Aboriginal People Research Articles

The survival benefit of deceased donor kidney transplantation for Aboriginal and Torres Strait Islander people, 2006-20: a retrospective national cohort study.

To quantify the survival benefit of kidney transplantation for Aboriginal and Torres Strait Islander people waitlisted for deceased donor kidney transplantation in Australia. Retrospective cohort study; analysis of linked data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry, the Australia and New Zealand Organ Donation (ANZOD) registry, and OrganMatch (Australian RedCross). All adult Aboriginal and Torres Strait Islander people (18 years or older) who commenced dialysis in Australia during 1 July 2006 - 31 December 2020 and were included in the kidney-only deceased donor transplant waiting list. Survival benefit of deceased donor kidney transplantation relative to remaining on dialysis. Of the 4082 Aboriginal and Torres Strait Islander people who commenced dialysis, 450 were waitlisted for kidney transplants (11%), of whom 323 received deceased donor transplants. Transplantation was associated with a significant survival benefit compared with remaining on dialysis after the first 12 months (adjusted hazard ratio [HR], 0.38; 95% confidence interval [CI], 0.20-0.73). This benefit was similar to that for waitlisted non-Indigenous people who received deceased donor kidney transplants (adjusted HR, 0.47; 95% CI, 0.40-0.57; Indigenous status interaction: P=0.22). From twelve months post-transplantation, deceased donor transplantation provides a survival benefit for Aboriginal and Torres Strait Islander people. Our findings provide evidence that supports efforts to promote the waitlisting of Aboriginal and Torres Strait Islander people who are otherwise eligible for transplantation.

Quality of hospital labour and delivery care: A multilevel analysis in Southern Nations and Nationalities People's Region of Ethiopia.

Ethiopia has one of the highest maternal mortality ratios in Africa. Few have examined the quality of labour and delivery (L&D) care in the country. This study evaluated the quality of routine L&D care and identified patient-level and hospital-level factors associated with the quality of care in a subset of government hospitals. This was a facility-based, cross-sectional study using direct non-participant observation carried out in 2016. All mothers who received routine L&D care services at government hospitals (n = 20) in one of the populous regions of Ethiopia, Southern Nations Nationalities and People's Region (SNNPR), were included. Mixed effects multilevel linear regression modeling was employed in two stages using hospital as a random effect, with quality of L&D care as the outcome and selected patient and hospital characteristics as independent variables. Patient characteristics included woman's age, number of previous births, number of skilled attendants involved in care process, and presence of any danger sign in current pregnancy. Hospital characteristics included teaching hospital status, mean number of attended births in the previous year, number of fulltime skilled attendants in the L&D ward, whether the hospital had offered refresher training on L&D care in the previous 12 months, and the extent to which the hospital met the 2014 Ethiopian Ministry of Health standards regarding to resources available for providing quality of L&D care (measured on a 0-100% scale). These standards pertain to availability of human resource by category and training status, availability of essential drugs, supplies and equipment in L&D ward, availability of laboratory services and safe blood, and availability of essential guidelines for key L&D care processes. On average, the hospitals met two-thirds of the standards for L&D care quality, with substantial variation between hospitals (standard deviation 10.9 percentage points). While the highest performing hospital met 91.3% of standards, the lowest performing hospital met only 35.8% of the standards. Hospitals had the highest adherence to standards in the domain of immediate and essential newborn care practices (86.8%), followed by the domain of care during the second and third stages of labour (77.9%). Hospitals scored substantially lower in the domains of active management of third stage of labour (AMTSL) (42.2%), interpersonal communication (47.2%), and initial assessment of the woman in labour (59.6%). We found the quality of L&D care score was significantly higher for women who had a history of any danger sign (β = 5.66; p-value = 0.001) and for women who were cared for at a teaching hospital (β = 12.10; p-value = 0.005). Additionally, hospitals with lower volume and more resources available for L&D care (P-values < 0.01) had higher L&D quality scores. Overall, the quality of L&D care provided to labouring mothers at government hospitals in SNNPR was limited. Lack of adherence to standards in the areas of the critical tasks of initial assessment, AMTSL, interpersonal communication during L&D, and respect for women's preferences are especially concerning. Without greater attention to the quality of L&D care, regardless of how accessible hospital L&D care becomes, maternal and neonatal mortality rates are unlikely to decrease substantially.

Culturally responsive occupational therapy practice with First Nations Peoples-A scoping review.

First Nations Peoples consistently demonstrate strength and resilience in navigating systemic health care inequities. Acknowledging racism as a health determinant underscores the urgent need for a counterforce-cultural safety. Indigenous Allied Health Australia (IAHA) contends that with cultural responsiveness, the health workforce can take action to create a culturally safe environment. To explore features of culturally responsive occupational therapy (OT) practice when providing a service with First Nations People and examine alignment of those features with the IAHA Cultural Responsiveness in Action Framework. A systematic scoping review was undertaken using CINAHL, Emcare, MEDLINE, PsychInfo and Scopus databases. Examples of culturally responsive OT practice with First Nations Peoples were mapped to the six IAHA Framework capabilities and confirmed by First Nations co-authors. OT practice with First Nations Peoples aligned with the six capabilities to varying degrees. The importance of OTs establishing relationships with First Nations People, applying self-reflection to uncover cultural biases, and addressing limitations of the profession's Western foundations was evident. Recognising the interrelatedness of the six capabilities, the absence of some may result in a culturally unsafe experience for First Nations People. OTs must acknowledge the leadership of First Nations Peoples by privileging their voices and consider how established practices may reinforce oppressive systems. To ensure a culturally safe environment for First Nations People, the OT profession must respect the leadership of First Nations Peoples and address the limitations of the profession's Western foundations to uphold the profession's core value of client-centred care.

Sex and Racial Disparities in Proportionate Mortality of Premature Myocardial Infarction in the United States: 1999 to 2020.

The incidence of premature myocardial infarction (PMI) in women (<65 years and men <55 years) is increasing. We investigated proportionate mortality trends in PMI stratified by sex, race, and ethnicity. CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) was queried to identify PMI deaths within the United States between 1999 and 2020, and trends in proportionate mortality of PMI were calculated using the Joinpoint regression analysis. We identified 3 017 826 acute myocardial infarction deaths, with 373 317 PMI deaths corresponding to proportionate mortality of 12.5% (men 12%, women 14%). On trend analysis, proportionate mortality of PMI increased from 10.5% in 1999 to 13.2% in 2020 (average annual percent change of 1.0 [0.8-1.2, P <0.01]) with a significant increase in women from 10% in 1999 to 17% in 2020 (average annual percent change of 2.4 [1.8-3.0, P <0.01]) and no significant change in men, 11% in 1999 to 10% in 2020 (average annual percent change of -0.2 [-0.7 to 0.3, P=0.4]). There was a significant increase in proportionate mortality in both Black and White populations, with no difference among American Indian/Alaska Native, Asian/Pacific Islander, or Hispanic people. American Indian/Alaska Natives had the highest PMI mortality with no significant change over time. Over the last 2 decades, there has been a significant increase in the proportionate mortality of PMI in women and the Black population, with persistently high PMI in American Indian/Alaska Natives, despite an overall downtrend in acute myocardial infarction-related mortality. Further research to determine the underlying cause of these differences in PMI mortality is required to improve the outcomes after acute myocardial infarction in these populations.

Hepatitis C (HCV) Reinfection and Risk Factors among Clients of a Low-Threshold Primary Healthcare Service for People Who Inject Drugs in Sydney, Australia.

Hepatitis C (HCV) reinfection studies have not focused on primary healthcare services in Australia, where priority populations including people who inject drugs (PWID) typically engage in healthcare. We aimed to describe the incidence of HCV reinfection and associated risk factors in a cohort of people most at risk of reinfection in a real-world community setting. We conducted a secondary analysis of routinely collected HCV testing and treatment data from treatment episodes initiated with direct-acting antiviral (DAA) therapy between October 2015 and June 2021. The overall proportion of clients (N = 413) reinfected was 9% (N = 37), and the overall incidence rate of HCV reinfection was 9.5/100PY (95% CI: 6.3-14.3). Reinfection incidence rates varied by sub-group and were highest for Aboriginal and/or Torres Strait Islander people (20.4/100PY; 95% CI: 12.1-34.4). Among PWID (N= 321), only Aboriginality was significantly associated with reinfection (AOR: 2.73, 95% CI: 1.33-5.60, p = 0.006). High rates of HCV reinfection in populations with multiple vulnerabilities and continued drug use, especially among Aboriginal and Torres Strait Islander people, highlight the need for ongoing regular HCV testing and retreatment in order to achieve HCV elimination. A priority is resourcing testing and treatment for Aboriginal and/or Torres Strait Islander people. Our findings support the need for novel and holistic healthcare strategies for PWID and the upscaling of Indigenous cultural approaches and interventions.

Peter Carey’s “Homo Australiensis” in A Long Way from Home

The paper examines Peter Carey’s first book about Indigenous Australians, a topic which he had neglected for decades. Until A Long Way from Home (2017) was written, the two-time Booker Prize winner renowned for portraying Australian identity had yet to confront this crucial matter which he believed was a fundamental issue of the country. Reasons behind this seemingly contradictory and lengthy absence are highlighted along with certain methods with which the author gradually exposes Australia’s shameful past in the treatment of First Nations people. Carey’s approach stays true to his body of work, namely the Aboriginal subject is complemented or intertwined with his portrayal of another layer of Australia’s history: the pan-European heritage of non-Indigenous Australians. But why and in what manner does he integrate European topics into a novel aiming to shed light on the maltreatment and neglect of First Nations Australians? Does this addition not dilute the original aim of paying homage to Indigenous Australia? My paper argues that Carey successfully utilises certain European identity themes to help show the gravity of sins committed against Australian Indigenous people. The author’s modus operandi is to piece together seemingly neglected fragments of the European legacy with First Nations Australia to reveal a unified entity. Via Willie Bachhuber, a character who most Australians can connect or identify with, Carey joins together various Australian identities which may not have been connected beforehand. With this technique Carey helps ensure the novel is about and for all Australians. I believe that A Long Way from Home crowns Peter Carey’s career as fully depicting Australianness without including Aboriginal people has up until now meant a quite incomplete oeuvre. An ultimate Australian character so-far elusive to Carey, a Homo Australiensis has come to life via a pseudo-German-Balt-Hungarian-Australian, who is actually a First Nations Australian with a white biological father.

“Co-Radicalization”: A Scientific Lens Proposal to Understand the Social Movements in Turkey

The term co-radicalization refers to intergroup hostilities leading to conflicts through cycles of reciprocal threat. This article explores the concept of co-radicalization in violent and non-violent terms and its potential application particularly in Turkey and broadly in the Middle East, a region characterized by ethnic, cultural and religious diversity, as well as socio-economic disparities. Drawing from the social fragmentations recently observed in Turkey, where scientific research on radicalism and co-radicalization is insufficient, the article offers several subjects of scrutiny, including (1) socio-economic co-radicalization between the native and migrant people in the fringes of the urban spaces, (2) the religious norm carriership led by the state institutions and the rise of “Deism” and atheism in response, and (3) the variety of non-violent radical expressions feeding each other, from music to satire. We conclude that the study of co-radicalization should be distinguished from the reductionist approaches to the concept, which tend to take terrorism and radicalism synonymously; the social scientific goal is to gain a deeper understanding of the complex dynamics behind societal divisions.

Understanding Indigenous Knowledge in Contemporary Consumption: A Framework for Indigenous Market Research Knowledge, Philosophy, and Practice from Aotearoa

Despite increased attention being given to Indigenous rights, decolonization, and reconciliation in a broader business setting, the engagement of business, marketing, and consumer studies with Indigenous cultures and peoples is negligible. Although Indigenous and First Nations peoples have a significant position in the social sciences, there is no specific body of marketing or consumer knowledge that is dedicated to Indigenous knowledge and practices, even though there is a growing interest in more inclusive and transformative marketing. This paper reports on current research on Indigenous worldviews and marketing, with a continuum of Indigenous research being presented which is particularly informed by Māori experiences in Aotearoa New Zealand. Several appropriate research methods for advancing Indigenous knowledge are presented. The paper concludes by noting the potential contributions that Indigenous knowledge may provide and some of the challenges faced.

Patterns of Mental Health Service Utilisation: A Population-Based Linkage of Over 17 Years of Health Administrative Records.

A cross-sectoral partnership was formed in 2021 in support of the recommendations in an audit on access to state-funded mental health services. In this first paper, we aimed to describe the demographic and service utilisation of adults with a mental health diagnosis in the Western Australian state-funded health system from 2005 to 2021. Inpatient, emergency department, specialised (ambulatory) community mental health service, and death records were linked in individuals aged ≥ 18 years with a mental health diagnosis in Western Australia. Altogether, 392,238 individuals with at least one mental health service contact between 1st January 2005 and 31st December 2021 were included for analysis. Females, Aboriginal and/or Torres Strait Islander people, and those who lived outside major cities or in the most disadvantaged areas were more likely to access state-funded mental health services. While the number of individuals who accessed community mental health services increased over time (from 28,769 in 2005 to 50,690 in 2021), the percentage increase relative to 2005 was notably greater for emergency department attendances (127% for emergency department; 76% for community; and 63% for inpatient). Conditions that contributed to the increase for emergency department were mainly alcohol disorder, reaction to severe stress and adjustment disorders, and anxiety disorders. Sex differences were observed between conditions. The pattern of access increased for emergency department and the community plus emergency department combination. This study confirmed that the patterns of access of state-funded mental health services have changed markedly over time and the potential drivers underlying these changes warrant further investigation.

Mining versus Indigenous Protected and Conserved Areas: Traditional Land Uses of the Anisininew in the Red Sucker Lake First Nation, Manitoba, Canada

Indigenous traditional land uses, including hunting, fishing, sacred activities, and land-based education at the Red Sucker Lake First Nation (RSLFN) in Manitoba, Canada, are impacted by mining. The Red Sucker Lake First Nation (RSLFN) people want their territories’ land and water to be protected for traditional uses, culture, and ecological integrity. Towards this goal, their Island Lake Tribal Council sought support for an Indigenous-protected and conserved area (IPCA) in their territory, outside of existing mining claims, but without success. The two-eyed seeing approach was adopted in this study. Traditional land use mapping and interviews were undertaken with 21 Indigenous people from the RSLFN, showing that many traditional land uses are concentrated on greenstone belts. The interviews revealed that mining exploration has resulted in large petroleum spills, noise distress, private property destruction, wildlife die-offs, and animal population declines. These issues negatively impact RSLFN’s traditional land use practices, ecosystem integrity, and community health. Governments need to partner with Indigenous communities to reach their biodiversity targets, particularly considering northern Canada’s peatlands, including those in the RSLFN territory, surpassing Amazon forests for carbon storage. The role of critical minerals in renewable energy and geopolitics has colonial governments undermining Indigenous rights, climate stabilization, and biodiversity to prioritize extractivism. Mining at the RSLFN has environmental impacts from exploration to decommissioning and after, as well as the massive infrastructure required that includes roads, hydro, and massive energy supplies, with a proposed multimedia national Northern Corridor to export RSLFN’s resources and other resources to six ports.

Towards a Fairer and More Equitable Bushfoods Industry: access and benefit-sharing and certification frameworks

ABSTRACT Australia’s bushfoods, botanicals and traditional medicines sector are a growing industry based on thousands of years of Indigenous Knowledge (IK). National and international growth in this industry does not provide satisfactory or equitable sharing of benefits, preventing opportunities and funding for Aboriginal and Torres Strait Islander peoples. Without prior informed consent (PIC) and access and benefit sharing (ABS) arrangements, alongside specific point of difference certification and labelling schemes, current industry inequities will continue. International protocols such as the Nagoya Protocol require ABS arrangements, and we argue whether a certification trademark (CTM) scheme could also support ABS in Australia. ABS lays the groundwork to ethically share IK to mitigate harms and provide benefits to Aboriginal and Torres Strait Islander peoples. Establishing coherent CTM and labelling schemes will complement and could work towards addressing the gaps and limitations in Australian ABS laws. CTM and labelling systems, as well as strategies and statements used by established alliances and organisations, provide insight into what mechanisms current ABS laws allow for. We use these examples to recommend the next steps.

Distraction in Australian language education policy: a call to re-centre language rights

ABSTRACT In this paper, we provide an overview of the policies that have existed in relation to Australian First Nations students’ languages, and English language and literacy learning before exploring how the politics of distraction manifests in this context. We then share our findings of an analysis of Australian language education policies for First Nations children and the media discourses which surround them. We argue that, in the context of First Nations languages and language learners, ‘language’ is conflated with either ‘literacy’ or ‘culture’ to distract from the sovereign language rights of First Nations peoples in Australia. We draw on the notion of ‘policy narrowing’ to explain this policy distraction and the ways in which it reproduces educational inequities for First Nations students in the Australian schooling system. To counter this, and the surrounding media discourses, governing educational bodies should re-centre language rights and language learner diversity in policymaking.

Amplifying Indigenous Australian Voices in the Conservation and Management of Rock Art

ABSTRACT Rock art is internationally recognised as a tangible connection to cultures past, whose conservation, and management programmes should be developed accordingly. When these heritage places are located within living cultural landscapes and are part of the continuing culture of First Nations people as they are in Australia, there is a fundamental requirement for programmes to be owned and implemented by the relevant communities. However, giving primacy to the voices of those with cultural authority and agency does not always amplify these efforts. To address this challenge, Traditional Owners came together, supported by a land management agency and researchers, to stage a rock art forum for Indigenous Australians in early 2023. This ground-breaking initiative is significant, because the first manual on conserving and managing rock art that gives primacy to the worldviews of Australia’s First Peoples will be an output from the forum. Past Australian publications om this subject have been authored by non-Indigenous scholars and practitioners who considered only an international framework for conserving and managing rock art as a cultural treasure. This paper considers discussions from the forum and the developing manual as shared stories of resilience to manage, protect and celebrate rock art through Indigenous-led initiatives to inform the present and prepare us for future advances in the discipline.

Outcomes of Revascularisation for Treating Lifestyle-Limiting Intermittent Claudication in Aboriginal and Torres Strait Islander People and Non-Indigenous Patients from North Queensland: A Retrospective Cohort Study.

Background: This retrospective analysis of an ongoing prospective cohort study aimed to assess the outcome of revascularisation for treating lifestyle-limiting intermittent claudication caused by peripheral artery disease (PAD) in Aboriginal and Torres Strait Islander Peoples and non-Indigenous North Queenslanders. Methods: Consenting patients with PAD who underwent endovascular or open revascularisation procedures for treating lifestyle-limiting intermittent claudication were included. The primary outcome measure was major adverse limb events (MALEs), defined as major amputation or the requirement for repeat open or endovascular revascularisation. Results: Of the 378 included patients, 18 (4.8%) identified as Aboriginal and/or Torres Strait Islander Peoples. During a mean follow-up (standard deviation) of 6.0 (3.9) years, the incidence of MALE was similar in the Aboriginal and Torres Strait Islander People and non-Indigenous Australians (absolute percentage: 50.0% vs. 40.6%, log rank p = 0.59). In both unadjusted and adjusted analyses, Aboriginal and Torres Strait Islander Peoples and non-Indigenous Australians had similar risks of MALE (unadjusted hazard ratio, HR, 1.20, 95% confidence interval, CI, 0.61, 2.36; adjusted HR 1.02, 95%CI 0.50, 2.06). Conclusions: This study suggests that Aboriginal and Torres Strait Islander People are under-represented in the population of patients undergoing revascularisation to treat intermittent claudication. Due to small numbers it cannot be reliably concluded that Aboriginal and Torres Strait Islander People and non-Indigenous Australians have similar rates of MALE.

Ascertainment of Aboriginal and Torres Strait Islander status for assessment of perinatal health outcomes: Reported versus derived maternal ethnicity in Western Australian pregnancy data.

Under-identification of Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) people can result in inaccurate estimation of health outcomes. Data linkage has improved identification of Aboriginal people in administrative datasets. To compare three methods of ascertainment of Aboriginal status using only pregnancy data from the Western Australian Midwives Notification System (MNS), to the linked Indigenous Status Flag (ISF) derived by the Department of Health. This retrospective population-based cohort study utilised logistic regression to determine which demographic characteristics were associated with under-identification, and the effect of ascertainment method on perinatal adverse outcomes. All methods identified a core group of 19 017 (83.0%) Aboriginal women and the ISF identified 2298 (10.0%) women who were not identified using any other method. Under-ascertainment was lowest when a woman's Aboriginal status was determined by ever being recorded as Aboriginal in the MNS data, and highest when taken as it had been recorded for the birth in question. Maternal age <20 years, smoking during pregnancy, pre-existing diabetes, a history of singleton preterm birth and being in the lowest 20% of Socio-Economic Indexes for Areas score were all associated with a higher chance of being identified by the methods using only the MNS. These methods were less likely to identify nulliparous women, and those with maternal age ≥35 years. The method of ascertainment of Aboriginality did not make a significant difference to the adjusted predicted marginal probabilities of adverse perinatal outcomes. Unlinked pregnancy data can be used for epidemiological research in Aboriginal obstetric populations.

Healing and wellbeing outcomes of services for Aboriginal people based on cultural therapeutic ways: A systematic scoping review.

Aboriginal Australians experience disproportionately high rates of mental health problems as the result of European colonisation, and Western evidence-based treatment has been strikingly ineffective in improving the situation. Cultural Therapeutic Ways is a culturally specific healing and wellbeing practice framework developed by the Victorian Aboriginal Child and Community Agency that focuses on culturally based practices, trauma awareness, and self-determination. Despite wide recognition of the importance of these elements in Indigenous healing and wellbeing programs, its measurable empirical impact is currently unclear. This paper summarises findings from a systematic scoping review to ascertain the published knowledge base for Cultural Therapeutic Ways and the gaps in knowledge that can inform future evaluation. Forty-two studies of programs that applied Cultural Therapeutic Ways with Indigenous participants from Australia, Canada, New Zealand, and the United States of America were identified from the literature search. Services based on Cultural Therapeutic Ways contributed to healing and wellbeing because they create safety, strengthen cultural connections, develop empowerment and provide opportunities to release emotion, and increase social and spiritual support. As the review set out to determine the published evidence base for Cultural Therapeutic Ways, other effective approaches may have been overlooked. To develop the evidence base for Cultural Therapeutic Ways, service design must clearly describe target groups, whether the program is delivered by Aboriginal people, the processes of Cultural Therapeutic Ways utilised in service delivery, and how they are blended with Western approaches. Research efforts could also productively be focused on identifying or constructing culturally appropriate outcome measures.

Voice Lessons

Abstract This paper reflects on the national referendum for an Indigenous Voice to Parliament that took place in Australia in mid-October 2023. At the time of writing, the aftershocks from the failure of the referendum to gain the necessary majorities were still being felt keenly by many of the Voice advocates and supporters. The hurt and grief of many First Nations people were shared by millions of non-Indigenous “Yes” voters, while much reckoning continued in the subsequent weeks and months. The author here explores what might have been gained if more attention had been given to what an Indigenous Voice to Parliament might “sound like,” instead of the excessive focus on, and public discourse around what it might “look like.” Resources from the philosophies and physiology of voice, communication ethics, cultural studies, critical anthropology, Australian Indigenous writing and scholarship, and psychoanalytic politics are utilised to explore the connections between the human voice, vocal expression, hearing and listening, silence and song.

What are Aboriginal children and young people in out‐of‐home care telling us? A review of the child voice literature to understanding perspectives and experiences of the statutory care system

AbstractAboriginal children and young people are over‐represented in the out‐of‐home care system, yet their voices are largely absent in practice and policy decision‐making. This paper presents a review of research that captures the voices of Aboriginal children and young people in out‐of‐home care. Three key themes are discussed: connection to culture, connection to family and participation. This paper argues for culturally meaningful research that honours child and youth citizenship, voice and roles in decision‐making as critical to quality care and positive outcomes. This paper aims to highlight the importance of listening and responding to the voices of Aboriginal children and young people as critical to the provision of appropriate care and supporting positive outcomes.

Strength together: examining risk and protective factors associated with dementia and cognitive impairment in Aboriginal and Torres Strait Islander peoples through harmonisation of landmark studies

BackgroundRates of dementia for Aboriginal and Torres Strait Islander peoples are three to five times greater compared to non-Indigenous Australians, with earlier age of onset. However, the risk and protective factors that drive these higher rates vary across existing cohort studies, with minimal findings on the role of vascular risk factors beyond stroke. Harmonisation of data across studies may offer greater insights through enhanced diversity and strengthened statistical capabilities. This study aims to combine three landmark cohort studies of Aboriginal and Torres Strait Islander participants to better understand the determinants of cognitive health and dementia.Methods/designThree cohort studies - the Kimberley Healthy Adults Project (KHAP, N = 363), Koori Growing Old Well Study (KGOWS, N = 336) and Torres Strait Dementia Prevalence Study (TSDPS, N = 274) - share a similar research methodology with demographic, medical history, psychosocial factors, cognitive tests and consensus clinical diagnoses of cognitive impairment and dementia. Associations between risk and protective factors of interest and the presence of dementia and/or cognitive impairment diagnoses will be evaluated by univariable and multivariable logistic regression in a harmonised cross-sectional cohort of 898 participants. Factors associated with incident dementia and/or cognitive impairment will be assessed in a subset of KHAP (n = 189) and KGOWS participants (n = 165) who were available in longitudinal follow-up, after exclusion of those with baseline dementia or cognitive impairment. Analyses in relation to outcome measure of death or dementia will be conducted to account for the competing risk of death. Logistic regression will be used to evaluate the association between the individual components of the 16-component Kimberley Indigenous Cognitive Assessment (KICA) tool and the presence of dementia and cognitive impairment determined by independent consensus diagnoses. Multivariable binary logistic regression will be used to adjust for the effect of confounding variables. Results will be reported as odds ratios (OR) with 95% confidence intervals (95% CI).DiscussionGreater understanding of risk and protective factors of dementia and cognitive impairment relevant to Aboriginal and Torres Strait Islander peoples may improve approaches across the life course to delay cognitive decline and reduce dementia risk.

Does Virtual Reality Training Increase Mindfulness in Aboriginal Out-of-Home Care Children?

ObjectivesThis study aimed to address the negative impacts of adverse childhood experiences (ACEs) on Aboriginal children and young people in out-of-home care (OOHC) using mindfulness-based interventions (MBIs) delivered via virtual reality (VR). MBIs can improve emotion regulation and executive functioning, but engagement can be challenging, especially for children with other health conditions and trauma.MethodVirtual reality goggles with a head-mounted display, head tracking, and handheld controls were used. Measures included heart rate variability (HRV), the State Mindfulness Scale, the Mindful Attention Awareness Scale, and the Behaviour Rating Inventory of Executive Function 2. The procedure involved a baseline assessment of state mindfulness, a 5-min sitting baseline HRV measurement, VR orientation, exploration of the VR landscape, a mindfulness body scan, a second HRV measurement during the body scan, and completing a post-VR questionnaire.ResultsNo significant improvement in state mindfulness was found as measured by the State Mindfulness Scale. However, a significant improvement with moderate effect size was seen pre-to-post-intervention on the Mindful Attention Awareness Scale (p = 0.007, d = − 0.69). We also explored the impact of age, sex, and diagnosis on the intervention and found significant improvements in state mindfulness across subgroups. HRV did not show a significant change pre-to-post-intervention.ConclusionsOur study highlights the potential for MBI-VR to improve mindfulness in Aboriginal children and young people in OOHC who have experienced abuse and trauma. Brief mindfulness sessions were effective at enhancing state mindfulness as measured by the MAAS; the older participants and those with mental health concerns benefitted the most. Further research with more diverse samples is needed to validate the findings and examine potential interactions between demographic and clinical factors.PreregistrationThis study is not preregistered.