Protecting the integrity of children and young people's nursing as a distinct field of practice.

At certain points in nursing history, it has been necessary to make a case for children and young people to be cared for by specialist nurses educated to meet their specific needs. However, in 2018 the updated Nursing and Midwifery Council (NMC) standards of proficiency for registered nurses adopted a generic rather than field-specific approach. This article reiterates that children, young people and their families have unique needs that are best met by nurses who are trained specifically to care for them. The case is made from a historical and legal perspective, concluding with a proposal that in the best interests of children, young people and their families, the NMC should embed specific competencies for children's nurses into its standards of proficiency to future-proof this field of practice.

A scoping review of national policies for child road injury in China.

There has been limited examination of child road injury policies. This study aims to systematically characterize national policies relevant to child road safety in China over the past two decades and identify potential gaps based on the WHO child road safety framework. As a scoping review, this study searched for national policies for child road safety on the websites of government agencies. A total of 22,487 policies were searched, of which 103 policies issued by 37 institutions, were included in the analysis, including 12 policies jointly developed by multiple agencies. Mapping identified policies to strategies in the WHO framework, most WHO strategies requiring legislation were found to be in place in China and to fully meet the intent of the WHO recommendation. The single exception was in the area of child restraints which was deemed to not be fully covered due to a lack of eligible policies on enforcement of child restraint use laws. Two strategies requiring standards were fully covered; eight strategies requiring policy support were partially or not covered, mainly related to equipping emergency vehicles with child-appropriate medical equipment. Enhancing school bus safety was identified as a policy focus area in China beyond those recommended by the WHO framework. This study identified three areas for improvement: (1) strengthening road safety policies targeting children, (2) strengthening enforcement of legislation, e.g., child restraint use, and (3) increasing multiple-sector cooperation on policy formulation. Funding: Ye Jin is supported by the Scholarship from the George Institute for Global Health and Tuition Fee Scholarships from University of New South Wales.

The effects of postural support padding modifications to child restraints for children with disability on crash protection.

OBJECTIVE: Many children with physical disabilities need additional postural support when sitting and supplementary padding is used on standards approved child restraints to achieve this when traveling in a motor vehicle. However, the effect of this padding on crash protection for a child is unknown. This study aimed to investigate the effect of additional padding for postural support on crash protection for child occupants in forward facing child restraints. METHODS: Forty frontal sled tests at 49 km/h were conducted to compare Q1 anthropometric test device (ATD) responses in a forward-facing restraint, with and without additional padding in locations to increase recline of the restraint, and/or support the head, trunk and pelvis. Three padding materials were tested: cloth toweling, soft foam, and expanded polystyrene (EPS). The influence of padding on head excursion, peak 3 ms head acceleration, HIC15, peak 3 ms chest acceleration and chest deflection were analyzed. RESULTS: The influence of padding varied depending on the location of use. Padding used under the restraint to increase the recline angle increased head injury metrics. Toweling in multiple locations which included behind the head increased head excursion and chest injury metrics. There was minimal effect on injury risk measures with additional padding to support the sides of the head or the pelvis position. Rigid EPS foam, as recommended in Australian standards and guidelines, had minimal effect on injury metrics when used inside the restraint, as did tightly rolled or folded toweling secured to the restraint at single locations around the body of the child. CONCLUSIONS: This study does not support the use of postural support padding to increase recline of a forward-facing restraint or padding behind the head. Recommendations in published standards and guidelines to not use foam that is spongy, soft or easily compressed, with preference for secured firm foam or short-term use of tightly rolled or folded toweling under the child restraint cover is supported. This study also highlights the importance of considering the whole context of child occupant protection when using additional padding, particularly the change in the child's seated position when adding padding in relation to the standard safety features of the restraint.

Survey Protocols, Response Rates, and Representation of Underserved Patients: A Randomized Clinical Trial.

Importance: Surveys often underrepresent certain patients, such as underserved patients. Methods that improve their response rates (RRs) would help patient surveys better represent their experiences and assess equity and equity-targeted quality improvement efforts. Objective: To estimate the effect of adding an initial web mode to existing Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey protocols and extending the fielding period on RR and representativeness of underserved patient groups. Design, Setting, and Participants: This randomized clinical trial included 36 001 patients discharged from 46 US hospitals from May through December 2021. Data analysis was performed from May 2022 to September 2023. Exposures: Patients were randomized to 1 of 6 survey protocols: 3 standard HCAHPS protocols (mail only, phone only, mail-phone) plus 3 web-enhanced protocols (web-mail, web-phone, web-mail-phone). Main Outcomes and Measures: RR and number of respondents per 100 survey attempts (yield) were calculated and compared for each of the 6 survey protocols, overall, and by patient age, service line, sex, and race and ethnicity. Results: A total of 34 335 patients (median age range, 55-59 years; 59.3% female individuals and 40.7% male individuals) were eligible and included in the study. Of the respondents, 6.9% were Asian American or Native Hawaiian or Other Pacific Islander, 0.7% were American Indian or Alaska Native, 11.5% were Black, 17.4% were Hispanic, 61.0% were White, and 2.6% were multiracial. Of the 6 protocols, RRs were highest in web-mail-phone (36.5%), intermediate for the 3 two-mode survey protocols (mail-phone, web-mail, web-phone, 30.3%-31.1%), and lowest for the 2 single-mode protocols (mail only, phone only, 22.1%-24.3%). Web-mail-phone resulted in the highest yield for 3 racial and ethnic groups (Black, Hispanic, and White patients) and second highest for another (multiracial patients). Otherwise, the highest or second highest yield was almost always a 2-mode protocol. Mail only was the lowest-yield protocol for Black, Hispanic, and multiracial patients and phone-only was the lowest-yield protocol for White patients; these 2 protocols tied for lowest-yield for Asian American or Native Hawaiian or Other Pacific Islander patients. Gains from multimode approaches were often 2 to 3 times as large for Asian American or Native Hawaiian or Other Pacific Islander, Black, Hispanic, and multiracial patients as for White patients. Web-mail-phone had the highest RR for 6 of 8 age groups and 4 of 5 combinations of service line and sex. Conclusions and Relevance: In this randomized clinical trial, web-first multimode survey protocols significantly improved the RR and representativeness of patient surveys. The best-performing protocol based on RR and representativeness was web-mail-phone. Web-phone performed well for young and diverse patient populations, and web-mail for older and less diverse patient populations. The US Centers for Medicare & Medicaid Services will allow hospitals to use the web-mail, web-phone, and web-mail-phone protocols for HCAHPS administration beginning in 2025.

Exploring the Potential of a Behavior Theory-Informed Digital Intervention for Infant Fall Prevention: Mixed Methods Longitudinal Study.

BACKGROUND: Falls are the most common hospitalized injury mechanism in children aged ≤1 years, and currently, there are no targeted prevention interventions. The prevention of falls in children of this age requires changes in the behavior of their caregivers, and theoretically informed digital behavior change interventions (DBCIs) may provide a unique mechanism for achieving effective intervention. However, user acceptance and the ability of DBCIs to effect the required changes in behavior are critical to their likelihood of success. OBJECTIVE: This study aims to evaluate a behavior theory-informed digital intervention developed following a user-centered approach for user experience, the potential for this intervention to prevent infant falls, and its impact on behavioral drivers underpinning fall risk in young children. METHODS: Parents of infants aged <1 year were recruited and asked to use the intervention for 3 months. A pre-post longitudinal design was used to examine the change in the potential to reduce the risk of falls after a 3-month exposure to the intervention. Postintervention data on behavioral drivers for fall prevention, user acceptability, and engagement with the app were also collected. Interviews were conducted to explore user experiences and identify areas for further improvement of the intervention. RESULTS: A total of 62 parents participated in the study. A statistically significant effect on the potential to reduce falls was observed after the intervention. This effect was higher for new parents. Parents agreed that the intervention targeted most of the target behavior drivers. The impact of behavior drivers and intervention on the potential for fall prevention had a positive correlation. The intervention demonstrated good levels of acceptability. Feedback from participants was mostly positive, and the primary area identified for further improvement was widening the scope of the intervention. CONCLUSIONS: This study demonstrated the promise of a newly developed digital intervention to reduce the risk of infant falls, particularly among new parents. It also showed a positive influence of the DBCI on the drivers of parental behaviors that are important for fall reduction among infants. The acceptability of the app was high, and important insights were gained from users about how to further improve the app.

Updated population-level estimates of child restraint practices among children aged 0-12 years in Australia, 10 years after introduction of age-appropriate restraint use legislation.

OBJECTIVE: Optimal child passenger protection requires use of a restraint designed for the age/size of the child (appropriate use) that is used in the way the manufacturer intended (correct use).This study aimed to determine child restraint practices approximately 10 years after introduction of legislation requiring correct use of age-appropriate restraints for all children aged up to 7 years. METHODS: A stratified cluster sample was constructed to collect observational data from children aged 0-12 years across the Greater Sydney region of New South Wales (NSW). Methods replicated those used in a similar 2008 study. Population weighted estimates for restraint practices were generated, and logistic regression used to examine associations between restraint type, and child age with correct use accounting for the complex sample. RESULTS: Almost all children were appropriately restrained (99.3%, 95% CI 98.4% to 100%). However, less than half were correctly restrained (no error=27.3%, 95% CI 10.8% to 43.8%, no serious error=43.8%, 95% CI 35.0% to 52.7%). For any error, the odds of error decreased by 39% per year of age (OR 0.61, 95% CI 0.46 to 0.81) and for serious error by 25% per year (OR 0.75, 95% CI 0.60 to 0.93). CONCLUSION: The findings demonstrate high levels of appropriate restraint use among children across metropolitan Sydney approximately 10 years after introduction of legislation requiring age-appropriate restraint use until age 7, however, errors in the way restraints remain common. IMPLICATIONS FOR PUBLIC HEALTH: Given the negative impact incorrect use has on crash protection, continuing high rates of incorrect use may reduce effectiveness of legislative change on injury reduction.

Australians' perceptions of the potential effects of increased access to alcohol via autonomous delivery services: A multi-method study.

INTRODUCTION: Rapid technological change will affect how people access harmful products. For example, automated delivery services are forecast to provide fast and affordable product access options for those purchasing alcohol. Information about the potential impacts of such innovations on alcohol purchase and consumption behaviors is lacking. The aim of this study was to explore how consumers may respond to future scenarios where alcohol is available via a range of autonomous alcohol delivery options. METHODS: In a two-stage process, qualitative individual interviews (n = 100) and a quantitative online survey (n = 1078) were conducted with Australians aged 18+ years. Quotas were used to achieve national representation on key demographic variables. Participants were exposed to scenarios outlining how autonomous vehicles are likely to be used for alcohol deliveries in the future and asked to discuss their intentions to use such services and their perceptions of any impacts on alcohol consumption at a societal level. RESULTS: Automated alcohol deliveries were generally considered to be highly convenient and therefore likely to be popular. Around one-third (37%) of survey respondents reported an intention to use such automated alcohol delivery services once they are available and almost half (47%) expected overall levels of alcohol consumption to increase across the population. CONCLUSION: Given potential levels of uptake, careful consideration needs to be given to the development and implementation of appropriate policy and regulatory frameworks to minimize the increased risk of alcohol-related harm associated with enhanced alcohol availability resulting from the emerging availability of autonomous delivery services.

Specific Genotypes Associated with Differences in Fasting Insulin Levels and Body Mass Index in Healthy Young Males: Implications for Gene-Nutrient Interactions-an Exploratory Study.

Background: Genetic variation may significantly impact an individual's susceptibility to diseases, particularly when combined with specific nutrients. Additionally, genetic variations can lead to interindividual differences in metabolic responses. Objective: The present study explores the association between gene variants and observed interindividual differences in metabolic responses. Methods: The study included 30 healthy males (aged 20-34) who underwent a fasting period and subsequently consumed a standardized meal. Blood samples were collected both before and after the meal to assess metabolic changes. BMI served as an indirect measure for assessing physiological responses associated with body composition. Appetite changes were assessed using an online Visual Analog 100-point Scale. Buccal swabs were collected to analyze genetic variants in single nucleotide polymorphisms (SNPs). Results: The data underwent multiple regression analysis, revealing significant associations with 3 SNPs and their metabolic status: the insulin-receptor substrate 1 (IRS1) gene variant rs2943641, genotypes CT and CC, with elevated fasting insulin levels (R2 = 0.639, P = < 0.0001); the mitochondrial uncoupling protein 1 (UCP1) gene variant rs1800592, genotypes GG and GA, with increased BMI (R2 = 0.261, P = 0.007); and the peroxisome proliferator-activated receptor γ2 (PPARγ2) gene variant rs1801282, genotypes GG and GC, with increased BMI (R2 = 0.200, P = 0.024). Conclusions: Therefore, our study established significant associations between these 3 SNPs and differences in fasting insulin levels and BMI within our cohort.

Feasibility and Usability of a Mobile App-Based Interactive Care Plan for Migraine in a Community Neurology Practice: Development and Pilot Implementation Study.

BACKGROUND: Migraine is a common and major cause of disability, poor quality of life, and high health care use. Access to evidence-based migraine care is limited and projected to worsen. Novel mobile health app-based tools may effectively deliver migraine patient education to support self-management, facilitate remote monitoring and treatment, and improve access to care. The risk that such an intervention may increase the care team workload is a potential implementation barrier. OBJECTIVE: This study aims to describe a novel electronic health record-integrated mobile app-based Migraine Interactive Care Plan (MICP) and evaluate its feasibility, usability, and impact on care teams in a community neurology practice. METHODS: Consecutive enrollees between September 1, 2020, and February 16, 2022, were assessed in a single-arm observational study of usability, defined by 74.3% (127/171) completing ≥1 assigned task. Task response rates, rate and type of care team escalations, and patient-reported outcomes were summarized. Patients were prospectively recruited and randomly assigned to routine care with or without the MICP from September 1, 2020, to September 1, 2021. Feasibility was defined by equal to or fewer downstream face-to-face visits, telephone contacts, and electronic messages in the MICP cohort. The Wilcoxon rank-sum test was used to compare continuous variables, and the chi-square test was used for categorical variables for those with at least 3 months of follow-up. RESULTS: A total of 171 patients were enrolled, and of these, 127 (74.3%) patients completed ≥1 MICP-assigned task. Mean escalations per patient per month was 0.9 (SD 0.37; range 0-1.7). Patient-confirmed understanding of the educational materials ranged from 26.6% (45/169) to 56.2% (95/169). Initial mean headache days per week was 4.54 (SD 2.06) days and declined to 2.86 (SD 1.87) days at week 26. The percentage of patients reporting favorable satisfaction increased from a baseline of 35% (20/57) to 83% (15/18; response rate of 42/136, 30.9% to 28/68, 41%) over the first 6 months. A total of 121 patients with MICP were compared with 62 patients in the control group. No differences were observed in the rate of telephone contacts or electronic messages. Fewer face-to-face visits were observed in the MICP cohort (13/121, 10.7%) compared with controls (26/62, 42%; P<.001). CONCLUSIONS: We describe the successful implementation of an electronic health record-integrated mobile app-based care plan for migraine in a community neurology practice. We observed fewer downstream face-to-face visits without increasing telephone calls, medication refills, or electronic messages. Our findings suggest that the MICP has the potential to improve patient access without increasing care team workload and the need for patient input from diverse populations to improve and sustain patient engagement. Additional studies are needed to assess its impact in primary care.

Associations between vision impairment and vision-related interventions on crash risk and driving cessation: systematic review and meta-analysis.

OBJECTIVES: To systematically investigate the associations between vision impairment and risk of motor vehicle crash (MVC) involvement, and evaluate vision-related interventions to reduce MVCs. DESIGN: Medline (Ovid), EMBASE and Global Health electronic databases were systematically searched from inception to March 2022 for observational and interventional English-language studies. Screening, data extraction and appraisals using the Joanna Briggs Institute appraisal tools were completed by two reviewers independently. Where appropriate, measures of association were converted into risk ratios (RRs) or ORs for meta-analysis. PARTICIPANTS: Drivers of four-wheeled vehicles of all ages with no cognitive declines. PRIMARY AND SECONDARY OUTCOMES: MVC involvement (primary) and driving cessation (secondary). RESULTS: 101 studies (n=778 052) were included after full-text review. 57 studies only involved older drivers (≥65 years) and 85 were in high-income settings. Heterogeneity in the data meant that most meta-analyses were underpowered as only 25 studies, further split into different groups of eye diseases and measures of vision, could be meta-analysed. The limited evidence from the meta-analyses suggests that visual field defects (four studies; RR 1.51 (95% CI 1.23, 1.85); p<0.001; I2=46.79%), and contrast sensitivity (two studies; RR 1.40 (95% CI 1.08, 1.80); p=0.01, I2=0.11%) and visual acuity loss (five studies; RR 1.21 (95% CI 1.02, 1.43); p=0.03, I2=28.49%) may increase crash risk. The results are more inconclusive for available evidence for associations of glaucoma (five studies, RR 1.27 (95% CI 0.67, 2.42); p=0.47; I2=93.48%) and cataract (two studies RR 1.15 (95% CI 0.97, 1.36); p=0.11; I2=3.96%) with crashes. Driving cessation may also be linked with glaucoma (two studies; RR 1.62 (95% CI 1.20, 2.19); p<0.001, I2=22.45%), age-related macular degeneration (AMD) (three studies; RR 2.21 (95% CI 1.47, 3.31); p<0.001, I2=75.11%) and reduced contrast sensitivity (three studies; RR 1.30 (95% CI 1.05, 1.61); p=0.02; I2=63.19%). Cataract surgery halved MVC risk (three studies; RR 0.55 (95% CI 0.34, 0.92); p=0.02; I2=97.10). Ranibizumab injections (four randomised controlled trials) prolonged driving in persons with AMD. CONCLUSION: Impaired vision identified through a variety of measures is associated with both increased MVC involvement and cessation. Cataract surgery can reduce MVC risk. Despite literature being highly heterogeneous, this review shows that detection of vision problems and appropriate treatment are critical to road safety. PROSPERO REGISTRATION NUMBER: CRD42020172153.

Differences in participant characteristics and observed child restraint use between population-based and restraint fitting service samples.

OBJECTIVE: To compare characteristics and restraint use between a population-based and fitting service sample of child restraint users. METHOD: Characteristics of the two samples were compared using chi-squared tests. Differences in errors in restraint use observed in the two samples were modeled using logistic regression. RESULTS: There were significant differences in child age (p < 0.001), and restraint types (p < 0.001) between the two samples, with more younger children in the fitting service sample. Controlling for differences in restraint type, the odds that adult participants were female were 61% less in the fitting service sample than in the population-based sample (OR 0.39, 95%CI 0.21-0.71). The odds that adult participants perceived a large risk associated with restraint misuse (OR 3.62, 95%CI 1.33-9.84), had a household income in the highest bracket (OR 3.89, 95%CI 1.20-12.62) and were living in areas of highest socioeconomic advantage (OR 2.72, 95%CI 1.22-6.06) were approximately three times higher in the fitting service sample. Overall, more participants had errors in restraint use in the population-based sample (p = 0.021). However, after controlling for restraint type, securing errors were three times more likely (OR 3.34, 95%CI 1.12-10.2), and serious installation errors were almost twice as likely (OR 1.91, 95% CI 1.09-3.39) in the fitting service sample. CONCLUSIONS: While less resource intensive, convenience and/or fitting service samples may be less representative than population-based samples. Given the need for efficiency, methods that combine randomized population-based invitations to participate in restraint fitting check day events across geographically representative areas may be useful for ongoing surveillance of child restraint use.

The inexorable rise of automated food deliveries and potential anticipatory policy actions.

OBJECTIVE: Food deliveries to consumers using autonomous vehicles are forecast to become commonplace in Australia and globally. The aims of this study were to (i) explore the anticipated nature of AV food delivery services in Australia and (ii) identify available policy options to optimise positive outcomes and minimise any negative consequences for health and well-being. METHODS: In total, 36 interviews were conducted with 40 expert stakeholders across a range of relevant sectors including transport, urban planning, health and telecommunications. Interviewees discussed the ways in which automated food deliveries are likely to be implemented and the potential implications for lifestyles and health. RESULTS: The interviewees expected automated food deliveries to constitute an extension of current trends towards online food ordering and rapid home deliveries, with potential adverse implications for diet quality at the population level. CONCLUSIONS: Effective regulation of automated food and beverage delivery services will be needed to anticipate and address this emerging phenomenon. IMPLICATIONS FOR PUBLIC HEALTH: There is the opportunity to optimise the public health outcomes associated with automated food deliveries while minimising potential negative consequences through proactive anticipatory action. Delays could result in undesirable and irreversible changes to the food environment.

Dialectical behavior therapy-skills system for cognitively challenged individuals with self-harm: a Swedish pilot study.

Background: Dialectical behavior therapy (DBT) is an evidence-based treatment for self-harm and emotion regulation difficulties. A modified version, DBT-Skills System (DBT-SS), has been developed in the USA for individuals with cognitive difficulties. The present study is a pilot study, testing the DBT-SS in a Swedish context. Methods: Six participants were treated with individual therapy and group skills training for 48 sessions each. A case series design was used to follow individual development over time. The primary outcome measure was reduction in challenging behaviors. Secondary outcomes were level of functioning in daily life, hospital admissions, and resilience and vulnerabilities in different risk domains. Data was analyzed using time-series diagrams. Effect sizes of changes were calculated using Cohen's d. Results: Challenging behaviors decreased over time and participants' global level of functioning increased. There was a reduction in number of hospital admissions over time. As for resilience and vulnerabilities, participants' overall level of risk in various areas remained unchanged or decreased after treatment. Conclusions: The results indicate that DBT-SS might be a promising treatment for cognitively challenged individuals with emotion regulation difficulties and challenging behaviors in a Swedish context. The study provides suggestions for a future randomized controlled trial. Supplemental data for this article is available online at here.

Paediatric healthcare and hospital worker SARS-CoV-2 IgG antibody: A longitudinal cohort study.

Background: This study sought to determine the prevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) nucleocapsid (N) and spike (S) protein immunoglobulin G (IgG) antibodies in healthcare and hospital workers (HCHWs), and changes in IgG N antibody levels over time. Methods: Longitudinal study of HCHWs at a freestanding, urban paediatric tertiary care hospital. Asymptomatic HCHWs aged ≥18 years working in clinical areas were eligible to enrol. Participants completed four surveys and blood draws over 12 months. Specimens were tested for IgG N at four timepoints and IgG S at 12 months. Results: In total, 531 HCHWs enrolled in this study; of these, 481 (91%), 429 (81%) and 383 (72%) completed follow-up blood draws at 2, 6 and 12 months, respectively. Five of 531 (1%), 5/481 (1%), 6/429 (1%) and 5/383 (1.3%) participants were seropositive for IgG N at baseline, 2, 6 and 12 months, respectively. All (374/374; 100%) participants who received one or two doses of either mRNA COVID-19 vaccine were seropositive for IgG S. One of nine unvaccinated participants was seropositive for IgG S. Conclusions: In this paediatric hospital, IgG N and IgG S were detected in 1.9% and 97.9% of HCHWs, respectively. This study demonstrated low transmission of SARS-CoV-2 among HCHWs with appropriate infection prevention measures.

Association of urine and plasma ADMA with atherosclerotic risk in DKD cardiovascular disease risk in diabetic kidney disease: findings from the Chronic Renal Insufficiency Cohort (CRIC) study.

BACKGROUND: Chronic kidney disease (CKD) is associated with atherosclerotic cardiovascular disease (ASCVD) risk, especially among those with diabetes. Altered metabolism of solutes that accumulate in CKD [asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA) and trimethylamine N-oxide (TMAO)] may reflect pathways linking CKD with ASCVD. METHODS: This case-cohort study included Chronic Renal Insufficiency Cohort participants with baseline diabetes, estimated glomerular filtration rate <60 mL/min/1.73 m2, and without prior history for each outcome. The primary outcome was incident ASCVD (time to first myocardial infarction, stroke or peripheral artery disease event) and secondary outcome was incident heart failure. The subcohort comprised randomly selected participants meeting entry criteria. Plasma and urine ADMA, SDMA and TMAO concentrations were determined by liquid chromatography-tandem mass spectrometry. Associations of uremic solute plasma concentrations and urinary fractional excretions with outcomes were evaluated by weighted multivariable Cox regression models, adjusted for confounding covariables. RESULTS: Higher plasma ADMA concentrations (per standard deviation) were associated with ASCVD risk [hazard ratio (HR) 1.30, 95% confidence interval (CI) 1.01-1.68]. Lower fractional excretion of ADMA (per standard deviation) was associated with ASCVD risk (HR 1.42, 95% CI 1.07-1.89). The lowest quartile of ADMA fractional excretion was associated with greater ASCVD risk (HR 2.25, 95% CI 1.08-4.69) compared with the highest quartile. Plasma SDMA and TMAO concentration and fractional excretion were not associated with ASCVD. Neither plasma nor fractional excretion of ADMA, SDMA and TMAO were associated with incident heart failure. CONCLUSION: These data suggest that decreased kidney excretion of ADMA leads to increased plasma concentrations and ASCVD risk.

Mapping frameworks and approaches to measuring the quality of transition support services for young people with intellectual and developmental disabilities.

Transition to adulthood for young people with intellectual disabilities and developmental disabilities (IDD) has been given significant attention in research, policy development and practice. The aim of this paper was to explore how a recently developed theoretical outcomes-based framework for measuring the quality of services for people with disabilities could potentially be useful in conceptualizing and supporting successful transition to adulthood. The theoretical discussion draws on both the scoping review and template analysis that was used to develop the Service Quality Framework and on a separate study synthesizing expert completed country templates and literature review which included models of and research on successful transition to adulthood. Synthesis identified that using a quality of life outcomes focused framework of Service Quality could be mapped onto and extend current thinking on what is seen as successful transition to adulthood by putting the focus on successful transition as people with IDD moving towards having similar opportunities and quality of life as other adults without disabilities living in the same community/society. Implications of a more wide-ranging definition and holistic view for both practice and future research are discussed.

Playground injury prevention: the need for consistent and national implementation of Australian safety standards.

OBJECTIVES: Hospitalisation rates for injury, including at playgrounds, have not changed in the past decade. There are nine Australian Standards specific to playgrounds. The impact (if any) of these standards on playground injury resulting in hospitalisation is unknown. METHODS: Retrospective data for patients under 18 years presenting to emergency departments and/or admitted between October 2015 and December 2019 due to an injury documented as occurring at a playground were retrieved by the Illawarra Shoalhaven Local Health District Planning, Information and Performance Department. Maintenance and Australian Standard (AS) compliance data for the 401 local playgrounds were requested from the four Local Governments in Illawarra Shoalhaven Local Health District. Descriptive statistics were used. RESULTS: A total of 548 children were treated in emergency departments and/or admitted following playground injury. There was an overall increase of 39.3% in playground injury across the study period, and expenditure rose from $43,478 in 2011 to $367,259 in 2019 (a 744.7% increase). CONCLUSIONS: Playground injury has not decreased in the Illawarra Shoalhaven. Data regarding maintenance and AS compliance are lacking. This is not unique to our region. IMPLICATIONS FOR PUBLIC HEALTH: Without a national approach to adequately resource and monitor playground injury, it is not possible to assess the impact of Australian Standards or any injury prevention program.

Expert stakeholders' views on the potential nature and impacts of autonomous alcohol home delivery.

INTRODUCTION: The emergence of autonomous vehicles (AV) heralds new methods of alcohol delivery that are likely to have substantial implications for home drinking. The aim of this study was to explore the factors that have the potential to hasten or restrict widescale increases in alcohol availability resulting from AVs. METHODS: Thirty-six interviews were conducted with 44 stakeholders across diverse sectors. Interviewees discussed their perceptions of how AVs will evolve and the implications for alcohol access. The interview transcripts were analysed to develop a typology of factors that need to be addressed to minimise harms associated with greater home alcohol consumption due to AVs. RESULTS: The interviewees identified a range of demand-side (e.g., enhanced convenience for consumers) and supply-side (e.g., increased efficiency for providers) factors associated with AV home deliveries that could increase the prevalence and volume of home drinking. A third category of factors related to potential forms of regulation: suggested harm-minimisation options related to appropriate enhancements of licensing restrictions and responsible service requirements and the use of various fiscal levers to introduce price barriers. DISCUSSION AND CONCLUSIONS: The suggested strategies will require collaborative efforts across government and non-government organisations to address the potential issues arising from the advent of AV alcohol deliveries. Technological and policy solutions will be needed to ensure responsible service of alcohol. This study provides policy makers with insights into forms of intervention that may be required to minimise the harms associated with the use of AVs in alcohol home delivery systems.

Falls from ladders in New South Wales: A data-linkage study.

INTRODUCTION: Fall from ladders is increasingly identified as a significant cause of injury and mortality, yet large-scale research into ladder fall outcomes and trends is limited. OBJECTIVES: To explore the nature and severity of injuries resulting from ladder falls and to determine predictors of Injury Severity Score (ISS) and 6-month mortality. METHODS: Data were obtained from the New South Wales (NSW) Trauma Registry, Admitted Patient Data Collection and Registry of Births, Deaths, and Marriages on patients aged 15 and over who had major trauma from a ladder fall and were admitted to hospital between January 1st, 2012, and July 31st, 2019. Data linkage and descriptive statistics were carried out alongside bivariate and multivariable regression analysis. RESULTS: 963 patients injured after ladder falls were identified. The mean age was 61.9 years (SD 14.2), 91.0% were male, and 489 (50.8%) were born in Australia. The height of fall was between one and five meters in 827 (86.2%) patients, and the place of fall was home and residential places in 27.5%. The most common body areas injured were the head (26.5%), spine (21.2%) and thorax (20.6%), and the median injury severity score was 17. The median length of stay of patients' in-hospital and intensive care unit was six days and two days, respectively. Six months post-discharge mortality was 6.4%. The unadjusted association between the presence of comorbidities or socio-economic class and ISS or mortality was not statistically significant. Increasing ISS was found to be associated with increasing age (Estimate (Est), 15.2; 95% Confidence Interval (CI), 12.3-18.1) and a fall height greater than five metres (Est, 5.8; CI, 3.2-8.4). Mortality was found to be associated with increasing age (Odds ratio (OR), 1.06; CI, 1.03-1.08) and increasing ISS (OR, 1.19; CI, 1.15-1.24). CONCLUSION: People presenting to the hospital after falling from a ladder were predominately male, aged over 60 and had fallen in a residential setting. Increasing age and fall height are associated with more severe injuries.