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Stevenson PG, Cooper MN, Billingham W, de Klerk N, Simpson SJ, Strunk T, Moore HC. Health service utilisation for acute respiratory infections in infants graduating from the neonatal intensive care unit: a population-based cohort study. BMC Pediatr 2023; 23:335. [PMID: 37393229 PMCID: PMC10314380 DOI: 10.1186/s12887-023-04152-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/24/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Despite advances in neonatal intensive care, babies admitted to Neonatal Intensive Care Units (NICU) suffer from adverse outcomes. We aim to describe the longer-term respiratory infectious morbidity of infants discharged from NICU using state-wide population-based linked data in Western Australia. STUDY DESIGN We used probabilistically linked population-based administrative data to analyse respiratory infection morbidity in a cohort of 23,784 infants admitted to the sole tertiary NICU, born 2002-2013 with follow up to 2015. We analysed incidence rates of secondary care episodes (emergency department presentations and hospitalisations) by acute respiratory infection (ARI) diagnosis, age, gestational age and presence of chronic lung disease (CLD). Poisson regression was used to investigate the differences in rates of ARI hospital admission between gestational age groups and those with CLD, after adjusting for age at hospital admission. RESULTS From 177,367 child-years at risk (i.e., time that a child could experience an ARI outcome), the overall ARI hospitalisation rate for infants and children aged 0-8 years was 71.4/1000 (95% confidence interval, CI: 70.1, 72.6), with the highest rates in infants aged 0-5 months (242.9/1000). For ARI presentations to emergency departments, equivalent rates were 114/1000 (95% CI: 112.4, 115.5) and 337.6/1000, respectively. Bronchiolitis was the most common diagnosis among both types of secondary care, followed by upper respiratory tract infections. Extremely preterm infants (< 28 weeks gestation at birth) were 6.5 (95% CI: 6.0, 7.0) times more likely and those with CLD were 5.0 (95% CI: 4.7, 5.4) times more likely to be subsequently admitted for ARI than those in NICU who were not preterm or had CLD after adjusting for age at hospital admission. CONCLUSIONS There is an ongoing burden of ARI in children who graduate from the NICU, especially those born extremely preterm, that persists into early childhood. Early life interventions to prevent respiratory infections in these children and understanding the lifelong impact of early ARI on later lung health are urgent priorities.
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Affiliation(s)
- Paul G Stevenson
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Matthew N Cooper
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Wesley Billingham
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Nicholas de Klerk
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Shannon J Simpson
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- Wal-yan Respiratory Centre, Telethon Kids Institute, Perth, WA, Australia
- School of Allied Health, Curtin University, Perth, WA, Australia
| | - Tobias Strunk
- Neonatal Directorate, Child and Adolescent Health Service, Perth, WA, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, PO Box 855, West Perth, WA, 6872, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, PO Box 855, West Perth, WA, 6872, Australia.
- School of Population Health, Curtin University, Perth, WA, Australia.
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Oakes DB, Baker MJ, McLeod C, Nattabi B, Blyth CC. Patient-reported outcome measures for paediatric acute lower respiratory infection studies. Eur Respir Rev 2023; 32:32/167/220229. [PMID: 36889787 PMCID: PMC10032589 DOI: 10.1183/16000617.0229-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/17/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are recommended for capturing meaningful outcomes in clinical trials. The use of PROMs for children with acute lower respiratory infections (ALRIs) has not been systematically reported. We aimed to identify and characterise patient-reported outcomes and PROMs used in paediatric ALRI studies and summarise their measurement properties. METHODS Medline, Embase and Cochrane were searched (until April 2022). Studies that reported on patient-reported outcome (or measure) use or development and included subjects aged <18 years with ALRIs were included. Study, population and patient-reported outcome (or measure) characteristics were extracted. RESULTS Of 2793 articles identified, 18 met inclusion criteria, including 12 PROMs. Two disease-specific PROMs were used in settings in which they had been validated. The Canadian Acute Respiratory Illness and Flu Scale was the most frequently used disease-specific PROM (five studies). The EuroQol-Five Dimensions-Youth system was the most frequently used generic PROM (two studies). There was considerable heterogeneity in validation methods. The outcome measures identified in this review lack validation for young children and none involve sufficient content validity for use with First Nations children. CONCLUSIONS There is an urgent need for PROM development that considers the populations in which the burden of ALRI predominates.
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Affiliation(s)
- Daniel B Oakes
- School of Population and Global Health, The University of Western Australia, Crawley, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Megan J Baker
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Charlie McLeod
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Australia
| | - Barbara Nattabi
- School of Population and Global Health, The University of Western Australia, Crawley, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Australia
- School of Medicine, University of Western Australia, Perth, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Perth, Australia
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Jones J, Durey A, Strobel N, McAuley K, Edmond K, Coffin J, McAullay D. Perspectives of health service providers in delivering best-practice care for Aboriginal mothers and their babies during the postnatal period. BMC Pregnancy Childbirth 2023; 23:8. [PMID: 36604651 PMCID: PMC9814443 DOI: 10.1186/s12884-022-05136-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 10/19/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Evidence suggests that Aboriginal babies in Western Australia are not receiving adequate primary health care in their first 3 months of life, leading to questions about enablers and constraints to delivering such care. This paper presents findings from a qualitative research project investigating health providers' perceptions and experiences of best and current practice in discharge planning, postnatal care and health education for Aboriginal mothers and their newborn babies. METHODS Constructivist grounded theory guided this research involving 58 semi-structured interviews conducted with health providers who deliver care to Aboriginal mothers and infants. Participants were recruited from hospital-based and primary health sites in metropolitan Perth, and regional and remote locations in Western Australia. RESULTS Structural factors enabling best practice in discharge planning, postnatal care, and health education for mothers included health providers following best practice guidelines and adequate staffing levels. Organisational enablers included continuity of care throughout pregnancy, birth and postnatally. In particular, good communication between services around discharge planning, birth notifications, and training in culturally respectful care. Structural and organisational constraints to delivering best practice and compromising continuity of care were identified as beyond individual control. These included poor communication between different health and social services, insufficient hospital staffing levels leading to early discharge, inadequate cultural training, delayed receipt of birth notifications and discharge summaries received by Aboriginal primary health services. CONCLUSION Findings highlight the importance of examining current policies and practices to promote best practice in postnatal care to improve health outcomes for mothers and their Aboriginal babies.
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Affiliation(s)
- Jocelyn Jones
- National Drug Research Institute, Curtin University, WA, Perth, Australia.
| | - Angela Durey
- grid.1012.20000 0004 1936 7910School of Population and Global Health, The University of Western Australia, WA Perth, Australia
| | - Natalie Strobel
- grid.1038.a0000 0004 0389 4302Kurongkurl Katitjin, Edith Cowan University, WA Perth, Australia
| | - Kimberley McAuley
- grid.1012.20000 0004 1936 7910School of Population and Global Health, The University of Western Australia, WA Perth, Australia
| | - Karen Edmond
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Juli Coffin
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, WA Perth, Australia
| | - Daniel McAullay
- grid.1038.a0000 0004 0389 4302Kurongkurl Katitjin, Edith Cowan University, WA Perth, Australia
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Short-Term Ambient Particulate Air Pollution and Hospitalization Expenditures of Cause-Specific Cardiorespiratory Diseases in China: A Multicity Analysis. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 15:100232. [PMID: 34528013 PMCID: PMC8342975 DOI: 10.1016/j.lanwpc.2021.100232] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/01/2021] [Accepted: 07/12/2021] [Indexed: 01/23/2023]
Abstract
Background Ambient air pollution is leading risk factor for health burden in China. Few studies in China have investigated the economic loss related to short-term exposure to ambient PM2.5, which could trigger acute onset of cardiorespiratory diseases within a few days. Methods Daily ambient air pollutants data are obtained for each city from the National Air Quality Monitoring System and daily hospitalization data are obtained from the urban employee-based basic medical insurance scheme database in 74 Chinese cities with an average coverage of 88.5 million urban employees during 2016-2017. A three-stage time-series analytic approach is used in this study to investigate the impact of short-term exposure to ambient fine particulate (PM2.5) air pollution on hospital admissions, expenses and hospital stays of three cause-specific cardiorespiratory diseases, including lower respiratory infections (LRI), coronary heart disease (CHD) and stroke in the included cities. Findings Based on the time-series analysis using daily hospitalization data, 28,560 LRI cases, 54,600 CHD cases, and 23,989 stroke cases are attributable to ambient PM2.5 in the 74 cities during the study period, and the related attributable expenses are 220 million CNY (US$ 32.9 million) for LRI, 458 million CNY (US$ 68.5 million) for CHD, and 410 million CNY (US$ 65.8 million) for stroke, respectively. These attributable numbers account for 1.45% to 2.05% of total hospital admissions and 1.10% to 1.51% of total expenses for the three diseases during 2016-2017, respectively. The attributable numbers for the three cause-specific cardiorespiratory diseases would increase to 362,007 hospital admission cases and 3.68 billion CNY expenses ($US550 million) in the entire urban employee population (299 million) in China during 2016-2017, and the related direct economic loss of absence from work would be 798 million CNY (US$ 119.3 million). Interpretation Our results support that short-term exposure to ambient PM2.5 pollution could lead to significant health and economic impacts in China. Reducing levels of ambient PM2.5 can avoid substantial health damage and expenditures, and generate appreciable economic benefits from decreasing absence from work. Funding Natural Science Foundation of China (82073509, 71903010, 71903011), and the National Key Research and Development Program of China (2017YFC0211600, 2017YFC0211601).
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Moore HC, de Klerk N, Blyth CC, Gilbert R, Fathima P, Zylbersztejn A, Verfürden M, Hardelid P. Temporal trends and socioeconomic differences in acute respiratory infection hospitalisations in children: an intercountry comparison of birth cohort studies in Western Australia, England and Scotland. BMJ Open 2019; 9:e028710. [PMID: 31110110 PMCID: PMC6530403 DOI: 10.1136/bmjopen-2018-028710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Acute respiratory infections (ARIs) are a global cause of childhood morbidity. We compared temporal trends and socioeconomic disparities for ARI hospitalisations in young children across Western Australia, England and Scotland. DESIGN Retrospective population-based cohort studies using linked birth, death and hospitalisation data. SETTING AND PARTICIPANTS Population birth cohorts spanning 2000-2012 (Western Australia and Scotland) and 2003-2012 (England). OUTCOME MEASURES ARI hospitalisations in infants (<12 months) and children (1-4 years) were identified through International Classification of Diseases, 10th edition diagnosis codes. We calculated admission rates per 1000 child-years by diagnosis and jurisdiction-specific socioeconomic deprivation and used negative binomial regression to assess temporal trends. RESULTS The overall infant ARI admission rate was 44.3/1000 child-years in Western Australia, 40.7/1000 in Scotland and 40.1/1000 in England. Equivalent rates in children aged 1-4 years were 9.0, 7.6 and 7.6. Bronchiolitis was the most common diagnosis. Compared with the least socioeconomically deprived, those most deprived had higher ARI hospitalisation risk (incidence rate ratio 3.9 (95% CI 3.5 to 4.2) for Western Australia; 1.9 (1.7 to 2.1) for England; 1.3 (1.1 to 1.4) for Scotland. ARI admissions in infants were stable in Western Australia but increased annually in England (5%) and Scotland (3%) after adjusting for non-ARI admissions, sex and deprivation. CONCLUSIONS Admissions for ARI were higher in Western Australia and displayed greater socioeconomic disparities than England and Scotland, where ARI rates are increasing. Prevention programmes focusing on disadvantaged populations in all three countries are likely to translate into real improvements in the burden of ARI in children.
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Affiliation(s)
- Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Nicholas de Klerk
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Department of Infectious Diseases, PrincessMargaret Hospital for Children, Perth, Western Australia, Australia
- PathWest Laboratory Medicine WA, QE11 Medical Centre, Perth, Western Australia, Australia
| | - Ruth Gilbert
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Ania Zylbersztejn
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Maximiliane Verfürden
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Pia Hardelid
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
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Barnes R, Blyth CC, de Klerk N, Lee WH, Borland ML, Richmond P, Lim FJ, Fathima P, Moore HC. Geographical disparities in emergency department presentations for acute respiratory infections and risk factors for presenting: a population-based cohort study of Western Australian children. BMJ Open 2019; 9:e025360. [PMID: 30804033 PMCID: PMC6443078 DOI: 10.1136/bmjopen-2018-025360] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Studies examining acute respiratory infections (ARIs) in emergency department (EDs), particularly in rural and remote areas, are rare. This study aimed to examine the burden of ARIs among Aboriginal and non-Aboriginal children presenting to Western Australian (WA) EDs from 2002 to 2012. METHOD Using a retrospective population-based cohort study linking ED records to birth and perinatal records, we examined presentation rates for metropolitan, rural and remote Aboriginal and non-Aboriginal children from 469 589 births. We used ED diagnosis information to categorise presentations into ARI groups and calculated age-specific rates. Negative binomial regression was used to investigate association between risk factors and frequency of ARI presentation. RESULTS Overall, 26% of presentations were for ARIs. For Aboriginal children, the highest rates were for those aged <12 months in the Great Southern (1233 per 1000 child-years) and Pilbara regions (1088 per 1000 child-years). Rates for non-Aboriginal children were highest in children <12 months in the Southwest and Kimberley (400 and 375 per 1000 child-years, respectively). Presentation rates for ARI in children from rural and remote WA significantly increased over time in all age groups <5 years. Risk factors for children presenting to ED with ARI were: male, prematurity, caesarean delivery and residence in the Kimberley region and lower socio-economic areas. CONCLUSION One in four ED presentations in WA children are for ARIs, representing a significant out-of-hospital burden with some evidence of geographical disparity. Planned linkages with hospital discharge and laboratory detection data will aid in assessing the sensitivity and specificity of ARI diagnoses in ED.
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Affiliation(s)
- Rosanne Barnes
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Australia
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- PathWest Laboratory Medicine WA, Perth Children’s Hospital, Nedlands, Australia
| | - Nicholas de Klerk
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Wei Hao Lee
- Emergency Department, Perth Children’s Hospital, Nedlands, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children’s Hospital, Nedlands, Australia
- Division of Emergency Medicine, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Peter Richmond
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Perth Children’s Hospital, Nedlands, Australia
| | - Faye J Lim
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Australia
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Lovie-Toon YG, Chang AB, Newcombe PA, Vagenas D, Anderson-James S, Drescher BJ, Otim ME, O’Grady KAF. Longitudinal study of quality of life among children with acute respiratory infection and cough. Qual Life Res 2018; 27:891-903. [DOI: 10.1007/s11136-017-1779-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2017] [Indexed: 12/25/2022]
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O’Grady KAF, Hall KK, Sloots TP, Anderson J, Chang AB. Upper airway viruses and bacteria in urban Aboriginal and Torres Strait Islander children in Brisbane, Australia: a cross-sectional study. BMC Infect Dis 2017; 17:245. [PMID: 28376882 PMCID: PMC5381068 DOI: 10.1186/s12879-017-2349-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 03/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Respiratory morbidity in Australian Indigenous children is higher than their non-Indigenous counterparts, irrespective of urban or remote residence. There are limited studies addressing acute respiratory illness (ARI) in urban Indigenous children, particularly those that address the upper airway microbiome and its relationship to disease. We aimed to describe the prevalence of upper airway viruses and bacteria in symptomatic and asymptomatic urban-based Australian Indigenous children aged less than 5 years. METHODS A cross-sectional analysis of data collected at baseline in an ongoing prospective cohort study of urban Aboriginal and Torres Strait Islander children registered with a primary health care service in the northern suburbs of Brisbane, Australia. Clinical, demographic and epidemiological data and bilateral anterior nasal swabs were collected on enrolment. Polymerase chain reaction was performed on nasal swabs to detect 17 respiratory viruses and 7 bacteria. The primary outcome was the prevalence of these microbes at enrolment. Logistic regression was performed to investigate differences in microbe prevalence between children with and without acute respiratory illness with cough as a symptom (ARIwC) at time of specimen collection. RESULTS Between February 2013 and October 2015, 164 children were enrolled. The median age at enrolment was 18.0 months (IQR 7.2-34.3), 49.4% were boys and 56 children (34.2%) had ARIwC. Overall, 133/164 (81%) nasal swabs were positive for at least one organism; 131 (79.9%) for any bacteria, 59 (36.2%) for any virus and 57 (34.8%) for both viruses and bacteria. Co-detection of viruses and bacteria was more common in females than males (61.4% vs 38.6%, p = 0.044). No microbes, alone or in combination, were significantly associated with the presence of ARIwC. CONCLUSIONS The prevalence of upper airways microbes in asymptomatic children is similar to non-Indigenous children with ARIwC from the same region. Determining the aetiology of ARIwC in this community is complicated by the high prevalence of multiple respiratory pathogens in the upper airways. STUDY REGISTRATION Australia New Zealand Clinical Trial Registry Registration Number: 12,614,001,214,628. Retrospectively registered.
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Affiliation(s)
- Kerry-Ann F. O’Grady
- Institute of Health & Biomedical Innovation, Centre for Children’s Health Research, Queensland University of Technology, 62 Graham Street, South Brisbane, QLD 4101 Australia
| | - Kerry K. Hall
- Institute of Health & Biomedical Innovation, Centre for Children’s Health Research, Queensland University of Technology, 62 Graham Street, South Brisbane, QLD 4101 Australia
| | - Theo P. Sloots
- Child Health Research Centre, Centre for Children’s Health Research, The University of Queensland, 62 Graham Street, South Brisbane, QLD 4101 Australia
| | - Jennie Anderson
- Caboolture Community Medical, King Street, Caboolture, QLD 4501 Australia
| | - Anne B. Chang
- Institute of Health & Biomedical Innovation, Centre for Children’s Health Research, Queensland University of Technology, 62 Graham Street, South Brisbane, QLD 4101 Australia
- Menzies School of Health Research, Charles Darwin University, Rocklands Drive, Tiwi, Northern Territory, 0810 Australia
- Department of Respiratory Medicine, Lady Cilento Children’s Hospital, Stanley Street, South Brisbane, QLD 4101 Australia
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Strobel NA, Peter S, McAuley KE, McAullay DR, Marriott R, Edmond KM. Effect of socioeconomic disadvantage, remoteness and Indigenous status on hospital usage for Western Australian preterm infants under 12 months of age: a population-based data linkage study. BMJ Open 2017; 7:e013492. [PMID: 28100563 PMCID: PMC5253619 DOI: 10.1136/bmjopen-2016-013492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Our primary objective was to determine the incidence of hospital admission and emergency department presentation in Indigenous and non-Indigenous preterm infants aged postdischarge from birth admission to 11 months in Western Australia. Secondary objectives were to assess incidence in the poorest infants from remote areas and to determine the primary causes of hospital usage in preterm infants. DESIGN Prospective population-based linked data set. SETTING AND PARTICIPANTS All preterm babies born in Western Australia during 2010 and 2011. MAIN OUTCOME MEASURES All-cause hospitalisations and emergency department presentations. RESULTS There were 6.9% (4211/61 254) preterm infants, 13.1% (433/3311) Indigenous preterm infants and 6.5% (3778/57 943) non-Indigenous preterm infants born in Western Australia. Indigenous preterm infants had a higher incidence of hospital admission (adjusted incident rate ratio (aIRR) 1.24, 95% CI 1.08 to 1.42) and emergency department presentation (aIRR 1.71, 95% CI 1.44 to 2.02) compared with non-Indigenous preterm infants. The most disadvantaged preterm infants (7.8/1000 person days) had a greater incidence of emergency presentation compared with the most advantaged infants (3.1/1000 person days) (aIRR 1.61, 95% CI 1.30 to 2.00). The most remote preterm infants (7.8/1000 person days) had a greater incidence of emergency presentation compared with the least remote preterm infants (3.0/1000 person days; aIRR 1.82, 95% CI 1.49 to 2.22). CONCLUSIONS In Western Australia, preterm infants have high hospital usage in their first year of life. Infants living in disadvantaged areas, remote area infants and Indigenous infants are at increased risk. Our data highlight the need for improved postdischarge care for preterm infants.
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Affiliation(s)
- Natalie A Strobel
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Sue Peter
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Kimberley E McAuley
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Daniel R McAullay
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia
- Kurongkurl Katitjin, Centre for Indigenous Australian Education and Research, Edith Cowan University, Perth, Western Australia, Australia
| | - Rhonda Marriott
- School of Psychology and Exercise Science, Murdoch University, Perth, Western Australia, Australia
| | - Karen M Edmond
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia
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Hall KK, Chang AB, Anderson J, Arnold D, Goyal V, Dunbar M, Otim M, O'Grady KAF. The Incidence and Short-term Outcomes of Acute Respiratory Illness with Cough in Children from a Socioeconomically Disadvantaged Urban Community in Australia: A Community-Based Prospective Cohort Study. Front Pediatr 2017; 5:228. [PMID: 29164080 PMCID: PMC5674932 DOI: 10.3389/fped.2017.00228] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 10/10/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Acute respiratory illnesses with cough (ARIwC) are predominant causes of morbidity in Australian Indigenous children; however, data on disease burden in urban communities are scarce. This study aimed to determine the incidence of ARIwC, the predictors of recurrent (≥4 episodes) ARIwC, and development of chronic cough following an ARIwC in urban, predominantly Indigenous, children aged <5 years from northern Brisbane, Australia. METHODS Prospective cohort study of children aged <5 years registered with a primary healthcare center. ARIwC episodes and outcomes were collected for 12 months. Recurrent ARIwC was defined as ≥4 episodes in 12 months. Chronic cough was defined as cough lasting >4 weeks. Children who developed chronic cough were reviewed by a pediatric pulmonologist. Incidence densities per child-month of observation were calculated and predictors of recurrent ARIwC and chronic cough were evaluated in logistic regression models. RESULTS Between February 2013 and November 2015, 200 children were enrolled; median age of 18.1 months, range (0.7-59.7 months) and 90% identified as Indigenous. A total of 1,722 child-months of observation were analyzed (mean/child = 8.58, 95% CI 8.18-9.0). The incidence of ARIwC was 24.8/100 child-months at risk (95% CI 22.3-27.5). Twenty-one children (10.5%) experienced recurrent ARIwC. Chronic cough was identified in 70/272 (25.7%) episodes of ARIwC. Predictors of recurrent ARIwC were presence of eczema, mold in the house, parent/carer employment status, and having an Aboriginal and Torres Strait Islander mother/non-Aboriginal and Torres Strait Islander father (compared to both parents being Aboriginal and Torres Strait Islander). Predictors of chronic cough included being aged <12 months, eczema, childcare attendance, previous history of cough of >4 weeks duration, having an Aboriginal and Torres Strait Islander mother/non-Aboriginal and Torres Strait Islander father (compared to both parents being Aboriginal and Torres Strait Islander), and a low income. Of those with chronic cough reviewed by a pediatric pulmonologist, a significant underlying disorder was found in 14 children (obstructive sleep apnea = 1, bronchiectasis = 2, pneumonia = 2, asthma = 3, tracheomalacia = 6). DISCUSSION This community of predominantly Aboriginal and Torres Strait Islander and socially disadvantaged children bear a considerable burden of ARIwC. One in 10 children will experience more than three episodes over a 12-month period and 1 in five children will develop chronic cough post ARIwC, some with a serious underlying disorder. Further larger studies that include a broader population base are needed.
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Affiliation(s)
- Kerry K Hall
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, South Brisbane, QLD, Australia
| | - Anne B Chang
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, South Brisbane, QLD, Australia.,Department of Respiratory Medicine, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia.,Menzies School of Health Research, Charles Darwin University, Tiwi, NT, Australia
| | | | - Daniel Arnold
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, South Brisbane, QLD, Australia
| | - Vikas Goyal
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, South Brisbane, QLD, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Melissa Dunbar
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, South Brisbane, QLD, Australia
| | - Michael Otim
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, South Brisbane, QLD, Australia.,Department of Health Services Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Kerry-Ann F O'Grady
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, South Brisbane, QLD, Australia
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11
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Sarna M, Ware RS, Sloots TP, Nissen MD, Grimwood K, Lambert SB. The burden of community-managed acute respiratory infections in the first 2-years of life. Pediatr Pulmonol 2016; 51:1336-1346. [PMID: 27228308 DOI: 10.1002/ppul.23480] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/14/2016] [Accepted: 05/02/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND Contemporary information on acute respiratory infections (ARIs) in children is based on hospital cohorts, primary healthcare presentations, and high-risk birth cohort studies. We describe the burden and determinants of symptomatic episodes of ARIs in unselected healthy infants in the first 2-years of life. METHODS One hundred and fifty-four infants from subtropical Brisbane, Australia participated in a longitudinal, community-based birth cohort study. A daily tick-box diary captured pre-defined respiratory symptoms. Parents also completed a burden diary, recording family physician and hospital visits, and antibiotic use. RESULTS Participants contributed 88,032 child-days (78.2% of expected), of which 17,316 (19.7%) days were symptomatic during 1,651 ARI episodes: incidence rate 0.56 ARIs per child-month (95%CI: 0.54, 0.59). Runny nose (14,220 days; 6.0-days median duration) and dry cough (6,880 days; 4.0-days median duration) were reported most frequently. Overall, 955 burden diaries recorded 455 family physician visits (1-8 visits per ARI) and 48 hospital presentations, including six hospital admissions. Antibiotics were prescribed on 209 occasions (21.9% of ARI episodes where burden diary submitted). Increasing age, non-summer seasons, and attendance at childcare were associated with an increased risk of ARI. CONCLUSIONS ARIs are a common cause of morbidity in the first 2-years of life, with children experiencing 13 discrete ARI episodes and almost 5-months of respiratory symptoms. Most ARIs are managed in the community by parents and family physicians. Antibiotic prescribing remains common for ARIs in young children. Secular societal changes, including greater use of childcare in early childhood, may have maintained the high ARI incidence in this age-group. Pediatr Pulmonol. 2016;51:1336-1346. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Mohinder Sarna
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.,Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Robert S Ware
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.,Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Theo P Sloots
- Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Pediatric Infectious Diseases Laboratory, Centre for Children's Health Research, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Michael D Nissen
- Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Keith Grimwood
- Menzies Health Institute Queensland, Griffith University and Gold Coast Health, Gold Coast, Queensland, Australia
| | - Stephen B Lambert
- Queensland Pediatric Infectious Diseases Laboratory, Centre for Children's Health Research, Children's Health Queensland, Brisbane, Queensland, Australia.,Communicable Diseases Branch, Queensland Health, Brisbane, Queensland, Australia
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12
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McAuley K, McAullay D, Strobel NA, Marriott R, Atkinson DN, Marley JV, Stanley FJ, Edmond KM. Hospital Utilisation in Indigenous and Non-Indigenous Infants under 12 Months of Age in Western Australia, Prospective Population Based Data Linkage Study. PLoS One 2016; 11:e0154171. [PMID: 27120331 PMCID: PMC4847930 DOI: 10.1371/journal.pone.0154171] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/08/2016] [Indexed: 12/31/2022] Open
Abstract
Background Indigenous infants (infants aged under 12 months) have the highest hospital admission and emergency department presentation risks in Australia. However, there have been no recent reports comparing hospital utilisation between Indigenous and non-Indigenous infants. Methods Our primary objective was to use a large prospective population-based linked dataset to assess the risk of all-cause hospital admission and emergency department presentation in Indigenous compared to non-Indigenous infants in Western Australia (WA). Secondary objectives were to assess the effect of socio-economic status (Index of Relative Socio-Economic Disadvantage [IRSD]) on hospital utilisation and to understand the causes of hospital utilisation. Findings There were 3,382 (5.4%) Indigenous and 59,583 (94.6%) non-Indigenous live births in WA from 1 January 2010 to 31 December 2011. Indigenous infants had a greater risk of hospital admission (adjusted odds ratio [aOR] 1.90, 95% confidence interval [95% CI] 1.77–2.04, p = <0.001) and emergency department presentation (aOR 2.15, 95% CI 1.98–2.33, p = <0.001) compared to non-Indigenous infants. Fifty nine percent (59.0%) of admissions in Indigenous children were classified as preventable compared to 31.2% of admissions in non-Indigenous infants (aOR 2.12, 95% CI 1.88–2.39). The risk of hospital admission in the most disadvantaged (IRSD 1) infants in the total cohort (35.7%) was similar to the risk in the least disadvantaged (IRSD 5) infants (30.6%) (aOR 1.04, 95% CI 0.96–1.13, p = 0.356). Interpretation WA Indigenous infants have much higher hospital utilisation than non Indigenous infants. WA health services should prioritise Indigenous infants regardless of their socio economic status or where they live.
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Affiliation(s)
- Kimberley McAuley
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
- * E-mail:
| | - Daniel McAullay
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
- Kurongkurl Katitjin, Centre for Indigenous Australian Education and Research, Edith Cowan University, Perth, Western Australia, Australia
| | - Natalie A. Strobel
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Rhonda Marriott
- School of Psychology and Exercise Science, Murdoch University, Perth, Western Australia, Australia
| | - David N. Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
| | - Julia V. Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
| | | | - Karen M. Edmond
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
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13
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McAullay D, McAuley K, Marriott R, Pearson G, Jacoby P, Ferguson C, Geelhoed E, Coffin J, Green C, Sibosado S, Henry B, Doherty D, Edmond K. Improving access to primary care for Aboriginal babies in Western Australia: study protocol for a randomized controlled trial. Trials 2016; 17:82. [PMID: 26869181 PMCID: PMC4751713 DOI: 10.1186/s13063-016-1206-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 01/29/2016] [Indexed: 11/26/2022] Open
Abstract
Background Despite a decade of substantial investments in programs to improve access to primary care for Aboriginal mothers and infants, more than 50 % of Western Australian Aboriginal babies are still not receiving primary and preventative care in the early months of life. Western Australian hospitals now input birth data into the Western Australian electronic clinical management system within 48 hours of birth. However, difficulties have arisen in ensuring that the appropriate primary care providers receive birth notification and clinical information by the time babies are discharged from the hospital. No consistent process exists to ensure that choices about primary care are discussed with Aboriginal families. Methods/Design We will undertake a population-based, stepped wedge, cluster randomized controlled trial of an enhanced model of early infant primary care. The intervention is targeted support and care coordination for Aboriginal families with new babies starting as soon as possible during the antenatal period or after birth. Dedicated health professionals and research staff will consult with families about the families’ healthcare needs, provide information about healthcare in the first 3 months of life, offer assistance with birth and Medicare forms, consult with families about their choice for primary care provider, offer to notify the chosen primary care provider about the baby’s health needs, and offer assistance with healthcare coordination at the time of discharge from the hospital. We will evaluate this model of care using a rigorous stepped wedge approach. Our primary outcome measure is a reduced hospitalization rate in infants younger than 3 months of age. Secondary outcome measures include completed Aboriginal and Torres Strait Islander child health screening assessments, immunization coverage, and satisfaction of the families about early infant primary care. We will also assess the cost effectiveness of the model of care. Discussion This study will be conducted over a 4-year period in partnership with birthing hospitals and primary care providers including Western Australian Aboriginal Community Controlled Health Services and the new Primary Health Networks. The results of our trial will be used to develop improved primary care models and to improve health outcomes for all Aboriginal infants. These are vital steps toward more equitable health service delivery for the Aboriginal and Torres Strait Islander children in Australia. Trial Registration Australian New Zealand Clinical Trials Registry Registration number: ACTRN12615000976583 Date registered: 17 September 2015
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Affiliation(s)
- Daniel McAullay
- University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia. .,Edith Cowen University, 2 Bradford St, Mount Lawley, WA, 6050, Australia.
| | - Kimberley McAuley
- University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - Rhonda Marriott
- Murdoch University, 90 South St, Murdoch, WA, 6150, Australia.
| | - Glenn Pearson
- Telethon Kids Institute, 100 Roberts Rd, Subiaco, WA, 6008, Australia.
| | - Peter Jacoby
- Telethon Kids Institute, 100 Roberts Rd, Subiaco, WA, 6008, Australia.
| | - Chantal Ferguson
- Western Australia Department of Health, 189 Royal Street, East Perth, WA, 6004, Australia.
| | - Elizabeth Geelhoed
- University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - Juli Coffin
- Geraldton Regional Aboriginal Medical Service, Holland St, Geraldton, WA, 6530, Australia.
| | - Charmaine Green
- University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia. .,Geraldton Regional Aboriginal Medical Service, Holland St, Geraldton, WA, 6530, Australia.
| | - Selina Sibosado
- University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia. .,Geraldton Regional Hospital, 51-85 Shenton St, Geraldton, WA, 6530, Australia.
| | - Barbara Henry
- Derbarl Yerrigan Aboriginal Medical Service, 156 Wittenoom St, East Perth, WA, 6004, Australia.
| | - Dorota Doherty
- University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia. .,King Edward Memorial Hospital, 374 Bagot Rd, Subiaco, WA, 6008, Australia.
| | - Karen Edmond
- University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia. .,Princess Margaret Hospital for Children, Roberts Rd, Subiaco, WA, 6008, Australia.
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Optimization is required when using linked hospital and laboratory data to investigate respiratory infections. J Clin Epidemiol 2015; 69:23-31. [PMID: 26303399 DOI: 10.1016/j.jclinepi.2015.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 07/06/2015] [Accepted: 08/17/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Despite a recommendation for microbiological testing, only 45% of children hospitalized for respiratory infections in our previous data linkage study linked to a microbiological record. We conducted a chart review to validate linked microbiological data. STUDY DESIGN AND SETTING The chart review consisted of children aged <5 years admitted to seven selected hospitals for respiratory infections in Western Australia, 2000-2011. We calculated the proportion of admissions where testing was performed and any pathogens detected. We compared these proportions between the chart review and our previous data linkage study. Poisson regression was used to identify factors predicting the likelihood of microbiological tests in the chart review cohort. RESULTS From the chart review, 77% of 746 records had a microbiological test performed compared with 46% of 18,687 records from our previous data linkage study. Of those undergoing testing, 66% of the chart review and 64% of data linkage records had ≥1 respiratory pathogen(s) detected. In the chart review cohort, frequency of testing was highest in children admitted to metropolitan hospitals. CONCLUSION Validation studies are essential to ensure the quality of linked data. Our previous data linkage study failed to capture all relevant microbiological records. Findings will be used to optimize extraction protocols for future linkage studies.
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