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This paper examines the perceived service needs of families of Hunter region preschool aged children with disruptive behaviour problems, attending centre-based child care services. Families were recruited via clinics and child care services, using defined eligibility criteria. Respondents ranked their service needs in clinical early education, and community-based categories, as well as strategies for cost reduction. Respondents also provided service utilisation, family stress, and socio-demographic details. The highest clinical service priorities entailed expansion of mainstream community treatment services. In the early education sector, highest priority was given to extending the behaviour management skills of existing child care staff, ahead of the need to recruit specialist staff. Priority was given to support groups and an information and referral service, ahead of respite services. Exceptional levels of family stress and burden of care were detected for this group. The findings provide a consumer's perspective on the provision of services for preschool-aged children with disruptive behaviour., This study was funded by the Hunter Area Health Service and the NSW Department of Education. Introduction Defiance, tantrums, inattentiveness, and high levels of motor activity are commonly seen in [...]

Research has determined that breast feeding is not a major contributor to cognitive development. In Australian tests between 1979 and 1982, assessments were made for bottle-fed and breast-fed children at ages two, four, seven and 11 to 13. After weighting for environmental, biomedical and sociodemographic factors, a statistically insignificant beneficial effect was observed for breast feeding.

Opportunistic survey methods might provide a practical and resource-efficient alternative to large-scale community surveys, and further studies are underway to validate this method a a community survey tool. The author bases this conclusion on opportunistic blood lead testing of a paediatric inpatient population, and provides statistics to support it.

Exposure to low levels of lead during early childhood may cause decreased intellectual development. A study compared the IQ scores of 494 seven-year-old children to their blood levels of lead both before birth and throughout the first seven years of their life. Children who had higher blood levels of lead before and after birth had lower IQ scores than those with lower blood levels of lead. At 15 months and two, three and four years old, children with a 30 microgram (ug) per deciliter concentration of lead in their blood had an IQ score that was 4% to 5% lower that of children with a 10 ug per deciliter concentration of lead in their blood. All of the children lived in a lead-smelting community in Australia and had been reported as having slower intellectual development at two and four years old. It is not known whether exposure to lead during early childhood affects mental development later in life.

Abstract 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

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]

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]

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]

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]

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.

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.

Comments on an article regarding the effectiveness of prenatal counseling on car safety for infants. Differences between counseled and noncounseled group of children restrained in automobiles; Argument on the scope of pediatric topics which should be or not to be published.

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.

Presents letters to the editor related to family. Comment on the article "In Defence of Progress," published in the previous issue of the journal "Family Matters"; Requirement of Australian government intervention to solve social problems; Need of international inequality to promote justice.

Our objective was to determine whether an asthma education program in schools would have 1) a direct impact on student knowledge and attitudes to asthma and quality of life of the students with asthma, 2) an indirect impact on teacher knowledge and attitudes to asthma and on school policies about asthma, and 3) a sustainable program after the resources to implement the research were withdrawn. Seventeen intervention and 15 control schools participated in a controlled trial. Baseline knowledge and attitudes were measured in year 8 students (ages 13-14 years) and their teachers together with quality of life in the students with asthma. A three-lesson package about asthma was delivered by teachers as part of the Personal Development/Health/Physical Education (PD/H/PE) curriculum. Follow-up questionnaires were administered to students and staff. Efforts to change school policies were documented. Five years after the intervention, PD/H/PE teachers were contacted to determine whether the program was still operating. Main outcome measures included asthma knowledge, attitudes, and quality of life. Questionnaires were returned by 4,161/4,475 of the year 8 students at baseline and by 3,443 at follow-up. In intervention schools, compared with control schools, students showed improved asthma knowledge (P < 0.0001), improvement in tolerance to asthma (P = 0.02), internal control (P = 0.03), and less tendency to believe in the role of chance in asthma control (P = 0.04). Students from intervention but not control schools showed significant improvements in overall quality of life (P = 0.003 vs. P = 0.82, respectively). Teachers from intervention schools showed significant increases in knowledge compared to control schools (P < 0.0001). Intervention schools were more likely to seek further health education about asthma (P < 0.01). Five years after the 35 schools involved in the development of the materials or the trial had been offered the Living With Asthma package, 25 (71%) were still teaching the program to most or all of their students. Fifty-nine of the 61 (97%) high schools in the Hunter Region now have the program. Management and distribution of the Living With Asthma program have been taken over by the Asthma Foundation of New South Wales. The package has been updated and is being offered to all high schools throughout New South Wales as part of the National Asthma-Friendly Schools Project. In conclusion, a teacher-led asthma education program in secondary school had direct and indirect beneficial outcomes and was sustained at a high level for 5 years in most schools in the Hunter Region, despite minimal ongoing maintenance and support from health workers., (Copyright 2004 Wiley-Liss, Inc.)