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PubMed1998

Assessing the validity of intercensal comparisons of indigenous Australians, 1986-96.

"The credibility of analysis of 1996 Census data on indigenous Australians hinges on who the people are who have changed their indigenous identification between the last two censuses. The number of people who identify as indigenous in either the Post-Enumeration Survey or the census is more stable than the prima facie evidence indicates. Also, the continuing low levels of education among the indigenous population means that self-identification signifies that one is, more than likely, disadvantaged. While it is difficult to say with absolute certainty that census statistics accurately reflect the economic status of the indigenous population, they are sufficiently credible to be taken at face value."

Australia↗
PubMed2026

Pharmacogenomic diversity in Amazonian Indigenous populations: implications for Berlin-Frankfurt-Münster acute lymphoblastic leukemia therapy.

PURPOSE: This study aimed to characterize pharmacogenomic variation in genes involved in the metabolism and transport of drugs used in Berlin-Frankfurt-Münster-based therapy in Amazonian Indigenous individuals and to compare allele frequencies with major continental populations. METHODS/PATIENTS: Whole-exome sequencing data previously generated from 64 healthy Indigenous individuals from 12 Amazonian ethnic groups were analyzed. A total of 120 genes associated with drugs used in Berlin-Frankfurt-Münster protocols were selected. Variants were annotated and filtered using bioinformatic quality-control criteria, and allele frequencies were compared with African, Admixed American, East Asian, European, and South Asian populations from the 1000 Genomes Project. Multidimensional scaling was used to assess population-level genetic similarity. RESULTS: After quality control, 648 variants were identified. Twenty-eight variants were observed exclusively in the Indigenous study population, including four nonsynonymous coding variants with moderate predicted impact. Significant allele-frequency differences were observed for ADA rs11555566, CBR3 rs881711, and CYP2B6 rs3745274; rs881711 and rs3745274 differed from all five reference populations. Multidimensional scaling showed a distinct Indigenous pharmacogenomic profile, with greater similarity to the Admixed American population. CONCLUSIONS: Amazonian Indigenous populations exhibit substantial pharmacogenomic diversity in genes relevant to Berlin-Frankfurt-Münster-based therapy. These findings identify candidate variants for functional and clinical validation and reinforce the importance of including underrepresented populations in pharmacogenomic research.

Acute lymphoblastic leukemia↗
PubMed2026

Indigenous body image amid rapid social and economic change: A reflexive thematic analysis of Wayuu narratives.

The Wayuu, Colombia's largest Indigenous group, are experiencing rapid social, economic, and technological change, including expanding internet access, educational opportunities, and increasing exposure to globalised media. Though the harmful effects of appearance-idealised media imagery on body image are well documented, indigenous body image research remains unevenly distributed across global contexts, with Latin American Indigenous communities particularly underrepresented. This study explored how Wayuu people understand and experience appearance ideals and body image in the context of expanding digital media exposure and rapid sociocultural and economic change. Five focus groups of up to 9 participants were conducted with 29 Wayuu participants (18-68 years; 23 women, 6 men). Using reflexive thematic analysis, three overarching themes were identified: (1) Intersecting sources of appearance pressure: encompassing influences from social media, Wayuu family expectations, and discrimination from non-Indigenous peers; (2) Negotiating and resisting appearance ideals: from body dissatisfaction and restrictive eating to affirmation of cultural identity as protection; and (3) The changing role of appearance in today's Wayuu culture: participants linked globalised appearance ideals to expanding educational opportunities, migration, digital connectivity, and broader socioeconomic transformations occurring within Wayuu territories. While exposure to global ideals fostered comparison and dissatisfaction, cultural pride and collective belonging appeared to buffer against internalised colonial values. Culturally grounded media literacy and education initiatives co-developed with Wayuu communities could foster critical reflection while strengthening heritage. These results highlight the need for decolonial, community-based approaches to body image research and intervention in Indigenous contexts.

Adolescent↗
PubMed2005

Ambivalent helpers and unhealthy choices: public health practitioners' narratives of Indigenous ill-health.

Public health practitioners in Australian indigenous health work in a complex political environment. Public health training is limited in providing them with conceptual tools needed to unpack the postcolonial nexus of 'fourth-world' health. A workshop was designed by the authors to facilitate critical reflection on how the concepts of race and culture are used in constructions of indigenous ill-health. It was attended by researchers, students, clinicians and bureaucrats working in public health in northern Australia. A thematic analysis of the workshop minutes provided insight into public health practitioners' narratives of Indigenous ill-health. The major themes that emerged included tension between structure and agency and between sameness and difference, and ambivalence surrounding the 'helper' identity of public health practitioners. We suggest that these narratives can be understood as attempts to maintain the moral integrity of both Indigenous people and practitioners. This task is necessitated by the specter of cultural relativism intrinsic to contemporary liberal discourses of multiculturalism that attempt to reconcile the universal rights of the citizen with the special rights of minority groups. We argue that the concepts of self-determination and neocolonialism mark the spaces where universal and particular discourses overlap and clash. Practitioners who seek to escape neocolonialism must inhabit only the discursive space of public health congruent with self-determination, leaving them in a bind common to many postcolonial situations. They must relieve the ill-health of indigenous people without acting upon them; change them without declaring that change is required.

Attitude of Health Personnel↗
PubMed2006

Indigenous health in Latin America and the Caribbean.

This review is the second in a series on Indigenous health, covering different regions and issues. We look briefly at the current state of Indigenous health in Latin America and the Caribbean, a region with over 400 different indigenous groups and a total population of 45 to 48 million people. We describe the complex history and current reality of Indigenous peoples' situation within the American continent. We discuss the importance of Indigenous health systems and medicines, and look at changing political environments in the region. The paper concludes with a discussion of the changing political and legislative environment in Latin American countries.

Caribbean Region↗
PubMed2003

Cancer in Indigenous Australians: a review.

OBJECTIVES: To summarize for the first time evidence of the impact of cancer on Indigenous Australians. METHODS: Medline search of peer-reviewed scientific journals, and extensive search of reports of government agencies, publications of cancer registries and non-government organizations, and other non-peer-reviewed sources. RESULTS: Indigenous Australians have much higher incidence rates than other Australians of cancers of the lung, liver, and cervix; but much lower rates of cancers of the breast, colon and rectum, prostate, melanoma of skin, and lymphoma. Some of these differences can be explained, in part at least, by differences in risk factor prevalence. Indigenous Australians also have higher mortality and lower survival from cancer as a whole than other Australians. More advanced disease at diagnosis, and possibly poorer treatment, are partly responsible for these differences, but other factors may also be involved. CONCLUSIONS: Less accessible and less effective health programs are as great a problem for cancer control as for other aspects of Indigenous health in Australia. Major improvements in preventive services, screening, primary care, and specialist treatment services are required to reduce cancer incidence and improve cancer outcomes for Australia's Indigenous people.

Alcohol Drinking↗
PubMed2006

Uncovering the determinants of cardiovascular disease among Indigenous people.

OBJECTIVE: This paper attempts to delineate an appropriate methodology for research into cardiovascular diseases (CVD) in the context of the Australian Indigenous population. DESIGN: Our argument proceeds in three main stages of critical analysis of the appropriate literature. First we demonstrate the extremely complex aetiology of CVD and also argue that, in any population, exposure to many of the more important risk factors at an individual or group level is generated through social and behavioural factors whose causation, persistence and reproduction are both complex and multilayered. Secondly, and having established that the aetiology and morbidity of CVD in various populations is a product of a complex and interactive hierarchy of biomedical, social and political processes, we argue that only research methodologies capable of encompassing the complete span of this hierarchy can be expected to generate results which are efficacious as a basis for intervention. Thirdly, and most importantly, we argue that in the Indigenous context a central and essential feature in the development of an appropriate methodology must be to centre Indigenous people themselves as the dominant partner in setting the research agenda and the conduct of research. RESULTS/CONCLUSIONS: We conclude that an appropriate methodology for the elucidation of the aetiology, and sequelae of CVD in Indigenous people, would go far beyond 'black box' epidemiology, would recognise the essentially social nature of chronic disease by deploying appropriate social theory within a transdisciplinary framework and would centre Indigenous people as the dominant partner in the research process.

Australia↗
PubMed1998

Positions and training of the indigenous health workforce.

A survey of community-controlled and state health services was conducted in 1995 as part of a needs assessment for a tertiary training initiative in applied epidemiology. Information for 792 Indigenous people in health-related occupations was obtained. Mean time in the current position was 4.8 years, 75% were in designated Aboriginal positions and 44% were health workers. Of the total, 49% had a diploma or certificate, but only 3% had a bachelors degree. The latter compares with 75% of the public health workforce generally which has a bachelors degree or higher. The high proportions of health worker and designated Aboriginal positions, short tenure and low level of degree training suggest that there are a range of employment and training issues which need to be addressed if an appropriate level of Indigenous workforce participation is to be achieved and Indigenous health professionals are to have access to the same vertical and lateral employment mobility as non-Indigenous workers. In particular, there is a huge need to enhance Indigenous participation in health workforce training, and to develop strategies for certification and recognition of the wide range of non-course-based training being undertaken.

Adolescent↗
PubMed2002

An evaluation of tobacco brief intervention training in three indigenous health care settings in north Queensland.

OBJECTIVE: To evaluate the pilot phase of a tobacco brief intervention program in three Indigenous health care settings in rural and remote north Queensland. METHODS: A combination of in-depth interviews with health staff and managers and focus groups with health staff and consumers. RESULTS: The tobacco brief intervention initiative resulted in changes in clinical practice among health care workers in all three sites. Although health workers had reported routinely raising the issue of smoking in a variety of settings prior to the intervention, the training provided them with an additional opportunity to become more aware of new approaches to smoking cessation. Indigenous health workers in particular reported that their own attempts to give up smoking following the training had given them confidence and empathy in offering smoking cessation advice. However, the study found no evidence that anybody had actually given up smoking at six months following the intervention. Integration of brief intervention into routine clinical practice was constrained by organisational, interpersonal and other factors in the broader socioenvironmental context. CONCLUSIONS/IMPLICATIONS: While modest health gains may be possible through brief intervention, the potential effectiveness in Indigenous settings will be limited in the absence of broader strategies aimed at tackling community-identified health priorities such as alcohol misuse, violence, employment and education. Tobacco and other forms of lifestyle brief intervention need to be part of multi-level health strategies. Training in tobacco brief intervention should address both the Indigenous context and the needs of Indigenous health care workers.

Health Personnel↗
PubMed1995

Evaluating government health and substance abuse programs for indigenous peoples: a comparative review.

Most health and substance abuse programs for indigenous peoples in Australia are funded by government. Over the past decade there have been calls for greater accountability in the conduct of these programs. Initial attempts focused on the development of standardised performance indicators, an approach that has been criticised on both political and methodological grounds. Recently, some government agencies have sought to identify culturally appropriate models for the evaluation of programs for indigenous peoples. In a comparative review of the evaluation of indigenous programs in Australia and Canada, conducted for the Western Australian Aboriginal Affairs Department, the authors were not able to identify any generally applicable models. However, this literature review and our own research and experience in working with Aboriginal community organisations have identified some principles that should be an essential part of any attempts to evaluate health and substance abuse programs for indigenous peoples. Underlying these principles is the realisation that evaluation is not a politically or ideologically neutral activity. Theoretical and methodological considerations of the evaluation process must take into account the very real differences between the agendas of indigenous peoples and those who seek to evaluate programs for them.

Australia↗
PubMed2003

The nurse's role in improving indigenous health.

The health status of indigenous peoples is a global concern with mortality and hospitalisation data indicating that the health of indigenous groups falls below that of other ethnic groups within their countries. The preliminary findings of grounded theory research project undertaken with a group of 23 New Zealand Maori women about their health priorities and 'mainstream' health service needs provide the foundation for an exploration of issues impacting on the health status of indigenous people. The role that nursing and nurses have in improving access and use of health services by indigenous people will be discussed. Strategies are suggested that nurses can utilise within their practice when working with local indigenous groups.

Cultural Diversity↗
PubMed2001

EBM and the health of Indigenous Australians.

Implementing evidence-based medicine (EBM) in primary healthcare for Indigenous people will usually involve increasing services, particularly those for chronic conditions. As shown by the example of diabetes care, there are significant organisational, educational, economic, cultural and structural barriers to implementing EBM in many Indigenous communities. Many of these barriers could be reduced by better-organised service delivery systems at the community level, greater numbers of Indigenous health professionals and greater advocacy for healthy public policy by health services. There is evidence that delivering evidence-based primary healthcare, particularly for chronic diseases, can improve health outcomes in Indigenous communities. There is a need for more investment in strategies to implement EBM and evidence-based public health in Indigenous settings.

Adult↗
PubMed2005

Impact of a collaborative shared antenatal care program for urban Indigenous women: a prospective cohort study.

OBJECTIVES: To evaluate the impact of a community-based, collaborative, shared antenatal care intervention (the Mums and Babies program) for Indigenous women in Townsville. DESIGN AND PARTICIPANTS: Prospective cohort study of women attending Townsville Aboriginal and Islander Health Service (TAIHS) for shared antenatal care with a singleton Indigenous birth between 1 January 2000 and 31 December 2003 (456 women; the MB group), compared with a historical control group of 84 women who attended TAIHS for antenatal care before the intervention between 1 January 1998 and 30 June1999, and a contemporary control group of 540 women who had a singleton birth at Townsville Hospital between 1 January 2000 and 30 June 2003, but did not attend TAIHS for antenatal care. INTERVENTION: Integration of previously autonomous service providers delivering shared antenatal care from TAIHS. MAIN OUTCOME MEASURES: Patterns of antenatal visits, proportion of women undertaking key antenatal screening, and perinatal outcomes. RESULTS: The number of Indigenous women who entered the MB program and gave birth at Townsville Hospital rose from 23.8% in 2000 to 61.2% in 2003. The number of antenatal care visits per pregnancy increased from three (interquartile [IQ] range, 2-6) in the historical control group to seven (IQ range, 4-10) in the MB group (P < 0.001). 88% of women in the MB group had at least one ultrasound. About 90% of all women attending for antenatal care were screened for sexually transmitted infections. In the MB group, there was a significant reduction in preterm births compared with the contemporary control group (8.7% v 14.3%, P < 0.01). There was no significant reduction in the prevalence of low birthweight births or perinatal mortality. CONCLUSION: A community-based collaborative approach to shared antenatal care services increased access to antenatal care and was associated with fewer preterm births among Indigenous women in Townsville. The model may be adaptable in other urban centres with multiple antenatal care providers and significant numbers of Indigenous people across Australia.

Adult↗
PubMed2006

Indigenous health research: a critical review of outputs over time.

OBJECTIVE: To determine the number and nature of publications on Indigenous health in Australia, Canada, New Zealand and the United States) in 1987-1988, 1997-1998 and 2001-2003. DATA SOURCES: MEDLINE and PsychLit databases were searched using the following terms: Aborigines or Aboriginal; Torres Strait Islander; Maori; American Indian; North American Indian, or Indian, North American; Alaska/an Native; Native Hawaiian; Native American; American Samoan; Eskimos or Inuit; Eskimos or Aleut; Metis; Indigenous. STUDY SELECTION: Publications were included if they were concerned with the health of Indigenous people of the relevant countries. 1763 Indigenous health publications were selected. DATA EXTRACTION: Publications were classified as either: original research; reviews; program descriptions; discussion papers or commentaries; or case reports. Research publications were further classified as either measurement, descriptive, or intervention. Intervention studies were then classified as either experimental or non-experimental. DATA SYNTHESIS: The total number of publications was highest in 1997-1998 for most countries. The most common type of publication across all time periods for all countries was research publications. In Australia only, the number of research publications was slightly higher in 2001-2003 compared with other time periods. For each country and at each time, research was predominantly descriptive (75%-92%), with very little measurement (0-11%) and intervention research (0-18%). Overall, of the 1131 research publications, 983 were descriptive, 72 measurement and 76 intervention research. CONCLUSIONS: The dominance of descriptive research in Indigenous health is not ideal, and our findings should be carefully considered by research organisations and researchers when developing research policies.

Australia↗
PubMedDate not supplied

Predictors of indigenous healer use among Samoans.

OBJECTIVE: To determine the utilization of alternative modalities of care (i.e., indigenous healers or fofo) by Samoans, the indigenous peoples of the US Territory of American Samoa and examine predictors (i.e., socio-demographic, access to care, health status, culture-specific beliefs about disease etiology and treatment, and intentions to use healers) of utilization of fofo. DESIGN: A cross-sectional design, with systematic, random sampling procedures. SUBJECTS: 1,834 adult Samoan men and women residing in American Samoa, Hawaii, and Los Angeles. OUTCOME MEASURE: Prevalence and predictors of utilization of fofo. Multivariate logistic regression was performed to determine independent predictors of utilization of fofo. RESULTS: The prevalence of use of fofo across the three study sites was 41.0%. The following variables emerged as significant predictors of use of fofo: older age (odds ratio [OR] = 1.60; 95% confidence interval [CI] = 1.25-2.06), resident of American Samoa (OR = 1.69, CI = 1.29-2.21), belief that indigenous healers can treat cancer (OR = 1.79, CI = 1.40-2.30), belief that some illnesses afflict only Samoans (OR = 2.15, CI = 1.72-2.70), and greater intentions to use a fofo (OR = 2.27, CI = 1.81-2.85). Some of the more common medical conditions for which Samoans used fofo were biomedically defined musculoskeletal and neurologic problems, and Samoan sicknesses (ma'i Samoa). CONCLUSIONS: Population-based estimates of use of alternative modalities of care by Samoans are comparable to that reported for the general US population. However, the predictors of utilization of indigenous healers are more likely to be culture-specific health beliefs about disease etiology and treatment. There is a need to better understand Samoan traditional medicine and help-seeking behavior and explore whether indigenous Samoan healers can assist in the delivery of clinically proven and culturally sensitive health interventions to positively impact both disease management and preventative behaviour in this minority Polynesian population.

Adult↗
PubMed2005

Challenges in preventing pyelonephritis in pregnant women in Indigenous communities.

INTRODUCTION AIM: To measure the quality of antenatal care in rural and remote regions of the Northern Territory, using asymptomatic bacteruria as an indicator. BACKGROUND: Indigenous Australian women and their babies have a greater frequency of adverse outcomes in pregnancy than their non-Indigenous counterparts. It is well established that asymptomatic bacteriuria may have serious outcomes in pregnancy, including an increased risk of pyelonephritis and a strong association with preterm and low birth weight delivery. Ensuring good quality antenatal care can reduce the individual risks of pregnancy for mothers and their babies. In the Northern Territory there are well established guidelines for antenatal care in rural and remote Indigenous communities. These are documented in the Women's Business Manual. Audit and feedback is one method that has been shown to have a small to moderate effect in changing clinician behaviour, in this case improving compliance with guidelines. METHODS: A retrospective chart audit of antenatal clients was conducted at 10 rural and remote primary health care clinics in the Northern Territory, Australia. The audit reviewed all the available charts (n = 268) of pregnant women, from the participating communities, who gave birth in 2002 or 2003. The diagnosis and management of asymptomatic bacteriuria was chosen as the indicator of quality antenatal care, as it is one of five areas of antenatal care where there is evidence that appropriate management improves outcomes. The quality of care was measured against the local guidelines, the Women's Business Manual. RESULTS: Women frequently had urine tests with where the dipstick showed an abnormal result, with 75% (95% CI [0.70,0.80]) of women having at least one episode of abnormal urinalysis during pregnancy. Six hundred and twenty episodes of abnormal urinalysis in pregnancy were identified. The incidence of bacteriuria at first visit was 16%, (95%-confidence interval = 95% CI [0.10, 0.21]). Compliance with the guidelines was poor. Fifty-six percent (95% CI [0.52,0.60]) of those samples testing positive on urinalysis were not sent to pathology for microscopy and culture, as recommended in the guidelines. Of those with a positive culture, 32% (95% CI 0.28,0.39) were appropriately treated with antibiotics. When antibiotics were given, good compliance of 82% (95% CI 0.76,0.87) with antibiotic guidelines was demonstrated. The positive predictive value of dipstick urinalysis in diagnosing asymptomatic bacteriuria was low in this study at 33.5%. There were 13 episodes of confirmed or probable pyelonephritis. No women with recurrent urinary tract infections were followed up according to protocol. CONCLUSION: Aboriginal women have worse pregnancy outcomes than the non-Indigenous population of Australia. Pyelonephritis is a preventable condition in pregnancy. In these rural and remote communities, pyelonephritis has not been prevented due, in part, to a failure to follow the local guidelines. Structural problems were identified and need to be addressed in order to improve compliance with guidelines and hence pregnancy outcomes for rural and remote Indigenous women.

Anti-Bacterial Agents↗
PubMed2004

Asymmetric larval interactions between introduced and indigenous ladybirds in North America.

Understanding the mechanisms that result in the success of introduced species will contribute to predicting future invasions and managing invaded systems. We examined interactions between larvae of two predatory ladybird species recently introduced to North America, Coccinella septempunctata (CS) and Harmonia axyridis (HA), and two indigenous ladybirds, Coccinella transversoguttata (CT) and Hippodamia convergens (HC). By pairing young and old larvae in the laboratory at low and high levels of aphid availability, we assessed the degree of asymmetry in intraguild predation (IGP), the strength of competitive effects on growth and development of larvae escaping predation, and the nature of attack and escape behavior among the species. Interactions were generally asymmetric, with larvae of introduced species acting most frequently as intraguild predators and larvae of indigenous species serving most frequently as intraguild prey (the two Coccinella spp., however, preyed on each other at similar rates). Because they were especially aggressive and because other larvae were least successful in escaping their attacks, larvae of HA had stronger negative effects on larvae of the two indigenous species than did larvae of CS. Such negative effects, expressed most strongly when aphid availability was low, were especially adverse for the smaller of the two indigenous species, HC. In general, older larvae interacted with each other more strongly than young larvae did, and older larvae had especially strong negative effects on young larvae when interactions occurred between age classes. Our results suggest that HA more than CS may represent a threat to indigenous ladybirds as an intraguild predator, and that IGP in turn may play a stronger role for HA than for C. septempunctata in promoting the successful invasion of North America.

Age Factors↗
PubMed2006

Evaluation of genetic diversity in Chinese indigenous chicken breeds using microsatellite markers.

China is rich in chicken genetic resources, and many indigenous breeds can be found throughout the country. Due to poor productive ability, some of them are threatened by the commercial varieties from domestic and foreign breeding companies. In a large-scale investigation into the current status of Chinese poultry genetic resources, 78 indigenous chicken breeds were surveyed and their blood samples collected. The genomes of these chickens were screened using microsatellite analysis. A total of 2740 individuals were genotyped for 27 microsatellite markers on 13 chromosomes. The number of alleles of the 27 markers ranged from 6 to 51 per locus with a mean of 18.74. Heterozygosity (H) values of the 78 chicken breeds were all more than 0.5. The average H value (0.622) and polymorphism information content (PIC, 0.573) of these breeds suggested that the Chinese indigenous chickens possessed more genetic diversity than that reported in many other countries. The fixation coefficients of subpopulations within the total population (F(ST)) for the 27 loci varied from 0.065 (LEI0166) to 0.209 (MCW0078), with a mean of 0.106. For all detected microsatellite loci, only one (LEI0194) deviated from Hardy-Weinberg equilibrium (HWE) across all the populations. As genetic drift or non-random mating can occur in small populations, breeds kept on conservation farms such a Langshan chicken generally had lower H values, while those kept on large populations within conservation regions possessed higher polymorphisms. The high genetic diversity in Chinese indigenous breeds is in agreement with great phenotypic variation of these breeds. Using Nei's genetic distance and the Neighbor-Joining method, the indigenous Chinese chickens were classified into six categories that were generally consistent with their geographic distributions. The molecular information of genetic diversity will play an important role in conservation, supervision, and utilization of the chicken resources.

Animals↗