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Mudiyanselage SB, Wanni Arachchige Dona S, Angeles MR, Majmudar I, Marembo M, Tan EJ, Price A, Watts JJ, Gold L, Abimanyi-Ochom J. The impact of maternal health on child's health outcomes during the first five years of child's life in countries with health systems similar to Australia: A systematic review. PLoS One 2024; 19:e0295295. [PMID: 38457392 PMCID: PMC10923423 DOI: 10.1371/journal.pone.0295295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/19/2023] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION The first five years of life is an important developmental period that establishes the foundation for future health and well-being. Mothers play a primary role in providing emotional and physical nourishment during early childhood. This systematic review aims to explore the association between maternal health and child health in the first five years of the child's life. MATERIALS AND METHODS As primary aims, we systematically synthesised published evidence relating to the first five years of life for associations between maternal health exposures (mental, physical and Health-Related Quality of Life (HRQoL) and child health outcomes (physical health, mental health, HRQoL and Health Service Use (HSU) /cost). As a secondary aim, we explored how the above associations vary between disadvantaged and non-disadvantaged populations. The search was limited to studies that published and collected data from 2010 to 2022. The systematic review was specific to countries with similar health systems to Australia. The search was conducted in MEDLINE, CINAHL, APA PsycINFO, GLOBAL HEALTH, and EMBASE databases. The quality of the included studies was assessed by The Effective Public Health Practice Project (EPHPP) tool. RESULTS Thirteen articles were included in the final synthesis from the identified 9439 articles in the primary search. Six (46%) explored the association between maternal mental health and child's physical health, two (15%) explored maternal and child's physical health, one (8%) explored maternal and child's mental health, one (8%) explored maternal physical health and child's HRQoL, and three (23%) explored maternal mental health and child's HSU. We found an association between maternal health and child health (physical and mental) and HSU outcomes but no association between maternal health and child's overall HRQoL. The results for disadvantaged communities did not show any difference from the general population. DISCUSSION AND CONCLUSION Our review findings show that maternal health influences the child's health in the first five years. However, the current evidence is limited, and the findings were primarily related to a specific maternal or child's health condition. There was no evidence of associations of child health outcomes in healthy mothers. There is an extensive research gap investigating maternal health exposures and child outcomes in quality of life and overall health.
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Affiliation(s)
- Shalika Bohingamu Mudiyanselage
- School of Health and Social Development and Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Sithara Wanni Arachchige Dona
- School of Health and Social Development and Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Mary Rose Angeles
- School of Health and Social Development and Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Ishani Majmudar
- School of Health and Social Development and Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Miriam Marembo
- Department of Econometrics and Business Statistics, Monash University, Clayton, Victoria, Australia
- Department of Education, Victoria, Melbourne, Australia
| | - Eng Joo Tan
- Monash University Health Economics Group (MUHEG), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anna Price
- Centre for Community Child Health, The Royal Children’s Hospital, Parkville, Victoria, Australia
- Population Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer J. Watts
- School of Health and Social Development and Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Lisa Gold
- School of Health and Social Development and Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Julie Abimanyi-Ochom
- School of Health and Social Development and Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
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Mills C, Hazeltine K, Zucco A, Phan T, Baker E. Therapist perceptions of barriers to telehealth uptake in children's occupational therapy. Aust Occup Ther J 2023. [PMID: 37127838 DOI: 10.1111/1440-1630.12875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/09/2023] [Accepted: 04/13/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION The COVID-19 pandemic resulted in a rapid shift to telehealth implementation across paediatric occupational therapy services. Although telehealth can be an appealing option, access is conditional, and the delivery of a telehealth service differs from face-to-face. If telehealth is to be a viable and equitable option for families, insight is needed into why the service might be declined. The purpose of our study was to explore barriers to paediatric occupational therapy telehealth services from client and therapist perspectives in a Greater Sydney local health district. METHOD A mixed method approach was used, including (i) retrospective review of clinical records for 250 clients seeking occupational therapy who declined the service and (ii) a focus group with four therapists providing the service. Client demographic information was summarised using descriptive statistics. Open-text responses about reasons for declining telehealth were analysed using qualitative content analysis, whereas thematic analysis was used to explore focus group data. FINDINGS Key findings from the mixed methods analysis identified barriers and issues to consider when working to ensure equitable access to telehealth for children and families. These issues included child engagement, family complexity, the nature of assessments, interventions, and overarching service characteristics as well as the family's digital inclusion. Digital inclusion comprises affordable access to the internet, data, and devices and the capacity of a child and/or family to engage online. CONCLUSION Our findings suggest that telehealth is not a panacea when face-to-face services are not available. Multiple barriers confounded uptake of telehealth prompting a call to action to ensure equitable access to occupational therapy services for all children.
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Affiliation(s)
- Caroline Mills
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, New South Wales, Australia
| | - Kirralee Hazeltine
- South Western Sydney Local Health District (SWSLHD), Liverpool, New South Wales, Australia
| | - Annette Zucco
- South Western Sydney Local Health District (SWSLHD), Liverpool, New South Wales, Australia
| | - Tracy Phan
- South Western Sydney Local Health District (SWSLHD), Liverpool, New South Wales, Australia
| | - Elise Baker
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
- South Western Sydney Local Health District (SWSLHD), Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Transforming Early Education and Child Health (TeEACH), Western Sydney University, Penrith, New South Wales, Australia
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Davidson SA, Ward R, Elliott C, Harris C, Bear N, Thornton A, Salt A, Valentine J. From guidelines to practice: A retrospective clinical cohort study investigating implementation of the early detection guidelines for cerebral palsy in a state-wide early intervention service. BMJ Open 2022; 12:e063296. [PMID: 36428013 PMCID: PMC9703326 DOI: 10.1136/bmjopen-2022-063296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To report on knowledge translation strategies and outcomes from the implementation of the early detection guidelines for cerebral palsy (CP) in a state-wide tertiary early intervention (EI) service and investigate the impact of social determinants on clinical services. DESIGN Retrospective longitudinal cohort study. SETTING The Western Australia tertiary paediatric EI service. PARTICIPANTS EI clinicians, consumers and children using the EI service. OUTCOME MEASURES Knowledge translation strategies including consumer perspectives, clinician training and Communities of Practice (CoP) guided implementation. We measured changes in referral number and age, delivery of early detection and intervention following the implementation of the guidelines. Exposure to adverse childhood experiences (ACEs), appointment non-attendance (DNA) rates, remoteness and socioeconomic quintiles were used to measure social determinants of health using negative binomial (Incidence Rate Ratios, IRR) and logistic regression (Odds Ratios, ORs). RESULTS Ten consumers participated in Focus Groups, 100 clinicians were trained and 22 clinicians established a monthly CoP. Referrals increased fourfold to 511 children. Corrected gestational age at referral decreased from a median of 16.1 to 5.1 months (p<0.001) and at first appointment from 18.8 to 6.8 months (p<0.001). Children living in social disadvantage had the highest DNA risk (quintile 1 vs 5: IRR 2.2, 95% CI 1.1 to 4.6, p=0.037). Children exposed to ACEs had higher odds of living in social disadvantage (quintile 1 vs 5, OR=3.8, 95% CI 1.4 to 10.0, p=0.007). No significant association was found between remoteness and DNA rate or ACE score. CONCLUSIONS Implementation strategies reduced referral age and improved the delivery of early detection assessments. Further investigation of the association between social disadvantage, DNA risk and ACE score is required in the development of a state-wide early detection network.
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Affiliation(s)
- Sue-Anne Davidson
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Kids Rehab WA, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Roslyn Ward
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Catherine Elliott
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Courtenay Harris
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Natasha Bear
- Institute for Health Research, Notre Dame University, Perth, Western Australia, Australia
| | - Ashleigh Thornton
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- Division of Paediatrics, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Alison Salt
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Kids Rehab WA, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Jane Valentine
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Kids Rehab WA, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
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Bessell S, Vuckovic C. How child inclusive were Australia's responses to COVID-19? THE AUSTRALIAN JOURNAL OF SOCIAL ISSUES 2022; 58:AJS4232. [PMID: 36247405 PMCID: PMC9537785 DOI: 10.1002/ajs4.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 06/16/2023]
Abstract
From March 2020, Australia introduced a range of policies to respond to COVID-19, most of which impacted significantly on the lives of children. This article applies a child-centred framework, developed from rights-based participatory research with children, to analyse how children have been represented in policy narratives around COVID-19 and the extent to which policy responses have been child-inclusive or child-centred. We argue that, overall, COVID-19 policy responses have failed to be child-inclusive or child-centred. This has important implications not only for understanding the impact of COVID-19 on children but also in understanding-and potentially rethinking-the place of children in policies as Australia emerges from COVID-19 restrictions.
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Affiliation(s)
- Sharon Bessell
- Crawford School of Public PolicyThe Australian National UniversityCanberraAustralia
| | - Celia Vuckovic
- Crawford School of Public PolicyThe Australian National UniversityCanberraAustralia
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Oben G, Crengle S, Kokaua J, Duncanson M. Deprivation trends in potentially avoidable medical hospitalisations of under-25-year-old Māori and non-Māori non-Pacific in Aotearoa New Zealand: a 20-year perspective. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2109691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Glenda Oben
- Te Ratonga Mātai Tahumaero Taitamariki o Aotearoa—New Zealand Child and Youth Epidemiology Service, Department of Women’s and Children’s Health, University of Otago, Dunedin, Aotearoa New Zealand
| | - Sue Crengle
- Ngāi Tahu Māori Health Research Unit, University of Otago, Dunedin, Aotearoa New Zealand
| | - Jesse Kokaua
- Va’a O Tautai—Centre for Pacific Health Research, University of Otago, Dunedin, Aotearoa New Zealand
| | - Mavis Duncanson
- Te Ratonga Mātai Tahumaero Taitamariki o Aotearoa—New Zealand Child and Youth Epidemiology Service, Department of Women’s and Children’s Health, University of Otago, Dunedin, Aotearoa New Zealand
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Oben G, Crengle S, Kokaua J, Duncanson M. Trends in deprivation in hospitalisations of Indigenous children and young people in Aotearoa New Zealand. J Paediatr Child Health 2022; 58:1345-1351. [PMID: 35426459 PMCID: PMC9542489 DOI: 10.1111/jpc.15979] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/03/2022] [Accepted: 03/28/2022] [Indexed: 11/27/2022]
Abstract
AIM To examine the 20-year trends in socio-economic inequities in hospitalisations of Māori and non-Māori non-Pacific (NMNP) under-25-year olds in Aotearoa New Zealand. METHODS Hospital discharge data for Māori and NMNP taitamariki aged under-25 years were extracted from the National Minimum Dataset for the period 2000-2019. Acute or arranged admissions to hospital were included where the primary diagnosis was for a medical condition. Age- and gender-standardised rates (per 1000, 0-24-year old) were calculated for both ethnic groups by area deprivation using the 2013 NZ census estimated resident population. For each ethnic group, inequity indices of socio-economic deprivation (Slope Index of Inequality and Relative Index of Inequality) were computed, using regression modelling, to quantify inequity of medical condition-related hospitalisations and its changes over time. RESULTS Hospitalisation rates for medical conditions were consistently higher for Māori than for NMNP under-25-year olds from 2000 to 2019. Māori taitamariki residing in the most deprived (quintile 5) areas were more likely than NMNP to be hospitalised for a medical condition at each time point. Deprivation inequities existed for both ethnic groups and were greater for Māori. Despite reducing deprivation inequities over time, ethnic differences persist on both absolute and relative scales. CONCLUSION Deprivation inequities in hospitalisation for medical conditions persist for Māori taitamariki compared with NMNP and highlights society's tolerance of enduring inequity in health outcomes.
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Affiliation(s)
- Glenda Oben
- New Zealand Child and Youth Epidemiology Service, Department of Women's and Children's HealthUniversity of OtagoDunedinNew Zealand
| | - Sue Crengle
- Department of Preventive and Social MedicineUniversity of OtagoDunedinNew Zealand
| | - Jesse Kokaua
- Va'a O Tautai—Centre for Pacific Health ResearchUniversity of OtagoDunedinNew Zealand
| | - Mavis Duncanson
- New Zealand Child and Youth Epidemiology Service, Department of Women's and Children's HealthUniversity of OtagoDunedinNew Zealand
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7
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Russell J, Grant CC, Morton S, Denny S, Paine (Tūhoe) SJ. Prevalence and predictors of developmental health difficulties within New Zealand preschool-aged children: a latent profile analysis. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2083188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Jin Russell
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Developmental Paediatrics, Neuroservices, Starship Children’s Health, Auckland, New Zealand
| | - Cameron C. Grant
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child & Youth Health, University of Auckland, Auckland, New Zealand
- General Paediatrics, Starship Children’s Health, Auckland, New Zealand
| | - Susan Morton
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
| | - Simon Denny
- Mater Research, Health Services Research Group, South Brisbane, Australia
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8
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O'Neill A, Edvardsson K, Hooker L. Clinical supervision practice by community-based child and family health nurses: A mixed-method systematic review. J Adv Nurs 2022; 78:1588-1600. [PMID: 35285975 PMCID: PMC9310731 DOI: 10.1111/jan.15191] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/05/2021] [Accepted: 01/31/2022] [Indexed: 11/27/2022]
Abstract
AbstractAimsTo systematically search the literature to identify studies related to clinical supervision in child and family health nurse contexts, and to determine the role it has in professional practice and the characteristics required for effective supervision.DesignA mixed‐method systematic review using a convergent integrative approach to data synthesis.Data sourceStudies only in English language were identified from searches of CINAHL, MEDLINE and EMBASE databases covering the years of publication from January 1990 to December 2020.Review methodsPrimary research studies of clinical supervision with child and family health nurses in community settings were included. Studies were critically appraised for methodological quality and data extracted, coded and analysed for themes in keeping with the review aims and key findings of each study.ResultsOf 2185 records screened, 63 full‐text papers were assessed for eligibility, which yielded 12 publications for inclusion—11 from the United Kingdom and one from Sweden. The majority (75%) of included studies were qualitative or mixed method. Four main themes with sub‐themes were identified: structural features, supportive experience, ensuring safety and strengthening practice.ConclusionClinical supervision across child and family health nurse contexts is limited. This study highlighted organizational commitment to clinical supervision as an important component of safe and quality practice. Supervisor training and supervisee orientation to supervision is required to optimize effective participation, together with shared agreement of the goals and purpose of supervision.ImpactThe findings from this review confirm the potential for clinical supervision to support improved outcomes for children and families. Understanding what models work best and in what contexts will inform workplace policy and educational programs for child and family nurses across diverse settings.
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Affiliation(s)
- Anne O'Neill
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityMelbourneVictoriaAustralia
| | - Kristina Edvardsson
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityMelbourneVictoriaAustralia
| | - Leesa Hooker
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityMelbourneVictoriaAustralia
- Rural Department of Nursing and Midwifery, La Trobe Rural Health SchoolLa Trobe UniversityBendigoVictoriaAustralia
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Villanueva K, Alderton A, Higgs C, Badland H, Goldfeld S. Data to Decisions: Methods to Create Neighbourhood Built Environment Indicators Relevant for Early Childhood Development. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095549. [PMID: 35564944 PMCID: PMC9102076 DOI: 10.3390/ijerph19095549] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/07/2022] [Accepted: 04/29/2022] [Indexed: 02/01/2023]
Abstract
Healthy development in the early years lays the foundations for children’s ongoing physical, emotional, and social development. Children develop in multiple contexts, including their local neighbourhood. Neighbourhood-built environment characteristics, such as housing, walkability, traffic exposure, availability of services, facilities, and parks, are associated with a range of health and wellbeing outcomes across the life course, but evidence with early years’ outcomes is still emerging. Data linkage techniques were used to assemble a dataset of spatial (objectively-measured) neighbourhood-built environment (BE) measures linked to participant addresses in the 2015 Australian Early Development Census (AEDC) for children living in the 21 most populous urban and regional Australian cities (n = 235,655) to help address this gap. This paper describes the methods used to develop this dataset. This linked dataset (AEDC-BE) is the first of its kind worldwide, enabling opportunities for identifying which features of the built environment are associated with ECD across Australia at scale, allow comparisons between diverse contexts, and the identification of where best to intervene. National data coverage provides statistical power to model real-world complexities, such as differences by city, state/territory, and remoteness. The neighbourhood-built environment can be modified by policy and practice at scale, and has been identified as a way to help reduce inequitable early childhood development outcomes.
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Affiliation(s)
- Karen Villanueva
- Centre for Urban Research, Royal Melbourne Institute of Technology (RMIT) University, Melbourne, VIC 3000, Australia; (A.A.); (C.H.); (H.B.)
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
- Correspondence: or
| | - Amanda Alderton
- Centre for Urban Research, Royal Melbourne Institute of Technology (RMIT) University, Melbourne, VIC 3000, Australia; (A.A.); (C.H.); (H.B.)
| | - Carl Higgs
- Centre for Urban Research, Royal Melbourne Institute of Technology (RMIT) University, Melbourne, VIC 3000, Australia; (A.A.); (C.H.); (H.B.)
| | - Hannah Badland
- Centre for Urban Research, Royal Melbourne Institute of Technology (RMIT) University, Melbourne, VIC 3000, Australia; (A.A.); (C.H.); (H.B.)
| | - Sharon Goldfeld
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
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10
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Eapen V, Woolfenden S, Schmied V, Jalaludin B, Lawson K, Liaw ST, Lingam R, Page A, Cibralic S, Winata T, Mendoza Diaz A, Lam-Cassettari C, Burley J, Boydell K, Lin P, Masi A, Katz I, Dadich A, Preddy J, Bruce J, Raman S, Kohlhoff J, Descallar J, Karlov L, Kaplun C, Arora A, Di Mento B, Smead M, Doyle K, Grace R, McClean T, Blight V, Wood A, Raine KH. "Watch Me Grow- Electronic (WMG-E)" surveillance approach to identify and address child development, parental mental health, and psychosocial needs: study protocol. BMC Health Serv Res 2021; 21:1240. [PMID: 34789234 PMCID: PMC8596348 DOI: 10.1186/s12913-021-07243-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/29/2021] [Indexed: 11/11/2022] Open
Abstract
Background The COVID-19 pandemic and the associated economic recession has increased parental psychosocial stress and mental health challenges. This has adversely impacted child development and wellbeing, particularly for children from priority populations (culturally and linguistically diverse (CALD) and rural/regional communities) who are at an already increased risk of health inequality. The increased mental health and psychosocial needs were compounded by the closure of in-person preventive and health promotion programs resulting in health organisations embracing technology and online services. Watch Me Grow- Electronic (WMG-E) – developmental surveillance platform- exemplifies one such service. WMG-E was developed to monitor child development and guide parents towards more detailed assessments when risk is identified. This Randomised Controlled Trial (RCT) aims to expand WMG-E as a digital navigation tool by also incorporating parents’ mental health and psychosocial needs. Children and families needing additional assessments and supports will be electronically directed to relevant resources in the ‘care-as-usual’ group. In contrast, the intervention group will receive continuity of care, with additional in-person assessment and ‘warm hand over’ by a ‘service navigator’ to ensure their needs are met. Methods Using an RCT we will determine: (1) parental engagement with developmental surveillance; (2) access to services for those with mental health and social care needs; and (3) uptake of service recommendations. Three hundred parents/carers of children aged 6 months to 3 years (recruited from a culturally diverse, or rural/regional site) will be randomly allocated to the ‘care-as-usual’ or ‘intervention’ group. A mixed methods implementation evaluation will be completed, with semi-structured interviews to ascertain the acceptability, feasibility and impact of the WMG-E platform and service navigator. Conclusions Using WMG-E is expected to: normalise and de-stigmatise mental health and psychosocial screening; increase parental engagement and service use; and result in the early identification and management of child developmental needs, parental mental health, and family psychosocial needs. If effective, digital solutions such as WMG-E to engage and empower parents alongside a service navigator for vulnerable families needing additional support, will have significant practice and policy implications in the pandemic/post pandemic period. Trial registration The trial (Protocol No. 1.0, Version 3.1) was registered with ANZCTR (registration number: ACTRN12621000766819) on July 21st, 2021 and reporting of the trial results will be according to recommendations in the CONSORT Statement.
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Affiliation(s)
- V Eapen
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia. .,South Western Sydney Local Health District, Liverpool, Australia.
| | - S Woolfenden
- Sydney Children's Hospital Randwick, Randwick, Australia
| | - V Schmied
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - B Jalaludin
- South Western Sydney Local Health District, Liverpool, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - K Lawson
- School of Business, Western Sydney University, Sydney, Australia
| | - S T Liaw
- Population Child Health Research Group, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,WHO Collaborating Centre for eHealth, University of New South Wales, Sydney, Australia
| | - R Lingam
- Population Child Health Research Group, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - A Page
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - S Cibralic
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - T Winata
- South Western Sydney Local Health District, Liverpool, Australia
| | - A Mendoza Diaz
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - C Lam-Cassettari
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - J Burley
- Population Child Health Research Group, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - K Boydell
- Black Dog Institute, Sydney, Australia
| | - P Lin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.,South Western Sydney Local Health District, Liverpool, Australia
| | - A Masi
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - I Katz
- Social Policy Research Centre, Faculty of Arts, Design, & Architecture, University of New South Wales, Sydney, Australia
| | - A Dadich
- School of Business, Western Sydney University, Sydney, Australia
| | - J Preddy
- Murrumbidgee Local Health District, Wagga Wagga, Australia
| | - J Bruce
- Murrumbidgee Local Health District, Wagga Wagga, Australia
| | - S Raman
- South Western Sydney Local Health District, Liverpool, Australia
| | - J Kohlhoff
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Karitane, Carramar, Australia
| | - J Descallar
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - L Karlov
- South Western Sydney Local Health District, Liverpool, Australia
| | - C Kaplun
- Ingham Institute for Applied Medical Research, Liverpool, Australia.,TeEACH -Transforming early Education and Child Health Research Centre, Western Sydney University, Sydney, Australia
| | - A Arora
- School of Health Sciences, Western Sydney University, Sydney, Australia.,Sydney Local Health District, Camperdown, Australia
| | - B Di Mento
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - M Smead
- Murrumbidgee Local Health District, Wagga Wagga, Australia
| | - K Doyle
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - R Grace
- TeEACH -Transforming early Education and Child Health Research Centre, Western Sydney University, Sydney, Australia
| | | | - V Blight
- South Western Sydney Local Health District, Liverpool, Australia
| | - A Wood
- Karitane, Carramar, Australia
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Findings from the Kids in Communities Study (KiCS): A mixed methods study examining community-level influences on early childhood development. PLoS One 2021; 16:e0256431. [PMID: 34469452 PMCID: PMC8409665 DOI: 10.1371/journal.pone.0256431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 08/07/2021] [Indexed: 11/19/2022] Open
Abstract
There is increasing international interest in place-based approaches to improve early childhood development (ECD) outcomes. The available data and evidence are limited and precludes well informed policy and practice change. Developing the evidence-base for community-level effects on ECD is one way to facilitate more informed and targeted community action. This paper presents overall final findings from the Kids in Communities Study (KiCS), an Australian mixed methods investigation into community-level effects on ECD in five domains of influence-physical, social, governance, service, and sociodemographic. Twenty five local communities (suburbs) across Australia were selected based on 'diagonality type' i.e. whether they performed better (off-diagonal positive), worse (off-diagonal negative), or 'as expected' (on-diagonal) on the Australian Early Development Census (AEDC) relative to their socioeconomic profile. The approach was designed to determine replicable and modifiable factors that were separate to socioeconomic status. Between 2015-2017, stakeholder interviews (n = 146), parent and service provider focus groups (n = 51), and existing socio-economic and early childhood education and care administrative data were collected. Qualitative and quantitative data analyses were undertaken to understand differences between 14 paired disadvantaged local communities (i.e. on versus off-diagonal). Further analysis of qualitative data elicited important factors for all 25 local communities. From this, we developed a draft set of 'Foundational Community Factors' (FCFs); these are the factors that lay the foundations of a good community for young children.
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Halfon N, Aguilar E, Stanley L, Hotez E, Block E, Janus M. Measuring Equity From The Start: Disparities In The Health Development Of US Kindergartners. Health Aff (Millwood) 2021; 39:1702-1709. [PMID: 33017235 DOI: 10.1377/hlthaff.2020.00920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Racialized disparities in health and well-being begin early in life and influence lifelong health outcomes. Using the Early Development Instrument-a population-level early childhood health measure-this article examines potential health inequities with regard to neighborhood income and race/ethnicity in a convenience sample of 183,717 kindergartners in ninety-eight US school districts from 2010 to 2017. Our findings demonstrate a distinct income-related outcome gradient. Thirty percent of children in the lowest-income neighborhoods were vulnerable in one or more domains of health development, compared with 17 percent of children in higher-income settings. Significantly higher rates of income-related Early Development Instrument vulnerability-defined as children falling below the tenth-percentile cutoff on any Early Development Instrument domain-were demonstrated for Black/African American and Hispanic/Latinx children. These findings underscore the utility of the Early Development Instrument as a way for communities to measure child health equity gaps and inform the design, implementation, and performance of multisector place-based child health initiatives. More broadly, results indicate that for the US to make significant headway in decreasing lifelong health inequities, it is important to achieve health equity by early childhood.
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Affiliation(s)
- Neal Halfon
- Neal Halfon is a professor of pediatrics at the Geffen School of Medicine; a professor of health policy and management at the Fielding School of Public Health; and a professor of public policy at the Luskin School of Public Affairs, all at the University of California Los Angeles (UCLA), and is director of the UCLA Center for Healthier Children, Families, and Communities, in Los Angeles, California
| | - Efren Aguilar
- Efren Aguilar is the geographic information systems lead at the Center for Healthier Children, Families, and Communities at UCLA
| | - Lisa Stanley
- Lisa Stanley is a project director for the Transforming Early Childhood Community Systems at the Center for Healthier Children, Families, and Communities at UCLA
| | - Emily Hotez
- Emily Hotez is a project scientist at the Center for Healthier Children, Families, and Communities at UCLA
| | - Eryn Block
- Eryn Block is a maternal and child health research fellow in the Department of Health Policy and Management at the Fielding School of Public Health at UCLA
| | - Magdalena Janus
- Magdalena Janus is a professor of psychiatry and behavioural neurosciences at McMaster University, in Hamilton, Ontario, Canada
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Molloy C, Moore T, O'Connor M, Villanueva K, West S, Goldfeld S. A Novel 3-Part Approach to Tackle the Problem of Health Inequities in Early Childhood. Acad Pediatr 2021; 21:236-243. [PMID: 33359515 DOI: 10.1016/j.acap.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/24/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022]
Abstract
The first 5 years of a child's life are crucial in laying the foundation for their health and developmental trajectory into adulthood. These early years are especially influenced by the surrounding environments in which children live and grow. A large international body of evidence demonstrates that children who experience disadvantage tend to fall increasingly behind over time. At the societal level, these inequities can cause substantial social burdens and significant costs across health, education, and welfare budgets. A contributing factor is that children experiencing adversity are less likely to have access to the environmental conditions that support them to thrive. Many of these factors are modifiable at the community or place level. We argue for three key-though not exhaustive-ideas that collectively could achieve more equitable outcomes for children facing disadvantage and experiencing adversity:We conclude that if adopted, these 3 ideas could contribute to the ability of local communities and networks to identify and respond to factors that address early childhood inequalities.
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Affiliation(s)
- Carly Molloy
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne (C Molloy, T Moore, M O'Connor, and S Goldfeld), Melbourne, Victoria, Australia
| | - Tim Moore
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne (C Molloy, T Moore, M O'Connor, and S Goldfeld), Melbourne, Victoria, Australia
| | - Meredith O'Connor
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne (C Molloy, T Moore, M O'Connor, and S Goldfeld), Melbourne, Victoria, Australia
| | - Karen Villanueva
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia; Centre for Urban Research, RMIT University (K Villanueva), Melbourne, Victoria, Australia
| | - Sue West
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia
| | - Sharon Goldfeld
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne (C Molloy, T Moore, M O'Connor, and S Goldfeld), Melbourne, Victoria, Australia.
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Bröder J, Okan O, Bauer U, Schlupp S, Pinheiro P. Advancing perspectives on health literacy in childhood and youth. Health Promot Int 2021; 35:575-585. [PMID: 31143943 DOI: 10.1093/heapro/daz041] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Children and young people's importance as core target population for health literacy has been highlighted throughout the literature due to the relevance of the early life phases for maintaining, restoring and promoting health during the life course. Transferring health literacy concepts to the target population, however, requires proper testing of their applicability and their fit to the developmental phases as well as the target populations' realities and needs. This article aims to discuss children's and young people's health literacy by elaborating and exploring childhood and youth as life phases with unique characteristics from multidisciplinary perspectives. Drawing on theories and findings from developmental studies, sociology and socialization research, health literacy in childhood and youth is discussed along five 'D' dimensions: (i) disease patterns and health perspectives, (ii) demographic patterns, (iii) developmental change, (iv) dependency and (v) democracy. The unique particularities of children and young people relevant for health literacy include their disease and health-risk profiles, their vulnerability to demographic factors, their social role and status, and their right to participation. Inter- and intra-generational relationships and an unequal distribution of power can either promote or hinder children and young people's health literacy development and their opportunities for participating in health-related decision making. Specifying what is called the 'contextual' and 'relational' dimension of health literacy for the target group requires considering their personal attributes and agency as contextually embedded and interrelated. Taking these considerations into account can help to move towards a more tailored and holistic approach to health literacy of children and young people.
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Affiliation(s)
- Janine Bröder
- Centre for Prevention and Intervention in Childhood and Adolescence (CPI), Bielefeld University, Bielefeld, Germany
| | - Orkan Okan
- Centre for Prevention and Intervention in Childhood and Adolescence (CPI), Bielefeld University, Bielefeld, Germany
| | - Ullrich Bauer
- Centre for Prevention and Intervention in Childhood and Adolescence (CPI), Bielefeld University, Bielefeld, Germany
| | - Sandra Schlupp
- Centre for Prevention and Intervention in Childhood and Adolescence (CPI), Bielefeld University, Bielefeld, Germany
| | - Paulo Pinheiro
- Centre for Prevention and Intervention in Childhood and Adolescence (CPI), Bielefeld University, Bielefeld, Germany
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15
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Beatson R, Molloy C, Perini N, Harrop C, Goldfeld S. Systematic review: An exploration of core componentry characterizing effective sustained nurse home visiting programs. J Adv Nurs 2021; 77:2581-2594. [PMID: 33481301 DOI: 10.1111/jan.14755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/09/2020] [Accepted: 12/07/2020] [Indexed: 12/15/2022]
Abstract
AIMS To identify the core components or potential 'active ingredients' of sustained nurse home visiting (SNHV) programs that have demonstrated positive effects on maternal or child health, psychosocial development, or self-sufficiency outcomes among disadvantaged families in high-income countries. DESIGN Systematic review with narrative summary. DATA SOURCES Programs were identified from searches of several reputable evidence clearing houses and the following bibliographic databases: Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Cochrane Central Register of Controlled Trials. Year of publication was originally restricted from 2008 -2018, with additional searches conducted up to 2019. REVIEW METHODS This review of SNHV program componentry builds on a previous evaluation of program effectiveness. Programs were selected for inclusion if they had been tested in a randomized or cluster-randomized controlled trial (RCT/CRCT). Componentry characteristics related to program delivery, nurse provider, and outcome-specific intervention content were then extracted. RESULTS Comparison of the seven eligible programs showed seven common core components: antenatal commencement, support to child age 2 years, at least 19 scheduled visits and experienced or highly qualified nurses with program-specific training, caseloads of approximately 25 families, regular supervision, and multidisciplinary supports. Outcome-specific program content was generally not well reported. CONCLUSION The findings from this review have utility in guiding the development of minimum standard benchmarks and best-practice recommendations for SNHV programs and call for more detailed publication of core content componentry in the SNHV literature. IMPACT Identification of the core componentry underpinning program effectiveness should inform policy decisions on program selection, adaptation for specific populations, and quality control. Such evidence-based decision-making should in turn lead to better maternal and child outcomes among disadvantaged families in high-income countries, reducing societal and economic burdens of inequity.
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Affiliation(s)
- Ruth Beatson
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Carly Molloy
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Sharon Goldfeld
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia
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Molloy C, Beatson R, Harrop C, Perini N, Goldfeld S. Systematic review: Effects of sustained nurse home visiting programs for disadvantaged mothers and children. J Adv Nurs 2021; 77:147-161. [PMID: 33038049 DOI: 10.1111/jan.14576] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/26/2020] [Accepted: 08/27/2020] [Indexed: 12/17/2022]
Abstract
AIMS To systematically evaluate published experimental studies of sustained nurse home visiting (SNHV) programs. This review summarizes the evidence and identifies gaps in the literature to inform practice, policy, and future research. DESIGN Restricted systematic review with narrative summary. DATA SOURCES Databases searched were Medline, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials. Year of publication was originally restricted from 2008 to the date of search (13 February 2018, with supplementary searches conducted to identify more recent publications (up to 2019). Several reputable evidence clearinghouses were also searched. REVIEW METHODS Studies were included if they used a randomized or cluster-randomized controlled trial to evaluate a home visiting program that: (a) targeted disadvantaged mothers; (b) commenced during pregnancy or prior to the child's first birthday; (c) had an intended duration of at least 12 months from the time of enrolment; and (d) was substantively delivered by nurses or midwives. Meta-analyses and reviews of studies meeting these criteria were also included. A quality appraisal was conducted for all studies. RESULTS Of 1,393 total articles, 30 met inclusion criteria. Seven specific SNHV programs were identified. Each demonstrated evidence of a positive statistical effect on at least one child or maternal outcome. CONCLUSION Sustained nurse home visiting programs benefit disadvantaged families, though effects vary across outcomes and subgroups. Further research is needed to discern the critical components of effective programs. IMPACT As SNHV programs have gained policy appeal, the need to evaluate the evidence-base supporting such interventions has become imperative. The findings of this review will assist policy-makers and practitioners in high-income countries to make evidence-informed decisions about which programs are best suited to addressing specific maternal and child outcomes for disadvantaged families. This should in turn ameliorate some of the inequalities in child development that have significant social and economic costs.
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Affiliation(s)
- Carly Molloy
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Vic., Australia
- University of Melbourne, Melbourne, Vic., Australia
| | - Ruth Beatson
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Vic., Australia
| | | | | | - Sharon Goldfeld
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Vic., Australia
- University of Melbourne, Melbourne, Vic., Australia
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17
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Newham JJ, McLean K, Ginja S, Hurt L, Molloy C, Lingam R, Goldfeld S. Brief evidence-based interventions for universal child health services: a restricted evidence assessment of the literature. BMC Public Health 2020; 20:993. [PMID: 32580720 PMCID: PMC7315474 DOI: 10.1186/s12889-020-09104-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/12/2020] [Indexed: 11/29/2022] Open
Abstract
Background Universal child health services (UCHS) provide an important pragmatic platform for the delivery of universal and targeted interventions to support families and optimize child health outcomes. We aimed to identify brief, evidence-based interventions for common health and developmental problems that could be potentially implemented in UCHS. Methods A restricted evidence assessment (REA) of electronic databases and grey literature was undertaken covering January 2006 to August 2019. Studies were eligible if (i) outcomes related to one or more of four areas: child social and emotional wellbeing (SEWB), infant sleep, home learning environment or parent mental health, (ii) a comparison group was used, (iii) universal or targeted intervention were delivered in non-tertiary settings, (iv) interventions did not last more than 4 sessions, and (v) children were aged between 2 weeks postpartum and 5 years at baseline. Results Seventeen studies met the eligibility criteria. Of these, three interventions could possibly be implemented at scale within UCHS platforms: (1) a universal child behavioural intervention which did not affect its primary outcome of infant sleep but improved parental mental health, (2) a universal screening programme which improved maternal mental health, and (3) a targeted child behavioural intervention which improved parent-reported infant sleep problems and parental mental health. Key lessons learnt include: (1) Interventions should impart the maximal amount of information within an initial session with future sessions reinforcing key messages, (2) Interventions should see the family as a holistic unit by considering the needs of parents with an emphasis on identification, triage and referral, and (3) Brief interventions may be more acceptable for stigmatized topics, but still entail considerable barriers that deter the most vulnerable. Conclusions Delivery and evaluation of brief evidence-based interventions from a UCHS could lead to improved maternal and child health outcomes through a more responsive and equitable service. We recommend three interventions that meet our criteria of “best bet” interventions.
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Affiliation(s)
- James J Newham
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Karen McLean
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| | - Samuel Ginja
- School of Psychology, Ulster University, Coleraine, UK
| | - Lisa Hurt
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Carly Molloy
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| | - Raghu Lingam
- School of Women's & Children's Health, University of New South Wales, Randwick, Australia.
| | - Sharon Goldfeld
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
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18
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Xafis V. 'What is Inconvenient for You is Life-saving for Me': How Health Inequities are playing out during the COVID-19 Pandemic. Asian Bioeth Rev 2020; 12:223-234. [PMID: 32427219 PMCID: PMC7229879 DOI: 10.1007/s41649-020-00119-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 02/04/2023] Open
Abstract
The COVID-19 pandemic has had a significant impact globally. Most affected, however, are those individuals and groups routinely disadvantaged by the social injustice created by the misdistribution of power, money, and resources. Simple measures that prevent the spread of COVID-19, such as frequent hand washing and social distancing, are unavailable to millions of people in the wealthiest of nations and in the poorest of nations. Disadvantaged groups are impacted more directly and in disproportionately higher numbers due to existing poor health, and the disruption of services central to securing an income and an education will have lasting consequences for their futures. The unintended effect of exclusionary government policies is that privileged citizens and healthcare systems are also at greater risk. This paper seeks to highlight the impact of COVID-19 on those already suffering health inequities through consideration of some of the social determinants of health on groups in affluent and poorer nations. It also highlights some of the factors that may assist in tackling health inequities as we emerge from this pandemic.
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Affiliation(s)
- Vicki Xafis
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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19
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Laurens KR, Islam F, Kariuki M, Harris F, Chilvers M, Butler M, Schofield J, Essery C, Brinkman SA, Carr VJ, Green MJ. Reading and numeracy attainment of children reported to child protection services: A population record linkage study controlling for other adversities. CHILD ABUSE & NEGLECT 2020; 101:104326. [PMID: 32014797 DOI: 10.1016/j.chiabu.2019.104326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/15/2019] [Accepted: 12/10/2019] [Indexed: 05/24/2023]
Abstract
BACKGROUND Maltreated children are at risk of poor educational outcomes, but also experience greater individual, family, and neighbourhood adversities that may obscure an understanding of relationships between child protection involvement and educational attainment. OBJECTIVE To examine associations between child protection involvement and 3rd- and 5th-grade reading and numeracy attainment, while controlling multiple other adversities. PARTICIPANTS AND SETTING Participants were 56,860 Australian children and their parents from the New South Wales Child Development Study with linked multi-agency records. METHODS Multinomial logistic regressions examined associations between level of child protection involvement (Out-Of-Home Care [OOHC] placement; substantiated Risk Of Significant Harm [ROSH]; unsubstantiated ROSH; non-ROSH; and no child protection report) and standardised tests of 3rd- and 5th-grade reading and numeracy. Fully adjusted models controlled demographic, pregnancy, birth, and parental factors, and early (kindergarten) developmental vulnerabilities on literacy and numeracy, and other developmental domains (social, emotional, physical, communication). RESULTS All children with child protection reports were more likely to attain below average, and less likely to attain above average, 3rd- and 5th-grade reading and numeracy, including children with reports below the ROSH threshold. Children with substantiated ROSH reports who were not removed into care demonstrated the worst educational attainment, with some evidence of protective effects for children in OOHC. CONCLUSIONS A cross-agency response to supporting educational attainment for all children reported to child protection services is required, including targeted services for children in OOHC or with substantiated ROSH reports, and referral of vulnerable families (unsubstantiated and non-ROSH cases) to secondary service organisations (intermediate intervention).
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Affiliation(s)
- Kristin R Laurens
- School of Psychology and Counselling, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
| | - Fahkrul Islam
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Maina Kariuki
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Felicity Harris
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | | | - Merran Butler
- NSW Department of Family and Community Services, NSW, Australia
| | | | | | - Sally A Brinkman
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia; School of Population Health, University of Adelaide, Adelaide, SA, Australia
| | - Vaughan J Carr
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Department of Psychiatry, Monash University, Melbourne, VIC, Australia; Neuroscience Research Australia, Sydney, NSW, Australia
| | - Melissa J Green
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Neuroscience Research Australia, Sydney, NSW, Australia
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Chando S, Craig JC, Burgess L, Sherriff S, Purcell A, Gunasekera H, Banks S, Smith N, Banks E, Woolfenden S. Developmental risk among Aboriginal children living in urban areas in Australia: the Study of Environment on Aboriginal Resilience and Child Health (SEARCH). BMC Pediatr 2020; 20:13. [PMID: 31931753 PMCID: PMC6956483 DOI: 10.1186/s12887-019-1902-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 12/23/2019] [Indexed: 12/05/2022] Open
Abstract
Background Most Australian Aboriginal children are on track with their development, however, the prevalence of children at risk of or with a developmental or behavioural problem is higher than in other children. Aboriginal child development data mostly comes from remote communities, whereas most Aboriginal children live in urban settings. We quantified the proportion of participating children at moderate and high developmental risk as identified by caregivers’ concerns, and determined the factors associated with developmental risk among urban Aboriginal communities. Methods Study methods were co-designed and implemented with four participating urban Aboriginal Community Controlled Health Services in New South Wales, Australia, between 2008 and 2012. Caregiver-reported data on children < 8 years old enrolled in a longitudinal cohort study (Study of Environment on Aboriginal Resilience and Child Health: SEARCH) were collected by interview. The Parents’ Evaluation of Developmental Status (PEDS) was used to assess developmental risk through report of caregiver concerns. Odds ratios (OR) were calculated using multinomial logistic regression to investigate risk factors and develop a risk prediction model. Results Of 725 children in SEARCH with PEDS data (69% of eligible), 405 (56%) were male, and 336 (46%) were aged between 4.5 and 8 years. Using PEDS, 32% were at high, 28% moderate, and 40% low/no developmental risk. Compared with low/no risk, factors associated with high developmental risk in a mutually-adjusted model, with additional adjustment for study site, were male sex (OR 2.42, 95% confidence intervals 1.62–3.61), being older (4.5 to < 8 years versus < 3 years old, 3.80, 2.21–6.54), prior history of ear infection (1.95, 1.21–3.15), having lived in 4 or more houses versus one house (4.13, 2.04–8.35), foster care versus living with a parent (5.45, 2.32–12.78), and having a caregiver with psychological distress (2.40, 1.37–4.20). Conclusion In SEARCH, 40% of urban Aboriginal children younger than 8 years were at no or low developmental risk. Several factors associated with higher developmental risk were modifiable. Aboriginal community-driven programs to improve detection of developmental problems and facilitate early intervention are needed.
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Affiliation(s)
| | - Jonathan C Craig
- University of Sydney, Sydney, Australia.,Flinders University, Adelaide, Australia
| | - Leonie Burgess
- Sax Institute, Sydney, Australia.,Australian National University, Canberra, Australia
| | - Simone Sherriff
- University of Sydney, Sydney, Australia.,Sax Institute, Sydney, Australia
| | | | - Hasantha Gunasekera
- University of Sydney, Sydney, Australia.,Sydney Children's Hospitals Network, Sydney, Australia
| | - Sandra Banks
- Tharawal Aboriginal Medical Service, Campbelltown, Australia
| | - Natalie Smith
- Riverina Medical and Dental Corporation, Wagga Wagga, Australia
| | - Emily Banks
- Australian National University, Canberra, Australia
| | - Sue Woolfenden
- Sydney Children's Hospitals Network, Sydney, Australia. .,University of New South Wales, School of Women and Children's Health, Sydney, Australia.
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21
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Uchitel J, Alden E, Bhutta ZA, Goldhagen J, Narayan AP, Raman S, Spencer N, Wertlieb D, Wettach J, Woolfenden S, Mikati MA. The Rights of Children for Optimal Development and Nurturing Care. Pediatrics 2019; 144:peds.2019-0487. [PMID: 31771960 DOI: 10.1542/peds.2019-0487] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2019] [Indexed: 11/24/2022] Open
Abstract
Millions of children are subjected to abuse, neglect, and displacement, and millions more are at risk for not achieving their developmental potential. Although there is a global movement to change this, driven by children's rights, progress is slow and impeded by political considerations. The United Nations Convention on the Rights of the Child, a global comprehensive commitment to children's rights ratified by all countries in the world except the United States (because of concerns about impingement on sovereignty and parental authority), has a special General Comment on "Implementing Child Rights in Early Childhood." More recently, the World Health Organization and United Nations Children's Fund have launched the Nurturing Care Framework for Early Childhood Development (ECD), which calls for public policies that promote nurturing care interventions and addresses 5 interrelated components that are necessary for optimal ECD. This move is also complemented by the Human Capital Project of the World Bank, providing a focus on the need for investments in child health and nutrition and their long-term benefits. In this article, we outline children's rights under international law, the underlying scientific evidence supporting attention to ECD, and the philosophy of nurturing care that ensures that children's rights are respected, protected, and fulfilled. We also provide pediatricians anywhere with the policy and rights-based frameworks that are essential for them to care for and advocate for children and families to ensure optimal developmental, health, and socioemotional outcomes. These recommendations do not necessarily reflect American Academy of Pediatrics policy.
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Affiliation(s)
| | - Errol Alden
- International Pediatric Association and Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.,Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Jeffrey Goldhagen
- Division of Community and Societal Pediatrics, Department of Pediatrics, College of Medicine, University of Florida, Jacksonville, Florida
| | | | - Shanti Raman
- International Pediatrics Association Standing Committee, International Society of Social Pediatrics and Child Health, Geneva, Switzerland.,Division of Community Pediatric, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Nick Spencer
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Donald Wertlieb
- Eliot-Pearson Department of Child Study and Human Development, School of Arts and Sciences, Tufts University, Medford, Massachusetts
| | - Jane Wettach
- Duke Children's Law Clinic, School of Law, Duke University, Durham, North Carolina; and
| | - Sue Woolfenden
- Discipline of Paediatrics, School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Mohamad A Mikati
- Division of Pediatric Neurology and .,Early Childhood Development Standing Advisory Group, International Pediatrics Association, St Louis, Missouri
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Lim J, Sarkozy V, Perkins D, Van Muster KA, Woolfenden S. Letter to the editor. J Paediatr Child Health 2019; 55:1513. [PMID: 31846158 DOI: 10.1111/jpc.14653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 09/01/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Jeanette Lim
- Department of Community and Child Health, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Vanessa Sarkozy
- Department of Community and Child Health, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Deborah Perkins
- Department of Community and Child Health, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Kerri-Anne Van Muster
- Department of Community and Child Health, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Susan Woolfenden
- Department of Community and Child Health, Sydney Children's Hospital, Sydney, New South Wales, Australia
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Molloy C, O'Connor M, Guo S, Lin C, Harrop C, Perini N, Goldfeld S. Potential of ‘stacking’ early childhood interventions to reduce inequities in learning outcomes. J Epidemiol Community Health 2019; 73:1078-1086. [DOI: 10.1136/jech-2019-212282] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 11/04/2022]
Abstract
BackgroundEarly childhood interventions are critical for reducing child health and development inequities. While most research focuses on the efficacy of single interventions, combining multiple evidence-based strategies over the early years of a child’s life may yield greater impact. This study examined the association between exposure to a combination of five evidence-based services from 0 to 5 years on children’s reading at 8–9 years.MethodsData from the nationally representative birth cohort (n=5107) of the Longitudinal Study of Australian Children were utilised. Risk and exposure measures across five services from 0 to 5 years were assessed: antenatal care, nurse home-visiting, early childhood education and care, parenting programme and the early years of school. Children’s reading at 8–9 years was measured using a standardised direct assessment. Linear regression analyses examined the cumulative effect of five services on reading. Interaction terms were examined to determine if the relationship differed as a function of level of disadvantage.ResultsA cumulative benefit effect of participation in more services and a cumulative risk effect when exposed to more risks was found. Each additional service that the child attended was associated with an increase in reading scores (b=9.16, 95% CI=5.58 to 12.75). Conversely, each additional risk that the child was exposed to was associated with a decrease in reading skills (b=−14.03, 95% CI=−16.61 to −11.44). Effects were similar for disadvantaged and non-disadvantaged children.ConclusionThis study supports the potential value of ‘stacking’ early interventions across the early years of a child’s life to maximise impacts on child outcomes.
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Dea C, Gauvin L, Fournier M, Goldfeld S. Does Place Matter? An International Comparison of Early Childhood Development Outcomes between the Metropolitan Areas of Melbourne, Australia and Montreal, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16162915. [PMID: 31416243 PMCID: PMC6720425 DOI: 10.3390/ijerph16162915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/24/2019] [Accepted: 07/28/2019] [Indexed: 11/17/2022]
Abstract
There is strong consensus about the importance of early childhood development (ECD) for improving population health and closing the health inequity gap. Environmental features and public policies across sectors and jurisdictions are known to influence ECD. International comparisons provide valuable opportunities to better understand the impact of these ecological determinants on ECD. This study compared ECD outcomes between metropolitan Melbourne (Australia) and Montreal (Canada), and contrasted disparities across demographic and socioeconomic characteristics. Methods: Population wide surveys using the Early Development Instrument (EDI) were conducted among 4–6 years-old children in both Montreal and Melbourne in 2012, measuring five domains of ECD: 1-Physical Health/Well-Being (PHYS); 2-Social Competence (SOC); 3-Emotional Maturity (EMOT); 4-Language/Cognitive Development (COGN); and 5-Communication Skills/General Knowledge (COMM). Descriptive analyses of summary EDI indicators and domain indicators (including median scores and interquartile ranges) were compared between metropolitan areas, using their respective 95% confident intervals (CIs). Analyses were performed using Stata software (v14). Results: The proportion of children developmentally vulnerable in at least one domain of ECD was 26.8% (95% CIs: 26.2, 27.3) in Montreal vs. 19.2% (95% CIs: 18.8, 19.5) in Melbourne. The Melbourne advantage was greatest for EMOT and COGN (11.5% vs. 6.9%; 13.0% vs. 5.8%). In both Montreal and Melbourne, boys, immigrants, children not speaking the language of the majority at home, and those living in the most deprived areas were at greater risk of being developmentally vulnerable. Relative risks as a function of home language and area-level deprivation subgroups were smaller in Montreal than in Melbourne. Conclusion: This study shows that Melbourne’s children globally experience better ECD outcomes than Montreal’s children, but that inequity gaps are greater in Melbourne for language and area-level deprivation subgroups. Further research is warranted to identify the environmental factors, policies, and programs that account for these observed differences.
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Affiliation(s)
- Catherine Dea
- Department of Social & Preventive Medicine, École de santé publique, Université de Montréal, Montréal, QC H3N 1X9, Canada
- Direction Régionale de Santé Publique, Centre Intégré Universitaire de Santé et Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC H2L 1M3, Canada
| | - Lise Gauvin
- Department of Social & Preventive Medicine, École de santé publique, Université de Montréal, Montréal, QC H3N 1X9, Canada
- Health Innovation and Evaluation Hub, Centre de recherche du CHUM, Montréal, QC H2X 0A9, Canada
| | - Michel Fournier
- Direction Régionale de Santé Publique, Centre Intégré Universitaire de Santé et Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC H2L 1M3, Canada
| | - Sharon Goldfeld
- Centre for Community Child Health, Murdoch Children's Research Institute, & Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne VIC 3052, Australia.
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Early determinants of linear growth and weight attained in the first year of life in a malaria endemic region. PLoS One 2019; 14:e0220513. [PMID: 31386682 PMCID: PMC6684079 DOI: 10.1371/journal.pone.0220513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/17/2019] [Indexed: 12/25/2022] Open
Abstract
We investigated linear growth and weight attained among 772 children at 10–15 months of age in the first population-based birth cohort in the Brazilian Amazon. Sociodemographic, maternal and birth characteristics were collected in interviews soon after birth at baseline. Anthropometric evaluation was conducted at 10–15 months. Multiple linear regression models were fitted for length-for-age (LAZ) and body mass index (BMI)-for-age Z scores (BAZ), considering a hierarchical conceptual framework with determinants at distal, intermediate and proximal levels, with adjustment for the child’s sex and age. Mean LAZ and BAZ were 0.31 (SD: 1.13) and 0.35 (SD: 1.06), respectively. Overall, 2.2% of children were stunted and 6.6% overweight. Among socioeconomic factors, household wealth index was positively associated with LAZ (p for trend = 0.01), while children whose families received assistance from the Bolsa Família conditional cash transfer program were 0.16 Z score thinner (95% CI: -0.31, -0.00). Maternal height and BMI were positively associated with both LAZ and BAZ at 10–15 months of age (p for trend <0.001). Child’s size at birth was positively related with LAZ (p<0.001 for both birth weight and length). BAZ was 0.34 (95% CI: 0.24, 0.44) higher, but 0.11 lower (95% CI: -0.21, -0.02), for each increase in 1 Z score of birth weight and length, respectively. Children with at least one reported malaria episode within the first year of life were 0.58 (95% CI: -1.05, -0.11) Z score shorter. Socioeconomic and intergenerational factors were consistently associated with LAZ and BAZ at 10–15 months of age. The occurrence of malaria was detrimental to linear growth. In a malaria endemic region, reduction of inequalities and disease burden over the first 1,000 days of life is essential for taking advantage of a critical window of opportunity that can redirect child growth trajectories toward better health and nutrition conditions in the long term.
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Herrera-Mora DB, Munar-Torres YE, Molina-Achury NJ, Robayo-Torres AL. Desarrollo infantil y condición socioeconómica. Artículo de revisión. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.15446/revfacmed.v67n1.66645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Introducción. El desarrollo infantil parte de factores endógenos y exógenos; entre estos últimos se encuentra la condición socioeconómica, la cual puede influir en la salud y las oportunidades en la vida adulta.Objetivos. Conocer y analizar la influencia de las condiciones socioeconómicas en el desarrollo infantil.Materiales y métodos. Se realizó una revisión bibliográfica en 10 bases de datos mediante una búsqueda de artículos publicados entre 2012 y 2017. Se seleccionaron los artículos con base en las palabras clave y la relación entre el desarrollo infantil y la condición socioeconómica.Resultados. Se seleccionaron 10 artículos. Las variables más utilizadas para valorar condición socioeconómica fueron ingresos familiares y educación parental y para desarrollo infantil, áreas de cognición, motricidad fina y gruesa. Se encontró una relación significativa entre desarrollo infantil y nivel socioeconómico, escolaridad, ocupación de los padres, estado civil de la madre y condiciones de la vivienda, que suponen una desventaja y la probabilidad de alteración en el desarrollo infantil.Conclusión. El desarrollo infantil está influenciado por condiciones socioeconómicas determinadas por aspectos histórico-culturales, abordadas en su mayoría desde la sociología funcionalista como factores aislados. Se propone un enfoque metodológico holístico e integrador que dé lugar a la historicidad como elemento nodal.
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Profiles of Mental Health Competence and Difficulties as Predictors of Children’s Early Learning. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-018-9252-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Goldfeld S, O’Connor M, Cloney D, Gray S, Redmond G, Badland H, Williams K, Mensah F, Woolfenden S, Kvalsvig A, Kochanoff AT. Understanding child disadvantage from a social determinants perspective. J Epidemiol Community Health 2017; 72:223-229. [DOI: 10.1136/jech-2017-209036] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 11/08/2017] [Accepted: 11/30/2017] [Indexed: 11/03/2022]
Abstract
BackgroundChild health and developmental inequities exist in all countries. Comprehensive and robust concepts of disadvantage are fundamental to growing an evidence base that can reveal the extent of inequities in childhood, and identify modifiable leverage points for change. We conceptualise and test a multidimensional framework of child disadvantage aligned to a social determinants and bioecological perspective.MethodsThe Longitudinal Study of Australian Children is a nationally representative sample of two cohorts of Australian children, including the birth cohort of 5107 infants, which commenced in May 2004. The analysis focused on disadvantage indicators collected at age 4–5 years. Confirmatory factor analysis was used to test a theoretically informed model of disadvantage. Concurrent validity was examined through associations with academic performance at 8–9 years.ResultsThe model comprising four latent factors of sociodemographic (10 indicators), geographical environments (three indicators), health conditions (three indicators) and risk factors (14 indicators) was found to provide a better fit for the data than alternative models. Each factor was associated with academic performance, providing evidence of concurrent validity.ConclusionThe study provides a theoretically informed and empirically tested framework for operationalising relative child disadvantage. Understanding and addressing inequities will be facilitated by capturing the complexity of children’s experiences of disadvantage across the multiple environments in which their development unfolds.
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Kimla K, Nathanson D, Woolfenden S, Zwi K. Identification of vulnerability within a child and family health service. AUST HEALTH REV 2017; 43:171-177. [PMID: 29157354 DOI: 10.1071/ah17024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 10/06/2017] [Indexed: 11/23/2022]
Abstract
Objective The aims of the present study were to describe the prevalence of vulnerability in a cohort of newborns, identify the factors that increase the risk of vulnerability and examine whether those who are most vulnerable are receiving home visits. Methods A prospective cross-sectional study was performed using data collected from questionnaires completed by child and family health nurses and obstetric discharge summaries for each mother-baby dyad. Descriptive frequencies and percentages are used to describe the proportions of children who were vulnerable, offered services and had risk factors for vulnerability. Categorical data were compared using Pearson's Chi-squared analysis. Results In all, 1517 newborns were included in the present study. Of these, 40.5% were identified as vulnerable and 13.9% had two or more risk factors for vulnerability (95% confidence interval (CI) 12-16%). The most common risk factors were biological. Across all newborns, 33.7% were visited at home, and 74.6% of vulnerable newborns were offered a home visit. Children identified as vulnerable were more likely to have a home visit than those who were not (z for 95% CI=1.96; P<0.1). Conclusions Although the high reported prevalence of identified risk needs to be confirmed in further studies, identifying vulnerability allowed the offer of home visiting to be directed towards those most likely to benefit. What is known about the topic? Of the Australian child population, 10-20% are vulnerable to adverse health, developmental and wellbeing outcomes. Vulnerable infants are at a greater risk of becoming vulnerable children, adolescents and adults over the life course. Biological and psychosocial risk factors for vulnerability are well described. Families with the greatest need are often the least likely to access or receive support, and have lower utilisation of preventative health services despite evidence that support in the first few years of life can significantly improve long-term outcomes. What does this paper add? This paper provides a detailed description of vulnerabilities in a cohort of newborns and demonstrates that it is possible to assign risk of vulnerability within existing child and family health services using tools that identify biological and psychosocial risk factors. Identification of vulnerability risk allows prioritisation of services to those with the greatest need. What are the implications for practitioners? It is possible to identify vulnerability risk within child and family health services. This allows those families at risk of future adverse health, developmental and wellbeing outcomes to be prioritised to receive health services and supports.
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Affiliation(s)
- Katarina Kimla
- Sydney Children's Hospitals Network, High Street, Randwick, Sydney, NSW 2031, Australia.
| | - Dania Nathanson
- Sydney Children's Hospitals Network, High Street, Randwick, Sydney, NSW 2031, Australia.
| | - Susan Woolfenden
- Sydney Children's Hospitals Network, High Street, Randwick, Sydney, NSW 2031, Australia.
| | - Karen Zwi
- Sydney Children's Hospitals Network, High Street, Randwick, Sydney, NSW 2031, Australia.
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Garg P, Ha MT, Eastwood J, Harvey S, Woolfenden S, Murphy E, Dissanayake C, Jalaludin B, Williams K, McKenzie A, Einfeld S, Silove N, Short K, Eapen V. Explaining culturally and linguistically diverse (CALD) parents' access of healthcare services for developmental surveillance and anticipatory guidance: qualitative findings from the 'Watch Me Grow' study. BMC Health Serv Res 2017; 17:228. [PMID: 28330490 PMCID: PMC5361826 DOI: 10.1186/s12913-017-2143-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 03/08/2017] [Indexed: 11/28/2022] Open
Abstract
Background Regular health visits for parents with young children provide an opportunity for developmental surveillance and anticipatory guidance regarding common childhood problems and help to achieve optimal developmental progress prior to school entry. However, there are few published reports from Australian culturally and linguistically diverse (CALD) communities exploring parents’ experiences for accessing child health surveillance programs. This paper aims to describe and explain parental experiences for accessing developmental surveillance and anticipatory guidance for children. Methods Qualitative data was obtained from 6 focus groups (33 parents) and seven in-depth interviews of CALD parents recruited from an area of relative disadvantage in Sydney. Thematic analysis of data was conducted using an ecological framework. Results An overarching theme of “awareness-beliefs-choices” was found to explain parents’ experiences of accessing primary health care services for children. “Awareness” situated within the meso-and macro-systems explained parents knowledge of where and what primary health services were available to access for their children. Opportunities for families to obtain this information existed at the time of birth in Australian hospitals, but for newly arrived immigrants with young children, community linkages with family and friends, and general practitioner (GPs) were most important. “Beliefs” situated within the microsystems included parents’ understanding of their children’s development, in particular what they considered to be “normal” or “abnormal”. Parental “choices”, situated within meso-systems and chronosystems, related to their choices of service providers, which were based on the proximity, continuity, purpose of visit, language spoken by the provider and past experience of a service. Conclusions CALD parents have diverse experiences with primary health care providers which are influenced by their awareness of available services in the context of their duration of stay in Australia. The role of the general practitioner, with language concordance, suggests the importance of diversity within the primary care health workforce in this region. There is a need for ongoing cultural competence training of health professionals and provisions need to be made to support frequent use of interpreters at general practices in Australia.
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Affiliation(s)
- Pankaj Garg
- Department of Community Paediatrics, Liverpool Hospital, Liverpool, Australia.,School of Women's and Children's Health, UNSW, Liverpool, Australia.,School of Medicine, University of Sydney, Westmead, Australia.,Ingham Institute of Applied Medicine, Liverpool, Australia
| | - My Trinh Ha
- University of Western Sydney, Penrith, NSW, Australia
| | - John Eastwood
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.,School of Public Health, University of Sydney, Sydney, NSW, Australia.,Ingham Institute of Applied Medicine, Liverpool, Australia.,School of Medicine, Griffith University, Gold Coast, QLD, Australia.,Syney Local Health District, Croydon, NSW, Australia
| | - Susan Harvey
- School of Nursing and Midwifery, Griffiths University, Queensland, Australia
| | - Sue Woolfenden
- Sydney Children's Hospital Network (Randwick), UNSW, Sydney, Australia
| | | | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Bin Jalaludin
- South Western Sydney Local Health District and UNSW, Sydney, Australia
| | - Katrina Williams
- Royal Children's Hospital, Melbourne and University of Melbourne, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Anne McKenzie
- Primary and Community Health, Child, Youth and Family, Child and Family Health Nursing, South Western Sydney Local Health District, Sydney, Australia
| | - Stewart Einfeld
- Centre for Disability Research and Policy and Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Natalie Silove
- The Children's Hospital at Westmead, University of Sydney, Sydney, Australia
| | - Kate Short
- Liverpool Hospital, South Western Sydney LHD, University of Sydney, Sydney, Australia
| | - Valsamma Eapen
- UNSW, South Western Sydney LHD, Ingham Institute of Applied Medicine, Liverpool, Australia. .,Infant Child and Adolescent Psychiatry, Academic Unit of Child Psychiatry, South West Sydney LHD, ICAMHS, Mental Health Centre, University of New South Wales, Liverpool Hospital, L1, Elizabeth Street, Liverpool, NSW, 2170, Sydney, Australia.
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Goldfeld S, Price A, Bryson H, Bruce T, Mensah F, Orsini F, Gold L, Hiscock H, Smith C, Bishop L, Jackson D, Kemp L. 'right@home': a randomised controlled trial of sustained nurse home visiting from pregnancy to child age 2 years, versus usual care, to improve parent care, parent responsivity and the home learning environment at 2 years. BMJ Open 2017; 7:e013307. [PMID: 28320789 PMCID: PMC5372045 DOI: 10.1136/bmjopen-2016-013307] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 11/08/2016] [Accepted: 01/04/2017] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION By the time children start school, inequities in learning, development and health outcomes are already evident. Sustained nurse home visiting (SNHV) offers a potential platform for families experiencing adversity, who often have limited access to services. While SNHV programmes have been growing in popularity in Australia and internationally, it is not known whether they can improve children's learning and development when offered via the Australian service system. The right@home trial aims to investigate the effectiveness of an SNHV programme, offered to women from pregnancy to child age 2 years, in improving parent care of and responsivity to the child, and the home learning environment. METHODS AND ANALYSIS Pregnant Australian women (n=722) are identified after completing a screening survey of 10 factors known to predict children's learning and development (eg, young pregnancy, poor mental or physical health, lack of support). Consenting women-surveyed while attending clinics at 10 hospitals in Victoria and Tasmania-are enrolled if they report having 2 or more risk factors. The intervention comprises 25 home visits from pregnancy to 2 years, focusing on parent care of the child, responsivity to the child and providing a good quality home learning environment. The standard, universal, Australian child and family health service provides the comparator (control). Primary outcome measures include a combination of parent-reported and objective assessments of children's sleep, safety, nutrition, parenting styles and the home learning environment, including the Home Observation of the Environment Inventory and items adapted from the Longitudinal Study of Australian Children. ETHICS AND DISSEMINATION This study is approved by the Royal Children's Hospital Human Research Ethics Committees (HREC 32296) and site-specific HRECs. The investigators and sponsor will communicate the trial results to stakeholders, participants, healthcare professionals, the public and other relevant groups via presentations and publications. TRIAL REGISTRATION NUMBER ISRCTN89962120, pre-results.
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Affiliation(s)
- Sharon Goldfeld
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, Victoria, Australia
- Population Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Anna Price
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, Victoria, Australia
- Population Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Hannah Bryson
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, Victoria, Australia
- Population Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Tracey Bruce
- Ingham Institute, Western Sydney University, Sydney, New South Wales, Australia
| | - Fiona Mensah
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Clinical Sciences and Biostatistics Unit, Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Francesca Orsini
- Clinical Sciences and Biostatistics Unit, Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Lisa Gold
- School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
| | - Harriet Hiscock
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, Victoria, Australia
- Population Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Charlene Smith
- Australian Research Alliance for Children and Youth, Canberra City, Australian Capital Territory, Australia
| | - Lara Bishop
- Population Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Dianne Jackson
- Australian Research Alliance for Children and Youth, Canberra City, Australian Capital Territory, Australia
| | - Lynn Kemp
- Ingham Institute, Western Sydney University, Sydney, New South Wales, Australia
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Woolfenden S, Eapen V, Jalaludin B, Hayen A, Kemp L, Dissanyake C, Hendry A, Axelsson E, Overs B, Eastwood J, Črnčec R, McKenzie A, Beasley D, Murphy E, Williams K. Prevalence and factors associated with parental concerns about development detected by the Parents' Evaluation of Developmental Status (PEDS) at 6-month, 12-month and 18-month well-child checks in a birth cohort. BMJ Open 2016; 6:e012144. [PMID: 27609853 PMCID: PMC5020845 DOI: 10.1136/bmjopen-2016-012144] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Early identification of developmental vulnerability is vital. This study aimed to estimate the prevalence of moderate or high developmental risk on the Parents' Evaluation of Developmental Status (PEDS) at 6-month, 12-month and 18-month well-child checks; identify associated risk factors; and examine documentation of the PEDS at well-child checks. DESIGN, PARTICIPANTS A prospective birth cohort of 2025 children with 50% of those approached agreeing to participate. Demographic data were obtained via questionnaires and linked electronic medical records. Telephone interviews were conducted with parents to collect PEDS data. PRIMARY AND SECONDARY OUTCOMES Multiple logistic regression analyses identified risk factors for moderate or high developmental risk on the PEDS. A Cumulative Risk Index examined the impact of multiple risk factors on developmental risk and documentation of the PEDS at the well-child checks. RESULTS Of the original cohort, 792 (39%) had 6-month, 649 (32%) had 12-month and 565 (28%) had 18-month PEDS data. Parental concerns indicating moderate or high developmental risk on the PEDS were 27% (95% CI 24 to 30) at 6 months, 27% (95% CI 24 to 30) at 12 months and 33% (95% CI 29 to 37) at 18 months. Factors associated with moderate or high developmental risk were perinatal risk (OR 12 months: 1.7 (95% CI 1.1 to 2.7)); maternal Middle Eastern or Asian nationality (OR 6 months: 1.6 (95% CI 1.1 to 2.4)), (OR 12 months: 1.7 (95% CI 1.1 to 2.7)); and household disadvantage (OR 6 months: 1.5 (95% CI 1.0 to 2.2). As the number of risk factors increased the odds increased for high or moderate developmental risk and no documentation of the PEDS at well-child checks. CONCLUSIONS Children with multiple risk factors are more likely to have parental concerns indicating developmental vulnerability using the PEDS and for these concerns to not be documented.
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Affiliation(s)
- Susan Woolfenden
- Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Valsamma Eapen
- Academic Unit of Child Psychiatry, South West Sydney Local Health District (AUCS), Sydney, New South Wales, Australia
- School of Psychiatry & Ingham Institute, University of New South Wales, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Bin Jalaludin
- Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- Epidemiology Group, Healthy People and Places Unit, South Western Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Hayen
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Lynn Kemp
- School of Nursing and Midwifery, University of Western Sydney, Penrith South DC, New South Wales, Australia
| | - Cheryl Dissanyake
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, South Australia, Australia
| | - Alexandra Hendry
- Early Years Research Group, Ingham Institute, Sydney South West Local Health District, Sydney, New South Wales, Australia
| | - Emma Axelsson
- Academic Unit of Child Psychiatry, South West Sydney Local Health District (AUCS), Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Bronwyn Overs
- Academic Unit of Child Psychiatry, South West Sydney Local Health District (AUCS), Sydney, New South Wales, Australia
| | - John Eastwood
- Community Paediatrics, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Rudi Črnčec
- Academic Unit of Child Psychiatry, South West Sydney Local Health District (AUCS), Sydney, New South Wales, Australia
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Anne McKenzie
- Sydney South West Local Health District, Australia,Sydney, New South Wales, Australia
| | - Deborah Beasley
- Office of Kids and Families (NSW Health), North Sydney, New South Wales, Australia
| | - Elisabeth Murphy
- Office of Kids and Families (NSW Health), North Sydney, New South Wales, Australia
| | - Katrina Williams
- Department of Paediatrics, University of Melbourne, Melbourne, South Australia, Australia
- Developmental Medicine, Royal Children's Hospital, Melbourne, South Australia, Australia
- Murdoch Children's Research Institute, Melbourne, South Australia, Australia
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Pina-Oliveira AA, Moreira RL, Pécora RAF, Chiesa AM. Analysis of the process of translation of knowledge regarding early childhood at the undergraduate level. Rev Esc Enferm USP 2014; 48 Spec No:160-7. [PMID: 25517850 DOI: 10.1590/s0080-623420140000600023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/05/2014] [Indexed: 11/21/2022] Open
Abstract
Objective To analyze innovative contents on Early Child Development Promotion. Method This action-research involves nine faculties from four Higher Education Institutions at inner-state of São Paulo, Brazil.Data were collected by syllabi analyses (2009-2011), interviews and focus group. We have adopted an ECDP underpinning from international consensus, thus evaluating KT Results We have found relevant incorporation between teaching and extension in Nursing (87,5%) and Psychology (75%) undergraduate courses, while Pedagogy was restricted to teaching. Conclusion This KT evaluation has evinced innovative potential of extension, regardless teaching and research, for a better Early Childhood.
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Festa N, Loftus PD, Cullen MR, Mendoza FS. Disparities in early exposure to book sharing within immigrant families. Pediatrics 2014; 134:e162-8. [PMID: 24918215 DOI: 10.1542/peds.2013-3710] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study examined the early developmental context of children in immigrant families (CIF), measured by the frequency with which parents share books with their children. METHODS Trends in the frequency with which parents report book sharing, defined in this analysis as reading or sharing picture books with their young children, were analyzed across immigrant and nonimmigrant households by using data from the 2005, 2007, and 2009 California Health Interview Survey. Stepwise multivariate logistic regression assessed the likelihood that CIF shared books with parents daily. RESULTS In this study, 57.5% of parents in immigrant families reported daily book sharing (DBS), compared with 75.8% of native-born parents. The lowest percentage of DBS was seen in Hispanic families with 2 foreign-born parents (47.1%). When controlling for independent variables, CIF with 2 foreign-born parents had the lowest odds of sharing books daily (odds ratio [OR]: 0.61; 95% confidence interval [CI]: 0.54-0.68). When stratified by race/ethnicity, separate multivariate logistic regressions revealed CIF status to be associated with lower odds of DBS for Asian (OR: 0.56; 95% CI: 0.38-0.81) and Hispanic CIF (OR: 0.49; 95% CI: 0.42-0.58). CONCLUSIONS There is an association between the lower odds of DBS and parental immigrant status, especially for Hispanic and Asian children. This relationship holds after controlling for variables thought to explain differences in literacy-related practices, such as parental education and income. Because book sharing is central to children's development of early literacy and language skills, this disparity merits further exploration with the aim of informing future interventions.
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Affiliation(s)
- Natalia Festa
- School of Medicine, Stanford University, Stanford, California
| | - Pooja D Loftus
- School of Medicine, Stanford University, Stanford, California;Division of General Medical Disciplines, Department of Medicine, and
| | - Mark R Cullen
- School of Medicine, Stanford University, Stanford, California;Division of General Medical Disciplines, Department of Medicine, and
| | - Fernando S Mendoza
- School of Medicine, Stanford University, Stanford, California;Division of General Pediatrics, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
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Developmental and mental health disorders: two sides of the same coin. Asian J Psychiatr 2014; 8:7-11. [PMID: 24655619 DOI: 10.1016/j.ajp.2013.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/05/2013] [Accepted: 10/09/2013] [Indexed: 02/07/2023]
Abstract
Children with developmental disorders (DD) are at substantially greater risk of developing mental health problems compared to typically developing children. However, the mental health co-morbidity is often missed or hidden in the context of DD leading to reduced quality of life and increased burden of care. Mental health problems in the context of DD also result in less optimal school and post-school outcomes with reduced opportunities for employment and community participation. There is also considerable overlap in the risk factors for both conditions, and these follow a cumulative risk model. Although awareness among clinicians and the public is improving, there is paucity of theoretical models, early identification frameworks as well as care pathways for interventions. This paper presents a framework for evaluating developmental vulnerability that highlights common risk factors for developmental and mental health disorders.
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