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Indigenous people of the Torres Strait Islands have been concerned about the safety of their traditional seafoods since the discovery of high cadmium levels in the liver and kidney of dugong and turtle in 1996. This study explored links between urinary cadmium levels and consumption frequency of these traditional foods and piloted a community-based methodology to identify potential determinants of cadmium exposure and accumulation. Consultations led to selection of one community for study from which 60 women aged 30 to 50 years participated in health and food frequency survey, urine collection and a routine health check. Urinary cadmium levels were determined by inductively coupled plasma-mass spectrometry; data were analysed using SPSS-14. The geometric mean cadmium level in this group of women was 1.17 (arithmetic mean 1.86) μg/g creatinine with one-third exceeding 2.0 μg/g creatinine. Heavy smoking (≥300 pack years) was linked to higher cadmium in urine, as was increasing age and waist circumference. Analysis of age-adjusted residuals revealed significant associations (P<0.05) between cadmium level and higher consumption of turtle liver and kidney, locally gathered clams, peanuts, coconut, chocolate and potato chips. Dugong kidney consumption approached significance (P=0.06). Multiple regression revealed that 40% (adjusted r2) of variation in cadmium level was explained by the sum of these associated foods plus heavy smoking, age and waist circumference. No relationships between cadmium and pregnancy history were found. This paper presents a novel approach to explore contributions of foods and other factors to exposure to toxins at community level and the first direct evidence that frequent turtle (and possibly dugong) liver and kidney and wild clam consumption is linked to higher urinary cadmium levels among Torres Strait Islander women.Journal of Exposure Science and Environmental Epidemiology (2007) 17, 298–306. doi:10.1038/sj.jes.7500547; published online 24 January 2007 [ABSTRACT FROM AUTHOR]

Background: The patient-centred medical home (PCMH) is a model of team-based primary care that is patient-centred, coordinated, accessible, and focused on quality and safety. In response to substantial population growth and increasing demand on existing primary care services, the Institute for Urban Indigenous Health (IUIH) developed the IUIH System of Care-2 (ISoC2), based on an international Indigenous-led PCMH. ISoC2 was piloted at an urban Aboriginal and Torres Strait Islander Community-Controlled Health Service in South-East Queensland between 2019–2020, with further adaptations made to ensure its cultural and clinical relevance to local Aboriginal and Torres Strait Islander people. Little is known on the implementation and impact of PCMH in the Australian Indigenous primary care setting. Changes in implementation process measures and outcomes relating to engagement and quality-of-care are described here. Methods: De-identified routinely collected data extracted from electronic health records for clients regularly attending the service were examined to assess pre-post implementation changes relevant to the study. Process measures included enrolment in PCMH team-based care, and outcome measures included engagement with the health service, continuity-of-care and clinical outcomes. Results: The number of regular clients within the health service increased from 1,186 pre implementation to 1,606 post implementation; representing a small decrease as a proportion of the services' catchment population (38.5 to 37.6%). In clients assigned to a care team (60% by end 2020), care was more evenly distributed between providers, with an increased proportion of services provided by the Aboriginal and Torres Strait Islander Health Worker (16–17% versus 10–11%). Post-implementation, 41% of clients had continuity-of-care with their assigned care team, while total, preventive and chronic disease services were comparable pre- and post-implementation. Screening for absolute cardiovascular disease risk improved, although there were no changes in clinical outcomes. Conclusions: The increase in the number of regular clients assigned to a team and their even distribution of care among care team members provides empirical evidence that the service is transforming to a PCMH. Despite a complex transformation process compounded by the COVID-19 pandemic, levels of service delivery and quality remained relatively stable, with some improvements in risk factor screening. [ABSTRACT FROM AUTHOR]

Background: Indigenous people tend to exhibit a higher burden of disability than their non-Indigenous counterparts, and are often underserved by disability services. Engaging appropriately with Indigenous communities, families and individuals in the initial stages of disability assessment and planning is crucial in order to build trust and understanding of disability service models and ensure that Indigenous people receive support that is tailored to their needs and cultural realities. This article aims to identify key elements of culturally competent communication in Indigenous disability assessment and planning, and provide recommendations for strengthening capacity in this area. Methods: This qualitative research was designed to involve Aboriginal and Torres Strait Islander people at all stages and to reflect the views of Aboriginal and Torres Strait Islander researchers, people and families affected by disability and the community-controlled health sector. Semi-structured individual interviews were undertaken with staff implementing the National Disability Insurance Scheme (NDIS) (n = 4), NDIS participants (n = 24), disability support providers and organisational partners (n = 19) and Community Connectors (n = 8) in Queensland and the Northern Territory of Australia. Key themes derived from thematic analysis included appropriate and adequate engagement of individuals with disability and their families, the role of trusted relationships, and culturally safe and appropriate communication during planning meetings. Results: Overall, the research findings highlight that a low level of cultural competence in the initial stages of the disability assessment and planning process exacerbated participant confusion and distrust towards assessment staff and the NDIS. Given difficulties in communication, participant understanding of the NDIS was generally limited. The necessity of culturally safe and appropriate use of interpreters was stressed, as was the role of trusted individuals, including existing service providers, Community Connectors and family members in providing a solid base for participant understanding of the NDIS. Conclusions: Cultural competence in disability assessment and planning can be strengthened through multi-level engagement with the Aboriginal community-controlled sector and community leaders. Implementing mechanisms to enable the involvement of families, trusted service providers and Community Connectors can support a more meaningful understanding of individuals' needs within their cultural context and in relation to their cultural roles. [ABSTRACT FROM AUTHOR]