Hospital service use for young people with chronic health conditions : a population-based matched retrospective cohort study

Aim: This study aims to identify the hospitalised morbidity associated with three common chronic health conditions among young people using a population-based matched cohort. Methods: A population-level matched case-comparison retrospective cohort study of young people aged ≤18 years hospitalised with asthma, type 1 diabetes (T1D) or epilepsy during 2005–2018 in New South Wales, Australia using linked birth, health and mortality records. The comparison cohort was matched on age, sex and residential postcode. Adjusted rate ratios (ARR) were calculated by sex and age group. Results: There were 65 055 young people hospitalised with asthma, 6648 with epilepsy, and 2209 with T1D. Young people with epilepsy (ARR 10.95; 95% confidence interval (CI) 9.98–12.02), T1D (ARR 8.64; 95% CI 7.72–9.67) or asthma (ARR 4.39; 95% CI 4.26–4.53) all had a higher risk of hospitalisation than matched peers. Admission risk was highest for males (ARR 11.00; 95% CI 9.64–12.56) and females with epilepsy (ARR 10.83; 95% CI 9.54–12.29) compared to peers. The highest admission risk by age group was for young people aged 10–14 years (ARR 5.50; 95% CI 4.77–6.34) living with asthma, children aged ≤4 years (ARR 12.68; 95% CI 11.35–14.17) for those living with epilepsy, and children aged 5–9 years (ARR 9.12; 95% CI 7.69–10.81) for those living with T1D compared to peers. Conclusions: The results will guide health service planning and highlight opportunities for better management of chronic health conditions, such as further care integration between acute, primary and community health services for young people

The experiences of parents in supporting their son or daughter with intellectual disability to learn about dying and death

Background People with intellectual disability have a limited understanding of dying and death. The role of parents in developing the understanding of their son or daughter with intellectual disability about these concepts is unclear. This study aimed to explore parental experiences when talking with their son or daughter with intellectual disability about dying and death. Method Four participants were interviewed about how they discussed dying and death with their son or daughter with intellectual disability. Thematic analysis was used to interpret the findings. Results Parents did more than talk to their son or daughter about death; they involved them in dying and death experiences. Parents’ motivations influenced the way they included their son or daughter in these experiences. Conclusions The parents played an important role in providing learning experiences for their son or daughter with intellectual disability about dying and death

Adherence issues in children and adolescents receiving highly active antiretroviral therapy

The introduction of highly active antiretroviral therapies (HAART) for the treatment of paediatric HIV infection poses additional adherence challenges for children and families living with HIV. A preliminary survey of 18 parents of children receiving HAART in Australia showed that although parents report high levels of child adherence to HAART, specific features of the medication regimen, such as taste and number of medications made administration of HAART extremely difficult. Moreover, interaction between the treatment regimen and the day-to-day lives of families increases the adherence challenge. While some agreement exists in relation to the concerns families have about negative aspects of HAART, the diversity of issues suggests the need for ongoing and individualized support and information to families

Hospital service use following an injury hospitalisation for young males and females in a population-level matched retrospective cohort study

Background: Children and young people who sustain injuries resulting in a hospital admission may experience adverse effects for months or years following the event. Understanding the attributable burden and health service needs is vital for public health planning as well as individual care provision. This study aims to identify the hospitalised morbidity associated with injury among young people by sex using a population-level matched cohort. Method: A population-level matched case-comparison retrospective cohort study of young people aged ≤18 years hospitalised for an injury during 2005-2018 in New South Wales, Australia using linked birth, health, and mortality records. The comparison cohort was matched on age, gender and residential postcode. Adjusted rate ratios (ARR) were calculated for age group, injury severity and nature of injury by sex. Results: There were 122,660 (60.9%) males and 78,712 (39.1%) females aged ≤18 years hospitalised after sustaining an injury. Males (ARR 2.89; 95%CI 2.81-2.97) and females (ARR 2.79; 95%CI 2.68-2.90) who were hospitalised after an injury had a higher risk of subsequent hospital admission than their matched peers. Males (ARR 3.38; 95%CI 2.81-4.05) and females (ARR 3.41; 95%CI 2.72-4.26) with serious injuries had a higher risk of admission compared to peers. Males with dislocations, sprains and strains (ARR 3.40; 95%CI 3.03-3.82), burns (ARR 3.37; 95%CI 2.99-3.80), and fractures (ARR 3.20; 95%CI 3.07-3.33), and females with burns (ARR 3.84; 95%CI 3.40-4.33), dislocations, sprains and strains (ARR 3.54; 95%CI 2.96-4.23), and traumatic brain injury (ARR 3.39; 95%CI 3.01-3.82) had the highest risk of subsequent hospitalisation compared to peers. Conclusion: Patient management and care extends beyond the injury admission as many young people face high levels of contact with health services in the months and years following injury. These findings will inform health service planning and trauma care management for young people and families affected by injury.</p

Health service use for young males and females with a mental disorder is higher than their peers in a population-level matched cohort

Background: To inform healthcare planning and resourcing, population-level information is required on the use of health services among young people with a mental disorder. This study aims to identify the health service use associated with mental disorders among young people using a population-level matched cohort. Method: A population-based matched case-comparison retrospective cohort study of young people aged ≤ 18 years hospitalised for a mental disorder during 2005–2018 in New South Wales, Australia was conducted using linked birth, health, and mortality records. The comparison cohort was matched on age, sex and residential postcode. Adjusted rate ratios (ARR) were calculated for key demographics and mental disorder type by sex. Results: Emergency department visits, hospital admissions and ambulatory mental health service contacts were all higher for males and females with a mental disorder than matched peers. Further hospitalisation risk was over 10-fold higher for males with psychotic (ARR 13.69; 95%CI 8.95–20.94) and anxiety (ARR 11.44; 95%CI 8.70-15.04) disorders, and for both males and females with cognitive and behavioural delays (ARR 10.79; 95%CI 9.30-12.53 and ARR 14.62; 95%CI 11.20-19.08, respectively), intellectual disability (ARR 10.47; 95%CI 8.04–13.64 and ARR 11.35; 95%CI 7.83–16.45, respectively), and mood disorders (ARR 10.23; 95%CI 8.17–12.80 and ARR 10.12; 95%CI 8.58–11.93, respectively) compared to peers. Conclusion: The high healthcare utilisation of young people with mental disorder supports the need for the development of community and hospital-based services that both prevent unnecessary hospital admissions in childhood and adolescence that can potentially reduce the burden and loss arising from mental disorders in adult life.</p

The impact of childhood epilepsy on academic performance: A population-based matched cohort study

Objectives: To compare academic performance and high school completion of young people admitted to hospital with epilepsy and matched peers from the general population not admitted to hospital with epilepsy during the study period. Methods: A population-based matched case-comparison cohort study of young people aged ≤18 years hospitalised with epilepsy during 2005-2018 in New South Wales, Australia, using linked birth, health, education, and mortality records. The comparison cohort was matched on age, sex, and residential postcode. Generalised linear mixed modelling examined risk of school performance below the national minimum standard (NMS), and generalised linear regression examined risk of not completing high school for young people hospitalised with epilepsy compared to matched peers not hospitalised with epilepsy during the study period. Adjusted relative risks (ARRs) with 95% confidence intervals (CIs) were derived from the final models. Results: Young people hospitalised with epilepsy had more than 3 times higher risk of not achieving the NMS for numeracy (ARR: 3.40; 95%CI 2.76‒4.18) and reading (ARR: 3.15; 95%CI 2.60‒3.82), compared to matched peers. Young people hospitalised with epilepsy had a 78% higher risk of not completing year 10 (ARR: 1.78; 95%CI 1.14‒2.79), 18% higher risk of not completing year 11 (ARR: 1.18; 95%CI 0.97‒1.45), and 38% higher risk of not completing year 12 (ARR: 1.38; 95%CI 1.14‒1.67), compared to matched counterparts. Conclusion: Young people hospitalised with epilepsy have higher risk of not achieving minimum standards for numeracy and reading and not completing high school compared to matched peers. There is a need for effective strategies and interventions (e.g., early seizure control and improved multidisciplinary management and care coordination) to minimise the potential adverse effect of epilepsy on education and its sequelae such as early school leaving, unemployment and poverty in adulthood.</p