Hypertension: high prevalence and a positive association with obesity among Aboriginal and Torres Strait Islander youth in far north Queensland.

OBJECTIVE: Hypertension and other chronic disease risks are common among Aboriginal and Torres Strait Islander adults but there is little evidence regarding the epidemiology of these risk factors during adolescence. This study examines the prevalence of pre-hypertension, hypertension and other cardiovascular risk factors in Aboriginal and Torres Strait Islander people aged 15-24 years living in remote Indigenous communities in north Queensland. In so doing, it aims to better inform the approach to cardiovascular disease in this population. METHODS: This is a descriptive study that retrospectively examines health service data from a program of community screening, the Young Persons Check (YPC). Participants were 1,883 Aboriginal and Torres Strait Islander people aged 15-24 years who attended for a YPC in 11 remote communities in north Queensland between March 2009 and April 2011. RESULTS: Overall, the prevalence of pre-hypertension was 34.0%; stage I hypertension was 17.7% and stage II hypertension was 3.3%. The prevalence of elevated waist circumference was 47.6%, overweight or obesity 45.9%, elevated triglycerides 18.3%, decreased HDL 54.8% and proteinuria 24.3%. The prevalence of hypertension (stage I or II) among Torres Strait Islander males was 34.1%, Aboriginal males 26.9%, Torres Strait Islander females 12.6% and Aboriginal females 13.0%. Hypertension was associated with sex (males) (OR= 4.37, p<0.000), overweight (OR=2.46, p<0.000), obesity (OR=4.59, p<0.000) and elevated triglycerides (OR=2.38, p<0.000). CONCLUSION: Pre-hypertension, hypertension and other cardiovascular risk in this population is highly prevalent. Hypertension was particularly prevalent among male participants. The results reiterate the importance of early life experience in cardiovascular disease prevention.

Successes in sexual health communications development, programmatic implementation and evaluation in the Torres Strait region 2006 to 2012.

OBJECTIVE: To evaluate the Indigenous sexual health promotion program in the Torres Strait 2006-2012 that culminated in an education-entertainment radio drama, Kasa Por Yarn (KPY). METHODS: A mixed methods approach applied to unpublished program documents and program-derived peer-reviewed publications was utilised. RESULTS: Early initiatives established a strong partnership with Torres Strait Islander stakeholders. Significant community engagement throughout ensured a positive process. Telephone survey data (n=100, TSI, 15-24 years) found: 95% had heard of KPY and 80% listened to 2 or more episodes (reach); 86% recalled storylines/characters (recall); and 54% talked about KPY to family/friends (resonance). There was improvement in sexual health knowledge scores (p<0.00) in the 15-19-year-old Torres Strait Islander population between 2007 and 2012. The 2012 15-24-year-old population exposed to KPY had higher sexual health knowledge scores compared with those unexposed (p=0.02). CONCLUSIONS: This is an uncommon comprehensive evaluation of population-based sexual health communications strategies delivered over years in a remote Australian setting. The findings are encouraging but demonstrate that positive shifts take time and are incremental. IMPLICATIONS: In addition to clinical strategies, strategic and sustained investment in sexual health promotion expertise that leads community partnership and program development is required to reduce youth risk and prevent HIV/AIDS in remote populations.

Was infectious syphilis being misclassified in remote Australian outbreaks? Evidence that informed modification of the national case definition.

OBJECTIVE: To assess the ability of the national case definition to identify infectious syphilis during an outbreak affecting predominantly Aboriginal and Torres Strait Islander people in a remote Australian region. METHODS: A retrospective case series study of all non-congenital syphilis cases in the region notified between 1 January 2009 and 31 December 2012 was performed. The national infectious syphilis case definition was compared with an expanded case definition derived from experienced clinician assessment and the definition proposed in the Interim Guidelines for the Public Health Management of Syphilis Outbreaks in Remote Populations in Australia from the Communicable Diseases Network Australia (CDNA). RESULTS: Two hundred and forty syphilis cases were notified, of which 44 (18.3%) were symptomatic. The national case definition classified 106 (44.2%) cases as infectious, compared with 182 (75.8%) using the clinician-derived expanded case definition and 165 (68.8%) by the interim guidelines case definition. Seven confirmed and 6 probable cases were diagnosed as a result of contact tracing of probable infectious cases identified using the expanded case definition. CONCLUSIONS AND IMPLICATIONS: The national case definition for infectious syphilis applied in this remote Australian outbreak underestimated infectious cases when compared with experienced clinicians' evaluation by up to 76 cases (42%) and was inadequate to monitor the magnitude of a syphilis outbreak in such a setting. This may compromise surveillance and resource allocation decisions, and could reduce the capacity to interrupt transmission and contain an outbreak. A revised national case definition, informed by this analysis, was released by CDNA in July 2015.

Are insights from Indigenous health shaping a paradigm shift in health promotion praxis in Australia?

Health promotion really is at a cross-road. Traditionally guided by the Ottawa Charter, it has been thought of as principle-guided actions, processes and technique, as well as outcomes or results. Health promotion has been characterised by its products and some even call it theory. In Australia, public funding for health promotion has, for many years, shaped its practice into behaviour change interventions. However, governments around the country are reconsidering their investments, evidenced by ideologically motivated policy shifts and associated substantial funding cuts. Recently, themes of empowerment, community control and community agency have emerged as new directions for future health promotion praxis and reports of activism-based approaches that seek to mobilise community energies around sexual health inequity have started to appear in the literature. Noting parallel developments in the social determinants and social change discourses, this paper posits that cutting edge health promotion efforts by Indigenous communities in Australia are shaping a new approach with potentially global application.

The Torres Indigenous Hip Hop Project: evaluating the use of performing arts as a medium for sexual health promotion.

ISSUE ADDRESSED: The Torres Indigenous Hip Hop Project (the Project) was conducted in the Torres and Northern Peninsula Area of Queensland during early 2010. This paper provides a critical analysis of project outcomes and identifies criteria that may form a suitable framework for the assessment of proposals for sexual health promotion using performing arts-based approaches in Aboriginal and Torres Strait Islander settings. METHODS: A case study method was used. The first phase of analysis assessed whether project objectives were met using data collected during project planning and implementation. The second phase used these findings, augmented by interviews with key personnel, to respond to the question 'How could this be done better?'. RESULTS: The Project required significant human and organisational implementation support. The project was successful in facilitating event-specific community mobilisation. It raised awareness of sexual health disadvantage and engaged effectively with the target group. It laid important groundwork to progress school-based and community mechanisms to address regional youth disadvantage. Against these benefits are issues of opportunity cost and the need for ongoing resources to capitalise on the opportunities created. CONCLUSIONS: With substantial support and planning, such approaches can play an important role in engaging young people and bridging the gap between clinical interventions and improvements in health deriving from community-driven strategies. SO WHAT? This paper contributes to existing literature by identifying key elements of an effective approach to using performing arts in sexual health promotion in Aboriginal and Torres Strait Islander settings. It also provides guidance when consideration is being given to investment in resource-intensive health promotion initiatives.

The Young Person Check: screening for sexually transmitted infections and chronic disease risk in remote Aboriginal and Torres Strait Islander youth.

OBJECTIVE: This paper describes the implementation and selected outcomes of the Young Person Check (YPC), a high-coverage screening program in far north Queensland targeting remote youth aged 15-24 years for sexually transmissible infections (STI) and chronic disease risk. The YPC was conducted 19 times in eight discrete remote communities and one community cluster between 2009 and 2012. METHODS: Narrative description of consultation processes, YPC planning, recruitment strategies, logistics, screen design, additional costs and data management; analysis of coverage by location, age group and gender, selected STI management outcomes, and clinic-based STI testing separate from YPCs. RESULTS: A total of 3,686 episodes of care were delivered, including 3,083 to Indigenous youth aged 15-24 years. Overall coverage of the 15-24 population was 73% for females and 72% for males. Median time to treatment for chlamydia/gonorrhoea cases was 13 days and 63% of cases had at least one contact treated. Clinic-based STI testing did not decrease. CONCLUSIONS: Positive outcomes of the YPC program, including satisfactory participation, rest on a rigorous approach to planning, recruitment and implementation; provision for STI follow-up; and data management. IMPLICATIONS: Testing and treatment strategies form an important element of efforts to address endemic STI and reduce HIV risk in remote Australian populations. Complementary population testing strategies will continue to be utilised and may contribute, if coverage is satisfactory. Programs such as the YPC should be considered in settings where the conditions outlined here can be met.

Chronic hepatitis B--care delivery and patient knowledge in the Torres Strait region of Australia.

BACKGROUND: Chronic hepatitis B (CHB) disproportionately affects Indigenous Australians. This article reports the findings of two studies in the Torres Strait and Northern Peninsula area (T&NPA) of Queensland in Australia. The aim of the first study was to assess CHB care delivery, the second assessed CHB patient knowledge about the condition. METHODS: A pathology database search (1997-2009) identified a cohort of potential CHB patients in T&NPA. A file audit assessed care delivery for a random sample of 83 CHB patients. A survey assessed knowledge of 42 CHB patients. RESULTS: A total of 365 hepatitis B positive patients were identified. There are gaps in patient review, monitoring, follow up and specialist referral. Patients had limited knowledge about CHB and measures to reduce its health impact. DISCUSSION: Chronic hepatitis B affects a substantial number of Indigenous adults in the T&NPA. There is limited adherence to clinical guidelines. Improved uptake of clinical guidelines adapted for remote areas, incorporation of CHB into systematic chronic disease care, and culturally appropriate patient education resources and programs are needed.

Enhanced surveillance for gonorrhoea in two diverse settings in Queensland in the 2000s: comparative epidemiology and selected management outcomes.

Gonorrhoea is an important sexually transmitted notifiable condition. This paper describes findings from two gonorrhoea enhanced surveillance programs operating during the 2000s in Queensland: one in the remote Torres and Northern Peninsula Area (T&NPA); the other in an urban region. The overall response rate in the T&NPA (2006-2011) was 82% (723 of 879), and in Brisbane Southside and West Moreton (BSWM) (2003-2011), it was 62% (1,494 of 2,401 notifications). In the T&NPA, cases were young (80% <25 years), Indigenous (97%) and 44% were male. In the BSWM, cases were predominantly male (76%), non-Indigenous (92%) and 42% were aged less than 25 years. Co-infection with chlamydia was found in 54% of males and 60% of females in the Torres, and in 18% of males and 35% of females in the BSWM. In the BSWM 35% of the men without a syphilis test recorded had reported sexual contact with men; similarly 34% of the men without an HIV test recorded had reported sexual contact with men. Compliance with recommended treatment (ceftriaxone) was greater than 90% in all years except 2008 (84%) in the T&NPA. Treatment compliance increased significantly, from 40% in 2003 to 84.4% in 2011 (P<0.0001) in the BSWM cohort. The proportion of contacts with a documented treatment date increased significantly in the T&NPA from 56% in 2009 to 76% in 2011 (P=0.019), after a system for follow-up with the clinician became routine. Gonorrhoea epidemiology and management challenges vary across Queensland populations. Enhanced surveillance allows public health authorities to monitor epidemiology and reminds clinicians to prioritise effective sexually transmitted infection treatment for their clients.

Youth and Relationship Networks (YARNS): mobilising communities for sexual health.

ISSUE ADDRESSED: Community participation is vital if sexual health disadvantage among Aboriginal and Torres Strait Islander young people is to be addressed, yet there is a paucity of literature examining this issue. METHODS: The development, nature and impact of a community participation strategy for sexual health, implemented in two North Queensland sites, provided the opportunity for a systematic study, using qualitative and grounded theory analytic methods, of the factors that enable and constrain community participation in this context. A total of 30 people participated, in individual interviews and focus groups. RESULTS: The community participation strategy was fundamental to the development of culturally and community congruent sexual health initiatives. There were also signs of a changing discourse in community around sexual health. Factors that enabled effective community participation involved individual attributes, structured group processes, organisational support, empowering external relationships, a culturally sensitive strategy and enhanced health and wellbeing. CONCLUSION: The model developed here identifies factors that enable community participation and mobilisation, thus providing a valuable tool for health practitioners seeking to plan and evaluate strategies that address entrenched disadvantage in Aboriginal and Torres Strait Islander populations.

Hip hopping the gap--performing arts approaches to sexual health disadvantage in young people in remote settings.

OBJECTIVE: Closing the gap in Indigenous health and wellbeing in remote settings in the Torres Strait and Northern Peninsula Area of Far North Queensland (FNQ) includes addressing a well-documented sexual health disadvantage among young people. Community mobilization around the underlying risk factors influencing sexual health is required. METHOD: Performing-arts-based workshops were conducted in schools and after-school venues in four remote Aboriginal and Torres Strait islander locations in FNQ in early 2010, to initiate consciousness-raising around the real dimensions of youth sexual health risk. Specific objectives included strengthening operational partnerships at school-level and developing ongoing consultative processes in each location for sexual health reference group development. RESULTS: Results include a significantly strengthened productive partnership with primary and high schools in each location and sixteen production-ready hip hop songs exploring a range of physical, emotional and sexual health themes authored by the students and recorded on site. Additional outcomes included the willingness of community councils and civil society organizations to support local sexual health reference group activity. CONCLUSIONS: This initiative, the Indigenous Hip Hop Project, although accompanied by opportunity costs including alternative, more core business uses of staff time and program budget, has demonstrated the power of tapping the creative energy of young people at risk and the potential for mobilizing communities to activism around sexual health disadvantage.

Epidemiology of syphilis in Australia: moving toward elimination of infectious syphilis from remote Aboriginal and Torres Strait Islander communities?

OBJECTIVE: To describe the epidemiology of infectious syphilis among Aboriginal and Torres Strait Islander (Indigenous) people in Australia. DESIGN AND SETTING: We assessed trends in national infectious syphilis notification rates from 2005 to 2009 using Poisson regression, with a focus on geographic and demographic differences by Indigenous status. We compared Indigenous and non-Indigenous rate ratios over the study period and summarised the annual changes (summary rate ratio). MAIN OUTCOME MEASURES: Crude notification rates and summary rate ratios by Indigenous status, jurisdiction, sex, age group and area of residence. RESULTS: From 2005 to 2009, in the Indigenous population, there was a substantial decline in the notification rate for infectious syphilis nationally; as well as in the following subgroups: females, 15-29 year olds, and people living in outer regional and remote areas in the Northern Territory and Queensland. In contrast, there was a significant (P < 0.001) upward trend in the notification rate in the non-Indigenous population nationally; as well as in males, in people aged 20 years and over, and in residents of metropolitan and regional areas, New South Wales, Queensland, South Australia, Victoria and Western Australia. The highest summary rate ratios were seen in remote/very remote areas (86.33; 95% CI, 57.45-129.74), in 15-19 year olds (64.65; 95% CI, 51.12-81.78), in females (24.59; 95% CI, 19.73-30.65), and in Western Australia (23.89; 95% CI, 19.82-28.82). CONCLUSION: These data demonstrate that Australia has two distinct patterns of infectious syphilis: a substantially declining occurrence in Indigenous remote communities and an increasing incidence in males residing in urban and regional areas. Given the decline in notification rates in Indigenous remote communities, now might be the right time to move toward eliminating infectious syphilis from Indigenous communities.

Should we change the focus of health promotion in sexual health clinics?

In a response to the recent article by Rudiger Pitroff and Elizabeth Goodburn on changing the focus of health promotion in sexual health clinics, Crouch and Fagan draw attention to the confusion among practitioners between brief interventions in clinics (health education) and the actual nature and scope of sexual health promotion. The response refocuses attention on the Ottawa Charter for Health Promotion and on the social determinants of sexual health inequity as appropriate design drivers of a pilot initiative proposed by Pitroff and Goodburn to re-orient sexual health service provision around the real needs of its clients.

Knowledge, attitudes and behaviours in relation to safe sex, sexually transmitted infections (STI) and HIV/AIDS among remote living north Queensland youth.

OBJECTIVE: To assess the knowledge, attitudes and behaviours of remote Aboriginal and Torres Strait Islander youth living in far north Queensland in relation to sexually transmitted infections, HIV/AIDS and safe sex. METHODS: Community consultation followed by local recruitment of a sample of young people who, in a facilitated same gender focus group setting, completed a questionnaire followed by open discussion of the issues in a range of remote locations during 2007. RESULTS: The remote living Indigenous youth demonstrated lower levels of knowledge in relation to STI and HIV and higher levels of partner change than was demonstrated in the 2002 national secondary school survey. Despite the high rates of bacterial STI in the region, there was an extremely low level of awareness of personal risk in relation to STI and HIV. CONCLUSION: There is an urgent need to strengthen school-based sex education and to develop innovative approaches to sexual health promotion in addition to improving clinical sexual health service provision.

Structure of the N-terminal calcium sensor domain of centrin reveals the biochemical basis for domain-specific function.

Centrin is an essential component of microtubule-organizing centers in organisms ranging from algae and yeast to humans. It is an EF-hand calcium-binding protein with homology to calmodulin but distinct calcium binding properties. In a previously proposed model, the C-terminal domain of centrin serves as a constitutive anchor to target proteins, and the N-terminal domain serves as the sensor of calcium signals. The three-dimensional structure of the N-terminal domain of Chlamydomonas rheinhardtii centrin has been determined in the presence of calcium by solution NMR spectroscopy. The domain is found to occupy an open conformation typical of EF-hand calcium sensors. Comparison of the N- and C-terminal domains of centrin reveals a structural and biochemical basis for the domain specificity of interactions with its cellular targets and the distinct nature of centrin relative to other EF-hand proteins. An NMR titration of the centrin N-terminal domain with a fragment of the known centrin target Sfi1 reveals binding of the peptide to a discrete site on the protein, which supports the proposal that the N-terminal domain serves as a calcium sensor in centrin.

Participation in cervical cancer screening by women in rural and remote Aboriginal and Torres Strait Islander communities in Queensland.

OBJECTIVE: To investigate the extent of participation in cervical cancer screening among women who live in discrete rural and remote Indigenous communities in Queensland. DESIGN: Descriptive analysis of data from the Queensland Health Pap Smear Registry for the period March 1999 to February 2001. SUBJECTS: Women aged 20-69 years who had given their address of usual residence as one of 13 discrete rural and remote Indigenous communities in Queensland. MAIN OUTCOME MEASURES: Proportion of women who participated in cervical screening over a two-year period ("biennial participation percentage") and variation in participation across the 13 communities. RESULTS: Overall, the biennial participation percentage in the Indigenous communities was 41.1%. This was 30% lower (risk ratio, 0.70; 95% CI, 0.67-0.72) than that for the rest of Queensland. There was statistically significant variation among communities, with biennial participation percentage ranging from 19.9% to 63.5%. CONCLUSIONS: The variation in participation across the communities suggests that the problem of low participation among Indigenous women is not intractable. Achieving participation rates similar to the highest rates found in our study would be of major benefit to Indigenous women.

Structural independence of the two EF-hand domains of caltractin.

Caltractin (centrin) is a member of the calmodulin subfamily of EF-hand Ca2+-binding proteins that is an essential component of microtubule-organizing centers in many organisms ranging from yeast and algae to humans. The protein contains two homologous EF-hand Ca2+-binding domains linked by a flexible tether; each domain is capable of binding two Ca2+ ions. In an effort to search for domain-specific functional properties of caltractin, the two isolated domains were subcloned and expressed in Escherichia coli. Ca2+ binding affinities and the Ca2+ dependence of biophysical properties of the isolated domains were monitored by UV, CD, and NMR spectroscopy. Comparisons to the corresponding results for the intact protein showed that the two domains function independently of each other in these assays. Titration of a peptide fragment from the yeast Kar1p protein to the isolated domains and intact caltractin shows that the two domains interact in a Ca2+-dependent manner, with the C-terminal domain binding much more strongly than the N-terminal domain. Measurements of the macroscopic Ca2+ binding constants show that only the N-terminal domain has sufficient apparent Ca2+ affinity in vitro (1-10 microm) to be classified as a traditional calcium sensor in signal transduction pathways. However, investigation of the microscopic Ca2+ binding events in the C-terminal domain by NMR spectroscopy revealed that the observed macroscopic binding constant likely results from binding to two sites with very different affinities, one in the micromolar range and the other in the millimolar range. Thus, the C-terminal domain appears to also be capable of sensing Ca2+ signals but is activated by the binding of a single ion.

The EF-hand domain: a globally cooperative structural unit.

EF-hand Ca(2+)-binding proteins participate in both modulation of Ca(2+) signals and direct transduction of the ionic signal into downstream biochemical events. The range of biochemical functions of these proteins is correlated with differences in the way in which they respond to the binding of Ca(2+). The EF-hand domains of calbindin D(9k) and calmodulin are homologous, yet they respond to the binding of calcium ions in a drastically different manner. A series of comparative analyses of their structures enabled the development of hypotheses about which residues in these proteins control the calcium-induced changes in conformation. To test our understanding of the relationship between protein sequence and structure, we specifically designed the F36G mutation of the EF-hand protein calbindin D(9k) to alter the packing of helices I and II in the apoprotein. The three-dimensional structure of apo F36G was determined in solution by nuclear magnetic resonance spectroscopy and showed that the design was successful. Surprisingly, significant structural perturbations also were found to extend far from the site of mutation. The observation of such long-range effects provides clear evidence that four-helix EF-hand domains should be treated as a single globally cooperative unit. A hypothetical mechanism for how the long-range effects are transmitted is described. Our results support the concept of energetic and structural coupling of the key residues that are crucial for a protein's fold and function.