Ten principles relevant to health research among Indigenous Australian populations

As committed Indigenous health researchers in Australia, these researchers aim to provide the answers to key questions relating to health that might enable Indigenous Australians to live the lives that they would choose to live. Working with Indigenous communities towards research that is relevant, effective and culturally respectful Writing in the Journal about Indigenous health in 2011, Sir Michael Marmot suggested that the challenge was to conduct research, and to ultimately apply findings from that research, to enable Indigenous Australians to lead more flourishing lives that they would have reason to value.1 As committed Indigenous health researchers in Australia, we reflect Marmot’s ideal — to provide the answers to key questions relating to health that might enable Indigenous Australians to live the lives that they would choose to live. As a group, we have over 120 collective years’ experience in Indigenous health research. Over this time, particularly in recent years as ethical guidelines have come into play, there have been many examples of research done well. However, as the pool of researchers is constantly replenished, we hold persisting concerns that some emerging researchers may not be well versed in the principles of best practice regarding research among Indigenous Australian populations. Implementing any research methodology among Indigenous Australian groups will work best when the following 10 principles are met. These principles are reflected in the many documents related to working and researching with Indigenous Australians; for example, the National Health and Medical Research Council (NHMRC) ethical guidelines for research among Aboriginal and Torres Strait Islander people.2 In this article, we set out these principles in one short, accessible document.   Download PDF Authors: Lisa M Jamieson, Yin C Paradies, Sandra Eades, Alwin Chong, Louise Maple-Brown, Peter Morris, Ross Bailie, Alan Cass, Kaye Roberts-Thomson and Alex Brown. Image: OpalMirror / flick

Indigenous and Non-Indigenous Child Oral Health in Three Australian States and Territories

Objectives: To explore the prevalence and severity of Indigenous and non-Indigenous child dental disease in relation to age, sex, residential location and socio-economic status in three Australian states and territories

Political economy, trade relations and health inequalities: lessons from general health

This article argues that health outcomes, specifically nutrition related health outcomes, are socially determined, and can be linked to a wider political economy in which peoples’ dietary consumption is structurally determined, evolving from political, economic and social forces. The article examines trade and investment agreements as regulatory vehicles that cultivate poor dietary consumption and inequalities in health outcomes between and within countries. How does this happen? The liberalization of trade and investment, and unfettered influence of powerful economic interests including transnational food and beverage companies has resulted in trade agreements that enable excess availability, affordability and acceptability of highly processed, nutrient poor foods worldwide, ultimately resulting in poor nutrition and consequently oral and other non-communicable diseases. These trade and nutrition policy tensions shine a spotlight on the challenges ahead for global health and development policies, including achievement of the Sustainable Development Goals

Review of Indigenous Oral Health

Indigenous Australians1 have poorer oral health than other Australians [1, 2]. Indigenous people suffer from more caries, periodontal diseases, and tooth loss than non-Indigenous people [3]. Tooth decay among the Indigenous population more commonly goes untreated, leading to more extractions. This discrepancy is attributed in part to the fact that access to culturally appropriate and timely dental care is often not available to Indigenous people, especially in rural and remote areas. Other information on oral health such as culturally appropriate resources about maintaining healthy teeth and mouths, and nutritional guidance on how much sugar is contained in certain foods and drinks, is also less available for the Indigenous Australian population. If Indigenous oral health is to be ameliorated, access to dental care must be improved, and an integrated holistic approach to oral health, which includes preventative measures, needs to be established

Why some species of birds do not avoid inbreeding: Insights from New Zealand robins and saddlebacks

When dispersal options are limited and encounters with relatives are likely, individuals need to recognize and avoid mating with kin to avoid the fitness costs of close inbreeding. New Zealand robins and saddlebacks are genetically monogamous and possess life-history traits that predict they should show zero tolerance of close inbreeding. However, of 11 population-years of pedigree data, there was evidence of inbreeding avoidance in only 1 year. We also found no indication that incestuous pairings were avoided or that individuals were choosing genetically dissimilar mates based on microsatellite DNA analysis. Furthermore, a review of the literature revealed that inbreeding avoidance via kin recognition is common in cooperatively breeding birds, but pair-breeding birds such as robins and saddlebacks mate randomly with respect to relatedness. A model that incorporates encounter rates with close kin for various degrees of mate-searching effort shows that inbreeding avoidance is beneficial at intermediate to high levels of encounter rates with close kin (as found in cooperative breeders), but that random mating is more beneficial at low or extremely high encounter rates. We conclude that random mating normally results in such low rates of close inbreeding that it exerts negligible selection pressure to evolve kin recognition. Consequently, many threatened species are unlikely to have a natural built-in mechanism for avoiding close inbreeding, and the assumption of random mating built into many population viability models may be appropriate

assessment of pain-related fear in individuals with chronic painful conditions

Background: Heightened fear and anxiety related to pain may result in emotional and behavioral avoidance responses causing disability, distress, and depression. Fear and anxiety associated with pain can potentially change the course of the pain experience. It is plausible that fear and anxiety related to pain affect the duration and frequency of pain experienced by the patient. Aim: The study aimed to examine the applicability of the Fear of Pain Questionnaire-III (FPQ-III) in identifying who are likely to report longer duration and greater frequency of pain experience. Methods: To test this hypothesis, a cross-sectional study was conducted with 579 individuals from a community-based sample living with chronic pain. The factor structure and validity of FPQ-III in the community-based sample were also tested. Results: The findings suggest higher fear of severe pain but lower fear of medical pain, associ- ated with longer duration and more frequent pain experience. The analysis also confirmed the three-factor structure of FPQ-III, demonstrating good internal consistency for fear of severe pain (0.71) and fear of medical pain (0.73) and acceptable range for fear of minor pain (0.65). Conclusion: These findings suggest that the FPQ-III can be potentially applied to identify individuals at risk for prolonged continuous pain and as a screening tool to measure fear and anxiety related to pain

A phase I pharmacokinetic and pharmacodynamic study of the oral mitogen-activated protein kinase kinase (MEK) inhibitor, WX-554, in patients with advanced solid tumours

Purpose: We performed a multi-centre phase I study to assess the safety, pharmacokinetics (PK) and pharmacodynamics (PD) of the orally available small molecule mitogen-activated protein kinase kinase (MEK) 1/2 inhibitor, WX-554, and to determine the optimal biological dose for subsequent trials. Experimental design: Patients with treatment-refractory, advanced solid tumours, with adequate performance status and organ function were recruited to a dose-escalation study in a standard 3 + 3 design. The starting dose was 25 mg orally once weekly with toxicity, PK and PD guided dose-escalation with potential to explore alternative schedules. Results: Forty-one patients with advanced solid tumours refractory to standard therapies and with adequate organ function were recruited in eight cohorts up to doses of 150 mg once weekly and 75 mg twice weekly. No dose-limiting toxicities were observed during the study, and a maximum tolerated dose (MTD) was not established. The highest dose cohorts demonstrated sustained inhibition of extracellular signal-regulated kinase (ERK) phosphorylation in peripheral blood mononuclear cells following ex-vivo phorbol 12-myristate 13-acetate stimulation. There was a decrease of 70 ± 26% in mean phosphorylated (p)ERK in C1 day 8 tumour biopsies when compared with pre-treatment tumour levels in the 75 mg twice a week cohort. Prolonged stable disease (>6 months) was seen in two patients, one with cervical cancer and one with ampullary carcinoma. Conclusions: WX-554 was well tolerated, and an optimal biological dose was established for further investigation in either a once or twice weekly regimens. The recommended phase 2 dose is 75 mg twice weekly