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The private car, as a dominant form of everyday mobilities across Australia and around the globe, continues to create a significant level of social and spatial injustice. Children are disproportionally affected by such injustices, not just through the loss of their basic rights to roam their local environments freely and safely due to traffic safety concerns and being greatly susceptible to illnesses generated by car-inducing pollution and noise, but also through being at the greatest risk of being hit by drivers. Road crashes continue to be the leading cause of death for children globally and our current – and decades long – ways of dealing with road violence are inadequate and counter-productive as they distract from what actually needs to be done. Utilising Boyden's framing of cultural maladaptation, this paper conceptualises current maladaptive transport discourses and discusses how they continue to harm the health and well-being of children. The paper highlights the need for the recognition of these maladaptive discourses, including our worldviews, languages and principles in order to replace them with new narratives which enable the transition to a future where children's mobility needs and rights are honoured. [ABSTRACT FROM AUTHOR]

Aim: This paper will review progress towards the identified targets within the Australian government policy document commonly known as 'Closing the Gap' and examine the role of nurses in supporting its implementation. Background: Australia is not alone in seeking to address the health inequity between Indigenous and non‐Indigenous people. Globally such health inequities are similar and require interventions supported by governments in conjunction with health and education systems to affect desired change. For this reason, it is timely to undertake a review of progress on the impact of the Closing the Gap initiative. Sources of evidence: The Australian national partnership agreement and subsequent annual performance reports issued between 2010 and 2017. Discussion: Targets set within the Australian government national partnership agreement have had a range of success. Those targets not on track require significant long‐term investment to ensure their success. Nurses as a large professional group are powerful advocates to speak up and support policy change that affects disempowered social groups. Conclusion: Long‐term social change takes time, yet without the commitment of Australian Governments through effective policy and economic support, the inequity in the health of Indigenous people will continue both now and in the future. Implications for health and social policy: Nurses, as the largest health professional group, are uniquely placed to support and implement social change at all levels of health care (primary, secondary and tertiary) and to lobby government to amend policy alongside those who are disempowered. Implications for nursing practice: Health promotion and education programmes that are led by nurses can make an impact to health disparities within groups who are most at risk. [ABSTRACT FROM AUTHOR]

The Victorian Child Death Review Committee (VCDRC) in Australia is a multidisciplinary Ministerial Advisory Committee established to review the deaths of children either currently child protection clients or known to the statutory child protection system. The Committee provides advice about each child death as well as insights into what are the surrounding patterns and issues. Key to this role is examining the contribution of the service sectors to the protection of children and the routine practices that are in place to respond to children and vulnerability. This paper provides a snapshot of the cases referred to the VCDRC and the key messages for practice drawn from them. What emerges is that often the threshold for when statutory child protection services must be involved in child and family matters can be ambiguous and that agreement about intervention, the level and nature of need or risk, and when cumulative harm and neglect require statutory responses are not always shared between agencies. It is clear that the lack of common frameworks about what constitutes child protection intervention challenges services. It is recommended that there be and used agreed definitions and frameworks to ensure shared understandings and collaborative responses across the service and legal systems. [ABSTRACT FROM AUTHOR]

Despite pronounced reductions in child mortality in industrialised countries, variations exist within and between countries. Many child deaths are preventable, and much could he done to further reduce mortality. For the family, their community, and professionals caring for them, every child’s death is a tragedy. Systematic review of all child deaths is grounded in respect for the rights of children and their families, and aimed towards the prevention of future child deaths. In a Series of three papers, we discuss child death in high-income countries in the context of evolving child death review processes. This paper outlines the background to and development of child death review in the USA, England, Australia, and New Zealand. We consider the purpose, process, and outputs of child death review, and discuss how these factors can contribute to a greater understanding of children’s deaths and to knowledge for the prevention of future child deaths. [ABSTRACT FROM AUTHOR]

In Australia, despite concerted government efforts over the last 30 years, Indigenous peoples' statistically measured well-being continues to be lower than that of non-Indigenous Australians with few exceptions (child mortality and early childhood education). This is for various reasons including the ongoing impacts of dispossession, inappropriate policies, restricted opportunities, and ignorance of Indigenous perspectives. This paper analyses key recent government development policies and related costs and benefits. It then proposes a capability-focused well-being approach considering country (Indigenous estate) as a pivot. Country offers a culturally appropriate enabling environment for participation in economic activities and learning through ceremonies and rituals. This allows Indigenous people to utilize their knowledges and skills in securing their well-being. We apply three scenarios as a tool to analyse current government expenditure on four program areas, namely: a safe and supportive environment; economic participation; healthy lives; and early childhood development. We argue that by utilizing imputed natural resource management revenues, estimated cost-savings of $4–18bn.pa can be achieved if official policies focus on an integrated approach of well-being through building and utilizing Indigenous capabilities. To demonstrate the real benefits and costs of the proposed approach, the Northern Territory is used as a case study. Our estimates suggest an estimated annual value of cost-savings at $127m-$471m. This amount could be invested towards country -related programs in remote communities to introduce and promote innovative enterprises in ecosystems services by managing natural resources – a growing market across the globe – that will enhance the well-being of local Indigenous communities and the management of natural resources for the wider Australian and global public. • Integrated analyzes of key government development policies and expenditures on Indigenous welfare. It offers an economic rationale for capability focused approach to enhance Indigenous well-being in Australia. • Estimated cost-savings of AUD 4–18billion per year using three scenarios for re-directing current government welfare expenditures on four program areas, i.e. a safe and supportive environment; economic participation; healthy lives; and early childhood development. These savings, if invested in peoples' country -based capabilities and developing related economic opportunities, will deliver multi-fold benefits. • A detailed case study of the Northern Territory showing that the total cost-savings at AUD 127–471million per year could be realized to improve Indigenous well-being by focusing on developing country -related opportunities. • The relevance and importance of Capability Approach for remote Indigenous communities in Australia, that may well be applicable for many others across the globe. [ABSTRACT FROM AUTHOR]

This paper compares and contrasts child death review (CDR) structures and processes in six countries - Australia, New Zealand, the United States, Canada, England and Wales. It presents findings from a comparative study based on analysis of data from 18 case studies. Data were collected through a combination of documentary analysis, interviews and observations. The study found that CDR processes vary according to: where the function is located and whether review is undertaken at state, local or national level; whether review is rooted in legislation; the focus of review; whether dedicated funding is provided; whether families are involved in the process; and whether structures are supported by useful data systems. It was not possible to evaluate the effectiveness of different review systems but the findings suggest that structure makes little difference in terms of determining the extent to which CDR findings inform prevention effort and activity. While factors such as lack of funding, lack of national data, or lack of legislation may hinder the work of CDR teams, CDR findings have informed prevention initiatives despite such barriers. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Messages Standardisation and aggregation of data at national or state level are crucial for effective CDR., A model of individual review, cross-case review and themed review can result in real learning and practice change., A public health model of CDR offers the most potential in terms of prevention., Families can contribute key information but participation must be managed sensitively and take account of cultural issues. [ABSTRACT FROM AUTHOR]

Background: Hospitalisation of a child is a unique opportunity for health staff to offer smoking cessation support; that is screening for carer smoking status, discussing cessation and providing interventions to carers who smoke. This has the potential to reduce the child's exposure to second-hand smoke, and in turn tobacco related illnesses in children. However, these interventions are not always offered in paediatric wards. The aim of this study was to explore the provision and prioritisation of smoking cessation support to patient carers in a paediatric ward with a high proportion of Aboriginal patients and carers in a regional area of Australia's Northern Territory. Methods: This is a qualitative descriptive study of data collected through semi-structured interviews with 19 health staff. The interviews were audio recorded and transcribed verbatim. Thematic analysis was performed on the transcripts. Results: We found low prioritisation of addressing carer smoking due to, a lack of systems and procedures to screen for smoking and provide quitting advice and unclear systems for providing more detailed cessation support to carers. Staff were demotivated by the lack of clear referral pathways. There were gaps in skills and knowledge, and health staff expressed a need for training opportunities in smoking cessation. Conclusion: Health staff perceived they would provide more cessation support if there was a systematic approach with evidence-based resources for smoking cessation. These resources would include guidelines and clinical record systems with screening tools, clear action plans and referral pathways to guide clinical practice. Health staff requested support to identify existing training opportunities on smoking cessation. [ABSTRACT FROM AUTHOR]

INJURIES ARE THE LEADING cause of death to young children in rural Australia, with drowning in farm dams being a major risk. This paper assesses the impact of an intervention to increase safe play areas on farms to prevent unsupervised access by young children to water bodies and other hazards. Surveys of 1,117 adult farmers attending Ag Quip Agricultural Field Days in NSW between 2003 and 2007 were used to identify the child security level of fences and changes in the percentage of farms with fenced house yards. Over this four-year period, the percentage of people who had a fenced yard on their farm ranged from 75 per cent to 79 per cent with no significant fluctuations. However, those with a safe play area who stated the area was difficult/almost impossible for a child 0-5yrs to breach, ranged from 40 per cent to 55 per cent over the period, with a statistically significant positive trend (X2=13.46 df=4 p⩽.01). Actions to improve child safety on farms and recall of child farm safety messages in the media in association with programs promoting securely fenced house yards are also discussed. In order to affect further reduction in child drowning incidents, there is an ongoing need to promote improved security of fenced house yards on farms in Australia. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular anomalies are the largest group of congenital anomalies and the major cause of death in young children, with various data linking rising atrial septal defect incidence (ASDI) with prenatal cannabis exposure. Objectives / Hypotheses. Is cannabis associated with ASDI in USA? Is this relationship causal?Methods: Geospatiotemporal cohort study, 1991-2016. Census populations of adults, babies, congenital anomalies, income and ethnicity. Drug exposure data on cigarettes, alcohol abuse, past month cannabis use, analgesia abuse and cocaine taken from National Survey of Drug Use and Health (78.9% response rate). Cannabinoid concentrations from Drug Enforcement Agency. Inverse probability weighted (ipw) regressions. Analysis conducted in R.Results: ASDI rose nationally three-fold from 27.4 to 82.8 / 10,000 births 1991-2014 during a period when tobacco and alcohol abuse were falling but cannabis was rising. States including Nevada, Kentucky, Mississippi and Tennessee had steeply rising epidemics (Time: Status β-estimate = 10.72 (95%C.I. 8.39-13.05), P < 2.0 × 10 - 16). ASDI was positively related to exposure to cannabis and most cannabinoids. Drug exposure data was near-complete from 2006 thus restricting spatial modelling from 2006 to 2014, N = 282. In geospatial regression models cannabis: alcohol abuse term was significant (β-estimate = 19.44 (9.11, 29.77), P = 2.2 × 10 - 4); no ethnic or income factors survived model reduction. Cannabis legalization was associated with a higher ASDI (Time: Status β-estimate = 0.03 (0.01, 0.05), P = 1.1 × 10 -3). Weighted panel regression interactive terms including cannabis significant (from β-estimate = 1418, (1080.6, 1755.4), P = 7.3 × 10 -15). Robust generalized linear models utilizing inverse probability weighting interactive terms including cannabis appear (from β-estimate = 78.88, (64.38, 93.38), P = 1.1 × 10 -8). Marginal structural models with machine-aided SuperLearning association of ASDI with high v. low cannabis exposure R.R. = 1.32 (1.28, 1.36). Model e-values mostly > 1.5.Conclusions: ASDI is associated with cannabis use, frequency, intensity and legalization in a spatiotemporally significant manner, robust to socioeconomicodemographic adjustment and fulfilled causal criteria, consistent with multiple biological mechanisms and similar reports from Hawaii, Colorado, Canada and Australia. Not only are these results of concern in themselves, but they further imply that our list of the congenital teratology of cannabis is as yet incomplete, and highlight in particular cardiovascular toxicology of prenatal cannabinoid and drug exposure. [ABSTRACT FROM AUTHOR]

Objectives: This study is an analysis of the contribution of pre-existing medical conditions to unintentional fatal child (0-14 years) drowning and a of critique prevention stratagems, with an exploration of issues of equity in recreation.Design: This study is a total population, cross-sectional audit of all demographic, forensic and on-site situational details surrounding unintentional fatal drowning of children 0-14 years in Australia for the period of 1 July 2002 to 30 June 2012. Data were sourced from the National (Australia) Coronial Information System. Age-specific disease patterns in the general population were obtained from the Australian Institute of Health and Welfare.Results: Four hundred and sixty-eight children drowned during the study period. Fifty-three (11.3%) had a pre-existing medical condition, of whom 19 suffered from epilepsy, 13 from autism and 5 with non-specific intellectual disabilities. Epilepsy is a risk factor in childhood drowning deaths, with a prevalence of 4.1% of drowning fatalities, compared with 0.7%-1.7% among the general 0-14 years population (relative risk: 2.4-5.8). Epilepsy was deemed to be contributory in 16 of 19 cases (84.2% of epilepsy cases) with a median age of 8 years. Asthma and intellectual disabilities were under-represented in the drowning cohort.Conclusion: Except for epilepsy, this research has indicated that the risks of drowning while undertaking aquatic activities are not increased in children with pre-existing medical conditions. Children with pre-existing medical conditions can enjoy aquatic activities when appropriately supervised. [ABSTRACT FROM AUTHOR]

It is not inconceivable that by 2035 the substantial gaps in child health across the Pacific can close significantly. Currently, Australia and New Zealand have child mortality rates of 5 and 6 per 1000 live births, respectively, while Pacific island developing nations have under 5 mortality rates ranging from 13 to 16 ( Vanuatu, Fiji and Tonga) to 47 and 58 per 1000 live births ( Kiribati and Papua New Guinea, respectively). However, these Pacific child mortality rates are falling, by an average of 1.4% per year since 1990, and more rapidly (1.9% per year) since 2000. Based on progress elsewhere, there is a need to (i) define the specific things needed to close the gaps in child health; (ii) be far more ambitious and hopeful than ever before; and (iii) form a new regional compact based on solidarity and interdependence. [ABSTRACT FROM AUTHOR]

The article discusses a study that aimed to establish how often supervision has been identified as a factor in coroner-certified unintentional deaths of children in Australia. The authors report that drowning ranks as a leading cause of unintentional injury-related deaths of children worldwide. They say, however, that quality and availability of data on child drowning vary across countries. The authors, referencing coroners' findings, confirm that absent or inadequate supervision may be associated with as many as 88.8% of child drownings in Australia.

Issue Addressed: In Australia, more than one toddler per month dies from being run over in a driveway and many more are injured. While there is currently no regulation in Australia regarding reverse warning systems, the issue has been debated over the years following several high profile cases. Methods: A computer-assisted telephone interview (CATI) survey of NSW households was undertaken in March 2008. Respondents were asked about their willingness to pay for the installation of vehicle reversing cameras at the expense of the purchaser. Results: The survey was completed by 590 respondents. There were no significant differences between males and females for willingness to pay $500 or $300 for a reversing camera in their current vehicle; however females were more willing to pay $150. There were no significant differences between age groups in willingness to pay for the installation. More than two-thirds of respondents would support legislation if it increased the cost of new cars by $300 and more than half if it increased by $500. Conclusions: This study suggests that the majority of adults would be prepared to pay a small amount of money to install a reversing camera in their current vehicle, but not sufficient to cover the full cost of installation. [ABSTRACT FROM AUTHOR]