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Objectives: This study developed predictive models for one‐week acute and six‐month persistent pain following root canal treatment (RCT). An additional aim was to study the gain in predictive efficacy of models containing clinical factors only, over models containing sociodemographic characteristics. Methods: A secondary data analysis of 708 patients who received RCTs was conducted. Three sets of predictors were used: (1) combined set, containing all predictors in the data set; (2) clinical set and (3) sociodemographic set. Missing data were handled by multiple imputation using the missing indicator method. The multilevel least absolute selection and shrinkage operator (LASSO) regression was used to select predictors into the final multilevel logistic models. Three measures, the area under the receiver operating characteristic curve (AUROC) and precision‐recall curve (AUPRC) and calibration curves, were used to assess the predictive performance of the models. Results: The selected‐in factors in the final models, using LASSO regression, are related to pre‐ and intra‐treatment clinical symptoms and pain experience. Predictive performance of the models remained the same with the inclusion (exclusion) of the socio‐demographic factors. For predicting one‐week outcome, the model built with combined set of predictors yielded the highest AUROC and AUPRC of 0.85 and 0.72, followed by the models built with clinical factors (AUROC = 0.82, AUPRC = 0.66). The lowest predictive ability was found in models with only sociodemographic characteristics (AUROC = 0.68, AUPRC = 0.40). Similar patterns were observed in predicting six‐month outcome, where the AUROC for models with combined, clinical and sociodemographic sets of predictors were 0.85, 0.89 and 0.66, respectively, and the AUPRC were 0.48, 0.53 and 0.22, respectively. Conclusions: Clinical factors such as the severity and experience of pre‐operative and intra‐operative pain were discovered important to the subsequent development of pain following RCTs. Adding sociodemographic characteristics to the models with clinical factors did not change the models' predictive performance or the proportion of explained variance. [ABSTRACT FROM AUTHOR]

Background: Low Apgar scores are associated with neonatal morbidity and mortality, but effects of Apgar scores of 0–5, 6, 7, 8 and 9 (compared with 10) on longer‐term neurodevelopmental outcomes are less clear. Aim: To examine the associations between Apgar scores of 0–5, 6, 7, 8 and 9 (compared with 10) and children's educational outcomes as measured by the Australian National Assessment Program—Literacy and Numeracy (NAPLAN) tests at age eight. Materials and Methods: We merged perinatal data including all children born in South Australia from 1999 to 2008 with school assessment data (NAPLAN). School assessments included five learning areas (domains)—reading, writing, spelling, grammar and numeracy. Each domain was categorised according to performing at or below National Minimum Standards (≤NMS). Effects were estimated using Augmented Inverse Probability Weighting (AIPW) accounting for a range of maternal, perinatal and sociodemographic characteristics. Results: Risk differences comparing five‐minute Apgar scores of 0–5 with Apgar scores of 10 for children performing ≤NMS for each domain were: reading (0.07 (95% CI −0.16 to 0.29)), writing (0.27 (95% CI −0.14 to 0.68)), spelling (0.15 (95% CI −0.10 to 0.40)), grammar (0.04 (95% CI −0.21 to 0.29)) and numeracy (0.21 (95% CI −0.04 to 0.45)). Risk differences for children performing ≤NMS were also evident when Apgar score of 6 was compared with Apgar score of 10. Conclusions: Children with five‐minute Apgar scores of 0–5 and 6, compared with Apgar score of 10, are at higher risk of scoring at/below the NMS on the NAPLAN assessments at eight years. [ABSTRACT FROM AUTHOR]

Aim: To quantify the frequency of emergency department (ED) presentations and profile the socio‐demographic, health and presentation characteristics of paediatric ED frequent presenters. Methods: A population‐based data linkage study of 55 921 children in the South Australian Early Childhood Data Project aged 0–12 years with 100 976 presentations to public hospital EDs in South Australia. For each child, the total number of recurrent ED presentations during a 364‐day period post‐index presentation was calculated. Frequent presenters were children who experienced ≥4 recurrent ED presentations. We determined the socio‐demographic, health and presentation characteristics by number of recurrent presentations. Results: Children with ≥4 recurrent presentations (4.4%) accounted for 15.4% of all paediatric ED presentations and 22.5% of subsequent admissions to hospital during the 12‐month study period. Compared to children with no recurrent ED presentation, frequent presenters had higher proportions of socio‐economic and health disadvantage at birth. One in two (49.3%) frequent presenters had at least one injury presentation and one (21.3%) in five had at least one presentation related to a chronic condition. Conclusions: Children with ≥4 presentations do not represent the majority of ED users. Nevertheless, they represent a disproportionate burden accounting for 15% of all paediatric ED presentations in a 12‐month period. Frequent presenters were characterised by early socio‐economic and health disadvantage, and childhood injury. Strategies targeting social disadvantage and childhood injury may reduce the burden of ED presentations. [ABSTRACT FROM AUTHOR]

Avin et al (2005) showed that, in the presence of exposure-induced mediator-outcome confounding, decomposing the total causal effect (TCE) using standard conditional exchangeability assumptions is not possible even under a nonparametric structural equation model with all confounders observed. Subsequent research has investigated the assumptions required for such a decomposition to be identifiable and estimable from observed data. One approach was proposed by VanderWeele et al (2014). They decomposed the TCE under three different scenarios: (1) treating the mediator and the exposure-induced confounder as joint mediators; (2) generating path-specific effects albeit without distinguishing between multiple distinct paths through the exposure-induced confounder; and (3) using so-called randomised interventional analogues where sampling values from the distribution of the mediator within the levels of the exposure effectively marginalises over the exposure-induced confounder. In this paper, we extend their approach to the case where there are multiple mediators that do not influence each other directly but which are all influenced by an exposure-induced mediator-outcome confounder. We provide a motivating example and results from a simulation study based on from our work in dental epidemiology featuring the 1982 Pelotas Birth Cohort in Brazil. [ABSTRACT FROM AUTHOR]

Background: Vaginal instrumental delivery is a common obstetrical intervention, but its effect on children's later development is not well known. Aims: To determine if vaginal instrumental delivery is associated with adverse neurodevelopment as measured by school achievement. Material and methods: We performed a whole‐of‐population study involving linkage of routinely collected perinatal data with school assessments among children born in South Australia from 1999 to 2008. Participants were singleton children born by forceps (n = 5494), ventouse (n = 6988), or normal delivery (n = 80 803). School achievement was measured through performance on the National Assessment Program in Literacy and Numeracy (NAPLAN), at around eight years of age. This assessment involved five domains and scores were categorised according to performing at or above National Minimum Standards (NMS). Effects of instrumental versus normal vaginal delivery were analysed via augmented inverse probability weighting (AIPW), taking into account a variety of maternal, perinatal and sociodemographic characteristics. Results: In unadjusted analyses, instrumental delivery was not associated with poor NAPLAN scores. AIPW analyses also suggested that instrumental delivery had minimal adverse effect on NAPLAN scores, with the largest difference being lower spelling scores among forceps‐delivered children (−0.022 (95% CI −0.0053–0.009)) compared with spontaneous vaginal births. The findings were consistent among exploratory subgroup analyses involving births in the absence of prolonged labour, with APGAR ≥ 9, and among normotensive and non‐diabetic mothers. Conclusion: In singleton children born at term, instrumental delivery does not have an adverse effect on neurodevelopment as measured by NAPLAN performance at age eight. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effect of a 2-year post-natal nurse home visiting (NHV) programme delivered in routine clinical practice to socially disadvantaged mothers on children's development at 5 years.Methods: The study was a natural experiment resulting from progressive rollout of NHV (2008-2012). Children of three groups of mothers, all eligible for NHV, were compared: (i) mothers receiving NHV in a metropolitan region (n = 197); (ii) mothers in a rural region prior to NHV being available (n = 94); and (iii) mothers receiving NHV in the rural region after it became available (n = 84). Outcomes were evaluated using the Child Behaviour Checklist, Child-Parent Relationships Scale, Behaviour Inventory of Executive Functioning and Australian Early Development Index.Results: Analyses were conducted using augmented inverse probability weighting accounting for differences in the groups' baseline characteristics. While some differences were observed in the range of 8-12% between the intervention and comparison groups (albeit with wide confidence intervals, e.g. 31% less likely to 4% more likely to be experiencing poor outcomes). For the majority of outcomes, however, there were no differences observed between the intervention and comparison groups.Conclusions: Post-natal NHV provided as a part of routine service delivery did not improve children's outcomes at 5 years. It may be that in the Australian context a NHV intervention, as offered in this study, does not provide additional benefits over standard care. [ABSTRACT FROM AUTHOR]

Background Caesarean birth is one of the most frequently performed major obstetrical interventions. Although there is speculation that caesarean at term may have consequences for children's later health and development, longer-term studies are needed. Aim We aimed to evaluate risks to poor school achievement among children born by caesarean section compared with spontaneous vaginal birth. Materials and Methods This population-based observational study involved linkage of routinely collected perinatal data with children's school assessments. Perinatal data included all children born in South Australia from 1999 to 2005. Participants were children born by elective caesarean (exposed, n = 650) or vaginal birth (unexposed, n = 2959), to women who previously had a caesarean delivery. School assessments were reported via a standardised national assessment program for children attending grade three (at ~eight years of age). Assessments included reading, writing, spelling, grammar and numeracy and were categorised according to performing at above or ≤National Minimum Standards ( NMS). Statistical analyses involved augmented inverse probability weighting (apiw) and accounted for a range of maternal, perinatal and sociodemographic characteristics. Results Children performing ≤ NMS for vaginal birth versus caesarean section were as follows: reading 144/640 (23%) and 688/2921 (24%), writing 69/636(11%) and 351/2917 (12%), spelling 128/646 (20%) and 684/2937 (23%), grammar 132/646 (20%) and 655/2937 (22%), and numeracy 151/634 (24%) and 729/2922 (25%). Both the raw data and the aipw analyses suggested little differences in school achievement between children born by caesarean versus vaginal birth. Conclusion Analyses that carefully controlled for a wide range of confounders suggest that caesarean section does not increase the risk of poor school outcomes at age eight. [ABSTRACT FROM AUTHOR]

Debate about the extent of breast cancer over-diagnosis due to mammography screening has continued for over a decade, without consensus. Estimates range from 0 to 54%, but many studies have been criticized for having flawed methodology. In this study we used a novel study design to estimate over-diagnosis due to organised mammography screening in South Australia (SA). To estimate breast cancer incidence at and following screening we used a population-based, age-matched case-control design involving 4,931 breast cancer cases and 22,914 controls to obtain OR for yearly time intervals since women's last screening mammogram. The level of over-diagnosis was estimated by comparing the cumulative breast cancer incidence with and without screening. The former was derived by applying ORs for each time window to incidence rates in the absence of screening, and the latter, by projecting pre-screening incidence rates. Sensitivity analyses were undertaken to assess potential biases. Over-diagnosis was estimated to be 8% (95%CI 2-14%) and 14% (95%CI 8-19%) among SA women aged 45 to 85 years from 2006-2010, for invasive breast cancer and all breast cancer respectively. These estimates were robust when applying various sensitivity analyses, except for adjustment for potential confounding assuming higher risk among screened than non-screened women, which reduced levels of over-diagnosis to 1% (95%CI 5-7%) and 8% (95%CI 2-14%) respectively when incidence rates for screening participants were adjusted by 10%. Our results indicate that the level of over-diagnosis due to mammography screening is modest and considerably lower than many previous estimates, including others for Australia. [ABSTRACT FROM AUTHOR]

Randomized controlled trial evidence shows that interventions before age 5 can improve skills necessary for educational success; the effect of these interventions on socioeconomic inequalities is unknown. Using trial effect estimates, and marginal structural models with data from the Avon Longitudinal Study of Parents and Children (n = 11,764, imputed), simulated effects of plausible interventions to improve school entry academic skills on socioeconomic inequality in educational achievement at age 16 were examined. Progressive universal interventions (i.e., more intense intervention for those with greater need) to improve school entry academic skills could raise population levels of educational achievement by 5% and reduce absolute socioeconomic inequality in poor educational achievement by 15%. [ABSTRACT FROM AUTHOR]

Background There is limited longitudinal data from high-income countries on the sequelae of anaemia during pregnancy. The aim of this study is to examine whether anaemia of pregnancy is associated with adverse perinatal outcomes and with children's developmental vulnerability. Methods We conducted a population-based study to link routinely collected government administrative data that involved all live births in the state of South Australia 1999-2005 ( n = 124 061) and a subset for whom developmental data were collected during a national census of children attending their first year of school in 2009 ( n = 13 654). Perinatal outcomes were recorded by midwives using a validated, standardised form. Development was recorded by schoolteachers using the Australian Early Development Index ( AEDI). Children in the lowest 10% of AEDI scores are indicative of developmental vulnerability. Results There were 8764/124 061 (7.1%) cases of anaemia. After adjustment for a range of potentially confounding factors, anaemia of pregnancy was associated with a higher risk of fetal distress [incident rate ratio ( IRR) 1.20 [95% CI 1.13, 1.27]] and preterm birth <37 weeks gestation ( IRR 1.23 [1.15, 1.31]), slightly higher birthweight [14 g (2, 26)] and newborns were less likely to require resuscitation ( IRR 0.94 [0.91, 0.097]). Anaemia of pregnancy was not associated with children's developmental vulnerability after adjustment for maternal, obstetric and sociodemographic covariables, either in complete case analyses ( n = 11 949) or after imputation for missing data ( n = 13 654). Conclusions Anaemia of pregnancy is associated with perinatal complications but not with children's developmental vulnerability at school entry. [ABSTRACT FROM AUTHOR]

Aim The aim of this study is to examine the amount of non-core (unhealthy) food advertising currently on Australian television (i) during children's programmes and viewing times; (ii) since the introduction of food industry self-regulatory initiatives in 2009; and (iii) whether advertising differs according to signatory status to industry initiatives. Methods We systematically searched Pub Med, Embase.com and JSTOR (media/marketing) databases; grey literature; and reference lists of relevant articles for studies published since 2009 that reported on food advertising on Australian television. Results The title and abstract of 316 articles were screened, yielding 25 articles considered potentially eligible, of which eight met the pre-defined selection criteria. Meta-analysis was not possible because of temporal and methodological differences across studies. The advertising of non-core foods was found to be negligible during programmes with a C-(children's) classification but ranged from 1.5 to 6.5/h during children's peak viewing times. From 2006 to 2011, non-core food advertising decreased by 0.18 advertisements per hour every year, whereas fast food advertising increased by 0.09/h; however, these analyses are based on one study with only five time points. During children's viewing times, signatories to industry initiatives advertise non-core foods at higher rates than non-signatories. Conclusions Although it is not possible to determine whether advertising has changed since the industry initiatives were introduced, signatories to the initiatives continue to advertise non-core foods at times when many children watch television. Future efforts to reduce children's exposure to food advertising should be focused on advertising during children's peak viewing times rather than by programme classifications. [ABSTRACT FROM AUTHOR]

The article presents a study to examine trends in child maltreatment reports to the Northern Territory Department of Children and Families among Aboriginal and non-Aboriginal children. It notes the increase in notifications highlighting the extent and tragedy of child maltreatment, which reached 286,437 involving 187,314 children in 2009-2010, with the Northern Territory showing a three-fold increase in five years. It finds that considerable increases were prominent among Aboriginal children.

Provides information on an article outlining the theoretical links between inequality and mortality while reviewing previous research on empirical links, summarizing the major changes in inequality in the United States during the last two decades. Details on income distribution and inequality in the United States; Information on theoretical links between inequality and health; Conclusion reached on these links.

The authors reflect on the impact of the 2009 industry initiatives Responsible Children's Marketing Initiative (RCMI) and the Quick Service Restaurant Industry Initiative for Responsible Advertising and Marketing to Children on television (TV) advertising of unhealthy food to children in Australia. The say that one of the challenges of the said initiatives is one how to define "advertising to children." They add that signatories to the industry initiatives may advertise unhealthy food on TV.