Tolerability and efficacy of sodium-glucose co-transporter-2 inhibitors in Australian Aboriginal and Torres Strait Islanders with type 2 diabetes mellitus: an observational study.

Sodium-glucose co-transporter-2 inhibitors (SGLT2i) have renal and cardiovascular benefits in addition to their glucose-lowering potential. Data on the efficacy and safety of SGLT2i in Australian Aboriginal and Torres-Strait Islanders are lacking. We conducted a single-centre retrospective study assessing the safety and effects on glycaemic control and albuminuria of SGLT2i in Aboriginal and Torres Strait Islander patients with type 2 diabetes mellitus.

Exploring self-determined solutions to service and system challenges to promote social and emotional wellbeing in Aboriginal and Torres Strait Islander people: a qualitative study.

Introduction: Many Aboriginal and Torres Strait Islander people living on Kaurna Country in northern Adelaide experience adverse health and social circumstances. The Taingiwilta Pirku Kawantila study sought to understand challenges facing Aboriginal and Torres Strait Islander communities and identify solutions for the health and social service system to promote social and emotional wellbeing. Methods: This qualitative study applied Indigenous methodologies undertaken with Aboriginal and Torres Strait Islander governance and leadership. A respected local Aboriginal person engaged with Aboriginal and Torres Strait Islander community members and service providers through semi-structured interviews and yarning circles that explored community needs and challenges, service gaps, access barriers, success stories, proposed strategies to address service and system challenges, and principles and values for service design. A content analysis identified the breadth of challenges in addition to describing key targets to empower and connect communities and optimize health and social services to strengthen individual and collective social and emotional wellbeing. Results: Eighty-three participants contributed to interviews and yarning circles including 17 Aboriginal community members, 38 Aboriginal and Torres Strait Islander service providers, and 28 non-Indigenous service providers. They expressed the need for codesigned, strengths-based, accessible and flexible services delivered by Aboriginal and Torres Strait Islander workers with lived experience employed in organisations with Aboriginal and Torres Strait Islander leadership and governance. Community hubs and cultural events in addition to one-stop-shop service centres and pre-crisis mental health, drug and alcohol and homelessness services were among many strategies identified. Conclusion: Holistic approaches to the promotion of social and emotional wellbeing are critical. Aboriginal and Torres Strait Islander people are calling for places in the community to connect and practice culture. They seek culturally safe systems that enable equitable access to and navigation of health and social services. Aboriginal and Torres Strait Islander workforce leading engagement with clients is seen to safeguard against judgement and discrimination, rebuild community trust in the service system and promote streamlined access to crucial services.

Considering difference: clinician insights into providing equal and equitable burns care for Aboriginal and Torres Strait Islander children.

OBJECTIVE: To better understand issues driving quality in burn care related to equity of outcomes and equality of provision for Aboriginal and Torres Strait Islander children. METHODS: Seventy-six interviews with team members who provide care for Aboriginal and Torres Strait Islander children in six paediatric burn units across five Australian jurisdictions were completed. Interface research methodology within a qualitative design guided data collection and analysis. RESULTS: Three themes were identified: i) Burn team members who identify the requirement to meet the specific needs of Aboriginal and Torres Strait Islander children and deliver differential care; ii) Burn team members who believe in equal care, but deliver differential care based on the specific needs of Aboriginal and Torres Strait Islander children; and iii) Burn team members who see little need for provision of differential care for Aboriginal and Torres Strait Islander children and rather, value the provision of equal care for all. CONCLUSION: Burn team members conflate equitable and equal care, which has implications for the delivery of care for Aboriginal and Torres Strait Islander children. Equitable care is needed to address disparities in post-burn outcomes, and this requires clinicians, healthcare services and relevant system structures to work coherently and intentionally to reflect these needs. Implications for public health: Changes in health policy, the embedding of Aboriginal and Torres Strait Islander liaison officers in burn care teams and systems that prioritise critical reflexive practice are fundamental to improving care.

Factors contributing to longer length of stay in Aboriginal and Torres Strait Islander children hospitalised for burn injury.

BACKGROUND: Aboriginal and Torres Strait Islander children have higher incidence, severity and hospital length of stay for their acute burn injuries than other Australian children. We examined factors contributing to longer length of stay for Aboriginal and Torres Strait Islander children with an acute burn injury. METHODS: Burns Registry of Australia and New Zealand admissions of children < 16 years of age between October 2009 and July 2018 were analysed. Descriptive statistics explored patient and injury characteristics; Cox-regression models estimated characteristics associated with longer length of stay. Knowledge Interface methodology and Indigenous research methods were used throughout. RESULTS: A total of 723 children were identified as Aboriginal and Torres Strait Islander and 6257 as other Australian. The median hospital length of stay for Aboriginal and Torres Strait Islander children (5 days [CI 5-6]) was 4 days longer than other Australian children (1 day [CI 1-2]). Remoteness, flame burns, high percentage total body surface area (%TBSA) and full thickness burns were factors associated with longer length of stay for Aboriginal and Torres Strait Islander children. Similar prognostic factors were identified for other Australian children along with Streptococcus sp. and Staphylococcus sp. infection. CONCLUSION: Remoteness, flame burns, %TBSA, and full thickness burns are prognostic factors contributing to extended hospital length of stay for all Australian children. These factors are more prevalent in Aboriginal and Torres Strait Islander children, impacting length of stay. Treatment programs, clinical guidelines, and burns policies should engage with the unique circumstances of Aboriginal and Torres Strait Islander children to mitigate inequities in health.

"Anybody can make kids; it takes a real man to look after your kids": Aboriginal men's discourse on parenting.

BACKGROUND: The realms of parenting have long belonged to females. In many cultures it has been a female who has predominantly cared for and raised children. For many Aboriginal and Torres Strait Islander male parents this has resulted in them being largely overlooked from contributing to the parenting conversation. Predictably, such a dominant discourse has led to an inadequate distribution of opportunities available and a societal perception that Aboriginal and Torres Strait Islander male parents are disinterested in and/or disengaged from their parental roles and responsibilities, however, this is far from the truth. METHODS: This study is entrenched in an Indigenist research approach which privileges Indigenous lives, Indigenous knowledges and Indigenous voices, and utilised the Research Topic Yarning method to capture participants stories. RESULTS: Four yarning groups were conducted across South Australia in Coober Pedy, Yalata, Port Lincoln and metropolitan Adelaide. In total, 46 Aboriginal men contributed their experiences and stories of their roles and responsibilities as parents to this study. Men described being a dad as a privilege, emotionally fulfilling and rewarding and although at times it can be challenging, neglecting their roles and responsibilities are not considered options. Lack of employment and therefore financial security were described as a challenge to fatherhood especially for fathers who live in remote communities. Aboriginal culture, connection to country and family were identified as critical elements and strengths for Aboriginal male parents. Furthermore, Aboriginal male parents are yearning for opportunities to participate in parenting programs including men's parenting groups. CONCLUSION: Consideration of and concern for Aboriginal and Torres Strait Islander men's involvement and experiences prior to conception, prenatal and postpartum has slowly gained momentum in recent years, yet there has been little improvement in the overall provision of appropriate parenting support services and/or programs for these men.

Use of telehealth for health care of Indigenous peoples with chronic conditions: a systematic review.

INTRODUCTION: Telehealth may be a cost effective modality in healthcare delivery, but how well used or how appropriate it is for the care of Indigenous peoples is unclear. This review examines the evidence for telehealth in facilitating chronic conditions management with Indigenous peoples. METHODS: Databases were systematically searched for qualitative or quantitative primary research studies that investigated telehealth use for chronic conditions management with Indigenous peoples worldwide. Evidence of effectiveness was by consumer health outcomes, evidence of acceptability was through consumer and user perception, and health service feasibility was evident by service impact. Data were assessed for quality and data extracted using pre-defined tools. RESULTS: Articles (n=32) examined effectiveness (n=11), critiqued telehealth from the perspectives of the client (n=10) and healthcare professionals (n=8), and examined feasibility (n=12). Studies reported Indigenous people tend to be satisfied with telehealth, but are sceptical about its cultural safety. Evidence for the effectiveness of telehealth from a western biomedical perspective was found. CONCLUSIONS: Telehealth is promising; however, a lack of robust studies in this review make tangible conclusions difficult. A better overall understanding of telehealth use with Indigenous peoples, including delivery of culturally competent health care, true consultation and cultural competency of the professionals involved, would be helpful. Telehealth may have the potential to improve health care for Indigenous people, however the modality needs to be culturally competent and the care received must be culturally safe.

Understanding burn injuries in Aboriginal and Torres Strait Islander children: protocol for a prospective cohort study.

INTRODUCTION: Although Aboriginal and Torres Strait Islander children in Australia have higher risk of burns compared with non-Aboriginal children, their access to burn care, particularly postdischarge care, is poorly understood, including the impact of care on functional outcomes. The objective of this study is to describe the burden of burns, access to care and functional outcomes in Aboriginal and Torres Strait Islander children in Australia, and develop appropriate models of care. METHODS AND ANALYSIS: All Aboriginal and Torres Strait Islander children aged under 16 years of age (and their families) presenting with a burn to a tertiary paediatric burn unit in 4 Australian States (New South Wales (NSW), Queensland, Northern Territory (NT), South Australia (SA)) will be invited to participate. Participants and carers will complete a baseline questionnaire; follow-ups will be completed at 3, 6, 12 and 24 months. Data collected will include sociodemographic information; out of pocket costs; functional outcome; and measures of pain, itch and scarring. Health-related quality of life will be measured using the PedsQL, and impact of injury using the family impact scale. Clinical data and treatment will also be recorded. Around 225 participants will be recruited allowing complete data on around 130 children. Qualitative data collected by in-depth interviews with families, healthcare providers and policymakers will explore the impact of burn injury and outcomes on family life, needs of patients and barriers to healthcare; interviews with families will be conducted by experienced Aboriginal research staff using Indigenous methodologies. Health systems mapping will describe the provision of care. ETHICS AND DISSEMINATION: The study has been approved by ethics committees in NSW, SA, NT and Queensland. Study results will be distributed to community members by study newsletters, meetings and via the website; to policymakers and clinicians via policy fora, presentations and publication in peer-reviewed journals.