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Tsang TW, Allen T, Turner A, Bowyer J, Fitzpatrick J, Latimer J, Oscar J, Carter M, Elliott EJ. Ophthalmic Findings in Aboriginal Children with High Rates of Prenatal Alcohol Exposure and Fetal Alcohol Spectrum Disorder: The Lililwan Project. Ophthalmic Epidemiol 2024:1-8. [PMID: 38569083 DOI: 10.1080/09286586.2024.2331539] [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: 06/18/2023] [Accepted: 03/08/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE To describe ophthalmic findings in an Indigenous paediatric population and the associations between fetal alcohol spectrum disorder (FASD), prenatal alcohol exposure (PAE), and eye anomalies. METHODS Medical records were reviewed for eye problems, and eye assessments were conducted by an orthoptist or ophthalmologist in the Lililwan Project cohort, which comprised 108 (81%) of all children born between 2002 and 2003, and residing in the remote Fitzroy Valley, Western Australia in 2010. Values from ophthalmic assessments and prevalence of abnormalities were presented for the total cohort and stratified by group: FASD; PAE (no FASD); and No PAE. RESULTS Of children, 55% had PAE and 19% FASD. Most (98%) had normal vision; 15.6% had keratometry cylinder values indicating astigmatism and potential for improved vision with glasses. Strabismus (22.3%), short palpebral fissure length (PFL; 21.3%), upslanting palpebral fissures (12.0%), follicular trachomatous inflammation (6.9%), abnormal slit lamp assessments (6.7%), retinal tortuosity (6.7%), and blepharoptosis (5.6%) were identified. Strabismus and trachoma rates were higher than in the general child population. Ophthalmic findings were similar between groups except for prevalence of short PFL (FASD > No PAE; p = 0.003); abnormal keratometry cylinder values (FASD [29.4%] and PAE (no FASD) [20.0%] > No PAE [5.3%]; p = 0.031) and blepharoptosis (FASD [9.5%] > other groups [0%]; p = 0.040). CONCLUSION Despite the small sample, some eye abnormalities were higher in children with PAE and/or FASD. Access to eye services or assessment of vision and structural eye anomalies is essential for Indigenous children, particularly those with PAE or FASD to allow early effective treatment.
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Affiliation(s)
- Tracey W Tsang
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Sydney Children's Hospital Network, Kids Research, Westmead, New South Wales, Australia
| | - Tiffany Allen
- Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Angus Turner
- Lions Eye Institute, Nedlands, Washington, Australia
- University of Western Australia, Perth, Western Australia, Australia
| | - Joshua Bowyer
- Lions Eye Institute, Nedlands, Washington, Australia
- University of Western Australia, Perth, Western Australia, Australia
- St. John of God Hospital Midland, Midland, Western Australia, Australia
| | - James Fitzpatrick
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| | - Jane Latimer
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - June Oscar
- Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, Australia
| | - Elizabeth J Elliott
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Sydney Children's Hospital Network, Kids Research, Westmead, New South Wales, Australia
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Yashadhana A, Zwi AB, Brady B, De Leeuw E, Kingsley J, O'Leary M, Raven M, Serova N, Topp SM, Fields T, Foster W, Jopson W, Biles B. Gaawaadhi Gadudha: understanding how cultural camps impact health, well-being and resilience among Aboriginal adults in New South Wales, Australia-a collaborative study protocol. BMJ Open 2023; 13:e073551. [PMID: 38135326 DOI: 10.1136/bmjopen-2023-073551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION The health and well-being of Aboriginal Australians is inextricably linked to culture and Country. Our study challenges deficit approaches to health inequities by seeking to examine how cultural connection, practice and resilience among Aboriginal peoples through participation in 'cultural camps' held on sites of cultural significance promotes health and well-being. METHODS AND ANALYSIS The study will be undertaken in close collaboration and under the governance of traditional cultural knowledge holders from Yuwaalaraay, Gamilaraay and Yuin nation groups in New South Wales, Australia. Three cultural camps will be facilitated, where participants (n=105) will engage in activities that foster a connection to culture and cultural landscapes. A survey assessing connection to culture, access to cultural resources, resilience, self-rated health and quality of life will be administered to participants pre-camp and post-camp participation, and to a comparative group of Aboriginal adults who do not attend the camp (n=105). Twenty participants at each camp (n=60) will be invited to participate in a yarning circle to explore cultural health, well-being and resilience. Quantitative analysis will use independent samples' t-tests or χ2 analyses to compare camp and non-camp groups, and linear regression models to determine the impact of camp attendance. Qualitative analysis will apply inductive coding to data, which will be used to identify connections between coded concepts across the whole data set, and explore phenomenological aspects. Results will be used to collaboratively develop a 'Model of Cultural Health' that will be refined through a Delphi process with experts, stakeholders and policymakers. ETHICS AND DISSEMINATION The study has ethics approval from the Aboriginal Health and Medical Research Council (#1851/21). Findings will be disseminated through a combination of peer-reviewed articles, media communication, policy briefs, presentations and summary documents to stakeholders.
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Affiliation(s)
- Aryati Yashadhana
- Centre for Primary Health Care & Equity, University of New South Wales, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Anthony B Zwi
- School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Brooke Brady
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Evelyne De Leeuw
- Centre for Primary Health Care & Equity, University of New South Wales, Sydney, New South Wales, Australia
- École de Santé Publique, l'Université de Montréal, Montréal, Quebec, Canada
| | - Jonathan Kingsley
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Michelle O'Leary
- Centre for Primary Health Care & Equity, University of New South Wales, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Miri Raven
- Social Policy Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Nina Serova
- Centre for Primary Health Care & Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephanie M Topp
- School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Ted Fields
- Centre for Primary Health Care & Equity, University of New South Wales, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Warren Foster
- Centre for Primary Health Care & Equity, University of New South Wales, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Wendy Jopson
- Social Policy Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Brett Biles
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
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Atkinson-Briggs S, Jenkins A, Keech A, Ryan C, Brazionis L. Prevalence of diabetic retinopathy and reduced vision among indigenous Australians in the nurse-led integrated Diabetes Education and Eye Screening study in a regional primary care clinic. Intern Med J 2023; 53:1188-1195. [PMID: 34779559 DOI: 10.1111/imj.15625] [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: 10/07/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nationally, Indigenous Australians are more likely to have diabetes and diabetic retinopathy (DR) than non-Indigenous Australians. However, the prevalence of DR and impaired vision in regional primary care settings is unclear. AIM To describe the prevalence and severity of DR and presenting vision level among Indigenous Australian adults with diabetes attending an indigenous primary care clinic in regional Australia. METHODS Participants underwent nurse-led retinal imaging and DR screening with offsite retinal grading in the integrated Diabetes Education and Eye Screening (iDEES) project implemented at a regional indigenous primary healthcare setting between January 2018 and March 2020. RESULTS Of 172 eligible adults, 135 (79%) were recruited and screened for DR and vision level. The median age was 56 (46-67) years, 130 (96%) had type 2 diabetes of median (interquartile range) duration 6 (2-12) years and 48 (36%) were male. Images from 132 (97.8%) participants were gradable. DR was present in 38 (29%) participants: mild non-proliferative in 33 (25%); moderate-severe in three (2.5%); and sight-threatening two (1.5%). Subnormal presenting vision was present in 33%. CONCLUSIONS A nurse-led model of care integrating diabetes eye screening and education at a single visit was successful at recruiting Indigenous Australian adults with diabetes, screening their vision and acquiring a high rate of gradable images. Even for a short duration of known diabetes, DR was present in three out of 10 patients screened.
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Affiliation(s)
- Sharon Atkinson-Briggs
- Department of Medicine, University of Melbourne (St Vincent's Hospital), Melbourne, Victoria, Australia
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Anthony Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Ryan
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Laima Brazionis
- Department of Medicine, University of Melbourne (St Vincent's Hospital), Melbourne, Victoria, Australia
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Topp SM, Tully J, Cummins R, Graham V, Yashadhana A, Elliott L, Taylor S. Rhetoric, Reality and Racism: The Governance of Aboriginal and Torres Strait Islander Health Workers in a State Government Health Service in Australia. Int J Health Policy Manag 2022; 11:2951-2963. [PMID: 35569001 PMCID: PMC10105169 DOI: 10.34172/ijhpm.2022.6750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 04/22/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In northern Australia, Aboriginal and Torres Strait Islander Health Workers (A&TSIHWs) are unique members of nominally integrated teams of primary care professionals. Spurred by research documenting ongoing structural violence experienced by Indigenous health providers and more recent challenges to recruitment and retention of A&TSIHWs, this study aimed to explore whether the governance of the A&TSIHW role supports full and meaningful participation. METHODS The qualitative study was co-designed by a team of Aboriginal, Torres Strait Islander and non-Indigenous collaborators. Data collection comprised document review and interviews with A&TSIHWs (n=51), clinicians (n=19) community members (n=8) and administrators (n=5) in a north Queensland health district. We analysed governance at multiple levels (regulatory, organisational, and socio-cultural) and used critical race theory to deepen exploration of the role of race and racism in shaping it. RESULTS Governance of the A&TSIHW role occurs within a health system where racism is built into, and amplified by, formal and informal rules at all levels. Racially discriminatory structures such as the previous but long-standing relegation of A&TSIHW into the same career stream as cleaners were mirrored in discriminatory rules and managerial practices such as an absence of career-specific corporate support and limited opportunities to participate in, or represent to, key leadership groups. These interacted with and helped perpetuate workplace norms permissive of disrespect and abuse by non-Indigenous professionals. Ongoing resistance to the structural violence required of, and demonstrated by A&TSIHWs speaks to the gap between rhetoric and reality of governance for A&TSIHWs. CONCLUSION Strengthening governance to support A&TSIHWs requires critical attention be given to the role of race and racism in regulatory structures, organisational practice, and inter-professional relationships. Addressing all domains will be essential to achieve systemic change that recognises, supports and embeds the unique knowledge, skills and functions of the A&TSIHW role.
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Affiliation(s)
- Stephanie M. Topp
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Josslyn Tully
- Torres and Cape Hospital and Health Services (TCHSS), Cairns, QLD, Australia
| | - Rachel Cummins
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Veronica Graham
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Aryati Yashadhana
- Centre for Primary Health Care & Equity, University of New South Wales, Sydney, NSW, Australia
- School of Population Health, UNSW, Sydney, NSW, Australia
- School of Social Sciences, UNSW, Sydney, NSW, Australia
| | - Lana Elliott
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Sean Taylor
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- NT Health, Darwin, NT, Australia
- Menzies School of Health Research, Darwin, NT, Australia
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de Leeuw E, Harris P, Kim J, Yashadhana A. A health political science for health promotion. Glob Health Promot 2021; 28:17-25. [PMID: 34510937 DOI: 10.1177/17579759211034418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
If health promotion as a field of change for human and ecological health is to maintain its urgency, it needs to continue building its policy credentials. This paper charts the development of policy as a concern for IUHE/IUHPE (International Union for Health Education/International Union for Health Promotion and Education) from the mid-1970s when 'health education policies' were prominent issues, to the launch of Healthy Public Policy (in the 1980s) and Health in All Policy (in the 2000s). We argue that solid conceptual and theoretical foundations exist to frame and develop the relevance and connectedness of health promotion more prominently. We start off with a brief introduction into (health) political science, and then illustrate the urgency of the argument with three case studies. The first takes a critical realist perspective on 'closing the gap' in Australian Indigenous populations. With recent evidence it demonstrates that the core of the policymaking process needs to re-align itself with an Indigenous narrative. The second case study reviews the politics of healthy urban planning and health equity in cities. Taking a critical theory institutionalist view, the case describes how the political and narrative parallels between urban theory and health equity have gone underexplored. With an explicit gaze to connect the two, the field could become a large and influential driver of enhanced health promotion and public health policy. The third case describes the languages, policy frames, and distinctions, in four urban/health paradigms. It shows that unconscious policy and practice bias exists in policy priorities and processes. We conclude with observations and recommendations on the role of health promotion as a conceptual realm and field of activity. We show that all health promoters should be aware of the political nature of their enterprise. Tools and analyses exist to help further action.
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Affiliation(s)
- Evelyne de Leeuw
- Centre for Health Equity Research, Training and Evaluation CHETRE, University of New South Wales, South Western Sydney Local Health District, and Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Patrick Harris
- Centre for Health Equity Research, Training and Evaluation CHETRE, University of New South Wales, South Western Sydney Local Health District, and Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Jinhee Kim
- Centre for Health Equity Research, Training and Evaluation CHETRE, University of New South Wales, South Western Sydney Local Health District, and Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Aryati Yashadhana
- Centre for Health Equity Research, Training and Evaluation CHETRE, University of New South Wales, South Western Sydney Local Health District, and Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
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Yashadhana A, Fields T, Burnett A, Zwi AB. Re-examining the gap: A critical realist analysis of eye health inequity among Aboriginal and Torres Strait Islander Australians. Soc Sci Med 2021; 284:114230. [PMID: 34315122 DOI: 10.1016/j.socscimed.2021.114230] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/18/2021] [Accepted: 07/13/2021] [Indexed: 11/17/2022]
Abstract
The prevalence of diabetes among Aboriginal and Torres Strait Islander (hereafter 'Aboriginal') Australians is three times greater than non-Aboriginal Australians, contributing to a greater risk of blindness from treatable and preventable ocular conditions, most prominently cataract and diabetic retinopathy. In rural and remote Aboriginal communities, blindness prevalence is higher, and ocular treatment coverage and uptake are lower. In collaboration with Aboriginal Community Based Researchers (CBRs), this study explored complex contingent factors that shape access to eye health services among rural and remote Aboriginal Australians living with diabetes. Interviews (n = 126) and focus groups (n = 12) were conducted with patients, primary care clinicians, and CBRs, in four rural communities in the Northern Territory and New South Wales. Factors internal and external to health systems were examined, drawing on Bourdieu's concepts of habitus, and doxa to understand agency and decision-making among patients and clinicians. The study used the ontology of critical realism, categorising contingent factors as underlying structures (generative mechanisms), and applying a decolonising approach that centred causal relationships and tensions between dominant (Western biomedical neoliberalism) and non-dominant (Aboriginal) value systems. Three forms of marginalisation; linguistic, economic, and cultural, were identified as the generative mechanisms that inhibit equitable eye health outcomes. Marginality is linked to structural factors that position Aboriginal culture as a barrier, and is reinforced through biomedical health systems, and the agents who operate in and influence them. In order to address eye health inequity, a shift in how Aboriginal cultural sovereignty is understood within health systems is needed, to position it as a strength that can facilitate eye care accessibility, and to support enhanced cultural responsivity among clinicians and service providers.
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Affiliation(s)
- Aryati Yashadhana
- Vision Cooperative Research Centre, Sydney, Australia; Centre for Health Equity Training Research & Evaluation (CHETRE), UNSW, Australia; School of Social Sciences, UNSW, Australia; Ingham Institute for Applied Medical Research, Australia.
| | - Ted Fields
- Vision Cooperative Research Centre, Sydney, Australia
| | - Anthea Burnett
- Vision Cooperative Research Centre, Sydney, Australia; School of Optometry & Vision Science, UNSW, Australia
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Mitchell W, Hassall M, Henderson T. Updating the model of eye care for Aboriginal populations in remote Central Australia. Clin Exp Ophthalmol 2020; 48:1299-1306. [PMID: 32748478 DOI: 10.1111/ceo.13838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 01/17/2023]
Abstract
Eye disease is the third-highest contributor towards health inequality for Aboriginal Australians. Understanding how the Central Australian ophthalmology service addresses complexities of remote eye care is crucial in understanding how expansion can meet current and future needs. The present study analyses findings from the MEDLINE database and Governmental reports, and descriptive information from stakeholders in Central Australia and the Australian Department of Health. We describe the current Central Australian ophthalmology model at three levels; (a) the healthcare service level (specialized primary care, local/outreach optometry and ophthalmology services, and intensive extended surgical weeks), (b) the community level (local community staff, clinics and initiatives, and eye "champions" and mutual support), and (c) the healthcare system level (federal and state government, and private funding). We conclude that building full-time specialist availability, and system-wide approaches to increase patient utilisation, will facilitate overcoming barriers of remoteness, and create enduring improvements in Central Australian eye care and health-inequality.
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Affiliation(s)
- William Mitchell
- Harvard TH Chan School of Public Health, Boston MA, USA.,Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Boston MA, USA
| | - Mark Hassall
- Flinders Medical Centre, Department of Ophthalmology, Bedford Park, SA, Australia
| | - Tim Henderson
- Alice Springs Hospital, Department of Ophthalmology, Alice Springs, NT, Australia
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Yashadhana A, Fields T, Blitner G, Stanley R, Zwi AB. Trust, culture and communication: determinants of eye health and care among Indigenous people with diabetes in Australia. BMJ Glob Health 2020; 5:e001999. [PMID: 32133172 PMCID: PMC7042588 DOI: 10.1136/bmjgh-2019-001999] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/19/2019] [Accepted: 11/22/2019] [Indexed: 12/27/2022] Open
Abstract
Introduction Our study aimed to identify factors that influence access to eye care and eye health outcomes for remote Indigenous Australians living with diabetes. Methods In collaboration with Indigenous Community-Based Researchers (CBR) and Aboriginal Community Controlled Health Services (ACCHS), a qualitative, participatory action research approach was taken, drawing on Indigenist and decolonising methodologies. The study was undertaken in four remote communities, in the Katherine region, Northern Territory and north-western New South Wales, Australia. Interviews and focus groups were undertaken with Indigenous adults aged ≥40 years living with diabetes (n=110), and primary care clinicians working in ACCHSs (n=37). A series of interviews with CBRs (n=13) were undertaken before and after data collection to add cultural insights and validation to participant accounts. Data were analysed inductively using grounded theory, in-depth discussion and NVivo V.11. Results More than one-third of all patients had little to no knowledge of how diabetes affects eye health. Limited access to health information and interpreters, language barriers, distrust of health providers and services, and limited cultural responsivity among non-Indigenous clinicians, were identified as determining factors in eye health and care. Discussion We outline a need to address gaps in trust and communication, through increased access to and resourcing of Indigenous language interpreters and cultural brokers, understandable and culturally sensitive diabetic eye health information and cultural responsivity training for non-Indigenous clinicians. Centring Indigenous cultures in healthcare practice will enable a shared understanding between clinicians and Indigenous patients, and subsequently more equitable eye health outcomes.
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Affiliation(s)
- Aryati Yashadhana
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Vision Cooperative Research Centre, Sydney, New South Wales, Australia
- Public Health Division, Brien Holden Vision Institute, Sydney, New South Wales, Australia
| | - Ted Fields
- Vision Cooperative Research Centre, Sydney, New South Wales, Australia
| | - Godfrey Blitner
- Vision Cooperative Research Centre, Sydney, New South Wales, Australia
| | - Ruby Stanley
- Vision Cooperative Research Centre, Sydney, New South Wales, Australia
| | - Anthony B Zwi
- Faculty of Arts and Social Sciences, School of Social Sciences, The University of New South Wales, Sydney, New South Wales, Australia
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