Topics
Indigenous health
Lip lupus erythematosus
A reminder of the high incidence of both systemic and cutaneous lupus erythematosus in Indigenous Australians.
Johanna M Warren · Peter F Bourke PhD, FRACP · Lachlan J Warren MB BS, FRACGP, FACD
The reliability of single-field fundus photography in screening for diabetic retinopathy: the Central Australian Ocular Health Study
A study comparing single-field fundus photography with expert clinical examination finds the former is a valid tool in detecting diabetic retinopathy in Indigenous people in remote communities of Central Australia.
Janice J-Y Ku MB BS · John Landers PhD, FRANZCO · Tim Henderson MB, ChB, FRANZCO · Jamie E Craig DPhil, FRANZCO
Male reproductive health disorders among Aboriginal and Torres Strait Islander men: a hidden problem?
A study of help-seeking behaviours, reproductive disorders and rates of testing for prostate problems in Aboriginal and Torres Strait Islander men from urban, rural and remote communities in the Northern Territory and Queensland.
Michael J Adams BSW, MA, PhD · Veronica R Collins BSc, MSc(Epidemiol), PhD · Michael P Dunne BA(Hons), PhD · David M de Kretser MB BS, MD, FRACP · Carol A Holden BSc(Hons), PhD, MPH
Sexual health in Indigenous communities
Extreme rates of gonorrhoea in remote areas must be reducedIn this issue of the Journal, there are two important articles highlighting the disadvantages experienced by Indigenous Australians, and offering important practical suggestions for improving health care.1,2 The article by Graham and colleagues analyses the notification rates for chlamydia and gonorrhoea in Australia by Indigenous status.1 Their findings are stunning. Compared with non-Indigenous Australians, Indigenous Australians have ...
Christopher K Fairley FRACP, PhD, FACSHP · Jane S Hocking MPH, MHlthSc, PhD
The roadmap to close the gap for vision
Indigenous Australians have six times more blindness than the national average, but 94% of the vision loss is preventable with eye examinations and timely access to treatment. The Roadmap emphasises regional needs-based planning for service delivery and accountability.
Hugh R Taylor MD, FRANZCO, AC · Andrea I Boudville MIH · Mitchell D Anjou MScOptom
Trends in reports of child maltreatment in the Northern Territory, 1999–2010
An analysis of administrative data shows rapid increases in both notifications and substantiated cases of maltreatment in the NT Aboriginal population, suggesting a need for further expansion of services to address both immediate safety and the wider determinants of maltreatment.
Steven L Guthridge MB BS, MTH, FAFPHM · Philip Ryan MB BS, FAFPHM · John R Condon PhD, FAFPHM · Leah M Bromfield BAppSci(Psych)(Hons), PhD · John R Moss MSocSci, MB BS, FPHAA · John W Lynch PhD, MPH
Epidemiology of chlamydia and gonorrhoea among Indigenous and non-Indigenous Australians, 2000–2009
Objectives: To assess notification trends for chlamydia and gonorrhoea infections in Indigenous Australians compared with non-Indigenous Australians in 2000–2009.Design and setting: We assessed trends in national notification rates using univariate Poisson regression and summary rate ratios.Main outcome measures: Crude notification rates and summary rate ratios, by Indigenous status, sex, age and area of residence.Results: Over the 10-year ...
Simon Graham BIS, MAppEpi · Rebecca J Guy BAppSc, MAppEpi, PhD · Basil Donovan MB BS, MD · Hamish McManus BEcon, BAcTS, MBIOS · Jiunn-Yih Su MB, MPH · Carol El-Hayek BSc, MEpi · Kellie S H Kwan BA(Hons), GradCertAppEpi · Amalie Dyda BHSc(Hons), MAppEpi · Handan C Wand MA, MSc, PhD · James S Ward BA
Changes in smoking intensity among Aboriginal and Torres Strait Islander people, 1994–2008
Together with reports of the decreasing prevalence of smoking among Indigenous people, this first report of a significant reduction in heavy smoking by Indigenous smokers is good news. Reducing smoking intensity and prevalence will lead to fewer deaths and less illness due to smoking. Reducing the number of heavy smokers will also assist smoking cessation among Indigenous people. These changes in smoking intensity occurred before the recent increase in attention to and investment in tobacco control in Indigenous communities, but at a time of significant mainstream anti-tobacco public health activity. Similar trends in smoking intensity have been reported in the total Australian population.
David P Thomas MB BS, PhD, FAFPHM
Genetic research in Indigenous health: significant progress, substantial challenges
To the Editor: Kowal’s article resonates with our experience.1 However, the National Health and Medical Research Council has supported genetic testing in Indigenous Australians for longer than she cites. Through a 1995–1997 project grant, a 1998 PhD scholarship,2,3 a 2006 program grant and an Australia Research Fellowship (2008–), the NHMRC has supported work on kidney and related chronic diseases, in protocols endorsed by two remote communities and approved ...
Wendy E Hoy
Genetic research in Indigenous health: significant progress, substantial challenges
To the Editor: We read with interest the article by Kowal about genetic research in Indigenous health.1 As stated, this topic is extremely sensitive, but it is one that we must now tackle. The article raises a related issue that has not received any attention: the provision of genetic health services to Aboriginal and Torres Strait Islander people. We should not presume that Aboriginal and Torres ...
Gail Garvey · Christina M Bernardes
Genetic research in Indigenous health: significant progress, substantial challenges
In reply: I thank Hoy, and Garvey and Bernardes, for their responses. Hoy highlights the difficulties her group has experienced in conducting genetic research in an Aboriginal community over two decades. Indeed, this was the project I referred to as losing its ethics approval as a direct result of the Human Genome Diversity Project. She attributes the difficulties she has faced to conflicting views between ...
Emma E Kowal
Severe drug-induced hypersensitivity syndrome with a shared HLA-B allele
We describe the first reported cases of phenytoin-related drug-induced hypersensitivity syndrome in unrelated Indigenous Australians with the same HLA-B*56:02 allele. These patients shared common clinical and pathological features, and all three were found to have the otherwise rare HLA-B allele, which might represent a novel genetic susceptibility factor for this syndrome.Clinical recordsPatient 1A 32-year-old Indigenous man from a remote Western Australian community presented with a fever, ...
Damian J Harding MB BS, BSc(Hons), MRCP · Kavitha Subramaniam MB BS, FRACP · Gerry MacQuillan MB BCh, FRACP, PhD · Joshua Davis MB BS, FRACP, PhD · David Nolan MB BS, PhD
The MJA, MDA National, Nossal Global Health Prize: broadening our horizons
Global health is, by definition, an area of great breadth and depth. There is enormous diversity in health systems and health outcomes, with life expectancy at birth varying from 82–84 years in Australia and Japan to less than 55 years in more than 20 African countries. Despite this diversity and difference, communicable diseases such as HIV and severe acute respiratory syndrome, and our more recent understanding of the ...
A Rob Moodie MB BS, MPH
Listening to what Indigenous people in remote communities say about alcohol restrictions and cannabis use: “Good thing that the alcohol’s gone, but the gunja has kept going”
In Cape York Indigenous communities, alcohol restrictions started in 2002–2003, with local prohibition in some communities since 2008. These restrictions may have halved alcohol-related injuries, a historically important change. However, residents of Cape York Indigenous communities suggest that there has been an accompanying rise in cannabis use over this period. During consultations in 2011 for Minister Macklin’s controversial Stronger Futures in ...
Cape York Cannabis Project Team
The role of HbA1c in the diagnosis of diabetes mellitus in Australia
For many years, the diagnosis of diabetes has been made through the laboratory-based measurement of fasting or random blood glucose levels, or using the oral glucose tolerance test. A glycated haemoglobin (HbA1c) level ≥ 6.5% (48 mmol/mol) is now also acceptable for diagnosing diabetes. Caution is needed in interpreting HbA1c test results in the presence of conditions affecting red blood cells or their survival time, ...
Michael C d’Emden MD, PhD, FRACP · Jonathan E Shaw MD, FRACP, FRCP · Peter G Colman MB BS, FRACP, MD · Stephen Colagiuri MB BS, FRACP · Stephen M Twigg MB BS, PhD, FRACP · Graham R D Jones MB BS, DPhil, FRCPA · Ian Goodall FAACB, FAIMS, FFSC(RCPA) · Hans G Schneider MD, FRCPA, FRACP · N Wah Cheung MB BS, PhD, FRACP
Indigenous health: New Zealand experience
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
Can we educate out of racism?
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
Ten principles relevant to health research among Indigenous Australian populations
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
Aboriginal women, alcohol and the road to fetal alcohol spectrum disorder
“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)
Improving the patient journey for Aboriginal and Torres Strait Islander people with acute coronary syndromes
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
Type 2 diabetes in young Indigenous Australians in rural and remote areas: diagnosis, screening, management and prevention
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
Prevalence of mental illness among Aboriginal and Torres Strait Islander people in Queensland prisons
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
An intensive smoking intervention for pregnant Aboriginal and Torres Strait Islander women: a randomised controlled trial
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
Do indigenous health curricula in health science education reduce disparities in health care outcomes?
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
Bringing our voices into the research world: lessons from the Kanyini Vascular Collaboration
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