ORCID Profile
0000-0001-8629-3390
Current Organisations
University of Melbourne
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Curtin University
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Aboriginal and Torres Strait Islander education not elsewhere classified | Public Health and Health Services | Aboriginal and Torres Strait Islander public health and wellbeing | Aboriginal and Torres Strait Islander peoples and the law | Health and Community Services | Social work not elsewhere classified | Epidemiology | Aboriginal and Torres Strait Islander Health | Population Trends and Policies | Health and community services | Information and Computing Sciences not elsewhere classified | Social epidemiology | Epidemiology | Other Information and Computing Sciences | Aboriginal and Torres Strait Islander community and regional development | Aboriginal and Torres Strait Islander peoples society and community | Social and Community Psychology
ANZSRC Socio-Economic Objective (SEO)
Computer Software and Services not elsewhere classified | Social Structure and Health | Aboriginal and Torres Strait Islander Development and Welfare | Communication Across Languages and Culture | Aboriginal and Torres Strait Islander Health - Health Status and Outcomes | Families and Family Services |
Related Links
Publications
Foundation for a Smoke-Free World and healthy Indigenous futures: An oxymoron?
Publisher: BMJ
Date: 10-05-2020
Antarctica's protected areas are inadequate, unrepresentative, and at risk
Publisher: Public Library of Science (PLoS)
Date: 17-06-2014
Factors relating to participation in follow-up to the 45 and up study in Aboriginal and non-Aboriginal individuals
Publisher: Springer Science and Business Media LLC
Date: 11-05-2016
Acceptability of an Emotional and Behavioural Screening Tool for Children in Aboriginal Community Controlled Health Services in Urban NSW
Publisher: SAGE Publications
Date: 10-2010
DOI: 10.3109/00048674.2010.489505
Abstract: Objective: To assess the acceptability and face validity of the Strengths and Difficulties Questionnaire (SDQ) in Aboriginal community controlled health services (ACCHOs) located in the greater Sydney region. Methods: A qualitative study was conducted in three ACCHOs located within the greater Sydney region in 2008–2009. A semi-structured approach was used in focus groups and small group interviews (n = 47) to elicit participants’ views on the appropriateness of the SDQ and any additional issues of importance to Aboriginal child and adolescent mental health. Results: The SDQ was found to cover many important aspects of Aboriginal child and adolescent mental health, however, the wording of some questions was considered ambiguous and some critical issues are not explored. The peer relationships subscale did not appear to fit well with Aboriginal concepts of the relative importance of different interpersonal relationships. Conclusion: Overall the SDQ was acceptable in ACCHOs in Sydney however, changes to the wording of some questions and the response scale may be indicated to improve cultural appropriateness and clarity. A further set of issues which are not covered by any commonly used screening tools but are of critical importance to Aboriginal child and adolescent mental health should also be considered by clinicians.
The risk status, screening history and health concerns of Aboriginal and Torres Strait Islander people attending an Aboriginal Community Controlled Health Service
Publisher: Wiley
Date: 26-04-2012
DOI: 10.1111/J.1465-3362.2012.00455.X
Abstract: Primary health-care services need to maximise prevention activities to improve the health of Aboriginal and Torres Strait Islander people. This study determined Aboriginal and Torres Strait Islander people's risk status and screening history for cardiovascular, diabetes and cancer, and identified opportunities for prevention based on patient's health concerns. Consenting adult patients attending an Aboriginal Community Controlled Health Service completed interview surveys. Outcome measures were: patient's self-reported rates of smoking, at-risk alcohol consumption, body mass index and screening rates for cholesterol, diabetes, blood pressure, cervical and breast cancer, the proportion of patients with multiple risk factors and health information patients prioritise to receive from their doctor. We surveyed 587 patients giving a consent rate of 77%. Patient's self-reported being at risk due to smoking (51%), harmful alcohol consumption in both short term (10%) and long term (10%), and overweight (28%) and obese (49%) body mass index. The proportion of patients who had not been screened within the recommended guidelines was 27% for cholesterol, 24% for diabetes, 40% for blood pressure, 47% for cervical cancer and 54% for breast cancer. The majority (73%) of patients had multiple risk factors. Patients prioritised receiving health information on diabetes (45%), weight (43%) and heart disease (43%). Many patients were at high risk, and were concerned about the health risks they experience. Strategies are needed to help clinic staff identify risks, and maximise prevention activities according to best-practice guidelines, particularly to patients who experience multiple risk factors.
Care co-ordination interventions to improve outcomes during pregnancy and early childhood (up to 5 years)
Publisher: Wiley
Date: 29-08-2017
Global Systematic Review of the Cost-Effectiveness of Indigenous Health Interventions
Publisher: Public Library of Science (PLoS)
Date: 05-11-2014
What is the value of a driver licence? A contingent valuation study of Australian adults
Publisher: Elsevier BV
Date: 02-2018
Maternal fetal programming of birthweight among Australian Aboriginal infants: a population-based data linkage study
Publisher: Elsevier BV
Date: 04-2019
Evidence for a comprehensive approach to Aboriginal tobacco control to maintain the decline in smoking: an overview of reviews among Indigenous peoples
Publisher: Springer Science and Business Media LLC
Date: 10-07-2017
Type 2 diabetes after gestational diabetes: Greater than fourfold risk among Indigenous compared with non-Indigenous Australian women
Publisher: Wiley
Date: 22-10-2016
DOI: 10.1002/DMRR.2715
Abstract: Gestational diabetes is associated with a high risk of type 2 diabetes. However, progression rates among Indigenous women in Australia who experience high prevalence of gestational diabetes are unknown. This retrospective cohort study includes all births to women at a regional hospital in Far North Queensland, Australia, coded as having 'gestational diabetes' from 1 January 2004 to 31 December 2010 (1098 births) and receiving laboratory postpartum screening from 1 January 2004 to 31 December 2011 (n = 483 births). Women who did not receive postpartum screening were excluded from the denominator. Data were linked between hospital electronic records, routinely collected birth data and laboratories, with s le validation by reviews of medical records. Analysis was conducted using Cox-proportional regression models. Indigenous women had a greater than fourfold risk of developing type 2 diabetes within 8 years of having gestational diabetes, compared with non-Indigenous women (hazards ratio 4.55, 95% confidence interval 2.63-7.88, p < 0.0001). Among women receiving postpartum screening tests, by 3, 5 and 7 years postpartum, 21.9% (15.8-30.0%), 25.5% (18.6-34.3%) and 42.4% (29.6-58.0%) Indigenous women were diagnosed with type 2 diabetes after gestational diabetes, respectively, compared with 4.2% (2.5-7.2%), 5.7% (3.3-9.5%) and 13.5% (7.3-24.2%) non-Indigenous women. Multivariate analysis showed an increased risk of developing type 2 diabetes among women with an early pregnancy body mass index ≥25 kg/m(2) , only partially breastfeeding at hospital discharge and gestational diabetes diagnosis prior to 17 weeks gestation. This study demonstrates that, compared with non-Indigenous women, Indigenous Australian women have a greater than fourfold risk of developing type 2 diabetes after gestational diabetes. Strategies are urgently needed to reduce rates of type 2 diabetes by supporting a healthy weight and breastfeeding and to improve postpartum screening among Indigenous women with gestational diabetes. Copyright © 2015 John Wiley & Sons, Ltd.
The Construct Validity of the Strengths and Difficulties Questionnaire for Aboriginal Children Living in Urban New South Wales, Australia
Publisher: Informa UK Limited
Date: 06-2014
DOI: 10.1111/AP.12045
Factors relating to high psychological distress in Indigenous Australians and their contribution to Indigenous–non‐Indigenous disparities
Publisher: Elsevier BV
Date: 04-2018
Abstract: To explore factors associated with high psychological distress among Aboriginal and non-Aboriginal Australians and their contribution to the elevated distress prevalence among Aboriginal people. Questionnaire data from 1,631 Aboriginal and 233,405 non-Aboriginal 45 and Up Study (NSW, Australia) participants aged ≥45 years were used to calculate adjusted prevalence ratios for high psychological distress (Kessler-10 score ≥22) for socio-demographic, health and disability-related factors, and to quantify contributions to differences in distress prevalence. While high-distress prevalence was increased around three-fold in Aboriginal versus non-Aboriginal participants, distress-related risk factors were similar. Morbidity and physical disability had the strongest associations high distress affected 43.8% of Aboriginal and 20.9% of non-Aboriginal participants with severe physical limitations and 9.5% and 3.9% of those without limitations, respectively. Differences in distress prevalence between Aboriginal and non-Aboriginal participants were essentially attributable to differences in SES, morbidity, disability/functional limitations and social support (fully-adjusted PR 1.19 [95% 1.08, 1.30]) physical morbidity and disability explained the bulk. The markedly elevated prevalence of high distress among older Aboriginal Australians appears largely attributable to greater physical morbidity and disability. Implications for public health: Addressing upstream determinants of physical morbidity and improved integration of social and emotional wellbeing care into primary care and chronic disease management are essential.
The Study of Environment on Aboriginal Resilience and Child Health (SEARCH): a long-term platform for closing the gap
Publisher: The Sax Institute
Date: 2016
DOI: 10.17061/PHRP2631635
Abstract: The full potential for research to improve Aboriginal health has not yet been realised. This paper describes an established long-term action partnership between Aboriginal Community Controlled Health Services (ACCHSs), the Aboriginal Health and Medical Research Council of New South Wales (AH&MRC), researchers and the Sax Institute, which is committed to using high-quality data to bring about health improvements through better services, policies and programs. The ACCHSs, in particular, have ensured that the driving purpose of the research conducted is to stimulate action to improve health for urban Aboriginal children and their families. This partnership established a cohort study of 1600 urban Aboriginal children and their caregivers, known as SEARCH (the Study of Environment on Aboriginal Resilience and Child Health), which is now having significant impacts on health, services and programs for urban Aboriginal children and their families. This paper describes some ex les of the impacts of SEARCH, and reflects on the ways of working that have enabled these changes to occur, such as strong governance, a focus on improved health, AH&MRC and ACCHS leadership, and strategies to support the ACCHS use of data and to build Aboriginal capacity.
Rationale and design of the Kanyini guidelines adherence with the polypill (Kanyini-GAP) study: A randomised controlled trial of a polypill-based strategy amongst Indigenous and non Indigenous people at high cardiovascular risk
Publisher: Springer Science and Business Media LLC
Date: 05-08-2010
Abstract: The Kanyini Guidelines Adherence with the Polypill (Kanyini-GAP) Study aims to examine whether a polypill-based strategy (using a single capsule containing aspirin, a statin and two blood pressure-lowering agents) amongst Indigenous and non-Indigenous people at high risk of experiencing a cardiovascular event will improve adherence to guideline-indicated therapies, and lower blood pressure and cholesterol levels. The study is an open, randomised, controlled, multi-centre trial involving 1000 participants at high risk of cardiovascular events recruited from mainstream general practices and Aboriginal Medical Services, followed for an average of 18 months. The participants will be randomised to one of two versions of the polypill, the version chosen by the treating health professional according to clinical features of the patient, or to usual care. The primary study outcomes will be changes, from baseline measures, in serum cholesterol and systolic blood pressure and self-reported current use of aspirin, a statin and at least two blood pressure lowering agents. Secondary study outcomes include cardiovascular events, renal outcomes, self-reported barriers to indicated therapy, prescription of indicated therapy, occurrence of serious adverse events and changes in quality-of-life. The trial will be supplemented by formal economic and process evaluations. The Kanyini-GAP trial will provide new evidence as to whether or not a polypill-based strategy improves adherence to effective cardiovascular medications amongst in iduals in whom these treatments are indicated. This trial is registered with the Australian New Zealand Clinical Trial Registry ACTRN126080005833347.
Obesity and its association with sociodemographic factors, health behaviours and health status among Aboriginal and non-Aboriginal adults in New South Wales, Australia
Publisher: BMJ
Date: 07-03-2018
Abstract: High body mass index (BMI) is the second leading contributor to Australia’s burden of disease and is particularly prevalent among Aboriginal peoples. This paper aims to provide insight into factors relating to obesity among Aboriginal adults and Aboriginal–non-Aboriginal differences. Cross-sectional analysis of data from the 45 and Up Study, comparing obesity (BMI ≥30 kg/m 2 ) prevalence and risk factors among 1515 Aboriginal and 213 301 non-Aboriginal adults in New South Wales. Age–sex-adjusted prevalence ratios (PRs) for obesity by sociodemographic factors, health behaviours and health status were estimated (multivariable log-binomial regression) for Aboriginal and non-Aboriginal participants separately. We quantified the extent to which key factors (physical activity, screen time, education, remoteness, area-level disadvantage) accounted for any excess Aboriginal obesity prevalence. Obesity prevalence was 39% among Aboriginal and 22% among non-Aboriginal participants (PR=1.65, 95% CI 1.55 to 1.76). Risk factors for obesity were generally similar for Aboriginal and non-Aboriginal participants and included in idual-level and area-level disadvantage, physical inactivity, and poor physical and mental health, with steeper gradients observed among non-Aboriginal participants for some factors (P interaction .05). Many risk factors were more common among Aboriginal versus non-Aboriginal participants key factors accounted for % of the excess Aboriginal obesity prevalence. A substantial proportion of the excess obesity prevalence among Aboriginal versus non-Aboriginal participants was explained by physical activity, screen time, education, remoteness and area-level disadvantage. Socioeconomic and health behaviour factors are potential targets for promoting healthy BMI, but these must be considered within the context of upstream social and cultural factors. Adults with health needs and disability require particular attention.
Exploring pathways to mental healthcare for urban Aboriginal young people: a qualitative interview study
Publisher: BMJ
Date: 07-2019
DOI: 10.1136/BMJOPEN-2018-025670
Abstract: To explore the perceptions of Aboriginal Community Controlled Health Service (ACCHS) staff involved in providing mental healthcare to Aboriginal young people of the current and ideal pathways to mental healthcare for urban Aboriginal young people attending ACCHSs, and to identify what additional supports staff may need to provide optimal mental healthcare to Aboriginal young people. Qualitative interview study conducted during May 2016–2017. Primary care, at two ACCHSs participating in the Study of Environment on Aboriginal Resilience and Child Health in New South Wales. Purposive s ling of staff involved in mental healthcare pathways of Aboriginal young people, including general practitioners (GPs), nurses and Aboriginal Health Workers (AHWs). All in iduals approached for interview (n=21) participated in the study. Four overarching themes and seven sub-themes were identified: availability and use of tools in practice (valuing training and desire for tools and established pathways), targeting the ideal care pathway (initiating care and guiding young people through care), influencing the care pathway (adversities affecting access to care and adapting the care pathway) and assessing future need (appraising service availability). Participants desired screening tools, flexible guidelines and training for healthcare providers to support pathways to mental healthcare for Aboriginal young people. Both GPs and AHWs were considered key in identifying children at risk and putting young people onto a pathway to receive appropriate mental healthcare. AHWs were deemed important in keeping young people on the care pathway, and participants felt care pathways could be improved with the addition of dedicated child and adolescent AHWs. The ACCHSs were highlighted as essential to providing culturally appropriate care for Aboriginal young people experiencing mental health problems, and funding for mental health specialists to be based at the ACCHSs was considered a priority.
A large proportion of poor birth outcomes among Aboriginal Western Australians are attributable to smoking, alcohol and substance misuse, and assault
Publisher: Springer Science and Business Media LLC
Date: 02-04-2019
Excess Risk of Stroke in Australia's Aboriginal and Torres Strait Islander Populations
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2011
Diabetes in pregnancy among indigenous women in australia, canada, new zealand and the united states: A systematic review of the evidence for screening in early pregnancy
Publisher: Wiley
Date: 05-2013
DOI: 10.1002/DMRR.2389
Use of family relationships improved consistency of identification of Aboriginal people in linked administrative data
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.JCLINEPI.2017.06.021
Abstract: Algorithms are often used to improve identification of Aboriginal Australians in linked data sets with inconsistent and incomplete recording of Aboriginal status. We compared how consistently some common algorithms identified family members, developed a new algorithm incorporating relatives' information, and assessed the effects of these algorithms on health estimates. The s le was people born 1980-2011 recorded as Aboriginal at least once (or a relative) in four Western Australian data sets and their relatives (N = 156,407). A very inclusive approach, ever-Aboriginal (EA/EA+, where + denotes children's records incorporated), and two more specific approaches, multistage median (MSM/MSM+) and last record (LR/LR+), were chosen, along with the new algorithm (MSM+Family). Ever-Aboriginal (EA) categorized relatives the least consistently 25% of parent-child triads had incongruent Aboriginal statuses with EA+, compared with only 9% with MSM+. With EA+, 14% of full siblings had different statuses compared with 8% for MSM+. EA produced the lowest estimates of the proportion of Aboriginal people with poor health outcomes. Using relatives' records reduced the number of uncategorized people and categorized as Aboriginal more people who had few records (e.g., no hospital admissions). When many data sets are linked, more specific algorithms select more representative Aboriginal s les and identify Aboriginality of relatives more consistently.
Antenatal smoking in vulnerable population groups: An area of need
Publisher: Informa UK Limited
Date: 2007
DOI: 10.1080/01443610701667486
Abstract: Antenatal smoking is a potentially preventable risk factor associated with pre-term birth and low birth weight. Rates of antenatal smoking, low birth weight, and infant mortality are all higher among the Indigenous populations than the non-Indigenous populations of Australia, Canada, New Zealand and the USA. Given this, it might be expected that publications examining smoking cessation efforts in Indigenous antenatal groups would be substantive. We examined the differences in the number and type of antenatal smoking publications for Indigenous and non-Indigenous populations across three time periods (1984-86, 1994-96 and 2004-06). Articles were classified as research studies (focusing on measurement, descriptive, or intervention studies), literature reviews, descriptions of programmes or research (with no data), or discussions. There was a significant increase in the number of publications relating to antenatal smoking among Indigenous populations in the time periods examined, but the total number of publications remained small. The number relating to general antenatal populations increased, but remained substantially lower than that relating to low birth weight. There was no increase in the proportional allocation of research articles to the intervention category in the later time period. The pattern of research output relating to antenatal smoking by mainstream or Indigenous populations is not optimal for advancement of knowledge in the field. There is a clear need for intervention-based research to allow the development of evidence-based practice for reducing the prevalence of antenatal smoking and associated health issues.
Liaison Psychiatry with Aboriginal and Torres Strait Islander Peoples
Publisher: SAGE Publications
Date: 2009
DOI: 10.1080/00048670902873649
Abstract: Objective: The aim of the present study was to describe the referral patterns, assessment and suggested management of Aboriginal and Torres Strait Islander peoples referred to an inner-city general hospital psychiatry service. The overarching goal was quality improvement. Method: Participants were identified from the consultation–liaison psychiatry database of all referrals to the service from the general hospital and Emergency Department. All people over 18 identifying as Aboriginal and/or Torres Strait Islander seen during the period 1 July 2004–30 June 2007 were included. Information regarding referral and liaison patterns, suggested psychiatric management, disposition and follow up were gathered retrospectively from the medical records, with a particular focus on cultural references. Results: There were 162 referrals to the consultation–liaison psychiatry team of people identifying as Aboriginal and/or Torres Strait Islander. The rate of referral to consultation–liaison psychiatry was 3%. The Emergency Department had the highest rate of referral followed by Obstetrics and Gynaecology. The most common reason for referral was assessment of risk. The patient's Aboriginal ethnicity was mentioned in 52.5% of consultation–liaison assessments. An Aboriginal health worker was consulted in 48.1% of cases. The most common management approach involved pharmacotherapy. The consultation–liaison service instigated legal interventions in 25% of cases. Forty-five patients were referred for psychiatric admission following their assessment. Mental health follow up was arranged in 43.8% of cases. Conclusions: The range of mental health problems referred and types of diagnoses made in Aboriginal and Torres Strait Islander peoples reflect what has been previously reported, particularly in relation to comorbidity. Aboriginal ethnicity was variably identified and Aboriginal health workers, general practitioners and families were not routinely involved in consultation–liaison psychiatry assessments, highlighting an opportunity to improve communication and the quality of patient care.
Physical functional limitations among aboriginal and non-aboriginal older adults: Associations with socio-demographic factors and health
Publisher: Public Library of Science (PLoS)
Date: 30-09-2015
Inequalities in ventilation tube insertion procedures between Aboriginal and non-Aboriginal children in New South Wales, Australia: A data linkage study
Publisher: BMJ
Date: 11-2013
The health-related quality of life of Indigenous populations: a global systematic review
Publisher: Springer Science and Business Media LLC
Date: 10-05-2016
DOI: 10.1007/S11136-016-1311-9
Abstract: Indigenous conceptions of health have been shown to differ from that of their non-Indigenous counterparts. As a result, there remains uncertainty over the appropriateness and value of using existing health-related quality-of-life (HRQoL) instruments in Indigenous communities. The objective of this review was to identify studies that either measure the HRQoL of an Indigenous population or validated a measure used to elicit the HRQoL in an Indigenous population. A systematic review of the published literature was conducted to (1) investigate the extent to which HRQoL instruments are used in Indigenous populations (2) to identify which instruments have been validated in which populations and (3) to identify which instruments have been tailored for use with Indigenous populations. Forty-one studies were included in the review. Only three of the 41 studies utilised Indigenous-specific instruments. The remainder (38 studies) utilised generic population or disease-specific instruments. Four studies found specific HRQoL instruments to be valid in these populations and 32 estimated the HRQoL of an Indigenous population. The limited ex les of Indigenous-specific instruments highlighted the potential importance to the HRQoL of these populations of domains that lie outside of traditional measures including social and community domains as well as domains relating to culture, diet and land use on top of more traditional HRQoL domains. Ensuring that the HRQoL of Indigenous populations is being appropriately measured is vital to prioritising available resources to the most effective interventions. HRQoL instruments present an opportunity to directly elicit and incorporate Indigenous preferences and conceptions of health into these decisions. Further work is required in the field to ensure that this potential is realised.
Study protocol: Our Cultures Count, the Mayi Kuwayu Study, a national longitudinal study of Aboriginal and Torres Strait Islander wellbeing
Publisher: BMJ
Date: 06-2018
Gestational Age and Child Development at Age Five in a Population‐Based Cohort of Australian Aboriginal and Non‐Aboriginal Children
Publisher: Wiley
Date: 22-11-2017
DOI: 10.1111/PPE.12426
Abstract: Preterm birth and developmental vulnerability are more common in Australian Aboriginal compared with non-Aboriginal children. We quantified how gestational age relates to developmental vulnerability in both populations. Perinatal datasets were linked to the Australian Early Development Census (AEDC), which collects data on five domains, including physical, social, emotional, language/cognitive, and general knowledge/communication development. We quantified the risk of developmental vulnerability on ≥1 domains at age 5, according to gestational age and Aboriginality, for 97 989 children born in New South Wales, Australia, who started school in 2009 or 2012. Seven thousand and seventy-nine children (7%) were Aboriginal. Compared with non-Aboriginal children, Aboriginal children were more likely to be preterm (5% vs. 9%), and developmentally vulnerable on ≥1 domains (20% vs. 36%). Overall, the proportion of developmentally vulnerable children decreased with increasing gestational age, from 44% at ≤27 weeks to 20% at 40 weeks. Aboriginal children had higher risks than non-Aboriginal children across the gestational age range, peaking among early term children (risk difference [RD] 19.0, 95% confidence interval [CI] 16.3, 21.7 relative risk [RR] 1.91, 95% CI 1.77, 2.06). The relation of gestational age to developmental outcomes was the same in Aboriginal and non-Aboriginal children, and adjustment for socio-economic disadvantage attenuated the risk differences and risk ratios across the gestational age range. Although the relation of gestational age to developmental vulnerability was similar in Aboriginal and non-Aboriginal children, Aboriginal children had a higher risk of developmental vulnerability at all gestational ages, which was largely accounted for by socio-economic disadvantage.
An intensive smoking intervention for pregnant aboriginal and Torres strait islander women: A randomised controlled trial
Publisher: AMPCo
Date: 07-2012
DOI: 10.5694/MJA11.10858
Abstract: To determine the effectiveness of an intensive quit-smoking intervention on smoking rates at 36 weeks' gestation among pregnant Aboriginal and Torres Strait Islander women. Randomised controlled trial. Pregnant Aboriginal and Torres Strait Islander women (n = 263) attending their first antenatal visit at one of three Aboriginal community-controlled health services between June 2005 and December 2009. A general practitioner and other health care workers delivered tailored advice and support to quit smoking to women at their first antenatal visit, using evidence-based communication skills and engaging the woman's partner and other adults in supporting the quit attempts. Nicotine replacement therapy was offered after two failed attempts to quit. The control ("usual care") group received advice to quit smoking and further support and advice by the GP at scheduled antenatal visits. Self-reported smoking status (validated with a urine cotinine measurement) between 36 weeks' gestation and delivery. Participants in the intervention group (n = 148) and usual care group (n = 115) were similar in baseline characteristics, except that there were more women who had recently quit smoking in the intervention group than the control group. At 36 weeks, there was no significant difference between smoking rates in the intervention group (89%) and the usual care group (95%) (risk ratio for smoking in the intervention group relative to usual care group, 0.93 [95% CI, 0.86-1.08] P = 0.212). Smoking rates in the two groups remained similar when baseline recent quitters were excluded from the analysis. An intensive quit-smoking intervention was no more effective than usual care in assisting pregnant Aboriginal and Torres Strait Islander women to quit smoking during pregnancy. Contamination of the intervention across groups, or the nature of the intervention itself, may have contributed to this result. Australian New Zealand Clinical Trials Registry ACTRN12609000929202.
Exploring disparities in acute myocardial infarction events between Aboriginal and non-Aboriginal Australians: Roles of age, gender, geography and area-level disadvantage
Publisher: Elsevier BV
Date: 07-2014
DOI: 10.1016/J.HEALTHPLACE.2014.03.009
Abstract: We investigated disparities in rates of acute myocardial infarction (AMI) between Aboriginal and non-Aboriginal people in the 199 Statistical Local Areas (SLAs) in New South Wales, Australia. Using routinely collected and linked hospital and mortality data from 2002 to 2007, we developed multilevel Poisson regression models to estimate the relative rates of first AMI events in the study period accounting for area of residence. Rates of AMI in Aboriginal people were more than two times that in non-Aboriginal people, with the disparity greatest in more disadvantaged and remote areas. AMI rates in Aboriginal people varied significantly by SLA, as did the Aboriginal to non-Aboriginal rate ratio. We identified almost 30 priority areas for universal and targeted preventive interventions that had both high rates of AMI for Aboriginal people and large disparities in rates.
Low rates of predominant breastfeeding in hospital after gestational diabetes, particularly among Indigenous women in Australia
Publisher: Elsevier BV
Date: 04-2017
Abstract: To investigate rates of 'any' and 'predominant' breastfeeding in hospital among Indigenous and non-Indigenous women with and without gestational diabetes mellitus (GDM). A retrospective study of singleton infants born from July 2007 to December 2010 at Cairns Hospital, Australia, following GDM pregnancy, using linked hospital and birth data (n=617 infants), with a subs le of medical record reviews (n=365 infants). Aggregate data were used to compare to breastfeeding rates among infants born following non-GDM pregnancy (n=7,894 infants). More than 90% of all women reported any breastfeeding before hospital discharge. About 80% of women without GDM reported predominant breastfeeding. Despite significant increases over time (p<0.0001), women with GDM were less likely to predominantly breastfeed (OR 0.32, 95%CI 0.27-0.38, p<0.0001) with lower rates among Indigenous women (53%) compared with non-Indigenous (60%) women (OR 0.78, 0.70-0.88, p<0.0001) and women having a caesarean birth or pre-term infant. Rates of predominant in-hospital breastfeeding were lower among women with GDM, particularly among Indigenous women and women having a caesarean or pre-term birth. Strategies are needed to support predominant in-hospital breastfeeding among women with GDM.
Identifying pregnant women at risk of poor birth outcomes
Publisher: Informa UK Limited
Date: 2009
DOI: 10.1080/01443610902753713
Abstract: Pregnancy is a vulnerable period in women's lives, with a range of maternal and environmental factors impacting upon pregnancy outcome. This study sought to explore the clustering of health risks among pregnant women, and compare the characteristics of women exhibiting clustered risks. A cross-sectional study was undertaken at a large public hospital in Queensland, Australia. Cluster analysis grouped women who had similar levels of risk based on health and lifestyle factors demonstrated to be associated with adverse maternal and infant outcomes. Interviews were conducted with 437 women. The results highlight the interconnectedness of demographic and health risks, and high concentration of risks among Indigenous women. Vulnerable women can be identified and targeted for public health interventions focussing on clustered risk factors, such as alcohol, smoking and sexually transmitted infections. Opportunity exists for screening in routine primary care to identify the in iduals who are at risk, rather than identifying specific risks.
Australian researchers oppose funding from the Foundation for a Smoke-Free World
Publisher: Elsevier BV
Date: 12-2018
Seeking a comprehensive approach to tobacco control for aboriginal and torres strait islander people
Publisher: AMPCo
Date: 06-2015
DOI: 10.5694/MJA15.00455
Mortality after admission for acute myocardial infarction in Aboriginal and non-Aboriginal people in New South Wales, Australia: a multilevel data linkage study
Publisher: Springer Science and Business Media LLC
Date: 10-04-2012
Cohort Profile: The Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) Study
Publisher: Oxford University Press (OUP)
Date: 29-03-2018
DOI: 10.1093/IJE/DYY046
Infant care practices in a metropolitan Aboriginal population
Publisher: Wiley
Date: 12-1999
DOI: 10.1046/J.1440-1754.1999.00425.X
Abstract: To describe sleeping position, room and bed-sharing, tobacco smoke exposure and infant feeding for a s le of Australian Aboriginal infants from a metropolitan area. Interviews with Aboriginal mothers who resided in the Perth metropolitan area and had given birth during a continuous 15-month study period. The interviews took place when the infants were approximately 6-12 weeks old and efforts were made to contact all eligible mothers. Results are presented as proportions with 95% confidence intervals. Of all the eligible mothers (n = 515), 87% were contacted and 53% (n = 273) completed the interview. Of all the infants, 11% slept prone, 96% shared a room and 68% shared a bed 65% of mothers smoked during pregnancy and 65% were smokers at the time of interview 66% of the partners were smokers and 80% of the infants were regularly exposed to tobacco smoke 89% of mothers initiated breast-feeding and 70% were breast-feeding at time of interview. Prevalences of non-prone sleeping and breast-feeding are similar to the overall Western Australian population, whilst tobacco smoke exposure of the infants is markedly higher. Programs of community and family education and support are required urgently to decrease this exposure.
Comparison of Two Sources of Clinical Audit Data to Assess the Delivery of Diabetes Care in Aboriginal Communities
Publisher: MDPI AG
Date: 17-10-2017
Physical activity, healthy lifestyle behaviors, neighborhood environment characteristics and social support among Australian Aboriginal and non-Aboriginal adults
Publisher: Elsevier BV
Date: 06-2016
Sexual behaviour, drug use and health service use by young Noongar people in Western Australia: A snapshot
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/SH14038
Abstract: Background This study aimed to describe sexual health behaviour, alcohol and other drug use, and health service use among young Noongar people in the south-west of Western Australia. Method: A cross-sectional survey was undertaken among a s le of 244 Noongar people aged 16−30 years. Results: The s le was more disadvantaged than the wider Noongar population. Sexual activity was initiated at a young age, 18% had two or more casual sex partners in the previous 12 months, with men more likely to have done so than women (23% vs 14%). Condoms were always or often carried by 57% of men and 37% of women, and 36% of men and 23% of women reported condom use at last sex with a casual partner. Lifetime sexually transmissible infection diagnosis was 14%. Forty percent currently smoked tobacco and 25% reported risky alcohol consumption on a weekly and 7% on an almost daily basis. Cannabis was used by 37%, 12% used drugs in addition to cannabis and 11% reported recently injecting drugs. In the previous 12 months, 66% had a health check and 31% were tested for HIV or sexually transmissible infections. Additionally, 25% sought advice or assistance for mental health or alcohol and other drug issues. Discussion: Although some respondents engaged in risky sexual behaviour, alcohol and other drug use or both, most did not. Particularly encouraging was the engagement of respondents with the health care system, especially among those engaging in risky behaviours. The results confound negative stereotypes of Aboriginal people and demonstrate a level of resilience among respondents.
Trends in maternal and newborn health characteristics and obstetric interventions among Aboriginal and Torres Strait Islander mothers in Western Australia from 1986 to 2009
Publisher: Wiley
Date: 03-11-2016
DOI: 10.1111/AJO.12416
Abstract: Detailed analyses of long-term trends in Aboriginal maternal and newborn health characteristics are lacking. To examine trends in maternal and newborn health characteristics for all mothers who were recorded as Aboriginal in the Western Australian Midwives' Notification System from 1986 to 2009. Births were categorised into four-year time intervals (1986-1989, 1990-1993, 1994-1997, 1998-2001, 2002-2005, 2006-2009). Trends in maternal demographic characteristics, pre-existing medical conditions, pregnancy complications and neonatal characteristics were examined. For 37 424 births recorded from 1986 to 2009, the proportion of births to mothers aged ≤19 years decreased (31-22%, P < 0.001) along with the prevalence of pre-ecl sia (6.8-4.0%, P < 0.001) and antepartum haemorrhage (4.8-3.2%, P < 0.001). There were increases in the prevalence of diabetes in pregnancy (3.8-6.6%, P < 0.001), induction of labour (17.8-21.4%, P < 0.001), elective caesarean (6.6-8.2%, P < 0.001) and emergency caesarean (9.5-14.9%, P < 0.001) deliveries. There were no changes in the overall prevalence of preterm births (15.4-15.9%, P = 0.32). However, increases were observed in the prevalence of medically indicated preterm births with and without prelabour rupture of membranes (1.0-1.7% P < 0.001 and 3.3-4.3% P = 0.005, respectively). There were no significant changes in the rates of smoking during pregnancy (51-52% from 1998 to 2009, P = 0.18), small-for-gestational age (16.9-17.2%, P = 0.07), suboptimal-birthweight (20.4-20.1%, P = 0.92), stillbirths (14.7 per 1000-12.1 per 1000, P = 0.22) and neonatal deaths (6.2 per 1000-5.5 per 1000, P = 0.68). Encouraging trends include reduced rates of teenage pregnancy, pre-ecl sia and antepartum haemorrhage. The persistent high rates of smoking during pregnancy, preterm births, stillbirths, neonatal deaths and increasing rates of diabetes in pregnancy are of concern.
Pneumococcal vaccination in Australian children: divergent outcomes
Publisher: Elsevier BV
Date: 10-2019
Healthcare expenditure on Indigenous and non-Indigenous Australians at high risk of cardiovascular disease
Publisher: Springer Science and Business Media LLC
Date: 23-06-2017
Maternal age and offspring developmental vulnerability at age five: A population-based cohort study of Australian children
Publisher: Public Library of Science (PLoS)
Date: 24-04-2018
Using breath carbon monoxide to validate self-reported tobacco smoking in remote Australian Indigenous communities
Publisher: Springer Science and Business Media LLC
Date: 20-02-2010
What are the factors associated with good mental health among Aboriginal children in urban New South Wales, Australia? Phase I findings from the Study of Environment on Aboriginal Resilience and Child
Publisher: BMJ
Date: 07-2016
Early life influences on cardio-metabolic disease risk in aboriginal populations-what is the evidence? A systematic review of longitudinal and case-control studies
Publisher: Oxford University Press (OUP)
Date: 12-2012
DOI: 10.1093/IJE/DYS190
Abstract: We systematically reviewed the published evidence for the developmental origins of health and disease hypothesis among aboriginal populations from Australia, Canada, New Zealand and the USA. Medline, EMBASE and the Informit Health databases were systematically searched (March 2012) using medical subject headings and keywords for studies that examined the effect of prenatal factors and birth outcomes on later life (≥3 years) cardio-metabolic diseases. Quality of studies was independently assessed by two reviewers using a risk of bias assessment tool main findings from studies with a low to moderate risk of bias were summarised qualitatively. In all, 844 studies were found 50 were included in the review of which 41 had a low-moderate risk of bias. There was strong evidence for an association between birth weight and type 2 diabetes (6/7 studies), impaired kidney function (6/7 studies) and high blood pressure (5/6 studies), whereas there was limited evidence for an association with metabolic abnormalities (4/7 studies) and adiposity (4/7). Exposure to maternal diabetes was strongly associated with type 2 diabetes (9/10 studies) and metabolic abnormalities (5/7 studies), whereas the association with adiposity was low (3/9 studies) the limited number of studies, to date, also show a relationship with high blood pressure (2/2 studies). This review highlights that interventions to reduce the burden of cardio-metabolic disease among aboriginal populations should focus on improving maternal health, particularly by reducing the prevalence of diabetes in pregnancy. Future research should also be directed towards potential protective actions, such as breastfeeding.
Low Rates of Postpartum Glucose Screening Among Indigenous and non-Indigenous Women in Australia with Gestational Diabetes
Publisher: Springer Science and Business Media LLC
Date: 07-2014
DOI: 10.1007/S10995-014-1555-3
Abstract: Women with gestational diabetes have a high risk of type 2 diabetes postpartum, with Indigenous women particularly affected. This study reports postpartum diabetes screening rates among Indigenous and non-Indigenous women with gestational diabetes, in Far North Queensland, Australia. Retrospective study including 1,012 women with gestational diabetes giving birth at a regional hospital from 1/1/2004 to 31/12/2010. Data were linked between hospital records, midwives perinatal data, and laboratory results, then analysed using survival analysis and logistic regression. Indigenous women had significantly longer times to first oral glucose tolerance test (OGTT) [hazards ratio (HR) 0.62, 95 % confidence interval (CI) 0.48-0.79, p < 0.0001) and 'any' postpartum glucose test (HR 0.81, 95 % CI 0.67-0.98, p = 0.03], compared to non-Indigenous women. Postpartum screening rates among all women were low. However, early OGTT screening rates (<6 months) were significantly lower among Indigenous women (13.6 vs. 28.3 %, p < 0.0001), leading to a persistent gap in cumulative postpartum screening rates. By 3 years postpartum, cumulative rates of receiving an OGTT, were 24.6 % (95 % CI 19.9-30.2 %) and 34.1 % (95 % CI 30.6-38.0 %) among Indigenous and non-Indigenous women, respectively. Excluding OGTTs in previous periods, few women received OGTTs at 6-24 months (7.8 vs. 6.7 %) or 2-4 years (5.2 vs. 6.5 %), among Indigenous and non-Indigenous women, respectively. Low rates of postpartum diabetes screening demonstrate that essential 'ongoing management' and 'equity' criteria for population-based screening for gestational diabetes are not being met particularly among Indigenous women, for whom recent guideline changes have specific implications. Strategies to improve postpartum screening after gestational diabetes are urgently needed.
Inequalities in pediatric avoidable hospitalizations between Aboriginal and non-Aboriginal children in Australia: A population data linkage study
Publisher: Springer Science and Business Media LLC
Date: 21-10-2016
'Next Generation Youth Well-being Study:' understanding the health and social well-being trajectories of Australian Aboriginal adolescents aged 10-24 years: Study protocol
Publisher: BMJ
Date: 03-2019
DOI: 10.1136/BMJOPEN-2018-028734
Abstract: Australian Aboriginal and/or Torres Strait Islander (hereafter referred to as ‘Aboriginal’) adolescents (10–24 years) experience multiple challenges to their health and well-being. However, limited evidence is available on factors influencing their health trajectories. Given the needs of this group, the young age profile of the Aboriginal population and the long-term implications of issues during adolescence, reliable longitudinal data are needed. The ‘Next Generation: Youth Well-being Study’ is a mixed-methods cohort study aiming to recruit 2250 Aboriginal adolescents aged 10–24 years from rural, remote and urban communities in Central Australia, Western Australia and New South Wales. The study assesses overall health and well-being and consists of two phases. During phase 1, we qualitatively explored the meaning of health and well-being for adolescents and accessibility of health services. During phase 2, participants are being recruited into a longitudinal cohort. Recruitment is occurring mainly through community networks and connections. At baseline, participants complete a comprehensive survey and undertake an extensive age relevant clinical assessment. Survey and clinical data will be linked to various databases including those relating to health services medication immunisation hospitalisations and emergency department presentations death registrations education child protection and corrective services. Participants will receive follow-up surveys approximately 2 years after their baseline visit. The ‘Next Generation’ study will fill important evidence gaps by providing longitudinal data on the health and social well-being of Aboriginal adolescents supplemented with narratives from participants to provide context. Ethics approvals have been sought and granted. Along with peer-reviewed publications and policy briefs, research findings will be disseminated via reports, booklets and other formats that will be most useful and informative to the participants and community organisations.
Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) study
Publisher: Springer Science and Business Media LLC
Date: 12-2013
Ten principles relevant to health research among Indigenous Australian populations
Publisher: AMPCo
Date: 07-2012
DOI: 10.5694/MJA11.11642
Testing for type 2 diabetes in Indigenous Australians: guideline recommendations and current practice
Publisher: AMPCo
Date: 09-2017
DOI: 10.5694/MJA16.00769
Abstract: To determine the proportion of Aboriginal Controlled Community Health Service (ACCHS) patients tested according to three national diabetes testing guidelines to investigate whether specific patient characteristics were associated with being tested. Cross-sectional study of 20 978 adult Indigenous Australians not diagnosed with diabetes attending 18 ACCHSs across Australia. De-identified electronic whole service data for July 2010 - June 2013 were analysed. Proportions of patients appropriately screened for diabetes according to three national guidelines for Indigenous Australians: National Health and Medical Research Council (at least once every 3 years for those aged 35 years or more) Royal Australian College of General Practitioners and Diabetes Australia (at least once every 3 years for those aged 18 years or more) National Aboriginal Community Controlled Health Organisation (annual testing of those aged 18 years or more at high risk of diabetes). 74% (95% CI, 74-75%) of Indigenous adults and 77% (95% CI, 76-78%) of 10 760 patients aged 35 or more had been tested for diabetes at least once in the past 3 years. The proportions of patients tested varied between services (range: all adults, 16-90% people aged 35 years or more, 23-92%). 18% (95% CI, 18-19%) of patients aged 18 or more were tested for diabetes annually (range, 0.1-43%). Patients were less likely to be tested if they were under 50 years of age, were transient rather than current patients of the ACCHS, or attended the service less frequently. Some services achieved high rates of 3-yearly testing of Indigenous Australians for diabetes, but recommended rates of annual testing were rarely attained. ACCHSs may need assistance to achieve desirable levels of testing.
Sleep influences on cardio-metabolic health in Indigenous populations
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.SLEEP.2018.10.011
Abstract: Indigenous populations continue to be among the world's most marginalized population groups. Studies in Indigenous populations from high income countries (including the United States, Canada, Australia, and New Zealand) indicate increased risk of sleep disorders compared to non-Indigenous populations. Poor sleep, whether it be short sleep duration or fragmented sleep, is a well-established risk factor for cardio-metabolic diseases. Given the implications, targeted improvement of poor sleep may be beneficial for the health and well-being of Indigenous people. In this narrative review, we will: (1) discuss the effects of sleep on the cardio-metabolic processes (2) examine sleep in Indigenous populations (3) review the association between sleep and cardio-metabolic risk in Indigenous populations and (4) review the potential role of sleep in cardiovascular disease risk detection and interventions to improve sleep and cardio-metabolic health in Indigenous people. In particular, this review highlights that the assessment of sleep quality and quantity may be a beneficial step toward identifying Indigenous people at risk of cardio-metabolic diseases and may represent a key intervention target to improve cardio-metabolic outcomes.
Assessing the accuracy of self-reported smoking status and impact of passive smoke exposure among pregnant Aboriginal and Torres Strait Islander women using cotinine biochemical validation
Publisher: Wiley
Date: 18-05-2010
DOI: 10.1111/J.1465-3362.2009.00078.X
Abstract: A significant level of misreport or error occurs during questionnaire-based assessment of smoking behaviour. Failure to measure environmental tobacco smoke, and participant's inclination to under-report their smoking raise questions as to the accuracy of assessment. In order to establish an estimation of the possible error associated with such assessment, the accuracy of self-reported smoking status among a group of pregnant Aboriginal and Torres Strait Islander women was examined. Women attending two Aboriginal Medical services in Far North Queensland for antenatal care were invited to participate. Women completed an interviewer assisted questionnaire relating to their smoking status and a 24 h diary of their exposure to nicotine and consumption of alcohol. Urine s les were analysed for cotinine using an Enzyme Linked Immunosorbent Assay. Cotinine analysis indicated that 17% of women who reported that they were non-smokers were likely to have misreported this status, or be exposed to high levels of passive smoke. The only significant predictors of cotinine level were self-reported nicotine exposure (including passive smoke) and number of cigarettes smoked in the previous 24 h. Other in idual and environmental variables had no significant influence on cotinine level using this analysis technique. The level of potential error in smoking assessment among this group was substantial. Exposure to environmental tobacco smoke might explain part of this error, but the reasons for misreport can only be speculated. This rate of misclassification should be taken into consideration in routine screening of antenatal women in primary health care.
Participant preferences for an Aboriginal-specific fall prevention program: Measuring the value of culturally-appropriate care
Publisher: Public Library of Science (PLoS)
Date: 31-08-2018
Assessment of fetal kidney growth and birth weight in an Indigenous Australian cohort
Publisher: Frontiers Media SA
Date: 09-01-2018
Measuring mental health in Indigenous young people: A review of the literature from 1998–2008
Publisher: SAGE Publications
Date: 04-06-2013
Abstract: Indigenous young people are disproportionately exposed to risk factors for poor mental health. Methodologically rigorous research will be critical in the development and evaluation of prevention and treatment programs. Research examining the mental health of Indigenous young people may have been undermined by poor measurement. The extent to which research has used measures with adequate psychometrics is unknown. MEDLINE, PsychINFO and PUBMED databases, were systematically searched to identify papers published between 1998–2008 measuring the mental health of Indigenous young people from Australia, Canada, New Zealand or the US. Data extracted included type of mental health instrument, psychometric analyses reported and results. Fifty-four relevant studies were identified. Seventy-nine mental health instruments were used, and 18% were bespoke. Only 14% of instruments had been validated for the relevant Indigenous population. Few studies reported assessment of the reliability or validity of instruments. Data about both the reliability and validity of 10 measures were reported. None of the measures met the standards set by the review. Evidence of at least one type of reliability and validity was demonstrated for six measures. From 1998–2008 few studies of mental health in Indigenous young people used measurement instruments with previously determined reliability and validity.
Temporal trends in weight and current weight‐related behaviour of Australian Aboriginal school‐aged children
Publisher: AMPCo
Date: 06-2014
DOI: 10.5694/MJA13.10614
Abstract: To report 13-year trends in weight status of Australian Aboriginal children, and to describe weight-related behaviour in children in 2010, by Aboriginality. Cross-sectional population surveys of children aged 5-16 years (n = 18 983) conducted in New South Wales schools in Term 1 of 1997, 2004 and 2010. For trend analysis: body mass index and waist-to-height ratio (WtHr). Analyses of weight-related behaviour from 2010 survey data included indicators of dietary habits, screen time (ST) and physical activity. Between 1997 and 2010, the relative increase in prevalence of overweight/obesity and WtHr ≥ 0.5 was 22.4% and 113.6%, respectively, among Aboriginal children, and 11.8% and 3.4%, respectively, among non-Aboriginal children. In 2010, Aboriginal children had 1.52 (95% CI, 1.03-2.24) greater odds of having a WtHr ≥ 0.5 than non-Aboriginal children. Compared with non-Aboriginal children, Aboriginal children also had significantly lower odds of eating breakfast daily (adjusted odds ratio [AOR], 0.72 95% CI, 0.52-0.99) and significantly greater odds of drinking ≥ 1 cup of soft drink daily (AOR, 1.61 95% CI, 1.13-2.29), having a television in their bedroom (AOR, 2.75 95% CI, 2.04-3.70), having no ST rules (AOR, 1.34 95% CI, 1.04-1.73) and exceeding ST recommendations on weekdays (AOR, 1.78 95% CI, 1.32-2.39). Overweight/obesity and WtHr have increased more rapidly in Aboriginal than non-Aboriginal children in NSW. Unhealthy weight-related behaviour was frequent among all children, but lack of daily breakfast, excessive ST and soft drink consumption appear particularly problematic among Aboriginal children. Raising awareness with families of the consequences of excessive ST and encouraging strategies to limit ST (such as rethinking placement of televisions in children's bedrooms and implementing ST rules) hold promise.
An intensive smoking intervention for pregnant Aboriginal and Torres Strait Islander women: a randomised controlled trial
Publisher: AMPCo
Date: 2013
DOI: 10.5694/MJA12.11298
‘They took the land, now we’re fighting for a house’: Aboriginal perspectives about urban housing disadvantage
Publisher: Informa UK Limited
Date: 18-09-2017
Aboriginal health: agreement between general practitioners and patients on their health risk status and screening history
Publisher: Elsevier BV
Date: 12-2014
Abstract: To examine agreement between patients' self-report and general practitioners' perception of their patients' health risk status and screening history. Patients attending an Aboriginal Community Controlled Health Service self-reported via survey their health risk status and screening history, while waiting to see their general practitioner (GP). Following the consultation the GP completed a corresponding survey. Prevalence rates and rates of agreement using the kappa statistic were calculated for both self-reported and GP-reported risk status for smoking, at-risk alcohol consumption and physical inactivity and screening history for blood pressure, cholesterol, diabetes and cervical cancer. Prevalence rates of health risks were similar from self-report versus GP-reported, yet differed on screening history. Patients who identified themselves as being at risk were often not the same as those identified by GPs. Agreement between patient and doctor was substantial for smoking, yet poor for at-risk alcohol consumption and physical inactivity. Agreement was fair for cholesterol and cervical cancer screening, and slight for blood pressure and diabetes screening. This study suggests that for effective preventive care, using self-report for some health risks may be reliable, but less so for screening history. Greater assistance is needed in primary health care settings to identify patients who are at risk.
Health research policy: a case study of policy change in Aboriginal and Torres Strait Islander health research
Publisher: Springer Science and Business Media LLC
Date: 26-02-2009
Abstract: There is considerable potential for health research to contribute to improved health services, programs, and outcomes the policies of health research funding agencies are critical to achieving health gains from research. The need for research to better address health disparities in Indigenous people has been widely recognised. This paper: (i) describes the policy changes made by the National Health and Medical Research Council (NHMRC) from 1997 to 2002 to improve funding of Aboriginal health research (ii) examines catalysts for the policy changes (iii) describes the extent to which policy changes were followed by new models of research and (iv) outlines issues for Indigenous health policy in the future. This study had two parts: (i) semi-structured interviews were conducted over a four -month period with seven in iduals who played a leading role in the policy changes at NHMRC during the period 1997–2002, to describe policy changes and to examine the catalysts for the changes (ii) a case study was undertaken to evaluate projects by recipients of NHMRC People Support awards and NHMRC Capacity Building Grants in Population Health Research to examine the types of research being undertaken five years after the policy changes were implemented. The proposals of these researchers were assessed in terms of whether they reported intending to: evaluate interventions engage Indigenous community members and organisations and build research capacity among Indigenous people. Seven policy changes over a period of five years were identified, including those to: establish an ethical approach to working with Indigenous people increase the influence of Indigenous people within NHMRC encourage priority research directed at improving Indigenous health and recognise Aboriginal and Torres Strait Islander health research as a priority area including a commitment to an expenditure target of 5% of annual funds. Seven catalysts for this change were identified. These included: a perceived lack of effective response to the health needs of Indigenous people a changed perception of the role of NHMRC in encouraging research to maximise health gains and leadership within the organisation. The case study analysis demonstrated that 45% of all People Support recipients intend to engage Indigenous community members and organisations in consultation, 26% included an evaluation of an intervention and two (6.5%) were granted to an in idual from an Indigenous background. Six of seven Population Health Capacity Building Grants that were awarded to study Indigenous health between 2004 and 2006 included an intervention component these grants supported 34 researchers from Indigenous backgrounds. NHMRC made significant policy changes from 1997 to 2002 to better support Indigenous health as a result of external pressure and internal commitment. The policy changes have made some progress in supporting better research models particularly in improving engagement with Indigenous communities. However, there remains a need for further reform to optimise research outcomes for Indigenous people from research.
Type 2 diabetes in Indigenous populations: Quality of intervention research over 20years
Publisher: Elsevier BV
Date: 2011
DOI: 10.1016/J.YPMED.2010.11.002
Abstract: A robust evidence base is needed to reduce the disproportionately high rates of diabetes-related mortality and complications among Indigenous peoples. This study aimed to evaluate the quantity and methodological quality of published intervention research on Type 2 and gestational diabetes in the Indigenous populations of Australia, Canada, New Zealand, and the United States from 1989 to 2008. A robust evidence base is needed to reduce the disproportionately high rates of diabetes-related mortality and complications among Indigenous peoples. Systematic searches of Medline, Embase, and EBM Reviews identified publications focused on Type 2 or gestational diabetes in Indigenous peoples published between 1 January 1989 and 31 December 2008. Total publication number and proportion of research involving interventions over time were examined. The quality of intervention studies was evaluated using Cochrane's Effective Practice and Organisation of Care (EPOC) criteria. Total publication number increased significantly over the 20 years (p<0.004). Research was predominantly descriptive (87%), with the proportion of research involving interventions increasing from 3% in 1989-1993 to 12% in 2003-2008 (χ(2)=12.42, df=3, p=0.006). However, only 25% (95%CI: 9-41%) of intervention studies met the EPOC methodological quality criteria other studies lacked sufficient controls or measurements over time. Increases in the amount of high-quality intervention research for prevention and treatment of Type 2 and gestational diabetes among Indigenous populations of these countries are needed.
Psychosocial interventions for supporting women to stop smoking in pregnancy
Publisher: John Wiley & Sons, Ltd
Date: 23-10-2013
Understanding burn injuries in Aboriginal and Torres Strait Islander children: protocol for a prospective cohort study: Table 1
Publisher: BMJ
Date: 10-2015
Psychological Distress, Stressful Life Events and Social Disadvantage in Pregnant Indigenous Australian Women Residing in Rural and Remote NSW: a Longitudinal Cohort Study
Publisher: Springer Science and Business Media LLC
Date: 30-09-2021
DOI: 10.1007/S40615-021-01159-5
Abstract: Pregnancy can be a stressful time for many women. Australian Indigenous women of childbearing age (18-44 years) have been found to experience high or very high rates of psychological distress. However, few studies have examined the burden of or any associations between stressful life events, social disadvantage and psychological distress for pregnant Indigenous women in Australia. Two hundred sixty-one rural and remote women, pregnant with an Indigenous infant, from New South Wales in Australia were invited to provide data regarding social disadvantage then complete the Kessler-10 and Stressful Life Events surveys via self-report during each trimester of their pregnancy. Descriptive statistics, Pearson's correlations, Mann-Whitney U and Kruskal-Wallis tests were performed to determine the burden of and any associations between the variables of interest. High rates of psychological distress were reported by participants with 16.9% scoring severe distress levels during their pregnancy. Participants also reported high rates of stressful life events with almost 25% experiencing the death of a family member or friend, almost 14% living in overcrowded accommodation, 11% having someone close to them jailed and 8% experience separation from their partner, during their pregnancies. Distress was associated with numerous stressful life events (e.g. witnessing violence, a family member in jail and overcrowding) and one aspect of social disadvantage (smoking status). Immediate attention needs to focus on the development of interventions to address the high levels of psychological distress and provide appropriate support services during periods of major life events for pregnant Australian Indigenous women.
Closing the gap in Aboriginal women's reproductive health: some progress, but still a long way to go
Publisher: Wiley
Date: 06-2016
DOI: 10.1111/AJO.12470
Smoking behaviours and other substance use among Indigenous and non‐Indigenous Australian secondary students, 2017
Publisher: Wiley
Date: 11-08-2021
DOI: 10.1111/DAR.13130
Improving the health of First Nations children in Australia
Publisher: AMPCo
Date: 07-2013
DOI: 10.5694/MJA13.10726
An Opportunity for Our Little Ones: Findings from an Evaluation of an Aboriginal Early Childhood Learning Centre in Central Australia
Publisher: Springer Science and Business Media LLC
Date: 31-03-2021
Building trust and sharing power for co-creation in Aboriginal health research: a stakeholder interview study
Publisher: Bristol University Press
Date: 08-2019
DOI: 10.1332/174426419X15524681005401
Abstract: Historically, Aboriginal health research in Australia has been non-participatory, misrepresentative, and has produced few measurable improvements to community health. The Study of Environment on Aboriginal Resilience and Child Health (SEARCH) was established to co-create and co-translate research. Over the past decade, SEARCH has built a sustainable partnership across policy, research, clinical and Aboriginal community sectors which has resulted in improvements in Aboriginal health through enhanced services, policies and programmes. This study describes the critical success factors behind SEARCH, focusing on how SEARCH was established, and continues to build trusting co-creative relationships. It also explores some continuing challenges and considers how the partnership might be strengthened. Semi-structured interviews were conducted with 26 stakeholders, purposively selected to obtain maximum ersity of roles and perspectives. Interview questions explored concepts that informed the development of SEARCH such as trust, transparency, leadership, governance, reciprocity and empowerment. Data was analysed thematically and written up using the qualitative description approach. Nine critical success factors were identified: shared power strong credible leadership shared vision, shared goals willingness to take risks connecting across cultures empowering the community valuing local Aboriginal knowledge ongoing investment and collaboration and adaptability. While each of these factors has areas for ongoing improvement, this case ex le demonstrates that co-creation and co-translation of research in Aboriginal health is achievable and, indeed, necessary to improve health outcomes.
Multimorbidity among Aboriginal people in New South Wales contributes significantly to their higher mortality
Publisher: AMPCo
Date: 07-2018
DOI: 10.5694/MJA17.00878
Abstract: To compare the prevalence of multimorbidity and its impact on mortality among Aboriginal and non-Aboriginal Australians who had been hospitalised in New South Wales in the previous 10 years. Cohort study analysis of linked NSW hospital (Admitted Patient Data Collection) and mortality data for 5 437 018 New South Wales residents with an admission to a NSW hospital between 1 March 2003 and 1 March 2013, and alive at 1 March 2013. Admissions for 30 morbidities during the 10-year study period were identified. The primary outcome was the presence or absence of multimorbidity during the 10-year lookback period the secondary outcome was mortality in the 12 months from 1 March 2013 to 1 March 2014. 31.5% of Aboriginal patients had at least one morbidity and 16.1% had two or more, compared with 25.0% and 12.1% of non-Aboriginal patients. After adjusting for age, sex, and socio-economic status, the prevalence of multimorbidity among Aboriginal people was 2.59 times that for non-Aboriginal people (95% CI, 2.55-2.62). The prevalence of multimorbidity was higher among Aboriginal people in all age groups, in younger age groups because of the higher prevalence of mental morbidities, and from age 60 because of physical morbidities. The age-, sex- and socio-economic status-adjusted hazard of one-year mortality (Aboriginal v non-Aboriginal Australians) was 2.43 (95% CI, 2.24-2.62), and 1.51 (95% CI, 1.39-1.63) after also adjusting for morbidity count. The prevalence of multimorbidity was higher among Aboriginal than non-Aboriginal patients, and this difference accounted for much of the difference in mortality between the two groups. Evidence-based interventions for reducing multimorbidity among Aboriginal and Torres Strait Islander Australians must be a priority.
Bibbulung Gnarneep (‘solid kid’): Causal pathways to poor birth outcomes in an urban Aboriginal birth cohort
Publisher: Wiley
Date: 06-2008
DOI: 10.1111/J.1440-1754.2008.01306.X
Abstract: To explore the causal pathways leading to poor birth outcomes among a cohort of Aboriginal infants. A cross-sectional study was conducted. Data were collected via face-to-face interviews conducted 6-12 weeks post partum and links to the WA Midwives' Notification System. Two hundred and seventy-three Aboriginal infants and their families from Perth, Western Australia were recruited in the mid to late 1990s. Poor birth outcome was defined as low birth weight and/or preterm birth. Criteria for poor birth outcome were met by 12.3% of the cohort. A history of maternal hypertension, vaginal bleeding and consumption of excess spirits in pregnancy were independent predictors of poor birth outcome. Mother being raised on a mission, maternal education, smoking during pregnancy and being exposed to passive smoke during pregnancy were also important risk factors. Results indicate that maternal social exposures, maternal ill-health before the index pregnancy and maternal ill-health during the index pregnancy are all important contributors to poor birth outcomes for urban Aboriginal infants. While the causes of poor birth outcomes are complex, the current study highlights several areas where preventive measures may be useful.
Incidence and outcomes of sepsis in Aboriginal and Torres Strait Islander and non-Indigenous residents of New South Wales: population-based cohort study
Publisher: Elsevier BV
Date: 06-09-2021
DOI: 10.51893/2021.3.OA11
Abstract: OBJECTIVE: To estimate the incidence and outcomes of sepsis hospitalisations in Aboriginal and Torres Strait Islander and non-Indigenous residents of New South Wales. DESIGN AND PARTICIPANTS: Prospective cohort study of residents aged 45 years and older, recruited between 2006 and 2009, and followed for hospitalisation for sepsis. MAIN OUTCOME MEASURES: Incidence and hazard ratio (HR) of sepsis hospitalisation and intensive care unit (ICU) admission identified using International Classification of Diseases (10th revision) coding on discharge data. Length of stay, readmission and mortality in those admitted for sepsis. RESULTS: Of 264 678 participants, 1928 (0.7%) identified as Aboriginal and/or Torres Strait Islander. Sepsis hospitalisation was higher in Aboriginal and Torres Strait Islander participants (8.67 v 6.12 per 1000 person-years age- and sex-adjusted HR, 2.35 95% CI, 1.98–2.80) but was attenuated after adjusting for sociodemographic factors, health behaviour and comorbidities (adjusted HR, 1.56 95% CI, 1.31–1.86). Among those hospitalised for sepsis, after adjusting for age and sex, there were no differences between the proportions of Aboriginal and Torres Strait Islander and non-Indigenous participants admitted to an ICU (18.0% v 16.1% P = 0.42) or deceased at 1 year (36.1% v 36.8% P = 0.92). Aboriginal and Torres Strait Islander participants had shorter lengths of hospital stay (9.98 v 11.72 days P 0.001) and ICU stay (4.38 v 6.35 days P 0.001) than non-Indigenous participants. Overall, more than 70% of participants were readmitted to hospital within 1 year. CONCLUSION: We found that the rate of sepsis hospitalisation in NSW was higher for Aboriginal and Torres Strait Islander adults. Culturally appropriate, community-led strategies targeting chronic disease prevention and the social determinants of health may reduce this gap. Preventing readmission following sepsis is a priority for all Australians.
Diabetes in pregnancy among indigenous women in Australia, Canada, New Zealand, and the United States: A method for systematic review of studies with different designs
Publisher: Springer Science and Business Media LLC
Date: 12-2011
To Close the Gap we need to identify the best (and worst) buys in Indigenous health
Publisher: Elsevier BV
Date: 06-2017
Pregnancy stress, healthy pregnancy and birth outcomes - The need for early preventative approaches in pregnant Australian Indigenous women: A prospective longitudinal cohort study
Publisher: Cambridge University Press (CUP)
Date: 17-01-2019
DOI: 10.1017/S204017441800079X
Abstract: Adverse pregnancy outcomes including prematurity and low birth weight (LBW) have been associated with life-long chronic disease risk for the infant. Stress during pregnancy increases the risk of adverse pregnancy outcomes. Many studies have reported the incidence of adverse pregnancy outcomes in Indigenous populations and a smaller number of studies have measured rates of stress and depression in these populations. This study sought to examine the potential association between stress during pregnancy and the rate of adverse pregnancy outcomes in Australian Indigenous women residing in rural and remote communities in New South Wales. This study found a higher rate of post-traumatic stress disorder, depression and anxiety symptoms during pregnancy than the general population. There was also a higher incidence of prematurity and LBW deliveries. Unfortunately, missing post-traumatic stress disorder and depressive symptomatology data impeded the examination of associations of interest. This was largely due to the highly sensitive nature of the issues under investigation, and the need to ensure adequate levels of trust between Indigenous women and research staff before disclosure and recording of sensitive research data. We were unable to demonstrate a significant association between the level of stress and the incidence of adverse pregnancy outcomes at this stage. We recommend this longitudinal study continue until complete data sets are available. Future research in this area should ensure prioritization of building trust in participants and overestimating s le size to ensure no undue pressure is placed upon an already stressed participant.
Mental health-related emergency department presentations and hospital admissions in a cohort of urban Aboriginal children and adolescents in New South Wales, Australia: findings from SEARCH
Publisher: BMJ
Date: 11-2018
DOI: 10.1136/BMJOPEN-2018-023544
Abstract: The aim of the current study is to quantify mental health-related emergency department (ED) presentations and hospitalisations, and associated child and family characteristics, in children recruited through four Aboriginal Community Controlled Health Organisations. Four Aboriginal Community Controlled Health Services that deliver primary care. All services were located in urban or large regional centres in New South Wales, Australia. 1476 Aboriginal children aged 0–17 years at recruitment to the Study of Environment on Aboriginal Resilience and Child Health. ED presentations and hospital admissions with a primary mental health diagnosis obtained via linkage to population health datasets. Over a median of 6-year follow-up, there were 96 ED presentations affecting 62 children (10.7/1000 person-years) and 49 hospitalisations affecting 34 children (5.5/1000 person-years) for mental health conditions. Presentations/admissions increased with age. ED presentation was increased with: living in foster versus parental care (adjusted rate ratio (RR)=3.97, 95% CrI 1.26 to 11.80) high versus low baseline child emotional/behavioural problems (adjusted RR=2.93, 95% CrI 1.50 to 6.10) and caregiver chronic health conditions versus none (adjusted RR=2.81, 95% CrI 1.31 to 6.63). Hospitalisations were significantly increased with caregiver unemployment versus home duties (adjusted RR=4.48, 95% CrI 1.26 to 17.94) and caregiver chronic health problems versus none (adjusted RR=3.83, 95% CrI 1.33 to 12.12). Tertiary care for mental health issues was relatively common among participating Aboriginal children, with risk elevated for those living in foster care, with prior mental health and behavioural problems and with carers with chronic illness and/or unemployment. While this study suggests high rates of serious mental health events among children from participating communities, the optimum means for reducing these rates, and the need for tertiary care, has not yet been determined. Such information is urgently required to inform policy and programmes to support Aboriginal child and adolescent mental health.
What factors contribute to positive early childhood health and development in Australian Aboriginal children? Protocol for a population-based cohort study using linked administrative data (The Seeding
Publisher: BMJ
Date: 18-05-2015
Indigenous women and smoking during pregnancy: Knowledge, cultural contexts and barriers to cessation
Publisher: Elsevier BV
Date: 06-2008
DOI: 10.1016/J.SOCSCIMED.2008.01.024
Abstract: Despite active tobacco control efforts in Australia, smoking prevalence remains disproportionately high in pregnant Indigenous women. This study investigated the place of smoking in pregnancy and attitudes towards smoking within the broader context of Indigenous lives. Focus groups and in-depth interviews were used to collect data from 40 women, and ten Aboriginal Health Workers (AHWs) in Perth, Western Australia. The research process and interpretation was assisted by working with an Indigenous community reference group. Results demonstrated the impact of contextual factors in smoking maintenance, and showed that smoking cessation even in pregnancy was not a priority for most women, given the considerable social and economic pressures that they face in their lives. Overwhelmingly, smoking was believed to reduce stress and to provide opportunities for relaxation. Pregnancy did not necessarily influence attitudes to cessation, though women's understanding of the consequences of smoking during pregnancy was low. Reduction of cigarette intake during pregnancy was seen as an acceptable and positive behaviour change. The AHWs saw their role to be primarily one of support and were conscious of the importance of maintaining positive relationships. As a result, they were often uncomfortable with raising the issue of smoking cessation with pregnant women. The stories of Indigenous women and AHWs provided important insight into smoking during pregnancy and the context in which it occurs.
Can early childhood education programs support positive outcomes for indigenous children? A systematic review of the international literature
Publisher: Elsevier BV
Date: 11-2020
Trends in neural tube defects in Western Australia in Indigenous and non‐Indigenous populations
Publisher: Wiley
Date: 07-2004
50 years since citizenship: successes and challenges in Indigenous health
Publisher: The Sax Institute
Date: 2017
DOI: 10.17061/PHRP2741730
Modern and traditional diets for Noongar infants
Publisher: Wiley
Date: 07-2010
DOI: 10.1111/J.1440-1754.2010.01752.X
Abstract: Aim: Describe breast‐ and bottle‐feeding patterns and the introduction of solid feeds and sugar containing drinks to the dietary intake of a cohort of urban Aboriginal infants in the first year of life. Methods: Two hundred and seventy‐four infants were recruited to a cohort study and information about infant nutrition was collected from their mothers during face to face interviews when the infants were aged 6–12 weeks, 7–8 months and 12 months old. Results: 88.3% of mothers initiated breast‐feeding, but only 43.8% of infants were exclusively breast‐fed at 6–12 weeks. By 12 months of age 69.8% of babies had received fruit juice in their bottles, 59.8% received cordial. 64.5% of infants were given water in their bottles. The majority of infants had received ‘fast foods’ by 12 months of age with 56.2% had been given coca cola, 68% lemonade and 78% fried chips. Conclusions: This study highlights areas in which nutrition health promotion can be targeted to prevent common childhood health problems including promoting and supporting mothers to sustain breast‐feeding and opportunities to reduce the sugar and fat intake among infants.
Aboriginal and Torres Strait Islander health: accuracy of patient self‐report of screening for diabetes, high cholesterol and cervical cancer
Publisher: Elsevier BV
Date: 04-2016
Abstract: To determine the accuracy and clinical utility of patient self-reported screening history. Aboriginal and Torres Strait Islander patients (≥18 years n=587) were interviewed on their screening history according to recommended time intervals these were matched to pathology data. The proportion of patients meeting screening guidelines were 32% (95%CI 26%-39%) for diabetes, 43% (95%CI 38%-47%) for cholesterol and 4.1% (95%CI 2.2%-7.3%) for cervical cancer. When patients reported having had the test, their accuracy (PPV) was low: 38% (95%CI 30%-46%) for diabetes, 47% (95%CI 42%-52%) for cholesterol, 6.5% (95%CI 3.0%-12%) for cervical cancer. However, for the minority of patients who had been screened, positive recall (sensitivity) was high: 94% (95%CI 85%-98%) for diabetes, 83% (95%CI 77%-88%) for cholesterol, 90% (95%CI 55%-98%) for cervical cancer. The accuracy of patient recall was good for those who reported not having been screened (NPV): 90% (95%CI 77%-97%) for diabetes, 70% (95%CI 61%-78%) for cholesterol, 99% (95%CI 95%-100%) for cervical cancer. The results indicate that reliance on self-report for patients' screening history is inappropriate due to missed opportunities for health gain. However, patients who report not being tested are sufficiently accurate to ensure that ordering the test in this group will involve only a small percentage of unnecessary assays. GPs often rely on self-report as a fast and inexpensive way to determine whether a patient requires screening. New strategies are needed to identify patients at risk.
Cancer and Aboriginal people in Australia: A review of the literature
Publisher: Informa UK Limited
Date: 03-2008
Planetary health: what is it and what should doctors do?
Publisher: AMPCo
Date: 04-2018
DOI: 10.5694/MJA18.00219
The prevalence of gestational diabetes mellitus among Aboriginal and Torres Strait Islander women in Australia: A systematic review and meta-analysis
Publisher: Wiley
Date: 03-2015
DOI: 10.1002/DMRR.2570
Abstract: Gestational diabetes mellitus (GDM) is an important and increasing health problem. This study aims to investigate and explain the marked variation in reported GDM prevalence among Australian Indigenous women. We searched five databases to August 2013 for studies of GDM prevalence two people independently assessed search results, extracted data, and appraised risk of bias. Meta-analysis was conducted, and between-study heterogeneity examined using subgroup analyses. Within-study findings were synthesized narratively. The pooled GDM prevalence from 23 of the 25 total studies (5.74%, 4.78-6.71) was similar to that reported in national studies, but heterogeneity was substantial (I(2) = 97%), making conclusions from between-study comparisons difficult. The greatest reductions in heterogeneity were seen within subgroups using localized diagnostic criteria (I(2) = 43%, 3 studies), universal screening (I(2) = 58%) and some jurisdictions, probably reflecting proxy measures of increased consistency in diagnostic and screening methods. Insufficient data were available to assess the effect of factors such as rurality, diagnostic criteria, study design and data sources on prevalence. Synthesis of within-study findings showed: higher age-adjusted prevalences of GDM in Indigenous versus non-Indigenous women Indigenous women have greater increases in prevalence with maternal age and non-Indigenous women appear to have a steeper increase in GDM prevalence over time. Prevalence increased almost fourfold in two studies following introduction of universal screening when compared with selective risk-based screening, although numbers were small. The published GDM prevalence among Indigenous women varies markedly, probably due to variation in diagnostic and screening practices.
Social and emotional developmental vulnerability at age five in Aboriginal and non-Aboriginal children in New South Wales: a population data linkage study
Publisher: Springer Science and Business Media LLC
Date: 31-07-2019
Data Resource Profile: Seeding Success: a cross-sectoral data resource for early childhood health and development research in Australian Aboriginal and non-Aboriginal children
Publisher: Oxford University Press (OUP)
Date: 11-05-2017
DOI: 10.1093/IJE/DYX051
No official identity: a data linkage study of birth registration of Aboriginal children in Western Australia
Publisher: Elsevier BV
Date: 08-2016
Abstract: Evidence of identity, particularly a birth certificate, is essential to access many rights. However, the births of many Aboriginal Australians are not registered when they are infants. We examined factors related to birth registration among Western Australian children born to Aboriginal mothers. All births to Aboriginal mothers in the Midwives Notification System in Western Australia (WA) from 1980 to 2010 were linked to birth registrations. Associations between registration and maternal and child characteristics were examined for children aged under 16 years in 2012. Among 49,694 births between 1980 and 2010, 18% of those aged under 16 years had unregistered births, compared to 3% of those aged 16-32 years. Unregistered births were most strongly associated with young maternal age at first birth (adjusted odds ratio [AOR] 5.22 95%CI 3.07-8.86 for 16 years or younger vs 30 years or older, among non-smokers), remoteness (AOR 2.17 95%CI 1.87-2.52 very remote vs major cities), mothers whose own birth was unregistered (AOR 3.00 95%CI 1.78-5.07) and no private hospital insurance (AOR 0.19 95%CI 0.11-0.31 insured vs uninsured). Unregistered births are common among WA Aboriginal children, particularly in disadvantaged families. Assistance before discharge from hospital may increase birth registrations.
Musculoskeletal health of Indigenous Australians
Publisher: Springer Science and Business Media LLC
Date: 14-07-2018
DOI: 10.1007/S11657-018-0493-X
Abstract: Research on non-communicable diseases (NCD) in Indigenous Australians has mostly focused on diabetes mellitus and chronic kidney or cardiovascular disease. Osteoporosis, characterised by low bone mass and structural deterioration of bone tissue, and sarcopenia, the age-related loss of muscle mass and strength, often co-exist with these common NCDs-the combination of which will disproportionately increase bone fragility and fracture risk and negatively influence cortical and trabecular bone. Furthermore, the social gradient of NCDs, including osteoporosis and fracture, is well-documented, meaning that specific population groups are likely to be at greater risk of poorer health outcomes: Indigenous Australians are one such group. This review summarises the findings reported in the literature regarding the muscle and bone health of Indigenous Australians. There are limited data regarding the musculoskeletal health of Indigenous Australians however, areal bone mineral density (aBMD) measured by dual-energy X-ray absorptiometry (DXA) is reported to be greater at the hip compared to non-Indigenous Australians. Falls are the leading cause of injury-related hospitalisations in older Australians, particularly Indigenous Australians, with a great proportion suffering from fall-related fractures. Despite sparse data, it appears that Indigenous men and women have a substantially higher risk of hip fracture at a much younger age compared to non-Indigenous Australians. Data on more detailed musculoskeletal health outcomes are required in Indigenous Australians to better understand fracture risk and to formulate evidence-based strategies for fracture prevention and to minimise the risk of falls.
Measuring psychological distress in older Aboriginal and Torres Strait Islanders Australians: a comparison of the K‐10 and K‐5
Publisher: Elsevier BV
Date: 12-2014
Abstract: To assess the cross-cultural validity of two Kessler psychological distress scales (K-10 and K-5) by examining their measurement properties among older Aboriginal and Torres Strait Islanders and comparing them to those in non-Aboriginal in iduals from NSW Australia. Self-reported questionnaire data from the 45 and Up Study for 1,631 Aboriginal and 231,774 non-Aboriginal people were used to examine the factor structure, convergent validity, internal consistency and levels of missing data of K-10 and K-5. We found excellent agreement in classification of distress of Aboriginal participants by K-10 and K-5 (weighted kappa=0.87), high internal consistency (Cronbach's alpha K-10: 0.93, K-5: 0.88), and factor structures consistent with those for the total Australian population. Convergent validity was evidenced by a strong graded relationship between the level of distress and the odds of: problems with daily activities due to emotional problems current treatment for depression or anxiety and poor quality of life. K-10 and K-5 scales are promising tools for measuring psychological distress among Aboriginal and Torres Strait Islanders aged 45 and over in research and clinical settings.
Pregnancy And Neonatal Diabetes Outcomes in Remote Australia: the PANDORA study—an observational birth cohort
Publisher: Oxford University Press (OUP)
Date: 30-11-2018
DOI: 10.1093/IJE/DYY245
Abstract: In Australia's Northern Territory, 33% of babies are born to Indigenous mothers, who experience high rates of hyperglycemia in pregnancy. We aimed to determine the extent to which pregnancy outcomes for Indigenous Australian women are explained by relative frequencies of diabetes type [type 2 diabetes (T2DM) and gestational diabetes (GDM)]. This prospective birth cohort study examined participants recruited from a hyperglycemia in pregnancy register. Baseline data collected were antenatal and perinatal clinical information, cord blood and neonatal anthropometry. Of 1135 women (48% Indigenous), 900 had diabetes: 175 T2DM, 86 newly diagnosed diabetes in pregnancy (DIP) and 639 had GDM. A group of 235 women without hyperglycemia in pregnancy was also recruited. Diabetes type differed for Indigenous and non-Indigenous women (T2DM, 36 vs 5% DIP, 15 vs 7% GDM, 49 vs 88%, p < 0.001). Within each diabetes type, Indigenous women were younger and had higher smoking rates. Among women with GDM/DIP, Indigenous women demonstrated poorer birth outcomes than non-Indigenous women: large for gestational age, 19 vs 11%, p = 0·002 neonatal fat 11.3 vs 10.2%, p < 0.001. In the full cohort, on multivariate regression, T2DM and DIP were independently associated (and Indigenous ethnicity was not) with pregnancy outcomes. Higher rates of T2DM among Indigenous women predominantly contribute to absolute poorer pregnancy outcomes among Indigenous women with hyperglycemia. As with Indigenous and minority populations globally, prevention or delay of type 2 diabetes in younger women is vital to improve pregnancy outcomes and possibly to improve the long-term health of their offspring.
Exploring factors impacting early childhood health among Aboriginal and Torres Strait Islander families and communities: Protocol for a population-based cohort study using data linkage (the 'Defying the Odds' study)
Publisher: BMJ
Date: 03-2018
DOI: 10.1136/BMJOPEN-2017-021236
Abstract: Empirical evidence on family and community risk and protective factors influencing the comparatively high rates of potentially preventable hospitalisations and deaths among Aboriginal and Torres Strait Islander infants and children is limited. As is evidence on geographical variation in these risks. The ‘Defying the Odds’ study aims to explore the impact of perinatal outcomes, maternal social and health outcomes and level of culturally secure service availability on the health outcomes of Western Australian (WA) Aboriginal infants and children aged 0–5 years. The study combines a retrospective cohort study that uses state-wide linked health and administrative data from 12 data sources for multiple generations within Aboriginal families in WA, with specifically collected survey data from health and social services supporting Aboriginal families in regions of WA. Data sources include perinatal/birth registration, hospital, emergency department, mental health services, drug and alcohol service use, mortality, infectious disease notifications, and child protection and family services. Multilevel regression models will be used to examine the intensity of admissions and presentations, mortality, intensity of long stays and morbidity-free survival (no admissions) for Aboriginal children born in WA in 2000–2013. Relationships between maternal (and grand-maternal) health and social factors and child health outcomes will be quantified. Community-level variation in outcomes for Aboriginal children and factors contributing to this variation will be examined, including the availability of culturally secure services. Online surveys were sent to staff members at relevant services to explore the scope, reach and cultural security of services available to support Aboriginal families across selected regions of WA. Ethics approvals have been granted for the study. Interpretation and dissemination are guided by the study team’s Aboriginal leadership and reference groups. Dissemination will be through direct feedback and reports to health services in the study and via scientific publications and policy recommendations.
The overall health and risk factor profile of Australian Aboriginal and Torres Strait Islander participants from the 45 and up study
Publisher: Springer Science and Business Media LLC
Date: 17-07-2013
Abstract: Despite large disparities in health outcomes between Aboriginal and non-Aboriginal Australians, detailed evidence on the health and lifestyle characteristics of older Aboriginal Australians is lacking. The aim of this study is to quantify socio-demographic and health risk factors and mental and physical health status among Aboriginal participants from the 45 and Up Study and to compare these with non-Aboriginal participants from the study. The 45 and Up Study is a large-scale study of in iduals aged 45 years and older from the general population of New South Wales, Australia responding to a baseline questionnaire distributed from 2006–2008. Odds ratios (OR) and 95% confidence intervals (CI) of self-reported responses from the baseline questionnaire for Aboriginal versus non-Aboriginal participants relating to socio-demographic factors, health risk factors, current and past medical and surgical history, physical disability, functional health limitations and levels of current psychological distress were calculated using unconditional logistic regression, with adjustments for age and sex. Overall, 1939 of 266,661 45 and Up Study participants examined in this study identified as Aboriginal and/or Torres Strait Islander (0.7%). Compared to non-Aboriginal participants, Aboriginal participants were significantly more likely to be: younger (mean age 58 versus 63 years) without formal educational qualifications (age- and sex- adjusted OR = 6.2, 95% CI 5.3-7.3) of unemployed (3.7, 2.9-4.6) or disabled (4.6, 3.9-5.3) work status and with a household income $20,000/year versus ≥ $70,000/year (5.8, 5.0-6.9). Following additional adjustment for income and education, Aboriginal participants were significantly more likely than non-Aboriginal participants to: be current smokers (2.4, 2.0-2.8), be obese (2.1, 1.8-2.5), have ever been diagnosed with certain medical conditions (especially: diabetes [2.1, 1.8-2.4] depression [1.6, 1.4-1.8] and stroke [1.8, 1.4-2.3]), have care-giving responsibilities (1.8, 1.5-2.2) have a major physical disability (2.6, 2.2-3.1) have severe physical functional limitation (2.9, 2.4-3.4) and have very high levels of psychological distress (2.4, 2.0-3.0). Aboriginal participants from the 45 and Up Study experience greater levels of disadvantage and have greater health needs (including physical disability and psychological distress) compared to non-Aboriginal participants. The study highlights the need to address the social determinants of health in Australia and to provide appropriate mental health services and disability support for older Aboriginal people.
Prevalence of gestational diabetes mellitus among Indigenous women and comparison with non-Indigenous Australian women: 1990-2009
Publisher: Wiley
Date: 29-04-2014
DOI: 10.1111/AJO.12213
Abstract: Evidence on long-term trends in gestational diabetes mellitus (GDM) prevalence in Australia is lacking. To assess and compare trends in GDM prevalence among Indigenous and non-Indigenous Australian women. Analysis of crude and age-adjusted GDM prevalence over time by Indigenous status and age, using routinely collected midwives data from Australian states and territories on mothers giving birth from 1990 to 2009. Despite considerable data variation, particularly in 1990-1999, and likely underestimation of GDM prevalence, crude and age-adjusted GDM prevalences were higher in Indigenous than non-Indigenous women at all time-points (4.7% vs 3.1% in 1990-1999 5.1% vs 4.5% in 2000-2009, P < 0.0001). Data variability precluded quantitative assessment of trends and changes in prevalence ratios before 2000. From 2000 to 2009, GDM prevalence increased significantly among Indigenous women by a mean 2.6% annually (Ptrend <0.0001), and non-Indigenous women by 3.2% annually (Ptrend <0.0001), with no significant trend in the age-adjusted Indigenous/non-Indigenous prevalence ratios (PR) (P = 0.34). GDM prevalence increased significantly with age (P < 0.0001), although the increase with age was significantly greater among Indigenous women (PR 5.34 (4.94-5.77), ≥35 vs <25 years) compared to non-Indigenous women (PR 3.72 (3.64-3.81), ≥35 vs <25 years), Pinteraction <0.0001. Bearing data quality concerns in mind, GDM prevalence is increasing rapidly among Australian women, more than doubling in non-Indigenous women between 1990 and 2009. Prevalence is consistently higher in Indigenous versus non-Indigenous women, with statistically consistent differences between the groups in recent years. The marked increase in prevalence with age highlights an important period for prevention, particularly for Indigenous women.
What's data got to do with it? A scoping review of data used as evidence in policies promoting the health of Aboriginal and Torres Strait Islander children in the Northern Territory, Australia
Publisher: Wiley
Date: 25-10-2023
DOI: 10.1002/HPJA.670
Abstract: Accurate data on the health of Australia's First Nations peoples is critical in determining appropriate public health programs and establishing a baseline against which to measure progress. The effective translation of evidence into practice continues to be a challenge for Australian health departments and policymakers. The objective of this scoping review was to (i) determine the extent and range of policies relevant to the health and well‐being of Aboriginal and Torres Strait Islander children in the Northern Territory (NT) to (ii) identify what data is reported to be used as evidence to reconcile policy goals with outcomes, (iii) to describe issues acknowledged by policy makers relating to data availability and/or limitations, and to (iv) examine how principles of Indigenous inclusion and self‐determination are included in these policies. A search for current policy documents, strategic plans/initiatives or frameworks was conducted across Ovid Medline, PubMed, Informit, Scopus, in addition to a web‐based search for grey literature. Current policy documents for the period 2010‐2021 were included providing at least one of the goals or objectives were relevant to the health and well‐being of Australian Aboriginal and Torres Strait Islander children from the NT. The search located 2610 unique citations. Full‐text screening was conducted on 85 documents, a total of 49 policy documents or strategic plans/frameworks were included in the final synthesis. The source of data being used as evidence was unclear or absent in 10 of the 49 (20.4%) identified policy documents. Limitations of the available data were mentioned to some extent, but detailed information on quality and completeness was largely absent. In mapping the key principles of working in Aboriginal and Torres Strait Islander health contexts, only two policies articulated the need for information sharing and data governance. This review underscores the importance of providing clear information about which data is being used to inform policy decisions so that they may be evaluated and critiqued in meaningful ways that ensure decision makers are accountable. Specific data items and/or indicators should be explicitly referenced as evidence used in the development of policies promoting the health of Aboriginal and Torres Strait Islander children and their communities from the outset so that evaluation is clear and policy makers are held accountable.
Disparities in revascularization rates after acute myocardial infarction between aboriginal and non-aboriginal people in Australia
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-02-2013
DOI: 10.1161/CIRCULATIONAHA.112.000566
Abstract: This study examined revascularization rates after acute myocardial infarction (AMI) for Aboriginal and non-Aboriginal patients sequentially controlling for admitting hospital and risk factors. Hospital data from the state of New South Wales, Australia (July 2000 through December 2008) were linked to mortality data (July 2000 through December 2009). The study s le were all people aged 25 to 84 years admitted to public hospitals with a diagnosis of AMI (n=59 282). Single level and multilevel Cox regression was used to estimate rates of revascularization within 30 days of admission. A third (32.9%) of Aboriginal AMI patients had a revascularization within 30 days compared with 39.7% non-Aboriginal patients. Aboriginal patients had a revascularization rate 37% lower than non-Aboriginal patients of the same age, sex, year of admission, and AMI type (adjusted hazard ratio, 0.63 95% confidence interval, 0.57–0.70). Within the same hospital, however, Aboriginal patients had a revascularization rate 18% lower (adjusted hazard ratio, 0.82 95% confidence interval, 0.74–0.91). Accounting for comorbidities, substance use and private health insurance further explained the disparity (adjusted hazard ratio, 0.96 95% confidence interval, 0.87–1.07). Hospitals varied markedly in procedure rates, and this variation was associated with hospital size, remoteness, and catheterization laboratory facilities. Aboriginal Australians were less likely to have revascularization procedures after AMI than non-Aboriginal Australians, and this was largely explained by lower revascularization rates at the hospital of first admission for all patients admitted to smaller regional and rural hospitals, a higher comorbidity burden for Aboriginal people, and to a lesser extent a lower rate of private health insurance among Aboriginal patients.
Psychological distress in carers of Aboriginal children in urban New South Wales: findings from SEARCH (phase one)
Publisher: AMPCo
Date: 07-2016
DOI: 10.5694/MJA16.00111
Abstract: To examine the factors associated with psychological distress in parents and carers of Aboriginal children living in urban communities in New South Wales. Cross-sectional survey (phase one of the Study of Environment on Aboriginal Resilience and Child Health [SEARCH], November 2007 - December 2011). Primary care 589 parents and carers of Aboriginal children were recruited when attending one of the four Aboriginal Community Controlled Health Services (ACCHSs) in urban NSW that participated in SEARCH. Kessler Psychological Distress Scale (K10) scores a score of 22 or higher was deemed to indicate high levels of psychological distress. High levels of psychological distress were identified in 18% of our s le. The factors most strongly associated with this distress were functional limitations (v those with K10 scores under 22: adjusted odds ratio [aOR], 4.2 95% CI, 1.3-13.5), previous hospitalisation (aOR, 5.5 95% CI, 1.5-19.4) or other treatment for social and emotional wellbeing (aOR, 3.3 95% CI, 1.3-8.4), low satisfaction with feeling part of the community (aOR, 0.83 95% CI, 0.70-0.98) and low involvement in clubs and groups (aOR, 2.9 95% CI, 1.2-7.3). Clinicians should note that those with functional limitations or a history of treatment for mental health problems are at higher risk of psychological distress and may require additional support. Increased funding that allows ACCHSs to provide mental health services, and funding and promoting programs and activities that increase social connectedness should remain focuses for ACCHSs and policy makers.
Influence of maternal adiposity, preterm birth and birth weight centiles on early childhood obesity in an Indigenous Australian pregnancy-through-to-early-childhood cohort study
Publisher: Cambridge University Press (CUP)
Date: 16-05-2019
DOI: 10.1017/S2040174418000302
Abstract: Childhood obesity rates are higher among Indigenous compared with non-Indigenous Australian children. It has been hypothesized that early-life influences beginning with the intrauterine environment predict the development of obesity in the offspring. The aim of this paper was to assess, in 227 mother–child dyads from the Gomeroi gaaynggal cohort, associations between prematurity, Gestation Related-Optimal Weight (GROW) centiles, maternal adiposity (percentage body fat, visceral fat area), maternal non-fasting plasma glucose levels (measured at mean gestational age of 23.1 weeks) and offspring BMI and adiposity (abdominal circumference, subscapular skinfold thickness) in early childhood (mean age 23.4 months). Maternal non-fasting plasma glucose concentrations were positively associated with infant birth weight ( P =0.005) and GROW customized birth weight centiles ( P =0.008). There was a significant association between maternal percentage body fat ( P =0.02) and visceral fat area ( P =0.00) with infant body weight in early childhood. Body mass index (BMI) in early childhood was significantly higher in offspring born preterm compared with those born at term ( P =0.03). GROW customized birth weight centiles was significantly associated with body weight ( P =0.01), BMI ( P =0.007) and abdominal circumference ( P =0.039) at early childhood. Our findings suggest that being born preterm, large for gestational age or exposed to an obesogenic intrauterine environment and higher maternal non-fasting plasma glucose concentrations are associated with increased obesity risk in early childhood. Future strategies should aim to reduce the prevalence of overweight/obesity in women of child-bearing age and emphasize the importance of optimal glycemia during pregnancy, particularly in Indigenous women.
The future growth and spatial shift of Australia's Aboriginal and Torres Strait Islander population, 2016–2051
Publisher: Wiley
Date: 03-11-2020
DOI: 10.1002/PSP.2401
A global perspective of Indigenous child health research: a systematic review of longitudinal studies
Publisher: Oxford University Press (OUP)
Date: 17-04-2021
DOI: 10.1093/IJE/DYAB074
Abstract: Rigorously designed longitudinal studies can inform how best to reduce the widening health gap between Indigenous and non-Indigenous children. A systematic review was performed to identify and present the breadth and depth of longitudinal studies reporting the health and well-being of Indigenous children (aged 0–18 years) globally. Databases were searched up to 23 June 2020. Study characteristics were mapped according to domains of the life course model of health. Risk of bias was assessed using the National Institutes of Health (NIH) Study Quality Assessment Tools. Reported level of Indigenous involvement was also appraised PROSPERO registration CRD42018089950. From 5545 citations, 380 eligible papers were included for analysis, representing 210 in idual studies. Of these, 41% were located in Australia (n = 88), 22.8% in the USA (n = 42), 11.9% in Canada (n = 25) and 10.9% in New Zealand (n = 23). Research tended to focus on either health outcomes (50.9%) or health-risk exposures (43.8%) 55% of studies were graded as ‘good’ quality and 89% of studies made at least one reference to the involvement of Indigenous peoples over the course of their research. We identified gaps in the longitudinal assessment of cultural factors influencing Indigenous child health at the macrosocial level, including connection to culture and country, intergenerational trauma, and racism or discrimination. Future longitudinal research needs to be conducted with strong Indigenous leadership and participation including holistic concepts of health. This is critical if we are to better understand the systematic factors driving health inequities experienced by Indigenous children globally.
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