Hospital-based case-control study of bronchiectasis in indigenous children in central Australia

Background: Childhood pneumonia has been reported to be associated with the development of bronchiectasis but there are no case-control studies that have examined this. This study examined the relationship between hospital admission for episode(s) of pneumonia and the risk of radiologically proven bronchiectasis. Methods: A medical record-based case-control study of bronchiectasis in Indigenous children was conducted in Central Australia. Controls (183), matched to cases (61) by gender, age and year of diagnosis, were Indigenous children hospitalized with other conditions. Results: There was a strong association between a history of hospitalized pneumonia and bronchiectasis [odds ratio (OR), 15.2; 95% confidence interval (95% CI) 4.4-52.7]. This was particularly evident in recurrent hospitalized pneumonia (P for trend < 0.01), severe pneumonia episodes with longer hospital stay (P for trend < 0.01), presence of atelectasis (OR 11.9; 95% CI 3.1-45.9) and requirement for oxygen (P for trend < 0.01). The overall number of pneumonia episodes, rather than its site, was associated with bronchiectasis. Although the total number of pneumonia episodes in the first year of life did not increase the risk of bronchiectasis, more severe episodes early in life did. Malnutrition, premature birth and being small for gestational age were more common findings among cases. Breast-feeding appeared to be a protective factor (OR 0.2; 95% CI 0.1-0.7). Conclusions: Although we cannot fully answer the question of why bronchiectasis is much more common in Indigenous children, we have provided strong evidence of an association between bronchiectasis and severe and recurrent pneumonia episodes in infancy and childhood.

A victim of its own success: Internationalization, neoliberalism, and organizational involution at the Business Council of Australia

The focus of this article is on the Business Council of Australia (BCA), an association of the CEOs of the 100 or so largest companies operating in Australia. Since its inception the BCA has been an influential supporter of largely successful efforts to neoliberalize and internationalize the Australian economy. Running in parallel with these developments, however, the BCA has moved from being a "somewhat strong" to a relatively weak policy organization. This article argues these two trends are causally related. Neoliberal-inspired economic restructuring and economic internationalization have weakened the "logic of membership" and the "logic of influence" of the BCA, leading to a process of organizational involution. Furthermore, potential offsets to what I describe as the organizational predations of neoliberalism and internationalization - especially via a willingness or capacity to forge supportive or mutualistic relations with the state - have not been realized.