Australian Aborigines Research Articles

Developing a protocol for neuroimaging to investigate brain ageing and dementia in collaboration with aboriginal Australian communities

AbstractBackgroundDementia rates in Aboriginal Australians are 3‐5 times higher than in the broader Australian population, and among the highest rates reported globally. Existing evidence suggests that dementia types are similar to those found in non‐Indigenous Australian populations. Neuroimaging, however, has not been previously available in any study of dementia in this population to support or inform clinical diagnoses.MethodThis study extends our epidemiological work, and arose from extensive community consultation and engagement. This engagement included a pilot MRI study (n=14), community planning survey, and guidance from an Aboriginal and Torres Strait Islander Steering Committee. The neuroimaging sub‐study is a prospective, cross‐sectional non‐interventional study. Participants first complete a comprehensive interview and diagnostic assessment as part of the Koori Growing Old Well study. Consenting participants with cognitive decline (diagnosis of cognitive impairment or dementia; n=40) and age/sex‐matched healthy controls (n=40) aged 60+ will undergo MR, FDG PET‐CT and PiB PET‐CT scans. An additional n=120 participants >55 years will be recruited to an MR scan‐only condition.ResultPilot work and consultation showed acceptability of neuroimaging with partnering Aboriginal communities, including 74% of planning survey participants (n=213) indicating that neuroimaging should be included in future dementia studies (Lavrencic et al., 2020, Int Psychogeriatr). Older Aboriginal people living in New South Wales, Australia are currently being recruited; n=20 have undergone PET‐CT and MR scans to date (expected study completion by 2023). Outcome analyses will compare cognitive decline and healthy control groups on a range of measures including amyloid burden, regional glucose metabolism, hippocampal atrophy/volume and vascular indices on MR. Associations between amyloid burden and vascular pathology will be examined for cases of possible/probable Alzheimer’s disease. Correlations between MR measures and early life stress, adult adversity, cognitive function, and clinically diagnosed cognitive impairment will be investigated.ConclusionOur study will, for the first time, investigate functional and anatomical neuroimaging in older Aboriginal Australians and inform dementia prevention, diagnosis and policy for Aboriginal Australians. It will also contribute to the wider literature on vascular risk in the pathogenesis of AD, with associated biomedical and social risk factors across the lifespan of Aboriginal Australians.

Behavioural and psychological symptoms of dementia in aboriginal australians

AbstractBackgroundBehavioural and Psychological Symptoms of Dementia (BPSD) and Neuropsychiatric Symptoms (NPS, in people without dementia) have not been examined in the Aboriginal Australian population despite high rates of dementia and cognitive decline. BPSD/NPS contribute significantly to poorer wellbeing, institutionalisation, and adverse outcomes. This study aims to identify the characteristics and factors associated with BPSD/NPS in older Aboriginal Australians.MethodData were from the Koori Growing Old Well Study, a longitudinal, population‐based study with Aboriginal Australians from 5 partnering communities in New South Wales (n=336 baseline including n=153 with medical assessment). Participant, care person and medical interviews were carried out. Baseline BPSD/NPS were classified using the Cambridge Behavioural Inventory‐Revised (CBI‐R) and social and clinical predictors were collected. Logistic regression analyses examined associations with severe BPSD/NPS.ResultCBI‐R data were available for n=132 (mean age= 67, SD= 6.6; 46% male). The prevalence of one or more NPS was high (66%), with 74% of mild cognitive impairment (MCI) and 100% of people with dementia experiencing symptoms. Patterns of behaviour change indicated that mood symptoms were prominent in MCI/mild dementia, symptoms of apathy worsened with dementia severity, and abnormal beliefs were more prominent in moderate/severe dementia. Stroke history (OR=4.4) and living in residential aged care (RAC; OR=10.8) were associated with severe BPSD/NPS. When presence of a dementia diagnosis was added to the model, only RAC (OR=5.5) and dementia presence (OR=5.8) remained significant.ConclusionThe prevalence of BPSD/NPS is high in Aboriginal communities, linked to the high rates of cognitive decline. Characterising the pattern and predictors of BPSD/NPS is critical for early intervention and support. Future research should validate culturally‐relevant assessment and models of care for BPSD/NPS.

Telephone cognitive screening with older aboriginal Australians: A preliminary study

AbstractBackgroundCognitive assessment via telehealth is being increasingly employed, particularly in the context of the COVID‐19 pandemic. Widespread access to video call software has improved the availability and quality of telehealth services however inequity of access to such technologies remains for some communities, especially when restricted to home‐based telehealth options. As such, telephone adaptations of existing cognitive screening tests need to be validated across diverse populations.MethodThe present study sought to evaluate an existing 26‐point telephone adaptation of the Mini Mental State Examination (TMMSE) in a sample of older Aboriginal Australians. Additionally, we aimed to evaluate a novel urban telephone adaptation of the Aboriginal‐specific Kimberly Indigenous Cognitive Examination short form (TKICA‐screen). A sub‐sample (n=20) of participants (age range: 55‐69 years; MMSE range: 23‐30), who had completed in‐person cognitive assessment (MMSE and KICA‐screen) within the past 6 months as part of the Koori Growing Old Well Study, completed telephone‐based cognitive testing using the TMMSE and TKICA‐screen.ResultThere was a moderate positive correlation between MMSE versions (r=.583; p=.011) with poorer performance on the TMMSE for Season (p=.016) and Phrase (p=.016) items. A weak correlation was observed between the KICA‐screen and TKICA‐screen (r=.196; p=.407) with participant’s performing significantly worse on the TKICA‐screen for Season (p=.016) and Picture Recall (p=0.001). Demographic factors, including age, sex and education were not associated with telephone screening performance. Participants with hearing problems performed worse than those without on the TKICA‐screen (p=.042), but there was no significant difference found on TMMSE (p=.609).ConclusionThis small pragmatic study had a number of limitations, but preliminary results indicate that the TMMSE may be a suitable alternative to the in‐person test in this population. However, the TKICA‐screen requires further revision and evaluation. Clinically, service‐to‐service video telehealth has enabled the continuation of geriatric medicine and dementia outreach clinics to rural Aboriginal community controlled health services throughout pandemic‐related public health restrictions. There is potential for telehealth services to enhance remote access to culturally safe dementia assessment, diagnosis and specialist care services for older Aboriginal Australians, but further research is required, particularly validation of cognitive assessment approaches.

The road beyond licensing: the impact of a driver licensing support program on employment outcomes for Aboriginal and Torres Strait Islander Australians

BackgroundWith increasingly tough graduated driver licensing laws in all Australian States and Territories, driver licensing support programs are recognised as being important to support Aboriginal and Torres Strait Islander peoples to obtain a driver licence. Such programs appear to improve licensing attainment rates, but few studies have examined the broader impact that these programs can have. This research aims to 1) examine the impact of a New South Wales (NSW) based driver licensing support program (Driving Change) on client employment outcomes; 2) assess the influence of geographical area of program delivery on driver licence attainment.MethodsDriving Change was delivered from February 2013 to August 2016 in 4 urban and 7 regional Aboriginal communities of NSW. Clients were followed-up at 6 months or more following contact with the program as part of routine program operations. Descriptive statistics and regression models were used to analyse data.ResultsFrom 933 clients contacted 254 agreed to provide feedback, a response rate of 27%. Those that responded were mostly female (57%), aged 24 years and under (72%), unemployed (85%) with secondary education or less (71%) and from a regional area (74%).Adjusted logistic regression indicated that clients who achieved an independent licence were more likely (OR: 2.5, 95% CI: 1.22–5.24, p = 0.011) of reporting a new job or change in job than those who did not attain a licence. Clients from regional areas were more likely (OR: 1.72, 95% CI: 1.27–2.33, p < 0.001) to gain an independent licence than those from urban areas. There was no difference in employment outcomes (OR: 1.2, 95% CI: 0.53–2.52, p = 0.719) for clients from urban compared to regional areas.ConclusionThe Driving Change program appears to be effective in improving employment outcomes for those who gained a licence. Clients from regional areas were more likely to gain a licence compared to those in urban settings, and were predominantly young and unemployed, often a hard to reach cohort. Future licensing programs being delivered in regional areas need integrated pathways into employment opportunities to provide holistic services that address the social and economic challenges faced by Aboriginal and Torres Strait Islander Australians.

Oral health education and prevention strategies among remote Aboriginal communities: a qualitative study.

The delivery of effective oral health promotion strategies is essential to improving oral health outcomes among remote Aboriginal communities. This study aimed to explore the perceptions and attitudes of Aboriginal Australians living in remote Kimberley communities towards oral health education and disease prevention. Semi-structured interviews and yarning circles were carried out following purposive sampling of Aboriginal adults living in the East Kimberley region of Western Australia. A total of 80 community members participated in the yarning process. School-based oral health promotion and community-driven restrictions on the sale of sugary food and drink were seen as positive strategies in improving oral health. Lifestyle changes brought about by modernity, internet availability and fixed community stores were perceived to create new challenges and shift the priorities for those living in remote communities. Community-based yarning may better inform future oral health strategies in the Kimberley. A neoliberal approach of shifting responsibility onto the individual ignores the complex social inequities faced by Aboriginal people living in remote communities where macro-level determinants such as remoteness, food security and education significantly influence decisions around diet and oral health.

Effects of Nutritional Interventions on Cardiovascular Disease Health Outcomes in Aboriginal and Torres Strait Islander Australians: A Scoping Review

Nutrition interventions can support Aboriginal and Torres Strait Islander peoples to reduce their risk of cardiovascular disease (CVD). This review examines nutritional interventions aiming to improve CVD outcomes and appraises peer-reviewed interventions using an Aboriginal and Torres Strait Islander Quality Appraisal Tool. Five electronic databases and grey literature were searched, applying no time limit. Two reviewers completed the screening, data extraction and quality assessment independently. The study quality was assessed using the South Australian Health and Medical Research Institute and the Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange Aboriginal and Torres Strait Islander Quality Appraisal Tool (QAT). Twenty-one nutrition programs were included in this review. Twelve reported on anthropometric measurements, ten on biochemical and/or hematological measurements and sixteen on other outcome domains. Most programs reported improvements in measurable CVD risk factors, including reduced body mass index (BMI), waist circumference (WC), weight, blood pressure and improved lipid profiles. Most programs performed well at community engagement and capacity strengthening, but many lacked the inclusion of Indigenous research paradigms, governance and strengths-based approaches. This review highlights the need for contemporary nutrition programs aimed at improving cardiovascular health outcomes to include additional key cultural components.

Why is the use of inappropriate medicines so high in Aboriginal Australians?

Why is the use of inappropriate medicines so high in Aboriginal Australians?

The impact of Marfan syndrome on an Aboriginal Australian family: 'I don't like it as much as I don't like cancer'.

Marfan syndrome (MFS) is an autosomal dominantly inherited connective tissue disorder. Aortic dilatation/dissection and ectopia lentis are the most severe features, which affect physical functioning and psychological well-being. In Aboriginal Australians, there is little psychosocial research on genetic conditions. This study explored the physical, psychological, and practical impacts of MFS on Aboriginal Australians. Eighteen (8 affected and 10 unaffected) members of a large Aboriginal Australian family with MFS participated in an ethically approved study. Semi-structured qualitative interviews were conducted, transcribed verbatim, and analyzed thematically. All individuals reported challenges from MFS, negatively affecting day-to-day living. Severe vision impairment was perceived as the greatest challenge, contributing to feelings of stigma and exclusion. With aging, concerns shifted toward cardiac complications. The unpredictability of lens dislocation and aortic dissection was reported to be psychologically challenging. Participants described MFS-related barriers to obtaining and retaining employment, especially following cardiac surgery; with consequential psychological and financial hardships. Participants articulated that their cultural drive to support the ill and respectfully mourn the deceased, regardless of distance, resulted in a significant financial burden. Additionally, when hospitalization and/or funerals occurred, financially solvent individuals were expected to share resources, without any expectation of repayment or reciprocity (i.e., 'demand sharing', common in Aboriginal Australian culture). This study documents the nature and pervasiveness of uncertainty for both affected and unaffected members of an MFS family. Many reported challenges are consistent with other MFS cohorts (including stigma, social exclusion, and unemployment). However, our findings suggest that cultural values may exacerbate the financial costs of MFS for Aboriginal Australians.

Alcohol dependence in a community sample of Aboriginal and Torres Strait Islander Australians: harms, getting help and awareness of local treatments

BackgroundFew studies have examined links between current alcohol dependence and specific harms among Indigenous Australians. We investigated these associations as well as help seeking for drinking, awareness of local treatments and recommendations to help family or friends cut down or stop drinking in two Indigenous communities.MethodsA representative sample of Indigenous Australians was surveyed in one urban and one remote community in South Australia. Data were collected via the Grog Survey App. Participants were dependent if they reported two or more symptoms of alcohol dependence (ICD-11). Pearson chi-square tests were used to describe relationships between employment by gender, and dependence by awareness of medicines and local treatment options. Multivariate logistic regressions were used to predict the odds of dependent drinkers experiencing harms and getting help for drinking, controlling for age, gender, schooling and income.ResultsA total of 775 Indigenous Australians took part in the study. After controlling for confounders, dependent drinkers were nearly eight times more likely to report a harm and nearly three times more likely to get help for their drinking—compared with non-dependent drinkers. Participants recommended accessing local support from an Aboriginal alcohol and other drugs worker, or a detoxification/ rehabilitation service.Discussion and conclusionsMore support and funding is needed for Indigenous Australians to ensure local treatment options for dependent drinkers are readily available, appropriate and accessible. Involvement of local Aboriginal or Torres Strait Islander health professionals in delivery of care can help ensure that it is appropriate to an individual’s culture and context.

Look After Them? Gender, Care and Welfare Reform in Aboriginal Australia

ABSTRACT The Cashless Debit Card (‘the card’) is a stringent form of welfare quarantining targeting Aboriginal Australians. Select social security recipients have 80% of their fortnightly payments sequestered onto an electronic card that blocks the purchase of alcohol or gambling products. Advocates for the card envisage that its introduction will normalise Aboriginal family life. Analysis of the relationship between gender, care and the neo-paternalistic welfare state has been largely overlooked in research concerning the card. This article redresses that neglect, placing the lived complexities of everyday caregiving within the larger landscape of the neo-paternalistic welfare state’s care. I craft three ethnographic portraits that exploire how the lived effects of the card are deeply shaped by culturally and historically conditioned caregiving practices. I then shift scales from everyday caregiving to the state’s provision of care, arguing that a neo-paternalistic welfare state has effectively supplanted the post-war Australian welfare state’s nurturance.

Introduction: Teaching the Future of Pacific Art

Although a few scholars have examined the training of Indigenous Pacific artists during the period of early contact with Europeans and Americans, as well as the education of Indigenous artists who practice heritage arts in the Pacific today, almost nothing has been written on the instruction of art in modern classroom and workshop settings with regard to Pacific Islanders and Aboriginal Australians. The four Discussion Roundtable articles in this volume focus on teaching art in Oceania—three address art education for Pacific Island students in a variety of settings, while the fourth is concerned with the presentation of Pacific arts and artists to an outside audience made up of American college students. As a departure from the academic articles usually found in these pages, and in contrast to the other contributions to this volume, these four pieces are narratives of personal journeys of discovery.

Interventions to address food insecurity among Aboriginal and Torres Strait Islander people: a rapid review.

Food insecurity disproportionately impacts Aboriginal and Torres Strait Islander Australians. This review sought to investigate research and evaluations of programs and interventions implemented to address food insecurity among Aboriginal and Torres Strait Islander communities. A rapid review was conducted to collate the available research from 6 databases. The search was conducted in May 2020. Search constructs related to food insecurity, Aboriginal and Torres Strait Islander people, and Australia. Twenty-five publications were included in this review, 24 reported on an intervention, while 9 were evaluations of an intervention. Interventions included behaviour change projects, including projects that sought to change purchasing and cooking behaviours, school-based education programs, and gardening programs. In general, the studies included in this sample were small and lacked a systematic consideration of the factors that shape the experience of food insecurity among Aboriginal and Torres Strait Islander people specifically. Based on the findings of this review, authors suggest greater consideration to the systematic determinants of food insecurity among Aboriginal and Torres Strait Islander communities to have lasting and sustainable impact on food insecurity. This review has been registered with the international prospective register of systematic reviews (PROSPERO: CRD42020183709). Novelty: Food insecurity among Aboriginal and Torres Strait Islander people poses significant risk to health and wellbeing. Small-scale food security interventions may not provide ongoing and sustained impact. Any intervention to promote food security will need to involve Aboriginal and Torres Strait Islander people and be sustained once external parties have left.

Neonatal death is a major concern for Indigenous women with asthma during pregnancy and could be prevented with better models of care.

Asthma is the most common respiratory illness in Aboriginal and Torres Strait Islander Australians. From the Mater Mothers routinely collected perinatal data in Brisbane we have identified that 24% of Indigenous and 17% of non-Indigenous women have pregnancies complicated by asthma. Indigenous women with asthma are more likely to have poorer birth outcomes when compared to non-Indigenous women with asthma, with neonatal death being doubled in asthmatic Indigenous women. These data indicate that asthma management during pregnancy is an unmet need for Indigenous women and essential if we are to avoid these devastating outcomes for Indigenous families.

Digital Support for Indigenous Research Methodologies

Research undertaken by outsiders into issues of concern to Aboriginal communities frequently ignores community culture and the knowledge embedded within Aboriginal communities. Methodologies are adopted which perpetuate the colonialist mindset of non-indigenous Australians leading to failed solutions to Aboriginal problems. This paper describes an Aboriginal-led community-based research project, exploring the role of Aboriginal Australians in caring for, and transforming, their own communities. It focuses on the roles that Information Systems can play when providing an accessible platform for Aboriginal voices. The authors conducted an in-depth case study of one Aboriginal Community Controlled Organisation (ACCO), the Illawarra Koori Men’s Support Group (IKMSG). The research consisted of a social network analysis (SNA) of the inter-organisational links of the IKMSG; interviews and focus groups with members of the IKMSG and the co-design of their first website. The prominence of the IKMSG in the SNA maps suggests that its work in the community is highly respected and that the model produced by this research can act as a guide for success in other ACCOs. The findings have been used to develop a theoretical model of Aboriginal community engagement and intervention. This model can enable authentic outcomes to projects which address Aboriginal concerns and support the conduct of community-led research in Aboriginal communities.

Closing the climb: refusal or reconciliation in Uluru-Kata Tjuta National Park?

ABSTRACT The Uluru Climb, located within Uluru-Kata Tjuta National Park, Australia, was permanently closed to tourists on the 26 October 2019 after decades of controversy. Determined by a unanimous vote of the Anangu majority Board of Management, news of the Climb’s closure quickly captured popular, political and media attention, not all of which was positive. Drawing on two periods of fieldwork – the first in November 2012 (n = 68 interviewees) and the second in May 2019 (n = 62 interviewees) – this paper discusses visitor responses to the Climb both in terms of the ongoing coloniality evident in discourses of nationalism and individual rights and the possibility of the transformation of such views via a range of emotional and affective engagements. We highlight the prevalence of feelings of ownership, empathy and shame in the deployment of a range of views on the Climb and other cultural restrictions, as well as their political implications in the context of contemporary Australian settler-colonialism. In so doing, we position an ethic of relationality as key to the mobilisation of feelings, emotions and affects necessary to transform the outlook of visitors in the context of ongoing reconciliation debates between Aboriginal and non-Aboriginal Australians.

Hospitalisation for systemic lupus erythematosus associates with an increased risk of mortality in Australian patients from 1980 to 2014: a longitudinal, population-level, data linkage, cohort study

ObjectiveMortality rates for patients with SLE have not been reported in Australia. This study determined the association between a hospitalisation for SLE with mortality.MethodsPopulation-level cohort study of patients with SLE...

Polyphenolic profile and ethno pharmacological activities of Callistemonsubulatus (Cheel) Craven leaves cultivated in Egypt

Ethnopharmacological relevanceThe genus Callistemon (syn. Melaleuca) of the myrtle family (Myrtaceae) has been documented as an integral part in the ethnobotanical system of the indigenous people of Australian mainland and many of its islands. Several Callistemons including the species subulatus were used by aboriginal Australians for making rafts, roofs for shelters, bandages, and food recipes, in addition to the management of wounds, infections, pain, cough, bronchitis, and gastrointestinal tract (GIT) disorders. Aim of the studyThe current study is designed to document the therapeutic effect of the aqueous methanolic extract (AME) of C. sabulatus Chell (syn. M. sabulata) leaves in the management of diarrhea and pain. Also, its influence on additional pharmacological modalities that are related to oxidative stress just as skin aging. Ultimately, the polyphenolic profile of the extract is disclosed and correlated to the aforementioned bioactivities. Materials and methodsThe extract was fractionated using various chromatography techniques and the structures of the isolated compounds were determined based on their chemical and spectral data. The antioxidant activity was assessed using multiple models, including 2,2-diphenyl-picrylhydrazyl (DPPH), oxygen radical absorbance capacity (ORAC) and β-carotene bleaching assays. The anti-skin aging effect was evaluated using different relevant enzymatic assays. The antinociceptive activity was investigated using acetic acid-induced writhing, hot plate test, and formalin-induced paw licking in mice models. The antidiarrheal activity was gauge using the castor oil induced diarrhea, enter pooling and gastrointestinal motility in vivo models. ResultsDiverse polyphenols, including quercetin-3-O-β-D-glucuronopyranoside (1), kaempferol-3-O-β-D-glucuronopyranoside (2), strictinin (3), quercetin-3-O-(2``-O-galloyl)-β-D-glucuronopyranoside (4), afzelin (5), di-galloyl glucose (6), mono-galloyl glucose (7), acacetin (8), apigenin-6,7-dimethyl ether (9), kaempferol trimethyl ether (10), dimethoxy chrysin (11), quercetin (12), kaempferol (13), methyl gallate (14), and gallic acid (15) were identified. The extract exhibited as significant antioxidant activity even better than that of Trolox or BHT. Moreover, it exerts elastase, tyrosinase, and collagenase inhibition activities, in addition to the significant peripheral and central analgesic activity in a dose-dependent manner (P < 0.0001). In castor oil induced diarrhea model, AME significantly prolonged the diarrhea onset, decreased the frequency of defecation, and weight of feces. Likewise, it exhibited a significant reduction in the gastrointestinal motility in charcoal meal model (P < 0.0001) and a considerable inhibitory effect on gastrointestinal transit and peristaltic index with all investigated doses (P < 0.0001). ConclusionEthnobotanicals are versatile resources for the management of various ailments by indigenous people and the experimental research is utmost to validate and uncover their pharmacological relevance. C. sabulatus leaves have strong antioxidant, analgesic, anti-skin aging, and antidiarrheal activities which are validated for the first time by various in vitro and in vivo models. The metabolic profile of the unprecedented AME of C. sabulatus leaves compromises a wide array of bioactive polyphenolic metabolites including, flavonoids, tannins, and phenolic acids that are correlated to the observed bioactivities. Altogether, ethnobotanicals with high and diverse contents of polyphenols are potential candidates for the management of various human aliments including neuropathies, GIT disorders, and skin aging conditions.

A Conceptual Model of Protective Factors Within Aboriginal and Torres Strait Islander Culture That Build Strength

The Aboriginal and Torres Strait Islander Australian population have endured immense hardship since the colonization of Australia characterized by the loss of lands, language, leadership, and family that contributes to the health and social inequities experienced today. Culture plays a significant role in shaping the health and wellbeing of all Aboriginal and Torres Strait Islander peoples, however the processes and mechanisms of cultural connection, how it builds strength and offers protection in times of hardship is less clear. This scoping review used the voice of Aboriginal and Torres Strait Islander Australians from qualitative research papers to hear what cultural factors are protective and the ways they offer this. Quantitative research papers were then explored to understand if connection to culture lead to better health or social outcomes. Four aspects of culture were integrated into a conceptual model—cultural activities, country, connection, and identity. The eight quantitative papers assessed connection to culture poorly making it difficult to definitively determine if a strong cultural connection leads to better outcomes. Practice implications and future directions led by this conceptual model are provided.

Understanding culturally safe aged care from the perspectives of older Aboriginal Australians in rural and remote communities.

Aboriginal and Torres Strait Islander peoples face challenges in accessing aged care and are less likely to use some services than their non-Indigenous counterparts. Culturally safe care is increasingly recognised as an enabler to improve access and quality of care. This study explored older Aboriginal peoples' perceptions and experience of culturally safe aged care. We conducted semi-structured interviews with sixty-three older Aboriginal people, purposively sampled from three rural and remote geographic locations in South Australia, between April and October 2018, with participants who were both receiving and not receiving aged care services. We asked participants how organisations do or could meet their aged care needs. We analysed interview data inductively into themes. These themes were incorporated into six principles of culturally safe aged care which were subsequently endorsed by participants and study stakeholders. Participants described culturally safe aged care services as those which facilitated or maintained connection to participants' culture, traditional lands and community. Five themes were identified: maintaining cultural identity, culturally informed service delivery, culturally competent workforce, culturally supportive environments and partnerships and collaboration within the aged care service system. Addressing cultural safety in aged care will require organisations to adapt their policies, service delivery, environments and work practices to meet the needs of older Aboriginal peoples. SO WHAT? Identifying culturally safe aged care from the perspectives of older Aboriginal and Torres Strait Islander peoples provides timely insight to how services may be better designed and implemented to promote quality of life.

Surgical Services for Breast Cancer Patients in Australia, is There a Gap for Aboriginal and/or Torres Strait Islander Women?

Breast cancer is the most commonly diagnosed cancer in Aboriginal and/or Torres Strait Islander women. When compared to other Australians, Aboriginal and/or Torres Strait Islander women have a higher breast cancer mortality rate. This systematic literature review examined disparities in breast cancer surgical access and outcomes for Aboriginal and/or Torres Strait Islander women. This systematic literature review, following the PRISMA guidelines, compared measures of breast cancer surgical care for Aboriginal and/or Torres Strait Islander people and other Australians. The 13 included studies were largely state-based retrospective reviews of data collected prior to the year 2012. Eight studies reported more advanced breast cancer presentation among Aboriginal and/or Torres Strait Islander women. Despite the increased distance to a multidisciplinary, specialist team, there were no disparities in seeing a surgeon, or in the time from diagnosis to surgical treatment. Two studies reported disparities in the receipt of surgery and two reported no variations. Three studies reported disparities in the receipt of mastectomy versus breast conserving surgery, whilst four studies reported no variations. No studies examined postoperative surgical outcomes. Aboriginal and/or Torres Strait Islander women present with more advanced breast cancer. There may be disparities in the receipt of surgery and the type of surgery. However, the metrics tested were not related to optimal care guidelines, and the databases utilised contain limited data on individual factors contributing to surgical care decisions. It is therefore difficult to determine whether the reported differences in the receipt of surgical care reflect disparate or appropriate care.