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PubMed2006

Tools and methodologies for investigating the mental health needs of Indigenous patients: it's about communication.

OBJECTIVE: To undertake a needs analysis to determine the quality and effectiveness of current mental health services to Indigenous patients within a health district of Southern Queensland. The present study focused on identifying gaps in the service provision for Indigenous patients. Tools and methodologies were developed to achieve this. METHOD: Before commencement of the needs analysis, a review of related national projects was completed. The needs analysis entailed the development and distribution of two separate questionnaires. A major priority of the questionnaire for Indigenous patients was ensuring that effective communication and cultural respect was achieved. A steering committee of both Indigenous and non-Indigenous experts collaborated on this. The second questionnaire was for employees of the mental health service. Both questionnaires were designed to provide a balanced perspective of current mental health service needs for Indigenous people within the mental health service. RESULTS: The predominant issue that emerged and underpinned all the results was communication. CONCLUSIONS: The present study has developed and used procedures for undertaking research involving Indigenous people. It has shown the importance of involving Indigenous people to help ensure successful communication, compliance and cooperation by Indigenous mental health patients.

Adolescent↗
PubMed2002

Involving indigenous peoples in protected area management: comparative perspectives from Nepal, Thailand, and China.

Despite over two decades of efforts towards involving indigenous and traditional peoples in protected area management, there are few successful examples. Several international principles and guidelines on indigenous peoples' involvement in protected areas exist. However, because of the lack of evaluation of whether or not these principles and guidelines have been put into practice, there is hardly any information that indicates the actual involvement of indigenous peoples in protected areas. This paper attempts to compare efforts in partnership between indigenous peoples and protected area authority in three Asian countries: Nepal, Thailand, and China. It shows that the involvement of indigenous peoples is more successful where park planning is participatory and where political and socioeconomic reforms are underway. Indigenous peoples are in conflict with park authorities where park management is centralized and nonparticipatory. Unless concrete efforts are made to address livelihood issues of indigenous peoples living in and around protected areas, park management aimed to protect wildlife will rarely succeed. Participatory park management that involves indigenous peoples and that addresses livelihood issues of indigenous communities will ultimately succeed in its efforts toward wildlife conservation.

Animals↗
PubMed2006

Indigenous beliefs and attitudes to AIDS precautions in a rural South African community: an empirical study.

BACKGROUND: It was recently hypothesized that indigenous belief systems might have a bearing on attitudes toward HIV/AIDS prevention in Southern Africa. PURPOSE: This article comprises the first empirical test of the hypothesis. METHODS: Participants (n = 407) lived in a remote rural area of KwaZulu Natal, South Africa, and were divided into younger (18-24 years) and older (35-45 years) cohorts. All participants completed a questionnaire measuring Attitudes to AIDS Precautions, indigenous knowledge, indigenous beliefs about ancestral protection, and indigenous beliefs about illness. RESULTS: Indigenous beliefs pertaining to health behavior emerged as multidimensional in both structure and effect. Among older participants, there were significant associations between indigenous belief measures and Attitudes to AIDS Precautions. In this group, a strong belief in ancestral protection was associated with more negative Attitudes to AIDS Precautions, whereas a strong belief in traditional explanations for illness was associated with more positive Attitudes to AIDS Precautions. The indigenous beliefs measures were not associated with Attitudes to AIDS Precautions among younger participants. CONCLUSIONS: The data lend modest support to the hypothesis that indigenous beliefs have a measurable association with attitudes to AIDS prevention, although these associations may be diminishing across generations. Further research, exploring a wider range of indigenous beliefs and focusing on actual precautionary behaviors rather than attitudes, seems merited.

Acquired Immunodeficiency Syndrome↗
PubMed2005

[Dimensions and potentialities of the geographic information system on indigenous health].

OBJECTIVE: To discuss the potentials of the Geographic Information System in the analysis of the epidemiological and socio-demographic profiles of indigenous peoples and of the organization of health services directed towards their care. METHODS: Geoprocessing analysis of tuberculosis, malaria and mortality notification of 374,123 indigenous people distributed in 36 Distritos Sanitários Especiais Indígenas (Special Indigenous Sanitary Districts) in Brazil was conducted. A gradient of risk intensity for tuberculosis, malaria, and infant mortality among indigenous populations was defined for the years 2000 to 2002. These coefficients were then compared with those of non-indigenous populations, during the same period. RESULTS: The analysis showed that the previous available data are fragmentary and do not allow for a comprehensive assessment of life conditions and health situations of these ethnic groups. The construction of gradients of risk indicated incidence of tuberculosis coefficients among the indigenous population more than 1,000 times greater than those found among the general population in Brazil. The mean malaria API among the indigenous population was up to 10 times greater than the mean values found among the non-indigenous population and the coefficient of infant mortality among the indigenous population varied from 74.7/1,000 live births in 2000 to 56.5/1,000 live births in 2001, exceeding the national average (31.8/1,000) for the same period in more than 100%. CONCLUSIONS: The Geographic Information System is a useful administrative tool for assessing health conditions, evaluating population risks, constructing scenarios, and planning intervention strategies in several levels, shifting quickly and efficiently between macro- and micro-level realities.

Brazil↗
PubMed2001

Regional variation in the incidence of end-stage renal disease in Indigenous Australians.

OBJECTIVE: To evaluate regional variation in the incidence of end-stage renal disease (ESRD) in Indigenous Australians, and to examine the proximity to ESRD treatment facilities of Indigenous patients. DESIGN: Secondary data review, with collection of primary data regarding patients' place of residence before beginning ESRD treatment. PARTICIPANTS: Indigenous ESRD patients who commenced treatment in Australia during 1993-1998. METHODS: We obtained data from the Australian and New Zealand Dialysis and Transplant Registry regarding 719 Indigenous patients who started ESRD treatment between 1 January 1993 and 31 December 1998. We obtained primary data from the treating renal units to determine the place of residence before beginning renal replacement therapy. We calculated the average annual incidence of ESRD for each of the 36 Aboriginal and Torres Strait Islander Commission regions using population estimates based on the 1996 Census, and calculated standardised incidence ratios with 95% confidence intervals for each region. We compared the number of cases with the treatment facilities available in each region. MAIN OUTCOME MEASURE: Regional standardised ESRD incidence for Indigenous Australians referenced to the total resident population of Australia. RESULTS: Standardised ESRD incidence among Indigenous Australians is highest in remote regions, where it is up to 30 times the national incidence for all Australians. In urban regions the standardised incidence is much lower, but remains significantly higher than the national incidence. Forty-eight per cent of Indigenous ESRD patients come from regions without dialysis or transplant facilities and 16.3% from regions with only satellite dialysis facilities. CONCLUSIONS: There is marked regional variation in the incidence of ESRD among Indigenous Australians. Because of the location of treatment centres, there is inequitable access to ESRD treatment services for a significant proportion of Indigenous patients.

Australia↗
PubMed2006

Health of Indigenous people in Africa.

Our paper is part of a series focusing on Indigenous peoples' health in different world regions. Indigenous peoples worldwide are subject to marginalisation and discrimination, systematically experiencing poorer health than do majority groups. In Africa, poor health in the general population is widely recognised, but the consistently lower health position and social status of Indigenous peoples are rarely noted. Disputed conceptual understandings of indigeneity, a history of discriminatory colonial and post-colonial policies, and non-recognition of Indigenous groups by some governments complicate the situation. We discuss two case studies, of the central African Pygmy peoples and the San of southern Africa, to illustrate recurring issues in Indigenous health in the continent. We make recommendations for the recognition of Indigenous peoples in Africa and improvements needed in the collection of health data and the provision of services. Finally, we argue that wider changes are needed to address the social determinants of Indigenous peoples' health.

Adult↗
PubMed2006

Social engineers and bystanders: the limits of 'responsibility' in Indigenous affairs.

OBJECTIVE: A significant shift is occurring in Australian Indigenous affairs. Contentiously, key Aboriginal and Torres Strait Islander leaders have challenged governments and organizations, both mainstream and Indigenous, to confront 'passive welfare dependence'. This paper explores some of the social justice implications and considers the roles of non-Indigenous professionals. METHODS: A publication by Pat Dodson and Noel Pearson is used to frame the discussion. RESULTS: Ambiguity surrounding a number of key concepts and the shifting territory of Indigenous rights has contributed to bureaucratic inertia in Indigenous affairs. A range of 'new' concepts is being introduced into the current debate, such as expectancy, reciprocity and mutual obligation, challenging ideas of responsibility, agency and the roles played by non-Indigenous bureaucrats and practitioners. CONCLUSIONS: Regardless of good intentions or social justice motivations, non-Indigenous interventions must be informed by an awareness of the potential to undermine Indigenous agency and, consequently, cause harm.

Culture↗
PubMed2006

Cancer diagnosis and treatment in the Northern Territory: assessing health service performance for indigenous Australians.

Indigenous Australians with cancer are diagnosed with more advanced disease and have lower survival than other Australians. To investigate reasons for these differences. Retrospective cohort study of 1197 indigenous and nonindigenous people in the Northern Territory diagnosed with cancers of the colon and rectum, lung, breast, cervix and non-Hodgkin lymphoma between 1991 and 2000. Outcome measures were stage at diagnosis and relative risk of cancer death. Indigenous people compared with nonindigenous people had higher relative odds of advanced stage of cancer at diagnosis (relative odds 1.9, 95% CI 1.3-2.7) for four cancers but lower relative odds for lung cancer (relative odds 0.3, 95% CI 0.2-0.5). None of the potentially contributing factors examined could explain this difference. Risk of cancer death (adjusted for cancer type and age and stage at diagnosis) was higher in indigenous than in nonindigenous people (relative risk 1.7, 95% CI 1.4-2.1). This difference, however, was confined to indigenous people with an indigenous first language (relative risk 2.9, 95% CI 2.2-3.8). Adjustment for cancer treatment variables further reduced but did not eliminate this higher risk of death. Although more advanced stage at diagnosis appeared to be a sufficient explanation for poorer cancer outcome in indigenous people whose first language was English, poorer treatment also contributed to, but was still not sufficient to explain, poorer outcome in those who had an indigenous first language. Other factors, possibly including communication difficulties, knowledge of and attitudes to cancer symptoms and treatment and social and cultural 'distance' from mainstream health services, may also be involved.

Cohort Studies↗
PubMed1995

Issues in health policy for indigenous peoples in Canada.

This paper provides a preliminary report on the work of the Canadian Royal Commission on Aboriginal Peoples. This commission has spent the past four years undertaking a comprehensive review of all matters pertaining to indigenous people in Canada, and will publish a final report in late 1995 or early 1996. The paper provides an overview of health policy issues examined by the commission. The author was employed by the commission in various capacities to contribute to this analysis of indigenous people's health policy concerns. A disproportionate burden of illness has been suffered by indigenous peoples in Canada. Past policy has systematically undermined the capacity of indigenous communities to develop their own health care systems. Current concerns about health problems and services, as expressed by indigenous people at the commission's community hearings, describe a need for a community-controlled and culturally appropriate approach to healing in indigenous communities. The commission's framework for developing an indigenous people's health strategy is intended to ensure that indigenous people have the capacity, the resources and the appropriate political environment in which to implement community healing. Its relevance to the Australian context may best be seen through a careful review of the commission's final report.

Canada↗
PubMed2002

Practical strategies for working with indigenous people living in Queensland, Australia.

Internationally, occupational therapists have recognized the need to provide culturally appropriate services for indigenous people. This study explored experiences, perspectives and practical strategies of occupational therapists working with Aboriginal and Torres Strait Islander people living in rural and remote areas of Queensland, Australia. Semi-structured interviews were conducted with eight occupational therapists who had at least 12 months' experience providing services to Aboriginal and Torres Strait Islander people in health, rehabilitation or education services. Key themes identified in the data focused on strategies for facilitating effective communication with individuals and families, and collaborating with other service providers. The role of Aboriginal Liaison Officers or Indigenous Health Workers was emphasized by participating therapists. Participants identified resources that they perceived as useful in their practice, such as cross-cultural training and access to indigenous health workers. Other resources suggested for further development included information about learning styles of indigenous people and information about cultural variations between specific Aboriginal and Torres Strait Islander communities. The small number of participants limits generalizability of the findings. However, therapists can decide on the relevance of strategies to their own workplaces. Suggestions for further research focused on improving occupational therapy services for indigenous people in Australia. These include an investigation of therapy goals with indigenous people, and interviews with indigenous Australians and indigenous health workers about their experiences and perceptions of occupational therapy.

Culture↗
PubMed2006

Acclimation effects on thermal tolerances of springtails from sub-Antarctic Marion Island: indigenous and invasive species.

Collembola are abundant and functionally significant arthropods in sub-Antarctic terrestrial ecosystems, and their importance has increased as a consequence of the many invasive alien species that have been introduced to the region. It has also been predicted that current and future climate change will favour alien over indigenous species as a consequence of more favourable responses to warming in the former. It is therefore surprising that little is known about the environmental physiology of sub-Antarctic springtails and that few studies have explicitly tested the hypothesis that invasive species will outperform indigenous ones under warmer conditions. Here we present thermal tolerance data on three invasive (Pogonognathellus flavescens, Isotomurus cf. palustris, Ceratophysella denticulata) and two indigenous (Cryptopygus antarcticus, Tullbergia bisetosa) species of springtails from Marion Island, explicitly testing the idea that consistent differences exist between the indigenous and invasive species both in their absolute limits and the ways in which they respond to acclimation (at temperatures from 0 to 20 degrees C). Phenotypic plasticity is the first in a series of ways in which organisms might respond to altered environments. Using a poorly explored, but highly appropriate technique, we demonstrate that in these species the crystallization temperature (Tc) is equal to the lower lethal temperature. We also show that cooling rate (1 degree C min(-1); 0.1 degrees C min(-1); 0.5 degrees C h(-1) from 5 to -1 degrees C followed by 0.1 degrees C min(-1)) has little effect on Tc. The indigenous species typically have low Tcs (c. -20 to -13 degrees C depending on the acclimation temperature), whilst those of the invasive species tend to be higher (c. -12 to -6 degrees C) at the lower acclimation temperatures. However, Ceratophysella denticulata is an exception with a low Tc (c. -20 to -18 degrees C), and in P. flavescens acclimation to 20 degrees C results in a pronounced decline in Tc. In general, the invasive and alien species do not differ substantially in acclimation effects on Tc (with the exception of the strong response in P. flavescens). Upper lethal temperatures (ULT50) are typically higher in the invasive (33-37 degrees C) than in the indigenous (30-33 degrees C) species and the response to acclimation differs among the two groups. The indigenous species show either a weak response to acclimation or ULT50 declines with increasing acclimation temperature, whereas in the invasive species ULT50 increases with acclimation temperature. These findings support the hypothesis that many invasive species will be favoured by climate change (warming and drying) at Marion Island. Moreover, manipulative field experiments have shown abundance changes in the indigenous and invasive springtail species in the direction predicted by the physiological data.

Acclimatization↗
PubMed2003

Patterns of injury in indigenous Australians admitted to Cairns Base Hospital.

AIM: To study and compare the type and frequency of injury to indigenous and non-indigenous patients admitted to the Orthopaedic Unit at Cairns Base Hospital. METHOD AND ANALYSIS: Relevant statistics for all patients were entered or calculated: demographics, length of stay, comorbidity and complications were available. After Variance Analysis, age-standardised rates of trauma were tested using confidence intervals. RESULTS: Of 2254 admissions for trauma in 32 months, 23% were indigenous (12% of the catchment population). Upper limb injuries were significantly higher for all indigenes, these males being admitted three times as frequently as non-indigenous males. Specific lesions showed greater differences and punch injuries were prominent in both indigenous sexes. Indigenous women were much more likely to be the victims of assault or fights than other groups. CONCLUSIONS: Personal injury costs are high in the indigenous community, in human and material terms. More resources should be directed towards injury prevention.

Adult↗
PubMed2004

The incidence of treated end-stage renal disease in New Zealand Maori and Pacific Island people and in Indigenous Australians.

BACKGROUND: Although Indigenous Australians, New Zealand Maori and Pacific Island people comprise an unduly high proportion of patients treated for end-stage renal disease (ESRD) in the two countries, no population-based age- and disease-specific rates have been published. METHODS: From data provided to the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), truncated age- and sex-standardized incidence rates were calculated for treated ESRD due to all causes and by primary renal disease, in four broad age groups of Maori, Pacific Island people and all 'other' New Zealanders and Indigenous and non-indigenous Australians, for the period 1992-2001. RESULTS: The incidence of ESRD did not differ in persons aged 0-14 years. In adults, Maori and Pacific Island people had similar rates of ESRD, a little more than half those of Indigenous Australians except in persons aged 65 years and over in whom the rates were nearly equal, but two to ten times the rates in 'other' New Zealanders and non-indigenous Australians. The excess of ESRD in Indigenous Australians was due principally to type II diabetic nephropathy and glomerulonephritis (all common types except lupus nephritis), but was seen also in respect of type I diabetic nephropathy, hypertensive renal disease and analgesic nephropathy, while the excess in Maori and Pacific Island people was confined to type II diabetic nephropathy, hypertensive renal disease and glomerulonephritis (especially lupus nephritis and type I mesangiocapillary glomerulonephritis, but not mesangial IgA disease). CONCLUSIONS: The incidence and pattern of treated ESRD differs quantitatively and qualitatively between Maori, Pacific Island people and other New Zealanders, and Indigenous and non-indigenous Australians.

Adolescent↗
PubMed1998

The interruption of transmission of indigenous measles in the United States during 1993.

BACKGROUND: The United States has a goal to eliminate all indigenous cases of measles by the year 2000. Initial interruption of indigenous measles transmission would be expected during a period of very low measles incidence as occurred during late 1993. METHODS: Indigenous measles cases (i.e. cases acquired in the United States and not traceable to any imported case) from 1993 were investigated to determine their source of infection. The probability of sustained undetected measles transmission between isolated indigenous cases was estimated. RESULTS: Of the 312 measles cases reported for 1993, only 25 (8%) occurred after September 19. Of these only 4 cases (16%) could be classified as indigenous. The estimated probability that any of these 4 cases resulted from indigenous measles transmission in theirs or any adjoining counties was 0.05 or less. CONCLUSIONS: Interruption of indigenous measles transmission appears to have occurred for the first time throughout the United States in 1993. This event provides strong support for the current national strategy for measles elimination. However, complete elimination of indigenous measles will require maintaining high population immunity to prevent spread from imported cases and attaining global measles control to prevent the importation of measles.

Adolescent↗
PubMed2006

Kidney transplant outcomes in the indigenous population in the Northern Territory of Australia.

BACKGROUND: Indigenous Australians develop end-stage renal disease (ESRD) at a significantly higher rate than nonindigenous Australians. Renal transplantation is the preferred treatment modality; however, they are underrepresented in the transplanted population. In addition, despite the morbidity and mortality gains demonstrated in other patient groups, it is unclear whether such an advantage is replicated for indigenous Australians. We have sought to identify some of the factors that lead to poorer outcomes within this group of recipients. METHODS: We performed a retrospective analysis of a cohort of renal transplant recipients (indigenous and nonindigenous) from the Northern Territory of Australia. RESULTS: Indigenous patients waited longer on dialysis, were more sensitized at the time of transplantation, and the number of human leukocyte antigen mismatches was greater. Overall renal allograft survival is poorer among indigenous Australians (HR 4.13, 2.0-8.5, P<0.0001) with the majority of grafts lost due to recipient death. The most common cause of death was septicemia. Graft loss due to any cause has not been influenced by the absence of full-time specialist staff at major treatment centers. Infection rates are greatly increased in indigenous patients (RR 4.1, 95% CI 3.5-4.7, P<0.0001), in addition to the incidence of rejection (RR 2.5 95% CI 1.8-3.5, P<0.001) and hospitalization (RR 3.9, 95% CI 3.2-4.9, P<0.0001). There is increased steroid exposure among indigenous recipients. CONCLUSIONS: Indigenous recipients of cadaveric kidney transplants have worse outcomes than nonindigenous recipients, mostly due to increased mortality and morbidity from infective causes.

Adult↗
PubMed1998

Data for diagnosis, monitoring and treatment in indigenous health: the case of cervical cancer.

Deficiencies in the availability and quality of data on the health status of indigenous Australians have long been recognised. For cervical cancer, data demonstrate a 2-5 fold greater incidence rate and an 8-10 fold greater mortality rate for Indigenous women compared to non-Indigenous Australians. However, incidence and mortality data are only available for some states and there is little or no information available on the geographic or social distribution of risk, or the reasons for risk differentials. There are also little or no data on the utilisation of, or preferences for, screening services. Thus, while there is clearly a need for a cervical cancer control program specifically to target Indigenous women, current data are inadequate to inform planning and implementation, and current systems are inadequate to monitor effectiveness. This situation is the result of insufficient research and inadequate attention to recording of Indigenous status in routine data systems and applies to a greater or lesser extent across the spectrum of health of Indigenous Australians. Health workers across the spectrum in mainstream and Indigenous medical services have a shared responsibility for improving the availability and quality of data and ensuring the appropriate use of information necessary to achieve and monitor improvements in service delivery and health status of Indigenous people.

Australia↗
PubMed2003

A review of tobacco interventions for Indigenous Australians.

OBJECTIVE: To conduct a review of interventions to reduce the harm resulting from tobacco use among Indigenous Australians and to discuss the likely effect of a range of tobacco interventions if conducted in this population. METHODS: A systematic review of medical literature and an audit of information from 32 government departments, non-government organisations and indigenous health organisations, which was completed in March 2001. RESULTS: A number of small tobacco programs had been conducted. Only four tobacco interventions had been evaluated in indigenous communities: a trial of training health professionals in conducting a brief intervention for smoking cessation; a trial of a CD-ROM on tobacco for use with indigenous schoolchildren; a qualitative evaluation of the effect of a mainstream advertising campaign on Indigenous people; and a pilot study of smoke-free workplaces, evaluated by qualitative methods. None of these studies assessed smoking cessation as an outcome. Two of these studies were unable to conclusively show any effect of the interventions; training health professionals in delivering a brief intervention resulted in some changes to practice and the evaluation of the mainstream advertising campaign showed that following the campaign, knowledge about tobacco had increased. CONCLUSIONS: There was a major lack of research on and evaluation of tobacco interventions for Indigenous Australians. IMPLICATIONS: More research and evaluation is required to ensure that tobacco interventions are appropriate and effective for Indigenous people. It is time to cease chronicling the ill health of Indigenous Australians and time to ensure the availability of well-evaluated, effective tobacco programs.

Adolescent↗
PubMed2004

National health workforce in discrete Indigenous communities.

OBJECTIVE: To identify areas of relative need and inform future planning of health workforce and health services in discrete Indigenous communities. METHOD: Descriptive analysis of relevant variables from the 1999 Community Housing and Infrastructure Needs Survey (CHINS), including all discrete Indigenous communities in Australia. RESULTS: Almost 90% of the Indigenous population of the Northern Territory live in discrete communities. The corresponding figure for Queensland, South Australia and Western Australia is around 25%, for New South Wales 8% and Victoria 1%. Just over 4000 people (5% of the population surveyed) live 100 kilometres or more from the nearest community health centre and almost 60,000 (54%) live 100 kilometres or more from the nearest hospital. Approximately 4000 Indigenous people (6% of population surveyed) have little or no access to a registered nurse or a doctor in their community. Access to Indigenous health workers is also limited, with more than 26,000 people (40%) having almost no access to a male Indigenous health worker and about 10,400 (16%) having almost no access to a female Indigenous health worker. More than 13,000 people (20%) have no access to a dentist and many thousands (30-50%) have no access to allied health or mental health care workers. An obstetrician or ENT/respiratory physician never visited the communities of almost 40,000 people (55% and 59%, respectively) and about 24,000 people (36%) have no access to an ophthalmologist. CONCLUSION: CHINS data provide a unique source of information to monitor the status of health services and the workforce in discrete Indigenous communities.

Australia↗