The contribution of sleep to ‘Closing the Gap’ in the health of Indigenous children: a methodological approach

Examination of the sleep of Australian Indigenous children presents some unique challenges, particularly in terms of community input, study design and in the collection of relevant data. Abstract Objectives: Research on Indigenous children’s sleep quality is likely to play a significant part in ‘Closing the Gap’ between Indigenous and non-Indigenous children’s health, academic performance and social outcomes. However, examination of the sleep of Australian Indigenous children presents some unique challenges, particularly in terms of community input, study design and in the collection of relevant data. Methods: The current literature on Indigenous sleep research is reviewed and includes factors such as mental and physical health, socioeconomic disadvantage, and their relationships to sleep. Challenges encountered in researching Indigenous sleep and strategies for best practice are explored. Conclusion: Many challenges exist in researching sleep in Indigenous children, but the imperative of undertaking this task is clear. An assessment of the sleep of Australian Indigenous children requires a thorough evaluation of factors that contribute to sleep health such as co-morbid disease, regional factors and social disadvantage. Methodological issues include appropriate assessment tools, affordable and objective sleep quality measures, accounting for differing cultural beliefs and practices and timekeeping associated with bedtimes and get-up times

Opinions and perceptions of Indigenous mental health applications from service providers and youth samples: a pilot study

Objective To evaluate opinions and perceptions around managing mental health and the relevance of available mental health applications (apps) for Indigenous youth populations by surveying values of Indigenous service providers and youth samples in a regional area, in order to better target online mental health information. Method Participants were 15 Indigenous youths (6 males, 9 females) with a mean (SD) age of 16.93 (2.37), and 30 Indigenous service providers (6 males, 24 females) with a mean age (SD) of 34.59 (12.26). Participants were recruited through a Queensland regional Indigenous community organisation, and given a face-to-face survey, (developed with Indigenous community members) during a social event. The survey asked how participants improve their mental health, their knowledge of current Indigenous mental health applications, and their perceived importance of values presented in those applications. Results Although Indigenous youth were not familiar with existing mental health apps, overall, participants agreed with the values presented in available mental health apps. Compared to Indigenous youth, service providers overall perceived presented values as significantly more important, and specifically found ‘Nature in the design’, ‘Themes of strength’, and ‘Themes of community’ to be most important. Regarding content, service providers and youth had different strategies for bolstering mental health with Indigenous sports stars the least popular in both groups. There were no statistical gender differences in thematic importance for bolstering mental health. Conclusions Mental health applications are little utilised by Indigenous youth so awareness needs to increase. In addition, these are viewed differently between service providers and youth. This may have relevance for uptake and usage of these apps within the mental health service delivery

Sleep health and its implications in First Nation Australians: A systematic review

Understanding the state of sleep health in First Nations Australians offers timely insight into intervention and management opportunities to improve overall health and well-being. This review explored the determinants and burden of poor sleep in First Nations Australians. A systematic search was conducted to identify studies published until August 2020 in First Nations Australian adults. Nine studies (n = 2640) were included, three in community settings, six in clinical populations. Across studies compared with non-Indigenous people, 15–34% of First Nations Australians experience less than recommended hours (<7 h/night), 22% reported fragmented, irregular, and unrefreshing sleep with a high prevalence of OSA in clinical populations (39-46%). Findings show First Nations Australians are significantly more likely to report worse sleep health than Non-Indigenous Australians in all measured domains of sleep. Co-designed sleep programs and service delivery solutions are necessary to ensure timely prevention and management of sleep issues in First Nations communities which to date have been underserved. Funding: No external funding was provided for this work

Sleep, performance and behaviour in Australian indigenous and non-indigenous children: An exploratory comparison

Sleep problems in Australian children are common and consequential but have not been investigated in Australian Aboriginal or Torres Strait Islander (indigenous) children. This study compares sleep in indigenous and non-indigenous children and investigates potential effects on school performance and daytime behaviour.Subjects included 25 indigenous and 25 non-indigenous children (mean standard deviation (SD) age = 8.8 (1.4 years), range 7–11.11 years), in six Northern Territory primary schools. Parents completed the Sleep Disorders Scale for Children which produces a T-score (mean = 50 (SD = 10)) for behavioural sleep disorders, sleep disordered breathing, parasomnias, excessive daytime sleepiness and night sweating. Behaviour and school grades were assessed with the parent-reported Child Behaviour Checklist.Behavioural sleep problems of initiating and maintaining sleep, or parasomnias were commonly reported by both groups (24–40%), with indigenous children under 9 years reporting the most problems. No between-group differences were found in school performance. Significant relationships between sleep quality and behaviours were found, particularly for indigenous children.These data suggest that substantial numbers of Australian children – more than one third in this pilot sample – may suffer from significant sleep problems. To the extent that sleep problems may impair prefrontal cortical function, emotional regulation, and control of behaviour, confirmation of current findings could have particular import for indigenous children.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78711/1/j.1440-1754.2009.01610.x.pd

Sleep and academic performance in Indigenous Australian children from a remote community: An exploratory studyjpc_2059 122

Aim: Disruptions to sleep in childhood are associated with poor behaviour and deficits in academic performance and executive function. Although academic performance of indigenous children from remote communities in Australia is documented as well below that of non- indigenous children, the extent of sleep disruption and its contribution to academic performance among this population has not been assessed. This pilot study aimed to objectively assess the sleep of remote indigenous children and the association between sleep disruption and both academic performance and executive function. Method: Twenty-one children from a remote Australian indigenous community aged 6–13 years wore actigraphy for two consecutive nights, reported subjective sleepiness, and were objectively assessed for academic performance (Wechsler Individual Achievement Test, 2nd Edition) and executive function (NEuroloPSYcological Assessment-II). Results: Results show marked reduction in sleep time, sleep fragmentation, academic performance and auditory attention compared with non-indigenous norms. Sleep duration was not associated with performance, possibly because of reduced sleep and performance observed across the entire group. Sleep fragmentation was associated with reduced reading and numerical skills (P \u3c 0.05). Conclusions: The sleep of indigenous children in remote communities is an important area of future inquiry, and our initial findings of poor sleep and an association between sleep disruption and academic performance may have important implications for intervention strategies aimed at ‘closing the gap’. Further studies should assess a broader range of demographic, social and economic factors to better understand the associations reported here and guide future intervention

Short term outcome of pshycoeducational program on coping abilities of mother of children with cancer

Objective: To evaluate a psycho-educational program (PeP) for parents ofchildren with cancer (PoCwC) in Malaysia. Methods: Seventy-nine parents were invited to be either in an intervention ( n = 41) or a control group ( n = 38 ). Baseline assessment took place upon agreement of participant. Shortterm effects were measured four weeks the intervention. Control parents received standard care. Intervention parents received in addition to standard care, 4 x 50 min sessions of information on childhood cancer and coping strategies. Result: Repeated measures of ANOVAs revealed increased knowledge about cancer ( p = 0.01 ) in the intervention parents compared with standard care. Intervention parents reported reduced anxiety and increased activities with children after the program; however, differences were not significant. · Conclusions: This PeP, the first of its kind in Malaysia, has significantly increased levels of knowledge among parents of seriously ill children which may point towards the potential for these services to increase coping in Malaysian PoCwC

Social-ecological considerations informing a universal screening strategy for sleep health in the community

“Poor sleep health” (PSH), defined as reduced amount of sleep and non-restorative sleep, affects cognitive, social and emotional development. Evidence suggests an association of sleep deprivation and mental health problems; however, there are no universal concepts allowing a first-tier screening of PSH at a community level. The focus of this narrative review is to highlight the cultural context of the current medicalized approach to PSH and to suggest social ecological strategies informing new and holistic community-based screening concepts. We present two conceptual screening frameworks; a “medical” and a merged “social emotional wellbeing framework” and combine them utilizing the concept of “ecologies.” The first framework proposes the incorporation of “sleep” in the interpretation of “vigilance” and “inappropriate” labeled behaviors. In the first framework, we provide a logic model for screening the myriad of presentations and possible root causes of sleep disturbances as a tool to assess daytime behaviors in context with PSH. In the second framework, we provide evidence that informs screening for “social emotional wellbeing” in the context of predictive factors, perpetuating factors and predispositions through different cultural perspectives. The distinct goals of both frameworks are to overcome training-biased unidirectional thinking and a priori medicalization of challenging, disruptive and/or disobedient behaviors. The latter has been explicitly informed by the critical discourse on colonization and its consequences, spearheaded by First Nations. Our “transcultural, transdisciplinary and transdiagnostic screening framework” may serve as a starting point from which adaptations of medical models could be developed to suit the purposes of holistic screening, diagnosis, and treatment of complex childhood presentations in different cultural contexts

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes

Type I interferon causes thrombotic microangiopathy by a dose-dependent toxic effect on the microvasculature

Many drugs have been reported to cause thrombotic microangiopathy (TMA), yet evidence supporting a direct association is often weak. In particular, TMA has been reported in association with recombinant type I interferon (IFN) therapies, with recent concern regarding the use of IFN in multiple sclerosis patients. However, a causal association has yet to be demonstrated. Here, we adopt a combined clinical and experimental approach to provide evidence of such an association between type I IFN and TMA. We show that the clinical phenotype of cases referred to a national center is uniformly consistent with a direct dose-dependent drug-induced TMA. We then show that dose-dependent microvascular disease is seen in a transgenic mouse model of IFN toxicity. This includes specific microvascular pathological changes seen in patient biopsies and is dependent on transcriptional activation of the IFN response through the type I interferon α/β receptor (IFNAR). Together our clinical and experimental findings provide evidence of a causal link between type I IFN and TMA. As such, recombinant type I IFN therapies should be stopped at the earliest stage in patients who develop this complication, with implications for risk mitigation