Healing journeys: experiences of young Aboriginal people in an urban Australian therapeutic community drug and alcohol program.

Disproportionately high numbers of Aboriginal young people access residential alcohol and other drug programs in Australia. While demand is high, these programs often have low numbers of Aboriginal staff. Residential programs, however, generally offer supports that reflect features of Aboriginal health care - holistic, group-based, connected to local communities, and addressing determinants of health. The qualitative research outlined in this paper was a collaboration between a mainstream residential therapeutic community program and two Aboriginal community-controlled organisations, and Aboriginal young people and researchers, with Aboriginal research leadership. It used an Aboriginal healing framework to understand the experiences of 12 young Aboriginal people in the program, triangulated with 19 key informant interviews. This provided an opportunity to understand how Indigenous knowledge about healing related to mainstream programs and the experiences of Aboriginal young people. This moves beyond individualist and deficit-focused conceptions of youth alcohol and drug use and centres Aboriginal cultures as healing. Findings point to the need for critically self-reflective mainstream organisations, a larger Aboriginal workforce with leadership roles, partnerships with Aboriginal Elders and organisations, and an investment in Aboriginal community-controlled alcohol and other drug services.

Onset and trajectory of alcohol and other drug use among Aboriginal men entering a prison treatment program: A qualitative study.

INTRODUCTION: Aboriginal and Torres Strait Islander people are vastly over-represented in Australian prisons. Many people in prison attribute in some way their offences to alcohol and/or other drug (AOD) use. This paper aims to understand AOD use before first and between terms in prison, among a group of Aboriginal men enrolled in a prison-based AOD treatment program. It examines opportunities for prevention or treatment that might interrupt the cycle of alcohol consumption, offending and imprisonment. METHODS: A thematic analysis of in-depth interviews with 14 Aboriginal men in an urban prison. RESULTS: Participants had low levels of formal education, none having completed high school and had spent limited or no time in the workforce. All 14 spoke of being negatively affected by AOD use within their families. First alcohol and cannabis use were around age 12-14 years, first amphetamines and/or heroin use was around age 15. As adults, they had unstable accommodation and when released from prison returned to the same situation they had been in previously. Most believed they would not have offended and subsequently imprisoned if they did not have a substance use disorder. DISCUSSION AND CONCLUSION: Without further support post-prison, the men in this study are likely to return to the same situation and continue their AOD use. Further efforts are needed to support families with substance use disorders and to give young Aboriginal and Torres Strait Islander people better education and training opportunities.

Standardised neonatal parenteral nutrition formulations - Australasian neonatal parenteral nutrition consensus update 2017.

BACKGROUND: The first consensus standardised neonatal parenteral nutrition formulations were implemented in many neonatal units in Australia in 2012. The current update involving 49 units from Australia, New Zealand, Singapore, Malaysia and India was conducted between September 2015 and December 2017 with the aim to review and update the 2012 formulations and guidelines. METHODS: A systematic review of available evidence for each parenteral nutrient was undertaken and new standardised formulations and guidelines were developed. RESULTS: Five existing preterm Amino acid-Dextrose formulations have been modified and two new concentrated Amino acid-Dextrose formulations added to optimise amino acid and nutrient intake according to gestation. Organic phosphate has replaced inorganic phosphate allowing for an increase in calcium and phosphate content, and acetate reduced. Lipid emulsions are unchanged, with both SMOFlipid (Fresenius Kabi, Australia) and ClinOleic (Baxter Healthcare, Australia) preparations included. The physicochemical compatibility and stability of all formulations have been tested and confirmed. Guidelines to standardise the parenteral nutrition clinical practice across facilities have also been developed. CONCLUSIONS: The 2017 PN formulations and guidelines developed by the 2017 Neonatal Parenteral Nutrition Consensus Group offer concise and practical instructions to clinicians on how to implement current and up-to-date evidence based PN to the NICU population.

Holistic primary health care for Aboriginal and Torres Strait Islander prisoners: exploring the role of Aboriginal Community Controlled Health Organisations.

OBJECTIVE: Aboriginal and Torres Strait Islander Community Controlled Health Organisations (ACCHOs) have been identified as having an important role in improving the health and wellbeing of individuals in prison; however, a lack of information exists on how to strengthen this role. This paper explores the experiences of ACCHO staff in primary health care to individuals inside or leaving prison. METHODS: Nineteen staff from four ACCHOs were interviewed. ACCHO selection was informed by proximity to prisons, town size and/or Local Government Area offending rates. Thematic analysis of the interviews was undertaken. RESULTS: While most ACCHOs had delivered post-release programs, primary health care delivery to prisoners was limited. Three themes emerged: i) a lack of access to prisoners; ii) limited funding to provide services to prisoners; and iii) the need for a team approach to primary health care delivery. CONCLUSION: A holistic model of care underpinned by a reliable funding model (including access to certain Medicare items) and consistent access to prisoners could strengthen ACCHOs' role in primary health care delivery to people inside or leaving prison. Implications for public health: ACCHOs have an important role to play in the delivery of primary health care to prisoners. Existing models of care for prisoners should be examined to explore how this can occur.

Converging drivers of interpersonal violence: Findings from a qualitative study in post-hurricane Haiti.

OBJECTIVE: Interpersonal violence affecting women and children is increasingly recognized as a public health priority in humanitarian emergencies. Yet, research and intervention efforts have been fragmented across gender-based violence and child protection sectors. Using data from the Transforming Households: Reducing Incidence of Violence in Emergencies (THRIVE) project, this study sought to qualitatively investigate the intersecting drivers of multiple forms of violence in Côteaux, Haiti, while obtaining insight on how these drivers may be influenced by a humanitarian emergency. METHODS: This analysis used transcripts obtained using a photo elicitation approach over the course of three sessions per person. Thirty-six individuals participated in the study: eight adult females, ten adult males, eight adolescent females, ten adolescent males. Participants were given cameras to capture images related to family relationships, family safety, and changes to family dynamics due to Hurricane Matthew and its aftermath. In subsequent sessions, these photographs were used as prompts for qualitative interviews. RESULTS: Multiple and converging drivers of interpersonal violence were identified including the accumulation of daily stressors, loss of power/control, learned behavior (intergenerational cycle of abuse), and inequitable gender norms, all of which were influenced by the humanitarian context caused by Hurricane Matthew. CONCLUSIONS: Our findings suggest multiple and converging drivers of violence may be exacerbated in times of crises, requiring interdisciplinary responses. In order to comprehensively address the drivers of violence, practitioners and policy makers should consider the needs of individuals and their families holistically, integrating community-led, gender transformative efforts and positive parenting with basic needs provision.

Examining the pathways for young people with drug and alcohol dependence: a mixed-method design to examine the role of a treatment programme.

INTRODUCTION: Young people with drug and alcohol problems are likely to have poorer health and other psychosocial outcomes than other young people. Residential treatment programmes have been shown to lead to improved health and related outcomes for young people in the short term. There is very little robust research showing longer term outcomes or benefits of such programmes. This paper describes an innovative protocol to examine the longer term outcomes and experiences of young people referred to a residential life management and treatment programme in Australia designed to address alcohol and drug issues in a holistic manner. METHODS AND ANALYSIS: This is a mixed-methods study that will retrospectively and prospectively examine young people's pathways into and out of a residential life management programme. The study involves 3 components: (1) retrospective data linkage of programme data to health and criminal justice administrative data sets, (2) prospective cohort (using existing programme baseline data and a follow-up survey) and (3) qualitative in-depth interviews with a subsample of the prospective cohort. The study will compare findings among young people who are referred and (a) stay 30 days or more in the programme (including those who go on to continuing care and those who do not); (b) start, but stay fewer than 30 days in the programme; (c) are assessed, but do not start the programme. ETHICS AND DISSEMINATION: Ethics approval has been sought from several ethics committees including a university ethics committee, state health departments and an Aboriginal-specific ethics committee. The results of the study will be published in peer-reviewed journals, presented at research conferences, disseminated via a report for the general public and through Facebook communications. The study will inform the field more broadly about the value of different methods in evaluating programmes and examining the pathways and trajectories of vulnerable young people.

Offending, custody and opioid substitution therapy treatment utilisation among opioid-dependent people in contact with the criminal justice system: comparison of Indigenous and non-Indigenous Australians.

BACKGROUND: Although Indigenous Australians are over-represented among heroin users, there has been no study examining offending, time in custody, and opioid substitution therapy (OST) treatment utilisation among Indigenous opioid-dependent (including heroin) people at the population level, nor comparing these to non-Indigenous opioid-dependent people. The aims of this study were to compare the nature and types of charges, time in custody and OST treatment utilisation between opioid-dependent Indigenous and non-Indigenous Australians in contact with the criminal justice system. METHODS: This was a population-based, retrospective data linkage study using records of OST entrants in New South Wales, Australia (1985-2010), court appearances (1993-2011) and custody episodes (2000-2012). Charge rates per 100 person-years were compared between Indigenous and non-Indigenous Australians by sex, age and calendar year. Statistical comparisons were made for variables describing the cumulative time and percentage of follow-up time spent in custody, as well as characteristics of OST initiation and overall OST treatment utilisation. RESULTS: Of the 34,962 people in the cohort, 6,830 (19.5%) were Indigenous and 28,132 (80.5%) non-Indigenous. Among the 6,830 Indigenous people, 4,615 (67.6%) were male and 2,215 (32.4%) female. The median number of charges per person against Indigenous people (25, IQR 31) was significantly greater than non-Indigenous people (9, IQR 16) (p < 0.001). Overall, Indigenous people were charged with 33.2% of the total number of charges against the cohort and 44.0% of all violent offences. The median percentage of follow-up time that Indigenous males and females spent in custody was twice that of non-Indigenous males (21.7% vs. 10.1%, p < 0.001) and females (6.0% vs. 2.9%, p < 0.001). The percentage of Indigenous people who first commenced OST in prison (30.2%) was three times that of non-Indigenous people (11.2%) (p < 0.001). Indigenous males spent less time in OST compared to non-Indigenous males (median percentage of follow-up time in treatment: 40.5% vs. 43.1%, p < 0.001). CONCLUSIONS: Compared to non-Indigenous opioid-dependent people, Indigenous opioid-dependent people in contact with the criminal justice system are charged with a greater number of offences, spend longer in custody and commonly initiate OST in prison. Hence, contact with the criminal justice system provides an important opportunity to engage Indigenous people in OST.

Pregnenolone sulfate and cortisol induce secretion of acyl-CoA-binding protein and its conversion into endozepines from astrocytes.

Acyl-CoA-binding protein (ACBP) functions both intracellularly as part of fatty acid metabolism and extracellularly as diazepam binding inhibitor, the precursor of endozepine peptides. Two of these peptides, ODN and TTN, bind to the GABA(A) receptor and modulate its sensitivity to gamma-aminobutyric acid (GABA). We have found that depolarization of mouse primary astrocytes induces the rapid release and processing of ACBP to the active peptides. We previously showed that ODN can trigger the rapid sporulation of the social amoeba Dictyostelium. Using this bioassay, we now show that astrocytes release the endozepine peptides within 10 min of exposure to the steroids cortisol, pregnenolone, pregnenolone sulfate, or progesterone. ACBP lacks a signal sequence for secretion through the endoplasmic reticulum/Golgi pathway and its secretion is not affected by addition of brefeldin A, a well known inhibitor of the classical secretion pathway, suggesting that it follows an unconventional pathway for secretion. Moreover, induction of autophagy by addition of rapamycin also resulted in rapid release of ACBP indicating that this protein uses components of the autophagy pathway for secretion. Following secretion, ACBP is proteolytically cleaved to the active neuropeptides by protease activity on the surface of astrocytes. Neurosteroids, such as pregnenolone sulfate, were previously shown to modulate the excitatory/inhibitory balance in brain through increased release of glutamate and decreased release of GABA. These effects of steroids in neurons will be reinforced by the release of endozepines from astrocytes shown here, and suggest an orchestrated astrocyte-neuron cross-talk that can affect a broad spectrum of behavioral functions.