Torres Strait Islander Population Research Articles

SY4 - Economic Evaluation of An Automated Retinal Image Analysis In Australian Aboriginal And Torres Strait Islander Populations For Detection of Diabetic Retinopathy

SY4 - Economic Evaluation of An Automated Retinal Image Analysis In Australian Aboriginal And Torres Strait Islander Populations For Detection of Diabetic Retinopathy

Comparing risks of cerebral palsy in births between Australian Indigenous and non-Indigenous mothers.

To compare proportions of live births subsequently described as having cerebral palsy (CP), the distributions of associated impairments, and the causes of postneonatal CP between Aboriginal and Torres Strait Islander (Indigenous) and non-Indigenous populations in Australia. Data from statutory birth records and CP registers for the 1996 to 2005 birth cohort in Queensland, Western Australia, and the Northern Territory were stratified by Indigenous status and whether the CP was acquired pre/perinatally or postneonatally. Relative risks associated with Indigenous status were estimated and the distributions of causes of postneonatal CP compared. Indigenous births had a relative risk of 4.9 (95% confidence interval [CI] 3.0-7.9) for postneonatal CP but only of 1.42 (95% CI 1.2-1.7) for pre/perinatal CP. Almost half of postneonatal CP in Indigenous infants resulted from infection, whereas for non-Indigenous infants the most frequent cause was cerebrovascular accident. The impairments of Indigenous CP and of postneonatally acquired CP tended to be more numerous and more severe. Indigenous children are at significantly greater risk of CP, particularly postneonatal CP. The predominant cause of postneonatal CP in non-Indigenous children has shifted to cerebrovascular accident over time; however, infections followed by head injury are still the most frequent causes in Indigenous infants.

Risk factors for cancer in the Australian Aboriginal and Torres Strait Islander population: a systematic review.

Cancer incidence in the Australian Aboriginal and Torres Strait Islander population is higher and survival lower compared with non-Indigenous Australians. A proportion of these cancers are potentially preventable if factors associated with carcinogenesis are known and successfully avoided. We conducted a systematic review of the published literature to examine risk factors for cancer in the Australian Aboriginal and Torres Strait Islander population. Electronic databases Medline, Web of Science and the Australian Aboriginal and Torres Strait Islander Health Bibliographic Index were searched through August 2014 using broad search terms. Studies reporting a measure of association between a risk factor and any cancer site in the Australian Aboriginal and Torres Strait Islander population were eligible for inclusion. Ten studies (1991-2014) were identified, mostly with small sample sizes, showing marked heterogeneity in terms of methods used to assess exposure and capture outcomes, and often using descriptive comparative analyses. Relatively young (as opposed to elderly) and geographically remote Aboriginal and Torres Strait Islanders were found to be at increased risk for selected cancers while most modifiable lifestyle and behavioural risk factors were rarely assessed. Further studies examining associations between potential risk factors and cancer will help define public health policy for cancer prevention in the Australian Aboriginal and Torres Strait Islander population.

Introduction: Australian Perspectives: Genocide, the Health Professions, and an Inglorious Past

Health & History, 2016. 18/2 1 Introduction Australian Perspectives: Genocide, the Health Professions, and an Inglorious Past Michael Robertson, Kirril Shields, and Linda Shields This special edition of Health and History falls on the seventieth anniversary of the verdicts of the Nuremburg International Military Tribunal war crimes trials, and the commencement of proceedings in United States-v-Karl Brandt et al. (the so-called ‘Doctors Trial’).1 It is therefore timely to reflect upon current historiographical and sociocultural engagements in relation to health and health practice that are legacies of the Holocaust. The aim of this special edition of Health and History is to provide an Australian scholarly voice to that history and historiography; to examine the role of health professionals within genocidal events that are not solely the Holocaust, but extend, in this case, to Armenia, Bosnia, and Australia. The term ‘genocide’ was coined in 1944 by Polish jurist Raphael Lemkin, who defined the act as ‘the destruction of a nation or of an ethnic group’.2 Yet the definition is problematic and the discipline of ‘genocide studies’ has come to integrate multiple discourses that reflect this divergence in opinions over what exactly constitutes genocide.3 Here, in this edition of Health and History, the nature of these killings and their location extends beyond Auschwitz, to other European locations, and to Australia itself. What is not included are the plethora of other genocides that erupted in Cambodia, Rwanda, and South Sudan; much of the ethnic cleansing of the colonial era both in and outside Australia; the program of state sponsored mass murder under Stalin’s rule; and recent events in Syria and Iraq. While genocide is not a criminal act particular to the Holocaust, the Holocaust is often considered the most bureaucratic of genocides given its reliance on the apparatus of the modern industrialised state. This apparatus included the government’s need for efficient transport infrastructure, the use of police and security services, certain functions of governmental hierarchies, the compliance of professions, a culture of scientism, and a willing 2 MICHAEL ROBERTSON, KIRRIL SHIELDS, LINDA SHIELDS or tightly controlled press.4 The uniqueness or distinctness of the Holocaust has been subject to considerable debate, often polemic and intensely political.5 Discourses surrounding the Holocaust are multi-faceted, shifting from suggestions that the Holocaust was a unique German act built from a particular meld of anti-Semitism and fascist politics, to the idea that this murderous episode was one of numerous killings carried out in the so-called ‘bloodlands’ of Eastern Europe.6 Included in this shifting focalisation are politicised debates over the use of the term ‘Holocaust’ to denote any victim of the National Socialist regime. Regardless of semantics or what might be considered the appropriation of blame, included in this bureaucratic system were health professionals such as nurses, physicians, paediatricians, and psychiatrists. This edition of Health and History examines the role of these health professionals as participants in this particular killing apparatus, but also as the victims of these measures, including Jewish health professionals denied the right to practice due to Nazi regulations. Garry Walter provides a biographical overview of his grandfather, the Austrian-Jewish doctor Otto Walter. The paper traces Otto’s early days as a reputable clinician inVienna prior to the Anschluss, and the subsequent repercussions National Socialism had on his life, family, and medical career. The narrative of Otto Walter’s life as an émigré European Jew in Australia demonstrates how institutionalised racism in the Australian academy, such as Sydney University’s Faculty of Medicine in the 1950s and 60s, was redolent of the racism he encountered in nazified Europe. Garry Walter’s personal homage to his grandfather bears witness to an individual and family tragedy against the backdrop of Mitteleuropa, drawing an arc of racist exclusion from Vienna to the xenophobic angst of the mid-century Sydney medical profession. Such observations intersect with Colin Tatz’s contribution, in which he considers more generally Australian attitudes to the genocide of the Australian Aboriginal and Torres Strait Islander population. Here Tatz outlines why he believes this killing and subjugation of indigenous Australians is a genocide. Tatz’s paper “Australia: The ‘Good’ Genocide Perpetrator?” seeks to define...

Yarning and appreciative inquiry: The use of culturally appropriate and respectful research methods when working with Aboriginal and Torres Strait Islander women in Australian prisons

With First Peoples and non–First Peoples scholars alike questioning the efficacy of research methods based solely upon accepted social science research paradigms with Aboriginal and Torres Strait Islander populations, innovative and ontologically inclusive alternatives require consideration. Research conducted with incarcerated Aboriginal and Torres Strait Islander women in the Northern Territory and Western Australia may provide such an opportunity, arguing for a method of ‘research at the interface’ that utilises appreciative inquiry with culturally appropriate conversations (yarning). Employed across four prisons, the interface research method was applied as an innovative solution to measuring prison performance. It highlighted the lived experience of incarceration while re-imagining the prison, as it exists when it functions at its best. The article begins with a snapshot of the research conducted with Aboriginal and Torres Strait Islander women in prisons across the Northern Territory and Western Australia; this provides a frame through which to consider the efficacy of interfacing First Peoples research paradigms with Western traditional modes of research. Furthermore, the innovative application of appreciative inquiry to the prison is discussed. Given that appreciative inquiry explores and privileges the narrative as a means of making sense of the prison experience, the authors suggest it complements the Aboriginal and Torres Strait Islander tradition of ‘yarning’. A yarning style represents a way of ensuring cultural safety, respect and the utilisation of First Peoples ontology to research conducted with Aboriginal and Torres Strait Islander women. Overall, it is delineated how interfacing appreciative inquiry and yarning may provide a viable alternative to the deep colonising and perpetually oppressive use of Western modes of scholarship when engaging in research with First Peoples.

Analysing and Projecting Indigenous Migration in Australia

In this paper, a model is developed to project interregional migration flows for the Aboriginal and Torres Strait Islander (Indigenous) populations in Australia at the state and territory level by age and sex. Migration flow data, obtained from the three most recent Australian quinary censuses (2001, 2006 and 2011), are first assessed and analysed in comparison with the patterns of the corresponding non-Indigenous population. Log-linear models are used to identify the key structures and patterns over time. A model is then developed to project the migration flows by origin, destination, age and sex forward in 5-year increments to 2031. This includes incorporating techniques to overcome the small number cell issues associated with the very small population size of the Indigenous population. The results of this research provide (i) insights into the different migration patterns of an important but disadvantaged minority population in Australia and (ii) inputs for a dynamic multiregional model of Indigenous population change.

Using Indigenist and Indigenous methodologies to connect to deeper understandings of Aboriginal and Torres Strait Islander peoples' quality of life.

The lack of a common description makes measuring the concept of quality of life (QoL) a challenge. Whether QoL incorporates broader social features or is attributed to health conditions, the diverse range of descriptions applied by various disciplines has resulted in a concept that is multidimensional and vague. The variety of theoretical conceptualisations of QoL confounds and confuses even the most astute. Measuring QoL in Aboriginal and Torres Strait Islander populations is even more challenging. Instruments commonly developed and used to measure QoL are often derived from research methodologies shaped by Western cultural perspectives. Often they are simply translated for use among culturally and linguistically diverse Aboriginal and Torres Strait Islander peoples. This has implications for Aboriginal and Torres Strait Islander populations whose perceptions of health are derived from within their specific cultures, value systems and ways of knowing and being. Interconnections and relationships between themselves, their communities, their environment and the natural and spiritual worlds are complex. The way in which their QoL is currently measured indicates that very little attention is given to the diversity of Aboriginal and Torres Strait Islander peoples' beliefs or the ways in which those beliefs shape or give structure and meaning to their health and their lives. The use of Indigenist or Indigenous methodologies in defining what Aboriginal and Torres Strait Islander peoples believe gives quality to their lives is imperative. These methodologies have the potential to increase the congruency between their perceptions of QoL and instruments to measure it.

Chronic kidney disease in an Aboriginal population: A nurse practitioner-led approach to management.

Chronic kidney disease (CKD) is a significant health problem impacting Australia's Aboriginal and Torres Strait Islander population. After age adjustment, the prevalence of kidney disease is 3.7 times higher in Aboriginal people and 7.3 times higher for end-stage kidney disease compared with the wider population. Yet at an Aboriginal Community Controlled Health Service (ACCHS) with a significant patient population, fewer than expected numbers of Aboriginal patients were identified with CKD. The ACCHS engaged a nurse practitioner to lead a systematic approach to the identification and treatment of CKD. This nurse practitioner-led approach to CKD was developed and implemented at a rural NSW ACCHS, with the support of a partnership formed between the nurse practitioner, the ACCHS, a nephrologist from a referral hospital and a statewide NGO. The primary measure for improvement has been to identify and stage patients with CKD and establish management plans as appropriate. This nurse-led project was established to: (i) identify patients with CKD; (ii) provide access for CKD patients to appropriate services; (iii) commence pharmacological and non-pharmacological strategies that enable remission or regression of CKD; and (iv) educate practice GPs and other staff members on CKD clinical guidelines and best practice. The CKD project has improved access to essential health care for vulnerable and at-risk populations, with 187 patients to date having been identified with kidney disease and staged for its severity. The need for strong multi-disciplinary teamwork has been demonstrated with good communication strategies implemented.

Identification change and its effect on projections of the Aboriginal and Torres Strait Islander population in Australia

Since the 1971 Census, the Australian Aboriginal and Torres Strait Islander (Indigenous) population has grown faster than predicted by births, deaths and migration. An important and likely source of this unexplained growth is identification change, where a person changes how they identify or are identified by the household between one census and the next. In this paper, we use the Australian Census Longitudinal Dataset to detect identification change between 2006 and 2011 and include this information in a multistate population projection model. The projection model is applied to Australia, New South Wales and the Northern Territory over the period 2011–2061. The results indicate that identification change, particularly in the youngest age groups (0–9 years), had a positive impact on Indigenous population growth between 2006 and 2011. The projected Indigenous population initially grows faster than otherwise due to a net increase in people identifying as Indigenous, but slows as it interacts with the slow-growing non-Indigenous population. The results also suggest that the way in which identification change is modelled substantially affects projected trajectories, particularly in areas where identification change is substantial. While demographic modelling would benefit from further multidisciplinary research on the drivers and populations at risk of Indigenous status change, this study underscores the importance of incorporating identification change to improve projections of the Indigenous population in Australia.

Cryptosporidiosis: A Disease of Tropical and Remote Areas in Australia.

Cryptosporidiosis causes gastroenteritis and is transmitted to humans via contaminated water and food, and contact with infected animals and people. We analyse long-term cryptosporidiosis patterns across Australia (2001–2012) and review published Australian studies and jurisdictional health bulletins to identify high risk populations and potential risk factors for disease. Using national data on reported cryptosporidiosis, the average annual rate of reported illness was 12.8 cases per 100 000 population, with cycles of high and low reporting years. Reports of illness peak in summer, similar to other infectious gastrointestinal diseases. States with high livestock densities like New South Wales and Queensland also record a spring peak in illnesses. Children aged less than four years have the highest rates of disease, along with adult females. Rates of reported cryptosporidiosis are highest in the warmer, remote regions and in Aboriginal and Torres Strait Islander populations. Our review of 34 published studies and seven health department reports on cryptosporidiosis in Australia highlights a lack of long term, non-outbreak studies in these regions and populations, with an emphasis on outbreaks and risk factors in urban areas. The high disease rates in remote, tropical and subtropical areas and in Aboriginal and Torres Strait Islander populations underscore the need to develop interventions that target the sources of infection, seasonal exposures and risk factors for cryptosporidiosis in these settings. Spatial epidemiology can provide an evidence base to identify priorities for intervention to prevent and control cryptosporidiosis in high risk populations.

P01.08 Structural and contextual factors in the sexual health of adolescent aboriginal australians: a systematic review

Background Levels of STIs and teenage pregnancy among Aboriginal and Torres Strait Islander populations are significantly higher than among non-Indigenous populations. However, recent research has shown few differences in the sexual behaviour of young Indigenous and non-Indigenous Australians. We conducted a systematic review to examine the multi-dimensional and socially constructed nature of adolescent sexuality with a view to developing meaningful STI and pregnancy reduction programmes for young Indigenous Australians. Methods Following standard guidelines for systematic reviews we searched eight relevant databases for published studies. We focused on publications since January 2003 using search terms: adolescent, youth, sexual, Australia, Indigenous, Aboriginal and Torres Strait. Given the limited amount of literature available we included all study designs and studies of broader age ranges or populations, but where Indigenous and adolescent populations were disaggregated in study results. Results We identified an initial 2,718 citations through the database search. After removing duplicates and citations that were not peer-reviewed or research articles, we screened 2,266 articles and excluded 2,158. The remaining 180 articles were reviewed in full: 93 did not meet inclusion criteria. Our review finally comprised 15 research papers, representing eleven distinct studies. Across the literature included in the review a number of key social determinants of poor sexual health were identified. These included alcohol, poverty, gender inequalities, intergenerational trauma, limited access to education and employment, shame, constrained adult role models and aspirations and restricted access to (sexual) health services. We examine the role of these factors with regard to adolescent Indigenous sexual health. Conclusions International research argues that promoting good sexual health requires a broader focus on sexuality. The socio-cultural and historical contexts of Indigenous communities suggest that focusing on strengths-based approaches to sexual health with peer or community facilitation might be acceptable and effective for young Indigenous Australians. Disclosure of interest statement Catherine MacPhail and Kathy McKay were supported by the Collaborative Research Network on Mental Health and Wellbeing in Rural Communities, Department of Industry, Innovation, Science, Research and Tertiary Education, Commonwealth Government of Australia.

Automated multi-lesion detection for referable diabetic retinopathy in indigenous health care.

Diabetic Retinopathy (DR) is a complication of diabetes mellitus that affects more than one-quarter of the population with diabetes, and can lead to blindness if not discovered in time. An automated screening enables the identification of patients who need further medical attention. This study aimed to classify retinal images of Aboriginal and Torres Strait Islander peoples utilizing an automated computer-based multi-lesion eye screening program for diabetic retinopathy. The multi-lesion classifier was trained on 1,014 images from the São Paulo Eye Hospital and tested on retinal images containing no DR-related lesion, single lesions, or multiple types of lesions from the Inala Aboriginal and Torres Strait Islander health care centre. The automated multi-lesion classifier has the potential to enhance the efficiency of clinical practice delivering diabetic retinopathy screening. Our program does not necessitate image samples for training from any specific ethnic group or population being assessed and is independent of image pre- or post-processing to identify retinal lesions. In this Aboriginal and Torres Strait Islander population, the program achieved 100% sensitivity and 88.9% specificity in identifying bright lesions, while detection of red lesions achieved a sensitivity of 67% and specificity of 95%. When both bright and red lesions were present, 100% sensitivity with 88.9% specificity was obtained. All results obtained with this automated screening program meet WHO standards for diabetic retinopathy screening.

Tobacco control policies and activities in Aboriginal community-controlled health services.

To describe tobacco control policies and activities at a nationally representative sample of Aboriginal community-controlled health services (ACCHSs). The Talking About The Smokes (TATS) project used a quota sampling design to recruit 34 ACCHSs around Australia. Between April 2012 and October 2013, a representative at each ACCHS completed a survey about the service's tobacco control policies and activities. Questions about support for smoke-free policies were also included in the TATS project survey of 2435 Aboriginal and Torres Strait Islander members of the communities served by the ACCHSs. ACCHS tobacco control policies and activities. Thirty-two surveys were completed, covering 34 sites. Most ACCHSs (24/32) prioritised tobacco control "a great deal" or "a fair amount", and all services had smoke-free workplace policies. Most had staff working on tobacco control and had provided tobacco control training within the past year. A range of quit-smoking information and activities had been provided for clients and the community, as well as extra smoking cessation support for staff. There was strong support for smoke-free ACCHSs from within the Aboriginal communities, with 87% of non-smokers, 85% of ex-smokers and 77% of daily smokers supporting a complete ban on smoking inside and around ACCHS buildings. The high level of commitment and experience within ACCHSs provides a strong base to sustain further tobacco control measures to reduce the very high smoking prevalence in Aboriginal and Torres Strait Islander populations.

Successes in sexual health communications development, programmatic implementation and evaluation in the Torres Strait region 2006 to 2012

Objective:To evaluate the Indigenous sexual health promotion program in the Torres Strait 2006–2012 that culminated in an education‐entertainment radio drama, Kasa Por Yarn (KPY). Methods:A mixed methods approach applied to unpublished program documents and program‐derived peer‐reviewed publications was utilised. Results:Early initiatives established a strong partnership with Torres Strait Islander stakeholders. Significant community engagement throughout ensured a positive process. Telephone survey data (n=100, TSI, 15–24 years) found: 95% had heard of KPY and 80% listened to 2 or more episodes (reach); 86% recalled storylines/characters (recall); and 54% talked about KPY to family/friends (resonance). There was improvement in sexual health knowledge scores (p<0.00) in the 15–19‐year‐old Torres Strait Islander population between 2007 and 2012. The 2012 15–24‐year‐old population exposed to KPY had higher sexual health knowledge scores compared with those unexposed (p=0.02). Conclusions:This is an uncommon comprehensive evaluation of population‐based sexual health communications strategies delivered over years in a remote Australian setting. The findings are encouraging but demonstrate that positive shifts take time and are incremental. Implications:In addition to clinical strategies, strategic and sustained investment in sexual health promotion expertise that leads community partnership and program development is required to reduce youth risk and prevent HIV/AIDS in remote populations.

Research methods of Talking About The Smokes: an International Tobacco Control Policy Evaluation Project study with Aboriginal and Torres Strait Islander Australians.

To describe the research methods and baseline sample of the Talking About The Smokes (TATS) project. The TATS project is a collaboration between research institutions and Aboriginal community-controlled health services (ACCHSs) and their state and national representative bodies. It is one of the studies within the International Tobacco Control Policy Evaluation Project, enabling national and international comparisons. It includes a prospective longitudinal study of Aboriginal and Torres Strait Islander smokers and recent ex-smokers; a survey of non-smokers; repeated cross-sectional surveys of ACCHS staff; and descriptions of the tobacco policies and practices at the ACCHSs. Community members completed face-to-face surveys; staff completed surveys on paper or online. We compared potential biases and the distribution of variables common to the main community baseline sample and unweighted and weighted results of the 2008 National Aboriginal and Torres Strait Islander Social Survey (NATSISS). The baseline survey (Wave 1) was conducted between April 2012 and October 2013. 2522 Aboriginal and Torres Strait Islander people in 35 locations (the communities served by 34 ACCHSs and one community in the Torres Strait), and 645 staff in the ACCHSs. Sociodemographic and general health indicators, smoking status, number of cigarettes smoked per day and quit attempts. The main community baseline sample closely matched the distribution of the Aboriginal and Torres Strait Islander population in the weighted NATSISS by age, sex, jurisdiction and remoteness. There were inconsistent differences in some sociodemographic factors between our sample and the NATSISS: our sample had higher proportions of unemployed people, but also higher proportions who had completed Year 12 and who lived in more advantaged areas. In both surveys, similar percentages of smokers reported having attempted to quit in the past year, and daily smokers reported similar numbers of cigarettes smoked per day. The TATS project provides a detailed and nationally representative description of Aboriginal and Torres Strait Islander smoking behaviour, attitudes, knowledge and exposure to tobacco control activities and policies, and their association with quitting.

Characteristics and outcomes of critically ill Aboriginal and/or Torres Strait Islander patients in North Queensland.

A retrospective cohort analysis of an admission database for the intensive care unit at The Townsville Hospital was undertaken to describe the characteristics and short-term outcomes of critically ill Aboriginal and Torres Strait Islander patients. The Townsville Hospital is the tertiary referral centre for Northern Queensland and services a region in which Aboriginal and Torres Strait Islander people constitute 9.6% of the population. Aboriginal and Torres Strait Islander patients were significantly younger and had higher rates of invasive mechanical ventilation, emergency admissions and transfers from another hospital. Despite these factors, intensive care mortality did not differ between groups (9.4% versus 7.7%, P=0.1). Higher Acute Physiology and Chronic Health Evaluation III-j scores were noted in the Aboriginal and Torres Strait Islander population requiring emergency admission (65 versus 60, P=0.022) but were lower for elective admission (38 versus 42, P <0.001). Despite higher predicted hospital mortality for Aboriginal and Torres Strait Islander patients requiring emergency admission, no significant difference was observed (20.1% versus 19.1%, P=0.656). In a severity adjusted model, Aboriginal and/or Torres Strait Islander status did not statistically significantly alter the risk of death (odds ratio 0.88, 95% confidence interval 0.65, 1.2, P=0.398). Though Aboriginal and Torres Strait Islander patients requiring intensive care differed in admission characteristics, mortality was comparable to other critically ill patients.

Understanding Closing the Gap strategies from the perspective of Aboriginal and Torres Strait Islander peoples and their primary healthcare providers: a systematic review protocol

REVIEW OBJECTIVE(S)/QUESTION(S) The objective of this systematic literature review is to understand Aboriginal and Torres Strait Islander people and their primary healthcare providers’ experiences of Closing the Gap strategies which have been implemented by primary healthcare services in Australia from 2008. In order to achieve this objective the following questions will be addressed. 1. What are Aboriginal and Torres Strait Islander peoples’ experiences of Closing the Gap strategies that have been implemented by primary healthcare services? 2. What are primary healthcare providers’ experiences of Closing the Gap strategies that have been implemented by primary healthcare services? INCLUSION CRITERIA Types of participants Participants for question 1: Aboriginal and Torres Strait Islander peoples living in Australia who have sought or accessed primary health care services since 2008. There is no age limit. The authors also acknowledge the heterogeneity of Aboriginal and Torres Strait Islander populations and therefore, will attempt to consider the experiences of a number of different types of communities, including regional (urban, rural, and remote) and language groups wherever possible. Participants for question 2: Primary healthcare providers, including clinicians, managers and administrators, who have provided care to Aboriginal and Torres Strait Islander communities since 2008. Phenomena and intervention of interest The phenomena of interest for questions one is Aboriginal and Torres Strait Islander peoples’ experiences of Closing the Gap strategies which have been implemented in primary healthcare settings. The phenomena of interest for question two is primary healthcare providers’ experiences of Closing the Gap strategies which have been implemented in primary healthcare settings. Context The context is the primary healthcare services provided for Australian Aboriginal and Torres Strait Islander peoples.

Aboriginal health policy: is nutrition the 'gap' in 'Closing the Gap'?

To examine the extent to which nutrition has been prioritised in national Aboriginal and Torres Strait Islander health policy. Australian Government websites were searched for Aboriginal-specific health policies and strategies developed between 2000 and 2012. Thirteen documents describing nine policies were analysed. Increased and more comprehensive inclusion of nutrition in Aboriginal health policy was identified during the first half of this period. In the second half, however, nutrition strategies were fragmented, and a much greater emphasis was placed on smoking. With the exception of food security in remote communities, nutrition seems to have disappeared from the national Aboriginal health policy agenda. This is a concern, given the burden of nutrition-related disease in the Aboriginal and Torres Strait Islander population.

Evidence for low high-density lipoprotein cholesterol levels in Australian indigenous peoples: a systematic review.

BackgroundLow plasma high-density lipoprotein cholesterol (HDL-C) levels are a strong, independent, but poorly understood risk factor for cardiovascular disease (CVD). Although this atherogenic lipid abnormality has been widely reported in Australia’s Indigenous peoples, Aboriginal and Torres Strait Islanders, the evidence has not come under systematic review. This review therefore examines published data for Indigenous Australians reporting 1) mean HDL-C levels for both sexes and 2) factors associated with low HDL-C.MethodsPubMed, Medline and Informit ATSI Health databases were systematically searched between 1950 and 2012 for studies on Indigenous Australians reporting mean HDL-C levels in both sexes. Retrieved studies were evaluated by standard criteria. Low HDL-C was defined as: <1.0 mmol/L. Analyses of primary data associating measures of HDL-C with other CVD risk factors were also performed.ResultsFifteen of 93 retrieved studies were identified for inclusion. These provided 58 mean HDL-C levels; 29 for each sex, most obtained in rural/regional (20%) or remote settings (60%) and including 51–1641 participants. For Australian Aborigines, mean HDL-C values ranged between 0.81-1.50 mmol/L in females and 0.76-1.60 mmol/L in males. Two of 15 studies reported HDL-C levels for Torres Strait Islander populations, mean HDL-C: 1.00 or 1.11 mmol/L for females and 1.01 or 1.13 mmol/L for males. Low HDL-C was observed only in rural/regional and remote settings - not in national or urban studies (n = 3) in either gender. Diabetes prevalence, mean/median waist-to-hip ratio and circulating C-reactive protein levels were negatively associated with HDL-C levels (all P < 0.05). Thirty-four per cent of studies reported lower mean HDL-C levels in females than in males.ConclusionsVery low mean HDL-C levels are common in Australian Indigenous populations living in rural and remote communities. Inverse associations between HDL-C and central obesity, diabetes prevalence and inflammatory markers suggest a particularly adverse CVD risk factor profile. An absence of sex dichotomy in HDL-C levels warrants further investigation.

A framework for overcoming disparities in management of acute coronary syndromes in the Australian Aboriginal and Torres Strait Islander population. A consensus statement from the National Heart Foundation of Australia.

Aboriginal and Torres Strait Islander patients with acute coronary syndromes (ACS) experience lower intervention rates and poorer outcomes compared with non-Indigenous patients. A broad range of geographical, cultural and systemic factors contribute to delays and suboptimal treatment for ACS. Every Indigenous ACS patient, regardless of where they live, should be able to expect a coordinated, patient-centred pathway of care provided by designated provider clinical networks and supported by Indigenous cardiac coordinators, Aboriginal liaison officers (ALOs) and health workers. These designated provider clinical networks provide: appropriate prehospital and inhospital treatment an individualised patient care plan developed jointly with the patient and his or her family culturally appropriate education initiated within the hospital setting and involving families with support from ALOs effective follow-up care and access to relevant secondary prevention programs. We outline generic pathways to provide policymakers, health planners and health care providers with a framework for ACS diagnosis and management that can be implemented across the diverse settings in which Aboriginal and Torres Strait Islander people reside and their care is delivered, in order to optimise care and assertively address the current disparities in outcomes.