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Background: Chronic hepatitis B (CHB) is endemic in the Aboriginal and Torres Strait Islander population of Australia's Northern Territory. Progression to liver disease can be prevented if holistic care is provided. Low health literacy amongst health professionals is a known barrier to caring for people living with CHB. We co-designed and delivered a culturally safe "Managing hepatitis B" training course for the Aboriginal health workforce. Here, we present an evaluation of the course. Objectives: 1. To improve course participants CHB-related knowledge, attitudes, and clinical practice. 2. To evaluate the "Managing hepatitis B" training course. 3. To enable participants to have the skills and confidence to be part of the care team. Methods: We used participatory action research and culturally safe principles. We used purpose-built quantitative and qualitative evaluation tools to evaluate our "Managing hepatitis B" training course. We integrated the two forms of data, deductively analysing codes, grouped into categories, and assessed pedagogical outcomes against Kirkpatrick's training evaluation framework. Results: Eight courses were delivered between 2019 and 2023, with 130 participants from 32 communities. Pre- and post-course questionnaires demonstrated statistically significant improvements in all domains, p<0.001 on 93 matched pairs. Thematic network analysis demonstrated high levels of course acceptability and significant knowledge acquisition. Other themes identified include cultural safety, shame, previous misinformation, and misconceptions about transmission. Observations demonstrate improvements in post-course engagement, a deep understanding of CHB as well as increased participation in clinical care teams. Conclusions: The "Managing hepatitis B" training course led to a sustained improvement in the knowledge and attitudes of the Aboriginal health workforce, resulting in improved care and treatment uptake for people living with CHB. Important non-clinical outcomes included strengthening teaching and leadership skills, and empowerment. [ABSTRACT FROM AUTHOR]

Aims: To determine rates and predictors of postpartum diabetes screening among Aboriginal and/or Torres Strait Islander and non‐Indigenous women with gestational diabetes mellitus (GDM). Methods: PANDORA is a prospective longitudinal cohort of women recruited in pregnancy. Postpartum diabetes screening rates at 12 weeks (75‐g oral glucose tolerance test (OGTT)) and 6, 12 and 18 months (OGTT, glycated haemoglobin [HbA1C] or fasting plasma glucose) were assessed for women with GDM (n = 712). Associations between antenatal factors and screening with any test (OGTT, HbA1C, fasting plasma glucose) by 6 months postpartum were examined using Cox proportional hazards regression. Results: Postpartum screening rates with an OGTT by 12 weeks and 6 months postpartum were lower among Aboriginal and/or Torres Strait Islander women than non‐Indigenous women (18% vs. 30% at 12 weeks, and 23% vs. 37% at 6 months, p < 0.001). Aboriginal and/or Torres Strait Islander women were more likely to have completed a 6‐month HbA1C compared to non‐Indigenous women (16% vs. 2%, p < 0.001). Screening by 6 months postpartum with any test was 41% for Aboriginal and/or Torres Strait Islander women and 45% for non‐Indigenous women (p = 0.304). Characteristics associated with higher screening rates with any test by 6 months postpartum included, insulin use in pregnancy, first pregnancy, not smoking and lower BMI. Conclusions: Given very high rates of type 2 diabetes among Aboriginal and Torres Strait Islander women, early postpartum screening with the most feasible test should be prioritised to detect prediabetes and diabetes for intervention. [ABSTRACT FROM AUTHOR]

Summary: Background: Few studies have assessed whether children exposed to in utero hyperglycaemia experience different growth trajectories compared to unexposed children. Objectives: To assess association of type 2 diabetes (T2D) and gestational diabetes mellitus (GDM) with early childhood weight, length/height and body mass index (BMI) trajectories, and with timing and magnitude of peak BMI in infancy. Methods: PANDORA is a birth cohort recruited from an Australian hyperglycaemia in pregnancy register, and women with normoglycaemia recruited from the community. Offspring growth measures were obtained from health records over a median follow‐up of 3.0 years (interquartile range 1.9–4.0). This analysis included children born to Aboriginal mothers with in utero normoglycaemia (n = 95), GDM (n = 228) or T2D (n = 131). Growth trajectories (weight, length/height and BMI) were estimated using linear mixed models with cubic spline functions of child age. Results: After adjustment for maternal factors (age, BMI, parity, smoking, and socioeconomic measures) and child factors (age, gestational age at birth, and sex), children born to mothers with T2D or GDM had lower weight, length/height and BMI trajectories in infancy than children born to mothers with normoglycaemia, but similar weight and BMI by completion of follow‐up. Children exposed to T2D had lower mean peak BMI 17.6 kg/m2 (95% confidence interval [CI] 17.3–18.0) than children exposed to normoglycaemia (18.6 kg/m2 [18.1–18.9]) (p = 0.001). Conclusions: Maternal hyperglycaemia was associated with differences in early childhood growth trajectories after adjustment for maternal BMI. Exploration of associations between in utero hyperglycaemia exposure and growth trajectories into later childhood is required. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence rates of hypertension, diabetes, ischaemic heart disease (IHD), renal disease and chronic obstructive pulmonary disease (COPD), and their co-occurrence among the remote Aboriginal population of the Northern Territory (NT) in 2005. Methods: Information from a primary care chronic disease register (CDR) and hospital inpatient database were linked to a population list by using a unique patient identifier. A capture-recapture method (CRM) and multivariate log-linear models were then applied to analyse the multiple datasets to estimate the prevalence rates for the selected diseases and case ascertainment in each data source. Results: The NT remote Aboriginal communities had considerably higher prevalence rates across all five chronic diseases than national health survey figures. At ages 50 years and over, the prevalence rates for hypertension and renal disease were above 50%, diabetes 40%, COPD 30% and IHD above 20%. In terms of data completeness, CDR and hospital sources were both relatively incomplete, generally around 20-60%. The most common co-occurrences for the five chronic diseases were between hypertension, diabetes, IHD and renal disease. Conclusions and implications: The prevalence rates calculated using this method are comparable to estimates from rigorous small area studies, but are markedly higher than those from single clinical data sources. The results indicate that there is a considerable underdiagnosis of preventable chronic diseases in the Aboriginal communities. Keywords: Prevalence, data collection, epidemiology, chronic diseases, Indigenous health services doi: 10.1111/j.1753-6405.2008.00245.x

Objective To determine the frequency of presentations and infectious-disease burden at primary health care (PHC) services in young children in two remote Aboriginal communities in tropical northern Australia. Methods Children born after 1 January 2001, who were resident at 30 September 2005 and for whom consent was obtained, Were studied. Clinic records were reviewed for all presentations between 1 January 2002 and 30 September 2005. Data collected included reason for presentation (if infectious), antibiotic prescription and referral to hospital. Findings There were 7273 clinic presentations for 174 children aged 0-4.75 years, 55% of whom were male. The median presentation rate per child per year was 16 (23 in the first year of life). Upper-respiratory-tract infections (32%) and skin infections (18%) were the most common infectious reasons for presentation. First presentations for scabies and skin sores peaked at the age of 2 months. By 1 year of age, 63% and 69% of children had presented with scabies and skin sores, respectively. Conclusion These Aboriginal children average about two visits per month to PHC centres during their first year of life. This high rate is testament to the disease burden, the willingness of Aboriginal people to use health services and the high workload experienced by these health services. Scabies and skin sores remain significant health problems, with this study describing a previously undocumented burden of these conditions commencing within the first few months of life. Appropriate prevention and treatment strategies should encompass early infancy to reduce the high burden of infectious diseases in this population. Objectif Determiner la frequence de presentation dans les services de soins de sante primaire et la charge de morbidite des jeunes enfants de deux communautes aborigenes eloignees du Nord de l&apos;Australie. Methodes Ont participe a l&apos;etude les enfants nes apres le 1er, janvier 2001, residant a cet endroit le 30 septembre 2005 et pour lesquels un consentement avait ete obtenu. On a releve dans les registres des dispensaires toutes les presentations d&apos;enfants entre le 1er janvier 2002 et le 30 septembre 2005. Parmi les informations recueillies figuraient les motifs de la presentation (en cas de pathologie infectieuse), ainsi que la prescription d&apos;antibiotiques et l&apos;orientation vers un hopital eventuelles. Resultats On a recense 7273 presentations dans un dispensaire, de 174 enfants de 0 a 4,75 ans, dont 55 % de garcons. La mediane du taux de presentation par enfant et par an etait de 16 (23 au cours de la premiere annee de vie). Les infections des voies respiratoires superieures (32 %) et les lesions cutanees (18 %) etaient les causes infectieuses les plus courantes de presentation. Les premieres presentations pour une gale ou une lesion cutanee atteignaient un pic pour l&apos;age de 2 mois. Apres 1 an, 63 et 69 % respectivement des enfants avaient ete presentes pour une gale ou une Iesion cutanee. Conclusion En moyenne, ces enfants aborigenes etaient presentes deux fois par mois dans un centre de sante primaire pendant leur premiere annee de vie. Ce taux eleve de frequentation temoigne de la forte morbidite, de la volonte des populations aborigenes de recourir a ces services et de l&apos;importante charge de travail qui pese sur ces demiers. La gale et les lesions cutanees restent des problemes de sante importants, representant une charge de morbidite notable des les premiers mois de la vie, comme l&apos;atteste, pour la premiere fois, la presente etude. Les strategies de prevention et de traitement appropriees doivent englober la petite enfance pour reduire la forte charge de morbidite due aux maladies infectieuses dans cette population. Objetivo Determinar la frecuencia de visitas y la carga de morbilidad infecciosa en los servicios de atencion primaria (AP) entre los ninos pequenos en dos comunidades aborigenes remotas de zonas tropicales del norte de Australia. Metodos Se estudio a una poblacion de ninos que habian nacido despues del 1 de enero de 2001 y residian en la zona al 30 de septiembre de 2005, tras obtener el consentimiento informado oportuno. Se examinaron los datos clinicos correspondientes a todas las visitas realizadas entre el 1 de enero de 2002 y el 30 de septiembre de 2005. Entre los datos recopilados figuraban el motivo de la visita (si era un proceso infeccioso), la prescripcion de antibioticos y la posible derivacion a un hospital. Resultados Se consideraron en total 7273 visitas a consultorios de 174 ninos de 0 a 4,75 anos, el 55% de los cuales eran varones. La tasa mediana de visitas por nino y ano fue de 16 (23 en el primer ano de vida). Las infecciones de las vias respiratorias superiores (32%) y las infecciones cutaneas (18%) fueron las causas infecciosas mas frecuentes de visita al consultorio. Las primeras visitas por sarna o heridas cutaneas presentaban un pico a la edad de dos meses. Al ano de edad, el 63% y el 69% de los ninos habian acudido con sarna y heridas cutaneas, respectivamente. Conclusion Los ninos aborigenes estudiados hicieron como promedio unas dos visitas al mes a los centros de atencion primaria durante su primer ano de vida. Esa elevada tasa refleja la carga de morbilidad existente, la voluntad de la poblacion aborigen de usar los servicios de salud y el gran volumen de trabajo a que deben hacer frente esos servicios. La sarna y las heridas cutaneas siguen siendo problemas sanitarios importantes en esa poblacion, y el estudio pone de relieve por primera vez que esas afecciones suponen una carga ya en los primeros meses de vida, de modo que, para conseguir reducir la alta morbilidad infecciosa en esa poblacion, las estrategias de prevencion y tratamiento deben abarcar el periodo neonatal,, Introduction There is a disproportionate disease burden in remote Aboriginal communities compared with the general Australian population. (1-5) These discrepancies begin at birth: the perinatal mortality rate for Aboriginal infants [...]

Abstract Background Vulvar cancer is a relatively rare malignancy, which occurs most often in postmenopausal women. We have previously identified a geographic cluster of vulvar cancer in young Indigenous women living in remote communities in the Arnhem Land region of Australia. In this population, we investigated the prevalence of oncogenic human papillomavirus (HPV) infection in anogenital samples (vulvar/vaginal/perianal area and cervix) and compared the overall, type-specific and multiple infection prevalence between sites. Methods A cross-sectional survey of 551 Indigenous women aged 18–60 years was undertaken in 9 Arnhem Land communities. Women were consented for HPV detection and genotyping collected by a combined vulvar/vaginal/perianal (VVP) sweep swab and a separate PreservCyt endocervical sample collected during Pap cytology screening. HPV DNA testing was undertaken using PCR with broad spectrum L1 consensus PGMY09/11 primers with genotyping of positive samples by Roche Linear Array. The primary outcomes were the prevalence of cervical and VVP high-risk (HR) HPV. Results The prevalence of VVP HR-HPV was 39%, which was significantly higher than the cervical HR-HPV prevalence (26%, p Conclusions In this population experiencing a cluster of vulvar cancer, the prevalence of cervical oncogenic HPV infection was similar to that reported by studies of other Australian women; however there was a significantly higher prevalence of vulvar/vaginal/perianal infection to cervical. The large discrepancy in HPV prevalence between anogenital sites in this population may represent more persistent infection at the vulva. This needs further investigation, including the presence of possible environmental and/or genetic factors that may impair host immunity.

Abstract Background Early onset and high prevalence of chronic disease among Indigenous Australians call for action on prevention. However, there is deficiency of information on the extent to which preventive services are delivered in Indigenous communities. This study examined the variation in quality of preventive care for well adults attending Indigenous community health centres in Australia. Methods During 2005-2009, clinical audits were conducted on a random sample (stratified by age and sex) of records of adults with no known chronic disease in 62 Indigenous community health centres in four Australian States/Territories (sample size 1839). Main outcome measures: i) adherence to delivery of guideline-scheduled services within the previous 24 months, including basic measurements, laboratory investigations, oral health checks, and brief intervention on lifestyle modification; and ii) follow-up of abnormal findings. Results Overall delivery of guideline-scheduled preventive services varied widely between health centres (range 5-74%). Documentation of abnormal blood pressure reading ([greater than or equal to]140/90 mmHg), proteinuria and abnormal blood glucose ([greater than or equal to]5.5 mmol/L) was found to range between 0 and > 90% at the health centre level. A similarly wide range was found between health centres for documented follow up check/test or management plan for people documented to have an abnormal clinical finding. Health centre level characteristics explained 13-47% of variation in documented preventive care, and the remaining variation was explained by client level characteristics. Conclusions There is substantial room to improve preventive care for well adults in Indigenous primary care settings. Understanding of health centre and client level factors affecting variation in the care should assist clinicians, managers and policy makers to develop strategies to improve quality of preventive care in Indigenous communities.

Abstract Background Australia's Aboriginal and Torres Strait Islander (Indigenous) populations have disproportionately high rates of adverse perinatal outcomes relative to other Australians. Poorer access to good quality maternal health care is a key driver of this disparity. The aim of this study was to describe patterns of delivery of maternity care and service gaps in primary care services in Australian Indigenous communities. Methods We undertook a cross-sectional baseline audit for a quality improvement intervention. Medical records of 535 women from 34 Indigenous community health centres in five regions (Top End of Northern Territory 13, Central Australia 2, Far West New South Wales 6, Western Australia 9, and North Queensland 4) were audited. The main outcome measures included: adherence to recommended protocols and procedures in the antenatal and postnatal periods including: clinical, laboratory and ultrasound investigations; screening for gestational diabetes and Group B Streptococcus; brief intervention/advice on health-related behaviours and risks; and follow up of identified health problems. Results The proportion of women presenting for their first antenatal visit in the first trimester ranged from 34% to 49% between regions; consequently, documentation of care early in pregnancy was poor. Overall, documentation of routine antenatal investigations and brief interventions/advice regarding health behaviours varied, and generally indicated that these services were underutilised. For example, 46% of known smokers received smoking cessation advice/counselling; 52% of all women received antenatal education and 51% had investigation for gestational diabetes. Overall, there was relatively good documentation of follow up of identified problems related to hypertension or diabetes, with over 70% of identified women being referred to a GP/Obstetrician. Conclusion Participating services had both strengths and weaknesses in the delivery of maternal health care. Increasing access to evidence-based screening and health information (most notably around smoking cessation) were consistently identified as opportunities for improvement across services.