To the Editor: We are writing to express our concern regarding the Perspective by Hyde.1 This is twofold: firstly, the title and related content are misleading and alarmist, especially in the Australian context; secondly, the publication process and outcome falls short of what we expect of The Medical Journal of Australia. Dr Hyde suggests that the risk of coronavirus disease 2019 (COVID-19) in children and schools has been overlooked. This assertion is in the title, in the concluding sentence, and is implied throughout the article. This is demonstrably not true: Australian paediatricians and public health experts have actively contributed to world-leading research into COVID-19 and schools through early implementation and assessment of school-based mitigation strategies,2, 3 surveillance, and generation of policy-relevant data. Three reports4-6 and a peer-reviewed publication3 have been generated from the National Centre for Immunisation Research and Surveillance commissioned by New South Wales Health, showing minimal transmission, as well as a review7 undertaken by the Murdoch Children’s Research Institute commissioned by the Victorian government. Importantly, this locally generated evidence and associated considered health and education policy guidance regarding COVID-19 acknowledge the profound and inequitable impact that school closures have on children’s learning and on child and family wellbeing, a matter that Hyde gives only limited consideration. Further, we point to a recently published expert systematic review8 that, in contrast to Hyde’s Perspective, shows compelling evidence that children are less likely than adults to acquire COVID-19 and are potentially less likely to transmit it. The corresponding editorial reinforces the importance of using an evidence-based approach.9 To our second concern, we question the need to publish and promote this article as a preprint in the first place, given that the benefit of preprint databases in biomedical sciences is the early, equitable and widespread distribution of research results not opinions.10 It is possible that the MJA’s promotion of this Perspective has contributed to unscientific populism surrounding COVID-19, children and schools. Parents and the wider community should be reassured that schools in Australia are being monitored closely and that educators and policy makers are extensively involved as stakeholders. No relevant disclosures.
Philip N Britton, Archana Koirala, Nicholas Wood et al.
The paper is part of a collaborative research organized by the International Association of Youth and Family Judges and Magistrates (AIMJF/IAYFJM) on child participation in juvenile justice. The article explains the legal, institutional and procedural aspects of child participation in the Justice System in Samoa
Young children aged birth to 5 years are known users of the internet, both unsupervised and in collaboration with adults. Adults also use the internet to share details of children’s lives with others, via sharenting and educational apps. During COVID-19 internet use by children and families rose significantly during periods of enforced stay-home. Internet use by children, and by adults on behalf exposes children to conduct, contact and content risks online. These risks mean that cyber-safety in the early years is increasingly necessary, especially concerning increased internet usage during COVID-19. While cyber-safety is well developed for primary and secondary-school aged children this is not the case for young children, their families and educators. This paper proposes a research agenda for cyber-safety in the early years, using critical constructivism and internet studies to define the internet as a non-unitary technology. Three main objects of study concerning cyber-safety in the early years, including the reference to COVID-19 are identified for targeted research, including: technologies, context and policy.
Children with paediatric rheumatic diseases (PRDs) are at increased risk of vaccine-preventable disease. Safe and effective vaccination is central to preventive care in PRD patients; however, uncertainty surrounding immunogenicity and safety has contributed to suboptimal vaccination. The aim of this study was to evaluate treatment effect on immunogenicity to vaccination in PRD patients and assess vaccine safety, specifically adverse events following immunisation (AEFI) and disease flare. Scoping review. In this scoping review, a systematic search of PubMed, CINAHL and Embase databases was conducted from 2014 to 23 August 2022 to identify observational studies evaluating the immunogenicity and safety of commonly used vaccinations in PRD patients. The primary outcome was immunogenicity (defined as seroprotection and protective antibody concentrations), with secondary outcomes describing AEFI and disease flare also extracted. Due to extensive heterogeneity related to diagnostic and vaccination variability, narrative synthesis was used to describe the findings of each study. Study quality was assessed via the Mixed Methods Appraisal Tool. The review was prospectively registered with PROSPERO (CRD42022307212). The search yielded 19 studies evaluating immunogenicity to vaccination and incidence of AEFI and disease flares in this population, which were of acceptable quality. Corticosteroids did not have deleterious effects on vaccine response. Treatment with conventional disease-modifying antirheumatic drugs (DMARDs) and biologic DMARDs generally had no effect immunogenicity in PRD patients. While patients exhibited adequate seroprotection, protective antibody levels were lower in patients on some immunosuppressant agents. Varicella infections were recorded post vaccination in several patients with low protective antibody levels undergoing treatment with DMARDs and corticosteroids. Most vaccines appear safe and effective in PRD patients, despite immunosuppressant treatment. Booster vaccinations should be considered with some studies highlighting inadequate seroprotection following primary course of vaccinations with acceleration of antibody decline over time. There was limited evidence to support avoiding live vaccines in PRD patients.
Jacqueline Cunninghame, Sophie Chien-Hui Wen, Mitchell Dufficy et al.
BACKGROUND Adolescents face a variety of potential harms in the online environment, including exposure to distressing illegal material, cyberbullying, image-based abuse, and “sextortion.” Various agencies provide on-demand helpline and information services for children and adolescents to support them with navigating online (and offline) harms. OBJECTIVE This study examined whether a chat-based conversational agent (chatbot) might be a useful additional tool for meeting the needs of adolescents at risk from online harms. We developed a prototype chatbot—including both conversational and menu-driven user options—and evaluated users’ trust in the chatbot. In this context, trust relates to perceptions of the chatbot’s usability and the value of the information and support it provides. METHODS Participants (n=224; mean age 16.8 years) interacted with the chatbots and evaluated them in terms of user trust: perceived usability and utility (ie, relevance of support resources provided). RESULTS Most participants (conversational chatbot: 141/224, 63% and menu-driven chatbot: 142/224, 63%) showed a willingness to click on the chatbots’ recommended support links. Participants with higher trust in the chatbots were more likely to click the links for recommended support services (with extreme evidence for large effects: δ=0.73, 95% credible interval [CrI] 0.46-1.00 and δ=0.78, 95% CrI 0.50-1.07, for the conversational and menu-driven chatbots, respectively; Bayes factor [BF10]>50,000), and participants who clicked the links, compared with those who did not, reported higher rates of positive attitudes toward their decision (with extreme evidence for large effects: δ=0.87, 95% CrI 0.58-1.15 and δ=0.84, 95% CrI 0.54-1.12, for the conversational and menu-driven chatbots, respectively; BF10>3,000,000). The conversational and menu-driven chatbots differed little in perceived trust or effectiveness. CONCLUSIONS Chatbots represent a promising additional tool to help adolescents access mental health–related support services and navigate online harms. However, establishing trust is critical.
Meriel Charles, James D. Sauer, Erin Roehrer et al.
Objectives: To investigate if Aboriginal people are equally included in new forms of vaccine safety post-marketing surveillance that support safety signal detection and confidence in the vaccine program by comparing the use of Vaxtracker active adverse events following immunisation (AEFI) surveillance between Aboriginal and non-Aboriginal parents of vaccinated children. Methods: In 2016, automated AEFI surveillance was conducted to monitor seasonal influenza vaccine in children aged 18 months to less than 5 years and for DTPa vaccine after the inclusion of a new dose at 18 months of age. To explore reasons for non-response, Aboriginal Immunisation Officers contacted the parents/carers of 24 (48.0%) Aboriginal children and 31 (26.7%) non-Aboriginal children who did not respond to the online survey. Results: There were differential response rates for both vaccines between Aboriginal and non-Aboriginal enrolees; 56.4% vs 76.8% (p=0.005) and 55.1% vs 78.2% (p Conclusion: New systems of vaccine safety surveillance may not adequately include Aboriginal people. Implications: Vaccine safety surveillance systems need to be designed to ensure high levels of participation and response from Aboriginal people.
Hunter New England Population Health, Patrick M. Cashman, Sally-Anne Munnoch et al.
PURPOSE: Adults and children with intellectual disability (ID) are vulnerable to preventable morbidity and mortality due to poor quality healthcare. While poor quality care has been commonly identified among children with ID, evidence of the patient safety outcomes for this group is lacking and therefore explored in this review. DATA SOURCES: Systematic searches of six electronic bibliographic research databases were undertaken from January 2000 to October 2017, in addition to hand searching. STUDY SELECTION: Keywords, subject headings and MeSH terms relating to the experience of iatrogenic harm during hospitalisation for children with ID were used. Potentially relevant articles were screened against the eligibility criteria. Non-English language papers were excluded. DATA EXTRACTION: Data regarding: author(s), publication year, country, sample, health service setting, study design, primary focus and main findings related to measures of quality and safety performance were extracted. RESULTS OF DATA SYNTHESIS: Sixteen studies met the inclusion criteria, with three themes emerging: the impact of the assumptions of healthcare workers (HCWs) about the child with ID on care quality and associated safety outcomes; reliance on parental presence during hospitalisation as a protective factor; and the need for HCWs to possess comprehensive understanding of the IDs experienced by children in their care, to scientifically deduce how hospitalisation may compromise their safety, care quality and treatment outcomes. CONCLUSION: When HCWs understand and are responsive to children's individual needs and their ID, they are better placed to adjust care delivery processes to improve care quality and safety during hospitalisation for children with ID.
Female genital mutilation (FGM) has historically been seen as a health concern limited to women living in other parts of the world. However, with the rising number of migrants, refugees and asylum seekers, countries like New Zealand, Australia and Europe have seen a surge in the number of women and girls affected by FGM seeking medical care. This topic is increasingly becoming relevant to primary health-care providers in this country and therefore a good understanding of this practice is important.
Abstract There is a growing body of literature about kinship care in the Western world; however, much of it focuses on grandparent care. A lesser known aspect of kinship care is the care of children by nonrelatives known to the child or their family. What little research exists about this group suggests that such placements are less stable than familial kinship care. This article reports a research study in Victoria, Australia, that explored nonfamilial kinship care through analysis of administrative data, interviews with young people and carers, and focus groups with kinship care support workers. It emerged that current administrative databases are not yet able to reliably identify the carer relationship, and thus the extent of such care arrangements cannot accurately be determined. Interviews and focus groups revealed that nonfamilial kinship care is diverse and qualitatively different from familial kinship care, bearing some similarities to foster care yet managed very differently. It is suggested that policymakers need to pay more attention to conceptualizing nonfamilial kinship care within kinship care policy frameworks and that greater attention is needed to the individual support needs of children in such placements and their carers.
Science, technology, engineering and mathematics (STEM) is an emerging field of research within early childhood education and care across the world. It aligns with approaches to support early learning and skill development, given the recognition of the importance of the first five years of life. In this study we explored the framework documents in Australian early childhood education to understand more about STEM in early childhood education and care. Our study is interested in the frequency of STEM, as well as the meanings associated with STEM with regards to child learning. We engage with a content analysis, looking at latent as well as manifest coding. Key themes emerge associated with the absence of some STEM areas, compared to others, as well as the positioning of STEM learning areas. More specifically, digital technologies dominate the other three disciplines of STEM. It is anticipated that by providing policy understanding, conversations can commence to support the implementation of STEM in early childhood education and care.
