Lehmann Deborah, Arumugaswamy Ashwini, Elsbury Dimity, Finucane Janine, Stokes Annette, Monck Ruth, Jeffries-Stokes Christine, McAullay Daniel, Coates Harvey, Stanley Fiona J
Telethon Institute for Child Health Research, Centre for Child Health Research, the University of Western Australia, West Perth, WA, Australia.
Paediatr Perinat Epidemiol. 2008 Jan;22(1):60-71. doi: 10.1111/j.1365-3016.2007.00891.x.
Otitis media (OM) is one of the most common paediatric illnesses for which medical advice is sought in developed countries. Australian Aboriginal children suffer high rates of OM from early infancy. The resultant hearing loss can affect education and quality of life. As numerous factors contribute to the burden of OM, interventions aimed at reducing the impact of single risk factors are likely to fail. To identify key risk factors and understand how they interact in complex causal pathways, we followed 100 Aboriginal and 180 non-Aboriginal children from birth to age 2 years in a semi-arid zone of Western Australia. We collected demographic, obstetric, socio-economic and environmental data, breast milk once, and nasopharyngeal samples and saliva on seven occasions. Ear health was assessed by clinical examination, tympanometry, transient evoked otoacoustic emissions and audiometry. We considered the conduct of our study in relation to national ethical guidelines for research in Aboriginal and Torres Strait Islander health. After 1 year of community consultation, the study was endorsed by local committees and ethical approval granted. Fieldwork was tailored to minimise disruption to people's lives and we provided regular feedback to the community. We saw 81% of non-Aboriginal and 65% of Aboriginal children at age 12 months. OM was diagnosed on 55% and 26% of routine clinical examinations in Aboriginal and non-Aboriginal children respectively. Aboriginal mothers were younger and less educated, fewer were employed and they lived in more crowded conditions than non-Aboriginal mothers. Sixty-four per cent of Aboriginal and 40% of non-Aboriginal babies were exposed to environmental tobacco smoke. Early consultation, provision of a service while undertaking research, inclusion of Aboriginal people as active members of a research team and appropriate acknowledgement will assist in ensuring successful completion of the research.
中耳炎（OM）是发达国家中最常见的需要寻求医疗建议的儿科疾病之一。澳大利亚原住民儿童从婴儿早期起中耳炎发病率就很高。由此导致的听力损失会影响教育和生活质量。由于导致中耳炎负担的因素众多，旨在降低单一风险因素影响的干预措施可能会失败。为了确定关键风险因素并了解它们在复杂因果路径中的相互作用方式，我们在西澳大利亚的一个半干旱地区对100名原住民儿童和180名非原住民儿童从出生到2岁进行了跟踪研究。我们收集了人口统计学、产科、社会经济和环境数据，采集了一次母乳，并在七个时间点采集了鼻咽样本和唾液。通过临床检查、鼓室图、瞬态诱发耳声发射和听力测定来评估耳部健康状况。我们根据关于原住民和托雷斯海峡岛民健康研究的国家伦理准则来考虑我们研究的开展情况。经过1年的社区咨询后，该研究得到了当地委员会的认可并获得了伦理批准。实地工作经过调整以尽量减少对人们生活的干扰，并且我们定期向社区反馈情况。在12个月大时，我们见到了81%的非原住民儿童和65%的原住民儿童。在原住民和非原住民儿童的常规临床检查中，分别有55%和26%被诊断患有中耳炎。与非原住民母亲相比，原住民母亲更年轻、受教育程度更低，就业的较少，并且生活环境更拥挤。64%的原住民婴儿和40%的非原住民婴儿接触过环境烟草烟雾。早期咨询、在开展研究的同时提供服务、让原住民作为研究团队的积极成员参与以及给予适当认可将有助于确保研究的成功完成。
