Exocrine pancreatic dysfunction in malnourished Australian Aboriginal children

Pancreatic exocrine dysfunction has been frequently recorded in protein-energy malnutrition in underdeveloped countries. In addition, the pancreas requires optimal nutrition for enzyme synthesis and potentially correctable pancreatic enzyme insufficiency may play a role in the continuation of protein-energy malnutrition. This problem has not been previously evaluated in Australian Aborigines. We have applied a screening test for pancreatic dysfunction (human immunoreactive trypsinogen [IRT] assay) to the study of 398 infants (6-36 months) admitted to the Alice Springs Hospital over a 20-month period. All infants were assessed by anthropometric measures and were assigned to to three nutritional groups (normal, moderate or severely malnourished) and two growth groups (stunted or not stunted). Of the 198 infants who had at least a single serum cationic trypsinogen measurement taken, normal values for serum IRT (with confidence limits) were obtained from 57 children, who were normally nourished. IRT levels were significantly correlated with the degree of underweight but there was no correlation with the degree of stunting or age. Mean IRT levels for the moderate and severely underweight groups were significantly greater than the mean for the normal group (P < 0.01). Seventeen children (8.6%) had trypsinogen levels in excess of the 95th percentile for the normally nourished group, reflecting acinar cell damage or ductal obstruction. We conclude that pancreatic dysfunction may be a common and important overlooked factor contributing to ongoing malnutrition and diseases in malnourished Australian Aboriginal children.

Expressions of shame in investigative interviews with Australian Aboriginal children

This study inspected a sample of 70 interview transcripts with Australian Aboriginal children to gain a sense of how frequently verbal shame responses were occurring in investigative interviews regarding alleged sexual abuse. Transcripts were examined to determine how children articulated shame, how interviewers reacted to these responses, and how shame related to children's accounts. Examination of frequencies revealed that verbal shame responses occurred in just over one-quarter of the interviews. One-way analyses of variance indicated that children who expressed shame within the interview spoke the same amount as children who did not express shame, however, they required more interviewer prompts before a disclosure was made. Interviews where children expressed shame also included a greater number of interviewer reminders compared to interviews without shame responses. Results emphasize the importance of interviewer awareness of shame, and also point to the value of reassurance, patience, and persistence with non-leading narrative prompting when interviewing children who express shame during discussions of sexual abuse.

Investigative Interviewing of Aboriginal children in cases of suspected sexual abuse

This study examined the investigative interviewing of Australian Aboriginal children in cases of alleged sexual abuse, with a focus on three commonly included components of interview protocols: ground rules, practice narrative, and substantive phase. Analysis of 70 field transcripts revealed that the overall delivery and practice of ground rules at the beginning of the interview was positively associated with the spontaneous usage of rules in children's narratives of abuse. When specifically examining the "don't know" rule, however, only practice had an effect of children's usage of the rule (as opposed to simple delivery or no delivery at all). Children spoke more words overall, and interviewers used more open-ended prompts during the substantive phase when the interviews contained a practice narrative. Children most often disclosed sexual abuse in response to an open-ended prompt; however, they produced the most words in response to suggestive prompts. This article concludes with a discussion of the effectiveness of ground rules, practice narratives, and questioning with Aboriginal children.

Improving investigative Interviews with Aboriginal children

This thesis focused on improving investigative interview protocols with Australian Aboriginal children (predominantly in cases of abuse). Current investigative interviewing procedures were evaluated, and a revised interview protocol tailored to Aboriginal children was created.

Professionals' perceptions regarding the suitability of investigative interview protocols with Aboriginal children

Objective: Despite the heterogeneity of Australian Aboriginal peoples, certain styles of relating are shared and are markedly different to the communication styles of non-Aboriginal peoples. These differences may affect the suitability of current investigative interview protocols to Australian Aboriginal children. This study aimed to qualitatively evaluate the applicability of an investigative interview protocol to Australian Aboriginal children and examine how it could be modified to better suit the communication styles in many Aboriginal communities. Method: A diverse group of 28 participants who had expertise in Aboriginal language and culture, as well as an understanding of the child investigative interview process, each partook in an in-depth semi-structured interview where they were prompted to reflect on Aboriginal language and culture with reference to a current interview protocol (in the context of sexual assault investigation). Results: Thematic analysis revealed overall support for the narrative-based structure of the interview protocol when eliciting information from Aboriginal children. A number of concerns were also identified, and these largely related to the syntax and vocabulary within the protocol, as well as the methods of questioning and building rapport with the child. Conclusions: Directions for future research and potential modifications to investigative interview protocols to better suit Aboriginal children are discussed.

Lower respiratory infections in Australian Indigenous children

Despite Australia being one of the wealthiest countries of the world, Australian Indigenous children have a health status and social circumstance comparable to developing countries. Indigenous infants have 10 times the mortality rate for respiratory conditions. The lower respiratory infection (LRI) rate in Australian Indigenous children is at least as high as that of children in developing countries; the frequency of hospitalisations of Indigenous infants is triple that of non-Indigenous Australian infants (201.7 vs. 62.6/1000, respectively). While Indigenous Australian children have many risk factors for LRIs described in developing countries, there is little specific data, and hence, evidence-based intervention points are yet to be identified. Efficacy of conjugate vaccines for common bacterial causes of pneumonia has been less marked in Indigenous children than that documented overseas. Gaps in the management and prevention of disease are glaring. Given the burden of LRI in Indigenous children and the association with long-term respiratory dysfunction, LRIs should be addressed as a matter of priority.

Kidney volume, blood pressure, and albuminuria: Findings in an Australian Aboriginal community

Background. Australian Aborigines are experiencing epidemic proportions of renal disease, marked by albuminuria and, variably, hematuria. They also have high rates of low birth weight, which have been associated with lower kidney volumes and higher blood pressures. The authors evaluated relationships between kidney volume, blood pressure, albuminuria, and hematuria in 1 homogeneous group. Methods Forty-three percent (672 of 1,560) of the population in a remote coastal Australian Aboriginal community aged 4.4 to 72.1 years participated in the study. Results: Kidney size correlated closely with body size. Systolic blood pressure (SBP) was correlated inversely with kidney length and kidney volume, after adjusting for age, sex, and body surface area (BSA); a 1-cm increase in mean kidney length was associated with a 2.2-mm Hg decrease in SBP, and a 10-mL increase in mean kidney volume was associated with a 0.6-mm Hg decrease in SBP (P = 0.001). Mean kidney volume explained 10% of the variance in SBP in a multivariate model containing age, sex, and BSA. In addition to higher SBP, adults who had the lowest quartiles of kidney volume also had the highest levels of overt albuminuria (P = 0.044). Conclusion: Smaller kidneys predispose to higher blood pressures and albuminuria in this population. The lower volumes possibly represent kidneys with reduced nephron numbers, which might be related to an adverse intrauterine environment. Susceptibility to renal disease could be a direct consequence of reduced nephron numbers; the higher blood pressures with which they are associated could also contribute to, as well as derive from, this association.

Reempowering ourselves: Australian Aboriginal women

The arrival of the colonists, the invasion of Aboriginal lands and the subsequent colonization of Australia had a disastrous effect on Aboriginal women, including on-going dispossession and disempowerment. Aboriginal women’s lives and gendered realities were forever changed in most communities. The system of colonization deprived Aboriginal women of land and personal autonomy and restricted the economic, political, social, spiritual and ceremonial domains that had existed prior to colonization. It also involved the implementation of overriding patriarchal systems. This is why Aboriginal women may find understanding within the women’s movement and why feminism might offer them a source of analysis. There are some connections in the various forms of social oppression, which give women connection and a sharing on some issues. However, imperialism and colonialism are also part of the women’s movement and feminism. This essay demonstrates why attempts to engage with feminism and to be included in women-centred activities might result in the denial and sidelining of Aboriginal sovereignty and further oppression and marginalisation of Aboriginal women. Moreover, strategies employed by non-Indigenous feminists can result in the maintenance of white women’s values and privileges within the dominant patriarchal white society. By engaging in these strategies feminists can also act in direct opposition to Aboriginal sovereignty and Aboriginal women. This essay states clearly that women who do not express positions or opinions in outright support of these activities still benefit from their position by proxy and contribute to the cultural dominance of non-Indigenous women. I argue that Aboriginal women need to define what empowerment might mean to themselves, and I suggest re-empowerment as an act of Aboriginal women’s healing and resistance to the on-going processes and impacts of colonization.

The meaning of cancer for Australian Aboriginal women : changing the focus of cancer nursing

Aim: The purpose of the study was to explore why Aboriginal women participate in cancer screening programs but appear reluctant to following-up results, or accept medical advice about treatment. Methods: Interpretive ethnography, a qualitative methodology, was used to explore Aboriginal women’s perception of cancer, and the cultural context in which meaning was constructed and influenced treatment decision. Data collection, which occurred over two years, involved fieldwork, participant-observation, face-to-face interviews and focus groups, in two rural Aboriginal communities. Forty eight interviews were recorded from a cross section of the communities, including cancer survivors and patients, family members, health care providers and other women from the community. Results: Key findings were that Aboriginal women’s had a fearful and fatalistic attitude toward cancer, doubted the efficacy of treatment and carried an enduring ambivalence toward the authority of whiteman’s medicine. The women faced a dilemma of wanting access to cancer treatment options but feared entering hospital or clinics not attuned to their cultural needs. Conclusion: The findings highlight the need for a culture-centred approach that decentres the authority of conventional services and instead gives prominence to Aboriginal cultural values as a focal point in cancer control. It should be the responsibility of cancer nurses and others to engage with their local Aboriginal communities to build relationships that foster an exchange of learning about cultural differences that make a difference to how cancer control is practiced.

Talkin' up sport and gender : Three Australian Aboriginal women speak

This paper presents the perspectives from three Aboriginal women on body image, sport and physical activity within Australian contemporary society. It draws on a range of literature along with artworks from visual artist Pamela Croft.

Cost-effectiveness analysis of a kidney and cardiovascular disease treatment program in an Australian Aboriginal population

The objective of the study was to assess, from a health service perspective, whether a systematic program to modify kidney and cardiovascular disease reduced the costs of treating end-stage kidney failure. The participants in the study were 1,800 aboriginal adults with hypertension, diabetes with microalbuminuria or overt albuminuria, and overt albuminuria, living on two islands in the Northern Territory of Australia during 1995 to 2000. Perindopril was the primary treatment agent, and other medications were also used to control blood pressure. Control of glucose and lipid levels were attempted, and health education was offered. Evaluation of program resource use and costs for follow-up periods was done at 3 and 4.7 years. On an intention-to-treat basis, the number of dialysis starts and dialysis-years avoided were estimated by comparing the fate of the treatment group with that of historical control subjects, matched for disease severity, who were followed in the before the treatment program began. For the first three years, an estimated 11.6 person-years of dialysis were avoided, and over 4.7 years, 27.7 person-years of dialysis were avoided. The net cost of the program was 1,210 dollars more per person per year than status quo care, and dialyses avoided gave net savings of 1.0 million dollars at 3 years and 3.4 million dollars at 4.6 years. The treatment program provided significant health benefit and impressive cost savings in dialysis avoided.

Australian Aboriginal words in English : their origin and meaning [Second edition]

Australian Aboriginal Words in English records the Aboriginal contribution to Australian English and provides a fascinating insight into the contact between the first Australians and European settlers. The words are grouped according to subject, and for each one there is information on the Aboriginal language from which it derives, the date of its first written use in English, and its present meaning and pronunciation. This book brings them together and provides the fullest available information about their Aboriginal background and their Australian English History.

Australian Aboriginal Words in English : their Origin and Meaning [First edition]

This extensive reference provides authoritative information about the history of over 400 words from Aboriginal languages, offering the fullest available information about their Aboriginal background and Australian English history. The book begins with a general history of the 250 Australian aboriginal languages, including profiles of the languages that have been most significant as sources for borrowing. The words are then grouped according to subject: birds, fish, edible flora, dwellings, etc., with each work listed in a dictionary-style entry. The book concludes by addressing how words changed in English, and discusses English words that have since been adopted into Aboriginal languages.