Understanding experiences of Aboriginal and/or Torres Strait Islander patients at the emergency departments in Australia

Objectives: The present study describes the experiences of Aboriginal and/or Torres Strait Islander patients and the factors that shaped their experiences of ED visits in regional settings. Methods: This is a qualitative descriptive study. We conducted semi-structured in-depth interviews with Aboriginal and/or Torres Strait Islander patients who used the ED services at three hospitals in New South Wales, Northern Territory and South Australia. We coded the collected data and analysed them using a thematic analysis technique. Results: A total of 33 Aboriginal and/or Torres Strait Islander patients participated. Analyses of their experiences revealed four themes, which included: (i) patients' waiting times in ED; (ii) cultural determinants of health; (iii) treatment services; and (iv) safety, security and privacy. Conclusions: A holistic approach and a robust hospital commitment to address cultural needs while considering overall health, social and emotional wellbeing, will enhance Aboriginal and/or Torres Strait Islander patients' satisfaction for ED visits

Development and use of prediction models for classification of cardiovascular risk of remote indigenous Australians

Background: Cardiovascular disease (CVD) is the leading cause of death for Indigenous Australians. There is widespread belief that current tools have deficiencies for assessing CVD risk in this high-risk population. We sought to develop a 5-year CVD risk score using a wide range of known risk factors to further improve CVD risk prediction in this population.Methods: We used clinical and demographic information on Indigenous people aged between 30 and 74 years without a history of CVD events who participated in the Well Person's Health Check (WPHC), a community-based survey. Baseline assessments were conducted between 1998 and 2000, and data were linked to administrative hospitalisation and death records for identification of CVD events. We used Cox proportional hazard models to estimate the 5-year CVD risk, and the Harrell's c-statistic and the modified Hosmer-Lemeshow (mH-L) χ2 statistic to assess the model discrimination and calibration, respectively.Results: The study sample consisted of 1,583 individuals (48.1% male; mean age 45.0 year). The risk score consisted of sex, age, systolic blood pressure, diabetes mellitus, waist circumference, triglycerides, and albumin creatinine ratio. The bias-corrected c-statistic was 0.72 and the bias-corrected mH-L χ2 statistic was 12.01 (p-value, 0.212), indicating good discrimination and calibration, respectively. Using our risk score, the CVD risk of the Indigenous Australians could be stratified to a greater degree compared to a recalibrated Framingham risk score.Conclusions: A seven-factor risk score could satisfactorily stratify 5-year risk of CVD in an Indigenous Australian cohort. These findings inform future research targeting CVD risk in Indigenous Australians

Parenting after a history of childhood maltreatment: a scoping review and map of evidence in the perinatal period

BACKGROUND AND AIMS:Child maltreatment is a global health priority affecting up to half of all children worldwide, with profound and ongoing impacts on physical, social and emotional wellbeing. The perinatal period (pregnancy to two years postpartum) is critical for parents with a history of childhood maltreatment. Parents may experience 'triggering' of trauma responses during perinatal care or caring for their distressed infant. The long-lasting relational effects may impede the capacity of parents to nurture their children and lead to intergenerational cycles of trauma. Conversely, the perinatal period offers a unique life-course opportunity for parental healing and prevention of child maltreatment. This scoping review aims to map perinatal evidence regarding theories, intergenerational pathways, parents' views, interventions and measurement tools involving parents with a history of maltreatment in their own childhoods. METHODS AND RESULTS:We searched Medline, Psychinfo, Cinahl and Embase to 30/11/2016. We screened 6701 articles and included 55 studies (74 articles) involving more than 20,000 parents. Most studies were conducted in the United States (42/55) and involved mothers only (43/55). Theoretical constructs include: attachment, social learning, relational-developmental systems, family-systems and anger theories; 'hidden trauma', resilience, post-traumatic growth; and 'Child Sexual Assault Healing' and socioecological models. Observational studies illustrate sociodemographic and mental health protective and risk factors that mediate/moderate intergenerational pathways to parental and child wellbeing. Qualitative studies provide rich descriptions of parental experiences and views about healing strategies and support. We found no specific perinatal interventions for parents with childhood maltreatment histories. However, several parenting interventions included elements which address parental history, and these reported positive effects on parent wellbeing. We found twenty-two assessment tools for identifying parental childhood maltreatment history or impact. CONCLUSIONS:Perinatal evidence is available to inform development of strategies to support parents with a history of child maltreatment. However, there is a paucity of applied evidence and evidence involving fathers and Indigenous parents.Catherine Chamberlain, Graham Gee, Stephen Harfield, Sandra Campbell, Sue Brennan, Yvonne Clark, Fiona Mensah, Kerry Arabena, Helen Herrman, Stephanie Brown, for the ‘Healing the Past by Nurturing the Future’ grou

Extra-academic transdisciplinarity and scientific pluralism : what might they learn from one another?

Peer reviewe

Evaluating Australian Indigenous community health promotion initiatives: a selective review

Effective health promotion interventions are critical to addressing the health needs of Indigenous people. We reviewed published and unpublished evaluation reports between 2000 and 2005 to identify practice issues pertinent to evaluators of Aboriginal and Torres Strait Islander health promotion initiatives. While the review of the literature was not systematic it was sufficiently comprehensive to provide a snapshot of evaluation practice currently in place within the Australian context. We found that published evaluation literature infrequently referred to the utilisation of guidelines for ethical research with Aboriginal and Torres Strait Islander peoples. The implications of this are that the importance and relevance of the guidelines for evaluative research are not being widely promoted or disseminated to evaluation practitioners and the role of the guidelines for improving evaluation practice remain unclear. While many innovative health promotion programs appear to have been highly regarded and well received by communities, the evaluation studies were not always able to report conclusively on the impact and health outcomes of these interventions or programs. This was due mainly to limitations in evaluation design that in some cases were insufficiently robust to measure the complex and multifaceted interventions described. To enhance rigour, evaluators of community health promotion initiatives could utilise mixed method approaches overtly informed by appropriate ethical guidelines, together with a broader range of qualitative methods aided by critical appraisal tools to assist in the design of evaluation studies