Royal Children's Hospital

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.

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.

Abstract Background Cardiac magnetic resonance (CMR) imaging is an important tool for diagnosis and morphological assessment of the heart in childhood HCM. Up to 20% of patients with childhood onset disease have an underlying RASopathy syndrome but to date no studies have reported the CMR findings in this population. Purpose To characterise CMR findings in RASopathy-associated HCM (RAS-HCM) investigate their role in prediction of major adverse cardiac events (MACE) in this population. Methods CMR findings from a multi-centre, retrospective, observational cohort of 47 children with RAS-HCM were compared with those of 85 children with s-HCM. Results Patients with RAS-HCM had a higher median indexed left ventricular mass (LVMi) (124g/m2 vs 105g/m2, p=0.027) but lower prevalence of left ventricular (LV) late gadolinium enhancement (LGE) (33.3% vs 55.6%, p<0.001). Patients with a RAF1 variant had a higher median maximal LV wall thickness (MLVWT; 23mm vs 12mm, p=0.029) and LVMi (160g/m2 vs 106g/m2, p=0.030), and a higher proportion of patients with hyperdynamic LV function (100% vs 58.3%, p=0.037) compared to PTPN11. Over a median follow up of 7.0 (IQR 3.5-12.0) years, 8 patients (17.0%) reached the MACE end point. On univariate regression analysis, LV end-diastolic volume (LVEDV) (HR 0.6, 95% CI 0.92-1, p=0.04), LV cardiac output (LVCO) (HR 0.43, 95% CI 0.19-0.97, p=0.04) and the presence of RVH (HR 0.09, 95% CI 0.01-0.86, p=0.04) emerged as potential predictors of MACE. Conclusions This multi-centre cohort study is, to our knowledge, the first that describes CMR features of pediatric RAS-HCM. Major findings include a lower prevalence of LV LGE compared to patients with sarcomeric HCM, with a higher LV indexed mass in patients with RAS-HCM, particularly those with RAF1 variants. These findings may have implications for the diagnosis and risk stratification of children with RAS-HCM.

Niemann-Pick disease type C (NP-C) is the fifth most prevalent lysosomal disorder in Australia. Diagnostic delay is common, impacted by disease heterogeneity, limited awareness within clinical gateway services and exclusion from state-based newborn screening programmes. A formal diagnosis, once established, places a substantial burden on the whole family, the negative impact of which is far-reaching. A clear understanding of diagnostic pathways and management objectives in NP-C is critical for optimal care. To develop an Australian standard of care for individuals diagnosed with NP-C and their families, reflecting international best practice and tailored to the Australian healthcare system. The Australian NPC Disease Foundation Inc. convened a national, multidisciplinary collaboration including NP-C treating clinicians, allied health professionals and a community advisory group. Using an iterative consensus approach, published international guidance statements were reviewed, ratified, excluded or modified to align with the Australian context. Consensus outputs included a diagnostic algorithm, a multidisciplinary care framework and management-centred management statements. The collaborative process resulted in a unified Australian standard of care for NP-C. This framework incorporates the carer perspective, emphasises shared decision-making and situates NP-C within the broader context of 'childhood dementias.' Consensus statements provide practical, evidence-aligned guidance on early recognition, diagnostic referral pathways and multidisciplinary management throughout disease progression. This initiative represents the first Australia-specific standard of care for NP-C. It is hoped that adoption of the framework will lead to improved experiences for Australians living with NP-C and their carers as they navigate the healthcare setting.

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.