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This study described the distribution of healthy body composition among Aboriginal adolescents in Australia aged 10-24 years and examined associations with health behaviours and self-rated health. Data were cross-sectional from the 'Next Generation: Youth Well-being study' baseline (N = 1294). We used robust Poisson regression to quantify associations of self-reported health behaviours (physical activity, screen time, sleep, consumption of vegetables, fruit, soft drinks and fast food, and tobacco smoking and alcohol) and self-rated health to healthy body mass index (BMI) and waist/height ratio (WHtR). Overall, 48% of participants had healthy BMI and 64% healthy WHtR, with healthy body composition more common among younger adolescents. Higher physical activity was associated with healthy body composition (5-7 days last week vs none; adjusted prevalence ratio (aPR) healthy BMI 1.31 [95% CI 1.05-1.64], and healthy WHtR 1.30 [1.10-1.54]), as was recommended sleep duration (vs not; aPR healthy BMI 1.56 [1.19-2.05], and healthy WHtR 1.37 [1.13-1.67]). There was a trend for higher proportion of healthy body composition with more frequent fast food consumption. Healthy body composition was also associated with higher self-rated health ('very good/excellent' vs 'poor/fair'; aPR healthy BMI 1.87 [1.45-2.42], and healthy WHtR 1.71 [1.40-2.10]). Culturally appropriate community health interventions with a focus on physical activity and sleep may hold promise for improving body composition among Aboriginal adolescents.

Physical activity typically decreases during teenage years and has been identified as a health priority by Aboriginal adolescents. We examined associations between physical activity levels and sociodemographic, movement and health variables in the Aboriginal led 'Next Generation: Youth Well-being (NextGen) Study' of Aboriginal people aged 10-24 years from Central Australia, Western Australia and New South Wales. Baseline survey data collected by Aboriginal researchers and Aboriginal youth peer recruiters from 2018 to 2020 examined demographics and health-related behaviours. Logistic regression was used to estimate odds ratios (OR) for engaging in high levels of physical activity in the past week (3-7 days; 0-2 days (ref), or 'don't remember') associated with demographic and behavioural factors. Of 1170 adolescents, 524 (41.9%) had high levels of physical activity; 455 (36.4%) had low levels; 191 (15.3%) did not remember. Factors independently associated with higher odds of physical activity 3-7 days/week were low weekday recreational screen time [55.3% vs. 44.0%, OR 1.79 (1.16-2.76)], having non-smoking friends [50.4% vs. 25.0%, OR 2.27 (1.03-5.00)] and having fewer friends that drink alcohol [48.1% vs. 35.2%, OR 2.08 (1.05-4.14)]. Lower odds of high physical activity were independently associated with being female [40.2% vs. 50.9%, OR 0.57 (0.40-0.80)] and some findings differed by sex. The NextGen study provides evidence to inform the co-design and implementation of strategies to increase Aboriginal adolescent physical activity such as focusing on peer influences and co-occurring behaviours such as screen time.

Background: Manual auscultation to detect abnormal breath sounds has poor inter-observer reliability. Digital stethoscopes (DS) with artificial intelligence (Al) could improve reliable detection of these sounds. Objective(s): We aimed to independently test the abilities of Al developed for the purpose of detecting wheezes/rhonchi and crackles in children. Method(s): 192 auscultation recordings collected from children using two different DS (ClinicloudTM and LittmanTM) were each tagged as containing wheezes/rhonchi, crackles or neither by a paediatric respiratory physician, based on audio playback and careful spectrogram and waveform analysis. Untagged versions of the recordings were submitted for analysis by a blinded Al algorithm (StethoMeTM Al) trained to detect pathologic paediatric breath sounds, which generated a probability score of the likelihood of presence of crackles orwheeze/rhonchi. Al outcome was compared with tagged outcomes on a per-recording basis, with receiver operating characteristic curves used to identify optimal cutoffs representing best Al performance. Result(s): With optimised Al thresholds, crackle detection positive percent agreement (PPA) was 0.95 and negative percent agreement (NPA) was 0.99 for Clinicloud recordings; for Littman-collected sounds PPA was 0.82 and NPA was 0.96. Wheeze detection PPA and NPA were 0.90 and 0.97 respectively (Clinicloud auscultation), with PPA 0.80 and NPA 0.95 for Littman recordings. Conclusion(s): Al can detect crackles and wheeze from breath sounds obtained using different DS devices with a degree of accuracy that approaches (or exceeds) that of clinicians. Careful integration into clinical practice may improve standards of care., A. Kevat, Monash Children's Hospital, Melbourne, Australia. E-mail: ajaykevat@gmail.com, CONFERENCE ABSTRACT

Background: Manual auscultation to detect abnormal breath sounds has poor inter-observer reliability. Digital stethoscopes with artificial intelligence (AI) could improve reliable detection of these sounds. We aimed to independently test the abilities of AI developed for this purpose. Method(s): One hundred and ninety two auscultation recordings collected from children using two different digital stethoscopes (ClinicloudTM and LittmanTM) were each tagged as containing wheezes, crackles or neither by a pediatric respiratory physician, based on audio playback and careful spectrogram and waveform analysis, with a subset validated by a blinded second clinician. These recordings were submitted for analysis by a blinded AI algorithm (StethoMe AI) specifically trained to detect pathologic pediatric breath sounds. Result(s): With optimized AI detection thresholds, crackle detection positive percent agreement (PPA) was 0.95 and negative percent agreement (NPA) was 0.99 for Clinicloud recordings; for Littman-collected sounds PPA was 0.82 and NPA was 0.96. Wheeze detection PPA and NPA were 0.90 and 0.97 respectively (Clinicloud auscultation), with PPA 0.80 and NPA 0.95 for Littman recordings. Conclusion(s): AI can detect crackles and wheeze with a reasonably high degree of accuracy from breath sounds obtained from different digital stethoscope devices, although some device-dependent differences do exist.Copyright © 2020 The Author(s).

The TSANZ develops position statements where insufficient data exist to write formal clinical guidelines. In 2018, the TSANZ addressed the question of potential benefits and health impacts of electronic cigarettes (EC). The working party included groups focused on health impacts, smoking cessation, youth issues and priority populations. The 2018 report on the Public Health Consequences of E-Cigarettes from the United States NASEM was accepted as reflective of evidence to mid-2017. A search for papers subsequently published in peer-reviewed journals was conducted in August 2018. A small number of robust and important papers published until March 2019 were also identified and included. Groups identified studies that extended, modified or contradicted the NASEM report. A total of 3793 papers were identified and reviewed, with summaries and draft position statements developed and presented to TSANZ membership in April 2019. After feedback from members and external reviewers, a collection of position statements was finalized in December 2019. EC have adverse lung effects and harmful effects of long-term use are unknown. EC are unsuitable consumer products for recreational use, part-substitution for smoking or long-term exclusive use by former smokers. Smokers who require support to quit smoking should be directed towards approved medication in conjunction with behavioural support as having the strongest evidence for efficacy and safety. No specific EC product can be recommended as effective and safe for smoking cessation. Smoking cessation claims in relation to EC should be assessed by established regulators.Copyright © 2020 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.

OBJECTIVES: To compare demographic and psychosocial characteristics of completed suicide between younger and older adolescents, and by sex. METHOD(S): Data was collected from the Victorian Suicide Register, which contains information on suicides reported to the Coroners Court of Victoria. RESULT(S): Between 2006 and 2015, there were 273 completed suicides aged 10-19 years, with none aged 10-12 years. There were 171 (63%) suicides in the older adolescent group (17-19 years), and 102 (37%) in the younger group (13-16 years). Males comprised 184 cases (67%) and females 89 (33%). A higher proportion of both younger and female adolescents had experienced abuse, peer conflict and bullying. There was also a higher incidence of previous self-harm in younger and female adolescents. Older adolescents were more likely to not be in formal education, employment or training. CONCLUSION(S): Suicide in younger adolescents and females appear to share characteristics, and differ from older and male adolescents. Negative interpersonal relationships and previous self-harm with possible co-existenting mental illness appear to be key differentiating features. Implications for public health: Understanding completed suicide is an important step towards prevention, and our results suggest a need for developmentally and sex-specific suicide prevention strategies.Copyright © 2019 The Authors.

The TSANZ develops position statements where insufficient data exist to write formal clinical guidelines. In 2018, the TSANZ addressed the question of potential benefits and health impacts of electronic cigarettes (EC). The working party included groups focused on health impacts, smoking cessation, youth issues and priority populations. The 2018 report on the Public Health Consequences of E-Cigarettes from the United States NASEM was accepted as reflective of evidence to mid-2017. A search for papers subsequently published in peer-reviewed journals was conducted in August 2018. A small number of robust and important papers published until March 2019 were also identified and included. Groups identified studies that extended, modified or contradicted the NASEM report. A total of 3793 papers were identified and reviewed, with summaries and draft position statements developed and presented to TSANZ membership in April 2019. After feedback from members and external reviewers, a collection of position statements was finalized in December 2019. EC have adverse lung effects and harmful effects of long-term use are unknown. EC are unsuitable consumer products for recreational use, part-substitution for smoking or long-term exclusive use by former smokers. Smokers who require support to quit smoking should be directed towards approved medication in conjunction with behavioural support as having the strongest evidence for efficacy and safety. No specific EC product can be recommended as effective and safe for smoking cessation. Smoking cessation claims in relation to EC should be assessed by established regulators.

The TSANZ develops position statements where insufficient data exist to write formal clinical guidelines. In 2018, the TSANZ addressed the question of potential benefits and health impacts of electronic cigarettes (EC). The working party included groups focused on health impacts, smoking cessation, youth issues and priority populations. The 2018 report on the Public Health Consequences of E-Cigarettes from the United States NASEM was accepted as reflective of evidence to mid-2017. A search for papers subsequently published in peer-reviewed journals was conducted in August 2018. A small number of robust and important papers published until March 2019 were also identified and included. Groups identified studies that extended, modified or contradicted the NASEM report. A total of 3793 papers were identified and reviewed, with summaries and draft position statements developed and presented to TSANZ membership in April 2019. After feedback from members and external reviewers, a collection of position statements was finalized in December 2019. EC have adverse lung effects and harmful effects of long-term use are unknown. EC are unsuitable consumer products for recreational use, part-substitution for smoking or long-term exclusive use by former smokers. Smokers who require support to quit smoking should be directed towards approved medication in conjunction with behavioural support as having the strongest evidence for efficacy and safety. No specific EC product can be recommended as effective and safe for smoking cessation. Smoking cessation claims in relation to EC should be assessed by established regulators.

The TSANZ develops position statements where insufficient data exist to write formal clinical guidelines. In 2018, the TSANZ addressed the question of potential benefits and health impacts of electronic cigarettes (EC). The working party included groups focused on health impacts, smoking cessation, youth issues and priority populations. The 2018 report on the Public Health Consequences of E-Cigarettes from the United States NASEM was accepted as reflective of evidence to mid-2017. A search for papers subsequently published in peer-reviewed journals was conducted in August 2018. A small number of robust and important papers published until March 2019 were also identified and included. Groups identified studies that extended, modified or contradicted the NASEM report. A total of 3793 papers were identified and reviewed, with summaries and draft position statements developed and presented to TSANZ membership in April 2019. After feedback from members and external reviewers, a collection of position statements was finalized in December 2019. EC have adverse lung effects and harmful effects of long-term use are unknown. EC are unsuitable consumer products for recreational use, part-substitution for smoking or long-term exclusive use by former smokers. Smokers who require support to quit smoking should be directed towards approved medication in conjunction with behavioural support as having the strongest evidence for efficacy and safety. No specific EC product can be recommended as effective and safe for smoking cessation. Smoking cessation claims in relation to EC should be assessed by established regulators.

Introduction Australian Aboriginal and/or Torres Strait Islander (hereafter referred to as 'Aboriginal') adolescents (10-24 years) experience multiple challenges to their health and well-being. However, limited evidence is available on factors influencing their health trajectories. Given the needs of this group, the young age profile of the Aboriginal population and the long-term implications of issues during adolescence, reliable longitudinal data are needed. Methods and analysis The 'Next Generation: Youth Well-being Study' is a mixed-methods cohort study aiming to recruit 2250 Aboriginal adolescents aged 10-24 years from rural, remote and urban communities in Central Australia, Western Australia and New South Wales. The study assesses overall health and well-being and consists of two phases. During phase 1, we qualitatively explored the meaning of health and well-being for adolescents and accessibility of health services. During phase 2, participants are being recruited into a longitudinal cohort. Recruitment is occurring mainly through community networks and connections. At baseline, participants complete a comprehensive survey and undertake an extensive age relevant clinical assessment. Survey and clinical data will be linked to various databases including those relating to health services; medication; immunisation; hospitalisations and emergency department presentations; death registrations; education; child protection and corrective services. Participants will receive follow-up surveys approximately 2 years after their baseline visit. The 'Next Generation' study will fill important evidence gaps by providing longitudinal data on the health and social well-being of Aboriginal adolescents supplemented with narratives from participants to provide context. Ethics and dissemination Ethics approvals have been sought and granted. Along with peer-reviewed publications and policy briefs, research findings will be disseminated via reports, booklets and other formats th

Introduction Australian Aboriginal and/or Torres Strait Islander (hereafter referred to as 'Aboriginal') adolescents (10-24 years) experience multiple challenges to their health and well-being. However, limited evidence is available on factors influencing their health trajectories. Given the needs of this group, the young age profile of the Aboriginal population and the long-term implications of issues during adolescence, reliable longitudinal data are needed. Methods and analysis The 'Next Generation: Youth Well-being Study' is a mixed-methods cohort study aiming to recruit 2250 Aboriginal adolescents aged 10-24 years from rural, remote and urban communities in Central Australia, Western Australia and New South Wales. The study assesses overall health and well-being and consists of two phases. During phase 1, we qualitatively explored the meaning of health and well-being for adolescents and accessibility of health services. During phase 2, participants are being recruited into a longitudinal cohort. Recruitment is occurring mainly through community networks and connections. At baseline, participants complete a comprehensive survey and undertake an extensive age relevant clinical assessment. Survey and clinical data will be linked to various databases including those relating to health services; medication; immunisation; hospitalisations and emergency department presentations; death registrations; education; child protection and corrective services. Participants will receive follow-up surveys approximately 2 years after their baseline visit. The 'Next Generation' study will fill important evidence gaps by providing longitudinal data on the health and social well-being of Aboriginal adolescents supplemented with narratives from participants to provide context. Ethics and dissemination Ethics approvals have been sought and granted. Along with peer-reviewed publications and policy briefs, research findings will be disseminated via reports, booklets and other formats th

Introduction: We report the results of video-assisted thoracoscopic surgery (VATS) in a large population of children with empyema, focusing on the factors affecting the postoperative length of stay (LOS). Material(s) and Method(s): After ethical approval (RES-18-0000-071Q), a retrospective review was performed (2013-2018). Results are reported as number of cases (%) and median (range) and analyzed by Mann-Whitney U and Kruskal-Wallis tests. Correlation analysis was conducted. Result(s): We identified 159 children with empyema; 75 [42 (56%) males] underwent VATS. Median age was 3.6 (0.4-14.5) years. Presentation was: autumn 15 (20%), winter 26 (35%), spring 18 (24%), summer 16 (21%) with no difference in LOS (P = .6). Preoperative symptoms duration was 7 (2-28) days. Postoperatively, chest drain was on suction in 30 (40%) patients, in situ for 3 (2-13) days. Six (8%) children required further procedures. LOS was 8 (3-47) days. Pleural fluid revealed: Streptococcus species. 41 (55%), other species 8 (11%), no bacteria 26 (34%); LOS was longer with positive pleural fluid: 9 (4-47) versus 6.5 (3-16) days (P = .02). There was no correlation between the LOS and preoperative symptoms duration (r = -0.03 [95% CI -0.3 to 0.2]; P = .7), empyema size (r = 0.2 [95% CI -0.07 to 0.5]; P = .1) and chest drain size (r = 0.09 [95% CI -0.14 to 0.3]; P = .4). Discussion(s): In our experience, >90% of children with empyema will be treated with a single VATS with an average LOS of 8 days. Positive microbiology culture significantly affects the LOS.© Copyright 2019, Mary Ann Liebert, Inc., publishers 2019.

Background: Digital stethoscope technology has been used to record and study normal and abnormal breath sounds in the paediatric population. There may be scope to utilise this technology to describe breath sound characteristics in the transitioning newborn. Method(s): A commercially available digital stethoscope and acquisition software was used to record breath sounds of term infants born via normal vaginal delivery (NVD) and elective caesarean section (CS) at one minute and two hours of life. Recordings had a bandpass filter applied and analysed using MATLAB. Power spectrum profiles, total power (TP), peak width (PW), spectrum slope (SL) and area under the regression line (PLN) were extracted and compared between delivery modes. Result(s): Sixty-one newborns were studied. Mean (SD) gestation and weight of 32 NVD infants was 38 (0.9) weeks and 3165.6 (447.1) grams, and 29 elective CS infants was 38 (0.9) weeks and 3222.1 (297.1) grams. 83.6% of 1 min and 100% of 2-h recordings were analysable. Mean difference in spectral features between CS and NVD groups at 1-min: TP 1.56 dB/Hz (p < 0.001), PW 4.14 Hz (p < 0.001), PLN 412.82 dB (p = 0.002), SL 0.63 dB/octave (p = 0.003). Mean difference at 2 h: TP 0.99 dB/Hz (p = 0.004), PW 1.54 Hz (p = 0.01), PLN 200.56 dB (p = 0.03), SL 0.34 dB/octave (p = 0.01). Conclusion(s): It is feasible to use digital stethoscope technology to assess breath sounds in the transitioning newborn. We were able to depict a difference in breath sound characteristics between infants delivered via elective CS and NVD. This may be associated with differential lung fluid clearance.

Delivery of culturally safe healthcare is critical to ensuring access to high-quality care for indigenous people. A key component of this is for Aboriginal and Torres Strait Islander people to be participants in the health workforce. The proportion of indigenous people in the health workforce should at least equate to the proportion in the population served. We describe the development and implementation of a successful affirmative action employment policy at Monash Health, one of Australia's largest Academic Health Centres, and provide perspective on its adoption.Copyright © 2019 Royal Australasian College of Physicians

Aim: To explore, synthesise and discuss currently available digital stethoscopes (DS) and the evidence for their use in paediatric medicine. Method(s): Systematic review and narrative synthesis of digital stethoscope use in paediatrics following searches of OVID Medline, Embase, Scopus, PubMed and Google Scholar databases. Result(s): Six digital stethoscope makes were identified to have been used in paediatric focused studies so far. A total of 25 studies of DS use in paediatrics were included. We discuss the use of digital stethoscope technology in current paediatric medicine, comment on the technical properties of the available devices, the effectiveness and limitations of this technology, and potential uses in the fields of paediatrics and neonatology, from telemedicine to computer-aided diagnostics. Conclusion(s): Further validation and testing of available DS devices is required. Comparison studies between different types of DS would be useful in identifying strengths and flaws of each DS as well as identifying clinical situations for which each may be most appropriately suited.Copyright ©2018 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd

AIM: To explore, synthesise and discuss currently available digital stethoscopes (DS) and the evidence for their use in paediatric medicine. METHODS: Systematic review and narrative synthesis of digital stethoscope use in paediatrics following searches of OVID Medline, Embase, Scopus, PubMed and Google Scholar databases. RESULTS: Six digital stethoscope makes were identified to have been used in paediatric focused studies so far. A total of 25 studies of DS use in paediatrics were included. We discuss the use of digital stethoscope technology in current paediatric medicine, comment on the technical properties of the available devices, the effectiveness and limitations of this technology, and potential uses in the fields of paediatrics and neonatology, from telemedicine to computer-aided diagnostics. CONCLUSION: Further validation and testing of available DS devices is required. Comparison studies between different types of DS would be useful in identifying strengths and flaws of each DS as well as identifying clinical situations for which each may be most appropriately suited.

Background and Aims: VATS is commonly performed in children with empyema, however, there is no data regarding the post-operative outcomes (after discharge) following the procedure. Method(s): A 5-year (2013-2018) retrospective review was performed on children treated with VATS and chest drain for empyema. The study was approved by the local ethics committee (RES-18-0000-071Q). Statistics: results are reported as number of cases (%) and median (range). Correlation and logistic regression analysis were performed. Result(s): We identified 62 children, 36 (58%) males, with a median age of 3.6 (0.4-14.5) years treated over the 5-year period. Presentation was: autumn 12 (19%), winter 19 (31%), spring 19 (31%) and summer 12 (19%) patients. Median post-operative follow-up was 47 (9-489) days. Streptococcus species were identified in 35 (56%) of cultures from pleural fluid. Chest drain was left in situ for a median of 4 (2-13) days. Four (6%) children required a second procedure (3 VATS, 1 thoracotomy). Median duration of pre-operative symptoms before the VATS procedure was 9 (4-17) days. Median post-operative length of stay was 8 (3-28) days and duration of oral antibiotics therapy after discharge was 28 (3-42) days. Thirty-nine (63%) required post-operative oxygen therapy for 3 (1-16) days. There was no correlation between the duration of pre-operative symptoms at the time of VATS and post-operative length of stay (r = -.03 [95% CI-0.3-0.2]; P = 0.7] (Figure) Post-operative x-ray was available for 56 (90%) patients and documented persisting lung or pleural abnormalities in 47 (84%). Logistic regression analysis failed to identify any predisposing factors for persisting x-ray abnormalities (P = 0.63). Conclusion(s): We found a significant incidence of persisting abnormalities on post-operative x-ray following VATS with chest drain for empyema in children. Long-term follow-up of children following VATS might be indicated to identify patients at risk of chronic respiratory pr

Background: Children's exposure to other people's tobacco smoke (environmental tobacco smoke, or ETS) is associated with a range of adverse health outcomes for children. Parental smoking is a common source of children's exposure to ETS. Older children in child care or educational settings are also at risk of exposure to ETS. Preventing exposure to ETS during infancy and childhood has significant potential to improve children's health worldwide. Objective(s): To determine the effectiveness of interventions designed to reduce exposure of children to environmental tobacco smoke, or ETS. Search Method(s): We searched the Cochrane Tobacco Addiction Group Specialised Register and conducted additional searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Education Resource Information Center (ERIC), and the Social Science Citation Index & Science Citation Index (Web of Knowledge). We conducted the most recent search in February 2017. Selection Criteria: We included controlled trials, with or without random allocation, that enrolled participants (parents and other family members, child care workers, and teachers) involved in the care and education of infants and young children (from birth to 12 years of age). All mechanisms for reducing children's ETS exposure were eligible, including smoking prevention, cessation, and control programmes. These include health promotion, social-behavioural therapies, technology, education, and clinical interventions. Data Collection and Analysis: Two review authors independently assessed studies and extracted data. Due to heterogeneity of methods and outcome measures, we did not pool results but instead synthesised study findings narratively. Main Result(s): Seventy-eight studies met the inclusion criteria, and we assessed all evidence to be of low or very low quality based on GRADE assessment. We judged nine studies to b

Introduction/Aim: The audio characteristics of abnormal paediatric breath sounds are not well-defined and digital techniques to capture them have not been widely investigated. Our study aimed to define the audiological features of abnormal paediatric breath sounds objectively and compare the ability of digital stethoscopes to detect them against auscultation using standard bell-and-diaphragm stethoscopes. Method(s): Twenty children with normal breath sounds, generalized wheeze or crackles, and some with a diagnosis of cystic fibrosis were auscultated by a paediatric consultant and digitally recorded using both the LittmanTM 3200 Digital Electronic Stethoscope and a ClinicloudTM Digital Stethoscope. We used spectrographic analysis and recording playback to detect abnormal breath sounds and define their audio waveform characteristics. Result(s): Digital stethoscopes were more sensitive than standard auscultation in detecting wheeze in our study. Patients with clinicallydescribed wheeze had periodic waveform segments of increased intensity and frequency compared to background breath sounds, mostly spanning expiration for a period of 0.03-1.2 seconds at frequencies of 100-1050Hz, and occasionally spanning shorter inspiratory segments. Recordings of patients with crackles revealed brief (6-20 millisecond) discontinuous sounds with a distinguishing waveform identifiable within them. Conclusion(s): Digital breath sound analysis may be more sensitive than manual auscultation in detecting breath sound abnormalities in children, with potential applications for improved diagnosis, data sharing and disease monitoring. Further research and development is needed.

Background: Children's exposure to other people's cigarette smoke (environmental tobacco smoke, or ETS) is associated with a range of adverse health outcomes for children. Parental smoking is a common source of children's exposure to ETS. Older children are also at risk of exposure to ETS in child care or educational settings. Preventing exposure to cigarette smoke in infancy and childhood has significant potential to improve children's health worldwide. Objective(s): To determine the effectiveness of interventions aiming to reduce exposure of children to ETS. Search Method(s): We searched the Cochrane Tobacco Addiction Group Specialized Register and conducted additional searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, EMBASE, CINAHL, ERIC, and The Social Science Citation Index & Science Citation Index (Web of Knowledge). Date of the most recent search: September 2013. Selection Criteria: Controlled trials with or without random allocation. Interventions must have addressed participants (parents and other family members, child care workers and teachers) involved with the care and education of infants and young children (aged 0 to 12 years). All mechanisms for reduction of children's ETS exposure, and smoking prevention, cessation, and control programmes were included. These include health promotion, social-behavioural therapies, technology, education, and clinical interventions. Data Collection and Analysis: Two authors independently assessed studies and extracted data. Due to heterogeneity of methodologies and outcome measures, no summary measures were possible and results were synthesised narratively. Main Result(s): Fifty-seven studies met the inclusion criteria. Seven studies were judged to be at low risk of bias, 27 studies were judged to have unclear overall risk of bias and 23 studies were judged to have high risk of bias. Seven interventions were targeted at populations or community settings, 23 studies were conduc

Our study aimed to objectively describe the audiological characteristics of wheeze and crackles in children by using digital stethoscope (DS) auscultation, as well as assess concordance between standard auscultation and two different DS devices in their ability to detect pathological breath sounds. Twenty children were auscultated by a paediatric consultant doctor and digitally recorded using the LittmanTM 3200 Digital Electronic Stethoscope and a ClinicloudTM DS with smart device. Using spectrographic analysis, we found those with clinically described wheeze had prominent periodic waveform segments spanning expiration for a period of 0.03-1.2 s at frequencies of 100-1050 Hz, and occasionally spanning shorter inspiratory segments; paediatric crackles were brief discontinuous sounds with a distinguishing waveform. There was moderate concordance with respect to wheeze detection between digital and standard binaural stethoscopes, and 100% concordance for crackle detection. Importantly, DS devices were more sensitive than clinician auscultation in detecting wheeze in our study. Conclusion(s): Objective definition of audio characteristics of abnormal paediatric breath sounds was achieved using DS technology. We demonstrated superiority of our DS method compared to traditional auscultation for detection of wheeze.What is Known:* The audiological characteristics of abnormal breath sounds have been well-described in adult populations but not in children.* Inter-observer agreement for detection of pathological breath sounds using standard auscultation has been shown to be poor, but the clinical value of now easily available digital stethoscopes has not been sufficiently examined.What is New:* Digital stethoscopes can objectively define the nature of pathological breath sounds such as wheeze and crackles in children.* Paediatric wheeze was better detected by digital stethoscopes than by standard auscultation performed by an expert paediatric clinician.Copyright © 2017, Spring

IMPORTANCE Reducing child exposure to tobacco smoke is a public health priority. Guidelines recommend that health care professionals in child health settings should address tobacco smoke exposure (TSE) in children. OBJECTIVE To determine the effectiveness of interventions delivered by health care professionals who provide routine child health care in reducing TSE in children. DATA SOURCES A secondary analysis of 57 trials included in a 2014 Cochrane review and a subsequent extended searchwas performed. Controlled trials (published through June 2015) of interventions that focused on reducing child TSE, with no restrictions placed on who delivered the interventions,were identified. Secondary data extractionwas performed in August 2015. STUDY SELECTION Controlled trials of routine child health care delivered by health care professionals (physicians, nurses, medical assistants, health educators, and dieticians) that addressed the outcomes of interest (TSE reduction in children and parental smoking behaviors) were eligible for inclusion in this review and meta-Analysis. DATA EXTRACTION AND SYNTHESIS Study details and quality characteristicswere independently extracted by 2 authors. If outcome measures were sufficiently similar, meta-Analysis was performed using the random-effects model by DerSimonian and Laird. Otherwise, the results were described narratively. MAIN OUTCOMES AND MEASURES The primary outcome measurewas reduction in child TSE. Secondary outcomes of interest were parental smoking cessation, parental smoking reduction, and maternal postpartum smoking relapse prevention. RESULTS Sixteen studiesmet the selection criteria. Narrative analysis of the 6 trials that measured child TSE indicated no intervention effects relative to comparison groups. Similarly, meta-Analysis of 9 trials that measured parental smoking cessation demonstrated no overall intervention effect (n = 6399) (risk ratio 1.05; 95%CI, 0.74-1.50; P = .78). Meta-Analysis of the 3 trials that measur

Background: Previous studies have identified inadequate management of procedural pain in paediatric emergency department patients.1 Staff perceptions of children's procedural pain and distress are likely to influence choice of treatment and efforts to manage discomfort. Although there is one previous study from a tertiary paediatric ED,2 most other information is from other settings such as paediatric oncology,3 adult emergency medicine,4 and adult palliative care.5 Objectives: To determine staff perceptions of pain and distress across a range of common paediatric clinical procedures, and to compare perceptions between various groups of staff (ED vs non-ED; medical vs nursing; experienced vs non-experienced). Method(s): Cross-sectional, previously validated survey2 of health professionals in ED, inpatient and ambulatory settings. Respondents were asked to record their previous procedural experience and perception of the pain and distress associated with each procedure (using a 100 mm visual analogue scale). Subgroup analysis was planned for ED vs non-ED staff; medical vs nursing staff; and experienced (>50 procedures) vs inexperienced (0-10 procedures). Result(s): 215 responses out of approximately 800 potential respondents. 108 responses from medical staff, 80 from nursing staff, and 23 from allied health staff. 7.9% of respondents were senior nurses, and 11.6% were consultant medical staff. The procedures considered most painful were burns dressing (78 mm [IQR 59 - 93 mm]), intravenous access (66 mm [IQR 39 - 76 mm]), intramuscular injection (64 mm [IQR 42 - 77 mm]) and suprapubic aspiration (63 mm [IQR 45 - 77 mm]). Those rated as most distressing were burns dressing (82 mm [IQR 70 - 92 mm]), nasogastric tube insertion (80 mm [IQR 67 - 90 mm]), intravenous access (77 mm [IQR 63 - 90 mm]) and suprapubic aspiration (73 mm [IQR 53 - 86 mm]). All procedures had higher overall ratings for distress than for pain. Significant differences were found between subgroups for

Background: We present the case of a male infant diagnosed with an anterior cystic neck mass at 21 weeks gestation. This had grown, proportional to the fetus, until delivery at 34 weeks gestation. The tracheoesophageal displacement index was 18 mm, indicating a critically compromised airway. It was postnatally identified as a low flow venous vascular malformation which on MRI had affected the posterior pharynx, tongue, anterior neck and mediastinum. Method(s): The baby was delivered using an EXIT procedure following preterm labour. He remained dependent on an endotracheal tube for airway patency and tracheostomy was performed, after debulking of the mass, at 5 months of age. A sclerotherapy regime was initiated at three months of age, with a combination of agents: 100% ethanol (3.5-13 ml per session), histoacryl: lipiodol mixture (4.5-9 ml per session) and bleomycin (3-10 IU per session). These were performed under general anaesthesia using fluoroscopic guidance. Result(s): On several occasions following sclerotherapy, the infant developed a transient oxygen requirement and inflammatory response. After the eighth administration of sclerosants, this progressed to intractable respiratory failure. Pneumonitis secondary to bleomycin was suspected. He required ventilation in 100% oxygen, HFOV, and iNO and was transferred on ECMO to an associated tertiary hospital for ongoing life support. He passed away ten days later due to complications of right-sided cardiac failure. Conclusion(s): Vascular malformations affecting the airway are difficult to manage, with high risks of morbidity and mortality. More study is required to examine the safety and efficacy of sclerosant agents in younger patients.

Introduction: There is a wide range of bacterial causes for childhood empyema worldwide; however the bacterial causes in Australia are unknown. The 7-valent conjugate pneumococcal vaccine (7vPCV) was added to the national immunisation program in Australia in 2005. Aim(s): To determine the causative bacterial pathogens and pneumococcal serotypes of childhood empyema in Australia, and the efficacy of the 7vPCV. Method(s): A research network comprising all 13 major paediatric hospitals in Australia recruited empyema patients over a 2 year period. Blood and pleural fluid underwent standard culture. Additionally all pleural fluid underwent polymerase chain reaction (PCR) to identify Streptococcus pneumoniae (SP) - targeting autolysin (lytA), Haemophilus influenzae (HI), Mycoplasma pneumoniae, Chlamydia pneumoniae, Staphylococcus aureus (SA) and methicillin-resistant SA (MRSA). All SP PCR-positive specimens were tested using multiplex PCR reverse line blot assays to identify individual, or groups of related serotypes. Result(s): 143 children, 81 male, median age 4.9 (range 0.4-15.5) years were recruited. of 124 blood cultures; 27 (21.8%) were positive as follows: SP, n=16 (59.3%); Streptococcus pyogenes, n=2 (7.4%); coagulase-negative staphylococcus n=3 (11.1%); Neisseria meningitidis, n=1 (3.7%); HI, n=1 (3.7%); MRSA, n=1 (3.7%); Streptococcus sanguinis, n=1 (3.7%); Actinomyces naeslundii, n=1 (3.7%). Two bacteria were isolated from one patient: Staphylococcus hominis (3.7%) and SA (3.7%). Forty seven (33.6%) of 140 pleural fluid samples were culture positive: S. pyogenes, n=14 (29.8%); SP, n=10 (21.3%); SA, n=9 (19.1%); MRSA, n=5 (10.6%); Streptococcus milleri, n=3 (6.4%); coagulase-negative staphylococcus, n=2 (4.3%); Pseudomonas aeruginosa, n=1 (2.1%); Mycobacterium tuberculosis, n=1 (2.1%); Staphylococcus cohnii, n=1 (2.1%); Bacillus cereus, n=1 (2.1%).Two or more organisms were isolated from two subjects; one with MRSA and SA and one with Eikenella corrodens (2.1%)

Background and objective: National surveillance of invasive pneumococcal disease (IPD) includes serotyping Streptococcus pneumoniae (SP) isolates from sterile site cultures. PCR is more sensitive and can identify more SP serotypes (STs) in culture-negative samples. The aim of this study was to determine whether enhanced surveillance of childhood empyema, using PCR, provides additional serotype information compared with conventional surveillance. Method(s): Pleural fluid (PF) from children with empyema were cultured and tested by PCR to identify SP, targeting the autolysin gene (lytA). Multiplex PCR-based reverse line blot assay was used to identify SP STs. Corresponding IPD surveillance and serotype data were obtained from the National Notifiable Diseases Surveillance System (NNDSS). Result(s): Eighty-nine children with empyema, aged <=16 years, were recruited between April 2008 and March 2009, inclusive. SP was isolated from 5/84 (5.9%) PF cultures and by PCR in 43/79 (54.4%) PF samples. © 2011 Asian Pacific Society of Respirology.

An increase in the incidence of empyema worldwide could be related to invasive pneumococcal disease caused by emergent nonvaccine replacement serotypes. To determine bacterial pathogens and pneumococcal serotypes that cause empyema in children in Australia, we conducted a 2-year study of 174 children with empyema. Blood and pleural fluid samples were cultured, and pleural fluid was tested by PCR. Thirty-two (21.0%) of 152 blood and 53 (33.1%) of 160 pleural fluid cultures were positive for bacteria; Streptococcus pneumoniae was the most common organism identified. PCR identified S. pneumoniae in 74 (51.7%) and other bacteria in 19 (13.1%) of 145 pleural fluid specimens. Of 53 samples in which S. pneumoniae serotypes were identified, 2 (3.8%) had vaccine-related and 51 (96.2%) had nonvaccine serotypes; 19A (n = 20; 36.4%), 3 (n = 18; 32.7%), and 1 (n = 8; 14.5%) were the most common. High proportions of nonvaccine serotypes suggest the need to broaden vaccine coverage.

Introduction: The 7-valent conjugate Pneumococcal vaccine (7vPCV) was added to the national immunisation program in Australia in 2005. Aim(s): To identify the Pneumococcal serotypes causing childhood empyema and determine the impact of 7vPCV vaccination in this disease. Method(s): Pleural fluid was collected from all children with empyema presenting to13 paediatric hospitals across Australia over 2 years. In addition to standard culture, pleural fluid underwent polymerase chain reaction (PCR) to identify S. Pneumoniae autolysin gene (lytA) and multiplex PCR based reverse line blot assay for 23 common serotypes. Serotypes below detection level or non-typeable, were tested using PCR to target the capsular polysaccharide synthesis (cps) gene cluster. Result(s): One hundred and forty-three children, 81 male, median age 4.9 (range 0.4- 15.5) years were recruited. S. Pneumoniae was identified in: blood culture, 16/124 (12.9%); pleural fluid culture, 10/140 (7.1%); PCR, 73/143 (51%). Serotypes included: 1 (n = 8); 3 (n = 18); 19A (n = 19); 7F7A (n = 2); 6B/6A (n = 1); 9V/9A (n = 1); 14 (n = 1); 15F (n = 1); 21 (n = 1); 22F/22A (n = 2); non-typeable (n = 8).Full vaccination data were available in 43/51 (84.3%) children with identified serotypes. In 22 fully vaccinated children; no 7vPCV serotypes were detected. In 21 partially or non-vaccinated children, 3 (21%) 7vPCV serotypes were identified. Conclusion(s): 7vPCV is highly effective. An emergence of non-vaccine serotypes in childhood empyema suggests broader vaccination coverage is needed.

Indigenous children living in arid Central Australia experience frequent outbreaks of rotavirus gastroenteritis. A widespread outbreak of G9 rotavirus infection occurred several months after introduction of the RIX4414 rotavirus vaccine. We performed a retrospective case-control study to determine vaccine efficacy during the outbreak. Two doses provided an estimated vaccine efficacy of 77.7% (95% confidence interval, 40.2%-91.7%) against hospitalization for gastroenteritis. Vaccine efficacy was 84.5% (95% confidence interval, 23.4%-96.9%) against confirmed cases of rotavirus infection. Vaccination was effective in this high-burden setting.