Child and adolescent obesity: part of a bigger picture

The prevalence of childhood overweight and obesity has risen substantially worldwide in less than one generation. In the USA, the average weight of a child has risen by more than 5 kg within three decades, to a point where a third of the country's children are overweight or obese. Some low-income and middle-income countries have reported similar or more rapid rises in child obesity, despite continuing high levels of undernutrition. Nutrition policies to tackle child obesity need to promote healthy growth and household nutrition security and protect children from inducements to be inactive or to overconsume foods of poor nutritional quality. The promotion of energy-rich and nutrient-poor products will encourage rapid weight gain in early childhood and exacerbate risk factors for chronic disease in all children, especially those showing poor linear growth. Whereas much public health effort has been expended to restrict the adverse marketing of breastmilk substitutes, similar effort now needs to be expanded and strengthened to protect older children from increasingly sophisticated marketing of sedentary activities and energy-dense, nutrient-poor foods and beverages. To meet this challenge, the governance of food supply and food markets should be improved and commercial activities subordinated to protect and promote children's health.

Child sexual abuse research: challenges of case tracking through administrative databases

Child sexual abuse has a serious impact on victims, their families and the broader community. As such, there is a critical need for sound research evidence to inform specialist responses. Increasingly, researchers are utilising administrative databases to track outcomes of individual cases across health, justice and other government agencies. There are unique advantages to this approach, including the ability to access a rich source of information at a population-wide level. However, the potential limitations of utilising administrative databases have not been fully explored. Because these databases were created originally for administrative rather than research purposes, there are significant problems with using this data at face value for research projects. We draw on our collective research experience in child sexual abuse to highlight common problems that have emerged when applying administrative databases to research questions. Some of the problems discussed include identification of relevant cases, ensuring reliability and dealing with missing data. Our article concludes with recommendations for researchers and policy-makers to enhance data quality.

The effect of victim age on police authorisation of charges in cases of child sexual abuse

In the study, a cohort of 440 child sexual abuse cases were used to model the effect of victim age on police authorisation of charges. Linear and quadratic effects of age were modelled in a logistic regression that controlled for case characteristics and evidence. The quadratic effect of victim age was strengthened when control variables were included in the model and the linear effect of age was not significant in the final model. The results indicated that cases involving victims in middle childhood had a higher proportion of suspects charged than cases involving victims in early childhood and adolescence. Possible mediators of the relationship between victim age and charges were explored and it was found that cases with older victims had a higher prevalence of extra-familial abuse and suspect confessions, and these factors had a positive effect on the proportion of suspects charged. Possible explanations for the quadratic effect of victim age and mediation are discussed.

The missing evidence: a systematic review of patients' experiences of adverse events in health care

PURPOSE: Preventable patient harm due to adverse events (AEs) is a significant health problem today facing contemporary health care. Knowledge of patients' experiences of AEs is critical to improving health care safety and quality. A systematic review of studies of patients' experiences of AEs was conducted to report their experiences, knowledge gaps and any challenges encountered when capturing patient experience data. DATA SOURCES: Key words, synonyms and subject headings were used to search eight electronic databases from January 2000 to February 2015, in addition to hand-searching of reference lists and relevant journals. STUDY SELECTION: Titles and abstracts of publications were screened by two reviewers and checked by a third. Full-text articles were screened against the eligibility criteria. DATA EXTRACTION: Data on design, methods and key findings were extracted and collated. RESULTS: Thirty-three publications demonstrated patients identifying a range of problems in their care; most commonly identified were medication errors, communication and coordination of care problems. Patients' income, education, health burden and marital status influence likelihood of reporting. Patients report distress after an AE, often exacerbated by receiving inadequate information about the cause. Investigating patients' experiences is hampered by the lack of large representative patient samples, data over sufficient time periods and varying definitions of an AE. CONCLUSION: Despite the emergence of policy initiatives to enhance patient engagement, few studies report patients' experiences of AEs. This information must be routinely captured and utilized to develop effective, patient-centred and system-wide policies to minimize and manage AEs.

Spatial abundance patterns and recruitment of a virus-affected commercial mollusc fishery

 Infectious pathogens figure prominently among those factors threatening marine wildlife. Mass mortality events caused by pathogens can fundamentally alter the structure of wild fish stocks and depress recruitment rates and yield. In the most severe instances, this can precipitate stock collapses resulting in dramatic economic losses to once valuable commercial fisheries. An outbreak of a herpes-like virus among commercially fished abalone populations in the south-west fishery of Victoria, Australia, during 2006-2007, has been associated with high mortality rates among all cohorts. Long-term records from fishery-independent surveys of blacklip abalone Haliotis rubra (Leach) enabled abundance from pre- and post-viral periods to be analysed to estimate stock density and biomass. The spatial distribution of abundance in relation to physical habitat variables derived from high-resolution bathymetric LiDAR data was investigated. Significant differences were observed in both measures between pre- and post-viral periods. Although there was some limited evidence of gradual stock improvement in recent years, disease-affected reefs have remained below productivity rates prior to the disease outbreak suggesting a reduction in larval availability or settlement success. This was corroborated by trends in sublegal sized blacklip abalone abundance that has yet to show substantial recovery post-disease. Abundance data were modelled as a function of habitat variables using a generalised additive model (GAM) and indicated that high abundance was associated with complex reef structures of coastal waters (<15 m). This study highlights the importance of long-term surveys to understand abalone recovery following mass mortality and the links between stock abundance and seafloor variability.

The effect of complainant age on outcomes in the criminal justice system: case tracking from report to conviction

 The thesis explored child sexual abuse in the criminal justice system and how victim age predicted case outcomes, including disclosures, charges and convictions. The findings highlighted that adolescent victims may experience unique challenges. Further, the relationships between victim age, case characteristics and evidence are crucial to explaining case outcomes.