Inequalities in Early Childhood outcomes: what lies beneath

This article uses the Australian Early Development Index to shine a light on inequity in child health and development. Introduction: Child health inequalities exist in all western countries including Australia and constitute a significant and potentially preventable public health problem. Although the data are limited, in Australia we know the predictors of future health inequities – differential health outcomes that are unjust, unnecessary and unacceptable, and potentially preventable – begin in utero. For example, there are differentially higher rates of maternal smoking and subsequent rates of low birth weights in Aboriginal mothers and those living in poorer and more remote areas. The increasing evidence from developmental health research suggests that inequities emerging in early childhood are maintained into adulthood as higher rates of mortality and physical, social and cognitive morbidity across the social gradient

Building early detection systems for child development problems and normal toddler eating

There is substantial research about the importance of identifying problems early, before they become entrenched. Intervening early in the course of a condition or problem increases the chance of there being a positive outcome; the earlier intervention is commenced, the more likely it is to be effective and less expensive.  Since early childhood is a time of rapid development in many domains (especially cognition, language, and social-emotional development), delay or dysfunction in these domains at this age is a strong predictor of problems at school and beyond. While significant developmental delay and serious health problems are usually detected in the first years of life, more subtle problems, especially of development and behaviour, are often not detected until the child is entering preschool, or until he/she begins school.  -------------------------- Feeding young children a healthy diet can be a challenge. Common problems may emerge later in the second year even in children who ate well previously. The developmental progress of the child will influence eating behaviours, with increasing independence and control played out at the dinner table. A decrease in growth velocity after the first year also means the quantity of food required relative to the child’s body size is reduced. To ensure enjoyable and healthy long term eating patterns, parents of toddlers need to make adjustments for the physical, social and emotional needs of their child. Many toddlers are picky eaters and food often becomes a source of conflict. Some commonly expressed concerns about toddler eating include: Multiple food dislikes, even when they have previously enjoyed a food A refusal to try new foods – \u27food neophobia\u27 A refusal to increase the texture of foods and gagging or lack of chewing. A preference for fluids and minimal solids Eating little at some meals Meal time tantrums  Getting up and down from the table frequently Needing to be bribed or distracted to eat It is uncommon for these behaviours to result in growth faltering or nutritional deficiencies in the short term. The recognition that early development of poor eating habits may progress and impact on the incidence of diet related lifestyle diseases means parents should manage these behaviours in a positive and effective way early on.&nbsp

Sustained home visiting for vulnerable families and children: a literature review of effective programs

Parenting young children has become a more complex and stressful business, especially for those families in our community with the least resources (Grose, 2006; Hayes et al, 2010; Poole, 2004; Richardson & Prior, 2005; Trask, 2010). A widening gap exists between families that function well and those that are vulnerable. The paradox of service delivery for children and families is that vulnerable families – that is, those families with the greatest needs – are also the least likely to be able to access those services (Ghate & Hazel, 2002; Fram, 2003). A range of barriers exist for vulnerable and at risk families in making use of services (Carbone et al, 2004). One of the key barriers to vulnerable families accessing services is that many find it difficult to relate to the formal service system and are easily alienated by practices others find acceptable. Research regarding parents’ experiences of support services suggests that parents want services where they are simultaneously cared for and enabled in their role as parents, and to receive services characterised by empathy, competence, functionality, respect, flexibility and honesty (Attide-Stirling et al, 2001; Winkworth et al, 2009). Vulnerable parents fear a loss of autonomy in their interactions with support services and want services that are non-judgemental and that provide continuity of care (Ghate & Hazel, 2002; von Bultzingslowen, 2006). In addition to the barriers faced by vulnerable and marginalised families in accessing services, the system does not work in an integrated or coherent fashion to ensure that all children and families needing support receive it. Furthermore, the vast majority of services for children and families in Australia do not have an outreach function, that is, a means of engaging these vulnerable and at risk families who are in need of support but use services inconsistently or not at all. In short, the service system was not designed to meet the needs of vulnerable families within the context of a rapidly changing social and economic climate. Therefore, many families requiring support are not receiving it. A research collaboration between the Australian Research Alliance for Children and Youth (ARACY), the Centre for Health Equity Research and Evaluation (CHETRE) and the Centre for Community Child Health (CCCH

Early learning programs that promote children’s developmental and educational outcomes

This resource sheet reviews international and Australian research evidence for the characteristics of early learning programs that are effective in promoting developmental and learning outcomes. The early years of life are the best opportunity to lay the foundations for a child’s future. By getting it right in early childhood, we plant the seeds for tomorrow’s engaged and active student, productive and skilled worker, and confident and loving parent. Investments of time and money in the early years have been shown to be far more cost-effective than investments made at any other time. The skills children develop as infants, toddlers and preschoolers are cumulative and form the basis for later skill development. Early learning contributes to a chain of effects that either reinforces initial achievements or exacerbates initial difficulties. As a result, children enter school with marked differences in the cognitive, emotional, attention-related, self-regulatory, learning and social skills needed for success in the school environment, and these differences are predictive of later academic success. Progress during the school years depends partly on early levels of functioning and partly on family socioeconomic status. Throughout the early years, socioeconomic disadvantage is associated with poorer outcomes in language and literacy, communication, socioemotional functioning and early learning skills. Attending an early learning program in the years before school has been shown to have significant benefits for children’s development, particularly for children growing up in situations of socioeconomic disadvantage or special need. However, many of these children miss out due to problems of access and uptake or cost and quality. This resource sheet reviews international and Australian research evidence for the characteristics of early learning programs that are effective in promoting developmental and learning outcomes. The bulk of this research is not Indigenous-specific. The review focuses on centre-based or school-based education and care settings; universal and targeted approaches to program delivery; and Australian studies that address the needs of Indigenous children. &nbsp

Perhaps the 1970s FOMC did what it said it did

Briefing forecasts prepared for the Federal Open Market Committee (FOMC) are used to estimate changes in the design of US monetary policy and in the implied policy target for inflation from 1970 through 1997. Both estimated policy rate responses and FOMC transcripts are consistent with intermediate targeting of monetary aggregates throughout the Great Inflation of the 1970s. The unpublished FOMC targets for M1 growth are tabulated. Empirical results support an effective inflation target of roughly 7% in the 1970s and 3% thereafter. A notable difference in the 1970s monetary policies of the US and Germany is the absence of explicit public objectives for US long-run inflation

Assessing the capacity of the health services research community in Australia and New Zealand

BACKGROUND: In order to profile the health services research community in Australia and New Zealand and describe its capacity, a web-based survey was administered to members of the Health Services Research Association of Australia and New Zealand (HSRAANZ) and delegates of the HSRAANZ's Third Health Services Research and Policy Conference. RESULTS: Responses were received from 191 individuals (68%). The responses of the 165 (86%) who conducted or managed health services research indicated that the health services research community in Australia and New Zealand is characterised by highly qualified professionals who have come to health services research via a range of academic and professional routes (including clinical backgrounds), the majority of whom are women aged between 35 and 54 who have mid- to senior- level appointments. They are primarily employed in universities and, to a lesser extent, government departments and health services. Although most are employed in full time positions, many are only able to devote part of their time to health services research, often juggling this with other professional roles. They rely heavily on external funding, as only half have core funding from their employing institution and around one third have employment contracts of one year or less. Many view issues around building the capacity of the health services research community and addressing funding deficits as crucial if health services research is to be translated into policy and practice. Despite the difficulties they face, most are positive about the support and advice available from peers in their work settings, and many are actively contributing to knowledge through academic and other written outputs. CONCLUSION: If health services research is to achieve its potential in Australia and New Zealand, policy-makers and funders must take the concerns of the health services research community seriously, foster its development, and contribute to maximising its capacity through a sustainable approach to funding. There is a clear need for a strategic approach, where the health services research community collaborates with competitive granting bodies and government departments to define and fund a research agenda that balances priority-driven and investigator-driven research and which provides support for training and career development

Outcomes of population based language promotion for slow to talk toddlers at ages 2 and 3 years: Let’s Learn Language cluster randomised controlled trial

Objective To determine the benefits of a low intensity parent-toddler language promotion programme delivered to toddlers identified as slow to talk on screening in universal services

Causal inference in multi-cohort studies using the target trial approach

Longitudinal cohort studies provide the opportunity to examine causal effects of complex exposures on long-term health outcomes. Utilizing data from multiple cohorts has the potential to add further benefit by improving precision of estimates through data pooling and allowing examination of effect heterogeneity across contexts. However, the interpretation of findings can be complicated by biases that may be compounded when pooling data or may contribute to discrepant findings when analyses are replicated across cohorts. Here we extend the target trial framework, already well established as a powerful tool for causal inference in single-cohort studies, to address the specific challenges that can arise in the multi-cohort setting. The approach considers the target trial as a central point of reference, as opposed to comparing one study to another. This enables clear definition of the target estimand and systematic consideration of sources of bias within each cohort and additional sources of bias arising from data pooling. Consequently, analyses can be designed to reduce these biases and the resulting findings appropriately interpreted. We use a case study to demonstrate the approach and its potential to strengthen causal inference in multi-cohort studies through improved analysis design and clarity in the interpretation of findings.Comment: 34 pages, 3 figure