Perspectives, understandings of dementia and lived experiences from Australian Aboriginal people in Western Australia.

OBJECTIVE: We explored understandings about dementia and lived experiences from carers among community-dwelling Aboriginal people in Western Australia (WA). METHODS: In partnership with Aboriginal medical services in WA, we conducted semi-structured interviews with Aboriginal people in Perth and Bunbury. All interviews were transcribed verbatim and coded thematically. RESULTS: We conducted 39 interviews. Dementia was associated with 'losing your memory', a 'change in behaviour' and unhealthy lifestyles. Increasing awareness about dementia in the community was noted particularly to enable people to recognise the early signs, feel safe to ask for help and know how to best support families. Families were primarily responsible for caring for people with dementia and were finding it difficult to manage. They expressed negative experiences with currently available aged care facilities. CONCLUSIONS: Increased awareness of dementia in the community through public health messaging and by health professionals and culturally secure services focussing on dementia care is required.

Young Aboriginal people in Australia who have never used marijuana in the 'Next Generation Youth Well-being study': A strengths-based approach.

BACKGROUND: Being young is a period of experimentation which can lead to increased vulnerability to poor health choices and outcomes. Aboriginal and Torres Strait Islander (Aboriginal) people have a long and strong history of resilience; however, a deficit approach is often taken with messages of poor health and low socioeconomic status. This study takes a strengths-based approach and examines the demographic factors and behaviours associated with never using marijuana among young Aboriginal people in Australia. METHODS: Overall, 521 Aboriginal people aged 16-24 years from Western Australia, Central Australia and New South Wales participated in the Next Generation: Youth Wellbeing Study. The baseline survey examined demographics, health-related behaviours and clinical indicators of young Aboriginal people. We calculated the number and proportion of young Aboriginal people who never used marijuana by demographics and behavioural factors. Logistic regression was used to assess the demographic and behavioural factors associated with never using marijuana. RESULTS: Of the 521 participants, 458 (87.9%) answered the question about marijuana use of which 220 had incomplete demographic or behavioural questions, leaving a final cohort of 301 participants. A total of 174 (57.8%) had never used marijuana. A higher proportion of young Aboriginal people who never used marijuana were younger (16-19 years old), female, queer, single, lived in Central Australia, were students, had never smoked tobacco, had never drank alcohol, never had anxiety and never had depression. Never using marijuana was independently associated with being a parent or carer of a child (Adjusted Odds Ratio (AOR): 2.80, 95% CI: 1.03-7.59, p = 0.043), never smoking tobacco (AOR: 29.73, 95 CI: 13.32-66.37, p < 0.001), never drinking alcohol (AOR: 2.78, 95 CI: 1.12-6.93, p = 0.028), not having anxiety (AOR: 3.49, 95 CI: 1.19-10.23, p = 0.022), and having lower levels of distress (AOR: 2.63, 95 CI: 1.20-5.77, p = 0.016). CONCLUSION: Our study shows that more than half of young Aboriginal people did not use marijuana, smoke, or drink alcohol and that those who had not used marijuana had lower levels of distress.

A multi-zoo investigation of nutrient provision for captive red-crested turacos.

Turacos (Musophagidae) are common zoo birds; the 14 species of Tauraco being most often exhibited. Turacos possess unique non-structural, copper-based feather pigments, and a specialized dietary strategy. Tauraco inhabit tropical woodlands, foraging for predominantly folivorous and/or frugivorous food items. Using a study population of 16 red-crested turacos (T. erythrolophus) at seven zoos in the United Kingdom, the nutrient composition of diets from diet sheets was calculated, using Zootrition v.2.6, Saint Louis Zoo, USA for analyses of important nutrients within each diet, and compared against an example of currently available literature. For all nutrients analyzed, significant differences were noted between amounts presented in each zoo's diet (as fed). Turacos are presented with a wide range of ingredients in diets fed, and all zoos use domestic fruits to a large extent in captive diets. Similarities exist between zoos when comparing amounts of as-fed fiber. Analysis of the calcium to phosphorous ratio for these diets showed there to be no significant difference from the published ratio available. While this is a small-scale study on only a limited number of zoos, it provides useful information on current feeding practice for a commonly-housed species of bird and highlights potential areas of deviation away from standard practice, as well as identifying ways of reducing wastage of food. Data on wild foraging behavior and food selection, or collaboration with tauraco keepers from institutions in the tropics, is recommended as a way of improving feeding regimes and updating feeding practice for this and other Tauraco species.

Prevalence of depression and its associations with cardio-metabolic control in Aboriginal and Anglo-Celt patients with type 2 diabetes: the Fremantle Diabetes Study Phase II.

AIMS: To determine the prevalence and associates of depression in Aboriginal and Anglo-Celt (AC) Australians with type 2 diabetes. METHODS: Community-based patients were screened using the Patient Health Questionnaire (PHQ-9) as part of detailed assessment. The prevalence of any current depression, major depression and antidepressant use by racial group was compared after adjustment for age, sex, educational attainment and marital status. Multiple logistic regression was used to determine associates of current depression. RESULTS: The 107 Aboriginal participants were younger (mean±SD 54.3±11.8 vs. 67.2±10.6 years), less often male (34.6% vs. 50.9%) and married (39.3% vs. 61.7%), and more likely to smoke (44.6% vs. 8.1%) than the 793 AC subjects (P≤0.002). Fifty-two Aboriginal (48.5%) and 772 AC participants (97.4%) completed the PHQ-9; these Aboriginals had similar socio-demographic, anthropometric and diabetes-related characteristics to those without PHQ-9 data. A quarter of the Aboriginals had current depression vs 10.6% of ACs (P=0.16), 15.4% vs. 4.1% had major depression (P=0.029), and 68.8% vs. 29.7% had untreated depression (P=0.032). Compared with non-depressed participants, patients with current depression were younger and more likely to smoke, to be overweight/obese and to have worse glycaemic control (P≤0.024). Significant independent associates of current depression were educational attainment (inversely), smoking status, body mass index and fasting plasma glucose in the AC group and alcohol use in the Aboriginal group. CONCLUSIONS: Although prevalence of depression was not significantly increased in the Aboriginal patients, it was more likely to be major and untreated. Depression complicating type 2 diabetes is associated with adverse cardiovascular risk.

Continuing disparities in cardiovascular risk factors and complications between aboriginal and Anglo-Celt Australians with type 2 diabetes: the Fremantle Diabetes Study.

OBJECTIVE: To determine whether disparities in the nature and management of type 2 diabetes persist between Aboriginal and the majority Anglo-Celt patients in an urban Australian community. RESEARCH DESIGN AND METHODS: Baseline data from the observational Fremantle Diabetes Study collected from 1993 to 1996 (phase I) and from 2008 to 2011 (phase II) were analyzed. Patients characterized as Aboriginal or Anglo-Celt by self-report and supporting data underwent comprehensive assessment, including questionnaires, examination, and biochemical testing in a single laboratory. Generalized linear modeling with age/sex adjustment was used to examine differences in changes in variables in the two groups between phases I and II. RESULTS: The indigenous participants were younger at entry and at diabetes diagnosis than the Anglo-Celt participants in both phases. They were also less likely to be educated beyond primary level and were more likely to be smokers. HbA(1c) decreased in both groups over time (Aboriginal median 9.6% [interquartile range 7.8-10.7%] to 8.4% [6.6-10.6%] vs. Anglo-Celt median 7.1% [6.2-8.4%] to 6.7% [6.2-7.5%]), but the gap persisted (P = 0.65 for difference between phases I and II by ethnic group). Aboriginal patients were more likely to have microvascular disease in both phases. The prevalence of peripheral arterial disease (ankle-brachial index ≤0.90 or lower-extremity amputation) increased in Aboriginal but decreased in Anglo-Celt participants (15.8-29.7 vs. 30.7-21.5%; P = 0.055). CONCLUSIONS: Diabetes management has improved for Aboriginal and Anglo-Celt Australian patients, but disparities in cardiovascular risk factors and complications persist.

Indigenous women and smoking during pregnancy: knowledge, cultural contexts and barriers to cessation.

Despite active tobacco control efforts in Australia, smoking prevalence remains disproportionately high in pregnant Indigenous women. This study investigated the place of smoking in pregnancy and attitudes towards smoking within the broader context of Indigenous lives. Focus groups and in-depth interviews were used to collect data from 40 women, and ten Aboriginal Health Workers (AHWs) in Perth, Western Australia. The research process and interpretation was assisted by working with an Indigenous community reference group. Results demonstrated the impact of contextual factors in smoking maintenance, and showed that smoking cessation even in pregnancy was not a priority for most women, given the considerable social and economic pressures that they face in their lives. Overwhelmingly, smoking was believed to reduce stress and to provide opportunities for relaxation. Pregnancy did not necessarily influence attitudes to cessation, though women's understanding of the consequences of smoking during pregnancy was low. Reduction of cigarette intake during pregnancy was seen as an acceptable and positive behaviour change. The AHWs saw their role to be primarily one of support and were conscious of the importance of maintaining positive relationships. As a result, they were often uncomfortable with raising the issue of smoking cessation with pregnant women. The stories of Indigenous women and AHWs provided important insight into smoking during pregnancy and the context in which it occurs.

Eyelid mucous membrane grafts: a histologic study of hard palate, nasal turbinate, and buccal mucosal grafts.

PURPOSE: To histologically evaluate the outcome of mucous membrane grafts to the eyelid. METHODS: Case series of 31 eyes from 24 patients who underwent transplantation of hard palate (25 eyes), buccal (1 eye), or nasal turbinate (5 eyes) mucosa to the posterior eyelid surface. These grafts were biopsied at 0.5 months to 84 months (mean, 20 months) postoperatively. They were examined with light microscopy and compared with either the donor mucosa from the same patient (2 patients) or the typical donor site histology (22 patients). RESULTS: Graft biopsies revealed general epithelial morphology that was quite similar to the respective donor sites in virtually all cases. Six (25%) of 24 hard palate graft biopsies, which were obtained at 8 months to 49 months (mean, 22 months) postoperatively, displayed orthokeratosis alternating with parakeratosis, while 12 (50%) demonstrated parakeratosis alone, and another 6 (25%) showed adjacent regions of parakeratotic and nonkeratinized epithelium. No hard palate grafts showed complete absence of keratinization after transplantation. Other significant findings included loss of goblet cells in nasal turbinate grafts and few submucosal glands remaining in any specimen. CONCLUSIONS: Full-thickness mucosal grafts typically maintain their native epithelial morphology following transplantation to the ocular surface. Submucosal glands usually do not survive transplantation, which could be the result of intentional thinning of the graft at the time of transplantation. Contrary to the opinion that hard palate graft epithelium usually undergoes metaplasia from keratinized to nonkeratinized within 6 months following transplantation to the eye, all hard palate grafts in this study remained orthokeratotic and/or parakeratotic.