PREDICT-CP: study protocol of implementation of comprehensive surveillance to predict outcomes for school-aged children with cerebral palsy

Objectives: Cerebral palsy (CP) remains the world’s most common childhood physical disability with total annual costs of care and lost well-being of $A3.87b. The PREDICT-CP (NHMRC 1077257 Partnership Project: Comprehensive surveillance to PREDICT outcomes for school age children with CP) study will investigate the influence of brain structure, body composition, dietary intake, oropharyngeal function, habitual physical activity, musculoskeletal development (hip status, bone health) and muscle performance on motor attainment, cognition, executive function, communication, participation, quality of life and related health resource use costs. The PREDICT-CP cohort provides further follow-up at 8–12 years of two overlapping preschool-age cohorts examined from 1.5 to 5 years (NHMRC 465128 motor and brain development; NHMRC 569605 growth, nutrition and physical activity). Methods and analyses: This population-based cohort study undertakes state-wide surveillance of 245 children with CP born in Queensland (birth years 2006–2009). Children will be classified for Gross Motor Function Classification System; Manual Ability Classification System, Communication Function Classification System and Eating and Drinking Ability Classification System. Outcomes include gross motor function, musculoskeletal development (hip displacement, spasticity, muscle contracture), upper limb function, communication difficulties, oropharyngeal dysphagia, dietary intake and body composition, participation, parent-reported and child-reported quality of life and medical and allied health resource use. These detailed phenotypical data will be compared with brain macrostructure and microstructure using 3 Tesla MRI (3T MRI). Relationships between brain lesion severity and outcomes will be analysed using multilevel mixed-effects models. Ethics and dissemination: The PREDICT-CP protocol is a prospectively registered and ethically accepted study protocol. The study combines data at 1.5–5 then 8–12 years of direct clinical assessment to enable prediction of outcomes and healthcare needs essential for tailoring interventions (eg, rehabilitation, orthopaedic surgery and nutritional supplements) and the projected healthcare utilisation

Measurements of the upper body ultraviolet exposure to golfers: non-melanoma skin cancer risk, and the potential benefits of exposure to sunlight

Background. Geographically, Queensland presents an extreme ultraviolet exposure climate to members of the public engaged in outdoor recreational activity. The risk of developing a skin cancer or an eye disease as a result of incidental exposure to naturally occurring ultraviolet radiation in the outdoor environment is proportionately high in a Queensland population compared to fair skinned population groups residing in comparable Northern Hemisphere latitudes. In contrast to these risks, elderly members of this high growth population group have been reported to be vitamin D deficient. The risks and potential benefits of exposure to sunlight in southern Queensland are assessed in this study with respect to recreational golfing. This sport is a popular recreational activity for the Queensland population and must be played during daylight hours. Methods. The erythemal and vitamin D effective ultraviolet exposure measured to the forearm, upper back and vertex are presented for individuals playing golf under various atmospheric conditions in a seven month period extending from summer to winter. Results. Mean summertime exposures were measured in the 2008 study period to be 1.4, 2.2 and 3.2 SED at forearm, upper back and vertex sites respectively compared to respective wintertime forearm, upper back and vertex exposures of 0.2, 0.3, 0.5 SED, where summertime exposures were recorded in the mean solar zenith angle ranges of 56o to 59o and wintertime exposures were recorded in the mean solar zenith angle range 74o to 83o. Vitamin D3 effective exposures were determined to vary from between 225 Jm-2, 325 Jm 2 and 475Jm-2 during summer and 48 Jm-2, 59 Jm-2 and 88 Jm-2 during winter for the respective forearm, upper back and vertex body sites measured in the above mean solar zenith angle ranges. Conclusion. Exposures to ambient UV during winter on the golf course between 3:00 pm and 5:30 pm could be beneficial for office workers for the production of vitamin D. Optimising exposure periods to late afternoon in the winter months and taking adequate sun protection measures in the summer months are important strategies that golfers can utilise for long term preventative health