Racial and Ethnic Disparity in 4Ms among Older Adults Among Telehealth Users as Primary Care.

Telehealth has been widely accepted as an alternative to in-person primary care. This study examines whether the quality of primary care delivered via telehealth is equitable for older adults across racial and ethnic boundaries in provider-shortage urban settings. The study analyzed documentation of the 4Ms components (What Matters, Mobility, Medication, and Mentation) in relation to self-reported racial and ethnic backgrounds of 254 Medicare Advantage enrollees who used telehealth as their primary care modality in Southern Nevada from July 2021 through June 2022. Results revealed that Asian/Hawaiian/Pacific Islanders had significantly less documentation in What Matters (OR = 0.39, 95%, p = .04) and Blacks had significantly less documentation in Mobility (OR = 0.35, p < .001) compared to their White counterparts. The Hispanic ethnic group had less documentation in What Matters (OR = 0.18, p < .001) compared to non-Hispanic ethnic groups. Our study reveals equipping the geriatrics workforce merely with the 4Ms framework may not be sufficient in mitigating unconscious biases healthcare providers exhibit in the telehealth primary care setting in a provider shortage area, and, by extrapolation, in other care settings across the spectra, whether they be in-person or virtual.

ICD-10 codes for surveillance of non-fatal abusive head trauma in Aotearoa New Zealand: a retrospective cohort study.

OBJECTIVES: To assess the validity of an International Classification of Diseases (ICD) code based definition of non-fatal head trauma caused by child abuse (abusive head trauma) for population surveillance in New Zealand. DESIGN: A retrospective cohort study of hospital inpatient records. SETTING: A tertiary children's hospital in Auckland, New Zealand. PARTICIPANTS: 1731 children less than 5 years of age who were discharged after a non-fatal head trauma event over a 10-year period from 1 January 2010 to 31 December 2019. OUTCOME MEASURES: The outcome of assessment by the hospital's multidisciplinary child protection team (CPT) was compared with the outcome of ICD, Tenth Revision (ICD-10) discharge coding for non-fatal abusive head trauma (AHT). The ICD-10 code definition of AHT was derived from an ICD, Ninth Revision, Clinical Modification definition developed by the Centers for Disease Control, Atlanta, Georgia, which requires both a clinical diagnosis code and a cause-of-injury code. RESULTS: There were 1755 head trauma events with 117 determined as AHT by the CPT. The ICD-10 code definition had a sensitivity of 66.7% (95% CI 57.4 to 75.1) and specificity of 99.8% (95% CI 99.5 to 100). There were only three false positives but 39 false negatives, with 18 of the false negatives coded with X59 (exposure to unspecified factor). CONCLUSIONS: The ICD-10 code broad definition of AHT is a reasonable epidemiological tool for passive surveillance of AHT in New Zealand but it underestimates the incidence. Its performance could be improved by clear documentation of child protection conclusions in clinical notes, clarifying coding practice and removing the exclusion criteria from the definition.

Impact of Advance Care Planning on the Hospitalization-Associated Utilization and Cost of Patients with Alzheimer's Disease-Related Disorders Receiving Primary Care via Telehealth in a Provider Shortage Area: A Quantitative Pre-Study.

Telehealth has been adopted as an alternative to in-person primary care visits. With multiple participants able to join remotely, telehealth can facilitate the discussion and documentation of advance care planning (ACP) for those with Alzheimer's disease-related disorders (ADRDs). We measured hospitalization-associated utilization outcomes, instances of hospitalization and 90-day re-hospitalizations from payors' administrative databases and verified the data via electronic health records. We estimated the hospitalization-associated costs using the Nevada State Inpatient Dataset and compared the estimated costs between ADRD patients with and without ACP documentation in the year 2021. Compared to the ADRD patients without ACP documentation, those with ACP documentation were less likely to be hospitalized (mean: 0.74; standard deviation: 0.31; p < 0.01) and were less likely to be readmitted within 90 days of discharge (mean: 0.16; standard deviation: 0.06; p < 0.01). The hospitalization-associated cost estimate for ADRD patients with ACP documentation (mean: USD 149,722; standard deviation: USD 80,850) was less than that of the patients without ACP documentation (mean: USD 200,148; standard deviation: USD 82,061; p < 0.01). Further geriatrics workforce training is called for to enhance ACP competencies for ADRD patients, especially in areas with provider shortages where telehealth plays a comparatively more important role.

George E. Davis: Editing the Chemical Trade Journal, 1887-1906.

This article explores George Davis's editing of the Chemical Trades Journal (CTJ) between 1887 and 1906, a period during which he was also working as a consultant chemist and consultant chemical engineer. Davis had worked from 1870 in various sectors of the chemical industry before becoming a sub-inspector in the Alkali Inspectorate between 1878 and 1884. It was during this period that the British chemical industry was facing severe economic pressure and to remain competitive was having to adapt to less wasteful and more efficient production. Drawing on this wide industrial experience, Davis developed a framework for chemical engineering with the broad aim of making chemical manufacture as economic as the latest science and technology would allow. Several important issues are raised by Davis's editorship of the weekly CTJ alongside his extensive consultancy work and other responsibilities: Davis's motivation given the likely impact on his consultancy work; the community the CTJ hoped to serve; competitive periodicals addressing the same market niche; the degree of focus on his chemical engineering framework; the changing content of the CTJ; and Davis's role as editor over a period of nearly twenty years.

Transition from paediatric to adult care in young people with diabetes; A structured programme from a regional diabetes service, Auckland, New Zealand.

AIM: To assess participation with a structured transition programme for adolescents with diabetes. METHODS: Data from a regional cohort aged less than 16 years of age with type 1 (T1) and type 2 diabetes (T2D) in Auckland, New Zealand (2006-2016). Participation was defined as opting into a structured transition programme. RESULTS: Five hundrend and twelve adolescents who were to be transferred to adult care (476 type 1 (T1D) and 36 type 2 (T2D)), overall participation rate of 83%, 86% (408/476) with T1D compared to 47% (17/36) with T2D. Within the cohort of T1D, participation rates for Maori and Pacific were lower (74% and 77%, respectively) than New Zealand Europeans (88%, p = 0.020 and p = 0.039, respectively). Lower socio-economic status was associated with reduced participation (77%) compared to higher socio-economic status (90%, p = 0.002). Of the 476 T1D who participated, 408 (96%) subsequently attended at least one adult service clinic ("capture"). 42% attended an adult clinic within the planned 3 months, 87% at 6 months and retention in adult clinics over 5 years of follow-up was 78%. By contrast, the 68 young people with T1D who did not participate in the structured transition had a capture rate of 78% (p < 0.001) and retention of 63% (p = 0.036). CONCLUSIONS: In adolescents with diabetes, a formal transition from a paediatric service was associated with high rates of adult capture and subsequent retention in adult care over a 5-year follow-up period. Low socio-economic status, Maori or Pacific ethnicity and T2D were associated with reduced participation in the structured transition programme.

Exploring the Impact of The NEST Collaborative's Remote Social Intervention on Feelings of Depression and Isolation.

Early evidence of remote, volunteer-led social support interventions to reduce social isolation in older adults has been encouraging; however, evaluation data on outcomes related to social isolation associated from these interventions is scarce. Here, we share programmatic details of a novel, statewide initiative, called the NEST Collaborative, rolled out to meet immediate emotional, informational, and instrumental needs of older adults in Nevada during the COVID-19 pandemic. The evaluation included 31 older adults participating in weekly one-to-one empathy-based phone calls with multi-generational volunteers seeking to enhance participants' social networks through meaningful friendships. The calls were associated with programmatically meaningful, though not statistically significant, improvements in modified Hawthorne Friendship Scale and PHQ-2 Depression Scale scores over two waves of survey responses. These results suggest that social isolation and depression among older adults decreased among our sample over a period of increased isolation and mental health burden across the general population. With the potential for sustained impact in reducing social isolation over time, remote social support programs, such as the NEST Collaborative, may have persistent value long-term, beyond time-limited crisis response contexts.

Determinants of acute kidney injury in children with new onset type 1 diabetes: A cohort study of children aged <15 years: Auckland, New Zealand (2006-2016).

OBJECTIVE: Acute kidney injury (AKI) may contribute to the risk of diabetic kidney disease, however, there have been limited studies of the incidence of AKI in well-defined populations of children with type 1 diabetes. The aim was to quantify AKI in children presenting with new onset type 1 diabetes from the regional paediatric diabetes service, Auckland, New Zealand. RESEARCH DESIGN AND METHODS: A retrospective analysis of a prospectively identified cohort study of children and adolescents presenting from 2006 to 2016 with type 1 diabetes aged <15 years. AKI was defined using Kidney Disease/Improving Global Outcomes serum creatinine criteria. RESULTS: There were 586 subjects: 52% male, with mean (SD) age 8.9 (3.8) years, with 151(25.8%) in diabetic ketoacidosis (DKA). AKI was present in 47%, 278/586, AKI was increased in those with DKA (125/151 (83%) DKA vs. 153/435 (35%) no-DKA). Univariable analysis showed that increased HbA1c, higher glucose levels, lower BMI SDS, lower bicarbonate and pH levels were all associated with AKI (p < .001). In multivariable analysis, AKI was associated with DKA and higher glucose levels independently. The majority of cases were stage 1 (203/278 [73%]), or stage 2 AKI 62/278 (22%). 13/278 (5%) had severe, Stage 3 AKI, and all presented in DKA (13/151 (8%) vs. 0/435 (0%) without DKA, p < .001). CONCLUSION: In this regional paediatric, cohort AKI is a common complication of children presenting with new onset type 1 diabetes. AKI is independently associated with higher glucose levels and DKA, and all cases of Stage 3 AKI were associated with DKA.

Surveillance of pediatric parapneumonic effusion/empyema in New Zealand.

AIM: The incidence of childhood empyema has been increasing in some developed countries despite the introduction of pneumococcal vaccination. This study aimed to document the incidence, bacterial pathogens, and morbidity/mortality of parapneumonic effusion/empyema in New Zealand. METHODS: A prospective study of 102 children <15 years of age requiring hospitalization with parapneumonic effusion/empyema between May 1, 2014 and May 31, 2016 notified via the New Zealand Paediatric Surveillance Unit. Parapneumonic effusion/empyema was defined as pneumonia and pleural effusion persisting ≥7 days, and/or any pneumonia, and pleural effusion necessitating drainage. Notifying pediatricians completed standardized questionnaires. RESULTS: Annual pediatric parapneumonic effusion/empyema incidence was 5.6/100,000 (95% confidence interval [CI]: 4.7-6.9). Most children (80%) required surgical intervention and 31% required intensive care. A causative organism was identified in 71/102 (70%) cases. Although Staphylococcus aureus (25%) and Streptococcus pneumoniae (25%) infection rates were equal, prolonged hospitalization and intensive care admission were more common in children with S. aureus PPE/E. Maori and Pasifika children were over-represented at 2.2 and 3.5 times, their representation in the New Zealand pediatric population. Pneumococcal vaccination was incomplete, with only 61% fully immunized and 30% unimmunized. Haemophilus influenzae type b vaccine uptake was near complete at 89/94 (95%), with influenza immunization only 3/78 (4%). CONCLUSIONS: New Zealand has a high incidence of pediatric complicated parapneumonic effusion/empyema with significant morbidity. S. aureus was a significant cause of severe empyema in New Zealand, particularly for Maori and Pasifika children. Improvements in vaccine coverage are needed along with strategies to reduce S. aureus disease morbidity.

Does the first hour of continuous electroencephalography predict neonatal seizures?

OBJECTIVE: Prolonged continuous video-electroencephalography (cEEG) is recommended for neonates at risk of seizures. The cost and expertise required to provide a real-time response to detected seizures often limits its utility. We hypothesised that the first hour of cEEG could predict subsequent seizures. DESIGN AND SETTING: Retrospective multicentre diagnostic accuracy study. PATIENTS: 266 term neonates at risk of seizure or with suspected seizures. INTERVENTION: The first hour of cEEG was graded by expert and novice interpreters as normal, mildly, moderately or severely abnormal; seizures were identified. MAIN OUTCOME MEASURES: Association between abnormalities in the first hour of cEEG and the presence of seizures during total cEEG monitoring. RESULTS: 50/98 (51%) of neonates who developed seizures had their first seizure in the first hour of cEEG monitoring. The 'time-to-event' risk of seizure from 0 to 96 hours was 0.38 (95% CI 0.32 to 0.44) while the risk in the first hour was 0.19 (95% CI 0.15 to 0.24). cEEG background was normal in 48% of neonates, mildly abnormal in 30%, moderately abnormal in 13% and severely abnormal in 9%. Inter-rater agreement for determination of background was very good (weighted kappa=0.81, 95% CI 0.72 to 0.91). When neonates with seizures during the first hour were excluded, an abnormal background resulted in 2.4 times increased risk of seizures during the subsequent monitoring period (95% CI 1.3 to 4.4, p<0.003) while a severely abnormal background resulted in a sevenfold increased risk (95% CI 3.4 to 14.3, p<0.0001). CONCLUSIONS: The first hour of cEEG in at-risk neonates is useful in identifying and predicting whether seizures occur during cEEG monitoring up to 96 hours. This finding enables identification of high-risk neonates who require closer observation.

George E. Davis (1850-1907): Transition From Consultant Chemist to Consultant Chemical Engineer in a Period of Economic Pressure.

This article explores how George Davis's vision for chemical engineering was contingent upon both the national economic conditions of the period (1870-1900) and the critical transition to more economic production for chemical manufacture. Trade tariffs and international competition exacerbated an already challenging economic climate and stricter government regulation of pollution from chemical manufactories added further pressure. Sectors of the British chemical industry faced over-capacity and over-production, while most sectors were wasteful of materials and energy and were over-manned. Davis's motivation was borne of his work as a chemist, as a consultant, and as an inspector with the Alkali Inspectorate. His search for knowledge and understanding was garnered from on-going investigations in the field and in his Technical Laboratory, coupled with developments in equipment and machinery. Recognising his own limited capability to overhaul the British chemical industry, Davis promoted his framework of chemical engineering to increase the cadre of chemical engineers.

Post-discharge outcomes for mothers and the mother-infant relationship following admission to a psychiatric Mother-Baby Unit.

Mother-Baby Unit research has focussed on maternal psychopathology over the course of an admission. Less is known about the baby's well-being, the shared relationship, or the mother's recovery. In an initial sample of 45 women, we describe discharge and post-discharge outcomes for maternal psychopathology (using maternal report and the Global Assessment of Function, GAF) and the mother-infant relationship (using the Child and Adult Relational Experimental Index, CARE Index). Three months post-discharge, one third of women described themselves as "completely recovered," one third were experiencing significant deterioration and 17% were readmitted to inpatient care. Poorer GAF scores were associated with a clinical diagnosis of comorbid personality disorder, antenatal presence of the index illness, partner illicit substance use, maternal perception of her bond, infant social withdrawal, and child protection concern. Post-discharge, the mother-infant relationship results were concerning. Only 17% were regarded as adequate. Improvement was observed across this period in 56% but relational deterioration occurred for 35%. Maternal and relational outcomes were weakly correlated at discharge (r² = 0.29, p = 0.07) but this was lost post-discharge (r² = 0.03, p = 0.89). The shared relationship and infant mental health should both be targets for intervention; both during MBU admission, and post-discharge.

La investigación sobre la Unidad de Madres y Bebés se han enfocado en la sicopatología materna a lo largo del curso de una admisión. Se conoce menos del bienestar del bebé, la relación entre ellos o la presente recuperación de la madre. En un grupo muestra inicial de 45 mueres, describimos resultados posteriores a cuando se les dio de alta en cuanto a la sicopatología materna (usando el reporte materno y la Evaluación Global de la Función, GAF) y la relación infante-madre (usando el Índice de Relación Experimental entre Niño y Adulto, Índice CARE). Tres meses después de que se les dio de alta, un tercio de las mujeres se describió a sí mismas como "completamente recuperadas," un tercio de ellas estaba experimentando un deterioro significativo y 17% fueron readmitidas bajo el cuidado de paciente interno. Los más pobres puntajes de GAF se asociaron con un diagnóstico clínico de trastornos de personalidad comórbidos, presencia antenatal de la enfermedad en el índice, uso ilícito de sustancias por parte de la pareja, percepción maternal de su unión afectiva, despego social del infante, así como la preocupación por la protección del infante. Después de que se les diera de alta, los resultados de la relación entre madre e infante fueron preocupantes. Sólo el 17% fue considerado adecuado. Se observaron mejoras a lo largo de este período en 56% pero el deterioro de la relación ocurrió en el 35%. El resultado materno y el de relación fueron asociados débilmente al momento de darles de alta (r2+0.29. p = 0.07) pero esto se perdió posteriormente al momento en que se les dio de alta. La relación compartida y la salud mental del infante deben ambas ser metas de intervención; ambas durante la admisión a la Unidad de Madres y Bebés y con posterioridad al momento en que se les da de alta.

Les recherches sur l'Unité psychiatrique Maman Bébé (en anglais Mother Baby Unit) ont porté sur la psychopathologie maternelle au cours d'une admission. On sait moins de choses sur le bien-être du bébé, leur relation ou la récupération en cours de la mère. Dans un échantillon initial de 45 femmes, nous décrivons des résultats à la sortie pour la psychopathologie maternelle (en utilisant le rapport maternel et l'Evaluation Globale de Fonction, soit GAF pour Global Assessment of Function en anglais) et la relation mère-bébé (en utilisant l'Index Expérimental Relationnel Enfant et Adulte, soir CARE Index, pour Child and Adult Relational Experimental Index en anglais). Trois mois après la sortie, un tiers des mères se décrivaient comme "ayant totalement récupéré", un tiers faisaient l'expérience d'une détérioration importante et 17% étaient réadmises en soins hospitaliers. Des scores GAF moins élevés étaient liés à un diagnostic clinique de trouble de la personnalité comorbide, à une présence anténatale de la maladie index, à une toxicomanie illicite du partenaire, à une perception maternelle de son lien, au retrait social du bébé et à des inquiétudes pour la protection de l'enfant. Après la sortie les résultats de la relation mère-bébé étaient inquiétants. Seuls 17% des résultats ont été considérés comme étant adéquats. Une amélioration a été observée durant cette période chez 56% mais une détérioration relationnelle a eu lieu pour 35%. Les résultats maternels et relationnels étaient faiblement corrélés à la sortie (r² = 0s29, p = 0,07) mais cela s'est avéré perdu après la sortie (r² = 0,03, p = 0,89). La relation partagée et la santé mentale du bébé devraient être tous deux des cibles d'intervention; à la fois durant l'admission dans l'Unité Maman Bébé et aussi après la sortie. Mots clés: bébé, après la sortie, unité maman bébé, santé mentale périnatale, relation mère-bébé.

Radiation doses in diagnostic imaging for suspected physical abuse.

OBJECTIVE: To measure the actual radiation dose delivered by imaging techniques commonly used in the radiography of suspected physical abuse and to make this information available to health professionals and families. METHODS: Data were collected retrospectively on children under 3 years referred for skeletal surveys for suspected physical abuse, non-contrast CT head scan or radionuclide imaging of the bones in Starship Children's Hospital, Auckland, New Zealand from January to December 2015. Patient size-specific conversion coefficients were derived from International Commission on Radiologic Protection tissue weighting factors and used to calculate effective dose. RESULTS: Seventy-one patients underwent an initial skeletal survey, receiving a mean effective dose of 0.20 mSv (95% CI 0.18 to 0.22). Sixteen patients had a follow-up survey with a mean effective dose of 0.10 mSv (95% CI 0.08 to 0.11). Eighty patients underwent CT head which delivered a mean effective dose of 2.49 mSv (95% CI 2.37 to 2.60). Thirty-nine patients underwent radionuclide bone imaging which delivered a mean effective dose of 2.27 mSv (95% CI 2.11 to 2.43). CONCLUSIONS: In a paediatric centre, skeletal surveys deliver a relatively low effective radiation dose, equivalent to approximately 1 month of background radiation. Non-contrast CT head scan and radionuclide bone imaging deliver similar doses, equivalent to approximately 1 year of background radiation. This information should be considered when gaining informed consent and incorporated in patient education handouts.

Incidence, Clinical Manifestations, and Severity of Juvenile Idiopathic Arthritis Among Maori and Pacific Island Children.

OBJECTIVE: To describe the incidence, demographics, diagnostic clinical manifestations, and severity of juvenile idiopathic arthritis (JIA) in Maori and Pacific Island children compared to European children. METHODS: A chart review was conducted of all children with JIA seen by Auckland pediatric and rheumatology services between the years 2000 and 2015. Demographic data and diagnostic clinical manifestations, including poor prognostic features, were collated. The incidence, diagnostic, clinical manifestations, and severity of JIA were determined and compared between ethnic groups, in particular Maori, Pacific Island, and European children. RESULTS: The overall incidence in a New Zealand cohort of children with JIA was 5.1/100,000 children per year, which was significantly higher among European children (7.2/100,000 children per year) compared to all other ethnic groups. Poor prognostic features at diagnosis were present in 36% of children with JIA, with significantly more Maori and Pacific Island children presenting with poor prognostic features compared to European children (58% versus 27%; P = 0.0001). Maori and Pacific Island children had significantly more poor prognostic features per child associated with JIA (1.10 versus 0.37; P < 0.0001) and in oligoarticular and polyarticular JIA (1.28 versus 0.40; P < 0.0001), which was independent of socioeconomic status. Significant features included cervical involvement (25% versus 9%; P = 0.03), erosive changes (22% versus 8%; P = 0.05), joint space narrowing (13% versus 2%; P = 0.02), and positive rheumatoid factor polyarticular disease (47% versus 14%; P = 0.01). CONCLUSION: Maori and Pacific Island children were more likely to present with poor prognostic features at diagnosis, although the incidence of JIA was demonstrated to be significantly higher among European children compared to all ethnic groups.

Prospective Evaluation of the ESPGHAN Guidelines for Diagnosis of Celiac Disease in New Zealand Children.

OBJECTIVE: The 2012 European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guideline for diagnosis of celiac disease (CD) questioned the requirement for intestinal biopsy to confirm the diagnosis. The guideline recommends that in symptomatic patients with consistent human leukocyte antigen (HLA) subtypes, the diagnostic accuracy of strongly positive serology is sufficient to confirm the diagnosis. We prospectively assessed these guidelines in a "real-life" clinical setting. METHODS: One hundred and four children referred for evaluation of possible CD were prospectively recruited. Following informed consent, blood was drawn for serological testing and HLA analysis at upper gastrointestinal endoscopy. Histological findings according to Marsh criteria were correlated with blood results and the accuracy of the guideline analyzed.The study also examined the role of deamidated gliadin peptide (DGP) in the diagnosis of CD. RESULTS: For symptomatic patients with consistent HLA subtypes, strongly positive serology (as described in the ESPGHAN guidelines) accurately predicted biopsy-proven CD in >95% of cases. DGP was positive in fewer patients than anti-TG2 or EMA. Incorporation of DGP as a second confirmatory serological test in place of EMA was associated with maintained predictive value of guideline, but fewer patients fulfilling criteria for biopsy-free diagnosis. CONCLUSIONS: The ESPGHAN guideline performs well in our population. Adoption of the guideline would reduce the number of patients requiring endoscopy without compromise in diagnostic accuracy. The involvement of pediatric gastroenterological expertise, however, remains key to diagnosis of CD.

Increasing incidence of type 2 diabetes in New Zealand children <15 years of age in a regional-based diabetes service, Auckland, New Zealand.

AIM: It is important to understand whether type 2 diabetes mellitus (T2DM) is increasing in childhood for health-care planning and clinical management. The aim of this study is to examine the incidence of T2DM in New Zealand children, aged <15 years from a paediatric diabetes centre, Auckland, New Zealand. METHODS: Retrospective analysis of prospectively collected data from a population-based referral cohort from 1995 to 2015. RESULTS: Hundred and four children presented with T2DM over the 21-year period. The female:male ratio was 1.8:1, at mean (standard deviation) age 12.9 (1.9) years, body mass index standard deviation score +2.3 (0.5), blood sugar 15.3 (8.5) mmol/L, HbA1c 76 (28) mmol/mol. At diagnosis, 90% had acanthosis nigricans and 48% were symptomatic. In all, 33% were Maori, 46% Pacific Island, 15% Asian/Middle Eastern and 6% European. There was a progressive secular increase of 5% year on year in incidence. The overall annual incidence of T2DM <15 years of age was 1.5/100 000 (1.2-1.9) (95% confidence interval), with higher rates in Pacific Island (5.9/100 000) and Maori (4.1/100 000). CONCLUSIONS: The incidence of T2DM in children <15 years of age in New Zealand has increased progressively at 5%/year over the last 21 years. The risk was disproportionately associated with girls and children from high-risk ethnic groups.

Hospital readmissions with acute infectious diseases in New Zealand children < 2 years of age.

BACKGROUND: Infectious diseases are the leading cause of hospital admissions in young children. Hospitalisation with an infectious disease is a recurrent event for some children. Our objective was to describe risk factors for infectious disease readmission following hospital admission with an infectious disease in the first two years of life. METHODS: We performed a national cohort study of New Zealand children, born 2005-2009, with an infectious disease admission before age 24 months. Children readmitted with an infectious disease within 12 months of the first infectious disease admission were identified. Every infectious disease admission was categorised as a respiratory, enteric, skin and soft tissue, urinary or other infection. Independent associations of demographic and child health factors with infectious disease readmission were determined using multiple variable logistic regression. RESULTS: From 2005 to 2011, there were 69,902 infectious disease admissions for 46,657 children less than two years old. Of these 46,657 children, 10,205 (22%) had at least one infectious disease readmission within 12 months of their first admission. The first infectious disease admission was respiratory (54%), enteric (15%), skin or soft tissue (7%), urinary (4%) or other (20%). Risk of infectious disease readmission was increased if the first infectious disease admission was respiratory (OR = 1.87, 95% CI 1.78-1.95) but not if it was in any other infectious disease category. Risk factors for respiratory infectious disease readmission were male gender, Pacific or Maori ethnicity, greater household deprivation, presence of a complex chronic condition, or a first respiratory infectious disease admission during autumn or of ≥3 days duration. Fewer factors (younger age, male gender, presence of a complex chronic condition) were associated with enteric infection readmission. The presence of a complex chronic condition was the only factor associated with urinary tract infection readmission and none of the factors were associated with skin or soft tissue infection readmission. CONCLUSIONS: In children less than two years old, infectious disease readmission risk is increased if the first infectious disease admission is a respiratory infectious disease but not if it is another infectious disease category. Risk factors for respiratory infectious disease readmission are different from those for other infectious disease readmissions.

Angiotensin-converting enzyme-inhibitor therapy in adolescents with type 1 diabetes in a regional cohort: Auckland, New Zealand from 2006 to 2016.

AIM: To review indications and use of angiotensin-converting enzyme-inhibitor (ACEI) therapy for the treatment of persistent microalbuminuria (MA) and/or hypertension (HTN) in adolescents with type 1 diabetes mellitus (T1DM). METHODS: Retrospective chart review of adolescent patients with T1DM seen within the paediatric diabetes service in Auckland, New Zealand, from 2006 to 2016. MA, HTN, patient demographic characteristics and ACEI prescribing and monitoring indices were examined. RESULTS: Five hundred adolescents with T1DM were included. There were 26 patients (5%) with MA and/or HTN. MA alone was present in 16, HTN alone in 3 and both HTN and MA in 7. The 5-year MA/HTN-free rate was 98%, and the 10-year MA/HTN-free rate was 93%. Longer disease duration and earlier diagnosis were predictors of MA/HTN. There was no significant difference in standard clinical indices between study patients and others. ACEI was prescribed for 17 of 26 patients for either HTN or MA. Within 6 weeks of ACEI commencement, less than half of the subjects had repeat serum creatinine and MA screens and no record of repeat blood pressure measurement. Despite this, all patients had 3-monthly reviews within outpatient clinics where adjustments of ACEI doses were made. CONCLUSION: In our regional adolescent population with T1DM, there were low rates of both MA and/or HTN. In those who required treatment with ACEI, clinical monitoring post-commencement of therapy was inconsistent. Local consensus guidelines for the management of persistent MA in children and adolescents with diabetes mellitus were developed in response to this study.

Is a rheumatic fever register the best surveillance tool to evaluate rheumatic fever control in the Auckland region?

AIM: To determine the most accurate data source for acute rheumatic fever (ARF) epidemiology in the Auckland region. METHOD: To assess coverage of the Auckland Regional Rheumatic Fever Register (ARRFR), (1998-2010) for children <15 years and resident in Auckland at the time of illness, register, hospitalisation and notification data were compared. A consistent definition was applied to determine definite and probable cases of ARF using clinical records. (www.heartfoundation.org.nz) RESULTS: Of 559 confirmed (definite and probable) RF cases <15 years (median age 10 years), seven were recurrences. Of 552 first episodes, the ARRFR identified 548 (99%), hospitalisations identified 501 (91%) including four not on the register, and public health notifications identified 384 (70%). Of hospitalisation cases, 33% (245/746), and of notifications 20% (94/478) did not meet the case definition and were therefore excluded. Between 1998-2010, eight cases, initially entered as ARF on the ARRFR, were later removed once further clinical detail was available. CONCLUSION: The ARRFR produced the most accurate information surrounding new cases of ARF (for children <15 years) for the years 1998-2010 in Auckland. This was significantly more accurate than medical officer of health notification and hospitalisation data.