Indigenous Australian Population Research Articles

Commentary: The pharmacogenomic landscape of an Indigenous Australian population

Commentary: The pharmacogenomic landscape of an Indigenous Australian population

Tonsils at Telethon: developing a standardised collection of tonsil photographs for group A streptococcal (GAS) research.

Group A streptococcus (GAS) infections, such as pharyngitis and impetigo, can lead to rheumatic fever and rheumatic heart disease (RHD). Australian Aboriginal and Torres Strait Islander populations experience high rates of RHD and GAS skin infection, yet rates of GAS pharyngitis are unclear. Anecdotally, clinical presentations of pharyngitis, including tonsillar hypertrophy and sore throat, are uncommon. This study aimed to develop a standardised set of tonsil photographs and determine tonsil size distribution from an urban paediatric population. A prospective cohort of children aged 3-15 years were recruited at the public events "Discover Day" and "Telethon Weekend" (October 2017) in Perth, Western Australia, Australia. Tonsil photographs, symptomatology, and GAS rapid antigen detection tests (RADT) were collected. Tonsil size was graded from the photographs using the Brodsky Grading Scale of tonsillar hypertrophy (Brodsky) by two independent clinicians, and inter-rater reliability calculated. Pharyngitis symptoms and GAS RADT were correlated, and immediate results provided. Four hundred and twenty-six healthy children participated in the study over three days. The median age was seven years [interquartile range (IQR) 5.9-9.7 years]. Tonsil photographs were collected for 92% of participants, of which 62% were rated as good-quality photographs and 79% were deemed of adequate quality for assessment by both clinicians. When scored by two independent clinicians, 57% received the same grade. Average Brodsky grades (between clinicians) were 11%, 35%, 28%, 22% and 5% of grades 0,1,2,3 and 4, respectively. There was moderate agreement in grading using photographs, and minimal to weak agreement for signs of infection. Of 394 participants, 8% reported a sore throat. Of 334 GAS RADT performed, <1% were positive. We report the first standardised use of paediatric tonsil photographs to assess tonsil size in urban-living Australian children. This provides a proof of concept from an urban-living cohort that could be compared with children in other settings with high risk of GAS pharyngitis or rheumatic fever such as remote-living Australian Indigenous populations.

SAT610 Multiple Endocrine Neoplasia Type 1 - The First Reported Case In An Indigenous Australian

Abstract Disclosure: E. Mignone: None. K. Neal: None. Background: Multiple Endocrine Neoplasia type 1 (MEN1) is a rare and under recognised syndrome. It has not been previously reported in Indigenous Australians for this reason. Clinical Case: A 48-year-old Indigenous Australian female was consulted on by an inpatient endocrine team in March 2020 for persistent hypercalcaemia on a background of a parathyroidectomy in 2011 for primary hyperparathyroidism (PHPTH). She was admitted to a remote Australian hospital for investigation and management of acute on chronic abdominal pain. Relevant medical history included a parathyroidectomy at age 40, multiple PE/DVT, MI, AF, CTEPH, right heart failure, HTLV-1 and recurrent abdominal pain presumed secondary to GORD. Gastroscopy from 2013 revealed chronic gastritis with hundreds of gastric polyps discovered on subsequent gastroscopy in 2015. The young age of PHPTH combined with her chronic gastritis and polyps prompted neuroendocrine tumour (NET) screening, including MEN1. At time of consult in 2020, laboratory studies were consistent with recurrence of PHPTH with a corrected calcium of 2.9 mmol/L (2.15-2.57mmol/L), serum PTH level 31.5 pmol/L (1-7pmol/L), vitamin D level 30 nmol/L, 24-hour urinary calcium variable between low and high. NET markers were markedly elevated with a gastrin level of 14042 ng/L (&amp;lt;100 ng/L), pancreatic polypeptide 2905 pmol/L (&amp;lt;55 pmol/L), urine 5HIAA ratio 8 mmol/L (&amp;lt;4 mmol/L), vasoactive intestinal peptide and glucagon levels normal. Pituitary studies, serum calcitonin, plasma metanephrines and PTH related protein levels were within normal limits. A CT of the abdomen showed thickened gastric folds, and persistent liver and IVC lesions from 2018. A diagnosis of Zollinger Ellison Syndrome (ZES) was made. Eventually, genetic testing was positive for a rare heterozygous variant of c.207dupC in exon 2 of MEN1 gene. A 68-gallium-DOTATATE PET/CT showed multiple avid pancreatic, gastric, nodal and liver lesions with high somatostatin receptor expression, suggestive of a neuroendocrine malignancy. Treatment was based largely on symptom control due to poor overall prognosis from underlying cardiorespiratory comorbidities. Abdominal pain from ZES was managed with a high dose PPI, H2 receptor antagonist and subcutaneous somatostatin analogue were trialled. Hypercalcaemia was treated with IV bisphosphonate therapy. Calcimimetic analogues were considered however patient declined. Genetic counselling was attempted however many cultural and logistical barriers were identified and family declined further testing. Unfortunately, our patient died in 2021 from presumed multifactorial respiratory failure. Conclusion: High index of suspicion is required to diagnose MEN1. This is particularly true within the Indigenous Australian population, with no prior documented cases reported. Presentation: Saturday, June 17, 2023

Comparison of Lung Cancer Surgery Outcomes in Queensland for Indigenous and Nonindigenous Australians

IntroductionIndigenous Australians (Aboriginal and Torres Strait Islander) have lower overall survival from lung cancer compared with nonindigenous Australians. Indigenous Australians receive higher rates of chemotherapy and/or radiotherapy. The equity of peri-operative care and thoracic surgical outcomes in Australian indigenous populations have not been contemporarily evaluated. MethodsWe performed a retrospective registry analysis of the Queensland Cardiac Outcomes Registry Thoracic Database evaluating all adult lung cancer resections across Queensland from January 1, 2016 to April 20, 2022. Evaluating the time from diagnosis to surgery, operative data, and postoperative morbidity and mortality comparing Aboriginal and/or Torres Strait Islander people with nonindigenous Australians. ResultsThere were 31 patients (2.56%) of 1208 who identified as indigenous. The mean age at surgery was 68.2 years versus 66 years in the indigenous and nonindigenous, respectively (p = 0.23). There was female predominance among indigenous patients (n = 28, 90.32%, p < 0.01) and the average body mass index was lower (22.52 versus 27.09, p < 0.01). There was no variation in the surgical parameters or histopathologic distribution of cancer type between groups. Multivariable logistic regression analysis suggested that indigenous patients were at elevated risk of blood transfusion (relative risk 3.9, p = 0.014, OR = 9.01, 95% confidence interval [CI]: 2.25–36.33, p < 0.01) and had greater transfusion requirements (risk ratio 4.08, p = 0.0116 and OR = 12.67, 95% CI: 2.25–71.49, p < 0.01); however, the influence of low absolute number of transfusions must be acknowledged here. Indigenous status was not associated with increased intensive care unit admission (OR = 1.79, 95% CI: 0.17–18.80, p = 0.62), return to operating theater (OR = 2.1, 95% CI: 0.24–18.15, p = 0.50), new atrial fibrillation (OR = 0.52, 95% CI: 0.07–4.01, p = 0.55), prolonged air leak (OR = 0.29, 95% CI: 0.04– 2.16, p = 0.228), or pneumonia postoperatively (OR = 4.77, 95% CI: 0.55–41.71, p = 0.16). With only three deaths, no meaningful trends were observed. Time from diagnosis to surgery was comparable in the indigenous and nonindigenous groups (88.6 d, 95% CI: 54.26–123.24 versus 86.2 d, 81.40–91.02, p = 0.87). Postoperative length of stay was not numerically or statistically different between groups. (indigenous 7.54 d versus nonindigenous 7.13 d, p = 0.90). ConclusionsIndigenous patients are more likely to receive a blood transfusion than nonindigenous patients during lung resection. Reassuringly, the perioperative care provided to indigenous Australians undergoing lung resection in Queensland seems to be comparable to that of the nonindigenous population.

Disease profiles in the Indigenous Australian population are suggestive of a common complement control haplotype.

Aboriginal and Torres Strait Islander People (respectfully referred to as Indigenous Australians herein) are disparately burdened by many infectious and chronic diseases relative to Australians with European genetic ancestry. Some of these diseases are described in other populations to be influenced by the inherited profile of complement genes. These include complement factor B, H, I and complement factor H-related (CFHR) genes that can contribute to a polygenic complotype. Here the focus is on the combined deletion of CFHR1 and 3 to form a common haplotype (CFHR3-1Δ). The prevalence of CFHR3-1Δ is high in people with Nigerian and African American genetic ancestry and correlates to a higher frequency and severity of systemic lupus erythematosus (SLE) but a lower prevalence of age-related macular degeneration (AMD) and IgA-nephropathy (IgAN). This pattern of disease is similarly observed among Indigenous Australian communities. Additionally, the CFHR3-1Δ complotype is also associated with increased susceptibility to infection with pathogens, such as Neisseria meningitidis and Streptococcus pyogenes, which also have high incidences in Indigenous Australian communities. The prevalence of these diseases, while likely influenced by social, political, environmental and biological factors, including variants in other components of the complement system, may also be suggestive of the CFHR3-1Δ haplotype in Indigenous Australians. These data highlight a need to define the Indigenous Australian complotypes, which may lead to the discovery of new risk factors for common diseases and progress towards precision medicines for treating complement-associated diseases in Indigenous and non-Indigenous populations. Herein, the disease profiles suggestive of a common complement CFHR3-1Δ control haplotype are examined.

Enabling Indigenous wellbeing in higher education: Indigenous Australian youth-devised strategies and solutions

Indigenous youth comprise over half of the Indigenous Australian population; however, there is a scarcity of research that focuses on improving Indigenous Australians’ wellbeing in higher education. The purpose of this study was to identify Indigenous-devised strategies to support wellbeing of salience to Indigenous Australian higher education students. Using Indigenous methodology, Indigenous youth (N = 7; aged between 18 and 25 years) studying at three higher education institutions in Australia participated in semi-structured interviews. Thematic analysis identified strategies and solutions for supporting and enhancing Indigenous youth wellbeing in higher education. Participants suggested that their wellbeing would benefit from increased opportunities for them to gain role models. They also suggested culturally supportive higher education environments were critical and could be achieved by employing more Indigenous academics and Indigenous mentors to implement personalised student support, introducing mandatory cultural competency training for all staff, and employing culturally safe counselling services. Indigenous youth also suggested strategies for enhancing institutional policy such as ensuring Indigenous culture and perspectives were taught across all faculties; developing reconciliation action plans, financial support, and scholarships to require proof of Aboriginality and evidence of hardship; and an institutional wellbeing strategy designed to support Indigenous students’ wellbeing.

The pharmacogenomic landscape of an Indigenous Australian population.

Background: Population genomic studies of individuals of Indigenous ancestry have been extremely limited comprising <0.5% of participants in international genetic databases and genome-wide association studies, contributing to a "genomic gap" that limits their access to personalised medicine. While Indigenous Australians face a high burden of chronic disease and associated medication exposure, corresponding genomic and drug safety datasets are sorely lacking. Methods: To address this, we conducted a pharmacogenomic study of almost 500 individuals from a founder Indigenous Tiwi population. Whole genome sequencing was performed using short-read Illumina Novaseq6000 technology. We characterised the pharmacogenomics (PGx) landscape of this population by analysing sequencing results and associated pharmacological treatment data. Results: We observed that every individual in the cohort carry at least one actionable genotype and 77% of them carry at least three clinically actionable genotypes across 19 pharmacogenes. Overall, 41% of the Tiwi cohort were predicted to exhibit impaired CYP2D6 metabolism, with this frequency being much higher than that for other global populations. Over half of the population predicted an impaired CYP2C9, CYP2C19, and CYP2B6 metabolism with implications for the processing of commonly used analgesics, statins, anticoagulants, antiretrovirals, antidepressants, and antipsychotics. Moreover, we identified 31 potentially actionable novel variants within Very Important Pharmacogenes (VIPs), five of which were common among the Tiwi. We further detected important clinical implications for the drugs involved with cancer pharmacogenomics such as thiopurines and tamoxifen, immunosuppressants like tacrolimus and certain antivirals used in the hepatitis C treatment due to potential differences in their metabolic processing. Conclusion: The pharmacogenomic profiles generated in our study demonstrate the utility of pre-emptive PGx testing and have the potential to help guide the development and application of precision therapeutic strategies tailored to Tiwi Indigenous patients. Our research provides valuable insights on pre-emptive PGx testing and the feasibility of its use in ancestrally diverse populations, emphasizing the need for increased diversity and inclusivity in PGx investigations.

Congestive Heart Failure in Indian Elders

Congestive Heart Failure (CHF) is a common complex clinical syndrome that underlines the inability of the heart to perform its circulatory function with the desired efficiency due to structural and/or functional alterations. There is paucity of good and reliable data in India and many developing countries on heart failure. The management of heart failurehas evolved over the years with the advent of new drugs and devices.But there is a need to uneartha true and meaningful nationaldata on the risk factors,available treatment options,and challenges in management that could be addressed to take advantage of the recent advances. CHF is a disease of the “elderly,” frequently occurs in the setting of normal ejection fraction, and has a poor prognosis, regardless of the level of systolic function. The highest prevalence of CHF is reported among Indigenous Australian population (5.3%), Germany (4%) and Canada 3.6%, Turkey 2.9%, and USA 2.6% as compared to only 0.3% in Indian population. Overall, more than 5 persons aged 60 to 69 and 10 persons per 1,000 population after 65 years of age suffer from CHF. The incidence of CHF is equally frequent in men and women globally, but it is more amongelderly women in India comparedto elderly men. The burden of heart failure is increasing at an alarming rate worldwide as well as in India. CHF not only increases the risk of mortality, morbidity and worsens the patient’s quality of life, but also puts a huge burden on the overall healthcare system. We need to acknowledge the fact that diagnostic and therapeutic methods available are also underused in the community. This review article is the result of witnessing the heart failure in 4 individuals in January 2023. Their symptomsand signs included Shortness of breath with routine activity like walking or household chores, fatigue, and weakness, Pedal oedema, rapid or irregular heartbeat, fluctuating Blood Pressure and Blood sugar levels, reduced ability to exercise and vomiting and aspirational pneumonia. The exponential rise in the incidence of uncontrolled hypertension and DM over the last couple of years has shaped the trajectory of HF development seen today. The key risk factors and causes of HF in our cases included hypertension (HT), diabetes mellitus (DM); chronic kidney disease (CKD). With the bestpossible management practices in cities likeBengaluru and Mysuru in Karnataka we could save only two of the 4 cases,both first-time hospitalized patients. Materials &amp; Methods: The third week of January2023 (17-25 January), the author had a misfortune being a witnessfor 3 women and one man between 64-85 years of age’s hospitalized for CHF with an outcome of 50% of them succumbing to CHF. This manuscript is a review of available information on the websites of World Heart Federation 2020, WHO, Global burden of disease 2019 report, ICC - National Heart Failure Registry, Reports of the Best Charities that fight Heart Diseases in 2023 including American Heart Association, The Children’s Heart Foundation, British Heart Foundation, Mended Hearts, Women Heart, Needy heart Foundation Bangalore and published papers in Indiaas evidences.

Facial Fractures in Indigenous and Non-indigenous Populations of South Australia.

Maxillofacial trauma in indigenous populations is complex with sociocultural factors, access to health care, and poorer general health issues that impact outcomes. Assaults and road traffic accidents are disproportionately experienced by indigenous persons compared with non-indigenous. A retrospective review was conducted from January 2012 to January 2017 at the Women and Children's Hospital and Royal Adelaide Hospital, Adelaide. All maxillofacial fractures that attended or were referred to the unit were included in this study. The primary objective was to analyze epidemiological trends of facial fractures and clinical outcomes in the South Australian indigenous and non-indigenous populations. Maxillofacial fractures in indigenous persons were less than in non-indigenous (31.2 versus 38.2y, P < 0.001) with 3.8 odds of a facial fracture. Assault was 2.9 times more likely to result in a facial fracture, falls 40.9% less likely, and sports 29.4% less likely compared with non-indigenous ( P < 0.001). Alcohol-related facial fractures had significantly higher rates [odds ratio (OR = 3.8)] compared with non-indigenous. Indigenous from most disadvantaged areas and very remote areas also had significantly higher odds of a facial fracture. Indigenous persons had higher operative rates (OR = 2.8), postoperative complications (OR = 3.1), and a 3.7-day mean difference for the length of stay (6.6 versus 2.9d, P < 0.001). Indigenous people are more likely to experience facial fractures from assault resulting in mandibular fractures, whereas non-indigenous people are likely to have sport or fall-related midface fractures. Young indigenous women from outer regional and very remote areas have greater odds of facial fractures caused by assault and alcohol with higher operative rates, postoperative complications, and extended length of stay.

Diagnostic accuracy of the Composite International Diagnostic Interview (CIDI 3.0) in an urban Indigenous Australian sample.

The Composite International Diagnostic Interview 3.0 is a standardised diagnostic interview commonly used in population-based mental health surveys, but has not been used in community-residing Indigenous Australians. This paper seeks to determine whether the Composite International Diagnostic Interview 3.0 can produce valid diagnostic information when compared with a diagnostic interview in an urban Indigenous Australian sample. This research was conducted over 10 weeks with adult Indigenous clients of two participating Aboriginal Medical Services in South-East Queensland. Using a cross-sectional, repeated-measures design, participants were administered the Composite International Diagnostic Interview 3.0 by an Indigenous interviewer and within 2 weeks attended a second appointment with an Indigenous clinical psychologist, who produced a diagnostic summary. The Composite International Diagnostic Interview 3.0 diagnoses were compared with the diagnostic summaries and clinical concordance between the two measures was calculated. The diagnostic accuracy of the Composite International Diagnostic Interview 3.0 differed by module. The Post-traumatic Stress Disorder and Major Depression modules had good utility in diagnosing post-traumatic stress disorder and major depressive episodes, respectively; however, the Mania module that provides diagnoses of bipolar disorder was found to be unsuitable for this population. Although there were no identified contraindications for the use of the Generalised Anxiety and Alcohol Use Disorder modules, further research on the diagnostic accuracy of these modules is warranted. The Composite International Diagnostic Interview 3.0 can accurately diagnose some common mental disorders in an Indigenous Australian population, but was found to be unsuitable for others. Given these findings, care should be taken when using the Composite International Diagnostic Interview 3.0 in epidemiological prevalence studies with Indigenous Australian populations.

P053 Acceptability, Adaptability and Adherence to Continuous Positive Airway Pressure Therapy among Aboriginal Australians - The “A5” Top End Northern Territory Australian Study

Abstract Obstructive sleep apnoea (OSA) is highly prevalent among the Australian Indigenous population. In this setting, alongside a high prevalence of chronic medical comorbidities, OSA may further perpetuate adverse health outcomes. Though CPAP is a well-established, proven therapeutic modality, acceptability, and adherence have not been examined among the Australian Indigenous population. 730 Indigenous Australian patients with a diagnostic sleep study recorded between 2011 and 2020 were included. CPAP therapy was assessed as Accepting (any recorded use), Adapting (≥30 days use) and Adhering (≥30 days with ≥4 hours use on ≥70% of nights). 649 (89%) Indigenous patients had OSA (25% mild, 25% moderate &amp; 50% severe). The majority of patients were male (53%), aged a median 47 years and were obese (72%), with 44% residing in remote locations. 309 (48%) Accepted CPAP, 197 (30%) Adapted to CPAP and 67 (10%) Adhered to CPAP. Acceptance, Adaptation and Adherence were higher in patients with Severe vs. Mild OSA (63, 44 &amp; 16% vs. 23, 10 &amp; 3%). OSA severity was associated with Acceptance and Adaptation to CPAP therapy but was not associated with Adherence. Remote residence was significantly and negatively associated with Adaptation and Adherence to therapy. Remote location was found to be the major factor defining whether patients continued therapy for ≥30 days and adhered to therapeutic guidelines. Given that 80% of Indigenous Australians in the NT reside in remote communities significant work needs to be done to promote adaptation and adherence to therapy in order to reduce morbidity associated with sleep disorders.

P055 Hospital admission rates and mortality among Indigenous patients with OSA – Top End Northern Territory perspective

Abstract Obstructive sleep apnoea (OSA) is highly prevalent among the Australian Indigenous population. Among other populations OSA has been linked to an increased risk of cardiac and respiratory disease and hospital presentations. It is plausible that CPAP adherence would reduce this risk. However, no such literature exists pertaining to the Indigenous Australian population. Indigenous Australian patients with OSA (assessed 2011-2020) and at least one hospital recorded (assessed 2011 – 2021) were included. ICD codes were used to assess hospital presentations and defined as Respiratory, Circulatory or Metabolic. Metabolic related hospital presentations were the most common (3,111 presentations, 66% of patients) followed by Circulatory system (1,900 presentations, 51% of patients) and Respiratory system (1,373 presentations, 45% of patients). Among the patients who had at least one of each respective presentation, the median number and rate of presentations was highest for Metabolic issues (median 4 presentations, rate 1.19/year), followed by Circulatory issues (median 3.5 presentations, rate 0.91/year) and Chronic Respiratory issues (median 3 presentations, rate 0.7/year). Adherence to CPAP significantly decreased the rate of Respiratory related presentations (beta -1.07 (95% CI -1.9, -0.2)). A high rate of hospital presentations exists among Indigenous Australian patients with OSA. Promoting the use of CPAP among Indigenous Australian patients may aid in reducing morbidity and mortality.

P031 Comparison of Level three sleep study against Level two studies in the diagnosis of OSA among Indigenous patients at the Top End Northern Territory of Australia

Abstract Introduction/Aim Level three sleep studies are performed on portable devices which provide information on 3 channels. Some studies have reported that the accuracy of level 3 studies could be as accurate as polysomnography in a sub-set of population in the diagnosis of OSA. However, there is limited information in the literature regarding the effectivity of level 3 study in comparison to level 1 or level 2 study among Indigenous patients. Methods Patients included in this study were adult Indigenous patients identified to have undergone both level 2 and level 3 sleep study. We assessed the accuracy of diagnosing the presence of OSA as per AHI Results There were 12 indigenous patients identified to have undergone both level 2 and level 3 study. Four out of the 12 level 2 sleep studies failed due to sensor dropouts. Excluding patients with failed studies, 4 out of the 8 patients showed a higher AHI on their level 2 sleep study compared to level 3 study. Six patients had the same severity of OSA identified on both Level 2 and Level 3 studies. Conclusion This study shows mixed results in the efficacy of Level 3 studies compared to Level 2 studies, though failure rates may be lower on Level 3 studies. A larger sample size is required to further elaborate on the validity and efficacy of Level 3 studies in the diagnosis of OSA among indigenous Australian population. Grant Support Nil to declare and no funding received for this study

P010 Success and failure rates of ambulatory home sleep studies (Level 2) among Indigenous patients

Abstract Introduction/Aim Level 2 sleep studies are being increasingly performed worldwide in order to minimise the cost and access to level1 in-lab polysomnography. However, their accuracy and validity remain disputed. For populations residing in regional and remote localities, access to level1 sleep studies are further compromised, such as among Indigenous people of Australia, where 80% reside in remote communities. There is limited information in the literature regarding the efficacy of level2 sleep studies among Indigenous patients. Hence, in this study we evaluated the efficacy of level2 sleep studies amongst an Indigenous population. Methods 552 level2 sleep studies from Indigenous patients recorded between 2011-2020 were included. Sleep studies were analysed and scored manually by registered polysomnographic technologist as per standard guidelines. The studies were also assessed to determine the soundness of the study. Demographic and clinical information of patients was also collected. Results 50% of the patients were female, and 51% resided in remote or very remote locations. Of the 552 studies, 47(8.5%) were failed. There was no significant differences in demographic factors between failed and successful studies. The most common reason for failure was intolerance of the sensors which resulting in removing the device. Conclusion Level 2 sleep studies showed high success rate amongst this Indigenous population with just 8.5% failure rate. As there is limited access to level 1 sleep studies among the Indigenous Australian population due to remoteness, this study shows that level 2 sleep studies are a feasible alternative in the diagnosis for the presence of sleep disorders.

Psychological Research in an Australian Remote Indigenous Context: Towards a Culturally Safe Cognitive Research Approach

Cognitive psychological research provides an evidence-based understanding of human cognition. For example, it can inform an understanding of how phonological awareness, visuospatial processing and working memory facilitate reading. However, the evidence base around reading acquisition is constructed from a Western, Educated, Industrialised, Rich and Democratic (WEIRD) perspective, with little consideration for whether such evidence extends to Australian Indigenous populations. Given the recognised need to improve literacy outcomes for Indigenous children, there is an applied benefit in conducting cognitive research to better understand how language, culture or context might influence the development of neurocognitive processes underlying reading in remote Indigenous communities. However, it is essential that cultural cognitive research be conducted in a culturally fair and culturally safe manner. This requires critiquing and challenging standard cognitive research approaches and methodologies. Here I reflect on research that investigated neurocognitive factors associated with reading in an Indigenous context. I highlight the disjuncture between cognitive psychological research and Indigenous custom and practice and suggest that culturally safe cognitive research must embed Indigenous ways of knowing, being and doing. I assert that to work alongside Indigenous researchers as allies, non-Indigenous researchers must develop intercultural research skills. This includes building cultural competence and engaging in critical self-reflexivity.

Maternal asthma in Australian indigenous women and perinatal outcomes: A whole population-linked study.

To assess the association between maternal asthma and adverse perinatal outcomes in an Australian Indigenous population. This prospective cohort study included all Indigenous mother and baby dyads for births from 2001 to 2013 in Western Australia (n= 25 484). Data were linked from Western Australia Births, Deaths, Midwives, Hospital, and Emergency Department collections. Maternal asthma was defined as a self-reported diagnosis at an antenatal visit or hospitalization or emergency visit for asthma during pregnancy or less than 3 years before pregnancy. Associations with birth, labor, and pregnancy outcomes were assessed using generalized estimating equations. Asthma exacerbation during pregnancy and stratification by remoteness was also assessed. Maternal asthma was associated with placental abruption (adjusted odds ratio [aOR], 1.59 [95% confidence interval (CI), 1.07-2.35]), threatened preterm labor (aOR, 1.58 [95% CI, 1.39-1.79]), and emergency cesarean sections (aOR, 1.27 [95% CI, 1.13-1.44]). These risks increased further with an asthma exacerbation during pregnancy or if the mother was from a remote area. No associations were found for low birth weight, preterm birth, small for gestational age, or perinatal mortality. Maternal asthma in Indigenous women is associated with an increased risk of emergency cesarean sections, placental abruption, and threatened preterm labor. These risks may be mitigated by improved management of asthma exacerbations during pregnancy.

A comprehensive human leukocyte antigen analysis of 36 782 cord blood units stored in the Australian Public Cord Blood Banking Network

Background and aimsThe network of public cord blood banks (CBBs) in Australia, known as AusCord, comprises CBBs located in Brisbane, Sydney and Melbourne. A novel comprehensive analysis has been performed to determine whether the cryopreserved, searchable cord blood unit (CBU) inventory of approximately 36 000 units share similar tissue types or haplotypes. MethodsHuman leukocyte antigen (HLA) data was analysed using Microsoft Excel following standardisation of typing data. ResultsThe analysis has found that the majority of stored, searched and released CBU exhibit a tissue type that is unique within and between the CBBs. Therefore, each collection performed by the CBBs is likely to comprise a tissue type that is not already stored among the total AusCord inventory. HLA alleles (HLA-A*34, HLA-B*56, HLA-DRB1*08:03), which are uncommon in European populations, were associated with Pacific Islander and/or Indigenous Australian populations and confirmed to be more frequent among donors who, when screened, self-identified as these ethnicities. ConclusionsThese data indicate that (i) continued addition of CBU to existing inventories is likely to further increase the HLA diversity and (ii) screening donors for ethnicity or strategically locating collection sites where ethnic minorities reside can successfully result in collection of rare HLA associated with ethnic minority groups for whom finding donors might otherwise be more difficult.

The role of chronic disease in the disparity of influenza incidence and severity between indigenous and non-indigenous Australian peoples during the 2009 influenza pandemic

BackgroundThe 2009 H1N1 influenza pandemic (influenza A(H1N1)pdm09) disproportionately impacted Indigenous peoples. Indigenous Australians are also affected by a health gap in chronic disease prevalence. We hypothesised that the disparity in influenza incidence and severity was accounted for by higher chronic disease prevalence.MethodsWe analysed influenza data from Western Australia, South Australia, the Northern Territory, and Queensland. We calculated population prevalence of chronic diseases in Indigenous and non-Indigenous Australian populations using nationally-collected health survey data. We compared influenza case notifications, hospitalisations, intensive care admissions, and deaths reported amongst the total population of Indigenous and non-Indigenous Australians ≥ 15 years. We accessed age-specific influenza data reported to the Australian Department of Health during the 2009 ‘swine flu’ pandemic, stratified by Indigenous status and the presence of one of five chronic conditions: chronic lower respiratory conditions, diabetes mellitus, obesity, renal disease, and cardiac disease. We calculated age-standardised Indigenous: non-Indigenous rate ratios and confidence intervals.FindingsChronic diseases were more prevalent in Indigenous Australians. Rates of influenza diagnoses were higher in Indigenous Australians and more frequent across all indices of severity. In those with chronic conditions, Indigenous: non-Indigenous influenza notification rate ratios were no lower than in the total population; in many instances they were higher. Rate ratios remained above 1·0 at all levels of severity. However, once infected (reflected in notifications), there was no evidence of a further increase in risk of severe outcomes (hospitalisations, ICU admissions, deaths) amongst Indigenous Australians compared to non-Indigenous Australians with a chronic disease.InterpretationHigher rates of influenza infection was observed amongst those Indigenous compared to non-Indigenous Australians, and this difference was preserved amongst those with a chronic condition. However, there was no further increase in prevalence of more severe influenza outcomes amongst Indigenous Australians with a chronic condition. This suggests that the prevalence of chronic disease, rather than Indigenous status, affected influenza severity. Other factors may be important, including presence of multiple morbidities, as well as social and cultural determinants of health.

The role of alcohol and drug intoxication in fatal drowning and other deaths that occur on the Australian coast

Introduction: Alcohol and drug (illicit or prescription) intoxication impairs motor skills, coordination, decision making abilities, hazard perception, and is known to increase the risk of death in coastal environments. Prior coastal safety research has focused largely on the impact of alcohol on drowning, with less research on the influence of drugs and leaving a significant number of other non-drowning fatalities largely excluded, despite being preventable with mitigation of injuries or medical factors. Method: This retrospective cross-sectional study explored the impact of alcohol and drugs on unintentional Australian drowning deaths and other coastal fatalities over a 16-year period to identify higher-risk populations and coastal activity groups for which alcohol/drug use is increased. Results: It was found that alcohol, benzodiazepines/sedatives, and amphetamine usage was prevalent in coastal deaths. Of the 2,884 coastal deaths, 80.6% of decedents had known toxicological data. Alcohol and/or drug intoxication contributed to 23% of coastal drowning deaths and 19% of fatalities. For drowning and other fatalities combined, 8.7% were due to alcohol, 8.7% due to drugs, and 4.1% due to both alcohol and drugs. Australian-born decedents were more likely to involve alcohol (RR = 1.7, 95%CI = 1.26–2.3, p < 0.001), drugs (RR = 2.62, 95%CI = 1.85–3.7, p < 0.001), or both alcohol and drugs (RR = 4.43, 95%CI = 2.51–7.82, p < 0.001) with an increased risk identified in Indigenous Australian populations (RR = 2.17, 95%CI = 1.12–4.24, p = 0.04). The impact of alcohol and drug intoxication varied by activity, with Personal Watercraft users more likely to die due to alcohol intoxication (RR = 2.67, 95%CI = 1.23–5.78, p = 0.035), while scuba divers (RR = 0, p < 0.001), snorkelers (RR = 0.14, 95%CI = 0.036–0.57, p < 0.001), and rock fishers (RR = 0.46, 95%CI = 0.22–0.96, p = 0.03) were less likely. Recreational jumping and fall-related coastal deaths were more likely to involve alcohol and alcohol/drugs combined. Practical Applications: This study identifies factors to further investigate or target with prevention strategies to decrease the holistic burden of mortality due to alcohol and/or drug usage on the Australian coast.

Assessment of Pain-Related Fear in Indigenous Australian Populations Using the Fear of Pain Questionnaire-9 (FPQ-9).

In this study, we examined the psychometric properties of the Fear of Pain Questionnaire (FPQ-9) in Indigenous Australian people. FPQ-9, a shorter version of the original Fear of Pain Questionnaire-III, was developed to support the demand for more concise scales with faster administration time in the clinical and research setting. The psychometric properties of FPQ-9 in Indigenous Australian participants (n = 735) were evaluated with network psychometrics, such as dimensionality, model fit, internal consistency and reliability, measurement invariance, and criterion validity. Our findings indicated that the original FPQ-9 three-factor structure had a poor fit and did not adequately capture pain-related fear in Indigenous Australian people. On removal of two cross-loading items, an adapted version Indigenous Australian Fear of Pain Questionnaire-7 (IA-FPQ-7) displayed good fit and construct validity and reliability for assessing fear of pain in a sample of Indigenous Australian people. The IA-FPQ-7 scale could be used to better understand the role and impact of fear of pain in Indigenous Australian people living with chronic pain. This could allow for more tailored and timely interventions for managing pain in Indigenous Australian communities.