Does angiotensin-1 converting enzyme genotype influence motor or cognitive development after pre-term birth?

BACKGROUND: Raised activity of the renin-angiotensin system (RAS) may both amplify inflammatory and free radical responses and decrease tissue metabolic efficiency and thus enhance cerebral injury in the preterm infant. The angiotensin-converting enzyme (ACE) DD genotype is associated with raised ACE and RAS activity as well as potentially adverse stimuli such as inflammation. The DD genotype has been associated with neurological impairments in the elderly, and thus may be also associated with poorer motor or cognitive development amongst children born preterm prematurely. METHODS: The association of DD genotype with developmental progress amongst 176 Caucasian children born at less than 33 weeks gestation (median birthweight 1475 g, range 645–2480 g; gestation 30 weeks, range 22–32; 108 male) was examined at 2 and 5 1/2 years of age. Measured neuro-cognitive outcomes were cranial ultrasound abnormalities, cerebral palsy, disability, Griffiths Developmental Quotient [DQ] at 2 yrs, and General Cognitive Ability [British Ability Scales-11] and motor performance [ABC Movement], both performed at 5 1/2 yrs. All outcomes were correlated with ACE genotype. RESULTS: The DD genotype was not associated with lower developmental quotients even after accounting for important social variables. CONCLUSION: These data do not support either a role for ACE in the development of cognitive or motor function in surviving infants born preterm or inhibition of ACE as a neuroprotective therapy

Determinants of Infant Mortality in Older ASEAN Economies

Infant mortality in the Association of Southeast Asian Nations (ASEAN) has been declining, yet disparities remain between the nations. This paper therefore explores the determinants of infant mortality in the older ASEAN-4 economies, Malaysia, Thailand, Indonesia and the Philippines using an Autoregressive Distributed Lag (ARDL) Error Correction Model framework. The key findings of the study are: First, there is evidence of long-run relationships among infant mortality, education, female fertility, income and access to healthcare. Second, the determinants of infant mortality vary between countries. Female fertility emerged as the main determinant of infant mortality in Malaysia, while access to healthcare matter for infant mortality in Indonesia, and to a lesser extent for the Philippines. The income effect is significant for reducing infant mortality in Malaysia, while female education is important for Indonesia and Thailand. Third, the speed of adjustment of infant mortality rate is comparatively low in ASEAN-4

Providing feedback on adherence increases use of preventive medication by asthmatic children

This study investigates the impact of measuring adherence and providing feedback on medication usage by children with unstable asthma. Adherence was measured using an electronic monitoring device. Subjects were randomized to either being told of their adherence during review consultations or for their adherence to remain undisclosed to their parents and treating physician. Subjects were reviewed monthly for 4 months. Twenty-six children aged between 6 and 14 years were recruited. Adherence was significantly higher in the intervention group (79% versus 58%,

Development of a treatment model for mothers with borderline personality disorder at a new mother and baby unit in Perth, Western Australia

RANZCP Keynote Abstract Background: Emotional dysregulation secondary to borderline personality disorder (BPD) can be exacerbated in the postnatal period, related to the developmental tasks of motherhood. In addition, infants of mothers with BPD often show a pattern of disorganized attachment that can further amplify maternal distress. There is limited research describing treatment models for BPD in the postnatal period. The Fiona Stanley Hospital Mother and Baby Unit (FSH MBU) is a new unit, offering multi-disciplinary psychiatric treatment for a broad range of mental health problems, in an inpatient setting, for women referred with their babies under the age of 1 year. Objectives: To examine the rate of referral and admission of mothers with BPD in comparison with mothers with other diagnoses admitted to the FSH MBU and to describe the development of an evidence-informed treatment model of care for this patient group. Methods: Retrospective case note audit of all admissions to the FSH MBU in its first 12 months (February 2015–2016), to examine psychosocial needs and outcomes and to correlate these with standardized screening tools. Furthermore, identification of treatment goals and treatment pathways for mothers with BPD will also be examined. Findings: Mothers with BPD are frequently referred for admission to the FSH MBU due to emotional dysregulation, comorbid depressive or anxiety disorders or complex social problems impacting their ability to cope with the care of their infants. They often face multifaceted challenges that require comprehensive assessment and care. Conclusions: Data collected and analysed will be essential to the understanding of the needs of these women and their families as well as necessary service provision. Collaboration between Australian MBUs with regard to further research and to refine current treatment models for this patient group is needed

Incentive device improves spacer technique but not clinical outcome in preschool children with asthma

Aim: To investigate the influence of an incentive device, the Funhaler, on spacer technique and symptom control in young children with asthma and recurrent wheeze

Lung Deposition of 99mTc-Radiolabeled Albuterol Delivered through a Pressurized Metered Dose Inhaler and Spacer with Facemask or Mouthpiece in Children with Asthma

Background: Research on the use of a pressurized metered dose inhaler (pMDI) with spacer (pMDI/spacer) in children has indicated oral inhalation via the spacer mouthpiece is more efficient than the combination of oral and nasal inhalation that occurs when a pMDI/spacer is used with a facemask. Changes in pMDI formulations and developments in spacer and facemask designs have highlighted the need for new comparative studies of spacer use, particularly focusing on the age at which children can be taught to transition from use of a pMDI/spacer with facemask to use of the spacer mouthpiece. Methods: Twelve children aged 3–5 years (7 males) with stable asthma were recruited. Of these, 10 children (6 males) completed both arms of the study. A transmission scan of each compliant subject was taken using a 37 MBq 99mTc flood source. Actuations (2–3) of a 99mTc-radiolabeled albuterol pMDI were administered through an antistatic spacer (OptiChamber Diamond) via either a facemask (medium LiteTouch facemask), or the spacer mouthpiece. The subject's inhalation pattern was simultaneously recorded using a pMDI Datalogger, and narrative data relating to tolerance and compliance were documented. Anterior and posterior planar scintigraphic scans were taken immediately after aerosol administration.Results: Mean (SD) lung deposition (% total dose) was 18.1 (9.1)% with the facemask and 22.5 (7.9)% with the spacer mouthpiece (p>0.05). Peripheral lung deposition (expressed as peripheral:central (P:C) ratio) was higher in 7 out of 10 children with the facemask compared with the spacer mouthpiece: 1.3 (0.26) vs. 1.2 (0.35); (p=0.11). Head and neck deposition was higher with use of the facemask compared with the spacer mouthpiece: 19.7 (10.6)% vs. 10.8 (5.3)% (p=0.011). Conclusions: Lung deposition achieved using the spacer with facemask was higher than previously reported, with a difference of only 4.4% of total dose measured compared to the deposition with mouthpiece. This may be due to a combination of factors including pMDI formulation, and use of an antistatic spacer with a flexible, well-fitting facemask

Usefulness of parental response to questions about adherence to prescribed inhaled corticosteroids in young children

Background Adherence to prescribed inhaled medication is often low in young children. Poor adherence to medication may contribute to lack of symptom control. Doctors are not good at predicting the adherence rates of their patients, and parental report of adherence does not correlate with objective measures of adherence. The objective of this study was to investigate whether parental admission of non-adherence and reasons given for non-adherence correlated with objectively measured adherence