Leigh Haysom

Is Low Birth Weight an Antecedent of CKD in Later Life? A Systematic Review of Observational Studies

BACKGROUND There has been considerable interest in the hypothesis that low birth weight may be a marker of impaired nephrogenesis and that this is causally related to chronic kidney disease (CKD). STUDY DESIGN Systematic review and meta-analysis of observational studies. SETTING & POPULATION Studies of the relationship between birth weight and CKD published before February 1, 2008, were identified by using electronic searches. SELECTION CRITERIA All studies that had collected data for birth weight and kidney function at greater than 12 months of age were eligible for inclusion, except for studies of extremely low-birth-weight infants, very premature infants, or toxic exposure in utero. STUDY FACTOR: Birth weight. OUTCOMES CKD defined as albuminuria, low estimated glomerular filtration rate (<60 mL/min/1.73 m(2) or < 10th centile for age/sex), or end-stage renal disease. RESULTS We analyzed 31 relevant cohort or case-control studies with data for 49,376 individuals and data for 2,183,317 individuals from a single record-linkage study. Overall, 16 studies reported a significant association between low birth weight and risk of CKD and 16 observed a null result. The combination of weighted estimates from the 18 studies for which risk estimates were available (n = 46,249 plus 2,183,317 from the record linkage study) gave an overall odds ratio (OR) of 1.73 (95% confidence interval [CI], 1.44 to 2.08). Combined ORs were consistent in magnitude and direction for risks of albuminuria (OR, 1.81; 95% CI, 1.19 to 2.77), end-stage renal disease (OR, 1.58; 95% CI, 1.33 to 1.88), or low estimated glomerular filtration rate (OR, 1.79; 95% CI, 1.31 to 2.45). LIMITATIONS A reliance on published estimates and estimates provided on request rather than individual patient data and the possibility of reporting bias. CONCLUSIONS Existing data indicate that low birth weight is associated with subsequent risk of CKD, although there is scope for additional well-designed population-based studies with accurate assessment of birth weight and kidney function and consideration of important confounders, including maternal and socioeconomic factors.

Traumatic brain injury, mental health, substance use, and offending among incarcerated young people.

Objective:Despite being at high risk, little is known about traumatic brain injuries (TBIs) among incarcerated young people. This study aims to describe the prevalence of TBI among incarcerated young people and assess the association with mental health, substance use, and offending behaviors. Setting:The 2009 NSW Young People in Custody Health Survey was conducted in 9 juvenile detention centers. Participants:A total of 361 young people agreed to participate, representing 80% of all incarcerated young people. Main Measures:Young people were asked if they ever had a head injury where they became unconscious or “blacked-out.” The survey used the Kiddie Schedule for Affective Disorders for Children to assess for psychiatric disorders, the Alcohol Use Disorder Identification Test, and the Severity of Dependence Scale to measure problematic substance use. Results:The sample comprised 88% man, 48% Aboriginal, with an average age of 17 years. One-third (32%) of young people reported ever experiencing a TBI, and 13% reported multiple TBIs. The majority (92%) of “most serious” TBIs were defined as mild, and the most common cause was an assault (62% woman, 34% man). Young people who reported a history of TBI (compared with those reporting no TBI) were significantly more likely to be diagnosed with a mental health disorder, psychological distress, a history of bullying, problematic substance use, participation in fights, and offending behaviors. Reporting multiple (>2) TBIs conferred a higher risk of psychological disorders and problematic substance use. Conclusions:Incarcerated young people have high rates of TBI. Enhanced detection of TBI among incarcerated young people will assist clinicians in addressing the associated psychosocial sequelae.

Cardiovascular risk factors in Australian indigenous and non-indigenous children: a population-based study.

Aim:  Indigenous people have a two‐ to tenfold increased risk of premature death from cardiovascular disease. We aimed to determine whether some key risk factors for cardiovascular disease occur more commonly in Aboriginal than non‐Aboriginal Australian children.

Risk of CKD in Australian Indigenous and Nonindigenous Children: A Population-Based Cohort Study

BACKGROUND Aboriginal Australians have a 9-fold increased risk of end-stage renal disease. There is no information about the natural history and risk of chronic kidney disease (CKD) in Aboriginal and non-Aboriginal children. STUDY DESIGN Using a prospective study design, we aimed to determine the prevalence of persistent markers and risk factors for CKD in Australian Aboriginal and non-Aboriginal children and whether Aboriginal children are at increased risk of persistent markers of CKD after accounting for sociodemographic differences. SETTING & PARTICIPANTS Children were enrolled from elementary schools throughout New South Wales. PREDICTOR Aboriginal (Aboriginal and Torres Strait Islander Australians) versus non-Aboriginal ethnicity. OUTCOMES & MEASUREMENTS Urine analysis, height, weight, blood pressure, birth weight, and sociodemographic status were measured at baseline and 2-year follow-up. Albuminuria was defined as albumin-creatinine ratio of 3.4 mg/mmol or greater, hematuria as 25 or greater red blood cells/microL (>or=1+), obesity as body mass index of 2 SDs or greater, and systolic and diastolic hypertension as blood pressure greater than the 90th percentile. RESULTS 2,266 children (55.1% Aboriginal; 51.0% boys; mean age, 8.9 +/- 2.0 years [SD] years) were enrolled at baseline. Early markers and predictors of CKD at baseline were frequent: hematuria (5.5%), albuminuria (7.3%), obesity (7.1%), systolic hypertension (7.2%), and diastolic hypertension (5.8%). 1,432 children (63%) were available for retesting at 2-year follow-up (54.0% Aboriginal; 50.5% boys; mean age, 10.5 +/- 2.0 years). Persistent obesity (5.3%) was frequent, but persistent markers of CKD were infrequent (systolic hypertension, 1.1%; diastolic hypertension, 0.2%; hematuria, 1.1%; and albuminuria, 1.5%). Although there were more Aboriginal than non-Aboriginal children with baseline hematuria (7.1% versus 3.6%; P = 0.001), after adjustment for age, sex, birth weight, and sociodemographic status, there was no increased risk of persistent hematuria, albuminuria, obesity, or hypertension in Aboriginal children. LIMITATIONS Persistent markers of CKD were much less frequent than anticipated, which may have affected study power. The group lost at follow-up was older children, which may have biased results. CONCLUSIONS Overall, only 20% of children found to have markers of early CKD had persistent abnormalities (diastolic and systolic hypertension, albuminuria, and hematuria) 2 years later, equivalent to a population point prevalence of 1% to 2% in children with a mean age of 10 years. Aboriginal children had greater rates of baseline and transient hematuria, but no increased risk of persistent markers of CKD, suggesting that adolescence and young adulthood is a critical time for preventative strategies.

Intellectual disability in young people in custody in New South Wales, Australia – prevalence and markers

BACKGROUND Intellectual disability (ID) is known to be more common in incarcerated groups, especially incarcerated youth. Aboriginal young people have higher rates of ID, and make up half of all youth in juvenile custody in New South Wales (NSW), Australia. We aimed to describe the prevalence of possible ID and borderline intellectual functioning (BIF) in young people in NSW custody, and to describe the association between possible ID and Aboriginality after adjusting for the inequalities in social disadvantage. METHODS Baseline study of all youth in NSW Custodial Centres between August and October 2009, with 18-month follow-up. Using Wechsler Intelligence Scale for Children - Fourth Edition (WISC-IV) and Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV) cognitive assessments, possible ID was defined as Extremely Low Intellectual Quotient range (Full Scale Intellectual Quotient, FSIQ < 70), and possible BIF was defined as Borderline IQ range (FSIQ < 80). Risk factors for possible ID and BIF included age, gender, Aboriginality, socio-economic disadvantage, offending history and psychological disorders. RESULTS N = 295 (65%) of all young people in NSW custody completed cognitive and psychological assessments (87% male, 50% Aboriginal, average age 17 years). Almost one half (45.8%) of young people had borderline or lower intellectual functioning (by IQ assessment), and 14% had an IQ in the extremely low range (FSIQ < 70), indicating a possible ID. Aboriginal participants were three times more likely than non-Aboriginal participants to have a possible ID, but after accounting for the excess disadvantage in the Aboriginal group, Aboriginality was no longer a marker of ID. Incarceration from a young age and psychosis were significantly associated with possible ID in Aboriginal participants, compared with Aboriginal participants first incarcerated at a later age, and Aboriginal participants without psychosis. CONCLUSION The inequalities in criminal justice between Aboriginal and non-Aboriginal youth may exacerbate or contribute to the intellectual impairment of those incarcerated from a young age. Aboriginal young people with psychosis are also at high risk of cognitive impairments that might indicate a possible co-morbid ID, and these patients should be diverted at court into community assessment services, rather than incarcerated. These results highlight a need for better and earlier identification of young people (particularly Aboriginal youth) at risk of ID and other co-morbidities in the juvenile justice system.

Smoking behaviours among young people in custody in New South Wales, Australia.

INTRODUCTION AND AIMS Despite smoking prevalence reductions in the general community, rates remain high among socially disadvantaged populations. This study describes the prevalence and predictors for smoking among young people in custody. DESIGN AND METHODS The 2009 NSW Young People in Custody Health Survey was conducted in nine juvenile detention centres. This paper reports on findings from the baseline questionnaire which included questions about smoking behaviours. Chi-squared statistics were used to compare the smoking characteristics by gender and Aboriginality. Logistic regression was used to determine predictors of smoking behaviours. RESULTS The baseline questionnaire included 316 participants with a response rate of 83%. The sample was 88% male, 48% Aboriginal, with an average age of 17 years (range 13-21 years). Nearly all (94%) participants had ever smoked tobacco, with 79% reporting smoking daily prior to custody. Predictors of heavy smoking (20 or more cigarettes per day) prior to custody included being female, high psychological distress and conduct disorder. Predictors for being a current smoker included being on remand, risky drinking and most or all friends as smokers. Predictors of being an aspirational smoker (will smoke on release) included using illicit drugs at least weekly prior to custody, and having most or all friends as smokers. DISCUSSION AND CONCLUSIONS Rates of smoking in young people entering custody are exceptionally high. Many young people continue to smoke during their incarceration, with an increasing aspiration to smoke upon release. Effective programs are needed that address these smoking behaviours in young people in custody.

Prevalence and perceptions of overweight and obesity in Aboriginal and non-Aboriginal young people in custody.

Objective: To describe prevalence of and risk factors for overweight, obesity and self‐perceived weight gain of Aboriginal and non‐Aboriginal Australian young people in custody at baseline and over 12 months of follow‐up.

Prevalence and Risk Factors for Methicillin-Resistant Staphylococcus aureus (MRSA) Infections in Custodial Populations: A Systematic Review:

Methicillin-resistant Staphylococcus aureus (MRSA) in prisons can result in serious morbidity and death. We reviewed rates and risk factors for MRSA infection in custody, searching Medline, EMBASE, and CINAHL databases. Between 1997 and 2015, 17 studies reported MRSA skin and soft tissue infections (SSTIs), with four case reports of MRSA non-SSTI (necrotizing pneumonias, brain abscess, and epiduritis). Significant associations with MRSA SSTI were found: MRSA colonization, previous skin infection, sharing soap or personal items, SSTI presenting as an abscess or furuncle, younger age, non-Caucasian, overweight, communal laundering, infrequent handwashing, lower hygiene score. Recommendations: early identification, isolation, and treatment of skin infections at admission; education on maintaining skin integrity and presenting early with skin infections; increasing hygiene by not sharing items and encouraging handwashing; improved handling and disinfection of communal laundering; influenza vaccination for all prisoners and staff; and population-based longitudinal studies including younger detainees.

Oral health and risk factors for dental disease of Australian young people in custody.

To describe the prevalence and risk factors for markers of poor oral health in Aboriginal and non‐Aboriginal young people in custody in Australia.

Methicillin-resistant Staphylococcus aureus skin and soft tissue infections in young people in custody in New South Wales: Staph infections in incarcerated teens

Methicillin‐resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) are problematic for incarcerated adolescents but have not been previously researched.