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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.

AIM Methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) are problematic for incarcerated adolescents but have not been previously researched. METHODS 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. RESULTS 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

Aim To describe the prevalence of nicotine dependence and acceptance of nicotine replacement therapy (NRT) in young people entering custody, where smoking is not allowed. Methods Cross-sectional study in 2013. Setting: All New South Wales Juvenile Justice Centres. Participants: Incarcerated youth, aged 12–21 years. Main exposures: gender, age, ethnicity, cannabis use. Main outcomes: rates of smoking, cannabis use, nicotine dependence, NRT acceptance. Results Data were collected from 252 Initial Reception Assessments (90.1% male, 56.3% Aboriginal, mean age 16.6 years ± 1.2 standard deviation). According to Fagerstrom screening, 207 (82.1%) young people smoked cigarettes immediately prior to their current incarceration, and of the smokers, 78 (38.4%) were nicotine dependent. Most young people (76.4%) were also daily cannabis users, with 85.6% of cigarette smokers also using cannabis daily. NRT (as 24-h nicotine patches prescribed for 2 weeks) was offered to 54 nicotine dependent and 7 non-dependent young people. Only 13 (21.3%) young people accepted NRT (all daily cannabis-using males), and only 2 young people completed the full prescription. Reasons for refusing or not completing NRT were a fear of ‘weird dreams’, sleeping issues or that it was no longer needed. Conclusions Many young people entering custody are nicotine-dependent cigarette smokers and daily cannabis users, and are at high risk of nicotine withdrawal on abstinence. NRT as patch therapy has poor acceptance in this group, except in young men who are daily cannabis users. Screening for nicotine dependence in high-risk young people should include questions about cannabis use, and alternatives to patch therapy deserve further research.

Aim To describe the prevalence and risk factors for markers of poor oral health in Aboriginal and non-Aboriginal young people in custody in Australia. Methods All incarcerated youth, aged 13–21 years, in New South Wales Juvenile Custodial Centres between August and October 2009 were invited to participate and undertake a dental exam. The main outcome measures were an assessment of moderate/abundant plaque, periodontal disease, dental caries experience, mean decayed and/or filled and/or missing teeth (DMFT) index and untreated decay. Results Two hundred ninety-four participants (91% male, 46% Aboriginal) underwent a dental exam. Markers of poor oral health were common – 49.4% with moderate/abundant plaque, 34.4% with periodontal disease, mean DMFT 3.56 and 54% having untreated decay. Risk factors independently associated with poor oral health were geographical remoteness and non-fluoridation of the water supply of the usual residence, a shorter incarceration time and dental treatment outside of custody. Conclusions Young people entering custody have poor oral health, with those from geographically remote areas without water fluoridation at highest risk. The incarceration period is an opportunity for oral health improvements in these young people through access to dental treatment services. Better triaging systems are needed to identify those of greatest priority, and prevention services are needed.

Background Intellectual disability (ID) is known to be more common in incarcerated groups, especially incarcerated youth. Aboriginal young people have higher rates of ID, and make up half of all youth in juvenile custody in New South Wales (NSW), Australia. We aimed to describe the prevalence of possible ID and borderline intellectual functioning (BIF) in young people in NSW custody, and to describe the association between possible ID and Aboriginality after adjusting for the inequalities in social disadvantage. Methods Baseline study of all youth in NSW Custodial Centres between August and October 2009, with 18-month follow-up. Using Wechsler Intelligence Scale for Children – Fourth Edition (WISC-IV) and Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV) cognitive assessments, possible ID was defined as Extremely Low Intellectual Quotient range (Full Scale Intellectual Quotient, FSIQ

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.

Introduction and Aims. 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. Design and Methods. 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. Results. 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 Discussion and Conclusions. 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.[Indig D, Haysom L. Smoking behaviours among young people in custody in New South Wales, Australia. Drug Alcohol Rev 2012;31:631–637]

Background There has been considerable interest in the hypothesis that low birth weight may be a marker of impaired nephrogenesis and that this is causally related to chronic kidney disease (CKD). Study Design Systematic review and meta-analysis of observational studies. Setting & Population Studies of the relationship between birth weight and CKD published before February 1, 2008, were identified by using electronic searches. Selection Criteria All studies that had collected data for birth weight and kidney function at greater than 12 months of age were eligible for inclusion, except for studies of extremely low-birth-weight infants, very premature infants, or toxic exposure in utero. Study Factor Birth weight. Outcomes CKD defined as albuminuria, low estimated glomerular filtration rate ( Results We analyzed 31 relevant cohort or case-control studies with data for 49,376 individuals and data for 2,183,317 individuals from a single record-linkage study. Overall, 16 studies reported a significant association between low birth weight and risk of CKD and 16 observed a null result. The combination of weighted estimates from the 18 studies for which risk estimates were available (n = 46,249 plus 2,183,317 from the record linkage study) gave an overall odds ratio (OR) of 1.73 (95% confidence interval [CI], 1.44 to 2.08). Combined ORs were consistent in magnitude and direction for risks of albuminuria (OR, 1.81; 95% CI, 1.19 to 2.77), end-stage renal disease (OR, 1.58; 95% CI, 1.33 to 1.88), or low estimated glomerular filtration rate (OR, 1.79; 95% CI, 1.31 to 2.45). Limitations A reliance on published estimates and estimates provided on request rather than individual patient data and the possibility of reporting bias. Conclusions Existing data indicate that low birth weight is associated with subsequent risk of CKD, although there is scope for additional well-designed population-based studies with accurate assessment of birth weight and kidney function and consideration of important confounders, including maternal and socioeconomic factors.

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.

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.