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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]

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]

Background: In children, chronic wet cough may be a sign of underlying lung disease, including protracted bacterial bronchitis (PBB) and bronchiectasis. Chronic (> 4 weeks in duration) wet cough (without indicators pointing to alternative causes) that responds to antibiotic treatment is diagnostic of PBB. Timely recognition and management of PBB can prevent disease progression to irreversible bronchiectasis with lifelong consequences. However, detection and management require timely health-seeking by carers and effective management by clinicians. We aim to improve (a) carer health-seeking for chronic wet cough in their child and (b) management of chronic wet cough in children by clinicians. We hypothesise that implementing a culturally integrated program, which is informed by barriers and facilitators identified by carers and health practitioners, will result in improved lung health of First Nations children, and in the future, a reduced the burden of bronchiectasis through the prevention of the progression of protracted bacterial bronchitis to bronchiectasis. Methods: This study is a multi-centre, pseudorandomised, stepped wedge design. The intervention is the implementation of a program. The program has two components: a knowledge dissemination component and an implementation component. The implementation is adapted to each study site using a combined Aboriginal Participatory Action Research and an Implementation Science approach, guided by the Consolidated Framework of Implementation Research. There are three categories of outcome measures related to (i) health (ii) cost, and (iii) implementation. We will measure health-seeking as the proportion of parents seeking help for their child in a 6-month period before the intervention and the same 6-month period (i.e., the same six calendar months) thereafter. The parent-proxy, Cough-specific Quality of Life (PC-QoL) will be the primary health-related outcome measure. Discussion: We hypothesise that a tailored intervention at each site will result in improved health-seeking for carers of children with a chronic wet cough and improved clinician management of chronic wet cough. In addition, we expect this will result in improved lung health outcomes for children with a chronic wet cough. Trial registration: Australian New Zealand Clinical Trials Registry; ACTRN12622000430730, registered 16 March 2022, Retrospectively registered. [ABSTRACT FROM AUTHOR]

The Indigenous populations of Australia and New Zealand are considered at higher risk of mood and anxiety disorders but many studies do not include direct comparisons with similar non-Indigenous controls. We conducted a systematic search of relevant electronic databases, as well as snowballing and targeted searches of the grey literature. Studies were included for meta-analysis if they compared rates of mood and anxiety disorders between Indigenous and non-Indigenous Australians or Maori. Seven Australian and 10 NZ studies were included. Overall, Indigenous people in both countries did not have significantly higher rates of disorder. However, in terms of specific disorders, there were differences in risk by gender, country (Australia or NZ), disorder type, and prevalence (current, 12-month or lifetime). For instance, Indigenous Australians and Maori both had significantly lower rates of simple phobias (current prevalence) and Maori participants had significantly lower rates of both lifetime simple phobia and generalised anxiety disorders. By contrast, Indigenous Australians had significantly higher rates of bipolar affective disorder and social phobia (current prevalence). Generalisations regarding the risk of psychiatric disorders in Indigenous people cannot therefore be made as this varies by several factors. These include disorder type, sociodemographic factors, Indigenous origin and study method., (Copyright © 2017. Published by Elsevier B.V.)