Comparison of fracture rates between indigenous and non-indigenous populations: a systematic review protocol

INTRODUCTION: Over recent years, there has been concerted effort to 'close the gap' in the disproportionately reduced life expectancy and increased morbidity experienced by indigenous compared to non-indigenous persons. Specific to musculoskeletal health, some data suggest that indigenous peoples have a higher risk of sustaining a fracture compared to non-indigenous peoples. This creates an imperative to identify factors that could explain differences in fracture rates. This protocol presents our aim to conduct a systematic review, first, to determine whether differences in fracture rates exist for indigenous versus non-indigenous persons and, second, to identify any risk factors that might explain these differences.

METHODS AND ANALYSIS: We will conduct a systematic search of PubMed, OVID, MEDLINE, CINAHL and EMBASE to identify articles that compare all-cause fracture rates at any skeletal site between indigenous and non-indigenous persons of any age. Eligibility of studies will be determined by 2 independent reviewers. Studies will be assessed for methodological quality using a previously published process. We will conduct a meta-analysis and use established statistical methods to identify and control for heterogeneity where appropriate. Should heterogeneity prevents numerical syntheses, we will undertake a best-evidence analysis to determine the level of evidence for differences in fracture between indigenous and non-indigenous persons.

ETHICS AND DISSEMINATION: This systematic review will use published data; thus, ethical permissions are not required. In addition to peer-reviewed publication, findings will be presented at (inter)national conferences, disseminated electronically and in print, and will be made available to key country-specific decision-makers with authority for indigenous health.

Cognitive processing in non-communicative patients:what can event-related potentials tell us?

Event-related potentials (ERP) have been proposed to improve the differential diagnosis of non-responsive patients. We investigated the potential of the P300 as a reliable marker of conscious processing in patients with locked-in syndrome (LIS). Eleven chronic LIS patients and 10 healthy subjects (HS) listened to a complex-tone auditory oddball paradigm, first in a passive condition (listen to the sounds) and then in an active condition (counting the deviant tones). Seven out of nine HS displayed a P300 waveform in the passive condition and all in the active condition. HS showed statistically significant changes in peak and area amplitude between conditions. Three out of seven LIS patients showed the P3 waveform in the passive condition and five of seven in the active condition. No changes in peak amplitude and only a significant difference at one electrode in area amplitude were observed in this group between conditions. We conclude that, in spite of keeping full consciousness and intact or nearly intact cortical functions, compared to HS, LIS patients present less reliable results when testing with ERP, specifically in the passive condition. We thus strongly recommend applying ERP paradigms in an active condition when evaluating consciousness in non-responsive patients.

Dangerous practices : the practicum experiences of non-Indigenous pre-service teachers in remote communities

This paper seeks to explore the risks of providing preserviceteachers with professional experiences in remote communities.In particular this paper focuses on the risks associated with this kindof professional experience. Twelve pre-service teachers wereinterviewed whilst on a three-week practicum around Katherine andin Maningrida in the Northern Territory during 2012. The dangersoutlined in this paper relate to the way their experiences continued tobe mediated by stereotypes and perpetuating colonial practices. Thepre-service teachers’ limited understandings of Indigenousknowledges and languages are discussed before exploring the vexedissue of reverse culture shock that some of the participants identifiedwhen they returned home. The paper concludes by exploring thenotion of ‘allies’ as a way to negotiate the problematic nature of thiswork.

Non-indigenous Japanese oyster drill Pteropurpura (Ocinebrellus) inornata (Récluz, 1851) (Gastropoda: Muricidae) on the south-west coast of Portugal

The Japanese oyster drill or rock snail Pteropurpura (Ocinebrellus) inornata (Récluz, 1851), a marine mollusc, belonging to the family Muricidae, is reported from Portugal for the first time. This non-indigenous species, most likely introduced accidentally from French oyster rearing areas into mainland Portugal, has been regularly sampled in shellfish-culture and nearby environments in Sagres, Algarve, Southwest Portugal since 2005–2008. Detailed studies are urgently needed in order to assess whether or not it has become an invasive species due to a range expansion beyond its point of initial introduction. Outputs should provide information to decision-makers to predict and limit further spread which might result in biodiversity loss and negative economical consequences in locally species-rich areas.

“A politics of what” : A praxiography of renal disease in Indigenous renal patients

The morbidity and mortality rates of renal disease in Indigenous Australians are significantly higher than those of non-Indigenous Australians, and are increasing. The dominant discourses of renal disease currently predicate this as essentially a client problem, rather than (for example) a health care system problem. These discourses are indicative of the dominant “white” paradigm of health care, which fosters an expectation of assimilation by the marginalised “other.” In this paper, we draw upon a sociological methodology (the actor network approach) and a qualitative method (discourse analysis) to tease out these issues in Indigenous renal disease. Based on empirical data, we explore on the one hand the requirements of the discourses, technologies and practices that have been developed for a particular type of renal patient and health system in Australia. On the other, we examine the cultural and practical specificities entailed in the performance of these technologies and practices in the Indigenous Australian context. The meeting of the praxiographic orientation of the actor network approach—which has been called “the politics of what” (Mol 2002)—and the sociocultural concerns of discourse analysis does provide a useful guide as to “what to do” when confronted with issues in health care that currently seems unfathomable. Our praxiographic analysis of the discourse enabled us to understand the difficulties involved in translating renal health care networks across cultural contexts in Australia and to understand the dynamic and contested nature of these networks. The actor network approach has its limitations, however, particularly in the articulation of possible strategies to align two disparate systems in a way that would ensure better health care for Indigenous renal patients. In this paper we will discuss some of the problems we encountered in drawing on this methodology in our attempt to unearth practical solutions to the conundrums our data presented.

Developing a model of care to improve the health and well-being for Indigenous people receiving renal dialysis treatment

The high levels of end-stage renal disease among Indigenous Australians, particularly in remote areas of the country, are a serious public health concern. The magnitude of the problem is reflected in figures from the Australian and New Zealand Transplant and Dialysis Registry that show that Indigenous Australians experience end-stage renal disease at a rate almost 9–10 times higher than other non-Indigenous Australians. A majority of Indigenous Australians have to relocate to receive appropriate renal dialysis treatment. In some Australian states, renal treatment is based on self-care dialysis which allows those Indigenous Australians to be treated back in their community. Evidence clearly shows that reuniting renal patients with community and family improves overall health and well-being for those Indigenous Australians. With the appropriate resources, training, and support, self-care management of renal dialysis treatment is an effective way for Indigenous people with end-stage renal failure to be treated at home. In this context, the study was used to gain insight and further understanding of the impact that end-stage renal disease and renal dialysis treatment has had on the lives of Indigenous community members. The study findings are from 14 individually interviewed people from South East Queensland. Data from the interviews were analysed using a combination of thematic and content analysis. The study methodology was based on qualitative data principles where the Indigenous community members were able to share their experiences and journeys living with end-stage renal disease. Many of the experiences and understanding closely relate to the renal disease pattern and the treatment with other outside influences, such as social, cultural, and environmental influences, all having an equal impact. Each community member’s experience with end-stage renal disease is unique; some manage with family and medical support, while others try to manage independently. From the study, community members who managed their renal dialysis treatment independently were much more aware of their renal health status. The study provides recommendations towards a model of care to improve the health and well-being is based on self-care and self-determination principles.

Drug-related emergency department visits by elderly patients presenting with non-specific complaints

BACKGROUND Since drug-related emergency department (ED) visits are common among older adults, the objectives of our study were to identify the frequency of drug-related problems (DRPs) among patients presenting to the ED with non-specific complaints (NSC), such as generalized weakness and to evaluate responsible drug classes. METHODS Delayed type cross-sectional diagnostic study with a prospective 30 day follow-up in the ED of the University Hospital Basel, Switzerland. From May 2007 until April 2009, all non-trauma patients presenting to the ED with an Emergency Severity Index (ESI) of 2 or 3 were screened and included, if they presented with non-specific complaints. After having obtained complete 30-day follow-up, two outcome assessors reviewed all available information, judged whether the initial presentation was a DRP and compared their judgment with the initial ED diagnosis. Acute morbidity ("serious condition") was allocated to individual cases according to predefined criteria. RESULTS The study population consisted of 633 patients with NSC. Median age was 81 years (IQR 72/87), and the mean Charlson comorbidity index was 2.5 (IQR 1/4). DRPs were identified in 77 of the 633 cases (12.2%). At the initial assessment, only 40% of the DRPs were correctly identified. 64 of the 77 identified DRPs (83%) fulfilled the criteria "serious condition". Polypharmacy and certain drug classes (thiazides, antidepressants, benzodiazepines, anticonvulsants) were associated with DRPs. CONCLUSION Elderly patients with non-specific complaints need to be screened systematically for drug-related problems. TRIAL REGISTRATION ClinicalTrials.gov: NCT00920491.

Capturing Australian indigenous perception of virtual landscape

This short paper presents a means of capturing non spatial information (specifically understanding of places) for use in a Virtual Heritage application. This research is part of the Digital Songlines Project which is developing protocols, methodologies and a toolkit to facilitate the collection and sharing of Indigenous cultural heritage knowledge, using virtual reality. Within the context of this project most of the cultural activities relate to celebrating life and to the Australian Aboriginal people, land is the heart of life. Australian Indigenous art, stories, dances, songs and rituals celebrate country as its focus or basis. To the Aboriginal people the term “Country” means a lot more than a place or a nation, rather “Country” is a living entity with a past a present and a future; they talk about it in the same way as they talk about their mother. The landscape is seen to have a spiritual connection in a view seldom understood by non-indigenous persons; this paper introduces an attempt to understand such empathy and relationship and to reproduce it in a virtual environment.

Psychotherapy in Australia : clinical psychology and its approach to depression

In Australia, clinical psychology training is dominated by cognitive and behavioral treatments (CBTs), although there is exposure to other theoretical orientations. Since 2001, over 20% of general medical practitioners (GPs) have received training in CBT, and psychiatry training increasingly incorporates CBT elements. Psychotherapy by medical practitioners is financially supported by universal health care funding with supplementation by patients and their private health insurance. Federally funded health benefits for up to 12 psychology consultations per year are provided on referral from GPs and psychiatrists, and initial take up has been very strong. Mrs. A would be a typical patient for such a referral. However, she would not fulfil criteria for priority access from state-funded mental health services. Mrs. A would probably consult a GP and receive antidepressants, although she may also access a range of other community support programs. Access to and acceptance of psychotherapy would be greater in urban areas, and if she were of Anglo-Saxon and non- indigenous origin.

Health, Death, and Indigenous Australians in the Coronial system

This paper details research conducted in Queensland during the first year of operation of the new Coroners Act 2003. Information was gathered from all completed investigations between December 2003 and December 2004 across five categories of death: accidental, suicide, natural, medical and homicide. It was found that 25 percent of the total number of Indigenous deaths recorded in 2004 were reported to, and investigated by, the Coroner, in comparison to 9.4 percent of non-Indigenous deaths. Moreover, Indigenous people were found to be over-represented in each category of death, except in death in a medical setting, where they were absent.

Book Review: Larissa Behrendt, Chris Cuneen and Terri Libesman, Indigenous Legal Relations in Australia (Oxford University Press, Melbourne 2009) 376pp

Indigenous Legal Relations in Australia is a welcome and refreshing addition to the current literature on Indigenous legal issues. Written by a team of highly qualified Indigenous and non-Indigenous academics who share a long term commitment to Indigenous legal and social justice issues, this book provides a clearly written and accessible introductory text for tertiary students and general readers alike who are seeking to gain a deeper understanding of the relationship between Indigenous Australians and the Anglo-Australian legal system.

Leading indigenous education in a remote location : reflections on teaching to be "proud and deadly"

This thesis is a critical reflection of the author’s time as a Principal of an Indigenous state school from 2003-2004. The purpose is to reassess the impact of her principalship in terms of the staff, students and Community change that affected learning outcomes at the school and to reanalyse to what actions and to whom positive changes could be attributed. This thesis reflects and identifies, in light of the literature, strategies which were effective in enhancing student learning outcomes. The focus of this thesis was the Doongal State School*, its students, staff and facilities. The author will attempt to draw out theoretical frameworks in terms of: (1) what changed educationally in Doongal State School, (2) what seemed to be important in the Principal’s role, (3) the processes that took place, and (4) the effect of being non- Indigenous and a female. Overall, the author undertook this critical reflection in order to understand and embrace educational practices that will (a) lessen the gap between the academic outcomes achieved by Indigenous and non-Indigenous students, and (b) enhance life choices for Indigenous children. The findings indicate that principal leadership is critical for success in Indigenous schools and is the centrepiece of the models developed to explain improvement at Doongal State School. School factors, Principal Leadership factors, Change factors and factors relating to being a non-Indigenous female principal, which, when implemented, will lead to improved educational outcomes for Indigenous students, have evolved as a result of this thesis. Principal Leadership factors were found to be the enablers for the effective implementation of the key components for success.

Romance and Reconciliation : The secret life of indigenous sexuality on Australian television drama

This article examines the representation of Indigenous sexuality on Australian television drama since the 1970s, suggesting the political importance of such representations. In 1976 Justine Saunders became the first regular Indigenous character on an Australian television drama series, as the hairdresser Rhonda Jackson in Number 96. She was presented as sexually attractive, but this was expressed through a rape scene after a party. Twenty five years later, Deborah Mailman starred in The Secret Life of Us, as Kelly, who is also presented as sexually attractive. But her character can be seen in many romantic relationships. The article explores changing representations that moved us from Number 96 to The Secret Life of Us, via The Flying Doctors and Heartland. It suggests that in representations of intimate and loving relationships on screen it has only recently become possible to see hopeful models for interaction between Indigenous and non-Indigenous Australians.

Indig-curious : what are the challenges for non Aboriginal theatre practitioners in accessing and interpreting Aboriginal themes?

How do non-Indigenous theatre practitioners, especially actors, access and incorporate Aboriginal themes in the plays they create or perform in? Will it ever be acceptable for a non-Aboriginal actor to play an Aboriginal role? In literature there are clear protocols for writing Aboriginal characters and themes. In the visual arts and in dance, non-Indigenous practitioners might 'reference' Aboriginal themes, but what about in theatre performance? This research embodies one cultural dilemma in a creative project and exegesis: exploring the complex issues which emerge when an Aboriginal playwright is commissioned to write an 'Aboriginal themed' play for two non-Aboriginal actors.

Narratives of mitigation : sentencing Indigenous criminal defendants in South Australia’s Higher Courts

In their statistical analyses of higher court sentencing in South Australia, Jeffries and Bond (2009) found evidence that Indigenous offenders were treated more leniently than non-Indigenous offenders, when they appeared before the court under similar numerical circumstances. Using a sample of narratives for criminal defendants convicted in South Australia’s higher courts, the current article extends Jeffries and Bond’s (2009) prior statistical work by drawing on the ‘focal concerns’ approach to establish whether, and in what ways, Indigeneity comes to exert a mitigating influence over sentencing. Results show that the sentencing stories of Indigenous and non-Indigenous offenders differed in ways that may have reduced assessments of blameworthiness and risk for Indigenous defendants. In addition, judges highlighted a number of Indigenous-specific constraints that potentially could result in imprisonment being construed as an overly harsh and costly sentence for Indigenous offenders.