Adrian J. Lowe

Description:To reduce chronic school absenteeism and morbidity and mortality among school-aged children, the prompt administration of albuterol sulfate in schools remains vital. School-based stock inhaler programs are a practical approach to ensure equitable access to life-saving rescue medication for students. School and community partnerships can potentially strengthen program implementation and fidelity by integrating evidence-based practices into routine care. We report the findings of a novel practice facilitation model developed by the Maricopa County Department of Public Health to facilitate the implementation of the Stock Inhaler for Schools Program in K-12 Schools. Three-hundred twenty-four schools participated in the program, with 153 schools reporting a stock inhaler event for a total of 1,310 events across four school years. Most events (78%) were compliant with the protocol for administering the stock inhaler to a student. These findings suggest that implementing a practice facilitation model is feasible and important for enhancing fidelity to program requirements.

Description:Background: Atopic dermatitis (AD) significantly impacts quality of life, with well-documented physical and psychological consequences. While disease burden is well characterised, the influence of psychosocial determinants on AD outcomes remains underexplored. This study examines these factors in an Australian paediatric population. Objective: To investigate whether children from populations at risk of health inequities-such as those from rural areas, culturally diverse backgrounds, First Nations communities, socioeconomically disadvantaged postcodes, those with neuropsychiatric conditions and 'Vulnerable' children (defined as those under state or relative care or with a history of familial abuse or neglect)-experience more severe disease. Methods: This retrospective cross-sectional study included children ≤ 16 years with confirmed AD attending a tertiary paediatric referral centre in Melbourne (Aug 2022-Aug 2023). Risk factors were defined by social determinants of health, including economic, cultural and geographic influences. Disease outcomes (severity, hospitalisations, emergency department visits treatment patterns) were analysed using univariate and multivariate methods. A total of 454 at-risk children were compared to 454 controls. Results: Children from at-risk groups were more likely to have severe AD (43.8% vs. 28.3%, p < 0.001), higher annual rates of hospital admissions, increased antibiotic use, and greater prednisolone use for flares (p < 0.001). Multivariate analysis revealed significantly higher odds of severe AD (aMOR 4.72, p < 0.001) and hospitalisation (aIRR 2.73, p < 0.001) in the at-risk cohort. Conclusions: Psychosocial determinants of health are associated with increased AD severity and healthcare use in children. These findings highlight the need for targeted, equity-focused interventions to reduce disparities in AD care in Australia.

Description:Pollen identification (ID) and quantification is important in many fields, including pollination ecology and agricultural sciences, and efforts to explore optimal molecular methods for identifying low concentrations of DNA from plant mixtures are increasing, but quantifying mixture proportions remains challenging. Traditional pollen ID using microscopy is time-consuming, requires expertise and has limited accuracy and throughput. Molecular barcoding approaches being explored offer improved accuracy and throughput. The common approach, amplicon sequencing, employs PCR amplification to isolate DNA barcodes, but introduces significant bias, impairing downstream quantification. We apply a novel molecular hybrid capture approach to artificial pollen mixtures to improve upon current taxon ID and quantification methods. The method randomly fragments DNA and uses RNA baits to capture DNA barcodes, which allows for PCR duplicate removal, reducing downstream quantification bias. Four reference databases were used to explore identification and quantification. A restricted matK database containing only mixture species yielded sequence proportions highly correlated with input pollen proportions, demonstrating the potential usefulness of hybrid capture for metabarcoding and quantifying pollen mixtures. Identification power was further tested using two reference libraries constructed from publicly available sequences: the matK plastid barcode and RefSeq complete chloroplast references. Single barcode-based taxon ID did not consistently resolve to species or genus level. The RefSeq chloroplast database performed better qualitatively but had limited taxon coverage (relative to species used here) and introduced ID issues. At the family level, both databases yielded comparable qualitative results, but the RefSeq database performed better quantitatively. Whilst the method developed here has tremendous potential, the choice and expansion of reference databases remains one of the most important factors allowing qualitative and quantitative accuracy using the full set of genomic regions screened by this hybrid capture method.

Description:Background: Allergic sensitization and respiratory infections commonly occur in childhood. Interplay between them in asthma development is known as the 'two-hit' hypothesis. There has been no previous investigation of this hypothesis on adult lung function. Objective: In a birth cohort at high risk for allergic diseases, we investigated interactions between these two factors and lung function outcomes into adulthood. Methods: Allergic sensitization was assessed at age 24 months by skin prick testing to aero and food allergens. Respiratory infection was defined as cough, rattle or wheeze measured by frequent questionnaires up to age 24 months. Regression models were utilized to identify interactions between these exposures and associations with lung function at ages 12, 18 and 25 years. Results: At age 25 years, those sensitized at age 2 years(n = 118) demonstrated reductions in pre-bronchodilator FEV1 of 0.06(95% CI: -0.12, 0.00, z-score units, p = .055) for each additional month of respiratory infections. Those not sensitized (n = 120) had increases in pre-bronchodilator FEV1 of 0.07 (95% CI: 0.02, 0.13, z-score units, p = .012) for each additional month of respiratory infection(pinteraction = .012). Similar findings were noted for FEV1/FVC ratio(pinteraction = .011), FEF25-75(pinteraction = .007) and absolute change in pre and post bronchodilator lung function. At 18 years, findings were similar; however, there was less evidence for interactions at 12 years. Conclusions: Our study findings support the 'two-hit' hypothesis of interactions between early-life allergic sensitization and increasing respiratory infections, and impairment in lung function up to age 25 years. Early childhood respiratory infections however had different impacts on lung function depending upon the presence or absence of allergic sensitization.

Description:Objective: Multiple myeloma (MM) is responsible for significant morbidity and mortality, yet our knowledge regarding MM aetiology remains limited. We investigated whether a history of allergic conditions is associated with MM risk. Methods: Incident cases (n = 782) of MM were recruited via cancer registries in Victoria and NSW. Controls (n = 733) were siblings (n = 436) or spouses (n = 297) of cases. Unconditional logistic regression was used to estimate odds ratios (OR) and 95 % confidence intervals (CI) for associations between self-reported allergic conditions (asthma, eczema, food allergy, hay fever) and MM risk. Results: Eczema was inversely associated with MM risk (OR = 0.54, 95 %CI = 0.42-0.70), as was a combined history of food allergy and eczema (OR = 0.52, 95 %CI = 0.29-0.93). There was an inverse association between a history of any allergic condition (compared with none) and risk of MM (OR = 0.68, 95 %CI = 0.55-0.84). In the mean-centred dose-risk analysis the OR was 0.87 (95 %CI = 0.73-1.04) per additional allergic condition of interest. No notable associations were identified for food allergy, asthma, or hay fever alone. Conclusions: We found that a history of allergic disease, particularly eczema, was associated with reduced MM risk. Further research is recommended to confirm findings and investigate potential mechanisms.