Fetal alcohol spectrum disorder resources for health professionals: a scoping review.

OBJECTIVES: This scoping review aimed to identify and critically appraise resources for health professionals to identify, diagnose, refer, and support individuals with fetal alcohol spectrum disorder (FASD)-including the extent to which the resources are appropriate for use in communities with First Nations Peoples. METHOD: Seven peer-reviewed databases (April 2022) and 14 grey literature websites (August 2022) were searched. The reference lists of all sources that underwent full-text review were handsearched, and FASD experts were consulted for additional sources. Resources were assessed using the Appraisal of Guidelines for REsearch and Evaluation II instrument and an adapted version of the National Health and Medical Research Council FORM Framework and iCAHE Guideline Quality Checklist. RESULTS: A total of 41 resources underwent data extraction and critical appraisal, as screening and/or diagnosis guidelines were excluded because they are covered in other reviews. Most were recently published or updated (n=24), developed in the USA (n=15, 36.6%) or Australia (n=12, 29.3%) and assisted with FASD patient referral or support (n=40). Most management guidelines scored 76%-100% on overall quality assessment (n=5/9) and were recommended for use in the Australian context with modifications (n=7/9). Most of the guides (n=15/22) and factsheets (n=7/10) received a 'good' overall score. Few (n=3/41) resources were explicitly designed for or with input from First Nations Australians. CONCLUSION: High-quality resources are available to support health professionals providing referrals and support to individuals with FASD, including language guides. Resources should be codesigned with people living with FASD to capture and integrate their knowledge and preferences.

Mental health in children conceived by Assisted Reproductive Technologies (ARTs): Insights from a longitudinal study of Australian children.

BACKGROUND: The mental health of children conceived using Assisted Reproductive Technologies (ARTs) such as In-Vitro-Fertilization (IVF) is a subject of significant controversy. Existing studies suggest children conceived through ART meet physical and cognitive developmental milestones at similar rates to their spontaneously conceived peers, however, a significant number of studies have connected ART conception with mental health conditions, particularly depression and attention-deficit hyperactivity disorder (ADHD) in adolescence. This study, therefore, aimed to determine whether maternal use of ARTs to achieve pregnancy is associated with an increased risk of mental disorders in these children, and whether these effects are sex-dependent or confounded by known covariates in the ART population. METHODS: Secondary data analysis was performed using Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC) data; a nationally representative population-based cross-sequential cohort study. Multivariate logistic regression models examined the impact of ART (including IVF and other fertility drugs, from LSAC wave-1 and wave-2 conducted in 2004 and 2006, respectively) on mental health outcomes (i.e., autism, ADHD, anxiety and/or depression, from LSAC waves 8 conducted in 2018) in Australian adolescents aged 18-19 years in 2018 (n = 1735). Known sociological and obstetric covariates including maternal age, birth weight, smoking and drinking alcohol during pregnancy, maternal gestational diabetes, postnatal depression, hypertension, and socioeconomic status were considered to generate an adjusted logistic model. Variables with a p-value of <0.05 in the regression models were considered statistically significant. RESULTS: Of the 1735 mother-child dyads analysed, the maternal mean age was 35.6 years (Standard deviation = ±4.75), approximately 5% of mothers (n = 89) used ART to become pregnant, and 22% of adolescents (n = 384) had a mental disorder. Longitudinal analysis revealed no relationship between ART and children developing a mental disorder in the LSAC population. CONCLUSION: These results should reassure parents considering ART that there is no increased risk of psychological or neurodevelopmental problems in their ART conceived offspring.

Vaccine-Preventable Disease Outbreaks among Healthcare Workers: A Scoping Review.

BACKGROUND: Outbreaks of vaccine preventable diseases (VPDs) in health care workers (HCWs) can result in morbidity and mortality and cause significant disruptions to health care services, patients and visitors as well as an added burden on the health system. This scoping review is aimed to describe the epidemiology of VPD outbreaks in HCW, caused by diseases which are prevented by the ten vaccines recommended by World Health Organization (WHO) for HCWs. METHODS: In April 2022 CINAHL, MEDLINE, Global Health and EMBASE were searched for all articles reporting on VPD outbreaks in HCWs since the year 2000. Articles were included regardless of language and study type. Clinical and epidemiological characteristics of VPD outbreaks were described. RESULTS: Our search found 9363 articles, of which 216 met inclusion criteria. Studies describing six of the ten VPDs were found: influenza, measles, varicella, tuberculosis, pertussis and rubella. Most articles (93%) were from high- and upper middle-income countries. While most outbreaks occurred in hospitals, several influenza outbreaks were reported in long term care facilities. Based on available data, vaccination rates amongst HCWs were rarely reported. CONCLUSION: We describe several VPD outbreaks in HCWs from 2000 to April 2022. The review emphasises the need to understand the factors influencing outbreaks in HCWs and highlight importance of vaccination amongst HCWs.

Role of internet use, mobile phone, media exposure and domestic migration on reproductive health service use in Bangladeshi married adolescents and young women.

Numerous studies have identified factors that are associated with increased access to reproductive health services in lower-middle-income countries (LMICs). However, limited studies examined the influence of access to internet or a mobile phone, media exposure and domestic migration on reproductive health services use in LMICs like Bangladesh. This study investigated the role of such factors on the use of contraceptives, antenatal care (ANC) and postnatal care (PNC) by married adolescents and young women in Bangladesh and whether it was varied by area. Secondary data for 1665 married women aged 15-24 years, sourced from the 2019 Multiple Indicator Cluster Surveys, were included in both bivariate analyses and logistic regression modelling to examine the role of access to internet and/or mobile phone, media exposure and domestic migration on the outcome variables (contraceptive, ANC and PNC). All regression models were controlled for age, wealth, education and number of existing children. Among all participants, 69.8% were aged 20-24 years and 85.6% lived in rural areas. Of the total sample, 67.5% used contraceptives, 75.7% utilised ANC and 48.7% accessed PNC. Domestic migration significantly increased contraceptive use, with women who had moved locally within the last five years 1.84 times more likely to use contraception than those who had never moved (95% CI: 1.41-2.41, p<0.001). Women with internet or mobile phone access were more likely to receive ANC (aOR: 1.57, 95% CI: 1.22-2.00, p<0.001) compared to those without internet/mobile phone access. Media exposure was found to increase the likelihood of receiving ANC in urban areas. No significant influence was found on the use of PNC. Internet/mobile-based platforms are promising avenues for public health messaging regarding ANC in Bangladeshi married adolescents and young women. Further research is required into determinants of PNC service use in low-resource settings.

Effect of exercise interventions on hospital length of stay and admissions during cancer treatment: a systematic review and meta-analysis.

OBJECTIVE: To assess the effect of participating in an exercise intervention compared with no exercise during cancer treatment on the duration and frequency of hospital admissions. DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE, EMBASE, PEDro and Cochrane Central Registry of Randomized Controlled Trials. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised studies published until August 2023 evaluating exercise interventions during chemotherapy, radiotherapy or stem cell transplant regimens, compared with usual care, and which assessed hospital admissions (length of stay and/or frequency of admissions). STUDY APPRAISAL AND SYNTHESIS: Study quality was assessed using the Cochrane Risk-of-Bias tool and Grading of Recommendations Assessment, Development and Evaluation assessment. Meta-analyses were conducted by pooling the data using random-effects models. RESULTS: Of 3918 screened abstracts, 20 studies met inclusion criteria, including 2635 participants (1383 intervention and 1252 control). Twelve studies were conducted during haematopoietic stem cell transplantation regimens. There was a small effect size in a pooled analysis that found exercise during treatment reduced hospital length of stay by 1.40 days (95% CI: -2.26 to -0.54 days; low-quality evidence) and lowered the rate of hospital admission by 8% (difference in proportions=-0.08, 95% CI: -0.13 to -0.03, low-quality evidence) compared with usual care. CONCLUSION: Exercise during cancer treatment can decrease hospital length of stay and admissions, although a small effect size and high heterogeneity limits the certainty. While exercise is factored into some multidisciplinary care plans, it could be included as standard practice for patients as cancer care pathways evolve.

Experience and impact of gender-based violence in Honiara, Solomon Islands: a cross-sectional study recording violence over a 12-month period.

OBJECTIVE: This study aims to collect data on the experience and impact of gender-based violence experienced by women attending health clinics in Honiara, Solomon Islands. METHOD: Any woman over the age of 18 who attended a local health clinic in Honiara, Solomon Islands during the time of recruitment (ten consecutive weekdays in May 2015) was eligible to participate in an interviewer administered, in-person survey, gathering data on gender-based violence over the past 12 months. RESULTS: A total of 100 women were recruited into this study. Of these women, 47% of women reported experiencing physical or sexual violence in the past 12 months. The most common perpetrators were the woman's husband or boyfriend. There are low rates of reporting, particularly through formal avenues such as to police or village leaders. Alcohol was involved in more than half the cases of reported violence. CONCLUSION: Women in this study report high rates of gender-based violence. To our knowledge, this is the only study examining women's personal experience of gender-based violence in the Solomon Islands, with self-reported data on the frequency and nature of the violence, and the impact on women, including physical and mental, utilisation of healthcare services, police and legal involvement. Efforts to reduce gender-based violence should aim to reduce intimate partner violence, increase reporting and address wider social attitudes towards gender equality.

Interventions for Young Children's Mental Health: A Review of Reviews.

To determine the efficacy of intervention programs for young children (4-9 years) with emerging mental health needs, we conducted a review of meta-analytic and systematic reviews of the intervention literature. Of 41,061 abstracts identified and 15,076 screened, 152 review articles met the inclusion criteria. We reviewed interventions across multiple disciplines targeting: (1) general mental health concerns; (2) internalizing symptoms; (3) externalizing symptoms; (4) anxiety; (5) depression; (6) trauma; (7) symptoms of attention-deficit/hyperactivity disorder; and (8) mental health concerns associated with autism spectrum disorder. Substantial evidence was found for the efficacy of behavioral and cognitive behavioral interventions for general mental health concerns, externalizing symptoms (generally, as well as ADHD, conduct, and other behavioral symptoms) and internalizing symptoms (generally, as well as anxiety) aged 4-9 years. Emerging evidence was identified for interventions targeting trauma symptoms, depression symptoms, and social, emotional and behavioral symptoms in autism spectrum disorder in children aged 4-9 years. Currently there is only limited emerging evidence regarding non-behavioral or non-cognitive behavioral interventions for programs targeting children ages 4-9 years where the aim is to deliver an evidence-based program to improve child social, emotional and/or behavioral functioning. Given the recent rises in mental health needs reported in children, targeted behavioral-and/or cognitive behavior therapy-based interventions should be made widely available to children (and their families) who experience elevated symptoms.

Persistence of the Omicron variant of SARS-CoV-2 in Australia: The impact of fluctuating social distancing.

We modelled emergence and spread of the Omicron variant of SARS-CoV-2 in Australia between December 2021 and June 2022. This pandemic stage exhibited a diverse epidemiological profile with emergence of co-circulating sub-lineages of Omicron, further complicated by differences in social distancing behaviour which varied over time. Our study delineated distinct phases of the Omicron-associated pandemic stage, and retrospectively quantified the adoption of social distancing measures, fluctuating over different time periods in response to the observable incidence dynamics. We also modelled the corresponding disease burden, in terms of hospitalisations, intensive care unit occupancy, and mortality. Supported by good agreement between simulated and actual health data, our study revealed that the nonlinear dynamics observed in the daily incidence and disease burden were determined not only by introduction of sub-lineages of Omicron, but also by the fluctuating adoption of social distancing measures. Our high-resolution model can be used in design and evaluation of public health interventions during future crises.

Health services for aboriginal and Torres Strait Islander children in remote Australia: A scoping review.

In Australia, there is a significant gap between health outcomes in Indigenous and non-Indigenous children, which may relate to inequity in health service provision, particularly in remote areas. The aim was to conduct a scoping review to identify publications in the academic and grey literature and describe 1) Existing health services for Indigenous children in remote Australia and service use, 2) Workforce challenges in remote settings, 3) Characteristics of an effective health service, and 4) Models of care and solutions. Electronic databases of medical/health literature were searched (Jan 1990 to May 2021). Grey literature was identified through investigation of websites, including of local, state and national health departments. Identified papers (n = 1775) were screened and duplicates removed. Information was extracted and summarised from 116 papers that met review inclusion criteria (70 from electronic medical databases and 45 from the grey literature). This review identified that existing services struggle to meet demand. Barriers to effective child health service delivery in remote Australia include availability of trained staff, limited services, and difficult access. Aboriginal and Community Controlled Health Organisations are effective and should receive increased support including increased training and remuneration for Aboriginal Health Workers. Continuous quality assessment of existing and future programs will improve quality; as will measures that reflect aboriginal ways of knowing and being, that go beyond traditional Key Performance Indicators. Best practice models for service delivery have community leadership and collaboration. Increased resources with a focus on primary prevention and health promotion are essential.

A review of risks, adverse effects and mitigation strategies when delivering mental health services using telehealth.

BACKGROUND: This paper presents a scoping review of the peer-reviewed literature regarding reported risks, adverse effects and mitigation factors related to providing mental health services using telehealth. AIMS: The paper aims to describe risks and risk management strategies. METHODS: Publications were included if they reported upon risks, adverse events or mitigation factors experienced, hypothesised or discussed for: any population (any country, any age), service (any mental health services), intervention (telehealth), English language, 2010 to 10 July 2021, any publication type (commentary, research, policy), excluding protocol papers, and self-help tools. The following databases were searched: PsycINFO (from 2010 to 10 July 2021), MEDLINE (2010 to 10 July 2021) and the Cochrane Database from 2010 to 10 July 2021. RESULTS: The search strategy resulted in 1,497 papers and after exclusions a final 55 articles were selected. Results of this scoping review are presented in terms of types of risk, risk by client population, risk by modality (eg group therapy using telehealth) and risk management. CONCLUSIONS: Recommendations for future research include gathering and publishing more detailed information regarding near-miss and actual adverse events when delivering mental health assessment and care using telehealth. In clinical practice, training is required for potential adverse events, and to prevent them and reporting mechanisms in place to collate and learn from these.

Self-harm in adolescence and risk of crash: a 13-year cohort study of novice drivers in New South Wales, Australia.

INTRODUCTION: Self-harm and suicide are leading causes of morbidity and death for young people, worldwide. Previous research has identified self-harm is a risk factor for vehicle crashes, however, there is a lack of long-term crash data post licensing that investigates this relationship. We aimed to determine whether adolescent self-harm persists as crash risk factor in adulthood. METHODS: We followed 20 806 newly licensed adolescent and young adult drivers in the DRIVE prospective cohort for 13 years to examine whether self-harm was a risk factor for vehicle crashes. The association between self-harm and crash was analysed using cumulative incidence curves investigating time to first crash and quantified using negative binominal regression models adjusted for driver demographics and conventional crash risk factors. RESULTS: Adolescents who reported self-harm at baseline were at increased risk of crashes 13 years later than those reporting no self-harm (relative risk (RR) 1.29: 95% CI 1.14 to 1.47). This risk remained after controlling for driver experience, demographic characteristics and known risk factors for crashes, including alcohol use and risk taking behaviour (RR 1.23: 95% CI 1.08 to 1.39). Sensation seeking had an additive effect on the association between self-harm and single-vehicle crashes (relative excess risk due to interaction 0.87: 95% CI 0.07 to 1.67), but not for other types of crashes. DISCUSSION: Our findings add to the growing body of evidence that self-harm during adolescence predicts a range of poorer health outcomes, including motor vehicle crash risks that warrant further investigation and consideration in road safety interventions. Complex interventions addressing self-harm in adolescence, as well as road safety and substance use, are critical for preventing health harming behaviours across the life course.

At the cultural interface: A systematic review of study characteristics and cultural integrity from twenty years of randomised controlled trials with Indigenous participants.

Purpose and aim: To identify and describe characteristics of Randomised Control Trial (RCT) design, implementation, and interpretation with a view tostrengtheningen the cultural integrity and scientific quality of this genre of research when used with, for and by Indigenous peoples. Issue: RCTs are widely regarded as the 'gold standard' method for evaluating the efficacy of an intervention. However, issues of cultural acceptability and higher attrition rates among RCT participants from diverse populations, including Indigenous participants, have been reported. A better understanding of cultural acceptability and attrition rates of RCTs has the potential to impact the translation of findings into effective policies, programs and practice. Method: A search of four electronic databases identified papers describing RCTs enrolling exclusively Australian Indigenous peoples over a 20-year period. The RCTs were assessed using: The Effective Public Health Practice Project's Quality Assessment Tool (EPHPP) and the Aboriginal & Torres Strait Islander Quality Appraisal Tool (QAT). The scores for each paper and the average scores of all papers were visualised using a Microsoft Excel™ Filled Radar Plot. Results: Seventeen trials met the inclusion criteria. There was wide variation in the quality of the included trials as assessed by the EPHPP and almost universally poor results when assessed for cultural appropriateness and integrity by the QAT. Conclusion: The value of the RCT research method, when applied to ultimately improve Australian Indigenous peoples' health, is diminished if issues of cultural integrity are not intrinsic to study design and execution. Our review found that it is feasible to have an RCT with both strong cultural integrity and high scientific quality. Attention to cultural integrity and community engagement, along with methodological rigour, may strengthen community ownership and contribute to more successful study adherence and potentially more effective translation of study findings into policy and practice.

Establishing therapeutic and supportive relationships throughout delivery of a school-based group parenting program via telehealth: Exploring causal pathways.

Background: Access to specialised early intervention mental health services for children, including group counselling for parents/carers, is still a challenge in non-metropolitan areas of Australia. Aim: To gain understanding of the acceptability of a school-based targeted parenting group program delivered via telehealth by exploring the experiences of parents/carers, clinicians and school staff, and asking what works, how, why and in what circumstances. Methods: Caregivers, clinicians and school staff involved in the delivery of a mental health program via telehealth into primary schools in two rural Local Health Districts (LHDs) in southern New South Wales (NSW) were invited to participate in interviews and/or focus group discussions. Thematic analysis of the data was conducted with reference to realist theory. Findings: We conducted semi-structured interviews with 12 caregivers, five semi-structured interviews and two focus group discussions with school staff from six participating schools, and three focus groups with seven clinicians who delivered the intervention. We found that the intervention and micro contexts interacted to influence acceptability by initiating or enhancing cohesion among caregivers, establishing channels of communication between caregivers and teachers, and connection between caregivers and clinicians despite geographic distance. Several adaptations were made to strengthen the therapeutic alliance between caregivers and clinicians. Conclusion: Relationships crucial to the success of delivering psychological group counselling were established. Regional community contexts can facilitate acceptability of parenting group counselling delivered into schools via telehealth. Implementation of the program was flexible enough to allow clinicians to adjust their approach and materials to better suit the telehealth modality.

Identifying potential factors associated with PCR testing for COVID-19 among Australian young people: cross-sectional findings from a longitudinal study.

BACKGROUND: Testing has played a crucial role in reducing the spread of COVID-19. Though COVID-19 symptoms tend to be less severe in adolescents and young adults, their highly social lifestyles can lead to increased transmission of the virus. In this study, we aimed to provide population-based estimates of polymerase chain reaction testing (PCR) for the COVID-19 pandemic and identify factors associated with PCR testing in Australian youth using the latest survey data from the Longitudinal Study of Australian Children (LSAC). METHODS: We used the latest wave (9C1) of the LSAC, collected from 16 to 21-year-old Australians via an online survey between October and December 2020. In total, 2291 youths responded to the questions about COVID-19 testing including factors related to the coronavirus restriction period (CRP) in Australia. Both bivariate and multivariate logistic regression analyses were performed to identify variables (sociodemographic factors and factors related to CRP) associated with COVID-19 testing. RESULTS: During the study period, 26% (n = 587) of Australian youth aged between 16 and 21 years were tested for COVID-19. The strongest predictor of COVID-19 testing was living in major cities (aOR 1.82, 95% CI:1.34-2.45; p < 0.01). Increased age (aOR 1.97, 1.00-3.89; p < 0.05) and having a pre-existing medical condition (aOR 1.27, 1.02-1.59; p < 0.05) were also significantly associated with a higher likelihood of COVID-19 testing. CONCLUSION: Age, remoteness and having a pre-existing medical illness were associated with PCR COVID-19 testing among Australian youth aged between 16 and 21 years in the first year of the COVID-19 pandemic. More research is warranted to identify factors associated with other COVID-19 testing methods and address the specific barriers that may limit COVID-19 testing in this age group.

Media discourse regarding COVID-19 vaccinations for children aged 5 to 11 in Australia, Canada, the United Kingdom and the United States of America: a comparative analysis using the Narrative Policy Framework.

BACKGROUND: Media narratives can shape public opinion and action, influencing people's perceptions and action regarding uptake of paediatric COVID-19 vaccines. COVID-19 has occurred at a time where 'infodemics', 'misinformation', and 'disinformation' are present, and as a result the COVID-19 response has suffered. OBJECTIVE: To investigate how narratives about paediatric COVID-19 vaccines have unfolded in the media of four English-speaking countries; USA, Australia, Canada and the UK. METHODS: The Narrative Policy Framework (NPF) was used to guide the comparative analyses of the major print and online news agencies' media regarding COVID-19 vaccines for the 5 to 11 year old age group. Data were sought using systematic searching on Factiva of four key phases of the paediatric vaccine approval and roll-out. RESULTS: 400 articles (287 for USA, 40 for Australia, 60 for Canada, and 13 for the United Kingdom) fit the search criteria and were included. Using the NPF, the following were identified in each of the articles: hero, villain, victim, plot. The USA was the earliest to vaccinate children, and other countries' media often lauded the USA for this. Australian and Canadian media narratives about 5-11 year old vaccines were commonly about protecting vulnerable people in society, whereas the USA and the UK narratives focused more on the vaccine helping children get back to school. All four countries focused on the 5-11 year old vaccine as being key to 'ending' the pandemic. Australian and Canadian narratives frequently compared vaccine roll-outs across states/provinces, and bemoaned local progress in vaccine delivery in comparison to other countries globally. Canadian and USA narratives highlighted the 'infodemic' about COVID-19 and disinformation regarding child vaccines as impeding uptake. All four of USA, Australia, UK, and Canada used war imagery in reporting about COVID-19 vaccines for children. The advent of the Omicron variant demonstrated that populations were fatigued by COVID-19 and the media reporting increasingly blamed those who were not vaccinated. The UK media narrative was unique in that it frequently described vaccinating children as a distraction from adult COVID-19 vaccination efforts. The USA and Canada had narratives expressing anger about potential vaccine passports for children. In Australia, general practitioners (GPs) were enveloped in the language of heroism. And lastly, the Canadian narrative was unique in expressing the desire to forgo adult COVID-19 vaccine 'boosters', as well as paediatric COVID-19 vaccines in order to ensure other adults globally could receive their initial vaccines. CONCLUSIONS: Public health emergencies require clear, compelling and above all, accurate communication. The stories told in this pandemic are compelling because they contain the classic elements of a narrative, however they can be reductive and inaccurate.

Patient-Reported Experiences and Satisfaction with Rural Outreach Clinics in New South Wales, Australia: A Cross-Sectional Study.

Introduction: Many studies have been conducted on how physicians view outreach health services, yet few have explored how rural patients view these services. This study aimed to examine the patient experience and satisfaction with outreach health services in rural NSW, Australia and the factors associated with satisfaction. Methods: A cross-sectional study was conducted among patients who visited outreach health services between December 2020 and February 2021 across rural and remote New South Wales, Australia. Data on patient satisfaction were collected using a validated questionnaire. Both bivariate (chi-squared test) and multivariate analyses (logistic regression) were performed to identify the factors associated with the outcome variable (patient satisfaction). Results: A total of 207 participants were included in the study. The mean age of respondents was 58.6 years, and 50.2% were men. Ninety-three percent of all participants were satisfied with the outreach health services. Respectful behaviours of the outreach healthcare practitioners were significantly associated with the higher patient satisfaction attending outreach clinics. Conclusions: The current study demonstrated a high level of patient satisfaction regarding outreach health services in rural and remote NSW, Australia. Further, our study findings showed the importance of collecting data about patient satisfaction to strengthen outreach service quality.

Healthcare Avoidance before and during the COVID-19 Pandemic among Australian Youth: A Longitudinal Study.

BACKGROUND: Access to healthcare for young people is essential to ensure they can build a foundation for a healthy life. However, during the COVID-19 pandemic, many people avoided seeking healthcare, adversely affecting population health. We investigated the factors associated with the avoidance of healthcare for Australian young people when they reported that they needed healthcare. We were able to compare healthcare avoidance during the COVID-19 pandemic with healthcare avoidance prior to COVID-19. METHODS: We used two recent data collection waves from the Longitudinal Study of Australian Children (LSAC)-Wave 9C1 during the COVID-19 pandemic in 2020, and Wave 8 data which were collected in 2018. The primary outcome of this study revealed the avoidance of healthcare among those who perceived the need for care. Bivariate analyses and multiple logistic regression models were employed to identify the factors associated with the avoidance of healthcare during the COVID-19 and pre-COVID-19 periods. RESULTS: In the sample of 1110 young people, 39.6% avoided healthcare during the first year of the COVID-19 pandemic even though they perceived that they had a health problem that required healthcare. This healthcare avoidance was similar to the healthcare avoidance in the pre-COVID-19 pandemic period (41.4%). The factors most strongly associated with healthcare avoidance during the COVID-19 pandemic were female gender, an ongoing medical condition, and moderately high psychological distress. In comparison, prior to the pandemic, the factor associated with healthcare avoidance was only psychological distress. The most common reason for not seeking healthcare was thinking that the problem would spontaneously resolve itself (55.9% during COVID-19 vs. 35.7% pre-COVID-19 pandemic). CONCLUSIONS: A large proportion of youths avoided healthcare when they felt they needed to seek care, both during and before the COVID-19 pandemic.

Protective Factors against Self-Harm and Suicidality among Australian Indigenous Adolescents: A Strengths-Based Analysis of the Longitudinal Study of Indigenous Children.

Background: Understanding and encouraging social and emotional well-being (SEWB) among Indigenous adolescents is vital in countering the impacts of colonisation and intergenerational trauma. As self-harm and suicidality are considered markers of poor SEWB among Indigenous communities, we aimed to identify the individual-level and community-level factors protecting Indigenous adolescents from self-harm and suicidality. Methods: Data came from Footprints in Time­The Longitudinal Study of Indigenous Children (waves 10 and 11), conducted among Indigenous families across Australia. A strengths-based analysis fitted multilevel logistic regression to explore associations with factors proposed as protective against self-reported self-harm and suicidality among Indigenous adolescents. Results: Our study cohort included 365 adolescents with complete data for the variables of interest. Adolescents had a mean (SD) age of 14.04 (0.45) years and a sex ratio of almost 1:1, and most were attending school (96.2%). Previous self-harm was reported by 8.2% (n = 30); previous suicidality was reported by 4.1% (n = 15). Individual-level factors protecting against self-harm and suicidality were being male, living in a cohesive family, and having low total Strengths and Difficulty Questionnaire scores (p < 0.05 for all). Residing in major cities compared with regional/remote areas was protective against self-harm (OR 5.94, 95% CI 1.31−26.81). Strong cultural identity was not found to be a protective factor against self-harm and/or suicidality in the sample. Conclusions: This study identified key individual- and community-level factors that can protect Australian Indigenous adolescents against self-harm and suicidality, particularly family cohesion. Identifying strengths for this at-risk population can inform prevention strategies, particularly for rural living adolescents with high distress.

Defining Growing Pains: A Scoping Review.

BACKGROUND AND OBJECTIVES: Up to one third of children may be diagnosed with growing pains, but considerable uncertainty surrounds how to make this diagnosis. The objective of this study was to detail the definitions of growing pains in the medical literature. METHODS: Scoping review with 8 electronic databases and 6 diagnostic classification systems searched from their inception to January 2021. The study selection included peer-reviewed articles or theses referring to "growing pain(s)" or "growth pain(s)" in relation to children or adolescents. Data extraction was performed independently by 2 reviewers. RESULTS: We included 145 studies and 2 diagnostic systems (ICD-10 and SNOMED). Definition characteristics were grouped into 8 categories: pain location, age of onset, pain pattern, pain trajectory, pain types and risk factors, relationship to activity, severity and functional impact, and physical examination and investigations. There was extremely poor consensus between studies as to the basis for a diagnosis of growing pains. The most consistent component was lower limb pain, which was mentioned in 50% of sources. Pain in the evening or night (48%), episodic or recurrent course (42%), normal physical assessment (35%), and bilateral pain (31%) were the only other components to be mentioned in more than 30% of articles. Notably, more than 80% of studies made no reference to age of onset in their definition, and 93% did not refer to growth. Limitations of this study are that the included studies were not specifically designed to define growing pains. CONCLUSIONS: There is no clarity in the medical research literature regarding what defines growing pain. Clinicians should be wary of relying on the diagnosis to direct treatment decisions.