Indigenous Australian Children Research Articles

Toward culturally-appropriate communication assessment for Indigenous Australian children with autism

We sought to determine if the Hearing and Talking Scale (HATS)—a tool developed to assess the communication, speech, and language development of Indigenous Australian children—might be applicable to Indigenous Australian children with autism. A HATS assessment was completed with four Indigenous Australian children. The children were aged 3–5 years and had been diagnosed with autism. The results were compared to scores from the Receptive-Expressive Emergent Language Scale (REEL-4), which is a standardised, norm-referenced assessment of expressive and receptive language development. The children’s early childhood teachers served as informants. Both the HATS and REEL-4 identified varying degrees of communication impairment suggesting that their combined use may represent a culturally appropriate and feasible communication assessment strategy. Future research into the reliability and validity of the HATS for assessing the communicative functioning of young Indigenous Australian children with autism or other types of developmental disabilities or delay is warranted.

Association between poor sleep and mental health issues in Indigenous communities across the globe: a systematic review.

Evidence from studies among non-Indigenous populations has established the association of poor sleep to mental health issues and supported how improving sleep could reduce the risk of mental ill health. In contrast, for Indigenous people, who experience disproportionate rates of mental ill health, the association between sleep and mental health and the potential of sleep health in reducing the risk and severity of mental health issues have never been fully reviewed. Considering the literature gap, this review assesses the association between sleep and mental health in Indigenous people. Following PRISMA guidelines, a study was submitted to the PROSPERO database for registration (293798) prior to commencing the review. Then academic databases were searched for relevant studies published up till 19 February 2023. Studies with quantitative data on sleep and mental health association in Indigenous people were included and a narrative review/synthesis was conducted. Seven studies, using carer/self-reports (six cross-sectional, one longitudinal) among three Indigenous groups (N = 3066) met the inclusion criteria. In Indigenous Australian children, arousal problems were associated with aggression, and withdrawn behavior, while early bedtime was associated with a lower risk of behavioral problems. In Native American young people, insomnia symptoms were associated with depressive symptoms in adults, short sleep was associated with affective disorders. Clinical sleep issues, i.e. restless leg and apnea, were associated with depression. In Amerindian/Mestizo adults, restless leg syndrome was associated with depression and anxiety. Overall, findings report the prevalence of poor sleep and mental health issues among Indigenous communities across the globe. Six studies scored "moderate quality" and one study scored "high quality" in quality assessment. While there is limited research available, our finding suggests an association between poor sleep and mental health issues in Indigenous people. Further investigation of the potential role of, and investing in, sleep health could help support mental health.

Early Childhood Caries Intervention in Aboriginal Australian Children: A Cross-in Randomized Trial.

Early childhood caries (ECC) is the strongest predictor of dental caries in adulthood. Indigenous children have higher levels of ECC compared with non-Indigenous children. The study aimed to estimate the efficacy of an ECC intervention among Aboriginal Australian children. Baby Teeth Talk was an outcome assessor-blinded, closed-cohort cross-in randomized controlled trial conducted in South Australia, Australia. We randomly allocated 448 women pregnant with an Aboriginal child to either an immediate (II) or delayed (DI) intervention group between January 2011 and May 2012. The immediate intervention comprised (1) provision of dental care to mothers during pregnancy; (2) application of fluoride varnish to teeth of children at ages 6, 12; and 18 mo; (3) motivational interviewing delivered in conjunction; and (4) anticipatory guidance. Mothers/children in the DI group received the same intervention commencing when the child was 24 mo of age. The outcomes were assessed by the number of decayed, missing, and filled teeth (dmft) in children aged 24, 36, and 60 mo. Regression-based approaches with generalized linear mixed effect (log-Poisson) model characterized the mean dmft to estimate risk ratios (RRs) and 95% confidence intervals (95% CIs). A total of 223 participants were randomly allocated to the II group and 225 to the DI group. Three hundred sixty-five children (178 II, 187 DI) received at least 1 dental clinical examination at 24, 36, and 60 mo of follow-up. The mean dmft was lower in the II group (0.48, 1.32, and 2.06) than in the DI group (0.82, 1.90, and 3.29) at each time point, respectively. The direct ECC intervention effect was to prevent/decrease dental decay experience (dmft) occurrence by 84% (RR = 1.84, 95% CI: 1.20-2.48) after adjusting for all covariates. Our analysis indicated that the time-varied ECC intervention had immediate and longer-term effects on the prevention of ECC among Indigenous Australian children. The study aimed to estimate the efficacy of an early childhood caries (ECC) intervention among Aboriginal Australian children. The findings indicated that the culturally appropriate ECC intervention is effective for the preventive of ECC and can be used by clinicians, educators, and policy makers when planning an ECC intervention, so as to prevent and reduce ECC and meet identified oral health needs across the Australian population, which is important for preventive dental care.

Descriptive Epidemiology of Pediatric Inflammatory Bowel Disease in Oceania: A Systematic Review and Meta-Analysis.

Pediatric inflammatory bowel diseases (IBDs) are chronic, idiopathic illnesses of the digestive tract, which can impact adversely on children's quality of life and burden health systems. International studies have shown these diseases are increasing. The aim was to describe pediatric IBD epidemiology across Oceania by conducting a systematic review and meta-analysis of incidence and prevalence. Medline, EMBASE and Web of Science databases were searched in October 2022 for studies reporting rates of IBD, Crohn disease (CD), or ulcerative colitis (UC) in children (≤19 years). Several data collection methodologies were included and pooled estimates of incidence and prevalence were calculated using a random effects model with I2 measures of heterogeneity. Nineteen articles provided 15 incidence and 7 prevalence studies. Fourteen studies were from Australia, 8 studies from New Zealand, and no studies were found from the Pacific Islands. Study dates ranged from 1950 to 2020 with 11 studies using population-based designs. Pooled estimates for annual incidence were IBD 4.1 (3.4-4.8, I2 = 98.7), CD 2.3 (1.9-2.7, I2 = 98.6), and UC 0.9 (0.6-1.1, I2 = 96.8) per 100,000 person-years. Prevalence rates were IBD 36.0 (23.5-48.5, I2 = 98.4), CD 23.2 (6.6-39.8, I2 = 97.8), and UC 7.6 (2.7-12.5, I2 = 99.6) per 100,000 persons. Pediatric IBD is prevalent in Oceania with high incidence rates, particularly for CD. Low rates of IBD were observed in indigenous Australian, Māori, and New Zealand Pacific children and there were no studies from the Pacific Islands highlighting this as an area in need of further research.

Incremental effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumonia hospitalisation among Australian Indigenous children: A record linkage study

BackgroundThe impact of pneumococcal conjugate vaccines (PCVs) on pneumonia in children is well-documented but data on 23-valent pneumococcal polysaccharide vaccine (PPV23) are lacking. Between 2001 and 2011, Indigenous children in Western Australia (WA) were recommended to receive PPV23 at 18–24 months of age following 3 doses of 7-valent PCV. We evaluated the incremental effectiveness of PPV23 against pneumonia hospitalisation. MethodsIndigenous children born in WA between 2001 and 2012 who received PCV dose 3 by 12 months of age were followed from 18 to 60 months of age for the first episode of pneumonia hospitalisation (all-cause and 3 subgroups: presumptive pneumococcal, other specified causes, and unspecified). We used Cox regression modelling to estimate hazard ratios (HRs) for pneumonia hospitalisation among children who had, versus had not, received PPV23 between 18 and 30 months of age after adjustment for confounders. Results11,120 children had 327 first episodes of all-cause pneumonia hospitalisation, with 15 (4.6%) coded as presumptive pneumococcal, 46 (14.1%) as other specified causes and 266 (81.3%) unspecified. No statistically significant reduction in all-cause pneumonia was seen with PPV23 (HR 1.11; 95% CI: 0.87–1.43), but the direction of the association differed for presumptive pneumococcal (HR 0.47; 95% CI: 0.16–1.35) and specified (HR 0.89; 95% CI: 0.49–1.62) from unspecified causes (HR 1.13; 95% CI: 0.86–1.49). During the baseline period before PPV23 vaccination (12–18 months), all-cause pneumonia risk was higher among PPV23-vaccinated than unvaccinated children (RR: 1.73; 95% CI: 1.30–2.28). ConclusionIn this high-risk population, no statistically significant incremental effect of a PPV23 booster at 18–30 months was observed against hospitalised all-cause pneumonia or the more specific outcome of presumptive pneumococcal pneumonia. Confounding by indication may explain the slight trend towards an increased risk against all-cause pneumonia. Larger studies with better control of confounding are needed to further inform PPV23 vaccination.

Computed Tomography Analysis of the Manufacture of Cast Head-Bust Figurines by Patricia ‘Pat’ Elvins (1922–2011)

The Alice Springs sculptor Patricia Elvins created a number of busts of Indigenous Australian men, women, and children, which were distributed as casts for the gift and souvenir market. Produced between the early-1960s and the early-1990s, these varnished casts exist with four different artists’ signatures, representing collaboration with different production potters who produced the casts. Macroscopic analysis shows significant differences in weight between casts of the same bust. CT scanning was carried out to understand the make-up of these casts and to illuminate differences in production techniques. The scanning revealed that all figurines were cast, but that casting techniques varied not only between production potters but also among figurines of the same potter. It revealed differences in the densities of the casting material, both between and within specimens, suggesting that production was not standardized but occurred in smaller batches, possibly on demand of low-volume sales stock. The study has shown the potential of non-destructive CT scanning to go beyond this and serve as a tool to examine the casting process itself as well as to contribute to an understanding of the nature of the plasters used.

P095 Clinical and polysomnographic characteristics of Indigenous and non-Indigenous children undergoing adenotonsillectomy with clinically suspected sleep disorders at the Top End Northern Territory of Australia

Abstract Sleep apnoea and poor sleep quality are growing public health issues which may begin in childhood and progress to significant lifelong morbidity. Literature regarding the prevalence of surgery for obstructive sleep apnoea (OSA) among Indigenous Australian children however is sparse. Children and polysomnographic (PSG) characteristics among children undergoing adenotonsillectomy (AT) for clinically suspected sleep-disordered breathing were assessed in this retrospective study. Paediatric patients Indigenous and non-Indigenous children referred for a diagnostic (PSG) via ENT service at the Top End Northern Territory of Australia for a sleep study between 2016 and 2020 were included. Of the 375 patients referred through an ENT service for a diagnostic PSG, 115 were identified to have undergone an AT and were included. The majority of patients were male (58%) and non-Indigenous (88%), in the normal weight category (64%) with a median age of 4.1 years. The median reported PDSS was 12, and snoring was reported in 77% of patients, with witnessed apnoeas in 31% and excessive daytime sleepiness in 23%. Most patients were identified to have OSA on PSG (65%, median AHI 1.6, 64% mild, 12% moderate, 23% severe). Median sleep efficiency was 85%, with a total sleep time of 520 minutes and WASO of 74 minutes. Total average SpO2 was a median of 93.5% and SpO2 Nadir 85%. We discuss how our findings can translate to future service planning and delivery whilst respecting cultural safety and indigenous group engagement.

P041 Poor Sleep and Mental Health Issues Among First Nations Peoples

Abstract To evaluate the evidence on sleep and mental health issues in First Nations peoples. A systematic literature search was conducted covering academic and grey literature databases for studies with quantitative data on sleep and mental health association in First Nations Peoples published until November 2021. The National Institutes of Health Quality Assessment Tool was used for quality assessment, and the Aboriginal and Torres Strait Islander Quality Appraisal Tool helped assess cultural appropriate conduct of research. Seven studies (6 cross-sectional and 1 longitudinal) among three First Nations groups (n=3075) were included. In Indigenous Australian children, arousal problems increased aggression, and withdrawn behaviour, while early bedtime protected against behavioural problems (OR: 0.48, 95% CI: 0.28 -0.82). In Native American youth, insomnia symptoms increased depressive symptoms (OR: 4.87, 95% CI: 2.4 to 9.89), while in adults, short sleep increased the risk of anxiety (16%) and affective disorders (16%). Clinical sleep issues, restless leg (OR: 1.82; 95% CI: 0.53 to 3.12), insomnia (OR: 4.49; 95% CI: 3.14 to 5.83), and apnoea (OR: 2.46; 95%CI: 0.47 to 4.46) were associated with depression. Similarly, in Ameridian/Mestizo adults, restless leg syndrome increased the risk of depression (OR: 4.5, 95% CI: 2.2 to 9.7) and anxiety (OR: 3.6, 95% CI: 1.7 to 7.7). Majority of the studies scored high in quality assessment but the lack of information limited adequately assessing cultural appropriateness. There is limited but strong evidence suggesting a strong role of poor sleep in mental health issues in First Nations peoples which compels investment in sleep health.

Association between lack of dental service utilisation and caregiver-reported caries in Australian Indigenous children: A national survey.

To investigate the association between the lack of dental service utilisation and dental caries in Australian Indigenous children. Data from the Longitudinal Study of Indigenous Children, which is a longitudinal population-based cross-sectional study in Australia were analysed. A total of 1258 children were included, consisting of the baby cohort and the child cohort at Wave 7. Logistic regression analysis was conducted to examine the association between caregiver-reported child dental caries and dental service utilisation. Multiple imputation using the fully conditional specifications approach was used to account for missing data. Around one tenth (12.3%) of Indigenous children did not see a dentist when required. Lack of dental service utilisation was associated with an increased likelihood of caregiver-reported dental caries (odds ratio (OR) 2.4; 95% confidence interval (CI) 1.5-3.8) and teeth removed due to dental caries (OR 2.3; 95% CI 1.1-4.7). These associations remained after adjusting for confounders (caregiver-reported dental caries OR 2.3; 95% CI 1.3-3.8; teeth removed due to dental caries OR 2.1; 95% CI 1.0-4.4). The reasons reported for not utilising dental services when required were the lack of an available dentist (31.4%), difficulties with physical access (19.8%), long waiting times (13.9%), financial issues with cost (5.8%) and feeling that 'they could cope' (4.6%). Lack of dental service utilisation was associated with dental caries and extraction due to caries in Australian Indigenous children.

Dental procedures in children with or without intellectual disability and autism spectrum disorder in a hospital setting.

This population-based cohort study investigated dental procedures in the hospital setting in Western Australian children with or without intellectual disability (ID) and/or autism spectrum disorder (ASD) aged up to 18 years. Considering previously reported disparities in dental disease between Indigenous and non-Indigenous Australian children, this study also investigated the effect of Indigenous status on dental procedures. Data on Western Australian live births from 1983 to 2010 from the Midwives Notification System were linked to the Intellectual Disability Exploring Answers database and the Hospital Morbidity Data collection. Primary admissions for relevant dental diagnoses were identified, and treatment procedures for dental hospitalization were investigated. Descriptive statistics and Pearson's chi-squared test of independence were used for analysis. Overall, 76 065 episodes of dental hospitalization were recorded. Amongst children with ID and/or ASD, Indigenous children experienced more extractions and fewer restorations (68.7% and 16.2%) compared to non-Indigenous children (51.5% and 25.9%). After 6 years, extraction occurred less often in children with ID and/or ASD than in those without, where most surgical dental extractions were in the age group of 13-18 years. This study indicates a need for further improvements in access to dental services and the quality of care provided in hospitals for children with ID/ASD. There is also concern that more vulnerable Indigenous and all disadvantaged children are receiving an inadequate level of dental services resulting in more emergency dental hospitalization and invasive treatment.

Sleep quality and obstructive sleep apnoea in Indigenous and non-Indigenous Australian children

BackgroundLiterature pertaining to the prevalence of obstructive sleep apnoea (OSA) and sleep quality among Indigenous Australian children is sparse. This study assessed various sleep related parameters and outcomes between Indigenous and non-Indigenous Australian children. MethodsChildren referred to the sleep health service in the Northern Territory of Australia for a clinically suspected sleep disorder between 2015 and 2021 were included in this study. Self-reported sleep measures alongside polysomnography data were assessed and compared between these two diverse ethnic population. ResultsOf the 671 sleep studies assessed, 121 (18%) were from Indigenous children. The majority of patients were male (61%), with a median age of 5.7 (3.5, 8.9) years, and body mass index (BMI) in the normal range (57%). Indigenous children were significantly older (median 7.2 years (4.5, 11.9), with a higher BMI (p = 0.005) and a greater proportion living in very remote locality (14% vs. 6% non-Indigenous, p = 0.001). Indigenous children had higher Paediatric Daytime Sleepiness Scale scores (p = 0.001), higher screen use before bed (p = 0.005), later bedtimes (p = 0.001) and reduced total sleep time (p = 0.034) compared to non-Indigenous children. Prevalence of OSA was higher in Indigenous children (55% vs. 48%) and with greater severity compared to non-Indigenous children. ConclusionsIn this study, OSA was more prevalent and more severe in Indigenous children than their non-Indigenous peers. However, this may not necessarily be extrapolated to the general Indigenous paediatric population. Sleep hygiene and sleep quantity was also decreased further impacting adequate sleep. This highlights the importance of identifying and managing these addressable parameters and for targeted interventions.

Bullied Because of Their Teeth: Evidence from a Longitudinal Study on the Impact of Oral Health on Bullying Victimization among Australian Indigenous Children.

Making life better for Indigenous peoples is a global priority. Although bullying and oral health have always been a topic of concern, there is limited information regarding the impact of this problem on the general population, with no evidence in this regard among the Australian Indigenous population. Thus, we aimed to quantify the relationship between bullying victimization and oral health problems by remoteness among 766 Australian Indigenous children aged between 10–15-years using data from the LSIC study. Bivariate and multilevel mixed-effect logistic regression analyses were employed. Findings indicated children self-reported bullying more than parents reported their children were being bullied (44% vs. 33.6%), with a higher percentage from rural/remote areas than urban areas. Parents reported that oral health problems increased the probability (OR 2.20, p < 0.05) of being bullied, in Indigenous children living in urban areas. Racial discrimination, lower level of parental education and poor child oral hygiene increase the risk of bullying victimization. Parental happiness with life and a safe community were associated with a lower risk of bullying. Dental problems are linked with Australian Indigenous children experiencing bullying victimization. Cultural resilience and eliminating discrimination may be two modifiable paths to ameliorating health issues associated with bullying in the Australian Indigenous community.

Socioeconomic Status and Toothbrushing in Indigenous and Non-Indigenous Australian Children.

Dental caries in children is a multifactorial and complex condition. Toothbrushing helps maintain good oral hygiene and delivers fluoride. However, determinants of toothbrushing could vary based on Indigenous status. This study aimed to assess the association between socioeconomic status and adequate toothbrushing practice (brushing twice or more a day) in Indigenous and non-Indigenous Australian children. Data were acquired from the National Child Oral Health Survey (NCOHS) 2012 to 2014. NCOHS administered questionnaires to parents of a representative sample of 24,215 Australian children aged 5 to 14 y recruited using a complex sampling method. Data on the frequency of toothbrushing and socioeconomic status were collected through the questionnaires. Statistical analysis was conducted progressively from bivariate to multivariable regression modeling, stratified by Indigenous status. Just over half of Indigenous children and over two-thirds of non-Indigenous children reported adequate toothbrushing. The prevalence of adequate brushing (twice or more a day) was 42% (95% confidence interval [CI], 1.10-1.84) higher among children with an overseas-born parent than those with Australian-born parents. Among non-Indigenous children, sex and age, parents' country of birth, number of children in the family, and other family socioeconomic indicators (education, income, private health insurance) were associated with adequate toothbrushing. The prevalence of adequate brushing was 1.09 (95% CI, 1.03-1.15) and 1.15 (95% CI, 1.10-1.21) times higher when their parent possessed vocational training and tertiary education, respectively, compared to those children whose parents had school-level education. There were differences in patterns of socioeconomic disparities for toothbrushing practices between Indigenous and non-Indigenous Australian children. To promote positive toothbrushing practices in children, dental clinicians and public health professionals must be aware of the determinants of toothbrushing practices. Socioeconomic disparities in toothbrushing frequency were more apparent in non-Indigenous children. These results will help develop population-specific interventions that tackle the determinants to help improve oral hygiene behavior in Indigenous and non-Indigenous children.

An Artificial Intelligence Computer-vision Algorithm to Triage Otoscopic Images From Australian Aboriginal and Torres Strait Islander Children.

To develop an artificial intelligence image classification algorithm to triage otoscopic images from rural and remote Australian Aboriginal and Torres Strait Islander children. Retrospective observational study. Tertiary referral center. Rural and remote Aboriginal and Torres Strait Islander children who underwent tele-otology ear health screening in the Northern Territory, Australia between 2010 and 2018. Otoscopic images were labeled by otolaryngologists to classify the ground truth. Deep and transfer learning methods were used to develop an image classification algorithm. Accuracy, sensitivity, specificity, positive predictive value, negative predictive value, area under the curve (AUC) of the resultant algorithm compared with the ground truth. Six thousand five hundred twenty seven images were used (5927 images for training and 600 for testing). The algorithm achieved an accuracy of 99.3% for acute otitis media, 96.3% for chronic otitis media, 77.8% for otitis media with effusion (OME), and 98.2% to classify wax/obstructed canal. To differentiate between multiple diagnoses, the algorithm achieved 74.4 to 92.8% accuracy and an AUC of 0.963 to 0.997. The most common incorrect classification pattern was OME misclassified as normal tympanic membranes. The paucity of access to tertiary otolaryngology care for rural and remote Aboriginal and Torres Strait Islander communities may contribute to an under-identification of ear disease. Computer vision image classification algorithms can accurately classify ear disease from otoscopic images of Indigenous Australian children. In the future, a validated algorithm may integrate with existing telemedicine initiatives to support effective triage and facilitate early treatment and referral.

In vitro Inhibition of respiratory pathogens by lactobacillus and alpha haemolytic streptococci from Aboriginal and Torres Strait Islander children.

To explore the in vitro ability of alpha haemolytic streptococcus (AHS) and lactobacilli (LBs), from Indigenous Australian children, to inhibit the growth of respiratory pathogens (Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis), also from Indigenous Australian children. The bacterial interference of 91 isolates, from Indigenous Australian children both with and without otitis media (OM) or rhinorrhoea, was investigated using agar overlay and cell-free supernatant. Promising isolates underwent whole genome sequencing to investigate upper respiratory tract tropism, antibiotic resistance and virulence. Antibiotic susceptibility was examined for ampicillin, amoxicillin +clavulanic acid and azithromycin. Differences in the strength of bacterial inferences in relation to OM was examined using a case series of three healthy and three children with OM. LBs readily inhibited the growth of pathogens. AHS were less effective, although several isolates inhibited S. pneumoniae. One L. rhamnosus had genes coding for pili to adhere to epithelial cells. We detected antibiotic resistance genes coding for antibiotic efflux pump and ribosomal protection protein. LBs were susceptible to antimicrobials in vitro. Screening for virulence detected genes encoding for two putative capsule proteins. Healthy children had AHS and LB that were more potent inhibitors of respiratory pathogens in vitro than children with OM. L. rhamnosus from remote Indigenous Australian children are potent inhibitors of respiratory pathogens in vitro. Respiratory/ear disease are endemic in Indigenous Australians. There is an urgent call for more effective treatment/prevention; beneficial microbes have not been explored. L. rhamnosus investigated in this study are potent inhibitors of respiratory pathogens in vitro and require further investigation.

Reading as A Cultural Tool for Neurocognitive Development: A Complex Interactive Relationship between Reading Acquisition and Visuospatial Development for Indigenous and non-Indigenous Australians

ABSTRACT Standard Australian reading assessment tests are criticized for being culturally inappropriate for use with Australian Indigenous children, particularly for those living in remote and very remote regions, as these tests are culturally biased towards mainstream Australian culture and imperceptive to Indigenous knowledge, language, concepts, and contexts. Based on an established understanding of the relationship between reading acquisition and visual perceptual development, we sought to examine the visuospatial processing ability of Indigenous and non-Indigenous children to determine whether visuospatial tasks that measure dorsal and ventral processing – two key visual processes associated with reading – can provide an indicative measure of reading aptitude across cultures, independent of reading ability. Using a coherent motion task to test dorsal processing we found that dorsal processes develop similarly for age-matched Indigenous and non-Indigenous children (Study 1) and appear to facilitate early reading acquisition for both cultural groups, independent of age (Study 2 and subsequent analyses). Together, these results suggest that while dorsal processes may facilitate reading, reading is not necessary to facilitate dorsal development. Additionally, using a coherent form task to test ventral processing, we found an interactive association between ventral development and reading acquisition, particularly for non-Indigenous children. In interpreting these findings, we discuss possible cultural factors that may explain development of dorsal and ventral processes for Indigenous and non-Indigenous children, and why a relationship between ventral processing and reading acquisition was not evident for Indigenous children. We also consider the potential for scaffolding literacy learning for Indigenous children based on neurocognitive strengths.

The use of consent forms in a "call from class" model of dental care for Australian Indigenous children.

Dental caries is one of the most prevalent non-communicable diseases in children. Indigenous children reported a disproportionately higher prevalence of dental disease compared to their age-matched counterparts. To improve access to dental care a community-controlled service provides culturally appropriate dental services on the site of an Indigenous primary and secondary school. The dental clinic utilises a "call from class" model of care. Consent forms seeking permission to undertake a dental examination without a parent/guardian present during school hours are sent home. When the forms are returned, the student is located in class and a dental examination is undertaken. A retrospective audit of dental records from 2019 and 2020 were undertaken. The number of consent forms sent and returned were recorded. In 2019, 87% (n=220) of the school population were sent consent forms. Of the forms issued, 70% (n=154) were returned. Almost all students required further treatment (90%, n=137) and were sent a treatment consent form. Of the total student population, 67% (n=171) were not seen or had outstanding treatment from unreturned forms. Proportions of incomplete treatment and unseen students were similar in 2020 (64%, n=173). In this model, barriers are lessened by providing a free dental service on the school site. Consent is an ethical and legal necessity to undertake dental examination and treatment. Using physical forms were effective for gaining consent for most children. However, less than half of the school population's dental treatment was completed. Future studies should be conducted to explore the acceptability of using consent forms by parents/guardians and different models to gain consent for children from complex social circumstances.

Increasing Empathy, Decreasing Prejudice: The Role Of Empathy In Challenging Prejudice Among Students

Is empathy a remedy for prejudice? This short paper argues it has a large role to play. It explores the authors’ observations as a Humanities teacher engaging Grade 8 Australian students between the ages of 12 and 14 in a study of the film Rabbit-Proof Fence. As students empathised with Aboriginal (Indigenous Australian) children forcibly removed from their families under Australian government policy in the twentieth century, they questioned the negative things they themselves had come to believe about Indigenous Australians.

A Systematic Review of Child Health and Developmental Outcomes Associated with Low Birthweight and/or Small for Gestational Age in Indigenous Children from Australia, Canada and New Zealand

While much is known about the health implications of low birthweight for infants and adults, there is limited information about the health implications in childhood, particularly for Indigenous children. The aim of this systematic review was to assess associations between low birthweight (LBW) and/or small for gestational age (SGA) and the developmental, physical or mental health outcomes for Australian, Canadian and New Zealand Indigenous children (5–12 years), including the potential mediating role of cultural connections. The review was guided by an Aboriginal Advisory Group established to guide the Aboriginal Families Study. Four databases were investigated with pre-determined inclusion/exclusion criteria. The search identified 417 articles after independent screening by two authors. Eight studies assessing six child outcomes were included. The review identified limited evidence, although the review suggested possible links between LBW and/or SGA and childhood asthma, lower body mass index (BMI) and poorer academic performance. Links between LBW, SGA and disability, global health and developmental vulnerability were inconclusive. One study identified cultural-based resilience as protective against perinatal adversity. In summary, research on the relationship between adverse birth outcomes and Indigenous children’s health and development is limited. Further investigation and collaboration with Indigenous communities is required to drive optimised health and social services responses and equitable system reform.

Upper Respiratory Tract Microbiome of Australian Aboriginal and Torres Strait Islander Children in Ear and Nose Health and Disease.

ABSTRACTThe objective of this study was to examine the nasal microbiota in relation to otitis media (OM) status and nose health in Indigenous Australian children. Children 2 to 7 years of age were recruited from two northern Australian (Queensland) communities. Clinical histories were obtained through parent interviews and reviews of the medical records. Nasal cavity swab samples were obtained, and the children’s ears, nose, and throat were examined. DNA was extracted and analyzed by 16S rRNA amplicon next-generation sequencing of the V3/V4 region, in combination with previously generated culture data. A total of 103 children were recruited (mean age, 4.7 years); 17 (16.8%) were healthy, i.e., normal examination results and no history of OM. The nasal microbiota differed significantly in relation to OM status and nose health. Children with historical OM had greater relative abundance of Moraxella, compared to healthy children, despite both having healthy ears at the time of swabbing. Children with healthy noses had greater relative abundance of Staphylococcus aureus, compared to those with rhinorrhea. Dolosigranulum was correlated with Corynebacterium in healthy children. Haemophilus and Streptococcus were correlated across phenotypes. Ornithobacterium was absent or was present with low relative abundance in healthy children and clustered around otopathogens. It correlated with Helcococcus and Dichelobacter. Dolosigranulum and Corynebacterium form a synergism that promotes upper respiratory tract (URT)/ear health in Indigenous Australian children. Ornithobacterium likely represents “Candidatus Ornithobacterium hominis” and in this population is correlated with a novel bacterium that appears to be related to poor URT/ear health.IMPORTANCE Recurring and chronic infections of the ear (OM) are disproportionately prevalent in disadvantaged communities across the globe and, in particular, within Indigenous communities. Despite numerous intervention strategies, OM persists as a major health issue and is the leading cause of preventable hearing loss. In disadvantaged communities, this hearing loss is associated with negative educational and social development outcomes, and consequently, poorer employment prospects and increased contact with the justice system in adulthood. Thus, a better understanding of the microbial ecology is needed in order to identify new targets to treat, as well as to prevent the infections. This study used a powerful combination of 16S rRNA gene sequencing and extended culturomics to show that Dolosigranulum pigrum, a bacterium previously identified as a candidate protective species, may require cocolonization with Corynebacterium pseudodiphtheriticum in order to prevent OM. Additionally, emerging and potentially novel pathogens and bacteria were identified.