The prevalence of glaucoma in indigenous Australians within Central Australia: the Central Australian Ocular Health Study

Aims To determine the prevalence of glaucoma within the indigenous Australian population living in central Australia. Methods 1884 individuals aged ≥20 years, living in one of 30 remote communities within the statistical local area of ‘Central Australia,’ were recruited for this study. This equated to 36% of those aged ≥20 years and 67% of those aged ≥40 years within this district. Slit-lamp examination of the anterior segment and intraocular pressure measurement, followed by stereoscopic slit-lamp funduscopy of the optic nerve, was performed. Selected patients underwent automated visual-field testing. The diagnosis of glaucoma was based on pre-existing definitions. Glaucoma prevalence data are presented. Results Seventeen individuals had glaucoma (0.90%). Causes of secondary glaucoma were found in four with neovascular glaucoma, two with uveitic glaucoma and four who had developed glaucoma subsequent to trauma or surgery. The remaining seven had no identifiable cause for their glaucoma and were thus classified as open-angle glaucoma equating to a prevalence of 0.52% (95% CI 0.14% to 0.90%) for those aged ≥40 years. Of these, four had an intraocular pressure ≤21 mm Hg, and three had an intraocular pressure >21 mm Hg. Conclusion The prevalence of open-angle glaucoma among indigenous Australians within central Australia was 0.52% for those aged ≥40 years. After adjustment for the age distribution of our sample, this is one-third the prevalence seen among the non-indigenous Australian population and is despite a higher prevalence of ocular parameters considered to be associated with glaucoma

Incidence of visual impairment due to cataract, diabetic retinopathy and trachoma in indigenous Australians within central Australia: the Central Australian Ocular Health Study

Author version made available in accordance with the publisher's policy.Background: To estimate the incidence and causes of visual impairment for the purposes of service provision among the indigenous Australian population within central Australia from its most common causes, namely cataract, diabetic retinopathy and trachoma. Design: Clinic-based cohort study. Participants: One thousand eight hundred eighty four individuals aged =20 years living in one of 30 remote communities within the statistical local area of 'Central Australia'. Methods: From those initially recruited, 608 (32%) participants were reviewed again between 6 months and 3 years (median 2 years). Patients underwent Snellen visual acuity testing and subjective refraction. Following this, an assessment of their anterior and posterior segments was made. Baseline results were compared with those who were reviewed. Main Outcome Measures: The annual incidence rates and causes of visual impairment (vision worse than Snellen visual acuity 6/12 in at least one eye). Results: The incidence of visual impairment in at least one eye was 6.6%, 1.2% and 0.7% per year for cataract, diabetic retinopathy and trachoma, respectively (7.9%, 1.5% and 0.7% per year for those aged =40 years). Advancing age was the main risk factor common to all three. Conclusion: It is important to be mindful not only of the prevalence of disease in a community but also of the rate at which new cases are occurring when allocating resources to address the ocular health needs of this region. Compared with historical data, diabetic retinopathy is emerging as a new and increasing threat to vision in this population.Australian National Health & Medical Research Counci

Palliative care for children and young people with stage 5 chronic kidney disease

Death from stage 5 chronic kidney disease (CKD 5) in childhood or adolescence is rare, but something that all paediatric renal physicians and most paediatricians will encounter. In this paper, we present the literature on three key areas of palliative care practice essential to good clinical management: shared decision-making, advance care planning, and symptom management, with particular reference to CKD 5 where kidney transplant is not an option and where a decision has been made to withdraw or withhold dialysis. Some areas of care, particularly with regard to symptom management, have not been well-studied in children and young people (CYP) with CKD 5 and recommendations with regard to drug choice and dose modification are based on adult literature, known pharmacokinetics, and clinical experience

Measuring Disease-Free Survival and Cancer Relapse Using Medicare Claims From CALGB Breast Cancer Trial Participants (Companion to 9344)

To determine the accuracy with which Medicare claims data measure disease-free survival in elderly Medicare beneficiaries with cancer, we performed a criterion validation study. We merged gold-standard clinical trial data of 45 elderly patients with node-positive breast cancer who were treated on the Cancer and Leukemia Group B (CAL-GB) adjuvant breast trial 9344 with Centers for Medicare and Medicaid Services (CMS) data files and compared the results of a CMS-based algorithm with the CALGB disease-free survival information to determine sensitivity and specificity. For 5-year disease-free survival, the sensitivity of the CMS-based algorithm was 100% (95% confidence interval [CI] = 81% to 100%), the specificity was 97% (95% CI = 83% to 100%), and the area under the receiver operator curve was 97% (95% CI = 90% to 100%). For 2-year disease-free survival, the test characteristics were less favorable: sensitivity was 83% (95% CI = 36% to 100%), specificity was 95% (95% CI = 83% to 100%), and area under the receiver operator curve was 84% (95% CI = 66% to 100%)

Use of Dried Capillary Blood Sampling for Islet Autoantibody Screening in Relatives:A Feasibility Study

Background: Islet autoantibody testing provides the basis for assessment of risk of progression to type 1 diabetes. We set out to determine the feasibility and acceptability of dried capillary blood spot–based screening to identify islet autoantibody–positive relatives potentially eligible for inclusion in prevention trials. Materials and Methods: Dried blood spot (DBS) and venous samples were collected from 229 relatives participating in the TrialNet Pathway to Prevention Study. Both samples were tested for glutamic acid decarboxylase, islet antigen 2, and zinc transporter 8 autoantibodies, and venous samples were additionally tested for insulin autoantibodies and islet cell antibodies. We defined multiple autoantibody positive as two or more autoantibodies in venous serum and DBS screen positive if one or more autoantibodies were detected. Participant questionnaires compared the sample collection methods. Results: Of 44 relatives who were multiple autoantibody positive in venous samples, 42 (95.5%) were DBS screen positive, and DBS accurately detected 145 of 147 autoantibody-negative relatives (98.6%). Capillary blood sampling was perceived as more painful than venous blood draw, but 60% of participants would prefer initial screening using home fingerstick with clinic visits only required if autoantibodies were found. Conclusions: Capillary blood sampling could facilitate screening for type 1 diabetes prevention studies.</p

Impact of psychiatric comorbidity on treatment of adolescent drug abusers

Abstract Comorbidity of substance abuse disorders (SUD) and psychiatric disorders is one of the most important areas of investigation in contemporary drug abuse treatment research. This study examined the impact of psychiatric comorbidity on the treatment of 182 adolescent drug abusers in a randomized clinical trial comparing family and individual cognitive-behavioral therapy. Three distinct groups of adolescent substance abusers were compared: (1) Exclusive Substance Abusers (SUD only); (2) Externalizers (SUD + externalizing disorder); and (3) Mixed Substance Abusers (SUD + externalizing and internalizing disorder). The purpose of this study was to determine whether adolescents in these comorbid groups differed in clinical presentation and treatment response. More severe comorbidity was associated with greater family dysfunction and being female and younger at intake. An examination of substance use trajectories over time indicated that the Mixed group initially responded to treatment but returned to intake levels of substance use by 1 year post-discharge.

The relative influence of intellectual disabilities and autism on sensory impairments and physical disability:A whole‐country cohort of 5.3 million children and adults

Background: Intellectual disabilities and autism are lifelong and often co‐occur. Little is known on their extent of independent association with sensory impairments and physical disability. Methods: For Scotland's population, logistic regressions investigated age–gender‐adjusted odds ratios (OR) of associations, independently, of intellectual disabilities and autism with sensory impairments and physical disability. Results: 1,548,819 children/youth, and 3,746,584 adults. In children/youth, the effect size of intellectual disabilities and autism, respectively, was as follows: blindness (OR = 30.12; OR = 2.63), deafness (OR = 13.98; OR = 2.31), and physical disability (OR = 43.72; OR = 5.62). For adults, the effect size of intellectual disabilities and autism, respectively, was as follows: blindness (OR = 16.89; OR = 3.29), deafness (OR = 7.47; OR = 2.36), and physical disability (OR = 6.04; OR = 3.16). Conclusions: Intellectual disabilities have greater association with the population burden of sensory impairments/physical disability, but autism is also associated regardless of overlap with intellectual disabilities. These may impact further on communication limitations due to autism and intellectual disabilities, increasing complexity of assessments/management of other health conditions. Clinicians need to be aware of these important issues

Transporting Clinical Research to Community Settings: Designing and Conducting a Multisite Trial of Brief Strategic Family Therapy

This paper describes the development and implementation of a trial of Brief Strategic Family Therapy (BSFT), an evidence-based drug intervention for adolescents, in eight community substance abuse treatment programs. Researchers and treatment programs collaborated closely to identify and overcome challenges, many of them related to achieving results that were both scientifically rigorous and applicable to the widest possible variety of adolescent substance abuse treatment programs. To meet these challenges, the collaborative team drew on lessons and practices from efficacy, effectiveness, and implementation research