Student experiences in a novel interprofessional neurodevelopmental clinic: a qualitative study.

BACKGROUND: Student-led clinics can provide low-cost speciality care and practical interprofessional education (IPE) opportunities. In Australia, there are currently limited speciality services available that provide neurodevelopmental assessments that consider fetal alcohol spectrum disorder (FASD) as one possible outcome. The aim of the current study was to understand student experiences in a novel interprofessional student-led clinic for children and adolescents with suspected or confirmed prenatal alcohol exposure. METHOD: Seventeen allied health university students (11 occupational therapy; 6 psychology) participated in individual semi-structured interviews following completion of a 10-week clinic placement. Reflexive thematic analysis was undertaken using NVivo12. RESULTS: Four main themes were generated: (1) Interprofessional practice a key for students' development as future healthcare professionals; (2) Meaningful relationships and students' belief they made a difference; (3) Novel challenges tested students' capabilities on placement; and (4) Supervisor attitude and approach to learning supported student development. CONCLUSIONS: The current study demonstrated that the interprofessional student-led neurodevelopmental clinic provided a valuable IPE opportunity for students.

Aetiology of permanent childhood hearing loss at a population level.

AIM: To evaluate and describe results of aetiological investigations offered to a population level cohort of babies who had confirmed permanent hearing loss after they either (i) failed universal neonatal hearing screening or (ii) passed newborn screening but were detected with a permanent hearing loss in early childhood. METHODS: Descriptive analysis of results of investigations offered to neonates and young children in whom permanent hearing loss was detected as part of a statewide newborn hearing screening programme. A total of 306 285 newborns were screened between 2013 and 2017. The failed screening results were confirmed by a diagnostic audiological assessment battery. Medical evaluation for the identification of the cause of the hearing loss was performed by a paediatrician or otolaryngologist, investigations were ordered using a stepwise approach, and aetiology was assigned using a coding scheme. RESULTS: Permanent hearing loss was confirmed in 967 children (0.3%). Data were available for 873. An aetiological factor was identified or presumed in 61.3% of cases. Genetic causes were present in 26.8% and structural causes were present in 24.9% of cases. Congenital cytomegalovirus was present in 4.4%. CONCLUSIONS: Use of a coding scheme is feasible at a population level and allows collation of data from multiple sites and will allow outcome mapping and service planning.

Recognition of attachment difficulties and developmental trauma is the responsibility of all paediatricians.

This article provides an overview of attachment theory, developmental trauma and trauma-informed care for paediatricians. The impact of difficult or impoverished parent-child relationships on brain development and long-term health is now well known. Recent neuroscience research reveals the adverse neurological impacts of developmental trauma and supports the biological basis of attachment theory. There is also an increasing body of evidence that childhood adversity is common and impacts physical and mental health throughout the life-span. Comprehensive paediatric assessment should include an understanding of attachment difficulties and developmental trauma. Viewing children and their families through a 'trauma-informed lens' can provide critical insights into their clinical presentation and care needs. All paediatricians should be providing and practicing trauma-informed care.

Predictors of specialist referral for developmental and behavioural problems in a Queensland urban Aboriginal and Torres Strait Islander community: a cross-sectional study.

BACKGROUND: The prevalence of developmental and/or behavioural problems is greater among Aboriginal and Torres Strait Islander children, compared with their non-Indigenous counterparts. We aimed to identify predictors of specialist paediatric referral for these problems that could enable primary health professionals to identify at-risk children and implement early interventions. METHODS: A cross-sectional study of urban Aboriginal and Torres Strait Islander children aged 0-14 years having annual child health checks from September 2010 to February 2012 was undertaken. Predictors of paediatric referral were identified using univariable and multivariable analyses. RESULTS: Of the 183 eligible children, 30% were referred to a paediatrician. Parental/carer mental illness was self-reported in 36% of cases and these children were more likely to be referred (OR = 3.07; 95% CI: 1.44, 6.57). DISCUSSION: The strong association between paediatric referral for behavioural and/or developmental problems and self-reported parental/carer mental illness highlights the intergenerational nature of health and social disadvantage.

The congenital hearing phenotype in GJB2 in Queensland, Australia: V37I and mild hearing loss predominates.

GJB2 was originally identified in severe, non-syndromic sensorineural hearing loss (SNHL), but was subsequently associated with mild and moderate SNHL. Given the increasing utilisation of genetic testing pre-conceptually, prenatally, and neonatally, it is crucial to understand genotype-phenotype correlations. This study evaluated the nature and frequency of GJB2 variants in an Australian paediatric population with varying degrees of SNHL ascertained through newborn hearing screening. Audiograms from individuals with GJB2 variants and/or a GJB6 deletion (GJB6-D13S11830) were retrospectively reviewed (n = 127). Two-thirds were biallelic (homozygous/compound heterozygous) for pathogenic/likely pathogenic variants of GJB2 and/or GJB6 (n = 80). The most frequent variant was c.109 G > A, followed by c.35delG and c.101 T > C. Compared to biallelic carriage of other GJB2 variants, c.109 G > A positive individuals (homozygous/compound heterozygous) were more likely to have mild HL at their initial and latest audiograms (p = 0.0004). Biallelic carriage of c.35delG was associated with moderately-severe or greater SNHL at both initial and latest audiograms (p = 0.007). The c.101 T > C variant presented with milder SNHL and U-shaped audiograms (p = 0.02). In this agnostically identified cohort, mild SNHL predominated in GJB2/GJB6 carriers in contrast to previous studies targeting individuals with significant loss. Consequently, c.109 G > A, associated with milder phenotypes, was the most frequent. This study provides valuable data to support prognostic confidence in genetic counselling.

Exploring the experience of service users following attendance at a student-led interprofessional neurodevelopmental clinic.

PURPOSE: The aim of the current study was to understand service users' experiences at a recently established student-led interprofessional neurodevelopmental clinic for children and adolescents with suspected or confirmed prenatal alcohol exposure. METHOD: Semi-structured interviews were completed at 3-months post-clinic attendance with 10 service users: eight parents/caregivers and two youth workers/case managers. Interview data were analysed thematically using NVivo12. RESULTS: Four main themes were developed: (1) clinic attendance seen as a positive event; (2) validation, clarification, and relief, but also challenges post-assessment; (3) need for further support and importance of advocacy; and (4) drawing on lived experiences for future service improvements. CONCLUSIONS: The current study demonstrated that service users reported benefits from tailored services delivered by student practitioners that were validating, supportive, and holistic. Findings from the current study can inform the development and implementation of future innovative service delivery models for individuals with suspected or confirmed prenatal alcohol exposure.

People with fetal alcohol spectrum disorder (FASD) can experience a range of neurocognitive impairments that impact their day-to-day living.Access to assessment, early diagnosis, and appropriate supports are important protective factors associated with improved outcomes for individuals with FASD.Results highlighted the benefits to rehabilitation professionals of listening to service users to understand the complexity of their lived experiences, including how this information can be used to improve service design and delivery.Results also highlighted the potential role of incorporating student-led clinics within models of healthcare and rehabilitation service delivery.Utilising student-led clinics can help to increase access to specialised services for underserved groups in our community, combat shortages in the health workforce, reduce burden on the public health system, and educate the future of rehabilitation professionals.

Comparison of body mass index and triceps skinfold at 5 years and young adult body mass index, waist circumference and blood pressure.

AIM: To examine which measure of obesity at 5 years, body mass index (BMI) or triceps skinfold thickness, is most strongly associated with 21-year risk factors for cardiovascular disease (CVD), including BMI, waist circumference (WC), systolic blood pressure (SBP) and diastolic blood pressure (DBP). METHODS: Longitudinal birth cohort study with BMI and triceps skinfold measurements at age 5, and BMI, WC and blood pressure at 21 years. Overweight and obesity at 5 years were determined according to Cole-International Obesity Task Force standards, at 21, by World Health Organization definitions. Triceps skinfold thickness measurements were converted to a z-score, and cut-offs for overweight and obesity were chosen to reflect similar proportions to the BMI subgroups. BMI, WC, SBP and DBP were also measured at 21 years. RESULTS: Five-year BMI and triceps skinfold thickness were both significantly associated with the CVD risk measures at 21 years. For overweight/obesity at 5 years, the adjusted odds ratio (95% confidence interval) for 21-year overweight/obesity was 5.6 (4.2, 7.4), for 21-year WC was 1.5 (1.2, 2.0). Mean difference (95% CI) in BMI was 4.4 (3.9, 5.0), in WC 8.3 cm (6.8, 9.8), in SBP 2.4 mm Hg (0.5, 4.3), in DBP 1.1 mm Hg (0.1, 2.2). For skinfold, the similar findings were odds ratio 2.6 (2.0, 3.4) and 1.2 (0.9, 1.6) for 21-year BMI and WC, and mean differences of 2.6 (2.0, 3.2), WC 4.8 cm (3.3, 6.3), SBP 2.3 mm Hg (0.5, 4.2) and DBP 0.7 mm Hg (-0.4, 1.8). CONCLUSIONS: In children with overweight/obesity, BMI rather than triceps skinfold is the preferred epidemiological measure for identifying young adult CVD risk markers of BMI, WC and blood pressure.

Cochlear nerve deficiency is an important cause of auditory neuropathy spectrum disorder at a population level in children.

OBJECTIVES: To determine the incidence, prevalence and describe risk factors and etiology for childhood Auditory Neuropathy Spectrum Disorder using population level data from a statewide universal newborn hearing program. METHODS: A retrospective statewide universal newborn hearing screening database review and descriptive analysis from 2012 to 2019 of demographic, risk factors and hearing loss etiology for babies with sensorineural hearing loss and ANSD was completed. A 2 stage aABR protocol was used and ANSD was classified when click evoked ABR were absent or grossly abnormal but otoacoustic emissions and or cochlear microphonics were present. Medical evaluation and investigation by a pediatrician or otolaryngologist was performed and etiology was assigned using a coding scheme. Next generation genetic sequencing was not available. RESULTS: From 2012 to 2019, 487 636 babies were screened for congenital hearing loss (99.1%) and 1150 were confirmed to have permanent SNHL, 80 of whom were diagnosed with ANSD (52 unilateral and 28 bilateral). The prevalence of ANSD was 7.0% and population prevalence was 0.16 per 1000 live births. The only demographic or risk factor significantly more likely to be associated with ANSD than SNHL was hyperbilirubinemia. The most common etiology for ANSD was hypoplasia or absence of the cochlear nerve with 37 cases (46.3%), and it was significantly more likely with unilateral than bilateral ANSD. CONCLUSION: At a population level, ANSD was more likely to be unilateral and the only perinatal risk factor significantly associated was hyperbilirubinemia. Cochlear nerve deficiency was the most common etiology. Given that this can occur in well babies, this provides further evidence for aABR as a preferred mode for newborn hearing screening.

Altered bone and body composition in children and adolescents with confirmed prenatal alcohol exposure.

Prenatal alcohol exposure can contribute to long term adverse health outcomes. Development of the skeletal system begins at the early embryonic stage and continues into early adulthood but the effect of prenatal alcohol exposure on skeletal growth is relatively unexplored in a clinical population. Here, we performed dual X-ray absorptiometry to examine bone, fat, and muscle accrual in children and adolescents diagnosed with, or at risk of, fetal alcohol spectrum disorders (FASDs). Children (aged 4-9 years) with FASD or at risk of FASD (n = 10) had similar growth to age matched controls (n = 27). By adolescence (aged ≥10 years), those with FASDs (n = 13) were shorter and had lower areal bone mineral density and lean tissue mass than typically developing peers (n = 29). Overall, adolescents diagnosed with FASDs had greater odds of impairments to bone and body composition. These findings highlight the importance of early FASD diagnosis and appropriate post-diagnostic medical follow-up to enable timely, effective interventions to optimize bone and body composition during paediatric growth.