Indigenous health program evaluation design and methods in Australia: a systematic review of the evidence

OBJECTIVE: Indigenous Australians experience a disproportionately higher burden of disease compared to non-Indigenous Australians. High-quality evaluation of Indigenous health programs is required to inform health and health services improvement. We aimed to quantify methodological and other characteristics of Australian Indigenous health program evaluations published in the peer-reviewed literature. METHODS: Systematic review of peer-reviewed literature (November 2009-2014) on Indigenous health program evaluation. RESULTS: We identified 118 papers describing evaluations of 109 interventions; 72.0% were university/research institution-led. 82.2% of evaluations included a quantitative component; 49.2% utilised quantitative data only and 33.1% used both quantitative and qualitative data. The most common design was a before/after comparison (30.5%, n=36/118). 7.6% of studies (n=9/118) used an experimental design: six individual-level and three cluster-randomised controlled trials. 56.8% (67/118) reported on service delivery/process outcomes (versus health or health risk factor outcomes) only. CONCLUSIONS: Given the number of Indigenous health programs that are implemented, few evaluations overall are published in the peer-reviewed literature and, of these, few use optimal methodologies such as mixed methods and experimental design. Implications for public health: Multiple strategies are required to increase high-quality, accessible evaluation in Indigenous health, including supporting stronger research-policy-practice partnerships and capacity building for evaluation by health services and government.This research received support from the Australian Primary Health Care Research Institute, Australian National University

Indirect effects of the COVID-19 pandemic on paediatric healthcare use and severe disease: a retrospective national cohort study

OBJECTIVES: To determine the indirect consequences of the COVID-19 pandemic on paediatric healthcare utilisation and severe disease at a national level following lockdown on 23 March 2020. DESIGN: National retrospective cohort study. SETTING: Emergency childhood primary and secondary care providers across Scotland; two national paediatric intensive care units (PICUs); statutory death records. PARTICIPANTS: 273 455 unscheduled primary care attendances; 462 437 emergency department attendances; 54 076 emergency hospital admissions; 413 PICU unplanned emergency admissions requiring invasive mechanical ventilation; and 415 deaths during the lockdown study period and equivalent dates in previous years. MAIN OUTCOME MEASURES: Rates of emergency care consultations, attendances and admissions; clinical severity scores on presentation to PICU; rates and causes of childhood death. For all data sets, rates during the lockdown period were compared with mean or aggregated rates for the equivalent dates in 2016–2019. RESULTS: The rates of emergency presentations to primary and secondary care fell during lockdown in comparison to previous years. Emergency PICU admissions for children requiring invasive mechanical ventilation also fell as a proportion of cases for the entire population, with an OR of 0.52 for likelihood of admission during lockdown (95% CI 0.37 to 0.73), compared with the equivalent period in previous years. Clinical severity scores did not suggest children were presenting with more advanced disease. The greatest reduction in PICU admissions was for diseases of the respiratory system; those for injury, poisoning or other external causes were equivalent to previous years. Mortality during lockdown did not change significantly compared with 2016–2019. CONCLUSIONS: National lockdown led to a reduction in paediatric emergency care utilisation, without associated evidence of severe harm

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

The positioning of Indigenous Australians as healthcare recipients

The everyday operations of Australia's socioeconomic, racial, and cultural hierarchies have health consequences for Indigenous Australians. By comparing the socioeconomic and demographic positioning of Indigenous and non-Indigenous Australians, we explore how the dominant "being" and "doing" of those who operate and control the health system impact Indigenous Australians. The ramifications of the ontological chasm between the two are then demonstrated in what happens, or not, around the seemingly straightforward task of collecting Indigenous status data for health statistics

Are you Aboriginal and/or Torres Strait Islander?: improving data collection at BreastScreen Victoria

Objective: To evaluate the ascertainment and recording of clients' Indigenous status at BreastScreen Victoria (BSV) by assessing: staff compliance with best practice recommendations in ascertaining Indigenous status data collection practices; and the consistency of recording of Indigenous status between visits. Methods: The Australian Bureau of Statistics/Australian Institute of Health and Welfare best practice recommendations for collecting Indigenous status data were compared against BSV practices. One hundred and thirty-three BSV staff were also surveyed about their practices of ascertaining Indigenous status. An audit of the consistency of recording Indigenous status at first and most recent visit to BSV was also conducted. Results: Current ascertainment and recording of Indigenous status by BSV staff does not comply with best practice recommendations. A high proportion of staff were not ascertaining Indigenous status (34%), and/or perceived they were prevented from asking women whether they were Indigenous (53%). The consistency of recording of Indigenous status between women's visits was also low. Implications: Our findings are likely to be found in other services where collection of Indigenous status data occurs. To improve data collection, services need to: ensure questions regarding Indigenous status comply with best practice recommendations; provide staff training regarding the importance of collecting the information; and improve Indigenous participation and control of data collection and dissemination

Investment in prisons: an investment in social exclusion? Linking the theories of Justice Reinvestment and Social exclusion to examine Australia's propensity to incarcerate

Much of the conceptual space occupied by Justice Reinvestment theory suggests clear links with the theoretical framework of Social Inclusion and therein understandings of the social determinants of health. This article seeks to explore this mutually interested and unified relationship, and furthermore examine how their combined adoption in Australia would provide benefits for the general population as well as those in contact with the criminal justice system. Despite the existence of consistently strong links between social disadvantage and imprisonment, it is apparent the social determinants of health have yet to adequately address their implications for incarceration. Forming these links, this article will introduce and explore the notion of the social determinants of incarceration. Moreover, the importance of the social and economic imperatives to be realised through the adoption of Justice Reinvestment ideals will be argued, in turn providing explanation for why the coalescing of Justice Reinvestment and Social Inclusion is fundamentally important to consider. Therefore, we hope to prompt insightful questioning of our current institutional processes such as: Is investment in new prisons really investment in social exclusion

Physics

Turbulent flow over homogeneous canopies with gaps of various lengths - The fluid flow within a canopy of uniform, densely packed elements containing a gap of various lengths was measured using planar particle image velocimetry. The model was submerged within a water channel in an open channel configuration with a flow depth three times the height of the canopy. The canopy included a gap which measured 0.5, 1, 2, 3, or 4 times the canopy height. The Reynolds number based on the submergence depth of the flow was found to be 12,600. Based on mean flow quantifications and turbulence statistics, the flow within the gap was found to fall into two regimes based on the ratio of the gap length to gap height. For the short gap regime, the shear layer at the top of the gap does not experience vertical growth and therefore the turbulence does not penetrate into the gap; however, for the long gap regime, the shear layer experiences significant vertical growth and enhances mixing within the gap. When compared to a solid cavity, significant differences are found in the behavior of the shear layer that develops at the top of the gap. Finally, a fluctuating velocity cross-correlation was performed to analyze the structure of vortices across the top of the canopy and over the canopy gap and additional differences were noted in the development of vortical structures over the gap when compared to the solid cavity.; Isothermal Crystallization of Poly(Vinyl Alcohol-co Ethylene) - Isothermal crystallization of the copolymer Poly(Vinyl Alcohol-co-Ethylene) was studied, with an ethylene content of 27%. Using a differential scanning calorimeter (DSC), the copolymer was crystallized between 160 and 180 degrees C. The crystallization kinetics were analyzed using the Avrami and Hoffman-Weeks methods. The overall morphology and crystal growth were determined from fitting parameters.; Rutherford Backscattering Spectrometry of Lead-Iron Diffusion - Accurate constraints of the diffusion closure temperature in radioisotope thermal-chronometers of early Solar System allow for greater accuracy in the dating of rocky bodies. These closure temperatures can be estimated based on the composition and geometry of the body, along with information about the diffusion coefficient and activation energy of the specific radioisotopes inside the body. Thin film diffusion experiments were performed on nine samples of pure iron pellets coated with 100nm of lead. These samples were subjected to heating at either 600°C for up to ten days, or 750°C for up to twenty-three hours, allowing for sufficient diffusion of the coating into the medium. The diffused samples were analysed at the University of Albany Ion Beam Laboratory using Rutherford Backscattering spectrometry (RBS). RBS spectra were processed using SIMNRA, an ion beam analysis program for Windows, to generate concentration profiles of the diffused lead. These profiles were fit to the thin-film solution to Fick\u27s Second Law linear diffusion equation, returning diffusion coefficients for Pb in Fe 600°C and 750°C. Our results give an activation energy of 364±53 kJ/mol, within reason of expected values for diffusion in metals. This information can be used in tandem with other work in this ongoing project