Christine L Roberts’s research while affiliated with UNSW Sydney and other places

Background: Low birthweight (<2500 g) is often used as a population-level indicator of maternal-child health, as it is easy to measure and correlates with poorer infant health outcomes. However, it conflates preterm birth and intrauterine growth restriction, which have different causal pathways and require different approaches to prevention. Small for gestational age (SGA) (a proxy for growth restriction) and preterm birth may be more informative measures. We evaluated low birthweight as a population-level indicator. Methods: We conducted a population-based cohort study of singleton live births in New South Wales (NSW), Australia, using linked data from 1994-2006 birth, hospital, death and educational records, with follow-up until 2014. Outcomes of babies born of low birthweight, preterm and SGA were compared with well-grown term infants (i.e. not low birthweight or SGA). Overlap between groups and temporal trends were also examined. Results: Of 1 093 765 singleton live births, 47 946 (4.4%) infants were low birthweight and had poorer outcomes than well-grown term infants (2.7% vs. 0.1% infant mortality; 13% vs. 6% below national minimum numeracy standard). SGA and preterm infants also had poorer outcomes (0.5%, 2.3% infant mortality respectively; 10%, 11% below numeracy standard) but 80% of SGA and 47% of preterm infants were not low birthweight. For all outcomes, low birthweight identified a smaller proportion of infants with poor outcomes than preterm birth and than either SGA or low birthweight at term. The proportion of low-birthweight births remained constant over time, while the proportion of births that were preterm increased and proportion of SGA decreased. Conclusions: Low birthweight, SGA and preterm infants are all at higher risk of poorer outcomes but low birthweight inadequately captures, and masks trends in, both preterm births and births that are SGA. Reporting preterm births and an indicator of growth restriction at term will identify vulnerable groups better than using the measure of low birthweight.

The present study investigated the role of psychostimulants (methylphenidate, dexamphetamine; prescribed to participants for diagnosed attention-deficit/hyperactivity disorder; ADHD) in reducing the negative effects of hyperactivity-inattention (H-I) on achievement through elementary school. Whereas the bulk of research investigating H-I and medication has focused on students (conducting student-level analyses), research into classroom climates and processes suggests this issue be examined at both student- and classroom-levels. The sample comprised 54,165 Australian students (from 5419 classrooms) for whom H-I data were available in kindergarten and achievement data were available in year 3 and year 5. In preliminary variance components analyses, findings showed there was notable variation in H-I and psychostimulant status from classroom to classroom. In multilevel path analysis, at both student- and class-levels psychostimulants reduced the negative effects of H-I on student achievement, to a level where H-I had no significant negative impact on achievement. These effects were not moderated by dosage or psychostimulant type. Taken together, our findings add to the body of effective multi-modal educational and psychological interventions used to enhance the achievement outcomes of individual students who present with ADHD and—of particular note and novelty in this study—the classrooms to which they belong.

Aim This study explored knowledge, experience and attitudes of health professionals towards early essential newborn care and skin‐to‐skin contact following Caesarean sections in a tertiary hospital in Central Vietnam. Method We conducted a cross‐sectional descriptive study using an anonymous questionnaire in March 2016. Health professionals from obstetrics, anaesthesiology and neonatology departments were surveyed. Results All of the 204 surveys were returned, accounting for 82% of total staff involved in the care for women and newborns with Caesarean sections. Correct knowledge of early essential newborn care was lowest among anaesthesiology staff. Health professionals reported that ≥90% of Caesarean section births they attended in the preceding week had skin‐to‐skin contact. Approximately 16% obstetricians, 71% midwives, 49% anaesthesiology and 76% neonatology staff considered the current frequency of skin‐to‐skin contact to be about right. The remainder considered the current rate too high. All professional groups identified the main difficulties of conducting skin‐to‐skin contact as the temperature in the operating theatre and the need for additional staff. Other concerns included increasing the risk the baby of falling off, prolonging the operation, and difficulty to monitor mothers. Conclusions The study identifies issues where improvements can be made in the implementation of skin‐to‐skin contact following Caesarean section. This article is protected by copyright. All rights reserved.

Online version of the article available at this URL: https://au.educationhq.com/news/48578/understanding-social-and-emotional-behaviours-in-early-education/

Background: Pediatric admissions to intensive care outside children's hospitals are generally excluded from registry-based studies. This study compares pediatric admission to specialist pediatric intensive care units (PICU) with pediatric admissions to intensive care units (ICU) in general hospitals in an Australian population. Methods: We undertook a population-based record linkage cohort study utilizing longitudinally-linked hospital and death data for pediatric hospitalization from New South Wales, Australia, 2010-2013. The study population included all new pediatric, post-neonatal hospital admissions that included time in ICU (excluding neonatal ICU). Results: Of 498,466 pediatric hospitalizations, 7525 (1.5%) included time in an intensive care unit - 93.7% to PICU and 6.3% to ICU in a general (non-PICU) hospital. Non-PICU admissions were of older children, in rural areas, with shorter stays in ICU, more likely admitted for acute conditions such as asthma, injury or diabetes, and less likely to have chronic conditions, receive continuous ventilatory support, blood transfusion, parenteral nutrition or die. Conclusions: A substantial proportion of children are admitted to ICUs in general hospitals. A comprehensive overview of pediatric ICU admissions includes these admissions and the context of the total hospitalization.

We examined two social and emotional behaviors (anxious and prosocial behavior) and their links with academic achievement among kindergarten students. We conducted a population-level examination among kindergarten students in New South Wales in 2009 and 2012 (N = 206,210) of the extent to which the two behaviors are associated with kindergarten achievement (unique and moderated effects). With a subsample (n = 52,661), we examined additional links to grade 3 achievement. Findings showed that anxious behavior was not, whereas prosocial behavior was, meaningfully associated with kindergarten achievement. There was no evidence of moderation. With the subsample, prosocial behavior was meaningfully associated with kindergarten achievement, and kindergarten achievement was associated with grade 3 achievement. An indirect association from prosocial behavior to grade 3 achievement via kindergarten achievement was also evident. Together, the findings yield information that is relevant to efforts aiming to promote academic achievement in the early years of schooling.

Relatively little attention has been given to understanding different social and emotional behavior (SEB) profiles among students and their links to important educational outcomes. We applied latent profile analysis to identify SEB profiles among kindergarten students based on five SEBs: cooperative, socially responsible, helpful, anxious, and aggressive-disruptive behavior. In Study 1, we identified SEB profiles among the population of students who attended kindergarten in New South Wales (NSW; Australia’s most populous state comprising Australia’s largest education jurisdictions), Australia in 2012 (N = 100,776). We also examined whether profile membership was differentially associated with students’ socioeducational characteristics (gender, age group, language background, neighborhood socioeconomic status, and learning disability status). Results revealed four different SEB profiles: social-emotional prosocial (SE-Prosocial), SE-Anxious, SE-Aggressive, and SE-Vulnerable groups. Profile membership was associated with the socioeducational characteristics in different ways (e.g., female and older students tended to be in the SE-Prosocial profile). In Study 2, we undertook replication with a different sample of children who attended kindergarten in 2009 in NSW (n = 52,661). We also examined whether the SEB profiles were associated with academic achievement in Grades 3 and 5 using standardized test scores. Results revealed the same four profiles as Study 1 and similarities in how profile membership was associated with the socioeducational characteristics. Moreover, profiles were associated with significantly different levels of achievement in Grades 3 and 5—highest for the SE-Prosocial and lowest for the SE-Vulnerable profiles. Together, the findings have implications for healthy student development and academic intervention.

Background: Chlamydia trachomatis is one of the most commonly diagnosed sexually transmitted infections worldwide, but reports in the medical literature of an association between genital chlamydia infection and adverse obstetric outcomes are inconsistent. Methods: The Western Australia Data Linkage Branch created a cohort of women of reproductive age by linking records of birth registrations with the electoral roll for women in Western Australia who were born from 1974 to 1995. The cohort was then linked to both chlamydia testing records and the state perinatal registry for data on preterm births and other adverse obstetric outcomes. We determined associations between chlamydia testing, test positivity, and adverse obstetric outcomes using multivariate logistic regression analyses. Findings: From 2001 to 2012, 101 558 women aged 15 to 38 years had a singleton birth. Of these women, 3921 (3·9%) had a spontaneous preterm birth, 9762 (9·6% of 101 371 women with available data) had a baby who was small for gestational age, and 682 (0·7%) had a stillbirth. During their pregnancy, 21 267 (20·9%) of these women had at least one chlamydia test record, and 1365 (6·4%) of those tested were positive. Before pregnancy, 19 157 (18·9%) of these women were tested for chlamydia, of whom 1595 (8·3%) tested positive for chlamydia. Among all women with a test record, after adjusting for age, ethnicity, maternal smoking, and history of other infections, we found no significant association between a positive test for chlamydia and spontaneous preterm birth (adjusted odds ratio 1·08 [95% CI 0·91-1·28]; p=0·37), a baby who was small for gestational age (0·95 [0·85-1·07]; p=0·39), or stillbirth (0·93 [0·61-1·42]; p=0·74). Interpretation: A genital chlamydia infection that is diagnosed and, presumably, treated either during or before pregnancy does not substantially increase a woman's risk of having a spontaneous preterm birth, having a baby who is small for gestational age, or having a stillbirth. Funding: Australian National Health and Medical Research Council.

Background Breastfeeding is recognized as the single most cost-effective intervention to reduce child morbidity and mortality. However, few studies have explored perceived barriers to breastfeeding and factors associated with breastfeeding intent among mothers of newborn babies in Viet Nam. We conducted a study to assess breastfeeding initiation rates, intent to breastfeed exclusively for 6 months or more and perceived barriers to breastfeed among mothers of newborn babies in Da Nang, Viet Nam. Methods We conducted a cross-sectional questionnaire survey of mothers in the postnatal wards of Da Nang Hospital for Women and Children in central Viet Nam from 10 February 2017 to 24 February 2017, following implementation of the World Health Organization (WHO) Essential Newborn Care (ENC) package. ResultsOf 286 mothers surveyed, 259 (90.6%) initiated breastfeeding; 203/258 (78.7%) within 1 hour (h) of birth. Most (207, 72.4%) mothers indicated intent to breastfeed exclusively for 6 months or more, but this was lower among mothers of preterm babies (82.2% versus 20.0%, p < 0.001) and those without post-secondary school education (74.8% versus 55.6%, p = 0.02). Amongst mothers struggling to establish breastfeeding, 18/27 (66.7%) had a Cesarean section. Planned non-exclusive breastfeeding was mostly (39, 60.9%) motivated by mothers’ concern that their milk supply would be insufficient for their baby’s growth requirements. Most mothers had good knowledge about the benefits of breastfeeding and indicated strong decision autonomy. Conclusions We documented high rates of early breastfeeding establishment and intent to breastfeed exclusively for 6 months or more. This probably reflects high levels of maternal education and successful implementation of the WHO ENC package. Mothers of premature babies may benefit from additional support.