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Indigenous patient navigator (IPN) programmes show promise in addressing barriers to cancer care and facilitation of patient self‐efficacy. The purpose of this paper is to describe and reflect upon the experience of training an IPN and implementation of the intervention in the Australian context with Indigenous cancer patients. Randomised clinical trial might provide the best available evaluation measure of an intervention but caution should be taken in the implementation process. Socio‐cultural aspects and training can affect the conduct of this type of intervention. We report here five issues needing consideration prior to implementing such intervention. Specifically: (1) recognition of the collective bonds within Indigenous community and understanding by IPN of the degree of personal assistance perceived as not intrusive by the patient; (2) conduct ongoing evaluation of the different role of an IPN involved in this intervention care provider vs. researcher. (3) meaningful engagement develops from a trusting/collaborative relationship between research team and study site staff which may not occur in the study time frame; (4) existing skills as well as training provided may not translate in the IPN understanding and aligning with the study objectives/research values; (5) recruitment of participants requires innovative and highly flexible strategies to be successful. [ABSTRACT FROM AUTHOR]

Objective: To describe the management of asthma in children in a remote indigenous community and the delivery of subspecialist service through the indigenous health-care model.Methodology: Children referred by indigenous health-care workers were evaluated prospectively by paediatric respiratory physicians, based on a standardized protocol, at a primary health care setting at Thursday Island, Queensland.Results: Forty of the 54 children referred with a provisional diagnosis of asthma did have asthma, with 30% having persistent asthma. Only 59% of parents knew the dose of the medication prescribed and 80% had minimal knowledge of the medications. In 88% of children, the management of asthma was improved by introduction of an appropriate spacer device and changing the dose and type of medications.Conclusions: The management of children with asthma in the Torres region can be improved substantially by the use of age appropriate delivery devices and medications, and improving knowledge of asthma. Specialist delivery service to remote indigenous communities can be effectively delivered in partnership with the indigenous health service. The high proportion of persistent asthma in the Torres Straits community in comparison to urbanised Australia raises issues of inequity of appropriate medical service delivery to remote indigenous communities. [ABSTRACT FROM AUTHOR]

Objectives: International studies have shown shifting demographic data and rising hospitalizations for alcohol-related cirrhosis (ARC), with a paucity of data from Australia. We examined hospitalizations, mortality and demographic data for people admitted with ARC over the last decade in Queensland, Australia., Study Design: Data linkage study., Methods: A retrospective analysis of adults hospitalized with ARC during 2008-2019 was performed using state-wide admissions data. International Classification of Diseases, 10th revision, codes identified admissions with the principal diagnosis of ARC based on validated algorithms. Comorbidity was assessed using the Charlson Comorbidity Index., Results: A total of 7152 individuals had 24,342 hospital admissions with ARC (16,388 were for ARC). There was a predominance of males (72.6%) and age ≥50 years (80.4%) at index admission. Females were admitted at a significantly younger age than men (59% of women and 43% of men were aged <60 years, P < 0.001). Comorbidities were common, with 45.1% of people having at least one comorbidity. More than half (54.6%) of the patients died over the study period (median follow-up time was 5.1 years; interquartile range 2.4-8.6). Women had significantly lower mortality, with 47.6% (95% confidence interval [CI] 45.0-50.2) probability of 5-year survival, compared with 40.1% (95% CI 38.5-41.6) in men. In multivariable analysis, this was attributable to significantly lower age and comorbidity burden in women. Significantly lower survival was seen in people with higher comorbidity burden. Overall, the number of admissions for ARC increased 2.2-fold from 869 admissions in 2008 to 1932 in 2019., Conclusions: Hospital admissions for ARC have risen substantially in the last decade. Females were admitted at a younger age, with fewer comorbidities and had lower mortality compared with males. The association between greater comorbidity burden and higher mortality has important clinical implications, as comorbidity-directed interventions may reduce mortality., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Little is known about the supportive care needs (SCN) of Australian Indigenous cancer patients. This cross-sectional study investigated the association between comorbidity and SCN among newly diagnosed Indigenous cancer patients in Queensland. Comorbidity was ascertained from medical chart review using the Charlson Comorbidity Index (CCI) and SCN were measured using the Supportive Care Needs Assessment Tool for Indigenous Peoples (SCNAT-IP). Of 183 participants, 76 (42%) had no comorbidity (CCI = 0), 60 (33%) had had a CCI score of 1 and 47 (26%) had a CCI of two or more, with the most common condition being diabetes (30%). The most common moderate-high unmet need items varied between comorbidity groups, although all patients most frequently reported moderate-high unmet need in the Physical and Psychological and the Practical and Cultural needs domains. Patients with the greatest comorbidity (CCI ≥ 2) had significantly more reduced odds of practical and cultural needs than patients without comorbidity (OR 0.28, 95% CI 0.11-0.75). This appeared to be partially explained by time since diagnosis, age, whether they were receiving current treatment and residential remoteness. Patients' experience of chronic disease, hospitals and the healthcare system may better prepare them for the practical and cultural aspects of their cancer journey., (© 2016 John Wiley & Sons Ltd.)

We conducted a cross-sectional study of Indigenous youths residing in the Torres Strait region of Australia to assess the prevalence of obesity and the metabolic syndrome. Data on body mass index (BMI), waist circumference, blood pressure, presence of acanthosis nigricans and blood glucose were collected. Fasting glucose, insulin, C-Peptide, HbA1c and lipids were measured, and an oral glucose tolerance test was performed in those with a BMI greater than 25 (childhood-equivalent cut-points) or fasting glucometer reading >5.5 mmol/L. Of 158 youths, 31% were overweight and 15% were obese, 38% had enlarged waist circumference consistent with central obesity, 43% had acanthosis nigricans and 27% were hypertensive. More females than males had enlarged waist circumferences (59% vs. 13%, P < 0.001). Among overweight or obese youth, 56% had significantly elevated insulin (P = 0.021); they also had higher HOMA-IR (P = 0.002). The metabolic syndrome was present in 17% of all youths (mostly females) and in 33% of the overweight or obese subgroup. Type 2 diabetes was diagnosed in two youths. These very high proportions of overweight or obese Torres Strait youth with metabolic risk factors have major public health implications.

Background: The association between diabetes and cancer incidence has been well documented, but relatively little research has been undertaken on the potential influence of diabetes on cancer survival and the research that is available has produced inconsistent results. Because Indigenous Australians have a high prevalence of diabetes, we assessed survival, stratified by diabetes, among Indigenous Australian cancer patients. We also assessed survival, stratified by diabetes, amongst a cohort of non-Indigenous Australian cancer patients., Methods: All-cause survival and cancer-specific survival in diabetic versus non-diabetic cancer patients were assessed in Indigenous and non-Indigenous cohorts separately, using proportional hazards models., Findings: Indigenous cancer patients with diabetes (n = 140) had an overall survival disadvantage compared to Indigenous cancer patients without diabetes (n = 675) with all-cause Hazard Ratio (HR) = 1.4 (95% CI 1.1-1.8) adjusted for age, sex, and cancer site. After further adjustment to take into account the greater number of non-cancer deaths and co-morbidities in Indigenous cancer patients with diabetes, and their later stage at cancer diagnosis with less cancer treatment, there was no residual difference in cancer-specific survival compared to Indigenous cancer patients without diabetes (cancer-specific HR = 1.0, 95% CI 0.8, 1.3). Fewer non-Indigenous cancer patients had diabetes (n = 52) and they showed no differences in survival compared to their counterparts without diabetes., Interpretation: The poorer survival of Indigenous Australian cancer patients with diabetes was due to more non-cancer deaths, later stage at cancer diagnosis, less cancer treatment, and more co-morbidities than Indigenous Australian cancer patients without diabetes. In contrast, diabetes did not appear to affect survival in non-Indigenous Australians with cancer, either because there were too few to detect a moderate deleterious effect or because there was no association. Understanding the relation between diabetes and cancer treatment and survival is important because both diabetes and cancer are relatively common diseases, increasingly likely to co-exist.

Skin infections are highly prevalent in many Australian Aboriginal communities. This study aimed to determine the prevalence of group A streptococcus (GAS) and Staphylococcus aureus in skin sores of Indigenous people living in an urban setting. We undertook a cross-sectional study of 173 children and youths attending the Wuchopperen Clinic (Cairns) for treatment of skin infections. Participants were interviewed using a structured questionnaire, and a skin lesion swab obtained. The median age was 5.3 years, with 42% identifying themselves as Torres Strait Islanders and 34% as Aboriginal. Impetigo (65%) was the most frequent diagnosis reported followed by scabies (19%); 79% of the lesions had erythema and 70% had exudate. Of 118 lesions, 114 were positive for pathogenic bacteria, with GAS isolated in 84 cases and S. aureus in 92; both these species were recovered from 63 lesions. Significant diversity of emm-types of GAS was associated with skin lesions in Indigenous patients (22 emm-types identified). Fifteen of the 92 S. aureus isolates were suggestive of being community-acquired on the basis of antimicrobial susceptibility profile and nine of these strains were co-cultured from nine lesions. These results have implications for future changes of antibiotic policies for the treatment of skin infections in this population.

Objective: To investigate Australian adults' awareness of the ultraviolet (UV) indexes forecast in the media, and whether these UV forecasts influence their behaviour in the sun., Methods: A self-administered questionnaire was used on two occasions in 1997 to ask about knowledge of UV indexes shown in the media and about possible influence on outdoor behaviour., Setting and Participants: Participants were 977 residents (423 men; 554 women) of Nambour originally randomly selected in 1986 from the electoral roll, who have been followed up subsequently., Results: The majority of people--92% of men and 86% of women--reported having seen or heard the UV indexes forecast during summer. Of these, significantly fewer men (107; 28%) than women (209; 46%) reported that their outdoor behaviour was influenced by knowledge of the forecast (p = 0.001). Neither age nor skin type, nor history of sunburns or skin cancer, affected knowledge of UV forecasts or their influence on behaviour., Conclusions and Implications: Although most people are aware of the forecasts of UV indexes in the media, the majority do not take them into account in their outdoor behaviour. Compared with women, men were more aware of, but less influenced by, forecasts of UV indexes. Better communication of the implications of the UV indexes is needed, particularly to men, if they are to adapt their outdoor behaviour to improve their sun protection.