Closing the gap in Indigenous Australian cancer care: Initiatives to foster cultural safety and improve access to radiation therapy.

INTRODUCTION: Aboriginal and Torres Strait Islander peoples receive a poorer cancer prognosis compared to non-Indigenous Australians. Indigenous access to cancer care is limited by several factors, including differences in cultural understanding surrounding cancer and distrust of mainstream health institutions. It is believed that radiation therapy is being under-utilised by the Indigenous community. In response, several strategies were implemented to increase presentation and attendance by Indigenous Australians at a rural, private radiation therapy practice. METHODS: A local Indigenous health service, Traditional Owners and Elders and the clinic's Reconciliation Action Plan Working Group were consulted to implement initiatives to reduce barriers to engaging in healthcare. One of these initiatives involved community consultation to select a culturally safe, Indigenous word to name one of the clinic's linear accelerators. Indigenous patient referrals into the clinic were tracked using an oncology information system. It is expected that by implementing several culturally safe strategies, there would be an increase in utilisation of the radiation therapy service and therefore, a decrease in Indigenous cancer burden across the local region. If strategies were yielding positive outcomes, there would be scope to implement these at other sites across a broader monitored network. RESULTS: Currently, service utilisation is being monitored to determine whether initiatives have been successful. Initial data evaluation has been conducted and results are showing increased service utilisation by the Indigenous community. CONCLUSION: Work has been undertaken to implement strategies to improve cultural safety and improve access to radiation therapy for Indigenous cancer patients. Preliminary results show an increase in the number of presentations to the clinic for radiation therapy treatment.

Maternal postpartum plasma folate status and preterm birth in a high-risk US population.

OBJECTIVE: While maternal folate deficiency has been linked to poor pregnancy outcomes such as neural tube defects, anaemia and low birth weight, the relationship between folate and preterm birth (PTB) in the context of the US post-folic acid fortification era is inconclusive. We sought to explore the relationship between maternal folate status and PTB and its subtypes, i.e. spontaneous and medically indicated PTB. DESIGN: Observational study. SETTING: Boston Birth Cohort, a predominantly urban, low-income, race/ethnic minority population at a high risk for PTB.ParticipantsMother-infant dyads (n 7675) enrolled in the Boston Birth Cohort. A sub-sample (n 2313) of these dyads had maternal plasma folate samples collected 24-72 h after delivery. RESULTS: Unadjusted and adjusted logistic regressions revealed an inverse relationship between the frequency of multivitamin supplement intake and PTB. Compared with less frequent use, multivitamin supplement intake 3-5 times/week (adjusted OR (aOR) = 0·78; 95 % CI 0·64, 0·96) or >5 times/week (aOR = 0·77; 95 % CI 0·64, 0·93) throughout pregnancy was associated with reduced risk of PTB. Consistently, higher plasma folate levels (highest v. lowest quartile) were associated with lower risk of PTB (aOR = 0·74; 95 % CI 0·56, 0·97). The above associations were similar among spontaneous and medically indicated PTB. CONCLUSIONS: If confirmed by future studies, our findings raise the possibility that optimizing maternal folate levels across pregnancy may help to reduce the risk of PTB among the most vulnerable US population in the post-folic acid fortification era.