Paediatrics (RCH) - Research Publications
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ItemNo Preview AvailableIntervention targets for reducing mortality between mid-adolescence and mid-adulthood: a protocol for a machine-learning facilitated systematic umbrella review(BMJ PUBLISHING GROUP, 2023-10)INTRODUCTION: A rise in premature mortality-defined here as death during the most productive years of life, between adolescence and middle adulthood (15-60 years)-is contributing to stalling life expectancy in high-income countries. Causes of mortality vary, but often include substance misuse, suicide, unintentional injury and non-communicable disease. The development of evidence-informed policy frameworks to guide new approaches to prevention require knowledge of early targets for intervention, and interactions between higher level drivers. Here, we aim to: (1) identify systematic reviews with or without meta-analyses focused on intervention targets for premature mortality (in which intervention targets are causes of mortality that can, at least hypothetically, be modified to reduce risk); (2) evaluate the review quality and risk of bias; (3) compare and evaluate each review's, and their relevant primary studies, findings to identify existing evidence gaps. METHODS AND ANALYSIS: In May 2023, we searched electronic databases (MEDLINE, PubMed, Embase, Cochrane Library) for peer-reviewed papers published in the English language in the 12 years from 2012 to 2023 that examined intervention targets for mortality. Screening will narrow these papers to focus on systematic reviews with or without meta-analyses, and their primary papers. Our outcome is death between ages 15 and 60 years; with potential intervention targets measured prior to death. A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) will be used to assess quality and risk of bias within included systematic reviews. Results will be synthesised narratively due to anticipated heterogeneity between reviews and between primary studies contained within included reviews. ETHICS AND DISSEMINATION: This review will synthesise findings from published systematic reviews and meta-analyses, and their primary reviewed studies, meaning ethics committee approval is not required. Our findings will inform cross-cohort consortium development, be published in a peer-reviewed journal, and be presented at national and international conferences. PROSPERO REGISTRATION NUMBER: CRD42022355861.
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ItemMortality among people who have experienced homelessness: protocol for a systematic review and meta-analysis(BMJ PUBLISHING GROUP, 2023-02)INTRODUCTION: Homelessness is a major contributor to health inequalities. People who experience homelessness are at markedly increased risk of multiple and complex health morbidities which likely increase their susceptibility to early, preventable death. Despite this, the mortality burden in this group remains poorly understood, limited in part by insufficient synthesis of data at a global level. This systematic review will synthesise international literature examining rates of risk and protective factors for mortality among people who have experienced homelessness. METHODS AND ANALYSIS: We will search MEDLINE, PsycINFO, Embase and PubMed for peer-reviewed cohort studies examining mortality among people who have experienced homelessness. No study eligibility restrictions will be placed on the date, country of origin, or language of publications, or age of the sample. We will assess the quality of included studies using the Methodological Standards for Epidemiological Research scale. Our measures of mortality will include: (A) incidence-all cause and cause specific, expressed as a crude mortality rate (CMR) per 1000 person-years, with 95% CI and (B) all cause and cause specific, indirectly standardised mortality ratios (SMRs) with 95%CI. Associations between risk and protective factors and all-cause and cause-specific mortality will be reported using pooled relative risk ratios with 95% CI. Where there are sufficient data, the influence of subgroup and methodological factors on CMRs, SMRs and predictive factors will be examined using meta-regression. ETHICS AND DISSEMINATION: This study does not require institutional ethics review or approval as it will synthesise findings from published studies that have previously been granted relevant ethics approvals. Study findings will be disseminated through a peer-reviewed journal article, conference and seminar presentations. A plain language summary will be distributed through the authors' academic and professional networks. PROSPERO REGISTRATION NUMBER: CRD42021272937.
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ItemAdolescent and young adult homelessness during the COVID-19 pandemic: Reflections and opportunities for multi-sectoral responses(Council to Homeless Persons, 2020)The COVID-19 pandemic has intensified national attention to homelessness over the course of 2020 because of concern about the spread of the novel coronavirus amongst homeless persons. It has also produced compelling reasons to look more closely at the long-neglected area of homelessness policy, and created opportunities to reverse years of inattention. Homelessness disproportionately affects adolescents and young adults, with rates rising before the pandemic. Recent homelessness funding increases and housing policy responses have also addressed health and social needs, and are continuing for the time being, however the risk of the virus is likely to remain for some time. Although Victoria has now successfully suppressed a second wave of infection in the community, the risk of a third wave is ever-present. As temporary homelessness funding and housing policy responses are scaled back, we may see a delayed ‘wave’ of adolescent and young adult homelessness, compounded by the multiple economic and social impacts of the pandemic, and associated state-wide lockdown. Preventing this ‘wave’ requires immediate evidence-based multi-sectoral action.