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The Chronicle – Publication of the Chronic Diseases NetworkVolume 25, Issue 3, August 2013

IN THIS ISSUE ….PREVENTION THROUGH LIFESTYLE

CONTENTS

Cover Page:Hello to all the Network Members

Themed Articles:Protect the children – prevention of kidney disease through lifestyleNew Australia Dietary Guidelines

General Articles:Australian Indigenous ClinicalInfoNetFrom the desk of the CMO

Tobacco Articles:Report describes progress being made in reducing NT smokingStarting to smoke: Experiences of Indigenous youth

Regional Profile:Daly River Region

The Chronic Diseases Network

The Chronic Diseases Network was set up in 1997 in response to the rising impact of chronic conditions in the NT. The Network is made up of organisations and individuals who have an interest in chronic conditions, with Steering Committee membership from: Aboriginal Medical Services of the NT Arthritis & Osteoporosis Foundation of the NT Asthma Foundation of the NTCancer Council of the NTHealthy Living NTHeart Foundation – NT DivisionMedicare Local NTMenzies School of Health ResearchNT DoH Allied Health/Environmental HealthNT DoH Community HealthNT DoH Health PromotionNT DoH Nutrition and Physical Activity NT DoH Chronic Conditions Strategy Unit

THE CHRONICLE - CDN EDITORIAL COMMITTEE CHRONIC DISEASES NETWORK T: 08 8985 8174 / F: 08 8985 8177 E: chronicdiseasesnetwork@nt.gov.auwww.chronicdiseasesnetwork.nt.gov.au

Contributions are consistent with the aims of the Chronic Diseases Network and are intended to: Inform and stimulate thought and action Encourage discussion and comment Promote communication, collaboration, coordination and collective memoryContributions appearing in The Chronicle do not necessarily reflect the views of the editor or DoH

Hello to all the Network MembersBreanna Marie Ellis, CDN CoordinatorChronic Conditions Strategy Unit, NT Department of Health

Recently I commenced as the Chronic Diseases Network (CDN) Coordinator. My first day was actually attending the 2013 Conference, so it was a wonderful chance to meet many of you and see what great work is being done around chronic disease prevention and management.

I came into the position with a background as an Occupational Therapist having worked in both clinical and strategic positions over the last 12 years. I have worked across Australia ranging from western Victoria, outback NSW, Northern Queensland, metropolitan Melbourne and Darwin. Much of my career has been around working with people with chronic disease so I understand the challenges that this can present but I am also buoyed by the great work being completed by members of the network.

Planning is now well underway for the 2014 Conference which will be held in conjunction with Northern Territory Medicare Local and the Australian Health Promotion Association. The theme for the conference is “Equity @ the Centre: Action on Social Determinants of Health” and will be held at the Alice Springs Convention Centre on the 4th and 5th of September. We have already secured some fantastic Keynote Speakers and I am looking forward to receiving some inspiring and creative abstracts.

I look forward to meeting many of you over the coming months and please don’t hesitate to contact me on 08 8985 8173 if you have any issues that may be relevant to CDN.

Protect the children – prevention of kidney disease through lifestyle Dorothy Brown, Renal Services Development OfficerSystem Planning and Development, NT Department of Health

Lifestyle can play a huge role in the prevention of kidney disease and its progression.

It is time for families to fight against kidney disease and to help control the problem it causes for so many people.

A healthy kidney has approximately 1.2 million kidney cells which is more than enough to last a lifetime. It is normal for kidney cells to start dying off as we grow older and so long as nothing bad happens to cause a lot of damage to the kidney cells along the way, by the time a person lives to the age of 80, they will still have more than half of their kidney cells left. This is enough to keep that person healthy – that’s why in a kidney transplant, there only needs to be one kidney transplanted.

Kidney cells can’t fix themselves. When kidney cells die, you can’t get them back. When a person only has 10% of their kidney cells that are working properly, they need to start thinking about having dialysis or kidney transplant to stay alive.

There are many lifestyle changes a person can make, both to prevent renal disease and to act as “speed bumps” to slow down the damage to kidney cells, but change does not come easily when you are an adult.

Parents can make a big difference in preventing kidney disease. Children need to be protected against kidney disease from an early age. This is the best chance of winning the fight against kidney disease.

Here is a list of some very important ways parents can help protect their children’s kidneys and to help fight against kidney disease.

Give babies the best chance in life. When mums are pregnant, it is important to eat good healthy food and not drink alcohol or smoke so that the baby will be born strong with normal sized healthy kidneys. Low birth weight babies have a much higher chance of ending up with chronic kidney disease.1

Cook healthy meals for children instead of letting them eat takeaways that make them fat. Obesity increases the chance of getting diabetes and high blood pressure.

Encourage children to drink water instead of soft drinks. Small children may not be able to get water for themselves. Make sure that toddlers are given enough water to drink. Kidneys need water to stay healthy.

Encourage children to play sports, ride bikes, swim or go for walks. This will help them to keep fit, keep them happy, keep their heart strong and also help to stop them getting fat. This is a “fun” way of helping them to avoid getting diabetes and high blood pressure and will also help to protect their kidneys.

Encourage children to have a shower every day to keep their skin healthy. If children have scabies or skin sores, take them to the clinic and get them treated. The bacteria that cause skin sores can result in causing damage to kidney cells.

Encourage children to clean their teeth and have check-ups with the dentist to avoid teeth and gum disease. Infections of the teeth and gums can cause heart and kidney damage.

Be good role models. Children watch what adults do and copy them. Parents can care for and enjoy their children and grandchildren better if they look after their own health. It is important to have blood pressure and diabetes check–ups. If you don't know you have a problem how can you control it? If diabetes and high blood pressure is not kept under control, this will damage the kidneys. It is usually necessary to take medication to keep diabetes and high blood pressure under good control. Try very hard to remember to take the medication and protect your kidneys from damage. The main cause of kidney disease in the Northern Territory is diabetes and high blood pressure that has not been under good control.

This last one is very important – tell the children about kidney disease.

It is very important for parents and elders to have the true story about how to prevent kidney disease and to pass on this knowledge to the children. Children cannot see when their kidneys are getting damaged like they can see a broken arm or a cut on their hand. They won’t know unless someone tells them. Kidney disease creeps up silently, inside them until so many kidney cells are damaged that there are not enough kidney cells left to do their job properly. This damage can be prevented.

Kidney disease is a big problem in the Northern Territory. It does not have to be like this. A lot of money is spent to treat kidney disease and that is good, but it is much better to prevent kidney disease happening in the first place. Parents and elders can help prevent kidney disease in the next generation by encouraging healthy lifestyle changes in the children today.

Reference:

1. Sarah L. White et al. Is Low Birth Weight an Antecedent of CKD in Later Life? A Systematic Review of Observational Studies, American Journal of Kidney Disease, Vol 54, Issue 2, August 2009, p48-261

Australian Indigenous HealthInfoNet: Prevention through Lifestyle – Internet-based knowledge for Physical ActivityCaitlin Gray, Research OfficerAustralian Indigenous HealthInfoNet

The Australian Indigenous HealthInfoNet supports the health workforce to achieve best practice by offering a comprehensive, free knowledge base in the area of modifiable risk factors, including physical activity and chronic health conditions that can be prevented through lifestyle.

There are two concepts that underpin the HealthInfoNet’s work. The first is evidence-based decision making, whereby relevant research and other information is collated and made available to inform the work of practitioners, policy-makers and others. The second is knowledge transfer, which involves

making these research findings available in a way that has immediate, practical utility. Implementation of these two concepts involves synthesis, exchange, and ethical application of knowledge through ongoing interaction between all stakeholders involved in the prevention of chronic health conditions among Indigenous Australians.

The HealthInfoNet web resource is suitable for use by workers seeking to support and encourage Indigenous Australians in the prevention of chronic health conditions through lifestyle choices, including modifiable risk factors such as physical activity. The HealthInfoNet recognises the link between modifiable risk factors and the prevention of chronic health conditions. In an attempt to address the significant disparity between Indigenous Australians and other Australians with chronic health conditions, the HealthInfoNet contains extensive information and resources for the workforce on the following areas:

physical activity substance use immunisation nutrition overweight and obesity

The HealthInfoNet has individual topic areas for each of these risk factors. These areas contain information on publications, organisations, programs and projects, and health promotion and practice resources that aim to assist the workforce in preventing chronic health conditions among Indigenous Australians.

Physical activity is recognised as a significant protective factor for Indigenous Australians in the prevention of chronic health conditions. The Australian Indigenous HealthInfoNet’s physical activity resource comprises over 300 relevant publications specific to physical activity among Indigenous Australians. Further details about organisations, programs and projects that have been undertaken in the area, and health promotion resources are also provided. The section contains other information that the workforce is likely to find useful, such as job opportunities and training. It is designed to inform and improve health services for Indigenous Australians at risk of developing chronic health conditions. There is also an online yarning place dedicated to the area of physical activity for members to share information and keep connected on matters of prevention through lifestyle.

A Review of physical activity among Indigenous Australians is due to be published later this year, it will contain information on physical activity levels among Indigenous people, the impact of low levels of physical activity on chronic health conditions, and other health considerations. The review also summarises different forms of participation, and the barriers to participation for Indigenous people. Importantly, the review also includes information on physical activity policies and strategies, and considers how culturally appropriate interventions and health promotion could lead to improvements in physical activity levels and subsequently the overall health of Indigenous people.

The review is an example of the HealthInfoNet’s work in the area of translational research, and was prepared by the Australian Indigenous HealthInfoNet as a part of its efforts to contribute to ‘closing the gap’ in health between Indigenous people and other Australians by making relevant, high quality knowledge and information easily accessible to policy makers, health service providers, program managers, clinicians, researchers and the general community.

The Australian Indigenous HealthInfoNet can be accessed at http://www.healthinfonet.ecu.edu.au

New Australian Dietary GuidelinesTamie Needham, Program Development OfficerNutrition and Physical Activity Strategy Unit, NT Department of Health

In February 2013, the National Health and Medical Research Council (NHMRC) released revised Australian Dietary Guidelines (ADGs) and Infant Feeding Guidelines (IFGs). Based on the latest scientific evidence, they describe the best approach to eating for a long and healthy life. Full copies of the Guidelines are available at www.eatforhealth.gov.au, as are companion resources including posters, brochures and magnets.

The key messages of the revised ADGs are very similar to the previous guidelines but have more emphasis on reducing consumption of saturated fat, and foods with added salt and sugar.

Long day care menu planner

In 2011, the NT Department of Health developed a long day care menu planner to support child care services offering food to children in their care. The resource outlines the number of serves required of each of the five food groups for children to receive 50% of their Recommended Daily Intake (RDI) of energy and nutrients. It also provides a checklist for kitchen staff to assess whether their menus will provide sufficient food for children across the day. The planner has just been updated to reflect the new dietary guidelines.

For more information, please contact Tamie Needham: tamie.needham@nt.gov.au

Eat Better, Move More 

Eat Better, Move More (EBMM) is a resource kit that contains education and information sessions that teach basic nutrition and physical activity concepts to help promote a healthy lifestyle and the prevention of chronic disease. EBMM aims to:

• increase understanding and awareness of a healthy lifestyle and the role of nutrition and physical activity

• explore barriers to a healthy lifestyle and to build the capacity of individuals and communities to overcome these

• facilitate the development of personal skills that promote a healthy lifestyle and reduce the risk factors of chronic disease

• facilitate and strengthen community action that leads to the promotion of a healthy lifestyle

The NT Department of Health developed the resource from the original concept of Queensland Health’s “Living Strong”, a Healthy Lifestyle Program. Living Strong was formerly called the “Healthy Weight Program”.

Modules and activities in the kit can be delivered independent of each other or sessions can be delivered as part of an ongoing program. There are 5 Modules:

1. Why do people get too big?2. Move more3. Healthy eating everyday4. Buying better food5. Healthy cooking

It is designed to be delivered by Nutritionists, Aboriginal Health Practitioners, Community Health Promotion Workers, nurses, doctors or other members of the community who see a need for education regarding healthy lifestyle messages and does not assume any prior nutrition knowledge.

The materials have been frequently evaluated and a major revision was undertaken in 2012 to incorporate feedback and suggestions made as part of the evaluation process. Another important aspect of the resource is the support provided by public health nutritionists to those who have been trained to use the materials.

For more information, please contact Tamie Needham: tamie.needham@nt.gov.au

Shape up Australia

On February 19, 2013, the Australian National Preventive Health Agency (ANPHA) launched Shape Up Australia. This is a new overweight and obesity prevention initiative to coordinate and implement a national approach to social marketing for preventive health programs. It is intended to guide consumers towards credible, evidence-based obesity prevention and healthy lifestyle information, services and programs by branding them with the Shape Up Australia logo.

The first branded activity to be launched was the Eat for Health cookbook, produced by ANPHA in collaboration with the Australian Women’s Weekly to support and promote use of the Australian Dietary Guidelines.

From April 2013, ANPHA will explore branding opportunities with selected stakeholders, including state, territory and local governments, public health non-government organisations (NGOs) and primary health care professionals (through the Medicare Locals network). Visit www.shapeup.gov.au for more information, including fact sheets and tools to help individuals ‘shape up’!

Good living with dogsDr Jan Allen BVSc MEnvMan, Program ManagerAnimal Management in Rural and Remote Indigenous Communities (AMRRIC)

Many people live closely with their dogs in Indigenous communities. Dogs are still used for hunting and important as companions and protectors – mostly for older people and children. They are often inside houses and on cold desert nights share beds with their owners and provide warmth on or even under the blankets.

The new Housing for Health Guide (available at: http://www.housingforhealth.com/) states:Dogs can carry and transmit bacteria and parasites, which may cause the following conditions in children and adults: skin infections, diarrhoeal disease such as Giardia, which is a common cause of chronic diarrhoea in young children and chronic gut parasite infection (http://www.housingforhealth.com/the-guide/health-housing/reducing-the-negative-effects-of-animals-insects-and-vermin/)

Dog health programs in remote communities enable these lifestyle choices and stop them from having detrimental effects on human health. A group of elderly women artists living on the edge of a remote community choose to have all the services offered by the program for their mob of dogs. This means their dogs are all desexed and regularly treated with an antiparasitic. The drug treats internal and external parasites – mange, lice, intestinal nematodes, heartworm and ticks.

These women have chosen to have a finite number of dogs - no more puppies. Their dogs are healthier, calmer, will put on weight, will stay at home more, fight less and have healthier skin.

These women have made choices to contribute to the lifestyle of the whole community so that their community is quieter – especially at night, safer - with less roaming dogs and packs of dogs, less collateral damage - dog bites, less faecal contamination (particularly from pups in houses) and less itchy skin predominantly in children.

Simple pruritis in humans can lead to a break in the skin from scratching, opening the way for Streptococcal infections. Dogs can act as a reservoir of constant transient parasitic skin infections in people if the aetiological agent remains untreated, so too remains the potential for repeated infections with possible progression to serious complications such as rheumatic fever, which can manifest as heart or kidney disease – some of the biggest killers of Indigenous Australians.

Dogs and cats as sources of pruritic agents should not be underestimated – particularly when in close (often overcrowded) living conditions with humans. Potential zoonoses from these companion animals that can cause pruritis in humans include Ringworm (Microsporum canis, Trichophyton mentagrophytes), lice (Trichodectus canus, linognathus piliferus setosus), fleas (Ctenocephalides felis ), ticks (Rhipicephalus sanguineus), mange (Sarcoptes scabiei) and hookworm (Ancylostoma caninum). Skin sore aetiology is illustrated in Diagram 1 below.

If these conditions are not treated on dogs and cats even when the parasite does not carry out its full life cycle on the animal host, repeated exposure will cause a continuing pruritis.

An extract, from the AMRRIC Fact Sheet-Scabies (http://www.amrric.org/sites/default/files/Zoonoses_scabies_fact_sheet.pdf)

Canine scabies mite (Sarcoptes scabiei) causes Transient Scabies in humans - an allergic skin reaction with vesicles (blisters), itchiness, and even pustules or skin sores if infected (for e.g. with Streptococci). It looks the same as human scabies.Transient Scabies can last for hours or several days. The rash is usually worse

on areas of skin that were in contact with the dog.The rash causes people to scratch, breaking the skin and opening the skin surface to infection by bacteria such as Staphylococcus and Streptococcus. Streptococcus pyogenes Group A is the main causative agent for Rheumatic heart disease and Post-streptococcal acute glomerulonephritis (autoimmune kidney disease).The itchiness happens every time the person touches an infected dog or bedding. The rash from Transient Scabies will disappear spontaneously in most humans when the dog and environment is successfully treated.

A dog with scabies will cause transient scabies in 25% of the humans in contact with it (Speare, R 2006).

How many people do you see jogging or riding a bike in remote communities or children choosing not to pass the house with the cheeky dogs and going the long way to school?

Taking the lifestyle choice to have dogs desexed reduces the hunger-fuelled roaming dogs (no starving, lactating or pregnant dogs, desexed dogs put on weight eating little) and the hormone-fuelled roaming and fighting of entire male dogs and dogs on heat. It will also ultimately reduce the number of dogs once the population of desexed animals reaches the figure of 80% natural attrition will kick in and dog numbers will reduce to the point where people have the number of dogs that they choose.

References:

2006, Scabies in Dogs and Humans, Dr Rick Speare, James Cook University, AMRRIC Dog People Conference 2006 Available at: http://www.amrric.org/resources/view/151

2010 Dog Health in Indigenous Communities - An Environmental Health Practitioners’ Guide Samantha Phelan. Available at: http://www.amrric.org/resources/view/243

For more information please contact Dr Jan Allen, AMRRIC Program Manager on 08 89481768 / 0438485336 or email: janallen@amrric.org

Skin sore aetiology is illustrated in Diagram 1 (Phelan,S 2010 Dog Health Programs in Indigenous Communities).

“Thousands view Wurli-Wurlinjang Health Service Health Promotional Music Videos”Sophie Gribble, Health Promotion CoordinatorWurli Wurlinjang Health Service

Over two weeks in March 2013, staff from Wurli Wurlinjang Health Service in Katherine, NT worked with Indigenous Hip Hop Projects (IHHP) and community members to create two health promotion music videos in the Katherine region.

IHHP are a team of talented artists working in hip hop, media, entertainment, and performing arts. IHHP have worked extensively in Aboriginal communities around Australia since 2004, and celebrate the fusion of traditional Indigenous culture and hip hop. They facilitate workshops that provide performance skills, leading up to events with performance, community strengthening, and community educational and health outcomes.

While working in the Katherine region, IHHP were guided in the right direction by Wurli Board Members and community leaders, who played a central role in developing the message and tone that is unique to each community and group of people. This project was part of the Health Promotion program at Wurli Wurlinjang Health Service.

The long-term goal of health promotion is to make a positive impact on the healthy behaviours of individuals, their families and the wider community.

A high level of community engagement was achieved throughout all aspects of this project. Ninety five out of 110 people in Rockhole community were engaged in the process of the Health Promotional music video. This involved people aged from 0-82 years of age.

Twenty nine of thirty members of StrongBala Men’s Health Program in Katherine were engaged in the process of the health promotional music video. Cultural safety, appropriateness and best practice were crucial factors in all aspects of this program.

In the previous month, the videos have been viewed more than 14,500 times.

“These wonderful videos will boost local Indigenous education and health outcomes. They demonstrate a high level of community engagement and participation, and that’s the key to their success,” said newly-appointed Wurli CEO Marion Scrymgour.

ABC TV 7.30 Report and National ABC news covered the project. A story on the making of the health promotional music videos was made after ABC TV heard about the project.

The continuation of this particular project will be in the form of DVD production. This health promotion DVD will include design elements by community members, the two music videos, photos of the making of the project, and the ABC 7.30 Report story. It will allow for the messages to be disseminated in the long term at the community level. This DVD will be disseminated to everyone who was involved in the project as well as other organisations across the NT.

The music videos will also be played at large community festivals including the Barunga Festival, Katherine Youth Week Battle of the Bands night, the Katherine Fringe Festival, and the Katherine Festival.

The collaboration also continues in the form of photography and health promotional poster development. This will involve community members matching lyrics to appropriate photos taken during production. These will then be created into posters for Wurli’s five clinic buildings and future health promotion projects.

The songs will also be played on NT-wide radio and national radio stations.

The Health promotional music videos are also being used by Wurli’s Health Promotion Coordinator Sophie Gribble, in schools, social media outlets, and with other community groups and organisations to further disseminate the message.

“We are very happy and proud to have made the video and loved that it was being seen by people all over the NT. We are just joining in together showing that we can do it with our own feelings, ideas and expressions. Less people go drinking now, everybody just goes fishing now and living a healthy way”. Noelene Andrews, Community Leader of Rockhole Community.

For more information, please contact:Sophie Gribble, Health Promotion CoordinatorWurli Wurlinjang Health Service: Gudbinji Clinic6 Kintore StreetPO BOX 896, Katherine, NT 0851P: (08) 8972 9157 or 0419965035

UNICEF and SONY photo workshop promotes rights with Darwin Indigenous youthAnnette Mageean, Coordinator Alcohol and Other Drugs Indigenous Communities Project (funded by Department of Health and Ageing)Amity Community Services Inc.

Indigenous children from Darwin have during April, been handed high-tech Sony cameras and instructed in documenting their lives thanks to a photography workshop hosted by UNICEF Australia, Amity Community Services Inc. and Sony Corporation.

EYE SEE worked with about 20 children and young people from Darwin communities, Milgarri (Knuckey’s Lagoon), Gurdorrka (Palmerston Indigenous Village) and Bagot, to help them create digital images of the world around them and social issues affecting them.

The aim of the EYE SEE project is to support human rights and help children develop the ability to express their feelings through a camera lens and broadcast their discovery to the world.

The project was run by acclaimed UNICEF photographer Giacomo Pirozzi who has worked worldwide to document UNICEF’s work to protect the rights of children. Giacomo designed the photography workshops for children to use photography to share their ideas and views.

In collaboration with Amity Community Services Inc, based in Darwin, and Sony Corporation, Pirozzi supported the workshop participants in creating images of their life to share with the wider world, namely an exhibition to be hosted for the nation’s political leaders in Canberra. Children and guardians, supported by UNICEF Australia and Amity shall attend the launch at Parliament House on the 17th June. Marta Mauas Perez will be providing the keynote address, a guest in Australia of Secretariat of National Aboriginal and Islander Child Care (SNAICC).

UNICEF advocacy officer Tara Broughan said the project was the 11th in a series of EYE SEE digital photography workshops and only the second to be held in a developed nation – the first being hosted in Japan shortly after the tsunami in 2011.

Previous EYE SEE workshops have been run for children in Argentina, Tunisia, Mali, South Africa, Ethiopia, Madagascar, Rwanda, Liberia and Pakistan.

Amity Community Services Inc chief executive officer Bernie Dwyer said it was great for the children his service worked with in Darwin to share an opportunity similar to ones experienced by children in other countries.

Sony Corporation’s head of CSR Innovation Asako Tomura backed Mr Dwyer’s comments adding it was a privilege for the Sony Corporation to bring its expertise to the partnership for the benefit of children.

“Sony is proud to support EYE SEE with our corporate social responsibility (CSR) philosophy ‘for the next generation’,” Ms Tomura said.

“We hope our technology and the power of imaging support empowering children and youth in indigenous communities in Australia,” she said.

Ms Broughan said the EYE SEE project was part of UNICEF Australia’s commitment to finding ways to enhance reconciliation between indigenous and non-indigenous Australian.

“We’re extremely fortunate to have Giacomo in Australia and partnerships with Sony Corporation and Amity Community Services Inc. to open this opportunity to indigenous children in these communities,” Ms Broughan said.

“With Amity Community Services Inc and Sony Corporation, UNICEF is educating Aboriginal and Torres Strait Islander children about their rights and supporting them to communicate their understanding of these rights through photography,” Ms Broughan said.

For more information please contact Annette Mageean, Coordinator / Alcohol and Other Drugs Indigenous Communities Project, funded by Department of Health and Ageing / Amity Community Services Inc., GPO Box 3628, Darwin NT 0801 / phone: (08) 8944 6565 / facsimile:  (08) 8981 8456 / www.amity.org.au

References:

Moore, K. (2013) UNICEF Australia Media Release. Avail: http://www.unicef.org.au/Media/Media-Releases/April-2013/UNICEF-and-Sony-photo-workshop-promotes-rights-wit.aspx (accessed: 15 April 2013)

UNICEF (2012) Conventions on the Rights of the Child. Avail: http://www2.ohchr.org/english/bodies/crc/docs/co/CRC_C_AUS_CO_4.pdf (accessed: 15 April 2013)

Australian Indigenous ClinicalInfoNetKathy Ride, Project ManagerAustralian Indigenous HealthInfoNet

What is the ClinicalInfoNet?

The Australian Indigenous ClinicalInfoNet (ClinicalInfoNet) is a new web resource that supports primary health care workers – including doctors, nurses and Indigenous health workers – by providing online access to relevant, evidence-based, current and culturally appropriate information.

The ClinicalInfoNet provides quick and easy access to a comprehensive collection of primary health-care support materials that can be used in the prevention, identification and management of chronic diseases in the Australian Indigenous population. All materials on the ClinicalInfoNet are selected for their relevance and quality, and have been approved for inclusion by a team of experts in Indigenous health and chronic disease.

Why is the ClinicalInfoNet necessary?

An Indigenous man has a life expectancy of about 11.5 years less than that of a non-Indigenous man, and an Indigenous woman has a life expectancy almost 10 years less than that of a non-Indigenous woman1. The health gap can be reduced by prevention, early identification and improved management of chronic diseases and their risk factors.

In managing chronic disease, primary health care professionals require access to a range of materials, such as tools and guidelines. Extensive clinical resources are available on the Internet but they are infrequently used by primary health care workers due to lack of awareness, time limitation and poor access. A comprehensive web resource that identifies and brings together existing materials from a wide range of sources is the best solution.

What can you find on the ClinicalInfoNet?

The ClinicalInfoNet brings together existing resources relating to five key chronic diseases that are major contributors to the burden of disease among Indigenous people:

cardiovascular disease diabetes chronic respiratory disease chronic kidney disease cancer

The resources available on the ClinicalInfoNet are selected for their application to patient management and include:

clinical guidelines and reference materials clinical tools patient education resources administrative information

These resources cover the areas of:

prevention management treatment drug therapy

The ClinicalInfoNet provides a sophisticated search facility for accessing materials that can be used in ‘real time’ during consultations or for follow-up. For example, the ClinicalInfoNet contains relevant

excerpts from the CARPA manual, a version of the Australian type 2 diabetes risk assessment tool (AUSDRISK) designed for Aboriginal Victorians, an asthma action plan developed for Indigenous people in remote areas, and proformas for MBS item 715 (the Medicare health assessment for Aboriginal and Torres Strait Islander people).

How can the ClinicalInfoNet be accessed?

The ClinicalInfoNet is a free web resource that does not require a login or subscription. It can be accessed directly at www.clinicalinfonet.net.au or via a search engine.

In addition, the ClinicalInfoNet can be accessed by GPs and other primary health care workers through the PrimaryCare Sidebar® which is linked to patient management system software (currently available through Medical Director and Best Practice).

How did the ClinicalInfoNet come about?

As part of its contribution to the Council of Australian Governments’ (COAG) Closing the Gap in Indigenous Health Outcomes agreement, the Australian Government committed to address the key barriers for Indigenous people accessing health care through mainstream services. The development of an online resource was seen as an important way of assisting primary health workers improve decision-making processes and inform them of options relating to chronic disease prevention and management with Indigenous people.

How is the ClinicalInfoNet managed?

The web resource is developed and managed by the Australian Indigenous HealthInfoNet (AIH), which has a well established reputation for providing quality, evidence-based material to inform practice and policy through its web resource (www.healthinfonet.ecu.edu.au). The Technical Reference Group that guides the development of the ClinicalInfoNet comprises representatives from key groups and individuals involved in Indigenous primary health care, all of whom have expertise in chronic disease management. The ClinicalInfoNet is funded by the Australian Department of Health and Ageing.

Artwork

The artwork on the ClinicalInfoNet is titled Yarla Jukurrpa (Bush Potato Dreaming) and was painted by Vistarria Nakamara Ross.

Logo

The logo was created by Dr Mick Adams, a descendent of the Yadhiagana people of Cape York Peninsula in Queensland. The imagery is a blending of Indigenous and western symbols; the serpent represents Indigenous creation and life, and western medicine; the plant represents healing in both cultures.

Where to now?

The ClinicalInfoNet is a work in progress. New materials are constantly being added and existing materials are systematically reviewed to ensure their relevance and currency. This process is guided by a team of content reviewers who are experts in chronic disease, Indigenous health and patient care. Users of the ClinicalInfoNet can also suggest items for inclusion or review by using the ‘Help’ link on the website footer. General feedback is encouraged via the ‘Contact us’ link.

Reference:

1 Australian Bureau of Statistics (2009). Experimental life tables for Aboriginal and Torres Strait Islander Australians: 2005-2007. (ABS Catalogue no. 3302.0.55.003) Canberra: Australian Bureau of Statistics.

Experiencing New Territory: My PEPA placement in the Top EndSally Eves, Senior Social WorkerKimberley Palliative Care Service

My name is Sally Eves and I work as a Senior Social Worker for the Kimberley Palliative Care Service and cover the whole of the Kimberley in a part time capacity!

Palliative care in the Kimberley has the same issues that affect people in the Northern Territory - for example the high incident of renal disease and death, the tyranny of distance in obtaining general medical and specialist services and the challenges of delivering palliative care to aboriginal clients in a culturally sensitive manner. For these reasons, I requested a PEPA placement with the Territory Palliative Care service situated on the Royal Darwin Hospital campus and I was lucky enough to secure a placement in February this year.

What is PEPA?

PEPA stands for Program of Experience in the Palliative Approach. The overall aims of the program are to further improve the skill and confidence of the generalist health workforce to work with people with palliative care needs, provide opportunities to ensure palliative care providers across the continuum are aware of and provide culturally appropriate palliative care and end of life support, including care preferences, spiritual requirements and bereavement expression. Whilst my PEPA placement was based in Darwin, placements are usually conducted in your own state, and are organised by the PEPA Co-ordinator for WA, Brooke Wilkinson.

My experience

On Sunday 17 February I flew from Broome to Darwin to meet up with Cheryl Nash, my social work mentor and supervisor, for a whirlwind 3 day placement. My introduction to this dynamic team began with my attendance at a staff meeting. Later, I met with many of the key staff on an individual basis to discuss their roles and to see them in action during case conferences, clinic reviews and teleconferences with remote clients.

One of the highlights of my trip was meeting Bev Derschow who developed and designed the Northern Territory Aboriginal Palliative Care model (see link below). Bev was able to share her experience in ‘spreading the word’ about palliative care and how finding the ‘right’ person to talk to when conducting a family meeting is imperative to culturally appropriate practice.

I learnt that the Territory Palliative Care (TPC) is a specialist program which provides a consultative service throughout the Northern Territory for clients with a life limiting illness. TPC is multidisciplinary and, while there are differences in staffing in Central Australia and the Top End, the full team includes specialist physicians, specialist nurses, social workers, occupational therapist and a pastoral care worker and volunteers.

During my placement I especially enjoyed meeting with Dave the Pastoral Care Worker, Julie Rankin the Occupational Therapist and, of course Cheryl Nash, one of the team of two Social Workers who provide services to inpatients of the Royal Darwin Hospital, people dying in the community and patients at the eleven bed hospice facility on site.

On my last day of my placement, I was also given a tour by Guam of the ‘state of the art’ Allan Walker Cancer Centre which provides the latest radiation and chemotherapy treatments for patients, reducing the need for lengthy interstate travel for the majority of NT cancer patients. I was happy to learn that this centre has the capability to accommodate patients from the Kimberley and that this may become a possibility in the future.

I can enthusiastically recommend a PEPA placement to anyone and I encourage you to contact Brooke Wilkinson, PEPA Co-ordinator WA on 9382 9372 to discuss the details about applying for a possible placement for yourself.

From the desk of the Chief Medical Officer, Prof Dinesh AryaNT Department of Health

Communication has to be key to delivering seamless, coordinated and well integrated care

As we prepare ourselves to work within the New Service Framework, there cannot be a better time to consider how we deliver direct clinical care. In my last column in `The Chronicle’ I suggested that there are two aspects that are particularly worthy of discussion at this time.

1. Our general approach to working with patients, their families, carers and the community2. Delivering care in a manner that is seamless, coordinated and well integrated

In the previous edition of `The Chronicle’ I presented my thoughts on our approach to working with patients (first point above) suggesting that our responsibility as healthcare providers has to be to:

1. Empower patients with necessary information and knowledge to look after themselves2. Ensure we understand their needs and expectations and provide treatment and care that

meets those needs and expectations3. Enable both patients and providers to have an uncompromising mutual respect for each other

Now to the second point about making every effort to deliver care that is seamless, coordinated and well integrated.

Effective communication

Good care coordination and well integrated care is a recipe for effective and efficient care in any setting, however when the setting is a health care system with responsibility for providing care to less than 250,000 people across 1.4 million square kilometres lack of integration and coordination tends to become a liability. Add to that complexity the need to engage and empower patients, their families and the wider community in care planning, one can understand why effective communication becomes an absolute key to delivering care that is seamless, coordinated and well integrated.

A number of system-wide initiatives are currently being progressed to make communication structured and consistent, and making clinical information accessible at the point of care delivery.

System-level initiatives

On 31 May 2013, over a 100 clinicians from across the Northern Territory (NT) health system attended the Transfer of Care Forum at the Darwin Convention Centre. This forum was attended by clinicians, managers and executives from primary, secondary and tertiary care sectors and focussed on transfer of care discussions with special consideration for rural and remote issues. Many people shared their perspective on how good transfer of care can facilitate well-coordinated care. The need to have ‘systems’ to improve continuity of care, a desire for a good electronic documentation system, improving health literacy and a potential need for care coordinators (and care coordination), amongst others, were put on the table as considerations for discussion.

Key health provider representatives in the NT, including the Department of Health (DoH), Medicare Local and AMSANT have been working to finalise a policy of transfer of care to ensure when care of a patient is transferred from one provider to another (or from one setting to another), there is consistent and structured handover of clinical information. A DoH ‘Clinical Handover Committee’ is currently in the process of finalising the DoH policy directive on making good and consistent clinical handover a reality.

There is a general acknowledgement that unless our clinical documentation systems are well connected, availability of clinical information at the point of care (therefore coordination of care) will not be easy. An initiative is currently underway to explore whether key clinical information bits within our different clinical information systems (e.g. PCIS, CCIS, CareSys, Clinical Work Station, etc.) can be brought together as a ‘Client Consolidated View’ so that essential clinical information that is currently inaccessible to clinicians is available at the point of care delivery. A number of clinicians and clinical managers in Darwin participated in a workshop in early June to identify what should be the minimum set of this clinical information that should be available within the ‘Client Consolidated View’. A similar workshop was planned in Alice Springs in late June. This work should help develop a business case to progress this initiative.

Key to coordinated care is how we communicate in our day to day practice

I believe any system-level initiative to improve coordination will be completely ineffective unless as health practitioners we adhere to communicating at the following four points.

1. At the point of referral/transfer: Both for primary care practitioners and specialists, it is essential that we communicate effectively at the point of referral and transfer (including discharge). This means ensuring referral and handover information is informative, acknowledges receipt of referral and/or acceptance of care.

2. Assessment and treatment planning: An assessment and management plan that does not consider needs of the patient holistically is an impediment to coordinated care. As practitioners, it has to be our responsibility to ensure that at every point of care, the assessment and management plan is updated and we communicate with others who are involved in providing care to the patient. The discipline of specialists sending reports to the primary care practitioner to detail their assessment and recommendations is worth preserving.

3. When treatment is recommended or prescribed: The point at which treatment is recommended or prescribed must remain an important point of communication with the patient, their carers and also with other members of the treating team (often including the multidisciplinary team, specialists and primary care practitioners).

4. The point at which treatment is changed: The whole purpose of a multidisciplinary input is to get the best expert brains to serve the needs of the patient. Difficulties arise when treatments are changed or altered without involving other people supporting the patient. Complications can be significant when it leads to drug interactions or treatments which are prescribed that may be contradictory.

REPORT DESCRIBES PROGRESS BEING MADE IN REDUCING NT SMOKING Professor David Thomas, National Heart Foundation Research Fellow Head, Tobacco Control Research ProgramMenzies School of Health Research, Darwin

The second Annual Report on progress in reducing smoking in the NT was released on World No Tobacco Day 31 May 2013. The report is produced by the NT Tobacco Control Advisory Committee which includes members from AMSANT, NT Government, local government, non-government organisations, academia and community representatives, and is chaired by David Thomas from Menzies.

This is a great resource for anyone interested in reducing smoking in the NT.

In one place, the report summarises new evidence, statistics and stories about the size of the problem and what is being done here in the NT. This year the report has included more stories and pictures of what is happening on the ground around the NT. It also still includes the most up to date statistics.

This year was another good year with increased efforts in reducing smoking and the harms it causes in the NT. The report includes stories about the expanding tobacco action workforce, increasing smokefree areas, new anti-smoking social marketing campaigns, new research and new legislation, including Australia’s world-leading plain-packaging laws.

But more can still be done. Too many Territorians still die early because of smoking.

The report calls on the NT Government to better protect our kids by banning smoking in cars with kids, as has occurred everywhere else in Australia. The report also calls on the Australian Government to significantly increase the tax on cigarettes, as increasing the tax and price of cigarettes has been shown to make the strongest impact of any policy on reducing smoking.

The report’s release was associated with considerable media interest, including the feature story on ABC TV News and 730 NT. Link to story is: http://www.abc.net.au/news/2013-05-31/a-report-card-on-the-nts-smoking-habit/4726722

The report is available at http://www.health.nt.gov.au/library/scripts/objectifyMedia.aspx?file=pdf/84/23.pdf&siteID=1&str_title=Tobacco Control Advisory Committee Annual Report 2013.pdf

Starting to smoke: Experiences of indigenous youthDr Vanessa Johnston,1 Mr Darren W Westphal,1 Ms Cyan Earnshaw,1 Dr David P Thomas,1,2

1Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University2The Lowitja Institute

Background

Most adult smokers begin smoking during adolescence. If young people do not start smoking during this period it is unlikely they ever will.1 By early adulthood, 42% of Indigenous Australians report that they are current smokers.2 The aim of the ‘Starting to Smoke’ project was to explore the reasons Indigenous young people in the Northern Territory (NT) start (or do not start) smoking, with a particular focus on the social and cultural factors that influence smoking uptake in this group.

This project was carried out in the Top End of the NT in Darwin and one remote community in Arnhem Land. The project used a participatory approach, involving a team of four trained young Aboriginal peer researchers who recruited participants and undertook the data collection. We also included a smaller group of non-Indigenous youths to understand if there were any major differences in the determinants of early smoking experiences.

Young people aged 13–20 years of age were recruited through schools, a local youth centre and peer networks. We completed group interviews with 65 participants and one-on-one interviews with 11 youths. Individual interviewees were given a camera to take photographs of how they experience smoking in their everyday lives. These photographs were used in interviews by the young participants to talk about their personal stories relating to smoking.

Results

We talked to 46 Indigenous and 19 non-Indigenous young people. The average age was 16 years. 40% were female and 37% were smokers. Of the Indigenous participants, 21 (46%) were smokers (this included occasional and regular smokers). Of the non-Indigenous participants, three reported smoking.

We found that the most important influences on smoking initiation came from young people’s immediate social environment – that is, from family and friends.

Family influences, including role modelling, providing access to tobacco and smoking socialisation (e.g. actively initiating young people into smoking), were all factors that contributed to early smoking experiences and appeared to set the foundation for some youths to progress to more regular smoking during their mid to late teens. Non-Indigenous participants reported that were similarly influenced to smoke by observing family members who smoked, and they frequently took tobacco from household supplies. However, experimenting with family members or being actively given tobacco by family members was reportedly less common among non-Indigenous youths.

By contrast, anti-smoking socialisation in the home appeared to be a key determinant of not smoking (see Photograph taken by a participant). This included smoke-free indoor spaces, not smoking around children, strong anti-smoking messages and clear, communicated consequences to smoking. This was reportedly true even when parents were smokers. Explicit parental anti-smoking socialisation was a more significant theme for non-Indigenous, compared with Indigenous, participants (although the majority of non-Indigenous participants were non-smokers). Nevertheless, the protective effect of anti-smoking socialisation, when it did occur, appeared to be the same across ethnic groups.

‘My youngest brother came along at an age where I was probably the most likely to make my mind up about smoking. I was around 11 or 12 years old and I had a lot more exposure from my friends… but then once he came along and my mum stopped and there was just none around the house. It helped reinforce the decision not to smoke.’ (Female, Indigenous, non-smoker, 17 years)

As youths progress through high school, the influence of friends and broader social networks on smoking behaviour reportedly increased. Participants noted that during high school years, social pressure to smoke was also an increasingly influential driver of experimentation and progression of smoking – both overt peer pressure and more implicit pressure to belong and fit in (the latter was more common). The findings also highlighted that smokers were more likely to be in closer friendship networks with other smokers (and, similarly, non-smokers were more likely to be in networks with other non-smokers). In some instances participants reported seeking out social networks with similar smoking norms and behaviour to their own. Peer group membership reinforced social norms around smoking behaviour and thus acted to reinforce or protect against smoking depending on the composition of the group.

Key messages from this research project

Family and peer influences play a central role in smoking uptake among Indigenous youths Social influences to smoke are similar between Indigenous and non-Indigenous youths but are

more widespread (especially in the family domain) among Indigenous youths Although Indigenous youths report high levels of exposure to smoking role models and

smoking socialisation practices among family and social networks, this study provides some indication of a progressive denormalisation of smoking among some Indigenous youths

Future programs aimed at preventing smoking uptake in this population need to focus on changing social normative beliefs around smoking, both at a population level and within young people’s immediate social environments. Such interventions could be effectively delivered in both the school and family environments

Measures to continue to denormalise smoking and to support families to provide clear anti-smoking socialisation messages to youths should contribute to reducing smoking uptake in this population

Acknowledgments

The team gratefully acknowledges the enormous contribution of the peer researchers who worked on this project: Cyan Earnshaw, Derek Mayo-Spry, Tiffany Wanybarrnga, Alvin Gaykamangu, Jasmine Christie and Renae Williams. We also thank the contribution made by the schools and the Darwin not-for-profit youth centre that participated in the project and of all of the young participants.

This project was funded by a grant from the Lowitja Institute. Vanessa Johnston is supported by an NHMRC Postdoctoral Training Fellowship for Aboriginal and Torres Strait Islander health research (545241). David Thomas is supported by a National Heart Foundation Research Fellowship (CR 09D 4712). For more information about this research, please contact Dr. Vanessa Johnston on vanessa.johnston@menzies.edu.au

References:

1. Mayhew KP, Flay BR, Mott JA. Stages in the development of adolescent smoking. Drug Alcohol Depend. 2000;59:S61-S81

2. ABS. National Aboriginal and Torres Strait Islander Social Survey 2008 Canberra: ABS (No. 4714.0): Australian Bureau of Statistics, 2009

Regional Profile - Daly River RegionAlex Wetten, Public Health Nutritionist/DietitianJulie Cook, Health Promotion OfficerTop End West, Health Development Team, NT Department of HealthSusan Wong, Member Services OfficerChronic Diseases Network, NT Department of Health

The Daly River region is situated approximately 240km south of Darwin and encompasses many ecosystems including hot springs, gorges with camping and the famous barramundi fishing!

Prior to European settlement, Daly River area was used to hold ceremonies and a place for Aboriginal people to trade. Malak Malak people are the traditional owners of the area who live in Nauiyu and at

Wooliana, downstream from the community. There are 28 different descent groups that act as trustees of the land and while most residents speak English, Ngan’gikuruggurr is the most prominent of 10 local languages spoken amongst the minority language groups that use the area along with the community of Nauiyu.

Nauiyu (pronounced now-yu) is the small community situated on the banks of the Daly River 220-230km south of Darwin and has an 86% Aboriginal population. It is also the home of the Merrepen Arts and Crafts Centre which hosts the annual Merrepen Festival.

The 2013 Merrepen Festival took place from 31st May to 2nd June and provided a unique opportunity for visitors to experience a visit to the Nauiyu community and participate in cultural and sporting activities. Merrepen artworks and screen printed fabrics made by the community were also available for purchase. One festival highlight was the River Side Concert which featured Wendy Matthews, Tracey Bunn, the Emu Sisters and Traditional Dancers performing on the banks of the Daly River.

Another highlight of the festival was witnessing the preparation of bush tucker like snake, turtle, wallaby, turkey and barramundi cooked in the ground using tree bark and stones. We then sat with the community and shared the bush tucker while listening to their stories.

The festival provided a great opportunity to work with the local community and reinforce the health benefits of bush tucker and support strong linkages to cultural traditions.