non-Indigenous Australian Children Research Articles

Optical Coherence Tomography-Derived Measurements of the Optic Nerve Head Structure of Aboriginal and Torres Strait Islander Children.

This study demonstrated significant differences in optic nerve head characteristics in Aboriginal and Torres Strait Islander children compared with non-Indigenous children, which has implications for glaucoma risk and diagnosis in Aboriginal and Torres Strait Islander populations. The purpose of this study was to examine the optic nerve head (ONH) characteristics of visually normal Aboriginal and Torres Strait Islander children and non-Indigenous Australian children. Spectral domain optical coherence tomography imaging was performed on the right eye of 95 Aboriginal and Torres Strait Islander children and 149 non-Indigenous Australian children (5-18 years). Horizontal and vertical line scans, centered on the ONH, were analyzed to determine the dimensions of the ONH (Bruch membrane opening diameter), optic cup diameter, Bruch membrane opening minimum rim width, and the peripapillary retinal nerve fiber layer thickness. The vertical but not horizontal Bruch membrane opening diameter of Aboriginal and Torres Strait Islander children was significantly larger than non-Indigenous children (mean difference: 0.09mm, P = 0.001). The horizontal (mean difference: 0.12mm, P = 0.003) and vertical cup diameter (mean difference: 0.16mm, P < 0.001) were also significantly larger in Aboriginal and Torres Strait Islander children, as were the horizontal and vertical cup-to-disc ratios (both P < 0.01). Aboriginal and Torres Strait Islander children also had a significantly thinner Bruch membrane opening minimum rim width in the superior, nasal, and temporal meridians (all P < 0.001). Peripapillary retinal nerve fiber layer thickness did not differ between groups. Differences exist in the ONH structure between Aboriginal and Torres Strait Islander children and non-Indigenous children, which may have implications for the detection and monitoring of ocular disease in this population and highlights the need to extend this research to the adult population.

Ocular biometry measures and their correlation with refractive error in Aboriginal and Torres Strait Islander children

ABSTRACT Clinical relevance The ocular biometry measures of the eye determine the refractive status, and while most refractive error develops during childhood, the ocular biometry measures of Aboriginal and Torres Strait Islander children have not previously been reported. Background To investigate the ocular biometry of Aboriginal and Torres Strait Islander children, including measures important in determining refractive error and those which relate to the risk of ocular disease. Methods Participants included 252 primary and secondary school children (Aboriginal and Torres Strait Islander: 101; non-Indigenous: 151), aged between 4 and 18 years. Habitual monocular distance visual acuity, cycloplegic autorefraction, and ocular optical biometry were measured in all participants and intraocular pressure measured in secondary school children using rebound tonometry. Results The mean (±SD) spherical equivalent refractive error of Aboriginal and Torres Strait Islander children was significantly less hyperopic than non-Indigenous children (Aboriginal and Torres Strait Islander: +0.52 ± 0.80 D; non-Indigenous: +0.86 D ±0.58 D; p < 0.001). There were no differences in axial length or axial length/corneal radius ratio between the two groups, however the mean lens power of Aboriginal and Torres Strait Islander children was significantly greater than that of non-Indigenous children (Aboriginal and Torres Strait Islander: 23.62 D; non-Indigenous: 22.51 D; p < 0.001). Aboriginal and Torres Strait Islander children had a thinner central corneal thickness (Aboriginal and Torres Strait Islander: 534 ± 37 µm; non-Indigenous: 543 ± 35 µm; p = 0.04), and lower intraocular pressure compared with non-Indigenous children (Aboriginal and Torres Strait Islander: 14.7 ± 3.8 mmHg; non-Indigenous: 16.0 ± 3.7; p = 0.02). Conclusion Differences exist in the refractive error, lens power, central corneal thickness, and intraocular pressure of Aboriginal and Torres Strait Islander children compared to non-Indigenous Australian children which have potential implications for the development of refractive error and ocular disease later in life.

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.

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.

Narrative comprehension skills of Indigenous and non-Indigenous Australian children in their first year of school

Purpose: The suitability of existing speech-language pathology assessments for Australian Aboriginal and Torres Strait Islander (Indigenous) children is questioned in the literature. There is emerging evidence that the differences reported between Indigenous and non-Indigenous Australian children on standardised assessment are diminished on more naturalistic assessments such as narrative production (macrostructure and microstructure). Little is documented, however, about the narrative comprehension skills of Australian children. This study explores the narrative comprehension skills of 40 typically developing Indigenous and non-Indigenous Australian children in their first year of school. Method: A cross-sectional comparative research design was used. Three non-standardised narrative assessments incorporating comprehension-production protocols were administered. Question responses were scored for accuracy and categorised according to story grammar targeted and inference (literal vs. non-literal). In addition, all participants completed the Peabody Picture Vocabulary Test fourth edition (PPVT-4). Result: A repeated-measures ANOVA was used to compare response accuracy to comprehension questions between cultural groups and across narrative protocols. While there was a significant difference in PPVT-4 scores, no significant differences were identified between response accuracy for the Indigenous and non-Indigenous children. Furthermore, response accuracy to comprehension questions was correlated with PPVT-4 scores for the non-Indigenous children only. Conclusion: Findings support the use of naturalistic assessment strategies such as narrative comprehension with Indigenous Australian children.

Footprints in Time: Physical Activity Levels and Sociodemographic and Movement-Related Associations Within the Longitudinal Study of Indigenous Children.

Emerging evidence suggests that Indigenous children have higher physical activity levels that non-Indigenous children, yet little is known of the factors that influence these levels or how they may be optimized. This study examines correlates of achieving ≥1hour/day of physical activity among Indigenous Australian children aged 8-13years. Data were collected through parental self-report in the Longitudinal Study of Indigenous Children. Proportions of children achieving ≥1hour/day physical activity, approximating the Australian aerobic physical activity recommendations, were calculated, and associations with sociodemographic, family composition, and movement-related factors were quantified using multiple logistic regression analyses. Half of the 1233 children achieved ≥1hour/day physical activity. Children from families with low parental education and unemployment, remote residence, low socioeconomic status, and without a father in the household were more likely to meet the recommendations. Achieving ≥1hour/day of physical activity was also associated with low levels of playing electronic games and total screen time. Sociodemographic correlates of physical activity among Indigenous Australian children run counter to those typically found in non-Indigenous Australian children. Further longitudinal examination of the predictors of these associations would provide a greater understanding of Indigenous physical activity determinants, to inform strategies to facilitate participation.

Response of Salivary Microbiota to Caries Preventive Treatment in Aboriginal and Torres Strait Islander Children

ABSTRACT A once-annual caries preventive (Intervention) treatment was offered to Aboriginal and Torres Strait Islander schoolchildren—a population with disproportionately poorer oral health than non-Indigenous Australian children—in the Northern Peninsula Area (NPA) of Far North Queensland (FNQ), which significantly improved their oral health. Here, we examine the salivary microbiota of these children (mean age = 10 ± 2.96 years; n = 103), reconstructing the bacterial community composition with high-throughput sequencing of the V4 region of bacterial 16S rRNA gene. Microbial communities of children who received the Intervention had lower taxonomic diversity than those who did not receive treatment (Shannon, p < 0.05). Moreover, the Intervention resulted in further decreased microbial diversity in children with active carious lesions existing at the time of saliva collection. Microbial species associated with caries were detected; Lactobacillus salivarius, Lactobacillus reuteri, Lactobacillus gasseri, Prevotella multisaccharivorax, Parascardovia denticolens, and Mitsuokella HMT 131 were significantly increased (p < 0.05) in children with severe caries, especially in children who did not receive the Intervention. These insights into microbial associations and community differences prompt future considerations to the mechanisms behind caries-preventive therapy induced change; important for understanding the long-term implications of like treatment to improve oral health disparities within Australia. Trial registration: ANZCTR, ACTRN12615000693527. Registered 3 July 2015, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368750&isReview=true

Role of maternal age at birth in child development among Indigenous and non-Indigenous Australian children in their first school year: a population-based cohort study

Indigenous Australian children are twice as likely to score poorly on developmental outcomes at age 5 years than their non-Indigenous peers. Indigenous children are also more likely to be born to younger mothers. We aimed to quantify the relationship between maternal age at childbirth and early childhood development outcomes in Indigenous and non-Indigenous children. In this population-based, retrospective cohort study, we used data from the Australian Early Development Census (AEDC) that were probabilistically linked by the New South Wales (NSW) Centre for Health Record Linkage to several NSW administrative datasets, including the Perinatal Data Collection, the Register of Births, Deaths and Marriages (for birth registrations), the Admitted Patient Data Collection, and public school enrolment records, as part of the Seeding Success study. The resulting data resource comprises a cohort of 166 278 children born in NSW whose first year of school was reported in a 2009 or 2012 AEDC record (which were the years of AEDC data available at the time of data linkage). The primary outcome was the aggregate outcome of developmental vulnerability (scores in the bottom decile, according to the 2009 benchmark, on one or more of the five AEDC domains, which include physical, social, emotional, language and cognitive, and communication development). This outcome was measured in singleton children without special needs recorded on the AEDC, in those with available developmental data. As a secondary outcome analysis, we also repeated the main analyses on the outcome of developmental vulnerability on the individual domains. We estimated the absolute risk of developmental vulnerability by maternal age in Indigenous and non-Indigenous populations, and we also estimated the risk difference and relative risk between Indigenous and non-Indigenous children by use of modified Poisson regression. Of 166 278 children in the cohort, 107 666 (64·8%) children were enrolled in a public school in NSW in 2009 or 2012, of whom 7994 (7·4%) children were Indigenous (ie, they, or either parent, were recorded as Aboriginal or Torres Strait Islander on one or more birth records) and 99 672 (92·6%) children were not Indigenous. After exclusions, the final study population included 99 530 children (7206 [7·2%] Indigenous and 92 324 [92·8%] non-Indigenous). Of those for whom developmental outcome data were available, 2581 (35·9%) of 7180 Indigenous children and 18 071 (19·7%) of 91 835 non-Indigenous children were developmentally vulnerable on one domain or more. The risk of developmental vulnerability decreased with maternal ages between 15 and 39 years, but the decrease in risk with maternal age was significantly steeper in non-Indigenous than Indigenous children. Developmental vulnerability is most common in Indigenous and non-Indigenous children born to young mothers; however, Indigenous children have an increased risk of this outcome across most of the maternal age range. Policies that improve the socioeconomic circumstances of Indigenous children and families could promote better developmental outcomes among Indigenous children. Culturally appropriate support for Indigenous children, including those born to young mothers and disadvantaged families, could also reduce early childhood developmental inequalities. The Australian National Health and Medical Research Council, Manitoba Centre for Health Policy.

Story-telling abilities of young Indigenous and non-Indigenous Australian children across three protocols

Purpose: Little is documented about the story-telling skills of Indigenous Australian children. Therefore, this study explores the complexity of stories produced by Indigenous and non-Indigenous Australian children in their first year of school.Method: An observational design allowed comparison across cultural groups and story protocols. Three stories were elicited from 49 Indigenous and non-Indigenous children aged 4;10 to 6;5. Stories were analysed using the Index of Narrative Complexity (INC) to generate scores for each story element. Story elements were further categorised and evaluated for level of use across participants. Story protocol and cultural group effects were explored using ANOVA.Result: Participant stories featured high use of characters, initiating events, attempts, and consequences; and little use of internal plans, formulaic markers, causal adverbial markers and evaluations. Story complexity scores did not differ between the Indigenous and non-Indigenous children, but significant differences were evident among the three, story protocols.Conclusion: Findings suggest that story elicitation protocols and analysis methods used in this study may be appropriate for use with both Indigenous and non-Indigenous children from urban contexts. However, caution is needed when making diagnostic decisions based on story complexity without well-developed, culturally appropriate protocols and normative data.

Association of Modifiable Risk Factors With Dental Caries Among Indigenous and Nonindigenous Children in Australia

Although the prevalence of untreated dental caries among Indigenous Australian children greatly exceeds the prevalence observed among non-Indigenous children, the associations of dental caries with risk factors is considered to be the same. To estimate the association of modifiable risk factors with area-based inequalities in untreated dental caries among Indigenous and non-Indigenous Australian children using decomposition analysis. Cross-sectional study using data from Australia's National Child Oral Health Study 2012-2014, a nationally representative sample of both Indigenous and non-Indigenous children aged 5 to 14 years. Data analyses were completed in November 2018. Outcomes were the mean number of decayed tooth surfaces in the primary dentition for children aged 5 to 10 years and mean number of decayed tooth surfaces in the permanent dentition for children aged 8 to 14 years. The area-based measure was the school-based Index of Community Socio-Educational Advantage, with individual-level variables including sex, equivalized household income, tooth-brushing frequency, sugar-sweetened beverage (SSB) consumption, time from last dental visit, and residing in an area with water fluoridation. There were 720 Indigenous children aged 5 to 10 years, 14 769 non-Indigenous children aged 5 to 10 years, 738 Indigenous children aged 8 to 14 years, and 15 631 non-Indigenous children aged 8 to 14 years. For area-based inequalities in primary dentition among Indigenous children, two-thirds of the contribution was associated with SSB consumption (65.9%; 95% CI, 65.5%-66.3%), followed by irregular tooth brushing (15.0%; 95% CI, 14.6%-15.5%) and low household income (14.5%; 95% CI, 14.1%-14.8%). Among non-Indigenous children, almost half the contribution was associated with low household income (47.6%; 95% CI, 47.6%-47.7%), followed by SSB consumption (31.0%; 95% CI, 30.9%-31.0%) and residing in an area with nonfluoridated water (9.5%; 95% CI, 9.5%-9.6%). For area-based inequalities in permanent dentition among Indigenous children, 40.0% (95% CI, 39.9%-40.1%) of the contribution was associated with residing in an area with nonfluoridated water, followed by low household income (20.0%; 95% CI, 19.7%-20.0%) and consumption of SSBs (20.0%; 95% CI, 19.9%-20.1%). Among non-Indigenous children, the contribution associated with low household income, SSB consumption, and last dental visit more than a year ago were each 28.6%. The association of modifiable risk factors with area-based inequalities in untreated dental caries among Indigenous and non-Indigenous Australian children differed substantially. Targets to reduce SSB consumption may reduce oral health inequalities for both groups; however, Indigenous children require additional focus on oral hygiene.

Influence of maternal adiposity, preterm birth and birth weight centiles on early childhood obesity in an Indigenous Australian pregnancy-through-to-early-childhood cohort study.

Childhood obesity rates are higher among Indigenous compared with non-Indigenous Australian children. It has been hypothesized that early-life influences beginning with the intrauterine environment predict the development of obesity in the offspring. The aim of this paper was to assess, in 227 mother-child dyads from the Gomeroi gaaynggal cohort, associations between prematurity, Gestation Related-Optimal Weight (GROW) centiles, maternal adiposity (percentage body fat, visceral fat area), maternal non-fasting plasma glucose levels (measured at mean gestational age of 23.1 weeks) and offspring BMI and adiposity (abdominal circumference, subscapular skinfold thickness) in early childhood (mean age 23.4 months). Maternal non-fasting plasma glucose concentrations were positively associated with infant birth weight (P=0.005) and GROW customized birth weight centiles (P=0.008). There was a significant association between maternal percentage body fat (P=0.02) and visceral fat area (P=0.00) with infant body weight in early childhood. Body mass index (BMI) in early childhood was significantly higher in offspring born preterm compared with those born at term (P=0.03). GROW customized birth weight centiles was significantly associated with body weight (P=0.01), BMI (P=0.007) and abdominal circumference (P=0.039) at early childhood. Our findings suggest that being born preterm, large for gestational age or exposed to an obesogenic intrauterine environment and higher maternal non-fasting plasma glucose concentrations are associated with increased obesity risk in early childhood. Future strategies should aim to reduce the prevalence of overweight/obesity in women of child-bearing age and emphasize the importance of optimal glycemia during pregnancy, particularly in Indigenous women.

Language abilities of Indigenous and non-Indigenous Australian children from low socioeconomic backgrounds in their first year of school

Purpose: Concern exists about the cross-cultural appropriateness of existing language assessments for non-mainstream populations, including Indigenous children who may speak a non-standard dialect of the mainstream language. This study therefore aims to investigate the language skills of Indigenous Australian children in comparison with non-Indigenous children, with a view to exploring the cultural appropriateness of language sampling assessment methods.Method: The performance of 51 typically developing Indigenous and non-Indigenous Australian children was compared on a standardised assessment and a spoken narrative protocol using language sample analysis measures. All children were in their first year of school and from the same regional city.Result: While the Indigenous children attained significantly lower receptive vocabulary scores than the non-Indigenous children, most language sampling measures from the spoken narrative protocol were similar across the two groups of children.Conclusion: Flexible, naturalistic language sampling approaches using a spoken narrative protocol are thus recommended for Indigenous children from the under-researched Australian context. However, normative data for language sampling are lacking, and further research is needed to explore the cultural validity of assessment and diagnostic procedures for Indigenous Australian children, as well as the influence of socioeconomic and family factors on language skills.

Children's Environmental Health Indicators in Australia

BackgroundAdverse environmental exposures in early life increase the risk of chronic disease but do not attract the attention nor receive the public health priority warranted. A safe and healthy environment is essential for children's health and development, yet absent in many countries. A framework that aids in understanding the link between environmental exposures and adverse health outcomes are environmental health indicators—numerical estimates of hazards and outcomes that can be applied at a population level. The World Health Organization (WHO) has developed a set of children's environmental health indicators (CEHI) for physical injuries, insect-borne disease, diarrheal diseases, perinatal diseases, and respiratory diseases; however, uptake of steps necessary to apply these indicators across the WHO regions has been incomplete. A first indication of such uptake is the management of data required to measure CEHI. ObjectivesThe present study was undertaken to determine whether Australia has accurate up-to-date, publicly available, and readily accessible data on each CEHI for indigenous and nonindigenous Australian children. FindingsData were not readily accessible for many of the exposure indicators, and much of the available data were not child specific or were only available for Australia’s indigenous population. Readily accessible data were available for all but one of the outcome indicators and generally for both indigenous and nonindigenous children. Although Australia regularly collects data on key national indicators of child health, development, and well-being in several domains mostly thought to be of more relevance to Australians and Australian policy makers, these differ substantially from the WHO CEHI. ConclusionsThe present study suggests that the majority of these WHO exposure and outcome indicators are relevant and important for monitoring Australian children’s environmental health and establishing public health interventions at a local and national level and collection of appropriate data would inform public health policy in Australia.

The effectiveness of school-based family asthma educational programs on the quality of life and number of asthma exacerbations of children aged five to 18 years diagnosed with asthma: a systematic review protocol.

REVIEW QUESTION / OBJECTIVE The objective of this review is to identify the best available quantitative evidence related to the effectiveness of school-based family asthma educational programs on the quality of life and number of asthma exacerbations of children aged five to18 years with a diagnosis of asthma. INCLUSION CRITERIA Types of participants This review will consider studies that include children, five to 18 years of age, of any gender, race, or ethnicity with a clinical diagnosis of asthma, who has participated in school-based asthma education programs that include their caregivers. Studies that include children younger than age five and older than age 18, with respiratory diseases other than asthma, who have not participated in school-based asthma education programs that include their caregivers will be excluded. Types of intervention(s) This review will consider studies that evaluate the effectiveness of school-based family asthma education interventions on the quality of life and number of asthma exacerbations of children with asthma compared to absence of school-based family asthma education programs. Types of outcomes This review will consider studies that include the following outcome measures: primary outcomes of quality of life and asthma exacerbations, and secondary outcomes of absences from school or work, physical activity intolerance, and emergency hospital visits as a result of asthma exacerbations. Quality of life can be measured by a valid and reliable tool such as the Pediatric Asthma Quality of Life Questionnaire. The number of asthma exacerbations can be measured by valid and reliable tools such as the TRUNCATED AT 250 WORDS

Prevalence and risk factors for parent-reported recurrent otitis media during early childhood in the Western Australian Pregnancy Cohort (Raine) Study.

To describe the prevalence and risk factors of recurrent otitis media (rOM) in an urban Australian population at 3 years of age. Cross-sectional examination of prevalence and risk factors of rOM in 2280 participants from the Raine Study enrolled from public and private hospitals in Perth, Western Australia, between 1989 and 1991. Parental report questionnaires at 3 years of age were used for rOM identification, with secondary confirmation by otoscopic examination at 1, 2 or 3 years of age. The prevalence of parent-reported rOM was 26.8% (611/2280) and 5.5% (125/2280) for severe rOM in the Study. Independent associations were found between rOM and the presence of older siblings, attendance at day care and the introduction of other milk products at ≤4 months of age. Independent associations for severe rOM were the presence of allergies and attendance at day care. Prevalence rates of rOM within the Raine Study children are similar to a number of other known cohorts. Parity, presence of allergies, attendance at day care and introduction of other milk products at ≤4 months are highlighted as specific risk factors for rOM in this population and presence of allergies and attendance at day care being risk factors for severe rOM. Diagnosis of rOM by parent report and the delay between data collection and reporting are limitations of this study. However, as there is very limited data on OM in urban, non-Indigenous Australian children, this study improves our understanding of OM for this group.

Contact with the juvenile justice system in children treated with stimulant medication for attention deficit hyperactivity disorder: a population study

Attention deficit hyperactivity disorder (ADHD) is the most frequent neurodevelopmental disorder in children and is sometimes noted retrospectively in young people and adults who are incarcerated. We aimed to investigate juvenile justice encounters in children with and without ADHD. Between January, 1995, and December, 2010, we did a population-based cohort study in Western Australia. Anonymised linked population data were obtained from the Western Australia Midwives Notification System. 12 831 non-Indigenous Australian children and young people aged 10-21 years, who were diagnosed and treated with stimulant drugs for ADHD and had a record in the Monitoring Drugs of Dependence System (ADHD cohort), were identified and frequency-matched by age, sex, and socioeconomic status to 29 722 non-Indigenous Australian children and young people who had no record in the Monitoring Drugs of Dependence System (controls). Community correction records and incarceration records were retrieved for all participants from Total Offending Management Solutions. Our primary outcome was to compare justice outcomes between children with ADHD and those without this disorder. We compared cohorts by conditional logistic regression analysis. 9939 boys and 2892 girls were diagnosed and treated for ADHD; 22 875 boys and 6847 girls were frequency-matched controls. 792 (8%) boys and 75 (3%) girls with ADHD had a community correction record, compared with 822 (4%) boys and 75 (1%) girls without ADHD. 132 (1%) boys and 11 (<1%) girls with ADHD had an incarceration record, compared with 108 (<1%) boys and five (<1%) girls without ADHD. Compared with controls, boys with ADHD were two and half times more likely to have a community correction record (odds ratio 2·48, 95% CI 2·22-2·76) or an incarceration record (2·63, 2·01-3·44). Compared with their non-ADHD counterparts, girls with ADHD were nearly three times more likely to have a community correction record (odds ratio 2·86, 95% CI 2·03-4·03) and seven times more likely to have an incarceration record (7·27, 2·29-23·08). Boys with ADHD received their first community correction record at a younger age compared with controls (15·9 vs 16·3 years; p=0·0005), but age at first community correction record was similar for girls (16·5 vs 16·4 years; p=0·87). Burglaries and breaking and entering were the most common reason for a first justice record (total 659 [37%]), and this offence was twice as likely in children with ADHD (for boys, odds ratio 2·24, 95% CI 1·90-2·64; for girls, 2·19, 1·40-3·42). Justice outcomes for boys and girls were more frequent among children and young people treated for ADHD compared with their non-ADHD counterparts. Unlike girls, boys were more likely to offend at a younger age. Early diagnosis and management of children and young people with ADHD might reduce the over-representation of children with this disorder within the juvenile justice system. National Health and Medical Research Council (Australia), Australian Research Council.

Has a National Policy Focus on Early Childhood Made a Difference for Indigenous Children? An Analysis of LSAC Data

Abstract The Australian policy environment has undergone significant changes with a move towards evidence-based policy development. It is in this climate that the Longitudinal Study of Australian Children (LSAC) began collecting data. The study began in 2003 with 2 cohorts of children (birth-1 year and 4–5 years) and the 5th wave of data collection occurred in 2011/12. In this analysis we use the data from the first wave of data (collected in the 6 months between August 2003 and March 2004) and the third wave, collected in the 9 months between July 2007 and April 2008. This latter was a time when a range of initiatives addressing Indigenous disadvantage through early childhood interventions had been in operation for some time: both early childhood and Indigenous policy was strongly focused on the quality of early childhood service provision, with a strong focus on evidence-based service development. In this paper we present a comparison of outcomes for Indigenous and non-indigenous Australian children who have grown up in these 2 different policy eras.

Cancer survival in Indigenous and non-Indigenous Australian children: what is the difference?

This study assessed variation in childhood cancer survival by Indigenous status in Australia, and explored the effect of place of residence and socio-economic disadvantage on survival. All children diagnosed with cancer during 1997-2007 were identified through the Australian Pediatric Cancer Registry. Cox regression analysis was used to assess the adjusted differences in survival. Overall, 5-years survival was 75.0 % for Indigenous children (n = 196) and 82.3 % for non-Indigenous children (n = 6,376, p = 0.008). Compared to other children, Indigenous cases had 1.36 times the risk of dying within 5 years of diagnosis after adjustments for rurality of residence, socio-economic disadvantage, cancer diagnostic group, and year of diagnosis (95 % CI 1.01-1.82). No significant survival differential was found for leukemias or tumors of the central nervous system; Indigenous children were 1.83 times more likely (95 % CI 1.22-2.74) than other children to die within 5 years from 'other tumors' (e.g., lymphomas, neuroblastoma). Among children who lived in 'remote/very remote/outer regional' areas, and among children with a subgroup of 'other tumors' that were staged, being Indigenous significantly increased the likelihood of death (HR = 1.69, 95 % CI 1.10-2.59 and HR = 2.99, 95 % CI 1.35-6.62, respectively); no significant differences by Indigenous status were seen among children with stage data missing. Differences in place of residence, socio-economic disadvantage, and cancer diagnostic group only partially explain the survival disadvantage of Indigenous children. Other reasons underlying the disparities in childhood cancer outcomes by Indigenous status are yet to be determined, but may involve factors such as differences in treatment.

A National Prospective Surveillance Study of Acute Rheumatic Fever in Australian Children

Acute rheumatic fever (ARF) is an important cause of heart disease in Indigenous people of northern and central Australia. However, little is known about ARF in children across all Australian population groups. This national prospective study was conducted to determine patterns of disease, and populations and regions at highest risk. The Australian Paediatric Surveillance Unit surveillance model was used to collect data on children with ARF across Australia. Children up to 15 years of age were included if they had an ARF episode diagnosed between October 1, 2007 and December 31, 2010 that met the case definition. ARF was identified in 151 children: 131 Indigenous Australians, 10 non-Indigenous Australians, 8 Pacific Islanders and 1 African (1 unknown). Common presenting features were joint symptoms, fever and carditis. Sydenham chorea was reported in 19% of children. Aseptic monoarthritis was a major manifestation in 19% of high-risk children. Seven non-Indigenous Australian children presented with classic, highly specific features compared with 23% of high-risk children, suggesting that subtle presentations of ARF are being missed in non-Indigenous children. Recent sore throat was reported in 33% of cases, including 25% of remote Indigenous children. There were delays in presentation to care and referral to higher-level care across urban/rural and remote areas. ARF may be more common than previously thought among low-risk children. These data should prompt an awareness of ARF diagnosis and management across all regions, including strategies for primary prevention. There should be renewed emphasis on treatment of sore throat in high-risk groups.