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0000-0002-3720-9655
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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 | Epidemiology | Health and Community Services | Mental Health | Population Trends and Policies | Public Health and Health Services not elsewhere classified |
ANZSRC Socio-Economic Objective (SEO)
Public Health (excl. Specific Population Health) not elsewhere classified | Preventive Medicine | Social Structure and Health | Child Health | Mental Health | Crime Prevention | Health Inequalities | Disease Distribution and Transmission (incl. Surveillance and Response)
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Publications
School absence and its effect on school performance for children born with orofacial clefts
Publisher: Wiley
Date: 06-2017
DOI: 10.1002/BDR2.1041
Abstract: School absence is associated with lower performance on standardized tests. Children born with orofacial clefts (OFC) are likely to have more absence than children without OFC however, school absence for children with OFC has not been quantified. We aimed to describe school absence and its relationship with school performance for children with and without OFC. Population-based record-linked cohort study of children (402 with OFC, 1789 without OFC) enrolled in schools in Western Australia, 2008 to 2012. We compared median school absence rates using Wilcoxon rank tests, and investigated the impact of school absence on standardized scores from reading, numeracy, and writing tests, using multivariable models fitted by generalized estimating equations. In Semester 1, at each primary school year level, children without OFC and children with cleft lip only or cleft palate only had similar median absence rates (approximately 1 week). Children with cleft lip and palate had significantly higher absence rates in Years 4 to 6 (between 1 and 2 weeks). During secondary school, median absence rates were higher (2 weeks) for all children, but not statistically different between children with and without OFC. Higher absence was significantly associated with lower standardized reading, numeracy, and writing scores. However, having a cleft of any type had little influence on the association between absence and test scores. School absence affected school performance for all children. Absence did not differentially disadvantage children born with OFC, suggesting current practices to identify and support children with OFC are minimizing effects of their absence on school performance. Birth Defects Research 109:1048-1056, 2017. © 2017 Wiley Periodicals, Inc.
Autism spectrum disorders in young children: Effect of changes in diagnostic practices
Publisher: Oxford University Press (OUP)
Date: 07-09-2009
DOI: 10.1093/IJE/DYP260
Abstract: It is unclear whether the increase in autism over the past two decades is a real increase or due to changes in diagnosis and ascertainment of autism spectrum disorders (ASDs), which include autism, Asperger syndrome and pervasive developmental disorder not otherwise specified (PDD-NOS). The aim of this study was to examine the trends in ASD over time in Western Australia (WA) and the possible effects and contribution of changes in diagnostic criteria, age at diagnosis, eligibility for service provision based on ASD diagnoses and changes in diagnostic practices. A population-based study was conducted among the cohort of children born in WA between 1983 and 1999 and diagnosed with ASD between the age of 2 and 8 years up to December 31, 2004. The trend in ASD diagnosis over the study period was assessed by investigating birth cohort and period effects, and examining whether these were modified by age of diagnosis. ASD diagnosis corresponding with changes in diagnostic criteria, funding and service provision over time were also investigated. A subgroup analysis of children aged <or=5 years was also conducted to examine trends in the incidence and age of diagnosis of ASD and intellectual disability (ID) and to investigate the role of changes in diagnostic practices. The overall prevalence of ASD among children born between 1983 and 1999 and diagnosed by age 8 was 30 per 10,000 births with the prevalence of autism comprising 21 per 10,000 births. The prevalence of ASD increased by 11.9% per annum, from 8 cases per 10,000 births in 1983 to 46 cases per 10,000 births in 1999. The annual incidence of ASD, based on newly diagnosed ASD cases in each year from 1985 to 2002, increased over the study period. The increase in incidence of ASD appeared to coincide with changes in diagnostic criteria and availability of funding and services in WA, particularly for children aged <5 years. The age-specific rates of autism and PDD-NOS increased over time and the median age of diagnosis for autism decreased from 4 to 3 years of age throughout the 1990s. For children aged <or=5 years the incidence of ASD diagnosis increased significantly from 1992, with an average annual increase of 22%. Similar findings were found for autism. In the corresponding years the incidence of diagnosis of severe ID fell by 10% per annum and mild-moderate ID increased by 3% per annum. The rise in incidence of all types of ASDs by year of diagnosis appears to be related to changes in diagnostic and service provision practices in WA. In children aged <or=5 years, diagnosis of severe ID decreased, but mild-moderate ID increased during the study period. A true increase in ASD cannot be ruled out.
The impact of general anesthesia on child development and school performance: a population‐based study
Publisher: Wiley
Date: 27-04-2018
DOI: 10.1111/PAN.13390
Abstract: There has been considerable interest in the possible adverse neurocognitive effects of exposure to general anesthesia and surgery in early childhood. The aim of this data linkage study was to investigate developmental and school performance outcomes of children undergoing procedures requiring general anesthesia in early childhood. We included children born in New South Wales, Australia of 37+ weeks' gestation without major congenital anomalies or neurodevelopmental disability with either a school entry developmental assessment in 2009, 2012, or Grade-3 school test results in 2008-2014. We compared children exposed to general anesthesia aged <48 months to those without any hospitalization. Children with only 1 hospitalization with general anesthesia and no other hospitalization were assessed separately. Outcomes included being classified developmentally high risk at school entry and scoring below national minimum standard in school numeracy and reading tests. Of 211 978 children included, 82 156 had developmental assessment and 153 025 had school test results, with 12 848 (15.7%) and 25 032 (16.4%) exposed to general anesthesia, respectively. Children exposed to general anesthesia had 17%, 34%, and 23% increased odds of being developmentally high risk (adjusted odds ratio [aOR]: 1.17 95% CI: 1.07-1.29) or scoring below the national minimum standard in numeracy (aOR: 1.34 95% CI: 1.21-1.48) and reading (aOR: 1.23 95% CI: 1.12-1.36), respectively. Although the risk for being developmentally high risk and poor reading attenuated for children with only 1 hospitalization and exposure to general anesthesia, the association with poor numeracy results remained. Children exposed to general anesthesia before 4 years have poorer development at school entry and school performance. While the association among children with 1 hospitalization with 1 general anesthesia and no other hospitalization was attenuated, poor numeracy outcome remained. Further investigation of the specific effects of general anesthesia and the impact of the underlying health conditions that prompt the need for surgery or diagnostic procedures is required, particularly among children exposed to long duration of general anesthesia or with repeated hospitalizations.
Maternal Conditions and Perinatal Characteristics Associated with Autism Spectrum Disorder and Intellectual Disability
Publisher: Public Library of Science (PLoS)
Date: 07-01-2013
Exploring Infant Fall Events Using Online Parenting Discussion Forums: Infodemiology Study (Preprint)
Publisher: JMIR Publications Inc.
Date: 22-10-2021
Abstract: alls represent the most common mechanism of injury requiring hospitalization among children under 12 months, and they commonly result in traumatic brain injury. Epidemiological studies exploring infant falls demonstrate the experienced burden, but they lack contextual information vital to the development of preventive interventions. he objective of this study was to examine contextual information for falls involving children under 12 months, using online parenting discussion forums. nline parenting forums provide an unobtrusive rich data source for collecting detailed information about fall events. Relevant discussions related to fall incidents were identified and downloaded using site-specific Google Search queries and a programming script. A qualitative descriptive approach was used to analyze the incidents and categorize contextual information into “precursor events” and “influencing factors” for infant falls. e identified 461 infant fall incidents. Common fall mechanisms included falls from furniture, falls when being carried or supported by someone, falls from baby products, and falls on the same level. Across the spectrum of fall mechanisms, common precursor events were infant rolling off, infant being alone on furniture, product misuse, caretaker falling asleep while holding the infant, and caretaker tripping/slipping while carrying the infant. Common influencing factors were infant’s rapid motor development, lapses in caretaker attention, and trip hazards. he findings define targets for interventions to prevent infant falls and suggest that the most viable intervention approach may be to target parental behavior change. Online forums can provide rich information critical for preventive interventions aimed at changing behavior.
Survival, Hospitalization, and Acute-Care Costs of Very and Moderate Preterm Infants in the First 6 Years of Life: A Population-Based Study
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.JPEDS.2015.10.028
Abstract: To investigate survival, hospitalization, and acute-care costs of very (28-31 weeks' gestation) and moderate preterm (32-33 weeks' gestation) infants in the first 6 years of life and compare outcomes with the more widely studied extremely preterm infants (24-27 weeks' gestation) and to full term (low risk) infants (39-40 weeks' gestation). Birth data from all women residing in New South Wales, Australia, with gestational ages between 24-33 and 39-40 weeks in 2001-2011 were linked probabilistically to hospitalization and mortality data. Study outcomes were evaluated with the use of descriptive and multivariable analyses at birth (N = 559,532), discharge (N = 540,240), and at 1 (N = 487,447) and 6 years of age (N = 230,498). Mortality was greatest among extremely preterm infants (eg, 31.2% within 6 years) and decreased with increasing gestational age. Likewise, hospitalization within the first year of life increased with decreasing gestational age (aOR 5.5 [95% CI 4.7-6.4], 3.7 [3.4-4.0], and 2.6 [2.5-2.8] for birth at 24-27, 28-31, and 32-33 weeks' gestation, relative to 39-40 weeks' gestation). Hospitalization remained significantly increased with preterm birth at each year of age up to 6 years (aORs 1.3-1.6 at 6 years). Cumulative costs were significantly greater with preterm birth within the first year of life, and also between 1 and 6 years of age. The risks of adverse health outcomes were significantly greater in very and moderately preterm infants relative to full term infants but lower than extremely preterm infants. Crucially, preterm birth was associated with prolonged increased odds of hospitalization (up to age 6 years), contributing to greater resource use.
A population‐based comparison of the post‐operative outcomes of open and laparoscopic appendicectomy in children
Publisher: AMPCo
Date: 07-2018
DOI: 10.5694/MJA17.00541
Abstract: To assess and compare the post-operative outcomes of open and laparoscopic appendicectomy in children. Record linkage analysis of administrative hospital (Admitted Patient Data Collection) and emergency department (Emergency Department Data Collection) data.Participants, setting: Children under 16 years of age who underwent an appendicectomy in a public or private hospital in New South Wales between January 2002 and December 2013. Association between type of appendicectomy and post-operative complications within 28 days of discharge, adjusted for patient characteristics and type of hospital. Of 23 961 children who underwent appendicectomy, 19 336 (81%) had uncomplicated appendicitis and 4625 (19%) had appendicitis complicated by abscess, perforation, or peritonitis. The proportion of laparoscopic appendicectomies increased from 11.8% in 2002 to 85.8% in 2013. In cases of uncomplicated appendicitis, laparoscopic appendicectomy was associated with more post-operative complications (mostly symptomatic re-admissions or emergency department presentations) than open appendicectomy (7.4% v 5.8%), but with a reduced risk of post-operative intestinal obstruction (adjusted odds ratio [aOR], 0.59 95% CI, 0.36-0.97). For cases of complicated appendicitis, the risk of wound infections was lower for laparoscopic appendicectomy (aOR, 0.67 95% CI, 0.50-0.90), but not the risks of intestinal obstruction (aOR, 0.97 95% CI, 0.62-1.52) or intra-abdominal abscess (aOR, 1.06 95% CI, 0.72-1.55). Post-appendicectomy outcomes were similar for most age groups and hospital types. Children with uncomplicated appendicitis have lower risk of post-operative bowel obstruction after laparoscopic appendicectomy than after open appendicectomy, but may be discharged before their post-operative symptoms have adequately resolved.
Exploring the potential of behaviour theory-informed digital intervention for infant fall prevention : a mixed method longitudinal study (Preprint)
Publisher: JMIR Publications Inc.
Date: 17-03-2023
DOI: 10.2196/47361
Toward a Behavior Theory–Informed and User-Centered Mobile App for Parents to Prevent Infant Falls: Development and Usability Study (Preprint)
Publisher: JMIR Publications Inc.
Date: 27-04-2021
Abstract: alls account for approximately 50% of infant injury hospitalizations, and caretaker behavior is central to preventing infant falls. Behavior theory–informed interventions for injury prevention have been suggested, but to date, few have been reported. The potential of using smartphones for injury prevention intervention delivery is also underexploited. his study aims to develop a behavior theory– and evidence-based as well as user-centered digital intervention as a mobile app for parents to prevent infant falls following agile development practices. nfant falls while feeding was selected as the fall mechanism to demonstrate the approach being taken to develop this intervention. In phase 1, the Behaviour Change Wheel was used as a theoretical framework supported by a literature review to define intervention components that were then implemented as a mobile app. In phase 2, after the person-based approach, user testing through think-aloud interviews and comprehension assessments were used to refine the content and implementation of the intervention. he target behaviors identified in phase 1 were adequate rest for the newborn’s mother and safe feeding practices defined as prepare, position, and place. From behavioral determinants and the Behaviour Change Wheel, the behavior change functions selected to achieve these target behaviors were psychological capability, social opportunity, and reflective motivation. The selected behavior change techniques aligned with these functions were providing information on health consequences, using a credible source, instruction on performing each behavior, and social support. The defined intervention was implemented in a draft Android app. In phase 2, 4 rounds of user testing were required to achieve the predefined target comprehension level. The results from the think-aloud interviews were used to refine the intervention content and app features. Overall, the results from phase 2 revealed that users found the information provided to be helpful. Features such as self-tracking and inclusion of the social and environmental aspects of falls prevention were liked by the participants. Important feedback for the successful implementation of the digital intervention was also obtained from the user testing. o our knowledge, this is the first study to apply the Behaviour Change Wheel to develop a digital intervention for child injury prevention. This study provides a detailed ex le of evidence-based development of a behavior theory–informed mobile intervention for injury prevention refined using the person-based approach.
First trimester screening of serum soluble fms-like tyrosine kinase-1 and placental growth factor predicting hypertensive disorders of pregnancy
Publisher: Elsevier BV
Date: 10-2013
DOI: 10.1016/J.PREGHY.2013.04.119
Abstract: To assess the accuracy of first trimester soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) in predicting pregnancy hypertension and pre-ecl sia and compare with the accuracy of routinely collected maternal and clinical risk factors. In this population-based cohort study, serum sFlt-1 and PlGF levels were measured in first trimester in 2,681 women with singleton pregnancies in New South Wales, Australia. Prediction of pregnancy hypertension and pre-ecl sia. There were 213 (7.9%) women with pregnancy hypertension, including 68 (2.5%) with pre-ecl sia. The area under the curve (AUC) for both sFlt-1 and PlGF was not different from chance, but combined was 0.55 (P=0.005). Parity and previous diagnosed hypertension had better predictive accuracy than serum biomarkers (AUC=0.64, P<0.001) and the predictive accuracy for all maternal and clinical information was fair (AUC=0.70, P<0.001 for pregnancy hypertension and AUC=0.74, P<0.001 for pre-ecl sia). Adding sFlt-1 and PlGF to maternal risk factors did not improve the ability of the models to predict pregnancy hypertension or pre-ecl sia. Maternal first trimester serum concentrations of sFlt-1 and PlGF do not predict hypertensive disorders in pregnancy any better than routinely collected clinical and maternal risk factor information. Screening for sFlt-1 and PlGF levels in early pregnancy would not identify those pregnancies at-risk.
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.
Age at Surgery and Outcomes of an Undescended Testis
Publisher: American Academy of Pediatrics (AAP)
Date: 02-2016
Abstract: Undescended testis (UDT) is the most common genital anomaly in boys. Current guidelines recommend surgery before 12 months of age to maximize fertility and potentially reduce the risk of future malignancy. We investigated the prevalence of UDT and examined rates of surgery and age at surgery in an Australian population. UDT was identified from all live-born infants in New South Wales, Australia, from 2001 to 2011 using routinely collected record-linked birth and hospital data. The prevalence of UDT, surgery rates, age at surgery, postsurgical outcomes, and risk factors for surgery performed later than the recommended age were evaluated. There were 10 875 (2.1%) boys with a recorded diagnosis of UDT. Corrective surgery was performed in 4980 (45.8%), representing a cumulative prevalence of 9.6 per 1000 male births. Five percent of surgeries were orchidectomies, and 9% of boys had revision surgery. Median age at surgery was 16.6 months (interquartile range 11.8 to 31.0 months), decreasing from 21 months for boys born in 2001 to 13 months for boys born in 2010. Among those boys having surgery before 36 months (n = 3897), 67% had corrective surgery after the recommended 12 months of age socioeconomic disadvantage, regional/remote area of residence, and lack of private health insurance were risk factors for having corrective surgery after 12 months. One in 50 boys born are diagnosed with UDT two-thirds had no report of corrective surgery. The age at surgery is decreasing however, two-thirds of surgeries are performed after 12 months of age.
Accidental pharmacological poisonings in young children: population-based study in three settings
Publisher: Informa UK Limited
Date: 15-01-2018
DOI: 10.1080/15563650.2017.1422509
Abstract: Pharmacological poisonings in young children are avoidable. Previous studies report calls to poisons centres, presentations to emergency departments (ED) or hospital admissions. There are limited data assessing concurrent management of poisonings across all three settings. We aimed to describe accidental pharmacological poisonings in young children across our Poisons Information Centre (PIC), EDs and hospitals. A population-based study in New South Wales, Australia, of PIC calls, ED presentations and hospital admissions for accidental pharmacological poisoning in children aged <5 years, 2007-2013. We examined trends, medicines responsible and subsequent management. Medicines were coded using ICD10-AM diagnosis codes (T36-50). Over 2007-2013, pharmacological poisonings accounted for 67,816 PIC calls, 7739 ED presentations and 2082 admissions. Rates (per 10,000 children) of PIC calls declined from 220 to 178 ED presentations were stable (∼22-24), with a decrease in emergency cases offset by an increase in semi- or non-urgent presentations hospital admissions declined (8-5). Most PIC calls related to "non-opioid analgesics" (25%), and "topical agents" (18%). Nearly every day, one child aged <5 years was admitted to hospital for poisoning. "Benzodiazepines", "other and unspecified antidepressants", "uncategorised antihypertensives", and "4-aminophenol derivatives" accounted for over one-third of all admissions. Most PIC calls (90%) were advised to stay home, 6% referred to hospital. One-quarter of ED presentations resulted in admission. Poisonings reported to PIC and hospitals declined, however, non-urgent ED presentations increased. Strategies to reduce therapeutic errors and access to medicines, and education c aigns to improve Poisons Centre call rates to prevent unnecessary ED presentations are needed.
Trends in the Diagnosis of Rett Syndrome in Australia
Publisher: Springer Science and Business Media LLC
Date: 09-2011
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.
Association and Predictive Accuracy of High TSH Serum Levels in First Trimester and Adverse Pregnancy Outcomes
Publisher: The Endocrine Society
Date: 09-2012
DOI: 10.1210/JC.2012-1193
Abstract: High serum levels of TSH have been associated with adverse pregnancy outcomes by some studies, and not by others. The aim of the study was to assess the association between high levels of TSH in the first trimester of pregnancy and adverse pregnancy outcomes and to examine the predictive accuracy as a screening test. Serum levels of TSH were measured in a cohort of 2801 women with a singleton pregnancy attending first trimester Down syndrome screening. Information on maternal and infant outcomes was obtained through record linkage to population-based birth and hospital data. Association between high TSH (>95th and >97.5th centiles) multiple of the median levels, and risk of adverse pregnancy outcomes was evaluated using multivariable logistic regression, and the predictive accuracy of models was assessed. Rates of infants being small for gestational age (SGA), preterm birth, preecl sia, miscarriage, and stillbirth were investigated. High TSH multiple of the median levels were associated with SGA (<10th centile) [adjusted odds ratio (aOR), 1.71 95% confidence interval (CI), 0.99-2.94] preterm birth at less than 37 wk gestation (aOR, 2.59 95% CI, 1.21-5.53) miscarriage (aOR, 3.66 95% CI, 1.59-8.44) and a composite measure of any study outcome (aOR, 2.10 95% CI, 1.23-3.59). The area under the receiver operator characteristic curves were 0.69 (95% CI, 0.65-0.73) for SGA 0.56 (95% CI, 0.51-0.61) for preterm birth 0.70 (95% CI, 0.61-0.79) for miscarriage and 0.63 (95% CI, 0.60-0.65) for any adverse pregnancy outcome. High TSH serum levels during the first trimester of pregnancy were associated with adverse pregnancy outcomes however, the predictive accuracy was poor. Screening for high TSH levels in the first trimester would be of no benefit to identify women at risk.
Prescribed medicine use and extent of off‐label use according to age in a nationwide sample of Australian children
Publisher: Wiley
Date: 16-02-2022
DOI: 10.1111/PPE.12870
Abstract: Medicine prescribing for children is impacted by a lack of paediatric‐specific dosing, efficacy and safety data for many medicines. To estimate the prevalence of medicine use among children and the rate of ‘off‐label’ prescribing according to age at dispensing. We used population‐wide primarily outpatient dispensing claims data for 15% of Australian children (0–17 years), 2013–2017 ( n = 840,190). We estimated prescribed medicine use and ‘off‐label’ medicine use according to the child's age ( year, 1–5 years, 6–11 years, 12–17 years) defined as medicines without age‐appropriate dose recommendations in regulator‐approved product information. Within off‐label medicines, we also identified medicines with and without age‐specific dose recommendations in a national prescribing guide, the Australian Medicines Handbook Children's Dosing Companion (AMH CDC). The overall dispensing rate was 2.0 dispensings per child per year. The medicines with the highest average yearly prevalence were systemic antibiotics (435.3 per 1000 children), greatest in children 1–5 years (546.9 per 1000). Other common medicine classes were systemic corticosteroids (92.7 per 1000), respiratory medicines (91.2 per 1000), acid‐suppressing medicines in children year (47.2 per 1000), antidepressants in children 12–17 years (40.3 per 1000) and psychostimulants in children 6–11 years (27.0 per 1000). We identified 12.2% of dispensings as off‐label based on age, but 66.3% of these had age‐specific dosing recommendations in the AMH CDC. Among children year, off‐label dispensings were commonly acid‐suppressing medicines (35.5%) and topical hydrocortisone (33.1%) in children 6–11 years, off‐label prescribing of clonidine (16.0%) and risperidone (13.1%) was common. Off‐label dispensings were more likely to be prescribed by a specialist (21.7%) than on‐label dispensings (7.5%). Prescribed medicine use is common in children, with off‐label dispensings for medicines without paediatric‐specific dosing guidelines concentrated in classes such as acid‐suppressing medicines and psychotropics. Our findings highlight a need for better evidence to support best‐practice prescribing.
Comparing a Mobile Phone Automated System With a Paper and Email Data Collection System: Substudy Within a Randomized Controlled Trial (Preprint)
Publisher: JMIR Publications Inc.
Date: 28-06-2019
Abstract: raditional data collection methods using paper and email are increasingly being replaced by data collection using mobile phones, although there is limited evidence evaluating the impact of mobile phone technology as part of an automated research management system on data collection and health outcomes. he aim of this study is to compare a web-based mobile phone automated system (MPAS) with a more traditional delivery and data collection system combining paper and email data collection (PEDC) in a cohort of breastfeeding women. e conducted a substudy of a randomized controlled trial in Sydney, Australia, which included women with uncomplicated term births who intended to breastfeed. Women were recruited within 72 hours of giving birth. A quasi-randomized number of women were recruited using the PEDC system, and the remainder were recruited using the MPAS. The outcomes assessed included the effectiveness of data collection, impact on study outcomes, response rate, acceptability, and cost analysis between the MPAS and PEDC methods. omen were recruited between April 2015 and December 2016. The analysis included 555 women: 471 using the MPAS and 84 using the PEDC. There were no differences in clinical outcomes between the 2 groups. At the end of the 8-week treatment phase, the MPAS group showed an increased response rate compared with the PEDC group (56% vs 37% i P /i & .001), which was also seen at the 2-, 6-, and 12-month follow-ups. At the 2-month follow-up, the MPAS participants also showed an increased rate of self-reported treatment compliance (70% vs 56% i P /i & .001) and a higher recommendation rate for future use (95% vs 64% i P /i & .001) as compared with the PEDC group. The cost analysis between the 2 groups was comparable. PAS is an effective and acceptable method for improving the overall management, treatment compliance, and methodological quality of clinical research to ensure the validity and reliability of findings.
Trends in pre‐existing mental health disorders among parents of infants born in Western Australia from 1990 to 2005
Publisher: AMPCo
Date: 05-2013
DOI: 10.5694/MJA12.11783
Abstract: To determine the prevalence of prior and current mental health disorders in parents, including trends over time. retrospective population cohort study using de-identified linked health data. Population of Western Australia. All parents of infants born in WA between 1990 and 2005. Prevalence of prior mental health disorders in parents by birth 2013 and by parent and child characteristics, including Aboriginality, maternal age, socioeconomic status and diagnostic groups. From 1990 to 2005, there was an increase in prevalence of prior mental health disorders in mothers, from 76 per 1000 births in 1990 to 131 per 1000 births in 2005 (3.7% increase per 2013 in the odds of children being born to mothers with a prior mental health disorder). There was also a 4.7% increase in odds per 2013 in the prevalence of mental health contacts that had taken place in the 12 months before the birth 2013 in mothers. In addition, there was an increase in prevalence of prior mental health disorders in fathers, from 56 per 1000 births in 1990 to 88 per 1000 births in 2005 (3.1% increase in odds per 2013). The diagnostic group with the highest prevalence in both mothers and fathers was substance-related disorders. From 1990 to 2005, there was an increase in prevalence of parents with a prior history of mental health disorders in WA. General practitioners and mental health workers can play an important role in identifying mental illness and in working with families to offer early intervention, referral and support.
Creating Change for Sustainability in Universities in Australia, One System at a Time
Publisher: Springer International Publishing
Date: 11-11-2016
Pharmacological management of anaemia in pregnancy: a review
Publisher: Wiley
Date: 06-2020
DOI: 10.1002/JPPR.1648
Evaluation of first trimester serum soluble endothelial cell-specific tyrosine kinase receptor in normal and affected pregnancies
Publisher: Informa UK Limited
Date: 13-10-2014
DOI: 10.3109/14767058.2014.969233
Abstract: To assess soluble endothelial cell-specific tyrosine kinase receptor (sTie-2) levels in the first trimester of pregnancy and its association with adverse pregnancy outcomes and examine the predictive accuracy. In this nested case-control study, serum sTie-2 levels were measured in 2616 women with singleton pregnancies attending first trimester screening in New South Wales, Australia. Multivariate logistic regression models were used to assess the association and predictive accuracy of serum sTie-2 with subsequent adverse pregnancy outcomes. Median (interquartile range) sTie-2 for the total population was 19.6 ng/ml (13.6-26.4). Maternal age, weight, and smoking status significantly affected sTie-2 levels. There was no difference in serum sTie-2 between unaffected and women with adverse pregnancy outcomes. After adjusting for maternal and clinical risk factors, low sTie-2 (<25th centile) was associated with preecl sia (Adjusted odds ratio: 1.61 95% CI: 1.01-2.57), however, the accuracy of sTie-2 in predicting preecl sia was not different from chance (AUC = 0.54 p = 0.08) and does not add valuable predictive information to maternal and clinical risk factors. Our findings suggest that low sTie-2 levels are associated with preecl sia, however, it does not add valuable information to clinical and maternal risk factor information in predicting preecl sia or any other adverse pregnancy outcomes.
Traffic emissions are associated with reduced fetal growth in areas of Perth, Western Australia: An application of the AusRoads dispersion model
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1111/J.1753-6405.2011.00760.X
Abstract: This study, in a region with relatively low industrial activity, used a highly specific marker for traffic emissions, accounted for the inherent fetal growth potential, and used complete record linkage of births, midwife notifications, deaths, hospital morbidity and birth defect records. Clinical records were obtained for pregnancies between 2000 and 2006 in three areas of Perth, Western Australia (n=3,501). We used carbon monoxide as a marker for locally derived traffic emissions, and assessed exposure using the AusRoads dispersion model. Fetal growth was characterised by proportion of optimal birth weight and investigated using multivariate mixed-effects regression. Exposure in the third trimester was associated with a -0.49% (sd=0.23%) change in proportion of optimal birth weight per 10 μg/m(3) increase in locally derived traffic emissions. However, this result was confined to one of the three study areas due to elevated exposure misclassification among women in the other two areas. Among this group, a neonate who would have otherwise attained an optimal birth weight of 3.5 kg would be expected to be born 58 g lighter for an interquartile increase in third trimester exposure, which was approximately half of the effect observed for maternal smoking during pregnancy. We observed an association between maternal exposure to traffic emissions and reduced fetal growth. This effect was supported by sensitivity analyses but only observed in one of the three study areas. Further studies are required to corroborate our results.
Developing evidence-based recommendations for optimal interpregnancy intervals in high-income countries: protocol for an international cohort study
Publisher: BMJ
Date: 2019
DOI: 10.1136/BMJOPEN-2018-027941
Abstract: Short interpregnancy interval (IPI) has been linked to adverse pregnancy outcomes. WHO recommends waiting at least 2 years after a live birth and 6 months after miscarriage or induced termination before conception of another pregnancy. The evidence underpinning these recommendations largely relies on data from low/middle-income countries. Furthermore, recent epidemiological investigations have suggested that these studies may overestimate the effects of IPI due to residual confounding. Future investigations of IPI effects in high-income countries drawing from large, population-based data sources are needed to inform IPI recommendations. We aim to assess the impact of IPIs on maternal and child health outcomes in high-income countries. This international longitudinal retrospective cohort study will include more than 18 million pregnancies, making it the largest study to investigate IPI in high-income countries. Population-based data from Australia, Finland, Norway and USA will be used. Birth records in each country will be used to identify consecutive pregnancies. Exact dates of birth and clinical best estimates of gestational length will be used to estimate IPI. Administrative birth and health data sources with % coverage in each country will be used to identify maternal sociodemographics, pregnancy complications, details of labour and delivery, birth and child health information. We will use matched and unmatched regression models to investigate the impact of IPI on maternal and infant outcomes, and conduct meta-analysis to pool results across countries. Ethics boards at participating sites approved this research (approval was not required in Finland). Findings will be published in peer-reviewed journals and presented at international conferences, and will inform recommendations for optimal IPI in high-income countries. Findings will provide important information for women and families planning future pregnancies and for clinicians providing prenatal care and giving guidance on family planning.
Seasonal variation in fetal growth: accounting for sociodemographic, biological, and environmental exposures
Publisher: Elsevier BV
Date: 2012
DOI: 10.1016/J.AJOG.2011.07.038
Abstract: We sought to investigate seasonal variation in fetal growth, accounting for important sociodemographic, biological, and environmental exposures. Records of births 1998 through 2006 in Perth, Western Australia were obtained (N = 147,357). We investigated small for gestational age and sex and the proportion of optimal birthweight (POBW) in relation to seasonal exposures (season, temperature, sunlight) by trimester of pregnancy. Adjustment was made for a wide range of risk factors. The POBW for neonates with third trimesters predominantly in summer was 0.18% (0.00-0.36%) lower than for those in winter. POBW decreased by 0.14% (0.01-0.27%) per interquartile range increase in third-trimester temperature (9.15°C). An interquartile range increase in temperature over pregnancy (0.73°C) was associated with an odds ratio of 1.02 (95% confidence interval, 1.00-1.05) for small for gestational age and sex. Reduced fetal growth was associated with elevated ambient temperatures throughout and late in pregnancy, independently of air pollution and other risk factors.
How are we assessing the safety and quality use of medicines used by young people in Australia?
Publisher: Wiley
Date: 10-05-2017
DOI: 10.1111/JPC.13567
Maternal car driving capacity after birth: a pilot prospective study randomizing postnatal women to early verses late driving in a driving simulator
Publisher: Informa UK Limited
Date: 25-09-2018
Unpacking the complex nature of the autism epidemic
Publisher: Elsevier BV
Date: 10-2010
Monitoring child abuse and neglect at a population level: Patterns of hospital admissions for maltreatment and assault
Publisher: Elsevier BV
Date: 11-2010
DOI: 10.1016/J.CHIABU.2010.04.003
Abstract: To investigate the prevalence, trends, and characteristics of maltreatment and assault related hospital admissions and deaths among children and identify common injuries and conditions associated with these admissions using routinely collected morbidity and mortality data. A retrospective cohort study of all children aged 0-17 years in Western Australia from 1980 to 2005 was identified from linked de-identified population level data. Annual trends in prevalence of assault and maltreatment related admissions were calculated and child characteristics were investigated using logistic regression models. Assault admissions more than doubled from 2.8 per 10,000 children in 1981 to 6.1 per 10,000 in 2005 (p<0.0001) and maltreatment admissions rose from 0.7 per 10,000 children in 1981 to 1.3 per 10,000 in 2005 (p<0.0001). Males aged greater than 12 years were at greater risk of an assault, while children aged less than 6 years were more likely to be at risk of maltreatment as well as those from greater disadvantaged backgrounds. Aboriginal children were more likely to be identified with assault and maltreatment compared to non-Aboriginal children. Common indicators of assault admissions included injuries of the skull and facial bones, intracranial, wrist, hand, and abdominal injuries. Children with maltreatment-related admissions were more likely to have superficial head or abdominal injuries and a high proportion had infectious and parasitic diseases, particularly intestinal infections. Many of these cases were associated with factors influencing health status, particularly socioeconomic and psychosocial circumstances. There has been a steady increase in the prevalence of assault and maltreatment related admissions. Specific child characteristics and injuries associated with child assault and maltreatment-related admissions have been identified using routinely collected morbidity data and may be utilized as potential indicators for identifying and monitoring child abuse and neglect. Broadening child maltreatment surveillance to children's admissions for assault and maltreatment is an important public health initiative which can be improved by the increased use of external cause codes. Health data is collected using international coding standards enhancing comparability across states and countries and has clinical implications in highlighting injuries associated with child abuse and neglect.
The burden of hospitalized sports-related injuries in children: an Australian population-based study, 2005–2013
Publisher: Springer Science and Business Media LLC
Date: 12-2018
Gestation at birth, mode of birth, infant feeding and childhood hospitalization with infection
Publisher: Wiley
Date: 29-05-2018
DOI: 10.1111/AOGS.13371
Abstract: Infections are a leading cause of mortality and morbidity in preschool children. We aimed to assess the impact of the co-occurrence of cesarean section, early birth and formula feeding on hospitalization with infection in early childhood. Population-based retrospective record-linkage cohort study of 488 603 singleton livebirths ≥32 weeks' gestational age in New South Wales, Australia, 2007-2012. Multivariable Cox-regression was used to estimate independent and combined adjusted associations of gestational age, mode of birth (vaginal or cesarean section by labor onset) and formula feeding with time to first and repeat hospitalization with infection for children less than five years of age. In all, 95 346 (19.5%) children were hospitalized with infection, and of these 24.8% (23 615) more than once. Median age at first and repeat hospitalization was 1.1 and 1.7 years, respectively. Earlier gestation, modes of birth other than spontaneous vaginal, and formula feeding were independently associated with an increased risk of first and repeat hospitalization with infection. At 32-36 weeks' gestation, co-occurrence of perinatal factors (cf. spontaneous vaginal birth at 39+ weeks without formula feeding) was associated with a 2-fold and 1.5-fold increased risk of first and repeat hospitalization, respectively. For births at 37-38 weeks, the increased risk was 1.5-fold and 1.25-fold for first and repeat hospitalization, respectively. Cesarean section, labor induction, birth at <39 weeks and formula feeding increase the risk of infection-related hospitalization in childhood, which increases further when these factors co-occur. Reducing early planned birth and supporting breastfeeding are potentially cost-effective approaches to reducing the risk of hospitalization.
Angiopoietin 1 and 2 serum concentrations in first trimester of pregnancy as biomarkers of adverse pregnancy outcomes
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.AJOG.2013.11.012
Abstract: To assess angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), and the Ang-1/Ang-2 ratio levels in the first trimester of pregnancy, their association with adverse pregnancy outcomes, and their predictive accuracy. This cohort study measured serum Ang-1 and Ang-2 levels in 4785 women with singleton pregnancies attending first trimester screening in New South Wales, Australia. Multivariate logistic regression models were used to assess the association and predictive accuracy of serum biomarkers with subsequent adverse pregnancy outcomes (small for gestational age, preterm birth, preecl sia, miscarriage >10 weeks, and stillbirth). Median (interquartile range) levels for Ang-1, Ang-2, and the Ang-1/Ang-2 ratio for the total population were 19.6 ng/mL (13.6-26.4), 15.5 ng/mL (10.3-22.7), and 1.21 (0.83-1.73), respectively. Maternal age, weight, country of birth, and socioeconomic status significantly affected Ang-1, Ang-2, and the Ang-1/Ang-2 ratio levels. After adjusting for maternal and clinical risk factors, women with low Ang-2 levels ( 90th percentile) had increased risk of developing most adverse pregnancy outcomes. Compared with the Ang-1/Ang-2 ratio alone, maternal and clinical risk factors had better predictive accuracy for most adverse pregnancy outcomes. The exception was miscarriage (Ang-1/Ang-2 ratio area under receiver operating characteristic curve = 0.70 maternal risk factors = 0.58). Overall, adding the Ang-1/Ang-2 ratio to maternal risk factors did not improve the ability of the models to predict adverse pregnancy outcomes. Our findings suggest that the Ang-1/Ang-2 ratio in first trimester is associated with most adverse pregnancy outcomes, but do not predict outcomes any better than clinical and maternal risk factor information.
Personal reflections. Part 91
Publisher: Walter de Gruyter GmbH
Date: 07-2002
Risk of stillbirth, preterm delivery, and fetal growth restriction following exposure in a previous birth: systematic review and meta‐analysis
Publisher: Wiley
Date: 03-10-2017
Abstract: Little is known about the risk of non-recurrent adverse birth outcomes. To evaluate the risk of stillbirth, preterm birth (PTB), and small for gestational age (SGA) as a proxy for fetal growth restriction (FGR) following exposure to one or more of these factors in a previous birth. We searched MEDLINE, EMBASE, Maternity and Infant Care, and Global Health from inception to 30 November 2016. Studies were included if they investigated the association between stillbirth, PTB, or SGA (as a proxy for FGR) in two subsequent births. Meta-analysis and pooled association presented as odds ratios (ORs) and adjusted odds ratios (aORs). Of the 3399 studies identified, 17 met the inclusion criteria. A PTB or SGA (as a proxy for FGR) infant increased the risk of subsequent stillbirth ((pooled OR 1.70 95% confidence interval, 95% CI, 1.34-2.16) and (pooled OR 1.98 95% CI 1.70-2.31), respectively). A combination of exposures, such as a preterm SGA (as a proxy for FGR) birth, doubled the risk of subsequent stillbirth (pooled OR 4.47 95% CI 2.58-7.76). The risk of stillbirth also varied with prematurity, increasing three-fold following PTB <34 weeks of gestation (pooled OR 2.98 95% CI 2.05-4.34) and six-fold following preterm SGA (as a proxy for FGR) <34 weeks of gestation (pooled OR 6.00 95% CI 3.43-10.49). A previous stillbirth increased the risk of PTB (pooled OR 2.82 95% CI 2.31-3.45), and subsequent SGA (as a proxy for FGR) (pooled OR 1.39 95% CI 1.10-1.76). The risk of stillbirth, PTB, or SGA (as a proxy for FGR) was moderately elevated in women who previously experienced a single exposure, but increased between two- and three-fold when two prior adverse outcomes were combined. Clinical guidelines should consider the inter-relationship of stillbirth, PTB, and SGA, and that each condition is an independent risk factor for the other conditions. Risk of adverse birth outcomes in next pregnancy increases with the combined number of previous adverse events. Why and how was the study carried out? Each year, around 2.6 million babies are stillborn, 15 million are born preterm (<37 weeks of gestation), and 32 million are born small for gestational age (less than tenth percentile for weight, smaller than usually expected for the relevant pregnancy stage). Being born preterm or small for gestational age can increase the chance of long-term health problems. The effect of having a stillbirth, preterm birth, or small-for-gestational-age infant in a previous pregnancy on future pregnancy health has not been summarised. We identified 3399 studies of outcomes of previous pregnancies, and 17 were summarised by our study. What were the main findings? The outcome of the previous pregnancy influenced the risk of poor outcomes in the next pregnancy. Babies born to mothers who had a previous preterm birth or small-for-gestational-age birth were more likely to be stillborn. The smaller and the more preterm the previous baby, the higher the risk of stillbirth in the following pregnancy. The risk of stillbirth in the following pregnancy was doubled if the previous baby was born both preterm and small for gestational age. Babies born to mothers who had a previous stillbirth were more likely to be preterm or small for gestational age. What are the limitations of the work? We included a small number of studies, as there are not enough studies in this area (adverse birth outcomes followed by adverse cross outcomes in the next pregnancy). We found very few studies that compared the risk of small for gestational age after preterm birth or stillbirth. Definitions of stillbirth, preterm birth categories, and small for gestational age differed across studies. We did not know the cause of stillbirth for most studies. What are the implications for patients? Women who have a history of poor pregnancy outcomes are at greater risk of poor outcomes in following pregnancies. Health providers should be aware of this risk when treating patients with a history of poor pregnancy outcomes.
Risk of Stillbirth, Preterm Delivery, and Fetal Growth Restriction Following Exposure in a Previous Birth: Systematic Review and Meta-analysis
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2018
Neonatal Morbidity at Term, Early Child Development, and School Performance: A Population Study
Publisher: American Academy of Pediatrics (AAP)
Date: 02-2018
Abstract: Investigate the association between severe neonatal morbidity (SNM) and child development and school performance among term infants. The study population included term infants without major congenital conditions born between 2000 and 2007 in New South Wales, Australia, with a linked record of developmental assessment at ages 4 to 6 years in 2009 or 2012 (n = 144 535) or school performance at ages 7 to 9 years from 2009 to 2014 (n = 253 447). Developmental outcomes included special needs or being vulnerable and/or at risk in 1 of 5 developmental domains. School performance outcomes were test exemption, or performing & −1 SD on reading or numeracy tests. Binary generalized estimating equations were used to estimate associations between SNM and outcomes, adjusting for sociodemographic, perinatal, and assessment and/or test characteristics. Overall, 2.1% of infants experienced SNM. The adjusted odds ratio (95% confidence interval) for SNM and physical health was 1.18 (1.08–1.29), 1.14 (1.02–1.26) for language and cognitive skills, and 1.14 (1.06–1.24) and 1.13 (1.05–1.21) for scoring & −1 SD in reading and numeracy, respectively. SNM was most strongly associated with special needs 1.34 (1.15–1.55) and test exemption 1.50 (1.25–1.81). SNM infants born at 37 to 38 weeks’ gestation and who were small for gestational age had the greatest likelihood of poorer outcomes. Term infants with SNM have greater odds of poor neurodevelopment in childhood. These findings provide population-based information for families and can inform clinical counseling and guidelines for follow-up and early intervention.
Acid suppressants for managing gastro-oesophageal reflux and gastro-oesophageal reflux disease in infants: a national survey
Publisher: BMJ
Date: 22-02-2018
DOI: 10.1136/ARCHDISCHILD-2017-314161
Abstract: To evaluate the diagnosis and management of reflux and gastro-oesophageal reflux disease (GORD) in infants aged <1 year presenting to general practitioners (GPs). A nationally representative, prospective, cross-sectional survey of GP activity in Australia, 2006-2016 (Bettering the Evaluation And Care of Health Study). Annually, a random s le of around 1000 GPs recorded details for 100 consecutive visits with consenting, unidentified patients. Diagnoses of reflux and GORD and their management including prescribing of acid-suppressant medicines (proton pump inhibitors (PPIs) and histamine receptor antagonists (H2RAs)) and counselling, advice or education. Of all infants' visits, 512 (2.7%) included a diagnosis of reflux (n=413, 2.2%) or GORD (n=99, 0.5%). From 2006 to 2016, diagnostic rates decreased for reflux and increased for GORD. Prescribing of acid suppressants occurred in 43.6% visits for reflux and 48.5% visits for GORD, similar to rates of counselling, advice or education (reflux: 38.5%, GORD: 43.4% of visits). Prescribing of PPIs increased (statistically significant only for visits for reflux), while prescribing of H2RAs decreased. Overprescribing of acid suppressants to infants may be occurring. In infants, acid-suppressant medicines are no better than placebo and may have significant negative side effects however, guidelines are inconsistent. Clear, concise and consistent guidance is needed. GPs and parents need to understand what is normal and limitations of medical therapy. We need a greater understanding of the influences on GP prescribing practices, of parents' knowledge and attitudes and of the pressures on parents of infants with these conditions.
Regan et al. Reply to Sibling Comparison Design in Birth-Spacing Studies
Publisher: Oxford University Press (OUP)
Date: 05-09-2019
DOI: 10.1093/AJE/KWY187
A Population-Based Matched-Sibling Analysis Estimating the Associations Between First Interpregnancy Interval and Birth Outcomes
Publisher: Oxford University Press (OUP)
Date: 05-09-2019
DOI: 10.1093/AJE/KWY188
Locally derived traffic-related air pollution and fetal growth restriction: A retrospective cohort study
Publisher: BMJ
Date: 31-07-2012
DOI: 10.1136/OEMED-2011-100509
Abstract: Fetal growth restriction has been inconsistently associated with maternal exposure to elevated levels of traffic-related air pollution. We investigated the relationship between an in idualised measure of fetal growth and maternal exposure to a specific marker for traffic-related air pollution. We estimated maternal residential exposure to a marker for traffic-related air pollution (nitrogen dioxide, NO2) during pregnancy for 23,452 births using temporally adjusted land-use regression. Logistic regression was used to investigate associations with small for gestational age and sex (SGA) and fetal growth restriction, defined as proportion of optimal birth weight (POBW) below the 10th percentile. Sub-populations investigated were: women who spent most time at home, women who did not move house, women with respiratory or circulatory morbidity, women living in low/middle/high socio-economic areas, women who delivered before 37 weeks gestation, and women who delivered from 37 weeks gestation. An IQR increase in traffic-related air pollution in the second trimester across all women was associated with an OR of 1.31 (95% CI 1.07 to 1.60) for fetal growth restriction. Effects on fetal growth restriction (low POBW) were highest among women who subsequently delivered before 37 weeks of gestation. Effects on SGA were highest among women who did not move house: OR 1.35 (95% CI 1.08 to 1.69). Larger effect sizes were observed for low POBW than for SGA. Exposure to traffic-related air pollution in mid to late pregnancy was associated with risk of SGA and low POBW in this study.
Maternal and neonatal outcomes of women with gestational diabetes and without specific medical conditions: an Australian population‐based study comparing induction of labor with expectant management
Publisher: Wiley
Date: 28-03-2022
DOI: 10.1111/AJO.13505
Abstract: To evaluate maternal birth and neonatal outcomes among women with gestational diabetes mellitus (GDM), but without specific medical conditions and eligible for vaginal birth who underwent induction of labour (IOL) at term compared with those who were expectantly managed. Population‐based cohort study of women with GDM, but without medical conditions, who had a singleton, cephalic birth at 38–41 completed weeks gestation, in New South Wales, Australia between January 2010 and December 2016. Women who underwent IOL at 38, 39, 40 weeks gestation (38‐, 39‐, 40‐induction groups) were compared with those who were managed expectantly and gave birth at and/or beyond the respective gestational age group (38‐, 39‐, 40‐expectant groups). Multivariable logistic regression analysis was used to assess the association between IOL and adverse maternal birth and neonatal outcomes taking into account potential confounding by maternal age, country of birth, smoking, residential location, residential area of socioeconomic disadvantage and birth year. Of 676 762 women who gave birth during the study period, 66 606 (10%) had GDM of these, 34799 met the inclusion criteria. Compared with expectant management, those in 38‐ (adjusted odds ratio (aOR) 1.11 95% CI, 1.04–1.18), 39‐ (aOR 1.21 95% CI, 1.14–1.28) and 40‐ (aOR 1.50 95% CI, 1.40–1.60) induction groups had increased risk of caesarean section. Women in the 38‐induction group also had an increased risk of composite neonatal morbidity (aOR 1.10 95% CI, 1.01–1.21), which was not observed at 39‐ and 40‐induction groups. We found no difference between groups in perinatal death or neonatal intensive care unit admission for births at any gestational age. In women with GDM but without specific medical conditions and eligible for vaginal birth, IOL at 38, 39, 40 weeks gestation is associated with an increased risk of caesarean section.
Association between pre-eclampsia and locally derived traffic-related air pollution: A retrospective cohort study
Publisher: BMJ
Date: 09-08-2012
Abstract: Pre-ecl sia is a common complication of pregnancy and is a major cause of fetal-maternal mortality and morbidity. Despite a number of plausible mechanisms by which air pollutants might contribute to this process, few studies have investigated the association between pre-ecl sia and traffic emissions, a major contributor to air pollution in urban areas. The authors investigated the association between traffic-related air pollution and risk of pre-ecl sia in a maternal population in the urban centre of Perth, Western Australia. The authors estimated maternal residential exposure to a marker for traffic-related air pollution (nitrogen dioxide, NO(2)) during pregnancy for 23 452 births using temporally adjusted land-use regression. Logistic regression was used to investigate associations with pre-ecl sia. Each IQR increase in levels of traffic-related air pollution in whole pregnancy and third trimester was associated with a 12% (1%-25%) and 30% (7%-58%) increased risk of pre-ecl sia, respectively. The largest effect sizes were observed for women aged younger than 20 years or 40 years or older, aboriginal women and women with pre-existing and gestational diabetes, for whom an IQR increase in traffic-related air pollution in whole pregnancy was associated with a 34% (5%-72%), 35% (0%-82%) and 53% (7%-219%) increase in risk of pre-ecl sia, respectively. Elevated exposure to traffic-related air pollution in pregnancy was associated with increased risk of pre-ecl sia. Effect sizes were highest for elevated exposures in third trimester and among younger and older women, aboriginal women and women with diabetes.
Rapid increase in intravenous iron therapy for women of reproductive age in Australia
Publisher: AMPCo
Date: 26-05-2020
DOI: 10.5694/MJA2.50618
Autism and Intellectual Disability Are Differentially Related to Sociodemographic Background at Birth
Publisher: Public Library of Science (PLoS)
Date: 30-03-2011
Prenatal Alcohol Exposure and Risk of Birth Defects
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2011
Outcomes of medically retrieved infants with bronchiolitis in high-income countries: A scoping review
Publisher: Elsevier BV
Date: 09-2023
Rapid increase in intravenous iron therapy for women of reproductive age in Australia
Publisher: AMPCo
Date: 13-03-2021
DOI: 10.5694/MJA2.50979
Inequality in early childhood chronic health conditions requiring hospitalisation: A data linkage study of health service utilisation and costs
Publisher: Wiley
Date: 22-11-2022
DOI: 10.1111/PPE.12818
Abstract: The cost of socioeconomic inequality in health service use among Australian children with chronic health conditions is poorly understood. To quantify the cost of socioeconomic inequality in health service use among Australian children with chronic health conditions. Cohort study using a whole‐of‐population linked administrative data for all births in Queensland, Australia, between July 2015 and July 2018. Socioeconomic status was defined by an areas‐based measure, grouping children into quintiles from most disadvantaged (Q1) to least disadvantaged (Q5) based on their postcode at birth. Study outcomes included health service utilisation (inpatient, emergency department, outpatient, general practitioner, specialist, pathology and diagnostic imaging services) and healthcare costs. Of the 238,600 children included in the analysis, 10.4% had at least one chronic health condition. Children with chronic health conditions in Q1 had higher rates of inpatient (6.6, 95% confidence interval [CI] 6.4, 6.7), emergency department (7.2, 95% CI 7.0, 7.5) and outpatient (20.3, 95% CI 19.4, 21.3) service use compared to children with chronic health conditions in Q5. They also had lower rates of general practitioner (37.5, 95% CI 36.7, 38.4), specialist (8.9, 95% CI 8.5, 9.3), pathology (10.7, 95% CI 10.2, 11.3), and diagnostic imaging (4.3, 95% CI 4.2,4.5) service use. Children with any chronic health condition in Q1 incurred lower median out‐of‐pocket fees than children in Q5 ($0 vs $741, respectively), lower median Medicare funding ($2710, vs $3408, respectively), and higher median public hospital funding ($31, 052 vs $23, 017, respectively). Children of most disadvantage are more likely to access public hospital provided services, which are accessible free of charge to patients. These children are less likely to access general practitioner, specialist, pathology and diagnostic imaging services all of which are critical to the ongoing management of chronic health conditions, but often attract an out‐of‐pocket fee.
Maternal vitamin D status in pregnancy and adverse pregnancy outcomes in a group at high risk for pre‐eclampsia
Publisher: Wiley
Date: 13-10-2010
DOI: 10.1111/J.1471-0528.2010.02742.X
Abstract: To determine in a group of pregnant women if vitamin D status, based on serum 25-hydroxyvitamin D (25OHD) concentration, was associated with a subsequent risk of pre-ecl sia or adverse pregnancy outcomes. Prospective cohort study. Vancouver, British Columbia, Canada (49°N). Women attending a specialist antenatal clinic because of clinical or biochemical risk factors for pre-ecl sia (n = 221). Serum 25OHD concentration measured between 10 and 20 weeks of gestation. Pre-ecl sia and composite adverse pregnancy outcomes. Of the women, 78% were vitamin D insufficient (25OHD <75 nmol/l) and 53% were vitamin D deficient (25OHD <50 nmol/l). There was no difference in the rates of pre-ecl sia, gestational hypertension, preterm birth or composite adverse pregnancy outcomes by 25OHD concentration. Vitamin D deficiency and insufficiency were common in a group of women at high risk of pre-ecl sia however, it was not associated with subsequent risk of an adverse pregnancy outcome.
Increasing Prevalence of Neonatal Withdrawal Syndrome: Population Study of Maternal Factors and Child Protection Involvement
Publisher: American Academy of Pediatrics (AAP)
Date: 04-2009
Abstract: OBJECTIVES. Illicit drug use during pregnancy is an important public health issue, with adverse effects on the newborn and implications for subsequent parenting. The aim of this study was to measure the birth prevalence of neonatal withdrawal syndrome over time, associated maternal characteristics and child protection involvement. METHODS. This is a retrospective cohort study that used linked health and child protection databases for all live births in Western Australia from 1980 to 2005. Maternal characteristics and mental health–and assault-related medical history were assessed by using logistic regression models. RESULTS. The birth prevalence of neonatal withdrawal syndrome increased from 0.97 to a high of 42.2 per 10 000 live births, plateauing after 2002. Mothers with a previous mental health admission, low skill level, Aboriginal status or who smoked during pregnancy were significantly more likely to have an infant with neonatal withdrawal syndrome. These infants were at greater risk for having a substantiated child maltreatment allegation and entering foster care. Increased risk for maltreatment was associated with mothers who were aged & years, were from socially disadvantaged backgrounds, Aboriginal status, and had a mental health–or assault-related admission. CONCLUSIONS. There has been a marked increase in neonatal withdrawal syndrome in the past 25 years. Specific maternal characteristics identified should facilitate planning for early identification and intervention for these women. Findings demonstrate an important pathway into child maltreatment and highlight the need for well-supported programs for women who use illicit drugs during pregnancy as well as the need for sustained long-term support after birth.
Quality of life of children and adolescents with chronic kidney disease: a cross-sectional study
Publisher: BMJ
Date: 17-07-2018
DOI: 10.1136/ARCHDISCHILD-2018-314934
Abstract: The aim was to compare quality of life (QoL) among children and adolescents with different stages of chronic kidney disease (CKD) and determine factors associated with changes in QoL. Cross-sectional. The Kids with CKD study involved five of eight paediatric nephrology units in Australia and New Zealand. There were 375 children and adolescents (aged 6–18 years) with CKD, on dialysis or transplanted, recruited between 2013 and 2016. Overall and domain-specific QoL were measured using the Health Utilities Index 3 score, with a scale from −0.36 (worse than dead) to 1 (perfect health). QoL scores were compared between CKD stages using the Mann-Whitney U test. Factors associated with changes in QoL were assessed using multivariable linear and ordinal logistic regression. QoL for those with CKD stages 1–2 (n=106, median 0.88, IQR 0.63–0.96) was higher than those on dialysis (n=43, median 0.67, IQR 0.39–0.91, p .001), and similar to those with kidney transplants (n=135, median 0.83, IQR 0.59–0.97, p=0.4) or CKD stages 3–5 (n=91, 0.85, IQR 0.60–0.98). Reductions were most frequent in the domains of cognition (50%), pain (42%) and emotion (40%). The risk factors associated with decrements in overall QoL were being on dialysis (decrement of 0.13, 95% CI 0.02 to 0.25, p=0.02), lower family income (decrement of 0.10, 95% CI 0.03 to 0.15, p=0.002) and short stature (decrement of 0.09, 95% CI 0.01 to 0.16, p=0.02). The overall QoL and domains such as pain and emotion are substantially worse in children on dialysis compared with earlier stage CKD and those with kidney transplants.
Research priorities for childhood chronic conditions: a workshop report.
Publisher: BMJ
Date: 02-10-2018
DOI: 10.1136/ARCHDISCHILD-2018-315628
Abstract: Chronic conditions are the leading cause of mortality, morbidity and disability in children. However, children and caregivers are rarely involved in identifying research priorities, which may limit the value of research in supporting patient-centred practice and policy. To identify priorities of patients, caregivers and health professionals for research in childhood chronic conditions and describe the reason for their choices. An Australian paediatric hospital and health consumer organisations. Recruited participants (n=73) included patients aged 8 to 14 years with a chronic condition (n=3), parents/caregivers of children aged 0 to 18 years with a chronic condition (n=19), representatives from consumer organisations (n=13) and health professionals including clinicians, researches (n=38) identified and discussed research priorities. Transcripts were thematically analysed. Seventy-eight research questions were identified. Five themes underpinned participants’ priorities: maintaining a sense of normality (enabling participation in school, supporting social functioning, promoting understanding and acceptance), empowering self-management and partnership in care (overcoming communication barriers, gaining knowledge and skills, motivation for treatment adherence, making informed decisions, access and understanding of complementary and alternative therapies),strengthening ability to cope (learning to have a positive outlook, preparing for home care management, transitioning to adult services), broadening focus to family (supporting sibling well-being, parental resilience and financial loss, alleviating caregiver burden), and improving quality and scope of health and social care (readdressing variability and inequities, preventing disease complications and treatment side effects, identifying risk factors, improving long-term outcomes, harnessing technology, integrating multidisciplinary services). Research priorities identified by children, caregivers and health professionals emphasise a focus on life participation, psychosocial well-being, impact on family and quality of care. These priorities may be used by funding and policy organisations in establishing a paediatric research agenda.
Maternal first trimester serum levels of free-beta human chorionic gonadotrophin and male genital anomalies
Publisher: Oxford University Press (OUP)
Date: 19-06-2016
Abstract: Are maternal first trimester levels of serum free-beta hCG associated with the development of hypospadias or undescended testis (UDT) in boys? Overall, first trimester maternal levels of serum free-beta hCG are not associated with hypospadias or UDT. However, elevated levels were found in severe phenotypes (proximal hypospadias and bilateral UDT) suggesting an altered pathway of hormonal release in early pregnancy. Human chorionic gonadotrophin peaks in first trimester of pregnancy stimulating fetal testosterone production, which is key to normal male genital development. Endocrine-disrupting insults early in pregnancy have been associated with increased risk of common genital anomalies in males such as hypospadias and UDT. One plausible etiological pathway is altered release of hCG. We conducted a record-linkage study of two separate populations of women attending first trimester aneuploidy screening in two Australian states, New South Wales (NSW) and Western Australia (WA), in 2006-2009 and 2001-2003, respectively. Included were women who gave birth to a singleton live born male infant. There were 12 099 boys from NSW and 10 518 from WA included, of whom 90 and 77 had hypospadias and 107 and 109 UDT, respectively. Serum levels of free-beta hCG were ascertained from laboratory databases and combined with relevant birth outcomes and congenital anomalies via record linkage of laboratory, birth, congenital anomalies and hospital data. Median and quartile levels of gestational age specific free-beta hCG multiple of the median (MoM) were compared between affected and unaffected boys. Logistic regression was used to evaluate the association between levels of free-beta hCG MoM and hypospadias or UDT, stratified by suspected placental dysfunction and co-existing anomalies. Where relevant, pooled analysis was conducted. There was no difference in median hCG levels amongst women with an infant with hypospadias (NSW = 0.88 MoM, P = 0.83 WA = 0.84 MoM, P = 0.76) or UDT (NSW = 0.89 MoM, P = 0.54 WA = 0.95 MoM, P = 0.95), compared with women with an unaffected boy (NSW = 0.92 MoM WA = 0.88 MoM). Low ( 75th centile) hCG levels were not associated with hypospadias or UDT, nor when stratifying by suspected placental dysfunction and co-existing anomalies. However, there was a tendency towards high levels for severe types, although confidence intervals were wide. When combining NSW and WA results, high hCG MoM levels (>75th centile) were associated with increased risk of proximal hypospadias (odds ratio (OR) 4.34 95% CI: 1.08-17.4) and bilateral UDT (OR 2.86 95% CI: 1.02-8.03). There were only small numbers of proximal hypospadias and bilateral UDT in both cohorts and although we conducted pooled analyses, results reported on these should be interpreted with caution. Gestational age by ultrasound may have been inaccurately estimated in small and large for gestational age fetuses affecting hCG MoM calculation in those pregnancies. Despite the reliability of our datasets in identifying adverse pregnancy outcomes, we did not have pathology information to confirm tissue lesions in the placenta and therefore our composite outcome should be considered as a proxy for placental dysfunction. This is one of the largest population-based studies examining the association between maternal first trimester serum levels of free-beta hCG and genital anomalies-hypospadias and UDT and the first to compare specific phenotypes by severity. Overall, our findings does not support the hypothesis that alteration in maternal hCG levels is associated with the development of male genital anomalies however, high hCG free-beta levels found in severe types suggest different underlying etiology involving higher production and secretion of hCG. These findings require further exploration and replication. This work was funded by the National Health and Medical Research Council (NHMRC) grant APP1047263. N.N. is supported by a NHMRC Career Development Fellowship APP1067066. C.B. was supported by a NHMRC Principal Research Fellowship #634341. The funding agencies had no role in the design, analysis, interpretation or reporting of the findings. There are no competing interests. Not applicable.
Toward a Behavior Theory–Informed and User-Centered Mobile App for Parents to Prevent Infant Falls: Development and Usability Study
Publisher: JMIR Publications Inc.
Date: 20-12-2021
DOI: 10.2196/29731
Abstract: Falls account for approximately 50% of infant injury hospitalizations, and caretaker behavior is central to preventing infant falls. Behavior theory–informed interventions for injury prevention have been suggested, but to date, few have been reported. The potential of using smartphones for injury prevention intervention delivery is also underexploited. This study aims to develop a behavior theory– and evidence-based as well as user-centered digital intervention as a mobile app for parents to prevent infant falls following agile development practices. Infant falls while feeding was selected as the fall mechanism to demonstrate the approach being taken to develop this intervention. In phase 1, the Behaviour Change Wheel was used as a theoretical framework supported by a literature review to define intervention components that were then implemented as a mobile app. In phase 2, after the person-based approach, user testing through think-aloud interviews and comprehension assessments were used to refine the content and implementation of the intervention. The target behaviors identified in phase 1 were adequate rest for the newborn’s mother and safe feeding practices defined as prepare, position, and place. From behavioral determinants and the Behaviour Change Wheel, the behavior change functions selected to achieve these target behaviors were psychological capability, social opportunity, and reflective motivation. The selected behavior change techniques aligned with these functions were providing information on health consequences, using a credible source, instruction on performing each behavior, and social support. The defined intervention was implemented in a draft Android app. In phase 2, 4 rounds of user testing were required to achieve the predefined target comprehension level. The results from the think-aloud interviews were used to refine the intervention content and app features. Overall, the results from phase 2 revealed that users found the information provided to be helpful. Features such as self-tracking and inclusion of the social and environmental aspects of falls prevention were liked by the participants. Important feedback for the successful implementation of the digital intervention was also obtained from the user testing. To our knowledge, this is the first study to apply the Behaviour Change Wheel to develop a digital intervention for child injury prevention. This study provides a detailed ex le of evidence-based development of a behavior theory–informed mobile intervention for injury prevention refined using the person-based approach.
Association of Gestational Age and Severe Neonatal Morbidity with Mortality in Early Childhood
Publisher: Wiley
Date: 24-10-2016
DOI: 10.1111/PPE.12323
Abstract: Although infant and child mortality rates have decreased substantially worldwide over the past two decades, efforts continue in many nations to further these declines. The identification of pertinent perinatal factors that are associated with early childhood mortality would help with these efforts. We investigated the association of two crucial perinatal factors, gestational age and severe neonatal morbidity at birth, with mortality during infancy (29-364 days) and early childhood (1-5 years). The study population included all singleton livebirths, ≥32 weeks' gestation in New South Wales, Australia in 2001-11. Birth data were linked to hospitalisation morbidity data and deaths data (linked birth cohort n = 871 916), and multivariable Cox regression models were used to assess mortality. The median follow-up time per child was 4.95 years (range 0.00-5.92 years 3 614 738 total person-years), with 984 deaths observed. Gestational age was associated with increased mortality, and specifically from deaths attributable to infections, respiratory conditions, and injuries during infancy, but not during early childhood. Severe neonatal morbidity strongly mediated the effects of gestational age during infancy, but not during early childhood, and was associated with increased mortality from circulatory, nervous, and respiratory system causes. The direct effects of gestational age on mortality extended up to 1 year of age, whereas severe neonatal morbidity remained associated with heightened mortality into early childhood. Efforts to maximise the health and well-being of vulnerable infants, with emphasis on preventing infections and injuries, may help further reduce early childhood mortality.
Relation between Intrauterine Growth and Subsequent Intellectual Disability in a Ten-year Population Cohort of Children in Western Australia
Publisher: Oxford University Press (OUP)
Date: 15-11-2007
DOI: 10.1093/AJE/KWM245
Abstract: The authors investigated the association between intrauterine growth and intellectual disability (ID). The appropriateness of intrauterine growth was assessed using percentage of optimal birth weight, a measure that accounts for gestational age, maternal height, parity, and infant sex. Using population-based record linkage, singleton Caucasian and Aboriginal children born in Western Australia in 1983-1992 and alive in 2002 with ID of unknown cause (n = 2,625) were compared with children without ID (n = 217,252). The odds of ID increased with less-than-optimal intrauterine growth. In Caucasian children, after adjustment for sociodemographic factors, severe growth restriction was associated with development of mild-moderate ID among preterm births ( or =37 weeks) (OR = 2.42, 95% CI: 1.88, 3.12) and with severe ID (OR = 4.79, 95% CI: 2.59, 8.83) among term births. Effects were similar among Aboriginal children. Severe growth restriction (OR = 3.2, 95% CI: 1.3, 7.9) and poor head growth (OR = 3.6, 95% CI: 1.4, 9.0) were independently associated with severe ID. Infants with excess intrauterine growth were more likely to be diagnosed with ID associated with autism spectrum disorder (OR = 2.36, 95% CI: 0.93, 6.03). These findings suggest that inappropriate intrauterine growth, less than or greater than optimal birth weight, is associated with development of ID.
Diet Quality following Total Meal Replacement Compared with Food-Based Weight-Loss Diets in Postmenopausal Women with Obesity: A Secondary Analysis of the TEMPO Diet Trial
Publisher: Elsevier BV
Date: 11-2021
DOI: 10.1093/JN/NXAB311
Abstract: Severely energy-restricted diets that utilize meal-replacement products are the most effective dietary treatment for obesity. However, there are concerns they may fail to educate in iduals on how to adopt a healthy food-based diet after weight loss. The aim of this research was to compare changes in diet quality following total meal replacement compared with food-based weight-loss diets. In this secondary analysis of a randomized controlled trial, 79 postmenopausal women aged 45-65 y, with a BMI (in kg/m2) of 30-40, were randomly assigned to either a total meal-replacement diet (energy intake restricted by 65-75% relative to requirements) for 16 wks, followed by a food-based diet (energy intake restricted by 25-35% relative to requirements) until 52 wks, or the food-based diet for the entire 52-wk period. Diet quality was scored at baseline and 52 wks using the Healthy Eating Index for Australian Adults, with score changes compared between groups using an independent t test. Diet quality improved from baseline in both groups, but less so in the total meal-replacement group, with a mean (SD) increase of 3.6 (10.8) points compared with 11.8 (13.9) points in the food-based group, resulting in a mean between-group difference of -8.2 (P = 0.004 95% CI: -13.8, -2.7) points. This improvement in diet quality within both groups was mostly driven by a reduction in the intake of discretionary foods. Intake remained below the recommendations at 52 wks for 4 of the 5 food groups in both dietary interventions. In postmenopausal women with obesity, weight-loss interventions that involve either a total meal-replacement diet or a food-based diet both improve diet quality, however, not sufficiently to meet recommendations. This highlights the importance of addressing diet quality as a part of all dietary weight-loss interventions. This trial is registered with the Australia and New Zealand Clinical Trials Registry as 12612000651886.
Childhood seizures after prenatal exposure to maternal influenza infection: a population-based cohort study from Norway, Australia and Canada
Publisher: BMJ
Date: 29-06-2021
DOI: 10.1136/ARCHDISCHILD-2021-322210
Abstract: To assess whether clinical and/or laboratory-confirmed diagnosis of maternal influenza during pregnancy increases the risk of seizures in early childhood. Analysis of prospectively collected registry data for children born between 2009 and 2013 in three high-income countries. We used Cox regression to estimate country-level adjusted HRs (aHRs) fixed-effects meta-analyses were used to pool adjusted estimates. Population-based. 1 360 629 children born between 1 January 2009 and 31 December 2013 in Norway, Australia (New South Wales) and Canada (Ontario). Clinical and/or laboratory-confirmed diagnosis of maternal influenza infection during pregnancy. We extracted data on recorded seizure diagnosis in secondary/specialist healthcare between birth and up to 7 years of age additional analyses were performed for the specific seizure outcomes ‘epilepsy’ and ‘febrile seizures’. Among 1 360 629 children in the study population, 14 280 (1.0%) were exposed to maternal influenza in utero. Exposed children were at increased risk of seizures (aHR 1.17, 95% CI 1.07 to 1.28), and also febrile seizures (aHR 1.20, 95% CI 1.07 to 1.34). There was no strong evidence of an increased risk of epilepsy (aHR 1.07, 95% CI 0.81 to 1.41). Risk estimates for seizures were higher after influenza infection during the second and third trimester than for first trimester. In this large international study, prenatal exposure to influenza infection was associated with increased risk of childhood seizures.
Knowledge, Beliefs, and Decisions of Pregnant Australian Women Concerning Donation and Storage of Umbilical Cord Blood: A Population-Based Survey
Publisher: Wiley
Date: 02-07-2014
DOI: 10.1111/BIRT.12121
Abstract: Many women giving birth in Australian hospitals can choose to donate their child's umbilical cord blood to a public cord blood bank or pay to store it privately. We conducted a survey to determine the proportion and characteristics of pregnant women who are aware of umbilical cord blood (UCB) banking and who have considered and decided about this option. The survey also sought to ascertain information sources, knowledge, and beliefs about UCB banking, and the effect of basic information about UCB on decisions. Researchers and hospital maternity staff distributed a survey with basic information about UCB banking to 1,873 women of at least 24 weeks' gestation who were attending antenatal classes and hospital clinics in 14 public and private maternity hospitals in New South Wales. Most respondents (70.7%) were aware of UCB banking. Their main information sources were leaflets from hospital clinics, print media, antenatal classes, TV, radio, friends, and relatives. Knowledge about UCB banking was patchy, and respondents overestimated the likelihood their child would need or benefit from UCB. Women who were undecided about UCB banking were younger, less educated, or from ethnic or rural backgrounds. After providing basic information about UCB banking, the proportion of respondents who indicated they had decided whether or not to donate or store UCB more than doubled from 30.0 to 67.7 percent. Basic information for parents about UCB banking can affect planned decisions about UCB banking. Information should be accurate and balanced, should counter misconceptions, and should target specific groups.
Levels of soluble fms-like tyrosine kinase one in first trimester and outcomes of pregnancy: a systematic review
Publisher: Springer Science and Business Media LLC
Date: 08-06-2011
Abstract: Angiogenic factors are involved in formation of new blood vessels required for placental development and function and critical for fetal growth and development. Soluble fms-like tyrosine kinase 1(sFlt-1) is an anti-angiogenic protein that inhibits formation of new blood vessels resulting in potential pregnancy complications. The objective of this study was to undertake a systematic review to assess levels of sFlt-1 in early pregnancy and association with adverse pregnancy outcomes. PubMed and Medline databases and reference lists were searched up to July 2010. Inclusion criteria were pregnant women, blood s le taken during first trimester and assessment/reporting of sFlt-1 concentrations and subsequent pregnancy complications. Twelve relevant studies were identified of 71 to 668 women. No pooling of results was undertaken due to variation in sFlt-1 concentrations (range, 166-6,349 pg/ml amongst controls), s les used (serum, plasma), different summary statistics (mean, median, odds ratio) and outcome definitions applied. Levels of sFlt-1 were generally higher among women who developed preecl sia (11 studies) or gestational hypertension (two studies), but not significantly different to normotensive women in most studies. There was no consistent pattern in association between sFlt-1 concentrations and fetal growth restriction (4 studies) and levels were non-significantly higher for women with postpartum bleeding (1 study) and significantly lower for stillbirths (1 study).This review found no clear evidence of an association between sFlt-1 levels in first trimester and adverse pregnancy outcomes. However, findings were affected by methodological, biological and testing variations between studies highlighting the need for consistent testing of new biomarkers and reporting of outcome measures.
Undescended testes
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2016
Prevalence, repairs and complications of hypospadias: an Australian population-based study
Publisher: BMJ
Date: 26-08-0003
DOI: 10.1136/ARCHDISCHILD-2015-308809
Abstract: To investigate hypospadias’ prevalence and trends, rate of surgical repairs and post-repair complications in an Australian population. Hypospadias cases were identified from all live-born infants in New South Wales, Australia, during the period 2001–2010, using routinely collected birth and hospital data. Prevalence, trends, surgical procedures or repairs, hospital admissions and complications following surgery were evaluated. Risk factors for reoperation and complications were assessed using multivariate logistic regression. There were 3186 boys with hypospadias in 2001–2010. Overall prevalence was 35.1 per 10 000 live births and remained constant during the study period. Proportions of anterior, middle, proximal and unspecified hypospadias were 41.3%, 26.2%, 5.8% and 26.6%, respectively. Surgical procedures were performed in 1945 boys (61%), with 1718 primary repairs. The overall post-surgery complication rate involving fistulas or strictures was 13%, but higher (33%) for proximal cases. Complications occurred after 1 year post-repair in 52.3% of cases and up to 5 years. Boys with proximal or middle hypospadias were at increased risk of reoperation or complications, but age at primary repair did not affect the outcome. One in 285 infants were affected with hypospadias, 60% required surgical repair or correction and one in eight experienced complications. The frequency of late complications would suggest that clinical review should be maintained for year post-repair.
Exploring the potential of behaviour theory-informed digital intervention for infant fall prevention, a mixed method longitudinal study (Preprint)
Publisher: JMIR Publications Inc.
Date: 17-03-2023
Abstract: alls are the most common hospitalised injury mechanism of children under 1 year, and currently, there are no targeted prevention interventions. Prevention of falls in children of this age requires changes in behaviour of their caregivers, and theoretically informed digital behaviour change interventions (DBCI) may provide a unique mechanism for achieving effective intervention. However, user acceptance and the ability of DBCI to affect the required changes in behaviour are critical to their likely success. he objective of the study was to evaluate a behaviour theory-informed digital intervention developed following a user-centred approach for user experience, the potential for this intervention to prevent infant falls, and its impact on behavioural drivers underpinning fall risk in young children. arents of infants were recruited aged year were recruited and asked to use the intervention for 3 months. A pre-post longitudinal design was followed to examine the change in the potential to reduce the risk of falls after 3-month exposure to the intervention. Post-intervention data on behavioural drivers for fall prevention, user acceptability and engagement with the app, were also collected. Interviews were conducted to explore user experience and to identify any areas for further improvement of the intervention. total of 62 parents participated in the study. A statistically significant effect on the potential to reduce falls was observed post-intervention. The effect was higher for new parents. Parents agreed the intervention targeted most of the target behaviour drivers. Behaviour drivers and intervention impact on potential for fall prevention had a positive correlation. The intervention demonstrated good levels of acceptability. Feedback from participants was mostly positive, and the primary area identified for further improvement was widening the scope of the intervention. his study demonstrated the promise of a newly developed digital intervention on reducing the risk of infant falls, particularly among new parents. It also showed a positive influence of the DBCI on drivers of parental behaviours important for fall reduction among infants. Acceptability of the app was high, and important insights were gained from users about how to further improve the app.
Comparing a Mobile Phone Automated System With a Paper and Email Data Collection System: Substudy Within a Randomized Controlled Trial
Publisher: JMIR Publications Inc.
Date: 25-08-2020
DOI: 10.2196/15284
Abstract: Traditional data collection methods using paper and email are increasingly being replaced by data collection using mobile phones, although there is limited evidence evaluating the impact of mobile phone technology as part of an automated research management system on data collection and health outcomes. The aim of this study is to compare a web-based mobile phone automated system (MPAS) with a more traditional delivery and data collection system combining paper and email data collection (PEDC) in a cohort of breastfeeding women. We conducted a substudy of a randomized controlled trial in Sydney, Australia, which included women with uncomplicated term births who intended to breastfeed. Women were recruited within 72 hours of giving birth. A quasi-randomized number of women were recruited using the PEDC system, and the remainder were recruited using the MPAS. The outcomes assessed included the effectiveness of data collection, impact on study outcomes, response rate, acceptability, and cost analysis between the MPAS and PEDC methods. Women were recruited between April 2015 and December 2016. The analysis included 555 women: 471 using the MPAS and 84 using the PEDC. There were no differences in clinical outcomes between the 2 groups. At the end of the 8-week treatment phase, the MPAS group showed an increased response rate compared with the PEDC group (56% vs 37% P .001), which was also seen at the 2-, 6-, and 12-month follow-ups. At the 2-month follow-up, the MPAS participants also showed an increased rate of self-reported treatment compliance (70% vs 56% P .001) and a higher recommendation rate for future use (95% vs 64% P .001) as compared with the PEDC group. The cost analysis between the 2 groups was comparable. MPAS is an effective and acceptable method for improving the overall management, treatment compliance, and methodological quality of clinical research to ensure the validity and reliability of findings.
Gun violence in Australia, 2002–2016: a cohort study
Publisher: Wiley
Date: 07-09-2021
DOI: 10.5694/MJA2.51251
Western Australian emergency department presentations related to child maltreatment and intentional injury: Population level study utilising linked health and child protection data
Publisher: Wiley
Date: 12-10-2011
DOI: 10.1111/J.1440-1754.2011.02189.X
Abstract: The aim of this study is to determine the proportion of child maltreatment-related emergency department (ED) presentations in Western Australia (WA) and describe the type of injuries associated with them. It is also to investigate the proportion of maltreatment-related ED presentations resulting in hospitalisation, the proportion referred to the Department for Child Protection and their outcomes. This is a retrospective cohort study of all children aged 0-17 years residing in WA from 2001 to 2005 who had an ED presentation recorded in the ED Data Collection. This study used de-identified administrative data linked across the Departments of Health and Child Protection. Only 0.03% of ED presentations were identified as maltreatment related and 0.2% for all intentional injury presentations. One in five children with maltreatment-related ED presentations was admitted to hospital and a similar proportion had a notification to Department for Child Protection and 87% of these subsequently substantiated. This study showed that there are limitations with ED data for child maltreatment surveillance in WA and raises concerns that there may be missed opportunities for identifying maltreatment and for referring families for further assessment and support. Recommendations are provided to improve maltreatment surveillance and ED data, particularly for the identification of external causes of injury.
Five‐year survival of infants with major congenital anomalies: a registry based study
Publisher: Wiley
Date: 13-06-2019
DOI: 10.1111/APA.14833
Abstract: To determine survival of infants with major congenital anomalies (CA) and assess the effect of co-existing anomalies and gestational age. All liveborn infants with major CA born in New South Wales (NSW), Australia, 2004-2009 were identified from the NSW Register of Congenital Conditions. Deaths were identified via record linkage to death registrations and five-year survival was estimated using Kaplan-Meier methods. There were 8521 liveborn infants with CA of whom 617 (7.2%) died within the first five years of life. Half of deaths occurred in the first week of life. The overall five-year survival rate was 92.8% (95%CI: 92.2-93.3) and 83.2% (95%CI: 79.0-87.4) for syndromes, 83.4% (95%CI: 80.9-85.9) for multiple, 85.1% (95%CI: 82.6-87.5) for chromosomal, 95.3% (95%CI: 94.8-95.8) for isolated and 96.2% (95%CI: 94.3-98.1) for non-Q chapter anomalies. Five-year survival for chromosomal, syndromes and sub-groups was higher for isolated compared with multiple anomalies ranging from 77.5% to 98.9% and 68.6% to 89.5%, respectively. Survival was lower for preterm (79.4% 95%CI: 77.5-81.4) than for term infants (95.8% 95%CI: 95.3-96.3). Nine in ten infants with major CA survive up to five years, although there is variability in survival across CA groups. Survival of infants with major congenital anomalies has improved in recent years.
Rates and types of hospitalisations for children who have subsequent contact with the child protection system: a population based case-control study
Publisher: BMJ
Date: 23-09-2009
Abstract: To determine whether children who have child maltreatment allegation or substantiation have a higher rate of general hospital admissions and injury related admissions when compared to other children and to investigate other types of admissions, such as mental health, infections and admissions due to external causes. A prospective matched case-control study of children born in Western Australia between 1990 and 2005 using de-identified record linked Child Protection and Hospital Morbidity data. Rates of prior hospital admissions for cases versus controls were calculated, and conditional logistic regression was used to estimate the effect of hospital admission rate on the risk of child maltreatment allegation and substantiated allegation. Children with child maltreatment allegations and substantiations had higher mean prior admission rates compared to controls. Higher rates of general admissions and admissions for injuries, infections, mental and behavioural disorders, and external causes of morbidity, were associated with a markedly increased risk of child maltreatment allegations and substantiation. The hospital system plays not only an important role both in the surveillance of maltreatment-related injuries and conditions but also in the role of prevention in the referral of families who may need support and assistance in ensuring the health and safety of their children. This research highlights the importance of moving to electronic patient records in identifying children who have high rates of admissions and the types of conditions they have previously presented with, particularly for injuries, mental and behavioural disorders and external causes of admissions.
Cytomegalovirus (CMV) infection and pregnancy-potential for improvements in Australasian maternity health providers’ knowledge
Publisher: Informa UK Limited
Date: 11-07-2017
DOI: 10.1080/14767058.2017.1344968
Abstract: To assess the knowledge, practice and attitudes of maternity clinicians regarding congenital cytomegalovirus (CMV). It is the most common congenital infection, and well-recognized cause of neurodevelopmental disability and hearing loss. New consensus recommendations state all pregnant women and health-care providers should be educated about congenital CMV infection and preventive measures. An email questionnaire was distributed in October 2015 to specialists, diplomates (general practitioners), and trainees of the Royal Australian New Zealand College of Obstetricians and Gynaecologists (RANZCOG), and Victorian and New South Wales midwives. 774 responded: (37.3% specialists, 17.3% diplomates, 16.8% trainees, 28.6% midwives). Clinicians had variable knowledge of fetal sequelae, transmission routes and prevention. Overall, 30.2% felt confident about discussing CMV in pregnancy: less than 10% of midwives (7.4%) and less than half of specialists (47.1%, p < .0001). Only 8.8% of respondents routinely discussed CMV prevention with pregnant women. The majority (69.3%) responded that professional societies should make practice recommendations, and 88% thought more patient information was needed, preferably leaflets. Australasian maternity clinicians lack confidence and knowledge about congenital CMV. Few (<10%) routinely provide advice on prevention. There is urgent need for clinical guidance and patient information to reduce the burden of disease.
Maternal Obesity and Male Genital Anomalies: Potential Role of Placental Insufficiency and Metabolic Syndrome
Publisher: Wiley
Date: 16-08-2017
DOI: 10.1111/PPE.12392
Sleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality risk
Publisher: BMJ
Date: 29-06-2021
DOI: 10.1136/BJSPORTS-2021-104046
Abstract: Although both physical inactivity and poor sleep are deleteriously associated with mortality, the joint effects of these two behaviours remain unknown. This study aimed to investigate the joint association of physical activity (PA) and sleep with all-cause and cause-specific mortality risks. 380 055 participants aged 55.9 (8.1) years (55% women) from the UK Biobank were included. Baseline PA levels were categorised as high, medium, low and no moderate-to-vigorous PA (MVPA) based on current public health guidelines. We categorised sleep into healthy, intermediate and poor with an established composited sleep score of chronotype, sleep duration, insomnia, snoring and daytime sleepiness. We derived 12 PA–sleep combinations, accordingly. Mortality risks were ascertained to May 2020 for all-cause, total cardiovascular disease (CVD), CVD subtypes (coronary heart disease, haemorrhagic stroke, ischaemic stroke), as well as total cancer and lung cancer. After an average follow-up of 11.1 years, sleep scores showed dose-response associations with all-cause, total CVD and ischaemic stroke mortality. Compared with high PA-healthy sleep group (reference), the no MVPA-poor sleep group had the highest mortality risks for all-cause (HR (95% CIs), (1.57 (1.35 to 1.82)), total CVD (1.67 (1.27 to 2.19)), total cancer (1.45 (1.18 to 1.77)) and lung cancer (1.91 (1.30 to 2.81))). The deleterious associations of poor sleep with all outcomes, except for stroke, was lified with lower PA. The detrimental associations of poor sleep with all-cause and cause-specific mortality risks are exacerbated by low PA, suggesting likely synergistic effects. Our study supports the need to target both behaviours in research and clinical practice.
Growth Parameters, Effect Measure Modification and the Association Between Vaccination and Early Childhood Hospitalization With Non-targeted Infections
Publisher: Oxford University Press (OUP)
Date: 19-09-2017
DOI: 10.1093/CID/CIX838
A Comparison of Autism Prevalence Trends in Denmark and Western Australia
Publisher: Springer Science and Business Media LLC
Date: 11-02-2011
DOI: 10.1007/S10803-011-1186-0
Abstract: Prevalence statistics for autism spectrum disorders (ASD) vary widely across geographical boundaries. Some variation can be explained by diagnostic methods, case ascertainment and age at diagnosis. This study compared prevalence statistics for two distinct geographical regions, Denmark and Western Australia, both of which have had population-based registers and consistent classification systems operating over the past decade. Overall ASD prevalence rates were higher in Denmark (68.5 per 10,000 children) compared with Western Australia (51.0 per 10,000 children), while the diagnosis of childhood autism was more prevalent in Western Australia (39.3 per 10,000 children) compared with Denmark (21.8 per 10,000 children). These differences are probably caused by local phenomena affecting case ascertainment but influence from biological or geographical factors may exist.
Australian Firearm Regulation at 25 — Successes, Ongoing Challenges, and Lessons for the World
Publisher: Massachusetts Medical Society
Date: 29-04-2021
DOI: 10.1056/NEJMP2102574
Evaluation of anti‐Mullerian hormone in the first trimester as a predictor for hypertensive disorders of pregnancy and other adverse pregnancy outcomes
Publisher: Wiley
Date: 03-03-2014
DOI: 10.1111/AJO.12183
Abstract: Prediction of pre-ecl sia and adverse pregnancy outcomes with biomarkers has been proposed. AMH is an ovary-specific growth factor, used to predict ovarian reserve, which changes with age similar to the change in age-related fertility. The aim of the study was to determine whether AMH tested in the first trimester of pregnancy was associated with pregnancy hypertension or adverse pregnancy outcomes. Retrospective cohort study of women who delivered singleton fetuses ≥20 weeks' gestation at Royal Hospital for Women, Sydney, Australia (n = 331). AMH was tested in 2011 via Beckman-Coulter Gen II ELISA method on frozen serum collected at the time of first trimester aneuploidy screening (10-13 + 6 weeks' gestation). Outcome data were obtained from the hospital database (ObstetriX). Main outcome measures were pregnancy hypertension (pre-ecl sia and gestational hypertension) and composite adverse pregnancy outcome. The median AMH level was 9.7 pmol/L (interquartile range (IQR) 3.9-17.3). There was a trend towards women with pregnancy hypertension having lower AMH levels than women without pregnancy hypertension (median 5.1 pmol/L, IQR 1.5-13.2 vs 9.4 IQR 3.9-17.3 P = 0.06). After adjusting for BMI ≥25, parity ≥1 and age ≥35, women with an AMH less than the 10th centile had a 3.3-fold increased risk of pregnancy hypertension (OR 3.3, 95% CI 1.2-8.7, P = 0.01). There were no other associations between low AMH concentration and adverse maternal or neonatal outcomes. Women with a very low AMH (1.5 pmol/L) in early pregnancy may have an increased risk of pregnancy hypertension. No other adverse pregnancy outcomes were identified.
Making sense of foetal growth: What is normal in twins?
Publisher: Wiley
Date: 09-2019
DOI: 10.1111/PPE.12586
The roles of anxious and prosocial behavior in early academic performance: A population-based study examining unique and moderated effects
Publisher: Elsevier BV
Date: 02-2018
Hospitalisations from 1 to 6 years of age: effects of gestational age and severe neonatal morbidity.
Publisher: Wiley
Date: 02-04-2015
DOI: 10.1111/PPE.12188
Abstract: To investigate whether the adverse infant health outcomes associated with early birth and severe neonatal morbidity (SNM) persist beyond the first year of life and impact on paediatric hospitalisations for children up to 6 years of age. The study population included all singleton live births, >32 weeks gestation in New South Wales, Australia, in 2001-2005, with follow-up to 6 years of age. Birth data were probabilistically linked to hospitalisation data (n = 392 964). The odds of hospitalisation, mean hospital length of stay (LOS) and costs, and cumulative LOS were evaluated by gestational age and SNM using multivariable analyses. A total of 74 341 (18.9%) and 41 404 (10.5%) infants were hospitalised once and more than once, respectively. SNM was associated with increased odds of hospitalisation once (adjusted odds ratio [aOR] 1.16 [95% confidence interval 1.10, 1.22]) and more than once [aOR 1.51 (1.43, 1.61)]. Decreasing gestational age was associated with increasing odds of hospitalisation more than once from aOR 1.19 at 37-38 weeks to 1.49 at 33-34 weeks. Average LOS and costs per hospital admission were increased with SNM but not with decreasing gestational age. Cumulative LOS was significantly increased with SNM and decreasing gestational age. Adverse effects of SNM and early birth persist between 1 and 6 years of age. Strategies to prevent early birth and reduce SNM, and to increase health monitoring of vulnerable infants throughout childhood may help reduce paediatric hospitalisations.
Early birth is a key factor in educational disadvantage of twins: A data linkage study
Publisher: Wiley
Date: 09-09-2020
DOI: 10.1111/APA.14966
Abstract: To assess educational outcomes of twins and quantify the degree this is mediated by gestational age and other perinatal factors. We conducted a population‐based record‐linkage cohort study of all live births ≥24 weeks gestation in New South Wales, Australia with a corresponding standardised school test result for grade 3 in 2008‐2014. The primary outcome was whether a child met the National Minimum Standard (NMS) cut‐off in literacy and numeracy domains. Robust multivariable Poisson models were used to obtain adjusted relative risks (aRRs), and mediation analysis conducted to assess contributing factors on the causal pathway. Of 351 791 liveborn infants, 10 365 (2.9%) were twins. After adjusting for maternal covariates and compared with singletons, twins had an increased risk of not meeting the NMS for all five literacy and numeracy domains (aRR 1.27‐1.45, P .001). Gestational age alone mediated up to 73% of aRRs and small for gestational age further attenuated these effects with only minimal risk remaining after adjusting for all mediators (aRR 0.94‐1.07). Almost all of the educational disadvantage experienced by twins, compared with singletons, is attributable to the risk associated with shorter gestational age, and partly by poor foetal growth. These findings support efforts to prolong gestation of twin pregnancies.
Association between male genital anomalies and adult male reproductive disorders: a population-based data linkage study spanning more than 40 years
Publisher: Elsevier BV
Date: 10-2018
Study protocol: evaluation of the probiotic Lactobacillus Fermentum CECT5716 for the prevention of mastitis in breastfeeding women: a randomised controlled trial
Publisher: Springer Science and Business Media LLC
Date: 19-05-2017
Reply to Ritchie‐McLean, Susanna; Wilmshurst, Sally, regarding their comment “Can population cohort studies assess the long‐term impact of anesthesia in children?”
Publisher: Wiley
Date: 12-2018
DOI: 10.1111/PAN.13520
Neurocognitive and Educational Outcomes in Children and Adolescents with CKD
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 22-02-2018
DOI: 10.2215/CJN.09650917
Abstract: Poor cognition can affect educational attainment, but the extent of neurocognitive impairment in children with CKD is not well understood. This systematic review assessed global and domain-specific cognition and academic skills in children with CKD and whether these outcomes varied with CKD stage. Electronic databases were searched for observational studies of children with CKD ages 21 years old or younger that assessed neurocognitive or educational outcomes. Risk of bias was assessed using a modified Newcastle–Ottawa scale. We used random effects models and expressed the estimates as mean differences with 95% confidence intervals stratified by CKD stage. Thirty-four studies (25 cross-sectional, n =2095 nine cohort, n =991) were included. The overall risk of bias was high because of selection and measurement biases. The global cognition (full-scale intelligence quotient) of children with CKD was classified as low average. Compared with the general population, the mean differences (95% confidence intervals) in full-scale intelligence quotient were −10.5 (95% confidence interval, −13.2 to −7.72 all CKD stages, n =758), −9.39 (95% confidence interval, −12.6 to −6.18 mild to moderate stage CKD, n =582), −16.2 (95% confidence interval, −33.2 to 0.86 dialysis, n =23), and −11.2 (95% confidence interval, −17.8 to −4.50 transplant, n =153). Direct comparisons showed that children with mild to moderate stage CKD and kidney transplants scored 11.2 (95% confidence interval, 2.98 to 19.4) and 10.1 (95% confidence interval, −1.81 to 22.0) full-scale intelligence quotient points higher than children on dialysis. Children with CKD also had lower scores than the general population in executive function and memory (verbal and visual) domains. Compared with children without CKD, the mean differences in academic skills ( n =518) ranged from −15.7 to −1.22 for mathematics, from −9.04 to −0.17 for reading, and from −14.2 to 2.53 for spelling. Children with CKD may have low-average cognition compared with the general population, with mild deficits observed across academic skills, executive function, and visual and verbal memory. Limited evidence suggests that children on dialysis may be at greatest risk compared with children with mild to moderate stage CKD and transplant recipients.
A Pilot Randomized Controlled Trial of a Partial Meal Replacement Preconception Weight Loss Program for Women with Overweight and Obesity
Publisher: MDPI AG
Date: 15-09-2021
DOI: 10.3390/NU13093200
Abstract: About half of Australian women have a body mass index in the overweight or obese range at the start of pregnancy, with serious consequences including preterm birth, gestational hypertension and diabetes, caesarean section, stillbirth, and childhood obesity. Trials to limit weight gain during pregnancy have had limited success and reducing weight before pregnancy has greater potential to improve outcomes. The PreBabe Pilot study was a randomised controlled pilot trial to assess the feasibility, acceptability and potential weight loss achieved using a commercial online partial meal replacement program, (MR) vs. telephone-based conventional dietary advice, (DA) for pre-conception weight-loss over a 10-week period. Women 18–40 years of age with a BMI ≥ 25 kg/m2 planning pregnancy within the next 6 to 12 months were included in the study. All participants had three clinic visits with a dietitian and one obstetric consultation. In total, 50 women were enrolled in the study between June 2018 and October 2019–26 in MR and 24 in DA. Study retention at the end of 10 week intervention 81% in the MR arm and 75% in the DA arm. In the-intention-to-treat analysis, women using meal replacements lost on average 5.4 ± 3.1% body weight compared to 2.3 ± 4.2% for women receiving conventional advice (p = 0.029). Over 80% of women in the MR arm rated the support received as excellent, compared to 39% in the DA arm (p 0.001). Women assigned to the MR intervention were more likely to achieve pregnancy within 12 months of the 10 week intervention (57% (12 of 21) women assigned to MR intervention vs. 22% (4 of 18) assigned to the DA group (p = 0.049) became pregnant). The findings suggest that a weight loss intervention using meal replacements in the preconception period was acceptable and may result in greater weight loss than conventional dietary advice alone.
Factors Associated with Recurrent Infant Feeding Practices in Subsequent Births
Publisher: SAGE Publications
Date: 20-08-2016
Abstract: Previous breastfeeding experience has been associated with subsequent infant feeding practices. However, few longitudinal studies have investigated formula-only feeding patterns or the full range of potentially associated characteristics. This study aimed to determine the recurrence of infant feeding practices and maternal, birthing, and infant characteristics associated with recurrent formula-only feeding and changes between exclusive breastfeeding and formula-only feeding across subsequent births. We conducted a population-based record-linkage study of 317 027 mothers, with a term singleton live-birth in 2007-2011, New South Wales, Australia. Infant feeding patterns were described using sequential birth pairs. For mothers with a first and second birth, robust Poisson regression was used to investigate the association between maternal, birthing, and infant characteristics and infant feeding patterns. Combined relative risks (RRs) were calculated for selected maternal characteristics. Across 69 994 sequential birth pairs, the recurrence rate of formula-only feeding was 71%, and 92% for exclusive breastfeeding. Maternal characteristics 25 years old, being Australian born or single, smoking during pregnancy, and living in lower socioeconomic areas were most strongly associated with repeat formula-only feeding (RR, 22.1 95% confidence interval [CI], 18.6-26.3), changing from exclusive breastfeeding to formula-only feeding (RR, 9.0 95% CI, 7.4-10.7), and being less likely to change from formula-only feeding to exclusive breastfeeding (RR, 0.47 95% CI, 0.38-0.59). Infant feeding practices were strongly recurrent, highlighting the importance of successful breastfeeding for first-time mothers. Additional support for young mothers from disadvantaged backgrounds accounting for infant feeding history, experiences, and common barriers could improve recurrent exclusive breastfeeding and positively affect infant and maternal health.
Socio‐demographic and familial factors associated with hospital admissions and repeat admission for dental caries in early childhood: A population‐based study
Publisher: Wiley
Date: 27-11-2022
DOI: 10.1111/CDOE.12708
Abstract: Dental caries remains a complex childhood condition often requiring preventable hospital admissions. There are limited population‐based epidemiological studies that use large and linked data sets to quantify the clinical, socio‐demographic and familial risk factors related to hospital admissions for dental caries. The aim of this study was to describe and quantify the rates, socio‐demographic, clinical characteristics and familial factors including repeat admissions associated with young children admitted to hospital for dental caries. This cohort study ( n = 33,438) used longitudinally linked hospital admission data among all children aged six years in NSW, Australia. Socio‐demographic and admission characteristics of children and those with one versus two or more admissions for dental caries were compared. Familial risk factors were analysed for a restricted cohort of families with two or more children ( n = 18,174) using multivariable logistic regression to assess the familial factors associated with multiple hospital admissions for dental caries adjusting for other socio‐demographic characteristics. There were 33,438 children aged six years who had 34,446 hospital admissions for dental caries between 2001 and 2014. The annual rate of 4.3 per 1000 children remained unchanged over the period. Most admissions required general anaesthesia (96%), and 8.4% of children had repeat admissions. Children living in disadvantaged or in regional and rural areas attending public hospitals were more likely to have dental extractions during the admission. Children from the same family had a 2.7‐fold increased odds of admission if the first child admitted was less than three years of age (adjusted odd ratio 2.69 95% CI: 2.36–3.07), a 1.5 fold increase for socioeconomic disadvantage (aOR 1.45 1.19 – 1.77) and a 1.9 fold increase of admission if the family had 4 or more children (aOR1.88 1.47 – 2.42). Findings highlight socio‐demographic inequities associated with hospital admission for dental caries. The provision of targeted dental care programs for ‘at‐risk’ families should address these inequalities and presents an opportunity to reduce dental caries related hospitalizations.
First trimester screening of maternal placental protein 13 for predicting preeclampsia and small for gestational age: In-house study and systematic review
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1016/J.PLACENTA.2012.05.012
Abstract: To describe normative levels of PP13 in first trimester of pregnancy and determine the accuracy of PP13 in predicting preecl sia and small for gestational age (SGA) infants. We measured PP13 in archived first trimester serum s les from an unselected maternal cohort of 2989 women. Associations of PP13 levels and diagnostic accuracy in predicting adverse pregnancy outcomes were assessed using multivariate logistic regression models. Due to inadequate number of cases we then conducted a systematic review and subsequent meta-analysis of predictive accuracy. Structured searches including all languages were completed in electronic databases and supplemented by cross-checking reference lists of relevant publications. Characteristics, data extraction and quality assessment of studies was conducted by independent assessors. Overall, 2678 women were included in the in-house study with 71 (2.7%) preecl sia cases, 5 (0.2%) early-onset preecl sia (≤34 weeks) cases and 191 (7.1%) and 41 (1.5%) infants SGA<10th and <3rd centile. Median (IQR) normative level of PP13 in unaffected pregnancies was 53.5 (37.7-71.8) pg/ml. The area under the receiver operating characteristic curve (AUC) for multivariate models was 0.72 (95%CI 0.66-0.78) for preecl sia 0.82 (95%CI 0.63-0.99) for early-onset preecl sia 0.73 (95%CI 0.69-0.77) for SGA<10th centile and 0.83 (95%CI 0.78-0.88) for SGA<3rd centile. Eight studies were included in the systematic review, normative levels of PP13 were assessed in four studies but these were variable and meta-analysis was performed on seven studies. Sensitivity rates of PP13 based on 5% fixed false positive rates were 24%, 45% and 26% for preecl sia, for early-onset preecl sia and SGA, respectively. There was no evidence of between-study heterogeneity. First trimester PP13, in combination with maternal characteristics and other serum biomarkers was inadequate for screening purposes and predicting women at risk.
Early Childhood Development of Boys with Genital Anomalies
Publisher: Wiley
Date: 31-03-2017
DOI: 10.1002/BDRA.23603
Abstract: Male genital anomalies often require surgery in early life to address functional and cosmetic consequences. However, there has been little assessment of developmental outcomes of affected boys. We conducted a population-based cohort study of all boys born in New South Wales, Australia, and undergoing school-entry developmental assessment in 2009 or 2012. Health and developmental information was obtained by means of record-linkage of birth, hospital and Australian Early Development Census data. Boys with hypospadias or undescended testis (UDT) were compared with those without. Developmental outcomes were assessed in five domains (physical health, emotional maturity, communication, cognitive skills, and social competence), and boys were categorized as vulnerable (<10 We included 420 boys with hypospadias, 873 with UDT, and 77,176 unaffected boys. There was no difference in the proportion of boys developmentally vulnerable in any domain or DHR between boys with hypospadias (DHR: n = 49 13.1% p = 0.9), UDT (n = 116 15.2% p = 0.06), and unaffected boys (n = 9278 12.9%). Compared with unaffected boys (n = 4826 6.3%), boys with hypospadias (n = 43 10.2% p < 0.001) or UDT (n = 105 12.0% p < 0.001) were more likely to have special needs. Stratified analyses revealed that only boys with UDT and coexisting anomalies had increased risk of being DHR (odds ratio: 2.65 95% confidence interval, 1.61-4.36) or special needs (odds ratio: 2.91 95% confidence interval, 2.00-4.22). We found no increased risk of poor development among boys with hypospadias or UDT. However, boys with UDT and coexisting anomalies were more likely to have poorer development and special needs. Birth Defects Research 109:535-542, 2017. © 2017 Wiley Periodicals, Inc.
Examination of validity of identifying congenital heart disease from hospital discharge data without a gold standard: Using a data linkage approach
Publisher: Wiley
Date: 29-03-2023
DOI: 10.1111/PPE.12976
Abstract: Administrative health data has been used extensively to examine congenital heart disease (CHD). However, the accuracy and completeness of these data must be assessed. To use data linkage of multiple administrative data sources to examine the validity of identifying CHD cases recorded in hospital discharge data. We identified all liveborn infants born 2013–2017 in New South Wales, Australia with a CHD diagnosis up to age one, recorded in hospital discharge data. Using record linkage to multiple data sources, the diagnosis of CHD was compared with five reference standards: (i) multiple hospital admissions containing CHD diagnosis (ii) receiving a cardiac procedure (iii) CHD diagnosis in the Register of Congenital Conditions (iv) cardiac‐related outpatient health service recorded and/or (v) cardiac‐related cause of death. Positive predictive values (PPV) comparing CHD diagnosis with the reference standards were estimated by CHD severity and for specific phenotypes. Of 485,239 liveborn infants, there were 4043 infants with a CHD diagnosis identified in hospital discharge data (8.3 per 1000 live births). The PPV for any CHD identified in any of the five methods was 62.8% (95% confidence interval [CI] 60.9, 64.8), with PPV higher for severe CHD at 94.1% (95% CI 88.2, 100). Infant characteristics associated with higher PPVs included lower birthweight, presence of a syndrome or non‐cardiac congenital anomaly, born to mothers aged years and residing in disadvantaged areas. Using data linkage of multiple datasets is a novel and cost‐effective method to examine the validity of CHD diagnoses recorded in one dataset. These results can be incorporated into bias analyses in future studies of CHD.
Twin pregnancies complicated by gestational diabetes mellitus: a single centre cohort study
Publisher: Wiley
Date: 22-02-2016
DOI: 10.1111/DME.13076
Abstract: In women with a twin pregnancy, to determine the incidence of, risk factors for and outcomes of women with gestational diabetes mellitus, and assess how these have changed with a change in gestational diabetes screening. Retrospective cohort study of women with a twin pregnancy attending an Australian tertiary hospital, 2002-2013. Information on gestational diabetes status, gestational diabetes risk factors and pregnancy outcomes was ascertained. Pregnancy outcomes included hypertensive disorders, twin birthweight centile and a composite adverse pregnancy outcome. Analysis was stratified pre ost screening protocol change (epoch 1: 2002-2009, epoch 2: 2010-2013) and by gestational diabetes status. Gestational diabetes was diagnosed in 86/982 (8.8%) women, increasing from 4.4% to 14.7% between epochs (P = 0.0001). The proportion of women with hypertensive disorders increased (11.7% vs. 13.4%, P = 0.009), but the proportion of infant's birthweight > 90th centile decreased (11.0% vs. 7.6%, P = 0.02) between epochs. Overall, 33.6% of women had ≥ 1 risk factors for gestational diabetes. Three-quarters (73.7%) of women overall had an adverse pregnancy outcome, with a slightly higher proportion in women with gestational diabetes compared with those with no gestational diabetes (79.7% vs. 73.1%, P = 0.06). The rate of the adverse pregnancy outcome did not change by epoch, after adjusting for maternal and pregnancy risk factors (adjusted odds ratio = 0.96, 95% confidence interval 0.73-1.26). Almost 1 in 10 women with a twin pregnancy were diagnosed with gestational diabetes, with the incidence of gestational diabetes increasing threefold with a new screening protocol. The pregnancy outcomes of women with a twin pregnancy did not change with increased detection and treatment for gestational diabetes.
Characteristics of non-Aboriginal and Aboriginal children and families with substantiated child maltreatment: a population-based study
Publisher: Oxford University Press (OUP)
Date: 22-02-2010
DOI: 10.1093/IJE/DYQ005
Abstract: To investigate specific child and parental factors associated with increased vulnerability to substantiated child maltreatment. A retrospective cohort study of all children born in Western Australia during 1990-2005 using de-identified record linked child protection, disability services and health data. Cox regression was used for univariate and multivariate analysis to determine the risk of substantiated child maltreatment for a number of child and parental factors, including child disability, parental age, socio-economic status, parental mental health, substance use and assault-related hospital admissions. Separate analyses were conducted for Aboriginal and non-Aboriginal children. This study found a number of child and parental factors that increase the risk of substantiated child maltreatment. The strongest factors were child intellectual disability, parental socio-economic status, parental age and parental hospital admissions related to mental health, substance use and assault. Awareness of the factors that make children and families vulnerable may aid the targeting of child maltreatment prevention programmes. To prevent child abuse and neglect it is essential that we have a platform of universal services, which assist parents in their role, as well as targeted services for at-risk families.
Birth outcomes by type of attendance at antenatal education: An observational study
Publisher: Wiley
Date: 17-05-2022
DOI: 10.1111/AJO.13541
Abstract: Antenatal education aims to prepare expectant parents for pregnancy, birth, and parenthood. Studies have reported antenatal education teaching breathing and relaxation methods for pain relief, termed psychoprophylaxis, is associated with reduction in caesarean section rates compared with general birth and parenting classes. Given the rising rates of caesarean section, we aimed to determine whether there was a difference in mode of birth in women based on the type of antenatal education attended. A cross‐sectional antenatal survey of nulliparous women ≥28 weeks gestation with a singleton pregnancy was conducted in two maternity hospitals in Sydney, Australia in 2018. Women were asked what type of antenatal education they attended and sent a follow‐up survey post‐birth. Hospital birth data were also obtained. Education was classified into four groups: psychoprophylaxis, birth and parenting, other, or none. Five hundred and five women with birth data were included. A higher proportion of women who attended psychoprophylaxis education had a vaginal birth (instrumental/spontaneous) (79%) compared with women who attended birth and parenting, other or no education (69%, 67%, 60%, respectively P = 0.045). After adjusting for maternal characteristics, birth and hospital factors, the association was attenuated (odds ratio 2.03 95% CI 0.93–4.43). Women who attended psychoprophylaxis couple‐based education had a trend toward higher rates of vaginal birth. Randomised trials comparing different types of antenatal education are required to determine whether psychoprophylaxis education can reduce caesarean section rates and improve other birth outcomes.
Exploring Infant Fall Events Using Online Parenting Discussion Forums: Infodemiology Study
Publisher: JMIR Publications Inc.
Date: 10-05-2022
DOI: 10.2196/34413
Abstract: Falls represent the most common mechanism of injury requiring hospitalization among children under 12 months, and they commonly result in traumatic brain injury. Epidemiological studies exploring infant falls demonstrate the experienced burden, but they lack contextual information vital to the development of preventive interventions. The objective of this study was to examine contextual information for falls involving children under 12 months, using online parenting discussion forums. Online parenting forums provide an unobtrusive rich data source for collecting detailed information about fall events. Relevant discussions related to fall incidents were identified and downloaded using site-specific Google Search queries and a programming script. A qualitative descriptive approach was used to analyze the incidents and categorize contextual information into “precursor events” and “influencing factors” for infant falls. We identified 461 infant fall incidents. Common fall mechanisms included falls from furniture, falls when being carried or supported by someone, falls from baby products, and falls on the same level. Across the spectrum of fall mechanisms, common precursor events were infant rolling off, infant being alone on furniture, product misuse, caretaker falling asleep while holding the infant, and caretaker tripping/slipping while carrying the infant. Common influencing factors were infant’s rapid motor development, lapses in caretaker attention, and trip hazards. The findings define targets for interventions to prevent infant falls and suggest that the most viable intervention approach may be to target parental behavior change. Online forums can provide rich information critical for preventive interventions aimed at changing behavior.
Financing Maternity and Early Childhood Healthcare in The Australian Healthcare System: Costs to Funders in Private and Public Hospitals Over the First 1000 Days
Publisher: Maad Rayan Publishing Company
Date: 12-05-2020
Abstract: Background: Maternity care is a significant contributor to overall healthcare expenditure, and private care is seen as a mechanism to reduce the cost to public funders. However, public funders may still contribute to part of the cost of private care. The paper aims to quantify (1) the cost to different funders of maternal and early childhood healthcare over the first 1000 days for both women giving birth in private and public hospitals (2) any variation in cost to different funders by birth type and (3) the cost of excess caesarean sections in public and private hospitals in Australia. Methods: This study utilised a whole of population linked administrative dataset, and classified costs by the funding source. The mean cost to different funders for private hospital births, and public hospital births in the Australian state, Queensland are presented by time period and by birth type. The World Health Organization’s (WHO’s) C-model was used to identify the optimal caesarean section rate based upon demographic and clinical factors, and counterfactual analysis was utilised to identify the cost to different funders if caesarean section had been utilised at this rate across Australia. Results: We found that for women who gave birth in a public hospital as a public patient, the mean cost was $22 474. For women who gave birth in a private hospital the mean cost was $24 731, and the largest contributor was private health insurers ($11 550), followed by Medicare ($7261) and in iduals ($3312). Private hospital births cost government funders $10 050 on average whereas public hospital public patient births cost government funders $21 723 on average and public hospital private patient births cost government funders $20 899 on average. If caesarean section deliveries were reduced, public hospital funders could save $974 million and private health insurers could save $216 million. Conclusion: Private hospital births cost government funders less than public hospital births, but government funders still pay for around 40% of the cost of private hospital births. Caesarean sections, which are more frequently performed in private hospitals, are costly to all funders and reducing them could impart significant cost savings to all funders.
Impact of Hospitalizations due to Chronic Health Conditions on Early Child Development
Publisher: Oxford University Press (OUP)
Date: 27-04-2023
Abstract: To assess the impact of hospitalization for chronic health conditions on early child development and wellbeing at school start. We conducted a longitudinal cohort study of children starting school using population-based record linkage of routinely collected admitted hospital data and standardized assessment of early childhood development (Australian Early Developmental Census: AEDC). Developmental vulnerability (DV) was defined as children scoring & th centile in any one of five developmental domains. Children scoring & th centile on two or more domains were considered developmentally high-risk (DHR). Children hospitalized with chronic health conditions were compared to children without hospitalizations prior to school start. Among 152,851 children with an AEDC record, 22,271 (14·6%) were hospitalized with a chronic condition. Children hospitalized with chronic health conditions were more likely to be DHR (adjusted odds ratio 1.25, 95% CI: 1.18–1.31) compared to children without hospitalizations. Children hospitalized more frequently (& times) or with longer duration (& weeks) had a 40% increased risk of being DHR (1.40, 95% CI: 1.05–1.88 and 1.40, 95% CI: 1.13–1.74, respectively). Children hospitalized with mental health/behavioral/developmental conditions had the highest risk of DHR (2.23, 95% CI: 1.72–2.90). Developmental vulnerability was increased for physical health (1.37, 95% CI: 1.30–1.45), language (1.28, 95% CI: 1.19–1.38), social competence (1.22, 95% CI: 1.16–1.29), communication (1.17, 95% CI: 1.10–1.23), and emotional maturity (1.16, 95% CI: 1.09–1.23). Frequent and longer duration hospitalizations for chronic health conditions can impact early childhood development. Research and interventions are required to support future development and well-being of children with chronic health conditions who are hospitalized.
The Role of Medication in Reducing the Negative Effects of Hyperactivity-Inattention on Achievement: A Population-based Longitudinal Investigation of Students and their Classrooms
Publisher: Elsevier BV
Date: 10-2018
The Real Happy Study: Protocol for a Prospective Assessment of the Real-World Effectiveness of the HAPIFED Program—a Healthy APproach to weIght management and Food in Eating Disorders
Publisher: MDPI AG
Date: 07-2019
DOI: 10.3390/BS9070072
Abstract: The prevalence of obesity with comorbid binge eating behaviour is growing at a faster rate than that seen for either obesity or eating disorders as separate conditions. Approximately 6% of the population are affected and they potentially face a lifetime of poor physical and mental health outcomes and an inability to sustain long-term weight loss. Current treatment options are inadequate in that they typically address either obesity or eating disorders exclusively, not the combination of both conditions. By treating one condition without treating the other, relapse is common, and patients are often left disappointed with their lack of weight loss. An integrated approach to treating these in iduals is needed to prevent a worsening of the comorbidities associated with excess body weight and eating disorders. A new therapy has recently been developed, named HAPIFED, which addresses both overweight/obesity and comorbid binge eating behaviour with the combination of behavioural weight loss therapy and cognitive behaviour therapy-enhanced (CBT-E). The aim of this paper is to document the protocol for the Real Happy Study, which will evaluate the effectiveness of the HAPIFED program in treating overweight or obesity with comorbid binge-eating behaviour in a real-world setting.
Corrigendum to “First trimester screening of maternal placental protein 13 for predicting preeclampsia and small for gestational age: In-house study and systematic review” [Placenta 33 (2012) 735–740]
Publisher: Elsevier BV
Date: 11-2012
Response to letter to Editor: Prediction of preeclampsia and fetal growth restriction using placental protein 13
Publisher: Elsevier BV
Date: 11-2012
Related Organisations
No related organisations have been discovered for Natasha Nassar.
Related Funding Activities
Linkage Projects - Grant ID: LP100200507
Start Date: 12-2010
End Date: 06-2018
Amount: $2,094,275.00
Funder: Australian Research Council
View Funded ActivityDiscovery Projects - Grant ID: DP110100967
Start Date: 07-2011
End Date: 05-2016
Amount: $199,655.00
Funder: Australian Research Council
View Funded Activity