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Bromley J, Sherrard S, Atkinson D, Marley JV, Henderson‐Yates L, Griffiths E. Early childhood development practices in a remote Aboriginal Community Controlled Health Services setting. Aust J Rural Health 2022; 30:860-869. [PMID: 35802805 PMCID: PMC10083997 DOI: 10.1111/ajr.12900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 05/15/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Supporting Early Childhood Development (ECD) is an Australian national priority. Aboriginal children in Western Australia's Kimberley region have much higher rates of developmental concerns at school entry than non-Aboriginal children. We aimed to describe ECD practices in the participating service; document follow-up of identified developmental concerns; and identify barriers and enablers to incorporating ECD practices into clinic activity. DESIGN Mixed-method design incorporating clinical audit and staff interviews. SETTING An Aboriginal Community Controlled Health Service (ACCHS) in the Kimberley region. PARTICIPANTS A total of 176 children receiving primary health care through the participating ACCHS; interviews with five ACCHS staff members. MAIN OUTCOME MEASURES Frequency of developmental enquiry by age and domain; follow-up of identified developmental concerns; and barriers and enablers to ECD practices. RESULTS Developmental enquiry was documented for 114 of 176 eligible children (65%), including in 80% of ACCHS child health assessments. Standardised ECD assessments were less common. Staff were aware of the importance of developmental enquiry, however, barriers to increasing ECD practices included a lack of resources and structured staff education, time pressures and a lack of role clarity between the ACCHS and government community health clinic. CONCLUSIONS This study provides insight into ECD practices in an ACCHS setting, highlighting the potential of primary health care to have an enhanced role in ECD if appropriate systems, training and tools are provided. A lack of role clarity across services, combined with poor communication between services, creates a potential risk for missed opportunities to support ECD.
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Affiliation(s)
- Jane Bromley
- Rural Clinical School of Western AustraliaThe University of Western AustraliaBroomeWAAustralia
| | - Stephanie Sherrard
- Rural Clinical School of Western AustraliaThe University of Western AustraliaBroomeWAAustralia
| | - David Atkinson
- Rural Clinical School of Western AustraliaThe University of Western AustraliaBroomeWAAustralia
| | - Julia V. Marley
- Rural Clinical School of Western AustraliaThe University of Western AustraliaBroomeWAAustralia
- Kimberley Aboriginal Medical ServicesBroomeWAAustralia
| | | | - Emma Griffiths
- Rural Clinical School of Western AustraliaThe University of Western AustraliaBroomeWAAustralia
- Kimberley Aboriginal Medical ServicesBroomeWAAustralia
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Jamieson EL, Dimeski G, Flatman R, Hickman PE, Ross Dallas Jones G, V Marley J, David McIntyre H, McNeil AR, Nolan CJ, Potter JM, Sweeting A, Ward P, Williams P, Rita Horvath A. Oral glucose tolerance test to diagnose gestational diabetes mellitus: Impact of variations in specimen handling. Clin Biochem 2022; 115:33-48. [PMID: 36244469 DOI: 10.1016/j.clinbiochem.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/10/2022] [Accepted: 10/04/2022] [Indexed: 11/03/2022]
Abstract
To improve birth outcomes, all pregnant women without known diabetes are recommended for an oral glucose tolerance test (OGTT) to screen for hyperglycaemia in pregnancy (diabetes in pregnancy or gestational diabetes mellitus (GDM)). This narrative review presents contemporary approaches to minimise preanalytical glycolysis in OGTT samples with a focus on GDM diagnosis using criteria derived from the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study. The challenges of implementing each approach across a diverse Australian healthcare setting were explored. Many Australian sites currently collect and transport OGTT samples at ambient temperature in sodium fluoride (NaF) tubes which is likely to lead to missed diagnosis of GDM in a significant proportion of cases. Alternative preanalytical solutions should be pragmatic and tailored to individual settings and as close as possible to the preanalytical conditions of the HAPO study for correct interpretation of OGTT results. Rapid centrifugation of barrier tubes to separate plasma could be suitable in urban settings provided time to centrifugation is strictly controlled. Tubes containing NaF and citrate could be useful for remote or resource poor settings with long delays to analysis but the impact on the interpretation of OGTT results should be carefully considered. Testing venous blood glucose at the point-of-care bypasses the need for glycolytic inhibition but requires careful selection of devices with robust analytical performance. Studies to evaluate the potential error of each solution compared to the HAPO protocol are required to assess the magnitude of misdiagnosis and inform clinicians regarding the potential impact on patient safety and healthcare costs.
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Carlin E, Ferrari K, Spry EP, Williams M, Atkinson D, Marley JV. Implementation of the ‘Kimberley Mum’s Mood Scale’ across primary health care services in the Kimberley region of Western Australia: A mixed methods assessment. PLoS One 2022; 17:e0273689. [PMID: 36054104 PMCID: PMC9439224 DOI: 10.1371/journal.pone.0273689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/13/2022] [Indexed: 11/19/2022] Open
Abstract
The Kimberley Mum’s Mood Scale (KMMS) was co-designed with Aboriginal women and healthcare professionals to improve culturally appropriate screening practices for perinatal depression and anxiety. This paper describes the implementation of the KMMS across the remote Kimberley region of Western Australia from January 2018 to December 2021. We used the Dynamic Sustainability Framework to progress the implementation and assess at the intervention, practice setting and ecological system level using a mixed methods approach to analyse implementation. Rates of administration and results of screening were described using a retrospective audit of electronic medical records. Analyses of KMMS training registry, stakeholder engagement and sustainability initiatives were descriptive. KMMS acceptability was assessed using qualitative descriptive approaches to analyse patient feedback forms (n = 39), healthcare professional surveys (n = 15) and qualitative interviews with healthcare professionals (n = 6). We found a significant increase in overall recorded perinatal screening (pre-implementation: 30.4% v Year 3: 46.5%, P < 0.001) and use of the KMMS (pre-implementation: 16.4% v Year 3: 46.4%, P < 0.001). There was improved fidelity in completing the KMMS (from 2.3% to 61.8%, P < 0.001), with 23.6% of women screened recorded as being at increased risk of depression and anxiety. Most healthcare professionals noted the high levels of perinatal mental health concerns, stress, and trauma that their patients experienced, and identified the KMMS as the most appropriate perinatal screening tool. Aboriginal women reported that it was important for clinics to ask about mood and feelings during the perinatal period, and that the KMMS was appropriate. Aboriginal women consistently reported that it was good to have someone to talk to. This study demonstrates that innovation in perinatal depression and anxiety screening for Aboriginal women is possible and can be implemented into routine clinical care with the support of a sustained multi-year investment and strong partnerships.
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Affiliation(s)
- Emma Carlin
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
- Kimberley Aboriginal Medical Services, Broome, Western Australia, Australia
- * E-mail:
| | - Katherine Ferrari
- Kimberley Aboriginal Medical Services, Broome, Western Australia, Australia
| | - Erica P. Spry
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
- Kimberley Aboriginal Medical Services, Broome, Western Australia, Australia
| | - Melissa Williams
- Kimberley Population Health Unit, Western Australian Country Health Service, Broome, Western Australia, Australia
| | - David Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
| | - Julia V. Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
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Jamieson EL, Spry EP, Kirke AB, Griffiths E, Porter C, Roxburgh C, Singleton S, Sterry K, Atkinson DN, Marley JV. Real-world screening for diabetes in early pregnancy: Improved screening uptake using universal glycated haemoglobin. Prim Care Diabetes 2021; 15:995-1001. [PMID: 34696991 DOI: 10.1016/j.pcd.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/10/2021] [Accepted: 09/30/2021] [Indexed: 11/19/2022]
Abstract
AIMS To improve perinatal outcomes, screening for hyperglycaemia using 75 g oral glucose tolerance test (OGTT) is recommended for all pregnant women at 24-28 weeks gestation (routine), and earlier if high-risk. Screening coverage for remote and Aboriginal Australian women is less than ideal. This study examined OGTT completion (early and routine) by women from rural and remote Western Australia compared with early glycated haemoglobin (HbA1c). METHODS In 2015-2018, 27 primary health care sites recruited 600 (233 Aboriginal) women aged ≥16-years, without pre-existing diabetes, who delivered >30-weeks gestation. All women presenting <20-weeks gestation (541) were offered an early study HbA1c. Early OGTTs were requested at the discretion of the local clinician, with routine OGTT offered at 24-28 weeks. RESULTS HbA1c uptake was high (85.7% Aboriginal, 86.4% non-Aboriginal); OGTT completion in Aboriginal women was low (early OGTT: 38.6% v 69.6% non-Aboriginal, P < 0.001; routine OGTT: 44.5% v 84.7% non-Aboriginal, P < 0.001). Aboriginal women with both early tests had HbA1c completed 3-weeks prior to OGTT (9.6 ± 3.5 v 12.5 ± 3.5 weeks gestation, P < 0.001). CONCLUSIONS Universal early pregnancy HbA1c appears feasible as an early screening test for women at risk of hyperglycaemia in pregnancy and would expedite and increase screening in Aboriginal women compared to an early OGTT.
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Affiliation(s)
- Emma L Jamieson
- The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 412, Bunbury, Western Australia 6230, Australia.
| | - Erica P Spry
- Kimberley Aboriginal Medical Services, 12 Napier Terrace, Broome, Western Australia 6725, Australia; The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, Western Australia 6725, Australia.
| | - Andrew B Kirke
- The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 412, Bunbury, Western Australia 6230, Australia.
| | - Emma Griffiths
- The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, Western Australia 6725, Australia.
| | - Cynthia Porter
- Geraldton Regional Aboriginal Medical Service, PO Box 5276, Geraldton, Western Australia 6531, Australia.
| | - Carly Roxburgh
- The Rural Clinical School of Western Australia, The University of Western Australia, 35 Stirling Terrace, Albany, Western Australia 6330, Australia.
| | - Sally Singleton
- The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, Western Australia 6725, Australia.
| | - Kylie Sterry
- The Rural Clinical School of Western Australia, The University of Western Australia, St Alban's Road (rear Kalgoorlie Hospital), Kalgoorlie, Western Australia 6433, Australia.
| | - David N Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, Western Australia 6725, Australia.
| | - Julia V Marley
- Kimberley Aboriginal Medical Services, 12 Napier Terrace, Broome, Western Australia 6725, Australia; The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, Western Australia 6725, Australia.
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Seear KH, Spry EP, Carlin E, Atkinson DN, Marley JV. Aboriginal women's experiences of strengths and challenges of antenatal care in the Kimberley: A qualitative study. Women Birth 2021; 34:570-577. [PMID: 33358130 DOI: 10.1016/j.wombi.2020.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/21/2020] [Accepted: 12/14/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND High-quality, culturally safe antenatal care has an important role in improving health outcomes of Aboriginal and Torres Strait Islander people. We sought to describe Aboriginal women's experiences of antenatal care in the Kimberley region of Western Australia, to better understand current systems and opportunities for enhancing antenatal care. METHODS Throughout the Kimberley, 124 Aboriginal women who had accessed antenatal care in 2015-2018 were recruited. They provided qualitative data during a health assessment or standalone interview. Transcripts were descriptively coded and thematically analysed. FINDINGS Most women expressed that overall they had a positive antenatal care experience. Key themes were the importance of positive relationships with antenatal care providers, the valuable role of family support during the antenatal period, challenges travelling for care and limitations of the Patient Assisted Travel Scheme, communication of pregnancy related information, and the provision of services. Almost all antenatal care providers described were non-Aboriginal. A few women spoke about involvement of Aboriginal Health Workers in their antenatal care, including recommending expansion of these roles. CONCLUSIONS The experiences shared by these Aboriginal women in the Kimberley contribute to broader evidence of a need to improve culturally safe antenatal care delivery for Aboriginal Australian women. Although excellent care was provided by a number of dedicated midwives, there were few Aboriginal antenatal staff and significant staff turnover. To improve the quality of care more local Aboriginal antenatal care providers, and additional support for the large number of women and their families required to travel, are required.
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Affiliation(s)
- Kimberley H Seear
- The Rural Clinical School of Western Australia, University of Western Australia, 12 Napier Terrace (PO Box 1377), Broome, WA 6725, Australia.
| | - Erica P Spry
- The Rural Clinical School of Western Australia, University of Western Australia, 12 Napier Terrace (PO Box 1377), Broome, WA 6725, Australia; Kimberley Aboriginal Medical Services, 12 Napier Terrace (PO Box 1377), Broome, WA 6725, Australia
| | - Emma Carlin
- The Rural Clinical School of Western Australia, University of Western Australia, 12 Napier Terrace (PO Box 1377), Broome, WA 6725, Australia; Kimberley Aboriginal Medical Services, 12 Napier Terrace (PO Box 1377), Broome, WA 6725, Australia
| | - David N Atkinson
- The Rural Clinical School of Western Australia, University of Western Australia, 12 Napier Terrace (PO Box 1377), Broome, WA 6725, Australia
| | - Julia V Marley
- The Rural Clinical School of Western Australia, University of Western Australia, 12 Napier Terrace (PO Box 1377), Broome, WA 6725, Australia; Kimberley Aboriginal Medical Services, 12 Napier Terrace (PO Box 1377), Broome, WA 6725, Australia
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Jamieson EL, Spry EP, Kirke AB, Griffiths E, Porter C, Roxburgh C, Singleton S, Sterry K, Atkinson DN, Marley JV. Prediabetes and pregnancy: Early pregnancy HbA 1c identifies Australian Aboriginal women with high-risk of gestational diabetes mellitus and adverse perinatal outcomes. Diabetes Res Clin Pract 2021; 176:108868. [PMID: 34023341 DOI: 10.1016/j.diabres.2021.108868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/06/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
AIMS To assess whether early pregnancy HbA1c can predict gestational diabetes mellitus (GDM) and adverse birth outcomes in Australian women. METHODS Prospective study of 466 women without diabetes, aged ≥16-years at first antenatal presentation. Recruitment was from 27 primary healthcare sites in rural and remote Australia from 9-January 2015 to 31-May 2018. HbA1c was measured with first antenatal investigations (<20-weeks gestation). Primary outcome measure was predictive value of HbA1c for GDM, by routine 75 g oral glucose tolerance test (OGTT; ≥24-weeks gestation), and for large-for-gestational-age (LGA) newborn. RESULTS Of 396 (129 Aboriginal) women with routine OGTT, 28.8% had GDM (24.0% Aboriginal). HbA1c ≥5.6% (≥38 mmol/mol) was highly predictive (71.4%, 95% CI; 47.8-88.7%) for GDM in Aboriginal women, and in the total cohort increased risk for LGA newborn (RR 2.04, 95% CI; 1.03-4.01, P = 0.040). There were clear differences between Aboriginal and non-Aboriginal women: 16.3% v 5.2% (P < 0.001) had elevated HbA1c whereas 12.4% v 29.6% (P < 0.001) developed hyperglycemia during pregnancy. CONCLUSIONS Early pregnancy HbA1c ≥5.6% (≥38 mmol/mol) identifies Aboriginal women with apparent prediabetes and elevated risk of having an LGA newborn. Universal HbA1c at first antenatal presentation could facilitate earlier management of hyperglycemia and improved perinatal outcome in this high-risk population.
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Affiliation(s)
- Emma L Jamieson
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, Building 3 Edith Cowan University, Robertson Drive, PO Box 412, Bunbury, WA 6230, Australia
| | - Erica P Spry
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia; Kimberley Aboriginal Medical Services, 12 Napier Terrace, Broome, WA 6725, Australia
| | - Andrew B Kirke
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, Building 3 Edith Cowan University, Robertson Drive, PO Box 412, Bunbury, WA 6230, Australia
| | - Emma Griffiths
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia
| | - Cynthia Porter
- Geraldton Regional Aboriginal Medical Service, Rifle Range Road, Rangeway, WA 6530, Australia
| | - Carly Roxburgh
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, 31 Stirling Terrace, Albany, WA 6330, Australia
| | - Sally Singleton
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia
| | - Kylie Sterry
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, St Alban's Road (rear Kalgoorlie Hospital), Kalgoorlie, WA 6433, Australia
| | - David N Atkinson
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia
| | - Julia V Marley
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia; Kimberley Aboriginal Medical Services, 12 Napier Terrace, Broome, WA 6725, Australia.
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Jamieson EL, Spry EP, Kirke AB, Roxburgh C, Atkinson DN, Marley JV. Underestimation of risk for large babies in rural and remote Australia: Time to change plasma glucose collection protocols. J Clin Transl Endocrinol 2021; 23:100247. [PMID: 33520662 PMCID: PMC7820914 DOI: 10.1016/j.jcte.2020.100247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 11/29/2022]
Abstract
In remote Australia, many women with GDM are missed due to test sample instability. FC tubes stabilise glucose but markedly increase GDM diagnosis in lower-risk women. Adjustment of FC results lowered GDM and improved risk-assessment for a large baby.
Aims Preanalytical glycolysis in oral glucose tolerance tests (OGTT) leads to substantial underestimation of gestational diabetes mellitus (GDM) and hence risk for large-for-gestational-age (LGA) babies. This paper quantified the impact of glycolysis on identification of LGA risk in a prospective rural and remote Australian cohort. Methods For 495 women, OGTT results from room temperature fluoride-oxalate (FLOX) tubes were algorithmically corrected for estimated glycolysis compared to 1) the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study protocol (FLOX tubes in ice-slurry); and 2) room temperature fluoride-citrate (FC) tubes. GDM was defined by International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. Unadjusted and corrected OGTT were related to LGA outcome. Results Correction for FC tubes increased GDM incidence from 9.7% to 44.6%. After correction for HAPO protocol, GDM incidence was 27.7% and prediction of LGA risk (RR 1.82, [1.11–2.99]) improved compared to unadjusted rates (RR 1.12, [0.51–2.47]). To provide similar results for FC tube correction (29.3% GDM; RR 1.81, [1.11–2.96]) required + 0.2 mmol/L adjustment of IADPSG criteria. Conclusions FC tubes present a practical alternative to the HAPO protocol in remote settings but give + 0.2 mmol/L higher glucose readings. Modification of IADPSG criteria would reduce perceived ‘overdiagnosis’ and improve LGA risk-assessment.
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Affiliation(s)
- Emma L Jamieson
- The University of Western Australia, The Rural Clinical School of Western Australia, Building 3 Edith Cowan University Campus, Robertson Drive, PO Box 412, Bunbury 6230, Australia
| | - Erica P Spry
- Kimberley Aboriginal Medical Services, 12 Napier Terrace, Broome 6725, Australia.,The University of Western Australia, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome 6725, Australia
| | - Andrew B Kirke
- The University of Western Australia, The Rural Clinical School of Western Australia, Building 3 Edith Cowan University Campus, Robertson Drive, PO Box 412, Bunbury 6230, Australia
| | - Carly Roxburgh
- The University of Western Australia, The Rural Clinical School of Western Australia, 35 Stirling Terrace, Albany 6330, Australia
| | - David N Atkinson
- The University of Western Australia, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome 6725, Australia
| | - Julia V Marley
- Kimberley Aboriginal Medical Services, 12 Napier Terrace, Broome 6725, Australia.,The University of Western Australia, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome 6725, Australia
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Jamieson EL, Spry EP, Kirke AB, Roxburgh C, Atkinson DN, Marley JV. Variations in the Prevalence of Gestational Diabetes Mellitus With Remote Testing and a Pragmatic Solution to Improve Accuracy. Diabetes Care 2021; 44:e4-e5. [PMID: 33168653 PMCID: PMC7783941 DOI: 10.2337/dc20-2211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/24/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Emma L Jamieson
- The Rural Clinical School of Western Australia, The University of Western Australia, Bunbury, Australia
| | - Erica P Spry
- Kimberley Aboriginal Medical Services, Broome, Australia.,The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Australia
| | - Andrew B Kirke
- The Rural Clinical School of Western Australia, The University of Western Australia, Bunbury, Australia
| | - Carly Roxburgh
- The Rural Clinical School of Western Australia, The University of Western Australia, Albany, Australia
| | - David N Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Australia
| | - Julia V Marley
- Kimberley Aboriginal Medical Services, Broome, Australia.,The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Australia
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Warwick S, LeLievre M, Seear K, Atkinson D, Marley JV. Above and Beyond: Fashioning an Accessible Health Service for Aboriginal Youth in Remote Western Australia. Prog Community Health Partnersh 2021; 15:e7. [DOI: 10.1353/cpr.2021.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Warwick S, LeLievre M, Seear K, Atkinson D, Marley JV. Above and Beyond: Fashioning an Accessible Health Service for Aboriginal Youth in Remote Western Australia. Prog Community Health Partnersh 2021; 15:463-473. [DOI: 10.1353/cpr.2021.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Seear KH, Atkinson DN, Lelievre MP, Henderson-Yates LM, Marley JV. Piloting a culturally appropriate, localised diabetes prevention program for young Aboriginal people in a remote town. Aust J Prim Health 2020; 25:495-500. [PMID: 31581978 DOI: 10.1071/py19024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 08/26/2019] [Indexed: 11/23/2022]
Abstract
Lifestyle changes are central to preventing type 2 diabetes. Embarking upon and sustaining change is challenging, and translation of prevention approaches into a wider range of real-world settings is needed. In this study, a locally adapted community-led diabetes prevention program with local young Aboriginal facilitators was created and trialled through the Derby Aboriginal Health Service (DAHS). The 8-week program highlighted causes and consequences of diabetes, incorporated physical activity and healthy eating topics with a focus on practical activities, and included stress management to support healthy lifestyles. Ten Aboriginal women and men aged 18-38 years participated in the pilot program. The program was found to be acceptable and appropriate, and other community members and organisations expressed interest in future participation. Participants reported that they gained important new knowledge and made changes in behaviours including shopping choices, portioning and soft drink consumption. Limitations included participant recruitment and attendance difficulties, which were attributed to program timing and competing demands. While this program was designed to be sustainable, and there were indications of feasibility, resource constraints impeded its integration into routine primary health care. Prevention of diabetes is a high priority for DAHS, and this program, with appropriate resources, provides a basis for ongoing practical prevention strategies.
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Affiliation(s)
- Kimberley H Seear
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace (PO Box 1377), Broome, WA 6725, Australia; and Corresponding author.
| | - David N Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace (PO Box 1377), Broome, WA 6725, Australia
| | - Matthew P Lelievre
- Derby Aboriginal Health Service, 1 Stanley Street (PO Box 1155), Derby, WA 6728, Australia; and Present address: North and West Remote Health, 53 Enid Street (PO Box 1127), Mount Isa, Qld 4825, Australia
| | | | - Julia V Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace (PO Box 1377), Broome, WA 6725, Australia; and Kimberley Aboriginal Medical Services, 12 Napier Terrace (PO Box 1377), Broome, WA 6725, Australia
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Manifold A, Atkinson D, Marley JV, Scott L, Cleland G, Edgill P, Singleton S. Complex diabetes screening guidelines for high-risk adolescent Aboriginal Australians: a barrier to implementation in primary health care. Aust J Prim Health 2020; 25:501-508. [PMID: 31634436 DOI: 10.1071/py19030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 09/16/2019] [Indexed: 11/23/2022]
Abstract
The aim of this study is to ascertain whether a simplified screening algorithm incorporating glycated haemoglobin (HbA1c) tests increases type 2 diabetes (T2D) screening in 10- to 14-year-old Aboriginal Australians presenting to primary healthcare (PHC) services. The study involved a 6-month pilot of a locally developed evidence-based screening algorithm in a remote Western Australian Kimberley town. A retrospective audit of electronic health records for the pilot period (27 June-26 December 2016) and a 6-month period before the screening algorithm was introduced (1 October 2015-31 March 2016) was conducted. Interviews were held with 30 PHC staff at participating PHC services, an Aboriginal Community Controlled Health Service (ACCHS) and a hospital-based general practice service. During the pilot, significantly more patients received an initial T2D screening test at the ACCHS (28/130 (22%) v. 50/139 (36%), P = 0.011), but there was no change at the hospital (0.02% v. 0.02%, P = 0.615). Staff feedback suggested measures to improve screening; these include simple guidelines, targeted screening, patient and staff education, point-of-care HbA1c tests and a whole-of-clinic approach to implementation. Implementing a screening algorithm for young-onset diabetes in Aboriginal Australians is challenging, but practical measures can be taken to improve screening.
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Affiliation(s)
- Andreana Manifold
- The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, WA 6725, Australia; and Corresponding author.
| | - David Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, WA 6725, Australia
| | - Julia V Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, WA 6725, Australia; and Kimberley Aboriginal Medical Services Ltd, PO Box 1377, Broome, WA 6725, Australia
| | - Lydia Scott
- Western Australia Country Health Service Kimberley, PO Box 62, Broome, WA 6725, Australia
| | - Gavin Cleland
- Western Australia Country Health Service Kimberley, PO Box 62, Broome, WA 6725, Australia
| | - Paula Edgill
- Derbarl Yerrigan Health Service, 156-172 Wittenoom Street, East Perth, WA 6004, Australia; and Centre for Aboriginal Medical and Dental Health, The University of Western Australia (M303), 35 Stirling Highway, Perth, WA 6009, Australia
| | - Sally Singleton
- The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, WA 6725, Australia
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13
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Straw S, Spry E, Yanawana L, Matsumoto V, Cox D, Cox E, Singleton S, Houston N, Scott L, Marley JV. Understanding lived experiences of Aboriginal people with type 2 diabetes living in remote Kimberley communities: diabetes, it don't come and go, it stays! Aust J Prim Health 2020; 25:486-494. [PMID: 31586501 DOI: 10.1071/py19021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 08/26/2019] [Indexed: 11/23/2022]
Abstract
This study aimed to explore the lived experiences of Kimberley Aboriginal people with type 2 diabetes managed by remote Aboriginal Community Controlled Health Services using phenomenological analysis. Semi-structured interviews formulated by Aboriginal Health Workers, researchers and other clinicians were used to obtain qualitative data from 13 adult Aboriginal patients with type 2 diabetes managed in two remote communities in the Kimberley. Together with expert opinion from local Aboriginal Health Workers and clinicians, the information was used to develop strategies to improve diabetes management. Of 915 regular adult patients in the two communities, 27% had type 2 diabetes; 83% with glycated haemoglobin A >10%. Key qualitative themes included: the need for culturally relevant education and pictorial resources; importance of continuous therapeutic relationships with healthcare staff; lifestyle management advice that takes into account local and cultural factors; and the involvement of Aboriginal community members and families in support roles. Recommendations to improve diabetes management in the remote communities have been made collaboratively with community input. This study provides a framework for culturally relevant recommendations to assist patients with diabetes, for collaborative research, and for communication among patients, Aboriginal Health Workers, community members, researchers and other clinicians. Interventions based on recommendations from this study will be the focus of further collaborative research.
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Affiliation(s)
- Sarah Straw
- Kimberley Regional Physician Team, Western Australia Country Health Service, PO Box 62, Broome, WA 6725, Australia; and Corresponding author.
| | - Erica Spry
- Kimberley Aboriginal Medical Services Ltd, PO Box 1377, Broome, WA 6725, Australia; and The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, WA 6725, Australia
| | - Louie Yanawana
- Kimberley Aboriginal Medical Services Ltd, PO Box 1377, Broome, WA 6725, Australia
| | - Vaughan Matsumoto
- Kimberley Aboriginal Medical Services Ltd, PO Box 1377, Broome, WA 6725, Australia
| | - Denetta Cox
- Kimberley Aboriginal Medical Services Ltd, PO Box 1377, Broome, WA 6725, Australia
| | - Erica Cox
- Kimberley Aboriginal Medical Services Ltd, PO Box 1377, Broome, WA 6725, Australia
| | - Sally Singleton
- Kimberley Aboriginal Medical Services Ltd, PO Box 1377, Broome, WA 6725, Australia; and The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, WA 6725, Australia
| | - Naomi Houston
- Kimberley Aboriginal Medical Services Ltd, PO Box 1377, Broome, WA 6725, Australia
| | - Lydia Scott
- Kimberley Regional Physician Team, Western Australia Country Health Service, PO Box 62, Broome, WA 6725, Australia
| | - Julia V Marley
- Kimberley Aboriginal Medical Services Ltd, PO Box 1377, Broome, WA 6725, Australia; and The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, WA 6725, Australia
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14
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Seear KH, Atkinson DN, Henderson-Yates LM, Lelievre MP, Marley JV. Maboo wirriya, be healthy: Community-directed development of an evidence-based diabetes prevention program for young Aboriginal people in a remote Australian town. Eval Program Plann 2020; 81:101818. [PMID: 32512400 DOI: 10.1016/j.evalprogplan.2020.101818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/17/2019] [Accepted: 04/18/2020] [Indexed: 06/11/2023]
Abstract
Supporting healthy lifestyle behaviours is a key aspect of preventing type 2 diabetes which disproportionately affects disadvantaged groups from a younger age. Formative participatory research was undertaken to design a program for young Aboriginal people in a remote town in North West Australia with a high level of health needs and relatively few prevention initiatives. Focus groups and advisory discussions with Aboriginal community members were used to determine the nature of the program. The need for a comprehensive program was consistently expressed and limited healthy lifestyle knowledge and difficulties with healthy eating influenced by food environments were noted to be important. With guidance from the Derby Aboriginal Health Service, findings were integrated with previous international research evidence to develop a program tailored to local Aboriginal people aged 15-25 years and refine it after piloting. This 8-session program, 'Maboo wirriya, be healthy' involved an education component consistent with the US Diabetes Prevention Program and practical activities including group exercise. Changes to program structure and documentation were made after piloting for future use. The community-directed approach used in this study is vital to ensure relevance of localised chronic disease prevention programs in a range of settings.
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Affiliation(s)
- Kimberley H Seear
- The Rural Clinical School of Western Australia, University of Western Australia, 12 Napier Terrace (PO Box 1377), Broome WA 6725, Australia.
| | - David N Atkinson
- The Rural Clinical School of Western Australia, University of Western Australia, 12 Napier Terrace (PO Box 1377), Broome WA 6725, Australia.
| | | | - Matthew P Lelievre
- Derby Aboriginal Health Service, 1 Stanley Street (PO Box 1155) Derby WA 6728, Australia.
| | - Julia V Marley
- The Rural Clinical School of Western Australia, University of Western Australia, 12 Napier Terrace (PO Box 1377), Broome WA 6725, Australia; Kimberley Aboriginal Medical Services, 12 Napier Terrace (PO Box 1377), Broome WA 6725, Australia.
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15
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Carlin E, Cox Z, Spry E, Monahan C, Marley JV, Atkinson D. "When I got the news": Aboriginal fathers in the Kimberley region yarning about their experience of the antenatal period. Health Promot J Austr 2020; 32:513-522. [PMID: 32589308 PMCID: PMC8359486 DOI: 10.1002/hpja.375] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/22/2020] [Indexed: 01/29/2023] Open
Abstract
Issue addressed Paternal involvement during the antenatal period is recognised as a positive contributor to a child's health and developmental outcomes. Little is known about Aboriginal Australian men's experiences and perceptions during their partner's antenatal period. Methods A qualitative yarning methodology was used to explore the experiences of ten Aboriginal Australian fathers during their partner's antenatal period, in a remote Northern Australian town. Results The study found the participants valued supporting their partners through pregnancy, making positive changes to their lifestyles, and having access to information on pregnancy. Participants described experiencing multiple stressors during the antenatal period that impacted on their social and emotional wellbeing. This is despite the range of protective factors identified by them. Participants had diverse experiences with health care providers during the antenatal period. Conclusions This study demonstrated that these Aboriginal men valued engagement with antenatal care (ANC) services and highlighted strategies to improve Aboriginal paternal involvement with ANC services. So what? Enhancing ANC to be inclusive of fathers, through a local co‐design process, could strengthen and support Aboriginal families to achieve improved health and wellbeing outcomes across the family system.
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Affiliation(s)
- Emma Carlin
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, WA, Australia.,Kimberley Aboriginal Medical Services, Broome, WA, Australia
| | - Zaccariah Cox
- Kimberley Aboriginal Medical Services, Broome, WA, Australia
| | - Erica Spry
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, WA, Australia.,Kimberley Aboriginal Medical Services, Broome, WA, Australia
| | - Conor Monahan
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, WA, Australia
| | - Julia V Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, WA, Australia.,Kimberley Aboriginal Medical Services, Broome, WA, Australia
| | - David Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, WA, Australia
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Carlin E, Spry E, Atkinson D, Marley JV. Why validation is not enough: Setting the scene for the implementation of the Kimberley Mum's Mood Scale. PLoS One 2020; 15:e0234346. [PMID: 32530934 PMCID: PMC7292413 DOI: 10.1371/journal.pone.0234346] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/22/2020] [Indexed: 01/15/2023] Open
Abstract
Background The two part Kimberley Mum’s Mood Scale (KMMS) has been developed and validated as a culturally appropriate perinatal depression and anxiety screening tool for Aboriginal women living in the sparsely populated Kimberley region of North West Australia. As part of implementation aspects of user acceptability were explored to improve clinical utilisation of the KMMS. Methods Eighteen health professionals involved in perinatal care participated in an online survey or a qualitative semi-structured interview. Ten Aboriginal women (who held administrative, professional or executive roles) were subsequently interviewed in depth to further explore aspects of KMMS user acceptability. Results Many of the health professionals were not using the second part of the KMMS (the psychosocial discussion tool). Time constraints and a perception that the KMMS is only appropriate for women with literacy issues were identified by health professionals as significant barriers to KMMS uptake. In contrast the Aboriginal women interviewed considered the KMMS to be important for literate Aboriginal women and placed high value on having the time and space to ‘yarn’ with health professionals about issues that are important to them. Conclusion Implementing the KMMS across the Kimberley region requires health professionals to be trained. It also requires strategic engagement with health services to ensure health professionals and mangers understand the rationale and significance of the KMMS and are engaged in its successful implementation.
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Affiliation(s)
- Emma Carlin
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
- Kimberley Aboriginal Medical Services, Broome, Western Australia, Australia
- * E-mail:
| | - Erica Spry
- Kimberley Aboriginal Medical Services, Broome, Western Australia, Australia
| | - David Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
| | - Julia V. Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
- Kimberley Aboriginal Medical Services, Broome, Western Australia, Australia
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17
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Carlin E, Blondell SJ, Cadet-James Y, Campbell S, Williams M, Engelke C, Taverner D, Marriott R, Edmonds K, Atkinson D, Marley JV. Study protocol: a clinical trial for improving mental health screening for Aboriginal and Torres Strait Islander pregnant women and mothers of young children using the Kimberley Mum's Mood Scale. BMC Public Health 2019; 19:1521. [PMID: 31727039 PMCID: PMC6857148 DOI: 10.1186/s12889-019-7845-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/24/2019] [Indexed: 12/13/2022] Open
Abstract
Background Improving the rates of, and instruments used in, screening for perinatal depression and anxiety among Aboriginal and Torres Strait Islander women are important public health priorities. The Kimberley Mum’s Mood Scale (KMMS) was developed and later validated as an effective and acceptable perinatal depression and anxiety screening tool for the Kimberley region under research conditions. Other regions have expressed interest in using the KMMS with perinatal Aboriginal and Torres Strait Islander women. It is, however, important to re-evaluate the KMMS in a larger Kimberley sample via a real world implementation study, and to test for applicability in other remote and regional environments before recommendations for wider use can be made. This paper outlines the protocol for evaluating the process of implementation and establishing the ‘real world’ validity and acceptability of the KMMS in the Kimberley, Pilbara and Far North Queensland in northern Australia. Methods The study will use a range of quantitative and qualitative methods across all sites. KMMS validation/revalidation internal consistency of Part 1 will be determined using Cronbach’s alpha. Equivalence for identifying risk of depression and anxiety compared to a standard reference assessment will be determined from receiver operating characteristic curves. Sensitivity and specificity will be determined based on these cut-points. Qualitative methods of phenomenology will be used to explore concepts of KMMS user acceptability (women and health professionals). Additional process evaluation methods will collate, assess and report on KMMS quality review data, consultations with health service administrators and management, field notes, and other documentation from the research team. This information will be reported on using the Dynamic Sustainability Framework. Discussion This project is contributing to the important public health priority of screening Aboriginal and Torres Strait Islander women for perinatal depression and anxiety with tools that are meaningful and responsive to cultural and clinical needs. Identifying and addressing barriers to implementation contributes to our understanding of the complexity of improving routine clinical practie. Trial registration The study was registered retrospectively on 15/05/2019 with the Australian and New Zealand Clinical Trial registry (ACTRN12619000580178).
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Affiliation(s)
- Emma Carlin
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia. .,Kimberley Aboriginal Medical Services, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia.
| | - Sarah J Blondell
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia
| | - Yvonne Cadet-James
- Apunipima Cape York Health Council, 186 McCoombe Street, PO Box 12045, Bungalow, QLD, 4870, Australia
| | - Sandra Campbell
- Centre for Indigenous Health Equity Research, Central Queensland University, Cnr of Shields and Lake Streets, Cairns, QLD, 4870, Australia
| | - Melissa Williams
- Western Australian Country Health Service - Kimberley Population Health Unit, 4/9 Napier Tce (WA 6725 Locked Bag 525), Broome, WA, 6725, Australia
| | - Catherine Engelke
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia
| | - Des Taverner
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia
| | - Rhonda Marriott
- Ngangk Yira: Murdoch University Research Centre for Aboriginal Health and Social Equity, Murdoch University, 90 South Street, Murdoch, WA, 6150, Australia
| | - Karen Edmonds
- King's College London, 1 Lambeth Palace Road, Waterloo, London, SE1 7EU, UK
| | - David Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia
| | - Julia V Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia.,Kimberley Aboriginal Medical Services, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia
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18
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Marley JV, Carlin E, Engelke C. Screening for perinatal depression and predictors of underscreening: findings of the Born in Queensland study. Med J Aust 2019; 211:189-189.e1. [PMID: 31264228 DOI: 10.5694/mja2.50257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Julia V Marley
- Rural Clinical School of Western Australia, University of Western Australia, Broome, WA.,Kimberley Aboriginal Medical Services, Broome, WA
| | - Emma Carlin
- Rural Clinical School of Western Australia, University of Western Australia, Broome, WA.,Kimberley Aboriginal Medical Services, Broome, WA
| | - Catherine Engelke
- Rural Clinical School of Western Australia, University of Western Australia, Kununurra, WA
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19
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Griffiths E, Atkinson D, Friello D, Marley JV. Pregnancy intentions in a group of remote-dwelling Australian Aboriginal women: a qualitative exploration of formation, expression and implications for clinical practice. BMC Public Health 2019; 19:568. [PMID: 31088427 PMCID: PMC6518809 DOI: 10.1186/s12889-019-6925-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unintended pregnancies are associated with poorer obstetric outcomes and are sometimes measured at a population level as a surrogate marker for reproductive autonomy and access to health services, including contraception. Aboriginal Australians face many disparities in health outcomes, including in reproductive health and antenatal care. We aimed to explore the formation and expression of pregnancy intentions in an Aboriginal population to inform health service improvements. METHODS Semi-structured interviews were conducted with 27 remote-dwelling Aboriginal women, aged 18-49 years. Content analysis was conducted; key themes were discussed with groups of women from participating communities to refine interpretation. RESULTS Most (19/27) participants expressed pregnancy intentions congruent with reported contraceptive behaviour while eight expressed ambivalent or uncertain intentions. Intentions were shaped by traditional kinship practices, reproductive autonomy and desired family formation. Younger women tended to aspire to smaller family sizes than older women and support was expressed for the postponement of first pregnancy to achieve other life goals. Women in these communities hold strong traditional beliefs, including regarding conception, but did not use traditional methods of contraception in place of modern methods. Reproductive coercion, in the form of pressure to fall pregnant, was recognised as an important issue by women in the community. CONCLUSION Consultation strategies that promote rapport, allow space for uncertainty and are inclusive of important personal and cultural contexts are likely to improve shared understanding of pregnancy intention. Universal screening for reproductive coercion and broad counselling on contraceptive options (including discrete methods) may reduce unmet need for contraception. Community approaches supporting reproductive autonomy that is inclusive of men, and enhanced educational and occupational opportunities for young women are needed.
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Affiliation(s)
- Emma Griffiths
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, WA, 6725, Australia. .,Kimberley Aboriginal Medical Services, Broome, WA, 6725, Australia.
| | - David Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, WA, 6725, Australia
| | - Domenica Friello
- Kimberley Aboriginal Medical Services, Broome, WA, 6725, Australia
| | - Julia V Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, WA, 6725, Australia.,Kimberley Aboriginal Medical Services, Broome, WA, 6725, Australia
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20
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Kirke AB, Atkinson D, Moore S, Sterry K, Singleton S, Roxburgh C, Parrish K, Porter C, Marley JV. Diabetes screening in pregnancy failing women in rural Western Australia: An audit of oral glucose tolerance test completion rates. Aust J Rural Health 2019; 27:64-69. [PMID: 30693987 DOI: 10.1111/ajr.12465] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To quantify screening rate for gestational diabetes mellitus and completion of oral glucose tolerance test in rural and remote Western Australia. DESIGN AND PARTICIPANTS Retrospective audit of 551 antenatal records from women of 16 years and older without pre-existing diabetes and with singleton pregnancies delivered in 2013. MAIN OUTCOME MEASURES Number of women recorded screened for gestational diabetes mellitus in second or third trimester using oral glucose tolerance test or other tests; gestational diabetes mellitus rate. RESULTS Only 278 (50.5%) women were screened with oral glucose tolerance test; 113 (20.5%) had no record of any screening related to gestational diabetes mellitus. In a nested mixed-effects logistic regression model, women with a previous gestational diabetes mellitus diagnosis, two or more risk factors (excluding ethnicity) or high-risk gestational diabetes mellitus ethnicity other than Australian Aboriginal were more likely to be screened, while Australian Aboriginal women were less likely to be screened with oral glucose tolerance test. Clinicians reported patient and clinician factors and logistical difficulties as reasons for the oral glucose tolerance test not being completed at their site. Of those screened with oral glucose tolerance test, a high rate of gestational diabetes mellitus was diagnosed (14.7% versus Western Australia state-wide average of 7.4%). CONCLUSION Adherence to oral glucose tolerance test screening in rural Western Australia is inadequate for effective screening for gestational diabetes mellitus. Screening was not acceptable or available for a significant proportion of women at risk. Efforts to improve oral glucose tolerance test adherence and exploration of alternative gestational diabetes mellitus screening strategies are required.
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Affiliation(s)
- Andrew B Kirke
- Rural Clinical School of Western Australia, University of Western Australia, Bunbury, Western Australia, Australia
| | - David Atkinson
- Rural Clinical School of Western Australia, University of Western Australia, Bunbury, Western Australia, Australia.,Kimberley Aboriginal Medical Services Council, Broome, Western Australia, Australia
| | - Sarah Moore
- Rural Clinical School of Western Australia, University of Western Australia, Bunbury, Western Australia, Australia
| | - Kylie Sterry
- Rural Clinical School of Western Australia, University of Western Australia, Bunbury, Western Australia, Australia
| | - Sally Singleton
- Rural Clinical School of Western Australia, University of Western Australia, Bunbury, Western Australia, Australia.,Kimberley Aboriginal Medical Services Council, Broome, Western Australia, Australia
| | - Carly Roxburgh
- Rural Clinical School of Western Australia, University of Western Australia, Bunbury, Western Australia, Australia
| | - Kate Parrish
- Veterinary Virology, Elizabeth Macarthur Agricultural Institute, Menangle, New South Wales, Australia
| | - Cindy Porter
- Combined Universities Centre for Rural Health, Geraldton, Western Australia, Australia
| | - Julia V Marley
- Rural Clinical School of Western Australia, University of Western Australia, Bunbury, Western Australia, Australia.,Kimberley Aboriginal Medical Services Council, Broome, Western Australia, Australia
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Warwick S, Atkinson D, Kitaura T, LeLievre M, Marley JV. Young Aboriginal People's Perspective on Access to Health Care in Remote Australia: Hearing Their Voices. Prog Community Health Partnersh 2019. [DOI: 10.1353/cpr.2019.0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Warwick S, Atkinson D, Kitaura T, LeLievre M, Marley JV. Young Aboriginal People's Perspective on Access to Health Care in Remote Australia: Hearing Their Voices. ACTA ACUST UNITED AC 2019; 13:171-181. [DOI: 10.1353/cpr.2019.0017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Aquino D, Leonard D, Hadgraft N, Marley JV. High prevalence of early onset anaemia amongst Aboriginal and Torres Strait Islander infants in remote northern Australia. Aust J Rural Health 2018. [DOI: 10.1111/ajr.12403] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Danielle Aquino
- Indigenous Australia Program; The Fred Hollows Foundation; Darwin Northern Territory Australia
| | - Dympna Leonard
- Tropical Public Health Services; Queensland Health; Cairns Queensland Australia
| | - Nyssa Hadgraft
- Kimberley Aboriginal Medical Services Ltd.; Broome Western Australia Australia
| | - Julia V. Marley
- Kimberley Aboriginal Medical Services Ltd.; Broome Western Australia Australia
- The Rural Clinical School of Western Australia; The University of Western Australia; Broome Western Australia Australia
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Leonard D, Aquino D, Hadgraft N, Thompson F, Marley JV. Poor nutrition from first foods: A cross-sectional study of complementary feeding of infants and young children in six remote Aboriginal communities across northern Australia. Nutr Diet 2017; 74:436-445. [DOI: 10.1111/1747-0080.12386] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Dympna Leonard
- Centre for Chronic Disease Prevention, Cairns Institute; James Cook University; Cairns Queensland Australia
- Tropical Public Health Services; Queensland Health; Cairns Queensland Australia
| | - Danielle Aquino
- Menzies School of Health Research; Darwin Northern Territory Australia
- Indigenous Australia Program; The Fred Hollows Foundation; Katherine Northern Territory Australia
| | - Nyssa Hadgraft
- Baker Heart and Diabetes Institute; Melbourne Victoria Australia
- Kimberley Aboriginal Medical Services Ltd.; Broome Western Australia Australia
| | - Fintan Thompson
- Centre for Chronic Disease Prevention, Cairns Institute; James Cook University; Cairns Queensland Australia
| | - Julia V. Marley
- Kimberley Aboriginal Medical Services Ltd.; Broome Western Australia Australia
- The Rural Clinical School of Western Australia; The University of Western Australia; Perth Western Australia Australia
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Griffiths EK, Marley JV, Friello D, Atkinson DN. Uptake of long-acting, reversible contraception in three remote Aboriginal communities: a population-based study. Med J Aust 2017; 205:21-5. [PMID: 27362683 DOI: 10.5694/mja16.00073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/04/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the use, effectiveness and acceptance of prescribed contraception in three remote Western Australian Aboriginal communities. PARTICIPANTS AND DESIGN Mixed method study, including retrospective file review of contraception methods for 566 regular female Aboriginal patients, 1 November 2010 - 1 September 2014, and semi-structured interviews with 20 Aboriginal women. SETTING Primary care clinics in three remote Aboriginal communities. MAIN OUTCOME MEASURES Number of episodes of contraceptive use, effectiveness and continuation rates of prescribed contraceptive use; personal experiences, attitudes towards and beliefs about contraception options. RESULTS 34% of women had used contraception, ranging from 15% of women aged younger than 15 years to 55% of women aged 15-19 years. The most common forms of contraception at the census date were long-acting reversible contraceptives (LARCs): 77% of women using contraception had an etonogestrel implant and 7% had depot medroxyprogesterone. Etonogestrel continuation rates at 1, 2 and 3 years were 87% (95% CI, 81-92%), 72% (95% CI, 64-78%) and 51% (95% CI, 41-60%) respectively. Medroxyprogesterone depot continuation at one year was only 14% (95% CI, 8-22%). Social acceptance of the etonogestrel implant was high; no concerns were raised about stigma or unwanted attention related to implant use. CONCLUSION The high uptake of LARCs in these communities is consistent with international recommendations about contraception use. High acceptability was reflected in excellent continuation rates. Service delivery models that use community engagement and capacity building are recommended for broadening the focus of sexual health beyond sexually transmitted disease detection and management, giving priority to the reproductive rights and unmet needs of Aboriginal women.
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Affiliation(s)
| | - Julia V Marley
- Kimberley Aboriginal Medical Services Council, Broome, WA
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Abstract
PROBLEM Adhoc culturally questionable perinatal mental-health screening among Aboriginal women in the Kimberley. BACKGROUND Mental-health issues, substance abuse and suicide attempts are high among young Aboriginal women in Australia. There is no evidence that the Edinburgh Postnatal Depression Scale (EPDS) is effective or culturally safe. Screening practices are complicated by limited understanding of the complex cultural interface between Western and Aboriginal beliefs and notions about health and mental-health. QUESTION What is the current context of perinatal mental-health screening practices among Aboriginal women in the Kimberley and what might be considered a culturally safe approach? METHODS A review of the literature and exploration of current screening practices preceded community participatory action research (CPAR) of perinatal mental-health screening. RESULTS More than 100 Kimberley women and 72 health practitioners contributed to this joint strategic body of work. Recommendations for practice include one single culturally appropriate Kimberley version of the EPDS.
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Affiliation(s)
- Jayne Kotz
- a School of Psychology and Exercise Science , Murdoch University , South Street, Murdoch , WA , Australia
| | - Ailsa Munns
- b School of Nursing, Midwifery & Paramedicine , Curtin University , Bentley , Australia
| | - Rhonda Marriott
- a School of Psychology and Exercise Science , Murdoch University , South Street, Murdoch , WA , Australia
| | - Julia V Marley
- c The Rural Clinical School of Western Australia , The University of Western Australia , Broome , Australia.,d Kimberley Aboriginal Medical Services , Broome , Australia
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Marley JV, Kotz J, Engelke C, Williams M, Stephen D, Coutinho S, Trust SK. Validity and Acceptability of Kimberley Mum's Mood Scale to Screen for Perinatal Anxiety and Depression in Remote Aboriginal Health Care Settings. PLoS One 2017; 12:e0168969. [PMID: 28135275 PMCID: PMC5279756 DOI: 10.1371/journal.pone.0168969] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/10/2016] [Indexed: 01/23/2023] Open
Abstract
Background The Edinburgh Postnatal Depression Scale (EPDS) is widely recommended for perinatal anxiety and depression screening. However, many Aboriginal women find EPDS language complex and confusing, and providers find using it with Aboriginal women challenging. The two part Kimberley Mum’s Mood Scale (KMMS) was developed to improve screening: Part 1 is a Kimberley version of EPDS; Part 2 is a psychosocial tool that enables contextualisation of Part 1 scores. We aimed to determine if KMMS is a valid and acceptable method of identifying Kimberley Aboriginal perinatal women at risk of anxiety or depressive disorders compared to a semi-structured clinical interview. Methods Across 15 sites in the Kimberley, Western Australia, 97 Aboriginal women aged 16 years and older who intended to continue with their pregnancy or had a baby within the previous 12 months were administered the KMMS by trained healthcare providers who provided an overall assessment of no, low, moderate or high risk; 91 participants were then independently assessed by a blinded clinical expert using Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria. A qualitative approach was used to determine KMMS’ acceptability. Results Part 1 had high internal consistency (Cronbach’s alpha, 0.89), and overall KMMS risk equivalence for screening for anxiety or depressive disorders was moderate (sensitivity, 83%; specificity, 87%; positive predictive value, 68%). Participants found the process easy and useful, and healthcare providers found KMMS more useful than EPDS. Part 2 allowed healthcare providers to ask questions that gave participants an opportunity to express themselves, resulting in a deeper understanding between them. Conclusion KMMS is an effective tool for identifying Kimberley Aboriginal perinatal women at risk of anxiety and depressive disorders. Adoption of KMMS with culturally safe training and support is likely to improve screening processes, and with further validation may have broader applicability across remote Australia.
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Affiliation(s)
- Julia V. Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
- Kimberley Aboriginal Medical Services Ltd, Broome, Western Australia, Australia
- * E-mail:
| | - Jayne Kotz
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
| | - Catherine Engelke
- Kimberley Aboriginal Medical Services Ltd, Broome, Western Australia, Australia
- The Rural Clinical School of Western Australia, The University of Western Australia, Kununurra, Western Australia, Australia
| | - Melissa Williams
- Western Australian County Health Service, Broome, Western Australia, Australia
| | - Donna Stephen
- Kimberley Aboriginal Medical Services Ltd, Broome, Western Australia, Australia
| | - Sudha Coutinho
- Independent Consultant, Broome, Western Australia, Australia
| | - Stephanie K. Trust
- Kimberley Aboriginal Medical Services Ltd, Broome, Western Australia, Australia
- Kununurra Medical, Kununurra, Western Australia, Australia
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Marley JV, Moore S, Fitzclarence C, Warr K, Atkinson D. Peritoneal dialysis outcomes of Indigenous Australian patients of remote Kimberley origin. Aust J Rural Health 2016; 22:101-8. [PMID: 25039843 PMCID: PMC4140604 DOI: 10.1111/ajr.12086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2013] [Indexed: 11/29/2022] Open
Abstract
Objectives To compare clinical outcomes and mortality rates between Kimberley Indigenous, other Indigenous and non-Indigenous Australian patients on peritoneal dialysis (PD). Design and participants Patients commencing renal replacement therapy (RRT) with PD for the first time from 1 January 2003 to 31 December 2009 were retrospectively identified. Secondary data from medical records and the Australian and New Zealand Dialysis and Transplant Registry from 1 January 2003 to 31 December 2010 were used to compare outcomes between patients. Main outcome measures Time to first peritonitis; failure and death rates per 100 patient-years, hazard ratios, unadjusted and adjusted (for age, sex, comorbid conditions, PD not the first RRT modality used). Comparison of the two PD systems used in the Kimberley. Results Kimberley patients had significantly shorter median time to first peritonitis (11.2 versus 21.5 months), higher technique failure (46.0 versus 25.2 per 100 patient-years) and shorter median survival on PD (17.5 versus 22.4 months) but similar adjusted mortality (hazard ratio 1.32; 95% CI, 0.76-2.29) as non-Indigenous patients. They also had a significantly higher technique failure rate than other Indigenous patients (46.0 versus 31.4 per 100 patient-years) and nearly double the average peritonitis episodes previously reported for Indigenous Australians (2.0 versus 1.15 per patient-year). Conclusions PD can bring patients closer to home; however, it is relatively short term and potentially hazardous. PD remains an important therapy for suitable remote patients to get closer to home, providing they are fully informed of the options. The current expansion of safer Kimberley haemodialysis options needs to continue.
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Affiliation(s)
- Julia V Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia; Kimberley Aboriginal Medical Services Council, Broome, Western Australia, Australia
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McAuley K, McAullay D, Strobel NA, Marriott R, Atkinson DN, Marley JV, Stanley FJ, Edmond KM. Hospital Utilisation in Indigenous and Non-Indigenous Infants under 12 Months of Age in Western Australia, Prospective Population Based Data Linkage Study. PLoS One 2016; 11:e0154171. [PMID: 27120331 PMCID: PMC4847930 DOI: 10.1371/journal.pone.0154171] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/08/2016] [Indexed: 12/31/2022] Open
Abstract
Background Indigenous infants (infants aged under 12 months) have the highest hospital admission and emergency department presentation risks in Australia. However, there have been no recent reports comparing hospital utilisation between Indigenous and non-Indigenous infants. Methods Our primary objective was to use a large prospective population-based linked dataset to assess the risk of all-cause hospital admission and emergency department presentation in Indigenous compared to non-Indigenous infants in Western Australia (WA). Secondary objectives were to assess the effect of socio-economic status (Index of Relative Socio-Economic Disadvantage [IRSD]) on hospital utilisation and to understand the causes of hospital utilisation. Findings There were 3,382 (5.4%) Indigenous and 59,583 (94.6%) non-Indigenous live births in WA from 1 January 2010 to 31 December 2011. Indigenous infants had a greater risk of hospital admission (adjusted odds ratio [aOR] 1.90, 95% confidence interval [95% CI] 1.77–2.04, p = <0.001) and emergency department presentation (aOR 2.15, 95% CI 1.98–2.33, p = <0.001) compared to non-Indigenous infants. Fifty nine percent (59.0%) of admissions in Indigenous children were classified as preventable compared to 31.2% of admissions in non-Indigenous infants (aOR 2.12, 95% CI 1.88–2.39). The risk of hospital admission in the most disadvantaged (IRSD 1) infants in the total cohort (35.7%) was similar to the risk in the least disadvantaged (IRSD 5) infants (30.6%) (aOR 1.04, 95% CI 0.96–1.13, p = 0.356). Interpretation WA Indigenous infants have much higher hospital utilisation than non Indigenous infants. WA health services should prioritise Indigenous infants regardless of their socio economic status or where they live.
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Affiliation(s)
- Kimberley McAuley
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
- * E-mail:
| | - Daniel McAullay
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
- Kurongkurl Katitjin, Centre for Indigenous Australian Education and Research, Edith Cowan University, Perth, Western Australia, Australia
| | - Natalie A. Strobel
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Rhonda Marriott
- School of Psychology and Exercise Science, Murdoch University, Perth, Western Australia, Australia
| | - David N. Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
| | - Julia V. Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
| | | | - Karen M. Edmond
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
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Marley JV, Oh MS, Hadgraft NT, Singleton SL, Isaacs K, Atkinson DN. Using glycated haemoglobin testing to simplify diabetes screening in remote Aboriginal Australian health care settings. Med J Aust 2015; 203:28-32. [DOI: 10.5694/mja14.01575] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 04/21/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Julia V Marley
- Rural Clinical School of Australia, University of Western Australia, Broome, WA
- Kimberley Aboriginal Medical Services, Broome, WA
| | - May Sian Oh
- Kimberley Aboriginal Medical Services, Broome, WA
| | | | | | - Kim Isaacs
- Kimberley Aboriginal Medical Services, Broome, WA
| | - David N Atkinson
- Rural Clinical School of Australia, University of Western Australia, Broome, WA
- Kimberley Aboriginal Medical Services, Broome, WA
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Marley JV, Oh MS, Hadgraft N, Singleton S, Isaacs K, Atkinson D. Cross-sectional comparison of point-of-care with laboratory HbA₁c in detecting diabetes in real-world remote Aboriginal settings. BMJ Open 2015; 5:e006277. [PMID: 25765020 PMCID: PMC4360580 DOI: 10.1136/bmjopen-2014-006277] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To determine if point-of-care (POC) glycated haemoglobin (HbA₁c) is sufficiently accurate in real-world remote settings to predict or exclude the diagnosis of diabetes based on laboratory HbA1c measurements. DESIGN Cross-sectional study comparing POC capillary HbA₁c results with corresponding venous HbA₁c levels measured in a reference laboratory. PARTICIPANTS Aboriginal patients ≥15 years old who were due for diabetes screening at the participating clinics were invited to participate. Two hundred and fifty-five Aboriginal participants were enrolled and 241 were included in the analysis. SETTING 6 primary healthcare sites in the remote Kimberley region of Western Australia from September 2011 to November 2013. MAIN OUTCOME MEASURES Concordance and mean differences between POC capillary blood HbA₁c measurement and laboratory measurement of venous blood HbA₁c level; POC capillary blood HbA1c equivalence value for screening for diabetes or a high risk of developing diabetes; sensitivity, specificity and positive-predictive value for diagnosing and screening for diabetes; barriers to conducting POC testing. RESULTS Concordance between POC and laboratory results was good (ρ=0.88, p<0.001). The mean difference was -0.15% (95% limits of agreement, -0.67% to 0.36%). POC HbA₁c measurements ≥6.5%, 48 mmol/mol had a specificity of 98.2% and sensitivity of 73.7% for laboratory measurements ≥6.5%. The POC equivalence value for screening for diabetes or a high risk of developing diabetes was ≥5.7%, 39 mmol/mol (sensitivity, 91%; specificity, 76.7% for laboratory measurements ≥6.0%, 42 mmol/mol). Staff trained by other clinic staff 'on the job' performed as well as people with formal accredited training. Staff reported difficulty in maintaining formal accreditation. CONCLUSIONS POC HbA₁c testing is sufficiently accurate to be a useful component in screening for, and diagnosing, diabetes in remote communities. Limited local training is adequate to produce results comparable to laboratory results and accreditation processes need to reflect this.
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Affiliation(s)
- Julia V Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia Kimberley Aboriginal Medical Services Council, Broome, Western Australia, Australia
| | - May S Oh
- Kimberley Aboriginal Medical Services Council, Broome, Western Australia, Australia
| | - Nyssa Hadgraft
- Kimberley Aboriginal Medical Services Council, Broome, Western Australia, Australia
| | - Sally Singleton
- Kimberley Aboriginal Medical Services Council, Broome, Western Australia, Australia
| | - Kim Isaacs
- Kimberley Aboriginal Medical Services Council, Broome, Western Australia, Australia
| | - David Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia Kimberley Aboriginal Medical Services Council, Broome, Western Australia, Australia
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Griffiths E, Reeve C, Marley JV. Hepatitis B notifications in a vaccinated cohort of Aboriginal people in the Kimberley region. Med J Aust 2014; 201:343-6. [PMID: 25222459 DOI: 10.5694/mja13.00255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 05/20/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To identify cases of hepatitis B infection after vaccination in Kimberley residents and determine maternal serostatus as a potential indicator of mode of transmission. DESIGN AND PARTICIPANTS Retrospective review of Kimberley residents with notified hepatitis B infection using records of vaccination history and child and maternal serology. MAIN OUTCOME MEASURES Confirmed cases of hepatitis B infection after vaccination; chronic infection in cases of hepatitis B infection after vaccination; maternal serostatus in confirmed cases of hepatitis B infection after vaccination. RESULTS From 1 January 1984 to 31 March 2011, we identified 17 cases of Aboriginal residents with hepatitis B infection after vaccination (10 chronic infections, five not defined and two cleared). In six patients, maternal chronic infection had been identified at some stage, raising the possibility of vertical transmission. In seven patients, maternal serology or evidence of subsequent acquisition suggested that horizontal transmission and therefore vaccination failure was likely. For four patients, there was inadequate information to assess possible mode of transmission. CONCLUSIONS Hepatitis B infection after full vaccination is not limited to children of mothers with active infection. Further undiagnosed infections in the Kimberley are likely, and active monitoring to detect the extent and likely cause of hepatitis B infection in vaccinated children is needed. In children where vertical transmission is a risk, prospective follow-up is warranted.
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Affiliation(s)
- Emma Griffiths
- Kimberley Population Health Unit, WA Department of Health, Broome, WA, Australia.
| | - Carole Reeve
- Kimberley Population Health Unit, WA Department of Health, Broome, WA, Australia
| | - Julia V Marley
- Kimberley Aboriginal Medical Services Council, Broome, WA, Australia
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Mc Loughlin F, Hadgraft NT, Atkinson D, Marley JV. Aboriginal health research in the remote Kimberley: an exploration of perceptions, attitudes and concerns of stakeholders. BMC Health Serv Res 2014; 14:517. [PMID: 25343849 PMCID: PMC4213490 DOI: 10.1186/s12913-014-0517-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 10/13/2014] [Indexed: 11/10/2022] Open
Abstract
Background For decades Indigenous peoples have argued for health research reform claiming methods used and results obtained often reflect the exploitative history of colonisation. In 2006 the Kimberley Aboriginal Health Planning Forum (KAHPF) Research Subcommittee (hereafter, the Subcommittee) was formed to improve research processes in the remote Kimberley region of north Western Australia. This paper explores the major perceptions, attitudes and concerns of stakeholders in the Subcommittee. Methods Qualitative analysis was carried out on data retrospectively collected from multiple evidentiary sources linked to the Subcommittee i.e. database, documents, interviews, review forms and emails from 1 January 2007 to 31 October 2013. Results From 1 January 2007 to 30 June 2013 the Subcommittee received 95 proposals, 57 (60%) driven by researchers based outside the region. Local stakeholders (22 from 12 different Kimberley organisations) raised concerns about 36 (38%) projects, 30 (83%) of which were driven by external researchers. Major concerns of local stakeholders were inadequate community consultation and engagement; burden of research on the region; negative impact of research practices; lack of demonstrable community benefit; and power and control of research. Major themes identified by external stakeholders (25 external researchers who completed the review form) were unanticipated difficulties with consultation processes; barriers to travel; perceiving research as a competing priority for health services and time-consuming ethics processes. External stakeholders also identified strategies for improving research practices in the Kimberley: importance of community support in building good relationships; employing local people; flexibility in research approaches; and importance of allocating sufficient time for consultation and data collection. Conclusions Health research in the Kimberley has improved in recent years, however significant problems remain. Prioritising research addressing genuine local needs is essential in closing the gap in Indigenous life expectancy. The long-term aim is for local health service connected researchers to identify priorities, lead, conduct and participate in the majority of local health research. For this to occur, a more radical move involving reconceptualising the research process is needed. Changes to institutional timeframes and funding processes could improve Indigenous and community-based research.
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Affiliation(s)
- Frieda Mc Loughlin
- Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, WA, 6725, Australia.
| | - Nyssa T Hadgraft
- Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, WA, 6725, Australia.
| | - David Atkinson
- Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, WA, 6725, Australia. .,The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA, 6725, Australia.
| | - Julia V Marley
- Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, WA, 6725, Australia. .,The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA, 6725, Australia.
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Stoneman A, Atkinson D, Davey M, Marley JV. Quality improvement in practice: improving diabetes care and patient outcomes in Aboriginal Community Controlled Health Services. BMC Health Serv Res 2014; 14:481. [PMID: 25288282 PMCID: PMC4282197 DOI: 10.1186/1472-6963-14-481] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 09/29/2014] [Indexed: 11/10/2022] Open
Abstract
Background Management of chronic disease, including diabetes, is a central focus of most Aboriginal Community Controlled Health Services (ACCHSs) in Australia. We have previously demonstrated that diabetes monitoring and outcomes can be improved and maintained over a 10-year period at Derby Aboriginal Health Service (DAHS). While continuous quality improvement (CQI) has been shown to improve service delivery rates and clinical outcome measures, the process of interpreting audit results and developing strategies for improvement is less well described. This paper describes the evaluation of care of patients with type 2 diabetes mellitus (T2DM) and features of effective CQI in ACCHSs in the remote Kimberley region of north Western Australia. Methods Retrospective audit of records for Aboriginal and Torres Strait Islander primary care patients aged ≥15 years with a confirmed diagnosis of T2DM at four Kimberley ACCHSs from 1 July 2011 to 30 June 2012. Interviews with health service staff and focus group discussions with patients post audit. Main outcome measures: diabetes care related activities, clinical outcome measures and factors influencing good diabetes related care and effective CQI. Results A total of 348 patients from the four ACCHSs were included in the study. Clinical care activities were generally high across three of the four health services (at least 71% of patients had cholesterol recorded, 89% blood pressure, 84% HbA1c). Patients from DAHS had lower median cholesterol levels (4.4 mmol/L) and the highest proportion of patients meeting clinical targets for HbA1c (31% v 16% ACCHS-3; P = 0.02). Features that facilitated good care included clearly defined staff roles for diabetes management, support and involvement of Aboriginal Health Workers, efficient recall systems, and well-coordinated allied health services. Effective CQI features included seamless and timely data collection, local ownership of the process, openness to admitting deficiencies and willingness to embrace change. Conclusions Well-designed health care delivery and CQI systems, with a strong sense of ownership over diabetes management led to increased service delivery rates and improved clinical outcome measures in ACCHSs. Locally run CQI processes may be more responsive to individual health services and more sustainable than externally driven systems.
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Affiliation(s)
- Alice Stoneman
- Launceston Clinical School, University of Tasmania, Locked Bag 1377, Launceston, TAS 7250, Australia.
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Affiliation(s)
- Emma Griffiths
- Kimberley Population Health Unit, WA Department of Health, Broome, WA
- Kimberley Aboriginal Medical Services Council, Broome, WA
| | - Carole Reeve
- Kimberley Population Health Unit, WA Department of Health, Broome, WA
- Centre for Remote Health, Flinders University, Alice Springs, NT
| | - Julia V Marley
- Kimberley Aboriginal Medical Services Council, Broome, WA
- Rural Clinical School of Australia, University of Western Australia, Broome, WA
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Marley JV, Kitaura T, Atkinson D, Metcalf S, Maguire GP, Gray D. Clinical trials in a remote Aboriginal setting: lessons from the BOABS smoking cessation study. BMC Public Health 2014; 14:579. [PMID: 24912949 PMCID: PMC4064520 DOI: 10.1186/1471-2458-14-579] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 06/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is limited evidence regarding the best approaches to helping Indigenous Australians to stop smoking. The composite analysis of the only two smoking cessation randomised controlled trials (RCTs) investigating this suggests that one-on-one extra support delivered by and provided to Indigenous Australians in a primary health care setting appears to be more effective than usual care in encouraging smoking cessation. This paper describes the lessons learnt from one of these studies, the Be Our Ally Beat Smoking (BOABS) Study, and how to develop and implement an integrated smoking cessation program. METHODS Qualitative study using data collected from multiple documentary sources related to the BOABS Study. As the project neared completion the research team participated in four workshops to review and conduct thematic analyses of these documents. RESULTS Challenges we encountered during the relatively complex BOABS Study included recruiting sufficient number of participants; managing the project in two distant locations and ensuring high quality work across both sites; providing appropriate training and support to Aboriginal researchers; significant staff absences, staff shortages and high workforce turnover; determining where and how the project fitted in the clinics and consequent siloing of the Aboriginal researchers relating to the requirements of RCTs; resistance to change, and maintaining organisational commitment and priority for the project. The results of this study also demonstrated the importance of local Aboriginal ownership, commitment, participation and control. This included knowledge of local communities, the flexibility to adapt interventions to local settings and circumstances, and taking sufficient time to allow this to occur. CONCLUSIONS The keys to the success of the BOABS Study were local development, ownership and participation, worker professional development and support, and operating within a framework of cultural safety. There were difficulties associated with the BOABS Study being an RCT, and many of these are shared with stand-alone programs. Interventions targeted at particular health problems are best integrated with usual primary health care. Research to investigate complex interventions in Indigenous health should not be limited to randomised clinical trials and funding needs to reflect the additional, but necessary, cost of providing for local control of planning and implementation.
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Affiliation(s)
- Julia V Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia
- Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, Western Australia 6725, Australia
| | - Tracey Kitaura
- Derby Aboriginal Health Service, 1 Stanley Street, PO Box 1155, Derby, Western Australia 6728, Australia
| | - David Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia
- Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, Western Australia 6725, Australia
| | - Sue Metcalf
- Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, Western Australia 6725, Australia
| | - Graeme P Maguire
- School of Medicine and Dentistry, James Cook University, Cairns, Queensland 4870, Australia
- Baker IDI, Alice Springs, Northern Territory 0871, Australia
| | - Dennis Gray
- National Drug Institute, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia
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Marley JV, Atkinson D, Kitaura T, Nelson C, Gray D, Metcalf S, Maguire GP. The Be Our Ally Beat Smoking (BOABS) study, a randomised controlled trial of an intensive smoking cessation intervention in a remote aboriginal Australian health care setting. BMC Public Health 2014; 14:32. [PMID: 24418597 PMCID: PMC3905726 DOI: 10.1186/1471-2458-14-32] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 12/20/2013] [Indexed: 11/25/2022] Open
Abstract
Background Australian Aboriginal and Torres Strait Islander peoples (Indigenous Australians) smoke at much higher rates than non-Indigenous people and smoking is an important contributor to increased disease, hospital admissions and deaths in Indigenous Australian populations. Smoking cessation programs in Australia have not had the same impact on Indigenous smokers as on non-Indigenous smokers. This paper describes the outcome of a study that aimed to test the efficacy of a locally-tailored, intensive, multidimensional smoking cessation program. Methods A randomised controlled trial of Aboriginal researcher delivered tailored smoking cessation counselling during face-to-face visits, aiming for weekly for the first four weeks, monthly to six months and two monthly to 12 months. The control (“usual care”) group received routine care relating to smoking cessation at their local primary health care service. Data collection occurred at enrolment, six and 12 months. The primary outcome was self-reported smoking cessation with urinary cotinine confirmation at final follow-up (median 13 (interquartile range 12–15) months after enrolment). Results Participants in the intervention (n = 55) and usual care (n = 108) groups were similar in baseline characteristics, except the intervention group was slightly older. At final follow-up the smoking cessation rate for participants assigned to the intervention group (n = 6; 11%), while not statistically significant, was double that of usual care (n = 5; 5%; p = 0.131). A meta-analysis of these findings and a similarly underpowered but comparable study of pregnant Indigenous Australian women showed that Indigenous Australian participants assigned to the intervention groups were 2.4 times (95% CI, 1.01-5.5) as likely to quit as participants assigned to usual care. Conclusions Culturally appropriate, multi-dimensional Indigenous quit smoking programs can be successfully implemented in remote primary health care. Intensive one-on-one interventions with substantial involvement from Aboriginal and Torres Strait Islander workers are likely to be effective in these settings. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12608000604303).
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Affiliation(s)
- Julia V Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia.
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Marley JV, Nelson C, O'Donnell V, Atkinson D. Quality indicators of diabetes care: an example of remote-area Aboriginal primary health care over 10 years. Med J Aust 2012; 197:404-8. [PMID: 23025738 DOI: 10.5694/mja12.10275] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe service characteristics of Derby Aboriginal Health Service (DAHS) and document diabetes management activities and intermediate clinical outcomes for Aboriginal patients with type 2 diabetes. DESIGN, SETTING AND PATIENTS Retrospective audit of records for patients ≥ 15 years old who had a confirmed diagnosis of type 2 diabetes, received primary health care from DAHS for at least 6 continuous months between 1 July 1999 and 30 June 2009, resided in the Derby area and were not on renal replacement therapy. MAIN OUTCOME MEASURES Electronic records of blood pressure (BP), glycated haemoglobin (HbA(1c)) level, weight, albumin-creatinine ratio, creatinine level or estimated glomerular filtration rate, lipid levels and smoking status during each audit year; and proportions of patients who met clinical targets for HbA(1c), BP and cholesterol. RESULTS Over the 10 years, the proportion of clinical care activities undertaken according to regional protocols increased significantly, with very high levels recorded in the last 3 years (at least 70% of patients had each activity recorded). There were significant improvements in systolic BP, diastolic BP and cholesterol levels over the 10 years (P < 0.001 for all). In the final year, 69% of patients had at least half their BP measurements ≤ 130/80 mmHg and 83% had median annual cholesterol levels of < 5.5 mmol/L. There were small improvements in HbA(1c) levels that approached statistical significance (P = 0.05). In the final year, 34% of patients had median annual HbA(1c) levels of ≤ 7.0%. CONCLUSIONS This study shows that diabetes monitoring and outcomes can be improved and maintained over a 10-year period in a well supported remote Aboriginal community-controlled health service setting.
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Affiliation(s)
- Julia V Marley
- Rural Clinical School of Western Australia, University of Western Australia, Broome, WA, Australia.
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Marley JV, Atkinson D, Nelson C, Kitaura T, Gray D, Metcalf S, Murray R, Maguire GP. The protocol for the Be Our Ally Beat Smoking (BOABS) study, a randomised controlled trial of an intensive smoking cessation intervention in a remote Aboriginal Australian health care setting. BMC Public Health 2012; 12:232. [PMID: 22439653 PMCID: PMC3349500 DOI: 10.1186/1471-2458-12-232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 03/23/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Australian Aboriginal peoples and Torres Strait Islanders (Indigenous Australians) smoke at much higher rates than non-Indigenous people and smoking is an important contributor to increased disease, hospital admissions and deaths in Indigenous Australian populations. Smoking cessation programs in Australia have not had the same impact on Indigenous smokers as on non-Indigenous smokers. This paper describes the protocol for a study that aims to test the efficacy of a locally-tailored, intensive, multidimensional smoking cessation program. METHODS/DESIGN This study is a parallel, randomised, controlled trial. Participants are Aboriginal and Torres Strait Islander smokers aged 16 years and over, who are randomly allocated to a 'control' or 'intervention' group in a 2:1 ratio. Those assigned to the 'intervention' group receive smoking cessation counselling at face-to-face visits, weekly for the first four weeks, monthly to six months and two monthly to 12 months. They are also encouraged to attend a monthly smoking cessation support group. The 'control' group receive 'usual care' (i.e. they do not receive the smoking cessation program). Aboriginal researchers deliver the intervention, the goal of which is to help Aboriginal peoples and Torres Strait Islanders quit smoking. Data collection occurs at baseline (when they enrol) and at six and 12 months after enrolling. The primary outcome is self-reported smoking cessation with urinary cotinine confirmation at 12 months. DISCUSSION Stopping smoking has been described as the single most important individual change Aboriginal and Torres Strait Islander smokers could make to improve their health. Smoking cessation programs are a major priority in Aboriginal and Torres Strait Islander health and evidence for effective approaches is essential for policy development and resourcing. A range of strategies have been used to encourage Aboriginal peoples and Torres Strait Islanders to quit smoking however there have been few good quality studies that show what approaches work best. More evidence of strategies that could work more widely in Indigenous primary health care settings is needed if effective policy is to be developed and implemented. Our project will make an important contribution in this area. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12608000604303).
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Affiliation(s)
- Julia V Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, Cnr Anne & Dora Street, PO Box 1377, Broome, WA, 6725, Australia
- Kimberley Aboriginal Medical Services Council, Cnr Anne & Dora Street, PO Box 1377, Broome, WA 6725, Australia
| | - David Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, Cnr Anne & Dora Street, PO Box 1377, Broome, WA, 6725, Australia
- Kimberley Aboriginal Medical Services Council, Cnr Anne & Dora Street, PO Box 1377, Broome, WA 6725, Australia
| | - Carmel Nelson
- Kimberley Aboriginal Medical Services Council, Cnr Anne & Dora Street, PO Box 1377, Broome, WA 6725, Australia
| | - Tracey Kitaura
- Derby Aboriginal Health Service, 1 Stanley Street, PO Box 1155, Derby, WA 6728, Australia
| | - Dennis Gray
- National Drug Institute, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Sue Metcalf
- Kimberley Aboriginal Medical Services Council, Cnr Anne & Dora Street, PO Box 1377, Broome, WA 6725, Australia
| | - Richard Murray
- School of Medicine and Dentistry, James Cook University, Cairns, Queensland 4870, Australia
| | - Graeme P Maguire
- School of Medicine and Dentistry, James Cook University, Cairns, Queensland 4870, Australia
- Baker IDI, Alice Springs, Northern Territory 0871, Australia
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Marley JV, Dent HK, Wearne M, Fitzclarence C, Nelson C, Siu K, Warr K, Atkinson D. Haemodialysis outcomes of Aboriginal and Torres Strait Islander patients of remote Kimberley region origin. Med J Aust 2010; 193:516-20. [DOI: 10.5694/j.1326-5377.2010.tb04035.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Accepted: 06/01/2010] [Indexed: 11/17/2022]
Affiliation(s)
- Julia V Marley
- Rural Clinical School of Western Australia, University of Western Australia, Broome, WA
- Kimberley Aboriginal Medical Services Council Inc, Broome, WA
| | - Hannah K Dent
- Discipline of Public Health, University of Adelaide; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA
| | - Maree Wearne
- Kimberley Aboriginal Medical Services Council Inc, Broome, WA
| | | | - Carmel Nelson
- Kimberley Aboriginal Medical Services Council Inc, Broome, WA
| | - Karen Siu
- Department of Renal Medicine, Royal Perth Hospital, Perth, WA
| | - Kevin Warr
- Department of Renal Medicine, Royal Perth Hospital, Perth, WA
| | - David Atkinson
- Rural Clinical School of Western Australia, University of Western Australia, Broome, WA
- Kimberley Aboriginal Medical Services Council Inc, Broome, WA
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Marley JV, Davis S, Coleman K, Hayhow BD, Brennan G, Mein JK, Nelson C, Atkinson D, Maguire GP. Point‐of‐care testing of capillary glucose in the exclusion and diagnosis of diabetes in remote Australia. Med J Aust 2007; 186:500-3. [PMID: 17516895 DOI: 10.5694/j.1326-5377.2007.tb01022.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Accepted: 04/03/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the utility of point-of-care (POC) capillary blood glucose measurements in the diagnosis and exclusion of diabetes in usual practice in primary health care in remote areas. DESIGN Cross-sectional study comparing POC capillary glucose results with corresponding venous glucose levels measured in a reference laboratory. PARTICIPANTS 200 participants aged 16-65 years enrolled: 198 had POC capillary glucose measurements; 164 also had acceptable venous glucose laboratory results. SETTING Seven health care sites in the Kimberley region of Western Australia from May to November 2006. MAIN OUTCOME MEASURES Concordance and mean differences between POC capillary blood glucose measurement and laboratory measurement of venous blood glucose level; POC capillary blood glucose equivalence values for excluding and diagnosing diabetes, and their sensitivity, specificity and positive-predictive value. RESULTS The concordance between POC and laboratory results was high (rho=0.93, P<0.001). The mean difference in results was 0.48 mmol/L (95% CI, 0.23-0.73; limits of agreement, - 2.6 to 3.6 mmol/L). The POC capillary glucose equivalence values for excluding and diagnosing diabetes were < 5.5 mmol/L (sensitivity, 53.3%; specificity, 94.4%; positive-predictive value, 88.9%; for a venous value of < 5.5 mmol/L) and >or= 12.2 mmol/L (sensitivity, 83.3%; specificity, 99.3%; positive-predictive value, 95.2%; for a venous value of >or= 11.1 mmol/L), respectively. While the choice of glucometer and whether or not patients were fasting altered these results, they did not have a significant influence on the diagnostic utility of POC glucose measurement in this setting. CONCLUSION POC capillary blood glucose analysers can be used as part of the process of diagnosing and excluding diabetes in remote rural communities using these locally established capillary equivalence values.
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Affiliation(s)
- Julia V Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, WA, Australia.
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Benson RA, Adamson K, Corsin-Jimenez M, Marley JV, Wahl KA, Lamb JR, Howie SEM. Notch1 co-localizes with CD4 on activated T cells and Notch signaling is required for IL-10 production. Eur J Immunol 2005; 35:859-69. [PMID: 15688350 DOI: 10.1002/eji.200425562] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The effector function of activated CD4(+) T cells and secretion of cytokines are important in the establishment of productive immune responses and tolerance. We identified expression by CD4(+) T cells of Notch receptors and ligands and enhanced Notch signaling upon activation. Notch1 expression was up regulated and co-localized with CD4 upon T cell stimulation. Disruption of Notch signaling did not affect proliferation, but attenuated cytokine secretion following CD3 ligation in the absence of anti-CD28 antibody. Notch signaling was absolutely necessary for transcription of IL-10 by stimulated CD4(+) T cells. CD4(+) T cells transfected with constitutively active Notch1 failed to proliferate, but exhibited enhanced cytokine secretion upon stimulation. Our data indicates that Notch receptor signaling can influence both proliferative and cytokine responses of CD4(+) T cells. In addition, the finding that Notch signaling is required for production of IL-10 may allude to a role in immune regulation.
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Affiliation(s)
- Robert A Benson
- Immunobiology Group, Medical Research Council Centre for Inflammation Research, University of Edinburgh Medical School, Edinburgh, UK.
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Leong CC, Marley JV, Loh S, Robinson BW, Garlepp MJ. The induction of immune responses to murine malignant mesothelioma by IL-2 gene transfer. Immunol Cell Biol 1997; 75:356-9. [PMID: 9315477 DOI: 10.1038/icb.1997.55] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Stable IL-2 transfectant clones have been derived from two non-immunogenic murine malignant mesothelioma (MM) cell lines to investigate the induction of protective antitumor immunity to MM. AC29-IL-2 transfectant clones grew at a slower rate in vivo than the parental cell line or a transfectant control clone but all inoculated mice developed tumours despite the continued ability of the tumour cells to express IL-2. Tumour development after inoculation of AB1-IL-2 transfectants varied, the degree of in vivo inhibition (40-100%) being directly related to the rate of IL-2 secretion of the transfectants. When mice which had rejected the AB1-IL-2 transfectants were challenged with parental AB1 cells, a proportion (16-70%) of mice from each group remained tumour free at least 45 days after challenge (naive mice developed tumours within 26 days). The inhibition of growth of the initial inoculum of AB1-IL-2 transfectants was independent of CD4+ and CD8+ cells, consistent with the demonstration of non-specific cytotoxic activity by splenocytes from mice inoculated with the IL-2 transfectants. These data suggest that IL-2 expression by MM cells is capable of generating in vivo immunity to the tumour. This immunity may be relatively weak or may be subject to down-regulation so that consistent rejection of unmodified tumour cells is not achieved. Genetic modification with combinations of genes, including IL-2 and B7-1, will be necessary for reliable generation of protective immunity to MM.
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Affiliation(s)
- C C Leong
- Australian Neuromuscular Research Institute, Queen Elizabeth II Medical Center, Nedlands, Australia
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Abstract
Transfection of the genes encoding the co-stimulatory molecules B7-1 and B7-2 has enhanced the development of immunity to a variety of experimental tumors, although most of these were inherently immunogenic. We have determined the effect of expression of these genes on the induction of immunity to 2 non-immunogenic murine malignant mesothelioma (MM) cell lines (AC29 and AB1). We had previously shown that B7-1 transfection into AC29 delayed but did not prevent tumor development by certain of the transfectant clones. Here we demonstrate that over-expression of B7-1 can inhibit tumor development by certain AB1-B7-1 clones, that inhibition of transfectant growth is dependent on CD4+ and CD8+ T cells and that mice that reject some of these transfectant clones are capable of rejecting subsequent inocula of the parental cell line, AB1. The transfectant clones can generate tumor-specific cytotoxic T cells. By contrast, expression of B7-2 in several clones derived from either AB1 or AC29 had no significant effect on the development of tumors in vivo. Our data are consistent with data from other systems that show differences in the effect of modification by B7-1 or B7-2 on the modulation of anti-tumor immune responses. They demonstrate that such modifications can induce protective immunity against an MM cell line but confirm the intra- and inter-tumoral heterogeneity in the effect of genetic modification on the induction of immunity. Our observations are relevant to human MM because these cell lines have been derived from asbestos-induced tumors and share many properties with human cell lines of the same histological type.
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Affiliation(s)
- C C Leong
- Australian Neuromuscular Research Institute, Queen Elizabeth II Medical Centre, Nedlands
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Leong CC, Marley JV, Robinson BWS, Garlepp MJ. B7-1 transfection can abrogate tumor non-immunogenicity but in vivo tumor outgrowth occurs via a decay in ctlactivity. Lung Cancer 1996. [DOI: 10.1016/0169-5002(96)81602-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Marley JV, Leong CC, Robinson BWS, Garlepp MJ. Coexpression of allogeneic MHC and a costimulatory molecule (B7-1) augments the immune response to a mesothelioma cell line. Lung Cancer 1996. [DOI: 10.1016/0169-5002(96)81603-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abraham LJ, Marley JV, Nedospasov SA, Cambon-Thomsen A, Crouau-Roy B, Dawkins RL, Giphart MJ. Microsatellite, restriction fragment-length polymorphism, and sequence-specific oligonucleotide typing of the tumor necrosis factor region. Comparisons of the 4AOHW cell panel. Hum Immunol 1993; 38:17-23. [PMID: 7905869 DOI: 10.1016/0198-8859(93)90515-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The location of the TNF and other genes in the central MHC and their possible relevance to disease susceptibility provided an impetus to develop useful typing markers. The 4AOHW undertook to assess the various markers available, including DNA sequence-based systems. A panel of well-characterized lymphoblastoid cell lines were typed by Nco I RLFP analysis, SSO typing, and TNF microsatellite typing. RFLP and SSO typing were relatively reproducible as judged by the blind replicates. The two techniques provided the same results with only one exception, and it would be reasonable to prefer SSO typing because of its advantages in terms of cost and time. Microsatellite typing was much more discriminating but, as expected, less robust in that some discrepancies were apparent. As a result of the workshop and subsequent testing, alleles and haplotypes were allocated to most cells within the 4AOHW panel, including 10W cells typed in previous studies. While there was evidence that microsatellites may be relatively stable, they have the potential to identify recent mutations within ancestral haplotypes.
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Affiliation(s)
- L J Abraham
- Department of Clinical Immunology, Royal Perth Hospital, Western Australia
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