Exploring the experience of service users following attendance at a student-led interprofessional neurodevelopmental clinic

PURPOSE

The aim of the current study was to understand service users' experiences at a recently established student-led interprofessional neurodevelopmental clinic for children and adolescents with suspected or confirmed prenatal alcohol exposure.

METHOD

Semi-structured interviews were completed at 3-months post-clinic attendance with 10 service users: eight parents/caregivers and two youth workers/case managers. Interview data were analysed thematically using NVivo12.

RESULTS

Four main themes were developed: (1) clinic attendance seen as a positive event; (2) validation, clarification, and relief, but also challenges post-assessment; (3) need for further support and importance of advocacy; and (4) drawing on lived experiences for future service improvements.

CONCLUSIONS

The current study demonstrated that service users reported benefits from tailored services delivered by student practitioners that were validating, supportive, and holistic. Findings from the current study can inform the development and implementation of future innovative service delivery models for individuals with suspected or confirmed prenatal alcohol exposure.

The congenital hearing phenotype in GJB2 in Queensland, Australia: V37I and mild hearing loss predominates

GJB2 was originally identified in severe, non-syndromic sensorineural hearing loss (SNHL), but was subsequently associated with mild and moderate SNHL. Given the increasing utilisation of genetic testing pre-conceptually, prenatally, and neonatally, it is crucial to understand genotype-phenotype correlations. This study evaluated the nature and frequency of GJB2 variants in an Australian paediatric population with varying degrees of SNHL ascertained through newborn hearing screening. Audiograms from individuals with GJB2 variants and/or a GJB6 deletion (GJB6-D13S11830) were retrospectively reviewed (n = 127). Two-thirds were biallelic (homozygous/compound heterozygous) for pathogenic/likely pathogenic variants of GJB2 and/or GJB6 (n = 80). The most frequent variant was c.109 G > A, followed by c.35delG and c.101 T > C. Compared to biallelic carriage of other GJB2 variants, c.109 G > A positive individuals (homozygous/compound heterozygous) were more likely to have mild HL at their initial and latest audiograms (p = 0.0004). Biallelic carriage of c.35delG was associated with moderately-severe or greater SNHL at both initial and latest audiograms (p = 0.007). The c.101 T > C variant presented with milder SNHL and U-shaped audiograms (p = 0.02). In this agnostically identified cohort, mild SNHL predominated in GJB2/GJB6 carriers in contrast to previous studies targeting individuals with significant loss. Consequently, c.109 G > A, associated with milder phenotypes, was the most frequent. This study provides valuable data to support prognostic confidence in genetic counselling.

Altered bone and body composition in children and adolescents with confirmed prenatal alcohol exposure

Prenatal alcohol exposure can contribute to long term adverse health outcomes. Development of the skeletal system begins at the early embryonic stage and continues into early adulthood but the effect of prenatal alcohol exposure on skeletal growth is relatively unexplored in a clinical population. Here, we performed dual X-ray absorptiometry to examine bone, fat, and muscle accrual in children and adolescents diagnosed with, or at risk of, fetal alcohol spectrum disorders (FASDs). Children (aged 4-9 years) with FASD or at risk of FASD (n = 10) had similar growth to age matched controls (n = 27). By adolescence (aged ≥10 years), those with FASDs (n = 13) were shorter and had lower areal bone mineral density and lean tissue mass than typically developing peers (n = 29). Overall, adolescents diagnosed with FASDs had greater odds of impairments to bone and body composition. These findings highlight the importance of early FASD diagnosis and appropriate post-diagnostic medical follow-up to enable timely, effective interventions to optimize bone and body composition during paediatric growth.

Aetiology of permanent childhood hearing loss at a population level

AIM

To evaluate and describe results of aetiological investigations offered to a population level cohort of babies who had confirmed permanent hearing loss after they either (i) failed universal neonatal hearing screening or (ii) passed newborn screening but were detected with a permanent hearing loss in early childhood.

METHODS

Descriptive analysis of results of investigations offered to neonates and young children in whom permanent hearing loss was detected as part of a statewide newborn hearing screening programme. A total of 306 285 newborns were screened between 2013 and 2017. The failed screening results were confirmed by a diagnostic audiological assessment battery. Medical evaluation for the identification of the cause of the hearing loss was performed by a paediatrician or otolaryngologist, investigations were ordered using a stepwise approach, and aetiology was assigned using a coding scheme.

RESULTS

Permanent hearing loss was confirmed in 967 children (0.3%). Data were available for 873. An aetiological factor was identified or presumed in 61.3% of cases. Genetic causes were present in 26.8% and structural causes were present in 24.9% of cases. Congenital cytomegalovirus was present in 4.4%.

CONCLUSIONS

Use of a coding scheme is feasible at a population level and allows collation of data from multiple sites and will allow outcome mapping and service planning.

Recognition of attachment difficulties and developmental trauma is the responsibility of all paediatricians

This article provides an overview of attachment theory, developmental trauma and trauma-informed care for paediatricians. The impact of difficult or impoverished parent-child relationships on brain development and long-term health is now well known. Recent neuroscience research reveals the adverse neurological impacts of developmental trauma and supports the biological basis of attachment theory. There is also an increasing body of evidence that childhood adversity is common and impacts physical and mental health throughout the life-span. Comprehensive paediatric assessment should include an understanding of attachment difficulties and developmental trauma. Viewing children and their families through a 'trauma-informed lens' can provide critical insights into their clinical presentation and care needs. All paediatricians should be providing and practicing trauma-informed care.

Predictors of specialist referral for developmental and behavioural problems in a Queensland urban Aboriginal and Torres Strait Islander community: a cross-sectional study

BACKGROUND

The prevalence of developmental and/or behavioural problems is greater among Aboriginal and Torres Strait Islander children, compared with their non-Indigenous counterparts. We aimed to identify predictors of specialist paediatric referral for these problems that could enable primary health professionals to identify at-risk children and implement early interventions.

METHODS

A cross-sectional study of urban Aboriginal and Torres Strait Islander children aged 0-14 years having annual child health checks from September 2010 to February 2012 was undertaken. Predictors of paediatric referral were identified using univariable and multivariable analyses.

RESULTS

Of the 183 eligible children, 30% were referred to a paediatrician. Parental/carer mental illness was self-reported in 36% of cases and these children were more likely to be referred (OR = 3.07; 95% 
CI: 1.44, 6.57).

DISCUSSION

The strong association between paediatric referral for behavioural and/or developmental problems and self-reported parental/carer mental illness highlights the intergenerational nature of health and social disadvantage.

Comparison of body mass index and triceps skinfold at 5 years and young adult body mass index, waist circumference and blood pressure

AIM

To examine which measure of obesity at 5 years, body mass index (BMI) or triceps skinfold thickness, is most strongly associated with 21-year risk factors for cardiovascular disease (CVD), including BMI, waist circumference (WC), systolic blood pressure (SBP) and diastolic blood pressure (DBP).

METHODS

Longitudinal birth cohort study with BMI and triceps skinfold measurements at age 5, and BMI, WC and blood pressure at 21 years. Overweight and obesity at 5 years were determined according to Cole-International Obesity Task Force standards, at 21, by World Health Organization definitions. Triceps skinfold thickness measurements were converted to a z-score, and cut-offs for overweight and obesity were chosen to reflect similar proportions to the BMI subgroups. BMI, WC, SBP and DBP were also measured at 21 years.

RESULTS

Five-year BMI and triceps skinfold thickness were both significantly associated with the CVD risk measures at 21 years. For overweight/obesity at 5 years, the adjusted odds ratio (95% confidence interval) for 21-year overweight/obesity was 5.6 (4.2, 7.4), for 21-year WC was 1.5 (1.2, 2.0). Mean difference (95% CI) in BMI was 4.4 (3.9, 5.0), in WC 8.3 cm (6.8, 9.8), in SBP 2.4 mm Hg (0.5, 4.3), in DBP 1.1 mm Hg (0.1, 2.2). For skinfold, the similar findings were odds ratio 2.6 (2.0, 3.4) and 1.2 (0.9, 1.6) for 21-year BMI and WC, and mean differences of 2.6 (2.0, 3.2), WC 4.8 cm (3.3, 6.3), SBP 2.3 mm Hg (0.5, 4.2) and DBP 0.7 mm Hg (-0.4, 1.8).

CONCLUSIONS

In children with overweight/obesity, BMI rather than triceps skinfold is the preferred epidemiological measure for identifying young adult CVD risk markers of BMI, WC and blood pressure.

Implementing the picture exchange communication system (PECS)

PECS was developed in Delaware, USA over 10 years ago by Bondy and Frost (1994a). Over the last two years PECS has been introduced to this country and has raised a great deal of interest in people working in the field of autistic spectrum disorders (ASD). This paper will address some of the issues that arose during the establishment of PECS in one special school. Changes seen in 21 children with severe learning difficulties who have been taught to use PECS are reported and the use of PECS with children who do not have an ASD is discussed.

Totally implantable venous access devices in cystic fibrosis: complications and patients' opinions

The introduction of totally implantable venous access devices (TIVAD) has provided a solution to difficult venous access in patients with cystic fibrosis. Early reports have, however, recognized a number of complications with their use. We report our experience with five devices used over 8 yrs with regard to complications and patient attitudes. Patients' notes were reviewed to record the details of TIVAD insertion, duration of function, and complications. In January 1996 the surviving 30 patients were surveyed on their attitudes to TIVAD and complications by written questionnaire. Sixty one ports were implanted in 42 patients (aged 16-47 yrs) between June 1988 and January 1996, giving a total of 1,510 patient-months' experience. The duration of function ranged from 2 weeks to 6 yrs. Survival analysis showed that the median survival of ports was 53 months, 42 out of 61 (69%) had not failed in service at the end of follow-up or patient death. Twenty-three complications occurred in 19 patients. These included: line occlusion (10 patients), venous thrombosis (4), difficult access (3), infection (2), cellulitis (1), inversion of port chamber (2) and pneumothorax (1). The questionnaire showed that patients had strong views on the positioning of their port. Lifestyle issues included interference with seatbelts (8 patients), sport (4), clothing (2), sexual relations (2) and cosmetic appearance (15). Complication rates were similar to those in other studies, although infection rates and salvage of an occluded port were lower. The survey highlighted a number of lifestyle issues, with cosmetic appearance deemed unsatisfactory by half of the patients. However, the majority (28 out of 30) believed their totally implantable venous access devices to be a better alternative to cannulae or long lines.

Making sense of percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy (PEG) is increasingly becoming the method of choice for patients requiring long term enternal nutrition (for example, those suffering from cystic fibrosis, or neuromuscular disorders). This paper explains the technique and care associated with PEG insertion.

Recovery of Salmonella species from nonfat dry milk rehydrated under rapid and reduced pre-enrichment conditions: collaborative study

A collaborative study was conducted to compare the relative efficiency of the AOAC rapid rehydration method with the reduced rehydration soak method for the recovery of Salmonella species from nonfat dry milk (NFDM). In the AOAC method, a 25 g sample of NFDM is rapidly rehydrated at a 1:9 sample/water ratio and mixed by swirling. After 60 min, the flask contents are adjusted to a pH of 6.8, and 0.45 mL of 1% aqueous brilliant green dye solution is added. The flasks are then incubated at 35 degrees C. In the soak method, a 25 g sample of NFDM is gently added to the sterile brilliant green (BG) water at a 1:9 sample/BG water ratio and allowed to soak undisturbed for 60 min at room temperature before incubation. Twelve collaborators analyzed 3 shipments of samples with the following results for the AOAC and soak methods: shipment 1-31 and 46 positive samples, respectively, with a 48% increase in detection by the soak method; shipment 3-45 and 66 positive samples, respectively, with a 47% increase in detection by the soak method; shipment 2--no significant difference in recovery of Salmonella species by the 2 methods. It is recommended that the official final action method for the detection of Salmonella species, 46.054-46.067, be revised to use the soak method for the analysis of nonfat dry milk.

Recovery of Salmonella Species from Nonfat Dry Milk Rehydrated Under Rapid and Reduced Pre-enrichment Conditions: Collaborative Study

A collaborative study was conducted to compare the relative efficiency of the AOAC rapid rehydration method with the reduced rehydration soak method for the recovery of Salmonella species from nonfat dry milk (NFDM). In the AOAC method, a 25 g sample of NFDM is rapidly rehydrated at a 1:9 sample/water ratio and mixed by swirling. After 60 min, the flask contents are adjusted to a pH of 6.8, and 0.45 mL of 1% aqueous brilliant green dye solution is added. The flasks are then incubated at 35°C. In the soak method, a 25 g sample of NFDM is gently added to the sterile brilliant green (BG) water at a 1:9 sample/ BG water ratio and allowed to soak undisturbed for 60 min at room temperature before incubation. Twelve collaborators analyzed 3 shipments of samples with the following results for the AOAC and soak methods: shipment 1—31 and 46 positive samples, respectively, with a 48% increase in detection by the soak method; shipment 3-45 and 66 positive samples, respectively, with a 47% increase in detection by the soak method; shipment 2—no significant difference in recovery of Salmonella species by the 2 methods. It is recommended that the official final action method for the detection of Salmonella species, 46.054- 46.067, be revised to use the soak method for the analysis of nonfat dry milk.