Top End Of Northern Territory Research Articles

Patient clinical and demographic factors associated with involuntary psychiatric admission in the northern territory top end.

Australia has inadequate publicly available data regarding the use of involuntary psychiatric care. This study examined the association between patient clinical/demographic factors and involuntary psychiatric admission following initial psychiatric assessment in Royal Darwin Hospital. Retrospective review of 638 psychiatric assessments followed by covariate analysis of patient variables associated with involuntary psychiatric admission. Most of the 225 psychiatric admissions were involuntary (92%). Male patients and those with a preferred language other than English had the highest risk of being admitted involuntarily (RR 1.09, χ2 [1] = 3.9, p = .048, and RR 1.11, p = .036, respectively). Further research regarding the influence of patient demographics and clinical factors on rates of involuntary admissions, particularly for Aboriginal patients, is recommended. The findings prompt discussion on strategies to improve monitoring of involuntary care and barriers to voluntary treatment.

The molecular characteristics of non-small cell lung cancer in the Northern Territory's Top End.

Indigenous Australians with lung cancer have poorer survival than non-Indigenous Australians. The reasons for the disparity are not fully understood and this study hypothesized that there may be a difference in the molecular profiles of tumors. The aim of this study, therefore, was to describe and compare the characteristics of non-small cell lung cancer (NSCLC) in the Northern Territory's Top End, between Indigenous and non-Indigenous patients, and describe the molecular profile of tumors in the two groups. A retrospective review was conducted of all adults with a new diagnosis of NSCLC in the Top End from 2017 to 2019. Patient characteristics assessed were Indigenous status, age, sex, smoking status, disease stage, and performance status. Molecular characteristics assessed were epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), v-raf murine sarcoma viral oncogene homolog B (BRAF), ROS proto-oncogene 1 (ROS1), Kirsten rat sarcoma viral oncogene homolog (KRAS), mesenchymal-epithelial transition (MET), human epidermal growth factor receptor 2 (HER2), and programmed death-ligand 1 (PD-L1). Student's t-test and Fisher's Exact Test were used in the statistical analysis. There were 152 patients diagnosed with NSCLC in the Top End from 2017-2019. Thirty (19.7%) were Indigenous and 122 (80.3%) were non-Indigenous. Indigenous patients compared to non-Indigenous patients were younger at diagnosis (median age 60.7 years versus 67.1 years, p = 0.00036) but were otherwise similar in demographics. PD-L1 expression was similar between Indigenous and non-Indigenous patients (p = 0.91). The only mutations identified among stage IV non-squamous NSCLC patients were EGFR and KRAS but testing rates and overall numbers were too small to draw conclusions about differences in prevalence between Indigenous and non-Indigenous patients. This is the first study to investigate the molecular characteristics of NSCLC in the Top End.

Molecular epidemiology of tuberculosis in northern Australia

Australia has one of the lowest rates of tuberculosis (TB) globally; however, the rates of TB in the Northern Territory (NT) Top End and in Far North Queensland are consistently higher than the national average. Genomic sequencing of Mycobacterium tuberculosis (MTB) is increasingly being implemented for transmission surveillance and antimicrobial resistance prediction. Genomic epidemiological studies in northern Australia have demonstrated the utility of sequencing for tracking TB transmission. In the NT Top End, this has demonstrated that most TB transmission is occurring in remote regions, with recent transmission and reactivation from latency contributing to incident TB. In Far North Queensland, genomics has been used to track transmission of a multidrug-resistant MTB clone across the Torres Strait. The next steps include implementation of MTB genomic sequencing in jurisdictional laboratories with real-time cross-jurisdictional analysis to inform public health management of TB.

The Removal of Subterranean Stormwater Drain Sumps as Mosquito Breeding Sites in Darwin, Australia

The Northern Territory Top End Health Service, Medical Entomology Section and the City of Darwin council carry out a joint Mosquito Engineering Program targeting the rectification of mosquito breeding sites in the City of Darwin, Northern Territory, Australia. In 2005, an investigation into potential subterranean stormwater breeding sites in the City of Darwin commenced, specifically targeting roadside stormwater side entry pits. There were 79 side entry pits randomly investigated for mosquito breeding in the Darwin suburbs of Nightcliff and Rapid Creek, with 69.6% of the pits containing water holding sumps, and 45.6% of those water holding sumps breeding endemic mosquitoes. Culex quinquefasciatus was the most common mosquito collected, accounting for 73% of all mosquito identifications, with the potential vector mosquito Aedes notoscriptus also recovered from a small number of sumps. The sumps were also considered potential dry season maintenance breeding sites for important exotic Aedes mosquitoes such as Aedes aegypti and Aedes albopictus, which are potential vectors of dengue, chickungunya and Zika virus. Overall, 1229 side entry pits were inspected in ten Darwin suburbs from 2005 to 2008, with 180 water holding sumps identified and rectified by concrete filling.

Burn injury as a result of interpersonal violence in the Northern Territory Top End

AimTo describe the demographics, circumstances, burn wound characteristics and current tertiary centre management of interpersonal violence (IPV) burn victims in the Northern Territory Top End. It is anticipated that such knowledge gained will be of benefit to key stakeholders across the spectrum of injury prevention and management in this region. MethodsAll adult admissions to the Royal Darwin Hospital (RDH) during 2010–2015 were identified through the Burns Registry of Australia and New Zealand. Demographic and burn characteristics were compared between those classified as IPV and non-IPV. Case note review provided supplementary data for the IPV subset. ResultsFifty-three patients met IPV criteria, comprising 7.4% of admissions to the RDH Burn Service. IPV burn victims were 2.3 times more likely to be female than those with non-IPV burn (95% CI: 1.2–4.3), and 17 times more likely to be Indigenous (95% CI: 7.9–35). Approximately half (53%) of IPV burns were classified as family or domestic violence; scalding was the most common mechanism in this group. Ten patients (19%) had incomplete burn care through self-discharge, all identified as Indigenous. Twenty percent of patients had no documented inpatient psychosocial support. ConclusionsFemale and Indigenous persons are at increased risk of IPV burn. The challenges of providing care to the IPV burn population extend beyond burn wound closure.

Iodine status of Indigenous and non-Indigenous young adults in the Top End, before and after mandatory fortification.

To assess the median urine iodine concentration (UIC) of young adults in the Top End of Northern Territory, before and after fortification of bread with iodised salt became mandatory. Analysis of cross-sectional data from two longitudinal studies, the Aboriginal Birth Cohort and the non-Indigenous Top End Cohort, pre- (Indigenous participants: 2006-2007; non-Indigenous participants: 2007-2009) and post-fortification (2013-15). Indigenous and non-Indigenous Australian young adults (mean age: pre-fortification, 17.9 years (standard deviation [SD], 1.20 years); post-fortification, 24.9 years (SD, 1.34 years). Median UIC (spot urine samples analysed by a reference laboratory), by Indigenous status, remoteness of residence, and sex. Among the 368 participants assessed both pre- and post-fortification, the median UIC increased from 58μg/L (interquartile range [IQR], 35-83μg/L) pre-fortification to 101μg/L (IQR, 66-163μg/L) post-fortification (P<0.001). Urban Indigenous (median IUC, 127μg/L; IQR, 94-203μg/L) and non-Indigenous adults (117μg/L; IQR, 65-160μg/L) were both iodine-replete post-fortification. The median UIC of remote Indigenous residents increased from 53μg/L (IQR, 28-75μg/L) to 94μg/L (IQR, 63-152μg/L; p<0.001); that is, still mildly iodine-deficient. The pre-fortification median UIC for 22 pregnant women was 48μg/L (IQR, 36-67μg/L), the post-fortification median UIC for 24 pregnant women 93μg/L (IQR, 62-171μg/L); both values were considerably lower than the recommended minimum of 150μg/L for pregnant women. The median UIC of young NT adults increased following mandatory fortification of bread with iodised salt. The median UIC of pregnant Indigenous women in remote locations, however, remains low, and targeted interventions are needed to ensure healthy fetal development.

Supporting Northern Territory Top End allied health graduates and early career staff by means of an interprofessional graduate program.

Objectives For allied health graduate staff, entry into the workforce can be challenging and complex to navigate. Formal, structured graduate programs in the Northern Territory are limited and are typically discipline specific. Discipline-specific graduate programs focus on clinical and specific skill sets. However, there is a need to support graduates and early career staff within a diverse and large health service by developing and encouraging interprofessional practice, as well as reflective and critical thinking skills. This article outlines a pilot inter-professional allied health graduate program trialled in the Northern Territory Top End, including program development, implementation and outcomes. Methods A formative study design using online pre- and post-program surveys for participants and their line managers was adopted. Results There was significant improvement noted in the graduates' confidence levels of understanding other professional roles after the pilot program. Graduates also reported an improved sense of support and reflective skills moving into their subsequent year of professional practice. Managers of graduates reported improved interprofessional practice and collaboration with other health professionals. Conclusions The pilot program provided a sustainable model of learning and development for early career allied health professionals. Supporting the Top End graduate allied health workforce proved to be an important factor in facilitating interprofessional practice from an early stage, as integrated care and interprofessional practice are crucial to patient treatment. What is known about the topic? Research from within Australia and internationally has demonstrated that preparing allied health professionals for interprofessional practice helped facilitate collaboration and partnerships among different professions. This, in turn, improved quality of patient health care outcomes. Interprofessional education has been documented as an effective means of educating clinicians. What does this paper add? This paper describes how interprofessional learning and education in the form of a structured graduate program affected the perceptions of staff and implementation of interprofessional practice in the Northern Territory (NT). The Top End of the NT is unique in that a large number of allied health professionals work within integrated multidisciplinary teams or hold sole positions within regional settings. This is the first graduate program for NT allied health professionals. What are the implications for practitioners? Allied health professionals are an integral part of a health service and fostering interprofessional practice early on can prepare new employees to collaborate and support each other with an understanding of the roles of other professionals.

Retrospective Audit of Rheumatic Heart Valve Surgical Outcomes in the Top End of Northern Territory, Australia

Retrospective Audit of Rheumatic Heart Valve Surgical Outcomes in the Top End of Northern Territory, Australia

Melioidosis Causing Critical Illness: A Review of 24 Years of Experience From the Royal Darwin Hospital ICU.

Melioidosis is increasing in incidence with newly recognized foci of melioidosis in the Americas, Africa, and elsewhere. This review describes the demographics, management, and outcomes of a large cohort of critically ill patients with melioidosis. Data were extracted from two prospective databases-the Menzies School of Health Research Melioidosis Database (1989-2013) and the Royal Darwin Hospital ICU Melioidosis Database (2001-2013). The Royal Darwin Hospital ICU is the only ICU in the tropical Top End of Northern Territory of Australia, an endemic area for melioidosis. The study included all patients with melioidosis admitted to Royal Darwin Hospital ICU from 1989 to 2013. From 1989 to 2013, 207 patients with melioidosis required admission to ICU. Mortality reduced from 92% (1989-1997) to 26% (1998-2013) (p < 0.001). The reduced mortality coincided with the introduction of an intensivist-led service, meropenem, and adjuvant granulocyte colony-stimulating factor for confirmed melioidosis sepsis in 1998. Pneumonia was the presenting illness in 155 of 207 (75%). ICU melioidosis patients (2001-2013) had an Acute Physiology and Chronic Health Evaluation II score of 23, median length of stay in the ICU of 7 days, and median ventilation hours of 130 and one third required renal replacement therapy. The mortality for critically ill patients with melioidosis in the Top End of the Northern Territory of Australia has substantially reduced over the past 24 years. The reduction in mortality coincided with the introduction of an intensivist-led model of care, the empiric use of meropenem, and adjunctive treatment with granulocyte colony-stimulating factor in 1998.

Indigenous Patients with Community Acquired Septic Shock Receive the Same Standard of Care as Non-Indigenous Patients in the Top End of Northern Territory, Australia

Introduction: Indigenous people have a fourfold higher incidence of sepsis in the Top End of the Northern Territory, Australia. However, their mortality from sepsis is not higher, despite an overall lower life expectancy, poorer access to healthcare, remoteness, higher chronic disease burden and social disadvantage. This suggests that Indigenous patients with sepsis receive the same standard of care as non-Indigenous patients; however, this has not been confirmed by investigation. The objective of the present study was to compare the early management of community acquired septic shock between Indigenous and non-Indigenous patients at the Royal Darwin Hospital (RDH) in the Top End of the Northern Territory, Australia. Methods: Retrospective case note review of adult patients with septic shock admitted via the Emergency department (ED) of RDH between 01/01/2004 to 01/08/2005. Comparisons between Indigenous and non-Indigenous patients with septic shock were made with respect to: time to antibiotic, fluid resuscitation, time spent in the ED, mechanical ventilation, vasopressor use, continuous renal replacement therapy (CRRT), source control, Intensive Care Unit (ICU) length of stay (LOS), hospital LOS, and mortality. Results: One hundred and twenty patients were included (69 Indigenous). Indigenous patients were younger, 46 (14) vs 54 (17) (p=0.004), with a higher chronic disease burden and similar Acute Physiology and Chronic Health Evaluation (APACHE) II scores, 20.1 (7.9) vs 20.7 (7.8). Indigenous patients had significantly higher rates of aeromedical retrieval, lower rates of self presentation (p Conclusions: Management of community acquired septic shock in the Top End of Australia does not appear to differ between Indigenous and non-Indigenous patients; including compliance with surviving sepsis guidelines, antibiotic therapy, intensive care therapies and source control. While this is encouraging, the contributing factors leading to a higher burden of sepsis and septic shock in Indigenous people in the Top End needs further investigation. The study’s findings also support the taking of blood cultures in septic shock, even if antibiotics have already been administered.

“We need our own food, to grow our own veggies…” Remote Aboriginal food gardens in the Top End of Australia's Northern Territory

Remote Aboriginal community gardens (gardens) frequently operate below their full potential. A set of gardening sustainability principles may improve their planning, operation and long-term sustainability. This paper aims to document the principles of sustainability of non-profit remote Aboriginal community gardens in the Top End of the Northern Territory. Throughout 2011, gardens in the Top End of the Northern Territory were visited. Interviews and observational data were used to explore the principles of garden sustainability with participants. Subsequent iterative thematic analysis informed development of a set of gardening sustainability principles. Principles of sustainability included effective garden planning; community autonomy, consultation and engagement; growing community vetted crops; employing long-term, effective, culturally sensitive managers; long-term, transparent funding organisations and cycles; garden integration into existing food supply chains; culturally appropriate employment arrangements; and physical aspects of successful gardening. This work uniquely consults gardeners, managers and Aboriginal and non-Aboriginal people of both genders in the largest reported study of its type, resulting in new and expanded findings, particularly including new social factors for gardening success. Expanding the understanding of what makes gardens work to include the important social factors identified here may have merit.

Sepsis in the tropical Top End of Australia's Northern Territory: disease burden and impact on Indigenous Australians

To describe the clinical and epidemiological features of sepsis and severe sepsis in the population of the tropical Top End of the Northern Territory of Australia and compare these with published estimates for temperate Australia, the United States and Europe. Prospective cohort study in the major hospital for tropical NT, a region where 27% of the population are Indigenous. We screened all adult (≥ 15 years) acute hospital admissions over a 12-month period (6 May 2007-5 May 2008) for sepsis by standard criteria, and collected standardised clinical data. Population-based incidence of community-onset sepsis and severe sepsis requiring intensive care unit (ICU) admission; 28-day mortality rate and microbial epidemiology. There were 1191 hospital admissions for sepsis in 1090 patients, of which 604 (50.7%) were Indigenous people; the average age was 46.7 years. The age-adjusted annual population-based incidence of sepsis was 11.8 admissions per 1000 (mortality rate, 5.4%), but for Indigenous people it was 40.8 per 1000 (mortality rate, 5.7%). For severe sepsis requiring ICU admission, the incidence was 1.3 per 1000 per year (mortality rate, 21.5%), with an Indigenous rate of 4.7 per 1000 (mortality rate, 19.3%). The incidence of sepsis in the tropical NT is substantially higher than that for temperate Australia, the United States and Europe, and these differences are mainly accounted for by the high rates of sepsis in Indigenous people. The findings support strategies to improve housing and access to health services, and reduce comorbidities, alcohol and tobacco use in Indigenous Australians. The burden of sepsis in indigenous populations worldwide requires further study to guide appropriate resourcing of health care and preventive strategies.

Delivery of maternal health care in Indigenous primary care services: baseline data for an ongoing quality improvement initiative

BackgroundAustralia's Aboriginal and Torres Strait Islander (Indigenous) populations have disproportionately high rates of adverse perinatal outcomes relative to other Australians. Poorer access to good quality maternal health care is a key driver of this disparity. The aim of this study was to describe patterns of delivery of maternity care and service gaps in primary care services in Australian Indigenous communities.MethodsWe undertook a cross-sectional baseline audit for a quality improvement intervention. Medical records of 535 women from 34 Indigenous community health centres in five regions (Top End of Northern Territory 13, Central Australia 2, Far West New South Wales 6, Western Australia 9, and North Queensland 4) were audited. The main outcome measures included: adherence to recommended protocols and procedures in the antenatal and postnatal periods including: clinical, laboratory and ultrasound investigations; screening for gestational diabetes and Group B Streptococcus; brief intervention/advice on health-related behaviours and risks; and follow up of identified health problems.ResultsThe proportion of women presenting for their first antenatal visit in the first trimester ranged from 34% to 49% between regions; consequently, documentation of care early in pregnancy was poor. Overall, documentation of routine antenatal investigations and brief interventions/advice regarding health behaviours varied, and generally indicated that these services were underutilised. For example, 46% of known smokers received smoking cessation advice/counselling; 52% of all women received antenatal education and 51% had investigation for gestational diabetes. Overall, there was relatively good documentation of follow up of identified problems related to hypertension or diabetes, with over 70% of identified women being referred to a GP/Obstetrician.ConclusionParticipating services had both strengths and weaknesses in the delivery of maternal health care. Increasing access to evidence-based screening and health information (most notably around smoking cessation) were consistently identified as opportunities for improvement across services.

Diversity of emm sequence types in group A beta-haemolytic streptococci in two remote Northern Territory Indigenous communities: Implications for vaccine development

There is a high burden of disease due to group A streptococcus (GAS) in remote Northern Territory (NT) Indigenous communities. A proposed 26-valent GAS M-type vaccine covers 80–90% of pharyngeal and invasive isolates in the US. We examined the diversity and distribution of emm types in two remote Indigenous communities in the NT Top End over a 17-year period and compared them to the proposed vaccine types. Eighty emm types were identified between 1991 and 2007. Diversity in both communities was high (overall Simpson's index 0.976), but varied between communities. Prior to 2004, 71 emm types were identified and an additional 9 emm types were identified during a period of active surveillance in 2004–2005. The proposed 26-valent vaccine would be expected to cover only 20% of emm types recovered in this study. Of the 80 emm types, 16 (20%) were new sequence types identified since the last assignment of M types in 2002. The diversity of streptococcal isolates was higher than that reported from most industrialized countries, and similar to that described in several developing countries. A vaccine based on such a variable antigen is unlikely to provide effective protection in the highest risk populations.

Disproportionate impact of pandemic (H1N1) 2009 influenza on Indigenous people in the Top End of Australia's Northern Territory

To describe the impact of pandemic (H1N1) 2009 influenza (nH1N1) on Indigenous people in the Top End of the Northern Territory at community, hospital and intensive care unit (ICU) levels. We analysed influenza notifications for the Top End from 1 June to 31 August 2009, as well as data on patients admitted through Top End emergency departments with an influenza-like illness. In addition, data on patients with nH1N1 who were admitted to Royal Darwin Hospital (RDH) and the RDH ICU were prospectively collected and analysed. Age-adjusted notification rates for nH1N1 cases, Top End hospital admission rates for patients with nH1N1 and RDH ICU admission rates for patients with nH1N1, stratified by Indigenous status. There were 918 nH1N1 notifications during the study period. The age-adjusted hospital admission rate for nH1N1 was 82 per 100 000 (95% CI, 68-95) estimated resident population (ERP) overall, with a markedly higher rate in the Indigenous population compared with the non-Indigenous population (269 per 100 000 versus 29 per 100 000 ERP; adjusted incidence rate ratio, 12 [95% CI, 7.8-18]). Independent predictors of ICU admission compared with hospitalisation were hypoxia (adjusted odds ratio [aOR], 4.5; CI, 1.5-13.1) and chest x-ray infiltrates (aOR, 4.3; CI, 1.5-12.6) on hospital admission. Pandemic (H1N1) 2009 influenza had a disproportionate impact on Indigenous Australians in the Top End, with hospitalisation rates higher than those reported elsewhere in Australia and overseas. These findings have implications for planning hospital and ICU capacity during an influenza pandemic in regions with large Indigenous populations. They also confirm the need to improve health and living circumstances and to prioritise vaccination in this population.

School screening in remote Aboriginal communities — results of an evaluation

AbstractAs part of ongoing quality assurance, the effectiveness of the school screening program in meeting the health needs of Aboriginal children in a rural district in the Northern Territory Top End was evaluated. The major health problems of Aboriginal children were analysed for their suitability for screening programs. A prospective cross-sectional study used routinely collected field data from the school screening program in 1993. To ascertain follow-up, children who had failed screening tests had their clinic notes reviewed. A total of 774 children from 11 remote communities were screened.The results confirmed high level of disease, with rates for anaemia, malnutrition and trachoma reaching 39%, 22% and 26% respectively. Nearly one-third failed the hearing screening, urinalysis was abnormal in 19%, 3% failed visual acuity and 6% were considered to have abnormal heart auscultation.>Many of the major health problems did not meet the recommended criteria for screening programs and others would be better dealt with by ongoing surveillance rather than a single screening. Some abnormalities found on screening were inadequately investigated and/or treated. This evaluation has demonstrated a limited role for school screening in identifying and meeting the health needs of Aboriginal children living in remote areas. In collaboration with the NT Department of Education, a school-age child health policy, including a new school-age child health surveillance program, is being developed. This promotes greater participation by communities, families and schools with the aim of improving the health and learning outcomes for all school-age children in the NT.

Acute rheumatic fever and rheumatic heart disease in the top end of Australia's Northern Territory.

To describe the epidemiological and clinical features of acute rheumatic fever and rheumatic heart disease in the Top End of the Northern Territory. A retrospective review (in some instances as far back as the 1960s) of all cases of known or suspected acute rheumatic fever or rheumatic heart diseases, with prospective validation of clinical status where necessary. Cases were ascertained from hospital and community medical clinic records and medical staff; and from records and health staff of 10 rural communities. Three hundred and eighty-six revised Jones criteria-confirmed episodes of acute rheumatic fever were documented in 249 individuals (99% Aboriginal). The annual incidence of confirmed acute rheumatic fever between 1989 and 1993 was 254 per 100,000 Aboriginal people aged 5 to 14 years. A more accurate estimate of 651 per 100,000 came from 10 rural communities with more complete information. As of 1995, there were 286 people living with established rheumatic heart disease (95% Aboriginal). The point prevalence of rheumatic heart disease among Aboriginal people was 9.6 per 1000, with a rate of 24 per 1000 in one large rural community. Sydenham's chorea was common, and associated with later rheumatic heart disease in 49% of cases. There was a preponderance of females with acute rheumatic fever, rheumatic heart disease and chorea. In Aboriginal people in rural northern Australia the incidence of acute rheumatic fever is higher than that reported anywhere in the world, and the prevalence of rheumatic heart disease is among the highest in the world. While continuing attention must be paid to alleviating the causes of these diseases of poverty, immediate action is needed to improve diagnosis of acute rheumatic fever, adherence to secondary benzathine penicillin prophylaxis regimens, and follow-up of rheumatic heart disease cases.