Judith Halliday

Asthma knowledge, attitudes, and quality of life in adolescents.

Adolescents with asthma, their peers, and their teachers were studied in order to establish the level of knowledge concerning asthma and its management, their attitudes towards asthma, and the degree quality of life impairment due to asthma. A community survey was conducted among year 8 high school students (n = 4161) and their teachers (n = 1104). There was a good response rate to the questionnaires from students (93%) and teachers (61%). Twenty three per cent of students had asthma and this caused mild to moderate quality of life impairment, particularly with strenuous exercise. Asthma was provoked by passive smoke exposure in 30% of asthmatic students and up to 51% of students avoided situations because of asthma triggers. Asthma knowledge was low in teachers (mean score 14.90 out of a possible 31), students without asthma (11.25) and students with asthma (14.50). Specific knowledge on the prevention and treatment of exercise induced asthma was poor. There was a moderate degree of tolerance towards asthma among all three groups. Most considered internal locus of control as important, although students without asthma also considered chance to be a determinant of outcomes for people with asthma. Asthma is a common cause of quality of life impairment among year 8 high school students. Although specific knowledge on asthma is low, students and teachers hold favourable attitudes towards asthma. There are opportunities to intervene and improve asthma management among adolescents.

Parental asthma knowledge: its association with readmission of children to hospital.

Objectives: To assess whether poor parental knowledge about asthma was a risk factor for readmission of their children to hospital.

A simple score and questionnaire to measure group changes in dietary fat intake

BACKGROUND A short 12-term questionnaire was designed to measure changes in the dietary intake of saturated and total fat among groups of people attending health promotion events. A simple score (the fat-habits score) derived from the questionnaire was compared with estimates of saturated and total fat intake (% total energy) estimated from a standard 180-item food frequency questionnaire of 105 children (less than 18 years) and 202 adults (greater than 18 years). RESULTS The correlation coefficients for saturated fat intake and the fat-habits score were 0.60 (95% CI = 0.50 to 0.68) in adults and 0.54 (95% CI = 0.39 to 0.66) in children, and those for total fat and the fat-habits score were 0.46 (95% CI = 0.41 to 0.56) in adults and 0.40 (95% CI = 0.22 to 0.55) in children. Linear regression equations relating the fat-habits score to saturated and total fat were used to predict changes in fat intake in 12 children and 27 adults who completed both questionnaires 6 months apart. The differences between the predicted changes in saturated and total fat and the observed changes measured by the food frequency questionnaires were not significant (saturated fat: adults -0.3%, 95% CI = -1.3 to 0.7%; children -0.2%, 95% CI = -1.7 to 1.3%; total fat: adults -0.6%, 95% CI = -2.9 to 1.7%; children -0.4%, 95% CI = -2.8 to 2.0%). The study had a 90% power of detecting a difference between the predicted and the observed changes for saturated fat of greater than +/- 1.7% (adults) and +/- 2.5% (children), and for total fat of greater than +/- 3.9% (adults) and +/- 4.0% (children). Conclusion. Thus simple scores can be used to evaluate group changes in fat intake.

Home-based management of children hospitalized with acute gastroenteritis

Objective: To determine the source of medical advice to parents and treatment administred at home for children admitted to hospital with acute gastroenteritis.

Increased wheeze but not bronchial hyperreactivity near power stations.

STUDY OBJECTIVE--In a previous study a higher than expected prevalence of asthma was found in Lake Munmorah, a coastal town near two power stations, compared with another coastal control town. This study aimed to compare atopy, bronchial hyperreactivity, and reported symptoms of asthma in the power station town and a second control area with greater socioeconomic similarity. DESIGN--A cross sectional survey was undertaken. SETTINGS--Lake Munmorah, a coastal town near two power stations, and Dungog, a country town in the Hunter Valley, NSW, Australia. PARTICIPANTS--All children attending kindergarten to year 6 at all schools in the two towns were invited to participate in 1990. The response rates for the questionnaire for reported symptoms and associated demographic data were 92% in Lake Munmorah and 93% in Dungog, with 84% and 90% of children respectively being measured for lung function, atopy, and bronchial reactivity. There were 419 boys and 432 girls aged 5 to 12 years. MEASUREMENTS AND MAIN RESULTS--Main outcome measures were current wheeze and bronchial hyper-reactivity, defined as a fall in forced expiratory volume in 1 second (FEV1) or peak expiratory flow (PEF) of 20% or more. Current wheeze was reported in 24.8% of the Lake Munmorah children compared with 14.6% of the Dungog children. Bronchial hyper-reactivity was similar for both groups--25.2% in Lake Munmorah and 22.3% in Dungog. The mean baseline FEV1 was lower in Lake Munmorah than in Dungog (p < 0.001). Dungog children were more likely to have positive skin test to house dust mite (Dungog 27.0%, Lake Munmorah 20.2%, p = 0.028) but there were no other differences in skin test atopy in the two towns. After adjusting for age, gender, any smoker in the house, and positive dust mite skin test, the odds of current wheeze in Lake Munmorah compared with Dungog was 2.16 (95% confidence interval 1.45, 3.15). CONCLUSIONS--Baseline lung function was lower and reported symptoms of asthma were higher in the power station town, but bronchial hyper-reactivity and skin test defined atopy were similar in the two communities. These results are consistent with the previous study and confirm the increased presence of reported symptomatic illness in the town near power stations.

Headache and asthma

The aim of this study was to investigate the association between headache and asthma, bronchodilators and atopy in school children. A cross‐sectional survey of all primary school children was conducted in two towns near Newcastle, New South Wales, Australia; one in the vicinity of two coal‐fired power stations, the other free of outdoor industrial air pollution. The main outcome measures were frequent headache, wheezing, bronchial reactivity, use of bronchodilators and atopy. Eight hundred and fifty‐one primary school children aged 5‐12 years participated (92% response rate). Twenty‐three per cent of the children were reported to have had a history of frequent headache. Crude odds ratios indicated that the odds of frequent headache was significantly higher in children with asthma and atopy and where there was a smoker in the home, but that there was no association between frequent headache and use of bronchodilators or the sex of the child or socio‐economic status measured as fathers occupation. Stepwise logistic regression with frequent headache as the outcome of interest showed that, after adjusting for age and smoking in the home, the odds ratio for asthma (defined as current wheeze) was 3.24 (95% confidence interval [CI] 2.19‐4.77). The similarly adjusted odds ratio for asthma defined as bronchial hyperreactivity (BHR).was 1.60 (95% Cl 1.09‐2.37). Atopy was not statistically significantly associated with headache for either model. Asthma (defined as wheeze or BHR) is an independent risk factor for frequent headache. The relationship between headache and asthma is an association with bronchial hyperresponsiveness rather than atopy.

Short Intervention Can Improve Knowledge About Childhood Asthma in Nursing Staff

Twenty-nine community or hospital-based general nurses from the Upper Hunter Valley attended a 3-hr seminar on asthma and completed a previously validated asthma knowledge questionnaire before and 6 weeks after the seminar. The mean initial score (maximum possible 31) was 20.6 [95% confidence interval (CI) 19.1-22.0], which increased at follow-up to 26.2 (95% CI 25.0-27.3). Only 5 of 29 nurses scored 24 or more initially compared with 17 of 21 at follow-up. Even after the seminar, the nurses had major deficiencies in knowledge about preventive medication and the management of exercise-induced asthma.

A New Method of Estimating Cost Effectiveness of Cholesterol Reduction Therapy for Prevention of Heart Disease

SummaryThe purpose of this study was to demonstrate a new method of estimating the cost effectiveness of interventions that lower blood cholesterol levels in the prevention of coronary heart disease (CHD) at the community level. The participants in the study were 67 651 men aged 35 to 64 years in the Lower Hunter region of New South Wales, Australia. Census data, risk factor profiles and CHD event rates from community surveillance, plus costs in 1988–1989 Australian dollars, were used as inputs to a computer program that used a logistic equation. The output estimated the CHD events avoided and the cost effectiveness of an intervention that identified and treated men with cholesterol levels >6.5 mmol/L with dietary modification and cholestyramine. The cost of implementation of the intervention was

Benzodiazepine Use as a Cause of Cognitive Impairment in Elderly Hospital Inpatients

A50.1 million to prevent 104 CHD events. The cost-effectiveness ratio was

Two hour seminar improves knowledge about childhood asthma in school staff.

A482 224 per CHD event avoided (SD =