Ear and hearing health in Aboriginal and Torres Strait Islander people aged 15 years and older: A scoping review.

OBJECTIVE: Review empirical research investigating the prevalence, experiences and management of hearing loss and ear disease in Aboriginal and Torres Strait Islander adults. DESIGN: Scoping review. STUDY SAMPLES: Searches of four electronic databases, Advanced Google, and key webpages identified 16,373 studies - 21 met inclusion criteria: original research relating to hearing/ear health and Aboriginal and Torres Strait Islander adults. RESULTS: Fourteen studies measured prevalence of hearing loss or middle-ear dysfunction, with a rate of hearing loss at an estimated 50% (reports ranging from 8% to 100%). Five studies reported views, attitudes, and experiences of hearing loss, with results showing hearing loss negatively impacted individual experiences in health and justice systems, and health professionals had limited understanding of the socioeconomic risk factors of middle ear disease. No articles directly reported on hearing loss management. CONCLUSIONS: There is a lack of research into the hearing health of Aboriginal and Torres Strait Islander adults, despite its critical importance in addressing health and social inequities. Given the widely varying and imprecise estimated rates of hearing loss detected, urgent action is needed to obtain accurate prevalence estimates and, in partnership with Aboriginal and Torres Strait Islander communities, identify the best methods of screening and managing hearing loss.

Aboriginal and Torres Strait Islander oral health and its impact among adults: A cross-sectional study.

BACKGROUND: Robust oral health epidemiological information for Aboriginal and Torres Strait Islander adults is scant. Set within a large urban population, this study describes self-reported oral health behaviours, status and impact assessed through computerized health checks (HC), stratified by age groups and sex, and identifies associations with dental appearance satisfaction. METHODS: This was a cross-sectional study of Aboriginal and Torres Strait Islander adults (aged ≥20 years) attending the Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care between 1 January 2014 and 31 December 2015 who had HC and provided research consent. RESULTS: There were 945 patients, 466 (49.3%) female, with an average age of 41.3 years (range, 20-82). Overall, 97.3% owned a toothbrush and 56.2% brushed two or more times/day. Despite self-reporting a significant oral health burden, only 28.8% visited a dentist within 12 months, mostly due to problems (84.3%). Surprisingly, only 28.4% reported dental appearance dissatisfaction, likely a result of community normalization whereby people are resigned to poor oral health. CONCLUSIONS: Under-utilization of dental services remains problematic for Aboriginal and Torres Strait Islander adults. To close the oral heath gap, culturally appropriate, acceptable and safe integrated primary health systems, with co-located dental services, demand consideration.

Model of care for the management of complex Type 2 diabetes managed in the community by primary care physicians with specialist support: an open controlled trial.

AIMS: To evaluate patient outcomes for a novel integrated primary/specialist model of community care for complex Type 2 diabetes mellitus management compared with outcomes for usual care at a tertiary hospital for diabetes outpatients. METHODS: This was a prospective open controlled trial performed in a primary and tertiary care setting in Australia. A total of 330 patients with Type 2 diabetes aged >18 years were allocated to an intervention (n=185) or usual care group (n=145). The intervention arm was a community-based model of care led by a general practitioner with advanced skills and an endocrinologist partnership. Usual care was provided via the hospital diabetes outpatient department. The primary end point was HbA(1c) concentration at 12 months. Secondary end points included serum lipids and blood pressure. RESULTS: The mean change in HbA1c concentration in the intervention group was -9 mmol/mol (-0.8%) at 12 months and in the usual care group it was -2 mmol/mol (-0.2%) (95% CI -5,1). The percentage of patients in the intervention group achieving the HbA(1c) target of ≤53 mmol/mol (7%) increased from 21 to 42% (P<0.001); for the usual care group there was a 1% increase to 39% of patients attaining this target (P=0.99). Patients in the intervention group experienced significant improvements in blood pressure and total cholesterol compared with those in the usual care group. The percentage of patients achieving clinical targets was greater in the intervention group for the combined target of HbA(1c) concentration, blood pressure and LDL cholesterol. CONCLUSIONS: A community-based, integrated model of complex diabetes care, delivered by general practitioners with advanced skills, produced clinical and process benefits compared with a tertiary diabetes outpatient clinic.

Research output of Australian general practice: a comparison with medicine, surgery and public health.

OBJECTIVES: To compare the productivity of Australian general practice in terms of research publications with the productivity of other medical disciplines. DESIGN: A survey of Australian general practice, medicine, surgery and public health publications carried out by manual searching of specific journals and an electronic search of the US National Library of Medicine's "PubMed" database. MAIN OUTCOME MEASURES: The number of original research publications by Australian general practitioners, physicians, surgeons and public health physicians during 1999; the relative publication rate of Australian general practice, medicine, surgery and public health over the period 1990-1999. RESULTS: Of original research articles published in 1999, GPs authored 65% (17/26) in Australian Family Physician and 3% (3/90) in the Medical Journal of Australia; physicians published 4% and 37%, respectively. The electronic search identified 54 research articles relating to Australian general practice published in 1999 in 21 different journals, only two of which were primary care journals. Over the period 1990-1999, there was a publication rate of one general practice [discipline] article per 1000 GPs in practice per year. Corresponding rates for medicine, surgery and public health were 105/1000, 61/1000 and 148/1000, respectively. CONCLUSIONS: There is considerable disparity between the level of research output of general practice and that of the disciplines of medicine, surgery and public health. If we are to have effective general practice research, we urgently need to develop research skills, a supportive infrastructure and a culture that nurtures research.