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Johnsen M, O'Donnell M, Harries M, Fisher C. Hospital-Based Healthcare Workers' Experiences of Involvement in Perinatal Child Protection Processes: A Scoping Literature Review. Trauma Violence Abuse 2024:15248380241247001. [PMID: 38686924 DOI: 10.1177/15248380241247001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
As the number of infants entering Out-of-Home Care at birth internationally continues to rise, Hospital-based healthcare workers (HBHCWs) are increasingly likely to become involved in ethically, morally, and legally complex child protection processes. This scoping review aimed to identify and synthesize qualitative literature pertaining to the perspectives of HBHCWs with experiences of involvement in child protection processes occurring in the perinatal period. JBI Methodology for Scoping Reviews guided this review. Databases Ovid MEDLINE, CINAHL Plus, PsycINFO, ProQuest, Web of Science, SCOPUS, and Informit were searched between March 1 and April 30, 2023. Eighteen sources were identified as meeting the criteria for inclusion following screening by two independent reviewers. Data extracted from the included sources are presented in narrative and tabular formats. Involvement in child protection processes is an inherently conflictual experience for HBHCWs and gives rise to internal, interpersonal, and interorganizational tensions. Involvement can have an enduring impact on the HBHCWs, particularly when an infant is removed from hospital by child protection authorities. Appropriate peer, managerial, and organizational level responses are essential to ameliorate risk to HBHCWs themselves and subsequently their practice with women, infants, and families. HBHCWs can provide valuable insight into the challenges of delivering healthcare at the interface of child protection. Future research should focus on building understanding of experiences across disciplines to ensure that interventions designed to prepare and support HBHCWs are effective and evidence-based.
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Affiliation(s)
- Maegan Johnsen
- The University of Western Australia, Perth, Australia
- The Women and Newborn Health Service, Subiaco, Australia
| | | | - Maria Harries
- The University of Western Australia, Perth, Australia
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Chikwava F, Cordier R, Ferrante A, O'Donnell M, Pakpahan E. Trajectories of homelessness and association with mental health and substance use disorders among young people transitioning from out-of-home care in Australia. Child Abuse Negl 2024; 149:106643. [PMID: 38262181 DOI: 10.1016/j.chiabu.2024.106643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 11/17/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Researchers have examined sub-groups that may exist among young people transitioning from out-of-home care (OHC) using various theoretical models. However, this population group has not been examined for trajectories of homelessness risk. OBJECTIVES To examine whether different subtypes of homelessness risk exist among young people transitioning from care and whether these trajectories of homelessness are associated with mental health and substance use disorders. PARTICIPANTS AND SETTING A retrospective population-based cohort study was conducted from a population of 1018 young people (aged 15-18 years) who transitioned from out-of-home in 2013 to 2014 in the state of Victoria, Australia, with follow-up to 2018. METHODS Latent Class Growth Analysis was conducted using linked data from homelessness data collections, child protection, mental health information systems, alcohol and drug use, and youth justice information systems. RESULTS Three sub-groups of young people were identified. The 'moving on' group (88 %) had the lowest levels of homelessness, with the slope of this trajectory remaining almost stable. The 'survivors' (7 %) group started off with a high risk of homelessness, followed by a sharp decrease in homelessness risk over time. The 'complex' (5 %) group started off with a low risk of homelessness but faced sharp increases in the risk of homelessness over time. CONCLUSIONS Our study demonstrates that subgroups of young people transitioning from care exist with distinct longitudinal trajectories of homelessness, and these classes are associated with different risk factors. Early intervention and different approaches to tackling homelessness should be considered for these three distinct groups before transitioning from care and during the first few years after leaving care.
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Affiliation(s)
- Fadzai Chikwava
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia; Mental Health Commission, Perth, Western Australia, Australia.
| | - Reinie Cordier
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia; Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom; Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Anna Ferrante
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Melissa O'Donnell
- Australian Centre for Child Protection, University of South Australia, Adelaide, South Australia, Australia; Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Eduwin Pakpahan
- Department of Mathematics, Physics & Electrical Engineering, Northumbria University, Newcastle upon Tyne, United Kingdom
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Maclean MJ, Lima F, O'Donnell M. Positive reading achievement outcomes in children who experience out-of-home care: Characteristics and predictors. Child Abuse Negl 2024; 149:106282. [PMID: 37353386 DOI: 10.1016/j.chiabu.2023.106282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 05/21/2023] [Accepted: 06/07/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Children who enter out-of-home care ('care') are at increased risk for low academic achievement. Nonetheless, some children who have experienced out-of-home care achieve highly. Several qualitative studies of academically successful young adults with care histories have highlighted factors that may contribute to positive outcomes; however longitudinal cohort research is needed to identify characteristics and predictors of higher achieving younger children who experienced care. OBJECTIVE To describe characteristics and circumstances of children with higher reading achievement who had entered care, and predictors of higher achievement. PARTICIPANTS AND SETTING The study included 778 children from the Pathways of Care Longitudinal Study (POCLS) in New South Wales, Australia. METHODS Prospective cohort data from interviews and linked administrative child protection and education data were used to identify factors associated with higher Year 3 reading achievement among Aboriginal and non-Aboriginal children that may assist in improving outcomes. RESULTS Although a lower proportion than the general population, almost half (46 %) of children who entered care were in the higher achievement group. Higher achieving students were a diverse group and faced many adversities commonly found among children who experienced care generally. Multivariable logistic regression showed higher achievement in the cohort was significantly associated with: average or above cognitive ability, low externalizing behaviour, highly-educated carers, and non-Aboriginal students. Several supports and services were associated with higher achievement, but inconsistently across analyses. CONCLUSIONS Results indicate potential interventions could target cognitive ability, wellbeing and environmental factors, and involve interventions directly with children and via carers to improve student outcomes.
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Affiliation(s)
- Miriam J Maclean
- Australian Centre for Child Protection, University of South Australia, Australia.
| | - Fernando Lima
- Australian Centre for Child Protection, University of South Australia, Australia
| | - Melissa O'Donnell
- Australian Centre for Child Protection, University of South Australia, Australia
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Lima F, Taplin S, Maclean M, O'Donnell M. Infants entering out-of-home care: Health, developmental needs and service provision. Child Abuse Negl 2024; 149:106577. [PMID: 38044250 DOI: 10.1016/j.chiabu.2023.106577] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND There are rising numbers of infants entering out-of-home care due to child protection concerns. Research has found that infants entering care are at higher risk of developmental vulnerability and poor health problems. OBJECTIVES To determine the prevalence of developmental vulnerability for children who entered care as infants, and the extent and likelihood of service provision in relation to their developmental vulnerability. PARTICIPANTS AND SETTING This study includes children who entered care before the age of 1 year for the first time between May 2010 and October 2011 in New South Wales, Australia, and who received final Children's Court care and protection orders by 30 April 2013. METHODS This is a prospective cohort study using interview data from the Pathways of Care Longitudinal Study (POCLS) as well as linked administrative child protection and health data. This study used standardised assessments (Age and Stages Questionnaire and the Brief Infant Toddler Social Emotional Assessment) included in the POCLS. Simple and multiple logistic regression analysis was conducted to investigate the likelihood of infants receiving professional services for developmental delays since placement. FINDINGS A high proportion of children who entered care as infants were identified as developmentally vulnerable through health indicators (36 %) and standardised assessments (70 %). Only 17 % of infants in care received services for developmental delay, with 20 % and 15 % of those identified as developmentally vulnerable through standardised assessments and health-related variables receiving services, respectively. CONCLUSIONS The findings point to the importance of developmental assessment of infants in care and the identification of developmental vulnerability and delays. The provision of early intervention services is essential for this group of high-risk infants and will be important in optimising their health, as well as social and emotional outcomes.
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Affiliation(s)
- Fernando Lima
- Australian Centre for Child Protection, University of South Australia, Perth, WA, Australia.
| | - Stephanie Taplin
- School of Public Health, Faculty of Health, University of Technology Sydney, Canberra, ACT, Australia
| | - Miriam Maclean
- Australian Centre for Child Protection, University of South Australia, Perth, WA, Australia
| | - Melissa O'Donnell
- Australian Centre for Child Protection, University of South Australia, Perth, WA, Australia
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Cowlishaw S, O'Dwyer C, Bowd C, Sadler N, O'Donnell M, Forbes D, Howard A. Pandemic impacts and experiences after disaster in Australia: qualitative study of compound impacts following the Black Summer bushfires. BJPsych Open 2024; 10:e43. [PMID: 38305026 PMCID: PMC10897690 DOI: 10.1192/bjo.2023.648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 12/07/2023] [Accepted: 12/14/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND The first cases of the COVID-19 pandemic in Australia were recorded in January 2020, which was during the 'Black Summer' bushfires of 2019-20 and prior to additional disasters in some regions. Few studies have considered the compound impact of disasters and the pandemic. AIMS To improve understanding of the impact on mental health and well-being of the pandemic in disaster-affected communities. METHOD We conducted semi-structured interviews (n = 18) with community members and online focus groups (n = 31) with help providers from three regions of rural Australia affected by bushfires and the pandemic. RESULTS Six themes were produced: (a) 'Pulling together, pulling apart', describing experiences after bushfires and prior to impacts of the pandemic; (b) 'Disruption of the 'normal response', encompassing changes to post-disaster recovery processes attributed to the pandemic; (c) 'Escalating tensions and division in the community', describing impacts on relationships; (d) 'Everywhere you turn you get a slap in the face', acknowledging impacts of bureaucratic 'red tape'; (e) 'There are layers of trauma', highlighting intersecting traumas and pre-existing vulnerabilities; and (f) 'Where does the help come from when we can't do it?', encompassing difficulties accessing services and impacts on the helping workforce. CONCLUSIONS This study furthers our understanding of compound disasters and situates pandemic impacts in relation to processes of adjustment and recovery from bushfires. It highlights the need for long-term approaches to resilience and recovery, investment in social infrastructure, multi-component approaches to workforce issues, and strategies to increase mental health support and pathways across services.
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Affiliation(s)
- S. Cowlishaw
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - C. O'Dwyer
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - C. Bowd
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - N. Sadler
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - M. O'Donnell
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - D. Forbes
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - A. Howard
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
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Sims SA, Pereira G, Fatovich DM, Preen D, O'Donnell M. Assessing the utility of night-time presentations as a proxy for alcohol-related harm among young emergency department trauma patients. Emerg Med Australas 2024; 36:47-54. [PMID: 37577775 PMCID: PMC10952259 DOI: 10.1111/1742-6723.14294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 07/03/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To assess the usefulness of night-time presentations to measure alcohol-related harm (ARH) in young trauma patients, aged 12-24 years, attending Western Australian EDs. METHODS A retrospective longitudinal study examined alcohol-related ED presentations in Western Australia (WA; 2002-2016) among 12- to 24-year-olds. Data from the Emergency Department Data Collection, WA State Trauma Registry Database and Hospital Morbidity Data Collection were used to identify ARH through specific codes and text searches. These were compared to ARH estimates based on presentation time. Statistical analysis involved sensitivity and specificity calculations and Cox proportional hazards modelling. RESULTS We identified 2644 (17.8%) night-time presentations as a proxy measure of ARH among the 14 887 presentations of patients aged 12-24 years. This closely matched the 3064 (20.6%) identified as ARH through coding methods. The highest risk for an ARH presentation occurred during the night hours between 00.00 and 04.59 hours. During these hours, the risk was 4.4-5.1 times higher compared to presentations at midday (between 12.00 and 12.59 hours). However, when looking at individual patients, we observed that night-time presentations were not a strong predictor of ARH (sensitivity: 0.39; positive predictive value: 0.46). CONCLUSIONS Implementing targeted interventions during night hours could be beneficial in addressing ARH presentations. However, relying solely on the time of presentation as a proxy for ARH is unlikely to effectively identify ARH in young individuals. Instead, the present study emphasises the importance of implementing mandatory data collection strategies in EDs to ensure accurate measurement of ARH cases.
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Affiliation(s)
- Scott A Sims
- School of Population and Global HealthThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Gavin Pereira
- Curtin School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- Centre for Fertility and HealthNorwegian Institute of Public HealthOsloNorway
| | - Daniel M Fatovich
- Emergency Medicine, Royal Perth HospitalThe University of Western AustraliaPerthWestern AustraliaAustralia
- Centre for Clinical Research in Emergency MedicineHarry Perkins Institute of Medical ResearchPerthWestern AustraliaAustralia
| | - David Preen
- School of Population and Global HealthThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Melissa O'Donnell
- School of Population and Global HealthThe University of Western AustraliaPerthWestern AustraliaAustralia
- Australian Centre for Child ProtectionUniversity of South AustraliaAdelaideSouth AustraliaAustralia
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Dhamrait G, O'Donnell M, Christian H, Taylor CL, Pereira G. Interpregnancy interval and adverse birth outcomes: a population-based cohort study of twins. BMC Pregnancy Childbirth 2024; 24:96. [PMID: 38297231 PMCID: PMC10832241 DOI: 10.1186/s12884-023-06119-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 11/10/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND To investigate associations between interpregnancy intervals (IPIs) and adverse birth outcomes in twin pregnancies. METHODS This retrospective cohort study of 9,867 twin pregnancies in Western Australia from 1980-2015. Relative Risks (RRs) were estimated for the interval prior to the pregnancy (IPI) as the exposure and after the pregnancy as a negative control exposure for preterm birth (< 37 weeks), early preterm birth (< 34 weeks), small for gestational age (SGA: < 10th percentile of birth weight by sex and gestational age) and low birth weight (LBW: birthweight < 2,500 g). RESULTS Relative to IPIs of 18-23 months, IPIs of < 6 months were associated with a higher risk of early preterm birth (aRR 1.41, 95% CI 1.08-1.83) and LBW for at least one twin (aRR 1.16, 95% CI 1.06-1.28). IPIs of 6-11 months were associated with a higher risk of SGA (aRR 1.24, 95% CI 1.01-1.54) and LBW for at least one twin (aRR 1.09, 95% CI 1.01-1.19). IPIs of 60-119 months and ≥ 120 months were associated with an increased risk of preterm birth (RR 1.12, 95% CI 1.03-1.22; and (aRR 1.25, 95% CI 1.10-1.41, respectively), and LBW for at least one twin (aRR 1.17, 95% CI 1.08-1.28; and aRR 1.20, 95% CI 1.05-1.36, respectively). IPIs of ≥ 120 months were also associated with an increased risk of early preterm birth (aRR 1.42, 95% CI 1.01-2.00). After negative control analysis, IPIs ≥ 120 months remained associated with early preterm birth and LBW. CONCLUSION Evidence for adverse associations with twin birth outcomes was strongest for long IPIs.
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Affiliation(s)
- Gursimran Dhamrait
- Telethon Kids Institute, The University of Western Australia, 15 Hospital Avenue, PO Box 855, West Perth, Nedlands, Western Australia, 6872, Australia.
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia.
| | - Melissa O'Donnell
- Telethon Kids Institute, The University of Western Australia, 15 Hospital Avenue, PO Box 855, West Perth, Nedlands, Western Australia, 6872, Australia
- Australian Centre for Child Protection, University of South Australia, Adelaide, South Australia, Australia
| | - Hayley Christian
- Telethon Kids Institute, The University of Western Australia, 15 Hospital Avenue, PO Box 855, West Perth, Nedlands, Western Australia, 6872, Australia
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Catherine L Taylor
- Telethon Kids Institute, The University of Western Australia, 15 Hospital Avenue, PO Box 855, West Perth, Nedlands, Western Australia, 6872, Australia
- Centre for Child Health Research, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Gavin Pereira
- Telethon Kids Institute, The University of Western Australia, 15 Hospital Avenue, PO Box 855, West Perth, Nedlands, Western Australia, 6872, Australia
- Curtin School of Population Health, Curtin University, Perth, Australia
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
- enAble Institute, Curtin University, Perth, Western Australia, Australia
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Sims SA, Pereira G, Fatovich D, Preen D, O'Donnell M. The hidden impact of alcohol on young victims: an analysis of alcohol-related police offences resulting in hospitalisation. BMC Public Health 2024; 24:206. [PMID: 38233840 PMCID: PMC10792924 DOI: 10.1186/s12889-024-17704-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Alcohol-related harm (ARH) is a significant public health concern affecting young individuals, particularly those involved in alcohol-related police incidents resulting in hospitalisation. However, the impact of alcohol on young victims remains under researched. This study aimed to identify the characteristics of offenders and victims involved in these incidents, analyse the types of offences, and understand the under-ascertainment of ARH in hospital records. METHODS A retrospective longitudinal study of 12-24-year-olds born between 1980 and 2005 was conducted using linked data from hospital admissions, emergency department presentations, and police incident records. Alcohol-related incidents were identified based on the attending officers' opinions in the Western Australia Police's Incident Management System (IMS). Logistic and log-binomial regression were utilised to analyse the factors associated with victimisation and under-ascertainment of ARH. RESULTS Our study included 22,747 individuals (11,433 victims and 11,314 offenders) involved in alcohol-related police incidents, with a small majority of victims being female (53%, n = 6,074) and a large majority of offenders being male (84.3%, n = 9,532). Most victims did not receive a diagnosis of ARH (71%, n = 760). Women were 10 times more likely to have been a victim in ARH police incidents and 2 times more likely to have an undiagnosed alcohol-related hospital admission than men. Victims and offenders predominantly came from disadvantaged areas and major cities. Aboriginal individuals were overrepresented as both offenders and victims. A significant proportion of individuals experienced emergency department presentations or hospital admissions, with head injuries being the most common. Assault causing bodily harm was the most prevalent offence resulting in hospitalisation (66%, n = 2,018). CONCLUSIONS There is a noteworthy disparity between the quantity of hospital admissions attributed to alcohol-related incidents and the number of cases that are formally classified as ARH in the hospital system. This disparity highlights a more profound issue of substantial under-ascertainment or inadequate identification of ARH than previously acknowledged. Our findings justify the prioritisation of prevention strategies, beyond improvement in the documentation of alcohol-related hospitalisation. Considering the scale of the problem, and the underestimation of the burden of alcohol-related hospitalisation, a proportional increase in investment is necessary to achieve population-level reductions in ARH.
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Affiliation(s)
- Scott Anthony Sims
- School of Population and Global Health, University of Western Australia, Perth, Australia.
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Australia
- enAble Institute, Curtin University, Perth, Australia
| | - Daniel Fatovich
- Emergency Medicine, Royal Perth Hospital, University of Western Australia, Perth, Australia
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Nedlands, Australia
| | - David Preen
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Melissa O'Donnell
- School of Population and Global Health, University of Western Australia, Perth, Australia
- Australian Centre for Child Protection, University of South Australia, Adelaide, Australia
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Orr C, Kelty E, O'Donnell M, Fisher CM, Glauert R, Preen DB. Reproductive and sexual health of Australian adolescents exposed to family and domestic violence. BMJ Sex Reprod Health 2023; 49:245-253. [PMID: 36889813 DOI: 10.1136/bmjsrh-2022-201684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND There is a dearth of research investigating sexually transmitted infections (STIs) in children exposed to family and domestic violence (FDV). Further, there is no research on terminations of pregnancy in children exposed to FDV. METHODS This retrospective cohort study used linked administrative data from Western Australia to investigate whether exposure to FDV is associated with a risk of hospitalisations for STIs and terminations of pregnancy in adolescents. This study involved children born from 1987 to 2010 whose mother was a victim of FDV. Identification of family and domestic violence was from two sources: police and hospital records. This approach provided an exposed cohort of 16 356 and a non-exposed cohort of 41 996. Dependant variables were hospitalisations for pregnancy terminations and STIs in children aged from 13 up to 18 years of age. The primary explanatory variable was exposure to FDV. Multivariable Cox regression was used to investigate the association of FDV exposure and the outcomes. RESULTS Following adjustment for sociodemographic and clinical factors, children exposed to FDV had an increased risk of hospitalisations for STIs (HR 1.49, 95% CI 1.15 to 1.92) and terminations of pregnancy (HR 1.34, 95% CI 1.09 to 1.63) as an adolescent than non-exposed peers. CONCLUSION Children exposed to FDV are at an increased risk of hospitalisation for STI and termination of pregnancy as an adolescent. Effective interventions are needed to support children exposed to FDV.
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Affiliation(s)
- Carol Orr
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Erin Kelty
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Melissa O'Donnell
- The Australian Centre for Child Protection, University of South Australia, Adelaide, South Australia, Australia
| | - Colleen M Fisher
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Rebecca Glauert
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Orr C, Kelty E, Fisher C, O'Donnell M, Glauert R, Preen DB. The lasting impact of family and domestic violence on neonatal health outcomes. Birth 2023; 50:578-586. [PMID: 36190166 DOI: 10.1111/birt.12682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 06/14/2022] [Accepted: 09/19/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare the health of neonates born to women who experienced family and domestic violence (FDV) 12 months prior to birth, with the health of neonates born to women with an earlier history of FDV and women with no history of FDV. METHODS A retrospective cohort of women who experienced FDV within 12 months of birth (antenatal FDV [AFDV]) (n = 1230) was identified using data from the Western Australia (WA) Police Force Incident Management System and WA Hospital Morbidity Data Collection. Two comparison cohorts were used, the first including women with a history of FDV (HFDV) 12-60 months prior to birth (n = 1549) and the second with no history of FDV (NFDV) recorded (n = 3690). Hospital, birth, mortality, and congenital anomaly data were used in generalized linear models to examine and compare neonatal health outcomes. RESULTS Women in the AFDV group had higher proportions of factors associated with poor neonatal outcomes including smoking (42.4%), substance use (23.0%), and mental health disorders (34.8%). Neonates born to AFDV mothers had significantly higher odds of congenital anomalies (OR: 1.51, 95% CI: 1.18-1.94), low birth weight (1.74, 1.45-2.10), and preterm birth (1.48, 1.22-1.79) compared with neonates born to NFDV mother. Neonatal health outcomes in those born to AFDV women were not significantly different from those born to HFDV women. CONCLUSIONS Antenatal and historical FDV were associated with poor neonatal health outcomes. Additional pregnancy and social support should be offered to women who have experienced FDV during or prior to pregnancy.
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Affiliation(s)
- Carol Orr
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Erin Kelty
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Colleen Fisher
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Melissa O'Donnell
- Australian Centre for Child Protection, The University of South Australia, Adelaide, South Australia, Australia
| | - Rebecca Glauert
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- The Raine Study, The University of Western Australia, Perth, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Harrap B, Gibberd A, O'Donnell M, Simons K, Jones J, Lima F, McAullay D, Falster K, Banks E, Eades S. Cumulative incidence of child protection system contacts among a cohort of Western Australian Aboriginal children born 2000 to 2013. Child Abuse Negl 2023; 143:106297. [PMID: 37352649 DOI: 10.1016/j.chiabu.2023.106297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/05/2023] [Accepted: 06/12/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Reducing the over-representation of Aboriginal children in the child protection system is a key target for the Australian government. OBJECTIVE We aimed to provide more recent evidence on the population-level cumulative incidence of contacts for Aboriginal children with child protective services (CPS) in Western Australia (WA). PARTICIPANTS AND SETTING Linked administrative data was provided for WA CPS between 2000 and 2015 for 33,709 Aboriginal children born in WA between 2000 and 2013. METHODS Descriptive summaries and cumulative incidence estimates were used to examine changes in CPS contact trends over time and within sibling groups. RESULTS There was an increase in early-childhood contacts for children born more recently, with 7.6 % and 2.3 % of children born in 2000-2001 having a notification and placement in out-of-home care by age one, respectively, compared to 15.1 % and 4.3 % of children born in 2012-2013. Among sibling groups where at least one sibling had a CPS contact, approximately half of children had their first contacts on the same date as another sibling. For children born after one of their siblings had been placed in out-of-home care, 31.9 % had themselves been placed in out-of-home care by age one. CONCLUSIONS Multiple children tend to be placed into out-of-home care when at least one sibling is, which is likely to have a significant impact on families affected. The additional risk of placement also carries over to children born after the first removal in a sibling group, highlighting the need for further support to prevent future removals.
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12
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Orr C, Fisher C, O'Donnell M, Glauert R, Preen DB. Epilepsy in children exposed to family and domestic violence in the first 5 years of life. J Paediatr Child Health 2022; 58:2183-2189. [PMID: 36054645 PMCID: PMC10087942 DOI: 10.1111/jpc.16179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 04/03/2022] [Accepted: 07/17/2022] [Indexed: 11/27/2022]
Abstract
AIM To investigate childhood (0-18 years) hospitalisation and emergency department (ED) contacts for epilepsy in Western Australian (WA) children exposed to family and domestic violence (FDV) pre 5 years of age compared to children with no FDV exposure. METHODS A retrospective, population-based cohort study included children born 1987-2010 who were identified as being exposed to FDV (n = 7018) from two sources: WA Police Information Management System and WA Hospital Morbidity Data Collection (HMDC) and a non-exposed comparison group (n = 41 996). Epilepsy contact was identified in HMDC and ED Data Collection records. Cox regression was used to estimate the adjusted and unadjusted hazard ratio and 95% confidence interval (CI) for epilepsy contact; adjustment was made for a range of demographic characteristics known to impact health outcomes. Analyses were stratified by Aboriginal and Torres Strait Islander status to account for higher rates of FDV and epilepsy hospital admissions in Aboriginal and Torres Strait Islander children. RESULTS Children exposed to FDV had a 62% (HR 1.62, 95% CI: 1.33-1.98) increased risk of epilepsy contact than non-exposed counterparts. Furthermore, the children exposed to FDV had a 50% longer average hospital stay for epilepsy than non-exposed children (4.7 days vs. 3 days, P = 0.006). When stratified by Aboriginal status, we found that Aboriginal children exposed to FDV stayed (on average) 2 days longer in hospital for epilepsy than their non-exposed counterparts (5.1 days vs. 3.1 days, P = 0.018). CONCLUSIONS FDV exposure in early childhood is associated with increased risk of requiring secondary health care and longer hospital stays for childhood epilepsy.
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Affiliation(s)
- Carol Orr
- The School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Collen Fisher
- The School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Melissa O'Donnell
- The Australian Centre for Child Protection, The University of South Australia, Adelaide, South Australia, Australia
| | - Rebecca Glauert
- The School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - David B Preen
- The School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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13
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Orr C, O'Donnell M, Fisher C, Bell M, Glauert R, Preen D. School Readiness of Children Exposed to Family and Domestic Violence. J Interpers Violence 2022; 37:NP20428-NP20458. [PMID: 34668413 DOI: 10.1177/08862605211050099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Children have a universal right to live free from exposure to family and domestic violence (FDV). Children exposed to FDV can experience long-term effects on their physical and psychological health and their social competencies including social, emotional, and cognitive skills and behaviours that underpin successful social adaptation and academic achievement. The aim of this study was to investigate if children exposed to FDV were more likely to be vulnerable on school readiness measures compared to those children who were not exposed. Our cohort study used de-identified individual-level administrative data of children born during 2002-2010, in Western Australia, who were identified in police and hospital records as being exposed to FDV during 2002-2015. Univariate and multivariate logistic regression was used to estimate the odds of vulnerability in Australian Early Development Census (AEDC) outcomes of children exposed to FDV compared to a non-exposed cohort. After adjusting for demographic characteristics, children exposed to FDV had higher odds than non-exposed children of being vulnerable in all five AEDC domains: physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (school-based) and communication skills and general knowledge. Exposed children have an increased likelihood of vulnerability in all five AEDC domains: physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (school-based) and communication skills and general knowledge. Comprehensive multiagency early intervention for children exposed to FDV is required to mitigate the impact on outcomes, and ultimately the need to prevent FDV is needed.
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Affiliation(s)
- Carol Orr
- The School of Population and Global Health, 2720The University of Western Australia, Perth, WA, Australia
| | - Melissa O'Donnell
- The Australian Centre for Child Protection, 1067The University of South Australia, Adelaide, SA, Australia
| | - Colleen Fisher
- The School of Population and Global Health, 2720The University of Western Australia, Perth, WA, Australia
| | - Megan Bell
- The School of Population and Global Health, 2720The University of Western Australia, Perth, WA, Australia
| | - Rebecca Glauert
- The School of Population and Global Health, 2720The University of Western Australia, Perth, WA, Australia
| | - David Preen
- The School of Population and Global Health, 2720The University of Western Australia, Perth, WA, Australia
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14
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English K, Alcorn S, Wright J, Smith K, Wilkinson M, Nunes R, Tarica J, Tadken Hirose K, O'Donnell M, Tran H. Adjuvant Treatment Decisions among Older Women with Early-Stage Breast Cancer Seen in Multidisciplinary Consultation vs. Standard Consultation. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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15
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Loughlin E, Gibbons O, Burke S, Okon M, O'Sullivan F, Drumm B, O'Donnell M, Patel S, Hickey P, McCarthy G, O'Malley G. 232 WORKING-UP DEMENTIA, A RETROSPECTIVE COHORT STUDY OF REFERRALS TO A SPECIALIST DEMENTIA SERVICE. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Rates of dementia in Ireland are rapidly increasing in line with our ageing population. Cases are predicted to more than double in the next 30 years from a prevalence of 55,000 in 2018, to 141,000 in 2050. Dementia services will be placed under significant pressure. It is essential that patients referred to specialist memory services are appropriately worked-up prior to referral, to ensure efficiency and optimise the running of these services, and also to improve patient experience.
Methods
We carried out a retrospective review of patients referred to the Psychiatry of Later Life Team for specialist dementia care by General Practitioners. We obtained date of referral to the service, and carried out an electronic chart review to evaluate the work-up performed prior to referral. Our standard work-up criteria consisted of neuroimaging (CT brain or MRI brain), and blood tests including B12, folate, and thyroid function tests within 12-months. Results were analysed descriptively.
Results
104 patients were included in the study, from referrals dated Nov 2014-June 2019. Neuroimaging had been performed in 79.8% (n=83) prior to referral- 89.1% CT, 9.6% MRI, 1.2% both CT and MRI. Of those who had neuroimaging, n=37 had been performed in the previous 12-months, representing 35.6% of overall cohort. In terms of blood work-up, 23.1% (n=24) had bloods performed in the 12 months prior to referral- 70.8% B12, folate and thyroid function tests; 20.8% TFTS only; 8.3% B12 and folate levels only).
Conclusion
Referrals to specialist memory services by General Practice often lack the appropriate first line investigations, which introduces delay in review and the need for further assessment once baseline investigations have been done. There is a need for a standardised work-up prior to referral for optimum running of such services.
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Affiliation(s)
- E Loughlin
- Sligo University Hospital , Sligo, Ireland
| | - O Gibbons
- National University of Ireland Galway , Ireland
| | - S Burke
- Sligo University Hospital , Sligo, Ireland
| | - M Okon
- Sligo University Hospital , Sligo, Ireland
| | | | - B Drumm
- Sligo University Hospital , Sligo, Ireland
| | | | - S Patel
- Sligo University Hospital , Sligo, Ireland
| | - P Hickey
- Sligo University Hospital , Sligo, Ireland
| | - G McCarthy
- Sligo University Hospital , Sligo, Ireland
| | - G O'Malley
- Sligo University Hospital , Sligo, Ireland
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16
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Burke S, Gibbons O, Ahmed M, Loughlin E, Drumm B, O'Sullivan F, Hickey P, O'Donnell M, Dolan C, McCarthy G, O'Malley G. 329 ANTICHOLINERGIC BURDEN IN PEOPLE LIVING WITH DEMENTIA ATTENDING GERIATRIC MEDICINE AND PSYCHIATRY FOR OLDER PERSONS SERVICES. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Anticholinergic burden is associated with an increase in cognitive decline, delirium and confusion. We aimed to examine the Anticholinergic Cognitive Burden (ACB) of patients referred to local dementia services, and the prescribing of acetylcholinesterase inhibitors in patients with a significant anticholinergic burden. We also looked at frequency of prescribing of classes of some medications known to increase anticholinergic burden.
Methods
A retrospective chart review was carried out of new referrals attending local Geriatric Medicine and/or Psychiatry For Older Persons outpatient services with a diagnosis of dementia between 2017 and 2018. Medications in use at the time of patient review were obtained. ACB was calculated using ACB score. Results were analysed descriptively.
Results
163 patients over 65 years old were included in this study, 94 (57.6%) were female. 30% (N = 49) had a significant anticholinergic burden (ACB >3). The mean ACB was 1.69 (Range 0 – 8). 38% of all patients (N = 63) were prescribed an acetylcholinesterase inhibitor, and of those, 20% (N = 13) had a significant anticholinergic burden. Polypharmacy (use of 5 medications or more) was evident with 76% (N = 124) patients. Regarding groups of medications known to increase ACB, 35.5% (N = 58) were prescribed antipsychotics and 18.4% (30) were prescribed benzodiazepines.
Conclusion
There is a significant anticholinergic burden among people living with dementia attending the geriatric medicine and psychiatry of later life services. Some patients with a significant anticholinergic burden were being prescribed acetylcholinesterase inhibitors. This suggests acetylcholinesterase inhibitors may be prescribed without also discontinuing inappropriate medications that are contributing to the anticholinergic burden. We should look to further reduce the anticholinergic burden of patients attending the dementia services by avoiding these medications or using alternatives where available.
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Affiliation(s)
- S Burke
- Sligo University Hospital , Sligo, Ireland
| | - O Gibbons
- National University of Ireland Galway , Galway, Ireland
| | - M Ahmed
- National University of Ireland Galway , Galway, Ireland
| | - E Loughlin
- Sligo University Hospital , Sligo, Ireland
| | - B Drumm
- Sligo University Hospital , Sligo, Ireland
| | | | - P Hickey
- Sligo University Hospital , Sligo, Ireland
- National University of Ireland Galway , Galway, Ireland
| | | | - C Dolan
- Sligo University Hospital , Sligo, Ireland
| | - G McCarthy
- National University of Ireland Galway , Galway, Ireland
- Sligo University Hospital , Sligo, Ireland
| | - G O'Malley
- Sligo University Hospital , Sligo, Ireland
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17
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Griffith V, Murphy R, Sheil O, Roche E, Devaney T, Geoghegan J, Robinson S, Waters R, O'Donnell M, Canavan M. 311 FROM ONE FRONT DOOR TO ANOTHER: OUTCOMES OF PATIENTS DIRECTLY DISCHARGED FROM THE FRAILTY AT THE FRONT DOOR SERVICE. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The Frailty at the Front Door service is a novel service that provides comprehensive geriatric assessment in the emergency department for older adults who have an unplanned emergency presentation to hospital. It is important to monitor outcomes of patients discharged by the service to ensure appropriate patient selection.
Methods
Patients over the age of 75 with a Manchester Triage Score of between three and five and a possible frailty syndrome are eligible for review by the service. After initial review patients are either discharged directly or recommended for admission. We reviewed the outcomes of patients who were discharged directly after Emergency Department (ED) assessment by the service.
Results
Discharge disposition was available for review in 413 (95%) of patients since initiation of the service in October 2021. 30% (n= 122) of patients were discharged directly after initial ED review. Elevated 4AT score (p = 0.002) but not frailty (p = 0.80) was associated with decreased chances of direct discharge. Of patients discharged directly from ED 13% were reviewed post discharge by the community integrated care team (GICOP), with 43% of these reviews taking place within 30 days. Overall, 16% of patients discharged directly represented to ED within 30 days. There was a trend towards lower rates of representation to ED among patients who were seen by GICOP after discharge from ED (p = 0.12).
Conclusion
There was a high rate of direct discharge after review by the service, with low rates of representation to hospital. While limited by low numbers there was a trend towards lower representation rates in patients reviewed post-discharge by the integrated care team. Future quality improvement initiatives will aim to improve the integration between the services and highlighting patients who would benefit from more timely reviews.
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Affiliation(s)
- V Griffith
- Galway University Hospital , Galway, Ireland
| | - R Murphy
- Galway University Hospital , Galway, Ireland
| | - O Sheil
- Galway University Hospital , Galway, Ireland
| | - E Roche
- Galway University Hospital , Galway, Ireland
| | - T Devaney
- Galway University Hospital , Galway, Ireland
| | - J Geoghegan
- Galway University Hospital , Galway, Ireland
| | - S Robinson
- Galway University Hospital , Galway, Ireland
| | - R Waters
- Galway University Hospital , Galway, Ireland
| | - M O'Donnell
- Galway University Hospital , Galway, Ireland
| | - M Canavan
- Galway University Hospital , Galway, Ireland
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Whelan A, Murphy R, Shiel E, Griffith V, Mannion K, Neachtain MN, Mannion E, Conry M, Geoghegan J, Waters R, O'Donnell M, Robinson S, Canavan M. 355 PREDICTORS OF HOME SUPPORT SERVICES AND THE CONSEQUENCES OF MISMATCH BETWEEN ALLOCATED AND RECEIVED SERVICES IN COGNITIVELY-IMPAIRED OLDER ADULTS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Home support services aim to support older people to remain at home. Despite substantial investment in home support hours (€600 million), this has not translated into increased carers on the ground for older people. We aimed to report patterns of home support service utilisation in older patients with memory problems, and identify any mis-matches between allocated and received hours, and the impact on patients and caregivers.
Methods
Retrospective analysis of consecutive patients referred to community geriatric clinic from January 2021 to May 2022. 95/104 patients who were identified were suitable for inclusion.
Results
Participants had a median age of 82 (IQR 78-86) of whom 57% were female (n=54). 80% (n=76) were frail (CFS ≥4), with 82% dependent for IADLs (Lawton-Brody IADL Scale ≤6). Median MOCA score was 18, with 44% having moderate to severe cognitive impairment (MOCA ≤17). 40% of patients lived with alone (n=38). 52% (n=49) received formal home supports while 80% (n=76) had an informal carer. 37% (n=18) had a mismatch between hours allocated and hours received. There was a significant difference between median hours of care allocated (7) and median hours of care received (5), p <0.001. Increasing age and frailty, worsening cognitive and functional impairment and living status (living alone) predicted allocation of home supports. Patients who lived with family members were 3 times more likely not to receive allocated hours (OR 3.84 (95% CI 1.2–13.7))
Conclusion
In this vulnerable population with cognitive and functional decline, just over half received formal home support hours. A large proportion experienced significant mismatch between allocated and received hours. Family and informal caregivers often have to fill gaps, adding to existing carer strain. Future models of home support should prioritise early intervention for people with IADL loss to remain independent at home and broaden of the scope of practice of carers to facilitate this.
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Affiliation(s)
- A Whelan
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
| | - R Murphy
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- School of Medicine, National University of Ireland, Galway , Galway, Ireland
| | - E Shiel
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- University Hospital Galway Department of Nursing, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - V Griffith
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
| | - K Mannion
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- University Hospital Galway Department of Nursing, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - M Ní Neachtain
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- University Hospital Galway Department of Nursing, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - E Mannion
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- University Hospital Galway Department of Nursing, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - M Conry
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
- University Hospital Galway Department of Social Work, , Galway, Ireland
| | - J Geoghegan
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - R Waters
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - M O'Donnell
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - S Robinson
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - M Canavan
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
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19
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Reddin C, Hanrahan C, Murphy R, Costello M, Waters R, O'Donnell M. 312 DOES EXCLUDING PATIENTS WITH ORTHOSTATIC HYPOTENSION AFFECT SAFETY ESTIMATES IN HYPERTENSION TRIALS? A SYSTEMATIC REVIEW AND COMPARATIVE META-ANALYSIS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In order to apply the findings of antihypertensive randomised controlled trials to older adults, it is important to understand the populations included and consider the generalizability of the results to cohorts that may have been excluded. The purpose of this study was to determine whether participants with orthostatic hypotension were included in randomised controlled trial of antihypertensive therapy and whether adverse event rates of particular importance to this cohort; namely falls or syncope differed based on their exclusion.
Methods
We performed a systematic review and meta-analysis of randomised controlled trials comparing antihypertensives to placebo, combination of antihypertensive agents compared to fewer antihypertensive or higher compared to lower blood pressure targets that reports falls or syncope outcomes. A random-effects meta-analysis was used to estimate a pooled treatment-effect overall in subgroups of trials which excluded patients with orthostatic hypotension and trials which did not exclude patients with orthostatic hypotension. Difference in treatment effect was assessed by testing P for interaction. The primary outcome measure was falls events.
Results
Forty-Seven trials were included, including 18 trials which excluded those with orthostatic hypotension and 29 trials which did not exclude those with orthostatic hypotension. Thirteen trials (n=94,222) reported falls. The baseline incidence of falls in the control group was 4.8% in trials which excluded orthostatic hypotension compared to 8.8% in trials which did not exclude participants with orthostatic hypotension. The association of antihypertensive treatment and falls was similar for trials which excluded those with orthostatic hypotension (OR 1.00; 95%CI, 0.89-1.13) and trials which did not exclude those with orthostatic hypotension (OR, 1.02; 95%CI, 0.88 –1.18).
Conclusion
The exclusion of patients with orthostatic hypotension may under-estimate the event rate of adverse events such as falls but does not appear to affect relative risk estimates associated with antihypertensives.
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Affiliation(s)
- C Reddin
- University Hospital Galway , Galway, Ireland
- National University of Ireland , Galway, Galway, Ireland
- Wellcome Trust – HRB, Irish Clinical Academic Training , Ireland, Ireland
| | - C Hanrahan
- University Hospital Galway , Galway, Ireland
| | - R Murphy
- University Hospital Galway , Galway, Ireland
- National University of Ireland , Galway, Galway, Ireland
| | - M Costello
- University Hospital Galway , Galway, Ireland
- National University of Ireland , Galway, Galway, Ireland
| | - R Waters
- University Hospital Galway , Galway, Ireland
| | - M O'Donnell
- University Hospital Galway , Galway, Ireland
- National University of Ireland , Galway, Galway, Ireland
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20
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Mc Carthy CE, Murphy R, McAteer C, Okon M, O'Donnell M. 279 INCLUSION OF OLDER PATIENTS IN CLINICAL TRIALS: A REVIEW OF A SINGLE, HIGH IMPACT, MEDICAL JOURNAL OVER A 2-YEAR PERIOD. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Older patients have the highest rates of multimorbidity and prescription drug use. Despite this, previous research has found that these patients are not well represented in Randomised-Control Trials (RCTs), limiting external validity. In recent years many guidelines have been issued to help facilitate the inclusion of older patients in RCTs. We aimed to explore the inclusion of older patients in recent RCTs publications.
Methods
A single, high impact, medical journal was systematically reviewed, with all full text publications between March 2019 and March 2021 being screened. All adult, Phase III, RCTs were selected. The age descriptors of controls were extracted, in addition to information on eligibility criteria that could lead to exclusion based on age, comorbidity, or cognition.
Results
Of 123 RCT publications, the mean age was ≥65 in 42.1% and ≥75 in 8.3%, while the 75th centile age was ≥65 in 72% and ≥75 in 25%. An explicit capacity requirement was present in 41.5% and those with cognitive impairment were excluded in 15.4%. Eligibility determined at the discretion of the investigator and a life-expectancy exclusion criteria were present in 33.3% and 36.6%, respectively. A maximum age limit was present in 18.7%. No RCTs excluded on the basis of polypharmacy. The mean/75th centile age differed significantly by speciality (p<0.05), oldest in cardiovascular and medical RCTs. Having a maximum age limit was significantly associated with a lower mean/75th centile age (p<0.01), while having a life-expectancy exclusion criteria was associated with a higher mean/75th centile age (p<0.05). The age did not differ significantly between pre/post-COVID-19 RCTs, or for other eligibility criteria studied.
Conclusion
While those ≥65 were well represented, those ≥75 were not. Eligibility criteria that could potentially lead to exclusion based on age, comorbidity, or cognition were also common, although the majority did not significantly affect age.
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Affiliation(s)
- CE Mc Carthy
- National University of Ireland , Galway, Galway, Ireland
| | - R Murphy
- National University of Ireland , Galway, Galway, Ireland
| | - C McAteer
- University Hospital Galway Department of Geriatric Medicine, , Galway, Ireland
| | - M Okon
- University Hospital Galway Department of Geriatric Medicine, , Galway, Ireland
| | - M O'Donnell
- National University of Ireland , Galway, Galway, Ireland
- University Hospital Galway Department of Geriatric Medicine, , Galway, Ireland
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21
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Murphy R, McCarthy C, Reddin C, Canavan M, O’Dwyer C, Mulroy M, O'Donnell M. 310 A COMPARATIVE ANALYSIS OF THE IRISH POST-GRADUATE GERIATRIC TRAINING SCHEME WITH THE EUROPEAN POST-GRADUATE CURRICULUM IN GERIATRIC MEDICINE. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Minimum training recommendations to become a specialist geriatrician in the EU have been published. In this study we sought to evaluate the curriculum of the higher specialist training scheme in Geriatric Medicine in Ireland and examine how it compares with the knowledge recommendations from the European post-graduate curriculum in Geriatric medicine, which is endorsed by both the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA).
Methods
In this study we examined the content of didactic study-day lectures given over a five-year rolling period which is the minimum duration of the higher specialist training programme in Geriatric medicine in Ireland. We also examined the published Irish curriculum and compared how both the Irish curriculum and content of the study-days matches up with the 36 items that are identified as the core knowledge content in the European post-graduate curriculum.
Results
There were 24 study days delivered over a five-year time period. The Irish geriatric medicine curriculum formally outlined that 30 of the 36 knowledge areas proposed in the European curriculum should be formally covered during post-graduate geriatric training in Ireland. The European curriculum recommended formal teaching in sarcopenia, sleep disorders, tissue viability, iatrogenic care delivered disorders, sexuality in older adults and geron-technology/e-health, none of which were referred to in the Irish curriculum. However, despite this discrepancy, formal teaching was delivered on 92% (n = 33) of proposed areas. Pain assessment, sleep disorders and tissue viability were areas not covered in Irish didactic study-days. 24 of 36 topics were covered at least twice.
Conclusion
There was high concordance between the content of the Irish and European post-graduate curriculum in Geriatric medicine. Benchmarking against European training standards is an opportunity to ensure that parity of education and training is achieved across the EU.
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Affiliation(s)
- R Murphy
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
| | - C McCarthy
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
| | - C Reddin
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
| | - M Canavan
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
| | - C O’Dwyer
- St. Vincent’s University Hospital Department of Geriatric Medicine, , Ireland
| | - M Mulroy
- Our Lady of Lourdes Hospital , Drogheda, Louth, Ireland
| | - M O'Donnell
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
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Dunne F, Newman C, Devane D, Smyth A, Alvarez-Iglesias A, Gillespie P, Browne M, O'Donnell M. A randomised placebo-controlled trial of the effectiveness of early metformin in addition to usual care in the reduction of gestational diabetes mellitus effects (EMERGE): study protocol. Trials 2022; 23:795. [PMID: 36131291 PMCID: PMC9494837 DOI: 10.1186/s13063-022-06694-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/26/2022] [Indexed: 11/12/2022] Open
Abstract
Background Pregnancies affected by gestational diabetes mellitus (GDM) are associated with an increased risk of adverse maternal and foetal outcomes. Current treatments for GDM involve initial medical nutritional therapy (MNT) and exercise and pharmacotherapy in those with persistent hyperglycaemia. Insulin is considered first-line pharmacotherapy but is associated with hypoglycaemia, excessive gestational weight gain (GWG) and an increased caesarean delivery rate. Metformin is safe in selected groups of women with GDM but is not first-line therapy in many guidelines due to a lack of long-term data on efficacy. The EMERGE trial will evaluate the effectiveness of early initiation of metformin in GDM. Methods EMERGE is a phase III, superiority, parallel, 1:1 randomised, double-blind, placebo-controlled trial comparing the effectiveness of metformin versus placebo initiated by 28 weeks (+6 days) plus usual care. Women aged 18–50 years will be recruited. Women with established diabetes, multiple pregnancies, known major congenital malformation or small for gestational age (<10th centile), intolerance or contraindication to the use of metformin, shock or sepsis, current gestational hypertension or pre-eclampsia, significant gastrointestinal problems, congestive heart failure, severe mental illness or galactose intolerance are excluded. Intervention Immediate introduction of metformin or placebo in addition to MNT and usual care. Metformin is initiated at 500mg/day and titrated to a maximum dose of 2500mg over 10 days. Women are followed up at 4 and 12 weeks post-partum to assess maternal and neonatal outcomes. The composite primary outcome measure is initiation of insulin or fasting blood glucose ≥ 5.1 mmol/L at gestational weeks 32 or 38. The secondary outcomes are the time to insulin initiation and insulin dose required; maternal morbidity at delivery; mode and time of delivery; postpartum glucose status; insulin resistance; postpartum body mass index (BMI); gestational weight gain; infant birth weight; neonatal height and head circumference at delivery; neonatal morbidities (neonatal care unit admission, respiratory distress, jaundice, congenital anomalies, Apgar score); neonatal hypoglycaemia; cost-effectiveness; treatment acceptability and quality of life determined by the EQ5D-5L scale. Discussion The EMERGE trial will determine the effectiveness and safety of early and routine use of metformin in GDM. Trial registration EudraCT Number 2016-001644-19l; NCT NCT02980276. Registered on 6 June 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06694-y.
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Affiliation(s)
- F Dunne
- Department of Medicine, HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland.
| | - C Newman
- Department of Medicine, HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - D Devane
- HRB-Trials Methodology Research Network, National University of Ireland Galway, Galway, Ireland.,School of Nursing and Midwifery, National University of Ireland, Galway, Ireland.,Evidence Synthesis Ireland, National University of Ireland Galway, Galway, Ireland.,Cochrane Ireland, National University of Ireland Galway, Galway, Ireland
| | - A Smyth
- Department of Medicine, HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - A Alvarez-Iglesias
- Department of Medicine, HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - P Gillespie
- Health Economics & Policy Analysis Centre (HEPAC), Institute for Lifecourse and Society (ILAS), National University of Ireland Galway, Galway, Ireland.,CÚRAM, the SFI Research Centre for Medical Devices (12/RC/2073_2), National University of Ireland Galway, Galway, Ireland
| | - M Browne
- Department of Medicine, HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - M O'Donnell
- Department of Medicine, HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
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23
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Harrap B, Gibberd A, O'Donnell M, Simons K, Eades S. Trends in the removal of Aboriginal children in Western Australia. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.1970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
ObjectivesTo understand in greater detail the rates of interaction Indigenous children have with the child protection system in Western Australia and how they vary by birth year, geographic region, and between family units.
ApproachWe used data linkage between the Western Australian Department of Communities (child protection data), the Midwives Notification System, and Deaths Registry. Our cohort consisted of all Aboriginal and/or Torres Strait Islander children born in Western Australia between 2000 and 2013, with child protection data available from 2000 to 2015. We used cumulative incidence curves to visualise the overall rates of interactions with the child protection system and decompose interactions using seven two-year birth cohorts, geographic child protection regions and family units.
ResultsOverall, the cohort there was a high level involvement of Indigenous children in the child protection system, with over 50% having at least one notification, 27% having a substantiated notification, and 15% ever having a placement in out-of-home care. When examining by birth cohort, the more recently born the birth cohort the earlier their first interactions with the child protection system tended to be. Results for the geographic and family unit analyses will be presented as this work is ongoing.
ConclusionIncreasing interactions occurring at earlier ages coincides with legislative and policy changes. The increase in placement in out-of-home care before the age of 1 for the most recently born cohorts warrants further investigation into whether this is occurring across the system or within particular communities or regions.
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24
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Gibberd A, Eades S, Psilos N, Bourke J, Leonard H, Carlin E, Kavanagh A, Walker R, O'Donnell M, Colbung R, Nelson L. Developmental disability among Aboriginal children in Western Australia (WA). Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.1855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
BackgroundWhile Aboriginal Australians are known to be disproportionately affected by intellectual disabilities (ID) and/or autism spectrum disorders (developmental disabilities), true prevalences among Aboriginal children are unclear, with evidence of delayed and missed diagnoses and barriers to services. This study estimated these prevalences and disability service use among WA Aboriginal children.
ApproachTwo cohorts and data sources were used. Firstly, a state-based health and disability data linkage for all WA Aboriginal children born 2000-2013, including hospital, public outpatient mental health, birth and death data and state registries of birth defects, cerebral palsy and ID. The cumulative incidence of diagnosis by age 18 was estimated. Secondly, prevalence of service access was estimated from all National Disability Insurance Scheme (NDIS) WA Aboriginal and non-Aboriginal participants aged 0-17 on 30/6/2021 with a primary diagnosis of ID (with or without fetal alcohol spectrum disorder (FASD)) or autism. Census population counts were denominators.
ResultsUsing the data linkage, 3.3% of Aboriginal children born 2000-2013 were diagnosed with developmental disability by 18 years. The most common diagnosis (2.5%) was ID without FASD. Using NDIS data, 3.1% of Aboriginal children were NDIS participants with development disability in 2021, but only 0.7% of children with ID without FASD. Instead, autism was most common diagnosis. Aboriginal children were more likely than non-Aboriginal children to be NDIS participants with autism (prevalence ratio (PR): 1.16, 95% confidence interval (CI): 1.06-1.26), ID without FASD (PR: 2.06, 95% CI: 1.80-2.35) and ID with FASD (PR: 40.5, 95%CI: 29.9-57.1). For both data sources, prevalences differed by region. Aboriginal NDIS participants with ID had an older age distribution than non-Aboriginal participants.
ConclusionFor both cohorts, the prevalence of developmental disability was >3%, though the contributions of ID and autism differed in the two data sources. Variation in diagnoses by region and Aboriginal status may indicate differential diagnosis and variation in age suggests delayed diagnoses or access to services for Aboriginal children.
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25
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Harrap B, Gibberd A, O'Donnell M, Simons K, Eades S. Reflections as a settler person doing research in collaboration with Indigenous peoples. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.1969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
ObjectivesTo reflect on my position as a settler person in Australia and ensure Indigenous voices are prioritised throughout my research, as part of a co-designed, Aboriginal-led study which aims to understand trends in the removal of Indigenous children born in Western Australia using data linkage and qualitative research.
ApproachAs a non-Indigenous person, it is important to reflect on my cultural background and acknowledge my limited understanding of the cultural context of the Indigenous communities represented in the data. Listening to Indigenous voices and collaborating with Indigenous peoples at all stages of my research – from my PhD supervisor to investigators on the broader study, to members of the community and policy reference groups – will be key to improve my understanding of the data from a system and context I am unfamiliar with.
ResultsCollaboration has been cyclical, with results from the qualitative research and discussion with the reference groups informing the initial quantitative research direction. Findings from this research were presented back to the groups, resulting in further questions and directions to explore.
The journey so far has been one of learning and understanding the skills I have and the role they can play whilst acknowledging the limits of my own knowledge and the need for Indigenous voices to guide the research in order to be doing research with Indigenous peoples, rather than on them.
ConclusionCo-design with Indigenous peoples is critical for doing research which affects them or uses data from their communities. Understanding my own cultural background and acknowledging the limitations of my experience continues to be important for honest and meaningful collaboration.
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26
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Chamberlain C, Gray P, Bennet D, Elliott A, Jackomos M, Krakouer J, Marriott R, O'Dea B, Andrews J, Andrews S, Atkinson C, Atkinson J, Bhathal A, Bundle G, Davies S, Herrman H, Hunter S, Jones‐Terare G, Leane C, Mares S, McConachy J, Mensah F, Mills C, Mohammed J, Hetti Mudiyanselage L, O'Donnell M, Orr E, Priest N, Roe Y, Smith K, Waldby C, Milroy H, Langton M. Supporting Aboriginal and Torres Strait Islander Families to Stay Together from the Start (SAFeST Start): Urgent call to action to address crisis in infant removals. Aust J Soc Issues 2022; 57:252-273. [PMID: 35910416 PMCID: PMC9304314 DOI: 10.1002/ajs4.200] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/29/2021] [Accepted: 01/01/2022] [Indexed: 05/22/2023]
Abstract
Reducing the rate of over-representation of Aboriginal and Torres Strait Islander children in out-of-home care (OOHC) is a key Closing the Gap target committed to by all Australian governments. Current strategies are failing. The "gap" is widening, with the rate of Aboriginal and Torres Strait Islander children in OOHC at 30 June 2020 being 11 times that of non-Indigenous children. Approximately, one in five Aboriginal and Torres Strait Islander children entering OOHC each year are younger than one year. These figures represent compounding intergenerational trauma and institutional harm to Aboriginal and Torres Strait Islander families and communities. This article outlines systemic failures to address the needs of Aboriginal and Torres Strait Islander parents during pregnancy and following birth, causing cumulative harm and trauma to families, communities and cultures. Major reform to child and family notification and service systems, and significant investment to address this crisis, is urgently needed. The Family Matters Building Blocks and five elements of the Aboriginal and Torres Strait Islander Child Placement Principle (Prevention, Participation, Partnership, Placement and Connection) provide a transformative foundation to address historical, institutional, well-being and socioeconomic drivers of current catastrophic trajectories. The time for action is now.
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Affiliation(s)
- Catherine Chamberlain
- Centre for Health EquityThe University of MelbourneMelbourneVic.Australia
- Judith Lumley CentreLa Trobe UniversityMelbourneVic.Australia
- The Lowitja InstituteCarltonVicAustralia
- NGANGK YIRA: Murdoch University Research Centre for Aboriginal Health and Social EquityMurdochWAAustralia
| | - Paul Gray
- SNAICC ‐ National Voice for our ChildrenCollingwoodVic.Australia
- Jumbunna Institute for Indigenous Education and ResearchUniversity of Technology SydneySydneyNSWAustralia
| | - Debra Bennet
- SNAICC ‐ National Voice for our ChildrenCollingwoodVic.Australia
- Relationships AustraliaEight Mile PlainsQLDAustralia
| | - Alison Elliott
- Bouverie CentreLa Trobe UniversityMelbourneVic.Australia
| | | | - Jacynta Krakouer
- SNAICC ‐ National Voice for our ChildrenCollingwoodVic.Australia
- Health and Social Care UnitMonash UniversityClaytonVic.Australia
| | - Rhonda Marriott
- NGANGK YIRA: Murdoch University Research Centre for Aboriginal Health and Social EquityMurdochWAAustralia
| | - Birri O'Dea
- Molly Wardaguga Research CentreCharles Darwin UniversityCasuarinaNTAustralia
| | - Julie Andrews
- Aboriginal StudiesLa Trobe UniversityMelbourneVic.Australia
| | - Shawana Andrews
- Melbourne Poche Centre for Indigenous HealthThe University of MelbourneMelbourneVic.Australia
- School of PsychiatryUniversity of NSWSydneyNSWAustralia
| | | | | | - Alex Bhathal
- Social Work and Social PolicyLa Trobe UniversityMelbourneVic.Australia
| | - Gina Bundle
- The Royal Women's Hospital, MelbourneParkvilleVic.Australia
| | - Shanamae Davies
- Women's and Children's Health Network South AustraliaAdelaideSAAustralia
| | - Helen Herrman
- Orygen and Centre for Youth Mental HealthThe University of MelbourneMelbourneVic.Australia
| | | | | | - Cathy Leane
- Women's and Children's Health Network South AustraliaAdelaideSAAustralia
| | - Sarah Mares
- School of PsychiatryUniversity of NSWSydneyNSWAustralia
| | - Jennifer McConachy
- Department of Social WorkThe University of MelbourneMelbourneVic.Australia
| | - Fiona Mensah
- Murdoch Children's Research InstituteMelbourneVic.Australia
- Royal Children's HospitalMelbourneVic.Australia
- Department of PaediatricsThe University of MelbourneMelbourneVic.Australia
| | - Catherine Mills
- Monash Bioethics CentreMonash UniversityClaytonVic.Australia
| | | | | | | | - Elizabeth Orr
- School of PsychiatryUniversity of NSWSydneyNSWAustralia
| | - Naomi Priest
- Murdoch Children's Research InstituteMelbourneVic.Australia
- Centre for Social Research and MethodsAustralian National UniversityCanberraACTAustralia
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVic.Australia
| | - Yvette Roe
- Molly Wardaguga Research CentreCharles Darwin UniversityCasuarinaNTAustralia
| | - Kristen Smith
- Centre for Health EquityThe University of MelbourneMelbourneVic.Australia
| | - Catherine Waldby
- Research School of Social SciencesThe Australian National UniversityCanberraACTAustralia
| | - Helen Milroy
- Perth Children's HospitalNedlandsWAAustralia
- Division of PsychiatryUniversity of Western AustraliaCrawleyWAAustralia
| | - Marcia Langton
- Centre for Health EquityThe University of MelbourneMelbourneVic.Australia
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27
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Orr C, Fisher C, Bell M, O'Donnell M, Martin K, Glauert R, Preen D. Exposure to family and domestic violence is associated with lower attendance and higher suspension in school children. Child Abuse Negl 2022:105594. [PMID: 35459527 DOI: 10.1016/j.chiabu.2022.105594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 02/01/2022] [Accepted: 03/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Exposure to family and domestic violence (FDV) in childhood can have a detrimental effect on children's health and social outcomes. However, research on the school outcomes of children exposed to FDV is scant. OBJECTIVES To investigate the impact of FDV exposure on school attendance and suspension in Aboriginal and non-Aboriginal children. METHODS A population-based retrospective cohort study of school children, in grade 1 to 10, born from 1993 to 2006 in Western Australia (n = 26,743) using linked administrative data. Multivariate logistic regression analysis was used to calculate odds ratios and 95% confidence intervals to determine the association with school attendance and suspension outcomes for children exposed to FDV compared to non-exposed children. RESULTS Compared to non-exposed children, children exposed to FDV have an increase of poor school attendance: Aboriginal children adjusted odds ratio (aOR) = 1.91, 95% confidence interval (CI): 1.75-2.07, non-Aboriginal children aOR = 2.42, 95%CI: 2.12-2.75. FDV-exposed children also have an increased risk of school suspension: Aboriginal children aOR = 1.60, 95%CI: 1.47-1.74, non-Aboriginal children aOR = 2.68, 95%CI: 2.35-3.05, compared to non-exposed counterparts. CONCLUSION Exposure to FDV is associated with an increased odds of poor school attendance and school suspension. Evidence-based and innovative strategies are needed to support children who are exposed to FDV. This involves responding in ways that does not cause further trauma to children; a restorative and trauma-informed approach is vital.
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Affiliation(s)
- Carol Orr
- The School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia.
| | - Colleen Fisher
- The School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
| | - Megan Bell
- The School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
| | - Melissa O'Donnell
- The Australian Centre for Child Protection, The University of South Australia. GPO Box 2471, Adelaide, SA 5001, Australia
| | - Karen Martin
- The School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
| | - Rebecca Glauert
- Raine Study, The University of Western Australia. 35 Stirling Highway, Perth, WA 6009, Australia
| | - David Preen
- The School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
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28
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Sims SA, Pereira G, Preen D, Fatovich D, O'Donnell M. Young people with prior health service contacts have increased risk of repeated alcohol-related harm hospitalisations. Drug Alcohol Rev 2022; 41:1226-1235. [PMID: 35385585 DOI: 10.1111/dar.13467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/03/2022] [Accepted: 03/10/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION After a first alcohol-related hospitalisation in youth, subsequent hospitalisations may demonstrate an increased risk of further alcohol-related hospitalisations, but there is no existing data on this. METHODS A retrospective longitudinal study between July 1992 and June 2017 using linked hospital administrative data identified 23 464 Western Australian young people [9009 (38.4%) females and 14 455 (61.6%) males], aged 12-24 years hospitalised for at least one alcohol-related harm (ARH) episode of care. Cox regression was used to estimate hazard ratios (HR) between risk factors and repeated alcohol-related hospitalisation after the first discharge for ARH. RESULTS Of those admitted for an alcohol-related hospitalisation (n = 23 464), 21% (n = 4996) were readmitted for ARH. This high-risk sub-group comprised 46% (n = 16 017) of the total alcohol-related admissions (n = 34 485). After the first discharge for ARH, 16% (804) of people who experienced an alcohol-related readmission were readmitted within 1 month, and 51.8% (2589) were readmitted within 12 months. At increased risk of readmission were Aboriginal people and those with prior health service contacts occurring before their first alcohol-related hospitalisation, including illicit drug hospitalisations, mental health contacts and, in a sub-analysis, emergency department presentations. DISCUSSION AND CONCLUSIONS The probability of a repeated ARH hospitalisation was highest in the first month after initial discharge. There is a high-risk sub-group of young people more likely to have a repeat ARH hospitalisation. This represents an opportunity to provide interventions to those most at risk of repeated ARH.
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Affiliation(s)
- Scott A Sims
- School of Population and Global Health, University of Western Australia, Perth, Australia.,Developmental Pathways and Social Policy, Telethon Kids Institute, Perth, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Australia.,enAble Institute, Curtin University, Perth, Australia.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - David Preen
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Daniel Fatovich
- Department of Emergency Medicine, Royal Perth Hospital, Perth, Australia.,Emergency Medicine, University of Western Australia, Perth, Australia
| | - Melissa O'Donnell
- School of Population and Global Health, University of Western Australia, Perth, Australia.,Developmental Pathways and Social Policy, Telethon Kids Institute, Perth, Australia.,Australian Centre for Child Protection, University of South Australia, Adelaide, Australia
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29
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Lima F, O'Donnell M, Bourke J, Wolff B, Gibberd A, Llewellyn G, Leonard H. Child protection involvement of children of mothers with intellectual disability. Child Abuse Negl 2022; 126:105515. [PMID: 35121441 DOI: 10.1016/j.chiabu.2022.105515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 12/09/2021] [Accepted: 01/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Children born to parents with intellectual disability (ID) have been shown as disproportionally represented in child protection services however with limited population-based research. OBJECTIVES To investigate child protection involvement for children born to mothers with ID in Western Australia using linked administrative data. PARTICIPANTS AND SETTING A cohort of 1106 children born to a mother with ID and a comparison group of 9796 children of mothers without ID were identified in Western Australia. METHODS Cox regression analyses stratified by maternal Aboriginal status were conducted to investigate risk of child involvement with child protection services and care placement. Interaction with child age, intellectual disability status, and maternal mental health and substance use was investigated. RESULTS Children born to a mother with ID were both at higher risk of having contact with child protection services (HR: 4.35 (3.70-5.12)) and placement in out-of-home care (HR: 6.21 (4.73-8.17)). For non-Aboriginal children, the risks of child protection involvement and placement for those born to mothers with ID were 7 times and 12 times higher than those of mothers without ID. The risk was lower for Aboriginal children, at 1.8 and 1.9 times, respectively. Infants born to mothers with ID were at higher risk of child protection involvement compared to other age groups. Maternal mental health and substance use moderated the increased risk. CONCLUSIONS Intellectual disability alone is not sufficient justification for removal of children from their parents. The challenge for family services is ensuring that resources are adequate to meet the family's needs.
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Affiliation(s)
- Fernando Lima
- Australian Centre for Child Protection, University of South Australia, Adelaide, Australia; Telethon Kids Institute, Perth, Australia
| | - Melissa O'Donnell
- Australian Centre for Child Protection, University of South Australia, Adelaide, Australia; Telethon Kids Institute, Perth, Australia; University of Western Australia, Perth, Australia
| | | | - Brittany Wolff
- Telethon Kids Institute, Perth, Australia; University of Western Australia, Perth, Australia
| | | | - Gwynnyth Llewellyn
- Centre for Disability Research and Policy, University of Sydney, Australia
| | - Helen Leonard
- Telethon Kids Institute, Perth, Australia; University of Western Australia, Perth, Australia.
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30
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Orr C, Fisher CM, Glauert R, Preen DB, O'Donnell M, Ed D. A Demographic Profile of Mothers and Their Children Who Are Victims of Family and Domestic Violence: Using Linked Police and Hospital Admissions Data. J Interpers Violence 2022; 37:NP500-NP525. [PMID: 32370589 DOI: 10.1177/0886260520916272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of this study was to examine the key sociodemographic characteristics of Australian mothers and their children who were victims of family and domestic violence (FDV) that resulted in the male perpetrator being criminally charged for the offense or the mother being hospitalized. A population-based retrospective cohort study using de-identified linked health and police data of mothers with children born 1987-2010 who were victims of FDV 2004-2008 was utilized. Results indicate that mothers who were identified in police data are different demographically from those identified in health data and differed again from mothers identified in both health and police data. Within Western Australia, 3% of the population identify as Aboriginal; however, 44% of mothers identified as victims in police data and 73% within the health data were Aboriginal. Of the mothers identified in police data, 30% were under 25 years of age at their first assault recorded in police data compared with 21% in those identified in both police and hospital data. Most mothers identified as victims of FDV in police data had children present at their assault (60.6%). Prevalence of FDV exposure, identified in police data, was significantly different in Aboriginal children compared with non-Aboriginal children. Aboriginal children had a 19-fold (p < .0001) increased difference in prevalence of exposure compared with their non-Aboriginal counterparts. The study reveals the challenges in identifying victims of FDV when relying on a single data source for research and highlights the need for multiple datasets when investigating FDV. The overrepresentation of Aboriginal mothers and children should be taken in the context of the long-lasting impact of colonization. As such, prevention and early intervention strategies need to be underpinned by Aboriginal communities' cultural authority.
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Affiliation(s)
- Carol Orr
- The University of Western Australia, Perth, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | | | - Rebecca Glauert
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - David B Preen
- The University of Western Australia, Perth, Australia
| | | | - Dip Ed
- Telethon Kids Institute, Perth, Western Australia, Australia
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31
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Geoghegan J, Conry M, Mannion E, Shiel E, Flanagan L, McCleane F, Nolan M, Corry M, Chawke M, Coffey K, Costello M, McCarty CE, O'Donnell M, Robinson S, Waters R, Canavan M. 90 IMPACT OF AN INTEGRATED CARE MODEL FOR OLDER PERSONS: EVALUATING A PILOT PROGRAMME. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
In September 2019 Sláintecare helped establish an Integrated Care team for Older People. The aim of this service was to provide a Comprehensive Geriatric Assessment (CGA) to older people within a community network. Service user experience/feedback are critically important for development of a team and a service. To give service users a platform to evaluate the service a patient experience survey was conducted.
Methods
The survey was designed by the multidisciplinary team, consisting of 13 closed/3 open questions. A Likert scale was utilised for closed questions and thematic analysis for open questions. A question on impact of COVID-19 was also included.
150 of the 950 service users who received a CGA from June 2020 to June 2021 were selected randomly and invited to participate in the postal survey. All participants received a covering letter, questionnaire and a stamped address envelope to return their completed surveys.
Results
47% response rate (71/150). 77% were aged ≥75. 52% completed the survey themselves, 48% required assistance. 61% attended more than twice and most would prefer to attend a local spoke clinic. 96% agreed/strongly agreed that they were satisfied with the service. 99% felt they were treated with dignity/respect and had confidence in the service. 93% agreed that they were involved in care decisions. 82% reported their carers had the opportunity to discuss concerns. Themes emerging included importance of care close to home, avoiding acute hospital, difficulty parking at tertiary centres. 42% highlighted isolation and loneliness due to COVID-19 as a major issue.
Conclusion
Service users had an overwhelmingly positive experience especially when care was delivered in clinics close to their homes. Development of the hub and spoke model is acceptable and feasible to older people and their carers’ in this region and will be the focus for expansion of this service.
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Affiliation(s)
- J Geoghegan
- Galway University Hospitals , Galway, Ireland
| | - M Conry
- Galway University Hospitals , Galway, Ireland
| | - E Mannion
- Galway University Hospitals , Galway, Ireland
| | - E Shiel
- St Brendan's Community Nursing Unit , Loughrea, Galway, Ireland
| | - L Flanagan
- Community Healthcare West , Galway, Ireland
| | - F McCleane
- Community Healthcare West , Galway, Ireland
| | - M Nolan
- Galway University Hospitals , Galway, Ireland
| | - M Corry
- Galway University Hospitals , Galway, Ireland
| | - M Chawke
- Galway University Hospitals , Galway, Ireland
| | - K Coffey
- Community Healthcare West , Galway, Ireland
| | - M Costello
- Galway University Hospitals , Galway, Ireland
| | - C E McCarty
- Galway University Hospitals , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - M O'Donnell
- Galway University Hospitals , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - S Robinson
- Galway University Hospitals , Galway, Ireland
| | - R Waters
- Galway University Hospitals , Galway, Ireland
| | - M Canavan
- Galway University Hospitals , Galway, Ireland
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Costello M, McCarthy C, Bosch J, Robinson S, Canavan M, O'Donnell M. 33 ARE CLINICAL TRIALS RANDOMISING HOUSEHOLDS TO LIFESTYLE INTERVENTIONS FOR THE PREVENTION OF COGNITIVE DECLINE FEASIBLE? Age Ageing 2021. [DOI: 10.1093/ageing/afab219.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Dementia is increasing in prevalence worldwide. Several lifestyle factors have been identified as targets for dementia prevention, which may be more effective if targeted at households instead of an individual. To date there have been no clinical trials randomising households to lifestyle interventions of sleep, diet and/or physical activity to prevent cognitive decline. To inform future studies, qualitative approaches can give valuable in-depth insights into the values and beliefs of all household members towards behavioural change.
Methods
Semi structured interviews were carried out among eight households affected by cognitive impairment. Interview content was analysed, and important themes identified.
Results
Eighteen participants were interviewed within household pods. Among those, eight had cognitive impairment and the remainder were spouses or first-degree relatives living in the same home. Several themes of interest emerged including household members without dementia were more likely to report poor sleep habits; sleep was perceived the hardest behaviour to change; although most participants had healthy diets, most were interested in making a change and felt there was a strong link with nutrition and cognition; physical activity is challenging to adapt due to lack of motivation and focus when individuals are cognitively impaired and motivation to pursue physical activity in households centred on relaxation and social interaction.
Conclusion
This study identified beliefs and preferences of households towards lifestyle intervention trials. Barriers to study participation including risk of harm, complexity of intervention and deviation from routine emerged during discussions. Findings from this study should be used to inform future clinical trial protocols and future qualitative studies should explore acceptability and feasibility of digital intervention applications.
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Affiliation(s)
- M Costello
- Galway University Hosptial , Galway, Ireland
- HRB-Clinical Research Facility, National University of Ireland Galway , Galway, Ireland
| | - C McCarthy
- Galway University Hosptial , Galway, Ireland
- HRB-Clinical Research Facility, National University of Ireland Galway , Galway, Ireland
| | - J Bosch
- Population Health Research Institute , Hamilton, Canada
| | - S Robinson
- Galway University Hosptial , Galway, Ireland
- HRB-Clinical Research Facility, National University of Ireland Galway , Galway, Ireland
| | - M Canavan
- Galway University Hosptial , Galway, Ireland
- HRB-Clinical Research Facility, National University of Ireland Galway , Galway, Ireland
| | - M O'Donnell
- Galway University Hosptial , Galway, Ireland
- HRB-Clinical Research Facility, National University of Ireland Galway , Galway, Ireland
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Shiel E, Costello M, McCarthy C, Murphy R, McDermott C, Geoghegan J, Mannion E, Conry M, Flanagan L, Moroney E, Bhaoill CU, Walsh C, Coffey K, Waters R, Robinson S, O'Donnell M, Canavan M. 112 INTEGRATED CARE PROGRAMME FOR OLDER PEOPLE (ICPOP) IN A RURAL SETTING—ROLE OF ADVANCED NURSE PRACTITIONER (ANP). Age Ageing 2021. [DOI: 10.1093/ageing/afab219.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Sláintecare advocates for right care, in the right place at the right time. ANPs for Older Persons in the community are uniquely placed to deliver care as close as possible to the older person’s home and to lead a holistic, flexible model of care minimising admission to acute care and maximising existing local resources. A pilot programme aimed at providing ANP led comprehensive geriatric assessment (CGA) (with Geriatrician support) to older people in a defined area commenced in June 2019. This pilot was part of a larger Hub and Spoke model funded by Sláintecare which gave additional MDT support.
Methods
A referral template was designed. Criteria for referral included; age > 75 years, Rockwood Frailty Scale 4–6 (focusing on Falls, Cognitive Impairment and Complex Frailty). Older people on the cusp of requiring long term care (LTC) were also prioritised. A prospective database of patients was maintained by the ANP to evaluate the service.
Results
From June 2019 to August 2021, 156 patients received an ANP led CGA, mostly conducted in the home. 247 reviews were conducted at the local spoke clinic and 46 joint ANP/Geriatrician home visits. Majority of referrals were from GP (n = 69), hospital (n = 30), LTC reviews (n = 22) and Community Nursing Units (CNUs) (n = 19). 449 outpatient appointments have been removed from the tertiary referral centre. Independent case load management from the ANP includes further appointments, telephone follow up/advice and she is a point of contact where crises arise before referral to acute services. 99% of patients surveyed reported satisfaction with the service especially the ease of local access and home visits.
Conclusion
Older Persons’ ANP can provide longitudinal care pathways for older adults in the community in conjunction with ICPOP and local CNUs, intervening before crises emerge and providing continuity of care and an alternative to acute care.
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Affiliation(s)
- E Shiel
- University Hospital Galway\St. Brendan's CNU , Galway, Ireland
| | - M Costello
- University Hospital Galway , Galway, Ireland
| | - C McCarthy
- University Hospital Galway , Galway, Ireland
| | - R Murphy
- University Hospital Galway , Galway, Ireland
| | - C McDermott
- University Hospital Galway , Galway, Ireland
| | - J Geoghegan
- University Hospital Galway , Galway, Ireland
| | - E Mannion
- University Hospital Galway , Galway, Ireland
| | - M Conry
- University Hospital Galway , Galway, Ireland
| | - L Flanagan
- Community Healthcare West , Galway, Ireland
| | - E Moroney
- Community Healthcare West , Galway, Ireland
| | | | - C Walsh
- Community Healthcare West , Galway, Ireland
| | - K Coffey
- Community Healthcare West , Galway, Ireland
| | - R Waters
- University Hospital Galway , Galway, Ireland
| | - S Robinson
- University Hospital Galway , Galway, Ireland
| | - M O'Donnell
- University Hospital Galway , Galway, Ireland
| | - M Canavan
- University Hospital Galway , Galway, Ireland
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Mc Carthy CE, O'Malley K, Mannion E, Geoghegan J, Costello M, Conry M, Flanagan L, Corry M, Reddin C, Murphy R, Waters R, O'Donnell M, Robinson S, Canavan M. 102 PROMOTING BRAIN HEALTH IN AN INTEGRATED CARE OUTREACH PROGRAMME. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Lifestyle modifications, in older at risk populations, may prevent or slow the rate of cognitive decline. Promotion of brain health has been recommended by the WHO and other governing bodies. Supporting patients in making these lifestyle changes, however, can be complex. Generic guidance may not apply to all in a heterogenous and frail patient cohort, when physical mobility may be limited and weight loss/nutrition a concern. We sought to review current practices and barriers to brain health guidance in a regional integrated care outreach programme (ICOP).
Methods
From March–June’21 the comprehensive geriatric assessment (CGA) of consecutive patients were reviewed. Those presenting with cognitive complaints, for their first assessment, were included. Demographic data and data on screening for hearing impairment and sleep disturbance were collected, in addition to information on physical activity and nutritional risk. Whether information and guidance on aspects of brain health was given was also assessed.
Results
30 patients met the inclusion criteria. The mean age was 80.3 and the mean clinical frailty scale (CFS) was 4.4. Hearing impairment was present in 20% (n = 6), with no information available in 10% (n = 3). All patients were screened for sleep disturbance, with 13% (n = 4) not fully satisfied with their sleep. Mobility aids, assistance or supervision were required in 40% (n = 12), and 23% (n = 7) were at medium or high malnutrition risk. Only 30% (n = 9) cooked their own meals. Generic brain health advice, or advice about sleep was documented in 30 (n = 9), without hearing impairment advice documented in any patient.
Conclusion
There are several barriers to brain health advice in the ICOP setting, with only 30% of patients having brain health advice documented. We are currently developing patient information leaflets on brain health, that will take potential barriers into account. Dedicated and specific information on local hearing services is also in development, as part of an ongoing quality improvement project.
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Affiliation(s)
- C E Mc Carthy
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - K O'Malley
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - E Mannion
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - J Geoghegan
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - M Costello
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - M Conry
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - L Flanagan
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - M Corry
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - C Reddin
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - R Murphy
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - R Waters
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - M O'Donnell
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - S Robinson
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - M Canavan
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
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Fluke JD, Tonmyr L, Gray J, Bettencourt Rodrigues L, Bolter F, Cash S, Jud A, Meinck F, Casas Muñoz A, O'Donnell M, Pilkington R, Weaver L. Child maltreatment data: A summary of progress, prospects and challenges. Child Abuse Negl 2021; 119:104650. [PMID: 32861435 DOI: 10.1016/j.chiabu.2020.104650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 06/19/2020] [Accepted: 07/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND In 1996, the ISPCAN Working Group on Child Maltreatment Data (ISPCAN-WGCMD) was established to provide an international forum in which individuals, who deal with child maltreatment data in their respective professional roles, can share concerns and solutions. OBJECTIVE This commentary describes some of the key features and the status of child maltreatment related data collection addressed by the ISPCAN-WGCMD. METHODS Different types of data collection methods including self-report, sentinel, and administrative data designs are described as well as how they address different needs for information to help understand child maltreatment and systems of prevention and intervention. RESULTS While still lacking in many parts of the world, access to child maltreatment data has become much more widespread, and in many places a very sophisticated undertaking. CONCLUSION The ISPCAN-WGCMD has been an important forum for supporting the continued development and improvement in the global effort to understand and combat child maltreatment thus contributing to the long term goals of the UN Convention on the Rights of the Child. Nevertheless, based on what has been learned, even greater efforts are required to improve data in order to effectively combat child maltreatment.
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Affiliation(s)
- John D Fluke
- Kempe Center, Department of Paediatrics, University of Colorado School of Medicine, USA.
| | - Lil Tonmyr
- Family Violence Surveillance, Public Health Agency of Canada, Ontario, Canada
| | | | | | - Flora Bolter
- Chargée d'études chez L'Observatoire national de la protection de l'enfance, France
| | - Scottye Cash
- School of Social Work, The Ohio State University, USA
| | - Andreas Jud
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Germany; School of Social Work, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland
| | - Franziska Meinck
- School of Social and Political Sciences, University of Edinburgh, UK; Optentia, Faculty of Health Sciences, North-West University, Vanderbejlpark, South Africa
| | | | | | - Rhiannon Pilkington
- School of Public Health, The University of Adelaide, South Australia, Australia
| | - Leemoy Weaver
- The University of the West Indies, Mona Campus, Jamaica
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36
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Orr C, Preen D, Fisher C, Sims S, O'Donnell M. Trends in Hospital Admissions for Intimate Partner Violence in Australian Mothers With Children Born From 1990 to 2009. J Interpers Violence 2021; 36:6998-7017. [PMID: 30813820 DOI: 10.1177/0886260519832905] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study aims to determine the prevalence, and trends over time, of Western Australian (WA) mothers who were victims of intimate partner violence (IPV) requiring hospital admission. The study investigated the prevalence of all mothers and the specific prevalence of Aboriginal and non-Aboriginal mothers. A population-based cohort study using de-identified linked health data of mothers of children born from 1990 to 2009 in WA was carried out. The prevalence of hospitalizations for IPV in mothers of children born in the period 1990-2009 (per 1,000 births) was calculated. Results indicate that the overall prevalence of hospital admissions for mothers assaulted 12 months prior to their child's birth month increased in the period 1990-2009, from 2.7 to 7.7 per 1,000 births. There was also an increase in the overall prevalence of hospital admissions of mothers who were assaulted 12 months prior to the birth month and 36 months after the birth month, from 8.9 per 1,000 births in 1990 to 19.4 per 1,000 births in 2009. In addition, being Aboriginal, having a mother <30 years of age, and being of low SES significantly increased the odds of having a mother with an IPV admission. This study highlights that while there has been an increase in the prevalence of IPV admissions for mothers of children born from 1990 to 2009 in WA, the level of prevalence has remained persistent for the last decade for the whole population. However, non-Aboriginal mothers have seen an increase in prevalence in the last decade. This increase is associated with the introduction of the Z63.0 code in International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM). This study highlights the importance of prioritizing groups for targeted early intervention and prevention as well as the need for culturally appropriate strategies to reduce the burden of interpersonal violence.
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Affiliation(s)
- Carol Orr
- The University of Western Australia, Perth, Australia
- Telethon Kids Institute, The University of Western Australia, Perth Australia
- The University of Notre Dame Australia, Fremantle, Australia
| | - David Preen
- The University of Western Australia, Perth, Australia
| | | | - Scott Sims
- Telethon Kids Institute, The University of Western Australia, Perth Australia
| | - Melissa O'Donnell
- Telethon Kids Institute, The University of Western Australia, Perth Australia
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Abstract
Studies have reported a dose-dependent relationship between gestational age and poorer school readiness. The study objective was to quantify the risk of developmental vulnerability for children at school entry, associated with gestational age at birth and to understand the impact of sociodemographic and other modifiable risk factors on these relationships. Linkage of population-level birth registration, hospital, and perinatal datasets to the Australian Early Development Census (AEDC), enabled follow-up of a cohort of 64,810 singleton children, from birth to school entry in either 2009, 2012, or 2015. The study outcome was teacher-reported child development on the AEDC with developmental vulnerability defined as domain scores < 10th percentile of the 2009 AEDC cohort. We used modified Poisson Regression to estimate relative risks (RR) and risk differences (RD) of developmental vulnerability between; (i) preterm birth and term-born children, and (ii) across gestational age categories. Compared to term-born children, adjustment for sociodemographic characteristics attenuated RR for all preterm birth categories. Further adjustment for modifiable risk factors such as preschool attendance and reading status at home had some additional impact across all gestational age groups, except for children born extremely preterm. The RR and RD for developmental vulnerability followed a reverse J-shaped relationship with gestational age. The RR of being classified as developmentally vulnerable was highest for children born extremely preterm and lowest for children born late-term. Adjustment for sociodemographic characteristics attenuated RR and RD for all gestational age categories, except for early-term born children. Children born prior to full-term are at a greater risk for developmental vulnerabilities at school entry. Elevated developmental vulnerability was largely explained by sociodemographic disadvantage. Elevated vulnerability in children born post-term is not explained by sociodemographic disadvantage to the same extent as in children born prior to full-term.
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Affiliation(s)
- Gursimran K Dhamrait
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.
| | - Hayley Christian
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Melissa O'Donnell
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- Australian Centre for Child Protection, University of South Australia, Adelaide, SA, Australia
| | - Gavin Pereira
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
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38
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Sims S, Preen D, Pereira G, Fatovich D, Livingston M, O'Donnell M. Alcohol-related harm in emergency departments: linking to subsequent hospitalizations to quantify under-reporting of presentations. Addiction 2021; 116:1371-1380. [PMID: 33027556 DOI: 10.1111/add.15284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/05/2020] [Accepted: 09/27/2020] [Indexed: 11/27/2022]
Abstract
TITLE Alcohol-related harm in emergency departments: linking to subsequent hospitalizations to quantify under-reporting of presentations. AIMS To quantify the proportion of emergency department (ED) presentations that could be identified as alcohol-related when linking to a patient's subsequent hospitalization, compared with using ED data alone, and to assess that comparison according to the change in alcohol harm rates over time and potential variations within subpopulations. DESIGN A retrospective study using linked hospital administrative data to identify ED patients who had subsequent alcohol-related hospitalizations. SETTING Western Australia. PARTICIPANTS A total of 533 816 Western Australian young people (246 866 females and 286 950 males), aged 12-24 years. MEASUREMENTS Whether or not presentations of young people to ED could be identified as alcohol-related, and for those that were not, how many had a subsequent alcohol-related hospitalization. Rates and proportions of alcohol-related harm for both methods of ascertainment were estimated by sex and Aboriginality across different age groups. FINDINGS Alcohol-related hospitalizations that followed an initial presentation at ED allowed the identification of an additional 19 994 alcohol-related presentations (95% increase). Linking to additional hospitalization information also resulted in significant variation in alcohol-related harm trends. In particular, trends in alcohol-related ED presentations for 21-24-year-old males were stable to slightly increasing using only ED data, but decreased after linking with hospitalization data (P < 0.05). Similarly, trends among Aboriginal persons aged 21-24 shifted from increasing using only ED data to being stable in comparison to presentations using subsequent hospitalizations (P < 0.05). CONCLUSIONS Among young people in Western Australia, twice as many emergency department presentations could be identified as being alcohol-related using diagnosis information from subsequent hospitalizations compared with emergency department data alone. When supplemented with hospitalization data, trends in alcohol-related harm presentations become significantly different within some subpopulations compared with using emergency department presentation data alone.
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Affiliation(s)
- Scott Sims
- Telethon Kids Institute, Perth, Australia.,School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - David Preen
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Gavin Pereira
- Telethon Kids Institute, Perth, Australia.,School of Public Health, Curtin University, Perth, Australia.,Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo
| | - Daniel Fatovich
- Department of Emergency Medicine, Royal Perth Hospital, Perth, Australia.,Emergency Medicine, The University of Western Australia, Perth, Australia
| | | | - Melissa O'Donnell
- Telethon Kids Institute, Perth, Australia.,Centre for Child Health Research, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia.,Australian Centre for Child Protection, University of South Australia, Australia
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Abstract
OBJECTIVE To retrospectively assess a cohort of mothers for characteristics of injuries that they have suffered as a result of family and domestic violence (FDV) and which have required admission to a hospital during both the intrapartum and postpartum periods. DESIGN AND SETTING Retrospective, whole-population linked data study of FDV in Western Australia using the Western Australia birth registry from 1990 to 2009 and Hospital Morbidity Data System records from 1970 to 2013. MAIN OUTCOME MEASURES Number of hospitalisations, and mode, location and type of injuries recorded, with particular focus on the head and neck area. RESULTS There were 11 546 hospitalisations for mothers due to FDV. 8193 hospitalisations recorded an injury code to the head and/or neck region. The upper and middle thirds of the face and scalp were areas most likely to receive superficial injuries (58.7% or 4158 admissions), followed by the mouth and oral cavity (9.7% or 687 admissions). Fracture to the mandible accounted for 479 (4.2%) admissions and was almost equal to the sum of the next three most common facial fractures (nasal, maxillary and orbital floor). Mothers more likely to be hospitalised due to a head injury from FDV included those with more than one child (OR=1.17, 95% CI 1.03 to 1.30) and those with infants (<1 year old) (OR=1.40, 95% CI 1.04 to 1.90) and young children (<7 years old) (OR=1.15, 95% CI 1.01 to 1.30). CONCLUSIONS FDV is a serious and ongoing problem and front-line clinicians are in need of evidence-based guidelines to recognise and assist victims of FDV. Mothers with children in their care are a particularly vulnerable group.
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Affiliation(s)
- Vishal Mahesh Bulsara
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Max K Bulsara
- Institute for Health Research, University of Notre Dame Australia School of Medicine, Fremantle, Western Australia, Australia
| | - Jim Codde
- Institute for Health Research, University of Notre Dame Australia School of Medicine, Fremantle, Western Australia, Australia
| | - David Preen
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Linda Slack-Smith
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Melissa O'Donnell
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
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40
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McCabe JJ, O'Reilly E, Coveney S, Collins R, Healy L, McManus J, Mulcahy R, Moynihan B, Cassidy T, Hsu F, Worrall B, Murphy S, O'Donnell M, Kelly PJ. Interleukin-6, C-reactive protein, fibrinogen, and risk of recurrence after ischaemic stroke: Systematic review and meta-analysis. Eur Stroke J 2021; 6:62-71. [PMID: 33817336 PMCID: PMC7995315 DOI: 10.1177/2396987320984003] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/06/2020] [Indexed: 01/02/2023] Open
Abstract
Background Recent randomised trials showed benefit for anti-inflammatory therapies in coronary disease but excluded stroke. The prognostic value of blood inflammatory markers after stroke is uncertain and guidelines do not recommend their routine measurement for risk stratification. Methods We performed a systematic review and meta-analysis of studies investigating the association of C-reactive protein (CRP), interleukin-6 (IL-6) and fibrinogen and risk of recurrent stroke or major vascular events (MVEs). We searched EMBASE and Ovid Medline until 10/1/19. Random-effects meta-analysis was performed for studies reporting comparable effect measures. Results Of 2,515 reports identified, 39 met eligibility criteria (IL-6, n = 10; CRP, n = 33; fibrinogen, n = 16). An association with recurrent stroke was reported in 12/26 studies (CRP), 2/11 (fibrinogen) and 3/6 (IL-6). On random-effects meta-analysis of comparable studies, CRP was associated with an increased risk of recurrent stroke [pooled hazard ratio (HR) per 1 standard-deviation (SD) increase in loge-CRP (1.14, 95% CI 1.06-1.22, p < 0.01)] and MVEs (pooled HR 1.21, CI 1.10-1.34, p < 0.01). Fibrinogen was also associated with recurrent stroke (HR 1.26, CI 1.07-1.47, p < 0.01) and MVEs (HR 1.31, 95% CI 1.15-1.49, p < 0.01). Trends were identified for IL-6 for recurrent stroke (HR per 1-SD increase 1.17, CI 0.97-1.41, p = 0.10) and MVEs (HR 1.22, CI 0.96-1.55, p = 0.10). Conclusion Despite evidence suggesting an association between inflammatory markers and post-stroke vascular recurrence, substantial methodological heterogeneity was apparent between studies. Individual-patient pooled analysis and standardisation of methods are needed to determine the prognostic role of blood inflammatory markers and to improve patient selection for randomised trials of inflammatory therapies.
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Affiliation(s)
- J J McCabe
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Neurovascular Unit for Applied Translational and Therapeutics Research, Catherine McAuley Centre, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland.,Medicine for the Elderly Department/Stroke Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - E O'Reilly
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland
| | - S Coveney
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Neurovascular Unit for Applied Translational and Therapeutics Research, Catherine McAuley Centre, Dublin, Ireland.,Department of Geriatric Medicine, Tallaght University Hospital, Dublin, Ireland
| | - R Collins
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Department of Geriatric Medicine, Tallaght University Hospital, Dublin, Ireland
| | - L Healy
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - J McManus
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Department of Geriatric Medicine, University Hospital Limerick, Ireland
| | - R Mulcahy
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Department of Geriatric Medicine, Waterford University Hospital, Waterford, Ireland
| | - B Moynihan
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - T Cassidy
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Geriatric and Stroke Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - F Hsu
- The Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - B Worrall
- Departments of Neurology and Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - S Murphy
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Neurovascular Unit for Applied Translational and Therapeutics Research, Catherine McAuley Centre, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland.,Medicine for the Elderly Department/Stroke Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - M O'Donnell
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland.,Department of Translational Medicine, National University of Ireland Galway, Ireland
| | - P J Kelly
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Neurovascular Unit for Applied Translational and Therapeutics Research, Catherine McAuley Centre, Dublin, Ireland.,Department of Neurology/Stroke Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
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41
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Pearson RJ, Jay MA, O'Donnell M, Wijlaars L, Gilbert R. Characterizing newborn and older infant entries into care in England between 2006 and 2014. Child Abuse Negl 2020; 109:104760. [PMID: 33053479 PMCID: PMC7718112 DOI: 10.1016/j.chiabu.2020.104760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The risk of entry to state care during infancy is increasing, both here in England and abroad, with most entering within a week of birth ('newborns'). However, little is known about these infants or of their pathways through care over early childhood. OBJECTIVE To characterize infant entries to care in England. PARTICIPANTS AND SETTING All children in England who first entered care during infancy, between April 2006 and March 2014 (n = 42,000). METHODS We compared sociodemographic and care characteristics for infants entering care over the study period by age at first entry (newborn: <1wks, older infant 1-51wks). Among those who entered before April 2010, we further characterized care over follow-up (i.e. 4 years from first entry) and employed latent class analysis to uncover any common pathways through care. RESULTS Almost 40 % of infants first entered care as a newborn. Most infants first entered care under s 20 arrangements (i.e. out-of-court, 60 % of newborns vs 47 % of older infants). Among infants entering before April 2010, most were adopted over follow-up (60 % vs 37 %), though many were restored to parental care (20 % vs 32 %) or exited care to live with extended family (13 % vs 19 %). One in six infants (17.7 %) had particularly unstable care trajectories over early childhood, typified by three or more placements or failed reunification. CONCLUSIONS Evidence-based strengthening of pre-birth social work support is needed to improve preventive interventions before birth, to more effectively target infant placement into care. Linkages between child protection records and information on parents are needed to inform preventive strategies.
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Affiliation(s)
- Rachel J Pearson
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.
| | - Matthew A Jay
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.
| | - Melissa O'Donnell
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; Australian Centre for Child Protection, University of South Australia, Adelaide, South Australia, Australia.
| | - Linda Wijlaars
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.
| | - Ruth Gilbert
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.
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42
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Maclean MJ, Taylor CL, O'Donnell M. Adolescent education outcomes and maltreatment: The role of pre-existing adversity, level of child protection involvement, and school attendance. Child Abuse Negl 2020; 109:104721. [PMID: 32987322 DOI: 10.1016/j.chiabu.2020.104721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Maltreated children are at high risk for low educational achievement, however few studies have accounted for confounding risk factors that commonly co-occur (including child, family and neighbourhood risk factors) and results have been mixed, particularly for adolescents. OBJECTIVES We aimed to 1) examine the relationship between maltreatment and low educational achievement among Year 9 students, taking into account child, family and neighbourhood risk factors; 2) assess subgroup differences in outcomes based on level of child protection involvement and maltreatment type; and 3) identify prevalence and risk factors for low educational achievement. PARTICIPANTS AND SETTING A population birth cohort of West Australian children (N = 33,866) who sat national reading achievement tests between 2008 and 2010 was used for the main analysis. METHODS Linked administrative data from Departments of Health, Communities (Child Protection and Family Support), Education, and the Disability Services Commission was used to conduct a series of logistic regression analyses. RESULTS Maltreatment was significantly associated with low Year 9 achievement, even after accounting for many child, family and neighbourhood risk factors (aOR 1.51, 95 % CI 1.35-1.69). Educational outcomes were consistently poor across subgroups in the child protection system, including those with different levels of child protection involvement and maltreatment types. Other notable risk factors for low achievement included intellectual disability, attendance, parents' level of education, Aboriginality, and being older (indicating possible grade retention). CONCLUSIONS Adolescents with a history of maltreatment are at risk for poor educational outcomes and need additional support. Multiple contributing risk factors suggest the need for whole-of-government solutions.
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Affiliation(s)
- Miriam J Maclean
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.
| | - Catherine L Taylor
- Telethon Kids Institute, The University of Western Australia, Perth, Australia; Centre for Child Health Research, The University of Western Australia, Australia
| | - Melissa O'Donnell
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
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43
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Hamilton SL, Maslen S, Watkins R, Conigrave K, Freeman J, O'Donnell M, Mutch RC, Bower C. 'That thing in his head': Aboriginal and non-Aboriginal Australian caregiver responses to neurodevelopmental disability diagnoses. Sociol Health Illn 2020; 42:1581-1596. [PMID: 32579286 DOI: 10.1111/1467-9566.13146] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Little is known about the significance of cultural differences to how caregivers receive a diagnosis of neurodevelopmental disability. As part of a Fetal Alcohol Spectrum Disorder prevalence study among sentenced, detained youth, our qualitative study explored the experiences of diagnostic assessment among detained young people and their caregivers. We present findings from the perspectives of caregivers. In conversation with the sociology of diagnosis literature, we present vignettes of three Aboriginal and two non-Aboriginal caregivers' experiences of the diagnostic assessment process. We found that Aboriginal caregivers conceptualised their children's diagnosis and ongoing management in the context of their family networks and community. In contrast, non-Aboriginal caregivers focused on how the diagnosis would affect their child and interactions with various institutions including healthcare systems and schools. Caregivers' engagement with diagnostic reports and resources also followed cultural lines. Reflections on intergenerational drinking were voiced by Aboriginal caregivers, who expressed shame at receiving diagnosis. These findings advance our appreciation of cultural difference in receiving a diagnosis, the examination of which is in its nascent stages. We also suggest ways to mitigate harm from a stigmatising diagnosis and soften the well-established effects of medical dominance over the process of defining a person's capacity and status.
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Affiliation(s)
- Sharynne L Hamilton
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia
| | - Sarah Maslen
- Faculty of Business, Government and Law, University of Canberra, Canberra, Australia
| | - Rochelle Watkins
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Katherine Conigrave
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Jacinta Freeman
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Melissa O'Donnell
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia
| | - Raewyn C Mutch
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia
| | - Carol Bower
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia
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44
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Cowlishaw S, Little J, Sbisa A, McFarlane A, Van Hooff M, Lawrence-Wood E, O'Donnell M, Hinton M, Sadler N, Savic A, Forbes D, Metcalf O. Prevalence and implications of gambling problems among firefighters. Addict Behav 2020; 105:106326. [PMID: 32004832 DOI: 10.1016/j.addbeh.2020.106326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/13/2020] [Accepted: 01/17/2020] [Indexed: 12/12/2022]
Abstract
Firefighting is a high-risk occupation that accounts for vulnerability to a range of mental health problems and addictive behaviours. However, no research has addressed whether this vulnerability extends to gambling problems, and the aim of this study was thus to provide new data on frequency and implications of such problems in this occupational context. The sample consisted of n = 566 career and retained firefighters who participated in a cross-sectional survey of an Australian metropolitan fire service. The Problem Gambling Severity Index (PGSI) was used to operationalise both clinically significant levels of problem gambling (PGSI ≥ 5), and 'at-risk' gambling (PGSI 1-4); alongside measures of major depression (PHQ-9), anxiety (GAD-7), Posttraumatic Stress Disorder (PCL-5) and alcohol problems (AUDIT), as well as other addictive behaviours, wellbeing and psychosocial issues. Results indicated 12.3% of firefighters that reported any gambling problems across a continuum of severity (PGSI ≥ 1), including 2.3% that were problems gamblers, and 10.0% reporting at-risk gambling. The weighted prevalence of problem gambling was comparable to other significant mental health conditions including depression and PTSD, while the rate of any gambling problems was high relative to other addictive behaviours. Gambling problems were associated with poor mental health and wellbeing, but not psychosocial indicators (e.g., financial difficulties). The findings suggest that gambling problems across a spectrum of severity may be significant yet hidden issues among emergency service workers, and thus require increased recognition and responses at the organisational level.
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45
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Lima F, Sims S, O'Donnell M. Harmful drinking is associated with mental health conditions and other risk behaviours in Australian young people. Aust N Z J Public Health 2020; 44:201-207. [PMID: 32364653 DOI: 10.1111/1753-6405.12978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/01/2019] [Accepted: 02/01/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To investigate factors associated with alcohol use in adolescents, with the focus on analysing the comorbidities between single-occasion harmful-drinking episodes with mental health issues and risk behaviours. METHODS This study used data from the Young Minds Matter survey, designed to inform on the prevalence of the seven most common mental health disorders of children and adolescents. Logistic regression modelling was used to assess the odds of harmful drinking behaviour in young people aged 13-17 years in Australia. RESULTS We found a strong association between single-occasion harmful drinking and mental health issues, which hold after controlling for sociodemographic characteristics. Young people with severe mental health issues within the past year were four times more likely to have been drinking at harmful levels in the past 30 days. CONCLUSIONS Alcohol use can have adverse health effects among children and adolescents. Research has found a bidirectional association between alcohol use and mental health conditions where the presence of one issue almost doubles the risk of having the other issue. Implications for public health: The comorbidity between these issues suggests the need for strategies to integrate policies addressing mental health and alcohol use disorders in young people.
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Affiliation(s)
| | - Scott Sims
- Telethon Kids Institute, Western Australia.,School of Population and Global Health, The University of Western Australia
| | - Melissa O'Donnell
- Telethon Kids Institute, Western Australia.,Centre for Child Health Research, The University of Western Australia
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46
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van Gelder N, Peterman A, Potts A, O'Donnell M, Thompson K, Shah N, Oertelt-Prigione S. COVID-19: Reducing the risk of infection might increase the risk of intimate partner violence. EClinicalMedicine 2020; 21:100348. [PMID: 32292900 PMCID: PMC7151425 DOI: 10.1016/j.eclinm.2020.100348] [Citation(s) in RCA: 208] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/02/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- N. van Gelder
- Department of Primary and Community Care, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, Geert Grooteplein 21 (route 117), 6500HB Nijmegen, the Netherlands
| | - A. Peterman
- Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Social and Economic Policy Unit, UNICEF Office of Research—Innocenti, Florence, Italy
| | - A. Potts
- The Global Women's Institute at the George Washington University, Washington, DC, USA
| | - M. O'Donnell
- Center for Global Development, Washington, DC, USA
| | | | - N. Shah
- United States Agency for International Development, Washington, DC, USA
| | - S. Oertelt-Prigione
- Department of Primary and Community Care, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, Geert Grooteplein 21 (route 117), 6500HB Nijmegen, the Netherlands
- Institute of Legal and Forensic Medicine, Charité – Universitätsmedizin, Berlin, Germany
- Corresponding author at: Department of Primary and Community Care, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, Geert Grooteplein 21 (route 117), 6500HB Nijmegen, the Netherlands.
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47
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Hamilton S, Reibel T, Maslen S, Watkins R, Jacinta F, Passmore H, Mutch R, O'Donnell M, Braithwaite V, Bower C. Disability "In-Justice": The Benefits and Challenges of "Yarning" With Young People Undergoing Diagnostic Assessment for Fetal Alcohol Spectrum Disorder in a Youth Detention Center. Qual Health Res 2020; 30:314-327. [PMID: 31691628 DOI: 10.1177/1049732319882910] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Undertaking research with young people presents an array of methodological challenges. We report the findings from a qualitative study that took place alongside a fetal alcohol spectrum disorder (FASD) prevalence study among detainees in Australia. Of 38 participants, 27 were Aboriginal youth. Interviews were conducted using "social yarning" and "research topic yarning," an Indigenous research method which allows for data collection in an exploratory, culturally safe way. A complex interplay emerged between social yarning and research topic yarning which provided a space to explore responsively with participants their experiences of FASD assessments. Flexibility, including language adaptation and visual descriptions about assessments, was utilized to assist participants recall and retell their experiences. There were, however, challenges in gathering data on the assessment experiences of some participants. We describe how employing a "yarning" method for collecting data could benefit children and young people undergoing neurodevelopmental assessments in the future.
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Affiliation(s)
| | - Tracy Reibel
- Telethon Kids Institute, West Perth, Western Australia, Australia
| | - Sarah Maslen
- University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Rochelle Watkins
- Telethon Kids Institute, West Perth, Western Australia, Australia
| | - Freeman Jacinta
- Telethon Kids Institute, West Perth, Western Australia, Australia
| | - Hayley Passmore
- Telethon Kids Institute, West Perth, Western Australia, Australia
| | - Raewyn Mutch
- Telethon Kids Institute, West Perth, Western Australia, Australia
| | | | - Valerie Braithwaite
- Australian National University College of Asia and the Pacific, Canberra, Australian Capital Territory, Australia
| | - Carol Bower
- Telethon Kids Institute, West Perth, Western Australia, Australia
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48
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Abstract
It is generally accepted that persons infected with human immunodeficiency virus (HIV) are at an increased risk of infection due to direct destruction of CD4+ lymphocytes and subsequently impaired cell-mediated immunity. Typically, HIV infection is associated with immunoglobulin elevations, but quantitative deficiencies in immunoglobulins have also been rarely described. We present an unusual case of common variable immunodeficiency (CVID) in a HIV-positive patient with recurrent severe respiratory infections. We review epidemiology, clinical presentation, and treatment of primary immunoglobulin deficiency. We also review the relationship between immunoglobulin deficiency and HIV and highlight the importance of recognizing the coexistence of two distinct immunodeficiency syndromes.
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Affiliation(s)
- D Gollapudi
- Division of General Internal Medicine, Harborview Medical Center, University of Washington, Seattle, WA, 98104, USA
| | - M O'Donnell
- Department of Medicine, Oregon Health & Science University, Portland, OR, 97239, USA.
| | - M NeSmith
- Division of Gastroenterology, Department of Medicine, Oregon Health & Science University, Portland, OR, 97239, USA
| | - K Kent
- Division of Hospital and Specialty Medicine, VA Portland Health Care System, Oregon Health & Science University, Portland, OR, 97239, USA
| | - A J Hunter
- Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, 97239-2997, USA
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49
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Fairthorne J, Bourke J, O'Donnell M, Wong K, de Klerk N, Llewellyn G, Leonard H. Pregnancy and birth outcomes of mothers with intellectual disability and their infants: Advocacy needed to improve well-being. Disabil Health J 2019; 13:100871. [PMID: 31806497 DOI: 10.1016/j.dhjo.2019.100871] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/04/2019] [Accepted: 11/11/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pregnancy in women with intellectual disability (ID) is increasingly recognised, along with their increased likelihood of experiencing risk factors for adverse pregnancy and infant outcomes. OBJECTIVES We aimed to compare risks of socio-demographic, pregnancy and infant outcomes of women with ID to other women. METHODS All mothers with children born in Western Australia from 1983 to 2012 were linked to the population-based Intellectual Disability Exploring Answers database. Mothers with ID were matched by age and Aboriginality to a population sample of mothers without ID. Pregnancy and birth outcomes were compared for both groups and logistic regression was used to compare outcome risks. RESULTS Compared to non-Aboriginal mothers without ID, non-Aboriginal mothers with ID were more likely to be of low socio-economic status, be without partner, smoke antenatally and have pre-existing asthma. They had a 1.5 times increased risk of pregnancy complications, specifically pre-eclampsia, urinary tract infection, threatened preterm labour and post-partum haemorrhage. After adjustment for maternal medical conditions and pregnancy complications, infants of Aboriginal mothers with ID had twice the risk of preterm birth and 1.6 times the risk of having percentage of optimal head circumference <95% compared to infants of Aboriginal mothers without ID. Infants of both Aboriginal and non-Aboriginal mothers with ID were more likely to have percentage of optimal birth weight <85% compared to those without ID. CONCLUSIONS For mothers with ID, modifiable risk factors for adverse outcomes need addressing. They may require additional assistance during pregnancy, including more frequent consultations and support to assist with pregnancy management.
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Affiliation(s)
- Jenny Fairthorne
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Jenny Bourke
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Melissa O'Donnell
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Kingsley Wong
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Nick de Klerk
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | | | - Helen Leonard
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
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50
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Balogh R, Leonard H, Bourke J, Brameld K, Downs J, Hansen M, Glasson E, Lin E, Lloyd M, Lunsky Y, O'Donnell M, Shooshtari S, Wong K, Krahn G. Data Linkage: Canadian and Australian Perspectives on a Valuable Methodology for Intellectual and Developmental Disability Research. Intellect Dev Disabil 2019; 57:439-462. [PMID: 31568733 DOI: 10.1352/1934-9556-57.5.439] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Data linkage holds great promise for generating new information about people with intellectual and developmental disabilities (IDD) as a population, yet few centers have developed the infrastructure to utilize this methodology. Two examples, from Canada and Australia, describe their efforts in building data linkage capabilities, and how linked databases can be used to identify persons with IDD and used for population-based research. The value of data linkage is illustrated through new estimates of prevalence of IDD; health service utilization patterns; associations with sociodemographic characteristics, and with physical and mental health conditions (e.g., chronic diseases, injury, fertility, and depression); and findings on equity in medical treatments. Examples are provided of findings used for governmental policy and program planning.
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Affiliation(s)
- Robert Balogh
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Helen Leonard
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Jenny Bourke
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Kate Brameld
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Jenny Downs
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Michele Hansen
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Emma Glasson
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Elizabeth Lin
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Meghann Lloyd
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Yona Lunsky
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Melissa O'Donnell
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Shahin Shooshtari
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Kingsley Wong
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Gloria Krahn
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
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