Murdoch Children's Research Institute

School-based programs represent a potential avenue for conducting population-wide paediatric blood pressure (BP) screening. The aim of this review was to systematically scope peer-reviewed literature reporting school-based BP screening, with respect to measurement protocols, diagnostic process coverage, and implementation considerations. Only peer-reviewed articles in English across PubMed, OVID Medline and OVID Embase were included. Two authors independently screened the article titles and abstracts prior to undertaking a full-text review. All disagreements were resolved through discussion and agreement. From each study, four categories of information were extracted: general information, BP measurement methodology, diagnostic process coverage, and implementation strategies. Each article was then assigned to one of three categories regarding the stated or implied study objectives: general school-based research incorporating BP measurement, hypertension prevalence studies, or hypertension screening studies. Of the 112 articles meeting the inclusion criteria, only 17 were categorised as hypertension screening studies. Within these, there was substantial variability in BP measurement techniques and adherence to the diagnostic process recommended by the American Academy of Pediatrics. Additionally, there was minimal reporting on implementation strategies. A pragmatic, standardised protocol for school-based BP screening is needed that includes recommended measurement methods, considers the trade-offs (in terms of feasibility and economics) of covering more or less of the diagnostic process in schools vs health care settings, and covers approaches to optimise implementability.

Urbanization is linked to mental health challenges, while urban nature is increasingly recognized for its restorative benefits. Yet, access to these benefits remains unequal. Latin American (LA) immigrants—a small but growing population in Canadian cities—may face distinct barriers to engaging with natural spaces, despite often relying on public resources for mental health and belonging. This study explores how urban nature contributes to well-being among LA immigrants in Vancouver, Canada. We conducted 30 semi-structured walking interviews in summer 2024 with participants who had lived in the city for one to ten years. Using reflexive thematic analysis, we examined how interactions with urban nature related to mental health and belonging, and the barriers that shaped these experiences. Nature supported mental health through five pathways: intrinsic qualities, meaningful activities, mindful engagement, personal reflection, and contrast with urban life. Belonging was fostered through engagement, cultural adaptation, and new traditions. However, structural and cultural barriers—including unfamiliar weather, limited prior nature experience, and exclusionary norms—restricted access and reduced benefits. Participants emphasized contemplative, reflective experiences over physical activity or socializing. Urban nature emerged as a space of negotiation where participants actively “tamed” unfamiliar environments to build connection and meaning—highlighting the need for inclusive, culturally responsive nature spaces. • Walking interviews explored Latin American immigrants' nature interactions. • Mental health linked to mindful engagement, contrast, and meaningful activities. • Belonging emerged through engagement, adaptation, and new traditions. • Barriers included climate, nature inexperience, and exclusionary social norms.

Vaccine administration errors, particularly those involving incorrect site and route, pose a significant concern for vaccine efficacy and patient safety. These errors can lead to clinical consequences like the formation of lumps, nerve damage, shoulder injury related to vaccine administration (SIRVA), and reduced immunity. Erroneous images of intramuscular and subcutaneous injection technique can inadvertently shape public and provider understanding of proper immunisation practices and may erode patients' confidence in vaccination. Since vaccine administration errors can impact patient safety, it is important for vaccine training materials and public images of vaccination to be accurate. This includes accurate depictions of vaccine administration, given that images play a key role in how people learn, including in medical education. We investigated 375 online images, retrieved from 34 Vaccine Safety Net (VSN) member websites, 12 international health organizations, 11 international news websites, four medical websites and two government health websites. Images of incorrect vaccination techniques were widespread across trusted online resources. Common errors included the use of incorrect injection angle and technique (n=67), as well as injections given too high (n=31), too low (n=46), too posterior (n=7), and too anterior (n=6). The common incorrect misrepresentation of immunisation injection technique may help "normalise" incorrect vaccine administration and pose an independent risk factor for increasing vaccine errors. Identifying common missteps in visual representations of vaccination could facilitate the development of automated tools to detect misleading content, ultimately promoting safe vaccination practices.

Bowel cancer screening using faecal immunochemical tests (FIT) can detect early signs of bowel cancer and pre-cancerous adenoma. Early detection enables early diagnosis and treatment thereby reducing associated morbidity and mortality from bowel cancer. The National Bowel Cancer Screening Program (NBCSP) in Australia mails free FIT kits to eligible people aged 50-74 every 2 years; currently, only 42% of people return their kits. People aged 45-49 are eligible but need to request their kit, and as this has been recently introduced, participation data are not yet available. Many people never participate despite multiple invitations; 'persistent never screeners' are defined as people who have received at least three NBCSP kits but never returned any. This trial aims to increase screening participation among persistent never screeners by modifying invitation materials. Eligible participants (persistent never screeners due for pre-invitation letters) will be randomly assigned to one of three trial arms over a 5-week enrolment period and followed up for 6 months. The trial will compare kit return between two intervention arms and a control arm to determine effectiveness. Individuals who are defined as persistent never screeners are eligible for the NBCSP and are due for a pre-invitation letter during the trial period. 1. A modified pre-invitation letter will be sent identifying that they have not yet screened with the program and that they are not up to date with their screening. It will highlight that they are at increased risk of bowel cancer and provide a QR code and weblink to a site that allows them to order a NBCSP kit. 2. A kit with revised invitation materials, including: a modified letter highlighting increased risk from not completing previous kits, a QR code linking to information addressing common screening barriers, and a modified outer envelope removing bowel cancer information from the front and adding 'Important information about your health inside' in seven languages. Standard NBCSP pre-invitation, invitation material and kit. This trial will provide evidence on whether modified invitation and pre-invitation materials can improve screening participation among persistent never-screeners, a consistently hard-to-reach subgroup in cancer screening programs globally.

There has been a striking shift toward earlier allergen introduction after updated 2016 Australian infant feeding guidelines. Identifying factors contributing to community uptake is important for ongoing allergy prevention efforts. To determine whether and how families received feeding advice, factors associated with the receipt and accuracy of advice, and the influence of advice on allergen introduction. Parent-completed questionnaires from the EarlyNuts population-based study of 11- to 15-month-old infants (n = 1,699), captured demographic characteristics, timing of allergen introduction, and information about feeding advice. Most families (99%) received feeding advice. Advice accuracy was highest for solids, egg, and peanut (93% to 97%), and lowest for dairy (81%). Families receiving accurate advice had greater odds of timely (4-11 months) introduction of peanut (odds ratio [OR] = 9.2; 95% CI, 5.5-15.6), egg (OR = 6.2; 95% CI, 2.9-13.4), tree nuts (OR = 3.0; 95% CI, 1.9-5.0), and dairy products (OR = 2.9; 95% CI, 1.8-4.7). Maternal child health nurses were the most common source of advice (87%) and were associated with increased odds of timely peanut (OR = 1.5; 95% CI, 1.0-2.2; P = .04), egg (OR = 2.2; 95% CI, 1.4-3.6; P = .001), and dairy (OR = 1.7; 95% CI, 1.0-2.8; P = .04) introduction. Infants with parents born outside Australia were less likely to receive allergen advice (eg, peanut advice: Australia [92%], other country [80%], and East Asia [76%]). Families residing in the North East region of Melbourne (Australia) had the highest rates of any group and accurate advice. The receipt and accuracy of infant feeding advice was widespread and associated with timely allergen introduction; however, rates were lower in culturally and linguistically diverse families. Guideline dissemination and adherence likely benefited from local council and maternal child health nurse programs.

Adolescents (10-24 years old) are increasingly being included as research partners or co-researchers in line with the United Nations Convention on the Rights of the Child. However, there is no existing guidance that explores the nuance of how adolescents can be involved as co-authors in peer reviewed research publications. Through this article, we reflect on our experiences co-authoring peer reviewed publications with adolescents and support this by drawing upon empirical evidence. This Viewpoint article discusses challenges before, during and after publication and provides guidance to journals, publishers, and researchers on ethically and authentically involving adolescents as co-authors. We also propose best practice recommendations to support co-authorship with adolescents. This article is intended to create a more inclusive publication landscape for adolescents who are increasingly participating as co-researchers across health research and should rightly be included as co-authors. Patient and Public Contribution: This article was written in collaboration with adolescents, professionals and academics contributing equally. All authors contributed to article planning, investigation, reviewing and editing and approving the final version of the article.

Children born very preterm (VPT) are vulnerable to academic challenges; however, it remains unclear whether these difficulties persist into early adolescence. This study aimed to investigate rates of academic impairment in children born VPT and full-term, and impairment stability from 7 to 13 years in children born VPT using 2 approaches: academic underachievement and IQ-achievement discrepancy. Participants were children born <30 weeks' gestational age and/or <1250 g and full-term (≥37 weeks' gestational age) assessed at 7 (VPT n = 197, full-term n = 69) and 13 years (VPT n = 179, full-term n = 61) on general cognitive ability (WASI-4 and KBIT-2), word reading, spelling, and mathematics (WRAT-4). Using an underachievement approach, children born VPT were more likely to have an academic impairment at ages 7 and 13 years compared with term-born controls, particularly in reading (odds ratio [OR] and confidence interval [CI] at 7 years: 3.72 [1.67-8.27], at 13 years: 2.55 [1.06-6.11]) and mathematics (OR [CI] at 7 years: 5.77 [2.51-13.25], at 13 years: 2.78 [1.36-5.69]). Rates of impairment were low for both groups using an IQ-achievement discrepancy approach, although a group difference was evident for mathematics impairment at 7 years (OR [CI] 5.94 [1.37-25.8]), with higher rates in the VPT group (15% vs 3%). Rates of academic impairment remained relatively stable between 7 and 13 years of age, regardless of the approach applied. The rate of academic impairment varies depending on the approach used to classify impairment. Our findings suggest that academic difficulties in children born VPT may reflect a general cognitive impairment rather than a specific academic deficit.

Congenital hearing loss affects about 1–2 in every 1000 babies born in Australia [1]. Around 50% of childhood hearing loss has an underlying genetic cause [2]. To date, over 500 causative genetic variants are known to be responsible for both syndromic and non-syndromic hearing loss [3]. Genomic testing has revolutionised clinicians' ability to provide accurate and timely diagnosis for individuals with hearing loss and their families. Australia is at the forefront of demonstrating exome sequencing's cost-effective value in informing prognosis, guiding management and clarifying the risk of recurrence in family members [4]. This piece of evidence was successfully used to initiate Medicare funding for exome sequencing in childhood hearing loss, available since 2023 with Medicare Benefits Schedule (MBS) items 73,440–73,444. Despite strong evidence of the benefit of genomic testing for these families, the combined uptake of these five MBS items—193 over 2 years—remains lower than the expected 180–200 per year and 3000 retrospectively eligible cases (Table 1). The available funding ($1200 for singleton test) is insufficient for laboratories to complete testing (as of December 2025: Victorian Clinical Genetics Services, $2195; Pathology Queensland, $2181), and testing processes are laboriously slow. In addition, there is limited access to genetic counselling, a vital service for families for adequate understanding and informed consent for testing. Genetics services often have long waitlists, inequitable and variable decisions about funded testing and a long wait for results. Consequently, most families are unable to realistically access genomic testing for hearing loss, and for those who can afford the test, the results may take several months. These delays mean that families might not receive results in time to inform reproductive decisions based on genetic risk or to plan early interventions for their infant, leaving them uninformed at a critical period. This situation reflects the broader challenge of MBS items in genomics (including paediatrics, renal, cardiac, neurology and cancer), whereby funding a test in isolation without considering staffing costs for laboratories, genetics services and patient perspectives has led to an implementation problem [7]. This frustrating gap and inequity in clinical care must be addressed. We must ensure there is adequate funding, resources and training for laboratories to complete genomic testing for hearing loss and other conditions, and increase access to genetic counselling through training, funding and recognition of the profession's invaluable work. Most of all, we owe affected families equitable access to the opportunity for genomic testing to provide better, personalised and informed care. Emma McGonigal: writing – original draft and writing – review and editing. Andrew White: conceptualisation, supervision and writing – review and editing. Valerie Sung: supervision and writing – review and editing. Karen Liddle, Lilian Downie and Emily Shepard: writing – review and editing. The authors have nothing to report. Emma McGonigal is a volunteer advocate for the Usher Syndrome Coalition; she receives no financial remuneration for this role. The authors have nothing to report.

Early detection and intervention for hearing loss can transform a child’s life, but Australia lacks a consistent nationwide system to track and improve outcomes. The ANCHOR survey mapped hearing services and datasets, showing that differences in data collection, challenges linking information, and gaps in oversight are key barriers, while strong support for a coordinated system is a major enabler. Understanding these factors brings us closer to a national system that helps every deaf and hard-of-hearing child reach their potential.