The value of asthma camps for young people in Victoria, Australia

Purpose: This paper investigates the impact of the Asthma Foundation of Victoria's educational camp program on children's knowledge of asthma and its management, their feelings about asthma, and their attitudes toward physical and social activities. Parents' observations of changes in their child's behaviour and attitudes are also reported.

Design and methods: This research was descriptive and applied. It used questionnaires at four stages (directly pre- and post- camp, three-four months and ten-15 months post-camp) of an asthma education camp program to assess child asthma knowledge levels. At three months post-camp, parental observations of children's attitudes and behaviours were assessed using a questionnaire. Children's feelings toward asthma were also assessed using a questionnaire pre- and post-camp.

Results: The children surveyed displayed a better knowledge of asthma and how to manage their condition immediately after the camp. This knowledge tended to return to pre-camp levels after ten months. The children also reported less anxiety and fear about their illness, a greater sense of wellbeing, and more confidence in participating in a whole range of physical and social activities. Many parents also noted positive changes in their children in terms of activities and asthma management at three months post-camp.

Clinical implications: Although there were limitations to sustaining knowledge gained in the asthma camping program, the camping experience provided a benefit for children in terms of promoting their mental and social wellbeing. When readers consider modernising asthma education (eg shorter camps, education in everyday social settings such as schools), they need to consider retaining the key ingredients of the more traditional camping program that supports good asthma management, wellbeing and social participation.

Meat consumption among 18-month-old children participating in the Childhood Asthma Prevention Study

Objective: To document meat consumption among 18-month-old children, for use in refining population dietary assessment methods and dietary guidance for young children.

Design: A secondary analysis of data collected in 1998-2000 from the 18 months follow up of the Childhood Asthma Prevention Study: an intervention trial of omega-3 oil supplementation and house-dust mite reduction, from birth to five years.

Subjects and setting: Pregnant women whose unborn children had an atopic family history were recruited from antenatal clinics of six hospitals in western Sydney. Carers of 429 18-month-old children (80% response) satisfactorily completed three-day weighed food records.

Main outcome measures: Mean and median intakes per day and portion sizes of various meats and meat products.

Statistical analyses: T-tests for comparing gender differences; Pearson correlation and one-way analysis of variance for relationships between meat and nutrient intake.

Results: During the recording period 94% of the children ate meat. McDonald's Chicken McNuggets^TM, beef mince, and beef sausages were the most frequently consumed meats. Median portion sizes ranged from 20-50 g, and were considerably smaller than 'usual' portions specified on food frequency questionnaires in common use. Higher meat diets in this age group were not associated with higher intakes of iron or zinc per MJ.

Conclusion: The marginally low intakes of iron and zinc in this age group could be improved by greater use of cuts of red meat appropriately prepared for toddlers.

Interventions for educating children who have attended the emergency room for asthma (Review)

Background: Asthma is one of the most common reasons for paediatric admissions to hospital, with substantial cost to the community. There is some evidence to suggest that many hospital admissions could be prevented with effective education about asthma and its management.
Objectives: To conduct a systematic review of the literature in order to identify whether asthma education leads to improved health outcomes in children who have attended the emergency department for asthma.
Search strategy: We searched the Cochrane Airways Group trials register, including MEDLINE, EMBASE, and CINAHL databases, and reference lists of trials and review articles.
Selection criteria: Randomised controlled trials or controlled clinical trials of asthma education for children who had attended the emergency department for asthma, with or without hospitalisation, within the previous 12 months. Data collection and analysis:Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information.
Main results: Eight trials involving 1407 patients were included, in all the education was provided by nurses or researchers. Compared to control (usual care or lower intensity education) education did not reduce subsequent emergency department (ED) visits [4 trials; relative risk (RR)= 0.87, 95% confidence interval (CI) 0.37 to 2.08], hospital admissions [5 trials; RR=0.74, 95% CI 0.38 to 1.46] and unscheduled doctor visits [5 trials; RR= 0.74, 95% CI 0.49 to 1.12). Each analysis showed evidence of heterogeneity among the studies (P<0.01). Subgroup analyses by the overall difference in scale of intervention between treatment and control groups (comprehensive programme versus information only) or the timing of the intervention/recruitment (early versus delayed) gave similar results to the main analysis and still revealed significant heterogeneity between trials. Authors' conclusions: On the basis of the published trials, there is no firm evidence to support the use of asthma education for children who have attended the emergency department for asthma as a means of reducing subsequent ED visits, hospital admissions or unscheduled doctor visits. Some trials appeared to show clear evidence of benefit, but reasons for differences between these and the negative studies is not clear. More research is required.

Medical knowledge discovery from a regional asthma dataset

Paediatric asthma represents a significant public health problem. To date, clinical data sets have typically been examined using traditional data analysis techniques. While such traditional statistical methods are invariably widespread, large volumes of data may overwhelm such approaches. The new generation of knowledge discovery techniques may therefore be a more appropriate means of analysis. The primary purpose of this study was to investigate an asthma data set, with the application of various data mining techniques for knowledge discovery. The current study utilises data from an asthma data set (n ≈ 17000). The findings revealed a number of factors and patterns of interest.

Prediction of paediatric asthma hospitalisation using data mining techniques

Research into the prevalence of hospitalisation among childhood asthma cases is undertaken, using a data set local to the Barwon region of Victoria. Participants were the parents/guardians on behalf of children aged between 5-11 years. Various data mining techniques are used, including segmentation, association and classification to assist in predicting and exploring the instances of childhood hospitalisation due to asthma. Results from this study indicate that children in inner city and metropolitan areas may overutilise emergency department services. In addition, this study found that the prediction of hospitalisaion for asthma in children was greater for those with a written asthma management plan.

Skin prick test can identify eczematous infants at risk of asthma and allergic rhinitis

Background: Assessment of allergic sensitization is not routinely performed in infants and young children with eczema.

Objective: To determine whether infants who have atopic eczema (with sensitization) are at a greater risk of developing asthma and allergic rhinitis (AR) than those with non-atopic eczema (without concurrent sensitization).

Methods: The presence of eczema was prospectively documented until 2 years of age in a birth cohort of 620 infants with a family history of atopic disease. Sensitization status was determined by skin prick tests (SPTs) at 6, 12, and 24 months using six common allergens. Interviews were conducted at 6 and 7 years to determine the presence of asthma and AR.

Results: Within the first 2 years of life, 28.7% of the 443 children who could be classified had atopic eczema: 20.5% had non-atopic eczema, 19.0% were asymptomatic but sensitized and 31.8% were asymptomatic and not sensitized. When compared with children with non-atopic eczema in the first 2 years of life, children with atopic eczema had a substantially greater risk of asthma [odds ratio (OR)=3.52, 95% confidence interval=1.88–6.59] and AR (OR=2.91, 1.48–5.71). The increased risk of asthma was even greater if the infant had a large SPT (OR=4.61, 2.34–9.09) indicative of food allergy. There was no strong evidence that children with non-atopic eczema had an increased risk of asthma or AR compared with asymptomatic children.

Conclusion: In children with eczema within the first 2 years of life, SPT can provide valuable information on the risk of childhood asthma and AR.

Aspects of the production of viscous capsular material by the yoghurt starter, streptococcus thermophilus

The technology of modern fermented milk production is not complicated and relies largely on the characteristics of the microorganisms used in its manufacture. Biochemical substances excreted by the starter cultures contribute to the chemical, physical and organoleptic properties of cultured milks. Chemical and organoleptic properties of yoghurt starter cultures have been widely studied over several decades. Conversely the biosynthetic processes and genetic control of the production of viscous extracellular material (slime) by selected thermophillic streptococci is still insufficiently understood. This study attempted to elucidate physiological aspects and the genetic control of slime production. An attempt to chemically induce ropiness was also preformed. Twenty strains of Gram positive, thermo-tolerant, milk dotting, catalase negative cocci were collected from a variety of sources. All strains were identified as Streptococcus thermophilus. Four of the isolates were identified as capable of producing an extracellular, ‘ropy’ capsular material. A negative staining method for highlighting capsular material under light microscopy was described. Ropy isolates displayed thick capsular zones of between 6-8 μm. The isolates graded as non-ropy produced only small capsular zones (less than 2 μm); two variants displayed no capsular material. Instability of the ropy phenotype during subculture and prolonged storage was described for all four ropy isolates at varied temperatures. Instability during transfer was reported as moderate with a loss of no more than 45% of ropy colonies after 15 subcultures at 48°C A significant increase in instability, during transfer, associated with an increase in incubation temperature (37-48°C) was also reported. Prolonged storage of ropy variants over ten days resulted in a drop in the number of ropy colonies. The loss was minimal when cultures were stored at 8°C, but excessive (approaching 100%) at 37°C This suggested the presence of capsular degradative substances. Analysis of the plasmid profiles of 20 strains identified only two strains harboured plasmid DNA. All plasmids were small, less than 23kilobases, and each strain possessed a single plasmid species. Only one ropy strain contained plasmid DNA that was shown, with the aid of curing experiments, not to be linked to production of the ropy phenotype. The amino acid analogue p-fluoro-DL-phenylalanine was unsuccessful in generating ropy colonies from non-ropy variants of Streptococcus thermophilus at low concentrations. Some technological considerations for the use of ropy variants of Streptococcus thermophilus in yoghurt starter cultures were made.

Evaluation of the Asthma Friendly Schools program

This thesis examined what makes schools want to embrace the Asthma Friendly Schools program. It also investigated the limitations and barriers of the Asthma Friendly Schools program and explored it's uptake by schools and the implications of the findings for the redesign of the program.

Effectiveness of asthma education camps as a learning environment for children

This study's main purpose was to determine if the children attending one of the Asthma Foundation of Victoria's camps learnt about asthma management and developed skills and behavior that are positive for self management to occur. Final conclusions showed that the program has a positive effect on the management of a child's asthma.

Oxidised mannan-listeriolysin O conjugates induce Th1/Th2 cytokine responses after intranasal immunisation

Clearance of infectious organisms does not always require polarised Th1 or Th2 responses and it may be advantageous for both Th1 and Th2 responses to be elicited for effective protection against an invading pathogen. It was the aim of this study to investigate oxidised mannan as a possible Th1/Th2 adjuvant. Oxidised mannan was conjugated to two candidate antigens and delivered intranasally to mice. Immunisation with the oxidised conjugate resulted in significant antigen specific proliferative responses, IL-2, IFN-γ and IL-4 production when compared to unconjugated controls.