Children In Melbourne Research Articles

The association between device-measured sitting time and cardiometabolic health risk factors in children

BackgroundThere is limited evidence of the associations between postural-derived sitting time, waist-worn derived sedentary time and children’s health and the moderation effect of physical activity (PA). This study examined associations of children’s device-measured sitting time with cardiometabolic health risk factors, including moderation by physical activity.MethodsCross-sectional baseline data from children (mean-age 8.2 ± 0.5 years) in Melbourne, Australia (2010) participating in the TransformUs program were used. Children simultaneously wore an activPAL to assess sitting time and an ActiGraph GT3X to assess sedentary time and physical activity intensity. Cardiometabolic health risk factors included: adiposity (body mass index [BMI], waist circumference [WC]), systolic and diastolic blood pressure (SBP, DBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), cholesterol, triglycerides, fasting plasma glucose (FPG), serum insulin, and 25-hydroxyvitaminD (25[OH]D). Linear regression models (n = 71–113) assessed associations between sitting time with each health risk factor, adjusted for different PA intensities (i.e. light [LIPA], moderate-vigorous intensities [MVPA], separately on each model), age, sex, adiposity, and clustering by school. Interaction terms examined moderation. The analyses were repeated using device-measured sedentary time (i.e. ActiGraph GT3X) for comparison.ResultsSitting time was positively associated with SBP (b = 0.015; 95%CI: 0.004, 0.026), DBP (b = 0.012; 95%CI:0.004, 0.020), and FPG (b = 0.001; 95%CI: 0.000, 0.000), after adjusting for higher PA intensities. The association between sitting time and insulin (b = 0.003; 95%CI: 0.000, 0.006) was attenuated after adjusting for higher PA intensities. When the models were adjusted for LIPA and MVPA, there was a negative association with LDL (b=-0.001; 95%CI: -0.002, -0.000 and b=-0.001; 95%CI: -0.003, -0.000, respectively). There was a negative association of sedentary time with WCz (b=-0.003; 95%CI: -0.005, 0.000) and BMIz (b=-0.003; 95%CI: -0.006, -0.000) when the models were adjusted by MVPA. Sedentary time was positively associated with triglycerides (b = 0.001; 95%CI: 0.000, 0.001) but attenuated after adjusting for MVPA. No evidence of moderation effects was found.ConclusionsHigher volumes of sitting and sedentary time were associated with some adverse associations on some cardiometabolic health risk factors in children. These associations were more evident when sitting time was the predictor. This suggests that reducing time spent sitting may benefit some cardiometabolic health outcomes, but future experimental research is needed to confirm causal relationships and identify the biological mechanisms that might be involved.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12609000715279.

Catch-up immunisation for migrant children in Melbourne: A qualitative study with providers to determine key challenges

BackgroundCurrent models of immunisation service delivery in Australia are not meeting the needs of migrant children, who experience a higher burden of vaccine preventable disease and lower immunisation rates compared to non-migrant children. Understanding the experiences of immunisation providers is critical for designing effective and tailored interventions to improve this service. This study aimed to identify the facilitators and barriers to providers delivering a comprehensive catch-up immunisation service to migrant children in Melbourne, Australia. MethodsSemi-structured interviews with council and general practice immunisation providers were conducted. Recorded interviews were transcribed and coded inductively using thematic analysis. Identified themes were then deductively categorised according to the Capability, Opportunity and Motivation of Behaviour (COM-B) model. ResultsTwenty-four providers (five practice nurses, six general practitioners, six council nurses and seven council administration officers) were interviewed between March and June 2021. Fourteen themes were identified that contributed to the delivery of an effective catch-up immunisation service. Capability themes included training, experience and skills to perform the service and communicate with families. Opportunity themes incorporated time, workplace norms, traits of migrant families, costs, systems and resources. Themes related to motivation were provider responsibility, beliefs about migrant health, and immunisation prioritisation. ConclusionsKey barriers for providers to deliver a comprehensive catch-up immunisation service were related to opportunity. Developing an online tool to support catch-up schedule development and reporting, and funding provider time to calculate the schedule are primary actions that could overcome opportunity barriers. Capability and motivation barriers for general practitioners included limited time, skills, and motivation compared to nurses. These barriers may be overcome with improvements to training that focus on upskilling nurses to deliver the catch-up service. Service delivery challenges are multifactorial, requiring a range of strategies to optimise this service and increase immunisation coverage in migrant children.

Three trajectories of gestational weight gain identified in an Australian twin study

ObjectivesGestational weight gain (GWG) has been associated with maternal and child health outcomes, but knowledge of appropriate GWG for twin gestations is limited. Study designThe Peri/Postnatal Epigenetic Twins Study is a prospective twin cohort study of 250 women and their twin children in Melbourne, Australia. We modeled trajectories of GWG using group-based growth modeling and compared these trajectories to GWG categories (within, above, or below current GWG recommendations for twin pregnancy). We fitted robust linear and Poisson regression models to assess associations of maternal pre-pregnancy and gestational exposures with risk of gaining weight outside the recommendations. ResultsOf the 250 women enrolled in the PETS, GWG measures were available for 172 women. Forty-seven percent of women had GWG within the current recommendations. We identified three GWG trajectories – 23.6% of women had low GWG throughout pregnancy, 34.5% had average GWG throughout pregnancy, and 42.0% had average initial GWG, followed by high GWG from trimester two until delivery. Gestational diabetes mellitus (GDM) was associated with increased risk of inadequate GWG (RR: 2.40, 95%CI: 1.53, 3.75). Pre-pregnancy obesity (RR: 1.88, 95%CI: 1.09, 3.26) and hypertensive disorders of pregnancy (RR: 2.64, 95%CI: 1.20, 5.81) were associated with increased risk of excessive GWG. ConclusionsMore than half of the women in the PETS did not meet the current GWG recommendations. Women with GDM or hypertensive disorders were more likely to gain weight outside these guidelines. More research is needed to establish comprehensive guidelines for twin pregnancies.

Backyard benefits? A cross-sectional study of yard size and greenness and children\u2019s physical activity and outdoor play

BackgroundThe home environment is the most important location in young children’s lives, yet few studies have examined the relationship between the outdoor home environment and child physical activity levels, and even fewer have used objectively measured exposures and outcomes. This study examined relationships between objectively assessed home yard size and greenness, and child physical activity and outdoor play.MethodsData were drawn from the HealthNuts study, a longitudinal study of 5276 children in Melbourne, Australia. We used cross-sectional data from a sample at Wave 3 (2013–2016) when participants were aged 6 years (n = 1648). A sub-sample of 391 children had valid accelerometer data collected from Tri-axial GENEActive accelerometers worn on their non-dominant wrist for 8 consecutive days. Yard area and greenness were calculated using geographic information systems. Objective outcome measures were minutes/day in sedentary, light, and moderate-vigorous physical activity (weekday and weekend separately). Parent-reported outcome measures were minutes/day playing outdoors (weekend and weekday combined). Multi-level regression models (adjusted for child’s sex, mother’s age at the birth of child, neighbourhood socioeconomic index, maternal education, and maternal ethnicity) estimated effects of yard size and greenness on physical activity.ResultsData were available on outdoor play for 1648 children and usable accelerometer data for 391. Associations between yard size/greenness and components of physical activity were minimal. For example, during weekdays, yard size was not associated with daily minutes in sedentary behaviour (β: 2.4, 95% CI: − 6.2, 11.0), light physical activity (β: 1.4, 95% CI: − 5.7, 8.5) or MVPA (β: -2.4, 95% CI: − 6.5, 1.7), with similar patterns at weekends. There was no relationship between median annual yard greenness and physical activity or play.ConclusionIn our study of young children residing in higher socio-economic areas of Melbourne yard characteristics did not appear to have a major impact on children’s physical activity. Larger studies with greater variation in yard characteristics and identification of activity location are needed to better understand the importance of home outdoor spaces and guide sustainable city planning.

COVID-19 public health measures and respiratory viruses in children in Melbourne.

AimTo describe the epidemiology of respiratory viruses in children before and during the 2020 SARS‐CoV‐2 pandemic and the relationship to public health measures instituted by the Victorian government.MethodsRetrospective audit of respiratory viruses at a tertiary paediatric hospital in Melbourne from January 2015 up to week 47, 2020 in children under 18 years of age. The proportion of positive cases in weeks 1–47 in 2015–2019 (period 1) were compared to weeks 1–47, 2020 (period 2), and reviewed in the context of public health restrictions in Victoria.ResultsAn annual average of 4636 tests were performed in period 1 compared to 3659 tests in period 2. Proportions of positive influenza A virus, influenza B virus, respiratory syncytial virus (RSV) and human parainfluenza virus were significantly reduced in period 2 compared to period 1: 77.3, 89.4, 68.6 and 66.9% reductions, respectively (all P < 0.001). From week 12–47, 2020, 28 893 SARS‐CoV‐2 tests were performed with a 0.64% positivity rate. Influenza viruses were not detected after week 17, RSV was not detected after week 35.ConclusionsStrict public health measures and border closures were successful in eliminating community transmission of SARS‐CoV‐2 in Melbourne. This was associated with a significant reduction in other respiratory virus infections in children. Identifying sustainable and effective ongoing public health interventions to reduce transmission of RSV and influenza could result in reduced morbidity and mortality in children and requires further research.

An Investigation into Interchange between Elderly Women and their Separated Adult Children in Melbourne:

An Investigation into Interchange between Elderly Women and their Separated Adult Children in Melbourne:

Standby Mothering: Temporalities, Affects, and the Politics of Mobile Intergenerational Care

ABSTRACT In this paper, I showcase how left-behind mothers in the Philippines use digital communication technologies in delivering care to their overseas adult children in Melbourne, Australia. As part of a broader research project on transnational family life, the findings were drawn upon in-depth interviews, visual methods, a simple participant observation, and field notes taking and analysis. The study deployed a mediated mobilities lens, paying close attention to the different forces that shape the provision of intergenerational care through mobile device use. Building upon a critical analysis of the digitalization of intergenerational relationships in a transnational context, I coin the term ‘standby mothering.’ This conception encapsulates the femininized, ubiquitous, networked, and ambivalent intergenerational care practices that are experienced and negotiated by distant mothers. On the one hand, mobile device use enables left-behind mothers to deliver emotional and practical caregiving. On the other hand, everyday temporal conditions and technological barriers impede the provision of intergenerational care. Communicative constraints are constantly managed through various tactics, ensuring the sustenance of transnational relationships. By interrogating the contradictory outcomes of transnational caregiving, I underscore the politics of mediated mobilities in a digital society. Here, the mobilization of gendered, networked, and differential care practices is influenced by uneven structural and even socio-technological dimensions. Ultimately, this paper elucidates a critical stance on re-examining the provision of informal, gendered, and networked care practices.

The self-as-mother in the preschool years: an interpretive phenomenological analysis

AbstractThere has been little research into the well-being of mothers after 12 months post-partum, despite researchers finding that depressive symptoms are more prevalent at 4 years post-partum than at any other time preceding this. The literature suggests that a woman’s view of the mother role impacts on her well-being in the early years of parenting. This qualitative research study investigated the experiences of mothers of preschool-aged children in Melbourne, Australia, and how they incorporated the role of mother into their self. Eight semi-structured interviews were completed, and interpretive phenomenological analysis was used to explore the data. The data revealed four subthemes relating to the emergence of the maternal self: becoming a mother as a journey of self-discovery, the biological imperatives of becoming a mother, remothering and the continued challenges of the emerging mother role. Although the experiences of mothering are as diverse as women themselves, even in the mostly homogenous sample, as in this study, several themes were present that both support and diverge from the existing literature.

Parenthood and cars: A weakening relationship?

A wide body of research supports the notion that the travel behaviour of families with children tends to be car dependent. Yet recent literature suggests a more varied set of travel practices are emerging among this group. Using data from a large-scale household travel survey, we explored whether changes are evident in levels of car use among three household groups in Melbourne, Australia. The three groups were selected to broadly represent a sequential order of life stages: Young Couples, Young Families, and School-age Families. Chi square and two-tailed t tests were used to examine changes in travel behaviour between 2007 and 2013/2014. Negative binomial regression analysis was then conducted to examine characteristics predicting vehicle, walking and public transit trips, among the three groups. Vehicle trips decreased for all groups between 2007 and 2013/2014; the decline was greatest among households with children present, both young and school-age. This suggests that a shift towards more sustainable travel behaviour is indeed apparent among families with young and school-age children in Melbourne. However, further research is required to understand the causes of the decline and to examine evidence of the decline in other locations.

Patterning of neighbourhood food outlets and longitudinal associations with children's eating behaviours

This study examined cross-sectional and prospective associations between typologies of neighbourhood food environment and dietary patterns among 10–12 year-old children. Baseline data were collected in 2003 and follow-up data in 2006 from children in Melbourne or Geelong. Parents completed a food frequency questionnaire at both time points. ‘Healthful’ and ‘energy-dense’ dietary pattern scores were computed. A Geographic Information System was used to determine the presence or absence of food outlets (cafés/restaurant; fast food; supermarkets/grocery stores; convenience store; greengrocer; and butcher, seafood or poultry retailer) within an 800 m road network buffer of home. Three typologies were identified: 1-variety of food outlets, including those selling core/fresh foods (n = 96); 2-café/restaurant and convenience (n = 160); 3-few types of outlets (n = 208). Latent class analysis was used to identify underlying unobservable typologies of neighbourhood food outlet availability. Linear mixed models were fitted to determine cross-sectional (n = 439) and longitudinal (n = 173) associations between the three identified neighbourhood typologies and each (log-transformed) dietary pattern, accounting for clustering within families and schools. There was little evidence of cross-sectional associations. The longitudinal analyses showed that compared to those with a variety of food outlets, those with few types had 25% lower scores for the healthful dietary pattern (p < 0.05) three years later. For optimal dietary patterns, availability of a variety of food outlets close to home, particularly those where core/fresh foods are available, may be important.

Early Childhood Vegetable, Fruit, and Discretionary Food Intakes Do Not Meet Dietary Guidelines, but Do Show Socioeconomic Differences and Tracking over Time

BackgroundDietary intakes of young children are likely to be important determinants of their short- and long-term health, yet there are few longitudinal dietary studies of this age group, and no previous assessments of diets before age 2 years compared with national dietary guidelines. ObjectiveThis study aimed to compare vegetable, fruit, and discretionary food intakes of children aged 9 months to 5 years to dietary guidelines, and to assess differences in intakes by socioeconomic status and tracking of intakes across early childhood. DesignThis study analyzed longitudinal data from the Melbourne Infant Feeding Activity and Nutrition Trial Program early childhood lifestyle intervention trial, and is the first study to compare diets of children younger than age 2 years to national dietary guidelines. Participants/settingParticipants were 467 children in Melbourne, Australia, aged 4 months at baseline (study conducted 2008-2015). Main outcome measuresMultiple 24-hour recalls with parents were conducted at child ages 9 months, 1.5 years, 3.5 years, and 5 years. Statistical analyses performedIntakes of vegetables, fruits, and discretionary foods were compared with Australian Dietary Guidelines. Differences by socioeconomic status and tracking of intakes of each food group were assessed by multivariable linear regression. ResultsFew children (<10%) met guidelines for discretionary food intakes at any age. Most children (≥90%) met vegetable and fruit guidelines at 9 months, but thereafter rates of adequate intakes reduced substantially. Children of higher socioeconomic status consumed diets closer to guidelines for most food groups at most ages. Tracking of intakes was apparent across ages, with the strongest and most consistent tracking for discretionary foods. ConclusionsThis study shows that diets of Australian children participating in this lifestyle intervention trial were suboptimal from early life. The evidence of differences by socioeconomic status and tracking from age 9 months, particularly for discretionary foods, highlights the importance of research and action to support appropriate introduction of complementary foods during the first year of life, and of focusing these efforts on disadvantaged groups.

Feasibility and Efficacy ofa Parent-Focused, Text Message-Delivered Intervention toReduce Sedentary Behavior in 2- to 4-Year-Old Children (Mini Movers): Pilot Randomized Controlled Trial.

BackgroundDespite public health guidelines to limit sedentary behavior, many young children spend large amounts of time sedentary (eg, screen and sitting time) during waking hours.ObjectiveThe objective of this study was to test the feasibility and efficacy of a parent-focused, predominantly text message–delivered intervention to support parents to reduce the amount of time their children spend in sedentary behavior.MethodsMini Movers was a pilot randomized controlled trial delivered to parents of 2- to 4-year-old children in Melbourne, Australia. Participants were recruited through playgroups, social media, and snowball sampling. Eligibility criteria were having an ambulatory child (2-4 years), English literacy, and smartphone ownership. Participants were randomized to intervention or wait-list control on a 1:1 ratio after baseline data collection. The 6-week intervention was predominantly delivered via text messages, using a Web-based bulk text message platform managed by the interventionist. Intervention strategies focused on increasing parental knowledge, building self-efficacy, setting goals, and providing reinforcement, and were underpinned by the Coventry, Aberdeen & London-Refined taxonomy of behavior change techniques and social cognitive theory. The primary outcome was intervention feasibility, measured by recruitment, retention, intervention delivery, and fidelity; process evaluation questionnaires; and qualitative interviews with a subsample of participants. Secondary outcomes were children’s screen and restraint time (parent report), sitting time (parent report, activPAL), and potential mediators (parent report). Linear regression models were used to determine intervention effects on secondary outcomes, controlling for the child’s sex and age and clustering by playgroup; effect sizes (Cohen's d) were calculated.ResultsA total of 57 participants (30 intervention; 27 wait-list control) were recruited, and retention was high (93%). Process evaluation results showed that the intervention was highly acceptable to parents. The majority of intervention components were reported to be useful and relevant. Compared with children in the control group, children in the intervention group had significantly less screen time postintervention (adjusted difference [95% CI]=−35.0 [−64.1 to −5.9] min/day; Cohen's d=0.82). All other measures of sedentary behavior were in the expected direction, with small to moderate effect sizes.ConclusionsMini Movers was shown to be a feasible, acceptable, and efficacious pilot intervention for parents of young children, warranting a larger-scale randomized control trial.Trial RegistrationAustralian New Zealand Clinical Trials registry: ACTRN12616000628448; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?ACTRN=12616000628448p (Archived by WebCite at http://www.webcitation.org/ 6wZcA3cYM)

The prevalence of food allergy and other allergic diseases in early childhood in a population-based study: HealthNuts age 4-year follow-up

The HealthNuts study previously reported interim prevalence data showing the highest prevalence of challenge-confirmed food allergy in infants internationally. However, population-derived prevalence data on challenge-confirmed food allergy and other allergic diseases in preschool-aged children remain sparse. This study aimed to report the updated prevalence of food allergy at age 1year from the whole cohort, and to report the prevalence of food allergy, asthma, eczema, and allergic rhinitis at age 4years. HealthNuts is a population-based cohort study with baseline recruitment of 5276 one-year-old children who underwent skin prick test (SPT) to 4 food allergens and those with detectable SPT results had formal food challenges. At age 4years, parents completed a questionnaire (81.3% completed) and those who previously attended the HealthNuts clinic at age 1year or reported symptoms of a new food allergy were invited for an assessment that included SPT and oral food challenges. Data on asthma, eczema, and allergic rhinitis were captured by validated International Study of Asthma and Allergies in Childhood questionnaires. The prevalence of challenge-confirmed food allergy at age 1 and 4years was 11.0% and 3.8%, respectively. At age 4years, peanut allergy prevalence was 1.9% (95% CI, 1.6% to 2.3%), egg allergy was 1.2% (95% CI, 0.9% to 1.6%), and sesame allergy was 0.4% (95% CI, 0.3% to 0.6%). Late-onset peanut allergy at age 4years was rare (0.2%). The prevalence of current asthma was 10.8% (95% CI, 9.7% to 12.1%), current eczema was 16.0% (95% CI, 14.7% to 17.4%), and current allergic rhinitis was 8.3% (95% CI, 7.2% to 9.4%). Forty percent to 50% of this population-based cohort experienced symptoms of an allergic disease in the first 4years of their life. Although the prevalence of food allergy decreased between age 1year and age 4years in this population-based cohort, the prevalence of any allergic disease among 4-year-old children in Melbourne, Australia, is remarkably high.

Mothers’ ideals and experiences of raising children in inner and outer suburban Melbourne, Australia

ABSTRACTParents’ perceptions of their neighbourhoods are important for child health outcomes. This study compared views among mothers in inner versus outer suburbs of Melbourne, Australia using a mixed methods approach. Mothers of preschool-aged children were recruited via playgroups, mother’s groups and preschools and interviewed face-to-face regarding their local area as a good place to raise a family, with a second open-ended interview focussing on mothers’ ideals and experiences of raising children in their current location. Findings demonstrated that mothers had different ideals for, and experiences of, raising their children in their neighbourhoods. Inner suburban mothers valued a manageable work/family balance and access to public transport over the size of their homes. However, access to childcare, secondary schooling and heavy traffic were issues, with the latter two being reasons for moving from the municipality. In contrast, outer suburban mothers preferred a larger home in neighbourhoods that they perceived as low crime, over accessibility to work. Access to a car and activities for their children were also important. Findings suggest no ‘one size fits all’ in respect to what features mothers expect from a good place to raise a family, or how they experience these features. This has implications for service delivery and social planning of suburbs.

Influencing the Influencers: The Role of Mothers in IT Career Choices

This paper reports on the outcomes from a pilot study targeted at mothers of school children in Melbourne, Australia. The aim of the study was to engender a positive view of technology in the participants and to introduce the concept of Information Technology (IT) as a potential career. Mothers were given the opportunity to develop basic IT skills and learn about different IT career pathways for their children with an emphasis on their daughters’ choices. Mothers were offered an evening course over a four week period that was designed to introduce them to a range of social media and Web 2.0 tools. Their opinions were documented using both questionnaires and informal discussions. It explored whether their attitudes towards IT can be changed by up-skilling and introducing them to the technologies their children commonly use. The findings of the pilot study suggest that addressing this demographic has the potential to make the participants question their pre-conceptions about IT careers for women.

Food Decisions Among Cambodian Migrant Mothers in Melbourne, Australia

Existing research suggests that children are largely affected by the health and eating behaviours practiced and normalised in their family and home environment. Few studies have considered specifically how migrant parents choose food for their children. This paper examines the food decisionmaking process of Cambodian mothers for their children in Melbourne. Nine Cambodian mothers were individually interviewed in this study. They were asked to discuss their experiences and perceptions of their food decision-making process. Data analysis showed six major themes: Home-food decisions, factors influencing home-food decisions, fast-food and school tuckshop-food decisions, factors influencing fast-food and school tuckshop-food decisions, and settlement experience and acculturation. Overall, the findings suggest that the challenges and aspirations of mothers in relation to providing food for their children were not about meeting demands and negotiating with children on food decisions, instead it was having enough financial capital and time to put healthy food on the table. This paper contributes to the limited literature on the food decision-making process of migrant mothers for their children in the context of socio-economic and settlement challenges.

Improving outcomes of preschool language delay in the community: protocol for the Language for Learning randomised controlled trial

BackgroundEarly language delay is a high-prevalence condition of concern to parents and professionals. It may result in lifelong deficits not only in language function, but also in social, emotional/behavioural, academic and economic well-being. Such delays can lead to considerable costs to the individual, the family and to society more widely. The Language for Learning trial tests a population-based intervention in 4 year olds with measured language delay, to determine (1) if it improves language and associated outcomes at ages 5 and 6 years and (2) its cost-effectiveness for families and the health care system.Methods/DesignA large-scale randomised trial of a year-long intervention targeting preschoolers with language delay, nested within a well-documented, prospective, population-based cohort of 1464 children in Melbourne, Australia. All children received a 1.25-1.5 hour formal language assessment at their 4th birthday. The 200 children with expressive and/or receptive language scores more than 1.25 standard deviations below the mean were randomised into intervention or ‘usual care’ control arms. The 20-session intervention program comprises 18 one-hour home-based therapeutic sessions in three 6-week blocks, an outcome assessment, and a final feed-back/forward planning session. The therapy utilises a ‘step up-step down’ therapeutic approach depending on the child’s language profile, severity and progress, with standardised, manualised activities covering the four language development domains of: vocabulary and grammar; narrative skills; comprehension monitoring; and phonological awareness/pre-literacy skills. Blinded follow-up assessments at ages 5 and 6 years measure the primary outcome of receptive and expressive language, and secondary outcomes of vocabulary, narrative, and phonological skills.DiscussionA key strength of this robust study is the implementation of a therapeutic framework that provides a standardised yet tailored approach for each child, with a focus on specific language domains known to be associated with later language and literacy. The trial responds to identified evidence gaps, has outcomes of direct relevance to families and the community, includes a well-developed economic analysis, and has the potential to improve long-term consequences of early language delay within a public health framework.Trial registrationCurrent Controlled Trials ISRCTN03981121.

The role of seasonal grass pollen on childhood asthma emergency department presentations

Few studies have focused on the role of grass pollen on asthma emergency department (ED) presentations among children. None have examined whether a dose-response effect exists between grass pollen levels and these asthma exacerbations. To examine the association between increasing ambient levels of grass pollen and asthma ED presentations in children. To determine whether these associations are seen only after a thunderstorm, or whether grass pollen levels have a consistent influence on childhood asthma ED visits during the season. A short time series ecological study was conducted for asthma presentations to ED among children in Melbourne, Victoria, and grass pollen, meteorological and air quality measurements recorded during the selected 2003 period. A semi-parametric Poisson regression model was used to examine dose-response associations between daily grass pollen levels and mean daily ED attendance for asthma. A smoothed plot suggested a dose-response association. As ambient grass pollen increased to about 19 grains/m(3) , the same day risk of childhood ED presentations also increased linearly (P < 0.001). Grass pollen levels were also associated with an increased risk in asthma ED presentations on the following day (lag 1, P < 0.001). This is the first study to establish a clear relationship between increased risk of childhood asthma ED attendance and levels of ambient grass pollen below 20 grains/m(3) , independent of any impact of thunderstorm-associated asthma. These findings have important implications for patient care, such as asthma management programs that notify the general public regarding periods of high grass pollen exposure, as well as defining the timing of initiation of pollen immunotherapy.

The Role of Seasonal Grass Pollen on Childhood Asthma Emergency Department Presentations

Identifying high grass pollen days is important for asthma management programs that issue warnings to patients who are at an increased risk of an asthma attack due to grass pollen exposure. We sought to examine the association between increasing ambient concentrations of grass pollen and asthma Emergency Department (ED) presentations in children during the 2003 grass pollen season in Melbourne, Victoria; and whether there was any added influence from thunderstorms. A short time series ecological study was conducted of ED presentations for asthma in children in Melbourne, Victoria and grass pollen, meteorological and air quality measurements recorded during the selected 2003 period. A semi-parametric Poisson regression model was used to examine the dose-response associations between daily grass pollen levels and mean daily ED attendances for asthma among children. A smoothed plot suggested a dose-response association - as ambient grass pollen increased to about 19 grains/m3 the same day risk of childhood ED presentations also increased (p < 0.001). Grass pollen levels were also associated with an increased risk in asthma ED presentations on the following day (lag 1, p < 0.001). This is the first study to establish a clear relationship between increased risk of childhood asthma ED attendance and increasing levels of ambient grass pollen below 20 grains/m3, independent of thunderstorm-associated asthma. Lower levels of pollen may contribute to asthma symptoms, so the limits of the pollen season may need to be reviewed and this in turn could affect the timing of immunotherapy.

Television viewing, television content, food intake, physical activity and body mass index: a cross-sectional study of preschool children aged 2–6 years

The mechanisms underlying the relationship between television (TV) viewing and weight status in preschool aged children are not well understood. This study aimed to explore the relationships between preschool children's TV viewing habits (i.e. time spent viewing, content watched and foods eaten while viewing), daily food intake, general physical activity levels and their body mass index (BMI). A cross-sectional sample of preschool children in Melbourne (n = 135). Mothers of preschoolers completed a 3-day TV diary; information was collected on viewing time, content and food consumed while watching TV. Mothers also reported their child's height, weight and physical activity behaviour. Associations between study and outcome variables were determined by bivariate correlations and hierarchical regression analyses. Mean age of preschoolers was 4.5 years and 14% were overweight or obese. The mean daily time spent watching TV was 90.7 minutes (SD 50.7) A small, positive correlation was found between viewing TV on weekdays and child BMIz, (p<0.05). This effect was moderate when controlled for total kilojoules consumed while watching TV (on weekdays) and number of minutes spent in sedentary activities (across three days). This study suggests that TV viewing may affect preschool child weight status through displacement of physical activity or eating while viewing.