Health Service Use and Needs of Aboriginal Children in the Remote Fitzroy Valley, WA

Despite a focus on closing the gap between Aboriginal and non-Aboriginal child health outcomes in Australia, there remain significant challenges to provision of health services in very remote communities.The Fitzroy Valley is home to 4500 people, the majority (81%) Aboriginal from five language groups. In 2009, Indigenous leaders initiated a research partnership to conduct The Lililwan Project to address community priorities linked to Fetal Alcohol Spectrum Disorders (FASD) and prenatal alcohol exposure (PAE). Chapter One provides a Thesis introduction and context amidst the broader scope of the Lililwan Project. We aim to identify service gaps and inform future policy and planning for the Fitzroy Valley and similar remote Australian communities. This Thesis aimed to conduct a literature review to assess availability, access, and use of health services by children in remote Australia. Chapter Two encompasses a strategic search and review of 92 grey and peer-reviewed documents. This chapter highlights the paucity of information around remote dwelling children's access to and health service utilisation across Australia. It highlights difficulties in delivering services in these remote locations. These findings show knowledge gaps of which we aimed to fill in subsequent chapters. Chapter Three aimed to document existing paediatric services in the Fitzroy Valley. Semi-structured interviews were performed with clinicians/service managers from 17 key service providers. Qualitative analyses occurred throughout. We identified that service delivery is impacted by inadequacies in staffing, infrastructure, funding complexities, service coordination, large geographic areas and extreme environment. There is a critical shortage of Aboriginal Health Workers (AHW) and a dearth of comprehensive preventative and primary health care. This work will inform future health service planning and staffing strategies. In Chapter Four we review lifetime (0-7 years) admissions to hospital for the Lililwan cohort. 70% of children had at least one admission (total 314 admissions, median 5, range 1-12). Infants (N=56) accounted for 38.6% of admissions. Primary admission reasons were infections including: lower respiratory; gastrointestinal; upper respiratory. Comorbidities were common. Many hospitalisations were feasibly preventable. The high rates may reflect disadvantage and limited access to outpatient and preventative health services. Chapter Five aimed to review emergency department (ED) presentations to the Fitzroy Crossing Hospital (between 2007-11) for the Lililwan cohort. There were 1058 presentations over 5-years. Most children (81%) had at least one presentation (median 9.0, range 1-50). Common presentations were for screening/follow-up/social reasons, injury, diseases of the ear, skin, respiratory tract. Children with prenatal alcohol exposure (PAE) presented at higher rates. Socio-economic factors were associated. Many presentations were potentially preventable. There is a need for culturally appropriate public health preventative strategies and improved access to primary health services. Chapter Six provides a summary of the principal findings of this Thesis, describes the implications, proposes directions for future research and presents recommendations. In conclusion, this Thesis provides the first population-based cohort study of predominantly Aboriginal children with PAE and FASD. The findings provide new information regarding children's access to and utilisation of health services in remote Australian communities. This demonstrates the significant challenges that children with complex chronic and acute health needs in remote Australia face. This has significant implications for informing future health services and workforce planning in remote Australia. Future work in this area is key to ensure the health and wellbeing needs of this particularly vulnerable group of children are met

Immunoglobulin Allotypes in Several North American Eskimo Populations

This is the published version. Copyright 1990 Wayne State University Press.Genetic data consisting of immunoglobulin testing (GM and KM) from 631 Eskimos from 5 populations are reported. These populations are Savoonga, Gambell (St. Lawrence Island), Wales, King Island, and Mckenzie Delta, Baffin Island. The GM and KM haplotypes are analyzed and compared to those occurring in Greenland, Canadian, Alaskan, and Siberian Eskimos and to other Siberian indigenous populations. These analyses suggest that during the peopling of the New World, four separate migrant groups crossed Beringia at various times

Pediatric hospital admissions in Indigenous children: a population-based study in remote Australia

Background: We analysed hospital admissions of a predominantly Aboriginal cohort of children in the remote Fitzroy Valley in Western Australia during the first 7 years of life. Methods: All children born between January 1, 2002 and December 31, 2003 and living in the Fitzroy Valley in 2009-2010 were eligible to participate in the Lililwan Project. Of 134 eligible children, 127 (95%) completed Stage 1 (interviews of caregivers and medical record review) in 2011 and comprised our cohort. Lifetime (0-7 years) hospital admission data were available and included the dates, and reasons for admission, and comorbidities. Conditions were coded using ICD-10-AM discharge codes. Results: Of the 127 children, 95.3% were Indigenous and 52.8% male. There were 314 admissions for 424 conditions in 89 (70.0%) of 127 children. The 89 children admitted had a median of five admissions (range 1-12). Hospitalization rates were similar for both genders (p = 0.4). Of the admissions, 108 (38.6%) were for 56 infants aged <12 months (median = 2.5, range = 1-8). Twelve of these admissions were in neonates (aged 0-28 days). Primary reasons for admission (0-7 years) were infections of the lower respiratory tract (27.4%), gastrointestinal system (22.7%), and upper respiratory tract (11.4%), injury (7.0%), and failure to thrive (5.4%). Comorbidities, particularly upper respiratory tract infections (18.1%), failure to thrive (13.6%), and anaemia (12.7%), were common. In infancy, primary cause for admission were infections of the lower respiratory tract (40.8%), gastrointestinal (25.9%) and upper respiratory tract (9.3%). Comorbidities included upper respiratory tract infections (33.3%), failure to thrive (18.5%) and anaemia (18.5%). Conclusion: In the Fitzroy Valley 70.0% of children were hospitalised at least once before age 7 years and over one third of admissions were in infants. Infections were the most common reason for admission in all age groups but comorbidities were common and may contribute to need for admission. Many hospitalizations were feasibly preventable. High admission rates reflect disadvantage, remote location and limited access to primary healthcare and outpatient services. Ongoing public health prevention initiatives including breast feeding, vaccination, healthy diet, hygiene and housing improvements are crucial, as is training of Aboriginal Health Workers to increase services in remote communities.The Lililwan project is supported by the National Health and Medical Research Council of Australia (NHMRC) (Elizabeth Elliott, Practitioner Fellowships 457,084 and 1,021,480, and project grant 1,024,474); the Australian Research Council (Jane Latimer, Future Fellowship 0130007); the Australian Government Departments of Health and Ageing (DoHA); and Families, Housing, Community Services and Indigenous Affairs (FaHCSIA); Save the Children Australia, the Foundation for Alcohol Research and Education and the University of Sydney Poche Institute (Philippa Dossetor, Poche Scholarship). Pro bono support has been provided by M&C Saatchi, Blake Dawson solicitors, and the Australian Human Rights Commission. Alexandra Martiniuk is funded by an NHMRC TRIP (Translating Research into Practice) Fellowship (2016–2018). Philippa Dossetor is supported by a parttime PhD scholarship through the Australian National University Medical School and the College of Biology, Medicine and the Environment

A telephone- and text-message based telemedical care concept for patients with mental health disorders - study protocol for a randomized, controlled study design

<p>Abstract</p> <p>Background</p> <p>As in other countries worldwide, the prevalence of mental disorders in Germany is high. Although numerically a dense network of in- and outpatient psychiatric health services exists, the availability in rural and remote regions is insufficient.</p> <p>In rural regions, telemedical concepts can be a chance to unburden and complement the existing healthcare system. Telemedical concepts consisting of video or telephone consulting show first positive results, but there are only a few studies with a randomized controlled design.</p> <p>To improve the treatment of patients with mental disorders in rural regions, we developed a telemedical care concept based on telephone contacts and text-messages. The primary objective of this study is to evaluate the effects of the telemedical interventions on psychopathological outcomes, e. g. anxiety, depressive symptoms, and somatisation. Secondary objective of the study is the analysis of intervention effects on the frequency of medical contacts with healthcare services. Furthermore, the frequency of patients' crises and the frequency and kind of interventions, initiated by the project nurses will be evaluated. We will also evaluate the acceptance of the telemedical care concept by the patients.</p> <p>Methods/Design</p> <p>In this paper we describe a three-armed, randomized, controlled study. All participants are recruited from psychiatric day hospitals. The inclusion criteria are a specialist-diagnosed depression, anxiety disorder, adjustment disorder or a somatoform disorder and eligibility to participate in the study. Exclusion criteria are ongoing outpatient psychotherapy, planned interval treatment at the day clinic and expected recurrent suicidality and self-injuring behaviour.</p> <p>The interventions consist of regular patient-individual telephone consultations or telephone consultations with complementing text-messages on the patients' mobile phone. The interventions will be conducted during a time period of 6 months.</p> <p>Trial registration</p> <p>This study is registered in the German Clinical Trials Register (DRKS00000662).</p

Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders

<p>Abstract</p> <p>Background</p> <p>Individuals with autism spectrum disorders (ASDs) often display symptoms from other diagnostic categories. Studies of clinical and psychosocial outcome in adult patients with ASDs without concomitant intellectual disability are few. The objective of this paper is to describe the clinical psychiatric presentation and important outcome measures of a large group of normal-intelligence adult patients with ASDs.</p> <p>Methods</p> <p>Autistic symptomatology according to the DSM-IV-criteria and the Gillberg & Gillberg research criteria, patterns of comorbid psychopathology and psychosocial outcome were assessed in 122 consecutively referred adults with normal intelligence ASDs. The subjects consisted of 5 patients with autistic disorder (AD), 67 with Asperger's disorder (AS) and 50 with pervasive developmental disorder not otherwise specified (PDD NOS). This study group consists of subjects pooled from two studies with highly similar protocols, all seen on an outpatient basis by one of three clinicians.</p> <p>Results</p> <p>Core autistic symptoms were highly prevalent in all ASD subgroups. Though AD subjects had the most pervasive problems, restrictions in non-verbal communication were common across all three subgroups and, contrary to current DSM criteria, so were verbal communication deficits. Lifetime psychiatric axis I comorbidity was very common, most notably mood and anxiety disorders, but also ADHD and psychotic disorders. The frequency of these diagnoses did not differ between the ASD subgroups or between males and females. Antisocial personality disorder and substance abuse were more common in the PDD NOS group. Of all subjects, few led an independent life and very few had ever had a long-term relationship. Female subjects more often reported having been bullied at school than male subjects.</p> <p>Conclusion</p> <p>ASDs are clinical syndromes characterized by impaired social interaction and non-verbal communication in adulthood as well as in childhood. They also carry a high risk for co-existing mental health problems from a broad spectrum of disorders and for unfavourable psychosocial life circumstances. For the next revision of DSM, our findings especially stress the importance of careful examination of the exclusion criterion for adult patients with ASDs.</p

Experiences of Receiving a Diagnosis of Autism Spectrum Disorder: A Survey of Adults in the United Kingdom

A total of 128 adults with high-functioning autism spectrum disorders were surveyed concerning the process they went through to obtain their diagnosis and the subsequent support they received. Results suggested that routes to diagnosis were quite heterogeneous and overall levels of satisfaction with the diagnostic process were mixed; 40 % of respondents were ‘very/quite’ dissatisfied, whilst 47 % were ‘very/quite’ satisfied. The extent of delays, number of professionals seen, quality of information given at diagnosis and levels of post-diagnostic support predicted overall satisfaction with the diagnostic process. Important areas and suggestions for improvement were noted for all stages of the diagnostic pathway. Respondents also displayed above average levels of depressed mood and anxiety, with greater support being requested in this area