The effect of the 'Swim Reaper' program on water safety awareness, drowning mortality and morbidity among males aged 15-34 years in Aotearoa, New Zealand.

BACKGROUND AND OBJECTIVE: To increase water safety awareness among young males New Zealand introduced the Swim Reaper program in 2016. The program ran annually over summer and in 2018/19 an evaluation was conducted. The objective of this study was to evaluate the impact of the 2018/19 Swim Reaper social media-based campaign on self-reported water safety awareness and identify changes in fatal and nonfatal drowning rates for New Zealand resident males aged 15-34 years before and after the 2016 Swim Reaper program. METHODS: Online surveys pre (December-2018) and post (February-March-2019) Swim Reaper campaign were used to estimate water safety awareness post-campaign relative to pre-campaign using negative binomial regression adjusted for potential confounders. Interrupted time series (ITS) analysis, adjusted for seasonality, explored changes in drowning mortality, hospital admissions and Accident Compensation Corporation (ACC) claims pre and post program introduction (2016). RESULTS: A total of 518 males responded (50.6% post-campaign). There were significant improvements (post vs. pre-campaign) in self-reported water safety awareness. ITS analysis showed a reduction in drowning related hospital admissions post relative to pre-program (RR = 0.47; [95%CI: 0.24-0.90]; p = 0.02). DISCUSSION: Young males are an at-risk cohort for drowning and creating behavior change among this group can be challenging. Using a unique, humor-based approach the Swim Reaper program appears to be having some impact on self-reported water safety behaviors, as well as unintentional drowning-related hospitalization rates. Further evaluation, more clearly linked to campaign themes, is required to ascertain direct impact of the program. CONCLUSION: The novelty and reach of the campaign within the context of a prevailing downward trend in drownings may provide support for social media-based programs targeting this hard-to-reach demographic.

Enriching Data Science and Health Care Education: Application and Impact of Synthetic Data Sets Through the Health Gym Project.

Large-scale medical data sets are vital for hands-on education in health data science but are often inaccessible due to privacy concerns. Addressing this gap, we developed the Health Gym project, a free and open-source platform designed to generate synthetic health data sets applicable to various areas of data science education, including machine learning, data visualization, and traditional statistical models. Initially, we generated 3 synthetic data sets for sepsis, acute hypotension, and antiretroviral therapy for HIV infection. This paper discusses the educational applications of Health Gym's synthetic data sets. We illustrate this through their use in postgraduate health data science courses delivered by the University of New South Wales, Australia, and a Datathon event, involving academics, students, clinicians, and local health district professionals. We also include adaptable worked examples using our synthetic data sets, designed to enrich hands-on tutorial and workshop experiences. Although we highlight the potential of these data sets in advancing data science education and health care artificial intelligence, we also emphasize the need for continued research into the inherent limitations of synthetic data.

Readmission to a non-index hospital following total joint replacement.

Aims: It is unclear whether mortality outcomes differ for patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) surgery who are readmitted to the index hospital where their surgery was performed, or to another hospital. Methods: We analyzed linked hospital and death records for residents of New South Wales, Australia, aged ≥ 18 years who had an emergency readmission within 90 days following THA or TKA surgery between 2003 and 2022. Multivariable modelling was used to identify factors associated with non-index readmission and to evaluate associations of readmission destination (non-index vs index) with 90-day and one-year mortality. Results: Of 394,248 joint arthroplasty patients (THA = 149,456; TKA = 244,792), 9.5% (n = 37,431) were readmitted within 90 days, and 53.7% of these were admitted to a non-index hospital. Non-index readmission was more prevalent among patients who underwent surgery in private hospitals (60%). Patients who were readmitted for non-orthopaedic conditions (62.8%), were more likely to return to a non-index hospital compared to those readmitted for orthopaedic complications (39.5%). Factors associated with non-index readmission included older age, higher socioeconomic status, private health insurance, and residence in a rural or remote area. Non-index readmission was significantly associated with 90-day (adjusted odds ratio (aOR) 1.69; 95% confidence interval (CI) 1.39 to 2.05) and one-year mortality (aOR 1.31; 95% CI 1.16 to 1.47). Associations between non-index readmission and mortality were similar for patients readmitted with orthopaedic and non-orthopaedic complications (90-day mortality aOR 1.61; 95% CI 0.98 to 2.64, and aOR 1.67; 95% CI 1.35 to 2.06, respectively). Conclusion: Non-index readmission was associated with increased mortality, irrespective of whether the readmission was for orthopaedic complications or other conditions.

Developmental trajectories of socio-emotional outcomes of children and young people in out-of-home care - Insights from data of Pathways of Care Longitudinal Study (POCLS).

BACKGROUND: There has been a limited understanding of the longitudinal trajectory and determinants of socio-emotional outcomes among children in out-of-home care (OOHC). OBJECTIVES: This study aimed to examine child socio-demographics, pre-care maltreatment, placement, and caregiver factors associated with trajectories of socio-emotional difficulties of children in OOHC. PARTICIPANTS AND SETTING: The study sample (n = 345) included data from the Pathways of Care Longitudinal Study (POCLS), a prospective longitudinal cohort of children aged 3-17 years who entered the OOHC system in New South Wales (NSW) Australia, between 2010 and 2011. METHODS: Group-based trajectory models were used to identify distinct socio-emotional trajectory groups based on the Child Behaviour Check List (CBCL) Total Problem T-scores completed at all four Waves 1-4. Modified Poisson regression analysis was conducted to assess the association (risk ratios) of socio-emotional trajectory group membership with pre-care maltreatment, placement, and caregiver-related factors. RESULTS: Three trajectories of socio-emotional development were identified: 'persistently low difficulties' (average CBCL T-score changed from 40 to 38 over time), normal (average CBCL T-score changed from 52 to 55 over time), and clinical (average CBCL T-score remained at 68 over time) trajectories. Each trajectory presented a stable trend over time. Relative/kinship care, as compared with foster care, was associated with the "persistently low" socio-emotional trajectory. Being male, exposure to ≥8 pre-care substantiated risk of significant harm (ROSH) reports, placement changes, and caregiver's psychological distress (more than two-fold increased risk) were associated with the clinical socio-emotional trajectory. CONCLUSIONS: Early intervention to ensure children have a nurturing care environment and psychological support to caregivers are vital for positive socio-emotional development over time among children in long-term OOHC.

An interactive geographic information system to inform optimal locations for healthcare services.

Large health datasets can provide evidence for the equitable allocation of healthcare resources and access to care. Geographic information systems (GIS) can help to present this data in a useful way, aiding in health service delivery. An interactive GIS was developed for the adult congenital heart disease service (ACHD) in New South Wales, Australia to demonstrate its feasibility for health service planning. Datasets describing geographic boundaries, area-level demographics, hospital driving times, and the current ACHD patient population were collected, linked, and displayed in an interactive clinic planning tool. The current ACHD service locations were mapped, and tools to compare current and potential locations were provided. Three locations for new clinics in rural areas were selected to demonstrate the application. Introducing new clinics changed the number of rural patients within a 1-hour drive of their nearest clinic from 44·38% to 55.07% (79 patients) and reduced the average driving time from rural areas to the nearest clinic from 2·4 hours to 1·8 hours. The longest driving time was changed from 10·9 hours to 8·9 hours. A de-identified public version of the GIS clinic planning tool is deployed at https://cbdrh.shinyapps.io/ACHD_Dashboard/. This application demonstrates how a freely available and interactive GIS can be used to aid in health service planning. In the context of ACHD, GIS research has shown that adherence to best practice care is impacted by patients' accessibility to specialist services. This project builds on this research by providing opensource tools to build more accessible healthcare services.

Software Application Profile: The daggle app-a tool to support learning and teaching the graphical rules of selecting adjustment variables using directed acyclic graphs.

MOTIVATION: Directed acyclic graphs (DAGs) are used in epidemiological research to communicate causal assumptions and guide the selection of covariate adjustment sets when estimating causal effects. For any given DAG, a set of graphical rules can be applied to identify minimally sufficient adjustment sets that can be used to adjust for bias due to confounding when estimating the causal effect of an exposure on an outcome. The daggle app is a web-based application that aims to assist in the learning and teaching of adjustment set identification using DAGs. GENERAL FEATURES: The application offers two modes: tutorial and random. The tutorial mode presents a guided introduction to how common causal structures can be presented using DAGs and how graphical rules can be used to identify minimally sufficient adjustment sets for causal estimation. The random mode tests this understanding by presenting the user with a randomly generated DAG-a daggle. To solve the daggle, users must correctly identify a valid minimally sufficient adjustment set. IMPLEMENTATION: The daggle app is implemented as an R shiny application using the golem framework. The application builds upon existing R libraries including pcalg to generate reproducible random DAGs, dagitty to identify all valid minimal adjustment sets and ggdag to visualize DAGs. AVAILABILITY: The daggle app can be accessed online at [http://cbdrh.shinyapps.io/daggle]. The source code is available on GitHub [https://github.com/CBDRH/daggle] and is released under a Creative Commons CC BY-NC-SA 4.0 licence.

Uptake of Team Care Arrangements for adults newly diagnosed with cancer.

BACKGROUND: Medicare-subsidised Team Care Arrangements (TCAs) support Australian general practitioners to implement shared care between collaborating health professionals for patients with chronic medical conditions and complex needs. We assessed the prevalence of TCAs, factors associated with TCA uptake and visits to TCA-subsidised allied health practitioners, for adults newly diagnosed with cancer in New South Wales, Australia. METHODS: We carried out a retrospective individual patient data linkage study with 13 951 45 and Up Study participants diagnosed with incident cancer during 2006-16. We used a proportional hazards model to estimate the factors associated with receipt of a TCA after cancer diagnosis. RESULTS: In total, 6630 patients had a TCA plan initiated (47.5%). A TCA was more likely for patients aged ≥65years, those with higher service utilisation 4-15months prior to cancer diagnosis, a higher number of comorbidities, lower self-rated overall health status, living in areas of greater socio-economic disadvantage, lower educational attainment and those with no private health insurance. A total of 4084 (61.6%) patients with a TCA had at least one TCA-subsidised allied health visit within 24months of the TCA. CONCLUSIONS: TCAs appear to be well targeted at cancer patients with chronic health conditions and lower socioeconomic status. Nevertheless, not all patients with a TCA subsequently attended a TCA-subsidised allied healthcare professional. This suggests either a misunderstanding of the plan, the receipt of allied health via other public schemes, a low prioritisation of the plan compared to other health care, or suboptimal availability of these services.

Estimating incidence rates of periprosthetic joint infection after hip and knee arthroplasty for osteoarthritis using linked registry and administrative health data.

AIMS: The aim of this study was to estimate the 90-day periprosthetic joint infection (PJI) rates following total knee arthroplasty (TKA) and total hip arthroplasty (THA) for osteoarthritis (OA). METHODS: This was a data linkage study using the New South Wales (NSW) Admitted Patient Data Collection (APDC) and the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), which collect data from all public and private hospitals in NSW, Australia. Patients who underwent a TKA or THA for OA between 1 January 2002 and 31 December 2017 were included. The main outcome measures were 90-day incidence rates of hospital readmission for: revision arthroplasty for PJI as recorded in the AOANJRR; conservative definition of PJI, defined by T84.5, the PJI diagnosis code in the APDC; and extended definition of PJI, defined by the presence of either T84.5, or combinations of diagnosis and procedure code groups derived from recursive binary partitioning in the APDC. RESULTS: The mean 90-day revision rate for infection was 0.1% (0.1% to 0.2%) for TKA and 0.3% (0.1% to 0.5%) for THA. The mean 90-day PJI rates defined by T84.5 were 1.3% (1.1% to 1.7%) for TKA and 1.1% (0.8% to 1.3%) for THA. The mean 90-day PJI rates using the extended definition were 1.9% (1.5% to 2.2%) and 1.5% (1.3% to 1.7%) following TKA and THA, respectively. CONCLUSION: When reporting the revision arthroplasty for infection, the AOANJRR substantially underestimates the rate of PJI at 90 days. Using combinations of infection codes and PJI-related surgical procedure codes in linked hospital administrative databases could be an alternative way to monitor PJI rates.Cite this article: Bone Joint J 2022;104-B(9):1060-1066.

Modelling vaccination capacity at mass vaccination hubs and general practice clinics: a simulation study.

BACKGROUND: COVID-19 mass vaccination programs place an additional burden on healthcare services. We aim to model the queueing process at vaccination sites to inform service delivery. METHODS: We use stochastic queue network models to simulate queue dynamics in larger mass vaccination hubs and smaller general practice (GP) clinics. We estimate waiting times and daily capacity based on a range of assumptions about appointment schedules, service times and staffing and stress-test these models to assess the impact of increased demand and staff shortages. We also provide an interactive applet, allowing users to explore vaccine administration under their own assumptions. RESULTS: Based on our assumed service times, the daily throughput for an eight-hour clinic at a mass vaccination hub ranged from 500 doses for a small hub to 1400 doses for a large hub. For GP clinics, the estimated daily throughput ranged from about 100 doses for a small practice to almost 300 doses for a large practice. What-if scenario analysis showed that sites with higher staff numbers were more robust to system pressures and mass vaccination sites were more robust than GP clinics. CONCLUSIONS: With the requirement for ongoing COVID-19 booster shots, mass vaccination is likely to be a continuing feature of healthcare delivery. Different vaccine sites are useful for reaching different populations and maximising coverage. Stochastic queue networks offer a flexible and computationally efficient approach to simulate vaccination queues and estimate waiting times and daily throughput to inform service delivery.

Children's Relative Age and Medicine Treatment for Attention-Deficit/Hyperactivity Disorder Across Australian Jurisdictions with Different School Enrolment Policies.

Background: Children who are relatively young for their school grade are more likely to receive treatment for attention-deficit/hyperactivity disorder (ADHD). It is unclear whether the phenomenon also exists across Australia or is impacted by the school enrolment policy in place. Objective: We evaluated the association between children's relative age and initiation of ADHD medicines across Australian jurisdictions with different school enrolment policies and rates of delayed school entry. Methods: We used Australia-wide dispensing data for a 15% random sample of children 4-9 years of age in 2013-2017 to create a nationwide cohort. Due to high rates of delayed school entry in New South Wales (NSW), we used linked prescribing and education data for a cohort of NSW residents starting school in 2009 and 2012. We estimated incidence rate ratios (IRRs) for ADHD medicine across children's birth month, sex, and jurisdiction. We used asthma medicines as a negative control. Results: For girls, we observed a relative age effect in three out of five jurisdictions, with an IRR ranging from 1.3 to 2.8, comparing the youngest versus oldest birth month thirds. We observed more modest effects among boys, ranging from null to 1.5-fold. In NSW, the relatively youngest boys were less likely to initiate stimulant medicines than the oldest (IRR = 0.5, 95% confidence interval 0.29-0.78). We did not observe a relative age effect for initiation of asthma medicines. Conclusions: In jurisdictions with low rates of delayed entry, relatively young children were more likely to initiate ADHD medicines than their older classmates. We observed the inverse association in NSW where delayed entry was highest, likely reflecting the characteristics and needs of children who delay school entry for 1 year and become the oldest children in the grade. Increased awareness around children's maturity differences and school readiness may enhance appropriate diagnosis and treatment of ADHD.

The impact of re-opening the international border on COVID-19 hospitalisations in Australia: a modelling study.

OBJECTIVE: To estimate the numbers of COVID-19-related hospitalisations in Australia after re-opening the international border. DESIGN: Population-level deterministic compartmental epidemic modelling of eight scenarios applying various assumptions regarding SARS-CoV-2 transmissibility (baseline R0 = 3.5 or 7.0), vaccine rollout speed (slow or fast), and scale of border re-opening (mean of 2500 or 13 000 overseas arrivals per day). SETTING: Simulation population size, age structure, and age-based contact rates based on recent estimates for the Australian population. We assumed that 80% vaccination coverage of people aged 16 years or more was reached in mid-October 2021 (fast rollout) or early January 2022 (slow rollout). MAIN OUTCOME MEASURES: Numbers of people admitted to hospital with COVID-19, December 2021 - December 2022. RESULTS: In scenarios assuming a highly transmissible SARS-CoV-2 variant (R0  = 7.0), opening the international border on either scale was followed by surges in both infections and hospitalisations that would require public health measures beyond mask wearing and social distancing to avoid overwhelming the health system. Reducing the number of hospitalisations to manageable levels required several cycles of additional social and mobility restrictions. CONCLUSIONS: If highly transmissible SARS-CoV-2 variants are circulating locally or overseas, large and disruptive COVID-19 outbreaks will still be possible in Australia after 80% of people aged 16 years or more have been vaccinated. Continuing public health measures to restrict the spread of disease are likely to be necessary throughout 2022.

Vaccinating Australia: How long will it take?

The Australian Government began to roll out the national COVID-19 vaccination program in late February 2021, with the initial aim to vaccinate the Australian adult population by the end of October 2021. The task of vaccinating some 20 million people presents considerable logistic challenges, but a rapid rollout is essential to allow for the reopening of borders and is especially urgent as new more transmissible variants arise. Here, we run a series of projections to estimate how long it will take to vaccinate the Australian population under different assumptions about the rate of vaccine administration, the schedule for vaccine eligibility and prevalence of vaccine hesitancy. Our analysis highlights the number of vaccine doses that can be administered per day as the key factor determining the duration of the vaccine rollout. A rate of 200,000 doses per day would achieve 90% population coverage by the end of 2021; 80,000 doses a day would see the rollout extended until mid-2023. Vaccine hesitancy has the potential to greatly slow down the rollout and becomes the main limiting factor when the supply of vaccine doses is high. Speed is of the essence when it comes vaccinating populations against COVID-19: a rapid rollout will minimise the risk of sporadic and costly lockdowns and the potential for small, local clusters getting out of control and sparking new epidemic waves. In order to achieve rapid population coverage, the Australian government must ramp up vaccine administration to at least 200,000 doses per day as quickly as possible, while also promoting vaccine willingness in the community through clear public health messaging, especially to known hesitant demographics.

Pregnancy and birth characteristics of Aboriginal twins in two Australian states: a data linkage study.

INTRODUCTION: Perinatal outcomes for singleton pregnancies are poorer, on average, for Aboriginal people than non-Aboriginal people, but little is known about Aboriginal multifetal pregnancies. Yet multifetal pregnancies and births are often more complicated and have poorer outcomes than singleton pregnancies. We describe the pregnancies, births and perinatal outcomes for Aboriginal twins born in Western Australia (WA) and New South Wales (NSW) with comparisons to Aboriginal singletons in both states and to non-Aboriginal births in NSW. MATERIALS AND METHODS: Whole-population birth records and birth and death registrations were linked for all births during 2000-2013 (WA) and 2002-2008 (NSW). Hospital records and the WA Register of Developmental Anomalies - Cerebral Palsy were linked for all WA births and hospital records for a subset of NSW births. Descriptive statistics are reported for maternal and child demographics, maternal health, pregnancy complications, births and perinatal outcomes. RESULTS: Thirty-four thousand one hundred twenty-seven WA Aboriginal, 32,352 NSW Aboriginal and 601,233 NSW non-Aboriginal births were included. Pregnancy complications were more common among mothers of Aboriginal twins than Aboriginal singletons (e.g. 17% of mothers of WA twins had hypertension/pre-eclampsia/eclampsia vs 8% of mothers of singletons) but similar to mothers of NSW non-Aboriginal twins. Most Aboriginal twins were born in a principal referral, women's or large public hospital. The hospitals were often far from the mother's home (e.g. 31% of mothers of WA Aboriginal twins gave birth at hospitals located more than 3 h by road from their home). Outcomes were worse for Aboriginal liveborn twins than Aboriginal singletons and non-Aboriginal twins (e.g. 58% of NSW Aboriginal twins were preterm compared to 9% of Aboriginal singletons and 49% non-Aboriginal twins). CONCLUSIONS: Mothers of Aboriginal twins faced significant challenges during the pregnancy, birth and the postnatal period in hospital and, in addition to accessible specialist medical care, these mothers may need extra practical and psychosocial support throughout their journey.

Medications used disproportionately during pregnancy: Priorities for research on the risks and benefits of medications when used during pregnancy.

PURPOSE: To identify medications used disproportionately more or less among pregnant women relative to women of childbearing age. METHODS: Medication use among pregnant women in New South Wales, Australia was identified using linked perinatal and pharmaceutical dispensing data from 2006 to 2012. Medication use in women of childbearing age (including pregnant women) was identified using pharmaceutical dispensing data for a 10% random sample of the Australian population. Pregnant social security beneficiaries (n = 111 612) were age-matched (1:3) to female social security beneficiaries in the 10% sample. For each medication, the risk it was dispensed during pregnancy relative to being dispensed during an equivalent time period among matched controls was computed. Medications were mapped to Australian pregnancy risk categories. RESULTS: Of the 181 included medications, 35 were statistically significantly more commonly dispensed to pregnant women than control women. Of these, 23 are categorised as posing no increased risk to the foetus. Among medications suspected of causing harm or having insufficient safety data, the strongest associations were observed for hydralazine, ondansetron, dalteparin sodium and ranitidine. Use was less likely during pregnancy than control periods for 127 medications, with the strongest associations observed for hormonal contraceptives and progestogens. CONCLUSIONS: Most medications found to be used disproportionately more by pregnant women are indicated for pregnancy-related problems. A large number of medications were used disproportionately less among pregnant women, where avoidance of some of these medications may pose a greater risk of harm. For many other medications avoided during pregnancy, current data are insufficient to inform this risk-benefit assessment.

Preschool attendance and developmental outcomes at age five in Indigenous and non-Indigenous children: a population-based cohort study of 100 357 Australian children.

BACKGROUND: Policies to increase Australian Indigenous children's participation in preschool aim to reduce developmental inequities between Indigenous and non-Indigenous children. This study aims to understand the benefits of preschool participation by quantifying the association between preschool participation in the year before school and developmental outcomes at age five in Indigenous and non-Indigenous children. METHODS: We used data from perinatal, hospital, birth registration and school enrolment records, and the Australian Early Development Census (AEDC), for 7384 Indigenous and 95 104 non-Indigenous children who started school in New South Wales, Australia in 2009/2012. Preschool in the year before school was recorded in the AEDC. The outcome was developmental vulnerability on ≥1 of five AEDC domains, including physical health, emotional maturity, social competence, language/cognitive skills and communication skills/general knowledge. RESULTS: 5051 (71%) Indigenous and 68 998 (74%) non-Indigenous children attended preschool. Among Indigenous children, 33% of preschool attenders and 44% of the home-based care group were vulnerable on ≥1 domains, compared with 17% of preschool attenders and 33% in the home-based care group among non-Indigenous children. In the whole population model, the adjusted risk difference for developmental vulnerability among preschool attenders was -7.9 percentage points (95% CI, -9.8 to -6.1) in non-Indigenous children and -2.8 percentage points (95% CI -4.8 to -0.7) in Indigenous children, compared with Indigenous children in home-based care. CONCLUSIONS: Our findings suggest a likely beneficial effect of preschool participation on developmental outcomes, although the magnitude of the benefit was less among Indigenous compared with non-Indigenous children.

Histopathological Findings Related to ORISE™ Injectable Submucosa Lifting Agent Used in the Endoscopic Mucosal Resection of Bowel Neoplasms: A Review of Three Cases.

The use of nonsaline injectable lifting agents is now routine in the performance of endoscopic mucosal resection of bowel neoplasms (EMR). These agents are used to elevate the mucosa from the muscularis propria and permit more a complete resection of the lesion while mitigating risk of possible thermal injury to the bowel wall and thus preventing perforation. After injection, these new agents, which are replacing normal saline, often remain present in the tissues for some time following the procedure and may be identified in the resection specimens where they may mimic a number of other conditions such as mucin pools, lymphangiomas, granulomatous inflammation, and amyloid deposition. We describe the histological findings associated with the use of nonsaline injectable mucosal lifting agents. Awareness of these agents and their associated artefact may reduce misdiagnosis or the use of unnecessary ancillary studies and highlights the importance of proving relevant clinical information on submission of specimens for pathological examination.

Role of maternal age at birth in child development among Indigenous and non-Indigenous Australian children in their first school year: a population-based cohort study.

BACKGROUND: Indigenous Australian children are twice as likely to score poorly on developmental outcomes at age 5 years than their non-Indigenous peers. Indigenous children are also more likely to be born to younger mothers. We aimed to quantify the relationship between maternal age at childbirth and early childhood development outcomes in Indigenous and non-Indigenous children. METHODS: In this population-based, retrospective cohort study, we used data from the Australian Early Development Census (AEDC) that were probabilistically linked by the New South Wales (NSW) Centre for Health Record Linkage to several NSW administrative datasets, including the Perinatal Data Collection, the Register of Births, Deaths and Marriages (for birth registrations), the Admitted Patient Data Collection, and public school enrolment records, as part of the Seeding Success study. The resulting data resource comprises a cohort of 166 278 children born in NSW whose first year of school was reported in a 2009 or 2012 AEDC record (which were the years of AEDC data available at the time of data linkage). The primary outcome was the aggregate outcome of developmental vulnerability (scores in the bottom decile, according to the 2009 benchmark, on one or more of the five AEDC domains, which include physical, social, emotional, language and cognitive, and communication development). This outcome was measured in singleton children without special needs recorded on the AEDC, in those with available developmental data. As a secondary outcome analysis, we also repeated the main analyses on the outcome of developmental vulnerability on the individual domains. We estimated the absolute risk of developmental vulnerability by maternal age in Indigenous and non-Indigenous populations, and we also estimated the risk difference and relative risk between Indigenous and non-Indigenous children by use of modified Poisson regression. FINDINGS: Of 166 278 children in the cohort, 107 666 (64·8%) children were enrolled in a public school in NSW in 2009 or 2012, of whom 7994 (7·4%) children were Indigenous (ie, they, or either parent, were recorded as Aboriginal or Torres Strait Islander on one or more birth records) and 99 672 (92·6%) children were not Indigenous. After exclusions, the final study population included 99 530 children (7206 [7·2%] Indigenous and 92 324 [92·8%] non-Indigenous). Of those for whom developmental outcome data were available, 2581 (35·9%) of 7180 Indigenous children and 18 071 (19·7%) of 91 835 non-Indigenous children were developmentally vulnerable on one domain or more. The risk of developmental vulnerability decreased with maternal ages between 15 and 39 years, but the decrease in risk with maternal age was significantly steeper in non-Indigenous than Indigenous children. INTERPRETATION: Developmental vulnerability is most common in Indigenous and non-Indigenous children born to young mothers; however, Indigenous children have an increased risk of this outcome across most of the maternal age range. Policies that improve the socioeconomic circumstances of Indigenous children and families could promote better developmental outcomes among Indigenous children. Culturally appropriate support for Indigenous children, including those born to young mothers and disadvantaged families, could also reduce early childhood developmental inequalities. FUNDING: The Australian National Health and Medical Research Council, Manitoba Centre for Health Policy.

Social and emotional developmental vulnerability at age five in Aboriginal and non-Aboriginal children in New South Wales: a population data linkage study.

BACKGROUND: Early childhood social and emotional development underpins later social, emotional, academic and other outcomes. The first aim of this study was to explore the association between child, family and area-level characteristics associated with developmental vulnerability, amongst Aboriginal and non-Aboriginal children in their first year of school. The second aim was to quantify the magnitude of the social and emotional developmental inequalities between Aboriginal and non-Aboriginal children and the extent to which differences in socioeconomic disadvantage and perinatal characteristics explained this inequality. METHODS: This retrospective cohort study used cross-sectoral data linkage to identify and follow participants from birth to school age. In this way, social and emotional development was examined in 7,384 Aboriginal and 95,104 non-Aboriginal children who were included in the Australian Early Development Census in their first year of full-time school in New South Wales (NSW) in 2009 or 2012 and had a birth registration and/or perinatal record in NSW. The primary outcome measures were teacher-reported social competence and emotional maturity as measured using the Australian version of the Early Development Instrument. RESULTS: The mean age at the start of the school year for children in the study sample was 5.2 years (SD = 0.36 years). While 84% of Aboriginal children scored favourably - above the vulnerability threshold - for social competence and 88% for emotional maturity, Aboriginal children were twice as likely as non-Aboriginal children to be vulnerable on measures of social development (RR = 2.00; 95%CI, 1.89-2.12) and had 89% more risk of emotional vulnerability (RR = 1.89; 95%CI, 1.77-2.02). The inequality between Aboriginal and non-Aboriginal children was largely explained by differences in the socioeconomic and perinatal health characteristics of children and families. Thus, after adjusting for differences in measures of socioeconomic advantage and disadvantage (Model 2), the relative risk was attenuated to 1.31 (95% CI: 1.23-1.40) on the social competence domain and 1.24 (95% CI, 1.15-1.33) on the emotional maturity domain. Child, family and area-level characteristics associated with vulnerability were identified. CONCLUSIONS: Most of the gap in early childhood social and emotional development between Aboriginal and non-Aboriginal children can be attributed to socioeconomic and early life health disadvantage. Culturally safe health and social policies addressing the socioeconomic and health inequalities experienced by Aboriginal children are urgently required.

Cured from a Cardiac Myxoma? Brain Intraparenchymal Hemorrhage in a Patient with a 10-Year Successfully Resected Cardiac Myxoma.

BACKGROUND: A cardiac myxoma (CM) is the most common primary tumor of the heart. This case report highlights that for metastatic CMs, even after a successful total resection, there is a small but real risk of recurrence that can manifest as late as 10 years after initial tumor resection. CASE DESCRIPTION: We present the case of a 53-year-old woman who visited the emergency room after a 4-day worsening right-sided weakness. The patient was diagnosed with a left CM 10 years previously, and a complete surgical resection was performed at that time. A noncontrast computed tomography of the head revealed a left parietal hematoma and a contrast computed tomography scan of the head revealed an enlarged left parieto-occipital vein that was subsequently shown to be part of an arteriovenous fistula. After embolization of the fistula was performed, postprocedure magnetic resonance imaging of the brain showed redemonstration of acute intraparenchymal hemorrhage with vasogenic edema. The history of a previously resected CM and the multifocal distribution of brain lesions opened the possibility of slow-growing metastasis from the previous myxoma. CONCLUSIONS: Our case report demonstrates the metastatic nature of CMs to the central nervous system, even after successful gross total resection and no local relapsing mass in subsequent ultrasonographic follow-ups. A comprehensive evaluation on clinical and imagological grounds is mandatory to rule out the presence of myxomatous metastatic disease. Awareness and recognition of the potential neurologic manifestations of a metastatic CM will prevent unnecessary diagnostic workup and treatments.