Parent initiated prednisolone for acute asthma in children of school age : randomised controlled crossover trial

Objective To evaluate the efficacy of a short course of parent initiated oral prednisolone for acute asthma in children of school age.

Design Double blind, randomised, placebo controlled, crossover trial in which episodes of asthma, rather than participants, were randomised to treatment.

Setting The Barwon region of Victoria, Australia.

Participants Children aged 5-12 years with a history of recurrent episodes of acute asthma.

Intervention A short course of parent initiated treatment with prednisolone (1 mg/kg a day) or placebo.

Main outcome measures The primary outcome measure was the mean daytime symptom score over seven days. Secondary outcome measures were mean night time symptom score over seven days, use of health resources, and school absenteeism.

Results 230 children were enrolled in the study. Over a three year period, 131 (57%) of the participants contributed a total of 308 episodes of asthma that required parent initiated treatment: 155 episodes were treated with parent initiated prednisolone and 153 with placebo. The mean daytime symptom score was 15% lower in episodes treated with prednisolone than in those treated with placebo (geometric mean ratio 0.85, 95% CI 0.74 to 0.98; P=0.023). Treatment with prednisolone was also associated with a 16% reduction in the night time symptom score (geometric mean ratio 0.84, 95% CI 0.70 to 1.00; P=0.050), a reduced risk of health resource use (odds ratio 0.54, 95% CI 0.34 to 0.86; P=0.010), and reduced school absenteeism (mean difference −0.4 days, 95% CI −0.8 to 0.0 days; P=0.045).

Conclusion A short course of oral prednisolone initiated by parents when their child experiences an episode of acute asthma may reduce asthma symptoms, health resource use, and school absenteeism. However, the modest benefits of this strategy must be balanced against potential side effects of repeated short courses of an oral corticosteroid.

Accepting the unacceptable : patriarchal hegemony and child support arrangements

This research explored how low-income single mothers' child support decisions were based on the 'best interests of the child'. While mothers desired joint financial responsibility for children, poor payment outcomes made mothers financially dependent on the state and resulted in single mothers' coerced acceptance of unacceptable child support arrangements.

Development of a retention model for child protection workers

This thesis addressed the critical issue of retention in the child protection workforce. Key predictors of a workers 'intention to stay' or the 'likelihood of staying' were lifestyle factors and whether a worker had contemplated leaving the organisation. The degree of satisfaction was not in itself predictive of either intentions to stay or the actual 'likelihood of staying'.

Impact of the Learn to Play program on play, social competence and language for children aged 5 - 8 years who attend a specialist school

Introduction
The aim of this study was to investigate the change in the relationship between play, language and social skills of children aged 5–8 years pre and post participation in the ‘Learn to Play’ program. The Learn to Play program is a child led play based intervention aimed at developing self-initiated pretend play skills in children.

Methods
All 19 participants attended a specialist school, with 10 of the 19 children having a diagnosis of autism. The play, language and social skills of the children were assessed at baseline and at follow up. Children were assessed using the Child-Initiated Pretend Play Assessment, the Preschool Language Scale and the Penn Interactive Peer Play Scale. Follow up data collection occurred after the children had been participating in the Learn to Play program for 1 hour twice a week for 6 months.

Results
After 6 months in the program, typical indicators of play accounted for an increase of 47.3% in shared variance with social interaction and an increase of 36% in shared variance for social connection. For language, object substitution ability accounted for 50% of the shared variance, which was an increase of 27% from baseline.

Conclusion
The ‘Learn to Play’ program was associated with increases in children's language and social skills over a 6-month period within a special school setting, indicating the Learn to Play program is an effective intervention for children with developmental disabilities. This paper presents an example of how the Learn to Play program can be adapted into a classroom setting.

School and individual-level characteristics are associated with children's moderate to vigorous intensity physical activity during school recess

Objective: The objective of this study was to identify school environmental characteristics associated with moderate to vigorous physical activity during school recess, including morning and lunch breaks.

Methods: Accelerometry data, child-level characteristics and school physical activity, policy and socio-cultural data were collected from 408 sixth grade children (mean age 11 years) attending 27 metropolitan primary schools in Perth, Western Australia. Hierarchical modelling identified key characteristics associated with children's recess moderate to vigorous physical activity (RMVPA).

Results: Nearly 40% of variability in children's RMVPA was explained by school environment and individual characteristics identified in this study. Children's higher daily RMVPA was associated with newer schools, schools with a higher number of grassed surfaces per child and fewer shaded grassed surfaces, and the physical education coordinator meeting Australian physical activity guidelines.

Conclusions: Characteristics of the school physical and social environments are strongly correlated with children's MPVA during recess.

The personal wellbeing index : psychometric equivalance for adults and school children

Despite the wealth of accumulated research evaluating subjective wellbeing (SWB) in children and adults, the validity of scores from parallel forms of SWB measures for each age group has yet to be empirically tested. This study examines the psychometric equivalence of the child and adult forms of the personal wellbeing index (PWI) using multiple-group confirmatory factor analysis. The child sample comprised 1,029 Victorian high-school students (aged 11–20) sampled across three independent studies. The adult sample comprised 1,965 Australian adults drawn from the Australian Unity Wellbeing Index. The results demonstrated strict factorial invariance between both versions, suggesting that the PWI measures the same underlying construct in adolescent and adult populations. These findings provide support for quantitative comparisons between adult and adolescent SWB data as valid.

Conducting field research in a primary school setting : methodological considerations for maximizing response rates, data quality and quantity

Background: Schools are an ideal setting in which to involve children in research. Yet for investigators wishing to work in these settings, there are few method papers providing insights into working efficiently in this setting.

Objective: The aim of this paper is to describe the five strategies used to increase response rates, data quality and quantity in the TRansport Environment and Kids (TREK) project.

Setting: The TREK project examined the association between neighbourhood urban design and active transport in Grade 5–7 school children (n = 1480) attending 25 primary schools in metropolitan Perth, Western Australia during 2007.

Method: Children completed several survey components during school time (i.e. questionnaire, mapping activity, travel diary and anthropometric measurements) and at home (i.e. pedometer study, parent questionnaire).

Results: Overall, 69.4% of schools and 56.6% of children agreed to participate in the study and, of these, 89.9% returned a completed travel diary, 97.8% returned their pedometer and 88.8% of parents returned their questionnaire. These return rates are superior to similar studies. Five strategies appeared important: (1) building positive relationships with key school personnel; (2) child-centred approaches to survey development; (3) comprehensive classroom management techniques to standardize and optimize group sessions; (4) extensive follow-up procedures for collecting survey items; and (5) a specially designed data management/monitoring system.

Conclusion: Sharing methodological approaches for obtaining high-quality data will ensure research opportunities within schools are maximized. These methodological issues have implications for planning, budgeting and implementing future research.

Multilevel analysis of the Be Active Eat Well intervention : environmental and behavioural influences on reductions in child obesity risk

Background: The Be Active Eat Well (BAEW) community-based child obesity prevention intervention was successful in modestly reducing unhealthy weight gain in primary school children using a multi-strategy and multi-setting approach.

Objective: To (1) examine the relationship between changes in obesity-related individual, household and school factors and changes in standardised child body mass index (zBMI), and (2) determine if the BAEW intervention moderated these effects.

Methods: The longitudinal relationships between changes in individual, household and school variables and changes in zBMI were explored using multilevel modelling, with measurement time (baseline and follow-up) at level 1, individual (behaviours, n=1812) at level 2 and households (n=1318) and schools (n=18) as higher levels (environments). The effect of the intervention was tested while controlling for child age, gender and maternal education level.

Results: This study confirmed that the BAEW intervention lowered child zBMI compared with the comparison group (−0.085 units, P=0.03). The variation between household environments was found to be a large contributor to the percentage of unexplained change in child zBMI (59%), compared with contributions from the individual (23%) and school levels (1%). Across both groups, screen time (P=0.03), sweet drink consumption (P=0.03) and lack of household rules for television (TV) viewing (P=0.05) were associated with increased zBMI, whereas there was a non-significant association with the frequency the TV was on during evening meals (P=0.07). The moderating effect of the intervention was only evident for the relationship between the frequency of TV on during meals and zBMI, however, this effect was modest (P=0.04).

Conclusions: The development of childhood obesity involves multi-factorial and multi-level influences, some of which are amenable to change. Obesity prevention strategies should not only target individual behaviours but also the household environment and family practices. Although zBMI changes were modest, these findings are encouraging as small reductions can have population level impacts on childhood obesity levels.

A new child protection strategy for Aboriginal communities in Western Australia

Despite numerous government inquiries and reforms, child sexual abuse in remote Aboriginal communities is a well-documented, ongoing problem. Established in Western Australia in 2009, Operation RESET is a multi-agency proactive community engagement initiative designed to improve the ability of communities and supporting agencies to detect, respond to and prevent child sexual abuse through the implementation of community engagement, capacity building and educational strategies. This comment describes the three core principles of Operation RESET: tackling child sexual abuse requires a collaborative, proactive approach between government and communities; the underlying causes and context of child sexual abuse must be recognised; and children's overall safety and wellbeing must be enhanced through integrated services that strengthen and empower families and communities. It also enumerates the seven phases of the operation's implementation, from identifying target communities to deploying an exit strategy. The comment ends by addressing the importance of empirical evaluation.

Expanding children's food experiences : the impact of a school-based kitchen garden program

Objective: Evaluate achievement of the Stephanie Alexander Kitchen Garden Program in increasing child appreciation of diverse, healthy foods.

Design: Comparative 2-year study.

Setting: Six program and 6 comparison primary schools in rural and metropolitan Victoria, Australia, matched for socioeconomic status and size.

Participants: A total of 764 children in grades 3 to 6 (8–12 years of age) and 562 parents recruited. Retention rates at follow-up included 85% children and 75% parents.

Intervention: Each week of the school year, children spent 45 to 60 minutes in a garden class and 90 minutes in a kitchen class.

Phenomenon of interest: Program impact on children’s willingness to try new foods, capacity to describe foods, and healthy eating.

Analysis: Qualitative data analyzed using inductive thematic analysis. Quantitative data analyzed using random-effects linear regressions adjusted for school clustering.

Results: Child and parent qualitative and quantitative measures (if never tried before, odds ratio 2.0; confidence interval, 1.06–3.58) showed increases in children’s reported willingness to try new foods. No differences in articulation of food descriptions (program vs comparison groups). Qualitative evidence showed that the program extended its influence to healthy eating, but this was not reflected in the quantitative evidence.

Conclusions and Implications: Findings indicate program success in achieving its primary objective, meriting further program research.

What factors are associated with adolescents' school break time physical activity and sedentary time?

Purpose Adolescents' physical activity levels during school break time are low and understanding correlates of physical activity and sedentary time in this context is important. This study investigated cross-sectional and longitudinal associations between a range of individual, behavioural, social and policy/organisational correlates and objectively measured school break time physical activity and sedentary time.

Methods In 2006, 146 adolescents (50% males; mean age = 14.1±0.6 years) completed a questionnaire and wore an accelerometer for ≥3 school days. Time spent engaged in sedentary, light (LPA) and moderate-to-vigorous physical activity (MVPA) during school break times (recess and lunchtime) were calculated using existing cut-points. Measures were repeated in 2008 among 111 adolescents. Multilevel models examined cross-sectional and longitudinal associations.

Results Bringing in equipment was cross-sectionally associated with 3.2% more MVPA during break times. Females engaged in 5.1% more sedentary time than males, whilst older adolescents engaged in less MVPA than younger adolescents. Few longitudinal associations were observed. Adolescents who brought sports equipment to school engaged in 7.2% less LPA during break times two years later compared to those who did not bring equipment to school.

Conclusion These data suggest that providing equipment and reducing restrictions on bringing in sports equipment to school may promote physical activity during school recess. Strategies targeting females' and older adolescents', in particular, are warranted.

Measuring harm: governing the effects of child sexual abuse

By analysing published research, and holding focus group discussions with counsellors, my thesis examines how the demands and practice of psychological measurement, understood as a scientific activity, have shaped, produced and constrained professional research and therapy concerning the effects of child sexual abuse.

Thirteen-year trends in child and adolescent fundamental movement skills: 1997-2010

Components of the diet associated with child adiposity: a cross-sectional study

Objective:
This study sought to determine which components of youths' diets were related to adiposity while controlling for potential often-neglected confounders such as moderate to vigorous physical activity (MVPA) and dietary reporting error. Secondary goals of this study were to determine the extent to which MVPA confounded the associations between diet and adiposity and whether associations between diet and adiposity would differ depending on reporting error.

Methods:
An ethnically diverse urban sample of 342 children aged 9–10 years and 323 adolescents aged 17–18 years were recruited for this cross-sectional study. Body mass index (BMI) and waist circumference (WC) were measured in the school; dietary assessment included three 24-hour recalls via telephone in the evenings, and MVPA assessment included 5 days of accelerometry. Over (n = 68), under (n = 250), or plausible (n = 347) dietary intake reporters were identified with the Huang calculation method. Linear regression assessed the relationship between adiposity indicators (BMI z-score and WC) and components of the diet (energy intake, food groups, macronutrients) after controlling for reporting error, demographic variables, and MVPA.

Results:
When dietary reporting error and potential confounders such as MVPA and demographic variables were controlled, energy intake (EI), vegetables, refined grains, total fat, total protein, and total carbohydrate were positively related to BMI z-score and WC and artificially sweetened beverages to WC. MVPA was a significant confounder. For BMI z-score, but not WC, relationships and strength of these relationships differed depending on dietary reporting error group (plausible, underreporter, overreporter).

Conclusions:
Among plausible reporters, as expected, EI, refined grains, and all macronutrients were positively related to adiposity; however, artificially sweetened beverages and vegetables, which are low-energy-dense foods, were also positively related to adiposity. Reporting error interfered with associations between diet and BMI z-score but not WC, suggesting WC is a more robust measure of adiposity in relation to diet.