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Background/Objectives To describe trends in overweight/obesity in early childhood for all children and those whose parents are concerned about their weight. To describe parents’ perceptions of their child’s weight and differences by their child’s anthropometric and sociodemographic factors. Subjects/Methods Analysis of the Kindergarten Health Check, a survey of all children enrolled in their first year of primary education in the Australian Capital Territory. Analysis of detailed data for 2014–2017, including qualitative analysis of parents’ comments on weight, and trends for 2001–2017. Results 71,963 children participated in the survey between 2001 and 2017 (20,427 between 2014 and 2017). The average age of children (2001–2017) was 5 years and 9.6 months at the time of their physical health check. 2377 children (3.5%) were classified as obese based on measured body mass index (BMI) between 2001 and 2017, and a further 7766 (11.6%) overweight. Similar proportions were seen for 2014–2017. Among children with overweight/obesity in 2014–2017, 86.4% of parents (2479/2868) described their children’s weight as healthy and 13.3% (382/2868) as overweight/obese. Just 11.5% (339/2946) of parents whose children were later measured with overweight/obesity identified having a concern about their child’s weight. Parental comments varied widely and were often incongruent with the known health risks associated with their child’s measured BMI. Comments from parents whose children were measured as obese often were normalising e.g., “born big, always big. Definitely NOT overweight, just bigger all over”, whilst parents of children in the healthy range expressed concerns about underweight. Conclusion Parents do not accurately perceive their child’s weight and few document concerns, even among children measuring in the obese BMI category. This lack of concern makes early interventions challenging as parents are in the “pre-contemplative” stage of behaviour change and may see public health campaigns or clinicians’ attempts to address their child’s weight as irrelevant or unhelpful.

Purpose To identify the influence of the therapeutic alliance on the effectiveness of obesity interventions delivered in primary care. Method Systematic review of randomized controlled trials of primary care interventions for adult patients living with obesity. Comprehensive search strategy using the terms ‘obesity’, ‘primary care’ and ‘intervention’ of seven databases from 1 January 1998 to March 2018. Primary outcome was difference in weight loss in interventions where a therapeutic alliance was present. Results From 10 636 studies, 11 (3955 patients) were eligible. Only one study had interventions that reported all aspects of therapeutic alliance, including bond, goals and tasks. Meta-analysis was not included due to high statistical heterogeneity and low numbers of trials; as per our protocol, we proceeded to narrative synthesis. Some interventions included the regular primary care practitioner in management; very few included collaborative goal setting and most used prescriptive protocols to direct care. Conclusions We were surprised that so few trials reported the inclusion of elements of the therapeutic alliance when relational aspects of primary care are critical for effectiveness. Interventions could be developed to maximize therapeutic relationships and research reports should describe interventions comprehensively. Systematic review registration number CRD42018091338 in PROSPERO (International prospective register of systematic reviews).

Nurse play a crucial role in reversing negative trends.

In 2015, the United Nations International Children’s Emergency Fund (UNICEF) named Syria as the most dangerous place on earth to be a child (UNICEF, 2). Since the onset of civil war in 2011, nearly 4.8 million Syrians are refugees outside of Syria and approximately 6 million are internally displaced (United Nations Office for the Coordination of Humanitarian Affairs, 2016). While some refugees have successfully resettled in North American and European nations, many remain in limbo in refugee camps. What is most staggering about the population of affected persons is that nearly half, approximately 6 million, are children (UNICEF, 2016). Nearly all of these children have been subjected to trauma that has manifested in a variety of ways. They have often been subjected to or witnessed violence and have experienced the loss of one or more of their caregivers. Refugees face difficulty accessing psychological and health services and are met with the stigma surrounding mental health in countries including Lebanon and Turkey, regions that many refugee children have fled to. In the absence of these supports, the mental trauma a child is experience can impact learning and development and have disastrous impacts on their future.

Background GPs are integral to the COVID-19 vaccination rollout, providing education and administering vaccines. We sought to describe how counselling relating to COVID-19 vaccination was impacting Australian general practice consultations. Methods We conducted an online, mixed-methods, cross-sectional survey of Australian community-based primary care from 7 to 15 July 2021. This survey, number 15 in a series of recurrent cross-sectional surveys conducted over a 14-month period, explored how counselling relating to COVID-19 vaccination was impacting general practice consultations, through multiple selection and open text responses; it also included questions on respondent and practice characteristics, and pandemic-related stress and strain. We calculated descriptive statistics for quantitative variables, and analysed free-text responses using an inductive content analysis approach. Results We received 73 responses (72 GPs) across all states/territories. Discussions with patients about COVID-19 vaccines and vaccination were common, increasing the duration of routine consultations by 6 min on average (s.d. 2.9). Respondents described the impact of the resulting time pressures, and the stress and challenges of participating in COVID-19 vaccine communication and administration. Although our results are illuminating, they are limited by the small sample, with some different characteristics from national estimates, an uncertain response rate and the inability to pilot the survey prior to distribution. Conclusions The significant impact on general practice consultation from COVID-19 vaccine counselling is on a background of ongoing pandemic-related stress and strain. With a strong track record of population vaccination, GPs are well-placed to deliver COVID-19 immunisations to the Australian population. However, they must be represented in planning and coordination, to reduce the overall burden on primary care.

Traumatic non-obstetrical hematomas of the vulva are rare, and most reports only involve adult patients. There are no data on presentation, management, and outcomes from either conservative or surgical management in pediatric and adolescent patients. The objective of this project was to compare the etiology, treatment, and outcomes of traumatic vulvar hematomas occurring in premenarchal and postmenarchal young women.A retrospective chart review was performed on females aged 0-24 years seen at a tertiary care academic center using ICD 9 and 10 codes for traumatic vulvar hematoma from 2006-2019. Data describing their clinical presentation and course were collected. IRB approval was obtained.Twenty patients, aged 3-23 years (median age of 13.5 years) were identified. All 8 premenarchal patients presented with a straddle injury, whereas only 50% of postmenarchal patients were found to have a straddle injury. Other etiologies among postmenarchal patients included consensual sexual intercourse and recent vulvar surgery. Hematoma diameter ranged from 1-3 cm in premenarchal patients and 0.4-7 cm in postmenarchal patients. Associated perineal lacerations were reported in 50% of the premenarchal girls and 8% of postmenarchal young women. Of the 8 premenarchal patients, 5 were managed conservatively, and 3 were taken to the operating room for repair of perineal lacerations; 1 patient also underwent evacuation of a 3-cm hematoma. Of the 12 postmenarchal patients, 5 had surgical intervention, 2 for pain secondary to large 7-cm hematomas and 3 for suspected vulvar abscesses, which were identified as hematomas after drainage. One patient in each group required a Foley catheter for comfort. Two postmenarchal patients required a second surgery for further wound management. One premenarchal patient with surgical treatment required a follow-up exam under anesthesia. Four patients were admitted for pain and postoperative observation, 1 of whom was premenarchal. Eleven patients were seen for follow-up, and 10 were doing well. One postmenarchal patient in the conservative management group returned to the Emergency Department with continued pain 10 days later.In this study that examined traumatic vulvar hematomas in premenarchal and postmenarchal young women, the only mechanism of injury in premenarchal girls was straddle injury, and surgical intervention was usually needed only for repair of perineal lacerations, not a primary hematoma. In the postmenarchal patients, surgical intervention was undertaken for larger hematomas and suspected vulvar abscesses. Our study suggests that most hematomas up to 3 cm in premenarchal patients and up to 6 cm in postmenarchal patients can be managed conservatively.

This paper, a review of recent literature dealing with the politics of school-community relations, attempts to order and analyze the main themes, identify the participants and settings, and describe the research approaches of the literature. One school of thought views education as separate from political concerns and maintains that schools should relate to the community only on particular issues about which decisions must be made. The more prevalent viewpoint studies schools within a political context and observes processes of decisionmaking to see how schools are run. Participants in school-community relations include school boards, superintendents, influentials, and citizens. Settings have become important as researchers adopt the viewpoint that school-community relations should be examined within their societal contexts. Unfortunately, the relative newness of research in school-community relations has caused a divergence of research methods, and the consequent generalizations lack unanimity. (Author/JF)

This annotated bibliography of school-community relations literature includes 79 citations subdivided into the following four categories: (1) General discussions of school-community relations, (2) school politics and community power structure, (3) schools and public relations, and (4) schools and urban problems. Citations of journal articles, books, pamphlets, dissertations, and research reports cover the years 1964 to the present. Material was selected on the basis of its general coverage and applicability, and its relevance to elementary and secondary levels of education. (JH)

To describe trends in overweight/obesity in early childhood for all children and those whose parents are concerned about their weight. To describe parents' perceptions of their child's weight and differences by their child's anthropometric and sociodemographic factors.Analysis of the Kindergarten Health Check, a survey of all children enrolled in their first year of primary education in the Australian Capital Territory. Analysis of detailed data for 2014-2017, including qualitative analysis of parents' comments on weight, and trends for 2001-2017.71,963 children participated in the survey between 2001 and 2017 (20,427 between 2014 and 2017). The average age of children (2001-2017) was 5 years and 9.6 months at the time of their physical health check. 2377 children (3.5%) were classified as obese based on measured body mass index (BMI) between 2001 and 2017, and a further 7766 (11.6%) overweight. Similar proportions were seen for 2014-2017. Among children with overweight/obesity in 2014-2017, 86.4% of parents (2479/2868) described their children's weight as healthy and 13.3% (382/2868) as overweight/obese. Just 11.5% (339/2946) of parents whose children were later measured with overweight/obesity identified having a concern about their child's weight. Parental comments varied widely and were often incongruent with the known health risks associated with their child's measured BMI. Comments from parents whose children were measured as obese often were normalising e.g., "born big, always big. Definitely NOT overweight, just bigger all over", whilst parents of children in the healthy range expressed concerns about underweight.Parents do not accurately perceive their child's weight and few document concerns, even among children measuring in the obese BMI category. This lack of concern makes early interventions challenging as parents are in the "pre-contemplative" stage of behaviour change and may see public health campaigns or clinicians' attempts to address their child's weight as irrelevant or unhelpful.

Previous primary studies have explored the association between blood pressure (BP) and mortality in ambulatory heart failure (HF) patients reporting varying and contrasting associations. The aim is to determine the pooled BP prognostic value and explore potential reasons for between-study inconsistency. We searched Medline, Cochrane, EMBASE and CINAHL from January 2005 to October 2018 for studies with ≥ 50 events (mortality and/or hospitalization) and included BP in a multivariable model in ambulatory HF patients. We pooled hazard ratios (random effects model) for systolic BP (SBP) or diastolic BP (DBP) effect on mortality and/or hospitalization risk. We used a priori defined sub-group analyses to explore heterogeneity and GRADE approach to assess the certainty of the evidence. Seventy-one eligible articles (239,467 screened) at low to moderate risk of bias included 235,752 participants. Higher SBP was associated with reduced all-cause mortality (HR 0.93, 95%CI 0.91-0.95, I

The health implications of urban development, particularly in rapidly changing, low-income urban neighborhoods, are poorly understood. We describe the Healthy Neighborhoods Study (HNS), a Participatory Action Research study examining the relationship between neighborhood change and population health in nine Massachusetts neighborhoods. Baseline data from the HNS survey show that social factors, specifically income insecurity, food insecurity, social support, experiencing discrimination, expecting to move, connectedness to the neighborhood, and local housing construction that participants believed would improve their lives, identified by a network of 45 Resident Researchers exhibited robust associations with self-rated and mental health. Resident-derived insights into relationships between neighborhoods and health may provide a powerful mechanism for residents to drive change in their communities., Robert Wood Johnson Foundation

Aim To estimate and describe trends in hospitalisations for Kawasaki disease in Australia. Methods Analysis of the National Hospital Morbidity Database for separations with a principal diagnosis of Kawasaki disease, 1993-1994 to 2017-2018. Limited to persons aged 0-19 years. Results Over the period 1993-1994 to 2017-2018, there were 6368 hospitalisations for Kawasaki disease among people aged 0-19 years; 433 same-day (6.8%) and 5935 overnight (93.2%). Among overnight separations, 15.8% were for children under the age of 1 year and 58.7% for those aged 1-4 years; 60.3% were for males. The hospitalisations rate has increased from 5.2 per 100 000 population in 1993-1994 to 12.4 per 100 000 in 2017-2018. The ratio of male to female hospitalisations was 1.5:1. Conclusions Kawasaki disease is uncommon among Australia children, but its incidence is increasing. As there are no known preventable risk factors for the disease, prompt identification and treatment remain crucial to minimising the risk of cardiovascular sequelae.

ObjectivesThere is mixed evidence on the relationship between physical activity and behavioural and mental health. We aimed to estimate the association between physical activity and risk of behavioural and mental health disorders in early school-aged children.DesignA series of cross-sectional complete enumeration (census) surveys.SettingsAll primary schools in the Australian Capital Territory, 2014–2016.ParticipantsAll children enrolled in their first year of full-time primary education (kindergarten) were invited to participate. Of the 16 662 eligible kindergarten children, 15 040 completed the survey for the first time.Outcome measuresAverage daily physical activity participation and prevalence of risk of behavioural and mental health disorders derived from parent-reported data and the Strengths and Difficulties Questionnaire (SDQ). Characteristics associated with SDQTotal difficultiesand subscales were estimated using logistic regression.Results8340 (61.7%) children met physical activity targets (60 min or more daily) and 709 (4.8%) were at clinically significant risk of behavioural and mental health disorders (Total difficulties).Known sociodemographic correlates were also those variables associated with high risk of behavioural and mental health disorders (Total difficulties): Aboriginal and Torres Strait Islander status (OR 2.72, 95% CI 1.78–4.16), relative socioeconomic disadvantage (most disadvantaged vs least disadvantaged, OR 1.86, 95% CI 1.38–2.50) and male sex (OR 1.80, 95% CI 1.49–2.17). Average daily physical activity was not significant, despite the highest levels of physical activity (90 min or more daily) being reported in boys, Aboriginal and Torres Strait Islander children and those from more disadvantaged areas.ConclusionsOur study provides comprehensive cross-sectional data on the relationship between physical activity participation and the risk of behavioural and mental health disorders in a large cohort of early school-aged Australian children. Aboriginal and Torres Strait Islander children, boys and those from the most disadvantaged socioeconomic group were at greatest risk of clinically significant behavioural and mental health disorders.

Children with glucocorticoid-treated illnesses are at risk for osteoporotic vertebral fractures, and growing awareness of this has led to increased monitoring for these fractures. However scant literature describes developmental changes in vertebral morphology that can mimic fractures. The goal of this paper is to aid in distinguishing between normal variants and fractures. We illustrate differences using lateral spine radiographs obtained annually from children recruited to the Canada-wide STeroid-Associated Osteoporosis in the Pediatric Population (STOPP) observational study, in which 400 children with glucocorticoid-treated leukemia, rheumatic disorders, and nephrotic syndrome were enrolled near glucocorticoid initiation and followed prospectively for 6 years. Normal variants mimicking fractures exist in all regions of the spine and fall into two groups. The first group comprises variants mimicking pathological vertebral height loss, including not-yet-ossified vertebral apophyses superiorly and inferiorly, which can lead to a vertebral shape easily over-interpreted as anterior wedge fracture, physiological beaking, or spondylolisthesis associated with shortened posterior vertebral height. The second group includes variants mimicking other radiologic signs of fractures: anterior vertebral artery groove resembling an anterior buckle fracture, Cupid's bow balloon disk morphology, Schmorl nodes mimicking concave endplate fractures, and parallax artifact resembling endplate interruption or biconcavity. If an unexpected vertebral body contour is detected, careful attention to its location, detailed morphology, and (if available) serial changes over time may clarify whether it is a fracture requiring change in management or simply a normal variant. Awareness of the variants described in this paper can improve accuracy in the diagnosis of pediatric vertebral fractures.

Introduction: New medical technology brings the potential of lawsuits related to the usage of that new technology. In recent years the use of point-of-care (POC) ultrasound has increased rapidly in the emergency department (ED). POC ultrasound creates potential legal risk to an emergency physician (EP) either using or not using this tool. The aim of this study was to quantify and characterize reported decisions in lawsuits related to EPs performing POC ultrasound. Methods: We conducted a retrospective review of all United States reported state and federal cases in the Westlaw database. We assessed the full text of reported cases between January 2008 and December 2012. EPs with emergency ultrasound fellowship training reviewed the full text of each case. Cases were included if an EP was named, the patient encounter was in the emergency department, the interpretation or failure to perform an ultrasound was a central issue and the application was within the American College of Emergency Physician (ACEP) ultrasound core applications. In order to assess deferred risk, cases that involved ultrasound examinations that could have been performed by an EP but were deferred to radiology were included. Results: We identified five cases. All reported decisions alleged a failure to perform an ultrasound study or a failure to perform it in a timely manner. All studies were within the scope of emergency medicine and were ACEP emergency ultrasound core applications. A majority of cases (n=4) resulted in a patient death. There were no reported cases of failure to interpret or misdiagnoses. Conclusion: In a five-year period from January 2008 through December 2012, five malpractice cases involving EPs and ultrasound examinations that are ACEP core emergency ultrasound applications were documented in the Westlaw database. All cases were related to failure to perform an ultrasound study or failure to perform a study in a timely manner and none involved failure to interpret or misdiagnosis when using of POC ultrasound. [West J Emerg Med. 2015;16(1):–0.]