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Objective: Between April 2015 and May 2016, a number of young males incarcerated at a Youth Justice center in New South Wales, Australia, were noted to have unexplained and significant neutropenia. None of the adolescents were prescribed quetiapine; however, it was prescribed for other young people in the center for this time period. The authors undertook a case series review to investigate the cause of this neutropenia. Methods: Case series review, including review of all pathology, electrocardiograms, medication charts, and medical file notes. Results: Quetiapine was used in the center; however, none of the young people with neutropenia were prescribed quetiapine (or any other medication causing neutropenia). During the assessments of these young people, it was found that the administration of quetiapine had changed during this time period to using pulverized quetiapine powder, administered after hours to young people when there were no health center staff available to supervise. On questioning, two neutropenic young people admitted to "snorting" diverted quetiapine powder. All instances of neutropenia resolved once the medication was removed from the center. Conclusions: Quetiapine has a high potential for abuse, especially in custodial settings. Quetiapine should never be crushed as this increases the potential for diversion, misuse, and serious side effects. Quetiapine misuse should be considered part of the differential diagnosis of unexplained neutropenia, especially in a setting where the drug is available.

Methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) are problematic for incarcerated adolescents but have not been previously researched.This was a 2-year prospective study of all New South Wales Juvenile Custodial Centres involving incarcerated youth aged 12-20 years. The main outcomes measured were MRSA SSTIs, MRSA molecular subtypes and associations with MRSA infection. Variables included age, gender, SSTI site and type, Indigenous status, incarceration time, lifetime incarcerations, intravenous drug use, overweight/obesity, recent antibiotic use and health centre presentations.From February 2013 to January 2015, there were 77 SSTIs (92.2% male, 59.2% Indigenous, mean age 16.9 years). The majority (77.9%) were collections, mostly on the lower limb (44.2%), and 33 (42.9%) isolates were MRSA; 94% were Panton-Valentine leukocidin positive. This represents 11 SSTIs per 1000 custodial admissions, and 4.7 MRSA SSTIs per 1000 custodial admissions. Independent associations with MRSA SSTI (vs. non-MRSA SSTI) were Indigenous status (adjusted odds ratio (AOR) 5.92, P 0.001), presenting with a collection (AOR 18.29, P 0.001) and recent antibiotic use (AOR 3.62, P 0.05).Incarcerated Australian youth have high rates of MRSA SSTIs, comparable to rates in US adult inmates, but with different molecular subtypes. At particular risk of MRSA infection are Indigenous youth, those with recent antibiotic use and those presenting with a collection. Many MRSA infections present at custodial admission, making surveillance and containment important, along with avoidance of unnecessary antibiotics and hand hygiene. Panton-Valentine leukocidin-positive MRSA predominates and is known for causing flu-associated necrotising pneumonia. Albeit a rare outcome, the seasonal influenza vaccination should be mandatory for youth in custody and custodial staff.

OBJECTIVE:: Despite being at high risk, little is known about traumatic brain injuries (TBIs) among incarcerated young people. This study aims to describe the prevalence of TBI among incarcerated young people and assess the association with mental health, substance use, and offending behaviors. SETTING:: The 2009 NSW Young People in Custody Health Survey was conducted in 9 juvenile detention centers. PARTICIPANTS:: A total of 361 young people agreed to participate, representing 80% of all incarcerated young people. MAIN MEASURES:: Young people were asked if they ever had a head injury where they became unconscious or "blacked-out." The survey used the Kiddie Schedule for Affective Disorders for Children to assess for psychiatric disorders, the Alcohol Use Disorder Identification Test, and the Severity of Dependence Scale to measure problematic substance use. RESULTS:: The sample comprised 88% man, 48% Aboriginal, with an average age of 17 years. One-third (32%) of young people reported ever experiencing a TBI, and 13% reported multiple TBIs. The majority (92%) of "most serious" TBIs were defined as mild, and the most common cause was an assault (62% woman, 34% man). Young people who reported a history of TBI (compared with those reporting no TBI) were significantly more likely to be diagnosed with a mental health disorder, psychological distress, a history of bullying, problematic substance use, participation in fights, and offending behaviors. Reporting multiple (>2) TBIs conferred a higher risk of psychological disorders and problematic substance use. CONCLUSIONS:: Incarcerated young people have high rates of TBI. Enhanced detection of TBI among incarcerated young people will assist clinicians in addressing the associated psychosocial sequelae. Language: en

OBJECTIVE To describe prevalence of and risk factors for overweight, obesity and self-perceived weight gain of Aboriginal and non-Aboriginal Australian young people in custody at baseline and over 12 months of follow-up. DESIGN, SETTING AND PARTICIPANTS Prospective cohort study of youths in custody in New South Wales, from August 2009, with follow-up at 3, 6 and 12 months. MAIN OUTCOME MEASURES Body mass index at baseline, categorised as overweight or obese using international cut-points; waist-to-height ratio (WHtR) at baseline, categorised as increased metabolic risk (≥ 0.5) or low metabolic risk (< 0.5); and self-perceived weight change at follow-up. RESULTS At baseline, 452 youths were incarcerated, 361 (79.9%) consented to participate, and complete anthropometry measurements were taken for 303 (67.0%). At 3, 6 and 12 months, there were 231 (76.2%), 158 (52.1%) and 143 (47.2%) participants, respectively. Two-hundred and sixty-four (87.1%) were male, 151 (49.8%) were Aboriginal, and 145 (47.9%) had been incarcerated for < 3 months at baseline. One hundred and forty-five (47.9%) were overweight or obese and 112 (37.0%) had a WHtR of ≥ 0.5 at baseline. However, only 72 (24.1%) perceived themselves as overweight at baseline, and 154 (71.6%) perceived a weight increase since incarceration despite improvements in diet and exercise. Longer incarceration time was strongly associated with overweight and obesity in Aboriginal youths at baseline and with self-perceived weight gain in non-Aboriginal youths at follow-up. CONCLUSIONS Overweight and obesity were highly prevalent but poorly recognised in young people in custody. A longer incarceration time had the strongest association with overweight obesity and self-reported weight gain. From a population health and policy perspective, changes to the liberal food environment and the approach to increasing physical activity in custody are warranted.

Albuminuria predicts cardiovascular and end-stage kidney disease in indigenous populations. Early detection in indigenous children may identify those who could benefit from early treatment. Community-based detection of albuminuria needs to be performed using a reliable, inexpensive, and widely available test, such as a proteinuria dipstick. Dipstick accuracy for detecting albuminuria in a community setting has not been evaluated. We assessed the accuracy of Multistix 10 SG dipsticks to detect baseline albuminuria and predict for persistent albuminuria at a 2-year follow-up in a population-based cohort of Australian Aboriginal and non-Aboriginal elementary-school-aged children. Variability in the accuracy of dipsticks in subgroups of higher risk children was analyzed using the relative diagnostic odds ratio (RDOR). Using Multistix 10 SG dipsticks, index-test-positive cases were defined as ≥0.30 g/L (1+) proteinuria and index-test-negative cases as

Background Aboriginal Australians have a 9-fold increased risk of end-stage renal disease. There is no information about the natural history and risk of chronic kidney disease (CKD) in Aboriginal and non-Aboriginal children. Study Design Using a prospective study design, we aimed to determine the prevalence of persistent markers and risk factors for CKD in Australian Aboriginal and non-Aboriginal children and whether Aboriginal children are at increased risk of persistent markers of CKD after accounting for sociodemographic differences. Setting & Participants Children were enrolled from elementary schools throughout New South Wales. Predictor Aboriginal (Aboriginal and Torres Strait Islander Australians) versus non-Aboriginal ethnicity. Outcomes & Measurements Urine analysis, height, weight, blood pressure, birth weight, and sociodemographic status were measured at baseline and 2-year follow-up. Albuminuria was defined as albumin-creatinine ratio of 3.4 mg/mmol or greater, hematuria as 25 or greater red blood cells/μL (≥1+), obesity as body mass index of 2 SDs or greater, and systolic and diastolic hypertension as blood pressure greater than the 90th percentile. Results 2,266 children (55.1% Aboriginal; 51.0% boys; mean age, 8.9 ± 2.0 years [SD] years) were enrolled at baseline. Early markers and predictors of CKD at baseline were frequent: hematuria (5.5%), albuminuria (7.3%), obesity (7.1%), systolic hypertension (7.2%), and diastolic hypertension (5.8%). 1,432 children (63%) were available for retesting at 2-year follow-up (54.0% Aboriginal; 50.5% boys; mean age, 10.5 ± 2.0 years). Persistent obesity (5.3%) was frequent, but persistent markers of CKD were infrequent (systolic hypertension, 1.1%; diastolic hypertension, 0.2%; hematuria, 1.1%; and albuminuria, 1.5%). Although there were more Aboriginal than non-Aboriginal children with baseline hematuria (7.1% versus 3.6%; P = 0.001), after adjustment for age, sex, birth weight, and sociodemographic status, there was no increased risk of persistent hematuria, albuminuria, obesity, or hypertension in Aboriginal children. Limitations Persistent markers of CKD were much less frequent than anticipated, which may have affected study power. The group lost at follow-up was older children, which may have biased results. Conclusions Overall, only 20% of children found to have markers of early CKD had persistent abnormalities (diastolic and systolic hypertension, albuminuria, and hematuria) 2 years later, equivalent to a population point prevalence of 1% to 2% in children with a mean age of 10 years. Aboriginal children had greater rates of baseline and transient hematuria, but no increased risk of persistent markers of CKD, suggesting that adolescence and young adulthood is a critical time for preventative strategies.

Aim: Indigenous people have a two- to tenfold increased risk of premature death from cardiovascular disease. We aimed to determine whether some key risk factors for cardiovascular disease occur more commonly in Aboriginal than non-Aboriginal Australian children. Methods: Children were enrolled from primary schools throughout New South Wales, the state with the highest number of Aboriginal people. Associations between ethnicity, gender, birthweight, socio-demographic status and hypertension, obesity, baseline and persistent albuminuria were determined. Results: A total of 2266 children (55% Aboriginal) were enrolled. Mean age was 8.9 years (±3.8 years). Obesity (body mass index ≥2 standard deviations) was detected in 7.1%, systolic hypertension (blood pressure >90th percentile) in 7.2%, diastolic hypertension in 5.9%, baseline albuminuria (albumin : creatinine ≥3.4 mg/mmol) in 7.3% and persistent albuminuria in 1.5% with no differences between Aboriginal and non-Aboriginal children. Hypertension was less common with increasing social disadvantage (trend P

Bone marrow transplant nephropathy (BMTN) classically presents more than 100 days after transplantation as an acute nephritis with hypertension, azotaemia and anemia that usually results in end stage renal failure (ESRF). The risk of developing BMTN may be greater with the use of more intensive chemotherapy and higher total body and tumor bed irradiation. Cis-retinoic acid (RA) may further increase the risk of developing BMTN. Here, we report the cases of two children who developed typical clinical and biochemical features of BMTN. They were both treated for stage IV neuroblastoma with chemotherapy, bone marrow transplant (BMT) conditioning that included total body irradiation and RA therapy after BMT, although the patient in case 1 had established renal insufficiency prior to the commencement of RA. Renal biopsy of these children showed classical BMTN histology, and the renal manifestations progressed quickly; the patient in case 1 became dialysis dependent by 1 year post-bone marrow transplant. Recently, RA has been added to the post-BMT therapy in children with stage IV neuroblastoma. The occurrence of BMTN in two children treated with RA in our unit is unlikely to be coincidental. Although RA has been shown to confer a significant survival advantage in this disease, animal studies and a previous case report have suggested it could increase the toxic effects of chemotherapy and renal irradiation. It is likely that RA contributed to the deterioration in renal function in these patients.

Despite smoking prevalence reductions in the general community, rates remain high among socially disadvantaged populations. This study describes the prevalence and predictors for smoking among young people in custody.The 2009 NSW Young People in Custody Health Survey was conducted in nine juvenile detention centres. This paper reports on findings from the baseline questionnaire which included questions about smoking behaviours. Chi-squared statistics were used to compare the smoking characteristics by gender and Aboriginality. Logistic regression was used to determine predictors of smoking behaviours.The baseline questionnaire included 316 participants with a response rate of 83%. The sample was 88% male, 48% Aboriginal, with an average age of 17 years (range 13-21 years). Nearly all (94%) participants had ever smoked tobacco, with 79% reporting smoking daily prior to custody. Predictors of heavy smoking (20 or more cigarettes per day) prior to custody included being female, high psychological distress and conduct disorder. Predictors for being a current smoker included being on remand, risky drinking and most or all friends as smokers. Predictors of being an aspirational smoker (will smoke on release) included using illicit drugs at least weekly prior to custody, and having most or all friends as smokers.Rates of smoking in young people entering custody are exceptionally high. Many young people continue to smoke during their incarceration, with an increasing aspiration to smoke upon release. Effective programs are needed that address these smoking behaviours in young people in custody.

Objective: To describe the natural history and risk of early chronic kidney disease (CKD) in Indigenous Australian populations. Design, setting and participants: A prospective cohort of 2266 Aboriginal and nonAboriginal children enrolled from primary schools throughout New South Wales from February 2002 to June 2004 and followed for 4 years. Main outcome measures: Urinalysis, height, weight, blood pressure, birthweight and sociodemographic status at baseline and 2- and 4-year follow-up; CKD risk factors: haematuria, albuminuria, obesity, and systolic and diastolic hypertension. Results: 2266 children (55% Aboriginal; 51% male; mean age, 8.9 years [SD, 2.0 years]) were enrolled at baseline. 1432 children (63%) were retested at 2-year follow-up, and 1506 children (67%) at 4-year follow-up. Prevalence of baseline CKD risk factors was frequent (2%–7%), but most abnormalities were transient. Besides persistent obesity (5.0%), persistence of CKD risk factors at final follow-up was low: haematuria (1.9%), albuminuria (2.4%), systolic hypertension (1.5%) and diastolic hypertension (0.2%). There was no difference in prevalence of persistent CKD risk factors between Aboriginal and non-Aboriginal children. Conclusions: Over 4 years of follow-up, Indigenous Australian children had no increased risk for early evidence of CKD. More than 70% of baseline risk factors were transient, and persistent risk factors were uncommon. Our findings suggest the increased risk for end-stage kidney disease seen in Indigenous adults is not yet manifest

Indigenous people suffer substantially more end-stage kidney disease (ESKD), especially Australian Aboriginals. Previous work suggests causal pathways beginning early in life. No studies have shown the prevalence of early markers of chronic kidney disease (CKD) in both Indigenous and non-Indigenous children or the association with environmental health determinants--geographic remoteness and socioeconomic disadvantage. Height, weight, blood pressure, and urinary abnormalities were measured in age- and gender-matched Aboriginal and non-Aboriginal children from elementary schools across diverse areas of New South Wales, Australia. Hematuria was defined asor=25 red blood cells/microl (or=1+), proteinuriaor=0.30 g/l (or=1+), and albuminuria (by albumin:creatinine)or=3.4 mg/mmol. Remoteness and socioeconomic status were assigned using the Accessibility and Remoteness Index of Australia and Socio-Economic Indexes For Areas. From 2002 to 2004, 2266 children (55% Aboriginal, mean age 8.9 years) were enrolled from 37 elementary schools. Overall prevalence of hematuria was 5.5%, proteinuria 7.3%, and albuminuria 7.3%. Only baseline hematuria was more common in Aboriginal children (7.1 versus 3.6%; P=0.002). At 2-year follow-up, 1.2% of Aboriginal children had persistent hematuria that was no different from non-Aboriginal children (P=0.60). Socioeconomic disadvantage and geographical isolation were neither significant nor consistent risk factors for any marker of CKD. Aboriginal children have no increase in albuminuria, proteinuria, or persistent hematuria, which are more important markers for CKD. This suggests ESKD in Aboriginal people may be preventable during early adult life.