Doungkamol Sindhusake

Effect of peer led programme for asthma education in adolescents: cluster randomised controlled trial

Abstract Objective: To determine the effect of a peer led programme for asthma education on quality of life and related morbidity in adolescents with asthma. Design: Cluster randomised controlled trial. Setting: Six high schools in rural Australia. Participants: 272 students with recent wheeze, recruited from a cohort of 1515 students from two school years (mean age 12.5 and 15.5 years); 251 (92.3%) completed the study. Intervention: A structured education programme for peers comprising three steps (the “Triple A Program”). Main outcome measures: Quality of life, school absenteeism, asthma attacks, and lung function. Results: When adjusted for year and sex, mean total quality of life scores showed significant improvement in the intervention than control group. Clinically important improvement in quality of life (>0.5 units) occurred in 25% of students with asthma in the intervention group compared with 12% in the control group (P=0.01). The number needed to treat was 8 (95% confidence interval 4.5 to 35.7). The effect of the intervention was greatest in students in year 10 and in females. Significant improvements occurred in the activities domain (41% v 28%) and in the emotions domain (39% v 19%) in males in the intervention group. School absenteeism significantly decreased in the intervention group only. Asthma attacks at school increased in the control group only. Conclusion: The triple A programme leads to a clinically relevant improvement in quality of life and related morbidity in students with asthma. Wider dissemination of this programme in schools could play an important part in reducing the burden of asthma in adolescents

Prevalence and characteristics of tinnitus in older adults: the Blue Mountains Hearing Study.

There have been few recent estimates of the prevalence of tinnitus from large population-based samples of older persons. Our study aimed to assess the prevalence and characteristics of prolonged tinnitus in a representative sample of 2015 adults aged 55–99 years, residing in the Blue Mountains, west of Sydney, Australia, during 1997–99. All participants underwent a detailed hearing examination by an audiologist, including comprehensive questions about hearing. After age adjustment, subjects reporting tinnitus had significantly worse hearing at both lower and higher frequencies (p < 0.001). This difference was more marked in younger than in older subjects (p < 0.05). Overall, 602 subjects (30.3%) reported having experienced tinnitus, with 48% reporting symptoms in both ears. Tinnitus had been present for at least 6 years in 50% of cases, and most (55%) reported a gradual onset. Despite tinnitus being described as mildly to extremely annoying by 67%, only 37% had sought professional help, and only 6% had received any treatment. Existen pocas estimaciones recientes sobre la prevalencia de acúfeno calculada en una población amplía en personas mayores. Nuestro estudio tiene como objetivo conocer la prevalencia y las características de acúfeno de larga evolución en una muestra representativa de 2015 adultos de 55 a 99 años, residentes de Blue Mountains, al oeste de Sydney, Australia, de 1997 a 1999. Todos los participantes se sometieron a un examen audiológico detallado realizado por un audiólogo, que incluyó preguntas sobre la audición. Después de un ajuste etáreo se observó que los sujetos que manifestaban acúfeno tenían peores umbrales tanto en altas como en bajas frecuencias (p < 0.001). Esta diferencia fue más marcada en sujetos jóvenes que en viejos (p < 0.05). Un total de 602 sujetos (30.3%) reportaron haber experimentado acúfeno; 48% de ellos en forma bilateral. En 50% de los casos, el acúfeno tenía al menos 6 años de evolución y el 55% reportó un inicio gradual. Aunque el acúfeno fue descrito como mediana a extremadamente molesto en el 67% de los casos, sólo el 37% había buscado ayuda profesional y sólo 6%) había recibido algún tipo de tratamiento.

Risk factors for tinnitus in a population of older adults: the blue mountains hearing study.

Objective To identify potential and modifiable risk factors for tinnitus in a population of older adults. Study Design Cross-sectional study. Detailed questionnaires were interviewer-administered in a representative sample of 2015 persons aged 55+ yr, living in an area west of Sydney, Australia. Air- and bone-conduction audiometric thresholds were measured from 250 to 8000 Hz and from 500 to 4000 Hz, respectively. TEOAE and SOAE were measured for both ears. Results After adjusting for multiple variables in a Cox proportional hazards model, factors that significantly increased the risk of tinnitus were poorer hearing and cochlear function, self-reported work-related noise exposure, and history of middle ear or sinus infections, severe neck injury or migraine. Conclusion Interventions aimed at reducing age-related hearing loss, particularly by reducing excessive work-related noise exposure, and the effective, timely treatment of ear-related infections, may all decrease the risk of tinnitus.

A prospective cohort study of health outcomes following whiplash associated disorders in an Australian population.

Objective: To define health outcomes of whiplash associated disorders (WAD) at three months, six months, and two years after injury and to examine predictors of these outcomes. Design: Prospective cohort study. Setting: New South Wales, Australia. Subjects: People with compensable motor crash injuries who reported whiplash as one of their injuries. Interventions: None. Main outcome measures: Functional Rating Index (FRI), Short Form 36 (SF-36) at three months, six months, and two years after injury, ascertained by telephone interview. Results: At three months, 33.6% of the cohort was recovered (as defined by FRI⩽25), increasing marginally at six months (38.9% recovered), but more significantly at two years (51.7% recovered, p = 0.001). The mean physical component score of the SF-36 improved at each time point (p = 0.002), while the mean mental component score did not (p = 0.59). Predictors of recovery at two years (as defined by global perceived effect) included a lower FRI index at baseline (p = 0.001) and closure of the claim at two years (p = 0.02). Conclusion: Whiplash injury had a large effect on the health of this Australian cohort of whiplash sufferers, with only 50% of the cohort recovered at two years. Physical measures of health appear to improve over time, whereas mental measures of health did not. Despite this, this cohort is largely able to participate in activities and work at two years. Prevention of chronic disability may lie with concentration of resources to those who score highly on the FRI at baseline. In addition, chronic psychological ill health may be prevented by directing treatment to those with poor scores on sensitive measures of psychological ill health at baseline.

Legislative change is associated with improved health status in people with whiplash.

Study Design. Interrupted time series. Objective. To assess whether a change in legislation improved health status and quality of life for people with whiplash. Summary of Background Data. Whiplash was the most prevalent injury in a compulsory, fault based, third party motor vehicle insurance scheme in New South Wales, Australia. Legislative change removed financial compensation for “pain and suffering” for whiplash, introduced clinical practice guidelines for its treatment; and changed regulations to permit earlier acceptance of compensation claims, and earlier access to treatment, for all types of injury. Methods. Three independent groups of people with whiplash were identified from insurance data (before legislative change—the 1999 group and, after legislative change—the 2001 and 2003 groups). Health status was assessed 2 years after injury by a telephone interviewer blinded to the study hypotheses. The main outcome measure was disability, as assessed by the Functional Rating Index (FRI). Pain and health-related quality of life was also assessed. Results. The mean FRI at 2 years after injury was 38.0% (SE, 1.9) for the 1999 group, 31.8% (SE, 2.1) for the 2001 group, and 30.1% (SE, 1.8) for the 2003 group (F = 5.0, P = 0.007). Improvement in secondary outcomes, including pain, also occurred. Conclusion. Health status of people with whiplash improved after legislative change. Design of compensation schemes should be undertaken with the understanding that the scheme structure may have substantial effects on the long-term health of injured people.

SEPSIS KILLS: early intervention saves lives.

Objective: To implement a statewide program for the early recognition and treatment of sepsis in New South Wales, Australia.

Risk factors for colonization with vancomycin-resistant enterococci in a Melbourne hospital.

OBJECTIVE To determine risk factors for colonization with vancomycin-resistant enterococci (VRE) in a hospital outbreak. DESIGN Outbreak investigation and case-control study. SETTING A referral teaching hospital in Melbourne, Australia. PARTICIPANTS Cases were inpatients colonized (with or without clinical disease) with VRE between July 26 and November 28, 1998; controls were hospitalized patients without VRE. METHODS Five cases of VRE were identified between July 26 and November 8, 1998, by growth of VRE from various sites. Active case finding by cultures of rectal swabs from patients surveyed in wards was commenced on July 26, after the first isolate of VRE. RESULTS There were 19 cases and 66 controls. All the VRE identified were vanB, and all were Enterococcus faecium. One molecular type predominated (18/19 cases). In a logistic-regression model, being on the same ward as a VRE case was the highest risk factor (odds ratio [OR], 82; 95% confidence interval [CI95], 5.7-1,176; P=.001). Having more than five antibiotics (OR, 11.9; CI95 1.1-129.6; P<.05), use of metronidazole (OR, 10.9; CI95, 1.7-69.8; P=.01), and being a medical patient (OR, 8.1; CI95, 1.4-47.6; P<.05) also were significant. Intensive care unit admission was associated with decreased risk (OR, 0.1; CI95, 0.01-0.8; P<.05). CONCLUSION Our findings are consistent with an acute hospital outbreak. Monitoring and control of antibiotic use, particularly metronidazole, may reduce VRE in our hospital. Ongoing surveillance and staff education also are necessary.

Folate fortification: potential impact on folate intake in an older population.

Objective: To examine the potential impact of different models of folate fortification of Australian foods on the folate intakes of older Australians.Design: Dietary data were collected using a food frequency questionnaire from people attending a population-based health study.Setting: Two postcode areas west of Sydney, Australia.Subjects: A total of 2895 people aged over 49 y, obtained from a door knock census (79% of 3654 subjects examined).Main outcome measures: The folate intake in this population was estimated using four different models: (1) pre-fortification folate values; (2) current voluntary folate fortification in Australia; (3) universal fortification of all foods permitted to add folate, at 25% recommended dietary intake (RDI) per reference serve; and (4) universal fortification of all foods permitted to add folate, at 50% RDI per reference serve. The increased bioavailability of synthetic folic acid (SFA) was included in the analysis.Results: At current voluntary folate fortification, approximately 65% of this population consume 320 µg dietary folate equivalents (DFE) or more per day from diet and supplements, and 0.4% (n=10) consume greater than the recommended upper safety level of 1000 µg from SFA. More than 95% of this older population would be expected to consume more than 320 µg DFE from diet and supplements with universal fortification at 50% of the RDI, and 0.5% (n=14) may consume greater than 1000 µg/day of SFA.Conclusions: There is unlikely to be a large increase in the proportion of older persons who are likely to consume more than the upper safety level of intake with universal folate fortification. As most of those who currently or are predicted to consume over 1000 µg SFA take supplements containing folic acid, it is highly recommended that vitamin B12 be included in any vitamin supplements containing folate.Sponsorship: This study was supported by the Australian National Health and Medical Research Council (NHMRC).European Journal of Clinical Nutrition (2001) 55, 793–800