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Previous studies have suggested that child abuse and neglect (CAN) is under recognised and under reported. Our aims were to examine and compare child protection (CP) knowledge, confidence and practice of frontline clinicians in general practice and hospital settings in South Western Sydney (SWS). We surveyed doctors and nurses in general practice and in the emergency department (ED) in a district in SWS using a validated questionnaire. Of the 113 responses, 62 were general practitioners (GPs), 9 practice nurses, 26 ED nurses and 16 ED doctors. The confidence level with identifying CAN was moderate, with a significant difference between groups. The majority (59%) had made previous CP reports, few suspected but decided not to report; reporting rates differed significantly. A majority (80%) reported some CP training; of the 22 with no training, 21 were GPs and practice nurses. Of those reporting some training, more than 70 per cent of ED nurses, GPs and practice nurses felt their training was inadequate, compared with 19 per cent of ED doctors. There are significant differences in confidence and practice between frontline clinicians in primary care and ED. Targeted CP training should be provided for all frontline clinicians with particular emphasis on primary care GPs. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Street and working children (SWC) and young people (YP) are highly vulnerable to violence, exploitation, hazardous environments and human rights violations. While the UN Committee on the Rights of the Child and the International Labour Organisation provide some guidance, there is limited information on their right to healthcare. This study aims to identify enablers and barriers to healthcare access for SWC and document associated rights violations., Methods: From 2000 to the present, we conducted systematic searches for SWC (0-18 years) in databases including MEDLINE, PsycINFO, EBSCO, PUBMED and PROQUEST, using broad search terms related to street children, working children, healthcare access and rights. The searches were supplemented by grey literature and hand searches. Two independent reviewers finalised the included studies, and data were analysed using a rights-based framework with narrative analysis and thematisation., Results: The initial search yielded 7346 articles (5972 for street children and 1374 for working children), with 35 studies (18 for street children and 17 for working children) included in the review. Most studies on working children (13/17) focused on trafficking/commercial exploitation. Studies were predominantly from Africa, followed by the USA, Asia, the UK and Canada, with only two employing a rights framework. SWC face barriers such as cost, distance, visibility/accessibility of services, stigma, seclusion, threats of violence, lack of legal documents, crisis-oriented healthcare use and self-medication. Enablers included agency, self-efficacy, positive relationships with adults and proactive healthcare use when accessible. Emergency departments are frequently accessed by SWC, indicating a need for healthcare professionals to be trained and sensitised. Holistic and comprehensive healthcare is essential., Conclusion: Significant research gaps exist, with many SWC populations under-represented. SWC share healthcare access barriers with other marginalised groups. Healthcare for SWC must be tailored to their unique needs and strengths and be holistic and trauma-informed., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Marginalised families faced significant challenges during the COVID-19 pandemic. This study explores inequalities in Japanese mothers' and children's health and well-being and family economic stability before and during the pandemic. Data sources were as follows: nationwide surveys in 2019 and 2021 of families with children using medical institutions across Japan; infant mortality and adolescent suicide rates between 2018 and 2021 from publicly available sources. Outcomes by poor and non-poor families were compared for 2019 and 2021 using simple descriptive statistics. Poor mothers' part-time working increased from 41% to 61% and regular employment was reduced by two thirds. The well-being of poor mothers worsened from 39% to 55%. Employment opportunities and well-being did not change for non-poor mothers. School subsidies among poor families increased from 23% to 55%. The infant mortality rate (IMR) among unemployed families increased significantly from 12.9/1000 to 18.2/1000 between 2018 and 2021 compared with a decreasing overall IMR from 1.9/1000 to 1.7/1000. Suicide rates in 10-19-year-olds increased over the same period although no socio-economic indicators were available. Inequalities in mothers' and children's health and well-being indicators and family economics increased between 2019 to 2021 in Japan. This study cannot attribute causes but suggests a possible role of the pandemic.

Objective: There is strong evidence of a link between parental substance use and/or mental health problems and adverse outcomes in children. We wanted to know the impact of these early childhood adversities on the health and social outcomes of children. We also wanted to determine whether early identification of these risks made a difference to the child's outcome and what effective strategies and interventions are available that will ensure the safety of children, provide support for them and improve their long-term outcomes., Method: This was a retrospective analysis of children attending a specialized Pediatric ("Branches") clinic in South West Sydney; set up for children exposed to perinatal risks including parental substance use and/or mental health problems. Total of 124 children attended the Branches clinic from January 2006 to December 2009. Data recorded included health, developmental and social outcomes., Result: Mean age of first presentation to the clinic was 3.95 years, majority (63%) were in foster care. Parental substance abuse was identified in 73% of the cases while parental mental health disorder was documented in 48% cases. A range of infection and other health related problems were identified, including the risk of hepatitis C transmission. Almost one third of children had incomplete immunization (29%) and over 90% of children needed referrals to services. We did not find any difference in outcomes or age of first presentation to the clinic between children identified in the perinatal period, compared to those not identified early., Conclusion: Our study found significant health problems in children exposed to perinatal risks. Early or perinatal identification of these risks did not affect outcomes in our setting. Better coordination between maternity, pediatrics, hospital and community services may improve child outcomes through earlier identification of health concerns.

Background: We describe reported immunisation status and primary health care utilisation in refugee and migrant young people in western Sydney, New South Wales., Method: Students attending an Intensive English Centre (IEC) high school in western Sydney were surveyed for self reported general health, immunisation status of hepatitis B and measles, mumps and rubella and attendance at general practice following arrival in Australia., Results: Of 165 respondents, 68 (41%) had a named general practitioner and 66 (40%) reported seeing a doctor in Australia. Students who had not seen a doctor in Australia were significantly more likely to request immunisation., Discussion: Refugee and migrant young people are likely to have a poor utilisation of primary health care relative to their needs. Most who had seen a GP in Australia required catch up immunisation. Stronger links and increased GP education about the requirements of these young people are needed to improve immunisation status and GP utilisation in this high risk group.