Publications List

Citation:

Thomas, D. 2012, 'National trends in Aboriginal and Torres Strait Islander smoking and quitting, 1994–2008', Australian and New Zealand Journal of Public Health, vol. 36, issue 1, pp. 24-29.

Abstract:

Objective: To describe the trends in the prevalence of smoking, quitting and initiation among Aboriginal and Torres Strait Islander men and women aged 18 years and over.

Methods: Analysis of responses to smoking questions in national Indigenous surveys in 1994, 2002, 2004 and 2008.

Results: Male Indigenous smoking prevalence fell significantly from 58.5% in 1994 to 52.6% in 2008, an absolute decrease of 0.4 (CI 0.1–0.7)% per year, with the same decline in remote and non-remote areas. Female smoking fell from 51.0% to 47.4%, with markedly different changes in remote and non-remote areas. In non-remote areas, there was an absolute decrease in female smoking of 0.5 (CI 0.2–0.9)% per year, but in remote areas, female smoking increased by 0.4 (CI 0.0–0.8)% per year. From 2002 to 2008, the percentage of ever-smokers who had quit (quit ratio) increased absolutely by 1% per year in both men and women, remote and non-remote areas. Results about trends in initiation were inconclusive.

Conclusions and Implications: Health Minister Roxon has committed to halving the Indigenous smoking prevalence by 2018, and has dramatically increased Indigenous-specific funding and activity in tobacco control. The reported historical trends in this paper are encouraging as they occurred at a time when there was little such tobacco control activity focused on Aboriginal and Torres Strait Islander people. However, to meet the Minister's goal, Indigenous smoking prevalence will need to fall more than six times as quickly as occurred from 1994 to 2008.

Citation:

Bailie, R., Si, D., Connors, C., Kwedza, R., O'Donoghue, L., Kennedy, C., Cox, R., Liddle, H., Hains, J., Dowden, M., Burke, H., Brown, A., Weeramanthri, T. & Thompson, S. 2011, 'Variation in quality of preventive care for well adults in Indigenous community health centres in Australia', Health Services Research, vol. 11, p. 139.

Abstract:

Background

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.

Methods

During 2005-2009, clinical audits were conducted on a random sample (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 (sample 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.

Results

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]140/90mmHg), proteinuria and abnormal blood glucose ([greater than or equal to]5.5mmol/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.

Conclusions

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.

Citation:

Dwyer J., Lavoie J., O’Donnell K., Marlina U. & Sullivan P. 2011, Contracting for Indigenous health care: towards mutual accountability, Australian Journal of Public Administration, vol. 70, no. 1, pp. 34–46.

Abstract:

In Australia and other industrialised countries, governments contract with the non-government sector for the provision of primary health care to indigenous peoples. Australian governments have developed policies and funding programs to support this health sector, but the current arrangements are unduly complex and fragmented.

The results of our study show that the complex contractual environment for Aboriginal Community-Controlled Health Services (ACCHSs) and their funders is an unintended but inevitable result of a quasi-classical approach to contracts applied by multiple funders. The analysis in this article highlights potential policy and program changes that could improve the effectiveness of funding and accountability arrangements, based on the use of an alliance contracting model, better performance indicators and greater clarity in the relative roles of national and jurisdictional governments.

Citation:

Fredericks, B. & Legge, D. 2011, Revitalizing Health for All: International Indigenous Representative Group. Learning from the Experience of Comprehensive Primary Health Care in Aboriginal Australia—A Commentary on Three Projects, The Lowitja Institute, Melbourne.

Abstract:

This paper presents a regional commentary on the three Australian projects of the Teasdale-Corti Global Health Research Partnership Program. The three Australian projects are: Victorian Aboriginal Health Service Ltd (VAHS), Melbourne, Victoria—Forty Years of Comprehensive Primary Health Care; Central Australian Aboriginal Congress Inc. (Congress), Alice Springs, Northern Territory—Ingkintja, Male Health Program; and Urapuntja Health Service (UHS), Utopia, Northern Territory—Outstation Health Care. It highlights common themes and lessons in respect to the Revitalising Health for All project in the context of Aboriginal and Torres Strait Islander health in Australia.

Citation:

Garvey, G., Cunningham, J., Valery, P.C., Condon, J., Roder, D., Bailie, R., Martin, J. & Olver, I. 2011, Reducing the burden of cancer for Aboriginal and Torres Strait Islander Australians: time for a coordinated, collaborative, priority-driven, Indigenous-led research program, Medical Journal of Australia, vol. 194, no. 10, pp 530-531.

Abstract:

• Australia’s efforts to prevent, diagnose and treat cancer are not as successful for Aboriginal and Torres Strait Islander people as they are for other Australians.
• There is a need for a nationally coordinated, collaborative, priority-driven research effort to better understand what works, and we need to implement that knowledge.
• All aspects of the process must involve genuine Indigenous leadership and participation.

Citation:

Howse, G. 2011, Legally Invisible—How Australian Laws Impede Stewardship and Governance for Aboriginal and Torres Strait Islander Health, The Lowitja Institute, Melbourne.

Abstract:

This paper explains the options available for Australian governments to articulate and allocate responsibilities for the health and health care of Aboriginal and Torres Strait Islander people in an enduring, reliable form. It was commissioned by the Lowitja Institute – Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research in response to widespread recognition of problems in the policy and administrative arrangements for health and health care for Australia’s First Peoples, including lack of clarity about the responsibilities of governments at various levels.

Citation:

Kowal, E., Rouhani, L. & Anderson, I. 2011, Genetic Research in Aboriginal and Torres Strait Islander Communities: Beginning the Conversation, The Lowitja Institute, Melbourne.

Abstract:

Genetics is at the forefront of medical research, but it is rarely used in Indigenous health research projects. This discussion paper is the outcome of the first ever national discussion of the conduct of genetic research in Indigenous communities in Australia convened by the Lowitja Institute in 2010. It reviews the ethical issues relevant to genetic research in an Australian Indigenous context; existing guidelines for genetic research in indigenous communities internationally; and literature on genetic literacy in Indigenous contexts. Finally, the discussion paper presents a summary of the productive and challenging conversations at the roundtable.

Citation:

Luke, J., Stewart, P.,Thorpe, R. & Anderson, I. 2011, Victorian Aboriginal Health Service Young People's Project: A Study of the Health and Wellbeing of Koori Youth in Melbourne, The Lowitja Institute, Melbourne.

Abstract:

This report builds on various community reports in a series entitled The Study of Young People's Health & Well-Being, previously published by the Victorian Aboriginal Health Service (VAHS) as part of the Young People’s project in 1999-2000.

This report provides an overview of the physical, social and emotional issues that affect Aboriginal youths, as well as the strengths and protective factors that make them resilient. It describes some of the findings from the Young People’s Project questionnaire survey and health check, together with findings from the discussions with young people and interviews with key people. These findings are supported by their direct words.

Copies of the report can be obtained from the Victorian Aboriginal Health Service.

Citation:

McCoy, B. F. 2011, Art into Health: Puntu Palyarrikuwanpa (Aboriginal Men Becoming Well), The Lowitja Institute, Melbourne.

Abstract:

This beautiful full-colour booklet describes a unique collection of 15 paintings through which Aboriginal men from the Western Desert offer their perspectives on their lives and wellbeing through art. Using contemporary techniques and methods, the artists present a wide range of narratives thatlink ancient ways of understanding and describing their world today. The collection, therefore, provides an important and valuable body of knowledge about Aboriginal health. [ISBN 978-1-921889-11-0]

Copies can be purchased for $15 each (post and handling included).  Enquiries by email to publications@lowitja.org.au .

Citation:

Robinson, G., Tyler, W., Jones, Y., Silburn, S. & Zubrick, S. 2011. Context, Diversity and Engagement: Early intervention with Australian Aboriginal families in urban and remote contexts. Children and Society (online early view)

Abstract:

This article describes challenges met implementing an early intervention programme for Aboriginal parents and their children in the NT (Northern Territory) of Australia in the context of efforts to remediate Aboriginal disadvantage. The intervention is an adaptation of an 8- to 10-week, manualised parenting programme designed for four- to six-year-old children with behavioural difficulties. It was implemented for both Aboriginal and non-Aboriginal children in urban Darwin and for Aboriginal children in three communities of the Tiwi Islands, near Darwin. Measured outcomes of the programme were positive overall with different outcomes by gender and Indigenous status. There were marked differences in retention of families from different socio-cultural backgrounds in the programme, with a significant loss of participants from referral through commencement to six-month follow-up. This drop-out was most marked for urban Aboriginal participants, despite highly flexible strategies of engagement and cultural adaptation of the approach pursued in each setting. The research provides lessons for the contextualisation of preventive interventions in diverse community settings and shows that systematic attention to cultural ‘fit’ of the intervention logic and cultural competence in engagement of disadvantaged families with multiple problems are fundamental to sustainability.

Citation:

Si, D., Dowden, M., Kennedy, C., Cox, R., O’Donoghue, L., Liddle, H., Kwedza, R., Connors, C., Thompson, S., Burke, H., Brown, A., Weeramanthri, T., Shierhout, G., Bailie, R. 2011, ‘Indigenous Community Care: Documented depression in patients with diabetes,’ Australian Family Physician, vol. 40, no. 5, pp. 331–3.

Abstract:

Aim: This article reports on documented levels of depression among people with diabetes attending Indigenous primary care centres.

Method: Between 2005 and 2009, clinical audits of diabetes care were conducted in 62 indigenous community health centres from four Australian states and territories.

Results: The overall prevalence of documented depression among people with diabetes was 8.8%. Fourteen (23%) of the 62 health centres had no record of either diagnosed depression or prescription of selective serotonin reuptake inhibitors among people with diabetes. For the remaining 48 centres, 3.3–36.7% of people with diabetes had documented depression.

Discussion: The results of this study are inconsistent with the evidence showing high prevalence of mental distress among Indigenous people. A more thorough investigation into the capacity, methods and barriers involved in diagnosing and managing depression in Indigenous primary care is needed.

Citation:

Helps, Y., Moodie, D. & Warman, G. 2010, Aboriginal People Travelling Well: Community Report, The Lowitja Institute, Melbourne.

Abstract:

The research described in this report focuses on the interaction between access to safe transport and the health and wellbeing of Aboriginal people in several distinct South Australian Aboriginal communities (urban, regional and remote). It draws on the fragmented literature and, through interviews and focus groups with Aboriginal people and their service providers, starts to develop a coherent view of the issues and possible responses.

Citation:

Lavoie, J., Dwyer, J. & Boulton, A., 2010 'Analysing contractual environments: lessons from Indigenous health in Canada, Australia and New Zealand', Public Administration, vol. 88, no. 3, pp. 665–79.

Abstract:

Contracting in health care is a mechanism used by the governments of Canada, Australia and New Zealand to improve the participation of marginalized populations in primary health care and improve responsiveness to local needs. As a result, complex contractual environments have emerged. The literature on contracting in health has tended to focus on the pros and cons of classical versus relational contracts from the funder's perspective.

This article proposes an analytical framework to explore the strengths and weaknesses of contractual environments that depend on a number of classical contracts, a single relational contract or a mix of the two. Examples from indigenous contracting environments are used to inform the elaboration of the framework. Results show that contractual environments that rely on a multiplicity of specific contracts are administratively onerous, while constraining opportunities for local responsiveness. Contractual environments dominated by a single relational contract produce a more flexible and administratively streamlined system.

Citation:

Thomas, D. P. & Glover, M. 2010, Smoking and Aboriginal and Torres Strait Islander and Maori Children, Journal of Paediatrics and Child Health, vol. 46, pp. 516–20.

Abstract:

Smoking and the deaths and suffering it causes are more common among Aboriginal and Torres Strait Islander peoples and Māori than other Australians and New Zealanders. While, many tobacco control activities that are not specifically targeted at children will have a positive impact on child health, this review concentrates on recent tobacco control research on pregnant women and children. The important tasks are to reduce smoking by pregnant Māori and Aboriginal and Torres Strait Islander women to reduce infant and child exposure to second-hand smoke and to reduce smoking initiation of children and adolescents. Health professionals who want to reduce the suffering caused by smoking among Māori and Aboriginal and Torres Strait Islander children can be guided by much new relevant research evidence and clear frameworks about how to approach tobacco control in these communities.

Citation:

Watson Rebecca, Adams Karen, Fredericks Bronwyn and Mahoney Ray. 2010. Strategic Directions Report for the Social Determinants of Aboriginal Health Project. Victorian Aboriginal Community Controlled Health Organisation (VACCHO), Melbourne.

Abstract:

Watson Rebecca, Adams Karen, Fredericks Bronwyn and Mahoney Ray. 2010. Strategic Directions Report for the Social Determinants of Aboriginal Health Project. Victorian Aboriginal Community Controlled Health Organisation (VACCHO), Melbourne.

This report explores ways to build capacity in Aboriginal and Torres Strait Islander social determinant research. It is the produce of a project that was funded by the CRCAH and conducted by the VACCHO Public Health Research Unit.

The project involved a series of workshops with VACCHO members and university representatives, and a forum with a range of stakeholders.  It aimed to identify major social determinants of Aboriginal health, explore key partnerships for future social determinants research, set the agenda for future research themes and focus on research processes and implementation issues.

Citation:

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

Abstract:

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:

Andrews, R. & Kearns, T. 2009, East Arnhem Regional Healthy Skin Project: Final Report 2008, Cooperative Research Centre for Aboriginal Health, Darwin.

Abstract:

The East Arnhem Regional Healthy Skin Project commenced in September 2004 with the aim of developing community-based control of skin in the region. The control had to be sustainable, properly evaluated and integrated into routine service delivery. The project provided screening for scabies, skin sores and tinea among children aged less than fifteen years, and was accompanied by treatment and follow-up services.

We developed resources to assist community workers and clinic staff in the diagnosis and treatment of skin conditions as well as a separate flip chart explaining the Healthy Skin Story.

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.

Abstract:

Citation:

Edmonds, F. with Clarke, M. 2009, ‘Sort of Like Reading a Map’: A Community Report on the Survival of South-East Australian Aboriginal Art since 1834, Cooperative Research Centre for Aboriginal Health, Darwin.

Abstract:

Edmonds, F. with Clarke, M. 2009, ‘Sort of Like Reading a Map’: A Community Report on the Survival of South-East Australian Aboriginal Art since 1834, Cooperative Research Centre for Aboriginal Health, Darwin.

In this report we explore the reasons behind the ‘hidden history’ of Aboriginal art in south-east Australia. We look at the continuing practice of art among Aboriginal people, mainly in Victoria, and the changes and adaptations to art practices that were often made in response to the colonising process. The recent practice of reclaiming or reinvigorating art styles fromthe past and developing these within contemporary artworks is also signifi cant in continuing the story of Aboriginal art in the region. The stories included here, told by Aboriginal artists and curators, also explore the signifi cance of art practices in maintaining south-east Australian Aboriginal culture, identity and wellbeing.

Citation:

Gallaher G., Ziersch A., Baum F., Bentley M., Palmer C., Edmondson W. & Winslow L. 2009. In Our Own Backyard: Urban Health Inequities and Aboriginal Experiences of Neighbourhood Life, Social Capital and Racism. Flinders University, Adelaide.

Abstract:

This report is about Aboriginal and Torres Strait Islander people who live in urban areas. Thus it contributes to filling the gap in literature and knowledge about the health and everyday life experience of urban Indigenous peoples.

The study aimed to explore the following:
• mental and physical health status and health inequities
• experience of urban neighbourhood life
• social capital
• experience of racism and its impact on health
for Aboriginal and Torres Strait Islander people living in urban Adelaide.

Citation:

Grieves, V. 2009, Aboriginal Spirituality: Aboriginal Philosophy, The Basis of Aboriginal Social and Emotional Wellbeing, Discussion Paper No. 9, Cooperative Research Centre for Aboriginal Health, Darwin.

Abstract:

Although this discussion paper has been developed for people working within health practice, as it explains, the wholistic philosophical basis of Aboriginal and Torres Strait Islander culture that encompasses wellbeing has applications in every area of engagement with Indigenous Australian people.

This literature review draws on a diverse range of sources including history, anthropology, sociology, literature, biography and autobiography, government reports, websites, and the writings of health and social and emotional wellbeing practitioners, describing their approaches to the implementation of programs.

Citation:

Kowanko I., Stewart T., Power C., Fraser R., Love I. and Bromely T., 2009. 'An Aboriginal Family and Community Healing Program in metropolitan Adelaide: description and evaluation', Australian Indigenous Health Bulletin, vol 9, no. 4, pp1-12.

Abstract:

This paper describes and evaluates the process, impacts and outcomes of an Aboriginal Family and Community Healing (AFCH) Program based in metropolitan Adelaide, South Australia. The evaluation used participatory action oriented methodology, mixed methods and multiple data sources. The AFCH comprised complex and dynamic activities for Aboriginal men, women and youth built around community engagement, and hosted by the regional primary health care Aboriginal outreach service. The AFCH Program was designed to develop effective responses to family violence that took into account the complexities within Aboriginal families and communities. The evaluation identified strengths of the program including: evidence-based design, holistic approach, clinical focus, committed staff, intersectoral linkages, peer support, mentoring, Aboriginal cultural focus, strategic partnerships and creative use of resources. Clients and workers were unanimous in their enthusiastic support for the program; their stories highlight beneficial impacts on Aboriginal clients, families and community. Other services may be able to adapt strategies from this AFCH to address the needs of their Aboriginal communities.

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.

Abstract:

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.

Abstract:

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.

Abstract:

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).

Abstract:

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.

Abstract:

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.

Abstract:

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:

Jackie Street, Fran Baum & Ian Anderson 2009, Is peer review useful in assessing research proposals in Indigenous health? A case study. Health Research Policy and Systems, 7 (2).

Abstract:

Jackie Street, Fran Baum & Ian Anderson 2009, Is peer review useful in assessing research proposals in Indigenous health? A case study. Health Research Policy and Systems, 7 (2).

Background: There has been considerable examination and critique of traditional (academic) peer review processes in quality assessment of grant applications. At the same time, the use of traditional research processes in Indigenous research has been questioned. Many grant funding organisations have changed the composition of their peer review panels to reflect these concerns but the question remains do these reforms go far enough? In this project we asked people working in areas associated with Aboriginal health research in a number of capacities, their views on the use of peer review in assessing Indigenous research proposals.

Methods: In semi-structured interviews we asked 18 individuals associated with an Australian Indigenous research funding organisation to reflect on their experience with peer review in quality assessment of grant applications. We also invited input from a steering group drawn from a variety of organisations involved in Aboriginal research throughout Australia and directly consulted with three Aboriginal-controlled health organisations.

Results: There was consensus amongst all participants that traditional academic peer review is inappropriate for quality assessment in Indigenous research. Many expressed the view that using a competitive grant review system in Aboriginal health was counterintuitive, since good research transfer is based on effective collaboration. The consensus within the group favoured a system which built research in a collaborative manner incorporating a variety of different stakeholders in the process. In this system, one-off peer review was still seen as valuable in the form of a "critical friend" who provided advice as to how to improve the research proposal.

Conclusion: Peer review in the traditional mould should be recognised as inappropriate in Aboriginal research. Building research projects relevant to policy and practice in Indigenous health may require a shift to a new way of selecting, funding and conducting research.

Citation:

Tongs, J., Fisher, J., Poroch, N., Thompson, D. & Arabena, K. 2009, ‘‘Mainstream Organisations’ Interaction with Aboriginal and Torres Strait Islander People in the Muuji Region of the Australian Capital Territory and New South Wales’, Aboriginal & Islander Health Worker Journal, vol. 33(1), pp. 8–10.

Abstract:

The Muuji Regional Centre for Social and Emotional Well being is a consortium of three Aboriginal community controlled health and medical services. It conducted a survey titled Services Survey of mainstream organizations over the period 2003-2006 which suggests various strategies for mainstream organizations to build their capacity to serve Aboriginal and Torres Strait Islander people.

Citation:

Wilson, G. 2009, What Do Aboriginal Women Think Is Good Antenatal Care? Consultation Report, Cooperative Research Centre for Aboriginal Health, Darwin.

Abstract:

The major research question that the consultation addressed was: What is good antenatal care? There were three parts to this question:

• What elements of antenatal care are identified as being important by Aboriginal women in the Central region?
• What are the features or dimensions of these identified elements?; and
• Which of these features or elements are the most important to Aboriginal women in the Central region?

The features of antenatal care identified and discussed by the women incorporated many social and economic aspects, as well as bio-medical and health service-related factors. For example, the need to feel and be safe from violence, the role of their families and partners, the importance of transport and the nature of their relationship with a health provider.

It is essential and of the utmost importance that health services are flexible, adaptive and responsive to these preferences so that young Aboriginal women are provided with a range of options for their care and the opportunity and support to exercise their own choices.

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.

Abstract:

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).

Abstract:

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.

Abstract:

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.

Abstract:

Abstract

Citation:

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

Abstract:

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.

Abstract:

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.

Abstract:

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.

Abstract:

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.

Abstract:

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.

Abstract:

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.

Abstract:

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.

Abstract:

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.

Abstract:

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.

Abstract:

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.

Abstract:

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.

Abstract:

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