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Background Exposure to cold indoor temperature ( Methods The health effect of eradicating cold housing through reductions in CVD was simulated using proportional multistate lifetable model. The model sourced CVD burden and epidemiological data from Australian and Global Burden of Disease studies. The prevalence of cold housing in Australia was estimated from the Australian Housing Conditions Survey. The effect of cold indoor temperature on blood pressure (and in turn stroke and coronary heart disease) was estimated from published research. Results Eradication of exposure to indoor cold could achieve a gain of undiscounted one and a half weeks of additional health life per person alive in 2016 (base-year) in cold housing through CVD alone. This equates to 0.447 (uncertainty interval: 0.064, 1.34; 3% discount rate) HALYs per 1,000 persons over remainder of their lives through CVD reduction. Eight percent of the total health gains are achievable between 2016 and 2035. Although seemingly modest, the gains outperform currently recommended CVD interventions including persistent dietary advice for adults 5–9% 5 yr CVD risk (0.017 per 1000 people, UI: 0.01, 0.027) and persistent lifestyle program for adults 5–9% 5 yr CVD risk (0.024, UI: 0.01, 0.027). Conclusion Cardiovascular health gains alone achievable through eradication of cold housing are comparable with real-life lifestyle and dietary interventions. The potential health gains are even greater given cold housing eradication will also improve respiratory and mental health in addition to cardiovascular disease.

Cold homes are associated with a range of serious health conditions as well as excess winter mortality. Despite a comparatively mild climate cold homes are a significant problem in the UK, with a recent estimate finding that over one-quarter of low-income households had been unable to adequately heat their home in winter 2022. The magnitude of cold housing in a country that benefits from a mild climate indicates indifference towards, or acceptance of, a significant minority of people living in inadequate conditions on the part of policy makers. Cold homes are therefore a source of social harm. Recent changes to the household energy price cap, the rising cost of living, the ongoing effects of the benefit cap, and below inflation uprating to social security benefits is likely to greatly exacerbate this issue. In this research we use data from the UK Household Longitudinal Study to explore whether living in a cold home causes mental health harm. We control for mental distress and housing temperature on entry to the survey in order to account for the potentially bi-directional relationship. Multilevel discrete-time event history models show that the transition into living in a home that is not suitably warm is associated with nearly double the odds of experiencing severe mental distress for those who had no mental distress at the beginning of the survey; and over three times the odds of severe mental distress for those previously on the borderline of severe mental distress. These results show the significant costs of failing to ensure that people are able to live in homes in which they are able to live comfortably by even the most basic standards. These costs will be felt not just individually, but also more broadly in terms of increased health spending and reduced working.

BackgroundFragile X syndrome (FXS) is a common cause of intellectual disability and autism spectrum disorder (ASD) usually associated with a CGG expansion, termed full mutation (FM: CGG ≥ 200), increased DNA methylation of theFMR1promoter and silencing of the gene. Mosaicism for presence of cells with either methylated FM or smaller unmethylated pre-mutation (PM: CGG 55–199) alleles in the same individual have been associated with better cognitive functioning. This study compares age- and sex-matched FM-only and PM/FM mosaic individuals on intellectual functioning, ASD features and maladaptive behaviours.MethodsThis study comprised a large international cohort of 126 male and female participants with FXS (aged 1.15 to 43.17 years) separated into FM-only and PM/FM mosaic groups (90 males, 77.8% FM-only; 36 females, 77.8% FM-only). Intellectual functioning was assessed with age appropriate developmental or intelligence tests. The Autism Diagnostic Observation Schedule-2nd Edition was used to examine ASD features while the Aberrant Behavior Checklist-Community assessed maladaptive behaviours.ResultsComparing males and females (FM-only + PM/FM mosaic), males had poorer intellectual functioning on all domains (p< 0.0001). Although females had less ASD features and less parent-reported maladaptive behaviours, these differences were no longer significant after controlling for intellectual functioning. Participants with PM/FM mosaicism, regardless of sex, presented with better intellectual functioning and less maladaptive behaviours compared with their age- and sex-matched FM-only counterparts (p< 0.05). ASD features were similar between FM-only and PM/FM mosaics within each sex, after controlling for overall intellectual functioning.ConclusionsMales with FXS had significantly lower intellectual functioning than females with FXS. However, there were no significant differences in ASD features and maladaptive behaviours, after controlling for intellectual functioning, independent of the presence or absence of mosaicism. This suggests that interventions that primarily target cognitive abilities may in turn reduce the severity of maladaptive behaviours including ASD features in FXS.

Unaffordable housing has a negative impact on mental health; however, little is known about the causal pathways through which it transmits this effect. We examine the role of financial hardship and social support as mediators of this relationship. We identified households where housing costs changed from affordable to unaffordable across two waves of the Household, Income and Labour Dynamics in Australia (HILDA) Survey (2014–2015). The sequential causal mediation analysis was used to decompose the total effect of unaffordable housing on mental health into the portion attributable to financial hardship and social support [natural indirect effect (NIE)] and the portion not occurring through measured pathways [natural direct effect (NDE)]. Mental health was measured using the Mental Health Inventory (MHI) and Kessler psychological distress (KPD) scale. Baseline covariates included age, sex, household income, financial hardship, social support, marital status and employment status. Bootstrapping with 1000 replications was used to calculate 95% confidence intervals (CIs). Multiple imputations using chained equations were applied to account for missing data. Unaffordable housing led to a change in mean mental health score on the MHI scale (− 1.3, 95% CI: − 2.1, − 0.6) and KPDS scale (0.9, 95% CI: 0.4, 1.4). Financial hardship accounted for 54% of the total effect on MHI scale and 53% on KPD scale. Collectively, financial hardship and social support explained 68% of the total effect on MHI scale and 67% on KPD scale, respectively. In conclusion, the negative mental health effect of unaffordable housing is largely mediated through increased financial hardship.

This research examines residential satisfaction in a large Public Rental Housing (PRH) program in the developing municipality of Chongqing, a city located in western China. Twenty-three critical factors were identified through intensive literature review and incorporated into a large-sample survey of eight residential estates of PRH in Chongqing. The survey data were analysed using factor analysis, one sample T-test, stepwise multiple regression analysis, and ANOVA. The results showed generally, the residents neither expressed satisfaction nor dissatisfaction with their current housing situation in the estates sampled. Five domains of residential satisfaction were identified ranging from dwelling features, dwelling facilities, public facilities, neighbourhood environment to housing policy. Factors in the domain of dwelling features, dwelling facilities and housing policies were found to make positive contribution to the residential satisfaction, while negative contributions were made by the factors in the domains of public facilities and neighbourhood environment. Three key determinants of overall residential satisfaction were identified using multiple regression, namely public facilities, neighbourhood environment and housing policies. In addition, the results revealed that age, education, family income, residence length and housing type have significant impact on residential satisfaction with PRH programs. Consequently, related policy interventions could be introduced to improve the residential satisfaction in public rental housing.

Background Fragile X syndrome (FXS) is a common monogenic cause of intellectual disability with autism features. While it is caused by loss of the FMR1 product (FMRP), mosaicism for active and inactive FMR1 alleles, including alleles termed premutation (PM: 55–199 CGGs), is not uncommon. Importantly, both PM and active full mutation (FM: ≥ 200 CGGs) alleles often express elevated levels of mRNA that are thought to be toxic. This study determined if complete FMR1 mRNA silencing from FM alleles and/or levels of FMR1 mRNA (if present) in blood are associated with intellectual functioning and autism features in FXS. Methods The study cohort included 98 participants (70.4% male) with FXS (FM-only and PM/FM mosaic) aged 1–43 years. A control group of 14 females were used to establish control FMR1 mRNA reference range. Intellectual functioning and autism features were assessed using the Mullen Scales of Early Learning or an age-appropriate Wechsler Scale and the Autism Diagnostic Observation Schedule-2nd Edition (ADOS-2), respectively. FMR1 mRNA was analysed in venous blood collected at the time of assessments, using the real-time PCR relative standard curve method. Results Females with FXS had significantly higher levels of FMR1 mRNA (p

This paper describes who is most likely to experience household employment insecurity and housing affordability stress - double precarity - and estimates the degree to which housing affordability mediates the effect of employment insecurity on mental health. We use a cohort of 24,201 participants in 2016 Household, Income and Labour Dynamics in Australia survey (6.2 repeated measures on average). We estimate the likelihood of onset of household employment insecurity, housing affordability stress and change in housing costs using longitudinal regression analyses for socio-demographic groups. We assess mediation by estimating how much exposure variable coefficients attenuate with inclusion of a mediator in fixed effects regression models. We also apply causal mediation methods to fixed-effects regression models to better account for exposure-mediator interaction and meet strict model assumptions. If people's households become insecurely employed, there are five times greater odds of them also experiencing housing affordability stress (OR 4.99 95%CI 4.21-5.90). Key cohorts within the population are shown to be especially vulnerable to double precarity - notably single parents (OR 2.91, 95%CI 1.94-4.35) and people who live alone (OR 4.42, 95% CI 3.03-6.45) (compared to couples), and people who are recently separated or divorced (OR 2.59, 95%CI 1.81-3.70). Mediation analysis confirms that household employment insecurity has a small, negative effect on mental health (Beta -0.24, 95%CI -0.38-0.11 on a 1 to 100-point scale with 10-point standard deviation). Estimates from casual mediation analyses suggest housing affordability accounts for 20% of the total effect; likely concentrated in the lowest and highest strata of income. Employment and housing insecurity represent a form of double precarity for people in households with a single income. When we consider the impact on mental health, we find evidence of a causal relationship between insecure employment onset and mental health, around one fifth of which is mediated by changing housing cost and onset of affordability stress.

Increasing numbers of relatively affluent people are endeavoring to reduce everyday consumption and waste in response to environmental and social concerns. This paper explores five activist lifestyles and grassroots social movements that aim to reduce everyday consumption to uncover who, why, what and how households reduce consumption. Our understanding of everyday consumption captures the design of the house, the physical dwelling and the experience of day-to-day living. We seek to understand the lifestyle and identity characteristics, motivations, barriers, meanings and cultural beliefs that influence social norms towards less consumption. Our review reveals that most people begin from raised consciousness and concern about production and consumption practices. Evidence is building that shows, for many people, living a less consumptive, more collaborative, simple, frugal, downshifted life is beneficial to human health and well-being and highlights part of the success of these movements and lifestyles. Activist lifestyles should be promoted to a relatively affluent public as creative, meaningful, and satisfying and not as sacrifices to be made. This central finding offers a potentially useful behavioral lever to complement structural level sustainable urban transitions. Refereed/Peer-reviewed

BackgroundAngelman syndrome (AS) is a rare genetic condition characterised by global developmental delay, including severe to profound intellectual disability. The parents of persons with AS experience increased stress, anxiety and depression. This impacts parents’ career choices and productivity.AimsTo estimate, for the first time, the total productivity lost by the parents of persons with AS over a 10-year period in Australia and the corresponding cost to society.Methods and proceduresA cost-of-illness model with simulated follow-up over a 10-year period was developed, with 2019 as the baseline year, facilitated by a Markov chain of life tables. The prevalence of persons with AS and their parents, the productivity-adjusted life years (PALYs) lost by parents, and the cost to society were estimated. Key data were obtained from a prospective cohort of AS families, peer-reviewed literature, and publicly available sources.Outcomes and resultsThe base-case productivity burden borne by the estimated 330 living parents of the 428 prevalent-persons with AS totalled AUD$45.30 million, corresponding to a loss of 38.42% of PALYs per-parent.Conclusions and implicationsCaring for a child with AS has a significant impact on the productivity of affected parents, with a large associated impact on the broader Australian economy.What this paper adds?Persons with AS require lifelong care and support. Consequently, AS results in a significant socioeconomic impact, borne both by the healthcare system and affected families. This is the first known study to estimate the total impact of caring for a child with AS on parental productivity, as well as the first study known to estimate the PALYs lost by a parental or caregiver population. This study found that caring for a child with AS has a significant impact on the productivity of affected parents, with a large associated impact on the broader Australian economy. At present, the supports available to persons with AS and their families include sleep aids and behavioural therapy. In future, specific therapeutic treatments for AS may become available, with trials underway at present investigating the efficacy and effectiveness of gene therapies for AS. As such, evidence regarding the total socioeconomic impact, including the parental productivity burden, attributable to AS is needed to inform future funding decisions.

Each year the proportion of Australians who rent their home increases and, for the first time in generations, there are now as many renters as outright homeowners. Researchers and policy makers, however, know very little about housing conditions within Australia’s rental housing sector due to a lack of systematic, reliable data. In 2020, a collaboration of Australian universities commissioned a survey of tenant households to build a data infrastructure on the household and demographic characteristics, housing quality and conditions in the Australian rental sector. This data infrastructure was designed to be national (representative across all Australian States and Territories), and balanced across key population characteristics. The resultant Australian Rental Housing Conditions Dataset (ARHCD) is a publicly available data infrastructure for researchers and policy makers, providing a basis for national and international research.

Cold housing is not widely recognized as a problem that occurs in mild-climate countries like Australia. But emerging evidence suggests that it is an important, albeit under-acknowledged, problem that may contribute to high rates of ill health and mortality during the winter months. We bring together two historically important theoretical developments to better understand the social and economic distribution of cold housing. Drawing on nationally representative data from the Household, Income and Labour Dynamics in Australia survey between 2001 and 2016, we find that the characteristics of households unable to adequately heat their homes strongly reflects known patterns of inequality across, for example, tenure, employment and health, but that there are also more unexpected trends in age and income. Critically, our analyses demonstrate that individuals’ vulnerability to cold housing risk can be anticipated, which has important implications for public policy and community-based interventions. Refereed/Peer-reviewed

This paper presents a national analysis of urban housing pathways. Focussing on the social housing sector, we follow social housing tenants as they move into, out of, and remain in, the sector over 15 years. Utilising a linked actuarial dataset, the paper reveals a typology of pathways, and examines the relationship between housing pathways and the receipt of broader government welfare. We find that not only is there no one social housing pathway in Australia; at different times in a household’s housing career, social housing may be used by them as a momentary stepping-stone, a safety net, or a springboard. Refereed/Peer-reviewed

This Collection offers insights from twenty of Australia’s leader academics and thinkers into the survey results of 15,000 Australian rental households. The Collection draws on data from The Australian Rental Housing Conditions Dataset funded by the Australian Research Council in partnership with six Australian universities as well an additional AHURI funded COVID-19 module.

This research investigated the mental and economic wellbeing of landlords and tenants affected by the COVID-19 pandemic.

Chromosome 15 (C15) imprinting disorders including Prader–Willi (PWS), Angelman (AS) and chromosome 15 duplication (Dup15q) syndromes are severe neurodevelopmental disorders caused by abnormal expression of genes from the 15q11–q13 region, associated with abnormal DNA methylation and/or copy number changes. This study compared changes in mRNA levels of UBE3A and SNORD116 located within the 15q11–q13 region between these disorders and their subtypes and related these to the clinical phenotypes. The study cohort included 58 participants affected with a C15 imprinting disorder (PWS = 27, AS = 21, Dup15q = 10) and 20 typically developing controls. Semi-quantitative analysis of mRNA from peripheral blood mononuclear cells (PBMCs) was performed using reverse transcription droplet digital polymerase chain reaction (PCR) for UBE3A and SNORD116 normalised to a panel of internal control genes determined using the geNorm approach. Participants completed an intellectual/developmental functioning assessment and the Autism Diagnostic Observation Schedule-2nd Edition. The Dup15q group was the only condition with significantly increased UBE3A mRNA levels when compared to the control group (p SNORD116 mRNA levels compared to controls (AS: p p = 0.002). Both UBE3A and SNORD116 mRNA levels were positively correlated with all developmental functioning scores in the deletion AS group (p p UBE3A and SNORD116 in PBMCs and brain specific processes underlying motor and language impairments and autism features in these disorders.

We have not yet seen the full effect of COVID-19 and the subsequent economic crisis, but this early analysis of the COVID19 module of the Australian Rental Housing Conditions Dataset (ARHCD) suggests that the rental sector will be where many of the upcoming challenges for Australia overlap • The COVID-19 module captures a 'snapshot' of circumstances for Australian renters The initial findings, presented here, suggest a policy-important cohort of tenants in Australia are lined up on the brink of a financial precipice Many renters are currently buffered from the full economic effects of the pandemic by their savings, their superannuation, and rent deferment, as well as temporary government supports in the form of eviction moratoriums, JobKeeper and JobSeeker • The impacts of COVID-19 across the rental sector are, in many respects, still emerging, and this presents a real challenge for policymakers in developing targeted and effective assistance While policy responses may, in the short term, focus on protective mechanisms, such as eviction moratoriums, the systemic nature of the challenges faced by renters suggests that long-term recovery will be most effectively realised through system-wide policy shifts • Challenges for effective policy response include the need to provide targeted assistance quickly, to provide a framework of certainty that enables all stakeholders in the rental sector to plan for the future (e g tenants, landlords, housing providers, social services), and to anticipate what issues may evolve in an extended pandemic • Without control of COVID-19 and the associated health risks, there can be no recovery for the Australian economy Housing is at the frontline of interventions-and, as such, is a potential weakness in recovery © Australian Housing and Urban Research Institute Limited 2020

This research examined the incidence of energy hardship for Australian low income renters, and considered strategies and policy actions to reduce its impact on the lives of such households. Up to 40% of Australian households who rent their housing experience energy hardship. Energy hardship can include both absolute and relative measures of financial hardship, as well as circumstances where residents limit their energy use for normal daily activities.

Persons with a disability are at a far higher risk of homelessness than those without. The economic, social and health challenges faced by disabled people are addressed, in Australia, by the recently implemented National Disability Insurance Scheme (NDIS). Using nationally representative, longitudinal household panel data, we construct the Index of Relative Homelessness Risk (IRHR) to track how the risk of homelessness for disabled persons has changed since the introduction of the NDIS. We find that, overall, fewer persons with a disability face moderate risk of homelessness but that many more face high risk. We conclude that the NDIS has not effectively protected disabled people from the risk of homelessness. We reflect on the implications of these findings for policy interventions. Refereed/Peer-reviewed

Fragile X syndrome (FXS) is caused by a hypermethylated full mutation (FM) expansion with ≥ 200 CGG repeats, and a decrease in FMR1 mRNA and its protein. However, incomplete silencing from FM alleles has been associated with more severe autism features in FXS males. This study compared scores on the Aberrant Behavior Checklist-Community-FXS version (ABC-CFX) in 62 males affected with FXS (3 to 32 years) stratified based on presence or absence of mosaicism and/or FMR1 mRNA silencing. Associations between ABC-CFX subscales and FMR1 mRNA levels, assessed using real-time PCR relative standard curve method, were also examined. The FXS group mosaic for premutation (PM: 55–199 CGGs) and FM alleles had lower irritability (p = 0.014) and inappropriate speech (p FMR1 mRNA. The PM/FM mosaic group also showed lower inappropriate speech scores compared to the incomplete silencing (p = 0.002) group. Increased FMR1 mRNA levels were associated with greater irritability (p FMR1 mRNA levels may be warranted in future research and clinical trials utilising ABC-CFX subscales as outcome measures.

Background Neurological assessments are commonly performed by podiatrists as a screening tool for peripheral neuropathy, and to identify the risk of foot ulceration and amputation. Monofilament and tuning fork assessments are routinely used to assess peripheral sensation. Whilst these assessments are commonly used to monitor foot health, there is potential for neurological results to illuminate a broader and more holistic perspective of a person’s overall health status. Methods Recruitment of fifty participants (31 female, 19 male; 71.78±9.64 years) for foot health screening was associated with a foot health week promotional event at the Charles Sturt University Community Engagement and Wellness Centre. Under the guidance of registered podiatrists, fourth year podiatry students completed basic neurological assessments to determine each participant’s neurological status. Participants also completed a modified Foot Health Status Questionnaire (FHSQ). Age and monofilament results were analysed using Spearman’s rho, while correlations involving FHSQ data were identified using a Kruskal-Wallis test. Results For those participants who reported an excellent rating of their own health, there was a statistically significant relationship with adequate vibration sensation (pDiscussion Significant correlations were observed between basic neurological assessments and a number of activities of daily living. While the findings reflect a correlational relationship, not causational, this still provides an opportunity for clinicians to view neurological assessment results more holistically. Whilst the immediate focus for a practitioner will be tissue viability, neurological findings may be useful to stimulate further discussion about a patient’s functional capacity by exploring issues beyond the presenting condition.

Using a population-based longitudinal dataset in Australia over nearly 20 years, this study examines the impact of tenure instability on mental health and psychological distress among a low-income working-age population. The analysis compares private renters (who are notable for their relative tenure insecurity in the Australian context) and homeowners with similar sociodemographic characteristics. To enhance group comparability and address the presence of time-varying covariates that confound and mediate the relationship between tenure exposure and mental health, marginal structural models were used applying weights estimated cumulatively over time. The results show that while private rental tenants report worse mental health than homeowners initially (mental health difference: Beta = -5.29, 95%CI -7.61 to -2.97; psychological distress difference: Beta = 1.77, 95%CI 0.55 to 2.99), this difference diminishes to become statistically indistinguishable by 5-6 years of occupancy (mental health difference at year 6: Beta = -2.09, 95%CI -4.31 to 0.13, predicted mental health increases: from 65.06 to 69.83 for private renters and from 70.46 to 72.02 for homeowners; psychological distress difference at year 5: Beta = 0.81, 95%CI -0.09 to 1.71, predicted psychological distress decreases: from 19.85 to 18.04 for private renters and from 17.95 to 17.10 for homeowners). Residential stability is particularly beneficial for private renters in early middle adulthood (35-44 years), with each additional year of stable occupancy for private renters correlated with a 0.99 (95%CI 0.46 to 1.53) increase in mental health and a -0.47 (95%CI -0.69 to -0.24) decrease in psychological distress. The findings provide evidence that stable and secure rental tenure is protective of mental health, and the mental health of stable renters becomes comparable to that of homeowners over time. This adds support for housing policies that promote and improve the stability and security of rental tenure.

Access to adequate, safe, secure, accessible and affordable housing is a fundamental human right and one stipulated in the United Nations Conventions on the Rights of Persons with Disabilities. Australian adults with disabilities experience housing disadvantage including homelessness, poor-quality housing and housing unaffordability; however, we lack a comprehensive comparison of the housing circumstances of people with and without disabilities and differences by impairment type. We analysed data from a nationally representative sample of 11,394 working-aged Australians collected in 2011. We found that people with disabilities experienced disadvantage across all housing indicators, and people with intellectual and psychological disabilities fared worst. These findings suggest that there is a housing crisis for Australians with disabilities, which may intensify with the introduction of the National Disability Insurance Scheme. There is a need to develop long-term housing solutions that promote independence, are accessible and affordable, and that consider location and neighbourhood context. Refereed/Peer-reviewed

Both sleep problems and unemployment are common in adults with autism spectrum disorder; however, little research has explored this relationship in this population. This study aimed to explore factors that may be associated with the presence of an International Classification of Sleep Disorders–Third Edition defined sleep disorder in adults with autism spectrum disorder (IQ > 80). A total of 36 adults with autism spectrum disorder and 36 controls were included in the study. Participants completed a 14-day actigraphy assessment and questionnaire battery. Overall, 20 adults with autism spectrum disorder met the International Classification of Sleep Disorders–Third Edition criteria for insomnia and/or a circadian rhythm sleep-wake disorder, while only 4 controls met criteria for these disorders. Adults with autism spectrum disorder and an International Classification of Sleep Disorders–Third Edition sleep disorder had higher scores on the Pittsburgh Sleep Quality Index and were more likely to be unemployed compared to adults with autism spectrum disorder and no sleep disorder. The findings demonstrate, for the first time, that sleep problems are associated with unemployment in adults with autism spectrum disorder. Further research exploring the direction of this effect is required; sleep problems that have developed during adolescence make attainment of employment for those with autism spectrum disorder difficult, or unemployment results in less restrictions required for optimal and appropriate sleep timing.

Increased intragenic DNA methylation of the Fragile X Related Epigenetic Element 2 (FREE2) in blood has been correlated with lower intellectual functioning in females with fragile X syndrome (FXS). This study explored these relationships in a paediatric cohort of males with FXS using Buccal Epithelial Cells (BEC). BEC were collected from 25 males with FXS, aged 3 to 17 years and 19 age-matched male controls without FXS. Methylation of 9 CpG sites within the FREE2 region was examined using the EpiTYPER approach. Full Scale IQ (FSIQ) scores of males with FXS were corrected for floor effect using the Whitaker and Gordon (WG) extrapolation method. Compared to controls, children with FXS had significant higher methylation levels for all CpG sites examined (p −7), and within the FXS group, lower FSIQ (WG corrected) was associated with higher levels of DNA methylation, with the strongest relationship found for CpG sites within FMR1 intron 1 (p −5). Applying the WG method to the FXS cohort unmasked significant epi-genotype-phenotype relationships. These results extend previous evidence in blood to BEC and demonstrate FREE2 DNA methylation to be a sensitive epigenetic biomarker significantly associated with the variability in intellectual functioning in FXS.

This paper presents an alternative view on the patterning of housing problems – across populations and within people. The conceptualization of housing problems through a ‘housing niche’ lens allows the cumulative influence of multiple housing vulnerabilities to be better visualized and understood. Using a large, representative sample of the Australian population, the analysis describes and models patterns of multiple housing problems, the characteristics of the population at risk, and reflects on the implications for how policy might better understand and respond to multiple housing problems.

Low and high serum retinol levels are associated with increased fracture risk and poor bone health. We recently showed retinoic acid receptors (RARs) are negative regulators of osteoclastogenesis. Here we show RARs are also negative regulators of osteoblast and adipocyte differentiation. The pan-RAR agonist, all-trans retinoic acid (ATRA), directly inhibited differentiation and mineralisation of early osteoprogenitors and impaired the differentiation of more mature osteoblast populations. In contrast, the pan-RAR antagonist, IRX4310, accelerated differentiation of early osteoprogenitors. These effects predominantly occurred via RARγ and were further enhanced by an RARα agonist or antagonist, respectively. RAR agonists similarly impaired adipogenesis in osteogenic cultures. RAR agonist treatment resulted in significant upregulation of the Wnt antagonist, Sfrp4. This accompanied reduced nuclear and cytosolic β-catenin protein and reduced expression of the Wnt target gene Axin2, suggesting impaired Wnt/β-catenin signalling. To determine the effect of RAR inhibition in post-natal mice, IRX4310 was administered to male mice for 10 days and bones were assessed by µCT. No change to trabecular bone volume was observed, however, radial bone growth was impaired. These studies show RARs directly influence osteoblast and adipocyte formation from mesenchymal cells, and inhibition of RAR signalling in vivo impairs radial bone growth in post-natal mice.

This paper reports on the first phase of an ambitious program of research that seeks to both understand the risk of homelessness amongst persons with a disability in Australia and shed light on the impact of a significant policy reform&mdash, the introduction of the National Disability Insurance Scheme (NDIS)&mdash, in changing the level of homelessness risk. This first paper, reports on the level of homelessness risk for persons with a disability prior to the introduction of the NDIS, with a subsequent paper providing updated data and analysis for the period post the implementation of the NDIS. In one sense, this paper provides the &lsquo, base&rsquo, condition prior to the introduction of the NDIS but also serves a far broader role in advancing our understanding of how disability and chronic ill-health affects the risk of homelessness. Our research finds that in the period prior to the introduction of the NDIS, a large proportion of people with disabilities were at risk of homelessness, but those whose disabilities affected their schooling or employment were at the greatest risk.

At the core of housing and welfare research is a premise that stable residential environments are important to children&rsquo, s health and development. The relationship between housing stability and health outcomes for children is, however, complex, stable housing situations are sometimes associated with poorer health outcomes, and some children may be more or less resilient to residential instability. The Longitudinal Study of Australian Children (LSAC) dataset enables us to longitudinally follow the housing and health of more than 10,000 children and their families. We employ a quantile analysis technique, a currently underutilized tool for testing associations across the distribution of an outcome, to test whether exposure to housing instability has a differential impact on children&rsquo, s health dependent on their initial health status. Our findings suggest that the health outcomes of residential instability are highly dependent on children&rsquo, s initial health status.

Rationale: Raised serum C-Reactive Protein (CRP) 14 days after a COPD exacerbation predicts a second exacerbation, presumably due to persistent inflammation or bacterial infection. We examined if a further exacerbation could be prevented by re-treating incompletely resolved COPD exacerbations using Ciprofloxacin. Methods: This multi-centre randomized double-blind placebo-controlled study assessed retreatment with twice daily oral ciprofloxacin 500mg vs placebo for 7 days in patients whose symptoms and/or CRP had not normalised ( Results: Of 826 COPD patients screened at 4 centres, 144 eligible participants with incomplete recovery at day 12-16 post exacerbation were randomised to ciprofloxacin (n=72) or placebo (n=72). Patients had baseline mean age 69.0, 63.2% male, FEV1 49.5% predicted and CAT score 20.5. Median time to the next exacerbation was 32.5 days (IQR 13-50) in the placebo arm and 34 days (IQR 17-62) in the treatment arm. After pre-specified adjustments for previous exacerbations and site there were no significant differences between the groups (p=0.76) (fig 1). No significant differences were seen in CAT, SGRQ or lung function between treatment groups. Conclusion: In patients with incomplete recovery after a treated COPD exacerbation, an additional course of ciprofloxacin provided no additional benefit relative to placebo.

This study describes monozygotic (MZ) male twins with fragile X syndrome (FXS), mosaic for normal size (NS: &lt, 44 CGGs), premutation (PM: 55&ndash, 199 CGG) and full mutation (FM alleles &ge, 200) alleles, with autism. At 4 years of age chromosomal microarray confirmed monozygosity with both twins showing an XY sex complement. Normal size (30 CGG), PM (99 CGG) and FM (388&ndash, 1632 CGGs) alleles were detected in Twin 1 (T1) by standard polymerase chain reaction (PCR) and Southern blot testing, while only PM (99 CGG) and FM (672&ndash, 1025) alleles were identified in Twin 2 (T2). At ~5 years, T2 had greater intellectual impairments with a full scale IQ (FSIQ) of 55 and verbal IQ (VIQ) of 59, compared to FSIQ of 62 and VIQ of 78 for T1. This was consistent with the quantitative FMR1 methylation testing, revealing 10% higher methylation at 80% for T2, suggesting that less active unmethylated alleles were present in T2 as compared to T1. AmplideX methylation PCR also identified partial methylation, including an unmethylated NS allele in T2, undetected by standard testing. In conclusion, this report demonstrates significant differences in intellectual functioning between the MZ twins mosaic for NS, PM and FM alleles with partial FMR1 promoter methylation.

International evidence suggests that cold housing – and its effects on health – is not just confined to countries with very cold winters. Rather, a small but increasing body of work is revealing that unacceptably low indoor temperatures are often experienced in housing in mild-climate countries. This paper presents the findings from a field study of wintertime thermal comfort conditions in metropolitan Adelaide, Australia. Participants were selected from a large random sample of 4500 Australian households in the Australian Housing Conditions Dataset (AHCD). Nineteen households who self-identified in the dataset as unable to keep warm in their homes in cold weather were included in the study. Each household was interviewed to assess their heating practices and attitudes, invited to complete a daily comfort survey, and had the temperature and humidity in their homes recorded. On average, internal temperatures in the sample houses were well below recommended minimum temperature thresholds and respondents reported low satisfaction with their indoor thermal environment. The majority of households had no plans to make changes to their house to improve wintertime indoor conditions; rather, participants demonstrated a wide variety of warmth practices mainly directed toward achieving comfort conditions in close proximity to their body instead of throughout the entire room. The results from this small, exploratory study of wintertime housing conditions suggest that cold housing is a real and immediate problem for many households, despite Australia's relatively mild climates. Refereed/Peer-reviewed

This paper uses longitudinal data to examine the interrelationship between two central social determinants of mental health – employment security and housing affordability. Data from ten annual waves of the longitudinal Household, Income and Labour Dynamics in Australia (HILDA) survey (which commenced in 2000/1 and is ongoing) were analysed using fixed-effects longitudinal linear regression. Change in the SF-36 Mental Component Summary (MCS) score of working age individuals (25–64 years) (51,885 observations of 10,776 people), associated with changes in housing affordability was examined. Models were adjusted for income, age, survey year, experience of serious injury/illness and separation/divorce. We tested for an additive interaction between the security of a household's employment arrangements and housing affordability. People in insecurely employed households appear more vulnerable than people in securely employed households to negative mental health effects of housing becoming unaffordable. In adjusted models, people in insecurely employed households whose housing became unaffordable experienced a decline in mental health (B=−1.06, 95% CI −1.75 to −0.38) while people in securely employed households experienced no difference on average. To progress our understanding of the Social Determinants of Health this analysis provides evidence of the need to bridge the (largely artificial) separation of social determinants, and understand how they are related., Highlights • Two main sources of socio-economic inequality in neo-liberal economies are employment security and housing affordability. • We understand little of their joint impact on mental health. • We found that insecurely employed households experience negative mental health effects of unaffordable housing. • This negative impact was not observed for securely employed households. • Our findings support more targeted housing affordability interventions.

This study uses a novel spatial approach to compare population density change across cities and over time. It examines spatio-temporal change in Australia’s five most populated capital cities from 1981 to 2011, and documents the established and emerging patterns of population distribution. The settlement patterns of Australian cities have changed substantially in the last 30 years. From the doughnut cities of the 1980s, programs of consolidation, renewal and densification have changed and concentrated population in our cities. Australian cities in the 1980s were characterised by sparsely populated, low density centres with growth concentrated to the suburban fringes. ‘Smart Growth’ and the ‘New Urbanism’ movements in the 1990s advocated higher dwelling density living and the inner cities re-emerged, inner areas were redeveloped, and the population distribution shifted towards increased inner city population densities. Policies aimed at re-populating the inner city dominated and the resultant changes are now visible in Australia’s five most populated capital cities. While this pattern has been reported in a number of studies, questions remain regarding the extent of these changes and how to analyse and visualise them across urban space. This paper reports on a spatial method which addresses the limitations of changing statistical boundaries to identify the changing patterns in Australian cities over time and space. Refereed/Peer-reviewed

In this issue of the Journal, Reeves et al. (Am J Epidemiol. 2016;184(6):421-429) present the findings of a natural experiment analyzing the association between reduced housing affordability and mental ill health. Their difference-in-difference analysis of cross-sectional, quarterly population health surveys administered before and after implementation of a policy to reduce Housing Benefit payments in the United Kingdom in April 2011 represents an important way to assess the impact of a national housing policy shift on public health. It is a well-conducted study harnessing a natural experiment and adds to the weight of evidence supporting an association between housing costs and mental health. However, quantitative bias analysis based on the reported findings suggests that a small amount of differential (by unblinded Housing Benefit status) misclassification bias in the outcome may be enough to explain the observed association. Our analysis of possible misclassification bias in the outcome used in the study highlights the need for caution when a difference-in-difference estimate is small, the population is not blinded to its postintervention exposure status, and the outcome measure is subjective and prone to differential (by unblinded exposure or treatment status) misclassification.

Housing is a central component of productive, healthy, and meaningful lives, and a principle social determinant of health and well-being. Surprisingly, though, evidence on the ways that housing influences health in Australia is poorly developed. This stems largely from the fact that the majority of the population are accommodated in good quality housing. The dominance of a “good housing paradigm” means that households living in poor quality and unhealthy housing are doubly disadvantaged—by the quality of their housing and because policy makers in Australia do not acknowledge the health effects of housing. In this article, we examine the relationship between health outcomes and quality of housing. We base our analysis on data from the Household Income and Labour Dynamics in Australia (HILDA) survey, a panel dataset that is representative across Australia. We find a sizeable, policy-important, and to date under-acknowledged cohort of Australians whose health is influenced by poor-condition dwellings. Refereed/Peer-reviewed

People with autism spectrum disorder (ASD) commonly experience other comorbidities. Studies indicate that between 50% and 83% of individuals with ASD have sleep problems or disorders. The most commonly reported sleep problems are: (a) insomnia symptoms including the inability to get to sleep or stay asleep; and (b) circadian rhythm sleep-wake disorders, defined as a misalignment between the timing of endogenous circadian rhythms and the external environment. The circadian system provides timing information for the sleep-wake cycle that is regulated by the interaction of an endogenous processes (circadian - Process C, and homeostatic - Process S) and synchronizing agents (neurohormones and neurotransmitters), which produce somnogenic activity. A clinical priority in ASD is understanding the cause of these sleep problems in order to improve treatment outcomes. This review approaches sleep in autism from several perspectives: Sleep-wake mechanisms and problems, and brain areas and molecules controlling sleep (e.g., GABA and melatonin) and wake maintenance (e.g., serotonin, acetylcholine and glutamate). Specifically, this review examines how altered sleep structure could be related to neurobiological alterations or genetic mutations and the implications this may have for potential pharmacological treatments in individuals with ASD.

Fragile X syndrome (FXS) is a leading single-gene cause of intellectual disability (ID) with autism features. This study analysed diagnostic and prognostic utility of the Fragile X-Related Epigenetic Element 2 DNA methylation (FREE2m) assessed by Methylation Specific-Quantitative Melt Analysis and the EpiTYPER system, in retrospectively retrieved newborn blood spots (NBS) and newly created dried blood spots (DBS) from 65 children with FXS (~2&ndash, 17 years). A further 168 NBS from infants from the general population were used to establish control reference ranges, in both sexes. FREE2m analysis showed sensitivity and specificity approaching 100%. In FXS males, NBS FREE2m strongly correlated with intellectual functioning and autism features, however associations were not as strong for FXS females. Fragile X mental retardation 1 gene (FMR1) mRNA levels in blood were correlated with FREE2m in both NBS and DBS, for both sexes. In females, DNAm was significantly increased at birth with a decrease in childhood. The findings support the use of FREE2m analysis in newborns for screening, diagnostic and prognostic testing in FXS.

Unaffordable housing costs are one of the most pressing issues facing our cities, affecting people's health in difficult to measure ways. People's health varies over time and dynamically interacts with experiences of housing. Longitudinal analyses rarely explicitly model these variations. Quantile regression is an underutilised tool for testing associations across the distribution of an outcome. In this paper we apply panel quantile regression to test whether cumulative exposure to unaffordable housing over time has differential impact on mental health, dependent on initial health status. Using an annual longitudinal sample of 20,906 urban Australians (2001–2016), we model mental health outcomes using quantile regression (accounting for being in 10th, 50th, 90th mental health percentile initially). Although traditional fixed-effects models find weak evidence of cumulative effect, quantile regression reveals that individuals with low-median initial mental health were more affected by unaffordable housing, and individuals with high initial mental health appeared to be protected. Our findings suggest quantile regression as a promising method for understanding complex human effects of urban problems, and that policies targeted toward people with the poorest mental health may mitigate the consequences of exposure to unaffordable housing.

Children with developmental disabilities experience a high degree of sleep disturbance. Insomnia symptoms are the most commonly reported problems, though circadian rhythm sleep-wake disorders may also be common. There is significant overlap between insomnia symptoms and several symptoms associated with circadian rhythm sleep-wake disorders (CRSWDs), suggesting that such disorders should be considered. A small body of literature has demonstrated that children with developmental disorders can present with circadian rhythm sleep-wake disorders. In particular irregular and free-running rhythms are commonly reported. Supporting the presence of CRSWDs, melatonin abnormalities have also been reported. This chapter demonstrates that CRSWDs may be common in children with developmental disorders and intellectual impairment and that consideration should be given to such diagnoses as these can inform the most appropriate treatment for each individual.

This study aimed to investigate the relationship between sleep, psychopathology (anxiety, depression and presleep arousal) symptoms, and cortisol in adults with autism spectrum disorder (ASD). The sample composed of 29 adults with ASD (51.7% males) and 29 control adults (51.7% males) aged 21-44 years. Thirteen adults with ASD were medicated for a comorbid diagnosis of anxiety and/or depression (ASD-Med), while the remaining 16 adults with ASD were not medicated for such diagnoses (ASD-Only). Participants completed a questionnaire battery, 14-day sleep/wake diary and 14-day actigraphy assessment. On one day during the data collection period, participants collected five saliva samples, hourly, prior to sleep and two morning samples; immediately upon waking and 30 min thereafter for the analysis of cortisol. Cortisol 1 hr prior to habitual sleep onset time was associated with poorer sleep efficiency in both ASD groups and increased wake after sleep onset duration (ASD-Only). Higher subjective somatic arousal was also associated with increased sleep onset latency, regardless of group, and poorer sleep efficiency in the ASD-Only group. ASD-Only participants had significantly greater reductions in evening cortisol concentrations compared to both ASD-Med and control participants. No significant group differences were found for the cortisol awakening response. Findings suggest a hyperarousal hypothesis of insomnia in adults with ASD. Moreover, the low cortisol levels observed in ASD-Only adults suggest dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. Longitudinal studies exploring the interplay between insomnia, anxiety and HPA axis regulation across the lifespan in those with ASD are warranted. Autism Res 2019, 12: 897-910. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Both objective (cortisol) and subjective (somatic) physiological arousal were associated with poor sleep quality in adults on the autism spectrum. Adults with autism spectrum disorder (ASD) who were not medicated for a comorbid diagnosis of anxiety and/or depression also had dampened cortisol secretion, suggesting a dysregulation of the hypothalamic pituitary axis. Longitudinal studies investigating the relationship between sleep, psychopathology symptoms and physiological arousal in autistic individuals are warranted. Autism Res 2019. © 2019 International Society for Autism Research, Wiley Periodicals, Inc.

Context This study reviews collective evidence on the longitudinal impact of housing disadvantage (based on tenure, precarity, and physical characteristics) on mental health. It is focused on temporally ordered studies where exposures preceded outcomes, a key criterion to establishing causal evidence. Evidence acquisition A systematic review of evidence on housing disadvantage and mental health was performed. The literature search used six electronic databases including MEDLINE (PubMed and Ovid platform), Embase, PsycINFO, Web of Science, SciELO, and Sociological Abstracts. Population-based longitudinal studies where exposure to housing disadvantage (excluding exposure to homelessness) preceded mental health were included. Methodologic quality of selected studies was examined using the Newcastle–Ottawa Quality Assessment Scale. Because of definitional and methodologic heterogeneity among studies, narrative synthesis rather than meta-analysis was used to summarize research findings. Evidence synthesis Of the 1,804 unique titles identified in the literature search, 12 met the selection criteria for inclusion in the systematic review. Housing disadvantage was measured by overcrowding, mortgage delinquency, housing mobility, housing tenure, subjective perceptions of inadequate housing, eviction, and physical housing conditions. Mental health was measured as depression, psychological impairment, anxiety, allostatic load, mental strain, and psychological health. Study sample sizes ranged from 205 to 16,234 people, and the follow-up period ranged from within 1 year to 34 years. Each study indicated a positive association between housing disadvantage and mental health for at least one housing disadvantage measure and mental health outcome. Conclusions This systematic review confirms that prior exposure to housing disadvantage may impact mental health later in life.

Background Prader-Willi syndrome (PWS) and Angelman syndrome (AS) are neurodevelopmental disorders that are caused by abnormal expression of imprinted genes in the 15q11-13 region. Dysregulation of genes located in this region has been proposed as a susceptibility factor for autism spectrum disorder (ASD) in both disorders. Methods This study aimed to explore symptoms of ASD in 25 PWS and 19 AS individuals aged between 1 and 39 years via objective assessment. Participants completed the Autism Diagnostic Observation Schedule-2nd Edition (ADOS-2) and a developmentally or age-appropriate intellectual functioning assessment. All participants had their genetic diagnosis confirmed using DNA methylation analysis and microarray testing of copy number changes within the 15q11-13 region. Results Participants with PWS had significantly higher overall and social affect calibrated severity scores (CSS) on the ADOS-2 compared to AS participants (p = .0055 and .0015, respectively), but the two groups did not differ significantly on CSS for the repetitive and restricted behaviour domain. Conclusions PWS cases presented with greater symptoms associated with ASD compared to individuals with AS. Mental health issues associated with PWS may contribute to elevated symptoms of ASD, particularly in adolescents and adults with PWS. Electronic supplementary material The online version of this article (10.1186/s11689-018-9242-0) contains supplementary material, which is available to authorized users.