Volume 197 Issue 1

Indigenous self-determination is essential to health and wellbeingFor me, the Aboriginal tent embassy is something that has always been there in my consciousness as something I gain strength from, and a reminder of how far we’ve come (and how far we have to go) in building a better future for Aboriginal and Torres Strait Islander peoples. Now at its 40th anniversary, the tent embassy continues to ...

Peter O’Mara FRACGP, FARGP, GradDipRuralGenPrac

What can the Treaty of Waitangi teach Australia about reducing disparities in health? The health status of indigenous populations in Australia and New Zealand gives justified cause for concern. After European colonisation, their survival was threatened by a range of infectious diseases to which they had little or no immunity. Though no longer the threat posed in the 19th century, the incidence of infectious diseases remains ...

Mason H Durie CNZM, MB ChB, DPsych, DLitt

The full content of this article is available by downloading the PDF.

The full content of this article is available by downloading the PDF.

Dennis McDermott argues that educating doctors about the health consequences of everyday racism towards Indigenous Australians challenges all involvedAgenuine engagement with Indigenous health issues challenges medical students and doctors alike. When participants in medical education analyse racism as a social determinant of health, the challenge deepens. The experience can range from disquieting to profoundly disturbing. For educators, the experience can be stressful, even daunting. Analysing racism ...

Dennis R McDermott BEc, BA(Hons)(Psych), MA

Working with Indigenous communities towards research that is relevant, effective and culturally respectful. Writing in the Journal about Indigenous health in 2011, Sir Michael Marmot suggested that the challenge was to conduct research, and to ultimately apply findings from that research, to enable Indigenous Australians to lead more flourishing lives that they would have reason to value. As committed Indigenous health researchers in Australia, we reflect ...

Lisa M Jamieson PhD · Yin C Paradies PhD · Sandra Eades PhD · Alwin Chong MPH · Louise Maple-Brown PhD · Peter Morris PhD · Ross Bailie PhD · Alan Cass PhD · Kaye Roberts-Thomson MPH · Alex Brown PhD

Genomics is a powerful research tool, but it must be handled with careOf all the measurements and biological samples used in health research, it is the extraction and analysis of genetic material that has caused the most controversy in indigenous health research across the globe. No other kind of research has a specific inter- national non-governmental organisation dedicated to opposing it — the Indigenous People’s ...

Emma E Kowal MB BS, BA(Hons), PhD

“The girls don’t drink much; ’bout the same as the fellas.” I am an Aboriginal woman, with traditional connections to the Bidjara people from central western Queensland and extensive experience in working with Aboriginal women who consume alcohol during pregnancy. During several decades of working in the health field, I have asked myself and others why Aboriginal people drink alcohol at such dangerous levels. As I have reported ...

Lorian G Hayes MAppEpid, BAppHlthSc(Hons)

A systematic search at the source of the smoking problemWhile there has been a redoubling of efforts to reduce smoking rates among Indigenous Australians, Indigenous health researchers have paid almost no attention to the tobacco industry — the “vector” of smoking-related diseases. The exceptions are two reports of the use of Aboriginal images to advertise Winfield cigarettes in Europe.1,2 We decided to examine industry documents ...

David P Thomas MB BS, PhD, FAFPHM · Laura Bond BHSc, MPH

To the Editor: It has been estimated that “levelling the playing field” in terms of cardiovascular health alone could narrow the life-expectancy gap between Indigenous and non-Indigenous Australians by 6.5 years.1 While there has been a particular (and important) focus on risk factor modification, and prevention and management of chronic disease, it is worth noting that, compared with other Australians, Aboriginal and Torres Strait Islander people have: three ...

Robert D Grenfell · Vicki Wade · Eleanor Clune · Kelley O’Donohue · Prue Power

To the Editor: Woods and colleagues provide a timely and descriptive reminder of cyclone Yasi and the 2010–2011 summer.1 The evacuation of the hospitals on the Cairns foreshore, a decision made by the Queensland Premier, was the largest hospital evacuation in Australian history. The capability to successfully aeromedically transport 297 patients 1800 km, in a window of 22 hours, without loss of life or reported adverse clinical incident, was ...

Jeannette R Young · Mark S Elcock · Peter J Aitken

To the Editor: George,1 who has received a research grant from Pfizer on smoking cessation, makes the manifestly incorrect statement that “there is no evidence for the effectiveness of cold turkey cessation, especially in moderate to heavy smokers”. In fact, it has always been the case that the most common method used by ex-smokers in their final successful attempt to quit is cold turkey.2 Those promoting ...

Simon Chapman

In reply: The response of Chapman to my article is not surprising, given his involvement in the Alpert article.1 The recommendations of Alpert and colleagues have already been criticised internationally, and debate on the effectiveness of pharmacological smoking cessation therapies is not new. Meta-analyses have shown 50% to 70% greater quit rates for nicotine replacement therapy (NRT) compared with placebo or in controls.2,3 Advocates of ...

Johnson George

To the Editor: National disclosure of health care-associated infections has recently been facilitated by the launch of the MyHospitals website by the Australian Institute of Health and Welfare (http://www.myhospitals. gov.au). As high rates of Staphylococcus aureus bacteraemia (SAB) have been reported at our tertiary health care facility,1 we wish to outline the pitfalls and potential misrepresentation of generic health care infection surveillance data when used ...

Leon J Worth · Karin A Thursky · Monica A Slavin

To the Editor: Rates of health care-associated Staphylococcus aureus bacteraemia (HCA-SAB) and hand hygiene (HH) compliance are now subject to public disclosure on the MyHospitals website (http://www.myhospitals.gov.au). HH compliance and HH alcohol hand rub and liquid soap procurement have been associated with reduced methicillin-resistant (but not methicillin-sensitive) S. aureus bacteraemias, generally in the presence of other co-interventions.1,2 However, the National Hand Hygiene Initiative advocates that ...

E Geoffrey Playford · David McDougall · Mary-Louise McLaws

To the Editor: Speer and colleagues’ recent article concerning pancreatic cancer outcomes makes sobering reading.1 Notwithstanding the results of surgery being in line with other case series, they found a somewhat high rate (nearly 40%) of positive resection margins in patients undergoing surgery with curative intent. The authors also cite evidence from other studies indicating benefit from a small number of surgeons each performing a ...

Andrew A Thomson

The burden of type 2 diabetes mellitus (T2DM) among Indigenous children and adolescents is much greater than in non-Indigenous young people and appears to be rising, although data on epidemiology and complications are limited. Young Indigenous people living in remote areas appear to be at excess risk of T2DM. Most young Indigenous people with T2DM are asymptomatic at diagnosis and typically have a family history ...

Peter Azzopardi MB BS, MEpi, FRACP · Alex D Brown BMed, MPH, PhD · Paul Zimmet MD, PhD, FRACP · Rose E Fahy MB BCh, FRACP, MRCP · Glynis A Dent Grad Cert Diabetes Education, Grad Cert Human Nutrition · Martin J Kelly MB BS, FACRRM, PhD · Kira Kranzusch MB BS, FRACP · Louise J Maple-Brown MB BS, FRACP, PhD · Victor Nossar MB BS, FRACP, FAFPHM · Martin Silink MD, FRACP · Ashim K Sinha MB BS, MD, FRACP · Monique L Stone MB BS, FRACP, MD · Sarah J Wren MHSc (Nursing), Grad Cert Diabetes Education

Objective: To estimate the prevalence of mental disorder in a representative sample of Aboriginal and Torres Strait Islander people in Queensland prisons.Design, setting and participants: Cross-sectional assessment of mental health using the Composite International Diagnostic Interview (CIDI) and clinical interviews, conducted by Indigenous mental health clinicians who undertook specific training for this purpose, with support from forensic psychiatrists when indicated. We ...

Edward B Heffernan MB BS, MPH, FRANZCP · Kimina C Andersen BSW · Abhilash Dev BDS, MPH · Stuart Kinner BA(Hons), PhD

Objective: To determine the effectiveness of an intensive quit-smoking intervention on smoking rates at 36 weeks’ gestation among pregnant Aboriginal and Torres Strait Islander women.Design: Randomised controlled trial.Setting and participants: Pregnant Aboriginal and Torres Strait Islander women (n = 263) attending their first antenatal visit at one of three Aboriginal community-controlled health services between June 2005 and December 2009.Intervention: A general ...

Sandra J Eades BMed, PhD · Rob W Sanson-Fisher PhD, ClinMPsych · Mark Wenitong BMed · Katie Panaretto MB BS · Catherine D’Este BMath, PhD · Conor Gilligan BBiomedSc, PhD · Jessica Stewart BA/LLB, MPP

Objectives: To document the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in the refugee population settling in Western Australia from 1 January 2006 to 31 December 2009 and make recommendations for future screening for chlamydia and gonorrhoea in the refugee population.Design and participants: A prevalence and quality assurance study of 2610 refugees aged 15 years and older who attended the Humanitarian Entrant Health Service in Western Australia ...

Veronica C Hoad MB BS, MPH · Aesen Thambiran MB BS, FRACGP

Objective: To undertake a systematic literature review to determine the scope, rationales, and evaluation foci of indigenous health curricula included in university-based professional training of health care service providers.Study design: Systematic review.Data sources: We searched the Australasian Medical Index, ATSIhealth (Aboriginal and Torres Strait Islander Health Bibliography), CINAHL PLUS, MEDLINE, SCOPUS version 4, and Web of Science databases using relevant keywords. Our ...

Shaun C Ewen BAppSc(Physio), MMIL, DEd · David J Paul MB BS, PhD · Gina L Bloom BA(Hons), MPhil

An adventure holiday provides respite, and an awareness of burdens carried by patients and their carers. Epidermolysis bullosa (EB) is a rare hereditary genodermatosis, classified into simplex, junctional and dystrophic EB (DEB), and Kindler syndrome. Patients with severe types of EB, such as junctional EB and recessive DEB (RDEB), experience a significant daily burden of disease due to extremely fragile skin and limited physical ability. In 2004, ...

Shelley J Hwang · Min-Hee Kim · Anna Kemble Welch BArch · Martin C Hanley BBSc · Dedee F Murrell BM BCh, MD, FACD

A group of Indigenous Research Fellows describe the lessons learnt from their involvement in Indigenous health researchWe are a group of Indigenous Research Fellows (IRFs) involved in the Kanyini Qualitative Study (KQS), examining barriers and enablers to chronic disease care for Indigenous Australians. The KQS forms part of the Kanyini Vascular Collaboration (KVC), a health services research program established to reduce the burden and suffering ...

Ricky A Mentha GradCert (RemoteHealthMgmt) · Joanne de Vries DipPHC · Pamela R Simon · Barry N Fewquandie GradCert(PHC) · John Brady BSciApp · Suzanne Ingram BA(Comm), GradCertHealthSciences

PROPOSALS FOR CHANGE, states Machiavelli, with whom the book opens, are met with retaliation from those “who do well out of the old order”. Jorm’s book regards “the old order” as “senior consultants doing it this way for twenty or thirty or forty years”. But another, more recent, order is also under fire: the increasing bureaucratic regulation of medical practice enacted by “primitive and poorly ...

Rick A M Iedema

There are plenty of opportunities to get involved as an educator in Indigenous health.

Sophie McNamara

Dr Shirley Godwin, senior lecturer in Indigenous Health, University of Notre Dame, Fremantle, WA

Cate Swannell

Associate Professor Peter O’Mara is president of the Australian Indigenous Doctors’ Association. He is head of the Discipline of Indigenous Health at the University of Newcastle, and a director of the Wollotuka Institute, which consolidates all Indigenous activities at the university. He continues to practise clinically as a GP at an Aboriginal Medical Service in Forster, NSW.

Interview by Sophie

Forensic physicians practise at the intersection of medicine and the legal system.

Sophie McNamara

How will the superannuation changes hit your nest egg?

Amanda Bryan