Comparison of Profiles of First Nations and Non-First Nations Children With Bronchiectasis Over Two 5-Year Periods in the Northern Territory, Australia.

BACKGROUND: Although the burden of bronchiectasis is recognized globally, pediatric data are limited, particularly on trends over the years. Also, no published data exists regarding whether vitamin D deficiency or insufficiency and human T-cell lymphotropic virus type 1 (HTLV-1) infection, both found to be related to severe bronchiectasis in First Nations adults, also are important in children with bronchiectasis. RESEARCH QUESTION: Among children with bronchiectasis, (1) have the clinical and BAL profiles changed between two 5-year periods (period 1, 2007-2011; period 2, 2012-2016) and (b) are vitamin D deficiency or insufficiency, HTLV-1 infection, or both associated with radiologic severity of bronchiectasis? STUDY DESIGN AND METHODS: We analyzed the data from children with bronchiectasis prospectively enrolled at Royal Darwin Hospital, Australia, at the first diagnosis; that is, no child was included in both periods. Data collected include demographics, BAL, routine investigation bloods, and high-resolution CT scan of the chest evaluated using the Bhalla and modified Bhalla scores. RESULTS: The median age of the 299 children was 2.2 years (interquartile range, 1.5-3.7 years). One hundred sixty-eight (56%) were male and most were First Nations (92%). Overall, bronchiectasis was high over time, particularly among First Nations children. In the later period, numbers of non-First Nations children more than tripled, but did not reach statistical significance. In period 2 compared with period 1, fewer First Nations children demonstrated chronic cough (period 1, 61%; period 2, 47%; P = .03), and were younger, First Nations children were less likely to have received azithromycin (period 1, 42%; period 2, 21%; P < .001), and the BAL fluid of First Nations children showed lower Haemophilus influenzae and Moraxella catarrhalis infection. HTLV-1 infection was not detected, and vitamin D deficiency or insufficiency did not correlate with severity of bronchiectasis. INTERPRETATION: Bronchiectasis remains high particularly among First Nations children. Important changes in their profiles that arguably reflect improvements were present, but overall, the profiles remained similar. Although vitamin D deficiency was uncommon, its role in children with bronchiectasis requires further evaluation. HTLV-1 infection was nonexistent and is unlikely to play any role in First Nations children with bronchiectasis.

Prevalence of overweight and obesity, and associations with socio-demographic factors in Kuwait.

BACKGROUND: Kuwait is amongst countries in the Gulf region with high income economy. According to the World Health Organisation (WHO), one in five adults in the Gulf region is obese. This study sought to evaluate the prevalence and magnitude of association between overweight, obesity, central obesity, and socio-demographic factors in Kuwait. METHODS: A population-based cross-sectional survey of diabetes and obesity in Kuwait - part of the Kuwait Diabetes Epidemiology Program - was conducted between 2011 and 2014, targeting adults aged 18-82 years using the WHO STEPwise approach to non-communicable disease surveillance. Body mass index (BMI) was calculated to classify overweight and obesity, and waist circumference (WC) used to express central obesity. Multivariable logistic regression was used to estimate relationships between socio-demographic factors, overweight (25.0-29.9 kg/m2), obesity (≥30.0 kg/m2) or central obesity (WC ≥ 80 cm women; WC ≥ 94 cm men). RESULTS: Records for gender (56% Men), age, BMI, governorate, and nationality existed for 4901 individuals. Mean age and BMI were 43 years and 30 kg/m2, respectively. Non-Kuwaiti nationals were more prevalent than Kuwaitis (76% vs 24%). Prevalence rates for overweight, obesity and central obesity were 40.6% (95%CI: 38.4-42.8%), 42.1% (95%CI: 40.0-44.3%) and 73.7% (95%CI: 71.7-75.6%), respectively. The youngest age group (18-29 years) had rates of 38.2% (95%CI: 29.2-47.7%), 27.2% (95%CI: 19.0-36.7%) and 49.9% (95%CI: 40.6-59.1%) for overweight, obesity and central obesity, respectively. In covariate-adjusted analyses, the odds of being overweight was 26% greater for men than for women. Conversely, women had a 54% (95%CI: 19-99%) and 7-fold (95%CI, 5-10-fold) greater odds of obesity/central obesity, respectively, than men. Greater educational attainment, physical activity, and non-Kuwaiti status were associated with lower odds of obesity/central obesity. History of smoking, elevated blood pressure, higher income, being married, greater age and female sex related to greater odds of obesity/central obesity. CONCLUSION: Overweight was greater in men, obesity greater in women. Overweight and obesity prevalence were high in young adults aged 18-29 years, a significant public health concern. Efforts to integrate mandatory physical education to the school curriculum and promoting the creation of recreation spaces/parks to promote physical activities, will play a vital role in the early prevention of overweight/obesity in Kuwait.

A decade on: Follow-up findings of indigenous children with bronchiectasis.

OBJECTIVE: The sole prospective longitudinal study of children with either chronic suppurative lung disease (CSLD) or bronchiectasis published in the current era was limited to a single center. We sought to extend this study by evaluating the longer-term clinical and lung function outcomes and their associated risk factors in Indigenous children of adolescents from Australia, Alaska, and New Zealand who participated in our previous CSLD or bronchiectasis studies during 2004-2010. METHODS: Between 2015 and 2018, we evaluated 131 out of 180 (72.8%) children of adolescents from the original studies at a single follow-up visit. We administered standardized questionnaires, reviewed medical records, undertook clinical examinations, performed spirometry, and scored available chest computed tomography scans. RESULTS: Participants were seen at a mean age of 12.3 years (standard deviation: 2.6) and a median of 9.0 years (range: 5.0-13.0) after their original recruitment. With increasing age, rates of acute lower respiratory infections (ALRI) declined, while lung function was mostly within population norms (median forced expiry volume in one-second = 90% predicted, interquartile range [IQR]: 81-105; forced vital capacity [FVC] = 98% predicted, IQR: 85-114). However, 43 out of 111 (38.7%) reported chronic cough episodes. Their overall global rating judged by symptoms, including ALRI frequency, examination findings, and spirometry was well (20.3%), stable (43.9%), or improved (35.8%). Multivariable regression identified household tobacco exposure and age at first ALRI-episode as independent risk factors associated with lower FVC% predicted values. CONCLUSION: Under our clinical care, the respiratory outcomes in late childhood or early adolescence are encouraging for these patient populations at high-risk of premature mortality. Prospective studies to further inform management throughout the life course into adulthood are now needed.

Fingernail cortisol as a marker of chronic stress exposure in Indigenous and non-Indigenous young adults.

Cumulative exposure to stress over a long period can negatively impact an individual's health. Significant advancements in biomarkers of chronic stress have been made, with the use of fingernails recently explored. Cross sectional data from the Australian Aboriginal Birth Cohort (Indigenous) and Top End Cohort (non-Indigenous) were used to investigate the associations (sociodemographic and emotional) of fingernail cortisol in Indigenous and non-Indigenous young adults. Details on sociodemographic (age, gender, and Indigenous identification), smoking and alcohol use, emotional wellbeing, and emotional stress (perceived stress and stressful events), and fingernail samples were obtained face-to-face. Fingernail samples were analyzed for 179 Indigenous and 66 non-Indigenous participants (21-28 years). Indigenous participants were subjected to higher rates of stressful events compared to non-Indigenous (Median 6.0; interquartile range (IQR) 4, 9 vs. 1.0; IQR 0, 2; p < .001). Median cortisol levels were similar between Indigenous and non-Indigenous participants (4.36 pg/mg; IQR 2.2, 10.0 vs. 3.87 pg/mg: IQR 2.0, 9.7; p = .68). However, Indigenous participants had a higher cortisol level on adjustment for emotional distress and exposure to stressful events (Geometric Mean 1.82; 95CI: 1.07-3.09), with a negative association with increasing number of stressful events (Geometric Mean 0.94; 95CI 0.90, 0.99). Collection of fingernails was an easily conducted, well-tolerated method to measure stress markers in this multicultural cohort. Indigenous young adults experienced a high number of stressful events which was associated with a lowering of fingernail cortisol levels.Lay abstractChronic stress can impact negatively on health and emotional wellbeing. A fingernail sample provided a culturally acceptable, noninvasive method of measuring chronic stress in Indigenous and non-Indigenous young adults. Cortisol levels, a marker of chronic stress, were different between Indigenous and non-Indigenous young adults and were influenced by emotional status and occurrence of multiple stressful events.

Sleep apnoea among Australian Aboriginal and non-Aboriginal patients in the Northern Territory of Australia-a comparative study.

Australian Aboriginal and Torres Straight Islanders (ATSI) are noted to have a higher burden of chronic health conditions. However, there is a paucity of data on obstructive sleep apnoea (OSA) in this population. In this retrospective study, we evaluated the clinical and polysomnographic (PSG) characteristics of ATSI and non-ATSI adult patients who underwent diagnostic PSG between 2011 and 2015. There were a total of 3078 patients. Of the total, 403 (13%) were of ATSI origin. Among those of ATSI origin, 61% were male and 39% females, while among the non-ATSI cohort, 66% were males. The median age was 47.8 years in ATSI and 51.5 years in the non-ATSI cohort. In the combined cohort, body mass index was more than 30 kg/m2 (61%), hypertension (14.4%), diabetes (17.8%), and heart disease (23.3%). The ATSI patients had higher rates of class III obesity (27 vs. 15%), hypertension (26 vs. 14%), cardiac disease (34 vs. 23%), and diabetes (37 vs. 17%). Among all the study participants, the PSG confirmed 83.7% of the patients had an apnoea-hypopnea index (AHI) more than 5/h, mild (AHI 5-15/h) in 28.4%, moderate (AHI 15-30/h) in 22.3%, and severe (AHI > 30/h) in 33.0%. Among the ATSI patients, 46% had severe OSA. The median total AHI value was higher in the ATSI population (25, interquartile range [IQR]: 11-58) compared to the non-ATSI (17, IQR: 7-36), and in rural/remote population (19, IQR: 8-42) compared to urban (17, IQR: 7-37). This trend was similar for NREM (non-rapid eye movement)-AHI and REM (rapid eye movement)-AHI scores, although statistically significant difference was found only with ATSI status. In the combined cohort the probability of (OR = 1.62, 95% CI: 1.32-2.00, p < 0.001) of severe OSA was 62% higher in individual with hypertension, however, when stratified by ATSI status, the association was only significant in the non-ATSI population (OR = 1.53 95% CI: 1.21-1.94, p < 0.001). The odds of severe AHI was also significantly associated with heart disease (1.37; 95% CI: 1.14,1.63, p < 0.001), diabetes (1.74; 95% CI: 1.43,2.10; p < 0.001) and smoking (1.28; 95% CI: 1.09,1.50, p = 0.0023) in the overall study cohort. In both ATSI and non-ATSI patients, body mass index, neck circumference, sleep efficiency, wake after sleep onset, and respiratory arousal index were significantly higher and independently associated with severe AHI.

Diet and lifestyle habits: Association with cardiovascular disease indices in a Nigerian sub-population.

BACKGROUND: There is inadequate evidence regarding the pattern of unhealthy lifestyle behaviours in Nigeria hence the aim of this study was to assess the pattern of lifestyle-related habits that predispose to risk of cardiovascular disease (CVD) indices in a Nigerian population. METHODS: A population-based cross-sectional study was carried out on 422 apparently healthy males and females ≥18 years old. The World Health Organisation (WHO) STEPwise questionnaire was used to collect information on tobacco use or smoking habits, alcohol consumption and dietary habits. Logistic regression analysis was employed. RESULTS: 22.8% and 30.2% of participants indicated that someone smoked in their home and/or in closed areas at workplace, respectively, in the past 30 days. 225/422 admitted to taking alcohol including 72% within the past 12 months. 52.8% of the participants consumed <5 servings of fruits and/or vegetables each day. Results further showed that participants with <5 servings of fruits and/or vegetables (OR: 1.06, CI: 1.01-1.13, p = 0.028) and high level of alcohol consumption (OR: 1.85, CI: 1.18-2.88, p = 0.007) were more likely to have hypertension. CONCLUSIONS: The relatively high prevalence of alcohol consumption and apparent unhealthy diet are of huge concern given the increasing prevalence of CVD indices in the population.