Search Results (185)

Aboriginal and Torres Strait Islander people who inject drugs face persistent health inequities, highlighting the need for programs that meet the needs of these groups. This study explored how intersectional stigma and discrimination affect Aboriginal and Torres Strait Islander people’s access to quality healthcare. Aboriginal and Torres Strait Islander participants aged ≥18 years who had injected drugs within the past 12 months were recruited from two regional needle and syringe programs (NSPs) and a major city NSP in Queensland, Australia. Participants completed a structured survey and yarned with an Aboriginal researcher and non-Indigenous research assistant about their healthcare experiences. Through a process of reflexive and thematic analysis, three major qualitative themes emerged: participants’ social circumstances and mental health challenges made help-seeking difficult and complex; enacted stigma and racism diminished access to health services and the quality of care received; and injecting drug use was associated with disconnection from culture and community. Privileging the expertise and voices of those with lived/living experience is essential for the creation of culturally safe, inclusive, and destigmatising healthcare services for Aboriginal and Torres Strait Islander people who inject drugs. Full article

Access to high-quality, culturally responsive nutrition advice during pregnancy is necessary for optimal health outcomes for mothers and babies. Evidence indicates that age, education and access to trained healthcare practitioners have a positive correlation with healthy food intake and positive outcomes. There are limited studies that discuss the importance of providing culturally responsive nutrition advice to pregnant Indigenous women. Therefore, this paper investigates the sources from which Indigenous women access nutrition information, assesses its adequacy in meeting needs, and identifies the effective ways to deliver this information. This study took place in Queensland (QLD), New South Wales (NSW), and Western Australia (WA), which were chosen to represent diverse cultural communities. A total of 103 participants were recruited, including Indigenous women and healthcare practitioners. Focus groups were audio-recorded, transcribed and analysed. Participants indicated that pregnant women are highly interested in improving their nutrition knowledge during pregnancy and actively seek information from their healthcare practitioners and dietitians. Findings suggested dissatisfaction with the information received, as it failed to address their needs. Results of this paper call for an urgent increased presence of community dietitians in antenatal clinics dedicated to Indigenous pregnant women as an additional way to provide families with the information they need for healthy pregnancies. Full article

To explore Indigenous patients’ use of a primary urgent care centre (PUCC) at a co-located general medical practitioner (GP)-led primary healthcare service (GP service) in regional Queensland, Australia, secondary data analysis was conducted using the 65,420 deidentified PUCC patients from 1 July 2020 to 30 June 2021, including Indigenous status. A Mann–Whitney U test and Chi-Square test were used to analyse patients’ arrival times, reasons to attend PUCC, and frequency of attendance. The proportion of Indigenous patients from the communities attending the PUCC was 9.8% while the proportion of Indigenous people in the general population was only 3.8%. Indigenous patients were more likely to be new patients to the GP service (13.6% never visited the GP service prior to PUCC) compared to non-Indigenous (9.6%) patients. The peak hours of attendance for Indigenous people were 11 a.m.–12 p.m. and 2 p.m.–3 p.m. while it was 10 a.m.–12 p.m. for non-Indigenous patients. The most common reason for attending PUCC for both patient groups was superficial injuries. The second most common reason was digestive issues for Indigenous patients and musculoskeletal issues for non-Indigenous patients. These findings provide insights for enhancing future PUCC models to better meet the community needs, especially the underserved Indigenous population in regional areas. Full article

Aboriginal and Torres Strait Islander ways of knowing, being and doing have fostered physical, social, and emotional wellbeing for millenia, forming a foundation of strength and resilience. However, colonisation, systemic violence and discrimination—including the forced removal of Aboriginal and Torres Strait Islander children, which continues today—have disrupted this foundation, leading to compounding cycles of intergenerational and complex trauma. The enduring impact of intergenerational and complex trauma is exemplified in increasing proportions of Aboriginal and Torres Strait Islander children being removed from their families and involved in the child protection and youth justice system—which represents a national crisis. Despite this crisis, the national response remains insufficient. To address these urgent issues, over 200 predominantly Aboriginal and Torres Strait Islander stakeholders, participated in Gathering the Seeds Symposium, the inaugural meeting for the Replanting the Birthing Trees project held in Perth in April 2023. This meeting marked the beginning of a public dialogue aimed at Closing the Gap by advancing community-led strategies to break cycles of trauma and foster cycles of nurturing, recovery, and wellbeing for Aboriginal and Torres Strait Islander parents and children across the first 2000 days. We outline critical shortcomings in the current child protection and youth justice systems, and the urgent need for child wellbeing reform. Importantly we highlight recommendations made in submissions in 2023 to two key Australian inquiries—the National Early Years Strategy and the Human Rights Commission inquiry into out of home care and youth justice systems. We argue that structural reforms and culturally safe and skillful care for parents experiencing trauma and violence is a serious gap, and a national priority. The first 2000 days represents a critical window of opportunity to transform cycles of trauma into cycles of healing. It is time to ‘replant the birthing trees’ and ensure that all Aboriginal and Torres Strait Islander babies and families can have the best possible start to life through comprehensive models of care grounded in recognition of the right to self-determination and culture. Full article

The recognition and treatment of scabies has been incorporated into Australian guidelines for the prevention of acute rheumatic fever (ARF) and rheumatic heart disease (RHD). The incidence of both diagnosed ARF and RHD is increasing in Far North Queensland (FNQ) in northeast tropical Australia, but the local burden of scabies is incompletely defined. We reviewed the results of every skin scraping collected in FNQ’s public health system between 2000 and 2023; 121/4345 (2.8%) scrapings were positive, including 19/1071 (1.8%) in the last 5 years of the study; the proportion of scrapings that were positive for scabies declined over the study period. Individuals who tested positive for scabies were no more likely to have had a prior diagnosis of ARF or RHD compared to the matched controls (1/101 (1%) versus 3/101 (3%), p = 1.0). During a median of 14.7 years of follow-up, individuals who tested positive for scabies were also no more likely to have a diagnosis of ARF or RHD than matched controls (2/100 (2%) versus 6/98 (6%); hazard ratio (95% confidence interval): 0.30 (0.06–1.50) p = 0.14). Microbiologically confirmed scabies is uncommon in FNQ and appears to make a limited contribution to the local incidence of ARF and RHD. Full article

Aboriginal parents experience neonatal intensive care settings at a higher rate than non-Indigenous parents. We sought to explore Aboriginal parents’ experiences of having a gaaynggal (baby) admitted to a neonatal intensive care unit (NICU) in order to improve culturally safe neonatal care environments. The yarning method was used to collect the qualitative data of 15 Aboriginal parents’ stories. Thematic analysis and collaborative yarning were used to determine themes. The themes emerging from the stories included Trauma and its triggers in the NICU; Aboriginal cultural caring practices are not upheld in the NICU; Covert racism and biases impact culturally safe experiences; Health provider communication can obstruct parents’ experience of cultural safety; and Recommendations to uphold culturally safe care in NICU. Culturally safe care practices have been identified as needed, to improve cultural safety in neonatal settings. Through further education and training, the facilitation of Aboriginal family connections and support groups, culturally inclusive spaces for parents and their kinship systems, and increasing Aboriginal staff representations across all levels of health professional experience, cultural safety for Aboriginal parents and gaaynggal can be increased. Full article

Background: Within recent years, there has been a notable lack of research examining the factors associated with adolescent use of anabolic–androgenic steroids (AASs) in Australia, meaning information regarding risk factors of Australian adolescent AAS use is outdated and potentially inaccurate. Methods: To address this omission, the present study examined the prevalence and correlates of adolescent (aged 11 to 19 years) AAS use within the EveryBODY study, a large-scale representative survey of adolescents’ disordered eating behaviours and body image concerns, involving 5071 adolescents across thirteen schools within the Sydney and Newcastle/Hunter region of New South Wales, Australia. Results: A total of 1.1% of adolescents reported lifetime use of AAS to increase muscularity. In univariate analyses, increased prevalence of AAS use was associated with male sex (OR = 5.67), identifying as Aboriginal or Torres Strait Islander (OR = 3.80), identifying as same-sex or questioning sexual attraction (OR = 3.17), higher drive for muscularity (OR = 2.19) and weight/shape concerns in the past month (OR = 1.28), and higher frequency of purging (OR = 1.11) and binge eating (OR = 1.09) in the past month. In multivariate analysis, only drive for muscularity (OR = 2.44) and purging behaviours (OR = 1.10) remained as significant correlates. Finally, adolescents who reported lifetime AAS use also reported feeling significantly higher levels of distress and physical and psychosocial impairment compared to adolescents who reported never having used AAS to increase muscularity. Conclusions: Positive correlations between disordered eating and weight and shape concerns with AAS use suggests that adolescent AAS use may be conceptualised within the spectra of disordered eating among youth. These findings provide clinicians, carers, and educators with prototypical factors that should assist in the screening of adolescent AAS use to facilitate early intervention. Full article

Often referred to as ‘the last unknown’, Papua New Guinea’s largely unexplored environments across its four distinct regions, the Highlands, New Guinea Islands, Momase, and Southern, exhibit remarkable diversity. Understanding this diversity is significant in contextualising the risk factors associated with developing non-communicable diseases. This review aims to map and summarise the literature to provide region-specific prevalence data for risk factors and non-communicable diseases. Four databases and grey literature were searched. Two reviewers completed the screening and data extraction. Twenty-one studies were included, with five reporting the data by region and the remaining reporting the data nationwide. Six studies reported on risk factors, thirteen reported on non-communicable diseases, and two reported on risk factors and non-communicable diseases. The Southern region, which includes the Capital, Port Moresby, reported the highest prevalence for most risk factors: anthropometric (overweight, obesity, and waist circumference), lifestyle (betel nut, alcohol, unhealthy diet, and stress), and biochemical (cholesterol, triglycerides, HbA1c, and metabolic syndrome). The findings of this review highlight the limited evidence base for region-specific risk factor data and the lack of objective diagnosis of non-communicable diseases. There were variations in the prevalence of specific risk factors by region; however, the Southern region stands out as requiring immediate attention for health promotion program interventions. Full article

Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) men’s health and social indicators reflect an ongoing legacy of social disruption with profound implications for broader family and community contexts. In response to recognized needs, healing programs have been implemented within Australia. The literature on relevant best practices for Indigenous men’s healing was explored to inform the planning and implementation of a local program. A scoping review of electronic databases was undertaken to retrieve information between 2012 and 2022 on social and emotional healing programs for Indigenous men that included a program evaluation. Of the 2123 identified articles, many lacked a program evaluation or were not specific to male participants, with nine meeting the inclusion criteria for the review. Six central elements that supported the programs’ reported efficacy were identified: kinship, cultural understanding, a view of healing as being holistic, a strengths-based approach, a male leadership team, and a consistent meeting space. These elements were important for the social and emotional healing of the Indigenous male participants. Based on these findings, there is an increased need for the identified elements to be incorporated into programs for Indigenous men to accompany ongoing efforts in improving the wellbeing of the Indigenous population overall. Full article

(1) Background: Completion of the full oral health course of care (CoC) is essential to prevent further deterioration of oral and overall health. Understanding these patterns, particularly in public oral healthcare services, is crucial for improving access to and the delivery of care. This study aims to identify the socio-demographic and clinical characteristics of adult patients who did not complete required dental treatments within a 12-month period at Monash Health Dental Services (MHDS), Melbourne, Victoria. (2) Methods: Data were collected on patients’ course of care (CoC), socio-demographic characteristics, and clinical information from the MHDS Titanium electronic database. This study represents a secondary data analysis from adult patients who attended MHDS between November 2022 and October 2023, excluding emergency dental care visits. Logistic regression analyzed the socio-demographic and clinical variables affecting CoC. (3) Results: Our findings identified several significant predictors of incomplete CoC; being a non-priority group, mental health clients, refugees, and identifying as Aboriginal or Torres Strait Islanders (OR = 1.41; 95% CI: 1.08–1.84). Conversely, speaking a language other than English increased the odds of completing treatment (OR = 0.85; 95% CI: 0.74–0.98). By age, patients in the 36-to-55- or the 56-to-75-year-old age groups were more likely to be in the incomplete group (OR = 1.65; 95% CI: 1.37–1.98; and OR = 1.43; 95% CI: 1.22–1.66, respectively). (4) Conclusions: This study identified predictors of discontinued care, emphasizing accessibility and equitable outcomes for users of public oral healthcare. The findings indicate that the predictors of course of care (CoC) completion differ from barriers to accessing care. This highlights key objectives in public health dentistry, focusing on improving accessibility and promoting equitable oral health outcomes for vulnerable populations. Full article

Background: The Beat It program is a clinician-led, community-based group exercise intervention for adults with Type 2 Diabetes Mellitus (T2DM). While previous studies have demonstrated its effectiveness in improving physical and mental health outcomes, this study explores the perspectives of Beat It Trainers to identify key factors contributing to the program’s success and areas for improvement. Methods: Semi-structured interviews were conducted with 11 Accredited Exercise Physiologists who had delivered both in-person and online versions of the program. Interviews were thematically analyzed using inductive approaches. Results: Eight main themes emerged: customization to individual needs, capability building, outcome improvement, affordability, accessibility, sustainability, and a holistic approach delivered in a group setting. Challenges identified included managing group dynamics, maintaining participant commitment in a fully subsidized program, and providing nutrition advice within the trainers’ scope of practice. The program’s adaptability to both in-person and online delivery modes was highlighted as enhancing its accessibility and resilience. Conclusions: This study provides valuable insights into the factors contributing to the success of the Beat It program from the implementers’ perspective. The findings suggest that investing in comprehensive training for facilitators, particularly in group dynamics management, could benefit similar programs. While the program’s fully subsidized structure reduces financial barriers to entry, innovative strategies to enhance participant engagement and perceived value should be explored. The success of the online delivery mode indicates that hybrid models offering both in-person and virtual options could increase accessibility in future supervised, community-based exercise programs for T2DM management. Full article

Objective: There is concern about the potential health implications of low-calorie sweetener (LCS) consumption. This study aimed to determine the prevalence and patterns of LCS use among women of reproductive age (WRA) in Australia. Methods: This cross-sectional study involved a two-stage analysis. First, latent class analyses (LCA) were employed to identify patterns of LCS use. Subsequently, regression analyses were conducted to assess the association between sociodemographic and lifestyle characteristics and the two outcomes: (1) self-reported LCS use, and (2) the identified LCS consumption patterns/classes. Results: A total of 405 WRA completed the survey (mean age 32.0 ± 8.6 years, mean BMI 28.71 ± 11.1 kg/m²)_, with 44.7% reporting LCS consumption. LCA analysis identified three distinct LCS consumption patterns: light users (45.9%), moderate users (26.0%) and heavy users (28.6%). A high proportion of participants did not meet the Australian dietary guidelines for recommended servings of vegetables (57.8%), dairy (44.2%), meat (48.2%) and grains (74.8%). Compared to Caucasian women, those from South Asian backgrounds (OR 4.16; 95% CI 1.71–10.1) and Aboriginal and Torres Strait Islander women (OR 1.40; 95% CI 0.42–4.63) were more likely to use LCS. Women who participated in the weight loss programs, with overweight/obesity, and those using LCS for weight loss purposes were more likely to be moderate or heavy LCS users than light users. Additionally, socioeconomically disadvantaged women were less likely to be moderate or heavy LCS users. Conclusions: This study highlights the widespread use of LCS among WRA in Australia, with distinct consumption patterns influenced by cultural, health-related, and socioeconomic factors. These findings underscore the need for targeted interventions to promote healthy eating practices within this population. Full article

Introduction: Patients receiving biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) for rheumatological conditions are at an increased risk of serious, potentially life-threatening, infection. However, the incidence, aetiology, and clinical course of serious infection in patients receiving b/tsDMARDs in tropical settings are incompletely defined. Methods: We retrospectively reviewed all patients with rheumatoid arthritis receiving b/tsDMARDs between October 2012 and October 2021, at Cairns Hospital in tropical Australia. The incidence, aetiology, and clinical course of serious infections (those requiring admission to hospital or parenteral antibiotics) were determined. Results: 310 patients had 1468 patient years of b/tsDMARD therapy during the study period; 74/310 (24%) had 147 serious infections translating to an overall risk of 10.0 episodes of serious infection per 100 patient years. The respiratory tract (50/147, 34%) and skin (37/147, 25%) were the most frequently affected sites. A pathogen was identified in 59/147 (40%) episodes and was most commonly Staphylococcus aureus (24/147, 16%). Only 2/147 (1%) were confirmed “tropical infections”: 1 case of Burkholderia pseudomallei and 1 case of mixed B. pseudomallei and community-acquired Acinetobacter baumannii infection. Overall, 13/147 (9%) episodes of serious infection required Intensive Care Unit admission (0.9 per 100-patient years of b/tsDMARD therapy) and 4/147 (3%) died from their infection (0.3 per 100-patient years of b/tsDMARD therapy). The burden of comorbidity and co-administration of prednisone were the strongest predictors of death or a requirement for ICU admission. Conclusions: The risk of serious infection in patients taking b/tsDMARDs in tropical Australia is higher than in temperate settings, but this is not explained by an increased incidence of traditional tropical pathogens. Full article

Background/objectives: Assessing perinatal diet and its determinants in Australia’s Aboriginal and Torres Strait Islander women remains challenging, given the paucity of tools that incorporate Aboriginal ways of knowing, being, and remembering within a quantitative framework. This study aimed to explore the determinants of perinatal nutrition in this population and to evaluate the efficacy of the Nutrition Education and Screening Tool (NEST) in collecting diet-related data in this population. Methods: This study employed a Participatory Action Research approach using the NEST as a foundation for structured research inquiry. Self-reported diet and determinants were collected from a cross-sectional cohort of Aboriginal and Torres Strait Islander women from Far North Queensland. Results: Participants (n = 30) declared excess consumption of meat and alternatives, fruit, vegetables and legumes, and dairy and alternatives. Grain and cereal consumption aligned with recommendations; wild-harvested foods comprised a mean 19.75% of their protein intake. Food frequency data were supported by participants’ descriptions of how they eat, combine, rotate, and cook these foods. Conclusions: Standard food frequency questionnaires are challenging for Aboriginal and Torres Strait Islanders as their concepts of time and ways of remembering are different from Western understanding. Use of the NEST allowed food frequency items to be explored, clarified, and cross-referenced; yarning provided a degree of support for quantitative data. The results of this study translate to future public health research, practice, and policy. Alternative quantitative measures to determine food frequency should be considered in future studies. These may include the cyclical approach to time that is well understood and integrated by Indigenous cultures. Full article

Introduction: Despite the increasing overrepresentation of Aboriginal and Torres Strait Islander (hereafter respectfully referred to as First Nations) children living in out-of-home care (OOHC) in Australia, little is known about their wellbeing needs. This comprehensive literature review aimed to identify these needs and the features of care required to meet them. Methods: MEDLINE, CINAHL, Scopus, Informit, PsycINFO, and Embase databases and relevant grey literature were searched from inception to December 2023 for articles presenting qualitative accounts and perspectives relevant to the wellbeing needs of First Nations children in OOHC. These included reports from First Nations children in OOHC; First Nations adults with lived experience of OOHC; carers, caseworkers, and organizational stakeholders; and First Nations community members with relevant lived and/or professional experience. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Braun and Clarke’s reflexive thematic analysis method for data analysis. Results: Thirty-five articles (19 peer-reviewed, 16 grey literature) met the inclusion criteria. Our analysis revealed six wellbeing needs of First Nations children in OOHC: Being seen, being heard; a sense of stability; holistic health support; social and cultural connections; culturally safe OOHC providers; and preparedness for transitioning out of care. A range of features of OOHC were also identified as critical for supporting these needs. Conclusions: Our findings suggest that First Nations children in OOHC have unique wellbeing needs in addition to safety, security, and health. Attention to the development and maintenance of social and cultural connections is an important concern that must be addressed by OOHC providers (caseworkers and organizations) and carers and supported by OOHC policy and the associated systems in Australia as part of providing culturally safe and supportive care. Full article