ORCID Profile
0000-0002-6501-5487
Current Organisations
Royal College of Physicians
,
Royal Australasian College of Physicians
,
Sydney Children's Hospitals Network Randwick and Westmead
,
University of Sydney
,
Leicester Royal Infirmary
,
Royal College of Paediatrics and Child Health
,
Saint Bartholomew's Hospital
,
University of Sydney School of Public Health
,
University of Leicester
,
University of London
,
George Institute for Global Health
,
Great Ormond Street Hospital for Children
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Public Health and Health Services | Health and Community Services | Preventive Medicine | Human Bioethics | Health Information Systems (Incl. Surveillance) | Epidemiology | Community Child Health | Health Promotion | Paediatrics | Organisational Planning and Management | Organisation and Management Theory
ANZSRC Socio-Economic Objective (SEO)
Bioethics | Child Health | Health Education and Promotion | Health and support services not elsewhere classified | Preventive medicine | Child health | Health policy evaluation | Health Policy Economic Outcomes |
Related Links
Publications
Impairment of motor skills in children with fetal alcohol spectrum disorders in remote Australia: The Lililwan Project
Publisher: Wiley
Date: 16-02-2016
DOI: 10.1111/DAR.12375
Abstract: We aimed to characterise motor performance in predominantly Aboriginal children living in very remote Australia, where rates of prenatal alcohol exposure (PAE) are high. Motor performance was assessed, and the relationship between motor skills, fetal alcohol spectrum disorders (FASD) and PAE was explored. Motor performance was assessed using the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition Complete Form, in a population-based study of children born in 2002 or 2003 living in the Fitzroy Valley, Western Australia. Composite scores ≥2SD (2nd percentile) and ≥1SD (16th percentile) below the mean were used respectively for FASD diagnosis and referral for treatment. FASD diagnoses were assigned using modified Canadian Guidelines. A total of 108 children (Aboriginal: 98.1% male: 53%) with a mean age of 8.7 years was assessed. The cohort's mean total motor composite score (mean ± SD 47.2 ± 7.6) approached the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition normative mean (50 ± 10). Motor performance was lower in children with FASD diagnosis than without (mean difference (MD) ± SD: -5.0 ± 1.8 confidence interval: -8.6 to -1.5). There was no difference between children with PAE than without (MD ± SE: -2.2 ± 1.5 confidence interval: -5.1 to 0.80). The prevalence of motor impairment (≥-2SD) was 1.9% in the entire cohort, 9.5% in children with FASD, 3.3% in children with PAE and 0.0% both in children without PAE or FASD. Almost of 10% of children with FASD has significant motor impairment. Evaluation of motor function should routinely be included in assessments for FASD, to document impairment and enable targeted early intervention.[Lucas BR, Doney R, Latimer J, Watkins RE, Tsang TW, Hawkes G, Fitzpatrick JP, Oscar J, Carter M, Elliott EJ. Impairment of motor skills in children with fetal alcohol spectrum disorders in remote Australia: The Lililwan Project. Drug Alcohol Rev 2016 :719-727].
Oral rehydration therapy: applied physiology
Publisher: Royal College of Physicians
Date: 06-2008
A national prospective surveillance study of acute rheumatic fever in Australian children.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2013
Preventing rotavirus gastroenteritis: Do you have the facts?
Publisher: Wiley
Date: 07-2007
DOI: 10.1111/J.1440-1754.2007.01163.X
Abstract: Abstract: From 1 July 2007 two new rotavirus vaccines licensed for use in Australia (RotaTeq CSL Biotherapies/Merck and Rotarix Glaxo Smith Kline) will be funded for the National Immunisation Program. The vaccines differ with respect to their composition and the timing and mode of administration. Both have been evaluated in huge randomised trials and shown to be highly effective in preventing rotavirus gastroenteritis, including severe disease requiring hospital admission. Neither has been associated with an increased rate of intussusception however, surveillance for adverse effects following vaccination will be important. As rotavirus infection is ubiquitous in young children, funding of this vaccine will significantly decrease the enormous morbidity and costs associated with this disease in our community.
Brucellosis: A rare cause of fever
Publisher: Wiley
Date: 11-2005
Sudden unexplained early neonatal death or collapse: a national surveillance study
Publisher: Springer Science and Business Media LLC
Date: 24-05-2016
DOI: 10.1038/PR.2016.110
Abstract: The incidence of sudden unexpected early neonatal death (SUEND) or acute life-threatening events (ALTEs) is reported as 0.05/1,000 to 0.38/1,000 live births. There is currently no national system in Australia for reporting and investigating such cases. A 3-y prospective, national surveillance study, run in collaboration with the Australian Pediatric Surveillance Unit (APSU). Data were provided by pediatricians reporting to APSU and independently ascertained by the Coroner in two states (NSW and QLD) and the Newborn Early Transport Network in NSW. A detailed deidentified questionnaire was created. In NSW and QLD, the incidence was 0.1 and 0.08/1,000 live births, respectively. Forty-eight definitive cases were identified. Common causes included accidental asphyxia, cardiac disease, persistent pulmonary hypertension of the newborn, and sudden infant death syndrome. Twenty-six babies collapsed on day 1 and 19 were found on the carer's chest. The incidence in NSW and QLD is higher than previously published. The first postnatal day is a vulnerable period for newborns, who require close observation particularly during skin-to-skin contact. Development and implementation of guidelines for safe sleeping in hospital are needed. Collaboration between obstetricians, midwives, and pediatricians is essential to ensure safety of the newborn.
Eosinophilic Esophagitis
Publisher: Wiley
Date: 22-07-2010
Effect of bicarbonate on efficacy of oral rehydration therapy: studies in an experimental model of secretory diarrhoea.
Publisher: BMJ
Date: 08-1988
Abstract: In situ perfusion of rat intestine was used to evaluate the effect of bicarbonate on the efficacy of a low sodium (35 mmol/l) glucose-electrolyte oral rehydration solution in normal and cholera toxin-treated rat small intestine. In normal intestine, absorption of water was greater (108 (8.1) microliters/min/g p less than 0.01) and sodium secretion less (-4.3 (0.3) mumol/min/g p less than 0.01) from the oral rehydration solution containing bicarbonate than from the solution in which bicarbonate was replaced by chloride ions (59.5 (7.2) microliters/min/g and -7.8 (0.8) mumol/min/g, respectively). Glucose absorption in normal intestine was similar with both solutions. In the secreting intestine, both oral rehydration solutions reversed net water secretion to absorption, but inclusion of bicarbonate resulted in significantly less net absorption of both water (2.18 (6.9) microliters/min/g p less than 0.05) and glucose (18.7 (2.1) mumol/min/g p less than 0.001) compared with bicarbonate free oral rehydration solution (19.4 (3.9) microliters/min/g and 35.8 (3.7) mumol/min/g, respectively). Net sodium secretion occurred in normal and secreting intestine but was significantly less with the bicarbonate containing oral rehydration solution. These findings suggest that the demonstrable advantage of bicarbonate in promoting water absorption from this oral rehydration solution in normal rat intestine does not apply to cholera toxin treated secreting intestine.
Researchers' experience with project management in health and medical research: Results from a post-project review
Publisher: Springer Science and Business Media LLC
Date: 02-06-2011
Impedance, neural response telemetry, and speech perception outcomes after reimplantation of cochlear implants in children
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2014
Rare childhood diseases
Publisher: BMJ
Date: 12-2008
Abstract: Paradoxically, rare diseases are common, collectively affecting 6-10% of the population and have a huge impact on patients and families, health services, clinicians and the wider community. Accurate data are required to inform clinical practice, government policy and health service planning. We recommend a national approach, similar to that adopted in the USA and Europe, to support research and promote advocacy and equitable access to services for children with rare diseases.
Childhood interstitial lung disease
Publisher: Wiley
Date: 30-04-2015
DOI: 10.1002/PPUL.23183
Abstract: Childhood interstitial lung disease (chILD) is a group of rare chronic and complex disorders of variable pathology. There has been no systematic review of published chILD research. This study aimed to describe chILD classification systems, epidemiology, morbidity, treatments, outcomes, and the impact of chILD on families and the burden on health services. A systematic literature search for original studies on chILD was undertaken in the major biomedical databases to the end of December 2013. Epidemiological studies, case series and studies describing classification systems were included. Single case studies were excluded. The search yielded 37 publications that met study criteria. Four different chILD classification systems have been proposed in the past decade. The incidence of chILD has been estimated at 0.13-16.2 cases/100,000 children/year. One to five new cases presented to in idual hospitals each year. In developed countries, the median mortality was 13% (6-19%). Morbidity and outcomes were highly variable and not systematically reported. Corticosteroids and hydroxychloroquine were the most common treatments. The impact of chILD on families and the burden on health services has not been studied. The heterogeneity of the chILD group of disorders, different determinations of what constitutes a chILD disorder and, a paucity of large epidemiological studies precludes consolidation of results across studies. Consensus on chILD classification is needed to support diagnosis and allow direct comparisons of research evidence. Active disease surveillance and international patient registries are required to advance understanding and management of chILD.
Cannabis use by women during pregnancy does not influence infant DNA methylation of the dopamine receptor DRD4
Publisher: Informa UK Limited
Date: 27-04-2017
Progressive myoclonic epilepsies: Recent genetic advances
Publisher: Wiley
Date: 04-1997
DOI: 10.1111/J.1440-1754.1997.TB01006.X
Abstract: The progressive myoclonic epilepsies are a rare group of debilitating epileptic encephalopathies characterized by myoclonic seizures, progressive neurological dysfunction and dementia. In the past year advances in gene mapping have isolated gene loci for the majority of progressive myoclonic disorders, paving the way for specific diagnosis, more accurate prognosis and risk calculation, as well as opening the potential for prenatal and pre-symptomatic diagnosis in at risk families.
Systematic review of interventions for children with Fetal Alcohol Spectrum Disorders
Publisher: Springer Science and Business Media LLC
Date: 25-05-2009
Prenatal Alcohol Exposure and Risk of Birth Defects
Publisher: American Academy of Pediatrics (AAP)
Date: 10-2010
Abstract: The goal was to examine the associations between dose, pattern, and timing of prenatal alcohol exposure (PAE) and birth defects. Data from a randomly selected, population-based cohort of nonindigenous women who gave birth to a live infant in Western Australia (WA) between 1995 and 1997 (N = 4714) were linked to WA Midwives Notification System and WA Birth Defects Registry data. We assessed the associations of PAE before pregnancy, in the first trimester, and in late pregnancy with any birth defect and with birth defects classified as alcohol-related birth defects (ARBDs) by the Institute of Medicine (IOM), by using logistic regression. The prevalence of birth defects classified as ARBDs by the IOM was low. Compared with abstinence, heavy PAE in the first trimester was associated with increased odds of birth defects classified as ARBDs (adjusted odds ratio: 4.6 [95% confidence interval: 1.5–14.3]), with similar findings after validation through bootstrap analysis. There was no association between low or moderate PAE and birth defects. A fourfold increased risk of birth defects classified as ARBDs was observed after heavy PAE in the first trimester. Many in idual birth defects included in the IOM classification for ARBDs either were not present in this cohort or were not associated with PAE. Large, population-based studies are needed to strengthen the evidence base for ARBDs.
Collaborating with consumer and community representatives in health and medical research in Australia: results from an evaluation
Publisher: Springer Science and Business Media LLC
Date: 14-05-2011
Injury and death associated with jumping castles: A public health issue
Publisher: Wiley
Date: 03-2022
DOI: 10.1111/JPC.15898
Influenza infection in infants aged <6 months during the H1N1-09 pandemic
Publisher: Wiley
Date: 18-06-2013
DOI: 10.1111/JPC.12266
Abstract: To document risk factors, clinical features and outcomes in infants <6 months old admitted with laboratory-confirmed influenza to The Children's Hospital at Westmead during the H1N1-09 pandemic. Prospective, hospital-based case series of infants admitted June-September 2009, identified by the Paediatric Active Enhanced Disease Surveillance system and supplemented by telephone interview post-discharge. Thirty-two infants <6 months old had influenza A: 18 H1N1-09, 11 H3N2 and three unknown subtypes. After discharge, 28 (88%) families were telephoned and provided additional information. Documented risk factors included close contact with young children (46%), living with a smoker (36%), intensive or special care at birth (25%), pre-existing illness (16%) and preterm birth (14%). The number of persons per household was double the state average. Only 14% of mothers were vaccinated against seasonal influenza. Infants commonly presented with cough (69%), coryza (69%), lethargy (38%), fever (31%), dyspnoea (31%) and vomiting (28%). Complications included pneumonia (22%), and bacterial (9%) and viral (6%) co-infection. Five infants (15%) required admission to intensive care, and one was mechanically ventilated. Sixteen (57%) had ongoing respiratory problems, and six (21%) presented to the Emergency Department within 6 months of discharge. These novel data are clinically important. Rates of influenza in infants may be reduced by vaccinating close contacts and minimising exposure to infected contacts and cigarette smoke.
Transient hypertrophic gastropathy
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-1998
DOI: 10.1097/00005176-199802000-00017
Abstract: Crystal phase quantum dots are formed by vertically stacking zinc-blende and wurtzite phases during nanowire growth. In this work, we show, using an atomistic many-body approach, that crystal field splitting in the wurtzite phase, as well as spontaneous polarization originating from the phase interfaces, will strongly affect the properties of lowest hole states in InP crystal phase quantum dots, and in turn the excitonic optical spectra. We also show that the artifact-free modeling of crystal phase quantum dots should incorporate any additional potentials on equal footing with the electron-hole interaction. In this paper, we discuss a reliable theoretical framework that can be applied to investigate the electronic and optical properties of InP-based crystal phase quantum dots. The importance of accurate excitonic calculations for such systems is highlighted in view of their potential applications in nanowire photonics, yet further research is necessary for bringing theory and experiment in agreement.
Exploring the potential to use data linkage for investigating the relationship between birth defects and prenatal alcohol exposure
Publisher: Wiley
Date: 07-2013
DOI: 10.1002/BDRA.23142
Abstract: This study explores the potential of data linkage to investigate the proportion of birth defects classified as alcohol-related (ARBD) by the Institutes of Medicine (IOM) that are attributable to maternal alcohol-use disorder. Maternal alcohol-use disorder was identified using International Classification of Diseases (9th and 10th revision) codes for alcohol-related diagnoses recorded on record-linked Western Australian health, mental health, and/or drug and alcohol datasets 1983 to 2007. Children of these mothers (n=23,859) were compared with a randomly selected cohort of children born to mothers without an alcohol diagnosis, frequency-matched by maternal age, Aboriginal status, and child's birth year (n=61,370). Birth defects were identified through linkage with the Western Australian Register of Developmental Anomalies and defects with chromosomal causes were excluded. Associations between overall and in idual IOM-designated ARBD and a maternal alcohol-related diagnosis recorded "during pregnancy" or "any" diagnosis (before/during/after pregnancy) was assessed using multivariate logistic regression to generate odds ratios and 95% confidence intervals. Population-attributable fractions were calculated for significant results using total population numbers. There was a significant association between maternal alcohol-related diagnoses recorded during pregnancy and ARBD (adjusted odds ratio, 3.14 95% confidence interval, 2.49-3.96), with an attributable fraction of 0.57%. "Any" maternal alcohol diagnosis demonstrated a higher attributable fraction for ARBD (1.53%), with the highest attributable fractions for microcephaly (7.31%), ptosis (3.75%), atrial septal defect (2.86%), and conotruncal heart defects (2.01%). Research using linked, population-based administrative health data has the potential to advance knowledge of ARBD. Routine collection and recording of alcohol use during pregnancy for all pregnant women is required and would enhance this methodology. Birth Defects Research (Part A) 97:497-504, 2013. © 2013 Wiley Periodicals, Inc.
Maternal and partner prenatal alcohol use and infant cognitive development
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.DRUGALCDEP.2017.12.038
Abstract: Teratogenicity of heavy prenatal alcohol exposure is established, but uncertainty remains regarding the impact of moderate alcohol exposure on cognitive deficits in infants. Separating in utero effects from environmental confounding is a challenge for observational studies consideration of alcohol use by partners as well as mothers may help clarify this. This study examined associations between prenatal alcohol use by both mothers and their partners and infant cognitive developmental outcomes at 12-months. Pregnant women (n = 1331) and their partners (n = 699) were recruited from antenatal clinics of three metropolitan public hospitals in Australia, and completed detailed interviews about alcohol consumptions throughout pregnancy. Infants were assessed with the Bayley Scales of Infant Development - Third edition (Bayley) at 12-months of age. Alcohol use during pregnancy was reported by 65.7% of mothers and 84.1% of partners. Using multiple methods to adjust for confounding factors, no evidence for impaired cognitive ability associated with alcohol use by mothers or their partners was observed. Children born to women who drank low-levels of alcohol had slightly higher Bayley cognitive scores than those born to abstaining women. There was some evidence for an interaction between sociodemographic factors and prenatal alcohol exposure on infant cognitive outcomes. This finding corroborates existing evidence to suggest there are no detrimental effects to infant cognitive development at 12-months of age following low-level prenatal alcohol exposure. Future prospective studies involving families of a broad range of backgrounds would be informative to clarify interaction between alcohol exposure and environmental factors on developmental outcomes.
Nosocomial vs community-acquired pandemic influenza A (H1N1) 2009: a nested case-control study.
Publisher: Elsevier BV
Date: 10-2012
DOI: 10.1016/J.JHIN.2012.07.006
Abstract: The characteristics of nosocomial influenza in children are not well described. To compare the characteristics of nosocomial and community-acquired pandemic influenza A (H1N1) 2009 (pH1N1) in Australian children. In a nested case-control study, the clinical and epidemiological features of nosocomial vs community-acquired pH1N1 were compared among hospitalized children aged <15 years in six paediatric hospitals in Australia between 1 June and 30 September 2009. Of 506 hospitalized children with pH1N1, 47 (9.3%) were of nosocomial origin. These 47 cases were compared with 141 gender- and age-matched controls. Cases had a significantly higher proportion of underlying medical conditions compared with controls (81% vs 42%, P < 0.001), and were more likely to be exposed to household smokers (36% vs 20%, P = 0.02). Fewer children with nosocomial influenza presented with classical symptoms of influenza, including subjective fever and lethargy. A higher proportion of children with nosocomial influenza received treatment with oseltamivir (77% vs 43%, P < 0.001), and they required a longer stay in hospital following the onset of influenza (mean 8.5 days vs 4.5 days, P = 0.006). Three children (2%) in the community-acquired group died of pH1N1, but there were no deaths in the nosocomial group. This study shows that children with pre-existing diseases and those who are exposed to household smokers are more susceptible to nosocomial pH1N1. They may have 'occult presentation' of influenza, but their course of illness is not markedly different from that of children with community-acquired influenza.
Paediatricians' knowledge, attitudes and practice following provision of educational resources about prevention of prenatal alcohol exposure and Fetal Alcohol Spectrum Disorder
Publisher: Wiley
Date: 30-03-2011
DOI: 10.1111/J.1440-1754.2011.02037.X
Abstract: The study aims to provide paediatricians in Western Australia (WA) with educational resources (www.ichr.uwa.edu.au/alcoholandpregnancy) about the prevention of prenatal alcohol exposure and fetal alcohol spectrum disorder, and assess changes in their knowledge, attitudes and practice about fetal alcohol syndrome (FAS) and alcohol consumption in pregnancy. Following our 2004 survey of paediatricians, we developed and distributed educational resources to 159 paediatricians in WA in 2007. Six months later, we surveyed these paediatricians and compared their responses with results from 2004 using prevalence rate ratios (PRRs) and 95% confidence intervals (CIs). Of 133 eligible paediatricians, 82 (61.7%) responded: 65.9% had seen the resources, of these 66.7% had used them and 29.6% said the resources had helped them change, or influenced their intent to change, their practice. There was no change in the proportion that knew all the essential features of FAS (18.3% in 2007 20.0% in 2004) or had diagnosed FAS (58.5% in 2007 58.9% in 2004). An increased proportion (75.6% in 2007 48.9% in 2004) agreed that pregnant women should completely abstain from consuming alcohol (PRR 1.55, 95% CI 1.21-1.97). Only 21.7% (no increase from 2004) routinely asked about alcohol use when taking a pregnancy history. We recommend that asking about alcohol use during pregnancy should be emphasised in paediatric training. Unless paediatricians' capacity to ask about alcohol consumption when taking a pregnancy history and to diagnose FAS is increased, FAS will remain under-diagnosed in Australia and opportunities for management, early intervention and prevention will be overlooked.
Lafora disease: A progressive myoclonus epilepsy
Publisher: Wiley
Date: 12-1992
DOI: 10.1111/J.1440-1754.1992.TB02717.X
Abstract: Lafora disease is a rare inborn error of metabolism resulting in storage of a polyglucosan in tissues including the brain, skin and liver. Four children are described with progressive myoclonus epilepsy and intellectual deterioration in whom this diagnosis was made. In two the diagnosis was confirmed by the presence of periodic acid schiff (PAS) positive, diastase resistant, colloidal iron staining inclusion material in the liver when they were referred to a paediatric gastroenterologist with abnormal liver function tests. In one, the diagnosis was made from cerebellar biopsy, although on retrospective review the liver biopsy performed at this time was abnormal. In a fourth child, whose sibling was affected, histological diagnosis was confirmed by skin biopsy, although clinical and EEG findings had been highly suggestive for several years. The disease has autosomal recessive inheritance, is progressive and the prognosis is poor. Paediatricians should be aware of this diagnosis, which is often delayed, as early histological diagnosis allows prognostic and genetic counselling and optimal treatment. Although the diagnosis was made by liver or brain biopsy in three cases, skin biopsy offers a reliable, less invasive means of diagnosis.
Health‐related out‐of‐pocket expenses for children living with rare diseases ‐ tuberous sclerosis and mitochondrial disorders: A prospective pilot study in Australian families
Publisher: Wiley
Date: 27-10-2021
DOI: 10.1111/JPC.15784
Abstract: We aimed to describe health‐related out‐of‐pocket (OOP) expenses incurred by Australian families living with children with chronic and complex diseases. 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. 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. 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.
Search for the ideal oral rehydration solution: studies in a model of secretory diarrhoea.
Publisher: BMJ
Date: 11-1991
Abstract: In situ perfusion of whole rat small intestine was used to compare the efficacy of five oral rehydration solutions in promoting water and sodium absorption in normal intestine and secreting intestine after exposure to cholera toxin. Solutions varied in their sodium (35-90 mmol/l) and glucose (111-200 mmol/l) concentrations, molar ratio of glucose:sodium (1.2-5.8), and osmolality (281-331 mOsmol/kg), and contained either bicarbonate (18-30 mmol/l) or citrate (10 mmol/l). In normal intestine all solutions promoted net water absorption. Cholera toxin induced reproducible water secretion but all solutions reversed this to absorption. Water absorption was greatest with solutions containing sodium 60 mmol/l and glucose 111 or 140 mmol/l, and with a glucose:sodium ratio approximately 2, in both normal and secreting intestine. All solutions promoted net glucose absorption in both normal and secreting intestine. Net sodium absorption occurred with solutions containing greater than or equal to 60 mmol/l sodium in normal intestine but sodium secretion occurred from all solutions in secreting intestine. Sodium movement was directly related to the sodium concentration of the solution and sodium secretion occurred despite net water and glucose absorption. We consider that these studies may guide future development of oral rehydration solutions.
Interventions to improve gross motor performance in children with neurodevelopmental disorders: a meta-analysis
Publisher: Springer Science and Business Media LLC
Date: 29-11-2016
Toppling television injuries in children and adolescents: a systematic review and meta-analysis
Publisher: BMJ
Date: 23-01-2023
Abstract: Toppling televisions (TVs) are a source of childhood injury but meta-analysis has not assessed the likelihood of TV injuries in children. To present pooled results for injuries, following a systematic review. MEDLINE, Scopus, Google Scholar and EMBASE databases were searched to 5 December 2022. 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. A standardised form was used to include information on publication year, study design, population type, country, s le size, mean age, risk factors, point estimates or data used to calculate ORs. 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. 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.
Gross motor performance in children prenatally exposed to alcohol and living in remote Australia
Publisher: Wiley
Date: 20-07-2016
DOI: 10.1111/JPC.13240
Abstract: This study aimed to determine the gross motor (GM) performance of Aboriginal children living in remote Australia. The relationship between GM skills, prenatal alcohol exposure (PAE) and fetal alcohol spectrum disorders (FASD) was explored. A population-based observation study was conducted in 2011 to assess motor performance in children living in the Fitzroy Valley, Western Australia, using the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2). BOT-2 data were retrospectively analysed using recently developed software enabling separation of fine and GM outcomes. A total of 108 children (98.1% Aboriginal 53% male, mean age: 8.7 years) were assessed. Half (52.2%) were exposed to at least 'risky' levels of PAE, and 21 (19%) were diagnosed with an FASD. The mean GM composite score of the cohort (47.0 ± 8.4) approached the BOT-2 normative mean (50.0 ± 10) and was similar between children with and without PAE (P = 0.27). This mean score, however, was significantly lower in children with FASD than without (mean difference: -5.5 ± 20.6 P = 0.006). Compared with children without FASD, children with FASD had significant impairment in subtests for running speed and agility (mean difference ± standard deviation (SD): -2.4 ± 8.1 P = 0.003) and strength (mean difference ± SD:-2.8 ± 9.9 P = 0.004) and (ii) a higher proportion than expected had overall GM impairment (≤2 SD: 9.5% ≤1 SD: 23.8%). In groups with PAE, no PAE and no FASD, GM function approached expected population norms. A higher than expected proportion of children with FASD had GM scores that indicated impairment and need for therapy. Evaluation of GM performance should routinely be included in FASD assessment to determine strategies to optimise child development.
Alcohol consumption by breastfeeding mothers: Frequency, correlates and infant outcomes
Publisher: Wiley
Date: 13-03-2017
DOI: 10.1111/DAR.12473
Abstract: There is limited research regarding the effects of alcohol consumption by breastfeeding mothers on infant development. This study examined the frequency, correlates and outcomes of alcohol use during lactation. Data were from an Australian cohort study. Maternal demographics and substance use were assessed during pregnancy and at 8 weeks and 12 months postpartum. Breastfeeding duration, infant feeding, sleeping and development (Ages and Stages Questionnaire) were also assessed postpartum. Logistic regression and general linear model analyses examined characteristics of women who drank during breastfeeding, and the association between alcohol use during breastfeeding and infant outcomes. Alcohol use was reported by 60.7% and 69.6% of breastfeeding women at 8 weeks and 12 months postpartum, respectively. Breastfeeding women who consumed alcohol were more likely to be born in Australia or another English-speaking country, be tertiary educated and have higher household incomes. Most drank at low levels (≤14 standard drinks per week, <3 per occasion) and employed strategies (e.g. timing of alcohol use) to minimise alcohol passed onto infants via breastmilk. Alcohol consumption was unrelated to breastfeeding duration, infant feeding and sleeping behaviour at 8 weeks, and most infant developmental outcomes at 8 weeks or 12 months, after adjusting for confounders. The only significant association showed that infants whose mothers drank at 8 weeks postpartum had more favourable results for personal-social development at 12 months compared with those whose mothers abstained. Low level drinking during breastfeeding is not linked with shorter breastfeeding duration or adverse outcomes in infants up to 12 months of age. [Wilson J, Tay RY, McCormack C, Allsop S, Najman J, Burns L, Olsson CA, Elliott E, Jacobs S, Mattick RP, Hutchinson D. Alcohol consumption by breastfeeding mothers: Frequency, correlates and infant outcomes. Drug Alcohol Rev 2017 :000-000].
Prevalence and patterns of alcohol use in pregnancy in remote W estern A ustralian communities: The L ililwanP roject
Publisher: Wiley
Date: 19-02-2015
DOI: 10.1111/DAR.12232
Abstract: Alcohol use in pregnancy is thought to be common in remote Australian communities, but no population-based data are available. Aboriginal leaders in remote Western Australia invited researchers to determine the prevalence and patterns of alcohol use in pregnancy within their communities. A population-based survey of caregivers of all children born in 2002/2003 and living in the Fitzroy Valley in 2010/2011 (n = 134). Alcohol use risk was categorised using the Alcohol Use Disorders Identification Test consumption subset (AUDIT-C) tool. Birth and child outcomes were determined by interview, medical record review and physical examination. 127/134 (95%) eligible caregivers participated: 78% were birth mothers, 95% were Aboriginal and 55% reported alcohol use in index pregnancies 88% reported first trimester drinking and 53% drinking in all trimesters. AUDIT-C scores were calculated for 115/127 women, of whom 60 (52%) reported alcohol use in pregnancy. Of the 60 women who drank (AUDIT-C score ≥ 1), 12% drank daily/almost daily, 33% drank 2-3 times per week 71% drank ≥ 10 standard drinks on a typical occasion 95% drank at risky or high-risk levels (AUDIT-C score ≥ 4). Mean AUDIT-C score was 8.5 ± 2.3 (range 2-12). The most common drinking pattern was consumption of ≥ 10 standard drinks either 2-4 times per month (27%) or 2-3 times per week (27%). High-risk alcohol use in pregnancy is common in remote, predominantly Aboriginal communities in north western Australia. Prevention strategies to reduce prenatal alcohol use are urgently needed.
Using the clinical challenges encountered by junior residents to inform curriculum for paediatric pre‐intern students
Publisher: Wiley
Date: 05-2010
DOI: 10.1111/J.1440-1754.2009.01682.X
Abstract: To develop and evaluate a novel skills-based education programme for medical students completing a paediatric pre-internship (PrInt) at the Children's Hospital at Westmead (CHW), Sydney which incorporated a mini-clinical evaluation exercise style formative assessment component and was based upon a local needs assessment of junior staff. We designed a teaching programme which included four interactive tutorials and formative assessment tasks using observed clinical exercises (OCE). The final programme was informed by a local need-based assessment of out-of-hours junior doctors' tasks. Students rated their level of confidence prior to and after the tutorial and following the OCE. Students provided structured and free text feedback on the programme. Of 29 PrInt students (2007-2008), with collectively 85 tutorial attendances, 84% rated the programme excellent (39%) or very good (45%). For each topic students' confidence increased after the tutorial and again after the OCE (P < 0.001). Improvement was most marked for skills for which students rated themselves pre-teaching as having poor confidence (pain management and calculation of rehydration fluids). Overall, the proportion with 'high' confidence increased from 8.2% pre-tutorial to 38.8% post-tutorial and 72.9% post-OCE (P 90%. Diaries from junior doctors during 20 shifts at the CHW recorded 398 out-of-hours activities, the most common of which are ordering intravenous fluids (19.6%), reviewing asthmatics (16.6%) and recharting medications (16.3%). PrInt students value structured teaching incorporating OCE, which allows assessment of clinical skills and direct formative feedback and promotes gains in confidence, knowledge and skills. Addition of OCE to the teaching programme significantly increased the confidence of PrInt students in performing specific tasks compared with an educational session alone. Local needs assessment of junior doctors by out-of-hours survey both confirmed selection of appropriate topics (pain, fluids) and informed additional topics (asthma management and bronchodilator weaning regime) for future PrInt student programmes.
Pandemic (H1N1) 2009 and seasonal influenza A (H3N2) in children's hospital, Australia
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 10-2011
No compromise on female genital mutilation
Publisher: Wiley
Date: 06-2017
DOI: 10.1111/JPC.13566
Surveillance of acute flaccid pjpclysis in Australia, 1995–97
Publisher: Wiley
Date: 12-1999
DOI: 10.1046/J.1440-1754.1999.00413.X
Abstract: Acute flaccid paralysis (AFP) surveillance in Australia as part of the World Health Organization (WHO) certification process for polio eradication in the Western Pacific region. Active monthly AFP surveillance through the Australian Paediatric Surveillance Unit, from March 1995 to December 1997. Based on 80 cases, the reported overall rate of AFP was 0.73 per 10(5) children < 15 years (below the expected 1 per 10(5)). The major causes of AFP were Guillain-Barré syndrome (51%) and transverse myelitis (19%). According to the WHO virological classification, there was no case of poliomyelitis, 37.5% were 'non-polio' and 62.5% cases were 'polio compatible' due to inadequate stool testing and follow-up. However, case review by an expert panel enabled 95% to be classified as 'non-polio'. Australia must improve AFP surveillance to confirm absence of wild poliovirus. Paediatricians can help Australia meet its certification requirements and contribute to the global eradication effort by reporting and investigating all cases of AFP.
Developing a Charter of Physical Activity and Sport for Children and Youth
Publisher: Elsevier BV
Date: 10-2003
DOI: 10.1111/J.1467-842X.2003.TB00825.X
Abstract: The purpose of this project was to develop a Charter of Physical Activity and Sport for Children and Youth. Its primary purpose is to provide a philosophical framework to support participation, enjoyment and safety in physical activity and sport for all Australian children and youth. The development of the charter was initiated by The Children's Hospital at Westmead, New South Wales (NSW) and was developed in consultation with 60 parent and community groups, sporting and recreational clubs and organisations, professional associations, schools, local and state government organisations and national sporting bodies. The charter emphasises that physical activity and sport should be a fundamental right of all children and youth be enjoyable enhance health and well-being be available for children and youth with disabilities and chronic illness include those who are geographically isolated be safe and free from physical and psychological abuse be free from exploitation for political, commercial or financial gain avoid elitism and be encouraged by a wide cross section of the community. Broad consensus has been reached by most organisations with a role or interest in child and youth sport and physical activity on the foundations for participation in these activities by young people living in NSW. Research and evaluation of practice in Australia is essential and will allow development of evidence-based guidelines for participation in physical activity and sport for young Australians, based on the philosophy of the charter.
Do eicosanoids cause colonic dysfunction in experimental E coli 0157:H7 (EHEC) infection?
Publisher: BMJ
Date: 06-2000
DOI: 10.1136/GUT.46.6.806
Abstract: The pathophysiology of enterohaemorrhagic Escherichia coli (EHEC) infection remains unclear. Eicosanoids have been implicated as pathophysiological mediators in other colitides. To determine if prostaglandin E(2) (PGE(2)) and leukotriene B(4) (LTB(4)) contribute to mucosal inflammation and dysfunction in EHEC colitis. Ten day old rabbits were infected with EHEC. For five days after infection, mucosal synthesis of PGE(2) and LTB(4) was measured in distal colonic tissue from control and infected animals and (51)Cr-EDTA permeability was assessed in vivo. Myeloperoxidase activity was measured and histological inflammation and damage were assessed at five days in control and infected animals and after treatment of infected animals with the LTB(4) synthesis inhibitor MK-886. In separate experiments, ion transport was measured in Ussing chambers, before and after in vitro addition of the cyclooxygenase inhibitor indomethacin. LTB(4) synthesis was increased from day 2 after infection onwards and PGE(2) synthesis was increased on day 3. Mucosal permeability did not increase until day 5 after infection. MK-886 inhibited colonic LTB(4) production but did not reduce diarrhoea, inflammation, or mucosal damage. Electrolyte transport was not significantly altered on day 3 after infection. However, both Cl secretion and reduced Na absorption found on day 5 were partially reversed by indomethacin. Tissue synthesis of PGE(2) and LTB(4) did not correlate temporally with EHEC induced inflammation or changes in mucosal permeability and ion transport. Cyclooxygenase inhibition partially reversed ion transport abnormalities but lipoxygenase inhibition did not affect mucosal inflammation or histological damage. We conclude that the contribution of eicosanoids to mucosal injury and dysfunction is more complex than previously suggested.
Nationwide study of haemolytic uraemic syndrome: clinical, microbiological, and epidemiological features
Publisher: BMJ
Date: 08-2001
DOI: 10.1136/ADC.85.2.125
Abstract: To establish the incidence and aetiology of haemolytic uraemic syndrome (HUS) in Australia and compare clinical and microbial characteristics of sporadic and outbreak cases. National active surveillance through the Australian Paediatric Surveillance Unit with monthly case notification from paediatricians, July 1994 to June 1998. Children under 15 years presenting with microangiopathic haemolytic anaemia, thrombocytopenia, and acute renal impairment were identified. Ninety eight cases were identified (incidence 0.64 per 10 5 children years/annum and 1.35 per 10 5 children years/annum). Eighty four were associated with diarrhoea (64 sporadic, 20 constituting an outbreak) and 14 were atypical. Shiga toxin producing Escherichia coli (STEC) O111:H− was the most common isolate in sporadic HUS and caused the outbreak. However O111:H− isolates from outbreak and sporadic cases differed in phage type and subtyping by DNA electrophoresis. STEC isolates from sporadic cases included O26:H−, O113:H21, O130:H11, OR:H9, O157:H−, ONT:H7, and ONT:H−. STEC O157:H7 was not isolated from any case. Only O111:H− isolates produced both Shiga toxins 1 and 2 and possessed genes encoding E coli attaching and effacing gene (intimin) and enterohemolysin. Outbreak cases had worse gastrointestinal and renal disease at presentation and more extrarenal complications. Linking national surveillance with a specialised laboratory service allowed estimation of HUS incidence and provided information on its aetiology. In contrast to North America, Japan, and the British Isles, STEC O157:H7 is rare in Australia however, non-O157:H7 STEC cause severe disease including outbreaks. Disease severity in outbreak cases may relate to yet unidentified virulence factors of the O111:H− strain isolated.
Persistence of acute rheumatic fever in a tertiary children's hospital
Publisher: Wiley
Date: 29-12-2011
DOI: 10.1111/J.1440-1754.2010.01935.X
Abstract: To identify and describe all children admitted with acute rheumatic fever (ARF) to a tertiary paediatric hospital in Sydney over a 9-year period and to describe their demographic and clinical characteristics, management and short-term outcomes. Delays in diagnosis, recurrence of ARF and use of secondary prophylaxis were also documented. Retrospective review of medical records for children aged < 15 years admitted to the Children's Hospital at Westmead, Sydney, with ARF (International Classification of Diseases (ICD)-10 classification I0.0-109.9) during 2000-2008. Only cases meeting the National Heart Foundation of Australia diagnostic criteria for ARF were included. Twenty-six children met the National Heart Foundation of Australia criteria for ARF. The median age was 11.5 years (range 5.8-14.6) and 15 (58%) were male. Ten (38%) identified as Pacific Islander, and 5 (19%) as Aboriginal and Torres Strait Islander (ATSI). Most (n= 20, 77%) lived in suburban Sydney, and 69% were classified in the two most disadvantaged quintiles on the Index of Relative Socioeconomic Disadvantage and Advantage. Four (15%) had Sydenham's chorea, and 81% had carditis (mitral and/or aortic regurgitation). Six (23%) children had previous ARF. Antibiotic prophylaxis to prevent recurrent ARF was prescribed in all cases, but 50% received oral penicillin, rather than by intramuscular injection. Barriers to timely diagnosis were identified in 81%, including delayed presentation and delayed referral. Most children presenting to the hospital with ARF lived in disadvantaged areas of Sydney. Pacific Islander and Aboriginal and Torres Strait Islander children were over-represented. Mitigation of RHD requires early identification of ARF and appropriate delivery of secondary prophylaxis.
Trampoline centre injuries in children and adolescents: a systematic review and meta-analysis
Publisher: BMJ
Date: 13-06-2022
DOI: 10.1136/INJURYPREV-2022-044530
Abstract: No evidence-based review has compared injury risks sustained on tr olines at home and in tr oline centres. To present pooled results for injury type, site and treatment from studies reporting injuries that occurred on tr olines at home and in tr oline centres. MEDLINE, Scopus, Google Scholar and Embase databases were searched to 31 December 2021. Inclusion criteria: (1) assessment of tr oline injuries (home and tr oline centres) (2) children and adolescents (3) the point estimate was reported as an odds ratio (OR) and (4) an internal comparison was used. 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. 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 .001), lower extremity injury (OR 2.81, 95% CI 1.99 to 3.97, p .001), sprains (OR 1.64, 95% CI 1.36 to 1.97, p .001) and a need for surgery (OR 1.89, 95% CI 1.37 to 2.60, p .001) at tr oline centres compared with home tr olines. 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 .001) and lacerations (OR 0.46, 95% CI 0.35 to 0.59, p .001) were less likely to occur at tr oline centres than at home. Children using tr oline centres are more likely to suffer severe trauma and require surgical intervention than children using home tr olines. Development and implementation of preventative strategies, public awareness, and mandatory safety standards are urgently required for tr oline centres.
Australian children living with rare diseases: health service use and barriers to accessing care
Publisher: Springer Science and Business Media LLC
Date: 18-01-2023
Febrile seizures following measles and varicella vaccines in young children in Australia
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1016/J.VACCINE.2014.10.071
Abstract: Febrile seizures (FS) are common in childhood with incidence peaking in the second year of life when measles and varicella-containing vaccines are administered. This study aimed to examine the vaccine-attributable risk of FS following separate administration of MMR and monovalent varicella vaccines (VV) prior to a planned change to MMRV as the second dose of measles-containing vaccine at 18 months of age. All FS cases in children aged <5 years from 1st January 2012 to 30th April 2013 were identified from emergency department (ED) and inpatient databases at five Australian tertiary paediatric hospitals participating in PAEDS (Paediatric Active Enhanced Disease Surveillance). Immunization records were obtained from the Australian Childhood Immunization Register (ACIR). The relative incidence (RI) of FS following MMR dose 1 (MMR1) and VV in children aged 11-23 months was determined using the self-controlled case series (SCCS) method and used to calculate attributable risk. There were 2013 FS episodes in 1761 children. The peak age at FS was 18 months. The risk of FS was significantly increased 5-12 days post receipt of MMR1 at 12 months (RI=1.9 [95% CI: 1.3-2.9]), but not after VV at 18 months (RI=0.6 [95% CI: 0.3-1.2]. The estimated excess annual number of FS post MMR1 was 24 per 100,000 vaccinated children aged 11-23 months (95% CI=7-49 cases per 100,000) or 1 per 4167 doses. Our study detected the expected increased FS risk post MMR1 vaccine at 12 months, but monovalent varicella vaccine at age 18 months was not associated with increased risk of FS. This provides baseline data to assess the risk of FS post MMRV, introduced in Australia as the second dose of measles-containing vaccine at 18 months of age in July 2013.
Maternal Bonding through Pregnancy and Postnatal: Findings from an Australian Longitudinal Study
Publisher: Georg Thieme Verlag KG
Date: 17-02-2017
Abstract: Background Mother-infant bonding provides the foundation for secure attachment through the lifespan and organizes many facets of infant social-emotional development, including later parenting. Aims To describe maternal bonding to offspring across the pregnancy and postnatal periods, and to examine a broad range of sociodemographic and psychosocial predictors of the maternal-offspring bond. Methods Data were drawn from a s le of 372 pregnant women participating in an Australian population-based longitudinal study of postnatal health and development. Participants completed maternal bonding questionnaires at each trimester and 8 weeks postnatal. Data were collected on a range of sociodemographic and psychosocial factors. Results Bonding increased significantly through pregnancy, in quality and intensity. Regression analyses indicated that stronger antenatal bonding at all time points (trimesters 1 through 3) predicted stronger postnatal bonding. Older maternal age, birth mother being born in a non-English speaking country, mother not working full time, being a first-time mother, breast-feeding problems, and baby's crying behavior all predicted poorer bonding at 8 weeks postpartum. Conclusion These novel findings have important implications for pregnant women and their infant offspring, and for health care professionals working in perinatal services. Importantly, interventions to strengthen maternal-fetal bonding would be beneficial during pregnancy to enhance postnatal bonding and infant health outcomes.
Surveillance of congenital rubella syndrome (CRS) in tertiary care hospitals in Hanoi, Vietnam during a rubella epidemic
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.VACCINE.2014.10.087
Abstract: To describe the epidemiology and clinical features of congenital rubella syndrome (CRS) in Hanoi, Vietnam. Prospective surveillance of CRS between May 2011 and March 2012 in Hanoi, Vietnam. CRS burden was assessed by clinical examination and collection of serum s les from infants in neonatology, cardiology and pediatric departments of two tertiary care hospitals in Hanoi. All infants born during the study period with clinical manifestations of CRS and seropositivity (IgM) for rubella were included in this study. During the surveillance period 113 infants were identified with confirmed CRS (clinical features and positive rubella IgM). Their mean age at diagnosis was 38.4 days (range 1-152 days) and 61% were female. Clinical manifestations of CRS included low birth weight<2500 g (86.0%), congenital heart disease (63.7%), hearing impairment (63.7%) and ophthalmological abnormalities (46.9%). Other clinical features at birth included: thrombocytopenia (85.0%), neonatal purpura (74.3%), splenomegaly (63.7%), hepatomegaly (62.8%) and blueberry muffin rash (61.1%). Among the mothers of infants with confirmed CRS none had received a rubella vaccine in the past and 88.4% gave a history of rubella contact during the pregnancy under study. In most cases (84.1%) maternal infection occurred in the first trimester. During the surveillance period the estimated annual incidence of CRS was 1.13/1000 live births (95% CI 0.92-1.34). These preliminary baseline data show a high burden of CRS in Hanoi, Vietnam and the urgent need for universal vaccination. Surveillance to determine and monitor the national burden of CRS is essential.
Two‐year pilot study of newborn screening for congenital adrenal hyperlasia in New South Wales compared with nationwide case surveillance in Australia
Publisher: Wiley
Date: 24-09-2008
Rise and fall of coeliac disease 1960-85.
Publisher: BMJ
Date: 08-1989
Abstract: A total of 192 children who presented with coeliac disease to Queen Elizabeth Hospital for Children from 1960-85 were reviewed in order to investigate the frequency and the age of presentation. There was a clear peak in the number of children presenting from 1971-5, and although the numbers declined subsequently they have remained at a level similar to numbers found before 1971. There was no difference in the mode of presentation but there was a definite increase in the age of presentation over the time period reviewed. Breast fed babies presented later than bottle fed babies (14 compared with 9 months) despite a similar age of gluten introduction. Similarly bottle fed babies and breast fed babies presented later after 1975 (10.5 compared with 7 months, and 18 compared with 9.5 months, respectively). Before 1975 the median age of gluten introduction was significantly less than that after 1975 (2 compared with 4 months) and the age of gluten introduction correlated with the age of presentation. It is concluded that breast feeding and the age of gluten introduction may influence the age of presentation of childhood coeliac disease but no clear reasons for the rise in incidence in the 1970s have been determined. It does not appear that the disease is declining, however, in recent years children have tended to present later in life.
Predictors of postnatal mother-infant bonding: the role of antenatal bonding, maternal substance use and mental health
Publisher: Springer Science and Business Media LLC
Date: 11-02-2016
DOI: 10.1007/S00737-016-0602-Z
Abstract: The emotional bond that a mother feels towards her baby is critical to social, emotional and cognitive development. Maternal health and wellbeing through pregnancy and antenatal bonding also play a key role in determining bonding postnatally, but the extent to which these relationships may be disrupted by poor mental health or substance use is unclear. This study aimed to examine the extent to which mother-fetal bonding, substance use and mental health through pregnancy predicted postnatal mother-infant bonding at 8 weeks. Participants were 372 women recruited from three metropolitan hospitals in Australia. Data was collected during trimesters one, two and three of pregnancy and 8 weeks postnatal using the Maternal Antenatal Attachment Scale (MAAS), Maternal Postnatal Attachment Scale (MPAS), the Edinburgh Antenatal and Postnatal Depression Scale (EPDS), the Depression and Anxiety Scales (DASS-21), frequency and quantity of substance use (caffeine, alcohol and tobacco) as well as a range of demographic and postnatal information. Higher antenatal bonding predicted higher postnatal bonding at all pregnancy time-points in a fully adjusted regression model. Maternal depressive symptoms in trimesters two and three and stress in trimester two were inversely related to poorer mother-infant bonding 8 weeks postnatally. This study extends previous work on the mother's felt bond to her developing child by drawing on a large s le of women and documenting the pattern of this bond at three time points in pregnancy and at 8 weeks postnatally. Utilising multiple antenatal waves allowed precision in isolating the relationships in pregnancy and at key intervention points. Investigating methods to enhance bonding and intervene in pregnancy is needed. It is also important to assess maternal mental health through pregnancy.
Efficacy of cannabinoids in neurodevelopmental and neuropsychiatric disorders among children and adolescents: a systematic review
Publisher: Springer Science and Business Media LLC
Date: 03-03-2023
DOI: 10.1007/S00787-023-02169-W
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 in iduals 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.
Sodium content of oral rehydration solutions: a reappraisal.
Publisher: BMJ
Date: 11-1989
Abstract: Although funds for livestock conservation are limited there is little known about the optimal allocation of conservation funds. A new algorithm was used to allocate Mio US dollar 1, 2, 3, 5 or unlimited funds, discounted over 50 years, on 23 African cattle breeds conserved with four different possible conservation programs. Additionally, Mio US dollar 1 was preferably allocated to breeds with special traits. The conceptional in situ conservation programs strongly involve breeders and give them part of the responsibility for the conservation of the breed. Therefore, the pure in situ conservation was more efficient than cryoconservation or combined in situ and cryoconservation. The average annual discounted conservation cost for a breed can be as low as US dollar 1000 to US dollar 4400 depending on the design of the conservation program and the economic situation of the country of conservation. The choice of the breeds and the optimal conservation program and the amount of money allocated to each breed depend on many factors such as the amount of funds available, the conservation potential of each breed, the effects of the conservation program as well as its cost. With Mio US dollar 1, 64% of the present ersity could be maintained over 50 years, which is 13% more than would be maintained if no conservation measures were implemented. Special traits could be conserved with a rather small amount of the total funds. Diversity can not be conserved completely, not even with unlimited funds. A maximum of 92% of the present ersity could be conserved with Mio US dollar 10, leaving 8% of the ersity to unpredictable happenings. The suggested algorithm proved to be useful for optimal allocation of conservation funds. It allocated the funds optimally among breeds by identifying the most suited conservation program for each breed, also accounting for differences in currency exchange rates between the different countries.
Kawasaki disease in Australia, 1993-95
Publisher: BMJ
Date: 1998
DOI: 10.1136/ADC.78.1.33
Abstract: To describe the epidemiology, management, and rate of cardiac sequelae of Kawasaki disease in Australia. Cases were notified to the Australian Paediatric Surveillance Unit, an active national surveillance scheme, from May 1993 to June 1995. 139 cases of Kawasaki disease were confirmed. In 1994, the annual incidence was 3.7/100,000 children < 5 years old. Sixteen children were not admitted to hospital. Coronary artery abnormalities were reported in 35 (25%) children. Two patients were diagnosed at postmortem examination. Sixty six per cent of patients were diagnosed within 10 days of onset and 81% of these received intravenous gammaglobulin within 10 days. Forty five of the notified children did not fulfil the study criteria because of streptococcal infection or insufficient clinical criteria. One child with streptococcal infection had coronary artery dilatation. Diagnosis of Kawasaki disease was delayed beyond 10 days in one third of patients, and almost 20% of children who could have received gammaglobulin within 10 days did not. The distinction between Kawasaki disease, streptococcal infection, and other possible diagnoses is problematic in some children.
Time- and sex-dependent associations between prenatal alcohol exposure and placental global DNA methylation
Publisher: Future Medicine Ltd
Date: 07-2018
Abstract: Aim: Epigenetic changes, in particular in the placenta, may mediate the effects of prenatal alcohol exposure (PAE) on children's health. We examined the relationship between PAE patterns, based on dose and timing, and placental global DNA methylation. Methods: Using linear regression analysis, we examined the association between different PAE categories and placental global DNA methylation (n = 187), using the proxy measure of Alu-interspersed repeats. Results: Following adjustment for important covariates, we found no evidence of an association between PAE and placental global DNA methylation overall. However, when stratifying by newborn sex, PAE throughout pregnancy was associated with higher placental global DNA methylation (1.5% p = 0.01) of male newborns. Conclusion: PAE may have sex-specific effects on placental global DNA methylation if alcohol is consumed throughout pregnancy.
Pertussis in infants: Preventing deaths and hospitalisations in the very young
Publisher: Wiley
Date: 28-03-2008
DOI: 10.1111/J.1440-1754.2008.01292.X
Abstract: Pertussis is a particular concern in infants under 6 months of age. They have the highest rates and severity of disease resulting in hospitalisation or death but are too young to be protected by current vaccination schedules. We outline the current epidemiology of pertussis in Australia and four potential strategies to prevent pertussis in the very young. First, universal adult and or adolescent vaccination second, indirect protection of infants by immunisation of parents and possibly others in close contact with the newborn, such as grandparents and health-care workers third, newborn and early infant vaccination (from birth to 1 month of age) and fourth maternal vaccination.
Challenges of transition to adult health services for patients with rare diseases
Publisher: AMPCo
Date: 06-2013
DOI: 10.5694/MJA13.10424
Intussusception following rotavirus vaccine administration: Post-marketing surveillance in the National Immunization Program in Australia
Publisher: Elsevier BV
Date: 04-2011
DOI: 10.1016/J.VACCINE.2011.01.088
Abstract: In Australia, post-marketing surveillance for intussusception following vaccination commenced with funding of RotaTeq(®) and Rotarix(®) vaccines under the National Immunization Program (NIP) in July 2007. Two active surveillance mechanisms (hospital-based case ascertainment and monthly reports from paediatricians) identified intussusception cases between 1st July 2007 and 31st December 2008 in four states. Linkage to vaccination records identified cases occurring within 1-7 and 1-21 days of rotavirus vaccination. Expected cases within the post-vaccination windows were calculated by applying rates of intussusception from national hospitalisation data over 6 years (mid-2000 to mid-2006), by age and state, to numbers vaccinated (by dose) according to the Australian Childhood Immunization Register. Combining exposure windows associated with all doses of rotavirus vaccine from 1 to 9 months of age, there was no evidence of an increased risk of intussusception following vaccination for either vaccine. However, in infants 1 to <3 months of age, there was suggestive evidence of excess intussusception cases 1-7 and 1-21 days following dose 1 (1-7 days: RotaTeq(®) relative risk (RR)=5.3, 95% confidence interval [CI] 1.1,15.4 Rotarix(®) RR 3.5, 95% CI 0.7,10.1 1-21 days: RotaTeq(®) RR 3.5, 95% CI 1.3, 7.6 Rotarix(®)RR 1.5, 95% CI 0.4, 3.9). There was no evidence that clinical outcome of intussusception occurring within 21 days of rotavirus vaccination differed from that in cases occurring later post-vaccination. Although we found no overall increase in intussusception following receipt of rotavirus vaccine, there was some evidence of an elevated risk following the first dose of both vaccines. Larger population-based studies using linked databases are required to provide more definitive evidence.
Assessing diagnostic and screening tests: Part 2. How to use the research literature on diagnosis
Publisher: BMJ
Date: 07-2001
Statistics Workbook for Evidence‐Based Health Care
Publisher: Wiley
Date: 29-08-2008
Polioviruses and other enteroviruses isolated from faecal samples of patients with acute flaccid paralysis in Australia, 1996-2004
Publisher: Wiley
Date: 24-05-2006
DOI: 10.1111/J.1440-1754.2006.00875.X
Abstract: Acute flaccid paralysis (AFP) is the most common clinical presentation of acute poliovirus infection, occurring in 0.1-1% of infected cases. AFP surveillance has been used world-wide to monitor the control and eradication of circulating wild poliovirus. This study aims to review the significance of all enteroviruses, including polioviruses, isolated from patients with AFP in Australia between 1996 and 2004. We undertook a retrospective review of all notified cases of AFP, aged 0-15 years and resident in Australia at the time of notification. We reviewed all available clinical and virological data for these cases and all records of the Polio Expert Committee, which determined the final classification for all cases. There were 335 notified cases that satisfied the case definition for AFP, 162 (48%) of whom had at least one faecal s le tested. Enteroviruses isolated from the faeces of 26 (16%) of the 162 cases were Coxsackie A24, Coxsackie B5, enterovirus 71, enterovirus 75, echovirus 9, echovirus 11 and echovirus 18. In addition, one or more polioviruses were isolated from the faeces of seven patients. Six of seven polioviruses were characterised as Sabin-like, one was not characterised, but all were considered to be incidental isolates. Five of these cases were classified as infant botulism, one case as transverse myelitis and one as a focal mononeuropathy. With the eradication of circulating wild polioviruses, other enteroviruses are being more commonly identified as the cause of polio-like illnesses. In the polio end game, when there is increased testing for polioviruses, it is important to consider infant botulism as a differential diagnosis in cases presenting with AFP.
The effects of electrode montage on the amplitude of wave V in the auditory brainstem response to maximum length sequence stimuli
Publisher: S. Karger AG
Date: 22-08-2007
DOI: 10.1159/000107432
Abstract: The use of maximum length sequence (MLS) stimuli to elicit an auditory brainstem response (ABR) has been limited, in part, by the observation that these stimuli reduce ABR wave litudes. This study recorded ABR waveforms from 14 normally hearing adults using MLS click stimuli (maximum stimulus rate = 250 clicks per second) at stimulus levels of 70, 60, 50, 40, 30 and 20 dB nHL, with a vertical and then an ipsilateral electrode montage. The vertical electrode montage produced significantly larger (p 0.05) wave V litudes, with no change in wave V latencies (p 0.05), at all stimulus levels. This result suggests a vertical electrode montage could be used to counter some of the loss in wave V litude observed when using MLS stimuli.
Protocol for hospital based-surveillance of cerebral palsy (CP) in Hanoi using the Paediatric Active Enhanced Disease Surveillance mechanism (PAEDS-Vietnam): a study towards developing hospital-based
Publisher: BMJ
Date: 11-2017
DOI: 10.1136/BMJOPEN-2017-017742
Abstract: The epidemiology, pathogenesis, management and outcomes of cerebral palsy (CP) in low-income and middle-income countries including Vietnam are unknown because of the lack of mechanisms for standardised collection of data. In this paper, we outline the protocol for developing a hospital-based surveillance system modelled on the Paediatric Active Enhanced Disease Surveillance (PAEDS) system in Australia. Using PAEDS-Vietnam we will define the aetiology, motor function and its severity, associated impairments, and nutritional and rehabilitation status of children with CP in Hanoi, Vietnam. These essential baseline data will inform future health service planning, health professional education and training, and family support. This is a hospital-based prospective surveillance of children with CP presenting to the rehabilitation, neurology and general paediatric services at the National Children’s Hospital and St Paul Hospital in Hanoi. We will use active, prospective daily case-finding for all children with CP aged years who are hospitalised or present to outpatient departments. Following parental consent, data will be collected using a modified version of the Australian Cerebral Palsy Register questionnaire. The data collection form has been developed in consultation with local and international experts and translated into Vietnamese. Information collected will include demographics, maternal health and birth history, type and severity of CP, known risk factors for CP, and nutrition, immunisation, education and rehabilitation status. This study was approved by the Hanoi Medical University Institutional Review Board (decision no 1722) and The University of Sydney Human Research Ethics Committee (approval no 2016/456). Establishment of PAEDS-Vietnam will enable hospital-based surveillance of CP for the first time in Vietnam. It will identify preventable causes of CP, patient needs and service gaps, and facilitate early diagnosis and intervention. Study findings will be disseminated through local and international conferences and peer-reviewed publications.
Modulation of host response to Escherichia coll 0157:H7 infection by anti-CD18 antibody in rabbits
Publisher: Elsevier BV
Date: 06-1994
DOI: 10.1016/0016-5085(94)90410-3
Abstract: Escherichia coli O157:H7 infection induces diarrhea, severe colitis, and colonic electrolyte transport abnormalities characterized by decreased Na absorption and Cl secretion. The aim of this study was to examine the role of the host inflammatory response in inducing distal colonic transport changes during infection with E. coli O157:H7. New Zealand white rabbits aged 10 days were infected with E. coli O157:H7 strain EDL933 (plasmid+, verotoxin 1+, verotoxin 2+). Studies were performed daily from day 1 to day 5 postinfection and compared with uninfected controls (10 days old). Distal colonic ion transport was studied in vitro under short-circuited conditions in Ussing chambers, and tissue inflammation was assessed by mucosal myeloperoxidase activities and mucosal neutrophil (polymorphonuclear neutrophil [PMN]) counts. In a second study, PMN infiltration was inhibited by an anti-CD18 (leukocyte adhesion molecule) monoclonal antibody, IB4, and histology and transport were studied on day 5 postinfection. Infection with O157:H7 induced diarrhea and inhibition of Na absorption by day 3. CI secretion occurred on day 5, coincident with tissue infiltration with PMN. Pretreatment with IB4 prevented histological damage and tissue infiltration with PMN, and it inhibited the transport abnormalities induced by infection alone. Infection with O157:H7 reduces Na absorption and stimulates Cl secretion in the distal colon. Disruption of the epithelium and changes in colonic electrolyte transport during enterohemorrhagic E. coli are mediated by the host inflammatory response.
Severe and traumatic injuries associated with home trampoline use in children and adolescents: A systematic review
Publisher: Wiley
Date: 30-09-2022
DOI: 10.1111/ACEM.14594
Patient use of a paediatric hospital casualty department in the east end of London
Publisher: Oxford University Press (OUP)
Date: 1987
Abstract: This paper describes two surveys carried out at the accident and emergency department of Queen Elizabeth Hospital, a specialist children's hospital situated in the east end of London. Both studies explored factors influencing attendance at the accident and emergency department. One was based on an analysis of recorded information (hospital notes) for a random s le of attenders, spread over a 12-month period. The second was based on personal interviews with a s le of children's parents. Both studies found problems with access to general practitioner care to be the main factors influencing attendance.
Pediatric cochlear implantation: Associated with minimal postoperative pain and dizziness
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2015
Evidence-based speech pathology: Barriers and benefits
Publisher: Informa UK Limited
Date: 06-2004
International collaboration to assess the risk of Guillain Barré Syndrome following Influenza A (H1N1) 2009 monovalent vaccines
Publisher: Elsevier BV
Date: 09-2013
DOI: 10.1016/J.VACCINE.2013.06.032
Abstract: The global spread of the 2009 novel pandemic influenza A (H1N1) virus led to the accelerated production and distribution of monovalent 2009 Influenza A (H1N1) vaccines (pH1N1). This pandemic provided the opportunity to evaluate the risk of Guillain-Barré syndrome (GBS), which has been an influenza vaccine safety concern since the swine flu pandemic of 1976, using a common protocol among high and middle-income countries. The primary objective of this project was to demonstrate the feasibility and utility of global collaboration in the assessment of vaccine safety, including countries both with and without an established infrastructure for vaccine active safety surveillance. A second objective, included a priori, was to assess the risk of GBS following pH1N1 vaccination. The primary analysis used the self-controlled case series (SCCS) design to estimate the relative incidence (RI) of GBS in the 42 days following vaccination with pH1N1 vaccine in a pooled analysis across databases and in analysis using a meta-analytic approach. We found a relative incidence of GBS of 2.42 (95% CI 1.58-3.72) in the 42 days following exposure to pH1N1 vaccine in analysis of pooled data and 2.09 (95% CI 1.28-3.42) using the meta-analytic approach. This study demonstrates that international collaboration to evaluate serious outcomes using a common protocol is feasible. The significance and consistency of our findings support a conclusion of an association between 2009 H1N1 vaccination and GBS. Given the rarity of the event the relative incidence found does not provide evidence in contradiction to international recommendations for the continued use of influenza vaccines.
Interventions for haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura
Publisher: Wiley
Date: 21-01-2009
Severe and Complicated Varicella and Associated Genotypes 10 Years After Introduction of a One-Dose Varicella Vaccine Program.
Publisher: Oxford University Press (OUP)
Date: 03-09-2019
Abstract: This national, sentinel prospective study aimed to identify children with severe hospitalized varicella, despite availability of universal 1-dose vaccination since 2005, and determine associations between virus genotypes and disease severity. Children with varicella or zoster from 5 Paediatric Active Enhanced Disease Surveillance hospitals were enrolled. Lesions were swabbed for genotyping. Associations with disease severity were analyzed using multiple regression. From 2007 to 2015, 327 children with confirmed varicella (n = 238) or zoster (n = 89) were enrolled. Two hundred three (62%) were immunocompetent children including 5 of 8 children who required intensive care unit management. Eighteen percent (36 of 203) of immunocompetent children had been previously vaccinated. Vaccinated children aged >18 months were less likely to have severe disease (9% 5 of 56) than unvaccinated children (21% 21 of 100 P = .05). Three of 126 children who had virus genotyping (2 immunocompromised) had varicella (n = 2) or zoster (n = 2) due to the Oka/vaccine strain. European origin clades predominated and were independently associated with more severe disease (odds ratio = 3.2 95% confidence interval, 1.1- 9.5 P = .04). Severe hospitalized varicella still occurs with a 1-dose varicella program, although predominantly in unvaccinated children. Most 1-dose vaccine recipients were protected against severe disease. Viral genotyping in complex hospitalized cases is important to assist in monitoring disease due to Oka-vaccine strain.
The role of bicarbonate and base precursors in treatment of acute gastroenteritis.
Publisher: BMJ
Date: 1987
DOI: 10.1136/ADC.62.1.91
Abstract: The renin-angiotensin system plays a critical role in the pathogenesis of several cardiovascular diseases, largely through activation of type I angiotensin (AT(1)) receptors by angiotensin II. Treatment with AT(1) receptor blockers (ARBs) is a proven successful intervention for hypertension and progressive heart and kidney disease. However, the ergent actions of AT(1) receptors on in idual cell lineages in hypertension may present novel opportunities to optimize the therapeutic benefits of ARBs. For ex le, T lymphocytes make important contributions to the induction and progression of various cardiovascular diseases, but new experiments indicate that activation of AT(1) receptors on T cells paradoxically limits inflammation and target organ damage in hypertension. Future studies should illustrate how these discrepant functions of AT(1) receptors in target organs versus mononuclear cells can be exploited for the benefit of patients with recalcitrant hypertension and other cardiovascular diseases.
Fetal Alcohol Spectrum Disorder resources for educators working within primary school settings: a scoping review protocol
Publisher: BMJ
Date: 04-2021
DOI: 10.1136/BMJOPEN-2020-045497
Abstract: 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. 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 in iduals 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. 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. Open Science Framework: osf.io/73pjh.
A boost for child passenger safety
Publisher: Wiley
Date: 04-2007
Study protocol: Asking QUestions about Alcohol in pregnancy (AQUA)
Publisher: Springer Science and Business Media LLC
Date: 03-09-2014
Capsule endoscopy: A new technology for investigating obscure gastrointestinal bleeding
Publisher: Wiley
Date: 05-2006
DOI: 10.1111/J.1440-1754.2006.00848.X
Abstract: In Australia, Medicare rebate was approved in May 2005 for use of capsule endoscopy in children aged 10 years and over. Approval was granted for an interim period to allow investigation of obscure ongoing or recurrent gastrointestinal bleeding, for which no cause could be found after investigation, including conventional radiology and endoscopy. Strict eligibility criteria for Medicare rebate for the procedure have been developed. These criteria relate to patient selection, type of device, timing of the procedure, qualifications of providers and requirements for prospectively monitoring the use, uefulness, safety and cost-effectiveness of the procedure in children.
Varicella vaccine effectiveness over 10 years in Australia; moderate protection from 1-dose program
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.JINF.2018.11.009
Abstract: To examine the impact of Australia's single dose infant varicella vaccination program, we assessed single dose varicella vaccine effectiveness (VE) in preventing hospitalised disease using two methods. Clinically confirmed varicella cases from the Paediatric Active Enhanced Disease Surveillance (PAEDS) sentinel network were age-matched to 20 controls obtained from the Australian Immunisation Register. Conditional logistic regression models were used to estimate VE and compared with estimates obtained using our second approach. There were 78 hospitalised varicella cases during the post vaccine introduction period from January 2008 to December 2015, who were eligible for funded varicella vaccination. Median age at onset was 4.5 years and more than half (59%) were vaccinated. The majority of children received one vaccine brand (Varilrix, GSK). The estimated case-control VE for one dose of vaccine against hospitalised varicella was 64.7% (95% CI: 43.3-78.0%) estimates using the screening method were not significantly different. Exclusion of children who were immunocompromised did not significantly alter VE estimates. Although Australia's program has impacted on the burden of varicella disease, single dose VE against varicella hospitalisation is only moderate. Greater reductions in varicella disease could potentially be achieved by incorporation of a second vaccine dose into the program to minimise breakthrough disease and interrupt virus circulation.
The Lililwan Project: study protocol for a population-based active case ascertainment study of the prevalence of fetal alcohol spectrum disorders (FASD) in remote Australian Aboriginal communities
Publisher: BMJ
Date: 2012
Mother–Infant and Partner–Infant Emotional Availability at 12 Months of Age: Findings From an Australian Longitudinal Study
Publisher: Wiley
Date: 06-08-2018
DOI: 10.1111/INFA.12247
A modified Delphi study of screening for fetal alcohol spectrum disorders in Australia
Publisher: Springer Science and Business Media LLC
Date: 25-01-2013
Evidence-based pediatrics: The future is now
Publisher: Elsevier BV
Date: 03-2000
Exercise for type 2 diabetes mellitus
Publisher: Wiley
Date: 19-07-2006
Female genital mutilation and cutting: A systematic literature review of health professionals' knowledge, attitudes and clinical practice
Publisher: Springer Science and Business Media LLC
Date: 12-2015
The natural history of scoliosis in females with rett syndrome
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2016
Childhood hepatitis C virus infection: An A ustralian national surveillance study of incident cases over five years
Publisher: Wiley
Date: 04-05-2015
DOI: 10.1111/JPC.12904
Abstract: An estimated 1.1% of Australian adults are infected with hepatitis C virus (HCV). Many develop chronic liver disease, and some develop liver failure or hepatocellular carcinoma. HCV infection in Australian children is poorly defined. We aimed to determine the reported incidence, clinical and epidemiological features of newly diagnosed HCV infection in Australian children presenting to paediatricians. We undertook prospective active national surveillance, using the Australian Paediatric Surveillance Unit, of incident HCV cases in children aged <15 years between 1(st) January 2003, and 31(st) December 2007. There were 45 confirmed cases of newly diagnosed HCV infection over five years (<1 per 100,000 children aged 14), were exposed through their own IV drug use. No children were co-infected with HIV and only one child was co-infected with HBV. All children were asymptomatic at diagnosis, although many had minor elevations in liver transaminases. Many clinicians reported difficulties with follow-up. Childhood HCV infection is uncommon in Australia, although our data likely underestimate the incidence. Only a small number of children aged <18 months was identified, despite known perinatal exposure. Opportunistic investigation of children at risk for HCV, improved education regarding vertical transmission for health care providers, and increased coordination of childhood HCV services are required to improve recognition and management of children with HCV.
Counting Fetal Alcohol Spectrum Disorder in A ustralia: The evidence and the challenges
Publisher: Wiley
Date: 25-04-2013
DOI: 10.1111/DAR.12047
Abstract: Alcohol exposure in utero is associated with a range of adverse outcomes in pregnancy and can cause long-term disability. Fetal alcohol spectrum disorder (FASD) is an umbrella term to describe a range of effects from prenatal alcohol exposure including fetal alcohol syndrome (FAS). Determining the prevalence of FASD is challenging. This narrative review collates information on the prevalence of FASD in Australia and documents the various methods used for attaining estimates and the limitations of the available data. Birth prevalence of FASD is most commonly measured through clinic-based studies, passive surveillance systems and active case ascertainment. Alcohol use in pregnancy and FAS in Australia is predominantly monitored through passive surveillance systems and under-ascertainment of cases is likely. State- and territory-based studies have reported birth prevalence rates of FAS of between 0.01 and 0.68 per 1000 live births. Prevalence rates of FASD have not been estimated in Australia. As reflected in the international data, Australian studies have found higher rates of FAS among some Indigenous communities. This likely reflects patterns of alcohol use and other socioeconomic risk factors. Under-recognition of FASD reflects incomplete and inconsistent data collections recording alcohol use in pregnancy, lack of awareness among health professionals and a lack of diagnostic and support services. Accurate measurement of FASD prevalence is crucial to inform policy, resource and service development in the areas of health, education, justice and community. There is a need for consensus on the collection and best use of data. [Burns L, Breen C, Bower C, O' Leary C, Elliott EJ. Counting fetal alcohol spectrum disorders in Australia: the evidence and the challenges. Drug Alcohol Rev 2013 :461-467].
Intestinal amoebiasis and giardiasis in southern Indian infants and children
Publisher: Oxford University Press (OUP)
Date: 05-1990
DOI: 10.1016/0035-9203(90)90328-C
Abstract: The role of Entamoeba histolytica and Giardia lamblia as causative agents of paediatric diarrhoea was studied in a southern Indian population. Relationship between infant feeding practices, co-existing malnutrition and the occurrence of intestinal amoebiasis and giardiasis was also examined. The subjects were 361 paediatric patients with acute diarrhoea and 70 hospitalized control children without diarrhoea. Faecal s les from cases and controls were examined for the protozoal pathogens using faecal preservatives, permanent staining and formalin-ether concentration. Bacteriological studies were conducted on 244 of the 361 cases. A high prevalence of invasive amoebiasis was seen in the 0-6 month (12.5%) and 7-12 month (20.3%) age groups. Giardiasis was uncommon under 6 months (2.1%) but occurred in 8-10% of all other age groups. Invasive amoebiasis occurred mainly in children on weaning foods (45.9%) but also [corrected] in exclusively breast-fed children (13.5%). Giardiasis was not seen in exclusively breast-fed infants, but commonly occurred in older children on normal diets. There was no association between amoebiasis or giardiasis and malnutrition.
Attitudes and behaviour predict women's intention to drink alcohol during pregnancy: the challenge for health professionals
Publisher: Springer Science and Business Media LLC
Date: 22-07-2011
How to practice evidence-based pediatrics
Publisher: BMJ
Date: 03-2001
Pharmacological interventions for ADHD symptoms in children with fetal alcohol spectrum disorders (FASD)
Publisher: Wiley
Date: 20-01-2017
Acute flaccid paralysis in Australian children
Publisher: Wiley
Date: 2003
DOI: 10.1046/J.1440-1754.2003.00065.X
Abstract: To describe the epidemiology and causes of acute flaccid paralysis (AFP) in Australian children, and the clinical features of the two most common causes of AFP, Guillain-Barré syndrome and transverse myelitis. Monthly active surveillance for AFP was carried out through the Australian Paediatric Surveillance Unit, with AFP defined as 'acute onset of flaccid paralysis in one or more limbs or of bulbar paralysis in any child less than 15 years of age'. Between March 1995 and December 1999, 143 cases of AFP were reported (approximately 0.8 per 100000 children < 15 years of age per annum). The age range was 2 months-14 years and 59% were boys. Out of these children, 137 (96%) were hospitalized and 47 required intensive care. No case of wild or vaccine-associated poliomyelitis was identified. The most common causes of AFP were Guillain-Barré syndrome in 67 (47%) and transverse myelitis in 27 (19%). Other diagnoses included acute disseminated encephalomyelitis, trauma, tick-bite paralysis and infantile botulism. The participation of paediatricians in AFP surveillance contributed to the accreditation of Australia (along with the other 36 countries of the western Pacific region) as 'polio free' by the World Health Organization in October 2000. The surveillance also provided data on the frequency of AFP and identified Guillain-Barré syndrome and transverse myelitis as the most common diagnoses. In this large national series, many other conditions that may present as non-polio AFP were identified.
Soft neurological signs and prenatal alcohol exposure: a population‐based study in remote Australia
Publisher: Wiley
Date: 15-03-2016
DOI: 10.1111/DMCN.13071
Abstract: To identify soft neurological signs (SNS) in a population-based study of children living in remote Aboriginal communities in the Fitzroy Valley, Western Australia, born between 2002 and 2003 and explore the relationship between SNS, prenatal alcohol exposure (PAE), and fetal alcohol spectrum disorders (FASD). The presence of SNS was assessed using the Quick Neurological Screening Test, 2nd edition (QNST-2), which has a total maximum score of 140. Higher scores indicated more SNS. 'Severe discrepancy' was defined as scores less than or equal to the fifth centile while 'moderate discrepancy' represented scores from the sixth to the 24th centile. Children were assigned FASD diagnoses using modified Canadian FASD diagnostic guidelines. A total of 108 of 134 (80.6%) eligible children (mean age 8y 9mo, SD=6mo, 53% male) were assessed. The median QNST-2 Total Score for all participants was within the normal category (19.0, range 4-66). However, the median QNST-2 Total Score was higher in children with than without (1) PAE (r=0.2, p=0.045) and (2) FASD (r=0.3, p=0.004). Half (8/16) of children scoring 'moderate discrepancy' and all (2/2) children scoring 'severe discrepancy' had at least three domains of central nervous system impairment. SNS were more common in children with PAE or FASD, consistent with the known neurotoxic effect of PAE. The QNST-2 is a useful screen for subtle neurological dysfunction indicating the need for more comprehensive assessment in children with PAE or FASD.
The picture talk project: Aboriginal community input on consent for research
Publisher: Springer Science and Business Media LLC
Date: 29-01-2019
Recommendations from a consensus development workshop on the diagnosis of fetal alcohol spectrum disorders in Australia
Publisher: Springer Science and Business Media LLC
Date: 02-10-2013
Hirschsprung's disease: the Australian Paediatric Surveillance Unit's experience
Publisher: Springer Science and Business Media LLC
Date: 03-04-2003
DOI: 10.1007/S00383-002-0842-Z
Abstract: Hirschsprung's disease (HD) was introduced into the Australian Paediatric Surveillance Unit (APSU) system in 1996 with the objective to collect data on demographics, incidence, family history, associated anomalies, clinical features, investigation, and surgical treatment in Australia. Children under 15 years of age with HD (confirmed by biopsy) were entered into a database maintained at The Children's Hospital at Westmead in Sydney. Nationwide, 127 children with HD were reported from January 1997 to December 2000, and near-complete information was available on 126. Neonatal presentation was seen in 114 cases (90%), whereas 12 (10%) presented post-neonatally. There was a history of delayed passage of meconium (more than 24 h) in 65 of the 114 patients (57%) who presented in the neonatal period. In those presenting post-neonatally there was no history of delayed passage of meconium. Primary pull-through was performed in 42 of the 82 patients (51%) operated upon. The Soave procedure was performed in 53 of the total 82 (65%) operations and 29 of 42(69%) primary pull-through operations. Pre-operative enterocolitis was seen in 15 of 126 (12%) and postoperative enterocolitis in 17 of 82 (21%) children. The majority of children with HD are diagnosed in the neonatal period (90%). Primary pull-through is becoming more popular (51%). The Soave procedure is the most commonly performed operation (65%) in Australia. Pre- and post-operative enterocolitis is still a significant problem.
Fetal alcohol spectrum disorder: Development of consensus referral criteria for specialist diagnostic assessment in Australia
Publisher: Springer Science and Business Media LLC
Date: 08-07-2014
Fine motor skills in children with prenatal alcohol exposure or fetal alcohol spectrum disorder
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2014
Behavior in Children with Fetal Alcohol Spectrum Disorders in Remote Australia: A Population-Based Study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2017
Severe combined immunodeficiency: A national surveillance study
Publisher: Wiley
Date: 18-04-2008
DOI: 10.1111/J.1399-3038.2007.00646.X
Abstract: National immunodeficiency registers in several countries have reported prevalence but not incidence rates for severe combined immunodeficiency (SCID). The objective of this study was to document the incidence and type of SCID in Australia, the age and clinical features at presentation and short-term management. The Australian Paediatric Surveillance Unit conducts active, monthly, national surveillance of rare disorders with reporting by child-health specialists. Between May 1995 and December 2001, clinicians provided clinical and laboratory data on children newly diagnosed with SCID. Thirty-three incident cases of SCID were identified [incidence 1.8/10(5) live births per annum 95% confidence interval (CI) 1.2-2.5]. Twenty-six children had classical SCID (1.45/10(5) live births 95% CI, 0.9-2.0) and 20 (77%) of these were boys. Classical SCID was X-linked in 13 children, autosomal recessive (AR), not further classified in four, and attributed to adenosine deaminase deficiency (ADA) in four, interleukin-7 receptor alpha chain deficiency in one, Ommen syndrome in two, and Di George syndrome in two. Twenty-one (81%) received bone marrow/stem cell transplantation, three of whom died between 1 and 4 months after transplantation (two ADA deficient, one AR). Seven children had atypical SCID, five of whom died within 1-4 yr of diagnosis. Most children with SCID presented with failure to thrive and recurrent infections and there was no significant delay between presentation and diagnosis. The reported national incidence of classical SCID in Australia (1.45/10(5) or approximately 4 cases per year or 1/69,000 live births) is consistent with the rate (1.4/10(5)) previously reported in Victoria. Diagnosis is rarely delayed, and transplantation is associated with good short-term survival.
Influenza-associated Encephalitis/Encephalopathy Identified by the Australian Childhood Encephalitis Study 2013-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2017
Low glycaemic index or low glycaemic load diets for overweight and obesity
Publisher: Wiley
Date: 18-07-2007
Acknowledging contribution to surveillance studies
Publisher: BMJ
Date: 07-2005
Children under 5 years presenting to paediatricians with near-drowning
Publisher: Wiley
Date: 08-2003
DOI: 10.1046/J.1440-1754.2003.00186.X
Abstract: To characterize children aged under 5 years who present to paediatricians following near-drowning and the circumstances surrounding the event, identify high-risk groups and document short-term outcome. Monthly notifications to the Australian Paediatric Surveillance Unit (an active, national surveillance system) between 1994 and 1996. Collection of additional case information from reporting doctors by postal questionnaire. All 169 reported cases of near-drowning were admitted to hospital (mean (SD) stay 6 (17) days) and 15% required intensive care (mean (SD) stay 19 (32) days). The mean (SD) age for near drowning was 26 (13) months and 22% children were aged between 12 and 18 months. Males predominated (1.6:1) and 69 (41%) of episodes occurred in summer (December - February). The majority (82%) of near-drownings occurred in the child's home, usually in a swimming pool or bath. Children who nearly drowned at home were significantly younger than those who nearly drowned in natural waterways or public pools. Neurological damage at discharge following near-drowning was reported in 7%. Children reported in this national case series represent the severe end of the spectrum of those who nearly drown, as indicated by their presentation to a paediatrician, universal hospitalization and adverse neurological outcome. The home is the site of most near-drownings and males and toddlers were at particular risk. Unimpeded access to pools and lack of supervision were identified as potentially modifiable factors for prevention. The study suggests the need for additional community education regarding the risks of near-drowning and for further research on long-term neuro-developmental outcomes following near-drowning.
Water and solute absorption from a new hypotonic oral rehydration solution: evaluation in human and animal perfusion models.
Publisher: BMJ
Date: 12-1992
Abstract: Controversy continues regarding the optimal composition of glucose electrolyte oral rehydration solutions for the treatment of acute diarrhoea. Four perfusion models (normal human jejunum, normal rat small intestine, cholera toxin treated secreting rat small intestine and rotavirus infected rat small intestine) have been developed and used to compare the efficacy of a hypotonic oral rehydration solution with standard United Kingdom British National formulary and developing world oral rehydration solutions (WHO). Despite obvious physiological and pathophysiological differences between these models there was general congruence in the water and solute absorption profiles of the different oral rehydration solutions. Hypotonic oral rehydration solution promoted significantly greater water absorption than other oral rehydration solutions in all rat models (p < 0.001) but apparently increased water absorption failed to achieve significance in human jejunum. British National Formulary-oral rehydration solution was unable to reverse net water secretion in both rotavirus and cholera toxin models. Net sodium absorption from hypotonic and WHO-oral rehydration solutions was significantly greater than from the low sodium British National Formulary-oral rehydration solutions (p < 0.001) except in the rotavirus model when absorption was similar to hypotonic-oral rehydration solutions. These findings show that there is agreement in the apparent efficacy of oral rehydration solutions in these animal and human perfusion models, and that improved water absorption with adequate sodium absorption may be achieved by reducing oral rehydration solution osmolality.
Colonic Structural and Ion Transport Abnormalities in Suckling Rabbits Infected with Escherichia coli K12
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-1997
DOI: 10.1097/00005176-199710000-00006
Abstract: Escherichia coli K12 is a laboratory strain considered nonpathogenic. The purpose of this study was to examine the effect of E. coli K12 infection on colonic structure and function. Suckling rabbits were infected at 10 days of age with 6 x 10(9) CFU E. coli by intragastric inoculation and were examined 4 to 5 days later. Segments of ileum and proximal and distal colon were removed for light and electron microscopy, and NaCl transport was examined in vitro under short-circuited conditions in Ussing chambers. Infection did not cause weight loss or diarrhea. Colonic mucosa was inflamed with infiltration by polymorphonuclear neutrophils mainly in the lamina propria. The proximal and distal colon exhibited reduced Na+ absorption. The proximal colon also showed increased Cl- secretion the ileum was unaffected. Infection with E. coli K12 disrupts the epithelium and alters ion transport in the colon, probably as a result of mucosal inflammation. The changes indicate that nonpathogenic E. coli have the potential to cause intestinal disease.
Comparing the use of, and considering the need for, lumbar puncture in children with influenza or other respiratory virus infections
Publisher: Wiley
Date: 05-11-2013
DOI: 10.1111/IRV.12039
Fever and urticaria in an African refugee
Publisher: Wiley
Date: 18-10-2006
DOI: 10.1111/J.1440-1754.2006.00960.X
Abstract: An 11-year-old African refugee presented with fever and urticaria commencing 2-h after taking praziquantel. He had been well previously, and the praziquantel was given to treat a serological diagnosis of schistosomiasis. The main differential diagnosis was between acute schistosomiasis and a drug reaction.
Longitudinal prediction of periconception alcohol use: a 20‐year prospective cohort study across adolescence, young adulthood and pregnancy
Publisher: Wiley
Date: 08-09-2022
DOI: 10.1111/ADD.15632
Abstract: 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. A longitudinal, population‐based study. Victoria, Australia. A total of 289 women in trimester three of pregnancy (age 29–35 years 388 pregnancies). 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. 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). 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.
Utility of early influenza diagnosis through point-of-care testing in children presenting to an emergency department
Publisher: Wiley
Date: 04-2016
DOI: 10.1111/JPC.13092
Abstract: Influenza causes a large burden of disease in children. Point-of-care testing (POCT) can rapidly diagnose influenza with the potential to reduce investigation and hospital admission rates, but information on its use in an Australian setting is limited. Through a retrospective review of laboratory-confirmed influenza cases presenting at a paediatric emergency department (ED) in 2009, we evaluated children diagnosed by POCT versus standard testing (direct fluorescent antibody, polymerase chain reaction or viral culture) and assessed differences in investigations, admission requirements, length-of-stay (LOS) in ED/hospital and antibiotic/antiviral prescription. The rate of serious bacterial infection was examined. Compared with standard testing (n = 65), children diagnosed by positive POCT (n = 236) had a shorter median hospital LOS by 1 day (P = 0.006), increased antiviral prescription (odds ratio 3.31, P < 0.001) and a reduction in the time to influenza diagnosis (2.4 vs. 24.4 h, P < 0.001) however, a negative POCT result (n = 63) resulted in delayed diagnosis (44.0 h, P = 0.001). POCT did not decrease LOS in ED. Interpretation of reductions in admission and investigations with POCT may be limited by possible confounding. Approximately 4% of influenza patients had a serious bacterial infection urinary tract infections were commonest (2.7%), but no cerebrospinal fluid cultures were positive. A single positive blood culture was seen among 332 immunocompetent influenza patients. Influenza diagnosis by POCT was quicker and reduced LOS of hospitalised children, whereas negative results delayed diagnosis. Negative POCT should not alter usual investigations if influenza remains suspected. A controlled prospective study during the influenza season is needed to clarify the direct benefits of POCT.
Knowledge and use of evidence‐based nutrition: a survey of paediatric dietitians
Publisher: Wiley
Date: 30-09-2003
DOI: 10.1046/J.1365-277X.2003.00462.X
Abstract: To survey paediatric dietitians' knowledge and use of evidence-based nutrition (EBN). Cross-sectional survey using reply-paid questionnaires. Paediatric dietitians in Australian teaching hospitals. Age, sex, appointment, clinical practice, research activities attitudes to, training in and use of EBN and perceived barriers to use of EBN. Data were analysed using descriptive statistics (SPSS). Fifty-nine (86%) of 69 questionnaires were returned. Most (97%) dietitians were women working full-time (63%), mean age 37 years (+/-9 SD). Most (75%) dietitians encountered knowledge gaps less than five times per week and most (87%) questions related to therapy. The majority (95%) performed their own literature searches, less than five times per month. All had access to >or=1 electronic literature databases including Medline (n = 58, 98%), Cochrane Library (n = 44, 75%) and CINAHL (n = 35, 59%). Information sources used most often were Medline and consultation with colleagues. Reported barriers to using EBN were lack of time (n = 53, 90%) or lack of skills for critical appraisal of published articles (n = 51, 86%) or literature searching (n = 48, 81%). While 53 (90%) believed in an evidence-based approach, 43 (73%) either did not practise EBN or rated themselves as beginners. Most dietitians favoured evidence-based practice, but reported lack of time, skills or rapid access to electronic databases as barriers to its practice.
Fetal alcohol spectrum disorder resources for health professionals: a scoping review protocol
Publisher: BMJ
Date: 09-2022
DOI: 10.1136/BMJOPEN-2022-065327
Abstract: 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. 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. 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.
Hemolytic Uremic Syndrome
Publisher: Elsevier BV
Date: 09-2005
Adherence to the caffeine intake guideline during pregnancy and birth outcomes: A prospective cohort study
Publisher: MDPI AG
Date: 07-03-2018
DOI: 10.3390/NU10030319
Consensus diagnostic criteria for fetal alcohol spectrum disorders in Australia: A modified Delphi study
Publisher: BMJ
Date: 2012
Serum antibody response in children with Giardia lamblia infection and identification of an immunodominant 57‐kilodalton antigen
Publisher: Wiley
Date: 05-1991
DOI: 10.1111/J.1365-3024.1991.TB00286.X
Abstract: Giardia lamblia antigens which react with sera from children with G. lamblia infection were investigated by sodium-dodecyl polyacrylamide gel electrophoresis and immunoblotting. Serum IgG, IgM and IgA response to the antigens were immunochemically characterized. Serum antibodies from all giardiasis patients, but none of the controls, was found to react with a 57-kilodalton antigen. The 57 kDa antigen elicited IgG and IgA but not IgM antibodies. The protein nature of the 57 kDa antigen was demonstrated by loss of antibody recognition after trypsin treatment of G. lamblia trophozoites. Subcellular fractionation of G. lamblia trophozoites followed by SDS-PAGE and immunoblotting showed that the 57 kDa antigen was probably not a component of the cytoskeleton.
Central nervous system manifestations in pediatric patients with influenza A H1N1 infection during the 2009 pandemic
Publisher: Elsevier BV
Date: 09-2014
DOI: 10.1016/J.PEDIATRNEUROL.2014.04.026
Abstract: A novel H1N1 influenza A virus (A(H1N1)pdm09) particularly affected in iduals <24 years of age during the 2009 pandemic. This study sought to better understand the risks and outcomes of central nervous system complications associated with pandemic influenza in the pediatric population. Retrospective review of patients with laboratory-confirmed influenza A(H1N1)pdm09 infection and central nervous system manifestations at Texas Children's Hospital between April 2009 and June 2010. Among 365 patients with influenza A(H1N1)pdm09, 32 (8.8%) had central nervous system manifestations at a median age of 4 years. Eight (25.0%) were previously healthy, and 12 (37.5%) had neurological pre-existing conditions. Of the 32 cases of influenza with neurological complications, seizure (n = 17 53.1%) was the most common central nervous system manifestation, followed by encephalitis (n = 4 12.5%), meningitis (n = 4 12.5%), encephalopathy (n = 3 9.4%), meningismus (n = 3 9.4%), focal hemorrhagic brain lesions (n = 2 6.3%), brain infarction (n = 1 3.1%), and sensorineural hearing loss (n = 1 3.1%). Two patients demonstrated two or more types of central nervous system complications. One patient had abnormal cerebrospinal fluid with pleocytosis. Almost two thirds of the children with central nervous system manifestations required intensive care unit admission and nearly half required mechanical ventilation. There were no deaths. Patients with pre-existing neurological conditions were at greater risk for central nervous system manifestations during pandemic influenza infection. Patients with central nervous system manifestations were more likely to experience severe illness, characterized by intensive care unit admission and mechanical ventilation, although overall outcomes were good. Influenza prevention in patients with underlying medical conditions, particularly those with neurological conditions, is important.
Mania in a patient with H1N1
Publisher: American Psychiatric Association Publishing
Date: 09-2010
Rare disease surveillance
Publisher: Wiley
Date: 12-1994
DOI: 10.1111/J.1440-1754.1994.TB00711.X
Abstract: Rare diseases in children account for disproportionate morbidity and mortality and are particularly demanding of both families and health resources. Surveillance may provide data on their epidemiology, aetiology, management and outcome and on the support requirements of affected children. Existing methods for rare disease surveillance include mandatory and voluntary notification schemes, which may be active or passive, hospital discharge databases and death certification data. The recent establishment of the Australian Paediatric Surveillance Unit has facilitated active, prospective, national case ascertainment by voluntary notification of selected rare conditions. Information obtained should enable estimation of incidence rates, evaluation of prevention and management strategies, extend data collected by existing methods and help estimate future health needs.
Seeking consent for research with indigenous communities: a systematic review
Publisher: Springer Science and Business Media LLC
Date: 22-10-2016
Prenatal Alcohol Consumption Between Conception and Recognition of Pregnancy
Publisher: Wiley
Date: 24-01-2017
DOI: 10.1111/ACER.13305
Abstract: Current estimates of the rates of alcohol-exposed pregnancies may underestimate prenatal alcohol exposure if alcohol consumption in early trimester 1, prior to awareness of pregnancy, is not considered. Extant literature describes predictors of alcohol consumption during pregnancy however, alcohol consumption prior to awareness of pregnancy is a distinct behavior from consumption after becoming aware of pregnancy and thus may be associated with different predictors. The purpose of this study was therefore to examine prevalence and predictors of alcohol consumption by women prior to awareness of their pregnancy, and trajectories of change to alcohol use following pregnancy recognition. Pregnant women (n = 1,403) were prospectively recruited from general antenatal clinics of 4 public hospitals in Australian metropolitan areas between 2008 and 2013. Women completed detailed interviews about alcohol use before and after recognition of pregnancy. Most women (n = 850, 60.6%) drank alcohol between conception and pregnancy recognition. Binge and heavy drinking were more prevalent than low-level drinking. The proportion of women who drank alcohol reduced to 18.3% (n = 257) after recognition of pregnancy. Of women who drank alcohol, 70.5% ceased drinking, 18.3% reduced consumption, and 11.1% made no reduction following awareness of pregnancy. Socioeconomic status (SES) was the strongest predictor of alcohol use, with drinkers more likely to be of high rather than low SES compared with abstainers (OR = 3.30, p < 0.001). Factors associated with different trajectories (either cessation, reduction, or continuation of drinking) included level of alcohol use prior to pregnancy recognition, age, pregnancy planning, and illicit substance use. In this s le of relatively high SES women, most women ceased or reduced drinking once aware of their pregnancy. However, the rate of alcohol-exposed pregnancies was higher than previous estimates when the period prior to pregnancy recognition was taken into account.
Alcohol and pregnancy: The pivotal role of the obstetrician
Publisher: Wiley
Date: 06-2008
Women's knowledge and attitudes regarding alcohol consumption in pregnancy: a national survey
Publisher: Springer Science and Business Media LLC
Date: 23-08-2010
Association between prenatal alcohol exposure and craniofacial shape of children at 12 months of age
Publisher: American Medical Association (AMA)
Date: 08-2017
Prenatal Alcohol Exposure, FASD, and Child Behavior: A Meta-analysis
Publisher: American Academy of Pediatrics (AAP)
Date: 03-2016
Abstract: Fetal alcohol spectrum disorders (FASD) and prenatal alcohol exposure (PAE) are associated with behavioral difficulties, although there are no published systematic reviews that summarize and critique the literature. To describe the behavioral characteristics of children with PAE and/or FASD, assessed using the Achenbach System of Empirically Based Assessments (ASEBA) for school-aged children with parent, teacher, and youth (self-report) forms. Electronic literature databases, reference lists, hand-searches. peer-reviewed observational studies. Study appraisal and data extraction were undertaken by 2 independent assessors. Meta-analyses were performed for parent-rated Internalizing, Externalizing, and Total problems scales. All other ASEBA scales were summarized qualitatively. Included were 23 articles 16 were used in meta-analyses. Pooled results showed higher Total (mean difference 12.1, 95% confidence interval [95% CI] 7.7–16.5), Internalizing (6.3, 95% CI 3.1–9.5), and Externalizing problems scores (12.5, 95% CI 7.9–17.0) in FASD than No FASD and greater odds of scoring in the “Clinical” range in FASD. Pooled results demonstrated higher problem scores in children with PAE (P & .05). Qualitative summaries of other scales from parents, teachers, and self-report show poorer behavior ratings in children with FASD and PAE on composite Problem and Competence scores and many Syndrome subscales. Findings were restricted to behaviors assessed using the ASEBA. The published literature was limited, often with only 1 study reporting on a particular scale. Meta-analysis reveals that FASD and PAE are associated with problematic behavior in many, but not all domains. This clearly affects families, and should be considered in clinical practice by providers.
Pilot surveillance for childhood encephalitis in Australia using the Paediatric Active Enhanced Disease Surveillance (PAEDS) network
Publisher: Cambridge University Press (CUP)
Date: 26-02-2016
DOI: 10.1017/S0950268816000340
Abstract: We aimed to assess the performance of active surveillance for hospitalized childhood encephalitis in New South Wales (NSW) using the Paediatric Active Enhanced Disease Surveillance (PAEDS) network to inform methodology for the nationwide Australian childhood encephalitis (ACE) study. We piloted active surveillance for suspected encephalitis from May to December 2013 at the Children's Hospital at Westmead, Sydney, NSW. Cases were ascertained using four screening methods: weekday nurse screening of admission records (PAEDS), cerebrospinal fluid (CSF) microscopy records, magnetic resonance imaging (MRI) reports, and pharmacy dispensing records. Comprehensive clinical data were prospectively collected on consented participants and subsequently reviewed by an expert panel. Cases were categorized as confirmed encephalitis or ‘not encephalitis’ encephalitis cases were sub-categorized as infectious, immune-mediated or unknown. We performed an ICD-10 diagnostic code audit of hospitalizations for the pilot period. We compared case ascertainment in the four screening methods and with the ICD code audit. Forty-eight cases of suspected encephalitis were identified by one or more methods. PAEDS was the most efficient mechanism (yield 34%), followed by MRI, CSF, and pharmacy audits (yield 14%, 12%, and 7% respectively). Twenty-five cases met the criteria for confirmed encephalitis. PAEDS was the most sensitive of the mechanisms for confirmed encephalitis (92%) with a positive predictive value (PPV) of 72%. The ICD audit was moderately sensitive (64%) but poorly specific (Sp 9%, PPV 14%). Of the 25 confirmed encephalitis cases, 19 (76%) were sub-categorized as infectious, three (12%) were immune-mediated, and three (12%) were ‘unknown’. We identified encephalitis cases associated with two infectious disease outbreaks (enterovirus 71, parechovirus 3). PAEDS is an efficient, sensitive and accurate surveillance mechanism for detecting cases of childhood encephalitis including those associated with emerging infectious diseases. Active surveillance significantly increases the ascertainment of encephalitis cases compared with passive approaches.
Pediatric cochlear implants: Additional disabilities prevalence, risk factors, and effect on language outcomes
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2012
Health Professionals Addressing Alcohol Use with Pregnant Women in Western Australia: Barriers and Strategies for Communication
Publisher: Informa UK Limited
Date: 06-2010
DOI: 10.3109/10826081003682172
Abstract: Health professionals have an important role to play in preventing prenatal alcohol exposure. In 2006 qualitative data were collected from 53 health professionals working in primary care in metropolitan and regional Western Australia. Thematic analysis was used to elucidate barriers in addressing prenatal alcohol use and the strategies used to overcome them. Health professionals identified strategies for obtaining alcohol use information from pregnant women but they are not recognizing moderate alcohol intake in pregnant women. Study limitations are noted and the implications of the results are discussed. This research was funded by the Health Promotion Foundation of Western Australia.
Low glycaemic index, or low glycaemic load, diets for diabetes mellitus
Publisher: Wiley
Date: 21-01-2009
Water and solute absorption from hypotonic glucose-electrolyte solutions in human jejunum.
Publisher: BMJ
Date: 04-1992
DOI: 10.1136/GUT.33.4.479
Abstract: While oral rehydration therapy with glucose-electrolyte solutions is highly effective, the optimal formulation has not yet been defined. Recent clinical studies suggest that stool volume, and thus water losses, may be reduced if glucose is replaced by a polymeric substrate which reduces osmolality. It is possible that the efficacy of glucose monomer based oral rehydration solutions (ORS) will also improve if osmolality is decreased. Using jejunal triple lumen perfusion in healthy adult volunteers net water and solute absorption were studied from three hypotonic solutions with different sodium concentrations (46, 60, 75 mmol/l) but identical glucose concentrations (90 mmol/l), thus allowing osmolality to rise (210, 240, and 270 mOsm/kg, respectively). Results from these solutions (ORS 45:210, ORS 60:240, and ORS 75:270) were compared with the World Health Organisation oral rehydration solution (WHO-ORS). Greatest water absorption was seen with ORS 60:240 (p less than 0.01). Sodium absorption from ORS 60:240 and WHO-ORS was similar and greater than sodium absorption from ORS 45:210 (p less than 0.05). Potassium and glucose absorption were greater from ORS 60:240 than from any of the other hypotonic solutions (p less than 0.05) and were equal to absorption from WHO-ORS). These results in a short segment of healthy human jejunum suggest that hypotonic ORS containing monomeric glucose may increase water absorption.
Novel inpatient surveillance in tertiary paediatric hospitals in New South Wales illustrates impact of first-wave pandemic influenza A H1N1 (2009) and informs future health service planning
Publisher: Wiley
Date: 23-11-2012
DOI: 10.1111/J.1440-1754.2011.02240.X
Abstract: To document the impact of pandemic influenza A H1N1 (2009) in New South Wales (NSW) children's hospitals. A novel surveillance system, Paediatric Active Enhanced Disease Surveillance (PAEDS), identified hospitalised children <15 years with laboratory-proven influenza (1 June-30 September 2009) in the three children's hospitals in NSW: Children's Hospital at Westmead (CHW), Sydney Children's Hospital, John Hunter Children's Hospital. Clinical characteristics, management and complications were documented, and at CHW comparison made with 2007 data. The 324 children identified represented 1802 hospital bed-days and 230 PICU bed-days. Most (73.1%) children had H1N1, one had an oseltamivir-resistant isolate. Median age was 2.5 years: 65% were <5 years. Although 80.9% had cough, 8.0% had no respiratory symptoms. Complications occurred in 34.6%, of whom 56% were previously healthy. Only 50% received antivirals. Forty children (12.3%) were admitted to PICU: one child with H1N1 died. At CHW, comparison between 2009 and 2007 showed nearly twice the total number of admissions (226 vs. 122) and PICU admissions (22 vs. 13), but no deaths either year. Vomiting was more frequent in 2009 than 2007 (38.5% vs. 13.1% P = 0.0001) as were neurological complications (11.4% vs. 2.4% P = 0.0027) but length of hospital and PICU stay were similar. PAEDS is a valuable surveillance tool that documented the impact of the H1N1 (2009) pandemic in NSW children's hospitals. High numbers of complications, often in previously well children, suggest an important role for early diagnosis, antiviral therapy and influenza vaccination. Observed regional differences identify areas potentially at greater risk in a subsequent wave.
Clinical epidemiology and predictors of outcome in children hospitalised with influenza A(H1N1)pdm09 in 2009: a prospective national study
Publisher: Wiley
Date: 27-09-2014
DOI: 10.1111/IRV.12286
Performance of acute flaccid paralysis surveillance compared with World Health Organization standards
Publisher: Wiley
Date: 30-07-2015
DOI: 10.1111/JPC.12691
Abstract: To compare acute flaccid paralysis (AFP) surveillance systems used by members of the International Network of Paediatric Surveillance Units (INoPSU) across the five AFP surveillance performance indicators recommended by the World Health Organization (WHO) for the maintenance of polio-free certification. A survey was administered to AFP surveillance co-ordinators in five INoPSU member countries (Australia, Belgium, Canada, New Zealand and Switzerland). Data collected included information on surveillance system processes, WHO-recommended performance indicators, investigative practices and final diagnoses of cases from 2006 to 2010. All countries contacted completed the survey. Each country used similar case definitions and processes for collecting AFP data. All countries used at least one of the WHO indicators for surveillance. No country consistently met the performance indicator for incidence or stool s ling. In all countries, at least one form of neurological testing was used to diagnose cases of AFP. Guillain-Barré syndrome was the most common final diagnosis in all countries for all years examined. Industrialised countries surveyed do not consistently meet the WHO-recommended AFP surveillance performance indicators. An opportunity exists for INoPSU to suggest a standard way for member countries to collect AFP data in order to examine the potential for strengthening the current systems or introducing additional enterovirus surveillance or alternative/complementary neurological performance measures suitable for countries that have eliminated polio. INoPSU member countries are evaluating these possibilities.
Is the practice of paediatric inpatient medicine evidence‐based?
Publisher: Wiley
Date: 08-2002
DOI: 10.1046/J.1440-1754.2002.00006.X
Abstract: To determine whether management provided to paediatric inpatients in general units was supported by high-level evidence. A retrospective review was carried out of all patients (n = 142) admitted during one calendar month to two general paediatric units in the USA and Australia. For each patient, the primary diagnosis and primary treatment were determined. A literature review was performed to determine whether the therapy used was evidence-based. The main outcome measure was the level of evidence supporting the primary intervention for the primary diagnosis of each patient. Level I evidence (at least one randomized trial) supported the primary intervention used in 31% of paediatric admissions and level II evidence (convincing non-experimental evidence) supported the primary intervention in 44% of admissions. Primary interventions were not supported by evidence (level III) in only two patients. The remaining 24% of patients were admitted for observation or evaluation only, and received no primary medical or surgical intervention. Most patients whose interventions were supported by randomized trials were admitted with either asthma or appendicitis. Most primary interventions (75%) in paediatric inpatients were supported by high-level published evidence (level I or II). A large number of patients were admitted for evaluation or observation only, and received no therapeutic intervention. Evidence to support this action is not available.
The Bruininks-Oseretsky Test of Motor Proficiency-Short Form is reliable in children living in remote Australian Aboriginal communities
Publisher: Springer Science and Business Media LLC
Date: 06-09-2013
Age-specific sero-prevalence of amoebiasis and giardiasis in Southern Indian infants and children
Publisher: Oxford University Press (OUP)
Date: 04-1992
Abstract: The age-specific sero-prevalence of amoebiasis and giardiasis was estimated in 91 pediatric diarrhoea and in 70 non-diarrhoeal cases from Southern India. Anti-amoeba/giardia IgG assays on 20 children with inflammatory bowel disease from the UK yielded base-line levels in a non-endemic symptomatic population. IgG, IgM, and IgA levels were estimated to E. histolytica and G. lamblia using an ELISA. Concomittant faecal examinations were done for the Indian children. There was a significant correlation between acquisition of sero-positivity and age. A rise in the IgG response to both organisms was evident between 38 and 47 and 13-24 months, respectively, in diarrhoeal and non-diarrhoeal cases. An appreciable IgM response occurred predominantly in diarrhoea cases and at a younger age (less than 24 months). IgA responses were low. Anti-protozoal IgG levels in the UK children were negligible. There was no relationship between faecal excretion and sero-positivity. The study shows an age-related antibody response to E. histolytica and G. lamblia.
Clinical features, oseltamivir treatment and outcome in infants aged <12 months with laboratory-confirmed influenza A in 2009
Publisher: SAGE Publications
Date: 10-2011
DOI: 10.3851/IMP1848
Abstract: Data on the use of oseltamivir in infants is limited. We documented the clinical presentations of infants aged months hospitalized with laboratory-confirmed influenza A in the southern hemisphere winter of 2009 and compared outcomes in relation to oseltamivir therapy. Data were extracted from prospectively collected and collated influenza case reports (June– September 2009) ascertained through Paediatric Active Enhanced Disease Surveillance, an in-patient surveillance system operating at the Children's Hospital at Westmead (CHW), Sydney, NSW, Australia. Nosocomial cases were excluded. Of 56 infants with definite influenza (35 pandemic H1N1 2009) admitted to the CHW, 20 were treated with oseltamivir. Overall, 12 (60%) of those treated with oseltamivir were aged months. Cough, fever and coryza were the most common clinical features (≥70%). Vomiting was present on admission in 31.4%. All 7 cases presenting with vomiting then given antiviral treatment had reduction of vomiting and the other 13 did not develop vomiting on treatment. There were three infants with hypoxaemia (oxygen saturation ≤93%) on presentation in the treatment group compared with none in the control group ( P=0.04). The median duration of hospital stay was the same in both groups (2.5 days). The use of oseltamivir was well tolerated in hospitalized infants. Vomiting, one of the widely reported side effects of oseltamivir, was found to be more a presenting symptom of influenza than a side effect of oseltamivir. Based on pulse oximetry, oseltamivir-treated cases may have been more severe on presentation, but there was no significant difference in length of hospital stay.
Australian guide to the diagnosis of foetal alcohol spectrum disorder: A summary
Publisher: Wiley
Date: 10-2017
DOI: 10.1111/JPC.13625
Neurologic complications of influenza A(H1N1)pdm09: surveillance in 6 pediatric hospitals.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-09-2012
The Spectrum and Burden of Influenza-Associated Neurological Disease in Children: Combined Encephalitis and Influenza Sentinel Site Surveillance From Australia, 2013-2015
Publisher: Oxford University Press (OUP)
Date: 29-04-2017
DOI: 10.1093/CID/CIX412
Abstract: There are few longitudinal studies of seasonal influenza-associated neurological disease (IAND) and none from the Southern Hemisphere. We extracted prospectively acquired Australian surveillance data from 2 studies nested within the Paediatric Active Enhanced Disease Surveillance (PAEDS) network: the Influenza Complications Alert Network (FluCAN) study and the Australian Childhood Encephalitis (ACE) study between 2013 and 2015. We described the clinical features and severity of IAND in children, including influenza-associated encephalitis/encephalopathy (IAE). We calculated the proportion of hospitalized influenza that is associated with IAND and IAE, and incidence of IAE. Over 3 influenza seasons, we identified 54 cases of IAND at 2 tertiary children's hospitals from Australia that accounted for 7.6% of hospitalized influenza. These included 10 cases of IAE (1.4% hospitalized influenza). The mean annual incidence of IAE among Australian children (aged ≤14 years) was 2.8 per 1000000. The spectrum of IAND was broad and included IAE (n = 10) including distinct acute encephalopathy syndromes, simple febrile seizures (n = 14), other seizures (n = 16), acute ataxia (n = 4), and other subacute syndromes (transverse myelitis [n = 1], opsoclonus myoclonus [n = 1]). Two-thirds of children with IAND were aged ≤4 years less than half had preexisting neurological disease or other risk factors for severe influenza. IAE caused death or neurological morbidity in half of cases. Seasonal influenza is an important cause of acute neurological disease in Australian children. The spectrum of seasonal IAND appears similar to that described during the 2009 H1N1 pandemic. IAE is associated with high morbidity and mortality.
Interventions for preventing diarrhea-associated hemolytic uremic syndrome: systematic review
Publisher: Springer Science and Business Media LLC
Date: 03-09-2013
Birth prevalence of Prader-Willi syndrome in Australia
Publisher: BMJ
Date: 03-2003
DOI: 10.1136/ADC.88.3.263
Abstract: This is the first population based study to estimate the birth prevalence of DNA proven Prader-Willi syndrome. Thirty infants were reported to the Australian Paediatric Surveillance Unit between 1998 and 2000, a prevalence of 4 per 100,000 live births or approximately 1/25,000 live births per annum.
The influence of prenatal alcohol exposure and maternal diet on offspring DNA methylation: a cross-species study
Publisher: Cold Spring Harbor Laboratory
Date: 18-06-2023
DOI: 10.1101/2023.06.15.544516
Abstract: Alcohol consumption in pregnancy can affect genome regulation in the developing offspring but results have been contradictory. We employed a physiologically relevant murine model of short-term moderate prenatal alcohol exposure (PAE) resembling common patterns of alcohol consumption in pregnancy. Moderate early PAE was sufficient to affect site-specific DNA methylation in new-born pups without altering behavioural outcomes in adult littermates. Whole genome-bisulphite sequencing of neonatal brain and liver revealed stochastic influence on DNA methylation that was mostly tissue-specific, with some perturbations likely originating as early as gastrulation. Methylation changes were enriched in non-coding genomic regions with regulatory potential indicative of broad effects of alcohol on genome regulation. Replication studies in human cohorts with fetal alcohol spectrum disorder suggested some effects were metastable at genes linked to disease-relevant traits including facial morphology, intelligence, educational attainment, autism, and schizophrenia. A maternal diet high in folate and choline protected against some of the damaging effects of PAE on DNA methylation. Our studies demonstrate that moderate early exposure is sufficient to affect fetal genome regulation even in the absence of overt phenotypic changes and highlight a role for preventative maternal dietary interventions.
Paediatrician experience of management of Sudden Unexpected Death in Infancy
Publisher: Elsevier BV
Date: 11-2021
DOI: 10.1016/J.JFLM.2021.102268
Abstract: Sudden unexpected death in infancy (SUDI) requires a thorough process of inquiry including a detailed history, death scene investigation and autopsy by appropriate and informed health professionals to identify aetiology. Paediatricians are required to conduct the medical, social and family history as well as provide support to the family for the approximately 45 deaths each year in New South Wales (NSW). The aim of this study is describe paediatricians' experience in conducting SUDI assessments with reference to current NSW Health policy and identify barriers to its implementation. Paediatricians in NSW who participate in the Australian Paediatric Surveillance Unit (APSU) were invited to complete a questionnaire requesting information about their knowledge and confidence in managing an infant presenting with SUDI, awareness and use of the NSW Health Policy Directive, and their own recommendations for management. A second questionnaire was completed by paediatricians who had attended a SUDI in the previous five years. The first survey was completed by 234/524 (44%) NSW paediatricians. Half the respondents (118/234) were aware of the SUDI Policy Directive and of those 72/118 (61%) had read it. Few paediatricians (63/234) 27% had received education on the Policy Directive or about SUDI management 55/234 (24%). The second survey was completed by 33/36 (92%) who had attended a SUDI, of whom 29% had not used the history protocol within the Policy Directive. Lack of awareness, perceived problems with the current Policy, and limited confidence suggests the model in NSW needs revision to meet international recommendations for best management and diagnosis and also supportive and preventive practices for parents.
Evaluation of a national resource to identify and study rare diseases
Publisher: Wiley
Date: 09-2009
DOI: 10.1111/J.1440-1754.2009.01549.X
Abstract: To evaluate the Australian Paediatric Surveillance Unit (APSU). We used criteria recommended by the Centres for Disease Control and Prevention (CDC) for evaluating surveillance systems and reviewed productivity, response rates, completeness of the mailing list and impacts of APSU studies. Anonymous evaluation questionnaires were sent to 1260 reporting clinicians, 42 researchers and 86 public health professionals to seek their feedback as users of the APSU. APSU provides national epidemiological and clinical data about rare childhood conditions that inform public health policy and clinical practice. Between 2000 and 2007, APSU data were disseminated in 106 journal articles, 207 scientific presentations and 85 media items. Of paediatricians and paediatric sub-specialists actively practicing in Australia and listed as Fellows of the Royal Australasian College of Physicians, 92% participate in APSU surveillance. An average 96% of monthly report cards were returned per annum since 2000. Sensitivity of case ascertainment was difficult to calculate for many conditions because alternative sources of ascertainment do not exist. Evaluation questionnaires were returned by 818 (65%) reporting clinicians, who believe APSU is valuable for generating knowledge 665 (81%), identifying research priorities 635 (78%), guiding clinical practice 572 (70%) and informing public health policy 575 (70%). Similar responses were received from researchers and public health professionals. The APSU fulfils its objectives and meets relevant CDC criteria for usefulness, simplicity, acceptability and representativeness, sensitivity and timeliness of data quality. However, stability is threatened by lack of continuing core funding. APSU is highly productive and valued by child health clinicians, researchers and public health professionals.
Bicarbonate and citrate in oral rehydration therapy: Studies in a model of secretory diarrhea
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-1993
DOI: 10.1097/00005176-199304000-00010
Abstract: In situ perfusion of the rat jejunum and ileum was used to study the effect of inclusion of bicarbonate or citrate on the ability of four oral rehydration solutions to promote small-intestinal absorption of water and sodium. Solutions varied in their sodium (60-90 mM) and glucose (111-140 mM) content and osmolality (281-331 mosmol/kg). They were studied before and after exclusion of base both in normal intestine and in secreting intestine after exposure to cholera toxin. All solutions promoted net water absorption in the normal intestine and reversed net water secretion to absorption in the cholera toxin-treated intestine to varying degrees. Net sodium movement was directly related to the sodium content of oral rehydration solutions. Inclusion of bicarbonate or citrate did not promote significantly greater absorption of water or sodium than did solutions without base, in normal or secreting intestine. In the secreting intestine, inclusion of bicarbonate in two solutions actually resulted in greater sodium secretion than did identical solutions from which bicarbonate was omitted. These studies suggest that the inclusion of base or base precursors in oral rehydration solutions to enhance water and sodium absorption is unjustified in both normal and secreting small intestine.
Interventions for Hemolytic Uremic Syndrome and Thrombotic Thrombocytopenic Purpura: A Systematic Review of Randomized Controlled Trials
Publisher: Elsevier BV
Date: 02-2009
DOI: 10.1053/J.AJKD.2008.07.038
Abstract: Hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) are related conditions with similar clinical features of variable severity. The objective of this systematic review is to evaluate the benefits and harms of available interventions for HUS and TTP. MEDLINE (1966 to June 2006), EMBASE (1980 to June 2006), the Cochrane Central Register, conference proceedings, and reference lists were searched to find randomized controlled trials (RCTs) of any intervention for HUS or TTP in patients of all ages selected for inclusion for this systematic review. Trials that compared an intervention with placebo, an intervention with supportive therapy, or one or more different interventions for HUS or TTP. For TTP trials, failure of remission at 2 weeks or less and at 1 month or longer, all-cause mortality rate, and relapse rate. For HUS trials, all-cause mortality, chronic reduced kidney function, and persistent proteinuria or hypertension at last follow-up. For TTP in adults, we found 6 RCTs of 331 patients. Two trials compared plasma infusion with plasma exchange using fresh frozen plasma and showed failure of remission at 2 weeks (2 trials, 140 patients relative risk, 2.87 95% confidence interval, 1.41 to 5.84), and all-cause mortality (relative risk, 1.91 95% confidence interval, 1.09 to 3.33) occurred more frequently in the plasma infusion group. Three trials compared plasma exchange using cryosupernatant plasma with plasma exchange using fresh frozen plasma, and a meta-analysis of these trials showed no difference. Seven RCTs in 476 young children with postdiarrheal HUS have been conducted. None of the evaluated interventions (fresh frozen plasma transfusion, heparin with or without urokinase or dipyridamole, Shiga toxin-binding protein, and steroid) were superior to supportive therapy alone for any outcomes. Limitations of this review include the small number and suboptimal quality of reporting of included trials, possibility of publication bias, small number of participants with atypical HUS, and failure to report results for patients with atypical and typical HUS separately. No additional therapy has been shown to increase efficacy over plasma exchange for TTP. No intervention has been shown to be superior to supportive therapy in patients with postdiarrheal HUS.
Impacts of national surveillance for uncommon conditions in childhood
Publisher: Wiley
Date: 04-10-2007
DOI: 10.1111/J.1440-1754.2007.01216.X
Abstract: The Australian Paediatric Surveillance Unit (APSU) facilitates the conduct of national collaborative research that is consistent with national health priorities, has potential to impact on public health, and addresses gaps in knowledge. Since 1993 paediatricians and other child health specialists have contributed monthly data on rare childhood conditions to the APSU. Over 40 conditions, including infectious diseases, injuries, vaccine-preventable diseases and genetic disorders have been studied. Information on epidemiology, frequency, diagnosis, management and short-term outcomes of these conditions is collected and provides evidence to support changes to clinical practice, prevention policy and allocation of health resources. In this review we give ex les of the value of information gathered through the APSU surveillance system in the last 14 years.
FAS in Australia: Fact or fiction?
Publisher: Wiley
Date: 2004
The Role of Antenatal and Postnatal Maternal Bonding in Infant Development
Publisher: Elsevier BV
Date: 06-2022
DOI: 10.1016/J.JAAC.2021.08.024
Abstract: 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). 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. 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). 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.
Prevalence and profile of Neurodevelopment and Fetal Alcohol Spectrum Disorder (FASD) amongst Australian Aboriginal children living in remote communities
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.RIDD.2017.04.001
Abstract: Despite multiple risk factors for neurodevelopmental vulnerability, few studies have assessed neurodevelopmental performance of Australian Aboriginal children. An important risk factor for neurodevelopmental vulnerability is prenatal alcohol exposure (PAE), which places children at risk for Fetal Alcohol Spectrum Disorder (FASD). This study assesses neurodevelopment outcomes in a population of Australian Aboriginal children with and without PAE. Children born in 2002/2003, and living in the Fitzroy Valley, Western Australia between April 2010 and November 2011, were eligible (N=134). Sociodemographic and antenatal data, including PAE, were collected by interview with 127/134 (95%) consenting parents/caregivers. Maternal/child medical records were reviewed. Neurodevelopment was assessed by clinicians blinded to PAE in 108/134 (81%) children and diagnoses on the FASD spectrum were assigned. Neurodevelopmental disorder was documented in 34/108 children (314.8 per 1000). Any diagnosis on the FASD spectrum was made in 21/108 (194.4 per 1000) children (95% CI=131.0-279.0). Neurodevelopmental impairment with or without PAE is highly prevalent among children in the Fitzroy Valley. Rates of diagnoses on the FASD spectrum are among the highest worldwide. Early intervention services are needed to support developmentally vulnerable children in remote communities.
It takes a village: Influencing policy and practice to prevent alcohol use in pregnancy and promote better outcomes for individuals living with Fetal Alcohol Spectrum Disorder
Publisher: Swansea University
Date: 02-03-2022
Abstract: Fetal Alcohol Spectrum Disorder (FASD) is a neurodevelopmental disorder caused by exposure to alcohol in utero. It has pervasive, lifelong impacts and is recognised as a major public health concern in many countries where alcohol is used. The FASD Research Australia Centre of Research Excellence (CRE) was funded by the National Health and Medical Research Council to generate and translate evidence to address prevention, diagnosis, and management of FASD in Australia. The current paper describes the approach to policy and practice impact taken by our CRE, including our stakeholder engagement processes and the key principles that underlie our approach. We provide ex les of policy and practice influence in FASD prevention, diagnosis and management that have been achieved over the past five years and discuss challenges that are routinely faced in the translation of our work.
Surgical fusion of early onset severe scoliosis increases survival in Rett syndrome: A cohort study
Publisher: Wiley
Date: 11-12-2016
DOI: 10.1111/DMCN.12984
Abstract: Scoliosis is a common comorbidity in Rett syndrome and spinal fusion may be recommended if severe. We investigated the impact of spinal fusion on survival and risk of severe lower respiratory tract infection in Rett syndrome. Data were ascertained from hospital medical records, the Australian Rett Syndrome Database, a longitudinal and population-based registry, and from the Australian Institute of Health and Welfare National Death Index database. Cox regression and generalized estimating equation models were used to estimate the effects of spinal surgery on survival and severe respiratory infection respectively in 140 females who developed severe scoliosis (Cobb angle ≥45°) before adulthood. After adjusting for mutation type and age of scoliosis onset, the rate of death was lower in the surgery group (hazard ratio [HR] 0.30, 95% confidence interval [CI] 0.12-0.74 p=0.009) compared to those without surgery. Rate of death was particularly reduced for those with early onset scoliosis (HR 0.17, 95% CI 0.06-0.52 p=0.002). There was some evidence to suggest that spinal fusion was associated with a reduction in risk of severe respiratory infection among those with early onset scoliosis (risk ratio 0.41, 95% CI 0.16-1.03 p=0.06). With appropriate cautions, spinal fusion confers an advantage to life expectancy in Rett syndrome.
Application of evidence-based teaching in maternal and child health in remote Vietnam
Publisher: Wiley
Date: 26-11-2009
DOI: 10.1016/J.IJGO.2008.10.008
Abstract: To develop, implement, and evaluate an evidence-based multidisciplinary teaching program to improve maternal and infant health in remote Vietnam. Needs assessments identified prevention of infection, neonatal resuscitation, and prevention of postpartum hemorrhage as primary targets. A 3-day workshop based on the small group, interactive, skills-based SCORPIO method was developed. Participants underwent formative written and performance-based assessments. Qualitative and quantitative evaluation of course content and teaching method was conducted. Two annual workshops were conducted for 58 health professionals, all of whom demonstrated skills acquisition to an adequate standard on completion. The workshops were rated as good or excellent overall by 100% of the participants, who reported that the content would help with their clinical work and that the teaching method was acceptable and easy to understand. We demonstrated the SCORPIO method can be adapted to teach knowledge and clinical skills in remote Vietnam. Further work is needed to demonstrate an effect on health outcomes.
Valuing the voice of lived experience as an imperative to address pre-natal alcohol exposure and fetal alcohol spectrum disorder: “You can’t fly yet!”. Commentary on “E-learning for fetal alcohol spectrum disorder: an environmental scan of the scope and content of free online training modules” (Bagley et al., 2022)
Publisher: Informa UK Limited
Date: 03-07-2023
CHARGE syndrome and Cochlear implantation: Difficulties and outcomes in the paediatric population
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.1016/J.IJPORL.2015.01.004
Abstract: CHARGE syndrome is a complex cluster of congenital abnormalities, these children may have absent or hypoplastic auditory nerves. Our objective was to assess preoperative factors and outcomes for paediatric cochlear implant recipients with CHARGE syndrome, to enable better surgical preparation and family counselling. The Sydney Cochlear Implant Centre database was searched for children with CHARGE syndrome who had received a cochlear implant at ages 16 and less. Data were collected regarding clinical history hearing assessments MRI and CT scan findings preoperative transtympanic electrical Auditory Brainstem Response (ABR) intraoperative findings and intraoperative electrical ABR and Neural Response Telemetry and language outcomes in terms of main language used and Categories of Auditory Performance scores (0-7 ranking). Ten children were identified. All seven prelingual profoundly deaf children with CHARGE syndrome had hypoplastic or absent auditory nerves bilaterally on MRI scans. Middle ear anatomy was often abnormal, affecting surgical landmarks and making identification of the cochlea very difficult in some cases. Three cases required repeated surgery to obtain successful cochlear implant insertion, one under CT scan image guided technique. All seven children used sign language, or simpler gestures, as their main mode of communication. Two children of of these children, who were implanted early, also attained some spoken language. CAP scores ranged from 0 to 6. The three children with CHARGE syndrome and progressive sensorineural hearing loss had a normal auditory nerve in at least one ear on MRI scans. All had preoperative verbal language, with CAP scores of 6, and continued with CAP scores of 6 following receipt of the cochlear implant. Children with CHARGE and congenital profound hearing loss all had hypoplasia or absent auditory nerves, affecting their outcomes with cochlear implants. They often had markedly abnormal middle ear anatomy and CT image guided surgery can be helpful. These children should be offered a bilingual early intervention approach, using sign language and verbal language, to ensure best language outcomes. Children with CHARGE syndrome and progressive profound hearing loss did well with cochlear implants and continue to be able to use verbal language.
Promoting Abstinence From Alcohol During Pregnancy: Implications From Formative Research
Publisher: Informa UK Limited
Date: 02-07-2013
DOI: 10.3109/10826084.2013.800118
Abstract: This research developed messages to promote abstinence from alcohol during pregnancy and identified elements that enhance message persuasiveness. An exploratory phase was conducted in 2009 that comprised four focus groups with 23 women in Western Australia and elicited beliefs and attitudes on alcohol use during pregnancy and motivations for behavior change. Four television concepts were subsequently developed and appraised in five focus groups with 31 participants using standard advertising pretesting questions. The implications for c aigns addressing prenatal alcohol exposure and further research are noted and limitations discussed. Funding was received from Healthway and the National Health and Medical Research Council.
Research protocol for the Picture Talk Project: a qualitative study on research and consent with remote Australian Aboriginal communities
Publisher: BMJ
Date: 12-2017
DOI: 10.1136/BMJOPEN-2017-018452
Abstract: Research with Indigenous populations is not always designed with cultural sensitivity. Few publications evaluate or describe in detail seeking consent for research with Indigenous participants. When potential participants are not engaged in a culturally respectful manner, participation rates and research quality can be adversely affected. It is unethical to proceed with research without truly informed consent. We describe a culturally appropriate research protocol that is invited by Aboriginal communities of the Fitzroy Valley in Western Australia. The Picture Talk Project is a research partnership with local Aboriginal leaders who are also chief investigators. We will interview Aboriginal leaders about research, community engagement and the consent process and hold focus groups with Aboriginal community members about in idual consent. Cultural protocols will be applied to recruit and conduct research with participants. Transcripts will be analysed using NVivo10 qualitative software and themes synthesised to highlight the key issues raised by the community about the research process. This protocol will guide future research with the Aboriginal communities of the Fitzroy Valley and may inform the approach to research with other Indigenous communities of Australia or the world. It must be noted that no community is the same and all research requires local consultation and input. To conduct culturally sensitive research, respected local people from the community who have knowledge of cultural protocol and language are engaged to guide each step of the research process from the project design to the delivery of results. Ethics approval was granted by the University of Sydney Human Research Ethics Committee (No. 2012/348, reference:14760), the Western Australia Country Health Service Ethics Committee (No. 2012:15), the Western Australian Aboriginal Health Ethics Committee and reviewed by the Kimberley Aboriginal Health Planning Forum Research Sub-Committee (No. 2012–008). Results will be disseminated through peer review articles, a local Fitzroy Valley report and conference presentations.
Health professionals' perceptions about the adoption of existing guidelines for the diagnosis of fetal alcohol spectrum disorders in Australia
Publisher: Springer Science and Business Media LLC
Date: 14-06-2012
Cohort profile: The Triple B Pregnancy Cohort Study: A longitudinal study of the relationship between alcohol, tobacco and other substance use during pregnancy and the health and well-being of Australian children and families
Publisher: Oxford University Press (OUP)
Date: 26-10-2018
DOI: 10.1093/IJE/DYX126
Perspective: 'The forgotten children: National inquiry into children in immigration detention (2014)'
Publisher: Wiley
Date: 04-2015
DOI: 10.1111/JPC.12873
Fetal alcohol spectrum disorders in Australia – the future is prevention
Publisher: The Sax Institute
Date: 03-2015
DOI: 10.17061/PHRP2521516
Abstract: Fetal alcohol spectrum disorders (FASD) are increasingly recognised throughout Australia as important, but preventable, disorders that result in lifelong problems with health and learning, mental health, behaviour and substance misuse. The role of this article is to highlight current efforts, which are in their infancy, to recognise and prevent FASD in Australia. A federal parliamentary inquiry into FASD (2011), development of an Australian Government 'action plan' to prevent FASD (2013) and the announcement in June 2014 of government funding to progress the plan and appoint a National FASD Technical Network have focused attention on the need for FASD prevention in Australia. Other welcome developments include the formation of Parliamentarians for the Prevention of FASD (2011), revision of guidelines regarding alcohol use in pregnancy by the National Health and Medical Research Council (NHMRC 2009) and provision of targeted funding for FASD research by the NHMRC (2013). Initiatives by Indigenous communities to restrict access to alcohol and diagnose and prevent FASD have had a significant impact in high-risk communities. The National Organisation for FASD has an important ongoing advocacy and educational remit. Nongovernment organisations such as the Foundation for Alcohol Research and Education have contributed to prevention by developing resources to assist health professionals to advise women about the harms of alcohol use in pregnancy encouraging men to abstain from alcohol during the pregnancy drafting a national plan and advocating for pregnancy warning labels on alcohol. Internationally, in 2014, a charter on prevention of FASD was published in The Lancet Global Health, and the World Health Organization released guidelines for identification and management of substance use in pregnancy. Early recognition and support for in iduals with FASD is crucial to prevent adverse secondary outcomes however, primary prevention of alcohol use in pregnancy, and hence FASD, should be our future goal. The causal pathway to drinking in pregnancy is complex and requires a broad social ecological approach. Prevention will take time, must involve all government sectors and should incorporate primary, secondary and tertiary strategies to target both the broader community and populations at high risk of alcohol use during pregnancy.
Graphomotor skills in children with prenatal alcohol exposure and fetal alcohol spectrum disorder: A population‐based study in remote Australia
Publisher: Wiley
Date: 19-09-2016
Abstract: Few studies have examined graphomotor skills in children with prenatal alcohol exposure (PAE) or fetal alcohol spectrum disorder (FASD). Graphomotor skills were assessed in 108 predominantly Australian Aboriginal children aged 7.5-9.6 years in remote Western Australia using clinical observations (pencil grasp writing pressure) and standardised assessment tools (the Evaluation Tool of Children's Handwriting and the Miller Function and Participation Scales - The Draw-a-Kid Game). Skills were compared between children (i) without PAE, (ii) PAE but not FASD and (iii) FASD. Most children used a transitional pencil grasp and exerted heavy handwriting pressure (83.3% and 30.6% of the cohort). The percentage of letters (M = 62.9%) and words (M = 73.3%) written legibly was low. Children with FASD were more likely than children without PAE to use a cross-thumb grasp (P = 0.027), apply heavy writing pressure (P = 0.036), be unable to write a sentence (P = 0.041) and show poorer word legibility (P = 0.041). There were no significant differences between groups for drawing outcomes, although some children with FASD drew pictures that appeared delayed for their age. There were no significant differences between children without PAE and those with PAE but who were not diagnosed with FASD. Overall, graphomotor skills were poor in this cohort, but children with FASD performed significantly worse than children without PAE. Findings suggest the need for improved occupational therapy services for children in remote regions and evaluation of graphomotor skills in children with PAE.
Evidence‐based paediatrics
Publisher: Wiley
Date: 02-1998
DOI: 10.1046/J.1440-1754.1998.00145.X
Abstract: Evidence-based medicine is practised widely in some specialties and is now part of many undergraduate and graduate medical curricula. However, the extent to which it is used in clinical paediatric practice is not known and its expansion remains a major challenge. Access to technology which facilitates literature searching, and development of journals addressing specific paediatric problems, will encourage the use of evidence-based medicine by the busy paediatrician. Informed practice of evidence-based medicine will ensure that clinical expertise is complemented by a thorough search, evaluation and judicious application of relevant information from the medical literature.
Geographic and Maternal Characteristics Associated with Alcohol Use in Pregnancy
Publisher: Wiley
Date: 04-04-2011
DOI: 10.1111/J.1530-0277.2011.01457.X
Abstract: To date, no studies have used population-level data to investigate whether maternal location of residence (metropolitan vs. regional/remote populations) is associated with alcohol use in pregnancy. This information has important implications for appropriate service provision. Information on all live births in New South Wales, Australia, was linked to records of alcohol-related admissions for mothers of these births over a 6-year period (2000 to 2006). Cases were women who had at least 1 alcohol-related hospital admission during pregnancy or at birth. Controls were women who had at least 1 live birth over that same time period but no alcohol-related hospital admissions during that time. Admissions were considered to be alcohol-related based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM) code. Demographic, obstetric, and neonatal variables were compared. A total of 417,464 singleton birth records were analyzed, 488 of which were coded positive for at least 1 alcohol-related ICD-10-AM diagnosis. Characteristics associated with alcohol-related admissions in pregnancy were residence in a remote/very remote area, being Australian-born, having had a previous pregnancy, smoking in the current pregnancy, and presenting late to antenatal care. Alcohol-exposed pregnancies were associated with a range of poor obstetric and neonatal outcomes, with no geographic differences noted. However, women in regional/remote areas were less likely to attend specialist obstetric hospitals. This study shows the need for standardized screening programs for alcohol use in pregnancy and where problematic use is detected, for clear clinical guidelines on management and referral.
The national incidence and clinical picture of SLE in children in Australia – a report from the Australian Paediatric Surveillance Unit
Publisher: SAGE Publications
Date: 06-10-2014
Abstract: The objectives of this paper are to prospectively determine the incidence of paediatric systemic lupus erythematosus (pSLE) in Australia as well as describe the demographics, clinical presentation and one-year outcome. Newly diagnosed cases of pSLE were ascertained prospectively from October 2009 to October 2011 through the Australian Paediatric Surveillance Unit (a national monthly surveillance scheme for notification of childhood rare diseases) as well as national subspecialty groups. Questionnaires were sent to notifying physicians at presentation and at one year. The annual incidence rate was 0.32 per 10 5 children aged less than 16 years. The incidence was significantly higher in children of Asian or Australian Aboriginal and Torres Strait Islander parents. Approximately one-third of children underwent a renal biopsy at presentation and 7% required dialysis initially although only one child had end-stage kidney disease (ESKD) at one-year follow-up. The incidence of pSLE in Australia is comparable to that worldwide with a significantly higher incidence seen in children of Asian and Australian Aboriginal and Torres Strait Islander backgrounds. Renal involvement is common but progression to ESKD, at least in the short term, is rare.
Impact of Gastrostomy Placement on Nutritional Status, Physical Health, and Parental Well-Being of Females with Rett Syndrome: A Longitudinal Study of an Australian Population
Publisher: Elsevier BV
Date: 09-2014
DOI: 10.1016/J.JPEDS.2018.04.050
Abstract: To evaluate how age-related trends in nutritional status, physical health, and parental well-being in females with Rett syndrome may be related to gastrostomy placement and to examine the impact of the procedure on mortality. We included 323 females from the Australian Rett Syndrome Study and analyzed their demographic, genetic, and child and parental health data collected from over 6 waves of follow-up questionnaire between 2000 and 2011. We used mixed-effects models to estimate the association between repeated measures of outcomes and age, gastrostomy placement and their interaction and Cox proportional hazards regression models to estimate relative risks of mortality for in iduals with gastrostomy. Nearly one-third (30.3%) of the cases underwent gastrostomy placement. Nutritional status based on weight, height, and body mass index (BMI) improved over time, and BMI was greater in in iduals with gastrostomy placement than in those without (adjusted β = 0.87, 95% CI 0.02-1.73). There was no association between gastrostomy placement and in idual's physical health outcomes or parental physical and mental health, nor did the age trend of these outcomes vary by gastrostomy insertion status. Nevertheless, among those at risk of suboptimal weight, the all-cause mortality rate was greater in those who had gastrostomy placement compared with those who had not (hazard ratio 4.07, 95% CI 1.96-8.45). Gastrostomy placement was associated with improvement in BMI in females with Rett syndrome, but its long-term impact on in iduals and their families is unclear.
Development of a reliable questionnaire to assist in the diagnosis of fetal alcohol spectrum disorders (FASD)
Publisher: Springer Science and Business Media LLC
Date: 07-03-2013
Weight in the First Year of Life: Associations with Maternal Prepregnancy Body Mass Index and Gestational Weight Gain—Findings from a Longitudinal Pregnancy Cohort
Publisher: Georg Thieme Verlag KG
Date: 08-02-2017
Abstract: Objective To investigate the obesogenic influence of maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) on infant weight at birth and 12 months postpartum in an Australian general population s le. Methods Data on 1,305 pregnant women were collected on prepregnancy BMI and GWG through maternal interview, on infant weight at birth through hospital records, and on infant weight 12 months postbirth through direct measurement. Relationships between prepregnancy, gestational weight exposures, and infant weight outcomes were assessed with and without adjustment for potential confounding. Results We observed a 14 to 24 g increase in infant birth weight for every 1 kg increase in maternal weight (infant birth weight: β(BMI) = 0.014, p 0.000 β(GWG) = 0.012, p 0.000 and 12 months: β(BMI) = 0.018, p 0.000 β(GWG) = 0.024, p 0.000). Effects remained after adjustment for potential confounders (infant birth weight: β(BMI) = 0.014, p 0.000 β(GWG) = 0.012, p 0.001 and 12 months: β(BMI)= 0.017, p ≤ 0.033 β(GWG) = 0.023, p = 0.001). However, the effects observed were small, and there was no evidence that GWG mediated relationships between preconception BMI and infant weight. Conclusion In a general population s le, there is a significant but not substantial observed relationship between maternal prepregnancy BMI and GWG and infant weight outcomes, suggesting a minor role for these factors at a population level.
Effect of Intestinal Microbial Ecology on the Developing Brain
Publisher: American Medical Association (AMA)
Date: 04-2013
DOI: 10.1001/JAMAPEDIATRICS.2013.497
Abstract: The mammalian gastrointestinal tract harbors a highly erse microbial population that plays a major role in nutrition, metabolism, protection against pathogens, and development of the immune system. It is estimated that at least 1000 different bacterial species cohabit the human intestinal tract. Most recently, the Human Microbiome Project, using new genomic technologies, has started a catalog of specific microbiome composition and its correlation with health and specific diseases. Herein we provide a brief review of the intestinal microbiome, with a focus on new studies showing that there is an important link between the microbes that inhabit the intestinal tract and the developing brain. With future research, an understanding of this link may help us to treat various neurobehavioral problems such as autism, schizophrenia, and anxiety.
Pre-admission management of acute gastroenteritis
Publisher: Wiley
Date: 02-1996
DOI: 10.1111/J.1440-1754.1996.TB01534.X
Abstract: Acute gastroenteritis contributes to significant morbidity and need for hospital admission. The current literature suggests outpatient management is often inappropriate. This study examines the pre-admission management of children admitted with acute gastroenteritis to a major children's hospital. Information was obtained from parental questionnaires and the medical notes for 164 children. Parents were poorly informed regarding appropriate home management. Over 70% sought professional advice prior to admission, usually from their general practitioner. Although 58% received advice on fluid therapy, an oral rehydration solution was recommended for only 32%, and only 9% actually used one before admission. Advice regarding fluid requirements was usually inadequate. Inappropriate medications were prescribed for 22% of children, including antibiotics (15.4%), antidiarrhoeals (1.2%) and anti-emetics (5.5%). Hospitalized children were generally well nourished with minimal dehydration and electrolyte disturbance. Oral rehydration therapy is utilized rarely and medications are over-utilized in home management of gastroenteritis. Education of parents, general practitioners and hospital doctors is essential to optimize outpatient management. The impact of optimal outpatient management on hospital admission rates and morbidity requires formal assessment.
Australian families living with rare disease
Publisher: Springer Science and Business Media LLC
Date: 11-02-2013
Abstract: Families of children living with a rare disease report significant health and social burden, however, few studies have systematically examined family needs by using validated tools to assess the scope and extent of this burden. Our aim was to develop a comprehensive survey to assess health, psychosocial and financial impacts on Australian families caring for a child with a rare disease. We developed a self-administered survey for parents/carers incorporating pre-validated tools. The survey included questions about experiences of diagnosis, health services use and needs, needs for peer and financial supports. Forty-seven families attending the state-wide Genetic Metabolic Disorders Service at the Children’s Hospital at Westmead, Sydney were invited to participate. Of 46 families who received the survey, 30 (65%) completed it. Most (93%) found the survey acceptable and relevant (91%). Patients were 1–17 years old, 14 (47%) male, and 12 (40%) non-Caucasian. Eighteen (60%) had a lysosomal storage disease and 12(40%) had a mitochondrial disorder. Eleven (38%) saw 3–5 doctors and four (14%) saw 6–10 doctors before receiving the correct diagnosis 43% felt diagnosis was delayed. Four (13%) were dissatisfied with the way diagnosis was given, due to insensitive style of communication, inadequate information and psychological support. Psychosocial impact was moderate to high for 90% of families and the level of impact was not dependent on the level of health functioning of the child. Twenty-six (87%) wanted, but only 13(43%) received, information about peer-support groups. The 30 children accounted for 168 visits to general practitioners and 260 visits to specialist doctors 21 (70%) children had at least one admission to hospital, including one who had 16 admissions in the previous 12 months. Most families (77%) received financial assistance but 52% believed this was insufficient. Families benefited from a specialised multi-disciplinary clinic but called for patient-held electronic medical records. Australian families caring for children with genetic metabolic disorders are adversely impacted by delays in diagnosis, lack of easy access to peer support groups and lack of psychological support. Further research is needed to estimate economic impact and to analyse health service delivery models for children with rare diseases in Australia.
Diagnosis of foetal alcohol syndrome and alcohol use in pregnancy: A survey of paediatricians' knowledge, attitudes and practice
Publisher: Wiley
Date: 18-10-2006
DOI: 10.1111/J.1440-1754.2006.00954.X
Abstract: To measure paediatricians' knowledge, attitudes and practices regarding foetal alcohol syndrome (FAS) and alcohol use during pregnancy. Postal survey of paediatricians in Western Australia in 2004. Of 179 eligible paediatricians, 132 (73.7%) responded (90 consultant paediatricians and 42 paediatric trainees). Of the 132 respondents, 18.9% identified all four essential diagnostic features for FAS. Only 49.2% had previously diagnosed FAS (range 1-30 cases) but 91.7% had seen children diagnosed by others 76.5% had suspected but not diagnosed FAS 12.1% had been convinced of but not recorded the diagnosis and 31.8% had referred children for diagnostic confirmation. Although 79.6% agreed early diagnosis might be advantageous, 69.6% said diagnosis might be stigmatising and 36.4% thought parents might resist referral for assessment and treatment. Although 78.2% agreed avoiding binge drinking may reduce FAS, only 43.9% believed women should abstain from using alcohol in pregnancy. Only 4.5% felt very prepared to deal with a patient with FAS: most wanted educational materials for themselves (69.7%) and child carers (71.2%). Only 23.3% routinely ask about alcohol use when taking a pregnancy history and 4.2% routinely provide information on the consequences of alcohol use. Only 11.4% had read the current Australian national health guideline regarding alcohol consumption in pregnancy and 9.1% provided advice consistent with the guideline. Paediatricians identified the need for educational materials about FAS and alcohol use in pregnancy for themselves and their clients. Lack of knowledge about FAS diagnosis and management will limit opportunities for diagnosis, prevention and early intervention.
Introduction: What is Evidence?
Publisher: Wiley
Date: 13-05-2004
Improving the quality of healthcare: a cross-sectional study of the features of successful clinical networks.
Publisher: The Sax Institute
Date: 2018
Abstract: Networks of clinical experts are being established internationally to help embed evidence based care in health systems. There is emerging evidence that these clinical networks can drive quality improvement programs, but the features that distinguish successful networks are largely unknown. We examined the factors that make clinical networks effective at improving quality of care and facilitating system-wide changes. We conducted a retrospective cross-sectional study of 19 state-wide clinical networks that reflected a range of medical and surgical specialty care and were in operation from 2006 to 2008 in New South Wales, Australia. We conducted qualitative interviews with network leaders to characterise potential impacts, and conducted internet surveys of network members to evaluate external support and the organisational and program characteristics of their respective networks. The main outcome measures were median ratings of in idual network impacts on quality of care and system-wide changes, determined through independent assessment of documented evidence by an expert panel. We interviewed 19 network managers and 32 network co-chairs 592 network members completed internet surveys. Three networks were rated as having had high impact on quality of care, and seven as having had high impact on system-wide change. Better-perceived strategic and operational network management was significantly associated with higher ratings of impact on quality of care (coefficient estimate 0.86 95% confidence interval [CI] 0.02, 1.69). Better-perceived leadership of the network manager (coefficient estimate 0.47 95% CI 0.10, 0.85) and strategic and operational network management (coefficient estimate 0.23 95% CI 0.06, 0.41) were associated with higher ratings of impact on system-wide change. This study represents the largest study of clinical networks undertaken to date. The results suggest that clinical networks that span the health system can improve quality of care and facilitate system-wide change. Network management and leadership, encompassing both strategic and operational elements at the organisational level, appear to be the primary influences on network success. These findings can guide future organisational and system-wide change programs and the development or strengthening of clinical networks to help implement evidence based care to improve service delivery and outcomes.
Prenatal Alcohol Exposure and Risk of Birth Defects
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2011
Fine motor skills in a population of children in remote Australia with high levels of prenatal alcohol exposure and Fetal Alcohol Spectrum Disorder
Publisher: Springer Science and Business Media LLC
Date: 21-11-2017
Fetal alcohol syndrome: a prospective national surveillance study
Publisher: BMJ
Date: 09-2008
Abstract: To describe the epidemiology of cases of fetal alcohol syndrome (FAS) seen by Australian paediatricians. Active, national case-finding using the Australian Paediatric Surveillance Unit (APSU). Monthly reporting of incident cases aged <15 years by paediatricians between January 2001 and December 2004. Over 1150 paediatricians submitted reports each month to the APSU. Of 169 reported cases, 92 fulfilled the study criteria for FAS. There was a significant increase in the number of children reported each year from 2001 to 2004. Of 92 children, 53.3% were male, 35.7% were preterm (<37 weeks' gestation) and 64.6% were of low birth weight (<2.5 kg). Most (94.4%) had high risk exposure to alcohol in utero and 78.3% were exposed to one or more additional drugs. The median age at diagnosis was 3.3 years (range: newborn to 11.9 years): 6.5% were diagnosed at birth and 63% by 5 years of age. Of the 92 cases, 56% had growth deficiency, 53.2% had microcephaly, 85.9% had evidence of central nervous system dysfunction, 24% had additional birth defects, 5.4% had sensorineural deafness and 4.3% had visual impairment. Of children with FAS, 65% were Indigenous, 51% had a sibling with FAS, and only 40.2% lived with a biological parent. Our data are the only prospective national data available on FAS throughout the world. These findings highlight the severity, complexity and impact of FAS, the need for effective strategies for prevention, and the necessity for education to facilitate earlier diagnosis, referral and reporting of cases.
Female genital mutilation in children presenting to Australian paediatricians
Publisher: BMJ
Date: 12-01-2017
DOI: 10.1136/ARCHDISCHILD-2016-311540
Abstract: The WHO reports that female genital mutilation/cutting (FGM/C) is an ancient cultural practice prevalent in many countries. FGM/C has been reported among women resident in Australia. Our paper provides the first description of FGM/C in Australian children. Cross-sectional survey conducted in April–June 2014. Paediatricians and other child health specialists recruited through the Australian Paediatric Surveillance Unit were asked to report children aged years with FGM/C seen in the last 5 years, and to provide data for demographics, FGM/C type, complications and referral for each case. Of 1311 eligible paediatricians/child health specialists, 1003 (76.5%) responded. Twenty-three (2.3%) respondents had seen 59 children with FGM/C and provided detailed data for 31. Most (89.7%) were identified during refugee screening and were born in Africa. Three (10.3%) were born in Australia: two had FGM/C in Australia and one in Indonesia. All parents were born overseas, mainly Africa (98.1%). Ten children had WHO FGM/C type I, five type II, five type III and six type IV. Complications in eight children included recurrent genitourinary infections, menstrual, sexual, fertility and psychological problems. Nineteen children (82.6%) were referred to obstetrics/gynaecology: 16 (69.9%) to social work and 13 (56.5%) to child protection. This study confirms that FGM/C is seen in paediatric clinical practice within Australia. Paediatricians need cultural awareness, education and resources to help them identify children with FGM/C and/or at risk of FGM/C, to enable appropriate referral and counselling of children, families and communities to assist in the prevention of this practice.
Experience of gastrostomy using a quality care framework: The example of rett syndrome
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2014
Alcohol consumption in a general antenatal population and child neurodevelopment at 2 years
Publisher: BMJ
Date: 24-08-2017
Abstract: Prenatal alcohol exposure (PAE) is a community health problem with up to 50% of pregnant women drinking alcohol. The relationship between low or sporadic binge PAE and adverse child outcomes is not clear. This study examines the association between PAE in the general antenatal population and child neurodevelopment at 2 years, accounting for relevant contributing factors. This prospective population-based cohort recruited 1570 pregnant women, providing sociodemographic, psychological and lifestyle information and alcohol use for five time periods. PAE categories were ‘low’, ‘moderate/high’, ‘binge’, in trimester 1 or throughout pregnancy. Measures of cognitive, language and motor development (Bayley Scales of Infant and Toddler Development) were available for 554 children, while measures of sensory processing (Infant/Toddler Sensory Profile) and social–emotional development (Brief Infant Toddler Social Emotional Assessment) were available for 948. A positive association in univariate analysis with low-level PAE throughout pregnancy and cognition (β=4.1, 95% CI −0.02 to 8.22, p=0.05) was attenuated by adjusting for environmental/social deprivation risk factors (β=3.06 (−1.19 to 7.30), p=0.16). Early binge drinking, plus continued PAE at lower levels, was associated with the child being more likely to score low in sensation avoidance (adjusted OR 1.88 (1.03 to 3.41), p=0.04). Early binge exposure, followed by lower-level PAE, demonstrated an increase in sensation-avoiding behaviour. There were, however, no significant associations between PAE and neurodevelopment following adjustment for important confounders and modifiers. Follow-up is paramount to investigate subtle or later onset problems.
Antimotility drugs for managing acute diarrhoea in children
Publisher: Wiley
Date: 12-05-2015
Involving consumers and the community in the development of a diagnostic instrument for fetal alcohol spectrum disorders in Australia
Publisher: Springer Science and Business Media LLC
Date: 30-07-2013
What do paediatricians think of the Australian Paediatric Surveillance Unit?
Publisher: Wiley
Date: 07-2010
DOI: 10.1111/J.1440-1754.2010.01755.X
Abstract: Aim: To explore clinicians' perceptions of the value, usefulness and limitations of the Australian Paediatric Surveillance Unit (APSU) and obtain direct feedback regarding the surveillance mechanism and suggestions for improvement. Methods: Anonymous postal survey of Australian paediatricians ( n = 1260) in 2007. Results: Of 1260 clinicians surveyed 818 (65%) responded, a similar proportion from all states/territories and specialties. Over half had participated in surveillance for years. The majority (95%), believe APSU research is valuable, for generating knowledge (81%), identifying research needs (78%), facilitating collaborative research (75%), supporting education and advocacy (74%), guiding clinical practice (70%), informing future policy (70%) and evaluating current policy (68%). Of 458 respondents who had ever reported a case (90%) had no objection to providing de‐identified clinical information and about 75% said questionnaires were easy to complete however, one third said clinical information requested was not always readily available. Most (680, 83%) respondents believed their contribution to the APSU was appropriately acknowledged and 20% said they had personally benefited from participation. The majority (90%) were willing to report immediately by email/fax hone in an epidemiological emergency. Lack of time and resources was the most common limitation to participation identified by clinicians: some suggested on‐line reporting would improve the ease and timeliness of reporting. Clinicians also suggested better use of the APSU website to disseminate results. Conclusion: Clinicians acknowledged the APSU as valuable. Improving communication with clinicians, ensuring that information requested in questionnaires is relevant and available, and developing a secure web‐based reporting system are future APSU priorities.
National surveillance of severe microcephaly in Australia.
Publisher: Wiley
Date: 20-05-2023
DOI: 10.1111/APA.16846
Determinants of successful clinical networks: The conceptual framework and study protocol
Publisher: Springer Science and Business Media LLC
Date: 13-03-2012
Australian children living with rare diseases: experiences of diagnosis and perceived consequences of diagnostic delays
Publisher: Springer Science and Business Media LLC
Date: 11-04-2017
The differential diagnosis of children with joint hypermobility: A review of the literature
Publisher: Springer Science and Business Media LLC
Date: 05-01-2009
The Marulu Strategy 2008–2012: overcoming Fetal Alcohol Spectrum Disorder (FASD) in the Fitzroy Valley
Publisher: Elsevier BV
Date: 10-2017
Abstract: Aboriginal leaders concerned about high rates of Fetal Alcohol Spectrum Disorder (FASD) in the Fitzroy Valley, remote north-western Australia, introduced restrictions on access to take-away full-strength alcohol. Following this, Aboriginal leaders engaged strategic partners in a broader strategy to address FASD in the region. The aim of this study was to develop and implement a community-led, researcher-supported, FASD strategy. A review of literature focusing on community-led FASD strategies identified key components that informed the Marulu FASD strategy. These included strategy ownership, leadership, and governance by participating communities, and a research framework. Community meetings and workshops led to the development of The Marulu FASD Strategy (2008). Feasibility and community consent to conduct a FASD prevalence study (the Lililwan Project) was confirmed, and implementation was progressed (2010-2013). Concurrent FASD prevention activities were conducted. In 2012, the Marulu FASD Unit was established within a local Aboriginal organisation to sustain and coordinate ongoing strategy activities. Community control of public health initiatives can be achieved when Aboriginal communities prioritise issues of significant concern, and engage strategic partners to overcome them. Implications for public health: The Marulu Strategy forms a template for action to address FASD and other public health issues in Aboriginal communities in Australia and internationally.
Water, electrolyte, glucose, and glycine absorption in rat small intestinal transplants
Publisher: Elsevier BV
Date: 04-1988
DOI: 10.1016/0016-5085(88)90540-9
Abstract: Water, electrolyte, glucose, and glycine absorption were studied in vivo in successful rat small intestinal transplants. Isolated bowel loops were transplanted from F1 hybrids into parental strain Lewis rats. A 7-day course of cyclosporin A was given for immunosuppression. Absorption was studied using a steady-state perfusion technique at either 9 or 21 days after transplantation. Histologic examination showed there was villus shortening with time but no evidence of rejection. When perfused with isotonic saline, both allografts and controls secreted water. However, allografts and denervated controls secreted chloride, whereas innervated controls absorbed chloride (p less than 0.05). There was a marked reduction in water and sodium absorption from 30 mM glucose-saline in transplanted loops and denervated controls, whereas glucose absorption was relatively preserved in these groups at 9 days (p less than 0.01). These changes could not be accounted for by rejection or ischemia. These studies demonstrate that denervation may be a major limiting factor in intestinal transplantation.
Development and validation of a survey to measure features of clinical networks.
Publisher: Springer Science and Business Media LLC
Date: 30-09-2016
The long-term outcomes of atypical haemolytic uraemic syndrome: a national surveillance study
Publisher: BMJ
Date: 04-01-2016
DOI: 10.1136/ARCHDISCHILD-2015-309471
Abstract: Atypical haemolytic uraemic syndrome (aHUS) accounts for ∼10% of all cases of HUS and is often due to complement dysregulation. The short-term outcomes for this disease are established, but there are limited long-term data. The long-term outcomes of a comprehensive nationwide cohort of children with aHUS are presented here. The Australian Paediatric Surveillance Unit prospectively collected data on all cases of HUS in children seen by paediatricians between 1994 and 2001. Patients with aHUS were followed-up with a written questionnaire to the treating clinician at 1 year and again before transition to adult services or at last known follow-up. There were 146 reported cases of HUS, of which 14 were aHUS. Ten children required dialysis at first presentation, including two who died and three who did not recover renal function. The disease was relapsing in all but one who survived the presenting episode, with most relapses occurring in the first 12 months. At 1 year, one child was lost to follow-up. Nine of the remaining 11 patients were dialysis dependent. Thirteen kidneys were transplanted into eight children. There was disease recurrence in eight kidneys, which resulted in graft loss in seven. There were three further deaths 1.7, 6.7 and 16.1 years after the initial presentation. Five children developed neurological complications and two had cardiac complications, largely at the time of onset of the disease. aHUS is a rare but devastating disease with very high mortality and morbidity that extends beyond the initial presentation period.
Low glycaemic index, or low glycaemic load, diets for diabetes mellitus
Publisher: John Wiley & Sons, Ltd
Date: 18-10-2006
Visual-motor integration, visual perception, and fine motor coordination in a population of children with high levels of Fetal Alcohol Spectrum Disorder
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.RIDD.2016.05.009
Abstract: Visual-motor integration (VMI) skills are essential for successful academic performance, but to date no studies have assessed these skills in a population-based cohort of Australian Aboriginal children who, like many children in other remote, disadvantaged communities, consistently underperform academically. Furthermore, many children in remote areas of Australia have prenatal alcohol exposure (PAE) and Fetal Alcohol Spectrum Disorder (FASD), which are often associated with VMI deficits. VMI, visual perception, and fine motor coordination were assessed using The Beery-Buktenica Developmental Test of Visual-Motor Integration, including its associated subtests of Visual Perception and Fine Motor Coordination, in a cohort of predominantly Australian Aboriginal children (7.5-9.6 years, n=108) in remote Western Australia to explore whether PAE adversely affected test performance. Cohort results were reported, and comparisons made between children i) without PAE ii) with PAE (no FASD) and iii) FASD. The prevalence of moderate (≤16th percentile) and severe (≤2nd percentile) impairment was established. Mean VMI scores were 'below average' (M=87.8±9.6), and visual perception scores were 'average' (M=97.6±12.5), with no differences between groups. Few children had severe VMI impairment (1.9%), but moderate impairment rates were high (47.2%). Children with FASD had significantly lower fine motor coordination scores and higher moderate impairment rates (M=87.9±12.5 66.7%) than children without PAE (M=95.1±10.7 23.3%) and PAE (no FASD) (M=96.1±10.9 15.4%). Aboriginal children living in remote Western Australia have poor VMI skills regardless of PAE or FASD. Children with FASD additionally had fine motor coordination problems. VMI and fine motor coordination should be assessed in children with PAE, and included in FASD diagnostic assessments.
Need to establish a national diagnostic capacity for foetal alcohol spectrum disorders
Publisher: Wiley
Date: 03-2009
DOI: 10.1111/J.1440-1754.2009.01464.X
Abstract: Alcohol exposure in pregnancy can induce a broad range of physical and developmental defects in the child, collectively known as foetal alcohol spectrum disorders (FASD). In Australia, there are proven gaps in our knowledge and practice for recognising and diagnosing FASD. The challenge for the Australian health professional is agreeing on a model for diagnosing and treating FASD. The diagnostic method must be evidence based, sensitive and specific, and account for other exposures during pregnancy and early life events. Training in application of the diagnostic method needs to be readily available in metropolitan and regional Australia. The University of Washington FASD 4-digit diagnostic code fulfils all of these best practice criteria, recommending itself as the method of choice.
Parechovirus encephalitis and neurodevelopmental outcomes
Publisher: American Academy of Pediatrics (AAP)
Date: 02-2016
Abstract: We aimed to describe the clinical features and outcome of human parechovirus (HPeV) encephalitis cases identified by the Australian Childhood Encephalitis (ACE) study. Infants with suspected encephalitis were prospectively identified in 5 hospitals through the (ACE) study. Cases of confirmed HPeV infection had comprehensive demographic, clinical, laboratory, imaging, and outcome at discharge data reviewed by an expert panel and were categorized by using predetermined case definitions. Twelve months after discharge, neurodevelopment was assessed by using the Ages and Stages Questionnaire (ASQ). We identified thirteen cases of suspected encephalitis with HPeV infection between May 2013 and December 2014. Nine infants had confirmed encephalitis median age was 13 days, including a twin pair. All had HPeV detected in cerebrospinal fluid with absent pleocytosis. Most were girls (7), admitted to ICU (8), and had seizures (8). Many were born preterm (5). Seven patients had white matter diffusion restriction on MRI 3 with normal cranial ultrasounds. At discharge, 3 of 9 were assessed to have sequelae however, at 12 months’ follow-up, by using the ASQ, 5 of 8 infants showed neurodevelopmental sequelae: 3 severe (2 cerebral palsy, 1 central visual impairment). A further 2 showed concern in gross motor development. Children with HPeV encephalitis were predominantly young, female infants with seizures and diffusion restriction on MRI. Cranial ultrasound is inadequately sensitive. HPeV encephalitis is associated with neurodevelopmental sequelae despite reassuring short-term outcomes. Given the absent cerebrospinal fluid pleocytosis and need for specific testing, HPeV could be missed as a cause of neonatal encephalopathy and subsequent cerebral palsy.
The use of low-glycaemic index diets in diabetes control
Publisher: Cambridge University Press (CUP)
Date: 27-04-2010
DOI: 10.1017/S0007114510001534
Abstract: The aim of diabetes management is to normalise blood glucose levels since improved blood glucose control is associated with fewer complications. Food affects blood glucose levels however, there is no universal approach to the optimal diabetic diet and there is controversy about the usefulness of the low-glycaemic index (GI) diet. To assess the effects of low-GI diets on glycaemic control in diabetes, we conducted electronic searches of the Cochrane Library, MEDLINE, EMBASE and CINAHL. We assessed randomised controlled trials (RCT) with interventions weeks that compared a low-GI diet with a higher-GI diet for type 1 or type 2 diabetes. Twelve RCT ( n 612) were identified. There was a significant decrease in glycated Hb (HbA1c) with low-GI diet than with the control diet, indicating improved glycaemic control (seven trials, n 457, weighted mean difference (WMD) − 0·4 % HbA1c, 95 % CI − 0·7, − 0·20, P = 0·001). In four studies reporting the results for glycaemic control as fructosamine, three of which were 6 weeks or less in duration, pooled data showed a decrease in fructosamine (WMD − 0·23 mmol/l, 95 % CI − 0·47, 0·00, P = 0·05), n 141, with low-GI diet than with high-GI diet. Glycosylated albumin levels decreased significantly with low-GI diet, but not with high-GI diet, in one study that reported this outcome. Lowering the GI of the diet may contribute to improved glycaemic control in diabetes.
Messages that increase women’s intentions to abstain from alcohol during pregnancy: results from quantitative testing of advertising concepts
Publisher: Springer Science and Business Media LLC
Date: 13-01-2014
Health professionals' knowledge, practice and opinions about fetal alcohol syndrome and alcohol consumption in pregnancy
Publisher: Elsevier BV
Date: 12-2005
DOI: 10.1111/J.1467-842X.2005.TB00251.X
Abstract: To measure the knowledge, attitudes and practices of health professionals regarding fetal alcohol syndrome (FAS) and alcohol use during pregnancy. A postal survey of a representative random s le of health professionals was conducted in Western Australia (WA) in 2002/03. 1,143 (79%) of 1,443 eligible health professionals completed the survey (87 Aboriginal Health Workers, 286 allied health professionals, 537 community nurses, 170 general practitioners and 63 obstetricians). Of 1,143 health professionals, 12% identified all four essential diagnostic features of FAS. Most (95%) had never diagnosed FAS. Although 82% believed that making a diagnosis of FAS might improve treatment plans and 85% agreed FAS was preventable, 53% said the diagnosis might be stigmatising. Only 2% felt very prepared to deal with FAS and most wanted information for themselves and their clients. Of the 659 health professionals caring for pregnant women, only 45% routinely ask about alcohol use in pregnancy, only 25% routinely provide information on the consequences of alcohol use in pregnancy and only 13% provide advice consistent with NHMRC guidelines on alcohol consumption in pregnancy. Health professionals have identified the need for educational materials for themselves and their clients. FAS is likely to be under-ascertained in Australia due to a lack of knowledge of FAS by health professionals. Until this lack of knowledge is addressed, opportunities for diagnosis and prevention of FAS will be limited.
The Royal Australasian College of Physicians Paediatic & Child Health Division 145 Macquarie Street, Sydney, NSW, 2000 Summary of position statement on inequities in child health Published by RACP
Publisher: Wiley
Date: 08-2018
DOI: 10.1111/JPC.14134
International survey of diagnostic services for children with Fetal Alcohol Spectrum Disorders
Publisher: Springer Science and Business Media LLC
Date: 15-04-2008
Case for varicella surveillance in Australia
Publisher: Wiley
Date: 18-10-2006
Australian Paediatric Surveillance Unit: Progress Report
Publisher: Wiley
Date: 02-2002
DOI: 10.1046/J.1440-1754.2002.00767.X
Abstract: The Australian Paediatric Surveillance Unit (APSU), through active surveillance, collects information on the epidemiology of rare or uncommon childhood conditions. This research resource allows paediatricians to collaborate at State, national and international levels. The APSU sends a monthly report card to all (currently 971) paediatricians in Australia, who in turn indicate whether or not they have seen a patient in the last month with any of the conditions listed (98% response rate in 1999). Study investigators, notified by the APSU of positive case reports, obtain demographic and clinical data on the patient from the reporting doctor by postal questionnaire (90% response rate in 1999). Since 1993, the APSU has monitored 27 conditions, including conditions that are vaccine-preventable, otherwise infectious, genetic, congenital and non-communicable. Information collected is disseminated to paediatricians and other health professionals via an annual report, newsletters and publications and is made available to the International Network of Paediatric Surveillance Units. Information provided by the APSU has raised awareness among paediatricians of rare and uncommon childhood conditions, and has been used by health authorities for planning of prevention and intervention strategies and allocation of health resources.
Bioinspired 3D Printable Soft Vacuum Actuators for Locomotion Robots, Grippers and Artificial Muscles.
Publisher: Mary Ann Liebert Inc
Date: 12-2018
Abstract: Continued technological progress in robotic systems has led to more applications where robots and humans operate in close proximity and even physical contact in some cases. Soft robots, which are made of highly compliant and deformable materials, provide inherent safety features unlike conventional robots that are made of stiff and rigid components. Soft robotics is a rapidly developing field exploiting biomimetic design principles, novel sensor and actuation concepts, and advanced manufacturing techniques. In this study, we propose novel 3D printable soft vacuum actuators that are inspired by the sporangium of fern trees. These actuators that are directly manufactured using commercial and affordable fused deposition modeling 3D printers offer many advantages such as high actuation speed (5.54 Hz), long lifetime (123,000 cycles), large payload to weight ratio (∼26), and significant output forces (∼16 N). The behavior of these actuators is accurately predicted, and their performance is optimized using finite element modeling. Furthermore, erse robotic applications such as locomotion robots (a walking robot moving with an average forward speed of
Call for a national plan for rare diseases
Publisher: Wiley
Date: 2010
DOI: 10.1111/J.1440-1754.2009.01608.X
Abstract: Australia requires a national plan, similar to plans developed internationally, to address the impacts of rare diseases on in iduals, the community and health services. Rare diseases often present in childhood, many are chronic, some life threatening and others associated with significant disability. However, diagnosis is often delayed, because of lack of knowledge and experience of health professionals and uncertainty about where to refer. Specialised health services are frequently lacking and specific therapies are often not available, partly because of lack of research funding directed towards rare diseases. A national plan would facilitate a coordinated response to service development, carer support, and health professional and community education, and would promote research and advocacy for affected children and their families.
RE-AIM Evaluation of the Alcohol and Pregnancy Project: Educational Resources to Inform Health Professionals About Prenatal Alcohol Exposure and Fetal Alcohol Spectrum Disorder
Publisher: SAGE Publications
Date: 03-02-2011
Abstract: The objective was to evaluate the Alcohol and Pregnancy Project that provided health professionals in Western Australia (WA) with educational resources to inform them about prevention of prenatal alcohol exposure and fetal alcohol spectrum disorder (FASD). The authors developed, produced, and distributed educational resources to 3,348 health professionals in WA. Six months later, they surveyed 1,483 of these health professionals. The authors used the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) to evaluate the project. The educational resources were effective in producing a 31% increase in the proportion of health professionals who routinely provided pregnant women with information about the consequences of drinking alcohol during pregnancy. One hundred percent of the settings adopted the project, it reached 96.3% of the target population, it was implemented as intended, and the resources were maintained (www.ichr.uwa.edu.au/alcoholandpregnancy). The educational resources for health professionals have potential to contribute to reducing prenatal alcohol exposure and FASD.
Fetal Alcohol Spectrum Disorders
Publisher: Routledge
Date: 08-10-2013
Congenital and neonatal varicella
Publisher: BMJ
Date: 24-02-2011
Abstract: Routine varicella zoster vaccination for children aged 18 months began in Australia from November 2005. The aim of this study was to compare the current incidence and outcomes of congenital and neonatal varicella in Australia with similarly collected data from 1995 to 1997. Active national prospective surveillance was carried out for congenital and neonatal varicella using the Australian Paediatric Surveillance Unit (APSU) for 3.5 years from June 2006. Around 1300 clinicians reported monthly according to predefined case criteria. During the study period the mean monthly return rate of APSU report cards was 93.7%. Two cases of congenital varicella (0.19 per 100 000 live births per annum) and 16 cases of neonatal varicella (2.0 per 100 000 live births per annum) were identified. During 2008 and 2009 no cases of congenital varicella were reported neonatal varicella rates declined to 0.7 per 100 000 live births per annum, a significant trend (p=0.005) and a reduction of over 85% compared with rates during 1995-1997 (the prevaccination era) and the first year of the current surveillance study. Eleven of 16 neonatal cases followed prenatal maternal infection seven of the 11 infections were acquired from children, four of whom were living in the same household. Ten (62.5%) infants with neonatal varicella were admitted to hospital, one of whom developed varicella pneumonitis requiring ventilatory support, but none died. Only one infecting contact had been vaccinated. There has been an apparent reduction of congenital varicella and a significant reduction of neonatal varicella in Australia following the introduction of universal varicella vaccination in 2005.
“Did you ever drink more?” A detailed description of pregnant women’s drinking patterns
Publisher: Springer Science and Business Media LLC
Date: 02-08-2016
Sex- and tissue-specific effects of binge-level prenatal alcohol consumption on DNA methylation at birth
Publisher: Future Medicine Ltd
Date: 12-2021
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 s les. Results: We identified no differentially methylated CpGs or differentially methylated regions (DMRs) at false discovery rate .05. However, using a sum-of-ranks approach, we identified a DMR in each tissue of female offspring. The DMR identified in buccal s les 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.
There's hope in the valley
Publisher: Wiley
Date: 03-2012
DOI: 10.1111/J.1440-1754.2012.02422.X
Abstract: Aboriginal women in the remote Fitzroy Valley region in Western Australia's Kimberley were concerned about high rates of alcohol use in pregnancy and its possible impact on child development. They successfully lobbied for restricted access to alcohol in 2007. In 2009 they developed a strategy for the diagnosis and prevention of Fetal Alcohol Spectrum Disorders (FASD) and the support of parents and carers of affected children. Aboriginal organisations then partnered with research and clinical groups from Sydney to conduct a FASD prevalence study. This commenced in 2010 following extensive community consultation and receipt of community consent. Data from this study are still being collected and will be used by the community to advocate for improved services and new models of health care. Prevention of FASD is important to optimise health and development for future generations of Aboriginal children and to ensure the transfer of culture and language from one generation to the next.
Changes in Patterns of Hospitalized Children With Varicella and of Associated Varicella Genotypes After Introduction of Varicella Vaccine in Australia
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2013
Assessing diagnostic and screening tests: Part 1. Concepts
Publisher: BMJ
Date: 06-2001
P aediatric A ctive E nhanced D isease S urveillance: A new surveillance system for A ustralia
Publisher: Wiley
Date: 19-06-2013
DOI: 10.1111/JPC.12282
Abstract: The Paediatric Active Enhanced Disease Surveillance (PAEDS) is described. PAEDS is active in four tertiary children's hospitals in four states of Australia and aims to address gaps in surveillance for severe vaccine-preventable diseases and adverse events following immunisation. From August 2007 to December 2010, surveillance nurses actively identified and recruited children admitted with: acute flaccid paralysis, varicella infection, intussusception, seizures in infants and pandemic influenza (June-October 2009). Details of presentation, medical and immunisation history, outcome and laboratory results were collected. Completeness of ascertainment was estimated through audits of International Classification of Diseases 10th edition-coded medical records where possible. Seven hundred thirty-three cases matching case definition criteria for the four conditions were recruited. In addition, 601 cases of influenza were recruited during the 2009 pandemic. PAEDS enhanced acute flaccid paralysis surveillance by the Australian Paediatric Surveillance Unit the World Health Organization surveillance target was met when Australian Paediatric Surveillance Unit and PAEDS cases were combined. Among 133 children hospitalised for varicella, only 16 were vaccinated s les of vesicle scrapings were collected in 57% for genotyping. Of 122 infants presenting with seizures, only six (12%) had received a vaccine in the last 7 days. Intussusception was more frequent among infants receiving their first dose of either of the rotavirus vaccines. Results informed policy and education for parents and health professionals. Preliminary audits of medical records suggest excellent ascertainment through PAEDS. PAEDS provides important, previously unavailable data to inform public health policy, clinical practice and community confidence. It has potential to respond quickly during outbreaks and epidemics.
Cochlear implant outcomes in cochlea nerve aplasia and hypoplasia
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2016
Evaluation of a national surveillance unit
Publisher: BMJ
Date: 1999
DOI: 10.1136/ADC.80.1.21
Abstract: The Australian Paediatric Surveillance Unit (APSU) facilitates national active surveillance of uncommon childhood conditions. This study assessed whether it fulfilled its objectives and satisfied criteria established by the Centers for Disease Control and Prevention (CDC) for evaluating surveillance systems. Anonymous questionnaires were sent to users of the system, in idual studies were reviewed, and data were collected from independent sources. Seven hundred and sixty six clinicians, 48 investigators, and 15 public health professionals responded to the questionnaires. Clinicians reported that the APSU was useful, 33% saying information provided by the APSU informed or changed their clinical practice. Most (88%) reported that completing monthly report cards was not a burden. Impact on policy development was limited by suboptimal dissemination of information to public health professionals. Flexibility and timeliness were limited by design. Estimated sensitivity of APSU studies ranged from 92% (congenital rubella) to 31% (drowning/near drowning). Positive predictive value of notified cases was over 70% for most studies. The APSU fulfils most of its objectives and meets CDC criteria salient to these. Ways in which the APSU could be improved have been identified, as have methodological challenges and limitations in applying CDC guidelines to this type of unit.
Acute gastroenteritis in children
Publisher: BMJ
Date: 04-01-2007
High global prevalence of alcohol use during pregnancy and fetal alcohol syndrome indicates need for urgent action
Publisher: Elsevier BV
Date: 03-2017
Written information and health professionals are the information sources about alcohol use in pregnancy most often used by pregnant women
Publisher: Wiley
Date: 14-07-2022
DOI: 10.1111/DAR.13512
Abstract: 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. 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. 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 [ pregnancy] and more highly educated) obtained no information regarding alcohol use in pregnancy. Antenatal providers should routinely provide information on alcohol use in pregnancy, including for women least likely to access available information.
Evidence‐based Pediatric Infectious Diseases
Publisher: Wiley
Date: 22-08-2007
Changes in health professionals' knowledge, attitudes and practice following provision of educational resources about prevention of prenatal alcohol exposure and fetal alcohol spectrum disorder
Publisher: Wiley
Date: 24-04-2011
DOI: 10.1111/J.1365-3016.2011.01197.X
Abstract: We provided health professionals in Western Australia (WA) with educational resources about prevention of prenatal alcohol exposure and fetal alcohol spectrum disorder and assessed changes in their knowledge, attitudes and practice concerning fetal alcohol syndrome (FAS) and alcohol consumption in pregnancy. Following our 2002 survey of health professionals in WA, we developed and distributed educational resources to 3348 health professionals in WA in 2007. Six months later we surveyed 1483 of these health professionals. Prevalence rate ratios [PRR] and 95% confidence intervals [CI] were calculated to compare 2007 results with results from the 2002 survey. Of the 1001 responding health professionals, 69.8% had seen the educational resources of these 77.1% have used them and 48.5% said the resources had assisted them to change their practice or their intention to change their practice. Compared with 2002, there was an increase in the proportion who knew all the essential features of FAS from 11.7% to 15.8% [PRR 1.35 95% CI 1.09, 1.67] and had diagnosed FAS, from 4.8% to 7.3% [PRR 1.52 95% CI 1.08, 2.13]. In 2007, 98.1% of health professionals stated they would advise pregnant women to consider not drinking at all or advise them that no alcohol in pregnancy is the safest choice. Health professionals surveyed in 2007 have increased their knowledge, changed their attitudes and practice about FAS, and altered the advice they give to pregnant women about alcohol consumption since our survey in 2002. It is essential that we build on this change and continue to support health professionals' knowledge, attitudes and practice about the prevention of prenatal alcohol exposure and fetal alcohol spectrum disorder. The educational resources for health professionals may be ordered as hard copies and downloaded from the internet www.ichr.uwa.edu.au/alcoholandpregnancy.
The Picture Talk Project: Starting a Conversation with Community Leaders on Research with Remote Aboriginal Communities of Australia
Publisher: Springer Science and Business Media LLC
Date: 11-05-2017
Commentary on: ‘Early versus delayed refeeding for children with acute diarrhoea’
Publisher: Wiley
Date: 03-2012
DOI: 10.1002/EBCH.1836
Pediatric hospital admissions in Indigenous children: a population-based study in remote Australia
Publisher: Springer Science and Business Media LLC
Date: 22-11-2017
Mazzotti-like reaction after treatment with praziquantel for schistosomiasis [3]
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2006
Gross Motor Deficits in Children Prenatally Exposed to Alcohol: A Meta-analysis
Publisher: American Academy of Pediatrics (AAP)
Date: 07-2014
Abstract: Gross motor (GM) deficits are often reported in children with prenatal alcohol exposure (PAE), but their prevalence and the domains affected are not clear. The objective of this review was to characterize GM impairment in children with a diagnosis of fetal alcohol spectrum disorder (FASD) or “moderate” to “heavy” maternal alcohol intake. A systematic review with meta-analysis was conducted. Medline, Embase, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, PEDro, and Google Scholar databases were searched. Published observational studies including children aged 0 to ≤18 years with (1) an FASD diagnosis or moderate to heavy PAE, or a mother with confirmed alcohol dependency or binge drinking during pregnancy, and (2) GM outcomes obtained by using a standardized assessment tool. Data were extracted regarding participants, exposure, diagnosis, and outcomes by using a standardized protocol. Methodological quality was evaluated by using Strengthening the Reporting of Observational Studies in Epidemiology guidelines. The search recovered 2881 articles of which 14 met the systematic review inclusion criteria. The subjects’ mean age ranged from 3 days to 13 years. Study limitations included failure to report cutoffs for impairment, nonstandardized reporting of PAE, and small s le sizes. The meta-analysis pooled results (n = 10) revealed a significant association between a diagnosis of FASD or moderate to heavy PAE and GM impairment (odds ratio: 2.9 95% confidence interval: 2.1–4.0). GM deficits were found in balance, coordination, and ball skills. There was insufficient data to determine prevalence. The significant results suggest evaluation of GM proficiency should be a standard component of multidisciplinary FASD diagnostic services.
Pregnancy and Pandemic Flu
Publisher: Oxford University Press (OUP)
Date: 03-2010
DOI: 10.1086/650461
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University Of Leicester
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Related Funding Activities
Linkage Projects - Grant ID: LP100100300
Start Date: 2010
End Date: 12-2015
Amount: $292,000.00
Funder: Australian Research Council
View Funded ActivityLinkage Projects - Grant ID: LP110200277
Start Date: 07-2011
End Date: 12-2015
Amount: $316,780.00
Funder: Australian Research Council
View Funded ActivityLinkage Projects - Grant ID: LP0882394
Start Date: 07-2008
End Date: 12-2013
Amount: $454,232.00
Funder: Australian Research Council
View Funded Activity