ORCID Profile
0000-0003-0327-7155
Current Organisations
University of Western Australia
,
Massachusetts General Hospital
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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)
Atomic, Molecular, Nuclear, Particle and Plasma Physics | Environment and Resource Economics | Environmental Science and Management | Aboriginal and Torres Strait Islander Environmental Knowledge | Environmental Rehabilitation (excl. Bioremediation) | Degenerate Quantum Gases and Atom Optics | Condensed Matter Imaging | Atomic and Molecular Physics
ANZSRC Socio-Economic Objective (SEO)
Rehabilitation of Degraded Farmland, Arable Cropland and Permanent Cropland Environments | Expanding Knowledge in the Physical Sciences | Aboriginal and Torres Strait Islander Development and Welfare | Native Forests | Expanding Knowledge in Technology |
Related Links
Publications
Missing voices
Publisher: SAGE Publications
Date: 31-12-2016
Abstract: Limited data exist on the extent of specific functional sequelae, including acquired communication disorder, among Aboriginal stroke survivors, making planning of multidisciplinary services difficult. To obtain estimates of the extent and profile of acquired communication disorder in Aboriginal and non-Aboriginal adult stroke survivors in Western Australia and investigate potential disparities in receiving in-hospital speech pathology services among survivors with acquired communication disorder. Stroke cases surviving their first stroke episode during 2002–2011 were identified using Western Australia-wide person-based linked hospital and mortality data, and their five-year comorbidity profiles determined. The mid-year prevalence of stroke cases with acquired communication disorder was estimated for 2011. Regression methods were used to investigate determinants of receiving speech pathology services among acquired communication disorder cases. Of 14,757 stroke survivors aged 15–79 years admitted in 2002–2011, 33% had acquired communication disorder (22% aphasia/dysphasia) and 777 (5.3%) were Aboriginal. Aboriginal patients were more likely to be younger, live remotely, and have comorbidities. A diagnosis of aphasia was more common in Aboriginal than non-Aboriginal patients 15–44 years (p = 0.003). A minimum of 107 Aboriginal and 2324 non-Aboriginal stroke patients with acquired communication disorder lived in Western Australia in 2011. Aboriginal status was not associated with receiving in-hospital speech services among acquired communication disorder patients in unadjusted or adjusted models. The relative youth, geographical distribution, high comorbidity prevalence, and cultural needs of Aboriginal stroke patients with acquired communication disorder should inform appropriate service design for speech pathology and rehabilitation. Innovative models are required to address workforce issues, given low patient volumes.
Cancer services and their initiatives to improve the care of indigenous Australians
Publisher: MDPI AG
Date: 11-04-2018
Not just bricks and mortar: Planning hospital cancer services for Aboriginal people
Publisher: Springer Science and Business Media LLC
Date: 14-03-2011
General practitioners’ perceptions of their communication with Australian Aboriginal patients with acquired neurogenic communication disorders
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.PEC.2019.07.029
Abstract: Aboriginal people have high rates of stroke and traumatic brain injury (TBI), often with residual, chronic communication deficits and multiple co-morbidities. This study examined general practitioners' (GPs') perceptions of their communication with Aboriginal patients with acquired communication disorders (ACD) after brain injury. Effective communication underpins good care but no previous research has explored this specific context. A qualitative descriptive approach was employed using interviews and focus groups with 23 GPs from metropolitan Perth and five regional sites in Western Australia. Data were analysed thematically. GPs reported low visibility of Aboriginal patients with ACD in their practices, minimal training on neurogenic ACD, and difficulty distinguishing ACD from cultural-linguistic factors. They had few communication resources, and depended on families and Aboriginal Health Workers to assist in interactions. They rarely used formal interpreting services or referred to speech pathology. They reported communication (dis)ability having low priority in consultations. GPs report difficulty recognising ACD and their lack of prioritising assessment and treatment of communication ability after brain injury potentially compounds the disadvantage and disempowerment experienced by many Aboriginal people. GPs require further communication and cultural training. Improved access to speech pathology and formal interpreting services would be beneficial.
Assessment of long-term outcomes of hepatitis C virus infection in a cohort of patients with acute hepatitis in 1971-1975: Results of a pilot study
Publisher: Wiley
Date: 19-04-2002
DOI: 10.1046/J.1440-1746.1999.01846.X
Abstract: To examine the long-term effects of hepatitis C virus (HCV) infection in a cohort of patients admitted to Fairfield Hospital with hepatitis from 1971 to 1975. The availability of stored sera from this time enabled testing to identify those who were anti-HCV positive on admission. Sixteen per cent (n = 230) of the cohort tested positive for HCV antibody (anti-HCV). The 'unexposed' group was selected from those who were anti-HCV negative. Systematic approaches were used to locate the cohort and health outcomes assessed by a study specific questionnaire and clinical review with repeat serology and liver function tests. Complete follow up has been achieved on a subset of 35 HCV-seropositive and 70 seronegative in iduals. The seropositive group was significantly more likely to have given a history of injecting drug use, the presumed route of infection. The seropositive group was also more likely to have elevated serum alanine aminotransferase levels, but only two (6%) were known to have progressed to cirrhosis. The anti-HCV-positive in iduals followed up to date are at increased risk of liver-related pathology, but few had progressed to cirrhotic liver disease. This differs from findings of transfusion-related studies and suggests, within the limitations of the study, that the natural history of community acquired HCV may be more benign.
Differences in stroke risk and cardiovascular mortality for Aboriginal and other Australian patients with atrial fibrillation
Publisher: AMPCo
Date: 06-02-2020
DOI: 10.5694/MJA2.50496
Study Protocol: Missing Voices - Communication Difficulties after Stroke and Traumatic Brain Injury in Aboriginal Australians
Publisher: Cambridge University Press (CUP)
Date: 20-07-2015
Abstract: Background: Aboriginal and Torres Strait Islander Australians experience stroke and traumatic brain injury (TBI) with much greater frequency than non-Aboriginal Australians. Acquired communication disorders (ACD) can result from these conditions and can significantly impact everyday life. Yet few Aboriginal people access rehabilitation services and little is known about Aboriginal peoples’ experiences of ACD. This paper describes the protocol surrounding a study that aims to explore the extent and impact of ACD in Western Australian Aboriginal populations following stroke or TBI and develop a culturally appropriate screening tool for ACD and accessible and culturally appropriate service delivery models. Method/Design: The 3-year, mixed methods study is being conducted in metropolitan Perth and five regional centres in Western Australia. Situated within an Aboriginal research framework, methods include an analysis of linked routine hospital admission data and retrospective file audits, development of a screening tool for ACD, interviews with people with ACD, their families, and health professionals, and drafting of alternative service delivery models. Discussion: This study will address the extent of ACD in Aboriginal populations and document challenges for Aboriginal people in accessing speech pathology services. Documenting the burden and impact of ACD within a culturally secure framework is a forerunner to developing better ways to address the problems faced by Aboriginal people with ACD and their families. This will in turn increase the likelihood that Aboriginal people with ACD will be diagnosed and referred to professional support to improve their communication, quality of life and functioning within the family and community context.
‘Everything is okay’: The influence of neoliberal discourse on the reported experiences of Aboriginal people in Western Australia who are HIV‐positive
Publisher: Informa UK Limited
Date: 11-2007
DOI: 10.1080/13691050701496913
Abstract: While Australian Aboriginal conceptions of health have been described as holistic and collective, contemporary approaches to health services and health research are often premised on the rational, reflexive subject of neoliberal discourse. This paper considers how neoliberal conceptions of health and subjectivity arose and were negotiated in the context of a qualitative research project on Aboriginal experiences of HIV in Western Australia. Questions about 'coping', 'future' and 'life changes' stood out in the interview transcripts as ex les of neoliberal discourse. This paper explores the reflexive, contextual and deflective responses to these questions and suggests they demonstrate how neoliberal discourse can produce the impression that 'everything is okay' despite the difficult social and economic conditions of everyday life experienced by many Aboriginal people. Aboriginal people with a chronic and serious infectious disease such as HIV may utilise the language of self-management and responsibility when talking about HIV with a non-Aboriginal researcher for pragmatic and utilitarian reasons. In this way, the responses of the Aboriginal participants in this study provide a valuable opportunity for exploring new approaches to both research methodology and health service delivery.
The general health status of people with mental illness
Publisher: SAGE Publications
Date: 03-2000
A cohort study: temporal trends in prevalence of antecedents, comorbidities and mortality in Aboriginal and non-Aboriginal Australians with first heart failure hospitalization, 2000-2009
Publisher: Springer Science and Business Media LLC
Date: 12-08-2015
Smartphones in the secondary prevention of cardiovascular disease: a systematic review
Publisher: Springer Science and Business Media LLC
Date: 07-02-2018
Factors associated with rural work for nursing and allied health graduates 15-17 years after an undergraduate rural placement through the University Department of Rural Health program
Publisher: Rural and Remote Health
Date: 31-01-2020
DOI: 10.22605/RRH5334
Validation study of GRACE risk scores in indigenous and non-indigenous patients hospitalized with acute coronary syndrome
Publisher: Springer Science and Business Media LLC
Date: 16-11-2015
An evaluation of school entry immunisation certificates in Victoria
Publisher: Wiley
Date: 12-02-1994
DOI: 10.1111/J.1753-6405.1994.TB00243.X
Abstract: We evaluated legislation introduced into Victoria in 1991 requiring that all children enrolling in primary school certify their immunisation status. Information was requested from all local councils. All primary schools in two local government areas were followed up, providing an indication of the validity of the analysis obtained from data collected during the mid-year census. From 166 of 210 local councils in Victoria, 48,422 documents relating to school entry immunisation certificates were issued for children entering their preparatory year. At least 522 children were enrolled in school on an undertaking to complete immunisation, and were likely to have had their immunisation completed as a result of the legislation. Only 170 statutory declarations of conscientious objection to immunisation were made, indicating that few parents are willing to express firm anti-vaccine sentiments. Compliance with the immunisation certificate legislation is overestimated by the mid-year census because many schools have accepted nonstatutory evidence of immunisation. Mobile and immigrant families find it particularly difficult to achieve certification. Local councils are inconsistent in the way in which they issue certificates. Further follow-up and feedback is essential to better inform schools and parents about the legislation. Such follow-up can improve the certification rates of children then and in subsequent years. The legislation has imposed a considerable workload on councils, but without efforts to improve compliance with the legislation and to develop practical guidelines for documentation of immunisation and appropriate guidelines regarding transfer, many inadequately immunised children may remain at risk from vaccine-preventable diseases.
Sleep facilitates spatial memory but not navigation using the Minecraft Memory and Navigation task
Publisher: Proceedings of the National Academy of Sciences
Date: 17-10-2022
Abstract: Sleep facilitates hippoc al-dependent memories, supporting the acquisition and maintenance of internal representation of spatial relations within an environment. In humans, however, findings have been mixed regarding sleep’s contribution to spatial memory and navigation, which may be due to task designs or outcome measurements. We developed the Minecraft Memory and Navigation (MMN) task for the purpose of disentangling how spatial memory accuracy and navigation change over time, and to study sleep’s independent contributions to each. In the MMN task, participants learned the locations of objects through free exploration of an open field computerized environment. At test, they were teleported to random positions around the environment and required to navigate to the remembered location of each object. In study 1, we developed and validated four unique MMN environments with the goal of equating baseline learning and immediate test performance. A total of 86 participants were administered the training phases and immediate test. Participants’ baseline performance was equivalent across all four environments, supporting the use of the MMN task. In study 2, 29 participants were trained, tested immediately, and again 12 h later after a period of sleep or wake. We found that the metric accuracy of object locations, i.e., spatial memory, was maintained over a night of sleep, while after wake, metric accuracy declined. In contrast, spatial navigation improved over both sleep and wake delays. Our findings support the role of sleep in retaining the precise spatial relationships within a cognitive map however, they do not support a specific role of sleep in navigation.
Supporting cancer control for Indigenous Australians: initiatives and challenges for cancer councils
Publisher: CSIRO Publishing
Date: 2008
DOI: 10.1071/AH080056
Abstract: As in other developed countries, the Australian population is ageing, and cancer rates increase with age. Despite their substantially lower life expectancy, Indigenous Australians are also experiencing concerning cancer statistics, characterised by increasing rates, later diagnosis, higher mortality, and lower participation in screening than the non-Indigenous population. Eighteen months after the first national Indigenous Cancer Control Forum, this environmental scan within the statebased Cancer Councils was undertaken to map activities in service provision in Indigenous cancer control with a view to sharing the lessons learned. The findings show that although most of the organisations had tried to work with Indigenous communities on cancer issues, there have been difficulties in building and sustaining relationships with Indigenous organisations. Lack of having Indigenous staff internally, few Indigenous-specific resources, and few planned, long-term commitments were some of the major impediments. Some of these limitations can easily be overcome by building and improving regional or local partnerships, providing cultural awareness training to internal staff, and by building the capacity of Indigenous organisations. Health promotion projects of the Cancer Councils directed at Indigenous people could be more effectively implemented with such considerations.
You're always hearing about the stats ... death happens so often: new perspectives on barriers to Aboriginal participation in cardiac rehabilitation
Publisher: AMPCo
Date: 05-2010
Delivering culturally appropriate residential rehabilitation for urban Indigenous Australians: A review of the challenges and opportunities
Publisher: Elsevier BV
Date: 07-2010
DOI: 10.1111/J.1753-6405.2010.00551.X
Abstract: To review the challenges facing Indigenous and mainstream services in delivering residential rehabilitation services to Indigenous Australians, and explore opportunities to enhance outcomes. A literature review was conducted using keyword searches of databases, on-line journals, articles, national papers, conference proceedings and reports from different organisations, with snowball follow-up of relevant citations. Each article was assessed for quality using recognised criteria. Despite debate about the effectiveness of mainstream residential alcohol rehabilitation treatment, most Indigenous Australians with harmful alcohol consumption who seek help have a strong preference for residential treatment. While there is a significant gap in the cultural appropriateness of mainstream services for Indigenous clients, Indigenous-controlled residential organisations also face issues in service delivery. Limitations and inherent difficulties in rigorous evaluation processes further plague both areas of service provision. With inadequate evidence surrounding what constitutes 'best practice' for Indigenous clients in residential settings, more research is needed to investigate, evaluate and contribute to the further development of culturally appropriate models of best practice. In urban settings, a key area for innovation involves improving the capacity and quality of service delivery through effective inter-agency partnerships between Indigenous and mainstream service providers.
Experience of healthcare access in australia during the first year of the covid-19 pandemic
Publisher: MDPI AG
Date: 12-10-2021
Abstract: Changes in health-seeking behaviours and challenges in accessing care have been reported during the COVID-19 pandemic. This qualitative study examines Australian experiences related to healthcare access during the early months of the pandemic. The study aimed to identify key areas of concern as well as opportunities for services to prevent, manage and treat health concerns when normal access was disrupted. Fifty-nine semi-structured interviews were analysed. Participants were interviewed between August and December in 2020 over telephone or Zoom and were located across Australia. Rapid identification of themes with an audio recordings technique was used to generate themes from the data. Participants described a variety of influences on their health-seeking behaviours, resulting in decisions to delay care or being unable to reach care. Many in iduals accessed health services via telehealth and offered a range of perceptions and views on its effectiveness and appropriateness. The findings illustrate that maintenance of health and access to healthcare and psychosocial support were compromised for some in iduals, leading to negative impacts on both mental and physical health. This highlights the need to provide mechanisms to facilitate a person’s ability to access care in a timely manner during a pandemic.
Are the processes recommended by the NHMRC for improving Cardiac Rehabilitation (CR) for Aboriginal and Torres Strait Islander people being implemented?: An assessment of CR Services across Western Australia
Publisher: Springer Science and Business Media LLC
Date: 12-2009
General Practitioners’ Knowledge, Attitudes, and Practices of Dietary Advice for Weight Control in Their Overweight Patients
Publisher: MDPI AG
Date: 27-06-2023
DOI: 10.3390/NU15132920
Abstract: This scoping review assessed the knowledge, attitudes, and practices of general practitioners (GPs) regarding dietary advice for weight management. A systematic search of PubMed, EMBASE, CINAHL, and MEDLINE was conducted for any qualitative, quantitative, and mixed-methods studies published in the past five years that informed GPs’ dietary advice for weight control. Thirteen studies were included in the analysis after screening 881 papers. These studies tended to focus mostly on GPs’ practices rather than their knowledge and attitudes. The most frequently mentioned dietary advice was to reduce calorie intake however, 32 different types of dietary advice were identified in the literature, including approaches such as intermittent fasting and a ketogenic diet that are not recommended in current guidelines. GPs showed varying levels of knowledge and attitudes regarding the best dietary advice for patients. Further research is needed to better understand GP perspectives, with efforts to assist GPs in providing tailored advice based on the latest evidence to improve patient outcomes required.
Reducing the health disparities of Indigenous Australians: time to change focus
Publisher: Springer Science and Business Media LLC
Date: 10-06-2012
Alcohol Experiences and Concerns of Newly Arrived Migrant Women
Publisher: SAGE Publications
Date: 2014
Abstract: Migrant women are under-represented as users of alcohol and other drug (AOD) services. This study examined AOD use by newly arrived women, identifying issues of concern to them. A questionnaire-based survey was conducted with 268 migrant women who had arrived in Perth, Western Australia, within the previous 5 years. Almost half were humanitarian entrants. Most women (76%) reported they did not drink alcohol. Of those who did, 10 were drinking at harmful levels and over half reported changes to their drinking patterns since arrival. One fifth of participants (20%) described distressing incidents related to alcohol or drug use by others. Migrant women are concerned by alcoholand drug-related problems, even if they do not drink themselves. Domestic violence and abuse by strangers were concerns that were aggravated by alcohol and drug use. As new migrants often lack strategies to prevent, or deal with alcohol-related misuse, provision of additional information and support is recommended.
The quality of Indigenous identification in administrative health data in Australia: insights from studies using data linkage
Publisher: Springer Science and Business Media LLC
Date: 16-11-2012
A qualitative exploration of priorities for quality improvement amongst Aboriginal and Torres Strait Islander primary health care services
Publisher: Springer Science and Business Media LLC
Date: 06-05-2021
DOI: 10.1186/S12913-021-06383-7
Abstract: Achieving quality improvement in primary care is a challenge worldwide, with substantial gaps between best practice and actual practice. Within the context of Australia, Aboriginal and Torres Strait Primary Health Care (PHC) services have great variation across settings, structures and context. Research has highlighted how these contextual differences can critically influence the success of Quality Improvement (QI) interventions and outcomes. Less understood is the interaction between local context and other factors, which may impact the implementation of QI interventions. This paper aims to explore the strengths and challenges in QI for Aboriginal and Torres Strait Islander PHC services and their priorities for improvement. A multiple case study design was adopted, working with eight Aboriginal and Torres Strait Islander PHC services in Northern Territory, Queensland and Western Australia. Data were collected via a health service survey, semi-structured interviews with health service staff and service users and researcher observations, to explore QI and perceptions of care quality at the service level. Data reported here were analysed using an iterative thematic technique, within-case and across-case. A total of 135 interviews were conducted with health service staff, service users and community members. Participants emphasised the centrality of resilient community, committed workforce and valued Aboriginal and Torres Strait Islander team members in delivering care. A shared purpose around improving the health of community was a significant driver. Key challenges included staff turnover and shortages, a complex and overwhelming acute and chronic care workload, building relationships and trust between health services and the community. Service-suggested priority areas for improvement were categorised into five themes: i) cultural safety (community driving health and planning for culturally safe services) ii) community engagement (through clinical activities in the community) iii) shared ownership and a team approach around QI iv) strengthening systems and consistent ways of doing things in the health service and v) strengthening local workforce (and resources for a culturally safe workforce). These findings advance understandings of relational, community and cultural factors which are identified priorities for the delivery of quality care in Aboriginal and Torres Strait Islander PHC services across varied contexts.
Factors associated with the rural and remote practice of medical workforce in Maluku Islands of Indonesia
Publisher: Springer Science and Business Media LLC
Date: 09-10-2021
DOI: 10.1186/S12960-021-00667-Z
Abstract: Many factors contribute to engagement in rural and remote (RR) medical practice, but little is known about the factors associated with rural and remote medical practice in such remote locations as the Maluku Province of Indonesia. This study describes factors associated with actual RR practice, preferred RR practice, and intention to remain practice in Maluku Province. An online survey of work-related experience and intentions for future rural work was administered to 410 doctors working in the Maluku province of Indonesia. Participant characteristics were described using descriptive statistics, associations between the independent variables with the location of the workforce, intention to remain practice in Maluku, preference for future RR practice in Maluku were analysed using Chi-square tests and logistic regression. A total of 324 responses (79% response rate) were recorded, comprising 70% females and 30% Pattimura University graduates of doctors employed in Maluku. Doctors working in RR areas were more likely to be a GP (OR 3.49, CI 1.03–11.8), have a monthly salary of more than IDR 6 million (OR 11.5, CI 4.24–31.1), and have no additional practice (OR 2.78, CI 1.34–5.78). Doctors intended to stay practice in Maluku were more likely to be born in Maluku (OR 7.77, CI 3.42–17.7) and have graduated from Pattimura University (OR 3.06, CI 1.09–8.54), and less likely to be a temporary employee (OR 0.24, CI 0.10–0.57). Doctors who prefer future RR practice in Maluku were more likely to experience rural living (OR 2.05 CI 1.05–3.99), have a positive indication of the impact of community exposure during medical schools on their current practice (OR 2.08, CI 1.06–4.09), currently practising in RR Maluku (OR 8.23, CI 3.27–20.8) and less likely to have bigger take-home pay (OR 0.30, CI 0.13–0.70). This study indicates that special attention should be given to recruiting doctors with a rural background and ongoing support through attractive opportunities to build a sustainable RR workforce. Since a regional medical school helps supply doctors to the RR areas in its region, a sustained collaboration between medical schools and local government implementing relevant strategies are needed to widen participation and improve the recruitment and retention of RR doctors.
Infectious diarrhoea in children: Controlling transmission in the child care setting
Publisher: Wiley
Date: 06-1994
DOI: 10.1111/J.1440-1754.1994.TB00621.X
Abstract: An increase in the number of preschool children cared for within groups in child care centres has been associated with increasing numbers of women in the workforce. Children at this age are at high risk for gastrointestinal diseases caused by a large number of enteric pathogens, and the risk is increased by the greater potential for person-to-person transmission within group care. This report considers the pathogens that may cause diarrhoeal illness in children, with particular reference to those that have been reported in formal day care settings. The major risk factors for transmission of these agents and a high rate of diarrhoeal illness in the child care setting include attendance of non-toilet-trained children, staff combining nappy changing and food preparation duties, large enrollment, low staff-to-child ratio, and poor hygiene and child handling practices. Investigations undertaken during an outbreak of diarrhoea have frequently used limited diagnostic testing, often suitable for identifying only bacterial and protozoal agents. Such limited investigations have tended to incriminate agents that have prolonged carriage and are easily identifiable in standard microbiology laboratories. Finding a pathogen in these circumstances needs to be interpreted with caution. Prevention and control measures include training and education in good personal hygiene, emphasis on the need for frequent handwashing, separation of change areas from food handling and eating areas, routine cleaning and disinfection of environmental surfaces and personal items, and exclusion of any child or child care worker with diarrhoea.
Hepatitis C treatment strategies in prisons: A cost-effectiveness analysis
Publisher: Public Library of Science (PLoS)
Date: 11-02-2021
DOI: 10.1371/JOURNAL.PONE.0245896
Abstract: In Australian prisons approximately 20% of inmates are chronically infected with hepatitis C virus (HCV), providing an important population for targeted treatment and prevention. A dynamic mathematical model of HCV transmission was used to assess the impact of increasing direct-acting antiviral (DAA) treatment uptake on HCV incidence and prevalence in the prisons in New South Wales, Australia, and to assess the cost-effectiveness of alternate treatment strategies. We developed four separate models reflecting different average prison lengths of stay (LOS) of 2, 6, 24, and 36 months. Each model considered four DAA treatment coverage scenarios of 10% (status-quo), 25%, 50%, and 90% over 2016–2045. For each model and scenario, we estimated the lifetime burden of disease, costs and changes in quality-adjusted life years (QALYs) in prison and in the community during 2016–2075. Costs and QALYs were discounted 3.5% annually and adjusted to 2015 Australian dollars. Compared to treating 10% of infected prisoners, increasing DAA coverage to 25%, 50%, and 90% reduced HCV incidence in prisons by 9–33% (2-months LOS), 26–65% (6-months LOS), 37–70% (24-months LOS), and 35–65% (36-months LOS). DAA treatment was highly cost-effective among all LOS models at conservative willingness-to-pay thresholds. DAA therapy became increasingly cost-effective with increasing coverage. Compared to 10% treatment coverage, the incremental cost per QALY ranged from $497-$569 (2-months LOS), -$280–$323 (6-months LOS), -$432–$426 (24-months LOS), and -$245–$477 (36-months LOS). Treating more than 25% of HCV-infected prisoners with DAA therapy is highly cost-effective. This study shows that treating HCV-infected prisoners is highly cost-effective and should be a government priority for the global HCV elimination effort.
An overview of cancer and beliefs about the disease in Indigenous people of Australia, Canada, New Zealand and the US
Publisher: Elsevier BV
Date: 04-2009
DOI: 10.1111/J.1753-6405.2009.00355.X
Abstract: Cancer among Indigenous populations in the developed world appears to have increased over past few decades. This article explores issues related to cancer among the Indigenous populations of Australia, Canada, New Zealand and the US and examines variations in the epidemiology, Indigenous peoples' perceptions about cancer and potential effects on care-seeking behaviour. A search of peer-reviewed journal articles, government reports, published and unpublished theses and other grey literature was undertaken using electronic databases and citation snowballing. Both epidemiological and qualitative studies were included. Cancer in Indigenous populations in these four countries is characterised by high incidence and mortality rates for specific cancers and lower survival rates as a result of late diagnosis, lower participation and poorer compliance with treatment. A higher prevalence of many cancer risk factors occurs across these populations. Fear of death, fatalism, payback, shame and other spiritual and cultural issues are reported in the few qualitative studies examining Indigenous beliefs and understanding of cancer which undoubtedly influences participation in cancer screening and treatment. The holistic approach (physical, mental, emotional and spiritual) to healing and well-being, and the concept that in idual, family and community are inseparable underpin Indigenous care-seeking behaviour. Further community-based research is needed to increase understanding of the needs of Indigenous people with cancer, and to guide policy and practice towards more supportive and effective care.
Passing on wisdom
Publisher: Rural and Remote Health
Date: 30-11-2019
DOI: 10.22605/RRH5444
Risk Factors for HIV/AIDS and Hepatitis C Among the Chronic Mentally Ill
Publisher: SAGE Publications
Date: 04-2001
DOI: 10.1046/J.1440-1614.2001.00867.X
Abstract: Objective: The objective of this study was to document the prevalence of risk factors for HIV/AIDS and hepatitis C among people with chronic mental illness treated in a community setting. Method: 234 patients attending four community mental health clinics in the North-western Health Care Network in Melbourne, Australia, completed an interviewer-administered questionnaire which covered demographics, risk behaviour and psychiatric diagnosis. Results: The s le was 58% male, and 79% of the s le had a primary diagnosis of schizophrenia. Forty-three per cent of mentally ill men and 51% of mentally ill women in the survey had been sexually active in the 12 months preceding the survey. One-fifth of mentally ill men and 57% of mentally ill women who had sex with casual partners never used condoms. People with mental illness were eight times more likely than the general population to have ever injected illicit drugs and the mentally ill had a lifetime prevalence of sharing needles of 7.4%. Conclusions: The prevalence of risk behaviours among the study group indicate that people with chronic mental illness should be regarded as a high-risk group for HIV/AIDS and hepatitis C. It is essential that adequate resources and strategies are targeted to the mentally ill as they are for other high-risk groups.
Ascertaining exposure categories of HIV‐infected individuals with previously unrecorded risk data
Publisher: AMPCo
Date: 07-1995
DOI: 10.5694/J.1326-5377.1995.TB126116.X
Abstract: To improve the quality of surveillance data for HIV in Victoria by following up all cases with an unknown exposure category and to determine whether those with no exposure category included cases of transmission other than via the conventionally recognised routes. The Victorian HIV database records data on all people diagnosed with HIV in Victoria, including information on route of exposure to the virus. We identified all HIV diagnoses to which no exposure category had been attributed and, with the permission of the State Minister for Health, obtained access to namecoded testing records. Exposure categories, where possible, were obtained directly from these records. Otherwise, cases were checked against the namecoded AIDS database and, if necessary, an intensive process of call-back to laboratories, diagnosing doctors and HIV treatment centres was undertaken. The database initially contained records for 289 people with unknown exposure categories (9.1% of Victorian people with HIV infection). We identified exposure categories for 155 of these people. Exposure categories for those cases previously without data were similar to those for cases where exposure category was known. No instances of HIV transmission by previously unrecognised means were detected.
Exploring undergraduate midwifery students’ readiness to deliver culturally secure care for pregnant and birthing Aboriginal women
Publisher: Springer Science and Business Media LLC
Date: 16-04-2015
Can the CHA2DS2‐VA schema be used to decide on anticoagulant therapy in Aboriginal and other Australians with non‐valvular atrial fibrillation?
Publisher: Wiley
Date: 04-2021
DOI: 10.1111/IMJ.15282
Factors contributing to delayed diagnosis of cancer among Aboriginal people in Australia: A qualitative study
Publisher: BMJ
Date: 06-2016
Differentiation of Rodent Bone Marrow Mesenchymal Stem Cells into Intervertebral Disc-like Cells Following Coculture with Rat Disc Tissue
Publisher: Mary Ann Liebert Inc
Date: 09-2009
Missed opportunities in educating aboriginal Australians about bowel cancer screening: Whose job is it anyway?
Publisher: Informa UK Limited
Date: 12-2013
DOI: 10.5172/CONU.2013.46.1.59
Abstract: A culturally relevant educational flipchart targeting Aboriginal people was distributed across Western Australia to support education on bowel cancer screening and encourage participation in the National Bowel Cancer Screening Program. Respondents s led from the flipchart distribution list were surveyed on the appropriateness, usefulness, and the extent to and manner in which they used the flipchart for educating Aboriginal clients. Despite praising the resource, few respondents used the flipchart as intended for various reasons, including the view that Aboriginal health education was the responsibility of Aboriginal health workers. Greater recognition by all health service providers is needed of their potential role in Aboriginal health education. Promoting a national health program of under-appreciated importance for a marginalised population is challenging. Effective utilisation of an educational tool is predicated on factors beyond its production quality and wide dissemination. Intended users require awareness of the underlying problem, and adequate time for and specific training in implementation of the tool.
Blood-borne viruses and their survival in the environment: is public concern about community needlestick exposures justified?
Publisher: Elsevier BV
Date: 12-2003
DOI: 10.1111/J.1467-842X.2003.TB00606.X
Abstract: More than 30 million needle syringes are distributed per year in Australia as a component of harm-reduction strategies for injecting drug users (IDU). Discarded needle syringes create considerable anxiety within the community, but the extent of needlestick injuries and level of blood-borne virus transmission risk is unclear. We have undertaken a review of studies of blood-borne virus survival as the basis for advice and management of community needlestick injuries. A Medline review of published articles on blood-borne virus survival and outcome from community injuries. Hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) can all survive outside the human body for several weeks, with virus survival influenced by virus titer, volume of blood, ambient temperature, exposure to sunlight and humidity. HBV has the highest virus titers in untreated in iduals and is viable for the most prolonged periods in needle syringes stored at room temperature. However, prevalence of HBV and HIV are only 1-2% within the Australian IDU population. In contrast, prevalence of HCV is 50-60% among Australian IDUs and virus survival in needle syringes has been documented for prolonged periods. There have been no published cases of blood-borne virus transmission following community needlestick injury in Australia. The risk of blood-borne virus transmission from syringes discarded in community settings appears to be very low. Despite this, procedures to systematically follow up in iduals following significant needlestick exposures sustained in the community setting should be developed.
“We’re very much part of the team here”
Publisher: Public Library of Science (PLoS)
Date: 22-09-2020
A screening tool for acquired communication disorders in Aboriginal Australians after brain injury
Publisher: Informa UK Limited
Date: 21-10-2020
Caution with post‐treatment test‐ of‐cure for genital chlamydia
Publisher: AMPCo
Date: 08-1997
DOI: 10.5694/J.1326-5377.1997.TB138826.X
Abstract: Visible Light Communication (VLC) is a wireless communication technology that uses visible light to transmit information. The most extended implementation of a VLC transmitter employs a DC-DC power converter that biases the High-Brightness LEDs (HB-LEDs), and a Linear Power Amplifier (LPA) that reproduces the communication signal. Unfortunately, the power efficiency of LPAs is very low, thus reducing the overall system efficiency and requiring huge cooling systems to extract the heat. In this work, the use of Class D Switching-Mode Power Amplifiers (SMPAs) is explored in order to overcome that limitation. It is important to note that this SMPA is widely used for different applications, such as audio and RF power lifiers. Therefore, there are a lot of versions of a Class D SMPA depending on the topology used for the implementation and the modulation strategy used to control the switches. Hence, this work aims to identify, adapt and explain in detail the best approach for implementing a Class D SMPA for VLC. In order to validate the proposed idea, a power-efficient VLC transmitter intended for short-range and low-speed applications was built and evaluated.
Hepatitis B infection in Victoria 1992: time to review the high‐risk vaccination strategy
Publisher: AMPCo
Date: 10-1993
Exploring the impact of an aboriginal health worker on hospitalised aboriginal experiences: Lessons from cardiology
Publisher: CSIRO Publishing
Date: 2009
DOI: 10.1071/AH090549
Abstract: To enhance Aboriginal inpatient care and improve outpatient cardiac rehabilitation utilisation, a tertiary hospital in Western Australia recruited an Aboriginal Health Worker (AHW). Interviews were undertaken with the cardiology AHW, other hospital staff including another AHW, and recent Aboriginal cardiac patients to assess the impact of this position. The impact of the AHW included facilitating culturally appropriate care, bridging communication ides, reducing discharges against medical advice, providing cultural education, increasing inpatient contact time, improving follow-up practices and enhancing patient referral linkages. Challenges included poor job role definition, clinical restrictions and limitations in AHW training for hospital settings. This study demonstrates that AHWs can have significant impacts on Aboriginal cardiac inpatient experiences and outpatient care. Although this study was undertaken in cardiology, the lessons are transferable across the hospital setting.
Beyond policy and planning to practice
Publisher: Springer Science and Business Media LLC
Date: 19-05-2008
Initial hospitalisation for atrial fibrillation in Aboriginal and non-Aboriginal populations in Western Australia
Publisher: BMJ
Date: 19-02-2015
DOI: 10.1136/HEARTJNL-2014-306678
Abstract: The epidemiology of atrial fibrillation (AF) among Aboriginal Australians is poorly described. We compared risk factors, incidence rates and mortality outcomes for first-ever hospitalised AF among Aboriginal and non-Aboriginal Western Australians 20-84 years. This retrospective cohort study used whole-of-state person-based linked hospital and deaths data. Incident hospital AF admissions (previous AF admission-free for 15 years) were identified and subsequent mortality determined. Disease-specific comorbidity histories were ascertained by 10-year look-back. Age-standardised incidence rates were estimated and the adjusted risk of 30-day and 1-year mortality calculated using regression methods. Aboriginal patients accounted for 923 (2.5%) of 37 097 incident AF admissions during 2000-2009. Aboriginal patients were younger (mean age 54.8 vs 69.3 years), had lower proportions of primary field AF diagnoses and higher comorbidities than non-Aboriginal patients. The Aboriginal and non-Aboriginal age-standardised incidence rates per 100,000 for men 20-54 years were 197 and 55 (ratio=3.6), for women 20-54 years were 122 and 19 (ratio=6.4), for men 55-84 years were 1151 and 888 (ratio=1.3), and for women 55-84 years were 1050 and 571 (ratio=1.8). While 30-day mortality was similar, crude 1-year mortality risks in Aboriginal and non-Aboriginal patients were 20.6% and 16.3% (adjusted HR=1.24) and 14.4% and 9.9% in 30-day survivors (adjusted HR=1.58). The incidence (particularly at young ages) and long-term mortality following hospitalised AF is significantly higher in Aboriginal people. Better control of the antecedent risk factors for AF, improved detection and management of AF itself and prevention of its complications are needed.
Knowledge translation lessons from an audit of Aboriginal Australians with acute coronary syndrome presenting to a regional hospital
Publisher: SAGE Publications
Date: 2016
Abstract: Translation of evidence into practice by health systems can be slow and incomplete and may disproportionately impact disadvantaged populations. Coronary heart disease is the leading cause of death among Aboriginal Australians. Timely access to effective medical care for acute coronary syndrome substantially improves survival. A quality-of-care audit conducted at a regional Western Australian hospital in 2011–2012 compared the Emergency Department management of Aboriginal and non-Aboriginal acute coronary syndrome patients. This audit is used as a case study of translating knowledge processes in order to identify the factors that support equity-oriented knowledge translation. In-depth interviews were conducted with a purposive s le of the audit team and further key stakeholders with interest/experience in knowledge translation in the context of Aboriginal health. Interviews were analysed for alignment of the knowledge translation process with the thematic steps outlined in Tugwell’s cascade for equity-oriented knowledge translation framework. In preparing the audit, groundwork helped shape management support to ensure receptivity to targeting Aboriginal cardiovascular outcomes. Reporting of audit findings and resulting advocacy were undertaken by the audit team with awareness of the institutional hierarchy, appropriate timing, personal relationships and recognising the importance of tailoring messages to specific audiences. These strategies were also acknowledged as important in the key stakeholder interviews. A follow-up audit documented a general improvement in treatment guideline adherence and a reduction in treatment inequalities for Aboriginal presentations. As well as identifying outcomes such as practice changes, a useful evaluation increases understanding of why and how an intervention worked. Case studies such as this enrich our understanding of the complex human factors, including in idual attributes, experiences and relationships and systemic factors that shape equity-oriented knowledge translation. Given the potential that improving knowledge translation has to close the gap in Aboriginal health disparities, we must choose strategies that adequately take into account the unique contingencies of context across institutions and cultures.
Reduction of Solar Keratoses by Regular Sunscreen Use
Publisher: Massachusetts Medical Society
Date: 14-10-1993
Time to bring down the twin towers in poor Aboriginal hospital care: addressing institutional racism and misunderstandings in communication
Publisher: Wiley
Date: 2012
DOI: 10.1111/J.1445-5994.2011.02628.X
Abstract: Improvements in Aboriginal health have been slow. Research demonstrates ongoing discrimination towards Aboriginal Australians based on race, including in health services, leads to poor health outcomes. Using an eclectic methodology based on observations and discussions with health practitioners experienced in working with Aboriginal patients, this paper identifies how cross-cultural misunderstandings undermine the quality of care to Aboriginal patients in hospital and offers suggestions for improving practice. It also explores the concept of institutional racism and challenges doctors to reflect on their role in perpetuating power imbalances. We argue that physicians and healthcare providers need to do more than just deliver evidence-based interventions, by critically reflecting on their own attitudes to and practices with Aboriginal Australians and work collectively to effect systemic change which creates a more inclusive and safe environment for all people accessing healthcare.
The distribution and determinants of mammographic density measures in Western Australian Aboriginal women
Publisher: Springer Science and Business Media LLC
Date: 28-02-2019
Changing conversations about family violence in regional Western Australia
Publisher: Elsevier BV
Date: 10-2023
Risk of antenatal psychosocial distress in indigenous women and its management at primary health care centres in Australia
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.GENHOSPPSYCH.2015.04.005
Abstract: This study explored the risk of antenatal psychosocial distress (APD) and associated potential factors and examined management aspects of risk of APD in women attending Aboriginal primary health care services in Australia. Audits of medical records of 797 pregnant women from 36 primary health centres in five jurisdictions (NSW, QLD, SA, WA and NT) were undertaken as part of a quality improvement programme. Information collected included mental health assessed by a standard screening tools, enquiry regarding social and emotional well-being (SEWB), depression management (including antidepressant medications) and referral. Around 18% (n=141) of women were at risk of APD based on assessment using a standard screening tool or by SEWB enquiry. There was a significant association between risk of distress and women's life style behaviours (e.g., alcohol, illicit drug use) and health centre characteristics. Of the 141 women, 16% (n= 22) were prescribed antidepressant drugs during pregnancy. A range of nonpharmaceutical mental health interventions were also recorded, including brief intervention of 61% (n=86), counselling of 57% (n=80) and cognitive behaviour therapy of 5% (n=7). About 39% (n=55) of women with APD were referred to external services for consultations with a psychiatrist, psychologist or social worker or to a women's refuge centre. The higher risk of APD associated with women's life style behaviour indicates that the better understanding of mental health in its cultural context is essential.
“The support has been brilliant”
Publisher: Springer Science and Business Media LLC
Date: 24-05-2021
DOI: 10.1186/S12913-021-06535-9
Abstract: Improving health outcomes for Indigenous people by providing person-centred, culturally safe care is a crucial challenge for the health sector, both in Australia and internationally. Many cancer providers and support services are committed to providing high quality care, yet struggle with providing accessible, culturally safe cancer care to Indigenous Australians. Two Australian cancer services, one urban and one regional, were identified as particularly focused on providing culturally safe cancer care for Indigenous cancer patients and their families. The article explores the experiences of Indigenous cancer patients and their families within the cancer services and ascertains how their experiences of care matches with the cancer services’ strategies to improve care. Services were identified as part of a national study designed to identify and assess innovative services for Indigenous cancer patients and their families. Case studies were conducted with a small number of identified services. In-depth interviews were conducted with Indigenous people affected by cancer and hospital staff. The interviews from two services, which stood out as particularly high performing, were analysed through the lens of the patient experience. Eight Indigenous people affected by cancer and 23 hospital staff (Indigenous and non-Indigenous) were interviewed. Three experiences were shared by the majority of Indigenous cancer patients and family members interviewed in this study: a positive experience while receiving treatment at the cancer service a challenging time between receiving diagnosis and reaching the cancer centre and the importance of family support, while acknowledging the burden on family and carers. This article is significant because it demonstrates that with a culturally appropriate and person-centred approach, involving patients, family members, Indigenous and non-Indigenous staff, it is possible for Indigenous people to have positive experiences of cancer care in mainstream, tertiary health services. If we are to improve health outcomes for Indigenous people it is vital more cancer services and hospitals follow the lead of these two services and make a sustained and ongoing commitment to strengthening the cultural safety of their service.
A systems approach to improving timeliness of immunisation
Publisher: Elsevier BV
Date: 06-2009
DOI: 10.1016/J.VACCINE.2009.02.068
Abstract: Timeliness of immunisation is important in achieving a protective effect at the in idual and population levels. Recent international research has highlighted the importance of organisational features of the health system in timely immunisation. This paper reports on an analysis of the availability of records of timely delivery of childhood immunisations in Indigenous primary care services and organisational features of vaccination programs in different jurisdictions in Australia. The findings demonstrate wide variation in recorded timely delivery of immunisations between health centres within and between jurisdictions. Significant deficiencies in the approach to delivery and recording of immunisations appear to be principally related to fragmented systems of delivery, recording and communication between child health and primary care services. Understanding these deficiencies presents opportunities for improving timely immunisation.
Hepatitis B Vaccination
Publisher: Springer Science and Business Media LLC
Date: 1995
DOI: 10.1007/BF03259050
Effectiveness of low‐dose intradermal hepatitis B vaccination: Five years’ experience of primary vaccination
Publisher: AMPCo
Date: 03-1993
Fulfilling prophecy? Sexually transmitted infections and HIV in Indigenous people in Western Australia
Publisher: AMPCo
Date: 08-2005
DOI: 10.5694/J.1326-5377.2005.TB06955.X
Abstract: To compare trends and rates of HIV and sexually transmitted infections in Indigenous and non-Indigenous people of Western Australia. Analysis of WA notification data for chlamydia, gonorrhoea, and primary and secondary syphilis in 2002, and for HIV infections from 1983 to 2002. Rates of HIV and sexually transmitted infection by Indigenous status. In 2002, there were 3046 notifications for chlamydia, 1380 for gonorrhoea and 64 for syphilis. When information on Indigenous status was available, Indigenous people accounted for 41% of chlamydia and 76% of gonorrhoea notifications, with Indigenous:non-Indigenous age-standardised rate ratios of 16 (95% CI, 14-17) and 77 (95% CI, 67-88), respectively. Indigenous people accounted for 90.6% of syphilis notifications (age-standardised Indigenous:non-Indigenous rate ratio, 242 [95% CI, 104-561]). From 1985 to 2002, HIV notification rates for non-Indigenous people in WA declined and rates for Indigenous people increased. From 1994 to 2002, there were 421 notifications of HIV infection in WA residents, 52 (12.4%) in Indigenous people and 369 (87.6%) in non-Indigenous people. Indigenous people accounted for 39% and 6.2% of all notifications in WA females and males, respectively. The Indigenous:non-Indigenous rate ratios were 18 (95% CI, 12-29) for females and 2 (95% CI, 1-3) for males. Indigenous Western Australians are at greater risk of HIV transmission than non-Indigenous people. Strategies to prevent further HIV infection in Indigenous Australians should include control of sexually transmitted infections.
Family planning among people living with HIV in post-conflict Northern Uganda: A mixed methods study
Publisher: Springer Science and Business Media LLC
Date: 20-09-2011
Complexity in disease management: A linked data analysis of multimorbidity in Aboriginal and non-Aboriginal patients hospitalised with atherothrombotic disease in Western Australia
Publisher: Public Library of Science (PLoS)
Date: 14-08-2018
Duration of participation in continuous quality improvement: a key factor explaining improved delivery of Type 2 diabetes services
Publisher: Springer Science and Business Media LLC
Date: 19-11-2014
How accessible are interpreter services to dialysis patients of Non-English Speaking Background?
Publisher: OMICS Publishing Group
Date: 11-2010
DOI: 10.4066/AMJ.2010.175
SURVEILLANCE FOR SEXUALLY TRANSMISSIBLE DISEASES IN VICTORIA, 1983 TO 1992
Publisher: Wiley
Date: 12-02-1994
DOI: 10.1111/J.1753-6405.1994.TB00278.X
Abstract: Surveillance systems have been developed in Victoria to determine trends in sexually transmissible diseases (STDs). Notifications to the Health Department (including laboratory notification since May 1990) have been supplemented by data about strains of Neisseria gonorrhoeae and cultures for Chlamydia trachomatis processed by the Microbiological Diagnostic Unit, enhanced laboratory surveillance of syphilis, and data on genital herpes and genital warts from the Melbourne Sexual Health Centre. During the period under review the incidence of gonorrhoea declined, rapidly at first, and then more slowly. For women, this trend has continued, while gonorrhoea acquired abroad by men has become relatively more important. Since 1988, gonorrhoea in homosexual men has increased, and rectal isolates have increased concurrently, raising concerns about HIV risk behaviour. Cases of syphilis are likely to be ascertained through STD, antenatal and refugee screening, rather than because of symptoms or contact tracing. Chlamydia is a the most common notifiable STD, despite underreporting and underdiagnosis. In 1991, 832 cases were notified, increasing to 1377 in 1992. In 1992, of the 73 cases (65 per cent of notifications) where the doctor identified a risk, 15 per cent was attributed to homosexual contact, and 27.4 per cent to heterosexual exposure. Limitations in the data include inadequate standard case definitions for many STDs, changes in the statutory requirement for notifications in 1990, underreporting, changes in diagnostic and screening patterns, and lack of detailed demographic data. Education of general practitioners is needed to improve diagnosis and notification of chlamydia.
Indigenous Australians Perceptions’ of Physical Activity: A Qualitative Systematic Review
Publisher: MDPI AG
Date: 14-07-2018
Abstract: Given poorer health and higher rates of chronic disease seen in Indigenous populations around the world and the evidence linking exercise with health and wellbeing, recommendations for encouraging and increasing Indigenous people’s participation in physical activity are needed. This paper systematically reviews published qualitative research papers exploring issues related to the perspectives of Indigenous Australians around physical activity. Key terms relevant to attitudes, beliefs, and perceptions of Indigenous Australians on physical activity and sport were explored in 11 electronic bibliographic databases including EMBASE, Medline and Web of Science. Of the 783 studies screened, eight qualitative studies met the selection criteria only one was exclusively undertaken in a rural setting. Four major themes emerged: family and community, culture and environment, sport, and gender differences. Men highlighted sport and going on walkabout as preferred types of physical activity while women preferred family-focused activities and activities and support for women's sport. Several studies found exercise was supported when in the context of family and community but was considered shameful when done only for oneself. Sport was regarded as playing an influential role in bringing communities together. Group, community, or family activities were desired forms of physical activity with the environment they are conducted in of high importance. These findings should inform future research and intervention programs aimed at addressing the physical activity levels of Indigenous Australians and may be relevant to other Indigenous populations.
What is the impact of missing Indigenous status on mortality estimates? An assessment using record linkage in Western Australia
Publisher: Elsevier BV
Date: 08-2009
DOI: 10.1111/J.1753-6405.2009.00403.X
Abstract: The analysis aimed to assess the Indigenous status of an increasing number of deaths not coded with a useable Indigenous status from 1997 to 2002 and its impact on reported recent gains in Indigenous mortality. The Indigenous status of WA death records with a missing Indigenous status was determined based upon data linkage to three other data sources (Hospital Morbidity Database System, Mental Health Information System and Midwives Notification System). Overall, the majority of un-coded cases were assigned an Indigenous status, with 5.9% identified as Indigenous from the M1 series and 7.5% from the M2 series. The significant increase in Indigenous male LE of 5.4 years from 1997 to 2002 decreased to 4.0 and 3.6 years using the M1 and M2 series, respectively, but remained significant. For Indigenous females, the non-significant increase in LE of 1.8 years from 1997 to 2002 decreased to 1.0 and 0.6 years. Furthermore, annual all-cause mortality rates were higher than in the original data for both genders, but the significant decline for males remained. Through data linkage, the increasing proportion of deaths not coded with a useable Indigenous status was shown to impact on Indigenous mortality statistics in Western Australia leading to an overestimate of improvements in life expectancy. Greater attention needs to be given to better identification and recording of Indigenous identifiers if real improvements in health status are to be demonstrated. A system that captures an in idual's Indigenous status once and is reflected in all health and administrative data systems needs consideration within Australia.
Confronting uncomfortable truths: Receptivity and resistance to Aboriginal content in midwifery education
Publisher: Informa UK Limited
Date: 12-2013
DOI: 10.5172/CONU.2013.46.1.113
Abstract: The emotional responses of students undertaking a new, compulsory unit on Indigenous cultures and health were investigated as part of a broader study looking at culturally secure practice in midwifery education and service provision for Aboriginal women. Classroom observations were conducted on a first year midwifery cohort from July to October 2012 and students completed 'before and after' questionnaires. A spectrum of emotional responses was identified and found to be consistent with studies of medical student exposure to Aboriginal content. While stereotypes were challenged and perceptions altered as a result of the content, issues surrounding racism remained unresolved, with some students expressing dismay at the attitudes of their peers. This study confirmed the need for content on Aboriginal health and cultures to extend beyond one unit in a course. Learning and knowledge must be carefully integrated and developed to maximise understanding and ensure that unresolved issues are addressed.
Science's great tragedy
Publisher: Elsevier BV
Date: 06-1998
DOI: 10.1111/J.1467-842X.1998.TB01401.X
Abstract: Cas7-11 is a Type III-E CRISPR Cas effector that confers programmable RNA cleavage and has potential applications in RNA interference. Cas7-11 encodes a single polypeptide containing four Cas7- and one Cas11-like segments that obscures the distinction between the multi-subunit Class 1 and the single-subunit Class-2 CRISPR Cas systems. We report a cryo-EM (cryo-electron microscopy) structure of the active Cas7-11 from Desulfonema ishimotonii (DiCas7-11) that reveals the molecular basis for RNA processing and interference activities. DiCas7-11 arranges its Cas7- and Cas11-like domains in an extended form that resembles the backbone made up by four Cas7 and one Cas11 subunits in the multi-subunit enzymes. Unlike the multi-subunit enzymes, however, the backbone of DiCas7-11 contains evolutionarily different Cas7 and Cas11 domains, giving rise to their unique functionality. The first Cas7-like domain nearly engulfs the last 15 direct repeat nucleotides in processing and recognition of the CRISPR RNA, and its free-standing fragment retains most of the activity. Both the second and the third Cas7-like domains mediate target RNA cleavage in a metal-dependent manner. The structure and mutational data indicate that the long variable insertion to the fourth Cas7 domain has little impact on RNA processing or targeting, suggesting the possibility for engineering a compact and programmable RNA interference tool.
Risk behaviours for blood-borne viruses in a Victorian prison
Publisher: SAGE Publications
Date: 03-1996
DOI: 10.1177/000486589602900102
Abstract: Hepatitis B and C viruses continue to spread in Victorians at risk of incarceration. We have therefore studied risk behaviours for these infections among 51 prisoners with a history of injecting drug use (IDU) in the central Victorian prison 33 were also interviewed about their tattooing experience. Half had injected inside prison in the preceding month, an average of 5.5 times, suggesting up to 9,000 injections p.a. in this prison. Almost all shared inadequately disinfected equipment, with no way of knowing how many had used it before. First sharing of injecting equipment had been in prison for a fifth. Almost 90% were HCV infected. Almost all had been tattooed, with 60% having had at least one while in prison, while five reported more than 50 tattoos in prison. Urgent consideration of methods to decrease these risks is necessary, including assessment of the feasibility of controversial strategies such as needle and syringe exchange programs and the provision of sterile tattooing equipment.
Integrated Clinical Decision Support Systems Promote Absolute Cardiovascular Risk Assessment: An Important Primary Prevention Measure in Aboriginal and Torres Strait Islander Primary Health Care
Publisher: Frontiers Media SA
Date: 04-09-2017
Antenatal emotional wellbeing screening in Aboriginal and Torres Strait Islander primary health care services in Australia
Publisher: Informa UK Limited
Date: 12-2013
DOI: 10.5172/CONU.2013.46.1.73
Abstract: The aim of this study was to examine the extent to which antenatal emotional wellbeing (EW) assessments are undertaken in primary health care (PHC) centres and factors associated with completion of EW screening. Medical records of 797 pregnant women from 36 PHC centres in five states (NSW, QLD, SA, WA and NT) were audited. Overall, 85% of the women were Aboriginal. The proportion of women with documented screening for EW varied from 5 to 38% between states (mean 17%). Aboriginal women were four times more likely (adjusted Odds Ratio (OR = 4.13, 95% CI = 2.46-6.92) to not be screened for antenatal EW than non-Aboriginal women. Aboriginality, <4 antenatal visits, absence of an antenatal and birth care plan, and lack of counselling on financial support were independently linked with no screening of EW. Provision of training for health service providers and further research on appropriate screening tools for Aboriginal women are needed to help redress this gap.
Developing the future rural nursing workforce: report on a nursing roundtable
Publisher: Elsevier BV
Date: 08-2020
Key features of palliative care service delivery to Indigenous peoples in Australia, New Zealand, Canada and the United States: a comprehensive review
Publisher: Springer Science and Business Media LLC
Date: 08-05-2018
Respect Is Central: A Critical Review of Implementation Frameworks for Continuous Quality Improvement in Aboriginal and Torres Strait Islander Primary Health Care Services
Publisher: Frontiers Media SA
Date: 16-07-2021
DOI: 10.3389/FPUBH.2021.630611
Abstract: Background: Primary health care (PHC) services are complex systems, shaped by an interplay of factors at in idual, organisational and broader system levels. For Aboriginal and Torres Strait Islander PHC services, closer relationships with the people they serve, local knowledge of community, and cultural awareness are critical. Continuous quality improvement (CQI) has proven to be an effective process for identification of priority issues in health care delivery and for instigating the design, implementation and evaluation of improvement interventions in these settings. However, wide-scale variation in care quality persists partly due to the mismatch between CQI interventions and context. Methods: This critical review of implementation frameworks for CQI in Aboriginal and Torres Strait Islander primary health care was conducted in two phases: (1) a review of primary published implementation frameworks used in PHC contexts, and (2) a comparison of key features of these frameworks with quality concepts identified by high-improving Aboriginal and Torres Strait Islander PHC services in remote Australia. Results: We found nine primary implementation frameworks previously used in PHC contexts guiding interventions within and between macro (broader contextual) level meso (health service) level and micro (community and inter-personal) level systems. There was commonality between these frameworks and key quality concepts in Aboriginal and Torres Strait Islander PHC. However, none of the frameworks covered all concepts with rare consideration of communities driving health improvement, two-way learning (integrating cultural knowledge into healthcare provision), and caring staff—engendering trusting relationships with community enacted through respect. Conclusion: Respect, as a secret essence, privileges the importance of culture, and is an essential element of CQI implementation frameworks for positive change in Aboriginal and Torres Strait Islander PHC services. It is essential to work with communities to design workforce models that grow a caring stable workforce to ensure improvements in quality of care that are effective for their context.
A systematic review of factors influencing fertility desires and intentions among people living with HIV/AIDS: Implications for policy and service delivery
Publisher: Springer Science and Business Media LLC
Date: 28-03-2009
DOI: 10.1007/S10461-009-9537-Y
Abstract: With availability of antiretroviral treatments, HIV is increasingly recognised as a chronic disease people live with for many years. This paper critically reviews the current literature on fertility desires and reproductive intentions among people living with HIV/AIDS (PLHIV) and critiques the theoretical frameworks and methodologies used. A systematic review was conducted using electronic databases: ISI Web of Knowledge, Science Direct, Proquest, Jstor and CINAHL for articles published between 1990 and 2008. The search terms used were fertility desire, pregnancy, HIV, reproductive decision making, reproductive intentions, motherhood, fatherhood and parenthood. Twenty-nine studies were reviewed. Fertility desires were influenced by a myriad of demographic, health, stigma-associated and psychosocial factors. Cultural factors were also important, particularly in Sub-Saharan Africa and Asia. Future research that examines fertility desires among PLHIV should include cultural beliefs and practices in the theoretical framework in order to provide a holistic understanding and to enable development of services that meet the reproductive needs of PLHIV.
The effect of general practice contact on cancer stage at diagnosis in Aboriginal and non-Aboriginal residents of New South Wales
Publisher: Springer Science and Business Media LLC
Date: 17-06-2023
DOI: 10.1007/S10552-023-01727-6
Abstract: Older age, risks from pre-existing health conditions and socio-economic disadvantage are negatively related to the prospects of an early-stage cancer diagnosis. With older Aboriginal Australians having an elevated prevalence of these underlying factors, this study examines the potential for the mitigating effects of more frequent contact with general practitioners (GPs) in ensuring local-stage at diagnosis. We compared the odds of local vs. more advanced stage at diagnosis of solid tumours according to GP contact, using linked registry and administrative data. Results were compared between Aboriginal ( n = 4,084) and non-Aboriginal ( n = 249,037) people aged 50 + years in New South Wales with a first diagnosis of cancer in 2003–2016. Younger age, male sex, having less area-based socio-economic disadvantage, and fewer comorbid conditions in the 12 months before diagnosis (0–2 vs. 3 +), were associated with local-stage in fully-adjusted structural models. The odds of local-stage with more frequent GP contact (14 + contacts per annum) also differed by Aboriginal status, with a higher adjusted odds ratio (aOR) of local-stage for frequent GP contact among Aboriginal people (aOR = 1.29 95% CI 1.11–1.49) but not among non-Aboriginal people (aOR = 0.97 95% CI 0.95–0.99). Older Aboriginal Australians diagnosed with cancer experience more comorbid conditions and more socioeconomic disadvantage than other Australians, which are negatively related to diagnosis at a local-cancer stage. More frequent GP contact may act to partly offset this among the Aboriginal population of NSW.
Better prevention and management of heart failure in Aboriginal Australians
Publisher: AMPCo
Date: 03-2015
DOI: 10.5694/MJA14.01393
Erasing Fear Memories with Extinction Training: Figure 1.
Publisher: Society for Neuroscience
Date: 10-11-2010
DOI: 10.1523/JNEUROSCI.4268-10.2010
Abstract: Decades of behavioral studies have confirmed that extinction does not erase classically conditioned fear memories. For this reason, research efforts have focused on the mechanisms underlying the development of extinction-induced inhibition within fear circuits. However, recent studies in rodents have uncovered mechanisms that stabilize and destabilize fear memories, opening the possibility that extinction might be used to erase fear memories. This symposium focuses on several of these new developments, which involve the timing of extinction training. Extinction-induced erasure of fear occurs in very young rats, but is lost with the development of perineuronal nets in the amygdala that render fear memories impervious to extinction. Moreover, extinction administered during the reconsolidation phase, when fear memory is destabilized, updates the fear association as safe, thereby preventing the return of fear, in both rats and humans. The use of modified extinction protocols to eliminate fear memories complements existing pharmacological strategies for strengthening extinction.
Cardiovascular risk factors for people with mental illness
Publisher: SAGE Publications
Date: 04-2001
DOI: 10.1046/J.1440-1614.2001.00877.X
Abstract: Objective: The objective of this study was to document the prevalence of risk factors for cardiovascular disease among people with chronic mental illness. Method: A cross-sectional survey was conducted of 234 outpatients attending a community mental health clinic in the North-western Health Care Network in Melbourne, Australia. Prevalence of smoking, alcohol consumption, body mass index, hypertension, salt intake, exercise and history of hypercholesterolemia was assessed. Results: Compared with a community s le, the mentally ill had a higher prevalence of smoking, overweight and obesity, lack of moderate exercise, harmful levels of alcohol consumption and salt intake. No differences were found on hypertension. Men, but not women, with mental illness were less likely to undertake cholesterol screening. Conclusions: Psychiatric outpatients have a high prevalence of cardiovascular risk factors which may account for the higher rate of cardiovascular mortality among the mentally ill. Further research is needed to trial and evaluate interventions to effectively modify risk factors in this vulnerable population.
Complex impact of remoteness on the incidence of myocardial infarction in Aboriginal and non-Aboriginal people in Western Australia
Publisher: Wiley
Date: 26-11-2012
DOI: 10.1111/J.1440-1584.2012.01314.X
Abstract: To determine the impact of remoteness on Aboriginal and non-Aboriginal myocardial infarction incidence rates in men and women of different ages. Descriptive study. Western Australia. Incident cases of myocardial infarction in Western Australia from 2000-2004 identified from person-linked files of hospital and mortality records. Analysis was undertaken for Aboriginal and non-Aboriginal populations, separately and combined, by broad age group, sex and remoteness. Incidence of myocardial infarction. In the combined analysis, age-standardised incidence was significantly higher for men in very remote areas (rate ratio 1.31: 95% confidence interval (CI), 1.19-1.45) and in women in both regional (rate ratio 1.12: 95% CI, 1.01-1.20) and very remote (rate ratio 2.05: 95% CI, 1.75-2.41) areas. Aboriginal rates were substantially higher than non-Aboriginal rates in all substrata. Compared with metropolitan people, regional Aboriginal men and very remote non-Aboriginal men aged 25-54 years had significantly higher incidence rates. For the remaining rural strata, there was either no geographical disadvantage or inconclusive findings. Non-metropolitan disadvantage in myocardial infarction rates is confirmed in regional areas and women in very remote areas. This disadvantage is partly explained by the high rates in Aboriginal people. Non-metropolitan dwellers are not uniformly disadvantaged, reflecting the interplay of the many factors contributing to the complex relationship between myocardial infarction incidence and sex, age, Aboriginality and residence. Aboriginal Western Australians in all regions and young non-Aboriginal men living in very remote areas need to be targeted to reduce disparities in myocardial infarction.
The epidemiology of notified genital Chlamydia trachomatis infection in Victoria, Australia: a survey of diagnosing providers
Publisher: SAGE Publications
Date: 06-1997
Impact of policy support on uptake of evidence-based continuous quality improvement activities and the quality of care for Indigenous Australians: a comparative case study
Publisher: BMJ
Date: 10-2017
DOI: 10.1136/BMJOPEN-2017-016626
Abstract: To examine the impact of state/territory policy support on (1) uptake of evidence-based continuous quality improvement (CQI) activities and (2) quality of care for Indigenous Australians. Mixed-method comparative case study methodology, drawing on quality-of-care audit data, documentary evidence of policies and strategies and the experience and insights of stakeholders involved in relevant CQI programmes. We use multilevel linear regression to analyse jurisdictional differences in quality of care. Indigenous primary healthcare services across five states/territories of Australia. 175 Indigenous primary healthcare services. A range of national and state/territory policy and infrastructure initiatives to support CQI, including support for applied research. (i) Trends in the consistent uptake of evidence-based CQI tools available through a research-based CQI initiative (the Audit and Best Practice in Chronic Disease programme) and (ii) quality of care (as reflected in adherence to best practice guidelines). Progressive uptake of evidence-based CQI activities and steady improvements or maintenance of high-quality care occurred where there was long-term policy and infrastructure support for CQI. Where support was provided but not sustained there was a rapid rise and subsequent fall in relevant CQI activities. Health authorities should ensure consistent and sustained policy and infrastructure support for CQI to enable wide-scale and ongoing improvement in quality of care and, subsequently, health outcomes. It is not sufficient for improvement initiatives to rely on local service managers and clinicians, as their efforts are strongly mediated by higher system-level influences.
Cultural respect in midwifery service provision for Aboriginal women: longitudinal follow-up reveals the enduring legacy of targeted program initiatives
Publisher: Springer Science and Business Media LLC
Date: 25-11-2020
DOI: 10.1186/S12939-020-01325-X
Abstract: Culturally competent maternity care provision to Aboriginal and Torres Strait Islander women was identified as a priority area by Australia’s National Maternity Services Plan in 2011. While midwifery programs responded by including core Indigenous content and community placements in curricula, little is known about whether knowledge learned, and insights gained in response to these initiatives have endured and been applied in clinical practice. This follow-up study explores the impact of a compulsory Indigenous unit and a remote clinical placement on two cohorts of non-Indigenous midwives who were participants in an earlier 2012–14 study. Fourteen non-Indigenous participants who were either students or recent graduates in 2012–14 were located and re-interviewed in 2019–20. In-depth interviews based on a semi-structured interview guide were conducted by telephone or face-to face recordings were transcribed and thematically analysed using standard qualitative procedures. Exposure to Indigenous content and settings during training had an enduring impact on participants’ midwifery practice most felt better prepared to provide culturally safe care, build respectful relationships and advocate for improved services for Aboriginal women. Despite this positive legacy, they also expressed apprehension about causing offence and recognised their own knowledge deficits with regard to Aboriginal cultural practices. Organisational constraints, including restrictions on the number of family members accompanying a birthing mother were identified as barriers to optimal care some positive organisational initiatives were also described. This follow-up study provides encouraging evidence that well-designed and delivered Indigenous content and community placement opportunities in midwifery programs can have a lasting impact on service provision to Aboriginal women, contribute to a more informed, empathetic and culturally competent maternity workforce and help catalyse health service changes towards more culturally safe care.
An analysis of reporting of sexually transmissible infections in indigenous Australians in mainstream Australian newspapers
Publisher: CSIRO Publishing
Date: 2007
DOI: 10.1071/SH06010
Abstract: Background: To investigate the nature of, and trends in, Australian print media coverage of sexually transmissible infections (STI) in indigenous Australians. Methods: Newspaper articles from January 1986 to June 2004 were downloaded from the Factiva database. Of 164 articles examined based on our search criteria, 100 were included for analysis. An assessment of the tone and content of each article was made by two reviewers, and data were entered and analysed using EpiInfo (Centers for Disease Control and Prevention, Atlanta, GA) Results: Most articles were serious (89%), matter of fact and information dense (50%) and critical of the subject of the article (44%). Of the articles that were emotive, 78% evoked a sense of shock or frustration. The stimulus for the article was government related in 65% a purely academic opinion was presented in 82% and only one viewpoint was presented in 73%. The papers publishing the greatest number of articles were The Sydney Morning Herald (31%) and The Age (18%). From 1996 there was an increase in the number of articles and improvements in the voice given to indigenous informants. This may reflect initiatives in journalism education and release of a protocol on how STI in indigenous communities should be reported. Conclusion: Overall, the style of reporting was heavy, dry and critical, written in an academic style and failed to critically examine or challenge government initiatives. The potential for print media to educate the general public is poorly utilised. Further exploration of how sensitive indigenous issues can be presented to avoid stereotyping, stigma and nihilism, while initiating more effective action, is needed.
Gaining a 'proper sense' of what happens out there: an 'Academic Bush Camp' to promote rural placements for students
Publisher: Wiley
Date: 29-06-2016
DOI: 10.1111/AJR.12199
Abstract: Undergraduates who undertake rural placements often choose a rural career. Reluctance from universities to send students to rural settings limits placement numbers. The Western Australian Centre for Rural Health (WACRH) invited allied health and nursing academics and clinical placement coordinators from Western Australian (WA) universities to an Academic Bush C . Based on situated learning theory, this c modelled student programs through experiential learning and structured workshops. It aimed to build relationships and showcase innovative rural learning opportunities. To build relationships and showcase innovative rural learning opportunities. An evaluation of a residential c based on situated learning theory. The c stated and finished in Geraldton, WA and was centered in Mt Magnet, WA a remote town 600 kilometres northeast of Perth. WACRH invited allied health and nursing academics and clinical placement coordinators from Western Australian (WA) universities. This c modelled student programs through experiential learning and structured workshops. Online pre- and post-c questionnaires included open-ended questions and questions on a 5-point Likert scale. Responses were analysed in SPSS 22 using descriptive statistics and Wilcoxon signed-rank test. Follow-up phone interviews six months later assessed longer-term reflections and changes in student placement practice. The main outcome measure was whether the c met participants' expectations, and their knowledge about and interest in WACRH's programs. Twelve academics from five WA universities and seven health disciplines attended. Nine had previously lived or worked rurally. The c met participants' expectations and all would recommend the opportunity to a colleague. Many valued the interaction with community and clinical placement partners and would have preferred more of this. The c increased awareness of WACRH's programs and benefits of longer rural placements and a service-learning environment. Six months later, participants' familiarity with WACRH's placement model, supports and staff had led to an enhanced willingness to place students. Rural academics can influence rural placement intentions by demonstrating the infrastructure, learning and academic support available. A c experience increases metropolitan academics' awareness of rural placement programs and willingness to encourage student participation. Participants with rural backgrounds appeared more receptive to rural learning possibilities.
Exploring Readiness for Change: Knowledge and Attitudes towards Family Violence among Community Members and Service Providers Engaged in Primary Prevention in Regional Australia
Publisher: MDPI AG
Date: 30-10-2019
Abstract: Community efforts at the primary prevention of family violence (FV) involve changing values, structures and norms that support gender inequality. This study examines the attitudes of a group of highly engaged community leaders and service providers involved in FV primary prevention in Geraldton, a small city in regional Western Australia. The outcomes of focus group discussions were mapped against a readiness for change model. Despite considerable involvement in discussions of FV prevention over time, the readiness level of these engaged community members for taking leadership roles in the prevention strategy were between pre-planning and preparation stages, although some in iduals’ understanding of the drivers of FV and readiness for implementing change was higher. Key areas for further education are the role of gender inequality as the primary driver of FV, particularly rigid gender roles and men’s control of decision making, and the role of alcohol and drugs as reinforcers but not primary drivers of FV.
Clinical decision support software for diabetic foot risk stratification: development and formative evaluation
Publisher: Springer Science and Business Media LLC
Date: 12-2015
HIV in the Mentally Ill
Publisher: SAGE Publications
Date: 04-1996
DOI: 10.3109/00048679609076094
Abstract: Objective: To review the published literature in relation to prevalence of HIV infection and risk behaviours for HIV among the mentally ill to assist in the development of appropriate strategies for public health policy, surveillance and clinical management of HIV and HIV risk in these groups. Method: A search of published literature was carried out using ‘Medline’, in association with following up appropriate papers cited in the References of journals identified. Results: The North American literature shows an increased risk of HIV infection in psychiatric patients receiving treatment in both inpatient or community settings. HIV infection is associated with a number of risk behaviours, particularly male homosexual sex and injecting drug use, and being the sexual partner of a person with a history of these. Impulsivity, high levels of sexual activity during acute exacerbations of psychiatric illness, poor skills at negotiating safe sex, homelessness and drug abuse are all risk behaviours common among those affected by some mental illnesses. The mentally ill also have a comparatively poorer knowledge of HIV/AIDS. There is a dearth of published Australian data addressing the question of HIV seroprevalence or risk in the mentally ill. Although there has been development and implementation of HIV risk-reduction programs overseas, the development and evaluation of any programs in Australia has not been published. Conclusions: Arguably, Australia has developed a comprehensive program of national surveillance for HIV infection and has been relatively successful in its response to the HIV epidemic, with the high rates of infection in the early to mid-1980s substantially reduced to around 600 new diagnoses per year. However, while risk behaviours which exposed those infected with the virus are recorded, underlying conditions which predispose them to these behaviours are not. Nevertheless, there is HIV infection amongst mentally ill and intellectually disabled people in Australia. Examination of the North American experience reveals opportunities to prevent a high rate of HIV infection in those with mental illness in Australia. Such a program would require adequate risk behaviour assessment, appropriate diagnostic testing and management, and development of specific educational interventions which are properly evaluated to ensure their effectiveness.
Australian cancer services
Publisher: Elsevier BV
Date: 12-2018
Abstract: To examine where Indigenous Australians undergo cancer treatment and learn about specific service initiatives that have been implemented to meet their needs. Public cancer treatment centres across Australia were invited to participate in an online survey about various characteristics of their centre, including the type of service provided, Indigenous patient numbers and policy, and implementation of Indigenous-specific initiatives. Surveys were completed for 58 of 125 public cancer treatment centres. Almost half (47%) of the services saw more than 10 Indigenous patients per year, although Indigenous patients generally represented a small minority of patients. The most commonly reported initiatives were "having links with Indigenous health organisations in the community" (74% of services), "making a dedicated effort to address the needs of Indigenous patients" (69%) and proactively "creating partnerships with Indigenous communities and health organisations" (69%). The majority of respondents indicated that they were working to meet the needs of Indigenous patients and were interested in learning strategies from others to improve their services. More work is needed to describe and evaluate the specific initiatives that have been implemented. Implications for public health: Information from this study can assist cancer service providers to identify gaps in current services, plan new service delivery initiatives and ultimately improve Indigenous cancer outcomes.
Disparities experienced by Aboriginal compared to non-Aboriginal metropolitan Western Australians in receiving coronary angiography following acute ischaemic heart disease: the impact of age and comorbidities
Publisher: Springer Science and Business Media LLC
Date: 21-10-2014
Providing health information for culturally and linguistically diverse women: priorities and preferences of new migrants and refugees
Publisher: Wiley
Date: 08-2013
DOI: 10.1071/HE12919
Incidence of and Case Fatality Following Acute Myocardial Infarction in Aboriginal and Non-Aboriginal Western Australians (2000-2004): A Linked Data Study
Publisher: Elsevier BV
Date: 12-2010
DOI: 10.1016/J.HLC.2010.08.009
Abstract: Despite Coronary Heart Disease exacting a heavy toll among Aboriginal Australians, accurate estimates of its epidemiology are limited. This study compared the incidence of acute myocardial infarction (AMI) and 28-day case fatality (CF) among Aboriginal and non-Aboriginal Western Australians aged 25-74 years from 2000-2004. Incident (AMI hospital admission-free for 15 years) AMI events and 28-day CF were estimated using person-based linked hospital and mortality data. Age-standardised incidence rates and case fatality percentages were calculated by Aboriginality and sex. Of 740 Aboriginal and 6933 non-Aboriginal incident events, 208 and 2352 died within 28 days, respectively. The Aboriginal age-specific incidence rates were 27 (males) and 35 (females) times higher than non-Aboriginal rates in the 25-29 year age group, decreasing to 2-3 at 70-74 years. The male:female age-standardised incidence rate ratio was 2.2 in Aboriginal people 25-54 years compared with 4.5 in non-Aboriginal people. Aboriginal age-standardised CF percentages were 1.4 (males) and 1.1 (females) times higher at age 25-54 years and 1.5 times higher at age 55-74 years. These data suggest higher CF and, more importantly, AMI incidence contribute to the excess ischaemic heart disease mortality in Aboriginal Western Australians. The poorer cardiovascular health in Aboriginal women, particularly in younger age groups, should be investigated.
Expert consensus on the attributes and competencies required for rural and remote junior physicians to work effectively in isolated indonesian communities
Publisher: Springer Science and Business Media LLC
Date: 09-08-2023
DOI: 10.1007/S10459-023-10275-2
Abstract: Indonesian physicians working in rural and remote areas must be equipped not only with generic competencies but also with the attributes and skills necessary to provide health care services without compromising quality. This study sought to reach a consensus on the attributes and competencies that are viewed as essential and important for working effectively as an early career doctor in rural and remote practice in Indonesia. A two-round Delphi study was conducted by reference to 27 consenting physicians working in rural and remote Indonesia. Forty-three items covering 9 attributes and 34 competencies were sent to these physicians to be rated on a Likert scale ranging from 1 to 5 in terms of their importance for effective rural and remote practice. Nine attributes and 29 competencies progressed to Round 2. All nine attributes and 29 competencies were identified as essential or important for junior physicians’ ability to be effective in their practice. The essential attributes included professional quality related to prioritising the rural community. The essential competencies included medical skills, professional behaviour, interprofessional skills, health promotion and connection to the rural community. The consensus thus reached on these essential and important attributes and competencies can inform curriculum development for the undergraduate and postgraduate training of junior rural and remote physicians.
Responses of Aboriginal and Torres Strait Islander Primary Health-Care Services to Continuous Quality Improvement Initiatives
Publisher: Frontiers Media SA
Date: 21-01-2016
Determinants and Gaps in Preventive Care Delivery for Indigenous Australians: A Cross-Sectional Analysis
Publisher: Frontiers Media SA
Date: 10-03-2016
Selecting instruments for assessing psychological wellbeing in Afghan and Kurdish refugee groups
Publisher: Springer Science and Business Media LLC
Date: 08-09-2010
Risk factors associated with hepatocellular carcinoma notified to the Anti-Cancer Council of Victoria in 1991-1992
Publisher: Elsevier BV
Date: 10-1997
DOI: 10.1111/J.1467-842X.1997.TB01767.X
Abstract: The study aimed to estimate the prevalence of risk factors for liver disease, particularly hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, in a population-based series of hepatocellular carcinoma, and to assess the feasibility of retrospective surveys in determining risk factors for hepatocellular carcinoma. A survey of all cases of hepatocellular carcinoma diagnosed in 1991 and 1992 documented the high contribution of alcoholic cirrhosis, particularly in Australian-born men. Low levels of testing for HBV and HCV made their contribution to hepatocellular carcinoma uncertain. No cases of hepatocellular carcinoma due to HBV or HCV were reported in Australian-born subjects. Higher rates of HBV carriage in those tested were found in Asian and Mediterranean immigrants. Testing for HCV was known to have occurred for less than a quarter of subjects, and assessment for multiple aetiological risk factors was rare. The burgeoning epidemic of HCV will require improved surveillance for the sequelae of long-term infection. Satisfactory surveillance will require cooperation from clinicians in regard to the completeness of medical records and adequate resources for cancer registries to supplement their passive reporting system with exposure data.
Health promotion resources for Aboriginal people: lessons learned from consultation and evaluation of diabetes foot care resources
Publisher: CSIRO Publishing
Date: 2010
DOI: 10.1071/HE10064
Abstract: Despite the startling age specific rate ratio for utations in 25-49 year olds of, 41.25 for knee utations and 27.5 for toe/foot utations for Aboriginal/non-Aboriginal people, there are no diabetes foot care education brochures or health promotion media available free of charge for Aboriginal people. This study consulted Aboriginal people about existing and potential resources for education on foot care. An Aboriginal and non-Aboriginal interviewer conducted six focus group discussions with a total of 60 Aboriginal people including Elders, community members, health workers, students and nurses. Focus groups discussed which materials, media and foot care messages worked best to communicate diabetes foot care messages. Participants were unequivocal in their preference for real pictures of foot problems rather than cartoons, clearly identifying a superior existing educational resource from the Indigenous Diabetic Foot Program. There was minimal support for many existing media and foot care messages. Participants preferred to develop their own messages and selected utilitarian media that would be used by all members of the Aboriginal community. We recommend the delivery of the Indigenous Diabetic Foot Program in Western Australia. Consultation and involvement of Aboriginal people was consistent with Aboriginal peoples' preferred style of conversation and inclusion and allowed the target audience to determine the end product for use in education and health promotion.
‘Connecting tracks’: exploring the roles of an Aboriginal women's cancer support network
Publisher: Hindawi Limited
Date: 22-06-2016
DOI: 10.1111/HSC.12261
Abstract: Aboriginal Australians are at higher risk of developing certain types of cancer and, once diagnosed, they have poorer outcomes than their non-Aboriginal counterparts. Lower access to cancer screening programmes, deficiencies in treatment and cultural barriers contribute to poor outcomes. Additional logistical factors affecting those living in rural areas compound these barriers. Cancer support groups have positive effects on people affected by cancer however, there is limited evidence on peer-support programmes for Aboriginal cancer patients in Australia. This paper explores the roles played by an Aboriginal women's cancer support network operating in a regional town in Western Australia. Data were collected through semi-structured interviews with 24 participants including Aboriginal and mainstream healthcare service providers, and network members and clients. Interviews were audiotaped and transcribed verbatim. Transcripts were subjected to inductive thematic analysis. Connecting and linking people and services was perceived as the main role of the network. This role had four distinct domains: (i) facilitating access to cancer services (ii) fostering social interaction (iii) providing a culturally safe space and (iv) building relationships with other agencies. Other network roles included providing emotional and practical support, delivering health education and facilitating engagement in cancer screening initiatives. Despite the network's achievements, unresolved tensions around role definition negatively impacted on the working relationship between the network and mainstream service providers, and posed a threat to the network's sustainability. Different perspectives need to be acknowledged and addressed in order to build strong, effective partnerships between service providers and Aboriginal communities. Valuing and honouring the Aboriginal approaches and expertise, and adopting an intercultural approach are suggested as necessary to the way forward.
Measuring for primary prevention: An online survey of local community perspectives on family and domestic violence in regional Australia
Publisher: Public Library of Science (PLoS)
Date: 10-04-2023
DOI: 10.1371/JOURNAL.PONE.0284302
Abstract: Family and domestic violence, encompassing erse behaviours including physical, sexual, emotional and financial abuse, is endemic worldwide and has multiple adverse health and social consequences. Principal drivers include traditional gender values that disempower women. Changing these is a key prevention strategy. In Australia, high-quality national surveys provide data on public perspectives concerning family and domestic violence but may not capture community-level ersity. As part of a project for primary prevention family and domestic violence in outer regional Australia, our aims were to develop and administer a questionnaire-based survey suitable for the local community encompassing knowledge about, attitudes towards, and personal experiences of family and domestic violence, to describe and to investigate the theoretical (factor) structure and local socio-demographic predictors of responses, and to determine the extent to which the survey findings are locally distinctive. The online community survey for local residents (≥15 years), comprised items on respondents’ sociodemographic characteristics plus questions abridged from pre-existing national instruments on knowledge about, attitudes towards, and personal experiences of family and domestic violence. Responses were rake-weighted to correct census-ascertained s le imbalance and investigated using exploratory factor analysis, with sociodemographic predictors determined using multiple linear regression and dominance analysis. Among 914 respondents, males (27.0%), those from age-group extremes, and less-educated persons were underrepresented. Familiarity with erse family and domestic violence behaviours was high among all subgroups. Poorer knowledge of the FDV behaviour continuum and attitudes supporting traditional gender roles and FDV were disproportionately evident among males, older respondents and those with lower education levels. Both the factor structure of extracted composite measures reflecting community perspectives and sociodemographic predictors of responses generally aligned with patterns evident in national data. Local reinforcement of existing nationwide findings on community understanding of and attitudes towards family and domestic violence provides salience for targeted interventions.
Systematic review of resilience-enhancing, universal, primary school-based mental health promotion programs
Publisher: Springer Science and Business Media LLC
Date: 05-07-2018
Collaborative data familiarisation and quality assessment
Publisher: SAGE Publications
Date: 27-03-2021
Abstract: Data quality is fundamental to the integrity of quantitative research. The role of external researchers in data quality assessment (DQA) remains ill-defined in the context of secondary use for research of large, centrally curated health datasets. In order to investigate equity of palliative care provided to Indigenous Australian patients, researchers accessed a now-historical version of a national palliative care dataset developed primarily for the purpose of continuous quality improvement. (i) To apply a generic DQA framework to the dataset and (ii) to report the process and results of this assessment and examine the consequences for conducting the research. The data were systematically examined for completeness, consistency and credibility. Data quality issues relevant to the Indigenous identifier and framing of research questions were of particular interest. The dataset comprised 477,518 records of 144,951 patients (Indigenous N = 1515 missing Indigenous identifier N = 4998) collected from participating specialist palliative care services during a period (1 January 2010–30 June 2015) in which data-checking systems underwent substantial upgrades. Progressive improvement in completeness of data over the study period was evident. The data were error-free with respect to many credibility and consistency checks, with anomalies detected reported to data managers. As the proportion of missing values remained substantial for some clinical care variables, multiple imputation procedures were used in subsequent analyses. In secondary use of large curated datasets, DQA by external researchers may both influence proposed analytical methods and contribute to improvement of data curation processes through feedback to data managers.
Confusion and anxiety following breast density notification
Publisher: MDPI AG
Date: 30-03-2020
DOI: 10.3390/JCM9040955
Abstract: In the absence of evidence-based screening recommendations for women with dense breasts, it is important to know if breast density notification increases women’s anxiety. This study describes psychological reactions and future screening intentions of women attending a public mammographic screening program in Western Australia. Two-thirds of notified women indicated that knowing their breast density made them feel informed, 21% described feeling anxious, and 23% confused. Of the notified women who reported anxiety, 96% intended to re-screen when due (compared to 91% of all notified women and 93% of controls p = 0.007 and p 0.001, respectively). In summary, reported anxiety (following breast density notification) appears to increase women’s intentions for future screening, not the reverse.
Delivery of child health services in Indigenous communities: implications for the federal government's emergency intervention in the Northern Territory
Publisher: AMPCo
Date: 05-2008
DOI: 10.5694/J.1326-5377.2008.TB01806.X
Abstract: To describe delivery of child health services in Australian Aboriginal communities, and to identify gaps in services required to improve the health of Aboriginal children. Cross-sectional baseline audit for a quality improvement intervention. 297 children aged at least 3 months and under 5 years in 11 Aboriginal communities in the Northern Territory, Far West New South Wales and Western Australia in 2006. Adherence to guideline-scheduled services including clinical examinations, brief interventions or advice on health-related behaviour and risks, and enquiry regarding social conditions and recorded follow-up of identified problems. Documentation of delivery of specific clinical examinations (26%-80%) was relatively good, but was poorer for brief interventions or advice on health-related behaviour and risks (5%-36%) and enquiry regarding social conditions (3%-11%). Compared with children in Far West NSW and WA, those attending NT centres were significantly more likely to have a record of growth faltering, underweight, chronic ear disease, anaemia, or chronic respiratory disease (P < 0.005). Only 11%-13% of children with identified social problems had an assessment report on file. An action plan was documented for 22% of children with growth faltering and 13% with chronic ear disease 43% of children with chronic respiratory disease and 31% with developmental delay had an assessment report on file. Existing systems are not providing for adequate follow-up of identified medical and social problems for children living in remote Aboriginal communities development of systems for immediate and longer-term sustainable responses to these problems should be a priority. Without effective systems for follow-up, screening children for disease and adverse social circumstances will result in little or no benefit.
A comparison of physicians and medical assistants in interpreting verbal autopsy interviews for allocating cause of neonatal death in Matlab, Bangladesh: Can medical assistants be considered an alternative to physicians?
Publisher: Springer Science and Business Media LLC
Date: 17-08-2010
Help yourself by helping us: responding to reviewers’ comments
Publisher: Elsevier BV
Date: 06-2012
Fostering Health Literacy Responsiveness in a Remote Primary Health Care Setting: A Pilot Study
Publisher: MDPI AG
Date: 16-04-2020
Abstract: Primary healthcare organisations have an important role in addressing health literacy as this is a barrier to accessing and utilising health care. Until recently, no organisational development tool operationalising health literacy in an Australian context existed. This research evaluated the efficacy of the Organisational Health Literacy Responsiveness (Org-HLR) tool and associated assessment process in a primary healthcare organisation in the Pilbara region of Western Australia. This study utilised a sequential explanatory mixed methods research design incorporating the collection and analysis of data in two phases: (1) Pre- and post-survey data and (2) seven semi-structured interviews. Survey results showed that participants’ confidence in core health literacy concepts improved from baseline following the intervention. Analysis of the interview data revealed participants’ initial understanding of health literacy was limited, and this impeded organisational responsiveness to health literacy needs. Participants reported the workshop and tool content were relevant to their organisation they valued involving members from all parts of the organisation and having an external facilitator to ensure the impartiality of the process. External barriers to improving their internal organisational health literacy responsiveness were identified, with participants acknowledging the management style and culture of open communication within the organisation as enablers of change. Participants identified actionable changes to improve their organisational health literacy responsiveness using the process of organisational assessment and change.
Study protocol: Audit and Best Practice for Chronic Disease Extension (ABCDE) Project
Publisher: Springer Science and Business Media LLC
Date: 17-09-2008
Screening — sensitivity, specificity and hepatitis C
Publisher: AMPCo
Date: 07-1996
DOI: 10.5694/J.1326-5377.1996.TB124877.X
Abstract: The epidemiology of respiratory syncytial virus (RSV) infection has changed during the COVID-19 pandemic. Our objectives were to describe the RSV epidemic in 2021 and compare it with the previous years to the pandemic. Retrospective study performed in Madrid (Spain) in a large paediatric hospital comparing the epidemiology and clinical data of RSV admissions during 2021 and the two previous seasons. 899 children were admitted for RSV infection during the study period. During 2021, the outbreak peaked in June and the last cases were identified in July. Previous seasons were detected in autumn-winter. The number of admissions in 2021 was significantly lower than in previous seasons. There were no differences between seasons regarding age, sex or disease severity. RSV hospitalizations during 2021 in Spain moved to summer with no cases in autumn and winter 2020-2021. Unlike other countries, clinical data were similar between epidemics.
Co-design of dementia prevention program for Aboriginal Australians (DAMPAA)
Publisher: Wiley
Date: 18-03-2023
DOI: 10.1002/ALZ.13032
Abstract: Dementia is highly prevalent in older Aboriginal Australians, with several modifiable risk factors. Currently, there is limited evidence on how to prevent cognitive decline in Aboriginal Australians. Based on our Theory of Change (ToC) framework, we co‐developed the Dementia risk management and prevention program for Aboriginal Australians (DAMPAA) aged over 45 years in partnership with Aboriginal community‐controlled organizations (ACCOs) and Elders. Qualitative data were collected through ACCO staff workshops, Elders yarning, and governance groups to inform the protocol. Additionally, we conducted a small pilot study. Expected DAMPAA ToC outcomes are: (1) improved daily function, (2) better cardiovascular risk management, (3) falls reduction, (4) improved quality of life, and (5) reduced cognitive decline. Attendance enablers are social interaction, environment, exercise type/level, and logistics. Findings suggest that ToC is an effective collaborative approach for co‐designing Aboriginal health programs.
Addressing Complex Social Problems Using the Lens of Family Violence
Publisher: MDPI AG
Date: 16-02-2023
Abstract: It is imperative that universities continue to explore innovations that support staff and student learning and pursue their mission to promote social responsibility and community service. Communities of Practice have been used to facilitate innovation and regenerate teaching and learning in tertiary contexts, including interdisciplinary collaborations around complex problems. This study describes the challenges and achievements of the first year of an interdisciplinary Community of Practice which aimed to create innovative approaches to teaching and learning about family and domestic violence, a complex social issue, inherently gendered, which receives little attention across the University discipline areas, despite the centrality of this issue in much of the future work of University graduates within a range of professional areas. We interviewed engaged members to explore the value gained from their first year of involvement in the Community of Practice. This initiative brought members substantial value while recognising the need for long-term engagement and commitment from the senior University leadership to embed innovation. A key lesson was that developing an innovative curriculum to address critical and ongoing social and public health issues requires much more senior leadership, responsibilities shared across faculty, and commitment of dedicated resources and staff time. The findings provide valuable learning for other Communities of Practice attempting to engage with complex problems and create innovative interdisciplinary approaches to teaching, learning, and research.
A profile of HIV testing in Victoria to the end of 1993
Publisher: Elsevier BV
Date: 04-2008
DOI: 10.1111/J.1753-6405.1996.TB01812.X
Abstract: Examination of testing patterns for human immunodeficiency virus (HIV) in a population is important because it affects interpretation of surveillance data on new HIV diagnoses and can guide the targeting and evaluation of c aigns to encourage appropriate antibody testing. This report describes a relatively inexpensive mechanism of collecting information on who is being tested for HIV in Victoria (other than at the Blood Bank). The annual number of HIV tests performed in Victoria increased steadily throughout the 1980s but the rate of increase slowed in the early 1990s. By 1993, women accounted for almost half of HIV tests, although they made up only 8 per cent of positive tests. There were marked differences in the volume of testing and testing profiles of different laboratories. The information available on personal risk category and the reasons for HIV tests show that many people of low risk are tested, although conclusions are limited by inadequate information elicited or provided by many requesting doctors. For better information on what is occurring with respect to HIV testing, the fundamental requirement is better compliance from requesting doctors in supplying basic information on who they test and why.
The effect of immunosuppressive agents on lymphocyte subsets in rat peripheral blood
Publisher: Elsevier BV
Date: 1987
DOI: 10.1016/0192-0561(87)90070-1
Abstract: A method for monitoring circulating lymphocytes subsets in the rat on an automated flow cytometer with monoclonal antibodies was used to ascertain in vivo effects of various doses of immunosuppressive agents. The agents tested were anti-lymphocyte serum (ALS), azathioprine (AZA), cyclophosphamide (CTX), cyclosporin A (CsA) and methylprednisolone (MP). Each immunosuppressive agent varied in its capacity to induce changes in T cell subsets and B cell numbers. The rapidity of onset of action of the agents varied considerably with ALS and MP maximal effects were seen within hours whilst the effects with CsA, cyclophosphamide (CTX) and azathioprine (AZA) took several days to develop. ALS had marked anti-T cell activity but did not selectively affect the T cell subsets. AZA and CTX both exerted their major effect upon the B cell (OX4+) subpopulation. CsA administration was associated with the appearance of many circulating lymphocytes which expressed the pan-T marker (W3/13) but neither of the T cell subset markers (W3/25, OX8). With CsA there was no significant alteration in the W3/25:OX8 ratio, although a persistent decrease in the number of all T lymphocytes was observed after administration of this drug at a dose of 45 mg/kg had ceased. MP was the only drug which had a marked selective effect on a T cell subset. The numbers of circulating Class II major histocompatibility complex (MHC) reactive lymphocytes (W3/25+) were significantly more depressed than the Class I MHC reactive subset (OX8+). This effect persisted for up to 31 days after the single injection of a depot preparation of this drug, and was found to be associated with prolonged survival of precultured endocrine xenografts.
Care seeking for fatal illness episodes in Neonates: a population-based study in rural Bangladesh
Publisher: Springer Science and Business Media LLC
Date: 14-10-2011
Evidence-based prescribing of drugs for secondary prevention of acute coronary syndrome in Aboriginal and non-Aboriginal patients admitted to Western Australian hospitals
Publisher: Wiley
Date: 04-2014
DOI: 10.1111/IMJ.12375
Abstract: To assess the level of evidence-based drug prescribing for acute coronary syndrome (ACS) at discharge from Western Australian (WA) hospitals and determine predictors of such prescribing in Aboriginal and non-Aboriginal patients. All Aboriginal (2002-2004) and a random s le of non-Aboriginal (2003) hospital admissions with a principal diagnosis of ACS were extracted from the WA Hospital Morbidity Data Collection of WA Data Linkage System. Clinical information, history of co-morbidities and drugs were collected from medical notes by trained data collectors. Evidence-based prescribing (EBP) was defined as prescribing of aspirin, statin and beta-blocker or angiotensin-converting enzyme inhibitor/angiotensin II antagonist. Records for 1717 ACS patients discharged alive from hospitals were reviewed. The majority of patients (71%) had EBP, and there was no significant difference between Aboriginal and non-Aboriginal patients (70% vs 71%, P = 0.36). Conversely, a significantly higher proportion of Aboriginal patients had none of the drugs prescribed compared with non-Aboriginal patients (11% vs 7%, P < 0.01). EBP for ACS was independently associated with male sex (odds ratio (OR) 1.63, 95% confidence interval (CI) 1.26-2.11), previous admission for ACS (OR 1.83, 95% CI 1.39-2.42) and diabetes (OR 1.36, 95% CI 1.04-1.79). However, ACS patients living in regional and remote areas, attending district or private hospitals, or with a history of chronic obstructive pulmonary disease were significantly less likely to have ACS drugs prescribed at discharge. Opportunity exists to improve prescribing of recommended drugs for ACS patients at discharge from WA hospitals in both Aboriginal and non-Aboriginal patients. Attention regarding pharmaceutical management post-ACS is particularly required for patients from rural and remote areas, and those attending district and private hospitals.
Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: a pooled analysis of 1018 population-based measurement studies with 88.6 mil
Publisher: Oxford University Press (OUP)
Date: 19-03-2018
DOI: 10.1093/IJE/DYY016
The association between mammographic density and breast cancer risk in Western Australian Aboriginal women
Publisher: Springer Science and Business Media LLC
Date: 12-04-2019
DOI: 10.1007/S10549-019-05225-9
Abstract: Mammographic density is an established breast cancer risk factor within many ethnically different populations. The distribution of mammographic density has been shown to be significantly lower in Western Australian Aboriginal women compared to age- and screening location-matched non-Aboriginal women. Whether mammographic density is a predictor of breast cancer risk in Aboriginal women is unknown. We measured mammographic density from 103 Aboriginal breast cancer cases and 327 Aboriginal controls, 341 non-Aboriginal cases, and 333 non-Aboriginal controls selected from the BreastScreen Western Australia database using the Cumulus software program. Logistic regression was used to examine the associations of percentage dense area and absolute dense area with breast cancer risk for Aboriginal and non-Aboriginal women separately, adjusting for covariates. Both percentage density and absolute dense area were strongly predictive of risk in Aboriginal women with odds per adjusted standard deviation (OPERAS) of 1.36 (95% CI 1.09, 1.69) and 1.36 (95% CI 1.08, 1.71), respectively. For non-Aboriginal women, the OPERAS were 1.22 (95% CI 1.03, 1.46) and 1.26 (95% CI 1.05, 1.50), respectively. Whilst mean mammographic density for Aboriginal women is lower than non-Aboriginal women, density measures are still higher in Aboriginal women with breast cancer compared to Aboriginal women without breast cancer. Thus, mammographic density strongly predicts breast cancer risk in Aboriginal women. Future efforts to predict breast cancer risk using mammographic density or standardize risk-associated mammographic density measures should take into account Aboriginal status when applicable.
Atrial Fibrillation in Indigenous Australians: A Multisite Screening Study Using a Single-Lead ECG Device in Aboriginal Primary Health Settings
Publisher: Elsevier BV
Date: 02-2021
Interpretation of hepatitis B virus serology results by medical scientists
Publisher: Elsevier BV
Date: 06-1995
Immunogenicity and reactogenicity of a combined hepatitis A-hepatitis B vaccine in adolescents
Publisher: Elsevier BV
Date: 04-1998
DOI: 10.1016/S1201-9712(98)90051-0
Abstract: To evaluate the immunogenicity and reactogenicity of two lots of a combined hepatitis A-hepatitis B vaccine (HAV, HBV) in healthy 15 to 18 year olds. This was a double-blind, randomized clinical study. Vaccine was administered into the deltoid at 0, 1, and 6 months. Immunogenicity was assessed by anti-HAV and anti-HBs antibody levels at 2, 6, and 7 months after the first vaccine dose. Reactogenicity was assessed through use of 3-day diary cards following each vaccination, plus recording other unsolicited reactions. A total of 160 adolescents were vaccinated 155 who were seronegative for hepatitis A and B at baseline and who completed the study were included in the immunogenicity analysis. The vaccine was well tolerated most side effects were local, of low intensity and short duration. Good immunogenicity was determined by antibody titers. High rates of seropositivity (99.4%) were achieved after two doses against HAV, and after three doses for anti-HBs (seroprotection = 98.7%). This combination vaccine will be useful for immunizing selected high-risk groups in developed countries. In countries where endemicity is low for both diseases, targeting students prior to risk of acquisition would be a feasible preventive strategy.
Impact of improved laboratory compliance on notification of genital Chlamydia trachomatis infection in Victoria
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-1997
DOI: 10.1097/00007435-199702000-00005
Abstract: Although regulations in Victoria require notification of chlamydia infection by both clinician and laboratory, review found many reports that were notified only by one source (i.e., were unmatched). To identify problems with the notification system and to improve the quality of surveillance for this disease. All notified cases of chlamydia diagnosed in January or February 1995 were followed up by contacting diagnosing doctors. Identified noncompliant laboratories were asked to provide a list of all diagnoses for the period and institute ongoing reporting. Notification data were reviewed for timeliness and completeness. Clinicians never notified without laboratory confirmation. Soliciting laboratory reports increased total notifications by 30%, and there was a highly significant improvement in reporting by both clinicians and laboratories. Reasons for failure to notify by clinicians included an assumption by some clinicians that laboratories would notify and ignorance that notification was required. Notified cases generally are now accompanied by a laboratory report, and although nonnotification by clinicians continues, notification has improved. Further improvements in clinician notification may depend on doctors knowing that public health action results from reporting. An alternative to requiring doctors' time to be spent in duplicate notification would be to strengthen laboratory reporting and then check that adequate treatment and partner notification has occurred through contact with the diagnosing doctor.
Strategies to Facilitate Improved Recruitment, Development, and Retention of the Rural and Remote Medical Workforce
Publisher: Maad Rayan Publishing Company
Date: 15-11-2021
Abstract: Background: Medical workforce shortages in rural and remote areas are a global issue. High-income countries (HICs) and low- and middle-income countries (LMICs) seek to implement strategies to address this problem, regardless of local challenges and contexts. This study distilled strategies with positive outcomes and success from international peer-reviewed literature regarding recruitment, retention, and rural and remote medical workforce development in HICs and LMICs. Methods: The Arksey and O’Malley scoping review framework was utilised. Articles were retrieved from electronic databases Medline, Embase, Global Health, CINAHL Plus, and PubMed from 2010-2020. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guideline was used to ensure rigour in reporting the methodology in the interim, and PRISMA extension for scoping review (PRISMA-ScR) was used as a guide to report the findings. The success of strategies was examined against the following outcomes: for recruitment - rural and remote practice location for development - personal and professional development and for retention - continuity in rural and remote practice and low turnover rates. Results: Sixty-one studies were included according to the restriction criteria. Most studies (n=53 87%) were undertaken in HICs, with only eight studies from LMICs. This scoping review found implementation strategies classified as Educational, Financial, and Multidimensional were successful for recruitment, retention, and development of the rural and remote medical workforce. Conclusion: This scoping review shows that effective strategies to recruit and retain rural and remote medical workforce are feasible worldwide despite differences in socio-economic factors. While adjustment and adaptation to match the strategies to the local context are required, the country’s commitment to act to improve the rural medical workforce shortage is most critical.
Children and adolescents are not small adults
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.JCLINEPI.2022.07.003
Abstract: Multimorbidity is of an increasing importance for the health of both children and adults but research has hitherto focused on adult multimorbidity. Hence, public awareness, practice, and policy lack vital information about multimorbidity in childhood and adolescence. We convened an international and interdisciplinary group of experts from six nations to identify key priorities supported by published evidence to strengthen research for children and adolescent with multimorbidity. Future research is encouraged (1) to develop a conceptual framework to capture unique aspects of child and adolescent multimorbidity-including definitions, characteristic patterns of conditions for different age groups, its dynamic nature through childhood and adolescence, and understanding of severity and trajectories for different clusters of multiple chronic conditions, (2) to define new indices to classify the presence of multimorbidity in children and adolescents, (3) to improve the availability and linkage of data across countries, (4) to synthesize evidence on the global phenomenon of multimorbidity in childhood and adolescence and health inequalities, and (5) to involve children and adolescents in research relevant to their health.
Applying a Midwifery Lens to Indigenous Health Care Delivery: The Contribution of Campus Learning and Rural Placements to Effecting Systemic Change
Publisher: SAGE Publications
Date: 04-05-2018
Abstract: Increasing cultural safety in health settings is essential to address stark health disparities between Indigenous and non-Indigenous Australians. Respect for cultural knowledge, better communication, and recognition of racism as a determinant of health are required for improved service delivery. How this knowledge is acquired in health professional training and translated to clinical settings is poorly understood. Impacts of an innovative Indigenous health unit and remote clinical placements on knowledge acquisition and attitude change were explored among midwifery students to inform cultural competency initiatives in health professional training. A multiphased, mixed methods research design used surveys, observations, and interviews. Qualitative analysis was strengthened through triangulation with quantitative data. A unit conceived with substantial Indigenous Australian input and which privileged these voices enhanced knowledge and shifted attitudes in a positive direction however, immediate gains diminished over time. Remote placements had a profound effect on student learning. Exposure to Indigenous Australians in classrooms and communities, and the self-reflection generated, helped dispel stereotypes and challenge assumptions based on limited cultural knowledge and contact. Optimization of receptivity to Indigenous Australian content and opportunities for remote placements contributed to students’ developing cultural capabilities with implications for all health professional training. Whether this heightened awareness is enough to address institutional racism identified in health service delivery remains unanswered. The focus must include those established health practitioners and administrators who influence organizational culture if real systemic change is to occur. Given appropriate on-going support, graduates can play a vital role in expediting this process.
Silver Linings Reported by Australians Experiencing Public Health Restrictions during the First Phase of the COVID-19 Pandemic: A Qualitative Report
Publisher: MDPI AG
Date: 29-10-2021
Abstract: This national study investigated the positives reported by residents experiencing the large-scale public health measures instituted in Australia to manage the first wave of the COVID-19 pandemic in 2020. Most Australians had not previously experienced the traditional public health measures used (social distancing, hand hygiene and restriction of movement) and which could potentially impact negatively on mental well-being. The research design included qualitative semi-structured phone interviews where participants described their early pandemic experiences. Data analysis used a rapid identification of themes technique, well-suited to large-scale qualitative research. The ninety participants (mean age 48 years 70 women) were distributed nationally. Analysis revealed five themes linked with mental well-being and the concept of silver linings: safety and security, gratitude and appreciation, social cohesion and connections, and opportunities to reset priorities and resilience. Participants demonstrated support for the public health measures and evidence of in idual and community resilience. They were cognisant of positives despite personal curtailment and negative impacts of public health directives. Stories of hope, strength, and acceptance, innovative connections with others and focusing on priorities and opportunities within the hardship were important strategies that others could use in managing adversity.
Accessing Primary Health Care: A Community Survey of Issues regarding General Practice and Emergency Department Services in an Outer Metropolitan Area
Publisher: CSIRO Publishing
Date: 2006
DOI: 10.1071/PY06049
Abstract: This survey aimed to identify views of residents of an outer metropolitan location towards general practice (GP) services, after-hours care and their use of emergency departments (ED). Four hundred respondents were selected randomly using quota s ling and interviewed by telephone. Respondents wanted a GP who was "easy to talk to", who listened and was interested in them, competent, straightforward and thorough. Of those who were dissatisfied, the main concerns were GPs' unwillingness to listen to the patient and rushing the consultation. GP visits occurred for specific health problems - most commonly fever, tiredness and respiratory conditions. Preventive advice regarding health and lifestyle issues was not mentioned as a reason for attending GPs. Appointment availability and financial issues impeded access to GPs. Most people who used an ED did so because of the unavailability of GP services, showing that access block starts in general practice, with the severity of their illness/injury being the second major reason.
Under-ascertainment of Aboriginality in records of cardiovascular disease in hospital morbidity and mortality data in Western Australia: a record linkage study
Publisher: Springer Science and Business Media LLC
Date: 12-2010
LEGISLATION FOR SCHOOL ENTRY IMMUNIZATION CERTIFICATES IN VICTORIA
Publisher: Wiley
Date: 12-02-1994
DOI: 10.1111/J.1753-6405.1994.TB00242.X
Abstract: In 1982 the National Health and Medical Research Council recommended that every state introduce legislation requiring immunisation certificates at school entry. Victoria was the first state to enact such legislation. This paper explores the process and difficulties encountered in achieving this legal requirement, describes the requirements under the legislation as it was finally introduced, and examines the early data available to the state health department regarding its implementation. Compliance with the legislation and immunisation status of children enrolling in government primary schools were ascertained from mid-year census data. In 1992 almost 90 per cent of children complied with the legislation, but because 10.2 per cent of children did not present a certificate it was possible to estimate only the lower limit of statewide coverage at 85 per cent against the prescribed diseases. School entry immunisation legislation may provide an important safety net to identify children with incomplete immunisation. However, the effectiveness of the legislation in Victoria remains unproven, and the requirements of the legislation are demanding for parents, local councils, and schools. The failure to document immunisation status in over 10 per cent of children indicates that further efforts to increase compliance are needed. This will require information on the vaccination status of those without certificates and the reasons they have not complied. The impact of the legislation needs further evaluation, although it may be years before its effectiveness can be gauged. Its effectiveness may depend upon enforcement of the requirement to exclude unimmunised children in disease outbreaks.
Exploring Australian Aboriginal Women's experiences of menopause: A descriptive study
Publisher: Springer Science and Business Media LLC
Date: 20-03-2014
Abstract: Despite extensive literature demonstrating differing experiences in menopause around the world, documentation of the experience of menopause in Australian Aboriginal women is scarce, and thus their menopausal experience is relatively unknown. This study aimed to understand Australian Aboriginal women’s understanding and experience of menopause and its impact on their lives. The study was an exploratory qualitative study. Twenty-five Aboriginal women were recruited from a regional centre in the Mid-West region of Western Australia using opportunistic and snowballing s ling. Interviews and focus group discussions were undertaken from February 2011 to February 2012 using open-ended questioning with a yarning technique. Thematic analysis was undertaken of the transcribed interviews. A number of themes were revealed. These related to the language used, meanings and attitudes to menopause, symptoms experienced, the role of men, a lack of understanding, coping mechanisms and the attribution of menopausal changes to something else. The term “change of life” was more widely recognised and signified the process of ageing, and an associated gain of respect in the local community. A fear of menopausal symptoms or uncertainty about their origin was also common. Overall, many women reported insufficient understanding and a lack of available information to assist them and their family to understand the transition. There are similarities between Aboriginal and non-Aboriginal experiences of menopause, including similar symptom profiles. The current language used within mainstream health settings may not be appropriate to this population if it fails to recognise the importance of language and reflect the attributed meaning of menopause. The fear of symptoms and uncertainty of their relationship to menopause demonstrated a need for more information which has not adequately been supplied to Australian Aboriginal women through current services. While this study is with a select population of Aboriginal Australian women, it reveals the importance of acknowledging differences, particularly in use of language to convey ideas and support Aboriginal women experiencing menopause.
‘It Shouldn’t Be This Hard’: Exploring the Challenges of Rural Health Research
Publisher: MDPI AG
Date: 22-11-2019
Abstract: Health research is important for innovation and assessment of health status and health interventions, and maintaining a strong, engaged cohort of rural health researchers is essential for the ongoing improvement of the health of rural populations. Ethical guidelines and processes ensure research is undertaken in a way that protects and, where possible, empowers participants. We set out to systematically examine and document the challenges posed by ethics and governance processes for rural health researchers in Western Australia (WA) and the impact on the research undertaken. In this qualitative study, fifteen WA-based rural health researchers were interviewed. The identified challenges included inefficient systems, gatekeeping, apparent resistance to research and the lack of research experience of those involved in approval processes. For researchers seeking to conduct studies to improve rural and Aboriginal health, extended delays in approvals can hold up and impede research, ultimately changing the nature of the research undertaken and constraining the willingness of practitioners and researchers to undertake health research. Unwieldy ethics processes were seen to have a particularly onerous impact on rural research pertaining to service delivery, multiple sites, and research involving Aboriginal people, impeding innovation and inquiry in areas where it is much needed.
Atrial fibrillation in the Indigenous populations of Australia, Canada, New Zealand, and the United States: a systematic scoping review
Publisher: Springer Science and Business Media LLC
Date: 13-08-2015
Serostatus for vaccine-preventable diseases in residents at Melbourne Juvenile Justice Centre
Publisher: Elsevier BV
Date: 10-2008
DOI: 10.1111/J.1467-842X.1998.TB01441.X
Abstract: There are concerns in Australia about inadequate rates of childhood immunisation, an important preventive measure to reduce infectious diseases. The population passing through the Melbourne Juvenile Justice Centre (MJJC) comes from a background at high risk for inadequate immunisation and outbreaks can occur in residential institutions. MJJC residents were invited to participate in a study by completing a medical officer-administered risk behaviour questionnaire and/or giving a blood s le. Ninety residents completed the questionnaire 83 gave blood s les. Sera were tested for measles, mumps, rubella and hepatitis A, B and C markers using standard commercial assays. Diphtheria and tetanus were tested with an ELISA in a public health laboratory familiar in the technique. Sixty four per cent (53/83) of participants were non-immune to at least one component of MMR and 44.6% (37/83) non-immune to either tetanus or diphtheria. Despite 61.1% of participants reporting injecting drug use, only 28.2% had protective levels of anti-HBs, 6.1% were positive for anti-HBc (2.4% equivocal), 22.9% were anti-HCV positive and 9.6% had markers of exposure to hepatitis A virus. These results show suboptimal levels of immunity in this institutional setting with the potential for disease outbreaks. Many residents miss adolescent school-based programs for immunisation because of truancy and early school leaving. Despite considerable risk of blood-borne viruses, many MJJC residents are inadequately vaccinated against hepatitis B.
Providing palliative care for cardiovascular disease from a perspective of sociocultural diversity: a global view.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2016
Invisible Beings?: HIV Infection in the Mentally Ill
Publisher: SAGE Publications
Date: 02-1996
Exploring treatment decision-making in cancer management for rural residents: Patient and provider perspectives on a recently established regional radiotherapy service.
Publisher: Wiley
Date: 26-03-2018
DOI: 10.1111/AJCO.12873
Abstract: The aim of this study was to examine stakeholders' views of how the establishment of the South West Radiation Oncology Service in Bunbury, Western Australia, has affected treatment decision-making, and the extent to which patients are involved in the decision-making process. Semi-structured in-depth interviews were undertaken with 21 service providers involved in the treatment and care of people with cancer, and 17 adults diagnosed with cancer who opted to undergo radiotherapy (RT) treatment at the Service. Data were subject to thematic analysis using the qualitative data analysis software NVivo 10. Patients were overwhelmingly positive about their experiences at the Service, praising the quality of the care provided and noting the convenience associated with receiving treatment locally. Most patients reported feeling involved in decision-making, but tended to rely on and generally adopt advice from medical professionals regarding type and location of treatment. Although service providers in the region had become more aware of the regional RT service and referrals had increased, some patients continued to travel to the metropolitan area for treatment. Reasons identified for this included the need for more specialized RT treatment and the more extensive range of allied health services offered. Increased convenience and a lower financial burden are key reasons why rural cancer patients prefer treatment at a regional RT service rather than travelling to metropolitan centers. These factors highlight the need for ongoing improvement in access to local RT services so that disparities in cancer outcomes between rural and metropolitan patients are reduced.
“You felt like a prisoner in your own self, trapped”
Publisher: Informa UK Limited
Date: 06-11-2021
DOI: 10.1080/09638288.2019.1686073
Abstract: Aboriginal Australians are under-represented in brain injury rehabilitation services despite a high incidence of both stroke and traumatic brain injury in this population. This study aimed to explore the experiences of Aboriginal Australian adults with acquired communication disorders (ACDs) after brain injury for the first time to inform the development of accessible and culturally secure service delivery models. Semi-structured interviews were undertaken with 32 Aboriginal people who had experienced a brain injury resulting in ACDs (aged 35-79 years) and 18 family members/carers across Western Australia. Thematic analysis identified common themes across participants. Overall themes related to communication (both related to the communication disorder and general healthcare interactions), health and social contexts, recovery, and support, being away from family and country, knowledge and beliefs about brain injury, and follow-up. An increase in healthcare staff's appreciation of the health and social contexts of Aboriginal people after brain injury is needed in order to improve communication with Aboriginal patients and the ability to offer accessible rehabilitation services. Ongoing support is required, with cultural identity noted as key to ensuring cultural security and ultimately recovery. Involvement of family and other Aboriginal people in recovery processes, as well as access to relevant Aboriginal languages and proximity to ancestral lands is central.Implications for rehabilitationAcknowledgment of cultural identity and strengths through involvement of extended family and Aboriginal Hospital Liaison Officers, access to language and proximity to country all central to rehabilitation planning for Aboriginal people after brain injury.Cultural security training for rehabilitation staff is recommended focusing on clear two-way communication skills to make medical information accessible for Aboriginal patients and to listen to patients' concerns in a way that respects cultural context.Information regarding practical support and implications for ongoing management of life after brain injury (for the person and their family) is essential, and should supplement the medical-related information provided.Follow-up post discharge from hospital best facilitated through establishing contact with local Aboriginal community through Aboriginal community controlled health services, community elders, and Aboriginal health workers across organisations.
Cardiac Rehabilitation for Aboriginal and Torres Strait Islander people in Western Australia
Publisher: Springer Science and Business Media LLC
Date: 13-07-2016
Cancer support services: Are they meeting the needs of rural radiotherapy patients?
Publisher: Hindawi Limited
Date: 07-08-2019
DOI: 10.1111/ECC.12904
Abstract: This paper examines the supportive care in place to meet the needs of patients receiving radiotherapy at a regional oncology service in Bunbury, Western Australia. Semi-structured in-depth interviews with 21 service providers and 17 adults diagnosed with cancer who underwent radiotherapy at the Service were recorded, transcribed and analysed thematically. Key themes relevant were co-operation and collaboration of interdisciplinary team members support from organisations to assist with accommodation, transport, emotional support and provision of practical assistance, as well as barriers to accessing support. Most participants were positive about the support available, recognising the needs of rural radiotherapy patients for assistance with travel, accommodation and psychosocial support to help deal with the stressors they face. Collaboration between the various service providers maximised the support available to patients but the drop off in psychosocial support once the intensity of treatment was completed was identified as a weakness in the support available. The support system, established around a regional radiotherapy service, was enhanced by the collaborative professional relationships developed among service providers. The service extends beyond clinical service delivery by recognising financial, logistical and psychosocial support needs, factors to be considered to ensure rural radiotherapy patients are provided with holistic care.
Longitudinal Follow Up of Early Career Midwives: Insights Related to Racism Show the Need for Increased Commitment to Cultural Safety in Aboriginal Maternity Care
Publisher: MDPI AG
Date: 31-01-2021
Abstract: Racism in health care undermines equitable service delivery, contributes to poorer health outcomes and has a detrimental effect on the Aboriginal workforce. In maternity care settings, Aboriginal women’s perceptions of discrimination are widespread, with the importance of cultural practices surrounding childbirth often not recognised. Efforts to build midwives’ cultural capabilities and address health disparities have seen Aboriginal content included in training programs but little is known about its application to clinical practice. This study reinterviewed midwives who had previously completed university midwifery training that aimed to increase understanding of Aboriginal people and cultural safety in health care. Participants were 14 non-Indigenous midwives and two Aboriginal midwives. Interviews explored the legacy of program initiatives on cultural capabilities and observations and experiences of racism in maternity care settings. Methods followed qualitative approaches for research rigour, with thematic analysis of transcribed interviews. Findings revealed the positive impact of well-designed content and placements, with non-Indigenous participants cognisant and responsive to casual racism but largely not recognising institutional racism. The Aboriginal midwives had experienced and were attuned to racism in all its guises and suggested initiatives to heighten awareness and dispel stereotypes. It is evident that greater attention must be paid to institutional racism in educational programs to increase its recognition and appropriate actions within health care settings.
Knowledge of and attitudes to infection control of tattooists at registered premises in Victoria, 1994
Publisher: Elsevier BV
Date: 02-2008
DOI: 10.1111/J.1467-842X.1997.TB01647.X
Abstract: Historically, the relationship between health authorities and tattooists has been marked by suspicion and mutual distrust, with tattooists being stereotyped as having little concern for hygiene, and considered largely ineducable about infection control. In this study, a random s le of tattooists working at one-third of the 65 registered tattooing premises in Victoria completed a questionnaire that recorded demographic information and knowledge and attitudes to Standards of practice for tattooing 1990, which specifies guidelines for infection control in Victorian tattooing premises. Of these premises, 89 per cent participated and 36 of 37 tattooists working therein (22 metropolitan, 14 country) completed the questionnaire 81 per cent were male. Reports by the tattooists indicated that: 50 per cent had not commenced immunisation for hepatitis B that 78, 42 and 34 per cent either had not been tested or were unsure whether they had been tested for hepatitis C, hepatitis B and human immunodeficiency virus (HIV) and that no tattooist was a hepatitis B carrier or was positive for hepatitis C or HIV. Respondents acknowledged the potential for transmission of infectious diseases through tattooing, endorsed formal training in tattooing and infection control for new tattooists, and supported continuing education in infection control for existing tattooists. Most were critical of environmental health officers, particularly for inaction in not closing and prosecuting unregistered tattooists. Despite deficiencies in the knowledge and training of tattooists in infection control, they recognise its importance and are willing to attend appropriate training.
Evidence-based interventions in primary care following acute coronary syndrome in Australia and New Zealand
Publisher: Springer Science and Business Media LLC
Date: 09-11-2016
An evaluation of tests in routine use for the quantitation of antibody to hepatitis B surface antigen
Publisher: Elsevier BV
Date: 12-1995
The Use of Community-Based Interventions in Reducing Morbidity from the Psychological Impact of Conflict-Related Trauma Among Refugee Populations: A Systematic Review of the Literature
Publisher: Springer Science and Business Media LLC
Date: 20-11-2011
DOI: 10.1007/S10903-010-9417-6
Abstract: With large numbers of refugee arrivals and numerous barriers to accessing services it is especially important that resources are efficiently and effectively directed to address the health needs of refugees. Ten databases were utilised to conduct the review, returning 156 titles which were assessed for validity based on specified criteria. The 14 critically appraised articles included in this review consist of experimental research and discussions on best practice. Articles consistently demonstrated the benefit of community-based mental health service in improving mental health outcomes. Themes of cultural awareness, language, setting, and post-migration stressors emerged across the articles. In addition, the studies also point to the gaps in research of a longitudinal nature and ones that deal with scattered populations post migration. Community-based interventions proved valuable for improving the mental health of refugees. However, additional interventions and evaluations are required to draw consistent and conclusive judgments on best practice in dealing with refugee mental health issues.
Sexually transmitted diseases and unwanted pregnancies in chronically ill psychiatric patients
Publisher: AMPCo
Date: 03-1997
The epidemiology of HIV in South African workplaces
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2007
Commitments, Conditions and Corruption: An Interpretative Phenomenological Analysis of Physician Recruitment and Retention Experiences in Indonesia
Publisher: MDPI AG
Date: 02-05-2022
Abstract: Complex factors influence physicians’ decisions to remain in rural and remote (RR) practice. Indonesia, particularly, has various degrees of poor governance contributing to physicians’ decisions to stay or leave RR practice. However, there is a paucity of literature exploring the phenomenon from the perspective of Indonesian RR physicians. This study explores physicians’ lived experiences working and living in Indonesian RR areas and the motivations that underpin their decisions to remain in the RR settings. An interpretative phenomenological analysis was utilised to explore the experiences of 26 consenting voluntary participants currently working in the RR areas of Maluku Province. A focus group discussion was undertaken with post-interns (n = 7), and semi-structured interviews were undertaken with junior (n = 9) and senior physicians (n = 10) working in district hospitals and RR health centres. Corruption was identified as an overarching theme that was referred to in all of the derived themes. Corruption adversely affected physicians’ lives, work and careers and influenced their motivation to remain working in Indonesia’s RR districts. Addressing the RR workforce shortage requires political action to reduce corruptive practice in the districts’ governance. Establishing a partnership with regional medical schools could assist in implementing evidence-based strategies to improve workforce recruitment, development, and retention of the RR medical workforce.
Yarning quiet ways: Aboriginal carers’ views on talking to youth about sexuality and relationships
Publisher: Wiley
Date: 28-12-2017
DOI: 10.1002/HPJA.14
Abstract: Research suggests that young Indigenous people want carers to take a more active role in discussions about sexual health. The aim of this study was to ascertain carers' perspectives of: the importance of providing young people with information about sex and sexual health what they want young people to know about sex and sexual health and facilitators and barriers to discussing sex and sexual health with youth. Thirteen focus groups and three interviews were conducted with 81 carers in four rural and urban regions of Western Australia. Data were coded using a thematic approach, analysed using inductive Framework Analysis, and interpreted using the Aboriginal Family Wellbeing Model of Empowerment. Many participants recognised the need for talking with young people about sex, and said they drew upon resources such as books, p hlets and television and used humour to impart lessons. However, a large proportion of participants reported difficulties in educating youth about sex. Participants noted that colonisation had disrupted traditional structures for educating young people, and that sex was a challenging topic. The forced removal of children had interfered with Indigenous family structures and deprived some participants of the opportunity to acquire knowledge and skills from their own parents. Our findings emphasise the potential role of culture and empowerment in further improving outcomes related to relationships and sexual health. There is a need for more research into models of culturally-empowering, family-centred strategies for improving the sexual literacy of Indigenous youth.
‘At the grass roots level it’s about sitting down and talking’: exploring quality improvement through case studies with high-improving Aboriginal and Torres Strait Islander primary healthcare services
Publisher: BMJ
Date: 05-2019
DOI: 10.1136/BMJOPEN-2018-027568
Abstract: Improving the quality of primary care is an important strategy to improve health outcomes. However, responses to continuous quality improvement (CQI) initiatives are variable, likely due in part to a mismatch between interventions and context. This project aimed to understand the successful implementation of CQI initiatives in Aboriginal and Torres Strait Islander health services in Australia through exploring the strategies used by ‘high-improving’ Indigenous primary healthcare (PHC) services. This strengths-based participatory observational study used a multiple case study method with six Indigenous PHC services in northern Australia that had improved their performance in CQI audits. Interviews with healthcare providers, service users and managers (n=134), documentary review and non-participant observation were used to explore implementation of CQI and the enablers of quality improvement in these contexts. Services approached the implementation of CQI differently according to their contexts. Common themes previously reported included CQI systems, teamwork, collaboration, a stable workforce and community engagement. Novel themes included embeddedness in the local historical and cultural contexts, two-way learning about CQI and the community ‘driving’ health improvement. These novel themes were implicit in the descriptions of stakeholders about why the services were improving. Embeddedness in the local historical and cultural context resulted in ‘two-way’ learning between communities and health system personnel. Practical interventions to strengthen responses to CQI in Indigenous PHC services require recruitment and support of an appropriate and well prepared workforce, training in leadership and joint decision-making, regional CQI collaboratives and workable mechanisms for genuine community engagement. A ‘toolkit’ of strategies for service support might address each of these components, although strategies need to be implemented through a two-way learning process and adapted to the historical and cultural community context. Such approaches have the potential to assist health service personnel strengthen the PHC provided to Indigenous communities.
Supporting nursing and allied health student placements in rural and remote Australia: a narrative review of publications by university departments of rural health
Publisher: Wiley
Date: 06-08-2023
DOI: 10.5694/MJA2.52032
Abstract: University departments of rural health are Commonwealth‐funded to improve recruitment and retention of the rural allied health and nursing (including midwifery) workforce, primarily through student placements. We examined publications by university departments of rural health that were focused on allied health and nursing students undertaking placements in rural Australia, to understand the characteristics, main findings and implications of the research conducted. Interprofessional learning was a key feature of placements and placement education, although other activities such as community engagement added to placement experiences. Factors such as quality supervision and being involved in the community contributed to a positive placement experience and increased rural practice intention. Tracking studies showed a relationship between rural placements, rural practice intention and rural practice. Rural placements occurred across a variety of settings and in locations consistent with the policy framework. Embedding university departments of rural health in rural communities enabled staff to build relationships and increase placement capacity.
Causes of Neonatal Deaths in a Rural Subdistrict of Bangladesh: Implications for Intervention
Publisher: Springer Science and Business Media LLC
Date: 06-09-2010
The impact of diagnosis of hepatitis C virus on quality of life
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-1999
Abstract: The aim of this study was to examine the effects of diagnosis of hepatitis C virus (HCV) infection on quality of life in a cohort admitted to Fairfield Infectious Diseases Hospital with acute hepatitis from 1971 to 1975. Sera stored from the original admission were tested for antibody to HCV. Systematic approaches were used to locate anti-HCV-positive in iduals and outcomes assessed by the Short Form 36 (SF-36) scale and a study-specific questionnaire as well as clinical review. Study subjects' SF-36 scores were compared with Australian population norms. Anti-HCV and HCV-RNA positive in iduals (n = 15) aware of their serostatus rated significantly worse on 7 of 8 SF-36 scales compared with population norms. However, HCV-seropositive and RNA-positive in iduals unaware of their HCV serostatus (n = 19) scored significantly worse in only 3 scales. Those aware of their serostatus did not differ sociodemographically, clinically, virologically, or serologically from those who were unaware, nor was there a link between quality of life (QOL) scores and objective measures of ill health. All subjects had injected drugs in the past. In conclusion, HCV-RNA and anti-HCV-positive in iduals in our study have significantly poorer subjective health status 26 years after original infection compared with population norms. QOL measures were significantly worse for HCV-seropositive in iduals aware of their serostatus compared with those unaware. We feel that the reduced QOL in the diagnosed group may be partially an effect of labeling and that the impact of the diagnostic process per se on QOL in in iduals with HCV requires further evaluation.
Necessity as the Catalyst of Change: Exploring Client and Provider Perspectives of Accelerated Implementation of Telehealth by a Regional Australian Community Service Organisation during COVID-19 Rest
Publisher: MDPI AG
Date: 30-10-2021
Abstract: Community services have played a significant role in supporting the psychosocial health and well-being of vulnerable populations during the SARS-CoV-2 (COVID-19) pandemic. To meet increased community needs, organisations were required to rapidly modify service provision, often using remote delivery systems. This in-depth study, undertaken early in the pandemic, explored staff and clients’ experiences of adapting to using telehealth to provide and access services in one regional social services agency. Semi-structured interviews from 15 staff and 11 clients from a regional not-for-profit agency in Western Australia were recorded and transcribed. Inductive coding, and thematic analysis identified eight subthemes, with experiences and perceptions of telehealth varying substantially among staff and client groups. Distinct benefits and challenges were associated with telehealth. Participants highlighted tensions and complexities and commented on the place of telehealth in the community service sector. Clients expressed the importance of relationships and communication. This study provides in-depth insights into the contextualised experiences of staff and clients during a time at which change was both enabled and necessary. The findings highlight the need for tailored service delivery choice client collaboration ongoing staff training relating to telehealth and guidelines specific to telehealth in the community service sector.
Using the Healthy Community Assessment Tool: Applicability and Adaptation in the Midwest of WA
Publisher: MDPI AG
Date: 03-04-2018
DOI: 10.20944/PREPRINTS201804.0041.V1
Abstract: Population based studies have associated poor living conditions with the persistent disparity in the health of Aboriginal and non-Aboriginal Australians. This project assesses the applicability of the Health Community Assessment Tool and its role in improving the environment of a small community in the Midwest of WA. The action research cycles started with the initial reflection on the suitability of the HCAT version 2 for the local community context and whether it was fit-for-purpose. The researcher provided & lsquo critical companionship& rsquo , while the participants of the study were invited to be co-researchers (the Assessors) who critically examined the HCAT and assess the community. The relevant domains to the serviced town (an outer regional community) were pest control and animal management healthy housing food supply community vibrancy, pride and safety reducing environmental tobacco smoke and promoting physical activity. The Assessors found the HCAT descriptors mostly aligned with their community context but found some of the items difficult to apply. Based on participant& rsquo s suggestions, some of the original scoring scales were reformatted. School attendance and illicit drug use were identified as a key outcome indicator for youth but were missing from the HCAT. The HCAT domains applied helped streamlining core business of agencies in the local community. The face validity of HCAT items were confirmed in this research with minor adjustments to reflect local context. Youth engagement to education is of high community concern and the development of an item would create similar interagency collaborative dialogues.
Social media and digital technology use among Indigenous young people in Australia: A literature review
Publisher: Springer Science and Business Media LLC
Date: 25-05-2016
“Listening to the silence quietly”: investigating the value of cultural immersion and remote experiential learning in preparing midwifery students for clinical practice
Publisher: Springer Science and Business Media LLC
Date: 2014
Refining the concept of cultural competence: building on decades of progress
Publisher: AMPCo
Date: 07-2013
DOI: 10.5694/MJA13.10499
Abstract: Cultural competence strategies aim to make health services more accessible for patients from erse cultural backgrounds. Recently, such strategies have focused on specific groups, and particularly Indigenous Australians, where services have failed to address large disparities in health outcomes. Limitations of cultural competence largely fall into three categories: lack of clarity around how the concept of culture is used in medicine, inadequate recognition of the "culture of medicine" and the scarcity of outcomes-based research that provides evidence of efficacy of cultural competence strategies. Narrow concepts of culture often conflate culture with race and ethnicity, failing to capture ersity within groups and thus reducing the effectiveness of cultural competence strategies. This also h ers the search for evidence linking cultural competence to a reduction in health disparities. Attention to cultural complexity, structural determinants of inequality and power differentials within health care settings not only provide a more expansive notion of cultural competence and a nuanced understanding of the role of culture in the clinic, but may assist in determining the contribution that cultural competence strategies can make to a reduction in health disparities.
Polyvalent vaccines and the National Immunisation Schedule
Publisher: AMPCo
Date: 07-1996
Up close and real: living and learning in a remote community builds students’ cultural capabilities and understanding of health disparities
Publisher: Springer Science and Business Media LLC
Date: 06-07-2017
Factors Associated With Children Diagnosed With Attention-Deficit/Hyperactivity Disorder and 30-Day Follow-up Care With Practitioners Among Medicaid Recipients in Georgia
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 24-09-2022
Factors Affecting the Retention of Indigenous Australians in the Health Workforce
Publisher: MDPI AG
Date: 04-05-2018
Improving palliative care outcomes for Aboriginal Australians: Service providers' perspectives
Publisher: Springer Science and Business Media LLC
Date: 23-07-2013
Assessing quality of diabetes care and its variation in Aboriginal community health centres in Australia
Publisher: Wiley
Date: 15-01-2010
DOI: 10.1002/DMRR.1062
Abstract: Examining variation in diabetes care across regions/organizations provides insight into underlying factors related to quality of care. The aims of this study were to assess quality of diabetes care and its variation among Aboriginal community health centres in Australia, and to estimate partitioning of variation attributable to health centre and in idual patient characteristics. During 2005-2009, clinical medical audits were conducted in 62 Aboriginal community health centres from four states/territories. Main outcome measures include adherence to guidelines-scheduled processes of diabetes care, treatment and medication adjustment, and control of HbA(1c), blood pressure, total cholesterol and albumin/creatinine ratio (ACR). Wide variation was observed across different categories of diabetes care measures and across centres: (1) overall adherence to delivery of services averaged 57% (range 22-83% across centres) (2) medication adjustment rates after elevated HbA(1c): 26% (0-72%) and (3) proportions of patients with HbA(1c) < 7%:27% (0-55%) with blood pressure < 130/80 mmHg: 36% (0-59%). Health centre level characteristics accounted for 36% of the total variation in adherence to process measures, and 3-11% of the total variation in patient intermediate outcomes the remaining, substantial amount of variation in each measure was attributable to patient level characteristics. Deficiencies in a range of quality of care measures provide multiple opportunities for improvement. The majority of variation in quality of diabetes care appears to be attributable to patient level characteristics. Further understanding of factors affecting variation in the care of in iduals should assist clinicians, managers and policy makers to develop strategies to improve quality of diabetes care in Aboriginal communities.
Indigenous beliefs about biomedical and bush medicine treatment efficacy for indigenous cancer patients: A review of the literature
Publisher: Wiley
Date: 02-2012
DOI: 10.1111/J.1445-5994.2011.02598.X
Abstract: Australia's indigenous people suffer from higher cancer mortality than non-indigenous Australians, a discrepancy partly caused by differences in beliefs about treatment efficacy between Indigenous patients and their non-indigenous healthcare providers. This paper critically reviews the literature associated with Indigenous beliefs about cancer treatment, both 'bush medicine' and biomedical, in order to provide recommendations to healthcare providers about accommodating indigenous beliefs when treating cancer. A search was undertaken of peer-reviewed journal papers using electronic databases and citation snowballing. Papers were selected for inclusion based upon relevance to themes that addressed the research questions. Literature suggests that indigenous beliefs about treatment efficacy for cancer involve five themes: (i) concerns about the toxicity of treatment (ii) disconnect with the physician (iii) fears about absence from home during treatment (iv) different beliefs about disease aetiology (v) biomedical cancer treatments failing to address holistic health. Although some information is known about indigenous Australian healing beliefs and practices associated with cancer treatment, few studies have addressed ways in which indigenous and biomedical approaches to cancer treatment might be integrated. Some recent work has examined the role of belief in cancer treatment, specifically bush medicine, but more research is required.
Rural-urban differentials in 30-day and 1-year mortality following first-ever heart failure hospitalisation in Western Australia: a population-based study using data linkage
Publisher: BMJ
Date: 05-2014
Hepatitis B Vaccination of Personnel Employed in Victorian Hospitals: Are Those at Risk Adequately Protected?
Publisher: Cambridge University Press (CUP)
Date: 1999
DOI: 10.1086/501552
Abstract: To examine the policies and practices in hospitals within the state of Victoria, Australia, with respect to vaccination of staff against hepatitis B infection. A written self-administered questionnaire to be completed by the infection control officer (or designated officer for hepatitis B vaccination) within each hospital. Public (teaching and nonteaching) and private hospitals, including metropolitan and rural institutions in Victoria. A random s le of 30% of Victorian hospitals were asked to participate in the survey. Of 78 eligible institutions, 69 (88%) completed and returned questionnaires. There was no consistent hepatitis B prevention policy in place across Victoria. Of the 69 responding hospitals, 63 (91%) offered hepatitis B vaccination to staff, and 58 (84%) of these also paid all costs of vaccination. Of the 63 hospitals offering vaccination to staff, 39 offered vaccination to all staff, 23 offered vaccination based on job title, and one offered vaccination based on anticipated exposure. In many institutions, postexposure protocols were recalled more readily than preexposure vaccination guidelines. Numerous respondents indicated a need for clear guidelines on policy and clarification on practical matters of management, such as acceptable immune levels, management of nonresponders to the primary series, and the need for, and timing of, booster doses of vaccine. Eleven (18%) of the 63 hospitals offering hepatitis B vaccination to staff undertook routine prevaccination screening, a practice not generally regarded as cost-effective in Australia. Fifty-five of these hospitals (91%) also undertook postvaccination screening. It is evident from this study that a considerable number of potentially susceptible healthcare personnel in Victorian hospitals remain unprotected against hepatitis B infection. A more reliable and consistent approach to preexposure hepatitis B vaccination is recommended
Factors Associated with Discharge Against Medical Advice within Year of First-Ever IHD Hospital Admissions in Aboriginal and Non-Aboriginal Western Australians
Publisher: Elsevier BV
Date: 2011
Attracting, Recruiting, and Retaining Medical Workforce: A Case Study in a Remote Province of Indonesia
Publisher: MDPI AG
Date: 12-2022
DOI: 10.20944/PREPRINTS202212.0001.V1
Abstract: .Abstract: Indonesia, one of the Asia Pacific LMICs, has suffered from a chronic medical workforce shortage. However, there are limited published studies describing the approaches implemented by the Indonesian government regarding the recruitment and retention of the medical workforce. This case study aimed to understand the current practices for recruitment and retention of the medical workforce in Indonesian rural and remote provinces. We conducted a case study of the Maluku Province of Indonesia with document analysis and key informant interviews with officials responsible for medical workforce recruitment and retention. We used the WHO& rsquo s guidelines as an analytical matrix to examine the recruitment and retention practices under four domains, i) educational, ii) regulatory, iii) financial, and iv) professional and personal development, and classified them into University/Medical School level and Government/Non-government level. Our findings suggest that Indonesia has implemented most of the WHO-recommended medical workforce recruitment and retention strategies. However, implementation is still problematic hence, the aim of establishing an adequate, sustainable medical workforce has not been reached. Nationwide government intervention in educational aspects is important to magnify the impact of the regional medical school initiatives. Relevant programs must be re-evaluated and re-enforced concerning significance, comprehensiveness and effectiveness for sustainable rural and remote medical workforce.
Ontology Supported Assistive Communications in Healthcare
Publisher: Association for Information Systems
Date: 2014
DOI: 10.17705/1CAIS.03414
Police, permits and politics: Navigating life on Australia's state borders during the COVID-19 pandemic
Publisher: Wiley
Date: 03-2022
DOI: 10.1111/AJR.12845
Abstract: To explore the ways in which the Coronavirus disease‐19 (COVID‐19) pandemic has affected Australians who live and travel in cross‐border regions in the course of their daily lives. Semi‐structured interviews were undertaken with participants by telephone. The analysis utilised qualitative exploratory methods and provided rich data through immersive and reflexive analysis. Interviews of people across Australia. Of 90 people interviewed in relation to their experiences of the COVID‐19 pandemic, 13 described challenges related to border crossing that impacted their usual work and personal life. Description of challenges faced by Australians living close to state borders due to internal border closures in the early period of COVID‐19 (2020). Policy changes surrounding border closures negatively impacted people’s wellbeing in Australia with three key interconnected themes identified for Australians living in cross‐border regions. First, border closures presented participants of these communities with physical barriers which reduced access to healthcare and employment. Second, participants reported how restrictions on travel to neighboring states and territories impacted their mental wellbeing. Finally, many Australians in cross‐border regions faced financial struggles exacerbated by border closures. Normally, interstate borders are largely invisible with formalities relevant to few circumstances. Since the emergence of the COVID‐19 pandemic, Australians who used to regularly cross these borders in the course of their daily activities were no longer able or willing to do so due to the uncertain circumstances surrounding border policy. This study elaborates on the impact of these closures on people’s physical, financial, and emotional state.
Aboriginal-mainstream partnerships: Exploring the challenges and enhancers of a collaborative service arrangement for Aboriginal clients with substance use issues
Publisher: Springer Science and Business Media LLC
Date: 10-01-2013
Transfers to metropolitan hospitals and coronary angiography for rural Aboriginal and non-Aboriginal patients with acute ischaemic heart disease in Western Australia
Publisher: Springer Science and Business Media LLC
Date: 05-2014
Why should Australia adopt universal infant hepatitis B vaccination?
Publisher: Elsevier BV
Date: 08-2008
Sexually transmitted diseases: we must commit to contact tracing
Publisher: AMPCo
Date: 07-1997
DOI: 10.5694/J.1326-5377.1997.TB138796.X
Abstract: Endocrine therapy for breast cancer often leads to drug resistance and tumor recurrence tumor hypoxia is also associated with mortality and tumor relapse. Cytochrome P450 1B1 (CYP1B1) regulates estrogen metabolism in breast cells and is known to be overexpressed in breast cancer tissue. Although the in idual association of hypoxia-induced hypoxia-inducible factor-1-alpha (HIF-1α) and CYP1B1 with tumorigenesis is well known, the association between HIF-1α and CYP1B1 leading to tumorigenesis has not been investigated. Here, we investigated the correlation between hypoxia and CYP1B1 expression in breast cancer cells for tumorigenesis-related mechanisms. Hypoxia was induced in the human breast cancer cell lines MCF-7 (Er-positive) and MDA-MB-231 (triple-negative) and the normal breast epithelial cell line MCF10A these cell lines were then subjected to immunoblotting, transient transfection, luciferase assays, gene silencing using small interfering RNA, polymerase chain reaction analysis, chromatin immunoprecipitation, co-immunoprecipitation, and mammalian two-hybrid assays. Furthermore, immunofluorescence analysis of the tumor microarrays was performed, and the pub2015 and the Cancer Genome Atlas patient datasets were analyzed. HIF-1α expression in response to hypoxia occurred in both normal and breast cancer cells, whereas CYP1B1 was induced only in estrogen receptor α (ERα)-positive breast cancer cells under hypoxia. HIF-1α activated ERα through direct binding and in a ligand-independent manner to promote CYP1B1 expression. Therefore, we suggested the mechanism by which hypoxia and ER-positivity orchestrate breast cancer relapse.
'I don't know why they don't come': Barriers to participation in cardiac rehabilitation
Publisher: CSIRO Publishing
Date: 2010
DOI: 10.1071/AH09803
Abstract: Objectives. To describe health professionals’ perceptions of Aboriginal people’s access to cardiac rehabilitation (CR) services and the role of institutional barriers in implementing the National Health and Medical Research Council (NHMRC) guidelines Strengthening Cardiac Rehabilitation and Secondary Prevention for Aboriginal and Torres Strait Islander peoples. Design. Qualitative study. Setting. Metropolitan and rural tertiary and community-based public CR services and Aboriginal health services in WA. Participants. Thirty-eight health professionals working in the CR setting. Method. Semistructured interviews were undertaken with 28 health professionals at public CR services and 10 health professionals from Aboriginal Medical Services in WA. The participants represented 17 services (10 rural, 7 metropolitan) listed in the WA Directory of CR services. Results. Emergent themes included (1) a lack of awareness of Aboriginal CR patients’ needs (2) needs related to cultural awareness training for health professionals and (3) Aboriginal health staff facilitate access for Aboriginal patients. Conclusions. Understanding the institutional barriers to Aboriginal participation in CR is necessary to recommend viable solutions. Promoting cultural awareness training, recruiting Aboriginal health workers and monitoring participation rates are important in improving health outcomes. What is already known about this subject? Significant health and social inequity exists for Aboriginal Australians. Despite the persisting high rates of morbidity and mortality related to cardiovascular disease in Aboriginal Australians, participation rates in cardiac rehabilitation remain low. What does this paper add? Despite widespread dissemination of NHMRC guidelines, there remains a disconnect between CR health professionals’ understandings and practices and the needs of Aboriginal people in WA. Increasing the volume and quality of cultural awareness training as well as access to Aboriginal health professionals are crucial in addressing this disparity. What are the implications for practitioners? Increasing the number and support of Aboriginal people trained as health professionals will assist the system to respond better to the needs of communities. Collaborative partnership models where Aboriginal and non-Aboriginal health professionals work together to increase mutual understanding are warranted.
Delay in commencement of palliative care service episodes provided to Indigenous and non-Indigenous patients: cross-sectional analysis of an Australian multi-jurisdictional dataset
Publisher: Springer Science and Business Media LLC
Date: 12-2018
Hepatitis A vaccination of child care workers in Victoria: are recommendations being implemented?
Publisher: Elsevier BV
Date: 12-1998
DOI: 10.1111/J.1467-842X.1998.TB01504.X
Abstract: This study examined the self-reported hepatitis A and B immunisation status of child care workers, the level of awareness among child care workers of the NHMRC recommendation for immunisation against hep. A and centre practices. A confidential mail survey was conducted in June 1996 with workers and co-ordinators from 113 randomly selected child care centres. Co-ordinators completed a questionnaire on the centre's characteristics and immunisation policy. Child care workers completed a second questionnaire on their immunisation knowledge or beliefs and immunisation status. Ninety-five centres (85%) and 607 (74%) workers participated. Only 11% of workers were vaccinated against hep. A, although the majority of child care worker respondents believed their occupation placed them at increased risk. Those vaccinated were more likely to be aware of the availability of hep. A vaccine, of the NHMRC recommendation for hep. A vaccination, and to have been vaccinated for hep. B. Centres in which co-ordinators perceived hep. A vaccination as important, and those which recorded staff immunisation, particularly hep. A, were more likely to have child care workers who were vaccinated against hep. A. In contrast, nearly two-thirds of child care workers reported that they were vaccinated against hep. B, although hep. B is not routinely recommended by the NHMRC for child care workers. These findings show a need for further policy and educational initiatives in the implementation of an immunisation strategy for child care workers.
Sequential monitoring of peripheral blood lymphocyte subsets in rats
Publisher: Wiley
Date: 03-1986
Abstract: The methodology of enumeration of T cell subsets in humans is well established and has widespread clinical application. Sequential monitoring of lymphocyte subsets in small animals requires a consistent and reliable methodology for staining and enumerating lymphocyte populations. The optimal conditions for enumerating subclasses of rat peripheral blood lymphocytes with the Spectrum III flow cytometer are described. The sources of biological variation and technical error that were considered in optimizing the techniques and the limitations in applying them are discussed.
Evaluation of infection control in registered tattooing premises in Victoria, 1994
Publisher: Elsevier BV
Date: 02-2008
DOI: 10.1111/J.1467-842X.1997.TB01648.X
Abstract: Tattooists at a random s le of registered tattooing premises were surveyed for self-reported compliance with infection-control practices specified in the Victorian Standards of practice for tattooing, and some were observed while tattooing. Of 35 respondents, 94 per cent reported that they believed their practice fully met the standards, yet 19 per cent of tattooists did not have a copy of the standards at their premises. Most believed the standards could be improved. There was considerable discrepancy between reported practice and that observed. Few tattooists understood or implemented universal precautions, and while most wore gloves, there was low level of use of eye and clothing protection. Tattooists touched many surfaces that had not been cleaned or disinfected between clients. Ultrasonic cleaners were generally operated without lids. Because of this, they were a danger both to operators and their clients. At no premises was equipment used that had been both cleaned according to the standards and sterilised in an autoclave that had passed a sterilisation test. The situation in Victoria is similar to that identified in other states. There is an urgent need for training of tattooists and the environmental health officers who supervise them.
Considerations in planning physical activity for older adults in hot climates
Publisher: MDPI AG
Date: 02-02-2021
Abstract: Regular physical activity has multiple health benefits for both the prevention and management of disease, including for older adults. However, additional precautions are needed with ageing given physiological changes and the increasing prevalence of comorbidities. Hot ambient temperatures increase the risks of exercise at any age, but are particularly important given thermoregulatory changes in older people. This narrative review informs planning of physical activity programs for older people living in rural areas with very hot climates for a period of the year. A multi-database search of peer-reviewed literature was undertaken with attention to its relevance to Australia, starting with definitions and standard advice in relation to physical activity programming and the incremental limitations imposed by age, rurality, and extreme heat. The enablers of and barriers to increasing physical activities in older adults and how they can be modified for those living in extreme hot climates is described. We describe multiple considerations in program design to improve safety, adherence and sustaining physical activity, including supervision, simple instructions, provision of reminders, social support, encouraging self-efficacy. Group-based activities may be preferred by some and can accommodate special populations, cultural considerations. Risk management is an important consideration and recommendations are provided to assist program planning.
Patterns of Medicare-funded primary health and specialist consultations in Aboriginal and non-Aboriginal Australians in the two years before hospitalisation for ischaemic heart disease
Publisher: Springer Science and Business Media LLC
Date: 02-08-2018
Using the Healthy Community Assessment Tool: Applicability and Adaptation in the Midwest of Western Australia
Publisher: MDPI AG
Date: 02-06-2018
Factors associated with perceived stigma among people living with HIV/AIDS in post-conflict northern Uganda
Publisher: Guilford Publications
Date: 06-2011
DOI: 10.1521/AEAP.2011.23.3.193
Abstract: HIV-related stigma continues to persist in several African countries including Uganda. This study quantified the burden of stigma and examined factors associated with stigma among 476 people living with HIV (PLHTV) in Gulu, northern Uganda. Data were collected between February and May 2009 using the HIV/AIDS Stigma Instrument-PLWA. Females more than males, respondents aged above 30 years, and those who had been on antiretroviral therapy for a longer time experienced higher levels of stigma. Verbal abuse and negative self-perception were more common forms of stigma. The association between antiretroviral therapy and stigma suggested that organizational aspects of antiretroviral delivery may lead to stigmatization of PLHIV. Interventions such as counseling of PLHIV, education of health workers and the community would lead to reductions in negative self-perception and verbal abuse and in turn improve the quality of life for PLHIV in northern Uganda.
Beyond enrolments
Publisher: Springer Science and Business Media LLC
Date: 02-09-2019
''If you don't believe it, it won't help you'': Use of bush medicine in treating cancer among Aboriginal people in Western Australia
Publisher: Springer Science and Business Media LLC
Date: 23-06-2010
Abstract: Little is known about the use of bush medicine and traditional healing among Aboriginal Australians for their treatment of cancer and the meanings attached to it. A qualitative study that explored Aboriginal Australians' perspectives and experiences of cancer and cancer services in Western Australia provided an opportunity to analyse the contemporary meanings attached and use of bush medicine by Aboriginal people with cancer in Western Australia Data collection occurred in Perth, both rural and remote areas and included in idual in-depth interviews, observations and field notes. Of the thirty-seven interviews with Aboriginal cancer patients, family members of people who died from cancer and some Aboriginal health care providers, 11 participants whose responses included substantial mention on the issue of bush medicine and traditional healing were selected for the analysis for this paper. The study findings have shown that as part of their healing some Aboriginal Australians use traditional medicine for treating their cancer. Such healing processes and medicines were preferred by some because it helped reconnect them with their heritage, land, culture and the spirits of their ancestors, bringing peace of mind during their illness. Spiritual beliefs and holistic health approaches and practices play an important role in the treatment choices for some patients. Service providers need to acknowledge and understand the existence of Aboriginal knowledge (epistemology) and accept that traditional healing can be an important addition to an Aboriginal person's healing complementing Western medical treatment regimes. Allowing and supporting traditional approaches to treatment reflects a commitment by modern medical services to adopting an Aboriginal-friendly approach that is not only culturally appropriate but assists with the cultural security of the service.
Putting Policy into Practice
Publisher: MDPI AG
Date: 06-01-2022
Abstract: Improving cancer outcomes for Indigenous people by providing culturally safe, patient-centred care is a critical challenge for health services worldwide. This article explores how three Australian cancer services perform when compared to two national best practice guidelines: the National Aboriginal and Torres Strait Islander Cancer Framework (Cancer Framework) and the National Safety and Quality Health Service (NSQHS) User Guide for Aboriginal and Torres Strait Islander Health (User Guide). The services were identified through a nationwide project undertaken to identify cancer services providing treatment to Indigenous cancer patients. A small number of services which were identified as particularly focused on providing culturally safe cancer care participated in case studies. Interviews were conducted with 35 hospital staff (Indigenous and non-Indigenous) and 8 Indigenous people affected by cancer from the three services. The interviews were analysed and scored using a traffic light system according to the seven priorities of the Cancer Framework and the six actions of the NSQHS User Guide. While two services performed well against the User Guide, all three struggled with the upstream elements of the Cancer Framework, suggesting that the treatment-focused Optimal Care Pathway for Aboriginal and Torres Strait Islander People with Cancer (Cancer Pathway) may be a more appropriate framework for tertiary services. This article highlights the importance of a whole-of-organisation approach when addressing and embedding the six actions of the User Guide. Health services which have successfully implemented the User Guide are in a stronger position to implement the Cancer Framework and Cancer Pathway.
The effect of regular sunscreen use on vitamin D levels in an Australian population: Results of a randomized controlled trial
Publisher: American Medical Association (AMA)
Date: 04-1995
Diabetes foot care education movies for Aboriginal people: Bran nue leg
Publisher: Wiley
Date: 09-2016
DOI: 10.1071/HE15040
Timely cancer diagnosis and management as a chronic condition: opportunities for primary care
Publisher: AMPCo
Date: 07-2008
DOI: 10.5694/J.1326-5377.2008.TB01921.X
Abstract: One in three men and one in four women in Australia will be diagnosed with cancer in the first 75 years of life. The majority will survive the cancer and ultimately die from unrelated causes. Many cancer patients and their families will experience some physical, social, economic and psychological sequelae, regardless of the prognosis. A recurring theme is that patients are disadvantaged by the lack of coordination of care and their needs are not being adequately met. We argue that greater integration of care through a multidisciplinary team of professionals, peer support groups and primary health practitioners functioning within a care hub could offer better practical and psychosocial supportive care for patients and their families.
Findings from a clinical audit in regional general practice of management of patients following acute coronary syndrome
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/PY15191
Abstract: Patients with acute coronary syndrome (ACS) require ongoing treatment and support from their primary care provider to modify cardiovascular risk factors (including diet, exercise and mood), to receive evidence-based pharmacotherapies and be properly monitored and to ensure their take-up and completion of cardiac rehabilitation (CR). This study assesses adherence to National Heart Foundation guidelines for ACS in primary care in a regional centre in Western Australia. Patients discharged from hospital after a coronary event (unstable angina or myocardial infarction) or a coronary procedure (stent or coronary artery bypass graft) were identified through general practice electronic medical records. Patient data was extracted using a data form based on National Heart Foundation guidelines. Summary statistics were calculated and reported. Our study included 22 GPs and 44 patients in a regional centre. In total, 90% (n=39) of discharge summaries recorded medications. Assessment of pharmacological management showed that 53% (n=23) of patients received four or more classes of pharmacotherapy and that GPs often augmented medication beyond that prescribed at discharge. Of 15 smokers, 13 (87%) had advice to quit documented. Minimal advice for other risk-factor modification was documented in care plans. Patients with type 2 diabetes (n=20) were 70% more likely to receive allied health referral (P=0.02) and 60% more likely to receive advice regarding diet and exercise (P=0.007). However, overall, only 30% (n=13) of those eligible were referred to a dietician, and only 25% were referred to CR (n=10) with six completing CR. Although most GPs did not use standardised tools for mood assessment, 18 (41%) patients were diagnosed as depressed, of which 88% (n=16) were started on antidepressants and 28% (n=6) were referred to a psychologist. Although pharmacotherapy, mood management and smoking cessation management generally followed recommended guidelines, risk factor management relating to diet and exercise by GPs require improvement. Detailed care plans and referral to CR and allied health staff for patient support is recommended.
Missing Voices: Profile, extent, and 12-month outcomes of nonfatal traumatic brain injury in Aboriginal and non-Aboriginal adults in Western Australia using linked administrative records
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2018
Symptom-related distress among indigenous Australians in specialist end-of-life care
Publisher: MDPI AG
Date: 30-04-2020
Abstract: Symptom relief is fundamental to palliative care. Aboriginal and Torres Strait Islander (Indigenous) Australians are known to experience inequities in health care delivery and outcomes, but large-scale studies of end-of-life symptoms in this population are lacking. We compared symptom-related distress among Indigenous and non-Indigenous Australian patients in specialist palliative care using the multi-jurisdictional Palliative Care Outcomes Collaboration dataset. Based on patient-reported rating scale responses, adjusted relative risks (aRRs) stratified by care setting were calculated for occurrence of (i) symptom-related moderate-to-severe distress and worsening distress during a first episode of care and (ii) symptom-related moderate-to-severe distress at the final pre-death assessment. The p-value significance threshold was corrected for multiple comparisons. First-episode frequencies of symptom-related distress were similar among Indigenous (n = 1180) and non-Indigenous (n = 107,952) patients in both inpatient and community settings. In final pre-death assessments (681 Indigenous and 67,339 non-Indigenous patients), both groups had similar occurrence of moderate-to-severe distress when care was provided in hospital. In community settings, Indigenous compared with non-Indigenous patients had lower pre-death risks of moderate-to-severe distress from overall symptom occurrence (aRR 0.78 p = 0.001 confidence interval [CI] 0.67–0.91). These findings provide reassurance of reasonable equivalence of end-of-life outcomes for Indigenous patients who have been accepted for specialist palliative care.
Hospital utilisation patterns for cardiovascular disease (CVD) 12 months post first-ever acute coronary syndrome (ACS) in Aboriginal and non-Aboriginal patients
Publisher: Elsevier BV
Date: 2017
It made me feel Brazilian!: Addressing prejudice through Capoeira classes in a school in Western Australia
Publisher: Wiley
Date: 23-11-2019
DOI: 10.1002/HPJA.219
Abstract: Social inclusion is important for mental health, and schools are important settings for creating positive attitudes against prejudice. Capoeira is a Brazilian traditional culture that is a mixture of dance, martial arts and games, and has many educational possibilities. Since it arose from and helped people rise above black oppression, the purpose of the project was introducing the content of capoeira to primary school students with the aim of promoting of mental health and preventing prejudice behaviours using an intercultural perspective in a school where nearly half the students are Aboriginal. Five capoeira classes were conducted in a primary school located in a regional city in Western Australia, with two Year 5-6 classes and boys and girls aged 11-12 years old. Activities were meant to create an environment of dialogue, joy and empathy towards a different culture. Feedback from 31 of 34 students were collected and analysed, dealing with their impressions, positive and negative aspects. The results were positive, with aspects of movement, joy, dance and music identified as important experiences. Empathy towards the new culture was written and drawn by many of the students. Joint work with teachers improved engagement and feedback from students. Capoeira can be an inspiring vehicle in intercultural education, promoting mental health and empathy for different cultures. SO WHAT?: Broad intercultural education which embraces positive cultural experiences and stories from elsewhere, delivered in schools can contribute to children's intercultural competence. Longer interventions with follow-up to measure changes in students' attitudes are required.
Juvenile offenders and hepatitis B: risk, vaccine uptake and vaccination status
Publisher: AMPCo
Date: 09-1998
DOI: 10.5694/J.1326-5377.1998.TB140281.X
Abstract: To determine the hepatitis B vaccination status of juvenile offenders in a custodial setting, their perceived risk of hepatitis B infection, and factors influencing vaccine uptake. 130 males aged 14-17 years resident at the Melbourne Juvenile Justice Centre for at least one week between mid-January and mid-December 1996 were invited to participate 90 (69%) completed a doctor-administered questionnaire, and blood for serological testing was obtained from 83 of these participants. Whether hepatitis B vaccine had been offered whether hepatitis B vaccine had been given the presence of antibodies to hepatitis B and C risk factors and self-perceived risk of hepatitis B. About a quarter of participants (22/83) had protective levels of antibody to hepatitis B surface antigen (anti-HBs). Forty (44%) participants reported having been offered hepatitis B vaccine they were more likely to be vaccinated and have protective levels of anti-HBs. Perceived risk for bloodborne virus infection was low, although two-thirds of participants were at high risk of hepatitis B infection. On serological testing, 6.4% (5/78) were positive for antibody to hepatitis B core antigen (anti-HBc), and a further 2.6% (2) had equivocal antibody levels. Of the 71 who were negative for anti-HBc, 51 (71.8%) were negative for anti-HBs. The targeted hepatitis B vaccination program has not adequately protected this group at high lifetime risk of hepatitis B. Failure to deliver vaccine may reflect lack of contact with healthcare services, oversight in offering vaccine and reluctance of youth to participate in preventive healthcare measures, often through not seeing themselves to be at risk. Universal approaches to vaccination may be more successful in vaccinating this group.
Prevalence of stroke and coexistent conditions: disparities between Indigenous and non-Indigenous Western Australians
Publisher: SAGE Publications
Date: 10-2014
DOI: 10.1111/IJS.12278
Abstract: Worldwide, the prevalence of stroke is poorly described in indigenous populations, despite high stroke burden. This paper reports the average point prevalence of hospitalized stroke and coexistent conditions (2007–2011) in indigenous and nonindigenous people in Western Australia, the largest and most sparsely populated Australian jurisdiction. Using state-wide linked hospital and mortality data, indigenous and nonindigenous prevalent stroke cases (aged 25–84 years) were identified after reviewing stroke admissions over a fixed 20-year look-back period. Prevalent cases were those alive at midyear of each study year. The 2007–2011 period prevalence was a weighted average of annual prevalence. Histories of 11 comorbidities were identified using the 20-year look-back period. Indigenous cases comprised 5% of the average 13 591 annual prevalent cases. Indigenous patients were more likely to be younger, female, and have unknown stroke type. Indigenous prevalence was higher at every age. The age-standardized prevalence in indigenous men (33·7 per 1000 95% confidence interval 31·9–35·4) was 3.7 times greater than in nonindigenous men (9·1 per 1000 95% confidence interval 9·0–9·2). The corresponding estimates for women were 27·1 per 1000 (25·7–28·4) and 6·1 per 1000 (6·0–6·2) (ratio = 4·4). The percentage with selected comorbid conditions was substantially higher for indigenous patients. The high stroke prevalence in indigenous Western Australians, coupled with clinical complexity from comorbid conditions, requires access to culturally appropriate medical, rehabilitation, and logistical support. Intensified primary and secondary prevention is needed to reduce the impact of stroke on indigenous people.
Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: The perspective of service providers
Publisher: Springer Science and Business Media LLC
Date: 04-11-2013
Study protocol for a prospective process evaluation of a culturally secure rehabilitation programme for Aboriginal Australians after brain injury
Publisher: BMJ
Date: 09-2021
DOI: 10.1136/BMJOPEN-2020-046042
Abstract: Aboriginal and Torres Strait Islander (hereafter respectfully referred to as Aboriginal) people are Australia’s First Peoples, having the longest continuous culture in the world and deep spiritual connections with ancestral land. Improvements in their health and well-being is a major policy goal of Australian governments, as the legacy of colonisation and disruption of cultural practices contribute to major health challenges. Lack of culturally secure services impacts participation of Aboriginal people in health services. Aboriginal people with a brain injury typically experience poor access to rehabilitation and support following hospital discharge. ‘Healing Right Way’ (HRW) is a randomised control trial aiming to improve access to interdisciplinary and culturally secure rehabilitation services for Aboriginal people after brain injury in Western Australia, improve health outcomes and provide the first best practice model. This protocol is for the process evaluation of the HRW trial. A prospective mixed methods process evaluation will use the Consolidated Framework for Implementation Research to evaluate implementation and intervention processes involved in HRW. Data collection includes qualitative and quantitative data from all sites during control and intervention phases, relating to three categories: (1) implementation of trial processes (2) cultural security training and (3) Aboriginal Brain Injury Coordinator role. Additional data elements collected from HRW will support the process evaluation regarding fidelity and intervention integrity. Iterative cross-sectional and longitudinal data synthesis will support the implementation of HRW, interpretation of findings and inform future development and implementation of culturally secure interventions for Aboriginal people. This process evaluation was reviewed by The University of Western Australia Human Research Ethics Committee (RA/4/20/4952). Evaluation findings will be disseminated via academic mechanisms, seminars at trial sites, regional Aboriginal health forums, peak bodies for Aboriginal health organisations and the Australian Indigenous HealthInfoNet ( healthinfonet.ecu.edu.au/ ). ACTRN12618000139279.
Perspectives of Aboriginal women on participation in mammographic screening
Publisher: Springer Science and Business Media LLC
Date: 11-09-2017
Improving rural and remote practitioners’ knowledge of the diabetic foot: findings from an educational intervention
Publisher: Springer Science and Business Media LLC
Date: 29-07-2016
Identifying culturally appropriate strategies for coronary heart disease secondary prevention in a regional Aboriginal Medical Service
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/PY12117
Abstract: Aboriginal Australians experience high rates of coronary heart disease (CHD) at an early age, highlighting the importance of effective secondary prevention. This study employed a two-stage process to evaluate CHD management in a regional Aboriginal Medical Service. Stage 1 involved an audit of 94 medical records of clients with documented CHD using the Audit and Best Practice in Chronic Disease approach to health service quality improvement. Results from the audit informed themes for focus group discussions with Aboriginal Medical Service clients (n = 6) and staff (n = 6) to ascertain barriers and facilitators to CHD management. The audit identified that chronic disease management was the focus of appointments more frequently than in national data (P 0.05), with brief interventions for lifestyle modification occurring at similar or greater frequency. However, referrals to follow-up support services for secondary prevention were lower (P 0.05). Focus groups identified psychosocial factors, systemic shortcomings, suboptimal medication use and variable awareness of CHD signs and symptoms as barriers to CHD management, whereas family support and culturally appropriate education promoted health care. To optimise CHD secondary prevention for Aboriginal people, health services require adequate resources to achieve best-practice systems of follow up. Routinely engaging clients is required to ensure services meet erse community needs.
Feasibility and acceptability of opportunistic screening to detect atrial fibrillation in Aboriginal adults
Publisher: Elsevier BV
Date: 08-2019
Abstract: Examine the feasibility and acceptability of an electrocardiogram (ECG) attached to a mobile phone (iECG) screening device for atrial fibrillation (AF) in Aboriginal Controlled Community Health Services (ACCHS) and other community settings. Semi-structured interviews were conducted with ACCHS staff in urban, rural and remote communities in three Australian states/territories. Quantitative and qualitative questions identified the enabling factors and barriers for staff and Aboriginal patients' receptiveness to the device. Mean quantitative scores and their standard deviation were calculated in Microsoft Excel and qualitative questions were thematically analysed. Eighteen interviews were conducted with 23 staff across 11 ACCHS. Quantitative data found staff were confident in providing iECG screening and managing the referral pathway, and thought the process was beneficial for patients. Qualitative data highlighted the usefulness of the device to undertake opportunistic screening and acceptability in routine practice, and provided opportunities to engage patients in education around AF. The iECG device was well accepted within ACCHSs and was feasible to use to screen for AF among Aboriginal patients. Implications for public health: The device can be used in clinical and community settings to screen Aboriginal people for atrial fibrillation to help reduce rates of stroke and other cardiovascular diseases.
The enablers, barriers and preferences of accessing radiation therapy facilities in the rural developed world – a systematic review
Publisher: Springer Science and Business Media LLC
Date: 28-11-2017
Learning to Fit in: An Exploratory Study of General Perceived Self Efficacy in Selected Refugee Groups
Publisher: Springer Science and Business Media LLC
Date: 16-11-2011
DOI: 10.1007/S10903-011-9547-5
Abstract: As self efficacy beliefs help determine an in idual's response to challenging situations, we explored the impact of the refugee experience on efficacy beliefs and their contribution to resettlement. General self efficacy (GSE) was assessed in 186 resettled Afghan and Kurdish refugees against a range of personal and temporal variables. Although no differences in GSE in relation to temporal factors were noted, significant relationships between self efficacy, lower psychological distress and higher subjective well being were evident. The findings suggest that GSE, because of its positive association with mental health and well being, is a variable worthy of further examination in refugees. In addition to ensuring a supportive environment for learning English, proactive employment strategies should be encouraged. Further research examining the use of successful refugee role models to promote self efficacy, enhance motivation for learning and ensure newly arrived refugees view resettlement as a challenge, rather than a threat, is recommended.
Improving cardiovascular outcomes among Aboriginal Australians
Publisher: SAGE Publications
Date: 2016
Abstract: The Aboriginal people of Australia have much poorer health and social indicators and a substantial life expectancy gap compared to other Australians, with premature cardiovascular disease a major contributor to poorer health. This article draws on research undertaken to examine cardiovascular disparities and focuses on ways in which primary care practitioners can contribute to reducing cardiovascular disparities and improving Aboriginal health. The overall research utilised mixed methods and included data analysis, interviews and group processes which included Aboriginal people, service providers and policymakers. Workshop discussions to identify barriers and what works were recorded by notes and on whiteboards, then distilled and circulated to participants and other stakeholders to refine and validate information. Additional engagement occurred through circulation of draft material and further discussions. This report distils the lessons for primary care practitioners to improve outcomes through management that is attentive to the needs of Aboriginal people. Aspects of primordial, primary and secondary prevention are identified, with practical strategies for intervention summarised. The premature onset and high incidence of Aboriginal cardiovascular disease make prevention imperative and require that primary care practitioners understand and work to address the social underpinnings of poor health. Doctors are well placed to reinforce the importance of healthy lifestyle at all visits to involve the family and to reduce barriers which impede early care seeking. Ensuring better information for Aboriginal patients and better integrated care for patients who frequently have complex needs and multi-morbidities will also improve care outcomes. Primary care practitioners have an important role in improving Aboriginal cardiovascular care outcomes. It is essential that they recognise the special needs of their Aboriginal patients and work at multiple levels both outside and inside the clinic for prevention and management of disease. A toolkit of proactive and holistic opportunities for interventions is proposed.
Improving Access to Cancer Treatment Services in Australia’s Northern Territory—History and Progress
Publisher: MDPI AG
Date: 23-06-2022
Abstract: Cancer is the leading cause of death in the Northern Territory (NT), Australia’s most sparsely populated jurisdiction with the highest proportion of Aboriginal people. Providing cancer care to the NT’s erse population has significant challenges, particularly related to large distances, limited resources and cultural differences. This paper describes the developments to improve cancer treatment services, screening and end-of-life care in the NT over the past two decades, with a particular focus on what this means for the NT’s Indigenous peoples. This overview of NT cancer services was collated from peer-reviewed literature, government reports, cabinet papers and personal communication with health service providers. The establishment of the Alan Walker Cancer Care Centre (AWCCC), which provides radiotherapy, chemotherapy and other specialist cancer services at Royal Darwin Hospital, and recent investment in a PET Scanner have reduced patients’ need to travel interstate for cancer diagnosis and treatment. The new chemotherapy day units at Alice Springs Hospital and Katherine Hospital and the rapid expansion of tele-oncology have also reduced patient travel within the NT. Access to palliative care facilities has also improved, with end-of-life care now available in Darwin, Alice Springs and Katherine. However, future efforts in the NT should focus on increasing and improving travel assistance and support and increasing the availability of appropriate accommodation ongoing implementation of strategies to improve recruitment and retention of health professionals working in cancer care, particularly Indigenous health professionals and expanding the use of telehealth as a means of delivering cancer care and treatment.
Are we really committed to making a difference? Reflections on Indigenous health research and dissemination
Publisher: Elsevier BV
Date: 10-2009
An exploration of inter-organisational partnership assessment tools in the context of Australian Aboriginal-mainstream partnerships: a scoping review of the literature
Publisher: Springer Science and Business Media LLC
Date: 23-04-2015
Let us not forget what the Romans did do—The impact of RHMT
Publisher: Wiley
Date: 25-07-2023
DOI: 10.1111/AJR.13023
Approaches to Facilitate Improved Recruitment, Development, and Retention of the Rural and Remote Medical Workforce: A Scoping Review Protocol
Publisher: Maad Rayan Publishing Company
Date: 10-03-2020
Abstract: Background: Medical workforce scarcity in rural and remote communities is a global problem, severely challenging healthcare delivery and health equity. Both developed and developing countries report geographically uneven distributions of the medical workforce. This scoping review synthesizes evidence from peer-reviewed and grey literature concerning approaches implemented to improve the recruitment, development, and retention of the rural medical workforce in both developed and developing countries. Methods: We will utilize the Arksey and O’Malley (2005) framework as the basis for this scoping review. The databases to be searched include Medline, Embase, Global Health, CINAHL Plus, and PubMed for articles from the last decade (2010-2019). Searches for unpublished studies and grey literature will be undertaken using the Google Scholar - Advanced Search tool. Quantitative and qualitative study designs will be included. Two authors will independently screen and extract relevant articles and information, with disagreements resolved by a third. Quantitative and qualitative analyses (thematic) will be conducted to evaluate and categorize the study findings. Discussion: The scoping review will aid in mapping the available evidence for approaches implemented to advance the process of recruitment, development, and retention of the medical workforce in the rural and remote areas in developed and developing nations.
Smoking cessation in indigenous populations of Australia, New Zealand, Canada, and the United States: Elements of effective interventions
Publisher: MDPI AG
Date: 31-01-2011
Heart failure among Indigenous Australians: a systematic review
Publisher: Springer Science and Business Media LLC
Date: 11-2012
Owning solutions: a collaborative model to improve quality in hospital care for Aboriginal Australians
Publisher: Wiley
Date: 10-07-2012
DOI: 10.1111/J.1440-1800.2011.00546.X
Abstract: Well-documented health disparities between Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) and non-Aboriginal Australians are underpinned by complex historical and social factors. The effects of colonisation including racism continue to impact negatively on Aboriginal health outcomes, despite being under-recognised and under-reported. Many Aboriginal people find hospitals unwelcoming and are reluctant to attend for diagnosis and treatment, particularly with few Aboriginal health professionals employed on these facilities. In this paper, scientific literature and reports on Aboriginal health-care, methodology and cross-cultural education are reviewed to inform a collaborative model of hospital-based organisational change. The paper proposes a collaborative model of care to improve health service delivery by building capacity in Aboriginal and non-Aboriginal personnel by recruiting more Aboriginal health professionals, increasing knowledge and skills to establish good relationships between non-Aboriginal care providers and Aboriginal patients and their families, delivering quality care that is respectful of culture and improving Aboriginal health outcomes. A key element of model design, implementation and evaluation is critical reflection on barriers and facilitators to providing respectful and culturally safe quality care at systemic, interpersonal and patient/family-centred levels. Nurses are central to addressing the current state of inequity and are pivotal change agents within the proposed model.
Preventing depression among older people living in rural areas: A randomised controlled trial of behavioural activation in collaborative care
Publisher: Wiley
Date: 31-10-2021
DOI: 10.1002/GPS.5449
Abstract: This study aimed to test if a behavioural activation (BA) programme was more effective than usual care at reducing the risk of conversion to major depression over 52 weeks among adults aged 65 years or older living in rural Western Australia. Secondary aims were to test if participants assigned to the BA intervention experienced greater decline in the severity of depressive and anxiety symptoms than older adults treated with usual care over 26 and 52 weeks, as well as greater improvement in physical and mental health‐related quality of life. Randomised controlled clinical trial that started recruitment in February 2016 in rural Western Australia. We used the electoral roll to invite adults aged 65 years or over living in suitable regions of Western Australia to take part in the study. We recruited those who consented and screened positive to at least one of the two Whooley questions: feeling down/depressed/hopeless or little interest or pleasure over the past month. Participants were randomly assigned to usual care or usual care plus a phone‐delivered BA program (1:1). The intervention consisted of a self‐managed BA program supported by three 45‐min phone sessions delivered by a BA therapist over a period of 8 weeks. We used the DSM‐5 criteria to establish the presence of a major depressive episode, and Patient Health Questionnaire, Generalised Anxiety Disorder Scale and SF‐36 to assess symptoms of depression, anxiety and quality of life. Of the 309 older adults randomised, 307 started the trial: 153 usual care and 154 BA (computer‐generated random permuted even blocks ranging in size from 8 to 20). Six participants developed a major depressive episode during follow‐up, four of them in the usual care group (odds ratio of depression associated with the intervention = 0.49, 95% CI = 0.04, 3.49—blind assessment). Seventy‐three (23.8%) participants were lost over 52 weeks—there were no differences between usual care and intervention group. Intention‐to‐treat analyses using mixed regression models found modest non‐significant effects of the BA intervention, while complete‐case analyses showed that participants treated with BA compared with usual care experienced significant improvements in depression and anxiety symptoms over 52 weeks, as well as improved mental health quality of life. Few participants developed a major depressive episode during follow‐up. The BA intervention was associated with improved symptoms of depression and anxiety, although the clinical significance of these benefits remains unclear.
Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: a pooled analysis of 96 population-based studies with 331 288 participants
Publisher: Elsevier BV
Date: 08-2015
Resettlement experiences and resilience in refugee youth in Perth, Western Australia
Publisher: Springer Science and Business Media LLC
Date: 10-06-2015
Documentation of children’s vaccination status in child care centres in Victoria
Publisher: Wiley
Date: 04-1998
DOI: 10.1046/J.1440-1754.1998.00194.X
Abstract: To assess the record-keeping of child care centres in Victoria with respect to children's vaccination status. A random s le of 113 centres from a list of over 800 registered Victorian child care centres received a mailed questionnaire on characteristics and policies of the centre, including documentation of attending children's vaccination status. The response rate was 86.7% more than 95% of centres had children under two in care. Only 85% of centres kept any record of children's immunisation status, with smaller centres and class 2 centres (occasional care centres) significantly less likely to keep records. Records were updated irregularly. Fewer than half of the centres studied kept a record of whether children had been vaccinated against Haemophilus influenzae type b. Despite the importance of documenting children's vaccination status, many child care centres have failed to develop adequate systems to record or update records of children's immunisation. This makes exclusion during outbreaks of a vaccine-preventable disease difficult. The ongoing process of accreditation may eventually improve performance, but both legislation and a better educational strategy to improve practice in this area are needed.
Statistical analysis plan for the stepped wedge clinical trial Healing Right Way-enhancing rehabilitation services for Aboriginal Australians after brain injury
Publisher: Springer Science and Business Media LLC
Date: 22-10-2022
DOI: 10.1186/S13063-022-06800-0
Abstract: Aboriginal Australians are known to suffer high levels of acquired brain injury (stroke and traumatic brain injury) yet experience significant barriers in accessing rehabilitation services. The aim of the Healing Right Way trial is to evaluate a culturally secure intervention for Aboriginal people with newly acquired brain injury to improve their rehabilitation experience and quality of life. Following publication of the trial protocol, this paper outlines the statistical analysis plan prior to locking the database. The trial involves a stepped wedge design with four steps over 3 years. Participants were 108 adult Aboriginal Australians admitted to one of eight hospitals (four rural, four urban) in Western Australia within 6 weeks of onset of a new stroke or traumatic brain injury who consented to follow-up for 26 weeks. All hospital sites started in a control phase, with the intervention assigned to pairs of sites (one metropolitan, one rural) every 26 weeks until all sites received the intervention. The two-component intervention involves training in culturally safe care for hospital sites and enhanced support provided to participants by Aboriginal Brain Injury Coordinators during their hospital stay and after discharge. The primary outcome is quality of life as measured by the Euro QOL–5D-3L VAS. A mixed effects linear regression model will be used to assess the between-group difference at 26 weeks post-injury. The model will control for injury type and severity, age at recruitment and time since commencement of the trial, as fixed effects. Recruitment site and participant will be included as random effects. Secondary outcomes include measurements of function, independence, anxiety and depression, carer strain, allied health occasions of service received and hospital compliance with minimum processes of care based on clinical guidelines and best practice models of care. The trial will provide the first data surrounding the effectiveness of an intervention package for Aboriginal people with brain injury and inform future planning of rehabilitation services for this population. The statistical analysis plan outlines the analyses to be undertaken. Australia New Zealand Clinical Trials Registry ACTRN12618000139279. Registered 30 January, 2018.
Voting with their feet - Predictors of discharge against medical advice in Aboriginal and non-Aboriginal ischaemic heart disease inpatients in Western Australia: An analytic study using data linkage
Publisher: Springer Science and Business Media LLC
Date: 20-08-2013
Men Against Violence
Publisher: Wiley
Date: 21-04-2021
DOI: 10.1002/HPJA.343
Abstract: Discussion of family violence is important but many men and boys struggle to engage with the topic. Primary prevention approaches focus on communicating with and educating the population, including men and boys, in the areas of healthy relationships, gender and violence. There can be both barriers to and also gains from these interventions. This paper describes a project implemented in Geraldton, Western Australia, and discusses what has been effective and ineffective during the project. The ‘Men Against Violence’ project targeted men and boys through local sporting clubs in the City of Greater Geraldton, in the Midwest region of Western Australia, through the use of face to face education, community radio and television interviews and other appropriate engagement strategies. ‘Men Against Violence’ events were held to connect with local male community members and address the role men can have in family violence prevention. We describe the three key engagement activities, working with the local Australian Rules football league, state‐league basketball team and a local high school Aboriginal football academy. These strategies provided avenues for contact with and the education of men and boys aged 12 years and older. Through successful partnerships with a number of local organisations, the ‘Men Against Violence’ project saw a high level of engagement with local men. The project also gained strong community support, with pockets of resistance encountered and managed. The ‘Men Against Violence’ project experienced highlights and barriers throughout the pilot project that can guide and inform future family violence prevention programs.
Let's CHAT (community health approaches to) dementia in Aboriginal and Torres Strait Islander communities
Publisher: Springer Science and Business Media LLC
Date: 12-03-2020
DOI: 10.1186/S12913-020-4985-1
Abstract: Documented rates of dementia and cognitive impairment not dementia (CIND) in older Aboriginal and Torres Strait Islander Peoples is 3–5 times higher than the rest of the population, and current evidence suggests this condition is under-diagnosed and under-managed in a clinical primary care setting. This study aims to implement and evaluate a culturally responsive best practice model of care to optimise the detection and management of people with cognitive impairment and/or dementia, and to improve the quality of life of carers and older Aboriginal and Torres Islander Peoples with cognitive impairment. The prospective study will use a stepped-wedge cluster randomised controlled trial design working with 12 Aboriginal Community Controlled Health Services (ACCHSs) across four states of Australia. Utilising a co-design approach, health system adaptations will be implemented including (i) development of a best practice guide for cognitive impairment and dementia in Aboriginal and Torres Strait Islander communities (ii) education programs for health professionals supported by local ch ions and (iii) development of decision support systems for local medical software. In addition, the study will utilise a knowledge translation framework, the Integrated Promoting Action on Research Implementation in Health Services (iPARIHS) Framework, to promote long-term sustainable practice change. Process evaluation will also be undertaken to measure the quality, fidelity and contextual influences on the outcomes of the implementation. The primary outcome measures will be rates of documentation of dementia and CIND, and evidence of improved management of dementia and CIND among older Indigenous peoples attending Aboriginal and Torres Strait Islander primary care services through health system changes. The secondary outcomes will be improvements to the quality of life of older Indigenous peoples with dementia and CIND, as well as that of their carers and families. The Let’s CHAT Dementia project will co-design, implement and evaluate a culturally responsive best practice model of care embedded within current Indigenous primary health care. The best practice model of care has the potential to optimise the timely detection (especially in the early stages) and improve the ongoing management of people with dementia or cognitive impairment. ACTRN12618001485224 . Date of registration: 04 of September 2019
Exploring systems that support good clinical care in indigenous primary health-care services: A retrospective analysis of longitudinal systems assessment tool data from high-improving services
Publisher: Frontiers Media SA
Date: 24-03-2017
The Special Issue on Indigenous health
Publisher: Elsevier BV
Date: 07-2010
Risk factors for hepatitis C transmission in the Victorian population: a telephone survey
Publisher: Elsevier BV
Date: 12-1999
DOI: 10.1111/J.1467-842X.1999.TB01548.X
Abstract: To measure knowledge and prevalences of risk factors for hepatitis C infection in the Victorian community. Telephone survey of 757 Victorian householders aged 15+ years, March 1996. An estimated 2.2% of Victorians have injected illicit drugs 4.8% have tattoos and 49.6% have skin piercings 11.4% received a blood transfusion before screening for HCV was introduced 10.9% have had a test for HCV antibody. A majority of respondents perceived sexual contact and receipt of a transfusion to be risks for HCV transmission. Risk factors associated with the spread of HCV are widespread in the Victorian community however, the most important risk factor--injecting drug use--has low prevalence. Considerable uncertainty exists about risk factors for hepatitis C. A very small percentage of Victorians are injecting drug users and therefore at highest risk of hepatitis C infection, therefore transmission control programs can be efficiently focused on this group. The Victorian community needs to be better educated about risk factors for hepatitis C, in particular that transfusions and blood donations are safe.
Education and training for preventing sharps injuries and splash exposures in healthcare workers
Publisher: Wiley
Date: 28-01-2016
A systematic review of measurement tools of health and well-being for evaluating community-based interventions.
Publisher: BMJ
Date: 03-06-2015
Abstract: Those interested in evaluating the effectiveness of community interventions on health and well-being need information about what tools are available and best suited to measure improvements that could be attributed to the intervention.This study evaluated published measurement tools of health and well-being that have the potential to be used before and after an intervention. A literature search of health and sociological databases was undertaken for articles that utilised measurement tools in community settings to measure overall health, well-being or quality of life. Articles were considered potentially relevant because they included use of measurement tools related to general health or well-being. These tools were evaluated by further searching of the literature to assess each tool's properties including: reliability validity responsiveness length use in cross-cultural settings global health or well-being assessment use of subjective measures clarity and cost. A composite score was made based on the average rating of all fields. Of 958 abstracts that were screened, 123 articles were extracted for review. From those articles, 27 measurement tools were selected and assessed. Based on the composite score assessing across all domains, five tools were rated as excellent. While tools may need to be selected for particular aims and interventions, a range of potential well-described tools already exist and should be considered for use in preference to ad hoc or bespoke tools. Any of the five tools rated as excellent are recommended to assess the impact of a community intervention.
Australians’ Experience of the COVID-19 Pandemic: Advantages and Challenges of Scaling Up Qualitative Research Using Large-Scale Rapid Analysis and Building Research Capacity Across Rural Australia
Publisher: SAGE Publications
Date: 2021
DOI: 10.1177/16094069211051937
Abstract: Australia responded to the emergence of the COVID-19 global pandemic in 2020 by initiating a border and bio-security zone lockdown and policies emphasising social distancing and hand hygiene. To understand the public response to this, Southern Queensland Rural Health commenced a two-phase research project exploring attitudes and practices towards the COVID-19 pandemic in Australia. An initial online survey foreshadowed 90 qualitative interviews with respondents to explore what the pandemic meant for everyday life. This paper details use of a qualitative approach by a national collaborative of investigators from 9 rural university departments in Australia who came together to research the qualitative phase of the project. Our methodological approach aligned with extant literature describing the management of large-scale interviewing and coding in the context of unfolding and dynamic contexts. The ‘RITA’ model (Rapid Identification of Themes from Audio recordings) entails a five-step process designed to progress from identifying research foci, through deductive and iterative coding to identify key concepts. We used a combination of coding templates, organisation and tagging of field notes and real-time sharing through a secure cloud drive to create a data set for immersive analysis and generation of ideas. Use of this method has added to the collective knowledge about successful rapid research investigations, recognising the inherent tension between speed and rigour. This is not a binary but a dialectic trustworthiness is integral to qualitative research. However, use of fresh approaches is accommodated by new technologies and can preserve adequate rigour while enabling collaboration, research capacity building and increasing the pace of data collection and analysis. This project has presented methodological challenges and highlights some strengths of such an approach. It is hoped that reporting our approach and experiences is useful for the broader health and research community considering large-scale qualitative research.
Indigenous compared with non-Indigenous Australian patients at entry to specialist palliative care
Publisher: Public Library of Science (PLoS)
Date: 02-05-2019
Analysis of reporting of family violence reporting in print media in regional Western Australia
Publisher: Elsevier BV
Date: 06-2022
Abstract: This research aimed to gain insights into the reporting of family violence (FV) and to explore any changes in FV reporting associated with a FV primary prevention initiative in Geraldton, Western Australia. An in-depth analysis of articles published by the Geraldton Guardian in 2019 examined the nature of FV reporting. Analysis was based on deductive coding from existing literature and inductive identification of new themes. A comparative analysis examined articles from the Geraldton Guardian and Albany Advertiser over the same three-month period in 2015, 2017 and 2019 to analyse trends in FV reporting. Of 135 articles analysed, there was alignment with five previously reported themes and two new themes were identified: FV as a public health issue and community responses to reduce FV. Episodic framing was overwhelmingly associated with court reporting. There was more reporting of efforts at primary prevention of FV over time in both newspapers. Local media can contribute to the promotion of community and public health issues related to FV. Efforts are needed to improve court reporting to situate FV in a broader context. Concerted efforts to educate the public and journalists can support FV being recognised as a public health issue.
Wide variation in sexually transmitted infection testing and counselling at Aboriginal primary health care centres in Australia
Publisher: Springer Science and Business Media LLC
Date: 15-02-2017
Exposure to hepatitis B and C of tattooists in Victoria in 1984
Publisher: Wiley
Date: 03-1997
DOI: 10.1111/J.1365-2893.1997.TB00216.X
Abstract: Although tattooing is recognized as a risk factor for transmission of hepatitis C, the efficiency with which transmission occurs is unknown. Sera stored from a serosurvey of tattooists undertaken in 1984 to test for human immunodeficiency virus (HIV) provided the opportunity to determine the prevalence of serological markers of hepatitis B virus (HBV) and hepatitis C virus (HCV) in tattooists at that time. The stored sera had been obtained from five unregistered and 36 of 37 (97%) of the registered tattooists operating in 1984. Serological status for hepatitis B (hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (HBsAb) and antibody to hepatitis B core antigen (HBcAb) in standard assays) or hepatitis C (HCV antibody reactivity in second and third generation tests, confirmed by recombinant immunoblot assay) was determined. No sera was HIV positive or HBsAg positive. Of 35 specimens tested for HCV specific antibody, only two (5.6%) were positive despite markers of HBV in 48.6% of the same sera. As acute HBV infection was common amongst tattooists prior to 1984, it is clear that hepatitis B vaccination would be of benefit to this group. Despite frequent needlestick injuries reported by tattooists at the time, the low seroprevalence of HCV in this group suggests that HCV may not be transmitted efficiently by intradermal inoculation using solid-bore tattooing needles.
Co-designing a framework for the adaptation of aphasia therapy for diverse cultural and linguistic backgrounds
Publisher: SAGE Publications
Date: 08-2022
HIV Risk Behaviour and HIV Testing of Psychiatric Patients in Melbourne
Publisher: SAGE Publications
Date: 08-1997
DOI: 10.3109/00048679709065079
Abstract: Objectives: Patients with chronic mental illnesses constitute an important risk group for HIV infection overseas. This study aimed to determine the prevalence of risk behaviours associated with HIV transmission and factors associated with HIV testing in psychiatric patients in Melbourne. Methods: Inpatients and outpatients completed an interviewer-administered questionnaire which covered demographics, psychiatric diagnosis, risk behaviour, and HIV education and testing. Results: Of 145 participants, 60% were male and 55.2% had schizophrenia. Injecting drug use (IDU) was reported by 15.9%, a figure approximately 10 times that found in other population surveys. Most patients reported sex in the last decade and over 20% had multiple sexual partners in the last year. Of males, 12.6% reported sex with another male (9.2% anal sex) 19.0% of females reported sex with a bisexual male. Nearly half of the males reported sex with a prostitute, 2.5 times that in a population s le. Only 15.9% reported ever having someone talk to them specifically about HIV and its transmission, although one-third had been tested for HIV. In multivariate analysis, male-male sex, paying for sex, and IDU were associated with HIV testing, but those whose primary language was not English were less likely to be tested. Those who had received HIV education were more likely to have used a condom last time they had sex (OR 4.52, 95%C11.49–14.0). Conclusions: This study provides evidence that those with serious mental illness in Victoria have higher rates of participation in risk behaviour for HIV infection than those in the general community. Attention to HIV education and prevention in this group has been inappropriately scant strategies to encourage safer behaviour are urgently needed.
Understanding, beliefs and perspectives of Aboriginal people in Western Australia about cancer and its impact on access to cancer services
Publisher: Springer Science and Business Media LLC
Date: 31-07-2009
Maintaining sexual health in commercial sex workers in Australia: condom effectiveness, screening, and management after acquiring sexually transmissible infections
Publisher: Elsevier BV
Date: 08-2004
DOI: 10.1111/J.1467-842X.2004.TB00443.X
Abstract: To provide practical advice to health care providers and public health practitioners regarding screening and management of sexually transmitted infections (STIs) in sex workers, and to examine the effectiveness of condoms in reducing transmission of STIs. Medline search using the key words sex workers, prostitutes, condoms and these terms in conjunction with pregnancy, sexually transmitted infections (including the names of in idual STIs), infectivity, exclusion periods. Additional articles were identified from cited references. Articles were selected on the basis of information provided on efficacy of condoms in STI prevention, prevalence of STIs in sex workers and changes following condom promotion, and advice about management of STIs in infected workers. Condoms offer some protection (30-90%) against STIs passed in semen, urethral, vaginal or cervical secretions (such as HIV, gonorrhoea, chlamydia). They give little to no protection (0-30%) against diseases due to skin-to-skin contact such as genital herpes and genital warts. Transmissibility of STIs varies according to the sex of the exposed person and the sexual practice. Condom effectiveness against STIs also varies with gender, and experience and consistency of condom use. Sex workers require regular screening for STIs as condom use is not fully protective. Management of sex workers identified with infection requires understanding of the issues faced by sex workers, biological characteristics of the infective organism, treatment efficacy, and test sensitivity and specificity. Advice on frequency of STI testing, supply of medical certificates, management of condom breakage, and management of infected sex workers is proposed.
Barriers and incentives to HIV treatment uptake among Aboriginal people in Western Australia
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2007
Educating the young about public health
Publisher: Elsevier BV
Date: 12-2009
Exploring the Implementation of Workplace-Focused Primary Prevention Efforts to Reduce Family Violence in a Regional City
Publisher: MDPI AG
Date: 13-12-2022
Abstract: In response to the high burden of family and domestic violence (FDV), The Australian National Plan to End Violence Against Women and Children has established that primary prevention measures are necessary to reduce FDV’s harmful impacts on health. The Community, Respect, and Equality (CRE) project is a primary prevention initiative aimed towards changing harmful social norms and practices that enable FDV in Geraldton, Western Australia. Organizations affiliated with the CRE are required to promote gender equality and a respectful work environment. However, there is a gap in the literature regarding the impact and effectiveness of such interventions, especially in rural/regional areas. As such, this study served to evaluate the project’s effectiveness in a CRE-certified workspace, a local non-profit social services provider. Investigators conducted interviews to learn how the organization had implemented the CRE, and whether the CRE had had an impact on social norms and practices within the work environment. Findings indicated that the project had largely failed to permeate workplace culture due to a lack of effective promotion, low perceived benefits, and low resources. Future interventions must take persuasive measures, even for organizations perceived to be receptive to change.
'Nowhere to room ... nobody told them': Logistical and cultural impediments to Aboriginal peoples' participation in cancer treatment
Publisher: CSIRO Publishing
Date: 2011
DOI: 10.1071/AH09835
Abstract: Background. Cancer mortality among Indigenous Australians is higher compared to the non-Indigenous population and attributed to poor access to cancer detection, screening, treatment and support services. A large proportion of Indigenous Australians live in rural and remote areas which makes access to cancer treatment services more challenging. Factors, such as transport, accommodation, poor socio-economic status and cultural appropriateness of services also negatively affect health service access and, in turn, lead to poor cancer outcomes. Design, setting and participants. Qualitative research with 30 in-depth interviews was conducted with Aboriginal people affected by cancer from across WA, using a variety of recruitment approaches. Results. The infrastructure around the whole-of-treatment experience affected the decision-making and experiences of Aboriginal patients, particularly affecting rural residents. Issues raised included transport and accommodation problems, travel and service expenses, displacement from family, concerns about the hospital environment and lack of appropriate support persons. These factors are compounded by a range of disadvantages already experienced by Aboriginal Australians and are vital factors affecting treatment decision-making and access. Conclusion. To improve cancer outcomes for Aboriginal people, logistical, infrastructure and cultural safety issues must be addressed. One way of ensuring this could be by dedicated support to better coordinate cancer diagnostic and treatment services with primary healthcare services. What is known about the topic? Cancer is a major cause of death among Indigenous Australians who are generally diagnosed later with their disease, have poorer continuity of care and lower uptake and completion of cancer treatment. For cancer diagnosis at an equivalent stage of cancer, Aboriginal people have poorer outcomes. What does this paper add? This study documents Aboriginal perspectives on basic infrastructure and logistical problems which impede their accessing hospital-based cancer treatments: transport, accommodation, preparation for the experience of hospital and cancer treatment, service affordability and the certainty of support services. What are the implications for practitioners? There are difficulties for practitioners in addressing the geographic, socioeconomic and cultural differences that Aboriginal people face in accessing cancer treatment. System level changes to ensure cultural safety, social support and better coordination with primary healthcare are essential to improve outcomes of Aboriginal people with cancer.
Addressing unresolved tensions to build effective partnerships: Lessons from an Aboriginal cancer support network
Publisher: Springer Science and Business Media LLC
Date: 04-11-2015
Between a rock and a hard place: stigma and the desire to have children among people living with HIV in northern Uganda.
Publisher: Wiley
Date: 31-05-2012
Looking through the Keyhole: Exploring Realities and Possibilities for School Breakfast Programs in Rural Western Australia
Publisher: MDPI AG
Date: 17-03-2018
DOI: 10.3390/NU10030371
Behavioural dynamics of a clinical trial of sunscreens for reducing solar keratoses in Victoria, Australia
Publisher: BMJ
Date: 12-1997
Abstract: To determine whether the behaviour of participants based on perception of treatment group in a randomised trial contributed to clinical outcome. A double blind randomised controlled trial of the effect of daily application of SPF 17 broad spectrum sunscreen cream (or placebo) on solar keratoses. A rural city in Victoria, Australia. Residents aged 40 years or over were invited by letter to attend for a skin cancer screening check. Of these, 588 people with between one and 30 solar keratoses enrolled in the trial and 431 completed the trial, which extended over a six month period that included summer. Participants' perceptions of their treatment allocation, adherence with the treatment regimen, adoption of other sun protection behaviours, side effects, and perceptions of change in condition were measured at two monthly intervals. There were no significant differences between those who completed the study and those that did not for sex, age, treatment group, skin type, number of solar keratoses or correct perception of treatment group. Thirty per cent of those completing the study correctly guessed their treatment allocation, and people were just as likely to be right as to be wrong when they stated their opinion about their treatment allocation (z = 1.04 p = 0.15). Study group, skin type, amount of time spent outdoors, presence of side effects, perceptions of change in skin condition did not significantly predict correct perception of treatment allocation. Multivariate analysis of variance indicated that adoption of other sun protection and adherence with cream use were not significantly affected by actual treatment allocation, correct perception of treatment allocation nor by their interaction. Poisson regression analysis showed a significantly lower difference ratio of solar keratoses in the sunscreen group compared with the placebo base cream group (OR 0.55 CI = 0.46, 0.64), and for women compared with men (OR = 0.76 CI = 0.63, 0.93) but no independent effect of any of the indices of other sun protection or adherence. A sufficient level of commitment to study procedures was achieved, so that trial participants did not adopt other behaviours that affected treatment outcomes. It is recommended that the potential threat to validity posed by the behaviour of participants be recognised at an early stage in planning of clinical trials, so that strategies to deal with this can be integrated into study protocols.
Incidence of first heart failure hospitalisation and mortality in Aboriginal and non-Aboriginal patients in Western Australia, 2000-2009
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.IJCARD.2014.02.020
Abstract: To compare the incidence of first heart failure (HF) hospitalisation, antecedent risk factors and 1-year mortality between Aboriginal and non-Aboriginal populations in Western Australia (2000-2009). A population-based cohort aged 20-84 years comprising Aboriginal (n=1013 mean 54±14 years) and non-Aboriginal patients (n=16,366 mean 71±11 years) with first HF hospitalisation was evaluated. Age and sex-specific incidence rates and HF antecedents were compared between subpopulations. Regression models were used to examine 30-day and 1-year (in 30-day survivors) mortality. Aboriginal patients were younger, more likely to reside in rural/remote areas (76% vs 23%) and to be women (50.6% vs 41.7%, all p<0.001). Aboriginal (versus non-Aboriginal) HF incidence rates were 11-fold higher in men and 23-fold in women aged 20-39 years, declining to about 2-fold in patients aged 70-84 years. Ischaemic and rheumatic heart diseases were more common antecedents of HF in younger (<55 years) Aboriginal versus non-Aboriginal patients (p =3) were also more prevalent in younger and older Aboriginal patients (p<0.001). Although 30-day mortality was similar in both subpopulations, Aboriginal patients aged<55 years had a 1.9 risk-adjusted hazard ratio (HR) for 1-year mortality (p=0.015). Aboriginal people had substantially higher age and sex-specific HF incidence rate and prevalence of HF antecedents than their non-Aboriginal counterparts. HR for 1-year mortality was also significantly worse at younger ages, highlighting the urgent need for enhanced primary and secondary prevention of HF in this population.
Improving cultural respect in primary care
Publisher: AMPCo
Date: 12-03-2019
DOI: 10.5694/MJA2.50059
Post mammographic screening behaviour
Publisher: Wiley
Date: 10-09-2021
DOI: 10.1002/HPJA.396
Abstract: Despite widespread calls for women undergoing mammographic screening to be informed of their breast density, concerns remain as to how this is interpreted and acted upon given the absence of evidence‐based supplemental screening recommendations for women with dense breasts. This study investigates the action women take in response to being notified they have dense breasts and what subsequent advice women receive from health professionals. Via a survey of nearly 7000 women, we assessed the post‐screening actions of women attending a population‐based mammographic screening program (BreastScreen) in Western Australia from 21 November 2017 to 19 April 2018. Women who reported that they were notified they had dense breasts were compared to controls (where applicable). Descriptive and logistic regression analyses were used to summarise responses from 6,183 women. Half of women notified that they have dense breasts consulted or intended to consult their General Practitioner (GP), particularly those notified for the first time (55%). Of those notified women who consulted their GP, 50% were referred to have supplemental screening. Overall, 20% of women notified as having dense breasts reported that they had an ultrasound due to their breast density. Self‐reported health service usage after mammographic screening is higher in women who have been notified they have dense breasts. So what? There is growing pressure for screening programs in Australia and internationally to routinely measure and report breast density to participants. Results from this study can inform screening programs of the likely impact of breast density notification on health service usage. While more information is needed to fill knowledge gaps in recommended action for women with dense breasts, the greatest risks to women arise from not being screened. Hence, health promotion practitioners and health providers should continue to encourage women to participate in BreastScreen programs.
'I've got to row the boat on my own, more or less'
Publisher: Cambridge University Press (CUP)
Date: 02-07-2019
Abstract: The overarching cultural context of the brain injury survivor, particularly that related to minority peoples with a history of colonisation and discrimination, has rarely been referred to in the research literature, despite profoundly influencing a person’s recovery journey in significant ways, including access to services. This study highlights issues faced by Australian Aboriginal traumatic brain injury (TBI) survivors in terms of real-life consequences of the high incidence of TBI in this population, current treatment and long-term challenges. A case study approach utilised qualitative interview and file review data related to five male Aboriginal TBI survivors diagnosed with acquired communication disorders. The five TBI survivors were from erse areas of rural and remote Western Australia, aged between 19 and 48 years at the time of injury, with a range of severity. Common themes included: significant long-term life changes short-term and long-term dislocation from family and country as medical intervention and rehabilitation were undertaken away from the person’s rural/remote home family adjustments to the TBI including permanent re-location to a metropolitan area to be with their family member in residential care challenges related to lack of formal rehabilitation services in rural areas poor communication channels poor cultural security of services and lack of consistent follow-up. These case reports represent some of the first documented stories of Aboriginal Australian TBI survivors. They supplement available epidemiological data and highlight different contexts for Aboriginal people after TBI, contributing to an overall profile that is relevant for rehabilitation service planning.
Development of the Aboriginal Communication Assessment After Brain Injury (ACAABI)
Publisher: Informa UK Limited
Date: 21-02-2017
DOI: 10.1080/17549507.2017.1290136
Abstract: Acquired communication disorders (ACD), following stroke and traumatic brain injury, may not be correctly identified in Aboriginal Australians due to a lack of linguistically and culturally appropriate assessment tools. Within this paper we explore key issues that were considered in the development of the Aboriginal Communication Assessment After Brain Injury (ACAABI) - a screening tool designed to assess the presence of ACD in Aboriginal populations. A literature review and consultation with key stakeholders were undertaken to explore directions needed to develop a new tool, based on existing tools and recommendations for future developments. The literature searches revealed no existing screening tool for ACD in these populations, but identified tools in the areas of cognition and social-emotional wellbeing. Articles retrieved described details of the content and style of these tools, with recommendations for the development and administration of a new tool. The findings from the interview and focus group views were consistent with the approach recommended in the literature. There is a need for a screening tool for ACD to be developed but any tool must be informed by knowledge of Aboriginal language, culture and community input in order to be acceptable and valid.
Healing Right Way: study protocol for a stepped wedge cluster randomised controlled trial to enhance rehabilitation services and improve quality of life in Aboriginal Australians after brain injury
Publisher: BMJ
Date: 09-2021
DOI: 10.1136/BMJOPEN-2020-045898
Abstract: Despite higher incidence of brain injury among Aboriginal compared with non-Aboriginal Australians, suboptimal engagement exists between rehabilitation services and Aboriginal brain injury survivors. Aboriginal patients often feel culturally insecure in hospital and navigation of services post discharge is complex. Health professionals report feeling ill-equipped working with Aboriginal patients. This study will test the impact of a research-informed culturally secure intervention model for Aboriginal people with brain injury. Design: Stepped wedge cluster randomised control trial design intervention sequentially introduced at four pairs of healthcare sites across Western Australia at 26-week intervals. Recruitment: Aboriginal participants aged ≥18 years within 4 weeks of an acute stroke or traumatic brain injury. Intervention: (1) Cultural security training for hospital staff and (2) local, trial-specific, Aboriginal Brain Injury Coordinators supporting participants. Primary outcome : Quality-of-life using EuroQOL-5D-3L (European Quality of Life scale, five dimensions, three severity levels) Visual Analogue Scale score at 26 weeks post injury. Recruitment of 312 participants is estimated to detect a difference of 15 points with 80% power at the 5% significance level. A linear mixed model will be used to assess the between-condition difference. Secondary outcome measures : Modified Rankin Scale, Functional Independence Measure, Modified Caregiver Strain Index, Hospital Anxiety and Depression Scale at 12 and 26 weeks post injury, rehabilitation occasions of service received, hospital compliance with minimum care processes by 26 weeks post injury, acceptability of Intervention Package, feasibility of Aboriginal Brain Injury Coordinator role. Evaluations : An economic evaluation will determine the potential cost-effectiveness of the intervention. Process evaluation will document fidelity to study processes and capture changing contexts including barriers to intervention implementation and acceptability/feasibility of the intervention through participant questionnaires at 12 and 26 weeks. The study has approvals from Aboriginal, university and health services human research ethics committees. Findings will be disseminated through stakeholder reports, participant workshops, peer-reviewed journal articles and conference papers. ACTRN12618000139279.
Occurrence and timely management of problems requiring prompt intervention among Indigenous compared with non-Indigenous Australian palliative care patients: a multijurisdictional cohort study
Publisher: BMJ
Date: 03-2021
DOI: 10.1136/BMJOPEN-2020-042268
Abstract: Anticipation and prompt relief of symptoms among patients with a life-limiting illness is a core element of palliative care. Indigenous Australians commonly encounter cultural barriers in healthcare that may impair outcomes. The Palliative Care Outcomes Collaboration collects patient care data for the purposes of continuous quality improvement and benchmarking, with each recorded care episode ided into phases that reflect a patient’s condition. We aimed to investigate differences between Indigenous and non-Indigenous patients in the occurrence and duration of ‘unstable’ phases (which indicate unanticipated deterioration in a patient’s condition or circumstances), and determine attainment of the relevant benchmark (resolution of unstable phases in ≤3 days in 90% of cases) for both groups. Cohort study. Australia-wide hospital-based and community-based specialist palliative care (1 January 2010 to 30 June 2015). 139 556 (1502 Indigenous and 138 054 non-Indigenous) adult patients. Indigenous and non-Indigenous patients were compared on (1) the risk of a phase being categorised as unstable, (2) the duration of unstable phases, and (3) the risk of unstable phases being prolonged ( days). Crude and adjusted estimates were produced from three-level robust Poisson regression and complementary log-log discrete time survival models. Unstable phases occurred with similar frequency overall among Indigenous and non-Indigenous patients (adjusted relative risks 1.06 95% CI 1.00 to 1.11 not significant after correction for multiple comparisons). The duration and risk of prolongation of unstable phases were similar in both patient groups, with no significant differences evident among subgroups. The benchmark was not met for either Indigenous or non-Indigenous patients (unstable phase duration days in 24.3% vs 25.5% p=0.398). Despite well-documented shortcomings of healthcare for Indigenous Australians, there is no clear evidence of greater occurrence or prolongation of unanticipated problems among Indigenous patients accessing specialist palliative care services in hospital or the community.
Variable effects of prevalence correction of population denominators on differentials in myocardial infarction incidence: a record linkage study in Aboriginal and non-Aboriginal Western Australians
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1016/J.JCLINEPI.2010.08.008
Abstract: To investigate the impact of prevalence correction of population denominators on myocardial infarction (MI) incidence rates, rate ratios, and rate differences in Aboriginal vs. non-Aboriginal Western Australians aged 25-74 years during the study period 2000-2004. Person-based linked hospital and mortality data sets were used to estimate the number of prevalent and first-ever MI cases each year from 2000 to 2004 using a 15-year look-back period. Age-specific and -standardized MI incidence rates were calculated using both prevalence-corrected and -uncorrected population denominators, by sex and Aboriginality. The impact of prevalence correction on rates increased with age, was higher for men than women, and substantially greater for Aboriginal than non-Aboriginal people. Despite the systematic underestimation of incidence, prevalence correction had little impact on the Aboriginal to non-Aboriginal age-standardized rate ratios (6% and 4% underestimate in men and women, respectively), although the impact on rate differences was more marked (12% and 6%, respectively). The percentage underestimate of differentials was greater at older ages. Prevalence correction of denominators, while more accurate, is difficult to apply and may add modestly to the quantification of relative disparities in MI incidence between populations. Absolute incidence disparities using uncorrected denominators may have an error >10%.
Patterns of Primary Care, Specialist Consultations, ED Attendances and Hospitalisations for Aboriginal and Non-Aboriginal Patients Following First Admission for Ischaemic Heart Disease in Western Australia
Publisher: Elsevier BV
Date: 08-2016
Talking about the not talked about: use of, and reactions to, a DVD promoting bowel cancer screening to Aboriginal people
Publisher: Elsevier BV
Date: 12-2016
Abstract: To examine a) the implementation and use of a DVD developed to educate Aboriginal people about bowel cancer and bowel cancer screening and b) broader aspects of Aboriginal participation in the National Bowel Cancer Screening Program. Qualitative methods and descriptive approaches were used. Data were collected using face-to-face and telephone interviews and focus group discussions. There were 67 participants, including those involved in the development and distribution of the DVD, health professionals and Aboriginal community members. Although the DVD received a positive reaction from participants, fewer than half the DVDs had been distributed. Furthermore, the small number of DVDs that had been distributed were under-utilised. The weaknesses do not appear to lie with the resource itself but can be attributed partly to poor distribution and promotion. This may have been compounded by the structure of the National Bowel Cancer Screening Program, which limited the engagement of Aboriginal community members and health providers whose focus is largely directed towards more pressing health care issues. Interest in the resource may increase once the Aboriginal component of the screening program is more closely linked with primary care.
Assessing the quality of maternal health care in Indigenous primary care services
Publisher: AMPCo
Date: 05-2010
Menopause and the influence of culture: another gap for Indigenous Australian women?
Publisher: Springer Science and Business Media LLC
Date: 12-2012
Abstract: There is great variation in experience of menopause in women around the world. The purpose of this study was to review current understanding of Australian Aboriginal and Torres Strait Islander (Indigenous) women’s experiences of menopause. The literature pertaining to the perception, significance and experience of menopause from a number of cultural groups around the world has been included to provide context for why Indigenous women’s experience might be important for their health and differ from that reported in other studies of Australian women and menopause. A search of databases including Ovid Medline, Pubmed, Web of Science, AUSThealth, AMED, EMBASE, Global Health and PsychINFO was undertaken from January 2011 to April 2011 using the search terms menopause, Indigenous, Aboriginal, attitudes, and perceptions and repeated in September 2012. Considerable research shows significant variation across cultures in the menopausal experience. Biological, psychological, social and cultural factors are associated with either positive or negative attitudes, perceptions or experiences of menopause in various cultures. Comparative international literature shows that neither biological nor social factors alone are sufficient to explain the variation in experiences of the menopausal transition. However, a strong influence of culture on the menopause experience can be found. The variation in women’s experience of menopause indicates that different cultural groups of women may have different understandings and needs during the menopausal transition. While considerable literature exists for Australian women as a whole, there has been little investigation of Australian Indigenous women, with only two research studies related to Indigenous women’s experiences of menopause identified. Differences in biocultural experience of menopause around the world suggest the importance of biocultural research. For the Indigenous women of Australia, the relative contribution of culture, social disadvantage and poor general health compared with non-Indigenous women to the experience of menopause is unknown. As such, further research and understanding of the experience of Indigenous women around Australia is needed. This information could assist in iduals, families, cultural groups and healthcare providers to enhance management and support for Indigenous Australian women.
Perspectives of Aboriginal People Affected by Cancer on the Need for an Aboriginal Navigator in Cancer Treatment and Support
Publisher: MDPI AG
Date: 30-12-2023
DOI: 10.3390/HEALTHCARE11010114
Abstract: Aboriginal and Torres Strait Islander Australians suffer higher rates of cancer and poorer outcomes than the wider population. These disparities are exacerbated by rurality and remoteness due to reduced access and limited engagement with health services. This study explored the cancer journeys of Aboriginal patients and carers, and their views on the establishment of an Aboriginal Patient Navigator role within the Western Australian healthcare system to support cancer patients and their families. Sixteen Aboriginal participants were interviewed either face to face, by telephone, or via video conferencing platforms. The interviews were then recorded, transcribed, and thematically analyzed using standard qualitative techniques. Close consultation within the research team enhanced the rigour and robustness of the study findings. Patients and carers identified many gaps in cancer service delivery that made their experiences stressful and unnecessarily complex. Challenges included a lack of stable accommodation, financial burdens, constant travel, being “off-Country”, and miscommunication with health professionals. Key sources of support and strength were the centrality of family and ongoing cultural connectedness. All participants were supportive of an Aboriginal Patient Navigator role that could address shortfalls in cancer service delivery, especially for patients from rural and remote communities. A culturally safe model of support has the potential to increase access, reduce anxiety and improve health outcomes.
Communication services for First Nations peoples after stroke and traumatic brain injury: Alignment of Sustainable Development Goals 3, 16 and 17
Publisher: Informa UK Limited
Date: 22-11-2023
Experiential learning to increase palliative care competence among the Indigenous workforce: An Australian experience
Publisher: BMJ
Date: 20-01-2019
DOI: 10.1136/BMJSPCARE-2016-001296
Abstract: Improving Indigenous people’s access to palliative care requires a health workforce with appropriate knowledge and skills to respond to end-of-life (EOL) issues. The Indigenous component of the Program of Experience in the Palliative Approach (PEPA) includes opportunities for Indigenous health practitioners to develop skills in the palliative approach by undertaking a supervised clinical placement of up to 5 days within specialist palliative care services. This paper presents the evaluative findings of the components of an experiential learning programme and considers the broader implications for delivery of successful palliative care education programme for Indigenous people. Semistructured interviews were conducted with PEPA staff and Indigenous PEPA participants. Interviews were recorded, transcribed and key themes identified. Participants reported that placements increased their confidence about engaging in conversations about EOL care and facilitated relationships and ongoing work collaboration with palliative care services. Management support was critical and placements undertaken in settings which had more experience caring for Indigenous people were preferred. Better engagement occurred where the programme included Indigenous staffing and leadership and where preplacement and postplacement preparation and mentoring were provided. Opportunities for programme improvement included building on existing postplacement and follow-up activities. A culturally respectful experiential learning education programme has the potential to upskill Indigenous health practitioners in EOL care.
What was the impact of a participatory research project in Australian Indigenous primary healthcare services? Applying a comprehensive framework for assessing translational health research to Lessons
Publisher: BMJ
Date: 02-2021
DOI: 10.1136/BMJOPEN-2020-040749
Abstract: To (1) apply the Framework to Assess the Impact from Translational health research (FAIT) to Lessons from the Best to Better the Rest (LFTB), (2) report on impacts from LFTB and (3) assess the feasibility and outcomes from a retrospective application of FAIT. Three Indigenous primary healthcare (PHC) centres in the Northern Territory, Australia project coordinating centre distributed between Townsville, Darwin and Cairns and the broader LFTB learning community across Australia. LFTB research team and one representative from each PHC centre. Impact reported as (1) quantitative metrics within domains of benefit using a modified Payback Framework, (2) a cost-consequence analysis given a return on investment was not appropriate and (3) a narrative incorporating qualitative evidence of impact. Data were gathered through in-depth stakeholder interviews and a review of project documentation, outputs and relevant websites. LFTB contributed to knowledge advancement in Indigenous PHC service delivery enhanced existing capacity of health centre staff, researchers and health service users enhanced supportive networks for quality improvement and used a strengths-based approach highly valued by health centres. LFTB also leveraged between $A1.4 and $A1.6 million for the subsequent Leveraging Effective Ambulatory Practice (LEAP) Project to apply LFTB learnings to resource development and creation of a learning community to empower striving PHC centres. Retrospective application of FAIT to LFTB, although not ideal, was feasible. Prospective application would have allowed Indigenous community perspectives to be included. Greater appreciation of the full benefit of LFTB including a measure of return on investment will be possible when LEAP is complete. Future assessments of impact need to account for the limitations of fully capturing impact when intermediate/final impacts have not yet been realised and captured.
Enhanced mindfulness-based stress reduction in episodic migraine: a randomized clinical trial with magnetic resonance imaging outcomes
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 13-03-2020
DOI: 10.1097/J.PAIN.0000000000001860
Abstract: We aimed to evaluate the efficacy of an enhanced mindfulness-based stress reduction (MBSR+) vs stress management for headache (SMH). We performed a randomized, assessor-blind, clinical trial of 98 adults with episodic migraine recruited at a single academic center comparing MBSR+ (n = 50) with SMH (n = 48). MBSR+ and SMH were delivered weekly by group for 8 weeks, then biweekly for another 8 weeks. The primary clinical outcome was reduction in headache days from baseline to 20 weeks. Magnetic resonance imaging (MRI) outcomes included activity of left dorsolateral prefrontal cortex (DLPFC) and cognitive task network during cognitive challenge, resting state connectivity of right dorsal anterior insula to DLPFC and cognitive task network, and gray matter volume of DLPFC, dorsal anterior insula, and anterior midcingulate. Secondary outcomes were headache-related disability, pain severity, response to treatment, migraine days, and MRI whole-brain analyses. Reduction in headache days from baseline to 20 weeks was greater for MBSR+ (7.8 [95% CI, 6.9-8.8] to 4.6 [95% CI, 3.7-5.6]) than for SMH (7.7 [95% CI 6.7-8.7] to 6.0 [95% CI, 4.9-7.0]) ( P = 0.04). Fifty-two percent of the MBSR+ group showed a response to treatment (50% reduction in headache days) compared with 23% in the SMH group ( P = 0.004). Reduction in headache-related disability was greater for MBSR+ (59.6 [95% CI, 57.9-61.3] to 54.6 [95% CI, 52.9-56.4]) than SMH (59.6 [95% CI, 57.7-61.5] to 57.5 [95% CI, 55.5-59.4]) ( P = 0.02). There were no differences in clinical outcomes at 52 weeks or MRI outcomes at 20 weeks, although changes related to cognitive networks with MBSR+ were observed. Enhanced mindfulness-based stress reduction is an effective treatment option for episodic migraine.
Measuring the effectiveness of prevention of family violence in a regional setting
Publisher: BMJ Publishing Group Ltd
Date: 03-2021
Good sleep is a mood buffer for young women during menses
Publisher: Oxford University Press (OUP)
Date: 23-03-2023
Abstract: We sought to elucidate the interaction between sleep and mood considering menstrual cycle phase (menses and non-menses portions of the cycle) in 72 healthy young women (18 – 33 y) with natural, regular menstrual cycles and without menstrual-associated disorders. This work fills a gap in literature of examining mood in context of sleep and menstrual cycle jointly, rather than in idually. Daily subjective measures of sleep and mood, and date of menses were remotely, digitally collected over a two-month period. Each morning, participants rated their sleep on the previous night, and each evening participants rated the extent of positive and negative mood for that day. Objective sleep was tracked with a wearable (ŌURA ring) during month two of the study. Time lag cross-correlation and mixed linear models were used to analyze the significance and directionality of the sleep-mood relationship, and how the interaction between menstrual cycle status and sleep impacted mood levels. We found that menstrual status alone did not impact mood. However, subjective sleep quality and menstrual status interacted to impact positive mood (p & .05). After a night of perceived poor sleep quality, participants reported lower positive mood during menses compared to non-menses portions of the cycle, while after a night of perceived good sleep quality participants reported equivalent levels of positive mood across the cycle. We suggest that the perception of good sleep quality acts as a mood equalizer, with good sleep providing a protective buffer to positive mood across the menstrual cycle.
AN ASSESSMENT OF FLOW CYTOMETRIC LYMPHOCYTE SUBSET MONITORING IN PERIPHERAL BLOOD OF RATS AS A METHOD OF DETECTING RECIPIENT RECOGNITION OR REJECTION OF MURINE ENDOCRINE XENOGRAFTS
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-1988
Study protocol: national research partnership to improve primary health care performance and outcomes for Indigenous peoples
Publisher: Springer Science and Business Media LLC
Date: 19-05-2010
Abstract: Strengthening primary health care is critical to reducing health inequity between Indigenous and non-Indigenous Australians. The Audit and Best practice for Chronic Disease Extension (ABCDE) project has facilitated the implementation of modern Continuous Quality Improvement (CQI) approaches in Indigenous community health care centres across Australia. The project demonstrated improvements in health centre systems, delivery of primary care services and in patient intermediate outcomes. It has also highlighted substantial variation in quality of care. Through a partnership between academic researchers, service providers and policy makers, we are now implementing a study which aims to 1) explore the factors associated with variation in clinical performance 2) examine specific strategies that have been effective in improving primary care clinical performance and 3) work with health service staff, management and policy makers to enhance the effective implementation of successful strategies. The study will be conducted in Indigenous community health centres from at least six States/Territories (Northern Territory, Western Australia, New South Wales, South Australia, Queensland and Victoria) over a five year period. A research hub will be established in each region to support collection and reporting of quantitative and qualitative clinical and health centre system performance data, to investigate factors affecting variation in quality of care and to facilitate effective translation of research evidence into policy and practice. The project is supported by a web-based information system, providing automated analysis and reporting of clinical care performance to health centre staff and management. By linking researchers directly to users of research (service providers, managers and policy makers), the partnership is well placed to generate new knowledge on effective strategies for improving the quality of primary health care and fostering effective and efficient exchange and use of data and information among service providers and policy makers to achieve evidence-based resource allocation, service planning, system development, and improvements of service delivery and Indigenous health outcomes.
Improvement in delivery of type 2 diabetes services differs by mode of care: a retrospective longitudinal analysis in the Aboriginal and Torres Strait Islander Primary Health Care setting
Publisher: Springer Science and Business Media LLC
Date: 07-10-2016
Afghan and Kurdish refugees, 8-20 years after resettlement, still experience psychological distress and challenges to well being
Publisher: Elsevier BV
Date: 04-2012
DOI: 10.1111/J.1753-6405.2011.00778.X
Abstract: To examine the resettlement experiences and provide data of well being and psychological distress for Afghan and Kurdish refugees settled between eight and 20 years in New Zealand and Australia. Participants completed the Kessler-10 Psychological Distress Scale (K10) and Personal Well Being Index (PWI) for subjective well being. A mixed methods approach was used, with participants also discussing during interview resettlement difficulties, quality of life (QOL) and sources of stress. Data from 81 Muslim participants is reported all spoke English, were generally well educated with 88% having secondary or tertiary level education, and the majority of those resettled before 2001 lived in Perth. Although psychological distress levels were mostly within the low-moderate risk range, significant differences were observed by gender and employment status. Participants identified a range of ongoing stressors with unemployment of particular concern. Social isolation and a sense that they would never really 'fit in' was also reported by some. Participants particularly valued the safety and improved quality of life in their host communities. Despite their appreciation of the overall resettlement experience, too much time to introspect, separation from family, status dissonance and still occasionally feeling overwhelmed by resettlement challenges is a long-term ongoing reality for some former refugees. Former refugees continue to struggle with unemployment, possible discrimination and loss of status long-term.
Respect, relationships, and just spending time with them: critical elements for engaging Aboriginal students in primary school education
Publisher: MDPI AG
Date: 22-12-2022
Abstract: While disparities in educational outcomes for Aboriginal children have narrowed in early childhood education and for Year 12 completions, these positive trends are not replicated in the intervening years where attendance, reading, writing, and numeracy targets have been missed. Erratic attendance in the primary years has the greatest impact on achievement literacy and numeracy scores decline as absences increase. Family functioning and health, caregiver expectations, past encounters with the education system and socio-economic disadvantage are all implicated in poorer rates of attendance. In response to community concerns, an Aboriginal/mainstream partnership was forged in 2011 and began work in 2016 to address patterns of attendance and achievement among Aboriginal primary students in a regional city in Western Australia. This paper describes the innovative, community-led “More Than Talk” program and presents findings from teaching and support staff interviews two years after implementation. Qualitative methods were employed to analyse the data, develop themes, and ensure rigour. Findings highlighted the cascading impact of erratic attendance and the role of strong relationships, respect, and investment of time with children as critical elements in student engagement and wellbeing. Community-led, collaborative educational programs have the potential to positively impact Aboriginal students’ engagement and contribute to culturally responsive environments. If sustained, such efforts can enable learning to flourish.
The frequency of reactions to sunscreens: results of a longitudinal population-based study on the regular use of sunscreens in Australia
Publisher: Oxford University Press (OUP)
Date: 05-1993
DOI: 10.1111/J.1365-2133.1993.TB00227.X
Abstract: Six-hundred-and-three people aged 40 or more years, from Maryborough in central Victoria, were enrolled in a randomized longitudinal study, which required daily application of either a SPF 15+, broad-spectrum, water-resistant sunscreen cream or the cream base without the active ingredients. The study duration was 7 months, from September 1991 until April 1992. One-hundred-and-fourteen (18.9%) of these subjects developed an adverse reaction to the cream they were applying. Patch testing, photopatch testing and scratch testing with the ingredients of the creams revealed that only a small proportion (< 10%) of the inflammatory eruptions were allergic in nature. None of the people tested was allergic to the sunscreen active ingredients. History and examination findings, where available, suggested that the majority of adverse responses were consistent with an irritant reaction, both to the sunscreen preparation and the base cream control. A higher than expected proportion of the people who developed an adverse reaction had a personal history consistent with atopy. Other reactions included acneiform eruptions and contact urticaria. A frequency of reactions to sunscreen preparations of over 15% means that further work is necessary to improve both the formulation of such products, and the manner and conditions under which they are used, to ensure satisfactory compliance.
Authors' response
Publisher: Elsevier BV
Date: 02-2010
Booster doses of hepatitis B vaccine: responses to low‐dose inoculations
Publisher: AMPCo
Date: 03-1993
DOI: 10.5694/J.1326-5377.1993.TB121829.X
Abstract: To examine the anamnestic response to hepatitis B vaccine in previously vaccinated subjects. Subjects who had received a course of hepatitis B vaccine at least two years previously had a s le of blood taken before and seven days after a low-dose booster of hepatitis B vaccine. A pilot group of laboratory scientists in the Microbiological Diagnostic Unit fifth year medical students, University of Melbourne and a group of ambulance officers from the Geelong Ambulance Depot (Victoria). All participants volunteered after having been informed of the study. Serum levels of antibody to hepatitis B surface antigen (HBsAg) were measured before and after the booster dose of vaccine and, when available, in serum taken a month after the end of the primary course of vaccine, and the changes in antibody level were studied. Although some in iduals with a restricted antibody response were identified, most showed a quick response. There was limited evidence that this rise peaked early and began to fall within weeks. In many subjects, levels of antibody to HBsAg peak early after booster doses of vaccine but the rapid anamnestic response to small amounts of antigen make it probable that effective protection from symptomatic illness may be long lasting, when there has been a satisfactory primary response. This provides an argument for testing for adequate seroconversion after vaccination.
The Effect of Regular Sunscreen Use on Vitamin D Levels in an Australian Population
Publisher: American Medical Association (AMA)
Date: 04-1995
Diagnosis of genital chlamydia by PCR in non‐remote communities
Publisher: AMPCo
Date: 09-1997
A Qualitative Study of the Impact of COVID-19 on Australians’ Hopes and Dreams for the Future
Publisher: Springer Science and Business Media LLC
Date: 21-02-2022
DOI: 10.1186/S12889-022-12746-4
Abstract: Although beginning in 2019, it was early in 2020 that the global community began to comprehend the significant impact that a pandemic of a new coronavirus might have on their own lives. This study was undertaken 6–9 months after significant public health restrictions were introduced within Australia and examined the impact of the COVID-19 on in iduals’ hopes and dreams for their future. Community members who responded to a survey about COVID-19 were invited to participate in follow up interviews if they reported living with a chronic condition. Participants across Australia who consented were interviewed between August and December in 2020 over telephone or videoconferencing. A specific question was included regarding the impact of COVID-19 on their hopes and dreams for the future. Rapid identification of themes with an audio recordings technique was used to generate themes from the data. The 90 participants were predominantly female (77%) and ranged in age from 20 to 81 years with a mean age of 50 years and lived in several Australian states. Following immersive analysis of interviews, the identified common themes impacting people’s hopes and dreams revealed: concerns for their own and others’ job stability and future work the impact on travel both for holidays, business and reconnecting with family reassessing of personal and social values and the intergenerational impact of such a profound pandemic, with concern for younger people particularly prominent in those concerns. Participants reflected on their loss of future dreams, with possibilities they had planned and worked towards not possible in the short term. The responses provide a window into how people view their future goals and aspirations during a time of global and local instability and highlights the potential future impacts of the COVID-19 pandemic.
Dealing with Intimate Partner Violence and Family Violence in a Regional Centre of Western Australia
Publisher: MDPI AG
Date: 24-04-2023
Abstract: In the Midwest region of Western Australia, rates of intimate partner and family violence (IPV/FV) are high. We undertook research into social workers’ knowledge, attitudes, and skills as part of addressing this significant public health issue. Social workers come into contact with people experiencing IPV/FV in multiple settings, so their understandings and responses are critical to the prevention and interventions related to violence against women. The goal of the research was to determine the issues that the social workers in this region needed to be addressed that could assist in tackling the problem of IPV/FV. A questionnaire included open-ended questions to capture information on respondents’ profiles, knowledge, attitudes, practices, and education around IPV/FV, with 29 of 37 social workers working in the region responding. We also elicited respondents' recommendations related to training and service delivery. Despite working in many settings, most social workers had contact with people experiencing IPV/FV and had reasonable confidence and knowledge that showed an understanding of the complexity of FV, including why women stay in violent relationships. This paper identified social workers’ need for more education, including during their university training, resources, and service coordination to support best practice delivery of services to people affected by IPV/FV. Training to develop skills for conversations about IPV/FV with clients, around safety planning, and greater access to safe alternative accommodation for those leaving FV were identified priorities.
Exploration of the beliefs and experiences of Aboriginal people with cancer in Western Australia: A methodology to acknowledge cultural difference and build understanding
Publisher: Springer Science and Business Media LLC
Date: 13-08-2009
Tracks to Postgraduate Rural Practice
Publisher: MDPI AG
Date: 14-03-2023
Abstract: The nursing workforce is the backbone of healthcare provision in rural and remote Australia. Introducing student nurses to rural clinical placements is one strategy used to address the shortfall of healthcare workers outside of major cities, with the goal of improving the training, recruitment and retention of nurses in rural areas. The aim of this qualitative, longitudinal study was to better understand personal and professional decision-making around rural nursing practice intentions and subsequent rural employment and retention. The study methodology consisted of repeated semi-structured interviews with student nurses who had completed at least one rural placement and following them on their journey to becoming graduate nurses over a 6-year period. Thematic longitudinal analysis was undertaken, with three main themes developing, each with further subthemes: (1) participants’ satisfaction with rural placements (2) their challenges with gaining employment and (3) considerations regarding ‘going rural’ for work. The participants engaged in both prospective and retrospective reflection around several professional, personal, and wider systemic barriers and enablers to rural practice, which are discussed in detail in this paper. The insights from this longitudinal study have the potential to assist the development of a sustainable rural nursing workforce through informing rural workforce programs, strategies and policies.
Overcoming language barriers in community-based research with refugee and migrant populations: Options for using bilingual workers
Publisher: Springer Science and Business Media LLC
Date: 12-04-2014
Sampling challenges in a study examining refugee resettlement
Publisher: Springer Science and Business Media LLC
Date: 15-03-2011
The experience of lung cancer in Aboriginal and Torres Strait Islander peoples and what it means for policy, service planning and delivery
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/AH10955
Abstract: Background. Aboriginal and Torres Strait Islander peoples experience inferior outcomes following diagnosis of lung cancer. Aim. To examine the experience of lung cancer in this population and identify reasons for poorer outcomes and lower levels of treatment compared with non-Aboriginal and Torres Strait Islander peoples, and opportunities for early intervention. Method. Literature was sought via electronic database searches and journal hand-searching for the period from January 1995 to July 2010. Databases used included Indigenous HealthInfoNet, SCOPUS, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, HealthInsite and Google Scholar. Findings. Exposure to risk factors, cultural and spiritual values, remoteness and geographic characteristics, entrenched socioeconomic inequalities and racism contribute to reduced service access and poor outcomes. The review highlighted a complex interplay of in idual, social, health system and environmental factors that impact on optimal lung cancer care and lung cancer outcomes. Considering the burden of lung cancer within a framework of social determinants of health is necessary for policy-making and service planning and delivery. Conclusions. It is imperative that the disproportionate burden of lung cancer in Aboriginal and Torres Strait Islander peoples is addressed immediately. Whilst strategic interventions in lung cancer prevention and care are needed, service providers and policy makers must acknowledge the entrenched inequality that exists and consider the broad range of factors at the patient, provider and system level. Primary care strategies and health promotion activities to reduce risk factors, such as smoking, must also be implemented, with Aboriginal and Torres Strait Islander peoples’ engagement and control at the core of any strategy. This review has indicated that multifaceted interventions, supported by enabling policies that target in iduals, communities and health professionals, are necessary to improve lung cancer outcomes and disparities. What is known about the topic? Aboriginal Australians suffer a disproportionate burden of ill health including poor outcomes from lung cancer. What does this paper add? This paper reports the outcomes of an integrative literature review. The paper identifies potential barriers to optimal lung cancer care and management for Aboriginal Australians. This paper describes barriers within the context of in idual beliefs and behaviours, healthcare systems issues and environmental issues. The authors conclude that acknowledging entrenched inequality and addressing factors at the patient, provider and system level are needed to reduce the lung cancer burden in Aboriginal Australians. What are the implications for practitioners? This paper highlights the need for a greater focus on lung cancer care, awareness and diagnosis within the Aboriginal Australian population. Addressing culturally appropriate smoking-cessation initiatives is of particular importance. Primary care practitioners are key to reducing the burden of lung cancer in Aboriginal Australians.
Promoting women's health in remote Aboriginal settings: Midwifery students' insights for practice
Publisher: Wiley
Date: 12-2015
DOI: 10.1111/AJR.12247
Abstract: To describe midwifery students' insights on promoting health to Aboriginal women in remote Australia following a supervised clinical placement. Semistructured, in-depth interviews were conducted with all midwifery students who undertook the placement between 2010 and 2013. Aboriginal communities on the Ngaanyatjarra Lands, Western Australia. Undergraduate and postgraduate midwifery students from a Western Australian university. Remote cultural immersion clinical placement. Student learning related to culturally respectful health care delivery and promotion of health. Students observed that, despite vast distances, high rates of participation in a breast screening program were achieved due to the informal provision of culturally relevant information and support. Opportunistic encounters in communities also enabled sexual health messages to be delivered more widely and in less formal settings. The role played by Aboriginal Health Workers and female family members was vital. The importance of culturally respectful approaches to sensitive women's business, including discretion, the use of local language and pictorial representations of information, was recognised as was the socio-cultural context and its impact on the health and well-being of the community. Although short in duration, the Ngaanyatjarra Lands clinical placement provided midwifery students with a rare opportunity to observe the importance of local contexts and cultural protocols in Aboriginal communities, and to adapt health promotion strategies to meet local needs and ways of doing things. These strategies embraced the strengths, assets and capacities of communities, yet students also witnessed challenges associated with access, delivery and acceptance of health care in remote settings.
HIV positive tests at Coronial Services in Victoria 1989-1996: lessons for HIV surveillance
Publisher: Elsevier BV
Date: 10-2008
DOI: 10.1111/J.1467-842X.1998.TB01433.X
Abstract: Results of routine testing at other sites can supplement surveillance of the HIV epidemic in Australia which is largely based upon voluntary testing. Since 1989, systematic onsite HIV testing has been undertaken on all bodies taken to the Victorian Institute of Forensic Medicine (VIFM). Information was collected on all cases of HIV infection detected at VIFM between 1989 and 1996, and matched to surveillance databases. In 8 years, 75 people were diagnosed with HIV all except one were male. The age range was 14-70 years, mean 37.4 years. The major causes of death were suicide 35%, AIDS 21%, drug toxicity 16%, natural causes 12% and injury 7%. The major exposure categories were male homosexual 51%, male bisexual 11%, homosexual/bisexual IDU 16%, IDU other 8%, and haemophiliac 7%. For only two was exposure information unavailable. Seropositivity for anti-HCV and HBsAg was 37% and 11% respectively. The deceased was recorded as having HIV/AIDS on the police report in 73% of cases, and at least 90% of subjects had been diagnosed with HIV prior to their death. The study suggests there is relatively little undiagnosed HIV infection in Victoria, that HIV infection has not moved outside traditional risk groups, and that many tests for HIV are undertaken using false namecodes. Many patients could not be matched on the HIV/AIDS databases, identifying a problem with HIV surveillance systems in Victoria, and the need to capture all information on HIV positives detected at VIFM.
An audit of health student immunisation at a University Department of Rural Health reveals the imperative for a coordinated approach
Publisher: Elsevier BV
Date: 04-2021
Hepatitis C transmission through tattooing: a case report
Publisher: Elsevier BV
Date: 06-2008
DOI: 10.1111/J.1467-842X.1996.TB01035.X
Abstract: We report the case of a prisoner for whom tattooing was the likely source of hepatitis C virus (HCV) infection. Many of the tattoos were carried out within prison using equipment that was multiply shared with other prisoners with limited access to means of disinfection. This case supports previous reports that prison is a risk factor for HCV infection and that HCV can be transmitted through tattooing. Use of unsterilised equipment for tattooing within prison must be a high-risk activity, given the high prevalence of HCV infection among those incarcerated. Harm reduction approaches are required to diminish risk in this environment.
Sensorimotor Peak Alpha Frequency Is a Reliable Biomarker of Prolonged Pain Sensitivity
Publisher: Oxford University Press (OUP)
Date: 27-06-2020
Abstract: Previous research has observed that the speed of alpha band oscillations (8–12 Hz range) recorded during resting electroencephalography is slowed in chronic pain patients. While this slowing may reflect pathological changes that occur during the chronification of pain, an alternative explanation is that healthy in iduals with slower alpha oscillations are more sensitive to prolonged pain, and by extension, more susceptible to developing chronic pain. To test this hypothesis, we examined the relationship between the pain-free, resting alpha oscillation speed of healthy in iduals and their sensitivity to two models of prolonged pain, Phasic Heat Pain and Capsaicin Heat Pain, at two visits separated by 8 weeks on average (n = 61 Visit 1, n = 46 Visit 2). We observed that the speed of an in idual’s pain-free alpha oscillations was negatively correlated with sensitivity to both models and that this relationship was reliable across short (minutes) and long (weeks) timescales. Furthermore, the speed of pain-free alpha oscillations can successfully identify the most pain sensitive in iduals, which we validated on data from a separate, independent study. These results suggest that alpha oscillation speed is a reliable biomarker of prolonged pain sensitivity with potential for prospectively identifying pain sensitivity in the clinic.
Missed opportunities in educating Aboriginal Australians about bowel cancer screening: whose job is it anyway?
Publisher: Informa UK Limited
Date: 04-08-2013
Modelling hepatitis C virus incidence, prevalence and long-term sequelae in Australia, 2001
Publisher: Oxford University Press (OUP)
Date: 10-2003
DOI: 10.1093/IJE/DYG101
Abstract: To plan an appropriate public health response to the hepatitis C virus (HCV) epidemic requires that estimates of HCV incidence and prevalence, and projections of the long-term sequelae of infection, are as accurate as possible. In this paper, mathematical models are used to synthesize data on the epidemiology and natural history of HCV in Australia to estimate HCV incidence and prevalence in Australia to end 2001, and project future trends in the long-term sequelae of HCV infection. Mathematical models of the HCV epidemic in Australia were developed based on estimates of the pattern of injecting drug use. Estimates of HCV infections due to injecting drug use were then adjusted to allow for HCV infections resulting from other transmission routes. Projections of the long-term sequelae of HCV infection were obtained by combining modelled HCV incidence with estimates of the progression rates to these outcomes. It was estimated that there were 210 000 (lower and upper limits of 157 000 and 252 000) people in Australia living with HCV antibodies at the end of 2001, with HCV incidence in 2001 estimated to be 16 000 (11 000-19 000). It was estimated that 6500 (5000-8000) people were living with HCV-related cirrhosis in 2001, that 175 (130-210) people developed HCV-associated liver failure, and that there were 50 (40-60) incident cases of HCV-related hepatocellular carcinoma (HCC). It was estimated that in 2001 22 500 quality adjusted life years were lost to chronic HCV infection, the majority (77%) in people with early (stage 0/1) liver disease. Model-based estimates were broadly consistent with other sources of information on the HCV epidemic in Australia. These models suggest that the prevalence of HCV-related cirrhosis and the incidence of HCV-related liver failure and HCC will more than triple in Australia by 2020.
Delivery of maternal health care in Indigenous primary care services: baseline data for an ongoing quality improvement initiative
Publisher: Springer Science and Business Media LLC
Date: 07-03-2011
Unmet supportive care needs among Indigenous cancer patients across Australia
Publisher: Rural and Remote Health
Date: 16-09-2019
DOI: 10.22605/RRH4660
Tobacco control practices among Aboriginal health professionals in Western Australia
Publisher: CSIRO Publishing
Date: 2009
DOI: 10.1071/PY08066
Abstract: Smoking among Aboriginal people is extremely widespread (50 v. 17% of the general population). Aboriginal Health Workers (AHW) are at the vanguard of tackling this problem but many themselves smoke and little is known of their knowledge, attitudes and practices regarding smoking cessation. Structured telephone interviews were conducted with 36 AHW, including 31% current smokers, 31% ex-smokers and 38% non-smokers, to assess their current smoking cessation practices and knowledge of health risks, nicotine dependence, cessation strategies and pharmacotherapies. AHW considered diabetes, alcohol use and heart disease more problematic than smoking among Aboriginal people. Fear of appearing hypocritical stopped many who smoke from discussing smoking cessation with clients but also stopped some non-smoking AHW whose colleagues or family smoked. Cultural concerns about telling others ‘what to do’ was also a major impediment. Knowledge of the health effects of smoking was good, but knowledge of appropriate advice around cessation pharmacotherapies was suboptimal. AHW trained in smoking cessation were more knowledgeable and active in smoking cessation, but most AHW had received no training, despite being keen to do so. Specific smoking cessation training is sought and appears needed by AHW, particularly in the areas of brief interventions, motivational interviewing, dependence assessment and pharmacotherapies.
An Exploration of Underrepresentation of Aboriginal Cancer Patients Attending a Regional Radiotherapy Service in Western Australia
Publisher: MDPI AG
Date: 14-02-2018
Evidence to service gap
Publisher: Springer Science and Business Media LLC
Date: 30-01-2018
Colorectal cancer screening knowledge, attitudes and behavioural intention among Indigenous Western Australians.
Publisher: Springer Science and Business Media LLC
Date: 18-07-2012
Variation in quality of preventive care for well adults in Indigenous community health centres in Australia
Publisher: Springer Science and Business Media LLC
Date: 06-2011
Abstract: Early onset and high prevalence of chronic disease among Indigenous Australians call for action on prevention. However, there is deficiency of information on the extent to which preventive services are delivered in Indigenous communities. This study examined the variation in quality of preventive care for well adults attending Indigenous community health centres in Australia. During 2005-2009, clinical audits were conducted on a random s le (stratified by age and sex) of records of adults with no known chronic disease in 62 Indigenous community health centres in four Australian States/Territories (s le size 1839). Main outcome measures: i) adherence to delivery of guideline-scheduled services within the previous 24 months, including basic measurements, laboratory investigations, oral health checks, and brief intervention on lifestyle modification and ii) follow-up of abnormal findings. Overall delivery of guideline-scheduled preventive services varied widely between health centres (range 5-74%). Documentation of abnormal blood pressure reading ([greater than or equal to]140/90 mmHg), proteinuria and abnormal blood glucose ([greater than or equal to]5.5 mmol/L) was found to range between 0 and 90% at the health centre level. A similarly wide range was found between health centres for documented follow up check/test or management plan for people documented to have an abnormal clinical finding. Health centre level characteristics explained 13-47% of variation in documented preventive care, and the remaining variation was explained by client level characteristics. There is substantial room to improve preventive care for well adults in Indigenous primary care settings. Understanding of health centre and client level factors affecting variation in the care should assist clinicians, managers and policy makers to develop strategies to improve quality of preventive care in Indigenous communities.
The prevalence of hepatitis C in patients admitted with acute hepatitis to Fairfield Infectious Diseases Hospital, 1971‐1975
Publisher: AMPCo
Date: 10-1998
DOI: 10.5694/J.1326-5377.1998.TB126803.X
Abstract: To identify and determine trends in the prevalence of hepatitis C virus (HCV) antibody in stored sera from 1971 to 1975 and to determine associations with HCV seropositivity, including markers for other hepatitis infections and possible routes of transmission. A retrospective cross-sectional study. 1511 adults admitted to Fairfield Infectious Diseases Hospital, Victoria, with a clinical and biochemical diagnosis of hepatitis between 1 January 1971 and 31 December 1975. Prevalence over study period of hepatitis A virus antibody (anti-HAV) IgM, hepatitis B core antibody (anti-HBc), hepatitis B surface antigen (HBsAg) and hepatitis C virus antibody (anti-HCV) in stored sera sociodemographic data and risk factors for blood-borne viruses documented in original medical records. Anti-HCV was detected in 17% of adults admitted with hepatitis from 1971 through 1975. Prevalence increased significantly over this period. Most cases were in young men who had a history of injecting drug use. HCV seropositivity was also significantly associated with markers for hepatitis B infection. Given the 20-30-year period between infection with hepatitis and the development of liver disease, our findings predict significant liver-related morbidity in Australia in the next decade. The increase in prevalence over the five years studied suggests rapid spread of HCV through susceptible populations, principally injecting drug users.
“Slowed right down”: Insights into the use of alcohol from research with Aboriginal Australians living with HIV
Publisher: Elsevier BV
Date: 03-2009
DOI: 10.1016/J.DRUGPO.2008.02.003
Abstract: To describe the role that alcohol plays in the lives of Aboriginal people living with HIV in Western Australia. Semi-structured interviews were conducted between February and September 2003 with 20 Aboriginal people who were HIV-positive almost half the total number of Aboriginal people known to be living with HIV in Western Australia at that time. The main purpose of the study was to document their experiences of living with HIV and aspects of health service delivery. Drinking emerged as a key theme in the majority of interviews. Alcohol had a major role in disinhibition and risk-taking behaviour of both the participants and those they socialized with. It was perceived as a commodity, a way of altering reality, and a pathway through which social connection was maintained and was central to the common narratives of loss, chaos and transformation. Post-diagnosis, alcohol helped with disclosure and temporary blunting of distress as a result of the HIV diagnosis. It also contributed to a lack of capacity to comply with anti-retroviral therapy although narratives also included personal growth and restoration of physical health. Effective strategies to reduce risk of STIs and HIV and prevent other health problems need to address substance use issues but this also requires amelioration of the structural inequalities that make minority groups vulnerable.
Australia's National Bowel Cancer Screening Program: does it work for Indigenous Australians?
Publisher: Springer Science and Business Media LLC
Date: 25-06-2010
Hepatitis infection among adolescents resident in Melbourne Juvenile Justice Centre: risk factors and challenges
Publisher: Elsevier BV
Date: 07-1999
DOI: 10.1016/S1054-139X(98)00086-X
Abstract: To describe patterns of infection with, and risks for, hepatitis A, B and C viruses (HAV, HBV, and HCV) in male adolescents detained in the Melbourne Juvenile Justice Centre (MJJC). A cross-sectional serosurvey for HAV, HBV, and HCV among 90 male adolescents aged 15-18 years who were resident in MJJC for more than 1 week in 1996. Nine percent had been exposed to HAV, 8% were positive or equivocal for exposure to HBV, and 21% were antibody positive for HCV. All those with hepatitis markers except one positive for HAV had been injection heroin users for more than 1 year. Of those who were not HBcAb positive, only 28% were immune to HBV. For most respondents, sexual and drug-using risks began in the early teens and were associated with leaving school prematurely. Respondents were vulnerable to exposure to blood-borne viruses from an early age, posing a challenge for health education programs. An opportunity exists for harm minimization and prevention of spread of blood-borne viruses within the first year of injection drug use in this population.
Aboriginal to non-Aboriginal differentials in 2-year outcomes following non-fatal first-ever acute MI persist after adjustment for co-morbidity
Publisher: Oxford University Press (OUP)
Date: 28-07-2012
Abstract: We investigated the relationship between Aboriginality and 2-year cardiovascular disease outcomes in non-fatal first-ever myocardial infarction during 2000-04, with progressive adjustment of covariates, including comorbidities. Historical cohort study. Person-linked hospital and mortality records were used to identify 28-day survivors of first-ever myocardial infarction in Western Australia during 2000-04 with 15-year lookback. The outcome measures were: (1) cardiovascular disease death (2) recurrent admission for myocardial infarction and (3) the composite of (1) and (2). Compared with non-Aboriginal patients, Aboriginals were younger and more likely to live remotely. The proportions having 5-year histories of diabetes and chronic kidney disease were double and triple those of non-Aboriginals. When adjusting for demographic variables alone, the Aboriginal to non-Aboriginal hazard ratios for cardiovascular death or recurrent myocardial infarction were 3.6 (95% CI 2.5-5.3) in men and 4.5 (95% CI 2.8-7.3) in women. After adjustment for comorbidities, including diabetes, chronic kidney disease and heart failure, the hazard ratios decreased 36% and 47% to 2.3 (1.6-3.0) and 2.4 (1.5-4.0) in males and females, respectively. The high prevalence of comorbidities in Aboriginal people, including diabetes, kidney disease, heart failure, and other risk factors contribute substantially to the disparity in post-myocardial infarction outcomes in Aboriginal people, reinforcing the importance of both primary prevention and comprehensive management of chronic conditions in this population. Aboriginality remains a significant independent risk factor for disease recurrence or mortality, even after adjusting for comorbidity, suggesting the need for society-level interventions addressing social disadvantage.
Challenges in managing acute cardiovascular diseases and follow up care in rural areas
Publisher: MDPI AG
Date: 15-12-2019
Abstract: This narrative review explores relevant literature that is related to the challenges in implementing evidence-based management for clinicians in rural and remote areas, while primarily focussing on management of acute coronary syndrome (ACS) and follow up care. A targeted literature search around rural/urban differences in the management of ACS, cardiovascular disease, and cardiac rehabilitation identified multiple issues that are related to access, including the ability to pay, transport and geographic distances, delays in patients seeking care, access to diagnostic testing, and timely treatment in an appropriate facility. Workforce shortages or lack of ready access to relevant expertise, cultural differences, and complexity that arises from comorbidities and from geographical isolation lified diagnostic challenges. Given the urgency in management of ACS, rural clinicians must act quickly to achieve optimal patient outcomes. New technologies and quality improvement approaches enable better access to rapid diagnosis, as well as specialist input and care. Achieving an uptake of cardiac rehabilitation in rural and remote settings poses challenges that may reduce with the use of alternative models to centre-based rehabilitation and use of modern technologies. Expediting improvement in cardiovascular outcomes and reducing rural disparities requires system changes and that clinicians embrace attention to prevention, emergency management, and follow up care in rural contexts.
The incidence of hepatitis B infection in Australia: an epidemiological review
Publisher: AMPCo
Date: 09-1996
DOI: 10.5694/J.1326-5377.1996.TB124993.X
Abstract: Hepatitis B virus (HBV) infection in Australia remains a significant problem despite the availability of an inexpensive vaccine. National information about incidence, prevalence, morbidity and the extent of vaccine coverage is incomplete improved surveillance would allow for better targeting and evaluation of prevention activities. Our estimates indicate that 75%-90% of cases of vertical transmission of HBV are preventable through vaccination of newborns whose mothers are carriers.
Examining the potential contribution of social theory to developing and supporting Australian Indigenous-mainstream health service partnerships
Publisher: Springer Science and Business Media LLC
Date: 20-09-2014
Improving the management of acute coronary syndrome for Aboriginal and non-Aboriginal patients in a regional hospital
Publisher: Elsevier BV
Date: 12-2016
Abstract: To determine inequities in clinical adherence to national diagnostic and management guidelines for acute coronary syndrome (ACS) for Aboriginal and non-Aboriginal ACS patients at a regional hospital. Covering two study periods (2011-12 2013-14), records of Aboriginal (n=276) and a random selection of non-Aboriginal patients (n=333) presenting to the Emergency Department with chest pain were retrospectively reviewed using an audit protocol. Groups were compared using logistic regression, controlling for age, sex and comorbidity. Pathway utilisation improved overall, but risk stratification improved only for non-Aboriginal patients (OR=3.34, 95%CI 1.88-5.94). Performance of two troponin measurements increased to 88% for both Aboriginal and non-Aboriginal presentations. Although initially higher for non-Aboriginal presentations, the likelihood of admission was found to be similar in the repeat audit (75.6% vs 78.6% p=0.60), reflecting a rise in Aboriginal presentations being admitted (OR=2.30, 95%CI 1.27-4.15). There was no significant difference in proportions transferred, receiving angiograms or for ST Elevation Acute Coronary Syndrome (a severe form of Acute Coronary Syndrome) being thrombolysed. Discharge against medical advice remained higher among Aboriginal presentations (OR=4.22, 95%CI 0.88-20.29). Although there was a general improvement in adherence to the chest pain pathway and a reduction in inequity in the treatment of Aboriginal people, there is continuing need for improvement in adherence to guidelines to optimise the management of ACS in this regional setting.
Is HIV screening being requested appropriately? The experience of a Victorian public health laboratory
Publisher: Elsevier BV
Date: 06-2008
DOI: 10.1111/J.1467-842X.1996.TB01024.X
Abstract: From the start of clinical testing for human immunodeficiency virus (HIV) antibody in 1985 until the end of June 1994, the Microbiological Diagnostic Unit tested 134 346 serum s les from 109 391 in iduals, identifying 672 as infected. A suitable database, using coded identities, was established from the beginning. Because the sera came from a variety of clinical settings, it was possible to extract information about patterns of requests for tests and about the yield of seropositive cases. The data were able to highlight factors associated with high rates of positive tests that can be lost in amalgamated statewide data. The discovery of HIV-positive females was sporadic and there was a much lower detection rate than from testing males. While males were most commonly diagnosed through specialist venereology services, 61 per cent of diagnoses in females were through nonspecialised practices, often those without previous experience in diagnosis and management of HIV infection. Despite some in idual exceptions, the requesting of HIV tests appears generally to have been justifiable (particularly in view of the direction of official preventive c aigns) and not profligate. Overall, where practice was unsatisfactory, this lay less in thoughtless ordering of tests than in failing to include with the specimen the elementary, but vital, epidemiological information requested.
Hepatitis A epidemiology in Australia: national seroprevalence and notifications
Publisher: AMPCo
Date: 11-2001
Giardia lamblia in children and the child care setting: A review of the literature
Publisher: Wiley
Date: 06-1994
Learning from follow-up of student placements in a remote community: a small qualitative study highlights personal and workforce benefits and opportunities
Publisher: Springer Science and Business Media LLC
Date: 04-09-2019
Changing Images of Refugees: A Comparative Analysis of Australian and New Zealand Print Media 1998−2008
Publisher: Informa UK Limited
Date: 10-2011
Measuring height and weight as part of routine mammographic screening for breast cancer
Publisher: SAGE Publications
Date: 09-07-2019
Abstract: Body mass index is a strong predictor of post-menopausal breast cancer risk and (negatively) confounds the association between mammographic breast density and breast cancer risk however, height and weight are not typically measured as part of routine mammographic screening. This study piloted voluntary height and weight measurement within the BreastScreen Western Australia (WA) programme, and assessed trial participation. From February 2016 to January 2018, 204,429 women attending BreastScreen WA were invited to have their height and weight measured and recorded as part of their routine screening mammogram. Descriptive data analysis was used to assess pilot participation rates by available screening data. Of the 204,429 patients who attended BreastScreen WA during the pilot, 76.35% (156,072) agreed to have their height and weight measured. Pilot participation rates were significantly lower in those patients with disabilities (RR: 0.626 95% CI: 0.600, 0.653), those who spoke a language other than English at home (RR: 0.876 95% CI: 0.867, 0.885), and those who identified as Aboriginal and Torres Strait Islander (RR: 0.829 95% CI: 0.807, 0.852). Pilot participation decreased over time from 88.9% in the first three months to 55.5% in the last month, due to lessening of support from BreastScreen staff. Measuring height and weight at the time of routine mammographic screening is feasible, although logistical issues, particularly the added time/effort required of support staff, should be considered. BreastScreen WA has since decided to collect voluntary self-reported height and weight data as routine screening policy.
Closing the (service) gap: exploring partnerships between Aboriginal and mainstream health services
Publisher: CSIRO Publishing
Date: 2011
DOI: 10.1071/AH10936
Abstract: Background. Although effective partnerships between Aboriginal and mainstream health services are critical to improve Aboriginal health outcomes, many factors can cause these partnerships to be tenuous and unproductive. Understanding the elements of best practice for successful partnerships is essential. Methods. A literature review was conducted in 2009 using keyword searches of electronic databases. Sourced literature was assessed for relevance regarding the benefits, challenges, lessons learnt and factors contributing to successful Aboriginal and mainstream partnerships. Key themes were collated. Results. Although there is much literature regarding general partnerships generally, few specifically examine Aboriginal and mainstream health service partnerships. Twenty-four sources were reviewed in detail. Benefits include broadening service capacity and improving the cultural security of healthcare. Challenges include the legacy of Australia’s colonial history, different approaches to servicing clients and resource limitations. Recommendations for success include workshopping tensions early, building trust and leadership. Conclusion. Although successful partnerships are crucial to optimise Aboriginal health outcomes, failed collaborations risk inflaming sensitive Aboriginal–non-Aboriginal relationships. Factors supporting successful partnerships remind us to develop genuine, trusting relationships that are tangibly linked to the Aboriginal community. Failure to invest in this relational process and push forward with ‘business as usual’ can ultimately have negative ramifications on client outcomes. What is known about the topic? Partnerships between different health services have long been recognised as beneficial for broadening service capacity and using resources more effectively to improve client care. The current policy climate particularly recognises partnerships between Aboriginal and mainstream services as offering multiple benefits for improving the cultural and clinical capacity of health service delivery to Aboriginal clients. Yet many challenges face these arrangements, including tensions stemming from historical and current race relations, different ways of working and ongoing Aboriginal disadvantage. What does this paper add? Although partnerships between Aboriginal and mainstream services are strongly advocated for, there is a paucity of research on the challenges in these arrangements and practical suggestions on how to make such partnerships genuinely successful. This paper analyses the results from research, case studies, reports and reviews to identify the factors that challenge and enhance partnerships between Aboriginal and mainstream health services. The collation of this information also enables indicators of best practice to be presented. What are the implications for practitioners? Although there are considerable challenges for Aboriginal and mainstream health services entering into partnerships, this paper offers health service practitioners and managers a summary of lessons learnt and a ‘checklist’ of best practice indicators to assist them in developing, implementing and sustaining a successful collaborative arrangement.
Contribution of university departments of rural health to rural health research: An analysis of outputs
Publisher: Wiley
Date: 18-02-2015
DOI: 10.1111/AJR.12142
Abstract: To assess the research contribution of eleven University Departments of Rural Health (UDRH) which were established as a rural health workforce program in the late 1990s through analysis of peer-reviewed journal output. Descriptive study based on validated publications from publication output reported in annual key performance indicator (KPI) reports to the Commonwealth Department of Health, Australia. In addition to counts and the type of publications, articles were examined to assess fields of research, evidence of research collaboration, and potential for influencing policy. Funding acknowledgement was examined to provide insight into funding sources and research consultancies. Of the 182 peer-reviewed articles, UDRH staff members were the first and corresponding author for 45% (n = 82) most (69%, n = 126) were original research. Most publications examined included Australian data only (80%, n = 101). Over half (56% n = 102) of the articles addressed rural health issues Aboriginal health was the main subject in 14% (n = 26). Thirty-three articles (18%) discussed the policy implications of the research and only half (51%, n = 93) of the articles listed sources of funding. Number of authors per article ranged from 1-19, with a mean of 5 (SD = 3.2) authors per article, two-thirds of articles included authors from 2-5 universities/organisations but only 5% of articles included an author from more than one UDRH. Staff from UDRHs are regularly publishing peer-reviewed articles, and research productivity demonstrated cooperation with external partners. Better collaboration between UDRH staff and others may help increase the quality and value of Australian rural health research.
Don't forget the hepatitis A vaccine
Publisher: AMPCo
Date: 08-1997
Barriers to participation of Aboriginal people in cancer care: communication in the hospital setting
Publisher: AMPCo
Date: 05-2009
DOI: 10.5694/J.1326-5377.2009.TB02569.X
Abstract: To report Aboriginal patients' views about effective communication between Aboriginal people and health service providers in Western Australian hospital settings. Qualitative study involving indepth interviews between 1 March 2006 and 30 September 2007 with 30 Aboriginal people affected by cancer from across WA. Aboriginal patients' views about the quality of communication within the hospitals, factors impairing communication and suggestions for improvement. Factors crucial to effective patient-provider communication such as language, shared understanding, knowledge and use of medical terminology require attention. Additionally, communication between Aboriginal people and health care professionals needs to be understood within a broader sociocultural and political context. Fear of the medical system and of being disempowered mistrust collective memories of the experience of colonisation and its aftermath lack of understanding of Aboriginal customs, values, lifestyle and the importance of family and land and experiences of racism were key issues impairing communication. Health service providers' inability to interpret non-verbal communication and the symbolism of hospital environments also posed problems. Key areas for the attention of health service providers in communicating and caring for Aboriginal people in the hospital setting include culturally sensitive and empathetic personal contact, acknowledgement and respect for Aboriginal family structures, culture and life circumstances, an understanding of the significant role of non-verbal communication, and the importance of history, land and community. Employing more Aboriginal health workers in hospitals, and allowing Aboriginal people to participate at a decision-making level in hospitals is likely to improve Aboriginal people's access to cancer treatment, and would be important symbols of progress in this area.
Making progress: The role of cancer councils in Australia in indigenous cancer control
Publisher: Springer Science and Business Media LLC
Date: 11-04-2014
Attracting, Recruiting, and Retaining Medical Workforce: A Case Study in a Remote Province of Indonesia
Publisher: MDPI AG
Date: 12-01-2023
Abstract: Indonesia, one of the Asia Pacific low-and middle-income countries (LMICs), has suffered from a chronic medical workforce shortage. However, there are limited published studies describing the approaches implemented by the Indonesian government regarding the recruitment and retention of the medical workforce. This case study aimed to understand the current practices for recruitment and retention of the medical workforce in Indonesian rural and remote provinces. We conducted a case study of the Maluku Province of Indonesia with a document analysis and key informant interviews with officials responsible for medical workforce recruitment and retention. We used the World Health Organization’s (WHO) guidelines as an analytical matrix to examine the recruitment and retention practices under the four domains of (i) educational, (ii) regulatory, (iii) financial, and (iv) professional and personal development and classified them into either University/Medical School level or Government/Non-government level. Our findings suggest that Indonesia implemented most of the WHO-recommended medical workforce recruitment and retention strategies. However, implementation is still problematic hence, the aim of establishing an adequate, sustainable medical workforce has not been reached. Nationwide government intervention in educational aspects is important to magnify the impact of regional medical school initiatives. Relevant programmes must be re-evaluated and re-enforced concerning significance, comprehensiveness, and effectiveness for a sustainable rural and remote medical workforce.
A descriptive model of patient readiness, motivators, and hepatitis C treatment uptake among Australian prisoners
Publisher: Public Library of Science (PLoS)
Date: 27-02-2014
Related Organisations
Walter And Eliza Hall Institute Of Medical Research
Location: Australia
Related Funding Activities
Discovery Projects - Grant ID: DP170101148
Start Date: 2017
End Date: 06-2021
Amount: $765,500.00
Funder: Australian Research Council
View Funded ActivityIndustrial Transformation Training Centres - Grant ID: IC210100034
Start Date: 09-2022
End Date: 09-2027
Amount: $4,986,473.00
Funder: Australian Research Council
View Funded Activity