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Background: The burden of chronic disease in Indigenous Australia is more than double that of non-Indigenous populations and even higher in remote Northern Territory (NT) communities. Sufficient levels of physical activity are known to reduce the risk of chronic disease and improve the health of those already suffering from chronic disease. It has been identified that effective promotion of physical activity in Indigenous settings requires the diverse cultural perspectives and participation of Indigenous people. However, Indigenous concepts of physical activity are not represented in the public health literature and examples of Indigenous involvement in physical activity promotion are scarce. This study aimed to explore and describe local perspectives, experiences and meanings of physical activity in two remote NT Indigenous communities. Methods: Qualitative research methods guided by ethnographic and participatory action research principles were used. Semi-structured interviews conducted with 23 purposively selected community members were the main source of data, augmented by five commissioned paintings by community-based artists and observations recorded in a journal by the first author. Results: The findings reveal that in this cultural context the meaning of physical activity is embedded in socially significant and economically necessary physical engagement with the environment. Participants described physical activities associated with Indigenous natural and cultural resource management, customary spaces, seasonal timing and traditional education as creating and protecting health. These activities were viewed not only as culturally appropriate physical activities that contribute to health but as legitimate, physically active forms of social organisation, education and employment that help to build and maintain relationships, wealth, resources and the environment. Conclusion: This different construction of physical activity in remote Indigenous communities highlights the importance of involving Indigenous people in the development and implementation of physical activity promotion. Physical activities associated with traditional Indigenous cultural practices and being active 'on country' need to be viewed as legitimate health promotion activities. Exploring further ways to enable Indigenous people in remote NT to be involved in creating viable active livelihoods on 'traditional country' needs to be considered as imperative to health improvement. [ABSTRACT FROM AUTHOR]

The human ethics issues surrounding the conduct of health science research have been the subject of increasing debate among biomedical and social science researchers in recent years. Ethics procedures in health-science research are typically concerned with protecting anonymity and confidentiality, and are tailored to work that primarily uses quantitative methodologies. For qualitative research in the health social sciences, a different set of ethical issues often arises in the research process. This article examines three case studies of qualitative researchers working with Indigenous Australian communities, focusing on the researchers' experiences with ethics committees and how they approached a range of ethical issues arising in the course of their research. Key issues include: obtaining informed consent for participant observation; the evolving nature of qualitative research; the difficulties in foreseeing changes in approach; and the distinction between the research team and the researched in participatory action research. [ABSTRACT FROM AUTHOR]

The subject of mental health has been discussed for some time in the literature on Australian Aboriginal peoples, although the volume of this work has been relatively small. This literature can be separated into two main approaches. The first has been concerned with documenting and analyzing disorders that are culturally specific to a particular group. The second, more recent body of literature understands mental health issues as resulting from a combination of factors related to the effects of colonization, such as loss of land, poverty, and the destruction of families. This literature is often aimed at diagnosis and the provision of appropriate services for Indigenous people without a comprehensive ethnographic understanding of the cultural specificities of certain mental health disorders. Although mental health problems are discussed, such as suicide, depression, and anxiety, little analysis is undertaken of how such states are locally experienced and understood. This paper reports the complexities involved in understanding mental health from the perspective of youth in a remote Aboriginal community in northern Australia. We argue that it is necessary to understand mental health within the broader context of the lives of Indigenous youth and, in particular, the interaction between their marginalization from participating in the opportunities that globalization offers with issues related to poverty, substance misuse, and specific cultural beliefs. [ABSTRACT FROM AUTHOR]

Aims This study aims to measure the prevalence rates and patterns of help-seeking behavior as a consequence of being harmed by drinkers in five Asian countries (India, Sri Lanka, Vietnam, Lao PDR and Thailand). Methods A total of 9832 respondents aged 18–65 years from the WHO/ThaiHealth Collaborative Project were surveyed between 2012 and 2014 about their experiences of being negatively affected due to another's drinking, and whether and where they sought help, focusing on four adverse aspects of harms from others' drinking. Results The prevalence of seeking help from any source in the past year due to harm from others' drinking ranged from 7% to 20%. The most common service used by those who were affected by other people's drinking was asking for help from friends, followed by calling the police and using health-related services. The largest proportion of help-seeking was among those reporting property harm, followed by those being harmed physically and sexually by drinkers. Conclusion Given a wide range of harms from others' drinking in the general population and different needs of those affected, prevalence rates for help-seeking behavior due to others' drinking in South and South East Asian countries were low and the help sought was often informal. There is a large knowledge gap in our understanding of the mechanisms of help-seeking behavior and the pathways for access to help among those affected. Further studies are important for enhancing the social response services available and making these more accessible to those who need help. [ABSTRACT FROM AUTHOR]

The article presents an obituary for David McKnight, Emeritus Professor of Anthropology at the London School of Economics.

Background: The burden of chronic disease in Indigenous Australia is more than double that of non-Indigenous populations and even higher in remote Northern Territory (NT) communities. Sufficient levels of physical activity are known to reduce the risk of chronic disease and improve the health of those already suffering from chronic disease. It has been identified that effective promotion of physical activity in Indigenous settings requires the diverse cultural perspectives and participation of Indigenous people. However, Indigenous concepts of physical activity are not represented in the public health literature and examples of Indigenous involvement in physical activity promotion are scarce. This study aimed to explore and describe local perspectives, experiences and meanings of physical activity in two remote NT Indigenous communities.Methods: Qualitative research methods guided by ethnographic and participatory action research principles were used. Semi-structured interviews conducted with 23 purposively selected community members were the main source of data, augmented by five commissioned paintings by community-based artists and observations recorded in a journal by the first author.Results: The findings reveal that in this cultural context the meaning of physical activity is embedded in socially significant and economically necessary physical engagement with the environment. Participants described physical activities associated with Indigenous natural and cultural resource management, customary spaces, seasonal timing and traditional education as creating and protecting health. These activities were viewed not only as culturally appropriate physical activities that contribute to health but as legitimate, physically active forms of social organisation, education and employment that help to build and maintain relationships, wealth, resources and the environment.Conclusion: This different construction of physical activity in remote Indigenous communities highlights the importance of involving Indigenous people in the development and implementation of physical activity promotion. Physical activities associated with traditional Indigenous cultural practices and being active 'on country' need to be viewed as legitimate health promotion activities. Exploring further ways to enable Indigenous people in remote NT to be involved in creating viable active livelihoods on 'traditional country' needs to be considered as imperative to health improvement. [ABSTRACT FROM AUTHOR]

Background: We report here selected findings from a mixed-methods study investigating the role of Australian rare disease patient organisations (RDPOs) in research. Despite there being many examples of RDPOs that have initiated and supported significant scientific advances, there is little information - and none at all in Australia - about RDPOs generally, and their research-related goals, activities, and experiences. This information is a pre-requisite for understanding what RDPOs bring to research and how their involvement could be strengthened.Methods: We reviewed 112 RDPO websites, conducted an online survey completed by 61 organisational leaders, and interviewed ten leaders and two key informants. Quantitative and qualitative data were analysed using basic descriptive statistics and content analysis, respectively.Results: Although most are small volunteer-based groups, more than 90% of the surveyed RDPOs had a goal to promote or support research on the diseases affecting their members. Nearly all (95 %) had undertaken at least one research-related activity - such as providing funding or other support to researchers - in the previous five years. However, RDPO leaders reported considerable challenges in meeting their research goals. Difficulties most frequently identified were insufficient RDPO resources, and a perceived lack of researchers interested in studying their diseases. Other concerns included inadequate RDPO expertise in governing research "investments", and difficulty engaging researchers in the organisation's knowledge and ideas. We discuss these perceived challenges in the light of two systemic issues: the proliferation of and lack of collaboration between RDPOs, and the lack of specific governmental policies and resources supporting rare disease research and patient advocacy in Australia.Conclusion: This study provides unique information about the experiences of RDPOs generally, rather than experiences retrospectively reported by RDPOs associated with successful research. We describe RDPOs' valuable contributions to research, while also providing insights into the difficulties for small organisations trying to promote research. The study is relevant internationally because of what it tells us about RDPOs; however, we draw attention to specific opportunities in Australia to support RDPOs' involvement in research, for the benefit of current and future generations affected by rare diseases. [ABSTRACT FROM AUTHOR]

Introduction: Clown doctors are a feature in paediatric hospitals, visiting children and families, providing a welcome escape from the reality of hospitalisation. Whilst the use of humour to improve health and wellbeing has been widely researched, limited exploration of the role of clown doctors has occurred. This research aims to elucidate the role of clown doctors within a paediatric hospital. Theory/Methods: In this ethnographic study, participants included the clown doctors and every person with whom they had a meaningful encounter. The narrative of the clown doctors was captured through 1,500 hours of participant observation documented over one year. Interviews and visual methods were utilised, with key informants drawing and explaining their experience of the clown doctors. A constructivist framework was used to analyse emergent themes. Results: Whilst almost universally acknowledged as a positive addition to the hospital, most people who encounter the clown doctors have little conception about the scope of their role. Themes that arose during observation that related to the function of clown doctors included: distraction, anxiety reduction and procedural assistance; entertainment and making people laugh; emotional support and providing comfort; and communication, including translating clinical information to families. These functional elements of the clown doctors are the result of a more complex, intimate human connection that arose due to the nature of the clown being low-status, open, and vulnerable, and in particular existing as an outsider within the medical establishment. These interconnected relationships drove engagement and resulted in clown doctors becoming privy to information, emotions, complaints, jokes, disclosures etc., often not revealed by patients and their families to staff members, or even vice versa. Discussion: While almost universally acknowledged as a positive addition to the hospital, most people who encounter the clown doctors have little conception about the scope of their role. The role of the clown doctors transcends traditional labels, but in crude terms it can be characterised as thus: role leads to function, which in turn leads to outcome. In terms of a joke analogy, function is the punch line of being a clown doctor. Conclusion: The results of this study provide a comprehensive understanding of clown doctors and the complexity of human relationships within a major paediatric hospital, uncovering a profound, nuanced culture cheerfully highlighting the need for a more person-centred approach to healthcare. Lessons Learned: This study has advanced understanding regarding clown doctors' unique contribution to healthcare delivery within a tertiary paediatric health service, highlighting their expertise in role-modelling person-centred interactions. Limitations: This study was conducted within one paediatric health service. The researchers believe however that the novel understandings regarding the role of the clown doctors generated through this study would likely transfer easily to other healthcare settings. Suggestions for Future Research: This study will inform future qualitative and quantitate research studies that aim to describe and measure the role of the clown doctors, as distinct from their activities, and the contribution this has to the experience of patients within health care services. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) is the single greatest contributor to the gap in life expectancy between Indigenous and non-Indigenous Australians. Our objective is to determine if holistic CVD risk assessment, introduced as part of the new Aboriginal and Torres Strait Islander Adult Health Check (AHC), results in better identification of elevated CVD risk, improved delivery of preventive care for CVD and improvements in the CVD risk profile for Aboriginal adults in a remote community. Methods: Interrupted time series study over six years in a remote primary health care (PHC) service involving Aboriginal adults identified with elevated CVD risk (N = 64). Several process and outcome measures were audited at 6 monthly intervals for three years prior to the AHC (the intervention) and three years following: (i) the proportion of guideline scheduled CVD preventive care services delivered, (ii) mean CVD medications prescribed and dispensed, (iii) mean PHC consultations, (iv) changes in participants' CVD risk factors and estimated absolute CVD risk and (v) mean number of CVD events and iatrogenic events. Results: Twenty-five percent of AHC participants were identified as having elevated CVD risk. Of these, 84% had not been previously identified during routine care. Following the intervention, there were significant improvements in the recorded delivery of preventive care services for CVD (30% to 53%), and prescription of CVD related medications (28% to 89%) (P < 0.001). Amongst participants there was a 20% relative reduction in estimated absolute CVD risk (P = 0.004) following the intervention. However, there were no significant changes in the mean number of PHC consultations or mean number of CVD events or iatrogenic events. Conclusions: Holistic CVD risk assessment during an AHC can lead to better and earlier identification of elevated CVD risk, improvement in the recorded delivery of preventive care services for CVD, intensification of treatment for CVD, and improvements in participants' CVD risk profile. Further research is required on strategies to reorient and restructure PHC services to the care of chronic illness for Aboriginal peoples in remote areas for there to be substantial progress in decreasing excess CVD related mortality. [ABSTRACT FROM AUTHOR]

Background: Although long-term alcohol and tobacco use have widely been recognised as important risk factors for cancer, the impacts of alcohol and tobacco health policies on cancer mortality have not been examined in previous studies. This study aims to estimate the association of key alcohol and tobacco policy or events in Australia with changes in overall and five specific types of cancer mortality between the 1950s and 2013.Methods: Annual population-based time-series data between 1911 and 2013 on per capita alcohol and tobacco consumption and head and neck (lip, oral cavity, pharynx, larynx and oesophagus), lung, breast, colorectum and anus, liver and total cancer mortality data from the 1950s to 2013 were collected from the Australian Bureau of Statistics and Cancer Council Victoria, the WHO Cancer Mortality Database and the Australian Institute of Health and Welfare. The policies with significant relations to changes in alcohol and tobacco consumption were identified in an initial model. Intervention dummies with estimated lags were then developed based on these key alcohol and tobacco policies and events and inserted into time-series models to estimate the relation of the particular policy changes with cancer mortality.Results: Liquor licence liberalisation in the 1960s was significantly associated with increases in the level of population drinking and thereafter of male cancer mortality. The introduction of random breath testing programs in Australia after 1976 was associated with a reduction in population drinking and thereafter in cancer mortality for both men and women. Meanwhile, the release of UK and US public health reports on tobacco in 1962 and 1964 and the ban on cigarette ads on TV and radio in 1976 were found to have been associated with a reduction in Australian tobacco consumption and thereafter a reduction in mortality from all cancer types except liver cancer. Policy changes on alcohol and tobacco during the 1960s-1980s were associated with greater changes for men than for women, particularly for head and neck, lung and colorectum cancer sites.Conclusion: This study provides evidence that some changes to public health policies in Australia in the twentieth century were related to the changes in the population consumption of alcohol and tobacco, and in subsequent mortality from various cancers over the following 20 years. [ABSTRACT FROM AUTHOR]