Institute for Respiratory Health

Research on the health literacy of parents with children with intellectual disability is limited. Understanding parents' healthcare skills and needs is essential for improving children's health and developing effective support. In this study we aimed to (1) explore the health literacy skills of parents that enabled them to support the health needs of their child with intellectual disability and the factors influencing these skills, and (2) identify opportunities to support parent health literacy. A qualitative study was carried out using interviews with 24 parents of children and young people with intellectual disability. A directed content analysis was completed, guided by the nine domains included in the Health Literacy Questionnaire. Participants demonstrated strong health literacy skills; however, there was diversity in their strengths and needs across different domains of health literacy. Navigating healthcare systems was the key area where participants faced challenges and required further support. Participants described factors including educational levels, professional expertise, experiences over time, and relationships with healthcare professionals which influenced their health literacy. Opportunities to improve health literacy were identified, addressing parents, healthcare professionals, and healthcare and disability services. Developing and maintaining health literacy is critical to parents supporting the health of children with intellectual disability. These results provide insight into how health literacy interventions can be designed to support parent health literacy. The study provides participants' recommendations for how healthcare professionals can support parent health literacy. These recommendations relate to the health literacy responsiveness of the professional and service.

To systematically review and analyze the effects of photobiomodulation on oral mucositis, xerostomia, salivary flow rates, oral pain, and quality of life in patients with head and neck cancer. A systematic search of six databases was conducted up to April 2025. Eligible randomized controlled trials (RCTs) examined the effects of photobiomodulation on the specified outcomes in patients with head and neck cancer. Pooled estimates (risk ratio [RR] and standardized mean difference [SMD]) were calculated using a three-level mixed-effects meta-analysis. Thirty-three articles describing 30 RCTs (n = 1748) were included. Photobiomodulation significantly reduced the risk of severe oral mucositis (RR 0.46, 95% CI: 0.29-0.71, P < 0.001) and severe oral pain (RR 0.35, 95% CI: 0.23-0.53, P < 0.001) compared with controls. Significant improvements were also observed for salivary flow rate (SMD 0.75, 95% CI: 0.03-1.46, P = 0.044). No significant effects were observed on xerostomia (SMD -0.07, 95% CI: -0.47-0.33, P = 0.646) and quality of life (SMD 1.06, 95% CI: -0.03-2.14, P = 0.060). The benefits were consistent across different photobiomodulation protocols for oral mucositis and quality of life. Photobiomodulation appears to be a promising supportive care intervention, reducing the risk of severe mucositis and oral pain, while potentially improving salivary flow rates and preserving quality of life in patients with head and neck cancer. However, the certainty of the evidence ranged from very low to low and most included studies presented a high risk of bias; therefore, these findings should be interpreted with caution.

BackgroundThe laboratory diagnosis of tuberculous pleuritis (TBP) is hindered by the paucibacillary nature of Mycobacterium tuberculosis in the pleural space, resulting in low sensitivity of microbiological culture and polymerase chain reaction–based analyses on pleural fluid. The use of metagenomic next-generation sequencing for diagnosing TBP may be limited by the background noise of DNA from nontuberculous mycobacteria.MethodsWe performed targeted sequencing to analyze M. tuberculosis DNA in paired pleural fluid and plasma from prospectively enrolled consecutive patients with new-onset pleural effusion. We used a bioinformatics alignment algorithm to the M. tuberculosis genome that was masked for regions with high sequence similarity to nontuberculous mycobacteria. Our primary outcome was a comparison of diagnostic sensitivity between M. tuberculosis sequencing as described above and culture using McNemar’s test.ResultsAmong the included 329 patients with pleural effusion, 34 patients with TBP were identified. Targeted sequencing detected M. tuberculosis DNA fragments in the pleural fluid of all TBP cases (median, 267.6 reads per 10 million [RP10M]; interquartile range [IQR], 30.8–2644.3) but absent in 288 out of 295 (97.6%) non-TBP samples (median, 0 RP10M; IQR, 0–0). Targeted sequencing of pleural fluid achieved a sensitivity of 97.1% for TBP detection at a cutoff of 2 RP10M, in contrast to 47.1% by M. tuberculosis culture (P<0.001, McNemar’s test). Sequencing yielded an area-under-the-curve value of 0.9996 (95% confidence interval, 0.9988–1.0000) for differentiating TBP and non-TBP. Plasma analysis by targeted sequencing with the same alignment algorithm reported an area-under-the-curve value of 0.9475 (95% confidence interval, 0.8929–1.0000).ConclusionsTargeted sequencing of pleural fluid with selectively masked M. tuberculosis genomic alignment accurately diagnosed TBP and outperformed conventional diagnostic tests. (Supported by InnoHK and the Hong Kong Tuberculosis, Chest and Heart Diseases Association; ClinicalTrials.gov number, NCT05397730.)

Exercise medicine has gained significant recognition owing to its demonstrated benefits throughout the breast cancer treatment continuum. While resistance exercise (RE) promotes improvements in lean mass and muscle strength, aerobic exercise (AE) enhances cardiorespiratory fitness, with several studies investigating both exercise modes in patients with breast cancer. However, because of an effect often referred to as interference effect, it is hypothesised that combining resistance and aerobic exercise (COMB) may compromise gains in lean mass and muscle strength and other outcomes in cancer populations. This study aims to investigate the presence of an interference effect from prescribing COMB compared with RE on fatigue, lean mass, physical function and muscle strength in women with breast cancer. In addition, it examines a range of demographic, clinical and exercise prescription moderators within this population. We searched seven databases from inception to January 2024 (PROSPERO CRD42023491118), with an updated search in April 2025. Eligible trials examined the effects of RE, AE and/or COMB in women diagnosed with breast cancer. The primary outcomes for this review were cancer-related fatigue, lean mass, physical function and/or lower-limb muscle strength. A random-effects network meta-analysis was undertaken to examine the effect of different exercise programs and controls, with specific focus on the comparisons between RE and COMB. Differences between RE and COMB above 0.20 standardised mean difference (SMD) were an indicative of a potential interference effect. We included a total of 131 articles describing 116 randomised trials (n = 9206). Both RE (SMD - 0.52, 95% CI - 0.83 to - 0.21, p = 0.001) and COMB (SMD - 0.47, 95% CI - 0.65 to - 0.29, p < 0.001) similarly reduced fatigue compared with controls. However, a potential interference effect was observed on fatigue during surgery (SMD - 0.23, 95% CI - 0.58 to 0.12, p = 0.191) and chemotherapy (SMD - 0.22, 95% CI - 0.59 to 0.16, p = 0.257), with RE showing greater benefits than COMB. For physical function, both RE (SMD 0.86, 95% CI 0.41-1.30, p < 0.001) and COMB (SMD 0.90, 95% CI 0.58-1.22, p < 0.001) improved outcomes compared with controls, though RE was superior to COMB in patients receiving hormone therapy (SMD 0.62, 95% CI - 0.56 to 1.81, p = 0.303). Differences between RE and COMB in lean mass (MD 0.18kg, 95% CI - 0.17-0.53kg, p = 0.303) and muscle strength (SMD 0.43, 95% CI - 0.01-0.86, p = 0.056) were not significant in the main analyses; however, sensitivity analyses omitting the outliers indicated significant differences favouring RE for lean mass (MD 0.36kg, 95% CI 0.15-0.57kg, p < 0.001) and muscle strength (SMD 0.40, 95% CI 0.08-0.71, p = 0.014). Our findings emphasise the importance of personalised exercise medicine targeted to treatment characteristics in women with breast cancer. While COMB may offer benefits across the outcomes investigated, prescribing RE alone may be preferable to minimize potential interference effects on lean mass and muscle strength, regardless of demographic, clinical and exercise prescription characteristics, as well as fatigue and physical function tests, particularly during adjuvant and hormonal therapies.

Abdominal pain is a common pediatric presentation in the emergency department (ED), and acute appendicitis (AA) is the most common surgical diagnosis. This study describes the management of suspected AA in a tertiary Australian pediatric ED. A single-center prospective observational study was performed between November 2022 and May 2023. Children aged 5 to 15 years presenting to the ED with acute abdominal pain and clinician suspicion of AA were included. Clinical gestalt was measured using a 5-point Likert Scale before and after blood tests. Diagnosis of AA was confirmed on histopathology, and non-AA was confirmed with follow-up at 30 to 60 days. The study enrolled 481 children; AA was diagnosed in 146 (30.6%). Patients with AA were older (11.1 vs. 10.0y) and more likely to be male (69.2% vs. 48.1%) compared with those without AA. Blood tests were performed in 449 (93.3%) children, with higher rates in AA cases (100% vs. 90.4%). Gestalt improved with blood test results, with overall diagnostic accuracy increasing from 65.9% pre-blood tests to 88.5% post-blood tests. Ultrasound (US) was performed in 361 (75.1%) children with a diagnostic accuracy of 90.6% and was frequently used even in patients deemed low-risk post-blood tests (65.7%). One hundred and fifty (31.2%) of suspected AA cases underwent surgery, with 3 negative appendectomies and 1 ovarian cystectomy without appendectomy. Median (IQR) hospital length of stay was significantly longer for AA cases than non-AA cases [50.8 (35.3 to 95.0) h vs. 7.1 (4.6 to 16.8) h]. This study reviews the management and outcomes of suspected AA in a high-volume Australian ED. It shows the importance of blood tests in improving diagnostic accuracy of clinician gestalt and highlights the potential overuse of US in low-risk patients. Future research should explore a more structured diagnostic approach to increase diagnostic accuracy, optimize resource utilization, and improve patient outcomes.

This study aimed to determine the self-reported impacts of COVID-19 on healthcare disruption for persons with multiple sclerosis (MS) in Australia and the personal characteristics and service factors associated with disruption. We used 2020 data from the Australian MS Longitudinal Study survey. We used univariate and backward-stepwise regression to explore the disease-related and demographic predictors of: i) the self-perceived influence of COVID-19 on medical care; and ii) the impact of reduced access to health services on health. We also quantified the cumulative impact reduced access to each health service had on the cohort, incorporating the volume and severity of the impact on health. Of the 1484 participants who provided data, 548 (36.9 %) participants reported the pandemic influenced their medical care. Participants who reported the pandemic influenced their medical care had a younger age, more comorbidities and more disability. 454 (30.6 %) participants reported that reduced access to health services impacted their health. Reduced access was most commonly reported for general practice (311, 21 %), neurology (246, 16.6 %) and physiotherapy (214, 14.4 %). Reduced access to physiotherapy had the greatest cumulative impact on health. The cumulative personal impact of reduced access across all health services was associated with several factors, including younger age, female sex and disability. One-third of Australians with MS experienced healthcare disruptions during the first year of the COVID-19 pandemic, with the reduced access to physiotherapy most significantly impacting health. The study underscores the importance of continuity of healthcare services during future crises and underscores the need for robust strategies such as hybrid healthcare models and telehealth frameworks to guard against risks to service delivery in the future.

BackgroundBlood eosinophils have become an invaluable tool in the assessment, management, and prognostication of patients with asthma and chronic obstructive pulmonary disease (COPD). Historically, the understanding and application of blood eosinophil counts (BEC) have been primarily based on data from high-income countries, with limited information available from developing regions, including the Indian subcontinent.Research QuestionThis study aims to assess the distribution and clinical relevance of BEC among patients with asthma and COPD as well as healthy volunteers across India, to determine if patterns observed in Western studies hold true in an Indian setting.Study Design and MethodsA multi-centre cross-sectional study was conducted at 16 clinics across India. Participants included patients diagnosed with asthma or COPD and healthy volunteers who were identified from referrals to these clinics. Comprehensive data collection involved demographics, medication use, smoking status, and pre- and post-bronchodilator spirometry. All participants underwent a laboratory full blood count.ResultsThe study comprised 4782 adults, including 1,332 patients with asthma (571 males, 761 females), 1,001 patients with COPD (691 males, 310 females), and 2,449 healthy volunteers (1,399 males, 1,050 females). Among patients with asthma, the mean BEC was higher at geometric mean 173.9 [156.2, 193.6]; patients with COPD had a mean BEC of 198.4 [178.6, 220.4] which was significantly higher than that of healthy volunteers (144.7 [134.5, 155.5]).InterpretationThe range of eosinophils in the contemporary Indian population aligns with data from Europe, affirming the validity of using BEC as a biomarker in obstructive lung disease within the Indian demographic. This insight challenges the prevailing assumption of distinct eosinophil count profiles in different geographical regions and underscores the global applicability of eosinophil-based management strategies for asthma and COPD.

RationaleThe precise nature of small airway obstructions in chronic obstructive pulmonary disease (COPD) remains poorly understood, especially at early disease stages.ObjectivesThis study aimed to characterize small airway obstructions and numbers up to the terminal bronchioles (TBs) in smokers with limited emphysema and end-stage COPD. We hypothesized that obstruction subtypes would differ in morphology, nature, and number from early to end-stage COPD.MethodsWhole lungs were inflated and processed from seven control donors (control: declined for extrapulmonary reasons); from eight donors with a history of smoking, of whom three had <5% emphysema (smokers with no emphysema) and five had >5% emphysema (smokers with emphysema); and from eight patients with end-stage COPD. Micro–computed tomography of tissue was used to assess number of TBs, aerated TBs, and number and type of obstructions and was cross-correlated with histopathology.Measurements and Main ResultsObstructions were mainly present in smokers with emphysema and patients with COPD, resulting in less aerated TBs. On the basis of emphysema extent, more nonaerated TBs were present in regions with no emphysema than in regions with mild emphysema; however, destruction was more prominent in mild emphysema. Multiple types of obstructions were identified, comprising occlusions, webs, and collapses. In smokers with emphysema, obstructions primarily comprised webs and occlusions, whereas all obstruction types were present in COPD. On histopathology, obstructions were identified as mucus plugs.ConclusionsMultiple types of obstruction characterized as mucus plugs were identified in smokers with emphysema and patients with end-stage COPD. Their morphology, nature, and number evolved from smokers with emphysema to end-stage COPD. A shift from obstruction-dominant dysfunction to destruction-dominant pathology was found in smokers on the basis of emphysema presence.

<bold>Background:</bold> Evaluation of multiple endpoints in clinical trials is often limited by endpoints of lower clinical importance. Win ratios are used to categorize multiple outcomes by clinical importance. <bold>Aims & Objectives:</bold> This post hoc analysis uses win ratios to compare dupilumab efficacy vs placebo in BOREAS and NOTUS. <bold>Methods:</bold> BOREAS (<ext-link>NCT03930732</ext-link>) and NOTUS (<ext-link>NCT04456673</ext-link>), phase 3 randomized, double-blind, placebo-controlled trials, enrolled patients with COPD, and type 2 inflammation (screening blood eosinophil count ≥300 cells/µL) on LABA/LAMA/ICS. Patients received add-on dupilumab 300 mg or placebo q2w for 52 weeks. Win ratio analysis compared each patient on dupilumab to each patient on placebo for time-to-event and occurrence-of-event. Endpoints were ordered based on clinical priority. <bold>Results:</bold> Evaluation of the pooled population (dupilumab n=938; placebo n=934) across multiple endpoints for occurrence-of-event showed patients receiving dupilumab being 32% more likely to avoid hierarchically important clinical deterioration compared with placebo (1.32; 95% CI 1.17, 1.49]) (<bold>Figure</bold>). Similar findings were seen for the time-to-event endpoints (win ratio 1.26; 95% CI 1.13, 1.40). <bold>Conclusions:</bold> Dupilumab vs placebo increased the odds of avoiding hierarchically worse clinical outcomes by 32% in patients with COPD and type 2 inflammation. <fig><object-id>erj;66/suppl_69/PA4572/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>