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The purpose of this perspective article is to emphasise the importance of the ‘First 2000 Days’ policy of life from conception to age five, and to propose new directions in which the policy’s implementation could be extended for the benefit of children and families. The proposed approach highlights principles of responsiveness, integration, sustainability and equity, specifying initiatives that embody the kind of innovation each principle aspires to. The article also proposes innovations in data collection and linkages that would strengthen the implementation of first 2000 days policies and frameworks. This perspective proposes a framework that could improve health systems implementation of services in the first 5 years of life, by proposing a well-coordinated continuum of services with integrated physical and digital solutions. This has the potential to transform how the health system monitors and responds to children and families’ needs in the critical early years of life during and beyond the current pandemic.

Watch Me Grow - Electronic (WMG-E) platform is an online resource to enhance the capacity of general practitioners (GPs) to involve parents in developmental surveillance. The aim of this study was to evaluate the acceptability and perceived utility of WMG-E.Semi-structured interviews were conducted with GPs/paediatricians (n = 6) and parents (n = 6). Focus groups were conducted with child and family health nurses (n = 25). Transcripts were analysed thematically.Participants indicated that WMG-E could empower clinicians and parents by enhancing health literacy about child developmental issues, but that it could also be disempowering if not used carefully. Clinicians mentioned being strategic at health service and public policy levels. A final theme was that of the need to balance widespread promotion with its targeted use.This study established the face validity of WMG-E, and reveals key lessons to inform the ways in which it is promoted and used.

RNA binding proteins (RBPs) are key regulators of gene expression. Small molecules targeting these RBP-RNA interactions are a rapidly emerging class of therapeutics for treating a variety of diseases. Ro-08-2750 (Ro) is a small molecule inhibitor identified as a competitive inhibitor of Musashi(MSI)-RNA interactions. Here we show Ro potently inhibits adrenocortical steroidogenesis and viability independent of MSI2 in multiple cell lines. We identified Ro-interacting proteins using an unbiased proteome-wide approach and discovered it is broadly targeting RBPs. To confirm this finding, we leveraged the large-scale ENCODE data and found a subset of RBPs whose depletion phenocopies Ro inhibition. We conclude that Ro is a promiscuous inhibitor of multiple RBPs, many containing RRM1 domains. Moreover, we provide a general framework for validating the specificity and identifying targets of RBP inhibitors in a cellular context.

IntroductionContinuity of child and family healthcare is vital for optimal child health and development for developmentally vulnerable children. Migrant and refugee communities are often at-risk of poor health outcomes, facing barriers to health service attendance including cultural, language, limited health literacy, discrimination and unmet psychosocial needs. ‘Integrated health-social care hubs’ are physical hubs where health and social services are co-located, with shared referral pathways and care navigation.AimOur study will evaluate the impact, implementation and cost-benefit of the First 2000 Days Care Connect (FDCC) integrated hub model for pregnant migrant and refugee women and their infants.Materials and methodsThis study has three components. Component 1 is a non-randomised controlled trial to compare the FDCC model of care with usual care. This trial will allocate eligible women to intervention and control groups based on their proximity to the Hub sites. Outcome measures include: the proportion of children attending child and family health (CFH) nurse services and completing their CFH checks to 12 months of age; improved surveillance of growth and development in children up to 12 months, post partum; improved breastfeeding rates; reduced emergency department presentations; and improved maternal well-being. These will be measured using linked medical record data and surveys. Component 2 will involve a mixed-method implementation evaluation to clarify how and why FDCC was implemented within the sites to inform future roll-out. Component 3 is a within-trial economic evaluation from a healthcare perspective to assess the cost-effectiveness of the Hubs relative to usual care and the implementation costs if Hubs were scaled and replicated.Ethics and disseminationEthical approval was granted by the South Eastern Sydney Local Health District Human Research Ethics Committee in July 2021 (Project ID: 020/ETH03295). Results will be submitted for publication in peer-reviewed journals and presented at relevant conferences.Trial registration numberACTRN12621001088831.

IntroductionThe increasing prevalence of developmental disorders in early childhood poses a significant global health burden. Early detection of developmental problems is vital to ensure timely access to early intervention, and universal developmental surveillance is recommended best practice for identifying issues. Despite this, there is currently considerable variation in developmental surveillance and screening between Australian states and territories and low rates of developmental screening uptake by parents. This study aims to evaluate an innovative web-based developmental surveillance programme and a sustainable approach to referral and care pathways, linking primary care general practice (GP) services that fall under federal policy responsibility and state government-funded child health services.Methods and analysisThe proposed study describes a longitudinal cluster randomised controlled trial (c-RCT) comparing a ‘Watch Me Grow Integrated’ (WMG-I) approach for developmental screening, to Surveillance as Usual (SaU) in GPs. Forty practices will be recruited across New South Wales and Queensland, and randomly allocated into either the (1) WMG-I or (2) SaU group. A cohort of 2000 children will be recruited during their 18-month vaccination visit or opportunistic visit to GP. At the end of the c-RCT, a qualitative study using focus groups/interviews will evaluate parent and practitioner views of the WMG-I programme and inform national and state policy recommendations.Ethics and disseminationThe South Western Sydney Local Health District (2020/ETH01625), UNSW Sydney (2020/ETH01625) and University of Queensland (2021/HE000667) Human Research Ethics Committees independently reviewed and approved this study. Findings will be reported to the funding bodies, study institutes and partners; families and peer-reviewed conferences/publications.Trial registration numberANZCTR12621000680864.

Compassion fatigue and vicarious trauma can be a consequence of social work practice in all contexts, including the fast-paced, crisis driven hospital environment. Four metropolitan hospitals collaborated with an academic partner to explore the understanding and awareness that hospital-based social workers have in this area, and to investigate both individual and organisational responsibility. The research utilised a Participatory Action Research methodology with Stage One being a collaboratively developed survey. The results of the survey showed that social workers’ understanding is impacted by their knowledge of compassion fatigue and vicarious trauma, the nature of everyday hospital practice, and the identification, provision of, and engagement in personal self-care and workplace support strategies. The findings highlighted the dual responsibility that employing hospitals and individuals have to care for themselves and each other, including the capacity for social workers to use supervision and collegial relationships to support their coping and resilience.

The adrenal gland is the site of steroid hormone synthesis. These hormones regulate many physiological processes including metabolism, blood pressure and volume, and sexual characteristic development. While signaling pathways, steroidogenic enzymes, and transcription factors have all been well characterized, little is known about the contribution of RNA-binding proteins (RBPs) in regulating steroidogenesis. We recently demonstrated that regulated RNA decay controls the timing of the steroidogenic gene expression response and identified 9 RBPs that regulate aldosterone production in an immortalized human cell line model for steroidogenesis, H295R. One of the RBPs we identified was Musashi-2 (MSI2), which is required for development of other steroidogenic tissues such as ovary and testis in mice. We found that MSI2 mRNA is enriched in human adrenal glands relative to other tissues, positively correlates in expression with mRNAs encoding steroidogenic enzymes, and abundantly expressed in H295R cells. Staining of normal human adrenal gland sections demonstrated that MSI2 protein is expressed in all three layers of the human adrenal cortex. Taken together, we hypothesized that MSI2 promotes steroidogenesis through regulating expression of target mRNAs encoding. Using the selective MSI2 inhibitor Ro-08-2750 (Ro) we found that aldosterone and cortisol production is decreased in a dosage dependent manner in H295R cells, which is consistent with siRNA knockdown of MSI2. We performed RNA-immunoprecipitation and sequencing and identified 1428 mRNA targets of MSI2 in H295R cells. A target of interest was Stearoyl-CoA Desaturase (SCD), which functions to convert saturated fatty acids to unsaturated fatty acids that promote formation of lipid droplets. Cholesterol esters in lipid droplets are a source of cholesterol used to produce all steroid hormones. Ro treatment of H295R cells resulted in a suppression of SCD mRNA and protein induction. Furthermore, inhibition of SCD with A939572 caused a dosage dependent decrease in aldosterone production. These data suggest that potentiation of stimulation dependent SCD induction is one mechanism by which MSI2 promotes steroidogenesis. It will be important to determine if and how MSI2 promotes steroidogenesis in primary human adrenal cells and mouse models. Since it is possible to deliver oligonucleotides to the adrenal cortex, disruption of MSI2-SCD mRNA regulatory interactions may open new therapeutic avenues for modulate aldosterone production. Presentation: Monday, June 13, 2022 12:00 p.m. - 12:15 p.m.

Objectives This study examined the risk factors for non-participation in a developmental surveillance program in a population in south-west Sydney with a high proportion of culturally diverse and socioeconomically disadvantaged people. Methods Data from 850 and 625 12- and 18-month-old children respectively from the Watch Me Grow (WMG) birth cohort were used for this study. Logistic regression models were used to assess risk factors for 12- and 18-month non-attendance at Well Child Visits, as well as non-completion of the developmental surveillance questionnaire Parents’ Evaluation of Developmental Status (PEDS) in the child’s personal health record (PHR). Results Independent risk factors for non-attendance at Well Child Visits were female sex of the child (odds ratio (OR) 12 months 1.5; 95% confidence interval (CI) 1.0–2.3), mother’s country of birth Australia (OR 18 months 1.8; 95% CI 1.2–2.7), annual household income less than A$25 001 (OR 12 months 1.8; 95% CI 1.0–3.2) and residing in a socioeconomically disadvantaged neighbourhood (OR 12 months 1.7; 95% CI 1.1–2.5). Independent risk factors for non-completion of PEDS in those who did not attend the Well Child Visit compared with those who did attend and did complete PEDS were household annual income at birth less than A$25 001 (OR 12 months 3.9; 95% CI 1.9–8.1) and residing in a socioeconomically disadvantaged neighbourhood (OR 12 months 2.1 (95% CI 1.2–3.7) and OR 18 months 2.0 (95% CI 1.2–3.6)). Conclusions In this population, children exposed to socioeconomic disadvantage are less likely to have attended a Well Child Visit and to have a completed PEDS in their PHR at 12 and/or 18 months of age. What is known about the topic? Developmental problems are common in early childhood, and children from socioeconomically disadvantaged households are at higher risk. Universal developmental surveillance programs may be effective at early identification of children at risk of developmental problems. Early childhood interventions, when accessed, can lessen the effects of developmental problems in later years. What does this paper add? This paper highlights that children exposed to socioeconomic disadvantage in early childhood who are at higher risk of having developmental problems are also at higher risk of missing out on early identification by non-participation in universal developmental surveillance. What are the implications for practitioners? A more equitable model of developmental surveillance should include a framework of proportionate universalism to ensure optimal engagement of high-risk population groups.

Aims and objectivesTo develop a profile of registered nurses working in Child and Family Health services across the Northern Sydney Local Health District to inform workforce strategic planning.BackgroundChild and family health nurses (CFHNs) are registered nurses holding recognized qualifications in child and family health. To date, information regarding Child and family health nurses has been very limited.MethodsThe survey was conducted using a self-administrated online questionnaire between March-June 2017.ResultsJust over 75% of the respondents were aged over 50 years. Job satisfaction and feeling valued are enablers for remaining in current positions and not feeling valued can contribute to leaving employment. Nearly, one-third of respondents are currently a carer.ConclusionThis study provides an insight into the demographics of Child and family health nurses in Northern Sydney Local Health District, including roles as carers. It also examines factors influencing Child and family health nurses to remain or leave current positions.Implication for nursing managementThis survey has drawn attention to the need for managers to urgently develop strategies, for example succession planning, to ensure that shortages of these experienced Child and family health nurses do not occur. The inability to staff Child and Family Health could potentially impact on the ability to provide services and meet key performance indicators.

Adrenal steroid hormone production is a dynamic process stimulated by adrenocorticotropic hormone (ACTH) and angiotensin II (AngII). These ligands initialize a rapid and robust gene expression response required for steroidogenesis. Here, we compare the predominant human immortalized cell line model, H295R cell, with primary cultures of adult adrenocortical cells derived from human kidney donors. We performed temporally resolved RNA-seq on primary cells stimulated with either ACTH or AngII at multiple time points. The magnitude of the expression dynamics elicited by ACTH was greater than AngII in primary cells. This is likely due to the larger population of adrenocortical cells that are responsive to ACTH. The dynamics of stimulus-induced expression in H295R cells are mostly recapitulated in primary cells. However, there are some expression responses in primary cells absent in H295R cells. These data are a resource for the endocrine community and will help researchers determine whether H295R is an appropriate model for the specific aspect of steroidogenesis that they are studying.

Developmental surveillance and screening is recommended for all children under five years of age, especially for those from at-risk populations such as First Nations children. No review to date has, however, evaluated the use of developmental screening tools with First Nations children. This review aimed to examine and synthesise the literature on developmental screening tools developed for, or used with, First Nations populations children aged five years or younger. A PRISMA-compliant systematic review was performed in the PsychInfo, PubMed, and Embase databases. Additional searches were also undertaken. In total 444 articles were identified and 13 were included in the final review. Findings indicated that several developmental screening tools have been administered with First Nations children. Most tools, however, have only been evaluated in one study. Results also found that no studies evaluated actions taken following positive screening results. More research evaluating the accuracy, acceptability, and feasibility of using developmental screeners with First Nations children is required before widespread implementation of developmental screening in clinical settings with First Nations children is recommended.

Bereavement support and conducting viewings for grieving family members are commonplace activities for social workers in the acute hospital setting, however the risks that COVID-19 has brought to the social work role in bereavement care has necessitated the exploration of creative alternatives. Social workers are acutely aware of the complicating factors when bereavement support is inadequately provided, let alone absent, and with the aid of technology and both individual advocacy, social workers have been able to continue to focus on the needs of the most vulnerable in the hospital system. By drawing on reflective journaling and verbal reflective discussions amongst the authors, this article discusses bereavement support and the facilitation of viewings as clinical areas in which hospital social work has been observed adapting practice creatively throughout the pandemic.

AIMS To describe the engagement of a cohort of urban Aboriginal families with an Early Childhood Health Service, and to assess any association of engagement with the service with screening by the Edinburgh Post-Natal Depression Scale (EPDS), full breastfeeding rates and post-natal smoking status. METHODS Routine electronic medical record data collected by a Child and Family Health Nurse between 2011 and 2014 was analysed retrospectively. Associations between use of the service and acceptance of EPDS, breastfeeding rates and post-natal smoking status were determined using binary and multinomial multiple logistic regression analyses. RESULTS There were 424 Aboriginal babies and 215 mothers included in the study. Each occasion of service increased the odds of accepting screening with the EPDS (odds ratio (OR) 1.02, 95% confidence interval (CI) 1.00-1.03, P = 0.04) and complete breastfeeding (OR 1.11, CI 1.01-1.23, P = 0.04), but not of quitting smoking (OR 0.99, CI 0.96-1.02, P = 0.34). Despite accounting for engagement with the service, overall uptake of the EPDS remained low; of 267 offers for EPDS screening, only 115 were accepted (43%). CONCLUSION The service was accessed in increasing numbers during the study period. Mothers who utilised the service more frequently were more likely to accept EPDS screening and exclusively breastfeed; however, acceptance of EPDS screening remained low overall. Further research is recommended to investigate the low acceptance of EPDS in this Aboriginal population and whether those results are transferable to other communities.

Aim To examine socio-demographic factors associated with maternal help-seeking for child developmental concerns in a longitudinal birth cohort study. An understanding of these factors is critical to improving uptake of services to maximise early identification and intervention for developmental concerns. Methods A birth cohort was recruited from the post-natal wards of two teaching hospitals and through community nurses in South Western Sydney, Australia, between November 2011 and April 2013. Of the 4047 mothers approached, 2025 consented to participate (response rate = 50%). Socio-demographic and service use information was collected after the child's birth and when the child was 18 months of age. Sources of help were divided into three categories (formal health services, other formal services and informal supports) and compound variables were created by summing the number of different sources identified by mothers. Results Significantly more sources of help were intended to be used and/or actually accessed by mothers born in Australia, whose primary language was English, with higher levels of education and annual household income, and among mothers of first-born children. Conclusions Developmental concerns are known to increase with increased psychosocial adversity. Our findings of reduced intent to access and use of services by socio-economically disadvantaged families and those from culturally and linguistically diverse backgrounds suggests that an inverse care effect is in operation whereby those children with the greatest health needs may have the least access to services. Possible explanations for this, and recommendations for improving service accessibility for these populations through targeted and culturally appropriate services, are discussed.

Background While developmental surveillance programs promote early identification of child developmental problems, evidence has indicated suboptimal uptake. This study aimed to identify predictors of developmental surveillance completion at 6 months postpartum. Methods Questionnaires were administered to the parents of 510 infants who were born in south western Sydney, Australia over a 22-month period. Attendance for developmental screening and completion of the Parents' Evaluation of Developmental Status (PEDS) at 6 months postpartum were modelled separately using multivariable logistic regression. Results Developmental surveillance attendance was predicted by higher levels of maternal education, annual income and being informed about checks. PEDS completion at 6 months of age was predicted by higher income and being informed, as well as being married, employed, speaking English at home, full-term birth and the professional status of the practitioner completing the check. Conclusions Barriers to developmental surveillance included low socioeconomic status, linguistic diversity and possible gaps in parental knowledge and professional education. Developmental surveillance rates may be increased by the addition of targeted parental and professional support within current universal frameworks.

BackgroundIn order to determine the extent to which care delivered to children is appropriate (in line with evidence-based care and/or clinical practice guidelines (CPGs)) in Australia, we developed a set of clinical indicators for 21 common paediatric medical conditions for use across a range of primary, secondary and tertiary healthcare practice facilities.MethodsClinical indicators were extracted from recommendations found through systematic searches of national and international guidelines, and formatted with explicit criteria for inclusion, exclusion, time frame and setting. Experts reviewed the indicators using a multi-round modified Delphi process and collaborative online wiki to develop consensus on what constituted appropriate care.ResultsFrom 121 clinical practice guidelines, 1098 recommendations were used to draft 451 proposed appropriateness indicators. In total, 61 experts (n = 24 internal reviewers, n = 37 external reviewers) reviewed these indicators over 40 weeks. A final set of 234 indicators resulted, from which 597 indicator items were derived suitable for medical record audit. Most indicator items were geared towards capturing information about under-use in healthcare (n = 551, 92%) across emergency department (n = 457, 77%), hospital (n = 450, 75%) and general practice (n = 434, 73%) healthcare facilities, and based on consensus level recommendations (n = 451, 76%). The main reason for rejecting indicators was 'feasibility' (likely to be able to be used for determining compliance with 'appropriate care' from medical record audit).ConclusionA set of indicators was developed for the appropriateness of care for 21 paediatric conditions. We describe the processes (methods), provenance (origins and evolution of indicators) and products (indicator characteristics) of creating clinical indicators within the context of Australian healthcare settings. Developing consensus on clinical appropriateness indicators using a Delphi approach and collaborative online wiki has methodological utility. The final indicator set can be used by clinicians and organisations to measure and reflect on their own practice.

Background: Variable and poor care quality are important causes of preventable patient harm. Many patients receive less than recommended care, but the extent of the problem remains largely unknown. The CareTrack Kids (CTK) research programme sought to address this evidence gap by developing a set of indicators to measure the quality of care for common paediatric conditions. In this study, we focus on one clinical area, 'preventive care' for pre-school aged children. Our objectives were two-fold: (i) develop and validate preventive care quality indicators and (ii) apply them in general medical practice to measure adherence. Methods: Clinical experts (n = 6) developed indicator questions (IQs) from clinical practice guideline (CPG) recommendations using a multi-stage modified Delphi process, which were pilot tested in general practice. The medical records of Australian children (n = 976) from general practices (n = 80) in Queensland, New South Wales and South Australia identified as having a consultation for one of 17 CTK conditions of interest were retrospectively reviewed by trained paediatric nurses. Statistical analyses were performed to estimate percentage compliance and its 95% confidence intervals. Results: IQs (n = 43) and eight care 'bundles' were developed and validated. Care was delivered in line with the IQs in 43.3% of eligible healthcare encounters (95% CI 30.5-56.7). The bundles of care with the highest compliance were 'immunisation' (80.1%, 95% CI 65.7-90.4), 'anthropometric measurements' (52.7%, 95% CI 35.6-69.4) and 'nutrition assessments' (38.5%, 95% CI 24.3-54.3), and lowest for 'visual assessment' (17.9%, 95% CI 8.2-31.9), 'musculoskeletal examinations' (24.4%, 95% CI 13.1-39.1) and 'cardiovascular examinations' (30.9%, 95% CI 12.3-55.5). Conclusions: This study is the first known attempt to develop specific preventive care quality indicators and measure their delivery to Australian children in general practice. Our findings that preventive care is not reliably delivered to all Australian children and that there is substantial variation in adherence with the IQs provide a starting point for clinicians, researchers and policy makers when considering how the gap between recommended and actual care may be narrowed. The findings may also help inform the development of specific improvement interventions, incentives and national standards. Refereed/Peer-reviewed

Background Encouraging early child development and the early identification of developmental difficulties is a priority. The Ministry of Health in the Australian State of New South Wales (NSW), has recommended a program of developmental surveillance using validated screening questionnaires, namely, the Parents’ Evaluation of Development Status (PEDS) and Ages and Stages Questionnaire (ASQs), however, the use of these tools has remained sub-optimal. A longitudinal prospective birth cohort “Watch Me grow” study was carried out in the South Western Sydney (SW) region of NSW to ascertain the uptake as well as the strategies and the resources required to maximise engagement in the surveillance program. This paper reports on a qualitative component of the study examining the attitudes, enablers and barriers to the current developmental surveillance practices, with reference to screening tools, amongst health professionals. Methods Qualitative data from 37 primary health care providers in a region of relative disadvantage in Sydney was analysed. Results The major themes that emerged from the data were the “difficulties/problems” and “positives/benefits” of surveillance in general, and “specificity” of the tools which were employed. Barriers of time, tool awareness, knowledge and access of referral pathways, and services were important for the physician providers, while the choice of screening tools and access to these tools in other languages were raised as important issues by Child and Family Health Nurses (CFHN). The use of these tools by health professionals was also influenced by what the professionals perceived as the parents’ understanding of their child’s development. While the PEDS and ASQs was utilised by CFHNs, both General Practitioners (GPs) and paediatricians commented that they lacked awareness of developmental screening tools and highlighted further training needs. Conclusions The results highlight the practical challenges to, and limited knowledge and uptake of, the use of recommended screening tools as part of developmental surveillance. There is a need for further research regarding the most effective integrated models of care which will allow for a better collaboration between parents and service providers and improve information sharing between different professionals such as CFHNs GPs, Practices nurses and Paediatricians involved in screening and surveillance programs.

IMPORTANCE The quality of routine care for children is rarely assessed, and then usually in single settings or for single clinical conditions. OBJECTIVE To estimate the quality of health care for children in Australia in inpatient and ambulatory health care settings. DESIGN, SETTING, AND PARTICIPANTS Multistage stratified sample with medical record review to assess adherence with quality indicators extracted from clinical practice guidelines for 17 common, high-burden clinical conditions (noncommunicable [n = 5], mental health [n = 4] , acute infection [n = 7], and injury [n = 1] ), such as asthma, attention-deficit/hyperactivity disorder, tonsillitis, and head injury. For these 17 conditions, 479 quality indicators were identified, with the number varying by condition, ranging from 9 for eczema to 54 for head injury. Four hundred medical records were targeted for sampling for each of 15 conditions while 267 records were targeted for anxiety and 133 for depression. Within each selected medical record, all visits for the 17 targeted conditions were identified, and separate quality assessments made for each. Care was evaluated for 6689 children 15 years of age and younger who had 15 240 visits to emergency departments, for inpatient admissions, or to pediatricians and general practitioners in selected urban and rural locations in 3 Australian states. These visits generated 160 202 quality indicator assessments. EXPOSURES Quality indicators were identified through a systematic search of local and international guidelines. Individual indicators were extracted from guidelines and assessed using a 2-stage Delphi process. MAIN OUTCOMES AND MEASURES Quality of care for each clinical condition and overall. RESULTS Of 6689 children with surveyed medical records, 53.6% were aged 0 to 4 years and 55.5% were male. Adherence to quality of care indicators was estimated at 59.8% (95% CI, 57.5%-62.0%; n = 160 202) across the 17 conditions, ranging from a high of 88.8% (95% CI, 83.0%-93.1%; n = 2638) for autism to a low of 43.5% (95% CI, 36.8%-50.4%; n = 2354) for tonsillitis. The mean adherence by condition category was estimated as 60.5% (95% CI, 57.2%-63.8%; n = 41 265) for noncommunicable conditions (range, 52.8%-75.8%); 82.4% (95% CI, 79.0%-85.5%; n = 14 622) for mental health conditions (range, 71.5%-88.8%); 56.3% (95% CI, 53.2%-59.4%; n = 94 037) for acute infections (range, 43.5%-69.8%); and 78.3% (95% CI, 75.1%-81.2%; n = 10 278) for injury. CONCLUSIONS AND RELEVANCE Among a sample of children receiving care in Australia in 2012-2013, the overall prevalence of adherence to quality of care indicators for important conditions was not high. For many of these conditions, the quality of care may be inadequate. Refereed/Peer-reviewed

Background Regular health visits for parents with young children provide an opportunity for developmental surveillance and anticipatory guidance regarding common childhood problems and help to achieve optimal developmental progress prior to school entry. However, there are few published reports from Australian culturally and linguistically diverse (CALD) communities exploring parents’ experiences for accessing child health surveillance programs. This paper aims to describe and explain parental experiences for accessing developmental surveillance and anticipatory guidance for children. Methods Qualitative data was obtained from 6 focus groups (33 parents) and seven in-depth interviews of CALD parents recruited from an area of relative disadvantage in Sydney. Thematic analysis of data was conducted using an ecological framework. Results An overarching theme of “awareness-beliefs-choices” was found to explain parents’ experiences of accessing primary health care services for children. “Awareness” situated within the meso-and macro-systems explained parents knowledge of where and what primary health services were available to access for their children. Opportunities for families to obtain this information existed at the time of birth in Australian hospitals, but for newly arrived immigrants with young children, community linkages with family and friends, and general practitioner (GPs) were most important. “Beliefs” situated within the microsystems included parents’ understanding of their children’s development, in particular what they considered to be “normal” or “abnormal”. Parental “choices”, situated within meso-systems and chronosystems, related to their choices of service providers, which were based on the proximity, continuity, purpose of visit, language spoken by the provider and past experience of a service. Conclusions CALD parents have diverse experiences with primary health care providers which are influenced by their awareness of available services in the context of their duration of stay in Australia. The role of the general practitioner, with language concordance, suggests the importance of diversity within the primary care health workforce in this region. There is a need for ongoing cultural competence training of health professionals and provisions need to be made to support frequent use of interpreters at general practices in Australia.

Objective To evaluate screening and diagnostic outcomes of the New South Wales Statewide Eyesight Preschooler Screening (StEPS) program, a state-funded, universal vision screening program for 4-year-old children. Design, setting and participants A cross-sectional evaluation of the StEPS program, in which eligible 4-year-old children were offered a vision screen in local health districts in NSW, between 1 July 2010 and 30 June 2011. Main outcome measures Number and proportion of eligible children who were offered screening; accepted screening; were screened and scored a pass or were referred (routinely or urgently) for further vision assessment; and were referred for further assessment and required intervention. Results Of 91 324 eligible 4-year-olds in NSW, 80 328 (88.0%) were offered screening, and 65 834 (72.1% of the eligible population) were screened. Of the children who were screened, 3867 (5.9%) scored less than 6/9-2 but better than 6/18 in one or both eyes and were referred to their general practitioner or eye health professional for further vision assessment. A further 1425 children (2.2%) scored 6/18 or less in one or both eyes and were referred for high-priority assessment. In the two local health districts with the most complete follow-up data, 704 of 779 children (90.4%) with routine referrals and 278 of 285 (97.5%) with high-priority referrals required treatment or review at a later date. Conclusions The StEPS program has achieved a high screening participation rate in NSW. Many children have been diagnosed and received treatment for previously undetected serious vision disorders that may otherwise have been diagnosed too late for effective intervention.

To examine socio-demographic factors associated with maternal help-seeking for child developmental concerns in a longitudinal birth cohort study. An understanding of these factors is critical to improving uptake of services to maximise early identification and intervention for developmental concerns.A birth cohort was recruited from the post-natal wards of two teaching hospitals and through community nurses in South Western Sydney, Australia, between November 2011 and April 2013. Of the 4047 mothers approached, 2025 consented to participate (response rate = 50%). Socio-demographic and service use information was collected after the child's birth and when the child was 18 months of age. Sources of help were divided into three categories (formal health services, other formal services and informal supports) and compound variables were created by summing the number of different sources identified by mothers.Significantly more sources of help were intended to be used and/or actually accessed by mothers born in Australia, whose primary language was English, with higher levels of education and annual household income, and among mothers of first-born children.Developmental concerns are known to increase with increased psychosocial adversity. Our findings of reduced intent to access and use of services by socio-economically disadvantaged families and those from culturally and linguistically diverse backgrounds suggests that an inverse care effect is in operation whereby those children with the greatest health needs may have the least access to services. Possible explanations for this, and recommendations for improving service accessibility for these populations through targeted and culturally appropriate services, are discussed.

Objectives Early identification of developmental vulnerability is vital. This study aimed to estimate the prevalence of moderate or high developmental risk on the Parents9 Evaluation of Developmental Status (PEDS) at 6-month, 12-month and 18-month well-child checks; identify associated risk factors; and examine documentation of the PEDS at well-child checks. Design, participants A prospective birth cohort of 2025 children with 50% of those approached agreeing to participate. Demographic data were obtained via questionnaires and linked electronic medical records. Telephone interviews were conducted with parents to collect PEDS data. Primary and secondary outcomes Multiple logistic regression analyses identified risk factors for moderate or high developmental risk on the PEDS. A Cumulative Risk Index examined the impact of multiple risk factors on developmental risk and documentation of the PEDS at the well-child checks. Results Of the original cohort, 792 (39%) had 6-month, 649 (32%) had 12-month and 565 (28%) had 18-month PEDS data. Parental concerns indicating moderate or high developmental risk on the PEDS were 27% (95% CI 24 to 30) at 6 months, 27% (95% CI 24 to 30) at 12 months and 33% (95% CI 29 to 37) at 18 months. Factors associated with moderate or high developmental risk were perinatal risk (OR 12 months: 1.7 (95% CI 1.1 to 2.7)); maternal Middle Eastern or Asian nationality (OR 6 months: 1.6 (95% CI 1.1 to 2.4)), (OR 12 months: 1.7 (95% CI 1.1 to 2.7)); and household disadvantage (OR 6 months: 1.5 (95% CI 1.0 to 2.2). As the number of risk factors increased the odds increased for high or moderate developmental risk and no documentation of the PEDS at well-child checks. Conclusions Children with multiple risk factors are more likely to have parental concerns indicating developmental vulnerability using the PEDS and for these concerns to not be documented.

To describe the engagement of a cohort of urban Aboriginal families with an Early Childhood Health Service, and to assess any association of engagement with the service with screening by the Edinburgh Post-Natal Depression Scale (EPDS), full breastfeeding rates and post-natal smoking status.Routine electronic medical record data collected by a Child and Family Health Nurse between 2011 and 2014 was analysed retrospectively. Associations between use of the service and acceptance of EPDS, breastfeeding rates and post-natal smoking status were determined using binary and multinomial multiple logistic regression analyses.There were 424 Aboriginal babies and 215 mothers included in the study. Each occasion of service increased the odds of accepting screening with the EPDS (odds ratio (OR) 1.02, 95% confidence interval (CI) 1.00-1.03, P = 0.04) and complete breastfeeding (OR 1.11, CI 1.01-1.23, P = 0.04), but not of quitting smoking (OR 0.99, CI 0.96-1.02, P = 0.34). Despite accounting for engagement with the service, overall uptake of the EPDS remained low; of 267 offers for EPDS screening, only 115 were accepted (43%).The service was accessed in increasing numbers during the study period. Mothers who utilised the service more frequently were more likely to accept EPDS screening and exclusively breastfeed; however, acceptance of EPDS screening remained low overall. Further research is recommended to investigate the low acceptance of EPDS in this Aboriginal population and whether those results are transferable to other communities.

Introduction: Despite the widespread availability of clinical guidelines, considerable gaps remain between the care that is recommended (appropriate care) and the care provided. This protocol describes a research methodology to develop clinical indicators for appropriate care for common paediatric conditions. Methods and analysis: We will identify conditions amenable to population-level appropriateness of care research and develop clinical indicators for each condition. Candidate conditions have been identified from published research; burden of disease, prevalence and frequency of presentation data; and quality of care priority lists. Clinical indicators will be developed through searches of national and international guidelines, and formatted with explicit criteria for inclusion, exclusion, time frame and setting. Experts will review the indicators using a wiki-based approach and modified Delphi process. A formative evaluation of the wiki process will be undertaken Ethics and dissemination: Human Research Ethics Committee approvals have been received from Sydney Children's Hospital Network, Children's Health Queensland Hospital and Health Service, and the Women's and Children's Health Network (South Australia). Applications are under review with Macquarie University and the Royal Australian College of General Practitioners. We will submit the results of the study to relevant journals and offer national and international presentations. Refereed/Peer-reviewed

Objectives To determine the amount of daily screen time in children 18 months of age and ascertain correlations that may be contributing to excessive screen use. Design A birth cohort was followed with telephone interviews at 6, 12 and 18 months of age. Information about screen time was collected at 18 months. Setting Parents were recruited from postnatal wards of 2 major public hospitals and at home visits conducted for new mothers within 4 weeks of birth in South Western Sydney (SWS). Participants Parents of 500 children with infants 18 months of age residing in SWS. Primary and secondary outcomes Screen time in infants 18 months of age and associated correlations. Results A large percentage of children 18 months of age (40%) had screen times >2 hours daily. There were significant associations between more than 2 hours of screen time daily and mothers without a partner (OR 4.32 (95% CI 1.67 to 11.15)); having 2 hours per day. Factors contributing to excess screen time have also been identified in this study; however, a greater understanding of risk factors needs to be ascertained in order to facilitate greater public health efforts to reduce screen exposure.

The bioenergetic fueling of cardiac muscle activity is tuned by Ca2+ signals propagated from SR to the mitochondrial matrix (excitation-bioenergetics coupling). Effective activation of the low-affinity mitochondrial Ca2+ uniporter (mtCU) is promoted by high [Ca2+] nanodomains where SR is tethered to mitochondria. Cardiac mitochondria have very large inner membrane (IMM) surface with extensive cristae folding but their mtCU current density is reportedly extremely low. We hypothesized that efficient excitation-bioenergetics coupling would require biased mtCU activity towards mitochondria-SR associations by mtCU being there more abundant and/or more efficient. To this end, we first analyzed the submitochondrial distribution of mtCU's pore protein, MCU in rat and mouse heart. Immunofluorescence (IF) in cells showed significant non-mitochondrial crossreactions; hence, we performed IF on mitochondria isolated from cardiac muscle (mtIF). mtIF showed 50% of punctate MCU positive structures colocalized with type-2 ryanodine receptor, suggesting a location bias to mitochondria-SR associations. Further, in submitochondrial membrane fractions MCU and the SR marker calsequestrin were both enriched with the inner-outer membrane contact points. Mitochondrial membranes in the SR fraction (MMSR) harbored as high concentrations of MCU as the crude mitochondria and much higher levels of the essential MCU regulator EMRE. Gel-filtration analysis showed size profiles of non-denaturing detergent-solubilized MCU- vs. EMRE-containing complexes largely overlapping in the SR fraction, while revealed MCU containing complexes without EMRE in the crude mitochondria. Finally, Ca2+ flux assays revealed more efficient mtCU-mediated Ca2+ uptake by the MMSR than the crude mitochondria. Our data thus suggest a distribution bias in the mtCU channel components over the cardiac IMM, turning mitochondria-SR interfaces to Ca2+ uptake ‘hotspots’ harboring all-EMRE-supported MCU while leaving other IMM areas less responsive to Ca2+ owing to EMRE-less mtCUs.

Introduction: Australian and international clinical practice guidelines are available for common paediatric conditions. Yet there is evidence that there are substantial variations between the guidelines, recommendations (appropriate care) and the care delivered. This paper describes a study protocol to determine the appropriateness of the healthcare delivered to Australian children for 16 common paediatric conditions in acute and primary healthcare settings. Methods and analysis: A random sample of 6000-8000 medical records representing a cross-section of the Australian paediatric population will be reviewed for appropriateness of care against a set of indicators within three Australian states (New South Wales, Queensland and South Australia) using multistage, stratified sampling. Medical records of children aged

The Aboriginal Maternal and Infant Health Service was established to improve the health of Aboriginal women during pregnancy and decrease perinatal morbidity and mortality for Aboriginal babies. The Service is delivered through a continuity-of-care model, where midwives and Aboriginal Health Workers collaborate to provide a high quality maternity service that is culturally sensitive, women centred, based on primary health-care principles and provided in partnership with Aboriginal people. An evaluation of the Service found that the program is achieving its goals in relation to the provision of antenatal and postnatal care and has demonstrated improvements in perinatal morbidity and mortality rates.

The NSW child health policy framework is informed by along and successful history of providing health services to children and their families, as well as recent policy developments at the national level.

The Schools as Community Centres Project is an innovative whole-of-government response in NSW to the needs of families with young children living in disadvantaged communities.

The NSW Health Department is currently developing a comprehensive child health policy, which is nearing completion. It will provide a framework for the health system to address the health care needs of children and provide child-focused and developmentally appropriate health services.

This article reports on a collaborative project between the NSW Health Department and the Department of Community Services (DCS) to examine DCS data on notifications of alleged and confirmed child abuse in NSW.

In 1992, the NSW Health Department and the Sudden Infant Death Association of NSW (SIDA) conducted Statewide health education campaigns aiming to reduce the incidence of Sudden Infant Death Syndrome (SIDS).

In NSW sudden infant death syndrome (SIDS) ranks high as a cause of death in the first year of life.

Background Universal developmental surveillance programs aimed at early identification and targeted early intervention significantly improve short- and long-term outcomes in children at risk of developmental disorders. However, a significant challenge remains in providing sufficiently rigorous research and robust evidence to inform policy and service delivery. This paper describes the methods of the ‘Watch Me Grow’ study that aims to maximise accurate early detection of children with developmental disorders through a partnership formed between policy makers, service providers and researchers. Methods/Design A mixed methods study design was developed consisting of: (1) a qualitative study of parents and health service providers to investigate barriers and enablers of developmental surveillance; (2) recruitment of a birth cohort and their longitudinal follow-up to 18 months of age to: a) assess risk factors for not accessing existing developmental surveillance programs and b) estimate the prevalence of children identified with developmental risk; (3) comparison of surveillance outcomes with a reference standard at 18 months of age to assess the diagnostic test accuracy of existing and alternative developmental surveillance tools; and (4) comparison of developmental surveillance models to inform policy recommendations. Data linkage will be used to determine the uptake and representativeness of the study participant group versus non-participants. Discussion The Watch Me Grow study is expected to provide a collaborative opportunity to enhance universal developmental surveillance for early accurate identification of developmental risk. This will also provide quality evidence about identification of developmental risk and access to services to be embedded in existing practice with linkages to policy development.

Background: The "Watch Me Grow" (WMG) study examines the current developmental surveillance system in South West Sydney. This paper describes the establishment of the study birth cohort, including the recruitment processes, representativeness, follow-up and participants' baseline risk for future developmental risk. Methods: Newborn infants and their parents were recruited from two public hospital postnatal wards and through child health nurses during the years 2011-2013. Data was obtained through a detailed participant questionnaire and linked with the participant's electronic medical record (EMR). Representativeness was determined by Chi-square analyses of the available clinical, psychosocial and sociodemographic EMR data, comparing the WMG participants to eligible non-participants. Reasons for non-participation were also elicited. Participant characteristics were examined in six, 12, and 18-month follow-ups. Results: The number of infants recruited totalled 2,025, with 50 % of those approached agreeing to participate. Reasons for parents not participating included: lack of interest, being too busy, having plans to relocate, language barriers, participation in other research projects, and privacy concerns. The WMG cohort was broadly representative of the culturally diverse and socially disadvantaged local population from which it was sampled. Of the original 2025 participants enrolled at birth, participants with PEDS outcome data available at follow-up were: 792 (39 %) at six months, 649 (32 %) at 12 months, and 565 (28 %) at 18 months. Participants with greater psychosocial risk were less likely to have follow-up outcome data. Almost 40 % of infants in the baseline cohort were exposed to at least two risk factors known to be associated with developmental risk. Conclusions: The WMG study birth cohort is a valuable resource for health services due to the inclusion of participants from vulnerable populations, despite there being challenges in being able to actively follow-up this population.