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Sahle BW, Banks E, Williams R, Joshy G, Jennings G, Craig JC, Larkins NG, Eades F, Ivers RQ, Eades S. Blood pressure in young Aboriginal and Torres Strait Islander people: analysis of baseline data from a prospective cohort study. Med J Aust 2025; 222:91-101. [PMID: 39663833 PMCID: PMC11787810 DOI: 10.5694/mja2.52558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/18/2024] [Indexed: 12/13/2024]
Abstract
OBJECTIVE To assess the distribution of blood pressure levels and the prevalence of hypertension and pre-hypertension in young Indigenous people (10-24 years of age). STUDY DESIGN Prospective cohort survey study (Next Generation: Youth Wellbeing Study); baseline data analysis. SETTING, PARTICIPANTS Aboriginal and Torres Strait Islander people aged 10-24 years living in regional, remote, and urban communities in Central Australia, Western Australia, and New South Wales; recruitment: March 2018 - March 2020. MAIN OUTCOME MEASURES Blood pressure categorised as normal, pre-hypertension, or hypertension using the 2017 American Academy of Pediatrics guidelines (10-17 years) or 2017 American College of Cardiology/American Heart Association guidelines (18-24 years); associations of demographic characteristics and health behaviours with hypertension and pre-hypertension, reported as relative risk ratios (RRRs) with 95% confidence intervals (CIs). RESULTS Complete data were available for 771 of 1244 study participants (62%); their mean age was 15.4 years (standard deviation [SD], 3.9 years), 438 were girls or young women (56.8%). Mean systolic blood pressure was 111.2 mmHg (SD, 13.7 mmHg), mean diastolic blood pressure 66.3 mmHg (SD, 11.0 mmHg). Mean systolic blood pressure was higher for male than female participants (mean difference, 6.38 mmHg; 95% CI, 4.60-8.16 mmHg), and it increased by 1.06 mmHg (95% CI, 0.76-1.36 mmHg) per year of age. Mean systolic blood pressure increased by 0.42 mmHg (95% CI, 0.28-0.54 mmHg) and diastolic blood pressure by 0.46 mmHg (95% CI, 0.35-0.57 mmHg) per 1.0 kg/m2 increase in body mass index. Ninety-one participants (11.8%) had blood pressure readings indicating pre-hypertension, and 148 (19.2%) had hypertension. The risks of pre-hypertension (RRR, 4.22; 95% CI, 2.52-7.09) and hypertension (RRR, 1.93; 95% CI, 1.27-2.91) were higher for male than female participants; they were greater for people with obesity than for those with BMI values in the normal range (pre-hypertension: RRR, 2.39 [95% CI, 1.26-4.55]; hypertension: RRR, 3.20 [95% CI, 1.91-5.35]) and for participants aged 16-19 years (pre-hypertension: 3.44 [95% CI, 1.88-6.32]; hypertension: RRR, 2.15 [95% CI, 1.29-3.59]) or 20-24 years (pre-hypertension: 4.12 [95% CI, 1.92-8.85]; hypertension: RRR, 4.09 [95% CI, 2.24-7.47]) than for those aged 10-15 years. CONCLUSIONS Blood pressure was within the normal range for most young Indigenous people in our study, but one in three had elevated blood pressure or hypertension. Community-level, culturally safe approaches are needed to avoid the early onset of cardiovascular risks, including elevated blood pressure.
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Affiliation(s)
| | - Emily Banks
- Centre for Public Health Data and Policy, National Centre for Epidemiology and Population HealthAustralian National UniversityCanberraACT
| | | | - Grace Joshy
- Centre for Public Health Data and Policy, National Centre for Epidemiology and Population HealthAustralian National UniversityCanberraACT
| | | | | | - Nicholas G Larkins
- Perth Children's HospitalPerthWA
- The University of Western AustraliaPerthWA
| | | | - Rebecca Q Ivers
- University of New South WalesSydneyNSW
- The George Institute for Global HealthUNSW SydneySydneyNSW
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Spierings S, Oguoma VM, Shakeshaft A, Walker J, Toombs M, Ward JS. Knowledge about COVID-19 vaccines among Aboriginal and Torres Strait Islander people, and attitudes to and behaviours regarding COVID-19 and influenza vaccination: a survey. Med J Aust 2025; 222:30-37. [PMID: 39655627 PMCID: PMC11725265 DOI: 10.5694/mja2.52551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/07/2024] [Indexed: 01/13/2025]
Abstract
OBJECTIVES To assess Aboriginal and Torres Strait Islander people's knowledge about coronavirus disease 2019 (COVID-19) vaccines, and their attitudes to and behaviours regarding COVID-19 and influenza vaccinations. STUDY DESIGN Web-based survey. SETTING Australia (excluding the Northern Territory), 1 October 2021 to 31 May 2022. PARTICIPANTS Convenience sample of Aboriginal and Torres Strait Islander people aged 16 years or older living in Australia. MAIN OUTCOME MEASURES Proportions of respondents who reported knowledge about COVID-19 vaccines, and attitudes to and behaviours regarding COVID-19 and influenza vaccinations. RESULTS A total of 530 people provided valid survey responses; their median age was 27 years (interquartile range, 23-38 years), 255 (48%) were from urban areas, and 309 (58%) were men. Of the 480 participants (91%) who provided complete survey questions (including sex and location information), larger proportion of men than women believed COVID-19 vaccines were very or extremely trustworthy (219, 79% v 124, 61%) and very or extremely effective (212, 76% v 138, 68%). The prevalence of COVID-19 vaccination was lower among respondents aged 60 years or older than among those aged 16-29 years (adjusted prevalence ration [PR], 0.81; 95% confidence interval [CI], 0.66-0.99). After adjusting for socio-demographic factors, the association between intention to receive the influenza vaccine and receiving the COVID-19 vaccine was statistically significant (adjusted PR, 1.18; 95% CI, 1.09-1.27). CONCLUSION The high levels of trust in COVID-19 vaccines and their effectiveness indicate that Aboriginal and Torres Strait Islander people are confident about their safety and efficacy and understand the importance of vaccination. The findings also highlight a positive attitude to vaccination and a commitment to preventive health measures among Aboriginal and Torres Strait Islander people.
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Affiliation(s)
- Shea Spierings
- Poche Centre for Indigenous HealthUniversity of QueenslandBrisbaneQLD
- ARC Centre of Excellence for Indigenous Futuresthe University of QueenslandBrisbaneQLD
| | - Victor M Oguoma
- Poche Centre for Indigenous HealthUniversity of QueenslandBrisbaneQLD
| | | | | | | | - James S Ward
- ARC Centre of Excellence for Indigenous Futuresthe University of QueenslandBrisbaneQLD
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Stevens J, Firth W, Dooley L, Longbottom H, Wills K, Egger G, Morgan B. Continuous Glucose Monitors and Programmed Shared Medical Appointments in Managing Type 2 Diabetes Mellitus Among First Nation Women in Australia: A Co-Designed Feasibility Study. Am J Lifestyle Med 2025:15598276241312084. [PMID: 39802907 PMCID: PMC11713975 DOI: 10.1177/15598276241312084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 12/15/2024] [Accepted: 12/20/2024] [Indexed: 01/16/2025] Open
Abstract
First Nations women in Australia diagnosed with type 2 diabetes, co-designed and attended a programmed shared medical appointment that included continuous glucose monitors and culturally responsive food appreciation activities over 8 weekly sessions to improve glycaemic control. The project was a single site, longitudinal change from baseline, mixed methods, feasibility study using HbA1c as the primary outcome measure. Secondary outcome measures included, weight, metabolic health-related blood panels, CGM, Blood Glucose Levels (BGL) time-in-range percentage, Patient Activation Measure (PAM) and Problem Areas In Diabetes (PAID) tools and client satisfaction survey and semi focussed interviews. Forty participants commenced and twenty-five participants completed the program (62,5%). Of the completing participants the mean HbA1c had an absolute reduction of 0.7 percentage points ( from baseline to program completion, P = .013). Eighteen (75%) reduced HbA1c and maintained some reduction for 12 months. Seven (28%) achieved remission, HbA1c <6.4% (46 mmol/l) maintained for 12 months. There were statistically significant improvements in weight, systolic blood pressure, liver enzymes, BGL time-in-range, PAM and PAID scores. It is feasible to use programmed shared medical appointments incorporating CGM aiming to improve glycaemic control and other metabolic measures of health among First Nations women in Australia. Trial Registration: The project was registered with the Australian and New Zealand Clinical Trial Registry ACTRN12622000650796. The trial web page = https://www.anzctr.org.au/ACTRN12622000650796.aspx.
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Affiliation(s)
- John Stevens
- Australasian Society of Lifestyle Medicine (ASLM) and Discipline Lead Lifestyle Medicine, Southern Cross University (SCU), Lismore, NSW, Australia
| | - Willow Firth
- Waminda, South Coast Women’s Aboriginal Health and Well-Being Organisation, Nowra, NSW, Australia
| | - Lynne Dooley
- Waminda, South Coast Women’s Aboriginal Health and Well-Being Organisation, Nowra, NSW, Australia
| | - Hayley Longbottom
- Waminda, South Coast Women’s Aboriginal Health and Well-Being Organisation, Nowra, NSW, Australia
| | - Kalinda Wills
- Waminda, South Coast Women’s Aboriginal Health and Well-Being Organisation, Nowra, NSW, Australia
| | - Garry Egger
- Australasian Society of Lifestyle Medicine (ASLM) and Discipline Lead Lifestyle Medicine, Southern Cross University (SCU), Lismore, NSW, Australia
| | - Bob Morgan
- Australasian Society of Lifestyle Medicine (ASLM), University of Newcastle, Newcastle, NSW, Australia
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Ashraf MA, Raza MA, Imran A, Amjad MN. Next-generation vaccines for influenza B virus: advancements and challenges. Arch Virol 2025; 170:25. [PMID: 39762648 DOI: 10.1007/s00705-024-06210-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 08/07/2024] [Indexed: 02/08/2025]
Abstract
To battle seasonal outbreaks of influenza B virus infection, which continue to pose a major threat to world health, new and improved vaccines are urgently needed. In this article, we discuss the current state of next-generation influenza B vaccine development, including both advancements and challenges. This review covers the shortcomings of existing influenza vaccines and stresses the need for more-effective and broadly protective vaccines and more-easily scalable manufacturing processes. New possibilities for vaccine development have emerged due to recent technical developments such as virus-like particle (VLP) platforms, recombinant DNA technologies, and reverse genetics. By using these methods, vaccines can be developed that elicit stronger and longer-lasting immune responses against various strains of influenza B virus. Vaccines may be more effective and immunogenic when adjuvants and new delivery mechanisms are used. Progress has been made in the development of influenza B vaccine mRNA vaccines, nanoparticle-based vaccines, and vector-based vaccines. However, there are still several obstacles to overcome before next-generation influenza B vaccines can be widely used, including the challenge of antigenic drift, the extinction of the B/Yamagata lineage, and difficulties in strain selection. There are also other challenges related to public acceptance, vaccine distribution, manufacturing complexity, and regulations. To overcome these challenges, scientists, politicians, and pharmaceutical firms must work together to expedite the development and licensing of vaccines and the establishment of immunization programs. The need for constant monitoring and quick adaptation of vaccines to match the currently circulating strains is further highlighted by the appearance of novel influenza B virus variants. To be ready for future pandemics and influenza B outbreaks, we need better vaccines and better monitoring systems.
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Affiliation(s)
- Muhammad Awais Ashraf
- CAS Key Laboratory of Molecular Virology & Immunology, Institutional Center for Shared Technologies and Facilities, Pathogen Discovery and Big Data Platform, Shanghai Institute of Immunity and Infection, Chinese Academy of Sciences, Yueyang Road 320, Shanghai, 200031, China.
- University of Chinese Academy of Sciences, Beijing, China.
| | - Muhammad Asif Raza
- CAS Key Laboratory of Molecular Virology & Immunology, Institutional Center for Shared Technologies and Facilities, Pathogen Discovery and Big Data Platform, Shanghai Institute of Immunity and Infection, Chinese Academy of Sciences, Yueyang Road 320, Shanghai, 200031, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Azka Imran
- University of Veterinary and Animal Sciences UVAS, Lahore, Pakistan
| | - Muhammad Nabeel Amjad
- CAS Key Laboratory of Molecular Virology & Immunology, Institutional Center for Shared Technologies and Facilities, Pathogen Discovery and Big Data Platform, Shanghai Institute of Immunity and Infection, Chinese Academy of Sciences, Yueyang Road 320, Shanghai, 200031, China
- University of Chinese Academy of Sciences, Beijing, China
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Lee AJ, Rainow S, Balmer L, Hutchinson R, Bryce S, Lewis M, Herron LM, Torzillo P, Stevens R, Kavanagh M, Wells L, Kenny I. Making it on the breadline - improving food security on the Anangu Pitjantjatjara Yankunytjatjara Lands, Central Australia. BMC Public Health 2024; 24:3087. [PMID: 39516793 PMCID: PMC11545495 DOI: 10.1186/s12889-024-20495-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/23/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND This longitudinal case study describes the efforts and impacts of community-controlled service organisations on the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands in Central Australia to tackle food security since the 1980s, with a focus on the last decade, particularly during a year of concerted action from mid-2018. METHODS The co-designed study comprised an interrupted time series with controls. Availability, affordability, accessibility and sales of foods in the community retail stores on the APY Lands were monitored regularly from 2014 to mid-2022, including by local research teams. Store nutrition policy was updated early 2018. For a year from mid-2018, of the eight communities with stores: (i) two were the focus for concerted intervention, including support from a locally based project officer to help implement the policy and action 105 community requests for nutrition activities (ii) three received usual support to implement the policy; and (iii) three were subject to 'business as usual'. From mid-2019, all communities/stores received usual service, from 2020 with some restrictions related to the COVID-19 pandemic. Results were compared over time, across different community/store groups and with controls. RESULTS In the 12 months from mid-2018, all food security metrics improved most in the two focus communities. Impacts were less marked in the communities without additional support to implement the revised nutrition policy, and even less apparent, although more varied, in the other three communities/stores. Dietary intake improved only in the two focus communities. In all communities from early 2020 most gains eroded due to impacts of the COVID-19 pandemic and other external stressors. Food security metrics, including price of healthy food, appeared more resilient in the focus communities, although diet quality worsened. At all times assessed, healthy diets were unaffordable for welfare-dependant households. CONCLUSIONS This co-designed study demonstrates the effectiveness of community-led approaches, confirming that it is possible to improve food security and diet in remote Aboriginal communities. However, sustained action and monitoring, dedicated resources and employment of local people are critical for success. Results also highlight that low incomes are a major barrier to food security.
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Affiliation(s)
- Amanda J Lee
- School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia.
| | - Stephan Rainow
- Nganampa Health Council, Alice Springs, Northern Territory, 0870, Australia
| | - Liza Balmer
- Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women's Council, Alice Springs, Northern Territory, 0870, Australia
| | - Rhiannon Hutchinson
- Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women's Council, Alice Springs, Northern Territory, 0870, Australia
| | - Suzanne Bryce
- Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women's Council, Alice Springs, Northern Territory, 0870, Australia
| | - Meron Lewis
- School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia
| | - Lisa-Maree Herron
- School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia
| | - Paul Torzillo
- The University of Sydney, Newtown, NSW, 2042, Australia
| | - Robert Stevens
- Mai Wiru Regional Stores Aboriginal Corporation, Alice Springs, Northern Territory, 0870, Australia
| | - Margaret Kavanagh
- Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women's Council, Alice Springs, Northern Territory, 0870, Australia
| | - Lisa Wells
- Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women's Council, Alice Springs, Northern Territory, 0870, Australia
| | - Ingrid Kenny
- Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women's Council, Alice Springs, Northern Territory, 0870, Australia
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Bush A, Byrnes CA, Chan KC, Chang AB, Ferreira JC, Holden KA, Lovinsky-Desir S, Redding G, Singh V, Sinha IP, Zar HJ. Social determinants of respiratory health from birth: still of concern in the 21st century? Eur Respir Rev 2024; 33:230222. [PMID: 38599675 PMCID: PMC11004769 DOI: 10.1183/16000617.0222-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/20/2024] [Indexed: 04/12/2024] Open
Abstract
Respiratory symptoms are ubiquitous in children and, even though they may be the harbinger of poor long-term outcomes, are often trivialised. Adverse exposures pre-conception, antenatally and in early childhood have lifetime impacts on respiratory health. For the most part, lung function tracks from the pre-school years at least into late middle age, and airflow obstruction is associated not merely with poor respiratory outcomes but also early all-cause morbidity and mortality. Much would be preventable if social determinants of adverse outcomes were to be addressed. This review presents the perspectives of paediatricians from many different contexts, both high and low income, including Europe, the Americas, Australasia, India, Africa and China. It should be noted that there are islands of poverty within even the highest income settings and, conversely, opulent areas in even the most deprived countries. The heaviest burden of any adverse effects falls on those of the lowest socioeconomic status. Themes include passive exposure to tobacco smoke and indoor and outdoor pollution, across the entire developmental course, and lack of access even to simple affordable medications, let alone the new biologicals. Commonly, disease outcomes are worse in resource-poor areas. Both within and between countries there are avoidable gross disparities in outcomes. Climate change is also bearing down hardest on the poorest children. This review highlights the need for vigorous advocacy for children to improve lifelong health. It also highlights that there are ongoing culturally sensitive interventions to address social determinants of disease which are already benefiting children.
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Affiliation(s)
- Andrew Bush
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK
| | - Catherine A Byrnes
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Starship Children's Health and Kidz First Hospital, Auckland, New Zealand
| | - Kate C Chan
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anne B Chang
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane and Menzies School of Health Research, Darwin, Australia
| | - Juliana C Ferreira
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Karl A Holden
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Stephanie Lovinsky-Desir
- Department of Pediatrics and Environmental Health Sciences, Columbia University Medical Center, New York, NY, USA
| | - Gregory Redding
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Varinder Singh
- Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Ian P Sinha
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Shearing T, Sivak L, Mejia G, Clinch N, O'Donnell K, Sinclair N, Kartinyeri J, Owen K, Clinch D, Morey K. A pilot place-based renal dialysis model of care responding to Aboriginal and Torres Strait Islander priorities in South Australia. Aust N Z J Public Health 2023; 47:100107. [PMID: 38070280 DOI: 10.1016/j.anzjph.2023.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/26/2023] [Accepted: 11/01/2023] [Indexed: 12/25/2023] Open
Affiliation(s)
- Toni Shearing
- Government of South Australia, Northern Adelaide Local Health Network, Australia
| | - Leda Sivak
- South Australian Health and Medical Research Institute, Wardliparingga Aboriginal Health Equity, Australia
| | - Gloria Mejia
- The University of Adelaide, Australian Research Centre for Population Oral Health (ARCPOH), Australia
| | | | - Kim O'Donnell
- The University of Adelaide, Aboriginal Kidney Kare Together Improving Outcomes Now (Akction2), Australia
| | - Nari Sinclair
- The University of Adelaide, Aboriginal Kidney Kare Together Improving Outcomes Now (Akction2), Australia
| | - Jared Kartinyeri
- The University of Adelaide, Aboriginal Kidney Kare Together Improving Outcomes Now (Akction2), Australia
| | - Kelli Owen
- The University of Adelaide, Aboriginal Kidney Kare Together Improving Outcomes Now (Akction2), Australia
| | - Douglas Clinch
- Government of South Australia, Southern Adelaide Local Health Network, Australia
| | - Kim Morey
- South Australian Health and Medical Research Institute, Wardliparingga Aboriginal Health Equity, Australia.
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Khatri RB, Assefa Y. Drivers of the Australian Health System towards Health Care for All: A Scoping Review and Qualitative Synthesis. BIOMED RESEARCH INTERNATIONAL 2023; 2023:6648138. [PMID: 37901893 PMCID: PMC10611547 DOI: 10.1155/2023/6648138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 08/03/2023] [Accepted: 10/07/2023] [Indexed: 10/31/2023]
Abstract
Background Australia has made significant progress towards universal access to primary health care (PHC) services. However, disparities in the utilisation of health services and health status remain challenges in achieving the global target of universal health coverage (UHC). This scoping review aimed at synthesizing the drivers of PHC services towards UHC in Australia. Methods We conducted a scoping review of the literature published from 1 January 2010 to 30 July 2021 in three databases: PubMed, Scopus, and Embase. Search terms were identified under four themes: health services, Australia, UHC, and successes or challenges. Data were analysed using an inductive thematic analysis approach. Drivers (facilitators and barriers) of PHC services were explained by employing a multilevel framework that included the proximal level (at the level of users and providers), intermediate level (organisational and community level), and distal level (macrosystem or distal/structural level). Results A total of 114 studies were included in the review. Australia has recorded several successes in increased utilisation of PHC services, resulting in an overall improvement in health status. However, challenges remain in poor access and high unmet needs of health services among disadvantaged/priority populations (e.g., immigrants and Indigenous groups), those with chronic illnesses (multiple chronic conditions), and those living in rural and remote areas. Several drivers have contributed in access to and utilisation of health services (especially among priority populations)operating at multilevel health systems, such as proximal level drivers (health literacy, users' language, access to health facilities, providers' behaviours, quantity and competency of health workforce, and service provision at health facilities), intermediate drivers (community engagement, health programs, planning and monitoring, and funding), and distal (structural) drivers (socioeconomic disparities and discriminations). Conclusion Australia has had several successes towards UHC. However, access to health services poses significant challenges among specific priority populations and rural residents. To achieve universality and equity of health services, health system efforts (supply- and demand-side policies, programs and service interventions) are required to be implemented in multilevel health systems. Implementation of targeted health policy and program approaches are needed to provide comprehensive PHC and address the effects of structural disparities.
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Affiliation(s)
- Resham B. Khatri
- Health Social Science and Development Research Institute, Kathmandu, Nepal
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
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Thompson F, Russell S, Quigley R, Sagigi B, Taylor S, McDonald M, Campbell S, Esterman A, Harriss LR, Miller G, Strivens E, McDermott R. Erratum: Potentially preventable dementia in a First Nations population in the Torres Strait and Northern Peninsula Area of North Queensland, Australia: a cross sectional analysis using population attributable fractions. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 37:100856. [PMID: 37693869 PMCID: PMC10485659 DOI: 10.1016/j.lanwpc.2023.100856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
[This corrects the article DOI: 10.1016/j.lanwpc.2023.100855.][This corrects the article DOI: 10.1016/j.lanwpc.2022.100532.].
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Affiliation(s)
- Fintan Thompson
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- University of South Australia, SA, Australia
| | - Sarah Russell
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Betty Sagigi
- Queensland Health, Torres and Cape Hospital and Health Service, Thursday Island, QLD, Australia
| | - Sean Taylor
- Top End Health Service, Northern Territory Government, Darwin, NT, Australia
| | - Malcolm McDonald
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | - Sandy Campbell
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, QLD, Australia
| | | | - Linton R. Harriss
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Gavin Miller
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
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Coombes J, Holland AJA, Ryder C, Finlay SM, Hunter K, Bennett-Brook K, Orcher P, Scarcella M, Briscoe K, Forbes D, Jacques M, Maze D, Porykali B, Bourke E, Kairuz Santos CA. Discharge interventions for First Nations people with a chronic condition or injury: a systematic review. BMC Health Serv Res 2023; 23:604. [PMID: 37296401 DOI: 10.1186/s12913-023-09567-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/17/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander peoples have a unique place in Australia as the original inhabitants of the land. Similar to other First Nations people globally, they experience a disproportionate burden of injury and chronic health conditions. Discharge planning ensures ongoing care to avoid complications and achieve better health outcomes. Analysing discharge interventions that have been implemented and evaluated globally for First Nations people with an injury or chronic conditions can inform the implementation of strategies to ensure optimal ongoing care for Aboriginal and Torres Strait Islander people. METHODS A systematic review was conducted to analyse discharge interventions conducted globally among First Nations people who sustained an injury or suffered from a chronic condition. We included documents published in English between January 2010 and July 2022. We followed the reporting guidelines and criteria set in Preferred Reporting Items for Systematic Review (PRISMA). Two independent reviewers screened the articles and extracted data from eligible papers. A quality appraisal of the studies was conducted using the Mixed Methods Appraisal Tool and the CONSIDER statement. RESULTS Four quantitative and one qualitative study out of 4504 records met inclusion criteria. Three studies used interventions involving trained health professionals coordinating follow-up appointments, linkage with community care services and patient training. One study used 48-hour post discharge telephone follow-up and the other text messages with prompts to attend check-ups. The studies that included health professional coordination of follow-up, linkage with community care and patient education resulted in decreased readmissions, emergency presentations, hospital length of stay and unattended appointments. CONCLUSION Further research on the field is needed to inform the design and delivery of effective programs to ensure quality health aftercare for First Nations people. We observed that discharge interventions in line with the principal domains of First Nations models of care including First Nations health workforce, accessible health services, holistic care, and self-determination were associated with better health outcomes. REGISTRATION This study was prospectively registered in PROSPERO (ID CRD42021254718).
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Affiliation(s)
- Julieann Coombes
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
| | - Andrew J A Holland
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Corner Hawkesbury Road and, Hainsworth St, Westmead, NSW, 2145, Australia
| | - Courtney Ryder
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
- Indigenous Health College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia
| | - Summer May Finlay
- School of Health and Society, Wollongong University, Wollongong, NSW, 2522, Australia
| | - Kate Hunter
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
| | - Keziah Bennett-Brook
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
| | - Phillip Orcher
- Agency for Clinical Innovations, 1 Reserve Rd, St Leonards, NSW, 2065, Australia
| | - Michele Scarcella
- The Sydney Children's Hospital Network (SCHN), Sydney, NSW, 2145, Australia
| | - Karl Briscoe
- National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners (NAATSIHWP), 31-37 Townshend Street, Phillip ACT, 2606, Australia
| | - Dale Forbes
- Department Community and Justice NSW, Sydney, NSW, 2012, Australia
| | - Madeleine Jacques
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Corner Hawkesbury Road and, Hainsworth St, Westmead, NSW, 2145, Australia
| | - Deborah Maze
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Corner Hawkesbury Road and, Hainsworth St, Westmead, NSW, 2145, Australia
| | - Bobby Porykali
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
| | - Elizabeth Bourke
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
| | - Camila A Kairuz Santos
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia.
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Factors associated with quitting among smoking cessation medication-assisted smokers and ex-smokers: A cross-sectional study in Australia. Prev Med Rep 2023; 32:102168. [PMID: 36922959 PMCID: PMC10009288 DOI: 10.1016/j.pmedr.2023.102168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/04/2023] Open
Abstract
Effective smoking cessation medications (SCM) are available and are recommended for the treatment of tobacco smoking. In this study, we evaluated rate and factors associated with successful quitting among individuals who supported their quit attempt using SCMs in Australia. An observational online cross-sectional survey was conducted using a convenience sample of smokers and ex-smokers in Australia. A self-administered questionnaire was used to evaluate socio-demographic, psychological, smoking, and medication use characteristics. The Fagerstrom Test for Nicotine Dependence scale was used to assess the level of nicotine addiction. Logistic regression used to identify factors associated with smoking cessation. Of the 201 respondents, 33.3% had successfully quit smoking. Nicotine replacement therapy (NRT), varenicline, and bupropion were used by 71.6%, 19.9%, and 8.5% respectively. The rate of quitting was 30.6%, 47.5%, and 23.5% for participants who used NRT, varenicline, and bupropion, respectively. Six in ten (59.6%) of the participants who were adherent to SCMs reported continuous abstinence. Whereas 22.9% reported quitting among participants who were nonadherent to SCMs. Adherence to SCMs was significantly associated with increased rate of quitting (AOR = 2.67, 95% CI of 1.17-6.10). Additionally, having smoke-free home was associated with successful smoking cessation (AOR = 2.34, 95% CI of 1.13-4.90). In conclusion, one in three participants self-reported that they successfully quit smoking. Adherence to SCMs and smoke-free home were strongly associated with quitting. Smoking cessation programs and future studies are recommended to incorporate medication adherence as a core component. Home-targeted and family-inclusive interventions are recommended to manage smoke-free homes and enhance success of quitting attempts.
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Walker D, Tynan A, Tucker T, Fisher B, Fisher T. Engaging with a rural Aboriginal community to identify strategies to improve oral health within their community: a qualitative study. Aust J Prim Health 2023; 29:38-46. [PMID: 36318903 DOI: 10.1071/py22215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Aboriginal and Torres Strait Islanders bear a higher burden of oral disease compared to non-Indigenous persons. Rural Aboriginal and Torres Strait Islander communities are further disadvantaged due to service access difficulties. This study, initiated by community concern for oral health identified through its Health Action Group, aimed to explore a rural Aboriginal community's strategies to resolve oral health problems. CONCLUSION Community members are aware of local barriers and potential facilitators for improving oral health within their community. Their identification of priority strategies can be used to inform the delivery of oral healthcareservices and to develop oral healthcare promotion programs for the community. Co-designing solutions with the community should be an integral part of solving complex problems such as oral health. METHODS A qualitative research study using a phenomenological research design with focus group discussions and in-depth interviews was completed in partnership with a rural community in Queensland, Australia, with a predominantly Aboriginal population. The research team included Aboriginal and non-Aboriginal personnel; community and external personnel; and dental and non-dental personnel. The collaborative approach included the development, implementation, analysis and interpretation of the research involving the community through its Health Action Group. Community engagement led to the recruitment of 27 participants from local health and community groups. RESULTS Themes emerging from the data included: reducing financial barriers to accessing oral health care; integrating oral health care with other health services; increasing oral healthcare promotion activities; and ensuring local input and cultural safety within local oral healthcare services.
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Affiliation(s)
- David Walker
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
| | - Anna Tynan
- Research Support Team, Baillie Henderson Hospital, Darling Downs Health, Corner of Torr and Hogg Street, Toowoomba, Qld 4350, Australia; and Southern Queensland Rural Health, The University of Queensland, Corner of Torr and Hogg Street, Toowoomba, Qld 4350, Australia
| | - Taygan Tucker
- Oral Health Services - Nhulunbuy, Top End Health Services, Northern Territory Government, Gove Dental Clinic, Endeavour Square, Nhulunbuy, NT 0880, Australia
| | - Barry Fisher
- Kingaroy Hospital, Darling Downs Health, 166 Youngman Street, Kingaroy, Qld 4610, Australia
| | - Tarita Fisher
- Darling Downs Health, PO Box 361, Murgon, Qld 4605, Australia
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13
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Barrett EM, Thurber KA, Learnihan V, Lovett R, Thandrayen J, Thomas DP, Colonna E, Banks E, Maddox R. Estimating population coverage of Tackling Indigenous Smoking teams, a placed-based health intervention in Australia. Aust N Z J Public Health 2023; 47:100012. [PMID: 36641958 DOI: 10.1016/j.anzjph.2022.100012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/01/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE As part of the Tackling Indigenous Smoking (TIS) program, TIS teams provide Aboriginal and Torres Strait Islander-led tobacco control in their geographic area. We aimed to estimate the percentage and number of Aboriginal and Torres Strait Islander peoples living in an area serviced by a TIS team in 2018-19. METHODS We analysed weighted, representative data from 8,048 Aboriginal and Torres Strait Islander people aged ≥10 years from the 2018-19 National Aboriginal and Torres Strait Islander Health Survey. TIS services mapping data were used to define areas served by TIS teams. Coverage was explored in relation to remoteness, program priority groups and sociodemographic characteristics. RESULTS Around three-quarters (76.4%,95%CI:72.9-79.9) of the 2018-19 population aged ≥10 years lived in an area served by TIS teams (n=479,000). Coverage by TIS teams was generally similar across groups, with few exceptions. CONCLUSIONS The recently announced expansion to national coverage would provide access to locally tailored tobacco control to a further 148,000 Aboriginal and Torres Strait Islander peoples aged ≥10 years, including 46,000 adults who currently smoke. IMPLICATIONS FOR PUBLIC HEALTH Expansion to national TIS team coverage is a welcomed first step on the path to ensuring equitable access to tobacco control.
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Affiliation(s)
- Eden M Barrett
- National Centre for Epidemiology and Population Health, The Australian National University, Australian Capital Territory, Australia; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Katherine A Thurber
- National Centre for Epidemiology and Population Health, The Australian National University, Australian Capital Territory, Australia
| | - Vincent Learnihan
- Health Research Institute, University of Canberra, Australian Capital Territory, Australia
| | - Raymond Lovett
- National Centre for Epidemiology and Population Health, The Australian National University, Australian Capital Territory, Australia; Ngiyampaa (Wongaibon), Australia
| | - Joanne Thandrayen
- National Centre for Epidemiology and Population Health, The Australian National University, Australian Capital Territory, Australia
| | - David P Thomas
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Australia
| | - Emily Colonna
- National Centre for Epidemiology and Population Health, The Australian National University, Australian Capital Territory, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, The Australian National University, Australian Capital Territory, Australia
| | - Raglan Maddox
- National Centre for Epidemiology and Population Health, The Australian National University, Australian Capital Territory, Australia; Bagumani (Modewa) Clan, Papua New Guinea.
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Getting DBT online down under: The experience of Australian and New Zealand Dialectical Behaviour Therapy programmes during the Covid-19 pandemic. PLoS One 2022; 17:e0275636. [PMID: 36201507 PMCID: PMC9536633 DOI: 10.1371/journal.pone.0275636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022] Open
Abstract
Dialectical Behaviour Therapy (DBT) is an intensive and multi-modal intervention developed for individuals with multiple comorbidities and high-risk behaviours. During pandemic-related lockdowns, many DBT services transitioned to delivering treatment via telehealth, but some did not. The current study sought to explore the experience of DBT teams in Australia and New Zealand who did and did not transition to telehealth during the early stages of the COVID19 pandemic, as the majority of research on DBT via telehealth has originated from North America, and focussed on therapists who did make this transition. DBT team leaders in Australia and New Zealand completed a survey with open-ended questions about the barriers they encountered to delivering DBT via telehealth, and for those teams that implemented telehealth, the solutions to those barriers. Respondents were also asked about specific barriers encountered by Indigenous and Pacific people service users. Of the 73 team leaders who took part, 56 reported providing either individual therapy, skills training or both modalities via video-call during lockdown. Themes emerging from perceived barriers affecting just DBT providers included the assessment & management of emotions and high-risk behaviours, threats to privacy and information security posed by telehealth, logistical issues related to remote sessions, and the remote management of therapy-interfering behaviour. Themes emerging from perceived barriers affecting both providers and service users included disruptions to therapeutic alliance, lack of willingness, lack of technical knowledge, lack of private spaces to do DBT via telehealth, and lack of resources. The solutions most frequently cited were the provision of education and training for therapists and service users in the use of telehealth, and the provision of resources to access telehealth. These findings are relevant to clinical delivery of DBT, as well as planning and funding for DBT telehealth services.
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Coombes J, Holland AJA, Hunter K, Bennett-Brook K, Ryder C, Finlay SM, Orcher P, Scarcella M, Briscoe K, Forbes D, Jacques M, Wilson R, Bourke E, Kairuz C. Discharge Interventions for First Nations People with Injury or Chronic Conditions: A Protocol for a Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11301. [PMID: 36141576 PMCID: PMC9517407 DOI: 10.3390/ijerph191811301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 06/12/2023]
Abstract
Severe injury and chronic conditions require long-term management by multidisciplinary teams. Appropriate discharge planning ensures ongoing care to mitigate the long-term impact of injuries and chronic conditions. However, First Nations peoples in Australia face ongoing barriers to aftercare. This systematic review will locate and analyse global evidence of discharge interventions that have been implemented to improve aftercare and enhance health outcomes among First Nations people with an injury or chronic condition. A systematic search will be conducted using five databases, Google, and Google scholar. Global studies published in English will be included. We will analyse aftercare interventions implemented and the health outcomes associated. Two independent reviewers will screen and select studies and then extract and analyse the data. Quality appraisal of the included studies will be conducted using the Mixed Methods Appraisal Tool and the CONSIDER statement. The proposed study will analyse global evidence on discharge interventions that have been implemented for First Nations people with an injury or chronic conditions and their associated health outcomes. Our findings will guide healthcare quality improvement to ensure Aboriginal and Torres Strait Islander peoples have ongoing access to culturally safe aftercare services.
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Affiliation(s)
- Julieann Coombes
- The George Institute for Global Health, Sydney, NSW 2042, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Andrew J. A. Holland
- Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- Department of Paediatric Surgery, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Kate Hunter
- The George Institute for Global Health, Sydney, NSW 2042, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | | | - Courtney Ryder
- The George Institute for Global Health, Sydney, NSW 2042, Australia
- Indigenous Health College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
- School of Population Health, University of New South Wales (UNSW), Sydney, NSW 2052, Australia
| | - Summer M. Finlay
- School of Health and Society, Wollongong University, Wollongong, NSW 2522, Australia
| | - Phillip Orcher
- Agency for Clinical Innovation, Sydney, NSW 2065, Australia
| | - Mick Scarcella
- The Sydney Children’s Hospital Network (SCHN), Sydney, NSW 2145, Australia
| | - Karl Briscoe
- National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners (NAATSIHWP), Canberra, ACT 2606, Australia
| | - Dale Forbes
- Department of Community and Justice, Sydney, NSW 2012, Australia
| | - Madeleine Jacques
- The Sydney Children’s Hospital Network (SCHN), Sydney, NSW 2145, Australia
| | - Roland Wilson
- Indigenous Health College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
| | - Elizabeth Bourke
- The George Institute for Global Health, Sydney, NSW 2042, Australia
| | - Camila Kairuz
- The George Institute for Global Health, Sydney, NSW 2042, Australia
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Thompson F, Russell S, Quigley R, Sagigi B, Taylor S, McDonald M, Campbell S, Esterman A, Harriss LR, Miller G, Strivens E, McDermott R. Potentially preventable dementia in a First Nations population in the Torres Strait and Northern Peninsula Area of North Queensland, Australia: A cross sectional analysis using population attributable fractions. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 26:100532. [PMID: 35833207 PMCID: PMC9272378 DOI: 10.1016/j.lanwpc.2022.100532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Dementia is highly prevalent among Australia's First Nations peoples, including Torres Strait Islander and Aboriginal peoples in Far North Queensland (FNQ). It is likely that historically recent exposure to modifiable risk factors underlies these rates, and a large proportion of dementia may be potentially preventable. Methods Data from two adult community health checks (2015-2018) were analyzed to determine the prevalence of 11 modifiable dementia risk factors among the First Nations residents of the Torres Strait and Northern Peninsula Area of FNQ. Population attributable fractions (PAF%) for dementia were calculated using age-standardized prevalence estimates derived from these health checks and relative risks obtained from previous meta-analyses in other populations. PAF% estimates were weighted for communality to account for overlap of risk factors. Findings Half (52·1%) of the dementia burden in this population may be attributed to 11 potentially modifiable risk factors. Hypertension (9·4%), diabetes mellitus (9·0%), obesity (8·0%), and smoking (5·3%) were the highest contributing risk factors. The contribution of depression (2·0%) and alcohol (0·3%) was lower than other global and national estimates. While the adjusted PAF% for social isolation was low based on the adult community health check data (1·6%), it was higher (4·2%) when official census data were analyzed. Interpretation These results suggest that a substantial proportion of dementia in FNQ First Nations peoples could potentially be prevented. Government investment in preventative health now is essential to reduce the future burden of dementia. Funding National Health and Medical Research Council (NHMRC, GNT1107140, GNT1191144, GNT1106175, GNT0631947).
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Affiliation(s)
- Fintan Thompson
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- University of South Australia, SA, Australia
| | - Sarah Russell
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Betty Sagigi
- Queensland Health, Torres and Cape Hospital and Health Service, Thursday Island, QLD, Australia
| | - Sean Taylor
- Top End Health Service, Northern Territory Government, Darwin, NT, Australia
| | - Malcolm McDonald
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | - Sandy Campbell
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, QLD, Australia
| | | | - Linton R. Harriss
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Gavin Miller
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
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McInerney-Leo AM, West J, Meiser B, West M, Toombs MR, Brown MA, Duncan EL. The impact of Marfan syndrome on an Aboriginal Australian family: 'I don't like it as much as I don't like cancer'. J Genet Couns 2022; 31:620-630. [PMID: 34713948 DOI: 10.1002/jgc4.1529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 09/09/2021] [Accepted: 10/17/2021] [Indexed: 01/01/2023]
Abstract
Marfan syndrome (MFS) is an autosomal dominantly inherited connective tissue disorder. Aortic dilatation/dissection and ectopia lentis are the most severe features, which affect physical functioning and psychological well-being. In Aboriginal Australians, there is little psychosocial research on genetic conditions. This study explored the physical, psychological, and practical impacts of MFS on Aboriginal Australians. Eighteen (8 affected and 10 unaffected) members of a large Aboriginal Australian family with MFS participated in an ethically approved study. Semi-structured qualitative interviews were conducted, transcribed verbatim, and analyzed thematically. All individuals reported challenges from MFS, negatively affecting day-to-day living. Severe vision impairment was perceived as the greatest challenge, contributing to feelings of stigma and exclusion. With aging, concerns shifted toward cardiac complications. The unpredictability of lens dislocation and aortic dissection was reported to be psychologically challenging. Participants described MFS-related barriers to obtaining and retaining employment, especially following cardiac surgery; with consequential psychological and financial hardships. Participants articulated that their cultural drive to support the ill and respectfully mourn the deceased, regardless of distance, resulted in a significant financial burden. Additionally, when hospitalization and/or funerals occurred, financially solvent individuals were expected to share resources, without any expectation of repayment or reciprocity (i.e., 'demand sharing', common in Aboriginal Australian culture). This study documents the nature and pervasiveness of uncertainty for both affected and unaffected members of an MFS family. Many reported challenges are consistent with other MFS cohorts (including stigma, social exclusion, and unemployment). However, our findings suggest that cultural values may exacerbate the financial costs of MFS for Aboriginal Australians.
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Affiliation(s)
- Aideen M McInerney-Leo
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | - Jennifer West
- Prince Charles Hospital Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Bettina Meiser
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Malcolm West
- Prince Charles Hospital Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Maree R Toombs
- Faculty of Medicine, Rural Clinical School, The University of Queensland, Toowoomba, Queensland, Australia
| | - Matthew A Brown
- NHS Foundation Trust and King's College London NIHR Biomedical Research Centre, London, UK
| | - Emma L Duncan
- Department of Twin Research & Genetic Epidemiology, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Endocrinology, NHS Foundation Trust, London, UK
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Manton D, Williams M, Hayen A. The Bunya Project: Protocol to develop culturally informed curriculum (Preprint). JMIR Res Protoc 2022; 12:e39864. [PMID: 37200069 DOI: 10.2196/39864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 02/19/2023] [Accepted: 03/14/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Indigenous peoples live across all continents, representing approximately 90 nations and cultures and 476 million people. There have long been clear statements about the rights of Indigenous peoples to self-determine services, policies, and resource allocations that affect our lives, particularly via the United Nations Declaration on the Rights of Indigenous Peoples. An area for urgent improvement is curricula that train the predominantly non-Indigenous health workforce about their responsibilities and that offer practical strategies to use when engaging with Indigenous peoples and issues. OBJECTIVE The Bunya Project is designed to advance Indigenous community-led teaching and evaluation of the embeddedness of strategies to achieve an Indigenous Graduate Attribute in Australia. The project centers the relationships with Aboriginal community services to lead education design relating to Indigenous peoples. The project aims to articulate community recommendations for university education in allied health in the usable format of digital stories to create culturally informed andragogy, curriculum, and assessment measures for use in teaching. It also aims to understand the impact of this work on student attitudes and knowledge about Indigenous peoples' allied health needs. METHODS Multilayered project governance was established, along with a 2-stage process using mixed methods participatory action research and critical reflection, using the reflective cycle by Gibbs. The first stage, preparing the soil, used community engagement, drew on lived experience, encouraged critical self-reflection, embodied reciprocity, and demanded working collectively. The second stage, planting the seed, requires more critical self-reflection, the development of community data through interviews and focus group discussions, the development of resources with an academic working group and community participants, the implementation of those resources with student feedback, the analysis of the feedback from students and community members, and reflection. RESULTS The protocol for the first stage, preparing the soil, is complete. The results of the first stage are the relationships built and the trust earned and gained, and it has resulted in the development of the planting the seed protocol. As of February 2023, we have recruited 24 participants. We will analyze data shortly and expect to publish the results in 2024. CONCLUSIONS The readiness of non-Indigenous staff to engage with Indigenous communities has not been ascertained by Universities Australia, nor can it be assured. Staff preparation and skills to support the curriculum, create a safe learning environment, and develop teaching and learning strategies to guide academics to recognize that how students learn is as important as the content students learn. This learning has broad implications and benefits for staff and students within their professional practice and for lifelong learning. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/39864.
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Perdacher E, Kavanagh D, Sheffield J, Healy K, Dale P, Heffernan E. Using the Stay Strong App for the Well-being of Indigenous Australian Prisoners: Feasibility Study. JMIR Form Res 2022; 6:e32157. [PMID: 35394444 PMCID: PMC9034424 DOI: 10.2196/32157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/18/2021] [Accepted: 01/24/2022] [Indexed: 01/04/2023] Open
Abstract
Background The gap between mental health needs and resources for Aboriginal and Torres Strait Islander people, the Indigenous people of Australia, is most marked in the prison population. Indigenous people are overrepresented in Australian prisons. In prison, this group experiences mental disorders to a greater degree than non-Indigenous prisoners. This group has also been found to experience mental disorder at a higher rate than Indigenous people in the community. In addition to pre-existing determinants of poor mental health, these high prevalence rates may reflect poor engagement in mainstream interventions or the efficacy of available interventions. In community populations, the use of digital mental health resources may help to increase access to well-being support. However, culturally appropriate digital tools have not been available to Indigenous people in prisons. The absence of feasibility and efficacy studies of these tools needs to be addressed. Objective The aim of this study is to determine the feasibility of the Stay Strong app as a digital well-being and mental health tool for use by Indigenous people in prison. Methods Dual government agency (health and corrective services) precondition requirements of implementation were identified and resolved. This was essential given that the Stay Strong app was to be delivered by an external health agency to Indigenous prisoners. Then, acceptability at a practice level was tested using postuse qualitative interviews with clients and practitioners of the Indigenous Mental Health Intervention Program. All Indigenous Mental Health Intervention Program practitioners (10/37, 27%) and client participants who had completed their second follow-up (review of the Stay Strong app; 27/37, 73%) during the study period were invited to participate. Results Owing to the innovative nature of this project, identifying and resolving the precondition requirements of implementation was challenging but provided support for the implementation of the app in practice. Acceptability of the app by clients and practitioners at a practice level was demonstrated, with nine themes emerging across the interviews: satisfaction with the current Stay Strong app, supported client goal setting, increased client self-insight, improved client empowerment, cultural appropriateness, enhanced engagement, ease of use, problems with using an Android emulator, and recommendations to improve personalization. Conclusions The Stay Strong Custody Project is a pioneering example of digital mental health tools being implemented within Australian prisons. Using the app within high-security prison settings was found to be feasible at both strategic and practice levels. Feedback from both clients and practitioners supported the use of the app as a culturally safe digital mental health and well-being tool for Aboriginal and Torres Strait Islander people in prison.
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Affiliation(s)
- Elke Perdacher
- Queensland Forensic Mental Health Service, Brisbane, Australia.,Forensic Mental Health Group, Queensland Centre for Mental Health Research, Brisbane, Australia.,School of Psychology, The University of Queensland, Brisbane, Australia
| | - David Kavanagh
- School of Psychology, The University of Queensland, Brisbane, Australia.,Centre for Children's Health Research and School of Psychology & Counselling, Queensland University of Technology, Brisbane, Australia
| | - Jeanie Sheffield
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Karyn Healy
- Queensland Forensic Mental Health Service, Brisbane, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Penny Dale
- Queensland Forensic Mental Health Service, Brisbane, Australia
| | - Edward Heffernan
- Queensland Forensic Mental Health Service, Brisbane, Australia.,Forensic Mental Health Group, Queensland Centre for Mental Health Research, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
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20
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de Jager E, Gunnarsson R, Ho YH. Disparities in surgical outcomes for low socioeconomic status patients in Australia. ANZ J Surg 2022; 92:1026-1032. [PMID: 35388595 PMCID: PMC9322460 DOI: 10.1111/ans.17675] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/16/2022] [Accepted: 03/20/2022] [Indexed: 01/14/2023]
Abstract
Background There are disparities in surgical outcomes for patients of low socioeconomic status globally, including in countries with universal healthcare systems. There is limited data on the impact of low socioeconomic status on surgical outcomes in Australia. This study examines surgical outcomes by both self‐reported unemployment and neighbourhood level socioeconomic status in Australia. Methods A retrospective administrative data review was conducted at a tertiary care centre over a 10‐year period (2008–2018) including all adult surgical patients. Multivariable logistic regression adjusting for year, age, sex and Charlson Comorbidity Index was performed. Results 106 197 patients underwent a surgical procedure in the decade examined. The overall adverse event rates were mortality (1.13%), total postoperative complications (10.9%), failure to rescue (0.75%) and return to theatre (4.31%). Following multivariable testing, unemployed and low socioeconomic patients had a higher risk of postoperative mortality (OR 2.06 (1.50–2.82), OR 1.37 (1.15–1.64)), all complications (OR 1.43 (1.31–1.56), OR 1.21 (1.14–1.28)), failure to rescue (OR 2.03 (1.39–2.95), OR 1.38 (1.11–1.72)) and return to theatre (OR 1.42 (1.27–1.59), OR 1.24 (1.14–1.36)) (P < 0.005 for all). Conclusions Despite universal healthcare, there are disparities in surgical adverse events for patients of low socioeconomic status in Australia. Disparities in surgical outcomes can stem from three facets: a patient's access to healthcare (the severity of disease at the time of presentation), variation in perioperative care delivery, and social determinants of health. Further work is required to pinpoint why these disparities are present and to evaluate the impact of strategies that aim to reduce disparities.
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Affiliation(s)
- Elzerie de Jager
- College of Medicine and Dentistry, The James Cook University, Townsville, Queensland, Australia
| | - Ronny Gunnarsson
- General Practice/Family medicine, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden.,Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden.,Primary Health Care Clinic for Homeless people, Närhälsan, Region Västra Götaland, Sweden
| | - Yik-Hong Ho
- College of Medicine and Dentistry, The James Cook University, Townsville, Queensland, Australia.,Townsville Clinical School, The Townsville Hospital, Townsville, Queensland, Australia
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21
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Conigrave JH, Lee KSK, Haber PS, Vnuk J, Doyle MF, Conigrave KM. More than three times as many Indigenous Australian clients at risk from drinking could be supported if clinicians used AUDIT-C instead of unstructured assessments. Addict Sci Clin Pract 2022; 17:23. [PMID: 35382880 PMCID: PMC8981780 DOI: 10.1186/s13722-022-00306-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/24/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander ('Indigenous') Australians experience a greater burden of disease from alcohol consumption than non-Indigenous peoples. Brief interventions can help people reduce their consumption, but people drinking at risky levels must first be detected. Valid screening tools (e.g., AUDIT-C) can help clinicians identify at-risk individuals, but clinicians also make unstructured assessments. We aimed to determine how frequently clinicians make unstructured risk assessments and use AUDIT-C with Indigenous Australian clients. We also aimed to determine the accuracy of unstructured drinking risk assessments relative to AUDIT-C screening. Finally, we aimed to explore whether client demographics influence unstructured drinking risk assessments. METHODS We performed cross-sectional analysis of a large clinical dataset provided by 22 Aboriginal Community Controlled Health Services in Australia. We examined instances where clients were screened with unstructured assessments and with AUDIT-C within the same two-monthly period. This aggregated data included 9884 observations. We compared the accuracy of unstructured risk assessments against AUDIT-C using multi-level sensitivity and specificity analysis. We used multi-level logistic regression to identify demographic factors that predict risk status in unstructured assessments while controlling for AUDIT-C score. RESULTS The primary variables were AUDIT-C score and unstructured drinking risk assessment; demographic covariates were client age and gender, and service remoteness. Clinicians made unstructured drinking risk assessments more frequently than they used AUDIT-C (17.11% and 10.85% of clinical sessions respectively). Where both measures were recorded within the same two-month period, AUDIT-C classified more clients as at risk from alcohol consumption than unstructured assessments. When using unstructured assessments, clinicians only identified approximately one third of clients drinking at risky levels based on their AUDIT-C score (sensitivity = 33.59% [95% CI 22.03, 47.52], specificity = 99.35% [95% CI 98.74, 99.67]). Controlling for AUDIT-C results and demographics (gender and service remoteness), clinicians using unstructured drinking risk assessments were more likely to classify older clients as being at risk from alcohol consumption than younger clients. CONCLUSIONS Evidence-based screening tools like AUDIT-C can help clinicians ensure that Indigenous Australian clients (and their families and communities) who are at risk from alcohol consumption are better detected and supported.
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Affiliation(s)
- James H Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, Level 6, King George V Building, Drug Health Services, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia.
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia.
| | - K S Kylie Lee
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, Level 6, King George V Building, Drug Health Services, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- La Trobe University, Centre for Alcohol Policy Research, Bundoora, Victoria, Australia
- Burnet Institute, Melbourne, Victoria, Australia
| | - Paul S Haber
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, Level 6, King George V Building, Drug Health Services, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Drug Health Services, Sydney, NSW, Australia
| | - Julia Vnuk
- Aboriginal Health Council of South Australia, Adelaide, SA, Australia
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, SA, Australia
| | - Michael F Doyle
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, Level 6, King George V Building, Drug Health Services, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
| | - Katherine M Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, Level 6, King George V Building, Drug Health Services, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Drug Health Services, Sydney, NSW, Australia
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22
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Tynan A, Walker D, Tucker T, Fisher B, Fisher T. Managing oral health care and prevention: The experience of Aboriginal and Torres Strait Islanders living in a rural community in Queensland, Australia. Aust J Rural Health 2022; 30:228-237. [PMID: 35196414 PMCID: PMC9306970 DOI: 10.1111/ajr.12853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 06/30/2021] [Accepted: 01/31/2022] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To understand the experience of rural Aboriginal and Torres Strait Islanders in engaging with oral health care services and programs in order to support the development of oral health services and prevention programs that better meet their needs. DESIGN The study used a qualitative research design, which aims to describe participants' lived experience of engaging with oral health services and prevention programs in a rural Aboriginal and Torres Strait Islander community. Focus group discussions and in-depth interviews were conducted with 27 participants. The 15 transcribed discussions were analysed using a 6-step phenomenological process. SETTING A rural community in Queensland, Australia, with a predominantly Aboriginal population. PARTICIPANTS Participants were purposively recruited from established health and community groups. MAIN OUTCOME System-level barriers to accessing and engaging with oral health services and prevention influence how communities manage oral health and seek treatment. RESULTS The study identified 4 main themes describing the community's experience: service location and the efforts required to access oral health services; the financial burden of accessing oral health care and practising prevention; lack of confidence in oral health services; and the avoidance or delaying of accessing care for dental problems. Results confirmed a high burden of oral disease but limited attendance at an oral health facility and difficulties engaging in preventative oral health behaviours. Treatment seeking was usually instigated by the experience of pain and typically at a tertiary health facility. CONCLUSION Aboriginal and Torres Strait Islanders in rural communities experience a high burden of oral disease but have limited engagement with oral health services. This is associated with system-level barriers to accessing and engaging with oral health services and prevention.
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Affiliation(s)
- Anna Tynan
- Baillie Henderson HospitalDarling Downs HealthToowoombaQueenslandAustralia
- The Rural Clinical SchoolThe University of QueenslandToowoombaQueenslandAustralia
| | - David Walker
- School of DentistryFaculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | - Taygan Tucker
- Kingaroy HospitalDarling Downs HealthKingaroyQueenslandAustralia
- Present address:
Oral Health Services – NhulunbuyTop End Health ServicesNorthern Territory Government Endeavour SquareGove Dental ClinicNhulunbuyNorthern TerritoryAustralia
| | - Barry Fisher
- Kingaroy HospitalDarling Downs HealthKingaroyQueenslandAustralia
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23
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Raja SS, Batey RG, Edwards S, Aung HH. Standards of liver cirrhosis care in Central Australia. World J Hepatol 2022; 14:559-569. [PMID: 35582288 PMCID: PMC9055197 DOI: 10.4254/wjh.v14.i3.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/04/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver cirrhosis and hepatocellular carcinoma (HCC) are highly prevalent in Australia’s Northern Territory. Contributing factors include high levels of alcohol consumption, viral hepatitis and metabolic syndrome. Rural Aboriginal residents form a significant proportion of the Central Australian population and present a challenge to traditional models of liver care. HCC surveillance and variceal screening are core components of liver cirrhosis management.
AIM To assess participation in HCC and variceal surveillance programmes in a Central Australian liver cirrhosis patient cohort.
METHODS Retrospective cohort study of patients with liver cirrhosis presenting to Alice Springs Hospital, Australia between January 1, 2012 and December 31, 2017. Demographic data, disease severity, attendance at hepatology clinics, participation in variceal and/or HCC surveillance programmes was recorded. Regression analyses were conducted to assess factors associated with two independent outcomes: Participation in HCC and variceal surveillance.
RESULTS Of 193 patients were identified. 82 patients (42.4%) were female. 154 patients (80%) identified as Aboriginal. Median Model for End-stage Liver Disease Score at diagnosis was 11. Alcohol was the most common cause of cirrhosis. Aboriginal patients were younger than non-Aboriginal patients (48.4 years vs 59.9 years, P < 0.001). There were similar rates of excess alcohol intake (72.6% vs 66.7%, P = 0.468) and obesity (34.5% vs 38.4%, P = 0.573 across non-Aboriginal and Aboriginal cohorts. 20.1% of patients took part in HCC surveillance and 42.1% of patients completed variceal screening. Aboriginal patients were less likely to engage with either HCC surveillance (OR: 0.38, 95%CI: 0.16-0.9, P = 0.025) or undergo variceal screening (OR: 0.31, 95%CI: 0.14-0.65, P = 0.002).
CONCLUSION HCC or variceal surveillance programmes had less uptake amongst Aboriginal patients. Greater emphasis needs to be placed on eliminating cultural obstacles to accessing hepatology services.
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Affiliation(s)
- Sreecanth S Raja
- Department of Gastroenterology, Alice Springs Hospital, Alice Springs 0870, Northern Territory, Australia
| | - Robert G Batey
- Department of Medicine, Alice Springs Hospital, Alice Springs 0870, Northern Territory, Australia
| | - Suzanne Edwards
- Department of Statistician, School of Public Health, University of Adelaide, Adelaide 5000, South Australia, Australia
| | - Hein H Aung
- Department of Medicine, Alice Springs Hospital, Alice Springs 0870, Northern Territory, Australia
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24
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Wyber R, Lizama C, Wade V, Pearson G, Carapetis J, Ralph AP, Bowen AC, Peiris D. Improving primary prevention of acute rheumatic fever in Australia: consensus primary care priorities identified through an eDelphi process. BMJ Open 2022; 12:e056239. [PMID: 35273057 PMCID: PMC8915338 DOI: 10.1136/bmjopen-2021-056239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/11/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To establish the priorities of primary care providers to improve assessment and treatment of skin sores and sore throats among Aboriginal and Torres Strait Islander people at risk of acute rheumatic fever (ARF) and rheumatic heart disease (RHD). DESIGN Modified eDelphi survey, informed by an expert focus group and literature review. SETTING Primary care services in any one of the five Australian states or territories with a high burden of ARF. PARTICIPANTS People working in any primary care role within the last 5 years in jurisdiction with a high burden of ARF. RESULTS Nine people participated in the scoping expert focus group which informed identification of an access framework for subsequent literature review. Fifteen broad concepts, comprising 29 strategies and 63 different actions, were identified on this review. These concepts were presented to participants in a two-round eDelphi survey. Twenty-six participants from five jurisdictions participated, 16/26 (62%) completed both survey rounds. Seven strategies were endorsed as high priorities. Most were demand-side strategies with a focus on engaging communities and individuals in accessible, comprehensive, culturally appropriate primary healthcare. Eight strategies were not endorsed as high priority, all of which were supply-side approaches. Qualitative responses highlighted the importance of a comprehensive primary healthcare approach as standard of care rather than disease-specific strategies related to management of skin sores and sore throat. CONCLUSION Primary care staff priorities should inform Australia's commitments to reduce the burden of RHD. In particular, strategies to support comprehensive Aboriginal and Torres Strait Islander primary care services rather than an exclusive focus on discrete, disease-specific initiatives are needed.
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Affiliation(s)
- Rosemary Wyber
- Health Systems Science, The George Institute for Global Health, Newtown, New South Wales, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Catalina Lizama
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Vicki Wade
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Glenn Pearson
- Aboriginal Health Institute Leadership Team, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Jonathan Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Anna P Ralph
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- General Medicine and Inectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - David Peiris
- Health Systems Science, The George Institute for Global Health, Newtown, New South Wales, Australia
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25
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Dunlop WA, Secombe PJ, Agostino JW, van Haren FMP. Characteristics and outcomes of Aboriginal and Torres Strait Islander patients with dialysis-dependent kidney disease in Australian intensive care units. Intern Med J 2022; 52:458-467. [PMID: 33012108 DOI: 10.1111/imj.15077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/04/2020] [Accepted: 09/27/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND In Australia, 531 people per million population have dialysis-dependent chronic kidney disease (CKD5D). The incidence is four times higher for Aboriginal and Torres Strait Islander (indigenous) people compared with non-Indigenous Australians. CKD5D increases the risk of hospitalisation, admission to the intensive care unit (ICU) and mortality compared with patients without CKD5D. There is limited literature describing short-term outcomes of patients with CKD5D who are admitted to the ICU, comparing indigenous and non-indigenous patients. AIMS This registry-based retrospective cohort analysis compared demographic and clinical data between indigenous and non-indigenous patients with CKD5D and tested whether indigenous status predicted short-term outcomes independently of other contributing factors. Adjusted hospital mortality was the primary outcome measure. METHODS Data were from the Australian and New Zealand Intensive Care Society's Centre for Outcome and Resource Evaluation Adult Patient Database. Australian ICU admissions between 2010 and 2017 were included. Data from 173 ICU (2136 beds) include 1 051 697 ICU admissions, of which 23 793 had a pre-existing diagnosis of CKD5D. RESULTS Indigenous patients comprised 11.9% of CKD5D patients in ICU. CKD5D was prevalent among 4.9% of indigenous and 2.9% of non-indigenous ICU admissions. Indigenous patients were 13.5 years younger, had fewer comorbidities and lower crude mortality despite equivalent calculated mortality risk. After adjusting for age, remoteness and severity of illness, indigenous status did not predict mortality. CONCLUSIONS Socioeconomic disadvantage contributes to earlier development of CKD5D and the overrepresentation in ICU of indigenous people. Mortality is equivalent once correcting for confounders, but addressing inequality requires strengthening preventative care.
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Affiliation(s)
- William A Dunlop
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Paul J Secombe
- Intensive Care Unit, Central Health Service, Alice Springs, Northern Territory, Australia
| | - Jason W Agostino
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Frank M P van Haren
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
- Intensive Care Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
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26
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Conigrave JH, Conigrave KM, Wilson S, Lee KSK. Indigenous Australian drinking risk: Comparing risk categorisations based on recall of recent drinking occasions to AUDIT-C screening in a representative sample. Drug Alcohol Rev 2022; 41:616-624. [PMID: 34750926 PMCID: PMC9299218 DOI: 10.1111/dar.13403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 09/23/2021] [Accepted: 10/11/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Aboriginal and Torres Strait Islander (Indigenous) Australians have identified alcohol consumption as an area of concern. Accurate screening tools are required to help detect and assist at-risk drinkers, and to provide accurate data to policy makers. The Finnish method (determining drinking patterns based on the last two to four drinking occasions), has been proposed as a culturally appropriate and effective screening tool for detecting Indigenous Australians at risk from alcohol consumption. While it has been found to be valid and acceptable for use with Indigenous Australians, the Finnish method has not been compared to the three-item Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) which is currently recommended by the Australian government for use in Aboriginal community-controlled health services. METHODS We compared the performance of the AUDIT-C and Finnish method as screening tools for detecting harms experienced from alcohol in a representative, cross-sectional, sample of Indigenous Australians. RESULTS AUDIT-C was substantially faster for participants to complete than the Finnish method. Metrics derived from both the AUDIT-C and Finnish method were similarly linked to the frequency of self-reported International Classification of Diseases, 11th revision dependence symptoms and harms. DISCUSSION AND CONCLUSIONS The AUDIT-C is likely most appropriate for use in clinical settings due to its speed and ease of use. The Finnish method provides relatively detailed information about drinking and is better suited to population surveys.
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Affiliation(s)
- James H. Conigrave
- Faculty of Medicine and Health, Central Clinical SchoolCentre of Research Excellence in Indigenous Health and Alcohol, The University of SydneySydneyAustralia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology)Drug Health Services, Sydney Local Health DistrictSydneyAustralia
| | - Katherine M. Conigrave
- Faculty of Medicine and Health, Central Clinical SchoolCentre of Research Excellence in Indigenous Health and Alcohol, The University of SydneySydneyAustralia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology)Drug Health Services, Sydney Local Health DistrictSydneyAustralia
- Drug Health ServiceRoyal Prince Alfred HospitalSydneyAustralia
| | - Scott Wilson
- Faculty of Medicine and Health, Central Clinical SchoolCentre of Research Excellence in Indigenous Health and Alcohol, The University of SydneySydneyAustralia
- Aboriginal Drug and Alcohol Council SA Aboriginal CorporationAdelaideAustralia
| | - K. S. Kylie Lee
- Faculty of Medicine and Health, Central Clinical SchoolCentre of Research Excellence in Indigenous Health and Alcohol, The University of SydneySydneyAustralia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology)Drug Health Services, Sydney Local Health DistrictSydneyAustralia
- Faculty of Health SciencesNational Drug Research Institute, Curtin UniversityPerthAustralia
- Burnet InstituteMelbourneAustralia
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneAustralia
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27
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Liew S, Gwynn J, Smith J, Johnson NA, Plotnikoff R, James EL, Turner N. The Barriers and Facilitators of Sport and Physical Activity Participation for Aboriginal Children in Rural New South Wales, Australia: A Photovoice Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1986. [PMID: 35206182 PMCID: PMC8871796 DOI: 10.3390/ijerph19041986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 12/10/2022]
Abstract
Participating in physical activity is beneficial for health. Whilst Aboriginal children possess high levels of physical activity, this declines rapidly by early adolescence. Low physical activity participation is a behavioral risk factor for chronic disease, which is present at much higher rates in Australian Aboriginal communities compared to non-Aboriginal communities. Through photos and 'yarning', the Australian Aboriginal cultural form of conversation, this photovoice study explored the barriers and facilitators of sport and physical activity participation perceived by Aboriginal children (n = 17) in New South Wales rural communities in Australia for the first time and extended the limited research undertaken nationally. Seven key themes emerged from thematic analysis. Four themes described physical activity barriers, which largely exist at the community and interpersonal level of children's social and cultural context: the physical environment, high costs related to sport and transport, and reliance on parents, along with individual risk factors such as unhealthy eating. Three themes identified physical activity facilitators that exist at the personal, interpersonal, and institutional level: enjoyment from being active, supportive social and family connections, and schools. Findings highlight the need for ongoing maintenance of community facilities to enable physical activity opportunities and ensure safety. Children held strong aspirations for improved and accessible facilities. The strength of friendships and the family unit should be utilized in co-designed and Aboriginal community-led campaigns.
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Affiliation(s)
- Sarah Liew
- South Western Sydney Local Health District, Sydney 2145, Australia; (S.L.); (J.S.)
| | - Josephine Gwynn
- Faculty of Medicine and Health, University of Sydney, Sydney 2006, Australia
| | - Janice Smith
- South Western Sydney Local Health District, Sydney 2145, Australia; (S.L.); (J.S.)
| | - Natalie A. Johnson
- College of Health, Medicine and Wellbeing, University of Newcastle Australia, Newcastle 2308, Australia;
- Hunter Medical Research Institute, Newcastle 2305, Australia; (R.P.); (E.L.J.)
| | - Ronald Plotnikoff
- Hunter Medical Research Institute, Newcastle 2305, Australia; (R.P.); (E.L.J.)
- College of Human and Social Futures, University of Newcastle Australia, Newcastle 2308, Australia
| | - Erica L. James
- Hunter Medical Research Institute, Newcastle 2305, Australia; (R.P.); (E.L.J.)
- College of Human and Social Futures, University of Newcastle Australia, Newcastle 2308, Australia
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28
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Mozun R, Berger F, Singer F. One size does not fit all-Why do pediatric spirometry estimates vary across populations "down under"? Pediatr Pulmonol 2022; 57:345-346. [PMID: 34767695 DOI: 10.1002/ppul.25751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Rebeca Mozun
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Florian Berger
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Florian Singer
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Paediatrics, PEDNET, Paediatric Clinical Trial Unit, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Acceptability and feasibility of strong & Deadly Futures, a culturally-inclusive alcohol and drug prevention program for aboriginal and/or Torres Strait Islander secondary students. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Gardiner FW, Rallah-Baker K, Dos Santos A, Sharma P, Churilov L, Donnan GA, Davis SM, Quinlan F, Worley P. Indigenous Australians have a greater prevalence of heart, stroke, and vascular disease, are younger at death, with higher hospitalisation and more aeromedical retrievals from remote regions. EClinicalMedicine 2021; 42:101181. [PMID: 34765955 PMCID: PMC8573152 DOI: 10.1016/j.eclinm.2021.101181] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We aimed to determine whether heart, stroke, and vascular disease (HSVD) prevalence and emergency primary evacuation (EPE), hospitalisation, and mortality differ by patient characteristics. METHODS An Australian-wide incidence population based study, with prospective data collected form the 1 July 2019 to the 30 October 2020. FINDINGS Indigenous Australians reported significantly higher prevalence of HSVD at 229.0 per-1000 as compared to 152.0 per-1000 non-Indigenous Australians: risk ratio 1.5 (95% CI 1.2-1.8). 583 remote patients received an EPE for HSVD, consisting of 388 (66.6%; 95% CI: 62.6-70.4) males and 195 (33.0%; 95% CI: 29.6-37.4) females. There were 289 (49.6%; 95% CI 45.4- 53.7) patients who identified as Indigenous, and 294 (50.4%; 95% CI 46.3- 54.6) as non-Indigenous. The mean Indigenous age during EPE was 48.0 (95% CI 45.9-50.1) years old, significantly lower than the non-Indigenous mean age of 55.6 (95% CI 53.8-57.4). Indigenous patients hospitalised for HSVD were younger, the majority younger than 65 years (n=21175; 73.7% 95% CI 73.2-74.2) as compared to non-Indigenous patients (n= 357654; 33.1% 95% CI 33.0-33.15). When adjusted for HSVD prevalence, remote Indigenous patients had a higher hospitalisation rate as compared to non-remote Indigenous patients (rate ratio: 1.6; 95% CI 1.3-2.0) and remote non-Indigenous patients (rate ratio: 1.2; 95% CI 1.0-1.5). More Indigenous patients died of HSVD before the age of 65 years (n=1875; 56.5% 95% CI 54.8-58.2) as compared to non-Indigenous patients (n= 16161; 10.6% 95% CI 10.45-10.8). INTERPRETATION Indigenous Australians have a higher prevalence, and younger age during EPE, and hospitalisation for HSVD than non-Indigenous Australians. FUNDING This is a self/internally-funded study, with the lead organisation being the Royal Flying Doctor Service (RFDS) of Australia. For the duration of the study period, the RFDS provided in-kind support including one full-time equivalent (FTE) and resources (office space, computer, research software, and office equipment). There was no external funding source that had a role in study design or data analysis or interpretation.
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Affiliation(s)
- Fergus W Gardiner
- The Royal Flying Doctor Service, Canberra, Australia
- Corresponding author. Dr Fergus W Gardiner, Royal Flying Doctor Service, Level 2, 10-12 Brisbane Avenue, Barton ACT 2600 Australia
| | - Kristopher Rallah-Baker
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Angela Dos Santos
- Department of Medicine (Austin Health), The University of Melbourne, Victoria Australia
| | | | - Leonid Churilov
- Department of Medicine (Austin Health), The University of Melbourne, Victoria Australia
| | - Geoffrey A Donnan
- Department of Medicine (Austin Health), The University of Melbourne, Victoria Australia
| | - Stephen M. Davis
- Department of Medicine (Austin Health), The University of Melbourne, Victoria Australia
| | - Frank Quinlan
- The Royal Flying Doctor Service, Canberra, Australia
| | - Paul Worley
- Riverland Mallee Coorong Local Health Network, Murray Bridge, Australia
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Lewis ET, Howard L, Cardona M, Radford K, Withall A, Howie A, Rockwood K, Peters R. Frailty in Indigenous Populations: A Scoping Review. Front Public Health 2021; 9:785460. [PMID: 34881221 PMCID: PMC8646043 DOI: 10.3389/fpubh.2021.785460] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Indigenous populations experience high rates of age-related illness when compared to their non-Indigenous counterparts. Frailty is a challenging expression of aging and an important public health priority. The purpose of this review was to map what the existing literature reports around frailty in Indigenous populations and to highlight the current gaps in frailty research within the Indigenous landscape. Method: Scoping review of English language original research articles focusing on frailty within Indigenous adult populations in settler colonial countries (Australia, Canada, New Zealand and USA). Ten electronic databases and eight relevant institutional websites were searched from inception to October 2020. Results: Nine articles met our inclusion criteria, finding this population having a higher prevalence of frailty and frailty occurring at younger ages when compared to their non-Indigenous counterparts, but two did not use a formal frailty tool. Females presented with higher levels of frailty. No culturally specific frailty tool was identified, and the included articles did not assess strategies or interventions to manage or prevent frailty in Indigenous peoples. Conclusions: There was little definitive evidence of the true frailty prevalence, approaches to frailty screening and of potential points of intervention to manage or prevent the onset of frailty. Improvements in the quality of evidence are urgently needed, along with further research to determine the factors contributing to higher rates of frailty within Indigenous populations. Incorporation of Indigenous views of frailty, and instruments and programs that are led and designed by Indigenous communities, are crucial to address this public health priority.
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Affiliation(s)
- Ebony T. Lewis
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia
- School of Psychology, Faculty of Science, University of New South Wales, Kensington, NSW, Australia
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Leanne Howard
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia
| | - Magnolia Cardona
- Gold Coast Hospital and Health Service, Southport, QLD, Australia
- Institute for Evidence-Based Healthcare, Bond University, Robina, QLD, Australia
| | - Kylie Radford
- School of Psychology, Faculty of Science, University of New South Wales, Kensington, NSW, Australia
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Adrienne Withall
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia
| | - Adam Howie
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia
| | - Kenneth Rockwood
- Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Ruth Peters
- School of Psychology, Faculty of Science, University of New South Wales, Kensington, NSW, Australia
- Neuroscience Research Australia, Randwick, NSW, Australia
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Jennings C, Patterson E, Curtis RG, Mazzacano A, Maher CA. Effectiveness of a Lifestyle Modification Program Delivered under Real-World Conditions in a Rural Setting. Nutrients 2021; 13:nu13114040. [PMID: 34836296 PMCID: PMC8620632 DOI: 10.3390/nu13114040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 12/13/2022] Open
Abstract
Whilst there is considerable evidence to support the efficacy of physical activity and dietary interventions in disease and death prevention, translation of knowledge into practice remains inadequate. We aimed to examine the uptake, retention, acceptability and effectiveness on physical activity, physical function, sitting time, diet and health outcomes of a Healthy Eating Activity and Lifestyle program (HEALTM) delivered under real-world conditions. The program was delivered to 430 adults living across rural South Australia. Participants of the program attended weekly 2 h healthy lifestyle education and exercise group-based sessions for 8 weeks. A total of 47 programs were delivered in over 15 communities. In total, 548 referrals were received, resulting in 430 participants receiving the intervention (78% uptake). At baseline, 74.6% of participants were female, the mean age of participants was 53.7 years and 11.1% of participants identified as Aboriginal and/or Torres Strait Islander. Follow-up assessments were obtained for 265 participants. Significant improvements were observed for walking, planned physical activity, incidental physical activity, total physical activity, 30 s chair stand, 30 s arm curl, 6 min walk, fruit consumption and vegetable consumption, sitting time and diastolic blood pressure. Positive satisfaction and favourable feedback were reported. The healthy lifestyle program achieved excellent real-world uptake and effectiveness, reasonable intervention attendance and strong program acceptability amongst rural and vulnerable communities.
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Affiliation(s)
- Cally Jennings
- Sonder, Edinburgh North, SA 5113, Australia; (E.P.); (A.M.)
- Correspondence:
| | | | - Rachel G. Curtis
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia; (R.G.C.); (C.A.M.)
| | - Anna Mazzacano
- Sonder, Edinburgh North, SA 5113, Australia; (E.P.); (A.M.)
| | - Carol A. Maher
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia; (R.G.C.); (C.A.M.)
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Wanni Arachchige Dona S, Angeles MR, Hall N, Watts JJ, Peeters A, Hensher M. Impacts of chronic disease prevention programs implemented by private health insurers: a systematic review. BMC Health Serv Res 2021; 21:1222. [PMID: 34763676 PMCID: PMC8582197 DOI: 10.1186/s12913-021-07212-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic diseases contribute to a significant proportion (71%) of all deaths each year worldwide. Governments and other stakeholders worldwide have taken various actions to tackle the key risk factors contributing to the prevalence and impact of chronic diseases. Private health insurers (PHI) are one key stakeholders, particularly in Australian health system, and their engagement in chronic disease prevention is growing. Therefore, we investigated the impacts of chronic disease prevention interventions implemented by PHI both in Australia and internationally. METHOD We searched multiple databases (Business Source Complete, CINAHL, Global Health, Health Business Elite, Medline, PsycINFO, and Scopus) and grey literature for studies/reports published in English until September 2020 using search terms on the impacts of chronic disease prevention interventions delivered by PHIs. Two reviewers assessed the risk of bias using a quality assessment tool developed by Effective Public Healthcare Panacea Project. After data extraction, the literature was synthesised thematically based on the types of the interventions reported across studies. The study protocol was registered in PROSPERO, CRD42020145644. RESULTS Of 7789 records, 29 studies were eligible for inclusion. There were predominantly four types of interventions implemented by PHIs: Financial incentives, health coaching, wellness programs, and group medical appointments. Outcome measures across studies were varied, making it challenging to compare the difference between the effectiveness of different intervention types. Most studies reported that the impacts of interventions, such as increase in healthy eating, physical activity, and lower hospital admissions, last for a shorter term if the length of the intervention is shorter. INTERPRETATION Although it is challenging to conclude which intervention type was the most effective, it appeared that, regardless of the intervention types, PHI interventions of longer duration (at least 2 years) were more beneficial and outcomes were more sustained than those PHI interventions that lasted for a shorter period. FUNDING Primary source of funding was Geelong Medical and Hospital Benefits Association (GMHBA), an Australian private health insurer.
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Affiliation(s)
- Sithara Wanni Arachchige Dona
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
- Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
| | - Mary Rose Angeles
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
- Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
| | - Natasha Hall
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
- Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
| | - Jennifer J Watts
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
- Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
| | - Anna Peeters
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
| | - Martin Hensher
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia.
- Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia.
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Christidis R, Lock M, Walker T, Egan M, Browne J. Concerns and priorities of Aboriginal and Torres Strait Islander peoples regarding food and nutrition: a systematic review of qualitative evidence. Int J Equity Health 2021; 20:220. [PMID: 34620180 PMCID: PMC8499519 DOI: 10.1186/s12939-021-01551-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 09/11/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander Australians experience persistent health and social inequities. Chronic conditions, many of which are diet-related, are leading contributors to the burden of disease and health inequity in Australia. First Nations Peoples have the right to be involved in all policy decisions affecting them. This review aimed to synthesise Aboriginal and Torres Strait Islander Peoples' concerns and priorities about food and nutrition in order to inform policies to improve health equity. METHODS MEDLINE, CINAHL, Informit and Google Scholar were systematically searched to identify qualitative studies-published from January 2008-that included data from Aboriginal and/or Torres Strait Islander Peoples about their concerns and priorities related to food and nutrition. Data were extracted from included studies using a pre-determined template and study quality was assessed using the Aboriginal and Torres Strait Islander Quality Appraisal Tool. Qualitative findings were synthesised using inductive thematic analysis and categorised based on an ecological model of health. RESULTS Twenty-one studies were included. Key factors influencing food and nutrition were identified across all levels of the ecological framework. These included interpersonal and institutional racism, junk food availability and marketing, food accessibility and affordability, housing conditions, food knowledge and cooking skills, and connection to family and culture. CONCLUSIONS Documenting Aboriginal and Torres Strait Islander Peoples' lived experiences of the colonised food system is one step necessary for informing policy to tackle food and nutrition inequities. Based on existing qualitative research, food and nutrition policymakers should prioritise building a supportive food environment by focusing on self-determination; ensuring access to healthy, affordable food and safe housing; and by eliminating systemic racism.
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Affiliation(s)
- Rebecca Christidis
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Locked Bag 20000, Geelong, Victoria Australia
| | - Mark Lock
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Locked Bag 20000, Geelong, Victoria Australia
| | - Troy Walker
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Locked Bag 20000, Geelong, Victoria Australia
| | - Mikaela Egan
- Victorian Aboriginal Community Controlled Health Organisation, 17-23 Sackville St, Collingwood, Victoria Australia
| | - Jennifer Browne
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Locked Bag 20000, Geelong, Victoria Australia
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Munsie C, Ebert J, Collins J, Plaster M, Joske D, Ackland T. A supervised exercise intervention during cancer treatment for adolescents and young adults-FiGHTING F!T: study protocol of a randomised controlled trial. Trials 2021; 22:676. [PMID: 34602065 PMCID: PMC8489079 DOI: 10.1186/s13063-021-05616-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 09/13/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND High-quality evidence supports the integration of exercise to mitigate treatment-related side effects in a wide range of paediatric and adult cancer cohorts. However, the implementation of exercise in adolescent and young adult (AYA) cancer patients is yet to be explored in depth. FiGHTINGF!T is a randomised controlled cross over trial designed to determine if a supervised, structured, and progressive exercise programme can reduce the decline in physical fitness (V02peak) associated with cancer treatment in AYAs from diagnosis. METHODS/DESIGN A total of 40 AYAs recently diagnosed and due to commence systemic treatment (± 2 weeks) for a primary haematological malignancy or solid tumour will be recruited and randomised to either an immediate exercise intervention or usual care (delayed exercise) for 10 weeks. This randomised controlled crossover trial will see both groups engage in a supervised exercise intervention from either diagnosis (baseline assessment) for 10 weeks (0-10 weeks) or following an interim assessment to 20 weeks (10-20 weeks). The bi-weekly tailored exercise programme will combine aerobic and resistance exercises and be supervised by an Accredited Exercise Physiologist. Participants will complete a range of assessments at 0, 10, and 20 weeks including cardiopulmonary exercise tests, 1 repetition maximum strength measures, physical functioning, and self-reported quality of life measurements. Patient-reported treatment-related toxicities will be recorded on a weekly basis. DISCUSSION The FiGHTINGF!T trial will provide insight into the potential benefits of a supervised exercise programme in AYAs undergoing cancer treatment. This trial will contribute to the evidence supporting the necessary integration of exercise during cancer treatment, specifically in the under-reported AYA cohort. TRIAL REGISTRATION This trial was registered retrospectively with the Australia New Zealand Clinical Trial registry ( ACTRN12620000663954 ). Registered on 10 June 2020.
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Affiliation(s)
- Claire Munsie
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia Australia
- Western Australian Youth Cancer Service, Perth, Western Australia Australia
- Sir Charles Gairdner Hospital, Perth, Western Australia Australia
| | - Jay Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia Australia
| | - Joanne Collins
- Western Australian Youth Cancer Service, Perth, Western Australia Australia
- Sir Charles Gairdner Hospital, Perth, Western Australia Australia
| | - Megan Plaster
- Western Australian Youth Cancer Service, Perth, Western Australia Australia
- Sir Charles Gairdner Hospital, Perth, Western Australia Australia
| | - David Joske
- Sir Charles Gairdner Hospital, Perth, Western Australia Australia
- School of Medicine, University of Western Australia, Western Australia Perth, Australia
| | - Timothy Ackland
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia Australia
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Allen B, Canuto K, Evans JR, Lewis E, Gwynn J, Radford K, Delbaere K, Richards J, Lovell N, Dickson M, Macniven R. Facilitators and Barriers to Physical Activity and Sport Participation Experienced by Aboriginal and Torres Strait Islander Adults: A Mixed Method Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9893. [PMID: 34574816 PMCID: PMC8468807 DOI: 10.3390/ijerph18189893] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
Physical activity has cultural significance and population health benefits. However, Aboriginal and Torres Strait Islander adults may experience challenges in participating in physical activity. This mixed methods systematic review aimed to synthetize existing evidence on facilitators and barriers for physical activity participation experienced by Aboriginal and Torres Strait Islander adults in Australia. The Joanna Briggs Institute methodology was used. A systematic search was undertaken of 11 databases and 14 grey literature websites during 2020. The included studies reported physical activity facilitators and barriers experienced by Aboriginal or Torres Strait Islander participants aged 18+ years, living in the community. Twenty-seven studies met the inclusion criteria. Sixty-two facilitators were identified: 23 individual, 18 interpersonal, 8 community/environmental and 13 policy/program facilitators. Additionally, 63 barriers were identified: 21 individual, 17 interpersonal, 15 community/environmental and 10 policy/program barriers. Prominent facilitators included support from family, friends, and program staff, and opportunities to connect with community or culture. Prominent barriers included a lack of transport, financial constraints, lack of time, and competing work, family or cultural commitments. Aboriginal and Torres Strait Islander adults experience multiple facilitators and barriers to physical activity participation. Strategies to increase participation should seek to enhance facilitators and address barriers, collaboratively with communities, with consideration to the local context.
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Affiliation(s)
- Bridget Allen
- Neuroscience Research Australia, Randwick, NSW 2031, Australia; (E.L.); (K.R.); (K.D.)
| | - Karla Canuto
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia;
- Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia
| | - John Robert Evans
- School of Public Health, University of Technology, Ultimo, NSW 2007, Australia;
| | - Ebony Lewis
- Neuroscience Research Australia, Randwick, NSW 2031, Australia; (E.L.); (K.R.); (K.D.)
- School of Population Health, UNSW Medicine & Health, UNSW Sydney, Kensington, NSW 2052, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Kensington, NSW 2052, Australia;
| | - Josephine Gwynn
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia;
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia; (J.R.); (M.D.)
| | - Kylie Radford
- Neuroscience Research Australia, Randwick, NSW 2031, Australia; (E.L.); (K.R.); (K.D.)
- UNSW Ageing Futures Institute, University of New South Wales, Kensington, NSW 2052, Australia;
- School of Psychology, UNSW Science, Kensington, NSW 2052, Australia
| | - Kim Delbaere
- Neuroscience Research Australia, Randwick, NSW 2031, Australia; (E.L.); (K.R.); (K.D.)
- School of Population Health, UNSW Medicine & Health, UNSW Sydney, Kensington, NSW 2052, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Kensington, NSW 2052, Australia;
| | - Justin Richards
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia; (J.R.); (M.D.)
- Faculty of Health, Te Herenga Waka—Victoria University Wellington, Wellington 6012, New Zealand
| | - Nigel Lovell
- UNSW Ageing Futures Institute, University of New South Wales, Kensington, NSW 2052, Australia;
- Faculty of Engineering, Graduate School of Biomedical Engineering, UNSW Sydney, Kensington, NSW 2052, Australia
| | - Michelle Dickson
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia; (J.R.); (M.D.)
| | - Rona Macniven
- School of Population Health, UNSW Medicine & Health, UNSW Sydney, Kensington, NSW 2052, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Kensington, NSW 2052, Australia;
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia;
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Farah Nasir B, Brennan-Olsen S, Gill NS, Beccaria G, Kisely S, Hides L, Kondalsamy-Chennakesavan S, Nicholson G, Toombs M. A community-led design for an Indigenous Model of Mental Health Care for Indigenous people with depressive disorders. Aust N Z J Public Health 2021; 45:330-337. [PMID: 34097328 DOI: 10.1111/1753-6405.13115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 02/01/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To generate outcomes for the development of a culturally appropriate mental health treatment model for Indigenous Australians with depression. METHODS Three focus group sessions and two semi-structured interviews were undertaken over six months across regional and rural locations in South West Queensland. Data were transcribed verbatim and coded using manual thematic analyses. Transcripts were thematically analysed and substantiated. Findings were presented back to participants for authenticity and verification. RESULTS Three focus group discussions (n=24), and two interviews with Elders (n=2) were conducted, from which six themes were generated. The most common themes from the focus groups included Indigenous autonomy, wellbeing and identity. The three most common themes from the Elder interviews included culture retention and connection to Country, cultural spiritual beliefs embedded in the mental health system, and autonomy over funding decisions. CONCLUSIONS A treatment model for depression must include concepts of Indigenous autonomy, identity and wellbeing. Further, treatment approaches need to incorporate Indigenous social and emotional wellbeing concepts alongside clinical treatment approaches. Implications for public health: Any systematic approach to address the social and cultural wellbeing of Indigenous peoples must have a community-led design and delivery.
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Affiliation(s)
- Bushra Farah Nasir
- Rural Clinical School, Faculty of Medicine, The University of Queensland
| | - Sharon Brennan-Olsen
- School of Health and Social Development, Deakin University, Victoria
- Institute for Health Transformation, Deakin University, Victoria
| | - Neeraj S Gill
- Rural Clinical School, Faculty of Medicine, The University of Queensland
- School of Medicine, Griffith University, Queensland
| | - Gavin Beccaria
- School of Psychology and Counselling, University of Southern Queensland
| | - Steve Kisely
- Southern Clinical School, School of Medicine, The University of Queensland
- Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Canada
| | - Leanne Hides
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland
| | | | - Geoffrey Nicholson
- Rural Clinical School, Faculty of Medicine, The University of Queensland
| | - Maree Toombs
- Rural Clinical School, Faculty of Medicine, The University of Queensland
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Adegboye OA, McBryde ES, Eisen DP. Tropical Australian Health-Data Linkage Shows Excess Mortality Following Severe Infectious Disease Is Present in the Short-Term and Long-Term after Hospital Discharge. Healthcare (Basel) 2021; 9:901. [PMID: 34356279 PMCID: PMC8303504 DOI: 10.3390/healthcare9070901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In this study, we aimed to assess the risk factors associated with mortality due to an infectious disease over the short-, medium-, and long-term based on a data-linkage study for patients discharged from an infectious disease unit in North Queensland, Australia, between 2006 and 2011. METHODS Age-sex standardised mortality rates (SMR) for different subgroups were estimated, and the Kaplan-Meier method was used to estimate and compare the survival experience among different groups. RESULTS Overall, the mortality rate in the hospital cohort was higher than expected in comparison with the Queensland population (SMR: 15.3, 95%CI: 14.9-15.6). The long-term mortality risks were significantly higher for severe infectious diseases than non-infectious diseases for male sex, Indigenous, residential aged care and elderly individuals. CONCLUSION In general, male sex, Indigenous status, age and comorbidity were associated with an increased hazard for all-cause deaths.
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Affiliation(s)
- Oyelola A. Adegboye
- World Health Organization Collaborating Center for Vector-Borne and Neglected Tropical Diseases, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville 4811, Australia; (E.S.M.); (D.P.E.)
| | - Emma S. McBryde
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville 4811, Australia; (E.S.M.); (D.P.E.)
| | - Damon P. Eisen
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville 4811, Australia; (E.S.M.); (D.P.E.)
- College of Medicine and Dentistry, James Cook University, Townsville 4811, Australia
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Thurber KA, Banks E, Joshy G, Soga K, Marmor A, Benton G, White SL, Eades S, Maddox R, Calma T, Lovett R. Tobacco smoking and mortality among Aboriginal and Torres Strait Islander adults in Australia. Int J Epidemiol 2021; 50:942-954. [PMID: 33491081 PMCID: PMC8271186 DOI: 10.1093/ije/dyaa274] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite generally high smoking prevalences, stemming from colonization, the relationship of smoking to mortality has not been quantified reliably in an Indigenous population. We investigate smoking and mortality among Aboriginal and Torres Strait Islander adults in Australia, where current adult daily smoking prevalence is 40.2%. METHODS A prospective study of 1388 cardiovascular disease- and cancer-free Aboriginal adults aged ≥45 years, of the 267 153 45 and Up Study participants randomly sampled from the New South Wales general population over 2006-09. Questionnaire and mortality data were linked (through the Centre for Health Record Linkage) to mid-2019. Adjusted hazard ratios (called relative risks, RRs) for all-cause mortality-among current- and past- versus never-smokers-were estimated overall, by smoking intensity and by age at cessation. Smoking-attributable fractions and associated deaths were estimated. RESULTS Over 14 586 person-years' follow-up (median 10.6 years), 162 deaths accrued. Mortality RRs [95% confidence interval (CI)] were 3.90 (2.52-6.04) for current- and 1.95 (1.32-2.90) for past- versus never-smokers, with age heterogeneity. RRs increased with smoking intensity, to 4.29 (2.15-8.57) in current-smokers of ≥25 cigarettes/day. Compared with never-smokers, RRs were 1.48 (0.85-2.57) for those quitting at <45 years of age and 2.21 (1.29-3.80) at 45-54 years. Never-smokers lived an average >10 years longer than current-smokers. Around half of deaths among adults aged ≥45 years were attributable to smoking, exceeding 10 000 deaths in the past decade. CONCLUSIONS In this population, >80% of never-smokers would survive to 75 years, versus ∼40% of current-smokers. Quitting at all ages examined had substantial benefits versus continuing smoking; those quitting before age 45 years had mortality risks similar to never-smokers. Smoking causes half of deaths in older Aboriginal and Torres Strait Islander adults; Indigenous tobacco control must receive increased priority.
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Affiliation(s)
- Katherine A Thurber
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
- Sax Institute, Ultimo, NSW, Australia
| | - Grace Joshy
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - Kay Soga
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - Alexandra Marmor
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
| | | | | | | | - Raglan Maddox
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - Tom Calma
- University of Canberra, Bruce, ACT, Australia
| | - Raymond Lovett
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
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Blignault I, Norsa L, Blackburn R, Bloomfield G, Beetson K, Jalaludin B, Jones N. "You Can't Work with My People If You Don't Know How to": Enhancing Transfer of Care from Hospital to Primary Care for Aboriginal Australians with Chronic Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7233. [PMID: 34299688 PMCID: PMC8306914 DOI: 10.3390/ijerph18147233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022]
Abstract
Indigenous Australians experience significantly poorer health compared to other Australians, with chronic disease contributing to two-thirds of the health gap. We report on an evaluation of an innovative model that leverages mainstream and Aboriginal health resources to enable safe, supported transfer of care for Aboriginal adults with chronic conditions leaving hospital. The multisite evaluation was Aboriginal-led and underpinned by the principles of self-determination and equity and Indigenous research protocols. The qualitative study documented processes and captured service user and provider experiences. We found benefits for patients and their families, the hospital and the health system. The new model enhanced the patient journey and trust in the health service and was a source of staff satisfaction. Challenges included staff availability, patient identification and complexity and the broader issue of cultural safety. Critical success factors included strong governance with joint cultural and clinical leadership and enduring relationships and partnerships at the service delivery, organisation and system levels. A holistic model of care, bringing together cultural and clinical expertise and partnering with Indigenous community organisations, can enhance care coordination and safety across the hospital-community interface. It is important to consider context as well as specific program elements in design, implementation and evaluation.
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Affiliation(s)
- Ilse Blignault
- Translational Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia;
| | - Liz Norsa
- Translational Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia;
| | - Raylene Blackburn
- South Western Sydney Local Health District, Liverpool, NSW 1871, Australia; (R.B.); (G.B.); (K.B.); (B.J.); (N.J.)
| | - George Bloomfield
- South Western Sydney Local Health District, Liverpool, NSW 1871, Australia; (R.B.); (G.B.); (K.B.); (B.J.); (N.J.)
| | - Karen Beetson
- South Western Sydney Local Health District, Liverpool, NSW 1871, Australia; (R.B.); (G.B.); (K.B.); (B.J.); (N.J.)
| | - Bin Jalaludin
- South Western Sydney Local Health District, Liverpool, NSW 1871, Australia; (R.B.); (G.B.); (K.B.); (B.J.); (N.J.)
- Ingham Institute for Applied Medical Research, UNSW Sydney, Liverpool, NSW 2170, Australia
| | - Nathan Jones
- South Western Sydney Local Health District, Liverpool, NSW 1871, Australia; (R.B.); (G.B.); (K.B.); (B.J.); (N.J.)
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Kairuz CA, Casanelia LM, Bennett-Brook K, Coombes J, Yadav UN. Impact of racism and discrimination on physical and mental health among Aboriginal and Torres Strait islander peoples living in Australia: a systematic scoping review. BMC Public Health 2021; 21:1302. [PMID: 34217243 PMCID: PMC8254223 DOI: 10.1186/s12889-021-11363-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 06/24/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Racism is increasingly recognised as a significant health determinant that contributes to health inequalities. In Australia efforts have been made to bridge the recognised health gap between Aboriginal and Torres Strait Islander people and other Australians. This systematic scoping review aimed to assess, synthesise, and analyse the evidence in Australia about the impacts of racism on the mental and physical health of Aboriginal and Torrens Strait Islander peoples. METHODS A systematic search was conducted to locate Australian studies in English published between 2000 and 2020. Five electronic databases were used: PubMed, CINAHL, Embase, Web of Science and the Australia's National Institute for Aboriginal and Torres Strait Islander Health Research. The search strategy included a combination of key words related with racism, mental health, physical health and Indigenous people. Data were extracted based on review questions and findings were synthesized in a narrative summary. RESULTS Of total 338 searched studies from five databases, 12 studies met the inclusion criteria for narrative synthesis where eight were cross-sectional studies and four prospective cohorts. General mental health and general health perception were the most frequently studied outcomes followed by child behaviour, smoking and substance consumption and specific health conditions. The prevalence of racism varied between 6.9 and 97%. The most common health outcomes associated with racism were general poor mental health and poor general health perception. More specific health outcomes such as anxiety, depression, child behaviour, asthma, increased BMI and smoking were also associated with racism but were analysed by a limited number of studies. Three studies analysed psychological distress, negative mental health, sleeping difficulties and negative perceived mental health according to severity of exposition to racism. CONCLUSION Racism is associated with negative overall mental and negative general health outcomes among Aboriginal and Torres Strait Islander peoples. Strategies to prevent all forms and sources of racism are necessary to move forward to bridging the health gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Further research is needed to understand in more detail the impact of racism from an Aboriginal and Torres Strait Islander definition of health and wellbeing.
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Affiliation(s)
- Camila A Kairuz
- Department of Public Health, Torrens University, Sydney, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Lisa M Casanelia
- Department of Public Health, Torrens University, Sydney, Australia
| | | | | | - Uday Narayan Yadav
- Department of Public Health, Torrens University, Sydney, Australia.
- Centre for Primary Health Care and Equity, Faculty of Medicine and Health, UNSW, Sydney, Australia.
- Center for Research Policy and Implementation, Biratnagar, Nepal.
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Thurber KA, Colonna E, Jones R, Gee GC, Priest N, Cohen R, Williams DR, Thandrayen J, Calma T, Lovett R. Prevalence of Everyday Discrimination and Relation with Wellbeing among Aboriginal and Torres Strait Islander Adults in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6577. [PMID: 34207406 PMCID: PMC8296443 DOI: 10.3390/ijerph18126577] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 11/18/2022]
Abstract
Discrimination is a fundamental determinant of health and health inequities. However, despite the high prevalence of discrimination exposure, there is limited evidence specific to Indigenous populations on the link between discrimination and health. This study employs a validated measure to quantify experiences of everyday discrimination in a national sample of Aboriginal and Torres Strait Islander (Australia's Indigenous peoples) adults surveyed from 2018 to 2020 (≥16 years, n = 8108). It quantifies Prevalence Ratios (PRs) and 95% Confidence Intervals (CIs) for wellbeing outcomes by level of discrimination exposure, and tests if associations vary by attribution of discrimination to Indigeneity. Of the participants, 41.5% reported no discrimination, 47.5% low, and 11.0% moderate-high. Discrimination was more commonly reported by younger versus older participants, females versus males, and those living in remote versus urban or regional areas. Discrimination was significantly associated in a dose-response manner, with measures of social and emotional wellbeing, culture and identity, health behaviour, and health outcomes. The strength of the association varied across outcomes, from a 10-20% increased prevalence for some outcomes (e.g., disconnection from culture (PR = 1.08; 95% CI: 1.03, 1.14), and high blood pressure (1.20; 1.09, 1.32)), to a five-fold prevalence of alcohol dependence (4.96; 3.64, 6.76), for those with moderate-high versus no discrimination exposure. The association was of consistent strength and direction whether attributed to Indigeneity or not-with three exceptions. Discrimination is associated with a broad range of poor wellbeing outcomes in this large-scale, national, diverse cohort of Aboriginal and Torres Strait Islander adults. These findings support the vast potential to improve Aboriginal and Torres Strait Islander peoples' wellbeing, and to reduce Indigenous-non-Indigenous inequities, by reducing exposure to discrimination.
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Affiliation(s)
- Katherine A. Thurber
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2600, Australia; (E.C.); (R.J.); (R.C.); (J.T.); (R.L.)
| | - Emily Colonna
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2600, Australia; (E.C.); (R.J.); (R.C.); (J.T.); (R.L.)
| | - Roxanne Jones
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2600, Australia; (E.C.); (R.J.); (R.C.); (J.T.); (R.L.)
| | - Gilbert C. Gee
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA 90024, USA;
| | - Naomi Priest
- Centre for Social Research and Methods, College of Arts and Social Sciences, Australian National University, Canberra, ACT 2600, Australia;
- Population Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia
| | - Rubijayne Cohen
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2600, Australia; (E.C.); (R.J.); (R.C.); (J.T.); (R.L.)
| | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Joanne Thandrayen
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2600, Australia; (E.C.); (R.J.); (R.C.); (J.T.); (R.L.)
| | - Tom Calma
- Poche Indigenous Health Network New South Wales, University of Sydney, Camperdown, NSW 2006, Australia;
- University of Canberra, Bruce, ACT 2617, Australia
- Ninti One, Hackney, SA 5071, Australia
| | - Raymond Lovett
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2600, Australia; (E.C.); (R.J.); (R.C.); (J.T.); (R.L.)
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Dyson H, Van Gestel R, van Doorslaer E. The relative importance and stability of disease burden causes over time: summarizing regional trends on disease burden for 290 causes over 28 years. Popul Health Metr 2021; 19:30. [PMID: 34112193 PMCID: PMC8190735 DOI: 10.1186/s12963-021-00257-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 04/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since the Global Burden of Disease study (GBD) has become more comprehensive, data for hundreds of causes of disease burden, measured using Disability Adjusted Life Years (DALYs), have become increasingly available for almost every part of the world. However, undergoing any systematic comparative analysis of the trends can be challenging given the quantity of data that must be presented. METHODS We use the GBD data to describe trends in cause-specific DALY rates for eight regions. We quantify the extent to which the importance of 'major' DALY causes changes relative to 'minor' DALY causes over time by decomposing changes in the Gini coefficient into 'proportionality' and 'reranking' indices. RESULTS The fall in regional DALY rates since 1990 has been accompanied by generally positive proportionality indices and reranking indices of negligible magnitude. However, the rate at which DALY rates have been falling has slowed and, at the same time, proportionality indices have tended towards zero. These findings are clearest where the focus is exclusively upon non-communicable diseases. Notably, large and positive proportionality indices are recorded for sub-Saharan Africa over the last decade. CONCLUSION The positive proportionality indices show that disease burden has become less concentrated around the leading causes over time, and this trend has become less prominent as the DALY rate decline has slowed. The recent decline in disease burden in sub-Saharan Africa is disproportionally driven by improvements in DALY rates for HIV/AIDS, as well as for malaria, diarrheal diseases, and lower respiratory infections.
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Affiliation(s)
- Henry Dyson
- Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Raf Van Gestel
- Erasmus School of Health Policy and Management & Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Eddy van Doorslaer
- Erasmus School of Health Policy and Management & Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Esgin T, Hersh D, Rowley KG, Macniven R, Glenister K, Crouch A, Newton RU. Physical Activity and Self-Reported Metabolic Syndrome Risk Factors in the Aboriginal Population in Perth, Australia, Measured Using an Adaptation of the Global Physical Activity Questionnaire (GPAQ). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5969. [PMID: 34199675 PMCID: PMC8199758 DOI: 10.3390/ijerph18115969] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/25/2021] [Accepted: 05/30/2021] [Indexed: 11/17/2022]
Abstract
Background: Complex, ongoing social factors have led to a context where metabolic syndrome (MetS) is disproportionately high in Aboriginal Australians. MetS is characterised by insulin resistance, abdominal obesity, hypertension, hypertriglyceridemia, high blood-sugar and low HDL-C. This descriptive study aimed to document physical activity levels, including domains and intensity and sedentary behaviour, and MetS risk factors in the Perth Aboriginal (predominately Noongar) community. Methods: The Global Physical Activity Questionnaire (GPAQ), together with a questionnaire on self-reported MetS risk factors, was circulated to community members for completion during 2014 (n = 129). Results: Data were analysed using chi-squared tests. The average (SD) age was 37.8 years (14) and BMI of 31.4 (8.2) kg/m2. Occupational, transport-related and leisure-time physical activity (PA) and sedentary intensities were reported across age categories. The median (interquartile range) daily sedentary time was 200 (78, 435), 240 (120, 420) and 180 (60, 300) minutes for the 18-25, 26-44 and 45+ year-olds, respectively (p = 0.973). Conclusions: An in-depth understanding of the types, frequencies and intensities of PA reported for the Perth Aboriginal community is important to implementing targeted strategies to reduce the prevalence of chronic disease in this context. Future efforts collaborating with community should aim to reduce the risk factors associated with MetS and improve quality of life.
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Affiliation(s)
- Tuguy Esgin
- Discipline of Exercise, Health and Performance, The University of Sydney, Sydney, NSW 2006, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA 6027, Australia; (D.H.); (R.U.N.)
| | - Deborah Hersh
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA 6027, Australia; (D.H.); (R.U.N.)
| | - Kevin G. Rowley
- Onemda VicHealth Koori Health Unit, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Rona Macniven
- School of Population Health, University of New South Wales, Kensington, NSW 2052, Australia;
- Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
- Faculty of Health, Medicine and Human Sciences, Macquarie University, North Ryde, NSW 2109, Australia
| | - Kristen Glenister
- Department of Rural Health, University of Melbourne, Shepparton, VIC 3630, Australia; (K.G.); (A.C.)
| | - Alan Crouch
- Department of Rural Health, University of Melbourne, Shepparton, VIC 3630, Australia; (K.G.); (A.C.)
| | - Robert U. Newton
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA 6027, Australia; (D.H.); (R.U.N.)
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD 4072, Australia
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Gerrard JM, Godwin S, Chuter V, Munteanu SE, West M, Hawke F. Release of the National Scheme's Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025; the impacts for podiatry in Australia: a commentary. J Foot Ankle Res 2021; 14:38. [PMID: 33971934 PMCID: PMC8108329 DOI: 10.1186/s13047-021-00466-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/16/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Developing since colonisation, Australia's healthcare system has dismissed an ongoing and successful First Nations health paradigm in place for 60,000 years. From Captain James Cook documenting 'very old' First Nations Peoples being 'far more happier than we Europeans' and Governor Arthur Phillip naming Manly in admiration of the physical health of Gadigal men of the Eora Nation, to anthropologist Daisy Bates' observation of First Nations Peoples living 'into their eighties' and having a higher life expectancy than Europeans; our healthcare system's shameful cultural safety deficit has allowed for an Aboriginal and Torres Strait Islander child born in Australia today to expect to live 9 years less than a non-Indigenous child. Disproportionately negative healthcare outcomes including early onset diabetes-related foot disease and high rates of lower limb amputation in Aboriginal and Torres Strait Islander Peoples contribute to this gross inequity. MAIN BODY In 2020, the Australian Health Practitioner Regulation Authority released the National Scheme's Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025 - empowering all registered health practitioners within Australia to provide health care to Aboriginal and Torres Strait Islander Peoples that is inclusive, respectful and safe, as judged by the recipient of care. This recently released strategy is critically important to the podiatry profession in Australia. As clinicians, researchers and educators we have a collective responsibility to engage with this strategy of cultural safety. This commentary defines cultural safety for podiatry and outlines the components of the strategy in the context of our profession. Discussion considers the impact of the strategy on podiatry. It identifies mechanisms for podiatrists in all settings to facilitate safer practice, thereby advancing healthcare to produce more equitable outcomes. CONCLUSION Aboriginal and Torres Strait Islander Peoples access health services more frequently and have better health outcomes where provision of care is culturally safe. By engaging with the National Scheme's Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy, all registered podiatrists in Australia can contribute to achieving equity in health outcomes for Aboriginal and Torres Strait Islander Peoples.
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Affiliation(s)
- James M. Gerrard
- College of Health, Medicine and Wellbeing, School of Health Sciences, University of Newcastle, Ourimbah, NSW 2258 Australia
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, 3086 Australia
| | - Shirley Godwin
- Rural Department of Nursing & Midwifery, La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, 3552 Australia
| | - Vivienne Chuter
- College of Health, Medicine and Wellbeing, School of Health Sciences, University of Newcastle, Ourimbah, NSW 2258 Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Ourimbah, NSW 2258 Australia
| | - Shannon E. Munteanu
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, 3086 Australia
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, 3086 Australia
| | - Matthew West
- College of Health, Medicine and Wellbeing, School of Health Sciences, University of Newcastle, Ourimbah, NSW 2258 Australia
| | - Fiona Hawke
- College of Health, Medicine and Wellbeing, School of Health Sciences, University of Newcastle, Ourimbah, NSW 2258 Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Ourimbah, NSW 2258 Australia
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Gonzalez-Chica D, Gillam M, Williams S, Sharma P, Leach M, Jones M, Walters L, Gardiner F. Pregnancy-related aeromedical retrievals in rural and remote Australia: national evidence from the Royal Flying Doctor Service. BMC Health Serv Res 2021; 21:390. [PMID: 33902590 PMCID: PMC8077896 DOI: 10.1186/s12913-021-06404-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/14/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Inequalities in the availability of maternity health services in rural Australia have been documented, but not the impact on aeromedical retrievals. This study aims to examine the prevalence of pregnancy-related aeromedical retrievals, the most common conditions (overall and in specific age groups), and their distribution according to operation area and demographic characteristics. METHODS Cross-sectional study using administrative data from the Royal Flying Doctors Service (RFDS) including all pregnant women aged 15-49 years retrieved by the RFDS between 2015 and 2019. All pregnancy-related aeromedical retrievals were classified according to the International Classification of Diseases, Tenth Revision (ICD-10, chapter XV). The distribution of pregnancy-related conditions was presented overall and stratified by age group (i.e. < 20 years, 20-34 years and 35+ years). Retrieval and receiving sites were geographically mapped with Tableau mapping software® based on postcode numbers of origin and destination. RESULTS A total of 4653 pregnancy-related retrievals were identified (mean age 27.8 ± 6.1 years), representing 3.1% of all RFDS transfers between 2015 and 18 and 3.5% in 2018-19 (p-value 0.01). The highest proportion of pregnancy-related retrievals (4.8%) occurred in Western operation. There was an apparent increase in pregnancy-related retrievals in South Australia and the Northern Territory (Central Operation) in 2018-19. Preterm labour/delivery was responsible for 36.4% of all retrievals (40.7% among women aged 15-19 years) and premature rupture of membranes for 14.9% (19.4% among women aged 35-49 years). Inter-hospital transfers represented 87.9% of all retrievals, with most patients relocated from rural and remote regions to urban hospitals; most retrievals occurred during the day, with a median distance of 300 km. Adolescents and Aboriginal and Torres Strait Islander were overrepresented in the sample (four and eight times higher than their metropolitan counterparts, respectively). CONCLUSIONS The proportion of pregnancy-related aeromedical retrievals varies geographically across Australia. Overall, one-third of retrievals were related to preterm/delivery complications, especially among adolescents. Most retrievals performed by the RFDS are susceptible to public health strategies aimed at improving antenatal care and preventing unintended pregnancies among adolescents and Aboriginal and Torres Strait Islander women. Greater capacity to manage pregnancy conditions in rural hospitals could reduce the requirement for aeromedical inter-hospital transfers.
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Affiliation(s)
- David Gonzalez-Chica
- Adelaide Rural Clinical School, The University of Adelaide, Helen Mayo North building, 109 Frome Road, Level 1, Room 106, Adelaide, SA 5005 Australia
| | - Marianne Gillam
- Department of Rural Health, University of South Australia, Mt Barker, SA Australia
| | - Susan Williams
- Adelaide Rural Clinical School, The University of Adelaide, Helen Mayo North building, 109 Frome Road, Level 1, Room 106, Adelaide, SA 5005 Australia
| | - Pritish Sharma
- Royal Flying Doctor Service of Australia, Canberra, ACT Australia
| | - Matthew Leach
- National Centre for Naturopathic Medicine, Southern Cross University, East Lismore, NSW Australia
| | - Martin Jones
- Department of Rural Health, University of South Australia, Mt Barker, SA Australia
| | - Lucie Walters
- Adelaide Rural Clinical School, The University of Adelaide, Helen Mayo North building, 109 Frome Road, Level 1, Room 106, Adelaide, SA 5005 Australia
| | - Fergus Gardiner
- Royal Flying Doctor Service of Australia, Canberra, ACT Australia
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Chakraborty A, Daniel M, Howard NJ, Chong A, Slavin N, Brown A, Cargo M. Identifying Environmental Determinants Relevant to Health and Wellbeing in Remote Australian Indigenous Communities: A Scoping Review of Grey Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4167. [PMID: 33920765 PMCID: PMC8071139 DOI: 10.3390/ijerph18084167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/31/2022]
Abstract
The high prevalence of preventable infectious and chronic diseases in Australian Indigenous populations is a major public health concern. Existing research has rarely examined the role of built and socio-political environmental factors relating to remote Indigenous health and wellbeing. This research identified built and socio-political environmental indicators from publicly available grey literature documents locally-relevant to remote Indigenous communities in the Northern Territory (NT), Australia. Existing planning documents with evidence of community input were used to reduce the response burden on Indigenous communities. A scoping review of community-focused planning documents resulted in the identification of 1120 built and 2215 socio-political environmental indicators. Indicators were systematically classified using an Indigenous indicator classification system (IICS). Applying the IICS yielded indicators prominently featuring the "community infrastructure" domain within the built environment, and the "community capacity" domain within the socio-political environment. This research demonstrates the utility of utilizing existing planning documents and a culturally appropriate systematic classification system to consolidate environmental determinants that influence health and disease occurrence. The findings also support understanding of which features of community-level built and socio-political environments amenable to public health and social policy actions might be targeted to help reduce the prevalence of infectious and chronic diseases in Indigenous communities.
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Affiliation(s)
- Amal Chakraborty
- School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (M.D.); (N.J.H.); (A.B.); (M.C.)
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia
| | - Mark Daniel
- School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (M.D.); (N.J.H.); (A.B.); (M.C.)
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT 2601, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Natasha J. Howard
- School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (M.D.); (N.J.H.); (A.B.); (M.C.)
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5000, Australia
| | - Alwin Chong
- Australian Centre for Child Protection, University of South Australia, Adelaide, SA 5001, Australia;
| | - Nicola Slavin
- Environmental Health Branch, Department of Health, Northern Territory Government, Casuarina, NT 0810, Australia;
| | - Alex Brown
- School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (M.D.); (N.J.H.); (A.B.); (M.C.)
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5000, Australia
| | - Margaret Cargo
- School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (M.D.); (N.J.H.); (A.B.); (M.C.)
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT 2601, Australia
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48
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Castle P. Practice learnings from the Psychologist Integration into Primary Health Care Pilot Program on the Tiwi Islands, Northern territory. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1080/00050067.2021.1900715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Snijder M, Lees B, Stearne A, Ward J, Garlick Bock S, Newton N, Stapinski L. An ecological model of drug and alcohol use and related harms among Aboriginal and Torres Strait Islander Australians: A systematic review of the literature. Prev Med Rep 2021; 21:101277. [PMID: 33391981 PMCID: PMC7773534 DOI: 10.1016/j.pmedr.2020.101277] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/23/2020] [Accepted: 11/21/2020] [Indexed: 11/17/2022] Open
Abstract
Globally, Indigenous populations experience a disproportionately higher burden of disease related to substance use. Effective prevention of harm related to substance use is a key strategy for improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples in Australia. To inform preventative approaches, this review synthesised the evidence of risk and protective factors of substance use and related harms among Aboriginal and Torres Strait Islander peoples. Eight peer-reviewed and two grey literature databases were systematically searched for quantitative or qualitative studies assessing factors associated with substance use and related harms among Aboriginal and Torres Strait Islander peoples, published between 1 January 1990 and 30 April 2018. Study quality was assessed using validated instruments. Risk or odds ratios were extracted or calculated and factors were summarised in an ecological model into individual, relationship, community, societal or culturally-distinct levels. Thirty-eight relevant studies were identified and reviewed. Individual-level risk factors for substance use were identified including low socio-economic status, high psychological distress, poly drug use and being male. Relationship-level factors were peer pressure and partner/family substance use; protective factors were supportive environments and positive role models. Community-level risk factors included availability of substances. Culturally-distinct factors included cultural connection as a protective factor, but cultural obligations around sharing was a risk factor. Societal risk factors included intergenerational trauma caused by government policies. These findings highlight the importance of tailored preventative approaches for Aboriginal and Torres Strait Islander communities that address identified risk factors and promote protective factors across all ecological levels.
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Affiliation(s)
- Mieke Snijder
- The Matilda Centre for Research in Mental Health and Substance Use, School of Medicine, Medicine and Health, The University of Sydney, Sydney, 2006 New South Wales, Australia
| | - Briana Lees
- The Matilda Centre for Research in Mental Health and Substance Use, School of Medicine, Medicine and Health, The University of Sydney, Sydney, 2006 New South Wales, Australia
| | | | - James Ward
- The Poche Centre for Indigenous Health, University of Queensland, St Lucia, 4067 Queensland, Australia
| | - Sophia Garlick Bock
- The Matilda Centre for Research in Mental Health and Substance Use, School of Medicine, Medicine and Health, The University of Sydney, Sydney, 2006 New South Wales, Australia
| | - Nicola Newton
- The Matilda Centre for Research in Mental Health and Substance Use, School of Medicine, Medicine and Health, The University of Sydney, Sydney, 2006 New South Wales, Australia
| | - Lexine Stapinski
- The Matilda Centre for Research in Mental Health and Substance Use, School of Medicine, Medicine and Health, The University of Sydney, Sydney, 2006 New South Wales, Australia
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50
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Emond K, Bish M, Savic M, Lubman DI, McCann T, Smith K, Mnatzaganian G. Characteristics of Confidence and Preparedness in Paramedics in Metropolitan, Regional, and Rural Australia to Manage Mental-Health-Related Presentations: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1882. [PMID: 33672055 PMCID: PMC7919464 DOI: 10.3390/ijerph18041882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 11/17/2022]
Abstract
Mental-health-related presentations account for a considerable proportion of the paramedic's workload in prehospital care. This cross-sectional study aimed to examine the perceived confidence and preparedness of paramedics in Australian metropolitan and rural areas to manage mental-health-related presentations. Overall, 1140 paramedics were surveyed. Pearson chi-square and Fisher exact tests were used to compare categorical variables by sex and location of practice; continuous variables were compared using the non-parametric Mann-Whitney and Kruskal-Wallis tests. Perceived confidence and preparedness were each modelled in multivariable ordinal regressions. Female paramedics were younger with higher qualifications but were less experienced than their male counterparts. Compared to paramedics working in metropolitan regions, those working in rural and regional areas were generally older with fewer qualifications and were significantly less confident and less prepared to manage mental health presentations (p = 0.001). Compared to male paramedics, females were less confident (p = 0.003), although equally prepared (p = 0.1) to manage mental health presentations. These results suggest that higher qualifications from the tertiary sector may not be adequately preparing paramedics to manage mental health presentations, which signifies a disparity between education provided and workforce preparedness. Further work is required to address the education and training requirements of paramedics in regional and rural areas to increase confidence and preparedness in managing mental health presentations.
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Affiliation(s)
- Kate Emond
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, P.O. Box 199, Bendigo 3552, Australia; (M.B.); (G.M.)
| | - Melanie Bish
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, P.O. Box 199, Bendigo 3552, Australia; (M.B.); (G.M.)
| | - Michael Savic
- Turning Point, Eastern Health, Melbourne 3120, Australia; (M.S.); (D.I.L.)
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne 3128, Australia
| | - Dan I. Lubman
- Turning Point, Eastern Health, Melbourne 3120, Australia; (M.S.); (D.I.L.)
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne 3128, Australia
| | - Terence McCann
- Department of Nursing and Midwifery, Institute of Health and Sport, Victoria University, Melbourne 3011, Australia;
| | - Karen Smith
- Ambulance Victoria, Melbourne 3500, Australia;
| | - George Mnatzaganian
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, P.O. Box 199, Bendigo 3552, Australia; (M.B.); (G.M.)
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