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Oppliger K, Blair S, Price R, Nahanee ML, Nahanee D, Duncan RTE, Lamont E, Beverly A, Dawson AS, Conklin AI. Promoting Slhánay̓ Sḵwálwen (Indigenous Women's Heart Health): Findings From Sharing Circles With Squamish Nation. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:509-520. [PMID: 38888537 DOI: 10.1016/j.jneb.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVE To gather knowledge and experiences from Squamish Nation citizens to codevelop a model of foraging walks for Indigenous women's heart health. DESIGN Qualitative study (sharing circles). SETTING Vancouver, Canada (virtual). PARTICIPANTS Squamish Nation community members (n = 9), Elders or Knowledge Keepers (n = 5), and researchers (n = 2). INTERVENTION Community-led foraging walks as a culturally safe nutrition education strategy. MAIN OUTCOME MEASURE(S) Perspectives and experiences. ANALYSIS Content analysis and narrative synthesis. RESULTS Personal experiences of foraging walks or knowledge of traditional plants were limited for most participants, and all desired to learn more about traditional foods using land-based activities. Participants identified a lack of nutrition education surrounding heart health and common mistreatment and judgment from health professionals. Participants identified important elements of a future Squamish program, including who should be involved, how to implement it, and the most effective temporal and physical setting. All agreed foraging walks help promote 5 dimensions of heart health (physical, emotional, spiritual, mental, and social) through physical activity, purposeful nutrition, and connection to community and culture. Findings from the sharing circles were used in the creation of a template for future foraging sessions and contributed to plant identification cards for the whole community. CONCLUSIONS AND IMPLICATIONS Community-based pilot studies to test foraging walks as a culturally safe and environmental approach to nutrition education and cardiovascular health awareness for Indigenous communities are warranted. Research to examine the similarities and differences across Indigenous groups related to understanding heart health and land-based practices for nutrition education and heart health awareness is needed.
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Affiliation(s)
- Kitty Oppliger
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Sammy Blair
- Food, Nutrition and Health Research Group, Faculty of Land and Food Systems, University of British Columbia, Vancouver, Canada
| | - Roberta Price
- Indigenous Health Initiative, Faculty of Nursing, University of British Columbia, Vancouver, Canada
| | | | - Delhia Nahanee
- Squamish (Sḵwx̱wú7mesh) Nation, North Vancouver and Squamish, British Columbia, Canada
| | | | - Evelyn Lamont
- Squamish (Sḵwx̱wú7mesh) Nation, North Vancouver and Squamish, British Columbia, Canada
| | - Alexandria Beverly
- Squamish (Sḵwx̱wú7mesh) Nation, North Vancouver and Squamish, British Columbia, Canada
| | | | - Annalijn I Conklin
- Food, Nutrition and Health Research Group, Faculty of Land and Food Systems, University of British Columbia, Vancouver, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada; Centre for Advancing Health Outcomes, Providence Health Care Research Institute, Vancouver, Canada.
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Yarning about Diet: The Applicability of Dietary Assessment Methods in Aboriginal and Torres Strait Islander Australians-A Scoping Review. Nutrients 2023; 15:nu15030787. [PMID: 36771491 PMCID: PMC9919225 DOI: 10.3390/nu15030787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Conventional dietary assessment methods are based predominately on Western models which lack Aboriginal and Torres Strait Islander knowledges, methodologies, and social and cultural contextualisation. This review considered dietary assessment methods used with Aboriginal and Torres Strait Islander populations and assessed their applicability. Four electronic databases and grey literature were searched with no time limit applied to the results. Screening, data extraction and quality appraisal were undertaken independently by two reviewers. Out of 22 studies, 20 were conducted in rural/remote settings, one in an urban setting, and one at the national population level. The most frequently used and applicable dietary assessment method involved store data. Weighed food records and food frequency questionnaires had low applicability. Modifications of conventional methods were commonly used to adapt to Indigenous practices, but few studies incorporated Indigenous research methodologies such as yarning. This highlights an opportunity for further investigation to validate the accuracy of methods that incorporate qualitative yarning-based approaches, or other Indigenous research methodologies, into quantitative data collection. The importance of developing validated dietary assessment methods that are appropriate for this population cannot be understated considering the high susceptibility to nutrition-related health conditions such as malnutrition, overweight or obesity, diabetes, and cardiovascular disease.
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Jayasinghe S, Faghy MA, Hills AP. Social justice equity in healthy living medicine - An international perspective. Prog Cardiovasc Dis 2022; 71:64-68. [PMID: 35490871 DOI: 10.1016/j.pcad.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 04/24/2022] [Indexed: 10/18/2022]
Abstract
Irrespective of geographical location, disadvantaged people are disproportionately affected by unnecessary disease and suffering caused by inequalities in health. Although equal access to opportunities for healthy living medicine regardless of legal, political, economic, or other circumstances should be a basic human right, it is increasingly improbable for scores of people, particularly in Africa, Asia, Latin America, and the Caribbean, to acquire this. In recent times, global initiatives have attempted to make 'healthy lifestyles' more equitable by pledging to be relevant to all economies, promoting prosperity, environmental protection, climate change interventions, and purposeful action to meet the needs of vulnerable populations, including women and children. Yet there remains much to be done to address and reduce the substantial international health equity gaps. Reducing disparities that disproportionately affect the lower end of social strata must entail collaborative and systemic action from important stakeholders across the whole system, an approach that translates theory and research into practice. Ideally, realist approaches that appreciate the importance of the context of problems and assume nothing works everywhere or for everyone, should be prioritised over linear/simple and non-scalable intervention strategies.
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Affiliation(s)
- Sisitha Jayasinghe
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia.
| | - Mark A Faghy
- Human Sciences Research Centre, University of Derby, Derby, UK; Department of Physical Therapy, College of Applied Sciences, University of Illinois at Chicago, Chicago, IL, USA; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
| | - Andrew P Hills
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
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Lee A, Stubbs C, Leonard D, Vidgen H, Minniecon D, Dick M, Cullerton K, Herron L. Rise and demise: a case study of public health nutrition in Queensland, Australia, over three decades. Health Promot Int 2021; 37:6378992. [PMID: 34597391 PMCID: PMC9067447 DOI: 10.1093/heapro/daab117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This case study describes the delivery and achievements of the public health nutrition programme in Queensland, Australia, over more than three decades. Analysis of publicly available documents related to statewide nutrition policy and programmes from 1983 to 2014 identified key inputs and programme impacts and outcomes, including an increase in fruit and vegetable intake by 1.1 serves per person per day and rates of exclusive breastfeeding for the first 6 months quadrupled. Mapping factors and milestones against a framework on determinants of political priority highlighted correlation with effective nutrition promotion policy and practice. Identified enablers included the influence of policy champions and advocates, quality of governance, focus on whole-of-population approaches, and periods of political will and economic prosperity. Key barriers included changes of ideology with government leadership; lack of commitment to long-term implementation and evaluation; and limited recognition of and support for preventive health and nutrition promotion. The case study shows that a coordinated, well-funded, intersectoral approach to improve nutrition and prevent chronic disease and malnutrition in all its forms can be achieved and produce promising impacts at state level, but that sustained effort is required to secure and protect investment. Political support for long-term investment in nutrition is essential to reduce the high cost of all diet-related diseases. Public health leadership to better prepare for risks around political cycles, secure adequate resources for evaluation, and better communicate impacts and outcomes may help protect future investments and achievements.
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Affiliation(s)
- Amanda Lee
- The School of Public Health, The University of Queensland, 266 Herston Road, Brisbane, 4006, Australia
| | - Christina Stubbs
- Formerly Queensland Health (1986-2012), 33 Charlotte Street, Brisbane, 4001, Australia
| | - Dympna Leonard
- Australian Institute of Tropical Health and Medicine, James Cook University, 14 McGregor Road, Smithfield, Cairns, 4870, Australia
| | - Helen Vidgen
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Victoria Park Road, Kelvin Grove, 4059, Australia
| | - Deanne Minniecon
- Health and Wellbeing Queensland, 139 Coronation Drive, Milton, 4064, Australia
| | - Mathew Dick
- Health and Wellbeing Queensland, 139 Coronation Drive, Milton, 4064, Australia
| | - Katherine Cullerton
- The School of Public Health, The University of Queensland, 266 Herston Road, Brisbane, 4006, Australia
| | - Lisa Herron
- The School of Public Health, The University of Queensland, 266 Herston Road, Brisbane, 4006, Australia
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Maitjara Wangkanyi: Insights from an Ethnographic Study of Food Practices of Households in Remote Australian Aboriginal Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218109. [PMID: 33153133 PMCID: PMC7663776 DOI: 10.3390/ijerph17218109] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 02/07/2023]
Abstract
Many historical, environmental, socioeconomic, political, commercial, and geographic factors underscore the food insecurity and poor diet-related health experienced by Aboriginal people in Australia. Yet, there has been little exploration of Aboriginal food practices or perspectives on food choice recently. This study, with 13 households in remote communities on the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands, fills this gap using ethnographic and Indigenist methods. Results highlight Anangu resourcefulness, securing food despite poverty and adversity, and provide unique insights into factors influencing the three major types and range of dietary patterns identified. These factors include household economic cycles and budgeting challenges; overcrowding and family structures, mobility and ‘organization’; available food storage, preparation and cooking infrastructure; and familiarity and convenience. Structural and systemic reform, respecting Aboriginal leadership, is required to improve food security.
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Canuto KJ, Aromataris E, Burgess T, Davy C, McKivett A, Schwartzkopff K, Canuto K, Tufanaru C, Lockwood C, Brown A. A scoping review of Aboriginal and Torres Strait Islander health promotion programs focused on modifying chronic disease risk factors. Health Promot J Austr 2019; 32:46-74. [PMID: 31724783 PMCID: PMC7891321 DOI: 10.1002/hpja.307] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 10/31/2019] [Accepted: 11/06/2019] [Indexed: 11/09/2022] Open
Abstract
Issue addressed Noncommunicable chronic disease underlies much of the life expectancy gap experienced by Aboriginal and Torres Strait Islander people. Modifying contributing risk factors; tobacco smoking, nutrition, alcohol consumption, physical activity, social and emotional wellbeing (SNAPS) could help close this disease gap. This scoping review identified and describes SNAPS health promotion programs implemented for Aboriginal and Torres Strait Islander people in Australia. Methods Databases PubMed, CINAHL, Informit (Health Collection and Indigenous Peoples Collection), Scopus, Trove and relevant websites and clearing houses were searched for eligible studies until June 2015. To meet the inclusion criteria the program had to focus on modifying one of the SNAPS risk factors and the majority of participants had to identify as being of Aboriginal and/or Torres Strait Islander heritage. Results The review identified 71 health promotion programs, described in 83 publications. Programs were implemented across a range of health and community settings and included all Australian states and territories, from major cities to remote communities. The SNAPS factor addressed most commonly was nutrition. Some programs included the whole community, or had multiple key audiences, whilst others focused solely on one subgroup of the population such as chronic disease patients, pregnant women or youth. Fourteen of the programs reported no outcome assessments. Conclusions Health promotion programs for Aboriginal and Torres Strait Islander people have not been adequately evaluated. The majority of programs focused on the development of individual skills and changing personal behaviours without addressing the other health promotion action areas, such as creating supportive environments or reorienting health care services. So What? This scoping review provides a summary of the health promotion programs that have been delivered in Australia for Aboriginal and Torres Strait Islander people to prevent or manage chronic disease. These programs, although many are limited in quality, should be used to inform future programs. To improve evidence‐based health promotion practice, health promotion initiatives need to be evaluated and the findings published publicly.
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Affiliation(s)
- Karla J Canuto
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Edoardo Aromataris
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Teresa Burgess
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Carol Davy
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Andrea McKivett
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Kate Schwartzkopff
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Kootsy Canuto
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, Australia
| | - Catalin Tufanaru
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Craig Lockwood
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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Gwynn J, Sim K, Searle T, Senior A, Lee A, Brimblecombe J. Effect of nutrition interventions on diet-related and health outcomes of Aboriginal and Torres Strait Islander Australians: a systematic review. BMJ Open 2019; 9:e025291. [PMID: 30948579 PMCID: PMC6500365 DOI: 10.1136/bmjopen-2018-025291] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To review the literature on nutrition interventions and identify which work to improve diet-related and health outcomes in Australian Aboriginal and Torres Strait Islander people. STUDY DESIGN Systematic review of peer-reviewed literature. DATA SOURCES MEDLINE, PubMed, Embase, Science Direct, CINAHL, Informit, PsychInfo and Cochrane Library, Australian Indigenous Health InfoNet. STUDY SELECTION Peer-reviewed article describing an original study; published in English prior to December 2017; inclusion of one or more of the following outcome measures: nutritional status, food/dietary/nutrient intake, diet-related biomedical markers, anthropometric or health measures; and conducted with Australian Aboriginal and Torres Strait Islander people. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and applied the Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project. A purpose designed tool assessed community engagement in research, and a framework was applied to interventions to report a score based on numbers of settings and strategies. Heterogeneity of studies precluded a meta-analysis. The effect size of health outcome results were estimated and presented as forest plots. RESULTS Thirty-five articles (26 studies) met inclusion criteria; two rated moderate in quality; 12 described cohort designs; 18 described interventions in remote/very remote communities; none focused solely on urban communities; and 11 reported moderate or strong community engagement. Six intervention types were identified. Statistically significant improvements were reported in 14 studies of which eight reported improvements in biochemical/haematological markers and either anthropometric and/or diet-related outcomes. CONCLUSIONS Store-based intervention with community health promotion in very remote communities, fiscal strategies and nutrition education and promotion programmes show promise. Future dietary intervention studies must be rigorously evaluated, provide intervention implementation details explore scale up of programmes, include urban communities and consider a multisetting and strategy approach. Strong Aboriginal and Torres Strait Islander community engagement is essential for effective nutrition intervention research and evaluation. PROSPERO REGISTRATION NUMBER CRD42015029551.
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Affiliation(s)
- Josephine Gwynn
- Faculty of Health Sciences, University of Sydney, Camperdown, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Kyra Sim
- Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia
- Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Tania Searle
- Department of Sociology, Flinders University, Adelaide, South Australia, Australia
| | - Alistair Senior
- Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia
- School of Life and Environmental Sciences, University of Sydney, Camperdown, New South Wales, Australia
| | - Amanda Lee
- School of Public Health, University of Queensland, Herston, Queensland, Australia
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
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Wright KM, Dono J, Brownbill AL, Pearson Nee Gibson O, Bowden J, Wycherley TP, Keech W, O'Dea K, Roder D, Avery JC, Miller CL. Sugar-sweetened beverage (SSB) consumption, correlates and interventions among Australian Aboriginal and Torres Strait Islander communities: a scoping review. BMJ Open 2019; 9:e023630. [PMID: 30819702 PMCID: PMC6398687 DOI: 10.1136/bmjopen-2018-023630] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 11/18/2018] [Accepted: 11/20/2018] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES Sugar-sweetened beverage (SSB) consumption in Australian Aboriginal and Torres Strait Islander people is reported to be disproportionally high compared with the general Australian population. This review aimed to scope the literature documenting SSB consumption and interventions to reduce SSB consumption among Australian Aboriginal and Torres Strait Islander people. Findings will inform strategies to address SSB consumption in Aboriginal and Torres Strait Islander communities. METHODS PubMed, SCOPUS, CINAHL, Informit, Joanna Briggs Institute EBP, Mura databases and grey literature were searched for articles published between January 1980 and June 2018. Studies were included if providing data specific to an Australian Aboriginal and/or Torres Strait Islander population's SSB consumption or an intervention that focused on reducing SSB consumption in this population. DESIGN Systematic scoping review. RESULTS 59 articles were included (1846 screened). While reported SSB consumption was high, there were age-related and community-related differences observed in some studies. Most studies were conducted in remote or rural settings. Implementation of nutrition interventions that included an SSB component has built progressively in remote communities since the 1980s with a growing focus on community-driven, culturally sensitive approaches. More recent studies have focused exclusively on SSB consumption. Key SSB-related intervention elements included incentivising healthier options; reducing availability of less-healthy options; nutrition education; multifaceted or policy implementation (store nutrition or government policy). CONCLUSIONS There was a relatively large number of studies reporting data on SSB consumption and/or sales, predominantly from remote and rural settings. During analysis it was subjectively clear that the more impactful studies were those which were community driven or involved extensive community consultation and collaboration. Extracting additional SSB-specific consumption data from an existing nationally representative survey of Aboriginal and Torres Strait Islander people could provide detailed information for demographic subgroups and benchmarks for future interventions. It is recommended that a consistent, culturally appropriate, set of consumption measures be developed.
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Affiliation(s)
- Kathleen M Wright
- Population Health Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Joanne Dono
- Population Health Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Aimee L Brownbill
- Population Health Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Odette Pearson Nee Gibson
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Sansom Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Jacqueline Bowden
- Population Health Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas P Wycherley
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Wendy Keech
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Health Translation SA, Adelaide, South Australia, Australia
| | - Kerin O'Dea
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - David Roder
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Jodie C Avery
- Population Health Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Caroline L Miller
- Population Health Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
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Kuhnlein HV, Burgess S. Improved Retinol, Carotene, Ferritin, and Folate Status in Nuxalk Teenagers and Adults after a Health Promotion Programme. Food Nutr Bull 2018. [DOI: 10.1177/156482659701800206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Plasma retinol and carotene, erythrocyte folate, serum ferritin, and haemoglobin were determined in native people living on the west coast of British Columbia before and after a three-year intervention programme of nutrition education and health promotion emphasizing local cultural food. One hundred ninety-nine persons participated before (T1) and 267 after (T2) the programme, with 107 persons participating in both periods. Overall T2 mean ± SEM adult (20–60 years) retinol increased (p <.05) over T1 from 23.8 ± 0.5 to 42.4 ± 17.3 μg/dl, carotene increased from 37.4 ± 1.2 to 54.1 ± 1.6 μg/dl, and erythrocyte folate increased from 226 ± 8 to 264 ± 8 ng/ml. T2 mean ± SEM adult ferritin and haemoglobin for all ages/sexes combined did not change; however, haemoglobin for older women 41 to 60 years of age increased (p <.05) from 12.4 ± 0.4 to 13.2 ± 0.2 g/dl, and the percentage of teenagers at risk for low ferritin levels was reduced for females from 85% to 17% and for males from 50% to 11%. It was concluded that the intervention programme improved vitamin A and folate status for the overall community and iron status for teenagers.
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Affiliation(s)
- Harriet V. Kuhnlein
- Centre for Indigenous Peoples’ Nutrition and Environment (CINE) and the School of Dietetics and Human Nutrition at McGill University in Ste. Anne de Bellevue, Quebec, Canada
| | - Sandy Burgess
- Medical Services Branch, Health Canada, Western Region, in Bella Coola, British Columbia, Canada
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Reading J, Ritchie AJ, Victor JC, Wilson E. Implementing Empowering Health Promotion Programmes for Aboriginal Youth in two Distinct Communities in British Columbia, Canada. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/175797590501200201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Whalan S, Farnbach S, Volk L, Gwynn J, Lock M, Trieu K, Brimblecombe J, Webster J. What do we know about the diets of Aboriginal and Torres Strait Islander peoples in Australia? A systematic literature review. Aust N Z J Public Health 2017; 41:579-584. [PMID: 28898509 DOI: 10.1111/1753-6405.12721] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/01/2017] [Accepted: 07/01/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To provide an overview of published research on the dietary intake of Aboriginal and Torres Strait Islander peoples. METHODS Peer-reviewed literature from 1990 to October 2016 was searched to identify studies that measured the dietary intake of Australian Aboriginal and Torres Strait Islander populations. Study quality was assessed using a purposely devised quality appraisal tool. Meta-analysis was not possible due to the heterogeneity in dietary intake assessment methods. A narrative synthesis of study findings, where key themes were compared and contrasted was completed. RESULTS Twenty-five articles from twenty studies with outcome measures related to dietary intake were included. Dietary intake was assessed by electronic store sales, store turnover method, 24-hour dietary recall, food frequency questionnaire and short questions. Consistent findings were low reported intakes of fruit and vegetables and high intakes of total sugar and energy-dense, nutrient-poor food and beverages. CONCLUSIONS While differences between studies and study quality limit the generalisability of the findings, most studies suggest that the diets of Aboriginal and Torres Strait Islander peoples are inadequate. Implications for public health: A more concerted approach to understanding dietary patterns of Aboriginal and Torres Strait Islander peoples is required to inform policy and practice to improve diet and nutrition.
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Affiliation(s)
- Sarah Whalan
- Menzies School of Health Research, Northern Territory
| | - Sara Farnbach
- The George Institute for Global Health, New South Wales
| | - Lena Volk
- The George Institute for Global Health, New South Wales
| | - Josephine Gwynn
- Faculty of Health Sciences, University of Sydney, New South Wales
| | - Mark Lock
- School of Medicine and Public Health, University of Newcastle, New South Wales
| | - Kathy Trieu
- The George Institute for Global Health, New South Wales
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Kolahdooz F, Pakseresht M, Mead E, Beck L, Corriveau A, Sharma S. Impact of the Healthy Foods North nutrition intervention program on Inuit and Inuvialuit food consumption and preparation methods in Canadian Arctic communities. Nutr J 2014; 13:68. [PMID: 24993180 PMCID: PMC4105507 DOI: 10.1186/1475-2891-13-68] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 06/24/2014] [Indexed: 11/24/2022] Open
Abstract
Background The 12-month Healthy Foods North intervention program was developed to improve diet among Inuit and Inuvialuit living in Arctic Canada and assess the impact of the intervention established for the communities. Methods A quasi-experimental study randomly selected men and women (≥19 years of age) in six remote communities in Nunavut and the Northwest Territories. Validated quantitative food frequency and adult impact questionnaires were used. Four communities received the intervention and two communities served as delayed intervention controls. Pre- and post-intervention changes in frequency of/total intake of de-promoted food groups and healthiness of cooking methods were determined. The impact of the intervention was assessed using analysis of covariance (ANCOVA). Results Post-intervention data were analysed in the intervention (n = 221) and control (n = 111) communities, with participant retention rates of 91% for Nunavut and 83% for the Northwest Territories. There was a significant decrease in de-promoted foods, such as high fat meats (−27.9 g) and high fat dairy products (−19.8 g) among intervention communities (all p ≤ 0.05). The use of healthier preparation methods significantly increased (14.7%) in intervention communities relative to control communities. Conclusions This study highlights the importance of using a community-based, multi-institutional nutrition intervention program to decrease the consumption of unhealthy foods and the use of unhealthy food preparation methods.
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Affiliation(s)
| | | | | | | | | | - Sangita Sharma
- Aboriginal and Global Health Research Group, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Unit 5-10, University Terrace, 8303-112 Street, Edmonton, AB T6G 2T4, Canada.
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Brimblecombe J, Maypilama E, Colles S, Scarlett M, Dhurrkay JG, Ritchie J, O'Dea K. Factors influencing food choice in an Australian Aboriginal community. QUALITATIVE HEALTH RESEARCH 2014; 24:387-400. [PMID: 24549409 DOI: 10.1177/1049732314521901] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We explored with Aboriginal adults living in a remote Australian community the social context of food choice and factors perceived to shape food choice. An ethnographic approach of prolonged community engagement over 3 years was augmented by interviews. Our findings revealed that knowledge, health, and resources supporting food choice were considered "out of balance," and this imbalance was seen to manifest in a Western-imposed diet lacking variety and overrelying on familiar staples. Participants felt ill-equipped to emulate the traditional pattern of knowledge transfer through passing food-related wisdom to younger generations. The traditional food system was considered key to providing the framework for learning about the contemporary food environment. Practitioners seeking to improve diet and health outcomes for this population should attend to past and present contexts of food in nutrition education, support the educative role of caregivers, address the high cost of food, and support access to traditional foods.
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Brimblecombe J, Ferguson M, Liberato SC, Ball K, Moodie ML, Magnus A, Miles E, Leach AJ, Chatfield MD, Ni Mhurchu C, O’Dea K, Bailie RS. Stores Healthy Options Project in Remote Indigenous Communities (SHOP@RIC): a protocol of a randomised trial promoting healthy food and beverage purchases through price discounts and in-store nutrition education. BMC Public Health 2013; 13:744. [PMID: 23938097 PMCID: PMC3751924 DOI: 10.1186/1471-2458-13-744] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 07/17/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Indigenous Australians suffer a disproportionate burden of preventable chronic disease compared to their non-Indigenous counterparts--much of it diet-related. Increasing fruit and vegetable intakes and reducing sugar-sweetened soft-drink consumption can reduce the risk of preventable chronic disease. There is evidence from some general population studies that subsidising healthier foods can modify dietary behaviour. There is little such evidence relating specifically to socio-economically disadvantaged populations, even though dietary behaviour in such populations is arguably more likely to be susceptible to such interventions.This study aims to assess the impact and cost-effectiveness of a price discount intervention with or without an in-store nutrition education intervention on purchases of fruit, vegetables, water and diet soft-drinks among remote Indigenous communities. METHODS/DESIGN We will utilise a randomised multiple baseline (stepped wedge) design involving 20 communities in remote Indigenous Australia. The study will be conducted in partnership with two store associations and twenty Indigenous store boards. Communities will be randomised to either i) a 20% price discount on fruit, vegetables, water and diet soft-drinks; or ii) a combined price discount and in-store nutrition education strategy. These interventions will be initiated, at one of five possible time-points, spaced two-months apart. Weekly point-of-sale data will be collected from each community store before, during, and for six months after the six-month intervention period to measure impact on purchasing of discounted food and drinks. Data on physical, social and economic factors influencing weekly store sales will be collected in order to identify important covariates. Intervention fidelity and mediators of behaviour change will also be assessed. DISCUSSION This study will provide original evidence on the effectiveness and cost-effectiveness of price discounts with or without an in-store nutrition education intervention on food and drink purchasing among a socio-economically disadvantaged population in a real-life setting. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12613000694718.
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Affiliation(s)
- Julie Brimblecombe
- Menzies School of Health Research, Building 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT 0810, Australia
- Charles Darwin University, Ellengowan Dr, Casuarina, NT 0810, Australia
| | - Megan Ferguson
- Menzies School of Health Research, Building 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT 0810, Australia
- Charles Darwin University, Ellengowan Dr, Casuarina, NT 0810, Australia
| | - Selma C Liberato
- Menzies School of Health Research, Building 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT 0810, Australia
- Charles Darwin University, Ellengowan Dr, Casuarina, NT 0810, Australia
- University of South Australia, Frome Rd, Adelaide, SA 5000, Australia
| | - Kylie Ball
- Centre for Physical Activity and Nutrition Research, Deakin University, Burwood Hwy, Burwood 3125, Australia
| | - Marjory L Moodie
- Deakin Health Economics Faculty of Health, Deakin University, 221 Burwood Hwy, Burwood 3125, Australia
| | - Anne Magnus
- Deakin Health Economics Faculty of Health, Deakin University, 221 Burwood Hwy, Burwood 3125, Australia
| | - Edward Miles
- Indigenous Community Volunteers Level 1, 29 Cavanagh St, Darwin, NT 0801, Australia
| | - Amanda J Leach
- Menzies School of Health Research, Building 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT 0810, Australia
- Charles Darwin University, Ellengowan Dr, Casuarina, NT 0810, Australia
| | - Mark D Chatfield
- Menzies School of Health Research, Building 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT 0810, Australia
- Charles Darwin University, Ellengowan Dr, Casuarina, NT 0810, Australia
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Kerin O’Dea
- Menzies School of Health Research, Building 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT 0810, Australia
- University of South Australia, Frome Rd, Adelaide, SA 5000, Australia
| | - Ross S Bailie
- Menzies School of Health Research, Building 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT 0810, Australia
- Charles Darwin University, Ellengowan Dr, Casuarina, NT 0810, Australia
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Johnston L, Doyle J, Morgan B, Atkinson-Briggs S, Firebrace B, Marika M, Reilly R, Cargo M, Riley T, Rowley K. A review of programs that targeted environmental determinants of Aboriginal and Torres Strait Islander health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:3518-42. [PMID: 23939388 PMCID: PMC3774452 DOI: 10.3390/ijerph10083518] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 08/02/2013] [Accepted: 08/05/2013] [Indexed: 11/15/2022]
Abstract
Objective: Effective interventions to improve population and individual health require environmental change as well as strategies that target individual behaviours and clinical factors. This is the basis of implementing an ecological approach to health programs and health promotion. For Aboriginal People and Torres Strait Islanders, colonisation has made the physical and social environment particularly detrimental for health. Methods and Results: We conducted a literature review to identify Aboriginal health interventions that targeted environmental determinants of health, identifying 21 different health programs. Program activities that targeted environmental determinants of health included: Caring for Country; changes to food supply and/or policy; infrastructure for physical activity; housing construction and maintenance; anti-smoking policies; increased workforce capacity; continuous quality improvement of clinical systems; petrol substitution; and income management. Targets were categorised according to Miller’s Living Systems Theory. Researchers using an Indigenous community based perspective more often identified interpersonal and community-level targets than were identified using a Western academic perspective. Conclusions: Although there are relatively few papers describing interventions that target environmental determinants of health, many of these addressed such determinants at multiple levels, consistent to some degree with an ecological approach. Interpretation of program targets sometimes differed between academic and community-based perspectives, and was limited by the type of data reported in the journal articles, highlighting the need for local Indigenous knowledge for accurate program evaluation. Implications: While an ecological approach to Indigenous health is increasingly evident in the health research literature, the design and evaluation of such programs requires a wide breadth of expertise, including local Indigenous knowledge.
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Affiliation(s)
- Leah Johnston
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, Melbourne School of Population & Global Health, The University of Melbourne, Carlton, VIC 3010, Australia; E-Mails: (L.J.); (J.D.); (B.F.); (M.M.); (R.R.); (K.R.)
| | - Joyce Doyle
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, Melbourne School of Population & Global Health, The University of Melbourne, Carlton, VIC 3010, Australia; E-Mails: (L.J.); (J.D.); (B.F.); (M.M.); (R.R.); (K.R.)
| | - Bec Morgan
- Centre of Excellence in Intervention and Prevention Science, Carlton, VIC 3053, Australia; E-Mail:
| | | | - Bradley Firebrace
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, Melbourne School of Population & Global Health, The University of Melbourne, Carlton, VIC 3010, Australia; E-Mails: (L.J.); (J.D.); (B.F.); (M.M.); (R.R.); (K.R.)
| | - Mayatili Marika
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, Melbourne School of Population & Global Health, The University of Melbourne, Carlton, VIC 3010, Australia; E-Mails: (L.J.); (J.D.); (B.F.); (M.M.); (R.R.); (K.R.)
| | - Rachel Reilly
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, Melbourne School of Population & Global Health, The University of Melbourne, Carlton, VIC 3010, Australia; E-Mails: (L.J.); (J.D.); (B.F.); (M.M.); (R.R.); (K.R.)
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Margaret Cargo
- School of Population Health, University of South Australia, Adelaide, SA 5000, Australia; E-Mail:
| | - Therese Riley
- Centre of Excellence in Intervention and Prevention Science, Carlton, VIC 3053, Australia; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +61-03-8344-0814
| | - Kevin Rowley
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, Melbourne School of Population & Global Health, The University of Melbourne, Carlton, VIC 3010, Australia; E-Mails: (L.J.); (J.D.); (B.F.); (M.M.); (R.R.); (K.R.)
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Adams K, Burns C, Liebzeit A, Ryschka J, Thorpe S, Browne J. Use of participatory research and photo-voice to support urban Aboriginal healthy eating. HEALTH & SOCIAL CARE IN THE COMMUNITY 2012; 20:497-505. [PMID: 22390223 DOI: 10.1111/j.1365-2524.2011.01056.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The aim of this research was to work collaboratively with an urban Aboriginal community to understand meanings of food and food insecurity and strengthen responses to this issue. The project took place at the Wathaurong Aboriginal Cooperative in Geelong, South Eastern Australia in 2009-2010. Photo-voice research methods were used to explore meanings of food and food insecurity. This identified that food selections were influenced by family harmony, collectivism and satiation of hunger with cheap high carbohydrate and fat foods. People were also proud of their hunter-gatherer heritage and saw the Wathaurong Aboriginal Cooperative as leaders in healthy food provision. Action research cycles were used to develop responses including plates depicting healthy food portions, social cooking opportunities, development of a cooking television series and a specialised cook-book. The partnership required researchers to listen carefully to respond to needs of the Wathaurong Aboriginal Cooperative, and this meant adapting research plans to suit the local environment and community partner needs. There is potential for Aboriginal organisations to provide further leadership for healthy eating and food security through workplace food policies and partnerships with food security agencies. Use of Aboriginal nutrition knowledge to provide nutrition education may be useful in health promotion approaches.
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Bailey S, Hunt J. Successful partnerships are the key to improving Aboriginal health. NEW SOUTH WALES PUBLIC HEALTH BULLETIN 2012; 23:48-51. [PMID: 22697093 DOI: 10.1071/nb11057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Partnership is a process that must be recognised as a fundamental part of any strategy for improving health outcomes for Aboriginal people. Addressing the inequities in health outcomes between Aboriginal people and other Australians will require a sustained, coordinated and well-informed approach that works to a set of goals and targets developed with input from the Aboriginal community. Partnerships provide the most effective mechanism for obtaining this essential input from Aboriginal communities and their representative organisations, enabling Aboriginal people to have an influence at all stages of the health-care process. Within the health sector, effective partnerships harness the efforts of governments and the expertise of Aboriginal Community Controlled Health Services, which offer the most effective means of delivering comprehensive primary health care to Aboriginal people.
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Affiliation(s)
- Sandra Bailey
- Aboriginal Health and Medical Research Council of NSW
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Wiltsey Stirman S, Kimberly J, Cook N, Calloway A, Castro F, Charns M. The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research. Implement Sci 2012; 7:17. [PMID: 22417162 PMCID: PMC3317864 DOI: 10.1186/1748-5908-7-17] [Citation(s) in RCA: 727] [Impact Index Per Article: 60.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 03/14/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The introduction of evidence-based programs and practices into healthcare settings has been the subject of an increasing amount of research in recent years. While a number of studies have examined initial implementation efforts, less research has been conducted to determine what happens beyond that point. There is increasing recognition that the extent to which new programs are sustained is influenced by many different factors and that more needs to be known about just what these factors are and how they interact. To understand the current state of the research literature on sustainability, our team took stock of what is currently known in this area and identified areas in which further research would be particularly helpful. This paper reviews the methods that have been used, the types of outcomes that have been measured and reported, findings from studies that reported long-term implementation outcomes, and factors that have been identified as potential influences on the sustained use of new practices, programs, or interventions. We conclude with recommendations and considerations for future research. METHODS Two coders identified 125 studies on sustainability that met eligibility criteria. An initial coding scheme was developed based on constructs identified in previous literature on implementation. Additional codes were generated deductively. Related constructs among factors were identified by consensus and collapsed under the general categories. Studies that described the extent to which programs or innovations were sustained were also categorized and summarized. RESULTS Although "sustainability" was the term most commonly used in the literature to refer to what happened after initial implementation, not all the studies that were reviewed actually presented working definitions of the term. Most study designs were retrospective and naturalistic. Approximately half of the studies relied on self-reports to assess sustainability or elements that influence sustainability. Approximately half employed quantitative methodologies, and the remainder employed qualitative or mixed methodologies. Few studies that investigated sustainability outcomes employed rigorous methods of evaluation (e.g., objective evaluation, judgement of implementation quality or fidelity). Among those that did, a small number reported full sustainment or high fidelity. Very little research has examined the extent, nature, or impact of adaptations to the interventions or programs once implemented. Influences on sustainability included organizational context, capacity, processes, and factors related to the new program or practice themselves. CONCLUSIONS Clearer definitions and research that is guided by the conceptual literature on sustainability are critical to the development of the research in the area. Further efforts to characterize the phenomenon and the factors that influence it will enhance the quality of future research. Careful consideration must also be given to interactions among influences at multiple levels, as well as issues such as fidelity, modification, and changes in implementation over time. While prospective and experimental designs are needed, there is also an important role for qualitative research in efforts to understand the phenomenon, refine hypotheses, and develop strategies to promote sustainment.
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Affiliation(s)
- Shannon Wiltsey Stirman
- Women's Health Sciences Division, National Center for PTSD, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University, Boston, MA, USA
| | - John Kimberly
- Department of Healthcare Management, The Wharton School of the University of Pennsylvania, Philadelphia, PA, USA
| | - Natasha Cook
- Women's Health Sciences Division, National Center for PTSD, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Amber Calloway
- Women's Health Sciences Division, National Center for PTSD, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University, Boston, MA, USA
| | - Frank Castro
- Women's Health Sciences Division, National Center for PTSD, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University, Boston, MA, USA
| | - Martin Charns
- VA Boston Healthcare System, Boston, MA, USA
- VA Center for Organization, Leadership, and Management Research, Boston, MA, USA
- Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
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Clifford A, Pulver LJ, Richmond R, Shakeshaft A, Ivers R. Smoking, nutrition, alcohol and physical activity interventions targeting Indigenous Australians: rigorous evaluations and new directions needed. Aust N Z J Public Health 2010; 35:38-46. [PMID: 21299699 DOI: 10.1111/j.1753-6405.2010.00631.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe and critique methodological aspects of interventions targeting reductions in smoking, poor nutrition, alcohol misuse and physical inactivity (SNAP risk factors) among Indigenous Australians. METHODS An electronic search of eight databases and a manual search of reference lists of literature reviews and reference libraries for Indigenous-specific intervention studies published in peer-reviewed journals (January 1990 to August 2007) were undertaken. Alcohol, smoking, nutrition or physical activity needed to be the primary focus of the study and the intervention needed to specifically target Indigenous Australians. RESULTS Twenty studies were selected for inclusion in the review. Methodologically, few studies employed randomisation or a control group, most omitted important details (e.g. costs), some did not report process measures (e.g. attrition rates), and some did not use validated measures. Two-thirds of interventions were implemented at the community level and employed multiple strategies. CONCLUSION There is a need for more rigorous evaluations of interventions targeting reductions in SNAP risk factors among Indigenous Australians, and to establish the reliability and validity of measures to quantify their effect. IMPLICATIONS It may be beneficial for future Indigenous-specific intervention research to focus on the evaluation of secondary prevention to complement the current concentration of effort targeting primary prevention. Community-wide interventions, combining strategies of greater intensity for high risk individuals with those of less intensity targeting lower risk individuals, might also offer considerable promise.
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Affiliation(s)
- Anton Clifford
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales.
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Daniel M, Lekkas P, Cargo M. Environments and cardiometabolic diseases in aboriginal populations. Heart Lung Circ 2010; 19:306-15. [PMID: 20356789 DOI: 10.1016/j.hlc.2010.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Accepted: 01/05/2010] [Indexed: 10/19/2022]
Abstract
This review establishes the relevance and frames the relationship of environmental factors to cardiometabolic risk factors and disease in Aboriginal populations. Environmental factors operate at the level of communities or populations. They include contextual measures of places and compositional measures of populations which together constitute "risk conditions" affecting individual risk factors. Environmental factors have been implicated by contrasting Aboriginal and non-Aboriginal populations in cardiometabolic risk factors and outcomes, or by geographic contrasts of Aboriginal populations in remote, rural and urban regions. It is unclear whether heterogeneity in contextual or compositional factors between and within Aboriginal populations is associated with heterogeneity in cardiometabolic risk factors and outcomes. Empirical literature that links environmental factors and cardiometabolic outcomes in Aboriginal populations is critically reviewed for three postulated pathways of influence: (1) behaviour; (2) psychosocial factors; and (3) stress response axes. These pathways, represented as interdependent, can explain how and why environments are associated with cardiometabolic outcomes. The need remains, however, to develop a robust quantitative evidence base in cardiometabolic research aimed at enhancing knowledge of the specific environmental factors related to the cardiometabolic health of Aboriginal populations as well as explicating the underlying mechanisms by which environmental risk conditions 'get under the skin'.
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Affiliation(s)
- Mark Daniel
- Sansom Institute, University of South Australia, Adelaide, Australia.
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Lee AJ, Leonard D, Moloney AA, Minniecon DL. Improving Aboriginal and Torres Strait Islander nutrition and health. Med J Aust 2009; 190:547-8. [PMID: 19450198 DOI: 10.5694/j.1326-5377.2009.tb02559.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Accepted: 04/06/2009] [Indexed: 11/17/2022]
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Gruen RL, Elliott JH, Nolan ML, Lawton PD, Parkhill A, McLaren CJ, Lavis JN. Sustainability science: an integrated approach for health-programme planning. Lancet 2008; 372:1579-89. [PMID: 18984192 DOI: 10.1016/s0140-6736(08)61659-1] [Citation(s) in RCA: 241] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Planning for programme sustainability is a key contributor to health and development, especially in low-income and middle-income countries. A consensus evidence-based operational framework would facilitate policy and research advances in understanding, measuring, and improving programme sustainability. We did a systematic review of both conceptual frameworks and empirical studies about health-programme sustainability. On the basis of the review, we propose that sustainable health programmes are regarded as complex systems that encompass programmes, health problems targeted by programmes, and programmes' drivers or key stakeholders, all of which interact dynamically within any given context. We show the usefulness of this approach with case studies drawn from the authors' experience.
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Affiliation(s)
- Russell L Gruen
- Department of Surgery, the Royal Melbourne Hospital and University of Melbourne, Melbourne, VIC, Australia
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Burke V, Zhao Y, Lee AH, Hunter E, Spargo RM, Gracey M, Smith R, Beilin LJ, Puddey IB. Hospital admissions and length of stay for coronary disease in an Aboriginal cohort. Nutr Metab Cardiovasc Dis 2008; 18:357-364. [PMID: 18042360 DOI: 10.1016/j.numecd.2007.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Revised: 03/21/2007] [Accepted: 03/29/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS Coronary disease (CHD)-related hospital admission is more common among indigenous than non-indigenous Australians. We aimed to identify predictors of hospital admission potentially useful in planning prevention programs. METHODS AND RESULTS Length of stay (LOS), interval between, and number of recurrent admissions were modelled with proportional hazards or negative binomial models using lifestyle data recorded in 1988-1989 among Aborigines (256 women, 258 men, aged 15-88years) linked to hospital records to 2002. Among 106 Aborigines with CHD, hypertension (hazard ratio (HR) 1.69, 95% CI 1.05-2.73); smoking (HR 1.90, 95% CI 1.02-3.53); consuming processed meat >4 times/month (HR 1.81, 95% CI 1.01-3.24); >6 eggs/week (HR 1.73, 95% CI 1.03-2.94); and lower intake of alcohol (HR 0.54, 95% CI 0.35-0.83) predicted LOS. Eating eggs (HR 1.05, 95% CI 1.01-1.09) and bush meats > or =7 times/month (HR 0.46, 95% CI 0.23-0.92) predicted interval between recurrent admissions. Hypertension (IRR 4.07; 95% CI 1.32-12.52), being an ex-drinker (IRR 6.60, 95% CI 2.30-19.00), eating red meat >6 times/week (IRR 0.98, 95% CI 0.97-0.99), bush meats >7 times/month (IRR 0.26, 95% CI 0.10-0.67), and adding salt to meals (IRR 3.16, 95% CI 1.12-8.92) predicted number of admissions. CONCLUSION Hypertension, alcohol drinking, smoking, and diet influence hospital admissions for CHD in Aboriginal Australians.
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Affiliation(s)
- V Burke
- University of Western Australia, School of Medicine and Pharmacology, Royal Perth Hospital Unit, Box X2213 GPO, Perth, WA 6847, Australia.
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Burke V, Zhao Y, Lee AH, Hunter E, Spargo RM, Gracey M, Smith RM, Beilin LJ, Puddey IB. Predictors of type 2 diabetes and diabetes-related hospitalisation in an Australian Aboriginal cohort. Diabetes Res Clin Pract 2007; 78:360-8. [PMID: 17532084 DOI: 10.1016/j.diabres.2007.04.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Accepted: 04/20/2007] [Indexed: 02/07/2023]
Abstract
Predictors of diabetes and diabetes-related hospitalisations were examined in 15-88-year-old Aboriginal Australians (256 women, 258 men), surveyed in 1988-1989. Linkage to death records and hospitalisations to 2002 allowed proportional hazards or negative binomial modelling. Forty-five men (18%) and 59 women (24%) developed diabetes. Risk of diabetes was predicted positively by waist girth (hazard ratio (HR) 1.08, 95% CI 1.04, 1.13), smoking (HR 2.05, 95% CI 1.23, 3.39) and eating processed meats>4 times/month (HR 1.58, 95% CI 1.05, 2.40) and negatively by lower alcohol intake (HR 0.69, 95% CI 0.49, 0.99), preferring wine (HR 0.13, 95% CI 0.02, 0.97) and eating bush meats>4 times/month (HR 0.34, 95% CI 0.13, 0.90). Hospitalisation was predicted positively by smoking (Incidence rate ratio (IRR) 3.72, 95% CI 1.70, 8.18) and eating processed meats (IRR 1.03, 95% CI 1.01, 1.06), and negatively by exercise>or=once/week (IRR 0.23, 95% CI 0.08, 0.65), eating bush meats (IRR 0.95, 95% CI 0.91, 0.99) and trimming fat from meats (IRR 0.53, 95% CI 0.30, 0.94). Length of hospital stay was predicted positively by eating processed meats (HR 1.76, 95% CI 1.23, 2.53) and added salt (HR 1.52, 95% CI 1.02, 2.26) and negatively by lower alcohol intake (HR 0.90, 95% CI 0.40, 0.92) and exercise (HR 0.66, 95% CI 0.46, 0.95). Central obesity and adverse lifestyle increase risk for diabetes or related hospitalisation among Aboriginal Australians.
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Affiliation(s)
- Valerie Burke
- University of Western Australia, School of Medicine and Pharmacology, Royal Perth Hospital, Australia.
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Burke V, Zhao Y, Lee AH, Hunter E, Spargo RM, Gracey M, Smith RM, Beilin LJ, Puddey IB. Health-related behaviours as predictors of mortality and morbidity in Australian Aborigines. Prev Med 2007; 44:135-42. [PMID: 17069878 DOI: 10.1016/j.ypmed.2006.09.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Revised: 09/12/2006] [Accepted: 09/20/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine predictors of coronary heart disease (CHD) and all-cause mortality in Aboriginal Australians. METHOD In 1988-89, a survey of Western Australian Aborigines (256 women, 258 men) aged 15-88 years documented diet, alcohol and smoking habits. Linkage to mortality and hospital admissions to the end of 2002 provided longitudinal data for modelling of coronary heart disease endpoints and all-cause mortality using Cox regression. RESULTS Coronary heart disease risk increased with smoking (HR 2.62, 95% CI: 1.19, 5.75), consumption of processed meats >once/week (HR 2.21, 95% CI: 1.05, 4.63), eggs >twice/week (HR 2.59, 95% CI: 1.11, 6.04) and using spreads on bread (HR 3.14. 95% CI: 1.03, 9.61). All-cause mortality risk was lower with exercise >once/week (HR 0.51, 95% CI 0.26, 1.05), increased in ex-drinkers (HR 3.66, 95% CI: 1.08, 12.47), heavy drinkers (HR 5.26, 95% CI: 1.46, 7.52) and with consumption of take away foods >nine times/month (HR 1.78, 95% CI 0.96, 3.29). Greater alcohol intake, smoking and adverse dietary choices clustered in 53% of men and 56% of women and increased risk of coronary heart disease (HR 2.1, 95% CI: 1.1, 4.0) and all-cause mortality (HR 2.3, 95% CI: 1.2, 4.2). CONCLUSION Lifestyle in Aboriginal Australians predicts coronary heart disease and all-cause mortality. Clustering of adverse behaviours is common and increases risk of coronary heart disease and death.
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Affiliation(s)
- V Burke
- University of Western Australia School of Medicine and Pharmacology, Royal Perth Hospital Unit, Box X2213 GPO, Perth 6847, Australia.
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Gracey MS. Nutrition‐related disorders in Indigenous Australians: how things have changed. Med J Aust 2007; 186:15-7. [PMID: 17229025 DOI: 10.5694/j.1326-5377.2007.tb00779.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Accepted: 10/18/2006] [Indexed: 11/17/2022]
Abstract
Awareness of a serious Indigenous health problem in Australia did not emerge until the 1960s and 1970s. Much attention was focused at the time on poor pregnancy outcomes, high infant and young child mortality rates, and childhood malnutrition and impaired growth, often associated with high infectious disease burdens. Although that situation has improved somewhat, Indigenous infant and child health is still poor compared with that of other Australian children. Over recent decades, there has been a rapid rise among Indigenous people of nutrition-related "lifestyle" disorders such as obesity, cardiovascular disease, type 2 diabetes mellitus and chronic renal disease and their complications. This epidemic of disabling and often fatal chronic diseases in Indigenous Australians is also occurring in disadvantaged groups in many other countries. Control of this potentially disastrous epidemic must become a much higher priority in Indigenous health programs. Governments must commit to this task in cooperation and collaboration with Indigenous organisations and communities.
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Bailie RS, Robinson G, Kondalsamy-Chennakesavan SN, Halpin S, Wang Z. Investigating the sustainability of outcomes in a chronic disease treatment programme. Soc Sci Med 2006; 63:1661-70. [PMID: 16750877 DOI: 10.1016/j.socscimed.2006.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Indexed: 11/29/2022]
Abstract
This study examines trends in chronic disease outcomes from initiation of a specialised chronic disease treatment programme through to incorporation of programme activities into routine service delivery. We reviewed clinical records of 98 participants with confirmed renal disease or hypertension in a remote indigenous community health centre in Northern Australia. For each participant the review period spanned an initial three years while participating in a specialised cardiovascular and renal disease treatment programme and a subsequent three years following withdrawal of the treatment programme. Responsibility for care was incorporated into the comprehensive primary care service which had been recently redeveloped to implement best practice care plans. The time series analysis included at least six measures prior to handover of the specialised programme and six following handover. Main outcome measures were trends in blood pressure (BP) control, and systolic and diastolic BP. We found an improvement in BP control in the first 6-12 months of the programme, followed by a steady declining trend. There was no significant difference in this trend between the pre- compared to the post-programme withdrawal period. This finding was consistent for control at levels below 130/80 and 140/90, and for trends in mean systolic and diastolic BP. Investigation of the sustainability of programme outcomes presents major challenges for research design. Sustained success in the management of chronic disease through primary care services requires better understanding of the causal mechanisms related to clinical intervention, the basis upon which they can be 'institutionalised' in a given context, and the extent to which they require regular revitalisation to maintain their effect.
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Affiliation(s)
- Ross S Bailie
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, NT, Australia
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Johnson K, Kennedy SB, Harris AO, Lincoln A, Neace W, Collins D. Strengthening the HIV/AIDS service delivery system in Liberia: an international research capacity-building strategy. J Eval Clin Pract 2005; 11:257-73. [PMID: 15869556 DOI: 10.1111/j.1365-2753.2005.00532.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Liberia's prolonged post-conflict transition has negatively impacted its health infrastructure, including the functioning of its health care delivery system. Considering the current national health crises, a study was conducted to identify research gaps and the need to propose changes for improving the health care delivery system in the country. The study results clearly demonstrated a lack of HIV/AIDS research infrastructure including organizational structure, linkages, leadership, champions, expertise, resources, and policies and procedures. Alignment of research needs and practice, and research use to support HIV/AIDS service delivery programmes in the country was also limited. An international research capacity-building partnership is proposed as an effective planned change strategy to strengthen HIV/AIDS-related research infrastructure and to inform management and practice within the Liberian HIV/AIDS service delivery system. A proposed capacity-building planning model can also strengthen research infrastructure and the production and use of research to positively impact the HIV/AIDS epidemic in Liberia and other developing countries.
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Affiliation(s)
- Knowlton Johnson
- Pacific Institute for Research & Evaluation (PIRE), Louisville Center, Louisville, KY 40208, USA.
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McDonald S, Maguire G, Duarte N, Wang XL, Hoy W. Homocysteine, renal disease and cardiovascular disease in a remote Australian Aboriginal community. Intern Med J 2005; 35:289-94. [PMID: 15845111 DOI: 10.1111/j.1444-0903.2005.00824.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Rates of renal and cardiovascular disease are high among Aboriginal Australians living in remote communities. Nutritional problems, in particular low folate levels, are also common. This suggests that increased homocysteine concentrations might be widespread, and a possible contributor to the high rates of cardiovascular disease. AIMS To examine homocysteine concentrations, and their relationships to folate levels, and to markers of renal disease and cardiovascular disease in a remote Aboriginal Australian community METHODS As part of a cross-sectional survey among adults in one community, homocysteine concentrations, concentrations of the crucial determinants (red blood cell (RBC) folate, vitamin B(12) and the C677T methylene tetrahydrofolate reductase polymorphism) and cardiovascular risk factors were examined. RESULTS Among 221 people, geometric mean homocysteine concentration was 11.8 micromol/L (range: 11.1-12.5 micromol/L), with 57/221 (26%) values > or =15.0 micromol/L. Higher concentrations were associated with older age, male gender, lower RBC folate and lower vitamin B(12) concentrations and homozygosity for C677T. Homocysteine concentrations were not related to the presence of albuminuria, other than over the overt albuminuria range. Homocysteine concentrations were inversely correlated with calculated glomerular filtration rate (GFR). Carotid intima-media thickness, however, was not related to homocysteine concentration. In multivariate analyses, age, male gender, lower RBC folate concentrations, lower vitamin B(12) concentrations, lower calculated GFR and the C677T polymorphism were all associated with homocysteine concentrations. CONCLUSIONS Homocysteine concentrations were consistent with previous limited reports in Aboriginal communities. Although superficially they are similar to reports from non-Aboriginal settings, the younger age of this cohort and the association of homocysteine concentrations with age suggest that age-specific concentrations are higher among Aboriginal Australians. In addition to dietary determinants, the high prevalence of apparently reduced renal function renal disease appears to be an important determinant of homocysteine concentrations in remote Aboriginal communities. The role of homocysteine concentrations as a potential mediator of the high rates of cardiovascular disease remains to be determined.
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Affiliation(s)
- S McDonald
- Menzies School of Health Research, Darwin, Northen Territory, Australia.
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30
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Abstract
Karat banana, pulque prepared from Agave species, and gac fruit are three traditional local food items recently studied intensively for their nutrition potential among traditional and indigenous peoples, and are examples of how local food-based strategies can be used to ensure micronutrient nutrition. Successful health promotion and intervention programs emphasizing traditional food systems are few in the international literature, but offer promise in understanding the potential of food-based strategies. Traditional food strategies could be used not only for alleviating malnutrition, but also for developing locally relevant programs for stemming the nutrition transition and preventing chronic disease, particularly among indigenous and traditional peoples who retain knowledge of using food species in their local ecosystems.
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Affiliation(s)
- Harriet V Kuhnlein
- Centre for Indigenous Peoples' Nutrition and Environment (CINE), School of Dietetics and Human Nutrition, Macdonald Campus of McGill Univerisity, 21,111 Lakeshore Rd., Ste. Anne de Bellevue, Quebec, Canada H9X3V9.
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Affiliation(s)
- Alan Cass
- The George Institute for International Health, Sydney, Australia
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Clough AR, Rowley K, O'Dea K. Kava use, dyslipidaemia and biomarkers of dietary quality in Aboriginal people in Arnhem Land in the Northern Territory (NT), Australia. Eur J Clin Nutr 2004; 58:1090-3. [PMID: 15220953 DOI: 10.1038/sj.ejcn.1601921] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Heavy kava use has been associated with sudden death in Aboriginal Australians in Arnhem Land (Northern Territory, Australia) where poor diets and a high incidence of premature coronary heart disease are known. Heavy kava users may suffer additional risk if further malnourished. Among 98 people (62 males, 36 females) in one community, 36 never used kava, 26 were past users, and 36 were continuing users. Across kava-using groups skinfold thickness, body mass index and body fat decreased. Total- and LDL-cholesterol were elevated in kava users compared to both former users and never users. HDL-cholesterol was higher in current users vs never users. Across kava-using groups, triglycerides, homocysteine and diet-derived antioxidant vitamins alpha-tocopherol and retinol, did not vary. Plasma carotenoid levels (indicative of vegetable and fruit intake) were very low, but when adjusted for plasma cholesterol, did not vary between kava-using groups. An obsession for kava drinking may mediate kava's direct effects on nutritional status.
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Affiliation(s)
- A R Clough
- Menzies School of Health Research and Charles Darwin University, Darwin, NT, Casuarina, NT, 0881, Australia.
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Cass A, Cunningham J, Snelling P, Wang Z, Hoy W. Exploring the pathways leading from disadvantage to end-stage renal disease for Indigenous Australians. Soc Sci Med 2004; 58:767-85. [PMID: 14672592 DOI: 10.1016/s0277-9536(03)00243-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Indigenous Australians are disadvantaged, relative to other Australians, over a range of socio-economic and health measures. The age- and sex-adjusted incidence of end-stage renal disease (ESRD)--the irreversible preterminal phase of chronic renal failure--is almost nine times higher amongst Indigenous than it is amongst non-indigenous Australians. A striking gradient exists from urban to remote regions, where the standardised ESRD incidence is from 20 to more than 30 times the national incidence. We discuss the profound impact of renal disease on Indigenous Australians and their communities. We explore the linkages between disadvantage, often accompanied by geographic isolation, and both the initiation of renal disease, and its progression to ESRD. Purported explanations for the excess burden of renal disease in indigenous populations can be categorised as: primary renal disease explanations;genetic explanations;early development explanations; and socio-economic explanations. We discuss the strengths and weaknesses of these explanations and suggest a new hypothesis which integrates the existing evidence. We use this hypothesis to illuminate the pathways between disadvantage and the human biological processes which culminate in ESRD, and to propose prevention strategies across the life-course of Indigenous Australians to reduce their ESRD risk. Our hypothesis is likely to be relevant to an understanding of patterns of renal disease in other high-risk populations, particularly indigenous people in the developed world and people in developing countries. Furthermore, analogous pathways might be relevant to other chronic diseases, such as diabetes and cardiovascular disease. If we are able to confirm the various pathways from disadvantage to human biology, we will be better placed to advocate evidence-based interventions, both within and beyond the scope of the health-care system, to address the excess burden of renal and other chronic diseases among affected populations.
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Affiliation(s)
- Alan Cass
- Menzies School of Health Research, PO Box 41096, Darwin, Casarina NT 0811, Australia.
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Rowley K, Walker KZ, Cohen J, Jenkins AJ, O'Neal D, Su Q, Best JD, O'Dea K. Inflammation and vascular endothelial activation in an Aboriginal population: relationships to coronary disease risk factors and nutritional markers. Med J Aust 2003; 178:495-500. [PMID: 12741936 DOI: 10.5694/j.1326-5377.2003.tb05324.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2003] [Accepted: 04/08/2003] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the levels of inflammation and vascular endothelial activation in an Aboriginal community, and the relationship of these factors to coronary heart disease (CHD) risk factors and markers of nutritional quality. DESIGN AND PARTICIPANTS A cross-sectional survey of 95 women and 76 men participating in a chronic-disease prevention program. SETTING A remote Aboriginal community in Western Australia in 1996. MAIN OUTCOME MEASURES Concentrations of markers of inflammation (C-reactive protein [CRP]) and vascular endothelial activation (soluble E-selectin [sE-selectin]); presence of metabolic syndrome; concentrations of diet-derived antioxidants. RESULTS Participants exhibited very high plasma concentrations of CRP (mean, 5.4 mg/L; 95% CI, 4.6-6.3 mg/L) and sE-selectin (mean, 119 ng/mL; 95% CI, 111-128 ng/mL). Both CRP and sE-selectin concentrations were significantly higher in the presence of the metabolic syndrome. There were significant inverse linear relationships between concentrations of CRP and plasma concentrations of the antioxidants lycopene, beta-carotene, cryptoxanthin and retinol. Even stronger inverse associations were evident between concentrations of sE-selectin and lycopene, beta-carotene, cryptoxanthin and lutein. CONCLUSIONS Vascular inflammation and endothelial activation may be important mediators of elevated CHD risk in Aboriginal people. Inadequate nutrition and physical inactivity may contribute to this process.
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Affiliation(s)
- Kevin Rowley
- University of Melbourne, Department of Medicine, St Vincent's Hospital, 4th Floor, Clinical Sciences Building, Fitzroy, Victoria 3065, Australia.
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Lee AJ, Darcy AM, Leonard D, Groos AD, Stubbs CO, Lowson SK, Dunn SM, Coyne T, Riley MD. Food availability, cost disparity and improvement in relation to accessibility and remoteness in Queensland. Aust N Z J Public Health 2002; 26:266-72. [PMID: 12141624 DOI: 10.1111/j.1467-842x.2002.tb00685.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This study is the first to describe disparity and change in the food supply between metropolitan, rural and remote stores by Accessibility/Remoteness Index of Australia (ARIA) category. A total of 92 stores (97% response rate) within five aggregate ARIA categories participated throughout Queensland in 2000. There was a strong association between ARIA category and the cost of the basket of basic foods, with prices being significantly higher (20% and 31% respectively) in the 'remote' and 'very remote' categories than in the 'highly accessible' category. The association with ARIA was less marked for fruit and vegetables than for other food groups, but not for tobacco and take-away food items. Basic food items were less available in the more remote stores. Over the past two years, relative improvements in food prices have been seen in stores in the 'very remote' category, with observed increases less than the consumer price index (CPI) for food. Some factors which may have contributed to this improvement are discussed.
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Affiliation(s)
- Amanda J Lee
- Statewide Health Promotion Unit, Public Health Services, Queensland Health, Brisbane.
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37
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Lee AJ, Darcy AM, Leonard D, Groos AD, Stubbs CO, Lowson SK, Dunn SM, Coyne T, Riley MD. Food availability, cost disparity and improvement in relation to accessibility and remoteness in Queensland. Aust N Z J Public Health 2002. [DOI: 10.1111/j.1467-842x.2002.tb00164.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Rowley KG, Su Q, Cincotta M, Skinner M, Skinner K, Pindan B, White GA, O'Dea K. Improvements in circulating cholesterol, antioxidants, and homocysteine after dietary intervention in an Australian Aboriginal community. Am J Clin Nutr 2001; 74:442-8. [PMID: 11566641 DOI: 10.1093/ajcn/74.4.442] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Poor nutrition contributes to high rates of coronary heart disease among Australian Aboriginal populations. Since late 1993, the Aboriginal community described here has operated a healthy lifestyle program aimed at reducing the risk of chronic disease. OBJECTIVE We evaluated the effectiveness of a community-directed intervention program to reduce coronary heart disease risk through dietary modification. DESIGN Intervention processes included store management policy changes, health promotion activities, and nutrition education aimed at high-risk individuals. Dietary advice was focused on decreasing saturated fat and sugar intake and increasing fruit and vegetable intake. Evaluation of the program included conducting sequential, cross-sectional risk factor surveys at 2-y intervals; measuring fasting cholesterol, lipid-soluble antioxidants, and homocysteine concentrations; and assessing smoking status. Nutrient intakes were estimated from analysis of food turnover in the single community store. RESULTS There was a significant reduction in the prevalence of hypercholesterolemia (age-adjusted prevalences were 31%, 21%, and 15% at baseline, 2 y, and 4 y, respectively; P < 0.001). There were significant increases in plasma concentrations of alpha-tocopherol, lutein and zeaxanthin, cryptoxanthin, and beta-carotene across the population. Retinol and lycopene concentrations did not change significantly. Mean plasma homocysteine concentrations decreased by 3 micromol/L. There was no significant change in smoking prevalence between the 2 follow-up surveys. There was an increase in the density of fresh fruit and vegetables and carotenoids in the food supply at the community store. CONCLUSION This community-directed dietary intervention program reduced the prevalence of coronary heart disease risk factors related to diet.
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Affiliation(s)
- K G Rowley
- University of Melbourne, Department of Medicine, St Vincent's Hospital, Fitzroy, VIC, Australia.
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39
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Abstract
Implementing evidence-based medicine (EBM) in primary healthcare for Indigenous people will usually involve increasing services, particularly those for chronic conditions. As shown by the example of diabetes care, there are significant organisational, educational, economic, cultural and structural barriers to implementing EBM in many Indigenous communities. Many of these barriers could be reduced by better-organised service delivery systems at the community level, greater numbers of Indigenous health professionals and greater advocacy for healthy public policy by health services. There is evidence that delivering evidence-based primary healthcare, particularly for chronic diseases, can improve health outcomes in Indigenous communities. There is a need for more investment in strategies to implement EBM and evidence-based public health in Indigenous settings.
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Affiliation(s)
- R A McDermott
- Tropical Public Health Unit, Queensland Health, Cairns.
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40
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Leemon M, Samman S. A food‐based systems approach to improve the nutritional status of Australian aborigines: A focus on zinc. Ecol Food Nutr 1998. [DOI: 10.1080/03670244.1998.9991564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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41
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Mak DB, McDermott R, Plant AJ, Scrimgeour D. The contribution of community health surveys to aboriginal health in the 1990s. Aust N Z J Public Health 1998; 22:645-7. [PMID: 9848956 DOI: 10.1111/j.1467-842x.1998.tb01462.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Community health surveys take place in many Aboriginal communities. We considered these surveys to determine their potential to contribute to Aboriginal health in the 1990s. Community health surveys--also known as health audits, community health screenings or check-ups--usually consist of a team of health professionals travelling to an Aboriginal community to measure a wide variety of parameters on as many of the people in the community as possible. For the individual participant, community health surveys represent a sporadic screening program which should meet the World Health Organization's criteria for screening. From the population health perspective, these surveys represent prevalence surveys which may contribute little new knowledge regarding Aboriginal health and do not, of themselves, change the urgent need for preventive health programs. Community health surveys should meet minimum scientific standards (i.e. have a clearly stated aim and use valid measurements and statistical techniques) and should incorporate practically feasible protocols and services for the follow-up of individuals with screen-detected abnormalities. They must have ethical and community approval and incorporate genuine consultation and feedback of results to the Aboriginal communities involved, in order for them to be justified.
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Affiliation(s)
- D B Mak
- Kimberley Public Health Unit, Health Department of Western Australia
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42
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43
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Renaud L, Chevalier S, O'Loughlin J. [Institutionalization of community programs: review of theoretical models and proposal of a model-]. Canadian Journal of Public Health 1997. [PMID: 9395417 DOI: 10.1007/bf03403872] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Community-based health promotion programs to change lifestyle habits must remain in their host organizations for extended periods of time in order to have impact. Their effectiveness can be closely linked to their long term viability or institutionalization. To remain viable, these programs must survive beyond initial investment and support by external organizations. However, some programs disappear when external investment is withdrawn. This can be costly and in addition can generate resistance to the implementation of other health promotion programs in the future. Recently, interest in the processes involved in the institutionalization of these programs has increased. Based on 28 publications, this article reviews selected conceptual models that highlight environmental, organizational, community and marketing-related, variables possibly related to the institutionalization process. A new model is proposed to link these diverse models according to: characteristics of the program, characteristics of the host organization, characteristics related to the adoption, implementation and incorporation of the program, and finally characteristics related to the fit (mutual adjustment) between the host and the program.
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Affiliation(s)
- L Renaud
- Régie régionale de Montréal-Centre, Québec.
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44
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Allman-Farnelli MA. Editorial. J Ren Nutr 1997. [DOI: 10.1016/s1051-2276(97)90038-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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45
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Balmer L, Foster V. Preliminary evaluation of the effects of a nutrition awareness project on the Ngaanyatjarra Pitjantjatjara Yankunytjatjara communities of central Australia. Collegian 1997; 4:26-32. [PMID: 9265511 DOI: 10.1016/s1322-7696(08)60218-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Preliminary observations from one nutrition awareness project--Approaches to Failure to Thrive--in progress in the Ngaanyatjarra Pitjantjatjara Yankunytjatjara region of central Australia are discussed, current strategies are listed and the need for multi-faceted solutions emphasised. A more rigorous quantitative evaluation is recommended, within the constraints of funding and access to data.
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Affiliation(s)
- L Balmer
- Ngaanyatjarra Health Service, Northern Territory
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46
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Hawe P, Noort M, King L, Jordens C. Multiplying health gains: the critical role of capacity-building within health promotion programs. Health Policy 1997; 39:29-42. [PMID: 10164903 DOI: 10.1016/s0168-8510(96)00847-0] [Citation(s) in RCA: 203] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Health outcomes in populations are the product of three factors: (1) the size of effect of the intervention; (2) the reach or penetration of an intervention into a population and (3) the sustainability of the effect. The last factor is crucial. In recent years, many health promotion workers have moved the focus of their efforts away from the immediate population group or environment of interest towards making other health workers and other organisations responsible for, and more capable of, conducting health promotion programs, maintaining those programs and initiating others. 'Capacity-building' by health promotion workers to enhance the capacity of the system to prolong and multiply health effects thus represents a 'value added' dimension to the health outcomes offered by any particular health promotion program. The value of this activity will become apparent in the long term, with methods to detect multiple types of health outcomes. But in the short term its value will be difficult to assess unless we devise specific measures to detect it. At present the term 'capacity-building' is conceptualised and assessed in different ways in the health promotion literature. Development of reliable indicators of capacity-building which could be used both in program planning and in program evaluation will need to take this into account. Such work will provide health-decision makers with information about program potential at the conclusion of the funding period, which could be factored into resource allocation decisions, in addition to the usual information about a program's impact on health outcomes. By program potential, we mean ability to reap greater and wider health gains.
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Affiliation(s)
- P Hawe
- Department of Public Health and Community Medicine, University of Sydney, Australia
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47
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Lee AJ, Hobson V, Katarski L. Review of the nutrition policy of the Arnhem Land Progress Association. Aust N Z J Public Health 1996; 20:538-44. [PMID: 8987227 DOI: 10.1111/j.1467-842x.1996.tb01636.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The process of implementation and the effect of the nutrition policy of the Arnhem Land Progress Association (ALPA) were reviewed three years after implementation of the policy in five remote Aboriginal community retail stores in May 1990. In 1993, compliance with the policy varied among stores. Recommended foods were available regularly in most communities; however, promotional and educational components of the policy were not widely implemented. Dietary improvements were evident in those communities where stores most complied with the policy. Some aspects of the ALPA nutrition policy require modification, and renewed commitment to the policy is likely to improve further the diet in the Aboriginal communities involved. The ALPA nutrition policy is a potential model for the development of other local food and nutrition policies in remote Aboriginal communities.
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Affiliation(s)
- A J Lee
- Menzies School of Health Research, Darwin
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48
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Lee A, Bonson AP, Powers JR. The effect of retail store managers on aboriginal diet in remote communities. Aust N Z J Public Health 1996; 20:212-4. [PMID: 8799099 DOI: 10.1111/j.1753-6405.1996.tb01821.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Key nutrient densities of the diet of two remote northern coastal Aboriginal communities were measured using the store-turnover method during the periods that three store managers were responsible for each store respectively. Individual store managers were a greater determinant of nutrient density than the community itself. Furthermore, nutrient densities tended to be highest in both communities when their stores were administered by one particular store manager. The results support the notion that store managers wield considerable power over the food supply of remote Aboriginal communities, and raise questions concerning the ability of Aboriginal community members to influence their own food supplies in retail stores. However, the study also confirms that store managers can be important allies in efforts to improve Aboriginal dietary intake.
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Affiliation(s)
- A Lee
- Menzies School of Health Research, Darwin
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