"Doing” social justice in early childhood: The potential of leadership

Early childhood education and care (ECEC) has long been connected with objectives related to social justice. ECEC in Australia has its roots in philanthropic and educational reform movements, and more recently with the National Early Childhood Reform Agenda, ECEC has once more been linked to the redressing inequality and disadvantage. Drawing on extant literature, including data from two previously reported Australian studies in which leadership emerged as having a transformational impact on service delivery, this paper examines the potential of early childhood leadership to generate ‘socially just’ educational communities. With reference to critical theory, we argue that critically informed, intentional and strategic organisational leadership can play a pivotal role in creating changed circumstances and opportunities for children and families.

Interrogating policy contradictions in literacy reforms about persuasive texts

Objectives Our overarching objective is to demonstrate the political contradictions about about how persuasive texts should be taught in the middle years of schooling, analysing two contradictory Australian wide educational reforms. We consider the complexities of power and access to literacy for students in relation to these reforms about the privileged genre of persuasion. Our work is framed by our appreciation of literacy as a social justice issue, and the notion of students’ pedagogic rights (Bernstein, 2000). Specifically, we introduce and analyse the knowledge and skills about persuasive text sanctioned by the Australian high-stakes test, the National Assessment Program for Literacy and Numeracy (NAPLAN), for students in the middle years of schooling (ACARA, 2013). We compare this to the contemporary emphasis on multimodal persuasive texts sanctioned by the recently released Australian Curriculum English (ACARA, 2014). We conclude our analysis by identifying biases in the structure of particular knowledges and the inherent threats to democracy.

Peripapillary choroidal thickness in childhood

Changes in the thickness of the invivo peripapillary choroid have been documented in a range of ocular conditions in adults; however, choroidal thickness in the peripapillary region of children has not been examined in detail. This study therefore aimed to investigate the thickness of the peripapillary choroid and the overlying retinal nerve fibre layer (RNFL) in a population of normal children with a range of refractive errors. Ninety-three children (37 myopes and 56 non-myopes) aged between 11 and 16 years, had measurements of peripapillary choroidal and RNFL thickness derived from enhanced depth imaging optical coherence tomography images (EDI-OCT, Heidelberg Spectralis). The average thickness was determined in a series of five 0.25 mm width concentric annuli (each divided into 8 equal sized 45° sectors) centred on the optic nerve head boundary, accounting for individual ocular magnification factors and the disc-fovea angle. Significant variations in peripapillary choroidal thickness were found to occur with both annulus location (p<0.001) and sector position (p<0.001) in this population of children. The innermost annulus (closest to the edge of the optic disc) exhibited the thinnest choroid (mean 77 ± 16 μm) and the outermost annulus, the thickest choroid (191 ± 52 μm). The choroid was thinnest inferior to the optic nerve head (139 ± 38 μm) and was thickest in the superior temporal sector (157 ± 40 μm). Significant differences in the distribution of choroidal thickness were also associated with myopia, with myopic children having significantly thinner choroids in the inner and outer annuli of the nasal and temporal sectors respectively (p<0.001). RNFL thickness also varied significantly with annulus location and sector (p<0.001), and showed differences in thickness distribution associated with refractive error. This study establishes the normal variations in the thickness of the peripapillary choroid with radial distance and azimuthal angle from the optic nerve head boundary. A significant thinning of the peripapillary choroid associated with myopia in childhood was also observed in both nasal and temporal regions. The changes in peripapillary RNFL and choroidal thickness associated with refractive error are consistent with a redistribution of these tissues occurring with myopic axial elongation in childhood.

Assessment of temperature effects on childhood pneumonia and diarrhoea

This thesis has identified the high risk areas of childhood pneumonia and diarrhoea in Queensland and quantified the effects of temperature on emergency department visits for childhood pneumonia and diarrhoea. It adds to the increasing evidence about the impacts of climate variability and change on children's health and may have significant implications for developing climate change adaptation strategies and paediatric care policies.

Pre-packaging preschool literacy: What drives early childhood teachers to use commercially produced phonics programs in prior to school settings

Language-rich environments are key to overall quality in early childhood settings, including frequent child–staff interactions around picture books and dramatic play. In a language-rich environment, explicit teaching of literacy concepts, such as phonics, is embedded in authentic and meaningful situations where alphabet letters and sounds are taught in a context meaningful to the child. Recent research, however, suggests that the use of commercial pre-packaged phonics programs (such as Letterland and Jolly Phonics) is widespread in prior to school settings in Sydney, Australia. Little is known about why early childhood teachers choose to use such programs with children aged five and under. In the present study, thematic analysis of data from interviews with five early childhood teachers using commercial phonics programs found that their reasons were pragmatic rather than pedagogical. Motivations included the idea that the programs reduced their workload, provided tangible evidence to parents of their child’s ‘school readiness’, and served as a marketing tool to attract parents. Further analysis found that the teachers were unable to articulate what phonics and phonological awareness are and how they are learnt in early childhood.

Feeling the pressure: Early childhood educators’ reported views about learning and teaching phonics in Australian prior-to-school settings

Early childhood educators’ beliefs about literacy teaching can impact on the types of phonics experiences educators provide for children in prior-to-school settings. The Australian Early Years Learning Framework supports a play-based, intentional approach to teaching phonics, however little is known about what Australian early childhood educators believe is important in teaching phonics in the prior-to-school years. Using a qualitative content analysis, this research study investigates 115 early childhood educators’ views about how phonics should be taught and the use of commercially produced phonics programs (e.g. Jolly Phonics and Letterland) in prior-to-school settings. This study further investigates educators’ perceived pressures to include structured phonics lessons, as a way of addressing parental notions of ‘school readiness’. The results of this study indicate conflicting views were held about how phonics should be taught. Some educators also experienced external pressures to engage in literacy practices that may be in opposition with their own beliefs about how literacy is learnt. This study provides insights into the pedagogical practices early childhood educators believe are appropriate when teaching phonics. The educational implications are discussed.

Effect and process evaluations of an early childhood obesity prevention intervention

The thesis develops a summative evaluation framework of the NOURISH Randomised Controlled Trial, and applies this to a selection of maternal feeding choice outcomes of the programme. The research is based on an ecological model of the complex set of factors that need to be acted upon to address childhood obesity. The novel approach extends the standard RCT effect evaluation, while also conducting an in-depth evaluation of the process of programme development and implementation. Research findings identify adaptations of intervention delivery that could improve its effectiveness and translatability, in a new cycle of the programme.

Environmental contributions to childhood cancers

Recent increases in incidence of childhood cancers cannot be explained by genetic factors. Identifying the environmental risk factors that may explain increases in cancer incidence is an important step to reduce the overall burden of disease. The risk factors for which the most evidence exists include ionising radiation, ultraviolet radiation and chemicals such as benzene and pesticides, biological agents as well as parental smoking and parental substance use. Regarding the link between exposure to non-ionising radiation and development of cancer, the evidence was limited. Maternal vitamin supplementation may reduce the risk of cancer in offspring. Environmental exposures encountered during development and early childhood may be even more important contributors to the risk of cancer than exposures in adulthood and the early developmental period presents an important opportunity for cancer prevention.

Estimating the burden of disease attributable to childhood and maternal undernutrition in South Africa in 2000

OBJECTIVES To estimate the disease burden attributable to being underweight as an indicator of undernutrition in children under 5 years of age and in pregnant women for the year 2000. DESIGN World Health Organization comparative risk assessment (CRA) methodology was followed. The 1999 National Food Consumption Survey prevalence of underweight classified in three low weight-for-age categories was compared with standard growth charts to estimate population-attributable fractions for mortality and morbidity outcomes, based on increased risk for each category and applied to revised burden of disease estimates for South Africa in 2000. Maternal underweight, leading to an increased risk of intra-uterine growth retardation and further risk of low birth weight (LBW), was also assessed using the approach adopted by the global assessment. Monte Carlo simulation-modeling techniques were used for the uncertainty analysis. SETTING South Africa. SUBJECTS Children under 5 years of age and pregnant women. OUTCOME MEASURES Mortality and disability-adjusted life years (DALYs) from protein- energy malnutrition and a fraction of those from diarrhoeal disease, pneumonia, malaria, other non- HIV/AIDS infectious and parasitic conditions in children aged 0 - 4 years, and LBW. RESULTS Among children under 5 years, 11.8% were underweight. In the same age group, 11,808 deaths (95% uncertainty interval 11,100 - 12,642) or 12.3% (95% uncertainty interval 11.5 - 13.1%) were attributable to being underweight. Protein-energy malnutrition contributed 44.7% and diarrhoeal disease 29.6% of the total attributable burden. Childhood and maternal underweight accounted for 2.7% (95% uncertainty interval 2.6 - 2.9%) of all DALYs in South Africa in 2000 and 10.8% (95% uncertainty interval 10.2 - 11.5%) of DALYs in children under 5. CONCLUSIONS The study shows that reduction of the occurrence of underweight would have a substantial impact on child mortality, and also highlights the need to monitor this important indicator of child health.

Catering for cultural and linguistic diversity: Using teacher created information texts

Teachers in the Pacific region have often signalled the need for more locally produced information texts in both the vernacular and English, to engage their readers with local content and to support literacy development across the curriculum. The Information Text Awareness Project (ITAP), initially informed by the work of Nea Stewart-Dore, has provided a means to address this need through supporting local teachers to write their own information texts. The article reports on the impact of an ITAP workshop carried out in Nadi, Fiji in 2012. Nine teacher volunteers from the project trialled the use of the texts in their classrooms with positive results in relation to student learning and belief in themselves as writers.

A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: A systematic analysis for the Global Burden of Disease Study 2010

BACKGROUND Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time. METHODS We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden. FINDINGS In 2010, the three leading risk factors for global disease burden were high blood pressure (7·0% [95% uncertainty interval 6·2-7·7] of global DALYs), tobacco smoking including second-hand smoke (6·3% [5·5-7·0]), and alcohol use (5·5% [5·0-5·9]). In 1990, the leading risks were childhood underweight (7·9% [6·8-9·4]), household air pollution from solid fuels (HAP; 7·0% [5·6-8·3]), and tobacco smoking including second-hand smoke (6·1% [5·4-6·8]). Dietary risk factors and physical inactivity collectively accounted for 10·0% (95% UI 9·2-10·8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water and sanitation accounting for 0·9% (0·4-1·6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania. INTERPRETATION Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children.

Combination chemotherapy for primary small intestinal lymphoma in the Middle East

Twelve patients with primary small intestinal lymphoma were followed prospectively for 3 years. Endoscopic abnormalities were diagnostic of lymphoma in all cases where the duodenum was involved (83%). In three cases (25%) the disease extended to the stomach. One patient (8%) had diffuse small cell cleaved and 11 (92%) diffuse large cell lymphoma stages I (8%), II (25%), III (58%) and IV (8%). Nine of them were unresectable and primarily treated with combination chemotherapy; 67% achieved complete remission, 22% partial response and 11% no response. Only one patient relapsed and achieved a second remission. All complete remission patients are currently alive and free of disease at a median follow-up of 36 months. Overall survival for all patients is 58%, and disease-free survival is 50%. No instance of chemotherapy-related bleeding or perforation was seen. Tetracycline was necessary for the treatment of IPSID-associated diarrhea and malabsorption in spite of cytotoxic chemotherapy.

Forward: Which childhood? Whose deficit?

A commentary on Whiteness studies, linguistic and cultural minority and Indigenous studies in early childhood language and literacy socialization. When the literature on ‘Whiteness’ first emerged in the 1990s, I was offended and skeptical. As an Asian who has lived in White-dominant cultures most of my life, my reflex was to say something like: “Yeah – they want to be ‘special’ too. After all our struggles to get beyond an unmarked place of deficit in the fields of disciplinary knowledge and social sciences – now they want ‘Whiteness’ as their own ethnic studies”...