Factors correlating to the propensity of general practitioners to substitute borderline vitamin B12 deficiency.

OBJECTIVE: This study aims to identify factors which correlate to the propensity of general practitioners (GPs) to prescribe supplementation for borderline vitamin B12 deficiency. DESIGN: Cross-sectional surveys were distributed in person. SETTING: Conferences held in Cairns, Palm Cove Beach, Mt Isa; educational meetings in Atherton; and meetings with individual general practices within the Cairns and Hinterland region. All located in Queensland, Australia. SUBJECTS: 128 practicing GP specialists and registrars (practitioners in training). MAIN OUTCOME MEASURES: Responses to the Likert scale statements with its five options scaling from 'strongly disagree' to 'strongly agree' were recoded to have binary outcomes for analysis. RESULTS: A survey response rate of 89% was achieved. Participants who felt patient demands influence the management of borderline vitamin B12 deficiency were more likely to prescribe supplementation (OR 2.4, p = 0.037). Participants who perceived an overuse of vitamin B12 were less likely to prescribe B12 (OR 0.39, p = 0.019). Participants who often saw patients with vitamin B12 deficiency were less likely to request for the complementary biomarkers plasma methylmalonic acid or total homocysteine (OR 0.41, p = 0.045). CONCLUSIONS: The identified disparity to prescribe vitamin B12 for borderline deficiency may be described as an attempt in the GP collective to seek a balance between being the patient's or the society's doctor. We propose that relevant authorities try to reduce this disparity by describing a management strategy for borderline vitamin B12 deficiency. Key points General practitioners hold different thresholds for commencing supplementation in cases of borderline vitamin B12 deficiency. Participants from Australia were asked to fill out a cross-sectional survey to explore factors which correlate with the propensity to prescribe in clinical practice. Our study identified that patient demands and a practitioner's perception of whether there is an overuse of vitamin B12 in the community influenced the propensity to treat for deficiency. The results give insight into reasons for initiating supplementation, and will help inform general practitioners on their current management.

Rapid Progress toward Elimination of Strongyloidiasis in North Queensland, Tropical Australia, 2000-2018.

Infection with Strongyloides stercoralis can cause life-threatening disease in immunocompromised patients. Strongyloidiasis is thought to be hyper-endemic in tropical Australia, but there are limited contemporary seroprevalence data to inform local elimination strategies. To define the temporospatial epidemiology of strongyloidiasis in Far North Queensland, tropical Australia, the serology results of 2,429 individuals tested for the infection between 2000 and 2018 were examined. The proportion of positive tests fell from 36/69 (52.2%) in 2000 to 18/222 (8.1%) in 2018 (P < 0.001). Indigenous patients were more likely to have a positive result (Odds Ratio [OR]: 3.9, 95% CI: 3.0-5.0); however, by the end of the study period, residence in a rural or remote location (OR 3.9 (95% CI: 1.2-13.0), P = 0.03) was a more important risk factor for seropositivity than Indigenous status (OR 1.1 (95% CI: 0.4-3.1) P = 0.91). Ivermectin prescription data were available for the period 2004-2018, with annual prescriptions increasing from 100 to 185 boxes (P = 0.01). The volume of ivermectin dispensed correlated negatively with seropositivity (Spearman's rho = -0.62, P = 0.02). An expanded environmental health program was implemented during the study period and likely contributed to the declining seroprevalence; however, the relative contributions of the individual components of this program are difficult to quantify. The seroprevalence of strongyloidiasis has declined markedly in this region of tropical Australia despite there being no targeted campaign to address the disease. Expanded prescription of ivermectin and public health interventions targeting the few remaining high-prevalence communities would be expected to expedite disease elimination.

Severe Respiratory Syncytial Virus Infection in Hospitalized Children Less Than 3 Years of Age in a Temperate and Tropical Climate.

BACKGROUND: Respiratory syncytial virus (RSV) infection is a frequent cause of hospitalization in infants younger than 3 years of age. We aimed to determine the factors associated with severe RSV disease. METHODS: Retrospective medical review of children up to 3 years of age admitted for laboratory-proven RSV infection between January 1, 2013, and December 31, 2014, was conducted at the Women's and Children's Hospital, Adelaide, South Australia, and the Paediatric Department at Cairns Hospital, Cairns, North Queensland. Severity of infection was determined using the validated Brisbane RSV Infection Severity Score. RESULTS: Four-hundred ninety-six children (383 at Women's and Children's Hospital and 113 at Cairns Hospital) were included in the study, with 76, 323 and 97 patients identified as having mild, moderate or severe disease, respectively. Decreasing age [odds ratio (OR) = 0.95; 95% confidence interval (CI) = 0.90-0.99, P = 0.020), and being Indigenous, increased (OR = 2.6; 95% CI = 1.4-4.9, P = 0.002) the risk of severe RSV infection in hospitalized children. Underlying respiratory (P = 0.029, OR = 2.5; 95% CI = 1.1-5.8) or cardiac (OR = 2.7; 95% CI = 1.1-6.4, P = 0.024) conditions, as well as the presence of tachypnoea on admission (OR = 2.2; 95% CI = 1.2-4.1, P = 0.009), were also independent predictors of severe RSV infection. Seasonal variation in hospitalization was observed between temperate and tropical climates but was not associated with disease severity. CONCLUSIONS: Young infants, Indigenous patients and children with underlying respiratory and cardiac disease should be observed closely for signs of deterioration. Infants with tachypnoea on admission should be continuously monitored.

The Health Effects of Strongyloidiasis on Pregnant Women and Children: A Systematic Literature Review.

Strongyloidiasis is a helminth infection that remains under-researched despite its ability to cause significant illness. Women and children may be at particular risk of health consequences from this parasite. This systematic literature review aims to examine research on the long-term health effects that strongyloidiasis has in pregnant women and children. We conducted a structured search using multiple databases to collect all primary studies discussing health effects of strongyloidiasis in the aforementioned groups. The review included 20 results: 16 primary studies and four case reports. The methodological quality of studies was substandard, and there was substantial heterogeneity to the statistical analysis and outcomes assessed in the literature. Statistically significant associations were found between strongyloidiasis and low birth weight, as well as wasting. No links were found between strongyloidiasis and anaemia. Due to testing methods used in the studies, the prevalence of Strongyloides stercoralis in these studies was probably under-estimated. Current research is suggestive that strongyloidiasis has long-term adverse health effects on the offspring of infected mothers and in chronically-infected children. Data analysis was hindered by both methodological and statistical flaws, and as such, reliable conclusions regarding the health impacts could not be formed.