J. Lynn Francis

Airway inflammation after treatment with aerosolized deoxyribonuclease in cystic fibrosis

Recombinant human deoxyribonuclease (rhDNase) has been shown to reduce sputum viscoelasticity and to improve lung function in patients with cystic fibrosis (CF). The aim of this study was to determine whether airway inflammation would decrease after administration of rhDNase. Twenty patients with CF and chronic suppurative lung disease inhaled 2.5 mg of rhDNase daily for 1 month. Before and after the 1‐month trial, lung function was measured and sputum was obtained, either after spontaneous expectoration or after sputum induction with hypertonic saline. Sputum total cell and differential counts were measured using techniques previously described. The mean age of the patients was 16.8 years (range, 6.7–27.5). After 1 month of rhDNase, mean FEV1 increased from a baseline of 62.3% predicted to 70.8% (P = 0.02, paired t test); and FVC increased from 74.4% to 83.9% predicted (P = 0.007). No significant differences were found in sputum cytology before or after rhDNase (median total cell counts 16.0 × 106/ml vs. 19.3 × 106/ml, P = 0.68). Thirteen patients had a 10% or greater increase in FEV1 after rhDNase (responders). Initial lung function was less in responders than in nonresponders (53.5% vs. 78.6%, P = 0.007). There was no significant change in total cell count and neutrophil count after rhDNase in either responders or nonresponders. We conclude that airway inflammation, as measured by total cell counts in sputum, was a prominent feature in cystic fibrosis, and neutrophils were the dominant inflammatory cells. Although the administration of rhDNase resulted in significant improvements in FEV1, there was no evidence of accompanying changes in airway inflammation. Pediatr Pulmonol. 1998;26:97–100.

An implementation intervention to encourage healthy eating in centre-based child-care services: impact of the Good for Kids Good for Life programme.

OBJECTIVE To determine the impact of an implementation intervention designed to introduce policies and practices supportive of healthy eating in centre-based child-care services. Intervention strategies included staff training, resources, incentives, follow-up support, and performance monitoring and feedback. DESIGN A quasi-experimental design was used to assess change over 20 months in healthy eating policy and practice in intervention and comparison child-care services. SETTING The Hunter New England (HNE) region of New South Wales (NSW), Australia. SUBJECTS All centre-based child-care services (n 287) in the intervention region (HNE) were invited and 240 (91% response rate) participated. Two hundred and ninety-six services in the rest of NSW were randomly selected as a comparison region and 191 participated (76% response rate). A sub-analysis was conducted on those services that provided children food (n 196 at baseline and n 190 at follow-up). Ninety-six provided menus for analysis at baseline (HNE, n 36; NSW, n 50) and 102 provided menus at follow-up (HNE, n 50; NSW, n 52). RESULTS Services in the intervention region were significantly more likely to provide only plain milk and water for children (P = 0.018) and to engage parents in nutrition policy or programmes (P = 0.002). They were also more likely (P = 0.056) to have nutrition policy on home packed food. In addition, menus of services that provided lunch were significantly more likely to comply with healthy eating guidelines for sweetened drinks (P < 0.001), fruit (P < 0.001) and vegetables (P = 0.01). CONCLUSIONS An implementation intervention was able to modify policy and practice in a large number of child-care services so that they were more supportive of healthy eating.

Utility of blood cultures in children admitted to hospital with community-acquired pneumonia.

The aim of the study was to assess the utility of blood cultures in children admitted to hospital with community‐acquired pneumonia. The primary outcome was the number of positive blood culture results, and secondary outcomes included the effect of positive blood culture results on management, and the identification of other clinical/biochemical variables that could predict blood culture results or the course of illness.

Acknowledging How Older Australian Women Experience Life After Stroke: How Does the WHO 18-Item Brief ICF Core Set for Stroke Compare?

We examined older womens qualitative experiences of stroke with the World Health Organizations 18-item Brief International Classification of Functioning, Disability and Health Core Set for Stroke. Women were participants of the Australian Longitudinal Study on Womens Health, born between 1921 and 1926, who had experienced a stroke in the previous 3 years. An inductive thematic analysis was conducted of womens qualitative experiences of stroke, which were then examined with the 18-item Brief Core Set for Stroke for congruency. Our analysis showed that for older Australian women, their concerns of poststroke living were not adequately classified, potentially impeding a full recovery.

Encouraging general practitioners to complete the four-year-old Healthy Kids Check and provide healthy eating and physical activity messages

Objective: To describe the impact of a training and support intervention to encourage completion of the Healthy Kids Check (HKC) by general practitioners (GP) or practice nurses (PN) and provision of brief advice on diet and physical activity.