Torres Strait Islander People Research Articles

Increasing access to screening for blood-borne viruses and sexually transmissible infections for Aboriginal and Torres Strait Islander Australians: evaluation of the Deadly Liver Mob program’s ‘cascade of care’ across nine sites in New South Wales, Australia

BackgroundAboriginal and Torres Strait Islander Australians are disproportionately impacted by blood-borne viruses (BBVs) and sexually transmissible infections (STIs). Stigma remains one of the key barriers to testing and treatment for BBVs and STIs, particularly among Aboriginal and Torres Strait Islander people. The Deadly Liver Mob (DLM) is a peer-delivered incentivised health promotion program by and for Aboriginal and Torres Strait Islander Australians. The program aims to increase access to BBV and STI education, screening, treatment, and vaccination for Aboriginal and Torres Strait Islander Australians in recognition of the systemic barriers for First Nations people to primary care, including BBV- and STI-related stigma, and institutional racism. This paper presents routinely collected data across nine sites on the ‘cascade of care’ progression of Aboriginal and Torres Strait Islander clients through the DLM program: hepatitis C education, screening, returning for results, and recruitment of peers.MethodsRoutinely collected data were collated from each of the DLM sites, including date of attendance, basic demographic characteristics, eligibility for the program, recruitment of others, and engagement in the cascade of care.ResultsBetween 2013 and 2020, a total of 1787 Aboriginal and Torres Strait Islander clients were educated as part of DLM, of which 74% went on to be screened and 42% (or 57% of those screened) returned to receive their results. The total monetary investment of the cascade of care progression was approximately $56,220. Data highlight the positive impacts of the DLM program for engagement in screening, highlighting the need for culturally sensitive, and safe programs led by and for Aboriginal and Torres Strait Islander people. However, the data also indicate the points at which clients ‘fall off’ the cascade, underscoring the need to address any remaining barriers to care.ConclusionsThe DLM program shows promise in acting as a ‘one stop shop’ in addressing the needs of Aboriginal and Torres Strait Islander people in relation to BBVs and STIs. Future implementation could focus on addressing any potential barriers to participation in the program, such as co-location of services and transportation.

Lung cancer screening for Aboriginal and Torres Strait Islander peoples: an opportunity to address health inequities.

Lung cancer screening for Aboriginal and Torres Strait Islander peoples: an opportunity to address health inequities.

Aboriginal and Torres Strait Islander employment provisions within enterprise agreements in Australian universities, the role of the National Tertiary Education Union and collective bargaining

Collective bargaining is the foundation for democracy in the workplace, and a mechanism for ensuring workers in Australia have improved working conditions whilst striving to reduce inequality. Collective bargaining offers potential to improve democratic workplace participation and socio-economic status of Aboriginal and Torres Strait Islander peoples, however, if done ineffectively can further entrench inequality. Aboriginal and Torres Strait Islander workplace issues need to be at the forefront of bargaining. In the Higher Education sector, collective agreements with universities cover the majority of employees and are negotiated by the National Tertiary Education Union (NTEU). The NTEU uses its bargaining power within the university sector to establish Aboriginal and Torres Strait Islander employment targets and other targeted provisions within enterprise agreements. These targets and other provisions aim to increase Aboriginal and Torres Strait Islander representation on campus, ensure fair and equitable working conditions and challenge entrenched inequality for Aboriginal and Torres Strait Islander workers within their universities. The NTEU has for over 20 years advocated for and won Aboriginal and Torres Strait Islander employment clauses in enterprise agreements. The National Aboriginal and Torres Strait Islander Policy Committee, under the direction of the Aboriginal and Torres Strait Islander members has pushed for these for the benefit of all Aboriginal and Torres Strait Islander peoples employed or yet to be employed in the higher education sector. The increase in Aboriginal and Torres Strait Islander employment in universities has and continues to be driven by NTEU.

Redressing barriers to healthcare for Aboriginal and Torres Strait Islander Peoples: preliminary findings from a mobile clinic in rural Victoria.

A mobile clinic is a promising model for delivering primary health care services to Aboriginal and Torres Strait Islander clients in rural areas, according to this paper which finds such a clinic provided services across the lifespan to clients in areas with high levels of socioeconomic and locational disadvantage.

Health workers’ perspectives of hepatitis B-related stigma among Aboriginal and Torres Strait Islander people in New South Wales, Australia

BackgroundExperiences of stigma and discrimination can act as a significant barrier to testing, monitoring, and treatment for hepatitis B virus (HBV). Aboriginal and Torres Strait Islander Australians are a population disproportionately impacted by HBV and yet limited research has explored HBV-related stigma in these communities. To begin preliminary explorations of HBV-related stigma among Aboriginal and Torres Strait Islander people, we interviewed health workers about their perceptions regarding HBV infection and HBV-related stigma.MethodsParticipants were recruited from staff involved in the Deadly Liver Mob (DLM) program which is a health promotion program that offers incentives for Aboriginal and Torres Strait Islander clients to be educated on viral hepatitis, recruit and educate peers, and receive screening and treatment for blood-borne viruses (BBVs) and sexually transmissible infections (STIs), and vaccination. Semi-structured interviews were conducted with 11 Aboriginal and Torres Strait Islander and non-Aboriginal or Torres Strait Islander health workers who have been involved in the development, implementation, and/or management of the DLM program within participating services in New South Wales, Australia.ResultsFindings suggest that stigma is a barrier to accessing mainstream health care among Aboriginal and Torres Strait Islander clients, with stigma being complex and multi-layered. Aboriginal and Torres Strait Islander people contend with multiple and intersecting layers of stigma and discrimination in their lives, and thus HBV is just one dimension of those experiences. Health workers perceived that stigma is fuelled by multiple factors, including poor HBV health literacy within the health workforce broadly and among Aboriginal and Torres Strait Islander clients, shame about social practices associated with viral hepatitis, and fear of unknown transmission risks and health outcomes. The DLM program was viewed as helping to resist and reject stigma, improve health literacy among both health workers and clients, and build trust and confidence in mainstream health services.ConclusionsHealth promotion programs have the potential to reduce stigma by acting as a ‘one stop shop’ for BBVs and STIs through one-on-one support, yarning, and promotion of the HBV vaccine, monitoring for chronic HBV, and treatment (where required).

Comparison of Lung Cancer Surgery Outcomes in Queensland for Indigenous and Nonindigenous Australians

IntroductionIndigenous Australians (Aboriginal and Torres Strait Islander) have lower overall survival from lung cancer compared with nonindigenous Australians. Indigenous Australians receive higher rates of chemotherapy and/or radiotherapy. The equity of peri-operative care and thoracic surgical outcomes in Australian indigenous populations have not been contemporarily evaluated. MethodsWe performed a retrospective registry analysis of the Queensland Cardiac Outcomes Registry Thoracic Database evaluating all adult lung cancer resections across Queensland from January 1, 2016 to April 20, 2022. Evaluating the time from diagnosis to surgery, operative data, and postoperative morbidity and mortality comparing Aboriginal and/or Torres Strait Islander people with nonindigenous Australians. ResultsThere were 31 patients (2.56%) of 1208 who identified as indigenous. The mean age at surgery was 68.2 years versus 66 years in the indigenous and nonindigenous, respectively (p = 0.23). There was female predominance among indigenous patients (n = 28, 90.32%, p < 0.01) and the average body mass index was lower (22.52 versus 27.09, p < 0.01). There was no variation in the surgical parameters or histopathologic distribution of cancer type between groups. Multivariable logistic regression analysis suggested that indigenous patients were at elevated risk of blood transfusion (relative risk 3.9, p = 0.014, OR = 9.01, 95% confidence interval [CI]: 2.25–36.33, p < 0.01) and had greater transfusion requirements (risk ratio 4.08, p = 0.0116 and OR = 12.67, 95% CI: 2.25–71.49, p < 0.01); however, the influence of low absolute number of transfusions must be acknowledged here. Indigenous status was not associated with increased intensive care unit admission (OR = 1.79, 95% CI: 0.17–18.80, p = 0.62), return to operating theater (OR = 2.1, 95% CI: 0.24–18.15, p = 0.50), new atrial fibrillation (OR = 0.52, 95% CI: 0.07–4.01, p = 0.55), prolonged air leak (OR = 0.29, 95% CI: 0.04– 2.16, p = 0.228), or pneumonia postoperatively (OR = 4.77, 95% CI: 0.55–41.71, p = 0.16). With only three deaths, no meaningful trends were observed. Time from diagnosis to surgery was comparable in the indigenous and nonindigenous groups (88.6 d, 95% CI: 54.26–123.24 versus 86.2 d, 81.40–91.02, p = 0.87). Postoperative length of stay was not numerically or statistically different between groups. (indigenous 7.54 d versus nonindigenous 7.13 d, p = 0.90). ConclusionsIndigenous patients are more likely to receive a blood transfusion than nonindigenous patients during lung resection. Reassuringly, the perioperative care provided to indigenous Australians undergoing lung resection in Queensland seems to be comparable to that of the nonindigenous population.

Exposure to the Family Wellbeing program and associations with empowerment, health, family and cultural wellbeing outcomes for Aboriginal and Torres Strait Islander peoples: a cross-sectional analysis

BackgroundEmpowerment is an internationally recognised concept commonly incorporated in First Nations and in this instance Aboriginal and Torres Strait Islander health and wellbeing programs. The Family Wellbeing Program is an empowerment program developed in partnership with Aboriginal and Torres Strait Islander peoples that has been widely delivered to Aboriginal and Torres Strait Islander communities across Australia for close to 30 years. To date, there has been limited quantitative analysis of how this program is linked to health and empowerment outcomes.MethodsCross sectional analysis of Mayi Kuwayu, the National Study of Aboriginal and Torres Strait Islander Wellbeing, baseline data (n = 9,843) recruited using multi-mode random sampling including mail out survey and in community convenience sampling. Logistic regression models were performed to calculate Prevalence Ratios (PRs) and 95% Confidence Intervals (CIs) to examine the association between personal control, life satisfaction, general health, family wellbeing and cultural wellbeing outcomes for Family Wellbeing participants (n = 718) versus non-participants (n = 9,125).ResultsCompared with non-FWB participants, FWB participants are more likely to be female (67.1% versus 58.4%), be aged 35–54 (41.8% versus 32.0%) and live in a remote area (17.7% versus 10.4%) and have educational attainment at the Year 12 level or above (57.8% versus 53.2%). Family Wellbeing participation was associated with a 13% higher reporting of family functioning, a 74% higher reporting of cultural participation and a 21% in higher reporting of local decision making in the local community compared to non-FWB participants. There were significant associations between FWB exposure compared to non-FWB exposure including reporting lower levels of health risk factors including quitting alcohol (26.4% versus 20.4%), regular exercise (67.7% versus 66.3%), quitting smoking (33.4% versus 31.9%). and e. FWB participants who had experienced both prison and youth detention were nearly double that of Non-FWB (3.5% versus 1.4%) and more reported being removed from their families as children (Stolen) (7.0% versus 4.1% Non-FWB).ConclusionThere are significant associations between Family Wellbeing exposure and organisation and community level empowerment outcomes, but only for some individual level empowerment outcomes. There is a lower reporting health risk factors including increased physical exercise, reduced alcohol use and smoking; and educational attainment among FWB participants compared to non-FWB participants. The results suggest individual, community and organisational empowerment needs to be explored further with more robust study designs that can attribute causality and direction of association.

Music, literature, and community: Reflections on a framework for learning through and from Aboriginal and Torres Strait Islander music

Inspired by a desire to explore ways in which non-Indigenous Australians can meaningfully connect with Aboriginal and Torres Strait Islander peoples, this article reflects on my doctoral studies and the role educators can have in holding space for First Nations peoples to directly contribute toward the creation of mutually rewarding teaching and learning experiences. It specifically evaluates the processes involved in establishing and implementing a project centered on my senior secondary music class as the students engaged in the collaborative reworking of two songs shared by Ngiyampaa composer and dancer, Peter Williams. The article is intentionally reflexive as it interrogates the journey and motivations behind conducting the study. As a non-Indigenous teacher-researcher, I table three foundational pillars behind my personal growth in understanding Aboriginal and Torres Strait Islander histories and cultures: the music, the academic literature, and most importantly, the local community. The article then discusses the challenges and factors that lead to the success of the musical interactions in the doctoral study—a process understood as co-composition—and critically, the transformative learning experiences gained as reciprocal relationships were forged during various stages of the project. Rather than promoting co-composition as a pedagogical strategy, this article encourages a heuristic approach to increased and effective inclusion of Aboriginal and Torres Strait Islander music in secondary music classes. By setting out in autoethnographic form the experience of implementing a considered, decolonial, and ethical approach to learning from and through Aboriginal and Torres Strait Islander music, I hope to encourage educators to imagine themselves in a narrative of their own, one that includes their students and members of the local First Nations community, leading to rich and rewarding musical collaborations and ongoing fruitful relationships.

“Working together… I can't stress how important it is”: Indigenous Health Liaison Officers’ insights into working with speech-language pathologists and Aboriginal and Torres Strait Islander peoples with stroke and TBI

Purpose Providing culturally safe speech-language pathology services to Aboriginal and Torres Strait Islander peoples with acquired communication disorders (ACDs) may be challenging for non-Indigenous speech-language pathologists (SLPs). Indigenous Health Liaison Officers (IHLOs) may share common histories and culture with patients, and provide valuable insights about cultural safety. The study aim was to explore IHLOs’ experiences of working with Aboriginal and Torres Strait Islander adults post-stroke or traumatic brain injury (TBI), and with the SLPs who provide services to these peoples. Method Using an interpretive description collaborative research design informed by culturally responsive principles, IHLOs (n = 7) participated in interviews facilitated by Aboriginal researchers and the principal investigator. Data were analysed using qualitative content analysis, informed by perspectives of Aboriginal researchers. Result Two themes, Connection and Spirit and Emotion, and six interdependent categories described how Aboriginal and Torres Strait Islander peoples have, and need, strong connections to family, country, health professionals, and ACD practices. Without these connections, patients’ wellbeing may be deeply affected. Conclusion SLPs must collaborate with IHLOs and patients’ family members and draw on their cultural knowledge, expertise, and guidance when working with Aboriginal and Torres Strait Islander peoples and ensure connections are created. These connections contribute to culturally safe and responsive speech-language pathology practice.

New directions in intergenerational child maltreatment research and responses: Knowledge gaps and recommendations

AbstractWhile there is much research on the topic of child maltreatment more broadly in Australia, a nuanced understanding of intergenerational child maltreatment is needed to improve our responses. Little work has considered all four intergenerational patterns of child maltreatment: cycle maintainers (maltreated parents with maltreated children), cycle breakers (maltreated parents with non‐maltreated children), cycle initiators (non‐maltreated parents with maltreated children) and a comparison group (non‐maltreated parents with non‐maltreated children). We use this terminology to maintain consistency with international literature, but acknowledge that these terms minimise the complexity inherent in contact with child protection systems. Research has mainly focused on maintainers, which hinders our ability to appropriately support all families and limits our understanding of individuals breaking the cycle. This paper outlines key knowledge gaps and identifies strategic areas of focus for researchers and policymakers. There is an urgent need for more emphasis on building resilience and strengths, the provision of more integrated and holistic support for families, and consideration of sex differences. We highlight the need for more research on this topic, particularly led by Aboriginal and Torres Strait Islander peoples, and hope that the recommendations in this paper can be revisited and updated as this important research base grows.

Implementation of telehealth primary health care services in a rural Aboriginal Community-Controlled Health Organisation during the COVID-19 pandemic: a mixed-methods study.

Globally, primary care organisations responded rapidly to COVID-19 physical distancing requirements through the adoption of telehealth to maintain the delivery of health care to communities. In Australia, temporary Medicare Benefits Schedule (MBS) telehealth items were introduced in March 2020 to enable the provision of telehealth services in the primary care setting. These changes included funding for two modes of telehealth delivery: videoconferencing and telephone consultations. As primary care organisations, Aboriginal Community Controlled Health Organisations (ACCHOs) rapidly adopted telehealth consultations to maintain the delivery of primary care services to Aboriginal and Torres Strait Islander clients. The aim of the present study was to evaluate the implementation (specifically the uptake, acceptability and requirements for delivery) of telehealth primary healthcare services for Aboriginal and/or Torres Strait Islander peoples by a rural ACCHO during COVID-19. A single-site convergent-parallel mixed-methods study was undertaken in the context of an ongoing research partnership established between a rural ACCHO and a university department of rural health. De-identified health service data from March 2020 to March 2021 was extracted, including MBS telehealth consultations and client demographics (eg age, gender and postcode). Variables were analysed using descriptive statistics to examine the uptake of telehealth by Aboriginal and Torres Strait Islander clients. A geographical analysis of postcode data was also undertaken. Semi-structured interviews were undertaken concurrently with a purposive sample of health service personnel (including health professionals) involved in the implementation or delivery of telehealth, and Aboriginal and/or Torres Strait Islander clients who had accessed telehealth, to explore the acceptability of telehealth and requirements for delivery. Thematic analysis using an inductive approach was undertaken. The analyses of quantitative and qualitative findings were merged to identify key concepts pertaining to the uptake, acceptability and requirements for telehealth delivery. During the first year of implementation, 435 telehealth primary healthcare consultations were delivered to Aboriginal and/or Torres Strait Islander clients. Seven health personnel and six Aboriginal and/or Torres Strait Islander clients participated in interviews. Merged findings from an analysis of quantitative and qualitative data were grouped under three concepts: uptake of telehealth consultations by Aboriginal and Torres Strait Islander clients, maintaining the delivery of ACCHO services during COVID-19, and implications for sustaining telehealth in an ACCHO. Findings identified that telehealth maintained the delivery of ACCHO services to Aboriginal and/or Torres Strait Islander clients across the lifespan during COVID-19, despite a preference for face-to-face consultations. A greater uptake of telephone consultations compared to videoconferencing was identified. Barriers to the utilisation of videoconferencing were largely technology related, highlighting the need for additional support for clients. Telehealth was a useful addition to face-to-face consultations when used in the appropriate context such as the administration of long-term medication prescriptions by a GP. Engaging the ACCHO sector in the policy discourse around telehealth is imperative for identifying requirements for ongoing implementation.

Closing the gap in Indigenous Australian cancer care: Initiatives to foster cultural safety and improve access to radiation therapy

IntroductionAboriginal and Torres Strait Islander peoples receive a poorer cancer prognosis compared to non-Indigenous Australians. Indigenous access to cancer care is limited by several factors, including differences in cultural understanding surrounding cancer and distrust of mainstream health institutions. It is believed that radiation therapy is being under-utilised by the Indigenous community. In response, several strategies were implemented to increase presentation and attendance by Indigenous Australians at a rural, private radiation therapy practice. MethodsA local Indigenous health service, Traditional Owners and Elders and the clinic's Reconciliation Action Plan Working Group were consulted to implement initiatives to reduce barriers to engaging in healthcare. One of these initiatives involved community consultation to select a culturally safe, Indigenous word to name one of the clinic's linear accelerators. Indigenous patient referrals into the clinic were tracked using an oncology information system. It is expected that by implementing several culturally safe strategies, there would be an increase in utilisation of the radiation therapy service and therefore, a decrease in Indigenous cancer burden across the local region. If strategies were yielding positive outcomes, there would be scope to implement these at other sites across a broader monitored network. ResultsCurrently, service utilisation is being monitored to determine whether initiatives have been successful. Initial data evaluation has been conducted and results are showing increased service utilisation by the Indigenous community. ConclusionWork has been undertaken to implement strategies to improve cultural safety and improve access to radiation therapy for Indigenous cancer patients. Preliminary results show an increase in the number of presentations to the clinic for radiation therapy treatment.

Management of encounters related to subfertility and infertility in Australian general practice: a focus on Aboriginal and Torres Strait Islander females

ObjectiveTo investigate the management of subfertility and infertility among Aboriginal and Torres Strait Islander females attending Australian general practice.MethodsCross-sectional study of 1,258,581 women (18–49 years) attending general practice between January 2011 and June 2019, utilising data from NPS MedicineWise MedicineInsight, a national general practice database in Australia.ResultsThe prevalence of subfertility/infertility encounters was lower for Aboriginal and Torres Strait Islander females (12.37 per 1,000) than for non-Indigenous females (16.62 per 1,000). Aboriginal and Torres Strait Islander females with a subfertility/infertility encounter were younger and more likely to live outside Major cities and in areas of socioeconomic disadvantage than non-Indigenous females. Rates of prescribed infertility medications were not different between groups, however Aboriginal and Torres Strait Islander females were more likely to receive a pelvic ultrasound (24.30% vs. 19.90%); tests for luteinizing hormone (31.89% vs. 25.65%); testosterone (14.93% vs. 9.96%) and; glycated haemoglobin (HbA1c) (6.32% vs. 3.41%),but less likely to receive an anti-müllerian hormone test (2.78% vs. 7.04%).ConclusionsLower encounter rates for infertility/subfertility among Aboriginal and Torres Strait Islander peoples may indicate access issues, preferred use of Aboriginal community-controlled health centres or younger average age at first birth and thus less age-related infertility.Implications for public healthFuture efforts should focus on maximising the inclusiveness of infertility surveillance. There is also a need for further research into the experiences of and preferences for infertility care and associated barriers among Aboriginal and Torres Strait Islander people.

Challenging deficit discourse in Aboriginal and Torres Strait Islander nutrition and dietetics research: A critical discourse analysis

Prior to colonisation, Aboriginal and Torres Strait Islander peoples used detailed knowledges on food and nutrition to develop sustainable practices which supported strong and healthy ways of life. Despite this, there is often a focus in the nutrition and dietetics literature on the deficits relating to food and nutrition for Aboriginal and Torres Strait Islander peoples, rather than the strengths. This study used a critical discourse analysis to investigate how Aboriginal and Torres Strait Islander peoples are portrayed in the discourse of peer-reviewed research relating to Aboriginal and Torres Strait Islander nutrition and dietetics. In doing so, this study explored the extent to which these portrayals perpetuate deficit discourse and the implications of this for Aboriginal and Torres Strait Islander peoples’ health, and nutrition and dietetics research. Four prominent themes were identified: problem describing, comparison, acknowledgment of colonisation and inclusion of Aboriginal and Torres Strait Islander perspectives. The results indicate that deficit discourse dominates nutrition and dietetics literature, and a lack of strengths-based discourse is evident. This study brings awareness to, and emphasises the importance of, challenging and changing these discourses to ones that are more strengths-based.

Culturally safe, trauma-informed approach to cognitive impairment and dementia in older Aboriginal and Torres Strait Islander people.

The population of older (age ≥50 years) Aboriginal and Torres Strait Islander people is increasing, and the rate of dementia in this group is three to fivefold higher than in the general population. Ahigh prevalence of risk factors across the life course likely contributes to theserates. This paper highlights practical ways toapply best practice principles when addressing the detection of cognitive impairment and dementia in older Aboriginal and Torres Strait Islander people and its management in the context of a person's family, carers andcommunity. Recognising culture, the collective nature of family and community decision making for a person, the ways to uphold respect for Elders and a trauma-informed approach are fundamental to the care ofolder Aboriginal and Torres Strait Islander people with cognitive impairment and dementia.

The relative value of sociocultural and infrastructural adaptations to heat in a very hot climate in northern Australia: a case time series of heat-associated mortality

Climate change is increasing heat-associated mortality particularly in hotter parts of the world. The Northern Territory is a large and sparsely populated peri-equatorial state in Australia. The Northern Territory has the highest proportion of Aboriginal and Torres Strait Islander people in Australia (31%), most of whom live in remote communities of over 65 Aboriginal Nations defined by ancient social, cultural, and linguistic heritage. The remainder non-Indigenous population lives mostly within the two urban centres (Darwin in the Top End region and Alice Springs in the Centre region of the Northern Territory). Here we aim to compare non-Indigenous (eg, high income) and Indigenous societies in a tropical environment and explore the relative importance of physiological, sociocultural, and technological and infrastructural adaptations to heat. In this case time series, we matched temperature at the time of death using a modified distributed lag non-linear model for all deaths in the Northern Territory, Australia, from Jan 1, 1980, to Dec 31, 2019. Data on deaths came from the national registry of Births, Deaths and Marriages. Cases were excluded if location or date of death were not recorded or if the person was a non-resident. Daily maximum and minimum temperature were measured and recorded by the Bureau of Meteorology. Hot weather was defined as mean temperature greater than 35°C over a 3-day lag. Socioeconomic status as indicated by Index of Relative Socioeconomic Disadvantage was mapped from location at death. During the study period, 34 782 deaths were recorded; after exclusions 31 800 deaths were included in statistical analysis (15 801 Aboriginal and 15 999 non-Indigenous). There was no apparent reduction in heat susceptibility despite infrastructural and technological improvements for the majority non-Indigenous population over the study period with no heat-associated mortality in the first two decades (1980-99; relative risk 1·00 [95% CI 0·87-1·15]) compared with the second two decades (2000-19; 1·14 [1·01-1·29]). Despite marked socioeconomic inequity, Aboriginal people are not more susceptible to heat mortality (1·05, [0·95-1·18]) than non-Indigenous people (1·18 [1·06-1·29]). It is widely believed that technological and infrastructural adaptations are crucial in preparing for hotter climates; however, this study suggests that social and cultural adaptations to increasing hot weather are potentially powerful mechanisms for protecting human health. Although cool shelters are essential during extreme heat, research is required to determine whether excessive exposure to air-conditioned spaces might impair physiological acclimatisation to the prevailing environment. Understanding sociocultural practices from past and ancient societies provides insight into non-technological adaptation opportunities that are protective of health. None.

Disease profiles in the Indigenous Australian population are suggestive of a common complement control haplotype.

Aboriginal and Torres Strait Islander People (respectfully referred to as Indigenous Australians herein) are disparately burdened by many infectious and chronic diseases relative to Australians with European genetic ancestry. Some of these diseases are described in other populations to be influenced by the inherited profile of complement genes. These include complement factor B, H, I and complement factor H-related (CFHR) genes that can contribute to a polygenic complotype. Here the focus is on the combined deletion of CFHR1 and 3 to form a common haplotype (CFHR3-1Δ). The prevalence of CFHR3-1Δ is high in people with Nigerian and African American genetic ancestry and correlates to a higher frequency and severity of systemic lupus erythematosus (SLE) but a lower prevalence of age-related macular degeneration (AMD) and IgA-nephropathy (IgAN). This pattern of disease is similarly observed among Indigenous Australian communities. Additionally, the CFHR3-1Δ complotype is also associated with increased susceptibility to infection with pathogens, such as Neisseria meningitidis and Streptococcus pyogenes, which also have high incidences in Indigenous Australian communities. The prevalence of these diseases, while likely influenced by social, political, environmental and biological factors, including variants in other components of the complement system, may also be suggestive of the CFHR3-1Δ haplotype in Indigenous Australians. These data highlight a need to define the Indigenous Australian complotypes, which may lead to the discovery of new risk factors for common diseases and progress towards precision medicines for treating complement-associated diseases in Indigenous and non-Indigenous populations. Herein, the disease profiles suggestive of a common complement CFHR3-1Δ control haplotype are examined.

Absolute cardiovascular risk assessment by Australian early-career general practitioners: a cross-sectional study

ObjectiveTo determine the prevalence and associations of general practice registrars’ performing absolute cardio-vascular risk (ACVR) assessment (ACVRa).DesignA cross-sectional study employing data (2017–2018) from the Registrar Clinical Encounters in Training project,...

Practice and product: a social semiotic approach to visual communication in sexual and reproductive health promotion

This article investigates the use of visual communication in sexual and reproductive health information resources produced by an Australian Family Planning organization for different populations – people from culturally and linguistically diverse backgrounds (especially recent immigrants from Syria and Afghanistan), Aboriginal and Torres Strait Islander people, and young people from both these groups. Co-authored by a semiotician and the manager of the organization’s Health Promotion Team, it combines visual analysis of semiotic products with firsthand experience of the organization’s semiotic practices. The article shows how the same medical information leads to different health information products for different groups on the basis of ideas about what can be considered culturally acceptable to these groups. In this way, it demonstrates a social semiotic approach to the analysis of visual communication in which the findings of analysing visual products are understood in relation to the practices of their production.

Disability workforce and the NDIS planning process in regional, rural and remote regions of Australia: Scoping review.

The Australian geographically rural and remote disability workforce has historically demonstrated difficulties to keep up with the demand for quality services and supports for people with disability. In 2013, the National Disability Insurance Scheme (NDIS) was launched to provide individualised disability support packages to meet people's needs. To receive funding, people with disability are required to develop a NDIS plan. That plan is then funded by the National Disability Insurance Agency (NDIA), the government agency responsible for managing the NDIS. Although the NDIS has been operating for almost 10 years, there is limited research into the planning experiences of the workforce in regional, rural and remote regions of Australia. This review aims to ascertain the level of scholarly investigation into workers' experiences of NDIS planning. Research publication databases were searched using a specific search string to identify publications that included reference to the workforce's experiences of the NDIS planning process in regional, rural and remote regions of Australia. The Mixed Methods Appraisal Tool (MMAT) was adopted to appraise the quality of the research publications. Research publications that focused on those working with Aboriginal and Torres Strait Islander people were also appraised using the Aboriginal and Torres Strait Islander Quality Appraisal Tool developed by the Centre for Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange. A thematic synthesis of the publications was undertaken to ascertain disability and health workforce experiences of the NDIS planning process. Seven papers met the selection criteria. Two papers were policy reviews and reported the improvements of the NDIS planning process since its inception. These studies reported four reoccurring themes: (1) cultural/socioeconomic and geographical factors; (2) administrative burden and bureaucracy; (3) values, culture and geography; and (4) burden on allied health workers. The NDIS planning process has developed and progressed since its rollout in 2013. There are limited research papers available that describe the workforce's experience of the planning process in regional, rural and remote regions. More research in this area is needed to identify the experiences of the disability workforce in relation to the NDIS planning process.