ORCID Profile
0000-0003-2112-3918
Current Organisations
Australian National University
,
Telethon Kids Institute
,
University of Canterbury
,
South Australian Health and Medical Research Institute
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Primary Health Care | Aboriginal and Torres Strait Islander Health | Public Health and Health Services | Social and Cultural Geography | Health and Community Services
ANZSRC Socio-Economic Objective (SEO)
Cardiovascular System and Diseases | Aboriginal and Torres Strait Islander Health - Determinants of Health | Social Structure and Health | Expanding Knowledge in Built Environment and Design |
Related Links
Publications
Indigenous healthcare worker involvement for Indigenous adults and children with asthma
Publisher: John Wiley & Sons, Ltd
Date: 17-10-2007
Screening for diabetic retinopathy and reduced vision among Indigenous Australians in Top End primary care health services: a TEAMSnet sub‐study
Publisher: Wiley
Date: 24-10-2021
DOI: 10.1111/IMJ.14971
Abstract: Diabetic retinopathy (DR) prevalence is higher in Indigenous Australians than in other Australians and is a major cause of vision loss. Consequently, timely screening and treatment is paramount, and annual eye screening is recommended for Indigenous Australians. To assess the prevalence of DR, reduced vision and DR treatment coverage among Indigenous Australian adults with diabetes attending Top End indigenous primary care health services. A cross‐sectional DR screening study conducted from November 2013 to December 2015 in two very remote Northern Territory Aboriginal primary healthcare services. In 287 subjects, the prevalence of non‐proliferative DR, proliferative DR and clinically significant diabetic macular oedema was 37.3%, 5.4% and 9.0% respectively. Treatment coverage for PDR was 60% (of 10 patients) and for CSMO was 17% (of 23 patients). Vision data were available from 122 participants at one site. The proportion with normal vision, reduced vision, impaired vision and blindness was 31.1%, 52.5%, 15.6% and 0.8% respectively. Overall, ungradable monocular image sets (46%) were associated with poorer quality images and missing protocol images (both P 0.001). Ungradable images for DR were associated with presence of small pupils/media opacities ( P 0.001). Ungradable images for diabetic macular oedema were associated with poorer image quality ( P 0.001), cataracts ( P 0.001) and small pupils ( P = 0.04). A high prevalence of DR, CSMO and impaired vision was noted in Indigenous Australians with diabetes. Screening in primary care is feasible, but more effective screening methods are needed.
Lessons learned from a periodontal intervention to reduce progression of chronic kidney disease among Aboriginal Australians
Publisher: Springer Science and Business Media LLC
Date: 15-10-2020
DOI: 10.1186/S13104-020-05317-6
Abstract: Periodontal disease is associated with chronic kidney disease (CKD), with both conditions being highly prevalent among Australia’s Aboriginal population. This paper reflects on the lessons learned following implementation of a periodontal intervention in the Central Australian region of the Northern Territory among Aboriginal adults with CKD. Between Oct 2016 and May 2019, research staff recruited 102 eligible participants. This was far below the anticipated recruitment rate. The challenges faced, and lessons learned, were conceptualised into five specific domains. These included: (1) insufficient engagement with the Aboriginal community and Aboriginal community-controlled organisations (2) an under-appreciation of the existing and competing patient commitments with respect to general health and wellbeing, and medical treatment to enable all study commitments (3) most study staff employed from outside the region (4) potential participants not having the required number of teeth (5) invasive intervention that involved travel to, and time at, a dental clinic. A more feasible research model, which addresses the ergent needs of participants, communities and service partners is required. This type of approach, with sufficient time and resourcing to ensure ongoing engagement, partnership and collaboration in co-design throughout the conduct of research, challenges current models of competitive, national research funding.
High Prevalence of Oral HPV Infection Among Indigenous Australians: An Observational Study
Publisher: Elsevier BV
Date: 2019
DOI: 10.2139/SSRN.3471347
Community Engagement and the Protection-Inclusion Dilemma
Publisher: Informa UK Limited
Date: 23-05-2023
Towards the development of a wellbeing model for Aboriginal and Torres Strait Islander peoples living with chronic disease
Publisher: Springer Science and Business Media LLC
Date: 15-09-2017
Disparities in acute in-hospital cardiovascular care for aboriginal and non-aboriginal South Australians
Publisher: AMPCo
Date: 09-2016
DOI: 10.5694/MJA16.00445
Abstract: To assess differences in the rates of angiography and subsequent revascularisation for Aboriginal and non-Aboriginal South Australians who presented with an acute coronary syndrome (ACS) to explore the reasons for any observed differences. Analysis of administrative data with logistic regression modelling to assess the relationship between Aboriginal status and the decision to undertake diagnostic angiography. A detailed medical record review of Aboriginal admissions was subsequently undertaken. Emergency ACS admissions to SA cardiac catheterisation hospitals, 2007-2012. 13 701 admissions of patients with an ACS, including 274 Aboriginal patients (2.1%). Rates of coronary angiography and revascularisation documentation of justification for non-invasive management. After adjustment for age, comorbidities and remoteness, Aboriginal patients presenting with an ACS were significantly less likely than non-Aboriginal patients to undergo angiography (odds ratio [OR], 0.4 95% CI, 0.3-0.5 P < 0.001). There was no significant difference in the rates of revascularisation for Aboriginal and non-Aboriginal patients who had undergone angiography. Reasons for Aboriginal patients not undergoing angiography included symptoms being deemed non-cardiac (16%), non-invasive test performed (8%), and discharge against medical advice (11%) the reasons were unclear for 36% of Aboriginal patients. After controlling for age and other factors, the rate of coronary angiography was lower among Aboriginal patients with an ACS in SA. The reasons for this disparity are complex, including patient-related factors and their preferences, as well as the appropriateness of the intervention. Improved consideration of the hospital experience of Aboriginal patients must be a priority for reducing health care disparities.
Associations with dental caries experience among a convenience sample of Aboriginal Australian adults
Publisher: Wiley
Date: 20-11-2015
DOI: 10.1111/ADJ.12256
Abstract: Few studies have examined dental caries experience in Aboriginal adults. The objectives of this study were to describe the dental caries experience of some Aboriginal Australian adults residing in the Northern Territory, and to determine associations with dental caries experience. A convenience s le of Aboriginal adults from Australia's Northern Territory was dentally examined. Self-reported oral health information was collected through a questionnaire. Data were available for 312 participants. The per cent of untreated decayed teeth (per cent DT >0) was 77.9 (95% CI 73.0 to 82.1), the mean DT was 3.0 (95% CI 2.6 to 3.4), the prevalence of any caries experience (the per cent DMFT >0) was 95.5 (95% CI 92.6 to 97.3) and the mean DMFT was 9.7 (95% CI 8.9 to 10.5). In multivariable analyses, unemployment and not brushing teeth the previous day were associated with the per cent DT >0. Problem-based dental attendance was associated with both the mean DT and the per cent DMFT >0. Older age, residing in the capital city, being non-incarcerated, last visiting a dentist <1 year ago and problem-based dental attendance were associated with the mean DMFT. Dental caries experience among this convenience s le of Aboriginal Australian adults was very high. Most factors associated with dental caries were social determinants or dental service access-related.
Periodontal disease and dental caries among Indigenous Australians living in the Northern Territory, Australia
Publisher: Wiley
Date: 04-02-2014
DOI: 10.1111/ADJ.12135
Abstract: The aim of this study was to describe the caries experience and severity of periodontal disease in a convenience s le of Indigenous Australians living in the Northern Territory. Data were gathered via self-reported questionnaire and dental examination by calibrated examiners. Socio-demographic characteristics were compared with data from the 2011 Australian census while prevalence of periodontal disease and dental caries was compared against weighted estimates from the National Survey of Adult Oral Health 2004-2006. In each comparison, non-overlapping 95% confidence intervals inferred a significant difference. Within-study comparisons were assessed via chi-square, t-tests and analysis of variance for differences among study participants. A total of 312 Indigenous Australian participants provided completed data (average age 39.5 ± 10.5 years, 174 males). Of these, 87.5% were confirmed periodontitis cases 3.5 times that of national-level estimates. The experience of untreated caries was five times that of national estimates (mean decayed 3.0 versus 0.6). Periodontitis case status was positively associated with older age, male gender and presence of diabetes. Periodontal disease and untreated caries were significantly more prevalent in this s le of Indigenous Australians compared to the general Australian population. The prevalence of periodontal disease was markedly higher than that previously described for Indigenous Australians.
Epidemiology of Atrial Fibrillation: The Australian and Asia-Pacific Perspective
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.HLC.2017.05.120
Abstract: The epidemic of atrial fibrillation (AF) is increasingly recognised as a growing health problem worldwide. Although epidemiological studies on AF in the Asia-Pacific region are scarce, given the increasing age and size of populations in this region, the burden of AF is expected to be far greater than in North America and Europe. This is not only due to the growing, ageing population but also an increased incidence of risk factors for AF, such as hypertension, obesity, metabolic syndrome and diabetes, in the Asia-Pacific region. While further, high quality data on such aspects as risk factors, racial disparities and clinical implications is urgently required, there is an immediate need for increased focus on appropriate stroke prophylaxis and risk factor management to minimise the clinical complications and societal burden of AF.
Our journey, our story: a study protocol for the evaluation of a co-design framework to improve services for Aboriginal youth mental health and well-being
Publisher: BMJ
Date: 05-2021
DOI: 10.1136/BMJOPEN-2020-042981
Abstract: Mainstream Australian mental health services are failing Aboriginal young people. Despite investing resources, improvements in well-being have not materialised. Culturally and age appropriate ways of working are needed to improve service access and responsiveness. This Aboriginal-led study brings Aboriginal Elders, young people and youth mental health service staff together to build relationships to co-design service models and evaluation tools. Currently, three Western Australian youth mental health services in the Perth metropolitan area and two regional services are working with local Elders and young people to improve their capacity for culturally and age appropriate services. Further Western Australian sites will be engaged as part of research translation. Relationships ground the study, which utilises Indigenous methodologies and participatory action research. This involves Elders, young people and service staff as co-researchers and the application of a decolonising, strengths-based framework to create the conditions for engagement. It foregrounds experiential learning and Aboriginal ways of working to establish relationships and deepen non-Aboriginal co-researchers’ knowledge and understanding of local, place-based cultural practices. Once relationships are developed, co-design workshops occur at each site directed by local Elders and young people. Co-designed evaluation tools will assess any changes to community perceptions of youth mental health services and the enablers and barriers to service engagement. The study has approval from the Kimberley Aboriginal Health Planning Forum Kimberley Research Subcommittee, the Western Australian Aboriginal Health Ethics Committee, and the Curtin University Human Research Ethics Committee. Transferability of the outcomes across the youth mental health sector will be directed by the co-researchers and is supported through Aboriginal and non-Aboriginal organisations including youth mental health services, peak mental health bodies and consumer groups. Community reports and events, peer-reviewed journal articles, conference presentations and social and mainstream media will aid dissemination.
Birth outcomes in women with gestational diabetes managed by lifestyle modification alone: The PANDORA study
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.DIABRES.2019.107876
Abstract: To assess outcomes of women in the Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) cohort with gestational diabetes mellitus (GDM) managed by lifestyle modification compared with women without hyperglycaemia in pregnancy. Indigenous (n = 97) and Europid (n = 113) women managed by lifestyle modification were compared to women without hyperglycaemia (n = 235). Multivariate linear and logistic regressions assessed whether GDM-lifestyle women had poorer outcomes compared to women without hyperglycaemia. Women with GDM-lifestyle had higher body mass index and lower gestational weight gain than women without hyperglycaemia. On univariate analysis, gestational age at delivery was lower and induction rates were higher in women with GDM-lifestyle than without hyperglycaemia. On multivariable regression, GDM-lifestyle was associated with lower gestational age at delivery (by 0.73 weeks), lower birthweight z-score (by 0.26, p = 0.007), lower likelihood of large for gestational age (LGA) [OR (95% CI): 0.55 (0.28, 1.02), p = 0.059], and greater likelihood of labour induction [2.34 (1.49, 3.66), p < 0.001] than women without hyperglycaemia. Women with GDM managed by lifestyle modification had higher induction rates and their offspring had lower birthweight z-scores, with a trend to lower LGA than those without hyperglycaemia in pregnancy. Further studies are indicated to explore reasons for higher induction rates.
Examining adherence to activity monitoring devices to improve physical activity in adults with cardiovascular disease: A systematic review
Publisher: Oxford University Press (OUP)
Date: 15-10-2018
Abstract: Activity monitoring devices are currently being used to facilitate and monitor physical activity. No prior review has examined adherence to the use of activity monitoring devices amongst adults with cardiovascular disease. Literature from June 2012 to October 2017 was evaluated to examine the extent of adherence to any activity monitoring device used to collect objective physical activity data. Randomized control trials comparing usual care against the use of an activity monitoring device, in a community intervention for adults from any cardiovascular diagnostic group, were included. A systematic search of databases and clinical trials registers was conducted using Joanna Briggs Institute methodology. Of 10 eligible studies, two studies reported pedometer use and eight accelerometer use. Six studies addressed the primary outcome. Mean adherence was 59.1% (range 39.6% to 85.7%) at last follow-up. Studies lacked equal representation by gender (28.6% female) and age (range 42 to 82 years). This review indicates that current research on activity monitoring devices may be overstated due to the variability in adherence. Results showed that physical activity tracking in women and in young adults have been understudied.
Do competing demands of physical illness in type 2 diabetes influence depression screening, documentation and management in primary care: a cross-sectional analytic study in Aboriginal and Torres Stra
Publisher: Springer Science and Business Media LLC
Date: 06-06-2013
Overview: The 2nd Indigenous Cardiovascular Health Conference of the Cardiac Society of Australia and New Zealand
Publisher: Elsevier BV
Date: 10-2012
DOI: 10.1016/J.HLC.2012.07.001
Abstract: Recent years have seen the Cardiac Society of Australia and New Zealand (CSANZ) focus its attention on improving outcomes for Indigenous people within Australia and New Zealand. The most visible of these activities has been the convening of conferences devoted specifically to understanding and overcoming the burden of cardiovascular disparities experienced by Aboriginal and Torres Strait Islanders within Australia and Maori and Pacific Islander populations within New Zealand. Following from the success of the first meeting, the second was held in Alice Springs in 2011. Alongside plenary sessions discussing primary prevention, improved care, secondary prevention and the social and cultural determinants of cardiovascular diseases (CVD), targeted workshops outlined the issues and priority activities for the CSANZ into the future. These included discussion of Workforce, Improving Chronic Care, Reducing the burden of Rheumatic Heart Disease and Reducing Disparities in Hospital Care.
The Keeping on Track Study: Exploring the Activity Levels and Utilization of Healthcare Services of Acute Coronary Syndrome (ACS) Patients in the First 30-Days after Discharge from Hospital
Publisher: MDPI AG
Date: 19-04-2019
Abstract: The aim of this study was to investigate the impact of bedside discharge education on activity levels and healthcare utilization for patients with acute coronary syndrome (ACS) in the first 30 days post-discharge. Knowledge recall and objective activity and location data were collected by global positioning systems (GPS). Participants were asked to carry the tracking applications (apps) for 30–90 days. Eighteen participants were recruited (6 metropolitan 12 rural) 61% ST elevation myocardial infarction (STEMI), mean age 55 years, 83% male. Recall of discharge education included knowledge of diagnosis (recall = 100%), procedures (e.g., angiogram = 40%), and comorbidities (e.g., hypertension = 60%, diabetes = 100%). In the first 30 days post-discharge, median steps per day was 2506 (standard deviation (SD) ± 369) steps (one participant completed 10,000 steps), 62% visited a general practitioner (GP) 16% attended cardiac rehabilitation, 16% visited a cardiologist, 72% a pharmacist, 27% visited the emergency department for cardiac event, and 61% a pathology service (blood tests). Adherence to using the activity tracking apps was 87%. Managing Big Data from the GPS and physical activity tracking apps was a challenge with over 300,000 lines of raw data cleaned to 90,000 data points for analysis. This study was an ex le of the application of objective data from the real world to help understand post-ACS discharge patient activity. Rates of access to services in the first 30 days continue to be of concern.
HPV and Oropharyngeal Cancer among Indigenous Australians: Study Protocol
Publisher: JMIR Publications Inc.
Date: 25-03-2018
An Aboriginal‐led consortium approach to chronic disease action for health equity and holistic wellbeing
Publisher: Wiley
Date: 29-06-2023
DOI: 10.1002/HPJA.765
Abstract: The Wellbeing Economy, which places human and ecological wellbeing at the centre of policy making, aligns with holistic Aboriginal and Torres Strait Islander conceptualisations of health and wellbeing. In order to address chronic diseases in South Australian Aboriginal and Torres Strait Islander populations, the South Australian Aboriginal Chronic Disease Consortium (Consortium) is fostering action in ways that align both with the Wellbeing Economy and with Health in All Policies (HiAP) approaches. In June 2017, the Consortium was established as a collaborative partnership between government and non‐government organisations, researchers, Aboriginal organisations and communities to lead the effective implementation of three state‐wide chronic disease plans. A coordinating centre was funded to support and progress the work of the Consortium. During its first 5 years, the Consortium has developed a foundation for sustained system reform through partnering with stakeholders, leading projects and initiatives, advocating for key priorities, leveraging existing infrastructure and funding, supporting services, and coordinating delivery of priority actions using innovative approaches. Through the Consortium governance structure, Aboriginal and Torres Strait Islander community members, policy actors, service providers and researchers oversee, drive, influence and support the implementation of priority action initiatives. Sustained funding, competing priorities of partner organisations and project evaluation are constant challenges. A consortium approach provides direction and shared priorities, which foster collaboration across and between organisations, service providers and the Aboriginal community. Aligning with HiAP approaches and the Wellbeing Economy, it harnesses knowledge, networks and partnerships that support project implementation and reduce duplication.
Rheumatic Fever Follow-Up Study (RhFFUS) protocol: A cohort study investigating the significance of minor echocardiographic abnormalities in Aboriginal Australian and Torres Strait Islander children
Publisher: Springer Science and Business Media LLC
Date: 27-11-2012
Utility of auscultatory screening for detecting rheumatic heart disease in high-risk children in Australia's Northern Territory
Publisher: AMPCo
Date: 08-2013
DOI: 10.5694/MJA13.10520
Abstract: To evaluate the utility of auscultatory screening for detecting echocardiographically confirmed rheumatic heart disease (RHD) in high-risk children in the Northern Territory, Australia. Cross-sectional screening survey. Twelve rural and remote communities in the NT between September 2008 and June 2010. 1015 predominantly Indigenous schoolchildren aged 5-15 2013s. All children underwent transthoracic echocardiography, using a portable cardiovascular ultrasound machine, and cardiac auscultation by a doctor and a nurse. Sonographers and auscultators were blinded to each others' findings and the clinical history of the children. Echocardiograms were reported offsite, using a standardised protocol, by cardiologists who were also blinded to the clinical findings. Presence of a cardiac murmur as identified by nurses (any murmur) and doctors (any murmur, and "suspicious" or "pathological" murmurs), compared with echocardiogram findings. RHD was defined according to the 2012 World Heart Federation criteria for echocardiographic diagnosis of RHD. Of the 1015 children screened, 34 (3.3%) had abnormalities identified on their echocardiogram 24 met echocardiographic criteria for definite or borderline RHD, and 10 had isolated congenital anomalies. Detection of any murmur by a nurse had a sensitivity of 47.1%, specificity of 74.8% and positive predictive value (PPV) of 6.1%. Doctor identification of any murmur had 38.2% sensitivity, 75.1% specificity and 5.1% PPV, and the corresponding values for doctor detection of suspicious or pathological murmurs were 20.6%, 92.2% and 8.3%. For all auscultation approaches, negative predictive value was more than 97%, but the majority of participants with cardiac abnormalities were not identified. The results were no different when only definite RHD and congenital abnormalities were considered as true cases. Sensitivity and positive predictive value of cardiac auscultation compared with echocardiography is poor, regardless of the expertise of the auscultator. Although negative predictive value is high, most cases of heart disease were missed by auscultation, suggesting that cardiac auscultation should no longer be used to screen for RHD in high-risk schoolchildren in Australia.
Smoke and mirrors: unanswered questions and misleading statements obscure the truth about organ sources in China.
Publisher: BMJ
Date: 04-05-2016
DOI: 10.1136/MEDETHICS-2016-103533
Abstract: This response refutes the claim made in a recent article that organs for transplantation in China will no longer be sourced from executed prisoners. We identify ongoing ethical problems due to the lack of transparent data on current numbers of transplants in China implausible and conflicting claims about voluntary donations and obfuscation about who counts as a voluntary donor. The big unanswered question in Chinese transplant ethics is the source of organs, and until there is an open and independently audited system in China, legitimate concerns remain about organ harvesting from prisoners of conscience.
Cancer treatment and the risk of cancer death among Aboriginal and non-Aboriginal South Australians
Publisher: Springer Science and Business Media LLC
Date: 29-10-2019
DOI: 10.1186/S12913-019-4534-Y
Abstract: Aboriginal and Torres Strait Islander Australians have poorer cancer outcomes than other Australians. Comparatively little is known of the type and amount of cancer treatment provided to Aboriginal and Torres Strait Islander people and the consequences for cancer survival. This study quantifies the influence of surgical, systemic and radiotherapy treatment on risk of cancer death among matched cohorts of cancer cases and, the comparative exposure of cohorts to these treatments. Cancers registered among Aboriginal South Australians in 1990–2010 ( N = 777) were matched with randomly selected non-Indigenous cases by sex, birth and diagnostic year, and primary site, then linked to administrative cancer treatment for the period from 2 months before to 13 months after diagnosis. Competing risk regression summarised associations of Indigenous status, geographic remoteness, comorbidities, cancer stage and treatment exposure with risk of cancer death. Fewer Aboriginal cases had localised disease at diagnosis (37.2% versus 50.2%) and they were less likely to: experience hospitalisation with cancer diagnosis, unadjusted odds ratio (UOR) = 0.76 95%CI = 0.59–0.98 have surgery UOR = 0.65 95%CI = 0.53–0.80 systemic therapies UOR = 0.64 95%CI = 0.52–0.78 or radiotherapy, UOR = 0.76 95%CI = 0.63–0.94. Localised disease carried lower risk of cancer death compared to advanced cases receiving surgery or systemic therapies, SHR = 0.34 95%CI = 0.25–0.47 and SHR = 0.35 95%CI = 0.25–0.48. Advanced disease and no treatment carried higher risk of cancer death, SHR = 1.82 95%CI = 1.26–2.63. The effects of treatment did not differ between Aboriginal and non-Indigenous cohorts. However, comparatively less exposure to surgical and systemic treatments among Aboriginal cancer cases further complicated the disadvantages associated with geographic remoteness, advanced stage of disease and co-morbid conditions at diagnosis and add to disparities in cancer death. System level responses to improving access, utilisation and quality of effective treatments are needed to improve survival after cancer diagnosis.
Exploring clinical predictors of cardiovascular disease in a central Australian Aboriginal cohort.
Publisher: Oxford University Press (OUP)
Date: 24-01-2013
Abstract: For Aboriginal populations, predicting in iduals at risk of cardiovascular disease (CVD) is difficult due to limitations and inaccuracy in existing risk-prediction algorithms. We examined conventional and novel risk factors associated with insulin resistance and the metabolic syndrome and assessed their relationships with subsequent CVD events. Longitudinal cohort. Aboriginal people (n = 739) from Central Australia completed population-based risk-factor surveys in 1995 and were followed up in 2005. Principal components analysis (PCA), regression and univariate analyses (using ROC defined cut-off points) were used to identify useful clinical predictors of primary CVD. PCA yielded five components: (1) lipids and liver function (2) insulin resistance (3) blood pressure and kidney function (4) glucose tolerance and (5) anti-inflammatory (low fibrinogen, high HDL cholesterol). Components 2, 3 and 4, and age were significant independent predictors of incident CVD, and smoking approached significance. In univariate analysis fasting glucose ≥ 4.8 mmol/l, total:HDL cholesterol ratio ≥ 5.7, non-HDL cholesterol ≥ 4.3 mmol/l, gamma-glutamyl transferase ≥ 70 U/l, albumin creatinine ratio ≥ 5.7 mg/mmol, systolic blood pressure ≥ 120 mmHg and diastolic blood pressure ≥ 70 mmHg were useful predictors of CVD. The co-occurrence of three or more risk variables (fasting glucose ≥ 4.8 mmol/l, total:HDL cholesterol ratio ≥ 5.7, blood pressure (systolic ≥ 120 mmHg diastolic ≥ 70 mmHg albumin:creatinine ratio ≥ 5.7 mg/mmol and smoking) had sensitivity of 82.0% and specificity of 59.9% for predicting incident CVD. Age is the strongest predictor of CVD for this population. For clinical identification of in iduals at high risk, screening for the combination of three or more of hyperglycaemia, dyslipidaemia, hypertension, albuminuria and smoking may prove a useful and efficient strategy.
PCSK9 Inhibitors in Hyperlipidemia: Current Status and Clinical Outlook
Publisher: Springer Science and Business Media LLC
Date: 19-04-2017
DOI: 10.1007/S40259-017-0220-Y
Abstract: The clinical reality of residual risk despite statin (HMG-CoA reductase inhibitor) therapy and emergence of statin intolerance support the need to develop additional lipid-lowering strategies. Proprotein convertase subtilisin kexin type 9 (PCSK9) has received considerable attention by virtue of genetic and clinical studies that have revealed its pivotal role in the regulation of cholesterol homeostasis. Monoclonal antibodies have been developed targeting PCSK9, which have been demonstrated to produce profound low-density lipoprotein cholesterol (LDL-C) lowering when provided as monotherapy or in combination with statins. With the reports that the PCSK9 inhibitor evolocumab has a favorable impact on both plaque progression and cardiovascular outcomes, these findings begin to translate the benefits of PCSK9 inhibition from lipids to the vessel wall and ultimately to clinical outcomes. The clinical implications for the use of these agents are reviewed in this article.
Indigenous peoples and inclusion in clinical and genomic research: Understanding the history and navigating contemporary engagement
Publisher: Elsevier BV
Date: 03-2023
Overcoming cardiovascular disease in Indigenous Australians
Publisher: AMPCo
Date: 2017
DOI: 10.5694/MJA16.00693
A review of outcome following valve surgery for rheumatic heart disease in Australia
Publisher: Springer Science and Business Media LLC
Date: 23-09-2015
Men, hearts and minds: developing and piloting culturally specific psychometric tools assessing psychosocial stress and depression in central Australian Aboriginal men
Publisher: Springer Science and Business Media LLC
Date: 02-08-2015
DOI: 10.1007/S00127-015-1100-8
Abstract: The health inequalities experienced by Aboriginal and Torres Strait Islander Australians are well documented but there are few empirical data outlining the burden, consequences, experience and expression of depressive illness. This paper seeks to address the lack of accessible, culturally specific measures of psychosocial stress, depression or quality of life developed for, and validated within, this population. Building on an extensive qualitative phase of research, a psychosocial questionnaire comprising novel and adapted scales was developed and piloted with 189 Aboriginal men across urban and remote settings in central Australia. With a view to refining this tool for future use, its underlying structure was assessed using exploratory factor analysis, and the predictive ability of the emergent psychosocial constructs assessed with respect to depressive symptomatology. The latent structure of the psychosocial questionnaire was conceptually aligned with the components of the a priori model on which the questionnaire was based. Regression modelling indicated that depressive symptoms were driven by a sense of injury and chronic stress and had a non-linear association with socioeconomic position. This represents the first community-based survey of psychosocial stress and depression in Aboriginal men. It provides both knowledge of, and an appropriate process for, the further development of psychometric tools, including quality of life, in this population. Further research with larger and more erse s les of Aboriginal people is required to refine the measurement of key constructs such as chronic stress, socioeconomic position, social support and connectedness. The further refinement, validation against criterion-based methods and incorporation within primary care services is essential.
Outcome following valve surgery in Australia: development of an enhanced database module
Publisher: Springer Science and Business Media LLC
Date: 17-01-2017
Mental Health and Psychosocial Challenges in the COVID-19 Pandemic: Food for Thought for Cardiovascular Health Care Professionals
Publisher: Elsevier BV
Date: 07-2020
Prioritizing Built Environmental Factors to Tackle Chronic and Infectious Diseases in Remote Northern Territory (NT) Communities of Australia: A Concept Mapping Study
Publisher: MDPI AG
Date: 13-05-2021
Abstract: High prevalence of chronic and infectious diseases in Indigenous populations is a major public health concern both in global and Australian contexts. Limited research has examined the role of built environments in relation to Indigenous health in remote Australia. This study engaged stakeholders to understand their perceptions of the influence of built environmental factors on chronic and infectious diseases in remote Northern Territory (NT) communities. A preliminary set of 1120 built environmental indicators were systematically identified and classified using an Indigenous Indicator Classification System. The public and environmental health workforce was engaged to consolidate the classified indicators (n = 84), and then sort and rate the consolidated indicators based on their experience with living and working in remote NT communities. Sorting of the indicators resulted in a concept map with nine built environmental domains. Essential services and Facilities for health/safety were the highest ranked domains for both chronic and infectious diseases. Within these domains, adequate housing infrastructure, water supply, drainage system, reliable sewerage and power infrastructure, and access to health services were identified as the most important contributors to the development of these diseases. The findings highlight the features of community environments amenable to public health and social policy actions that could be targeted to help reduce prevalence of chronic and infectious diseases.
Rural and Remote Cardiology During the COVID-19 Pandemic: Cardiac Society of Australia and New Zealand (CSANZ) Consensus Statement
Publisher: Elsevier BV
Date: 07-2020
The Diagnosis and Management of Chronic Rheumatic Heart Disease—An Australian Guideline
Publisher: Elsevier BV
Date: 08-2008
Factors influencing health care utilisation among Aboriginal cardiac patients in central Australia: A qualitative study
Publisher: Springer Science and Business Media LLC
Date: 06-03-2013
Abstract: Aboriginal Australians suffer from poorer overall health compared to the general Australian population, particularly in terms of cardiovascular disease and prognosis following a cardiac event. Despite such disparities, Aboriginal Australians utilise health care services at much lower rates than the general population. Improving health care utilisation (HCU) among Aboriginal cardiac patients requires a better understanding of the factors that constrain or facilitate use. The study aimed to identify ecological factors influencing health care utilisation (HCU) for Aboriginal cardiac patients, from the time of their cardiac event to 6–12 months post-event, in central Australia. This qualitative descriptive study was guided by an ecological framework . A culturally-sensitive illness narrative focusing on Aboriginal cardiac patients’ “typical” journey guided focus groups and semi-structured interviews with Aboriginal cardiac patients, non-cardiac community members, health care providers and community researchers. Analysis utilised a thematic conceptual matrix and mixed coding method. Themes were categorised into Predisposing, Enabling, Need and Reinforcing factors and identified at In idual, Interpersonal, Primary Care and Hospital System levels. Compelling barriers to HCU identified at the Primary Care and Hospital System levels included communication, organisation and racism. In idual level factors related to HCU included language, knowledge of illness, perceived need and past experiences. Given these in idual and health system barriers patients were reliant on utilising alternate family-level supports at the Interpersonal level to enable their journey. Aboriginal cardiac patients face significant barriers to HCU, resulting in sub-optimal quality of care, placing them at risk for subsequent cardiovascular events and negative health outcomes. To facilitate HCU amongst Aboriginal people, strategies must be implemented to improve communication on all levels and reduce systemic barriers operating within the health system.
Randomised clinical trial using Coronary Artery Calcium Scoring in Australian Women with Novel Cardiovascular Risk Factors (CAC-WOMEN Trial): study protocol
Publisher: BMJ
Date: 12-2022
DOI: 10.1136/BMJOPEN-2022-062685
Abstract: Cardiovascular disease (CVD) is the leading cause of death in women around the world. Aboriginal and Torres Strait Islander women (Australian Indigenous women) have a high burden of CVD, occurring on average 10–20 years earlier than non-Indigenous women. Traditional risk prediction tools (eg, Framingham) underpredict CVD risk in women and Indigenous people and do not consider female-specific ‘risk-enhancers’ such as hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM) and premature menopause. A CT coronary artery calcium score (‘CT-calcium score’) can detect calcified atherosclerotic plaque well before the onset of symptoms, being the single best predictor for future cardiac events. A CT-calcium score may therefore help physicians intensify medical therapy in women with risk-enhancing factors. This multisite, single-blind randomised (1:1) controlled trial of 700 women will assess the effectiveness of a CT-calcium score-guided approach on cardiovascular risk factor control and healthy lifestyle adherence, compared with standard care. Women without CVD aged 40–65 (35–65 for Aboriginal and Torres Strait Islander women) at low-intermediate risk on standard risk calculators and with at least one risk-enhancing factor (eg, HDP, GDM, premature menopause) will be recruited. Aboriginal and Torres Strait Islander women will be actively recruited, aiming for ~10% of the s le size. The 6-month coprimary outcomes will be low-density lipoprotein cholesterol and systolic blood pressure. Barriers and enablers will be assessed, and a health economic analysis performed. Western Sydney Local Health District Research Ethics Committee (HREC 2021/ETH11250) provided ethics approval. Written informed consent will be obtained before randomisation. Consent will be sought for access to in idual participant Medicare Benefits Schedule, Pharmaceutical Benefits Scheme claims usage through Medicare Australia and linked Admitted Patient Data Collection. Study results will be disseminated via peer-reviewed publications and presentations at national and international conferences. ACTRN12621001738819p.
Medical Management of Rheumatic Heart Disease: A Systematic Review of the Evidence
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2018
Understanding the utilization of primary health care services by Indigenous men: a systematic review
Publisher: Springer Science and Business Media LLC
Date: 23-10-2018
Contribution of cardiometabolic risk factors to estimated glomerular filtration rate decline in I ndigenous A ustralians with and without albuminuria ‐ the eGFR Follow‐up Study
Publisher: Wiley
Date: 07-2018
DOI: 10.1111/NEP.13073
Abstract: We assessed associations between cardiometabolic risk factors and estimated glomerular filtration rate (eGFR) decline according to baseline albuminuria to identify potential treatment targets in Indigenous Australians. The eGFR Follow-up Study is a longitudinal cohort of 520 Indigenous Australians. Linear regression was used to estimate associations between baseline cardiometabolic risk factors and annual Chronic Kidney Disease Epidemiology Collaboration eGFR change (mL/min per 1.73m After a median of 3 years follow-up, progressive declines of the age- and sex-adjusted mean eGFR were observed across albuminuria categories (-2.0 [-2.6 to -1.4], -2.5 [-3.7 to -1.3] and -6.3 [-7.8 to -4.9] mL/min per 1.72m Over a 3 year period, marked eGFR decline was observed with greater baseline albuminuria. Cardiometabolic risk factors were not strong predictors for eGFR decline in Indigenous Australians without albuminuria. Longer follow-up may elucidate the role of these predictors and other mechanisms in chronic kidney disease progression in this population.
Atrial fibrillation in Indigenous and non-Indigenous Australians: A cross-sectional study
Publisher: BMJ
Date: 10-2014
DOI: 10.1136/BMJOPEN-2014-006242
Abstract: To examine the prevalence of atrial fibrillation (AF) and cardiac structural characteristics in Indigenous and non-Indigenous Australians. Retrospective cross-sectional study linking clinical, echocardiography and administrative databases over a 10-year period. A tertiary, university teaching hospital in Adelaide, Australia. Indigenous and non-Indigenous Australians. AF prevalence and echocardiographic characteristics. Indigenous Australians with AF were significantly younger compared to non-Indigenous Australians (55±13 vs 75±13 years, p .001). As a result, racial differences in AF prevalence and left atrial diameter varied according to age. In those under 60 years of age, Indigenous Australians had a significantly greater AF prevalence (2.57 vs1.73%, p .001) and left atrial diameters (39±7 vs 37±7 mm, p .001) compared to non-Indigenous Australians. In those aged 60 years and above, however, non-Indigenous Australians had significantly greater AF prevalence (9.26 vs 4.61%, p .001) and left atrial diameters (39±7 vs 37±7 mm, p .001). Left ventricular ejection fractions were less in Indigenous Australians under 60 years of age (49±14 vs 55±11%, p .001) and not statistically different in those aged 60 years and above (47±11 vs 52±13, p=0.074) compared to non-Indigenous Australians. Despite their younger age, Indigenous Australians with AF had similar or greater rates of cardiovascular comorbidities than non-Indigenous Australians with AF. Young Indigenous Australians have a significantly greater prevalence of AF than their non-Indigenous counterparts. In contrast, older non-Indigenous Australians have a greater prevalence of AF compared to their Indigenous counterparts. These observations may be mediated by age-based differences in comorbid cardiovascular conditions, left atrial diameter and left ventricular ejection fraction. Our findings suggest that AF is likely to be contributing to the greater burden of morbidity and mortality experienced by young Indigenous Australians. Further study is required to elucidate whether strategies to prevent and better manage AF in Indigenous Australians may reduce this burden.
Effective primary care management of type 2 diabetes for indigenous populations: A systematic review.
Publisher: Public Library of Science (PLoS)
Date: 10-11-2022
DOI: 10.1371/JOURNAL.PONE.0276396
Abstract: Indigenous peoples in high income countries are disproportionately affected by Type 2 Diabetes. Socioeconomic disadvantages and inadequate access to appropriate healthcare are important contributors. This systematic review investigates effective designs of primary care management of Type 2 Diabetes for Indigenous adults in Australia, Canada, New Zealand, and the United States. Primary outcome was change in mean glycated haemoglobin. Secondary outcomes were diabetes-related hospital admission rates, treatment compliance, and change in weight or Body Mass Index. Included studies were critically appraised using Joanna Briggs Institute appraisal checklists. A mixed-method systematic review was undertaken. Quantitative findings were compared by narrative synthesis, meta-aggregation of qualitative factors was performed. Seven studies were included. Three reported statistically significant reductions in means HbA1c following their intervention. Seven components of effective interventions were identified. These were: a need to reduce health system barriers to facilitate access to primary care (which the other six components work towards), an essential role for Indigenous community consultation in intervention planning and implementation, a need for primary care programs to account for and adapt to changes with time in barriers to primary care posed by the health system and community members, the key role of community-based health workers, Indigenous empowerment to facilitate community and self-management, benefit of short-intensive programs, and benefit of group-based programs. This study synthesises a decade of data from communities with a high burden of Type 2 Diabetes and limited research regarding health system approaches to improve diabetes-related outcomes. Policymakers should consider applying the seven identified components of effective primary care interventions when designing primary care approaches to mitigate the impact of Type 2 Diabetes in Indigenous populations. More robust and culturally appropriate studies of Type 2 Diabetes management in Indigenous groups are needed. Registered with PROSPERO (02/04/2021: CRD42021240098 ).
“Anybody can make kids; it takes a real man to look after your kids”
Publisher: Public Library of Science (PLoS)
Date: 22-11-2019
The Design and Rationale of the Australian Cooperative National Registry of Acute Coronary care, Guideline Adherence and Clinical Events (CONCORDANCE)
Publisher: Elsevier BV
Date: 07-2013
DOI: 10.1016/J.HLC.2012.12.013
Abstract: Cardiovascular observational registries characterise patients and describe the manner and use of therapeutic strategies. They facilitate analyses on the quality of care among participating institutions and document variations in clinical practice which can be benchmarked against best practice recommendations. The Cooperative National Registry of Acute Coronary care, Guideline Adherence and Clinical Events (CONCORDANCE) is an Australian observational registry that describes management and outcomes in patients with acute coronary syndromes (ACS) and feeds back both performance and outcome measures to participating hospitals. The CONCORDANCE registry has been designed within a comparative effectiveness research (CER) framework to collect and report data from hospitals located in geographically erse regions of Australia. Information including patient demographics, presenting characteristics, past medical history, in-hospital management and outcomes at six months and two years are entered into a web-based database using an electronic clinical record form (eCRF). In idual hospital information is returned to the sites in a real time confidential report detailing information on key performance indicator (KPI) process measures and outcomes benchmarked against the aggregated study cohort. Governance rules ensure data security and protect patient and clinician confidentiality. Consistent with a CER framework, additional characteristics of the registry include: (a) the capacity to evaluate associations between the inter and intra hospital systems and the provision of evidence based care and outcomes, (b) ongoing data collection from representative hospitals which allow spatial and temporal analysis of change in practice and the application of treatment modalities in the real world setting and (c) the provision of a data spine for quality improvement strategies and practical clinical trials. The CONCORDANCE registry is a clinician-driven initiative describing clinical care for ACS patients admitted to Australian hospitals. The registry generates high quality data which is fed back to clinicians, and key stakeholders in ACS care. Using a CER approach, the registry describes the translation of randomised trial evidence into practice, and provides insights into strategies that could improve care and ultimately patient outcomes.
Youth-onset type 2 diabetes among First Nations young people in northern Australia
Publisher: Elsevier BV
Date: 2022
Hazardous and harmful alcohol use in the Northern Territory, Australia: the impact of alcohol policy on critical care admissions using an extended sampling period
Publisher: Wiley
Date: 23-04-2021
DOI: 10.1111/ADD.15432
Abstract: To describe the effect of alcohol policy on the incidence of intensive care unit (ICU) admissions associated with hazardous and harmful alcohol use in the Northern Territory (NT) of Australia Before and after analysis of admissions to NT ICUs between April 2018 and September 2019, extending on both a descriptive study describing hazardous and harmful alcohol use and single‐centre analyses of harm minimization policies. After exclusions, 2281 (83%) admissions were analysed, 20.3% of which were associated with hazardous and harmful alcohol use. Primary outcome was the incidence of admissions associated with hazardous and harmful alcohol use in the 5 months preceding (baseline period) the introduction of new alcohol policies [full‐time stationing of Police Auxiliary Liquor Inspectors (PALIs) and minimum unit price (MUP)] compared with 12 months (post‐intervention) following. Secondary outcomes included measures of resource use [length of stay (LoS), need for mechanical ventilation] and mortality, stratified by site. Overall, there was a 4.5% [95% confidence interval (CI) = 0.8–8.2%] absolute risk reduction between the time‐periods (95% CI = 23.4 versus 18.9% for baseline and post‐intervention, respectively, P = 0.01), predominantly due to a reduction in admissions associated with acute misuse (2.3%, 95% CI = −0.2 to 4.9% risk reduction, P = 0.06). There were regional differences, with a more marked relative risk reduction observed in Central Australia compared with the city of Darwin (27.0 versus 16.7% relative risk reduction, respectively). Introduction of new alcohol harm minimization policies in the Northern Territory of Australia appears to have reduced the number of intensive care unit admissions associated with hazardous and harmful alcohol use. Strength of effect varies by geographical region and chronicity of hazardous and harmful alcohol use.
Depression and diabetes: treatment and health-care delivery
Publisher: Elsevier BV
Date: 06-2015
Apparent Contrasting Rates of Pharyngitis and Pyoderma in Regions where Rheumatic Heart Disease is Highly Prevalent
Publisher: Elsevier BV
Date: 08-2007
DOI: 10.1016/J.HLC.2007.02.087
Abstract: The aim of the study was to describe the epidemiology of pharyngitis and pyoderma in a Central Australian Aboriginal community with a high prevalence of rheumatic heart disease (RHD) and compare it to communities in the Top End of the Northern Territory. Following ethics approval and community consultation, selected households were enrolled and visited over a 13-month period. People were asked if they had a sore throat and/or skin sores and asked about current or recent use of antibiotics all throats and any pyoderma lesions were swabbed for bacterial culture. Beta-haemolytic streptococci (BHS), including group A streptococcus (GAS), were identified in the central laboratory using standard methods. Household crowding was also assessed. Results were then compared to those from the Top End study. Sore throat was relatively common (480 episodes per 100 person years), although there was only one case of GAS pharyngitis in 326 consultations. Only 5.5% of children <15 years had pyoderma during the course of the study. This is the opposite picture to that reported in the Top End where symptomatic pharyngitis is rare and pyoderma is common. Although the data are limited, the epidemiology of pharyngitis and pyoderma in this Central Australian Aboriginal community appears to be more akin to that seen in temperate climates rather than tropical Top End communities. In this community, RHD preventative measure should continue to include aggressive treatment of pharyngitis according to recommendations.
Chronic kidney disease and socio-economic status: a cross sectional study
Publisher: Informa UK Limited
Date: 31-10-2017
More than dirt: Sedimentary ancient DNA and Indigenous Australia
Publisher: Wiley
Date: 12-07-2023
Abstract: The rise of sedimentary ancient DNA (sedaDNA) studies has opened new possibilities for studying past environments. This groundbreaking area of genomics uses sediments to identify organisms, even in cases where macroscopic remains no longer exist. Managing this substrate in Indigenous Australian contexts, however, requires special considerations. Sediments and soils are often considered as waste by‐products during archaeological and paleontological excavations and are not typically regulated by the same ethics guidelines utilised in mainstream ‘western’ research paradigms. Nevertheless, the product of sedaDNA work—genetic information from past fauna, flora, microbial communities and human ancestors—is likely to be of cultural significance and value for Indigenous peoples. This article offers an opinion on the responsibilities of researchers in Australia who engage in research related to this emerging field, particularly when it involves Indigenous communities. One aspect that deserves consideration in such research is the concept of benefit sharing. Benefit sharing refers to the practice of ensuring that the benefits that arise from research are shared equitably with the communities from which the research data were derived. This practice is particularly relevant in research that involves Indigenous communities, who may have unique cultural and spiritual connections to the research material. We argue that the integration of Traditional Knowledges into sedaDNA research would add enormous value to research and its outcomes by providing genomic outputs alongside and within the rich context of multimillennia oral histories.
Equitable Expanded Carrier Screening Needs Indigenous Clinical and Population Genomic Data
Publisher: Elsevier BV
Date: 08-2020
Effectiveness of discharge education on outcomes in acute coronary syndrome patients: a systematic review protocol
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2018
DOI: 10.11124/JBISRIR-2017-003543
Abstract: The question of this review is what is the effectiveness of discharge education on outcomes in acute coronary syndrome patients?
Hospitalizations for Chronic Conditions Among Indigenous Australians After Medication Copayment Reductions: the Closing the Gap Copayment Incentive
Publisher: Springer Science and Business Media LLC
Date: 31-10-2016
Cohort Profile: The Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) Study
Publisher: Oxford University Press (OUP)
Date: 29-03-2018
DOI: 10.1093/IJE/DYY046
A systems approach to improving timeliness of immunisation
Publisher: Elsevier BV
Date: 06-2009
DOI: 10.1016/J.VACCINE.2009.02.068
Abstract: Timeliness of immunisation is important in achieving a protective effect at the in idual and population levels. Recent international research has highlighted the importance of organisational features of the health system in timely immunisation. This paper reports on an analysis of the availability of records of timely delivery of childhood immunisations in Indigenous primary care services and organisational features of vaccination programs in different jurisdictions in Australia. The findings demonstrate wide variation in recorded timely delivery of immunisations between health centres within and between jurisdictions. Significant deficiencies in the approach to delivery and recording of immunisations appear to be principally related to fragmented systems of delivery, recording and communication between child health and primary care services. Understanding these deficiencies presents opportunities for improving timely immunisation.
Chilli intake is inversely associated with hypertension among adults
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.CLNESP.2017.12.007
Abstract: This study aimed to examine the association between chilli intake and the incidence of hypertension in a Chinese adult population. Adults aged 20-75 years in the China Health and Nutrition Survey were followed from 1991 to 2011. Dietary data were collected during home visits using a 3-day food record in 1991, 1993, 1997, 2000, 2004, 2006, 2009 and 2011. Cox regression was used in the analysis. Blood pressure was measured at each data collection point. 13,670 adults were followed for a median of 9.0 years. During 132,089 person years of follow-up 4040 subjects developed hypertension. Chilli consumption was inversely associated with the incidence of hypertension. The incidence rate of hypertension was 30.5, 33.4, 31.9, and 24.0 per 1000 person years among those who consumed no chilli or 1-20, 20.1-50, ≥50.1 g/day respectively. Adjusting for age, gender, energy intake, sodium and fat intake, smoking, alcohol consumption and physical activity, those with increasing cumulative average chilli intake were less likely to develop hypertension: 0, 1-20, 20.1-50 and ≥50.1 g/day had a hazard ratio (HR) for hypertension of 1.00, 0.80 (95%CI 0.73-0.88), 0.81 (0.73-0.89) and 0.65 (0.57-0.75) (p for trend <0.001) respectively. The association was independent of overall dietary patterns and BMI. There was no significant interaction between chilli intake and gender, income, education and residence (urban/rural) in relation to the risk of hypertension. Chilli intake is inversely associated with the risk of developing hypertension in Chinese adults.
Preconception care for women with type 2 diabetes mellitus: A mixed-methods study of provider knowledge and practice
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.DIABRES.2017.03.035
Abstract: Preconception care may decrease adverse pregnancy outcomes associated with pre-existing diabetes mellitus. Aboriginal Australians are at high risk of type 2 diabetes mellitus (T2DM), with earlier onset. We explored practitioner views on preconception care delivery for women with T2DM in the Northern Territory, where 31% of births are to Aboriginal women. Mixed-methods study including cross-sectional survey of 156 health practitioners and 11 semi-structured interviews. Practitioners reported low attendance for preconception care however, 51% provided counselling on an opportunistic basis. Rural/remote practitioners were most likely to find counselling feasible. The majority (69%) utilised appropriate guidelines and addressed lifestyle modifications including smoking (81%), weight management (79%), and change medications appropriately such as ceasing ACE inhibitors (69%). Fewer (40%) prescribed the recommended dose of folate (5mg) or felt comfortable recommending delaying pregnancy to achieve optimal preconception glucose control (42%). Themes identified as barriers to care included the complexity of care setting and infrequent preconception consultations. There was a focus on motivation of women to make informed choices about conception, including birth spacing, timing and contraception. Preconception care enablers included cross-cultural communication, a multi-disciplinary care team and strong client-based relationships. Health practitioners are keen to provide preconception counselling and reported knowledge of evidence-based guidelines. Improvements are needed in recommending high dose folate and optimising glucose control. Cross-cultural communication and team-based care were reported as fundamental to successful preconception care in women with T2DM. Continued education and policy changes are required to support practitioners in opportunities to enhance pregnancy planning.
Qualitative study of psychosocial factors impacting on Aboriginal women’s management of chronic disease
Publisher: Springer Science and Business Media LLC
Date: 13-01-2020
DOI: 10.1186/S12939-019-1110-3
Abstract: Aboriginal women are frequently called upon to support their families and other community members. At times, such supporting roles can be burdensome for these women. Many Aboriginal women live with chronic conditions. We explored the ways in which the women’s caring roles impacted on how they maintained their own health. The aim of this manuscript is to explore the psychosocial factors associated with the management of health and chronic disease in Aboriginal women. An interpretive phenomenological approach was used for the analysis of 72 in-depth semi-structured interviews. These interviews were conducted in four community controlled Aboriginal health services, in urban, rural and remote settings, across two states and a territory in Australia. Women living with chronic disease experience multiple challenges while caring for family, such as intergenerational trauma, mental health issues relating to addiction, domestic and family violence and incarceration. When these women become ill, they also have to take care of themselves. These women provided informal and unfunded care in response to a range of complex family and community problems. This continuous caring for family affected the women’s ability to maintain their health and manage their own chronic conditions. The caring roles and responsibilities Aboriginal women have in their community impact on their health. Aboriginal women provide much needed refuge and support to family and the wider community. Underfunded and over-burdened formal support services are not meeting the needs of many Aboriginal women. Improved culturally secure resources and social services are required within communities to support Aboriginal women to successfully manage their own health.
Equity for Indigenous Australians in intensive care.
Publisher: AMPCo
Date: 16-09-2019
DOI: 10.5694/MJA2.50339
Diabetes prevalence and determinants in Indigenous Australian populations: A systematic review
Publisher: Elsevier BV
Date: 08-2011
DOI: 10.1016/J.DIABRES.2011.06.012
Abstract: To perform a systematic review of the prevalence of diabetes and impaired glucose tolerance (IGT) in Indigenous Australians in order to clarify overall patterns, by determinants such as age, gender, region, ethnicity and remoteness. The OVID interface to Medline and the Australian Indigenous HealthInfoNet databases were systematically searched from years 1997 to 2010. Studies reporting diabetes prevalence were included if they used population-based s les of Indigenous Australians. Diagnosis of diabetes was based on self-report or standard diagnostic criteria. Twenty-four studies were included. The diabetes prevalence ranged from 3.5 to 33.1% IGT estimates ranged from 4.7 to 21.1%. Prevalence was greater among Indigenous Australian women compared to men, the Northern Territory's Top End compared to Central Australia, Torres Strait Islanders compared to Aboriginals, older (≥35 years) compared to younger (<35 years) age groups, and remote compared to urban settings. Patterns of IGT prevalence were similar to those observed for diabetes. Although the prevalence of diabetes and IGT is high, there appears to be considerable variation in prevalence between different segments of the Australian Indigenous population. Data on diabetes prevalence in the urban Australian Indigenous population is lacking, despite accounting for almost three quarters of the total population.
Exploring the expression of depression and distress in aboriginal men in central Australia: a qualitative study
Publisher: Springer Science and Business Media LLC
Date: 08-2012
Effects of full-mouth scaling on the periodontal health of Indigenous Australians: a randomized controlled trial
Publisher: Wiley
Date: 09-2013
DOI: 10.1111/JCPE.12152
Abstract: Simplified periodontal therapy might be a pragmatic strategy for public health programmes targeting Indigenous Australian adults. The objective of this randomized controlled trial was to evaluate oral health effects of single-visit, non-surgical periodontal therapy compared to no treatment. This parallel-group, randomized, open label clinical trial enrolled 273 Indigenous Australians aged ≥18 years with periodontitis. Intervention participants received full-mouth periodontal scaling and root planing during a single visit while the control group received no treatment. Endpoints were summary variables derived from clinical assessments of probing depth, clinical attachment loss, plaque, calculus and gingival bleeding before treatment and 3 months later. Endpoints could be calculated for 169 participants with follow-up data. Compared to the control group, there were statistically significant reductions in extent of shallow pockets: PD ≥4 mm (mean difference -2.86, [95% CI -5.01 to -0.71], p = 0.009) and gingival bleeding (mean difference -0.25, [95% CI -0.43 to -0.08], p = 0.005) but not deeper pockets PD ≥5 mm (mean difference -0.48, [95% CI -1.78 to 0.82], p = 0.468) or plaque scores. Periodontal therapy produced improvements in shallow periodontal pockets and measures of gingival bleeding in these Indigenous Australians.
Cardiometabolic risk and disease in Indigenous Australians: The heart of the heart study
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.IJCARD.2013.12.026
Abstract: This study assessed the burden and determinants of cardiovascular and metabolic risk in a community s le of high risk Indigenous Australians. Indigenous Australians are over-represented in the most disadvantaged strata of Australian society. The role of psychosocial and socioeconomic factors in patterning cardiometabolic disease in this population is unclear. The Heart of the Heart Study was a cross sectional study of 436 Aboriginal adults from remote, urban and peri-urban communities around Alice Springs (Northern Territory, Australia). Participants underwent detailed assessments of socio-demographic, psychosocial, cardiovascular and metabolic status. In iduals with depression were twice as likely to have cardiovascular disease (OR 2.03 1.07-3.88 p<0.05). Chronic kidney disease (39.7%, 37.2% and 18.2%) and diabetes (28.4%, 34.0% and 19.2%) were more common in peri-urban and remote compared to urban communities. Cardiovascular disease did not vary across locations (p=0.069), but coronary artery disease did (p=0.035 for trend). Unemployed in iduals were more likely to have cardiovascular disease (OR 2.32 1.33-4.06 p<0.001). Socioeconomic gradients in coronary artery disease, all cardiovascular disease and diabetes, as measured by income, operated differentially across locations (p for location/socioeconomic status interactions 0.002 0.01 and 0.04 respectively). Participants had high rates of pre-existing cardiovascular disease, diabetes and chronic kidney disease. Cardiovascular risk in these communities was associated with psychosocial factors and socioeconomic indicators. However, gradients operated differentially across location. These data provide a strong foundation for better understanding key drivers of increased levels of cardiovascular and other common forms of non-communicable disease in Indigenous people.
The Epidemiology and Burden of Childhood Chronic Pancreatitis in South Australia
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.JPEDS.2021.11.068
Abstract: To assess longitudinal, population-based data on the prevalence and impact of chronic pancreatitis in children. Administrative data linkage was used to ascertain an index cohort consisting of all in iduals who had an initial diagnosis of chronic pancreatitis before age 19 years in the South Australian public hospital system between June 2000 and June 2019. Age- and sex-matched controls were drawn from the general population of South Australia, children with type 1 diabetes, and children with type 2 diabetes. Main outcomes and measures included hospital visits, days in hospital, emergency department (ED) visits, intensive care unit (ICU) admissions, education comparators, and incidence and prevalence estimates. A total of 73 incident cases were identified. The crude prevalence and incidence of pediatric chronic pancreatitis were estimated at 6.8/100 000 and 0.98/100 000 per year, respectively. Of the index cohort, 24 cases (32.8%) of pediatric chronic pancreatitis were identified as occurring in children of Aboriginal and/or Torres Strait Islander descent. Compared with matched general population controls, children with chronic pancreatitis averaged 11-fold more hospital visits, 5-fold more ED visits, and 9-fold more ICU admissions spent 10-fold more days in the hospital and had a 2-fold higher rate of absence from school (P < .001 for all). Similarly, children with chronic pancreatitis used substantially more health resources than children with type 1 or 2 diabetes. Pediatric patients with chronic pancreatitis consume a high volume of public health services and are significantly impacted in their ability to engage in education.
Healthcare expenditure on Indigenous and non-Indigenous Australians at high risk of cardiovascular disease
Publisher: Springer Science and Business Media LLC
Date: 23-06-2017
Psychological distress and self‐rated oral health among a convenience sample of I ndigenous A ustralians
Publisher: Wiley
Date: 11-09-2016
DOI: 10.1111/JPHD.12080
Abstract: This study sought to: a) estimate the frequency of poor self-rated oral health as assessed by a summary measure b) compare frequency according to sociodemographic, behavioral, and psychological distress factors and (3) determine if psychological distress was associated with poor self-rated oral health after adjusting for confounding. Data were from a convenience s le of Indigenous Australian adults (n = 289) residing in Australia's Northern Territory. Poor self-rated oral health was defined as reported experience of toothache, poor dental appearance or food avoidance in the last 12 months. A logistic regression model was used to evaluate socio-demographic, behavioral, and psychological distress associations with poor self-rated oral health (SROH). Effects were quantified as odds ratios (OR). The frequency of poor SROH was 73.7 percent. High psychological distress, measured by a Kessler-6 score ≥8, was experienced by 33.9 percent of participants. Poor SROH was associated with high levels of psychological distress, being older, being female, and usually visiting a dentist because of a problem. In the multivariable model, factors that were significantly associated with poor SROH after adjustment for other covariates included having a high level of psychological distress (OR 2.74, 95% CI 1.25-6.00), being female (OR 2.22, 95% CI 1.03-4.78), and usually visiting a dentist because of a problem (OR 3.57, 95% CI 1.89-6.76). Poor self-rated oral health and high levels of psychological distress were both highly frequent among this vulnerable population. Psychological distress was significantly associated with poor self-rated oral health after adjustment for confounding.
Prevalence of oral human papillomavirus infection among Australian indigenous adults
Publisher: American Medical Association (AMA)
Date: 08-06-2020
Disparities in breast screening, stage at diagnosis, cancer treatment and the subsequent risk of cancer death
Publisher: Springer Science and Business Media LLC
Date: 14-06-2019
Overcoming the tyranny of distance: An analysis of outreach visits to optimise secondary prevention of cardiovascular disease in high-risk individuals living in Central Australia
Publisher: Wiley
Date: 19-08-2016
DOI: 10.1111/AJR.12222
Abstract: We examined the logistical challenges of conducting an outreach, secondary prevention program for adults discharged from Alice Springs Hospital following an acute presentation of cardiovascular disease. This represents a sub-study of the Central Australian Heart Protection Study (CAHPS). Clinical, logistic and demographic data were used to examine the characteristics of outreach visits in the intervention arm of the study. Fifty subjects initially allocated to the intervention arm of the trial were studied. Completion of scheduled, plus additional outreach visits according to the intervention protocol. The majority of subjects presented with an acute coronary syndrome (44/50 (88%)) and 31 (62%) were of Indigenous ethnicity. However, Indigenous subjects being younger (53.1 ± 11.1 versus 58.0 ± 11.0 years non-Indigenous) had a more complex risk factor and co-morbid profile, with significantly more diabetes (77% versus 26% P < 0.001), hypertension (81% versus 53% P = 0.04) and renal failure (52% versus 21% P = 0.03). Community of origin of Indigenous subjects was 230 ± 208 km from the hospital versus 61 ± 150 km for non-Indigenous subjects (P = 0.004). Indigenous subjects missed a significantly higher number of scheduled visits at six months (1.39 ± 2.14 versus 0.16 ± 0.50 visits P = 0.02). However, multivariate analyses suggested that distance did not influence successful completion of visits. These early findings from CAHPS are invaluable to understanding and improving the feasibility of secondary prevention programs for Indigenous adults living with heart disease in remote communities.
The Incidence of Stroke in Indigenous Populations of Countries With a Very High Human Development Index
Publisher: Frontiers Media SA
Date: 22-04-2021
DOI: 10.3389/FNEUR.2021.661570
Abstract: Background and Aims: Despite known Indigenous health and socioeconomic disadvantage in countries with a Very High Human Development Index, data on the incidence of stroke in these populations are sparse. With oversight from an Indigenous Advisory Board, we will undertake a systematic review of the incidence of stroke in Indigenous populations of developed countries or regions, with comparisons between Indigenous and non-Indigenous populations of the same region, though not between different Indigenous populations. Methods: Using PubMed, OVID-EMBASE, and Global Health databases, we will examine population-based incidence studies of stroke in Indigenous adult populations of developed countries published 1990-current, without language restriction. Non-peer-reviewed sources, studies including & Indigenous People, or with insufficient data to determine incidence, will be excluded. Two reviewers will independently validate the search strategies, screen titles and abstracts, and record reasons for rejection. Relevant articles will undergo full-text screening, with standard data extracted for all studies included. Quality assessment will include Sudlow and Warlow's criteria for population-based stroke incidence studies, the Newcastle-Ottawa Scale for risk of bias, and the CONSIDER checklist for Indigenous research. Results: Primary outcomes include crude, age-specific and/or age-standardized incidence of stroke. Secondary outcomes include overall stroke rates, incidence rate ratio and case-fatality. Results will be synthesized in figures and tables, describing data sources, populations, methodology, and findings. Within-population meta-analysis will be performed if, and where, methodologically sound and comparable studies allow this. Conclusion: We will undertake the first systematic review assessing disparities in stroke incidence in Indigenous populations of developed countries. Data outputs will be disseminated to relevant Indigenous stakeholders to inform public health and policy research.
The Effect of a Cardiovascular Polypill Strategy on Pill Burden
Publisher: Wiley
Date: 02-11-2015
Abstract: Recent trials of cardiovascular polypills in high-risk populations show improvements in the use of cardiovascular preventive treatments, compared to usual care. We describe patterns of pill burden in Australian practice, define the impact of polypill therapy on pill burden, and explore how physicians add medication to polypill therapy. The Kanyini Guidelines Adherence with the Polypill Study was an open-label trial involving 623 participants in Australia which randomized participants to a polypill strategy (containing a statin, antiplatelet agent, and two blood-pressure-lowering medications) or usual care. Participants either had established cardiovascular disease or were at high calculated risk (≥15% over 5 years). Current medications, daily pill burden, and self-reported use of combination treatment were recorded prior to randomization and at study end. Median pill burden at baseline and study end was compared in both arms. Subgroup analysis of the polypill strategy on trial primary outcomes was conducted by pill burden at baseline. Median total and cardiovascular pill burdens of the polypill group decreased from 7 to 5 and from 4 to 2, respectively (median change -2 IQR -3, 0), with no change in the usual care group (comparison of change P < 0.001). No change was seen for noncardiovascular medications. Of those still using the polypill at study end, 43.8% were prescribed additional medications 84.5% of these additional medications were blood-pressure-lowering medications. Within the polypill group, lower pill burden at baseline was associated with greater increases in the use of indicated cardiovascular preventive medications at study end compared to those with higher pill burdens. No trend was observed between the level of baseline pill burden and the effect of poylpill treatment on systolic blood pressure or total cholesterol. A cardiovascular polypill in contemporary Australian practice reduces cardiovascular and total pill burdens, despite frequent prescription of additional medications.
Nutritional predictors of chronic disease in a Central Australian Aboriginal cohort: A multi-mixture modelling analysis
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.NUMECD.2015.11.009
Abstract: Chronic diseases (including diabetes, cardiovascular disease, hypertension and chronic kidney disease) are major contributors to the total burden of disease for Aboriginal people. Here we used novel epidemiological modelling to investigate nutritional profiles at a population level associated with chronic disease. Multi-mixture modelling, was used to group members of a Central Australian Aboriginal population (n = 444) based on their nutritional profile from a risk factor prevalence survey in 1995. Multi-mixture modelling assigned % membership to four classes Class 1 (young, low adiposity and lipids, low dietary antioxidants n = 171.7) Class 2 (older, greater adiposity and lipids n = 22.6) Class 3 (predominantly female, greater adiposity and antioxidants, low smoking n = 134.3) and Class 4 (predominantly male, greater lipids and adiposity, low antioxidants, high smoking prevalence n = 115.4). For persons free of chronic disease (n = 285), incident chronic disease for classes 1, 3 and 4 was determined using follow up hospital, primary health care and death records collected in 2004/05. Fifty-four percent of Class 4 had incident chronic disease, an excess of 3355 events per 100,000 person years relative to Class 1. Incident CVD, hypertension, or CKD was highest for Class 4 and incident diabetes highest for Class 3. Multi-mixture modelling appears useful in identifying population subgroups of an Aboriginal population at risk of chronic conditions.
“I feel more comfortable speaking to a male”: Aboriginal and Torres Strait Islander men’s discourse on utilizing primary health care services
Publisher: Springer Science and Business Media LLC
Date: 12-2018
The premature mortality to incidence ratio (PREMIER): a person-centred measure of cancer burden
Publisher: Cold Spring Harbor Laboratory
Date: 18-10-2021
DOI: 10.1101/2021.10.17.21265122
Abstract: Cancer control initiatives are informed by quantifying the capacity to reduce cancer burden through effective interventions. Burden measures using health administrative data are a sustainable way to support monitoring and evaluating of outcomes among patients and populations. The PREmature Mortality to IncidencE Ratio (PREMIER) is one such burden measure. We use data on Aboriginal and non-Aboriginal South Australians from 1990 to 2010 to show how PREMIER quantifies disparities in cancer burden: between populations between sub-population cohorts where stage at diagnosis is available and when follow-up is constrained to 24-months after diagnosis. PREMIER cancer is the ratio of years of life expectancy lost due to cancer (YLL cancer ) to life expectancy years at risk at time of cancer diagnosis (LYAR) for each person. The Global Burden of Disease standard life table provides referent life expectancies. PREMIER cancer was estimated for the population of cancer cases diagnosed in South Australia from 1990 to 2010. Cancer stage at diagnosis was also available for cancers diagnosed in Aboriginal people and a cohort of non-Aboriginal people matched by sex, year of birth, primary cancer site and year of diagnosis. Cancers diagnoses (N=144,891) included 777 among Aboriginal people. Cancer burden described by PREMIER cancer was higher among Aboriginal than non-Aboriginal (0.55, 95%CIs 0.52-0.59 versus 0.39, 95%CIs 0.39-0.40). Diagnoses at younger ages among Aboriginal people, 7 year higher LYAR (31.0, 95%CIs 30.0-32.0 versus 24.1, 95%CIs 24.1-24.2) and higher premature cancer mortality (YLL cancer = 16.3, 95%CIs 15.1-17.5 versus YLL cancer = 8.2, 95%CIs 8.2-8.3) influenced this. Disparities in cancer burden between the matched Aboriginal and non-Aboriginal cohorts manifested 24-months after diagnosis with PREMIER cancer 0.44, 95%CIs 0.40-0.47 and 0.28, 95%CIs 0.25-0.31 respectively. PREMIER described disproportionately higher cancer burden among Aboriginal people in comparisons involving: all people diagnosed with cancer the matched cohorts and, within groups diagnosed with same staged disease. The extent of disparities were evident 24-months after diagnosis. This is evidence of Aboriginal peoples’ substantial capacity to benefit from cancer control initiatives, particularly those leading to earlier detection and treatment of cancers. PREMIER’s use of readily available, person-level administrative records can help evaluate health care initiatives addressing this need.
Association between hyperglycaemia in pregnancy and growth of offspring in early childhood: The PANDORA study
Publisher: Wiley
Date: 29-05-2022
DOI: 10.1111/IJPO.12932
Abstract: Few studies have assessed whether children exposed to in utero hyperglycaemia experience different growth trajectories compared to unexposed children. To assess association of type 2 diabetes (T2D) and gestational diabetes mellitus (GDM) with early childhood weight, length/height and body mass index (BMI) trajectories, and with timing and magnitude of peak BMI in infancy. PANDORA is a birth cohort recruited from an Australian hyperglycaemia in pregnancy register, and women with normoglycaemia recruited from the community. Offspring growth measures were obtained from health records over a median follow‐up of 3.0 years (interquartile range 1.9–4.0). This analysis included children born to Aboriginal mothers with in utero normoglycaemia ( n = 95), GDM ( n = 228) or T2D ( n = 131). Growth trajectories (weight, length/height and BMI) were estimated using linear mixed models with cubic spline functions of child age. After adjustment for maternal factors (age, BMI, parity, smoking, and socioeconomic measures) and child factors (age, gestational age at birth, and sex), children born to mothers with T2D or GDM had lower weight, length/height and BMI trajectories in infancy than children born to mothers with normoglycaemia, but similar weight and BMI by completion of follow‐up. Children exposed to T2D had lower mean peak BMI 17.6 kg/m 2 (95% confidence interval [CI] 17.3–18.0) than children exposed to normoglycaemia (18.6 kg/m 2 [18.1–18.9]) ( p = 0.001). Maternal hyperglycaemia was associated with differences in early childhood growth trajectories after adjustment for maternal BMI. Exploration of associations between in utero hyperglycaemia exposure and growth trajectories into later childhood is required.
Walking an Indigenous Pathway: Bridging the Gap in Cardiovascular Health
Publisher: Elsevier BV
Date: 06-2019
Inclusivity and equity in human microbiome research
Publisher: Elsevier BV
Date: 02-2019
A systematic review on assessment and management of preventive cardiovascular care in primary health for Aboriginal and Torres Strait Islander women and men
Publisher: CSIRO Publishing
Date: 08-04-2022
DOI: 10.1071/PY21219
Abstract: In promoting positive cardiovascular health for Aboriginal and Torres Strait Islander peoples, there is a need to ensure provision of high-quality risk assessment and management in primary healthcare settings. There is some evidence of gender gaps for Australian women in the provision of cardiovascular risk assessment and management however, there is little understanding of whether these gaps are also present for Aboriginal and Torres Strait Islander women. A mixed-method systematic review was utilised to synthesise existing evidence on the provision of assessment and management against guideline-recommended care for Aboriginal and Torres Strait Islander women, and determine whether gender disparities in provision of care exist for this population. Sixteen studies that report gender-specific data indicate there are significant gaps in the provision of assessment and management for Aboriginal and Torres Strait Islander women and men alike. There is no evidence of incorporation of social and emotional wellbeing into cardiovascular care and limited studies outlining the assessment and management of behaviours and factors that may be protective of cardiovascular health. Furthermore, little is known about the provision of care in mainstream primary health services for Aboriginal and Torres Strait Islander peoples.
Community leadership and empowerment are essential for eliminating rheumatic heart disease
Publisher: AMPCo
Date: 11-07-2020
DOI: 10.5694/MJA2.50695
Social and emotional wellbeing assessment instruments for use with Indigenous Australians: A critical review
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.SOCSCIMED.2017.06.046
Abstract: There is growing recognition that in addition to universally recognised domains and indicators of wellbeing (such as population health and life expectancy), additional frameworks are required to fully explain and measure Indigenous wellbeing. In particular, Indigenous Australian wellbeing is largely determined by colonisation, historical trauma, grief, loss, and ongoing social marginalisation. Dominant mainstream indicators of wellbeing based on the biomedical model may therefore be inadequate and not entirely relevant in the Indigenous context. It is possible that "standard" wellbeing instruments fail to adequately assess indicators of health and wellbeing within societies that have a more holistic view of health. The aim of this critical review was to identify, document, and evaluate the use of social and emotional wellbeing measures within the Australian Indigenous community. The instruments were systematically described regarding their intrinsic properties (e.g., generic v. disease-specific, domains assessed, extent of cross-cultural adaptation and psychometric characteristics) and their purpose of utilisation in studies (e.g., study setting, intervention, clinical purpose or survey). We included 33 studies, in which 22 distinct instruments were used. Three major categories of social and emotional wellbeing instruments were identified: unmodified standard instruments (10), cross-culturally adapted standard instruments (6), and Indigenous developed measures (6). Recommendations are made for researchers and practitioners who assess social and emotional wellbeing in Indigenous Australians, which may also be applicable to other minority groups where a more holistic framework of wellbeing is applied. It is advised that standard instruments only be used if they have been subject to a formal cross-cultural adaptation process, and Indigenous developed measures continue to be developed, refined, and validated within a erse range of research and clinical settings.
Global epidemiology of valvular heart disease
Publisher: Springer Science and Business Media LLC
Date: 25-06-2021
DOI: 10.1038/S41569-021-00570-Z
Abstract: Valvular heart disease (VHD) is a major contributor to loss of physical function, quality of life and longevity. The epidemiology of VHD varies substantially around the world, with a predominance of functional and degenerative disease in high-income countries, and a predominance of rheumatic heart disease in low-income and middle-income countries. Reflecting this distribution, rheumatic heart disease remains by far the most common manifestation of VHD worldwide and affects approximately 41 million people. By contrast, the prevalence of calcific aortic stenosis and degenerative mitral valve disease is 9 and 24 million people, respectively. Despite a reduction in global mortality related to rheumatic heart disease since 1900, the death rate has remained fairly static since 2000. Meanwhile, deaths from calcific aortic stenosis have continued to rise in the past 20 years. Epidemiological data on other important acquired and congenital forms of VHD are limited. An ageing population and advances in therapies make an examination of the changing global epidemiology of VHD crucial for advances in clinical practice and formulation of health policy. In this Review, we discuss the global burden of VHD, geographical variation in the presentation and clinical management, and temporal trends in disease burden.
Performance of cardiovascular risk prediction equations in Indigenous Australians
Publisher: BMJ
Date: 16-01-2020
DOI: 10.1136/HEARTJNL-2019-315889
Abstract: To assess the performance of cardiovascular disease (CVD) risk equations in Indigenous Australians. We conducted an in idual participant meta-analysis using longitudinal data of 3618 Indigenous Australians (55% women) aged 30–74 years without CVD from population-based cohorts of the Cardiovascular Risk in IndigenouS People(CRISP) consortium. Predicted risk was calculated using: 1991 and 2008 Framingham Heart Study (FHS), the Pooled Cohorts (PC), GloboRisk and the Central Australian Rural Practitioners Association (CARPA) modification of the FHS equation. Calibration, discrimination and diagnostic accuracy were evaluated. Risks were calculated with and without the use of clinical criteria to identify high-risk in iduals. When applied without clinical criteria, all equations, except the CARPA-adjusted FHS, underestimated CVD risk (range of percentage difference between observed and predicted CVD risks: −55% to −14%), with underestimation greater in women (−63% to −13%) than men (−47% to −18%) and in younger age groups. Discrimination ranged from 0.66 to 0.72. The CARPA-adjusted FHS equation showed good calibration but overestimated risk in younger people, those without diabetes and those not at high clinical risk. When clinical criteria were used with risk equations, the CARPA-adjusted FHS algorithm scored 64% of those who had CVD events as high risk corresponding figures for the 1991-FHS were 58% and were 87% for the PC equation for non-Hispanic whites. However, specificity fell. The CARPA-adjusted FHS CVD risk equation and clinical criteria performed the best, achieving higher combined sensitivity and specificity than other equations. However, future research should investigate whether modifications to this algorithm combination might lead to improved risk prediction.
Improving health service delivery for women with diabetes in pregnancy in remote Australia: Survey of care in the Northern Territory Diabetes in Pregnancy Partnership
Publisher: Wiley
Date: 11-10-2014
DOI: 10.1111/AJO.12246
Building better systems of care for Aboriginal and Torres Strait Islander people: findings from the Kanyini health systems assessment
Publisher: Springer Science and Business Media LLC
Date: 28-10-2012
Cardiovascular Abnormalities in Patients with Major Depressive Disorder
Publisher: Springer Science and Business Media LLC
Date: 07-2009
DOI: 10.2165/00023210-200923070-00004
Abstract: This article provides a detailed review of the association of major depression with coronary heart disease (CHD), examines the biological variables underpinning the linkage and discusses the clinical implications for treatment. When considering the co-morbidity between major depressive disorder (MDD) and CHD it is important to differentiate between (i) the prevalence and impact of MDD in those with existing CHD and (ii) MDD as a risk factor for the development of CHD. Whether the same biological mechanisms are at play in these two instances remains unknown. Depression is common in patients with CHD. Importantly, depression in these patients increases mortality. There is also consistent evidence that MDD is a risk factor for the development of CHD. The relative risk of developing CHD is proportional to the severity of depression and is independent of smoking, obesity, hypercholesterolaemia, diabetes mellitus and hypertension. There is a clear need to identify the underlying neurochemical mechanisms responsible for MDD and their linkage to the heart and vascular system. Of particular interest are activation of stress pathways, including both the sympathetic nervous system and hypothalamic-pituitary-adrenal axis, and inflammatory-mediated atherogenesis. Elevated sympathetic activity, reduced heart rate variability and increased plasma cortisol levels have been documented in patients with MDD. In addition to direct effects on the heart and vasculature, activation of stress pathways may also be associated with increased release of inflammatory cytokines such as interleukin-6 and tumour necrosis factor-alpha. Elevated levels of C-reactive protein are commonly observed in patients with MDD. The majority of investigations examining treatment of depression following myocardial infarction have focused on safety and efficacy there is little evidence to indicate that treating depression in these patients improves survival. Given that strategies for preventive therapy remain incompletely formulated, future research should focus on generating a better understanding of the neurobiology of MDD and heart disease as a basis for rational and effective therapy.
The burden and implications of preoperative atrial fibrillation in Australian heart valve surgery patients
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.IJCARD.2016.11.070
Abstract: Atrial fibrillation (AF) is the most common preoperative arrhythmia in heart valve surgery patients and its prevalence is rising. This study aims to investigate the impact of AF on valve surgery early complications and survival and on valve disease of different aetiologies and populations with particular reference to Indigenous Australians with rheumatic heart disease (RHD). The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database was analysed to determine the association between preoperative AF and valve surgery outcome. Its association with demographics, co-morbidities, preoperative status and short and long term outcome was assessed. Outcome of 1594 RHD and 19,029 non-RHD-related surgical procedures was analysed. Patients with preoperative AF were more likely to be older, female, Indigenous, to have RHD and to bear a greater burden of comorbidities. Patients with RHD and preoperative AF had a longer hospital stay and were more likely to require reoperation. Adjusted short (OR 1.4, 95% CI 1.2-1.7) and long term (HR 1.5, 95% CI 1.3-1.7) survival was inferior for patients with non-RHD preoperative AF but was no different for Indigenous and non-Indigenous Australians with RHD. In this prospective Australian study, patients with valve disease and preoperative AF had inferior short and long term survival. This was particularly the case for patients with non-RHD valve disease. Earlier intervention or more aggressive AF management should be investigated as mechanisms for enhancing postoperative outcomes. This may influence treatment choice and the need for ongoing anticoagulation.
Exploring barriers to and enablers of adequate healthcare for Indigenous Australian prisoners with cancer: a scoping review drawing on evidence from Australia, Canada and the United States
Publisher: Springer Science and Business Media LLC
Date: 03-05-2016
Māori, Pacific, Aboriginal and Torres Strait Islander Women’s Cardiovascular Health: Where Are the Opportunities to Make a Real Difference?
Publisher: Elsevier BV
Date: 2021
Getting it Right: validating a culturally specific screening tool for depression (aPHQ-9) in Aboriginal and Torres Strait Islander Australians
Publisher: AMPCo
Date: 30-06-2019
DOI: 10.5694/MJA2.50212
Abstract: To determine the validity, sensitivity, specificity and acceptability of the culturally adapted nine-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander people. Prospective observational validation study, 25 March 2015 - 2 November 2016. 500 adults (18 years or older) who identified as Aboriginal or Torres Strait Islander people and attended one of ten primary health care services or service events in urban, rural and remote Australia that predominantly serve Indigenous Australians, and were able to communicate sufficiently to respond to questionnaire and interview questions. Criterion validity of the aPHQ-9, with the depression module of the Mini-International Neuropsychiatric Interview (MINI) 6.0.0 as the criterion standard. 108 of 500 participants (22% 95% CI, 18-25%) had a current episode of major depression according to the MINI criterion. The sensitivity of the aPHQ-9 algorithm for diagnosing a current major depressive episode was 54% (95% CI, 40-68%), its specificity was 91% (95% CI, 88-94%), with a positive predictive value of 64%. For screening for a current major depressive episode, the area under the receiver operator characteristic curve was 0.88 (95% CI, 0.85-0.92) with a cut-point of 10 points its sensitivity was 84% (95% CI, 74-91%) and its specificity 77% (95% CI, 71-83%). The aPHQ-9 was deemed acceptable by more than 80% of participants. Indigenous Australians found the aPHQ-9 acceptable as a screening tool for depression. Applying a cut-point of 10 points, the performance characteristics of the aPHQ were good.
Uncovering the Determinants of Cardiovascular Disease among Indigenous People
Publisher: Informa UK Limited
Date: 05-2006
DOI: 10.1080/13557850500485485
Abstract: This paper attempts to delineate an appropriate methodology for research into cardiovascular diseases (CVD) in the context of the Australian Indigenous population. Our argument proceeds in three main stages of critical analysis of the appropriate literature. First we demonstrate the extremely complex aetiology of CVD and also argue that, in any population, exposure to many of the more important risk factors at an in idual or group level is generated through social and behavioural factors whose causation, persistence and reproduction are both complex and multilayered. Secondly, and having established that the aetiology and morbidity of CVD in various populations is a product of a complex and interactive hierarchy of biomedical, social and political processes, we argue that only research methodologies capable of encompassing the complete span of this hierarchy can be expected to generate results which are efficacious as a basis for intervention. Thirdly, and most importantly, we argue that in the Indigenous context a central and essential feature in the development of an appropriate methodology must be to centre Indigenous people themselves as the dominant partner in setting the research agenda and the conduct of research. We conclude that an appropriate methodology for the elucidation of the aetiology, and sequelae of CVD in Indigenous people, would go far beyond 'black box' epidemiology, would recognise the essentially social nature of chronic disease by deploying appropriate social theory within a transdisciplinary framework and would centre Indigenous people as the dominant partner in the research process.
The metabolic syndrome and CVD outcomes for a central Australian cohort
Publisher: Elsevier BV
Date: 06-2013
DOI: 10.1016/J.DIABRES.2013.03.020
Abstract: We investigated if the metabolic syndrome (MetS) and its component risk factors predict cardiovascular disease (CVD) for Aboriginal people from central Australia. WHO (HR 2.83), NCEP (1.80) and IDF (2.47) definitions of the MetS all had positive associations with CVD, however offered little above in idual MetS components for hyperglycaemia.
Aboriginal experiences of cancer and care coordination: Lessons from the Cancer Data and Aboriginal Disparities (CanDAD ) narratives
Publisher: Wiley
Date: 24-04-2018
DOI: 10.1111/HEX.12687
Assessment of fetal kidney growth and birth weight in an Indigenous Australian cohort
Publisher: Frontiers Media SA
Date: 09-01-2018
Rights, interests and expectations: Indigenous perspectives on unrestricted access to genomic data
Publisher: Springer Science and Business Media LLC
Date: 06-04-2020
Bridging the Survival Gap Between Indigenous and Non-Indigenous Australians: Priorities for the Road Ahead
Publisher: Elsevier BV
Date: 04-2009
DOI: 10.1016/J.HLC.2009.01.005
Abstract: The life-expectancy gap between Indigenous and non-Indigenous Australians remains one of contemporary Australia's most enduring health ides. The reduction of observed health outcome disparity between population groups based on measures of socioeconomic status, geography, or ethnicity stands as a key target of coordinated societal and health system reform. CVD remains the principal cause of death among all Australian population groups, including Aboriginal males and females, and is the primary contributor to the 17-year life-expectancy gap between Aboriginal and non-Aboriginal Australians. This paper discusses the challenges inherent, from the perspective of broader policy frameworks and health system reform, to reducing disparity between population groups within Australia, and outlines the opportunities for change that could contribute benefit to Aboriginal and mainstream Australians in regards to reducing the burden of CVD and related conditions. Further, through mapping adverse outcomes to acute cardiac events it seeks to discuss several key targets for reform that may serve to reduce health disparity between Aboriginal and non-Aboriginal Australians.
Predicting in-hospital death during acute presentation with pulmonary embolism to facilitate early discharge and outpatient management
Publisher: Public Library of Science (PLoS)
Date: 13-07-2017
Perspectives on rehabilitation for Aboriginal people with stroke: a qualitative study
Publisher: Informa UK Limited
Date: 28-06-2022
DOI: 10.1080/10749357.2021.1911771
Abstract: Aboriginal and Torres Strait Islander (hereinafter respectfully termed Aboriginal) people have a greater incidence of stroke at a younger age than non-Indigenous people in Australia. The needs and preferences of Aboriginal people for rehabilitation and longer-term support remain largely unknown. To identify the long-term rehabilitation needs of Aboriginal people who have a stroke, from the perspectives of Aboriginal persons with stroke and health care providers. Aboriginal people who had experienced stroke in the previous three years were interviewed to obtain their experiences of rehabilitation care. Health professionals who provided care in each of six designated hospitals and nearby community health sites were involved in focus groups and in idual interviews. Information obtained was thematically analyzed separately for Aboriginal people with stroke and health professionals, and compared using Nvivo. Among six Aboriginal people with stroke and 78 healthcare providers, four main themes emerged: the importance of family variable access to services the impact of stroke on Aboriginal peoples' lives and making positive choices. Communication and involvement of family was highlighted as essential for a shared understanding, particularly when making decisions about participating in short and long-term rehabilitation. Co-morbidities, conflicting priorities, and inadequate or inflexible services and transport compounded issues with changing life roles. Stories of resilience were also shared. Aboriginal people report making positive lifestyle changes, but experience significant unmet rehabilitation needs. Addressing issues of communication, advocacy and flexible delivery should improve some of the shortfalls in service provision, particularly in regional and remote areas.
Echocardiographic Screening for Rheumatic Heart Disease in Indigenous Australian Children: A Cost–Utility Analysis
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2017
Abstract: Rheumatic heart disease ( RHD ) remains a leading cause of cardiovascular morbidity and mortality in children and young adults in disadvantaged populations. The emergence of echocardiographic screening provides the opportunity for early disease detection and intervention. Using our own multistate model of RHD progression derived from Australian RHD register data, we performed a cost–utility analysis of echocardiographic screening in indigenous Australian children, with the dual aims of informing policy decisions in Australia and providing a model that could be adapted in other countries. We simulated the outcomes of 2 screening strategies, assuming that RHD could be detected 1, 2, or 3 years earlier by screening. Outcomes included reductions in heart failure, surgery, mortality, disability‐adjusted life‐years, and corresponding costs. Only a strategy of screening all indigenous 5‐ to 12‐year‐olds in half of their communities in alternate years was found to be cost‐effective (incremental cost‐effectiveness ratio less than AU$50 000 per disability‐adjusted life‐year averted), assuming that RHD can be detected at least 2 years earlier by screening however, this result was sensitive to a number of assumptions. Additional modeling of improved adherence to secondary prophylaxis alone resulted in dramatic reductions in heart failure, surgery, and death these outcomes improved even further when combined with screening. Echocardiographic screening for RHD is cost‐effective in our context, assuming that RHD can be detected ≥2 years earlier by screening. Our model can be adapted to any other setting but will require local data or acceptable assumptions for model parameters.
Psychological Distress, Stressful Life Events and Social Disadvantage in Pregnant Indigenous Australian Women Residing in Rural and Remote NSW: a Longitudinal Cohort Study
Publisher: Springer Science and Business Media LLC
Date: 30-09-2021
DOI: 10.1007/S40615-021-01159-5
Abstract: Pregnancy can be a stressful time for many women. Australian Indigenous women of childbearing age (18-44 years) have been found to experience high or very high rates of psychological distress. However, few studies have examined the burden of or any associations between stressful life events, social disadvantage and psychological distress for pregnant Indigenous women in Australia. Two hundred sixty-one rural and remote women, pregnant with an Indigenous infant, from New South Wales in Australia were invited to provide data regarding social disadvantage then complete the Kessler-10 and Stressful Life Events surveys via self-report during each trimester of their pregnancy. Descriptive statistics, Pearson's correlations, Mann-Whitney U and Kruskal-Wallis tests were performed to determine the burden of and any associations between the variables of interest. High rates of psychological distress were reported by participants with 16.9% scoring severe distress levels during their pregnancy. Participants also reported high rates of stressful life events with almost 25% experiencing the death of a family member or friend, almost 14% living in overcrowded accommodation, 11% having someone close to them jailed and 8% experience separation from their partner, during their pregnancies. Distress was associated with numerous stressful life events (e.g. witnessing violence, a family member in jail and overcrowding) and one aspect of social disadvantage (smoking status). Immediate attention needs to focus on the development of interventions to address the high levels of psychological distress and provide appropriate support services during periods of major life events for pregnant Australian Indigenous women.
Aboriginal and Torres Strait Islander peoples' perceptions of quality of life and wellbeing and how they are measured: a systematic review protocol
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2014
Evaluating a research capacity strengthening program for Aboriginal community-controlled health organisations
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/PY18058
Abstract: A Masterclass Program was developed to strengthen the research capacity of staff within Aboriginal Community-Controlled Health Organisations (ACCHOs) and featured three Masterclasses delivered across Australia, including Understanding Research, Undertaking Research and Research Evaluation. A mixed-method process and impact evaluation of the Masterclass Program was undertaken. The process evaluation examined the reach of the Program and the impact evaluation comprised an online survey (n=45) and semi-structured interviews (n=21) with Masterclass participants. During 2014–17, 27 Masterclasses were delivered to 260 people, including predominantly ACCHO personnel but also Indigenous doctors and research institute staff who work closely with the ACCHO sector. Most survey respondents felt the Masterclasses improved their understanding of research and their willingness to participate in and undertake research. The qualitative analysis confirmed this and suggested that Masterclasses were implemented in a supportive learning environment which led to increased research capacity (increased research awareness, changed perceptions, increased understanding, critical thinking and new confidence) and ultimately enhanced research engagement (willingness to participate, motivating others, empowered critique of research partners and proposals, interest in further research training). Barriers to research engagement and areas for improvement of the Masterclass Program before, during and after Masterclasses were also identified.
Northern Territory Heart Failure Initiative -Clinical Audit (NTHFI-CA)-a prospective database on the quality of care and outcomes for acute decompensated heart failure admission in the Northern Territory: Study design and rationale
Publisher: BMJ
Date: 2014
Murru Minya–informing the development of practical recommendations to support ethical conduct in Aboriginal and Torres Strait Islander health research: a protocol for a national mixed-methods study
Publisher: BMJ
Date: 02-2023
DOI: 10.1136/BMJOPEN-2022-067054
Abstract: Conducting ethical and high-quality health research is crucial for informing public health policy and service delivery to reduce the high and inequitable burden of disease experienced by Aboriginal and Torres Strait Islander people. Ethical guidelines and principles specifically for health research with Aboriginal and Torres Strait Islander people have been developed for use since 1987. However, there has been limited examination of how these are being applied to the conduct of research. Murru Minya will be a large-scale national study to examine the implementation of ethical processes in Aboriginal and Torres Strait Islander health research. A mixed-methods design will be used in four baarra (steps). The first three baarra will collect knowledge, experiences and wisdom from three key groups: Aboriginal and Torres Strait Islander communities, research academics, and Human Research Ethics Committees using online surveys, yarning, and semistructured interviews. This knowledge will inform the final baarra of developing a set of practical recommendations to support ethical conduct in Aboriginal and Torres Strait Islander health research into the future. Ethical approval for this research project has been granted by National, State and Territory Human Research Ethics Committees. This research has been developed in collaboration with Aboriginal and Torres Strait Islander researchers, Aboriginal Community Controlled Health Organisation representatives, Aboriginal community members, the National Health Leadership Forum, and Aboriginal and Torres Strait Islander research team. The knowledge translation plan will be integrated and revised throughout the project as partnerships and engagement with Aboriginal and Torres Strait Islander communities continue. All findings will be shared with peak Aboriginal research bodies and Aboriginal and Torres Strait Islander communities in ways that are meaningful to them.
Circadian disruption by short light exposure and a high energy diet impairs glucose tolerance and increases cardiac fibrosis in Psammomys obesus
Publisher: Springer Science and Business Media LLC
Date: 06-05-2021
DOI: 10.1038/S41598-021-89191-7
Abstract: Type 2 diabetes mellitus (T2DM) increases cardiac inflammation which promotes the development of cardiac fibrosis. We sought to determine the impact of circadian disruption on the induction of hyperglycaemia, inflammation and cardiac fibrosis. Methods: Psammomys obesus ( P. obesus ) were exposed to neutral (12 h light:12 h dark) or short (5 h light:19 h dark) photoperiods and fed a low energy (LE) or high energy (HE) diet for 8 or 20 weeks. To determine daily rhythmicity, P. obesus were euthanised at 2, 8, 14, and 20 h after ‘lights on’. Results: P. obesus exposed to a short photoperiod for 8 and 20 weeks had impaired glucose tolerance following oral glucose tolerance testing, compared to a neutral photoperiod exposure. This occurred with both LE and HE diets but was more pronounced with the HE diet. Short photoperiod exposure also increased myocardial perivascular fibrosis after 20 weeks on LE (51%, P 0.05) and HE (44%, P 0.05) diets, when compared to groups with neutral photoperiod exposure. Short photoperiod exposure caused elevations in mRNA levels of hypertrophy gene Nppa (atrial natriuretic peptide) and hypertrophy transcription factors Gata4 and Mef2c in myocardial tissue after 8 weeks. Conclusion: Exposure to a short photoperiod causes impaired glucose tolerance in P. obesus that is exacerbated with HE diet and is accompanied by an induction in myocardial perivascular fibrosis.
Hyperglycemia in pregnancy and developmental outcomes in children at 18-60 months of age: The PANDORA Wave 1 study
Publisher: Cambridge University Press (CUP)
Date: 04-04-2022
DOI: 10.1017/S2040174422000101
Abstract: This study aimed to explore the association between hyperglycemia in pregnancy (type 2 diabetes (T2D) and gestational diabetes mellitus (GDM)) and child developmental risk in Europid and Aboriginal women. PANDORA is a longitudinal birth cohort recruited from a hyperglycemia in pregnancy register, and from normoglycemic women in antenatal clinics. The Wave 1 substudy included 308 children who completed developmental and behavioral screening between age 18 and 60 months. Developmental risk was assessed using the Ages and Stages Questionnaire (ASQ) or equivalent modified ASQ for use with Aboriginal children. Emotional and behavioral risk was assessed using the Strengths and Difficulties Questionnaire. Multivariable logistic regression was used to assess the association between developmental scores and explanatory variables, including maternal T2D in pregnancy or GDM. After adjustment for ethnicity, maternal and child variables, and socioeconomic measures, maternal hyperglycemia was associated with increased developmental “concern” (defined as score ≥1 SD below mean) in the fine motor (T2D odds ratio (OR) 5.30, 95% CI 1.77–15.80 GDM OR 3.96, 95% CI 1.55–10.11) and problem-solving (T2D OR 2.71, 95% CI 1.05–6.98 GDM OR 2.54, 95% CI 1.17–5.54) domains, as well as increased “risk” (score ≥2 SD below mean) in at least one domain (T2D OR 5.33, 95% CI 1.85–15.39 GDM OR 4.86, 95% CI 1.95–12.10). Higher maternal education was associated with reduced concern in the problem-solving domain (OR 0.27, 95% CI 0.11–0.69) after adjustment for maternal hyperglycemia. Maternal hyperglycemia is associated with increased developmental concern and may be a potential target for intervention so as to optimize developmental trajectories.
Preventing recurrent rheumatic fever: the role of register based programmes
Publisher: BMJ
Date: 09-2005
Maternal body mass index, excess gestational weight gain, and diabetes are positively associated with neonatal adiposity in the Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) s
Publisher: Wiley
Date: 16-01-2019
DOI: 10.1111/IJPO.12490
Abstract: In-utero exposures likely influence the onset and severity of obesity in youth. With increasing rates of type 2 diabetes mellitus (T2DM) and maternal adiposity in pregnancy globally, it is important to assess the impact of these factors on neonatal adipose measures. To evaluate the contribution of maternal ethnicity, body mass index (BMI), gestational weight gain, and hyperglycaemia to neonatal adiposity. Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) is a longitudinal cohort study of Australian mother and neonate pairs. In this analysis, Indigenous (n = 519) and Europid (n = 358) women were included, of whom 644 had hyperglycaemia (type 2 diabetes [T2DM], diabetes in pregnancy [DIP], or gestational diabetes [GDM]). Associations between maternal ethnicity, hyperglycaemia, BMI and gestational weight gain, and the neonatal outcomes of length, head circumference, sum of skinfolds, total body fat, and percentage body fat were examined. Models were adjusted for maternal age, smoking status, parity, education, neonatal gender, and gestational age. Among those with hyperglycaemia in pregnancy, Indigenous women had a higher proportion of T2DM and DIP (36%, 13%) compared with Europid women (4%, 3%). In multivariate analysis, maternal T2DM (compared with no hyperglycaemia), BMI during pregnancy, and excess compared with appropriate gestational weight gain, were significantly associated with greater neonatal measures. DIP was associated with greater sum of skinfolds, total body fat, and percentage body fat. Indigenous ethnicity was associated with greater sum of skinfolds. Maternal BMI, excess gestational weight gain, and hyperglycaemia operated as independent factors influencing neonatal adiposity. Interventions addressing these factors are needed to reduce neonatal adiposity.
Pediatric Mortality Due to Inborn Errors of Metabolism in Victoria, Australia: A Population-Based Study
Publisher: American Medical Association (AMA)
Date: 08-09-2010
Enablers and barriers to primary healthcare for Aboriginal and Torres Strait Islander adolescents: Study protocol for participatory mixed-methods research that builds on WHO global standards
Publisher: BMJ
Date: 04-2021
DOI: 10.1136/BMJOPEN-2020-046459
Abstract: One-third of Australia’s Aboriginal and Torres Strait Islander population are adolescents. Recent data highlight their health needs are substantial and poorly met by existing services. To design effective models of primary healthcare, we need to understand the enablers and barriers to care for Aboriginal and Torres Strait Islander adolescents, the focus of this study. This protocol was codesigned with Apunipima Cape York Health Council that supports the delivery of primary healthcare for 11 communities in Far North Queensland. We framed our study around the WHO global standards for high-quality health services for adolescents, adding an additional standard around culturally safe care. The study is participatory and mixed methods in design and builds on the recommended WHO assessment tools. Formative qualitative research with young people and their communities (exploring concepts in the WHO recommended quantitative surveys) seeks to understand demand-side enablers and barriers to care, as well as preferences for an enhanced response. Supply-side enablers and barriers will be explored through: a retrospective audit of clinic data (to identify current reasons for access and what can be strengthened) an objective assessment of the adolescent friendliness of clinical spaces anonymous feedback from adolescent clients around quality of care received and what can be improved and surveys and qualitative interviews with health providers to understand their perspectives and needs to provide enhanced care. This codesigned project has been approved by Apunipima Cape York Health Council and Far North Queensland Human Research Ethics Committee. The findings from this project will inform a codesigned accessible and responsive model of primary healthcare for Aboriginal and Torres Strait Islander adolescents.
Getting it Right: Study protocol to determine the diagnostic accuracy of a culturally-specific measure to screen for depression in Aboriginal and/or Torres Strait Islander people
Publisher: BMJ
Date: 12-2016
Elevated HDL-bound miR-181c-5p level is associated with diabetic vascular complications in Australian Aboriginal people
Publisher: Springer Science and Business Media LLC
Date: 02-03-2021
DOI: 10.1007/S00125-021-05414-6
Abstract: Diabetes is a major burden on Australia's Indigenous population, with high rates of disease and vascular complications. Diabetic vascular complications are associated with impaired ischaemia-driven angiogenesis. MicroRNAs (miRNAs) are key players in the regulation of angiogenesis. HDL-cholesterol (HDL-c) levels are inversely associated with the risk of developing diabetic complications and HDL can carry miRNAs. HDL-miRNA profiles differ in disease states and may present as biomarkers with the capacity to act as bioactive signalling molecules. Recent studies have demonstrated that HDL becomes dysfunctional in a diabetic environment, losing its vasculo-protective effects and becoming more pro-atherogenic. We sought to determine whether HDL-associated miRNA profiles and HDL functionality were predictive of the severity of diabetic vascular complications in Australia's Indigenous population. HDL was isolated from plasma s les from Indigenous participants without diabetes ('Healthy'), with type 2 diabetes mellitus ('T2DM') and with diabetes-associated macrovascular complications (specifically peripheral artery disease, 'T2DM+Comp'). To assess HDL angiogenic capacity, human coronary artery endothelial cells were treated with PBS, reconstituted HDL (rHDL, positive control) or isolated HDL and then exposed to high-glucose (25 mmol/l) conditions. The expression levels of two anti-angiogenic miRNAs (miR-181c-5p and miR-223-3p) and one pro-angiogenic miRNA (miR-27b-3p) were measured in the HDL fraction, plasma and treated human coronary artery endothelial cells by quantitative real-time PCR. In vitro endothelial tubule formation was assessed using the Matrigel tubulogenesis assay. Strikingly, we found that the levels of the anti-angiogenic miRNA miR-181c-5p were 14-fold higher (1454 ± 1346%) in the HDL from Aboriginal people with diabetic complications compared with both the Healthy (100 ± 121%, p < 0.05) and T2DM (82 ± 77%, p < 0.05) groups. Interestingly, we observed a positive correlation between HDL-associated miR-181c-5p levels and disease severity (p = 0.0020). Under high-glucose conditions, cells treated with rHDL, Healthy HDL and T2DM HDL had increased numbers of tubules (rHDL: 136 ± 8%, p < 0.01 Healthy HDL: 128 ± 6%, p < 0.01 T2DM HDL: 124 ± 5%, p < 0.05) and branch points (rHDL: 138 ± 8%, p < 0.001 Healthy HDL: 128 ± 6%, p < 0.01 T2DM HDL: 127 ± 5%, p < 0.01) concomitant with elevations in mRNA levels of the key hypoxia angiogenic transcription factor HIF1A (rHDL: 140 ± 10%, p < 0.01 Healthy HDL: 136 ± 8%, p < 0.01 T2DM HDL: 133 ± 9%, p < 0.05). However, this increase in angiogenic capacity was not observed in cells treated with T2DM + Comp HDL (tubule numbers: 113 ± 6%, p = 0.32 branch points: 113 ± 5%, p = 0.28 HIF1A: 117 ± 6%, p = 0.43), which could be attributed to the increase in cellular miR-181c-5p levels (T2DM + Comp HDL: 136 ± 7% vs PBS: 100 ± 9%, p < 0.05). In conclusion, HDL from Aboriginal people with diabetic complications had reduced angiogenic capacity. This impairment is associated with an increase in the expression of anti-angiogenic miR-181c-5p. These findings provide the rationale for a new way to better inform clinical diagnosis of disease severity with the potential to incorporate targeted, personalised HDL-miRNA intervention therapies to prevent further development of, or to reverse, diabetic vascular complications in Australian Aboriginal people.
Study protocol: Audit and Best Practice for Chronic Disease Extension (ABCDE) Project
Publisher: Springer Science and Business Media LLC
Date: 17-09-2008
Underuse and overuse of anticoagulation for atrial fibrillation: A study in Indigenous and non-Indigenous Australians
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.IJCARD.2015.03.064
Abstract: Atrial fibrillation (AF) is a leading cause of preventable stroke in Australia. Given that anticoagulation therapy can significantly reduce this stroke risk, we sought to characterise anticoagulation use in Indigenous and non-Indigenous Australians with AF. Administrative, clinical and prescription data from patients with AF were linked. Anticoagulation use was characterised according to guideline-recommended risk scores and Indigenous status. 19,613 in iduals with AF were studied. Despite a greater prevalence of other risk factors, Indigenous Australians were significantly younger than their non-Indigenous counterparts (p<0.001) and thus had lower CHADS₂- (1.19±0.32 vs 1.99±0.47, p<0.001) and CHA₂DS₂VASc-scores (1.47 ± 0.03 vs 2.82 ± 0.08, p<0.001). Correspondingly, the percentage of Indigenous Australians with CHADS₂ ≥ 2 (39.6% vs 44.1%, p<0.001) and CHA₂DS₂VASc-scores ≥ 2 (62.9% vs 78.8%, p<0.001) was also lower. Indigenous Australians, however, had greater rates of under- and over-anticoagulation. Overall, 72.1% and 68.9% of Indigenous and non-Indigenous Australians with CHADS₂ scores ≥2, and 76.3% and 71.3% with CHA₂DS₂VASc scores ≥2, were under-anticoagulated. Similarly, 27.4% and 24.1% of Indigenous and non-Indigenous Australians with CHADS₂ scores=0, and 24.0% and 16.7% with CHA₂DS₂VASc-scores=0, were over-anticoagulated. In multivariate analyses, Indigenous Australians were more likely to receive under- or over-anticoagulation according to CHADS₂- or CHA₂DS₂VASc-score (p=0.045 and p<0.001 respectively). Anticoagulation for AF is frequently not prescribed in accordance with guideline recommendations. Under-anticoagulation in those at high stroke risk, and over-anticoagulation in those at low risk, is common and more likely in Indigenous patients with AF. Improving adherence to guideline recommendations for anticoagulation in AF may reduce both ischaemic and haemorrhagic strokes in Indigenous and non-Indigenous Australians.
Diabetes care in remote Australia: the antenatal, postpartum and inter-pregnancy period
Publisher: Springer Science and Business Media LLC
Date: 28-10-2019
DOI: 10.1186/S12884-019-2562-6
Abstract: Aboriginal and Torres Strait Islander women experience high rates of diabetes in pregnancy (DIP), contributing to health risks for mother and infant, and the intergenerational cycle of diabetes. By enhancing diabetes management during pregnancy, postpartum and the interval between pregnancies, the DIP Partnership aims to improve health outcomes and reduce risks early in the life-course. We describe a mixed methods formative study of health professional’s perspectives of antenatal and post-partum diabetes screening and management, including enablers and barriers to care. Health professionals involved in providing diabetes care in pregnancy, from a range of health services across the Northern Territory, completed the survey ( n = 82) and/or took part in interviews and/or focus groups ( n = 62). Qualitative findings highlighted factors influencing the delivery of care as reported by health professionals, including: whose responsibility it is, access to care, the baby is the focus and pre-conception care. The main challenges were related to: disjointed systems and confusion around whose role it is to provide follow-up care beyond six weeks post-partum. Quantitative findings indicated that the majority of health professionals reported confidence in their own skills to manage women in the antenatal period (62%, 40/79) and slightly lower rates of confidence in the postpartum interval (57%, 33/58). These findings regarding whose role it is to provide postpartum care, along with opportunities to improve communication pathways and follow up care have informed the design of a complex health intervention to improve health systems and the provision of DIP related care.
Getting to the heart of the matter: a research partnership with Aboriginal women in South and Central Australia
Publisher: Informa UK Limited
Date: 22-12-2023
Working Towards Eye Health Equity for Indigenous Australians with Diabetes
Publisher: MDPI AG
Date: 12-12-2019
Abstract: Type 2 diabetes mellitus (T2DM) poses significant challenges to in iduals and broader society, much of which is borne by disadvantaged and marginalised population groups including Indigenous people. The increasing prevalence of T2DM among Indigenous people has meant that rates of diabetes-related complications such as blindness from end-stage diabetic retinopathy (DR) continue to be important health concerns. Australia, a high-income and resource-rich country, continues to struggle to adequately respond to the health needs of its Indigenous people living with T2DM. Trends among Indigenous Australians highlight that the prevalence of DR has almost doubled over two decades, and the prevalence of diabetes-related vision impairment is consistently reported to be higher among Indigenous Australians (5.2%–26.5%) compared to non-Indigenous Australians (1.7%). While Australia has collated reliable estimates of the eye health burden owing to T2DM in its Indigenous population, there is fragmentation of existing data and limited knowledge on the underlying risk factors. Taking a systems approach that investigates the social, environmental, clinical, biological and genetic risk factors, and—importantly—integrates these data, may give valuable insights into the most important determinants contributing to the development of diabetes-related blindness. This knowledge is a crucial initial step to reducing the human and societal impacts of blindness on Indigenous Australians, other priority populations and society at large.
Pregnancy stress, healthy pregnancy and birth outcomes - The need for early preventative approaches in pregnant Australian Indigenous women: A prospective longitudinal cohort study
Publisher: Cambridge University Press (CUP)
Date: 17-01-2019
DOI: 10.1017/S204017441800079X
Abstract: Adverse pregnancy outcomes including prematurity and low birth weight (LBW) have been associated with life-long chronic disease risk for the infant. Stress during pregnancy increases the risk of adverse pregnancy outcomes. Many studies have reported the incidence of adverse pregnancy outcomes in Indigenous populations and a smaller number of studies have measured rates of stress and depression in these populations. This study sought to examine the potential association between stress during pregnancy and the rate of adverse pregnancy outcomes in Australian Indigenous women residing in rural and remote communities in New South Wales. This study found a higher rate of post-traumatic stress disorder, depression and anxiety symptoms during pregnancy than the general population. There was also a higher incidence of prematurity and LBW deliveries. Unfortunately, missing post-traumatic stress disorder and depressive symptomatology data impeded the examination of associations of interest. This was largely due to the highly sensitive nature of the issues under investigation, and the need to ensure adequate levels of trust between Indigenous women and research staff before disclosure and recording of sensitive research data. We were unable to demonstrate a significant association between the level of stress and the incidence of adverse pregnancy outcomes at this stage. We recommend this longitudinal study continue until complete data sets are available. Future research in this area should ensure prioritization of building trust in participants and overestimating s le size to ensure no undue pressure is placed upon an already stressed participant.
Exploring the Reported Strengths and Limitations of Aboriginal and Torres Strait Islander Health Research: A Narrative Review of Intervention Studies
Publisher: MDPI AG
Date: 23-02-2023
Abstract: High quality intervention research is needed to inform evidence-based practice and policy for Aboriginal and Torres Strait Islander communities. We searched for studies published from 2008–2020 in the PubMed database. A narrative review of intervention literature was conducted, where we identified researcher reported strengths and limitations of their research practice. A total of 240 studies met inclusion criteria which were categorised as evaluations, trials, pilot interventions or implementation studies. Reported strengths included community engagement and partnerships s le qualities Aboriginal and Torres Strait Islander involvement in research culturally appropriate and safe research practice capacity building efforts providing resources or reducing costs for services and communities understanding local culture and context and appropriate timelines for completion. Reported limitations included difficulties achieving the target s le size inadequate time insufficient funding and resources limited capacity of health workers and services and inadequate community involvement and communication issues. This review highlights that community consultation and leadership coupled with appropriate time and funding, enables Aboriginal and Torres Strait Islander health intervention research to be conducted. These factors can enable effective intervention research, and consequently can help improve health and wellbeing outcomes for Aboriginal and Torres Strait Islander people.
Intensive LDL Reduction Post Acute Coronary Syndromes: A Catalyst for Improved Outcomes
Publisher: Elsevier BV
Date: 11-2016
Synopsis of an integrated guidance for enhancing the care of familial hypercholesterolaemia
Publisher: Elsevier BV
Date: 06-2021
Twelve-month mortality outcomes for Indigenous and non-Indigenous people admitted to intensive care units in Australia: a registry-based data linkage study.
Publisher: Wiley
Date: 30-10-2022
DOI: 10.5694/MJA2.51763
Abstract: To compare longer term (12-month) mortality outcomes for Indigenous and non-Indigenous people admitted to intensive care units (ICUs) in Australia. Retrospective registry-based data linkage cohort study analysis of all admissions of adults (16 years or older) to Australian ICUs, 1 January 2017 - 31 December 2019, as recorded in the Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database (APD), linked using the SLK-581 key to National Death Index data. Unadjusted and adjusted mortality risk, censored at twelve months from the start of index ICU admission. Secondary outcomes were unadjusted and adjusted mortality twelve months from admission to the ICU. The APD recorded 330 712 eligible ICU admissions during 2017-2019 (65% of all ICU admissions registered), of which 11 322 were of Indigenous people (3.4%). Median age at admission was lower for Indigenous patients (51.2 [IQR, 36.7-63.6] years) than for non-Indigenous patients (66.5 [IQR, 52.7-76.1] years). Unadjusted mortality risk was similar for Indigenous and non-Indigenous patients (hazard ratio, 1.01 95% CI, 0.97-1.06), but was higher for Indigenous patients after adjusting for age, admission diagnosis, illness severity, hospital type, jurisdiction, remoteness and socio-economic status (adjusted hazard ratio, 1.20 95% CI, 1.14-1.27). Twelve-month mortality was higher for Indigenous than non-Indigenous patients (adjusted odds ratio, 1.24 95% CI, 1.16-1.33). Twelve-month mortality outcomes are poorer for people admitted to ICUs in Australia than for the general population. Further, after adjusting for age and other factors, survival outcomes are poorer for Indigenous than non-Indigenous people admitted to ICUs. Critical illness may therefore contribute to shorter life expectancy among Indigenous Australians.
Cord blood metabolic markers are strong mediators of the effect of maternal adiposity on fetal growth in pregnancies across the glucose tolerance spectrum: the PANDORA study
Publisher: Springer Science and Business Media LLC
Date: 08-01-2020
DOI: 10.1007/S00125-019-05079-2
Abstract: We aimed to assess associations between cord blood metabolic markers and fetal overgrowth, and whether cord markers mediated the impact of maternal adiposity on neonatal anthropometric outcomes among children born to Indigenous and Non-Indigenous Australian women with normal glucose tolerance (NGT), gestational diabetes mellitus (GDM) and pregestational type 2 diabetes mellitus. From the Pregnancy and Neonatal Outcomes in Remote Australia (PANDORA) study, an observational cohort of 1135 mother-baby pairs, venous cord blood was available for 645 singleton babies (49% Indigenous Australian) of women with NGT (n = 129), GDM (n = 419) and type 2 diabetes (n = 97). Cord glucose, triacylglycerol, HDL-cholesterol, C-reactive protein (CRP) and C-peptide were measured. Multivariable logistic and linear regression were used to assess the associations between cord blood metabolic markers and the outcomes of birthweight z score, sum of skinfold thickness (SSF), being large for gestational age (LGA) and percentage of body fat. Pathway analysis assessed whether cord markers mediated the associations between maternal and neonatal adiposity. Elevated cord C-peptide was significantly associated with increasing birthweight z score (β 0.57 [95% CI 0.42, 0.71]), SSF (β 0.83 [95% CI 0.41, 1.25]), percentage of body fat (β 1.20 [95% CI 0.69, 1.71]) and risk for LGA [OR 3.14 [95% CI 2.11, 4.68]), after adjusting for age, ethnicity and diabetes type. Cord triacylglycerol was negatively associated with birthweight z score for Indigenous Australian women only. No associations between cord glucose, HDL-cholesterol and CRP >0.3 mg/l (2.9 nmol/l) with neonatal outcomes were observed. C-peptide mediated 18% (95% CI 13, 36) of the association of maternal BMI with LGA and 11% (95% CI 8, 17) of the association with per cent neonatal fat. Cord blood C-peptide is an important mediator of the association between maternal and infant adiposity, across the spectrum of maternal glucose tolerance.
Response to the Letter by Kawada et al. regarding the manuscript entitled The metabolic syndrome and CVD outcomes for a central Australian cohort
Publisher: Elsevier BV
Date: 11-2013
The clinical and genetic features of hereditary pancreatitis in South Australia.
Publisher: Wiley
Date: 16-05-2022
DOI: 10.5694/MJA2.51517
Response to Letter to the Editor: Essential Service Standards for Equitable National Cardiovascular Care for Aboriginal and Torres Strait Islander people
Publisher: Elsevier BV
Date: 06-2015
Effectiveness of fixed dose combination medication (‘polypills’) compared with usual care in patients with cardiovascular disease or at high risk: A prospective, individual patient data meta-analysis
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.IJCARD.2015.12.015
Abstract: To conduct a prospective, in idual participant data (IPD) meta-analysis of randomised controlled trials comparing a polypill-based approach with usual care in high risk in iduals. Three trials comparing polypill-based care with usual care in in iduals with CVD or high calculated cardiovascular risk contributed IPD. Primary outcomes were self-reported adherence to combination therapy (anti-platelet, statin and ≥ two blood pressure (BP) lowering agents), and difference in mean systolic BP (SBP) and LDL-cholesterol at 12 months. Analyses used random effects models. Among 3140 patients from Australia, England, India, Ireland, New Zealand and The Netherlands (75% male, mean age 62 years), median follow-up was 15 months. At baseline, 84%, 87% and 61% respectively were taking a statin, anti-platelet agent and at least two BP lowering agents. At 12 months, compared to usual care, participants in the polypill arm had higher adherence to combination therapy (80% vs. 50%, RR 1.58 95% CI, 1.32 to 1.90 p < 0.001), lower SBP (-2.5 mmHg 95% CI, -4.5 to -0.4 p = 0.02) and lower LDL-cholesterol (-0.1 mmol/L 95% CI, -0.2 to 0.0 p = 0.04). Baseline treatment levels were a major effect modifier for adherence and SBP (p-homog < 0.0001 and 0.02 respectively) with greatest improvements seen among those under-treated at baseline. Polypill therapy significantly improved adherence, SBP and LDL-cholesterol in high risk patients compared with usual care, especially among those who were under-treated at baseline.
Determinants of achieving early blood pressure control with monotherapy in a primary care setting
Publisher: Wiley
Date: 16-07-2013
DOI: 10.1111/JCH.12164
Cohort profile: indigenous human papillomavirus and oropharyngeal squamous cell carcinoma study - a prospective longitudinal cohort
Publisher: BMJ
Date: 06-2021
DOI: 10.1136/BMJOPEN-2020-046928
Abstract: Our aims are to: (1) estimate prevalence, incidence, clearance and persistence of oral human papillomavirus (HPV) infection among Indigenous Australians (2) identify risk factors associated with oropharyngeal squamous cell carcinoma (OPSCC)-related HPV types (HPV 16 or 18) (3) develop HPV-related health state valuations and (4) determine the impact on OPSCC and cervical cancers, and the cost-effectiveness of extending publicly-funded HPV vaccination among Indigenous Australians. Participants were recruited from February 2018 to January 2019. Twelve-month follow-up occurred from March 2019 to March 2020. Participants provided socio-demographic characteristics, health-related behaviours including tobacco and alcohol use and sexual history. Health state preferences in regard to HPV vaccination, knowledge regarding HPV infection, OPSCC and cervical cancer were collected using a two-stage standard gamble approach. Participants provided saliva s les and DNA for microbial genotyping was extracted. Of the 910 participants who were positive for β-globin at baseline, 35% had any oral HPV infection. The most prevalent HPV types were 13 or 32 (Heck’s disease 23%). The second most prevalent types were associated with OPSCC (HPV 16 or 18 3.3%). Of the 645 participants who were positive for β-globin at 12-month follow-up, 43% had any HPV infection. Of these, 33% were HPV types 13 or 32 and 2.5% were HPV 16 or 18. Some 588 participants had β-globin positive oral s les at baseline and 12-month follow-up. The prevalence of any oral HPV infection increased from 34% at baseline to 44% at 12-month follow-up due to increases in HPV types 13 or 32 (20% at baseline and 34% at 12-month follow-up). Further funding will be sought to continue follow-up of this cohort, and to include (after a full medical history) a thorough clinical examination of the external head and neck a complete oral examination and examination of the oropharynx. Blood tests for early stage OPSCC will also be undertaken.
Oral health of aboriginal people with kidney disease living in Central Australia
Publisher: Springer Science and Business Media LLC
Date: 04-02-2021
DOI: 10.1186/S12903-021-01415-4
Abstract: Associations between kidney disease and periodontal disease are not well documented among Aboriginal people of Australia. The purpose of this investigation was to report and compare demographic, oral health, anthropometric and systemic health status of Aboriginal Australians with kidney disease and to compare against relevant Aboriginal Australians and Australian population estimates. This provides much needed evidence to inform dental health service provision policies for Aboriginal Australians with kidney disease. S le frequencies and means were assessed in adults represented in six datasets including: (1) 102 Aboriginal Australians with kidney disease residing in Central Australia who participated in a detailed oral health assessment (2) 312 Aboriginal participants of the Northern Territory’s PerioCardio study (3) weighted estimates from 4775 participants from Australia’s National Survey of Adult Oral Health (NSAOH) (4) Australian 2016 Census (all Australians) (5) National Health Survey 2017–2018 (all Australians) and (6) Australian Health Survey: Biomedical Results for Chronic Diseases, 2011–2012 (all Australians). Oral health status was described by periodontal disease and experience of dental caries (tooth decay). Statistically significant differences were determined via non-overlapping 95% confidence intervals. Aboriginal Australians with kidney disease were significantly older, less likely to have a tertiary qualification or be employed compared with both PerioCardio study counterparts and NSAOH participants. Severe periodontitis was found in 54.3% of Aboriginal Australians with kidney disease, almost 20 times the 2.8% reported in NSAOH. A higher proportion of Aboriginal Australians with kidney disease had teeth with untreated caries and fewer dental restorations when compared to NSAOH participants. The extent of periodontal attachment loss and periodontal pocketing among Aboriginal Australians with kidney disease (51.0%, 21.4% respectively) was several magnitudes greater than PerioCardio study (22.0%, 12.3% respectively) and NSAOH (5.4%, 1.3% respectively) estimates. Aboriginal Australians with kidney disease exhibited more indicators of poorer oral health than both the general Australian population and a general Aboriginal population from Australia’s Northern Territory. It is imperative that management of oral health among Aboriginal Australians with kidney disease be included as part of their ongoing medical care.
Measuring the gap—It may well be worse than we thought
Publisher: Elsevier BV
Date: 12-2010
A scoping review of Aboriginal and Torres Strait Islander health promotion programs focused on modifying chronic disease risk factors
Publisher: Wiley
Date: 09-12-2021
DOI: 10.1002/HPJA.307
Tackling Cardiovascular Risk in Type 2 Diabetes: Does Baseline Glucose Control Matter?
Publisher: Elsevier BV
Date: 10-2018
Quality and Reliability of Current Measurements: A case study of overlapping ADCP datasets obtained in deep water Gulf of Mexico
Publisher: IEEE
Date: 2008
Pregnancy And Neonatal Diabetes Outcomes in Remote Australia: the PANDORA study—an observational birth cohort
Publisher: Oxford University Press (OUP)
Date: 30-11-2018
DOI: 10.1093/IJE/DYY245
Abstract: In Australia's Northern Territory, 33% of babies are born to Indigenous mothers, who experience high rates of hyperglycemia in pregnancy. We aimed to determine the extent to which pregnancy outcomes for Indigenous Australian women are explained by relative frequencies of diabetes type [type 2 diabetes (T2DM) and gestational diabetes (GDM)]. This prospective birth cohort study examined participants recruited from a hyperglycemia in pregnancy register. Baseline data collected were antenatal and perinatal clinical information, cord blood and neonatal anthropometry. Of 1135 women (48% Indigenous), 900 had diabetes: 175 T2DM, 86 newly diagnosed diabetes in pregnancy (DIP) and 639 had GDM. A group of 235 women without hyperglycemia in pregnancy was also recruited. Diabetes type differed for Indigenous and non-Indigenous women (T2DM, 36 vs 5% DIP, 15 vs 7% GDM, 49 vs 88%, p < 0.001). Within each diabetes type, Indigenous women were younger and had higher smoking rates. Among women with GDM/DIP, Indigenous women demonstrated poorer birth outcomes than non-Indigenous women: large for gestational age, 19 vs 11%, p = 0·002 neonatal fat 11.3 vs 10.2%, p < 0.001. In the full cohort, on multivariate regression, T2DM and DIP were independently associated (and Indigenous ethnicity was not) with pregnancy outcomes. Higher rates of T2DM among Indigenous women predominantly contribute to absolute poorer pregnancy outcomes among Indigenous women with hyperglycemia. As with Indigenous and minority populations globally, prevention or delay of type 2 diabetes in younger women is vital to improve pregnancy outcomes and possibly to improve the long-term health of their offspring.
Human Papillomavirus and Oropharyngeal Cancer Among Indigenous Australians: Protocol for a Prevalence Study of Oral-Related Human Papillomavirus and Cost-Effectiveness of Prevention
Publisher: JMIR Publications Inc.
Date: 08-06-2018
DOI: 10.2196/10503
Critically ill Indigenous Australians and mortality: a complex story
Publisher: AMPCo
Date: 13-06-2020
DOI: 10.5694/MJA2.50661
Investigating the feasibility, acceptability and appropriateness of outreach case management in an urban Aboriginal and Torres Strait Islander primary health care service: a mixed methods exploratory
Publisher: Springer Science and Business Media LLC
Date: 13-05-2016
Understanding culturally safe aged care from the perspectives of older Aboriginal Australians in rural and remote communities
Publisher: Wiley
Date: 24-09-2022
DOI: 10.1002/HPJA.541
Abstract: Aboriginal and Torres Strait Islander peoples face challenges in accessing aged care and are less likely to use some services than their non‐Indigenous counterparts. Culturally safe care is increasingly recognised as an enabler to improve access and quality of care. This study explored older Aboriginal peoples’ perceptions and experience of culturally safe aged care. We conducted semi‐structured interviews with sixty‐three older Aboriginal people, purposively s led from three rural and remote geographic locations in South Australia, between April and October 2018, with participants who were both receiving and not receiving aged care services. We asked participants how organisations do or could meet their aged care needs. We analysed interview data inductively into themes. These themes were incorporated into six principles of culturally safe aged care which were subsequently endorsed by participants and study stakeholders. Participants described culturally safe aged care services as those which facilitated or maintained connection to participants’ culture, traditional lands and community. Five themes were identified: maintaining cultural identity, culturally informed service delivery, culturally competent workforce, culturally supportive environments and partnerships and collaboration within the aged care service system. Addressing cultural safety in aged care will require organisations to adapt their policies, service delivery, environments and work practices to meet the needs of older Aboriginal peoples. SO WHAT? Identifying culturally safe aged care from the perspectives of older Aboriginal and Torres Strait Islander peoples provides timely insight to how services may be better designed and implemented to promote quality of life.
High Baseline Levels of Tumor Necrosis Factor Receptor 1 Are Associated With Progression of Kidney Disease in Indigenous Australians With Diabetes: The eGFR Follow-up Study
Publisher: American Diabetes Association
Date: 24-01-2018
DOI: 10.2337/DC17-1919
Abstract: To examine the association between soluble tumor necrosis factor receptor 1 (sTNFR1) levels and kidney disease progression in Indigenous Australians at high risk of kidney disease. This longitudinal observational study examined participants aged ≥18 years recruited from & sites across diabetes and/or kidney function strata. Baseline measures included sTNFR1, serum creatinine, urine albumin-to-creatinine ratio (uACR), HbA1c, C-reactive protein (CRP), waist-to-hip ratio, systolic blood pressure, and medical history. Linear regression was used to estimate annual change in estimated glomerular filtration rate (eGFR) for increasing sTNFR1, and Cox proportional hazards were used to estimate the hazard ratio (HR) and 95% CI for developing a combined renal outcome (first of a ≥30% decline in eGFR with a follow-up eGFR & mL/min/1.73 m2, progression to renal replacement therapy, or renal death) for increasing sTNFR1. Over a median of 3 years, participants with diabetes (n = 194) in the highest compared with the lowest quartile of sTNFR1 experienced significantly greater eGFR decline (−4.22 mL/min/1.73 m2/year [95% CI −7.06 to −1.38] P = 0.004), independent of baseline age, sex, eGFR, and uACR. The adjusted HR (95% CI) for participants with diabetes per doubling of sTNFR1 for the combined renal outcome (n = 32) was 3.8 (1.1–12.8 P = 0.03). No association between sTNFR1 and either renal outcome was observed for those without diabetes (n = 259). sTNFR1 is associated with greater kidney disease progression independent of albuminuria and eGFR in Indigenous Australians with diabetes. Further research is required to assess whether TNFR1 operates independently of other metabolic factors associated with kidney disease progression.
‘We get so task orientated at times that we forget the people’: staff communication experiences when caring for Aboriginal cardiac patients
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/AH17290
Abstract: Objective The aim of this study was to describe the experiences of communication for staff providing cardiac care for Aboriginal and Torres Strait Islander patients in hospital and discuss potential improvements. Methods Focus group discussions were performed with 58 multidisciplinary staff who provide care for Aboriginal and Torres Strait Islander cardiac patients in two metropolitan and two regional hospitals in South Australia and Northern Territory. Inductive thematic analysis was undertaken to identify staff perceptions of communication challenges and strategies for improvement. Results There were five key themes: (1) communication is central to good care (2) communication within busy clinical environments (3) supporting a strong Aboriginal workforce (4) a cultural as well as clinical focus and (5) particular challenges working with patients from remote areas. Conclusions Providing effective communication that is both clinically and culturally appropriate is often challenging within a busy and non-adaptive hospital environment. Moving beyond clinical tasks, increased Aboriginal and Torres Strat Islander health workforce and cultural competency, supporting coordinated care and improved skills are required to meet the communication needs of Aboriginal and Torres Strait Islander patients. What is known about this topic? Communication between patients, their families and hospital staff is crucial for health care quality and safety. There is little understanding of the challenges and opportunities for staff to meet the communication needs of Aboriginal and Torres Strait Islander cardiac patients to address disparities in acute care settings. What does this paper add? This paper discusses the barriers and potential improvements, as identified by hospital staff providing care to Aboriginal and Torres Strait Islander cardiac patients in both metropolitan and regional settings. What are the implications for practitioners? Practitioners should be trained and supported in providing both clinically and culturally safe care for Aboriginal and Torres Strait Islander patients. This requires adequate time, two-way communication and resources to support and facilitate effective communication.
The fraction of life years lost after diagnosis (FLYLAD): a person-centred measure of cancer burden
Publisher: Springer Science and Business Media LLC
Date: 13-09-2023
Efficacy and safety of tenecteplase in combination with enoxaparin, abciximab, or unfractionated heparin: the ASSENT-3 randomised trial in acute myocardial infarction
Publisher: Elsevier BV
Date: 08-2001
Cancer Data and Aboriginal Disparities Project (CanDAD) - an overdue cancer control initiative
Publisher: Hindawi Limited
Date: 26-02-2016
DOI: 10.1111/ECC.12466
Epidemiology of Sudden Cardiac Death: Global and Regional Perspectives
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.HLC.2018.08.026
Abstract: Despite advancements in prevention and treatment, sudden cardiac death (SCD) remains a leading cause of mortality and is responsible for approximately half of all deaths from cardiovascular disease. Outcomes continue to remain poor following a sudden cardiac arrest, with most in iduals not surviving. Although coronary heart disease remains the dominant underlying condition, our understanding of SCD is improving through greater knowledge of clinical risk factors, cardiomyopathies, and primary arrhythmic disorders. However, despite a growing wealth of information from studies in North America, Europe, and Japan, data from other global regions (and particularly from low-and middle-income countries) remains scarce.
Periodontal disease and chronic kidney disease among Aboriginal adults; an RCT
Publisher: Springer Science and Business Media LLC
Date: 31-10-2015
What Becomes of the Broken Hearted? Coronary Heart Disease as a Paradigm of Cardiovascular Disease and Poor Health Among Indigenous Australians
Publisher: Elsevier BV
Date: 09-2005
Telehealth in Australia: an evolution in health care services
Publisher: AMPCo
Date: 07-2013
DOI: 10.5694/MJA12.11324
Influence of maternal adiposity, preterm birth and birth weight centiles on early childhood obesity in an Indigenous Australian pregnancy-through-to-early-childhood cohort study
Publisher: Cambridge University Press (CUP)
Date: 16-05-2019
DOI: 10.1017/S2040174418000302
Abstract: Childhood obesity rates are higher among Indigenous compared with non-Indigenous Australian children. It has been hypothesized that early-life influences beginning with the intrauterine environment predict the development of obesity in the offspring. The aim of this paper was to assess, in 227 mother–child dyads from the Gomeroi gaaynggal cohort, associations between prematurity, Gestation Related-Optimal Weight (GROW) centiles, maternal adiposity (percentage body fat, visceral fat area), maternal non-fasting plasma glucose levels (measured at mean gestational age of 23.1 weeks) and offspring BMI and adiposity (abdominal circumference, subscapular skinfold thickness) in early childhood (mean age 23.4 months). Maternal non-fasting plasma glucose concentrations were positively associated with infant birth weight ( P =0.005) and GROW customized birth weight centiles ( P =0.008). There was a significant association between maternal percentage body fat ( P =0.02) and visceral fat area ( P =0.00) with infant body weight in early childhood. Body mass index (BMI) in early childhood was significantly higher in offspring born preterm compared with those born at term ( P =0.03). GROW customized birth weight centiles was significantly associated with body weight ( P =0.01), BMI ( P =0.007) and abdominal circumference ( P =0.039) at early childhood. Our findings suggest that being born preterm, large for gestational age or exposed to an obesogenic intrauterine environment and higher maternal non-fasting plasma glucose concentrations are associated with increased obesity risk in early childhood. Future strategies should aim to reduce the prevalence of overweight/obesity in women of child-bearing age and emphasize the importance of optimal glycemia during pregnancy, particularly in Indigenous women.
Aboriginal and Torres Strait Islander patients requiring critical care: characteristics, resource use, and outcomes
Publisher: Elsevier BV
Date: 09-2019
“Language Breathes Life”—Barngarla Community Perspectives on the Wellbeing Impacts of Reclaiming a Dormant Australian Aboriginal Language
Publisher: MDPI AG
Date: 15-10-2019
Abstract: Traditional languages are a key element of Indigenous peoples’ identity, cultural expression, autonomy, spiritual and intellectual sovereignty, and wellbeing. While the links between Indigenous language loss and poor mental health have been demonstrated in several settings, little research has sought to identify the potential psychological benefits that may derive from language reclamation. The revival of the Barngarla language on the Eyre Peninsula, South Australia, offers a unique opportunity to examine whether improvements in mental health and social and emotional wellbeing can occur during and following the language reclamation process. This paper presents findings from 16 semi-structured interviews conducted with Barngarla community members describing their own experienced or observed mental health and wellbeing impacts of language reclamation activities. Aligning with a social and emotional wellbeing framework from an Aboriginal and Torres Strait Islander perspective, key themes included connection to spirituality and ancestors connection to Country connection to culture connection to community connection to family and kinship connection to mind and emotions and impacts upon identity and cultural pride at an in idual level. These themes will form the foundation of assessment of the impacts of language reclamation in future stages of the project.
Feasibility of once weekly exenatide-LAR and enhanced diabetes care in Indigenous Australians with type 2 diabetes. (Long-acting-Once-Weekly-Exenatide laR-SUGAR, Lower SUGAR study).
Publisher: Wiley
Date: 09-2021
DOI: 10.1111/IMJ.15428
Abstract: Diabetes is 3‐4 times more prevalent in Indigenous Australians with blood glucose levels often above target range. Once weekly formulations of exenatide(exenatide‐LAR) have demonstrated significantly greater improvements in glycaemic management with no increased risk of hypoglycaemia and with reductions in bodyweight but have not been studied in Indigenous Australians. To assess the feasibility and metabolic effects of once weekly supervised injection of exenatide‐LAR in addition to standard care in Indigenous Australians with type 2 diabetes. Two communities in Central Australia with longstanding specialist clinical outreach services were allocated by random coin toss to receive once‐weekly exenatide‐LAR injection with weekly nurse review and adjustment of medication for 20 weeks (community with exenatide‐LAR) or to weekly nurse review in addition to standard care over 20 weeks (community without exenatide‐LAR). The primary outcome was the feasibility of an intensive diabetes management model of care with and without weekly supervised exenatide‐LAR. Secondary outcomes included change in HbA1c. Thirteen participants from the community with exenatide‐LAR and nine participants from the community without exenatide‐LAR were analysed. Eighty‐five percent of in iduals in the community with exenatide‐LAR and 67% in the community without exenatide‐LAR attended more than half of clinic visits. Median difference in the change in HbA1c from baseline to final visit, adjusted for baseline HbA1c, between the community with exenatide‐LAR and the community without exenatide‐LAR was −3.1%, 95% CI (−5.80%, −0.38% P = 0.03). Weekly exenatide‐LAR combined with weekly nurse review demonstrated greater improvements in HbA1c, highlighting its potential for use in remote communities.
Non-communicable diseases, infection and survival in a retrospective cohort of Indigenous and non-Indigenous adults in Central Australia
Publisher: BMJ
Date: 07-2013
Cancer data and aboriginal disparities (CanDAD)-developing an Advanced Cancer Data System for Aboriginal people in South Australia: A mixed methods research protocol
Publisher: BMJ
Date: 12-2016
Quantitative evaluation of an outreach case management model of care for urban Aboriginal and Torres Strait Islander adults living with complex chronic disease: a longitudinal study
Publisher: Springer Science and Business Media LLC
Date: 06-10-2020
DOI: 10.1186/S12913-020-05749-7
Abstract: Chronic diseases are the leading contributor to the excess morbidity and mortality burden experienced by Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) people, compared to their non-Indigenous counterparts. The Home-based Outreach case Management of chronic disease Exploratory (HOME) Study provided person-centred, multidisciplinary care for Indigenous people with chronic disease. This model of care, aligned to Indigenous peoples’ conceptions of health and wellbeing, was integrated within an urban Indigenous primary health care service. We aimed to determine the impact of this model of care on participants’ health and wellbeing at 12 months. HOME Study participants were Indigenous, regular patients of the primary health care service, with a diagnosis of at least one chronic disease, and complex health and social care needs. Data were collected directly from participants and from their medical records at baseline, and 3, 6 and 12 months thereafter. Variables included self-rated health status, depression, utilisation of health services, and key clinical outcomes. Participants’ baseline characteristics were described using frequencies and percentages. Generalized estimating equation (GEE) models were employed to evaluate participant attrition and changes in outcome measures over time. 60 participants were enrolled into the study and 37 (62%) completed the 12-month assessment. After receiving outreach case management for 12 months, 73% of participants had good, very good or excellent self-rated health status compared with 33% at baseline ( p 0.001) and 19% of participants had depression compared with 44% at baseline ( p = 0.03). Significant increases in appointments with allied health professionals ( p 0.001) and medical specialists other than general practitioners ( p = 0.001) were observed at 12-months compared with baseline rates. Mean systolic blood pressure decreased over time ( p = 0.02), but there were no significant changes in mean HbA1c, body mass index, or diastolic blood pressure. The HOME Study model of care was predicated on a holistic conception of health and aimed to address participants’ health and social care needs. The positive changes in self-rated health and rates of depression evinced that this aim was met, and that participants received the necessary care to support and improve their health and wellbeing.
Strengthening assessment and response to mental health needs for Aboriginal and Torres Strait Islander children and adolescents in primary care settings: study protocol for the Ngalaiya Boorai Gabara
Publisher: BMJ
Date: 09-2022
DOI: 10.1136/BMJOPEN-2022-063154
Abstract: Opportunities for improved mental health and wellbeing of Aboriginal and Torres Strait Islander children and young people lie in improving the capability of primary healthcare services to identify mental healthcare needs and respond in timely and appropriate ways. The development of culturally appropriate mental health assessment tools and clinical pathways have been identified as opportunities for strengthening workforce capacity in this area. The Ngalaiya Boorai Gabara Budbut implementation project seeks to pursue these opportunities by developing and validating a psychosocial assessment tool, understanding what services need to better care for your people and developing resources that address those needs. The project will be governed by a research governance group comprising Aboriginal service providers, young people, and researchers. It will be implemented in an urban health service in Canberra, and regional services in Moree, Wollongong, and the Illawarra regions of New South Wales Australia. The validation study will follow an argument-based approach, assessing cultural appropriateness and ease of use test–retest validity internal consistency, construct validity and the quality of decisions made based on the assessment. Following piloting with a small group of young people and their caregivers (n=10), participants (n=200) will be young people and/or their caregivers, attending one of the partner services. The needs assessment will involve an in-depth exploration of service via an online survey (n=60) and in-depth interviews with service providers (n=16) and young people (n=16). These activities will run concurrently. Service providers, researchers and the governance group will codesign resources that respond to the needs identified and pilot them through the participating services. The Aboriginal Health and Medical Research Council of NSW Human Research Ethics committee (#1769/21) has approved this project. Informed consent will be obtained from all participants and/or their caregivers (with assent from those aged years) prior to participating in all aspects of the study. Research dissemination will occur through participating health services, academic journal articles and conference presentations.
Health‐related behaviours in a remote Indigenous population with Type 2 diabetes: a Central Australian primary care survey in the Telehealth Eye and Associated Medical Services Network [TEAMS
Publisher:
Wiley
Date:
09-09-2019
DOI:
10.1111/DME.14099
Abstract: There is a wealth of data concerning the health behaviours of Indigenous Australians, but the health behaviours of Indigenous Australians with diabetes are not systematically documented. At the clinical level, understanding a person's health behaviours can help identify and address barriers to diabetes care and promote good clinical outcomes. We used a novel survey tool to systematically collect health behaviour data on Smoking, Nutrition, Alcohol consumption, Physical activity and Emotional well-being (SNAPE) from Indigenous Australians with Type 2 diabetes in a remote primary care setting in Alice Springs. At least one of the five surveys in the SNAPE tool was completed by 210 participants: 30% male, mean age 52.6 years (range 22.9 - 87.4). Fifty per cent of men and 23% of women were current smokers (P < 0.001). None of the participants reported an adequate intake of vegetables. Only 9.6% reported an adequate fruit intake. Some 49% of men and 32% of women consumed alcohol in the past year (P = 0.022), and 46% of drinkers were considered high-risk or likely-dependent drinkers. On average, participants walked 10 min or more at a time 6.0 days a week and spent 4.8 h sitting on a weekday. Mean adapted Patient Health Questionnaire 9 score was 4.61, with 34% of participants having mild depressive symptoms and 11% having moderate-severe depressive symptoms. Our SNAPE survey tool results present a high-risk, disadvantaged Indigenous population with Type 2 diabetes. More resources will be needed to sustainably implement interventions with the goal of improving health behaviours and subsequent long-term health.
Publisher: Wiley
Date: 09-09-2019
DOI: 10.1111/DME.14099
Abstract: There is a wealth of data concerning the health behaviours of Indigenous Australians, but the health behaviours of Indigenous Australians with diabetes are not systematically documented. At the clinical level, understanding a person's health behaviours can help identify and address barriers to diabetes care and promote good clinical outcomes. We used a novel survey tool to systematically collect health behaviour data on Smoking, Nutrition, Alcohol consumption, Physical activity and Emotional well-being (SNAPE) from Indigenous Australians with Type 2 diabetes in a remote primary care setting in Alice Springs. At least one of the five surveys in the SNAPE tool was completed by 210 participants: 30% male, mean age 52.6 years (range 22.9 - 87.4). Fifty per cent of men and 23% of women were current smokers (P < 0.001). None of the participants reported an adequate intake of vegetables. Only 9.6% reported an adequate fruit intake. Some 49% of men and 32% of women consumed alcohol in the past year (P = 0.022), and 46% of drinkers were considered high-risk or likely-dependent drinkers. On average, participants walked 10 min or more at a time 6.0 days a week and spent 4.8 h sitting on a weekday. Mean adapted Patient Health Questionnaire 9 score was 4.61, with 34% of participants having mild depressive symptoms and 11% having moderate-severe depressive symptoms. Our SNAPE survey tool results present a high-risk, disadvantaged Indigenous population with Type 2 diabetes. More resources will be needed to sustainably implement interventions with the goal of improving health behaviours and subsequent long-term health.
Comorbidities contribute to the risk of cancer death among Aboriginal and non-Aboriginal South Australians: Analysis of a matched cohort study
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.CANEP.2017.12.005
Abstract: Aboriginal Australians have poorer cancer survival than other Australians. Diagnoses at later stages and correlates of remote area living influence, but do not fully explain, these disparities. Little is known of the prevalence and influence of comorbid conditions experienced by Aboriginal people, including their effect on cancer survival. This study quantifies hospital recorded comorbidities using the Elixhauser Comorbidity Index (ECI), examines their influence on risk of cancer death, then considers effect variation by Aboriginality. Cancers diagnosed among Aboriginal South Australians in 1990-2010 (N = 777) were matched with randomly selected non-Aboriginal cases by birth year, diagnostic year, sex, and primary site, then linked to administrative hospital records to the time of diagnosis. Competing risk regression summarised associations of Aboriginal status, stage, geographic attributes and comorbidities with risk of cancer death. A threshold of four or more ECI conditions was associated with increased risk of cancer death (sub-hazard ratio SHR 1.66, 95%CI 1.11-2.46). Alternatively, the presence of any one of a subset of ECI conditions was associated with similarly increased risk (SHR = 1.62, 95%CI 1.23-2.14). The observed effects did not differ between Aboriginal and matched non-Aboriginal cases. However, Aboriginal cases experienced three times higher exposure than non-Aboriginal to four or more ECI conditions (14.2% versus 4.5%) and greater exposure to the subset of ECI conditions (20.7% versus 8.0%). Comorbidities at diagnosis increased the risk of cancer death in addition to risks associated with Aboriginality, remoteness of residence and disease stage at diagnosis. The Aboriginal cohort experienced comparatively greater exposure to comorbidities which adds to disparities in cancer outcomes.
The impact of an alcohol floor price on critical care admissions in Central Australia.
Publisher: AMPCo
Date: 12-11-2020
DOI: 10.5694/MJA2.50404
Landscape of clinical trial activity focusing on Indigenous health in Australia: an overview using clinical trial registry data from 2008-2018
Publisher: Springer Science and Business Media LLC
Date: 14-05-2022
DOI: 10.1186/S12889-022-13338-Y
Abstract: Aboriginal and Torres Strait Islander peoples (hereafter respectfully referred to as Indigenous Australians) represent about 3% of the total Australian population. Major health disparities exist between Indigenous and Non-Indigenous Australians. To address this, it is vital to understand key health priorities and knowledge gaps in the current landscape of clinical trial activity focusing on Indigenous health in Australia. Australian-based clinical trials registered on the Australian New Zealand Clinical Trials Registry or ClinicalTrials.gov from 2008 to 2018 were analysed. Australian clinical trials with and without a focus on Indigenous health were compared in terms of total numbers, participant size, conditions studied, design, intervention type and funding source. Of the 9206 clinical trials included, 139 (1.5%) focused on Indigenous health, with no proportional increase in Indigenous trials over the decade ( p = 0.30). Top conditions studied in Indigenous-focused trials were mental health ( n = 35, 28%), cardiovascular disease ( n = 20, 20%) and infection ( n = 16, 16%). Compared to General Australian trials, Indigenous-focused trials more frequently studied ear conditions (OR 20.26, 95% CI 10.32–37.02, p 0.001), infection (OR 3.11, 95% CI 1.88–4.85, p 0.001) and reproductive health (OR 2.59, 95% CI 1.50–4.15, p 0.001), and less of musculoskeletal conditions (OR 0.09, 95% CI 0.00–0.37, p 0.001), anaesthesiology (OR 0.16, 95% CI 0.01–0.69, p = 0.021) and surgery (OR 0.17, 95% CI 0.01–0.73, p = 0.027). For intervention types, Indigenous trials focused more on prevention ( n = 48, 36%) and screening ( n = 18, 13%). They were far less involved in treatment ( n = 72, 52%) as an intervention than General Australian trials ( n = 6785, 75%), and were less likely to be blinded ( n = 48, 35% vs n = 4273, 47%) or have industry funding ( n = 9, 7% vs 1587, 17%). Trials with an Indigenous focus differed from General Australian trials in the conditions studied, design and funding source. The presented findings may inform research prioritisation and alleviate the substantial burden of disease for Indigenous population.
Cardiovascular disease risk assessment for Aboriginal and Torres Strait Islander adults aged under 35 years: a consensus statement
Publisher: AMPCo
Date: 15-03-2020
DOI: 10.5694/MJA2.50529
Long term outcomes for Aboriginal and Torres Strait Islander Australians after hospital intensive care
Publisher: AMPCo
Date: 02-06-2020
DOI: 10.5694/MJA2.50649
Assessing quality of diabetes care and its variation in Aboriginal community health centres in Australia
Publisher: Wiley
Date: 15-01-2010
DOI: 10.1002/DMRR.1062
Abstract: Examining variation in diabetes care across regions/organizations provides insight into underlying factors related to quality of care. The aims of this study were to assess quality of diabetes care and its variation among Aboriginal community health centres in Australia, and to estimate partitioning of variation attributable to health centre and in idual patient characteristics. During 2005-2009, clinical medical audits were conducted in 62 Aboriginal community health centres from four states/territories. Main outcome measures include adherence to guidelines-scheduled processes of diabetes care, treatment and medication adjustment, and control of HbA(1c), blood pressure, total cholesterol and albumin/creatinine ratio (ACR). Wide variation was observed across different categories of diabetes care measures and across centres: (1) overall adherence to delivery of services averaged 57% (range 22-83% across centres) (2) medication adjustment rates after elevated HbA(1c): 26% (0-72%) and (3) proportions of patients with HbA(1c) < 7%:27% (0-55%) with blood pressure < 130/80 mmHg: 36% (0-59%). Health centre level characteristics accounted for 36% of the total variation in adherence to process measures, and 3-11% of the total variation in patient intermediate outcomes the remaining, substantial amount of variation in each measure was attributable to patient level characteristics. Deficiencies in a range of quality of care measures provide multiple opportunities for improvement. The majority of variation in quality of diabetes care appears to be attributable to patient level characteristics. Further understanding of factors affecting variation in the care of in iduals should assist clinicians, managers and policy makers to develop strategies to improve quality of diabetes care in Aboriginal communities.
Characteristics and value of Aboriginal Community Controlled Health Organizations' primary health care and their financing needs: a protocol for systematic evidence reviews.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2015
Mastery, perceived stress and health-related behaviour in northeast Arnhem Land: A cross-sectional study
Publisher: Springer Science and Business Media LLC
Date: 27-09-2006
Associations of gestational diabetes and type 2 diabetes during pregnancy with breastfeeding at hospital discharge and up to 6 months: the PANDORA study
Publisher: Springer Science and Business Media LLC
Date: 10-09-2020
Listen, understand, collaborate: developing innovative strategies to improve health service utilisation by Aboriginal and Torres Strait Islander men
Publisher: Elsevier BV
Date: 08-2019
Periodontal therapy and glycaemic control among individuals with type 2 diabetes: reflections from the PerioCardio study
Publisher: Wiley
Date: 06-2017
DOI: 10.1111/IDH.12234
Abstract: Diabetes mellitus and periodontal disease are highly prevalent among Indigenous Australian adults. Untreated periodontitis impacts glycaemic control in people with diabetes. The aim of this study was to report on the effect of periodontal therapy on glycaemic control among people with obesity. This subgroup analysis is limited to 62 participants with diabetes from the original 273 Aboriginal Australian adults enrolled into the PerioCardio study. Intervention participants received full-mouth non-surgical periodontal scaling during a single, untimed session while controls were untreated. Endpoints of interest included change in glycated haemoglobin (HbA1c), C-reactive protein (CRP) and periodontal status at 3 months post-intervention. There were more females randomized to the treatment group (n = 17) than control (n = 10) while the control group had a higher overall body mass index (BMI) [mean (SD)] 33.1 (9.7 kg m Non-surgical periodontal therapy did not significantly reduce glycated haemoglobin in participants with type 2 diabetes. Reasons are likely to be multifactorial and may be influenced by persistent periodontal inflammation at the follow-up appointments. Alternatively, the BMI of study participants may impact glycaemic control via alternative mechanisms involving the interplay between inflammation and adiposity meaning HbA1c may not be amenable to periodontal therapy in these in iduals.
Rationale and design of the Kanyini guidelines adherence with the polypill (Kanyini-GAP) study: A randomised controlled trial of a polypill-based strategy amongst Indigenous and non Indigenous people at high cardiovascular risk
Publisher: Springer Science and Business Media LLC
Date: 05-08-2010
Abstract: The Kanyini Guidelines Adherence with the Polypill (Kanyini-GAP) Study aims to examine whether a polypill-based strategy (using a single capsule containing aspirin, a statin and two blood pressure-lowering agents) amongst Indigenous and non-Indigenous people at high risk of experiencing a cardiovascular event will improve adherence to guideline-indicated therapies, and lower blood pressure and cholesterol levels. The study is an open, randomised, controlled, multi-centre trial involving 1000 participants at high risk of cardiovascular events recruited from mainstream general practices and Aboriginal Medical Services, followed for an average of 18 months. The participants will be randomised to one of two versions of the polypill, the version chosen by the treating health professional according to clinical features of the patient, or to usual care. The primary study outcomes will be changes, from baseline measures, in serum cholesterol and systolic blood pressure and self-reported current use of aspirin, a statin and at least two blood pressure lowering agents. Secondary study outcomes include cardiovascular events, renal outcomes, self-reported barriers to indicated therapy, prescription of indicated therapy, occurrence of serious adverse events and changes in quality-of-life. The trial will be supplemented by formal economic and process evaluations. The Kanyini-GAP trial will provide new evidence as to whether or not a polypill-based strategy improves adherence to effective cardiovascular medications amongst in iduals in whom these treatments are indicated. This trial is registered with the Australian New Zealand Clinical Trial Registry ACTRN126080005833347.
The Cardiac Society Inaugural Cardiovascular Health Conference
Publisher: Elsevier BV
Date: 05-2010
Coronary Disease in Indigenous Populations: Summary from the CSANZ Indigenous Cardiovascular Health Conference
Publisher: Elsevier BV
Date: 05-2010
Aboriginal and Torres Strait Islander men and parenting
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/PY19106
Abstract: Aboriginal and Torres Strait Islander men rarely rate a mention within discussions of parenting unless framed in the negative, or as the cause of dysfunctional family life. Consequently, the roles and responsibilities of Aboriginal and Torres Strait Islander men within parenting have largely been neglected or ignored. This scoping review aimed to identify and describe Aboriginal and Torres Strait Islander parenting programs that focused on male parents. A comprehensive search was conducted of databases, PubMed and Informit ATSIhealth, to identify peer-review publications, while relevant websites were also searched for grey literature. The review identified eight programs that met the inclusion criteria. The review highlights the lack of rigorously researched and published literature on parenting programs that focus on Aboriginal and Torres Strait Islander male parents. The programs all reported positive outcomes and demonstrate that given the opportunity, Aboriginal and Torres Strait Islander male parents are ready and determined to fulfil their roles and responsibilities as parents to the best of their ability for the benefit of their families and communities. The provision of inclusive parenting programs and services will equip Aboriginal and Torres Strait Islander male parents to better support their families during these important times.
Further investment in Aboriginal and Torres Strait Islander men's health research funding is urgently required
Publisher: Elsevier BV
Date: 04-2023
Outcomes after mitral valve surgery for rheumatic heart disease
Publisher: BMJ
Date: 19-06-2017
The quality of health research for young indigenous Australians: Systematic review
Publisher: AMPCo
Date: 07-2013
DOI: 10.5694/MJA12.11141
Abstract: To assess the extent and quality of the evidence base related to the health and wellbeing of young Indigenous Australians. Systematic review of peer-reviewed literature grading of quality of literature mapping of s le characteristics and study foci. English language publications, 1 Jan 1994 - 1 Jan 2011 in MEDLINE, ERIC, CINAHL, EMBASE, ATSIhealth, PsycINFO, the Cochrane Library and the Australian Indigenous HealthInfoNet. Inclusion criteria were: published 1 Jan 1994 - 1 Jan 2011 original peer-reviewed research reported data for Australian Aboriginal and Torres Strait Islanders aged 10-24 2013s focused on health and wellbeing. Grading for quality included ascertainment of Indigenous status, representativeness of the s le for the target population, and quality of measures of exposure and outcome. 360 peer-reviewed publications met inclusion criteria 90 (25%) exclusively s led Indigenous young people. 250 studies (69%) were of good-quality design 124 of these focused on health outcomes (15 of these evaluated an intervention) and 116 focused on health-risk exposure (26 evaluative). The methodological quality of data improved during 1994-2010 however, only 17% of studies focused on urban populations. A third of good-quality studies of health outcome focused on communicable diseases such as sexually transmitted infections and tuberculosis. There was good-quality data for oral health and substance use, and some data for adolescent pregnancy. Data on mental disorders, injury and cause-specific mortality were limited. Despite improvements, there are important gaps in the evidence base for the health of young Indigenous Australians. Our study points to the need for greater research investment in urban settings and with regard to mental disorders and injury, with a further emphasis on trials of preventive and clinical intervention.
Rheumatic heart disease in Indigenous young peoples
Publisher: Elsevier BV
Date: 06-2021
Screening rates for diabetic retinopathy among Aboriginal and Torres Strait Islander women with hyperglycaemia in pregnancy: The PANDORA cohort study.
Publisher: Wiley
Date: 09-2021
DOI: 10.1111/CEO.13985
Providing guideline-recommended preventive cardiovascular care to Aboriginal and Torres Strait Islander women: exploring gender differences with a medical record review in primary health care
Publisher: CSIRO Publishing
Date: 19-08-2022
DOI: 10.1071/PY22064
Abstract: Background For Aboriginal and Torres Strait Islander women, the premature burden of cardiovascular disease is affecting their capacity to fulfil roles in society, and promote the health and wellbeing of future generations. In Australia, there is limited understanding of the difference in primary preventive cardiovascular care experienced by women, despite knowledge of sex and gender differentials in health profile and receipt of guideline-based acute care. This paper sought to explore the health profile and receipt of assessment and management of cardiovascular risk for Aboriginal and Torres Strait Islander women accessing preventive primary health care, and investigate gender differentials. Method Records of 1200 current clients, 50% women, aged 18–74 years from three Aboriginal Health Services in central and South Australia for the period 7/2018–6/2020 were reviewed. Results Twelve percent had documented cardiovascular disease. Compared with men, women with no recorded cardiovascular disease had a greater likelihood of being overweight or obese, a waist circumference indicative of risk, diabetes, and depression. Women were less likely to report being physically active. Conclusions The research concluded that gaps exist in the provision and recording of guideline-recommended primary preventive care regardless of sex. These are stark, given the evident burden.
Long QT syndrome type 1 in an Australian indigenous patient
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2020
Aboriginal community controlled health organisations address health equity through action on the social determinants of health of Aboriginal and Torres Strait Islander peoples in Australia
Publisher: Springer Science and Business Media LLC
Date: 12-2020
DOI: 10.1186/S12889-020-09943-4
Abstract: Indigenous populations globally are continually striving for better health and wellbeing due to experiencing significant health and social inequities. The social determinants of health are important contributors to health outcomes. Comprehensive primary health care that is governed and delivered by Indigenous people extends beyond the biomedical model of care to address the social determinants of health. Aboriginal Community Controlled Health Organisations (ACCHOs) are known to provide culturally informed, holistic health services that directly and indirectly address the social determinants of health. The range and extent of their activities in addressing the social determinants of health, however, is not well documented. The most recent ACCHO annual reports were retrieved online or by direct correspondence. For coding consistency, a dictionary informed by the World Health Organization’s Conceptual Framework for Action on the Social Determinants of Health was developed . A document and textual analysis of reports coded ACCHO activities and the determinants of health they addressed, including intermediary determinants, socio-economic position and/or socio-political context. Summary statistics were reported. Representative quotes illustrating the unique nature of ACCHO service provision in addressing the social determinants of health were used to contextualise the quantitative findings. Sixty-seven annual reports were collected between 2017 and 2018. Programs were delivered to population groups across the life span. Fifty three percent of reports identified programs that included work at the socio-political level and all annual reports described working to improve socioeconomic position and intermediary determinants of health through their activities. Culture had a strong presence in program delivery and building social cohesion and social capital emerged as themes. This study provides evidence of the considerable efforts of the ACCHO sector, as a primary health care provider, in addressing the social determinants of health and health inequity experienced by Indigenous communities. For the Aboriginal and Torres Strait Islander population, ACCHOs not only have an essential role in addressing immediate healthcare needs but also invest in driving change in the more entrenched structural determinants of health. These are important actions that are likely to have an accumulative positive effect in closing the gap towards health equity.
Non-communicable disease mortality in young people with a history of contact with the youth justice system in Queensland, Australia
Publisher: Elsevier BV
Date: 08-2023
Contemporary Incidence and Prevalence of Rheumatic Fever and Rheumatic Heart Disease in Australia Using Linked Data: The Case for Policy Change
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-10-2020
Abstract: In 2018, the World Health Organization prioritized control of acute rheumatic fever (ARF) and rheumatic heart disease (RHD), including disease surveillance. We developed strategies for estimating contemporary ARF/RHD incidence and prevalence in Australia (2015–2017) by age group, sex, and region for Indigenous and non‐Indigenous Australians based on innovative, direct methods. This population‐based study used linked administrative data from 5 Australian jurisdictions. A cohort of ARF (age years) and RHD cases ( years) were sourced from jurisdictional ARF/RHD registers, surgical registries, and inpatient data. We developed robust methods for epidemiologic case ascertainment for ARF/RHD. We calculated age‐specific and age‐standardized incidence and prevalence. Age‐standardized rate and prevalence ratios compared disease burden between demographic subgroups. Of 1425 ARF episodes, 72.1% were first‐ever, 88.8% in Indigenous people and 78.6% were aged years. The age‐standardized ARF first‐ever rates were 71.9 and 0.60/100 000 for Indigenous and non‐Indigenous populations, respectively (age‐standardized rate ratio=124.1 95% CI, 105.2–146.3). The 2017 Global Burden of Disease RHD prevalent counts for Australia ( years) underestimate the burden (1518 versus 6156 Australia‐wide extrapolated from our study). The Indigenous age‐standardized RHD prevalence (666.3/100 000) was 61.4 times higher (95% CI, 59.3–63.5) than non‐Indigenous (10.9/100 000). Female RHD prevalence was double that in males. Regions in northern Australia had the highest rates. This study provides the most accurate estimates to date of Australian ARF and RHD rates. The high Indigenous burden necessitates urgent government action. Findings suggest RHD may be underestimated in many high‐resource settings. The linked data methods outlined here have potential for global applicability.
Comparison of creatinine and cystatin C based eGFR in the estimation of glomerular filtration rate in Indigenous Australians: The eGFR Study
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1016/J.CLINBIOCHEM.2016.11.024
Abstract: The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation that combines creatinine and cystatin C is superior to equations that include either measure alone in estimating glomerular filtration rate (GFR). However, whether cystatin C can provide any additional benefits in estimating GFR for Indigenous Australians, a population at high risk of end-stage kidney disease (ESKD) is unknown. Using a cross-sectional analysis from the eGFR Study of 654 Indigenous Australians at high risk of ESKD, eGFR was calculated using the CKD-EPI equations for serum creatinine (eGFRcr), cystatin C (eGFRcysC) and combined creatinine and cystatin C (eGFRcysC+cr). Reference GFR (mGFR) was determined using a non-isotopic iohexol plasma disappearance technique over 4h. Performance of each equation to mGFR was assessed by calculating bias, % bias, precision and accuracy for the total population, and according to age, sex, kidney disease, diabetes, obesity and c-reactive protein. Data were available for 542 participants (38% men, mean [sd] age 45 [14] years). Bias was significantly greater for eGFRcysC (15.0mL/min/1.73m Cystatin C based eGFR equations may not perform well in populations with high levels of chronic inflammation. CKD-EPI eGFR based on serum creatinine remains the preferred equation in Indigenous Australians.
Acute Coronary Syndromes in Indigenous Australians: Opportunities for Improving Outcomes Across the Continuum of Care
Publisher: Elsevier BV
Date: 05-2010
DOI: 10.1016/J.HLC.2010.02.011
Abstract: Amongst a long list of health issues driving the disparity experienced by Indigenous Australians, cardiovascular disease (CVD) remains the primary target. It is the principal cause of death and of excess death among Indigenous people in Australia, and accounts for almost one-third of the life expectancy gap. Most attention has focused on the higher burden of traditional risk factors experienced by Indigenous people to explain CVD disparity. Far less attention has focused on the quality and outcomes of health system performance in explaining these differentials. The CASPA study was a retrospective, mixed-methods clinical registry and quality improvement program established in the NT of Australia, focused on the patterns, burdens, provision of care, experience of services, adverse outcomes and their determinants among 492 patients (214 Indigenous and 278 non-Indigenous). Indigenous patients were significantly younger and more likely to have existing CVD risk factors and co-morbid chronic disease. During hospitalisation they received similar rates of evidence-based care with the exception of lower rates of diagnostic angiography (36.2% vs. 47.6%, p=0.012), lower rates of in-patient cardiac rehabilitation (8.9% vs. 15.3%, p=0.03) and lower prescription of discharge statin (44.8% vs. 57.8%, p=0.006). Indigenous patients were more likely to die during two years of follow-up (30% vs. 17.8%, p=0.002). Both Indigenous and non-Indigenous patients were similarly under-prescribed evidence based therapy after discharge. Exploratory qualitative examination of the experience of Indigenous patients in Alice Springs identified significant barriers to care across the continuum. Improvements in the delivery of known effective therapies will make a significant impact on adverse outcomes in Indigenous and non-Indigenous patients alike. Comprehensive and sustained prospective data collection to compliment system reform is essential to improve outcomes and reduce disparity in CVD outcomes experienced by Indigenous Australians.
Emerging diabetes and metabolic conditions among Aboriginal and Torres Strait Islander young people
Publisher: AMPCo
Date: 18-01-2019
DOI: 10.5694/MJA2.13002
Improving Cardiovascular Care for Indigenous Populations
Publisher: Elsevier BV
Date: 05-2010
DOI: 10.1016/J.HLC.2010.02.015
Abstract: The challenges and opportunities for provision of, and access to, reliable chronic cardiovascular health care for Indigenous people were addressed by expert speakers from New Zealand and Australia. It is well recognised that cardiovascular disease is a life-long concern, requiring reliable follow-up, early transition of clinical research into practice and ongoing support of patients. The clinical outcomes and long-term prognosis of in iduals with cardiovascular disease are critically dependent upon the quality and availability of follow-up and chronic care facilities. This paper summarises the principal issues identified by the expert speakers for the provision of chronic cardiovascular health care to Indigenous peoples in Australia and New Zealand identifies common challenges and describes important initiatives which the Cardiac Society of Australia and New Zealand (CSANZ), in partnership with health care professionals, communities and governments, can undertake in order to achieve the goals of uniform and equitable health care for chronic cardiovascular disease in all the Indigenous peoples, relevant to the needs of these peoples, in New Zealand and Australia. The issues addressed by the meeting include: 1) Determination of appropriate models for effective delivery of cardiovascular health care. (2) Who should deliver cardiovascular health care and what are the workforce requirements. (3) What support systems and infrastructure are required. (4) How can primary care and secondary specialist services be effectively integrated.
Clinical Outcomes in Trials Evaluating Lipid-Lowering Drugs
Publisher: Springer Science and Business Media LLC
Date: 21-04-2017
DOI: 10.1007/S40256-017-0231-6
Abstract: While statins have formed the cornerstone of strategies for cardiovascular prevention, the residual risk related to low-density lipoprotein cholesterol (LDL-C) and other lipoprotein factors provides a landscape for development of new therapies. However, a number of lipid-modifying therapies have failed to reduce cardiovascular event rates in contemporary clinical trials of statin-treated patients. The factors considered in outcome measure selection for clinical trials of novel lipid-lowering therapies are reviewed. Evaluation of lipid-modifying drugs in clinical trials spans a spectrum from their effects on conventional circulating lipid parameters through to their impact on atherosclerotic plaque and ultimately clinical outcomes. The design of these trials has an important impact on the result and ultimate interpretation of these studies.
Overview and Determinants of Cardiovascular Disease in Indigenous Populations
Publisher: Elsevier BV
Date: 05-2010
DOI: 10.1016/J.HLC.2010.02.017
Abstract: Cardiovascular disease (CV) is an important problem among the 400 million Indigenous Populations around the world, and has been included in the World Health Organization (WHO) "2008-2013 Action Plan for Non-Communicable Diseases". Our understanding of the causes of CV disease in the Indigenous populations of Australia and New Zealand will be facilitated by better understanding the causes of CV disease in Indigenous populations around the world. The opening scientific presentations of the Inaugural CSANZ Conference on Indigenous Cardiovascular Health were from two international speakers notable for their commitment to Indigenous Health as a global problem.
Recommendations Arising from the Inaugural CSANZ Conference on Indigenous Cardiovascular Health
Publisher: Elsevier BV
Date: 05-0004
Rheumatic Heart Disease in Indigenous Populations
Publisher: Elsevier BV
Date: 05-2010
DOI: 10.1016/J.HLC.2010.02.019
Abstract: Rates of acute rheumatic fever and chronic rheumatic heart disease in Aboriginal people, Torres Strait Islanders and Māori continue to be unacceptably high. The impact of rheumatic heart disease is inequitable on these populations as compared with other Australians and New Zealanders. The associated cardiac morbidity, including the development of rheumatic valve disease, and cardiomyopathy, with possible sequelae of heart failure, development of atrial fibrillation, systemic embolism, transient ischaemic attacks, strokes, endocarditis, the need for interventions including cardiac surgery, and impaired quality of life, and shortened life expectancy, has major implications for the in idual. The adverse health and social effects may significantly limit education and employment opportunities and increase dependency on welfare. Additionally there may be major adverse impacts on family and community life. The costs in financial terms and missed opportunities, including wasted young lives, are substantial. Prevention of acute rheumatic fever is dependent on the timely diagnosis and treatment of sore throats and skin infections in high-risk groups. Both Australia and New Zealand have registries for acute rheumatic fever but paradoxically neither includes all cases of chronic rheumatic heart disease many of whom would benefit from close surveillance and follow-up. In New Zealand and some Australian States there are programs to give secondary prophylaxis with penicillin, but these are not universal. Surgical outcomes for patients with rheumatic valvular disease are better for valve repair than for valve replacement. Special attention to the selection of the appropriate valve surgery and valve choice is required in pregnant women. It may be necessary to have designated surgical units managing Indigenous patients to ensure high rates of surgical repair rather than valve replacement. Surgical guidelines may be helpful. Long-term follow-up of the outcomes of surgery in Indigenous patients with rheumatic heart disease is required. Underpinning these strategies is the need to improve poverty, housing, education and employment. Cultural empathy with mutual trust and respect is essential. Involvement of Indigenous people in decision making, design, and implementation of primary and secondary prevention programs, is mandatory to reduce the unacceptably high rates of rheumatic heart disease.
A review of valve surgery for rheumatic heart disease in Australia
Publisher: Springer Science and Business Media LLC
Date: 02-10-2014
Study Protocol - Accurate assessment of kidney function in Indigenous Australians: aims and methods of the eGFR Study
Publisher: Springer Science and Business Media LLC
Date: 19-02-2010
Co-Designing Health Service Evaluation Tools That Foreground First Nation Worldviews for Better Mental Health and Wellbeing Outcomes
Publisher: MDPI AG
Date: 13-08-2021
Abstract: It is critical that health service evaluation frameworks include Aboriginal people and their cultural worldviews from design to implementation. During a large participatory action research study, Elders, service leaders and Aboriginal and non-Aboriginal researchers co-designed evaluation tools to test the efficacy of a previously co-designed engagement framework. Through a series of co-design workshops, tools were built using innovative collaborative processes that foregrounded Aboriginal worldviews. The workshops resulted in the development of a three-way survey that records the service experiences related to cultural safety from the perspective of Aboriginal clients, their carer/s, and the service staff with whom they work. The surveys centralise the role of relationships in client-service interactions, which strongly reflect their design from an Aboriginal worldview. This paper provides new insights into the reciprocal benefits of engaging community Elders and service leaders to work together to develop new and more meaningful ways of servicing Aboriginal families. Foregrounding relationships in service evaluations reinstates the value of human connection and people-centred engagement in service delivery which are central to rebuilding historically fractured relationships between mainstream services and Aboriginal communities. This benefits not only Aboriginal communities, but also other marginalised populations expanding the remit of mainstream services to be accessed by many.
Human Papillomavirus and Oropharyngeal Cancer Among Indigenous Australians: Protocol for a Prevalence Study of Oral-Related Human Papillomavirus and Cost-Effectiveness of Prevention (Preprint)
Publisher: JMIR Publications Inc.
Date: 25-03-2018
Abstract: ropharyngeal cancer is an important, understudied cancer affecting Aboriginal and Torres Strait Islander Australians. The human papillomavirus (HPV) is a significant risk factor for oropharyngeal cancer. Current generation HPV vaccines are effective against the 2 most common types of high-risk HPVs in cancer (hrHPVs 16/18). his study aims (1) to yield population estimates of oncogenic genotypes of HPV in the mouth and oropharynx of defined Aboriginal and Torres Strait Islander populations (2) to estimate the proportion of oropharyngeal cancer attributable to HPV among these Australian citizens (3) to estimate the impact of HPV vaccination as currently implemented on rates of oropharyngeal cancer among Aboriginal and Torres Strait Islander Australians and (4) taking into account impact on oropharyngeal as well as cervical cancer, to evaluate efficacy and cost-effectiveness of targeted extended HPV vaccination to older ages, among our study population. ur study design and operation is straightforward, with minimal impost on participants. It involves testing for carriage of hrHPV in the mouth and oropharynx among 1000 Aboriginal South Australians by simple saliva collection and with follow-up at 12 and 24 months, collection of sexual history at baseline, collection of information for estimating health state (quality-of-life) utilities at baseline, genotyping of viruses, predictive outcome and cost-effectiveness modeling, data interpretation and development of vaccination, and follow-up management strategies driven by the Aboriginal community. articipant recruitment for this study commenced in February 2018 and enrollment is ongoing. The first results are expected to be submitted for publication in 2019. he project will have a number of important outcomes. Synthesis of evidence will enable generation of estimates of the burden of oropharyngeal cancer among Aboriginal and Torres Strait Islander Australians and indicate the likely effectiveness and cost-effectiveness of prevention. This will be important for health services planning, and for Aboriginal health worker and patient education. The results will also point to important areas where research efforts should be focused to improve outcomes in Aboriginal and Torres Strait Islander Australians with oropharyngeal cancer. There will be a strong focus on community engagement and accounting for the preferences of in iduals and the community in control of HPV-related cancers. The project has international relevance in that it will be the first to systematically evaluate prevention of both cervical and oropharyngeal cancer in a high-risk Indigenous population taking into account all population, testing, and surveillance options. R1-10.2196/10503
Primary Health Care for Aboriginal Australian Women in Remote Communities after a Pregnancy with Hyperglycaemia
Publisher: MDPI AG
Date: 22-01-2020
Abstract: Background: Hyperglycaemia in pregnancy contributes to adverse outcomes for women and their children. The postpartum period is an opportune time to support women to reduce cardiometabolic and diabetes risk in subsequent pregnancies. Aims: To identify strengths and gaps in current care for Aboriginal women after a pregnancy complicated by hyperglycaemia. Methods: A retrospective review of the 12 month postpartum care provided by primary health centres in remote Australia in 2013–2014 identified 195 women who experienced hyperglycaemia in pregnancy (gestational diabetes (GDM) (n = 147), type 2 diabetes (T2D) (n = 39), and unclear diabetes status (n = 9)). Results: Only 80 women (54%) with GDM had postpartum glycaemic checks. Of these, 32 women were diagnosed with prediabetes (n = 24) or diabetes (n = 8). Compared to women with GDM, women with T2D were more likely to have their weight measured (75% vs. 52%, p .01), and smoking status documented as “discussed” (65% vs. 34%, p 0.01). Most women (97%) accessed the health centre at least once in the 12 month postpartum period but, during these visits, only 52% of women had service provision, either structured or opportunistic, related to diabetes. Conclusion: High rates of dysglycaemia among women screened for T2D after GDM in the 12 month postpartum period highlight the need for increased screening and early intervention to prevent the development of T2D and its complications. Whilst a clear strength was high postpartum attendance, many women did not attend health services for diabetes screening or management.
Sociodemographic variations in the amount, duration and cost of potentially preventable hospitalisation for chronic conditions among Aboriginal and non-Aboriginal Australians: a period prevalence stud
Publisher: BMJ
Date: 10-2017
DOI: 10.1136/BMJOPEN-2017-017331
Abstract: To determine disparities in rates, length of stay (LOS) and hospital costs of potentially preventable hospitalisations (PPH) for selected chronic conditions among Aboriginal and non-Aboriginal South Australians (SA), then examine associations with area-level socioeconomic disadvantage and remoteness. Period prevalence study using linked, administrative public hospital records. Participants included all SA residents in 2005–2006 to 2010–2011. Analysis focused on those in iduals experiencing chronic PPH as defined by the Australian Institute of Health and Welfare. Number and rates (unadjusted, then adjusted for sex and age) of chronic PPH, total LOS and direct hospital costs by Aboriginality. Aboriginal SAs experienced higher risk of index chronic PPH compared with non-Aboriginals (11.5 and 6.2 per 1000 persons per year, respectively) and at younger ages (median age 48 vs 70 years). Once hospitalised, Aboriginal people experienced more chronic PPH events, longer total LOS with higher costs than non-Aboriginal people (2.6 vs 1.9 PPH per person 11.7 vs 9.0 days LOS at $A17 928 vs $A11 515, respectively). Compared with population average LOS, the standardised rate ratio of LOS among Aboriginal people increased by 0.03 (95% CI 0.00 to 0.07) as disadvantage rank increased and 1.04 (95% CI 0.63 to 1.44) as remoteness increased. Non-Aboriginal LOS also increased as disadvantage increased but at a lower rate (0.01 (95% CI 0.01 to 0.01)). Costs of Aboriginal chronic PPH increased by 0.02 (95% CI 0.00 to 0.06) for each increase in disadvantage and 1.18 (95% CI 0.80 to 1.55) for increased remoteness. Non-Aboriginal costs also increased as disadvantage increased but at lower rates (0.01 (95% CI 0.01 to 0.01)). Aboriginal people’s heightened risk of chronic PPH resulted in more time in hospital and greater cost. Systematic disparities in chronic PPH by Aboriginality, area disadvantage and remoteness highlight the need for improved uptake of effective primary care. Routine, regional reporting will help monitor progress in meeting these population needs.
Ethnic-Specific Normative Reference Values for Echocardiographic LA and LV Size, LV Mass, and Systolic Function
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.JCMG.2015.02.014
Abstract: This study sought to derive age-, sex-, and ethnic-appropriate adult reference values for left atrial (LA) and left ventricular (LV) dimensions and volumes, LV mass, fractional shortening, and ejection fraction (EF) derived from geographically erse population studies. The current recommended reference values for measurements from echocardiography may not be suitable to the erse world population to which they are now applied. Population-based datasets of echocardiographic measurements from 22,404 adults without clinical cardiovascular or renal disease, hypertension, or diabetes were combined in an in idual person data meta-analysis. Quantile regression was used to derive reference values at the 95th percentile (upper reference value [URV]) and fifth percentile (lower reference value [LRV]) of each measurement against age (treated as linear), separately within sex and ethnic groups. The URVs for left ventricular end-diastolic volume (LVEDV), LV end-systolic volume, and LV stroke volume (SV) were highest in Europeans and lowest in South Asians. Important sex and ethnic differences remained after indexation by body surface area or height for these measurements, as well as for the LRV for SV. LVEDV and SV decreased with increasing age for all groups. Importantly, the LRV for EF differed by ethnicity there was a clear apparent difference between Europeans and Asians. The URVs for LV end-diastolic diameter and LV end-systolic diameter were higher for Europeans than those for East Asian, South Asian, and African people, particularly among men. Similarly, the URVs for LA diameter and volume were highest for Europeans. Sex- and/or ethnic-appropriate echocardiographic reference values are indicated for many measurements of LA and LV size, LV mass, and EF. Reference values for LV volumes and mass also differ across the age range.
Improving Outcomes after Coronary Artery Bypass Surgery: Lessons from Indigenous Australians
Publisher: Elsevier BV
Date: 08-2013
Simulation of the crystal growth of platelet sea ice with diffusive heat and mass transfer
Publisher: International Glaciological Society
Date: 2015
Abstract: Antarctic coastal sea ice often grows in water that has been supercooled by interaction with an ice shelf. In these situations, ice crystals can form at depth, rise and deposit under the sea-ice cover to form a porous layer that eventually consolidates near the base of the existing sea ice. The least consolidated portion is called the sub-ice platelet layer. Congelation growth eventually causes the sub-ice platelet layer to become frozen into the sea-ice cover as incorporated platelet ice. In this study, we simulate these processes in three dimensions using Voronoi dynamics to govern crystal growth kinetics. Platelet deposition, in situ growth and incorporation into the sea-ice cover are integrated into the model. Heat and mass transfer are controlled by diffusion. We extract and compare spatial-temporal distributions of porosity, salinity, temperature and crystallographic c -axes with observations from McMurdo Sound, Antarctica. The model captures the crystallographic structure of incorporated platelet ice as well as the topology of the sub-ice platelet layer. The solid fraction, which has previously been poorly constrained, is simulated to be ∼0.22, in good agreement with an earlier estimate of 0.25 ± 0.06. This property of the sub-ice platelet layer is important for biological processes, and for the freeboard-thickness relationship around Antarctica.
Characteristics and outcomes of patients admitted to regional and rural intensive care units in Australia
Publisher: Elsevier BV
Date: 12-2020
DOI: 10.51893/2020.4.OA6
Abstract: Objective: To describe the characteristics and outcomes of patients admitted to regional and rural intensive care units (ICUs). Design, setting and participants: Retrospective database review using the Australian and New Zealand Intensive Care Society Adult Patient Database for admissions between January 2009 and June 2019. Characteristics and outcomes of patients admitted to regional and rural ICUs were compared with metropolitan and tertiary ICUs. Main outcome measures: Primary outcome was hospital mortality. Secondary outcomes included patient characteristics, ICU mortality, ICU and hospital length of stay, need for mechanical ventilation and need for interhospital transfer. Results: Over the s ling period, admissions to regional/rural ICUs averaged nearly 19 000 episodes per annum and comprised 20% of critical care admissions in Australia. Unadjusted mortality was lower, a result that persisted after adjustment for a range of confounders (odds ratio, 0.73 95% CI, 0.67–0.80 P 0.01). Admissions are more likely to be emergencies, and patients are more likely to live in areas of relative disadvantage and to require interhospital transfer, but are less likely to require mechanical ventilation. Conclusions: Although illness severity is lower for patients admitted to regional/rural ICUs, hospital mortality after adjustment for a range of confounders is lower. Compared with tertiary ICUs, emergency admissions are more likely, which may have implications for surge capacity during pandemic illness, while mechanical ventilation is less frequently required. Regional/rural ICUs provide care to a substantial proportion of critically ill patients and have a crucial role in the support of regional Australians.
The more things change, the more they stay the same: enduring inequity in Indigenous health
Publisher: CSIRO Publishing
Date: 05-08-2021
DOI: 10.1071/AHV45N4_ED1
Echocardiographic screening for rheumatic heart disease in high and low risk Australian children
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 13-05-2014
DOI: 10.1161/CIRCULATIONAHA.113.003495
Abstract: Echocardiographic screening for rheumatic heart disease (RHD) is becoming more widespread, but screening studies to date have used different echocardiographic definitions. The World Heart Federation has recently published new criteria for the echocardiographic diagnosis of RHD. We aimed to establish the prevalence of RHD in high-risk Indigenous Australian children using these criteria and to compare the findings with a group of Australian children at low risk for RHD. Portable echocardiography was performed on high-risk Indigenous children aged 5 to15 years living in remote communities of northern Australia. A comparison group of low-risk, non-Indigenous children living in urban centers was also screened. Echocardiograms were reported in a standardized, blinded fashion. Of 3946 high-risk children, 34 met World Heart Federation criteria for definite RHD (prevalence, 8.6 per 1000 [95% confidence interval, 6.0–12.0]) and 66 for borderline RHD (prevalence, 16.7 per 1000 [95% confidence interval, 13.0–21.2]). Of 1053 low-risk children, none met the criteria for definite RHD, and 5 met the criteria for borderline RHD. High-risk children were more likely to have definite or borderline RHD than low-risk children (adjusted odds ratio, 5.7 [95% confidence interval, 2.3–14.1] P .001). The prevalence of definite RHD in high-risk Indigenous Australian children approximates what we expected in our population, and no definite RHD was identified in the low-risk group. This study suggests that definite RHD, as defined by the World Heart Federation criteria, is likely to represent true disease. Borderline RHD was identified in children at both low and high risk, highlighting the need for longitudinal studies to evaluate the clinical significance of this finding.
Disparities in cancer stage at diagnosis and survival of Aboriginal and non-Aboriginal South Australians
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.CANEP.2017.04.013
Abstract: This study tested the utility of retrospectively staging cancer registry data for comparing stage and stage-specific survivals of Aboriginal and non-Aboriginal people. Differences by area level factors were also explored. This test dataset comprised 950 Aboriginal cases and all other cases recorded on the South Australian cancer registry with a 1977-2010 diagnosis. A sub-set of 777 Aboriginal cases diagnosed in 1990-2010 were matched with randomly selected non-Aboriginal cases by year of birth, diagnostic year, sex, and primary site of cancer. Competing risk regression summarised associations of Aboriginal status, stage, and geographic attributes with risk of cancer death. Aboriginal cases were 10 years younger at diagnosis, more likely to present in recent diagnostic years, to be resident of remote areas, and have primary cancer sites of head & neck, lung, liver and cervix. Risk of cancer death was associated in the matched analysis with more advanced stage at diagnosis. More Aboriginal than non-Aboriginal cases had distant metastases at diagnosis (31.3% vs 22.0, p<0.001). After adjusting for stage, remote-living Aboriginal residents had higher risks of cancer death than Aboriginal residents of metropolitan areas. Non-Aboriginal cases had the lowest risk of cancer death. Retrospective staging proved to be feasible using registry data. Results indicated more advanced stages for Aboriginal than matched non-Aboriginal cases. Aboriginal people had higher risks of cancer death, which persisted after adjusting for stage, and applied irrespective of remoteness of residence, with highest risk of death occurring among Aboriginal people from remote areas.
Factors Associated with Routine Dental Attendance among Aboriginal Australians
Publisher: Project MUSE
Date: 2016
Abstract: To determine factors associated with routine dental attendance in Aboriginal Australians. Data of 271 Aboriginal adults residing in Australia's Northern Territory were used. Routine dental attendance was defined as last visiting a dentist less than one year ago or visiting a dentist for a check-up. Both bivariate and multivariable analytical techniques were used. While 27% visited a dentist in the past year, 29% of these visited for a check-up. In bivariate analysis, being female, low psychological distress, and low clinical attachment loss (CAL) were associated with visiting a dentist within last year. Being aged younger than 39 years, male, no oral health impairment, being caries-free, low CAL, and low apolipoprotein B were associated with visiting for a check-up. Clinical attachment loss remained associated with visiting a dentist less than one year ago while being younger than 39 years and having no oral health impairment remained associated with usually visiting for a check-up in multivariable analysis. Younger age, no oral health impairment, and low CAL were associated with routine dental attendance among Indigenous Australians.
Improving postpartum screening after diabetes in pregnancy: Results of a pilot study in remote Australia
Publisher: Wiley
Date: 02-10-2018
DOI: 10.1111/AJO.12894
Abstract: The postpartum period is a critical time to improve health outcomes for Aboriginal women, particularly for those who have chronic conditions. To assess enhanced support methods (for women following diabetes in pregnancy (DIP)) to improve completion rates of recommended postpartum health checks. Fifty-three Aboriginal women in the Northern Territory (NT) were contacted in the postpartum period to encourage medical check-ups. Messages were delivered through phone (call or text messages) or other methods (Facebook or email). The primary outcome was postpartum blood glucose testing (oral glucose tolerance testing (OGTT), random or fasting glucose and HbA1c). Establishing contact with women was difficult. Of 137 messages sent to 52 women, 22 responded (42%). Phone was the most common contact method with successful contact made from 16 of 119 (13%) attempts. Rates of postpartum OGTT completion were higher in the group successfully contacted (32% vs 7%). However, for any postpartum glucose testing (including OGTT and HbA1c) rates were 25 of 42 (60%) and neither success in making contact nor the contact method was associated with higher rates. The small s le size limits our conclusions however, results highlight that engaging remote women postpartum is difficult. While rates of postpartum OGTT completion differed according to successful contacts, rates of any postpartum blood glucose testing did not. Further research is needed to explore feasible intervention methods to improve postpartum screening after a pregnancy complicated by diabetes.
Investing in the health of Aboriginal and Torres Strait Islander adolescents: a foundation for achieving health equity
Publisher: AMPCo
Date: 12-02-2020
DOI: 10.5694/MJA2.50500
Postpartum uptake of diabetes screening tests in women with gestational diabetes: The PANDORA study.
Publisher: Wiley
Date: 21-11-2022
DOI: 10.1111/DME.14999
Abstract: To determine rates and predictors of postpartum diabetes screening among Aboriginal and/or Torres Strait Islander and non‐Indigenous women with gestational diabetes mellitus (GDM). PANDORA is a prospective longitudinal cohort of women recruited in pregnancy. Postpartum diabetes screening rates at 12 weeks (75‐g oral glucose tolerance test (OGTT)) and 6, 12 and 18 months (OGTT, glycated haemoglobin [HbA 1C ] or fasting plasma glucose) were assessed for women with GDM ( n = 712). Associations between antenatal factors and screening with any test (OGTT, HbA 1C , fasting plasma glucose) by 6 months postpartum were examined using Cox proportional hazards regression. Postpartum screening rates with an OGTT by 12 weeks and 6 months postpartum were lower among Aboriginal and/or Torres Strait Islander women than non‐Indigenous women (18% vs. 30% at 12 weeks, and 23% vs. 37% at 6 months, p 0.001). Aboriginal and/or Torres Strait Islander women were more likely to have completed a 6‐month HbA 1C compared to non‐Indigenous women (16% vs. 2%, p 0.001). Screening by 6 months postpartum with any test was 41% for Aboriginal and/or Torres Strait Islander women and 45% for non‐Indigenous women ( p = 0.304). Characteristics associated with higher screening rates with any test by 6 months postpartum included, insulin use in pregnancy, first pregnancy, not smoking and lower BMI. Given very high rates of type 2 diabetes among Aboriginal and Torres Strait Islander women, early postpartum screening with the most feasible test should be prioritised to detect prediabetes and diabetes for intervention.
Developing the Indigenous Language and Wellbeing Survey: approaches to integrating qualitative findings into a survey instrument
Publisher: SAGE Publications
Date: 09-2023
Targeting obesity, diabetes and the metabolic syndrome: are we trying to close the barn door after the horse bolted?
Publisher: Informa UK Limited
Date: 21-02-2014
Type 2 diabetes in young Indigenous Australians in rural and remote areas: diagnosis, screening, management and prevention
Publisher: AMPCo
Date: 07-2012
DOI: 10.5694/MJA12.10036
Abstract: The burden of type 2 diabetes mellitus (T2DM) among Indigenous children and adolescents is much greater than in non-Indigenous young people and appears to be rising, although data on epidemiology and complications are limited. Young Indigenous people living in remote areas appear to be at excess risk of T2DM. Most young Indigenous people with T2DM are asymptomatic at diagnosis and typically have a family history of T2DM, are overweight or obese and may have signs of hyperinsulinism such as acanthosis nigricans. Onset is usually during early adolescence. Barriers to addressing T2DM in young Indigenous people living in rural and remote settings relate to health service access, demographics, socioeconomic factors, cultural factors, and limited resources at in idual and health service levels. We recommend screening for T2DM for any Aboriginal or Torres Strait Islander person aged > 10 years (or past the onset of puberty) who is overweight or obese, has a positive family history of diabetes, has signs of insulin resistance, has dyslipidaemia, has received psychotropic therapy, or has been exposed to diabetes in utero. In idualised management plans should include identification of risk factors, complications, behavioural factors and treatment targets, and should take into account psychosocial factors which may influence health care interaction, treatment success and clinical outcomes. Preventive strategies, including lifestyle modification, need to play a dominant role in tackling T2DM in young Indigenous people.
Strengthening approaches to respond to the social and emotional well-being needs of Aboriginal and Torres Strait Islander people: the Cultural Pathways Program
Publisher: Cambridge University Press (CUP)
Date: 2021
DOI: 10.1017/S1463423621000402
Abstract: Aboriginal and Torres Strait Islander holistic health represents the interconnection of social, emotional, spiritual and cultural factors on health and well-being. Social factors (education, employment, housing, transport, food and financial security) are internationally described and recognised as the social determinants of health. The social determinants of health are estimated to contribute to 34% of the overall burden of disease experienced by Aboriginal and Torres Strait Islander people. Primary health care services currently ‘do what it takes’ to address social and emotional well-being needs, including the social determinants of health, and require culturally relevant tools and processes for implementing coordinated and holistic responses. Drawing upon a research-setting pilot program, this manuscript outlines key elements encapsulating a strengths-based approach aimed at addressing Aboriginal and Torres Strait Islander holistic social and emotional well-being. The Cultural Pathways Program is a response to community identified needs, designed and led by Aboriginal and Torres Strait Islander people and informed by holistic views of health. The program aims to identify holistic needs of Aboriginal and Torres Strait Islander people as the starting point to act on the social determinants of health. Facilitators implement strengths-based practice to identify social and cultural needs (e.g. cultural and community connection, food and financial security, housing, mental health, transport), engage in a goal setting process and broker connections with social and health services. An integrated culturally appropriate clinical supervision model enhances delivery of the program through reflective practice and shared decision making. These embedded approaches enable continuous review and improvement from a program and participant perspective. A developmental evaluation underpins program implementation and the proposed culturally relevant elements could be further tailored for delivery within primary health care services as part of routine care to strengthen systematic identification and response to social and emotional well-being needs.
Effect of periodontal therapy on arterial structure and function among aboriginal Australians: A randomized, controlled trial
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2014
DOI: 10.1161/HYPERTENSIONAHA.114.03359
Abstract: Observational studies and nonrandomized trials support an association between periodontal disease and atherosclerotic vascular disease. Both diseases occur frequently in Aboriginal Australians. We hypothesized that nonsurgical periodontal therapy would improve measures of arterial function and structure that are subclinical indicators of atherosclerotic vascular disease. This parallel-group, randomized, open label clinical trial enrolled 273 Aboriginal Australians aged ≥18 years with periodontitis. Intervention participants received full-mouth periodontal scaling during a single visit, whereas controls received no treatment. Prespecified primary end points measured 12-month change in carotid intima-media thickness, an indicator of arterial structure, and 3- and 12-month change in pulse wave velocity, an indicator of arterial function. ANCOVA used complete case data to evaluate treatment group differences. End points could be calculated for 169 participants with follow-up data at 3 months and 168 participants at 12 months. Intima-media thickness decreased significantly after 12 months in the intervention group (mean reduction=−0.023 [95% confidence interval {CI}, −0.038 to −0.008] mm) but not in the control group (mean increase=0.002 [95% CI, −0.017 to 0.022] mm). The difference in intima-media thickness change between treatment groups was statistically significant (−0.026 [95% CI, −0.048 to −0.003] mm P =0.03). In contrast, there were no significant differences between treatment groups in pulse wave velocity at 3 months (mean difference, 0.06 [95% CI, −0.17 to 0.29] m/s P =0.594) or 12 months (mean difference, 0.21 [95% CI, −0.01 to 0.43] m/s P =0.062). Periodontal therapy reduced subclinical arterial thickness but not function in Aboriginal Australians with periodontal disease, suggesting periodontal disease and atherosclerosis are significantly associated.
Longitudinal Displacement of the Carotid Wall and Cardiovascular Risk Factors: Associations with Aging, Adiposity, Blood Pressure and Periodontal Disease Independent of Cross-Sectional Distensibility and Intima-Media Thickness
Publisher: Elsevier BV
Date: 10-2012
DOI: 10.1016/J.ULTRASMEDBIO.2012.05.004
Abstract: The recently discovered longitudinal displacement of the common carotid arterial wall (i.e., the motion along the same plane as the blood flow), may be associated with incident cardiovascular events and represents a novel and relevant clinical information. At present, there have only been a few studies that have been conducted to investigate this longitudinal movement. We propose here a method to assess noninvasively the wall bi-dimensional (two-dimensional [2-D], cross-sectional and longitudinal) motion and present an original approach that combines a robust speckle tracking scheme to guidance by minimal path contours segmentation. Our method is well suited to large clinical population studies as it does not necessitate strong imaging prerequisites. The aim of this study is to describe the association between the longitudinal displacement of the carotid arterial wall and cardiovascular risk factors, among which periodontal disease. Some 126 Indigenous Australians with periodontal disease, an emerging risk factor, and 27 healthy age- and sex-matched non-indigenous control subjects had high-resolution ultrasound scans of the common carotid artery. Carotid intima-media thickness and arterial wall 2-D motion were then assessed using our method in ultrasound B-mode sequences. Carotid longitudinal displacement was markedly lower in the periodontal disease group than the control group (geometric mean (IQR): 0.15 mm (0.13) vs. 0.42 mm (0.30), respectively p < 0.0001), independent of cardiovascular risk factors, cross-sectional distensibility and carotid intima-media thickness (p < 0.0001). A multivariable model indicated that the strongest correlates of carotid longitudinal displacement in adults with periodontal disease were age (β-coefficient = -.235, p = .03), waist (β-coefficient = -.357, p = 0.001), and pulse pressure (β-coefficient = .175, p = 0.07), independent of other cardiovascular risk factors, cross-sectional distensibility and pulse wave velocity. Carotid longitudinal displacement, estimated with our approach, is impaired in the periodontal disease group, independent of established cardiovascular risk factors and other noninvasive measures of arterial stiffness, and may represent an important marker of cardiovascular risk.
Systematic review to inform prevention and management of chronic disease for Indigenous Australians: overview and priorities.
Publisher: Elsevier BV
Date: 02-2016
Abstract: To describe the main characteristics of systematic reviews addressing questions of chronic disease and related risk factors for Indigenous Australians. We searched databases for systematic reviews meeting inclusion criteria. Two reviewers assessed quality and extracted characteristics using pre-defined tools. We identified 14 systematic reviews. Seven synthesised evidence about health intervention effectiveness four addressed chronic disease or risk factor prevalence and six conducted critical appraisal as per current best practice. Only three reported steps to align the review with standards for ethical research with Indigenous Australians and/or capture Indigenous-specific knowledge. Most called for more high-quality research. Systematic review is an under-utilised method for gathering evidence to inform chronic disease prevention and management for Indigenous Australians. Relevance of future systematic reviews could be improved by: 1) aligning questions with community priorities as well as decision maker needs 2) involvement of, and leadership by, Indigenous researchers with relevant cultural and contextual knowledge iii) use of critical appraisal tools that include traditional risk of bias assessment criteria and criteria that reflect Indigenous standards of appropriate research. Systematic review method guidance, tools and reporting standards are required to ensure alignment with ethical obligations and promote rigor and relevance.
Psychological distress and ischaemic heart disease: Cause or consequence? Evidence from a large prospective cohort study
Publisher: BMJ
Date: 19-09-2017
Abstract: Ischaemic heart disease (IHD) incidence is elevated in people reporting psychological distress. The extent to which this relationship is causal or related to reverse causality-that is, undiagnosed disease causing distress-is unclear. We quantified the relationship between psychological distress and IHD, with consideration of confounding and undiagnosed disease. Questionnaire data (2006-2009) from 151 811 cardiovascular disease-free and cancer-free Australian general population members aged ≥45years (45 and Up Study) were linked to hospitalisation and mortality data, to December 2013. A two-stage approach estimated HRs for incident IHD (IHD-related hospitalisation or death) for low (Kessler-10 scores: 10-<12), mild (12-<16), moderate (16-<22) and high (22-50) psychological distress, adjusting for demographic and behavioural characteristics, and then restricting to those with no/minor functioning limitations (likely free from undiagnosed disease). Over 859 396 person-years, 5230 incident IHD events occurred (rate: 6.09/1000person-years). IHD risk was increased for mild (age-adjusted and sex-adjusted HR: 1.18, 95% CI 1.11 to 1.26), moderate (1.36, 1.25 to 1.47), and high (1.69, 1.52 to 1.88) versus low distress. HRs attenuated to 1.15 (1.08 to 1.22), 1.26 (1.16 to 1.37) and 1.41 (1.26 to 1.57) after adjustment for demographic and behavioural characteristics and were further attenuated by 35%-41% in those with no/minor limitations, leaving a significant but relatively weak dose-response relationship: 1.11 (1.02 to 1.20), 1.21 (1.08 to 1.37) and 1.24 (1.02 to 1.51) for mild, moderate and high versus low distress, respectively. The observed adjustment-related attenuation suggests measurement error/residual confounding likely contribute to the remaining association. A substantial part of the distress-IHD association is explained by confounding and functional limitations, an indicator of undiagnosed disease. Emphasis should be on psychological distress as a marker of healthcare need and IHD risk, rather than a causative factor.
Is Lp(a) Ready for Prime Time?
Publisher: Elsevier BV
Date: 09-2014
Resting heart rate, physiological stress and disadvantage in Aboriginal and Torres Strait Islander Australians: analysis from a cross-sectional study
Publisher: Springer Science and Business Media LLC
Date: 11-02-2016
Progress in adolescent health and wellbeing: tracking 12 headline indicators for 195 countries and territories, 1990-2016.
Publisher: Elsevier BV
Date: 03-2019
Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) study
Publisher: Springer Science and Business Media LLC
Date: 12-2013
Ten principles relevant to health research among Indigenous Australian populations
Publisher: AMPCo
Date: 07-2012
DOI: 10.5694/MJA11.11642
Breastfeeding and infant growth in offspring of mothers with hyperglycaemia in pregnancy: The pregnancy and neonatal diabetes outcomes in remote Australia study
Publisher: Wiley
Date: 20-02-2022
DOI: 10.1111/IJPO.12891
Abstract: Benefits of breastfeeding on infant growth in children born to mothers with gestational diabetes mellitus (GDM) are uncertain. To describe growth trajectories between birth and 14 months according to breastfeeding and maternal hyperglycaemia in pregnancy, and assess associations between breastfeeding and 14 month growth outcomes among children born to mothers with GDM. Data on 258 Aboriginal and Torres Strait Islander infants from the PANDORA study born to mothers with normoglycaemia ( n = 73), GDM ( n = 122), or with pre‐existing type 2 diabetes ( n = 63) in pregnancy were assessed. Infant weight and BMI growth trajectories according to predominant breastfeeding at 6 months and hyperglycaemia in pregnancy were developed using mixed‐effect models and cubic splines. Associations between breastfeeding and 14‐month growth outcomes ( z ‐scores: weight‐for‐age, weight‐for‐length and BMI) were evaluated using linear regression in a subgroup of infants born to mothers with GDM. Predominantly breastfed infants had lower BMI trajectories compared to those not predominantly breastfed, irrespective of maternal hyperglycaemia in pregnancy status ( p 0.01 for all groups), and lower weight trajectories among those born to mothers with GDM ( p = 0.006). Among offspring of women with GDM, predominant breastfeeding was only associated with lower weight‐for‐age at 14 months, however adjusting for maternal obesity, smoking, and parity attenuated observed associations. Maternal obesity remained significantly associated with greater infant growth. Predominant breastfeeding was associated with reduced growth among children born to women with and without hyperglycaemia in pregnancy. However, among children exposed to GDM in utero, maternal obesity largely explained this association.
Ending rheumatic heart disease in Australia
Publisher: AMPCo
Date: 11-2020
DOI: 10.5694/MJA2.50853
Management and 1‐Year Outcomes of Patients With Newly Diagnosed Atrial Fibrillation and Chronic Kidney Disease: Results From the Prospective GARFIELD‐AF Registry
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-02-2019
Abstract: Using data from the GARFIELD ‐ AF (Global Anticoagulant Registry in the FIELD –Atrial Fibrillation), we evaluated the impact of chronic kidney disease ( CKD ) stage on clinical outcomes in patients with newly diagnosed atrial fibrillation ( AF ). GARFIELD ‐ AF is a prospective registry of patients from 35 countries, including patients from Asia (China, India, Japan, Singapore, South Korea, and Thailand). Consecutive patients enrolled (2013–2016) were classified with no, mild, or moderate‐to‐severe CKD , based on the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative guidelines. Data on CKD status and outcomes were available for 33 024 of 34 854 patients (including 9491 patients from Asia) 10.9% (n=3613) had moderate‐to‐severe CKD , 16.9% (n=5595) mild CKD , and 72.1% (n=23 816) no CKD . The use of oral anticoagulants was influenced by stroke risk (ie, post hoc assessment of CHA 2 DS 2 ‐ VAS c score), but not by CKD stage. The quality of anticoagulant control with vitamin K antagonists did not differ with CKD stage. After adjusting for baseline characteristics and antithrombotic use, both mild and moderate‐to‐severe CKD were independent risk factors for all‐cause mortality. Moderate‐to‐severe CKD was independently associated with a higher risk of stroke/systemic embolism, major bleeding, new‐onset acute coronary syndrome, and new or worsening heart failure. The impact of moderate‐to‐severe CKD on mortality was significantly greater in patients from Asia than the rest of the world ( P =0.001). In GARFIELD ‐ AF , moderate‐to‐severe CKD was independently associated with stroke/systemic embolism, major bleeding, and mortality. The effect of moderate‐to‐severe CKD on mortality was even greater in patients from Asia than the rest of the world. URL : www.clinicaltrials.gov . Unique identifier: NCT 01090362.
Depression and blood pressure control
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2009
A framework for overcoming disparities in management of acute coronary syndromes in the australian aboriginal and torres strait islander population
Publisher: AMPCo
Date: 06-2014
DOI: 10.5694/MJA12.11175
Abstract: Aboriginal and Torres Strait Islander patients with acute coronary syndromes (ACS) experience lower intervention rates and poorer outcomes compared with non-Indigenous patients. A broad range of geographical, cultural and systemic factors contribute to delays and suboptimal treatment for ACS. Every Indigenous ACS patient, regardless of where they live, should be able to expect a coordinated, patient-centred pathway of care provided by designated provider clinical networks and supported by Indigenous cardiac coordinators, Aboriginal liaison officers (ALOs) and health workers. These designated provider clinical networks provide: appropriate prehospital and inhospital treatment an in idualised patient care plan developed jointly with the patient and his or her family culturally appropriate education initiated within the hospital setting and involving families with support from ALOs effective follow-up care and access to relevant secondary prevention programs. We outline generic pathways to provide policymakers, health planners and health care providers with a framework for ACS diagnosis and management that can be implemented across the erse settings in which Aboriginal and Torres Strait Islander people reside and their care is delivered, in order to optimise care and assertively address the current disparities in outcomes.
Reaching cardiovascular prevention guideline targets with a polypill-based approach: a meta-analysis of randomised clinical trials
Publisher: BMJ
Date: 28-06-2018
DOI: 10.1136/HEARTJNL-2018-313108
Abstract: The aim of this study was to determine the effect of polypill-based care on the achievement of 2016 European Society of Cardiology (ESC) guideline targets for blood pressure (BP), low-density lipoprotein (LDL) cholesterol and antiplatelet therapy. We conducted an in idual participant data meta-analysis of three randomised clinical trials that compared a strategy using a polypill containing aspirin, statin and antihypertensive therapy with usual care in patients with a prior cardiovascular disease (CVD) event or who were at high risk of their first event. Overall, the trials included 3140 patients from Australia, England, India, Ireland, the Netherlands and New Zealand (75% male, mean age 62 years and 76% with a prior CVD event). The primary outcome for this study was the proportion of people achieving ESC guideline targets for BP, LDL and antiplatelet therapy. Those randomised to polypill-based care were more likely than those receiving usual care to achieve recommended targets for BP (62% vs 58%, risk ratio (RR) 1.08, 95% CI 1.02 to 1.15), LDL (39% vs 34%, RR 1.13, 95% CI 1.02 to 1.25) and all three targets for BP, LDL and adherence to antiplatelet therapy (the latter only applicable to those with a prior CVD event) simultaneously (24% vs 19%, RR 1.27, 95% CI 1.10 to 1.47) at 12 months. There was no difference between groups in antiplatelet adherence (96% vs 96%, RR 1.00, 95% CI 0.98 to 1.01). There was heterogeneity by baseline treatment intensity such that treatment effects increased with the fewer the number of treatments being taken at baseline: for patients taking 3, 2 and 0–1 treatment modalities the RRs for reaching all three guideline goals simultaneously were 1.10 (95% CI 0.94 to 1.30, 22% vs 20%), 1.62 (95% CI 1.09 to 2.42, 27% vs 17%) and 3.07 (95% CI 1.77 to 5.33, 35% vs 11%), respectively. Polypill-based therapy significantly improved the achievement of all three ESC targets for BP, LDL and antiplatelet therapy compared with usual care, particularly among those undertreated at baseline.
Associations with sight-threatening diabetic macular oedema among Indigenous adults with type 2 diabetes attending an Indigenous primary care clinic in remote Australia: a Centre of Research Excellenc
Publisher: BMJ
Date: 07-2021
DOI: 10.1136/BMJOPHTH-2020-000559
Abstract: To identify factors associated with sight-threatening diabetic macular oedema (STDM) in Indigenous Australians attending an Indigenous primary care clinic in remote Australia. A cross-sectional study design of retinopathy screening data and routinely-collected clinical data among 236 adult Indigenous participants with type 2 diabetes (35.6% men) set in one Indigenous primary care clinic in remote Australia. The primary outcome variable was STDM assessed from retinal images. Age (median (range)) was 48 (21–86) years, and known diabetes duration (median (range)) was 8.0 (0–24) years. Prevalence of STDM was high (14.8%) and similar in men and women. STDM was associated with longer diabetes duration (11.7 vs 7.9 years, respectively p .001) and markers of renal impairment: abnormal estimated Glomerular Filtration Rate (eGFR) (62.9 vs 38.3%, respectively p=0.007), severe macroalbuminuria ( mg/mmol) (20.6 vs 5.7%, respectively p=0.014) and chronic kidney disease (25.7 vs 12.2%, respectively p=0.035). Some clinical factors differed by sex: anaemia was more prevalent in women. A higher proportion of men were smokers, prescribed statins and had increased albuminuria. Men had higher blood pressure, but lower glycated Haemoglobin A1c (HbA1c) levels and body mass index, than women. STDM prevalence was high and similar in men and women. Markers of renal impairment and longer diabetes duration were associated with STDM in this Indigenous primary care population. Embedded teleretinal screening, known diabetes duration-based risk stratification and targeted interventions may lower the prevalence of STDM in remote Indigenous primary care services. Australia and New Zealand Clinical Trials Register: ACTRN 12616000370404.
Clinical outcomes associated with albuminuria in central Australia: A cohort study
Publisher: Springer Science and Business Media LLC
Date: 05-08-2016
Dynamics of ribosome composition and ribosomal protein phosphorylation in immune signaling in Arabidopsis thaliana
Publisher: Oxford University Press (OUP)
Date: 12-10-2023
DOI: 10.1093/NAR/GKAD827
Progression of Kidney Disease in Indigenous Australians: The eGFR Follow-up Study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 13-04-2016
DOI: 10.2215/CJN.09770915
Abstract: Indigenous Australians experience a heavy burden of CKD. To address this burden, the eGFR Follow-Up Study recruited and followed an Indigenous Australian cohort from regions of Australia with the greatest ESRD burden. We sought to better understand factors contributing to the progression of kidney disease. Specific objectives were to assess rates of progression of eGFR in Indigenous Australians with and without CKD and identify factors associated with a decline in eGFR. This observational longitudinal study of Indigenous Australian adults was conducted in sites. The baseline cohort was recruited from community and primary care clinic sites across five strata of health, diabetes status, and kidney function. Participants were then invited to follow up at 2–4 years if unavailable, vital status, progression to RRT, and serum creatinine were obtained from medical records. Primary outcomes were annual eGFR change and combined renal outcome (first of ≥30% eGFR decline with follow-up eGFR ml/min per 1.73 m 2 , progression to RRT, or renal death). Participants ( n =550) were followed for a median of 3.0 years. Baseline and follow-up eGFR (geometric mean [95% confidence interval], 83.9 (80.7 to 87.3) and 70.1 (65.9 to 74.5) ml/min per 1.73 m 2 , respectively. Overall mean annual eGFR change was −3.1 (−3.6 to −2.5) ml/min per 1.73 m 2 . Stratified by baseline eGFR (≥90, 60–89, ml/min per 1.73 m 2 ), annual eGFR changes were −3.0 (−3.6 to −2.4), −1.9 (−3.3 to −0.5), and −5.0 (−6.5 to −3.6) ml/min per 1.73 m 2 . Across baseline eGFR categories, annual eGFR decline was greatest among adults with baseline albumin-to-creatinine ratio (ACR) mg/g (30 mg/mmol). Baseline determinants of the combined renal outcome (experienced by 66 participants) were higher urine ACR, diabetes, lower measured GFR, and higher C-reactive protein. The observed eGFR decline was three times higher than described in nonindigenous populations. ACR was confirmed as a powerful predictor for eGFR decline across erse geographic regions.
What Indigenous Australian clients value about primary health care: a systematic review of qualitative evidence.
Publisher: Elsevier BV
Date: 08-2017
Abstract: To synthesise client perceptions of the unique characteristics and value of care provided in Aboriginal Community Controlled Health Organisations (ACCHOs) compared to mainstream/general practitioner services, and implications for improving access to quality, appropriate primary health care for Indigenous Australians. Standardised systematic review methods with modification informed by ethical and methodological considerations in research involving Indigenous Australians. Perceived unique valued characteristics of ACCHOs were: 1) accessibility, facilitated by ACCHOs welcoming social spaces and additional services 2) culturally safe care and 3) appropriate care, responsive to holistic needs. Provider-client relationships characterised by shared understanding of clients' needs, Indigenous staff, and relationships between clients who share the same culture, are central to ACCHO clients' perceptions of ACCHOs' unique value. The client perceptions provide insights about how ACCHOs address socio-economic factors that contribute to high levels of chronic disease in Indigenous communities, why mainstream PHC provider care cannot substitute for ACCHO care, and how to improve accessibility and quality of care in mainstream providers. Implications for public health: To increase utilisation of PHC services in Indigenous Australian communities, and help close the gaps between the health status of Indigenous and non-Indigenous Australians, Indigenous community leaders and Australian governments should prioritise implementing effective initiatives to support quality health care provision by ACCHOs.
What are the resourcing requirements for an Aboriginal and Torres Strait Islander primary health care research project?
Publisher: The Sax Institute
Date: 09-2020
Direct assessment of mental health and metabolic syndrome amongst Indonesian adolescents: a study design for a mixed-methods study sampled from school and community settings.
Publisher: Informa UK Limited
Date: 16-03-2020
Associations between periodontal disease and cardiovascular surrogate measures among Indigenous Australians
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.IJCARD.2014.02.015
Abstract: Inflammation is a key pathogenetic factor in atherogenesis. Periodontitis is a chronic inflammatory source which can have systemic impacts. Indigenous Australians have a higher prevalence of periodontal disease and experience cardiovascular disease earlier than non-Indigenous Australians. The aim was to describe the association between severity of periodontal inflammatory disease and measures of arterial structure and function. Periodontal disease in a convenience s le of Indigenous Australians was assessed clinically for those with periodontal disease, the extent of periodontal pockets ≥ 4 mm was stratified into quartiles. Vascular health was measured non-invasively via carotid-dorsalis pedis pulse-wave velocity (PWV), and via B-mode ultrasound of the common carotid intima-media (IMT). Non-fasting blood s les were collected for lipid and inflammatory marker evaluation. Linear regression models were constructed to determine the associations between extent of periodontal pocketing and vascular health, adjusting for traditional cardiovascular common risk factors. 273 Indigenous Australian adults were recruited and complete data was available for 269 participants (154 males), median age 39 years. Arterial stiffness (PWV) significantly increased with increasing extent of periodontal pocketing (p trend=0.001). By contrast, carotid IMT did not differ across quartiles. Periodontal pocketing was associated with central arterial stiffness, a marker of presymptomatic arterial dysfunction, in Indigenous Australian adults with periodontal disease.
The health and wellbeing of Indigenous adolescents: a global collective for an equitable and sustainable future
Publisher: Elsevier BV
Date: 2022
Social and economic factors, maternal behaviours in pregnancy and neonatal adiposity in the PANDORA cohort
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.DIABRES.2020.108028
Abstract: Australian Indigenous women experience high rates of social disadvantage and type 2 diabetes (T2D) in pregnancy, but it is not known how social factors and maternal behaviours impact neonatal adiposity in offspring of women with hyperglycaemia in pregnancy. Participants were Indigenous (n = 404) and Europid (n = 240) women with gestational diabetes mellitus (GDM) or T2D in pregnancy and their offspring in the Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) study. Social, economic factors, and maternal behaviours were measured in pregnancy and six neonatal anthropometric outcomes were examined after birth. On univariate analysis, maternal education < 12 years (p = 0.03), unemployment (p = 0.001), welfare income vs no welfare income (p = 0.001), lower area based socio-economic score (p 2 times/week (p = 0.002) were associated with increased sum of skinfolds (SSF) in offspring. Smoking was significantly associated with a reduction in anthropometric measures, except SSF. In multivariable models adjusted for ethnicity, BMI and hyperglycaemia, social and economic factors were no longer significant predictors of neonatal outcomes. Smoking was independently associated with a reduction in length, head circumference and fat free mass. Frequent fast food intake remained independently associated with SSF (β-coefficient 1.08 mm, p = 0.02). In women with hyperglycaemia in pregnancy, social factors were associated with neonatal adiposity, particularly skinfold measures. Promoting smoking cessation and limited intake of energy-dense, nutrient-poor foods in pregnancy are important to improve neonatal adiposity and lean mass outcomes. Addressing inequities in social and economic factors are likely to be important, particularly for Indigenous women or women experiencing social disadvantage.
Alcohol misuse and critical care admissions in the Northern Territory
Publisher: Wiley
Date: 09-2021
DOI: 10.1111/IMJ.15212
Abstract: The Northern Territory (NT) has a long history of heavy alcohol consumption with a correspondingly high attributable morbidity and mortality. To describe the number of admissions to intensive care associated with alcohol misuse. This is a prospective case–control study including all admissions to NT intensive care units (ICU) between 1 July 2018 and 30 June 2019. Characteristics and outcomes of patients who had an admission associated with alcohol misuse (a composite measure of acute and/or chronic misuse) were compared to those who did not. Primary outcome was the number of admissions associated with alcohol misuse. Secondary outcomes included measures of resource use (length of stay (LoS), need for mechanical ventilation) and mortality adjusted for illness severity. Over the s ling period there were 1664 admissions. After exclusions, 1471 admissions were analysed, of which 307 (21%) were associated with alcohol misuse. Acute or chronic misuse was associated with 3.7% and 12.1% of admissions respectively, while 5.1% met criteria for both. Admissions associated with alcohol misuse more frequently required ventilation (38.4% vs 20.7%, P 0.01) and had longer ICU (2.8 vs 2.1 days, P 0.01) and hospital LoS (9.1 vs 7.1 days, P 0.01). There was no difference in hospital mortality (7.2% vs 7.7%, P = 0.94), even after adjustment for illness severity, hospital and diagnostic category. Alcohol misuse is associated with a substantial number of critical care admissions and consumes considerable acute care resources. Further policy directed at harm minimisation and epidemiological work at jurisdictional and national level is necessary.
Aboriginal and Torres Strait Islander health promotion programs for the prevention and management of chronic diseases: a scoping review protocol.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2017
DOI: 10.11124/JBISRIR-2016-003021
Abstract: The scoping review project will identify and describe the existing research on health promotion programs and activities focusing on modifying risk factors (specifically to reduce smoking and alcohol consumption, increase physical activity and improve nutrition and social and emotional wellbeing) and/or improving the management of chronic diseases (specifically obesity, type 2 diabetes, chronic kidney disease and cardiovascular disease) for Aboriginal and Torres Strait Islander peoples across a erse range of health and community settings.
Aboriginal community-controlled aged care: principles, practices and actions to integrate with primary health care
Publisher: Cambridge University Press (CUP)
Date: 2021
DOI: 10.1017/S1463423621000542
Abstract: To identify: 1) best practice aged care principles and practices for Aboriginal and Torres Strait Islander older peoples, and 2) actions to integrate aged care services with Aboriginal community-controlled primary health care. There is a growing number of older Aboriginal and Torres Strait Islander peoples and an unmet demand for accessible, culturally safe aged care services. The principles and features of aged care service delivery designed to meet the unique needs of Aboriginal and Torres Strait Islander peoples have not been extensively explored and must be understood to inform aged care policy and primary health care planning into the future. The research was governed by leaders from across the Aboriginal community-controlled primary health care sector who identified exemplar services to explore best practice in culturally aligned aged care. In-depth case studies were undertaken with two metropolitan Aboriginal community-controlled services. We conducted semi-structured interviews and yarning circles with 46 staff members to explore key principles, ways of working, enablers and challenges for aged care service provision. A framework approach to thematic analysis was undertaken with emergent findings reviewed and refined by participating services and the governance panel to incorporate national perspectives. A range of principles guided Aboriginal community-controlled aged care service delivery, such as supporting Aboriginal and Torres Strait Islander identity, connection with elders and communities and respect for self-determination. Strong governance, effective leadership and partnerships, Aboriginal and Torres Strait Islander workforce and culturally safe non-Indigenous workforce were among the identified enablers of aged care. Nine implementation actions guided the integration of aged care with primary health care service delivery. Funding limitations, workforce shortages, change management processes and difficulties with navigating the aged care system were among the reported challenges. These findings contribute to an evidence base regarding accessible, integrated, culturally safe aged care services tailored to the needs of Aboriginal and Torres Strait Islander peoples.
Good Heart: Telling Stories of Cardiovascular Protective and Risk Factors for Aboriginal Women
Publisher: Elsevier BV
Date: 2021
Environmental risk conditions and pathways to cardiometabolic diseases in indigenous populations
Publisher: Annual Reviews
Date: 21-04-2011
DOI: 10.1146/ANNUREV.PUBLHEALTH.012809.103557
Abstract: This review examines environments in relation to cardiometabolic diseases in Indigenous populations in developed countries. Environmental factors are framed in terms of context (features of places) and composition (features of populations). Indigenous peoples are seen to have endured sociopolitical marginalization and material disadvantage spanning generations. Past adverse collective experiences, modified by culture, are reflected by current heterogeneity in environmental context and composition. As risk conditions, unfavorable contextual and compositional exposures influence the expression of cardiometabolic risk for in iduals. Minimal research has evaluated heterogeneity in risk conditions against heterogeneity in cardiometabolic diseases between or within Indigenous populations. Thus far, the features of populations, not of places themselves, have been implicated in relation to cardiometabolic diseases. Behavioral, psychosocial, and stress-axis pathways may explain the relationships between risk conditions and cardiometabolic diseases. Implications of environmental factors and their pathways as well as important research needs are discussed in relation to ecological prevention to reduce cardiometabolic diseases.
Vaccine preventable diseases in indigenous populations—International perspectives
Publisher: Elsevier BV
Date: 10-2007
Improving systems of care during and after a pregnancy complicated by hyperglycaemia: A protocol for a complex health systems intervention
Publisher: Springer Science and Business Media LLC
Date: 09-2020
DOI: 10.1186/S12913-020-05680-X
Abstract: Many women with hyperglycaemia in pregnancy do not receive care during and after pregnancy according to standards recommended in international guidelines. The burden of hyperglycaemia in pregnancy falls disproportionately upon Indigenous peoples worldwide, including Aboriginal and Torres Strait Islander women in Australia. The remote and regional Australian context poses additional barriers to delivering healthcare, including high staff turnover and a socially disadvantaged population with a high prevalence of diabetes. A complex health systems intervention to improve care for women during and after a pregnancy complicated by hyperglycaemia will be implemented in remote and regional Australia (the Northern Territory and Far North Queensland). The Theoretical Domains Framework was used during formative work with stakeholders to identify intervention components: (1) increasing workforce capacity, skills and knowledge and improving health literacy of health professionals and women (2) improving access to healthcare through culturally and clinically appropriate pathways (3) improving information management and communication (4) enhancing policies and guidelines (5) embedding use of a clinical register as a quality improvement tool. The intervention will be evaluated utilising the RE-AIM framework at two timepoints: firstly, a qualitative interim evaluation involving interviews with stakeholders (health professionals, ch ions and project implementers) and subsequently a mixed-methods final evaluation of outcomes and processes: interviews with stakeholders survey of health professionals an audit of electronic health records and clinical register and a review of operational documents. Outcome measures include changes between pre- and post-intervention in: proportion of high risk women receiving recommended glucose screening in early pregnancy diabetes-related birth outcomes proportion of women receiving recommended postpartum care including glucose testing health practitioner confidence in providing care, knowledge and use of relevant guidelines and referral pathways, and perception of care coordination and communication systems changes to health systems including referral pathways and clinical guidelines. This study will provide insights into the impact of health systems changes in improving care for women with hyperglycaemia during and after pregnancy in a challenging setting. It will also provide detailed information on process measures in the implementation of such health system changes.
Stroke incidence and subtypes in Aboriginal people in remote Australia: a healthcare network population-based study
Publisher: BMJ
Date: 10-2020
DOI: 10.1136/BMJOPEN-2020-039533
Abstract: We aimed to compare the incidence, subtypes and aetiology of stroke, and in-hospital death due to stroke, between Aboriginal and non-Aboriginal people in Central Australia, a remote region of Australia where a high proportion Aboriginal people reside (40% of the population). We hypothesised that the rates of stroke, particularly in younger adults, would be greater in the Aboriginal population, compared with the non-Aboriginal population we aimed to elucidate causes for any identified disparities. A retrospective population-based study of patients hospitalised with stroke within a defined region from 1 January 2011 to 31 December 2014. Alice Springs Hospital, the only neuroimaging-capable acute hospital in Central Australia, serving a network of 50 healthcare facilities covering 672 000 km 2 . 161 residents (63.4% Aboriginal) of the catchment area admitted to hospital with stroke. Rates of first-ever stroke, overall (all events) stroke and in-hospital death. Of 121 residents with first-ever stroke, 61% identified as Aboriginal. Median onset-age (54 years) was 17 years younger in Aboriginal patients (p .001), and age-standardised stroke incidence was threefold that of non-Aboriginal patients (153 vs 51 per 100 000, incidence rate ratio 3.0, 95% CI 2 to 4). The rate ratios for the overall rate of stroke (first-ever and recurrent) were similar. In Aboriginal patients aged years, the incidence of ischaemic stroke was 14-fold greater (95% CI 4 to 45), and intracerebral haemorrhage 19-fold greater (95% CI 3 to 142) than in non-Aboriginal patients. Crude prevalence of diabetes mellitus (70.3% vs 34.0%, p .001) and hypercholesterolaemia (68.9% vs 51.1%, p=0.049) was greater, and age-standardised in-hospital deaths were fivefold greater (35 vs 7 per 100 000, 95% CI 2 to 11) in Aboriginal patients than in non-Aboriginal patients. Stroke incidence (both subtypes) and in-hospital deaths for remote Aboriginal Australians are dramatically greater than in non-Aboriginal people, especially in patients aged years.
From Deficit to Strength-Based Aboriginal Health Research—Moving toward Flourishing
Publisher: MDPI AG
Date: 04-04-2023
Abstract: Aboriginal Australians have a fundamental human right to opportunities that lead to healthy and flourishing lives. While the impact of trauma on Aboriginal Australians is well-documented, a pervasive deficit narrative that focuses on problems and pathology persists in research and policy discourse. This narrative risks further exacerbating Aboriginal disadvantage through a focus on ‘fixing what is wrong’ with Aboriginal Australians and the internalising of these narratives by Aboriginal Australians. While a growing body of research adopts strength-based models, limited research has sought to explore Aboriginal flourishing. This conceptual paper seeks to contribute to a burgeoning paradigm shift in Aboriginal research, seeking to understand what can be learned from Aboriginal people who flourish, how we best determine this, and in what contexts this can be impactful. Within, we argue the case for a new approach to exploring Aboriginal wellbeing that integrates salutogenic, positive psychology concepts with complex systems theory to understand and promote Aboriginal wellbeing and flourishing. While deeper work may be required to establish the parameters of a strength-based, culturally aligned Aboriginal conceptualisation of positive psychology, we suggest the integration of Aboriginal and Western methodologies offers a unique and potent means of shifting the dial on seemingly intractable problems.
Are minor echocardiographic changes associated with an increased risk of acute rheumatic fever or progression to rheumatic heart disease?
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.IJCARD.2015.07.005
Abstract: The World Heart Federation criteria for the echocardiographic diagnosis of rheumatic heart disease (RHD) include a category "Borderline" RHD which may represent the earliest evidence of RHD. We aimed to determine the significance of minor heart valve abnormalities, including Borderline RHD, in predicting the future risk of acute rheumatic fever (ARF) or RHD. A prospective cohort study of Aboriginal and Torres Strait Islander children aged 8 to 18 years was conducted. Cases comprised children with Borderline RHD or other minor non-specific valvular abnormalities (NSVAs) detected on prior echocardiography. Controls were children with a prior normal echocardiogram. Participants underwent a follow-up echocardiogram 2.5 to 5 years later to assess for progression of valvular changes and development of Definite RHD. Interval diagnoses of ARF were ascertained. There were 442 participants. Cases with Borderline RHD were at significantly greater risk of ARF (incidence rate ratio 8.8, 95% CI 1.4-53.8) and any echocardiographic progression of valve lesions (relative risk 8.19, 95% CI 2.43-27.53) than their Matched Controls. Cases with Borderline RHD were at increased risk of progression to Definite RHD (1 in 6 progressed) as were Cases with NSVAs (1 in 10 progressed). Children with Borderline RHD had an increased risk of ARF, progression of valvular lesions, and development of Definite RHD. These findings provide support for considering secondary antibiotic prophylaxis or ongoing surveillance echocardiography in high-risk children with Borderline RHD.
Excess stroke incidence in young Aboriginal people in South Australia
Publisher: SAGE Publications
Date: 16-05-2018
Abstract: Retrospective data indicate increased stroke incidence in Aboriginal/Torres Strait Islander (Indigenous) Australians, possibly with poorer outcomes. We present the first prospective population-based stroke incidence study in Indigenous Australians. We pooled data from ASCEND and SEARCH, two prospective “ideal” South Australian stroke incidence studies, ASCEND conducted in urban Northwestern Adelaide (2009–2010) and SEARCH in five South Australian rural centers (2009–2011). We calculated age-standardized incidence for Aboriginal and non-Aboriginal people. The study population comprised 261,403 inhabitants. Among 432 first-ever strokes, 13 were in Aboriginal people (median age 51 vs. 78 years for non-Aboriginal people, p 0.001). Age-standardized stroke incidence per 100,000 in Aboriginal patients (116, 95% CI: 95–137) was nearly two-fold that of non-Aboriginal patients (67, 95% CI: 51–84). Age-stratified excess incidence in Aboriginal people was restricted to those aged 55 years (incidence rate ratio (IRR) 3.5, 95% CI: 2–7), particularly for intracerebral hemorrhage (IRR: 16, 95% CI: 4–61). The excess stroke incidence in Aboriginal South Australians appears substantial, especially in those aged years. Further work is required to delineate and address disparities.
Real‐world experience of metformin use in pregnancy: Observational data from the Northern Territory Diabetes in Pregnancy Clinical Register
Publisher: Wiley
Date: 19-02-2019
Abstract: In Australia's Northern Territory, Indigenous mothers account for 33% of births and have high rates of hyperglycemia in pregnancy. The prevalence of type 2 diabetes (T2D) in pregnancy is up to 10-fold higher in Indigenous than non-Indigenous Australian mothers, and the use of metformin is common. We assessed birth outcomes in relation to metformin use during pregnancy from a clinical register. The study included women with gestational diabetes (GDM), newly diagnosed diabetes in pregnancy (DIP), or pre-existing T2D from 2012 to 2016. Data were analyzed for metformin use in the third trimester. Regression models were adjusted for maternal age, body mass index, parity, and insulin use. Of 1649 pregnancies, 814 (49.4%) were to Indigenous women, of whom 234 (28.7%) had T2D (vs 4.6% non-Indigenous women P < 0.001). Metformin use was high in Indigenous women (84%-90% T2D, 42%-48% GDM/DIP) and increased over time in non-Indigenous women (43%-100% T2D, 14%-35% GDM/DIP). Among Indigenous women with GDM/DIP, there were no significant differences between groups with and without metformin in cesarean section (51% vs 39% adjusted odds ratio [aOR] 1.25, 95% confidence interval [CI] 0.87-1.81), large for gestational age (24% vs 13% aOR 1.5, 95% CI 0.9-2.5), or serious neonatal adverse events (9.4% vs 5.9% aOR 1.32, 95% CI 0.68-2.57). Metformin use was independently associated with earlier gestational age (37.7 vs 38.5 weeks), but the risk did not remain independently higher after exclusion of women managed with medical nutrition therapy alone, and the increase in births <37 weeks was not significant on multivariate analysis. We found no clear evidence of any adverse outcomes related to the use of metformin for the treatment of hyperglycemia in pregnancy.
Surgical and percutaneous management of Aboriginal Australians with rheumatic heart disease: Timeliness and concordance between practice and guidelines
Publisher: Elsevier BV
Date: 07-2021
Gestational diabetes is associated with postpartum hemorrhage in Indigenous Australian women in the PANDORA study: A prospective cohort
Publisher: Wiley
Date: 19-08-2021
DOI: 10.1002/IJGO.13846
Abstract: To assess associations of hyperglycemia in pregnancy with the risk of postpartum hemorrhage (PPH) in a prospective cohort of Indigenous and non‐Indigenous women, compared with normoglycemia. Data were from 1102 (48% Indigenous) women of the Pregnancy And Neonatal Diabetes Outcomes in Remote Australia (PANDORA) Study. Age‐adjusted associations of gestational diabetes mellitus (GDM) or pre‐existing type 2 diabetes mellitus (T2DM), obstetric and demographic covariables with PPH (blood loss ≥500 ml) were assessed using logistic regression. Multivariable‐adjusted models included Indigenous ethnicity, diabetes type and their interaction. A higher proportion of Indigenous women developed PPH than non‐Indigenous women (32% versus 22% P 0.001). Compared with non‐Indigenous women with normoglycemia, risks of PPH for Indigenous women with GDM or T2DM were higher (odds ratio [OR] 1.83, 95% confidence intervals [CI] 1.11–3.02, and OR 1.72, 95% CI 0.99–3.00 after age adjustment, OR 1.84, 95% CI 1.06–3.19, and OR 1.33, 95% CI 0.70–2.54 after adjustment for school education and delivery mode, and OR 1.62, 95% CI 0.95–2.77, and OR 0.99, 95% CI 0.53–1.86 after adjustment for birth weight). Importantly, Indigenous women without hyperglycemia in pregnancy were not at increased risk of PPH. The significantly higher rates of PPH experienced by Indigenous women compared with non‐Indigenous women may be explained by a greater effect of GDM among Indigenous women that was only partly accounted for by birth weight.
Cardiometabolic Risk Markers for Aboriginal and Torres Strait Islander Children and Youths: A Systematic Review of Data Quality and Population Prevalence
Publisher: MDPI AG
Date: 26-06-2023
Abstract: Cardiovascular disease and type 2 diabetes mellitus are leading contributors to the health inequity experienced by Aboriginal and Torres Strait Islander peoples, and their antecedents can be identified from early childhood. We aimed to establish the quality of available data and the prevalence of cardiometabolic risk markers among Aboriginal and Torres Strait Islander children and youths (0–24-year-olds) to inform public health approaches. A systematic review of the peer-reviewed and grey literature was conducted between 1 January 2000–28 February 2021. Included studies reported population prevalence of cardiometabolic risks, including elevated blood pressure, obesity, central adiposity, dyslipidaemia, hyperglycaemia, and ‘metabolic syndrome’ for Aboriginal and Torres Strait Islander people aged 0–24 years. Fifteen studies provided population estimates. Data quality was limited by low response rates (10/15 studies) and suboptimal outcome measurements. Obesity is the most reported risk (13/15 studies). Aboriginal and Torres Strait Islander children have an excess risk of obesity from early childhood and prevalence increases with age: 32.1% of Aboriginal and Torres Strait Islander 18–24-year-olds had obesity and 50.8% had central adiposity. In a cohort of 486 9–14-year-olds in Darwin, 70% had ≥1 component of metabolic syndrome 14% met the full criteria for the syndrome. The prevalence of cardiometabolic risk in Aboriginal and Torres Strait Islander young people is difficult to estimate due to limitations in measurement quality and s ling representativeness. Available data suggest that cardiometabolic risk markers are evident from early childhood. The establishment of national and state-level datasets and a core outcome set for cardiometabolic screening would provide opportunities for preventative action.
Clinical Pathway for Coronary Atherosclerosis in Patients Without Conventional Modifiable Risk Factors
Publisher: Elsevier BV
Date: 09-2023
The effect of a periodontal intervention on cardiovascular risk markers in Indigenous Australians with periodontal disease: the PerioCardio study
Publisher: Springer Science and Business Media LLC
Date: 26-09-2011
Abstract: Indigenous Australians experience an overwhelming burden of chronic disease, including cardiovascular diseases. Periodontal disease (inflammation of the tissues surrounding teeth) is also widespread, and may contribute to the risk of cardiovascular diseases via pathogenic inflammatory pathways. This study will assess measures of vascular health and inflammation in Indigenous Australian adults with periodontal disease, and determine if intensive periodontal therapy improves these measures over a 12 month follow-up. The aims of the study are: (i) to determine whether there is a dose response relationship between extent and severity of periodontal disease and measures of vascular health and inflammation among Indigenous Australian adults with moderate to severe periodontal disease and (ii) to determine the effects of periodontal treatment on changes in measures of vascular health and inflammation in a cohort of Indigenous Australians. This study will be a randomised, controlled trial, with predominantly blinded assessment of outcome measures and blinded statistical analysis. All participants will receive the periodontal intervention benefits (with the intervention delayed 12 months in participants who are randomised to the control arm). Participants will be Indigenous adults aged ≥25 years from urban centres within the Top End of the Northern Territory, Australia. Participants assessed to have moderate or severe periodontal disease will be randomised to the study's intervention or control arm. The intervention involves intensive removal of subgingival and supragingival calculus and plaque biofilm by scaling and root-planing. Study visits at baseline, 3 and 12 months, will incorporate questionnaires, non-fasting blood and urine s les, body measurements, blood pressure, periodontal assessment and non-invasive measures of vascular health (pulse wave velocity and carotid intima-media thickness). Primary outcome measures are pulse wave velocity and carotid intima-media thickness. The study will assess the periodontal-cardiovascular disease relationship among Indigenous Australian adults with periodontal disease, and the effectiveness of an intervention aimed at improving periodontal and cardiovascular health. Efforts to understand and improve Indigenous oral health and cardiovascular risk may serve as an important means of reducing the gap between Indigenous and non-Indigenous health in Australia. Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000817044
Accurate Assessment of Kidney Function in Indigenous Australians: The Estimated GFR Study
Publisher: Elsevier BV
Date: 10-2012
'We're here to listen and help them as well': A qualitative study of staff and Indigenous patient perceptions about participating in social and emotional wellbeing research at primary healthcare services
Publisher: Springer Science and Business Media LLC
Date: 07-10-2019
DOI: 10.1186/S12888-019-2263-8
Abstract: Research can inform culturally-appropriate care to strengthen social and emotional wellbeing (SEWB) among Aboriginal and Torres Strait Islander (hereafter, the term ‘Indigenous Peoples’ is respectfully used and refers to all Aboriginal and/or Torres Strait Islander Peoples of Australia). We acknowledge the cultural ersity of Australia’s Indigenous First Peoples and they do not represent a homogenous group.) (hereafter Indigenous) Peoples. We explore the perspectives of primary healthcare staff and Indigenous patients about their willingness to and experiences participating in SEWB research. Process evaluation using grounded theory approaches of Getting it Right : The validation study , a national validation designed Indigenous SEWB research project ( N = 500). Primary healthcare staff ( n = 36) and community members ( n = 4) from nine of ten primary healthcare services involved with the research project completed qualitative semi-structured interviews. Interview data were triangulated with participant feedback (responses to structured questions and free-text feedback collected during Getting it Right ), study administrative data (participant screening logs, communication logs, study protocol, deviation logs and ethics correspondence) and interviewer field notes. Three themes about staff, patient and community perspectives concerning research participation developed: (1) considering the needs, risk, preferences and impact of participation in research for staff, patients and community (2) building staff confidence speaking to patients about research and SEWB problems and (3) patients speaking openly about their SEWB. Some staff described pressure to ensure patients had a positive experience with the research, to respond appropriately if patients became upset or SEWB problems were identified during interviews, or due to their dual role as community member and researcher. Patients and staff reported that patients were more likely to participate if they knew the staff outside of the service, especially staff with a shared cultural background, and they perceived SEWB as a community priority. Staff reported their skills speaking to patients about the research and SEWB improved during the research, which built their confidence. Contrary to staff preconceptions, staff and patients reported that many patients appreciated the opportunity to speak about their SEWB and contributing to research that may eventually enhance SEWB in their community. Our research project was considered acceptable by most staff and patients. The positive outcomes reported by staff and feedback from patients highlights the importance of providing opportunities for people to speak about their SEWB and for research-informed SEWB PHC care. Getting it Right is registered on ANZCTR12614000705684 .
Type 2 diabetes after a pregnancy with gestational diabetes among first nations women in Australia: The PANDORA study
Publisher: Elsevier BV
Date: 11-2021
Association between maternal hyperglycemia in pregnancy and offspring anthropometry in early childhood: the pandora wave 1 study
Publisher: Springer Science and Business Media LLC
Date: 22-08-2023
DOI: 10.1038/S41366-023-01366-6
Abstract: In-utero hyperglycemia exposure influences later cardiometabolic risk, although few studies include women with pre-existing type 2 diabetes (T2D) or assess maternal body mass index (BMI) as a potential confounder. To explore the association of maternal T2D and gestational diabetes mellitus (GDM) with childhood anthropometry, and the influence of maternal BMI on these associations. The PANDORA cohort comprises women ( n = 1138) and children ( n = 1163). Women with GDM and T2D were recruited from a hyperglycemia in pregnancy register, and women with normoglycemia from the community. Wave 1 follow-up included 423 children, aged 1.5–5 years (median follow-up age 2.5 years). Multivariable linear regression assessed associations between maternal antenatal variables, including BMI and glycemic status, with offspring anthropometry (weight, height, BMI, skinfold thicknesses, waist, arm and head circumferences). Greater maternal antenatal BMI was associated with increased anthropometric measures in offspring independent of maternal glycemic status. After adjustment, including for maternal BMI, children exposed to maternal GDM had lower mean weight (−0.54 kg, 95% CI: −0.99, −0.11), BMI (−0.55 kg/m 2 , 95% CI: −0.91, −0.20), head (−0.52 cm, 95% CI: −0.88, −0.16) and mid-upper arm (−0.32 cm, 95% CI: −0.63, −0.01) circumferences, and greater mean suprailiac skinfold (0.78 mm, 95% CI: 0.13, 1.43), compared to children exposed to normoglycemia. Adjustment for maternal BMI strengthened the negative association between GDM and child weight, BMI and circumferences. Children exposed to maternal T2D had smaller mean head circumference (−0.82 cm, 95% CI: −1.33, −0.31) than children exposed to normoglycemia. Maternal T2D was no longer associated with greater child mean skinfolds ( p = 0.14) or waist circumference ( p = 0.18) after adjustment for maternal BMI. Children exposed to GDM had greater suprailiac skinfold thickness than unexposed children, despite having lower mean weight, BMI and mid-upper arm circumference, and both GDM and T2D were associated with smaller mean head circumference. Future research should assess whether childhood anthropometric differences influence lifetime cardiometabolic and neurodevelopmental risk.
A Clinical Guide for Assessment and Prescription of Exercise and Physical Activity in Cardiac Rehabilitation. A CSANZ Position Statement
Publisher: Elsevier BV
Date: 09-2023
Optimising Secondary Prevention and Cardiac Rehabilitation for Atherosclerotic Cardiovascular Disease During the COVID-19 Pandemic: A Position Statement From the Cardiac Society of Australia and New Z
Publisher: Elsevier BV
Date: 07-2020
Health service changes to address diabetes in pregnancy in a complex setting: perspectives of health professionals.
Publisher: Springer Science and Business Media LLC
Date: 03-08-2017
Addressing inequities in access to quality health care for indigenous people
Publisher: CMA Joule Inc.
Date: 04-11-2008
DOI: 10.1503/CMAJ.081445
Integrated guidance for enhancing the care of familial hypercholesterolaemia in Australia
Publisher: Elsevier BV
Date: 03-2021
Delivery of maternal health care in Indigenous primary care services: baseline data for an ongoing quality improvement initiative
Publisher: Springer Science and Business Media LLC
Date: 07-03-2011
Effect of intensive structured care on individual blood pressure targets in primary care: multicentre randomised controlled trial
Publisher: BMJ
Date: 20-11-2012
DOI: 10.1136/BMJ.E7156
Building Indigenous health workforce capacity and capability through leadership – the Miwatj health leadership model
Publisher: Cambridge University Press (CUP)
Date: 2021
DOI: 10.1017/S1463423621000554
Abstract: In the crowded field of leadership research, Indigenous leadership remains under-researched. This article explores the Leadership Model of an Aboriginal Community Controlled Primary Health Care Organisation providing services to the Yolngu people of remote northern Australia: the Miwatj Health Aboriginal Corporation (Miwatj). The limited research which does exist on Indigenous leadership points to unique challenges for Indigenous leaders. These challenges relate to fostering self-determination in their communities, managing significant community expectations, and navigating a path between culturally ergent approaches to management and leadership. Guided by Indigenous methodology and using a mixed methods approach, semi-structured interviews, self-reported health service data, organisational and publicly available documents, and literature were analysed using a framework method of thematic analysis to identify key themes of the Miwatj Leadership Model. The Miwatj Leadership Model is underpinned by three distinctive elements: it offers Yolngu people employment opportunities it supports staff who want to move into leadership positions and provides capacity building through certificates and diplomas and it provides for the physical, emotional, and cultural wellbeing of all Yolngu staff. Furthermore, the model respects traditional Yolngu forms of authority and empowers the community to develop, manage and sustain their own health. The Miwatj Leadership Model has been successful in providing formal pathways to support Indigenous staff to take on leadership roles, and has improved the accessibility and acceptability of health care services as a result of Yolngu employment and improved cultural safety. Translating the Miwatj Leadership Model into other health services will require considerable thought and commitment. The Miwatj Leadership Model can be adapted to meet the needs of other health care services in consideration of the unique context within which they operate. This study has demonstrated the importance of having a formal leadership model that promotes recruitment, retention, and career progression for Indigenous staff.
The future of acute rheumatic fever and rheumatic heart disease in Australia
Publisher: Wiley
Date: 08-2012
DOI: 10.5694/MJA12.10980
Identification of Aboriginal children using linked administrative data: Consequences for measuring inequalities
Publisher: Wiley
Date: 18-04-2016
DOI: 10.1111/JPC.13132
Abstract: The aim of this study was to examine the identification of Aboriginal children in multiple administrative datasets and how this may affect estimates of health and development. Data collections containing a question about Aboriginal ethnicity: birth registrations, perinatal statistics, Australian Early Development Census and school enrolments were linked to datasets recording developmental outcomes: national literacy and numeracy tests (National Assessment Program - Literacy and Numeracy), Australian Early Development Census and perinatal statistics (birthweight) for South Australian children born 1999-2005 (n = 13 414-44 989). Six algorithms to derive Aboriginal ethnicity were specified. The proportions of children thus quantified were compared for developmental outcomes, including those scoring above the national minimum standard in year 3 National Assessment Program - Literacy and Numeracy reading. The proportion of Aboriginal children identified varied from 1.9% to 4.7% when the algorithm incremented from once to ever identified as Aboriginal, the latter using linked datasets. The estimates of developmental outcomes were altered: for ex le, the proportion of Aboriginal children who performed above the national minimum standard in year 3 reading increased by 12 percentage points when the algorithm incremented from once to ever identified as Aboriginal. Similar differences by identification algorithm were seen for all outcomes. The proportion of South Australian children identified as Aboriginal in administrative datasets, and hence inequalities in developmental outcomes, varied depending on which and how many data sources were used. Linking multiple administrative datasets to determine the Aboriginal ethnicity of the child may be useful to inform policy, interventions, service delivery and how well we are closing developmental gaps.
Variation in quality of preventive care for well adults in Indigenous community health centres in Australia
Publisher: Springer Science and Business Media LLC
Date: 06-2011
Abstract: Early onset and high prevalence of chronic disease among Indigenous Australians call for action on prevention. However, there is deficiency of information on the extent to which preventive services are delivered in Indigenous communities. This study examined the variation in quality of preventive care for well adults attending Indigenous community health centres in Australia. During 2005-2009, clinical audits were conducted on a random s le (stratified by age and sex) of records of adults with no known chronic disease in 62 Indigenous community health centres in four Australian States/Territories (s le size 1839). Main outcome measures: i) adherence to delivery of guideline-scheduled services within the previous 24 months, including basic measurements, laboratory investigations, oral health checks, and brief intervention on lifestyle modification and ii) follow-up of abnormal findings. Overall delivery of guideline-scheduled preventive services varied widely between health centres (range 5-74%). Documentation of abnormal blood pressure reading ([greater than or equal to]140/90 mmHg), proteinuria and abnormal blood glucose ([greater than or equal to]5.5 mmol/L) was found to range between 0 and 90% at the health centre level. A similarly wide range was found between health centres for documented follow up check/test or management plan for people documented to have an abnormal clinical finding. Health centre level characteristics explained 13-47% of variation in documented preventive care, and the remaining variation was explained by client level characteristics. There is substantial room to improve preventive care for well adults in Indigenous primary care settings. Understanding of health centre and client level factors affecting variation in the care should assist clinicians, managers and policy makers to develop strategies to improve quality of preventive care in Indigenous communities.
Rheumatic heart disease in Indigenous children in northern Australia: Differences in prevalence and the challenges of screening
Publisher: AMPCo
Date: 09-2015
DOI: 10.5694/MJA15.00139
Abstract: To compare regional differences in the prevalence of rheumatic heart disease (RHD) detected by echocardiographic screening in high-risk Indigenous Australian children, and to describe the logistical and other practical challenges of RHD screening. Cross-sectional screening survey performed between September 2008 and November 2010. Thirty-two remote communities in four regions of northern and central Australia. 3946 Aboriginal or Torres Strait Islander children aged 5-15 years. Portable echocardiography was performed by cardiac sonographers. Echocardiograms were recorded and reported offsite by a pool of cardiologists. RHD was diagnosed according to 2012 World Heart Federation criteria. The prevalence of definite RHD differed between regions, from 4.7/1000 in Far North Queensland to 15.0/1000 in the Top End of the Northern Territory. The prevalence of definite RHD was greater in the Top End than in other regions (odds ratio, 2.3 95% CI, 1.2-4.6, P = 0.01). Fifty-three per cent of detected cases of definite RHD were new cases the prevalence of new cases of definite RHD was 4.6/1000 for the entire s le and 7.0/1000 in the Top End. Evaluation of socioeconomic data suggests that the Top End group was the most disadvantaged in our study population. The prevalence of definite RHD in remote Indigenous Australian children is significant, with a substantial level of undetected disease. Important differences were noted between regions, with the Top End having the highest prevalence of definite RHD, perhaps explained by socioeconomic factors. Regional differences must be considered when evaluating the potential benefit of widespread echocardiographic screening in Australia.
Urban Aboriginal and Torres Strait Islander children's exposure to stressful events: a cross‐sectional study
Publisher: AMPCo
Date: 07-2013
DOI: 10.5694/MJA12.11716
Abstract: To determine the frequency and types of stressful events experienced by urban Aboriginal and Torres Strait Islander children, and to explore the relationship between these experiences and the children's physical health and parental concerns about their behaviour and learning ability. Cross-sectional study of Aboriginal and Torres Strait Islander children aged ≤ 14 2013s presenting to an urban Indigenous primary health care service in Brisbane for annual child health checks between March 2007 and March 2010. Parental or carer report of stressful events ever occurring in the family that may have affected the child. Of 344 participating children, 175 (51%) had experienced at least one stressful event. Reported events included the death of a family member or close friend (40 23%), parental orce or separation (28 16%), witness to violence or abuse (20 11%), or incarceration of a family member (7 4%). These children were more likely to have parents or carers concerned about their behaviour (P < 0.001) and to have a history of ear (P < 0.001) or skin (P = 0.003) infections. Children who had experienced stressful events had poorer physical health and more parental concern about behavioural 1s than those who had not. Parental disclosure in the primary health care setting of stressful events that have affected the child necessitates appropriate medical, psychological or social interventions to ameliorate both the immediate and potential lifelong negative impact. However, treating the impact of stressful events is insufficient without dealing with the broader political and societal 1s that result in a clustering of stressful events in the Aboriginal and Torres Strait Islander population.
The need for a roadmap to guide actions for Aboriginal and Torres Strait Islander adolescent health
Publisher: Wiley
Date: 04-06-2022
DOI: 10.5694/MJA2.51592
Access to primary health care services for Indigenous peoples: A framework synthesis
Publisher: Springer Science and Business Media LLC
Date: 30-09-2016
DOI: 10.1186/S12939-016-0450-5
Abstract: Indigenous peoples often find it difficult to access appropriate mainstream primary health care services. Securing access to primary health care services requires more than just services that are situated within easy reach. Ensuring the accessibility of health care for Indigenous peoples who are often faced with a vast array of additional barriers including experiences of discrimination and racism, can be complex. This framework synthesis aimed to identify issues that hindered Indigenous peoples from accessing primary health care and then explore how, if at all, these were addressed by Indigenous health care services. To be included in this framework synthesis papers must have presented findings focused on access to (factors relating to Indigenous peoples, their families and their communities) or accessibility of Indigenous primary health care services. Findings were imported into NVivo and a framework analysis undertaken whereby findings were coded to and then thematically analysed using Levesque and colleague's accessibility framework. Issues relating to the cultural and social determinants of health such as unemployment and low levels of education influenced whether Indigenous patients, their families and communities were able to access health care. Indigenous health care services addressed these issues in a number of ways including the provision of transport to and from appointments, a reduction in health care costs for people on low incomes and close consultation with, if not the direct involvement of, community members in identifying and then addressing health care needs. Indigenous health care services appear to be best placed to overcome both the social and cultural determinants of health which h er Indigenous peoples from accessing health care. Findings of this synthesis also suggest that Levesque and colleague's accessibility framework should be broadened to include factors related to the health care system such as funding.
Adherence to activity monitoring devices or smartphone applications for improving physical activity in adults with cardiovascular disease: A systematic review protocol
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2018
Health and wellbeing of Indigenous adolescents in Australia: a systematic synthesis of population data
Publisher: Elsevier BV
Date: 02-2018
High-Energy Diet and Shorter Light Exposure Drives Markers of Adipocyte Dysfunction in Visceral and Subcutaneous Adipose Depots of Psammomys obesus
Publisher: MDPI AG
Date: 13-12-2019
DOI: 10.3390/IJMS20246291
Abstract: Dysfunctional adipose tissue phenotype underpins type 2 diabetes mellitus (T2DM) development. The disruption of circadian rhythms contributes to T2DM development. We investigated the effects of high-energy diet and photoperiod length on visceral and subcutaneous adipose tissue phenotype. Psammomys obesus sand rats exposed to neutral (12 light:12 dark) or short (5 light:19 dark) photoperiod were fed a low- (LE) or high- (HE) energy diet. The HE diet and/or short photoperiod reduced subcutaneous expression of adipocyte differentiation/function markers C/ebpα, Pparδ, Pparγ and Adipoq. Visceral Pparα levels were elevated in the 5:19HE group however, the HE diet and/or short photoperiod decreased visceral Pparγ and Adipoq expression. 5:19HE animals had elevated Ucp1 yet lower Pgc-1α levels. The HE diet increased visceral Tgf-β1, Ccl2 and Cd68 levels, suggestive of a pro-inflammatory state. Daily visceral rhythms of these genes were affected by a short photoperiod and/or HE diet. The 12:12HE, 5:19LE or 5:19HE animals had a higher proportion of larger adipocytes, indicating increased adipocyte hypertrophy. Collectively, the HE diet and/or shorter light exposure drives a dysfunctional adipose tissue phenotype. Daily rhythms are affected by a short photoperiod and HE diet in a site-specific manner. These findings provide mechanistic insight on the influence of disrupted circadian rhythms and HE diet on adipose tissue phenotype.
Improving Models of Care for Diabetes in Pregnancy: Experience of Current Practice in Far North Queensland, Australia
Publisher: Frontiers Media SA
Date: 19-07-2019
Implementation and prospective evaluation of the Country Heart Attack Prevention model of care to improve attendance and completion of cardiac rehabilitation for patients with cardiovascular diseases living in rural Australia: a study protocol
Publisher: BMJ
Date: 02-2022
DOI: 10.1136/BMJOPEN-2021-054558
Abstract: Despite extensive evidence of its benefits and recommendation by guidelines, cardiac rehabilitation (CR) remains highly underused with only 20%–50% of eligible patients participating. We aim to implement and evaluate the Country Heart Attack Prevention (CHAP) model of care to improve CR attendance and completion for rural and remote participants. CHAP will apply the model for large-scale knowledge translation to develop and implement a model of care to CR in rural Australia. Partnering with patients, clinicians and health service managers, we will codevelop new approaches and refine/expand existing ones to address known barriers to CR attendance. CHAP will codesign a web-based CR programme with patients expanding their choices to CR attendance. To increase referral rates, CHAP will promote endorsement of CR among clinicians and develop an electronic system that automatises referrals of in-hospital eligible patients to CR. A business model that includes reimbursement of CR delivered in primary care by Medicare will enable sustainable access to CR. To promote CR quality improvement, professional development interventions and an accreditation programme of CR services and programmes will be developed. To evaluate 12-month CR attendance/completion (primary outcome), clinical and cost-effectiveness (secondary outcomes) between patients exposed (n=1223) and not exposed (n=3669) to CHAP, we will apply a multidesign approach that encompasses a prospective cohort study, a pre-post study and a comprehensive economic evaluation. This study was approved by the Southern Adelaide Clinical Human Research Ethics Committee (HREC/20/SAC/78) and by the Department for Health and Wellbeing Human Research Ethics Committee (2021/HRE00270), which approved a waiver of informed consent. Findings and dissemination to patients and clinicians will be through a public website, online educational sessions and scientific publications. Deidentified data will be available from the corresponding author on reasonable request. ACTRN12621000222842.
Case load and valve surgery outcome in Australia
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.IJCARD.2016.06.179
Abstract: In Australia it has been suggested that heart valve surgery, particularly for rheumatic heart disease (RHD), should be consolidated in higher volume centres. International studies of cardiac surgery suggest large volume centres have superior outcomes. However the effect of site and surgeon case load on longer term outcomes for valve surgery has not been investigated. The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database was analysed. The adjusted association between both average annual site and surgeon case load on short term complications and short and long-term survival was determined. Outcomes associated with 20,116 valve procedures at 25 surgical sites and by 93 surgeons were analysed. Overall adjusted analysis showed increasing site and surgeon case load was associated with longer ventilation, less reoperation and more anticoagulant complications. Increasing surgeon case load was also associated with less acute kidney injury. Adjusted 30-day mortality was not associated with site or surgeon case load. There was no consistent relationship between increasing site case load and long term survival. The association between surgeon case load and outcome demonstrated poorer adjusted survival in the highest volume surgeon group. In this Australian study, the adjusted association between surgeon and site case load was not simple or consistent. Overall larger volume sites or surgeons did not have superior outcomes. Mandating a particular site case load level for valve surgery or a minimum number of procedures for in idual surgeons, in an Australian context, cannot be supported by these findings.
Diabetic retinopathy in a remote Indigenous primary healthcare population: a Central Australian diabetic retinopathy screening study in the Telehealth Eye and Associated Medical Services Network proje
Publisher: Wiley
Date: 27-02-2018
DOI: 10.1111/DME.13596
Abstract: To determine diabetic retinopathy prevalence and severity among remote Indigenous Australians. A cross-sectional diabetic retinopathy screening study of Indigenous adults with Type 2 diabetes was conducted by locally trained non-ophthalmic retinal imagers in a remote Aboriginal community-controlled primary healthcare clinic in Central Australia and certified non-ophthalmic graders in a retinal grading centre in Melbourne, Australia. The main outcome measure was prevalence of any diabetic retinopathy and sight-threatening diabetic retinopathy. Among 301 participants (33% male), gradable image rates were 78.7% (n = 237) for diabetic retinopathy and 83.1% (n = 250) for diabetic macular oedema, and 77.7% (n = 234) were gradable for both diabetic retinopathy and diabetic macular oedema. For the gradable subset, the median (range) age was 48 (19-86) years and known diabetes duration 9.0 (0-24) years. The prevalence of diabetic retinopathy was 47% (n = 110) and for diabetic macular oedema it was 14.4% (n = 36). In the fully gradable imaging studies, sight-threatening diabetic retinopathy prevalence was 16.2% (n = 38): 14.1% (n = 33) for clinically significant macular oedema, 1.3% (n = 3) for proliferative diabetic retinopathy and 0.9% (n = 2) for both. Sight-threatening diabetic retinopathy had been treated in 78% of detected cases. A novel telemedicine diabetic retinopathy screening service detected a higher prevalence of 'any' diabetic retinopathy and sight-threatening diabetic retinopathy in a remote primary care setting than reported in earlier surveys among Indigenous and non-Indigenous populations. Whether the observed high prevalence of diabetic retinopathy was attributable to greater detection, increasing diabetic retinopathy prevalence, local factors, or a combination of these requires further investigation and, potentially, specific primary care guidelines for diabetic retinopathy management in remote Australia. Clinical Trials registration number: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN 12616000370404.
Effectiveness, cost effectiveness, acceptability and implementation barriers/enablers of chronic kidney disease management programs for Indigenous people in Australia, New Zealand and Canada: A systematic review of mixed evidence
Publisher: Springer Science and Business Media LLC
Date: 06-04-2016
Identifying Environmental Determinants Relevant to Health and Wellbeing in Remote Australian Indigenous Communities: A Scoping Review of Grey Literature
Publisher: MDPI AG
Date: 15-04-2021
Abstract: The high prevalence of preventable infectious and chronic diseases in Australian Indigenous populations is a major public health concern. Existing research has rarely examined the role of built and socio-political environmental factors relating to remote Indigenous health and wellbeing. This research identified built and socio-political environmental indicators from publicly available grey literature documents locally-relevant to remote Indigenous communities in the Northern Territory (NT), Australia. Existing planning documents with evidence of community input were used to reduce the response burden on Indigenous communities. A scoping review of community-focused planning documents resulted in the identification of 1120 built and 2215 socio-political environmental indicators. Indicators were systematically classified using an Indigenous indicator classification system (IICS). Applying the IICS yielded indicators prominently featuring the “community infrastructure” domain within the built environment, and the “community capacity” domain within the socio-political environment. This research demonstrates the utility of utilizing existing planning documents and a culturally appropriate systematic classification system to consolidate environmental determinants that influence health and disease occurrence. The findings also support understanding of which features of community-level built and socio-political environments amenable to public health and social policy actions might be targeted to help reduce the prevalence of infectious and chronic diseases in Indigenous communities.
Lipid profiles and persisting inflammation following critical illness in a C entral A ustralian population: a prospective longitudinal observational study
Publisher: Wiley
Date: 04-2013
DOI: 10.1111/IMJ.12086
Abstract: No published data exist following the changes in lipid profile during and after an episode of acute illness for the Australian Indigenous population. This paper presents data focusing on lipid profiles and inflammatory markers in a group of survivors of critical illness in Central Australia, prospectively recruited to a larger trial exploring the medium-term sequelae of an intensive care unit admission. This data confirm that lipid profiles in acute illness are deranged, and that recovery may differ between indigenous and non-indigenous populations.
A pragmatic randomized trial of a polypill-based strategy to improve use of indicated preventive treatments in people at high cardiovascular disease risk
Publisher: Oxford University Press (OUP)
Date: 27-03-2014
Abstract: Most in iduals at high cardiovascular disease (CVD) risk worldwide do not receive any or optimal preventive drugs. We aimed to determine whether fixed dose combinations of generic drugs ('polypills') would promote use of such medications. We conducted a randomized, open-label trial involving 623 participants from Australian general practices. Participants had established CVD or an estimated five-year CVD risk of ≥15%, with indications for antiplatelet, statin and ≥2 blood pressure lowering drugs ('combination treatment'). Participants randomized to the 'polypill-based strategy' received a polypill containing aspirin 75 mg, simvastatin 40 mg, lisinopril 10 mg and either atenolol 50 mg or hydrochlorothiazide 12.5 mg. Participants randomized to 'usual care' continued with separate medications and doses as prescribed by their doctor. Primary outcomes were self-reported combination treatment use, systolic blood pressure and total cholesterol. After a median of 18 months, the polypill-based strategy was associated with greater use of combination treatment (70% vs. 47% relative risk 1.49, (95% confidence interval (CI) 1.30 to 1.72) p < 0.0001 number needed to treat = 4.4 (3.3 to 6.6)) without differences in systolic blood pressure (-1.5 mmHg (95% CI -4.0 to 1.0) p = 0.24) or total cholesterol (0.08 mmol/l (95% CI -0.06 to 0.22) p = 0.26). At study end, 17% and 67% of participants in polypill and usual care groups, respectively, were taking atorvastatin or rosuvastatin. Provision of a polypill improved self-reported use of indicated preventive treatments. The lack of differences in blood pressure and cholesterol may reflect limited study power, although for cholesterol, improved statin use in the polypill group counter-balanced use of more potent statins with usual care.
Incidence of Stroke in the Aboriginal and Non-Aboriginal Populations of Australia: A Data Linkage Study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2010
DOI: 10.1161/STROKEAHA.122.041975
Abstract: Most estimates of stroke incidence among Aboriginal and Torres Strait Islander (hereinafter Aboriginal) Australians are confined to single regions and include small s le sizes. We aimed to measure and compare stroke incidence in Aboriginal and non-Aboriginal residents across central and western Australia. Whole-population multijurisdictional person-linked data from hospital and death datasets were used to identify stroke admissions and stroke-related deaths (2001–2015) in Western Australia, South Australia, and the Northern Territory. Fatal (including out-of-hospital deaths) and nonfatal incident (first-ever) strokes in patients aged 20-84 years were identified during the 4-year study period (2012–2015), using a 10-year lookback period to exclude people with prior stroke. Incidence rates per 100 000 population/year were estimated for Aboriginal and non-Aboriginal populations, age-standardized to the World Health Organization World Standard population. In a population of 3 223 711 people (3.7% Aboriginal), 11 740 incident (first-ever) strokes (20.6% regional/remote location of residence 15.6% fatal) were identified from 2012 to 2015, 675 (5.7%) in Aboriginal people (73.6% regional/remote 17.0% fatal). Median age of Aboriginal cases (54.5 years 50.1% female) was 16 years younger than non-Aboriginal cases (70.3 years 44.1% female P .001), with significantly greater prevalence of comorbidities. Age-standardized stroke incidence in Aboriginal people (192/100 000 [95% CI, 177–208]) was 2.9-fold greater than in non-Aboriginal people (66/100 000 [95% CI, 65–68]) aged 20-84 years fatal incidence was 4.2-fold greater (38/100 000 [95% CI, 31–46] versus 9/100 000 [95% CI, 9–10]). Disparities were particularly apparent at younger ages (20–54 years), where age-standardized stroke incidence was 4.3-fold greater in Aboriginal people (90/100 000 [95% CI, 81–100]) than non-Aboriginal people (21/100 000 [95% CI, 20–22]). Stroke occurred more commonly, and at younger ages, in Aboriginal than non-Aboriginal populations. Greater prevalence of baseline comorbidities was present in the younger Aboriginal population. Improved primary prevention is required. To optimize stroke prevention, interventions should include culturally appropriate community-based health promotion and integrated support for nonmetropolitan health services.
Nutritional predictors of successful chronic disease prevention for a community cohort in Central Australia
Publisher: Cambridge University Press (CUP)
Date: 17-11-2015
DOI: 10.1017/S1368980015003262
Abstract: To investigate biomarkers of nutrition associated with chronic disease absence for an Aboriginal cohort. Screening for nutritional biomarkers was completed at baseline (1995). Evidence of chronic disease (diabetes, CVD, chronic kidney disease or hypertension) was sought from primary health-care clinics, hospitals and death records over 10 years of follow-up. Principal components analysis was used to group baseline nutritional biomarkers and logistic regression modelling used to investigate associations between the principal components and chronic disease absence. Three Central Australian Aboriginal communities. Aboriginal people ( n 444, 286 of whom were without chronic disease at baseline) aged 15–82 years. Principal components analysis grouped twelve nutritional biomarkers into four components: ‘lipids’ ‘adiposity’ ‘dietary quality’ and ‘habitus with inverse quality diet’. For the 286 in iduals free of chronic disease at baseline, lower adiposity, lower lipids and better dietary quality components were each associated with the absence at follow-up of most chronic diseases examined, with the exception of chronic kidney disease. Low ‘adiposity’ component was associated with absence of diabetes, hypertension and CVD at follow-up. Low ‘lipid’ component was associated with absence of hypertension and CVD, and high ‘dietary quality’ component was associated with absence of CVD at follow-up. Lowering or maintenance of the factors related to ‘adiposity’ and ‘lipids’ to healthy thresholds and increasing access to a healthy diet appear useful targets for chronic disease prevention for Aboriginal people in Central Australia.
Process evaluation of the Getting it Right study and acceptability and feasibility of screening for depression with the aPHQ-9
Publisher: Springer Science and Business Media LLC
Date: 18-09-2019
DOI: 10.1186/S12889-019-7569-4
Abstract: The Getting it Right study determined the validity, sensitivity, specificity and acceptability of the culturally adapted 9-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander (hereafter referred to as Indigenous) people. In this process evaluation we aimed to explore staff perceptions about whether Getting it Right was conducted per protocol, and if the aPHQ-9 was considered an acceptable and feasible screening tool for depression in primary healthcare. This process evaluation will provide information for clinicians and policy makers about the experiences of staff and patients with Getting it Right and what they thought about using the aPHQ-9. Process evaluation using grounded theory approaches. Semi-structured interviews with primary healthcare staff from services participating in Getting it Right were triangulated with feedback (free-text and elicited) from participants collected during the validation study and field notes. Data were thematically analysed according to the Getting it Right study protocol to identify the acceptability and feasibility of the aPHQ-9. Primary healthcare staff ( n = 36) and community members ( n = 4) from nine of the ten participating Getting it Right services and Indigenous participants ( n = 500) from the ten services that took part. Most staff reported that the research was conducted according to the study protocol. Staff from two services reported sometimes recruiting opportunistically (rather than recruiting consecutive patients attending the service as outlined in the main study protocol), when they spoke to patients who they knew from previous interactions, because they perceived their previous relationship may increase the likelihood of patients participating. All Getting it Right participants responded to at least six of the seven feedback questions and 20% provided free-text feedback. Most staff said they would use the aPHQ-9 and most participants said that the questions were easy to understand (87%), the response categories made sense (89%) and that they felt comfortable answering the questions (91%). Getting it Right was predominantly conducted according to the study protocol. The aPHQ-9, the first culturally adapted, nationally validated, freely available depression screening tool for use by Indigenous people, appears to be acceptable and feasible to use. Australian New Zealand Clinical Trial Registry ANZCTR12614000705684 , 03/07/2014.
Early repolarization patterns associated with increased arrhythmic risk are common in young non-Caucasian Australian males and not influenced by athletic status
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.HRTHM.2015.03.060
Abstract: Early repolarization (ER) with a horizontal ST segment (ST-h) and high- litude J waves in the inferior leads is associated with an increased risk of cardiac arrhythmic death. The effect of ethnicity and athletic status on this increased-risk ER pattern has not been established. Aboriginal Australian/Torres Strait Islander and Pacific Islander/Maori (non-Caucasian [non-C]) subjects are well represented in Australian sport however, the patterns and prevalence of ER in these populations are unknown. The purpose of this study was to assess the prevalence and effect of athletic activity on ER patterns in young non-C and Caucasian (C) subjects. Twelve-lead ECGs of 726 male athletes (23.8% non-C) and 170 male controls (45.9% non-C) aged 16-40 years were analyzed for the presence of ER, defined as J-point elevation (J wave, QRS slur, or discrete ST elevation) ≥0.1 mV in ≥2 inferior (II, III, aVF) or lateral (I, aVL,V4-V6) leads. ST morphology was coded as horizontal (ST-h) or ascending (ST-a). "Increased-risk ER" was defined as inferior ER with ST-h and J waves >2 mV. Regardless of athletic status, ER and increased-risk ER were more prevalent in non-C than in C subjects (53.8% vs 32% and 7.6% vs 1.2%, respectively, P <.0001). Whereas lower heart rate, larger QRS voltage, and shorter QRS duration were predictors of ER, non-C ethnicity was the only independent predictor of increased-risk ER (odds ratio 17.621, 95% confidence interval 4.98-62.346, P < .0001). ER patterns associated with increased arrhythmic risk are more common in young non-C than C subjects and were not influenced by athletic status. The long-term clinical significance of ER in these populations is yet to be determined.
Improving systems of prenatal and postpartum care for hyperglycemia in pregnancy: A process evaluation
Publisher: Wiley
Date: 04-09-2021
DOI: 10.1002/IJGO.13850
Abstract: To identify successes to date and opportunities for improvement in the implementation of a complex health systems intervention aiming to improve prenatal and postpartum care and health outcomes for women with hyperglycemia in pregnancy in regional and remote Australia. A qualitative evaluation, underpinned by the RE‐AIM framework (reach, effectiveness, adoption, implementation, maintenance), was conducted mid‐intervention. Semi‐structured interviews were conducted with the participants, who included clinicians, regional policymakers and managers, and study implementation staff. Interviewees ( n = 45) reported that the early phase of the intervention had resulted in the establishment of a clinician network, increased clinician awareness of hyperglycemia in pregnancy, and improvements in management, including earlier referral for specialist care and a focus on improving communication with women. Enablers of implementation included existing relationships with stakeholders and alignment of the intervention with health service priorities. Challenges included engaging remote clinicians and the labor‐intensive nature of maintaining a clinical register of women with hyperglycemia in pregnancy. The early phase of this health systems intervention has had a positive perceived impact on systems of care for women with hyperglycemia in pregnancy. Findings have informed modifications to the intervention, including the development of a communication and engagement strategy.
Time to get anxious about the broken hearted?
Publisher: Elsevier BV
Date: 11-2010
Implementation of a diabetes in pregnancy clinical register in a complex setting: Findings from a process evaluation
Publisher: Public Library of Science (PLoS)
Date: 04-08-2017
Heart failure, ventricular dysfunction and risk factor prevalence in Australian Aboriginal peoples: the Heart of the Heart Study
Publisher: BMJ
Date: 11-08-2012
DOI: 10.1136/HEARTJNL-2012-302229
Abstract: Limited strategies have been developed to evaluate and address the alarming discrepancy in early mortality between Indigenous and non-Indigenous populations. To assess heart failure (HF), HF risk factors and document cardiac characteristics in an Australian Aboriginal population. Adults were enrolled across six Aboriginal communities in Central Australia. They undertook comprehensive cardiovascular assessments, including echocardiography, to determine HF status, asymptomatic ventricular dysfunction and underlying risk factor profile. Of 436 participants (mean age 44±14 years 64% women) enrolled, 5.3% (95% CI 3.2% to 7.5%) were diagnosed with HF, only 35% of whom had a pre-existing HF diagnosis. Asymptomatic left ventricular dysfunction (ALVD) was seen in 13% (95% CI 9.4% to 15.7%) of the population. Estimates of HF risk factor prevalence were as follows: body mass index (BMI) ≥30 kg/m(2) 42%, hypertension 41%, diabetes mellitus 40%, coronary artery disease (CAD) 7% and history of acute rheumatic fever or rheumatic heart disease 7%. In logistic regression analysis (after adjustment for age and gender), HF was associated with CAD (OR=9.6, p<0.001), diabetes (OR=5.4, p=0.002), hypertension (OR=4.8, p=0.006), BMI ≥30 kg/m(2) (OR=2.9, p=0.02), acute rheumatic fever or rheumatic heart disease (OR=5.6, p=0.001) and B-type natriuretic peptide (OR=1.02, p<0.001). The burden of HF, ALVD and risk factors in this population was extremely high. This study highlights potentially modifiable targets on which to focus resources and screening strategies to prevent HF in this high-risk Indigenous population.
Implementing guideline based heart failure care in the Northern territory: challenges and solutions
Publisher: Elsevier BV
Date: 05-2014
Related Organisations
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Location: Australia
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