New South Wales Research Articles

Effect of perioperative management on early graft function in living donor paediatric kidney transplantation

Abstract Background Paediatric kidney transplantation has an increased risk of surgical and vascular complications, with intensive care monitoring required postoperatively. This study aimed to determine if perioperative management affects early graft function in living donor paediatric kidney transplantation. Methods Clinical data was extracted from the electronic medical record for living donor kidney transplants at two paediatric centres covering the state of New South Wales (NSW), Australia from 2009 to 2021. Estimated glomerular filtration rate (eGFR) of 7 days and 1-month post-transplant were calculated as measures of early graft function. Results Thirty-nine eligible patients (female n (%) 13 (33%)) with a median (IQR) age of 6 (3–9) years and pre-transplant eGFR of 7 (6–10) mL/min/1.73 m2 were analysed. Mean (SD) central venous pressure (CVP) after revascularisation was 11 (4) mmHg. Intraoperatively, mean volume of fluid administered was 84 (39) mL/kg, and 34 (87%) patients received vasoactive agents. Average systolic blood pressure (BP) in the first 24-h post-transplant was 117 (12) mmHg. Postoperatively, median volume of fluid administered in the first 24 h was 224 (159–313) mL/kg, and 17 (44%) patients received vasoactive agents. Median eGFR 7 days and 1-month post-transplant were 115 (79–148) and 103 (83–115) mL/min/1.73 m2, respectively. Linear regression analyses demonstrated that after adjusting for age, the average CVP after revascularisation and average systolic BP in the first 24-h post-transplant were not associated with eGFR in the first month post-transplant. Conclusions Targeted intraoperative and postoperative fluid and haemodynamic characteristics were achieved but did not correlate with early graft function. Graphical Abstract

Sociodemographic Factors and Presentation Features of Individuals Seeking Mental Health Care in Emergency Departments: A Retrospective Cohort Study.

Emergency Department (ED) presentations for Mental Health (MH) help-seeking have been rising rapidly, with EDs as the main entry point for most individuals in Australia. The objective of this retrospective cohort study was to analyse the sociodemographic and presentation features of people who sought mental healthcare in two EDs located in a regional coastal setting in New South Wales (NSW), Australia from 2016 to 2021. This article is a part of a broader research study on the utilisation of machine learning in MH. The objective of this study is to identify the factors that lead to the admission of individuals to an MH inpatient facility when they seek MH care in an ED. Data were collected using existing records and analysed using descriptive univariate analysis with statistical significance between the two sites was determined using Chi squared test, p < 0.05. Two main themes characterise dominant help-seeking dynamics for MH conditions in ED, suicidal ideation, and access and egress pathways. The main findings indicate that suicidal ideation was the most common presenting problem (38.19%). People presenting to ED who 'Did not wait' or 'Left at own risk' accounted for 10.20% of departures from ED. A large number of presentations arrived via the ambulance, accounting for 45.91%. A large proportion of presentations are related to a potentially life-threatening condition (suicidal ideation). The largest proportion of triage code 1 'Resuscitation' was for people with presenting problem of 'Behavioural Disturbance'. Departure and arrival dynamics need to be better understood in consultation with community and lived experience groups to improve future service alignment with the access and egress pathways for emergency MH care.

Acceptability and timing considerations when administering patient-reported outcome measures (PROMs) among people with chronic health conditions who are culturally and linguistically diverse (CALD): a qualitative study protocol

IntroductionPatient-reported outcome measures (PROMs) are validated and standardised questionnaires that capture patients’ own reports of their symptoms, functioning and well-being. PROMs can facilitate communication between patients and clinicians, reduce symptom...

Early life child protection contacts and developmental risk at age five: a whole-of-population cohort study of 479,413 children in two Australian states.

IntroductionChildren who experience maltreatment have worse health and development outcomes than other children. Early prevention relies on opportunities to respond to system contacts that reliably indicate the population burden of children’s future developmental risk. Objectives and ApproachWe quantified the population burden of developmental vulnerability at age five by the type, timing, and frequency of child protection contacts before school, among children in two Australian states. We used linked whole-population births, child protection and Australian Early Development Census (AEDC) data (2009-2018 cycles) in New South Wales (NSW) and South Australia (SA). Results56,650/398,702 (14%) NSW and 12,617/80,731 (16%) SA children had ≥1 child protection contacts before school. The risk of developmental vulnerability on ≥1 domains was lowest in the no child protection group (NSW, 17-18%; SA, 19%), with higher risks in the child protection report (NSW, 28-29%; SA, 32-35%) through to the OOHC (NSW, 35-38%; SA, 39-50%) groups, with a similar pattern for the risk of medically diagnosed conditions. Children with only one child protection report before school had a higher developmental risk than the no child protection group (NSW, 34% versus 21%; SA, 42% versus 24%). Conclusions/ImplicationsEven a single child protection report in the first 2000 days of children’s lives was a robust indicator of developmental risk at age five, with higher developmental risks among children with more serious child protection contacts before school. Child protection reports represent an under-utilised asset to inform early universal and targeted support from health, human and early education services.

Future Scenarios of Design Rainfall Due to Upcoming Climate Changes in NSW, Australia

The occurrence of rainfall is significantly affected by climate change around the world. While in some places this is likely to result in increases in rainfall, both winter and summer rainfall in most parts of New South Wales (NSW), Australia are projected to decrease considerably due to climate change. This has the potential to impact on a range of hydraulic and hydrologic design considerations for water engineers, such as the design and construction of stormwater management systems. These systems are currently planned based on past extreme rain event data, and changes in extreme rainfall amounts due to climate change could lead to systems being seriously undersized (if extreme precipitation events become more common and/or higher in magnitude) or oversized (if extreme rainfall events become less frequent or decrease in magnitude). Both outcomes would have potentially serious consequences. Consequently, safe, efficient, and cost-effective urban drainage system design requires the consideration of impacts arising from climate change on the approximation of design rainfall. This study examines the impacts of climate change on the probability of occurrence of daily extreme rainfall in New South Wales (NSW), Australia. The analysis was performed for 29 selected meteorological stations located across NSW. Future design rainfall in this research was determined from the projected rainfall for different time periods (2020 to 2039, 2040 to 2059, 2060 to 2079, and 2080 to 2099). The results of this study show that design rainfall for the standard return periods was, in most cases, lower than that derived employing the design rainfall obtained from the Australian Bureau of Meteorology (BoM). While most of the analysed meteorological stations showed significantly different outcomes using the climate change scenario data, this varied considerably between stations and different time periods. This suggests that more work needs to be performed at the local scale to incorporate climate change predicted rainfall data into future stormwater system designs to ensure the best outcomes.

Stimulant treatment for attention-deficit/hyperactivity disorder and risk of first and repeat criminal offending: a population data linkage cohort study

ObjectiveTo examine the effect of stimulant treatment on first and repeat criminal offending among children and young adults with attention deficit-hyperactivity disorder (ADHD). ApproachA population data linkage cohort study of individuals born in New South Wales (NSW), Australia in 1990-2005 and followed until May 2016. Individuals linked to stimulant treatment authorizations for ADHD in the NSW Ministry of Health controlled substance database were frequency matched (1:10) to controls without ADHD. Proven criminal offenses were linked from statewide court records. First and repeat offenses were examined separately using modified cox regression and Prentice, Williams, Peterson (PWP) models, respectively. ResultsThe cohort included 75,650 individuals with ADHD and 745,634 controls. A total of 59,658 individuals (7.3%) committed an offense and individuals with ADHD committed 3 times as many offenses. For all age and sex groups, the risk of a first offense was increased among individuals with ADHD but reduced by treatment (Males 10-17 years, untreated Hazard Ratio (HR) 2.02 95% confidence interval (CI) 1.95, 2.10, treated HR 1.52 95% CI 1.41, 1.62). The effect estimates were reduced for repeat offenses (Males 10-17 years, untreated HR 1.09 95% CI 1.05, 1.13, treated HR 0.97 95% CI 0.90, 1.04) with mixed results for the effect of treatment. ConclusionsIndividuals with ADHD had increased risk of offending, but stimulant treatment reduced the risk of first offenses. This association and benefit of treatment were reduced among prior offenders. ImplicationsAdequate treatment may help keep young people with ADHD out of the criminal justice system.

Aboriginal and Torres Strait Islander people who smoke and want to quit - a cohort profile from the Koori Quit Pack study.

Reducing the prevalence of smoking is a national priority, however there is limited evidence on what smoking cessation supports are utilised, accessible, and effective among Aboriginal and Torres Strait Islander people. This paper describes a cohort profile of Aboriginal and Torres Strait Islander people who smoke and want to quit to inform tailored smoking cessation interventions. Aboriginal and Torres Strait Islander people residing in New South Wales (NSW), Australian Capital Territory (ACT), and Victoria, who were smokers wanting to quit, were recruited through health services and online advertisements from May to October 2022. Descriptive and inferential statistics were used to summarise participant characteristics and explore factors associated with previous use and adherence to Nicotine Replacement Therapy (NRT) and intention to use Quitline services. 165 participants were recruited. Almost all (93.9%) had made at least one previous quit attempt, and 40.6% had used behavioural support. The majority believed NRT was safe (80.6%), effective (70.3%) and tried NRT previously (89%). Preferred forms of NRT for current quit attempts were nicotine patches (85.5%) and inhalers (69.7%). Intention to use Quitline was found to be higher among participants aged 31-45 years compared to participants under 30 years (AOR=3.12, 95%CI, 1.01-9.76). Aboriginal and Torres Strait Islander people are highly motivated to be smoke-free. However, efforts to enhance access and adherence to cessation supports are needed. The rapid recruitment and interest in the mailout cessation support should be scaled up to support Aboriginal and Torres Strait Islander peoples to quit. The Australian Government has recently launched a national tobacco strategy which includes targets for reducing smoking prevalence to less than 27% among Aboriginal and Torres Strait Islander peoples. In order to meet these targets Aboriginal and Torres Strait Islander people who smoke and want to quit should have access to culturally safe and responsive support. We found that Aboriginal and Torres Strait Islander people have made quit attempt, accessed evidence-based smoking cessation care, and have positive attitudes towards NRT. However, acknowledging relapse, further evidence is required to understand the factors associated with sustained quitting.

A forgotten pioneer in Australian psychiatry: Dr Edward Waldegrave Wardley (1813-1872).

British-born Dr Edward Waldegrave Wardley (MRCSL, 1842) is an unacknowledged pioneer in the history of mental health care in Australia. Between 1857 and 1872, he assisted in the development of a policy of non-restraint across lunatic asylums in New South Wales (NSW). He then went on to extend this approach to the treatment of NSW's criminally insane patients. In addition, he trialled experiments to intellectually engage educated psychiatric patients across the colony. A prolific writer, and sufferer of chronic depression, Dr Wardley serves as a unique example of a nineteenth-century alienist with lived experience of mental illness.

Tidal Impoundment and Mangrove Dieback at Cabbage Tree Basin, NSW: Drivers of Change and Tailored Management for the Future

Major storms can cause significant changes to coastal and wetland environments. A series of storm events in 2020 resulted in closure of the historically open estuary at Cabbage Tree Basin, Port Hacking, New South Wales (NSW), Australia. Prolonged tidal impoundment (3 months) led to substantial changes in hydrological and sedimentological processes, resulting in widespread mangrove dieback. This study aimed to quantify the degree of impact and recovery for mangroves, identify factors contributing to dieback, and consider the implications for carbon sequestration. This was achieved using remotely piloted aircraft structure-from-motion approaches, aerial photography, and field-based assessments of vegetation health and above-ground biomass (AGB). Mangroves were classified as ‘dead’, ‘partially dead’, and ‘live’. In October 2019, there was 10.8 ha of live mangroves, with this reduced to 6.6 ha by August 2022. Digital surface models (DSMs) were intersected with classified mangroves to assess the vertical distribution of each zone. All mangroves classified as ‘dead’ were distributed at elevations < 0.4 m with respect to the Australian Height Datum (AHD), suggesting these regions were persistently inundated, which was confirmed by water level loggers (inundated during logger deployment). Field data confirmed substrate elevation related to dieback with the proportion of ‘live’ mangroves greatest at elevations > 0.6 m AHD. Substrate elevation and distance to the estuary mouth were significantly correlated with species, with Avicennia marina located at lower tidal positions and closer to the entrance compared to Aegiceras corniculatum. The dieback event equated to a loss of 81.5 ± 48 Mg of above-ground biomass, 38.1 ± 22.5 Mg C, or 140 ± 82 Mg CO2 equivalence (CO2e). This study provides an important baseline for monitoring dieback events. Continued monitoring is crucial to assess recovery and to tailor management strategies.

Young Onset Dementia in New South Wales, Australia in 1891: What has Changed Since Then?

This study aimed to determine the prevalence and types of young onset dementia (YOD) in New South Wales (NSW), Australia, in 1891 with comparisons to 21st century estimates. Changes might inform future service planning for persons with YOD. Medical case books of two Hospitals for the Insane were examined at the State Archives and clinical and sociodemographic information extracted of persons who were under the age of 65 in April 1891, when a NSW Census occurred, and were given a dementia diagnosis or had symptoms consistent with dementia. Consensus 21st century 'probable' and 'possible' all cause dementia and major neurocognitive disorder diagnoses were determined by two psychiatrists. Prevalence estimates of moderate-severe dementia were determined and compared with 21st century estimates and dementia types. Of 161 potential dementia cases, 123 were given a consensus 'probable' dementia diagnosis, 28 a 'possible' dementia diagnosis, and ten were given a non-dementia diagnosis, with 'all cause dementia' and 'major neurocognitive disorder' diagnoses identical. Most dementia cases were male (n=119, 78.8%). 'Unspecified dementia' was the most frequent diagnosis (n=47, 31.1%), followed by dementia secondary to syphilis (n=35, 23.2%), epileptic dementia (n=30, 19.9%), alcohol-related dementia (n=17, 11.3%), and mixed dementia (n=16, 10.6%). Epileptic dementia had the youngest average age of admission (34.9years). Other than epileptic dementia, all other dementia types were more frequent in males. Prominent clinical symptoms included neurological signs (n=79, 52.3%), psychosis (n=77, 51.0%), agitation (n=75, 49.7%), and aggression (n=45, 29.8%). Most dementia cases either died in hospital (n=79, 52.3%) or were transferred to a long stay hospital (n=57, 37.7%). The estimated point prevalence of YOD in persons aged 30-59 in 1891 (86 per 100,000) was higher than current Australian and global estimates in this age group due to the high rates in males (126per 100,000), but in those aged 60-64, the prevalence in 1891 (159per 100,000) was much lower than current estimates. This first examination of YOD in the nineteenth century found high rates of dementia in those under the age of 60 compared with current estimates, particularly in men aged between 30 and 59years old, and largely due to syphilis, alcohol and epilepsy, conditions that are now treatable and thus demonstrating the potential of effective treatments for YOD.

The resurgence of influenza A/H3N2 virus in Australia after the relaxation of COVID-19 restrictions during the 2022 season.

This study retrospectively analyzed the genetic characteristics of influenza A H3N2 (A/H3N2) viruses circulating in New South Wales (NSW), the Australian state with the highest number of influenza cases in 2022, and explored the phylodynamics of A/H3N2 transmission within Australia during this period. Sequencing was performed on 217 archived specimens, and A/H3N2 evolution and spread within Australia were analyzed using phylogenetic and phylodynamic methods. Hemagglutinin genes of all analyzed NSW viruses belonged to subclade 3C.2a1b.2a.2 and clustered together with the 2022 vaccine strain. Complete genome analysis of NSW viruses revealed highly frequent interclade reassortments between subclades 3C.2a1b.2a.2 and 3C.2a1b.1a. The estimated earliest introduction time of the dominant subgroup 3C.2a1b.2a.2a.1 in Australia was February 22, 2022 (95% highest posterior density: December 19, 2021-March 13, 2022), following the easing of Australian travel restrictions, suggesting a possible international source. Phylogeographic analysis revealed that Victoria drove the transmission of A/H3N2 viruses across the country during this season, while NSW did not have a dominant role in viral dissemination to other regions. This study highlights the importance of continuous surveillance and genomic characterization of influenza viruses in the postpandemic era, which can inform public health decision-making and enable early detection of novel strains with pandemic potential.

Factors associated with electroconvulsive therapy treatment for adults with serious psychiatric conditions in Australia.

To identify factors associated with receiving electroconvulsive therapy (ECT) for serious psychiatric conditions. Retrospective observational study using hospital administrative data linked with death registrations and outpatient mental health data in New South Wales (NSW), Australia. The cohort included patients admitted with a primary psychiatric diagnosis between 2013 and 2022. The outcome measure was receipt of ECT. Of 94,950 patients, 3465 (3.6%) received ECT. The likelihood of receiving ECT was higher in older (hazard ratio [HR] = 1.03), female (HR = 1.24) patients. Compared to depression, patients with schizophrenia/schizoaffective disorder (HR = 0.79), schizophrenia-related disorders (HR = 0.37), mania (HR = 0.64) and other mood disorders (HR = 0.45) had lower odds of receiving ECT. Patients with depression and one other serious psychiatric condition had higher odds of receiving ECT than depression alone. Bipolar disorder likelihood of ECT did not differ from depression. A higher number of mental health outpatient visits in the prior year and an involuntary index admission with depression were also associated with receiving ECT. Likelihood of receiving ECT increased with year of admission (HR = 1.32), private patient status (HR = 2.06), higher socioeconomic status (HR = 1.09) and being married (HR = 1.25). ECT use for depression and bipolar disorder in NSW aligns with clinical national guidelines. Patients with schizophrenia/schizoaffective, schizophrenia-related disorders, mania and other mood disorders had lower likelihood of ECT than depression, despite ECT being recommended by clinical guidelines for these diagnoses. Variations in ECT were strongly associated with healthcare access, with private patients twice as likely to receive ECT than their public counterparts, suggesting a need to explore ECT accessibility.

Feline Encounters Down Under: Investigating the Activity of Cats and Native Wildlife at Sydney's North Head.

Cats (Felis catus) are widespread across Australia, including within natural and protected areas, and in many areas, cats, including owned domestic cats, are not restricted in where or when they can roam. In Australia, cats have contributed to the decline of many native species and continue to be a problem for governments. North Head, Manly, is home to an endangered population of Long-nosed Bandicoot (Perameles nasuta) and the only mainland breeding colony of Little Penguin (Eudyptula minor) in New South Wales (NSW). Camera traps were installed for a 5-week period across North Head to determine the spatial and temporal distribution of cat activity. As well as capturing instances of cats, the cameras detected native animals such as birds, possums, Long-nosed Bandicoots and other small mammals. An analysis of the camera images showed cats could be found within protected areas of the headland (where cats are prohibited) and along the boundary with the adjacent suburban area of Manly. Cats were mostly detected during the night. There were high occurrences of overlap between cats and Long-nosed Bandicoots (Dhat 0.82), possums (Dhat 0.88) and other small mammals (Dhat 0.67). These findings indicate that cats are active across the Manly headland at the same time as native animals, both within protected areas where cats are prohibited and in adjacent residential areas, and this could have implications for these populations.

Assessing the implementation of healthy eating and physical activity policies and practices in Early Childhood Education and Care in New South Wales, Australia: A cross-sectional study.

Australian children are not meeting the recommended physical activity (PA) and healthy eating (HE) guidelines. Health behaviour practices implemented in community settings such as early education services can improve child's health outcomes and are therefore key to help meet guidelines. This study aimed to measure the implementation of HE and PA policies and practices in Early Childhood Education and Care (ECEC) services in New South Wales (NSW), Australia, and to examine their association with service characteristics. A random sample of 1122 centre-based ECEC services were invited to a cross-sectional survey measuring HE and PA policy and practice implementation. Regression analyses were conducted to assess the relationship between the service characteristics and implementation of policies/practices. In total, 565 ECEC services completed the survey. Results show that while some practices are implemented, the implementation of practices promoting HE and PA education is low. Practices related to educator training for HE (18%) and PA (13%) were poorly implemented. The implementation of practices such as 'providing educator training around child PA', 'engaging families in activities to increase child PA' and 'encouraging supportive feeding practices' were significantly higher in services located in major cities than regional/remote services. 'Having a PA policy' and the practice of 'limiting the use of screen time' was significantly higher in long day care services than in preschools. The implementation of 'providing educator-led PA', 'providing free play opportunities' and 'having a PA policy' was significantly lower in private not-for-profit community managed services than in private for-profit services. Implementation of various HE and PA policies and practices in regional/remote services, private not-for-profit services and preschools across NSW could be improved. SO WHAT?: Future research should be prioritised towards identifying factors influencing the implementation of these policies and practices to best tailor implementation support efforts for those who need it the most.

Beyond the Preamble: Legislating the right to self-determination in a NSW Human Rights Act

This article examines the inclusion of the right to self-determination in existing models of state and territory human rights legislation and proposes its inclusion in a future human rights act in New South Wales (NSW), to advance the rights of First Peoples in the criminal justice system. I explore how this would provide a mechanism for state restraint and a legal framework for prioritising self-determined First Nations critique, research and service delivery in carceral systems. The role of courts in holding the state to account and developing legal pluralism in rights jurisprudence is also discussed.

Determining the best practice for Sydney rock oyster, Saccostrea glomerata, reef restoration and enhanced ecological benefits

BackgroundShellfish reef restoration is relatively new in Australia, particularly to intertidal estuarine environments. In late 2019/early 2020 the first large-scale shellfish reef restoration project of the Sydney rock oyster, Saccostrea glomerata was undertaken in the Myall and Karuah Rivers, Port Stephens, on the mid north coast of New South Wales (NSW), Australia. The present study aimed to determine whether locally sourced clean conspecific oyster shells, and/or locally quarried rocks were better for natural recruitment of natural S. glomerata for large-scale oyster reef restoration, and subsequent recruitment of fishes and invertebrates. Over two years, recruitment of S. glomerata spat, and associated fishes and invertebrates were assessed on reefs made of: (1) rock, and (2) rock and shell.ResultsThe mean (± SE) density of oyster spat on rock reefs (Myall River: 1790 ± 48, Karuah River: 1928 ± 68) was significantly greater (Myall River: ANOVA Si: MS 2, 18 = 31080167, F = 96.05, P < 0.001, Karuah River: ANOVA Si x Ti: MS 18, 270 = 2965449, F = 5.99, P < 0.001) than on rock and shell reefs (Myall River: 840 ± 40, Karuah River: 1505 ± 75). Rock reefs had significantly greater densities (Myall River: ANOVA Si x Ti: MS 18, 270 = 15657, F = 2.71, P < 0.001, Karuah River: ANOVA Si x Ti: MS 18, 270 = 20322, F = 5.25, P < 0.001) of the most abundant invertebrate, Bembicium auratum (Myall River: 85 ± 9, Karuah River: 100 ± 8) than reefs of rock and shell (Myall River: 59 ± 8, Karuah River: 44 ± 5), but there was no significant difference in the diversity and relative abundance of the most abundant species of fish, Acanthopagrus australis.ConclusionsThis study demonstrates that using locally sourced rock is better for S. glomerata recruitment than shells. Although shell might have benefits that were not investigated in the present study, such as elicit greater social licence for oyster reef restoration projects, but as shown here, it may not be beneficial from an ecological perspective. With the global expansion of the range of different native species of reef oysters for restoration, the appropriate material used for reef bases needs to be chosen for a specific species and purpose.

Does gambling expenditure have any effect on crime?

Australians spend more per capita on gambling than any other country in the world. Electronic gaming machines (EGM) expenditure accounts for almost 90% of this expenditure. No study to date has conducted a rigorous longitudinal analysis of the relationship between gambling expenditure and crime. This study aimed to estimate the short-and long-run relationship between gambling expenditure and crime. Longitudinal analysis using panel autoregressive distributed lag (ARDL) modelling. Recorded property and violent crimes committed in New South Wales (NSW), Australia,between 28 December 2015 and 5 January 2020. Monthly gross EGM expenditure profit, broken down by Local Government Area (LGA). Monthly recorded rates of assault, break enter and steal (dwelling), break enter and steal (non-dwelling), break enter and steal (total), motor vehicle theft, stealing from a motor vehicle, stealing from a retail store, stealing from the person, stealing (total) and fraud. Each 10% increase in gambling expenditure in NSW is associated with annual: 7.4% increase in assaults, 10.5% increase in break and enter (dwelling) offences; 10.3% increase in break and enter (non-dwelling) offences; 11% increase in motor vehicle theft offences; 8.2% increase in stealing from motor vehicle offences; and 7.4% increase in fraud offences. Electronic gaming expenditure appears to be positively associated with property and violent crime in New South Wales, Australia.

The development of a new oral health patient reported outcome measure: the New South Wales public dental services approach

BackgroundAddressing Patient Reported Outcomes (PROs) is essential for patient-centred care, shared decision making and improved health outcomes. Value-based health care systems in New South Wales (NSW) have a growing focus on collecting and using PROs that matter most to patients to improve their healthcare outcomes. Developing oral health patient reported outcomes measures (OH-PROM) is a first step towards value-based oral health care. This paper describes the development process of an adult and child OH-PROM tool that can be piloted for NSW public dental patients.MethodsAn expert panel was assembled to undertake a systematic process of developing OH-PROMs for NSW Health. Key methodological considerations included: (1) forming an expert panel to specify the target population and context of implementation, (2) rapid literature review and environmental scan to identify existing validated OH-PROM tools for adults and children. (3) consensus gathering with the expert panel (4) consumer feedback, and (5) finalisation of the tool for electronic oral health record (eOHR) integration to establish a set of questions, that were relevant, context-appropriate, and important to oral healthcare outcomes for patients using public dental services.ResultsThe panel considered a total of 59 questions from two child (15), and four adult (44) Oral Health Related Quality of Life (OHRQoL) questionnaires used to collect OH-PROMs. These questions were mapped to the four key dimensions of OHRQoL for OH-PROMs: Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact. The consensus resulted in seven questions that aligned with these four dimensions to form two new NSW OH-PROM tools: one for adults and one for children. The tools were tested with consumers for understandability and usefulness before being incorporated into the electronic oral health record system, in readiness for future pilot testing.ConclusionThe process for developing new OH-PROMs for NSW public dental services took a pragmatic approach that combined literature appraisal, expert consensus, and consumer consultation. Future work will assess the implementation of the OH-PROM tool and test its validity for broader use as an outcome measure for value-based oral healthcare.

Nutrition and physical activity practices in family day care: A cross-sectional survey of Australian family day care educators.

Munch & Move is a New South Wales (NSW) Ministry of Health program offering family day care (FDC) educators training to support children's healthy behaviours. This study examined educators' nutrition, physical activity and screen time practices and relationships between Munch & Move training and professional development (PD) on these practices. NSW FDC educators (n = 186) completed an online survey from July 2020-June 2021. Differences between groups based on Munch & Move training (trained; not trained) and PD (those who completed PD ≥1 time per year; those who completed PD <1 time per year or never) were tested using bivariate analyses. A significantly higher proportion of educators trained in Munch & Move offered information to families regarding food serving sizes, nutrition policies, and children's physical activity and screen time. Over one-third in both groups did not meet the guideline of no screen time for children under 2 years old. Compared with those who completed PD ≥1 time per year, a significantly higher proportion of educators who completed PD <1 time per year or never did not provide families with nutrition guidelines or resources. Educators trained in Munch & Move, and those who completed PD more frequently, demonstrated better nutrition, physical activity and screen time practices in several areas. SO WHAT?: This study demonstrated benefits of the Munch & Move program, implemented with support from Local Health District health promotion officers, and highlighted key areas for improvement in healthy practices in FDC.

Racialised identities of multilingual teachers: stories, experiences and agentic action of Indonesian teachers in Australian schools

ABSTRACT In a context of increasing deficit discourses about multiculturalism and multilingualism, this study examined the racialised identities of multilingual Indonesian teachers in secondary schools in New South Wales (NSW), Australia. Informed by the Douglas Fir Group Framework (2016), the study unpacked teachers’ socio-cultural, and linguistic trajectories in schools to understand the ways in which they navigate, negotiate, and resist their racialised identities at micro, meso, and macro levels of activity. Through semi-structured interviews with six Indonesian teachers teaching Bahasa Indonesia in NSW schools, the study focused on three broad dimensions, namely: (i) teachers’ perceived racialised identities in connection with their students and colleagues in schools (micro); (ii) the perceived institutional practices that reproduce racialisation and marginalisation (meso); and (iii) the broader societal factors that contribute to ‘self’ and ‘other’ racialisation (macro). Thematic analysis of the interview data reveal that teachers identify systemic ‘thinking’ and ‘doing’ that essentialise their racialised identities, Additionally, the racialisation of Indonesian language teachers in broader societal contexts is influenced by systemic factors, including language policies and institutional structures. Findings suggest that despite the pervasive forces which perpetuate monolithic thinking in schools, teachers engage in agentic action that seeks to resist and overcome their racialised identities.