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Background: Home visiting programs are implemented in high income countries to improve outcomes for families with young children. Significant resources are invested in such programs and high quality evaluations are important. In the context of research trials, implementation quality is often poorly reported and, when reported, is variable. This paper presents the quality of implementation of the right@home program, a sustained nurse home visiting intervention trialled in Australia, and delivered in a ‘real world’ context through usual child and family health services. right@home is structured around the core Maternal Early Childhood Sustained Home-visiting (MECSH) program, which is a salutogenic, child focused prevention model. Method: At each visit right@home practitioners completed a checklist detailing the client unique identifier, date of contact and activities undertaken. These checklists were collated to provide data on intervention dose, retention to program completion at child age 2 years, and visit content, which were compared with the program schedule. Quality of family-provider relationship was measured using the Session Rating Scale. Exploratory factor analysis was conducted to identify clusters of activities and allow qualitative assessment of concordance between program aims and program delivery. Results: Of 363 intervention families offered the program, 352 (97·0%) commenced the program and 304 (87·3%) completed the program to child age 2 years. 253 of 352 (71·9%) families who commenced the program received more than 75 percent of scheduled visits including at least one antenatal visit. Families rated the participant-practitioner relationship highly (mean 39.4/40). The factor analysis identified six antenatal and six postnatal components which were concordant with the program aims. Conclusions: The right@home program was delivered with higher adherence to program dose, schedule and content, and retention than usually reported in other home visiting research. Program compliance may have resulted from program design (visit schedule, dose, content and delivery flexibility) that was consistent with family aims. [ABSTRACT FROM AUTHOR]

Aim To report a programme theory for pre-natal home visiting by nurses in the context of a sustained nurse home visiting programme by exploring pre- and postnatal outcomes and characteristics of the intervention that may have contributed to the outcomes. Background Studies have shown sustained nurse home visiting commencing pre-natally to be effective. Few studies have explored the processes by which pre-natal activities by nurses contribute to achieving effective outcomes. Design Process evaluation. Methods Process and outcome data from a randomized controlled trial of sustained nurse home visiting in an area of socioeconomic disadvantage in Western Sydney between 2005-2008 were collated. The pre-natal intervention focused on improving transition to parenting by supporting mothers through pregnancy. Health and service use outcome data were analysed for 208 women (111 intervention; 97 comparison receiving usual care). Five nurses delivering the intervention completed checklists detailing activities undertaken. Results Nurses provided information, psychosocial support, and health promoting activities for families. Intervention mothers had a higher rate of unassisted vaginal births than the general population. Compared with comparison mothers, intervention mothers at 4-6 weeks postnatally reported better general health and felt significantly more enabled to cope with and understand their baby and to care for themselves and their baby. Conclusion Comprehensive support, in a context of enabling client-nurse relationships and continuity of carer are the ways by which antenatal nurse home visiting achieves benefits for women and infants, having an impact on both clinical outcomes such as rates of normal vaginal delivery and maternal service engagement. [ABSTRACT FROM AUTHOR]

Objective: To examine the effects of paternal depression during children's first year on their wellbeing at 4-5 years of age using a large, representative sample of Australian families.Design, Setting and Participants: Prospective study of Australian families from 2004 to 2008. Two-biological-parent families (n = 2620) from the Longitudinal Study of Australian Children were included if depression measures were available for both parents in 2004, behavioural and developmental measures were available for children in 2008, and the families had not separated by 2008.Main Outcome Measure: Child scores on the Strengths and Difficulties Questionnaire and on a set of Derived Outcome Indices, measured when the child was 4-5 years old. Logistic regression modelling was used to investigate how early paternal depression in 2004 influenced child outcomes 4 years later.Results: Early paternal depression was a significant predictor of a range of poorer child outcomes (odds ratio [OR] for behavioural difficulties, 3.34 [95% CI, 3.06-3.65]; OR for a low development and wellbeing score, 2.70 [95% CI, 2.44-2.98]). These effects remained significant after controlling for both early maternal depression and later paternal depression (adjusted OR for behavioural difficulties, 1.93 [95% CI, 1.75-2.14]; OR for a low development and wellbeing score, 1.65 [95% CI, 1.48-1.85]).Conclusions: Depression in fathers during the first year of a child's life can have a detrimental impact on their child's behaviour, and social and emotional development at the point of school entry, in addition to and uniquely compared with depression in mothers. Early intervention to identify and address the mental health needs of fathers is required for the benefit of fathers, children and families. [ABSTRACT FROM AUTHOR]

The article presents research which assessed the impact of the outcomes of early paternal depression on children's development. The researchers performed a study of families using depression measures in Australia from 2004 to 2008. They found that the occurrence of depression among fathers during the first year of the life of their children can cause detrimental effect of their behavior.

Objective To investigate the impact of a long-term nurse home visiting programme, embedded within a universal child health system, on the health, development and well-being of the child, mother and family. Design Randomised controlled trial. Setting/participants 208(111 intervention, 97 comparison) eligible at-risk mothers living in a socioeconomically disadvantaged area in Sydney, booking into the local public hospital for confinement. Intervention A sustained and structured nurse home visiting antenatal and postnatal parenting education and support programme. Control Usual universal care. Main outcome measures The quality of the home environment for child development (12-24 months), parent-child interaction and child mental, psychomotor and behavioural development at 18 months. Results Mothers receiving the intervention were more emotionally and verbally responsive (HOME observation) during the first 2 years of their child's life than comparison group mothers (mean difference 0.5; 95% CI 0.1 to 0.9). Duration of breastfeeding was longer for intervention mothers than comparison mothers (mean difference 7.9 weeks; 95% CI 2.9 to 12.9). There was no significant difference in parent--child interaction between the intervention and comparison groups. There were no significant overall group differences in child mental, psychomotor or behavioural development. Mothers assessed antenatally as having psychosocial distress benefitted from the intervention across a number of areas. Conclusion This sustained nurse home visiting programme showed trends to enhanced outcomes in many, but not all, areas. Specifically, it resulted in clinically enhanced outcomes in breastfeeding duration and, for some subgroups of mothers, women's experience of motherhood and children's mental development. Trial registration number ACTRN12608000473369. [ABSTRACT FROM AUTHOR]

Background: Vaccine-preventable diseases cause significant morbidity and mortality worldwide and in developing countries in particular. Information on coverage and reasons for non-vaccination is vital to enhance overall vaccination activities. Of the several survey techniques available for investigating vaccination coverage in a given setting, the Lot Quality Technique (LQT) remains appealing and could be used in developing countries by local health personnel of district or rural health authorities to evaluate their performance in vaccination and many other health-related programs. This study aimed to evaluate vaccination coverage using LQT in a selected semi-urban setting in Turkey. Methods: A LQT-based cross-sectional study was conducted in Kecioren District on a representative sample of residents aged 12-23 months in order to evaluate coverage for routine childhood vaccines, to identify health units with coverage below 75%, and to investigate reasons for non-vaccination. Results: Based on self-reports, coverage for BCG, diphtheria-pertussis-tetanus (DPT-3), oral polio-3, hepatitis-3, and measles vaccines ranged between 94-99%. Coverage for measles was below 75% in five lots. The relatively high educational and socioeconomic status of parents in the study group alone could not minimize the "considerable" risk of vaccine-preventable diseases in the District and dictates a continuity of efforts for improving vaccination rates, with special emphasis on measles. We believe that administrative methods should be backed up by household surveys to strengthen vaccination monitoring and that families should be trained and motivated to have their children fully vaccinated according to the recommended schedule and in a timely manner. Conclusion: This study identified vaccine coverage for seven routine vaccines completed before the age of 24 months as well as the areas requiring special attention in vaccination services. The LQT, years after its introduction to health-related research, remains an appealing technique for rapid evaluation of the extent of a variety of local health concerns in developing countries, in rural areas in particular, and is very efficient in determining performance of individual subunits in a given service area. Training of local health personnel on use of the LQT could expedite response to local health problems and could even motivate them in conducting their own surveys tailored to their professional interests. [ABSTRACT FROM AUTHOR]

Background: Home visiting programs comprising intensive and sustained visits by professionals (usually nurses) over the first two years of life show promise in promoting child health and family functioning, and ameliorating disadvantage. Australian evidence of the effectiveness of sustained nurse home visiting in early childhood is limited. This paper describes the method and cohort characteristics of the first Australian study of sustained home visiting commencing antenatally and continuing to child-age two years for at-risk mothers in a disadvantaged community (the Miller Early Childhood Sustained Home-visiting trial). Methods and design: Mothers reporting risks for poorer parenting outcomes residing in an area of socioeconomic disadvantage were recruited between February 2003 and March 2005. Mothers randomised to the intervention group received a standardised program of nurse home visiting. Interviews and observations covering child, maternal, family and environmental issues were undertaken with mothers antenatally and at 1, 12 and 24 months postpartum. Standardised tests of child development and maternal-child interaction were undertaken at 18 and 30 months postpartum. Information from hospital and community heath records was also obtained. Discussion: A total of 338 women were identified and invited to participate, and 208 were recruited to the study. Rates of active follow-up were 86% at 12 months, 74% at 24 months and 63% at 30 months postpartum. Participation in particular data points ranged from 66% at 1 month to 51% at 24 months postpartum. Rates of active follow-up and data point participation were not significantly different for the intervention or comparison group at any data point. Mothers who presented for antenatal care prior to 20 weeks pregnant, those with household income from full-time employment and those who reported being abused themselves as a child were more likely to be retained in the study. The Miller Early Childhood Sustained Home-visiting trial will provide Australian evidence of the effectiveness of sustained nurse home visiting for children at risk of poorer health and developmental outcomes. [ABSTRACT FROM AUTHOR]

Summary: The aim of this study was to assess mothers’ knowledge on newborn care as well as factors associated with poor knowledge. A cross-sectional study sampled 446 mother–newborn pairs from five hospitals in the Puttalam district of Sri Lanka by stratified random sampling. Maternal knowledge on newborn care was assessed using a questionnaire with 50 statements via exit interview. A knowledge score was created by allocating 1 point for each correct response, which was dichotomised as ‘satisfactory’ or ‘poor’ by the median score. Only 21.7% correctly answered that ‘surgical spirit’ (70% isopropyl alcohol) should not be applied on the umbilical stump. More than 90% of mothers knew about breastfeeding on demand, the advantages of colostrum and the duration of exclusive breastfeeding. Except for a few conditions, mothers demonstrated a satisfactory knowledge in recognising danger signs of the newborn. According to multivariate analysis, primiparae (odds ratio (OR)=2.31; 95% CI 1.53–3.50), unemployed women (OR=3.31; 95% CI 1.89–5.80) and those with delayed antenatal booking visits (OR=2.02; 95% CI 1.26–2.23) were more likely to have poor knowledge. In conclusion, mothers had a satisfactory level of knowledge about breastfeeding and recognition of danger signs, but knowledge about care of the umbilical cord was poor. Maternal education programmes should place more emphasis on first-time mothers, unemployed women and those with delayed booking visits. [Copyright &y& Elsevier]

Societal responses to the existence of substance misuse fluctuate between harm minimisation and prohibition. Both approaches are predominantly downstream reactions to substance misuse that focus on the supply of harmful substances and the containment of misuse through treatment, rehabilitation or punishment. Until recently, little attention has been paid to the upstream individual, family, relationship, community or societal antecedents of substance misuse (which often overlap with those for other adverse life outcomes, such as unemployment, antisocial personality disorder and mental health problems) that have operated during earlier life. A growing body of evidence highlights the overlapping biological and experiential antecedents for substance abuse and other poor outcomes as well as the trajectory-changing protective factors that can prevent risks being translated into destiny. Risk minimisation and protection enhancement embedded in family and social systems are the essential building blocks of a set of early intervention strategies that begin antenatally and continue through the developing years of childhood, adolescence and young adult life, that have been shown to be effective in improving many outcomes in development, health and well-being. Much remains to be done to enable the promise of effective universal and targeted early intervention to be translated into policies, programs and practices that could be life-changing for citizens bogged in the mire of substance misuse and their children. Realistic, timely investment, influenced by the best scientific evidence indicating what works, for whom, under what circumstances, an increased degree of collaboration within and between governments and their agencies to enable “whole of government” responses in partnership with community-based initiatives are essential along with investments in multidisciplinary program evaluation research that will enable evidence-informed policy decisions to be tailored to the needs of individual countries. [Vimpani G. Getting the mix right: family, community and social policy interventions to improve outcomes for young people at risk of substance misuse. Drug Alcohol Rev 2005;24:111 – 125] [ABSTRACT FROM AUTHOR]

We compared high-precision lead isotopic ratios in deciduous teeth and environmental samples to evaluate sources of lead in 10 children from six houses in a primary zinc-lead smelter community at North Lake Macquarie, New South Wales, Australia. Teeth were sectioned to allow identification of lead exposure in utero and in early childhood. Blood lead levels in the children ranged from 10 to 42 µg/dL and remained elevated for a number of years. For most children, only a small contribution to tooth lead can be attributed to gasoline and paint sources. In one child with a blood lead concentration of 19.7 µg/dL, paint could account for about 45% of lead in her blood. Comparison of isotopic ratios of tooth lead levels with those from vacuum cleaner dust, dust-fall accumulation, surface wipes, ceiling (attic) dust, and an estimation of the smelter emissions indicates that from approximately 55 to 100% of lead could be derived from the smelter. For a blood sample from another child, > 90% of lead could be derived from the smelter. We found varying amounts of in utero-derived lead in the teeth. Despite the contaminated environment and high blood lead concentrations in the children, the levels of lead in the teeth are surprisingly low compared with those measured in children from other lead mining and smelting communities. Key words: children; environmental samples; isotopes; lead; smelter; teeth. [ABSTRACT FROM AUTHOR]

Editorial. Focuses on strategies to strengthen families by minimizing substance misuse. Importance of family and parenting issues in relation to preventing substance misuse; Influence of family on child development and adolescent risk behaviors; List of family characteristics which play a role in the development of substance misuse. [ABSTRACT FROM AUTHOR]

Prevents letters to the editor of the 'British Medical Journal' about a variety of topics. Preventing obesity in children; Hidden sugars in food; Patient-centered approach in the management of hypertension; How involving patients can work in home blood glucose testing; Violence as a public health problem; Vaccine induced protection against hepatitis B; Other topics.

Editorial. Focuses on the development of population-wide strategies in countries aimed at improving the developmental health and well-being of children. Elimination of child poverty by Sure Start in Great Britain; Budget for the implementation of the Agenda for Children in Canada; Australia's Stronger Families and Communities strategy to promote intervention measures at a family and community level.

The article comments on the needs of community child health practice in Australia. The claim that training in community child health lacks quality control is not supported by evidence. Also, there is no evidence supporting the claims that research funding in community child health is comparatively poor. Instead, the existing structure is well-placed to respond to the emergence of high prevalence conditions.

The author reflects on the difficulties on reporting and notification and having substantial data from child protection agencies to monitor child maltreatment. Topics discussed include the mortality and hospital morbidity data as an alternative measure in gathering data, the suspected child abuse and neglect (SCAN) medical protocol, and broadening rules in coding to improve the capture of cases of child abuse.

The authors discuss the issue on Australian children brought to out-of-home care. It makes reference to the first national standards launched on July 1, 2011 on giving these children chances for optimum health after identification of abuse or neglect. They argue that in many cases, practice has failed to meet expectations in this regard. The authors assert the importance of providing interventions to children during the period in which maltreatment has not yet been identified.

A letter is presented from 12 health and medical health scientists including Anthony J. McMichael, Stephen R. Leeder, and Bruce K. Armstrong to the Prime Minister on climate change and its health consequences.

Background: Home visiting programs comprising intensive and sustained visits by professionals (usually nurses) over the first two years of life show promise in promoting child health and family functioning, and ameliorating disadvantage. Australian evidence of the effectiveness of sustained nurse home visiting in early childhood is limited. This paper describes the method and cohort characteristics of the first Australian study of sustained home visiting commencing antenatally and continuing to child-age two years for at-risk mothers in a disadvantaged community (the Miller Early Childhood Sustained Home-visiting trial).Methods and Design: Mothers reporting risks for poorer parenting outcomes residing in an area of socioeconomic disadvantage were recruited between February 2003 and March 2005. Mothers randomised to the intervention group received a standardised program of nurse home visiting. Interviews and observations covering child, maternal, family and environmental issues were undertaken with mothers antenatally and at 1, 12 and 24 months postpartum. Standardised tests of child development and maternal-child interaction were undertaken at 18 and 30 months postpartum. Information from hospital and community heath records was also obtained.Discussion: A total of 338 women were identified and invited to participate, and 208 were recruited to the study. Rates of active follow-up were 86% at 12 months, 74% at 24 months and 63% at 30 months postpartum. Participation in particular data points ranged from 66% at 1 month to 51% at 24 months postpartum. Rates of active follow-up and data point participation were not significantly different for the intervention or comparison group at any data point. Mothers who presented for antenatal care prior to 20 weeks pregnant, those with household income from full-time employment and those who reported being abused themselves as a child were more likely to be retained in the study. The Miller Early Childhood Sustained Home-visiting trial will provide Australian evidence of the effectiveness of sustained nurse home visiting for children at risk of poorer health and developmental outcomes.Trial Registration: ACTRN12608000473369. [ABSTRACT FROM AUTHOR]

Investigates the determinants of blood lead concentration (PbB) in children living in Port Pirie, Australia. Significance of age and place of residency to PbB concentration; Increase in PbB occurrence at age 6 and 15; Risk of children living Port Pirie.