General practitioners’ perceptions of their communication with Australian Aboriginal patients with acquired neurogenic communication disorders

Objective: Aboriginal people have high rates of stroke and traumatic brain injury (TBI), often with residual, chronic communication deficits and multiple co-morbidities. This study examined general practitioners’ (GPs’) perceptions of their communication with Aboriginal patients with acquired communication disorders (ACD) after brain injury. Effective communication underpins good care but no previous research has explored this specific context. Methods: A qualitative descriptive approach was employed using interviews and focus groups with 23 GPs from metropolitan Perth and five regional sites in Western Australia. Data were analysed thematically. Results: GPs reported low visibility of Aboriginal patients with ACD in their practices, minimal training on neurogenic ACD, and difficulty distinguishing ACD from cultural-linguistic factors. They had few communication resources, and depended on families and Aboriginal Health Workers to assist in interactions. They rarely used formal interpreting services or referred to speech pathology. They reported communication (dis)ability having low priority in consultations. Conclusion: GPs report difficulty recognising ACD and their lack of prioritising assessment and treatment of communication ability after brain injury potentially compounds the disadvantage and disempowerment experienced by many Aboriginal people. Practice implications: GPs require further communication and cultural training. Improved access to speech pathology and formal interpreting services would be beneficial

Development of the Aboriginal Communication Assessment After Brain Injury (ACAABI): A screening tool for identifying acquired communication disorders in Aboriginal Australians

Purpose: Acquired communication disorders (ACD), following stroke and traumatic brain injury, may not be correctly identified in Aboriginal Australians due to a lack of linguistically and culturally appropriate assessment tools. Within this paper we explore key issues that were considered in the development of the Aboriginal Communication Assessment After Brain Injury (ACAABI) – a screening tool designed to assess the presence of ACD in Aboriginal populations. Method: A literature review and consultation with key stakeholders were undertaken to explore directions needed to develop a new tool, based on existing tools and recommendations for future developments. Result: The literature searches revealed no existing screening tool for ACD in these populations, but identified tools in the areas of cognition and social-emotional wellbeing. Articles retrieved described details of the content and style of these tools, with recommendations for the development and administration of a new tool. The findings from the interview and focus group views were consistent with the approach recommended in the literature. Conclusions: There is a need for a screening tool for ACD to be developed but any tool must be informed by knowledge of Aboriginal language, culture and community input in order to be acceptable and valid

Balance as bias, resolute on the retreat? Updates & analyses of newspaper coverage in the United States, United Kingdom, New Zealand, Australia and Canada over the past 15 years

Through this research, we systematically updated and expanded understanding of how the print media represent evidence of human contributions to climate change. We built on previous research that examined how the journalistic norm of balanced reporting contributed to informationally biased print media coverage in the United States (U.S.) context. We conducted a content analysis of coverage across 4856 newspaper articles over 15 years (2005&ndash;2019) and expanded previous research beyond U.S. borders by analyzing 17 sources in five countries: the United Kingdom (U.K.), Australia, New Zealand, Canada, and the U.S. We found that across all the years of analysis, 90% of the sample accurately represented climate change. In addition, our data suggests that scientifically accurate coverage of climate change is improving over time. We also found that media coverage was significantly less accurate in 2010 and significantly more accurate in 2015, in comparison to the sample average. Additionally, Canada&rsquo;s National Post, Australia&rsquo;s Daily Telegraph and Sunday Telegraph, and the U.K.&rsquo;s Daily Mail and Mail on Sunday (all historically conservative outlets) had significantly less accurate coverage of climate change over this time period than their counterparts.</p

“You felt like a prisoner in your own self, trapped”: The experiences of Aboriginal people with acquired communication disorders

Purpose: Aboriginal Australians are under-represented in brain injury rehabilitation services despite a high incidence of both stroke and traumatic brain injury in this population. This study aimed to explore the experiences of Aboriginal Australian adults with acquired communication disorders (ACDs) after brain injury for the first time to inform the development of accessible and culturally secure service delivery models. Methods and materials: Semi-structured interviews were undertaken with 32 Aboriginal people who had experienced a brain injury resulting in ACDs (aged 35–79 years) and 18 family members/carers across Western Australia. Thematic analysis identified common themes across participants. Results: Overall themes related to communication (both related to the communication disorder and general healthcare interactions), health and social contexts, recovery, and support, being away from family and country, knowledge and beliefs about brain injury, and follow-up. Conclusions: An increase in healthcare staff’s appreciation of the health and social contexts of Aboriginal people after brain injury is needed in order to improve communication with Aboriginal patients and the ability to offer accessible rehabilitation services. Ongoing support is required, with cultural identity noted as key to ensuring cultural security and ultimately recovery. Involvement of family and other Aboriginal people in recovery processes, as well as access to relevant Aboriginal languages and proximity to ancestral lands is central. Implications for rehabilitation Acknowledgment of cultural identity and strengths through involvement of extended family and Aboriginal Hospital Liaison Officers, access to language and proximity to country all central to rehabilitation planning for Aboriginal people after brain injury. Cultural security training for rehabilitation staff is recommended focusing on clear two-way communication skills to make medical information accessible for Aboriginal patients and to listen to patients’ concerns in a way that respects cultural context. Information regarding practical support and implications for ongoing management of life after brain injury (for the person and their family) is essential, and should supplement the medical-related information provided. Follow-up post discharge from hospital best facilitated through establishing contact with local Aboriginal community through Aboriginal community controlled health services, community elders, and Aboriginal health workers across organisations

Statistical analysis plan for the stepped-wedge clinical trial Healing Right Way - Enhancing rehabilitation services for Aboriginal Australians after brain injury

Background: Aboriginal Australians are known to suffer high levels of acquired brain injury (stroke and traumatic brain injury) yet experience significant barriers in accessing rehabilitation services. The aim of the Healing Right Way trial is to evaluate a culturally secure intervention for Aboriginal people with newly acquired brain injury to improve their rehabilitation experience and quality of life. Following publication of the trial protocol, this paper outlines the statistical analysis plan prior to locking the database. Methods: The trial involves a stepped wedge design with four steps over 3 years. Participants were 108 adult Aboriginal Australians admitted to one of eight hospitals (four rural, four urban) in Western Australia within 6 weeks of onset of a new stroke or traumatic brain injury who consented to follow-up for 26 weeks. All hospital sites started in a control phase, with the intervention assigned to pairs of sites (one metropolitan, one rural) every 26 weeks until all sites received the intervention. The two-component intervention involves training in culturally safe care for hospital sites and enhanced support provided to participants by Aboriginal Brain Injury Coordinators during their hospital stay and after discharge. The primary outcome is quality of life as measured by the Euro QOL–5D-3L VAS. A mixed effects linear regression model will be used to assess the between-group difference at 26 weeks post-injury. The model will control for injury type and severity, age at recruitment and time since commencement of the trial, as fixed effects. Recruitment site and participant will be included as random effects. Secondary outcomes include measurements of function, independence, anxiety and depression, carer strain, allied health occasions of service received and hospital compliance with minimum processes of care based on clinical guidelines and best practice models of care. Discussion: The trial will provide the first data surrounding the effectiveness of an intervention package for Aboriginal people with brain injury and inform future planning of rehabilitation services for this population. The statistical analysis plan outlines the analyses to be undertaken. Trial registration: Australia New Zealand Clinical Trials Registry ACTRN12618000139279. Registered 30 January, 2018

The 2018 report of the Lancet Countdown on health and climate change: shaping the health of nations for centuries to come

The Lancet Countdown: tracking progress on health and climate change was established to provide an independent, global monitoring system dedicated to tracking the health dimensions of the impacts of, and the response to, climate change. The Lancet Countdown tracks 41 indicators across five domains: climate change impacts, exposures, and vulnerability; adaptation, planning, and resilience for health; mitigation actions and health co-benefits; finance and economics; and public and political engagement. This report is the product of a collaboration of 27 leading academic institutions, the UN, and intergovernmental agencies from every continent. The report draws on world-class expertise from climate scientists, ecologists, mathematicians, geographers, engineers, energy, food, livestock, and transport experts, economists, social and political scientists, public health professionals, and. doctors. The Lancet Countdown’s work builds on decades of research in this field, and was first proposed in the 2015 Lancet Commission on health and climate change,1 which documented the human impacts of climate change and provided ten global recommendations to respond to this public health emergency and secure the public health benefits available (panel 1)

The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises

The Lancet Countdown is an international collaboration, established to provide an independent, global monitoring system dedicated to tracking the emerging health profile of the changing climate. The 2020 report presents 43 indicators across five sections: climate change impacts, exposures, and vulnerability; adaptation, planning, and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. This report represents the findings and consensus of the 35 leading academic institutions and UN agencies that make up the Lancet Countdown, and draws on the expertise of climate scientists, geographers, and engineers; of energy, food, and transport experts; and of economists, social and political scientists, data scientists, public health professionals, and doctors

General Practitioners\u27 Perceptions of Barriers to Servicing Aboriginal people with Acquired Communication Disorders in WA

Stroke and traumatic brain injury (TBI) occur at higher rates and at younger ages in Aboriginal adults as compared to the non-Aboriginal population. Approximately one third of people post stroke experience acquired communication disorders (ACDs) and cognitive communication disorders are also common following (TBI). General practitioners (GPs) are often the initial point of contact into the health system for people in the community, including those discharged from hospital and rehabilitation following stroke or TBI. GPs’ decisions about ongoing referrals and management of health conditions may have a considerable influence on the opportunities, decisions and care of Aboriginal people with ACD. However, there is almost no published information on how GPs view working with this client group and what issues they view as important or challenging. This presentation is based on individual and group interviews with 14 GPs working in metropolitan, and regional settings across WA and carried out as part of the larger NHMRC-funded Missing Voices study. Our presentation uses thematic analysis of these transcribed interviews to draw out key issues which GPs consider influences their ability to service Aboriginal patients with ACD, their understanding of the nature and potential recovery trajectories of ACD and perceptions of their clients’ needs. Our findings suggest that ACD is not always fully understood by GPs, presents with very particular challenges, and increases risk of falling through gaps in services. The communication difficulties experienced by Aboriginal people with ACD often compound an already complex picture of health and social care issues, and leave this population vulnerable to further disadvantage. More could be done to prepare, inform and assist GPs in managing Aboriginal people with ACD

Middle Eastern Newspaper Coverage of Climate Change or Global Warming, 2004-2020 - April 2020

The Media and Climate Change Observatory Data monitors 120 sources (across newspapers, radio and TV) in 55 countries in seven different regions around the world. Data is assembled by accessing archives through the Lexis Nexis, Proquest and Factiva databases via the University of Colorado libraries. More information may be found at: http://sciencepolicy.colorado.edu/media_coverage.</p