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Lifestyle changes are central to preventing type 2 diabetes. Embarking upon and sustaining change is challenging, and translation of prevention approaches into a wider range of real-world settings is needed. In this study, a locally adapted community-led diabetes prevention program with local young Aboriginal facilitators was created and trialled through the Derby Aboriginal Health Service (DAHS). The 8-week program highlighted causes and consequences of diabetes, incorporated physical activity and healthy eating topics with a focus on practical activities, and included stress management to support healthy lifestyles. Ten Aboriginal women and men aged 18–38 years participated in the pilot program. The program was found to be acceptable and appropriate, and other community members and organisations expressed interest in future participation. Participants reported that they gained important new knowledge and made changes in behaviours including shopping choices, portioning and soft drink consumption. Limitations included participant recruitment and attendance difficulties, which were attributed to program timing and competing demands. While this program was designed to be sustainable, and there were indications of feasibility, resource constraints impeded its integration into routine primary health care. Prevention of diabetes is a high priority for DAHS, and this program, with appropriate resources, provides a basis for ongoing practical prevention strategies. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the prevalence of polypharmacy, under-prescribing and potentially inappropriate medicine use among Aboriginal Australians living in remote Western Australia.Design: Cross-sectional study.Setting: Six remote communities and the town of Derby in the Kimberley, Western Australia.Participants: Aboriginal people aged 45 years or more with complete medication histories.Main Outcome Measures: Proportions of patients with medicine histories indicating polypharmacy, potential under-prescribing of indicated medicines, or potentially inappropriate prescribing (including potential prescribing cascades or drug interactions).Results: Complete medicine histories were available for 273 participants. The mean number of prescribed medicines was 5.1 (SD, 3.6). At least one form of suboptimal prescribing was identified for 166 participants (61%), including polypharmacy for 145 (53%), potential under-prescribing of at least one indicated medicine for 33 (12%), and potentially inappropriate prescribing for 54 participants (20%). Potential prescribing cascades or drug interactions were identified for 12 participants (4%).Conclusions: Potentially suboptimal prescribing affected more than half the participating older Aboriginal Australians from the Kimberley. If generalisable to other remote Indigenous Australians, the prevalence of polypharmacy, potentially inappropriate prescribing, and under-prescribing of indicated medicines is problematic, and suggests that older Indigenous people in remote areas are at risk of medicine-related harm. [ABSTRACT FROM AUTHOR]

Objective: To describe the frequencies of acute kidney injury (AKI) and of associated diagnoses in Indigenous people in a remote Western Australian region.Design: Retrospective population-based study of AKI events confirmed by changes in serum creatinine levels.Setting, Participants: Aboriginal and Torres Strait Islander residents of the Kimberley region of Western Australia, aged 15 years or more and without end-stage kidney disease, for whom AKI between 1 June 2009 and 30 May 2016 was confirmed by an acute rise in serum creatinine levels.Main Outcome Measures: Age-specific AKI rates; principal and other diagnoses.Results: 324 AKI events in 260 individuals were recorded; the median age of patients was 51.8 years (IQR, 43.9-61.0 years), and 176 events (54%) were in men. The overall AKI rate was 323 events (95% CI, 281-367) per 100 000 population; 92 events (28%) were in people aged 15-44 years. 52% of principal diagnoses were infectious in nature, including pneumonia (12% of events), infections of the skin and subcutaneous tissue (10%), and urinary tract infections (7.7%). 80 events (34%) were detected on or before the date of admission; fewer than one-third of discharge summaries (61 events, 28%) listed AKI as a primary or other diagnosis.Conclusion: The age distribution of AKI events among Indigenous Australians in the Kimberley was skewed to younger groups than in the national data on AKI. Infectious conditions were common in patients, underscoring the significance of environmental determinants of health. Primary care services can play an important role in preventing community-acquired AKI; applying pathology-based criteria could improve the detection of AKI. [ABSTRACT FROM AUTHOR]

Objective: To assess the use, effectiveness and acceptance of prescribed contraception in three remote Western Australian Aboriginal communities.Participants and Design: Mixed method study, including retrospective file review of contraception methods for 566 regular female Aboriginal patients, 1 November 2010 - 1 September 2014, and semi-structured interviews with 20 Aboriginal women.Setting: Primary care clinics in three remote Aboriginal communities.Main Outcome Measures: Number of episodes of contraceptive use, effectiveness and continuation rates of prescribed contraceptive use; personal experiences, attitudes towards and beliefs about contraception options.Results: 34% of women had used contraception, ranging from 15% of women aged younger than 15 years to 55% of women aged 15-19 years. The most common forms of contraception at the census date were long-acting reversible contraceptives (LARCs): 77% of women using contraception had an etonogestrel implant and 7% had depot medroxyprogesterone. Etonogestrel continuation rates at 1, 2 and 3 years were 87% (95% CI, 81-92%), 72% (95% CI, 64-78%) and 51% (95% CI, 41-60%) respectively. Medroxyprogesterone depot continuation at one year was only 14% (95% CI, 8-22%). Social acceptance of the etonogestrel implant was high; no concerns were raised about stigma or unwanted attention related to implant use.Conclusion: The high uptake of LARCs in these communities is consistent with international recommendations about contraception use. High acceptability was reflected in excellent continuation rates. Service delivery models that use community engagement and capacity building are recommended for broadening the focus of sexual health beyond sexually transmitted disease detection and management, giving priority to the reproductive rights and unmet needs of Aboriginal women. [ABSTRACT FROM AUTHOR]

Background: Indigenous infants (infants aged under 12 months) have the highest hospital admission and emergency department presentation risks in Australia. However, there have been no recent reports comparing hospital utilisation between Indigenous and non-Indigenous infants. Methods: Our primary objective was to use a large prospective population-based linked dataset to assess the risk of all-cause hospital admission and emergency department presentation in Indigenous compared to non-Indigenous infants in Western Australia (WA). Secondary objectives were to assess the effect of socio-economic status (Index of Relative Socio-Economic Disadvantage [IRSD]) on hospital utilisation and to understand the causes of hospital utilisation. Findings: There were 3,382 (5.4%) Indigenous and 59,583 (94.6%) non-Indigenous live births in WA from 1 January 2010 to 31 December 2011. Indigenous infants had a greater risk of hospital admission (adjusted odds ratio [aOR] 1.90, 95% confidence interval [95% CI] 1.77–2.04, p = <0.001) and emergency department presentation (aOR 2.15, 95% CI 1.98–2.33, p = <0.001) compared to non-Indigenous infants. Fifty nine percent (59.0%) of admissions in Indigenous children were classified as preventable compared to 31.2% of admissions in non-Indigenous infants (aOR 2.12, 95% CI 1.88–2.39). The risk of hospital admission in the most disadvantaged (IRSD 1) infants in the total cohort (35.7%) was similar to the risk in the least disadvantaged (IRSD 5) infants (30.6%) (aOR 1.04, 95% CI 0.96–1.13, p = 0.356). Interpretation: WA Indigenous infants have much higher hospital utilisation than non Indigenous infants. WA health services should prioritise Indigenous infants regardless of their socio economic status or where they live. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the potential of glycated haemoglobin A (HbA[1c) testing (HbA1c) algorithm) in screening and diagnosis of diabetes in Aboriginal Australian. The cross-sectional study involved 250 Aboriginal Australians aged 15 years or more without confirmed diabetes and due for diabetes testing . Results indicated that HbA1ctesting-based algorithm may simplify diabetes testing in remote areas.

The article presents a study which explores the impact of the Rural Clinical School of Western Australia (RCSWA) program on work location of medical graduates. A comparison of the work location of medical graduates from the University of Western Australia who completed Year 5 of the medical school between 2002 and 2009 is highlighted. According to the study, RCSWA participation is associated with the likelihood of working rurally.

The article presents a study aimed at assessing the utility of auscultatory screening for the detection of rheumatic heart disease (RHD) confirmed by echocardiography in high-risk children in Northern Territory. It states that the result of the comparison of sensitivity and positive predictive value of cardiac auscultation with echocardiography is poor. Results suggest that cardiac auscultation should not be used for RHD screening in high-risk schoolchildren in Australia.

The article presents a study which measured chronic obstructive lung diseases (COPD) prevalence in people aged 40 or above in Australia. It states that spirometry was used to measure forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and the FEV1/FVC ratio. It notes that spirometric evidence and symptoms of the disease increase with age and were common in people 40 or above.

The article presents the Commentary in Diabetes Care have raised issues with respect to the method of handling blood samples for oral glucose tolerance tests (OGTT) and the prevalence of gestational diabetes mellitus (GDM). Topics include Australian sites continue to rely solely on collection tubes containing fluoride for stabilization of glucose, and the impact of glycolysis is likely exacerbated in remote compared with urban settings due to greater distances to the laboratory.

The article discusses English Reverend Richard Clarke (1723-1802), notable for his preaching in South Carolina in the 1750s. It is largely based upon information taken from the court records of the Prerogative Court of Canterbury, England regarding a probate case for the estate of haberdasher Kezia Sindram, the aunt of Clarke's fourth wife Sarah Lee, with additional information found in "The Papers of Henry Laurens," by British merchant and South Carolina politician Laurens. It discusses Clarke's career as an educator, writer, and minister; his family and relatives; and his associates.

Objectives: To compare regional differences in the prevalence of rheumatic heart disease (RHD) detected by echocardiographic screening in high-risk Indigenous Australian children, and to describe the logistical and other practical challenges of RHD screening.Design: Cross-sectional screening survey performed between September 2008 and November 2010.Setting: Thirty-two remote communities in four regions of northern and central Australia.Participants: 3946 Aboriginal or Torres Strait Islander children aged 5-15 years.Intervention: Portable echocardiography was performed by cardiac sonographers. Echocardiograms were recorded and reported offsite by a pool of cardiologists.Main Outcome Measures: RHD was diagnosed according to 2012 World Heart Federation criteria.Results: The prevalence of definite RHD differed between regions, from 4.7/1000 in Far North Queensland to 15.0/1000 in the Top End of the Northern Territory. The prevalence of definite RHD was greater in the Top End than in other regions (odds ratio, 2.3; 95% CI, 1.2-4.6, P = 0.01). Fifty-three per cent of detected cases of definite RHD were new cases; the prevalence of new cases of definite RHD was 4.6/1000 for the entire sample and 7.0/1000 in the Top End. Evaluation of socioeconomic data suggests that the Top End group was the most disadvantaged in our study population.Conclusions: The prevalence of definite RHD in remote Indigenous Australian children is significant, with a substantial level of undetected disease. Important differences were noted between regions, with the Top End having the highest prevalence of definite RHD, perhaps explained by socioeconomic factors. Regional differences must be considered when evaluating the potential benefit of widespread echocardiographic screening in Australia. [ABSTRACT FROM AUTHOR]

Objective: To assess intrinsic capacity, an important component of ageing well, in older Aboriginal people living in remote Western Australia., Study Design: Longitudinal cohort study; secondary analysis of survey and clinical assessment data., Setting: Kimberley region of Western Australia (six remote communities, and the town of Derby)., Participants: Aboriginal people aged 45 years or older, initially recruited 15 July 2004 - 17 November 2006., Main Outcome Measures: Intrinsic capacity (assessed in each participant by questionnaire and review by a consultant specialist), overall and by domain, and presence of core activity limitations, at baseline and follow-up (8 February 2011 - 6 June 2013); risk of death by follow-up; preservation of intrinsic capacity at follow-up., Results: The mean age of the 345 participants at baseline was 60.2 years (standard deviation [SD], 11.6 years; range, 45-96 years); 152 were men (44.1%) and 193 were women (55.9%). Intrinsic capacity was unimpaired in all five domains for 55 participants (15.9%; 95% confidence interval [CI], 12.4-20.2%). Capacity in the vitality domain was unimpaired in 325 respondents (94.2%), in the psychological/mood domain in 318 (92.2%), and in the cognition domain in 289 people (83.8%); the locomotion domain was unimpaired in 174 people (50.4%), and the sensory domain in 117 people (33.9%). The proportion of men with full capacity in all five domains (32 of 152, 21.1%) was larger than for women (23 of 193, 11.9%). Of the 274 people included in follow-up analyses, intrinsic capacity was lower than at baseline for 66 people (24.1%), it was unchanged or improved in 111 participants (40.5%; 95% CI, 34.8-46.5%), and 97 people had died (35.4%). Thirty-seven of the 177 surviving participants for whom complete data were available had full capacity in all domains (20.9%; 95% CI, 15.5-27.6%). After adjustment for age, the number of unimpaired intrinsic capacity domains at baseline was inversely associated with having a core activity limitation at baseline (per domain: adjusted prevalence ratio, 0.43; 95% CI, 0.34-0.55) and follow-up (adjusted risk ratio, 0.62; 95% CI, 0.44-0.88), and with risk of death by follow-up (adjusted risk ratio, 0.83; 95% CI, 0.71-0.96)., Conclusions: Impaired intrinsic capacity in older Aboriginal people living in the Kimberley was most frequent in the sensory and locomotion domains. Reduced capacity in these domains could be highly amenable to treatment that would ensure that Elders can continue to take part in activities important for quality of life., (© 2024 AMPCo Pty Ltd.)