Kee Low, David Cheng, Tim Karl, Brett Garner

Faculty of Science, Medicine and Health - Papers: part A

ATP-binding cassette transporter A7 (ABCA7) is expressed in the brain and has been detected in macrophages, microglia, and neurons. ABCA7 promotes efflux of lipids from cells to apolipoproteins and can also regulate phagocytosis and modulate processing of amyloid precursor protein (APP) to generate the Alzheimer's disease (AD) amyloid-β (Aβ) peptide. Genome-wide association studies have indicated that ABCA7 single nucleotide polymorphisms confer increased risk for late-onset AD; however, the role that ABCA7 plays in the brain in the AD context is unknown. In the present study, we crossed ABCA7-deficient (A7-/-) mice with J20 amyloidogenic mice to address this issue. We show …

Dairy Consumption And The Risk Of 15-Year Cardiovascular Disease Mortality In A Cohort Of Older Australians, Jimmy Chun Yu Louie, Victoria M. Flood, George Burlutsky, Anna M. Rangan, Timothy P. Gill, Paul Mitchell

Faculty of Science, Medicine and Health - Papers: part A

The effects of habitual dairy consumption and the risk of 15-year cardiovascular disease (CVD) mortality in a cohort of older Australians were investigated. Participants (n = 2900) completed a validated 145-item semi-quantitative food frequency questionnaire. Cox proportional hazards regression models were used to investigate associations between tertiles of the dairy consumption, including low/reduced fat dairy, whole fat dairy and their ratio (ratioLF/WF), and risk of mortality from coronary heart disease (CHD), stroke or combined CVD. There were 548 recorded cases of CVD mortality in this cohort. For total dairy intake, a reduction in risk of CVD was only seen in …

A Proposed Approach To Monitor Private-Sector Policies And Practices Related To Food Environments, Obesity And Non-Communicable Disease Prevention, G Sacks, B Swinburn, V Kraak, S Downs, C Walker, S Barquera, S Friel, C Hawkes, B Kelly, S Kumanyika, M L'Abbe, A Lee, T Lobstein, J Ma, J Macmullan, S Mohan, C Monteiro, B Neal, M Rayner, D Sanders, W Snowdon, S Vandevijvere

Faculty of Science, Medicine and Health - Papers: part A

Private-sector organizations play a critical role in shaping the food environments of individuals and populations. However, there is currently very limited independent monitoring of private-sector actions related to food environments. This paper reviews previous efforts to monitor the private sector in this area, and outlines a proposed approach to monitor private-sector policies and practices related to food environments, and their influence on obesity and non-communicable disease (NCD) prevention. A step-wise approach to data collection is recommended, in which the first ('minimal') step is the collation of publicly available food and nutrition-related policies of selected private-sector organizations. The second ('expanded') step …

Preventive Evidence Into Practice (Pep) Study: Implementation Of Guidelines To Prevent Primary Vascular Disease In General Practice Protocol For A Cluster Randomised Controlled Trial, Mark Fort Harris, Jane Lloyd, John Litt, Mieke Van Driel, Danielle Mazza, Grant Russell, Jane Smith, Chris Del Mar, Elizabeth Denney-Wilson, Sharon M. Parker, Yordanka Krastev, Upali W. Jayasinghe, Richard J. Taylor, Nicholas Zwar, Jinty Wilson, Helen Bolger-Harris, Justine Waters

Faculty of Science, Medicine and Health - Papers: part A

Background: There are significant gaps in the implementation and uptake of evidence-based guideline recommendations for cardiovascular disease (CVD) and diabetes in Australian general practice. This study protocol describes the methodology for a cluster randomised trial to evaluate the effectiveness of a model that aims to improve the implementation of these guidelines in Australian general practice developed by a collaboration between researchers, non-government organisations, and the profession.Methods: We hypothesise that the intervention will alter the behaviour of clinicians and patients resulting in improvements of recording of lifestyle and physiological risk factors (by 20%) and increased adherence to guideline recommendations for: the …

Novel Behavioural Characteristics Of The Appswe/Ps1Δe9 Transgenic Mouse Model Of Alzheimer's Disease, David Cheng, Warren Logge, Jac Kee Low, Brett Garner, Tim Karl

Illawarra Health and Medical Research Institute

In order to better understand animal models of Alzheimer's disease, novel phenotyping strategies have been established for transgenic mouse models. In line with this, the current study characterised male APPxPS1 transgenic mice on mixed C57BL/6JxC3H/HeJ background for the first time for social recognition memory, sensorimotor gating, and spatial memory using the cheeseboard test as an alternative to the Morris water maze. Furthermore, locomotion, anxiety, and fear conditioning were evaluated in transgenic and wild type-like animals. APPxPS1 males displayed task-dependent hyperlocomotion and anxiety behaviours and exhibited social recognition memory impairments compared to wild type-like littermates. Spatial learning and memory, fear conditioning, …

Factors Associated With Chronic Kidney Disease Progression In Australian Nephrology Practices, Neil Boudville, Anna Kemp, Henry Moody, Robert G. Fassett, Eugenie Pedagogos, Craig Nelson, Helen Healy, George Mangos, Geoff Kirkland, Troy Kay, Paul Champion De Crespigny, David Hoffman, David Waugh

Illawarra Health and Medical Research Institute

Background/Aims: Chronic kidney disease (CKD) is a major health issue worldwide. The aim of this study was to explore factors associated with CKD progression in Australian nephrology practices. Methods: This was a retrospective study utilising an electronic medical record (EMR), Audit4 (Software for Specialists, Australia). The baseline visit was defined as the first entry into the EMR. The primary outcome was the rate of change in estimated glomerular filtration rate (eGFR). Results: 1,328 patients were included with a mean eGFR at baseline of 37.4 ± 0.7 ml/min/1.73 m2, a mean follow-up of 17.7 months and a mean annual rate of …

Is Seladin-1 Really A Selective Alzheimer's Disease Indicator?, Laura J. Sharpe, Jenny Wong, Brett Garner, Glenda M. Halliday, Andrew J. Brown

Faculty of Science, Medicine and Health - Papers: part A

Selective Alzheimer's Disease Indicator-1 (Seladin-1) was originally identified by its down-regulation in the brains of Alzheimer's disease (AD) patients. Here, we re-examine existing data and present new gene expression data that refutes its role as a selective AD indicator. Furthermore, we caution against the use of the name “Seladin-1” and instead recommend adoption of the approved nomenclature, 3β-hydroxysterol Δ24-reductase (or DHCR24), which describes its catalytic function in cholesterol synthesis. Further work is required to determine what link, if any, exists between DHCR24 and AD.

Understanding And Benchmarking Health Service Achievement Of Policy Goals For Chronic Disease, Erica Bell, Bastian Seidel

Faculty of Science, Medicine and Health - Papers: part A

Background Key challenges in benchmarking health service achievement of policy goals in areas such as chronic disease are: 1) developing indicators and understanding how policy goals might work as indicators of service performance; 2) developing methods for economically collecting and reporting stakeholder perceptions; 3) combining and sharing data about the performance of organizations; 4) interpreting outcome measures; 5) obtaining actionable benchmarking information. This study aimed to explore how a new Boolean-based small-N method from the social sciences—Qualitative Comparative Analysis or QCA—could contribute to meeting these internationally shared challenges. Methods A ‘multi-value QCA’ (MVQCA) analysis was conducted of data from 24 …

Short And Long Sleep Duration Are Associated With Prevalent Cardiovascular Disease In Australian Adults, Christopher A. Magee, Len Kritharides, John Attia, Patrick Mcelduff, Emily Banks

Faculty of Health and Behavioural Sciences - Papers (Archive)

A growing number of studies from a range of different countries have observed an association between sleep duration and cardiovascular disease. The objective of this paper was to examine the associations between sleep duration and prevalent cardiovascular disease in a large sample of Australian adults, and identify the sociodemographic and health-related factors moderating these associations. Participants included 218 155 Australian adults aged 45 years and over. The results indicated that 6 h versus 7 h sleep was associated with increased odds of heart disease [odds ratio (OR) = 1.11 (1.06–1.17)], diabetes [OR = 1.15 (1.09–1.22)], stroke [OR = 1.25 (1.14–1.38)] …

Amyloid Beta Selectively Modulates Neuronal Trkb Alternative Transcript Expression With Implications For Alzheimer's Disease, J Wong, M Higgins, G Halliday, B Garner

Illawarra Health and Medical Research Institute

Dysregulation in brain-derived neurotrophic factor (BDNF)/full-length TrkB (TrkB-TK+) signaling is implicated in promoting neurodegeneration in Alzheimer's disease (AD). BDNF/TrkB-TK+ signaling can be modulated by the presence of truncated TrkB isoforms (TrkB-TK-, TrkB-Shc). All TrkB isoforms are encoded by different alternative transcripts. In this study, we assessed if expression of the three main TrkB alternative transcripts, TrkB-TK+, TrkB-TK-, and TrkB-Shc are altered in AD. Using a cohort of control and AD brains (n=29), we surveyed the hippocampus, temporal cortex, occipital cortex, and cerebellum and found specific increases in TrkB-Shc, a neuron-specific transcript, in the AD hippocampus. No significant changes were detected …

Srp20 Regulates Trkb Pre-Mrna Splicing To Generate Trkb-Shc Transcripts With Implications For Alzheimer's Disease, Jenny Wong, Brett Garner, Glenda M. Halliday, John B.J Kwok

Illawarra Health and Medical Research Institute

Previously, we reported elevated levels of the neuronspecific tropomyosin receptor kinase B (TrkB) transcript, TrkB- sarc homology containing (Shc) in the hippocampus of Alzheimer’s disease (AD) brains. In this study, we determined how TrkB-Shc transcripts are increased in AD. Utilizing a TrkB minigene transiently transfected into SHSY5Y cells, we found increased exon 19 inclusion in TrkB minigene transcripts (to generate TrkB-Shc) following cellular exposure to amyloid beta 1–42 (Ab42). As this suggested altered TrkB pre-mRNA splicing in AD, we conducted an in silico screening for putative splice regulatory protein-binding sites in the intron/exon splice regulatory regions of exons 18 and …

Guidelines For The Management Of Absolute Cardiovascular Disease Risk, Leonard F. Arnolda

Illawarra Health and Medical Research Institute

The National Vascular Disease Prevention Alliance (NVDPA) is an alliance of four leading and well-known Australian charities: Diabetes Australia, the National Heart Foundation of Australia, Kidney Health Australia and the National Stroke Foundation. In 2000, these four charities began to work together to reduce the burden of cardiovascular disease in Australia. Much of the work of the NVDPA to date has been to promote the use of an 'absolute risk' approach to predicting risk of cardiovascular disease. The NVDPA advocates to government and professional bodies for a health system that supports an absolute risk approach. The NVDPA aims to raise …

Disease Awareness Advertising: Women's Intentions Following Exposure, Danika Hall, Sandra C. Jones, Donald C. Iverson

Faculty of Health and Behavioural Sciences - Papers (Archive)

Background: In Australia, where direct to consumer advertising of prescription medicines is prohibited, pharmaceutical companies can sponsor disease awareness advertising targeting consumers. This study examined the impact of disease awareness advertising exposure on older women's reported behavioural intentions. Method: Women were approached in a shopping centre and randomly assigned mock advertisements for two health conditions. Disease information and sponsors were manipulated. Results: Two hundred and forty-one women responded to 466 advertisements. Almost half reported an intention to ask their doctor for a prescription or referral as a result of seeing the advertisement, but more reported they would talk to their …

Effects Of Dairy Products On Crohn's Disease Symptoms Are Influenced By Fat Content And Disease Location But Not Lactose Content Or Disease Activity Status In A New Zealand Population, Deborah Nolan, Linda C. Tapsell, Rong Hu, Dug Yeo Han, Lynnette Ferguson

Faculty of Health and Behavioural Sciences - Papers (Archive)

Background Dairy products have been perceived as having the potential to cause adverse effects in individuals with Crohn’s disease (CD) and are often avoided, potentially increasing the risk of osteoporosis and related morbidity associated with inadequate dietary calcium intake. Objective To evaluate the self-reported effects of dairy products on CD symptoms and to determine whether these effects differed between types of dairy products consumed and disease state or location. Design Secondary analysis of dietary survey and clinical data from participants in the Genes and Diet in Inflammatory Bowel Disease study based in Auckland, New Zealand. Subjects/setting One hundred and sixty-five …

Sound Assessment Of A Role For Fish Oil In Therapeutics Or Prevention Of Cardiovascular Disease Jeopardised By Confused Study Design, Peter L. Mclennan

Graduate School of Medicine - Papers (Archive)

The study by Galan and colleagues in the SU.FOL.OM3 collaborative group has added further confusion to the omega-3 story, which in this case largely derives from confusion in the study design. Confusion about the likely mechanism of cardiovascular protection and hence expected outcomes; confusion in the subject selection; confusion about the timing of intervention; confusion about the active components of fish oil.

Genetic Adult Lactase Persistence Is Associated With Risk Of Crohn's Disease In A New Zealand Population, Deborah Nolan, Dug Yeo Han, Wen Jiun Lam, Angharad R. Morgan, Alan G. Fraser, Linda C. Tapsell, Lynnette R. Ferguson

Faculty of Health and Behavioural Sciences - Papers (Archive)

Background Mycobacterium avium subspecies paratuberculosis (MAP) is an infective agent found in ruminants and milk products, which has been suggested to increase the risk of gastrointestinal inflammation in genetically susceptible hosts. It is hypothesized that lactase persistence facilitates exposure to such milk products increasing the likelihood of adverse outcomes. Individuals either homozygous or heterozygous for the T allele of DNA variant, rs4988235, located 14kb upstream from the LCT locus, are associated with having lactase persistence. The aim of this study was to determine whether lactase persistence as evident by the T allele of rs4988235 is associated with Crohn’s Disease (CD) …

Short Term Effects Of Energy Restriction And Dietary Fat Sub-Type On Weight Loss And Disease Risk Factors, Linda C. Tapsell, Marijka Batterham, Xu-Feng Huang, Sze Yen Tan, Grigorijs Teuss, Karen E. Charlton, Jane E. O'Shea, Eva M. Warensjo

Faculty of Health and Behavioural Sciences - Papers (Archive)

Background and aims: Decreasing energy intake relative to energy expenditure is the indisputable tenet of weight loss. In addition to caloric restriction modification of the type of dietary fat may provide further benefits. The aim of the present study was to examine the effect of energy restriction alone and with dietary fat modification on weight loss and adiposity, as well as on risk factors for obesity related disease. Methods and results: One-hundred and fifty overweight men and women were randomized into a 3 month controlled trial with four low fat (30% energy) dietary arms: (1) isocaloric (LF); (2) isocaloric with …

Defining The Host Mucosal And Gut Microflora Interactions In Crohn's Disease Using Redundancy Analysis On Microarray Datasets, Caroline A. Kerr, J Shaw, Christopher S. Mcsweeney, Seungha Kang, M J. Buckley, T Lockett, Peter Pavlik

Graduate School of Medicine - Papers (Archive)

Introduction: Crohn’s disease (CD) is an inflammatory bowel disease that is characterised by chronic relapsing inflammation of the digestive tract. There is a significant body of evidence that suggests the intestinal mucosal microbiome interacts with the immune response to produce pathological inflammation and together these factors play a major role in the pathogenesis of CD. The aim of this study is to investigate interactions between the human intestinal mucosal transcriptome and mucosal microbiome using multivariate redundancy analysis on microarray datasets.

Methods: DNA and RNA were extracted from the same mucosal biopsies collected from CD patients (terminal ileum: n=5 from sites …

Lipids And Alzheimer's Disease, Brett Garner

Faculty of Science, Medicine and Health - Papers: part A

According to the World Health Organisation (WHO), the number of people suffering from Alzheimer's disease (AD) worldwide is around 18 million. The prevalence of AD doubles every five years between 65 and 85 years of age and it is estimated that due to the ageing population, 34 million people will suffer from AD by 2025. The WHO has also stated that if AD onset were delayed by 5 years, the number of cases worldwide could be halved. Currently there are no curative or disease-stalling treatments for AD and a major research effort is underway in order to better understand the …

Uptake Of Medicare Chronic Disease Items In Australia By General Practice Nurses And Aboriginal Health Workers, Elizabeth J. Halcomb, Patricia M. Davidson, Nicola Brown

Faculty of Science, Medicine and Health - Papers: part A

The Australian health care system is currently in a state of reform and there is increasing pressure to provide care in community settings. Rising costs, demands and population ageing underscore the importance of adopting models of health care delivery to address changing epidemiological patterns. Population ageing and the increase of chronic conditions challenge models based on acute care. Changes to the Medicare benefits schedule have facilitated the development of a range of expanded nursing services in the general practice setting. In particular, item number 10997 was introduced to reimburse practice nurses and Aboriginal health workers (AHWs) for providing monitoring and …

Content Analysis Of Disease Awareness Advertisements In Popular Australian Women's Magazines, Danika V. Hall, Sandra C. Jones, Donald C. Iverson

Faculty of Health and Behavioural Sciences - Papers (Archive)

Objective: To examine the nature of disease awareness advertising (DAA). Design: Therapeutic advertisements in six popular Australian women’s magazines were monitored between April 2006 and March 2007. A subset of advertisements was included in the study based on criteria derived from a definition of DAA. Unique advertisements were analysed by four independent coders. Main outcome measures: Types of advertisements and their sponsors, the types of disease information present, and the persuasive techniques utilised. Results: Of 711 advertisements identified, 60 met the inclusion criteria for DAA, and 30 of these were unique. Over one-third of the advertisements were classified as “unbranded …