Children’s food and activity patterns following a six-month child weight management program

Objective To describe the impact of a parent-led, family focused child weight management program on the food intake and activity patterns of pre-pubertal children. Methods n assessor-blinded, randomized controlled trial involving 111 (64% female) overweight, pre-pubertal children 6 to 9 years of age randomly assigned to parenting-skills training plus intensive lifestyle education, parenting-skills training alone, or a 12-month wait-listed control. Study outcomes were assessed at baseline, 6 months, and 12 months. This paper presents data on food intake assessed via a validated 54-item parent completed dietary questionnaire and activity behaviours assessed via a parent-report 20-item activity questionnaire. Results Intake of energy-dense nutrient poor foods was lower in both intervention groups at 6 months (mean difference, P+DA -1.5 serves [CI -2.0;-1.0]; P -1.0 serves [-2.0;-0.5]) and 12 months (mean difference P+DA -1.0 serves [CI -2.0;-0.5]; P -1.0 serves [-1.5; 0.0]) compared to baseline. Intake of vegetables, fruit, breads and cereals, meat and alternatives and dairy foods remained unchanged. Regardless of study group there were significant reductions over time in the reported time spent engaged in small screen activities and an increase in the time reported spent in active play. Conclusion Child weight management intervention that promotes food intake in line with national dietary guidelines achieves a reduction in children’s intake of energy dense, nutrient poor foods. This was achieved without compromising intake of nutrient-rich food and changes in were maintained even once the intervention ceased.

Feasibility of using health data sources to inform product safety surveillance in Queensland : a report for the Queensland Injury Prevention Council

This report provides an evaluation of the current available evidence-base for identification and surveillance of product-related injuries in children in Queensland. While the focal population was children in Queensland, the identification of information needs and data sources for product safety surveillance has applicability nationally for all age groups. The report firstly summarises the data needs of product safety regulators regarding product-related injury in children, describing the current sources of information informing product safety policy and practice, and documenting the priority product surveillance areas affecting children which have been a focus over recent years in Queensland. Health data sources in Queensland which have the potential to inform product safety surveillance initiatives were evaluated in terms of their ability to address the information needs of product safety regulators. Patterns in product-related injuries in children were analysed using routinely available health data to identify areas for future intervention, and the patterns in product-related injuries in children identified in health data were compared to those identified by product safety regulators. Recommendations were made for information system improvements and improved access to and utilisation of health data for more proactive approaches to product safety surveillance in the future.

Child welfare policy and practice on children’s exposure to domestic violence

There are emerging movements in several countries to improve policy and practice to protect children from exposure to domestic violence. These movements have resulted in the collection of new data on EDV and the design and implementation of new child welfare policies and practices. To assist with the development of child welfare practice, this article summarizes current knowledge on the prevalence of EDV, and on child welfare services policies and practices that may hold promise for reducing the frequency and impact of EDV on children. We focus on Australia, Canada, and the United States, as these countries share a similar socio-legal context, a long history of enacting and expanding legislation about reporting of maltreatment, debates regarding the application of reporting laws to EDV, and new child welfare practices that show promise for responding more effectively to EDV.

Predictive modelling : parents’ decision making to use online child health information to increase their understanding and/or diagnose or treat their child’s health

Abstract Background The quantum increases in home Internet access and available online health information with limited control over information quality highlight the necessity of exploring decision making processes in accessing and using online information, specifically in relation to children who do not make their health decisions. Objectives To understand the processes explaining parents’ decisions to use online health information for child health care. Methods Parents (N = 391) completed an initial questionnaire assessing the theory of planned behaviour constructs of attitude, subjective norm, and perceived behavioural control, as well as perceived risk, group norm, and additional demographic factors. Two months later, 187 parents completed a follow-up questionnaire assessing their decisions to use online information for their child’s health care, specifically to 1) diagnose and/or treat their child’s suspected medical condition/illness and 2) increase understanding about a diagnosis or treatment recommended by a health professional. Results Hierarchical multiple regression showed that, for both behaviours, attitude, subjective norm, perceived behavioural control, (less) perceived risk, group norm, and (non) medical background were the significant predictors of intention. For parents’ use of online child health information, for both behaviours, intention was the sole significant predictor of behaviour. The findings explain 77% of the variance in parents’ intention to treat/diagnose a child health problem and 74% of the variance in their intentions to increase their understanding about child health concerns. Conclusions Understanding parents’ socio-cognitive processes that guide their use of online information for child health care is important given the increase in Internet usage and the sometimes-questionable quality of health information provided online. Findings highlight parents’ thirst for information; there is an urgent need for health professionals to provide parents with evidence-based child health websites in addition to general population education on how to evaluate the quality of online health information.

School based youth health nurses and a true health promotion approach : the Ottawa what?

Aim: The purpose of this research is to examine School Based Youth Health Nurses experience of a true health promotion approach. Background: The School Based Youth Health Nurse Program is a state-wide school nursing initiative in Queensland, Australia. The program employs more than 120 fulltime and fractional school nurses who provide health services in state high schools. The role incorporates two primary components: individual health consultations and health promotion strategies. Design/Methods: This study is a retrospective inquiry generated from a larger qualitative research project about the experience of school based youth health nursing. The original methodology was phenomenography. In-depth interviews were conducted with sixteen school nurses recruited through purposeful and snowball sampling. This study accesses a specific set of raw data about School Based Youth Health Nurses experience of a true health promotion approach. The Ottawa Charter for Health Promotion (1986) is used as a framework for deductive analysis. Results: The findings indicate school nurses have neither an adverse or affirmative conceptual experience of a true health promotion approach and an adverse operational experience of a true health promotion approach based on the action areas of the Ottawa Charter. Conclusions: The findings of this research are important because they challenge the notion that school nurses are the most appropriate health professionals to undertake a true health promotion approach. If school nurses are the most appropriate health professionals to do a true health promotion approach, there are implications for recruitment and training and qualifications. If school nurses are not, who are the most appropriate health professionals to do school health promotion? Implications for Practice: These findings can be applied to other models of school nursing in Australia which emphasises a true health promotion approach because they relate specifically to school nurses’ experience of a true health promotion approach.

“Yarning” as a method for community-based health research with indigenous women : the indigenous women's wellness research program

This project explores yarning as a methodology for understanding health and wellness from an indigenous woman's perspective. Previous research exploring indigenous Australian women's perspectives have used traditional Western methodologies and have often been felt by the women themselves to be inappropriate and ineffective in gathering information and promoting discussion. This research arose from the indigenous women themselves, and resulted in the exploration of using yarning as a methodology. Yarning is a conversational process that involves the sharing of stories and the development of knowledge. It prioritizes indigenous ways of communicating, in that it is culturally prescribed, cooperative, and respectful. The authors identify different types of yarning that are relevant throughout their research, and explain two types of yarning—family yarning and cross-cultural yarning—which have not been previously identified in research literature. This project found that yarning as a research method is appropriate for community-based health research with indigenous Australian women. This may be an important finding for health professionals and researchers to consider when working and researching with indigenous women from other countries.

The Large Allen Cognitive Level Screen as an indicator for medication adherence among adults accessing community mental health services

Background: Medication remains the cornerstone treatment for mental illness. Cognition is one of the strongest predictors of non-adherence. The aim of this preliminary investigation was to examine the association between the Large Allen Cognitive Level Screen (LACLS) and medication adherence among a small sample of mental health service users to determine whether the LACLS has potential as a screening tool for capacity to manage medication regimens. Method: Demographic and clinical information was collected from a small sample of people who had recently accessed community mental health services. Participants then completed the LACLS and the Medication Adherence Rating Scale (MARS) at a single time point. The strength of association between the LACLS and MARS was examined using Spearman rank-order correlation. Results: A strong positive correlation between the LACLS and medication adherence (r = 0.71, p = 0.01) was evident. No participants reported the use of medication aids despite evidence of impaired cognitive functioning. Conclusion: This investigation has provided the first empirical evidence indicating that the LACLS may have utility as a screening instrument for capacity to manage medication adherence among this population. While promising, this finding should be interpreted with caveats given its preliminary nature.

Mandatory Reporting Laws and Identification of Child Abuse and Neglect: Consideration of Differential Maltreatment Types, and a Cross-Jurisdictional Analysis of Child Sexual Abuse Reports

Mandatory reporting laws have been created in many jurisdictions as a way of identifying cases of severe child maltreatment on the basis that cases will otherwise remain hidden. These laws usually apply to all four maltreatment types. Other jurisdictions have narrower approaches supplemented by differential response systems, and others still have chosen not to enact mandatory reporting laws for any type of maltreatment. In scholarly research and normative debates about mandatory reporting laws and their effects, the four major forms of child maltreatment—physical abuse, sexual abuse, emotional abuse, and neglect—are often grouped together as if they are homogenous in nature, cause, and consequence. Yet, the heterogeneity of maltreatment types, and different reporting practices regarding them, must be acknowledged and explored when considering what legal and policy frameworks are best suited to identify and respond to cases. A related question which is often conjectured upon but seldom empirically explored, is whether reporting laws make a difference in case identification. This article first considers different types of child abuse and neglect, before exploring the nature and operation of mandatory reporting laws in different contexts. It then posits a differentiation thesis, arguing that different patterns of reporting between both reporter groups and maltreatment types must be acknowledged and analysed, and should inform discussions and assessments of optimal approaches in law, policy and practice. Finally, to contribute to the evidence base required to inform discussion, this article conducts an empirical cross-jurisdictional comparison of the reporting and identification of child sexual abuse in jurisdictions with and withoutmandatory reporting, and concludes that mandatory reporting laws appear to be associated with better case identification.

Mothers and health promotion : closing the gap for 100% measles immunization in North Vietnam

Objectives This study aims to develop a better understanding of mothers’ knowledge, understanding, and attitude towards children’s measles immunization and explore the relationship between mothers’ understanding of measles immunization and health promotion programs in North Vietnam. Methods Semi-structured interviews were conducted with 15 mothers of children aged 1 or 6 years old between 2006 and 2010 in two provinces in North Vietnam. Ten interviews were transcribed and analysed to explore themes while other five interviews were cross-referenced for congruency. Among the ten mothers whose interviews were analysed, there were five mothers whose children received the full measles immunization schedule (two doses) and five mothers whose children received one or none of measles vaccination. Results Mothers had different levels of understanding and a strong positive attitude towards measles immunization. Mothers considered health officers at the commune health centres who played an important role in the promotion of measles immunization, as the main source of information. The relationship between the mother’s understanding about measles immunization and health promotion programs was found to be both positive and negative. Conclusion Mothers whose children received the full measles immunization schedule paid more attention to measles immunization and health promotion programs compared with mothers whose children received one or none of measles vaccination. Mothers’ misunderstanding about the measles immunization schedule was the main reason for choosing not to receive the measles immunizations. These findings help to improve communication with mothers about measles immunization and close the gap for 100% measles immunization in North Vietnam.

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.

Developing countries and the potential of mandatory reporting laws to identify severe child abuse and neglect

This chapter considers the key characteristics of different types of child abuse and neglect, and outlines the nature and justifiability of mandatory reporting laws. The issue of whether these laws may be useful for child protection in developing countries with emerging economies is an important one. ‘Developing country’ is a term used by various institutions to describe a nation which has a lower living standard, industrial base, and human development index (HDI) compared to other countries (World Bank 2012; United Nations Development Programme 2013). In the context of developing countries, the chapter addresses two questions: first, might some forms of maltreatment be more suited to mandatory reporting than others? Second, what options for child protection may be considered by developing countries, taking into account children’s needs, cultural conditions and practices, economic imperatives, and the different levels of preparedness to implement child protection strategies?

Is comfort important for optimal use of child restraints?

Suboptimal restraint use, particularly the incorrect use of restraints, is a significant and widespread problem among child vehicle occupants, and increases the risk of injury. Previous research has identified comfort as a potential factor influencing suboptimal restraint use. Both the real comfort experienced by the child and the parent’s perception of the child’s comfort are reported to influence the optimal use of restraints. Problems with real comfort may lead the child to misuse the restraint in their attempt to achieve better comfort whilst parent-perceived discomfort has been reported as a driver for premature graduation and inappropriate restraint choice. However, this work has largely been qualitative. There has been no research that objectively studies either the association between real and parental perceived comfort, or any association between comfort and suboptimal restraint use. One barrier to such studies is the absence of validated tools for quantifying real comfort in children. We aimed to develop methods to examine both real and parent-perceived comfort and examine their effects on suboptimal restraint use. We conducted online parent surveys (n=470) to explore what drives parental perceptions of their child’s comfort in restraint systems (study 1) and used data from field observation studies (n=497) to examine parent-perceived comfort and its relationship with observed restraint use (study 2). We developed methods to measure comfort in children in a laboratory setting (n=14) using video analysis to estimate a Discomfort Avoidance Behaviour (DAB) score, pressure mapping and adapted survey tools to differentiate between comfortable and induced discomfort conditions (study 3). Preliminary analysis of our recent online survey of Australian parents (study 1) indicates that 23% of parents report comfort as a consideration when making a decision to change restraints. Logistic regression modelling of data collected during the field observation study (study 2) revealed that parent-perceived discomfort was not significantly associated with premature graduation. Contrary to expectation, children of parents who reported that their child was comfortable were almost twice as likely to have been incorrectly restrained (p<0.01, 95% CI 1.24 - 2.77). In the laboratory study (study 3) we found our adapted survey tools did not provide a reliable measurement of real comfort among children. However our DAB score was able to differentiate between comfortable and induced discomfort conditions and correlated well with pressure mapping. Our results suggest that while some parents report concern about their child’s comfort, parent-reported comfort levels were not associated with restraint choice. If comfort is important for optimal restraint use, it is likely to be the real comfort of the child rather than that reported by the parent. The method we have developed for studying real comfort can be used in naturalistic studies involving child occupants to further understand this relationship. This work will be of interest to vehicle and child restraint manufacturers interested in improving restraint design for young occupants as well as researchers and other stakeholders interested in reducing the incidence of restraint misuse among children.

Designing a quality health information system: Case study analysis of maternal and child health in Papua New Guinea

Papua New Guinea (PNG) is facing what must seem like an insurmountable challenge to deliver quality healthcare servicesfor women living in both rural and urban areas. Glo bal governing bodies and donor agencies including WHO and UN have indicated that PNG does not have an appropriate health information system. Although there are some systems in place, to date, little research has been conducted on improving or resolving the data integrity and integration issues of the existing health information systems and automating the capture of women and newborns information in PNG. This current research study concentrates on the adoption of eHealth, as an innovative tool to strengthen the health information systems in PNG to meet WHO standards. The research targets maternal and child health focussing on child birth records asan exemplar...

Community Controlled Health Services: What They Are and How They Work

This chapter provides an overview of the role of community controlled health services and health sector and the role of the nurse.