Near-vision impairment and unresolved vision problems in Indigenous Australian adults.

BACKGROUND: To describe near-vision impairment, self-reported unresolved vision problems and barriers to having near-vision correction in Indigenous Australians. DESIGN: A nationwide population-based study designed to determine the causes and prevalence of vision loss and utilization of eye care services. PARTICIPANTS: Indigenous Australians aged ≥40 years. METHODS: Using a multistage random cluster sampling methodology, 30 geographical areas stratified by remoteness were selected to obtain a representation of Indigenous Australians. Visual acuity was conducted using a standard E chart. A questionnaire collected data on eye health, eye care service utilization and vision-related quality of life. MAIN OUTCOME MEASURES: Near-vision impairment defined as presenting binocular near visual acuity

A foodborne outbreak of campylobacteriosis at a wedding - Melbourne, Australia, 2022.

Campylobacter is the most common bacterial cause of foodborne gastroenteritis in Australia; however, outbreaks caused by the pathogen are relatively uncommon. In March 2022, the Victorian Department of Health was notified of a gastrointestinal illness in 20 guests following attendance at a wedding reception. Two of these individuals were notified with laboratory-confirmed campylobacteriosis, and an investigation was undertaken to identify the source of the infection and implement strategies to prevent further illness. A case-control study was conducted to determine the likely source of infection. Cases were defined as attendees of the wedding reception, with onset of diarrhoea and/or abdominal cramping 1-10 days after attending the function. Controls were randomly selected from the remaining list of non-ill guests. Cases and controls were interviewed using a standardised, menu-based questionnaire. Food preparation processes were documented, and food samples collected. A total of 29 wedding guests met the case definition. Cases reported onset of illness 2-5 days following the wedding and major symptoms included abdominal cramping (100%), diarrhoea (90%), headache (79%), and fever (62%). Two cases were hospitalised, one with ongoing secondary neurological sequelae. Illness was significantly associated with consumption of a duck breast brioche canapé containing duck liver parfait (odds ratio = 2.85; 95% confidence interval: 1.03-7.86). No leftover food samples were available for testing. The investigation found that the duck canapé was the likely vehicle of infection. Consistent with the literature on Campylobacter transmission, it is likely that inadequate cooking of the duck liver for the parfait was the contributing factor that led to illness. This highlights the risks posed by undercooked poultry dishes, and shows that education of food handlers remains a priority.

The impact of the 21 November 2016 epidemic thunderstorm asthma event on general practice clinics in metropolitan Melbourne, Australia.

BACKGROUND AND OBJECTIVES: On 21 November 2016, parts of Victoria experienced a devastating epidemic thunderstorm asthma (ETSA) event. The aim of this study was to describe the epidemiology and burden of the 2016 ETSA event at MedicineInsight-registered general practices in the Melbourne metropolitan area in Victoria, Australia. METHOD: A cross-sectional study was conducted using patient record data from 21-23 November 2016. Codes were developed to identify all patients presenting to MedicineInsight-registered general practices with asthma during the 2016 ETSA event. RESULTS: During the event, there were 787 more asthma-related encounters to MedicineInsight general practices than expected, which represented a 7.1-fold increase (605% increase). Estimates suggest that there were between approximately 8940 and 13,689 more asthma-related encounters than expected across metropolitan Melbourne. DISCUSSION: General practices were significantly affected by the 2016 ETSA event. This work highlights the important part that general practices play in responding to ETSA events and the need for these practices to be prepared to respond.

Eye health service access and utilization in the National Indigenous Eye Health Survey.

BACKGROUND: To determine access to and utilization of eye health services for indigenous Australians. DESIGN: A national, stratified, random cluster sample was drawn from 30 communities across Australia that each included about 300 indigenous people. PARTICIPANTS: A total of 1189 indigenous adults aged 40 and above were examined, representing 79% of the target population. METHODS: Eye health services data including nature and availability of facilities and workforce supply were collected for comparison with eye health prevalence data. The data were collected in 2008. MAIN OUTCOME MEASURES: Low vision prevalence and coverage rate for distance refractive correction. RESULTS: The full-time equivalent availability of an optometrist working in an Aboriginal Medical Service was significantly associated with both a decrease in the prevalence of low vision (t = -2.41, P = 0.02) and an increase in the coverage rate for distance refractive correction (t = 2.99, P = 0.006). These associations were not replicated when comparing availability of private or hospital-based optometry in each community. Regional eye health coordinators appeared to provide an improved utilization of Aboriginal Health Services and therefore improved access to Aboriginal medical service optometry. CONCLUSIONS: Eye health services for indigenous Australians need to be provided in culturally appropriate facilities with clear links to the indigenous community to optimize access to care and reduce the prevalence of vision impairment. The adequate provision of accessible eye care services is an important component in 'closing the gap' in vision loss for indigenous Australians.

Prevalence of self-reported diabetes and diabetic retinopathy in indigenous Australians: the National Indigenous Eye Health Survey.

BACKGROUND: To assess the prevalence of diabetes and diabetic retinopathy in indigenous Australians aged ≥40 years. DESIGN: The National Indigenous Eye Health Survey used a stratified, multistage cluster probability sampling frame to provide a representative sample of the indigenous Australian population. PARTICIPANTS: One thousand one hundred and eighty-nine eligible indigenous adults were examined using standardized procedures. METHODS: Each participant underwent a comprehensive eye examination included presenting and best corrected visual acuity, visual field, fundus and lens photography. MAIN OUTCOME MEASURES: Diabetic retinopathy. RESULTS: The prevalence of diabetes in the 1189 eligible indigenous adults was 37.3% (95% confidence interval: 34.6-40.2%). The prevalence of diabetic retinopathy among 394 people with diabetes was 29.7% (95% confidence interval: 25.2-34.2%), and 17.8% (95% confidence interval: 14.0-21.6%), 8.9% (95% confidence interval: 6.1-11.7%) and 3.1% (95% confidence interval: 1.3-4.7%) for mild or moderate diabetic retinopathy, clinically significant macular oedema and severe or proliferative diabetic retinopathy, respectively. Diabetic retinopathy was presented in 6.3% in those who did not report diabetes. The risk of diabetic retinopathy increased with duration of diabetes (the adjusted odds ratios were 3.4 for 10-19 years, 6.1 for 20-29 years and 25.8 for ≥30 years). CONCLUSIONS: The prevalence of self-reported diabetes in indigenous Australians is more than eight times higher than that in non-indigenous Australians. The prevalence of diabetic retinopathy in people with diabetes is similar to that of non-indigenous Australians.

Self-reported vision and health of indigenous Australians.

PURPOSE: To describe the self-reported vision, history of eye disease and general health of indigenous Australian participants in the National Indigenous Eye Health Survey. METHODS: Using a multistage cluster sampling methodology, 30 geographic areas, stratified by remoteness, were selected to provide a representative population of indigenous Australians aged 5-15 years and 40 years and over. Before an eye examination, participants completed a questionnaire about their eye health and eye care facilities consulted, satisfaction with their vision and general health. RESULTS: A total of 1694 indigenous children (49.2% female, mean age 9.5 ± 2.9 years) and 1189 adults (61.0% female, mean age 53.1 ± 9.7 years) participated. Three-quarters of adults (259/342) and 88.4% of children (129/146) wore the right distance glasses. Adults from remote areas were less likely to have refractive error (P = 0.002) as well as males versus females (P = 0.02). Similar results were found for children. Adults wearing appropriate distance glasses were as satisfied with their vision as people with normal vision who did not need glasses (P = 0.6). Both groups were more satisfied with their distance vision than people with poor presenting vision (P = 0.007). Self-report of cataract, diabetic retinopathy, glaucoma and age-related macular degeneration did not match with clinical findings (P < 0.001). Over 37% of adults (417/1187) and 1.3% of children (22/1691) reported having diabetes. CONCLUSION: The National Indigenous Eye Health Survey provided information to guide future planning of eye health prevention strategies for indigenous Australians. Findings indicate the importance of correcting refractive error to improve quality of life. Prevention messages should be renewed in appropriate sociocultural formats.

Cataract in indigenous Australians: the National Indigenous Eye Health Survey.

BACKGROUND: To determine the prevalence of vision loss due to cataract in indigenous Australians. METHODS: A national, stratified, random cluster sample was selected in 30 communities across Australia. Data collection was undertaken in 2008. Adults 40 years and older were examined using a standardized protocol that included a questionnaire. The presence of visually significant cataract was assessed. RESULTS: Response rates were good and 1189 indigenous adults were examined and overall recruitment was 72%. Low vision (<6/12-6/60) due to cataract occurred in 2.52% (1.63-3.41%) and blindness (<6/60) in 0.59% (95% CI: 0.24-1.21%). The cataract coverage rate (proportion of those with visually significant cataract who had been operated on) was 65.3% (95% CI: 55.0-74.6%). Projections suggest that there are 3234 indigenous adults with vision loss from cataract. CONCLUSIONS: Cataract remains a major cause of vision loss in Aboriginal and Torres Strait Islander peoples. There were no significant regional or state differences in the prevalence of cataract or of cataract surgical coverage, which suggests that increased cataract surgery services are required across the country to address cataract in indigenous Australians.

Are convergence lines associated with high asthma presentation days? A case-control study in Melbourne, Australia.

BACKGROUND: In epidemic thunderstorm asthma (ETSA) events a large number of people develop asthma symptoms over a short period of time. This is thought to occur because of a unique combination of high amounts of pollen and certain meteorological conditions. However, the exact cause and mechanism of epidemic thunderstorm asthma remains unclear. OBJECTIVES: The objective of this study was to test the hypothesis that convergence lines may be a causative factor in ETSA events, by investigating whether convergence line weather events are associated with the occurrence of high asthma presentations days during the Victorian grass pollen season (October-December). METHODS: A case control method was used. All public hospitals within 75 km of the Melbourne weather radar were included, and data were taken from 2009 to 2017 during the Victorian grass pollen season. Cases hospital days were hospitals with a high number of asthma presentations within a 24-h period, and controls were hospitals with an expected number of asthma presentations. Exposure was defined as geographical proximity of a convergence line to the hospital case or control. RESULTS: Eighty-one case hospital days and 157 hospital day controls were included in the study. The odds of exposure to a convergence line were significantly higher for cases than for controls at all exposure distances. At 4 km, 80 of the 81 cases had been exposed to a convergence line. CONCLUSION: Convergence lines appear to be a necessary, but not sufficient, element in the cause of epidemic thunderstorm asthma. This is the first study to show a clear link between epidemic thunderstorm asthma and convergence lines.

The forecasting of dynamical Ross River virus outbreaks: Victoria, Australia.

Ross River virus (RRV) is Australia's most epidemiologically important mosquito-borne disease. During RRV epidemics in the State of Victoria (such as 2010/11 and 2016/17) notifications can account for up to 30% of national RRV notifications. However, little is known about factors which can forecast RRV transmission in Victoria. We aimed to understand factors associated with RRV transmission in epidemiologically important regions of Victoria and establish an early warning forecast system. We developed negative binomial regression models to forecast human RRV notifications across 11 Local Government Areas (LGAs) using climatic, environmental, and oceanographic variables. Data were collected from July 2008 to June 2018. Data from July 2008 to June 2012 were used as a training data set, while July 2012 to June 2018 were used as a testing data set. Evapotranspiration and precipitation were found to be common factors for forecasting RRV notifications across sites. Several site-specific factors were also important in forecasting RRV notifications which varied between LGA. From the 11 LGAs examined, nine experienced an outbreak in 2011/12 of which the models for these sites were a good fit. All 11 LGAs experienced an outbreak in 2016/17, however only six LGAs could predict the outbreak using the same model. We document similarities and differences in factors useful for forecasting RRV notifications across Victoria and demonstrate that readily available and inexpensive climate and environmental data can be used to predict epidemic periods in some areas. Furthermore, we highlight in certain regions the complexity of RRV transmission where additional epidemiological information is needed to accurately predict RRV activity. Our findings have been applied to produce a Ross River virus Outbreak Surveillance System (ROSS) to aid in public health decision making in Victoria.

A Qualitative Evaluation of a Decision Support System for District-Level Disease Surveillance in Sierra Leone.

A decision support system for district-level disease surveillance was piloted with the Port Loko District Health Management Team in Sierra Leone. Through a qualitative evaluation, the study explores the impact of the system on disease surveillance workflows. Results indicate that the system aided decision making for operational tasks, and reduced the time taken to analyze and report surveillance data. In addition, the study discusses the challenges of deploying a pilot system during the Ebola recovery in Sierra Leone, and proposes a high-level architecture for a modular, interoperable decision support system for disease surveillance for public health decision makers in low-resource health systems.

Design and evaluation of a web-based decision support tool for district-level disease surveillance in a low-resource setting.

During the 2014 West African Ebola Virus outbreak it became apparent that the initial response to the outbreak was hampered by limitations in the collection, aggregation, analysis and use of data for intervention planning. As part of the post-Ebola recovery phase, IBM Research Africa partnered with the Port Loko District Health Management Team (DHMT) in Sierra Leone and GOAL Global, to design, implement and deploy a web-based decision support tool for district-level disease surveillance. This paper discusses the design process and the functionality of the first version of the system. The paper presents evaluation results prior to a pilot deployment and identifies features for future iterations. A qualitative assessment of the tool prior to pilot deployment indicates that it improves the timeliness and ease of using data for making decisions at the DHMT level.

The Impact of Knowledge and Attitudes on Access to Eye-Care Services in Cambodia.

PURPOSE: To investigate how knowledge and attitudes influence the access to eye-care services in Takeo Province, Cambodia. DESIGN: A cross-sectional survey (n=600). METHODS: 30 villages were randomly selected. Groups included: >50 years, 30-49 years, and parents with children <5 years. A newly developed Knowledge, Attitude and Practice in Eye Health (KAP-EH) questionnaire about knowledge and treatment of eye diseases, practices and attitudes to accessing services was used to interview respondents. Descriptive analysis, including Chi square and logistic regression tested for associations with sub-groups of gender, age group, education and self-reported type of disability. RESULTS: The proportion of respondents who reported having knowledge of specific eye conditions ranged from 97% for eye injury, to 8% for diabetic eye disease. While 509 (85%) people reported knowledge of cataract, 47% did not know how cataract was treated and only 19% listed surgery. The older group (66.5%) were least informed about cataract (p= 0.001) compared to other groups, and were least likely to believe that some blindness could be prevented (p < 0.001). Women (55%) were more likely than men (46%) (p=0 .003) to report that a child with blindness could attend school, as did people without a disability compared to those with a disability (58% vs 34%) (p < 0.001). CONCLUSIONS: The knowledge about cataract and refractive error and what to do to resolve the problems was low among this population and this study suggests that poor knowledge of eye diseases might contribute to the occurrence of un-operated cataract and uncorrected refractive error.

Glaucoma prevalence in Indigenous Australians.

AIM: Define the prevalence of glaucoma within the Indigenous Australian population. METHODS: Aboriginal and Torres Strait Islander adults aged ≥ 40 years were recruited from 30 randomly selected sample areas or communities. Participants were regarded to have glaucoma if they had a cup:disc ratio (CDR) of > 0.8, or missed ≥ 2 points on the Frequency Doubling Test and a CDR > 0.7 in at least one eye. RESULTS: 1189 eligible adult participants were examined, representing 72% of the target population. After excluding cases with missing or ungradable information, the authors found a 2.2% (95% CI 1.6% to 3.6%) overall prevalence of glaucoma. In univariate analyses, the odds of glaucoma increased with age (χ² trend=4.38, p < 0.001), male gender (OR 2.43, 95% CI 1.10 to 5.41), less than secondary education (OR 4.74, 95% CI 1.96 to 11.45) and self-reported history of glaucoma (OR 20.8; 95% CI 6.23 to 69.51). After a multivariate analysis, none of these attributes other than history of glaucoma remained significant. No cases of low vision (presenting visual acuity (VA) < 6/12 to ≤ 6/60) or blindness (presenting VA < 6/60) were solely attributable to glaucoma. The mean optic disc diameter was 1.93 mm (SD 0.19) for left and right eyes, while the mean CDR for right eyes was 0.44 (SD 0.15) and for left eyes 0.43 (SD 0.16). CONCLUSIONS: This population-based study examined the prevalence of glaucoma within the Indigenous Australian population, and although an infrequent cause of vision loss, definable rates of disease were seen. The results may suggest a potential introduction of Caucasian glaucoma-associated genes into this community, differently used diagnostic criteria or sampling bias compared with previous surveys.

Sampling and recruitment methodology for a national eye health survey of Indigenous Australians.

OBJECTIVE: To review the process of sample selection and highlight the methodological difficulties encountered during a nationwide survey of Indigenous Australians, to determine the prevalence and causes of vision impairment and evaluate access to and utilisation of eye care services. METHODS: Using a multi-stage, random cluster sampling methodology, 30 geographic areas stratified by remoteness, were selected to provide a representative population of approximately 3,000 Indigenous Australians aged 5-15 and 40 years and older, and a small non-Indigenous sample in selected remote areas. Recruitment was adapted to local conditions. The rapid assessment methodology included a questionnaire, tests of visual acuity, trachoma grading, frequency doubling perimetry and non-mydriatic fundus photography. RESULTS: The number of people examined was 2883/3662 (78.7%) Indigenous and 136 (83.4%) non-Indigenous. The percentage of the expected population who were enumerated during the survey varied; discrepancies were largest in urban areas (34.5%) compared to very remote areas (97.1%). CONCLUSIONS: The unexpected variation in predicted population numbers and participation rates could be explained in part by local circumstances, degree of urbanisation, interpretation of the definition of 'Indigenous' and time constraints. IMPLICATIONS: For successful recruitment, a community-specific approach is essential, including collaboration with local organisations and liaison with health workers of each gender.

The prevalence and causes of vision loss in Indigenous Australians: the National Indigenous Eye Health Survey.

AIM: To determine the prevalence and causes of vision loss in Indigenous Australians. DESIGN, SETTING AND PARTICIPANTS: A national, stratified, random cluster sample was drawn from 30 communities across Australia that each included about 300 Indigenous people of all ages. A sample of non-Indigenous adults aged > or = 40 years was also tested at several remote sites for comparison. Participants were examined using a standardised protocol that included a questionnaire (self-administered or completed with the help of field staff), visual acuity (VA) testing on presentation and after correction, visual field testing, trachoma grading, and fundus and lens photography. The data were collected in 2008. MAIN OUTCOME MEASURES: VA; prevalence of low vision and blindness; causes of vision loss; rates of vision loss in Indigenous compared with non-Indigenous adults. RESULTS: 1694 Indigenous children and 1189 Indigenous adults were examined, representing recruitment rates of 84% for children aged 5-15 years and 72% for adults aged > or = 40 years. Rates of low vision (VA < 6/12 to > or = 6/60) were 1.5% (95% CI, 0.9%-2.1%) in children and 9.4% (95% CI, 7.8%-11.1%) in adults. Rates of blindness (VA < 6/60) were 0.2% (95% CI, 0.04%-0.5%) in children and 1.9% (95% CI, 1.1%-2.6%) in adults. The principal cause of low vision in both adults and children was refractive error. The principal causes of blindness in adults were cataract, refractive error and optic atrophy. Relative risks (RRs) of vision loss and blindness in Indigenous adults compared with adults in the mainstream Australian population were 2.8 and 6.2, respectively. By contrast, RRs of vision loss and blindness in Indigenous children compared with mainstream children were 0.2 and 0.6, respectively. CONCLUSION: Many causes of vision loss in our sample were readily avoidable. Better allocation of services and resources is required to give all Australians equal access to eye health services.

The prevalence of trachoma in Australia: the National Indigenous Eye Health Survey.

OBJECTIVE: To determine the prevalence of trachoma among Indigenous Australians. DESIGN, SETTING AND PARTICIPANTS: A national, stratified, random cluster sample survey of Indigenous children (5-15 years) and adults (>or= 40 years) in 30 communities across Australia. Data collection was undertaken in 2008. MAIN OUTCOME MEASURES: Results based on a standardised protocol that included trachoma grading and double grading of photographs of the tarsus. RESULTS: 1694 Indigenous children and 1189 Indigenous adults were examined. Recruitment rates were 84% for children and 72% for adults. The overall rate of follicular trachomatous inflammation among children was 3.8%, ranging from 0.6% in major cities to 7.3% in very remote areas; 50% of communities in very remote areas had endemic rates (> 5%). Trachomatous scarring (TS) occurred among 15.7% of adults, trachomatous trichiasis (TT) among 1.4% and corneal opacity (CO) among 0.3%. TS was found in all regions and TT in all except major cities and inner regional areas. The highest community rates for TS were 58.3%; for TT, 14.6%; and for CO, 3.3%. CONCLUSION: Blinding endemic trachoma remains a major public health problem in many Aboriginal and Torres Strait Islander communities. Although active trachoma is predominantly seen in very remote communities, scarring and blinding sequelae occur among Indigenous people across the country. The Australian Government's recent commitment to eliminate blinding trachoma is welcomed and much needed.