Lung sickness in Murri kids : a cohort study in urban Indigenous children

QLD, 4Murri Health Group, Caboolture, QLD Introduction Respiratory illnesses with cough as a symptom are predominant causes of morbidity in young Australian Indigenous children. With the exception of ear disease, there are limited studies that have addressed burden and outcome. Also, there are no studies that are specific to urban Indigenous children. Aim: We aim to comprehensively investigate the incidence, aetiology, risk factors for and outcomes of acute respiratory illnesses (ARIs) in this population. Methods A cohort study of Indigenous children aged less than 5 years registered with an urban Indigenous primary health care service. Comprehensive baseline data are collected and children are followed monthly for 12 months to capture ARI events. ARI events are subsequently followed weekly for 4 weeks to determine cough outcomes, with review by a paediatric respiratory physician if cough has not resolved within 28 days. Results To date, 58 children (57% female) have been enrolled and 46 ARIs have been captured over 907 child weeks of observation (5.1 events per 100 child weeks, 95%CI 3.7–6.8). 13 ARIs (28.3%) have resulted in persistent cough for >28 days following onset. Conclusion Our early findings suggest an excess incidence of ARI in this population. The proportion of ARIs resulting in persistent cough for more than 4 weeks is the highest yet reported. Key Words: Indigenous, acute respiratory illness, paediatric.

What’s driving the uptake of prefabricated housing in Australia?

Prefabrication has been promoted as a means to improve the efficiency of the Australian house building industry. Issues affecting the uptake of prefabrication were identified through interviews with small and medium sized building companies. Prefabrication’s specific impact on housing construction and smaller organisations has not been frequently investigated. Similar past research has been conducted without the use of a clear theoretical grounding guiding the identification of relevant issues. The current study is guided by a combination of the Theory of Planned Behaviour (TPB) and the Technology Acceptance Model (TAM). This allowed the identification of a broad range of issues across attitudinal, normative, behavioural control and technology adaptation domains. Results revealed improved quality was often offset against practical cost implications. While a high quality of prefabricated products was reported, key technical challenges included coordinating the transporting of modules, and balancing standardisation and product flexibility. Resistance from traditional industry stakeholders regarding build methods, financing, and openness to encouraging prefabrication was commonly reported. The key role of government decision making in facilitating greater demand and competitiveness of prefabricated businesses in the consumer marketplace was also highlighted. Further research is currently being undertaken by the authors, which builds on the exploratory results of the current study through confirmatory, quantitative surveying.

Treatment for gender dysphoria in children : the new legal, ethical and clinical landscape

- Gender dysphoria is a condition in which a child's subjectively felt identity and gender are not congruent with her or his biological sex. Because of this, the child suffers clinically significant distress or impairment in social functioning. - The Family Court of Australia has recently received an increasing number of applications seeking authorisation for the provision of hormones to treat gender dysphoria in children. - Some medical procedures and interventions performed on children are of such a grave nature that court authorisation must be obtained to render them lawful. These procedures are referred to as special medical procedures. - Hormonal therapy for the treatment of gender dysphoria in children is provided in two stages occurring years apart. Until recently, both stages of treatment were regarded by courts as special medical treatments, meaning court authorisation had to be provided for both stages. - In a significant recent development, courts have drawn a distinction between the two stages of treatment, permitting parents to consent to the first stage. In addition, it has been held that a child who is determined by a court to be Gillick competent can consent to stage 2 treatment. - The new legal developments concerning treatment for gender dysphoria are of ethical, clinical and practical importance to children and their families, and to medical practitioners treating children with gender dysphoria. Medical practitioners should benefit from an understanding of the recent developments in legal principles. This will ensure that they have up-to-date information about the circumstances under which treatment may be conducted with parental consent, and those in which they must seek court authorisation.

Toward making inroads in reducing the disparity of lung health in Australian Indigenous and New Zealand Maori children

Globally, Indigenous populations, which include Aboriginal and Torres Strait islanders in Australia and Māori people in New Zealand (NZ), have poorer health than their non-Indigenous counterparts. Indigenous peoples worldwide face substantial challenges in poverty, education, employment, housing and disconnection from ancestral lands. While addressing social determinants of health is a priority, solving clinical issues is equally important. Indeed, ignoring the latter until social issues improve risks further disparity as this may take generations. A systematic overview of interventions addressing social determinants of health found a striking lack of reliable evaluations.Where evidence was available, health improvement associated with interventions was modest or uncertain. 10 Thus advances in healthcare remain essential and these require the best evidence available in 11 preventing and managing common illnesses, including respiratory illnesses.

How to plan and implement an environmental education program for a conservation area : lessons from Australia and Borneo

The Augo Wetland Forest Park, along with other conservation areas around the world, provides an opportunity for a personal connection with the natural world - an opportunity for creating ways to convince people to reverse the degradation of the planet. In this presentation I use the settings approach, as used by the World Health Organisation in health promotion, as a framework. The WHO’s 1986 Ottawa Charter states that "Health is created and lived by people within the settings of their everyday life; where they learn, work, play, and love." I argue that, similarly, a conservation area provides a setting for people to connect with environmental issues and can be the place where positive behaviours and actions for the environment are created and enacted. In a wired and virtual world, such settings may be the only opportunity some people, especially children, get to connect with the environment. An evidence-based, intentionally designed and implemented environmental education program enhances the opportunities for the personal connection and subsequent action. Planning and implementing an Environmental education program for a conservation area requires an understanding of the principles of three domains: • Environmental Communication • Environmental Education • Environmental Interpretation In this presentation I define these domains and demonstrate how they become interdependent within the context of a particular setting such as a conservation area. I outline the principles of each domain and demonstrate how they can be enacted with reference to environmental education program case studies from settings in Australia and Borneo. The first case study is based around a proposal for a planned residential community at Eden’s Crossing, in Brisbane’s high growth Western corridor. The setting featured a number of important natural and heritage conservation characteristics and the developer wanted to be pro-active in informing the market what this development aims to achieve in terms of innovative community and environmental objectives. By designing an education and interpretation program in line with best practice education and interpretation principles the developers would be assisted in their efforts to build community, preserve heritage, and facilitate environmentally sensitive lifestyles for the future residents of Eden’s Crossing. Above all, the strategy focused on advancing sustainability in a way that made the Eden’s Crossing greenfield development significantly greener. It did this by interacting with prospective purchasers, and building knowledge about sustainability with a view to shaping the future community of Eden’s Crossing in terms of attitudes and behaviours. The second case study is based around the development of the Rainforest Interpretation Centre (RIC), now renamed the Rainforest Discovery Centre, an environmental education facility managed by the Sabah Forestry Department (SFD) and located at the edge of the Kabili-Sepilok Forest Reserve in the East Malaysian state of Sabah (Borneo). This setting is of paramount importance for biodiversity conservation and research and a vital habitat for orang utan. As an Environmental Education Consultant I was tasked with developing an environmental education program for this setting as part of the SFD’s long- term strategy towards sustainable forest management. By employing the principles of Environmental Education and Environmental Interpretation I designed and implemented a program with three major components: • an environmental education component for visiting primary and secondary school groups. • an environmental education component for in-service and pre-service teachers and teacher educators. • a public awareness and environmental interpretation component which caters for the general public and tourists. From these modest beginnings the program has expanded and new facilities have been developed to meet the demands of visitors, teachers and students. The effectiveness of the program can be traced back to the grounding in the principles of best practice environmental education, communication and interpretation.

Child and youth sport in rurally remote regions of Australia: the views of a north Queensland community

This study addresses the under-researched area of community sport in rurally isolated contexts. Data were gathered using semi-structured interviews with teachers, children, parents, and local community members from a small township in an isolated North Queensland region. The data indicate that community sport for young people is circumstantially difficult in some regional centres, but is none-the-less viewed differently by different sectors of the community. There is much value ascribed to sport as part of the social and cultural capital of the area however, it appears that community opinion is divided on the quality of sport experiences available with the young people of the community being particularly critical of the facilities, equipment, and the level of service from sports organisations in larger towns and cities.

Associations between early shared music activities in the home and later child outcomes : findings from the Longitudinal Study of Australian Children

The benefits of early shared book reading between parents and children have long been established,yet the same cannot be said for early shared music activities in the home. This study investigated the parent–child home music activities in a sample of 3031 Australian children participating in Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC) study. Frequency of shared home music activities was reported by parents when children were 2–3 years and a range of social, emotional,and cognitive outcomes were measured by parent and teacher report and direct testing two years later when children were 4–5 years old. A series of regression analyses (controlling for a set of important socio-demographic variables) found frequency of shared home music activities to have a small significant partial association with measures of children’s vocabulary, numeracy, attentional and emotional regulation, and prosocial skills. We then included both book reading and shared home music activities in the same models and found that frequency of shared home music activities maintained small partial associations with measures of prosocial skills, attentional regulation, and numeracy. Our findings suggest there may be a role for parent-child home music activities in supporting children’s development.

The challenges of meeting the needs of children with Autism Spectrum Disorders (ASD) during out of hospital interactoins with Paramedics

This poster presents the results of a critical review of the literature on the intersection between paramedic practice with Autism Spectrum Disorder (ASD) and previews the clinical and communication challenges likely to be experienced with these patients. Paramedics in Australia provide 24/7 out-of-hospital care to the community. Although their core business is to provide emergency care, paramedics also provide care for vulnerable people as a consequence of the social, economic or domestic milieu. Little is known about the frequency of use of emergency out-of-hospital services by children with ASD and their families. Similarly, little is known about the attitudes and perceptions of paramedics to children with ASD and their emergency health care. However, individuals with ASD are likely to require paramedic services at some point across the life span and may be more frequent users of health services as a consequence of the challenges they face. The high rate of co-morbidities of people diagnosed with ASD is reported and includes seizure disorders, gastro-intestinal disorders, metabolic disorders, hormonal dysfunction, ear, nose and throat infections, hearing impairment, hypertension, allergies/anaphylaxis, immune disorders, migraine and diabetes, gross/fine motor skill dysfunction, premature birth, birth defects, obesity and mental illness. Individuals with ASD may frequently experience concurrent communication, behaviour and sensory challenges. Consequently, Paramedics can encounter difficulties gathering important patient information which may compromise sensitive care. These interactions occur often in high pressure and emotionally challenging environments, which add to the difficulties in communicating the treatment and transport needs of this population.

Market segmentation : insights for changing children's physical activity behaviour

Market segmentation has received relatively limited attention in social marketing, particularly within the context of changing children’s physical activity behaviour. This is an important area of investigation given growing concern over childhood obesity globally. The present research aims to extend current understanding of the applicability of market segmentation within this context. The results of a two-step cluster analysis on data from 512 respondents of an online survey show three distinct segments of caregivers, each with unique beliefs about their primary school children walking to/from school. The results demonstrate the validity of employing the process of market segmentation within this social context and provide further insights for targeting the identified segments through tailored social marketing programs.

Equal shared parental responsibility and shared care post-return to Australia under the Hague Child Abduction Convention

This article explores the outcomes experienced by abducting primary carer mothers and their children post-return to Australia under the Hague Convention on Civil Aspects of International Child Abduction.1 The circumstances faced by families that experience international parental child abduction are examined by considering how part VII of the Australian Family Law Act 1975 (Cth) is applied to resolve parenting disputes post-return. At present, the statutory criteria found in part VII encourage an equal shared parental responsibility and shared care parenting approach.2 This emphasis aligns children’s best interests with collaborative parenting3 and their parents living within close geographical proximity of each other to facilitate the practicalities of the approach.4 Arguably, these statutory criteria guide the exercise of judicial discretion to determine a child’s best interests towards a parenting arrangement that is incompatible with the lifestyle and functional characteristics of these families.

Urban Aboriginal and Torres Strait Islander children's exposure to stressful events : a cross sectional study

Objectives To determine the frequency and types of stressful events experienced by urban Aboriginal and Torres Strait Islander children, and to explore the relationship between these experiences and the children’s physical health and parental concerns about their behaviour and learning ability. Design, setting and participants Cross-sectional study of Aboriginal and Torres Strait Islander children aged ≤ 14 years presenting to an urban Indigenous primary health care service in Brisbane for annual child health checks between March 2007 and March 2010. Main outcome measures Parental or carer report of stressful events ever occurring in the family that may have affected the child. Results Of 344 participating children, 175 (51%) had experienced at least one stressful event. Reported events included the death of a family member or close friend (40; 23%), parental divorce or separation (28; 16%), witness to violence or abuse (20; 11%), or incarceration of a family member (7; 4%). These children were more likely to have parents or carers concerned about their behaviour (P < 0.001) and to have a history of ear (P < 0.001) or skin (P = 0.003) infections. Conclusions Children who had experienced stressful events had poorer physical health and more parental concern about behavioural issues than those who had not. Parental disclosure in the primary health care setting of stressful events that have affected the child necessitates appropriate medical, psychological or social interventions to ameliorate both the immediate and potential lifelong negative impact. However, treating the impact of stressful events is insufficient without dealing with the broader political and societal issues that result in a clustering of stressful events in the Aboriginal and Torres Strait Islander population.

Child health and the income gradient : evidence from Australia

The positive relationship between household income and child health is well documented in the child health literature but the precise mechanisms via which income generates better health and whether the income gradient is increasing in child age are not well understood. This paper presents new Australian evidence on the child health–income gradient. We use data from the Longitudinal Study of Australian Children (LSAC), which involved two waves of data collection for children born between March 2003 and February 2004 (B-Cohort: 0–3 years), and between March 1999 and February 2000 (K-Cohort: 4–7 years). This data set allows us to test the robustness of some of the findings of the influential studies of Case et al. [Case, A., Lubotsky, D., Paxson, C., 2002. Economic status and health in childhood: the origins of the gradient. The American Economic Review 92 (5) 1308–1344] and Currie and Stabile [Currie, J., Stabile, M., 2003. Socioeconomic status and child health: why is the relationship stronger for older children. The American Economic Review 93 (5) 1813–1823], and a recent study by Currie et al. [Currie, A., Shields, M.A., Price, S.W., 2007. The child health/family income gradient: evidence from England. Journal of Health Economics 26 (2) 213–232]. The richness of the LSAC data set also allows us to conduct further exploration of the determinants of child health. Our results reveal an increasing income gradient by child age using similar covariates to Case et al. [Case, A., Lubotsky, D., Paxson, C., 2002. Economic status and health in childhood: the origins of the gradient. The American Economic Review 92 (5) 1308–1344]. However, the income gradient disappears if we include a rich set of controls. Our results indicate that parental health and, in particular, the mother's health plays a significant role, reducing the income coefficient to zero; suggesting an underlying mechanism that can explain the observed relationship between child health and family income. Overall, our results for Australian children are similar to those produced by Propper et al. [Propper, C., Rigg, J., Burgess, S., 2007. Child health: evidence on the roles of family income and maternal mental health from a UK birth cohort. Health Economics 16 (11) 1245–1269] on their British child cohort.

What roles do contemporaneous and cumulative incomes play in the income–child health gradient for young children? Evidence from an Australian Panel

The literature to date shows that children from poorer households tend to have worse health than their peers, and the gap between them grows with age. We investigate whether and how health shocks (as measured by the onset of chronic conditions) contribute to the income–child health gradient and whether the contemporaneous or cumulative effects of income play important mitigating roles. We exploit a rich panel dataset with three panel waves called the Longitudinal Study of Australian children. Given the availability of three waves of data, we are able to apply a range of econometric techniques (e.g. fixed and random effects) to control for unobserved heterogeneity. The paper makes several contributions to the extant literature. First, it shows that an apparent income gradient becomes relatively attenuated in our dataset when the cumulative and contemporaneous effects of household income are distinguished econometrically. Second, it demonstrates that the income–child health gradient becomes statistically insignificant when controlling for parental health and health-related behaviours or unobserved heterogeneity.

Does school type affect cognitive and non-cognitive development in children? Evidence from Australian primary schools

This paper investigates the effects of primary school choices on cognitive and non-cognitive development in children using data from the Longitudinal Study of Australian Children (LSAC). We militate against the measurement problems that are associated with individual unobserved heterogeneity by exploiting the richness of LSAC data and applying contemporary econometric approaches. We find that sending children to Catholic or other independent primary schools has no significant effect on their cognitive and non-cognitive outcomes. The literature now has evidence from three different continents that the returns to attending Catholic primary schools are no different than public schools.