The effects of an area-based intervention on the uptake of maternal and child health assessments in Australia : a community trial

Background
Recognition of the importance of the early years in determining health and educational attainment and promotion of the World Health Organization Health for All (HFA) principles has led to an international trend towards community-based initiatives to improve developmental outcomes among socio-economically disadvantaged children. In this study we examine whether, Best Start, an Australian area-based initiative to improve child health was effective in improving access to Maternal and Child Health (MCH) services.

Methods
The study compares access to information, parental confidence and annual 3.5 year Ages and Stages visiting rates before (2001/02) and after (2004/05) the introduction of Best Start. Access to information and parental confidence were measured in surveys of parents with 3 year old children. There were 1666 surveys in the first wave and 1838 surveys in the second wave. The analysis of visiting rates for the 3.5 year Ages and Stages visit included all eligible Victorian children. Best Start sites included 1,739 eligible children in 2001/02 and 1437 eligible children in 2004/05. The comparable figures in the rest of the state were and 45, 497 and 45, 953 respectively.

Results
There was a significant increase in attendance at the 3.5 year Ages and Stages visit in 2004/05 compared to 2001/02 in all areas. However the increase in attendance was significantly greater at Best Start sites than the rest of the state. Access to information and parental confidence improved over the course of the intervention in Best Start sites with MCH projects compared to other Best Start sites.

Conclusion
These results suggest that community-based initiatives in disadvantaged areas may improve parents' access to child health information, improve their confidence and increase MCH service use. These outcomes suggest such programmes could potentially contribute to strategies to reduce child health inequalities.

Improving the competency of police officers in conducting investigative interviews with children

Despite the provision of 'best-practice' guidelines regarding conducting interviews with children, research indicates that most investigative interviews do not adhere to these guidelines. To date, there has been little discussion in the literature of the conditions that are needed to promote and sustain expertise in forensic interviewing. The current paper addresses this limitation by describing the main factors preventing the adoption of 'best-practice' interview guidelines. A description of these barriers (and the literature that supports them) forms the basis for the review component of this paper as well as the subsequent recommendations for change.

Assessing the validity of impact pathways for child labour and well-being in social life cycle assessment

Background, aim and scope: Assuming that the goal of social life cycle assessment (SLCA) is to assess damage and benefits on its ‘area of protection’ (AoP) as accurately as possible, it follows that the impact pathways, describing the cause effect relationship between indicator and the AoP, should have a consistent theoretical foundation so the inventory results can be associated with a predictable damage or benefit to the AoP. This article uses two concrete examples from the work on SLCA to analyse to what extent this is the case in current practice. One considers whether indicators included in SLCA approaches can validly assess impacts on the well-being of the stakeholder, whereas the other example addresses whether the ‘incidence of child labour’ is a valid measure for impacts on the AoPs.

Materials and methods: The theoretical basis for the impact pathway between the relevant indicators and the AoPs is analysed drawing on research from relevant scientific fields.

Results:   The examples show a lack of valid impact pathways in both examples. The first example shows that depending on the definition of ‘well-being’, the assessment of impacts on well-being of the stakeholder cannot be performed exclusively with the type of indicators which are presently used in SLCA approaches. The second example shows that the mere fact that a child is working tells little about how this may damage or benefit the AoPs, implying that the normally used indicator; ‘incidence of child labour’ lacks validity in relation to predicting damage or benefit on the AoPs of SLCA.

Discussion: New indicators are proposed to mitigate the problem of invalid impact pathways. However, several problems arise relating to difficulties in getting data, the usability of the new indicators in management situations, and, in relation to example one, boundary setting issues.

Conclusions: The article shows that it is possible to assess the validity of the impact pathways in SLCA. It thereby point to the possibility of utilising the same framework that underpins the environmental LCA in this regard. It also shows that in relation to both of the specific examples investigated, the validity of the impact pathways may be improved by adopting other indicators, which does, however, come with a considerable ‘price’.

Recommendations and perspectives: It is argued that there is a need for analysing impact pathways of other impact categories often included in SLCA in order to establish indicators that better reflect actual damage or benefit to the AoPs.

Can improving working memory prevent academic difficulties? a school based randomised controlled trial

Background: Low academic achievement is common and is associated with adverse outcomes such as grade repetition, behavioural disorders and unemployment. The ability to accurately identify these children and intervene before they experience academic failure would be a major advance over the current ‘wait to fail’ model. Recent research suggests that a possible modifiable factor for low academic achievement is working memory, the ability to temporarily store and manipulate information in a ‘mental workspace’. Children with working memory difficulties are at high risk of academic failure. It has recently been demonstrated that working memory can be improved with adaptive training tasks that encourage improvements in working memory capacity. Our trial will determine whether the intervention is efficacious as a selective prevention strategy for young children at risk of academic difficulties and is cost-effective.

Methods/Design: This randomised controlled trial aims to recruit 440 children with low working memory after a school-based screening of 2880 children in Grade one. We will approach caregivers of all children from 48 participating primary schools in metropolitan Melbourne for consent. Children with low working memory will be randomised to usual care or the intervention. The intervention will consist of 25 computerised working memory training sessions, which take approximately 35 minutes each to complete. Follow-up of children will be conducted at 6, 12 and 24 months post-randomisation through child face-to-face assessment, parent and teacher surveys and data from government authorities. The primary outcome is academic achievement at 12 and 24 months, and other outcomes include child behaviour, attention, health-related quality of life, working memory, and health and educational service
utilisation.

Discussion: A successful start to formal learning in school sets the stage for future academic, psychological and economic well-being. If this preventive intervention can be shown to be efficacious, then we will have the potential to prevent academic underachievement in large numbers of at-risk children, to offer a ready-to-use intervention to the Australian school system and to build international research partnerships along the health education interface, in order to carry our further studies of effectiveness and generalisability.

Improving outcomes of preschool language delay in the community : protocol for the Language for Learning randomised controlled trial

Background

Early language delay is a high-prevalence condition of concern to parents and professionals. It may result in lifelong deficits not only in language function, but also in social, emotional/behavioural, academic and economic well-being. Such delays can lead to considerable costs to the individual, the family and to society more widely. The Language for Learning trial tests a population-based intervention in 4 year olds with measured language delay, to determine (1) if it improves language and associated outcomes at ages 5 and 6 years and (2) its cost-effectiveness for families and the health care system.

Methods/Design

A large-scale randomised trial of a year-long intervention targeting preschoolers with language delay, nested within a well-documented, prospective, population-based cohort of 1464 children in Melbourne, Australia. All children received a 1.25-1.5 hour formal language assessment at their 4th birthday. The 200 children with expressive and/or receptive language scores more than 1.25 standard deviations below the mean were randomised into intervention or ‘usual care’ control arms. The 20-session intervention program comprises 18 one-hour home-based therapeutic sessions in three 6-week blocks, an outcome assessment, and a final feed-back/forward planning session. The therapy utilises a ‘step up-step down’ therapeutic approach depending on the child’s language profile, severity and progress, with standardised, manualised activities covering the four language development domains of: vocabulary and grammar; narrative skills; comprehension monitoring; and phonological awareness/pre-literacy skills. Blinded follow-up assessments at ages 5 and 6 years measure the primary outcome of receptive and expressive language, and secondary outcomes of vocabulary, narrative, and phonological skills.

Discussion

A key strength of this robust study is the implementation of a therapeutic framework that provides a standardised yet tailored approach for each child, with a focus on specific language domains known to be associated with later language and literacy. The trial responds to identified evidence gaps, has outcomes of direct relevance to families and the community, includes a well-developed economic analysis, and has the potential to improve long-term consequences of early language delay within a public health framework.

How significant is partnership formation in area-based projects to increase parental attendance at maternal and child health services

Objectives: 

Improving the care of children with advanced cancer by using an electronic patient-reported feedback intervention : results from the PediQUEST randomized controlled trial.

This study aimed to determine whether feeding back patient-reported outcomes (PROs) to providers and families of children with advanced cancer improves symptom distress and health-related quality of life (HRQoL).

The influence of yarn parameters on the ultraviolet protection of yarns

 Improving ultraviolet (UV) protection of textiles is essential to protect wearers against UV radiation induced risks. In addition to fabric parameters, yarn parameters are important factors affecting UV protection of textiles. This work is to examine the influence of yarn parameters on UV protection in order to set up a statistical model for predicting the UV protection of yarns. Wool yarns with different variables were used to test the ultraviolet protection factor (UPF) values for data analysis and the model verification. The model provides the optimized parameters for the UV protective fabric design. This work is helpful as a pre-cursor to the development of a more advanced optical model, which will look at understanding the penetration of UV light through fibres, yarns and fabrics.

Prosecutors' perspectives on clarifying terms for genitalia in child sexual abuse interviews

In investigative interviews with alleged victims of child sexual abuse, professionals must establish the nature of the alleged abuse by determining what body parts were involved in the offending. This can be difficult, however, because children often use colloquial (non-anatomical) terms to describe genitalia, and there has been little direction for interviewers about clarifying these terms sufficiently to establish the charge. The aim of this study was to address the need for guidance from prosecutors about the level of clarity in terms required from a legal perspective, and how this clarity can be achieved. A focus group of nine prosecutors (representing all but one Australian State and Territory) were asked to consider what degree of clarity in terminology for genitalia was adequate and how such clarity could be achieved. Thematic analysis revealed that a reduction in specific questioning around genitalia would improve the usefulness of investigative interviews with children from a legal perspective. Recommendations for improving interviews about abuse with child witnesses are discussed. © 2014 The Australian Psychological Society.

Obesity prevention in early life: an opportunity to better support the role of Maternal and Child Health Nurses in Australia

BACKGROUND: Because parents with young children access primary health care services frequently, a key opportunity arises for Maternal and Child Health (MCH) nurses to actively work with families to support healthy infant feeding practices and lifestyle behaviours. However, little is known regarding the extent to which MCH nurses promote obesity prevention practices and how such practices could be better supported. METHODS: This mixed methods study involved a survey of 56 MCH nurses (response rate 84.8 %), 16 of whom participated in semi-structured qualitative interviews. Both components aimed to examine the extent to which nurses addressed healthy infant feeding practices, healthy eating, active play and limiting sedentary behavior during routine consultations with young children 0-5 years. Key factors influencing such practices and how they could be best supported were also investigated. All data were collected from September to December 2013. Survey data were analysed descriptively and triangulated with qualitative interview findings, the analysis of which was guided by grounded theory principles. RESULTS: Although nurses reported measuring height/length and weight in most consultations, almost one quarter (22.2 %) reported never/rarely using growth charts to identify infants or children at risk of overweight or obesity. This reflected a reluctance to raise the issue of weight with parents and a lack of confidence in how to address it. The majority of nurses reported providing advice on aspects of infant feeding relevant to obesity prevention at most consultations, with around a third (37 %) routinely provided advice on formula preparation. Less than half of nurses routinely promoted active play and only 30 % discussed limiting sedentary behaviour such as TV viewing. Concerns about parental receptiveness and maintaining rapport were key barriers to more effective implementation. CONCLUSION: While MCH nurses are well placed to address obesity prevention in early life, there is currently a missed public health opportunity. Improving nurse skills in behaviour change counseling will be key to increasing their confidence in raising sensitive lifestyle issues with parents to better integrate obesity prevention practices into normal MCH service delivery.

Teeth Tales: a community-based child oral health promotion trial with migrant families in Australia

OBJECTIVES: The Teeth Tales trial aimed to establish a model for child oral health promotion for culturally diverse communities in Australia. DESIGN: An exploratory trial implementing a community-based child oral health promotion intervention for Australian families from migrant backgrounds. Mixed method, longitudinal evaluation. SETTING: The intervention was based in Moreland, a culturally diverse locality in Melbourne, Australia. PARTICIPANTS: Families with 1-4-year-old children, self-identified as being from Iraqi, Lebanese or Pakistani backgrounds residing in Melbourne. Participants residing close to the intervention site were allocated to intervention. INTERVENTION: The intervention was conducted over 5 months and comprised community oral health education sessions led by peer educators and follow-up health messages. OUTCOME MEASURES: This paper reports on the intervention impacts, process evaluation and descriptive analysis of health, knowledge and behavioural changes 18 months after baseline data collection. RESULTS: Significant differences in the Debris Index (OR=0.44 (0.22 to 0.88)) and the Modified Gingival Index (OR=0.34 (0.19 to 0.61)) indicated increased tooth brushing and/or improved toothbrushing technique in the intervention group. An increased proportion of intervention parents, compared to those in the comparison group reported that they had been shown how to brush their child's teeth (OR=2.65 (1.49 to 4.69)). Process evaluation results highlighted the problems with recruitment and retention of the study sample (275 complete case families). The child dental screening encouraged involvement in the study, as did linking attendance with other community/cultural activities. CONCLUSIONS: The Teeth Tales intervention was promising in terms of improving oral hygiene and parent knowledge of tooth brushing technique. Adaptations to delivery of the intervention are required to increase uptake and likely impact. A future cluster randomised controlled trial would provide strongest evidence of effectiveness if appropriate to the community, cultural and economic context. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12611000532909).

Improving photoprotection of Beauveria bassiana conidia for biological control of the cactus pest Dactylopius opuntiae in the semiarid region northeast of Brazil

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Optimized allocation of sectionalizing switches and control and protection devices for reliability indices improvement in distribution systems

Reliability of power supply is related, among other factors, to the control and protection devices allocation in feeders of distribution systems. In this way, optimized allocation of sectionalizing switches and protection devices in strategic points of distribution circuits, improves the quality of power supply and the system reliability indices. In this work, it is presented a mixed integer non-linear programming (MINLP) model, with real and binary variables, for the sectionalizing switches and protection devices allocation problem, in strategic sectors, aimed at improving reliability indices, increasing the utilities billing and fulfilling exigencies of regulatory agencies for the power supply. Optimized allocation of protection devices and switches for restoration, allows that those faulted sectors of the system can be isolated and repaired, re-managing loads of the analyzed feeder into the set of neighbor feeders. Proposed solution technique is a Genetic Algorithm (GA) developed exploiting the physical characteristics of the problem. Results obtained through simulations for a real-life circuit, are presented. © 2004 IEEE.

Social Panorama of Latin America 2006

Includes bibliography

Regulation, worker protection and active labour-market policies in Latin America

Includes bibliography