Prospective community programme versus parent-driven care to prevent respiratory morbidity in children following hospitalisation with severe bronchiolitis or pneumonia.

BACKGROUND: Hospitalisation with severe lower respiratory tract infection (LRTI) in early childhood is associated with ongoing respiratory symptoms and possible later development of bronchiectasis. We aimed to reduce this intermediate respiratory morbidity with a community intervention programme at time of discharge. METHODS: This randomised, controlled, single-blind trial enrolled children aged <2 years hospitalised for severe LRTI to 'intervention' or 'control'. Intervention was three monthly community clinics treating wet cough with prolonged antibiotics referring non-responders. All other health issues were addressed, and health resilience behaviours were encouraged, with referrals for housing or smoking concerns. Controls followed the usual pathway of parent-initiated healthcare access. After 24 months, all children were assessed by a paediatrician blinded to randomisation for primary outcomes of wet cough, abnormal examination (crackles or clubbing) or chest X-ray Brasfield score ≤22. FINDINGS: 400 children (203 intervention, 197 control) were enrolled in 2011-2012; mean age 6.9 months, 230 boys, 87% Maori/Pasifika ethnicity and 83% from the most deprived quintile. Final assessment of 321/400 (80.3%) showed no differences in presence of wet cough (33.9% intervention, 36.5% controls, relative risk (RR) 0.93, 95% CI 0.69 to 1.25), abnormal examination (21.7% intervention, 23.9% controls, RR 0.92, 95% CI 0.61 to 1.38) or Brasfield score ≤22 (32.4% intervention, 37.9% control, RR 0.85, 95% CI 0.63 to 1.17). Twelve (all intervention) were diagnosed with bronchiectasis within this timeframe. INTERPRETATION: We have identified children at high risk of ongoing respiratory disease following hospital admission with severe LRTI in whom this intervention programme did not change outcomes over 2 years. TRIAL REGISTRATION NUMBER: ACTRN12610001095055.

Household characteristics of children under 2 years admitted with lower respiratory tract infection in Counties Manukau, South Auckland.

AIM: To describe household characteristics of admissions for lower respiratory tract infection (LRI) in children aged less than 2 years in Counties Manukau, South Auckland, New Zealand. METHODS: Prospective recruitment of all children aged less than 2 years admitted with a primary diagnosis of LRI from August to December 2007 with caregiver questionnaire. RESULTS: There were 580 admissions involving 465 children, 394 of whom had completed questionnaires (85% response rate). Sixty-four percent of admissions had a diagnosis of bronchiolitis and 26% of pneumonia. Relative risk of admission was 4.4 (95% CI 3.2-6.2) for Maori, 5.8 (4.4-7.9) for Pacific peoples compared with European/others and 3.1 (2.4-3.9) for the most deprived quintile compared with other quintiles. Longer total stay was more likely in those of younger age, who were premature or of Maori or Pacific ethnicity. Household characteristics demonstrate that 25% live with =7 other people, 33% live with 4 or more children, 65% of children are exposed to cigarette smoke and 27% use no form of heating. CONCLUSIONS: Among young children admitted with LRI there is a high rate of exposure to known avoidable risk factors such as smoking, lack of heating and large households in overcrowded conditions.

School-based prevention of acute rheumatic fever: a group randomized trial in New Zealand.

BACKGROUND: Acute rheumatic fever (ARF) and its sequela, rheumatic heart disease is the commonest cause of childhood cardiac morbidity globally. The current approach to the prevention of a primary attack of rheumatic fever in children using oral medication for streptococcal pharyngitis is poorly supported. The efficacy of injectable penicillin, in high rheumatic fever incidence military environments is indisputable. OBJECTIVE: To evaluate school-based control of rheumatic fever in an endemic area. METHODS: Fifty-three schools ( approximately 22,000 students) from a rheumatic fever high incidence setting ( approximately 60/100,000) in Auckland, New Zealand were randomized. The control group received routine general practice care. The intervention was a school-based sore throat clinic program with free nurse-observed oral penicillin treatment of group A streptococcal pharyngitis. The outcome measure was ARF in any child attending a study school. Analysis A defined ARF cases using criteria derived from Jones Criteria 1965 (definite) and 1956 (probable) with more precise definitions. Analysis B was based on 1992 Jones criteria but also included echocardiography to determine definite cases. RESULTS: In Analysis A, 24 (55/100,000) cases occurred in clinic schools and 29 (67/100,000) in nonclinic schools, a 21% reduction when adjusted for demography and study design (P = 0.47). Analysis B revealed a 28% reduction 26 (59/100,000) and 33 (77/100,000) cases, respectively (P = 0.27). CONCLUSION: This study involving 86,874 person-years showed a nonsignificant reduction in the school-based sore throat clinic programs.

Debunking the myths to provide 21st Century management of gout.

Epidemiologic and recent qualitative research suggests that the impact of under-treated gout is far more significant than many health professionals realise. The magnitude of this impact for Maaori and Pacific men of working age has been identified as a particular concern by the recently formed Maaori Gout Action Group in Counties Manukau District Health Board (South Auckland, New Zealand). The Group has identified that to achieve modern management of gout, those with gout need to be supported by primary care practitioners who are aware of the need for early intervention with allopurinol, as well as whaanau/families and communities who understand the impact and causes of gout and the lifestyle changes that are needed alongside long-term allopurinol. The Group wishes to support further research into the impact and causes of gout, particularly for Maaori, and to develop strategic alliances to ensure that the treatment and prevention of gout is advocated by those working with conditions such as diabetes and cardiovascular disease where gout is a frequent comorbidity.