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    Identifying genes in Parkinson disease: state of the art

    Elaine GY Chew, Jia Nee Foo and Eng-King Tan
    Med J Aust 2018; 208 (9): . || doi: 10.5694/mja17.01254
    Published online: 21 May 2018

    Recent studies are expanding our understanding of the genetic basis of Parkinson disease

    Parkinson disease (PD) is a common neurodegenerative disorder which manifests as bradykinesia, movement rigidity and tremors in affected individuals. Our understanding of the genetic basis of PD has been steadily increasing since the initial report of α-synuclein mutations two decades ago.1 Mutations implicated in familial PD fully account for monogenic inheritance and point to potential functional mechanisms underlying PD.2,3 However, most sporadic PD cannot be accounted for by known familial PD genes, with the late-onset nature of PD making further linkage studies challenging. Genome-wide association and whole exome sequencing studies have implicated a growing list of mutations and genes in PD, which are expected to provide new insights into potential pathways involved in PD pathogenicity.


    • 1 Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore
    • 2 Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
    • 3 National Neuroscience Institute, Singapore
    • 4 Duke–NUS Medical School, Singapore


    Acknowledgements: 

    Eng-King Tan acknowledges funding from the National Medical Research Council Singapore under the Singapore Translational Research Investigator Award and the Translational and Clinical Research Flagship Programme (NMRC/TCR/013-NNI/2014); Duke–NUS Medical School; and the Singapore Millennium Foundation. Jia Nee Foo is a Singapore National Research Foundation Fellow (NRF-NRFF2016-03).

    Competing interests:

    No relevant disclosures.

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      Clinical Oncology Society of Australia position statement on exercise in cancer care

      Prue Cormie, Morgan Atkinson, Lucy Bucci, Anne Cust, Elizabeth Eakin, Sandra Hayes, Alexandra L McCarthy, Andrew Murnane, Sharni Patchell and Diana Adams
      Med J Aust 2018; 209 (4): . || doi: 10.5694/mja18.00199
      Published online: 7 May 2018

      Abstract

      Introduction: Clinical research has established exercise as a safe and effective intervention to counteract the adverse physical and psychological effects of cancer and its treatment. This article summarises the position of the Clinical Oncology Society of Australia (COSA) on the role of exercise in cancer care, taking into account the strengths and limitations of the evidence base. It provides guidance for all health professionals involved in the care of people with cancer about integrating exercise into routine cancer care.

      Main recommendations: COSA calls for:

      • exercise to be embedded as part of standard practice in cancer care and to be viewed as an adjunct therapy that helps counteract the adverse effects of cancer and its treatment;
      • all members of the multidisciplinary cancer team to promote physical activity and recommend that people with cancer adhere to exercise guidelines; and
      • best practice cancer care to include referral to an accredited exercise physiologist or physiotherapist with experience in cancer care.

      Changes in management as a result of the guideline: COSA encourages all health professionals involved in the care of people with cancer to:

      • discuss the role of exercise in cancer recovery;
      • recommend their patients adhere to exercise guidelines (avoid inactivity and progress towards at least 150 minutes of moderate intensity aerobic exercise and two to three moderate intensity resistance exercise sessions each week); and
      • refer their patients to a health professional who specialises in the prescription and delivery of exercise (ie, accredited exercise physiologist or physiotherapist with experience in cancer care).

      • 1 Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC
      • 2 Youth Cancer Services South Australia and Northern Territory, Adelaide, SA
      • 3 Peter MacCallum Cancer Centre, Melbourne
      • 4 Cancer Epidemiology and Prevention Research Group, University of Sydney, Sydney, NSW
      • 5 Melanoma Institute Australia, Sydney, NSW
      • 6 University of Queensland, Brisbane, QLD
      • 7 Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD
      • 8 University of Auckland, Auckland, NZ
      • 9 Macarthur Cancer Therapy Centre, South Western Sydney Local Health District, Sydney, NSW


      Correspondence: prue.cormie@acu.edu.au
      Acknowledgements: 

      This position statement was developed with the support of the COSA Council and Exercise and Cancer Group. We acknowledge the feedback provided by the COSA members and affiliated organisations throughout the national consultation process. We also acknowledge the contribution of COSA staff who assisted in the development of the position statement. Anne Cust is supported by National Health and Medical Research Council and Cancer Institute NSW Career Development Fellowships. Sandra Hayes receives fellowship funding from Cancer Council Queensland.

      Competing interests:

      No relevant disclosures.

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        Developmental dysplasia of the hip: addressing evidence gaps with a multicentre prospective international study

        Emily K Schaeffer, IHDI Study Group and Kishore Mulpuri
        Med J Aust 2018; 208 (8): . || doi: 10.5694/mja18.00154
        Published online: 7 May 2018

        Summary

         

        • There is a lack of high quality evidence available to guide clinical practice in the treatment and management of developmental dysplasia of the hip (DDH).
        • Evidence has been limited by persistent confusion on diagnostic and classification terminology, variability in surgeon decision making and a reliance on single centre, retrospective studies with small patient numbers.
        • To address gaps in knowledge regarding screening, diagnosis and management of DDH, the International Hip Dysplasia Institute began a multicentre, international prospective study on infants with hips dislocated at rest.
        • This review discusses the current state of screening, diagnostic and management practices in DDH and addresses important unanswered questions that will be critical in identifying best practices and optimising patient outcomes.
        • There is insufficient evidence to support universal ultrasound screening; instead, selective screening should be performed by 6–8 weeks of age on infants with risk factors of breech presentation, family history, or history of clinical hip instability. Follow-up of infants with risk factors and normal initial screening should be considered to at least 6 months of age.
        • Brace treatment is a sensible first-line treatment for management of dislocated hips at rest in infants < 6 months of age.
        • Early operative reduction may be considered as there is insufficient evidence to support a protective role for the ossific nucleus in the development of avascular necrosis.

         


        • 1 BC Children's Hospital, Vancouver, Canada
        • 2 University of British Columbia, Vancouver, Canada
        • 3 Orlando Health Center, Orlando, FL, USA


        Correspondence: kmulpuri@cw.bc.ca
        Acknowledgements: 

        We thank members of the IHDI Study Group for their intellectual and data contributions to the IHDI and IHDR studies; and Niamul Quader for supplying the image and data for Box 3.

        Competing interests:

        We have received funding for research support from the registry seed grant, the IHDI, the Children’s Hospital Research Institute and the I'm a HIPpy Foundation.

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        • 45. Quader N, Hodgson A, Mulpuri K, et al. Towards reliable automatic characterization of neonatal hip dysplasia from 3D ultrasound images. In: Ourselin S, Joskowicz L, Sabuncu M, et al, editors. Medical Image Computing and Computer-Assisted Intervention – MICCAI 2016. Lecture Notes in Computer Science, vol. 9900. Springer: 2016: 602-609. https://link.springer.com/chapter/10.1007/978-3-319-46720-7_70 (viewed Mar 2018).
        • 46. Quader N, Hodgson AJ, Mulpuri K, et al. A 3D femoral head coverage metric for enhanced reliability in diagnosing hip dysplasia. In: Descoteaux M, Maier-Hein L, Franz A, et al, editors. Medical Image Computing and Computer-Assisted Intervention – MICCAI 2017. Lecture Notes in Computer Science, vol. 10433. Springer: 2017: 100-107. https://link.springer.com/chapter/10.1007/978-3-319-66182-7_12 (viewed Mar 2018).
        • 47. Ilfeld FW, Westin GW, Makin MY. Missed or developmental dislocation of the hip. Clin Orthop Relat Res 1986; 203: 276-281.
        • 48. Lennox IA, McLauchlan J, Murali R. Failures of screening and management of congenital dislocation of the hip. J Bone Joint Surg Br 1993; 75: 72-75.
        • 49. Sink EL, Ricciardi BF, Torre KD, Price CT. Selective ultrasound screening is inadequate to identify patients who present with symptomatic adult acetabular dysplasia. J Child Orthop 2014; 8: 451-455.
        • 50. Imrie M, Scott V, Stearns P, et al. Is ultrasound screening for DDH in babies born breech sufficient? J Child Orthop 2010; 4: 3-8.
        • 51. Sankar WN, Gornitzky AL, Clarke NM, et al. Closed reduction for developmental dysplasia of the hip: Early-term results from a prospective, multicenter cohort. J Pediatr Orthop 2016; doi:10.1097/BPO0000000000000895 [Epub ahead of print].
        • 52. Schaeffer EK, Mulpuri K, Sankar WN, et al. Open reduction for developmental dysplasia of the hip: early outcomes from a multi-centre, international prospective cohort study [abstract]. J Child Orthop 2017; 11 (Suppl 1): S164.
        • 53. Narayanan U, Mulpuri K, Sankar WN, et al. Reliability of a new radiographic classification for developmental dysplasia of the hip. J Pediatr Orthop 2015; 35: 478-484.
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        • 56. Rebello G, Joseph B. Late presentation of developmental dysplasia of the hip in children from southwest India – will screening help? Ind J Orthop 2003; 37: 210-214.
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        • 58. Heikkilä E, Ryöppy S, Louhimo L. Late diagnosis in congenital dislocation of the hip. Acta Orthop Scand 1984; 55: 256-260.
        • 59. Inoue T, Naito M, Nomiyama H. Treatment of developmental dysplasia of the hip with the Pavlik harness: factors for predicting unsuccessful reduction. J Pediatr Orthop B 2001; 10: 186-191.
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        • 65. Mulpuri K, Schaeffer EK, Andrade J, et al. What risk factors and characteristics are associated with late-presenting dislocations of the hip in Infants? Clin Orthop Relat Res 2016; 474: 1131-1137.
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        • 67. Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am 1980; 62: 876-888.
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        • 77. Dhar S, Taylor JF, Jones WA. Early open reduction for congenital dislocation of the hip. J Bone Joint Surg Br 1990; 72: 175-180.

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          The rate of anterior cruciate ligament reconstruction in Australia is high: a national registry is needed

          John W Orchard, Lars Engebretsen and Julian A Feller
          Med J Aust 2018; 208 (8): . || doi: 10.5694/mja18.00095
          Published online: 7 May 2018

          Supporting a registry is an investment in the long term health of our nation

          This issue of the MJA includes the results of an important study that again indicate the high rate of anterior cruciate ligament (ACL) reconstruction in Australia.1 It was already known that Australia has relatively high rates of knee ACL injuries, surgical reconstruction,2,3 and knee replacement (arthroplasty).4 The new data highlight worrying increases in the rates of both primary and revision ACL reconstruction, particularly in adolescents.1 Many factors could potentially explain an increase in the rate of ACL surgery, including more accurate diagnosis, greater access to surgery, and more people playing sport (factors that would be pleasing), but also an increase in the rate of ACL injuries per exposure (which would be disappointing). It is harder to envisage a positive explanation for an increase in the revision ACL reconstruction rate, but it is important to differentiate between contributors to failure, particularly between surgical factors (ie, techniques associated with a higher failure rate) and rehabilitation factors, such as returning to sport before adequate functional recovery has been achieved.5,6


          • 1 University of Sydney, Sydney, NSW
          • 2 University of Oslo, Oslo, Norway
          • 3 OrthoSport Victoria, Melbourne, VIC


          Correspondence: johnworchard@gmail.com
          Competing interests:

          No relevant disclosures.

          • 1. Zbrojkiewicz D, Vertullo C, Grayson JE. Increasing rates of anterior cruciate ligament reconstruction in young Australians, 2000–2015. Med J Aust 2018; 208: 354-358.
          • 2. Janssen KW, Orchard JW, Driscoll TR, et al. High incidence and costs for anterior cruciate ligament reconstructions performed in Australia from 2003–2004 to 2007–2008: time for an anterior cruciate ligament register by Scandinavian model? Scand J Med Sci Sports 2012; 22: 495-501.
          • 3. Lekkas C, Clarnette R, Graves SE, et al. Feasibility of establishing an Australian ACL registry: a pilot study by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Knee Surg Sports Traumatol Arthrosc 2017; 25: 1510-1516.
          • 4. Pabinger C, Lothaller H, Geissler A. Utilization rates of knee-arthroplasty in OECD countries. Osteoarthritis Cartilage 2015; 23: 1664-1673.
          • 5. Nagelli CV, Hewett TE. Should return to sport be delayed until 2 years after anterior cruciate ligament reconstruction? Biological and functional considerations. Sports Med 2017; 47: 221-232.
          • 6. Grindem H, Snyder-Mackler L, Moksnes H, et al. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med 2016; 50: 804-808.
          • 7. Granan LP, Forssblad M, Lind M, et al. The Scandinavian ACL registries 2004-2007: baseline epidemiology. Acta Orthop 2009; 80: 563-567.
          • 8. Magnussen RA, Trojani C, Granan LP, et al. Patient demographics and surgical characteristics in ACL revision: a comparison of French, Norwegian, and North American cohorts. Knee Surg Sports Traumatol Arthrosc 2015; 23: 2339-2348.
          • 9. Maletis GB, Granan LP, Inacio MC, et al. Comparison of community-based ACL reconstruction registries in the US and Norway. J Bone Joint Surg Am 2011; 93 Suppl 3: 31-36.
          • 10. Havelin L, Espehaug B, Vollset S, et al. The effect of the type of cement on early revision of Charnley total hip prostheses. A review of eight thousand five hundred and seventy-nine primary arthroplasties from the Norwegian Arthroplasty Register. J Bone Joint Surg Am 1995; 77: 1543-1550.
          • 11. Kolling C, Simmen B, Labek G, et al. Key factors for a successful National Arthroplasty Register. J Bone Joint Surg Br 2007; 89: 1567-1573.
          • 12. Gianotti S, Marshall S, Hume P, et al. Incidence of anterior cruciate ligament injury and other knee ligament injuries: a national population-based study. J Sci Med Sport 2009; 12: 622-627.
          • 13. Moses B, Orchard J, Orchard J. Systematic review: annual incidence of ACL injury and surgery in various populations. Res Sports Med 2012; 20: 157-179.
          • 14. Ardern CL, Ekås G, Grindem H, et al. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries. Knee Surg Sports Traumatol Arthrosc 2018; doi:10.1136/bjsports-2018-099060. [Epub ahead of print].
          • 15. Khan T, Alvand A, Prieto-Alhambra D, et al. ACL and meniscal injuries increase the risk of primary total knee replacement for osteoarthritis: a matched case-control study using the Clinical Practice Research Datalink (CPRD). Br J Sports Med 2018; doi:10.1136/bjsports-2017-097762. [Epub ahead of print].
          • 16. Taylor JB, Waxman JP, Richter SJ, et al. Evaluation of the effectiveness of anterior cruciate ligament injury prevention programme training components: a systematic review and meta-analysis. Br J Sports Med 2015; 49: 79-87.
          • 17. Orchard J, Chivers I, Aldous D, et al. Ryegrass is associated with fewer non-contact anterior cruciate ligament injuries than bermudagrass. Br J Sports Med 2005; 39: 704-709.

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            Why are so many more adolescents presenting to our emergency departments with mental health problems?

            Susan M Sawyer and George C Patton
            Med J Aust 2018; 208 (8): . || doi: 10.5694/mja18.00213
            Published online: 7 May 2018

            New data on the rise in presentations should be seen as canaries in the coal mine

            Australia has in recent decades made major investments in mental health care; government expenditure has risen rapidly,1 the availability of psychological therapies has expanded,2 antidepressant use has increased,3 and the size of the mental health workforce has grown.4 There has also been a major focus on adolescents with the national rollout of Headspace centres and early psychosis programs.5 Data in two articles in this issue of the Journal, describing trends in mental health crisis presentations by adolescents to emergency departments in Australia’s two most populous states, provide an important test of the success of these investments.


            • 1 Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC
            • 2 University of Melbourne, Melbourne, VIC
            • 3 Murdoch Children's Research Institute, Melbourne, VIC


            Correspondence: susan.sawyer@rch.org.au
            Competing interests:

            No relevant disclosures.

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              Children as haematopoietic stem cell donors: ethically challenging and legally complex

              Shih-Ning Then, Ian H Kerridge and Michael Marks
              Med J Aust 2018; 208 (8): . || doi: 10.5694/mja17.00758
              Published online: 7 May 2018

              Clinicians should be aware of the particular physical and psychological risks of haematopoietic stem cell donation in the paediatric setting, and the varying laws between states and territories

              Allogeneic donor blood and bone marrow transplantation can treat a range of malignant and non-malignant diseases. For children with aplastic anaemia, severe combined immunodeficiency, leukaemia, sickle-cell disease, thalassaemia and inborn errors of metabolism, it may provide the only possibility of cure and long term survival. Although associated with considerable recipient mortality (5–12% transplant-related mortality at one year)1 and morbidity, advances in tissue typing, supportive care, patient selection, conditioning regimens and the prevention and treatment of graft-versus-host disease have dramatically improved outcomes, with up to 80% of recipients becoming long term survivors of bone marrow transplant.2


              • 1 Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD
              • 2 Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW
              • 3 Royal Children's Hospital, Melbourne, VIC
              • 4 University of Melbourne, Melbourne, VIC


              Correspondence: Shih-Ning.Then@qut.edu.au
              Competing interests:

              Shih-Ning Then is currently a member of the NHMRC Organ and Tissue Working Committee. The views expressed in this article are those of the authors and do not represent the views of the Committee.

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                Parechovirus: an important emerging infection in young infants

                Philip N Britton, Cheryl A Jones, Kristine Macartney and Allen C Cheng
                Med J Aust 2018; 208 (8): . || doi: 10.5694/mja18.00149
                Published online: 30 April 2018

                Summary

                 

                • Epidemics of human parechovirus (HPeV) causing disease in young children have occurred every 2 years in Australia since 2013. HPeV genotype 3 caused the epidemic from late 2017 to early 2018.
                • Most HPeV infections cause no or mild symptoms including gastroenteritis or influenza-like illness. Characteristically, young infants present with fever, irritability and on occasions a diffuse rash (“red, hot and angry” babies).
                • Severe disease can manifest as meningoencephalitis, seizures or sepsis-like presentations (including septic shock), or less common presentations including signs of surgical abdomen.
                • Testing for HPeV by specific molecular tests is indicated in children younger than 6 months of age with characteristic presentations without another confirmed diagnosis including febrile illnesses with other suggestive features (eg, rash, seizures), sepsis syndromes (including shock), and suspected meningoencephalitis (which may be detected by magnetic resonance imaging only).
                • There are no effective antiviral therapies. Treatment is primarily supportive, including management of complications.
                • Some infants with severe HPeV infection may have adverse neurodevelopment. Follow-up by a paediatrician is recommended.

                 


                • 1 University of Sydney, Sydney, NSW
                • 2 The Children's Hospital at Westmead, Sydney, NSW
                • 3 University of Melbourne, Melbourne, VIC
                • 4 Melbourne Academic Centre for Health, Melbourne, VIC
                • 5 National Centre for Immunisation Research and Surveillance, Sydney, NSW
                • 6 Monash University, Melbourne, VIC


                Correspondence: allen.cheng@monash.edu
                Acknowledgements: 

                Allen Cheng and Philip Britton are supported by NHMRC Fellowship funding. We thank the PAEDS surveillance nurses and investigators and investigators on the Australian childhood encephalitis and related studies including Julia Clark, Nigel Crawford, Jim Buttery, Christopher Blyth, Joshua Francis, Brendan McMullan, Alison Kesson, Nicole Dinsmore, Alissa McMinn, Sonia Dougherty, Carolyn Finucane and Christine Heath.

                Competing interests:

                No relevant disclosures.

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                  Presentations to NSW emergency departments with self-harm, suicidal ideation, or intentional poisoning, 2010–2014

                  Jayashanki Perera, Timothy Wand, Kendall J Bein, Dane Chalkley, Rebecca Ivers, Katharine S Steinbeck, Robyn Shields and Michael M Dinh
                  Med J Aust 2018; 208 (8): . || doi: 10.5694/mja17.00589
                  Published online: 23 April 2018

                  Abstract

                  Objective: To evaluate population trends in presentations for mental health problems presenting to emergency departments (EDs) in New South Wales during 2010–2014, particularly patients presenting with suicidal ideation, self-harm, or intentional poisoning.

                  Design, setting and participants: This was a retrospective, descriptive analysis of linked Emergency Department Data Collection registry data for presentations to NSW public hospital EDs over five calendar years, 2010–2014. Patients were included if they had presented to an ED and a mental health-related diagnosis was recorded as the principal diagnosis.

                  Main outcome measures: Rates of mental health-related presentations to EDs by age group and calendar year, both overall and for the subgroups of self-harm, suicidal ideation and behaviour, and intentional poisoning presentations.

                  Results: 331 493 mental health-related presentations to 115 NSW EDs during 2010–2014 were analysed. The presentation rate was highest for 15–19-year-old patients (2014: 2167 per 100 000 population), but had grown most rapidly for 10–14-year-old children (13.8% per year). The combined number of presentations for suicidal ideation, self-harm, or intentional poisoning increased in all age groups, other than those aged 0–9 years; the greatest increase was for the 10–19-year-old age group (27% per year).

                  Conclusions: The rate of mental health presentations to EDs increased significantly in NSW between 2010 and 2014, particularly presentations by adolescents. Urgent action is needed to provide better access to adolescent mental health services in the community and to enhance ED models of mental health care. The underlying drivers of this trend should be investigated to improve mental health care.

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                  • 1 Royal Prince Alfred Hospital, Sydney, NSW
                  • 2 Sydney Nursing School, University of Sydney, Sydney, NSW
                  • 3 The George Institute for Global Health, Sydney, NSW
                  • 4 Flinders University, Adelaide, SA
                  • 5 University of Sydney, Sydney, NSW
                  • 6 Sydney Medical School, University of Sydney, Sydney, NSW


                  Acknowledgements: 

                  We acknowledge the NSW Ministry of Health and the Centre for Health Record Linkage (CHeReL) for granting access to and linkage of the data. This project was funded by the NSW Agency for Clinical Innovation and Emergency Care Institute.

                  Competing interests:

                  No relevant disclosures.

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                    Tick-induced allergies: mammalian meat allergy and tick anaphylaxis

                    Sheryl A van Nunen
                    Med J Aust 2018; 208 (7): . || doi: 10.5694/mja17.00591
                    Published online: 16 April 2018

                    Summary

                     

                    • Mammalian meat allergy after tick bites and tick anaphylaxis are the most serious tick-induced allergies. They are often severe, should be largely avoidable and offer fascinating insights into the development and prevention of allergies.
                    • Australian clinicians reported the first cases of tick anaphylaxis and discovered the association between tick bites and the development of mammalian meat allergy. The subsequent finding of the allergen epitope within the meat responsible for the allergic reaction, α-gal (galactose-α-1,3-galactose), stimulated further interest in this emergent allergy.
                    • Reports of mammalian meat allergy associated with bites from several tick species have now come from every continent where humans are bitten by ticks. The number of diagnosed patients has continued to rise.
                    • Clinically, mammalian meat allergy and tick anaphylaxis present quite differently. The prominent role of cofactors in triggering episodes of mammalian meat allergy can make its diagnosis difficult.
                    • Management of mammalian meat allergy is complicated by the manifold potential therapeutic implications due to the widespread distribution of the mammalian meat allergen, α-gal. Exposures to α-gal-containing medications have proved lethal in a minority of people, and fatal tick anaphylaxis has been reported in Australia. Prevention of tick bites is prudent and practicable; killing the tick in situ is crucial to both primary and secondary prevention of allergic reactions.
                    • Mechanisms in the development of mammalian meat allergy constitute a paradigm for how allergies might arise.

                     


                    • 1 Royal North Shore Hospital, Sydney, NSW
                    • 2 Tick-Induced Allergies Research and Awareness Centre, Sydney, NSW


                    Correspondence: vannunen@med.usyd.edu.au
                    Competing interests:

                    No relevant disclosures.

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                      Damp housing, gas stoves, and the burden of childhood asthma in Australia

                      Luke D Knibbs, Solomon Woldeyohannes, Guy B Marks and Christine T Cowie
                      Med J Aust 2018; 208 (7): . || doi: 10.5694/mja17.00469
                      Published online: 16 April 2018

                      Abstract

                      Objective: To determine the proportion of the national childhood asthma burden associated with exposure to dampness and gas stoves in Australian homes.

                      Design: Comparative risk assessment modelling study.

                      Setting, participants: Australian children aged 14 years or less, 2011.

                      Main outcome measures: The population attributable fractions (PAFs) and number of disability-adjusted life years (DALYs) for childhood asthma associated with exposure to damp housing and gas stoves.

                      Results: 26.1% of Australian homes have dampness problems and 38.2% have natural gas as the main energy source for cooktop stoves. The PAF for childhood asthma attributable to damp housing was 7.9% (95% CI, 3.2–12.6%), causing 1760 disability-adjusted life years (DALYs; 95% CI, 416–3104 DALYs), or 42 DALYs/100 000 children. The PAF associated with gas stoves was 12.3% (95% CI, 8.9–15.8%), corresponding to 2756 DALYs (95% CI, 1271–4242), or 67 DALYs/100 000 children. If all homes with gas stoves were fitted with high efficiency range hoods to vent gas combustion products outdoors, the PAF and burden estimates were reduced to 3.4% (95% CI, 2.2–4.6%) and 761 DALYs (95% CI, 322–1199).

                      Conclusions: Exposure to damp housing and gas stoves is common in Australia, and is associated with a considerable proportion of the childhood asthma burden. Strategies for reducing exposure to indoor dampness and gas combustion products should be communicated to parents of children with or at risk of asthma.

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                      • 1 University of Queensland, Brisbane, QLD
                      • 2 Woolcock Institute of Medical Research, Sydney, NSW
                      • 3 Liverpool Hospital, Sydney, NSW
                      • 4 South Western Sydney Clinical School, University of New South Wales, Sydney, NSW


                      Correspondence: l.knibbs@uq.edu.au
                      Acknowledgements: 

                      This work was supported by the National Health and Medical Research Council (Luke Knibbs: Early Career Fellowship [APP1036620]; Guy Marks: Centres of Research Excellence grant [APP1030259]), the Centre for Air Quality and Health Research and Evaluation (Luke Knibbs, Christine Cowie: postdoctoral fellowships), and the New South Wales Ministry of Health (funding to Christine Cowie and Guy Marks).

                      Competing interests:

                      No relevant disclosures.

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