ORCID Profile
0000-0002-8588-580X
Current Organisations
Queensland Health
,
Queensland University of Technology
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Publisher: BMJ
Date: 2013
Publisher: Elsevier BV
Date: 04-2006
DOI: 10.1111/J.1467-842X.2006.TB00111.X
Abstract: To assess the characteristics of Indigenous births and to examine the risk factors for preterm (<37 weeks), low birth weight (<2,500 g) and small for gestational age (SGA) births in a remote urban setting. Prospective cohort of singleton births to women attending Townsville Aboriginal and Islander Health Services (TAIHS) for shared antenatal care between 1 January 2000 and 31 December 2003. Demographic, obstetric, and antenatal care characteristics are described. Risk factors for preterm birth, low birth weight and SGA births are assessed. The mean age of the mothers was 25.0 years (95% CI 24.5-25.5), 15.8% reported hazardous or harmful alcohol use, 15.1% domestic violence, 30% had an inter-pregnancy interval of less than 12 months and 9.2% an unwanted pregnancy. The prevalence of infection was 50.2%. Predictors of preterm birth were a previous preterm birth, low body mass index (BMI) and inadequate antenatal care, with the subgroup at greatest risk of preterm birth being women with a previous preterm birth and infection in the current pregnancy. Predictors of a low birth weight birth were a previous stillbirth, low BMI and an interaction of urine infection and non-Townsville residence predictors of an SGA birth were tobacco use, pregnancy-induced hypertension and interaction of urine infection and harmful alcohol use. The prevalence of demographic and clinical risk factors is high in this group of urban Indigenous women. Strategies addressing potentially modifiable risk factors should be an important focus of antenatal care delivery to Indigenous women and may represent an opportunity to improve perinatal outcome in Indigenous communities in Australia.
Publisher: Wiley
Date: 08-05-2008
Publisher: AMPCo
Date: 07-2012
DOI: 10.5694/MJA11.10858
Abstract: To determine the effectiveness of an intensive quit-smoking intervention on smoking rates at 36 weeks' gestation among pregnant Aboriginal and Torres Strait Islander women. Randomised controlled trial. Pregnant Aboriginal and Torres Strait Islander women (n = 263) attending their first antenatal visit at one of three Aboriginal community-controlled health services between June 2005 and December 2009. A general practitioner and other health care workers delivered tailored advice and support to quit smoking to women at their first antenatal visit, using evidence-based communication skills and engaging the woman's partner and other adults in supporting the quit attempts. Nicotine replacement therapy was offered after two failed attempts to quit. The control ("usual care") group received advice to quit smoking and further support and advice by the GP at scheduled antenatal visits. Self-reported smoking status (validated with a urine cotinine measurement) between 36 weeks' gestation and delivery. Participants in the intervention group (n = 148) and usual care group (n = 115) were similar in baseline characteristics, except that there were more women who had recently quit smoking in the intervention group than the control group. At 36 weeks, there was no significant difference between smoking rates in the intervention group (89%) and the usual care group (95%) (risk ratio for smoking in the intervention group relative to usual care group, 0.93 [95% CI, 0.86-1.08] P = 0.212). Smoking rates in the two groups remained similar when baseline recent quitters were excluded from the analysis. An intensive quit-smoking intervention was no more effective than usual care in assisting pregnant Aboriginal and Torres Strait Islander women to quit smoking during pregnancy. Contamination of the intervention across groups, or the nature of the intervention itself, may have contributed to this result. Australian New Zealand Clinical Trials Registry ACTRN12609000929202.
Publisher: Elsevier BV
Date: 04-2006
DOI: 10.1111/J.1467-842X.2006.TB00112.X
Abstract: To increase Pap smear participation and to assess the prevalence of sexually transmitted infection (STI) in urban Indigenous women in Townsville. Convenience s le of women attending Townsville Aboriginal and Islanders Health Services (TAIHS) for health care participating in the Trichomonas vaginalis (TV) project, coordinated by an Aboriginal Health Worker (AHW) trained in women's health and cervical screening. 198 women, aged 20-69 years of age, attending TAIHS between March 2002 and 31 January 2004. Pap smear participation and prevalence of STIs. Pap smear participation among eligible women at TAIHS increased from 20.9% pre TV project to 28.6% during the project and 35.6% in the 12 months post completion of the TV project (p<0.0001), an increase of 70.3%. Of 196 smears performed during the study, 20 (10.6%, 95% CI 6.2-15) were abnormal abnormality was more common in non-Indigenous 8/50 (16.0%) than in Indigenous women 12/139 (8.6%), but did not reach significance (p=0.180). The prevalence of Chlamydia trachomatis was low, with no differences between the Indigenous and non-Indigenous groups, and highest in younger women: 6/44 (13.6%) in women less than 25 years Trichomonas vaginalis was more common in the Indigenous group. An AHW trained to perform and advocating for Pap smear participation has significantly increased the smear participation at TAIHS. The overall prevalence of STI was low.
Publisher: Wiley
Date: 04-2002
DOI: 10.1046/J.1440-1754.2002.00760.X
Abstract: To compare the epidemiology of sudden infant death syndrome (SIDS) in Indigenous and non-Indigenous infants in north Queensland, and to assess the quality of data recorded for SIDS deaths. Records were obtained for SIDS cases from all coronial courts in north Queensland from 1990 to 1998. Demographic characteristics, ethnicity, age at death, sleeping and feeding patterns, smoking incidences and autopsy findings were compared. Incidences, medians and univariate associations were generated where appropriate. There were 83 248 live births for the 9-year period 71 389 non-Indigenous and 11 859 Indigenous births. There were 69 SIDS deaths (0.83 per 1000 live births). Overall, recording of demographic and death scene data was poor. Thirty-eight autopsies (55%) were performed by specialist pathologists. There were 22 (32%) non-Indigenous and 22 (32%) Indigenous SIDS deaths (25 ethnicity unknown), giving an estimated relative risk of 2.82 (95% CI 2, 4). Median age at death was 13.1 weeks (range 1-83 weeks) with 14% of deaths occurring in the neonatal period for both groups. Sleeping position was not recorded in 42% of cases and co-sleeping was not recorded in 27% of cases. Bed sharing was more common amongst Indigenous infants. Fifty-two per cent of SIDS cases occurred in the wet season and 48% in the dry season. Data recorded for SIDS deaths in north Queensland are poor, preventing specific conclusions concerning SIDS risk factors. However, SIDS rates may be up to three-fold higher in the Indigenous population. A uniform system of post-mortem and death scene data reporting is needed urgently.
Publisher: Wiley
Date: 05-10-1999
DOI: 10.1046/J.1440-1754.1999.355417.X
Abstract: Children with urinary tract infections (UTI) are at risk of renal scarring which may lead to impaired renal function and hypertension. This study examines the risk factors that predispose to recurrent UTI in children and the role of recurrent UTI in renal scarring. A group of 290 children under 5 years of age with a first symptomatic UTI were studied. Micturating cystourethrogram and dimercaptosuccinic acid (DMSA) renal scintigraphy were performed at entry, and DMSA was repeated 1 year later. Two hundred and sixty-one children (90%) were followed up at 1 year. There were 46 confirmed recurrent infections in 34 children, a recurrence rate of 12%. Multiple recurrence occurred in 14/34 (34%) children. Age of less than 6 months on entry independently predicted for recurrent UTI (odds ratio (OR): 2.9)). Compliance with prophylactic antibiotics fell throughout the year of follow up. Vesicoureteric reflux (VUR) was present in 14/34 (34%) of the group with recurrent UTI, 69/256 (27%) without recurrence. Urinary tract infection was significantly associated with bilateral and intrarenal reflux grade 3-5 reflux independently predicted for recurrent UTI (OR: 3.5). Recurrent UTI was significantly associated with high grade DMSA defects on entry, renal parenchymal defects at 1 year follow up, and new defects at 1 year. The independent risk factors for recurrent UTI identified by this study were an age of less than 6 months at the index UTI and grade 3-5 VUR. These findings suggest more selective targeting may minimize problems associated with prophylaxis and improve outcomes for children with urine infection.
Publisher: American Physiological Society
Date: 06-1991
DOI: 10.1152/JAPPL.1991.70.6.2448
Abstract: On the basis of its potent proinflammatory and spasmogenic effects, N-formyl-methionyl-leucyl-phenylalanine (FMLP), a bacterial oligopeptide, is a putative mediator of bronchoconstriction and airway inflammation during bacterial bronchial infection. However, after an FMLP dose-response curve in rabbits, tachyphylaxis to a second challenge was seen in some rabbits and airway inflammation was absent. This study was designed to reproduce the more prolonged airway exposure to FMLP that may occur during bacterial infection. Two groups of rabbits received FMLP [5 mg/ml in 66% dimethyl sulfoxide- (DMSO) saline] or DMSO diluent alone by nebulization every 15 min for 2 h. Pulmonary resistance (RL) was measured at 1 and 2 h. Recovery from bronchoconstriction was also assessed by measuring RL every 30 min for 2 h after the final FMLP administration. Sections of trachea and large bronchi were prepared and graded by quadrant from 0 to 3 for inflammation, a total score from 0 to 12 being given for each section. There was a progressive increase in RL in FMLP-treated rabbits, reaching 68 +/- 9% above baseline after 120 min, a significantly greater change than after diluent, 8 +/- 12% (P less than 0.01). RL remained elevated above baseline for 90 min after the final FMLP dose. Inflammation scores were greater after FMLP than DMSO: 9.3 +/- 0.5 vs. 4.3 +/- 0.7 (P less than 0.01) in trachea and 5.2 +/- 0.4 vs. 1.7 +/- 0.5 (P less than 0.01) in lobar bronchi. We conclude that prolonged exposure of airways to FMLP produces a sustained increase in RL and airway inflammation, the cardinal features of infective exacerbations of chronic airflow limitation.
Publisher: Elsevier BV
Date: 02-2010
DOI: 10.1111/J.1753-6405.2010.00471.X
Abstract: This study assessed brief intervention (BI) activity and organisation capacity for smoking, nutrition, alcohol and physical activity (SNAP framework) and key clinical prevention activities in four Aboriginal and Torres Strait Islander medical services in Queensland. A mixed methods design was used including: staff surveys of knowledge and attitudes (n=39), focus groups to discuss perceived barriers and enablers and chart audits (n=150) to quantify existing BI activity. Of 50 clinical staff, 46 participated in the staff survey and focus groups across the four sites. BI was perceived to be important. There was significant variation in completion of records for SNAP risk factors, key clinical and BI activities across the sites. At least one SNAP factor status was recorded in 130/150 (86.7%) patient charts audited and there was a significant trend of increased recording of SNAP factors with increasing number of patient visits. Of those identified at risk 78% received at least one BI. Where risk was identified 65/96 (67.7%) patients required multiple BIs. BI for tobacco use was consistently high across all sites. Only one site recorded regular care planning and Adult Health Checks. Impacting factors included leadership, high staff turnover, multiple medical records and staff health status. Inflexible staff training, competing health priorities and high levels of staff turnover were identified as key barriers to the delivery of BI in clinical settings. The data suggests a good base of existing BI activity for smoking and key clinical activities which may improve with further support.
Publisher: Wiley
Date: 18-05-2010
DOI: 10.1111/J.1465-3362.2009.00078.X
Abstract: A significant level of misreport or error occurs during questionnaire-based assessment of smoking behaviour. Failure to measure environmental tobacco smoke, and participant's inclination to under-report their smoking raise questions as to the accuracy of assessment. In order to establish an estimation of the possible error associated with such assessment, the accuracy of self-reported smoking status among a group of pregnant Aboriginal and Torres Strait Islander women was examined. Women attending two Aboriginal Medical services in Far North Queensland for antenatal care were invited to participate. Women completed an interviewer assisted questionnaire relating to their smoking status and a 24 h diary of their exposure to nicotine and consumption of alcohol. Urine s les were analysed for cotinine using an Enzyme Linked Immunosorbent Assay. Cotinine analysis indicated that 17% of women who reported that they were non-smokers were likely to have misreported this status, or be exposed to high levels of passive smoke. The only significant predictors of cotinine level were self-reported nicotine exposure (including passive smoke) and number of cigarettes smoked in the previous 24 h. Other in idual and environmental variables had no significant influence on cotinine level using this analysis technique. The level of potential error in smoking assessment among this group was substantial. Exposure to environmental tobacco smoke might explain part of this error, but the reasons for misreport can only be speculated. This rate of misclassification should be taken into consideration in routine screening of antenatal women in primary health care.
Publisher: Springer Science and Business Media LLC
Date: 10-09-2020
DOI: 10.1038/S41746-020-00325-Z
Abstract: Digital health applications (apps) have the potential to improve health behaviors and outcomes. We aimed to examine the effectiveness of a consumer web-based app linked to primary care electronic health records (EHRs). CONNECT was a multicenter randomized controlled trial involving patients with or at risk of cardiovascular disease (CVD) recruited from primary care (Clinical Trial registration ACTRN12613000715774). Intervention participants received an interactive app which was pre-populated and refreshed with EHR risk factor data, diagnoses and, medications. Interactive risk calculators, motivational messages and lifestyle goal tracking were also included. Control group received usual health care. Primary outcome was adherence to guideline-recommended medications (≥80% of days covered for blood pressure (BP) and statin medications). Secondary outcomes included attainment of risk factor targets and eHealth literacy. In total, 934 patients were recruited mean age 67.6 (±8.1) years. At 12 months, the proportion with % days covered with recommended medicines was low overall and there was no difference between the groups (32.8% vs. 29.9% relative risk [RR] 1.07 [95% CI, 0.88–1.20] p = 0.49). There was borderline improvement in the proportion meeting BP and LDL targets in intervention vs. control (17.1% vs. 12.1% RR 1.40 [95% CI, 0.97–2.03] p = 0.07). The intervention was associated with increased attainment of physical activity targets (87.0% intervention vs. 79.7% control, p = 0.02) and e-health literacy scores (72.6% intervention vs. 64.0% control, p = 0.02). In conclusion, a consumer app integrated with primary health care EHRs was not effective in increasing medication adherence. Borderline improvements in risk factors and modest behavior changes were observed.
Publisher: Wiley
Date: 04-09-2017
DOI: 10.1111/DAR.12609
Abstract: There is a concern that cannabis use is an important barrier to reducing Aboriginal and Torres Strait Islander smoking. We investigate the associations of cannabis use and tobacco smoking and quitting in two large national s les. The 2012-2013 National Aboriginal and Torres Strait Islander Health Survey was a national stratified random household survey conducted between April 2012 and February 2013, and included 2580 adult Aboriginal and Torres Strait Islander smokers. The Talking About The Smokes Project interviewed a national quota s le of 1301 Aboriginal and Torres Strait Islander adult smokers between August 2013 and August 2014. Both surveys asked about tobacco smoking and quitting, cannabis use and socio-demographic factors. Both surveys estimated that cannabis use is common among Aboriginal and Torres Strait Islander smokers (National Aboriginal and Torres Strait Islander Health Survey: 32%, Talking About The Smokes: 24%). Both surveys found a higher prevalence of cannabis use among smokers who were male, younger, unemployed or who more frequently consumed five or more alcoholic drinks in a day. However, the two surveys provided inconsistent evidence about whether cannabis use is associated with not quitting smoking tobacco. We did not find consistent evidence in this setting that cannabis use is an obstacle to quitting tobacco smoking. Nevertheless, we would still recommend that clinicians counselling Aboriginal and Torres Strait Islander tobacco smokers about quitting talk about cannabis use because its use is common and almost all mix it with tobacco.
Publisher: AMPCo
Date: 27-06-2020
DOI: 10.5694/MJA2.50667
Publisher: Springer Science and Business Media LLC
Date: 12-2014
Publisher: AMPCo
Date: 2013
DOI: 10.5694/MJA12.11298
Publisher: Wiley
Date: 02-2002
DOI: 10.1046/J.1440-1754.2002.00782.X
Abstract: To compare perinatal outcomes for all births, and the morbidity and mortality patterns of babies admitted to neonatal intensive care, for non-Indigenous, Aboriginal and Torres Strait Islander (TSI) people in a major remote urban centre. A prospective cohort study of all births and consecutive admissions to the Neonatal Intensive Care Unit/Special Baby Care Unit (NICU/SCBU) at Kirwan Hospital for Women (KWH), Townsville (a tertiary referral hospital) was conducted from January 1998 to June 1999. There were 2575 births, with 2392 (93%) booked into KWH for delivery. The Aboriginal group differed from the non-Indigenous group only in the prevalence of low-birthweight births. The TSI group had significantly higher perinatal mortality rates, preterm and low-birthweight births than the non-Indigenous group. Seven hundred and fifty-eight babies were admitted to NICU/SCBU: 586 (77%) non-Indigenous, 129 (17%) Aboriginal, 43 (6%) TSI. There were significantly more preterm, lower birthweight and longer stay length Aboriginal and TSI babies. Being Indigenous was not associated with neonatal death. Gestation of less than 28 weeks, congenital anomalies, and high-grade cerebral haemorrhage, but not ethnicity, were independent risk factors for neonatal death. Maternal risk factors, including poor antenatal care attendance, were more prevalent amongst Indigenous women. Neonatal outcomes for Aboriginal infants were better than expected from national and State reports. Outcomes for Torres Strait Islander infants were worse than expected. Ethnicity was not a risk factor for neonatal death. These findings suggest that outcomes may be further improved by programmes to increase access for Indigenous women to antenatal care services.
Publisher: BMJ
Date: 07-2021
DOI: 10.1136/BMJOQ-2020-001091
Abstract: A national accreditation policy for the Australian primary healthcare (PHC) system was initiated in 2008. While certification standards are mandatory, little is known about their effects on the efficiency and sustainability of organisations, particularly in the Aboriginal Community Controlled Health Service (ACCHS) sector. The literature review aims to answer the following: to what extent does the implementation of the International Organisation for Standardization 9001:2008 quality management system (QMS) facilitate efficiency and sustainability in the ACCHS sector? Thematic analysis of peer-reviewed and grey literature was undertaken from Australia and New Zealand PHC sector with a focus on First Nations people. The databases searched included Medline, Scopus and three Informit sites (AHB-ATSIS, AEI-ATSIS and AGIS-ATSIS). The initial search strategy included quality improvement, continuous quality improvement, efficiency and sustainability. Sixteen included studies were assessed for quality using the McMaster criteria. The studies were ranked against the criteria of credibility, transferability, dependability and confirmability. Three central themes emerged: accreditation (n=4), quality improvement (n=9) and systems strengthening (n=3). The accreditation theme included effects on health service expenditure and clinical outcomes, consistency and validity of accreditation standards and linkages to clinical governance frameworks. The quality improvement theme included audit effectiveness and value for specific population health. The theme of systems strengthening included prerequisite systems and embedded clinical governance measures for innovative models of care. The ACCHS sector warrants reliable evidence to understand the value of QMSs and enhancement tools, particularly given ACCHS (client-centric) services and their specialist status. Limited evidence exists for the value of standards on health system sustainability and efficiency in Australia. Despite a mandatory second certification standard, no studies reported on sustainability and efficiency of a QMS in PHC.
Publisher: Elsevier BV
Date: 06-2017
Abstract: To assess whether social, economic and demographic measures are associated with initiating and sustaining quit attempts in a national s le of Aboriginal and Torres Strait Islander smokers. We analysed data from 759 adults who reported smoking at least weekly in the Talking About The Smokes baseline survey (April 2012 - October 2013) and completed a follow up survey a year later (August 2013 - August 2014). Almost none of the standard baseline socioeconomic indicators predicted making or sustaining quit attempts. However, becoming employed was associated with making quit attempts (OR 1.88) and both becoming employed (OR 3.03) and moving to purchase a home (OR 2.34) were both positively associated with sustaining abstinence of one month or more. More smokers who had insufficient money for food or essentials because of money spent on cigarettes had made a quit attempt (OR 1.47) and sustained abstinence of one month or more (OR 1.74). Disadvantage does not seem to have pervasive negative effects on quitting. We should be more optimistic in our tobacco control activities with the most disadvantaged among Aboriginal and Torres Strait Islander smokers. Increasing personal empowerment (e.g. getting a job) may lead to at least short-term improvements in quitting.
Publisher: AMPCo
Date: 06-2014
DOI: 10.5694/MJA13.00005
Abstract: The national Closing the Gap framework commits to reducing persisting disadvantage in the health of Aboriginal and Torres Strait Islander people in Australia, with cross-government-sector initiatives and investment. Central to efforts to build healthier communities is the Aboriginal community controlled health service (ACCHS) sector its focus on prevention, early intervention and comprehensive care has reduced barriers to access and unintentional racism, progressively improving in idual health outcomes for Aboriginal people. There is now a broad range of primary health care data that provides a sound evidence base for comparing the health outcomes for Indigenous people in ACCHSs with the outcomes achieved through mainstream services, and these data show: models of comprehensive primary health care consistent with the patient-centred medical home model coverage of the Aboriginal population higher than 60% outside major metropolitan centres consistently improving performance in key performance on best-practice care indicators and superior performance to mainstream general practice. ACCHSs play a significant role in training the medical workforce and employing Aboriginal people. ACCHSs have risen to the challenge of delivering best-practice care and there is a case for expanding ACCHSs into new areas. To achieve the best returns, the current mainstream Closing the Gap investment should be shifted to the community controlled health sector.
Publisher: Wiley
Date: 29-05-2021
DOI: 10.1111/AJR.12706
Abstract: To estimate the number of general practice‐appropriate attendances in a remote emergency department and explore the reasons for patients’ choice of service. A four‐step case study approach was adopted, focusing on hospital emergency department (ED) attendances that were potentially manageable in general practice. A large, remote community with substantial populations of Indigenous peoples and fly‐in, fly‐out mining industry workers. The ED is experiencing rapid growth in demand for services for lower urgency. Patients attending the emergency department with lower urgency problems. ED attendance data for 2016 were reviewed to identify lower urgency presentations. Patient records for 400 randomly selected presentations were subject to deeper analysis. A prospective survey was conducted over 6 months of 369 ED patients with lower urgency presentations. The proportion of patients attending the ED with GP‐appropriate problems and influences on their decisions to attend the ED. About 48% of all attendances met the agreed definition of GP‐appropriate problems. About half of presentations were during the normal work hours and about half of patients stated that GP services were unavailable. Younger age, lack of information about local GP services, and perceptions of convenience contributed significantly to seeking ED care. Increasing the availability of GP services alone is unlikely to be sufficient to change service utilisation. Strategies should include raising community awareness of how and when to utilise the appropriate service, understanding different models of care, and the need to register with a general practice.
Publisher: American Physiological Society
Date: 02-1991
DOI: 10.1152/JAPPL.1991.70.2.877
Abstract: Inhalation of f-Met-Leu-Phe (FMLP) produces dose-dependent increases in pulmonary resistance (RL) in rabbits. We hypothesized that inhibition of neutral endopeptidase (NEP), which has high affinity for FMLP, would augment the response to FMLP inhalation. We found the increase in RL above baseline in response to FMLP to be reduced from 56 +/- 18 to 8 +/- 10% (P less than 0.01) by phosphoramidon (1 mg/kg) and to 15 +/- 6% (P less than 0.02) by thiorphan (3 mg/kg). The geometric mean dose of FMLP producing a 20% rise in RL (PC20RL FMLP) was increased by phosphoramidon from 1.1 to 4.5 mg/ml (P less than 0.05). Enkephalins, which are also NEP substrates, modulate cholinergic neurotransmission in the airway. Inhibition of the FMLP response by phosphoramidon was reversed by coadministration of naloxone (0.1 mg/kg) after atropine (2 mg/kg) the change in RL in response to FMLP was reduced to 7 +/- 4% (P less than 0.01), whereas morphine (0.15 mg/kg) increased PC20RL FMLP to 5.1 mg/ml (P less than 0.05). FMLP-induced bronchoconstriction in the rabbit is vagally mediated, and reduced responses after NEP inhibition may reflect modulation of cholinergic bronchoconstriction by enkephalins. Changes in airway NEP activity may influence the activity of a wide range of its substrates, of which some are bronchoconstrictors and others bronchodilators.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2015
DOI: 10.1161/CIRCOUTCOMES.114.001235
Abstract: Despite effective treatments to reduce cardiovascular disease risk, their translation into practice is limited. Using a parallel arm cluster-randomized controlled trial in 60 Australian primary healthcare centers, we tested whether a multifaceted quality improvement intervention comprising computerized decision support, audit/feedback tools, and staff training improved (1) guideline-indicated risk factor measurements and (2) guideline-indicated medications for those at high cardiovascular disease risk. Centers had to use a compatible software system, and eligible patients were regular attendees (Aboriginal and Torres Strait Islander people aged ≥35 years and others aged ≥45 years). Patient-level analyses were conducted using generalized estimating equations to account for clustering. Median follow-up for 38 725 patients (mean age, 61.0 years 42% men) was 17.5 months. Mean monthly staff support was hour/site. For the coprimary outcomes, the intervention was associated with improved overall risk factor measurements (62.8% versus 53.4% risk ratio 1.25 95% confidence interval, 1.04–1.50 P =0.02), but there was no significant differences in recommended prescriptions for the high-risk cohort (n=10 308 56.8% versus 51.2% P =0.12). There were significant treatment escalations (new prescriptions or increased numbers of medicines) for antiplatelet (17.9% versus 2.7% P .001), lipid-lowering (19.2% versus 4.8% P .001), and blood pressure–lowering medications (23.3% versus 12.1% P =0.02). In Australian primary healthcare settings, a computer-guided quality improvement intervention, requiring minimal support, improved cardiovascular disease risk measurement but did not increase prescription rates in the high-risk group. Computerized quality improvement tools offer an important, albeit partial, solution to improving primary healthcare system capacity for cardiovascular disease risk management. URL: www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=336630 . Australian New Zealand Clinical Trials Registry No. 12611000478910.
Publisher: Springer Science and Business Media LLC
Date: 08-12-2022
Publisher: Wiley
Date: 09-09-2005
DOI: 10.1111/J.1440-1584.2005.00718.X
Abstract: Much of the ill health of Australian Indigenous populations can be attributed to diet-related diseases. Many of these diseases and the deleterious dietary choices are thought to begin in early childhood. This project therefore aimed to assess the nutritional health status of children in Townsville. It enabled the Townsville Aboriginal and Islander community to identify and redress nutrition-related issues considered important in improving the overall health status of their community. Baseline urinalysis, anthropometrics, general overall health assessment, dietary and exercise histories were collected. This screening was repeated annually. Diet and exercise histories were recorded biannually. Based in three Northern Queensland health region (pre)primary schools with a high proportion of Indigenous children. Baseline results demonstrated that more children are overweight to obese than underweight. There was no significant difference in body mass index between Indigenous and Non-Indigenous children. Indigenous children were shown to consume less vegetable and dairy products and were significantly more likely to suffer from anaemia, iron depletion and eosinophilia than non-Indigenous children. Indigenous children were also twice as likely to have runny noses and are more than three times more likely to have skin sores. These results support that the health status of the Indigenous children is poorer than that of non-Indigenous children. They demonstrate an immediate need to implement culturally appropriate nutritional and exercise programs within the school environment to improve dietary habits and overall health. Implementation of nutritional, drinking and exercise programs may significantly improve these children's overall awareness and behaviour concerning nutrition and health.
Publisher: BMJ
Date: 2012
Publisher: Springer Science and Business Media LLC
Date: 08-12-2022
Publisher: Wiley
Date: 04-04-2022
DOI: 10.1002/HPJA.485
Abstract: National smoking prevalence is decreasing among Aboriginal and Torres Strait Islander people. In remote areas, Aboriginal and Torres Strait Islander smoking prevalence remains higher than in nonremote areas and is not improving. We analysed data from 539 daily and weekly smokers from remote areas who completed baseline surveys at either Wave 1 (April 2012‐October 2013) or Wave 2 (August 2013‐August 2014), including 157 from Wave 1 who also completed Wave 2, from the Talking About The Smokes project. We assessed associations between baseline predictor measures and having made any quit attempt in the past year and, among those who did, having sustained the last quit attempt for one month or more. More smokers had made a quit attempt if they were younger or reported being unable to buy essentials due to money spent on smokes, being more stressed, having several pro‐quitting motivations and attitudes, having an effective smoke‐free home, or being encouraged to quit by a health professional or by family/friends. Of these, more had sustained their last quit attempt for one month or more if they reported being more socially advantaged, no smoking‐induced deprivation, being less dependent, chewing pituri or an having effective smoke‐free home. Health staff should consider the quite different factors associated with starting and then sustaining a quit attempt. Our findings support continued attention in remote areas on smoke‐free homes and health staff providing regular encouragement to all smokers to quit and more use of smokers' friends and family for support.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-10-2017
Abstract: We evaluated a multifaceted, computerized quality improvement intervention for management of cardiovascular disease ( CVD ) risk in Australian primary health care. After completion of a cluster randomized controlled trial, the intervention was made available to both trial arms. Our objective was to assess intervention outcomes in the post‐trial period and any heterogeneity based on original intervention allocation. Data from 41 health services were analyzed. Outcomes were (1) proportion of eligible population with guideline‐recommended CVD risk factor measurements and (2) the proportion at high CVD risk with current prescriptions for guideline‐recommended medications. Patient‐level analyses were conducted using generalized estimating equations to account for clustering and time effects and tests for heterogeneity were conducted to assess impact of original treatment allocation. Median follow‐up for 22 809 patients (mean age, 64.2 years 42.5% men, 26.5% high CVD risk) was 17.9 months post‐trial and 35 months since trial inception. At the end of the post‐trial period there was no change in CVD risk factor screening overall when compared with the end of the trial period (64.7% versus 63.5%, P =0.17). For patients at high CVD risk, there were significant improvements in recommended prescriptions at end of the post‐trial period when compared with the end of the trial period (65.2% versus 56.0%, P .001). There was no heterogeneity of treatment effects on the outcomes based on original randomization allocation. CVD risk screening improvements were not observed in the post‐trial period. Conversely, improvements in prescribing continued, suggesting that changes in provider and patient actions may take time when initiating medications. URL : www.anzctr.org.au . Unique identifier: 12611000478910.
Publisher: Springer Science and Business Media LLC
Date: 12-11-2018
Publisher: BMJ
Date: 03-2002
Publisher: Wiley
Date: 16-05-2006
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/PY15115
Abstract: This paperexplores the patterns ofpatients’accessingsix Aboriginal and Islander CommunityControlled Health Services (AICCHSs) in Queensland. Between August 2011 and February 2014, 26199 patients made at least one visit over a 2-year period prior to at least one of six Queensland AICCHS – one urban service (RA 1) in south-east Queensland, and five services in regional towns (RA 3) in Far North Queensland. Geospatial mapping of addresses for these registered patients was undertaken. The outcomes analysed included travel times to, the proportion of catchment populations using each AICCHS and an assessment of alternative mainstream general practice availability to these patients was made. In brief, the use of AICCHS was higher than Australian Bureau of Statistics census data would suggest. Approximately 20% of clients travel more than 30min to seek Aboriginal Health services, but only 8% of patients travelled longer than 60min. In the major city site, many other general practitioner (GP) services were bypassed. The data suggest Aboriginal and Islander patients in Queensland appear to value community-controlled primary care services. The number of Indigenous clients in regional locations in the Far North Queensland registered with services is often higher than the estimated resident population numbers.
Publisher: Elsevier BV
Date: 06-2020
Publisher: Wiley
Date: 04-2002
DOI: 10.1046/J.1440-1754.2002.00759.X
Abstract: To assess the prevalence of sudden infant death syndrome (SIDS) risk factors in the Indigenous and non-Indigenous community of Townsville, a large remote urban centre in north Queensland, Australia. Thirty Indigenous and 30 non-Indigenous women with young children were surveyed using sections of the West Australian Infancy and Pregnancy Survey 1997-1998. The prevalence of SIDS risk factors was compared between the two groups and medians and univariate associations were generated where appropriate. The Indigenous women were significantly younger and more likely to be single. The median age of the infants was 8 months (range 0.3-26 months) with no difference between the two groups. Thirty-seven per cent of Indigenous infants slept prone (cf. 17% of non-Indigenous infants P = 0.03), and 77% shared a bed (cf. 13% of non-Indigenous infants P < 0.001). The Indigenous households had significantly more members, with 57% including extended family members (cf. 20% non-Indigenous group P = 0.003). Fifty-three per cent of the Indigenous women smoked during pregnancy (cf. 23% of non-Indigenous women P = 0.017), 60% were smokers at the time of the interview, and smoking occurred inside 40% of Indigenous houses (cf. 20% and 20% for non-Indigenous women, respectively P < 0.001, 0.09). This small survey suggests that the prevalence of SIDS risk factors is higher in the Indigenous population, and a new approach to education is needed urgently to promote SIDS awareness among Indigenous women.
Publisher: Springer Science and Business Media LLC
Date: 13-09-2011
Publisher: Elsevier BV
Date: 12-2017
Publisher: BMJ
Date: 2017
Location: Australia
Location: Australia
No related grants have been discovered for Kathryn Panaretto.