Suchergebnisse

ABSTRACT
ObjectivesA key target to reduce the gap in early childhood outcomes between Australian Aboriginal and non-Aboriginal children has been to increase preschool enrolment rates, particularly in remote communities. However, there is little population-based information on preschool attendance and its impact on child development for Aboriginal children specifically. This study aims to examine: (i) the characteristics of children, families and areas associated with preschool attendance; and (ii) the association between preschool attendance and childhood development in the first year of school for Aboriginal and non-Aboriginal children in Australia's most populous state, New South Wales (NSW).
ApproachRoutinely-collected birth registration, perinatal, health and education data were used to create a linked dataset consisting of an almost complete population of children known as the 'Seeding Success' cohort. These children were born in NSW and had an Australian Early Development Census (AEDC) checklist completed by their teacher in their first year of school in NSW in 2009 and 2012 (n=154,936). Multilevel Poisson regression modelling was used to determine child-, family- and area-level characteristics associated with preschool attendance in the year before starting school. The association between preschool attendance and childhood development in the first year of school, as measured across five AEDC developmental domains, was also examined.
Results71% of Aboriginal children attended preschool in the year before school (95% CI: 70% to 72%) compared with 76% of non-Aboriginal children (95% CI: 76% to 77%). The prevalence of preschool attendance was lower in major cities compared with regional and remote areas, with 65% of Aboriginal children attending preschool in major cities compared with 73% in outer regional and 79% in remote areas. Factors associated with preschool attendance in the year before starting school included being non-Aboriginal, speaking English as a first language, having a mother with a partner, having fewer older siblings, living in a more remote area and living in a less socioeconomically disadvantaged area. After adjusting for potentially confounding factors, Aboriginal children who attended preschool were more likely to be developmentally 'on track' compared with Aboriginal children who did not attend preschool, in four of the five AEDC domains.
ConclusionThe barriers to preschool attendance for Aboriginal children living in major cities should be further explored. Targeted support for families and areas where preschool attendance is lower is likely required to ensure children have access to the apparent benefits of preschool education.

Osteoporotic fractures impose substantial morbidity and mortality among older adults. Undertreatment is an ongoing concern; treatment rates declined following reports of adverse effects of guideline-recommended bisphosphonates, but new antiresorptives have since become available. Our goal was to identify contemporary trends in osteoporosis treatment guideline adherence in a high fracture-risk population. We conducted a secondary data analysis using electronic health record data of adults aged ⩾65 years from 68 residential aged care facilities in Australia during 2014-2017 (n = 9094). Using medication administration data, we identified antiresorptive (bisphosphonates and denosumab) and vitamin D supplement use among residents with osteoporosis. Regression was used to evaluate temporal trends, and resident and facility characteristics associated with antiresorptive use and vitamin D use. In 2014, 34% of women and 42% of men with osteoporosis used antiresorptives; this decreased 8 percentage points by 2017. Antiresorptive use was higher among those with a history of fracture and lower in the last year of life. Denosumab use increased but did not substitute for the continued decline in bisphosphonate use. Vitamin D was consistently used by more than 60% of residents and was higher among those with fracture history. Greater attention to the treatment of osteoporosis treatment rates among this high fracture-risk population is warranted.

ABSTRACT
ObjectivesAlmost one-fifth of Australian Aboriginal mothers give birth before 20 years of age compared with 3% of non-Aboriginal mothers. We aim to quantify the effect of maternal age at birth on child development outcomes in Aboriginal compared with non-Aboriginal children.
ApproachThe 'Seeding Success' study cohort comprises an almost complete population of children who started school in Australia's most populous state, New South Wales (NSW), in 2009 or 2012, and were born in NSW, identified by linking Australian Early Development Census (AEDC) data to perinatal and birth registration datasets. Of the 154,936 children in the cohort, 8001 (5%) were Aboriginal. We calculated the risk of developmental vulnerability on one or more AEDC domains by maternal age at birth and Aboriginality. Risk differences and risk ratios (RR) were estimated as measures of absolute and relative inequalities, respectively. Multilevel Poisson regression was used to test the effect of maternal age on child development by Aboriginality.
Results1383 (17%) Aboriginal children were born to a mother <20 years compared with 4310 (3%) non-Aboriginal children. Among Aboriginal and non-Aboriginal children, the risk of developmental vulnerability decreased with increasing maternal age up to 35 years; the risk increased for children born to mothers >35 years. Among Aboriginal children, the risk decreased from 46% (95%CI, 39-52) to 31% (95%CI, 24-38) in children born to mothers' aged ≤16 years to age 35 years, respectively. In non-Aboriginal children, the risk decreased from 38% (95%CI, 33-43) to 16% (95%CI, 15-17) in those born to mothers' aged ≤16 years to 35 years, respectively. Risk differences and risk ratios for developmental vulnerability between Aboriginal and non-Aboriginal children increased with increasing maternal age. Compared to non-Aboriginal children born to mothers aged ≥20 years (ref group, RR, 1.0), the RR for developmental vulnerability was 1.7 (95% CI, 1.6-1.9) for non-Aboriginal children born to mothers aged <20 years; 1.6 (95% CI, 1.6-1.7) for Aboriginal children born to mothers aged ≥20 years; and 2.2 (95% CI, 2.0-2.3) for Aboriginal children born to mothers aged <20 years.
ConclusionChildren born to very young mothers had a high risk of vulnerability regardless of Aboriginality, whereas Aboriginal children had a greater risk of developmental vulnerability across the rest of the maternal age range. Both absolute and relative inequalities in developmental vulnerability increased with increasing maternal age. Early intervention and support services targeted at Aboriginal mothers and their children, regardless of the mother's age, may reduce this inequality.

AbstractBackgroundAdults with intellectual disability are at higher risk of being administered psychotropic medications. The UK‐developed SPECTROM (Short‐term PsychoEducation for Carers To Reduce Over Medication of people with intellectual disabilities) training programme educates disability support workers on psychotropic medications and alternatives to these medications.MethodInterviews were conducted with 10 participants who took part in the pilot SPECTROM training programme to elicit their views on the programme and its appropriateness in an Australian context.ResultsThe key theme was 'Need for a psychotropic medication practice framework'. Four sub‐themes were Broad satisfaction with the SPECTROM training programme; Disability support workers acknowledging the limitations of their scope of practice; Empowering training through prescriptive and reflective methods and; Need for future mentoring from Multi‐Disciplinary Team members in the application of new knowledge.ConclusionsParticipants felt that whilst they could improve their knowledge and attitudes surrounding psychotropic medication administration for behaviours of concern through SPECTROM training, a national practice framework is needed to execute its goals at scale.