Ear and hearing health in Aboriginal and Torres Strait Islander people aged 15 years and older: A scoping review.

OBJECTIVE: Review empirical research investigating the prevalence, experiences and management of hearing loss and ear disease in Aboriginal and Torres Strait Islander adults. DESIGN: Scoping review. STUDY SAMPLES: Searches of four electronic databases, Advanced Google, and key webpages identified 16,373 studies - 21 met inclusion criteria: original research relating to hearing/ear health and Aboriginal and Torres Strait Islander adults. RESULTS: Fourteen studies measured prevalence of hearing loss or middle-ear dysfunction, with a rate of hearing loss at an estimated 50% (reports ranging from 8% to 100%). Five studies reported views, attitudes, and experiences of hearing loss, with results showing hearing loss negatively impacted individual experiences in health and justice systems, and health professionals had limited understanding of the socioeconomic risk factors of middle ear disease. No articles directly reported on hearing loss management. CONCLUSIONS: There is a lack of research into the hearing health of Aboriginal and Torres Strait Islander adults, despite its critical importance in addressing health and social inequities. Given the widely varying and imprecise estimated rates of hearing loss detected, urgent action is needed to obtain accurate prevalence estimates and, in partnership with Aboriginal and Torres Strait Islander communities, identify the best methods of screening and managing hearing loss.

Methodological pluralism for better evaluations of complex interventions: lessons from evaluating an innovation platform in Australia.

Complex interventions, such as innovation platforms, pose challenges for evaluators. A variety of methodological approaches are often required to build a more complete and comprehensive understanding of how complex interventions work. In this paper, we outline and critically appraise a methodologically pluralist evaluation of an innovation platform to strengthen primary care for Aboriginal and Torres Strait Islander Australians. In doing so, we aim to identify lessons learned from the approach taken and add to existing literature on implementing evaluations in complex settings, such as innovation platforms. The pluralist design used four evaluation approaches-developmental evaluation, principles-focused evaluation, network analysis, and framework analysis-with differing strengths and challenges. Taken together, the multiple evaluation approaches yielded a detailed description and nuanced understanding of the formation, functioning and outcomes of the innovation platform that would be difficult to achieve with any single evaluation method. While a methodologically pluralist design may place additional pressure on logistical and analytic resources available, it enables a deeper understanding of the mechanisms that underlie complex interventions.

Nutritional and pulmonary function assessment in chronic obstructive pulmonary disease: Effects of nutritional supplementation.

We found that with oral supplementation by a liquid soy-based protein hydrolysate in malnourished COPD patients (BMI <= 20), it possible to increase weight over a 6-week period, and body water and an index of muscle mass (MAMC), but not total body nitrogen (TBN judged by Nitrogen Index) which identifies a particular challenge for nutrition support in COPD patients. There was no associated improvement in pulmonary function but we found that better nourished COPD patients (BMI > 20) had some pulmonary function advantage; it is suggested that TBN may need to improve with nutrition support for pulmonary function to improve.

Effect of rice cereal feedings on bone mineralization and calcium homeostasis in cow milk formula fed infants.

OBJECTIVE: We conducted a prospective randomized, single-blinded clinical trial to test the hypothesis that intake of formula plus cereals between the ages of 16 and 26 weeks postnatally (as compared to formula alone) would lead to lower bone mineral content (BMC), higher parathyroid hormone (PTH) concentration, lower serum calcium (Ca), magnesium (Mg) and osteocalcin (OC); and increased continuous night sleep. METHODS: At 16 weeks postnatally, 41 healthy, term infants were randomized to formula alone or formula and cereal. RESULTS: We found no significant differences in growth or sleep pattern, nor in BMC between groups. Serum PTH concentration was significantly increased in the cereal group at 26 weeks. CONCLUSION: We speculate that the increase in PTH is due to relative Ca deficiency or is responsive to increased phosphate load in the cereal group.

Bone mineral content of infants fed soy-based formula.

We compared the results of two studies that measured the bone mineral content (BMC) of 57 infants fed soy-based formula and 27 infants fed human milk or cow milk-based formula at various ages from 2 weeks to 1 year. In a study by Chan et al., the BMC of 40 white infants fed soy-based formula and 10 infants (of unstated race) fed human milk was measured at 2 weeks and at 2 and 4 months of age. The infants fed soy-based formula also had BMC measured at 6 and 12 months; the BMC of these infants was compared to the BMC of human milk-fed historical control subjects. The BMC was similar at 2 weeks in both groups but was lower in infants fed soy-based formula than in human milk-fed infants at 2 and 4 months. The BMC was similar in historical control subjects fed human milk and in soy formula-fed infants at 6 and 12 months. In the Steichen-Tsang study, the BMC of 17 soy formula-fed infants and of 17 white infants fed cow milk-based formula was measured at 6 weeks and at 3, 6, and 12 months of age. The BMC was similar at 6 weeks in both groups but was lower in infants fed soy-based formula than in those fed cow milk-based formula at 3, 6, and 12 months. The BMC of the historical control group fed human milk and of the soy formula-fed infants was also similar. In the first year of life, the BMC of infants fed soy formula and those fed human milk appears to be similar, especially after 6 months of age. However, the BMC of infants so fed may be lower than that of infants fed cow milk-based formula.

Jaundice in neonates with sickle cell disease. A case-control study.

This matched, case-control study was conducted on 68 neonates with sickle cell disease (SCD) to test the hypothesis that SCD contributes to neonatal jaundice. Previous uncontrolled studies have suggested that SCD leads to a high rate of neonatal jaundice. After matching, two neonates without SCD born in the same year were selected for each patient with SCD by use of random numbers. Matching factors were gestational age, sex, birth weight, and race. Serum bilirubin concentrations and the presence or absence of clinical jaundice were recorded. Information on factors potentially influencing the rate of neonatal jaundice was obtained for the first three days of life: maternal drug, alcohol, and tobacco usage, intrauterine infection, Apgar scores, highest infant hematocrit, culture-proved sepsis, blood group incompatibilities, hemorrhages, and presence of red blood cell sickling. We found no increase in the rate of clinical jaundice and no increase in the bilirubin concentration in either the entire group of patients with SCD, or in the subgroups with either homozygous or S-hemoglobin C disease, compared with their respective controls. We conclude that SCD probably is not a significant factor predisposing to neonatal jaundice.

Clinical presentation of homozygous sickle cell disease.

The pattern of initial clinical symptoms and signs developing in a representative sample of 305 children with homozygous sickle cell (SS) disease diagnosed at birth was analyzed. Specific symptoms were present by age 6 months in 6% of the group, and had developed by the first to eighth birthdays in 32%, 61%, 78%, 86%, 90%, 92%, 94%, and 96%, respectively. Inclusion of nonspecific symptoms in the analysis led to earlier recognition by a mean of 3 months in the first year and by a mean of approximately 1 year between the ages of 2 and 4 years. Dactylitis was the most common initial symptom, noted in 40% of the group overall and in 50% in the first 2 years. Painful crisis was the first symptom in more than one fourth of the patients and was the most frequent symptom after the age of 2 years. Acute splenic sequestration led to presentation in one-fifth of the group overall and in one third of patients younger than 2 years. The most common nonspecific symptom was pneumonia. There was a significant trend of earlier presentation in children with low fetal hemoglobin levels. The age at presentation did not appear to be affected by alpha-thalassemia status.