ORCID Profile
0000-0002-5561-5200
Current Organisations
Sydney Children's Hospital
,
Sydney Children's Hospitals Network Randwick and Westmead
,
University of New South Wales
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Publisher: Wiley
Date: 14-02-2018
DOI: 10.1111/JPC.13865
Abstract: The aim of this study was to assist clinicians evaluating refugee children for latent tuberculosis infection (LTBI) by comparing paired tuberculin skin test (TST) and Quantiferon Gold In-Tube (QGIT) test results with clinical management decisions and follow-up data in a large cohort of newly arrived refugee children. This was a retrospective analysis of all refugee children (<15 years of age) evaluated for LTBI with both TST and interferon-γ release assay between 2007 and 2010 in the Illawarra-Shoalhaven region of New South Wales, Australia. Demographics, country of origin, bacille Calmette-Guerin (BCG) vaccination status, chest X-ray results, TST and QGIT test results, clinical management and outcome on long-term follow-up were assessed. Of 272 children evaluated, complete results were available for 212 (78%). The vast majority (207 98%) were from Africa or Southeast Asia. Overall, 33 (16%) children were treated for LTBI 13 (39%) had concordant TST and QGIT results and 20 (61%) discordant results. Of 63 (30%) TST-positive (≥10 mm) children, 46 (73%) were QGIT assay-negative, 44 (70%) had a BCG scar, 3 (5%) were younger than 2 years and 6 (10%) were treated for LTBI. Of 32 QGIT assay-positive children, 15 (47%) were TST negative, 31 (97%) had a BCG scar, all were older than 2 years and 14 (44%) were treated for LTBI. Discordant TST and QGIT results were found in a high percentage of refugee children. QGIT is convenient and more specific than TST to diagnose LTBI in BCG-vaccinated children, although a careful tuberculosis exposure history and clinical assessment to rule out active disease remain important.
Publisher: Springer Science and Business Media LLC
Date: 21-10-2016
Publisher: MDPI AG
Date: 29-05-2019
Abstract: Background: Aboriginal Australian children have higher rates of mortality at younger ages than non-Aboriginal Australian children. We aimed to (i) calculate the case fatality rate (CFR) for Aboriginal and non-Aboriginal children admitted to children’s hospitals in New South Wales (NSW) and (ii) identify predictors of CFR. Methods: We used a retrospective cross-sectional analysis of data from electronic medical records for in-patient admissions to the Sydney Children’s Hospitals Network (SCHN) over five years (2011–2015). Logistic regression analysis was used to identify predictors of mortality and excess deaths in Aboriginal children were calculated. Results: There were 241,823 presentations over the 5-year period. The CFR for Aboriginal children was double that of non-Aboriginal children (0.4% vs. 0.2%, p = 0.002), with Aboriginal children under 2 years and from remote and regional Australia at highest risk of excess mortality. Predictors of death for all children in order of significance were: Circulatory disorders (Odds Ratio (OR) 17.16, p 0.001), neoplasm/blood/immune disorders (OR 2.77, p 0.001), emergency admissions (OR 1.94, p 0.001), aboriginality (OR 1.73, p = 0.005) and longer length of stay (OR 1.012 p 0.001). Conclusions: Our data show that Aboriginal children are almost twice as likely to die than non-Aboriginal children. In particular, excess deaths in Aboriginal children are most commonly from outer regional and remote areas and children aged under 2 years with perinatal or circulatory conditions.
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/AH17263
Abstract: Objective The aim of this study is to describe the experience of developing key performance indicators (KPIs) for Sydney Children’s Hospital Network (SCHN), the largest paediatric healthcare entity in Australia. Methods Beginning with a published methodology, the process of developing KPIs involved five phases: (1) identification of potential KPIs referencing the organisational strategic plan and pre-existing internal and external documents (2) consolidation into a pragmatic set (3) analysis of potential KPIs against selection criteria (4) mapping these back against the strategic plan and management structure and (5) presentation to key stakeholders to ensure suitability and traction. Consistent with the strategic plan, a subset of indicators was selected to address quality of care for children from priority populations. Results A pragmatic list of 60 mandated and 50 potential KPIs was created from the 328 new and 397 existing potentially relevant KPIs generated by the executive team. Of these, 20 KPIs were selected as the most important 65% were process measures. The majority of mandated KPIs were process measures. Of the KPIs selected to highlight inequities, there were proportionately more outcome measures (44% outcome, 27% process). Less than one-third could currently be measured by the organisation and were thus aspirational. Conclusion Developing a KPI suite requires substantial time, effort and organisational courage. A structured approach to performance measurement and improvement is needed to ensure a balanced suite of KPIs that can be expected to drive an organisation to improve child health outcomes. Future directions for SCHN include a systematic approach to implementation beyond the mandated KPIs, including KPIs that reflect equity and improved outcomes for priority populations, development of meaningful measures for the aspirational KPIs, adding structure KPIs and measurement of changes in child health outcomes related to the development of this KPI process. What is known about the topic? Health services are increasingly required to demonstrate accountability through KPIs. There is a body of literature on both theoretical frameworks for measuring performance and a long list of possible measures, however developing a meaningful suite of KPIs remains a significant challenge for in idual organisations. What does this paper add? This paper describes lessons learned from the practical, pragmatic application of a published methodology to develop a suite of KPIs for the largest paediatric healthcare entity in Australia. It provides a select list of the highest-level KPIs selected by the organisation to stimulate further discussion among similar organisations in relation to KPI selection and implementation. What are the implications for practitioners? Developing and implementing a suite of meaningful KPIs for a large organisation requires courage, an understanding of health informatics, stakeholder engagement, stamina and pragmatism. The process we describe can be replicated and/or modified as needed, with discussion of key lessons learned to help practitioners plan ahead.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2007
Publisher: BMJ
Date: 2019
DOI: 10.1136/BMJOPEN-2018-022633
Abstract: To investigate differences in demographic and clinical characteristics of Aboriginal and non-Aboriginal children aged 0–4 years hospitalised for unintentional poisoning in New South Wales (NSW), Australia. Retrospective whole-of-population cohort analysis of linked hospital and mortality data for 2000–2014. All children (Aboriginal and non-Aboriginal) under the age of 5 years who were born in a hospital in NSW from 2000 to 2009. The primary outcome was hospitalisation for unintentional poisoning. Logistic regression was used to estimate odds of poisoning hospitalisation for Aboriginal and non-Aboriginal children. Poisoning agents and clinical outcomes were compared by Aboriginality. The cohort included 767 119 children, including 28 528 (3.7%) Aboriginal children. Aboriginal children had approximately three times higher rates of hospitalised poisoning (1.34%) compared with non-Aboriginal children (0.41%). Poisoning incidence peaked at 2–3 years of age. Male sex, socioeconomic disadvantage and geographical remoteness were associated with higher odds of poisoning hospitalisation for Aboriginal and non-Aboriginal children, but associations with disadvantage and remoteness were statistically significant only for non-Aboriginal children. Most (83%) poisonings were caused by pharmaceutical agents. Few Aboriginal and non-Aboriginal children had repeat admissions for poisoning most had a length of stay of 1 day or less. Only 8% of poisoning admissions involved contact with a social worker. Commonly used medications in the general population contribute to poisonings among both Aboriginal and non-Aboriginal preschool-aged children. This study highlights a need to develop culturally safe poisoning prevention strategies and policies.
Publisher: Wiley
Date: 23-11-2017
DOI: 10.1111/JPC.13785
Abstract: To describe the engagement of a cohort of urban Aboriginal families with an Early Childhood Health Service, and to assess any association of engagement with the service with screening by the Edinburgh Post-Natal Depression Scale (EPDS), full breastfeeding rates and post-natal smoking status. Routine electronic medical record data collected by a Child and Family Health Nurse between 2011 and 2014 was analysed retrospectively. Associations between use of the service and acceptance of EPDS, breastfeeding rates and post-natal smoking status were determined using binary and multinomial multiple logistic regression analyses. There were 424 Aboriginal babies and 215 mothers included in the study. Each occasion of service increased the odds of accepting screening with the EPDS (odds ratio (OR) 1.02, 95% confidence interval (CI) 1.00-1.03, P = 0.04) and complete breastfeeding (OR 1.11, CI 1.01-1.23, P = 0.04), but not of quitting smoking (OR 0.99, CI 0.96-1.02, P = 0.34). Despite accounting for engagement with the service, overall uptake of the EPDS remained low of 267 offers for EPDS screening, only 115 were accepted (43%). The service was accessed in increasing numbers during the study period. Mothers who utilised the service more frequently were more likely to accept EPDS screening and exclusively breastfeed however, acceptance of EPDS screening remained low overall. Further research is recommended to investigate the low acceptance of EPDS in this Aboriginal population and whether those results are transferable to other communities.
Publisher: Wiley
Date: 25-02-2021
DOI: 10.1111/JPC.15403
Abstract: There is limited information on the health status of urban Australian Aboriginal children and young people attending community‐based child health services. Such information is vital to plan appropriate services. The objective of the study is to describe the health status and service use of children and young people presenting to an urban Aboriginal Community Paediatric Service in Sydney, Australia. Cross‐sectional analysis of routinely collected data extracted from electronic medical records and the Australian Immunisation Register for urban Aboriginal children and young people aged 0–18 years who visited the service between January 2013 and December 2017. A total of 273 Aboriginal children and young people had 609 occasions of service. Almost all (97.35%) were fully immunised. Forty‐six percent of occasions of service noted diagnoses 55% of the consultations were for mental health and behavioural disorders. The most frequent diagnoses were speech and language delay, attention deficit hyperactivity disorder and school difficulty. Psychosocial concerns were noted in 61.2% of occasions of service, and 19.4% of children had a history of prematurity. Eighty‐five percent of consultations had an onward referral to additional services. The most common referrals were for audiology, ear‐nose and throat specialists and speech therapy. There were low numbers of referrals to mental health services relative to the high number of mental health diagnoses. It is essential that we address the mental, developmental and psychosocial needs of Aboriginal children and young people who attend urban Community Child Health services. Integrated service models should be developed in partnership with Aboriginal community to do this.
Publisher: MDPI AG
Date: 03-11-2020
Abstract: Background: The aim of this study was to measure young people’s health status and explore associations between health status and belonging to one or more socio-culturally marginalised group. Methods: part of the Access 3 project, this cross-sectional survey of young people aged 12–24 years living in New South Wales, Australia, overs led young people from one or more of the following groups: Aboriginal and or Torres Strait Islander living in rural and remote areas homeless refugee and/or, sexuality and/or gender erse. This paper reports on findings pertaining to health status, presence of chronic health conditions, psychological distress, and wellbeing measures. Results: 1416 participants completed the survey 897 (63.3%) belonged to at least one marginalised group 574 (40.5%) to one, 281 (19.8%) to two and 42 (3.0%) to three or four groups. Belonging to more marginalised groups was significantly associated with having more chronic health conditions (p = 0.001), a greater likelihood of high psychological distress (p = 0.001) and of illness or injury related absence from school or work (p 0.05). Conclusions: increasing marginalisation is associated with decreasing health status. Using an intersectional lens can to be a useful way to understand disadvantage for young people belonging to multiple marginalised groups.
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/AH17024
Abstract: Objective The aims of the present study were to describe the prevalence of vulnerability in a cohort of newborns, identify the factors that increase the risk of vulnerability and examine whether those who are most vulnerable are receiving home visits. Methods A prospective cross-sectional study was performed using data collected from questionnaires completed by child and family health nurses and obstetric discharge summaries for each mother–baby dyad. Descriptive frequencies and percentages are used to describe the proportions of children who were vulnerable, offered services and had risk factors for vulnerability. Categorical data were compared using Pearson’s Chi-squared analysis. Results In all, 1517 newborns were included in the present study. Of these, 40.5% were identified as vulnerable and 13.9% had two or more risk factors for vulnerability (95% confidence interval (CI) 12–16%). The most common risk factors were biological. Across all newborns, 33.7% were visited at home, and 74.6% of vulnerable newborns were offered a home visit. Children identified as vulnerable were more likely to have a home visit than those who were not (z for 95% CI=1.96 P& .1). Conclusions Although the high reported prevalence of identified risk needs to be confirmed in further studies, identifying vulnerability allowed the offer of home visiting to be directed towards those most likely to benefit. What is known about the topic? Of the Australian child population, 10–20% are vulnerable to adverse health, developmental and wellbeing outcomes. Vulnerable infants are at a greater risk of becoming vulnerable children, adolescents and adults over the life course. Biological and psychosocial risk factors for vulnerability are well described. Families with the greatest need are often the least likely to access or receive support, and have lower utilisation of preventative health services despite evidence that support in the first few years of life can significantly improve long-term outcomes. What does this paper add? This paper provides a detailed description of vulnerabilities in a cohort of newborns and demonstrates that it is possible to assign risk of vulnerability within existing child and family health services using tools that identify biological and psychosocial risk factors. Identification of vulnerability risk allows prioritisation of services to those with the greatest need. What are the implications for practitioners? It is possible to identify vulnerability risk within child and family health services. This allows those families at risk of future adverse health, developmental and wellbeing outcomes to be prioritised to receive health services and supports.
Publisher: Informa UK Limited
Date: 07-2010
Publisher: BMJ
Date: 23-12-2017
Publisher: Oxford University Press (OUP)
Date: 14-01-2014
DOI: 10.1093/IJE/DYT269
Publisher: AMPCo
Date: 08-2015
DOI: 10.5694/MJA15.00593
Publisher: Public Library of Science (PLoS)
Date: 13-02-2017
Publisher: Informa UK Limited
Date: 06-1999
Abstract: Rates of infection by the human immunodeficiency virus (HIV) have been increasing rapidly in South Africa over the last decade. This study documents the changes over time in prevalence of HIV infection amongst hospitalized children, and its effects on the profile of disease and in-hospital mortality over the period 1992-1997. Admissions to the paediatric medical wards between January 1992 and April 1997 were obtained from the routine computerized database held in the Department of Paediatrics at Chris Hani Baragwanath Hospital. HIV tests were performed on clinical indications only. Over the study period there were 22,633 admissions involving 19,918 children. Total annual admissions increased by 23.6% between 1992 and 1996. Prevalence of HIV infection increased from 2.9% in 1992 to 20% in 1997. HIV-infected children had a younger age distribution, longer median length of stay and more readmissions (p < 0.001) compared with HIV-negative and untested children. HIV-infected children accounted for the increased number of admissions for pneumonia, gastro-enteritis, malnutrition and tuberculosis, and the rise in in-hospital mortality by 42% from 4.3% in 1992 to 6.1% in 1997. Paediatric HIV infection has changed the profile of paediatric admission diagnoses and increased in-hospital mortality in the relatively short time between 1992 and 1997. Over the same period, HIV-negative children showed declining rates of malnutrition, vaccine-preventable diseases and admission to the intensive care unit.
Publisher: Wiley
Date: 09-2003
DOI: 10.1046/J.1440-1754.2003.00205.X
Abstract: To evaluate the impact of risperidone on functional impairment in a paediatric s le and to document the range of adverse drug reactions. Risperidone treatment in children and adolescents (n = 51) with severe behavioural disturbances was assessed retrospectively to determine clinical response and adverse events. The change in patient functional performance during treatment was assessed using the Royal Alexandra Hospital for Children Measure of Function (MOF) score. Changes in target behaviours (such as severe aggression) were also assessed. The average duration of follow up was 9 months. Clinical improvement was demonstrated in 76% of the s le. There was a statistically significant improvement in the mean MOF with risperidone therapy (10.61 with 99% confidence interval 6.6-14.6). Risperidone appeared to be particularly useful in patients with autistic spectrum disorders. Twenty-five of the 51 patients (49%) experienced side-effects including sedation (27%), weight gain (20%), anticholinergic (10%) and extrapyramidal (8%) side-effects. This study suggests that risperidone is an effective agent in severely behaviourally disturbed paediatric patients. However, risperidone use is limited by the high frequency of side-effects. Randomized controlled trial data are required to determine the safety and efficacy of risperidone.
Publisher: Wiley
Date: 29-05-2017
DOI: 10.1111/JPC.13551
Abstract: This study aimed to describe refugee children, their families and settlement characteristics, and how their development and social-emotional well-being change over time. We conducted a longitudinal study of 61 refugee children (6 months to 15 years) in an Australian setting, over 2009-2013 and measured child, family and settlement factors as well as physical health, development and social-emotional well-being (Strengths and Difficulties Questionnaire, SDQ). Questionnaires were completed with parents of 54 (89%) children at year 2 and 52 (100%) at year 3. Forty percent of parents had low levels of education, 30% of fathers were absent on arrival, 13% of children were born in refugee c s and 11% of parents self-disclosed previous trauma. Over time, there was increased parental employment (P = 0.001), improved English proficiency for partners (P = 0.02) and reduced stressful life events in the last 12 months (P = 0.003). At years 2 and 3, parents were studying English (96% 76%), accessing government financial support (96% 100%) and primary health care (98% 87%), and feeling supported by their own (78% 73%) or the general (69% 63%) community. Fifteen percent of children had a chronic disease, and 13% were obese and overweight. In pre-school children, 27% had mild developmental problems in year 2 all were normal by year 3. Abnormal SDQ total difficulties scores reduced over time from 13 to 6% of children but this did not reach significance. Most refugee children have developmental and well-being outcomes within the normal range by year 3. However, a minority of children have persistently poor social-emotional outcomes.
Publisher: Elsevier BV
Date: 04-2016
Abstract: To evaluate an urban art-based community health program (Ngala Nanga Mai We Dream) that seeks to improve health, education, empowerment and connectedness of Aboriginal parents by describing paediatric health service attendance, maternal educational engagement, participant growth and empowerment, and worker and participant experiences. Mixed methods were used. Qualitative data was collected through interviews and focus groups. Demographics, health service use and child health status were extracted from clinical records. Psycho-social empowerment and wellbeing was measured using the Growth and Empowerment Measure (GEM). A Critical Effectiveness Factor framework that measures factors necessary for success, effectiveness and sustainability was used to assess program quality. Between 2009 and 2012, 92 Aboriginal parents participated. A total of 93.5% of regular participants engaged their children at least once with paediatric health services and 27.1% undertook further education. Empowerment scores significantly improved, despite little change in psychological distress. The program operationalised all 10 Critical Effectiveness Factors for youth wellbeing. Ngala Nanga Mai creates an environment of social connectedness, strengthened parenting, maternal and child wellbeing and empowerment. It supports increased utilisation of health, education and support services, and early detection of treatable child health issues. Improving the health of Aboriginal children requires new strategies and learning from innovative programs. Solid baseline data, long-term follow-up data and meaningful health outcome data are critical to improving services and health outcomes at the program level. Ultimately, long-term commitment to adequate resourcing is needed in order to deliver broader improvement of child health outcomes.
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.CHIABU.2016.07.004
Abstract: In Australia, paediatricians and Child Protection Specialists provide the medical and forensic examinations of child victims of sexual assault. There are workforce challenges in the recruitment and retention of doctors to undertake child sexual assault (CSA) work particularly in remote and rural areas. Pediatric Sexual Assault Nurse Examiner (PSANE) programs have existed in the USA and the UK for many years. Using Rapid Evidence Assessment (REA) methodology, a systematic search of the literature was performed to ascertain what is known about SANE programs, to evaluate the evidence for their effectiveness across a number of domains (accessibility, health and legal outcomes and cost effectiveness) and to inform policy on models of care and elements of best practice which may be appropriate for local implementation in Australia. This review showed that despite the limited evidence available and significant gaps in the evidence, SANEs provide a high standard of medical care and are not detrimental to the legal process. By providing recommendations regarding the potential value, effectiveness and feasibility of establishing a PSANE program in Australia, this article may be of interest to other high income countries facing similar workforce challenges in meeting the needs of children with alleged sexual assault.
Publisher: MDPI AG
Date: 12-04-2019
Abstract: Background: Patients who discharge against medical advice (DAMA) from hospital carry a significant risk of readmission and have increased rates of morbidity and mortality. We sought to identify the demographic and clinical characteristics of DAMA patients from a tertiary paediatric hospital. Methods: Data were extracted retrospectively from electronic medical records for all inpatient admissions over a 5-year period. Demographic characteristics (age, sex, Aboriginality, socioeconomic status and remoteness of residence) and clinical characteristics (admitting hospital site, level of urgency on admission, diagnosis and previous DAMA) were extracted and logistic regression models were used to identify predictors of DAMA with 95% confidence intervals. Results: There were 246,359 admissions for 124,757 patients, of which 1871 (0.8%) admissions and 1730 patients (1.4%) DAMA. Predictors of DAMA in a given admission were hospital site (OR 4.8, CI 4.2–5.7, p 0.01), a mental health/behavioural diagnosis (OR 3.3, CI 2.2–4.8, p 0.01), Aboriginality (OR 1.6, CI 1.3–2.1, p 0.01), emergency rather than elective admissions (OR 0.7ha, CI 0.6–0.8, p 0.01), a gastrointestinal diagnosis (OR 1.5, CI 1.1–2.0, p = 0.04) and a history of previous DAMA (OR 2.0, CI 1.2–3.2, p = 0.05). Conclusions: There are clear predictors of DAMA in this tertiary hospital admission cohort and identification of these provides opportunities for intervention at a practice and policy level in order to prevent adverse outcomes.
Publisher: Wiley
Date: 29-01-2013
DOI: 10.1111/JPC.12101
Publisher: Wiley
Date: 21-05-2013
DOI: 10.1111/JPC.12225
Abstract: This study describes the presentations made to the Sydney Children's Hospital (SCH) Emergency Department (ED) by local Aboriginal and Torres Strait Islander (Aboriginal) children with particular reference to children who present frequently or whose presentation was preventable. Data from the SCH ED Information System were extracted for all presentations made by children who identified as Aboriginal, aged between 0-15 years, who presented between 2005-2008. Presentations were coded according to the presenting problem, diagnosis, outcome, and whether the presentations were potentially preventable. Preventable presentations include those presentations considered to be avoidable and those that could have been managed by a local primary care or community service. There were 1252 presentations to the SCH ED by 453 Aboriginal children aged 0-15 years. More than 50% of children presented more than once. Seventy-nine children presented more than five times. Nearly 45% of presentations were coded as potentially preventable. A significant proportion of ED presentations were potentially preventable with the use of culturally appropriate and accessible local community and primary health care services and better referral pathways back to these services. Community engagement is required to raise awareness of common presentations and to look at strategies to prevent common problems both occurring and presenting to the ED. This will enhance the health of urban Aboriginal children.
Publisher: Wiley
Date: 05-08-2021
DOI: 10.1111/JPC.15017
Publisher: Wiley
Date: 07-2007
Publisher: BMJ
Date: 22-12-2022
DOI: 10.1136/ARCHDISCHILD-2022-324442
Abstract: To describe the health and well-being of children and young people (CYP) seeking asylum subjected to Australia’s immigration policy of indefinite mandatory detention on Nauru. Cross-sectional analysis of a cohort of CYP seeking asylum. Australian paediatric clinicians from 10 health services completed detailed health assessments around the time of transfer from Nauru, mostly to Australia. Sixty-two CYP who were ≤18 years on entry into offshore immigration detention on Nauru between 2013 and 2019. Mean age at health assessment was 9 years. Health outcomes were categorised as physical, mental or neurodevelopmental concerns/conditions. Risk and protective factor data were collected using the adverse childhood experiences and refugee-specific adverse childhood experiences tools. Over half of the CYP (n=32, 52%) were held on Nauru for ≥4 years. The vast majority of CYP had physical health (n=55, 89%) and mental health (n=49, 79%) concerns including self-harm or suicidal ideation/attempt (n=28, 45%). Mental health concerns were more likely in CYP who were school-aged (p=0.001), had been held on Nauru for ≥1 year (p=0.01) originated from the Eastern Mediterranean region (p .05) witnessed trauma (p .05) or had exposure to ≥4 refugee-specific adverse childhood experiences (p .05). Neurodevelopmental concerns were seen in eight children (13%). This study highlights the almost universal physical and mental health difficulties in a s le of CYP who experienced forced migration and were subjected to Australia’s offshore immigration detention policy. Immigration detention in recipient countries, a known adverse childhood experience, may contribute to or exacerbate harmful outcomes in CYP seeking asylum.
Publisher: Wiley
Date: 29-09-2016
DOI: 10.1111/JPC.12989
Abstract: To describe the development of the Optimising Health and Learning Program, guided by the only available published framework for the delivery of health services to newly arrived refugee children and report on the evaluation of the programme. We conducted process and impact evaluation using a mixed methods approach. The s le was 294 refugee young people enrolled in two Intensive English Centres in New South Wales. We collected quantitative data (demographic and clinical information) as well as qualitative data via focus groups, key informant interviews, surveys and programme documentation. Qualitative data were subjected to thematic analysis programme documents underwent document review. There were high levels of programme participation (90%), and the yield from routine health screening was high (80% of participants screened positive for two or more health conditions). All identified programme development strategies were implemented programme partners and participants reported satisfaction with the programme. Sixteen programme partners were identified with a high level of intersectoral collaboration reported. Significant in-kind contributions and seed funding enabled the uptake of the programme to increase from one to five Intensive English Centres over a 4-year period. Process and impact evaluation identified that the programme was well implemented and met its stated objectives of increasing the detection of health conditions likely to impact on student health and learning linkage of newly arrived students and their families with primary health care and coordination of care across primary health and specialist services.
Publisher: BMJ
Date: 06-2020
Publisher: BMJ
Date: 09-2000
DOI: 10.1136/ADC.83.3.227
Abstract: To document the impact that rapid increases in HIV infection in hospitalised children at Chris Hani Baragwanath Hospital has had on in-hospital mortality. Hospital discharge summaries from January 1992 to the end of 1996 were reviewed. There were 20 733 admissions in the five year period 7985 (39%) were tested for HIV. In tested admissions above 15 months of age, 4.9% were HIV infected in 1992, increasing to 35% in 1996. Under 15 months of age, 9% of tested admissions were positive in 1992, increasing to 46% in 1996. The proportion of all hospital deaths occurring in children considered HIV infected (ELISA testing together with clinical features if 15 months or younger) increased from 6.7% in 1992 to 46. 1% in 1996 (p < 0.001). In-hospital mortality for all children increased by 21% from 4.3% in 1992 to 5.2% in 1996. Mortality rates declined in uninfected children from 5.4% in 1992 to 4.5% in 1996 (chi(2) trend 3.3 p = 0.06). The mortality rate of children has increased at Chris Hani Baragwanath Hospital as a result of HIV infection. Almost half the deaths were HIV related in 1996. HIV infection is threatening the advances that have been made on child survival in South Africa over the last few decades.
Publisher: BMJ
Date: 27-11-1999
Publisher: Wiley
Date: 14-06-2015
DOI: 10.1111/CCH.12265
Abstract: While current strategies to address the needs of vulnerable child populations in Australia aim to reduce inequities, they are isolated, group specific and disparate. The aim of this study was to address health inequities by generating tools that are useful in clinical service settings to assist with the identification, prioritization and monitoring of all vulnerable populations. Current local and national initiatives to address inequities were reviewed. Shared strategies in delivering health services to vulnerable populations were highlighted, and existing tools used for identification and prioritization were adapted. Analysis of at-risk populations resulted in the formulation of four key questions to identify vulnerable children at presentation to services and strategies for prioritizing children within services. An existing refugee child health service delivery framework was adapted as a proposal for use in the development and evaluation of services for all vulnerable child populations. A systemic approach across all vulnerable populations, supplemented by group-specific measures, is likely to add value to health service delivery as well as be more efficient and sustainable than multiple group-specific interventions. Given the limited outcome evidence available, there is also a need to collect data on vulnerable children and to track the effectiveness of interventions designed to address their health needs.
Publisher: Wiley
Date: 15-06-2015
DOI: 10.1111/CCH.12264
Abstract: Children and young people from vulnerable population groups, including Indigenous Australians, those in out of home care, those with disabilities and those from refugee families, have difficulties in accessing health services and are at high risk of adverse outcomes, driving population health inequity. Although heterogeneous, these groups face common disadvantage and shared challenges in health service utilization. This study aims to analyse the demographics of vulnerable child populations in NSW, the rationale for focussing on their health needs and strategies for addressing population health inequity. A literature review was undertaken on vulnerable child populations and successful strategies for improving their health outcomes. NSW data on vulnerable children were collated. Vulnerable children in NSW are estimated to comprise 10-20% of the childhood population. Efforts to improve their health and well-being can be justified based on child rights, a focus on equity and effectiveness of care, public opinion and the evidence base supporting such interventions. Targeted (subpopulation specific) interventions and delivery of universally applied (population wide) strategies that disproportionately benefit vulnerable populations have been shown to be effective in reducing healthcare disparities. Most available information relates to specific vulnerable population groups. However, some effective strategies and key principles are broadly applicable to the vulnerable child population as a whole. Vulnerable children should be a key focus of healthcare interventions if inequities are to be addressed.
Publisher: Wiley
Date: 07-2015
DOI: 10.1111/JPC.12953
Publisher: Wiley
Date: 07-2015
DOI: 10.1111/JPC.12954
Publisher: Springer Science and Business Media LLC
Date: 27-06-2019
Publisher: Wiley
Date: 16-09-2022
DOI: 10.1111/JPC.15747
Abstract: Multi-site research studies are essential if we are to conduct national research across all Australian jurisdictions. There is widespread agreement among clinicians and researchers that obtaining essential approvals to conduct multi-site research studies in Australia can be complex, bureaucratic and time consuming. Although there is inherent value in the review process, resources and months of valuable research time are often expended long before the study has begun. Using our recent experience for a multi-site, longitudinal paediatric cohort study of children and adolescents who were detained in offshore immigration detention on Nauru, we describe the process of navigating the ethics and governance approval systems. We identify tips for researchers and clinicians conducting multi-site studies, including early consultation with ethics and governance committees, using their recommended templates, anticipating time delays, and commencing time consuming processes as early as permissible. Our recommendations at the systemic level include streamlined and integrated ethics and governance review processes for all Australian jurisdictions, with co-ordinated requests for further information, a standardised approach across all Research Governance Offices, a rapid system for addressing amendments and in idualised study support and consultations. Above all, a nationally agreed framework whereby ethics and governance committees across jurisdictions communicate with each other, use the same electronic platform and present a unified process whilst protecting the welfare, rights, dignity and safety of research participants is required. The complexity of the current ethics and governance processes may inadvertently and unintentionally be a barrier to conducting ethical research.
Publisher: Informa UK Limited
Date: 04-1998
DOI: 10.1080/09540129850124488
Abstract: This paper describes the development of a community-based family HIV clinic in south London, an area with one of the highest rates of HIV seroprevalence in the UK. The King's family clinic was developed by broadening existing interdisciplinary services for women with HIV, utilizing the strengths of community-based paediatric care as well as integrating paediatric support from acute hospital-based services. Different models of care for children infected or affected by HIV and problems encountered in developing the service, including ethical dilemmas, and current activity are discussed.
Publisher: BMJ
Date: 03-2020
DOI: 10.1136/BMJPO-2019-000615
Abstract: Immigration detention has a profound and negative impact on the physical health, mental health, development and social-emotional well-being of children, adolescents and their families. Australian clinicians will report results from detailed health and well-being assessments of asylum seeking children and adolescents who have experienced prolonged immigration detention. This is a national, multicentre study with a longitudinal cohort design that will document health and well-being outcomes of the children and adolescents who have been detained in offshore detention on the remote island of Nauru. Outcome measures will be reported from the time arrival in Australia and repeated over a 5-year follow-up period. Measures include demographics, residency history and refugee status, physical health and well-being outcomes (including mental health, development and social-emotional well-being), clinical service utilisation and psychosocial risk and protective factors for health and well-being (eg, adverse childhood experiences). Longitudinal follow-up will capture outcomes over a 5-year period after arrival in Australia. Analysis will be undertaken to explore baseline risk and protective factors, with regression analyses to assess their impact on health and well-being outcomes. To understand how children’s outcomes change over time, multilevel regression analysis will be utilised. Structural equation modelling will be conducted to explore the correlation between baseline factors, mediational factors and outcomes to assess trajectories over time. This research project was approved by the Sydney Children’s Hospitals Network Human Research Ethics Committee. Subsequent site-specific approvals have been approved in 5 of the 11 governing bodies where the clinical consultations took place. In order to ensure this research is relevant and sensitive to the needs of the cohort, our research team includes an asylum seeker who has spent time in Australian immigration detention. Results will be presented at conferences and published in peer-reviewed Medline-indexed journals.
Publisher: Wiley
Date: 04-2015
DOI: 10.1111/JPC.12873
Publisher: BMJ
Date: 11-07-2018
DOI: 10.1136/ARCHDISCHILD-2016-312495
Abstract: This longitudinal study investigated protective factors for social-emotional well-being in refugee children in Australia. Newly arrived refugee children aged 4–15 years were recruited between 2009 and 2013 and assessments were conducted at two points, at years 2 and 3 postarrival. Social-emotional well-being was assessed using the Strengths and Difficulties Questionnaire (SDQ). Protective factors were assessed by structured interview and the Social Readjustment Rating Scale (SRRS) scores reflect fewer stressful life events in the previous year. Forty-three eligible refugee children were recruited. The SDQ was completed by parents in 90% and protective factor data in 80% at years 2 and 3 of follow-up. Protective factors for normal SDQ scores were: originating from Africa (p=0.01), father present on arrival (p=0.019) and family SRRS scores at year 2 (p=0.045). The median number of protective factors was 4 (range 1–8). Better SDQ scores were associated with ≥4 protective factors (p .006). Furthermore, more protective factors increased the child’s likelihood of a stable or improved SDQ score over time (p .04). Modifiable protective factors likely to promote social-emotional well-being include stability in the child’s school and residence, parental employment, financial and marital stability, proximity to one’s own ethnic community and external community support. Cumulative protective factors, some of which are potentially modifiable, can predict social-emotional well-being in newly arrived refugee children. Children with four or more protective factors are at low risk of poor social-emotional well-being.
Publisher: Wiley
Date: 07-2015
DOI: 10.1111/JPC.12950
Publisher: Springer Science and Business Media LLC
Date: 24-11-2017
DOI: 10.1007/S00787-017-1082-Z
Abstract: Accumulating literature demonstrates that immigration detention is harmful to children. However, there is a scarcity of scientifically rigorous and reliable data about the health of children held in detention facilities. The aim of the study was to compare a community-based population of recently arrived refugee children flown into Australia, not detained, resettled in a non-urban area, with a population of children who arrived by boat seeking asylum, detained since arrival. The parent-version of the strength and difficulties questionnaire (SDQ) of children aged 4-15 years was compared in children living in the community with those held in detention. We compared 86 children who had a parent-completed SDQ performed, 38 (44%) in the community group and 48 (56%) in the detention group. The community s le had been living in Australia for 325 days, with no time in detention. The detention s le had been living in detention for a mean of 221 days. The mean age was similar for the community and detention s le at 8.4 years (P = 0.18). In the total s le, children in the detention group had significantly higher SDQ total difficulties scores than children in the community group (P < 0.0001). There was no difference between age groups (P = 0.82). The children in the detention group had, on average, an SDQ total difficulties score that was 12 points higher than children in the community group. Four of the five SDQ subscale scores indicated greater disturbance amongst children in detention (< 0.0001) compared to children living in the community. The detention group had significantly higher scores (P < 0.001) for all except Pro-social scores as compared to Australian norms for the 4-6 and 7-15 years age group. This study presents a rare opportunity to compare the wellbeing of displaced children who were detained following arrival in Australia with those settled in the Australian community since arrival. The community children's scores approximated data from the general Australian childhood population. Children held in detention had significantly more social, emotional and behavioural difficulties than children living in the community, and at levels resembling a clinical cohort. Despite the small s le size, data restrictions and other limitations of the data, statistical significance in differences between the community and detention children is marked and arguably demonstrates the negative impact of post-arrival detention in children who are presumed to have similar levels of pre-arrival adversity. If the objective is to optimise the health and wellbeing of children seeking asylum, removal of post-arrival detention is one of the most powerful interventions available to host countries.
Publisher: Wiley
Date: 07-07-2010
DOI: 10.1111/J.1440-1754.2010.01796.X
Abstract: To propose a framework for good practice to promote improved access, equity and quality of care in service delivery for newly arrived refugee children. Development of a framework based on national and international literature and current service models in Australian paediatric refugee health. Ten elements of a framework for good practice were identified: comprehensive health screening coordination of initial and ongoing health care integration of physical, developmental and psychological health care consumer participation culturally and linguistically appropriate service provision intersectoral collaboration accessible and affordable services and treatments data collection and evaluation to inform evidence-based practice capacity building and sustainability and advocacy. High-quality care can be achieved through a range of service models. The elements identified provide a framework for evaluating current services and for planning future service development. The framework for good practice can be applied to facilitate improvements in refugee health care and to reduce the gap between health needs and currently available services.
Publisher: Informa UK Limited
Date: 09-2020
Publisher: Wiley
Date: 06-08-2007
DOI: 10.1111/J.1440-1754.2007.01147.X
Abstract: Human rights are those basic standards without which people cannot live in dignity. Children are at risk of human rights violations because of their vulnerability in society. The Convention on the Rights of the Child (CRC), a United Nations (UN) treaty acknowledges that addressing children's human rights requires special attention. In Australia groups such as children seeking asylum, Aboriginal and Torres Strait Islander children, children with disabilities, children in care and children living in poverty are identified to be at particular risk. As in iduals and collectively, we have had a long history of gathering information, advocacy and tailoring training to improve children's health and well-being. A human rights approach and the use of the CRC provide an additional framework to do this.
Publisher: BMJ
Date: 03-1995
DOI: 10.1136/IP.1.1.26
Abstract: To describe the patterns and causes of childhood injury presenting to a South African township health centre in 1991. Retrospective review of clinic held case notes. Typical South-African urban township within Greater Johannesburg. 695 subjects aged 0-19 years presenting as a direct result of injury. Overall rates of presentation for injury were 6297/100,000/year (95% confidence interval 5463 to 7131) 35% of injuries were caused by violence, 14% by traffic, and 51% by other unintentional causes (such as falls and sport injuries). Males had higher rates of presentation than females for violent (p < 0.001) and unintentional injuries (p < 0.01), but rates were similar for traffic injuries. The highest rates were for injuries caused by violence in 15-19 year-old males and were 9319/100,000/year. Rates are lower than in more developed countries. However, they appear to represent the more severe end of the spectrum of injury severity. The rates are similar for those below age 10 years and higher for those above age 10 years compared with severe injury rates in other studies. These data are likely to underestimate true rates. The risk of injuries caused by violence increase with age and these injuries are more serious than those due to other causes. Males are at higher risk for all types of injury except traffic injury.
Publisher: Wiley
Date: 11-2012
DOI: 10.1111/J.1440-1754.2012.02588.X
Abstract: The study aims to assess the sensitivity and specificity of the Australian Developmental Screening Test (ADST) in a clinical setting in detecting developmental concerns that warrant further assessment or treatment. Clients referred to an inner Sydney Community Health Centre with developmental concerns were initially assessed using the ADST, followed within 12 weeks by an assessment using the Griffiths Mental Developmental Scales (GMDS) as the gold standard. Of the 65 eligible children, 46 (71%) had results indicating further assessment (42) or follow-up (4) was needed (using the criteria recommended in the ADST manual). However, of these only 21 (46%) had an abnormal GMDS. This gave a sensitivity of 95% but a specificity of only 52%. New threshold criteria for further assessment were developed and applied to three age groups. If children aged under 2 years are assessed using the standard ADST threshold, and children 2 years or older are assessed using the new ADST cut-off, then the tool has a sensitivity of 95%, a specificity of 82%, a positive likelihood ratio of 5.24 (95% CI 2.78, 9.88) and negative likelihood ratio of 0.06 (0.01, 0.40). Modified criteria for the ADST developed in this study showed good specificity and sensitivity for detection of developmental problems in this population, referred because of developmental concerns. Further testing to see if these new criteria perform well in a different population is now needed.
Publisher: Wiley
Date: 13-05-2007
Publisher: Wiley
Date: 15-07-2018
DOI: 10.1111/JPC.14072
Abstract: To determine the cultural competency training, knowledge and attitudes of health professionals about Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) health-care delivery. Survey of medical (n = 200), nursing (n = 200) and other health professionals (n = 210) working in two tertiary paediatric hospitals in December 2013. The main outcome measures were training in Aboriginal health-care delivery, knowledge of Aboriginal health and services, attitudes to identification of Aboriginal patients and suggested ways to improve health-care delivery to Aboriginal patients. We received responses from 286 of 572 (50.0%) staff with valid emails: 75 medical, 88 nursing and 123 other health professionals. A minority reported receiving specific Aboriginal health training (126/286, 44.8%) and Aboriginal cultural competency training (106/286, 37.1%). Medical staff were less likely than others to report Aboriginal health-care training (P = 0.01), cultural competency training (P < 0.001) and that their training equipped them to manage Aboriginal patients (P = 0.04). Few medical staff reported a good/very good knowledge of the services provided by the Aboriginal Community Controlled Health Services (20.0%), the Federal Government Closing the Gap initiative (14.7%) or the Royal Australasian College of Physicians' Reconciliation Action Plan (8.0%). Only 62 of 286 (21.7%) staff agreed that they usually asked patients arents whether they identified as Aboriginal. Although 256 of 286 (89.5%) agreed that Aboriginal staff were an important resource, only 125 of 286 (43.7%) had referred Aboriginal patients to one. The opportunities we have identified to improve health-care delivery to Aboriginal patients include: increasing Aboriginal cultural competency training, correct identification of Aboriginal patients, referring Aboriginal patients to Aboriginal health-care services and increased awareness of Aboriginal Community Controlled Health Services.
Publisher: SAGE Publications
Date: 21-12-2018
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/AH14259
Abstract: Objectives The aims of the present study were to: (1) describe the health status and health indicators for urban Aboriginal children (age 0–16 years) in south-east Sydney and (2) evaluate the quality of routinely collected clinical data and its usefulness in monitoring local progress of health outcomes. Methods Aboriginal maternal and child health routine data, from multiple databases, for in iduals accessing maternal and child health services between January 2007 and December 2012 were examined and compared with state and national health indicators. Results Reductions in maternal smoking, premature delivery and low birthweight delivery rates were achieved in some years, but no consistent trends emerged. Paediatric services had increased referrals each year. The most frequent diagnoses were nutritional problems, language delay or disorder and developmental delay or learning difficulties. Twenty per cent of children had a chronic medical condition requiring long-term follow-up. Aboriginal children were more likely to be discharged from hospital against medical advice than non-Aboriginal children. Routinely collected data did not include some information essential to monitor determinants of health and health outcomes. Conclusions Aboriginal children living in this urban setting had high levels of need. Routinely recorded data were suboptimal for monitoring local health status and needed to reflect national and state health indicators. Routinely collected data can identify service gaps and guide service development. What is known about this topic? Despite improvements in some areas, there continue to be significant gaps in maternal and child health outcomes between Aboriginal and non-Aboriginal Australians. These are poorly documented at a local service level. What does this paper add? Intensive, local services offered to Aboriginal women and children can result in rapid service engagement. Health service data routinely collected by local services can be used to demonstrate reductions in antenatal risk factors in pregnant Aboriginal women, even within the short time frame of 6 years. However, improvements in child health outcomes may require longer time frames. In this urban setting, the most frequent diagnoses in Aboriginal children attending the service were nutritional problems, language delay or disorder and developmental delay or learning difficulties. What are the implications for practitioners? Key information regarding determinants of health should be routinely monitored at a local level to understand local rates and health needs in addition to evaluating and quantifying the effectiveness of service delivery or health promotion activities.
Publisher: BMJ
Date: 08-2016
Publisher: John Wiley & Sons, Ltd
Date: 18-07-2007
Publisher: Wiley
Date: 16-04-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2013
Publisher: Wiley
Date: 27-03-2015
DOI: 10.1111/CCH.12246
Abstract: In Australia, Aboriginal children experience significantly poorer health outcomes compared with non-Aboriginal children. Health policies aimed at improving Aboriginal health outcomes include interventions in the early childhood period. There is a need for government health services to work in partnership with Aboriginal people and other services to achieve the highest level of health possible for Aboriginal children, who often require a range of services to meet complex needs. This paper describes the views of service providers on how paediatric outreach services work in partnership with other services, Aboriginal families and the community and how those partnerships could be improved to maximize health outcomes for children. In-depth, semi-structured interviews and focus groups were conducted with managers and service providers over a 6-week period in 2010. The views and suggestions of participants were documented and a thematic analysis was undertaken. Analysis of two focus groups with seven service providers and five in idual interviews with service managers resulted in the identification of four themes: (i) using informal and formal ways of working (ii) cultivating effective relationships (iii) demonstrating cultural sensitivity and (iv) forging strong leadership. Use of formal and informal approaches facilitated effective relationships between service providers and Aboriginal families and communities. Partnerships with the community were founded on a culturally appropriate model of care that recognized a holistic approach to health and wellness. Leadership emerged as an essential component of effective partnerships, cultivating the ethos of the workplace and creating an environment where collaboration is supported. Culturally appropriate child health services, which utilize effective relationships and employ a range of informal and formal collaboration with other services and community members, are well positioned to implement health policy and improve access to services for Aboriginal children with better health outcomes as a result.
Location: Australia
No related grants have been discovered for Karen Zwi.