Unintended consequences: Alcohol screening at urban Aboriginal Community Controlled Health Services was suppressed during COVID-19 lockdowns

INTRODUCTION

Regular screening for risky drinking is important to improve the health of Aboriginal and Torres Strait Islander Australians. We explored whether the rate of screening for risky drinking using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questions was disrupted at Aboriginal Community Controlled Health Services (ACCHS) during state-wide and territory-wide COVID-19 lockdowns in 2020.

METHODS

Retrospective analysis of screening data from 22 ACCHSs located in New South Wales, the Northern Territory, Queensland, South Australia, Victoria and Western Australia. These services provide holistic and culturally appropriate primary care. A multi-level Poisson regression, including AR(1) autocorrelation, was used to predict counts of AUDIT-C screening at ACCHSs.

RESULTS

AUDIT-C screening was suppressed during state-wide and territory-wide lockdowns in 2020 (incident rate ratio [IRR] 0.42 [0.29, 0.61]). The effect of lockdowns differed by service remoteness. While there was a substantial reduction in AUDIT-C screening for urban and inner regional services (IRR 0.25 [95% confidence interval (CI) 0.15, 0.42]), there was not a statistically significant change in screening at outer regional and remote (IRR 0.60 [95% CI 0.33, 1.09]) or very remote services (IRR 0.67 [95% CI 0.40, 1.11]).

DISCUSSION AND CONCLUSIONS

The COVID-19 lockdowns in Australia likely suppressed rates of screening for risky drinking in urban and inner regional regions. As harm from alcohol consumption may have increased during lockdowns, policymakers should consider implementing measures to enable screening for risky drinking to continue during future lockdowns.

High and variable population prevalence of HLA-B*56:02 in indigenous Australians and relation to phenytoin-associated drug reaction with eosinophilia and systemic symptoms

Phenytoin drug reaction with eosinophilia and systemic symptoms (DRESS) in 3 Aboriginal Australians positive for HLA-B*56:02 has been previously reported. We report the allele frequency of HLA-B*56:02 in 2 South Australian populations, 1 Aboriginal (4.8%, 95% confidence interval 2.4-7.8%) and the other European (0%). We compared the frequency with publicly available information on HLA-B*56:02 status in other Indigenous Australian (n = 4) and European Australian cohorts (n = 1). In the Indigenous Australian cohorts, HLA-B*56:02 allele frequency ranged from 1.3 to 19%. We also describe an additional case of phenytoin DRESS (RegiSCAR DRESS score 7) in an Aboriginal Australian that was associated with HLA-B*56:02 and with CYP2C9*1/*3 genotype. In Aboriginal Australians, phenytoin DRESS appears distinctly linked to HLA-B*56:02 with an allele carriage rate substantially higher than in Europeans, but also with considerable regional variation. Investigations of human leucocyte antigen and other contributing genes and severe adverse drug reactions in understudied non-European populations are required to optimize safe medication use and inform risk mitigation strategies.

Grip strength among Indigenous and non-Indigenous Australian adults: a longitudinal study of the effects of birth size and current size

OBJECTIVES

Indigenous Australians are born smaller than non-Indigenous Australians and are at an increased risk of early onset of frailty. This study aimed to identify the relationship between birth size, current size and grip strength, as an early marker of frailty, in Indigenous and non-Indigenous young adults.

DESIGN

Cross sectional data from two longitudinal studies: Aboriginal birth cohort (Indigenous) and top end cohort (non-Indigenous).

SETTING

Participants reside in over 40 urban and remote communities across the Northern Territory, Australia.

PARTICIPANTS

Young adults with median age 25 years (IQR 24-26); 427 participants (55% women), 267 (63%) were remote Indigenous, 55 (13%) urban Indigenous and 105 (25%) urban non-Indigenous.

OUTCOME MEASURES

Reliable birth data were available. Anthropometric data (height, weight, lean mass) and grip strength were directly collected using standardised methods. Current residence was classified as urban or remote.

RESULTS

The rate of low birthweight (LBW) in the non-Indigenous cohort (9%) was significantly lower than the Indigenous cohort (16%) (-7%, 95% CI -14 to 0, p=0.03). Indigenous participants had lower grip strength than non-Indigenous (women, -2.08, 95% CI -3.61 to -0.55, p=0.008 and men, -6.2, 95% CI -9.84 to -2.46, p=0.001). Birth weight (BW) was associated with grip strength after adjusting for demographic factors for both women (β=1.29, 95% CI 0.41 to 2.16, p=0.004) and men (β=3.95, 95% CI 2.38 to 5.51, p<0.001). When current size (lean mass and body mass index [BMI]) was introduced to the model BW was no longer a significant factor. Lean mass was a positive indicator for grip strength, and BMI a negative indicator.

CONCLUSIONS

As expected women had significantly lower grip strength than men. Current size, in particular lean mass, was the strongest predictor of adult grip strength in this cohort. BW may have an indirect effect on later grip strength via moderation of lean mass development, especially through adolescence and young adulthood.

Common mental disorders among Indigenous people living in regional, remote and metropolitan Australia: a cross-sectional study

OBJECTIVE

To determine, using face-to-face diagnostic interviews, the prevalence of common mental disorders (CMD) in a cohort of adult Indigenous Australians, the cultural acceptability of the interviews, the rates of comorbid CMD and concordance with psychiatrists' diagnoses.

DESIGN

Cross-sectional study July 2014-November 2016. Psychologists conducted Structured Clinical Interviews for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision Axis I Disorders (SCID-I) (n=544). Psychiatrists interviewed a subsample (n=78).

SETTING

Four Aboriginal Medical Services and the general community located in urban, regional and remote areas of Southern Queensland and two Aboriginal Reserves located in New South Wales.

PARTICIPANTS

Indigenous Australian adults.

OUTCOME MEASURES

Cultural acceptability of SCID-I interviews, standardised rates of CMD, comorbid CMD and concordance with psychiatrist diagnoses.

RESULTS

Participants reported that the SCID-I interviews were generally culturally acceptable. Standardised rates (95% CI) of current mood, anxiety, substance use and any mental disorder were 16.2% (12.2% to 20.2%), 29.2% (24.2% to 34.1%), 12.4% (8.8% to 16.1%) and 42.2% (38.8% to 47.7%), respectively-6.7-fold, 3.8-fold, 6.9-fold and 4.2-fold higher, respectively, than those of the Australian population. Differences between this Indigenous cohort and the Australian population were less marked for 12-month (2.4-fold) and lifetime prevalence (1.3-fold). Comorbid mental disorder was threefold to fourfold higher. In subgroups living on traditional lands in Indigenous reserves and in remote areas, the rate was half that of those living in mainstream communities. Moderate-to-good concordance with psychiatrist diagnoses was found.

CONCLUSIONS

The prevalence of current CMD in this Indigenous population is substantially higher than previous estimates. The lower relative rates of non-current disorders are consistent with underdiagnosis of previous events. The lower rates among Reserve and remote area residents point to the importance of Indigenous peoples' connection to their traditional lands and culture, and a potentially important protective factor. A larger study with random sampling is required to determine the population prevalence of CMD in Indigenous Australians.

Finding Color in Conformity: A Commentary on Culturally Specific Risk Factors for Violence in Australia

This article outlines the current utility of Indigenous culturally specific risk factors for violence and the ramifications for cross-cultural risk prediction. The Indigenous culturally specific violence risk factor literature has provided a rich body of contextual information outlining Indigenous patterns of criminal behaviour. This information has the capacity to facilitate offender responsivity and treatment targets in addition to assisting clinicians identify the presence of risk markers among Indigenous clients. However, if intended for inclusion in risk prediction models, culturally specific risk items then require further quantitative analysis to establish robust associations and probability estimates for recidivistic outcome.

Inflammation, high ferritin, and erythropoietin resistance in indigenous maintenance hemodialysis patients from the Top End of Northern Australia

Use of erythropoiesis-stimulating agents (ESAs) has improved the management of anemia in patients on maintenance hemodialysis (MHD). Iron deficiency and inflammation cause ESAs resistance and are both common among indigenous people of Northern Australia. As part of quality assurance in our Renal Anaemia Management program, we observed that there was use of higher doses of ESAs and adjuvant iron therapy in our MHD patients. This study aimed to explore the relationship among iron studies, inflammation, ESA responsiveness, and ESAs and iron requirements in indigenous patients on MHD from the Top End of Northern Australia. We performed a retrospective cohort analysis of anemia management in a cohort of our patients on MHD. We extracted data for 178 indigenous and 19 non-indigenous patients from 1 March 2009 to 28 February 2010 from the Renal Anaemia Management database, which collects data prospectively in MHD patients. Ninety-nine percent of the whole sample had a ferritin level above the international guidelines threshold of >500 µg/L. Indigenous patients had higher ferritin (1534 ± 245.5 µg/L vs. 1013 ± 323.3 µg/L, P = 0.002). C-reactive protein (CRP) was high in 56.9% of the total cohort. One hundred percent of those with normal CRP had high ferritin (>500 µg/L). C-reactive protein was higher in indigenous than in non-indigenous patients. Erythropoiesis-stimulating agents hyporesponsiveness was higher in indigenous patients (P < 0.0001). There was no significant difference in ESAs hyporesponsiveness among different levels of CRP (P = 0.116), ferritin (P = 0.408), and transferrin saturation (P = 0.503). Indigenous patients required higher total iron dose (2820.30 [2000-4350] vs. 2336.12 [1912-2900], P = 0.02). There was no significant relationship between the high ferritin and CRP. In indigenous dialysis patients, iron therapy and ESAs use are higher. The high iron use is due to a lack of published evidence to guide the administration of iron in patients with high ferritin. The high ferritin and ESAs resistance could not be fully explained by inflammation and need further evaluation. Further studies are required to determine the safe use of iron and management of ESAs resistance in our hemodialysis population.

Variant human T-cell lymphotropic virus type 1c and adult T-cell leukemia, Australia

Human T-cell lymphotropic virus type 1 is endemic to central Australia among Indigenous Australians. However, virologic and clinical aspects of infection remain poorly understood. No attempt has been made to control transmission to indigenous children. We report 3 fatal cases of adult T-cell leukemia/lymphoma caused by human T-cell lymphotropic virus type 1 Australo-Melanesian subtype c.

Indigenous men's groups and social and emotional well-being: an indigenous doctor's perspective

OBJECTIVES

Traditional indigenous society promoted the social and emotional well-being of indigenous men through the meeting of men in daily life and during ceremonial times. There is an increasing recognition that men's groups use similar mechanisms to enhance the social and emotional well-being of participants and their communities. This paper seeks to increase understanding of the processes and impacts of contemporary indigenous men's groups from an indigenous doctor's perspective.

METHOD

Review of published and unpublished literature and reflections on the primary author's experiences within several indigenous men's groups using a participatory action research model were used to examine how participation within these groups can improve social and emotional well-being.

RESULTS

There is a scarcity of published data on the distribution, activities and outcomes of indigenous men's groups. Published qualitative and experiential observations suggest that they contribute to improved social and emotional well-being for participants, their families and communities.

CONCLUSIONS

Men's groups may be a good adjunct to the outpatient care of indigenous patients. As the published literature is entirely qualitative, mixed methods evaluation using appropriate and sensitive measures would assist in systematically capturing the impacts and outcomes of men's groups. Such evaluations could enhance programme longevity and encourage the referral of patients by mainstream mental health practitioners.