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Tautolo ES, Wong C, Vandal A, Jalili-Moghaddam S, Griffiths E, Iusitini L, Trenholme A, Byrnes C. Respiratory Health of Pacific Youth: An Observational Study of Associated Risk and Protective Factors Throughout Childhood. JMIR Res Protoc 2020; 9:e18916. [PMID: 33084587 PMCID: PMC7641786 DOI: 10.2196/18916] [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: 03/26/2020] [Revised: 07/13/2020] [Accepted: 07/27/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Respiratory disease is the third most common cause of death in New Zealand, with Pacific people living in New Zealand bearing the greatest burden of this type of disease. Although some epidemiological outcomes are known, we lack the specifics required to formulate targeted and effective public health interventions. The Pacific Islands Families (PIF) birth cohort study is a study that provides a unique source of data to assess lung function and current respiratory health among participants entering early adulthood and to examine associations with early life events during critical periods of growth. OBJECTIVE This paper aims to provide an overview of the design, methods, and scope of the Respiratory Health of Pacific Youth Study, which uses the overall PIF study cohort aged 18-19 years. METHODS From 2000-2019, the PIF study has followed, from birth, the growth, and the development of 1398 Pacific children born in Auckland, New Zealand. Participants were nested within the overall PIF study (at ages 18-19 years) from June 2018, and assessments were undertaken until mid-November 2019. The assessments included respiratory and general medical histories, a general physical examination, assessment of lung function (forced expiratory volume and forced vital capacity), self-completed questionnaires (St George's Respiratory Questionnaire, European Quality of Life 5 Dimensions-3 Level, Epworth Sleepiness Scale for Children and Adolescents, and Leicester Cough Questionnaire), blood tests (eosinophils, Immunoglobulin E, Immunoglobulin G, Immunoglobulin A, Immunoglobulin M, and C-reactive protein), and chest x-rays. Noninferential analyses will be carried out on dimensionally reduced risk and protective factors and confounders. RESULTS Data collection began in June 2018 and ended in November 2019, with a total of 466 participants recruited for submission of the paper. Collection and collation of chest x-ray data is still underway, and data analysis and expected results will be published by November 2020. CONCLUSIONS This is the first longitudinal observational study to address the burden of respiratory disease among Pacific youth by determining factors in early life that impose long-term detriments in lung function and are associated with the presence of respiratory illness. Identifying risk factors and the magnitude of their effects will help in adopting preventative measures, establishing whether any avoidable risks can be modified by later resilient behaviors, and provide baseline measurements for the development of respiratory disease in later adult life. The study results can be translated into practice guidelines and inform health strategies with immediate national and international impact. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/18916.
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Affiliation(s)
- El-Shadan Tautolo
- AUT Pacific Health Research Centre, Faculty of Health & Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Conroy Wong
- Department of Respiratory Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Alain Vandal
- Department of Biostatistics, University of Auckland, Auckland, New Zealand
| | - Shabnam Jalili-Moghaddam
- AUT Pacific Health Research Centre, Faculty of Health & Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Emily Griffiths
- AUT Pacific Health Research Centre, Faculty of Health & Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Leon Iusitini
- AUT Pacific Health Research Centre, Faculty of Health & Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Adrian Trenholme
- Department of Respiratory Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Catherine Byrnes
- Paediatric Department, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
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Wen SCH, Miles F, McSharry B, Wilson E. Varicella in a Paediatric Intensive Care Unit: 10-year review from Starship Children's Hospital, New Zealand. J Paediatr Child Health 2014; 50:280-5. [PMID: 24372783 DOI: 10.1111/jpc.12473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2013] [Indexed: 11/27/2022]
Abstract
AIMS Varicella is now a vaccine-preventable disease but is generally considered benign, making it a low priority for a funded universal immunisation scheme. We aimed to increase the knowledge of the severity, morbidity and mortality caused by varicella, by a review of cases requiring paediatric intensive care in New Zealand where vaccine is available but not funded. METHODS This is a retrospective chart review of children admitted to the paediatric intensive care unit (PICU) over a 10-year period (July 2001-July 2011) identified from the PICU database with a primary or secondary code for varicella. RESULTS Thirty-four cases were identified and 26 cases were included. Of the 26 cases, 84.6% were Maori or Pacific Island ethnicity, 54% had no preceding medical condition and 23% were immunocompromised. Main PICU admission reasons were neurologic (38.5%), secondary bacterial sepsis or shock (26.9%), respiratory (15.4%), disseminated varicella (11.5%), or other causes (7.7%). Fifty per cent of children required inotropic support and 81% invasive ventilation. Four children died (15%), three of whom were immunocompromised. A further eight children (31%) had ongoing disability at hospital discharge. CONCLUSION Varicella, or its secondary complications, requiring paediatric intensive care, carries high mortality, particularly for immunocompromised patients, and long-term morbidities, mostly affecting previously healthy children.
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Affiliation(s)
- Sophie Chien-Hui Wen
- Department of Paediatric Infectious Disease, Starship Children's Hospital, Auckland, New Zealand
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Grant CC, Wall CR, Gibbons MJ, Morton SM, Santosham M, Black RE. Child nutrition and lower respiratory tract disease burden in New Zealand: a global context for a national perspective. J Paediatr Child Health 2011; 47:497-504. [PMID: 21040074 DOI: 10.1111/j.1440-1754.2010.01868.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM To consider the contribution of malnutrition to acute lower respiratory infection (ALRI) disease burden in children <5 years old in New Zealand (NZ). METHODS The contribution of maternal and child malnutrition to ALRI disease burden in early childhood globally was described. A literature review was conducted to describe the nutritional status and ALRI disease burden of NZ children <5 years old. RESULTS The four key nutritional risk factors for ALRI disease burden globally are macronutrient undernutrition, low birthweight, zinc deficiency and suboptimal breastfeeding. In addition, maternal nutritional status and vitamin D deficiency are potentially important nutritional determinants of ALRI disease burden. Relative to other developed countries, NZ has a large ALRI disease burden in pre-school-aged children. Pneumonia and bronchiolitis hospitalisation rates are two to four times greater than other developed countries. The ALRI disease burden varies with ethnicity, being highest in Pacific, intermediate in Maori and lowest in European children. Three of the four key nutritional risk factors for global ALRI disease burden--low birthweight, zinc deficiency and suboptimal breastfeeding--are potential contributors to ALRI disease burden in NZ. In addition to these factors, vitamin D deficiency during early childhood and maternal vitamin D deficiency are also potentially important particularly with respect to the larger disease burden in Pacific and Maori children. CONCLUSION The contribution of malnutrition to ALRI disease burden in NZ requires greater clarification. Such clarification is necessary to inform the development of nutritional policy, which seeks to improve early child health.
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Affiliation(s)
- Cameron C Grant
- Department of Paediatrics, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand.
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Borrows J, Williams M, Schluter P, Paterson J, Langitoto Helu S. Pacific Islands Families Study: The Association of Infant Health Risk Indicators and Acculturation of Pacific Island Mothers Living in New Zealand. JOURNAL OF CROSS-CULTURAL PSYCHOLOGY 2010. [DOI: 10.1177/0022022110362750] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Pacific Islands Families study follows a cohort of 1,398 Pacific infants born in Auckland, New Zealand. This article examines associations between maternal acculturation, measured by an abbreviated version of the General Ethnicity Questionnaire, and selected infant and maternal health risk indicators. Findings reveal that those with strong alignment to Pacific culture had significantly better infant and maternal risk factor outcomes than those with weak cultural alignment. In terms of Berry’s classical acculturation model, separators had the best infant and maternal outcomes; integrators had reasonable infant and maternal outcomes, while assimilators and marginalisors appeared to have the poorest infant and maternal outcomes. These findings suggest that retaining strong cultural links for Pacific immigrants is likely to have positive health benefits.
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Affiliation(s)
- Jim Borrows
- Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand,
| | - Maynard Williams
- Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand
| | - Philip Schluter
- School of Public Health and Psychosocial Studies, AUT University, Auckland, New Zealand, and the University of Queensland, School of Nursing and Midwifery, Australia
| | - Janis Paterson
- School of Public Health and Psychosocial Studies, AUT University, Auckland, New Zealand
| | - S. Langitoto Helu
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
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Mistry R, Pasisi L, Chong S, Stewart J, She RW. Socioeconomic deprivation and burns. Burns 2010; 36:403-8. [DOI: 10.1016/j.burns.2009.05.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Revised: 05/21/2009] [Accepted: 05/28/2009] [Indexed: 10/20/2022]
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Abstract
Acute lower respiratory infections (ALRI) are the major cause of morbidity and mortality in young children worldwide. ALRIs are important indicators of the health disparities that persist between Indigenous and non-Indigenous children in developed countries. Bronchiolitis and pneumonia account for the majority of the ALRI burden. The epidemiology, diagnosis, and management of these diseases in Indigenous children are discussed. In comparison with non-Indigenous children in developing countries they have higher rates of disease, more complications, and their management is influenced by several unique factors including the epidemiology of disease and, in some remote regions, constraints on hospital referral and access to highly trained staff. The prevention of repeat infections and the early detection and management of chronic lung disease is critical to the long-term respiratory and overall health of these children.
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Affiliation(s)
- Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University Darwin, Rocklands Drive, Tiwi, NT 0811, Australia.
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Abstract
OBJECTIVES To determine the aetiology, incidence and short-term outcomes of New Zealand children with acute kidney injury (AKI) requiring renal replacement therapy (RRT) over a 6-year period. METHODS A retrospective chart review of all children requiring RRT for AKI from January 2001 to December 2006 at Starship Children's Hospital, Auckland, New Zealand was conducted. The primary outcome was survival to discharge. RESULTS A total of 226 children required RRT for AKI over the 6-year study period. The annual incidence was 4.0 per 100,000 total population under 15 years of age. The commonest causes of AKI were post cardiac surgery (58%), haemolytic uraemic syndrome (17%), sepsis (13%) and glomerulonephritis (4%). The survival rate to hospital discharge was 89%. A total of 40% of all surviving children had one or more abnormalities at the time of discharge suggestive of ongoing renal dysfunction (hypertension, continuing need for antihypertensive medication, reduced estimated glomerular filtration rate or abnormal urinalysis). More Maori and Pacific Island children were treated for AKI than would be expected from population data (P < 0.0001). Sepsis and glomerulonephritis were seen more commonly as causes of AKI in Maori and Pacific Island children compared with New Zealand European children. CONCLUSION In our study, 40% of surviving children had evidence of short-term renal dysfunction at discharge following AKI. This suggests that all children should undergo a period of follow-up after any episode of AKI to look for resolution or further development of signs of renal injury.
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Affiliation(s)
- Emma F Ball
- Department of Paediatric Nephrology, Starship Children's Hospital, Auckland, New Zealand.
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Abstract
AIM To examine dental service use and dental care receipt by a range of factors among Maori, Pacific and New Zealand European or Other children in New Zealand. METHODS Data were from the 2002 National Children's Nutrition Survey. Bivariate associations were calculated between three dental service use and dental care receipt measures, and 48 personal characteristics in five domains. Analyses took into account the complex sampling design. RESULTS Some 3275 children participated; 37.4% Maori, 32.3% Pacific and 30.3% New Zealand European or Other. Irregular dental attendance was associated with children who were 11-14 years, Pacific, had not always lived in New Zealand, lived in rented accommodation, frequently watched television, consumed breakfast on the way to school, purchased lunch, consumed sugar-containing products or had food security issues. A higher proportion of children who were aged 11-14 years, Maori, had low household income, lived with 4+ children, regularly watched television, consumed breakfast on the way to school, frequently consumed high-sugar foods, had food security issues, experienced dental pain at night or had received dental care under a general anaesthetic had received a restoration. Extraction receipt was associated with children who were Pacific, had low household income, had a disability, purchased their lunch, regularly consumed high-sugar-containing products, had food security issues, had experienced dental pain at night or received dental care under a general anaesthetic. CONCLUSIONS Material and behavioural factors all play a role in New Zealand child use of dental services and receipt of dental care.
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Affiliation(s)
- Lisa M Jamieson
- Australian Research Centre for Population Oral Health, The University of Adelaide, South Australia, Australia.
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Miles F, Voss L, Segedin E, Anderson BJ. Review of Staphylococcus aureus infections requiring admission to a paediatric intensive care unit. Arch Dis Child 2005; 90:1274-8. [PMID: 16301556 PMCID: PMC1720228 DOI: 10.1136/adc.2005.074229] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To review clinical features and outcome of children with severe Staphylococcus aureus sepsis (SAS) presenting to a paediatric intensive care unit (PICU) with particular focus on ethnicity, clinical presentation, cardiac involvement, and outcome. METHODS Retrospective chart review of patients coded for SAS over 10 years (October 1993 to April 2004). RESULTS There were 58 patients identified with SAS over the 10 year study period; 55 were community acquired. This accounted for 4% of hospital admissions for SAS over this time; children with staphylococcal illness comprised 1% of all admissions to the PICU. Maori and Pacific children with SAS were overly represented in the PICU (81%) from a paediatric population where they contribute 21.6%. Musculoskeletal symptoms (79%) dominated presentation rather than isolated pneumonia (10%). An aggressive search for foci and surgical drainage of infective foci was required in 50% of children. Most children had multifocal disease (67%) and normal cardiac valves (95%); the few children (12%) presenting with methicillin resistant S aureus (MRSA) had community acquired infection. The median length of stay in the PICU was 3 (mean 5.8, SD 7.6, range 1-44) days. The median length of stay in hospital was 15 (mean 21, SD 22.7, range 2-149) days. Mortality due to SAS was 8.6% (95% CI 1.4-15.8%) compared with the overall mortality for the PICU of 6% (95% CI 5.3-6.7%). Ten children had significant morbidity after discharge. CONCLUSIONS Community acquired SAS affects healthy children, is multifocal, and has high morbidity and mortality, in keeping with the high severity of illness scores on admission. It is imperative to look for sites of dissemination and to drain and debride foci. Routine echocardiography had low yield in the absence of pre-existing cardiac lesions, persisting fever, or persisting bacteraemia.
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Affiliation(s)
- F Miles
- Paediatric Intensive Care Unit, Auckland Children's Hospital, New Zealand.
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Twiss J, Metcalfe R, Edwards E, Byrnes C. New Zealand national incidence of bronchiectasis "too high" for a developed country. Arch Dis Child 2005; 90:737-40. [PMID: 15871981 PMCID: PMC1720490 DOI: 10.1136/adc.2004.066472] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIMS To prospectively estimate the incidence of bronchiectasis among New Zealand (NZ) children, to consider aetiology and severity, and to evaluate regional and ethnic variation. METHODOLOGY NZ paediatricians were surveyed monthly for new cases of bronchiectasis during 2001 and 2002 via the NZ paediatric surveillance unit (with coverage of >94% of NZ paediatricians). Notified cases had their computed tomography scans reviewed and scored for severity. Confirmed cases were followed up by postal questionnaire one year after diagnosis. Demographic, aetiological, and severity data were collected. RESULTS Ninety nine notifications were received. Sixty five cases were confirmed. An overall incidence of 3.7 per 100,000 under 15 year old children per year was estimated. Incidence was highest in Pacific children at 17.8 compared with 4.8 in Maori, 1.5 in NZ European, and 2.4 other per 100,000 per year. Incidence varied significantly by region. The median age at diagnosis was 5.2 years; the majority had symptoms for more than two years. Eighty three per cent had bilateral disease, with a median of three lobes affected, mean FEV1 of 77% predicted, and modified Bhalla HRCT score of 18. CONCLUSIONS The incidence of bronchiectasis is high in NZ children, nearly twice the rate for cystic fibrosis and seven times that of Finland, the only other country reporting a childhood national rate. Incidence varied substantially between ethnicities. Most cases developed disease in early childhood and had delayed diagnosis.
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Affiliation(s)
- J Twiss
- Starship Childrens' Hospital, Auckland District Health Board, Auckland, New Z.
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Edwards EA, Douglas C, Broome S, Kolbe J, Jensen CG, Dewar A, Bush A, Byrnes CA. Nitric oxide levels and ciliary beat frequency in indigenous New Zealand children. Pediatr Pulmonol 2005; 39:238-46. [PMID: 15635620 DOI: 10.1002/ppul.20155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
New Zealand children's morbidity from respiratory disease is high. This study examines whether subclinical ciliary abnormalities underlie the increased prevalence of respiratory disease in indigenous New Zealand children. A prospective study enrolled a group of healthy children who were screened for respiratory disease by questionnaire and lung function. Skin-prick tests were performed to control for atopy. Exhaled and nasal NO was measured online by a single-breath technique using chemiluminescence. Ciliary specimens were obtained by nasal brushings for assessment of structure and function. The ciliary beat frequency (CBF) (median CBF, 12.5 Hz; range, 10.4-16.8 Hz) and NO values (median exhaled NO, 5.6 ppb; range, 2.3-87.7 ppb; median nasal NO, 403 ppb; range, 34-1,120 ppb) for healthy New Zealand European (n=58), Pacific Island (n=61), and Maori (n=16) children were comparable with levels reported internationally. No ethnic differences in NO, atopy, or CBF were demonstrated. Despite an apparently normal ciliary beat, the percentage of ciliary structural defects was 3 times higher than reported controls (9%; range, 3.6-31.3%), with no difference across ethnic groups. In conclusion, it is unlikely that subclinical ciliary abnormalities underlie the increased prevalence of respiratory disease in indigenous New Zealand children. The high percentage of secondary ciliary defects suggests ongoing environmental or infective damage.
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Affiliation(s)
- E A Edwards
- Department of Paediatrics, University of Auckland and Starship Children's Hospital, Auckland, New Zealand.
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Edwards EA, Twiss J, Byrnes CA. Treatment of paediatric non-cystic fibrosis bronchiectasis. Expert Opin Pharmacother 2005; 5:1471-84. [PMID: 15212598 DOI: 10.1517/14656566.5.7.1471] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Non-cystic fibrosis (CF) bronchiectasis, the abnormal dilatation of bronchial airways, is a heterogeneous condition caused by a variety of lung insults and results in significant morbidity and mortality. Although frequently reported as being an uncommon respiratory disease in the developed world, its impact on the respiratory health of specific populations has recently received increased attention. There are limited data on which to base management strategies. This article reviews the evidence for current treatment practices, provides an opinion on best practice, and discusses likely new therapies. Consideration is also given to the pharmacoeconomic hurdles that face the populations most affected.
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Affiliation(s)
- Elizabeth Anne Edwards
- University of Auckland and Starship Children's Hospital, Department of Respiratory Medicine, Private Bag 92024, Auckland, New Zealand.
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Edwards EA, Asher MI, Byrnes CA. Paediatric bronchiectasis in the twenty-first century: experience of a tertiary children's hospital in New Zealand. J Paediatr Child Health 2003; 39:111-7. [PMID: 12603799 DOI: 10.1046/j.1440-1754.2003.00101.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Despite its decline in developed countries, bronchiectasis appeared to be a common diagnosis in Auckland, New Zealand children. The aims of this study were: to document the number of children in Auckland with bronchiectasis, their severity, clinical characteristics and possible aetiologies; to assess whether there was a relationship between ethnicity and poverty; and to estimate a crude bronchiectasis prevalence rate for New Zealand. METHODS A retrospective review of the case histories of all children attending a tertiary children's hospital in Auckland with bronchiectasis diagnosed by high-resolution chest computed tomography (CT) scan, during the period 1998-2000 was undertaken. Data collected included patient demographics, number of hospitalizations pre- and post-diagnosis, lung function tests, radiology and investigations. The New Zealand deprivation 1996 index was applied to the data to obtain a measure of socio-economic status. RESULTS Bronchiectasis was found to be common, with an estimated prevalence of approximately one in 6000 in the Auckland paediatric population. It was disproportionately more common in the Pacific Island and Maori children. In Pacific Island children, bronchiectasis not caused by cystic fibrosis was nearly twice as common in the general population than cystic fibrosis. Socio-economic deprivation and low immunization rates may be significant contributing factors. The bronchiectasis seen was extensive. Ninety-three percent had bilateral disease and 64% had involvement of four or more lobes on chest CT scan. A wide range of comorbidities and underlying aetiologies were evident. CONCLUSIONS Paediatric bronchiectasis in Auckland, New Zealand, is common but underresourced. Only the most severe cases are being recognized, providing a significant challenge for paediatric health professionals.
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Affiliation(s)
- E A Edwards
- Department of Paediatrics, University of Auckland and Starship Children's Hospital, New Zealand.
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