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Van Schaik K.D.,Harvard University | Thompson S.C.,Combined Universities Center for Rural Health
Internal Medicine Journal | Year: 2012

Background: Australia's Indigenous people suffer from higher cancer mortality than non-Indigenous Australians, a discrepancy partly caused by differences in beliefs about treatment efficacy between Indigenous patients and their non-Indigenous healthcare providers. This paper critically reviews the literature associated with Indigenous beliefs about cancer treatment, both 'bush medicine' and biomedical, in order to provide recommendations to healthcare providers about accommodating Indigenous beliefs when treating cancer. Methods: A search was undertaken of peer-reviewed journal papers using electronic databases and citation snowballing. Papers were selected for inclusion based upon relevance to themes that addressed the research questions. Results: Literature suggests that Indigenous beliefs about treatment efficacy for cancer involve five themes: (i) concerns about the toxicity of treatment; (ii) disconnect with the physician; (iii) fears about absence from home during treatment; (iv) different beliefs about disease aetiology; (v) biomedical cancer treatments failing to address holistic health. Conclusions: Although some information is known about Indigenous Australian healing beliefs and practices associated with cancer treatment, few studies have addressed ways in which Indigenous and biomedical approaches to cancer treatment might be integrated. Some recent work has examined the role of belief in cancer treatment, specifically bush medicine, but more research is required. © 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians. Source

Aujla N.,University of Leicester | Skinner T.C.,Combined Universities Center for Rural Health | Khunti K.,University of Leicester | Davies M.J.,University of Leicester
Diabetic Medicine | Year: 2010

Aims To compare the identification of prevalent depressive symptoms by the World Health Organization-5 Wellbeing Index (WHO-5) and Centre for Epidemiological Studies Depression Scale (CES-D) for South Asian and white European people, male and female, attending a diabetes screening programme, and to explore the adequacy of the screening tools for this population. An additional aim was to further explore associations of depressive symptoms with impaired glucose regulation (IGR) and Type 2 diabetes mellitus (Type2 DM). Methods Eight hundred and sixty-four white European (40-75 years old) and 290 South Asian people (25-75 years old) underwent an oral glucose tolerance test (OGTT), detailed history and anthropometric measurements and completed the WHO-5 and CES-D. Depressive symptoms were defined by a WHO-5 score ≤ 13, and CES-D score ≥ 16. Results Unadjusted prevalence of depressive symptoms with the WHO-5, for people with Type2 DM was 42.3% (47.4% in white European; 28.6% in South Asian) and for IGR 30.7% (26% in white European; 45.8% in South Asian). With the CES-D, the prevalence in Type2 DM was 27.2% (25.4% in white European; 31.8% in South Asian) and for IGR 30.7% (27.8% in white European; 40.7% in South Asian). Statistically significant differences in the prevalence of depressive symptoms for sex or ethnicity were not identified. Odds ratios adjusted for age, sex and ethnicity showed no significant association of depression with Type2 DM or IGR, with either WHO-5 or CES-D. Agreement was moderate (κ = 0.48, 95% confidence intervals 0.42-0.54), and reduced when identifying depressive symptoms in people with Type2 DM. For this group, a WHO-5 cut-point of ≤ 10 was optimal. Conclusions Depressive symptoms, identified by WHO-5 or CES-D, were not significantly more prevalent in people with Type2 DM or IGR. The WHO-5 and CES-D differed in their identification of depressive symptoms in people with Type2 DM, though discrepancies between sex and ethnicity were not identified. © 2010 Diabetes UK. Source

Skinner T.C.,Combined Universities Center for Rural Health | Cameron F.J.,University of Melbourne
Diabetic Medicine | Year: 2010

In paediatric diabetes, the concept of intensive therapy in the post-Diabetes Control and Complications Trial period has become subverted by a pharmaco-technological paradigm at the expense of other aspects of care such as goal-setting and psychosocial support. This review examines which patients benefit most from intensive therapy in terms of glycaemic control (HbA 1c). It also reviews published controlled trial and observational data relating to the impact of various insulin types and delivery systems on glycaemic control and canvasses the literature dealing with the impact of patient support, philosophy of care, goal setting and treating team dynamic on HbA1c. Taking into account the characteristics of those patients who benefit most from intensive therapy, the quantum of HbA1c change and the persistence of changes that have been reported in selected and non-selected patient groups, it appears that there is a clear hierarchy in aspects of therapy that improve glycaemic control for children and adolescents with Type 1 diabetes. Prime issues appear to be patient support, team cohesion and goal setting. The reported glycaemic benefits achieved by an isolated emphasis upon a pharmaco-technological paradigm are limited in children and adolescents. It appears that only after the prime issues have been first considered will the potential benefits of the insulin types and regimens then be realized. © 2010 Diabetes UK. Source

Bailey S.,Combined Universities Center for Rural Health | Scalley B.,Geraldton Population Health Unit | Gilles M.,Geraldton Population Health Unit
Australian Family Physician | Year: 2015

Background: Approximately 75% of patients exposed to the hepatitis C virus will become chronically infected. Polymerase chain reaction (PCR) testing more than 6 months after exposure is necessary to identify this group. This pilot study assessed the practical application of PCR testing in the general practice context. Methods: General practitioners of patients newly notified as positive for hepatitis C antibody between 1 August 2007 and 1 August 2012 were invited to participate. They completed a self-administered survey, recording details on the use of hepatitis C PCR testing in their patients. Results: The survey found that 16 patients (46%) did not undergo any PCR testing for hepatitis C. Of those who underwent PCR testing, 11 (58%) were positive on PCR testing but only six (55%) of those with a positive PCR test were retested 6 months later. Discussion: Appropriate use of PCR is necessary to identify patients with chronic hepatitis C and offer appropriate referral and treatment. Source

Schoen D.,Royal Perth Hospital | Balchin D.,Chronic Disease Management Team | Thompson S.,Curtin University Australia | Thompson S.,Combined Universities Center for Rural Health
Health Promotion Journal of Australia | Year: 2010

Issues addressed: Despite the startling age specific rate ratio for amputations in 25-49 year olds of, 41.25 for knee amputations and 27.5 for toe/foot amputations for Aboriginal/non-Aboriginal people, there are no diabetes foot care education brochures or health promotion media available free of charge for Aboriginal people.1 This study consulted Aboriginal people about existing and potential resources for education on foot care. Method: An Aboriginal and non-Aboriginal interviewer conducted six focus group discussions with a total of 60 Aboriginal people including Elders, community members, health workers, students and nurses. Focus groups discussed which materials, media and foot care messages worked best to communicate diabetes foot care messages. Results: Participants were unequivocal in their preference for real pictures of foot problems rather than cartoons, clearly identifying a superior existing educational resource from the Indigenous Diabetic Foot Program. There was minimal support for many existing media and foot care messages. Participants preferred to develop their own messages and selected utilitarian media that would be used by all members of the Aboriginal community. Conclusions: We recommend the delivery of the Indigenous Diabetic Foot Program in Western Australia. Consultation and involvement of Aboriginal people was consistent with Aboriginal peoples' preferred style of conversation and inclusion and allowed the target audience to determine the end product for use in education and health promotion. Source

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