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Hazelwood coalmine fire exposed unborn children to respiratory damage
In utero exposure to the air pollution caused by the Hazelwood coalmine fire has been associated with increased reports of respiratory infections and wheeze in young children 2–4 years later, leading to a call for public health responses to forefront the protection of pregnant women and young children. The Hazelwood fire occurred in February 2014, exposing a large number of people in Victoria’s Latrobe Valley to high levels of air pollution for 6 weeks. Research published online by the MJA analysed data from 79 children who were exposed to the Hazelwood smoke while in utero, 81 who were 0–2 years old when exposed to the smoke, and 129 who were conceived after the fire (ie, unexposed). The researchers were led by Associate Professor Fay Johnston from the Menzies Institute for Medical Research at the University of Tasmania. Johnston and colleagues found that in the children exposed in utero, each 10 µg/m3 increase in mean daily fine particulate matter (PM2.5) exposure was associated with increased reports of runny nose/cough, wheeze, seeking health professional advice, and doctor diagnoses of upper respiratory tract infections, cold or flu. In those exposed during early childhood, each 100 µg/m3 increase in peak 24-hour PM2.5 exposure was associated with increased use of asthma inhalers but not any of the other health outcomes that were measured. “Our findings suggest an increased susceptibility to acute respiratory infections during childhood after exposure in utero to a severe air pollution episode,” they wrote. “Severe episodic smoke events from bushfires and planned burns are common in Australia (and elsewhere), and their number will increase with climate change. Our findings highlight the particular vulnerability of the very young, including unborn babies, to insults during critical developmental periods and the importance of protecting them during landscape fire smoke events and other causes of air pollution. Our findings suggest that in utero exposure to smoke may have a greater impact on long term respiratory health than exposure during the first two years of life. Protecting pregnant women and young children from episodic severe smoke events should be central to public health responses to poor air quality,” Johnston and colleagues concluded.
Frailty index may improve care for older Australians
A new “frailty index” has been developed which may help identify elderly people at high risk who could then receive targeted interventions to delay admitting them to residential aged care, according to research published online by the MJA. The researchers analysed de-identified data from 903 996 non-Indigenous Australians aged 65 years or more, living in the community and assessed for subsidised aged care eligibility (by an Aged Care Assessment Team) during 2003–2013. They then worked through 204 candidate variables, with the final index including 44 variables: eight activity limitations, 24 health conditions, and 12 signs and symptoms. The validity of the frailty index was assessed by comparing the distribution of frailty index scores with that of service approvals by accredited assessors and by how well it predicted mortality and entry into permanent residential care after the aged care eligibility assessment. The researchers, led by Dr Jyoti Khadka from the Registry of Senior Australians at the South Australian Health and Medical Research Institute, found the following: the mean frailty index score for the individuals undergoing aged care eligibility assessments in Australia during 2003–2013 was 0.20; the proportion of assessed older people with scores exceeding 0.20 (at the higher end of the frail scale) increased from 32.1% in 2003–2005 to 75.0% in 2012–2013; the risks of death and entry into permanent residential aged care at 1, 3 and 5 years after assessment increased with frailty index score; the predictive validity of models including age, sex, and frailty index score was 0.64 for death and 0.63 for entry into permanent residential aged care within 1 year of assessment. “We found that mean frailty index scores for people for whom aged care services were approved increased during 2003–2013,” wrote Khadka and colleagues. “Older people are choosing to remain in their own homes longer; consequently, the proportion with high level care needs entering aged care increased fourfold between 2009 (13%) and 2018 (53%). We found that frailty scores were higher for men than women under 93 years of age. Men may be more likely than older women to be cared for by spouses or other relatives, deferring the need for formal aged care and therefore increasing their relative frailty when they are assessed; this difference also highlights the social importance of informal caregivers. Including frailty index scores improved the predictive ability of statistical models for predicting mortality and entry into permanent residential aged care based on age and sex,” they wrote. “The association of index scores with all-cause mortality and admission to residential aged care, independent of chronological age, supports the value of the frailty index as a measure of health in older people. Our [frailty] index could be used to identify people at high risk, who could receive targeted interventions to delay admitting them to residential care,” they concluded. “We derived our frailty index from aged care eligibility data routinely collected as part of the national Aged Care Assessment Program. Frailty scores could be electronically calculated, and therefore support assessment of the risk of vulnerability, during the 180 000 eligibility assessments performed each year. The frailty index can be employed by researchers to adjust analyses of national aged care data for frailty. The identification of frailer groups at higher risk in this population supports the need for further investigations of novel models of care and interventions for preventing the poor outcomes associated with frailty.”
New online at the MJA
Perspective: Navigating the complexities of voluntary assisted dying in palliative care
Waran and William; doi: 10.5694/mja2.50729 … FREE ACCESS for 1 week
Podcast: Associate Professor Leeroy William, Clinical Director of Supportive and Palliative Care at Eastern Health, Melbourne … OPEN ACCESS permanently