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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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Elder BC, Soldatić K, Schwartz MA, Barney J, Howard D, McGee P. Barriers Experienced by First Nations Deaf People in the Justice System. JOURNAL OF DEAF STUDIES AND DEAF EDUCATION 2024:enae021. [PMID: 38826120 DOI: 10.1093/jdsade/enae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 04/27/2024] [Accepted: 05/09/2024] [Indexed: 06/04/2024]
Abstract
Anecdotal evidence strongly suggests that members of the First Nations Deaf community experience more barriers when engaging with the criminal justice system than those who are not deaf. Therefore, our purpose for writing this article is to highlight legal and policy issues related to First Nations Deaf people, including perspectives of professionals working with these communities, living in Australia who have difficulty in accessing supports within the criminal justice system. In this article, we present data from semi-structured qualitative interviews focused on four key themes: (a) indefinite detention and unfit to plead, (b) a need for an intersectional approach to justice, (c) applying the maximum extent of the law while minimizing social services-related resources, and (d) the need for language access and qualified sign language interpreters. Through this article and the related larger sustaining project, we seek to center the experiences and needs of First Nations Deaf communities to render supports for fair, just, and equitable access in the Australian criminal justice system to this historically marginalized group.
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Affiliation(s)
- Brent C Elder
- Department of Wellness and Inclusive Services in Education, Rowan University, 201 Mullica Hill Dr., Glassboro, New Jersey 08028, United States
| | - Karen Soldatić
- Canada Excellence Research Chair in Health Equity and Community Wellbeing (CERC), Toronto Metropolitan University, Institute of Culture and Society, Western Sydney University (Institute Fellow), 288 Church Street Toronto ON Canada M5B 1M5, Australia
| | - Michael A Schwartz
- College of Law, Syracuse University, 950 Irving Ave, Syracuse, New York 13244, United States
| | - Jody Barney
- The Winston Churchill Memorial Trust, GPO Box 1536, Canberra ACT 2601, Australia
| | - Damien Howard
- Phoenix Consulting, PO Box 793 Nightcliff 0814, Australia
| | - Patrick McGee
- The Winston Churchill Memorial Trust, GPO Box 1536, Canberra ACT 2601, Australia
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Oguoma VM, Mathew S, Begum T, Dyson E, Ward J, Leach AJ, Barzi F. Trajectories of otitis media and association with health determinants among Indigenous children in Australia: the Longitudinal Study of Indigenous Children. Public Health 2023; 225:53-62. [PMID: 37922586 DOI: 10.1016/j.puhe.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 08/30/2023] [Accepted: 09/13/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES Indigenous children in Australia experience high burden of persistent otitis media (OM) from very early age. The aim was to identify distinct trajectories of OM in children up to age 10-12 years and examine the association with socio-economic determinants. STUDY DESIGN A multistage clustered national panel survey. METHODS The study analysed the birth cohort of the Longitudinal Study of Indigenous Children from 2008 to 2018, comprising 11 study waves. Group-based trajectory modelling was used to identify different trajectories of OM outcome. Multinomial logistic regression was applied to examine the relationship between trajectories and individual, household and community-level socio-economic determinants. RESULTS This analysis included 894 children with at least three responses on OM over the 11 waves, and the baseline mean age was 15.8 months. Three different trajectories of OM were identified: non-severe OM prone, early/persistent severe OM and late-onset severe OM. Overall, 11.4% of the children had early/persistent severe OM from birth to 7.5 to nine years, while late-onset severe OM consisted of 9.8% of the children who had first OM from age 3.5 to five years. Children in communities with middle and the highest socio-economic outcomes have lower relative risk of early/persistent severe OM (adjusted relative risk ratio = 0.39, 95% confidence interval = 0.22-0.70 and adjusted relative risk ratio = 0.22, 95% confidence interval = 0.09-0.52, respectively) compared to children in communities with lowest socio-economic outcomes. CONCLUSION Efforts to close the gap in the quality of life of Indigenous children must prioritise strategies that prevent severe ear disease (runny ears and perforation), including improved healthcare access, reduced household crowding, and better education, and more employment opportunities.
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Affiliation(s)
- V M Oguoma
- Poche Centre for Indigenous Health, The University of Queensland, Toowong, Australia; Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
| | - S Mathew
- Poche Centre for Indigenous Health, The University of Queensland, Toowong, Australia
| | - T Begum
- Poche Centre for Indigenous Health, The University of Queensland, Toowong, Australia
| | - E Dyson
- Poche Centre for Indigenous Health, The University of Queensland, Toowong, Australia
| | - J Ward
- Poche Centre for Indigenous Health, The University of Queensland, Toowong, Australia
| | - A J Leach
- Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - F Barzi
- Poche Centre for Indigenous Health, The University of Queensland, Toowong, 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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Baidawi S, Papalia N, Featherston R. Gender Differences in the Maltreatment-Youth Offending Relationship: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:1140-1156. [PMID: 34907817 PMCID: PMC10012399 DOI: 10.1177/15248380211052106] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Maltreated and child welfare-involved youth are over-represented in juvenile justice systems. These youth are at a greater risk of serious offending and justice system entrenchment relative to their non-maltreated peers. Understanding gender differences in the pathways to justice involvement and the nature of offending among maltreated children is critical for informing policy and practice. Yet, this body of evidence is fragmented. This scoping review identified and narratively synthesized evidence from studies reporting on gender differences in the individual characteristics, maltreatment experiences, child protection involvement and offending profiles of maltreated youth who offend. A comprehensive search of four databases generated 11,568 publications, from which 180 met the review's inclusion criteria. These primary studies included participants aged 8-21 years with a history of childhood maltreatment and youth offending and reported at least one gendered analysis. Some consistent findings were reported across studies. A greater level of child welfare involvement and maltreatment exposure (particularly sexual abuse and multi-type maltreatment) was found for justice involved girls, relative to boys. Maltreated and child welfare-involved boys appear more likely to offend than girls, but findings about how gender moderates the maltreatment-offending relationship were inconsistent. Child welfare systems involvement (particularly foster care and residential care) appeared to be an important moderator for girls, and school performance mediated outcomes for boys. Across this body of evidence, few studies accounted for under-reporting of abuse and neglect when using youth self-report measures of maltreatment. Future research is needed which explicitly explores how gender moderates the maltreatment-offending relationship.
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Affiliation(s)
- Susan Baidawi
- Department of Social Work, Monash University, Melbourne, VIC, Australia
- Susan Baidawi, Department of Social Work, Monash University, PO Box 197, Caulfield East, Melbourne, VIC 3145, Australia.
| | - Nina Papalia
- Centre for Forensic Behavioural Science, Swinburne University of Technology and the Victorian Institute of Forensic Mental Health (Forensicare), Melbourne, VIC, Australia
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He VY, Leckning B, Malvaso C, Williams T, Liddle L, Guthridge S. Opportunities for prevention: a data-linkage study to inform a public health response to youth offending in the Northern Territory, Australia. BMC Public Health 2021; 21:1600. [PMID: 34461862 PMCID: PMC8404303 DOI: 10.1186/s12889-021-11645-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 08/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous studies have demonstrated a strong link between child maltreatment and subsequent youth offending, leading to calls for early intervention initiatives. However, there have been few whole-population studies into the dimensions of statutory child maltreatment responses that can inform these programs. The aim of this study was to investigate the sex-specific association between level and timing of child protection system (CPS) contact and youth offending. METHODS This retrospective cohort study used linked individual-level records from multiple agencies, for 10,438Aboriginal children born in the Northern Territory between 1999 and 2006. The outcome measure was the first alleged offence. Key explanatory variables were level (no contact through to out-of-home care) and timing (0-4 years, 5-9 years, or both) of CPS contact. The Kaplan-Meier method was used to estimate cumulative incidence and a flexible parametric survival model to estimate hazard ratios (HR). RESULTS Children with no record of CPS contact before age 10 had the lowest cumulative incidence of first alleged offence by age 18 (boys: 23.4% [95%CI:21.0-26.1]; girls: 6.6% [95%CI:5.3-8.2]) and those with a record of out-of-home care the highest CI (boys: 45.5% [95%CI:37.0-54.9]; girls: 18.6% [95%CI:13.0-26.2]). The association of CPS contact with the relative risk of a first alleged offence was greatest for children aged 10-13 years and decreased with age. Timing of CPS contact was also associated with increasing cumulative incidence. The relative risk for first alleged offence was generally higher for children with CPS contact, of any type, during both developmental phases including notifications during both phases (boys, HR at age 11: 8.9 [95%CI:4.2-17.2]; girls, HR at age 11: 13.7 [95%CI:3.8-48.9]) and substantiations during both phases (boys, HR at age 11: 17.0 [95%CI:9.6-30.0]; girls, HR at age 11: 54.1 [95%CI:18.1-162]). CONCLUSION The increased risk of offending associated with level and timing of early CPS contact highlights opportunities for a differentiated public health response to improve life trajectories for children and to reduce youth crime. Although children with unsubstantiated notifications of maltreatment do not meet the criteria for a statutory CPS response, the higher risk of offending among these children supports their inclusion in targeted preventive interventions.
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Affiliation(s)
- Vincent Yaofeng He
- Menzies School of Health Research, Building Red 9, Charles Darwin University, Casuarina campus, Ellengowan Drive, Casuarina NT, Northern Territory, 0810, Australia.
| | - Bernard Leckning
- Menzies School of Health Research, Building Red 9, Charles Darwin University, Casuarina campus, Ellengowan Drive, Casuarina NT, Northern Territory, 0810, Australia
| | - Catia Malvaso
- University of Adelaide, Adelaide, South Australia, Australia
| | - Tamika Williams
- Menzies School of Health Research, Building Red 9, Charles Darwin University, Casuarina campus, Ellengowan Drive, Casuarina NT, Northern Territory, 0810, Australia
| | - Leanne Liddle
- Aboriginal Justice Unit, Department of the Attorney-General and Justice, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Steven Guthridge
- Menzies School of Health Research, Building Red 9, Charles Darwin University, Casuarina campus, Ellengowan Drive, Casuarina NT, Northern Territory, 0810, Australia
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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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Leach AJ, Mulholland EK, Santosham M, Torzillo PJ, McIntyre P, Smith-Vaughan H, Wilson N, Arrowsmith B, Beissbarth J, Chatfield MD, Oguoma VM, Licciardi P, Skull S, Andrews R, Carapetis J, McDonnell J, Krause V, Morris PS. Interchangeability, immunogenicity and safety of a combined 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (Synflorix) and 13-valent-PCV (Prevenar13) schedule at 1-2-4-6 months: PREVIX_COMBO, a 3-arm randomised controlled trial. Vaccine X 2021; 7:100086. [PMID: 33681756 PMCID: PMC7930582 DOI: 10.1016/j.jvacx.2021.100086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 11/18/2022] Open
Abstract
A mix of SynflorixTM (S) and Prevenar13TM (P) at 1–2-4–6 months (SSSP) is safe. At 7 months the SSSP schedule is immunogenic against 13 serotypes* and protein D. One-month dose of Synflorix is immunogenic* (8 of 10 serotypes) Two-month dose of Prevenar13 is poorly immunogenic** (8 of 13 serotypes) Two-month dose of Synflorix is superior (8 serotypes) or similar (4) to Prevenar13 *GMC ≥ 0·35 µg/mL **GMC ≤ 0·35 µg/mL. A 4-dose schedule is superior to either 3-dose schedule, particularly against 6B, 19F, and 23F.
Background Aboriginal children living in remote communities are at high risk of early and persistent otitis media. Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) are primary pathogens. Vaccines with potential to prevent early OM have not been evaluated in this population. We compared immunogenicity (ELISA and opsonophagocytic activity) of a combination of Synflorix™ (PHiD-CV10, 10 serotypes and protein D of NTHi) and Prevenar13™ (PCV13, 10 serotypes plus 3, 6A, and 19A), with recommended schedules. Methods This open-label superiority trial randomised (1:1:1) Aboriginal infants at 28 to 38 days of age, to PCV13 (P) at 2–4-6 months (_PPP), PHiD-CV10 (S) at 2–4-6 months (_SSS), or PHiD-CV10 at 1–2–4 plus PCV13 at −6 months (SSSP). Primary outcomes (blinded) were immunogenicity against PCV13-only serotypes 3, 6A, 19A, and PHiD-CV10-only protein D at 7 months. Secondary outcomes include immunogenicity against all serotypes at 2, 4 and 7 months. Findings Between 2011 and 2017, 425 infants were allocated to _PPP(143), _SSS(141) or SSSP(1 4 1). An intention to treat approach including all available data was used. The SSSP group had superior immunogenicity against serotypes 3, 6A, and 19A compared to _SSS (OPA GMT ratios 8.1 to 59.5, p < 0.001), and against protein D compared to _PPP (GMC ratio 11.9 (95%CI 9.7 to 14.6)). Immune responses to protein D and 3, 6A, and 19A in SSSP were not significantly lower (i.e. no harm) than either _SSS or _PPP. For ten common serotypes responses at 2, 4 and 7 months were superior for SSSP (following 1-, 2-, and 4- doses) than _SSS and _PPP (following 0-, 1-, and 3- doses). At 4 months, _SSS was superior to _PPP. Reactogenicity and hospitalisations were rare and unrelated to the intervention. Interpretation From two months, the 1–2–4–6-month combined schedule (SSSP) was safe and significantly more immunogenic than 2–4–6-month schedules. The earlier responses may be beneficial in high-risk populations.
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Affiliation(s)
- Amanda Jane Leach
- Child Health Division, Menzies School of Heath Research, PO Box 41096, Casuarina, Australia
- Charles Darwin University, Northern Territory, Australia
- Corresponding author at: Child Health Division, Menzies School of Heath Research, PO Box 41096, Casuarina, Northern Territory, Australia.
| | - Edward Kim Mulholland
- Murdoch Children’s Research Institute, Department of Paediatrics, University of Melbourne, Australia
- London School of Hygiene and Tropical Medicine, UK
| | | | - Paul John Torzillo
- Prince Alfred Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Peter McIntyre
- National Centre for Immunization Research and Surveillance, Sydney, Australia
| | - Heidi Smith-Vaughan
- Child Health Division, Menzies School of Heath Research, PO Box 41096, Casuarina, Australia
- Charles Darwin University, Northern Territory, Australia
| | - Nicole Wilson
- Child Health Division, Menzies School of Heath Research, PO Box 41096, Casuarina, Australia
- Charles Darwin University, Northern Territory, Australia
| | - Beth Arrowsmith
- Child Health Division, Menzies School of Heath Research, PO Box 41096, Casuarina, Australia
- Charles Darwin University, Northern Territory, Australia
| | - Jemima Beissbarth
- Child Health Division, Menzies School of Heath Research, PO Box 41096, Casuarina, Australia
- Charles Darwin University, Northern Territory, Australia
| | - Mark D. Chatfield
- Child Health Division, Menzies School of Heath Research, PO Box 41096, Casuarina, Australia
- Charles Darwin University, Northern Territory, Australia
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Victor M. Oguoma
- Child Health Division, Menzies School of Heath Research, PO Box 41096, Casuarina, Australia
- Charles Darwin University, Northern Territory, Australia
- Health Research Institute, University of Canberra, Canberra, Australia
| | - Paul Licciardi
- Murdoch Children’s Research Institute, Dept of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Sue Skull
- Dept of Child Health Research, Perth Children’s Hospital, University of Western Australia, Perth, Australia
| | - Ross Andrews
- Child Health Division, Menzies School of Heath Research, PO Box 41096, Casuarina, Australia
- Charles Darwin University, Northern Territory, Australia
- Australian National University, Canberra, Australia
| | - Jonathan Carapetis
- Telethon Kids Institute, University of Western Australia, Australia
- Perth Children’s Hospital, Perth, Australia
| | | | - Vicki Krause
- Centre for Disease Control, Northern Territory Department of Health, Darwin, Australia
| | - Peter Stanley Morris
- Child Health Division, Menzies School of Heath Research, PO Box 41096, Casuarina, Australia
- Charles Darwin University, Northern Territory, Australia
- Department of Paediatrics, Royal Darwin Hospital, Darwin Northern Territory, Australia
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He VY, Guthridge S, Su JY, Howard D, Stothers K, Leach A. The link between hearing impairment and child maltreatment among Aboriginal children in the Northern Territory of Australia: is there an opportunity for a public health approach in child protection? BMC Public Health 2020; 20:449. [PMID: 32252723 PMCID: PMC7132974 DOI: 10.1186/s12889-020-8456-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/04/2020] [Indexed: 12/04/2022] Open
Abstract
Background International studies provide evidence of an association between child disabilities, including hearing impairment (HI), and child maltreatment. There are high prevalences of ear disease with associated HI, and child maltreatment among Australian Aboriginal children, but the link between HI and child maltreatment is unknown. This study investigates the association between HI and child maltreatment for Aboriginal children living in the Northern Territory (NT) of Australia. Methods This was a retrospective cohort study of 3895 Aboriginal school-aged children (born between 1999 and 2008) living in remote NT communities. The study used linked individual-level information from health, education and child protection services. The outcome variables were child maltreatment notifications and substantiations. The key explanatory variable, HI, was based on audiometric assessment. The Kaplan–Meier estimator method was used in univariate analysis; Cox proportional hazards regression was used in multivariable analysis. Results A majority of the study cohort lived in very remote (94.5%) and most disadvantaged (93.1%) regions. Among all children in the study cohort, 56.1% had a record of either HI or unilateral hearing loss (UHL), and for those with a history of contact with child protection services (n = 2757), 56.7% had a record of HI/UHL (n = 1564). In the 1999–2003 birth cohort, by age 12 years, 53.5% of children with a record of moderate or worse HI had at least one maltreatment notification, compared to 47.3% of children with normal hearing. In the 2004–2008 cohort, the corresponding results were 83.4 and 71.7% respectively. In multivariable analysis, using the full cohort, children with moderate or worse HI had higher risk of any child maltreatment notification (adjusted Hazard Ratios (adjHR): 1.16, 95% CI:1.04–1.30), notification for neglect (adjHR:1.17, 95% CI:1.04–1.31) and substantiation (adjHR:1.20, 95% CI:1.04–1.40), than children with normal hearing. In the 2004–2008 birth cohort, children with moderate or worse HI had higher risk of a substantiated episode of physical abuse (adjHR:1.47, 95% CI:1.07–2.03) than children with normal hearing. Conclusion Our findings demonstrate the urgent need for HI and child maltreatment prevention strategies through raised community awareness and inter-agency collaboration. Effective information-sharing between service providers is a critical first step to a public health approach in child protection.
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Affiliation(s)
- Vincent Yaofeng He
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, 0811, Australia.
| | - Steven Guthridge
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, 0811, Australia
| | - Jiunn-Yih Su
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, 0811, Australia
| | - Damien Howard
- Phoenix Consulting, Nightcliff, Northern Territory, 0810, Australia
| | - Kylie Stothers
- Indigenous Allied Health Australia, Katherine, Northern Territory, 0850, Australia
| | - Amanda Leach
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, 0811, Australia
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