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Background: We report an obstetric case involving an RhD‐positive woman who had developed a red blood cell (RBC) antibody that was not detected until after delivery of a newborn, who presented with a positive direct antiglobulin test result. Immunohematology studies suggested that the maternal antibody was directed against a low‐prevalence antigen on the paternal and newborn RBCs. Results: Comprehensive blood group profiling by targeted exome sequencing revealed a novel nonsynonymous single nucleotide variant (SNV) RHCE c.486C>G (GenBank MZ326705) on the RHCE*Ce allele, for both the father and newborn. A subsequent genomic‐based study to profile blood groups in an Indigenous Australian population revealed the same SNV in 2 of 247 individuals. Serology testing showed that the maternal antibody reacted specifically with RBCs from these two individuals. Discussion: The maternal antibody was directed against a novel antigen in the Rh blood group system arising from an RHCE c.486C>G variant on the RHCE*Ce allele linked to RHD*01. The variant predicts a p.Asn162Lys change on the RhCE protein and has been registered as the 56th antigen in the Rh system, ISBT RH 004063. Conclusion: This antibody was of clinical significance, resulting in a mild to moderate hemolytic disease of the fetus and newborn (HDFN). In the past, the cause of such HDFN cases may have remained unresolved. Genomic sequencing combined with population studies now assists in resolving such cases. Further population studies have potential to inform the need to design population‐specific red cell antibody typing panels for antibody screening in the Australian population. [ABSTRACT FROM AUTHOR]

Introduction: Cough is the most common symptom leading to medical consultation. Chronic cough results in significant health care costs, impairs quality of life, and may indicate the presence of a serious underlying condition. Here, we present a summary of an updated position statement on cough management in the clinical consultation. Main recommendations: Assessment of children and adults requires a focused history of chronic cough to identify any red flag cough pointers that may indicate an underlying disease. Further assessment with examination should include a chest x‐ray and spirometry (when age > 6 years). Separate paediatric and adult diagnostic management algorithms should be followed. Management of the underlying condition(s) should follow specific disease guidelines, as well as address adverse environmental exposures and patient/carer concerns. First Nations adults and children should be considered a high risk group. The full statement from the Thoracic Society of Australia and New Zealand and Lung Foundation Australia for managing chronic cough is available at https://lungfoundation.com.au/resources/cicada‐full‐position‐statement. Changes in management as a result of this statement: Algorithms for assessment and diagnosis of adult and paediatric chronic cough are recommended.High quality evidence supports the use of child‐specific chronic cough management algorithms to improve clinical outcomes, but none exist in adults.Red flags that indicate serious underlying conditions requiring investigation or referral should be identified.Early and effective treatment of chronic wet/productive cough in children is critical.Culturally specific strategies for facilitating the management of chronic cough in First Nations populations should be adopted.If the chronic cough does not resolve or is unexplained, the patient should be referred to a respiratory specialist or cough clinic. [ABSTRACT FROM AUTHOR]

Bronchiectasis is a chronic respiratory disorder that is most prevalent in Indigenous populations in remote northern communities in Australia. Indigenous Australians with bronchiectasis have a shorter life expectancy compared to non-Indigenous adults with the condition. The Thoracic Society of Australia and New Zealand (TSANZ) has released a position statement to increase awareness and provide evidence-based recommendations for diagnosis, treatment, and prevention. The statement emphasizes early diagnosis and treatment in children and the need for health service equity to ensure appropriate care for Indigenous populations and underserviced communities. The updated statement covers various aspects of bronchiectasis, including clinical features, investigations, management objectives, and other related topics. The statement aims to improve patient care and will be supported by webinars, checklists, and quality standards documents. However, there are still knowledge gaps and more efforts are needed to address the heterogeneity of the condition and allocate resources to diverse populations. [Extracted from the article]

Background: Liver diseases are important contributors to the mortality gap between Indigenous and non‐Indigenous Australians. Aims: This cohort study examined factors associated with hospital admissions and healthcare outcomes among Indigenous Australians with cirrhosis. Methods: Patient‐reported outcomes were obtained by face‐to‐face interview (Chronic Liver Disease Questionnaire and Short Form 36 (SF‐36)). Clinical data were extracted from medical records and through data linkage for 534 patients (25 indigenous). Cumulative overall survival (Kaplan–Meier), rates of hospital admissions and emergency presentations, and costs were assessed by indigenous status. Incidence rate ratios (IRR; Poisson regression) were reported. Results: Indigenous Australians admitted to hospital with cirrhosis had lower educational status compared with non‐indigenous patients (79.2% vs 43.4%; P < 0.001). The two groups had, in general, similar clinical characteristics including disease severity (P = 0.78), presence of cirrhosis complications (P = 0.67), comorbidities (P = 0.62), rates of cirrhosis‐related admissions (P = 0.86) and 5‐year survival (P = 0.30). However, indigenous patients had a lower score in the SF‐36 domain related to bodily pain (P = 0.037), more cirrhosis admissions via the emergency department (IRR = 1.42, 95% confidence interval (CI) 1.10–1.83) and fewer planned cirrhosis admissions (IRR = 0.32, 95% CI 0.14–0.72). The total cost for cirrhosis‐related hospital admissions for 534 patients over 6 years (July 2012 to June 2018) was A$13.7 million. The cost of cirrhosis‐related hospital admissions was double for indigenous patients (cost ratio = 2.04, 95% CI 2.04–2.05). Conclusions: Our data highlight the disparities in health service use and patient‐reported outcomes, despite having similar clinical profiles. Integration between primary care, Aboriginal Community Controlled Health Organisations and liver specialists is critical for appropriate health service delivery and effective use of resources. Chronic liver disease costs the community dearly. [ABSTRACT FROM AUTHOR]

This position statement, updated from the 2015 guidelines for managing Australian and New Zealand children/adolescents and adults with chronic suppurative lung disease (CSLD) and bronchiectasis, resulted from systematic literature searches by a multi‐disciplinary team that included consumers. The main statements are:Diagnose CSLD and bronchiectasis early; this requires awareness of bronchiectasis symptoms and its co‐existence with other respiratory diseases (e.g., asthma, chronic obstructive pulmonary disease).Confirm bronchiectasis with a chest computed‐tomography scan, using age‐appropriate protocols and criteria in children.Undertake a baseline panel of investigations.Assess baseline severity, and health impact, and develop individualized management plans that include a multi‐disciplinary approach and coordinated care between healthcare providers.Employ intensive treatment to improve symptom control, reduce exacerbation frequency, preserve lung function, optimize quality‐of‐life and enhance survival. In children, treatment also aims to optimize lung growth and, when possible, reverse bronchiectasis.Individualize airway clearance techniques (ACTs) taught by respiratory physiotherapists, encourage regular exercise, optimize nutrition, avoid air pollutants and administer vaccines following national schedules.Treat exacerbations with 14‐day antibiotic courses based upon lower airway culture results, local antibiotic susceptibility patterns, clinical severity and patient tolerance. Patients with severe exacerbations and/or not responding to outpatient therapy are hospitalized for further treatments, including intravenous antibiotics and intensive ACTs.Eradicate Pseudomonas aeruginosa when newly detected in lower airway cultures.Individualize therapy for long‐term antibiotics, inhaled corticosteroids, bronchodilators and mucoactive agents.Ensure ongoing care with 6‐monthly monitoring for complications and co‐morbidities.Undertake optimal care of under‐served peoples, and despite its challenges, delivering best‐practice treatment remains the overriding aim. [ABSTRACT FROM AUTHOR]

Public health, Health promotion, Legislation, medical, Health services, Indigenous health, Healthcare disparities, Patient rights This is because access to health services under the AAAQ framework cannot be considered separate and distinct from health service availability, acceptability and quality: all four AAAQ elements are essential, and overlap and interrelate.[8], [9], [10] For example, a health service might be available on paper, but it is not accessible in practice because the Indigenous health consumer has a disability and is unable to access the health service building or cannot access a computer in an appropriate space for a confidential telehealth consultation. Keywords: Public health; Health promotion; Health services; Legislation, medical; Indigenous health; Healthcare disparities; Patient rights EN Public health Health promotion Health services Legislation, medical Indigenous health Healthcare disparities Patient rights 5 8 4 01/17/23 20230116 NES 230116 Queensland's approach to Indigenous health equity planning and implementation should align with existing international frameworks The Australian state of Queensland is embedding Indigenous-led strategies to advance health equity for Aboriginal and Torres Strait Islander people (hereafter respectfully referred to as Indigenous people) on paper and in practice. [Extracted from the article]

Note: We respectfully refer to Aboriginal and Torres Strait Islander people as Indigenous in this study. Objective: To design and develop an Indigenous specific suicide intervention skills program that focuses on education and intervention training as an effective suicide prevention strategy. Method: Using a co‐designed wrap‐around framework, we developed a program in collaboration with >90 communities, stakeholders and service providers across Australia to understand knowledge, awareness and sense of connectedness between at‐risk groups and health services or support groups. Results: The I‐ASIST training provides participants with the necessary skills and knowledge to apply a suicide intervention model. The framework behind the intervention model provides caregivers the awareness to recognise when someone may be at risk of suicide. It then gives them the skills to connect with a person at risk of suicide and to understand and clarify that risk, steps to keep that person safe for a specific period and then provide them with the resources or links required for further help. The program enables the development of knowledge through interactive strategies through cultural recognition and empowerment of participants. Based on a social‐enterprise model, I‐ASIST has been translated into a certified program supported by LivingWorks Australia. Conclusion: Based on a strengths‐based and self‐determination model of co‐design, this grass roots innovative framework creates suicide safer communities. [ABSTRACT FROM AUTHOR]

Carbal proposed that the MOB van serve as a primary health care clinic to gauge need and, with the permission of local authorities, it was located in a park in the town centre. In February 2013, Carbal Medical Services (Carbal) and the University of Queensland launched the Mobile Outreach Boomerang (MOB) van - a mobile primary health care clinic. [Extracted from the article]

Marfan syndrome (MFS) is an autosomal dominantly inherited connective tissue disorder. Aortic dilatation/dissection and ectopia lentis are the most severe features, which affect physical functioning and psychological well‐being. In Aboriginal Australians, there is little psychosocial research on genetic conditions. This study explored the physical, psychological, and practical impacts of MFS on Aboriginal Australians. Eighteen (8 affected and 10 unaffected) members of a large Aboriginal Australian family with MFS participated in an ethically approved study. Semi‐structured qualitative interviews were conducted, transcribed verbatim, and analyzed thematically. All individuals reported challenges from MFS, negatively affecting day‐to‐day living. Severe vision impairment was perceived as the greatest challenge, contributing to feelings of stigma and exclusion. With aging, concerns shifted toward cardiac complications. The unpredictability of lens dislocation and aortic dissection was reported to be psychologically challenging. Participants described MFS‐related barriers to obtaining and retaining employment, especially following cardiac surgery; with consequential psychological and financial hardships. Participants articulated that their cultural drive to support the ill and respectfully mourn the deceased, regardless of distance, resulted in a significant financial burden. Additionally, when hospitalization and/or funerals occurred, financially solvent individuals were expected to share resources, without any expectation of repayment or reciprocity (i.e., 'demand sharing', common in Aboriginal Australian culture). This study documents the nature and pervasiveness of uncertainty for both affected and unaffected members of an MFS family. Many reported challenges are consistent with other MFS cohorts (including stigma, social exclusion, and unemployment). However, our findings suggest that cultural values may exacerbate the financial costs of MFS for Aboriginal Australians. [ABSTRACT FROM AUTHOR]

Background: The caries process follows a strong social gradient which can commence in the first years of life. Yet data on young children remain limited. This study reports the potential risk factors and indicators in urban, Aboriginal and Torres Strait Islander children aged less than 5 and estimates the prevalence of caries.Methods: Demographic and risk factor and risk indicator data were collected at baseline in a cohort study of children attending a health clinic in north Brisbane. Dentulous children received a basic oral examination to explore the presence of decayed, missing and filled teeth (dmft). Descriptive analyses were performed. A backwards stepwise logistic regression model was performed to identify potential associations with dmft status.Results: In this study, 180 children enrolled: 111 children received the oral examination, of whom 14 (12.6%) (mean age 35 months) were estimated to have dmft >0. There was a high prevalence of socio-economic, dietary and behavioural risk factors/indicators present for children. Due to the small sample size, planned regression was not performed.Conclusions: Overall, the prevalence of risk factors and risk indicators for caries in the study population is high. More culturally appropriate resources that support preventive care need to be invested before children are school aged. [ABSTRACT FROM AUTHOR]

Objective: To determine the role of rural background and years of rural clinical school training on subsequent rural clinical practice.Design, Setting and Participants: Retrospective cohort study of University of Queensland (UQ) medical graduates who graduated during the period 2002-2011 (contacted via internet, telephone and mail, using information obtained from UQ, the Australian Health Practitioner Regulation Agency, and telephone directory and internet searches) who completed an online or hard copy questionnaire during the period December 2012 to October 2013.Main Outcome Measure: Current clinical practice in a rural location.Results: Of 1572 graduates to whom the questionnaire was sent, 754 (48.0%) completed the questionnaire. Of the respondents, 236 (31.3%) had a rural background and 276 (36.6%) had attended the University of Queensland Rural Clinical School (UQRCS). Clinical practice location was rural for 18.8% (90/478) of UQ metropolitan clinical school attendees and 41.7% (115/276) of UQRCS attendees (P < 0.001). In the multivariate model with main effects, independent predictors of rural practice were (OR [95% CI]): UQRCS attendance for 1 year (1.84 [1.21-2.82]) or 2 years (2.71 [1.65-4.45]), rural background (2.30 [1.57-3.36]), partner with rural background (3.08 [1.96-4.84]), being single (1.98 [1.28-3.06]) and having a bonded scholarship (2.34 [1.37-3.98]). In the model with interaction between UQRCS attendance and rural background, independent predictors of rural practice were rural background and UQRCS attendance for 1 year (4.44 [2.38-8.29]) or 2 years (7.09 [3.57-14.10]), partner with rural background (3.14 [1.99-4.96]), being single (2.02 [1.30-3.12]) and bonded scholarship (2.27 [1.32-3.90]). The effects of rural background and UQRCS attendance were duration dependent.Conclusions: This study strengthens evidence that, after adjusting for multiple confounders, a number of exposures are independent predictors of rural medical practice. The strong positive interaction between rural background and rural clinical school exposure, and the duration-dependent relationships, could help inform policy changes aimed at enhancing the efficacy of Australia's rural clinical school program. [ABSTRACT FROM AUTHOR]