Teses / dissertações sobre o tema "Aboriginal Australians – Health and hygiene – Australia"

"January 2003." Bibliography: 10.1-10.11 leaves. This thesis presents results from the Katherine Region Diabetic Retinopathy Study (1993-1996). These results provide the first detailed information on the basic epidemiology of diabetic retinopathy and impaired vision in an Aboriginal diabetic population.

Until recently, there was no dementia screening tool for Indigenous Australians and a paucity of information on the extent of dementia in Indigenous Australians. This thesis describes the development and validation of a tool to assess cognitive impairment in remote Indigenous Australians with the primary purpose of determining the prevalence of dementia and other associated conditions in this population. The tool was reevaluated with the larger prevalence sample and a short version of the tool was developed and evaluated. The Kimberley Indigenous Cognitive Assessment (KICA) tool was validated with Indigenous Australians aged over 45 years from the Kimberley region of Western Australia (n=70). The results were later confirmed in a larger sample from the remote Kimberley (n=363), and an additional sample in rural and remote areas of the Northern Territory (n=47). The KICA results were compared to independent consensus diagnoses using DSM-IV and ICD-10. Interpreters were used whenever participants were not proficient in English. These data led to the determination of a cut-off score of 33/34 out of a possible total score of 39 for the cognitive component of the KICA (KICA-Cog), with a sensitivity of 0.93 and specificity of 0.95 and AUC of 0.98. The tool is now widely used within remote areas of Australia. A short version of the KICACog (sKICA-Cog) was developed and found to be a valid brief screening tool for dementia in the Kimberley population, and had a cut-off score of 20/21 out of a possible 25, with a sensitivity of 0.89, specificity of 0.95 and AUC of 0.98. The sKICA-Cog should be used in combination with the KICA cognitive informant questionnaire (KICA-IQ). The KICA-IQ cut-off score of 2/3 out of a possible 16 was determined, with a sensitivity of 0.76 and specificity of 0.84 and AUC of 0.91. Using the validated KICA, the prevalence of dementia and cognitive impairment not dementia (CIND) was determined in a semi-purposive sample consisting of 363 Indigenous Australians aged over 45 years from 6 Aboriginal communities and one town in the Kimberley region. Participants were screened with the full KICA and 165 participants had an independent specialist review with consensus diagnoses. The prevalence of dementia was 12.4%, 5.2 times greater than the Australian prevalence of 2.4%, after age adjustment. The prevalence of CIND was 8.0%. Characteristics associated with dementia included older age, male gender (OR 3.1, 95% CI 1.4, 6.8), no formal education (OR 2.7, 95% CI 1.1, 6.7), smoking (OR 4.5, 95% CI 1.1, 18.6), previous stroke (OR 17.9, 95% CI 5.9, 49.7), epilepsy (OR 33.5, 95% CI 4.8, 232.3) and head injury (OR 4.0, 95% CI 1.7, 9.4). Other factors associated with dementia included incontinence, falls and poor mobility. The KICA is a valid assessment tool for rural and remote Indigenous Australians. The prevalence of dementia amongst Indigenous Australians is substantially higher than generally found in non - Indigenous Australians and other populations in the developed and developing world.

Master of Philosophy
As Australia’s leading agency for funding health research (expending over $400 million in 2006), the National Health and Medical Research Council (NHMRC) has a major responsibility to improve the evidence base for health policy and practice. There is an urgent need for better evidence to guide policy and programs that improve the health of Indigenous peoples. In 2002, NHMRC endorsed a series of landmark policy changes to acknowledge its ongoing role and responsibilities in Indigenous health research—adopting a strategic Road Map for research, improving Indigenous representation across NHMRC Council and Principal Committees, and committing 5% of its annual budget to Indigenous health research. This thesis examines how these policies evolved, the extent to which they have been implemented, and their impact on agency expenditure in relation to People Support. Additionally, this thesis describes the impact of NHMRC policies in reshaping research practices among Indigenous populations.

The hypothesis central to this study is that the implementation of a canine breeding and parasite control program in Aboriginal communities results in a reduction in the reservoir of zoonotic parasites within communities. The effect of the parasite and breeding control program on the health status of dogs as well as the population characteristics of dogs in communities was also investigated. The study was conducted in 17 Aboriginal communities of the Kimberley region of Western Australia, divided into three regions according to cultural and geographical attributes. All dogs from each community were permanently identified using a microchip system. Owners of dogs were asked the usual location of their animals, the origins of their dogs and the whereabouts of any missing animals at subsequent visits. Every three months dogs were treated with 200ygikg iverrnectin (a potent endo- and ecto-parasiticide) subcutaneously and adult female dogs were treated with an injectable contraceptive (10-30mgkg proligestone) at the request of their owners. At the time of treatment, dogs were assessed for ecto-parasites and photographs taken for later comparison and diagnosis of alopecic skin conditions. Faecal and blood samples were collected every three to six months and skin scrapings were collected from dogs that were refractory to treatment. The samples were used to determine internal parasite prevalence (using formal ethyl acetate sedimentation), blood parameters (for anaemia status) and evidence of scabies or Demodex infestation. A pilot study at one group of communities, involving weekly assessment of dogs after one iverrnectin treatment, showed that the treatment was effective in reducing the prevalence of scabies (as determined by clinical evaluation), hookworm and ticks. The treatment resulted in improvement in animal health as evidenced by a reduction in the number of dogs with anaemia. The long-term use of the ivermectin treatments at the other communities showed that over a period of three years, the prevalence of scabies and hookworm had reduced at most areas. The initial scabies prevalence varied from 17 to 52% and reduced to below 10% for all communities. The hookworm infection rates were affected by seasonal factors, as was evidenced by a seasonal variance in prevalence. Animals that were treated with ivermectin, though, had lower prevalences of hookworm than those that were not. There was a reasonable compliance rate for contraceptive treatments for female dogs (greater than 60% at each visit) and fewer puppies were born within communities when compared with rates before and after the establishment of the treatment program. High rates of acquisition of puppies from other communities continued to maintain the dog population numbers despite the reduction in breeding within communities. The dog population was young, biased towards male dogs, and very unstable (almost 50% of dogs died or went missing in a one year period). The rate of dog ownership across the Kimberley varied according to the region investigated and always remained higher or equal to ownership rates at the town centres of the Kimberley Region (as determined by a survey conducted during the study). Overall the canine parasite and breeding control program resulted in a reduction in scabies and hookworm prevalence in dogs (and hence a reduction in the potential zoonotic transmission), a reduction in dog breeding within communities, an improvement in dog health, and an understanding in the dynamics and health status of dogs within communities.

Self determination has been recognised as a basic human right both internationally and, to an extent, locally, but it is yet to be fully realised for Aboriginal Peoples in Australia. The assertion of Aboriginal community control in Aboriginal health has been at the forefront of Aboriginal peoples' advocacy for self determination for more than thirty years. Aboriginal Community Controlled Health Services and their representative organisations have been the site of considerable resistance and contestation in the struggles involved in trying to improve Aboriginal health experiences. Drawing on some of these experiences I explore the apparent inability of policy and decision makers to listen to systematic voices calling for change from the Aboriginal Community Controlled Health sector. It is government inability to act more fully on clear and repeated messages that is a source of much disquiet within representative Aboriginal organisations. Such disquiet is grounded in a belief that colonial notions continue to influence decision making at policy, practice and research levels resulting in a significant impediment to the realisation of self determination and associated human rights in Aboriginal health matters and Aboriginal Affairs more broadly.

[Truncated abstract] Indigenous Australians suffer cardiovascular disease (CVD) at a rate six times greater than the general population in Australia and while the incidence of CVD has been reduced dramatically amongst the majority of non-indigenous Australians and amongst Indigenous populations in other countries in the last 30 years, there has been little change in the figures for Aboriginal Australians, showing that heart health campaigns have little impact, for this group of people. Aims : The principal aims of this study were firstly, to determine and record the barriers to the development and delivery of CVD prevention programs amongst Indigenous Australians and secondly, to develop an alternative, effective and culturally sensitive method of delivering heart health messages. Methods and results : The study was qualitative research undertaken in three South-West towns of Western Australia where the incidence of CVD was high amongst the Aboriginal community members. The use of semi-formal interviews, informal individual consultation, observation, and focus groups were methods implemented to obtain information. The first phase of the research was to identify the barriers which affected the Aboriginal Health Workers’ ability to deliver specialist educational programs. Questionnaires and interviews with the Aboriginal Health Workers and other health professionals in the towns, and community focus groups were undertaken in this phase of the study. The second phase of the research was aimed at developing an alternative strategy for delivering heart health messages. The focus changed to adopt more traditional ways of passing on information in Indigenous communities. The idea of small gatherings of friends or family with a trusted community member presenting the health message was developed. The third phase of the research was to implement this new approach. Lay educators who had been identified within focus groups and by Aboriginal Health Workers were trained in each of the towns and a protocol involving discussions of health issues, viewing a video on CVD, produced by the National Heart Foundation, sharing in a ‘heart healthy’ lunch and partaking in a ‘heart health’ knowledge game which was developed specifically for the gatherings. Several of these gatherings were held in each of the towns and they became known as ‘HeartAware parties’.

This thesis concerns the relationship between ideology, values, beliefs, politics, language, discourses, public policy and health outcomes. By examining the origins of federal health policy concerning Aboriginal and Torres Strait Islander Peoples 1972-2001 I have explored the idea that the way a problem is constructed through language determines solutions enacted to solve that problem, and subsequent outcomes. Despite three decades of federal policy activity Aboriginal and Torres Strait Islander children born at the start of the 21st Century could expect to live almost 20 years less than non-Indigenous Australians. Explanations for the gap include that the colonial legacy of dispossession and disease continues to wreak social havoc and that both health policy and structures for health services have been fundamentally flawed. The research described in this thesis focuses on the role of senior Federal politicians in the health policy process. The research is grounded in theory which suggests that the values and beliefs of decision makers are perpetuated through language. Using critical discourse analysis the following hypotheses were tested: 1. That an examination of the language of Federal politicians responsible for the health of Aboriginal and Torres Strait Islander Peoples over three decades would reveal their beliefs, values and discourses concerning Aboriginal and Torres Strait Islander Peoples and their health 2. That the discourses of the Federal politicians contributed to policy discourses and frames in the Aboriginal and Torres Strait Islander health policy environment, and 3. That there is a relationship between the policy discourses of the Aboriginal and Torres Strait Islander health policy environment and health outcomes for Aboriginal and Torres Strait Islander Peoples. The hypotheses were proven. I concluded that there was a relationship between the publicly-expressed values and beliefs of politicians responsible for health, subsequent health policy and resulting health outcomes. However, a model in which theories of discourse, social constructions of people and problems, policy development and organisational decision-making were integrated did not adequately explain the findings. I developed the concept of "policy imagination" to explain the discrete mechanism by which ideology, politics, policy and health were related. My research suggests that the ideology and values which drove decision-making by Federal politicians responsible for the health of all Australians contributed to the lack of population-wide improvement in health outcomes for Aboriginal and Torres Strait Islander Peoples in the late 20th Century.

This study concerned a primary health care approach to trachoma control in two Central Australian Aboriginal communities. The World Health Organization (WHO) has advocated that the best method to control trachoma is the SAFE strategy (Surgery, Antibiotics, Facial hygiene, and Environmental improvements), and this approach was adopted.
The communities, Pipalyatjara and Mimili, with populations slightly less than 300 each, are located in the Anangu Pitjantjatjara (AP) lands of Central Australia, in the northwest corner of the South Australia territory. At Pipalyatjara, a full SAFE-type intervention was undertaken, with the ‘E’ component designed and implemented by the NHC (Nganampa Health Council Inc.). At Mimili, only a SAF-type of intervention was implemented.
Baseline data was gathered for 18 months from March 1999 through September 2000 (five visits to Pipalyatjara and four at Mimili), and included determining trachoma prevalence levels using the WHO system, facial cleanliness, and nasal discharge parameters. A trachoma health program was implemented at the end of this period and a one-time dose of azithromycin was given in September of 2000. The chief focus of the study was children under 15 years of age.
Improvements in road sealing, landscaping, and the creation of mounds were started to improve dust control. Concurrently, efforts were made in the houses of the residents to improve the nine healthy living practices, which were scored in two surveys, in March 1999 and August 2001. Trachoma prevalence, and levels of facial cleanliness and nasal discharge were determined at 3, 6, and 12 months following antibiotic administration.
In children less than 15 years of age, the pre-intervention prevalence level of TF (Trachoma Follicular) was 42% at Pipalyatjara, and 44% at Mimili. For the 1-9 year age group, the TF prevalence was 47% and 54% respectively. For TI (Trachoma Intense), the pre-intervention prevalence was 8% for Pipalyatjara, and 9% for Mimili. The TF prevalence, adjusted for clustering, and using only individuals present at baseline and follow-up (3, 6, and 12 months post-intervention), was 41.5%, 21.2%, 20.0%, and 20.0% at Pipalyatjara respectively. For Mimili, the corresponding prevalence figures were 43.5%, 18.2%, 18.2%, and 30%.
In the 1-9 year age group, a lower TF prevalence existed between the pre-intervention and 12-month post-intervention points at Pipalyatjara compared to Mimili. The TF prevalence after the intervention was also lower for males compared to females, when the cohorts were grouped by gender, rather than community. It is posited that reinfection was much higher at Mimili within this age group, however, in both communities, there appeared to be a core of females whose trachoma status did not change. This is speculated as mainly being caused by prolonged inflammation, though persistent infection C. Trachomatis cannot be ruled out.
Facial cleanliness and nasal discharge continued to improve throughout the intervention at both communities, but at the 3-month post-intervention point no longer became a good predictor of trachoma.
It is not known whether the improvements in the environment at Pipalyatjara were responsible for the reduction in trachoma prevalence 12 months after the intervention, relative to Mimili.

Thesis (Ph.D.)--University of Melbourne, Dept. of Opthalmology, 2007.
Typescript. SAFE Strategy refers to Surgery for trichiasis, Antibiotics for active infection, Facial cleanliness and Environmental improvements. Includes bibliographical references (leaves 233-253). Also available electronically: http://eprints.unimelb.edu.au/archive/00003844.

This study investigated the influence of cultural change and acculturation on health-related help seeking behaviour of Vietnamese-Australians. Using convenience sampling, 94 Vietnamese-Australians, 106 Anglo-Australians, and 49 Vietnamese in Vietnam participated in the study. Beliefs about health and health-related help-seeking behaviours were assessed through measures of common mental health symptoms, illness expression (somatisation, psychologisation), symptom causal attributions (environmental, psychological, biological), and choice of help seeking (self-help, family/friends, spiritual, mental health, Western medicine, Eastern medicine).Vietnamese-Australian data was compared with that of the Anglo-Australian and Vietnamese-in Vietnam. Results revealed that the help seeking behaviours and health related cognitions of Vietnamese-Australians, while significantly different from those of Anglo-Australians, were similar to those of Vietnamese in Vietnam. Specifically, both Vietnamese groups were less likely than Anglo-Australians to somatise and psychologise or attribute the cause of symptoms to environmental, psychological or biological causes. However, the two Vietnamese groups were not different from each other in their style of illness expression or in their symptom causal attributions. The Vietnamese-Australians reported experiencing more mental health symptoms than the Vietnamese in Vietnam but fewer than the Anglo-Australians. In relation to help seeking, the Anglo-Australians chose self-help more than the Vietnamese, but there were few other differences between the cultural groups. To investigate the influence of acculturation on health-related beliefs and help seeking behaviour, Vietnamese-Australians were compared according to their modes of acculturation (integration, assimilation, separation, and marginalisation). Generally, results showed a distinct pattern of response. Those with high levels of acculturation towards the Australian culture (the integration and the assimilation) were found to be most similar (in that they scored the highest in most areas measured) to the Anglo-Australians, while few differences were found between the separated and the marginalised groups. Further, cultural orientation was a powerful predictor of help seeking. In that, original cultural orientation predicted selection of help seeking from Western and Eastern medicine, whereas, the host cultural orientation was a more robust predictor of the other variables. However, neither cultural orientation predicted preference for mental health help. Finally, the study found that, although the combination of symptom score, modes of illness expression, and symptom causal attribution were strong predictors of choice of help seeking of Vietnamese-Australians, acculturation scores further improved predictive power. The results were discussed in terms of the various limitations and constraints on interpretation of this complex data set.

Thesis (M.D.)--University of Adelaide, Dept. of General Practice, 2005.
Includes publications published as a result of ideas developed in this thesis, inserted at end. "April 2005" Includes bibliographical references (leaves 210-242).

Diabetes in Indigenous Australians occurs at a younger age and at almost four times the rate of non-Indigenous Australians. While the cause for this health disparity is multi-factorial, recent studies suggest that nutrition, and particularly magnesium intake, may play a role in onset of diabetes and related pathologies. No study has ever examined whether there is any relationship between diabetes and magnesium intake in Indigenous Australians, and the present study therefore sought to establish whether any such interrelationship existed. As part of this study, dietary magnesium intake was estimated in an urban cohort of Aboriginal and Torres Strait Islander subjects and compared to the average Australian dietary intake. An ecological study then explored environmental correlates, and specifically the magnesium level in drinking water, to diabetes mortality. Finally, total and free serum magnesium concentrations were determined to identify any differences in magnesium status between diabetic and non-diabetic Indigenous and non-Indigenous Australians, and also to compare which of the two parameters was a more sensitive measure of magnesium status and diabetic risk. All Aboriginal and Torres Strait Islander people that were recruited for this study were patients of the Townsville Aboriginal and Islander Health Services, Townsville, North Queensland, who presented for health monitoring and subsequently required fasting blood tests as part of that routine care. Additional non-Indigenous people were recruited from five GP practices in the Townsville area. Inclusion criteria included persons over the age of 15 (Tanner Stage 5) who had lived in the Townsville area for at least ten days. Exclusion criteria included chronic diarrhoea, alcoholism or binge drinking in the past two weeks, use of diuretics, consumption of magnesium supplements, reduced renal function (urinary albumin to creatinine ratio exceeding > 2.5 mg/mmol in men and > 3.5 mg/mmol in women), severe mental illness, pregnancy, or breastfeeding. Our results indicated that 60% of the Indigenous people assessed in this study had a dietary intake of magnesium that was below the estimated average magnesium requirement for half the national population. Additionally, the average magnesium intake in Indigenous Australians was significantly less than the intake of non-Indigenous Australians (p<0 .001). A significant negative correlation was found between the incidence of diabetes related mortality and the concentration of magnesium in drinking water in Queensland, confirming previous reports from the USA that drinking water magnesium may be an important factor in development of diabetes. The needs assessment study confirmed that diabetes in both Indigenous and non-Indigenous Australians was associated with reduced levels of total serum magnesium, and more importantly, that total serum magnesium was lower in Indigenous Australians who did not have diabetes compared with their non-Indigenous counterparts (p=<0.001). In the absence of diabetes, the prevalence of hypomagnesaemia was 17.2% for the non-Indigenous but 36.9% for the Indigenous subjects. Finally, the ionic serum magnesium analysis confirmed the results of the total serum magnesium study, and demonstrated that ionic magnesium was strongly correlated to the total magnesium concentration (r: 0.75. p < 0.001), with the relationship being apparent irrespective of either diabetic (r: 0.66 to 0.81. p<0.001) or ethnicity (r = 0.71 to 0.81. p<0.001)." We conclude that although not causal, the evidence suggests that magnesium may be a significant contributing factor to diabetes in Australia, especially for Aboriginal and Torres Strait Islander peoples, and that further investigation of the potential relationship between magnesium and diabetes in the Australian Indigenous populations, and possible corrective interventions, is highly warranted.
http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1348469
Thesis (Ph.D.) - University of Adelaide, School of Medical Sciences, 2008

Includes publications published as a result of ideas developed in this thesis, inserted at end.
"April 2005"
Includes bibliographical references (leaves 210-242)
242 leaves :
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Examines goal setting in people with diabetes as part of chronic disease management in a rural setting. The studies were performed in Eyre Peninsula with a significant (10-20%) Aboriginal population.
Thesis (M.D.)--University of Adelaide, Dept. of General Practice, 2005

Otitis media and consequent hearing loss are known to be high in Koori communities. Previous research on otitis media in Koori communities has focused on its identification, treatment and management. Little research has focused on the prevention of otitis media. Victorian Aboriginal communities often have small populations which result in small sample sizes for research projects. Consequently use of traditional quantitative methods to measure of change arising from health interventions can be problematic. The aim of the research was to describe Koori children’s otitis media risk factors using a Koori research method in order to develop, implement and evaluate preventative interventions.