Measuring vision using innate behaviours in mice with intact and impaired retina function.

Measuring vision in rodents is a critical step for understanding vision, improving models of human disease, and developing therapies. Established behavioural tests for perceptual vision, such as the visual water task, rely on learning. The learning process, while effective for sighted animals, can be laborious and stressful in animals with impaired vision, requiring long periods of training. Current tests that that do not require training are based on sub-conscious, reflex responses (e.g. optokinetic nystagmus) that don't require involvement of visual cortex and higher order thalamic nuclei. A potential alternative for measuring vision relies on using visually guided innate defensive responses, such as escape or freeze, that involve cortical and thalamic circuits. In this study we address this possibility in mice with intact and degenerate retinas. We first develop automatic methods to detect behavioural responses based on high dimensional tracking and changepoint detection of behavioural time series. Using those methods, we show that visually guided innate responses can be elicited using parametisable stimuli, and applied to describing the limits of visual acuity in healthy animals and discriminating degrees of visual dysfunction in mouse models of retinal degeneration.

Changing mortality patterns in Kimberley Aborigines.

BACKGROUND/AIMS: To examine the causes of officially reported deaths from several categories among Aboriginal and non-Aboriginal people in a statistical division of north-west Australia from 2002 to 2011. METHODS: A cross-sectional analysis of official Death Registration data to calculate mortality rate ratios (Aboriginal against non-Aboriginal) for that decade in six major International Classification of Disease (ICD)-10 categories. The study setting was the West Kimberley Health District in the far north of Western Australia. RESULTS: Death rates of Aborigines relative to non-Aborigines were much higher, by more than 10 times in some categories. Most of the excess deaths in these categories were due to circulatory diseases, injury and poisonings, neoplasms, diabetes, respiratory, and genitourinary conditions. CONCLUSION: This study has documented the heavy burden of mortality in West Kimberley Aborigines compared with the pattern found in non-Aboriginal people living in the same region.

Why closing the Aboriginal health gap is so elusive.

A wide gap persists between the health of Aboriginal and non-Aboriginal Australians despite a recent Federal government commitment to close the gap by 2030. The complex underlying factors include socioeconomic and environmental disadvantage, inadequate education, underemployment, racial prejudice, high-risk health-related behaviours and limited access to clinical services and health promotion programmes. Over recent decades some aspects of Aboriginal health have deteriorated badly, largely from a surge in chronic 'lifestyle' diseases like diabetes, cardiovascular and kidney disorders plus the effects of tobacco smoking, alcohol and drug abuse and high rates of violence and trauma. To correct these inequities will require improving many social and environmental factors. These include education, living conditions, vocational training, employment, closer cooperation between government and non-government agencies, access to affordable and nutritious fresh food, with better access to high-quality medical treatment, health promotion and disease prevention programmes. Indigenous people must be encouraged to become more involved in activities to improve their health and have more responsibility for the decision-making processes this will entail. Governments must support these changes to help close the Aboriginal health gap.

Population dynamics of methicillin-susceptible and -resistant Staphylococcus aureus in remote communities.

OBJECTIVES: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was first reported in remote regions of Western Australia (WA) in 1992 and is now the predominant MRSA isolated in the State. To gain insights into the emergence of CA-MRSA, 2146 people living in 11 remote WA communities were screened for colonization with S. aureus. METHODS: Antibiogram analysis, contour-clamped homogeneous electric field electrophoresis, multilocus sequence typing, Panton-Valentine leucocidin determinant detection and accessory genetic regulator typing were performed to characterize the isolates. MRSA was further characterized by staphylococcal cassette chromosome mec typing. RESULTS: The S. aureus population consisted of 13 clonal complexes and two Singleton lineages together with 56 sporadic isolates. Five lineages contained MRSA; however, these were not the predominant methicillin-susceptible S. aureus (MSSA) lineages. There was greater diversity amongst the MSSA while the MRSA appeared to have emerged clonally following acquisition of the staphylococcal cassette chromosome mec. Three MRSA lineages were considered to have been endemic in the communities and have subsequently become predominant lineages of CA-MRSA in the wider WA community. People colonized with MSSA tended to harbour clones of a different genetic lineage at each anatomical site while people colonized with MRSA tended to harbour clones of the same lineage at each site. Overall, the isolates were resistant to few antimicrobials. CONCLUSIONS: Although the evidence suggests that in WA CA-MRSA strains arose in remote communities and have now disseminated into the wider community, there is no evidence that they arose from the predominant MSSA clones in these communities.

Hospital admissions and length of stay for coronary disease in an Aboriginal cohort.

BACKGROUND AND AIMS: Coronary disease (CHD)-related hospital admission is more common among indigenous than non-indigenous Australians. We aimed to identify predictors of hospital admission potentially useful in planning prevention programs. METHODS AND RESULTS: Length of stay (LOS), interval between, and number of recurrent admissions were modelled with proportional hazards or negative binomial models using lifestyle data recorded in 1988-1989 among Aborigines (256 women, 258 men, aged 15-88years) linked to hospital records to 2002. Among 106 Aborigines with CHD, hypertension (hazard ratio (HR) 1.69, 95% CI 1.05-2.73); smoking (HR 1.90, 95% CI 1.02-3.53); consuming processed meat >4 times/month (HR 1.81, 95% CI 1.01-3.24); >6 eggs/week (HR 1.73, 95% CI 1.03-2.94); and lower intake of alcohol (HR 0.54, 95% CI 0.35-0.83) predicted LOS. Eating eggs (HR 1.05, 95% CI 1.01-1.09) and bush meats > or =7 times/month (HR 0.46, 95% CI 0.23-0.92) predicted interval between recurrent admissions. Hypertension (IRR 4.07; 95% CI 1.32-12.52), being an ex-drinker (IRR 6.60, 95% CI 2.30-19.00), eating red meat >6 times/week (IRR 0.98, 95% CI 0.97-0.99), bush meats >7 times/month (IRR 0.26, 95% CI 0.10-0.67), and adding salt to meals (IRR 3.16, 95% CI 1.12-8.92) predicted number of admissions. CONCLUSION: Hypertension, alcohol drinking, smoking, and diet influence hospital admissions for CHD in Aboriginal Australians.

The CUPDAY Study: prebiotic-probiotic milk product in 1-3-year-old children attending childcare centres.

AIM: The aim of the study was to evaluate the efficacy of a milk product containing probiotics and prebiotics (CUPDAY Milk) on the incidence of diarrhoea in children attending daycare centres. METHODS: The study was undertaken in a randomized controlled trial with 496 children aged 1-3 years attending 29 childcare centres in Perth, Australia. The endpoint for the study was the number of days in which children were recorded as having four or more stools. The diarrhoeal rates were analyzed by Poisson regression using 'intention to treat' (all children) and 'reduced' (children enrolled for more than 10 days) data sets. RESULTS: There was no difference in demographic characteristics between the case and control groups. In the 'intention to treat' analysis, a total of 41 745 child-days were included in the study. The adjusted risk ratio for those consuming the 'Cupday' milk drink was 0.82 (95% CI 0.73-0.94) for the intention to treat sample (n = 496) and 0.80 (95% CI 0.70-0.91) for the reduced sample (n = 315). The children consuming the 'Cupday' drink had a 20% reduction in the number of days experiencing four or more stools per day. CONCLUSION: A milk containing probiotics and prebiotics reduced the number of days children attending child care who had four or more stools by 20%.

Health-related behaviours as predictors of mortality and morbidity in Australian Aborigines.

OBJECTIVE: To examine predictors of coronary heart disease (CHD) and all-cause mortality in Aboriginal Australians. METHOD: In 1988-89, a survey of Western Australian Aborigines (256 women, 258 men) aged 15-88 years documented diet, alcohol and smoking habits. Linkage to mortality and hospital admissions to the end of 2002 provided longitudinal data for modelling of coronary heart disease endpoints and all-cause mortality using Cox regression. RESULTS: Coronary heart disease risk increased with smoking (HR 2.62, 95% CI: 1.19, 5.75), consumption of processed meats >once/week (HR 2.21, 95% CI: 1.05, 4.63), eggs >twice/week (HR 2.59, 95% CI: 1.11, 6.04) and using spreads on bread (HR 3.14. 95% CI: 1.03, 9.61). All-cause mortality risk was lower with exercise >once/week (HR 0.51, 95% CI 0.26, 1.05), increased in ex-drinkers (HR 3.66, 95% CI: 1.08, 12.47), heavy drinkers (HR 5.26, 95% CI: 1.46, 7.52) and with consumption of take away foods >nine times/month (HR 1.78, 95% CI 0.96, 3.29). Greater alcohol intake, smoking and adverse dietary choices clustered in 53% of men and 56% of women and increased risk of coronary heart disease (HR 2.1, 95% CI: 1.1, 4.0) and all-cause mortality (HR 2.3, 95% CI: 1.2, 4.2). CONCLUSION: Lifestyle in Aboriginal Australians predicts coronary heart disease and all-cause mortality. Clustering of adverse behaviours is common and increases risk of coronary heart disease and death.

Caring for the health and medical and emotional needs of children of migrants and asylum seekers.

UNLABELLED: Political turmoil, military conflicts and other international sociological upheavals are causing significant immigration of large numbers of people, including infants and children, in Europe. Many of these young migrants are refugees. These youngsters have significant health needs, and medical conditions (such as infectious diseases) and mental health problems due to their previous stressful situations and the difficulties that they often experience while settling, even temporarily, into their new environments. Government authorities must screen for transmissible diseases and ensure that vaccine-preventable infections are adequately covered. Paediatricians must give the best possible care for these children and act as their advocates. This can be enhanced by collaborating with national and international paediatric societies and with international non-government agencies. This problem is not confined to Europe; world-wide, it occurs on a massive scale and causes huge burdens for poorer countries that have serious difficulties in coping with the extra financial, personnel and infrastructure needs imposed by massive, uncontrolled migration of populations that are often unhealthy and inadequately nourished. However, this should not be used as a pretext to deny safe refuge to children and their families who need it. CONCLUSION: Massive movements of infant and child immigrants and refugees across European borders over recent years have brought challenges to paediatricians because of the needs for the health and medical and mental health care of these young people. Paediatricians have an important role in their care and by acting, wherever possible, as their advocates. This is a massive problem, world-wide, in which paediatricians can have a potentially significant positive impact.

Factors associated with the initiation of breast-feeding by Aboriginal mothers in Perth.

OBJECTIVES: To identify the prevalence of breast-feeding at discharge and the determinants of breast-feeding initiation amongst Aboriginal women. DESIGN: A prospective cohort study using a self-administered baseline questionnaire and telephone-administered follow-up interviews. SETTING: Six hospitals with maternity wards in Perth, Western Australia. SUBJECTS: Four hundred and twenty-five Aboriginal mothers of newborn infants. RESULTS: At discharge, 89.4% of Aboriginal mothers were breast-feeding. Breast-feeding at discharge was most positively associated with perceived paternal support of breast-feeding, with an adjusted odds ratio (OR) of 6.65 (95% confidence interval (CI) 2.81-15.74), and with maternal age (OR 1.12, 95% CI 1.03-1.22), but negatively associated with parity and having delivered vaginally. CONCLUSION: The factors independently associated with breast-feeding at discharge were similar to those previously identified for a group of non-Aboriginal Perth women, suggesting that separate breast-feeding interventions specially targeted at Aboriginal women are not warranted. The findings do, however, highlight the importance of including the father in the breast-feeding discussions.

Hospitalisation for gastroenteritis in Western Australia.

AIMS: To document gastroenteritis hospitalisations of the 1995-96 cohort of infants born in Western Australia to mid-2002, and to assess factors associated with their hospitalisations and readmissions. METHODS: Retrospective analysis of the State's hospitalisation data, Midwives' Notification of Births data, the Australian Bureau of Statistics mortality data and clinical and demographic information. RESULTS: Aboriginal infants were hospitalised for gastroenteritis eight times more frequently than their non-Aboriginal peers, and were readmitted more frequently and sooner for diarrhoeal illnesses than the other group. They also stayed in hospital for twice as long and many Aboriginal patients were hospitalised on numerous occasions. Hospitalisation rates were higher in remote areas and were significantly associated with co-morbidities such as undernutrition, anaemia, co-existing infections, and intestinal carbohydrate intolerance. CONCLUSIONS: Gastroenteritis is very prevalent in Australian Aboriginal infants and children and is a major cause of their hospitalisation in Western Australia. It is often associated with undernutrition, anaemia, intestinal parasitic infestations, other infections, intestinal carbohydrate intolerance, and, in some instances, with low birth weight. This is often due to unhygienic living conditions and behaviours and presents major challenges to public health, health promotion, and clinical personnel, particularly paediatric services. Childhood diarrhoeal diseases occur commonly in other indigenous groups but have not received the attention that they deserve.

Orphaned and vulnerable to infection, undernutrition and early death: increasing threats to infants and children.

UNLABELLED: Infants and young children in Guinea-Bissau who were made motherless had much higher mortality rates than a control group of subjects. Child mortality was higher in rural than urban children and was highest under 2 y of age and within 6 mo of their mothers' deaths. The authors of this study, which appears elsewhere in this issue, suggest that premature weaning may contribute to this excess mortality. CONCLUSION: There are many causes of maternal mortality that can lead to motherlessness among infants and children, particularly in developing countries. Multifaceted approaches to the care of these children are needed to lessen their excessive mortality. Paediatricians have a potentially very important role in preventing this burden of childhood ill-health and deaths.

Gastroenteritis and environmental health among Aboriginal infants and children in Western Australia.

OBJECTIVE: To retrospectively examine rates of hospitalization of infants and children in Western Australia for gastroenteritis from 1994 through 2000. METHODOLOGY: Analysis of hospital separations data from the Hospital Morbidity Data System of the Department of Health, Western Australia. RESULTS: Rates of hospitalization of Aboriginal infants and children for gastroenteritis from 1994 to 2000 in Western Australia were approximately seven times higher than for their non-Aboriginal peers. This was despite some decline in Aboriginal hospitalization rates over the study period. This may have been due to a simultaneous decline in hospital admissions of non-Aboriginal infants and children. Rates of hospitalization of Aboriginal infants and children were much higher in non-metropolitan rather than in metropolitan regions. There was a remarkable fall in the deaths of Aboriginal infants and children from gastroenteritis between 1970 and 2000. There were no deaths recorded in Western Australian hospitals from this disease from 1990 to 2000.

The challenges of fostering infants and children.

UNLABELLED: There are various reasons for and ways of fostering infants and children in different parts of the world. In a traditional society, for example among Australian Aboriginals, children who have been subjected to catastrophes such as maternal death are taken care of in their extended families, whereas children in the Western world are fostered mainly because of adverse psychosocial factors such as abuse or neglect. In transitional societies and urban slums, where there are few protective mechanisms, the sufferings of orphans may be extreme and they run a great risk of being exploited in various ways or of becoming involved in criminal street gangs. CONCLUSION: The fostering of infants and children around the world creates many yet unanswered challenges. This rather neglected area is in urgent need of much more attention, especially in transitional societies.

Factors affecting length of hospitalization of infants and children for recurrent gastroenteritis in Western Australia.

AIM: Aboriginal infants in Western Australia (WA) have much higher rates of hospitalization for gastroenteritis than do their non-Aboriginal peers. The aim of this 7-y retrospective study was to investigate the factors affecting the duration of hospitalizations due to recurrent gastroenteritis in WA. METHODS: All infants born in WA in 1995 and 1996 who had indexed gastroenteritis admissions during their first year of life (n = 1009) were followed until 31 May 2002. Linked hospitalization and birth records were retrieved to derive the outcome measures, associated co-morbidities and other demographic variables. A proportional hazards frailty model was then used to determine factors influencing discharge from hospital for the study cohort. RESULTS: Aboriginal patients were readmitted to hospital more frequently and stayed in hospital more than twice as long as non-Aborigines. Factors that slowed the rate of discharge from hospital included Indigenous status and the presence of coexisting conditions such as dehydration, sugar intolerance, failure to thrive and iron-deficiency anaemia. CONCLUSION: Gastrointestinal infections are common illnesses in infants and children, particularly for those who live in overcrowded and unhygienic conditions. Coexisting morbidities including undernutrition, nutrient deficiencies, other infections and gastrointestinal carbohydrate intolerance contribute to prolonged and recurrent hospitalization. Multifaceted clinical, disease prevention and health/hygiene promotion are needed to lessen the burden of these infections.

Factors affecting birthweight of rural Australian Aborigines.

AIM: To examine factors affecting birthweight of Aboriginal infants in the Kimberley region of north-west Australia. RESEARCH DESIGN: A retrospective study of maternal and infant health records obtained through routine data collection. SUBJECTS AND METHODS: Birthweight and length of 2959 infants born to 1822 women from 1986 to 1994 were analysed. Mothers and infants were matched using unique identification codes. Index births and subsequent births to the same mother were collated in order to examine relative birth order effects and to calculate birth intervals. RESULTS: Regression analysis showed significant associations between weight of the index birth and maternal age (p < 0.001), remoteness of locality (p < 0.01), sex of the infant (p < 0.001) and maternal height (p < 0.001). Length at birth was significantly associated with ethnicity of infant (Aboriginal vs Aboriginal/non-Aboriginal admixture, p < 0.05), sex (p < 0.001), remoteness (p < 0.01) and maternal height (p < 0.001). Similar associations were observed for second and subsequent births. Birth interval was not associated with birthweight or length. Low birthweight was also more common to Aboriginal mothers compared with mothers of Aboriginal/non-Aboriginal admixture (13.1% vs 9.2%; chi(2) = 5.1, p < 0.025) even though there were no differences in height between these two groups. Teenage mothers (< or =19 years) were no more likely to have low birthweight babies than older mothers. Of the variables examined, the only significant predictor of low birthweight was a previous low birthweight baby (relative risk = 4.45, p < 0.001). CONCLUSIONS: Short birth intervals and teenage births were not significant contributors to low birthweight in the present study. The high prevalence and duration of breastfeeding in the Kimberley may contribute to long average birth intervals. Pre-term birth, rather than intrauterine growth retardation, is likely to be the most common cause of low birthweight in this population.

Child health in an urbanizing world.

UNLABELLED: The aim of this study is to document and comment on the effects of urbanization on child health, internationally, using published reports and the author's personal experience. Urbanization is having profound effects on the health and well-being of infants and children in industrialized and developing countries. This will affect generations into the future. The changes are not confined to cities and large towns; they rapidly influence transitional societies in remote and rural areas, because globalization is changing infant feeding practices and children's diets and lifestyles. In developing countries, overcrowding and environmental pollution are massive problems made worse by undernutrition and infections, particularly respiratory and diarrhoeal diseases. In developed societies there are many other problems, e.g. injuries, poisonings, violence, drug abuse, exposure to industrial and atmospheric pollutants, including pesticides, sexually transmissible diseases, and "lifestyle", diseases including obesity and cardiovascular disease risk. There is an urgent need for paediatricians, health planners, policy-makers, governments and the community to understand these issues and work towards minimizing their harmful effects on children. CONCLUSION: Urbanization has profound effects on child health, globally; these must be recognised so that harmful influences of urbanization can be reduced for the benefit of all children.

Child health in the new millennium.

In today's modern, industrialized and affluent countries, like Japan and Australia, better living conditions and hygiene, plentiful nutritious food and rapid advances in biology and medical technologies have helped to bring about dramatic improvements in child health. The previous heavy burdens of infections and undernutrition have been eliminated or can now be controlled or effectively treated. In these countries, child health standards are higher than ever and expectation of life at birth is much higher than in the past. Some of the technological advances that have helped bring about this transformation are immunization, antimicrobial therapy, successful treatment of childhood leukemias, transplantation of vital organs and implementation of genetic diagnosis and gene therapy. The use of genetically modified foods and the prospects for cloning of humans are areas of intense interest and controversy. However, these advances have their disadvantages (e.g. antibiotic-induced drug resistance). Urbanization has encouraged the 'westernization' of dietary patterns and the long-term 'lifestyle diseases' that can follow in adults. Accidents, violence and drug abuse are major problems in many parts of the world. Changes in attitudes to sexuality and the spread of HIV/AIDS is another major problem, especially in Africa and Asia. Environmental pollution and the degradation of agricultural lands, rivers and seas are also important. Ironically, standards of child health and the prospects for long life in countries like Japan are better than ever before, but social and environmental changes are presenting children and their carers with new and unanswered challenges as we enter the 21 st century and the new millennium.

Historical, cultural, political, and social influences on dietary patterns and nutrition in Australian Aboriginal children.

Before permanent European colonization 2 centuries ago, Australian Aborigines were preagriculturalist hunter-gatherers who had adapted extraordinarily well to life in a variety of habitats ranging from tropical forests, coastal and riverine environments, savannah woodlands, and grasslands to harsh, hot, and very arid deserts. Colonization had serious negative effects on Aboriginal society, well-being, and health, so much so that Aborigines are now the unhealthiest subgroup in Australian society. The change from active and lean hunter-gatherers to a more sedentary group of people whose diet is now predominantly Westernized has had, and continues to have, serious effects on their health, particularly in relation to cardiovascular disease and type 2 diabetes mellitus, which are highly prevalent among Aborigines. The contemporary diets of Australian Aborigines are energy rich and contain high amounts of fat, refined carbohydrates, and salt; they are also poor in fiber and certain nutrients, including folate, retinol, and vitamin E and other vitamins. Risks of development of cardiovascular disease and type 2 diabetes in this population probably develop during late childhood and adolescence. This indicates a need for greater emphasis on health promotion and disease prevention than at present and a need to plan these in culturally sensitive, secure, and appropriate ways. Most information about Aboriginal diets is anecdotal or semiquantitative. More effort needs to be invested in studies that more clearly and precisely define dietary patterns in Aboriginal people, especially children, and how these patterns influence their growth, nutritional status, and health, prospectively.

Birthweights and growth of infants in five Aboriginal communities.

OBJECTIVES: To improve, by culturally appropriate means, birthweights and growth of children up to three years of age over 14 months in five Aboriginal communities in north-western Australia. METHODS: Frequent individual nutritional assessment of infants and children with counselling of mothers and carers and of pregnant women and the introduction of the Aboriginal-controlled Strong Women, Strong Babies, Strong Culture maternal support program. Outcomes compared with those in the same communities for the five years preceding intervention. RESULTS: By international standards, pre-intervention birthweights of full-term infants (37-42 weeks) were only moderately depressed and recovered to exceed standard weight-for-age within two weeks of birth. Growth of full-term infants slowed abruptly after six months. Prevalence and duration of breastfeeding were very high. Prevailing low average birthweight was chiefly attributable to a prevalence of pre-term birth approaching 20%. Intervention was not accompanied by any change in full-term birth weight but was associated with increased weight gain after six months. From 12 to 36 months growth rose by 30 g per month (p = 0.001). Average birthweights of pre-term infants were < 2,500 g and average weight-for-age did not improve during intervention. CONCLUSIONS: Both low birthweight and a disproportionate part of intransigent failure to grow by Aboriginal infants were associated with pre-term birth. Depressed average growth of full-term infants appeared to respond to nutritional counselling accompanied by a community support program. IMPLICATIONS: Investigation of the causes of the exceptionally high rate of Aboriginal pre-term birth in the region is urgently required.