Monitoring pulmonary rehabilitation and long-term oxygen therapy for people with chronic obstructive pulmonary disease (COPD)

This report outlines a proposed approach to monitoring access to, and utilisation of, pulmonary rehabilitation and long term oxygen therapy, by capitalising on existing data sources and identifying data development opportunities.SummaryChronic obstructive pulmonary disease (COPD) is a major cause of death and disability in Australia. About 1 in 13 people aged 40 and over have lung function consistent with a diagnosis of COPD. The disease develops over many years and therefore mainly affects middle-aged and older people. Smoking is its main, but not only, cause. Current clinical guidelines for the management of COPD (developed by the Thoracic Society of Australia and New Zealand and Lung Foundation Australia) emphasise the importance of care that encompasses both drug and non-drug based interventions designed to improve quality of life and survival. Pulmonary rehabilitation is a system of care that includes a combination of exercise, education and psychosocial support. It has been shown to have a wide range of beneficial effects, particularly because of its exercise component. Pulmonary rehabilitation implemented after a hospital admission reduces the risk of re-hospitalisation and death, and improves quality of life. Selective use of long-term oxygen therapy (LTOT)-the provision of supplemental oxygen therapy for 15 hours per day or more for people with COPD who have persistently low levels of oxygen in their blood-has been shown to improve quality of life and improve survival. Both of these therapies are among the key non-pharmacological interventions recommended in national and international clinical guidelines. Available evidence suggests, however, that pulmonary rehabilitation and LTOT are under-utilised in managing patients with COPD in Australia. The full extent of service provision, utilisation and under-utilisation is not known as there are no national data. This report outlines: proposed indicators relevant to monitoring access to, and utilisation of, pulmonary rehabilitation and LTOT in Australiaexisting data sources that may inform these indicatorsoptions for data developmentpotential challenges in monitoring these therapies. Improved information about access to, and use of, these interventions among people with COPD would enable: identification of opportunities for health improvementmeasurement of the benefits derived from these interventions. This would form a useful basis for data development to support assessment of the appropriateness of use, barriers to uptake and outcomes of these therapies. Similar information about the provision of non-inpatient, non-procedural and non- pharmaceutical therapies is also relevant to monitoring other chronic diseases in which these interventions improve quality of life and extend life. The authors of this report are Guy Marks, Helen Reddel, Elyse Guevara-Rattray, Leanne Poulos and Rosario Ampon of the Australian Centre for Asthma Monitoring (ACAM)

ABSTRACT BOOK 50th World Conference on Lung Health of the International Union Against Tuberculosis and Lung Disease (The Union)

The International Journal of Tuberculosis and Lung Disease is an official journal of The Union. The Journal’s main aim is the continuing education of physicians and other health personnel, and the dissemination of the most up-to-date infor mation in the field of tuberculosis and lung health. It publishes original articles and commissioned reviews not only on the clinical and biological and epidemiological aspects, but also—and more importantly—on community aspects: fundamental research and the elaboration, implementation and assessment of field projects and action programmes for tuberculosis control and the promo tion of lung health. The Journal welcomes articles submitted on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research

Risk of Tuberculosis in Dialysis Patients: A Nationwide Cohort Study

Extent: 6p.BACKGROUND: The ability to identify individuals at increased risk of developing tuberculosis (TB) has important implications for public health policy and patient care. We conducted a general population historical cohort study in all Australian States and Territories to establish the risk of TB arising in people on chronic hemo- or peritoneal dialysis. METHODOLOGY/PRINCIPAL FINDINGS: Cases of TB disease in patients receiving chronic dialysis were identified by record linkage using the Australia & New Zealand Dialysis and Transplant Registry (ANZDATA) and State and Territory TB notification databases 2001 to 2006. Main outcome measure was the relative risk of TB in people on dialysis, adjusted for TB incidence in country of birth, sex, age and indigenous status. A total of 6,276 cases of active TB were reported among 19,855,283 people living in Australia between 2001 and 2006. Among 14,506 patients on dialysis, 37 had a notification for TB disease after commencing dialysis, of whom 28 were culture positive. The incidence of TB was 66.8/100,000/year (95% CI 47.7 to 93.2) among people on dialysis and 5.7/100,000/year (95% CI 5.5 to 5.8) in the general population. The adjusted relative risk (aRR) of TB in people on dialysis was 7.8 (95% CI 3.3 to 18.7), and the aRR of culture positive TB was 8.6 (95% CI 3.9 to 19.3). CONCLUSIONS/SIGNIFICANCE: Patients on dialysis are at increased risk of TB. The final decision to screen for, and to treat, LTBI in individual dialysis patients will be influenced by a cumulative assessment of the risk of reactivation of TB and by assessment of risk factors for adverse effects of treatment.Claudia C. Dobler, Stephen P. McDonald and Guy B. Mark

Congenital Rubella Syndrome in Fiji, 1995-2010

Setting. A nationwide study in Fiji. Objective. To describe the incidence of congenital rubella syndrome (CRS) and its relationship to the incidence of notified cases of rubella in Fiji from 1995 to 2010. Design. Descriptive, retrospective review of all recorded congenital abnormalities associated with live births in Fiji over 16 years. Results. There were 294 infants who met the criteria for CRS. Of these, 95% were classified as "suspected" cases, 5% were "clinically confirmed," and none were "laboratory confirmed cases". There was a significant linear increase over the study period in the incidence of CRS (odds ratio 1.045 per year, 95% CI 1.019 to 1.071, P ≤ 0.001). There was no significant association between the incidence of CRS and the reported incidence of rubella (P = 0.3). Conclusion. There is a rising trend in reports of suspected CRS cases in Fiji. This highlights the need to strengthen surveillance for CRS through improvements in clinical and laboratory diagnosis to confirm or exclude suspected cases. It is also important to ensure high coverage of rubella vaccination in Fiji

Infant and early childhood dietary predictors of overweight at age 8 years in the CAPS population

BACKGROUND/OBJECTIVES: Programs to address obesity are a high priority for public policy especially for young children. Research into dietary determinants of obesity is challenging but important for rational planning of interventions to prevent obesity, given that both diet and energy expenditure influence weight status. We investigated whether early life dietary factors were predictive of weight status at 8 years in a cohort of Australian children. SUBJECTS/METHODS: We used data from the Childhood Asthma Prevention Study-a birth cohort at high risk of asthma. Dietary data (3-day weighed food records) were collected at 18 months and height, weight and waist circumference were collected at 8 years. We assessed the relationship between dietary predictor variables and measures of adiposity using linear regression. RESULTS: Intakes of protein, meat and fruit at age 18 months were positively associated with measures of adiposity at age 8 years, namely, body mass index and/or waist circumference. We also showed a significant negative relationship between these measures of adiposity at 8 years and intake at 18 months of dairy foods as a percent of total energy, and intake of energy dense cereal-based foods such as cookies and crackers. CONCLUSIONS: This birth cohort study with rigorous design, measures and analyses, has shown a number of associations between early dietary intake and subsequent adiposity that contribute to the growing evidence base in this important field.National Health and Medical Research Council of AustraliaHjärt- och LungfondenSvenska LäkarsällskapetManuscrip

Respiratory medication use in Australia 2003–2013: treatment of asthma and COPD

This report describes patterns of dispensing of respiratory medications in Australia through detailed analyses of Pharmaceutical Benefits Scheme data, as well as other sources, to draw inferences about respiratory medication use among patients with asthma and chronic obstructive pulmonary disease. Summary This report focuses on medications dispensed for asthma (a chronic airways disease affecting children and adults) and chronic obstructive pulmonary disease, which primarily affects older adults who have been smokers). In 2013, one or more respiratory medications were dispensed to 2,042,104 people in Australia (9.1% of the population)

Ethanol consumption impairs vestibulo-ocular reflex function measured by the video head impulse test and dynamic visual acuity

Ethanol affects many parts of the nervous system, from the periphery to higher cognitive functions. Due to the established effects of ethanol on vestibular and oculomotor function, we wished to examine its effect on two new tests of the vestibulo-ocular reflex (VOR): the video head impulse test (vHIT) and dynamic visual acuity (DVA). We tested eight healthy subjects with no history of vestibular disease after consumption of standardized drinks of 40% ethanol. We used a repeated measures design to track vestibular function over multiple rounds of ethanol consumption up to a maximum breath alcohol concentration (BrAC) of 1.38‰. All tests were normal at baseline. VOR gain measured by vHIT decreased 25% by the highest BrAC level tested in each subject. Catch-up saccades were negligible at baseline and increased in number and size with increasing ethanol consumption (from 0.13° to 1.43° cumulative amplitude per trial). DVA scores increased by 86% indicating a deterioration of acuity, while static visual acuity (SVA) remained unchanged. Ethanol consumption systematically impaired the VOR evoked by high-acceleration head impulses and led to a functional loss of visual acuity during head movement.NHMR

Breastfeeding, asthma, and allergy : a tale of two cities

BACKGROUND: The effect of breastfeeding duration on subsequent asthma and allergy remains the subject of much controversy. OBJECTIVE: To investigate whether differences in study design or disease-related exposure modification were the cause of the differences in study findings. METHOD: The data from two cohorts, the Childhood Asthma Prevention Study (CAPS) from Australia and the Barn Allergi Miljo Stockholm cohort from Sweden, which had reported different findings on the association between breastfeeding and asthma, were combined. For this analysis, the definitions for breastfeeding, asthma, and allergy were harmonized. Subjects were included if they had at least one parent with wheeze or asthma and had a gestational age of more than 36 wks (combined n = 882). The risk of disease-related exposure modification was assessed using survival analysis. RESULTS: Breastfeeding reduced the risk of asthma at 4/5 and 8 yrs of age in children with a family history of asthma. The effect was stronger in the Swedish cohort. Breastfeeding had no effect on the prevalence of sensitization to inhaled allergens in this cohort with a family history of asthma but was a risk factor for sensitization to cow's milk, peanuts, and eggs in the CAPS cohort at 4/5 yrs and in the combined cohort at 8 yrs. There was no evidence to support the existence of disease-related exposure modification in either cohort. CONCLUSION: These findings point to the importance of harmonization of features of study design, including subject selection criteria and variable definitions, in resolving epidemiological controversies such as those surrounding the impact of breastfeeding on asthma and allergic sensitization.National Health and Medical Research Council of AustraliaStockholm County CouncilHjärt- och LungfondenThe Swedish Asthma and Allergy AssociationVetenskapsrådetThe Centre for Allergy research Karolinska InstitutetManuscrip

Strabismus measurements with novel video goggles

PURPOSE: To assess the validity of a novel, simplified, noninvasive test for strabismus using video goggles. DESIGN: Cross-sectional method comparison study in which the new test, the strabismus video goggles, is compared with the existing reference standard, the Hess screen test. PARTICIPANTS: We studied 41 adult and child patients aged ≥6 years with ocular misalignment owing to congenital or acquired paralytic or comitant strabismus and 17 healthy volunteers. METHODS: All participants were tested with binocular infrared video goggles with built-in laser target projection and liquid crystal display shutters for alternate occlusion of the eyes and the conventional Hess screen test. In both tests, ocular deviations were measured on a 9-point target grid located at 0±15° horizontal and vertical eccentricity. MAIN OUTCOME MEASURES: Horizontal and vertical ocular deviations at 9 different gaze positions of each eye were measured by the strabismus video goggles and the Hess screen test. Agreement was quantified as the intraclass correlation coefficient. Secondary outcomes were the utility of the goggles in patients with visual suppression and in children. RESULTS: There was good agreement between the strabismus video goggles and the Hess screen test in the measurements of horizontal and vertical deviation (intraclass correlation coefficient horizontal 0.83, 95% confidence interval [0.77, 0.88], vertical 0.76, 95% confidence interval [0.68, 0.82]). Both methods reproduced the characteristic strabismus patterns in the 9-point grid. In contrast to Hess screen testing, strabismus video goggle measurements were even possible in patients with comitant strabismus and visual suppression. CONCLUSIONS The new device is simple and is fast and accurate in measuring ocular deviations, and the results are closely correlated with those obtained using the conventional Hess screen test. It can even be used in patients with visual suppression who are not suitable for the Hess screen test. The device can be applied in children as young as 6 years of age