ORCID Profile
0000-0001-9673-1913
Current Organisation
James Cook University
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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.
Anthropology | Public Health and Health Services | Health Policy | Medical And Health Sciences Not Elsewhere Classified | Public Health and Health Services not elsewhere classified | Gender Specific Studies | Social And Cultural Anthropology | Social and Community Psychology
Gender | Substance Abuse | Women’s health | Men’s health | Public Services Policy Advice and Analysis |
Publisher: Elsevier BV
Date: 09-2010
Publisher: Springer Science and Business Media LLC
Date: 2010
Publisher: BMJ
Date: 07-2016
Publisher: Springer Science and Business Media LLC
Date: 23-04-2012
DOI: 10.1057/CPCS.2011.19
Publisher: Elsevier BV
Date: 02-2002
DOI: 10.1111/J.1467-842X.2002.TB00271.X
Abstract: Estimating illicit substance use in epidemiological studies is challenging, particularly across ethical, cultural and language barriers. While developing the methods for a case-control study of the effects of heavy kava consumption among Aboriginal people in remote Northern Territory (NT), we examined the validity and utility of alternative methods for estimating exposure. We assessed the level of agreement between a consensus of Aboriginal health workers in two different communities using interviews conducted with community members and health workers and in iduals' self-reported kava consumption. Exposure measures included history of kava use, current kava use and history of heavy use. Agreement between a health worker consensus classification and in iduals' self-report was analysed and agreement among several health workers in a consensus classification without self-report was assessed. Health workers concurred about an in idual's history of kava use (k=0.83), current use (k=0.43) and also level of use (k=0.33). There was very good agreement between health workers' consensus and self-reported history of use (k=0.77). Agreement among health workers about current kava use was poor (k=0.08), while there was fair agreement between health workers and self-reported heavy kava users (k=0.36). Data from review of clinic patient notes supported agreement between consensus classification and self-reported history and level of use (k=0.39). Self-reported kava use may be a poor estimate of current use especially when obtained from interviews away from a confidential clinic setting. Consensus classification by knowledgeable Aboriginal health workers provided comprehensive coverage, efficiently and with greater reliability and assisted to identify 'excessive' kava use.
Publisher: BMJ
Date: 05-06-2014
Publisher: Elsevier BV
Date: 02-2011
DOI: 10.1111/J.1753-6405.2010.00632.X
Abstract: To review available literature addressing the issue of whether smoking status of Indigenous Health Workers (IHWs) impedes provision of health information about smoking tobacco to their communities. Databases were searched for publications that examined IHWs' smoking status or quit support programs for IHWs. Studies were categorised as reviews and commentaries, intervention studies or descriptive research. Fourteen studies met inclusion criteria. Overall, the literature suggests that IHWs' smoking status is a barrier. However, the poor quality of most studies weakens the evidence for this conclusion. The issue of IHWs smoking status as a barrier is peripheral to all but two of the studies. Literature cited and reviewed was often not exhaustive and relied on only a few preceding empirical studies. Most studies were unclear about whether IHWs' views were reported as distinct from views of health staff in general. The recent COAG investment to Tackling Smoking is an important contribution to Closing the Gap in the health of Indigenous Australians. However, there remain potential barriers faced by IHWs that may undermine efforts to reduce Indigenous smoking. Overcoming these barriers and assisting IHWs to quit smoking may provide an opportunity to address high rates of smoking in Indigenous communities. Further research is required with a balance between descriptive research to assess the issue and intervention research to address it.
Publisher: Oxford University Press (OUP)
Date: 15-07-2015
DOI: 10.1093/NTR/NTV018
Abstract: Smoking prevalence among Indigenous Australians nationally (45%) is more than double that of other Australians but ranges up to 82% in remote communities, causing significant health disparities. This paper examines trends in peer-reviewed research outputs related to Indigenous Australian tobacco control over the past decade and describes their research translation potential and alignment with national and jurisdictional policy priorities. Systematic searches of electronic databases were conducted: Medline, CINAHL, Cochrane Systematic Reviews, PsychInfo, and Australian HealthInfoNET for English-language peer-reviewed publications (2004-2013) primarily focusing on Indigenous Australian tobacco use. Publications were categorized by types, topics, and geographic location. Following established procedures, "reviews" and "commentaries" were distinguished from "original research," the latter further classified as "measurement," "descriptive," or "intervention" studies. Research translation categories used were: "synthesis," "dissemination," "exchange," and "application." The majority of 78 publications meeting selection criteria focused on cessation treatment (28%), monitoring and prevalence (24%) and passive smoking (13%). "Original research" was mostly "descriptive/epidemiologic" (81%) with few "intervention" studies (9%). Many studies were in remote communities. Components of research translation were identified in 50% of the publications with little evidence of dissemination strategies. Remote community populations are an area of great need. However, generally it is disappointing that since 2004, few intervention studies are available to guide efforts to reduce tobacco-related health disparities. Stronger and more immediate alignment of policy with research that contributes to the evidence-base is required together with more systematic use of research dissemination translation strategies to better match evidence with priorities which may develop rapidly over time.
Publisher: Informa UK Limited
Date: 22-02-2019
DOI: 10.1080/10826084.2018.1504078
Abstract: Heavy cannabis use in remote Indigenous Australian communities potentially contributes to existing health disparities. Community members' perceptions of cannabis harms will support harm-minimization in these settings. To describe perceived cannabis harms reported by a cohort of Indigenous Australians living in small, isolated communities as an indication of their existing resources for change. Inductive thematic analysis of 407 semi-structured interviews with participants in a cohort study in three remote communities in Cape York in far north Queensland (Australia) revealed major areas of concern about cannabis. Three attitudinal categories were defined according to reported cannabis impacts and urgency for change: 1- "LOW CONCERN" said cannabis was a low priority community issue 2- "SOME CONCERN" tolerated cannabis use but identified personal or community-level concerns and 3- "HIGH CONCERN" expressed strong aversion to cannabis and identified serious personal or community-level harms. The characteristics and the patterns of concerns were summarized across the groups. "Category 1- LOW CONCERN" (n = 107), mostly current users, emphasized personal "financial impacts" and "stress." "Category 2 - SOME CONCERN" (n = 141) perceived community level impacts warranting systematic action, particularly on "employment" and "Category 3 - HIGH CONCERN" (n = 159), most of the never users, emphasized concerns for families and youth. Irrespective of use history, the cohort reported financial and abstinence-related stress, overlapping alcohol issues and generally endorsed alleviating impacts on children and youth. Nearly ubiquitous experience with cannabis harms and impacts in this cohort suggests resources for harm reduction including family and cultural obligation, stress relief, financial management, and engagement are available across all community members, not just users.
Publisher: BMJ
Date: 02-2004
Publisher: Elsevier BV
Date: 05-2022
DOI: 10.1016/J.THORSURG.2021.11.002
Abstract: The continuing shortage of pulmonary grafts from donors after brain death has led to a resurgence of interest in lung transplantation from donors after circulatory death (DCD). Most lungs from donors after withdrawal from life-sustaining therapy can be recovered rapidly and transplanted directly without ex-vivo assessment in case functional warm ischemic time is limited to 30 to 60 min. The potential of the DCD lung pool is still underutilized and should be maximized in countries with existing legislation. Countries lacking a DCD pathway should be encouraged to develop national ethical, professional, and legal frameworks to address public and professional concerns.
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.1016/J.DRUGPO.2015.01.003
Abstract: Very high rates of injury and death during the 1990s were linked with increased alcohol availability and misuse in discrete Indigenous communities in rural and remote Queensland (Australia). To address widespread concerns about a public health crisis, from 2002, the Queensland Government implemented alcohol control strategies known as 'Alcohol Management Plans' (AMPs) in 19 of these communities. Although resources for prevention and treatment were promised, AMPs became increasingly focused on local prohibition, restricted access to alcohol and punitive measures for breaching restrictions. An examination of legislation, regulations, explanatory notes, and published documents indicates this focus evolved across four phases since 2002. The first phase, from 2002 to 2004, saw 'restricted areas' with alcohol 'carriage limits' introduced, restricting the amounts and types of liquor permitted within some communities. The second phase (2002-2007) featured evaluations and reviews by the Queensland Government bringing recommendations for more stringent controls. Additionally, beyond the 'restricted areas', licenced premises situated within the 'catchments' of the targeted communities, mainly located in the nearby regional towns, became subject to 'minimising harm' provisions. These more stringent controls were implemented widely in the third phase (2008-2011) when: the operations of seven community-managed liquor outlets were terminated the trading arrangements of two others were modified Police powers to search and seize were increased and 'attempting' to take liquor into a 'restricted area' also became an offence. Some communities have seen a reduction in alcohol-related harms that have been attributed to these alcohol control strategies. This commentary maps the recent regulatory history of Queensland's alcohol controls targeting discrete Indigenous communities highlighting their increasing focus on punitive measures to reduce access to alcohol. With AMPs in Queensland currently under Government review, and with community resolve for change rising, the limits to Government controls and punitive measures may have been reached.
Publisher: Wiley
Date: 07-2008
DOI: 10.1080/09595230802089693
Abstract: Diversion from court and prison has been recommended for Indigenous Australian youth who commit offences. As no evaluations of such programmes have been published, we describe processes and early outcomes of a ersion programme in the Northern Territory. From 2003 to 2006, among 1700 remote Indigenous community residents, 35 young people (aged 11-18 years, median 15 years) committed offences. They were erted from criminal justice and referred to a community-based ersion initiative. Client assessment records and staff interviews furnished data to examine clients' ersion pathways and early programme results. Eighteen clients were reportedly using a substance at the time of their offence cannabis (n = 9), petrol (n = 5), alcohol (n = 4). The remaining 17 had histories of using one or more of these. Two clients could not complete local ersion programs because they moved to other regions one case was not pursued for legal reasons, leaving 32 clients exposed to the local programme. By July 2006, four clients were continuing in their programmes, three had breached them, but 25 had completed them in periods ranging from 2 to 60 weeks (median = 26 weeks), a completion rate of 89% (25/28). Just one client re-offended after completing ersion. A high completion rate was achieved despite: a dearth of locally available drug and alcohol treatment services and ersion options shifts in police approaches heavy administrative burdens to meet legal requirements and difficulties communicating across cultural barriers.
Publisher: Springer Science and Business Media LLC
Date: 22-06-2011
DOI: 10.1057/CPCS.2011.3
Publisher: Informa UK Limited
Date: 06-2004
Publisher: Informa UK Limited
Date: 2003
Abstract: Hepatic toxicity from manufactured herbal remedies that contain kava lactones has been reported in Europe, North America, and Australia. There is no evidence for serious liver damage in kava-using populations in Pacific Island societies or in Indigenous Australians who have used aqueous kava extracts. This article presents evidence that liver function changes in users of aqueous kava extracts appear to be reversible. Data from one Arnhem Land community [Northern Territory (NT), Australia] with 340 indigenous people older than 15 years of age in 2000 are used. This study was a cross-sectional study with 98 participants, 36 of whom had never used kava. Among 62 kava users, 23 had discontinued kava at least 1 year before the study. Continuing users had not used kava for 1 to 2 months (n = 10) or 1 to 2 weeks previously (n = 15). Some (n = 14) had used kava within the previous 24 hr. Liver function tests were compared across these groups, taking into account differences due to age, sex, alcohol, and other substance use. The average quantity of kava powder consumed was 118 g/week, and median duration of use was 12 years (range, 1-18 years). Kava usage levels were less than one-half of those found in previous studies. More recent kava use was independently associated with higher levels of liver enzymes gamma-glutamyl transferase (GGT) (p < 0.001) and alkaline phosphatase (ALP) (p < 0.001), but not with alanine aminotransferase or bilirubin, which were not elevated. In those who were not heavy alcohol users, only those who used kava within the previous 24 hr showed GGT levels higher than nonusers (p < 0.001), whereas higher ALP levels occurred only in those who last used kava 1 to 2 weeks (p = 0.015) and 24 hr previously (p = 0.005). Liver function changes in users of aqueous kava extracts at these moderate levels of consumption appear to be reversible and begin to return to baseline after 1 to 2 weeks abstinence from kava. No evidence for irreversible liver damage has been found.
Publisher: BMJ
Date: 05-09-2011
DOI: 10.1136/INJURYPREV-2011-040080
Abstract: Closed circuit television (CCTV) systems which incorporate real-time communication links between camera room operators and on-the-ground security may limit injuries resulting from alcohol-related assault. This pilot study examined CCTV footage and operator records of security responses for two periods totalling 22 days in 2010-2011 when 30 alcohol-related assaults were recorded. Semistructured discussions were conducted with camera room operators during 18 h of observation. Camera operators were proactive, efficiently directing street security to assault incidents. The system intervened in 40% (n=12) of alcohol-related assaults, limiting possible injury. This included three incidents judged as potentially preventable. A further five (17%) assault incidents were also judged as potentially preventable, while 43% (n=13) happened too quickly for intervention. Case studies describe security intervention in each category. Further research is recommended, particularly to evaluate the effects on preventing injuries through targeted awareness training to improve responsiveness and enhance the preventative capacity of similar CCTV systems.
Publisher: Wiley
Date: 09-2006
DOI: 10.1080/09595230600883339
Abstract: The objective of this study was to describe some costs and challenges for conducting follow-up interviews about substance use in Indigenous groups in northern Australia. In a remote region in the Northern Territory in 2001, 131 Indigenous people (aged 13 - 36 years) were approached for interview regarding their substance use. Of these, 108 (54 males, 54 females) were interviewed successfully. Follow-up interviews were attempted in 2004. Study records traced progress and costs. In 2001, the response rate was 82% (108/131). In 2004, 22 participants could not be found after four attempts although they were known by health workers to still reside in the region. Fifteen were not residing in the region during 2004 and were lost to follow-up, four were in prison and three were deceased. Fourteen contacted either refused directly (n = 1) or repeatedly postponed interview (n = 13). Fifty follow-up interviews were completed, a response rate of 78% among 64 participants contacted. The overall response rate in those approached was 64% (0.82 * 0.78). Costs for 108 interviews were 45 person-days and Dollars A19,000 (32% = travel/associated costs). Costs for 50 follow-up interviews were 60 person-days and Dollars A25,500 (39% = travel/associated costs). Such follow-up studies in these settings could be complemented by retrospective case - control approaches and by using proxy respondents to increase study efficiency.
Publisher: Wiley
Date: 18-04-2006
DOI: 10.1111/J.1360-0443.2006.01393.X
Abstract: Few studies describe cannabis use in indigenous populations, and no longitudinal studies are available in Australia. We conducted 3-year follow-up interviews and assessments in Aboriginal communities in Arnhem Land (Northern Territory, NT). A randomly selected s le (n = 161 80 males, 81 females aged 13-36 years) was assessed in October 2001 and then reassessed in September 2004. An opportunistically recruited s le (n = 104 53 males, 51 females aged 13-36 years) was also interviewed in 2001 and followed-up in 2004. Cannabis and other substance use were determined by combining proxy assessments by local Aboriginal health workers, medical records and data from interviews. Changes in cannabis use and symptoms of misuse were assessed using McNemar's test for paired proportions and the Wilcoxon signed rank test. Logistic regression assessed associations between clinical presentations and cannabis use at both time-points. Those who used cannabis at both baseline and follow-up were at greater risk than those who never used it to have suffered: auditory hallucinations suicidal ideation and imprisonment. In the randomly selected cohort there were fewer cannabis users at follow-up than at baseline (P = 0.003). The reduction was evident in females generally (P = 0.008) and older males (aged = 16 at baseline) (P = 0.007). In those interviewed at both baseline and follow-up we measured no statistically significant reduction in frequency and levels of use, although fewer cannabis users reported symptoms of misuse such as: fragmented thought processes memory disruption difficulties controlling use and auditory and visual hallucinations. Modest reductions in cannabis use and its consequences in this population were demonstrated. These may be the result of enhanced supply control and broader socio-political changes.
Publisher: Springer Science and Business Media LLC
Date: 21-05-2014
Publisher: Wiley
Date: 2008
DOI: 10.1080/09595230701711124
Abstract: We evaluated a community-driven initiative established to prevent substance misuse and increase respect for culture and their elders among young people in a group of remote Aboriginal communities in Arnhem Land, Northern Territory (NT), Australia. The Youth Development Unit provided a range of training, recreational and cultural activities within a community development framework to all young people in the community. Methods of operation, community acceptability, perceived impact and likely ability to meet goals were assessed. Data included community, staff and stakeholder interviews and observation. School attendance, youth apprehension rates and information on levels of substance use were compared 2 years before and after the initiative was implemented. Interviewees reported increased youth training and recreational opportunities, increased communication between local agencies, overall satisfaction with programme delivery and optimism that it could achieve its goals. Suggested improvements included even more training, cultural programmes and other activities and employment of more community-based Indigenous staff. The importance of key staff, involvement of a respected Indigenous staff member and community engagement were noted as probable contributors to its success. Indigenous young people in Australia remain one of the most disadvantaged and vulnerable groups. Community-driven preventive initiatives offer enhanced youth resilience and connectedness in remote Aboriginal communities and alternatives to substance use.
Publisher: BMJ
Date: 31-07-2014
Publisher: Springer Science and Business Media LLC
Date: 13-03-2014
Publisher: BMJ
Date: 2013
Publisher: BMJ
Date: 13-03-2015
Publisher: Springer Science and Business Media LLC
Date: 03-10-2011
DOI: 10.1057/SJ.2011.24
Publisher: Elsevier BV
Date: 1998
DOI: 10.1111/J.1467-842X.1998.TB01157.X
Abstract: In 1994 the Commonwealth funded studies to establish and develop Aboriginal health services. One such study was undertaken in 1995 at Maningrida, Northern Territory: to identify the health-service needs of the population and consider community management structures to identify Northern Territory expenditure for primary health care and to provide a three- to five-year development budget. Approximately 2100 Aboriginal residents in the region used the service, including 750 living on 24 outstations within 75 km. Nearly 40 per cent were aged under 15 years. Childhood morbidity was high, with children under two averaging 1.4 hospital admissions per year. The age pyramid reflected premature adult mortality from the third decade of life. Service providers identified inadequate staffing and infrastructure as barriers to service development. Community consultations emphasised the need for resident doctors, improved outstation services and aged and respite care, local training for Aboriginal health workers and housing for staff. These developments would require per capita primary health care expenditure ($872) to be doubled. Aboriginal people in remote areas are disadvantaged through Commonwealth Grants Commission funding formulae and lack of Medicare access. As the sole funding source, the Northern Territory spends over $1.83 million per year providing health services at Maningrida. Additionally, the study proposed that the Commonwealth spend $1.96 million a year over five years on staffing and infrastructure. Local Aboriginal organisations also agreed to allocate resources for health service development. Ineffective implementation, lack of clarification of government responsibilities and funding shortfalls remain barriers to developing remote Aboriginal health services.
Publisher: Wiley
Date: 12-10-2022
Abstract: The Queensland Police Service (QPS) and Queensland Ambulance Service may detain and transport persons experiencing major disturbances in their mental capacity to an ED for urgent care. Queensland's new mental health legislation (March 2017) makes this legal intervention difficult to scrutinise. For a large non‐metropolitan region, QPS records for emergency examination orders (EEOs) and emergency examination authorities (EEAs) were compared with annual reports of Queensland's Director of Mental Health and Chief Psychiatrist. From 2009–2010 to March 2017, QPS‐registered EEOs totalled 12 903 while annual reports attributed 9441 to QPS (27% fewer). From March 2017 to 2019–2020, QPS‐registered EEAs totalled 6887. Annual reports declared 1803 EEAs in total for this period, without distinguishing those registered by QPS from the Queensland Ambulance Service. Past year proportions of EEOs, however, indicate perhaps ~1100 originated with QPS (84% fewer). Information crucial for considered emergency mental healthcare responses for thousands of people is no longer readily available.
Publisher: Elsevier BV
Date: 2015
Publisher: BMJ
Date: 22-08-2013
DOI: 10.1136/TOBACCOCONTROL-2012-050436
Abstract: To summarise published empirical research on culturally targeted anti-tobacco media messages for Indigenous or First Nations people and examine the evidence for the effectiveness of targeted and non-targeted c aigns. Studies were sought describing mass media and new media interventions for tobacco control or smoking cessation in Indigenous or First Nations populations. Studies of any design were included reporting outcomes of media-based interventions including: cognitions, awareness, recall, intention to quit and quit rates. Then, 2 reviewers independently applied inclusion criteria, which were met by 21 (5.8%) of the studies found. One author extracted data with crosschecking by a second. Both independently assessed papers using Scottish Intercollegiate Guidelines Network (SIGN quantitative studies) and Daly et al (qualitative studies). A total of 21 studies were found (4 level 1 randomised controlled trials (RCTs), 11 level 2 studies and 6 qualitative studies) and combined with narrative synthesis. Eight evaluated anti-tobacco TV or radio c aigns two assessed US websites three New Zealand studies examined mobile phone interventions five evaluated print media three evaluated a CD-ROM, a video and an edutainment intervention. Although Indigenous people had good recall of generic anti-tobacco messages, culturally targeted messages were preferred. New Zealand Maori may be less responsive to holistic targeted c aigns, despite their additional benefits, compared to generic fear c aigns. Culturally targeted internet or mobile phone messages appear to be as effective in American Indians and Maori as generic messages in the general population. There is little research comparing the effect of culturally targeted versus generic messages with similar message content in Indigenous people.
Publisher: Elsevier BV
Date: 12-2014
Publisher: Wiley
Date: 11-2009
DOI: 10.1111/J.1465-3362.2009.00067.X
Abstract: To examine predictors of cannabis use at 5 year follow up in an Australian Aboriginal cohort. A longitudinal study consisting of two waves of data collection 5 years apart was conducted. Of the 100 Aboriginal residents (aged 13-36 years) interviewed about cannabis use in 2001, 83 were re-interviewed in 2005-2006 from three remote communities in Arnhem Land, Northern Territory, Australia. Self-reported cannabis use was categorised at each time point (none former use, quit > or = 3 months lighter use, or = 6 cones, daily) and summarised as any current use, heavy use, dependence or cessation. Other substance use, employment and involvement in school or training were also compiled. Most respondents who reported cannabis use at baseline again reported use at follow up. A history of petrol sniffing predicted later heavy cannabis use (P < 0.05). Trends were evident for men to have persisting cannabis use, and for employment and/or engagement in school or training to be associated with cannabis cessation. Ongoing heavy cannabis use is commonplace in this Aboriginal cohort and raises concerns for the physical, social and psychiatric burden on these already vulnerable communities. Prevention, treatment and intervention programs developed with communities are badly needed.
Publisher: Elsevier BV
Date: 07-2013
Publisher: AMPCo
Date: 07-2015
DOI: 10.5694/MJA15.00066
Publisher: Springer Science and Business Media LLC
Date: 03-2011
Publisher: BMJ
Date: 24-07-2009
Publisher: Wiley
Date: 12-2002
DOI: 10.1080/0959523021000023207
Abstract: The objective of this study was to describe patterns of substance use among remote Aboriginal community populations. The setting was the eastern Arnhem Land ('Miwatj') region of the Northern Territory's (NT) 'Top End', with a population of 4217 Aboriginal people over 15 years of age using a cross-sectional description and comparison. S le 1 (n = 689) from the region used data from health-worker consensus classification of kava, alcohol, tobacco, petrol and cannabis use. S le 2 (n = 101) from one community used self-reported use, age at commencement, duration, amounts consumed and expenditure. In 1999 (s le 1), 46% of males and 18% of females were kava users, alcohol: 53% males, 12% females, tobacco: 68% males, 65% females, and cannabis: 31% males, 8% females. Less than 5% sniffed petrol. In one community in 2000, 39% males and 20% females reported using cannabis during the previous month. In this community between 1999 and 2000, the proportion of current kava users among men declined (77-52%, p = 0.015) with a tendency in women for a decrease in the proportion of tobacco users (87-69%, p = 0.096). The increase in the proportion of cannabis users in men (21-39%, p = 0.068) was not statistically significant. However, in women the increase was significant (0-20%, p = 0.013). Gross expenditure on tobacco and kava were similar in 2000: both greater than cannabis and alcohol. Median years used ranged from 4 years for cannabis and 20 years for tobacco. The data supported anecdotes of a recent rise in cannabis use, especially in women. Kava use declined in men. Tobacco use patterns in women may have been changing. Average per capita consumption of alcohol was low compared with other 'Top End' areas. Such varied and dynamic substance use patterns pose challenges for research and policy.
Publisher: Wiley
Date: 05-01-2011
DOI: 10.1111/J.1465-3362.2010.00279.X
Abstract: While petrol sniffing afflicts several isolated Indigenous groups internationally, few studies have examined the factors contributing to continued sniffing following treatment.This study aims to describe those factors in a group of Aboriginal Australian users. During residential treatment, 56 petrol sniffers completed baseline demographic and substance use questionnaires and cognitive and psychological assessments. Eighty per cent were reassessed and interviewed an average of 9 months (SD = 4) later. Cognitive, psychological, substance use and sociocultural factors were compared between those who relapsed at follow up and those who maintained abstinence. More males (n = 44) than females (n = 12) were studied. Of the 45 in iduals followed up, 58% (n = 26) relapsed. Significant risk factors for relapse included the ready availability of petrol, living in urban centres, being unmarried and living with fewer people (P < 0.05). Other potential risk factors, indicated by P-values < 0.10, included younger age of first petrol use, having sniffed within 14 days prior to treatment, poly substance use, sniffing in response to negative emotions, and feeling lonely at baseline and having sleep problems at follow up. This study identified psychosocial factors that may be associated with continued petrol sniffing among Aboriginal Australians post treatment. Future research, interventions and policy relating to petrol sniffing should consider these factors.
Publisher: Wiley
Date: 23-03-2023
Abstract: In Queensland, where a person experiences a major disturbance in their mental capacity, and is at risk of serious harm to self and others, an emergency examination authority (EEA) authorises Queensland Police Service (QPS) and Queensland Ambulance Service (QAS) to detain and transport the person to an ED. In the ED, further detention for up to 12 h is authorised to allow the examination to be completed. Little published information describes these critical patient encounters. Queensland's Public Health Act (2005) , amended in 2017, mandates the use of the approved EEA form. Data were extracted from a convenience s le of 942 EEAs including: (i) patient age, sex, address (ii) free text descriptions by QPS and QAS officers of the person's behaviour and any serious risk of harm requiring urgent care (iii) time examination period commenced and (iv) outcome upon examination. Of 942 EEA forms, 640 (68%) were retrieved at three ‘larger central’ hospitals and 302 (32%) at two ‘smaller regional’ hospitals in non‐metropolitan Queensland. QPS initiated 342 (36%) and QAS 600 (64%) EEAs for 486 (52%) males, 453 (48%) females and two intersexes ( %), aged from 9 to 85 years (median 29 years, 17% aged years). EEAs commonly occurred on weekends (32%) and between 2300 and midnight (8%), characterised by ‘drug and/or alcohol issues’ (53%), ‘self‐harm’ (40%), ‘patient aggression’ (25%) and multiple prior EEAs (23%). Although information was incomplete, most patients (78%, n = 419/534) required no inpatient admission. EEAs furnish unique records for evaluating the impacts of Queensland's novel legislative reforms.
Publisher: Cambridge University Press (CUP)
Date: 08-2003
DOI: 10.1017/S0950268803008628
Abstract: Pneumonia causes significant morbidity and mortality in Aboriginal populations in Australia's Northern Territory (NT). Kava, consumed in Arnhem Land since 1982, may be a risk factor for infectious disease including pneumonia. A case–control study ( n =115 cases n =415 controls) was conducted in 7001 Aboriginal people (4217 over 15 years). Odds ratios (OR) were calculated by conditional logistic regression with substance use and social factors as confounders. Pneumonia was not associated with kava use. Crude OR=1·26 (0·74–2·14, P =0·386), increased after controlling for confounders (OR=1·98, 0·63–6·23, P =0·237) but was not significant. Adjusted OR for pneumonia cases involving kava and alcohol users was 1·19 (0·39–3·62, P =0·756). In communities with longer kava-using histories, adjusted OR was 2·19 (0·67–7·14, P =0·187). There was no kava dose–response relationship. Crude ORs for associations between pneumonia and cannabis use (OR=2·27, 1·18–4·37, P =0·014) and alcohol use (OR=1·95, 1·07–3·53, P =0·026) were statistically significant and approached significance for petrol sniffing (OR=1·98, 0·99–3·95, P =0·056).
Publisher: Oxford University Press (OUP)
Date: 04-10-2013
DOI: 10.1093/NTR/NTS211
Abstract: Maternal smoking rates in Australian Aboriginal women are triple that of the general population, with little evidence for successful interventions. We reviewed the literature to understand smoking and cessation in Aboriginal and Torres Strait Islander women and provide recommendations for targeted interventions. Six databases were searched using terms related to smoking, pregnancy, and Aboriginal Australians. Two reviewers independently assessed papers for inclusion and quality. Meta-ethnography synthesized first- and second-order constructs from included studies and constructed a line of argument. Seven relevant studies were analyzed. The synthesis illustrates 11 third-order constructs operating on the levels of self, family, and social networks, the wider Aboriginal community, and broader external influences. Highlighted are social norms and stressors within the Aboriginal community perpetuating tobacco use insufficient knowledge of smoking harms inadequate saliency of antismoking messages and lack of awareness and use of pharmacotherapy. Indigenous Health Workers have a challenging role, not yet fulfilling its potential. Pregnancy is an opportunity to encourage positive change where a sense of a "protector role" is expressed. This review gives strength to evidence from in idual studies across erse Indigenous cultures. Pregnant Aboriginal and Torres Strait Islander smokers require comprehensive approaches, which consider the environmental context, increase knowledge of smoking harms and cessation methods, and provide culturally targeted support. Long term, broad strategies should de-normalize smoking in Aboriginal and Torres Strait Islander communities. Further research needs to examine causes of resistance to antitobacco messages, clarify contributing roles of stress and depression, and attitudes to pharmacotherapy.
Publisher: Elsevier BV
Date: 08-2015
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.DRUGALCDEP.2019.03.019
Abstract: Impurities in commonly used illicit drugs raise concerns for unwitting consumers when pharmacologically active adulterants, especially new psychoactive substances (NPS), are used. This study examines impurities detected in illicit drugs seized in one Australian jurisdiction. Queensland Health Forensic and Scientific Services provided analytical data. Data described the chemical composition of 9346 s les of 11 illicit drugs seized by police during 2015-2016. Impurities present in primary drugs were summarized and tabulated. A systematic search for published evidence reporting similar analyses was conducted. Meth hetamine was the primary drug in 6608 s les, followed by MDMA (1232 s les) and cocaine (516 s les). Purity of primary drugs ranged from ∼30% for cocaine, 2-CB and GHB to >90% for THC, meth hetamine, heroin and MDMA. Meth hetamine and MDMA contained the largest variety of impurities: 22 and 18 variants, respectively. Drug adulteration patterns were broadly similar to those found elsewhere, including NPS, but in some primary drugs impurities were found which had not been reported elsewhere. Psychostimulants were adulterated with each other. Levamisole was a common impurity in cocaine. Psychedelics were adulterated with meth hetamine and NPS. Opioids were quite pure, but some s les contained meth hetamine and synthetic opioids. Impurities detected were mostly pharmacologically active adulterants probably added to enhance desired effects or for active bulking. Given the designer nature of these drug cocktails, the effects of the adulterated drugs on users from possible complex multi-drug interactions is unpredictable. Awareness-raising among users, research into complex multi-drug effects and ongoing monitoring is required.
Publisher: Informa UK Limited
Date: 12-2011
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.DRUGPO.2016.06.015
Abstract: Favourable impacts are reported from complex alcohol control strategies, known as 'Alcohol Management Plans' (AMPs) implemented 14 years ago in 19 Aboriginal and Torres Strait Islander (Indigenous) communities in Queensland (Australia). However, it is not clear that all communities benefited and that positive impacts were sustained. Service providers, key stakeholders and community leaders provided insights about issues and impacts. Participants (N=382) were recruited from knowledgeable and experienced persons using agency lists and by recommendation across sectors which have a mandate for managing alcohol-related issues and consequences of AMP policies in communities. In semi-structured interviews, participants (51% Indigenous, 55% male and comprised of at least one-third local community residents) were asked whether they believed alcohol controls had been effective and to describe any favourable and unfavourable outcomes experienced or perceived. Inductive techniques were used for thematic analysis of the content of transcribed recorded interviews. Comments reflecting themes were assessed across service sectors, by gender, Indigenous status and remoteness. Participants attributed reduced violence and improved community amenity to AMPs, particularly for 'very remote' communities. Participants' information suggests that these important achievements happened abruptly but may have become undermined over time by: the availability of illicit alcohol and an urgency to consume it migration to larger centres to seek alcohol criminalization substitution of illicit drugs for alcohol changed drinking behaviours and discrimination. Most issues were more frequently linked with 'very remote' communities. Alcohol restrictions in Queensland's Indigenous communities may have brought favourable changes, a significant achievement after a long period of poorly regulated alcohol availability from the 1980s up to 2002. Subsequently, over the past decade, an urgency to access and consume illicit alcohol appears to have emerged. It is not clear that relaxing restrictions would reverse the harmful impacts of AMPs without significant demand reduction, treatment and ersion efforts.
Publisher: Informa UK Limited
Date: 10-11-2016
Publisher: Springer Science and Business Media LLC
Date: 28-09-2012
DOI: 10.1007/S11684-012-0213-7
Abstract: Head and neck cancer (HNC) consists of a group of malignancies affecting closely related anatomical regions of the upper aerodigestive tract (UADT), including the oral cavity, salivary glands, upper and lower jaw bones and facial skin the nasal cavity, paranasal sinuses, pharynx, larynx and thyroid gland (although the latter is often excluded and considered as part of endocrine neoplasms). Of these, 90% of HNCs are histologically squamous cell carcinomas originating from the mucosal lining. These malignancies are strongly associated with certain environmental and life-style risk factors, principally tobacco in both smoked and smokeless forms, excessive alcohol consumption, diets poor in antioxidants and essential micronutrients, UV light, chemicals used in certain workplaces, and viruses, principally certain strains of human papillomavirus (HPV) and Epstein-Barr virus (EBV). These cancers are frequently aggressive in their biological behaviour with local invasion and metastasis to lymph nodes in the neck. Since most patients are already at late stages of disease at the time of diagnosis, the desirable practice of early diagnosis (first sign of the malignant lesion at an initial stage) and early treatment, a critical priority to save lives and retain quality of life, is difficult to implement. Thus, primary prevention has been set as a key goal. This article aims to reinforce the basic knowledge of aetiology, key risk factors related to the development of head and neck cancer, basic features of clinical appearance of this group of cancers, and strategies for prevention and early detection.We also suggest basic research strategies on the basis of current knowledge, which should ultimately lead to the improvement of clinical management.
Publisher: Wiley
Date: 02-2011
Publisher: Elsevier BV
Date: 12-2011
DOI: 10.1016/J.HEALTHPOL.2011.07.004
Abstract: To develop culturally appropriate and effective strategies to reduce the risk from pandemic influenza (H1N109) in rural and remote Australian Aboriginal and Torres Strait Islander communities. Participatory Action Research (PAR) approach that enabled communities and researchers to work together to develop understanding and take action to reduce risk. The H1N109 pandemic raised deep concerns and serious issues in all of the Aboriginal and Torres Strait Islander communities involved in this project. The participants expressed distrust and scepticism in relation to current Australian health policies on containment and told the researchers that specific plans for Aboriginal and Torres Strait Islander peoples were needed. Respondents indicated that policies and plans had been developed without respectful engagement with communities. The strong and recurring themes that emerged from the PAR cycles were: the importance of family ways of life and realities of living in response to influenza and key messages to government and health services to focus on communication, understanding and respect. The essential work of reducing risk of pandemic influenza with Aboriginal and Torres Strait Islander communities is not straightforward, but this project has highlighted a number of useful pathways to continue to journey along with communities. A number of strategies to reduce the spread of pandemic influenza in Aboriginal and Torres Strait Islander communities were identified. These strategies would make a good starting point for conversations with communities and health services. In Aboriginal and Torres Strait Islander communities the environment, community structures and traditions vary. Respectful engagement with communities is needed to develop effective policy.
Publisher: Wiley
Date: 03-2010
DOI: 10.1111/J.1465-3362.2009.00094.X
Abstract: This study examined prevalence and predictors of alcohol consumption and alcohol problems in a s le of medical students in Vietnam. A cross-sectional survey using a multi-stage cluster s ling approach was conducted in 2007 in two universities in Vietnam. The students (n = 619, 100% response rate) completed questionnaires based on the Alcohol Use Disorder Identification Test. A score of >or=8 defined presence of alcohol problems. Data analyses adjusted for the cluster s ling approach. Overall 65.5% of students had drunk alcohol during the previous year while alcohol problems were detected in 12.5%. Male students, students who reported that their family members drank and students who reported that their flat mates were drinking were more likely to be current drinkers. Male students were 14.3 times more likely to have an Alcohol Use Disorder Identification Test score of >or=8 compared with female students (P = 0.005). Intervention programs focusing on male students and their social environment are warranted. As Vietnamese society rapidly modernises prevention programs for female students may also be needed.
Publisher: Springer Science and Business Media LLC
Date: 18-07-2016
Publisher: Wiley
Date: 2008
DOI: 10.1111/J.1445-5994.2007.01539.X
Abstract: Assuring participant confidentiality in illicit drugs research has raised legal questions and challenges both for researchers and ethics committees. There are similar challenges for clinicians. To study cannabis use in Aboriginal people in Arnhem Land (Northern Territory), a risk-management approach was successful. Aboriginal participants were informed in their own language that confidentiality could not be assured if they disclosed information about illegal behaviours. Researchers avoided questions of intrinsic interest to law enforcement. Relationships between researchers and study participants and the integrity of the study were preserved. These considerations have relevance for clinicians as well as researchers dealing with the influence of illicit behaviours on health.
Publisher: Wiley
Date: 2003
DOI: 10.1002/HUP.532
Abstract: Kava is an extract from the Piper methysticum Forst. f. plant that has social and spiritual importance in Pacific islands societies. Herbal remedies that contain kava are used for the psychiatric treatment of anxiety and insomnia. Laboratory studies have found only subtle, if any, changes on cognitive or motor functions from the acute effects of consuming small clinical doses of kava products. Intoxication from recreational doses of kava has not been studied. The performance of in iduals intoxicated from drinking kava (n=11) was compared with a control group (n=17) using saccade and cognitive tests. On average, intoxicated in iduals had consumed 205 g of kava powder each (approximately 150 times clinical doses) in a group session that went for 14.4 h and ended 8 h prior to testing. Intoxicated kava drinkers showed ataxia, tremors, sedation, blepharospasm and elevated liver enzymes (GGT and ALP), together with saccadic dysmetria, saccadic slowing and reduced accuracy performing a visual search task that only became evident as the task complexity increased. Kava intoxication is characterized by specific abnormalities of movement coordination and visual attention but normal performance of complex cognitive functions. Saccade abnormalities suggest disruption of cerebellar and GABAergic functions.
Publisher: Springer Science and Business Media LLC
Date: 02-2003
Publisher: Springer Science and Business Media LLC
Date: 31-10-2010
Publisher: Wiley
Date: 03-2011
DOI: 10.1111/J.1465-3362.2010.00205.X
Abstract: In remote Indigenous Australian communities measuring in idual tobacco use can be confounded by cultural expectations, including sharing. We compared self-reported tobacco consumption with community-level estimates in Arnhem Land (Northern Territory). In a cross-sectional survey in three communities (population 2319 Indigenous residents, aged ≥16 years), 400 Indigenous residents were interviewed (206 men, 194 women). Eight community stores provided information about tobacco sold during the survey. To gauge the impact of 255 non-Indigenous residents on tobacco turnover, 10 were interviewed (five men, five women). Breath carbon monoxide levels confirmed self-reported smoking. Self-reported number of cigarettes smoked per day was compared with daily tobacco consumption per user estimated using amounts of tobacco sold during 12 months before the survey (2007-2008). 'Lighter smokers' (<10 cigarettes per day) and 'heavier smokers' (≥10 cigarettes per day) in men and women were compared. Of 400 Indigenous study participants, 305 (76%) used tobacco four chewed tobacco. Of 301 Indigenous smokers, 177 (58%) provided self-reported consumption information a median of 11-11.5 cigarettes per day in men and 5.5-10 cigarettes per day in women. Men were three times (odds ratio=2.9) more likely to be 'heavier smokers'. Store turnover data indicated that Indigenous tobacco users consumed the equivalent of 9.2-13.1 cigarettes per day very similar to self-reported levels. Sixty per cent (=6/10) of non-Indigenous residents interviewed were smokers, but with little impact on tobacco turnover overall (2-6%). Smoking levels reported by Indigenous Australians in this study, when sharing tobacco was considered, closely reflected quantities of tobacco sold in community stores.
Publisher: Wiley
Date: 03-2004
Publisher: Wiley
Date: 08-2003
DOI: 10.1046/J.1444-0903.2003.00405.X
Abstract: Heavy kava use in Aboriginal communities has been linked to various health effects, including anecdotes of sudden cardiac deaths. To examine associations between kava use and potential health effects. A cross-sectional study was carried out within a kava-using east Arnhem Land Aboriginal community in tropical northern Australia. One-hundred-and-one adults who were current, recent or non-users of kava were enrolled in March 2000. Main outcome measures were physical, anthropometric, biochemical, haematological, immunological and neurocognitive assessments. Kava users more frequently showed a characteristic dermopathy (P<0.001). They had increased levels of gamma-glutamyl transferase and alkaline phosphatase (P<0.001). Lymphocyte counts were significantly lower in kava users (P<0.001). Fibrinogen, plasminogen activator inhibitor-1 and neurocognitive tests were not different between kava use categories. IgE and IgG antibodies were elevated across the whole group, as were C-reactive protein and homocysteine. Kava use was associated with dermopathy, liver function abnormalities and decreased lymphocytes. If kava continues to be used by Aboriginal populations, monitoring should focus on the health consequences of these findings, including a possible increase in serious infections. The interaction between kava, alcohol and other substances requires further study. Although markers of cardiovascular risk are increased across the population, these were not higher in kava users, and this increase may be linked to the large infectious pathogen burden reflective of the socioeconomic disadvantage seen in many remote Aboriginal communities.
Publisher: AMPCo
Date: 09-2012
DOI: 10.5694/MJA12.10343
Publisher: Springer Science and Business Media LLC
Date: 14-08-2009
DOI: 10.1007/S11695-009-9931-6
Abstract: In some bariatric patients with predominantly intra-abdominal fat a shallow fat layer separates the gastric band access port from the skin. We hypothesise that subfascial port placement in these patients reduces skin erosions and port infections and improves cosmesis as weight loss occurs. This study aims to compare port complications, cosmetic outcome and ease of band adjustment with access ports in front of or behind the rectus muscle. We retrospectively compared complications and cosmetic outcomes of patients with subfascial ports to a control group matched for gender, BMI and age. Each subject completed a questionnaire utilising a 1 to 10 scale for nine parameters related to comfort and cosmesis and two parameters related to discomfort during adjustments. Sixty-eight patients with subfascial ports were identified and the overall response rate was 84%. The groups were well matched for gender (m:f ratio 1.8:1 vs. 1.7:1, p = 1.000), age (51.0 vs. 49.6 years, p = 0.528) and BMI (39.8 vs. 40.3 kg/m², p = 0.585). There was no difference in port infection rates (0/68 vs. 1/68, p = 1.000) but the subfascial group had more hernias (3/68 vs. 0/68, p = 0.244). Subfascial patients experienced more pain during adjustments (score 4.3 vs. 2.6, p = 0.047) but a combined analysis of cosmesis showed a slight positive trend (1.58 vs. 1.76, p = 0.379). Both port locations are well tolerated. Subfascial placement is associated with more pain during adjustments but there is no difference in port infection or skin erosion rates.
Publisher: Wiley
Date: 12-2004
DOI: 10.1080/09595230412331324509
Abstract: A recent rise in cannabis use in Indigenous communities in northern Australia may have compounded existing patterns of other substance use. This paper describes these patterns in Arnhem Land in the 'Top End' of the Northern Territory (NT). Economic impacts of the cannabis trade are also described. In a descriptive cross-sectional study, random s les included 336 people (169 males, 167 females) aged 13 - 36 years. Consensus classification of lifetime and current use of cannabis, alcohol, tobacco, kava, inhalants (petrol) and other drugs was derived based on health workers' proxy assessments. A s le (n = 180, aged 13 - 36) was recruited opportunistically for interview. Lifetime cannabis users among those interviewed (n = 131, 81 males, 50 females) described their current cannabis use, usual quantities purchased and consumed, frequency and duration of cannabis use and other substance use. In the random s les, 69% (63 - 75%) of males and 26% (20 - 31%) of females were lifetime cannabis users (OR = 7.4, 4.5 - 12.1, p < 0.001). The proportion of males currently using cannabis was 67% (60 - 73%) while the proportion of females currently using cannabis was 22% (16 - 27%) (OR = 7.9, 4.8 - 13.1, p < 0.001). Current cannabis users were more likely than non-users to be also using alcohol (OR = 10.4, 4.7 - 23.3, p < 0.001), tobacco (OR = 19.0, 7.9 - 45.8, p < 0.001) and to have sniffed petrol (OR = 9.1, 4.6 - 18.0, p < 0.001) but were less likely to be using kava (OR = 0.4, 0.2 - 0.9, p < 0.001). Among those interviewed, higher tobacco consumption in current users and greater alcohol use in lifetime users was associated with increased cannabis use. Action is required to reduce cannabis use, especially in combination with other substances.
Publisher: Wiley
Date: 23-08-2013
DOI: 10.1111/DAR.12070
Abstract: In Arnhem Land's remote Aboriginal communities [Northern Territory], very high smoking rates and overcrowding mean high exposure to Environmental Tobacco Smoke. This study compared smokers who restrict their smoking in these environments with those who do not. In 2008-2009, 258 smokers (137 males and 121 females) aged ≥ 16 years, provided information permitting categorisation of those who 'RESTRICT' their smoking in the house, car or workplace from those who do 'NOT RESTRICT'. Univariable and multivariable logistic regressions compared 'RESTRICT' and 'NOT RESTRICT' groups by gender, age group, daily use, tobacco consumption, time-to-first-cigarette and quit intentions. Those in the 'RESTRICT' group explained their motivations, summarised using qualitative data analysis. Men were almost twice as likely to 'NOT RESTRICT' their smoking (odds ratio = 1.88, 95% confidence interval = 1.14-3.08, P = 0.013). Time-to-first-cigarette was the strongest predictor to 'NOT RESTRICT' in women (odds ratio = 3.48, 95% confidence interval = 1.44-8.41, P = 0.006) with daily consumption the strongest predictor in men (odds ratio = 3.15, 95% confidence interval = 1.39-7.18, P = 0.006). Men and women shared similar motivations for restricting smoking. Smoke-free homes and workplaces are important opportunities to reduce exposure to Environmental Tobacco Smoke in remote Indigenous communities.
Publisher: Elsevier BV
Date: 07-2010
DOI: 10.1111/J.1753-6405.2010.00556.X
Abstract: To describe and discuss challenges and opportunities encountered when estimating tobacco consumption in six remote Aboriginal communities using tobacco sales data from retail outlets. We consider tobacco sales data collected from retail outlets selling tobacco to six Aboriginal communities in two similar but separate studies. Despite challenges--including: not all outlets provided data data not uniform across outlets (sales and invoice data) change in format of data personnel change or management restructures and anomalies in data and changes in community populations--tobacco consumption was estimated and returned through project newsletters and community feedback sessions. Amounts of tobacco sold were returned using graphs in newsletters and pictures of items common to the community in community feedback sessions. Despite inherent limitations of estimating tobacco consumption using tobacco sales data, returning the amount of tobacco sold to communities provided an opportunity to discuss tobacco consumption and provide a focal point for in idual and community action. Using this method, however, may require large and sustained changes be observed over time to evaluate whether initiatives to reduce tobacco consumption have been effective. Estimating tobacco consumption in remote Aboriginal communities using tobacco sales data from retail outlets requires careful consideration of many logistical, social, cultural and geographic challenges.
Publisher: Wiley
Date: 09-2000
DOI: 10.1080/713659370
Publisher: Springer Science and Business Media LLC
Date: 24-12-2011
DOI: 10.1245/S10434-010-1474-5
Abstract: Most studies analyzing risk factors for pulmonary morbidity date from the early 1990s. Changes in technology and treatment such as minimally invasive esophagectomy (MIE) and neoadjuvant treatment mandate analysis of more contemporary cohorts. Predictive factors for overall and specific pulmonary morbidity in 858 patients undergoing esophagectomy between 1998 and 2008 in five Australian university hospitals were analyzed by logistic regression models. A total of 394 patients underwent open esophagectomy, and 464 patients underwent MIE. A total of 259 patients received neoadjuvant chemoradiotherapy, 139 preoperative chemotherapy alone, and 2 preoperative radiotherapy alone. In-hospital mortality was 3.5%. Smoking and the number of comorbidities were risk factors for overall pulmonary morbidity (odds ratio [OR] 1.47, P = 0.016 OR 1.35, P = 0.001) and pneumonia (OR 2.29, P = 0.002 1.56, P = 0.005). The risk of respiratory failure was higher in patients with more comorbidities (OR 1.4, P = 0.035). Respiratory comorbidities (OR 3.81, P = 0.017) were strongly predictive of postoperative acute respiratory distress syndrome (ARDS). ARDS (4.51, P = 0.032) or respiratory failure (OR 8.7, P < 0.001), but not anastomotic leak (OR 2.22, P = 0.074), were independent risk factors for death. MIE (OR 0.11, P < 0.001) and thoracic epidural analgesia (OR 0.12, P = 0.003) decreased the risk of respiratory failure. Neoadjuvant treatment was not associated with an increased risk of pulmonary complications. Preoperative comorbidity and smoking were risk factors for respiratory complications, whereas neoadjuvant treatment was not. MIE and the use of thoracic epidural analgesia decreased the risk of respiratory failure. Respiratory failure and ARDS were the only independent factors associated with an increased risk of in-hospital death, whereas anastomotic leakage was not.
Publisher: Hogrefe Publishing Group
Date: 09-2014
DOI: 10.1027/0227-5910/A000265
Abstract: Background: Indigenous young people have significantly higher suicide rates than their non-indigenous counterparts. There is a need for culturally appropriate and effective suicide prevention programs for this demographic. Aims: This review assesses suicide prevention programs that have been evaluated for indigenous youth in Australia, Canada, New Zealand, and the United States. Method: The databases MEDLINE and PsycINFO were searched for publications on suicide prevention programs targeting indigenous youth that include reports on evaluations and outcomes. Program content, indigenous involvement, evaluation design, program implementation, and outcomes were assessed for each article. Results: The search yielded 229 articles 90 abstracts were assessed, and 11 articles describing nine programs were reviewed. Two Australian programs and seven American programs were included. Programs were culturally tailored, flexible, and incorporated multiple-levels of prevention. No randomized controlled trials were found, and many programs employed ad hoc evaluations, poor program description, and no process evaluation. Conclusion: Despite culturally appropriate content, the results of the review indicate that more controlled study designs using planned evaluations and valid outcome measures are needed in research on indigenous youth suicide prevention. Such changes may positively influence the future of research on indigenous youth suicide prevention as the outcomes and efficacy will be more reliable.
Publisher: Wiley
Date: 19-05-2021
DOI: 10.1111/DAR.13272
Abstract: This closing commentary to the special section presents an overview of the Queensland Alcohol‐related violence and Night‐Time Economy Monitoring evaluation findings in comparison to those from other jurisdictions where similar interventions have been implemented (such as Sydney and Newcastle), and especially with previous studies that have used similar evaluation methodologies, such as the Dealing with Alcohol and the Night‐Time Economy study. Overall, the articles documented promising reductions in alcohol‐related harm, building on the existing evidence base for multi‐pronged interventions in entertainment districts. Importantly, this is the first comprehensive investigation to also look at impacts on nightlife‐related business and findings demonstrated, that there were improvements for many businesses. There are substantial policy implications for Queensland and other jurisdictions (nationally and globally) wanting to reduce late night alcohol‐related harm in entertainment districts.
Publisher: Wiley
Date: 18-05-2021
DOI: 10.1111/DAR.13270
Abstract: This commentary introduces the special section on the outcomes of the Queensland Alcohol‐related violence and Night‐time Economy Monitoring project and outlines the political and policy context of the interventions put in place under the Queensland government's Tackling Alcohol‐Fuelled Violence strategy. The development of the strategy was informed by alcohol policy initiatives trialled in other major Australian cities over the past two decades. The articles in this special section examine the impact of the Tackling Alcohol‐Fuelled Violence policy stages on alcohol‐related harms and local economies across selected entertainment precincts (Safe Night Precincts). A rich array of data were utilised, including administrative health and justice data, data reflective of nightlife trading (i.e. foot traffic data, ID scanner data and live music performances) and street surveys. Findings have implications for research, policy and practice and demonstrate the need for comprehensive evaluations that can accommodate the complexities of modern alcohol policy in Australia.
Publisher: Elsevier BV
Date: 10-2010
DOI: 10.1016/J.ACTATROPICA.2010.05.012
Abstract: Controlling dengue fever in Australia and internationally, relies heavily upon the actions of residents as well as community education and awareness of the risks. Although it has been well established in medical anthropology that the success of health interventions is highly dependent upon a clear grasp of lay knowledge of disease, limited attention has been given to lay understandings of dengue fever and its vectors in the extant literature. We begin addressing this hiatus through an examination of north Queensland residents' knowledge of the breeding habitats of Aedes aegypti mosquitoes. Building on the insights of earlier social research, we use factor analysis to examine the results of a series of randomly selected telephone surveys and compare responses over time and between cities. Our analysis confirms that many people assume that Ae. aegypti is ubiquitous in the landscape, that it lives and breeds not only around the home, but also in a variety of geographical spaces located beyond the suburban 'backyard', and beyond the control of local residents. Lay understandings appear to be placing people at risk from dengue, influencing the mosquito management practices of local residents and acting as a source of resistance to public health messages that focus on in idual responsibility. A way forward through the provision of new information that challenges key assumptions is provided in the discussion. We argue that rather than dismissing lay understandings as ignorance, strategies, practices and policy based on a detailed understanding of this knowledge will mean that practitioners are better able to address these assumptions and will likely be more effective at educating the public of the risks posed by dengue.
Publisher: Wiley
Date: 03-2003
Publisher: Wiley
Date: 22-05-2007
DOI: 10.1111/J.1360-0443.2007.01840.X
Abstract: With chronic alcohol abuse, cognitive studies suggest that progressive cognitive decline may precede more serious and irreversible neurological syndromes. The early detection of cognitive impairment may therefore aid in the prevention of permanent brain damage. Despite the devastating consequences of alcohol abuse among Aboriginal Australians, the effects on brain function have never been studied in this population and a lack of appropriate assessment tools has prevented the development of such research. To determine the impact of long-term and heavy episodic alcohol use on cognitive function in Aboriginal people. Cross-sectional comparing heavy episodic alcohol users with non-alcohol users. Two remote Aboriginal communities in north-east Arnhem Land, northern Australia. The control group consisted of 24 non-drinkers (15 males, nine female) and the heavy episodic group consisted of 20 people (19 males, one female) who had been drinking alcohol in a heavy episodic style (median 14 drinks per occasion) for a mean of 8.9 years (SD = 5.0). Interview to obtain demographic information, substance abuse history and symptoms of mental health and wellbeing, together with a computerized cognitive assessment battery (CogState Ltd). Compared with non-drinkers, heavy episodic drinkers showed reduced psychomotor speed (P = 0.04) and reduced accuracy when performing tasks of attention (P = 0.045), working memory (P = 0.04), implicit memory (P = 0.03) and associate learning and memory (P = 0.001). Specific cognitive abnormalities that suggest frontostriatal abnormalities and have been observed in association with chronic alcoholism in other populations were observed among Aboriginal Australians who were heavy episodic alcoholic users.
Publisher: SAGE Publications
Date: 10-2002
DOI: 10.1046/J.1440-1614.2002.01027.X
Abstract: Objective: This review considers the context in which kava is used, together with its underlying psychopharmacological mechanisms, to investigate the neurobehavioural effects associated with kava use. Method: We conducted a systematic search using the computerized databases MEDLINE, OVID and PsychLIT for all articles containing any of the following words: kava, kavain, kawa and Piper methysticum. In the opinion of the authors, all articles from this collection containing data that could inform the neurological and cognitive sequelae of kava use were included for the purpose of this review. Results: The use of kava occurs among indigenous populations in the South Pacific and in northern Australia, while also being used throughout the western world as a herbal medicine. Animal studies show that kava lactones alter neuronal excitation through direct interactions with voltage-dependent ion channels, giving rise to kava's muscle relaxant, anaesthetic, anxiolytic and anticonvulsive properties. Several isolated cases of psychotic and severe dystonic reactions following kava use suggest that kava also has psychoactive properties, yet there is no conclusive evidence that kava interferes with normal cognitive processes. Conclusions: Kava is effective in the treatment of tension and anxiety. There may be riskfactors for severe motor and psychiatric responses to kava use, although these are not wellunderstood. Given the increasingly widespread use of kava, further investigation is necessary to gain an understanding of its immediate neuropsychiatric effects and long-term cognitive effects.
Publisher: Springer Science and Business Media LLC
Date: 09-01-2014
Publisher: Elsevier BV
Date: 12-2000
Publisher: SAGE Publications
Date: 19-06-2022
DOI: 10.1177/0310057X211070011
Abstract: Lung transplantation is limited by a lack of suitable lung donors. In Australia, the national donation organisation (DonateLife) has taken a major role in optimising organ donor identification. However, the potential outside the DonateLife network hospitals remains uncertain. We aimed to create a prediction model for lung donation within the DonateLife network and estimate the untapped lung donors outside of the DonateLife network. We reviewed all deaths in the state of Victoria’s intensive care units using a prospectively collected population-based intensive care unit database linked to organ donation records. A logistic regression model derived using patient-level data was developed to characterise the lung donors within DonateLife network hospitals. Consequently, we estimated the expected number of lung donors in Victorian hospitals outside the DonateLife network and compared the actual number. Between 2014 and 2018, 291 lung donations occurred from 8043 intensive care unit deaths in DonateLife hospitals, while only three lung donations occurred from 1373 ICU deaths in non-DonateLife hospitals. Age, sex, postoperative admission, sepsis, neurological disease, trauma, chronic respiratory disease, lung oxygenation and serum creatinine were factors independently associated with lung donation. A highly discriminatory prediction model with area under the receiver operator characteristic curve of 0.91 was developed and accurately estimated the number of lung donors. Applying the model to non-DonateLife hospital data predicted only an additional five lung donors. This prediction model revealed few additional lung donor opportunities outside the DonateLife network, and the necessity of alternative and novel strategies for lung donation. A donor prediction model could provide a useful benchmarking tool to explore organ donation potential across different jurisdictions, hospitals and transplanting centres.
Publisher: Springer Science and Business Media LLC
Date: 28-06-2004
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.WOMBI.2013.08.006
Abstract: Smoking prevalence in Aboriginal and Torres Strait Islander pregnant women is quadruple that of non-Indigenous counterparts, impacting on the health of babies and children. To explore attitudes and experiences related to prenatal tobacco smoking by Aboriginal women and household smoking, and to provide recommendations for culturally appropriate interventions. We conducted five focus groups with clients and family members of a regional NSW Aboriginal maternity service (n=18). Committees, including Aboriginal representatives, oversaw the study. We analysed transcripts with the constant comparative method and developed key categories. Categories included: social and family influences, knowing and experiencing the health effects of smoking, responses to health messages, cravings and stress, giving up and cutting down, managing smoke-free homes and cars, and community recommendations. Smoking in pregnancy and passive smoking were acknowledged as harmful for babies and children. Anti-tobacco messages and cessation advice appeared more salient when concordant with women's lived experience. Reduced cigarette consumption was reported in pregnancy. Despite smoking in the home, families were engaged in the management of environmental tobacco smoke to reduce harm to babies and children. Abstinence was difficult to initiate or maintain with the widespread use of tobacco in the social and family realm. Anti-tobacco messages and interventions should relate to Aboriginal women's experiences, improve understanding of the quitting process, support efficacy, and capitalise on the positive changes occurring in smoke-free home management. Focus group participants recommended in idual, group and family approaches, and access to cessation services and nicotine replacement therapy for Aboriginal pregnant women who smoke.
Publisher: Wiley
Date: 20-12-2011
DOI: 10.1111/J.1465-3362.2011.00405.X
Abstract: Anecdotal reports suggest that high rates of cannabis use and dependence are significant issues in Indigenous communities in north Queensland however, there is little scientific evidence to support or refute this. The Cape York Cannabis Project seeks to investigate cannabis use rates, cannabis dependence and mental health impacts for the first time in three Cape York Indigenous communities. The current study reports preliminary findings, resulting from interviews with 133 Indigenous participants aged 14-47 years from one Cape York community. Quantitative data were gathered on rates of cannabis use, cannabis dependence as measured by a score of ≥ 3 the Severity of Dependence Scale. Qualitative self-report data were gathered concerning mental health impacts of cannabis and reasons for quitting. Very high rates of cannabis use were identified, with 66.2% of males and 30.5% of females interviewed being current users. An additional 12.2% of males and 30.5% of females were former users, and 21.6% of males and 39% of females had never used cannabis. High rates of cannabis dependence were also observed. Of those current users who used cannabis at least weekly, 67.7% reported cannabis dependence. A range of mental health impacts due to cannabis were reported. In total, 76.1% of current users were considering quitting or cutting down. Rates of use and dependence were much higher than national rates, and indicate significant mental health harms due to cannabis. Further investigation of mental health impacts of cannabis is required, as is intervention to reduce these impacts.
Publisher: Springer Science and Business Media LLC
Date: 04-2016
Publisher: Oxford University Press (OUP)
Date: 03-2003
Abstract: To determine whether patients hospitalized with acute myocardial infarction (AMI) in an Australian setting receive better pharmacological care if managed by cardiologists than by non-cardiologists. Retrospective chart review of patients hospitalized between 1 January 1997 and 30 June 1998, undertaken by abstractors blind to study objectives. One tertiary and two community hospitals in south-east Queensland, Australia, in which all patients admitted with AMI were cared for by cardiologists and general physicians, respectively. Two cohorts of consecutive patients satisfying diagnostic criteria for AMI: 184 in the tertiary hospital and 207 in the community hospitals. Frequency of use, in highly eligible patients, of thrombolysis, beta-blockers, aspirin, angiotensin-converting enzyme (ACE) inhibitors, lipid-lowering agents, nitrates, and calcium antagonists. Cohorts were compared for differences in prognostic factors or illness severity. In community hospital patients, there was greater use of thrombolysis [100% versus 83% in the tertiary hospital difference 17%, 95% confidence interval (CI) 11-26% P < 0.001] and of ACE inhibitors (84% versus 66% difference 18%, 95% CI 3-34% P = 0.02), and lower median length of stay (6.0 days versus 7.0 days P = 0.001) compared with tertiary hospital patients. Frequency of use of other drugs, and adjusted rates of death and re-infarction were the same for both cohorts. With respect to pharmacological management of patients hospitalized with AMI, cardiologists and general physicians appear to provide care of similar quality and achieve equivalent outcomes. Further studies are required to confirm the generalizability of these results to Australian practice as a whole.
Publisher: Wiley
Date: 08-2015
DOI: 10.1111/INM.12155
Publisher: MDPI AG
Date: 11-10-2013
Publisher: Wiley
Date: 03-2005
DOI: 10.1111/J.1360-0443.2005.01040.X
Abstract: To assess whether cannabis use, recently taken up by many indigenous Australians in remote communities, has reinforced tobacco use. Cross-sectional study. Three eastern Arnhem Land communities (Northern Territory, NT) total population = 3384, in 2001. From 1247 people aged 17-36 years, 190 (120 males, 70 females) were opportunistically recruited. Self-reported life-time and current tobacco, cannabis and other substance use were confirmed by local health workers and using clinic records. Participants reported level of substance use, frequency and duration (years used). Associations with tobacco use were calculated (odds ratios: OR) using logistic regression with age, sex, alcohol use and a history of petrol sniffing as confounders. In univariate analyses current tobacco users were more likely than non-users to be using cannabis (OR = 3.1, 1.5-6.2, P = 0.002) and this association remained in multivariate analyses (OR = 3.0, 1.4-6.8, P = 0.006). Tobacco use was associated with the number of years of cannabis use (P = 0.035). The likelihood that tobacco users were also cannabis users increased as quantity of cannabis used increased (P = 0.008). Current tobacco use was no more likely in those who initiated cannabis from 1998 onwards than in those who initiated cannabis before 1998 (OR = 1.1, 0.4-3.2, P = 0.881). One-third of life-time users of both tobacco and cannabis initiated their use at or near the same time, and very few of these (12%) had discontinued either cannabis or tobacco. Cannabis appears to have influenced the continued use of tobacco in these populations with possible additional burdens for cardiovascular and respiratory diseases and challenges for interventions.
Publisher: Springer Science and Business Media LLC
Date: 28-07-2012
Publisher: AMPCo
Date: 03-2013
DOI: 10.5694/MJA12.10343C
Publisher: Springer Science and Business Media LLC
Date: 20-02-2010
Publisher: Elsevier BV
Date: 04-2013
Publisher: MDPI AG
Date: 21-12-2022
DOI: 10.3390/NU15010035
Abstract: Plant-based proteins are generally characterised by lower Indispensable Amino Acid (IAA) content, digestibility, and anabolic properties, compared to animal-based proteins. However, they are environmentally friendlier, and wider consumption is advocated. Older adults have higher dietary protein needs to prevent sarcopenia, a disease marked by an accelerated loss of muscle mass and function. Given the lower environmental footprint of plant-based proteins and the importance of optimising dietary protein quality among older adults, this paper aims to assess the net peripheral Amino Acid (AA) appearance after ingestion of three different plant protein and fibre (PPF) products, compared to whey protein with added fibre (WPF), in healthy older adults. In a randomised, single-blind, crossover design, nine healthy men and women aged ≥65 years consumed four test meals balanced in AA according to the FAO reference protein for humans, matched for leucine, to optimally stimulate muscle protein synthesis in older adults. A fasted blood s le was drawn at each visit before consuming the test meal, followed by postprandial arterialise blood s ling every 30 min for 3 h. The test meal was composed of a soup containing either WPF or PPF 1–3. The PPF blends comprised pea proteins with varying additional rice, pumpkin, soy, oat, and/or almond protein. PPF product ingestion resulted in a lower maximal increase of postprandial leucine concentration and the sum of branched-chain AA (BCAA) and IAA concentrations, compared to WPF, with no effect on their incremental area under the curve. Plasma methionine and cysteine, and to a lesser extent threonine, appearance were limited after consuming the PPF products, but not WPF. Despite equal leucine doses, the WPF induced greater postprandial insulin concentrations than the PPF products. In conclusion, the postprandial appearance of AA is highly dependent on the protein source in older adults, despite providing equivalent IAA levels and dietary fibre. Coupled with lower insulin concentrations, this could imply less anabolic potential. Further investigation is required to understand the applicability of plant-based proteins in healthy older adults.
Start Date: 2013
End Date: 2015
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2008
End Date: 06-2012
Amount: $100,492.00
Funder: Australian Research Council
View Funded ActivityStart Date: 11-2016
End Date: 12-2022
Amount: $400,500.00
Funder: Australian Research Council
View Funded Activity