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Australia's Northern Territory is twice the size of Texas, with only 230,000 people living in its enormous space. About half reside in the capital Darwin in the tropical far north; the next biggest town with a population of 25,000 people is Alice Springs, 1600 kilometers south in the central desert. Some 70,000 Indigenous people form 30% of the population in the Northern Territory. A majority live in very remote communities that are difficult to access and are not reachable for much of the year during the monsoonal wet season. Life for many Indigenous youth and their families in remote areas includes extreme poverty, poor and overcrowded housing, lack of sanitation, poor health, sexual and other violence, neglect, substance abuse, welfare dependence, no work, and no future--for many there seems to be no hope. Youth suicide is among the highest on the planet. It is not that Indigenous youth have fewer strengths than other Australian youth. On the contrary, they burst with talent across the whole gamut of human endeavour: aesthetics, bravery, generosity, ecological understanding, humour, language, music, patience, sport, and wisdom. Here is where hope lies, with wise elders and communities nurturing and encouraging their youth into a full-orbed life. In this article, the authors first provide historical context to explain how the indigenous communities have been stripped of hope for more than two centuries. They then introduce "Families and Schools Together" ("FAST"), a non-profit organization that promotes family strengthening programs to help kids succeed in schools and life. In 2000, Education Transformations, in partnership with elders from a remote region south of Darwin, developed a residential high school for young people from remote communities. Indigenous elders on the project planning group sought ways of supporting families and their children. This led to an affiliation with FAST. The authors also describe Youth FAST, a primary tool used by the Smith Family (a large Australian charitable organization) in its "Girls at the Centre" programme, and the elements of the program that make it successful. The authors explain that the experience of Families and Schools Together is that when Indigenous people are trusted and supported to make decisions for themselves, children, youth, families, and the whole community benefit. This is also the case with Community Driven Education, a similar program, where communities are in the driving seat for the education of their youth. When communities are trusted to do the best for their youth, everyone is made stronger. The authors go on to describe the impact of Community Driven Education on the indigenous communities and the importance of its presence. Both initiatives went into effect in Australia's Northern Territory with the assistance of Education Transformations. Both programs are informed by experiences in Indigenous communities around the world and adapted as Territory Indigenous communities decide what works best for them.

This study evaluated a professional learning approach using a core team (CT) model to assist primary (elementary) schools to develop whole-school collaborative conflict resolution processes. Thirteen schools were matched and randomly assigned to the enhancing relationships in school communities programme ("n"?=?10) or a non-programme control group ("n"?=?3). Programme schools provided a core (professional learning) team, who attended professional learning days, and disseminated programme content throughout their schools. Programme schools also received one full school staff workshop. After one year, CT participants were more likely to apply a collaborative conflict resolution model to problem scenarios and report greater knowledge and skills compared to non-programme-school control participants. Compared to the non-programme control group, non-core team programme school staff described using more cooperative approaches to handling conflict, especially when they had received more professional development from their CT. Programme school teachers taught more hours conflict resolution curriculum, and increases in hours taught by programme (but not control) teachers were associated with teacher reported increases in student understanding and use of cooperative methods. Patterns also supported a role of self-efficacy in implementation. The potential usefulness of a CT professional learning model for assisting schools to develop cooperative conflict resolution approaches was supported. (Contains 3 tables and 1 figure.)

Objective: To investigate the management impact of non‐mydriatic fundus photography (NMFP) implementation for appropriate ED patients; compare the diagnostic accuracy of direct ophthalmoscopy (DO) and NMFP, and determine the prevalence of fundus pathology in a regional Australian ED. Methods: This before/after crossover study prospectively enrolled patients presenting with headache, neurological deficit, visual disturbance and/or hypertensive urgency. Patients received DO examination, then separate NMFP examination. Emergency clinicians (ECs) were surveyed on their patient management plans following both DO examination and NMFP imaging. Telemedicine review of NMFP images was performed by an ophthalmologist within 48 h, and any additional management changes were documented. Results: The use of NMFP influenced changes in management in 52 (39%) of 133 enrolled patients (95% confidence interval 31–48%). Of these, 65% were escalations of management due to acute fundus pathology, while 35% were de‐escalating changes following normal fundus findings. ECs diagnostic accuracy for acute fundus pathology improved from 0% to 29% sensitivity, and 59% to 84% specificity using DO and NMFP respectively, and telemedicine registrar review increased this to 50% sensitivity and 86% specificity. The period prevalence of acute fundus pathology was 10.5% (95% confidence interval 6–17%). Conclusion: The addition of NMFP images can significantly impact the management of ED patients requiring fundus examination, facilitating expedited and optimised patient care. NMFP improves ECs diagnostic acumen for fundus pathology over DO examination and telehealth specialist review is important for diagnostic accuracy. There is a clinically important prevalence of fundus pathology in this regional ED setting. [ABSTRACT FROM AUTHOR]

Parkinsonia aculeata L. (Fabaceae: Caesalpinioideae), native to the Americas, is a designated Weed of National Significance in Australia. The leaf‐feeding geometrid moth species, Eueupithecia cisplatensis Prout (Lepidoptera: Geometridae), was identified as a potential biological control agent of P. aculeata following native range surveys in Argentina. After importation into quarantine for host specificity assessment, this species was identified as a cryptic species complex of two morphologically similar species. The new species, Eueupithecia vollonoides Hausmann (Lepidoptera: Geometridae), was subsequently described. The biology and host range of both moth species were examined to determine their suitability as biological control agents. Host specificity was evaluated in the native range, by surveying insects found on closely related plant species, and in the laboratory, by no‐choice larval development tests. Native range surveys and laboratory assays revealed a high level of specificity to P. aculeata by both Eueupithecia species. Of the 71 plant species from the Fabaceae family that were tested, E. cisplatensis completed development on only one non‐target species, Parkinsonia praecox. This plant species is not present in Australia, and no Eueupithecia species were found to use P. praecox in the field in its native range. Hence, the risk of non‐target effects if these species were to be released in Australia was considered to be low. One mitochondrial (COI) gene region and two nuclear (28S and CAD) gene regions were tested for their ability to differentiate between the two cryptic species. COI haplotypes from E. cisplatensis and E. vollonoides belong to two divergent haplotype groups and can reliably distinguish either species from the other. Some 28S and CAD gene haplotypes are shared at low frequencies, perhaps because of rare or historical hybridisation or incomplete lineage sorting, thus cannot reliably discriminate between the species. This pattern of mito‐nuclear discordance requires further elucidation using population genetics studies to determine its biological significance. Based on the results of host specificity tests, E. cisplatensis and E. vollonoides were approved for release in Australia in May 2013 and May 2014, respectively. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of fundus pathology in metropolitan Australian EDs utilising a non‐mydriatic fundus photography screening programme. Secondary objectives include diagnostic accuracy among emergency physicians compared to telehealth ophthalmologist review. Methods: Prospective cross‐sectional study investigating non‐mydriatic fundus photography as a new diagnostic test in two tertiary Australian EDs. Consecutive adult patients were enrolled if they presented with headache, focal neurological deficit, visual disturbance or diastolic BP >120 mmHg. Diagnostic agreement was determined using kappa statistics and sensitivity and specificity using a reference standard consensus ophthalmology review. Results: A total of 345 consecutive patients were enrolled among whom 56 (16%, 95% confidence interval [CI] 13–21) had urgent fundus pathology. Agreement between emergency physician and ophthalmic assessment of fundus photographs was 74% (kappa = 0.196, P = 0.001). Emergency physicians had 40% sensitivity (95% CI 27–54) and 82% specificity (95% CI 76–86) for detecting urgent pathology on photographs. Conclusions: Fundus photography detects a clinically significant proportion of fundus pathology and urgent diagnoses. Telehealth specialist image review is important to detect some important, time‐critical illnesses that can be missed in routine care. This offers an accurate alternative to direct ophthalmoscopy that warrants further research in Australian EDs. [ABSTRACT FROM AUTHOR]

Purpose: To examine changing patterns of ophthalmic presentations to emergency departments (EDs) during the lockdowns associated with the first wave of the COVID-19 pandemic in Australia and the two months immediately following lockdown relaxation. Patients and Methods: This was a retrospective audit of triage coding and ICD-10-AM coding for all patient presentations to four Australian EDs from March 29 to May 31 in 2019 and 2020 (the COVID-19 lockdown period and the corresponding period in 2019), and from June 1 to July 31 in 2019 and 2020 (the post-lockdown period and the corresponding period in 2019). Number of ophthalmic presentations triaged per day and number of seven common and/or time-sensitive, vision threatening ophthalmic diagnoses were examined. Differences in mean daily presentation numbers were assessed with non-paired Student's t-test with Bonferroni correction. Results: Total ophthalmic presentations per day during COVID-19 lockdowns fell by 16% compared to the corresponding period in 2019 (13.0 ± 4.0 in 2019 vs 10.8 ± 3.3 in 2020, mean ± standard deviation; p=0.01). There was also a significant decrease in presentations of atraumatic retinal detachment, conjunctivitis, and eye pain. In the two months following easing of lockdown restrictions, total ophthalmic presentations per day returned to the same level as that of the corresponding period in 2019 (12.2 ± 4.3 in 2019 vs 12.3 ± 4.1 in 2020, p=0.97). Conclusion: Total ophthalmic presentations and presentations of atraumatic retinal detachment, conjunctivitis and, eye pain to EDs fell during the lockdowns associated with the first wave of COVID-19 in Australia. These may represent delays in patients seeking appropriate medical attention and may have implications on patient morbidity long after the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Public hospital ophthalmology services are in high demand and patients requiring medical or surgical intervention for glaucoma may worsen while awaiting care. In Australia, tertiary hospital care requires a referral from primary care providers. This study investigates the quality of glaucoma referrals received at a tertiary public hospital in Australia, and describes the types of glaucoma cases referred for hospital management.Methods: An investigation of 200 sequential glaucoma referrals received at a major Australian public hospital from 2013-2016, and the subsequent hospital management. A clinical file audit was made of patient medical records, including referral letters to extract the referral content, and the hospital glaucoma diagnostic outcomes and patient management.Results: Most referrals came from optometrists (72 per cent) and general practitioners (22 per cent) with the remainder from other specialists. The majority of the referrals contained less than 50 per cent of the key clinical and demographic parameters. Referrals from optometrists provided more ophthalmic information (visual acuity, visual field, intraocular pressure, ocular history). Referrals from general practitioners contained more medical information (systemic co-morbidities medication and allergies). The median wait-time from referral to hospital appointment was 400 days. Of patients attending a hospital appointment, 59 per cent required surgical or medical management, and 16 per cent did not have glaucoma. Overall 18 per cent were discharged, with no differences noted by referral content or referring practitioner.Conclusion: Most referrals did not include useful diagnostic information on ocular, medical and social risks for glaucoma. There is an opportunity to improve targeting of primary care referrals for glaucoma, since patients who were discharged immediately after their hospital appointment are exacerbating the long hospital wait-time. Better information transfer may help to identify patients requiring more urgent intervention. A standardised referral template and guidelines would support collaborative care and streamline access to hospital services. [ABSTRACT FROM AUTHOR]

Patients with diabetes require regular examination for eye disease, usually in primary care settings. Guidelines recommend patients with at least moderate non-proliferative diabetic retinopathy (NPDR) be referred to an ophthalmologist for treatment; however, poorly targeted referrals lead to access blocks. The quality of new referrals associated with diabetes to a public ophthalmology service in Sydney, New South Wales, Australia, were assessed for referral completeness and targeting. A cross-sectional audit of medical records for new patients referred to Westmead Hospital Eye Clinic in 2016 was completed. Completeness of medical and ophthalmic information in referrals and subsequent patient diagnosis and management in 2016–17 was recorded. Sub-analyses were conducted by primary care referrer type (GP or optometrist). In total, 151 new retinopathy referrals were received; 12% were sent directly to a treatment clinic. Information was incomplete for diabetes status (>60%), medical (>50%) and ophthalmic indicators (>70%), including visual acuity (>60%). GP referrals better recorded medical, and optometrists (37%) ophthalmic information, but information was still largely incomplete. Imaging was rarely included (retinal photos <1%; optical coherence tomography <3%). Median appointment wait-time was 124 days; 21% of patients received treatment (laser or anti-vascular endothelial growth factor) at this or the following encounter. Targeting referrals for ocular complication of diabetes to public hospitals needs improvement. Education, feedback and collaborative care mechanisms should be considered to improve screening and referral in primary care. Diabetic retinopathy (DR) is a leading cause of blindness, and moderate DR (or above) requires management with an ophthalmologist. However, public eye clinics have access blocks. High quality referrals are needed to make decisions regarding the urgency of patient care for ocular complications associated with diabetes. Primary care-initiated referrals are poorly targeted to tertiary care. To improve diabetic retinopathy screening and management, strategies should focus on education and feedback for primary care providers as well as integration of care. [ABSTRACT FROM AUTHOR]

Background: This study aims to explore patient perspectives regarding their journey to glaucoma care and sought to understand the determinants that guide their access to tertiary glaucoma care.Methods: Twenty-nine patients who are glaucoma suspects or had definitive diagnosis of glaucoma were recruited from a large public glaucoma clinic and a private ophthalmology clinic in Sydney. Face-to-face, in-depth semi-structured interviews were conducted between April and December 2017. Interviews were recorded and transcribed verbatim. A framework method was used for thematic analysis of the data.Results: Thematic analysis resulted in the emergence of eight main themes. There was limited patient participation in decision making in their journey to glaucoma care. Consequently, there was great trust placed in the referring clinician. Patients valued their vision and therefore expressed a desire for high-quality care. They placed considerable trust in their specialist but were often unsure how to evaluate the quality of care received. Patients lacked an understanding of the cost of glaucoma care and for some, cost remained a barrier to the access of private care. There were variable experiences with waiting times and the journey to clinic, with many patients making concessions and requiring support to access care.Conclusion: This study is the first qualitative study exploring the perspectives of glaucoma patients in Australia and the determinants of access to care. These findings support and can inform development of patient-centred models of care furthering patient trust and empowerment. [ABSTRACT FROM AUTHOR]

Purpose: To meet the needs of an ageing population and optimise health expenditure, delivery of care should be based on evidence. However, the level of evidence‐based care delivered to patients with eye conditions is rarely assessed. This study thus aimed to determine the percentage of eyecare encounters at which a sample of adult Australians received appropriate care (i.e., eyecare in line with evidence‐based or consensus‐based guidelines). Methods: A cross‐sectional retrospective review of optometry practice records was conducted using random stratified (by state) sampling in mainland Australia. Eighty‐five clinical indicators were developed from evidence‐based clinical practice guideline recommendations and refined by panels of experts using a modified Delphi process. Healthcare records of patients 18 years and over were examined against these indicators, representing appropriate care for three common eye conditions (preventative eyecare, glaucoma, and diabetic eyecare). Encounters occurred in optometry practices that were selected to be representative of the socioeconomic profile of Australian practices. The primary outcome measure was percentage compliance of eyecare delivery against the clinical indicators. Results: From 426 optometry practices contacted by mail or telephone, 90 (21%) replied, 46 proved eligible and 42 were included in the study and visited for data collection. From these 1260 patient records were reviewed. Appropriate eyecare was received by Australian patients at an average of 71% (95%CI 70%, 73%) of eligible encounters. The percentage of appropriateness of eyecare at the condition level for preventative, glaucoma and diabetic eyecare was 81% (95%CI 79%, 83%), 63% (95%CI 61%, 64%), and 69% (95%CI 66%, 73%), respectively. Appropriateness of eyecare delivery was lowest for the domains of history taking and physical examination for all eye conditions. Conclusions: There were pockets of excellence but consistent delivery of appropriate eyecare needs improvement, and gaps in eyecare delivery should be addressed. [ABSTRACT FROM AUTHOR]

Rheumatic heart disease, as a result of a single or recurrent episode of acute rheumatic fever (ARF), remains a significant cause of morbidity and mortality in northern and remote Australia; ARF has a peak incidence among 5-14-year-old Aboriginal and Torres Strait Islander children. Long-term regular benzathine penicillin G injections are the only currently successful secondary prevention strategy; however, rates of adherence remain critically low. In contrast, rates of adherence to immunisations on the National Immunisation Program (NIP) Schedule are high, even among this target population. This article compares strategies used to implement and improve ARF secondary prophylaxis with those used in the NIP. Some successful NIP strategies, such as Service Incentive Payment for health providers, home-visiting delivery models and integration into the National Immunisation Register, if applied to ARF secondary prophylaxis have the potential to improve benzathine penicillin G adherence. [ABSTRACT FROM AUTHOR]

Abstract: Importance: Referral letters constitute the first step on the pathway to cataract surgery; however, little is known on how effective referral letters are in providing adequate information to triage patients and inform surgical prioritization. Background: Benchmarking exercises are important to document referral processes and to identify areas where improvements can be made. Design: Cross‐sectional study with longitudinal follow‐up conducted at two metropolitan public hospitals in New South Wales, Australia. Participants: A total of 400 sequential cataract referral letters. Methods: An audit of cataract referral letters was performed and content benchmarked against international prioritization tools. Medical records were reviewed 1 year following referral. Main Outcome Measures: Referral quality and waiting times. Results: Two‐thirds of patients referred for cataract surgery were yet to have their initial hospital appointment in the year following referral (65%, 245/376). One half of referrals seen in clinic (49%, 64/113) were not listed for cataract surgery. Multivariate analysis revealed referral letter content was not indicative of surgical booking, with the major predictors being hospital‐recorded visual acuity and grading of cataract (P < 0.0001). Referral content lacked sufficient detail to apply prioritization tools developed in other settings. Conclusion and Relevance: This audit highlights a disconnect between referral letter content and hospital assessment of patients. Current referrals to public hospitals are poorly targeted, with high numbers of referred patients not proceeding to surgery. Patients commonly waited over 1 year to have their ophthalmic assessment at these public hospital eye clinics, revealing lengthy ‘wait‐for‐waits’ as a barrier to care. Standardized referral templates may facilitate improvement of referral pathways and shorten waiting times. [ABSTRACT FROM AUTHOR]

Background: It is critical to consult patients to develop patient-centred cataract surgery care. We aimed to identify attributes patients consider when making decisions about cataract surgery in an Australian context, where both publicly and privately funded surgery are available. This is the first step in investigating how decisions are made about cataract surgery services.Methods: This observational qualitative study was undertaken in two public hospitals and one private practice in Sydney, Australia. The study involved 19 women and men with age-related cataracts and no previous cataract surgery, aged > 18 years, able to speak conversational English or Mandarin. A multi-stage attribute development process was followed, including: literature review, semi-structured interviews with surgery candidates in three eye clinics, and review by an expert panel. The main outcome measures were primary attributes for making choices about cataract surgery.Results: Wait time, cost, institutional reputation, surgeon experience and travel time were identified as principal attributes; lower value was placed on consultation length and accessibility. Non-English speaking participants indicated greater interest in pre-operative information than English speakers, but expressed trust in the Australian healthcare system.Conclusions: Findings suggest individuals prioritise attributes which consume time or incur costs when accessing care (wait time, cost and travel time). They also consider factors associated with the outcome of their cataract surgery (surgeon experience and institutional reputation). Similar to other decision-making processes, patients are likely to trade between these different attributes depending on their personal preferences and circumstances. [ABSTRACT FROM AUTHOR]

Background Increase in intraocular pressure is a recognized complication of corticosteroid treatment via intravitreal or periocular injections for treatment of a range of conditions including macular oedema and retinal neovascularization. Design This surveillance study was designed to determine the incidence and nature of severe intraocular pressure elevation as a complication of intravitreal or periocular corticosteroid injections in Australia and New Zealand. Participants Seventeen cases meeting the defined criteria of severe intraocular pressure elevation, above 35 mmHg, following an intravitreal or periocular corticosteroid injection were included in the study. Methods Over an 18-month period, ophthalmologists were invited to report cases to the Australian and New Zealand Ophthalmic Surveillance Unit. After reporting, further demographic and clinical information was sought via a follow-up questionnaire. Main Outcome Measures Intraocular pressure elevation above 35 mmHg. Results Follow-up questionnaires were received for 20 cases of 34 initially reported to the unit. Seventeen met the defined criteria. Triamcinolone acetonide was used in all 17 cases, with 16 delivered as a 4-mg intravitreal injection. There was an absence of identified underlying risk factors in the majority of cases with personal history of glaucoma in 2 of 17 cases. No cases reported a positive family history of glaucoma. Trabeculectomy was performed in 8 of 17 patients (47%) for intraocular pressure management. Conclusions Severe intraocular pressure elevation following intravitreal or periocular corticosteroid injection can occur in the absence of risk factors such as personal and family history of glaucoma. The severe intraocular pressure elevation may ultimately require trabeculectomy. [ABSTRACT FROM AUTHOR]

Background Ensuring adherence to treatment and retention is important in clinical trials, particularly in remote areas and minority groups. We describe a novel approach to improve adherence, retention and clinical review rates of Indigenous children. Methods This descriptive study was nested within a placebo-controlled, randomised trial (RCT) on weekly azithromycin (or placebo) for 3-weeks. Indigenous children aged ⩽24-months hospitalised with acute bronchiolitis were recruited from two tertiary hospitals in northern Australia (Darwin and Townsville). Using mobile phones embedded within a culturally-sensitive approach and framework, we report our strategies used and results obtained. Our main outcome measure was rates of adherence to medications, retention in the RCT and self-presentation (with child) to clinic for a clinical review on day-21. Results Of 301 eligible children, 76 (21%) families declined participation and 39 (13%) did not have access to a mobile phone. 186 Indigenous children were randomised and received dose one under supervision in hospital. Subsequently, 182 (99%) children received dose two (day-7), 169 (93%) dose three (day-14) and 180 (97%) attended their clinical review (day-21). A median of 2 calls (IQR 1-3) were needed to verify adherence. Importantly, over 97% of children remained in the RCT until their clinical endpoint at day-21. Conclusions In our setting, the use of mobile phones within an Indigenous-appropriate framework has been an effective strategy to support a clinical trial involving Australian Indigenous children in urban and remote Australia. Further research is required to explore other applications of this approach, including the impact on clinical outcomes. [ABSTRACT FROM AUTHOR]

The article discusses the things to consider when collaborating care for patients with glaucoma and suspected by ophthalmologists and optometrists in Australia. An overview about the prevalence of the eye disease in the nation is provided. The guidelines are said to provide a standard framework for appropriate examination of patients and collaboration between optometrists and ophthalmologists.

A bstract Background: Glaucoma is a sight-threatening disease affecting 3% of the population over the age of 50. Glaucoma is treatable, and severe vision loss can usually be prevented if diagnosis is made at an early stage. Genetic factors play a major role in the pathogenesis of the condition, and therefore, genetic testing to identify asymptomatic at-risk individuals is a promising strategy to reduce the prevalence of glaucoma blindness. Furthermore, unravelling genetic risk factors for glaucoma would also allow a better understanding of the pathogenesis of the condition and the development of new treatments. Design: The Australian and New Zealand Registry of Advanced Glaucoma is a prospective study that aims to develop a large cohort of glaucoma cases with severe visual field loss to identify novel genetic risk factors for glaucoma blindness. Methods: Clinical information and blood are collected from participants after referral by eye practitioners. Samples are collected across Australia and New Zealand using postage kits. Participants: Our registry has recruited just over 2000 participants with advanced glaucoma, as well as secondary and developmental glaucomas. Results: A positive family history of glaucoma is present in more than half of the advanced glaucoma cases and the age at diagnosis is significantly younger for participants with affected relatives, which reinforces the involvement of genetic factors in glaucoma. Conclusions: With the collection of glaucoma cases recruited so far, our registry aims to identify novel glaucoma genetic risk factors to establish risk profiling of the population and protocols for genetic testing. [ABSTRACT FROM AUTHOR]

Although unusual in western countries and in Australia in general, post-streptococcal glomerulonephritis (PSGN) is still common in Australian Aboriginal children living in remote communities. Here, we evaluated whether episodes of acute PSGN increased the risk for chronic kidney disease in later life in 1519 residents of a remote Aboriginal community (85% of those age eligible), with high rates of renal and cardiovascular disease, who participated in a health screen over a 3-year period. Of these, 200 had had at least one episode of PSGN, with 27 having had multiple episodes, usually in childhood. High levels of albuminuria (albumin/creatinine ratio) with increasing age were confirmed. All PSGN episodes were associated with group A streptococcal skin infections, often related to scabies. In both genders, aged 10-39 years at screening, about one in five had such a history. Among them, PSGN (5 years or more earlier) was significantly associated with higher levels of albuminuria than those without. In women, aged 30-39 years, a history of PSGN was associated with a significantly higher frequency of estimated glomerular filtration rates <60 ml/min. The adjusted odds ratios for an albumin/creatinine ratio over 34 g/mol (overt albuminuria) in males and females with a history of PSGN were 4.6 and 3.1, respectively, compared with those without a history. Thus, PSGN contributes to the very serious burden of chronic kidney disease in this community. Rigorous strategies to prevent scabies and Group A streptococcal infections will reduce this burden. [ABSTRACT FROM AUTHOR]

Background: Acute lower respiratory infections are the commonest cause of morbidity and potentially preventable mortality in Indigenous infants. Infancy is also a critical time for post-natal lung growth and development. Severe or repeated lower airway injury in very young children likely increases the likelihood of chronic pulmonary disorders later in life. Globally, bronchiolitis is the most common form of acute lower respiratory infections during infancy. Compared with non-Indigenous Australian infants, Indigenous infants have greater bacterial density in their upper airways and more severe bronchiolitis episodes. Our study tests the hypothesis that the anti-microbial and anti-inflammatory properties of azithromycin, improve the clinical outcomes of Indigenous Australian infants hospitalised with bronchiolitis. Methods: We are conducting a dual centre, randomised, double-blind, placebo-controlled, parallel group trial in northern Australia. Indigenous infants (aged ⩽ 24-months, expected number = 200) admitted to one of two regional hospitals (Darwin, Northern Territory and Townsville, Queensland) with a clinical diagnosis of bronchiolitis and fulfilling inclusion criteria are randomised (allocation concealed) to either azithromycin (30 mg/kg/dose) or placebo administered once weekly for three doses. Clinical data are recorded twice daily and nasopharyngeal swab are collected at enrolment and at the time of discharge from hospital. Primary outcomes are 'length of oxygen requirement' and 'duration of stay,' the latter based upon being judged as 'ready for respiratory discharge'. The main secondary outcome is readmission for a respiratory illness within 6-months of leaving hospital. Descriptive virological and bacteriological (including development of antibiotic resistance) data from nasopharyngeal samples will also be reported. Discussion: Two published studies, both involving different patient populations and settings, as well as different macrolide antibiotics and treatment duration, have produced conflicting results. Our randomised, placebocontrolled trial of azithromycin in Indigenous infants hospitalised with bronchiolitis is designed to determine whether it can reduce short-term (and potentially long-term) morbidity from respiratory illness in Australian Indigenous infants who are at high risk of developing chronic respiratory illness. If azithromycin is efficacious in reducing the morbidly of Indigenous infants hospitalised with bronchiolitis, the intervention would lead to improved short term (and possibly long term) health benefits. Trial registration: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000326099 [ABSTRACT FROM AUTHOR]

Aims: To review and present the most important issues related to kidney disease in Aboriginal, Torres Strait Islander, Maori and Pacific Islander children from Australia and New Zealand. Methods: A review of medical literature about: 1. incidence of kidney disease in Indigenous children in Australia and New Zealand, especially where rates are different from the general populations, 2. factors in early life which increase risk for chronic kidney disease in adult life, and 3. early identification and primary and secondary interventions in childhood which may prevent chronic kidney disease in adults. Results: Kidney diseases, both acute and chronic are more common in Maori, Pacific Islander, Australian Aboriginal and Torres Strait Islander people. The reasons are multiple and include genetic, environmental and socio-economic factors. In childhood post streptococcal glomerulonephritis, haemolytic uraemic syndrome, renal stones and acute kidney injury all occur at higher frequency in at least some of the Indigenous populations. Chronic kidney disease CKD occurs more commonly, and at a younger age in Indigenous than non Indigenous people. Factors involved may include reduced nephron endowment at birth, and subsequent insults including nephritis, obesity, and early onset type 2 diabetes, as well as underlying socioeconomic and environmental determinants. Conclusion: A lifecourse understanding allows one to conceptualise multiple risk factors and target interventions. [ABSTRACT FROM AUTHOR]

Glaucoma is a chronic disease which requires ongoing management, and there is an ever-increasing demand of public eye health services.[1] In Australia, a referral from a primary care provider is required for a patient to access specialist eye care at a tertiary hospital.[1] However, beyond administrative requirements, there is currently no established recommendation or templates for what information should be included in a referral in the field of ophthalmology, or more specifically glaucoma. The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) collaborative care guidelines for glaucoma[2] offer more specific guidance on communication of patient information for collaborative management between optometrists and ophthalmologists. Royal College of ophthalmologists glaucoma commissioning guidance development G. the Royal College of Ophthalmologists' glaucoma commissioning guidance: executive summary. [Extracted from the article]

Rates of albuminuria and haematuria are extremely high with haematuria prevalence as high as 30–50% in adults of some Aboriginal groups. Dipstick testing of urine is routinely carried out in Aboriginal communities and as part of school screening programmes. Evaluation of the many affected individuals has traditionally included renal ultrasound examination, which involves considerable expense and logistic problems in remote communities. The present study was conducted to evaluate the usefulness of ultrasound in this setting. A population survey was conducted in a remote community. Urine dipstick analysis and the albumin : creatinine ratio (ACR; g/mol) were measured in 1440 people over 5 years of age (89% of the eligible population), and a detailed renal ultrasound examination was performed in a random subset of 647 people (41.1% of the whole group), 276 aged 5–19 years and 371 over 20 years of age. Urine dipstick proteinuria (>1+) was present in 8.5% (23/271) of those aged 5–19 years and 37.9% (132/348) in those aged over 20 years; pathological albuminuria (ACR > 3.4) was present in 7.6% (21/276) and 54.7% (203/371), respectively, and isolated haematuria was present in 7.7% (21/273) and 11.5% (40/347), respectively. Eight ultrasound abnormalities were found. Ultrasound findings did not change the management of any individual. Renal ultrasound added little to the evaluation of people with asymptomatic proteinuria or haematuria in this setting. In this scenario, ultrasound examination could be reserved for the cases with an unusual presentation where findings are likely to influence the prognosis or treatment, or in preparation for a renal biopsy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of hospital admissions for indigenous children with malnutrition in a rural/remote Australian centre. Design: Retrospective review of the medical records. Setting: Rural secondary hospital. Subjects: Remote and rural indigenous children aged less than four years managed for malnutrition in Alice Springs Hospital (ASH). Main outcome measure: The primary outcome measure was weight gain during hospitalisation and post-hospitalisation. Secondary outcome measures were yield of investigations, diagnoses made, treatments given, social interventions, readmission rate and nosocomial infection. Results: Median age of the 55 children was 15.1 months. Median weight change was 1.5 g day-' prior to hospitalisation, 36.7 g day-1 during and 9 g day-1 two months following hospitalisation (P < 0.05). Investigations performed had high yields (80% of children had a treatable organic contributor to malnutrition). Nosocomial infection occurred in 21(38%) children. Readmission occurred at an average of 1.9 times per child (range 0-5), 34 (37%) occurred within three months and 48 (52%) within six months. Conclusion: In rural Indigenous children with malnutrition, hospitalisation was effective in re-establishing growth and defining organic contributors to malnutrition. However, the high readmission rate and nosocomial infection mandates that alternative models to nutritional rehabilitation, in addition to a broad psychosocial and public health approach to prevention and management of malnutrition, is required. [ABSTRACT FROM AUTHOR]