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Biological invasions are a main threat to biodiversity. Seebens et al. find that Indigenous Peoples' lands host 30% fewer alien species than other lands. This finding calls for additional examination of the drivers of such difference, from Indigenous Peoples' land management practices to the values that guide relations with nature. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionTo describe ophthalmic findings in an Indigenous paediatric population and the associations between fetal alcohol spectrum disorder (FASD), prenatal alcohol exposure (PAE), and eye anomalies.Medical records were reviewed for eye problems, and eye assessments were conducted by an orthoptist or ophthalmologist in the Lililwan Project cohort, which comprised 108 (81%) of all children born between 2002 and 2003, and residing in the remote Fitzroy Valley, Western Australia in 2010. Values from ophthalmic assessments and prevalence of abnormalities were presented for the total cohort and stratified by group: FASD; PAE (no FASD); and No PAE.Of children, 55% had PAE and 19% FASD. Most (98%) had normal vision; 15.6% had keratometry cylinder values indicating astigmatism and potential for improved vision with glasses. Strabismus (22.3%), short palpebral fissure length (PFL; 21.3%), upslanting palpebral fissures (12.0%), follicular trachomatous inflammation (6.9%), abnormal slit lamp assessments (6.7%), retinal tortuosity (6.7%), and blepharoptosis (5.6%) were identified. Strabismus and trachoma rates were higher than in the general child population. Ophthalmic findings were similar between groups except for prevalence of short PFL (FASD > No PAE; p = 0.003); abnormal keratometry cylinder values (FASD [29.4%] and PAE (no FASD) [20.0%] > No PAE [5.3%]; p = 0.031) and blepharoptosis (FASD [9.5%] > other groups [0%]; p = 0.040).Despite the small sample, some eye abnormalities were higher in children with PAE and/or FASD. Access to eye services or assessment of vision and structural eye anomalies is essential for Indigenous children, particularly those with PAE or FASD to allow early effective treatment. [ABSTRACT FROM AUTHOR]

In the Ngaanyatjarra Lands of desert Western Australia, older people are being encouraged to participate meaningfully in student education. This initiative is being led by two of the authors of this article, senior Ngaanyatjarra women, both of whom work with the Ngaanyatjarra Lands School with its campuses in eight remote communities spread over hundreds of kilometres. Elderly men and women, some of whom are residents in the Ngaanyatjarra Aged Care home (Ngaanyatjarra Health Service, 2021), are eagerly participating in the planning of bush trips, gathering their traditional resources, seeds, grinding stones, bush resins, recalling stories, songs, and dances—as they prepare for the bush camps with students. During the camps the schoolteachers step back and the elderly lead in what is known as two‐way science. At first glance, this work may look like it is simply focused on the educational needs of students with senior Yarnangu acting in a supporting role. However, this article will demonstrate the continuous connections and responsibilities, laid out in the Tjukurrpa (the Dreaming), between the old and the young, to their ancestral lands. It sets out how according to “Tjukurrpa thinking,” the principal way to provide good care is by helping senior people remain on country with family, pass on their knowledge to younger people, and thus keep strong languages and kurrunpa (people’s spirit) alive.

Aim: To examine whether differences in tacrolimus and mycophenolic acid (MPA) pharmacokinetics contribute to the poorer kidney transplant outcomes experienced by Aboriginal Australians. Methods: Concentration‐time profiles for tacrolimus and MPA were prospectively collected from 43 kidney transplant recipients: 27 Aboriginal and 16 Caucasian. Apparent clearance (CL/F) and distribution volume (V/F) for each individual were derived from concentration‐time profiles combined with population pharmacokinetic priors, with subsequent assessment for between‐group difference in pharmacokinetics. In addition, population pharmacokinetic models were developed using the prospective dataset supplemented by previously developed structural models for tacrolimus and MPA. The change in NONMEM objective function was used to assess improvement in goodness of model fit. Results: No differences were found between Aboriginal and Caucasian groups or empirical Bayes estimates, for CL/F or V/F of MPA or tacrolimus. However, a higher prevalence of CYP3A5 expressers (26% compared with 0%) and wider between‐subject variability in tacrolimus CL/F (SD = 5.00 compared with 3.25 L/h/70 kg) were observed in the Aboriginal group, though these differences failed to reach statistical significance (p =.07 and p =.08). Conclusion: There were no differences in typical tacrolimus or MPA pharmacokinetics between Aboriginal and Caucasian kidney transplant recipients. This means that Bayesian dosing tools developed to optimise tacrolimus and MPA dosing in Caucasian recipients may be applied to Aboriginal recipients. In turn, this may improve drug exposure and thereby transplant outcomes in this group. Aboriginal recipients appeared to have greater between‐subject variability in tacrolimus CL/F and a higher prevalence of CYP3A5 expressers, attributes that have been linked with inferior outcomes. Summary at a glance: This prospective observational study examined for differences in tacrolimus and mycophenolic acid pharmacokinetics between Aboriginal and Caucasian Australian kidney transplant recipients. No differences were found, arguing against differential drug exposure as a contributor to the poorer transplant outcomes experienced by Aboriginal Australians. [ABSTRACT FROM AUTHOR]

Marfan syndrome (MFS) is an autosomal dominantly inherited connective tissue disorder. Aortic dilatation/dissection and ectopia lentis are the most severe features, which affect physical functioning and psychological well‐being. In Aboriginal Australians, there is little psychosocial research on genetic conditions. This study explored the physical, psychological, and practical impacts of MFS on Aboriginal Australians. Eighteen (8 affected and 10 unaffected) members of a large Aboriginal Australian family with MFS participated in an ethically approved study. Semi‐structured qualitative interviews were conducted, transcribed verbatim, and analyzed thematically. All individuals reported challenges from MFS, negatively affecting day‐to‐day living. Severe vision impairment was perceived as the greatest challenge, contributing to feelings of stigma and exclusion. With aging, concerns shifted toward cardiac complications. The unpredictability of lens dislocation and aortic dissection was reported to be psychologically challenging. Participants described MFS‐related barriers to obtaining and retaining employment, especially following cardiac surgery; with consequential psychological and financial hardships. Participants articulated that their cultural drive to support the ill and respectfully mourn the deceased, regardless of distance, resulted in a significant financial burden. Additionally, when hospitalization and/or funerals occurred, financially solvent individuals were expected to share resources, without any expectation of repayment or reciprocity (i.e., 'demand sharing', common in Aboriginal Australian culture). This study documents the nature and pervasiveness of uncertainty for both affected and unaffected members of an MFS family. Many reported challenges are consistent with other MFS cohorts (including stigma, social exclusion, and unemployment). However, our findings suggest that cultural values may exacerbate the financial costs of MFS for Aboriginal Australians. [ABSTRACT FROM AUTHOR]

This paper will explain the concept of double perspective and the impact that this cultural understanding may have on the health of the Indigenous peoples of Scandinavia. In inter-cultural communication, one set of meanings may be discernible to the outsider while a whole extra set of restricted or underlying meanings are only accessible for those people who have the cultural knowledge to discern them. These different sets of meanings embody a double perspective. It is not dual perspectives on the same reality but rather seeing two separate but overlapping realities. We will discuss the layers of meaning which are involved in the interactions between public healthcare institutions, clinicians and staff, and Indigenous people including the Sámi. These interactions are influenced by the impact of colonization and the ongoing epistemicide of Indigenous thought. By realising the improved resilience that a double perspective brings to Indigenous peoples, an awareness of the inclusion and exclusion of Indigenous persons, cultures and histories should become established in public institutions and in everyday life. A double perspective carries Sámi resilience, and should be understood as a key to support individual health, and also the collective wellbeing of a people living on their traditional yet colonized land. [ABSTRACT FROM AUTHOR]

Abstract Background Associations between kidney disease and periodontal disease are not well documented among Aboriginal people of Australia. The purpose of this investigation was to report and compare demographic, oral health, anthropometric and systemic health status of Aboriginal Australians with kidney disease and to compare against relevant Aboriginal Australians and Australian population estimates. This provides much needed evidence to inform dental health service provision policies for Aboriginal Australians with kidney disease. Methods Sample frequencies and means were assessed in adults represented in six datasets including: (1) 102 Aboriginal Australians with kidney disease residing in Central Australia who participated in a detailed oral health assessment; (2) 312 Aboriginal participants of the Northern Territory’s PerioCardio study; (3) weighted estimates from 4775 participants from Australia’s National Survey of Adult Oral Health (NSAOH); (4) Australian 2016 Census (all Australians); (5) National Health Survey 2017–2018 (all Australians) and; (6) Australian Health Survey: Biomedical Results for Chronic Diseases, 2011–2012 (all Australians). Oral health status was described by periodontal disease and experience of dental caries (tooth decay). Statistically significant differences were determined via non-overlapping 95% confidence intervals. Results Aboriginal Australians with kidney disease were significantly older, less likely to have a tertiary qualification or be employed compared with both PerioCardio study counterparts and NSAOH participants. Severe periodontitis was found in 54.3% of Aboriginal Australians with kidney disease, almost 20 times the 2.8% reported in NSAOH. A higher proportion of Aboriginal Australians with kidney disease had teeth with untreated caries and fewer dental restorations when compared to NSAOH participants. The extent of periodontal attachment loss and periodontal pocketing among Aboriginal Australians with kidney disease (51.0%, 21.4% respectively) was several magnitudes greater than PerioCardio study (22.0%, 12.3% respectively) and NSAOH (5.4%, 1.3% respectively) estimates. Conclusions Aboriginal Australians with kidney disease exhibited more indicators of poorer oral health than both the general Australian population and a general Aboriginal population from Australia’s Northern Territory. It is imperative that management of oral health among Aboriginal Australians with kidney disease be included as part of their ongoing medical care.

The aim of this study was to evaluate program retention factors in a repeated team-based weight-loss and healthy lifestyle program for Aboriginal and Torres Strait Islander Peoples. Data comprised 3107 participants in 10 Aboriginal Knockout Health Challenge contests. Multiple variable and bivariate analyses compared age, gender, self-reported behaviors (physical activity and fruit and vegetable consumption) and objectively measured weight between completers and non-completers. First-time participants (n = 3107) who completed were more likely to be female, be older, weigh less and have more completing members in their team; only the number of team members completing was significant among participants (n = 1245) who took part in a second contest participation. Multivariate results were similar, with a participant’s odds of completing on their first and second participation occasion increasing by 1.16 and 1.18, respectively, with every teammate completed. Given that the strongest effect centered on a social factor, this highlights the importance of having community-driven design and the benefits of a group-based approach to engage and maintain First Peoples’ engagement in preventive health programs. Further, by identifying a change in factors associated with retention in successive weight-loss attempts, this study improves understanding of retention in weight-loss programs more generally.

Objective: To explore the rates and characteristics of self-harm across the Kimberley region of Western Australia. Method: Retrospective, cross-sectional audit. We obtained and descriptively analysed routinely collected self-harm data from the Kimberley District of the Western Australia Police Force (2014–2018) and the Emergency Department Data Collection (June 2017–December 2018). Variables included age, sex, Indigenous status, time of incident, and alcohol and drug use. Results: The rate of emergency department attendance for self-harm was three times higher in the Kimberley than the rest of Western Australia. Both emergency department and police data showed a disproportionately high percentage of incidents involving Aboriginal people, with highest rates in the 15–19 and 20–24 year age groups. Almost 80% of self-harm events recorded by police involving individuals aged 25–50 years involved alcohol. Many self-harm incidents occurred in the evening and at night. Conclusions: The rates of self-harm across the Kimberley region from 2014–2018 are unacceptably high. Increased funding and alignment of services to meet regional need are required as part of a holistic effort to reduce regional rates of self-harm. [ABSTRACT FROM AUTHOR]

Background and objectives Aboriginal Australians and Torres Strait Islanders (hereafter respectfully referred to as Indigenous Australians) experience a high burden of chronic non-communicable diseases (NCDs). Increased NCD risk is linked to oral diseases mediated by the oral microbiota, a microbial community influenced by both vertical transmission and lifestyle factors. As an initial step towards understanding the oral microbiota as a factor in Indigenous health, we present the first investigation of oral microbiota in Indigenous Australian adults. Methodology Dental calculus samples from Indigenous Australians with periodontal disease (PD; n  = 13) and non-Indigenous individuals both with (n  = 19) and without PD (n  = 20) were characterized using 16S ribosomal RNA gene amplicon sequencing. Alpha and beta diversity, differentially abundant microbial taxa and taxa unique to different participant groups were analysed using QIIME2. Results Samples from Indigenous Australians were more phylogenetically diverse (Kruskal–Wallis H  = 19.86, P  = 8.3 × 10−6), differed significantly in composition from non-Indigenous samples (PERMANOVA pseudo- F  = 10.42, P  = 0.001) and contained a relatively high proportion of unique taxa not previously reported in the human oral microbiota (e.g. Endomicrobia). These patterns were robust to stratification by PD status. Oral microbiota diversity and composition also differed between Indigenous individuals living in different geographic regions. Conclusions and implications Indigenous Australians may harbour unique oral microbiota shaped by their long relationships with Country (ancestral homelands). Our findings have implications for understanding the origins of oral and systemic NCDs and for the inclusion of Indigenous peoples in microbiota research, highlighting the microbiota as a novel field of enquiry to improve Indigenous health. [ABSTRACT FROM AUTHOR]

Abstract Objective Periodontal disease is associated with chronic kidney disease (CKD), with both conditions being highly prevalent among Australia’s Aboriginal population. This paper reflects on the lessons learned following implementation of a periodontal intervention in the Central Australian region of the Northern Territory among Aboriginal adults with CKD. Results Between Oct 2016 and May 2019, research staff recruited 102 eligible participants. This was far below the anticipated recruitment rate. The challenges faced, and lessons learned, were conceptualised into five specific domains. These included: (1) insufficient engagement with the Aboriginal community and Aboriginal community-controlled organisations; (2) an under-appreciation of the existing and competing patient commitments with respect to general health and wellbeing, and medical treatment to enable all study commitments; (3) most study staff employed from outside the region; (4) potential participants not having the required number of teeth; (5) invasive intervention that involved travel to, and time at, a dental clinic. A more feasible research model, which addresses the divergent needs of participants, communities and service partners is required. This type of approach, with sufficient time and resourcing to ensure ongoing engagement, partnership and collaboration in co-design throughout the conduct of research, challenges current models of competitive, national research funding.

Abstract Background Community-based weight loss programs may have potential to address overweight and obesity at the population level. However, participation patterns and individual outcomes from these programs are understudied. This study examined repeat participation patterns and participant weight change between contests over seven years of an Aboriginal Australian team-based program in order to identify (1) predictors of repeat participation and (2) associations with weight change between contests. Methods Data for the 12 contests from 2012 to 2018 were merged, with probabilistic record matching. A total of 7510 enrolments were registered for the 12 contests, representing 4438 unique people. Contest lengths varied from 10 to 16 weeks in duration. Non-repeat participants were those who only competed once in the program by the end of 2018, and repeaters were those who competed in at least two contests. Associations between repeat participation and participant baseline (i.e., first participation occasion) characteristics, change in diet and physical activity and percent change in weight during the first participation occasion were examined using crossed random effects (for person and team) regression adjusted for exposure to the program. Weight percentage change between contests was calculated for consecutive participation occasions occurring at least three months apart, converted to percent change per month. Weight change was regressed on number of repeat participation occasions adjusted for age, gender, baseline weight at first participation occasion, and weight percent change in the immediately preceding contest. Results One-third of the 4433 participants participated more than once, with women more likely than men to repeat. A 1% reduction in weight during a competition was associated with an increase in weight of 0.05% per month between competition end and subsequent participation. Regain was smaller the heavier participants were at their first participation. Conclusions While individuals benefit from weight loss through program participation, strengthening strategies for weight loss maintenance within or following the program could improve long-term weight outcomes and reduce weight cycling.

The process of "postcolonizing" continues in the former settler colony of Australia, entailing intense struggles over national identity and culture. Digital heritage plays a key role in these conflicts, in the form of historical and newer archives that have become increasingly important within Indigenous advocacy for recognition. Constructed from more traditional museum, library and private collections, these have become digital assets that now circulate in radically different ways—for example, as proof of identities, and links to Country. Since the late 1990s, as a result of postcolonizing advocacy by Indigenous people and cultural institutions in alliance with rapidly developing digital technologies, a profound shift in management practices has facilitated the assertion of control by First Nations people. These are exemplified by the Aṟa Irititja project, and its replicants, such as the Storylines project at the State Library of Western Australia. Digital heritage and digitized historical photographs in particular are now considered to be key resources for building Aboriginal history and identity, challenging oppressive state narratives and strengthening communities. Despite concerns regarding loss of culture caused by globalization and continuing inequalities, Aboriginal interests have drawn upon this expanded photographic digital heritage resource, to advance their rights through new temporal practices of production, circulation, and consumption. [ABSTRACT FROM AUTHOR]

Objective: In 2017, a Northern Territory PHN funded pilot program integrating psychology into remote Aboriginal Health Centres, was launched at Julanimawu Health Centre at Wurrumiyanga, Bathurst Island, Tiwi Islands (pop.1600). Psychology was identified as the allied health approach most attuned to the influential socio-cultural needs of Australian Aboriginal people when negotiating health care and effecting behavioural change; namely, providing a time rich, systemic, behaviourally focused, empathic perspective with a story telling method. Method: The program was designed to address the psychological needs of the community through two clearly stated pathways: supporting and educating the staff of the Health Centre on the effects of trauma, and providing a psychological service directly to the community. The psychologist recorded program participant demographic information and kept a diary that acknowledged the program intentions in relation to her experience. Results: Overall, the pilot program demanded non-traditional responses in a non-traditional psychology setting and the capacity to maintain equilibrium without expectation in the face of intergenerational trauma. Aboriginal culture impacted significantly on psychological practice, resulting in a process of decolonisation. The psychologist responded to different perceptions of time, resources, communication, connection and obligation and championed the Social Emotional Wellbeing approach to Aboriginal health. On a systemic level, while the program model recognised that behaviour largely determines health outcomes, the program outcomes suggested that culture largely determines behaviour. Conclusions: A Social Emotional Wellbeing approach is highly applicable, however, the approach requires champions to further support integration into the Health Centre system. Key Points What is already known: The health and wellbeing of Australian Aboriginals is impacted by the consequences of colonisation. The integration of psychology into health care is beneficial when addressing trauma related health issues. Behaviour largely determines health outcomes. What this topic adds: Behaviour largely reflects culture. Decolonising psychology requires an active process contingent on cultural knowledge. Privileging the multi-dimensional connections of social emotional wellbeing is a pathway forward. [ABSTRACT FROM AUTHOR]

Objective: This paper describes the validation of culture-bound syndromes with Urban (N=34) and Rural (N=31) Aboriginal participants. While culture bound syndromes have long been discussed in the international literature (see Cuellar & Paniagua, 2000), published empirical research with Aboriginal Australian populations remains absent. Critically, the secret nature of Aboriginal cultural practices presents additional research challenges which arguably do not impact to the same extent in other Indigenous cultures. The impacts on ensuring culturally and clinically competent assessment in the context of escalating rates of Indigenous suicide and mental health are significant. Method: Thematic analysis occurred with data generated from three phases of focus groups to address study objectives. The final stage involved a critical analysis of the DSM-IV Outline for Cultural Formulation ("OCF") for the Aboriginal Australian context. Results: Validation of seven culture bound syndromes with predominant symptom consistency across locations is presented as well as determination of the cultural triggers implicated in the development of culture bound syndromes. Finally, an adaptation of the OCF is proposed to enable clinicians to undertake clinically and culturally valid assessment of Aboriginal clients. Conclusions: Practitioners are provided with guidance in the identification and formulation of culture-bound syndromes with Aboriginal Australian clients. KEY POINTS What is already known about this topic: (1) Anecdotal evidence of the existence of culture bound syndromes has been cited in a small number of papers. (2) Culture bound syndromes have long been discussed in the international literature. (3) DSM-IV Outline for Cultural Formulation ("OCF") ensures guidance for practitioners around the formulation of culture bound syndromes. What this topic adds: (1) Empirically validates the existence of culture bound syndromes with Aboriginal Australian populations for the first time. (2) Validates symptom consistency across urban and rural Aboriginal Australian environments. (3) Provides practitioners with guidance regarding the formulation of assessment with Aboriginal clients experiencing culture bound syndromes. [ABSTRACT FROM AUTHOR]

Background: Associations between kidney disease and periodontal disease are not well documented among Aboriginal people of Australia. The purpose of this investigation was to report and compare demographic, oral health, anthropometric and systemic health status of Aboriginal Australians with kidney disease and to compare against relevant Aboriginal Australians and Australian population estimates. This provides much needed evidence to inform dental health service provision policies for Aboriginal Australians with kidney disease. Methods: Sample frequencies and means were assessed in adults represented in six datasets including: (1) 102 Aboriginal Australians with kidney disease residing in Central Australia who participated in a detailed oral health assessment; (2) 312 Aboriginal participants of the Northern Territory's PerioCardio study; (3) weighted estimates from 4775 participants from Australia's National Survey of Adult Oral Health (NSAOH); (4) Australian 2016 Census (all Australians); (5) National Health Survey 2017–2018 (all Australians) and; (6) Australian Health Survey: Biomedical Results for Chronic Diseases, 2011–2012 (all Australians). Oral health status was described by periodontal disease and experience of dental caries (tooth decay). Statistically significant differences were determined via non-overlapping 95% confidence intervals. Results: Aboriginal Australians with kidney disease were significantly older, less likely to have a tertiary qualification or be employed compared with both PerioCardio study counterparts and NSAOH participants. Severe periodontitis was found in 54.3% of Aboriginal Australians with kidney disease, almost 20 times the 2.8% reported in NSAOH. A higher proportion of Aboriginal Australians with kidney disease had teeth with untreated caries and fewer dental restorations when compared to NSAOH participants. The extent of periodontal attachment loss and periodontal pocketing among Aboriginal Australians with kidney disease (51.0%, 21.4% respectively) was several magnitudes greater than PerioCardio study (22.0%, 12.3% respectively) and NSAOH (5.4%, 1.3% respectively) estimates. Conclusions: Aboriginal Australians with kidney disease exhibited more indicators of poorer oral health than both the general Australian population and a general Aboriginal population from Australia's Northern Territory. It is imperative that management of oral health among Aboriginal Australians with kidney disease be included as part of their ongoing medical care. [ABSTRACT FROM AUTHOR]

Causal attributions are important determinants of how health threats are processed and affect health-related behaviors. To date, there has been no research on causal attributions in genetic conditions in Aboriginal Australians. Forty members of a large Aboriginal Australian family with Marfan syndrome (MFS) were invited to participate in an ethically approved study exploring causal attributions, including perceived causes of phenotypic variability within the family. Eighteen individuals consented to conduct semi-structured qualitative interviews, which were recorded, transcribed verbatim and analyzed thematically. Most participants knew that MFS was genetic, but there were diverse theories about inheritance, including beliefs that it skipped generations, was affected by birth order and/or gender, and that it co-occurred with inheritance of blue eyes within this family. The mutation was thought to have been inherited from British settlers and initially triggered by disease or diet. Factors believed to modify disease severity included other genes and lifestyle factors, particularly alcohol and substance abuse and stress. Generally, this family did not endorse “blaming” chance or a higher power for phenotypic variability, though some felt that the spirits or a deity may have played a role. In conclusion, although participants knew MFS was a genetic condition, many speculated about the role of non-genetic causes in initiating the original mutation; and the gene-environment interaction was thought to affect severity. This study demonstrates a successful approach for exploring causal attributions in other genetic conditions in First Australians.

As in several other settler colonial societies, Australia has come some way to recognising the suffering inflicted upon its First Peoples as a consequence of colonisation. Such historical reassessment of the nation's origins has given rise to a backlash of unsettlement. Australia's History Wars feature claims and counter claims regarding the number of Aboriginal people intentionally murdered by colonists as distinct from 'unintentional' Indigenous fatalities resulting from introduced infectious diseases. Following recent critiques of the 'virgin soil' hypothesis in context of the Columbian Exchange (for example Cameron, Catherine M., Paul Kelton, and Alan C. Swedlund, eds. 2015. Beyond Germs: Native Depopulation in North America. Tucson: University of Arizona Press.), I argue that biological determinism has similarly obscured the violence of Australian settler colonialism. Focussing on observations of a mid-nineteenth century outbreak of smallpox in Australia's Northwest, I seek to expand the horizons of debates concerning the scope and extent of settler colonial violence to include the appraisal of introduced diseases as a form of structural violence. [ABSTRACT FROM AUTHOR]

Background: Community-based weight loss programs may have potential to address overweight and obesity at the population level. However, participation patterns and individual outcomes from these programs are understudied. This study examined repeat participation patterns and participant weight change between contests over seven years of an Aboriginal Australian team-based program in order to identify (1) predictors of repeat participation and (2) associations with weight change between contests.Methods: Data for the 12 contests from 2012 to 2018 were merged, with probabilistic record matching. A total of 7510 enrolments were registered for the 12 contests, representing 4438 unique people. Contest lengths varied from 10 to 16 weeks in duration. Non-repeat participants were those who only competed once in the program by the end of 2018, and repeaters were those who competed in at least two contests. Associations between repeat participation and participant baseline (i.e., first participation occasion) characteristics, change in diet and physical activity and percent change in weight during the first participation occasion were examined using crossed random effects (for person and team) regression adjusted for exposure to the program. Weight percentage change between contests was calculated for consecutive participation occasions occurring at least three months apart, converted to percent change per month. Weight change was regressed on number of repeat participation occasions adjusted for age, gender, baseline weight at first participation occasion, and weight percent change in the immediately preceding contest.Results: One-third of the 4433 participants participated more than once, with women more likely than men to repeat. A 1% reduction in weight during a competition was associated with an increase in weight of 0.05% per month between competition end and subsequent participation. Regain was smaller the heavier participants were at their first participation.Conclusions: While individuals benefit from weight loss through program participation, strengthening strategies for weight loss maintenance within or following the program could improve long-term weight outcomes and reduce weight cycling. [ABSTRACT FROM AUTHOR]

Causal attributions are important determinants of how health threats are processed and affect health-related behaviors. To date, there has been no research on causal attributions in genetic conditions in Aboriginal Australians. Forty members of a large Aboriginal Australian family with Marfan syndrome (MFS) were invited to participate in an ethically approved study exploring causal attributions, including perceived causes of phenotypic variability within the family. Eighteen individuals consented to conduct semi-structured qualitative interviews, which were recorded, transcribed verbatim and analyzed thematically. Most participants knew that MFS was genetic, but there were diverse theories about inheritance, including beliefs that it skipped generations, was affected by birth order and/or gender, and that it co-occurred with inheritance of blue eyes within this family. The mutation was thought to have been inherited from British settlers and initially triggered by disease or diet. Factors believed to modify disease severity included other genes and lifestyle factors, particularly alcohol and substance abuse and stress. Generally, this family did not endorse "blaming" chance or a higher power for phenotypic variability, though some felt that the spirits or a deity may have played a role. In conclusion, although participants knew MFS was a genetic condition, many speculated about the role of non-genetic causes in initiating the original mutation; and the gene-environment interaction was thought to affect severity. This study demonstrates a successful approach for exploring causal attributions in other genetic conditions in First Australians. [ABSTRACT FROM AUTHOR]

Like many nations, Australia is becoming superdiverse. Influenced by international conflict, tourism, migration and other global transfers, minorities proliferate and enjoy multiple intersecting affiliations associated with ethnicity, religion, language, class, transnational ties and more. Though in the everyday this interculturality works quite well, the multicultural mode of governance is finding its limits insofar as minority groups live parallel lives and drift to a separatism that can problematise national cohesion. Indigenous Australians are a component of this, both of and not of the nation, the same as and different from other Australians, and internally diverse. In their respect, multicultural governance predicated on bloc difference and a singular categoric subject is inadequate. That approach has spawned policies, programs and practices poorly directed at the real-life diversity. Examples include 'Aboriginal learning styles', cultural competence, 'Aboriginalised' workplaces and Aboriginal Child Placement Principle. These policies are applied to a populace that is differently Aboriginal and embedded in the nation around the country. I argue that multicultural governance is having counter-productive consequences as a result of its inadequacy to superdiverse realities and that reforms predicated on Aboriginal bothness are critical for Aborigines and instructive for the nation in governing superdiversity generally. [ABSTRACT FROM AUTHOR]

Importance Epidemiological data on visually significant ocular trauma in the Top End of the Northern Territory. Background: Our main objective is to determine whether Indigenous patients are disproportionately affected by visually significant ocular trauma as compared to non‐Indigenous patients. Design This was a retrospective audit at the Royal Darwin Hospital in the Top End of the Northern Territory during January 2013 to June 2015. Participants: A total of 104 ocular trauma patients were included; 43 were Indigenous and 61 were non‐Indigenous. Methods: Medical records of patients with ocular trauma between January 2013 and June 2015 (except simple, non‐penetrating corneal foreign bodies and abrasions) were reviewed. Vision loss was defined by visual acuity: mild ≥6/18, moderate 6/18‐6/60, severe ≤6/60 following World Health Organization standards. Main Outcome Measures: The study included the incidence of ocular trauma patients by ethnicity (Indigenous vs non‐Indigenous). Our secondary outcome included vision loss, mechanism of injury, open vs closed injury, age, remoteness and alcohol involvement. Results: A total of 104 patient charts were reviewed; 43 (41%) were Indigenous and 61 (59%) were non‐Indigenous. Alleged assault was the greatest contributor to ocular trauma in both groups (74% in Indigenous vs 39% non‐Indigenous). Severe vision loss was more prevalent in the Indigenous vs non‐Indigenous patients (30% vs 16%). Conclusions and Relevance: Indigenous patients were disproportionately affected by visually significant ocular trauma compared to non‐Indigenous patients. This research provides important data on ocular trauma in the Northern Territory. Further prevention strategies are needed to reduce vision loss in this population. [ABSTRACT FROM AUTHOR]

The placement of Indigenous girls and young women in white homes to work as servants was a key strategy of official policy and practice in both the United States and Australia. Between the 1880s and the Second World War, under the outing programs in the U.S. and various apprenticeship and indenturing schemes in Australia, the state regulated and constructed relations between Indigenous and white women in the home. Such state intervention not only helped to define domesticity in a modern world, but was integral to the formation of the modern settler colonial nation in its claims to civilizing authority in the United States and Australia. In the context of settler colonialism, domesticity was not hegemonic in this period, but rather was precarious and uncertain. By prescribing and demanding from employers demonstrations of domesticity, the state was engaged in perfecting white women as well as Indigenous women, the latter as the colonized, to be domesticated, and the former as the colonizer, to domesticate. [ABSTRACT FROM AUTHOR]

This paper explores the intersections and reciprocal interactions between literature and history with reference to texts marked by their Aboriginal authorship. Two life stories published in the last decade of twentieth century Australia spawn reflections on this topic. Here, the analysis and interpretation of Follow the Rabbit-Proof Fence and Auntie Rita focuses on both their literary and historical features, taking into account the emotional and political issues they engage with. [ABSTRACT FROM AUTHOR]

This paper explores the lived experiences of Majesty. She is transgender, a former sex worker, and identifies as an Aboriginal Australian. Her status as a sex worker is embodied in both her previously held male identity and her transgender identity, however it is her transgender identity which challenges Majesty's own notions and ideas about sex and sex work. The lines between intimacy, sex, and sex work are connected to Majesty's identities in ways that are both fluid and complex. Drawing on Indigenous Standpoint Theory and trans geographies, this paper explores the tensions and possibilities of including Indigenous trans voices to unsettle the white and heteronormative thinking of sexually based services. In doing so, it complicates concepts of race, gender and sexuality, contributing a narrative from Indigenous Standpoints that enrich the trans geography literature. [ABSTRACT FROM AUTHOR]

In 2000, Noel Pearson drew on his experiences of growing up on the Hope Vale, the Guugu Yimidhirr–speaking community that emerged from the Cape Bedford mission in the south east of Cape York, to write a revisionist history of the region. Indigenous communities were “strong, if bruised” in the wake of colonisation, he argued, but had descended into chaos since the 1970s because alcohol and welfare benefits had undermined the formerly resilient Aboriginal norms of “responsibility”. This paper offers a critical review of this politically potent account of the past, drawing on alternative oral histories, ethnographies and ethnohistories of Hope Vale, including Pearson’s own honours thesis (1986). Without challenging this sketch of his own experience, nor the sincerity of his nostalgia for the mission of his youth, I argue that Pearson’s more recent retellings are selective. In particular, his revisionist history overlooks evidence of drug abuse in the early colonial period and overstates both Guugu Yimidhirr agency in the process of missionisation and the uniformity and representativeness of the community that developed at Cape Bedford. Finally, I offer some possible personal, philosophical and political explanations for Pearson’s shifting approach to the past. [ABSTRACT FROM PUBLISHER]

Abstract: Background: Rituximab, an anti‐CD20 B‐cell depleting monoclonal antibody, is increasingly prescribed off‐label for a range of autoimmune diseases. There has not previously been an audit of off‐label rituximab use in the Northern Territory, where the majority of patients are Aboriginal. Aims: To evaluate retrospectively off‐label rituximab use in autoimmune diseases in the Top End of the Northern Territory. Methods: We performed a retrospective audit of 8 years of off‐label rituximab use at the Royal Darwin Hospital, the sole tertiary referral centre for the Darwin, Katherine and East Arnhem regions. Electronic and paper records were reviewed for demographic information, diagnosis/indication for rituximab, doses, previous/concomitant immunosuppression, clinical outcomes and specific adverse events. Results: Rituximab was prescribed off‐label to 66 patients for 24 autoimmune diseases. The majority of patients (62.1%) were Aboriginal and 60.6% female. The most common indications were refractory/relapsing disease despite standard therapies (68.7%) or severe disease with rituximab incorporated into an induction immunosuppressive regimen (19.4%). Systemic lupus erythematosus was the underlying diagnosis in 28.8% of cases. A clinically significant response was demonstrated in 74.2% of cases overall. There were 18 clinically significant infections; however, 13 were in patients receiving concurrent immunosuppressive therapy. There was a total of nine deaths from any cause. Conclusion: Rituximab has been used off‐label for a range of autoimmune diseases in this population with a high proportion of Aboriginal patients successfully and safely in the majority of cases. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) is the driving force behind the discrepancy in life expectancy between indigenous and non-indigenous groups in many countries. Preceding CVD many indigenous groups exhibit a cluster of cardiometabolic risk factors, including overweight-obesity, diabetes, high cholesterol, and high blood pressure. In turn, modifiable lifestyle risk factors contribute to the development of this cluster of cardiometabolic conditions. Modifiable lifestyle risk factors include, but are not limited to, physical inactivity, poor nutrition, excessive alcohol consumption, and cigarette smoking. Notably, these metabolic and lifestyle risk factors are relatively simple to monitor and track. The current review will look at modifiable cardiometabolic (overweight-obesity, diabetes mellitus, high cholesterol, and high blood pressure) and lifestyle (physical inactivity, poor nutrition, risky alcohol behavior, and cigarette smoking) risk factors among indigenous populations from Australia (Aboriginal Australians and Torres Strait Islanders), New Zealand (Mβori) and the United States (Native Americans). Discussion will focus on the causal relationship between modifiable lifestyle risk factors and cardiometabolic outcomes, as well as, simple measurements for tracking these risk factors.

This article builds upon a previous application of Nimi Wariboko’s “Charismatic City” proposal, adapting it to the Australian context. Within this metaphor, the Pentecostal worshipper is situated in a rhizomatic network that flows with particular energies, forming a new spirit-ed common space that serves as the basis of global civil society. In this network, the culturally dominant metropolis and the culturally alternative heteropolis speak in distinct voices or tongues: An act that identifies and attunes participants to the Spirit’s existing work in the world. Here, two interweaving Australian Pentecostalisms are presented. The metropolis in this example is Hillsong Church, well known for its song repertoire and international conferences. In contrast, the heteropolis is a diverse group led by Aboriginal Australian pastors Will and Sandra Dumas from Ganggalah Church. In 2017, Hillsong Conference incorporated a Christianised version of an “Acknowledgement to Country,” a traditional Indigenous ceremonial welcome, into its public liturgy, which is arguably evidence of speaking new languages. In this case, it also serves a political purpose, to recognise Aboriginal Pentecostals within a new commons. This interaction shows how Joel Robbin’s Pentecostal “impulses” of “globalization,” “cultural fragmentation” and “world-making” can operate simultaneously within the ritual life of national churches.

Streptococcus dysgalactiae subsp. equisimilis (groups C and G streptococci [GCS/GGS]) is an increasingly recognized human pathogen, although it may follow indirect pathways. Prospective surveillance of selected households in 3 remote Aboriginal communities in Australia provided 337 GCS/GGS isolates that were emm sequence-typed. Lancefield group C isolates (GCS) were localized to specific households and group G isolates (GGS) were more evenly distributed. GCS/GGS was more frequently recovered from the throat than group A streptococci (GAS [S. pyogenes]) but rarely recovered from skin sores, and then only with Staphylococcus aureus or GAS. Symptomatic GGS/GGC pharyngitis was also rare. Specific emm sequence types of GCS/GGS did not appear to cycle through the communities (sequential strain replacement) in a manner suggesting acquisition of type-specific immunity. These communities already have high levels of streptococcal and poststreptococcal disease. GCS/GGS may increase in importance as it acquires key virulence factors from GAS by lateral gene transfer.

Just world research has shown that observers derogate victims more for their misfortunes if the perpetrator is not harshly punished (Lerner in J Personal Soc Psychol 1(4):355-360, 1980). However, few studies have investigated minority group derogation as a just world preservation strategy after instances of intergroup harm-doing. This study is among the first to demonstrate the derogation of both individual victims and of the victim's minority group experimentally, using the context of a racist hate crime in Australia. In the present experiment, participants ( N = 110) read a news article describing a hate crime against an Aboriginal Australian teenager and were informed that the perpetrator was harshly or leniently punished (secure vs. justice threat condition). Our results show that in the justice threat condition, participants not only derogated the individual Aboriginal Australian victim more after his death, they also expressed greater racism toward the victim's group. An indirect effect of the justice threat condition on modern racism via individual victim derogation was observed, along with moderating effects of individual differences in belief in a just world. These findings provide support for the alarming hypothesis that racist hate crimes are not only the manifestation of a racist society, but may also bolster racial prejudices if leniently treated. The results highlight the important role of political and judicial authorities, whose response or non-response to a hate crime can exacerbate or ameliorate existing prejudices. [ABSTRACT FROM AUTHOR]

Australian Pentecostals, both Indigenous and non-Indigenous, are speaking new tongues in their worship practices, forming new poetic languages of singing and conversation relevant for spatially dislocated twenty-first-century life. Using Nimi Wariboko's three-city model offered in Charismatic City and the Public Resurgence of Religion, this article assesses Australian pentecostal worship practice in light of his "Charismatic City." The article suggests that this emergent, poetic language of Spirit empowerment situates the worshipper in a rhizomatic network that flows with pentecostal energies, forming a new commons or space that is the basis of its global civil society. It presents two local case studies from Hillsong Church's pneumatological song repertoire (1996-2006), and yarning conversation rituals at Ganggalah Church led by Aboriginal Australian pastors. These new languages identify and attune participants to the Spirit's work in the world, particularly useful for urban cities and cyberspace. [ABSTRACT FROM AUTHOR]

Aim Aboriginal leaders concerned about high rates of alcohol use in pregnancy invited researchers to determine the prevalence of fetal alcohol syndrome ( FAS) and partial fetal alcohol syndrome ( pFAS) in their communities. Methods Population-based prevalence study using active case ascertainment in children born in 2002/2003 and living in the Fitzroy Valley, in Western Australia ( April 2010- November 2011) ( n = 134). Socio-demographic and antenatal data, including alcohol use in pregnancy, were collected by interview with 127/134 (95%) consenting parents/care givers. Maternal/child medical records were reviewed. Interdisciplinary assessments were conducted for 108/134 (81%) children. FAS/pFAS prevalence was determined using modified Canadian diagnostic guidelines. Results In 127 pregnancies, alcohol was used in 55%. FAS or pFAS was diagnosed in 13/108 children, a prevalence of 120 per 1000 (95% confidence interval 70-196). Prenatal alcohol exposure was confirmed for all children with FAS/pFAS, 80% in the first trimester and 50% throughout pregnancy. Ten of 13 mothers had Alcohol Use Disorders Identification Test scores and all drank at a high-risk level. Of children with FAS/pFAS, 69% had microcephaly, 85% had weight deficiency and all had facial dysmorphology and central nervous system abnormality/impairment in three to eight domains. Conclusions The population prevalence of FAS/pFAS in remote Aboriginal communities of the Fitzroy Valley is the highest reported in Australia and similar to that reported in high-risk populations internationally. Results are likely to be generalisable to other age groups in the Fitzroy Valley and other remote Australian communities with high-risk alcohol use during pregnancy. Prevention of FAS/pFAS is an urgent public health challenge. [ABSTRACT FROM AUTHOR]

This is the introduction to the special issue of Reflections: Narratives of Professional Helping, Honoring Our Indigenous Elders in Social Work Education. This special issue was co-edited by Hilary N. Weaver, University at Buffalo School of Social Work; Mary Kate Dennis, University of Kansas School of Social Welfare, and Katie Johnston-Goodstar, University of Minnesota School of Social Work. The issue includes narratives about Indigenous social work educators and/or educational programs who have had a significant impact on the social work profession, social work education and the Indigenous scholars in academia. "Indigenous Peoples" are defined as those peoples and nations which have historical continuity with pre-invasion and pre-colonial societies that developed on their territories, consider themselves distinct from other sectors of the societies now prevailing on those territories, or parts of them. [ABSTRACT FROM AUTHOR]

There are ethnic group differences in academic achievement among Australian students, with Aboriginal students performing substantially below and Asian students above their peers. One factor that may contribute to these effects is societal stereotypes of Australian Asian and Aboriginal students, which may bias teachers’ evaluations and influence student outcomes. A questionnaire assessing academic expectancies for hypothetical students from different ethnic groups was administered to 55 experienced teachers and 144 training teachers. A measure of self-expectancies and group expectancies was administered to 516 school students. The findings revealed that Asian students were expected to perform better in mathematics and expend greater effort than Aboriginal and Anglo-Australian students. In turn, there were higher expectancies for mathematics performance for Anglo-Australian students compared with Aboriginal students. We discuss the potential implications of these stereotypes for students’ school achievement, particularly the risk that negative implicit stereotypes might result in these students being directed to special education. [ABSTRACT FROM AUTHOR]

The purpose of this review is to compare the prevalence of diabetic retinopathy ( DR) between Indigenous and non-Indigenous Australians with Diabetes Mellitus ( DM). Australian DR prevalence data from 6 Indigenous studies ( n = 2865) and 5 non-Indigenous studies ( n = 9801) conducted between 1985 and 2013 were included for analysis. Estimated prevalence of any DR among Indigenous Australians with DM was 23.4% compared with 28.9% for non-Indigenous Australians (χ2 = 26.9, P < 0.001). In studies performed after 1990, a significantly higher rate of diabetic macular edema was found in Indigenous compared with non-Indigenous Australians with DM (7.6% versus 4.9%, χ2 = 6.67, P = 0.01). Although there are limitations in comparing these studies, one explanation for the observed data could be a model in which Indigenous Australians are relatively resistant to early stage DR, but with a subset progressing to sight threatening DR due to individual genetic and environmental susceptibility factors coupled with poor glycemic control. [ABSTRACT FROM AUTHOR]

The hormone thyroxine that regulates mammalian metabolism is carried and stored in the blood by thyroxine-binding globulin (TBG). We demonstrate here that the release of thyroxine from TBG occurs by a temperature-sensitive mechanism and show how this will provide a homoeostatic adjustment of the concentration of thyroxine to match metabolic needs, as with the hypothermia and torpor of small animals. In humans, a rise in temperature, as in infections, will trigger an accelerated release of thyroxine, resulting in a predictable 23% increase in the concentration of free thyroxine at 398C. The in vivo relevance of this fever-response is affirmed in an environmental adaptation in aboriginal Australians.We show how two mutations incorporated in their TBG interact in a way that will halve the surge in thyroxine release, and hence the boost in metabolic rate that would otherwise occur as body temperatures exceed 378C. The overall findings open insights into physiological changes that accompany variations in body temperature, as notably in fevers. [ABSTRACT FROM AUTHOR]

Aboriginal Australian performances, created from within their own traditional practices, have often dealt with aspects of European colonization and racism in a humorous manner. There are numerous accounts of these, including performances that were satirical and which treated traumatic acts of racialized violence in Australia in a comedic form. Indeed, Aboriginal audiences are documented as laughing uproariously at these performances. Examples include performances from Arnhem Land in the north, which centred on white men abducting women for sexual use; others from Stradbroke Island, off the coast of Queensland, include the ways in which the Europeans in the volunteer land army used their training and arms to kill Aboriginal people. This article examines the translation of traumatic events into comedic performances in the context of the major trauma of colonization, illustrating the particular manner by which humour offers ways of acting out and dealing with events that cause communal and individual traumas. [ABSTRACT FROM AUTHOR]