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Habib AR, Crossland G, Sacks R, Singh N, Patel H. Tele-otology for Aboriginal and Torres Strait Islander People Living in Rural and Remote Areas. Laryngoscope 2024. [PMID: 38982868 DOI: 10.1002/lary.31624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 05/06/2024] [Accepted: 06/17/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE To evaluate a referral-based, tele-otology service in rural and remote areas of the Northern Territory, Australia. METHODS A retrospective observational cohort study was performed of a tele-otology service in 93 Aboriginal and Torres Strait Islander communities (2011 to 2019). Assessments included face-to-face examinations performed by Clinical Nurse Consultants and audiologists, and asynchronous reviews performed by otolaryngologists. Multivariable logistic regression was performed to determine the likelihood of ear disease, adjusted for age and gender. Intra- and inter-rater agreement was assessed between otolaryngologists. RESULTS A total of 3,950 patients were reviewed (6,838 encounters, 13,726 ear assessments). The median age of patients was 9.8 years (interquartile range: 7.2 years). Overall, 62.2% of patients were identified with ear disease and 62.5% identified with hearing loss. Substantial intra- and inter-rater agreement in diagnosis was found between otolaryngologists (κ = 0.71 and κ = 0.78, respectively). The most common ear conditions identified were chronic otitis media (COM, 28.1%) and otitis media with effusion (OME, 16.5%). Topical or oral antibiotics were initiated in 14.1% of all encounters, most often for acute otitis media or COM. Surgery was recommended in 27.7% of all encounters, most often myringoplasty, adenoidectomy, and myringotomy with insertion of tympanostomy tubes. CONCLUSION Tele-otology is a critical component of an integrated approach to evaluating ear disease in Indigenous people living in rural and remote areas. The high prevalence of OME, COM, and surgical recommendations highlights the need for community engagement, regular follow-up, and early interventions to prevent long-term hearing loss. LEVEL OF EVIDENCE N/A Laryngoscope, 2024.
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Affiliation(s)
- Al-Rahim Habib
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Otolaryngology-Head and Neck Surgery, Royal Darwin Hospital, Top End Health Service, Department of Health, Tiwi, Northern Territory, Australia
- Department of Otolaryngology-Head and Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Graeme Crossland
- Department of Otolaryngology-Head and Neck Surgery, Royal Darwin Hospital, Top End Health Service, Department of Health, Tiwi, Northern Territory, Australia
| | - Raymond Sacks
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Narinder Singh
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Otolaryngology-Head and Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Hemi Patel
- Department of Otolaryngology-Head and Neck Surgery, Royal Darwin Hospital, Top End Health Service, Department of Health, Tiwi, Northern Territory, Australia
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Engstrom T, Lobo EH, Watego K, Nelson C, Wang J, Wong H, Kim SL, Oh SI, Lawley M, Gorse AD, Ward J, Sullivan C. Indigenous data governance approaches applied in research using routinely collected health data: a scoping review. NPJ Digit Med 2024; 7:68. [PMID: 38491156 PMCID: PMC10943072 DOI: 10.1038/s41746-024-01070-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/29/2024] [Indexed: 03/18/2024] Open
Abstract
Globally, there is a growing acknowledgment of Indigenous Peoples' rights to control data related to their communities. This is seen in the development of Indigenous Data Governance standards. As health data collection increases, it's crucial to apply these standards in research involving Indigenous communities. Our study, therefore, aims to systematically review research using routinely collected health data of Indigenous Peoples, understanding the Indigenous Data Governance approaches and the associated advantages and challenges. We searched electronic databases for studies from 2013 to 2022, resulting in 85 selected articles. Of these, 65 (77%) involved Indigenous Peoples in the research, and 60 (71%) were authored by Indigenous individuals or organisations. While most studies (93%) provided ethical approval details, only 18 (21%) described Indigenous guiding principles, 35 (41%) reported on data sovereignty, and 28 (33%) addressed consent. This highlights the increasing focus on Indigenous Data Governance in utilising health data. Leveraging existing data sources in line with Indigenous data governance principles is vital for better understanding Indigenous health outcomes.
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Affiliation(s)
- Teyl Engstrom
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia.
| | - Elton H Lobo
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia.
| | - Kristie Watego
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Carmel Nelson
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Jinxiang Wang
- Poche Centre for Indigenous Health, The University of Queensland, Herston, QLD, Australia
| | - Howard Wong
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | - Sungkyung Linda Kim
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | - Soo In Oh
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | | | | | - James Ward
- Poche Centre for Indigenous Health, The University of Queensland, Herston, QLD, Australia
| | - Clair Sullivan
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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Harkus S, Marnane V, O'Keeffe I, Kung C, Ward M, Orr N, Skinner J, Hughes JK, Fonua Wiradjuri L, Kennedy Wiradjuri M, Kong Worimi K, Belfrage M. Development of the national consensus statement on ear health and hearing check recommendations for Aboriginal and Torres Strait Islander children aged under 6 years attending primary care: systematic scoping review and e-Delphi. BMC PRIMARY CARE 2024; 25:86. [PMID: 38486181 PMCID: PMC10938761 DOI: 10.1186/s12875-024-02307-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Early detection of long-term, often asymptomatic, middle ear infection in young Aboriginal and Torres Strait Islander children is more likely to be achieved when ear health and hearing checks are routinely undertaken in primary healthcare. Evidence consistently demonstrates the adverse impacts of this condition on the development and wellbeing of children and their families. We aimed to develop feasible, evidence- and consensus-based primary healthcare recommendations addressing the components and timing of ear health and hearing checks for Aboriginal and Torres Strait Islander children aged under 6 years, not already known to have, nor being actively managed for, ear and hearing problems. METHODS A 22-person working group comprising Aboriginal and Torres Strait Islander and non-Indigenous members from the primary healthcare, ear, hearing, and research sectors provided guidance of the project. A systematic scoping review addressed research questions relating to primary health ear health and hearing checks for Aboriginal and Torres Strait Islander and other populations at increased risk of persistent ear health problems. Twelve primary studies and eleven guidelines published between 1998 and 2020 were identified and reviewed. Quality and certainty of evidence and risk of bias ratings were completed for studies and guidelines. In the absence of certain and direct evidence, findings and draft recommendations were presented for consensus input to a 79-member expert panel using a modified e-Delphi process. Recommendations were finalised in consultation with working group members and presented to expert panel members for input on considerations relating to implementation. RESULTS Overall, the quality, certainty, and directness of evidence in the studies and guidelines reviewed was low. However, the findings provided a basis and structure for the draft recommendations presented during the consensus-building process. After two e-Delphi rounds, seven goals and eight recommendations on the components and timing of Ear Health and Hearing Checks in primary healthcare for young Aboriginal and Torres Strait Islander children were developed. CONCLUSIONS The systematic scoping review and consensus-building process provided a pragmatic approach for producing strong recommendations within a reasonably short timeframe, despite the low quality and certainty of evidence, and paucity of studies pertaining to primary healthcare settings.
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Affiliation(s)
| | | | | | | | - Meagan Ward
- National Acoustic Laboratories, Sydney, Australia
| | - Neil Orr
- Macquarie University, Sydney, Australia
| | | | | | | | | | | | - Mary Belfrage
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
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Nash K, Gwynne K, Dimitropoulos Y, Fitzpatrick M, Gunasekera H, Halvorsen L, Kong K, Lumby N, Macniven R, Parter C, Wingett A, McMahon C. INdigenous Systems and Policies Improved and Reimagined for Ear and hearing care (INSPIRE): a multi-method study protocol. BMJ Open 2024; 14:e079850. [PMID: 38199621 PMCID: PMC10806583 DOI: 10.1136/bmjopen-2023-079850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Otitis media (middle ear disease) severity and chronicity among Aboriginal and Torres Strait Islander people, as well as gaps in socioeconomic outcomes related to hearing loss, indicates a breakdown in the current ear and hearing care system. The ear and hearing care system spans multiple sectors due to long-term impacts of otitis media and hearing loss in health, education and employment, necessitating a multi-disciplinary cross-sectorial approach to ear and hearing care. Public policies shape the current ear and hearing care system and here it is argued that a critical public policy analysis across different sectors is needed, with strong Aboriginal and Torres Strait Islander leadership and guidance. The current study aims to establish consensus-based ear and hearing care policy solutions for Aboriginal and Torres Strait Islander people in Australia. METHODS AND ANALYSIS This multi-method study will be guided by a Brains Trust with strong Aboriginal and Torres Strait Islander leadership. Public policies in hearing health, social services, and education will be scoped to identify policy gaps, using the World Health Organization framework. Qualitative data will be collected through a culturally specific process of yarning circles to identify policy challenges and/or limitations in enabling accessible ear and hearing care programs/services for Aboriginal and Torres Strait Islander people, using dimensions of Morestin's public policy appraisal tool as an interview guide for stakeholders. Themes from the yarning circles will be used to inform an expert Delphi process to establish consensus-based policy solutions for optimising the ear and hearing care system for Aboriginal and Torres Strait Islander people. ETHICS AND DISSEMINATION This study has approval from the Australian Institute of Aboriginal and Torres Strait Islander Studies Ethics Committee. Study findings will be disseminated to community through Brains Trust members and study participants, as well as through publications in peer-reviewed journals and research forum presentations.
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Affiliation(s)
- Kai Nash
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Kylie Gwynne
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Dimitropoulos
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Mark Fitzpatrick
- Telethon Speech and Hearing, Perth, Western Australia, Australia
| | | | - Luke Halvorsen
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Kelvin Kong
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
| | - Noeleen Lumby
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Rona Macniven
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Carmen Parter
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Amanda Wingett
- College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Catherine McMahon
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Su JY, Leach AJ, Cass A, Morris PS, Kong K. An evaluation of the quality of ear health services for Aboriginal children living in remote Australia: a cascade of care analysis. BMC Health Serv Res 2023; 23:1186. [PMID: 37907905 PMCID: PMC10617165 DOI: 10.1186/s12913-023-10152-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND In the Northern Territory (NT) the prevalence of otitis media (OM) in young Aboriginal children living in remote communities has persisted at around 90% over the last few decades. OM-associated hearing loss can cause developmental delay and adversely impact life course trajectories. This study examined the 5-year trends in OM prevalence and quality of ear health services in remote NT communities. METHODS A retrospective analysis was performed on de-identified clinical data for 50 remote clinics managed by the NT Government. We report a 6-monthly cascade analysis of the proportions of children 0-16 years of age receiving local guideline recommendations for surveillance, OM treatment and follow-up at selected milestones between 2014 and 2018. RESULTS Between 6,326 and 6,557 individual children were included in the 6-monthly analyses. On average, 57% (95%CI: 56-59%) of eligible children had received one or more ear examination in each 6-monthly period. Of those examined, 36% (95%CI: 33-40%) were diagnosed with some type of OM, of whom 90% had OM requiring either immediate treatment or scheduled follow-up according to local guidelines. Outcomes of treatment and follow-up were recorded in 24% and 23% of cases, respectively. Significant decreasing temporal trends were found in the proportion diagnosed with any OM across each age group. Overall, this proportion decreased by 40% over the five years (from 43 to 26%). CONCLUSIONS This cascade of care analysis found that ear health surveillance and compliance with otitis media guidelines for treatment and follow-up were both low. Further research is required to identify effective strategies that improve ear health services in remote settings.
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Affiliation(s)
- Jiunn-Yih Su
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Amanda Jane Leach
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Peter Stanley Morris
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Royal Darwin Hospital, Darwin, NT, Australia
| | - Kelvin Kong
- John Hunter Children's Hospital, Newcastle, NSW, Australia
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Harkus S, Marnane V, O'Keeffe I, Kung C, Ward M, Orr N, Skinner J, Kong K, Fonua L, Kennedy M, Belfrage M. Routine ear health and hearing checks for Aboriginal and Torres Strait Islander children aged under 6 years attending primary care: a national consensus statement. Med J Aust 2023; 219:386-392. [PMID: 37716709 DOI: 10.5694/mja2.52100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 08/23/2023] [Indexed: 09/18/2023]
Abstract
This consensus statement provides new recommendations for primary care assessment of ear health and hearing status of young Aboriginal and Torres Strait Islander children who are not known to have, or are not being actively managed for, ear health and hearing problems. Any child identified with otitis media should be actively managed. This national consensus statement extends existing treatment and management guidelines. MAIN RECOMMENDATIONS: Undertake checks at least 6-monthly, commencing at 6 months until 4 years of age, then at 5 years. Undertake checks more frequently in high risk settings for children under 2 years, when acceptable to families, or in response to parent/carer concerns. Ask parents/carers about concerns, signs, and symptoms; check children's listening and communication skills; and assess middle ear appearance and mobility. Otoacoustic emissions testing is suggested when equipment is available, primary health practitioners have capability and confidence to use the equipment, and there is local preference for its use. Video otoscopy is suggested for health promotion purposes, and/or for sharing images with other health practitioners. Audiometry should be done as per existing guidelines: when there are parent/carer concerns, signs of persistent/recurrent otitis media, or when listening and communication development is not yet on track. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT: Key practice changes include routine use of tympanometry, and listening and communication skills checklists. Implementation will require access to equipment and training; clear information on immediate, practical actions for families; timely pathways to referral services; and a change management process that shifts perception and tolerance of otitis media and its impacts and raises expectations that Aboriginal and Torres Strait Islander children can have healthy ears and hearing.
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Affiliation(s)
- Samantha Harkus
- National Acoustic Laboratories, Macquarie University, Sydney, NSW
| | - Vivienne Marnane
- National Acoustic Laboratories, Macquarie University, Sydney, NSW
| | - Isabel O'Keeffe
- National Acoustic Laboratories, Macquarie University, Sydney, NSW
| | - Carmen Kung
- National Acoustic Laboratories, Macquarie University, Sydney, NSW
| | - Meagan Ward
- National Acoustic Laboratories, Macquarie University, Sydney, NSW
| | - Neil Orr
- Macquarie University, Sydney, NSW
| | | | - Kelvin Kong
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW
| | - Lose Fonua
- Centre for Health Equity, University of Melbourne, Melbourne, VIC
| | | | - Mary Belfrage
- Royal Australian College of General Practitioners, Melbourne, VIC
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Veselinović T, Weeks SA, Swift VM, Morrison NR, Doyle JE, Richmond HJ, Alenezi EMA, Tao KFM, Richmond PC, Choi RSM, Mulders WHAM, Goulios H, Lehmann D, Brennan-Jones CG. Ear and hearing outcomes in Aboriginal infants living in an urban Australian area: the Djaalinj Waakinj birth cohort study. Int J Audiol 2023:1-9. [PMID: 37694733 DOI: 10.1080/14992027.2023.2252177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE Describe the ear and hearing outcomes in Aboriginal infants in an Australian urban area. DESIGN Aboriginal infants enrolled in the Djaalinj Waakinj prospective cohort study had ear health screenings at ages 2-4, 6-8 and 12-18 months and audiological assessment at ∼12 months of age. Sociodemographic, environmental characteristics, otoscopy, otoacoustic emissions, tympanometry and visual reinforcement audiometry data were collected. STUDY SAMPLE 125 infants were enrolled in the study; 67 completed audiological assessment, 62, 54, and 58 of whom attended ear screenings at 2-4, 6-8 and 12-18 months. RESULTS Of the children that attended the audiological assessment, 36.5%, 50% and 64.3% of infants had otitis media (OM) at 2-4, 6-8 and 12-18 months. Using a 10 dB correction factor, 44.8% of infants had hearing loss (HL) (≥ 25 dB HL) at ∼ 12 months of age. More males (X2=5.4 (1df, p = 0.02)) and infants with OM at audiological assessment (X2=5.8 (1df, p = 0.02)) had HL. More infants that used a pacifier at 12-18 months of age had HL (X2=4.7 (1df, p = 0.03)). CONCLUSION Aboriginal infants in an urban area have high rates of HL and OM, which requires early surveillance and timely treatment to reduce the medical and developmental impacts of OM and HL.
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Affiliation(s)
- Tamara Veselinović
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- School of Human Sciences, The University of Western Australia, Perth, Australia
| | - Sharon A Weeks
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Valerie M Swift
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Natasha R Morrison
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - June E Doyle
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Holly J Richmond
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Eman M A Alenezi
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Faculty of Allied Health Sciences, Kuwait University, Kuwait City, Kuwait
| | - Karina F M Tao
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Perth Children's Hospital, Perth, Australia
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Discipline of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia
| | - Robyn S M Choi
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- School of Human Sciences, The University of Western Australia, Perth, Australia
| | | | - Helen Goulios
- School of Human Sciences, The University of Western Australia, Perth, Australia
| | - Deborah Lehmann
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Christopher G Brennan-Jones
- Wesfarmers Centre of Vaccines and Infectious diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Perth Children's Hospital, Perth, Australia
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
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Leach AJ. What does microbiology have to do with the Hearing for Learning Initiative (HfLI)? MICROBIOLOGY AUSTRALIA 2022. [DOI: 10.1071/ma22035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Where would we be without microbiology in tackling the high prevalence of otitis media (OM; middle ear infection) and disabling hearing loss that disadvantage Australian First Nations children living in remote communities? Understanding the microbiology of OM in this population has been critical in directing innovative clinical trials research and developing appropriate evidence-based practice guidelines. While these processes are critical to reducing disadvantage associated with OM and disabling hearing loss, a remaining seemingly insurmountable gap has remained, threatening progress in improving the lives of children with ear and hearing problems. That gap is created by the crisis in primary health care workforce in remote communities. Short stay health professionals and fly-in fly-out specialist services are under-resourced to manage the complex needs of the community, including prevention and treatment of otitis media and hearing loss rehabilitation. Hence the rationale for the Hearing for Learning Initiative – a workforce enhancement model to improve sustainability, cultural appropriateness, and effectiveness of evidence-based ear and hearing health care for young children in remote settings. This paper summarises the role of microbiology in the pathway to the Hearing for Learning Initiative.
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Sonodynamic Therapy Exciting the Herbal Nanocomposite with Spider-web-like Effect to Combat Otitis Media. Int J Pharm 2022; 621:121820. [DOI: 10.1016/j.ijpharm.2022.121820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/21/2022] [Accepted: 05/07/2022] [Indexed: 11/22/2022]
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Walsh R, Reath J, Gunasekera H, Leach A, Kong K, Askew D, Girosi F, Hu W, Usherwood T, Lujic S, Spurling G, Morris P, Watego C, Harkus S, Woodall C, Tyson C, Campbell L, Hussey S, Abbott P. INFLATE: a protocol for a randomised controlled trial comparing nasal balloon autoinflation to no nasal balloon autoinflation for otitis media with effusion in Aboriginal and Torres Strait Islander children. Trials 2022; 23:309. [PMID: 35421984 PMCID: PMC9009496 DOI: 10.1186/s13063-022-06145-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 03/04/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Otitis media with effusion (OME) is common and occurs at disproportionately higher rates among Indigenous children. Left untreated, OME can negatively affect language, development, learning, and health and wellbeing throughout the life-course. Currently, OME care includes observation for 3 months followed by consideration of surgical ventilation tube insertion. The use of a non-invasive, low-cost nasal balloon autoinflation device has been found beneficial in other populations but has not been investigated among Aboriginal and Torres Strait Islander children. METHODS/DESIGN This multi-centre, open-label, randomised controlled trial will determine the effectiveness of nasal balloon autoinflation compared to no nasal balloon autoinflation, for the treatment of OME among Aboriginal and Torres Strait Islander children in Australia. Children aged 3-16 years with unilateral or bilateral OME are being recruited from Aboriginal Health Services and the community. The primary outcome is the proportion of children showing tympanometric improvement of OME at 1 month. Improvement is defined as a change from bilateral type B tympanograms to at least one type A or C1 tympanogram, or from unilateral type B tympanogram to type A or C1 tympanogram in the index ear, without deterioration (type A or C1 to type C2, C3, or B tympanogram) in the contralateral ear. A sample size of 340 children (170 in each group) at 1 month will detect an absolute difference of 15% between groups with 80% power at 5% significance. Anticipating a 15% loss to follow-up, 400 children will be randomised. The primary analysis will be by intention to treat. Secondary outcomes include tympanometric changes at 3 and 6 months, hearing at 3 months, ear health-related quality of life (OMQ-14), and cost-effectiveness. A process evaluation including perspectives of parents or carers, health care providers, and researchers on trial implementation will also be undertaken. DISCUSSION INFLATE will answer the important clinical question of whether nasal balloon autoinflation is an effective and acceptable treatment for Aboriginal and Torres Strait Islander children with OME. INFLATE will help fill the evidence gap for safe, low-cost, accessible OME therapies. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry ACTRN12617001652369 . Registered on 22 December 2017. The Australia New Zealand Clinical Trials Registry is a primary registry of the WHO ICTRP network and includes all items from the WHO Trial Registration data set. Retrospective registration.
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Affiliation(s)
- Robyn Walsh
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Jennifer Reath
- School of Medicine, Western Sydney University, Sydney, Australia
| | | | - Amanda Leach
- Menzies School of Health Research, Darwin, Australia
| | - Kelvin Kong
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Deborah Askew
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Federico Girosi
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Wendy Hu
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Timothy Usherwood
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sanja Lujic
- Centre for Big Data Research in Health, The University of New South Wales, Sydney, Australia
| | - Geoffrey Spurling
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care (Inala Indigenous Health Service) Queensland Health, Brisbane, Australia
| | - Peter Morris
- Menzies School of Health Research, Darwin, Australia
| | - Chelsea Watego
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | | | | | - Claudette Tyson
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | | | - Sylvia Hussey
- Townsville Aboriginal and Islander Health Service, Townsville, Australia
| | - Penelope Abbott
- School of Medicine, Western Sydney University, Sydney, Australia.
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11
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Perdrizet J, Farkouh RA, Horn EK, Hayford K, Sings HL, Wasserman MD. The broader impacts of otitis media and sequelae for informing economic evaluations of pneumococcal conjugate vaccines. Expert Rev Vaccines 2022; 21:499-511. [PMID: 35191368 DOI: 10.1080/14760584.2022.2040989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Otitis media (OM) is a common childhood infection. Pneumococcal conjugate vaccines (PCVs) prevent OM episodes, thereby reducing short- and long-term clinical, economic, humanistic, and societal consequences. Most economic evaluations of PCVs focus on direct health gains and cost savings from prevented acute episodes but do not fully account for the broader societal impacts of OM prevention. AREAS COVERED This review explores the broader burden of OM on children, caregivers, and society to better inform future economic evaluations of PCVs. EXPERT OPINION OM causes a substantial burden to society through long-term sequelae, productivity losses, reduced quality of life for children and caregivers, and contribution to antimicrobial resistance from inappropriate antibiotic use. The effect of PCVs on acute OM has been recognized globally, yet the broader impact has not been consistently quantified, studied, or communicated. Economic evaluations of PCVs must evolve to include broader effects for patients, caregivers, and society from OM prevention. Future PCVs with broader coverage may further reduce OM incidence and antimicrobial resistance, but optimal uptake will depend on increasing the recognition and use of novel frameworks that include broader benefits. Communicating the full value of PCVs to decision makers may result in wider access and positive societal returns.
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Affiliation(s)
- Johnna Perdrizet
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
| | - Raymond A Farkouh
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
| | - Emily K Horn
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
| | - Kyla Hayford
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer, Inc., Toronto, Canada
| | - Heather L Sings
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer, Inc., Collegeville, PA, USA
| | - Matt D Wasserman
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
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Taylor SL, Papanicolas LE, Richards A, Ababor F, Kang WX, Choo JM, Woods C, Wesselingh SL, Ooi EH, MacFarlane P, Rogers GB. Ear microbiota and middle ear disease: a longitudinal pilot study of Aboriginal children in a remote south Australian setting. BMC Microbiol 2022; 22:24. [PMID: 35026986 PMCID: PMC8756658 DOI: 10.1186/s12866-022-02436-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/29/2021] [Indexed: 12/03/2022] Open
Abstract
Background Otitis media (OM) is a major disease burden in Australian Aboriginal children, contributing to serious long-term health outcomes. We report a pilot analysis of OM in children attending an outreach ear and hearing clinic in a remote south Australian community over a two-year period. Our study focuses on longitudinal relationships between ear canal microbiota characteristics with nasopharyngeal microbiota, and clinical and treatment variables. Results Middle ear health status were assessed in 19 children (aged 3 months to 8 years) presenting in remote western South Australia and medical interventions were recorded. Over the two-year study period, chronic suppurative OM was diagnosed at least once in 7 children (37%), acute OM with perforation in 4 children (21%), OM with effusion in 11 children (58%), while only 1 child had no ear disease. Microbiota analysis of 19 children (51 sets of left and right ear canal swabs and nasopharyngeal swabs) revealed a core group of bacterial taxa that included Corynebacterium, Alloiococcus, Staphylococcus, Haemophilus, Turicella, Streptococcus, and Pseudomonas. Within-subject microbiota similarity (between ears) was significantly greater than inter-subject similarity, regardless of differences in ear disease (p = 0.0006). Longitudinal analysis revealed changes in diagnosis to be associated with more pronounced changes in microbiota characteristics, irrespective of time interval. Ear microbiota characteristics differed significantly according to diagnosis (P (perm) = 0.0001). Diagnoses featuring inflammation with tympanic membrane perforation clustering separately to those in which the tympanic membrane was intact, and characterised by increased Proteobacteria, particularly Haemophilus influenzae, Moraxella catarrhalis, and Oligella. While nasopharyngeal microbiota differed significantly in composition to ear microbiota (P (perm) = 0.0001), inter-site similarity was significantly greater in subjects with perforated tympanic membranes, a relationship that was associated with the relative abundance of H. influenzae in ear samples (rs = − 0.71, p = 0.0003). Longitudinal changes in ear microbiology reflected changes in clinical signs and treatment. Conclusions Children attending the ear and hearing clinic in a remote Aboriginal community present with a broad spectrum of OM conditions and severities, consistent with other remote Aboriginal communities. Ear microbiota characteristics align with OM diagnosis and change with disease course. Nasopharyngeal microbiota characteristics are consistent with the contribution of acute upper respiratory infection to OM aetiology. Supplementary Information The online version contains supplementary material available at 10.1186/s12866-022-02436-x.
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13
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Hirsch SD, Elling CL, Bootpetch TC, Scholes MA, Hafrén L, Streubel SO, Pine HS, Wine TM, Szeremeta W, Prager JD, Einarsdottir E, Yousaf A, Baschal EE, Rehman S, Bamshad MJ, Nickerson DA, Riazuddin S, Leal SM, Ahmed ZM, Yoon PJ, Kere J, Chan KH, Mattila PS, Friedman NR, Chonmaitree T, Frank DN, Ryan AF, Santos-Cortez RLP. The role of CDHR3 in susceptibility to otitis media. J Mol Med (Berl) 2021; 99:1571-1583. [PMID: 34322716 PMCID: PMC8541908 DOI: 10.1007/s00109-021-02118-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 12/30/2022]
Abstract
Otitis media (OM) is common in young children and can cause hearing loss and speech, language, and developmental delays. OM has high heritability; however, little is known about OM-related molecular and genetic processes. CDHR3 was previously identified as a locus for OM susceptibility, but to date, studies have focused on how the CDHR3 p.Cys529Tyr variant increases epithelial binding of rhinovirus-C and risk for lung or sinus pathology. In order to further delineate a role for CDHR3 in OM, we performed the following: exome sequencing using DNA samples from OM-affected individuals from 257 multi-ethnic families; Sanger sequencing, logistic regression and transmission disequilibrium tests for 407 US trios or probands with OM; 16S rRNA sequencing and analysis for middle ear and nasopharyngeal samples; and single-cell RNA sequencing and differential expression analyses for mouse middle ear. From exome sequence data, we identified a novel pathogenic CDHR3 splice variant that co-segregates with OM in US and Finnish families. Additionally, a frameshift and six missense rare or low-frequency variants were identified in Finnish probands. In US probands, the CDHR3 p.Cys529Tyr variant was associated with the absence of middle ear fluid at surgery and also with increased relative abundance of Lysobacter in the nasopharynx and Streptomyces in the middle ear. Consistent with published data on airway epithelial cells and our RNA-sequence data from human middle ear tissues, Cdhr3 expression is restricted to ciliated epithelial cells of the middle ear and is downregulated after acute OM. Overall, these findings suggest a critical role for CDHR3 in OM susceptibility. KEY MESSAGES: • Novel rare or low-frequency CDHR3 variants putatively confer risk for otitis media. • Pathogenic variant CDHR3 c.1653 + 3G > A was found in nine families with otitis media. • CDHR3 p.Cys529Tyr was associated with lack of effusion and bacterial otopathogens. • Cdhr3 expression was limited to ciliated epithelial cells in mouse middle ear. • Cdhr3 was downregulated 3 h after infection of mouse middle ear.
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Affiliation(s)
- Scott D Hirsch
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus (CU-AMC), 12700 E. 19th Ave, Aurora, CO, 80045, USA
| | - Christina L Elling
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus (CU-AMC), 12700 E. 19th Ave, Aurora, CO, 80045, USA
| | - Tori C Bootpetch
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus (CU-AMC), 12700 E. 19th Ave, Aurora, CO, 80045, USA
| | - Melissa A Scholes
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus (CU-AMC), 12700 E. 19th Ave, Aurora, CO, 80045, USA
- Department of Pediatric Otolaryngology, Children's Hospital Colorado (CHCO), 13123 E. 16th Ave, Aurora, CO, 80045, USA
| | - Lena Hafrén
- Department of Otorhinolaryngology, Head & Neck Surgery, University of Helsinki and Helsinki University Hospital, Tukholmankatu 8A, 00290, Helsinki, Finland
| | - Sven-Olrik Streubel
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus (CU-AMC), 12700 E. 19th Ave, Aurora, CO, 80045, USA
- Department of Pediatric Otolaryngology, Children's Hospital Colorado (CHCO), 13123 E. 16th Ave, Aurora, CO, 80045, USA
| | - Harold S Pine
- Department of Otolaryngology, University of Texas Medical Branch (UTMB), 301 8th St, Galveston, TX, 77550, USA
| | - Todd M Wine
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus (CU-AMC), 12700 E. 19th Ave, Aurora, CO, 80045, USA
- Department of Pediatric Otolaryngology, Children's Hospital Colorado (CHCO), 13123 E. 16th Ave, Aurora, CO, 80045, USA
| | - Wasyl Szeremeta
- Department of Otolaryngology, University of Texas Medical Branch (UTMB), 301 8th St, Galveston, TX, 77550, USA
| | - Jeremy D Prager
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus (CU-AMC), 12700 E. 19th Ave, Aurora, CO, 80045, USA
- Department of Pediatric Otolaryngology, Children's Hospital Colorado (CHCO), 13123 E. 16th Ave, Aurora, CO, 80045, USA
| | - Elisabet Einarsdottir
- Folkhälsan Institute of Genetics and Molecular Neurology Research Program, University of Helsinki, PO Box 63, Biomedicum 1, 3rd floor, Haartmaninkatu 8, 00014, Helsinki, Finland
- Department of Biosciences and Nutrition, Karolinska Institute, 141 86, Huddinge, Stockholm, Sweden
- Science for Life Laboratory, Department of Gene Technology, KTH-Royal Institute of Technology, 171 21, Solna, Sweden
| | - Ayesha Yousaf
- Bahauddin Zakariya University, Multan, 60000, Punjab, Pakistan
| | - Erin E Baschal
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus (CU-AMC), 12700 E. 19th Ave, Aurora, CO, 80045, USA
| | - Sakina Rehman
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, University of Maryland, 670 West Baltimore St., Room 7181, Baltimore, MD, 21201, USA
| | - Michael J Bamshad
- Department of Genome Sciences, University of Washington, William H. Foege Hall, 3720 15th Ave. NE, Seattle, WA, 98195, USA
| | - Deborah A Nickerson
- Department of Genome Sciences, University of Washington, William H. Foege Hall, 3720 15th Ave. NE, Seattle, WA, 98195, USA
| | - Saima Riazuddin
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, University of Maryland, 670 West Baltimore St., Room 7181, Baltimore, MD, 21201, USA
| | - Suzanne M Leal
- Center for Statistical Genetics, Gertrude H. Sergievsky Center, Department of Neurology, Taub Institute for Alzheimer's Disease and the Aging Brain, Columbia University, William Black Building, 650 West 168th St, New York, NY, 10032, USA
| | - Zubair M Ahmed
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, University of Maryland, 670 West Baltimore St., Room 7181, Baltimore, MD, 21201, USA
| | - Patricia J Yoon
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus (CU-AMC), 12700 E. 19th Ave, Aurora, CO, 80045, USA
- Department of Pediatric Otolaryngology, Children's Hospital Colorado (CHCO), 13123 E. 16th Ave, Aurora, CO, 80045, USA
| | - Juha Kere
- Folkhälsan Institute of Genetics and Molecular Neurology Research Program, University of Helsinki, PO Box 63, Biomedicum 1, 3rd floor, Haartmaninkatu 8, 00014, Helsinki, Finland
- Department of Biosciences and Nutrition, Karolinska Institute, 141 86, Huddinge, Stockholm, Sweden
| | - Kenny H Chan
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus (CU-AMC), 12700 E. 19th Ave, Aurora, CO, 80045, USA
- Department of Pediatric Otolaryngology, Children's Hospital Colorado (CHCO), 13123 E. 16th Ave, Aurora, CO, 80045, USA
| | - Petri S Mattila
- Department of Otorhinolaryngology, Head & Neck Surgery, University of Helsinki and Helsinki University Hospital, Tukholmankatu 8A, 00290, Helsinki, Finland
| | - Norman R Friedman
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus (CU-AMC), 12700 E. 19th Ave, Aurora, CO, 80045, USA
- Department of Pediatric Otolaryngology, Children's Hospital Colorado (CHCO), 13123 E. 16th Ave, Aurora, CO, 80045, USA
| | - Tasnee Chonmaitree
- Division of Infectious Diseases, Department of Pediatrics, UTMB, 301 8th St, Galveston, TX, 77550, USA
| | - Daniel N Frank
- Division of Infectious Diseases, Department of Medicine, School of Medicine, CU-AMC, 12700 E. 19th Ave, Aurora, CO, 80045, USA
| | - Allen F Ryan
- Division of Otolaryngology, Department of Surgery, San Diego School of Medicine and Veterans Affairs Medical Center, University of California, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Regie Lyn P Santos-Cortez
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus (CU-AMC), 12700 E. 19th Ave, Aurora, CO, 80045, USA.
- Center for Children's Surgery, CHCO, 13123 E. 16th Ave, Aurora, CO, 80045, USA.
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Kong K, Cass A, Leach AJ, Morris PS, Kimber A, Su JY, Oguoma VM. A community-based service enhancement model of training and employing Ear Health Facilitators to address the crisis in ear and hearing health of Aboriginal children in the Northern Territory, the Hearing for Learning Initiative (the HfLI): study protocol for a stepped-wedge cluster randomised trial. Trials 2021; 22:403. [PMID: 34134736 PMCID: PMC8207498 DOI: 10.1186/s13063-021-05215-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 03/21/2021] [Indexed: 02/03/2023] Open
Abstract
Background Almost all Aboriginal children in remote communities have persistent bilateral otitis media affecting hearing and learning throughout early childhood and school years, with consequences for social and educational outcomes, and later employment opportunities. Current primary health care and specialist services do not have the resources to meet the complex needs of these children. Method/design This stepped-wedge cluster randomised trial will allocate 18 communities to one of five 6-monthly intervention start dates. Stratification will be by region and population size. The intervention (Hearing for Learning Initiative, HfLI) consists of six 20-h weeks of training (delivered over 3 months) that includes Certificate II in Aboriginal Primary Health Care (3 modules) and competencies in ear and hearing data collection (otoscopy, tympanometry and hearScreen), plus 3 weeks of assisted integration into the health service, then part-time employment as Ear Health Facilitators to the end of the trial. Unblinding will occur 6 months prior to each allocated start date, to allow Community Reference Groups to be involved in co-design of the HfLI implementation in their community. Relevant health service data will be extracted 6-monthly from all 18 communities. The primary outcome is the difference in proportion of children (0 to 16 years of age) who have at least one ear assessment (diagnosis) documented in their medical record within each 6-month period, compared to control periods (no HfLI). Secondary outcomes include data on sustainability, adherence to evidence-based clinical guidelines for otitis media, including follow-up and specialist referrals, and school attendance. Structured interviews with staff working in health and education services, Ear Health Trainees, Ear Health Facilitators and families will assess process outcomes and the HfLI broader impact. Discussion The impact of training and employment of Ear Health Facilitators on service enhancement will inform the health, education and employment sectors about effectiveness of skills and job creation that empowers community members to contribute to addressing issues of local importance, in this instance ear and hearing health of children. Trial registration ClinicalTrials.gov NCT03916029. Registered on 16 April 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05215-7.
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Affiliation(s)
- Kelvin Kong
- University of Newcastle, John Hunter Children's Hospital, Newcastle, NSW, 2300, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, 58 Rocklands Drive, Darwin, NT, 0810, Australia
| | - Amanda Jane Leach
- Menzies School of Health Research, Charles Darwin University, 58 Rocklands Drive, Darwin, NT, 0810, Australia.
| | - Peter Stanley Morris
- Menzies School of Health Research, Charles Darwin University, 58 Rocklands Drive, Darwin, NT, 0810, Australia.,Royal Darwin Hospital, Darwin, NT, Australia
| | - Amy Kimber
- Menzies School of Health Research, Charles Darwin University, 58 Rocklands Drive, Darwin, NT, 0810, Australia
| | - Jiunn-Yih Su
- Menzies School of Health Research, Charles Darwin University, 58 Rocklands Drive, Darwin, NT, 0810, Australia
| | - Victor Maduabuchi Oguoma
- Menzies School of Health Research, Charles Darwin University, 58 Rocklands Drive, Darwin, NT, 0810, Australia.,Health Research Institute, University of Canberra, Canberra, ACT, Australia
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15
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Leach AJ, Mulholland EK, Santosham M, Torzillo PJ, McIntyre P, Smith-Vaughan H, Wilson N, Arrowsmith B, Beissbarth J, Chatfield MD, Oguoma VM, Morris PS. Otitis media outcomes of a combined 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine and 13-valent pneumococcal conjugate vaccine schedule at 1-2-4-6 months: PREVIX_COMBO, a 3-arm randomised controlled trial. BMC Pediatr 2021; 21:117. [PMID: 33685411 PMCID: PMC7938290 DOI: 10.1186/s12887-021-02552-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 02/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aboriginal children living in Australian remote communities are at high risk of early and persistent otitis media, hearing loss, and social disadvantage. Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) are the primary pathogens. We compared otitis media outcomes in infants randomised to either a combination of Synflorix™ (PHiD-CV10, with protein D of NTHi) and Prevenar13™ (PCV13, with 3, 6A, and 19A), with recommended schedules for each vaccine alone. We previously reported superior broader overall immunogenicity of the combination schedule at 7 months, and early superiority of PHiD-CV10 compared to PCV13 at 4 months. METHODS In an open-label superiority trial, we randomised (1:1:1) Aboriginal infants at 28 to 38 days of age, to either Prevenar13™ (P) at 2-4-6 months (_PPP), Synflorix™ (S) at 2-4-6 months (_SSS), or Synflorix™ at 1-2-4 months plus Prevenar13™ at 6 months (SSSP). Ears were assessed using tympanometry at 1 and 2 months, combined with otoscopy at 4, 6, and 7 months. A worst ear diagnosis was made for each child visit according to a severity hierarchy of normal, otitis media with effusion (OME), acute otitis media without perforation (AOMwoP), AOM with perforation (AOMwiP), and chronic suppurative otitis media (CSOM). RESULTS Between September 2011 and September 2017, 425 infants were allocated to _PPP(143), _SSS(141) or SSSP(141). Ear assessments were successful in 96% scheduled visits. At 7 months prevalence of any OM was 91, 86, and 90% in the _PPP, _SSS, and SSSP groups, respectively. There were no significant differences in prevalence of any form of otitis media between vaccine groups at any age. Combined group prevalence of any OM was 43, 57, 82, 87, and 89% at 1, 2, 4, 6, and 7 months of age, respectively. Of 388 infants with ear assessments at 4, 6 and 7 months, 277 (71.4%) had OM that met criteria for specialist referral; rAOM, pOME, or CSOM. CONCLUSIONS Despite superior broader overall immunogenicity of the combination schedule at 7 months, and early superiority of PHiD-CV10 compared to PCV13 at 4 months, there were no significant differences in prevalence of otitis media nor healthy ears throughout the first months of life. TRIAL REGISTRATION ACTRN12610000544077 registered 06/07/2010 and ClinicalTrials.gov NCT01174849 registered 04/08/2010.
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Affiliation(s)
- Amanda Jane Leach
- Child Health Division, Menzies School of Heath Research, Casuarina, Northern Territory Australia
- Charles Darwin University, Casuarina Northern Territory, Australia
| | - Edward Kim Mulholland
- Murdoch Children’s Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Australia
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Paul John Torzillo
- Prince Alfred Hospital, Sydney, NSW Australia
- University of Sydney, NSW, Australia
| | - Peter McIntyre
- National Centre for Immunization Research and Surveillance, Sydney, NSW Australia
| | - Heidi Smith-Vaughan
- Child Health Division, Menzies School of Heath Research, Casuarina, Northern Territory Australia
- Charles Darwin University, Casuarina Northern Territory, Australia
| | - Nicole Wilson
- Child Health Division, Menzies School of Heath Research, Casuarina, Northern Territory Australia
- Charles Darwin University, Casuarina Northern Territory, Australia
| | - Beth Arrowsmith
- Child Health Division, Menzies School of Heath Research, Casuarina, Northern Territory Australia
- Charles Darwin University, Casuarina Northern Territory, Australia
| | - Jemima Beissbarth
- Child Health Division, Menzies School of Heath Research, Casuarina, Northern Territory Australia
- Charles Darwin University, Casuarina Northern Territory, Australia
| | - Mark D. Chatfield
- Child Health Division, Menzies School of Heath Research, Casuarina, Northern Territory Australia
- Charles Darwin University, Casuarina Northern Territory, Australia
- Centre for Health Services Research Faculty of Medicine, University of Queensland, Brisbane QLD, Australia
| | - Victor M. Oguoma
- Child Health Division, Menzies School of Heath Research, Casuarina, Northern Territory Australia
- Charles Darwin University, Casuarina Northern Territory, Australia
- Health Research Institute University of Canberra, Canberra, ACT Australia
| | - Peter Stanley Morris
- Child Health Division, Menzies School of Heath Research, Casuarina, Northern Territory Australia
- Charles Darwin University, Casuarina Northern Territory, Australia
- Department of Paediatrics , Royal Darwin Hospital, Darwin, Northern Territory Australia
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