'I am absolutely shattered': the impact of chronic low back pain on Australian Aboriginal people.

BACKGROUND: Aboriginal people in Australia have been uniquely identified as less susceptible to chronic low back pain (CLBP) disability when compared to non-Aboriginal populations, reportedly due to cultural beliefs about pain. A qualitative, culturally secure research approach was used to explore this assumption. METHODS: In-depth interviews were undertaken with 32 Aboriginal men and women with CLBP in regional and remote areas of Western Australia. Interviews were conducted collaboratively with male and female Aboriginal co-investigators, and with the support of local Aboriginal community organizations. A primary focus was to investigate the impact of CLBP from the perspective of Aboriginal people living with the condition. RESULTS: The experience of CLBP was found to be multidimensional, impacting on activities of daily life, employment, sport and family participation, emotional and cultural well-being. CONCLUSIONS: Contrary to previous assumptions, CLBP is profoundly disabling for some Aboriginal people and a priority health concern. Issues of gender, cultural obligations and the emotional consequences of CLBP are important consideration for health care. These findings, and the contextual approach used to gain an in-depth understanding of CLBP, may be relevant to populations elsewhere.

Training rural and remote therapy assistants in Western Australia.

CONTEXT: Therapy assistants (TAs) are widely used in the delivery of therapy services in rural Western Australia (WA). Appropriate training for TAs is an essential part of their practice; however, to date most TAs are trained 'on-the-job', thus taxing the scarce resources of rural and remote allied health professionals (AHPs). There has been limited recognized training that is suitable to their role and easily accessed by rural and remote TAs. ISSUE: This project report describes the development and evaluation of training for TAs across country WA to address these issues. Sixteen training modules were developed congruent with the requirements of TA work in rural WA. Modules were designed, developed and delivered via videoconference by rural and remote AHPs. A partnership with a registered training provider has allowed TAs to use this training as credit toward a recognized qualification. LESSONS LEARNT: A high level of attendance across all country regions of WA confirmed a need for this training. Modules that focussed on a clinical topic, presenters that were well organized, who supplied resources to support the training, and used interactive case scenarios were received most positively. For AHPs this training reduced the work required for training TAs at individual sites. The training resources developed in this project are relevant to other rural and remote health services utilizing a similar model of allied health service delivery. The model of training developed is based on a 'ground-up' approach to ensure training meets the established need. Developing stand-alone training packages that are also adapted for distance learning improves the sustainability and accessibility to training. Therapy assistants are now able to use on-the-job training to achieve a recognized qualification. Despite this it is not believed feasible for health services to insist that rural and remote TAs have a standardized qualification for their work. This article adds to a growing body of work describing the key features of rural and remote TA models of service delivery.

Arsenite enhances DNA double-strand breaks and cell killing of methyl methanesulfonate-treated cells by inhibiting the excision of alkali-labile sites.

Analysis of DNA strand breaks by alkaline elution indicates that DNA repair of Chinese hamster ovary cells treated with methyl methanesulfonate (MMS) was inhibited by sodium arsenite. Comparing the profiles of a 36-min elution with buffer pH 12.1 and a 12-h elution with buffer pH 12.4 revealed that alkali-labile sites were increased more than frank breaks in the combined treatment with MMS plus arsenite. Enhancement of alkali-labile sites was detected with low doses of MMS and arsenite, whereas enhancement of frank breaks required higher doses of MMS and arsenite. Double-strand breaks were detected after incubating the MMS-treated cells in an arsenite-containing medium for 18 or 12 h but not less than 6 h. No double-strand breaks were detected when MMS-damaged cells were posttreated with arsenite for 3 h; however, double-strand breaks were detected after further incubating these cells in arsenite-free medium for 18 h. Thus, inhibition of arsenite on the excision of methylated bases may have accumulated a large number of alkali-labile sites in the parental strands, and DNA replication may then generate breaks in the non-methylated daughter strands. Double-strand breaks may result from overlapping gaps between the parental and daughter strands and/or postreplication repair. These double-strand breaks may then result in the synergistic cell death as observed with posttreatment of MMS-damaged cells with arsenite for 1 or 3 h.