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PubMed2006

Vaccine preventable diseases and vaccination policy for indigenous populations.

Compared with nonindigenous people, indigenous people in first-world countries have experienced much higher rates of many vaccine preventable diseases. This systematic review of published scientific literature, government reports, and immunization guidelines from Australia, Canada, New Zealand, and the United States compares pre- and postvaccination disease rates and vaccination policy for indigenous people in these four countries. Nationally funded universal vaccination programs are clearly the most effective way of reducing disease in indigenous populations. Most successful have been programs for viral diseases in which strain variations are not important and herd immunity is high, such as measles and hepatitis B. For bacterial infections, strain variations (pneumococcal disease), heavy nasopharyngeal colonization of young infants (pneumococcal and Haemophilus influenzae type b disease), low vaccine effectiveness in adults with a high prevalence of risk factors (polysaccharide pneumococcal vaccine), and waning immunity (pertussis) have been associated with continuing or widening disparities between indigenous and nonindigenous populations. However, universal vaccination programs are not always possible. Geographic targeting of all persons in certain regions with high disease rates has been successful, as has targeting of indigenous populations in regions where they constitute larger proportions of the population. In national programs targeting only indigenous people, it has been difficult to achieve high coverage, particularly in urban areas. Innovative program approaches are particularly needed in these situations.

Australia↗
PubMed2006

Cervical smear participation and prevalence of sexually transmitted infections in women attending a community-controlled Indigenous health service in north Queensland.

OBJECTIVE: To increase Pap smear participation and to assess the prevalence of sexually transmitted infection (STI) in urban Indigenous women in Townsville. DESIGN: Convenience sample of women attending Townsville Aboriginal and Islanders Health Services (TAIHS) for health care participating in the Trichomonas vaginalis (TV) project, coordinated by an Aboriginal Health Worker (AHW) trained in women's health and cervical screening. PARTICIPANTS: 198 women, aged 20-69 years of age, attending TAIHS between March 2002 and 31 January 2004. MAIN OUTCOME MEASURES: Pap smear participation and prevalence of STIs. RESULTS: Pap smear participation among eligible women at TAIHS increased from 20.9% pre TV project to 28.6% during the project and 35.6% in the 12 months post completion of the TV project (p<0.0001), an increase of 70.3%. Of 196 smears performed during the study, 20 (10.6%, 95% CI 6.2-15) were abnormal; abnormality was more common in non-Indigenous 8/50 (16.0%) than in Indigenous women 12/139 (8.6%), but did not reach significance (p=0.180). The prevalence of Chlamydia trachomatis was low, with no differences between the Indigenous and non-Indigenous groups, and highest in younger women: 6/44 (13.6%) in women less than 25 years; Trichomonas vaginalis was more common in the Indigenous group. CONCLUSION: An AHW trained to perform and advocating for Pap smear participation has significantly increased the smear participation at TAIHS. The overall prevalence of STI was low.

Adult↗
PubMed2005

Toward health and wellbeing for indigenous Australians.

The health of indigenous Australians remains well below that of non-indigenous Australians and indigenous peoples in Canada and New Zealand. Although recent planning has initiated many outstanding, culturally appropriate programmes with indigenous involvement, health statistics only reflect marginal improvement in recent years. It is crucial that positive programmes are sustained with appropriately directed funding. An approach that includes respect for the emotional and spiritual wellbeing of Australia's indigenous peoples will assist to redress some of the disadvantage caused by dispossession of country, language, and identity. It is clear from many programmes that are in place, that primary health care delivered locally through community controlled organisations, will minimise the impact of serious illnesses that currently threaten whole families and communities. Westernized health care systems are slow to learn from indigenous peoples in Australia and other places, that maintenance of wellness, not management of illness should be the goal.

Australia↗
PubMed2005

[Indigenous organizations and health district apportionment: the gap between seeing and believing in health policies].

This study aims to analyze the ethno-political, ethical, and health repercussions, for indigenous peoples' organizations involved in agreements with the Ministry of Health, resulting from the implementation of Special Indigenous Health Districts (DSEI) in the State of Amazonas, Brazil. The DSEIs chosen for analysis were those of Manaus and Rio Negro. Data were collected from reports drafted during and after planning and other meetings of the respective indigenous peoples' organizations, participatory observation in events organized to evaluate the health district apportionment process, and interviews with indigenous and non-indigenous managers of DSEIs. The article discusses the ambiguity of indigenous peoples' organizations in having to exercise their own political role while implementing a state policy, assumed as a way to overcome the stigma of their presumed inability to head the process of implementing a DSEI.

Brazil↗
PubMed2006

[Implementation of indigenous people's health policy in Angra dos Reis, Rio de Janeiro, Brazil: obstacles and prospects].

This article discusses the Brazilian National Policy for Indigenous People's Health, formulated in the 1990s as part of the national Health Reform Movement and based on the creation (in 1999) of the Indigenous Healthcare Sub-System. Coordinated at the central government level under the administration of the National Health Foundation/Ministry of Health, the implementation of this sub-system required adaptations in the organization of health services systems at the local level, with the creation of Special Indigenous Health Districts. This configuration showed the need for dialogue and negotiation among the various institutions involved with indigenous affairs, from the perspective of overcoming various conflicts and operational difficulties. The current analysis identifies the difficulties in the implementation of a differentiated indigenous health policy under federal responsibility and within the decentralized Brazilian Unified Health System (SUS), since the absence of specific mechanisms and instruments regulating the operationalization of these services at the local level and the lack of more effective supervision and on-going evaluation of this policy mean that differentiated care for the indigenous population is subject to both the vices and virtues of local policy.

Brazil↗
PubMed2006

Meeting the health needs of Indigenous people: how is nursing education meeting the challenge?

Australian Indigenous people continue to have health outcomes that are near to the worst in the world but similar to those of the Indigenous peoples in countries such as Canada and New Zealand. Numerous policies and strategies have been implemented in Australia in an attempt to rectify this situation. This paper provides an overview of the issues directly related to the provision of a skilled workforce prepared for delivery of appropriate health services to Indigenous people. It includes an overview of the need for Indigenous people in nursing and the issues facing them when they enrol in undergraduate nursing courses. It also proposes changes necessary to ensure non-indigenous nurses are better prepared to work effectively with Indigenous people in the future.

Curriculum↗
PubMed2006

Building service capacity within a regional district mental health service: recommendations from an Indigenous mental health symposium.

CONTEXT: In response to recent developments within the mental health services of south-east Queensland, the Toowoomba District Mental Health Service (TDMHS) has developed a Model of Service Delivery, which outlines the range of services provided for consumers across their lifespan. Indigenous consumers of the TDMHS come from a wide area of communities in the surrounding shires (Rural, remote and metropolitan areas (RRMA) 4-7). It was recognised by the service that Indigenous mental health consumers have unique needs and, because of these needs, this area of service delivery required greater attention and further development. In December 2004, a symposium was organised by the service to bring together a range of speakers and delegates working in the area of Indigenous mental health to discuss issues and work towards developing strategies to enable the service to better meet the needs of Indigenous consumers in this region of south-east Queensland. ISSUES: The symposium program consisted of keynote speakers and invited papers and culminated with an afternoon workshop that collated the symposium's main issues and themes around building service capacity for Indigenous mental health consumers. The objective of the workshop was 'Identifying ways to meet Indigenous mental health needs'. This workshop gave the delegates a chance to reflect, discuss and brainstorm the major issues of concern relating to this question. A group facilitator guided the discussion and organised the delegates into groups to evaluate, debate and propose recommendations for each of the major issues that emerged. LESSONS LEARNED: The feedback and discussion arising from the workshop is presented. Sixteen major themes emerged from the workshop. Seven of these were voted by the participants as being dominant and in greatest need of discussion: (1) communication; (2) cultural respect; (3) culturally appropriate clinical tools; (4) supportive management; (5) patient compliance; (6) career structure; and (7) empowerment. These seven themes are discussed and recommendations arising from the workshop are noted.

Community Mental Health Services↗
PubMed1999

Differential contribution of indigenous men and women to the formation of an urban population in the Amazon region as revealed by mtDNA and Y-DNA.

The human populations of the Brazilian Amazon were formed by interethnic crosses between Europeans, Africans, and Amerindians. The relative contribution of men and women of different ethnic groups was not homogeneous, since the social policies of the first three centuries of Brazilian colonization encouraged mating between European men and indigenous women and, later on, African women. In order to test this model based on historical data, we compared the relative contribution of the Y-DNA and mtDNA of Amerindian and non-Amerindian populations to the formation of the urban population of the town of Belém, in the Amazon region, on the basis of a C-->T mutation at locus DYS199 present in 90% of the Amerindian Y-DNA and of five markers that define 99% of the mitochondrial sequences of Amerindians. The contribution of indigenous men to the formation of this population was less than 5%, whereas the contribution of indigenous women was estimated at more than 50% of the mitochondrial sequences of the same population. Thus, the present results demonstrate that the contribution of indigenous women to the formation of the Belém population was 10 times higher than the contribution of indigenous men, a genetic consequence of social behavior and attitudes of the past; our results also help clarify the process of integration of indigenous communities into the urban societies in Brazil and possibly in other countries.

Brazil↗
PubMed2006

Suicide among Indigenous Sami in Arctic Norway, 1970-1998.

Suicide mortality was examined between 1970 and 1998 in a cohort of 19,801 persons categorized as indigenous Sami in Arctic Norway. Standardized mortality ratios (SMR) were calculated using the suicide rates of the rural population of Arctic Norway as reference. There was a significant moderate increased risk for suicide among indigenous Sami (SMR = 1.27, 95% Confidence interval (CI): 1.02-1.56). In the study period, 89 suicides occurred in the cohort (70 men and 19 women) with increased suicide mortality both for indigenous Sami males (SMR = 1.27; 95% CI: 0.99-1.61) and females (SMR = 1.27; 95% CI: 0.77-1.99). Significant increased suicide mortality was found for young Sami aged 15-24 for both males (SMR = 1.82; 95% CI: 1.13-2.78) and females (SMR = 3.17; 95% CI: 1.17-6.91). Significant increased suicide mortality was found for indigenous Sami males residing in Sami core area (SMR = 1.54; 95% CI: 1.04-2.20) and for indigenous Sami males not belonging to semi-nomadic reindeer herding (SMR = 1.30; 95% CI: 1.00-1.65). Clusters of suicides in Sami core area may explain the increased suicide mortality found in subgroups among indigenous Sami.

Adolescent↗
PubMed1984

The practice of 'Dr' Paep: continuity and change in indigenous healing in northern Thailand.

Dr. Paep Plienphleng is an indigenous curer in a rural district in Chiang Mai Province, Northern Thailand, where he is numbered among the group of healers known as mqq mueang ('Northern doctors'). He specializes in curing saan or 'tumors' by combining several techniques: indigenous surgery, herbal curing and supernatural curing. Other aspects of Dr Paep's practice have been due to larger trends in indigenous healing that have affected him and other curers over past decades. This paper describes the practice of Dr Paep and some aspects of his healing, and examines the context of his practice by exploring other categories of indigenous healers found in this area of the North. It is concluded that Northern Thai healing is undergoing a transformation from a stress on general healing to an emphasis on the use of supernatural cures, more specialization among healers and efforts to adapt services to fit the plural system of care found in this rural Northern Thai environment. Thus, we find the skills of indigenous healers and the nature of indigenous Northern Thai medicine allow for creative adaptation to a changing medical environment.

Family Practice↗
PubMed2005

Carotid artery intimal medial thickness, brachial artery flow-mediated vasodilation and cardiovascular risk factors in diabetic and non-diabetic indigenous Australians.

BACKGROUND: Indigenous Australians are at high risk for cardiovascular disease and type 2 diabetes. Carotid artery intimal medial thickness (CIMT) and brachial artery flow-mediated vasodilation (FMD) are ultrasound imaging based surrogate markers of cardiovascular risk. This study examines the relative contributions of traditional cardiovascular risk factors on CIMT and FMD in adult Indigenous Australians with and without type 2 diabetes mellitus. METHOD: One hundred and nineteen Indigenous Australians were recruited. Physical and biochemical markers of cardiovascular risk, together with CIMT and FMD were measured for all subjects. RESULTS: Fifty-three Indigenous Australians subjects (45%) had type 2 diabetes mellitus. There was a significantly greater mean CIMT in diabetic versus non-diabetic subjects (p=0.049). In the non-diabetic group with non-parametric analyses, there were significant correlations between CIMT and: age (r=0.64, p<0.001), systolic blood pressure (r=0.47, p<0.001) and non-smokers (r=-0.30, p=0.018). In the diabetic group, non-parametric analysis showed correlations between CIMT, age (r=0.36, p=0.009) and duration of diabetes (r=0.30, p=0.035) only. Adjusting for age, sex, smoking and history of cardiovascular disease, Hb(A1c) became the sole significant correlate of CIMT (r=0.35, p=0.01) in the diabetic group. In non-parametric analysis, age was the sole significant correlate of FMD (r=-0.31, p=0.013), and only in non-diabetic subjects. Linear regression analysis showed significant associations between CIMT and age (t=4.6, p<0.001), systolic blood pressure (t=2.6, p=0.010) and Hb(A1c) (t=2.6, p=0.012), smoking (t=2.1, p=0.04) and fasting LDL-cholesterol (t=2.1, p=0.04). There were no significant associations between FMD and examined cardiovascular risk factors with linear regression analysis CONCLUSIONS: CIMT appears to be a useful surrogate marker of cardiovascular risk in this sample of Indigenous Australian subjects, correlating better than FMD with established cardiovascular risk factors. A lifestyle intervention programme may alleviate the burden of cardiovascular disease in Indigenous Australians by reducing central obesity, lowering blood pressure, correcting dyslipidaemia and improving glycaemic control. CIMT may prove to be a useful tool to assess efficacy of such an intervention programme.

Adult↗
PubMed2006

Clear not simple: an approach to community consultation for a maternal pneumococcal vaccine trial among Indigenous women in the Northern Territory of Australia.

PneuMum is a randomised controlled maternal vaccination trial, using 23-valent Pneumococcal Polysaccharide Vaccine (23vPPV) during the third trimester or at delivery compared to vaccination at 7 months post delivery. The primary outcomes are infant middle ear disease and nasopharyngeal pneumococcal carriage at 7 months of age. PneuMum is the first vaccine trial to be conducted among Indigenous people in the Northern Territory. We describe the study design and the approach taken to develop the PneuMum message in collaboration with key Indigenous stakeholders and then to communicate the PneuMum message with Indigenous communities and potential participants. We hope that these methods will provide a model for future research involving Indigenous communities to ensure Indigenous involvement in research and ultimate improvements in Indigenous health.

Adolescent↗
PubMed1998

Indigenous health: patterns of variation in terms of disease categories.

While many studies investigated the higher morbidity and mortality levels of indigenous Australians in the high-density indigenous areas in the Northern Territory, Western Australia and South Australia, few examined the situation in New South Wales, where more than 28% of the indigenous population lives. Admissions to acute public and private hospitals in New South Wales for 1989-1995 are used in the study reported here to examine indigenous health and its differential patterns by disease categories. The study allowed for the monitoring of disease groups with particularly high indigenous admissions and, accordingly, pinpointed areas for improvement. Age-standardised estimates for the indigenous population are provided. Age composition of admissions for each disease category and admissions by residential area are also estimated.

Adolescent↗
PubMed2005

Evaluating an indigenous sexual health peer education project.

ISSUE ADDRESSED: Many Indigenous Australians are dealing with a wide range of sexual health issues including contraception, HIV/AIDS and other sexually transmitted infections. The Indigenous Peer Education Program provided training to young, marginalised and disadvantaged Indigenous people to become sexual health peer educators within their communities. METHODS: The initiative comprised peer educator training, capacity building, and the development and dissemination of sexual health educational materials through an arts-based strategy. Evaluation involved a retrospective qualitative methodology, including document analysis, interviews and focus groups. RESULTS: The program was successful in training 22 young Indigenous peer educators and developing and disseminating more than 2,600 sexual health education resources to young Indigenous people and their community. CONCLUSIONS: The project had a positive immediate impact upon young Indigenous participants who reported and demonstrated increased knowledge of sexual health issues and skills as peer educators. The evaluation documented the program development and the immediate effects on participants, but did not enable an assessment of long-term effects for participants, service providers or the community. The evaluation identified areas for program improvement and challenges for program sustainability. The initiative was well supported within the local community and peer educators continued to engage in opportunistic sexual health promotion.

Adolescent↗
PubMed2003

Renal transplantation for Indigenous Australians: identifying the barriers to equitable access.

OBJECTIVE: To assess Indigenous Australians' access to renal transplantation, compared with non-Indigenous Australians. To examine whether disparities are due to a lower rate of acceptance onto the waiting list and/or a lower rate of moving from the list to transplantation. DESIGN: National cohort study using data from the Australian and New Zealand Dialysis and Transplant Registry. We included all end-stage renal disease (ESRD) patients under 65 years of age who started treatment in Australia between January 1993 and December 1998. We used survival analysis to examine the time from commencement of renal replacement therapy (RRT) to transplantation. We measured time from commencement of RRT to acceptance onto the waiting list (stage 1), and time from acceptance onto the waiting list to transplantation (stage 2). The main outcome measures were (1) acceptance onto the waiting list and (2) receipt of a transplant, before 31 March 2000. RESULTS: Indigenous patients had a lower transplantation rate (adjusted Indigenous: non-Indigenous rate ratio 0.32, 95% CI 0.25-0.40). They had both a lower rate of acceptance onto the waiting list (adjusted rate ratio 0.50, 95% CI 0.44-0.57) and a lower rate of moving from the list to transplantation (adjusted rate ratio 0.50, 95% CI 0.38-0.65). The disparities were not explained by differences in age, sex, co-morbidities or cause of renal disease. CONCLUSIONS: Indigenous Australians face barriers to acceptance onto the waiting list and to moving from the list to transplantation. Further research to identify the causes could facilitate strategies to improve equity in transplantation.

Australia↗
PubMed2001

Variation in mortality rates in Australia: correlation with Indigenous status, remoteness and socio-economic deprivation.

BACKGROUND: The aim of this study was to study ecological correlations between age-adjusted all-cause mortality rates in Australian statistical divisions and (1) the proportion of residents that self-identify as Indigenous, (2) remoteness, and (3) socio-economic deprivation. METHODS: All-cause mortality rates for 57 statistical divisions were calculated and directly standardized to the 1997 Australian population in 5-year age groups using Australian Bureau of Statistics (ABS) data. The proportion of residents who self-identified as Indigenous was obtained from the 1996 Census. Remoteness was measured using ARIA (Accessibility and Remoteness Index for Australia) values. Socioeconomic deprivation was measured using SEIFA (Socio-Economic Index for Australia) values from the ABS. RESULTS: Age-standardized all-cause mortality varies two-fold from 5.7 to 11.3 per 1,000 across Australian statistical divisions. Strongest correlation was between Indigenous status and mortality (r = 0.69, p < 0.001). Correlation between remoteness and mortality was modest (r = 0.39, p = 0.002) as was correlation between socio-economic deprivation and mortality (r = -0.42, p = 0.001). Excluding the three divisions with the highest mortality, a multiple regression model using the logarithm of the adjusted mortality rate as the dependent variable showed that the partial correlation (and hence proportion of the variance explained) for Indigenous status was 0.03 (9 per cent; p = 0.03), for SEIFA score was -0.17 (3 per cent; p = 0.22); and for remoteness was -0.22 (5 per cent; p = 0.13). Collectively, the three variables studied explain 13 per cent of the variability in mortality. CONCLUSIONS: Ecological correlation exists between all-cause mortality, Indigenous status, remoteness and disadvantage across Australia. The strongest correlation is with Indigenous status, and correlation with all three characteristics is weak when the three statistical divisions with the highest mortality rates are excluded. Intervention targeted at these three statistical divisions could reduce much of the variability in mortality in Australia.

Australia↗
PubMed2002

Making medicine indigenous: homeopathy in South India.

Historical studies of homeopathy in Europe and the USA have focused on practitioners' attempts to emphasize 'modern' and 'scientific' approaches. Studies of homeopathy in India have focused on a process of Indianization. Arguing against such unilineal trajectories, this paper situates homeopathy in South India within the context of shifting relations between 'scientific' and 'indigenous' systems of medicine. Three time periods are considered. From 1924 through 1934, homeopathy was singled out by Government of Madras officials as 'scientific', as contrasted with the 'indigenous' Ayurvedic, Siddha, and Unani systems of medicine. From 1947 through 1960, both 'indigenous' and 'scientific' interpretations of homeopathy were put forward by different factions. An honorary director of homeopathy proposed the Indianization of homeopathy, and its reconciliation with Ayurveda; this view conflicted with the Madras government's policy of expanding the 'scientific' medical curriculum of the Government College of Indigenous Medicine. It was not until the early 1970s that homeopathy was officially recognized in Tamilnadu State. By then, both homeopathy and Ayurveda had become conceptualized as non-Tamil, in contrast with promotion of the Tamil Siddha system of 'indigenous' medicine. Thus, constructs of 'indigenous' and 'scientific' systems of medicine are quite malleable with respect to homeopathy in South India.

Colonialism↗
PubMed2006

'It's very difficult to get respite out here at the moment': Australian findings on end-of-life care for Indigenous people.

Whilst access to respite care has been found to represent an important source of support for terminally ill patients and their families, the availability of these services to Indigenous Australians has to date remained undocumented. This potential need for respite in Indigenous communities was explored as part of a National Health and Medical Research Council (NH&MRC) funded study designed to develop an innovative model for Indigenous palliative care. The data needed for model development were collected through a series of open-ended, qualitative interviews conducted with a cross-section of consumers and health professionals within the Northern Territory, Australia. The findings reflected a serious need for Indigenous respite services, coupled with a severe deficiency in the present availability of these services, especially within rural and regional areas. This lack of local respite services was documented to be negatively impacting upon the ability of carers to fulfil their caring duties and was found placing undue physical, emotional and economic stress upon carers, patients and their families. Furthermore, the lack of access to local respite services documented was found to be forcing rural and regional patients to relocate to metropolitan areas away from the family, community and land to which strong ties are held. The lack of Indigenous respite services was also found to obstruct patients' and carers' wishes for death to occur in the local community, rather than in far away cities. Significant obstacles were found to be hindering the provision of respite care to Indigenous Australians, namely beliefs about families looking after their own, resource restrictions, limited staff availability in local areas, as well as problems associated with hostel use in metropolitan areas. The conclusions drawn from this study suggest the importance of tackling the obstacles preventing local respite services being established in areas close to where patients and carers live.

Cross-Sectional Studies↗