Identifying anxiety disorders in autistic youth can be challenging due to the unique presentation of anxiety symptoms in autistic youth and the difficulties youth may have reporting on their own anxiety symptoms. These challenges underscore the need for objective and reliable measures. Understanding whether autonomic activity is associated with the presence of anxiety may lead to its use as an objective anxiety assessment tool in individuals who may otherwise struggle to communicate their feelings of anxiety. Most published studies examining autonomic activity and anxiety in autistic individuals lack information regarding racial demographic information, and those that do are predominantly composed of White individuals. These findings highlight the critical need for future research that includes more diverse samples and uses consistent, ecologically valid methods to examine the relation between anxiety and autonomic activity in autistic populations. This study aims to recruit a large sample of racially diverse adolescents to evaluate whether atypical autonomic activity serves as a biomarker of anxiety in autistic and non-autistic youth. This manuscript outlines the recruitment strategies for this study protocol, providing a framework for understanding the interplay between physiological, psychological and contextual factors including self-identified race in anxiety among autistic and non-autistic adolescents.

Autistic (n=80) and non-autistic (n=80) adolescents aged 11–14 years and their caregivers will be invited to participate in the current study. Autism diagnosis will be confirmed by gold-standard assessments. All participants will complete an in-person visit assessing their child’s cognitive abilities and trait-level anxiety and mental health symptoms, learn how to wear a non-invasive heart rate band that will collect ECG and respiration data, complete a 5-minute in-lab baseline of autonomic activity and enroll in experience sampling. Next, participants will complete three 5-minute baselines of autonomic activity at home, followed by 5 days of wearing the heart rate band for 5 hours per day, overlapping with ecological momentary assessment of their mood. Primary outcome measures include trait-level parent and self-reports of anxiety, real-time self-reports of anxiety captured through ecological momentary assessment, and both baseline and in-the-moment heart rate variability.

The study protocol has been approved by the University of Maryland’s Institutional Review Board. Results will be disseminated through peer-reviewed publications and conferences. Deidentified data from participants who consent to have their data shared with other researchers will be uploaded to the National Data Archive Collection C5316.

To describe the available literature on the epidemiology and factors associated with osteoporosis, falls and fractures in four chronic inflammatory rheumatic diseases (CIRD): rheumatoid arthritis (RA); psoriatic arthritis (PsA); ankylosing spondylitis (AS); and systemic lupus erythematosus (SLE).

Scoping review, using the Joanna Briggs Institute framework.

MEDLINE, Embase and CINAHL from January 2000 to December 2023.

Observational studies reporting on the epidemiology and/or associated factors for osteoporosis, falls and fractures in RA, PsA, AS or SLE.

Two independent reviewers used a standard data extraction form including report methods, definitions, outcomes and associated factors. Results are summarised with descriptive statistics.

288 studies met inclusion criteria, with 170 studies on RA, 19 on PsA, 49 on AS and 60 on SLE. Most studies were cross-sectional, with Europe and Asia having the greatest output. Most papers reported on osteoporosis and fractures as outcomes, with only 27 reporting falls, of which 24 were in RA. Participants’ demographics and disease-related parameters were the most frequently explored potential associated factors.

RA was the most well-studied CIRD with regard to the epidemiology and associated factors for osteoporosis, fractures and falls. Cross-sectional was the most common study design, with a higher proportion of cohort studies in RA. There is a paucity of studies assessing falls in CIRDs other than RA. Future observational research should be conducted with large prospective CIRD cohorts, with falls as an outcome and associated factor for fractures. This may enable better understanding of the risk and consequences of osteoporosis, fractures and falls, which may improve preventive care.

Physical activity has important benefits for the prevention and management of chronic diseases and healthy ageing. Health professionals have valuable opportunities to promote physical activity to a large group of people across the lifespan. Promotion of Physical Activity by Health Professionals is a hybrid type 1 effectiveness-implementation cluster randomised trial designed to evaluate the impact of physical activity promotion by health professionals (n=30 clusters) on physical activity participation in their patients (n=720). To inform the future implementation of this programme, we will be conducting a within-trial and modelled economic evaluation.

We will conduct a cost-effectiveness and cost-utility analysis from the perspective of the healthcare, aged care and disability funder. The time horizon will be 6 months for the within-trial analysis and 2 years for the modelled analysis. Data on intervention costs will be collected using trial records. Data on healthcare utilisation will be collected using data linkage. Incremental cost-effectiveness ratios (ICERs) will be reported for physical activity and quality-adjusted life years outcomes. Bootstrapping will be used to explore uncertainty around the ICERs and estimate 95% CIs. Results will be presented on a cost-effectiveness plane. The probability that the intervention would be cost-effective at varying willingness-to-pay thresholds will be presented using a cost-effectiveness acceptability curve.

Ethics approval was obtained through Sydney Local Health District (RPAH zone) Ethics Review Committee (X23-0197). The findings of this study will be disseminated through peer-reviewed journal articles and conference presentations.

Australian New Zealand Clinical Trials Registry: ACTRN12623000920695.