ERA Medical Peer Reviewed Papers/Journal Articles

Impact of Domestic Violence and Drug Abuse in Pregnancy on Maternal Attachment and Infant Temperament in Teenage Mothers in the Setting of Best Clinical Practice

Julie A. Quinlivan et al. — Wed, 28 Apr 2010 19:12:03 PDT

We examined whether the prenatal detection of family violence and initiation of a comprehensive prenatal individualised care program could ameliorate the impact of family violence on maternal attachment to her infant at 6-months of age. An assessment of domestic violence was established for each subject at the 1^st antenatal visit and women were classified as being exposed to domestic violence in pregnancy (EDV) or as being not exposed to domestic violence. Outcomes were determined 6 months postpartum. Of 173 consecutive women who met the eligibility criteria, consent was obtained from 150 (87% response). Women who had been subjected to domestic violence showed reduced overall attachment scores to their infants. Following multivariate analysis, drug use in pregnancy and domestic violence showed a significant independent effect on maternal attachment. Drug abuse and domestic violence were also associated with an increase in the easy-difficult scale of infant temperament. Thus, despite excellence in prenatal care, drug abuse and domestic violence were associated with poorer maternal attachment and assessment of infant temperament, suggesting that additional interventions are still required. [ABSTRACT FROM AUTHOR]

Psychologic Changes After a Gynecologic Cancer

Rodney W. Petersen et al. — Tue, 27 Apr 2010 23:44:14 PDT

Aim: The aim of this study was to explore the wider psychologic symptomatology experienced by women with a new diagnosis of a gynecologic cancer at the point of diagnosis and 6 weeks later.

Methods: A prospective cohort study was carried out with ethics committee approval and informed consent. Women were recruited from three tertiary hospitals in Australia over an 8-month period. In order to cover a diverse range of potential symptomatology, we utilized the Hopkins Symptom Checklist (HSCL)-90, which covers 90 separate psychologic symptoms that can then be coded into eight domains. Women also completed questions relating to their perceived level of social support, and demographic data were collated separately. Results: Key findings were that levels of symptomatology remained uniform across the first 6 weeks following the diagnosis of the cancer regardless of the site of the cancer. Across the spectrum of symptomatology domains, the median scores were all higher in women with poor social supports compared with those with higher social support levels at 6 weeks. Statistically significant differences were observed in the domains of phobic-anxiety, retarded depression, and agitated depression at 6 weeks’ follow up.

Conclusion: Women with a new diagnosis of a gynecologic cancer experience diverse psychologic symptomatology. Symptoms persist over the first 6 weeks and are higher in women with poor social supports. Screening of women for adequate social support structure and targeted interventions to resolve symptomatology need to be tailored to the type of symptoms experienced.

Prevalence of Chlamydia Trachomatis in a Public Colposcopy Clinic Population

Rodney W. Petersen et al. — Sun, 18 Apr 2010 21:03:57 PDT

Background: Chlamydia trachomatis is a major public health issue, with notifications of this sexually transmitted disease continuing to rise in Australia. Women attending colposcopy clinics are referred for treatment of cervical abnormalities often associated with human papilloma virus (HPV) infection. There is evidence that women who have acquired one sexually transmitted infection, such as HPV, are at higher risk of acquiring another. Women attending colposcopy clinics may therefore be at risk of undiagnosed infection with C. trachomatis.

Aim: To determine the prevalence of C. trachomatis in women attending a public metropolitan colposcopy clinic in Victoria.

Methods: A cross-sectional study was performed. Institutional ethics committee approval and informed consent were obtained. Consecutive women attending the colposcopy clinic completed a questionnaire and had a swab collected from the endocervix for analysis by polymerase chain reaction for C. trachomatis. Positive screens were treated in accordance with best practice. Data were analysed with Minitab Version 2004 (Minitab Inc, State College, PA, USA).

Results: Of 581 women approached to participate in the trial, consent was obtained from 568 women (98%) and final outcome data was available on 560 women (99%). The overall rate of chlamydial infection was 2.1% (95% CI 1.5–2.7%). However, in women aged 25 years or less the rate was 5.8% (95% CI 3.8–7.8%) and in women over 25 years it was only 0.9% (95% CI 0.4–1.4%). Apart from age, no other demographic factor was significantly associated with chlamydial infection.

Conclusion: Although the prevalence of chlamydial infection in the colposcopy clinic population as a whole does not warrant a policy for routine screening, screening directed at women aged 25 years or less would gain the greatest yields in terms of cost efficacy. Such a policy should be implemented as standard practice.

Managing Back Pain in Pregnancy Using a Support Garment: A randomised trial

S M. Kalus et al. — Sun, 18 Apr 2010 19:52:28 PDT

Objective: Large population studies have shown that low back pain affects about 50% of pregnant women. The aim of this study was to determine whether the use of the BellyBra® in pregnant women with back pain is associated with changes in assessments of pain severity, physical activity and satisfaction with life after 3 weeks of intervention compared with tubigrip, a more generic form of support.

Design: Randomised controlled trial.

Setting: A tertiary referral hospital in Australia.

Population: Women between 20 and 36 weeks of pregnancy with lumbar back or posterior pelvic pain.

Methods: Participants were randomised to the BellyBra® (the study device) or to tubigrip (the control) by means of computer-generated numbered, sealed, opaque envelopes.

Main outcome measures: The primary outcomes were pain severity and physical activity, and the secondary outcome was satisfaction with life.

Results: One hundred and fifteen women consented to participate in the trial. Mean visual analogue scale scores of pain severity decreased from 6.1 to 4.5 in the study device group (P= 0.001) and from 6.0 to 4.7 in the control group (P= 0.003). There was no significant difference between the groups in this outcome (P= 0.61). However, the study device group demonstrated a significantly greater reduction in Likert scale assessments of the impact of back pain on sleeping (P= 0.007), getting up from a sitting position (P= 0.02) and walking (P= 0.001) than the control group. There was also a significant reduction in the use of analgesic medication in the study group (P= 0.01).

Conclusion: The BellyBra® and tubigrip were both associated with a reduction in the severity of pregnancy-related low back pain. The BellyBra® was more effective than tubigrip, however, in alleviating the impact of pain on a number of physical activities that constitute daily life.

Wolinella succinogenes Response to Ox-Bile Stress

Bernice M. Tan et al. — Thu, 08 Apr 2010 21:42:43 PDT

The bacterium Wolinella succinogenes is the only known species of its genus. It was first isolated from cow ruminal fluid, and in cattle, it dwells in the reticulum and rumen compartments of the stomach. The global protein response of W. succinogenesto ox-bile was investigated with the aim to understand bile-tolerance mechanisms of the bacterium. Bacteria were grown in liquid media supplemented with different bile concentrations to determine its effects on growth and morphology. Proteomic analyses served to identify 14 proteins whose expression was modulated by the presence of 0.2% bile. Quantitative real-time PCR analyses of the expression of selected genes were employed to obtain independent confirmation of the proteomics data. Proteins differentially expressed revealed metabolic pathways involved in the adaptation of W. succinogenes to bile. The data suggested that bile stress elicited complex physiological responses rather than just specific pathways, and identified proteins previously unknown to be involved in the adaptation of bacteria to bile.

Effects of Helicobacter hepaticus on the proteome of HEp-2 cells

Arinze S. Okoli et al. — Wed, 07 Apr 2010 22:00:21 PDT

Helicobacter hepaticus infects the bowel and biliary tree of several animals, producing inflammation. Colonisation of mouse livers can induce hepatocellular carcinomas. The effects of H. hepaticus on the proliferation and global protein expression of human HEp-2 cells were studied by examining the changes in the protein profiles of cells exposed to the bacterium. HEp-2 cells were grown for four days under a microaerobic atmosphere or under the same conditions in co-cultures with H. hepaticus at various inoculum densities. Enlargement, distension and elongation of HEp-2 cells were observed in co-cultures with H. hepaticus. The number of live cells declined by only an order of magnitude at bacterial inocula of ∼10⁹ cfu/ml, but were reduced to less than 10³ cells/ml at ∼10¹⁰ cfu/ml bacteria inocula. Protein expression by HEp-2 cells was investigated employing two-dimensional gel electrophoresis. In cells grown with or without bacteria, 17 differentially expressed proteins were identified by tandem mass spectrometry. These proteins participated in several biological functions including amino acid metabolism, cell growth and proliferation, stress response, protein translation and modification, etc. The onset of a catastrophic killing of HEp-2 cells at a bacterial density of ∼10⁹ cfu/ml suggested a multimodal action for H. hepaticus infection, and the modulation of the expression of proteins involved in different biological functions showed that the presence of H. hepaticus has broad effects on the physiology of HEp-2 cells.

Expression of the developmental Sonic hedgehog (Shh) signalling pathway is up-regulated in chronic lung fibrosis and the Shh receptor patched 1 is present in circulating T lymphocytes

Gareth A. Stewart et al. — Tue, 30 Mar 2010 20:24:34 PDT

During pulmonary development, Sonic hedgehog (Shh) and transforming growth factor β1 (TGF-β1) signalling both contribute to branching morphogenesis. In interstitial lung disease, the complex alveolar structure of the lung is disrupted and remodelled, which leads to fibrosis, loss of respiratory surface, morbidity, and mortality. It is well documented that TGF-β1 is involved in fibrosis. However, little is known about Shh signalling in damaged epithelia. This study examined whether or not components of the Shh signalling pathway, as well as TGF-β1, are expressed in human fibrotic lung disease (cryptogenic fibrosing alveolitis and bronchiectasis) and in murine experimental models of fibrotic and non-fibrotic chronic pulmonary inflammation. Using immunohistochemistry, it was observed that Shh, like TGF-β1, is up-regulated in epithelial cells at sites of fibrotic disease but not nonfibrotic inflammation. The Shh receptor patched was detected in infiltrating mononuclear cells and alveolar macrophages, as well as normal resting peripheral blood T lymphocytes. Neither Shh nor patched is expressed by hyperproliferative goblet cells in inflammatory epithelium. This study demonstrates that patched is present in human peripheral CD4 and CD8 lymphocytes at both protein and mRNA levels. Taken together, these results suggest that components of the highly conserved Shh signalling pathway may play a role in the remodelling of damaged pulmonary epithelium and that damaged epithelium and cells of the immune system may communicate via this pathway.

A case study of the evaluation of a public health intervention

Bradley Forssman et al. — Tue, 30 Mar 2010 18:06:23 PDT

Large public health interventions to control infectious disease outbreaks are common, but rigorous evaluation to improve the quality and effectiveness of these is rarely undertaken. Following a large community-based clinic to prevent a hepatitis A outbreak, a multifaceted and multidisciplinary evaluation was conducted involving consumers, health professionals and industry partners. The results of this evaluation were used to produce practical operational guidelines for the planning and conduct of future interventions. These guidelines have been distributed to all public health units in New South Wales and may be included in the next edition of the NSW Health notifiable diseases manual. The evaluation approach can be applied to all public health interventions across NSW and Australia to assist in the development of operational guidelines, in order to increase the quality of public health action in outbreak prevention.

Factors affecting mothers’ knowledge of genetic screening

Christine Suriadi et al. — Mon, 29 Mar 2010 20:11:29 PDT

Objective: To evaluate mothers’ knowledge of terms used in genetic counselling and their participation in Down syndrome and newborn screening.

Setting: An obstetric tertiary referral hospital in Australia. Population: A total of 232 consecutive women delivering a liveborn baby.

Methods: Participants were interviewed within 24 h of blood being taken from their baby by the heel prick test for the newborn screen. Non-English speaking women were included using medical interpreters. The questionnaire assessed knowledge of terms used in genetic counselling for Down syndrome and newborn screening. A second researcher, blinded to subject demographics, scored questionnaires using a predefined scoring system.

Main outcome: Demographic factors affecting knowledge and knowledge of Down syndrome and newborn screening test uptake.

Results: A total of 200 women consented to participate in the present study (86.2%). New mothers had limited knowledge of genetic disease (median: 4/15, interquartile range: 2–8). In multivariate analysis, Caucasian ethnic background, English as the first language, higher level of education, and knowledge of family history were significant associations of higher knowledge scores (all P < 0.006). The majority of participants who had Down syndrome testing (54%) were aware that they had done so (51.5%; κ = 90.9%). In multivariate analysis age >35 years, English as a first language and non-married status were associated with increased test uptake. In contrast, only 26.5% of participants knew that their child had undergone the newborn screen, despite it having been carried out on 98% of babies (κ = 1.5%).

Conclusion: Newborn screening practices may need to be reviewed.

Early stress predicts age at menarche and first birth, adult attachment and expected lifespan

James S. Chisholm et al. — Thu, 25 Mar 2010 22:30:31 PDT

Life history theory suggests that in risky and uncertain environments the optimal reproductive strategy is to reproduce early in order to maximize the probability of leaving any descendants at all. The fact that early menarche facilitates early reproduction provides an adaptationist rationale for our first two hypotheses: that women who experience more risky and uncertain environments early in life would have (1) earlier menarche and (2) earlier first births than women who experience less stress at an early age. Attachment theory and research provide the rationale for our second two hypotheses: that the subjective early experience of risky and uncertain environments (insecurity) is (3) part of an evolved mechanism for entraining alternative reproductive strategies contingent on environmental risk and uncertainty and (4) reflected in expected lifespan. Evidence from our pilot study of 100 women attending antenatal clinics at a large metropolitan hospital is consistent with all four hypotheses: Women reporting more troubled family relations early in life had earlier menarche, earlier first birth, were more likely to identify with insecure adult attachment styles, and expected shorter lifespans. Multivariate analyses show that early stress directly affected age at menarche and first birth, affected adult attachment in interaction with expected lifespan, but had no effect on expected lifespan, where its original effect was taken over by interactions between age at menarche and adult attachment as well as age at first birth and adult attachment. We discuss our results in terms of the need to combine evolutionary and developmental perspectives and the relation between early stress in general and father absence in particular.

Domestic violence, single parenthood, and fathers in the setting of teenage pregnancy

Louisa H. Tan et al. — Thu, 25 Mar 2010 21:13:34 PDT

Purpose: To explore the relative impact of demographic and early interpersonal family relationships as associations of fatherhood where the mother is a teenager, compared to where the mother is over 20 years of age.

Method: A prospective cross-sectional cohort study was undertaken. Institutional ethics committee approval and informed consent were obtained. Data were analyzed from interviews with consecutive males about to become fathers where the mother was aged less than 20 years (teenage) and compared to information from males about to become fathers where the mother was aged 20 years or more (control). Subjects were interviewed to obtain information covering their early life experiences, demographic information, drug use, opinion of the pregnancy, and future planning.

Results: In multivariate analysis, and after controlling for family income and education, the following factors had a significant independent association with fatherhood in the setting of teenage pregnancy: a history of parental separation/divorce in early childhood, exposure to family violence in early childhood, and illicit drug use (ever or in pregnancy).

Conclusions: Fathers, in the setting of teenage pregnancy, are more likely to report adverse early family relationships, such as exposure to domestic violence or parental separation or divorce. As such, these fathers may lack a positive role model for parenting and fatherhood.

Diversity of risk factors for stroke: the putative roles and mechanisms of depression and air pollution

Jacques Joubert et al. — Thu, 25 Mar 2010 20:20:01 PDT

Several conventional risk factors for stroke and cerebrovascular disease, such as hypertension, smoking, and atrial fibrillation, are widely recognized. Correct management of these modifiable factors significantly reduces stroke risk. We review the research evidence that depressive symptoms and increased atmospheric pollution are associated with an increased risk of stroke, and outline putative mechanisms that may account for these associations. The data on depression and stroke risk strongly indicate the need for treatment intervention studies. The design and implementation of intervention studies related to air pollution requires better understanding of the pathophysiologic mechanisms linking exposures to the onset of stroke.

This issue of Environmental Neurology - Proceedings of the Meetings of the Environmental Neurology Club, held in Paris, France, 2-3 December 2005 and in Metz, France, 7 February 2007, under the aegis of the French Society of Neurology, The University of Metz, and the Environmental Neurology Research Group of the World Federation of Neurology (ENRG-WFN)

Differences in learning objectives during the labour ward clinical attachment between medical students and their midwifery preceptors

Julie A. Quinlivan et al. — Thu, 25 Mar 2010 00:45:53 PDT

Objectives: Midwives have been actively involved in the clinical teaching of medical students for many years. However, this role has received little attention and limited research has been conducted into either its efficacy or the development of strategies to maximise the potential of such teaching opportunities. We examined medical student and midwifery preceptor attitudes towards students’ learning objectives during the labour ward placement.

Methods: A descriptive cross-sectional survey of midwifery preceptors and medical students was undertaken. The setting was an Australian teaching and tertiary referral hospital. The questionnaire contained questions about strategies to improve medical student involvement on the labour ward and opinions towards core competencies of the student curriculum.

Results: Of 94 questionnaires issued to midwifery preceptors, 63 were returned (response rate 67%). Of 130 questionnaires issued to medical students, 93 were returned (response rate 72%). Major differences in the expectations of students and midwifery preceptors were identified. Only 17% of midwives felt medical students should be involved in helping mothers with breastfeeding, and some no longer saw a role for students in delivering babies or performing well baby checks. These differences in opinions led to student dissatisfaction with their obstetric learning experience.

Conclusion: Educators need to ensure that students and midwifery preceptors identify common learning objectives. Failure to address these differences may lead to poor interdisciplinary relationships.

Demographic variables routinely collected at colposcopic examination do not predict who will default from conservative management of cervical intraepithelial neoplasia 1

Julie A. Quinlivan et al. — Thu, 25 Mar 2010 00:18:48 PDT

Objective: As a result of the low incidence of progression from low grade epithelial abnormalities to cervical intraepithelial neoplasia (CIN) 3 or cervical cancer, a conservative approach to management is supported, especially in young women. Loss to follow-up is a recognised problem with a conservative approach however, with women defaulting known to experience higher rates of cancer.

Aim: To determine if any routinely collected demographic variables could predict which Australian women would subsequently default from care having initially elected to have conservative management of CIN 1 lesions.

Methods: Prospectively collected data was audited on 279 women with a colposcopically directed biopsy diagnosis of CIN 1, confirmed on external review, who were enroled by their own choice into a conservative management program and monitored until a definitive lesion outcome was determined. Women who defaulted from follow-up and were lost to care providers despite follow-up appointments and reminder letters were compared to women who completed follow-up with either lesion resolution or progression requiring treatment, to establish if there were any demographic variables to predict default from care.

Results: Fifty-two (18.5%) women subsequently defaulted from follow-up. There were no significant differences in age, parity, proportion of women who were pregnant at diagnosis, smoking status, immunosuppressed or had a ‘human papillomavirus (HPV) effect’ reported on Pap-smear or colposcopic examination.

Conclusion: We cannot easily identify a subgroup of women who are more likely to default from follow-up of CIN 1 using routinely collected demographic data. Default from follow-up is a major risk with conservative approaches and further research to reduce default rates are required.

Consensus statement: Menstrual and contraceptive management in women with an intellectual disability

Eleanor Atkinson et al. — Tue, 23 Mar 2010 20:25:25 PDT

Chairman’s foreword

A National Consensus meeting was held on 28 October 2001 to discuss the evidence-based management of menstrual problems in women with intellectual disabilities. Participants were all active members of The Australian Society of Paediatric and Adolescent Gynaecology. Prior to the meeting, an extensive literature review was undertaken to review best clinical practice. In addition, members consulted with State based Guardianship Boards or Family Courts to obtain information relevant to individual states. The outcomes listed in the present document were achieved by complete consensus of participants.

Consensus statement: The management of congenital genital tract anomalies in women

Eleanor Atkinson et al. — Tue, 23 Mar 2010 19:39:36 PDT

Chairman’s foreword

A National Consensus meeting was held on 28 October 2001 to discuss evidence-based management of vaginal agenesis. Participants were all active members of The Australian Society of Paediatric and Adolescent Gynaecology. Prior to the meeting, an extensive literature review was undertaken to review best clinical practice. The outcomes listed in the present document were achieved by complete consensus of participants.

Changing faces: a review of infectious disease screening of refugees by the Migrant Health Unit, Western Australia in 2003 and 2004

Jennifer A. Martin et al. — Tue, 23 Mar 2010 19:09:18 PDT

Objective: To document demographic characteristics and prevalence of infectious diseases in refugees and humanitarian entrants attending the Migrant Health Unit (MHU) in Perth for health assessment from 1 January 2003 to 31 December 2004.

Design: Retrospective case series.

Participants: All refugees and humanitarian entrants arriving in Western Australia on subclass 200 and subclass 202 visas who were invited to attend the MHU.

Main outcome measures: Demographic details, results of Mantoux tests, and blood and faecal tests for infectious diseases and parasites.

Results: WA accepted 2781 refugee and humanitarian entrants in 2003 and 2004; 2617 were invited to attend the MHU, and 2111 (81%) actually attended for screening. Over three-quarters arrived from Africa. Overall, 25% had a positive Mantoux test result, 5% were carriers of hepatitis B, and 5% had positive serological test results for syphilis. People arriving from sub-Saharan Africa had the highest prevalence of most diseases, with 8% having malaria, 7% schistosomiasis, 5% hookworm, and 2% strongyloidiasis.

Conclusion: Disease prevalence varied greatly between refugees from different countries and was particularly high in those arriving from sub-Saharan Africa, the origin of most of Australia’s refugee and humanitarian entrants. These data support the need for refugees and humanitarian entrants from countries with high rates of disease to have access to a comprehensive postarrival medical assessment and appropriate follow-up health care. Health services must provide beneficial and cost-effective services that protect the health of both individual refugees and the wider community.

Bacterial endotoxin – a trigger factor for alcoholic pancreatitis? Evidence from a novel, physiologically relevant animal model

Alain Vonlaufen et al. — Mon, 22 Mar 2010 21:45:14 PDT

Background and Aims: This study examined the possible role of endotoxinemia (from increased gut permeability) as an additional trigger factor for overt pancreatic disease and as a promoter of chronic pancreatic injury in alcoholics by using a rat model of chronic alcohol feeding and in vitro experiments with cultured pancreatic stellate cells (PSCs), the key mediators of pancreatic fibrosis.

Methods: In the in vivo model, Sprague-Dawley rats fed isocaloric Lieber-DeCarli liquid diets ± alcohol for 10 weeks were challenged with a single dose or 3 repeated doses of the endotoxin lipopolysaccharide (LPS) and the pancreas was examined. In the in vitro studies, rat PSCs were assessed for activation on exposure to LPS ± ethanol. The expression of LPS receptors TLR4 and CD14 also was assessed in rat and human PSCs.

Results: In the in vivo model, single or repeated LPS challenge resulted in significantly greater pancreatic injury in alcohol-fed rats compared with rats fed the control diet without alcohol. Notably, repeated LPS injections caused pancreatic fibrosis in alcohol-fed rats, but not in rats fed the control diet. In the in vitro studies, PSCs were activated by LPS. Alcohol + LPS exerted a synergistic effect on PSC activation. Importantly, both rat and human PSCs expressed TLR4 and CD14.

Conclusions: This study describes, for the first time, a clinically relevant animal model of alcohol-related pancreatic injury and provides strong in vivo and in vitro evidence that suggests that LPS is a trigger factor in the initiation and progression of alcoholic pancreatitis.

Campylobacter jejuni response to ox-bile stress

Edward M. Fox et al. — Wed, 17 Mar 2010 21:29:14 PDT

Campylobacter jejuni is a pathogen that colonizes the intestinal tract of humans and some animals. The in vitro responses of the bacterium to ox-bile were studied using proteomics to understand the molecular mechanisms employed by C. jejuni to survive bile stress. Its in vitro tolerance to bile was determined by growing the bacterium for 18 h in liquid cultures containing different bile concentrations. Significant growth inhibition was observed in the presence of 2.5% bile, and a decrease of 1.12 log units was measured at a bile concentration of 5%. Protein expression profiles of bacteria grown with and without bile were compared using two-dimensional polyacrylamide gel electrophoresis. Proteins with differential intensities greater than two-fold were identified using tandem mass spectrometry. Nuclear magnetic resonance spectroscopy and spectrophotometry were employed to measure enzyme activities in cell extracts from bacteria grown with and without bile. Together with proteins known to be involved in C. jejuni bile tolerance, the presence of bile modulated the expression of proteins such as elongation factors, ferritin, chaperones, ATP synthase and others, previously unknown to be implicated in the response of the bacterium to bile.

Better late than never: a national approach to trachoma control

Donna B. Mak — Tue, 16 Mar 2010 22:24:10 PDT

In line with its Vision 2020 initiative, the World Health Organization adopted a resolution to eliminate blinding trachoma by 2020. To achieve this goal, WHO recommends the SAFE strategy (Surgery, Antibiotics, Facial cleanliness and Environmental improvement) for countries implementing trachoma control programs. Australia is the only developed country of the 57 trachoma endemic countries listed by WHO. (1)

Trachoma was endemic and a significant cause of blindness in many parts of the Western world, including Australia, until the early 1900s. As housing, hygiene and living conditions improved, trachoma disappeared from most parts of Australia.2 However, these improvements are yet to occur in remote Aboriginal populations in Australia, where trachoma is still endemic.