Menzies School of Health Research

This is the second of three reports arising from a research Inquiry examining Australia’s Indigenous housing system. The report examines how the system is structured, operates and is funded, and explores housing tenure choices for Aboriginal and Torres Strait Islander peoples. Current governance arrangements in the Indigenous housing system are complex and poorly coordinated. A comprehensive national Aboriginal and Torres Strait Islander housing strategy is required to align mechanisms and policies, promote greater accountability to First Nations people, and bolster self-determination in the sector. This research builds the evidence base to support the creation of a national strategy.

Household overcrowding is a major driver of acute rheumatic fever and rheumatic heart disease, along with other adverse social, cultural and health outcomes in remote Aboriginal communities. Overcrowding is compounded by poor thermal performance of current housing, energy insecurity and climate change. Despite strong evidence of the causes of rheumatic heart disease, upstream prevention through housing design remains underexplored. Wilya Janta, an Aboriginal-led organisation in Tennant Creek, has developed the Explain Home design: a culturally responsive, climate-adapted prototype designed to reduce overcrowding-related harms. With an unprecedented $4 billion investment in remote housing, health professionals have a critical role in advocating for evidence-informed, culturally safe housing as a form of preventive health intervention to improve equity and outcomes.

OBJECTIVE:Determine whether watchful waiting is non-inferior to immediate oral antibiotics for uncomplicated acute otitis media among urban Aboriginal and Torres Strait Islander children. STUDY TYPE:Non-inferiority unblinded randomised controlled trial. SETTING AND PARTICIPANTS:Eight Aboriginal Medical Services across three Australian states and territories between 25 August 2014 and 2 June 2023. Children (aged 1.5-16 years) with type B tympanograms and bulging tympanic membrane or acute pain/irritability were randomised by site and age (1.5-6 years and 7-16 years), with stratification using randomly allocated, permuted blocks of four and six in length. MAIN OUTCOME MEASURES:Watchful waiting compared with immediate oral antibiotics using modified intention-to-treat (using only available data) and per-protocol analyses of Day 7 clinical resolution with non-inferiority threshold set at 10 percentage points. RESULTS:Children were randomly allocated to watchful waiting (134), six of whom were lost to follow-up or immediate antibiotics (129) with three lost to follow-up. Resolution occurred in 57/106 (53.8%) watchful waiting and 68/113 (60.2%) immediate antibiotic group of those with complete Day 7 data (-6.4 percentage points difference; 90% confidence interval [CI], -17.4 to 4.6) (modified intention-to-treat analysis). Per-protocol analysis similarly demonstrated reduced resolution in the watchful waiting group (49/97; 50.5%) compared with immediate antibiotics (67/112; 59.8%) with -9.3 percentage points difference (90% CI, -20.6 to 2.0). There was less Day 3 diarrhoea in watchful waiting (3/90; 3.3%) than in the immediate antibiotic group (13/93 [14.0%]; -10.7 percentage points difference; 95% CI, -18.6 to -2.7) but no other differences in vomiting, diarrhoea or rash (Days 3-14). Day 7 analgesia use was higher in the watchful waiting (53/107 [49.5%]) than immediate antibiotic group (37/116 [31.9%]; 17.6 percentage points difference; 95% CI, 4.9 to 30.1). There were no intervention-related severe adverse events or perforations. CONCLUSION:Although our results are numerically similar to those reported in other low-risk populations and no unexpected safety signals were observed in the watchful waiting arm, non-inferiority was not established. Larger, adequately powered trials are required to determine whether watchful waiting is non-inferior in this population. TRIAL REGISTRATION:Australian New Zealand Clinical Trials Registry ACTRN#12613001068752.

OBJECTIVE:Risk prediction models for community-acquired pneumonia (CAP) in hospitalised children are limited, especially in upper-middle-income countries. We developed a PaEdiatric Pneumonia Severity (PEPS) score to aid early risk stratification and examined its discriminatory ability. DESIGN:Prospective cohort study. SETTINGS AND PATIENTS:Between April 2022 and April 2023, children aged 1 month to <12 years hospitalised with radiographic-confirmed CAP were enrolled in Sabah, Malaysia. MAIN OUTCOME MEASURES:Key clinical factors were collected to develop risk profiles for mild, moderate, and severe CAP. The PEPS score was derived from the final multivariable model and its ability to discriminate CAP severity assessed. RESULTS:Among 868 children, 639 (73.6%) had mild, 83 (9.6%) moderate, and 146 (16.8%) severe CAP. Independent factors associated with moderate/severe CAP were age <6 months (adjusted OR (ORadj)=6.81, 95% CI 4.65 to 9.98), partial/unvaccinated status (ORadj=2.66, 95% CI 1.47 to 4.81), vomiting/refusal of feeds (ORadj=1.77, 95% CI 1.19 to 2.61), hypoxaemia (oxygen saturation 90-93% (ORadj=2.38, 95% CI 1.22 to 4.64); <90% (ORadj=28.88, 95% CI 13.37 to 62.35)) and anaemia (ORadj=1.76, 95% CI 1.17 to 2.67). The model demonstrated excellent discrimination in identifying risk of children having moderate/severe CAP (c-statistic=0.81, 95% CI 0.78 to 0.84). The developed PEPS score (0-13) stratified children into low-risk (score 0-1), moderate-risk (score 2-4) and high-risk (score ≥5) groups with observed rates of moderate/severe CAP 10.9%, 29.1%, and 76.9%, respectively, and demonstrated strong predictive performance for moderate/severe CAP (c-statistic=0.81, 95% CI 0.77 to 0.84). CONCLUSION:The PEPS score, the first developed in an upper-middle-income country using radiographic-confirmed CAP, accurately discriminates mild from moderate/severe hospitalised CAP. It may support case management in similar settings, but requires external validation before broader implementation.

Introduction Psychotic disorders often emerge from subclinical traits linked to schizotypy or bipolarity, and the crucial selective or indicated prevention could be implemented based on the identification of these. Objectives This study identifies low-risk individuals in a non-clinical population using psychometric measures, and our goal was to explore allostatic load (AL) as a marker of latent vulnerability. Methods Three groups were created based on psychometric measures, which identified 30 individuals with positive schizotypy traits (PSF), 25 with cyclothymic bipolarity traits (CF), and 30 healthy controls (HCs). Allostatic load was calculated using 21 biomarkers, and Machine learning (ML) models identified key predictive features and reduced-feature models validated robustness. Results Significant differences were observed between the three groups in the oxidative system ( p = 0.014). SHAP analysis revealed creatinine, diastolic blood pressure, uric acid, and low-density lipids as key predictors for the CF group and heart rate, TSH, uric acid, and glucose for the PSF group. Machine learning achieved 76% accuracy using all 21 biomarkers and maintained the performance using a reduced 10-biomarker model. The AL was significantly ( p = 0.010 and 0.005) lower in the CF individuals than HCs using 10 and 6 biomarkers, respectively, while no difference was shown between the PSF and HCs. Conclusions This study highlights the use of AL index in detecting early psychiatric risk. Distinct physiological patterns were observed in the PSF and CF groups. A targeted 10-biomarker AL index maintained predictive accuracy. Disclosure of Interest None Declared