Adherence to secondary prevention of rheumatic fever and rheumatic heart disease in young people: an 11-year retrospective study.

OBJECTIVES: To evaluate the secondary prevention of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in the Townsville region, Australia. METHODS: Adherence to benzathine benzylpenicillin G (BPG) was determined for 196 children and young adults aged under 22 years between January 2009 and December 2019, and factors associated with BPG adherence were analysed. Secondary outcomes included attendance at specialist reviews and echocardiograms. RESULTS: Adequate adherence (80%) to regular BPG injections was met by 51.1% of the cohort. Adequate BPG adherence more likely occurred for those that attended the Paediatric Outreach Clinic (OR4.15, 95%CI:2.13-8.05) or a school delivery program (OR1.87, 95%CI:1.11-3.45). People with moderate/severe RHD had greater BPG adherence (OR1.76,95%CI:1.00-3.10). People in rural/remote areas were less likely to have adequate BPG adherence compared to urban counterparts (OR0.31, 95%CI:0.15-0.65). Adherence to echocardiography was 66% and specialist review attendance was 12.5-50%. CONCLUSION: Half of the cohort in the Townsville region received adequate BPG prophylaxis to prevent ARF/RHD. Although rates were relatively higher than those reported in other Australian regions, health delivery goals should be close to 100%. Low attendance at specialist services was reported. Implication for public health: Delivery models with dedicated services, case management and family support could improve BPG adherence in individuals with ARF/RHD. Further resources in rural and remote areas are needed.

Can I breastfeed my baby with Down syndrome? A scoping review.

AIM: To summarise existing evidence about barriers and enablers to breastfeeding babies with Down syndrome (DS) in peer-reviewed literature. METHODS: Ovid Medline, CINAHL, Scopus and Ovid Emcare were searched. Inclusion and exclusion criteria were used to screen yielded articles and those meeting the criteria were included for data extraction. Two authors extracted data including outcomes, design, definition of DS, barriers and enablers to breastfeeding babies with DS. RESULTS: Sixteen studies met the inclusion and exclusion criteria. Barriers and enablers were categorised into maternal, child and health professional factors. CONCLUSIONS: This review identified a significant literature gap related to breastfeeding babies with DS and more definitive research under current standards is needed. Mothers reported the need for high-quality health professional breastfeeding support and evidence-based effective breastfeeding techniques. A collaborated and concerted approach from both mothers and health professionals is important to optimise breastfeeding for babies with DS.

Rheumatic heart disease in pregnancy and neonatal outcomes: A systematic review and meta-analysis.

PURPOSE: Associations between rheumatic heart disease (RHD) in pregnancy and fetal outcomes are relatively unknown. This study aimed to review rates and predictors of major adverse fetal outcomes of RHD in pregnancy. METHODS: Medline (Ovid), Pubmed, EMcare, Scopus, CINAHL, Informit, and WHOICTRP databases were searched for studies that reported rates of adverse perinatal events in women with RHD during pregnancy. Outcomes included preterm birth, intra-uterine growth restriction (IUGR), low-birth weight (LBW), perinatal death and percutaneous balloon mitral valvuloplasty intervention. Meta-analysis of fetal events by the New-York Heart Association (NYHA) heart failure classification, and the Mitral-valve Area (MVA) severity score was performed with unadjusted random effects models and heterogeneity of risk ratios (RR) was assessed with the I2 statistic. Quality of evidence was evaluated using the GRADE approach. The study was registered in PROSPERO (CRD42020161529). FINDINGS: The search identified 5949 non-duplicate records of which 136 full-text articles were assessed for eligibility and 22 studies included, 11 studies were eligible for meta-analyses. In 3928 pregnancies, high rates of preterm birth (9.35%-42.97%), LBW (12.98%-39.70%), IUGR (6.76%-22.40%) and perinatal death (0.00%-9.41%) were reported. NYHA III/IV pre-pregnancy was associated with higher rates of preterm birth (5 studies, RR 2.86, 95%CI 1.54-5.33), and perinatal death (6 studies, RR 3.23, 1.92-5.44). Moderate /severe mitral stenosis (MS) was associated with higher rates of preterm birth (3 studies, RR 2.05, 95%CI 1.02-4.11) and IUGR (3 studies, RR 2.46, 95%CI 1.02-5.95). INTERPRETATION: RHD during pregnancy is associated with adverse fetal outcomes. Maternal NYHA III/IV and moderate/severe MS in particular may predict poor prognosis.

Lessons to be learned: Using National Immunisation strategies to improve adherence to acute rheumatic fever secondary prophylaxis.

Rheumatic heart disease, as a result of a single or recurrent episode of acute rheumatic fever (ARF), remains a significant cause of morbidity and mortality in northern and remote Australia; ARF has a peak incidence among 5-14-year-old Aboriginal and Torres Strait Islander children. Long-term regular benzathine penicillin G injections are the only currently successful secondary prevention strategy; however, rates of adherence remain critically low. In contrast, rates of adherence to immunisations on the National Immunisation Program (NIP) Schedule are high, even among this target population. This article compares strategies used to implement and improve ARF secondary prophylaxis with those used in the NIP. Some successful NIP strategies, such as Service Incentive Payment for health providers, home-visiting delivery models and integration into the National Immunisation Register, if applied to ARF secondary prophylaxis have the potential to improve benzathine penicillin G adherence.

Benefits of simulated General Practice clinics in the preparation of medical students for primary healthcare.

The James Cook University (JCU) medical school has a mission to produce doctors who are willing to work across northern Australia and may choose generalist rather than specialist careers. In addition to real-life placements in primary healthcare settings, the medical school has developed simulated General Practice (GP) clinics (simGPclinic) for Year 5 (Y5) students. This study compares the simGPclinic with actual GP placements for authenticity, teaching clinical skills, and preparation for real-life primary healthcare settings. Y5 students were administered a survey following their simGPclinic (n = 65; response rate = 97%). Students rated the simGPclinic's authenticity as 77 out of 100, and were more likely to rate the simGPclinic as being 'better' than their real-life GP placement in teaching them to: 'formulate a medical management plan and order correct pathology tests'; 'rule out the "red flags" for the key clinical problem'; 'undertake a patient-centred history and examination'; 'make a differential diagnosis for the key clinical problem'; and, 'develop communications skills'. The simGPclinic provided medical students with authentic and positive learning experiences in primary healthcare that were at least as beneficial as those provided in real-life settings, as well as being more reliable and better structured.

Diabetic ketoacidosis incidence in children at first presentation of type 1 diabetes at an Australian regional hospital: The effect of health professional education.

BACKGROUND: Diabetic ketoacidosis (DKA) is an acute life threatening, resource intensive preventable complication of type 1 diabetes which has major biopsychosocial effects on patients and families. Incidence of pediatric DKA has been studied nationally and internationally in metropolitan centers. This study analyzed the DKA incidence at first presentation of type 1 diabetes at Townsville Hospital, before and after an educational intervention. This is the first study of its kind in a regional center in Queensland, Australia. METHOD: The inclusion criteria consisted of children (0-18 years) diagnosed with type 1 diabetes from January, 2006 to December, 2016. Medical and laboratory patient data was retrospectively collected. Quantitative analysis was conducted using SPSS. Education sessions were delivered to health professionals by a pediatric endocrinologist during 2015 and 2016. DKA and its severity were defined by the International Society of Pediatric Diabetes 2014 Guidelines. RESULTS: In total, 106 patients met inclusion criteria. Average incidence of DKA at first presentation of type 1 diabetes was 48.10%. Pre- and post-intervention incidences were 54.90% and 25%, respectively (P = 0.01). DKA severity pre- and post-intervention were severe (48.88%, 33.33%), moderate (26.67%, 16.67%), and mild (24.44%, 50%), respectively (P = 0.53). CONCLUSIONS: DKA incidence at first presentation of type 1 diabetes prior to intervention, is higher than that reported by other studies in Australia: Brisbane (31.8%) and Sydney (37.7%). DKA incidence at first presentation of type 1 diabetes decreased significantly during the period of health professional education.

Who paints the picture? Images of health professions in rural and remote student resources.

INTRODUCTION: Rural and remote Australia has a severe shortage of health professionals and the health of its people is relatively poor. For decades, national and international studies have demonstrated that health professionals who grow up in rural areas are more likely to practise in rural areas when compared with health professionals raised in the city. However, an often unrecognised consequence of the severe shortage of health professionals is the severe shortage of role models to inspire rural and remote school students to go on to become health professionals. So how do these school students paint a picture for themselves of what it would be like to be a health professional? Do they acquire images from school? Career development theorists suggest that children start to shape ideas about careers before preschool and then continue to shape these ideas throughout their school years. They also agree that, to aspire to a career, a student must first know about that career. At the time of writing, no review of primary school curricular materials in rural and remote Australia related to information inspiring students to health professions was available in the literature. METHODS: This article reports on an analysis of all the Department of Education set curricular materials studied by rural and remote distance-education school students in years 3-7 in one Australian state. The aim was to look for content relevant to careers in the health professions. RESULTS: Students are provided with very little information to help them build an image of these careers. Some of the information, provided in the students' curricular materials, painted negative images of health professionals, especially doctors. CONCLUSIONS: These findings contribute to an understanding of why relatively few students from rural and remote Australia go on to become health professionals. It is exhilarating to realise these findings are modifiable, with the potential to improve future rural health workforce recruitment and retention.