148 results on '"Maple-Brown, L"'
Search Results
2. Improving systems of care during and after a pregnancy complicated by hyperglycaemia: A protocol for a complex health systems intervention
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MacKay, D., Kirkham, R., Freeman, N., Murtha, K., Van Dokkum, P., Boyle, J., Campbell, S., Barzi, F., Connors, C., O'Dea, K., Oats, J., Zimmet, P., Wenitong, M., Sinha, A., Hanley, A. J., Moore, E., Peiris, D., McLean, A., Davis, B., Whitbread, C., McIntyre, H. D., Mein, J., McDermott, R., Corpus, S., Canuto, K., Shaw, J. E., Brown, A., Maple-Brown, L., Webster, Vanya, Graham, Sian, Bell, Dianne, Keeler, Katarina, Wapau, Chenoa, Zachariah, Martil, Barrett, Jennifer, Dias, Tara, Vine, Kristina, Davis, Bronwyn, Chitturi, S., Eades, S., Inglis, C., Dempsey, K., Lynch, M., Skinner, T., Wright, R., MacKay, D, Kirkham, R, Freeman, N, Murtha, K, O'Dea, K, and Maple-Brown, L
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Native Hawaiian or Other Pacific Islander ,Pregnancy in Diabetics ,Health informatics ,Health administration ,Study Protocol ,0302 clinical medicine ,Pregnancy ,Health care ,Medicine ,Mass Screening ,030212 general & internal medicine ,Referral and Consultation ,Aboriginal ,healthcare delivery ,Health Policy ,Nursing research ,lcsh:Public aspects of medicine ,Prenatal Care ,Quality Improvement ,Government Programs ,Female ,Queensland ,gestational diabetes ,health systems ,diabetes in pregnancy ,Adult ,Torres Strait Islander ,medicine.medical_specialty ,Referral ,Health Personnel ,030209 endocrinology & metabolism ,Health literacy ,Prenatal care ,03 medical and health sciences ,Nursing ,Northern Territory ,Health Services, Indigenous ,Humans ,Indigenous Australian ,Maternal Health Services ,health services ,mixed methods evaluation ,Medical Assistance ,type 2 diabetes in pregnancy ,business.industry ,Public health ,lcsh:RA1-1270 ,Pregnancy Complications ,Hyperglycemia ,business - Abstract
BackgroundMany women with hyperglycaemia in pregnancy do not receive care during and after pregnancy according to standards recommended in international guidelines. The burden of hyperglycaemia in pregnancy falls disproportionately upon Indigenous peoples worldwide, including Aboriginal and Torres Strait Islander women in Australia. The remote and regional Australian context poses additional barriers to delivering healthcare, including high staff turnover and a socially disadvantaged population with a high prevalence of diabetes.MethodsA complex health systems intervention to improve care for women during and after a pregnancy complicated by hyperglycaemia will be implemented in remote and regional Australia (the Northern Territory and Far North Queensland). The Theoretical Domains Framework was used during formative work with stakeholders to identify intervention components: (1) increasing workforce capacity, skills and knowledge and improving health literacy of health professionals and women; (2) improving access to healthcare through culturally and clinically appropriate pathways; (3) improving information management and communication; (4) enhancing policies and guidelines; (5) embedding use of a clinical register as a quality improvement tool. The intervention will be evaluated utilising the RE-AIM framework at two timepoints: firstly, a qualitative interim evaluation involving interviews with stakeholders (health professionals, champions and project implementers); and subsequently a mixed-methods final evaluation of outcomes and processes: interviews with stakeholders; survey of health professionals; an audit of electronic health records and clinical register; and a review of operational documents. Outcome measures include changes between pre- and post-intervention in: proportion of high risk women receiving recommended glucose screening in early pregnancy; diabetes-related birth outcomes; proportion of women receiving recommended postpartum care including glucose testing; health practitioner confidence in providing care, knowledge and use of relevant guidelines and referral pathways, and perception of care coordination and communication systems; changes to health systems including referral pathways and clinical guidelines.DiscussionThis study will provide insights into the impact of health systems changes in improving care for women with hyperglycaemia during and after pregnancy in a challenging setting. It will also provide detailed information on process measures in the implementation of such health system changes.
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- 2020
3. Periodontal therapy and glycaemic control among individuals with type 2 diabetes: reflections from the PerioCardio study
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Kapellas, K, Mejia, G, Bartold, P M, Skilton, M R, Maple-Brown, L J, Slade, G D, OʼDea, K, Brown, A, Celermajer, D S, and Jamieson, L M
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- 2016
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4. Development of a single-frequency bioimpedance prediction equation for fat-free mass in an adult Indigenous Australian population
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Hughes, J T, Maple-Brown, L J, Piers, L S, Meerkin, J, O'Dea, K, and Ward, L C
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- 2015
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5. ‘No sugar’, ‘no junk food’, ‘do more exercise’ – moving beyond simple messages to improve the health of Aboriginal women with Hyperglycaemia in Pregnancy in the Northern Territory – A phenomenological study
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Kirkham, R., primary, King, S., additional, Graham, S., additional, Boyle, J.A., additional, Whitbread, C., additional, Skinner, T., additional, Rumbold, A., additional, and Maple-Brown, L., additional
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- 2021
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6. Perinatal factors relating to changes in maternal body fat in late gestation
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Maple-Brown, L J, Roman, N M, Thomas, A, Presley, L H, and Catalano, P M
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- 2013
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7. Associations with dental caries experience among a convenience sample of Aboriginal Australian adults
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Amarasena, N, Kapellas, K, Skilton, M R, Maple-Brown, L J, Brown, A, OʼDea, K, Celermajer, D S, and Jamieson, L M
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- 2015
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8. Strategies to address the challenges of youth-onset type 2 diabetes among Aboriginal and Torres Strait Islander communities: INV3bis
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Maple-Brown, L.
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- 2015
9. Performance of formulas for estimating glomerular filtration rate in Indigenous Australians with and without Type 2 diabetes: the eGFR Study
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Maple-Brown, L. J., Ekinci, E. I., Hughes, J. T., Chatfield, M., Lawton, P. D., Jones, G. R. D., Ellis, A. G., Sinha, A., Cass, A., Hoy, W. E., OʼDea, K., Jerums, G., and MacIsaac, R. J.
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- 2014
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10. Periodontal disease and dental caries among Indigenous Australians living in the Northern Territory, Australia
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Kapellas, K, Skilton, M R, Maple-Brown, L J, Do, L G, Bartold, P M, OʼDea, K, Brown, A, Celermajer, D S, and Jamieson, L M
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- 2014
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11. Area-under-the-HbA1c-curve above the normal range and the prediction of microvascular outcomes: an analysis of data from the Diabetes Control and Complications Trial
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Maple-Brown, L. J., Ye, C., and Retnakaran, R.
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- 2013
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12. Maternal Pregravid Weight Is the Primary Determinant of Serum Leptin and Its Metabolic Associations in Pregnancy, Irrespective of Gestational Glucose Tolerance Status
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Maple-Brown, L., Ye, C., Hanley, A. J., Connelly, P. W., Sermer, M., Zinman, B., and Retnakaran, R.
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- 2012
13. Risk factors for cardiovascular disease do not fully explain differences in carotid intima-media thickness between Indigenous and European Australians without diabetes
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Maple-Brown, L., Hodge, A., Cunningham, J., Celermajer, D. S., and OʼDea, K.
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- 2009
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14. RECRUITMENT CHALLENGES OF THE eGFR STUDY: ACCURATE ASSESMENT OF RENAL FUNCTION IN INDIGENOUS AUSTRALIANS: 016
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SHARMA, S, HUGHES, J, LAWTON, P, OʼDEA, K, and MAPLE-BROWN, L
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- 2008
15. METHOLODOLOGY OF THE eGFR STUDY: ACCURATE ASSESSMENT OF RENAL FUNCTION IN INDIGENOUS AUSTRALIANS: 013
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LAWTON, P, MAPLE-BROWN, L, HUGHES, J, SHARMA, S, PANAGIOTOPOULOS, S, JONES, G, CASS, A, OʼDEA, K, and JERUMS, G
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- 2008
16. Increased carotid intima-media thickness in remote and urban Indigenous Australians: impact of diabetes and components of the metabolic syndrome
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Maple-Brown, L., Cunningham, J., Celermajer, D. S., and OʼDea, K.
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- 2007
17. Familial hypocalciuric hypercalcaemia in a large family with neurofibromatosis 1
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Maple-Brown, L J, Williams, R A, and Ward, R L
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- 2002
18. SAT-184 Is hyperfiltration associated with higher urine albumin-to-creatinine ratio at follow up among Indigenous Australians? The eGFR follow-up study
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EKINCI, E., primary, Barr, E.L., additional, Barzi, F., additional, Hughes, J.T., additional, Lawton, P.D., additional, Hoy, W., additional, Cass, A., additional, Thomas, M., additional, MacIsaac, R.J., additional, and Maple-Brown, L., additional
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- 2019
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19. Associations of mortality and cardiovascular disease risks with diabetes and albuminuria in urban Indigenous Australians: the DRUID follow‐up study
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Barr, E. L. M., primary, Cunningham, J., additional, Tatipata, S., additional, Dunbar, T., additional, Kangaharan, N., additional, Guthridge, S., additional, Li, S. Q., additional, Condon, J. R., additional, Shaw, J. E., additional, O'Dea, K., additional, and Maple‐Brown, L. J., additional
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- 2017
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20. Management of diabetes in Indigenous communities: lessons from the Australian Aboriginal population
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Nguyen, H. D., primary, Chitturi, S., additional, and Maple‐Brown, L. J., additional
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- 2016
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21. Longitudinal displacement of the carotid wall and cardiovascular risk factors: associations with aging, adiposity, blood pressure and periodontal disease independent of cross-sectional distensibility and intima-media thickness
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Zahnd, G., Vray, D., Sérusclat, A., Alibay, D., Bartold, M., Durand, M., Jamieson, L., Kapellas, K., Maple-Brown, L., O\textquoterightDea, K., Moulin, Philippe, Celermajer, D., Skilton, M., Imagerie Ultrasonore, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hopital Cardio-Thoracique et Vasculaire Louis Pradel, Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Laboratoire de recherche en Hydrodynamique, Énergétique et Environnement Atmosphérique (LHEEA), École Centrale de Nantes (ECN)-Centre National de la Recherche Scientifique (CNRS), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL)
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[SPI.ACOU]Engineering Sciences [physics]/Acoustics [physics.class-ph] ,Imagerie Ultrasonore ,reseau_international ,[SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging ,Labex CELYA ,reseau_internationnal ,[INFO.INFO-IM]Computer Science [cs]/Medical Imaging ,categₘixte ,Australie ,imagerie_ultrasonore ,[SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing ,ComputingMilieux_MISCELLANEOUS ,Labex PRIMES - Abstract
International audience
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- 2012
22. The Effect of Periodontal Therapy on Carotid Intima-Media Thickness among Aboriginal Australians: A Randomised Controlled Trial.
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Kapellas, K., primary, Maple-Brown, L. J., additional, Jamieson, L. M., additional, Do, L. G., additional, O'Dea, K., additional, Brown, A., additional, Celermajer, D. S., additional, Slade, G. D., additional, and Skilton, M. R., additional
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- 2015
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23. Health service changes to address diabetes in pregnancy in a complex setting: perspectives of health professionals.
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Kirkham, R., Boyle, J. A., Whitbread, C., Dowden, M., Connors, C., Corpus, S., McCarthy, L., Oats, J., McIntyre, H. D., Moore, E., O'Dea, K., Brown, A., Maple-Brown, L., and NT Diabetes in Pregnancy Partnership
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MEDICAL care ,PREGNANCY complications ,MEDICAL personnel ,GESTATIONAL diabetes ,TYPE 2 diabetes ,TYPE 2 diabetes treatment ,FOCUS groups ,QUALITY assurance ,MEDICAL care of indigenous peoples ,THERAPEUTICS - Abstract
Background: Australian Aboriginal and Torres Strait Islander women have high rates of gestational and pre-existing type 2 diabetes in pregnancy. The Northern Territory (NT) Diabetes in Pregnancy Partnership was established to enhance systems and services to improve health outcomes. It has three arms: a clinical register, developing models of care and a longitudinal birth cohort. This study used a process evaluation to report on health professional's perceptions of models of care and related quality improvement activities since the implementation of the Partnership.Methods: Changes to models of care were documented according to goals and aims of the Partnership and reviewed annually by the Partnership Steering group. A 'systems assessment tool' was used to guide six focus groups (49 healthcare professionals). Transcripts were coded and analysed according to pre-identified themes of orientation and guidelines, education, communication, logistics and access, and information technology.Results: Key improvements since implementation of the Partnership include: health professional relationships, communication and education; and integration of quality improvement activities. Focus groups with 49 health professionals provided in depth information about how these activities have impacted their practice and models of care for diabetes in pregnancy. Co-ordination of care was reported to have improved, however it was also identified as an opportunity for further development. Recommendations included a central care coordinator, better integration of information technology systems and ongoing comprehensive quality improvement processes.Conclusions: The Partnership has facilitated quality improvement through supporting the development of improved systems that enhance models of care. Persisting challenges exist for delivering care to a high risk population however improvements in formal processes and structures, as demonstrated in this work thus far, play an important role in work towards improving health outcomes. [ABSTRACT FROM AUTHOR]- Published
- 2017
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24. Development of a single-frequency bioimpedance prediction equation for fat-free mass in an adult Indigenous Australian population
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Hughes, J T, primary, Maple-Brown, L J, additional, Piers, L S, additional, Meerkin, J, additional, O'Dea, K, additional, and Ward, L C, additional
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- 2014
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25. Area‐under‐the‐HbA1c‐curve above the normal range and the prediction of microvascular outcomes: an analysis of data from the Diabetes Control and Complications Trial
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Maple‐Brown, L. J., primary, Ye, C., additional, and Retnakaran, R., additional
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- 2012
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26. Area-under-the-HbA1c-curve above the normal range and the prediction of microvascular outcomes: an analysis of data from the Diabetes Control and Complications Trial.
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Maple‐Brown, L. J., Ye, C., and Retnakaran, R.
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DIABETES complications , *DIAGNOSIS of diabetes , *CLINICAL trials , *GLYCOSYLATED hemoglobin , *EVALUATION of medical care , *DATA analysis , *RECEIVER operating characteristic curves - Abstract
Aims In the Diabetes Control and Complications Trial, mean updated HbA1c accounted for most of the differential risk of microvascular complications between intensive and conventional insulin therapy. We hypothesized, however, that a more precise measure of chronic hyperglycaemic exposure may be the incremental area-under-the-HbA1c-curve above the Diabetes Control and Complications Trial-standardized normal range for HbA1c (iAUCHbA1c>norm). Methods Using the Principal Diabetes Control and Complications Trial data set, we compared the following three measures of chronic glycaemic exposure for their capacity to predict retinopathy, nephropathy and neuropathy during the Diabetes Control and Complications Trial: mean updated HbA1c, iAUCHbA1c>norm, and total area-under-the-HbA1c-curve (tAUCHbA1c). For each outcome, models using each of these three glycaemic measures were compared in the following three ways: hazard or odds ratio, χ2 statistic, and Akaike information criterion. Results The three glycaemic measures did not differ in their prediction of neuropathy. iAUCHbA1c>norm was modestly superior to mean updated HbA1c for predicting nephropathy (χ2 P = 0.017, Akaike P = 0.032). In contrast, for predicting retinopathy, both iAUCHbA1c>norm (χ2 P = 0.0005, Akaike P = 0.0005) and tAUCHbA1c (χ2 P = 0.004, Akaike P = 0.004) were significantly better than mean updated HbA1c. Varying its HbA1c threshold incrementally between 37 and 53 mmol/mol (5.5-7.0%), inclusive, did not improve the prediction of retinopathy by iAUCHbA1c>threshold beyond that of tAUCHbA1c,consistent with the concept of a continuous relationship between glycaemia and retinopathy, with no glycaemic threshold. Conclusions Both iAUCHbA1c>norm and tAUCHbA1c were superior to mean updated HbA1c for predicting retinopathy. Optimal assessment of chronic glycaemic exposure as a determinant of retinopathic risk may require consideration of both the degree of hyperglycaemia and its duration. [ABSTRACT FROM AUTHOR]
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- 2013
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27. Factors Associated with Routine Dental Attendance among Aboriginal Australians
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Amarasena, Najith, Kapellas, Kostas, Skilton, Michael R, Maple-Brown, Louise J, Brown, Alex, Bartold, Mark, O’Dea, Kerin, Celermajer, David, and Jamieson, Lisa M
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- 2016
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28. Oral health behaviours and perceptions reported by Indigenous Australians living in Darwin, Northern Territory.
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Amarasena, N., Kapellas, K., Skilton, M., Maple-Brown, L., Brown, A., Bartold, P. M., O'Dea, K., Celermajer, D., Slade, G., and Jamieson, L. M.
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Objective: To describe the reported oral health behaviours and perceptions of Indigenous Australians living in Darwin, Northern Territory and to compare those with estimates for Darwin and Australia derived from the National Survey of Adult Oral Health (NSAOH). Participants: A total of 181 Indigenous Australians aged 22 years and over living in Darwin, participating in screening for a wider randomised clinical trial, were included. Method: Information on socio-demographic characteristics, oral health status including oral health behaviours and perceptions was collected using a questionnaire. Differences between the Darwin study (DS) participants and Australians in NSAOH were made based on non-overlapping 95% confidence intervals. Results: Almost 72% of DS participants had last seen a dentist over a year earlier, compared to 47% and 39% of NSAOH Darwin and Australian participants, respectively. A higher proportion of DS participants usually visited a dentist because of a problem than NSAOH Darwin and NSAOH Australian participants. A higher proportion of DS participants had avoided or delayed a dental visit because of cost than NSAOH participants. Over three times as many DS participants rated their oral health as fair/poor compared to NSAOH participants. A higher proportion of DS participants had perceived gum disease and one or more symptoms of gum disease than NSAOH participants. A higher proportion of DS participants experienced toothache, felt uncomfortable about appearance of their mouth and avoided eating because of oral problems than NSAOH participants. Conclusions: A higher proportion of Indigenous Australians living in Darwin presented with non-optimal oral health behaviours and perceptions compared with both the Darwin and Australian general populations. [ABSTRACT FROM AUTHOR]
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- 2014
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29. Diabetes care in remote Australia: the antenatal, postpartum and inter-pregnancy period.
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Kirkham, R., Trap-Jensen, N., Boyle, J. A., Barzi, F., Barr, E. L. M., Whitbread, C., Van Dokkum, P., Kirkwood, M., Connors, C., Moore, E., Zimmet, P., Corpus, S., Hanley, A. J., O'Dea, K., Oats, J., McIntyre, H. D., Brown, A., Shaw, J. E., Maple-Brown, L., and NT Diabetes in Pregnancy Partnership
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MEDICAL personnel as patients ,MEDICAL screening ,PRENATAL care ,POSTNATAL care - Abstract
Background: Aboriginal and Torres Strait Islander women experience high rates of diabetes in pregnancy (DIP), contributing to health risks for mother and infant, and the intergenerational cycle of diabetes. By enhancing diabetes management during pregnancy, postpartum and the interval between pregnancies, the DIP Partnership aims to improve health outcomes and reduce risks early in the life-course. We describe a mixed methods formative study of health professional's perspectives of antenatal and post-partum diabetes screening and management, including enablers and barriers to care.Methods: Health professionals involved in providing diabetes care in pregnancy, from a range of health services across the Northern Territory, completed the survey (n = 82) and/or took part in interviews and/or focus groups (n = 62).Results: Qualitative findings highlighted factors influencing the delivery of care as reported by health professionals, including: whose responsibility it is, access to care, the baby is the focus and pre-conception care. The main challenges were related to: disjointed systems and confusion around whose role it is to provide follow-up care beyond six weeks post-partum. Quantitative findings indicated that the majority of health professionals reported confidence in their own skills to manage women in the antenatal period (62%, 40/79) and slightly lower rates of confidence in the postpartum interval (57%, 33/58).Conclusion: These findings regarding whose role it is to provide postpartum care, along with opportunities to improve communication pathways and follow up care have informed the design of a complex health intervention to improve health systems and the provision of DIP related care. [ABSTRACT FROM AUTHOR]- Published
- 2019
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30. Cross-sectional associations of albuminuria among Aboriginal and Torres Strait Islander adults: the eGFR Study.
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Hughes, J. T., Maple‐Brown, L. J., Thomas, M., Lawton, P. D., Sinha, A., Cass, A., Barzi, F., Jones, G. R. D., Jerums, G., MacIsaac, R. J., O'Dea, K., and Hoy, W. E.
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ALBUMINURIA , *BLOOD pressure , *WAIST-hip ratio , *HEMATURIA , *TORRES Strait Islanders , *HEALTH of Aboriginal Australians , *HEALTH - Abstract
ABSTRACT Objective To describe the detailed associations of albuminuria among a contemporary cohort of Aboriginal and Torres Strait Islander people to inform strategies for chronic kidney disease prevention and management. Methods A cross-sectional analysis of Indigenous participants of the eGFR Study. Measures Clinical, biochemical and anthropometric measures were collected (including body-circumferences, blood pressure (BP); triglycerides, HbA1c, liver function tests, creatinine; urine- microscopic-haem, albumin: creatinine ratio (ACR), prescriptions- angiotensin converting enzyme inhibitor or angiotensin receptor II antagonist (ACEI/ARB). Albuminuria and diabetes were defined by an ACR>3.0 mg/mmol, and HbA1c≥48 mmol/mol or prior history respectively. Waist: hip ratio (WHR), and estimated glomerular filtration rate (eGFR) were calculated. ACR was non-normally distributed; a logarithmic transformation was applied (in base 2), with each unit increase in log2-albuminuria representing a doubling of ACR. Results 591 participants were assessed (71% Aboriginal, 61.6% female, mean age 45.1 years, BMI 30.2 kg/m2, WHR 0.94, eGFR 99.2 ml/min/1.73m2). The overall prevalence of albuminuria, diabetes, microscopic-haem and ACEI/ARB use was 41.5%, 41.5%, 17.8% and 34.7% respectively; 69.3% of adults with albuminuria and diabetes received an ACEI/ARB. Using multivariable linear regression modelling, the potentially modifiable factors independently associated with log2-albuminuria were microscopic-haem, diabetes, WHR, systolic BP, alkaline phosphatase (all positive) and eGFR (inverse). Conclusion Albuminuria is associated with diabetes, central obesity and haematuria. High ACEI/ARB prescribing for adults with diabetes and albuminuria was observed. Further understanding of the links between fat deposition, haematuria and albuminuria is required. [ABSTRACT FROM AUTHOR]
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- 2018
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31. Diabetes care in remote Australia: the antenatal, postpartum and inter-pregnancy period
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Alex Brown, P. Van Dokkum, Kerin O'Dea, Harold David McIntyre, Federica Barzi, Paul Zimmet, Louise J. Maple-Brown, Jacqueline Boyle, Elizabeth Moore, Sumaria Corpus, Christine Connors, Anthony J. Hanley, N. Trap-Jensen, Elizabeth L M Barr, Jeremy Oats, Marie Kirkwood, Renae Kirkham, Jonathan E. Shaw, Cherie Whitbread, Kirkham, R, Trap-Jensen, N, Boyle, JA, Barzi, F, Barr, ELM, Whitbread, C, Van Dokkum, P, Kirkwood, M, Connors, C, Moore, E, Zimmet, P, Corpus, S, Hanley, AJ, O'Dea, K, Oats, J, McIntyre, HD, and Maple-Brown, L
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Male ,Native Hawaiian or Other Pacific Islander ,Pregnancy in Diabetics ,Preconception Care ,Health Services Accessibility ,0302 clinical medicine ,Pregnancy ,postpartum ,030212 general & internal medicine ,Cultural Competency ,030503 health policy & services ,Obstetrics and Gynecology ,Focus Groups ,3. Good health ,Perinatal Care ,Female ,0305 other medical science ,Cultural competence ,diabetes in pregnancy ,Research Article ,Adult ,medicine.medical_specialty ,Maternal-Child Health Services ,Attitude of Health Personnel ,Reproductive medicine ,Health intervention ,lcsh:Gynecology and obstetrics ,antenatal ,Indigenous ,03 medical and health sciences ,Birth Intervals ,Diabetes management ,Postpartum ,Northern Territory ,medicine ,Humans ,Antenatal ,lcsh:RG1-991 ,Health Services Needs and Demand ,business.industry ,Infant ,healthcare services ,medicine.disease ,Focus group ,Diabetes, Gestational ,Family medicine ,business ,Diabetes in pregnancy ,Healthcare services - Abstract
Background Aboriginal and Torres Strait Islander women experience high rates of diabetes in pregnancy (DIP), contributing to health risks for mother and infant, and the intergenerational cycle of diabetes. By enhancing diabetes management during pregnancy, postpartum and the interval between pregnancies, the DIP Partnership aims to improve health outcomes and reduce risks early in the life-course. We describe a mixed methods formative study of health professional’s perspectives of antenatal and post-partum diabetes screening and management, including enablers and barriers to care. Methods Health professionals involved in providing diabetes care in pregnancy, from a range of health services across the Northern Territory, completed the survey (n = 82) and/or took part in interviews and/or focus groups (n = 62). Results Qualitative findings highlighted factors influencing the delivery of care as reported by health professionals, including: whose responsibility it is, access to care, the baby is the focus and pre-conception care. The main challenges were related to: disjointed systems and confusion around whose role it is to provide follow-up care beyond six weeks post-partum. Quantitative findings indicated that the majority of health professionals reported confidence in their own skills to manage women in the antenatal period (62%, 40/79) and slightly lower rates of confidence in the postpartum interval (57%, 33/58). Conclusion These findings regarding whose role it is to provide postpartum care, along with opportunities to improve communication pathways and follow up care have informed the design of a complex health intervention to improve health systems and the provision of DIP related care.
- Published
- 2019
32. Health service changes to address diabetes in pregnancy in a complex setting: perspectives of health professionals
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R. Kirkham, J. A. Boyle, C. Whitbread, M. Dowden, C. Connors, S. Corpus, L. McCarthy, J. Oats, H. D. McIntyre, E. Moore, K. O’Dea, A. Brown, L. Maple-Brown, On behalf of the NT Diabetes in Pregnancy Partnership, Kirkham, R, Boyle, JA, Whitbread, C, Dowden, M, Connors, C, Corpus, S, McCarthy, L, Oats, J, McIntyre, J, Moore, E, O'Dea, K, Brown, A, and Maple-Brown, L
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medicine.medical_specialty ,Native Hawaiian or Other Pacific Islander ,Health Personnel ,Integration of care ,Pregnancy in Diabetics ,030209 endocrinology & metabolism ,Healthcare delivery ,Health informatics ,Health administration ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Pregnancy ,Health care ,Health Services, Indigenous ,Humans ,Medicine ,030212 general & internal medicine ,health services ,indigenous ,Health policy ,healthcare delivery ,HRHIS ,business.industry ,lcsh:Public aspects of medicine ,Health Policy ,Nursing research ,Public health ,Australia ,integration of care ,lcsh:RA1-1270 ,Focus Groups ,Quality Improvement ,Health services ,Indigenous ,3. Good health ,Diabetes Mellitus, Type 2 ,General partnership ,Female ,Diabetes in pregnancy ,business ,Delivery of Health Care ,diabetes in pregnancy ,Research Article - Abstract
Background: Australian Aboriginal and Torres Strait Islander women have high rates of gestational and pre-existing type 2 diabetes in pregnancy. The Northern Territory (NT) Diabetes in Pregnancy Partnership was established to enhance systems and services to improve health outcomes. It has three arms: a clinical register, developing models of care and a longitudinal birth cohort. This study used a process evaluation to report on health professional's perceptions of models of care and related quality improvement activities since the implementation of the Partnership. Methods: Changes to models of care were documented according to goals and aims of the Partnership and reviewed annually by the Partnership Steering group. A 'systems assessment tool' was used to guide six focus groups (49 healthcare professionals). Transcripts were coded and analysed according to pre-identified themes of orientation and guidelines, education, communication, logistics and access, and information technology. Results: Key improvements since implementation of the Partnership include: health professional relationships, communication and education; and integration of quality improvement activities. Focus groups with 49 health professionals provided in depth information about how these activities have impacted their practice and models of care for diabetes in pregnancy. Co-ordination of care was reported to have improved, however it was also identified as an opportunity for further development. Recommendations included a central care coordinator, better integration of information technology systems and ongoing comprehensive quality improvement processes. Conclusions: The Partnership has facilitated quality improvement through supporting the development of improved systems that enhance models of care. Persisting challenges exist for delivering care to a high risk population however improvements in formal processes and structures, as demonstrated in this work thus far, play an important role in work towards improving health outcomes. Refereed/Peer-reviewed
- Published
- 2017
33. Risk factors for cardiovascular disease do not fully explain differences in carotid intima-media thickness between Indigenous and European Australians without diabetes
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David S. Celermajer, Louise J. Maple-Brown, Kerin O'Dea, Allison M. Hodge, Joan Cunningham, Maple-Brown, L, Hodge, A, Cunningham, J, Celemajer, DS, and O'Dea, K
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Adult ,Blood Glucose ,Male ,Tunica media ,European Australians ,medicine.medical_specialty ,Indigenous Australians ,carotid intima-media thickness ,Endocrinology, Diabetes and Metabolism ,Blood lipids ,Indigenous ,Endocrinology ,Risk Factors ,cardiovascular disease ,Internal medicine ,Diabetes mellitus ,Epidemiology ,Diabetes Mellitus ,medicine ,Humans ,Risk factor ,Ultrasonography ,diabetes ,business.industry ,differences ,Australia ,Middle Aged ,Anthropometry ,medicine.disease ,Lipids ,Surgery ,C-Reactive Protein ,Carotid Arteries ,medicine.anatomical_structure ,risk factor ,Intima-media thickness ,Cardiovascular Diseases ,Female ,Tunica Intima ,Tunica Media ,business ,Demography - Abstract
Summary Objective To investigate whether cardiovascular risk factors can explain the higher carotid intima–media thickness (CIMT) in Indigenous compared with European Australians. Design Cross-sectional study in three subgroups. Patients Non-diabetic urban European (n = 86), urban Indigenous (n = 69), and remote Indigenous (n = 60) Australians aged 25–64 years. Measurements CIMT, age, sex, anthropometry, blood pressure, smoking status, fasting glucose and insulin, haemoglobin (Hb)A1c, homocysteine, C-reactive protein (CRP), lipids, urinary albumin and creatinine. Results CIMT and levels of risk factors, except fasting glucose and total cholesterol, worsened across the three groups. Logn fasting insulin [β = 0·022, 95% confidence interval (CI) 0–0·0439], age (β = 0·006, 95% CI 0·004–0·007), gender (female β = –0·005 vs. male, 95% CI –0·084 to –0·026), mean arterial pressure (MAP) (β = 0·001, 95% CI 0·001–0·002) and ethnicity/location [urban Indigenous (β = 0·027, 95% CI –0·010 to 0·064 vs. European); remote Indigenous (β = 0·083, 95% CI 0·042–0·123 vs. European)] explained 41% of variance in CIMT. Significant interactions were seen for ethnicity/location with age (P = 0·014) and MAP (P = 0·018). Age was consistently associated with CIMT across the three populations, and was associated with larger increments in CIMT for the Indigenous subgroups (β = 0·007, 95% CI 0·005–0·009 urban; β = 0·007, 95% CI 0·004–0·010 remote) compared with Europeans (β = 0·003, 95% CI 0·002–0·006) in models including age, sex and MAP. MAP was only associated with CIMT in the remote Indigenous subgroup. Conclusion After adjusting for selected risk factors, CIMT in remote Indigenous participants was still higher than in Europeans. The slope of the association between age and CIMT steepened from urban Europeans to remote Indigenous.
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- 2009
34. Oral health behaviours and perceptions reported by Indigenous Australians living in Darwin, Northern Territory
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Amarasena, N, Kapellas, K, Skilton, M, Maple-Brown, L, Brown, A, Bartold, PM, O'Dea, K, Celemajer, D, Slade, G, and Jamieson, LM
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perceptions ,Indigenous Australian ,oral health behaviours ,humanities - Abstract
Objective: To describe the reported oral health behaviours and perceptions of Indigenous Australians living in Darwin, Northern Territory and to compare those with estimates for Darwin and Australia derived from the National Survey of Adult Oral Health (NSAOH). Participants: A total of 181 Indigenous Australians aged 22 years and over living in Darwin, participating in screening for a wider randomised clinical trial, were included. Method: Information on socio-demographic characteristics, oral health status including oral health behaviours and perceptions was collected using a questionnaire. Differences between the Darwin study (DS) participants and Australians in NSAOH were made based on non-overlapping 95% confidence intervals. Results: Almost 72% of DS participants had last seen a dentist over a year earlier, compared to 47% and 39% of NSAOH Darwin and Australian participants, respectively. A higher proportion of DS participants usually visited a dentist because of a problem than NSAOH Darwin and NSAOH Australian participants. A higher proportion of DS participants had avoided or delayed a dental visit because of cost than NSAOH participants. Over three times as many DS participants rated their oral health as fair/poor compared to NSAOH participants. A higher proportion of DS participants had perceived gum disease and one or more symptoms of gum disease than NSAOH participants. A higher proportion of DS participants experienced toothache, felt uncomfortable about appearance of their mouth and avoided eating because of oral problems than NSAOH participants. Conclusions: A higher proportion of Indigenous Australians living in Darwin presented with non-optimal oral health behaviours and perceptions compared with both the Darwin and Australian general populations. Refereed/Peer-reviewed
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- 2014
35. Aboriginal young people's experiences of type 2 diabetes diagnosis, management and support: A qualitative study in the Kimberley region of Western Australia.
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Spry E, Seear K, Harkin B, O'Donnell V, Maple-Brown L, Atkinson D, and Kirkham R
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Issues Addressed: In Australia, Aboriginal and Torres Strait Islander young people in remote settings are most-affected by young onset type 2 diabetes (T2D). It is necessary to understand young people's experiences, including factors impacting on self-management, to improve models of care., Methods: A phenomenological methodology underpinned this qualitative study in Western Australia's Kimberley region. Two Aboriginal Community Controlled Health Services supported recruitment of seven Aboriginal young people aged 12-24 with T2D, who participated in interviews. A carer and health professional of one young person in each site were also interviewed and relevant medical record data reviewed to assist with triangulation of data. De-identified transcripts were inductively coded and a coding structure developed with oversight by a Kimberley Aboriginal researcher., Results: Young people reported varied experiences and emotions relating to a T2D diagnosis. Most recounted this was upsetting and some reported current negative impact on emotional wellbeing. Challenges with understanding and managing diabetes were highlighted, particularly regarding healthy eating, physical activity and medication. Family are a prominent source of self-management support, with the intergenerational impact of diabetes being evident for each participant. Positive relationships with health professionals, entailing continuity of care, were valued., Conclusions: There are significant emotional and medical challenges for young people with T2D and their families. Recommendations from this work will contribute to the development of local resources and initiatives to improve diabetes-related support. SO WHAT?: Alongside broader efforts to support good health at the societal level, enhanced health education and family-oriented support structures including Aboriginal clinical staff for young people with T2D are needed., (© 2024 The Author(s). Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)
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- 2024
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36. Engagement and partnership with consumers and communities in the co-design and conduct of Research: Lessons from the INtravenous iron polymaltose for First Nations Australian patients with high FERRitin levels on haemodialysis (INFERR) clinical trial.
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Long S, Ross C, Koops J, Coulthard K, Nelson J, Shapkota AK, Hewett L, Tate-Baker J, Graham J, Mukula R, Tetteh C, Hoppo L, Cherian S, Pawar B, Chmielewski HL, Gold LM, Rathnayake G, Heron B, Brewster-O'Brien T, Karepalli V, Maple-Brown L, Batey R, Morris P, Davies J, Fernandes DK, Thomas S, Abeyaratne A, Lawton PD, Barzi F, Taylor S, Mayo M, Cass A, and Majoni SW
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Background: Engagement and partnership with consumers and communities throughout research processes produces high quality research meeting community needs and promoting translation of research into improved policy and practice. Partnership is critical in research involving Aboriginal and/or Torres Strait Islander people (First Nations Peoples) to ensure cultural safety. We present lessons from the design, implementation and progress of the National Health and Medical Research Council funded INtravenous iron polymaltose for First Nations Australian patients with high FERRitin levels on hemodialysis (INFERR) clinical trial., Main Body: The trial was designed to understand the benefits and harms of iron therapy in First Nations Australians on haemodialysis with anaemia and hyperferritinaemia. The lack of evidence for treatment was discussed with patients who were potential participants. A key element ensuring safe conduct of the INFERR trial was the establishment of the Indigenous Reference Groups (IRGs) comprising of dialysis patients based in the Top End of Australia and Central Australia. Two IRGs were needed based on advice from First Nations communities and researchers/academics on the project regarding local cultural differences and approaches to trial conduct. The IRGs underpin culturally safe trial conduct by providing input into study materials and translating study findings into effective messages and policies for First Nations dialysis patients. Throughout the trial conduct, the IRGs' role has developed to provide key mechanisms for advice and guidance regarding research conduct both in this study and more broadly. Support provided to the IRGs by trial First Nations Research Officers and independent First Nations researchers/academics who simplify research concepts is critical. The IRGs have developed feedback documents and processes to participants, stakeholders, and the renal units. They guarantee culturally safe advice for embedding findings from the trial into clinical practice guidelines ensuring evidence-based approaches in managing anaemia in haemodialysis patients with hyperferritinaemia., Conclusion: Active consumer and community partnership is critical in research conduct to ensure research impact. Strong partnership with consumers in the INFERR clinical trial has demonstrated that First Nations Consumers will engage in research they understand, that addresses health priorities for them and where they feel respected, listened to, and empowered to achieve change., (© 2024. Crown.)
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- 2024
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37. Technology advances in diabetes pregnancy: right technology, right person, right time.
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McLean A, Maple-Brown L, and Murphy HR
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This review outlines some of the extraordinary recent advances in diabetes technology, which are transforming the management of type 1 diabetes before, during and after pregnancy. It highlights recent improvements associated with use of continuous glucose monitoring (CGM) but acknowledges that neither CGM nor insulin pump therapy are adequate for achieving the pregnancy glucose targets. Furthermore, even hybrid closed-loop (HCL) systems that are clinically effective outside of pregnancy may not confer additional benefits throughout pregnancy. To date, there is only one HCL system, the CamAPS FX, with a strong evidence base for use during pregnancy, suggesting that the pregnancy benefits are HCL system specific. This is in stark contrast to HCL system use outside of pregnancy, where benefits are HCL category specific. The CamAPS FX HCL system has a rapidly adaptive algorithm and lower glucose targets with benefits across all maternal glucose categories, meaning that it is applicable for all women with type 1 diabetes, before and during pregnancy. For women of reproductive years living with type 2 diabetes, the relative merits of using non-insulin pharmacotherapies vs diabetes technology (dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors) are unknown. Despite the urgent unmet need and potential benefits, studies of pharmacotherapy and technology use are extremely limited in pregnant women with type 2 diabetes., (© 2024. The Author(s).)
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- 2024
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38. Benchmarking for healthy food stores: protocol for a randomised controlled trial with remote Aboriginal and Torres Strait Islander communities in Australia to enhance adoption of health-enabling store policy and practice.
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Brimblecombe J, Ferguson M, McMahon E, Fredericks B, Turner N, Pollard C, Maple-Brown L, Batstone J, McCarthy L, Miles E, De Silva K, Barnes A, Chatfield M, Hill A, Christian M, van Burgel E, Fairweather M, Murison A, Lukose D, Gaikwad S, Lewis M, Clancy R, Santos C, Uhlmann K, Funston S, Baddeley L, Tsekouras S, Ananthapavan J, Sacks G, and Lee A
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- Humans, Australia, Australian Aboriginal and Torres Strait Islander Peoples, Commerce, Rural Population, Randomized Controlled Trials as Topic, Benchmarking, Diet, Healthy, Food Supply standards
- Abstract
Background: Aboriginal and Torres Strait Islander communities in remote Australia have initiated bold policies for health-enabling stores. Benchmarking, a data-driven and facilitated 'audit and feedback' with action planning process, provides a potential strategy to strengthen and scale health-enabling best-practice adoption by remote community store directors/owners. We aim to co-design a benchmarking model with five partner organisations and test its effectiveness with Aboriginal and Torres Strait Islander community stores in remote Australia., Methods: Study design is a pragmatic randomised controlled trial with consenting eligible stores (located in very remote Northern Territory (NT) of Australia, primary grocery store for an Aboriginal community, and serviced by a Nutrition Practitioner with a study partner organisation). The Benchmarking model is informed by research evidence, purpose-built best-practice audit and feedback tools, and co-designed with partner organisation and community representatives. The intervention comprises two full benchmarking cycles (one per year, 2022/23 and 2023/24) of assessment, feedback, action planning and action implementation. Assessment of stores includes i adoption status of 21 evidence-and industry-informed health-enabling policies for remote stores, ii implementation of health-enabling best-practice using a purpose-built Store Scout App, iii price of a standardised healthy diet using the Aboriginal and Torres Strait Islander Healthy Diets ASAP protocol; and, iv healthiness of food purchasing using sales data indicators. Partner organisations feedback reports and co-design action plans with stores. Control stores receive assessments and continue with usual retail practice. All stores provide weekly electronic sales data to assess the primary outcome, change in free sugars (g) to energy (MJ) from all food and drinks purchased, baseline (July-December 2021) vs July-December 2023., Discussion: We hypothesise that the benchmarking intervention can improve the adoption of health-enabling store policy and practice and reduce sales of unhealthy foods and drinks in remote community stores of Australia. This innovative research with remote Aboriginal and Torres Strait Islander communities can inform effective implementation strategies for healthy food retail more broadly., Trial Registration: ACTRN12622000596707, Protocol version 1., (© 2024. The Author(s).)
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- 2024
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39. Correction: Developing an integrated clinical decision support system for the early identification and management of kidney disease-building cross-sectoral partnerships.
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Gorham G, Abeyaratne A, Heard S, Moore L, George P, Kamler P, Majoni SW, Chen W, Balasubramanya B, Talukder MR, Pascoe S, Whitehead A, Sajiv C, Maple-Brown L, Kangaharan N, and Cass A
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- 2024
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40. Developing an integrated clinical decision support system for the early identification and management of kidney disease-building cross-sectoral partnerships.
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Gorham G, Abeyaratne A, Heard S, Moore L, George P, Kamler P, Majoni SW, Chen W, Balasubramanya B, Talukder MR, Pascoe S, Whitehead A, Sajiv C, Maple-Brown L, Kangaharan N, and Cass A
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- Humans, Delivery of Health Care, Northern Territory, Hospitals, Risk Assessment, Decision Support Systems, Clinical
- Abstract
Background: The burden of chronic conditions is growing in Australia with people in remote areas experiencing high rates of disease, especially kidney disease. Health care in remote areas of the Northern Territory (NT) is complicated by a mobile population, high staff turnover, poor communication between health services and complex comorbid health conditions requiring multidisciplinary care., Aim: This paper aims to describe the collaborative process between research, government and non-government health services to develop an integrated clinical decision support system to improve patient care., Methods: Building on established partnerships in the government and Aboriginal Community-Controlled Health Service (ACCHS) sectors, we developed a novel digital clinical decision support system for people at risk of developing kidney disease (due to hypertension, diabetes, cardiovascular disease) or with kidney disease. A cross-organisational and multidisciplinary Steering Committee has overseen the design, development and implementation stages. Further, the system's design and functionality were strongly informed by experts (Clinical Reference Group and Technical Working Group), health service providers, and end-user feedback through a formative evaluation., Results: We established data sharing agreements with 11 ACCHS to link patient level data with 56 government primary health services and six hospitals. Electronic Health Record (EHR) data, based on agreed criteria, is automatically and securely transferred from 15 existing EHR platforms. Through clinician-determined algorithms, the system assists clinicians to diagnose, monitor and provide guideline-based care for individuals, as well as service-level risk stratification and alerts for clinically significant events., Conclusion: Disconnected health services and separate EHRs result in information gaps and a health and safety risk, particularly for patients who access multiple health services. However, barriers to clinical data sharing between health services still exist. In this first phase, we report how robust partnerships and effective governance processes can overcome these barriers to support clinical decision making and contribute to holistic care., (© 2024. The Author(s).)
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- 2024
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41. Codesigning enhanced models of care for Northern Australian Aboriginal and Torres Strait Islander youth with type 2 diabetes: study protocol.
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Kirkham R, Puszka S, Titmuss A, Freeman N, Weaver E, Morris J, Mack S, O'Donnell V, Boffa J, Dowler J, Ellis E, Corpus S, Graham S, Scott L, Sinha AK, Connors C, Shaw JE, Azzopardi P, Brown A, Davis E, Wicklow B, and Maple-Brown L
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- Humans, Adolescent, Australia, Australian Aboriginal and Torres Strait Islander Peoples, Delivery of Health Care, Focus Groups, Diabetes Mellitus, Type 2 therapy, Health Services, Indigenous
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Introduction: Premature onset of type 2 diabetes and excess mortality are critical issues internationally, particularly in Indigenous populations. There is an urgent need for developmentally appropriate and culturally safe models of care. We describe the methods for the codesign, implementation and evaluation of enhanced models of care with Aboriginal and Torres Strait Islander youth living with type 2 diabetes across Northern Australia., Methods and Analysis: Our mixed-methods approach is informed by the principles of codesign. Across eight sites in four regions, the project brings together the lived experience of Aboriginal and Torres Strait Islander young people (aged 10-25) with type 2 diabetes, their families and communities, and health professionals providing diabetes care through a structured yet flexible codesign process. Participants will help identify and collaborate in the development of a range of multifaceted improvements to current models of care. These may include addressing needs identified in our formative work such as the development of screening and management guidelines, referral pathways, peer support networks, diabetes information resources and training for health professionals in youth type 2 diabetes management. The codesign process will adopt a range of methods including qualitative interviews, focus group discussions, art-based methods and healthcare systems assessments. A developmental evaluation approach will be used to create and refine the components and principles of enhanced models of care. We anticipate that this codesign study will produce new theoretical insights and practice frameworks, resources and approaches for age-appropriate, culturally safe models of care., Ethics and Dissemination: The study design was developed in collaboration with Aboriginal and Torres Strait Islander and non-Indigenous researchers, health professionals and health service managers and has received ethical approval across all sites. A range of outputs will be produced to disseminate findings to participants, other stakeholders and the scholarly community using creative and traditional formats., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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42. Continuous Glucose Monitoring Metrics in High-Risk Pregnant Women with Type 2 Diabetes.
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McLean A, Barr E, Tabuai G, Murphy HR, and Maple-Brown L
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- Infant, Newborn, Pregnancy, Female, Humans, Adult, Blood Glucose, Pregnant Women, Blood Glucose Self-Monitoring, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 1 drug therapy, Pregnancy in Diabetics, Hypoglycemia prevention & control, Infant, Newborn, Diseases
- Abstract
Objective: To describe glucose metrics in a high-risk population of women with type 2 diabetes (T2DM) in pregnancy and to explore the associations with neonatal outcomes. Research Design and Methods: Prospective observational study of 57 women. Continuous glucose monitoring (CGM) trajectories were determined from metrics collected in early and late gestation using the first and last two (mean 16 and 35) weeks of Freestyle Libre data. Logistic regression was used to examine associations of CGM metrics with neonatal hypoglycemia (glucose <2.6 mmol/L requiring intravenous dextrose) and large for gestational age (LGA) (>90th percentile for gestational age and sex). Pregnancy-specific target glucose range was 3.5-7.8 mmol/L (63-140 mg/dL). Results: Forty-one women used CGM for 15 weeks (mean age 33 years, 73% Aboriginal or Torres Strait Islander, 32% living remotely). There was limited change in average metrics from early to late pregnancy. For the subgroup with sensor use >50% ( n = 29), mean time in range (TIR) increased by 9%, time above range reduced by 12%, average glucose reduced by 1 mmol/L, and time below range increased by 3%. Neonatal hypoglycemia was associated with most CGM metrics, HbA1c and CGM targets, particularly those from late pregnancy. LGA was associated with hyperglycemic metrics from early pregnancy. Each 1% increase TIR was associated with a 4%-5% reduction in risk of neonatal complications. Conclusion: In this high-risk group of women with T2DM, CGM metrics only improved during pregnancy in those with greater sensor use and were associated with LGA in early pregnancy and neonatal hypoglycemia throughout. Culturally appropriate health care strategies are critical for successful use of CGM technology.
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- 2023
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43. Circulating epigenomic biomarkers correspond with kidney disease susceptibility in high-risk populations with type 2 diabetes mellitus.
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Khurana I, Howard NJ, Maxwell S, Du Preez A, Kaipananickal H, Breen J, Buckberry S, Okabe J, Al-Hasani K, Nakasatien S, Himathongkam T, Cooper ME, Maple-Brown L, Thewjitcharoen Y, Brown A, and El-Osta A
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- Humans, Albuminuria complications, Disease Susceptibility complications, Epigenomics, Australia, Kidney, Biomarkers, Glomerular Filtration Rate, Diabetes Mellitus, Type 2 complications, Diabetic Nephropathies diagnosis, Diabetic Nephropathies genetics, Diabetic Nephropathies metabolism
- Abstract
Aims: To investigate epigenomic indices of diabetic kidney disease (DKD) susceptibility among high-risk populations with type 2 diabetes mellitus., Methods: KDIGO (Kidney Disease: Improving Global Outcomes) clinical guidelines were used to classify people living with or without DKD. Differential gene methylation of DKD was then assessed in a discovery Aboriginal Diabetes Study cohort (PROPHECY, 89 people) and an external independent study from Thailand (THEPTARIN, 128 people). Corresponding mRNA levels were also measured and linked to levels of albuminuria and eGFR., Results: Increased DKD risk was associated with reduced methylation and elevated gene expression in the PROPHECY discovery cohort of Aboriginal Australians and these findings were externally validated in the THEPTARIN diabetes registry of Thai people living with type 2 diabetes mellitus., Conclusions: Novel epigenomic scores can improve diagnostic performance over clinical modelling using albuminuria and GFR alone and can distinguish DKD susceptibility., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)
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- 2023
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44. Interventions to address global inequity in diabetes: international progress.
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Walker AF, Graham S, Maple-Brown L, Egede LE, Campbell JA, Walker RJ, Wade AN, Mbanya JC, Long JA, Yajnik C, Thomas N, Ebekozien O, Odugbesan O, DiMeglio LA, and Agarwal S
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- Humans, Social Environment, Ecosystem, Diabetes Mellitus epidemiology, Diabetes Mellitus therapy
- Abstract
Diabetes is a serious chronic disease with high associated burden and disproportionate costs to communities based on socioeconomic, gender, racial, and ethnic status. Addressing the complex challenges of global inequity in diabetes will require intentional efforts to focus on broader social contexts and systems that supersede individual-level interventions. We codify and highlight best practice approaches to achieve equity in diabetes care and outcomes on a global scale. We outline action plans to target diabetes equity on the basis of the recommendations established by The Lancet Commission on Diabetes, organising interventions by their effect on changing the ecosystem, building capacity, or improving the clinical practice environment. We present international examples of how to address diabetes inequity in the real world to show that approaches addressing the individual within a larger social context, in addition to addressing structural inequity, hold the greatest promise for creating sustainable and equitable change that curbs the global diabetes crisis., Competing Interests: Declaration of interests AFW is supported by The Leona M and Harry B Helmsley Charitable Trust (2005-03934) and the National Institutes of Health-National Institute of Diabetes and Digestive Kidney Disease (5P30DK111024-07). LM-B is supported by an Australian National Health and Medical Research Council (NHMRC) investigator grant (1194698), and leads projects that are funded by NHMRC, the Australian Department of Health, and the Australian Medical Research Future Fund. LEE and JAC are supported by the National Institutes of Health-National Institute of Diabetes and Digestive Kidney Disease (R01DK118038 and R01DK120861, awarded to LEE; K01DK131319, awarded to JAC). LEE and RJW are supported by the National Institute on Minority Health and Health Disparities (R01MD013826, awarded to LEE and RJW; R01MD017574, awarded to LEE). RJW is supported by the American Diabetes Association (1-19-JDF-075). ANW is supported by the National Institutes of Health-Fogarty International Centre (K43TW010698). ANW declares an honorarium received from Sanofi for serving as a panel member at an educational event on thyroid cancer. JCM receives honorarium from Servier Laboratories for serving on the advisory committee at educational events. OE is a health-care disparities adviser (on a temporary advisory board role) for Medtronic. OE has received research support through his organisation T1D Exchange from Medtronic, Vertex, Dexcom, and Eli Lilly. Medtronic supports components of T1DX-QI health equity work. The T1DX-QI is funded by The Leona M and Harry B Helmsley Charitable Trust. LAD has received research support to her institution from Dompé, Lilly, MannKind, Medtronic, Provention, and Zealand Pharma; and served as a consultant for Abata Therapeutics and Vertex. SA is supported by the National Institutes of Health-National Institute of Diabetes and Digestive Kidney Disease (R01DK132302, K23115896, and P30DK111022-07), JDRF, and The Leona M and Harry B Helmsley Charitable Trust. SA receives research devices, but not salary support from Dexcom and Abbott, and is a health-care disparities adviser (on a temporary advisory board role) for Medtronic and Beta Bionics. All other authors declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)
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- 2023
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45. The role of structural racism and geographical inequity in diabetes outcomes.
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Agarwal S, Wade AN, Mbanya JC, Yajnik C, Thomas N, Egede LE, Campbell JA, Walker RJ, Maple-Brown L, and Graham S
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- Humans, Systemic Racism, Prevalence, Social Factors, Diabetes Mellitus epidemiology, Diabetes Mellitus therapy, Racism
- Abstract
Diabetes is pervasive, exponentially growing in prevalence, and outpacing most diseases globally. In this Series paper, we use new theoretical frameworks and a narrative review of existing literature to show how structural inequity (structural racism and geographical inequity) has accelerated rates of diabetes disease, morbidity, and mortality globally. We discuss how structural inequity leads to large, fixed differences in key, upstream social determinants of health, which influence downstream social determinants of health and resultant diabetes outcomes in a cascade of widening inequity. We review categories of social determinants of health with known effects on diabetes outcomes, including public awareness and policy, economic development, access to high-quality care, innovations in diabetes management, and sociocultural norms. We also provide regional perspectives, grounded in our theoretical framework, to highlight prominent, real-world challenges., Competing Interests: Declaration of interests SA is supported by the National Institutes of Health-National Institute of Diabetes and Digestive Kidney Disease (R01DK132302, K23115896, and P30DK111022-07), JDRF, and The Leona M and Harry B Helmsley Charitable Trust. SA receives research devices, but not salary support from Dexcom and Abbott, and is a health-care disparities adviser (on a temporary advisory board role) for Medtronic and Beta Bionics. ANW is supported by the National Institutes of Health-Fogarty International Centre (K43TW010698). ANW declares an honorarium received from Sanofi for serving as a panel member at an educational event on thyroid cancer. JCM receives honorarium from Servier Laboratories for serving on the advisory committee at educational events. LEE and JAC are supported by the National Institutes of Health-National Institute of Diabetes and Digestive Kidney Disease (R01DK118038 and R01DK120861, awarded to LEE; K01DK131319, awarded to JAC). LEE and RJW are supported by the National Institute on Minority Health and Health Disparities (R01MD013826, awarded to LEE and RJW; R01MD017574, awarded to LEE). RJW is supported by the American Diabetes Association (1-19-JDF-075). LM-B is supported by an Australian National Health and Medical Research Council (NHMRC) investigator grant (1194698), and leads projects that are funded by NHMRC, the Australian Department of Health, and the Australian Medical Research Future Fund. All other authors declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)
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- 2023
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46. "Sometimes Our Mob Don't Really Take It Serious Until It's Serious": The Experiences of Western Australian Aboriginal Adolescents Living With Type 2 Diabetes, Their Parents, and Their Family Members.
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Carman R, Towell-Barnard A, Shah M, Davis E, Maple-Brown L, Pearson G, Arabiat D, Kirkham R, and Whitehead L
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- Adolescent, Humans, Australia, Australian Aboriginal and Torres Strait Islander Peoples, Family, Parents, Qualitative Research, Diabetes Mellitus, Type 2 ethnology, Diabetes Mellitus, Type 2 therapy
- Abstract
Objectives: In Australia, Aboriginal children experience disproportionate rates of type 2 diabetes (T2D) compared with non-Aboriginal children. The aim of this qualitative study was to explore the experiences of Aboriginal adolescents with T2D and their family members to better understand the influences of T2D on self-management, with findings used to inform an enhanced service model of care., Methods: Semistructured interviews were conducted with purposively selected Western Australian Aboriginal adolescents with T2D and their parents and guardians. Interviews were transcribed verbatim and analyzed with NVivo software using interpretative thematic analysis; overarching themes were generated., Results: Interviews with 24 participants, including 8 adolescents aged 11 to 16 years, were conducted across 4 regions of Western Australia. A high proportion of these adolescents were diagnosed with T2D during an unrelated hospitalization or medical appointment. Most did not fully understand or were unaware of the long-term impact of T2D. Discussions about diabetes within families did not typically occur, and shame and concealment of the diagnosis was a common finding. The parents of the adolescents described the diagnosis of T2D as compounding an already challenging set of circumstances for the family; this impacted their capacity to promote self-management activities and attend hospital and outpatient appointments., Conclusions: This study privileges the voices of Aboriginal adolescents and family members and offers insight into their personal narrative of living with T2D. Building family and community capacity to normalize preventive activities and manage T2D postdiagnosis is recommended to improve health outcomes., (Copyright © 2023 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)
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- 2023
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47. Racial microaggressions and interculturality in remote Central Australian Aboriginal healthcare.
- Author
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Wicks M, Hampshire C, Campbell J, Maple-Brown L, and Kirkham R
- Subjects
- Humans, Australia, Australian Aboriginal and Torres Strait Islander Peoples, Delivery of Health Care, Diabetes Mellitus, Type 2, Health Services, Indigenous, Microaggression
- Abstract
Background: An epidemic of type 2 diabetes in remote Aboriginal people in Central Australia, contributes to high rates of morbidity and mortality. Remote non-Aboriginal Health Care Workers (HCW) and the Aboriginal people they serve inhabit a complex cultural interface. This study aimed to recognise racial microaggressions in the everyday discourse of HCWs. It proposes a model of interculturality for remote HCWs that avoids racialisation and essentialising of Aboriginal people's identities and cultures., Methods: Semi-structured in-depth interviews were undertaken with HCWs from two Primary Health Care services in very remote Central Australia. Fourteen interviews were analysed from seven Remote Area Nurse, five Remote Medical Practitioners and two Aboriginal Health Practitioners. Discourse analysis was employed to explore racial microaggressions and power relations. NVivo software assisted in the thematic organisation of microaggressions according to a predefined taxonomy., Results: Seven microaggression themes were identified - racial categorization and sameness, assumptions about intelligence and competence, false colour blindness, criminality and dangerousness, reverse racism and hostility, treatment as second-class citizens and pathologizing culture. A model of interculturality for remote HCWs was based on concepts of the third space, deCentred hybrid identities and small culture formation on-the-go combined with a duty-conscious ethic, cultural safety and humility., Conclusions: Racial microaggressions are common in the discourse of remote HCWs. The model of interculturality proposed could improve intercultural communication and relationships between HCWs and Aboriginal people. This improved engagement is required to address the current diabetes epidemic in Central Australia., (© 2023. The Author(s).)
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- 2023
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48. Pancreatitis and post-pancreatitis diabetes in Central Australia.
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Wicks MM, Barr ELM, and Maple-Brown L
- Subjects
- Humans, Female, Male, Retrospective Studies, Australia epidemiology, Health Services, Diabetes Mellitus epidemiology, Pancreatitis diagnosis, Pancreatitis epidemiology
- Abstract
Background: Pancreatitis and diabetes are common among Aboriginal people of Central Australia. The contribution of pancreatitis to the development of post-pancreatitis diabetes mellitus (PPDM) is not known., Aims: To describe among Aboriginal and non-Aboriginal people living in Central Australia, (i) the prevalence and aetiology of acute (AP) and chronic pancreatitis (CP), and (ii) diagnosis of new onset diabetes after pancreatitis., Methods: Retrospective medical record review of patients ≥15 years admitted to hospitals in the Central Australia Health Service between 2009 and 2018 with pancreatitis. Prevalence as a proportion of the resident population and aetiology of AP and CP were determined. Diagnosis of new onset diabetes after admission with pancreatitis was assessed., Results: Of the 638 patients assessed, 73% were Aboriginal and 48% female. The annual prevalence in 2009 and 2018 for AP was 171 and 203 per 100 000 persons, and for CP was 206 and 114 per 100 000 persons respectively. Rates were high in Aboriginal people. Alcohol aetiology was most common in Aboriginal people (66%) and biliary aetiology in non-Aboriginal people (37%). A diagnosis of diabetes after pancreatitis was detected in 125 (29%) of 438 patients who did not have a diabetes diagnosis previously recorded, and 20 of the 22 tested for diabetes-associated antibodies were negative, fitting criteria for PPDM., Conclusion: Prevalence of AP and CP in Central Australia was higher in Aboriginal than non-Aboriginal people. Few patients with diabetes recorded after pancreatitis had appropriate PPDM diagnostic testing. Interdisciplinary education on the diagnosis of PPDM is required., (© 2021 Royal Australasian College of Physicians.)
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- 2023
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49. The Global Alliance for Chronic Diseases researchers' statement on non-communicable disease research with Indigenous peoples.
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Meharg DP, Naanyu V, Rambaldini B, Clarke MJ, Lacey C, Jebasingh F, Lopez-Jaramillo P, Gould GS, Aceves B, Alison JA, Chaiton M, Chen J, Gonzalez-Salazar F, Goodyear-Smith F, Gwynne KG, Lee KS, MacKay D, Maple-Brown L, Mishara BL, Nigenda G, Ramani-Chander A, Sherwood SG, Thomas N, Thrift AG, and Anderson M
- Subjects
- Humans, Indigenous Peoples, Chronic Disease, Research Personnel, Noncommunicable Diseases prevention & control
- Abstract
Competing Interests: DPM is supported as a fellow of the Wingara Mura Leadership Program, University of Sydney and received a grant from The University of Sydney, Charles Perkins Centre Aboriginal and Torres Strait Islander Wingara Mura Leadership Academy Early to Mid-Career Research Seeding Grant; associated manuscript processing charges will be costed to these funds. LM-B received a NHMRC Australia grant to their university for salary and research projects, including Global Alliance for Chronic Diseases (GACD), and was a board member for the Australian Diabetes Society 2014–2021. GSG received consulting fees from the Australian Department of Health and NSW Health for their role on a national advisory panel review about medications for smoking cessation and clinical work in refugee health; had unpaid leadership roles for the Global Alliance for Chronic Disease and Global Implementation Society; and received grants to their institution for research into Indigenous smoking cessation from the Australian Department of Health, NHMRC, GACD and Cancer Australia and Cure Cancer Australia. AGT received grants from NHMRC Australia (grant numbers 1143155, 1171966, and 1182071) and a Medical Research Future Fund (Australian Government; grant number 2015976) while writing the grant; funds were made to their institution. JAA received a NHMRC Australia, GACD grant for the Breathe Easy, Walk Easy, Lungs for Life (BE WELL) project and grant funds used to attend annual GACD scientific meetings. KSL received NHMRC Centre of Research Excellence (application number 1117198) and Ideas grant (application number 1183744). MC received a GACD/Canadian Institute of Health Research (CIHR) grant to their institution. MA received a CIHR grant for a research programme with Indigenous communities (commercial tobacco harm reduction) and is a Pallium Canada board member. FGo-Sm received Global Alliance for Chronic Diseases-Health Research Council funding to their institution in 2017 (reference: 17/705). DM received a postgraduate scholarship from the National Health and Medical Research Council (NHMRC), Australia while preparing this manuscript; was an unpaid member of Australian Diabetes Association's Clinical Advisory Sub-Committee and the Northern Territory Maternal and Neonatal Network. These institutions had no role or influence on the content of the manuscript. All other authors declare no competing interests. We acknowledge all members of the GACD Indigenous Population Working Group for their advice, guidance and support preparing this statement. This statement reflects the perspectives of the contributing authors of the GACD Indigenous Populations Working Group, but it does not necessarily reflect the perspective of GACD and the funding agencies.
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- 2023
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50. Feasibility and Acceptability of Intermittently Scanned Continuous Glucose Monitoring for Women with Type 2 Diabetes in Pregnancy.
- Author
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McLean A, Sinha A, Barr E, and Maple-Brown L
- Subjects
- Pregnancy, Humans, Female, Feasibility Studies, Blood Glucose Self-Monitoring, Blood Glucose, Diabetes Mellitus, Type 2
- Published
- 2023
- Full Text
- View/download PDF
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