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Tsang TW, Allen T, Turner A, Bowyer J, Fitzpatrick J, Latimer J, Oscar J, Carter M, Elliott EJ. Ophthalmic Findings in Aboriginal Children with High Rates of Prenatal Alcohol Exposure and Fetal Alcohol Spectrum Disorder: The Lililwan Project. Ophthalmic Epidemiol 2024:1-8. [PMID: 38569083 DOI: 10.1080/09286586.2024.2331539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 03/08/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE To describe ophthalmic findings in an Indigenous paediatric population and the associations between fetal alcohol spectrum disorder (FASD), prenatal alcohol exposure (PAE), and eye anomalies. METHODS Medical records were reviewed for eye problems, and eye assessments were conducted by an orthoptist or ophthalmologist in the Lililwan Project cohort, which comprised 108 (81%) of all children born between 2002 and 2003, and residing in the remote Fitzroy Valley, Western Australia in 2010. Values from ophthalmic assessments and prevalence of abnormalities were presented for the total cohort and stratified by group: FASD; PAE (no FASD); and No PAE. RESULTS Of children, 55% had PAE and 19% FASD. Most (98%) had normal vision; 15.6% had keratometry cylinder values indicating astigmatism and potential for improved vision with glasses. Strabismus (22.3%), short palpebral fissure length (PFL; 21.3%), upslanting palpebral fissures (12.0%), follicular trachomatous inflammation (6.9%), abnormal slit lamp assessments (6.7%), retinal tortuosity (6.7%), and blepharoptosis (5.6%) were identified. Strabismus and trachoma rates were higher than in the general child population. Ophthalmic findings were similar between groups except for prevalence of short PFL (FASD > No PAE; p = 0.003); abnormal keratometry cylinder values (FASD [29.4%] and PAE (no FASD) [20.0%] > No PAE [5.3%]; p = 0.031) and blepharoptosis (FASD [9.5%] > other groups [0%]; p = 0.040). CONCLUSION Despite the small sample, some eye abnormalities were higher in children with PAE and/or FASD. Access to eye services or assessment of vision and structural eye anomalies is essential for Indigenous children, particularly those with PAE or FASD to allow early effective treatment.
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Affiliation(s)
- Tracey W Tsang
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Sydney Children's Hospital Network, Kids Research, Westmead, New South Wales, Australia
| | - Tiffany Allen
- Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Angus Turner
- Lions Eye Institute, Nedlands, Washington, Australia
- University of Western Australia, Perth, Western Australia, Australia
| | - Joshua Bowyer
- Lions Eye Institute, Nedlands, Washington, Australia
- University of Western Australia, Perth, Western Australia, Australia
- St. John of God Hospital Midland, Midland, Western Australia, Australia
| | - James Fitzpatrick
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| | - Jane Latimer
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - June Oscar
- Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, Australia
| | - Elizabeth J Elliott
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Sydney Children's Hospital Network, Kids Research, Westmead, New South Wales, Australia
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Thompson DK, Kelly CE, Dhollander T, Muggli E, Hearps S, Lewis S, Nguyen TNN, Spittle A, Elliott EJ, Penington A, Halliday J, Anderson PJ. Associations between low-moderate prenatal alcohol exposure and brain development in childhood. Neuroimage Clin 2024; 42:103595. [PMID: 38555806 PMCID: PMC10998198 DOI: 10.1016/j.nicl.2024.103595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND The effects of low-moderate prenatal alcohol exposure (PAE) on brain development have been infrequently studied. AIM To compare cortical and white matter structure between children aged 6 to 8 years with low-moderate PAE in trimester 1 only, low-moderate PAE throughout gestation, or no PAE. METHODS Women reported quantity and frequency of alcohol consumption before and during pregnancy. Magnetic resonance imaging was undertaken for 143 children aged 6 to 8 years with PAE during trimester 1 only (n = 44), PAE throughout gestation (n = 58), and no PAE (n = 41). T1-weighted images were processed using FreeSurfer, obtaining brain volume, area, and thickness of 34 cortical regions per hemisphere. Fibre density (FD), fibre cross-section (FC) and fibre density and cross-section (FDC) metrics were computed for diffusion images. Brain measures were compared between PAE groups adjusted for age and sex, then additionally for intracranial volume. RESULTS After adjustments, the right caudal anterior cingulate cortex volume (pFDR = 0.045) and area (pFDR = 0.008), and right cingulum tract cross-sectional area (pFWE < 0.05) were smaller in children exposed to alcohol throughout gestation compared with no PAE. CONCLUSION This study reports a relationship between low-moderate PAE throughout gestation and cingulate cortex and cingulum tract alterations, suggesting a teratogenic vulnerability. Further investigation is warranted.
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Affiliation(s)
- Deanne K Thompson
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Victoria, Australia; Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Claire E Kelly
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Thijs Dhollander
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Evelyne Muggli
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Stephen Hearps
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Victoria, Australia
| | | | - Alicia Spittle
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Physiotherapy, The University of Melbourne, Victoria, Australia
| | - Elizabeth J Elliott
- The University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia; Kids Research, Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
| | - Anthony Penington
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Victoria, Australia; Royal Children's Hospital, Parkville, Victoria, Australia
| | - Jane Halliday
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Victoria, Australia
| | - Peter J Anderson
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia.
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Rice LJ, Cannon L, Dadlani N, Cheung MMY, Einfeld SL, Efron D, Dossetor DR, Elliott EJ. Efficacy of cannabinoids in neurodevelopmental and neuropsychiatric disorders among children and adolescents: a systematic review. Eur Child Adolesc Psychiatry 2024; 33:505-526. [PMID: 36864363 PMCID: PMC10869397 DOI: 10.1007/s00787-023-02169-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/14/2023] [Indexed: 03/04/2023]
Abstract
A better understanding of the endocannabinoid system and a relaxation in regulatory control of cannabis globally has increased interest in the medicinal use of cannabinoid-based products (CBP). We provide a systematic review of the rationale and current clinical trial evidence for CBP in the treatment of neuropsychiatric and neurodevelopmental disorders in children and adolescents. A systematic search of MEDLINE, Embase, PsycINFO, and the Cochrane Central Register of Trials was performed to identify articles published after 1980 about CBP for medical purposes in individuals aged 18 years or younger with selected neuropsychiatric or neurodevelopmental conditions. Risk of bias and quality of evidence was assessed for each article. Of 4466 articles screened, 18 were eligible for inclusion, addressing eight conditions (anxiety disorders (n = 1); autism spectrum disorder (n = 5); foetal alcohol spectrum disorder (n = 1); fragile X syndrome (n = 2); intellectual disability (n = 1); mood disorders (n = 2); post-traumatic stress disorder (n = 3); and Tourette syndrome (n = 3)). Only one randomised controlled trial (RCT) was identified. The remaining seventeen articles included one open-label trial, three uncontrolled before-and-after trials, two case series and 11 case reports, thus the risk of bias was high. Despite growing community and scientific interest, our systematic review identified limited and generally poor-quality evidence for the efficacy of CBP in neuropsychiatric and neurodevelopmental disorders in children and adolescents. Large rigorous RCTs are required to inform clinical care. In the meantime, clinicians must balance patient expectations with the limited evidence available.
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Affiliation(s)
- Lauren J Rice
- The University of Sydney, Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Sydney, NSW, Australia.
- Sydney Children's Hospitals Network, Kids Research, Sydney, Australia.
- The University of Sydney, Faculty of Medicine and Health, Brain and Mind Centre, Sydney, NSW, Australia.
| | - Lisa Cannon
- The University of Sydney, Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Sydney, NSW, Australia
- Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia
| | - Navin Dadlani
- The University of Sydney, Faculty of Medicine and Health, Brain and Mind Centre, Sydney, NSW, Australia
| | - Melissa Mei Yin Cheung
- The University of Sydney, Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Sydney, NSW, Australia
- Sydney Children's Hospitals Network, Kids Research, Sydney, Australia
| | - Stewart L Einfeld
- The University of Sydney, Faculty of Medicine and Health, Brain and Mind Centre, Sydney, NSW, Australia
| | - Daryl Efron
- Department of General Paediatrics, Health Services, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - David R Dossetor
- Sydney Children's Hospitals Network, Kids Research, Sydney, Australia
| | - Elizabeth J Elliott
- The University of Sydney, Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Sydney, NSW, Australia
- Sydney Children's Hospitals Network, Kids Research, Sydney, Australia
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Phan J, Eslick GD, Elliott EJ. Demystifying the global outbreak of severe acute hepatitis of unknown aetiology in children: A systematic review and meta-analysis. J Infect 2024; 88:2-14. [PMID: 38007049 DOI: 10.1016/j.jinf.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND The sudden outbreak of severe acute hepatitis of unknown aetiology (SAHUA) in the first half of 2022 affected more than 1010 children in 35 countries worldwide. Dire clinical outcomes, such as acute liver failure necessitating transplantation, neurological symptoms, long-term sequelae, and death, highlight the need to determine the pathogenesis of this condition. Hypotheses on the aetiology include adenovirus and SARS-CoV-2 infections and an aberrant immune response to multiple pathogen exposure following lifting of lockdown measures but further investigation is required to reach an informed consensus. METHODS A literature search was performed on MEDLINE and EMBASE in accordance with PRISMA guidelines for systematic reviews. Primary studies reporting data on severe acute hepatitis of unknown aetiology in children from the COVID-19 era were selected for inclusion in our review. Data on patient demographics, clinical presentation and outcomes, and diagnostic testing for coinfection were extracted. Meta-analysis used a random-effects model. RESULTS The 33 included studies (30 case series and 3 case-control studies) described a total of 3636 cases of SAHUA (reported 1 January, 2019-31 December, 2022), with a median age of 3.5 years. Of these, 214 children (5.9%) received a liver transplant and 66 (1.8%) died. Whilst data on diagnostic testing was incomplete, the most frequently detected coinfections were with adenovirus and/or adeno-associated virus 2 (AAV2). Other common childhood respiratory and enteric pathogens, such as enterovirus, rhinovirus, and herpesviruses (EBV and HHV-6), were also identified. CONCLUSION Coinfection with AAV2 and other common childhood pathogens may predispose children to develop this novel severe hepatitis. Altered susceptibility and response to such pathogens may be a consequence of immunological naivety following pandemic restrictions. Further investigations are needed to generate high-quality evidence on aetiology for different patient demographics and geographical areas.
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Affiliation(s)
- Julie Phan
- The Australian Paediatric Surveillance Unit [APSU], The Kids Research Institute, The Children's Hospital, Westmead, Westmead, New South Wales, Australia
| | - Guy D Eslick
- The Australian Paediatric Surveillance Unit [APSU], The Kids Research Institute, The Children's Hospital, Westmead, Westmead, New South Wales, Australia.
| | - Elizabeth J Elliott
- The Australian Paediatric Surveillance Unit [APSU], The Kids Research Institute, The Children's Hospital, Westmead, Westmead, New South Wales, Australia
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Teutsch SM, Nunez CA, Morris A, Eslick GD, Elliott EJ. Erratum to Commun Dis Intell (2018) 2023;47. (https://doi.org/10.33321/cdi.2023.47.46). Commun Dis Intell (2018) 2023; 47. [PMID: 37857553 DOI: 10.33321/cdi.2023.47.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Indexed: 10/21/2023]
Abstract
The text within this report, as originally published, incorrectly stated that the two included cases of dengue had not recently travelled to a dengue-endemic country. A reexamination of the case data has shown that both cases had recently travelled to a country where dengue is endemic. The paragraph below provides the corrected text for the dengue case descriptions, and replaces the paragraph at the foot of the right-hand column of text on page 10 of the published report. In 2022, two cases of dengue were notified to the APSU, one confirmed and one probable (Table 1), and the incidence estimate for the surveillance period (1 February - 31 December 2022) is shown in Table 2. Neither child had a prior history of dengue; however, both had recently travelled to an endemic country. One had DENV2 serotype and the serotype was not recorded for the second child. Both children were hospitalised and symptoms included fever, rash, cough, severe abdominal pain, diarrhoea, fatigue, retro-orbital pain and myalgia/arthralagia joint pains. One child had respiratory co-infection with human metapneumovirus. Both children received supportive therapies (intravenous fluids, pain relief) and one child received ceftriaxone. On discharge, one child had ongoing problems including arthralgia, fatigue, thrombocytopaenia and hepatitis.
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Affiliation(s)
- Suzy M Teutsch
- The Australian Paediatric Surveillance Unit; The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia; The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia.
| | - Carlos A Nunez
- The Australian Paediatric Surveillance Unit; The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia; The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
| | - Anne Morris
- The Australian Paediatric Surveillance Unit; The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia; The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
| | - Guy D Eslick
- The Australian Paediatric Surveillance Unit; The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia; The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
| | - Elizabeth J Elliott
- The Australian Paediatric Surveillance Unit; The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia; The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
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Eslick GD, Teutsch SM, Elliott EJ. Japanese encephalitis virus: changing the clinical landscape of encephalitis in Australia. Med J Aust 2023; 219:393. [PMID: 37640507 DOI: 10.5694/mja2.52090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Guy D Eslick
- University of Sydney, Sydney, NSW
- Australian Paediatric Surveillance Unit, Children's Hospital at Westmead, Sydney, NSW
| | - Suzy M Teutsch
- University of Sydney, Sydney, NSW
- Australian Paediatric Surveillance Unit, Children's Hospital at Westmead, Sydney, NSW
| | - Elizabeth J Elliott
- University of Sydney, Sydney, NSW
- Australian Paediatric Surveillance Unit, Children's Hospital at Westmead, Sydney, NSW
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Rogers AM, Youssef GJ, Teague S, Sunderland M, Le Bas G, Macdonald JA, Mattick RP, Allsop S, Elliott EJ, Olsson CA, Hutchinson D. Association of maternal and paternal perinatal depression and anxiety with infant development: A longitudinal study. J Affect Disord 2023; 338:278-288. [PMID: 37302506 DOI: 10.1016/j.jad.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Maternal and paternal perinatal depression and anxiety are theorised to adversely impact infant development. Yet, few studies have assessed both mental health symptoms and clinical diagnoses within the one study. Moreover, research on fathers is limited. This study therefore aimed to examine the association between symptoms and diagnoses of maternal and paternal perinatal depression and anxiety with infant development. METHOD Data were from the Triple B Pregnancy Cohort Study. Participants included 1539 mothers and 793 partners. Depressive and anxiety symptoms were assessed using the Edinburgh Postnatal Depression Scale and Depression Anxiety Stress Scales. Major depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder, and agoraphobia were assessed using the Composite International Diagnostic Interview in trimester three. Infant development was assessed at 12-months using the Bayley Scales of Infant and Toddler Development. RESULTS Antepartum, maternal depressive and anxiety symptoms were associated with poorer infant social-emotional (d = -0.11, p = .025) and language development (d = -0.16, p = .001). At 8-weeks postpartum, maternal anxiety symptoms were associated with poorer overall development (d = -0.11, p = .030). No association was observed for clinical diagnoses in mothers, nor paternal depressive and anxiety symptoms or clinical diagnoses; albeit risk estimates were largely in the expected direction of adverse effects on infant development. CONCLUSIONS Evidence suggests that maternal perinatal depression and anxiety symptoms may adversely impact infant development. Effects were small but findings underscore the importance of prevention, early screening and intervention, alongside consideration of other risk factors during early critical periods.
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Affiliation(s)
- Alana M Rogers
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Victoria, Australia.
| | - George J Youssef
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Victoria, Australia.
| | - Samantha Teague
- Department of Psychology, College of Healthcare Sciences, James Cook University, Queensland, Australia.
| | - Matthew Sunderland
- University of Sydney, Matilda Centre for Research in Mental Health and Substance Use, New South Wales, Australia.
| | - Genevieve Le Bas
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Victoria, Australia.
| | - Jacqui A Macdonald
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Victoria, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Melbourne, Australia; University of Melbourne, Department of Paediatrics, Royal Children's Hospital, Australia.
| | - Richard P Mattick
- The University of New South Wales, National Drug and Alcohol Research Centre, New South Wales, Australia.
| | - Steve Allsop
- Curtin University, National Drug Research Institute, Western Australia, Australia.
| | - Elizabeth J Elliott
- University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescence, New South Wales, Australia; Sydney Children's Hospitals Network, Westmead, Sydney, Australia.
| | - Craig A Olsson
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Victoria, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Melbourne, Australia; University of Melbourne, Department of Paediatrics, Royal Children's Hospital, Australia.
| | - Delyse Hutchinson
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Victoria, Australia; The University of New South Wales, National Drug and Alcohol Research Centre, New South Wales, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Melbourne, Australia; University of Melbourne, Department of Paediatrics, Royal Children's Hospital, Australia.
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Teutsch SM, Nunez CA, Morris A, Eslick GD, Elliott EJ. Australian Paediatric Surveillance Unit (APSU) Annual Surveillance Report 2022. Commun Dis Intell (2018) 2023; 47. [PMID: 37817313 DOI: 10.33321/cdi.2023.47.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Indexed: 10/12/2023]
Abstract
For 30 years the Australian Paediatric Surveillance Unit (APSU) has conducted national surveillance of rare communicable diseases and rare complications of communicable diseases. In this report, we describe the results of thirteen such studies surveyed by the APSU in 2022, including reported case numbers and incidence estimates, demographics, clinical features, management and short-term outcomes. Conditions described are: acute flaccid paralysis (AFP); congenital cytomegalovirus (cCMV); neonatal and infant herpes simplex virus (HSV) infection; perinatal exposure to human immunodeficiency virus (HIV) and paediatric HIV infection; severe complications of influenza; juvenile-onset recurrent respiratory papillomatosis (JoRRP); congenital rubella infection/syndrome; congenital varicella syndrome (CVS) and neonatal varicella infection (NVI); and the new conditions dengue; Q fever; and severe acute hepatitis. In 2022, cases of severe complications of influenza were reported to the APSU for the first time since 2019. This likely reflects the easing of government-mandated restrictions imposed in 2020-2021 to curb the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the re-emergence of a range of infectious diseases. As previously, AFP surveillance by the APSU contributed to Australia achieving a minimum target incidence of one AFP case per 105 children aged less than 15 years. Cases of JoRRP and NVI were reported in 2022. This indicates potential gaps in human papillomavirus (HPV) and varicella vaccination coverage respectively, especially in high-risk groups such as young migrant and refugee women of childbearing age from countries without universal vaccination programs. Paediatric HIV case numbers resulting from mother-to-child-transmission (MTCT) of HIV remain low in Australia due to use of effective intervention strategies. However, there has been an increase in the number of imported cases of HIV in children (mainly perinatally-acquired) from countries with a high HIV prevalence. Without effective vaccines, there has been no decline in the incidence of congenital CMV and neonatal HSV, indicating the importance of early identification and management to reduce morbidity and mortality. The first cases of dengue, Q fever and severe acute hepatitis were received by APSU in 2022, including two cases of acute hepatitis in which aetiology has not been confirmed to date. The APSU has an important ongoing role in monitoring rare childhood infections.
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Affiliation(s)
- Suzy M Teutsch
- The Australian Paediatric Surveillance Unit;The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia; The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia.
| | - Carlos A Nunez
- The Australian Paediatric Surveillance Unit;The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia; The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
| | - Anne Morris
- The Australian Paediatric Surveillance Unit;The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia; The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
| | - Guy D Eslick
- The Australian Paediatric Surveillance Unit;The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia; The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
| | - Elizabeth J Elliott
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia; The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia; Director of the Australian Paediatric Surveillance Unit
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9
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Hayes N, Bagley K, Hewlett N, Elliott EJ, Pestell CF, Gullo MJ, Munn Z, Middleton P, Walker P, Till H, Shanley DC, Young SL, Boaden N, Hutchinson D, Kippin NR, Finlay‐Jones A, Friend R, Shelton D, Crichton A, Reid N. Lived experiences of the diagnostic assessment process for fetal alcohol spectrum disorder: A systematic review of qualitative evidence. Alcohol Clin Exp Res (Hoboken) 2023; 47:1209-1223. [PMID: 37132046 PMCID: PMC10947124 DOI: 10.1111/acer.15097] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/21/2023] [Indexed: 05/04/2023]
Abstract
Early assessment and diagnosis of FASD are crucial in providing therapeutic interventions that aim to enhance meaningful participation and quality of life for individuals and their families, while reducing psychosocial difficulties that may arise during adolescence and adulthood. Individuals with lived experience of FASD have expertise based on their own lives and family needs. Their insights into the assessment and diagnostic process are valuable for improving service delivery and informing the provision of meaningful, person- and family-centered care. To date, reviews have focused broadly on the experiences of living with FASD. The aim of this systematic review is to synthesize qualitative evidence on the lived experiences of the diagnostic assessment process for FASD. Six electronic databases, including PubMed, the Cochrane Library, CINAH, EMBASE, PsycINFO, and Web of Science Core Collection were searched from inception until February 2021, and updated in December 2022. A manual search of reference lists of included studies identified additional studies for inclusion. The quality of included studies was assessed using the Critical Appraisal Skills Program Checklist for Qualitative Studies. Data from included studies were synthesized using a thematic analysis approach. GRADE-CERQual was used to assess confidence in the review findings. Ten studies met the selection criteria for inclusion in the review. Thematic analysis identified 10 first-level themes relating to four over-arching topics: (1) pre-assessment concerns and challenges, (2) the diagnostic assessment process, (3) receipt of the diagnosis, and (4) post-assessment adaptations and needs. GRADE-CERQual confidence ratings for each of the review themes were moderate to high. The findings from this review have implications for referral pathways, client-centered assessment processes, and post-diagnostic recommendations and support.
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Affiliation(s)
- Nicole Hayes
- Child Health Research CentreThe University of QueenslandSouth BrisbaneQueenslandAustralia
- Australian Research Council Centre of Excellence for the Digital ChildQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Kerryn Bagley
- La Trobe Rural Health SchoolLa Trobe UniversityBendigoVictoriaAustralia
- Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | - Nicole Hewlett
- Child Health Research CentreThe University of QueenslandSouth BrisbaneQueenslandAustralia
- First Nations Cancer and Wellbeing Research TeamThe University of QueenslandHerstonQueenslandAustralia
| | - Elizabeth J. Elliott
- Faculty of Medicine and Health, Specialty of Child and Adolescent HealthThe University of SydneySydneyNew South WalesAustralia
- The Sydney Children's Hospitals NetworkSydneyNew South WalesAustralia
| | - Carmela F. Pestell
- School of Psychological ScienceUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Matthew J. Gullo
- School of Applied PsychologyGriffith UniversityMount GravattQueenslandAustralia
| | - Zachary Munn
- Health Evidence Synthesis, Recommendations and Impact, School of Public Health, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Philippa Middleton
- South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- The University of AdelaideAdelaideSouth AustraliaAustralia
| | - Prue Walker
- Victorian Fetal Alcohol ServiceMonash Children's HospitalClaytonVictoriaAustralia
- Australian Childhood FoundationAbbotsfordVictoriaAustralia
| | - Haydn Till
- Child Development ServiceGold Coast Hospital and Health ServiceSouthportQueenslandAustralia
- School of Applied PsychologyGriffith UniversityGold CoastQueenslandAustralia
| | - Dianne C. Shanley
- School of Applied PsychologyGriffith UniversityGold CoastQueenslandAustralia
- Menzies Health Institute of QueenslandGriffith UniversityGold CoastQueenslandAustralia
| | - Sophia L. Young
- Child Health Research CentreThe University of QueenslandSouth BrisbaneQueenslandAustralia
| | - Nirosha Boaden
- School of Social Sciences, Faculty of Social WorkThe University of New South WalesSydneyNew South WalesAustralia
| | - Delyse Hutchinson
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
- National Drug and Alcohol Research CentreThe University New South WalesSydneyNew South WalesAustralia
- Centre for Adolescent HealthMurdoch Children's Research Institute, Royal Children's HospitalMelbourneVictoriaAustralia
- Department of PaediatricsUniversity of Melbourne, Royal Children's HospitalMelbourneVictoriaAustralia
| | - Natalie R. Kippin
- Curtin School of Allied HealthCurtin UniversityWestern AustraliaBentleyAustralia
| | - Amy Finlay‐Jones
- Telethon Kids InstituteNedlandsWestern AustraliaAustralia
- School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia
- Medical SchoolUniversity of Western AustraliaCrawleyWestern AustraliaAustralia
| | - Rowena Friend
- Patches Assessment ServiceDarwinNorthern TerritoryAustralia
- Faculty of HealthCharles Darwin UniversityDarwinNorthern TerritoryAustralia
| | - Doug Shelton
- School of Medicine and DentistryGriffith UniversityGold CoastQueenslandAustralia
- Community Child HealthGold Coast Hospital and Health ServiceSouthportQueenslandAustralia
| | - Alison Crichton
- Victorian Fetal Alcohol ServiceMonash Children's HospitalClaytonVictoriaAustralia
- Department of PaediatricsMonash UniversityMelbourneVictoriaAustralia
| | - Natasha Reid
- Child Health Research CentreThe University of QueenslandSouth BrisbaneQueenslandAustralia
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10
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Nunez C, Morris A, Elliott EJ. National surveillance of severe microcephaly in Australia. Acta Paediatr 2023. [PMID: 37183370 DOI: 10.1111/apa.16846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/11/2023] [Accepted: 05/12/2023] [Indexed: 05/16/2023]
Affiliation(s)
- Carlos Nunez
- The University of Sydney. Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, NSW, Australia
- The Australian Paediatric Surveillance Unit (APSU). Sydney, NSW, Australia
| | - Anne Morris
- The University of Sydney. Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, NSW, Australia
- The Australian Paediatric Surveillance Unit (APSU). Sydney, NSW, Australia
- Kids Research, The Sydney Children's Hospitals Network (Westmead), Sydney, NSW, Australia
| | - Elizabeth J Elliott
- The University of Sydney. Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, NSW, Australia
- The Australian Paediatric Surveillance Unit (APSU). Sydney, NSW, Australia
- Kids Research, The Sydney Children's Hospitals Network (Westmead), Sydney, NSW, Australia
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11
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Nunez C, Eslick GD, Elliott EJ. Toppling television injuries in children and adolescents: a systematic review and meta-analysis. Inj Prev 2023; 29:195-199. [PMID: 36690352 DOI: 10.1136/ip-2022-044773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/18/2022] [Indexed: 01/24/2023]
Abstract
CONTEXT Toppling televisions (TVs) are a source of childhood injury but meta-analysis has not assessed the likelihood of TV injuries in children. OBJECTIVE To present pooled results for injuries, following a systematic review. DATA SOURCES MEDLINE, Scopus, Google Scholar and EMBASE databases were searched to 5 December 2022. STUDY SELECTION Included studies met the following criteria: (1) assessed toppling TV injuries in paediatric populations; (2) reported point estimates as an OR or enabled its calculation and (3) used a comparison group. DATA EXTRACTION A standardised form was used to include information on publication year, study design, population type, country, sample size, mean age, risk factors, point estimates or data used to calculate ORs. RESULTS A total of 12 803 TV injuries were identified (five studies). Head and neck injuries (OR: 2.13, 95% CI: 1.21 to 3.75) and hospital admission (OR: 2.28, 95% CI: 1.80 to 2.90) were more likely in children aged under 6 years than over 6 years. Conversely, torso injuries were less likely in younger children (OR: 0.60, 95% CI: 0.51 to 0.70). Children under 6 were two and a half times more likely to die or be admitted to an intensive care unit (ICU) as a result of toppling TVs, although this was not statistically significant. Males did not sustain more TV injuries than females. CONCLUSIONS Children aged under 6 years are more likely to die, sustain head injuries and require hospital treatment from toppling TVs. Strategies for injury prevention must go beyond warning labels to include community education, promotion and use of tip restraint devices, mandatory safety standards and a commitment from manufacturers to improve TV sets stability.
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Affiliation(s)
- Carlos Nunez
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Australian Paediatric Surveillance Unit, Sydney, New South Wales, Australia
| | - Guy D Eslick
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Australian Paediatric Surveillance Unit, Sydney, New South Wales, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Australian Paediatric Surveillance Unit, Sydney, New South Wales, Australia
- Kid's Research, Sydney Children's Hospitals Network (Westmead), Sydney, NSW, Australia
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12
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Walker J, Teutsch S, Morris A, Eslick GD, Hassan Al Imam M, Khan A, Booy R, Elliott EJ, Khandaker G. Active prospective national surveillance for congenital and neonatal varicella in Australia shows potential prevention opportunities. Vaccine X 2023; 13:100278. [PMID: 36874633 PMCID: PMC9978842 DOI: 10.1016/j.jvacx.2023.100278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
To compare the incidence and outcomes of congenital and neonatal varicella in Australia in the pre-vaccination (1995-1997) and post-vaccination era (after 2005 to November 2020), active prospective national surveillance for congenital varicella syndrome (CVS) and neonatal varicella infection (NVI) was conducted through the Australian Paediatric Surveillance Unit (APSU). Compared with 1995-1997, there was a 91.5% reduction in the incidence of CVS and a 91.3% reduction in the incidence of NVI in 2009-2020. However, almost half of the mothers in 2009-2020 were born overseas and came from countries without a vaccination program. Although there has been a substantial and sustained decrease in the reported incidence of CVS and NVI in Australia since 2006, congenital and neonatal varicella infections persist. Thus, there is an opportunity for targeted screening of varicella in young migrant, asylum seeker and refugee women at risk of varicella infection and prioritisation for vaccination to prevent CVS and NVI.
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Affiliation(s)
- Jacina Walker
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Suzy Teutsch
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network (Westmead), Sydney, New South Wales, Australia
| | - Anne Morris
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network (Westmead), Sydney, New South Wales, Australia.,The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
| | - Guy D Eslick
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network (Westmead), Sydney, New South Wales, Australia
| | - Mahmudul Hassan Al Imam
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia.,School Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Arifuzzaman Khan
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia.,School of Public Health, The University of Queensland, Brisbane, Australia
| | - Robert Booy
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia.,National Centre for Immunisation Research and Surveillance, Sydney, New South Wales, Australia
| | - Elizabeth J Elliott
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network (Westmead), Sydney, New South Wales, Australia.,The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
| | - Gulam Khandaker
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia.,The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia.,School Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
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13
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Eslick GD, Nunez C, Elliott EJ. Severe and traumatic injuries associated with home trampoline use in children and adolescents: A systematic review. Acad Emerg Med 2023; 30:209-213. [PMID: 36070198 DOI: 10.1111/acem.14594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Guy D Eslick
- The Australian Paediatric Surveillance Unit, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Carlos Nunez
- The Australian Paediatric Surveillance Unit, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth J Elliott
- The Australian Paediatric Surveillance Unit, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
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14
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Abstract
Alcohol readily crosses the placenta and may disrupt fetal development. Harm from prenatal alcohol exposure (PAE) is determined by the dose, pattern, timing and duration of exposure, fetal and maternal genetics, maternal nutrition, concurrent substance use, and epigenetic responses. A safe dose of alcohol use during pregnancy has not been established. PAE can cause fetal alcohol spectrum disorders (FASD), which are characterized by neurodevelopmental impairment with or without facial dysmorphology, congenital anomalies and poor growth. FASD are a leading preventable cause of birth defects and developmental disability. The prevalence of FASD in 76 countries is >1% and is high in individuals living in out-of-home care or engaged in justice and mental health systems. The social and economic effects of FASD are profound, but the diagnosis is often missed or delayed and receives little public recognition. Future research should be informed by people living with FASD and be guided by cultural context, seek consensus on diagnostic criteria and evidence-based treatments, and describe the pathophysiology and lifelong effects of FASD. Imperatives include reducing stigma, equitable access to services, improved quality of life for people with FASD and FASD prevention in future generations.
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Affiliation(s)
- Svetlana Popova
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.
| | - Michael E Charness
- VA Boston Healthcare System, West Roxbury, MA, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Larry Burd
- North Dakota Fetal Alcohol Syndrome Center, Department of Pediatrics, University of North Dakota School of Medicine and Health Sciences, Pediatric Therapy Services, Altru Health System, Grand Forks, ND, USA
| | - Andi Crawford
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - H Eugene Hoyme
- Sanford Children's Genomic Medicine Consortium, Sanford Health, and University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA
| | - Raja A S Mukherjee
- National UK FASD Clinic, Surrey and Borders Partnership NHS Foundation Trust, Redhill, Surrey, UK
| | - Edward P Riley
- Center for Behavioral Teratology, San Diego State University, San Diego, CA, USA
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,New South Wales FASD Assessment Service, CICADA Centre for Care and Intervention for Children and Adolescents affected by Drugs and Alcohol, Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
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15
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Teutsch S, Zurynski Y, Eslick GD, Deverell M, Christodoulou J, Leonard H, Dalkeith T, Johnson SLJ, Elliott EJ. Australian children living with rare diseases: health service use and barriers to accessing care. World J Pediatr 2023:10.1007/s12519-022-00675-6. [PMID: 36653598 PMCID: PMC9848027 DOI: 10.1007/s12519-022-00675-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/08/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Children with rare diseases experience challenges at home and school and frequently require multi-disciplinary healthcare. We aimed to determine health service utilization by Australian children with rare diseases and barriers to accessing healthcare. METHODS Parents completed an online survey on health professional and emergency department (ED) presentations, hospitalization, and barriers to accessing services. Potential barriers to service access included residential location (city, regional, remote) and child health-related functioning, determined using a validated, parent-completed measure-of-function tool. RESULTS Parents of 462 children with over 240 rare diseases completed the survey. Compared with the general population, these children were more likely to be hospitalized [odds ratio (OR) = 17.25, 95% confidence interval (CI) = 15.50-19.20] and present to the ED (OR = 4.15, 95% CI = 3.68-4.68) or a family physician (OR = 4.14, 95% CI = 3.72-4.60). Child functional impairment was nil/mild (31%), moderate (48%) or severe (22%). Compared to children with nil/mild impairment, those with severe impairment were more likely to be hospitalized (OR = 13.39, 95% CI = 7.65-23.44) and present to the ED (OR = 11.16, 95% CI = 6.46-19.27). Most children (75%) lived in major cities, but children from regional (OR = 2.78, 95% CI = 1.72-4.55) and remote areas (OR = 9.09, 95% CI = 3.03-25.00) experienced significantly more barriers to healthcare access than children from major cities. Barriers included distance to travel, out-of-pocket costs, and lack of specialist medical and other health services. CONCLUSIONS Children with rare diseases, especially those with severe functional impairment have an enormous impact on health services, and better integrated multidisciplinary services with patient-centered care are needed. Access must be improved for children living in rural and remote settings.
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Affiliation(s)
- Suzy Teutsch
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia.
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, NSW, Australia.
| | - Yvonne Zurynski
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, NSW, Australia
- Australian Institute of Health Innovation, Center for Healthcare Resilience and Implementation Science, and NHMRC Partnership Centre in Health System Sustainability, Macquarie University, Sydney, NSW, Australia
| | - Guy D Eslick
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, NSW, Australia
| | - Marie Deverell
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, NSW, Australia
- Government Department of Health Western Australia, Perth, WA, Australia
| | - John Christodoulou
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
- Murdoch Children's Research Institute and Victorian Clinical Genetics Services, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
| | - Troy Dalkeith
- Genetic Metabolic Disorders Service, Sydney Children's Hospitals Network, Westmead, NSW, Australia
| | - Sandra L J Johnson
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, NSW, Australia
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16
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Doherty E, Wiggers J, Wolfenden L, Tully B, Lecathelinais C, Attia J, Elliott EJ, Dunlop A, Symonds I, Rissel C, Tsang TW, Kingsland M. Differential effectiveness of a practice change intervention to improve antenatal care addressing alcohol consumption during pregnancy: Exploratory subgroup analyses within a randomised stepped-wedge controlled trial. Midwifery 2023; 116:103528. [PMID: 36334528 DOI: 10.1016/j.midw.2022.103528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A practice change intervention demonstrated improvements in the provision of antenatal care addressing alcohol consumption. The aim of this study was to explore whether the effectiveness of the intervention differed between subgroups of pregnant women and types and location of maternity services. DESIGN AND SETTING Post-hoc exploratory subgroup analyses of the outcomes from a randomised stepped-wedge controlled trial conducted with all public maternity services within three sectors of a local health district in Australia. MEASUREMENTS Two outcomes (receipt of alcohol assessment and complete care) measured at two visit types (initial and subsequent) were included in analyses. Logistic regression models explored interactions between pre-post differences and subgroups of women (age, Aboriginal origin, education level, disadvantage, gravidity and alcohol consumption in pregnancy) and services (geographic remoteness, service and provider type/s) that have been reported to be associated with variation in guideline implementation. FINDINGS Surveys from 5694 women were included in the analyses. For the initial visit, no significant differential intervention effects between subgroups of women or type/location of services were found for either outcome. For subsequent visits, the intervention effect differed significantly only between Aboriginal origin subgroups (Aboriginal OR: 1.95; 95% CI: 0.99-3.85; non-Aboriginal OR: 5.34; 95% CI: 4.17-6.83; p<0.01) and women's alcohol consumption in pregnancy subgroups (consumed alcohol OR: 1.28; 95% CI: 0.59-2.78; not consumed alcohol OR: 5.22; 95% CI: 4.11-6.65; p<0.001) for assessment of alcohol consumption. KEY CONCLUSIONS These exploratory results suggest that the intervention may have had similar effects between different subgroups of women and types and location of services, with the exception of women who were non-Aboriginal and women who had not consumed alcohol, for whom the intervention was potentially more effective. IMPLICATIONS FOR PRACTICE The practice change intervention could be implemented with different maternity service and provider types to effectively support improvements in antenatal care addressing alcohol consumption. These exploratory results provide further data for hypothesis generation regarding targeted areas for the testing of additional strategies that enable Aboriginal women to benefit equally from the intervention, and to ensure those women most in need of care, those consuming alcohol during pregnancy, have their care needs met.
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Affiliation(s)
- Emma Doherty
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia.
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia
| | - Luke Wolfenden
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia
| | - Belinda Tully
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia
| | - Christophe Lecathelinais
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia
| | - John Attia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, New South Wales 2006, Australia; Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales 2145, Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia; Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales 2302, Australia
| | - Ian Symonds
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Chris Rissel
- College of Medicine and Public Health, Flinders University, Casuarina, Northern Territory 0909, Australia
| | - Tracey W Tsang
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, New South Wales 2006, Australia; Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales 2145, Australia
| | - Melanie Kingsland
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia
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17
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Dossetor PJ, Freeman JM, Thorburn K, Oscar J, Carter M, Jeffery HE, Harley D, Elliott EJ, Martiniuk ALC. Health services for aboriginal and Torres Strait Islander children in remote Australia: A scoping review. PLOS Glob Public Health 2023; 3:e0001140. [PMID: 36962992 PMCID: PMC10022200 DOI: 10.1371/journal.pgph.0001140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/21/2022] [Indexed: 02/15/2023]
Abstract
In Australia, there is a significant gap between health outcomes in Indigenous and non-Indigenous children, which may relate to inequity in health service provision, particularly in remote areas. The aim was to conduct a scoping review to identify publications in the academic and grey literature and describe 1) Existing health services for Indigenous children in remote Australia and service use, 2) Workforce challenges in remote settings, 3) Characteristics of an effective health service, and 4) Models of care and solutions. Electronic databases of medical/health literature were searched (Jan 1990 to May 2021). Grey literature was identified through investigation of websites, including of local, state and national health departments. Identified papers (n = 1775) were screened and duplicates removed. Information was extracted and summarised from 116 papers that met review inclusion criteria (70 from electronic medical databases and 45 from the grey literature). This review identified that existing services struggle to meet demand. Barriers to effective child health service delivery in remote Australia include availability of trained staff, limited services, and difficult access. Aboriginal and Community Controlled Health Organisations are effective and should receive increased support including increased training and remuneration for Aboriginal Health Workers. Continuous quality assessment of existing and future programs will improve quality; as will measures that reflect aboriginal ways of knowing and being, that go beyond traditional Key Performance Indicators. Best practice models for service delivery have community leadership and collaboration. Increased resources with a focus on primary prevention and health promotion are essential.
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Affiliation(s)
- Phillipa J Dossetor
- Clinical Medical School, College of Medicine, Biology & Environment, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Joseph M Freeman
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - Kathryn Thorburn
- Nulungu Research Institute, University of Notre Dame, Broome, Australia
| | - June Oscar
- Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, Australia
| | - Heather E Jeffery
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - David Harley
- Clinical Medical School, College of Medicine, Biology & Environment, Australian National University, Canberra, Australian Capital Territory, Australia
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-UQ, The University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth J Elliott
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia
- The Sydney Children's Hospital Network (Westmead), Kids Research, Westmead, Australia
| | - Alexandra L C Martiniuk
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- George Institute for Global Health, Sydney, Australia
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18
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Donnelley E, Teutsch S, Zurynski Y, Nunez C, Khandaker G, Lester-Smith D, Festa M, Booy R, Elliott EJ, Britton PN, Phu A, Handel D. Severe Influenza-Associated Neurological Disease in Australian Children: Seasonal Population-Based Surveillance 2008-2018. J Pediatric Infect Dis Soc 2022; 11:533-540. [PMID: 36153667 DOI: 10.1093/jpids/piac069] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/29/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Influenza-associated neurological disease (IAND) is uncommon but can result in death or neurological morbidity in children. We aimed to describe the incidence, risk factors, and outcome of children with IAND from seasonal influenza in Australia. METHODS We analyzed national, population-based, surveillance data for children aged ≤ 14 years with severe influenza and neurological involvement, over 11 Australian influenza seasons, 2008-2018, by the Australian Paediatric Surveillance Unit. RESULTS There were 633 laboratory-confirmed cases of severe influenza reported. Of these, 165 (26%) had IAND. The average annual incidence for IAND was 3.39 per million children aged ≤ 14 years. Compared to cases without neurological complications, those with IAND were more likely to have a pre-existing neurological disease (odds ratio [OR] 3.03, P < .001), but most children with IAND did not (n = 135, 82%). Children with IAND were more likely to receive antivirals (OR 1.80, P = .002), require intensive care (OR 1.79, P = .001), require ventilation (OR 1.99; P = .001), and die (OR 2.83, P = .004). CONCLUSIONS IAND is a preventable cause of mortality, predominantly in otherwise well children. Incidence estimates validate previous sentinel site estimates from Australia. IAND accounted for a quarter of all severe influenza, is associated with intensive care unit admission, and accounted for half of all influenza deaths.
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Affiliation(s)
- Erin Donnelley
- Department of General Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Suzy Teutsch
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Yvonne Zurynski
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Institute of Health Innovation, National Health and Medical Research Council Partnership Centre for Health System Sustainability, Macquarie University, Sydney, New South Wales, Australia
| | - Carlos Nunez
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Gulam Khandaker
- Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia.,Research Division, Central Queensland University, Queensland, Australia
| | - David Lester-Smith
- Department of General Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marino Festa
- Department of Intensive Care Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Kids Critical Care Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Robert Booy
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Elizabeth J Elliott
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Philip N Britton
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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19
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Lowrie N, Le Bas G, Youssef G, Macdonald JA, Teague S, Rogers A, Sunderland M, Mattick R, Elliott EJ, Allsop S, Burns L, Najman J, Jacobs S, Olsson CA, Hutchinson D. Association of adolescent and young adult depression and anxiety with perinatal mental health in fathers: Findings from an Australian longitudinal study. J Psychiatr Res 2022; 156:206-213. [PMID: 36265257 DOI: 10.1016/j.jpsychires.2022.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 09/07/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
The current study examined associations between preconception diagnoses of major depressive disorder (MDD) and anxiety disorders in adolescence and young adulthood and perinatal depression and anxiety symptoms in early fatherhood. In an Australian community cohort study of health and development, earlier history of MDD and anxiety disorders (extending back to adolescence) were assessed retrospectively in the third trimester of pregnancy via the Composite International Diagnostic Interview. Paternal perinatal depression and anxiety were then assessed prospectively over three timepoints (third trimester of pregnancy, 8 weeks and 12 months postpartum), using established cut-points on the Edinburgh Postnatal Depression Scale and the Depression Anxiety Stress Scales (anxiety subscale). Mixed-effects regression models examined risk associations between preconception diagnoses of MDD and anxiety disorders, and perinatal depression and anxiety symptoms at each timepoint, adjusting for socio-demographic factors and concurrent maternal mental health difficulties. The odds of clinically concerning levels of paternal perinatal depression and anxiety were 6-fold and 4-fold higher, respectively, in men with a preconception history of MDD. The odds of perinatal depression were 3-fold higher in men with a preconception history of an anxiety disorder. Less evidence was found for an association between preconception diagnoses of an anxiety disorder and perinatal anxiety in fathers. Interventions aimed at improving mental health in men during adolescence and young adulthood may promote continued psychological health in men during early fatherhood.
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Affiliation(s)
- Nele Lowrie
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia.
| | - Genevieve Le Bas
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia.
| | - George Youssef
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Royal Children's, Hospital, Melbourne, Australia; University of Melbourne, Department of Paediatrics, Royal Children's Hospital, Melbourne, Australia.
| | - Jacqui A Macdonald
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Royal Children's, Hospital, Melbourne, Australia; University of Melbourne, Department of Paediatrics, Royal Children's Hospital, Melbourne, Australia.
| | - Samantha Teague
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia; James Cook University, Department of Psychology, College of Healthcare Sciences, Townsville, Australia.
| | - Alana Rogers
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia.
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia.
| | - Richard Mattick
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
| | - Elizabeth J Elliott
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; The Sydney Children's Hospitals Network, Westmead, Sydney, Australia.
| | - Steve Allsop
- National Drug Research Institute, Curtin University, Perth, Australia.
| | - Lucinda Burns
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
| | - Jake Najman
- School of Public Health, Faculty of Medicine, University of Queensland, Australia.
| | - Sue Jacobs
- Department of Obstetrics, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
| | - Craig A Olsson
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Royal Children's, Hospital, Melbourne, Australia; University of Melbourne, Department of Paediatrics, Royal Children's Hospital, Melbourne, Australia.
| | - Delyse Hutchinson
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Royal Children's, Hospital, Melbourne, Australia; University of Melbourne, Department of Paediatrics, Royal Children's Hospital, Melbourne, Australia; National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
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20
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Doherty E, Kingsland M, Wiggers J, Wolfenden L, Hall A, McCrabb S, Tremain D, Hollis J, Licata M, Wynne O, Dilworth S, Daly JB, Tully B, Dray J, Bailey KA, Elliott EJ, Hodder RK. The effectiveness of implementation strategies in improving preconception and antenatal preventive care: a systematic review. Implement Sci Commun 2022; 3:121. [PMID: 36419177 PMCID: PMC9682815 DOI: 10.1186/s43058-022-00368-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/03/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Clinical guideline recommendations for addressing modifiable risk factors are not routinely implemented into preconception and antenatal care. This review assessed the effectiveness of implementation strategies in improving health professional provision of preconception and antenatal care addressing tobacco smoking, weight management and alcohol consumption. METHODS A systematic review of randomised and non-randomised studies with a parallel comparison group was conducted. Eligible studies used implementation strategy/ies targeted at health professionals to improve at least one element of preconception and/or antenatal care (smoking: ask, advise, assess, assist, arrange; weight/alcohol: assess, advise, refer) compared to usual practice/control or alternative strategies. Eligible studies were identified via CENTRAL, MEDLINE, EMBASE, Maternity and Infant Care, CINAHL and other sources. Random-effects meta-analyses were conducted where appropriate, with other findings summarised using the direction of effect. The certainty of the pooled evidence was assessed using the GRADE approach. RESULTS Fourteen studies were included in the review. Thirteen were in the antenatal period and 12 tested multiple implementation strategies (median: three). Meta-analyses of RCTs found that implementation strategies compared to usual practice/control probably increase asking (OR: 2.52; 95% CI: 1.13, 5.59; 3 studies; moderate-certainty evidence) and advising (OR: 4.32; 95% CI: 3.06, 6.11; 4 studies; moderate-certainty evidence) about smoking and assessing weight gain (OR: 57.56; 95% CI: 41.78, 79.29; 2 studies; moderate-certainty evidence), and may increase assessing (OR: 2.55; 95% CI: 0.24, 27.06; 2 studies; low-certainty evidence), assisting (OR: 6.34; 95% CI: 1.51, 26.63; 3 studies; low-certainty evidence) and arranging support (OR: 3.55; 95% CI: 0.50, 25.34; 2 studies; low-certainty evidence) for smoking. The true effect of implementation strategies in increasing advice about weight gain (OR: 3.37; 95% CI: 2.34, 4.84; 2 non-randomised studies; very low-certainty evidence) and alcohol consumption (OR: 10.36; 95% CI: 2.37, 41.20; 2 non-randomised studies; very low-certainty evidence) is uncertain due to the quality of evidence to date. CONCLUSIONS Review findings provide some evidence to support the effectiveness of implementation strategies in improving health professional delivery of antenatal care addressing smoking and weight management. Rigorous research is needed to build certainty in the evidence for improving alcohol and weight gain advice, and in preconception care. TRIAL REGISTRATION PROSPERO-CRD42019131691.
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Affiliation(s)
- Emma Doherty
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Melanie Kingsland
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - John Wiggers
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia ,National Centre of Implementation Science, Wallsend, NSW 2287 Australia
| | - Luke Wolfenden
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia ,National Centre of Implementation Science, Wallsend, NSW 2287 Australia
| | - Alix Hall
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Sam McCrabb
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Danika Tremain
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia
| | - Jenna Hollis
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Milly Licata
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Olivia Wynne
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Sophie Dilworth
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Justine B. Daly
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Belinda Tully
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia
| | - Julia Dray
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia
| | - Kylie A. Bailey
- grid.266842.c0000 0000 8831 109XSchool of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW Australia
| | - Elizabeth J. Elliott
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, Camperdown, NSW 2006 Australia ,grid.413973.b0000 0000 9690 854XSydney Children’s Hospital Network, Kids’ Research Institute, Westmead, NSW 2145 Australia
| | - Rebecca K. Hodder
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia ,National Centre of Implementation Science, Wallsend, NSW 2287 Australia
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21
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Teutsch SM, Nunez CA, Morris A, Eslick GD, Berkhout A, Novakovic D, Brotherton JM, McGregor S, Khawar L, Khandaker G, Booy R, Jones CA, Rawlinson W, Thorley BR, Elliott EJ. Australian Paediatric Surveillance Unit (APSU) Annual Surveillance Report 2021. Commun Dis Intell (2018) 2022; 46. [PMID: 36303401 DOI: 10.33321/cdi.2022.46.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The Australian Paediatric Surveillance Unit (APSU) has been conducting surveillance of rare communicable and non-communicable conditions in children since its inception in 1993. In this report, the results are described of surveillance of ten communicable diseases (and complications) for 2021, including the numbers of cases and incidence estimates; demographics; clinical features; and management and short-term outcomes. The included diseases are: acute flaccid paralysis (AFP); congenital cytomegalovirus (CMV); neonatal herpes simplex virus (HSV) infection; paediatric human immunodeficiency virus (HIV) infection; perinatal exposure to HIV; severe complications from influenza; juvenile-onset respiratory papillomatosis (JoRRP); congenital rubella syndrome; congenital varicella syndrome; and neonatal varicella infection. In 2021, cases of JoRRP were reported to the APSU for the first time since 2017, indicating potential gaps in HPV vaccination. AFP surveillance by APSU again contributed to Australia achieving a minimum target incidence of one AFP case per 100,000 children aged < 15 years. There were no cases of children with severe complications of influenza. No cases of varicella or congenital rubella were reported; however, at-risk populations, especially young migrant and refugee women from countries without universal vaccination programs, need to be screened and prioritised for vaccination prior to pregnancy. Cases of perinatal exposure to HIV continue to increase; however, the rate of mother-to-child-transmission remains at low levels due to the use of effective intervention strategies. Case numbers of congenital CMV and neonatal HSV remain steady in the absence of vaccines, prompting the need for greater awareness and education, with recent calls for target screening of at-risk infants for congenital CMV.
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Affiliation(s)
- Suzy M Teutsch
- The Australian Paediatric Surveillance Unit
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health
- The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
| | - Carlos A Nunez
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health
- The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
- The Australian Paediatric Surveillance Unit
| | - Anne Morris
- The Australian Paediatric Surveillance Unit
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health
- The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
| | - Guy D Eslick
- The Australian Paediatric Surveillance Unit
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health
- The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
| | - Angela Berkhout
- Infection Management & Prevention Service, The Queensland Children's Hospital
- The University of Queensland, Faculty of Medicine, Brisbane, Queensland, AUSTRALIA
| | - Daniel Novakovic
- Dr Liang Voice Program, The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Sydney, New South Wales, AUSTRALIA
| | - Julia Ml Brotherton
- Australian Centre for the Prevention of Cervical Cancer
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, AUSTRALIA
| | - Skye McGregor
- The Kirby Institute, The University of New South Wales, Sydney, New South Wales, AUSTRALIA
| | - Laila Khawar
- The Kirby Institute, The University of New South Wales, Sydney, New South Wales, AUSTRALIA
| | - Gulam Khandaker
- Central Queensland Hospital and Health Service, Rockhampton, Queensland, AUSTRALIA
| | - Robert Booy
- The University of Sydney, Faculty of Medicine and Health
- The National Centre for Immunisation Research and Surveillance, Sydney, New South Wales, AUSTRALIA
| | - Cheryl A Jones
- The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, AUSTRALIA
| | - William Rawlinson
- Virology and OTDS Laboratories, NSW Health Pathology Randwick and UNSW Sydney, New South Wales, AUSTRALIA
| | - Bruce R Thorley
- National Enterovirus Reference Laboratory and WHO Polio Regional Reference Laboratory, Victorian Infectious Disease Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, AUSTRALIA
| | - Elizabeth J Elliott
- The Australian Paediatric Surveillance Unit
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health
- The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
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22
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Tsang TW, Finlay-Jones A, Perry K, Grigg JR, Popova S, Cheung MMY, Bower C, Tam P, Jamieson RV, Elliott EJ. Eye Abnormalities in Children with Fetal Alcohol Spectrum Disorders: A Systematic Review. Ophthalmic Epidemiol 2022:1-12. [DOI: 10.1080/09286586.2022.2123004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Tracey W Tsang
- The University of Sydney Children’s Hospital Westmead Clinical School, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Westmead, NSW, Australia, and Sydney Children’s Hospital Network, Kids Research, Westmead, Australia
| | - Amy Finlay-Jones
- Alcohol & Pregnancy and FASD Research, Telethon Kids Institute, West Perth, Australia
- Curtin University, West Perth, Australia
| | - Kerrin Perry
- The University of Sydney Children’s Hospital Westmead Clinical School, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Westmead, NSW, Australia, and Sydney Children’s Hospital Network, Kids Research, Westmead, Australia
| | - John R Grigg
- Save Sight Institute, Faculty of Medicine and Health, the University of Sydney, Sydney, Australia
- Sydney Eye Hospital, Sydney, Australia
| | - Svetlana Popova
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Canada; Dalla Lana School of Public Health, University of Toronto, Canada; Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Melissa Mei Yin Cheung
- The University of Sydney Children’s Hospital Westmead Clinical School, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Westmead, NSW, Australia, and Sydney Children’s Hospital Network, Kids Research, Westmead, Australia
- Australian Paediatric Surveillance Unit, Kids Research, Westmead, Australia
| | - Carol Bower
- Alcohol & Pregnancy and FASD Research, Telethon Kids Institute, West Perth, Australia
| | - Patrick Tam
- Embryology Research Unit, Children’s Medical Research Institute, the University of Sydney, Westmead, NSW, Australia; and School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Robyn V Jamieson
- Sydney Eye Hospital, Sydney, Australia
- Department of Clinical Genetics, Western Sydney Genetics Program, Sydney Children’s Hospitals Network, Westmead, NSW, Australia, and Eye Genetics Research Unit, Children’s Medical Research Institute, Sydney Children’s Hospitals Network, Westmead, Australia
| | - Elizabeth J Elliott
- The University of Sydney Children’s Hospital Westmead Clinical School, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Westmead, NSW, Australia, and Sydney Children’s Hospital Network, Kids Research, Westmead, Australia
- Australian Paediatric Surveillance Unit, Kids Research, Westmead, Australia
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23
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Okurame JC, Cannon L, Carter E, Thomas S, Elliott EJ, Rice LJ. Fetal alcohol spectrum disorder resources for health professionals: a scoping review protocol. BMJ Open 2022; 12:e065327. [PMID: 36100303 PMCID: PMC9472138 DOI: 10.1136/bmjopen-2022-065327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION People with fetal alcohol spectrum disorder (FASD) encounter a range of health and allied health providers and require specialised support to ensure health services are provided safely and effectively. Not all health professionals possess the knowledge or expertise required for the identification, assessment, referral and management of FASD. Accessible resources for understanding and managing FASD can help create awareness in health professionals and ensure patients receive the correct diagnosis and timely access to the necessary supports and services. The aim of this scoping review is to identify and analyse FASD resources for health professionals. METHODS AND ANALYSIS A comprehensive search of eight databases (MEDLINE, Scopus, PsycINFO, CINAHL, PubMED, EMBASE, Web of Science and Trip Medical Database) and nine grey literature databases (FASD Hub, NOFASD Australia, National Organisation for FASD, FASD United, HealthInfoNet, Proof Alliance, Child Family Community Australia, Foundation for Alcohol Research & Education and the Australian Department of Health websites) will be conducted using three search engines including PubMed, Ovid and Google advanced search (search dates: October 2021 to May 2022). Consultations will also be carried out with international and national experts in the diagnosis/management of FASD to obtain any additional relevant published or unpublished resources. Inclusion criteria were developed to guide the selection of resources that are publicly available, primarily focused on FASD and curated for health professionals for the identification, management or referral of FASD. Critical appraisal process will be executed using the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) tool to assess the quality of selected resources. ETHICS AND DISSEMINATION Ethical approval is not required for the scoping review. Scoping review results will be presented at relevant national and international conferences and published in peer-reviewed journals. Search results will be made available to ensure reproducibility and transparency.
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Affiliation(s)
| | - Lisa Cannon
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Emily Carter
- Marulu Unit, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Kimberley, Australia
| | - Sue Thomas
- Marulu Unit, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Kimberley, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Kids Research, The Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Lauren J Rice
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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24
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Tsang TW, Kingsland M, Doherty E, Wiggers J, Attia J, Wolfenden L, Dunlop A, Tully B, Symonds I, Rissel C, Lecathelinais C, Elliott EJ. Effectiveness of a practice change intervention in reducing alcohol consumption in pregnant women attending public maternity services. Subst Abuse Treat Prev Policy 2022; 17:63. [PMID: 36045392 PMCID: PMC9429389 DOI: 10.1186/s13011-022-00490-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 11/19/2022] Open
Abstract
Background The aim of this study was to examine the effect of a practice change intervention to support the implementation of guideline-recommended care for addressing alcohol use in pregnancy on self-reported alcohol use during pregnancy. Methods A randomized, stepped-wedge controlled trial in three clusters (sectors) within the Hunter New England Local Health District (NSW, Australia). We evaluated a practice change intervention that supported the introduction of a new model of care for reducing alcohol use in pregnancy, consistent with local and international guidelines, and implemented in random order across the sectors. Each week throughout the study period, pregnant women who attended any public antenatal services within the previous week, for a 27–28 or 35–36 week gestation visit, were randomly sampled and invited to participate in the survey. The intended intervention for all women was Brief advice (to abstain from alcohol and information about potential risks). Women identified as medium-risk alcohol consumers using the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) were to be offered referral to a phone coaching service, and women identified as high-risk were to be offered referral to a Drug and Alcohol Service. Rates of self-reported alcohol use (AUDIT-C risk level and special occasion drinking) were summarized and compared in groups of women pre-intervention and post-intervention using multivariable logistic regression. Results Surveys were completed by 1309 women at pre-intervention and 2540 at post-intervention. The majority of women did not drink during pregnancy (pre-intervention: 89.68%; post-intervention: 90.74%). There was no change in the proportion of women classified as No risk from drinking (AUDIT-C score = 0) or Some risk from drinking (AUDIT-C score ≥ 1) pre- or post-intervention (p = 0.08). However, a significant reduction in special occasion drinking was observed (pre-intervention: 11.59%; post-intervention: 8.43%; p < 0.001). Conclusions Special occasion drinking was reduced following implementation of guideline-recommended care. Failure to change other patterns of alcohol use in pregnancy may reflect barriers to implementing the model of care in antenatal care settings and the need to address other social determinants of alcohol use. Trial registration Australian and New Zealand Clinical Trials Registry (registration number: ACTRN12617000882325; date: 16 June 2017).
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25
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Abstract
OBJECTIVE To evaluate the impact of fetal alcohol spectrum disorder (FASD) on child and family functioning. DESIGN Prospective survey. SETTING Multidisciplinary FASD assessment service. PATIENTS Caregivers of 35 children with FASD. MAIN OUTCOME MEASURES Child-health-related functioning (Royal Alexandra Hospital for Children Measure of Function (MOF)), family impact (Impact on Family (IOF) Scale), impact on siblings and caregiver stress. RESULTS Most caregivers were foster carers (74%). Children with FASD (median age 8.7 years; 54% male) were a median of 7.0 years at diagnosis. Regarding child-health-related functioning, 43% reported moderate, severe or major problems in at least one area on the MOF. IOF was moderate (60%) or high (34%). Poorer child-health-related functioning was associated with greater impact on family. Unaffected siblings received less parental attention and displayed anger or frustration about the affected child's needs. Caregivers reported frequent and high levels of stress. CONCLUSIONS FASD impacts children's health, and function of the family and unaffected siblings. These novel findings highlight the need for family-oriented service development.
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Affiliation(s)
- Natalie Lynette Phillips
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Marcel David Zimmet
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Amy Phu
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Meenakshi Rattan
- Department of Psychological Medicine, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Yvonne Zurynski
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia .,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
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Doherty E, Wiggers J, Nathan N, Hall A, Wolfenden L, Tully B, Elliott EJ, Attia J, Dunlop AJ, Symonds I, Tsang TW, Reeves P, McFadyen T, Wynne O, Kingsland M. Iterative delivery of an implementation support package to increase and sustain the routine provision of antenatal care addressing alcohol consumption during pregnancy: study protocol for a stepped-wedge cluster trial. BMJ Open 2022; 12:e063486. [PMID: 35882461 PMCID: PMC9330336 DOI: 10.1136/bmjopen-2022-063486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/14/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Antenatal care addressing alcohol consumption during pregnancy is not routinely delivered in maternity services. Although a number of implementation trials have reported significant increases in such care, the majority of women still did not receive all recommended care elements, and improvements dissipated over time. This study aims to assess the effectiveness of an iteratively developed and delivered implementation support package in: (1) increasing the proportion of pregnant women who receive antenatal care addressing alcohol consumption and (2) sustaining the rate of care over time. METHODS AND ANALYSIS A stepped-wedge cluster trial will be conducted as a second phase of a previous trial. All public maternity services within three sectors of a local health district in Australia will receive an implementation support package that was developed based on an assessment of outcomes and learnings following the initial trial. The package will consist of evidence-based strategies to support increases in care provision (remind clinicians; facilitation; conduct educational meetings) and sustainment (develop a formal implementation blueprint; purposely re-examine the implementation; conduct ongoing training). Measurement of outcomes will occur via surveys with women who attend antenatal appointments each week. Primary outcomes will be the proportion of women who report being asked about alcohol consumption at subsequent antenatal appointments; and receiving complete care (advice and referral) relative to alcohol risk at initial and subsequent antenatal appointments. Economic and process evaluation measures will also be reported. ETHICS AND DISSEMINATION Ethical approval was obtained through the Hunter New England (16/11/16/4.07, 16/10/19/5.15) and University of Newcastle Human Research Ethics Committees (H-2017-0032, H-2016-0422) and the Aboriginal Health and Medical Research Council (1236/16). Trial findings will be disseminated to health service decision makers to inform the feasibility of conducting additional cycles to further improve antenatal care addressing alcohol consumption as well as at scientific conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trials Registry (ACTRN12622000295741).
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Affiliation(s)
- Emma Doherty
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - John Wiggers
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Belinda Tully
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales, Australia
| | - John Attia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Clinical Research Design and Statistics, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Adrian John Dunlop
- Drug and Alcohol Clinical Services Research, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Ian Symonds
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Tracey W Tsang
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales, Australia
| | - Penny Reeves
- Health Research Economics, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Tameka McFadyen
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Thurru Indigenous Health Unit, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Olivia Wynne
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Melanie Kingsland
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
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Tsang TW, Kingsland M, Doherty E, Anderson AE, Tully B, Ward S, Wiggers J, Elliott EJ. Written information and health professionals are the information sources about alcohol use in pregnancy most often used by pregnant women. Drug Alcohol Rev 2022; 41:1599-1609. [PMID: 35836339 DOI: 10.1111/dar.13512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Alcohol use in pregnancy remains common in Australia, despite national guidelines recommending that pregnant women abstain. The aims of this study were to investigate where pregnant women obtain information about alcohol use in pregnancy and the relationship between the information source used and women's demographic characteristics and alcohol use. METHODS In this cross-sectional survey of pregnant women attending public maternity services in the Hunter New England region (New South Wales), women were asked, 'Where did you get information to help you make decisions about alcohol use during pregnancy?'. The number and types of information sources were analysed using descriptive statistics. Associations between women's information sources, and their demographic characteristics and alcohol use in pregnancy were assessed using chi-square tests and logistic regression. RESULTS Of 4511 pregnant women surveyed, 80.1% used at least one type of information source (range 0-5). Written/electronic information (45.4%), health providers (37.6%) and family/friends (19.5%) were the sources most reported. Higher use of written/electronic information, antenatal health providers and family/friends was associated with first pregnancy, younger age and higher education. The type of information source used was associated with alcohol use in pregnancy. Women who reported alcohol use were more likely to receive information from written/electronic sources. Almost 20% of women (older, multiparous [>1 pregnancy] and more highly educated) obtained no information regarding alcohol use in pregnancy. DISCUSSION AND CONCLUSIONS Antenatal providers should routinely provide information on alcohol use in pregnancy, including for women least likely to access available information.
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Affiliation(s)
- Tracey W Tsang
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney, Sydney, Australia.,Sydney Children's Hospitals Network, Kids Research, Sydney, Australia
| | - Melanie Kingsland
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Emma Doherty
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Amy E Anderson
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Belinda Tully
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia
| | - Sarah Ward
- Foundation for Alcohol Research and Education, Canberra, Australia
| | - John Wiggers
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney, Sydney, Australia.,Sydney Children's Hospitals Network, Kids Research, Sydney, Australia
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Nunez C, Eslick GD, Elliott EJ. Trampoline centre injuries in children and adolescents: a systematic review and meta-analysis. Inj Prev 2022; 28:440-445. [PMID: 35697515 DOI: 10.1136/injuryprev-2022-044530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/01/2022] [Indexed: 01/03/2023]
Abstract
CONTEXT No evidence-based review has compared injury risks sustained on trampolines at home and in trampoline centres. OBJECTIVE To present pooled results for injury type, site and treatment from studies reporting injuries that occurred on trampolines at home and in trampoline centres. DATA SOURCES MEDLINE, Scopus, Google Scholar and Embase databases were searched to 31 December 2021. STUDY SELECTION Inclusion criteria: (1) assessment of trampoline injuries (home and trampoline centres); (2) children and adolescents; (3) the point estimate was reported as an odds ratio (OR); and (4) an internal comparison was used. DATA EXTRACTION Data were reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A random-effects model was used to estimate effect. RESULTS There were 1 386 843 injuries (n=11 studies). There was an increased likelihood of musculoskeletal and/or orthopaedic injuries (OR 2.45, 95% CI 1.66 to 3.61, p<0.001), lower extremity injury (OR 2.81, 95% CI 1.99 to 3.97, p<0.001), sprains (OR 1.64, 95% CI 1.36 to 1.97, p<0.001) and a need for surgery (OR 1.89, 95% CI 1.37 to 2.60, p<0.001) at trampoline centres compared with home trampolines. Conversely, upper extremity injury (OR 0.49, 95% CI 0.25 to 0.95, p=0.03), concussion (OR 0.48, 95% CI 0.35 to 0.65, p<0.001) and lacerations (OR 0.46, 95% CI 0.35 to 0.59, p<0.001) were less likely to occur at trampoline centres than at home. CONCLUSIONS Children using trampoline centres are more likely to suffer severe trauma and require surgical intervention than children using home trampolines. Development and implementation of preventative strategies, public awareness, and mandatory safety standards are urgently required for trampoline centres.
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Affiliation(s)
- Carlos Nunez
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia .,The Australian Paediatric Surveillance Unit, The Sydney Children's Hospital Network (Westmead), Sydney, New South Wales, Australia
| | - Guy D Eslick
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,The Australian Paediatric Surveillance Unit, The Sydney Children's Hospital Network (Westmead), Sydney, New South Wales, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,The Australian Paediatric Surveillance Unit, The Sydney Children's Hospital Network (Westmead), Sydney, New South Wales, Australia
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Le Bas G, Youssef G, Macdonald JA, Teague S, Mattick R, Honan I, McIntosh JE, Khor S, Rossen L, Elliott EJ, Allsop S, Burns L, Olsson CA, Hutchinson D. The Role of Antenatal and Postnatal Maternal Bonding in Infant Development. J Am Acad Child Adolesc Psychiatry 2022; 61:820-829.e1. [PMID: 34555489 DOI: 10.1016/j.jaac.2021.08.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 08/09/2021] [Accepted: 09/13/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The affectional bond experienced by a mother toward her developing fetus/infant has been theorized to be a critical factor in determining infant developmental outcomes; yet there remains a paucity of research in this area, and a lack of high-quality longitudinal studies. This study aimed to examine the extent to which mother-to-infant bonding predicted infant development in a multi-wave longitudinal pregnancy cohort study (N = 1,347). METHOD Self-reported bonding was assessed using the Maternal Antenatal Attachment Scale at each trimester, and the Maternal Postnatal Attachment Scale at 8 weeks and 12 months postpartum. Infant development was assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) at 12 months. RESULTS Bonding predicted indicators of infant social-affective development, including social-emotional, behavioral, and temperamental outcomes. Effect sizes ranged from small to moderate, increasing over the perinatal period (β = 0.11-0.27). Very small effects were also identified in the relationship between bonding and cognitive, language, and motor development (β = 0.06-0.08). CONCLUSION Findings suggest that a mother's perceived emotional connection with her child plays a role in predicting social-affective outcomes; prediction may not extend to other domains of infant development. Maternal bonding may therefore be a potentially modifiable predictor of infant social-affective outcomes, offering important considerations for preventive intervention.
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Affiliation(s)
- Genevieve Le Bas
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia
| | - George Youssef
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Royal Children's Hospital, Melbourne, Australia
| | - Jacqui A Macdonald
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Royal Children's Hospital, Melbourne, Australia
| | - Samantha Teague
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia
| | - Richard Mattick
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Ingrid Honan
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Jennifer E McIntosh
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Royal Children's Hospital, Melbourne, Australia; The Bouverie Centre, La Trobe University, Bundoora, Australia
| | - Sarah Khor
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia
| | - Larissa Rossen
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; The British Columbia Children's Hospital Research Institute, The University of British Columbia, Canada
| | - Elizabeth J Elliott
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia; The Sydney Children's Hospitals Network at Westmead, Sydney, Australia
| | - Steve Allsop
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Lucinda Burns
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Craig A Olsson
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Royal Children's Hospital, Melbourne, Australia
| | - Delyse Hutchinson
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Royal Children's Hospital, Melbourne, Australia; National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
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30
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Doherty E, Kingsland M, Elliott EJ, Tully B, Wolfenden L, Dunlop A, Symonds I, Attia J, Ward S, Hunter M, Azzopardi C, Rissel C, Gillham K, Tsang TW, Reeves P, Wiggers J. Practice change intervention to improve antenatal care addressing alcohol consumption during pregnancy: a randomised stepped-wedge controlled trial. BMC Pregnancy Childbirth 2022; 22:345. [PMID: 35448996 PMCID: PMC9027411 DOI: 10.1186/s12884-022-04646-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/30/2022] [Indexed: 12/17/2022] Open
Abstract
Background Clinical guideline recommendations for addressing alcohol consumption during pregnancy are sub-optimally implemented and limited evidence exists to inform practice improvements. The aim of this study was to estimate the effectiveness of a practice change intervention in improving the provision of antenatal care addressing alcohol consumption during pregnancy in public maternity services. Methods A randomised stepped-wedge controlled trial was undertaken with all public maternity services in three sectors (one urban, two regional/rural) of a single local health district in New South Wales, Australia. All antenatal care providers were subject to a seven-month multi-strategy intervention to support the introduction of a recommended model of care. For 35 months (July 2017 – May 2020) outcome data were collected from randomly selected women post an initial, 27–28 weeks and 35–36 weeks gestation antenatal visit. Logistic regression models assessed intervention effectiveness. Results Five thousand six hundred ninety-four interviews/online questionnaires were completed by pregnant women. The intervention was effective in increasing women’s reported receipt of: assessment of alcohol consumption (OR: 2.63; 95% CI: 2.26–3.05; p < 0.001), advice not to consume alcohol during pregnancy and of potential risks (OR: 2.07; 95% CI: 1.78–2.41; p < 0.001), complete care relevant to alcohol risk level (advice and referral) (OR: 2.10; 95% CI: 1.80–2.44; p < 0.001) and all guideline elements relevant to alcohol risk level (assessment, advice and referral) (OR: 2.32; 95% CI: 1.94–2.76; p < 0.001). Greater intervention effects were found at the 27–28 and 35–36 weeks gestation visits compared with the initial antenatal visit. No differences by sector were found. Almost all women (98.8%) reported that the model of care was acceptable. Conclusions The practice change intervention improved the provision of antenatal care addressing alcohol consumption during pregnancy in public maternity services. Future research could explore the characteristics of pregnant women and maternity services associated with intervention effectiveness as well as the sustainment of care practices over time to inform the need for, and development of, further tailored practice change support. Trial registration Australian and New Zealand Clinical Trials Registry (Registration number: ACTRN12617000882325; Registration date: 16/06/2017) https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372985&isReview=true
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Affiliation(s)
- Emma Doherty
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, 2287, Australia. .,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, 2308, Australia. .,Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia.
| | - Melanie Kingsland
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, 2287, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, 2006, Australia.,Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales, 2145, Australia
| | - Belinda Tully
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, 2287, Australia
| | - Luke Wolfenden
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, 2287, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia.,Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, 2302, Australia
| | - Ian Symonds
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - John Attia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia
| | - Sarah Ward
- Foundation for Alcohol Research and Education, Deakin, Australian Capital Territory, 2600, Australia
| | - Mandy Hunter
- Maternity and Gynaecology John Hunter Hospital, New Lambton Heights, New South Wales, 2305, Australia
| | - Carol Azzopardi
- Maternity and Gynaecology John Hunter Hospital, New Lambton Heights, New South Wales, 2305, Australia
| | - Chris Rissel
- College of Medicine and Public Health, Flinders University, Casuarina, Northern Territory, 0909, Australia
| | - Karen Gillham
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, 2287, Australia
| | - Tracey W Tsang
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, 2006, Australia.,Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales, 2145, Australia
| | - Penny Reeves
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, 2287, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia
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Deverell M, Phu A, Elliott EJ, Teutsch SM, Eslick GD, Stuart C, Murray S, Davis R, Dalkeith T, Christodoulou J, Zurynski YA. Health-related out-of-pocket expenses for children living with rare diseases - tuberous sclerosis and mitochondrial disorders: A prospective pilot study in Australian families. J Paediatr Child Health 2022; 58:611-617. [PMID: 34704652 DOI: 10.1111/jpc.15784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 09/21/2021] [Accepted: 09/26/2021] [Indexed: 11/29/2022]
Abstract
AIM We aimed to describe health-related out-of-pocket (OOP) expenses incurred by Australian families living with children with chronic and complex diseases. METHODS A prospective pilot study of OOP expenses in families with children with tuberous sclerosis (TS) or mitochondrial disorders (MD) in 2016-2017. An initial survey assessed the family's financial situation, child's health functioning and estimated previous 6 months' and lifetime OOP expenses. Thereafter, families completed a survey each month for 6 months, prospectively tracking OOP expenses. RESULTS Initial surveys were completed by 13 families with 15 children; median age 7 years (range: 1-12); 5 with MD, 10 with TS. All families reported OOP expenses: 38% paid $2000 per annum, more than double the annual per-capita OOP costs reported for Australia by the Organisation for Economic Co-operation and Development. Eight families estimated $5000-$25 000 in OOP expenses over their child's lifetime and 62% of mothers reduced or stopped work due to caring responsibilities. Eleven families paid annual private health insurance premiums of $2000-$5122, but 72% said this was poor value-for-money. Prospective tracking by eight families (9 children) identified the median OOP expenditure was $863 (range $55-$1398) per family for 6 months. OOP spending was associated with visits to allied health professionals, non-prescription medicines, special foods, supplements and disposable items. Eight families paid for 91 prescription medications over 6 months. CONCLUSION All families caring for children with TS or MD reported OOP expenses. A larger study is needed to explore the affordability of health care for children living with a broader range of chronic diseases.
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Affiliation(s)
- Marie Deverell
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.,Clinical Excellence Division, Government Department of Health Western Australia, Perth, Western Australia, Australia
| | - Amy Phu
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Suzy M Teutsch
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Guy D Eslick
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Clare Stuart
- Tuberous Sclerosis Australia, Sydney, New South Wales, Australia
| | - Sean Murray
- Australian Mitochondrial Disorders Foundation, Sydney, New South Wales, Australia
| | - Rebecca Davis
- Australian Mitochondrial Disorders Foundation, Sydney, New South Wales, Australia
| | - Troy Dalkeith
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - John Christodoulou
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mitochondrial Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Yvonne A Zurynski
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.,NHMRC Partnership Centre in Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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32
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Rice LJ, Tsang TW, Carter E, Hand M, Davies J, Thomas S, Bedford E, Bear E, Carter C, Cannon L, Elliott EJ. Bigiswun Kid Project: a longitudinal study of adolescents living with high rates of prenatal alcohol exposure, fetal alcohol spectrum disorder and early life trauma in remote Australian Aboriginal communities. BMJ Open 2022; 12:e058111. [PMID: 35365538 PMCID: PMC8977804 DOI: 10.1136/bmjopen-2021-058111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/16/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The Lililwan Project was the first Australian population-based prevalence study of fetal alcohol spectrum disorder (FASD) using active case ascertainment. Conducted in 2010-2011, the study included 95% of all eligible children aged 7-9 years living in the very remote Aboriginal communities of the Fitzroy Valley, Western Australia. Women from Marninwarntikura Women's Resource Centre, a local Aboriginal-led organisation, are concerned that some participants from the study are struggling in adolescence so partnered with researchers from the University of Sydney to follow up the Lililwan cohort in 2020-2022 at age 17-19 years.The overarching aim of the Bigiswun Kid Project is to identify adolescents' needs and build knowledge to inform services to improve the health and well-being of adolescents in remote Aboriginal communities. The specific aims are to: (1) provide a voice to adolescents and their families to understand the health and well-being status of the Lililwan cohort at 17-19 years. (2) Examine relationships between exposures during pregnancy, birth characteristics, and health and neurodevelopment at 7-9 years, and positive/adverse adolescent outcomes at 17-19 years. This information will identify prenatal and early life factors that predict good health and well-being in adolescence. (3) Determine whether management plans provided in the Lililwan Project were followed, and identify past and present service gaps, support needs and barriers to service use. (4) Determine if key physical characteristics of FASD change between childhood and adolescence in this Aboriginal population. ETHICS AND DISSEMINATION Approved by the Kimberley Aboriginal Health Planning Forum and relevant ethics committees.
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Affiliation(s)
- Lauren J Rice
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| | - Tracey W Tsang
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| | - Emily Carter
- Marulu Team, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Marmingee Hand
- Marulu Team, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Jadnah Davies
- Marulu Team, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Sue Thomas
- Marulu Team, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Eric Bedford
- Marulu Team, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Emma Bear
- Marulu Team, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Cheyenne Carter
- Marulu Team, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Lisa Cannon
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
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Muggli E, Hearps S, Halliday J, Elliott EJ, Penington A, Thompson DK, Spittle A, Forster DA, Lewis S, Anderson PJ. A data driven approach to identify trajectories of prenatal alcohol consumption in an Australian population-based cohort of pregnant women. Sci Rep 2022; 12:4353. [PMID: 35288617 PMCID: PMC8921195 DOI: 10.1038/s41598-022-08190-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/09/2022] [Indexed: 01/08/2023] Open
Abstract
Accurate information on dose, frequency and timing of maternal alcohol consumption is critically important when investigating fetal risks from prenatal alcohol exposure. Identification of distinct alcohol use behaviours can also assist in developing directed public health messages about possible adverse child outcomes, including Fetal Alcohol Spectrum Disorder. We aimed to determine group-based trajectories of time-specific, unit-level, alcohol consumption using data from 1458 pregnant women in the Asking Questions about Alcohol in Pregnancy (AQUA) longitudinal study in Melbourne, Australia. Six alcohol consumption trajectories were identified incorporating four timepoints across gestation. Labels were assigned based on consumption in trimester one and whether alcohol use was continued throughout pregnancy: abstained (33.8%); low discontinued (trimester one) (14.4%); moderate discontinued (11.7%); low sustained (13.0%); moderate sustained (23.5%); and high sustained (3.6%). Median weekly consumption in trimester one ranged from 3 g (low discontinued) to 184 g of absolute alcohol (high sustained). Alcohol use after pregnancy recognition decreased dramatically for all sustained drinking trajectories, indicating some awareness of risk to the unborn child. Further, specific maternal characteristics were associated with different trajectories, which may inform targeted health promotion aimed at reducing alcohol use in pregnancy.
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Quinn HE, Comeau JL, Marshall HS, Elliott EJ, Crawford NW, Blyth CC, Kynaston JA, Snelling TL, Richmond PC, Francis JR, Macartney KK, McIntyre PB, Wood NJ. Pertussis Disease and Antenatal Vaccine Effectiveness in Australian Children. Pediatr Infect Dis J 2022; 41:180-185. [PMID: 34711785 DOI: 10.1097/inf.0000000000003367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Population-level studies of severe pertussis extending beyond infancy are sparse, and none in the context of antenatal vaccination. We compared hospitalized pertussis cases from birth to 15 years of age before and after introduction of antenatal immunization. METHODS Active surveillance of laboratory-confirmed pertussis hospitalizations in a national network of pediatric hospitals in Australia January 2012 to June 2019. Impact of maternal vaccination was assessed by vaccine effectiveness (VE) in cases and test-negative controls with <2 months of age and by before-after comparison of age distribution of cases. Among cases eligible for one or more vaccine doses, we examined proportions age-appropriately immunized and with comorbidities by age group. RESULTS Among 419 eligible cases, the proportion <2 months of age significantly decreased from 33.1% in 2012 to 2014 compared with 19.6% in 2016 to 2019 when mothers of only 4 of 17 (23.5%) cases <2 months of age had received antenatal vaccination. VE was estimated to be 84.3% (95% CI, 26.1-96.7). Across all years (2012-2019), of 55 cases 4-11 months of age, 21 (38%) had ≥2 vaccine doses, whereas among 155 cases ≥12 months of age, 122 (85.2%) had ≥3 vaccine doses. Prevalence of comorbidities (primarily cardiorespiratory) increased from 5 (2.1%) <6 months of age to 36 (24.2%) ≥12 months of age (P < 0.001), with 6/16 (38%) cases ≥12 months of age who required intensive care having comorbidities. CONCLUSIONS Below the age of 12 months, prevention of severe pertussis will be maximized by high maternal antenatal vaccine uptake and timeliness of infant vaccine doses. Despite full immunization, we found children ≥12 months of age accounted for 27% of hospitalizations <15 years, with 24% having comorbities, suggesting new vaccine strategies, such as additional doses or more immunogenic vaccines, require evaluation.
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Affiliation(s)
- Helen E Quinn
- From the National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jeannette L Comeau
- From the National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Helen S Marshall
- Women's and Children's Hospital, Adelaide, South Australia, Australia
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Elizabeth J Elliott
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
- Australian Paediatric Surveillance Unit (APSU), Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Nigel W Crawford
- Murdoch Children's Research Institute and The University of Melbourne, Parkville, Victoria, Australia
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Christopher C Blyth
- Wesfarmer's Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Perth Children's Hospital, Perth, Western Australia, Australia
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | | | - Tom L Snelling
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
- Wesfarmer's Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Peter C Richmond
- Wesfarmer's Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Perth Children's Hospital, Perth, Western Australia, Australia
| | - Joshua R Francis
- Global & Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Kristine K Macartney
- From the National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Peter B McIntyre
- From the National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Womens and Childrens Health. University of Otago, Dunedin, New Zealand
| | - Nicholas J Wood
- From the National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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Nunez C, Morris A, Hansen M, Elliott EJ. Microcephaly in Australian infants: A retrospective audit. J Paediatr Child Health 2022; 58:448-458. [PMID: 34553803 DOI: 10.1111/jpc.15739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/30/2022]
Abstract
AIM To describe clinical characteristics, outcomes and causes of microcephaly in children whose condition was identified within the first year of life. METHODS Retrospective review of medical records of microcephalic children born between 2008 and 2018 and admitted for any reason during the same period to a tertiary paediatric hospital. Microcephaly was defined as occipitofrontal circumference (OFC) more than two standard deviations below the mean (>-2 SD). RESULTS Between January 2008 and September 2018, 1083 medical records were retrieved. Of the children, 886 were ineligible and 197 were confirmed cases of microcephaly. Of cases, 73 (37%) had primary microcephaly (at birth) and 72 (37%) had severe microcephaly (OFC > -3 SD). Of microcephalic children, 192 (98%) had congenital anomalies, of whom 93% had major anomalies, mostly cardiovascular or musculoskeletal. Neurological signs or symptoms were reported in 148 (75%), seizures being the most common. Of the 139 children with abnormal central nervous system (CNS) imaging, one or more structural brain abnormalities were identified in 124 (89%). Failure to reach developmental milestones was observed in 69%, visual impairment in 41% and cerebral palsy in 13%. Microcephaly was idiopathic in 51% and 24% had diagnosed genetic disorders. There was no association between developmental outcomes or structural brain anomalies and severity of microcephaly or timing of diagnosis. CONCLUSION Our results suggest the need for a systematic investigative approach to diagnosis, including a careful history, examination, genetic testing and neuroimaging, to determine the underlying cause of microcephaly, identify co-morbidities, predict prognosis and guide genetic counselling and therapy.
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Affiliation(s)
- Carlos Nunez
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,The Australian Paediatric Surveillance Unit, Sydney, New South Wales, Australia
| | - Anne Morris
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,The Australian Paediatric Surveillance Unit, Sydney, New South Wales, Australia.,The Kid's Institute, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Michele Hansen
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,The Australian Paediatric Surveillance Unit, Sydney, New South Wales, Australia.,The Kid's Institute, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
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36
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Cheung MMY, Tsang TW, Watkins R, Birman C, Popova S, Elliott EJ. Ear Abnormalities Among Children with Fetal Alcohol Spectrum Disorder: A Systematic Review and Meta-Analysis. J Pediatr 2022; 242:113-120.e16. [PMID: 34780779 DOI: 10.1016/j.jpeds.2021.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/14/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To systematically review and conduct meta-analysis on studies that report the type and prevalence of functional and structural ear abnormalities among children with prenatal alcohol exposure and/or fetal alcohol spectrum disorder (FASD). STUDY DESIGN MEDLINE, PubMed, Embase, Web of Science, PsycINFO, ERIC, CINAHL, and Maternity and Infant Care were searched from 1806 through March 2021. Reference lists of relevant articles were manually searched. Studies reporting on functional and/or structural ear abnormalities among children (<18 years) with prenatal alcohol exposure and/or FASD were eligible. Data extraction and quality assessment were performed by one reviewer and independently checked by another. A random effects meta-analysis was conducted. RESULTS A total of 31 studies met the inclusion criteria and 25 were included in the meta-analyses, representing a total of 843 children with prenatal alcohol exposure and 1653 children with FASD. Functional ear abnormalities with the highest pooled prevalence were chronic serous otitis media (88.5%; 95% CI, 70.4%-99.3%), abnormal auditory filtering (80.1%; 95% CI, 76.5%-84.3%), and unspecified conductive hearing loss (68.0%; 95% CI, 51.9%-82.2%). Structural ear abnormalities with the highest pooled prevalence were microtia (42.9%; 95% CI, 26.8%-59.7%), railroad track ear (16.8%; 95% CI, 8.1%-27.7%), and misplaced ear (12.3%; 95% CI, 7.6%-17.9%). CONCLUSIONS Our findings highlight the importance of examining the ears during assessment for FASD, and the need for public health messaging regarding the harms of prenatal alcohol exposure.
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Affiliation(s)
- Melissa Mei Yin Cheung
- The University of Sydney Children's Hospital Westmead Clinical School, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia; Australian Pediatric Surveillance Unit, Kids Research, Sydney Children Hospitals Network, Westmead, Australia.
| | - Tracey W Tsang
- The University of Sydney Children's Hospital Westmead Clinical School, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
| | - Rochelle Watkins
- Telethon Kids Institute, Perth Children's Hospital, Perth, Australia
| | - Catherine Birman
- The University of Sydney Children's Hospital Westmead Clinical School, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia; Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, Australia
| | - Svetlana Popova
- Center for Addiction and Mental Health, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Elizabeth J Elliott
- The University of Sydney Children's Hospital Westmead Clinical School, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia; Australian Pediatric Surveillance Unit, Kids Research, Sydney Children Hospitals Network, Westmead, Australia
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Eslick GD, Nunez C, Elliott EJ. Injury and death associated with jumping castles: A public health issue. J Paediatr Child Health 2022; 58:546-548. [PMID: 35244303 DOI: 10.1111/jpc.15898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Guy D Eslick
- The Australian Paediatric Surveillance Unit (APSU), The Sydney Children's Hospital Network Westmead, The University of Sydney, Sydney, New South Wales, Australia
| | - Carlos Nunez
- The Australian Paediatric Surveillance Unit (APSU), The Sydney Children's Hospital Network Westmead, The University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth J Elliott
- The Australian Paediatric Surveillance Unit (APSU), The Sydney Children's Hospital Network Westmead, The University of Sydney, Sydney, New South Wales, Australia
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Hutchinson D, Spry EA, Mohamad Husin H, Middleton M, Hearps S, Moreno-Betancur M, Elliott EJ, Ryan J, Olsson CA, Patton GC. Longitudinal prediction of periconception alcohol use: a 20-year prospective cohort study across adolescence, young adulthood and pregnancy. Addiction 2022; 117:343-353. [PMID: 34495562 DOI: 10.1111/add.15632] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/17/2021] [Accepted: 06/16/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Alcohol consumption is common in adolescence and young adulthood and may continue into pregnancy, posing serious risk to early fetal development. We examine the frequency of periconception alcohol use (prior to pregnancy awareness) and the extent to which adolescent and young adult alcohol use prospectively predict periconception use. DESIGN A longitudinal, population-based study. SETTING Victoria, Australia. PARTICIPANTS A total of 289 women in trimester three of pregnancy (age 29-35 years; 388 pregnancies). MEASURES The main exposures were binge [≥ 4.0 standard drinks (SDs)/day] and frequent (≥ 3 days/week) drinking in adolescence (mean age = 14.9-17.4 years) and young adulthood (mean age 20.7-29.1 years). Outcomes were frequency (≥ 3 days/week, ≥ monthly, never) and quantity (≥ 4.0 SDs, ≥ 0.5 and < 4.0 SDs, none) of periconception drinking. FINDINGS Alcohol use was common in young adulthood prior to pregnancy (72%) and in the early weeks of pregnancy (76%). The proportions drinking on most days and binge drinking were similar at both points. Reflecting a high degree of continuity in alcohol use behaviours, most women who drank periconceptionally had an earlier history of frequent (77%) and/or binge (85%) drinking throughout the adolescent or young adult years. Young adult binge drinking prospectively predicted periconception drinking quantity [odds ratio (OR) = 3.7, 95% confidence interval (CI) = 1.9-7.4], compared with women with no prior history. Similarly, frequent young adult drinking prospectively predicted frequent periconception drinking (OR = 30.7, 95% CI = 12.3-76.7). CONCLUSIONS Women who engage in risky (i.e. frequent and binge) drinking in their adolescent and young adult years are more likely to report risky drinking in early pregnancy prior to pregnancy recognition than women with no prior history of risky drinking.
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Affiliation(s)
- Delyse Hutchinson
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth A Spry
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Hanafi Mohamad Husin
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Melissa Middleton
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen Hearps
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Margarita Moreno-Betancur
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia.,The Sydney Children's Hospital Network, Westmead, Kid's Research, Sydney, NSW, Australia
| | - Joanne Ryan
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Department of Epidemiology, Monash University, Prahran, VIC, Australia
| | - Craig A Olsson
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - George C Patton
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
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Muggli E, Halliday J, Elliott EJ, Penington A, Thompson D, Spittle AJ, Forster D, Lewis S, Hearps S, Anderson PJ. Cohort profile: early school years follow-up of the Asking Questions about Alcohol in Pregnancy Longitudinal Study in Melbourne, Australia (AQUA at 6). BMJ Open 2022; 12:e054706. [PMID: 35039298 PMCID: PMC8765013 DOI: 10.1136/bmjopen-2021-054706] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The Asking Questions about Alcohol in Pregnancy (AQUA) study, established in 2011, is a prebirth cohort of 1570 mother and child pairs designed to assess the effects of low to moderate prenatal alcohol exposure and sporadic binge drinking on long-term child development. Women attending general antenatal clinics in public hospitals in Melbourne, Australia, were recruited in their first trimester, followed up three times during pregnancy and at 12 and 24 months postpartum. The current follow-up of the 6-8-year-old children aims to strengthen our understanding of the relationship between these levels of prenatal alcohol exposure and neuropsychological functioning, facial dysmorphology, brain structure and function. PARTICIPANTS Between June 2018 and April 2021, 802 of the 1342 eligible AQUA study families completed a parent-report questionnaire (60%). Restrictions associated with COVID-19 pandemic disrupted recruitment, but early school-age neuropsychological assessments were undertaken with 696 children (52%), and 482 (36%) craniofacial images were collected. A preplanned, exposure-representative subset of 146 children completed a brain MRI. An existing biobank was extended through collection of 427 (32%) child buccal swabs. FINDINGS TO DATE Over half (59%) of mothers consumed some alcohol during pregnancy, with one in five reporting at least one binge-drinking episode prior to pregnancy recognition. Children's craniofacial shape was examined at 12 months of age, and low to moderate prenatal alcohol exposure was associated with subtle midface changes. At 2 years of age, formal developmental assessments showed no evidence that cognitive, language or motor outcome was associated with any of exposure level. FUTURE PLANS We will investigate the relationship between prenatal alcohol exposure and specific aspects of neurodevelopment at 6-8 years, including craniofacial shape, brain structure and function. The contribution of genetics and epigenetics to individual variation in outcomes will be examined in conjunction with national and international collaborations.
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Affiliation(s)
- Evelyne Muggli
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Halliday
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Reproductive Epidemiology, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Elizabeth J Elliott
- Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Anthony Penington
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Plastic and Maxillofacial Unit, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Deanne Thompson
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alicia Jane Spittle
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Della Forster
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Sharon Lewis
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Reproductive Epidemiology, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Peter J Anderson
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
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Lees B, Riches J, Mewton L, Elliott EJ, Allsop S, Newton N, Thomas S, Rice LJ, Nepal S, Teesson M, Stapinski LA. Fetal alcohol spectrum disorder resources for educators: A scoping review. Health Promot J Austr 2022; 33:797-809. [PMID: 35028999 PMCID: PMC9544813 DOI: 10.1002/hpja.574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/08/2021] [Accepted: 01/04/2022] [Indexed: 12/02/2022] Open
Abstract
Children with foetal alcohol spectrum disorder (FASD) can experience neurodevelopmental, physical, psychological and behavioural impairments that can result in a disrupted school experience. However, educators often have limited knowledge or experience in the identification and support of students with FASD, and there is a critical need for effective tools and resources to ensure students with FASD are supported in their ongoing learning and development. This scoping review aimed to identify and evaluate publicly available educator resources that aid in the identification, and support of students with FASD in primary/elementary school. In addition, educators and FASD experts were consulted to obtain feedback on currently available resources, and key issues and priorities for FASD resources. In total, 124 resources were identified by searching peer‐reviewed and grey literature databases, app stores, podcast services and contacting FASD experts. Information was found on identification (23 resources) and support of students with FASD (119 resources). No resources provided information on the referral. Most resources were average (40%) to good (33%) quality, as measured by a composite tool based on adaptions of the NHMRC FORM Framework and iCAHE Guideline Quality Checklist. A minority of resources had been formally evaluated (7%). Review findings and consultations with experts and educators indicate a critical need for referral guides, evidence‐based short‐format resources and centralised access for school communities to high‐quality resources. Taken together, this study has identified key areas for future resource development and research to better support primary school students with FASD.
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Affiliation(s)
- Briana Lees
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Julia Riches
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Louise Mewton
- Centre for Healthy Brain Ageing, University of New South Wales, Australia
| | - Elizabeth J Elliott
- The University of Sydney, Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Sydney, Australia.,The Sydney Children's Hospitals Network, Westmead, Sydney, Australia
| | - Steve Allsop
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Nicola Newton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Sue Thomas
- Marulu Unit, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Australia
| | - Lauren J Rice
- The Sydney Children's Hospitals Network, Westmead, Sydney, Australia.,The Brain and Mind Centre, The University of Sydney, Australia
| | - Smriti Nepal
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Lexine A Stapinski
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
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Walker LJ, Thorley BR, Morris A, Elliott EJ, Saul N, Britton PN. Using the Acute Flaccid Paralysis Surveillance System to Identify Cases of Acute Flaccid Myelitis, Australia, 2000‒2018. Emerg Infect Dis 2022; 28:20-28. [PMID: 34932461 PMCID: PMC8714202 DOI: 10.3201/eid2801.211690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Since 2012, the United States has reported a distinct syndrome of acute flaccid paralysis (AFP) with anterior myelitis, predominantly in children. This polio-like syndrome was termed acute flaccid myelitis (AFM). Australia routinely conducts AFP surveillance to exclude poliomyelitis. We reviewed 915 AFP cases in Australia for children <15 years of age during 2000‒2018 and reclassified a subset to AFM by using the US Council of State and Territorial Epidemiologists case definition. We confirmed 37 AFM cases by using magnetic resonance imaging findings and 4 probable AFM cases on the basis of cerebrospinal fluid pleocytosis. Nonpolio enteroviruses were detected in 33% of AFM cases from which stool samples were tested. Average annual AFM incidence was 0.07 cases/100,000 person-years in children <15 years of age. AFM occurred sporadically in Australia before 2010 but regularly since then, indicating sustained, albeit rare, clinical manifestation in children. The AFP surveillance system in Australia is well-positioned to identify future AFM cases.
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42
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Loke YJ, Muggli E, Saffery R, Ryan J, Lewis S, Elliott EJ, Halliday J, Craig JM. Sex- and tissue-specific effects of binge-level prenatal alcohol consumption on DNA methylation at birth. Epigenomics 2021; 13:1921-1938. [PMID: 34841896 DOI: 10.2217/epi-2021-0285] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Binge-level prenatal alcohol exposure (PAE) causes developmental abnormalities, which may be mediated in part by epigenetic mechanisms. Despite this, few studies have characterised the association of binge PAE with DNA methylation in offspring. Methods: We investigated the association between binge PAE and genome-wide DNA methylation profiles in a sex-specific manner in neonatal buccal and placental samples. Results: We identified no differentially methylated CpGs or differentially methylated regions (DMRs) at false discovery rate <0.05. However, using a sum-of-ranks approach, we identified a DMR in each tissue of female offspring. The DMR identified in buccal samples is located near regions with previously-reported associations to fetal alcohol spectrum disorder (FASD) and binge PAE. Conclusion: Our findings warrant further replication and highlight a potential epigenetic link between binge PAE and FASD.
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Affiliation(s)
- Yuk Jing Loke
- Molecular Immunity, Murdoch Children's Research Institute, Victoria, 3052, Australia.,Department of Paediatrics, University of Melbourne, Victoria, 3010, Australia
| | - Evelyne Muggli
- Department of Paediatrics, University of Melbourne, Victoria, 3010, Australia.,Victorian Infant Brain Studies, Murdoch Children's Research Institute, Victoria, 3052, Australia.,Reproductive Epidemiology, Murdoch Children's Research Institute, Victoria, 3052, Australia
| | - Richard Saffery
- Molecular Immunity, Murdoch Children's Research Institute, Victoria, 3052, Australia.,Department of Paediatrics, University of Melbourne, Victoria, 3010, Australia
| | - Joanne Ryan
- Molecular Immunity, Murdoch Children's Research Institute, Victoria, 3052, Australia.,Biological Neuropsychiatry & Dementia Unit, School of Public Health, Monash University, Victoria, 3004, Australia
| | - Sharon Lewis
- Department of Paediatrics, University of Melbourne, Victoria, 3010, Australia.,Reproductive Epidemiology, Murdoch Children's Research Institute, Victoria, 3052, Australia
| | - Elizabeth J Elliott
- Specialty of Child & Adolescent Health, Faculty of Medicine & Health, University of Sydney, NSW, 2050, Australia.,The Australian Paediatric Surveillance Unit, Sydney Children's Hospital Network, NSW, 2045, Australia
| | - Jane Halliday
- Department of Paediatrics, University of Melbourne, Victoria, 3010, Australia.,Reproductive Epidemiology, Murdoch Children's Research Institute, Victoria, 3052, Australia
| | - Jeffrey M Craig
- Molecular Immunity, Murdoch Children's Research Institute, Victoria, 3052, Australia.,Department of Paediatrics, University of Melbourne, Victoria, 3010, Australia.,The Institute of Mental & Physical Health & Clinical Translation, Deakin University, Victoria, 3220, Australia
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43
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Teutsch SM, Nunez CA, Morris A, Eslick GD, Khandaker G, Berkhout A, Novakovic D, Brotherton JML, McGregor S, King J, Egilmezer E, Booy R, Jones CA, Rawlinson W, Thorley BR, Elliott EJ. Australian Paediatric Surveillance Unit (APSU) Annual Surveillance Report 2020. ACTA ACUST UNITED AC 2021; 45. [PMID: 34711146 DOI: 10.33321/cdi.2021.45.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract For 27 years, national prospective data on selected rare childhood diseases have been collected monthly by the Australian Paediatric Surveillance Unit (APSU) from paediatricians and other clinical specialists who report cases in children aged up to 16 years. We report here the annual results of APSU surveillance in 2020 for ten rare communicable diseases and complications of communicable diseases, namely: acute flaccid paralysis (AFP); congenital cytomegalovirus (CMV) infection; neonatal herpes simplex virus (HSV) infection; perinatal exposure to human immunodeficiency virus (HIV); paediatric HIV infection; severe complications of seasonal influenza; juvenile onset recurrent respiratory papillomatosis (JoRRP); congenital rubella syndrome; congenital varicella syndrome; and neonatal varicella infection. We describe the results for each disease in the context of the total period of study, including demographics, clinical characteristics, treatment and short-term outcomes. Despite challenges presented by the coronavirus disease 2019 (COVID-19) pandemic in 2020, more than 1,400 paediatricians reported regularly to the APSU and an overall monthly reporting rate of > 90% was achieved. The minimum AFP target of 1 case per 100,000 children aged less than 15 years was achieved and there were few cases of vaccine-preventable diseases (JoRRP, rubella, varicella). However, high cases of congenital CMV, neonatal HSV and perinatal exposure to HIV persist. There were no severe complications of seasonal influenza reported for the first time in 13 years. This is consistent with other surveillance data reporting a decline of influenza and other communicable diseases in 2020, and likely reflects the wider effects of public health measures to reduce transmission of SARS-CoV-2 in the Australian community.
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Affiliation(s)
- Suzy M Teutsch
- The Australian Paediatric Surveillance Unit.,The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, AUSTRALIA.,The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
| | - Carlos A Nunez
- The Australian Paediatric Surveillance Unit.,The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, AUSTRALIA.,The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
| | - Anne Morris
- The Australian Paediatric Surveillance Unit.,The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, AUSTRALIA.,The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
| | - Guy D Eslick
- The Australian Paediatric Surveillance Unit.,The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, AUSTRALIA.,The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
| | - Gulam Khandaker
- Director of Public Health/Public Health Physician and Director of Medical Research, Central Queensland Hospital and Health Service, Rockhampton, Queensland, AUSTRALIA
| | - Angela Berkhout
- Microbiology Registrar, Microbiology and laboratory services, The Royal Children's Hospital, Melbourne, Victoria, AUSTRALIA
| | - Daniel Novakovic
- ENT, Head and Neck Surgeon, Laryngologist, and Director, Dr Liang Voice Program, The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Sydney, New South Wales, AUSTRALIA
| | - Julia M L Brotherton
- Medical Director, VCS Population Health, VCS Foundation, Melbourne, Victoria, AUSTRALIA.,Honorary Principal Fellow, Melbourne School of Population and Global Health, University of Melbourne, Victoria, AUSTRALIA
| | - Skye McGregor
- Epidemiologist, The Kirby Institute, UNSW Sydney, New South Wales, AUSTRALIA
| | - Jonathan King
- Epidemiologist, The Kirby Institute, UNSW Sydney, New South Wales, AUSTRALIA
| | - Ece Egilmezer
- Virology Research Laboratory, Prince of Wales Hospital, Randwick, Sydney, New South Wales, AUSTRALIA.,UNSW Sydney, New South Wales, AUSTRALIA
| | - Robert Booy
- Senior Professorial Fellow, National Centre for Immunisation Research and Surveillance, Sydney, New South Wales, AUSTRALIA
| | - Cheryl A Jones
- Dean and Head of Sydney Medical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, AUSTRALIA
| | - William Rawlinson
- Senior Medical Virologist, Director of Serology, Virology and OTDS Laboratories, NSW Health Pathology Randwick, Sydney, New South Wales, AUSTRALIA.,UNSW Sydney, New South Wales, AUSTRALIA
| | - Bruce R Thorley
- Head, National Enterovirus Reference Laboratory and WHO Polio Regional Reference Laboratory, Victorian Infectious Disease Reference Laboratory, Melbourne, Victoria, AUSTRALIA.,The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, AUSTRALIA
| | - Elizabeth J Elliott
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, AUSTRALIA.,The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
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44
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Nunez C, Morris A, Jones CA, Badawi N, Baynam G, Hansen M, Elliott EJ. Microcephaly in Australian children, 2016-2018: national surveillance study. Arch Dis Child 2021; 106:849-854. [PMID: 33229416 DOI: 10.1136/archdischild-2020-320456] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe infants aged <12 months reported with microcephaly to the Australian Paediatric Surveillance Unit (APSU) following emergence of Zika virus infection internationally. DESIGN, SETTING AND PATIENTS National, active, monthly surveillance for microcephaly using the APSU. Microcephaly was defined as occipitofrontal circumference (OFC) of more than 2 SDs below the mean for age, gender and gestation. MAIN OUTCOME MEASURES Clinical spectrum, aetiology and birth prevalence of microcephaly reported by paediatricians. RESULTS Between June 2016 and July 2018, 106 notifications were received, with clinical details provided for 96 (91%). After excluding ineligible notifications, 70 cases were confirmed, giving an annual birth prevalence of 1.12 (95% CI 0.88 to 1.42) per 10 000 live births. Of the total number of cases, 47 (67%) had primary microcephaly (at birth); and 25 (36%) had severe microcephaly (OFC >3 SDs). Birth defects were reported in 42 (60%). Of 49 infants with developmental assessment details available, 25 (51%) had failed to reach all milestones. Vision impairment was reported in 14 (26%). The cause of microcephaly was unknown in 60%: 13 (19%) had been diagnosed with genetic disorders; 22 (39%) had anomalies on neuroimaging. No congenital or probable Zika infection was identified. Severe microcephaly was more often associated with hearing impairment than microcephaly of >2 SDs but ≤3 SDs below the mean (p<0.007). Indigenous children and children with socioeconomic advantage were over-represented among children with microcephaly. CONCLUSION Novel national data on microcephaly highlight the high proportion of idiopathic cases. This has implications for prevention and management and suggests the need for a standardised diagnostic approach and ongoing surveillance mechanism in Australia.
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Affiliation(s)
- Carlos Nunez
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia .,The Australian Paediatric Surveillance Unit, Sydney, New South Wales, Australia
| | - Anne Morris
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,The Australian Paediatric Surveillance Unit, Sydney, New South Wales, Australia.,The Sydney Children's Hospitals Network (Westmead), Sydney, NSW, Australia
| | - Cheryl A Jones
- The Sydney Children's Hospitals Network (Westmead), Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Nadia Badawi
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,The Sydney Children's Hospitals Network (Westmead), Sydney, NSW, Australia.,Professor of Cerebral Plasy, Macquarie Group Foundation, The CP Research Institute, Sydney, NSW, Australia
| | - Gareth Baynam
- Western Australian Register of Developmental Anomalies, King Edward Memorial Hospital Perth, Perth, Western Australia, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Michele Hansen
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,The Australian Paediatric Surveillance Unit, Sydney, New South Wales, Australia.,The Sydney Children's Hospitals Network (Westmead), Sydney, NSW, Australia
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45
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Tsang TW, Kingsland M, Doherty E, Anderson AE, Tully B, Crooks K, Symonds I, Tremain D, Dunlop AJ, Wiggers J, Elliott EJ. Predictors of alcohol use during pregnancy in Australian women. Drug Alcohol Rev 2021; 41:171-181. [PMID: 34062031 DOI: 10.1111/dar.13330] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This paper aimed to document alcohol use during pregnancy and determine predictors of ongoing use, including knowledge and agreement with national alcohol guideline recommendations. METHODS Pregnant women (n = 1179) attending public antenatal services in a Local Health District in NSW, Australia, were surveyed about their alcohol use before pregnancy and after pregnancy recognition, and awareness of, and agreement with, national alcohol guidelines and health-related statements. Respondent characteristics, drinking behaviour and predictors of ongoing drinking during pregnancy were assessed. RESULTS Most women consumed alcohol before pregnancy (79.3%) but the majority (82.0%) stopped following pregnancy recognition. Half the ongoing drinkers only drank on special occasions. Most (63.6%) women were aware of the national guidelines: 78.1% knew the recommendation that consuming no alcohol in pregnancy is safest, 4.6% thought some alcohol was safe and 17.3% were unsure. Predictors [OR (95%CI)] of ongoing drinking were older age [1.11 (1.07, 1.15)]; medium [2.42 (1.46, 4.00)] or high-risk drinking pre-pregnancy [3.93 (2.35, 6.56)]; and agreement that: avoiding alcohol in pregnancy is safest [0.05 (0.006, 0.47)]; avoiding alcohol is important for baby's health [0.14 (0.06, 0.31)] and pregnancy is a good time to change alcohol use for mother's health [0.29 (0.13, 0.63)]. DISCUSSION AND CONCLUSIONS Results emphasise the importance of asking about special occasion drinking, the link between pre-pregnancy drinking and ongoing drinking during pregnancy, and the need to understand why women disagree with the national guideline. To ensure guidelines have their intended benefit, interventions to promote behaviour change relating to alcohol consumption during pregnancy are warranted.
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Affiliation(s)
- Tracey W Tsang
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney Children's Hospital Westmead Clinical School, Sydney, Australia.,Sydney Children's Hospital Network, Kids Research, Sydney, Australia
| | - Melanie Kingsland
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Emma Doherty
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Amy E Anderson
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Belinda Tully
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia
| | - Kristy Crooks
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Ian Symonds
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Danika Tremain
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Adrian J Dunlop
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia.,Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia
| | - John Wiggers
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Elizabeth J Elliott
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney Children's Hospital Westmead Clinical School, Sydney, Australia.,Sydney Children's Hospital Network, Kids Research, Sydney, Australia
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Lees B, Elliott EJ, Allsop S, Thomas S, Riches J, Nepal S, Rice LJ, Newton N, Mewton L, Teesson M, Stapinski LA. Fetal Alcohol Spectrum Disorder resources for educators working within primary school settings: a scoping review protocol. BMJ Open 2021; 11:e045497. [PMID: 33820791 PMCID: PMC8030464 DOI: 10.1136/bmjopen-2020-045497] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Many children affected by Fetal Alcohol Spectrum Disorder (FASD) exhibit neurocognitive delays that contribute to secondary consequences, including a disrupted school experience. Educators often have limited knowledge or experience in the identification, referral, management and accommodation of students with FASD. Effective resources and tools for educators are crucial to ensure these students are supported in their ongoing learning, development and school participation. This scoping review aims to identify and evaluate resources for educators that aid in the identification, management, or accommodation of students with FASD. METHODS AND ANALYSIS A search will be conducted in 9 peer-reviewed and 11 grey literature databases, Google search engine, two app stores and two podcast streaming services (planned search dates: November 2020 to February 2021). Relevant experts, including researchers, health professionals and individuals with lived experience of FASD, will be contacted in February and March 2021 to identify additional (including unpublished) resources. Resources will be selected based on registered, prespecified inclusion-exclusion criteria, and the quality of included resources will be critically appraised using a composite tool based on adaptions of the National Health and Medical Research Council FORM Framework and the iCAHE Guideline Quality Checklist. Relevant experts will also be requested to provide feedback on included resources. ETHICS AND DISSEMINATION Ethical approval for this scoping review was obtained from the University of Sydney Human Research Ethics Committee (2020/825). Results of the review will be disseminated through a peer-reviewed publication, conference presentations, and seminars targeting audiences involved in the education sector. TRIAL REGISTRATION Open Science Framework: osf.io/73pjh.
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Affiliation(s)
- Briana Lees
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown, New South Wales, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Steve Allsop
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Sue Thomas
- Marulu Unit, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Julia Riches
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown, New South Wales, Australia
| | - Smriti Nepal
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown, New South Wales, Australia
| | - Lauren J Rice
- The Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
- The Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicola Newton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown, New South Wales, Australia
| | - Louise Mewton
- Centre for Healthy Brain Ageing, University of New South Wales, Randwick, New South Wales, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown, New South Wales, Australia
| | - Lexine A Stapinski
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown, New South Wales, Australia
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Teutsch SM, Zurynski YA, Nunez C, Lester-Smith D, Festa M, Booy R, Elliott EJ. Ten Years of National Seasonal Surveillance for Severe Complications of Influenza in Australian Children. Pediatr Infect Dis J 2021; 40:191-198. [PMID: 33093432 DOI: 10.1097/inf.0000000000002961] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Severe complications of influenza in children are uncommon but may result in admission to hospital or an intensive care unit (ICU) and death. METHODS Active prospective surveillance using the Australian Paediatric Surveillance Unit with monthly reporting by pediatricians of national demographic and clinical data on children with <15 years of age hospitalized with severe complications of laboratory-confirmed influenza during ten influenza seasons 2008-2017. RESULTS Of 722 children notified, 613 had laboratory-confirmed influenza and at least one severe complication. Most (60%) were <5 years of age; 10% were <6 months, hence ineligible for vaccination. Almost half of all cases were admitted to ICU and 30 died. Most children were previously healthy: 40.3% had at least one underlying medical condition. Sixty-five different severe complications were reported; pneumonia was the most common, occurring in over half of all cases. Influenza A accounted for 68.6% hospitalizations; however, influenza B was more often associated with acute renal failure (P = 0.014), rhabdomyolysis (P = 0.019), myocarditis (P = 0.015), pericarditis (P = 0.013), and cardiomyopathy (P = 0.035). Children who died were more likely to be older (5-14 years), have underlying medical conditions, be admitted to ICU, and have encephalitis, acute renal failure, or myocarditis. Only 36.1% of all children reported received antiviral medications, and 8.5% were known to be vaccinated for seasonal influenza. CONCLUSIONS Severe influenza complications cause morbidity and mortality in children, which may increase if coinfection with COVID-19 occurs in the 2020 season and beyond. Increased vaccination rates, even in healthy children, early diagnosis and timely antiviral treatment are needed to reduce severe complications and death.
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Affiliation(s)
- Suzy M Teutsch
- From the The Australian Paediatric Surveillance Unit, Kid's Research, Sydney Children's Hospitals Network, Westmead
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney
| | - Yvonne A Zurynski
- From the The Australian Paediatric Surveillance Unit, Kid's Research, Sydney Children's Hospitals Network, Westmead
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney
- NHMRC Partnership Centre in Health System Sustainability, Australian Institute of Health Innovation, Macquarie University
| | - Carlos Nunez
- From the The Australian Paediatric Surveillance Unit, Kid's Research, Sydney Children's Hospitals Network, Westmead
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney
| | - David Lester-Smith
- From the The Australian Paediatric Surveillance Unit, Kid's Research, Sydney Children's Hospitals Network, Westmead
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney
| | - Marino Festa
- Kids Critical Care Research, The Children's Hospital at Westmead
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance, Sydney, NSW, Australia
| | - Elizabeth J Elliott
- From the The Australian Paediatric Surveillance Unit, Kid's Research, Sydney Children's Hospitals Network, Westmead
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney
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48
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Le Bas GA, Youssef GJ, Macdonald JA, Mattick R, Teague SJ, Honan I, McIntosh JE, Khor S, Rossen L, Elliott EJ, Allsop S, Burns L, Olsson CA, Hutchinson DM. Maternal bonding, negative affect, and infant social-emotional development: A prospective cohort study. J Affect Disord 2021; 281:926-934. [PMID: 33229017 DOI: 10.1016/j.jad.2020.11.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Theoretical perspectives and empirical evidence suggest that maternal bonding and negative affect play a role in supporting infant social-emotional development (Branjerdporn et al., 2017; Kingston et al., 2012; O'Donnell et al., 2014; Van den Bergh et al., 2017). However, the complex pathways likely to exist between these constructs remain unclear, with limited research examining the temporal and potentially bi-directional associations between maternal bonding and negative affect across pregnancy and infancy. METHODS The interrelationships between maternal bonding, negative affect, and infant social-emotional development were examined using multi-wave perinatal data from an Australian cohort study (N = 1,579). Self-reported bonding and negative affect were assessed at each trimester, and 8 weeks and 12 months postpartum. The Bayley-III social-emotional scale was administered at age 12 months. RESULTS Results revealed strong continuities in bonding and negative affect across pregnancy and postpartum. Small associations (β = -.10 to -.20) existed between maternal negative affect during pregnancy and poor early bonding. Higher postnatal maternal bonding predicted infant social-emotional development (β = .17). LIMITATIONS Limitations include a somewhat advantaged and predominantly Anglo-Saxon sample of families, and the use of self-report measures (though with strong psychometric properties). These limitations should be considered when interpreting the study findings. CONCLUSIONS Maternal bonding and negative affect are interrelated yet unique constructs, with suggested developmental interplay between mother-to-infant bonding and infant social-affective development.
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Affiliation(s)
- Genevieve A Le Bas
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Geelong, Australia
| | - George J Youssef
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Geelong, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Jacqui A Macdonald
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Geelong, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Department of Paediatrics, Royal Children's Hospital, Melbourne, Australia
| | - Richard Mattick
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Samantha J Teague
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Geelong, Australia
| | - Ingrid Honan
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Jennifer E McIntosh
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Geelong, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Department of Paediatrics, Royal Children's Hospital, Melbourne, Australia; La Trobe University, The Bouverie Centre, College of Science, Health and Engineering, Bundoora, Australia
| | - Sarah Khor
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Larissa Rossen
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; British Columbia Children's Hospital Research Institute, The University of British Columbia, Vancouver, Canada
| | - Elizabeth J Elliott
- Speciality of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; The Children's Hospital at Westmead, Sydney, Australia
| | - Steve Allsop
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Lucinda Burns
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Craig A Olsson
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Geelong, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Department of Paediatrics, Royal Children's Hospital, Melbourne, Australia
| | - Delyse M Hutchinson
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Geelong, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Department of Paediatrics, Royal Children's Hospital, Melbourne, Australia; National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
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49
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Britton PN, Dale RC, Blyth CC, Clark JE, Crawford N, Marshall H, Elliott EJ, Macartney K, Booy R, Jones CA. Causes and Clinical Features of Childhood Encephalitis: A Multicenter, Prospective Cohort Study. Clin Infect Dis 2021; 70:2517-2526. [PMID: 31549170 DOI: 10.1093/cid/ciz685] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/24/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND We aimed to determine the contemporary causes, clinical features, and short-term outcome of encephalitis in Australian children. METHODS We prospectively identified children (≤14 years of age) admitted with suspected encephalitis at 5 major pediatric hospitals nationally between May 2013 and December 2016 using the Paediatric Active Enhanced Disease Surveillance (PAEDS) Network. A multidisciplinary expert panel reviewed cases and categorized them using published definitions. Confirmed encephalitis cases were categorized into etiologic subgroups. RESULTS From 526 cases of suspected encephalitis, 287 children met criteria for confirmed encephalitis: 57% (95% confidence interval [CI], 52%-63%) had infectious causes, 10% enterovirus, 10% parechovirus, 8% bacterial meningoencephalitis, 6% influenza, 6% herpes simplex virus (HSV), and 6% Mycoplasma pneumoniae; 25% (95% CI, 20%-30%) had immune-mediated encephalitis, 18% acute disseminated encephalomyelitis, and 6% anti-N-methyl-d-aspartate receptor encephalitis; and 17% (95% CI, 13%-21%) had an unknown cause. Infectious encephalitis occurred in younger children (median age, 1.7 years [interquartile range {IQR}, 0.1-6.9]) compared with immune-mediated encephalitis (median age, 7.6 years [IQR, 4.6-12.4]). Varicella zoster virus encephalitis was infrequent following high vaccination coverage since 2007. Thirteen children (5%) died: 11 with infectious causes (2 influenza; 2 human herpesvirus 6; 2 group B Streptococcus; 2 Streptococcus pneumoniae; 1 HSV; 1 parechovirus; 1 enterovirus) and 2 with no cause identified. Twenty-seven percent (95% CI, 21%-31%) of children showed moderate to severe neurological sequelae at discharge. CONCLUSIONS Epidemic viral infections predominated as causes of childhood encephalitis in Australia. The leading causes include vaccine-preventable diseases. There were significant differences in age, clinical features, and outcome among leading causes. Mortality or short-term neurological morbidity occurred in one-third of cases.
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Affiliation(s)
- Philip N Britton
- Discipline of Child and Adolescent Health, Sydney Medical School, Children's Hospital at Westmead, New South Wales.,Marie Bashir Institute of Infectious Diseases and Biosecurity Institute, University of Sydney, New South Wales.,Departments of Infectious Diseases and Microbiology, New South Wales
| | - Russell C Dale
- Discipline of Child and Adolescent Health, Sydney Medical School, Children's Hospital at Westmead, New South Wales.,Neurology, Children's Hospital at Westmead, New South Wales
| | - Christopher C Blyth
- Perth Children's Hospital, Nedlands, Perth, Western Australia.,Telethon Kids Institute and School of Medicine, University of Western Australia, Nedlands, Perth, Western Australia.,PathWest Laboratory Medicine Western Australia and Queen Elizabeth II Medical Centre, Nedlands, Perth, Western Australia
| | - Julia E Clark
- Children's Health Queensland, Brisbane.,School of Clinical Medicine, University of Queensland, Brisbane
| | - Nigel Crawford
- Murdoch Children's Research Institute and Royal Children's Hospital, Victoria.,University of Melbourne, Victoria
| | - Helen Marshall
- Women's and Children's Hospital, South Australia.,Robinson Research Institute, University of Adelaide, South Australia, and
| | - Elizabeth J Elliott
- Discipline of Child and Adolescent Health, Sydney Medical School, Children's Hospital at Westmead, New South Wales.,Australian Paediatric Surveillance Unit, New South Wales, Australia
| | - Kristine Macartney
- Discipline of Child and Adolescent Health, Sydney Medical School, Children's Hospital at Westmead, New South Wales.,Departments of Infectious Diseases and Microbiology, New South Wales.,National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - Robert Booy
- Discipline of Child and Adolescent Health, Sydney Medical School, Children's Hospital at Westmead, New South Wales.,Marie Bashir Institute of Infectious Diseases and Biosecurity Institute, University of Sydney, New South Wales.,Departments of Infectious Diseases and Microbiology, New South Wales.,National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - Cheryl A Jones
- Marie Bashir Institute of Infectious Diseases and Biosecurity Institute, University of Sydney, New South Wales.,Murdoch Children's Research Institute and Royal Children's Hospital, Victoria.,University of Melbourne, Victoria
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50
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Finlay-Jones A, Symons M, Tsang W, Mullan R, Jones H, McKenzie A, Reibel, Cannon L, Birda B, Reynolds N, Sargent P, Gailes H, Mayers D, Elliott EJ, Bower C. Community Priority setting for Fetal Alcohol Spectrum Disorder Research in Australia. Int J Popul Data Sci 2020; 5:1359. [PMID: 34036178 PMCID: PMC8130797 DOI: 10.23889/ijpds.v5i1.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Introduction Fetal Alcohol Spectrum Disorder (FASD) is a neurodevelopmental disorder caused by prenatal alcohol exposure (PAE). FASD research is a rapidly growing field that crosses multiple disciplines. To ensure research is relevant and meaningful for people living with FASD, their families, and the broader public there is a need to engage community members in setting priorities for research. Objectives Our primary objective was to formally identify the views of people living with FASD, their parents/caregivers, service providers, and the general community on the research priorities for FASD and alcohol use in pregnancy in Australia. Our secondary objective was to provide an overview of current research in the highest priority areas identified. Methods The approach for this study involved two community surveys and a consensus workshop, followed by a rapid literature review. Survey responses (n = 146) were collected and grouped using qualitative thematic analysis. The themes identified were then ranked in a second survey (n = 45). The 22 highest ranked themes were considered in a workshop with 21 community members, and consensus on the top ten priority areas was sought. The priority areas were grouped into conceptually similar topics and rapid literature reviews were undertaken on each. Results A diverse range of priorities was identified within key areas of prevention, diagnosis, and therapy. On request from participants, separate priority lists were developed by Aboriginal and non-Aboriginal participants. Conclusion There is need for a national network of researchers to take forward the research commenced by the Centre of Research Excellence, FASD Research Australia, in addressing community priorities. Key Words Community, priorities, FASD, rapid review, Australia.
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Affiliation(s)
- A Finlay-Jones
- Telethon Kids Institute, NHMRC FASD Research Australia Centre of Research Excellence, Nedlands, Western Australia, Australia
| | - M Symons
- Telethon Kids Institute, NHMRC FASD Research Australia Centre of Research Excellence, Nedlands, Western Australia, Australia
| | - W Tsang
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - R Mullan
- Telethon Kids Institute, NHMRC FASD Research Australia Centre of Research Excellence, Nedlands, Western Australia, Australia
| | - H Jones
- Telethon Kids Institute, NHMRC FASD Research Australia Centre of Research Excellence, Nedlands, Western Australia, Australia
| | - A McKenzie
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Reibel
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Western Australia, Australia
| | - L Cannon
- Telethon Kids Institute, NHMRC FASD Research Australia Centre of Research Excellence, Nedlands, Western Australia, Australia
| | | | | | | | | | | | - E J Elliott
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - C Bower
- Telethon Kids Institute, NHMRC FASD Research Australia Centre of Research Excellence, Nedlands, Western Australia, Australia
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