Indigenous Status Research Articles

Chronic hepatitis B care in regional Australia: implications for clinical practice and public health policy.

Australia is struggling to meet its National Hepatitis B Strategy care targets, particularly in nonmetropolitan settings. It is vital to engage priority populations and improve their access to recommended care to reach these targets. This retrospective study examined people living with chronic hepatitis B (CHB) in regional North Queensland, Australia, and determined whether their care adhered to current national CHB management guidelines. The analysis aimed to identify gaps in care that might be addressed to improve future outcomes. All individuals referred to the gastroenterology clinic at the Townsville University Hospital in regional North Queensland, Australia, for CHB care between January 2015 and December 2020 were identified. Their linkage to care, engagement in care and receipt of guideline-recommended CHB care were determined. Of 255 individuals, 245 (96%) were linked to care; 108 (42%) remained engaged in care and 86 (38%) were receiving guideline-recommended care in 2021. There were 91/255 (36%) who identified as Indigenous Australians. Indigenous status was the only independent predictor of not being linked to care (odds ratio (OR): 0.13 (95% confidence interval (CI): 0.03-0.60), P = 0.01), not being engaged in care (OR: 0.19 (95% CI: 0.10-0.36), P < 0.0001), not receiving guideline-recommended CHB care (OR: 0.16 (95% CI: 0.08-0.31), P < 0.0001) or not being engaged in a hepatocellular carcinoma surveillance programme (OR: 0.08 (95% CI: 0.02-0.27), P < 0.0001). Current approaches are failing to deliver optimal CHB care to Indigenous Australians in regional North Queensland. Targeted strategies to ensure that Indigenous Australians in the region receive equitable care are urgently needed.

Can ICD-10 Z codes be used as proxy measures for ACE categories? – a proof of concept

ABSTRACT Objective The landmark study by Felitti showed adverse childhood experiences (ACEs) influence future health outcomes. This paper looks at the routine data collected in a Child and Youth Mental Health Service (CYMHS) related to contextual factors in the International Classification of Diseases (ICD-10 Z codes) and seeks to identify proxies for the ten original ACEs categories. In the absence of routinely collected ACE categories, these ICD-10 Z codes which could potentially act as ACE proxies would be helpful for clinical understanding and service delivery. Method ICD-10 Z codes collected routinely from 2108 individuals were analysed to identify Z codes which might serve as proxies for the ACE categories. To understand whether these Z codes were used appropriately during service delivery to indicate ACE categories, randomly selected files of patients having at least one of the above Z codes in their list of diagnoses were reviewed. Subsequently, the associations between several Z codes (serving as ACE proxies), demographic factors, and clinical outcome measures were explored. Results Significant differences were observed in terms of the mean ACE score of patients when sex, Indigenous status and certain diagnostic groups were considered. Similarly, when patient groups having exposure to different numbers of ACEs were compared, significant differences were observed in outcome scores (HoNOSCA and CGAS). Conclusion There is evidence that certain Z codes, can act as ACE proxies. This suggests a possible utility of this method in studying other associations and possibly helping to tailor future therapeutic interventions.

Exploring factors associated with chronic and serious offending in detained dual system youth

ABSTRACT Young people who have both child protection and youth justice contact have been termed ‘dual system youth’. Dual system youth have been found to engage in more frequent and serious offending than justice-involved youth without child protection histories. It is unclear which psychological factors contribute to offending amongst dual-system youth. This study aimed to examine associations between child protection involvement, psychological/behavioural factors, and justice system involvement. The sample comprised 192 young people detained in juvenile correctional centres across two sites in Victoria, Australia between July 2011 and June 2012. Instruments were administered to gauge psychopathology and behaviour, while information regarding demographic details, child protection history, and offence data were obtained from client files. Results indicated that having a child protection history was associated with having both a violent index offence and a higher number of previous orders. Sensitivity to anger was also associated with having a violent index offence, while being male and aged 17–18 were associated with a higher number of previous orders. Child protection history moderated the relationship between Indigenous status and the number of prior orders, and between externalising symptoms and prior orders. Implications for clinical practice and future research are discussed.

The effectiveness of maternal pertussis vaccination for protecting Aboriginal and Torres Strait Islander infants against infection, 2012-2017: a retrospective cohort study.

To evaluate the effectiveness of maternal pertussis vaccination for preventing pertussis infections in Aboriginal and Torres Strait Islander infants under seven months of age. Retrospective cohort study; analysis of linked administrative health data. Mother-infant cohort (Links2HealthierBubs) including all pregnant women who gave birth to live infants (gestational age ≥ 20 weeks, birthweight ≥ 400 g) in the Northern Territory, Queensland, and Western Australia during 1 January 2012 - 31 December 2017. Proportions of women vaccinated against pertussis during pregnancy, rates of pertussis infections among infants under seven months of age, and estimated effectiveness of maternal vaccination for protecting infants against pertussis infection, each by Indigenous status. Of the 19 892 Aboriginal and Torres Strait Islander women who gave birth to live infants during 2012-2017, 7398 (37.2%) received pertussis vaccine doses during their pregnancy, as had 137 034 of 259 526 non-Indigenous women (52.8%; Indigenous v non-Indigenous: adjusted odds ratio, 0.66; 95% confidence interval [CI], 0.62-0.70). The annual incidence of notified pertussis infections in non-Indigenous infants declined from 16.8 (95% CI, 9.9-29) in 2012 to 1.4 (95% CI, 0.3-8.0) cases per 10 000 births in 2017; among Aboriginal and Torres Strait Islander infants, it declined from 47.6 (95% CI, 16.2-139) to 38.6 (95% CI, 10.6-140) cases per 10 000 births. The effectiveness of maternal vaccination for protecting non-Indigenous infants under seven months of age against pertussis infection during 2014-17 was 68.2% (95% CI, 51.8-79.0%); protection of Aboriginal and Torres Strait Islander infants was not statistically significant (36.1%; 95% CI, -41.3% to 71.1%). During 2015-17, maternal pertussis vaccination did not protect Aboriginal and Torres Strait Islander infants in the NT, Queensland, and WA against infection. Increasing the pertussis vaccination rate among pregnant Aboriginal and Torres Strait Islander women requires culturally appropriate, innovative strategies co-designed in partnership with Indigenous organisations and communities.

“Navigating chaos”: Urban, Rural, and Remote Patient Experiences in Accessing Healthcare with Indigenous and Non-Indigenous Perspectives of Living with Chronic Low Back Pain

ABSTRACT Background Healthcare access for chronic low back pain is complex and should consider not only the health system, but patient care seeking experiences as well. People who live in rural and remote communities and/or identify as being Indigenous may often encounter additional barriers to accessing care for chronic low back pain; thus, these contexts must be considered to fully understand barriers and facilitators. Aims The aim of this study was to understand care-seeking experiences of people living with chronic back pain in Saskatchewan and determine unique experiences facing urban, rural, remote, and/or Indigenous peoples. Methods Thirty-three participants with chronic low back pain completed a preliminary survey followed by individual semistructured interviews. Participants were categorized as urban, rural, or remote including Indigenous status. A qualitative interpretive research approach with inductive thematic analysis was employed. Results Three overarching themes were identified with the following subthemes: (1) healthcare access challenges: challenges to accessing care, challenges within the health system, and challenges leading to self-directed management/coping strategies; (2) healthcare access facilitators: funded care, participant education and knowledge, patient–provider communication, and care closer to home; and (3) participant recommendations for improved care provision: coordination of care, integrative and holistic care, and patient-centered care and support. Rural and remote participants highlighted travel as a main barrier. Indigenous participant experiences emphasized communication with healthcare providers and past experiences influencing desire to access care. Conclusion Participants identified a range of challenges and facilitators as well as recommendations for improving access to care for chronic low back pain, with unique barriers for rural, remote, and Indigenous participants.

Equitable Machine Learning for Hypoglycaemia Risk Management.

We developed a machine learning (ML) model for the detection of patients with high risk of hypoglycaemic events during their hospital stay to improve the detection and management of hypoglycaemia. Our model was trained on data from a regional local health care district in Australia. The model was found to have good predictive performance in the general case (AUC 0.837). We conducted subgroup analysis to ensure that the model performed in a way that did not disadvantage population subgroups, in this case based on gender or indigenous status. We found that our specific problem domain assisted us in reducing unwanted bias within the model, because it did not rely on practice patterns or subjective judgements for the outcome measure. With careful analysis for equity there is great potential for ML models to automate the detection of high-risk cohorts and automate mitigation strategies to reduce preventable errors.

Hospital length of stay and readmission after elective surgery: a comparison of current and former smokers with non-smokers

BackgroundThe purpose of this study was to investigate differences between non-smokers, ex-smokers and current smokers in hospital length of stay (LOS), readmission (seven and 28 days) and cost of readmission for patients admitted for elective surgery.MethodsA retrospective cohort study of administrative inpatient data from 24, 818 patients admitted to seven metropolitan hospitals in Western Australia between 1 July 2016 and 30 June 2019 for multiday elective surgery was conducted. Data included smoking status, LOS, procedure type, age, sex and Indigenous status. LOS for smoking status was compared using multivariable negative binomial regression. Odds of readmission were compared for non-smokers and both ex-smokers and current smokers using separate multivariable logistic regression models.ResultsMean LOS for non-smokers (4.7 days, SD=5.7) was significantly lower than both ex-smokers (6.2 days SD 7.9) and current smokers (6.1 days, SD=8.2). Compared to non-smokers, current smokers and ex-smokers had significantly higher odds of readmission within seven (OR=1.29; 95% CI: 1.13, 1.47, and OR=1.37; 95% CI: 1.19, 1.59, respectively) and 28 days (OR=1.35; 95% CI: 1.23, 1.49, and OR=1.53; 95% CI: 1.39, 1.69, respectively) of discharge. The cost of readmission for seven and 28-day readmission was significantly higher for current smokers compared to non-smokers (RR=1.52; 95% CI: 1.1.6, 2.0; RR=1.39; 95% CI: 1.18, 1.65, respectively).ConclusionAmong patients admitted for elective surgery, hospital LOS, readmission risk and readmission costs were all higher for smokers compared with non-smokers. The findings indicate that provision of smoking cessation treatment for adults undergoing elective surgery is likely to produce multiple benefits.

Benchmarking non-attendance patterns in paediatric medical imaging: A retrospective cohort study spotlighting First Nations children

IntroductionNon-attendance at Medical Imaging (MI) appointments can result in inefficiencies in healthcare resource allocation, increased financial burdens, and lead to potential barriers to effective healthcare delivery. We evaluated factors associated with non-attendance of MI appointments for children including variables: gender; age groups; residential postcodes; Indigenous status; appointment dates; appointment reminders and socio-economic status. MethodRetrospective cohort study of children with scheduled MI appointments at a Tertiary paediatric hospital in Australia, between January and December 2022. Data were extracted from the Radiology Information System and integrated with socio-economic census data through linking with postcode. Chi-squared, and logistic regression analysis were performed to identify significant predictors of non-attendance. ResultsOut of 17,962 scheduled outpatient appointments, 6.2 % did not attend. Males were less likely to attend than females (7.3 % vs. 5.8 %; p < 0.001). Older children had the highest frequency of non-attendance (p < 0.001). First Nations identified children had a higher likelihood of non-attendance at 14.5 % compared to non-First Nations at 5.8 %, and the odds ratio (OR) of First Nation children not attending was 2.54 (CI 2.13–3.03; p < 0.001) higher than non-First Nations children. Children from areas of disadvantage were less likely to attend (p < 0.001). Bone mineral densitometry had the highest odds of non-attendance (19.4 % of bookings) compared to other imaging modalities (p < 0.001). ConclusionThe following characteristics were associated with non-attendance: older male gender, residing in areas of socio-economic disadvantage, or identifying as First Nations Australians. By reviewing these findings with the cultural and professional experience of our Indigenous co-author, we have identified some strategies for improving attendance amongst First Nations children. Implications for practiceFactors associated with non-attendance, or “missed opportunities for care”, provide opportunities for intervention to improve attendance for vulnerable groups of children who require medical imaging.

Indigenous Australians critically ill with sepsis: Characteristics, outcomes, and areas for improvement

BackgroundAboriginal and Torres Strait Islander Australians have amongst the highest incidence of sepsis globally. ObjectiveThe objective of this study was to describe the characteristics, short- and long-term outcomes of non-Indigenous, Aboriginal Australian and Torres Strait Islander Australians admitted with sepsis to an intensive care unit (ICU) to inform healthcare outcome improvement. MethodsA retrospective cohort study of 500 consecutive sepsis admissions to the Cairns Hospital ICU compared clinical characteristics, short-term (before ICU discharge) and long-term (2000 days posthospital discharge) outcomes. Cohort stratification was done by voluntary disclosure of Indigenous status. ResultsOf the 442 individual admissions, 145 (33%) identified as Indigenous Australian. Indigenous and non-Indigenous Australians had similar admission Acute Physiology and Chronic Health Evaluation-3 scores (median [interquartile range]: 70 [52–87] vs. 69 [53–87], P = 0.87), but Indigenous patients were younger (53 [43–60] vs. 62 [52–73] years, P < 0.001) and were more likely to have chronic comorbidities such as type 2 diabetes (58% vs. 23%, P < 0.001), cardiovascular disease (40% vs 28%, P = 0.01), and renal disease (39% vs. 10%, P < 0.001). They also had more hazardous healthcare behaviours such as smoking (61% vs. 45%, P = 0.002) and excess alcohol consumption (40% vs. 18%, P < 0.001). Despite this, the case-fatality rate of Indigenous and non-Indigenous Australians before ICU discharge (13% vs. 12%, P = 0.75) and 2000 days post hospital discharge (25 % vs. 28 %, P = 0.40) was similar. Crucially, however, Indigenous Australians died younger both in the ICU (median [interquartile range] 54 (50–60) vs. 70 [61–76], P < 0.0001) and 2000 days post hospital discharge (58 [53–63] vs. 70 [63–77] years, P < 0.0001). ConclusionsAlthough Indigenous Australians critically ill with sepsis have similar short and long-term mortality rates, they present to hospital, die in-hospital, and die post-discharge significantly younger. Unique cohort characteristics may explain these outcomes, and assist clinicians, researchers and policy-makers in targeting interventions to these characteristics to best reduce the burden of sepsis in this cohort and improve their healthcare outcomes.

Seasonality of associations between production of indigenous foods and food security status of mother-child dyads in Kisumu County, Kenya

BackgroundFood insecurity is a major predicament for rural populations, especially mothers and children, whose livelihoods are often dependent on rain-fed agriculture. Indigenous foods have the potential of mitigating food insecurity as they can thrive in poor agro-ecological conditions. However, the associations between indigenous food production and food security status of mothers and children drawn from rural contexts has not been expansively assessed. Food insecurity evident by high food poverty rates remain high in Kisumu County due to over-reliance on food imports from other counties. The objective of the study was to assess seasonality in associations between production of selected indigenous foods (kidney beans, soya beans, millet, cassava, sweet potatoes, groundnuts, green grams, cow peas, amaranth leaves, spider plant leaves, black night shade leaves, mangoes, guavas, lime, and tamarind) and food security status of mothers and children during planting and harvesting seasons.MethodsWe used a longitudinal study design adopting both quantitative and qualitative data collection methods. A structured questionnaire assessed production of selected indigenous foods in the sampled households, Household Food Insecurity Access Scale for mother’s food security status and Prevalence of Underweight for children’s food security status. Ordinal logistic regression was used to derive odds ratio (OR), which assessed strength of associations between dependent variables (mother’s and children’s food security status) and independent variables (production of selected indigenous foods). Significance was determined at α ≤ 0.05.ResultsResults demonstrated that during planting season, production of kidney beans decreased the odds of mothers being severely food insecure by 53% (OR = 0.469, 95% CI = 0.228–0.964, p = 0.039). In the same season, sorghum production demonstrated 3.5 times increase in odds of children being severely food insecure (OR = 3.498, 95% CI = 1.454–8.418, p = 0.005). During harvesting season, production of kidney beans was associated with a 62% reduction in the odds of children being severely food insecure (OR = 0.379, 95% CI = 0.190–0.754, p = 0.006).ConclusionsProduction of some of the selected indigenous foods demonstrated significant odds of predicting mother’s and children’s food security status across both study seasons. An intervention-based study approach that would best establish causal associations of indigenous food production and food security status is recommended.

Service User Perspectives of Family Involvement and Mental Health Care Outcomes in Queensland

Family‐focussed practice is an important component of mental health care. In Australia, service users’ views about their experience of service are collected using instruments such as the Your Experience of Service (YES) survey. This study examined 10,579 Queensland (Australia) service users’ experiences of mental health services during 2019–2021, with a particular focus on their perspectives of how family and carers are involved in their care. The study examined if family‐focussed practice is welcomed by service users and if it is important in terms of predicting recovery‐related outcomes (e.g., hopefulness, managing day‐to‐day life, well‐being, and experience of care) and which demographics (e.g., age, gender, and Indigenous status) and service characteristics (e.g., time in service, duration, year of service, and setting type) are associated with these outcomes and with family member involvement. A substantial majority of service users reported a positive experience of care (very good or excellent), feeling they had opportunities for family involvement and that their opinions about family involvement were respected (usually or always). Chi‐square tests and nonlinear regression models showed that family involvement predicts care outcomes. Specifically, where individuals felt that their perspectives were recognised, their outcomes were consistently rated as more positive. The results also revealed that setting, age group, time in service, and admission status were significantly correlated with all user experience outcome variables and family‐oriented variables. Future research has the potential to further strengthen this understanding of service users’ preferred opportunities and opinions about family involvement and how to improve family engagement and better meet the needs of service users and their families.

Impact of special economic zones on socioeconomics and local development in Pakistan: Evidence from Allama Iqbal Special Economic Zone, Faisalabad.

The purpose of this study was to investigate the impact of SEZ on indigenous peoples' socioeconomic status and local development in the study area. A quantitative approach to analyzing the socioeconomics of treatment and control groups. A structured questionnaire was designed and a field survey was undertaken to collect primary data from respondents. This study used Principal Component Analysis (PCA) to create a socioeconomic index for two groups: those who sold their agricultural land and those who did not sell, and a two-sample independent t-test was used to determine the influence of SEZ on socioeconomic and local development. The results showed that the compensation amount for the acquired land not only improved the socio-economic living conditions of the indigenous population in short run, but also transformed their type of employment from agriculture to labor work, increased health expenditure, increased household wealth and minor changes in education expenditure and construction effected new houses, most of which is used for child marriage, vehicle purchased and dowary expenses in the special economic zone. This unproductive spending increases in the short term, which in the long run will convert skeikonicity into deprivation. Previous studies focused only on the geopolitics behind the geo-economy and the challenges and success factors for SEZs in Pakistan. This study is unique as it is the first attempt that uses statistical and economic tools to identify the positive and negative impacts of SEZ on the local development in the area. It makes an academic contribution to the literature to improve the knowledge of the effects of these special economic zones on the local development in any area.

Hypershell Omega Exoskeleton: Enhancing Hiking Adventures for All Ages

The Hypershell Omega exoskeleton is a breakthrough in biotechnology, enhancing outdoor experiences for all age groups by amplifying agility and movement efficiency. This exoskeleton, distinct from medical applications, incorporates AI-integrated knee motors to improve user mobility during hiking. Enhanced stability, especially beneficial for rugged terrains, potentially enhances safety. Factors impacting accessibility, such as employment, disability, and Indigenous status are explored, with varied ethical considerations. The intersection of disability and socioeconomic status highlights potential barriers, while geographical isolation in Indigenous communities calls for targeted marketing. Emerging research suggests expanding future applications to more diverse demographics, but psychological factors and funding biases may act as limitations.

The Dyson Zone: A Groundbreaking Audio and Air-purifying Technology

Outdoor activities in both rural and urban areas are often hindered by air pollution. The brand-new Dyson Zone is a technology allowing individuals to concurrently enjoy noise-cancelling music and get high-quality protection from air pollution. In research trials, Dyson’s dual-filter system has proven robust efficacy in preventing the inhalation of polluted air. The availability of this product is affected by support networks, the presence of disabilities, and Indigenous status. These social determinants of health work both in isolation and in combination to provide preferential accessibility to certain subgroups. As the Dyson Zone provides a novel introduction to future purification systems, further research should be reinforced.

Seismic Powered Clothing: A Novel Technology to Improve Hiker Experience

Hiking is a hobby enjoyed by individuals of all ages, but many experience issues such as muscle pain, fatigue, and injuries. SeismicTM recently created a new technology that is safe and sustainable for older adults, called SeismicTM Powered Clothing (SPC). SPC provides older adults with support when performing actions like hiking, preventing them from experiencing any negative effects. While SPC may be extremely beneficial to a large population, social determinants of health (SDoHs) including Indigenous status, food insecurity, employment/working conditions, and geographical location may impact the access of this biotechnology. Nonetheless, future applications of SPC involve its use in running and assisting individuals with Duchenne muscular dystrophy.

Culturally appropriate psychotherapy and its retention: An example from Far North Queensland (Australia)

BackgroundCulturally appropriate mental health care is essential in remote Australia. However, while associated with the development of an effective therapeutic alliance, current literature insufficiently reports the retention and psychotherapy outcomes of Indigenous adults. We aimed to describe the characteristics and retention of clients attending the Far North Mental Health and Wellbeing Service (FNS). MethodsWe conducted a retrospective cross-sectional study on clients who received one or more psychotherapy consultations between 1st July 2019 and 31st December 2020. Population, entrance, and treatment characteristics were described, with retention compared between the major cultural groups. Entrance characteristics comprised referral pathway and reason for presentation and were investigated as alternative predictors of client retention. FindingsThere were 186 non-Indigenous (68.3 % female) and 174 Indigenous (62.6 % female) clients, with a median number of 3.0 consultations (IQR 2.0–5.3). Indigenous status did not significantly predict retention. Referral pathway significantly predicted the number of consultations (Wald X2(6) = 17.67, p = .0071) and immediate discontinuation (Wald X2(6) = 12.94, p = .044), with self-referred clients having the highest retention. Initial presentation reason significantly predicted the number of consultations (Wald X2(5) = 13.83, p = .017), with clients with potential health hazards related to socioeconomic and psychosocial circumstances having the lowest retention. Significantly more Indigenous clients presented for this reason (20.1 % vs 4.3 %). InterpretationComparable retention of Indigenous clients suggests cultural appropriateness of the psychotherapy being delivered by the FNS. Services might use the described therapeutic approach as a guide for culturally appropriate care.

Servur'a and Krym'a (Crimean Roma) as Indigenous Peoples of Ukraine

The article presents an ethnographic and sociological description of two sub-ethnic groups of Ukrainian Roma: Sérvur’a and Krým’a (Crimean Roma). Based on the field research conducted in 2016–2022, we have concluded that the Krym’a and the Servur’a are (sub-) ethnic groups which meet most of the national and international criteria for being regarded as indigenous people of Ukraine. Servur’a and Krýmʼa were both formed in the territory of Ukraine, are predominantly based in Ukraine, are bearers of distinctive languages and cultures, have traditional, social, cultural and/or representative bodies, identify as (indigenous) people of Ukraine, as is reflected in their self-names; each of them is an ethnic minority within the population of Ukraine, and neither has a state formation of its own outside of Ukraine. Therefore, they fully satisfy the requirements of the relevant Ukrainian legislation. Additional grounds for classifying Servur’a and Krym’a as indigenous peoples are their non-dominant position in society, their traumatic historical experience, which includes the Holocaust of the Roma, the 1944 deportation of the Crimean peoples, as well as their vulnerability to forced displacement from their historic lands and the fact that the Krym’a became refugees and internally displaced persons as a result of the Russian-Ukrainian war. In the authors’ opinion, the initiation of the discussion on granting indigenous status to the Servur’a and the Krym’a can draw attention to the urgent problems of all Romani ethnic groups in Ukraine and give impetus to the formation of the state’s policy towards the Roma.

Indigenous identity identification in administrative health care data globally: A scoping review.

Both Indigenous and non-Indigenous governments and organizations have increasingly called for improved Indigenous health data in order to improve health equity among Indigenous peoples. This scoping review identifies best practices, potential consequences and barriers for advancing Indigenous health data and Indigenous data sovereignty globally. A scoping review was conducted to capture the breadth and nature of the academic and grey literature. We searched academic databases for academic records published between 2000 and 2021. We used Google to conduct a review of the grey literature. We applied Harfield's Aboriginal and Torres Strait Islander Quality Appraisal Tool (QAT) to all original research articles included in the review to assess the quality of health information from an Indigenous perspective. In total, 77 academic articles and 49 grey literature records were included. Much of the academic literature was published in the last 12years, demonstrating a more recent interest in Indigenous health data. Overall, we identified two ways for Indigenous health data to be retrieved. The first approach is health care organizations asking clients to voluntarily self-identify as Indigenous. The other approach is through data linkage. Both approaches to improving Indigenous health data require awareness of the intergenerational consequences of settler colonialism along with a general mistrust in health care systems among Indigenous peoples. This context also presents special considerations for health care systems that wish to engage with Indigenous communities around the intention, purpose, and uses of the identification of Indigenous status in administrative databases and in health care settings. Partnerships with local Indigenous nations should be developed prior to the systematic collection of Indigenous identifiers in health administrative data. The QAT revealed that many research articles do not include adequate information to describe how Indigenous communities and stakeholders have been involved in this research. There is consensus within the academic literature that improving Indigenous health should be of high priority for health care systems globally. To address data disparities, governments and health organizations are encouraged to work in collaboration with local Indigenous nations and stakeholders at every step from conceptualization, data collection, analysis, to ownership. This finding highlights the need for future research to provide transparent explanation of how meaningful Indigenous collaboration is achieved in their research.

Sacred serpents and the discourse on conservation: Interrogating interspecies dynamics in rural Bardhaman

AbstractBuilt on extensive ethnographic fieldwork in rural Bardhaman, West Bengal, India, the article argues for the centrality of animals’ non‐human agency as sacred beings involved in interactive experiences with humans, amidst changing climatic conditions. For the people of Musharu, the sacredness of their village deity is embedded in their practical ways of living and inhabiting with special varieties of cobras as exemplars of sacred nature. The article also draws attention to how the survival of these local cobras is adversely affected due to monsoonal vulnerability. The article addresses three critical concerns. It situates the human–snake interaction within wider discourse of post‐humanist debates, highlighting the elusive nature of the ‘wild’ and the animalist agency it enables. It captures alternative versions of conservation that the human–animal–divine nexus in Musharu creates. The third concerns the reproduction of rural community consciousness and indigeneity that this interaction brings about. It concludes with the understanding that Musharu's human–animal inhabitation reveals the contextual nature of ‘wilderness’ reframes the Indigenous status emerging out of human–non‐human associations and rethinks the role of local cultures in global wildlife conservation discourses.

Impact of health risk factors on healthcare resource utilization, work-related outcomes and health-related quality of life of Australians: a population-based longitudinal data analysis.

Health risk factors, including smoking, excessive alcohol consumption, overweight, obesity, and insufficient physical activity, are major contributors to many poor health conditions. This study aimed to assess the impact of health risk factors on healthcare resource utilization, work-related outcomes and health-related quality of life (HRQoL) in Australia. We used two waves of the nationally representative Household, Income, and Labor Dynamics in Australia (HILDA) Survey from 2013 and 2017 for the analysis. Healthcare resource utilization included outpatient visits, hospitalisations, and prescribed medication use. Work-related outcomes were assessed through employment status and sick leave. HRQoL was assessed using the SF-6D scores. Generalized estimating equation (GEE) with logit or log link function and random-effects regression models were used to analyse the longitudinal data on the relationship between health risk factors and the outcomes. The models were adjusted for age, sex, marital status, education background, employment status, equilibrium household income, residential area, country of birth, indigenous status, and socio-economic status. After adjusting for all other health risk factors covariates, physical inactivity had the greatest impact on healthcare resource utilization, work-related outcomes, and HRQoL. Physical inactivity increased the likelihood of outpatient visits (AOR = 1.60, 95% CI = 1.45, 1.76 p < 0.001), hospitalization (AOR = 1.83, 95% CI = 1.66-2.01, p < 0.001), and the probability of taking sick leave (AOR = 1.31, 95% CI = 1.21-1.41, p < 0.001), and decreased the odds of having an above population median HRQoL (AOR = 0.48, 95% CI = 0.45-0.51, p < 0.001) after adjusting for all other health risk factors and covariates. Obesity had the greatest impact on medication use (AOR = 2.02, 95% CI = 1.97-2.29, p < 0.001) after adjusting for all other health risk factors and covariates. Our study contributed to the growing body of literature on the relative impact of health risk factors for healthcare resource utilization, work-related outcomes and HRQoL. Our results suggested that public health interventions aim at improving these risk factors, particularly physical inactivity and obesity, can offer substantial benefits, not only for healthcare resource utilization but also for productivity.