Publications

Citation:

Kelaher, M., Parry, A., Day, S., Paradies, Y., Lawlor, J. & Solomon, L. 2010, Improving the Identification of Aboriginal and Torres Strait Islander People in Mainstream General Practice, The Lowitja Institute, Melbourne

Description:

Better identification of Indigenous patients in general practices would improve their access to Medicare benefits such as health checks that could help ‘Close the Gap’, yet many GPs don’t consider ethnicity to be relevant to quality of care.  This study reviewed the effectiveness of strategies that aim to improve the identification of Indigenous people.
 
National data and research evidence indicate that less than one third of general practices routinely collect information on the Indigenous status of patients. Improved identification of Aboriginal and Torres Strait Islander patients would support new ‘Closing the Gap’ initiatives to extend the delivery of routine health checks and chronic disease management services. 

Citation:

Anderson, I. 2009, ‘Close the Gap: National Indigenous Health Equality Council’, Medical Journal of Australia, vol. 190(10), pp. 546.

Description:

The National Indigenous Health Equality Council (NIHEC; http://www.nihec.gov.au/) was established in July 2008 to advise the Australian Government Minister for Health and Ageing. Most of its members are Indigenous Australians, with expertise drawn from across the Aboriginal and mainstream health sectors and Australian Government. The Council’s terms of reference focus on:

• Its role in the development and monitoring of progress towards a set of health-related goals and targets to support the government’s commitments to Indigenous life expectancy and child mortality.

• Providing national leadership in responding to the government’s commitment to closing the gap of Indigenous disadvantage by advising the government on working towards the provision of equitable and sustainable health outcomes for Indigenous Australians.

• Providing strategic advice on:

  • the commitments made under the March 2008 Statement of Intent on achieving Indigenous health equality;

  • the development and monitoring of health-related goals and targets to support the government’s commitments to life expectancy and child mortality;

  • priorities for Aboriginal and Torres Strait Islander health, including strategies for meeting targets agreed upon by the Australian Government and the Council of Australian Governments (COAG);

  • monitoring progress towards closing the gap of Indigenous disadvantage; and

  • any specific matters referred to it by the government and the Australian Health Ministers’ Advisory Council.

As a first priority, NIHEC was asked to make recommendations on workforce development and sustainability, including advice on pathways to increase Indigenous workforce representation.

Recent NIHEC initiatives include projects to:

• Map workforce development initiatives (the “Helicopter Project”);

• Articulate the parameters of a forward-looking workforce agenda in Indigenous health (the “Visions/Futures” Project); and

• Develop a national instrument for Aboriginal and Torres Strait Islander health goals and targets.

NIHEC has also agreed to provide strategic advice supporting the implementation of COAG’s 2008 $1.5 billion investment in Indigenous health.

Citation:

Burgess, C., Johnston, F., Berry, H., McDonnell, J., Yibarbuk, D., Gunabarra, C., Mileran, A. & Bailie, R. 2009, ‘Healthy Country Healthy People: The relationship between Indigenous health status and “caring for country”’, Medical Journal of Australia, vol. 190(10), pp. 567–72.

Description:

Citation:

Dwyer, J., O’Donnell, K., Lavoie, J., Marlina, U. & Sullivan, P. 2009, The Overburden Report: Contracting for Indigenous Health Services, Cooperative Research Centre for Aboriginal Health, Darwin.

Description:

Dwyer, J., O’Donnell, K., Lavoie, J., Marlina, U. & Sullivan, P. 2009, The Overburden Report: Contracting for Indigenous Health Services, Cooperative Research Centre for Aboriginal Health, Darwin.

In Australia, Aboriginal and Torres Strait Islander community health organisations play a signifi cant role as providers of essential primary health care (PHC) in rural, remote and urban settings. Australian governments have developed policies and funding programs to support this growing health sector. But the current arrangements for funding are much criticised.

Our examination of the current practices and policies of health authorities has identified characteristics of the funding relationship that are important barriers to good practice, as well as some enabling factors.

Governments are committed to the development of a robust comprehensive PHC sector, but the classical contracting model is not adequate to support the achievement of this goal. We suggest that implementation of government policy commitments will require a different way of thinking about the relationship between government and the sector, with implications for both sides.

Citation:

Garnett, S. T., Sithole, B., Whitehead, P. J., Burgess, C. P., Johnston, F. H. & Lea, T. 2009, ‘Healthy Country, Healthy People: Policy implications of links between Indigenous human health and environmental condition in tropical Australia’, Australian Journal of Public Administration, vol. 68(1), pp. 53–66.

Description:

Investment in programs that help Indigenous people undertake work maintaining the environmental health of their country has benefits for the environment as well as the physical, mental and cultural health of the Indigenous people involved. For health these findings have direct implications for some national health policies, service provision to homelands, health promotion and Indigenous health research. There are also direct implications for environmental investment in northern Australia and the design and regulation of markets in resource entitlements. Indirectly the findings should be important for economic, employment and education policies as well as those promoting social harmony. Given the range of benefits there is a strong argument for cross-agency investment in working on country by Indigenous people.

Citation:

Kelly, K., Dudgeon, P., Gee, G. & Glaskin, B. 2009, Living on the Edge: Social and Emotional Wellbeing Risk and Protective Factors for Serious Psychological Distress among Aboriginal and Torres Strait Islander People, Discussion Paper No. 10, Cooperative Research Centre for Aboriginal Health, Darwin.

Description:

Kelly, K., Dudgeon, P., Gee, G. & Glaskin, B. 2009, Living on the Edge: Social and Emotional Wellbeing Risk and Protective Factors for Serious Psychological Distress among Aboriginal and Torres Strait Islander People, Discussion Paper No. 10, Cooperative Research Centre for Aboriginal Health, Darwin.

This paper has been prepared by the Australian Indigenous Psychologists Association (AIPA) to generate discussionaround the determinants of Indigenous social and emotional wellbeing (SEWB), and to provide a range of recommendations for addressing the current gap in social and emotional wellbeing between Indigenous and non-Indigenous Australians.

Citation:

Laycock, A. with Walker, D., Harrison, N. & Brands, J. 2009, Supporting Indigenous Researchers: A Practical Guide for Supervisors, Cooperative Research Centre for Aboriginal Health, Darwin.

Description:

Laycock, A. with Walker, D., Harrison, N. & Brands, J. 2009, Supporting Indigenous Researchers: A Practical Guide for Supervisors, Cooperative Research Centre for Aboriginal Health, Darwin.

Supporting Indigenous Researchers: A Practical Guide for Supervisors is about good practice in developing the capacity of Indigenous health researchers.  It offers offer practical information, advice, strategies and success stories in Indigenous health research.

Chapters 1 to 3 raise and discuss workplace issues for Indigenous health researchers and their supervisors. The chapters focus on what makes the supervision of Indigenous researchers different to the supervision of non-Indigenous researchers, and suggest ways to build a reciprocal and supportive supervisor–researcher relationship and a strong intercultural research team.
Much of the information is presented through the refl ections, experiences and advice of Indigenous researchers and research supervisors.

Chapters 4 to 7 provide workplace supervisors with practical strategies to tackle the issues raised in Part A and to support Indigenous researchers. The chapters use real examples and stories to guide supervisors in:
• job planning and recruitment of emerging Indigenous researchers
• induction and orientation
• work planning and performance appraisal
• assessing training needs
• designing and supporting on-the-job training and professional development.

Citation:

Maple-Brown, L., Hodge, A., Cunningham, J., Celermajer, D. S. & O’Dea, K. 2009, ‘Risk Factors for Cardiovascular Disease Do not Fully Explain Differences in Carotid Intima-media Thickness between Indigenous and European Australians without Diabetes’, Clinical Endocrinology, vol. 71(2), pp. 189–94.

Citation:

McCoy, B., Ross, R. & Elston, J. 2009, ‘Boys Becoming Men: What makes a difference’, Australasian Psychiatry, vol. 17, pp. 1, S37–S40.

Description:

Objective: In 1983 an Under 17 Australian Rules Football team visited Melbourne. They came from Townsville in North Queensland and the majority were Aboriginal and Torres Strait Islander. For several months prior to the trip they worked to raise the money and resources they needed for the trip. This paper describes the preliminary results of a research project that looked at the health of this group 25 years later. What can we learn from their experience in 1983? What can they tell us about the health of the next generation of young Aboriginal and Torres Strait Islander men?

Method: The research project used a mixture of quantitative and qualitative research methods. It included a questionnaire, interviews, workshop and a focus group.

Results: All of those involved in 1983 are still alive. Over a range of social and economic indicators many score very well but there are signs, as with other Aboriginal and Torres Strait Islander men, of underlying health issues.

Conclusions: Sport can provide for young Aboriginal and Torres Strait Islander men a culturally 'safe' place where important values across generations are developed and sustained.

Citation:

Middleton PF, for the SHRP team. Preventing infants deaths among Aboriginal and teenage women in South Australia. Adelaide: The University of Adelaide, 2009.

Description:

This research was commissioned by e Strategic Health Research Program (SHRP) of the South Australian Department of Health.  It explored strategies and models that might be considered in the South Australian context for preventing infant mortality for Aboriginal and Torres Strait Islander women and teenage women from urban, regional/rural and remote regions.

Citation:

Muller, R., Ward, P., Winefield, T., Tsourtos, G. & Lawn, S. 2009, ‘The Importance of Resilience to Primary Care Practitioners: An interactive psycho-social model’, Australasian Medical Journal, vol. 2(1).

Description:

In this paper, it is argued that an understanding of the factors that make up resilience can enhance communication and concordance between practitioner and patient. A model is presented demonstrating that resilience is an interaction between factors in the internal domain, comprising psychological characteristics and resources, and the external domain, comprising the social environment surrounding the individual. As resilience manifests itself in different ways across the life-cycle, and according to individual circumstances, time is also an important part of the model presented in this paper. Understanding this model of resilience can lead to an insight that there are factors that can be influenced whereby the primary care practitioner can treat the patient, or refer them after a process of concordance through a deeper understanding of the factors that surround a patient’s current health status. Underlying the model is the view that resilience is linked to the assets model of health, seeking to promote and maintain health and prevent illness. Therefore, primary care practitioners, through a deeper understanding of the circumstances of the patient, and through understanding the factors that promote resilience, may be better able to take action in health promotion and maintenance.

Citation:

Robinson, G., Zubrick, S. R., Silburn, S. R., Jones, Y., Cubillo, C., D’Aprano, A., McGuinness, K., Bell, M., Wilkins, T., Stock, C. & West, M. 2009, Let’s Start. Exploring Together for Indigenous Schools and Preschools: Final Evaluation Report, School for Social and Policy Research, Institute of Advanced Studies, Charles Darwin University, Darwin.

Description:

The Let’s Start project was a trial to implement the Exploring Together Preschool
Program (ETPP) in the Northern Territory (NT) for Indigenous and other parents
and children. The project commenced in 2004–2005 with funding under the Australian
government’s Stronger Families and Communities Strategy, in the Invest to
Grow Program.1 It was implemented in partnership with NT Departments of
Health and Families (DHF) and Employment and Training (DET), including
DET’s Students’ Services Division; schools in Darwin, Palmerston and Jabiru; and
schools within DET’s Top End Group Schools on Melville Island. Some nongovernment
schools, most notably, Murrupurtiyanuwu Catholic School (MCS) at
Nguiu on Bathurst Island, were also important participants in the project.

(Note: description first paragraph of exec summary)

Citation:

Shemesh, T., Rowley, K. G., Jenkins, A. J., Best, J. D. & O’Dea, K. 2009, ‘C-Reactive Protein Levels are Very High and More Stable over Time than the Traditional Vascular Risk Factors Total Cholesterol and Systolic Blood Pressure in an Australian Aboriginal Cohort’, Clinical Chemistry, February, vol. 55, pp. 336–41.

Description:

Background: Stability of circulating high-sensitivity C-reactive protein (hsCRP) concentrations has implications for its utility in assessing cardiovascular disease (CVD) risk. We sought to determine hsCRP reproducibility in an indigenous Australian cohort with a view to use hsCRP as a marker of future CVD in community-based risk-factor screenings.

Methods: Seventy people living in a community on the northern coast of Australia participated in 2 risk-factor screenings over a median (interquartile range) follow-up time of 829 (814–1001) days. hsCRP was measured by high-sensitivity nephelometry.

Results: Geometric mean hsCRP concentrations at baseline and follow-up were 4.5 and 5.1 mg/L, respectively (P = 0.220), and Pearson product-moment correlation was 0.775. The proportion of people at high CVD risk (hsCRP >3.0 mg/L) at baseline was 67.1% and remained consistently high (68.6%) at follow-up. Linear regression analysis for follow-up hsCRP as a function of baseline hsCRP, sex, and differences in total and regional body fatness showed that baseline hsCRP was the single predictor in the model, accounting for 63.9% of the total variance in follow-up hsCRP (P_model < 0.001). Prevalence agreement (95% CI) between baseline and follow-up for the hsCRP >3.0 mg/L category was 84% (73%–92%) (P_McNemar = not significant), and coefficient was fair (0.64, compared with 0.31 for systolic blood pressure 140 mmHg and 0.43 for total cholesterol 5.5 mmol/L).

Conclusions: hsCRP concentrations remained consistently reproducible over time across a wide concentration range in an Aboriginal cohort. Correlations between concentrations over time were better than for other traditional CVD risk factors. hsCRP concentration has potential as a marker of future CVD risk.

Citation:

Thomas, D. P., Johnston, V., Fitz, J. & McDonnell, J. 2009, ‘Monitoring Local Trends in Indigenous Tobacco Consumption’, Australian and New Zealand Journal of Public Health, vol. 33, pp. 65–7.

Description:

Objective : To compare two methods of monitoring tobacco consumption in remote Indigenous communities.

Methods : We examined the monthly difference between wholesale invoice and point-of-sale data for tobacco products from three stores from remote Aboriginal communities in the Northern Territory. We assessed three measures of wholesale data.

Results : The average monthly difference between the sale data and the average of wholesale invoices for the previous, same and following month was -33 cigarettes per day (95% CI -157, 92). This average of three months' wholesale invoices provided a more precise estimate than either wholesale invoices from the same or previous month.

Conclusion : Tobacco wholesale data provided a close estimate of sales data in these stores.

Implications : This wholesale data could be used to monitor local trends in remote Indigenous tobacco consumption, facilitating the evaluation of the impact of tobacco control activities and informing future work to reduce Indigenous smoking and its harms.

Description:

Citation:

Kelaher, M., Sheila, P., Lambert, H., Ahmad, W., Paradies, Y. & Davey Smith, G. 2008, ‘Discrimination and Health in an English Study’, Social Science & Medicine, vol. 66(7), pp. 1627–36.

Description:

In this study we examine the relationship between education, racial discrimination and health among white (n = 227), African Caribbean (n = 213) and Indian and Pakistani (n = 233) adults aged between 18 and 59 years living in Leeds, England, as measured in a stratified population survey. Measures of discrimination included any physical attack, verbal abuse and a combined variable, any discrimination due to race, colour, ethnicity or sex. Analyses were conducted examining the relationship between education and discrimination, discrimination and health, and discrimination and health controlling for education. People educated above secondary level were more likely than people educated to secondary level or below to report being physically attacked, verbally abused and exposed to discrimination. People from minority ethnic groups (African Caribbean and Indian Pakistani) were more likely to be verbally abused and exposed to discrimination than the white group. Ethnicity and education interacted for African Caribbeans, such that respondents with post-school qualifications were more likely to report verbal abuse or any discrimination. There was no association between having been exposed to any kind of discrimination and having fair or poor health. Physical attack and any discrimination were associated with anxiety, worry and depression. The results remained unchanged when ethnicity and education were included in the models. Education and ethnicity were associated with differences in exposure to discrimination. In turn, exposure to discrimination was associated with higher levels of anxiety, worry or depression although there was no association between discrimination and health. The results support the contention that racial discrimination may play an important role in modifying the relationship between ethnicity, socioeconomic position and health. The counter-intuitive relationship between education and levels of reported discrimination in non-minority ethnic groups highlights the value of explicitly modeling discrimination to gain a better understanding of the social determinants of health.

Citation:

Anderson, I. P. S. 2008, ‘An Analysis of National Health Strategies Addressing Indigenous Injury: Consistencies and gaps’, Injury: International Journal of the Care of the Injured, Supplement, pp. S53–S58.

Description:

This paper reviews the inclusion of injury in national Aboriginal and Torres Strait Islander health strategy. The review focused on strategies published during the period 2003 2008 or strategies which are otherwise identified as current for this period. Their content in relation to injury and its antecedents is described. This content is evaluated using the National Aboriginal and Torres Strait Islander Safety Promotion Strategy as a benchmark. The review demonstrates that injury is recognised as a public health priority across Indigenous health strategy documents, and strategies that address social and emotional wellbeing (including violence and one of its antecedents, alcohol and substance misuse) are clearly reinforced across national strategy in Indigenous health. However, there are some significant gaps and fragmentation of injury strategy remains a continuing challenge in this field.

Citation:

Rumbold, A. R. & Cunningham, J. 2008, ‘A Review of the Impact of Antenatal Care Services for Australian Indigenous Women and Attempts to Strengthen these Services’, Maternal and Child Health Journal, vol. 12(1), pp. 83–100 (Epub 19 June).

Description:

Objectives  To review evaluations of changes in the delivery of antenatal care for Australian Indigenous women and the impact on care utilization and quality, birth outcomes and women’s views about care.

Citation:

Anderson, I. 2008, The Knowledge Economy and Aboriginal Health Development: DeansLecture, Faculty of Medicine, Dentistry and HealthSciences, 13 May 2008, Onemda VicHealth Koori Health Unit, The University of Melbourne, Melbourne.

Description:

Anderson, I. 2008, The Knowledge Economy and Aboriginal Health Development: DeansLecture, Faculty of Medicine, Dentistry and HealthSciences, 13 May 2008, Onemda VicHealth Koori Health Unit, The University of Melbourne, Melbourne.

On 13 May 2008, Professor Anderson delivered a Deans Lecture for the Faculty of Medicine, Dentistry and Health Sciences on the knowledge economy and Aboriginal health development. In that lecture, he called for a change in the way Australian universities approach the development of the health workforce, research and health information systems, and capacity exchange with Indigenous communities. This proposed change would be critical, Professor Anderson stated, to making possible the Federal Governments visionary promise of closing the Indigenous health gap by 2030.

Citation:

Bailie, R. S., Si, D., Dowden, M. C., Connors, C. M., O’Donoghue, L., Liddle, H. E., Cox, R. J., Burke, H. P., Thompson, S. C. & Brown, A. D. H. 2008, ‘Delivery of Child Health Services in Indigenous Communities: Implications for the federal government’s emergency intervention in the Northern Territory’, Medical Journal of Australia, vol. 188(10), pp. 615–18.

Description:

Abstract

Citation:

Briggs, V. n.d. (2008), Targeting Indigenous Australians' Smoking Rates, policy brief, Centre for Excellence in Indigenous Tobacco Control, Melbourne.

Description:

Briggs, V. n.d. (2008), Targeting Indigenous Australians' Smoking Rates, policy brief, Centre for Excellence in Indigenous Tobacco Control, Melbourne.

Tobacco use is the leading risk factor contributing to disease and death among Indigenous Australians. This policy brief gives further information about high smoking rates among Indigenous Australians and strategies to address these. Also included is information about the Centre for Excellent in Indigenous Tobacco Control (CEITC).

Citation:

Burgess, C. P., Mileran, A. & Bailie, R. 2008, ‘Beyond the Mainstream: Health gains in remote Aboriginal communities’, Australian Family Physician, December, vol. 37(12), pp. 986–8.

Description:

At the request of, and in collaboration with, Aboriginal landowners in central Arnhem Land, the study investigated the ecological and human health outcomes associated with ‘caring for country’ practices. The study demonstrated significant and substantial health benefits associated with greater participation in caring for country, along with a healthier environment.

Citation:

Centre for Excellence in Indigenous Tobacco Control (CEITC) 2008, Indigenous Tobacco Control in Australia: Everybodys Business, National Indigenous Tobacco Control Research Roundtable Report, Brisbane, Australia, 23 May 2008, CEITC, The University ofMelbourne, Melbourne.

Description:

Centre for Excellence in Indigenous Tobacco Control (CEITC) 2008, Indigenous Tobacco Control in Australia: Everybodys Business, National Indigenous Tobacco Control Research Roundtable Report, Brisbane, Australia, 23 May 2008, CEITC, The University ofMelbourne, Melbourne.

The National Indigenous Tobacco Control Research Roundtable brought together sixty-six representatives from community-controlled organisations, research institutions, state, territory and federal governments, and non-government organisations (NGOs), to discuss gaps and priorities in the research agenda in Indigenous tobacco control.

From an analysis of the priorities and their accompanying discussions, five areas have been highlighted that represent gaps in knowledge about Indigenous tobacco control and that require further work:

- Creating positive environments for smoking cessation.
- Improving our understanding of motivations for smoking and not smoking.
- Improving our knowledge of best practice interventions.
- Empowering and supporting the health workforce.
- Best use of resources to support tobacco control.

Citation:

Clucas, D. B., Carville, K. S., Connors, C., Currie, B. J., Carapetis, J. R. & Andrews, R. A. 2008, ‘Disease Burden and Health Care Clinic Attendances for Young Children in Remote Aboriginal Communities of Northern Australia’, Bulletin of the World Health Organization, vol. 86(4), pp. 231–2.

Description:

There is a disproportionate disease burden in remote Aboriginal communities compared with the general Australian population.^1–5 These discrepancies begin at birth: the perinatal mortality rate for Aboriginal infants in Darwin is three times that of the non-indigenous population.⁶ Health problems in these communities are similar to those seen in developing-country contexts.^1,7–9 Indigenous children suffer from a wide variety of diseases including some rarely, if ever, seen in the non-indigenous population since improvements in economic and living conditions led to a reduction in the burden of infectious diseases.¹

Primary health care (PHC) centres, including both Aboriginal-community controlled health services and government-run clinics, are present in most remote communities in Australia. Staff numbers vary but usually include a nurse clinic manager and Aboriginal health workers. Additional clinical nursing staff members vary depending on the size of the PHC centre and are supported by either resident or visiting medical officers. Skin infections and infestations are among the most common reasons for children in these communities to present to PHC centres.¹⁰ These conditions remain a significant public-health problem in developing countries and among indigenous populations in industrialized nations. In resource-poor communities worldwide, scabies prevalence in the general population is up to 10%.¹¹ In remote Aboriginal communities in Australia’s Northern Territory, scabies is endemic, with up to 50% of children and 25% of adults infested at some times.^12,13

Secondary infection of scabies lesions is common. Group A streptococcal pyoderma is very common in Aboriginal children in the Northern Territory,^14,15 with 50–70% of cases reported to be secondary to scabies.^12,13 Group A streptococcal pyoderma leads to acute poststreptococcal glomerulonephritis,^16,17 and underlies most cases of invasive group A streptococcal infections, especially in tropical regions.^18,19 Links between scabies and high rates of acute rheumatic fever in remote Aboriginal communities in the Northern Territory have also been postulated.²⁰ With rates of poststreptococcal disease in these communities being among the highest in the world,^21,22 prevention of scabies and skin sores in this region could have far-reaching implications.

We aimed to review clinic presentations in the first few years of life within two remote Aboriginal communities of Australia to assess the level of health-care seeking behaviour in this context and to determine the burden of scabies, skin sores and other infectious diseases.

Methods

Citation:

Costa, N., Sullivan, M., Walker, R. & Robinson, K. 2008, ‘Victorian Emergency Department Presentations of Aboriginal and Torres Strait Islander People’, Health Information Management Journal, October.

Description:

This paper explains how routinely collected data can be used to examine the emergency department attendances of Victorian Aboriginal and Torres Strait Islander people. The data reported in the Victorian Emergency Minimum Dataset (VEMD) for the 2006/2007 financial year were analysed. The presentations of Aboriginal and Torres Strait Islander and non-Aboriginal people were compared in terms of age, gender, hospital location (metropolitan and rural) and presenting condition. Aboriginal and Torres Strait Islander people were found to attend the emergency department 1.8 times more often than non-Aboriginal people. While the emergency department presentation rates of metropolitan Aboriginal and Torres Strait Islander and non-Aboriginal people were similar, rural Aboriginal and Torres Strait Islander people presented to the emergency department 2.3 times more often than non-Aboriginal people. The injuries or poisonings, respiratory conditions and mental disorders presentation rates of the Aboriginal and Torres Strait Islander and non-Aboriginal population were compared. No previous studies have assessed the accuracy of the Indigenous status and diagnosis fields in the VEMD; therefore the quality of this data is unknown.

(This abstract from http://findarticles.com/p/articles/mi_6819/is_3_37/ai_n31583149/)

Citation:

CRCAH, Telethon Institute for Child Health Research & Department of Families, Housing, Community Services and Indigenous Affairs 2008, Stories on ‘Growing Up’ from Indigenous People in the ACT Metro/Queanbeyan Region, Occasional Paper No. 20, Australian Government, Canberra.

Description:

CRCAH, Telethon Institute for Child Health Research & Department of Families, Housing, Community Services and Indigenous Affairs 2008, Stories on ‘Growing Up’ from Indigenous People in the ACT Metro/Queanbeyan Region, Occasional Paper No. 20, Australian Government, Canberra.

By the Cooperative Research Centre for Aboriginal Health, Telethon Institute for Child Health Research, and Department of Families, Housing, Community Services and Indigenous Affairs.

This paper presents a summary of the information collected during FaHCSIA’s community engagement qualitative trial undertaken in the Australian Capital Territory (ACT) metropolitan (metro) region and the Queanbeyan region. It is based on focus group and in-depth interviews with key informants and community members including: Elders, parents, care givers, young people, prominent Indigenous organisations and government departments funding Indigenous programs. The trial was conducted between January and August 2005.

Citation:

Cunningham, J., O’Dea, K., Dunbar, T. & Maple-Brown, L. 2008, ‘Perceived Weight Versus Body Mass Index among Urban Aboriginal Australians: Do perceptions and measurements match?’, Australian and New Zealand Journal of Public Health, vol. 32, pp. 135–8.

Description:

Objective: To examine the relationship between perceived body weight and measured Body Mass Index (BMI) among urban Aboriginal Australian adults.

Methods: We compared responses to a question on perceived weight with BMI based on measured health and weight among 248 Aboriginal volunteers aged ≥15 years who took part in a larger health study in the Darwin area between September 2003 and March 2004. Logistic regression was used to examine associations between socio-economic, demographic and cultural factors and under-assessment of weight.

Results: Being male and having diabetes were significantly associated with under-assessment of weight. Despite under-assessment being common, most participants with a BMI ≥25 – and almost all (>90%) those with BMI≥25 plus high waist circumference – described themselves as overweight.

Conclusions: Study participants with BMI≥25 were generally able to classify themselves appropriately as overweight.

Implications: Lack of awareness of weight is unlikely to represent a major barrier to engaging Aboriginal people. However, other barriers exist, and both individual-level and environmental/structural approaches are required to reduce the burden of obesity among Aboriginal Australians.

Citation:

Cunningham, J., Rumbold, A. R., Zhang, X. & Condon, J. R. 2008, ‘Incidence, Aetiology, and Outcomes of Cancer in Indigenous Peoples in Australia’, Lancet Oncol., vol. 9(6), pp. 585–95.

Description:

Citation:

Davis, S. R. & Brands, J. 2007, Research Priorities in Aboriginal Prisoner Health: Recommendations and outcomes from the CRCAH Aboriginal Prisoner Health Industry Roundtable, Discussion Paper No. 6, CRCAH, Darwin.

Description:

Davis, S. R. & Brands, J. 2007, Research Priorities in Aboriginal Prisoner Health: Recommendations and outcomes from the CRCAH Aboriginal Prisoner Health Industry Roundtable, Discussion Paper No. 6, CRCAH, Darwin.

Citation:

Esler, D. M., Johnston, F., Thomas, D. P. & Davis, B. 2008, ‘The Validity of a Depression Screening Tool Modified for Use with Aboriginal or Torres Strait Islander People’, Australian and New Zealand Journal of Public Health, vol. 32, pp. 317–21.

Description:

Objectives: To assess the reliability and validity of a depression screening tool — the PHQ-9©Pfizer Inc. modified for use with Aboriginal and Torres Strait Islander people. We also sought to determine the prevalence of depression in a sample of Indigenous people with ischaemic heart disease (IHD).

Methods: The modified PHQ-9 was administered to a sample of Indigenous people with IHD by an Aboriginal Health Worker (AHW). Tool results were then compared with the results of a psychiatric diagnostic interview conducted by a medical practitioner. Thirty four IHD patients attending an Aboriginal Community Controlled Health Service (ACCHS) in Darwin in 2006 and 2007 participated in the study. The modified PHQ-9's sensitivity, specificity, positive and negative predictive value were calculated for major and minor depression. Chronbach's alpha of the screening test was calculated to measure internal consistency. The prevalence of depression in the study group was also determined.

Results: The prevalence of major depression in the sample was 15.4% (95% CI 7.2%-29.7%). When assessing for major depression the modified PHQ-9 was 80% sensitive (95% CI 66.4-93.6%) and 71.4% (95% CI 56.0-86.8%) specific. A 'mini' version of the modified PHQ-9 demonstrated 100% sensitivity (95% CI 100%-100%) and 12.5% specificity (95% CI 7.0% -25.7%) Chronbach's alpha was 0.8.

Conclusion: The modified PHQ-9 and the mini-tool, showed promise in this setting. Further investigation with a larger number of Aboriginal and Torres Strait Islander participants is warranted.

Implications: This study has implications both for the Medicare funded Aboriginal Adult Health Checks and for program planning for Aboriginal IHD patients.

Citation:

Jamieson, L. M., Harrison, J. E. & Berry, J. G. 2008, ‘Hospitalised Head Injury Due to Assault among Indigenous and Non-Indigenous Australians’, Medical Journal of Australia, vol. 188, pp. 576–7.

Citation:

Johnston, V. F. & Thomas, D. P. 2008, ‘Smoking Behaviours in a Remote Australian Indigenous Community: The influence of family and other factors’, Social Science & Medicine, vol. 67, pp. 1708–16.

Description:

In Australia, tobacco smoking is more than twice as common among Indigenous people as non-Indigenous people. Some of the highest smoking rates in the country are in remote Indigenous communities in the Northern Territory of Australia. Owing to this high prevalence, tobacco use today is the single biggest contributing risk factor for excess morbidity and mortality among Indigenous Australians. Despite this, there is a lack of published research which qualitatively explores the social context of Indigenous smoking behaviour or of meanings and perceptions of smoking among Indigenous people. The aim of this study was to understand why Indigenous people start to smoke, the reasons why they persist in smoking and the obstacles and drivers of quitting. We conducted semi-structured interviews with a purposive sample of 25 Indigenous community members in two remote communities in the Northern Territory and 13 health staff. The results indicate that there is a complex interplay of historical, social, cultural, psychological and physiological factors which influence the smoking behaviours of Indigenous adults in these communities. In particular, the results signal the importance of the family and kin relations in determining smoking behaviours. While most community participants were influenced by family to initiate and continue to smoke, the health and well being of the family was also cited as a key driver of quit attempts. The results highlight the importance of attending to social and cultural context when designing tobacco control programs for this population. Specifically, this research supports the development of family-centred tobacco control interventions alongside wider policy initiatives to counter the normalisation of smoking and assist individuals to quit.

Citation:

Ju, H., Rumbold, A. R., Willson, K. J. & Crowther, C. A. 2008, ‘Borderline Gestational Diabetes Mellitus and Pregnancy Outcomes’, BMC Pregnancy and Childbirth, vol. 8, p. 31.

Description:

Background

The impact of borderline gestational diabetes mellitus (BGDM), defined as a positive oral glucose challenge test (OGCT) and normal oral glucose tolerance test (OGTT), on maternal and infant health is unclear. We assessed maternal and infant health outcomes in women with BGDM and compared these to women who had a normal OGCT screen for gestational diabetes.

Methods

We compared demographic, obstetric and neonatal outcomes between women participating in the Australian Collaborative Trial of Supplements with antioxidants Vitamin C and Vitamin E to pregnant women for the prevention of pre-eclampsia (ACTS) who had BGDM and who screened negative on OGCT.

Results

Women who had BGDM were older (mean difference 1.3 years, [95% confidence interval (CI) 0.3, 2.2], p = 0.01) and more likely to be obese (27.1% vs 14.1%, relative risk (RR) 1.92, [95% CI 1.41, 2.62], p < 0.0001) than women who screened negative on OGCT. The risk of adverse maternal outcome overall was higher (12.9% vs 8.1%, RR 1.59, [95% CI 1.00, 2.52], p = 0.05) in women with BGDM compared with women with a normal OGCT. Women with BGDM were more likely to develop pregnancy induced hypertension (17.9% vs 11.8%, RR 1.51, [95% CI 1.03, 2.20], p = 0.03), have a caesarean for fetal distress (17.1% vs 10.5%, RR 1.63, [95% CI 1.10, 2.41], p = 0.01), and require a longer postnatal hospital stay (mean difference 0.4 day, [95% CI 0.1, 0.7], p = 0.01) than those with a normal glucose tolerance.

Infants born to BGDM mothers were more likely to be born preterm (10.7% vs 6.4%, RR 1.68, [95% CI 1.00, 2.80], p = 0.05), have macrosomia (birthweight ≥4.5 kg) (4.3% vs 1.7%, RR 2.53, [95% CI 1.06, 6.03], p = 0.04), be admitted to the neonatal intensive care unit (NICU) (6.5% vs 3.0%, RR 2.18, [95% CI 1.09, 4.36], p = 0.03) or the neonatal nursery (40.3% vs 28.4%, RR 1.42, [95% CI 1.14, 1.76], p = 0.002), and have a longer hospital stay (p = 0.001). More infants in the BGDM group had Sarnat stage 2 or 3 neonatal encephalopathy (12.9% vs 7.8%, RR 1.65, [95% CI 1.04, 2.63], p = 0.03).

Conclusion

Women with BGDM and their infants had an increased risk of adverse health outcomes compared with women with a negative OGCT. Intervention strategies to reduce the risks for these women and their infants need evaluation.

Trial registration

Current Controlled Trials ISRCTN00416244

Citation:

Maple-Brown, L., Cunningham, J., Dunne, K., Whitbread, C., Howard, D., Weeramanthri, T., Tatipata, S., Dunbar, T., Harper, C. A., Taylor, H., Zimmet, P., O’Dea, K. & Shaw, J. 2008, ‘Complications of Diabetes in Urban Indigenous Australians: The DRUID Study’, Diabetes Research and Clinical Practice, vol. 80, pp. 455–62.

Description:

Aims

To accurately assess the management and complications of type 2 diabetes in urban Indigenous Australians and compare the risk of complications with a general Australian population (AusDiab Study).

Methods

The Darwin Region Urban Indigenous Diabetes (DRUID) Study included 1004 volunteers aged ≥15 years; diabetes status was classifiable for 866. The assessment of diabetic complications and metabolic control was performed in participants with known diabetes (KDM) and diabetes newly diagnosed by the study (NDM) using an interviewer-administered questionnaire and clinical examination.

Results

Among 172 DRUID participants eligible for complications assessment, 135 were assessed, including 99 KDM (mean age 53 years) and 36 NDM (mean age 47 years). Percentages of KDM participants meeting therapeutic targets were: HbA1c < 7%, 29%; blood pressure < 130/80 mmHg, 45%; total cholesterol < 5.5mmol/L, 65%. Among KDM, 39% had albuminuria, 21% retinopathy, 12% peripheral vascular disease (PVD), 9% neuropathy. Factors independently associated with diabetic complications were: albuminuria–HbA1c, systolic blood pressure; retinopathy–diabetes duration; PVD–age. Compared to AusDiab participants after adjusting for other risk factors, DRUID participants had 2–3-fold increased risk of albuminuria and PVD and a non-significant increased risk of neuropathy, but no increased risk of retinopathy.

Conclusions

Urban Indigenous Australians with diabetes are relatively young and have poor glycaemic control. Compared to the general Australian population with type 2 diabetes, they have greater adjusted risk of albuminuria and PVD but not retinopathy. Urgent action is required to prevent diabetes at a population level and improve diabetes management in this high-risk population.

Citation:

McCoy, B. 2008, ‘Maparn: Traditionalist health and healing in a Western and Christian World,’ in O. Lardinois & B. Vermander (eds), Shamanism and Christianity: Religious Encounters among Indigenous Peoples of East Asia, Taipei Ricci Institute, Taipei.

Citation:

McCoy, B. F. 2008, Holding Men: Kanyirninpa and the health of Aboriginal men, Aboriginal Studies Press, Canberra.

Description:

McCoy, B. F. 2008, Holding Men: Kanyirninpa and the health of Aboriginal men, Aboriginal Studies Press, Canberra.

This is an easily readable book that explores how Indigenous men understand their lives, their health and their culture.

Using conversations, stories and art, the author shows how Kimberley desert communities have a cultural value and relationship described as kanyirninpa or holding.

The author uses examples from Australian Rules football, petrol sniffing and imprisonment to reveal the possibilities for lasting improvements to mens health based on kanyirninpas expression of deep and enduring cultural values and relationships.

While young Indigenous mens lives remain vulnerable in a rapidly changing world, the author believes that an understanding of kanyirninpa (one of the key values that has sustained Aboriginal desert life for centuries) may provide the hope of change and better health for all. It also offers insights for all who wish to grow up their young people.

Citation:

Nagel, T., Robinson, G., Trauer, T. & Condon, J. 2008, ‘An Approach to Treating Depressive and Psychotic Illness in Indigenous Communities’, Australian Journal of Primary Health, vol. 14(1), pp. 17–24.

Description:

This study is one of the activities of a multi-site research program, the Australian Mental Health Initiative (AIMhi), funded by the National Health and Medical Research Council. AIMhi in the Northern Territory collaborated with Aboriginal mental health workers and Northern Territory remote service providers in developing a range of resources and strategies to promote improved Indigenous mental health outcomes. A brief intervention that combines the principles of motivational interviewing, problem solving therapy and chronic disease self-management is described. The intervention has been integrated into a randomised controlled trial. Early findings suggest that the strategy and its components are well received by clients with chronic mental illness, and their carers, in remote communities.

Citation:

O’Neal, D. N., Piers, L. S., Iser, D. M., Rowley, K. G., Jenkins, A. J., Best, J. D. & O’Dea, K. 2008, ‘Australian Aboriginal People and Torres Strait Islanders Have an Atherogenic Lipid Profile that Is Characterised by Low HDL-cholesterol Level and Small LDL Particles’, Atherosclerosis, 6 April.

Description:

Aim

To characterise lipid profiles for Australian Aboriginal people and Torres Strait Islanders.

Methods

Community-based, cross-sectional surveys in 1995–1997 including: 407 female and 322 male Australian Aboriginal people and 207 female and 186 male Torres Strait Islanders over 15 years old. A comparator of 78 female (44 with diabetes) and 148 male (73 with diabetes) non-indigenous participants recruited to clinical epidemiological studies was used. Lipids were determined by standard assays and LDL diameter by gradient gel electrophoresis.

Results

Diabetes prevalence was 14.8% and 22.6% among Aboriginal people and Torres Strait Islanders, respectively. LDL size (mean [95% CI (confidence interval)]) was smaller (P < 0.05) in non-diabetic Aboriginal (26.02 [25.96–26.07] nm) and Torres Strait Islander women (26.01 [25.92–26.09] nm) than in non-diabetic non-indigenous women (26.29 [26.13–26.44] nm). LDL size correlated (P < 0.0005) inversely with triglyceride, WHR, and fasting insulin and positively with HDL-cholesterol. HDL-cholesterol (mean [95% CI] mmol/L) was lower (P < 0.0005) in indigenous Australians than in non-indigenous subjects, independent of age, sex, diabetes, WHR, insulin, triglyceride, and LDL size: Aboriginal (non-diabetic women, 0.86 [0.84–0.88]; diabetic women, 0.76 [0.72–0.80]; non-diabetic men, 0.79 [0.76–0.81]; diabetic men, 0.76 [0.71–0.82]); Torres Strait Islander (non-diabetic women, 1.00 [0.95–1.04]; diabetic women, 0.89 [0.83–0.96]; non-diabetic men, 1.00 [0.95–1.04]; diabetic men, 0.87 [0.79–0.96]); non-indigenous (non-diabetic women, 1.49 [1.33–1.67]; diabetic women, 1.12 [1.03–1.21]; non-diabetic men, 1.18 [1.11–1.25]; diabetic men, 1.05 [0.98–1.12]).

Conclusions

Indigenous Australians have a dyslipidaemia which includes small LDL and very low HDL-cholesterol levels. The dyslipidaemia was equally severe in both genders. Strategies aimed at increasing HDL-cholesterol and LDL size may reduce high CVD risk for indigenous populations.

Citation:

Paradies, Y. n.d. (2008), Racism Undermines Health, policy brief, Menzies School of Health Research, CRCAH, Onemda VicHealth Koori Health Unit & The University of Melbourne, Melbourne.

Description:

Paradies, Y. n.d. (2008), Racism Undermines Health, policy brief, Menzies School of Health Research, CRCAH, Onemda VicHealth Koori Health Unit & The University of Melbourne, Melbourne.

The key messages of this policy brief are (1) racism against Indigenous people is still widespread in Australia, (2) racism has a detrimental impact on the health of Indigenous Australians, (3) there is a need to invest in further research.

Citation:

Pyett, P., Waples-Crowe, P., Loughron, K. H. & Gallagher, J. 2008, ‘Healthy Pregnancies, Healthy Babies for Koori Communities: Some of the issues around alcohol and pregnancy’, Aboriginal and Islander Health Worker Journal, vol. 32(1), pp. 30–2.

Description:

Citation:

Rowley, K. & Brown, A. 2008, Heart Health Follow Up Study: WAHAC Cohort, March 1995–December 2004, The University of Melbourne, Melbourne, December.

Citation:

Rowley, K., Wang, Z., Luke, J. & Brown, A. 2008, Predicting Cardiovascular Disease for Aboriginal People in Central Australia: Preliminary Analysis from the Heart Health Follow Up Study, The University of Melbourne and Baker-IDI Heart and Diabetes Research Institute, Melbourne (Confidential).

Description:

This study is a follow-up of cardiovascular disease outcomes for a cohort of Aboriginal people in the Northern Territory who participated in a health screening program (Heart Health) in the 1990s. It aimed to identify what clinical measures best predict the risk of heart attack and stroke in Aboriginal communities in Central Australia.

Citation:

Rumbold, A. R., Cunningham, J., Bailie, R. S. & Hiller, J. E. 2008, ‘Exploring the Characteristics of the Research Workforce in Aboriginal and Torres Strait Islander Health’, Australian and New Zealand Journal of Public Health, vol. 32(1), pp. 12–18.

Description:

Objective: This study was conducted to better understand the characteristics of current and past researchers in Indigenous health in Australia and the factors that may influence decisions about working in this field.

Methods: A self-administered survey by e-mail or post to all individuals listed as an author on a published paper or who completed a PhD or masters research degree in the field of Indigenous health between 1995 and 2004.

Results: We identified 472 papers and 151 theses; from these, 1,067 authors were identified. Completed questionnaires were returned by 373 authors (35%), of whom 32 (9%) identified as Aboriginal and/or Torres Strait Islander. The majority (80%) of respondents were active in research but only 38% considered Indigenous health to be their primary area of research. The most important attractive factor about Indigenous health research (IHR) selected by respondents was "important area/national priority" (35%) and the most unattractive factor was "politics" (30%). There was considerable ambivalence about recommending a career in IHR to an early career researcher. When asked what was required to attract researchers into IHR, respondents cited the need for improved institutional support, mentoring, long-term funding and sustainable career pathways.

Conclusions and Implications: This study contributes to a greater understanding of Australia's research workforce in Indigenous health. It provides evidence of a strongly perceived need for institutional reform that supports Indigenous health research, for sustainable approaches to funding, and for mentoring initiatives for early career researchers.

Citation:

Shemesh, T., Rowley, K. G., Piers, L. S., Best, J. D. & O’Dea, K. 2008, ‘Low High-density Lipoprotein Cholesterol Is the most Prevalent Metabolic Abnormality for Australian Aboriginal People Even when Lean’, European Journal of Cardiovascular Prevention and Rehabilitation, vol. 15, pp. 49–51.

Description:

Citation:

Si, D., Bailie, R., Cunningham, J., Robinson, G., Dowden, M., Stewart, A., Connors, C. & Weeramanthri, T. 2008, ‘Describing and Analysing Primary Health Care System Support for Chronic Illness Care in Indigenous Communities in Australia’s Northern Territory— Use of the Chronic Care Model’, BMC Health Services Research, vol. 8(112).

Description:

Background

Indigenous Australians experience disproportionately high prevalence of, and morbidity and mortality from chronic illness such as diabetes, renal disease and cardiovascular disease. Improving the understanding of how Indigenous primary care systems are organised to deliver chronic illness care will inform efforts to improve the quality of care for Indigenous people.

Methods

This cross-sectional study was conducted in 12 Indigenous communities in Australia's Northern Territory. Using the Chronic Care Model as a framework, we carried out a mail-out survey to collect information on material, financial and human resources relating to chronic illness care in participating health centres. Follow up face-to-face interviews with health centre staff were conducted to identify successes and difficulties in the systems in relation to providing chronic illness care to community members.

Results

Participating health centres had distinct areas of strength and weakness in each component of systems: 1) organisational influence – strengthened by inclusion of chronic illness goals in business plans, appointment of designated chronic disease coordinators and introduction of external clinical audits, but weakened by lack of training in disease prevention and health promotion and limited access to Medicare funding; 2) community linkages – facilitated by working together with community organisations (e.g. local stores) and running community-based programs (e.g. "health week"), but detracted by a shortage of staff especially of Aboriginal health workers working in the community; 3) self management – promoted through patient education and goal setting with clients, but impeded by limited focus on family and community-based activities due to understaffing; 4) decision support – facilitated by distribution of clinical guidelines and their integration with daily care, but limited by inadequate access to and support from specialists; 5) delivery system design – strengthened by provision of transport for clients to health centres, separate men's and women's clinic rooms, specific roles of primary care team members in relation to chronic illness care, effective teamwork, and functional pathology and pharmacy systems, but weakened by staff shortage (particularly doctors and Aboriginal health workers) and high staff turnover; and 6) clinical information systems – facilitated by wide adoption of computerised information systems, but weakened by the systems' complexity and lack of IT maintenance and upgrade support.

Conclusion

Using concrete examples, this study translates the concept of the Chronic Care Model (and associated systems view) into practical application in Australian Indigenous primary care settings. This approach proved to be useful in understanding the quality of primary care systems for prevention and management of chronic illness. Further refinement of the systems should focus on both increasing human and financial resources and improving management practice.

Citation:

Street, J., Baum, F. & Anderson, I. 2008, Making Research Relevant: Grant assessment processes in Indigenous research, Discussion Paper No. 3, CRCAH, Darwin.

Description:

Street, J., Baum, F. & Anderson, I. 2008, Making Research Relevant: Grant assessment processes in Indigenous research, Discussion Paper No. 3, CRCAH, Darwin.