Aboriginal And Torres Strait Islander Research Articles

The Western Australian experience of COVID-19 after the borders reopened: evaluation of public health modelling predictions.

Western Australia (WA) serves as a unique global case study on the impact of coronavirus disease 2019 (COVID-19) on an isolated, prepared and highly vaccinated population. This study builds upon the study performed by House et al. through an extended data set. To examine the impact of COVID-19 at the only quaternary hospital in WA following the border opening from 3 March to 17 July 2022. A total of 257 adults were admitted with COVID-19 under either respiratory or the intensive care unit (ICU). Admission numbers, disease severity, ICU admission, prevalence of COVID-19 deterioration risk factors, length of stay and mortality. A total of 257 patients were admitted with COVID-19, under respiratory (81.7%) and ICU (18.3%). COVID-19 was the primary reason for admission for 67.7%. Ten patients died during the study, with seven deaths attributed to COVID pneumonitis. COVID-19 severity was 37.4% mild, 37.0% moderate, 18.3% severe and 7.4% critical. Risk factors for requiring ICU included incomplete immunisation status (P = 0.011), chronic kidney disease (P = 0.008) and Aboriginal and Torres Strait Islander (ATSI) ethnicity. The WA Department of Health predicted that the number of hospitalisations and ICU cases were significantly higher than the actual number of cases. The number of hospitalisations and ICU COVID-19 cases were significantly less than predicted, likely due to high population vaccination rates prior to border opening. The main risk factors for COVID-19 severity were incomplete immunisation and ATSI ethnicity.

Incidence and epidemiology of aneurysmal subarachnoid haemorrhage in Australian Aboriginal and Torres Strait Islanders; a ten-year population study

Health disparity between Aboriginal and Torres Strait Islander (ATSI) Australians and non ATSI Australians is well established. Incidence and epidemiology of aneurysmal subarachnoid haemorrhage (aSAH) in the ATSI population is less well described. An observational, cross-sectional study was conducted to identify all acute spontaneous subarachnoid haemorrhage in the Hunter New England and Mid North Coast population of New South Wales, Australia. Population and baseline information was obtained from the Australian Consens data. The size of the population was 1.1 million. Over the 9.8 year period, 959 admissions for subarachnoid haemorrhage were identified, of which, 531 were due to aneurysm rupture. The ATSI population represented 6 % of the study population and had a higher incidence of aSAH (11.5 per 100,000 person years’ vs 5.8 per 100,000 person years). The mean age at presentation was 8.6 years younger than the non-ATSI group (48.8 years vs 57.4 years). The ATSI population had higher rates of smoking and family history of aneurysms, but lower rates of premorbid hypertension. The overall rate of hospitalization for aneurysmal subarachnoid haemorrhage was higher in the indigenous Australian group, especially in younger patients. Higher smoking rates could be a contributing factor.

“You can be the kind of woman that you are”: the discursive management of intersecting identities in leadership talk

The present study investigates how culturally and linguistically diverse (CALD), and Aboriginal and Torres Strait Islander (ATSI) women mobilize intersecting identities through speeches delivered during women in leadership forums. As more women aspire to positions of leadership, the discursive analysis of identity management for understanding how identities are made relevant is critical. Using a discursive psychological approach, this research examines intersectionality as a social action, as it is played out in practice rather than as a theoretical concept. Here it is being anchored to empirical data to explore how it operates in the broader context of leadership talk, in particular, how diverse women represent themselves as leaders and what key identities emerge. The analysis demonstrates that in accounting for how these women achieved leadership positions, the speakers used their multiple identities as strategic resources. These identities included the categories of race, culture, gender, and parenthood. The insights from this study are significant as they shed light on the persisting barriers for women in achieving equal opportunity.

A single-centre experience of immune checkpoint inhibitors in patients with cancer in the Top End of the Northern Territory, Australia from 2016 to 2021.

e18841 Background: Immune checkpoint inhibitors (ICI) have transformed the oncological landscape, but are associated with immune-related adverse events (irAE) of varying frequency and severity. This regional single-centre experiential study evaluates the real-world incidence of irAE in patients in the Top End of the Northern Territory of Australia. The Top End represents a diverse population with high proportions of Aboriginal and Torres Strait Islander (ATSI) patients and patients living in remote and very remote areas. This captured cohort is under-represented in clinical trials. Methods: We identified all patients with solid tumours who were prescribed ICI between January 2016 and December 2021. We manually reviewed electronic and paper hospital records to record patient characteristics, treatments received, irAE, irAE treatment and patient outcomes. Results: 226 patients across 11 solid tumour streams received ICI. Of these, 58% had lung cancer, 27% melanoma, 5% head & neck cancer, 4% renal cell carcinoma, and the remainder other tumour streams. 70% were male and the median age at diagnosis was 63 years [28-84 years]. 16% identified as ATSI(compared to 2.8% ATSI nation-wide and 26.3% ATSI in the Northern Territory). Of the investigational cohort, 13% were treated in the adjuvant and 87% in the palliative setting. 11% received combination versus 89% single-agent ICI. 30% of patients had concurrent chemotherapy. 122 patients (54%) experienced any grade irAE as documented by the treating oncologist in the medical records. 59 patients (26%) had a severe (grade 3, 4, or 5) irAE. The fatality rate was 0.88% (2 patients); both were treated with a PD-L1 inhibitor for non-small cell lung cancer (NSCLC) and diagnosed with immune-related pneumonitis. The most common irAE were rash (18%), colitis (16%), arthralgia/myalgia (13%), pneumonitis (12%), thyroiditis/hypothyroidism (12%), hepatitis (9%), and adrenal insufficiency (7%). 24% of irAE required hospitalisation and 32% led to discontinuation of treatment. The median number of irAE per patient was 1. Among patients with the most common tumour types (melanoma and NSCLC), rates of irAE were, in both cases, 59% any grade irAE and 20% severe irAE. When compared to published literature, real-world rates of any grade adverse event were significantly lower than reported number in trials – likely due to exclusion of common non-immune-related adverse events in our data set. Rates of severe and fatal irAE were in line with published data. Conclusions: Immune-related adverse events are common among patients in the Top End and reflect rates in the published literature. We did not identify any safety concerns in our cohort of patients – including amongst ATSI patients and those living in remote and very remote areas. Further data analysis is needed to assess frequency and severity of irAE by specific tumour type and ICI.

ACHIEVING EQUITABLE ACCESS TO ELECTIVE ARTHROPLASTY FOR ABORIGINAL AND TORRES STRAIT ISLANDER POPULATION IN A REGIONAL NSW HEALTH DISTRICT: COMPARISON WITH NATIONAL DATA

Aboriginal and Torres Strait Islander (ATSI) people have higher elective wait times compared to non-ATSI population in Australia. The Murrumbidgee Local Health District (MLHD) in southern New South Wales services 125,242km2 and a population of 287,000 people, with 5.8% identifying as ATSI. The aim of this study is to investigate the arthroplasty waitlist time of ATSI, and the impact of rurality on joint replacement, within the MLHD and compared to the Australian national data.1435 consecutive patients who underwent elective hip or knee arthroplasty from July 2018 to June 2021 were collated. Demographics, ATSI status, total wait time, readiness for care, and rurality were collected. Rurality was measured by distance from the arthroplasty hospital within MLHD. 1,151 patients were included after excluding patients with missing data or underwent emergent surgery.Within this cohort, 72 of 1,151 patients (6.2%) identified as ATSI. ATSI were younger than non-ATSI population (60.7y v 66.4y). There was no difference between Aboriginal status and ready for care wait time (368.0 v 349.9 days; p=0.116). The rurality of the groups was similar and increasing rurality did not affect total wait time (ATSI 103.1km v 98.6km; p=0.309). There was no difference in total or not-ready-for-care time between the groups (p: 0.68).Findings suggest equitable access to joint arthroplasty in the MLHD between ATSI and non-ATSI populations, which differs from the national experience. There is no significant difference between rurality and accessibility in the MLHD. This may be a result of the increased focus to ATSI and rural health within the district. A state or national study would be beneficial in identifying high performing regions and reviewing processes that enable equitable and accessible care.MLHD provides equitable access to arthroplasty surgery between ATSI and non-ATSI, as well as patients from rural areas within the LHD.

Hearing loss increases with size but not site of tympanic membrane perforation in Aboriginal Australian children in remote locations.

To investigate the effect of size, site, and activity of tympanic membrane (TM) perforation on hearing loss (HL) in Aboriginal and Torres Strait Islander (ATSI) children. Observational study. Children aged 5-18 years who identified as ATSI at seven Anangu community schools within the Anangu Pitjantjatjara Yankunytjatjara Lands and Maralinga Lands of South Australia underwent 4-frequency pure-tone audiometry (0.5, 1, 2, and 4kHz) and video-otoscopy (VO). VO data was reviewed by surgeons for a middle ear diagnosis and VO files with TM perforations were then classified by perforation site (AS, AI, PS, PI, A, P, I) and size (<25%, 25%-50%, 50%-75%, or 75%-100%). Five hundred seventy-five VO files with matching audiological data were obtained. Active perforations (35 dBHL; 28-44 IQR) demonstrated greater HL than inactive perforations (31 dBHL; 29-39 IQR) p=.0029. For inactive perforations there was a significant difference between <25% and all larger perforations (p < .0001) whereas for active perforations the significance changed to between <25% (p < .0001) and 25%-50% (p < .05) when compared to larger perforations. When perforation site was compared within all size/activity groups, no statistically different findings were identified. In all analyses, findings did not change when individual frequencies were compared to 4-frequency pure-tone average dBHL. In ATSI children from remote communities, HL is greater in ears with larger perforations and active middle ear disease but there was no relationship between perforation site and HL.Level of evidence: Level 4.

School Age Developmental Outcomes of Children Conceived by IVF Compared with Controls: A Population Linkage Study

Background: There has been increasing interest in assessing longer term developmental and health outcomes in IVF-conceived offspring compared with those born after natural conception. So far, the findings have been conflicting. The Australian Early Developmental Consensus (AEDC) assesses children in their first year of primary school across five domains; physical health and wellbeing, social competence, emotional maturity, language and cognitive skills, and communication skills and general knowledge. Aim: To compare school entry (5-7 years of age) outcomes in IVF-conceived children in Victoria with naturally conceived controls. Method: We undertook a statewide data linkage study, with perinatal data (births 2005-2014) linked to data from major IVF providers in Victoria and the AEDC. Our approach to analysis included: complete case analysis, multiple imputation of missing data, consideration of clustering (siblings) and inverse probability weighted modeling to adjust for covariates. Our primary outcome was an AEDC score indicative of developmental vulnerability in two or more domains. We adjusted for the child’s age at assessment, sex, highest level of maternal education, maternal age, parity, SEIFA (Socio-Economic Indexes for Areas) quintile, language background other than English, and Aboriginal and Torres Strait Islander (ATSI) status. Results: The linked dataset comprised 163,418 children, including 4,441 IVF-conceived children. The IVF conceived population had older, more highly educated mothers who lived in more affluent areas and were less likely to be from non-English speaking backgrounds or identify as ATSI. IVF-conceived children were less likely to be developmentally vulnerable, in both unadjusted (RR 0.59, 95%CI: 0.52-0.67, p&lt;0.001) and adjusted analyses (aRR 0.72, 95%CI: 0.58-0.88, p&lt;0.001). Conclusion: Children conceived by IVF were less likely to be developmentally vulnerable in their first year of schooling, compared with peers conceived naturally. Further research should aim to understand if similar patterns are seen in other education and health domains and the potential mechanisms for these differences.

1295School age outcomes in IVF-conceived children compared with controls: a population linkage study

Abstract Background There is interest in longer term outcomes in IVF-conceived offspring compared with those conceived naturally. So far, the findings have been conflicting. The Australian Early Developmental Consensus (AEDC) assesses children in their first year of primary school across five domains. Methods To compare school entry outcomes in IVF-conceived children with naturally conceived controls, we undertook a statewide data linkage study, with perinatal data (2005-2014) linked to data from IVF providers in Victoria and the AEDC. Our approach to analysis included: complete case analysis, multiple imputation of missing data, consideration of clustering (siblings) and inverse probability weighted modeling to adjust for covariates. Our primary outcome was an AEDC score indicative of developmental vulnerability in two or more domains. We adjusted for confounders: child’s age at assessment, sex, highest level of maternal education, maternal age, parity, SEIFA (Socio-Economic Indexes for Areas) quintile, language background other than English, and Aboriginal and Torres Strait Islander (ATSI) status. Results The linked dataset comprised 163,418 children, including 4,441 IVF-conceived children. The IVF-conceived population had older, more highly educated mothers who lived in more affluent areas and were less likely to be from non-English speaking backgrounds or identify as ATSI. IVF-conceived children were less likely to be developmentally vulnerable, in both unadjusted (RR 0.59, 95%CI:0.52-0.67, p &amp;lt; 0.001) and adjusted analyses (aRR 0.72, 95%CI:0.58-0.88, p &amp;lt; 0.001). Conclusions IVF-conceived were less likely to be developmentally vulnerable in their first year of schooling, compared with peers conceived naturally.

The epidemiology of melioidosis in Townsville, Australia.

Melioidosis in an infection caused by Burkholderia pseudomallei, an organism endemic to tropical and subtropical regions. This study describes the epidemiology of melioidosis in Townsville, QLD, Australia, as well as clinical features, risk factors associated with the disease, the burden of infection on the Aboriginal and Torres Strait Islander (ATSI) community and patient outcomes over time. From 1997 to 2020, 128 patients were admitted to Townsville University Hospital. The total annual incidence of infection was 3.2 cases per 100000 compared with 15.3 per 100000 in the ATSI population. The majority of cases (n=82 [64%]) were male. Alcohol excess (55%) and diabetes mellitus (48%) were the most common risk factors. Bacteraemia occurred in 87 (70%) patients and pneumonia was the most common focus of infection in 84 (69%). The case fatality rate was 23%, with no difference for the ATSI population (6/32 [19%]). The presence of malignancy was the risk factor most associated with mortality (relative risk 2.7 [95% confidence interval 1.4-5.1], p=0.005). The ATSI community was overrepresented in this study, however, there was no significant difference in adverse outcomes. The case fatality rate was higher than in other regions in Australia. This discrepancy may relate in part to the different risk groups seen in these settings coupled with potential organism variability.

OUTCOMES OF HEART FAILURE AND ACUTE CORONARY SYNDROME IN INDIGENOUS POPULATION IN A REGIONAL AUSTRALIAN SETTING

Aboriginal and Torres Strait Islander (ATSI) Australians have poorer health outcomes compared to non-Indigenous Australians. We aim to investigate the outcomes of indigenous acute coronary syndrome (ACS) and heart failure (HF) patients compared to non-indigenous patients. All patients 18 years and

Influence of Ethnicity on Outcomes of Diabetes Inpatient Hypoglycemia: an Australian Perspective.

AimsTo evaluate outcomes of diabetic inpatient hypoglycemia among Aboriginal and Torres Strait Islander (ATSI) compared with Australian Caucasian patients.MethodsA retrospective audit of diabetic patients aged > 18 years admitted at a regional hospital general ward between April 1, 2015, and March 31, 2016, was analyzed. The database contains clinical information at the time of admission and initial discharge and readmission within 4 weeks thereafter.ResultsA total of 1618 (of 6027) patients were admitted with diabetes representing 23.7% of the total ward admissions, of which 484 (29.9%) had inpatient hypoglycemia. Of the 91 patients with available data analyzed, ATSI origin with inpatient hypoglycemia was associated with longer length of stay (LOS) (hazard ratio [HR], 2.1, 95% confidence interval [CI], 1.2-3.5), whereas severe hypoglycemia (≤ 2.2 mmol/L) in both ATSI and non-ATSI was significantly associated with longer LOS (HR, 2.3; 95% CI, 1.2-4.2). No significant differences in LOS were found for gender, age, and Carlson comorbidity index (CCI). The adjusted model for likelihood of readmission, gender, indigenous status, and CCI were not significant risk factors for readmission to the hospital. Readmitted patients were older (50-59 years vs < 50 years, P = 0.001; 60-69 years vs < 50 years, P = 0.032; 70+ years vs < 50 years, P = 0.031).ConclusionWe reported high rate of inpatient hypoglycemia in our study population. Indigenous Australian diabetic patients with inpatient hypoglycemia had significantly longer LOS compared with non-Indigenous Caucasian counterparts. Further prospective studies on a larger population are needed to confirm our findings.

P188 Aboriginal and Torres Strait Australians have significantly worse coronary disease, risk factors and 4 year outcomes compared with non-indigenous Australians

Abstract Introduction The Aboriginal and Torres Strait Islander (ATSI) population in Australia appear to present with coronary disease more frequently, have worse risk factors, worse coronary disease and poorer outcomes, however there is limited data available on this population.  The ATSI population represent 8% of the Cairns total population. We undertook to compare these findings and four-year outcomes in ATSI versus non-indigenous patients aged &amp;lt; 50 years old undergoing coronary angiography. Methods   We collected data on all patients aged &amp;lt; 50 years old, who underwent coronary angiography at Cairns Hospital over a two-year period (2014-2016), from the Queensland Coronary Outcomes Registry. Data of patient risk factors and 4 year outcomes were collected using electronic hospital medical records and electronic discharge summaries available on all Queensland patients. Patients residing outside Queensland were excluded. Results From 2014-2016, a total of 555 patients &amp;lt; 50 years old underwent coronary angiography. The average age was 43. 322 (58.0%) patients were male and 233 (42.0%) were female. 271 patients (48.8%) identified as ATSI.  Coronary risk factors - 42.4% of ATSI patients had diabetes vs 13.7 in the non-indigenous group, 58.7% of ATSI patients vs 43.7% had hyperlipidaemia, 61.3% of ATSI patients vs 39.8% were current smokers, 65.3% of ATSI patients vs 42.3% were hypertensive, and 64.2% of ATSI patients vs 50.4% had a family history of premature coronary artery disease. This demonstrates significantly higher incidence of cardiac risk factors in ATSI patients (combined risk factors P = 0.00086).   When comparing coronary artery disease, as demonstrated by coronary angiography, the ATSI group had significantly more abnormal coronary angiograms - 74.5% compared to the non-indigenous group 42.3% (P = 0.000006). There was not a statistically significant difference between the severity of coronary artery disease between the two populations who had coronary disease, however, the ATSI population demonstrated a higher incidence of triple vessel disease. ATSI patients were more likely to have repeat coronary angiography 11% vs 4%. In the four-year follow up period, 18.5% of the ATSI population had at least one major adverse cardiac event (MACE), whereas in the non-indigenous group 7.0% had at least one MACE.  There was not a statistically significant difference between all cause mortality between the two populations. Conclusion   We have shown that Aboriginal and Torres Strait Islanders Australians are more likely to have coronary angiography at a younger age. That Aboriginal and Torres Strait Islanders Australians have a significantly higher incidence of cardiac risk factors, higher incidence of coronary artery disease, and more major cardiac events after undergoing coronary angiography compared to non-indigenous patients. The all cause mortality in this young population was not significantly different.

Editorial: Discovering Industrial-Era Francophone Ecoregions

This article, and its associated issue, involve Aboriginal and Torres Strait Islander (ATSI) research in the sense that a post-colonial theoretical framework, which has been used in ATSI research, has been applied in a French context. This research does not involve direct research of ATSI peoples or their culture.

Health literacy in Indigenous people with chronic disease living in remote Australia

BackgroundHealth literacy is strongly associated with health outcomes and is important for health policy and service delivery. Low health literacy was reported in 59% of Australian adults, however, there is no national data on the health literacy of Aboriginal and Torres Strait Islander (ATSI) peoples. The ATSI population in Australia experience a notable gap in health outcomes compared with non-Indigenous Australians which is due, in part to a higher prevalence of chronic diseases. The health outcome gap is more pronounced in rural and remote locations. This study aims to establish the health literacy profile of ATSI adults with chronic disease living in remote North-West Queensland Australia, and to investigate associations between the Health Literacy Questionnaire (HLQ) domains and self-reported chronic disease and demographic characteristics.MethodsUsing a cross-sectional design, 200 ATSI adults with a diagnosis of chronic disease/s (cardiovascular disease, diabetes, respiratory disease and/or chronic kidney disease) were recruited from two sites with the assistance of Aboriginal Health Workers. Data were collected using the HLQ, a multidimensional 44 item instrument to assess nine domains of health literacy. Demographic and health data were also collected. Analysis of variance using backwards modelling was used to determine predictors of health literacy.ResultsParticipants were mostly male (53.5%) and aged between 19 and 89 years. The most prevalent chronic disease was cardiovascular disease (74%) followed by diabetes (67.5%). More than half (62%) had two or more chronic diseases. There was at least one independent predicator for each of the nine health literacy domains. Age, number of chronic diseases, gender, and level of education were all highly significant predictors of health literacy.ConclusionImproved health literacy will enable individuals to take an active role in their health. Understanding the health literacy of ATSI adults is a crucial first step. Our findings can assist Australian healthcare organisations to review their health literacy responsiveness and examine ways to improve patients’ needs and health capabilities to better support people to engage in effective self-management for chronic diseases.

The Domestic Violence Protection Order System as Entry to the Criminal Justice System for Aboriginal and Torres Strait Islander People

The domestic violence protection order (DVO) system is a hybrid system of criminalisation in which the DVO itself is a civil order, but any contravention of that order may result in a criminal charge. Limited attention has been paid to the potential consequences of criminalisation through the hybrid DVO system in the Australian context. We use Queensland as a case study and examine administrative data gathered through Queensland Courts.  We show that a disproportionate number of Aboriginal and Torres Strait Islander (ATSI) people are named on DVOs, charged with contraventions of DVOs and significantly more likely than non-Indigenous people to receive a sentence of imprisonment for a contravention of a DVO, compared to non-Indigenous people. We find that ATSI women are particularly overrepresented in this system. We review explanations for these startling figures and emphasize the need for a change in approach.

Pulmonary Hypertension in Central Australia: A Community-Based Cohort Study

The burden of pulmonary hypertension (PHT) in Central Australia has not been previously studied. Our aim is to characterise the prevalence, clinical classification, and long-term survival of individuals with PHT in Central Australia. A community-based cohort study of all individuals diagnosed with PHT in Central Australia between 2005 and 2016 was undertaken. We estimated PHT prevalence using population data, describe clinical PHT classification, and characterised long-term survival using Kaplan-Meier approaches. A total of 183 patients were identified (mean age 52±16years, 63% female). Of these individuals, 149 (81.4%) were of Aboriginal and Torres Strait Islander (ATSI) descent. The prevalence per 100,000 of any PHT was significantly higher In ATSI (723 [95% CI 608-839] compared to non-ATSI individuals (126 [95% CI 84-168], p<0.001). Furthermore, ATSI individuals were diagnosed at younger ages compared to non-ATSI individuals (49±15 vs 64±16years, p<0.001). Median estimated pulmonary artery systolic pressure (ePASP) was higher in patients with pulmonary arterial hypertension (PAH) compared to other causes (62 [IQR 54-69] vs 50 [IQR 44-58] mmHg, p<0.01). The median survival rate from diagnosis was 9 years (IQR 7.2-13.2). Age and ePASP were significant predictors of mortality (HR 1.05 [95% CI 1.02-1.07] and HR 1.56 [95% 1.00-2.42] respectively). In this community based study, we found a high burden of PHT in Central Australia. The prevalence of PHT is greater in ATSI individuals and is diagnosed at younger ages compared to non-ATSI individuals. Together with other cardiovascular diseases, PHT may be in-part contributing to the gap in life expectancy between ATSI and non-ATSI individuals.

Paediatric thoracic empyema in the tropical North Queensland region of Australia: Epidemiological trends over a decade.

The Townsville Hospital and Health Service is the regional referral centre for children in the north of Queensland. Aboriginal and Torres Strait Islander (ATSI) people make up 7-10% of the population. Increasing numbers of children with paediatric thoracic empyema (pTE) are being referred to Townsville Hospital and Health Service for management. This study aims to describe the incidence rates, epidemiology, microbiology and trends of this disease in North Queensland over a 10-year period. A retrospective chart review of all children (1 month to 16 years), admitted in the years 2007-2016, with community-acquired pTE was conducted. International Classification of Diseases codes were used to identify the patients. Epidemiological and microbiological data were extracted from records. Of the 123 cases identified, incidence rates per 100 000 were 8.5 (95% confidence interval (CI) 8.4-8.6) in all children and much higher at 19.8 (95% CI: 19.5-21.9) in ATSI children. The under 5 years age group had the highest rate (24.5; 95% CI: 24.4-24.6). There was a progressive rise in incidence during the 10-year period, with the highest incidence of 15.2 (95% CI: 15.1-15.2) occurring in 2016. A pathogen was isolated in 76% of cases. Non-multi-resistant methicillin-resistant Staphylococcus aureus was the most common pathogen isolated in 22 of 64 ATSI children (34%), while Streptococcus pneumoniae was the most common pathogen isolated in 27 of 59 non-ATSI children (46%). A high and increasing incidence of pTE in North Queensland is being observed. ATSI children have higher incidence rates and are more likely to have non-multi-resistant methicillin-resistant Staphylococcus aureus as a causative agent.

Validation of an Accelerated Diagnostic Protocol for Aboriginal and Torres Strait Islander Patients with Suspected Acute Coronary Syndrome

Introduction: Aboriginal and Torres Strait Islander (ATSI) people have a high burden of cardiovascular disease. Observed rates of major coronary events are seven to nine times higher in people aged < 45 years for this population when compared with non-Indigenous Australians. The Improved Assessment of Chest Pain Trial (ImpACT) protocol is an evidenced-based ADP, which combines sensitive troponin testing, objective testing and clinical criteria, including age, to identify patients at high, intermediate or low risk of acute coronary syndrome (ACS). The Accelerated Chest Pain Risk Evaluation (ACRE) project is currently implementing the ImpACT protocol into public hospitals across Queensland. Aboriginal and Torres Strait Islander patients were under-represented in the original ImpACT study.

Infectious complications in indigenous renal transplant recipients in Western Australia.

Infectious complications remain a significant risk following renal transplantation. To examine the burden and pattern of infection following renal transplantation in Aboriginal and Torres Strait Islander (ATSI) compared to non-ATSI. A retrospective cohort study of 141 consecutive adult renal transplant recipients in Western Australia between 2005 and 2011 was conducted. We determined baseline serological status for relevant organisms, the number of patients with specific infections, infectious admission in the first year post-transplantation and the rate of infectious death during follow up. There were 57 ATSI and 84 non-ATSI renal transplant recipients. ATSI compared to non-ATSI had a high rate of cytomegalovirus (CMV) seropositivity (98.2% vs 73.2%, P < 0.001), HBcAb positivity (100% vs 13.3%, P < 0.001) and strongyloides seropositivity (ATSI 3/12 tested). In the first year post-transplant, ATSI compared to non-ASTI had a higher rate of pneumonia (17.9% vs 3.6% of patients, P = 0.006), and non-significant trend to higher rates of gastrointestinal parasitic infection (7.0% vs 1.2% of patients, P = 0.158), invasive fungal infection (10.5% vs 4.8% of patients, P = 0.316), and hospitalisation because of infection (10.0 vs 5.5 days, P = 0.071). Overall 5-year cumulative survival was lower for ATSI versus non-ATSI (0.64 vs 0.86, P = 0.022) with two-thirds of ATSI deaths attributed to infection. ATSI are at high risk of infectious complications after renal transplantation associated with a burden of hospitalisation and death. Augmented screening and prophylaxis for infectious diseases should be considered. Further study needs to identify contributing environmental and immunity factors.

Aboriginal Voices and Inclusivity in Australian Land Use Country Planning

Following the Australian High Court’s decision in the &lt;em&gt;Mabo &lt;/em&gt;case in 1992, it is now instrumental for land use planners to be educated and skilled in Aboriginal and Torres Strait Islander (ATSI) people’s rights, interests, needs and aspirations in conventional and contemporary land use planning processes to ensure inclusivity within Australian culture and its structures.  As an applied science discipline, for land use planning these imperatives include formally recognising ATSI peoples’ long connections with &lt;em&gt;Country&lt;/em&gt;, acceptance of the High Court’s rejection of the doctrine of &lt;em&gt;terra nullius&lt;/em&gt;, recognition that ATSI people will always retain their special relationship with and responsibility for land and sea &lt;em&gt;Country&lt;/em&gt;, but more importantly incorporating Indigenous land planning values into extant Western land use planning instruments (ALGA 1999:225).  This paper reviews and critiques the position and alignment of this applied science discipline, from an Indigenous perspective, and its policy and education accreditation governance role in responding to contemporary land use determinations as it impacts upon inclusivity of Indigenous knowledge, law, and policy in practice and educating the future generation of land use planners.