Feasibility of Implementing Infant Home Visiting in a Central Australian Aboriginal Community.

The Australian Nurse-Family-Partnership Program, an adaption of the Olds' Nurse-Family-Partnership (NFP), commenced in Alice Springs in 2009 (Central Australia FPP), aiming to improve the health and social outcomes of Aboriginal mothers and infants. This study explores the feasibility of NFP implementation in a remote Australian Aboriginal community. Feasibility was defined by programme uptake by eligible women, retention in the programme, actual vs. scheduled visits and extent of programme content delivery. Programme uptake was established from pregnancy data in the patient Clinical Information System and programme referrals to December 31, 2015. Rates of withdrawal, retention and content delivery were derived from FPP data and compared with published NFP data. Modified Poisson regression was used to identify client characteristics associated with retention beyond the child's first birthday. There were 469 valid referrals (43% of eligible pregnancies) and 299 women with at least one completed home visit by December 31, 2015. Of these, 41% completed the programme to the child's second birthday and 53% beyond the child's first birthday. Dominant reasons for leaving were "moved out of service area" (35%) and "declined further participation" (35%). There was a statistically significant positive association for programme retention with later gestational age at referral (RR = 1.27, p value = 0.03). A high proportion (75%) of scheduled visits was achieved and high delivery of programme content (80%). Central Australia FPP is the first implementation of the NFP model in a remote Aboriginal community. This study found that it can be implemented successfully in this setting. Outcome evaluation is needed to test achievement of hypothesised benefits.

Aging has greater impact on anaerobic versus aerobic power in trained masters athletes.

This study measured the relative rates of change of the three human energy systems across a 30-year age range. A cross-section of highly trained masters cyclists (n = 156 males and 17 females; 35-64 years) were tested for maximal cycling performance. There were 50 (29%) track sprint cyclists and the remaining (71%) were predominantly road cycling specialists. A 10 s peak power test measured anaerobic power, a 30 s test measured anaerobic capacity, and a progressive test to volitional fatigue was used to determine peak aerobic power. Participants' exercise patterns were recorded using a physical activity recall questionnaire. Linear regression showed significant changes in anaerobic performance with aging. Peak anaerobic power (W · kg⁻¹) declined at a rate (mean ± SEE) of 8.1 ± 4.1% per decade (P < 0.0001) and anaerobic capacity (kJ · kg⁻¹) declined at 8.0 ± 3.3% per decade (P < 0.0001). Peak aerobic power [W · kg⁻¹] did not change significantly with age [-1.8 ± 1.5% per decade (P = 0.218)]. This cross-sectional study showed performance of the two anaerobic energy systems declined significantly across the age spectrum with no change in aerobic capacity.

Evaluating antimicrobial prescribing practice in Australian remote primary healthcare clinics.

BACKGROUND: Inappropriate antimicrobial prescribing contributes to the emergence of antimicrobial resistance. Gaps exist in the understanding of antimicrobial prescribing in the remote setting. We aimed to assess adherence to guidelines and appropriateness of antimicrobial prescribing in Central Australia. METHODS: A retrospective study assessing antimicrobial prescriptions in ten Aboriginal clinics (three in remote communities and seven in regional centre) using a validated evaluation tool. Antimicrobials prescribed between 1 January-31 December 2018 were randomly selected for inclusion into the study. The main outcome measures were the rates of guideline adherence and inappropriate prescribing. RESULTS: A total of 180 prescriptions were included (96.1% Aboriginal, 32.2% male). Ninety-nine (55.0%) prescriptions were written by general practitioners (GPs), 57 (31.7%) by nurses and 24 (13.3%) by others. Forty-three (25.7%) assessable prescriptions were deemed inappropriate and 75 (44.4%) did not adhere to guidelines. Prescriptions written by GPs were less likely to adhere to guidelines, particularly GPs located in remote communities. The most common reasons for inappropriate prescribing were incorrect dosage/frequency and antimicrobial not indicated. Skin and soft-tissue infection was the commonest indication, with 29 of 41 (70.7%) prescriptions deemed appropriate. Prescriptions for lower respiratory-tract infection had the lowest rate of appropriateness, with one of seven prescriptions deemed appropriate (14.3%). Antimicrobials with the lowest rate of appropriateness were ciprofloxacin, amoxicillin-clavulanate and cefalexin, at 50%, 56%, and 62%, respectively. CONCLUSION: A quarter of antimicrobial prescriptions written in select remote central Australian Aboriginal primary healthcare clinics were deemed inappropriate. The implementation of a comprehensive antimicrobial stewardship program is recommended.

Child protection outcomes of the Australian Nurse Family Partnership Program for Aboriginal infants and their mothers in Central Australia.

BACKGROUND: The Nurse Family Partnership Program developed in the USA, designed to improve mother and infant/child outcomes, has reported lower rates of child protection system involvement. The study tested the hypothesis that an adapted Nurse Family Partnership Program implemented in an Aboriginal community in Central Australia (the FPP) would improve Child Protection outcomes. METHODS: This was a retrospective and prospective cohort study drawing on linked administrative data, including birth registry, primary health care client information system, FPP program data, and child protection data. Participants were children of women eligible for the FPP program (an exposed and a control group of women, eligible but not referred) live-born between 1/3/2009 (program commencement) and 31/12/2015. Child protection data covered all reports, investigations, substantiations and out-of-home care placements from the time of the child's birth to 31/12/2016. Generalised linear modelling was used to estimate the relative risk (RR) of involvement with child protection and type of involvement (report, investigation, substantiation, out-of-home-care placement) among FPP and control children. RESULTS: FPP mothers (n = 291) were on average younger, were more likely to be first-time mothers and experiencing housing instability than control mothers (n = 563). Among younger mothers ≤20 years, FPP children had statistically significantly lower rates of involvement with child protection (ARRreport = 0.49, 95% CI: 0.29 to 0.82; ARRinvestigation = 0.34, 95% CI: 0.19 to 0.64; ARRsubstantiation = 0.45, 95% CI: 0.21 to 0.96) and experience fewer days in care (ARR = 0.10, 95% CI: 0.02 to 0.48). Among children of first-time mothers, FPP children also had statistically significantly lower rates of involvement with child protection (ARRreport = 0.50, 95% CI: 0.30 to 0.83; ARRinvestigation = 0.36, 95% CI: 0.19 to 0.67; ARRsubstantiation = 0.38, 95% CI: 0.18 to 0.80) and fewer days in care (ARR = 0.06, 95% CI: 0.01 to 0.27). CONCLUSION: Study results suggest a modified Nurse Family Partnership delivered by an Indigenous community-controlled organisation may have reduced child protection system involvement in a highly vulnerable First Nations population, especially in younger or first-time mothers. Testing these results with an RCT design is desirable.

Hypomagnesaemia and its potential impact on thiamine utilisation in patients with alcohol misuse at the Alice Springs Hospital.

INTRODUCTION AND AIMS: Alcohol rapidly reduces thiamine among alcohol-dependent individuals. Poor diet and alcohol's impact on absorption, storage, activation and excretion of thiamine are thought to be the mechanisms. Previous literature identifies magnesium as an important cofactor in thiamine utilisation, which might also be compromised in alcohol dependent patients. The aim was to describe the thiamine status and clinical profile for a sample of heavy alcohol users entering the Alice Springs Hospital in the Northern Territory of Australia and to examine the relationship between thiamine deficiency, magnesium deficiency and cognitive functioning. DESIGN AND METHODS: Cross-sectional study examining thiamine pyrophosphate (TPP) and magnesium concentrations for a sample of 62 males and 43 females (N = 105; n = 88 Aboriginal, n = 13 non-Indigenous). Cognition was assessed using the Rowland Universal Dementia Assessment Scale. RESULTS: TPP concentrations were within or above the reference range. Aboriginal patients had significantly lower TPP than non-Indigenous patients. A marginally significant difference was found between individuals with thiamine supplementation recorded within the previous 20 days compared with those without. Mean serum magnesium was in the low normal range with magnesium deficiency (i.e. <0.80 mmol L(-1)) present in 48% of those tested. Serum magnesium (but not TPP) concentrations correlated positively with cognitive test scores. DISCUSSION AND CONCLUSIONS: Despite increased exposure to risk factors for Wernicke Korsakoff Syndrome, no patient had TPP concentrations below the reference range. High patient readmission and aggressive thiamine treatment policies may explain this finding. However, low magnesium may be prevalent and could contribute to impaired thiamine utilisation.

Effects of fish oil supplementation on learning and behaviour of children from Australian Indigenous remote community schools: a randomised controlled trial.

Omega-3 fatty acids are essential for brain function. We recruited 409 children aged 3-13 years (M=8.27, SD=2.17) for a randomised controlled trial supplementing with placebo or fish oil capsules (providing 750mg docosahexaenoic plus eicosapentaenoic acids, and 60mg gamma linolenic acid/school day) for 20 school weeks (Phase 1) followed by one-way crossover to fish oil (Phase 2). Children undertook assessments of reading, spelling and non-verbal cognitive development (Draw-A-Person) at baseline, 20 and 40 weeks. Teachers completed Conners Behaviour Rating Scales (CBRS). The treatment group showed improvements in Draw-A-Person compared with the placebo during Phase 1 (p=0.029), with strongest effects in Indigenous 7-12 year olds (p=0.008). The placebo group showed significant within-group improvements after switching to treatment (p<0.001). There was no treatment effect for reading or spelling, and CBRS data were unable to be analysed. These findings may be understood in the context that sustained school attendance and nutrition interact to produce school-related achievement.