Transepithelial corneal crosslinking (CXL) is a novel surgical approach for the treatment of keratoconus, which is a bilateral asymmetrical ophthalmological disease accompanied by progressive corneal ectasia. Silicon hydrogel (SiH) contact lenses have been extensively used in clinical ophthalmologic medicine, as a postoperative ophthalmological intervention. However, the ideal lens application duration after transepithelial CXL remains uncertain. Here, we aimed to investigate the effects and comfort of immediate corneal contact lens use after transepithelial CXL for keratoconus.In this prospective study, 60 patients with keratoconus who underwent transepithelial CXL treatment were enrolled from September 2021 to January 2023 with a male:female ratio of 39:21, and an average age of 25.42 ± 5.47 years. The patients were divided randomly into two groups: group A contained 30 patients wearing silicone hydrogel contact lenses for 7 days postoperatively, and group B contained 30 patients wearing the same contact lenses for 3 days.Ten subjective ophthalmologic symptoms were surveyed by the patients, including pain, photophobia, foreign body sensation, tearing, burning, blurred vision, dry eyes, difficulty opening the eyes, astringency, and stinging. Ophthalmologic signs, including corneal edema and conjunctival congestion, were recorded by a single clinician on postoperative days 1, 3, and 7.P = 0.04), where group B scored (0.01 ± 0.41) lesser than group A (0.12 ± 0.29), whilst corneal edema in both groups recorded significantly different on postoperative days 5 and 7 .Each surgical procedure was readily performed without complications, and both groups postoperative day 7 (Immediate use of silicone hydrogel corneal lenses after transepithelial CXL effectively alleviates postoperative ocular distress, particularly with a three-day use period as the ideal duration. Keratoconus is a bilateral asymmetrical ophthalmological disease accompanied by progressive corneal ectasia. The major clinical characteristics are substantial thinning and bulging of the cornea, as well as astigmatism to various extents, resulting in a rapid reduction in visual acuity.The prevalence and incidence rates are approximately 1:375, and are distributed globally , 3.Corneal crosslinking (CXL) is regarded as an effective clinical treatment for preventing disease progression . TransepAlthough the corneal epithelial layer is untouched during transepithelial CXL procedures, topical destruction caused by riboflavin infiltration and UV light exposure may lead to postoperative pain, photophobia, and foreign body sensation in patients . TherefoThe main component of the silicon hydrogel (SiH) corneal contact lens is silicone hydrogel, containing 38% hydrogen, a diameter of 14 mm, with base curve 8.8 mm, and corneal central thickness of 0.07 mm . CompareThe US Food and Drug Administration (FDA) has approved the overnight use or continuous wearing of contact lenses as part of the treatment of keratoconus . TherefoTherefore, in this study, we investigated the impact of contact lens application after transepithelial CXL to analyze whether the patient’s overall comfort is related to the duration of lens wearing and to further evaluate patient satisfaction based on the attained ophthalmologic evidence.Patients received transepithelial CXL between September 2021 and January 2023 and were selected from the Fudan University-affiliated Eye and ENT hospital. The inclusion criterion was clear diagnosis of spontaneous keratoconus, pediatric keratoconus, increase of maximum keratometry by at least 1 Diopter (D) or increase of pachymetry by at least 20 microns in a year,preoperative topography  results indication of the thinnest corneal thickness > 380 um, and age ranges between 18–35 years old. Carriers of systemic diseases, autoimmune diseases, or psychological diseases were excluded. The evaluation of lens comfort was conducted by an experienced ophthalmologist, observed via a slit-lamp, and postoperative corneal morphologies were recorded for each individual.P > 0.05) as indicated in Table In this prospective study, 60 participants (60 eyes) were recruited, with an average age of 25.42 ± 5.47 years. The male:female ratio was 39:2. The patients were divided into groups A and B based on the random number table method, and each group contained 30 patients. There were no significant differences between the two groups . In terms of postoperative medication use, each patient was provided with Clopito  and Flumei drops  after surgery, accompanied with a follow up period of 7 days.On the day after the operation, the researcher evaluated the lens condition of each patient using a slit-lamp microscope, including the central position of the lens, any horizontal or vertical lens displacement, degree of lens movement during natural blinking in the original ocular position and upward gaze position, and wettability of the lens. Patients in Group A underwent lens removal at postoperative day 7, whereas those in Group B underwent lens removal after 3 days.A standard self-administered questionnaire was adopted for both groups to record the postoperative comfort of the ocular area, which was administered on postoperative days 1, 3, 5, and 7. The questionnaire assessed 10 symptoms, including photophobia, tearing, burning, pain, foreign body sensation, blurred vision, difficulty opening the eyes, dry eyes, edema, and sting. Each feature was scored from 0–3, where a score of 0 was considered asymptomatic, and scores of 1, 2, and 3 were rated as mild, moderate, and severe, respectively. The participants received a tutorial regarding the questionnaire, and the completed questionnaires were collected on the day of the re-examination.The visual analogue scale (VAS) is used to assess the severity of postoperative ocular pain. The VAS for pain is composed of a 10 cm straight line, which is marked with 0 at one end and 10 at the other. A score of 0 represents “no pain,” score 1–3 represents “mild pain,” which does not affect sleeping; score 4–6 is defined as “moderate pain,” which affects night sleep; score 7–10 is regarded as “severe pain,” which severely affects sleeping . The parA single blinded test was applied for corneal edema assessment, where one senior ophthalmologist masked the allocation of the participant’s group while examining the ocular condition of each participant using slit-lamp microscopy. The resulting ocular status was recorded using a score range between 0–3. A higher score represents worse symptoms, where 0 implies a symptom-free cornea and 3 indicates the most edematous cornea. In addition, conjunctival congestion was examined by the same experienced doctor via slit-lamp using the same single blinding method and the ophthalmologic status was recorded. Scoring ranged 0–3, and the higher the score, the worse the conjunctival congestion.Corneal contact lens conditions were also recorded at each examination.P < 0.05 was considered statistically significant. Lens displacements from the center were analyzed using the mean standard deviation.The database was established in Excel using SPSS 20.0 statistical software. All the data were tested for homogeneity of variance and sphericity. Further, analysis of variance (ANOVA) and chi-square tests were used for comparison of preoperative basic condition in the two groups, and repeated measures analysis of variance (rANOVA) and one-way ANOVA were used for postoperative comparison between groups; All surgical procedures were performed smoothly without any complications. In total, 60 patients in groups A and B completed the entire period of lens wearing and observation.The center of the lens was well accommodated as it evenly covered the entire cornea. The degree of horizontal and vertical displacement of the lens center was within 1 mm, and the necessary mobility for lens in situ and upward gazing positions was sufficient, which were 0.61 ± 0.38 mm and 0.88 ± 0.12 mm, respectively. No accidental lens detachment occurred, and the wetness of the lens was ample.P < 0.001), whereas the grouping effect was not statistically significant (P = 0.50), as illustrated in Table The subjective signs for both groups were thoroughly examined with the corresponding time effect, indicating obvious statistical differences between the two groups P < 0.00, whereasThe total subjective symptom scores in the two groups demonstrated a downward trend with time, stipulating the highest score on postoperative day 1, followed by a significant reduction on postoperative day 3; only a few decreases were observed from postoperative days 3 to 5 and 5 to 7. The distinguishing symptoms that patients reported postoperatively were "foreign body sensation,” “dry eyes,” “pain,” and "photophobia.” In particular, 88.3% of participants complained of foreign body sensation, 72% had dry eyes, 61% had photophobia, and 42% patients with varying degrees of pain.P = 0.04), where the score of group B (0.01 ± 0.41) with lens removal after postoperative day 3 was distinctly lesser in pain than that of group A (0.12 ± 0.29) with lens removal after postoperative day 7. The corneal edema score for the two groups manifested a statistical difference on postoperative days 5 and 7 , where group B scored lower than group A.Further, at postoperative day 7, score of “pain” indicated an obvious statistical difference between two groups (P > 0.05) (Table P = 0.04), where patients in group B experienced less pain (0.01 ± 0.41) than did in group A (0.12 ± 0.29)  Table . Howeveroup A 0.1 ± 0.29 (P = 0.42) and "dry eyes" (P = 0.26), the time effects of the score of the remaining eight symptoms showed significant statistical difference (P < 0.05), and the tendency declined over time; the scores of all 10 symptoms had an obvious decrease at postoperative day 3. The postoperative "dry eye" symptoms lasted the longest, and the pain of varying degrees remained high, up to 62%, for both groups on postoperative day 7.In the overall evaluation of 10 subjective symptoms (rANOVA) between the two groups A and B, except for "sting" (P < 0.001), and its tendency decreased with time, whereas the grouping effect of ocular sign scores in the two groups was not statistically significant.The time effect of this study demonstrated a significant statistical difference between the scores of corneal edema and conjunctival hyperemia on postoperative days 1, 3, 5, and 7 , increased ocular surface disease index (OSDI), and impaired meibomian gland dysfunction , 26. FurThis study has several limitations. As the present study was based on the subjective sensations of the participants, each patient’s identity and profile, such as educational background or comprehension ability, could equally influence the results. Further investigations that incorporate more subjective parameters are required. Moreover, tolerance of the lens for these two groups was not examined prior to the intervention, which may have also affected the results of the study.In conclusion, 3 days is regarded as a desirable period for wearing corneal lenses in postoperative trans-epithelial CXL, showing satisfactory results in clinical observation, delivering better ocular sensation, and sufficient visual quality for patients with keratoconus.


Mental health literacy has implications for mental disorder recognition, help-seeking, and stigma reduction. Research on binge-eating disorder mental health literacy (BED MHL) is limited. To address this gap, our study examined BED MHL in a community sample.Two hundred and thirty-five participants completed an online survey. Participants read a vignette depicting a female character with BED then completed a questionnaire to assess five components of BED MHL .About half of participants correctly identified BED as the character’s main problem (58.7%). The most frequently selected cause of the problem was psychological factors (46.8%) and a majority indicated that the character should seek professional help (91.9%). When provided a list of possible interventions, participants endorsed psychologist the most (77.9%).Compared to previous studies, our findings suggest that current BED MHL among members of the public is better, but further improvements are needed. Initiatives to increase knowledge and awareness about the symptoms, causes, and treatments for BED may improve symptom recognition, help-seeking, and reduce stigma.The online version contains supplementary material available at 10.1186/s40337-023-00795-y. Ensuring that people have accurate knowledge about eating disorders is important to reduce stigma and improve access to treatment. We conducted a study to explore what people know about binge-eating disorder mental health literacy (BED MHL). Two hundred and thirty-five participants read a vignette about an adult woman with BED and then completed an online survey to assess their knowledge. Most participants correctly identified BED as the main problem and identified appropriate causes and treatments. Our results help clarify what people know and what they do not know about BED, which can inform programs that are designed to reduce stigma and improve access to care.The online version contains supplementary material available at 10.1186/s40337-023-00795-y. Mental health literacy (MHL) refers to public knowledge and understanding about mental disorders . StudiesBED is a serious eating disorder characterized by recurrent episodes of binge eating in the absence of extreme weight control behaviour such as purging . EpisodeN = 290 adolescents). In another study, Anderson and colleagues [N = 1666) were unable to correctly identify BED in a vignette and also viewed BED as less severe than bulimia nervosa. Further, McNicholas and colleagues [Research to date has provided preliminary evidence that the public have poor BED MHL. For example, O’Connor and colleagues  found thlleagues  found thlleagues  found thIn a study conducted with the general population, Mond and Hay  found thThe aim of our study was to assess current BED MHL using a vignette-survey design while addressing some limitations of previous studies. Namely, we based our vignette description of BED on DSM-5 diagnostic criteria while excluding extraneous information that could distract from BED recognition . Additionally, we updated previous MHL questionnaires to better assess domains of MHL relevant for BED including participants’ ability to identify the main problem, their knowledge about likely causes of the problem, their understanding of the need for treatment, their ability to identify helpful interventions, and their ability to anticipate a likely prognosis if treatment were received.Additionally, studies suggest that sociodemographic factors such as gender, age, level of education, and personal experience with an eating disorder may influence problem recognition and opinions about help-seeking for eating disorders , 22, 24.n = 3), spent less than seven seconds on the vignette screen (n = 4), or did not complete any MHL questions (n = 2). The final sample (N = 235) was 85.1% female with a mean age was 37.6 years (range: 18–75 years). Most participants identified as Caucasian (95.7%), followed by Indigenous (2.6%), and other (1.6%). Most completed some post-secondary education (87.5%), and 8.1% self-reported having a prior eating disorder diagnosis. Participants were invited to enter a draw for one of two $50 gift cards as a token of appreciation. This study was approved by the Memorial University Interdisciplinary Committee on Ethics in Human Research.Two-hundred and forty-four participants were recruited through advertisements posted on social networking sites  and in public locations throughout St. John’s, Canada. The advertisements indicated that participants would complete an online survey on “opinions about eating behaviours” and did not mention BED or MHL specifically. Participants accessed the survey via Qualtrics by clicking on a link or emailing a research assistant. Upon accessing the survey, participants were presented with a consent form, demographic questions, a vignette, a MHL questionnaire, and a feedback sheet. Participants were excluded if they were less than 18 years old . Following this, participants were asked if they currently or have previously had a problem similar to the character. Lastly, participants were informed that the character had BED and were then asked several direct questions . For each MHL question, participants were given several options to select from including, “Other (please specify)”, “Not sure”, “None of the above”, and “Not applicable (I do not think Jane has a problem)” to limit biased responding.The MHL questionnaire  to examine the relationship between personal experience with an eating disorder and opinions about help-seeking. A Bonferroni-corrected alpha level of 0.01 (0.05/5) was used for these analyses.When asked, “Please indicate which weight category you think Jane likely belongs to”, the vast majority of participants characterized Jane as either overweight or obese (90.1%) followed by the recommended weight range (7.8%), and the underweight weight range (2.2%).main problem?”, more than half of participants (58.7%) selected BED , followed by “Not sure” (26.8%) (see Table When asked “Do you think Jane has a problem?” most participants responded “Yes” (88.9%), followed by “Not sure” 10.2%), and “No” (0.9%). When asked, “How would you describe Jane’s problem?”, about half of the sample 49.5%) responded that Jane had a mental health problem . When asked, “Do you believe you might currently have a problem similar to Jane’s problem?”, nearly a third of participants reported that they believe they currently have a problem similar to Jane’s (32.9%).After being informed that Jane has BED, participants were asked, “Have you ever heard of binge-eating disorder?” and the vast majority of participants responded “Yes” (95.3%). When asked “Do you think binge-eating disorder is an official mental disorder?”, participants selected “Yes” most often (77.4%), followed by “Not sure” (20.4%), and “No” (2.1%). When asked, “How common do you think binge-eating disorder is in the general adult population?” 42.2% of participants indicated more than 15% of the population, 40% of participants indicated between 5 and 15% of the population, and 17.9% of participants indicated 5% or less of the population.χ²  = 2.781, p = .095, OR = 1.899. Additionally, females were approximately twice as likely as males to recommend that the character seek professional help , but this difference was also not significant, χ²  = 1.259, p = .2618, OR = 1.947. Regarding age, there was a significant moderate negative correlation between age and participants’ ability to correctly identify BED in the vignette, r = − .257, p < .01, indicating that younger participants were better able to recognize BED in the vignette than older participants. Regarding education, there was no significant correlation between level of education and participants’ belief that the character should seek professional help, r = .063, p = .340. Regarding personal experience, participants with personal experience were approximately nine times more likely to recommend that the character seek professional help compared to participants without personal experience , although this difference was not statistically significant, p = .051, OR = 9.330.Females were approximately twice as likely than males to correctly identify BED in the vignette , but this difference was not significant, This study assessed BED MHL among a self-selected sample of adults from the general population, primarily females. Overall, we found better BED MHL in our sample compared to previous studies. In terms of problem recognition, 58.7% of participants successfully identified BED as the most likely problem, which contrasts with lower problem recognition rates of 11.7% and 19.2% observed in prior studies , 24. TheRegarding perceived causes, 46.8% of participants selected “Psychological factors” as the primary cause of the character’s problem, suggesting that many understood that BED is related to mental well-being , 39. HowRegarding knowledge about help-seeking and interventions, most participants (91.9%) agreed that the vignette character should seek professional help. Additionally, most (70.6%) reported that if the vignette character did receive treatment, “She would have a full recovery, but problems might reoccur”. These findings are indicative of good MHL given that, while BED symptoms improve with treatment , relapseIn terms of demographic variables related to help-seeking knowledge, females were two times more likely than males to recommend that the character seek professional help and participants with personal experience were nine times more likely than those without personal experience. Despite these moderate to large effect sizes, these differences were not statistically significant, which could reflect a lack of statistical power given our sample of 235 participants. Research would benefit from an in-depth examination of the sociodemographic characteristics related to BED MHL in a larger sample.not seek help if they had a problem like the vignette character because they would not want anyone to know, and symptomatic participants were more likely to believe that someone with bulimia would face discrimination. In contrast, our finding on help-seeking suggests that most people view binge eating as a valid health problem warranting treatment. In fact, individuals with lived experience in our sample were nine times more likely to recommend help-seeking. Today, BED MHL initiatives should incorporate the voices of individuals with lived experience to encourage help-seeking and reduce stigma associated with this disorder.Given that our sample was largely female with a majority endorsing a similar problem at some point in their life, it is both surprising and encouraging that most participants agreed that the vignette character should seek help for her problem. In a vignette study by Mond and colleagues  on MHL fTo our knowledge, this is the first study to examine BED MHL since 2008 . A primaWhile our study provides a timely update to the existing BED MHL literature, there are some limitations. First, our sample consisted primarily of white, female participants. Future studies should recruit samples that are more diverse in gender and ethnicity/race, or participants that are underrepresented in this literature . Related to this, more than half of our sample (54.9%) reported having experienced a similar problem in the past, and one third (32.9%) reported currently having a similar problem. These percentages could reflect the fact that many people experience difficulties with overeating  or a tenOur study provides updated findings on public knowledge about BED. Understanding what people do not know about BED is essential for the development of effective MHL initiatives. BED MHL initiatives are necessary to improve problem recognition, help-seeking, and access to effective treatments , 4 as weAdditional file 1. MHL vignette and questionnaire.


An assay response factor, C, relates Δλ to Br– concentrationas a function of CsPbI3 concentration. The observed kinetics,as well as calculated rate constants, equilibrium, and activationenergy of the solvolysis reaction tested correspond closely to syntheticliterature values, validating the assay. Factors that influence thesensitivity and performance of the assay, such as CsPbI3 size, morphology, and concentration, are discussed.In this work, we demonstrate a photoluminescence-basedmethod tomonitor the kinetics of an organohalide reaction by way of detectingreleased bromide ions at cesium lead halide nanoparticles. Small aliquotsof the reaction are added to an assay with known concentrations ofCsPbI As ionization energies decrease from F– > Cl– > Br– > I–, the resulting highest occupied molecular orbital(HOMO) contributionto the valence band of CsPbX3 results in band gap energy(Eg) decreases, with, for example, a CsPbBr3 nanoparticle emitting at higher energies than CsPbI3.19 The precise emission wavelength isfurther a function of quantum confinement . A novel property of these materials is the rapidion exchange (IE) that can occur without altering the morphology orsize, with halide exchange (HE) in particular serving as a powerfulway to fine-tune PL emission and absorption postsynthesis.25 While IE is also observed in chalcogen quantum rods26 and quantum dots,27 the HE inCsPbX3 is more sensitive to the thermodynamics of the ternaryionic lattices,29 the kinetics of nonequilibrium conditions,30 more labile ligand capping,31 and especiallyhigh ion vacancy concentrations.34 The use of HE in PL-basedsensing has been explored for the detection of halomethanes,35 as well as detection of halides in oils36 and sweat.37 In addition,organohalides have served as halide precursors in CsPbX3 syntheses, including bromobenzene38 andbenzoyl halides.39All inorganic cesium lead halides , cesium carbonate , 1-octadecene, oleic acid , oleylamine , methanol, 1-butanol , methyl acetate ,potassium bromide , hydrobromic acid , and 2-bromo-2-methylbutane were purchased from Sigma Aldrich. Hexanes  andacetone  were manufactured by BDH. Dimethyl sulfoxide  and potassium hydroxide  were purchased from FisherScientific, and ethanol  was manufactured by Pharmco-AAPER.All chemicals were used without further purification.Lead(II) iodide ; then,0.5 mL of both neat OAm and neat OAc was injected into the solution.The reaction was allowed to mix until PbI2 was dissolved,yielding a faint yellow solution. The temperature (T) was then raised to 140 °C and allowed to equilibrate. Next,a premade solution of 0.125 M cesium oleate (Cs2CO3 dissolved in OAc and degassed) was heated to ∼80 °C,and then, a 0.4 mL aliquot was rapidly injected into the PbI2 solution. Upon injection, the solution turned dark red, indicatingthe nucleation and growth of OAm- and OAc-capped CsPbI3, and the reaction was quenched by removing the vessel from the heatingmantle and cooled carefully in a water bath. Upon cooling, multiple1 mL aliquots were removed, stored under Ar, and refrigerated. Beforeuse, these samples were first centrifuged at 5000 rpm and 1844g for 1 min to remove large aggregates. The Hx-rich supernatantwas transferred and concentrated to ∼0.2 mL using either arotavap or N2 stream before 1.5 mL of BuOH or MeAc41 was added in an Eppendorf tube. The tubes werethen vortexed before being centrifuged at 10,000 rpm (7378g) to fine pellets, dried under Ar, and resuspended in 1.0mL of Hx. The concentrations of the final stock solutions were determinedspectroscopically using an estimated extinction coefficient (ε)of 6.4 × 106 M–1 cm–1 at 425 nm.20The synthesisof the CsPbI3 and allowed to equilibrate for 3min before PL measurements. Here, we note that the CsPbI3 concentration was independently determined spectroscopically beforeeach aliquot was added to ensure consistency.Ina typical experiment, a 25 mL four-neck round-bottom flask with acondenser was loaded with 10 mL of BuOH and heated to the target temperature.Next, 12.8 μL of 2-bromo-2-methylbutane (S) was added, yieldinga 10 mM solution. During the reaction, a 100 μL aliquot wasremoved and immediately cooled. Next, 2.5 μL of this aliquotwas injected into an Eppendorf tube or cuvette containing a 700 μLHx solution of CsPbIOptical characterization was performedon a Cary 50 Bio UV–vis spectrophotometer , andphotoluminescence spectroscopy was performed on a Cary Eclipse fluorescencespectrophotometer . The excitation wavelength was 400nm. The powder X-ray diffraction (XRD) measurements were performedusing a D2 PHASER  with a Cu radiation source. Sampleswere prepared by drop-casting purified products on a zero-diffractionquartz holder or by addition of dried powders. Transmission electronmicroscopy (TEM) was performed on a JEM 1400  operatedat 120 kV using samples drop-cast onto carbon-coated Cu grids.3) used in thisstudy that were synthesized with oleylamine (OAm) and oleic acid (OAc)ligand capping and purified following reported methods.40 The first band edge absorption observed by UV–vis correspondsto the minimum edge length for CsPbI3 whose nanoform istypically platelets, which corresponds to a thickness of >5 nmforabsorption at ∼640 nm. The corresponding PL emission wavelengthwas centered at 663 nm (λ0). 3, revealing a cubic crystal structure and square-plate-likemorphology, with average edge lengths (l) of 8.5± 1.3 nm. Here, we note that CsPbI3 products purifiedwith methyl acetate (MeAc) were more stable in both PL quantum yield(QY) as well as stoichiometry and size.41 Nonetheless, CsPbI3 was stored in dry solvents undernitrogen and used soon after synthesis, as older samples showed evidenceof QY loss associated with CsPbI3 sintering and CsPb2I5 phases forming, as was revealed by TEM and shownin Figure S1. Such impurities are alsoindicated by the broad diffraction at ∼20°. The CsPbI3 concentrations in solution were estimated using UV–visabsorbance at 425 nm.33–), the CsPbI3 crystal structure undergoes halide exchange(HE) to formCsPbBrxI–x3 mixed halide crystals, which is driven in large part by highion vacancies at the crystal surface after synthesis and CsPbBr3 having more favorable Goldschmidt parameters.42 Moreover, as x increases, so too does the material’s band gap (Eg), and thus, a UV–vis and PL emission blueshiftto a new wavelength (λt) occurs.It is important to note that an opposite redshift occurs when CsPbBrxI–x3 isreacted with excess I– sources, although that isnot studied in this system.31 In this paper,we focus on monitoring the PL change, but it is important to notethat similar results can be achieved using UV–vis wavelengthchanges.When reacted with bromine ions .30 As shown in – concentration ([Br–]) causes a Δλof ∼90 nm, and this response was found to be proportional tothe total CsPbI3 concentration in solution ([CsPbI3]). –] for [CsPbI3] of ∼11 (i), 31 (ii), and 40 nM (iii).C) as a function of [CsPbI3], where C has units of nanometer shift per micromolar Br– (Δλ (nm)/[Br–] μΜ), asshown in 3] = 30 nM can expect aΔλ = 3.7 nm per μM of Br–, witha maximum Δλ of ∼120 nm . The C-value also indicates thatcare must be made to add sufficient [CsPbI3] as to notrapidly saturate the ion exchange response .In the assay studies below, [CsPbI3] was kept between 20and 40 nM, and the concentrations of the reactants in the reactionwere adjusted accordingly. Further, we repeatedly found a linear Δλtrend up to what we estimated to be an x of ∼0.8, at which point ion equilibrium between I– and Br– plays a more direct role. Finally, theHE was fast, and Figure S2 shows detailedPL spectra of the assay response over 200 s.To better combine thesethree parameters, – in solution, particularly Br– released during an organohalide reaction. Such an approach is illustratedin tert-amylbutylether (P), protons (H+), and Br–. This reaction is known to goto completion and have simple kinetics, making it a reasonable proofof concept. As the reaction occurs, 2.5 μL aliquots are sampledand then added to separate vials or cuvettes containing known [CsPbI3] and volume (700 μL), and the resulting Δλis an indicator of S consumption, thus a proxy for kinetics.It was hypothesizedthat HE could be used as a sensitive colorimetricassay of Brversus time, is shownin –] using C = 1.302 nm/μM Br– at [CsPbI3]= 46 nM. From this, a kinetic trace is generated by conversion to[S] by:–]t is the assay-determined concentrationand D is a dilution factor considering the aliquotand assay volumes. 3, indicating that PL changeswere the result of Br– release duringthe organic reaction and not direct HE, as shown in Figure S3. We also note that the charge pair for Br– is likely H+ from BuOH; however,it could also be a protonated oleylammonium (OAm+) ligandclosely associated with the CsPbI3 organic capping by thetime of HE.33T = 50 (i), 55 (ii), 60 (iii),65 (iv), and 70 °C (v). Here, we note that the assay HE reactionoccurred at room temperature, while aliquots were sampled from thehot reaction. The T-dependent kinetics as well asfinal concentrations or equilibrium can be observed. The equilibriumin particular shows a well-known phenomenon where the buildup of HBrpromotes acid-catalyzed ether cleavage and regenerates S (reversereaction), as has been reported for other tertiary ethers under anhydrousconditions.44 These results also act as remindersthat only a small portion of the reaction medium is removed for eachassay point. Aliquots from 65 (iv) and 75 °C (v) showed somevariability in λt, as shown in theerror bars from repeating the assay three times. We attribute thisvariability, especially at early sampling times, to the higher [Br–] in those aliquots and likely nonuniform pipette-basedmixing, resulting in varied CsPbBrxI–x3 compositions, leading to broadPL and sample-to-sample variability.To show the utility ofthis assay, reactions at different temperatureswere studied. N1 reaction like this solvolysis obeys a first-orderrate law with respect to [S] byk isthe apparent rate constant at T. The data in Table S1) from which k was calculated (Table S2).For reference, the predicted solvolysis rates based on literaturevalues for activation energy (Ea) of 103.3kJ/mol and a pre-exponential factor (A) of 6.626× 1018 are shown as dashed lines.45 At elevated T, the trends change due toacid-catalyzed tertiary ether cleavage, which is a bimolecular reactionwith second-order kinetics and is governed by a slow R3C–OH+–R rearrangement.46 Assuming that the rearrangement is the slowest step, thekinetic rate relationship can be approximated in the steady-statecondition as a pseudoreversible first-order reaction given as follows:k1 is the rate for solvolysis of S to formP and k2 is the rate for HBr-mediatedcleavage to regenerate [S]. Therefore, fitting the data in k1 = 884.7 × 10–6 s and k2 = 174.6 × 10–6 s (see Tables S1 and S2). At 70 °C, kfast = 923.1 × 10–6 s and kslow = 77.9 × 10–6 s,suggesting that the forward reaction becomes more competitive at 70°C. Fitting the region between 0 and 3600 s with a single exponentialand using k1 = 725.4 × 10–6 s and k2 = 162.22 × 10–6 s.48From these kinetic plots,the reaction rates were determined, whichfor an Sk values were used to calculate Ea forthe solvolysis reaction, as shown in the inset of Ea to be 96.3 ± 8.0 kJ/mol, a value that is closeto the NMR-determined one of 103.3 kJ/mol,49 further validating that the PL response of CsPbI3 servesas an accurate measurement of the reaction progress. Here, we notethat the lowest T point in the Arrhenius plot istaken from the literature.49 The discrepancy invalues is likely the result of the variability of the assay at thisearly point and potentially from an imprecise ε used to estimatethe CsPbI3 concentration.Finally, these extracted temperature-dependent 3 serves as a sensitive colorimetricway to detect Br– ions released during a chemicalreaction. While not the focus ofthis study, the sensitivity or detection limit of such an assay isexpected to be low considering that it is PL-based and that CsPbI3 and other CsPbX3  have highQY. Moreover, in this study, detection limits were not critical, asthe chemical reaction occurred at high concentrations. However, precisionand performance of the PL shift as well as peak broadening will beinfluenced by several morphological and stoichiometric factors. Inthe assay above, one size and morphology of CsPbI3 wereused, but response will be related to these factors since they dictatethe total amount of ions available for HE. In essence, larger sizes will require higher [Br–] to be exchanged with I– to significantly alterthe stoichiometry enough for a PL change. More studies are needed,but C for CsPbI3 at two volumes,revealing a lower slope for larger sizes indicating less sensitivity,and Figure S5 shows a calculation of therelationship between the CsPbI3 volume and its initialPL wavelength maximum. Lower concentrations of smaller CsPbI3 are predicted to have the most accurate and sensitive assay response.From an end-user perspective, the size and concentration of CsPbI3 are required, and combined with the reaction conditions , the appropriate amount of CsPbI3 required for optimum response can be determined. Finally,it is also worth considering CsPbI3 with more nanoplatelet-likemorphologies51 or nanoparticles that start frommixed halide concentrations that may provide more stability and shelflife.31 Ultimately, this new type of colorimetricassay for organic reactions could find utility at the benchtop, asa quantitative PL-based analogue to thin-layer chromatography (TLC)or, at industrial scales, as an in-line detector for flow chemistry.Taken together, these resultsindicate that HE at CsPbI3 nanoparticles were halide exchanged with Br– ionsforming CsPbBrxIx3–, and the resulting optical blueshifts were systematicallyquantified. The determination of the sensitivity factor (C) relates wavelength shift per micromolar quantities of Br– ions in solution, as a function of the starting CsPbI3 concentration. This then allowed for the colorimetric monitoringof an organohalide reaction where the Br– byproductswere detected in solution. The utility of this assay was then shownby the ease of which a solvolysis reaction kinetics could be monitoredby the PL wavelength change. Rate constants, equilibrium, and activationenergies of the external reaction were determined, resulting in valuesclose to those reported in the synthetic literature, and determinedby techniques like NMR. Future assays will explore how to incorporatePL intensity data into the assay, as well as monitor other halidesand organohalide reactions using different CsPbX3 compositionsand morphologies.In this study, well-characterized and quantifiedCsPbI


The 2019 novel coronavirus disease (COVID-19) outbreak affected people’s lifestyles and increased their risk for depressive and anxiety symptoms . We assessed depression and anxiety in residents of Macau during “the 6.18 COVID-19 outbreak” period and explored inter-connections of different symptoms from the perspective of network analysis.In this cross-sectional study, 1,008 Macau residents completed an online survey comprising the nine-item Patient Health Questionnaire (PHQ-9) and seven-item Generalized Anxiety Disorder Scale (GAD-7) to measure depression and anxiety, respectively. Central and bridge symptoms of the depression-anxiety network model were evaluated based on Expected Influence (EI) statistics, while a bootstrap procedure was used to test the stability and accuracy of the network model.Descriptive analyses indicated the prevalence of depression was 62.5% [95% confidence interval (CI) = 59.47–65.44%], the prevalence of anxiety was 50.2% [95%CI = 47.12–53.28%], and 45.1% [95%CI = 42.09–48.22%] of participants experienced comorbid depression and anxiety. “Nervousness-Uncontrollable worry” (GADC) (EI = 1.15), “Irritability” (GAD6) (EI = 1.03), and “Excessive worry” (GAD3) (EI = 1.02) were the most central symptoms, while “Irritability” (GAD6) (bridge EI = 0.43), “restlessness” (GAD5) (bridge EI = 0.35), and “Sad Mood” (PHQ2) (bridge EI = 0.30) were key bridge symptoms that emerged in the network model.Nearly half of residents in Macau experienced comorbid depression and anxiety during the 6.18 COVID-19 outbreak. Central and bridge symptoms identified in this network analysis are plausible, specific targets for treatment and prevention of comorbid depression and anxiety related to this outbreak. AccordiSince late 2019, Macau has been hit by six waves of COVID-19; consequently, the economy has not yet recovered to its pre-pandemic levels , and manHistorically, cutoff values based on total scores from standard questionnaires have been used to screen for depression and anxiety in epidemiological research . AlthougSeveral network analysis studies have examined psychiatric symptoms and interactions among Macau residents during the COVID-19 pandemic. For example, in a network model of depression alone, the most important nodes were fatigue, motor impairments, and guilt . In rese2.2.1.via the smartphone-based application, “Questionnaire Star”.This study was conducted between July 26, 2022, and September 9, 2022, using a convenience sampling method immediately after the “the 6.18 COVID-19 outbreak” which lasted from 18 June to 1 Aug 2022 in Macau , 28. A q2.2.The following socio-demographic data were collected: age, gender, marital status, living situation, level of education, and employment situation. In addition, pandemic-relevant information was recorded, including personal economic loss caused during the COVID-19 pandemic, worry about COVID-19 infection, and experiences of being quarantined during the COVID-19 pandemic.The validated Chinese version of the nine-item Patient Health Questionnaire (PHQ-9) , 30, was2.3.2.3.1.Frequency analyses and sample mean calculations were performed to describe the nature of the study sample.2.3.2.goldbricker function to identify redundant nodes in the depression and anxiety network model for Macau residents. Following a previous study  so a transformation program was applied to normalize data before conducting the GGM network analysis , though continuous variables should have a normal multivariate distribution with this approach , 37. Theanalysis . In the analysis . Howeveranalysis . LASSO canalysis .2.3.4.After obtaining the optimal network, the Fruchterman-Reingold algorithm was used to identify the layout of nodes . We used2.3.5.case-dropping subset bootstrap” procedure was used  met all study entry criteria and completed the assessment (participation rate = 98.8%). Conversely, the other 12 residents either refused the invitation or did not complete the assessment. The average age of participants was 34.85 years [standard deviation (SD) = 11.5 years]. A majority of participants had a college or higher education (82.4%), and lived with others (92.8%), while less than half were married (46.7%). Regarding COVID-19-related queries, most participants reported feeling worried about being infected (60.7%), and around two-thirds acknowledged financial losses during the pandemic (63.2%) . The pre3.2.The goldbricker function analysis identified two pairs of redundant nodes: “Sleep” (PHQ3)—“Appetite” (PHQ5), and “Nervousness” (GAD1)—“Uncontrollable worry” (GAD2), both of which had 14.28% of correlations significantly different from all other nodes in the network. The two depressive symptoms were combined as a new symptom “Sleep-Appetite” (PHQC), while the two anxiety symptoms were combined as a “Nervousness-Uncontrollable worry” (GADC) node. There were 14 nodes in the final network model, including eight depression nodes and six anxiety nodes see .For edges, the left panel of 3.3.In terms of nodes, the right panel of 3.4.4.This study found that the prevalence of depression and anxiety comorbidity was high among Macau residents during “the 6.18 COVID-19 outbreak.” In the comorbidity network model, the most central symptoms were from the anxiety community and underscored how anxiety may have a critical role in activating the co-occurrence of depression and anxiety in the context of a local COVID-19 outbreak. However, this finding is also consistent with previous findings from a depression and anxiety comorbidity evolution study in which anxiety symptoms emerged earlier than depression . In addiThis study provided novel data related to depression and anxiety comorbidity in the context of pandemics, as both (i) “sleep” and “appetite,” and (ii) “nervousness” and “uncontrollable worry” were highly correlated symptom dyads. Comorbid depression and anxiety is common , 56, andOur analyses showed that “sleep” and “appetite” reflected similar response tendencies in Macau residents  in the cIdentifying the most influential nodes in a network model is important for generating empirically grounded hypotheses regarding symptoms that are critical to the occurrence and development of comorbid disorders/syndromes . In this“Irritability” (GAD6) was also among the most important central symptoms and bridge symptoms in the network model; this finding implies that reducing irritability should be useful in reducing anxiety as well as the co-occurrence of depression and anxiety in the context of ongoing community emergency situations. Irritability reflects heightened arousal that often arises from blocked goal attainment and is a typical feature of anger . During Finally, “Restlessness” (GAD5) and “Sad mood” (PHQ2) emerged as key bridge symptoms in this study in line with recent findings from another depression-anxiety network analysis . Deactivvia validated questionnaires. Consequently, diagnoses of depression and anxiety disorders could not be made. Third, responses biases related to recall and/or social desirability could not be ruled out as influences due to the reliance on self-report measures of experience. Fourth, various factors associated with depressive and anxiety symptoms, including social support and stressful life events, were not assessed in an effort to maintain reasonable response burdens on unpaid volunteers. Finally, for logistical reasons, convenience sampling rather than random sampling was used, so representativeness of the study sample may have been reduced. On a related note, majorities of participants were women and young adults (mean age = 33.85), so findings may not generalize well to all age groups or across gender.Despite its potential implications, the main limitations of this study should be mentioned. First, this was a cross-sectional study so causal directions between symptoms could not be determined. Prospective studies and randomized control trials targetting comorbidity may help to clarify causal directions in future studies. Second, due to restrictions and human resource demands related to the outbreak, in-person structured clinical interviews could not be conducted and depressive and anxiety symptoms were measured In conclusion, we found that anxiety and depression comorbidity was common among Macau residents during the 6.18 COVID-19 outbreak. “Nervousness-Uncontrollable worry” (GADC), “Irritability” (GAD6), and “Excessive worry” (GAD3) were the most central symptoms, while “Irritability” (GAD6), “restlessness” (GAD5), and “Sad Mood” (PHQ2) were the most important bridge symptoms in the depression-anxiety network model, suggesting that these symptoms would be useful targets for intervention within this context. For example, cognitive behavioral therapy that targets these symptoms based on behavioral activation and cognitive restructuring could be helpful for those who experience comorbid depression and anxiety during pandemic outbreaks.xyutly@gmail.com.The datasets presented in this article are not readily available because the University of Macau Institutional Review Board (IRB) that approved the study prohibits the authors from making publicly available the research dataset of clinical studies. Requests to access the datasets should be directed to The studies involving human participants were reviewed and approved by University of Macau Institutional Review Board (IRB). The patients/participants provided their written informed consent to participate in this study.YF, SS, and Y-TX: study design. PC, TS, ML, K-IL, IC, ZS, and TC: data collection, analysis, and interpretation. H-LS, Y-LT, and Y-TX: drafting of the manuscript. TJ: critical revision of the manuscript. All authors contributed to the article and approved the submitted version.This study was supported by the National Science and Technology Major Project for investigational new drug (2018ZX09201-014), the Beijing Hospitals Authority Clinical Medicine Development of special funding support (XMLX202128), and the University of Macau .The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.The handling editor YZ declared a shared affiliation with the authors YF and SS at the time of review.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Empowerment is an internationally recognised concept commonly incorporated in First Nations and in this instance Aboriginal and Torres Strait Islander health and wellbeing programs. The Family Wellbeing Program is an empowerment program developed in partnership with Aboriginal and Torres Strait Islander peoples that has been widely delivered to Aboriginal and Torres Strait Islander communities across Australia for close to 30 years. To date, there has been limited quantitative analysis of how this program is linked to health and empowerment outcomes.n = 9,843) recruited using multi-mode random sampling including mail out survey and in community convenience sampling. Logistic regression models were performed to calculate Prevalence Ratios (PRs) and 95% Confidence Intervals (CIs) to examine the association between personal control, life satisfaction, general health, family wellbeing and cultural wellbeing outcomes for Family Wellbeing participants (n = 718) versus non-participants .Cross sectional analysis of Mayi Kuwayu, the National Study of Aboriginal and Torres Strait Islander Wellbeing, baseline data , be aged 35–54 (41.8% versus 32.0%) and live in a remote area (17.7% versus 10.4%) and have educational attainment at the Year 12 level or above (57.8% versus 53.2%). Family Wellbeing participation was associated with a 13% higher reporting of family functioning, a 74% higher reporting of cultural participation and a 21% in higher reporting of local decision making in the local community compared to non-FWB participants. There were significant associations between FWB exposure compared to non-FWB exposure including reporting lower levels of health risk factors including quitting alcohol (26.4% versus 20.4%), regular exercise (67.7% versus 66.3%), quitting smoking (33.4% versus 31.9%). and e. FWB participants who had experienced both prison and youth detention were nearly double that of Non-FWB (3.5% versus 1.4%) and more reported being removed from their families as children (Stolen) (7.0% versus 4.1% Non-FWB).There are significant associations between Family Wellbeing exposure and organisation and community level empowerment outcomes, but only for some individual level empowerment outcomes. There is a lower reporting health risk factors including increased physical exercise, reduced alcohol use and smoking; and educational attainment among FWB participants compared to non-FWB participants. The results suggest individual, community and organisational empowerment needs to be explored further with more robust study designs that can attribute causality and direction of association.The online version contains supplementary material available at 10.1186/s12889-023-16450-9. Empowerment theory has become a common concept in public health since the World Health Organisations’ 1986 Ottawa Charter recognised ‘the process of enabling people to increase control over, and to improve, their health’ as vital to creating global health equity , 3. ObseEmpowerment is complimentary to Self-determination which comes from an international rights framework  and is commonly advocated for by Indigenous communities worldwide. Self-determination is a long standing legal and policy concept advocated by Aboriginal and Torres Strait Islander peoples since the early 1970’s and is a dynamic right to make decisions and to control their implementation. While there are differences, empowerment can be thought of in this instance as the processes of realising self-determination.Wallerstein’s work on empowerment as a health enhancing strategy asserts that understanding the role of social protective factors is key to developing effective theory of change models that can reduce ill health brought about by social inequity . This apCommunity empowerment theorists pointed out that consideration must be made to variations in protective factors by population, geography and time , 7. TheyThe Family Wellbeing program (FWB) was developed in 1993, conceived in consultation with a group of survivors of the stolen generations. The stolen generation were and are Aboriginal people forcibly removed from their families and were required by the state to undertake domestic or agricultural labour training, then be in the employ of non-Indigenous families from the early 1900’s through to the end of the 17,970’s. The Family Wellbeing program it is a group learning program that focuses on five stages of personal, family and community empowerment. Initiated as an employment and training program it has been adapted and delivered for a range of community identified needs and audiences; including suicide prevention, family violence, inmate education and parenting support . CommonlThe FWB has been delivered in 60 known sites across Australia with more than 5,400 participants , 14.Existing studies and evaluations of the FWB have analysed the applicability of empowerment used in the program to Aboriginal and Torres Strait Islander contexts –17, the This analysis examined the relationship between exposure to the FWB on health, wellbeing, cultural and empowerment outcomes.Mayi Kuwayu: The National Study of Aboriginal and Torres Strait Islander Wellbeing (the Mayi Kuwayu Study) is a longitudinal study that has been designed to quantify the links between social and cultural determinants, such as cultural expression, community decision making and family connection, to health and wellbeing , 9. It iN = 9,843), and includes all responses received between 2018-December 2020. FWB participants are identified by a question asking ‘Have you ever participated in: the Family Wellbeing Program?’, non-FWB were any survey participant who did not select the “Family Wellbeing Program” option. No information was collected on the date of participation in the program.This cross-sectional analysis is conducted using the third release (R.3) of the Mayi Kuwayu baseline data . The research was conducted with ethics approvals from relevant Aboriginal and Torres Strait Islander organisations, and from national, state and territory Human Research Ethics Committees (HRECs).‘Have you ever participated in: Family Wellbeing Program’.Family Wellbeing participants are identified through Mayi Kuwayu question. Outcome variables used in the study were selected based on analysis of the literature, including previous evaluations of the program , 17, 23 Personal empowerment was measured with responses to the question, “how much are you in control of your life?”’, with response options “A lot”, “A fair bit”, “A little bit” and “Not at all”. These were then dichotomised as a (0) not at all and (1) little—a lot. Life satisfaction was measured according to responses to the question, “How satisfied are you with your life?”, with response options “a lot”, “a fair bit”, “a little bit” and “not at all”. These were then categorized as a (0) not at all and (1) little to a lot. General health was measured according to the question “How would you rate your general health?”; response options were “poor”, “fair”, “good”, “very good” or “excellent”. Responses were categorised as (0) poor-fair and (1) good–excellent.Family functioning was measured according to a composite score of responses to a set of nine questions asking “In my family…”, “We get together and cope in the hard times”, “we celebrate special days/ events”, “we talk with each other about the things that matter”, “we are always there for each other”, “we manage money well”, “we have common interests”, “people are accepted for who they are”, “we have good support from mob”, “we have family knowledge and traditions that we pass on to our children”. With response options “not at all” (1), “a little bit” (2), “a fair bit” (3) to “a lot” (4), and “unsure” (0). Responses were summed (range: 0–36), and participants were categorized as having (0) low- moderate family functionality (score 0–29) or (1) high family functionality (score 30–36). Responses to the nine questions were summed for participants with complete data only; participants missing responses to any of the questions were coded as missing. All outcome measures above were coded as binary for use in the regression analysis.For organisational empowerment a composite score of the cultural knowledge and practice subset was created, that includes questions relating to contribution to community and participation in community-based events. The score was made up of responses to ten questions, summed together to generate a total cultural wellbeing score ranging from zero to 40. The questions asked “How much time do you spend…” 1. “With someone who has cultural knowledge (elder or knowledge holder)?” 2. “Learning and using knowledge from Aboriginal/Torres Strait Islander Law (or Lore)?” 3. “On country?” 4. “Getting or eating bush tucker ?” 5. “Learning culture, kinship and respect?” 6. “Making art, music or painting?” 7. “Passing on cultural knowledge?” 8. “Participating in social events related to Aboriginal/Torres Strait Islander people ?” 9. “Contributing to your community ?” 10. “Receiving Aboriginal/Torres Strait Islander healing methods ?”. With response options "Not at all" (1), "A little bit" (2), "A fair bit" (3) and "A lot" (4). Responses for the 10 questions were summed together to generate a total cultural wellbeing score ranging from zero to 40; participants missing any data had their score coded as missing. A binary category was created of (0) low cultural wellbeing  and (1) high cultural wellbeing (scores between 15 and 40).Decision making was measured by the question “in the Aboriginal and/ or Torres Strait Islander community where I live now local Aboriginal and Torres Strait Islander people make community decisions” with response options “Not at all”, “A little bit”, “A fair bit”, “A lot” and “Unsure”. Responses were coded and categorised to (0) not at all  and (1) A little – a lot; unsure was coded as missing.The presence of a drug and/ or alcohol problem was measured by response to the question that asked, “has a doctor ever told you that you have…drug or alcohol problem” with responses “no” and “yes”. Participants were also asked “do you drink alcohol?” with responses categorised as “current drinker”, “ex-drinker” and “never drinker”. Current smoker was measured with response to question “Do you smoke?”, with response categories created for “current smoker”, ex-smoker” and “never smoker”. Current smokers were also asked “do you want to quit smoking?” with five response options that were categorised as “not at all or unsure” and “a little to a lot”. For exercise in the past week where participants were asked to select the days that they did 30 or more minutes of exercise (Monday – Sunday) the responses (1 for each day selected) were summed into three categories “none”, “1–2 days” and “3 or more”.Eight demographic variables were used in the study including gender, age, location, and education. Following consultation with FWB providers we added measures for incarceration, low income, being removed as a child Stolen and housn) overall and by FWB exposure. A Chi-square statistic was calculated to test for significant differences between FWB exposure and the categories of each demographic variable  and 95% Confidence Intervals (CIs) are presented for each exposure/outcome association. Models are presented unadjusted and adjusted accounting for gender, age, location and being an ex-drinker as these were conceptually thought to be linked to both exposure and outcome variables. A sensitivity analysis was conducted to address possible contamination within the analysis with Family Wellbeing Services  run by tOf the total study population , 718 indicated participating in the FWB program and 9,125 did not indicate participation in FWB. Around 6 in 10 (59.5%) were female and the predominant age category was 55 + (40.9%). Close to half of the study respondents lived in a regional area (47.6%), with 41.1% residing in a major city and 10.9% residing in a remote area.p < 0.05) observed between FWB and non-FWB participants including by gender with around two-thirds (67.1%) of FWB participants being female (versus 58.4% Non-FWB), being in the 35-54 yr age category . Regional areas were the most common area of residence for both FWB (49.4%) and Non-FWB (47.4%), however more of the FWB group resided in remote areas (17.7%) compared to 10.4% of non-FWB participants. Less than one third of FWB participants (32.0%) lived in a major city (versus 41.8% non-FWB).There were a number of significant differences . There was no difference in family financial status between the two groups. A significantly higher level of overcrowding was reported by FWB participants (21.6% versus 16.3% Non-FWB).There were significant differences in reporting of incarceration and stolen generations between FWB and non-FWB participants with 7% of FWB participants reporting being stolen or removed as children compared to 4% of Non-FWB participants. Most FWB participants (83.3%) reported no experience of incarceration (versus 88.6% non-FWB). Overall FWB participants reported a significantly higher level of both prison and youth detention (3.5% versus 1.4% non-FWB).Overall, 6.3% of Mayi Kuwayu participants reported a diagnosis of a drug or alcohol problem by a doctor  of FWB participants had stopped drinking (versus 20.4% Non-FWB) and around a third 33.4% had quit smoking (31.9% Non-FWB). Of current smokers 79.8% in the FWB participant group reported wanting to quit smoking, compared to 76.6% of Non-FWB smokers. The majority of FWB participants (67.7%) had undertaken 3 or more days of exercise in the past week, (versus 66.3% non-FWB), less than one-fifth (18.3%) of the exposed group reported having done no exercise in the past week to 22% of the non-FWB.Against the personal empowerment outcomes, 94.2% of all participants reported a little to a lot of personal control, similarly 91.6% reported a little to a lot of life satisfaction (91.6%). Against the organisational empowerment outcome 41.2% of participants reported high levels cultural wellbeing. Around half of survey participants (47.9%) felt that local people made decisions in the community that they lived.The prevalence of high personal control and life satisfaction was similar across FWB and Non-FWB participants. There were significant differences on family and community empowerment including almost half of FWB participants (45.7%) reporting high-very high outcomes on the family functionality scale (versus 34% Non-FWB) and 70.9% reporting moderate-high cultural wellbeing (versus 38.9% Non-FWB). Almost three-quarters (74.5%) of FWB participants reported that local Aboriginal and/ or Torres Strait Islander people made decisions in their community, compared to less than half of the Non-FWB group (45.8%).There were no significant differences in life control PR 1.00 (CI. 1.00–1.00), life satisfaction PR 1.00 (0.98–1.02) or general health 0.95 (0.90–1.02) between FWB participants and non-Participants. There was a significant 13% increase in reporting high levels of family wellbeing PR 1.13 (CI 1.04–1.22); a 74% increase in reporting high levels of cultural wellbeing PR 1.74 (CI 1.66–1.83); and a 21% increase in reporting high levels of local decision making by Aboriginal and Torres Strait Islander people PR 1.21 (CI 1.16–1.25). After adjustment for gender, age, location and being an ex-drinker there was no difference in all but one exposure outcome relationship. Being a former drinker did reduce the prevalence ratio of cultural wellbeing to a 13% increase from a 74% increase in the unadjusted model.In this cohort of Aboriginal and Torres Strait Islander adults we observed significant associations between FWB participation and higher reporting of some outcomes including cultural wellbeing, community empowerment and for high-very high family functioning (13%). We did not observe a significant association between FWB participation, personal empowerment and general health. We did observe significant associations between FWB participation and increased prevalence of addressing health risk factors including quitting smoking, increased physical inactivity and quitting alcohol. We also observed a significant increase in year 12 or higher educational attainment amongst FWB participants compared to Non-FWB (57.8% v 52.8%) participants.These findings are in line with previous qualitative studies where participants reported wanting to connect with their spirituality. This accords with previous qualitative FWB studies where participants felt that colonisation had undermined Indigenous culture and spirituality . This maThe higher prevalence of participation in the FWB program by people who live remote areas, have been Stolen and experienced incarceration , accords with a history of program delivery for stolen generations and those experiencing incarceration and supports the flexibility of the program to address local needs identified by communities, including removal and incarceration . The outIt is unclear why there is no significant association between FWB program exposure and life control and life satisfaction in this study, given both the strong focus in the program on individual healing and wellbeing, and the associated improvements in the outcome measures of family functioning, cultural wellbeing and community decision making. However, the findings are still in line with definitions of empowerment processes as a dynamic continuum , 5; wherA limitation of this study is that it is cross-sectional and therefore no causality can be attributed and we are also unable to assess the direction of association. Another limitation is the high scores in life satisfaction and control across both the exposed and non-exposed group, contributing to a ‘ceiling effect’ which limits variation in outcomes between the two groups. To overcome these limitations, exploration of how these outcomes change over time for participants using more robust study designs would be desirable. The possible confusion of the program with other similarly named programs or services was also raised as a possible weakness of the study, as stated previously this was a particular concern in Queensland, however the sensitivity analysis identified no significant difference and therefore all Queensland participants were included in the final analysis. We note that mandating of the program may have occurred in some areas but we were unable to determine if participants were mandated, which may impact on the results. There is also a question of cultural nuance that requires adaption to the levels of analysis, or domains within them, to be more in line with Aboriginal and Torres Strait Islander cultural understandings of self. This would be in line with earlier qualitative evaluations of the Family Wellbeing program that found participants placed particular emphasis on relational and spiritual traits as attributes of empowerment , 18.Missing from the analysis is information on structural change, or evidence of how an empowerment intervention such as the Family Wellbeing program can influence changed conditions, different policies or impact experiences of racism. For example, the ability of participants to improve their housing conditions in remote areas where housing infrastructure is limited and over-crowding more common . There aThe FWB program was significantly associated with higher reporting of cultural wellbeing, family functioning and local decision-making, reporting included reduction of risk factors, such as drinking and smoking, implies a model whereby both immediate and intermediate effects when compared to non-FWB participants. These positive associations are encouraging, particularly in combination with past consistent qualitative evidence of program benefits. A fuller evaluation of this program is warranted, using more robust study designs to provide a prospective quantification of the benefits of participation.Additional file 1: Appendix 1. Framework for empowerment evaluation outcomes.