Sean Beggs

Off-label use of medicines in paediatric inpatients at an Australian teaching hospital

The study aims to investigate the prevalence of off‐label prescribing in the general paediatric ward at a major teaching hospital in Tasmania, Australia.

Expression of PPARγ and Paraoxonase 2 Correlated with Pseudomonas aeruginosa Infection in Cystic Fibrosis

The Pseudomonas aeruginosa quorum sensing signal molecule N-3-oxododecanoyl-l-homoserine lactone (3OC12HSL) can inhibit function of the mammalian anti-inflammatory transcription factor peroxisome proliferator activated receptor (PPAR)γ, and can be degraded by human paraoxonase (PON)2. Because 3OC12HSL is detected in lungs of cystic fibrosis (CF) patients infected with P. aeruginosa, we investigated the relationship between P. aeruginosa infection and gene expression of PPARγ and PON2 in bronchoalveolar lavage fluid (BALF) of children with CF. Total RNA was extracted from cell pellets of BALF from 43 children aged 6 months–5 years and analyzed by reverse transcription–quantitative real time PCR for gene expression of PPARγ, PON2, and P. aeruginosa lasI, the 3OC12HSL synthase. Patients with culture-confirmed P. aeruginosa infection had significantly lower gene expression of PPARγ and PON2 than patients without P. aeruginosa infection. All samples that were culture-positive for P. aeruginosa were also positive for lasI expression. There was no significant difference in PPARγ or PON2 expression between patients without culture-detectable infection and those with non-Pseudomonal bacterial infection, so reduced expression was specifically associated with P. aeruginosa infection. Expression of both PPARγ and PON2 was inversely correlated with neutrophil counts in BALF, but showed no correlation with other variables evaluated. Thus, lower PPARγ and PON2 gene expression in the BALF of children with CF is associated specifically with P. aeruginosa infection and neutrophilia. We cannot differentiate whether this is a cause or the effect of P. aeruginosa infection, but propose that the level of expression of these genes may be a marker for susceptibility to early acquisition of P. aeruginosa in children with CF.

High Peripheral Blood Th17 Percent Associated with Poor Lung Function in Cystic Fibrosis

People with cystic fibrosis (CF) have been reported to make lung T cell responses that are biased towards T helper (Th) 2 or Th17. We hypothesized that CF-related T cell regulatory defects could be detected by analyzing CD4+ lymphocyte subsets in peripheral blood. Peripheral blood mononuclear cells from 42 CF patients (6 months–53 years old) and 78 healthy controls (2–61 years old) were analyzed for Th1 (IFN-γ+), Th2 (IL-4+), Th17 (IL-17+), Treg (FOXP3+), IL-10+ and TGF-β+ CD4+ cells. We observed higher proportions of Treg, IL-10+ and TGF-β+ CD4+ cells in CF adults (≥ 18 years old), but not children/adolescents, compared with controls. Within the CF group, high TGF-β+% was associated with chronic Pseudomonas aeruginosa lung infection (p < 0.006). We observed no significant differences between control and CF groups in the proportions of Th1, Th2 or Th17 cells, and no association within the CF group of any subset with sex, CFTR genotype, or clinical exacerbation. However, high Th17% was strongly associated with poor lung function (FEV1 % predicted) (p = 0.0008), and this association was strongest when both lung function testing and blood sampling were performed within one week. Our results are consistent with reports of CF as a Th17 disease and suggest that peripheral blood Th17 levels may be a surrogate marker of lung function in CF.

Seasonal Variation in the Nutritional Status of Children Aged 6 to 60 Months in a Resettlement Village in West Timor

Childhood malnutrition remains a public health issue in Indonesia with a national prevalence of wasting of 13% and stunting of 36%. In rural areas nutritional status depends on local agriculture and may fluctuate in relation to harvest time. The aim of this study was to characterise seasonal variations in nutritional status in two resettlement villages in the Oesao district, Nusa Tenggara Timur. A cross sectional study was conducted in a convenience sample of children after the wet season (March). Children aged 6 to 60 months were assessed for nutritional status using anthropometric and biochemical measures. A subset of these children was re-assessed for anthropometry after the dry season (November). Weight-for-height z scores improved significantly from mean±SD of -1.7± 0.9 in March to -1.3±0.9 in November (p<0.001). There was no significant change in height between seasons. Prevalence of wasting, (weight-for-height z score <-2), was 42% in March and 19% in November (p<0.001). However, stunting rates increased significantly from 42% in March to 45% in November (p<0.001). Thirty six per cent of children were anaemic (Hb level <11 mg/100 mL), 68% were vitamin A deficient (plasma vitamin A level <0.8 μmol/L) and 50% were zinc deficient (plasma zinc <9.94 μmol/L). All children except one were positive for intestinal parasites. These data indicate seasonal changes in anthropometry with inconsistent effects depending on the anthropometric index measured. Wasting and stunting were higher than the national average, alongside high rates of anaemia, zinc and vitamin A deficiencies.

Pilot evaluation of web enabled symptom monitoring in cystic fibrosis

Background: People with cystic fibrosis (CF) frequently experience isolation and are subjected to extensive complex treatment regimens which could be complemented by remote support. In the current research this is particularly relevant as the location, Tasmania, has the second highest incidence of CF in the world. This paper provides an overview of the evaluation of a pilot trial of an information system conceptualised and developed to assist people with CF, and their families, to enhance their skills and communication in relation to self-management for their condition. Methods: The pilot involved people with CF ranging in age from 19 months to 52 years and their families. The primary outcome was the perceived usability of the online-symptom diary from the user’s perspective. To assess perceived usability qualitative semi-structured interviews were conducted pre- and post-pilot and analysed using thematic coding. Results: Participants initially and primarily perceived myCF as a system that would help others and enable peer support. Connectivity and involvement were highlighted as complex issues that needed consideration. Conclusion: There was an overall encouraging response to the pilot and indications that the use of information communication technology to complement health care delivery and facilitate self-care skills may be particularly suited to the Australian context where geographical distances and isolation provide a relative barrier to specialist care for chronic complex conditions.

Australian Report on Pediatric Medication Issues

Australian prescribers have faced many of the same issues as those in other developed countries in relation to medicines for children. Australia represents <1% of the world pharmaceutical market, with the pediatric market being a fraction of this. Thus, Australia’s ability to influence the global market has been seen as limited, and it had been hoped that Australian children would benefit from international efforts in the area of medicines for children. This, however, has not eventuated, with there being very little change in the availability of medications for children in Australia over the past 2 decades. A number of reviews have been undertaken looking at the issue of medication for children in Australia and what could be done. Recently, two significant events have occurred: the first is the establishment of a pediatric medicines advisory group by the Australian government and the second is the decision to fund the development of a national pediatric dosing reference. These events represent significant progress, but are only the first of many steps required to improve medications for children in the ‘land of Oz’ (Australia).

Exclusive breastfeeding and the acceptability of donor breast milk for sick, hospitalized infants in Kupang, Nusa Tenggara Timur, Indonesia: a mixed-methods study

Background: The eastern Indonesian province of Nusa Tenggara Timur (NTT) has an infant mortality rate of 45 per 1000, higher than the national average (28/1000). Exclusive breastfeeding, important for improving newborn and infant survival, is encouraged among hospitalized infants in Kupang, the provincial capital of NTT. However, barriers to hospitalized infants receiving breast milk may exist. Objectives: This study explored the barriers and enablers to exclusive breastfeeding among sick and low birth weight hospitalized infants in Kupang, NTT. The attitudes and cultural beliefs of health workers and mothers regarding the use of donor breast milk (DBM) were also explored. Methods: A mixed-methods study using a convergent parallel design was conducted. A convenience sample of 74 mothers of hospitalized infants and 8 hospital staff participated in semi-structured interviews. Facility observational data were also collected. Analysis was conducted using Davis’s barrier analysis method. Results: Of the 73 questionnaires analyzed, we found that 39.7% of mothers retrospectively reported exclusively breastfeeding and 37% of mothers expressed breast milk. Expressing was associated with maternal reported exclusive breastfeeding χ2 (1, N = 73) = 6.82, P = .009. Staff supported breastfeeding for sick infants, yet mothers could only access infants during set nursery visiting hours. No mothers used DBM, and most mothers and staff found the concept distasteful. Conclusions: Increasing mothers’ opportunities for contact with infants is the first step to increasing exclusive breastfeeding rates among hospitalized infants in Kupang. This will facilitate mothers to express their breast milk, improve the acceptability of DBM, and enhance the feasibility of establishing a DBM bank.

Do children with cystic fibrosis receiving outreach care have poorer clinical outcomes than those treated at a specialist cystic fibrosis centre

Abstract Introduction Although cystic fibrosis (CF) centre care is generally considered ideal, children living in regional Australia receive outreach care supported by the academic CF centres. Methods This is a retrospective database review of children with CF treated at the Royal Childrens Hospital in Melbourne and its outreach clinics in Albury (Victoria), and Tasmania. The aim was to compare the outcomes of children with CF managed at an academic centre with that of outreach care, using lung function, nutritional status and Pseudomonas aeruginosa colonisation. Three models of care, namely CF centre care, Shared care and predominantly Local care, were compared, based on the level of involvement of CF centre multidisciplinary team. In our analyses, we controlled for potential confounders, such as socio‐economic status and the degree of remoteness, to determine its effect on the outcome measures. Results There was no difference in lung function, i.e. forced expiratory volume in 1 s (FEV 1), the prevalence of Pseudomonas aeruginosa colonisation or nutritional status (body mass index (BMI)) between those receiving CF centre care and various modes of outreach care. Neither socio‐economic status, measured by the Socio‐Economic Index for Area (SEIFA) for disadvantage, nor distance from an urban centre (Australian Standard for Geographical Classification (ASGC)) were associated with lung function and nutritional outcome measures. There was however an association between increased Pseudomonas aeruginosa colonisation and poorer socio‐economic status. Conclusion Outcomes in children with CF in regional and remote areas receiving outreach care supported by an academic CF centre were no different from children receiving CF centre care.

Supporting Cystic Fibrosis With ICT

ICT use in cystic fibrosis management provides an alternative means of information supply to individuals, families, health care professionals and other stakeholders. The purpose of this paper is to present the evolution of a series of projects culminating in a project that translates the previous research into practice. In this paper the sequential nature of the projects will be detailed. The three projects explored are the Pathways Home for Respiratory Illness Project (Pathways Home), Enhancing Self-Efficacy for Self-Management in People with Cystic Fibrosis and the Tasmanian Community Fund Project (myCF pilot).

Swimming training for asthma in children and adolescents aged 18 years and under

This is the protocol for a review and there is no abstract. The objectives are as follows: The objective of this review is to determine the effectiveness of swimming training as an intervention for asthma in children and adolescents aged 18 years and under.