Socioeconomic inequalities in cardiovascular mortality and the role of childhood socioeconomic conditions and adulthood risk factors : a prospective cohort study with 17-years of follow up

Background The mechanisms underlying socioeconomic inequalities in mortality from cardiovascular diseases (CVD) are largely unknown. We studied the contribution of childhood socioeconomic conditions and adulthood risk factors to inequalities in CVD mortality in adulthood. Methods The prospective GLOBE study was carried out in the Netherlands, with baseline data from 1991, and linked with the cause of death register in 2007. At baseline, participants reported on adulthood socioeconomic position (SEP) (own educational level), childhood socioeconomic conditions (occupational level of respondent’s father), and a broad range of adulthood risk factors (health behaviours, material circumstances, psychosocial factors). This present study is based on 5,395 men and 6,306 women, and the data were analysed using Cox regression models and hazard ratios (HR). Results A low adulthood SEP was associated with increased CVD mortality for men (HR 1.84; 95% CI: 1.41-2.39) and women (HR 1.80; 95%CI: 1.04-3.10). Those with poorer childhood socioeconomic conditions were more likely to die from CVD in adulthood, but this reached statistical significance only among men with the poorest childhood socioeconomic circumstances. About half of the investigated adulthood risk factors showed significant associations with CVD mortality among both men and women, namely renting a house, experiencing financial problems, smoking, physical activity and marital status. Alcohol consumption and BMI showed a U-shaped relationship with CVD mortality among women, with the risk being significantly greater for both abstainers and heavy drinkers, and among women who were underweight or obese. Among men, being single or divorced and using sleep/anxiety drugs increased the risk of CVD mortality. In explanatory models, the largest contributor to adulthood CVD inequalities were material conditions for men (42%; 95% CI: −73 to −20) and behavioural factors for women (55%; 95% CI: -191 to −28). Simultaneous adjustment for adulthood risk factors and childhood socioeconomic conditions attenuated the HR for the lowest adulthood SEP to 1.34 (95% CI: 0.99-1.82) for men and 1.19 (95% CI: 0.65-2.15) for women. Conclusions Adulthood material, behavioural and psychosocial factors played a major role in the explanation of adulthood SEP inequalities in CVD mortality. Childhood socioeconomic circumstances made a modest contribution, mainly via their association with adulthood risk factors. Policies and interventions to reduce health inequalities are likely to be most effective when considering the influence of socioeconomic circumstances across the entire life course and in particular, poor material conditions and unhealthy behaviours in adulthood.

A comparison of Chinese and Australian early childhood mathematics

In the 21st century mathematics proficiency is synonymous with a numerate citizenry. In the past few decades young children’s ability to reason mathematically and develop mathematical proficiencies has been recognised. This paper explores the history of early childhood mathematics (ECME) that may explicate differences in Chinese and Australian contexts. Results of this review established that China and Australia are diametrically positioned in ECME. Influencing each countries philosophies and practices are their cultural beliefs. ECME in China and Australia must be culturally sustainable to achieve excellent outcomes for young children. Ongoing critique and review is necessary to ensure that ECME is meeting the needs of all teachers and children in their particular context. China and Australia with their rich contrasting philosophies can assist each other in their journeys to create exemplary ECME for the 21st century.

Exploring the process of meaning making in healing after childhood sexual assault : a case study approach

Childhood sexual assault (CSA) is one of the most devastating of all traumatic experiences with population studies documenting survivors experiencing higher levels of pathology than general trends in survivors of other traumatic experiences. Yet recent research has demonstrated that far from being permanently crippled by their experiences, many adult survivors of CSA manage to heal and move forward in their lives to experience a rich and fulfilling existence. In this paper two case studies are presented to provide a detailed account of how a person who has experienced CSA may find a pathway to healing. Moreover, data demonstrates that meaning making, spiritual or otherwise, is a pivotal part of acceptance of CSA and ensuing growth. The case studies highlight the unique journeys of two women and the underlying similarities in their pathway to healing. Clinical implications of the research are discussed and specific strategies for encouraging healing and growth are outlined.

International trends in early childhood education for sustainability

Early childhood education for sustainability (ECEfS) is an emerging field within education – a synthesis of early childhood education and education for sustainability. As a distinct field of educational inquiry and practice, it is less than 20 years old in Australia. My personal story is one that emerged from teaching Aboriginal children in an Indigenous community. These experiences made me question the marginalization of Indigenous peoples in Australian society, the colonizing impacts of education, gave me deeper understandings of human-environment interactions, and the effects of poverty and powerlessness on options for Indigenous people in Australia and elsewhere where people and their lands have been exploited. These experiences saw me return to university to undertake a degree in environmental studies to help me better understand the nexus between society, environment and economy. Hence my background in education for sustainability comes as much from the social sciences as from the biological/ecological sciences and shapes my orientation to my work in ECEFS...

Action for change? Embedding Aboriginal and Torres Strait Islander perspectives in early childhood education curricula

This thesis focuses on non-Indigenous educators’ work around embedding Indigenous perspectives in early childhood education curricula. In place of reporting examples of ‘good’ educational practice, the study questions how whiteness and racism continue to operate in diversity work that is seen to be productive and inclusive. The thesis argues for a more comprehensive framework for embedding Indigenous perspectives in before-school contexts to support educators’ efforts. New strategies for professional development are also suggested to support changes in disciplinary knowledge and pedagogy.

Outcomes of an early feeding practices intervention to prevent childhood obesity

Objective Use a randomised controlled trial (RCT) to evaluate outcomes of a universal intervention to promote protective feeding practices, which commenced in infancy and aimed to prevent childhood obesity Subjects and Methods The NOURISH RCT enrolled 698 first-time mothers (mean age 30.1 years, SD=5.3) with healthy term infants (51% female) aged 4.3 (SD=1.0) months at baseline. Mothers were randomly allocated to self-directed access to usual care or to attend two 6-session interactive group education modules that provided anticipatory guidance on early feeding practices. Outcomes were assessed six months after completion of the second information module, 20 months from baseline and when the children were two years old. Maternal feeding practices were self-reported using validated questionnaires and study-developed items. Study-measured child height and weight were used to calculate BMI Z-score. Results Retention at follow-up was 78%. Mothers in the intervention group reported using responsive feeding more frequently on 6/9 subscales and 8/8 items (Ps ≤.03) and overall less ‘controlling feeding practices’ (P<.001). They also more frequently used feeding practices (3/4 items; Ps <.01) likely to enhance food acceptance. No statistically significant differences were noted in anthropometric outcomes (BMI Z-score: P=.11), nor in prevalence of overweight/obesity (control 17.9% vs. intervention 13.8%, P=.23). Conclusions Evaluation of NOURISH at child age two years found that anticipatory guidance on complementary feeding, tailored to developmental stage, increased use by first-time mothers of 'protective' feeding practices that potentially support the development of healthy eating and growth patterns in young children.

Screening in early childhood for risk of later mental health problems : a longitudinal study

Depression in childhood or adolescence is associated with increased rates of depression in adulthood. Does this justify efforts to detect (and treat) those with symptoms of depression in early childhood or adolescence? The aim of this study was to determine how well symptoms of anxiety/depression (A-D) in early childhood and adolescence predict adult mental health. The study sample is taken from a population-based prospective birth cohort study. Of the 8556 mothers initially approached to participate 8458 agreed, of whom 7223 mothers gave birth to a live singleton baby. Children were screened using modified Child Behaviour Checklist (CBCL) scales for internalizing and total problems (T-P) at age 5 and the CBCL and Youth Self Report (YSR) A-D subscale and T-P scale at age 14. At age 21, a sub-sample of 2563 young adults in this cohort were administered the CIDI-Auto. Results indicated that screening at age 5 would detect few later cases of significant mental ill-health. Using a cut-point of 20% for internalizing at child age 5 years the CBCL had sensitivities of only 25% and 18% for major depression and anxiety disorders at 21 years, respectively. At age 14, the YSR generally performed a little better than the CBCL as a screening instrument, but neither performed at a satisfactory level. Of the children who were categorised as having YSR A-D at 14 years 30% and 37% met DSM-IV criteria for major depression and anxiety disorders, respectively, at age 21. Our findings challenge an existing movement encouraging the detection and treatment of those with symptoms of mental illness in early childhood.

Extreme temperatures and emergency department admissions for childhood asthma in Brisbane, Australia

Objectives To examine the effect of extreme temperatures on emergency department admissions (EDAs) for childhood asthma. Methods An ecological design was used in this study. A Poisson linear regression model combined with a distributed lag non-linear model was used to quantify the effect of temperature on EDAs for asthma among children aged 0–14 years in Brisbane, Australia, during January 2003–December 2009, while controlling for air pollution, relative humidity, day of the week, season and long-term trends. The model residuals were checked to identify whether there was an added effect due to heat waves or cold spells. Results There were 13 324 EDAs for childhood asthma during the study period. Both hot and cold temperatures were associated with increases in EDAs for childhood asthma, and their effects both appeared to be acute. An added effect of heat waves on EDAs for childhood asthma was observed, but no added effect of cold spells was found. Male children and children aged 0–4 years were most vulnerable to heat effects, while children aged 10–14 years were most vulnerable to cold effects. Conclusions Both hot and cold temperatures seemed to affect EDAs for childhood asthma. As climate change continues, children aged 0–4 years are at particular risk for asthma.

Early childhood teachers' pedagogical practice : what they know, think and do with young children experiencing parental separation and divorce

This grounded theory study examined the practices of twenty-one Australian early childhood teachers who work with children experiencing parental separation and divorce. Findings showed that teachers constructed personalised support for these children. Teachers’ pedagogical decision-making processes had five phases: constructing their knowledge, applying their knowledge, applying decision-making schema, taking action, and monitoring action and evaluating. This study contributes new understandings about teachers’ work with young children experiencing parental separation and divorce, and extends existing theoretical frameworks related to the provision of support. It adds to scholarship by applying grounded theory methodology in a new context. Recommendations are made for school policies and procedures within and across schools and school systems.

The rise of government in Early Childhood Education and Care following the Child Care Act 1972 : the lasting legacy of the 1990s in setting the reform agenda for ECEC in Australia

Less than twenty years on from the proclamation of the Child Care Act 1972, and introduction of funding for not-for-profit child care centres, a series of market-driven public policies paved the way for the emergence of Australia’s current ECEC quasi-market. Seeking to respond to increasing demand for work-related child care in the 1990s, and to manage associated costs, a succession of Australian Governments turned to market theory and New Public Management (NPM) principles to inform ECEC policy. Reflecting on an era of high policy activity within ECEC, this paper examines a series of policy events and texts that set the course for the reform agenda that was to ensue in ECEC.

'I want to educate school age children' : producing early childhood teacher professional identities

The Australian Government’s current workforce reforms in early childhood education and care (ECEC) include a major shift in qualification requirements. The new requirement is that university four-year degree-qualified teachers are employed in before-school contexts, including child care. Ironically, recent research studies show that, in Australia, the very preservice teachers who are enrolled in these degree programs have a reluctance to work in childcare. This article reports on part of a larger study which is inquiring into how early childhood teacher professional identities are discursively produced, and provides a partial mapping of the literature. One preservice teacher’s comment provides the starting point, and the paper locates some the discourses that are accessible to preservice teachers as they prepare for the early years workforce. An awareness of the discursive field provides a sound background for preparing early childhood teachers. A challenge for the field is to consider which discourses are dominant, and how they potentially work to privilege work in some ECEC contexts over others.

Producing and maintaining professional identities in early childhood

This study is an inquiry into early childhood teacher professional identities. In Australia, workforce reforms in early childhood include major shifts in qualification requirements that call for a university four-year degree-qualified teacher to be employed in child care. This marks a shift in the early years workforce, where previously there was no such requirement. At the same time as these reforms to quality measures are being implemented, and requiring a substantive up skilling of the workforce, there is a growing body of evidence through recent studies that suggests these same four-year degree-qualified early childhood teachers have an aversion to working in child care. Their preferred employment option is to work in the early years of more formal schooling, not in before-school contexts. This collision of agendas warrants investigation. This inquiry is designed to investigate the site at which advocacy for higher qualification requirements meets early childhood teachers who are reluctant to choose child care as a possible career pathway. The key research question for this study is: How are early childhood teachers’ professional identities currently produced? The work of this thesis is to problematise the early childhood teacher in child care through a particular method of discourse analysis. There are two sets of data. The first was a key early childhood political document that read as a "moment of arising" (Foucault, 1984a, p. 83). It is a political document which was selected for its current influence on the early childhood field, and in particular, workforce reforms that call for four-year degree-qualified teachers to work in before-school contexts, including child care. The second data set was generated through four focus group discussions conducted with preservice early childhood teachers. The document and transcripts of the focus groups were both analysed as text, as conceptualised by Foucault (1981). Foucault’s work spans a number of years and a range of philosophical matters. This thesis draws particularly on Foucault’s writings on discourse, power/knowledge, regimes of truth and resistance. In order to consider the production of early childhood teachers’ professional identities, the study is also informed by identity theorists, who have worked on gender, performativity and investment (Davies, 2004/2006; McNay, 1992; Osgood, 2012; Walkerdine, 1990; Weedon, 1997). The ways in which discourses intersect, compete and collide produce the subject (Foucault, 1981) and, in the case of this inquiry, there are a number of competing discourses at play, which produce the early childhood teacher. These particular theories turn particular lenses on the question of professional identities in early childhood, and such a study calls for the application of particular methodologies. Discourse analysis was used as the methodological framework, and the analysis was informed by Foucauldian concepts of discourse. While Foucault did not prescribe a form of discourse analysis as a method, his writings nonetheless provide a valuable framework for illuminating discursive practices and, in turn, how people are affected, through the shifts and distribution of power (Foucault, 1980a). The treatment used with both data sets involved redescription. For the policy document, a technique for reading document-as-text applied a genealogical approach (Foucault, 1984a). For the focus groups, the process of redescription (Rorty, 1989) involved reading talk-as-text. As a method, redescription involves describing "lots and lots of things in new ways until you have created a pattern of linguistic behaviour which will tempt the new generation to adopt it" (Rorty, 1989, p. 9). The development and application of categories (Davies, 2004/2006) built on a poststructuralist theoretical framework and the literature review informed the data analysis method of discourse analysis. Irony provided a rhetorical and playful tool (Haraway, 1991; Rorty, 1989), to look to how seemingly opposing discourses are held together. This opens a space to collapse binary thinking and consider seemingly contradictory terms in a way in which both terms are possible and both are true. Irony resists the choice of one or the other being right, and holds the opposites together in tension. The thesis concludes with proposals for new, ironic categories, which work to bring together seemingly opposing terms, located at sites in the field of early childhood where discourses compete, collide and intersect to produce and maintain early childhood teacher professional identities. The process of mapping these discourses goes some way to investigating the complexities about identities and career choices of early childhood teachers. The category of "the cost of loving" captures the collision between care/love, inherent in child care, and new discourses of investment/economics. Investment/economics has not completely replaced care/love, and these apparent opposites were not read as a binary because both are necessary and both are true (Haraway, 1991). They are held together in tension to produce early childhood teacher professional identities. The policy document under scrutiny was New Directions, released in 2007 by the then opposition ALP leader, Kevin Rudd. The claim was made strongly that the "economic prosperity" of Australia relies on investment in early childhood. The arguments to invest are compelling and the neuroscience/brain research/child development together with economic/investment discourses demand that early childhood is funding is increased. The intersection of these discourses produces professional identities of early childhood teachers as a necessary part of the country’s economy, and thus, worthy of high status. The child care sector and work in child care settings are necessary, with children and the early childhood teacher playing key roles in the economy of the nation. Through New Directions it becomes sayable (Foucault, 1972/1989) that the work the early childhood teacher performs is legitimated and valued. The children are produced as "economic units". A focus on what children are able to contribute to the future economy of the nation re-positions children and produces these "smart productive citizens", making future economic contribution. The early childhood teacher is produced through this image of a child and "the cost of loving" is emphasised. A number of these categories were produced through the readings of the document-as text and the talk-as-text. Two ironic categories were read in the analysis of the transcripts of the focus group discussions, when treated as talk-as-text data: the early childhood teacher as a "heroic victim"; and the early childhood teacher as a "glorified babysitter". This thesis raises new questions about professional identities in early childhood. These new questions might go some way to prompt re-thinking of some government policy, as well as some aspects of early childhood teacher education course design. The images of children and images of child care provide provocations to consider preservice teacher education course design. In particular, how child care, as one of the early childhood contexts, is located, conceptualised and spoken throughout the course. Consideration by course designers and teacher educators of what discourses are privileged in course content —what discourses are diminished or silenced—would go some way to reconceptualising child care within preservice teacher education and challenging dominant ways of speaking child care, and work in child care. This inquiry into early childhood teachers’ professional identities has gone some way to exploring the complexities around the early childhood teacher in child care. It is anticipated that the significance of this study will thus have immediate applicably and relevance for the Australian early childhood policy landscape. The early childhood field is in a state of rapid change, and this inquiry has examined some of the disconnects between policy and practice. Awareness of the discourses that are in play in the field will continue to allow space for conversations that challenge dominant assumptions about child care, work in child care and ways of being an early childhood teacher in child care.

Integrating early childhood teachers into long day care : building respectful relationships

Amongst the current reforms in early childhood in Australia is the requirement for four year university degree-qualified teachers to be employed to provide a kindergarten program for four-year-old children in the year prior to school entry. The possibility for long day care to provide a funded kindergarten program, with an early childhood teacher (ECT) presents a change for the field. With this change come challenges, though also opportunities to think in new and different ways about what long day care and working in long day care might look like.

Randomized controlled trial : a randomized controlled clinical trial comparing a remineralizing paste with an antibacterial gel to prevent early childhood caries

PURPOSE: The purpose of this study was to compare twice daily tooth-brushing using 0.304 percent fluoride toothpaste alone with: (1) twice daily tooth-brushing plus once daily 10% casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste; and (2) twice daily tooth-brushing plus once daily 0.12% chlorhexidine gel (CHX) for reducing early childhood caries (ECC) and mutans streptococci (MS) colonization. METHODS: Subjects (n=622) recruited at birth were randomized to receive either CPP-ACP or CHX or no product (study control [SC]). All children were examined at 6, 12, and 18 months old in their homes, and at 24 months old in a community dental clinic. RESULTS: At 24 months old, the caries incidence was 1% (2/163) in CPP-ACP, 2% (4/180) in CHX, and 2% (3/188) in SC groups. In children who were previously MS colonized at 12 and 18 months old, 0% (0/11) and 5% (3/63), respectively, of the CPP-ACP group remained MS-positive versus 22% (2/9) and 72% (18/25) in CHX and 16% (4/25) and 50% (7/14) in SC groups (P<.001). CONCLUSIONS: There is insufficient evidence to justify the daily use of casein phosphopeptide-amorphous calcium phosphate or chlorhexidine gel to control early childhood caries.