| The following summary has been adapted from the 24 August 2004 National Institute of Clinical Studies media release.
The Cochrane Users Award was established by the National Institute of Clinical Studies (NICS), Australia’s national agency for helping close gaps between best available evidence and current clinical practice. Among winners in the second annual award were: the National Aboriginal Community Controlled Health Organisation (NACCHO); and Dr Richard Murray, Medical Director, Population Health, Kimberley Aboriginal Medical Services Council, WA. Winners were selected by a multidisciplinary judging panel that included a consumer representative. The purpose of the award is to recognise health practitioners who make the best use of research evidence contained in the Cochrane Library, an online database of international scientific research which provides reliable evidence about the effects of health care. Dr Heather Buchan (CEO, NICS) reported that the Cochrane Reviews were increasingly being used to influence policy and practice internationally and the high level of entries indicated an exciting range of uses in Australia. Australians have free access to the Cochrane library after the Institute successfully negotiated, on behalf of the Australian Government, for a national licence to the library. Previously the database had only been available with a paid subscription which limited its use. NACCHO was the major winner of the ‘Primary/Community Care’ category and also won a general category award. Its review of the management of otitis media was undertaken in response to significant clinical practice uncertainty about the treatment of ear infections in the Aboriginal population. Calls from Aboriginal leaders for a large scale clinical trial to improve the treatment for chronic suppurative otitis media (CSOM), lead to a double-blind, multi-centre, randomised controlled trial, known as the NACCHO ear trial. It was found that when compared with current Australian guidelines, fluoroquinolone-containing eardrops recommended in the Cochrane Library, were 47% more effective than those previously used by local practitioners. Mr Tony McCartney (NACCHO Chair) explained that NACCHO has recommended that Australian guidelines be changed to reflect the findings and encouraged pharmaceutical bodies and the Therapeutic Goods Administration (TGA) to register topical fluoroquinolones as treatment for CSOM in Australia. Changes have already been made in Western Australia (WA). A general category award went to Dr Richard Murray, Medical Director, Population Health, Kimberley Aboriginal Medical Services Council, WA. The Kimberley Aboriginal Medical Services Council has been working to address the inconsistent clinical responses of health professionals to Aboriginal people, particularly in remote Australia. Dr Richard Murray and Dr Sophie Couzos are editors and contributing authors of the book, Aboriginal Primary Health Care: An Evidence-based Approach, Oxford University Press (now in its second edition), which cites over 80 Cochrane Reviews. The aim of the book is to support clinicians, public health providers and Aboriginal communities in applying effective evidence-based health interventions for health matters such as renal disease, diabetes, ear infections and rheumatic fever. This project has lead to the development of evidence-based initiatives, for example, the introduction of a Medicare rebate for a preventive health assessment in younger Aboriginal people and Torres Strait Islanders. For further information about the awards contact: Kelly Ward For information on how to access and use the Cochrane Library, visit the National Institute of Clinical Studies website. |
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Category: Vol 4 No 3, July 2004 – September 2004
Be Active Australia: A Health Sector Framework for Action 2005 – 2010
| The following summary has been adapted from the Be Active Australia section of the National Public Health Partnership website.
The draft Be Active Australia – a National Physical Activity for Health Action Plan (now renamed Active Australia: A Health Sector Framework for Action 2005 -2010) was released in April 2004 for consultation. Consultations took place in each jurisdiction and 70 submissions, representing over 250 organisations, were received. The Strategic Inter-Governmental forum on Physical Activity and Health (SIGPAH) sought comment from Aboriginal and Torres Strait Islander peoples across Australia through a parallel consultation process undertaken by Innovative Leadership Australia. (View the Bidgerdii Aboriginal and Torres Strait Islanders Corporation submission for the development of the Aboriginal and Torres Strait Islander component of the Plan – PDF – 129KB). On 9 June 2004, a national consensus workshop on the draft plan was held to review the issues raised by Aboriginal and Torres Strait Islander organisations and individuals during the national consultations, as well as to allow participants to make recommendations. Outcomes were presented on 10 June 2004 to the whole-of -population workshop and participants focussed on reaching an agreement on the Plan and implementation issues. SIGPAH met on 11 June 2004 to discuss incorporation of the consultation findings into a final draft and is currently preparing the Plan for National Public Health Partnership (NPHP) Member endorsement to refer to the Australian Health Ministers’ Advisory Council and Health Ministers. For further information view: |
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Aboriginal Health Conference 2004 – Partnerships for Better Health
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The Aboriginal Health 2004 Conference – the third in a series of biennial conferences held in Perth, Western Australia – was conducted 1 – 2 July. The 2004 conference theme – Partnerships for Better Health – recognises the importance of various groups working together to improve the health of Aboriginal people. Conference delegates from across the state included community workers, general practitioners and Aboriginal health workers. The conference program (view program) included a range of Indigenous presentations addressing the health of Indigenous people in community and hospital settings. Issues discussed included:
• social wellbeing;
• communicable diseases;
• renal disease;
• diabetes;
• cardiovascular disease; and
• community projects
The keynote speaker, Dr Sue Gordon, described her life journey and discussed the Inquiry into response by Government Agencies to complaints of family violence and child abuse in Aboriginal Communities.
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A pre-conference Aboriginal health promotion workshop, held on 30 June, supported the conference theme and provided a forum to strengthen participants’ responses to key health issues within their local communities. Discussion focused on the priority areas of smoking, nutrition and physical activity and issues identified by participants during the recent Aboriginal Health Promotion Videoconference Series (AHPVCS) including men’s, maternal and child health.
A HealthInternet café was held at the conference by staff from the Australian Indigenous HealthInfoNet: Bronwyn Gee; Neil Thomson; Natalie Weissofner; Ellie Kirov and Jane Burns. Delegates were provided with an opportunity to learn about the online information resources available on the HealthInfoNet website and other HealthInfoNetservices, such as Internet training.
We would like to thank the conference participants who provided written permission for us to display their photos here
Type 2 diabetes and patterns of alcohol use in a Queensland Aboriginal community
Hilary Bambrick
IntroductionType 2 diabetes is a significant cause of excess Indigenous morbidity and mortality, and cardiovascular disease is the leading cause of Indigenous death [2]. Moderate alcohol consumption may confer some cardiovascular benefits [3], reduce the incidence of diabetes [4], and reduce cardiovascular risk among those who have diabetes [5], but the heavy use of alcohol can contribute to poorer cardiovascular health and may increase serious complications from diabetes, through increasing triglyceride levels [6], and can cause liver and pancreas damage [7]. Fewer Indigenous people consume alcohol than the non-Indigenous people, but when alcohol is consumed, it tends to be at much higher levels [8]. These broad trends do not consider the impact that being diagnosed with diabetes (which is very common among Indigenous people) might have on alcohol use or differences between women and men. Determining such patterns of alcohol use at a community level is especially important given its influence on diabetes management and contribution to overall cardiovascular health. MethodsThis study took place in a large, urbanised Aboriginal community (population approximately 1,200) in southeast Queensland between September and December 2000. Participants with diagnosed type 2 diabetes (49 women, 38 men) were identified through the community hospital database. At the time of the study, the hospital served as an outpatient clinic providing near universal coverage of the community. Participants without diagnosed diabetes (‘never-diagnosed’) were recruited through household sampling (62 women, 55 men) where one person aged over 18 years from each household was randomly selected using a Kish grid. Response rates were high (approximately 90% diagnosed and 70% never-diagnosed eligible people), but men were slightly less likely than women to participate. Participants with diagnosed diabetes were on average 15 years older than never-diagnosed participants (women: diagnosed range 19-71, mean 47 years, never-diagnosed range 18-66, mean 32 years; men: diagnosed range 27-79, mean 49 years; never-diagnosed range 19-65, mean 35 years). Further details on participant selection methods are provided elsewhere [9]. Participants were asked about the frequency of their alcohol consumption (the usual number of days per week on which alcohol was used) and the amount of alcohol they consumed (number of drinks usually consumed on a drinking day). The total number of drinks usually consumed per week was then estimated. The study was approved by the Human Research Ethics Committee at the Australian National University. ResultsOverall, 48% of women and 67% of men in the study (56% of all participants) reported that they consume alcohol. Participants with diagnosed diabetes were less likely to drink than never-diagnosed participants (women RR=0.3, 95%CI 0.2-0.5; men RR=0.7, 95%CI 0.5-0.9). Most of those who did consume alcohol did so on fewer than two days per week. Overall, only 21% of women and 19% of men consumed alcohol on three or more days each week. On a day when alcohol was used, however, the number of drinks consumed tended to be very high (mean=17, range 3.5 to >20). No participant reported consuming just one or two drinks on a day when they were drinking. Figure 1 shows estimated weekly alcohol consumption, usual number of drinking days per week and usual number of drinks consumed on a drinking day for women and men by diabetes diagnosis.
Figure 1. Usual number of drinks per week (A) (calculated by midpoint of number of days * midpoint number of drinks per drinking day), usual number of drinking days per week (B) and usual number of drinks consumed per drinking day (C) for diagnosed (solid line) and healthy (dotted line) women and men. ANOVA was used to test significance. Age was controlled for. NB. ‘Number of drinks’ was not standardised, for example, as one can of beer contains approximately 1.4 ‘standard drinks’, the number of standard drinks consumed may be much higher than the number reported. In Australia, one standard drink contains 10g of alcohol (the amount of alcohol in a ‘standard’ drink varies internationally) [1] .
After controlling for age, differences between diagnosed and never-diagnosed participants were significant for number of drinks per week (ANOVA: women 9.4 versus 34.4, p<0.001; men 10.6 versus 31.2, p=0.004), and number of drinking days per week (women 0.5 versus 1.9, p<0.001; men 0.7 versus 1.7, p=0.011). Women and men with diabetes who did drink were drinking less on a drinking day than others (ANOVA: women 15.5 versus 18.4, p=0.003; men 16.0 versus 16.5, p=0.006). This might be partially related to age, at least among women, as the significance of the differences was reduced when age was included in the model as a covariate (women p=0.48; men p=0.012). The differences between these groups may not be fully explained by the smaller proportion of people with diagnosed diabetes who drink. When only those who did drink were considered, diagnosed men drank significantly less per week than others (14.6 versus 42.4, p=0.039) but were not drinking significantly less often (1.0 versus 2.3 times per week, p=0.079). Diagnosed women who drank were not drinking significantly less per week than other women who drank (26.54 versus 54.2, p=0.156), nor did they drink significantly less often (1.3 versus 2.9, p=0.075). DiscussionOf all study participants, 56% (20% diagnosed women, 69% never-diagnosed women, 53% diagnosed men, 76% never-diagnosed men) reported that they consumed alcohol. This contrasts with the 83% reported for Australia as a whole [2]. People in this community who have had diabetes diagnosed were less likely to consume alcohol than those who had never been diagnosed with diabetes. They also drink less per week, had fewer drinking days per week and consumed less per drinking day. Much of the difference was due to the greater proportion of those with diabetes abstaining from alcohol altogether. Diagnosed women and men consumed less alcohol than never-diagnosed women and men, all those who drank consumed large quantities of alcohol on a drinking day. Low levels of alcohol consumption (such as 1-2 drinks on several days per week) is protective against cardiovascular disease and diabetes [3, 5, 10]. In this study, participants were either non-drinkers or consumed large quantities on a few drinking days per week. According to the Australian alcohol guidelines, the risk of alcohol-related harm can be considered in terms of short-term and long-term risks (Table 1) [11]. Short-term risky or high-risk drinking refers to the quantity consumed on a given drinking day, while long-term risk refers to the usual quantity consumed each week. In the short term, risks include increased likelihood of accidents, physical and sexual assault, and a reduced capacity to protect against sexually transmitted infections and pregnancy. In the long-term, regular heavy drinking by women increases their risk of cardiovascular disease and other chronic degenerative disorders, such as liver damage and diabetes resulting from pancreatitis. Table 1. Australian risk classifications for alcohol-related harm in the short- and long-term [11]
In the Australian population as a whole, 12% of women and 15% of men drink one or more times per week at levels considered either risky or high-risk in the short-term [12]. Prevalence of short-term risky and high risk drinking differed in the current study according to diabetes status, with never-diagnosed women reporting the highest levels and diagnosed women the lowest (20% of diagnosed women, 29% of diagnosed men, 69% of never-diagnosed women, 62% of never-diagnosed men). Many of those with diagnosed diabetes did not drink, but those that did still consumed quantities of alcohol that were risky or high-risk in the short-term. Given the ready availability of simple sugars in alcohol, heavy alcohol consumption among diabetics, even if infrequent, is a serious concern in terms of short-term blood glucose control and long-term contribution to cardiovascular damage. Long-term risky and high-risk drinking has been estimated to occur in approximately 20% of Indigenous Australians, while for Australian women and men the overall prevalences are 9% and 10% respectively [13]. Results from this study indicate that among those who have never had diabetes diagnosed, up to 60% of women and 49% of men are drinking at risky and high-risk levels. The prevalence of long-term risky drinking is, however, much lower among people with diagnosed diabetes, at 6% for women and 16% for men. The current study found that not only is the prevalence of short-term risky drinking higher among never-diagnosed women than never-diagnosed men, the long-term drinking behaviour of women is at least as risky as that of men. In the past, the heavy consumption of alcohol has been frequently associated with notions of masculinity [14, 15]. A propensity for more general risk-taking is also commonly associated with men rather than with women, especially young men, and particularly those who are disaffected and feel that they have little to lose [16]. The combination of being both male and socially disadvantaged is generally considered to produce the worst outcomes for health [17]. This no doubt remains a very important aspect of alcohol use, but this study demonstrates patterns of consumption by women also need to be addressed more comprehensively. Some of women’s excess risky drinking in comparison to men’s arises from the lower thresholds defining risk for women, but many women reported drinking greater quantities of alcohol than men – amounts that are two and three times those defined as high risk. The use of self-reported alcohol consumption is a limitation of this study. ‘Number of drinks’ consumed was not based on Australian standard drinks, but, given that standard drinks containing 10g of alcohol are frequently smaller than individual items consumed (such as a can of beer which is approximately 1.4 standard drinks), the reporting is likely to underestimate rather than overestimate the number of standard drinks consumed by participants. As total weekly consumption was derived from the midpoints of both alcohol frequency categories (number of days per week) and number of drinks usually consumed, the study may overestimate consumption for some but underestimate for others. Further, the survey questions were framed in the present, and may not indicate longer term drinking patterns. For example, some may have considered themselves to be non-drinkers because it had been several months since they had consumed alcohol. As questions were not asked about past drinking behaviours it cannot be confirmed that being diagnosed with diabetes causes changes to drinking behaviours. Major strengths of the study include the very high response rates (70%-90%), and the willingness of participants to answer questions relating to their alcohol consumption behaviour. Participants’ willingness to take part in the study and awareness that their answers would be kept confidential suggests there is no reason to doubt the integrity of the responses. The age difference between those diagnosed with diabetes and never-diagnosed participants was not a significant factor in the different drinking behaviours of the two groups. Age was found to have an effect only in the amount consumed per drinking day. That fewer people with diagnosed diabetes drank and that those who did drink did so less often than never-diagnosed people is probably primarily due to efforts made to follow diabetes management advice to ‘drink less alcohol’. If so, this success should be built upon, with further efforts to reduce the amount consumed on a drinking day. Changing drinking behaviours of individuals means changing the dominant drinking culture. The pattern of either abstaining from alcohol or consuming risky quantities is probably the result of interlinking factors with deep historical roots. Polarising morality around alcohol use widens the divide between non-drinkers and heavy drinkers, and fails to allow room for moderation, which could confer some cardiovascular benefits. Alcohol may contribute to obesity through supplying excess calories [18], but a review of national data on Indigenous obesity found that those who did not drink alcohol had, on average, a higher body mass index (BMI) than those who drank [19]. This could be because heavy drinking often correlates with heavy smoking, and also because heavy drinking itself may limit the intake of foods. For example, participants in the present study who regularly missed meals sometimes reported that this was because they had been drinking or were ‘grog sick’. The lower BMIs among drinkers found in the review of national data could also be because the behaviour-modifying potential of diabetes diagnosis was not considered. People with diagnosed diabetes may have both a higher BMI and be less likely to consume alcohol than those without. An environment where there are low levels of physical activity combined with a diet that is typically energy-dense promotes both cardiovascular disease and diabetes. The effects of physical inactivity and an energy-dense diet may be exacerbated by the patterns of drinking that are taking place among never-diagnosed people, increasing their future risk of diabetes and cardiovascular disease. Overall, there appears to have been some success in reducing alcohol intake among those who have been diagnosed with diabetes, but considerable emphasis should be placed also on finding strategies to reduce the amount that people drink ‘on a drinking day’. Acknowledgements References
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New Medicare health checks for Indigenous Australians
The following summary has been adapted from the 5 May 2004 Department of Health and Ageing media release
Indigenous Australians continue to have a life expectancy approximately 20 years less than the community average. Regular health checks help reduce or prevent serious illness. The Australian Government has introduced a new Medicare funded health check for Indigenous Australians, to help prevent and treat chronic illness. Two yearly health checks for Aboriginal and Torres Strait Islander people aged between 15 and 54 (inclusive) have been included in the Medicare Benefits Schedule since 1st May 2004.
The aim of this new health assessment is to improve the overall health of Indigenous Australians by ensuring early intervention and diagnosis for treatable conditions. The health check includes:
- taking the patient’s medical history;
- examining the patient;
- making or arranging any required investigations;
- assessing the patient’s health;
- undertaking any necessary interventions or referrals; and
- documenting a straightforward strategy for good health.
It is recommended that the health check be performed by the patient’s doctor but in some circumstances parts of the check may be carried out by an Aboriginal or Torres Strait Islander health worker, nurse or other health professional under the supervision of the patient’s doctor.
For further information:
