Donald Payne

A video questionnaire identifies upper airway abnormalities in preschool children with reported wheeze

Background: Accurate characterisation of subjects is essential to interpret data from studies investigating preschool wheezing. Aim: To assess whether a video questionnaire (VQ) identifies upper airway abnormalities in preschool children with reported wheeze. Methods: Forty three children (median age 17 months, range 3–58) undergoing fibreoptic bronchoscopy for clinical investigation of troublesome noisy breathing at a tertiary centre were studied. Parents were shown a VQ with four clips (wheeze, stridor, and two other upper respiratory noises) and chose the clip(s) resembling their child’s main symptom. Doctor observed symptoms, parental reported symptoms, and symptoms identified on VQ were related to bronchoscopy. Results: Thirty subjects had wheeze as the main symptom: 19 had doctor observed wheeze (DOW) and 11 had parental reported wheeze (RW). Parents of two of the subjects with RW identified wheeze alone on VQ and both had normal bronchoscopic findings. Five of the remaining nine subjects with RW had upper airway abnormalities at bronchoscopy. Parents of six subjects with RW identified a noise other than wheeze on VQ; four of these had upper airway abnormalities. Parents of two subjects with RW did not identify a noise on VQ; one had upper airway abnormalities. Of the 19 with DOW, nine parents identified wheeze alone on VQ, and all had a normal upper airway. Parents of nine subjects with DOW identified a noise other than wheeze as an equal or only symptom, (no noise identified in one), and five had upper airway abnormalities. Conclusion: A VQ helps to identify upper airway abnormalities in preschool children with a history of wheezing.

Health of adolescent refugees resettling in high-income countries

Adolescent refugees are a vulnerable population with complex healthcare needs that are distinct from younger and older age groups. Physical health problems are common in this cohort with communicable diseases being the focus of attention followed by an emphasis on nutritional deficiencies and other chronic disorders. Adolescent refugees have also often experienced multiple traumatic stressors and are at a heightened risk of developing mental health problems. Navigating these problems at the time of pubertal development adds further challenges and can exacerbate or lead to the emergence of health risk behaviours. Educational difficulties and acculturation issues further compound these issues. Adolescents who have had experiences in detention or are unaccompanied by parents are particularly at risk. Despite a constantly growing number of adolescent refugees resettling in high-income countries, knowledge regarding their specific healthcare needs is limited. Research data are largely extrapolated from studies conducted within paediatric and adult cohorts. Holistic management of the medical and psychological issues faced by this group is challenging and requires an awareness of the socioeconomic factors that can have an impact on effective healthcare delivery. Legal and ethical issues can further complicate their management and addressing these in a culturally appropriate manner is essential. Early identification and management of the healthcare issues faced by adolescent refugees resettling in high-income countries are key to improving long-term health outcomes and future healthcare burden. This review article aims to increase knowledge and awareness of these issues among paediatricians and other health professionals.

Adolescent and young adult health in a children's hospital: Everybody's business.

Background:  To guide the development of adolescent health training and the planning of future services, accurate data describing health service use by adolescents and young adults are needed.

Development of the bronchial epithelial reticular basement membrane: relationship to epithelial height and age

Background The bronchial epithelium and underlying reticular basement membrane (RBM) have a close spatial and functional inter-relationship and are considered an epithelial–mesenchymal trophic unit (EMTU). An understanding of RBM development is critical to understanding the extent and time of appearance of its abnormal thickening that is characteristic of asthma. Methods RBM thickness and epithelial height were determined in histological sections of cartilaginous bronchi obtained postmortem from 47 preterm babies and infants (median age 40 weeks gestation (22 weeks gestation–8 months)), 40 children (2 years (1 month–17 years)) and 23 adults (44 (17–90) years) who had died from non-respiratory causes, and had no history of asthma. Results The RBM was visible by light microscopy at 30 weeks gestation. RBM thickness increased in successive age groups in childhood; in infants (r=0.63, p<0.001) and in children between 1 month and 17 years (r=0.82, p<0.001). After 18 years, RBM thickness decreased with increasing age (r=−0.42, p<0.05). Epithelial height showed a similar relationship with age, a positive relationship from preterm to 17 years (r=0.50, p<0.001) and a negative relationship in adulthood (r=−0.84, p<0.0001). There was a direct relationship between epithelial height and RBM thickness (r=0.6, p<0.001). Conclusions The RBM in these subjects was microscopically identifiable by 30 weeks gestation. It thickened during childhood and adolescence. In adults, there was either no relationship with age, or a slow reduction in thickness in older age. Developmental changes of RBM thickness were accompanied by similar changes in epithelial height, supporting the close relationship between RBM and epithelium within the EMTU.

Management of urinary tract infection in a tertiary children's hospital before and after publication of the NICE guidelines

Introduction The UK National Institute for Health and Clinical Excellence (NICE) introduced guidelines for the diagnosis, treatment and management of urinary tract infection (UTI) in children and adolescents in August 2007. Aim The primary aim was to determine whether publication of NICE guidelines was associated with a change in the use of diagnostic imaging investigations in patients with a documented first UTI in a tertiary childrens hospital. Secondary aims were to describe the epidemiology, microbiology, prescription of prophylactic antibiotics and follow-up for these children, and the incidence of structural renal tract abnormalities, vesicoureteric reflux and renal uptake defects identified. Methods Retrospective review of the case notes of patients presenting to Princess Margaret Hospital, Perth, Western Australia with a first UTI over a 4-year period (August 2005–2009). Details of demographics, radiological investigations, microbiology and follow-up were obtained. Data for subjects presenting before and after 31 August 2007 were compared. Results Data from 659 subjects, median age 6 (range 0–186) months were analysed. Compared with the pre-NICE period, there was no change in the proportion of patients undergoing renal USS in the 2 years following publication of the guidelines. There was a decrease in the proportion undergoing MCUG (p<0.0001) and receiving antibiotic prophylaxis (p<0.0001) and an increase in the proportion undergoing DMSA (p<0.001). Conclusions Practice changed following publication of the NICE guidelines. While the reduction in MCUG requests and prescription of antibiotic prophylaxis is in line with NICE guidelines, the increase in DMSA requests is contrary to the recommendations.

Opportunistic adolescent health screening of surgical inpatients

Purpose Opportunistic health screening has long been promoted by advocates of adolescent health. However, there are few objective data documenting the outcomes in an inpatient setting. Methods The authors performed opportunistic health screening on 114 surgical inpatients, median age 14 (range 10–18) years, admitted to a general adolescent ward in a tertiary childrens hospital. A four-page paper document with a formatted list of questions, based on the Home, Education, Activities, Drugs, Sexual Health, Suicide framework, was developed to standardise screening and documentation. Results Areas of concern requiring intervention were identified in 34 (30%) patients. Specific interventions included referrals to the Adolescent Medicine clinic (n=6), Hospital School Services (n=7) and Psychological Medicine (n=7). Conclusions Consideration should be given to offer adolescent health screening to all surgical inpatients. Further research should involve the participation of young people and should focus on the outcomes, feasibility, acceptability and resource implications of such screening.

Chemical and glass thermometers for axillary temperatures: how do they compare?

Axillary temperatures recorded with a disposable chemical thermometer (DCT) measured a mean 0.29 degrees C higher than a mercury in glass thermometer (MGT) but differences could be wide. Differences between the same methods were however also wide. The DCT is safe and easy to use. Provided the higher readings are taken into consideration it is a suitable alternative to the MGT.

Prolonged school non-attendance in adolescence: a practical approach

Prolonged school non-attendance in adolescence poses a significant public health concern. Adverse outcomes for adolescents who have missed out on the social and academic benefits of high school include mental health disorders and economic, social and relationship difficulties that may persist into adulthood. Healthcare professionals are often consulted in cases of prolonged school non-attendance. Diagnosis and management of specific physical and mental health problems must be the health professionals initial priority, with the subsequent development of a management plan to assist with school reintegration. Using a specific framework, an understanding of the factors contributing to a young persons school non-attendance can be developed. Intervention leading to a successful return to school has the potential to lower the risk of associated long-term adverse health outcomes.

Meeting the needs of young people in hospital

Adolescent and young adult (AYA) health has been on the agenda for some time,1 with no shortage of reports and guidelines highlighting the importance of developing clinical services for young people.2–6 However, these recommendations are yet to be translated into established clinical practice, with a culture of young peoples health embedded in every health service. Common causes of morbidity among young people include mental health problems, drug and alcohol misuse, injuries (intentional and non-intentional), and sexual health problems.7 In addition, the number of adolescents and young adults growing up with chronic diseases of childhood continues to increase, placing pressure on both paediatric and adult services.8 There are compelling reasons to increase the focus on young peoples health as this is a group for whom improvements in outcomes have not matched those seen among other age groups (eg, the under-5s and the elderly).7 Investment in young peoples health is required to address this imbalance and to consolidate the improvements in outcomes that have resulted from previous investment in early childhood. A greater focus on young people will also address many of the health behaviours that determine key outcomes in later life, thus reducing pressure on health service use by older adults.9 ,10 For hospital-based clinicians wishing to establish AYA services, how should they proceed and what might such services look like? This article provides some suggestions. The scope of any AYA service that clinicians provide will depend on where they work; for example, in a general, childrens, adult or subspecialist hospital. General hospitals would seem best suited to developing AYA services as they manage patients across the whole AYA age range (10–24 years). In contrast, clinicians in specialist childrens or adult hospitals are frequently faced with having to convince hospital managers that young peoples health …

Adolescent and young adult medicine in Australia and New Zealand: towards specialist accreditation.

Abstract In Australia and New Zealand, a critical mass of academic and clinical leadership in Adolescent Medicine has helped advance models of clinical services, drive investments in teaching and training, and strengthen research capacity over the past 30 years. There is growing recognition of the importance of influencing the training of adult physicians as well as paediatricians. The Royal Australasian College of Physicians (RACP) is responsible for overseeing all aspects of specialist physician training across the two countries. Following advocacy from adolescent physicians, the RACP is advancing a three-tier strategy to build greater specialist capacity and sustain leadership in adolescent and young adult medicine (AYAM). The first tier of the strategy supports universal training in adolescent and young adult health and medicine for all basic trainees in paediatric and adult medicine through an online training resource. The second and third tiers support advanced training in AYAM for specialist practice, based on an advanced training curriculum that has been approved by the RACP. The second tier is dual training; advanced trainees can undertake 2 years training in AYAM and 2 years training in another area of specialist practice. The third tier consists of 3 years of advanced training in AYAM. The RACP is currently seeking formal recognition from the Australian Government to have AYAM accredited, a process that will be subsequently undertaken in New Zealand. The RACP is expectant that the accreditation of specialist AYAM physicians will promote sustained academic and clinical leadership in AYAM to the benefit of future generations of young Australasians.