Paediatrics (RCH) - Research Publications
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ItemNo Preview AvailableBetter together: Advancing life course research through multi-cohort analytic approaches(ELSEVIER SCI LTD, 2022-09)Longitudinal cohorts can provide timely and cost-efficient evidence about the best points of health service and preventive interventions over the life course. Working systematically across cohorts has the potential to further exploit these valuable data assets, such as by improving the precision of estimates, enhancing (or appropriately reducing) confidence in the replicability of findings, and investigating interrelated questions within a broader theoretical model. In this conceptual review, we explore the opportunities and challenges presented by multi-cohort approaches in life course research. Specifically, we: 1) describe key motivations for multi-cohort work and the analytic approaches that are commonly used in each case; 2) flag some of the scientific and pragmatic challenges that arise when adopting these approaches; and 3) outline emerging directions for multi-cohort work in life course research. Harnessing their potential while thoughtfully considering limitations of multi-cohort approaches can contribute to the robust and granular evidence base needed to promote health and wellbeing over the life span.
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ItemThe effect of adverse and positive experiences on inflammatory markers in Australian and UK children(ELSEVIER, 2022-12)BACKGROUND: The relationship between childhood adversity and inflammation is well-established. Examination of positive experiences can provide a more complete understanding of intervention opportunities. We investigated associations of adverse and positive experiences, and their intersection, with inflammation in children and adolescents. METHODS: Data sources: Longitudinal Study of Australian Children (LSAC; N = 1237) and Avon Longitudinal Study of Parents and Children (ALSPAC; N = 3488). Exposures: Adverse and positive experiences assessed repeatedly (LSAC: 0-11 years; ALSPAC: 0-15 years). Outcomes: Inflammation quantified by high sensitivity C-reactive protein (hsCRP) and glycoprotein acetyls (GlycA) (LSAC: 11-12 years; ALSPAC: 15.5 years). Analyses: Linear regression on the log-transformed outcomes estimated the relative difference in inflammatory markers with adverse/positive experiences, adjusting for socio-demographics and concurrent positive/adverse experiences, respectively. RESULTS: Most associations were in the expected direction but differed in magnitude by exposure, outcome and cohort. Across both cohorts, adverse experiences were associated with up to 7.3% higher hsCRP (95% CI: -18.6%, 33.2%) and up to 2.0% higher GlycA (95% CI: 0.5%, 3.5%); while positive experiences were associated with up to 22.1% lower hsCRP (95% CI: -49.0%, 4.7%) and 1.3% lower GlycA (95% CI: -2.7%, 0.2%). In LSAC, the beneficial effect of positive experiences on inflammation was more pronounced among those with fewer concurrent adverse experiences. CONCLUSION: Across two cohorts, we found small but directionally consistent associations between adverse experiences and higher inflammation, and positive experiences and lower inflammation, particularly for GlycA. Future research should give further consideration to positive experiences to complement the current focus on adversity and inform the design and evaluation of early life interventions.
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ItemData Resource Profile: Melbourne Children's LifeCourse initiative (LifeCourse)(OXFORD UNIV PRESS, 2022-10-13)
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ItemNo Preview AvailableLeveraging Research to Drive More Equitable Reading Outcomes: An Update(Elsevier, 2022-04-09)Home reading and preschool interventions can reduce socioeconomic inequities in children's reading skills and future health morbidity, but they are insufficient alone. There are opportunities to design and evaluate multilevel interventions needed to help drive systems towards equity in reading.
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ItemInequalities in the distribution of COVID-19-related financial difficulties for Australian families with young children(WILEY, 2022-11)BACKGROUND: We examine (1) the frequency of financial difficulties in Australian families with young children (0-8 years) in the early and later phases of the pandemic; (2) the extent to which parents' pre-pandemic socio-economic disadvantage (SED) predicted financial difficulties; and (3) whether grandparent intergenerational SED further amplified this risk. METHOD: Data: Australian Temperament Project (ATP; established 1983, N = 2443) and ATP Generation 3 study (ATPG3; established 2012; N = 702), of which 74% (N = 553) completed a COVID-specific module in the early (May-September 2020) and/or later (October-December 2021) phases of the pandemic. OUTCOMES: Parent-reported loss of employment/reduced income, difficulty paying for essentials, and financial strain. EXPOSURES: Pre-pandemic parent and grandparent education and occupation. ANALYSIS: Logistic regressions, estimated via generalized estimating equations, were used to examine associations between the pre-pandemic SED of parents and grandparents and their interaction with financial difficulties, adjusting for potential confounders. RESULTS: At both pandemic time points, a third of parents reported adverse financial impacts (early: 34%, 95% confidence interval [CI] = 30-38; later: 32%, 95% CI = 28-36). Each standard deviation increase in the parents' pre-pandemic SED was associated with a 36% increase in the odds of reporting multiple financial difficulties (odds ratio [OR] = 1.36, 95% CI = 1.04-1.78). There was little evidence of an interaction between the SED of parents and grandparents. CONCLUSIONS: Financial impacts related to the COVID-19 pandemic were common and, irrespective of grandparent SED, disproportionately borne by parents with higher pre-pandemic SED. Given the well-established relationship between disadvantage and child health and development, sustained and well-targeted government supports will be critical to minimizing adverse impacts in years to come.
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ItemNatural history of mental health competence from childhood to adolescence(BMJ PUBLISHING GROUP, 2022-02)BACKGROUND: Mental health competence (MHC) involves psychosocial capabilities such as regulating emotions, interacting well with peers and caring for others, and predicts a range of health and social outcomes. This study examines the course of MHC from childhood to adolescence and patterning by gender and disadvantage, in Australian and UK contexts. METHODS: Data: Longitudinal Study of Australian Children (n=4983) and the Millennium Cohort Study (n=18 296). Measures: A measure capturing key aspects of MHC was derived summing items from the parent-reported Strengths and Difficulties Questionnaire, assessed at 4-5 years, 6-7 years, 10-11 years and 14-15 years. Analysis: Proportions of children with high MHC (scores ≥23 of range 8-24) were estimated by age and country. Random-effects models were used to define MHC trajectories according to baseline MHC and change over time. Sociodemographic patterns were described. RESULTS: The prevalence of high MHC steadily increased from 4 years to 15 years (from 13.6% to 15.8% and 20.6% to 26.2% in Australia and the UK, respectively). Examination of trajectories revealed that pathways of some children diverge from this normative MHC progression. For example, 7% and 9% of children in Australia and the UK, respectively, had a low starting point and decreased further in MHC by mid-adolescence. At all ages, and over time, MHC was lower for boys compared with girls and for children from disadvantaged compared with advantaged family backgrounds. CONCLUSIONS: Approaches to promoting MHC require a sustained focus from the early years through to adolescence, with more intensive approaches likely needed to support disadvantaged groups and boys.
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ItemNo Preview AvailableInequities in Children's Reading Skills: The Role of Home Reading and Preschool Attendance.(Elsevier Masson, 2021-08)Objective Children from socioeconomically disadvantaged backgrounds have poorer learning outcomes. These inequities are a significant public health issue, tracking forward to adverse health outcomes in adulthood. We examined the potential to reduce socioeconomic gaps in children's reading skills through increasing home reading and preschool attendance among disadvantaged children. Methods We drew on data from the nationally representative birth cohort of the Longitudinal Study of Australian Children (N = 5107) to examine the impact of socioeconomic disadvantage (0-1 year) on children's reading skills (8-9 years). An interventional effects approach was applied to estimate the extent to which improving the levels of home reading (2-5 years) and preschool attendance (4-5 years) of socioeconomically disadvantaged children to be commensurate with their advantaged peers, could potentially reduce socioeconomic gaps in children's reading skills. Results Socioeconomically disadvantaged children had a higher risk of poor reading outcomes compared to more advantaged peers: absolute risk difference = 20.1% (95% confidence interval [CI]: 16.0%-24.2%). Results suggest that improving disadvantaged children's home reading and preschool attendance to the level of their advantaged peers could eliminate 6.5% and 2.1% of socioeconomic gaps in reading skills, respectively. However, large socioeconomic gaps would remain, with disadvantaged children maintaining an 18.3% (95% CI: 14.0%-22.7%) higher risk of poor reading outcomes in absolute terms.
Conclusion
There are clear socioeconomic disparities in children's reading skills by late childhood. Findings suggest that interventions that improve home reading and preschool attendance may contribute to reducing these inequities, but alone are unlikely to be sufficient to close the equity gap. -
ItemExposure to adversity and inflammatory outcomes in mid and late childhood(Elsevier BV, 2020-12)Background: We aimed to estimate the association between exposure to adversity and inflammatory markers in mid (4 years) and late (11–12 years) childhood, and whether effects differ by type and timing of exposure. Methods: Data sources: Barwon Infant Study (BIS; N = 510 analyzed) and Longitudinal Study of Australian Children (LSAC; N = 1156 analyzed). Exposures: Adversity indicators assessed from 0 to 4 (BIS) and 0–11 years (LSAC): parent legal problems, mental illness and substance abuse, anger in parenting responses, separation/divorce, unsafe neighborhood, and family member death; a count of adversities; and, in LSAC only, early (0–3), middle (4–7), or later (10–11) initial exposure. Outcomes: Inflammation quantified by high sensitivity C-reactive protein (hsCRP, Log (ug/ml)) and glycoprotein acetyls (GlycA, Log (umol/L)). Analyses: Linear regression was used to estimate relative change in inflammatory markers, adjusted for sociodemographic characteristics, with exposure to adversity. Outcomes were log-transformed. Results: Evidence of an association between adversity and hsCRP was weak and inconsistent (e.g., 3+ versus no adversity: BIS: 12% higher, 95%CI -49.4, 147.8; LSAC 4.6% lower, 95%CI: −36.6, 48.3). A small positive association between adversity and GlycA levels was observed at both 4 years (e.g., 3+ versus no adversity: 3.3% higher, 95%CI -3.0, 9.9) and 11–12 years (3.2% higher, 95%CI 0.8, 5.8). In LSAC, we did not find evidence that inflammatory outcomes differed by initial timing of adversity exposure. Conclusions: Small positive associations between adversity and inflammation were consistently observed for GlycA, across two cohorts with differing ages. Further work is needed to understand mechanisms, clinical relevance, and to identify opportunities for early intervention.
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ItemBetter support for children with additional health and developmental needs in school settings: Perspectives of education experts(WILEY, 2020-07)AIM: Many children start school with additional health and developmental needs (AHDN), yet how best to support these children for optimal outcomes in the school setting is a complex challenge. This study aims to determine the views of education experts on what differentiates the most effective primary schools. METHODS: Qualitative interviews were conducted with nine senior leaders across the education system responsible for managing or improving practice across a range of schools or school regions in Victoria. Using a positive deviance approach, which investigates strategies already implemented in organizations achieving desired outcomes, the semi-structured interviews aimed to elicit instances of perceived good practice that already exists within the school system. Interviews were analysed using inductive content analysis. RESULTS: All education experts reported high variability across schools and suggested a number of factors differentiating those that were most effective at supporting children with AHDN. They included the presence of strong teacher support by the school leadership team; explicit and documented processes to guide the practice of teachers and ensure consistency at a whole school level; inclusive relationships and environments; participation and knowledge sharing between medical, allied health and other stakeholders in the care team; and an evidenced-based approach to allocating resources to programmes and strategies. CONCLUSION: This exploration of instances of good practice can generate novel insights into a complex problem. Current findings suggest a number of potential opportunities for enhancing practice that can be tested in future research. Improving outcomes for this vulnerable and significant group of children will require collaboration across health and education.
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ItemLearning outcomes of children with teacher-identified emerging health and developmental needs.(Wiley, 2020-03-01)OBJECTIVES: Children's additional health and developmental needs are often first identified by teachers when they begin school. This study estimates the Grade 3 literacy and numeracy outcomes of children with teacher-identified additional needs emerging in the first year of school, including the added burden conferred by socioeconomic disadvantage. METHODS: Population linked data (N=42,619) was analysed from the Australian Early Development Census, which includes teacher reports on children's health and development at school entry, and the National Assessment Program - Literacy and Numeracy, a direct assessment of reading and numeracy skills at Grade 3. Linear regression analyses were used to estimate associations between emerging needs and learning outcomes, adjusted for sociodemographic characteristics. The combined effect of emerging needs and low maternal education (an indicator of socioeconomic disadvantage) on academic outcomes was examined by estimating the relative excess risk due to interaction (RERI). RESULTS: Emerging health and developmental needs at school entry was associated with lower reading (b=-26.86, 95%CI=-29.19, -24.52) and numeracy (b=-24.39, 95%CI=-26.43, -22.35) outcomes at Grade 3. The combined effect of emerging needs and socioeconomic disadvantage was greater than expected when their individual effects are summed (RERI=0.38, 95%CI 0.22, 0.55 for reading and RERI=0.27, 95%CI 0.10, 0.43 for numeracy). CONCLUSION: In the current study, emerging health and developmental needs identified by teachers at the outset of schooling was associated with poorer literacy and numeracy skills at Grade 3, and family socioeconomic disadvantage appeared to further amplify this effect. Meeting the needs of these children will require timely and coordinated supports across the health and education systems, particularly for those children who are also disadvantaged.