A systematic approach to chronic heart failure care : a consensus statement

The National Heart Foundation of Australia assembled an expert panel to provide guidance on policy and system changes to improve the quality of care for people with chronic heart failure (CHF). The recommendations have the potential to reduce emergency presentations, hospitalisations and premature death among patients with CHF. Best-practice management of CHF involves evidencebased, multidisciplinary, patient-centred care, which leads to better health outcomes. A CHF care model is required to achieve this. Although CHF management programs exist, ensuring access for everyone remains a challenge. This is particularly so for Aboriginal and Torres Strait Islander peoples, those from non-metropolitan areas and lower socioeconomic backgrounds, and culturally and linguistically diverse populations. Lack of data and inadequate identifi cation of people with CHF prevents effi cient patient monitoring, limiting information to improve or optimise care. This leads to ineff ectiveness in measuring outcomes and evaluating the CHF care provided. Expanding current cardiac registries to include patients with CHF and developing mechanisms to promote data linkage across care transitions are essential. As the prevalence of CHF rises, the demand for multidisciplinary workforce support will increase. Workforce planning should provide access to services outside of large cities, one of the main challenges it is currently facing. To enhance community-based management of CHF, general practitioners should be empowered to lead care. Incentive arrangements should favour provision of care for Aboriginal and Torres Strait Islander peoples, those from lower socioeconomic backgrounds and rural areas, and culturally and linguistically diverse populations. Ongoing research is vital to improving systems of care for people with CHF. Future research activity needs to ensure the translation of valuable knowledge and high quality evidence into practice.

Regional differences in the reproductive parameters of the sparsely-spotted stingaree, Urolophus paucimaculatus, from South-Eastern Australia

Whether spatial variation occurs in the life-history traits of chondrichthyan species is important to fisheries modelling and assessments. A study on the reproductive parameters of Urolophus paucimaculatus from four separate regions across south-eastern Australia found regional differences in maximum total length (TL), size-at-maturity, size-at-maternity and litter sizes. Inshore embayments (Port Phillip Bay (PPB) and Corner Inlet (CI)) appear to allow for larger TLs (females and males) than do offshore areas (Lakes Entrance (LE) and Western Bass Strait (WBS)). Size-at-maturity and size-at-maternity decreased across longitude from west (PPB) to east (LE) and seasonality of parturition and ovulation occurred earlier in PPB (August-October) than in LE (September-December). Maximum litter size correlated with maximum TL (six in PPB, five in each of CI and LE, and four in WBS). There was uncertainty in classifying females for maternal condition because the reproductive cycle appears to range from a continuous annual cycle to a non-continuous biennial cycle. Much of the uncertainty arises from the ambiguity of observation of non-pregnant mature females, which have either aborted through capture and handling, or are in a 'resting year' between pregnancies. Most likely, the majority are reproducing annually with an unknown proportion of females non-continuous and resting between pregnancies.

Aboriginal health promotion through addressing employment discrimination

The Localities Embracing and Accepting Diversity (LEAD) program aimed to improve the mental health of Aboriginal Victorians by addressing racial discrimination and facilitating social and economic participation. As part of LEAD, Whittlesea Council adopted the Aboriginal Employment Pathways Strategy (AEPS) to increase Aboriginal employment and retention within the organisation. The Aboriginal Cultural Awareness Training Program was developed to build internal cultural competency and skills in recruiting and retaining Aboriginal staff. Analysis of surveys conducted before (pre; n=124) and after (post; n=107) the training program indicated a significant increase in participant understanding across all program objectives and in support of organisational policies to improve Aboriginal recruitment and retention. Participants ended the training with concrete ideas about intended changes, as well as how these changes could be supported by their supervisors and the wider organisation. Significant resources have since been allocated to implementing the AEPS over 5 years. In line with principles underpinning the National Aboriginal and Torres Strait Islander Health Plan 2013-23, particularly the focus on addressing racism as a determinant of health, this paper explores the AEPS and training program as promising approaches to health promotion through addressing barriers to Aboriginal employment. Possible implications for other large organisations are also considered.

Supporting healthy communities through arts programs

There are some evaluations, critical descriptions of programs and systematic reviews on the benefits to Aboriginal and Torres Strait Islander communities from participation in arts programs. These include: improved physical and mental health and wellbeing; increased social inclusion and cohesion; some improvements in school retention and attitudes towards learning; increased validation of, and connection to, culture; improved social and cognitive skills; and some evidence of crime reduction.The effects of arts programs can be powerful and transformative. However, these effects tend to be indirect.For example, using these programs to reduce juvenile anti-social behaviour largely work through diversion: providing alternative safe opportunities to risk taking, maintenance of social status, as well as opportunities to build healthy relationships with Elders and links with culture.Art forms such as song, dance and painting, coupled with ceremony, are integral to cultural continuity and cultural maintenance in Indigenous Australian communities.

Supporting healthy communities through sports and recreation programs

There is some evidence, in the form of critical descriptions of programs and systematic reviews, on the benefits to Aboriginal and Torres Strait Islander communities from participation in sport and recreational programs. These include some improvements in school retention, attitudes towards learning, social and cognitive skills, physical and mental health and wellbeing; increased social inclusion and cohesion; increased validation of and connection to culture; and crime reduction.Although the effects of sports and recreation programs can be powerful and transformative, these effects tend to be indirect. For example, using these programs to reduce juvenile antisocial behaviour largely work through diversion, providing alternative safe opportunities to risk taking, maintenance of social status, as wellas opportunities to build healthy relationships with Elders and links with culture.Although Indigenous Australians have lower rates of participation in sport than non-Indigenous people, surveys suggest that around one-third of Indigenous people participate in some sporting activity (ABS 2010). That makes sports a potentially powerful vehicle for encouraging Indigenous communities to look at challenging personal and community issues.Within Indigenous communities, a strong component of sport and recreation is the link with traditional culture. Cultural activities such as hunting are generally more accepted as a form of sport and recreation than traditional dance. Therefore sport and recreation are integral in understanding ‘culture’ within Indigenous communities, as well as highlighting the culture within which sport and recreation operate.

Genetic counseling for Indigenous Australians: an exploratory study from the perspective of genetic health professionals

Indigenous populations are thought to have particularly low levels of access to genetic health services, and cultural issues may be a contributing factor. This article presents the findings of the first study of genetic health service provision to Indigenous Australians. This qualitative study aimed to identify elements of culturally-competent genetic health service provision in Indigenous Australian contexts. Twelve semi-structured interviews were conducted with genetic counselors and clinical geneticists from around Australia who had delivered services to Indigenous Australians. Participants were asked to describe their experiences and identify any collective cultural needs of Indigenous clients, as well as comment on specific training and resources they had received or used. Interviews were audio-recorded and transcribed with thematic analysis conducted on the data. The findings show that participants were reluctant to generalize the needs of Indigenous peoples. Some participants asserted that Indigenous peoples have needs that differ from the general population, while others felt that there were no collective cultural needs, instead advocating an individualized approach. Being flexible and practical, taking time to build rapport, recognizing different family structures and decision-making processes, as well as socio-economic disadvantage were all identified as important factors in participants' interactions with Indigenous clients. Indigenous support workers and hospital liaison officers were seen as valuable resources for effective service provision. The implications of this study for training and practice are discussed.