Michelle Kennedy, Kade Booth, Jamie Bryant, Felicity Collis, Catherine Chamberlain, Jaquelyne Hughes, Romany McGuffog, Breanne Hobden, Kalinda E Griffiths, Mark Wenitong, Peter O'Mara, Alex Brown, Sandra J Eades, Kelvin M Kong, Raymond W Lovett
Objectives
To describe human research ethics committee (HREC) members’ reports of: HREC membership structures; HREC processes for reviewing Aboriginal and Torres Strait Islander health and medical research; and experiences and perceptions of review operations.
Study design
Cross-sectional 36-item survey and qualitative interviews with a subsample of survey participants.
Setting, participants
Current and past members (preceding five years) of HRECs who assessed Aboriginal and Torres Strait Islander research.
Main outcomes
Survey and interview results related to HREC structures, processes and functioning; challenges in review processes; and what is needed to improve ethical governance.
Results
229 HREC members completed the survey and 13 were interviewed. Half the participants (115 of 221, 52%) reported having an Aboriginal and Torres Strait Islander representative position. Key issues identified related to assessment processes and resourcing, including burden on Aboriginal and Torres Strait Islander members, ability for Aboriginal and Torres Strait Islander HRECs to manage additional applications, lack of clarity around specific assessment criteria for general population studies, lack of cohesion across the application or complaints processes, and lack of resourcing and infrastructure to monitor ethical practice after approval.
Conclusion
Aboriginal and Torres Strait Islander people carry an important role and burden in the review of applications and monitoring of health research. However, Aboriginal and Torres Strait Islander people are not presently involved in all aspects of ethical research governance within current HREC structures, including the review and monitoring of approved research. Standardised processes and guidelines that uphold Aboriginal and Torres Strait Islander rights and expert knowledges are required.
{"title":"Human research ethics committee processes and practices for approving Aboriginal and Torres Strait Islander health research: a mixed methods study","authors":"Michelle Kennedy, Kade Booth, Jamie Bryant, Felicity Collis, Catherine Chamberlain, Jaquelyne Hughes, Romany McGuffog, Breanne Hobden, Kalinda E Griffiths, Mark Wenitong, Peter O'Mara, Alex Brown, Sandra J Eades, Kelvin M Kong, Raymond W Lovett","doi":"10.5694/mja2.52563","DOIUrl":"10.5694/mja2.52563","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To describe human research ethics committee (HREC) members’ reports of: HREC membership structures; HREC processes for reviewing Aboriginal and Torres Strait Islander health and medical research; and experiences and perceptions of review operations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Cross-sectional 36-item survey and qualitative interviews with a subsample of survey participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>Current and past members (preceding five years) of HRECs who assessed Aboriginal and Torres Strait Islander research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcomes</h3>\u0000 \u0000 <p>Survey and interview results related to HREC structures, processes and functioning; challenges in review processes; and what is needed to improve ethical governance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>229 HREC members completed the survey and 13 were interviewed. Half the participants (115 of 221, 52%) reported having an Aboriginal and Torres Strait Islander representative position. Key issues identified related to assessment processes and resourcing, including burden on Aboriginal and Torres Strait Islander members, ability for Aboriginal and Torres Strait Islander HRECs to manage additional applications, lack of clarity around specific assessment criteria for general population studies, lack of cohesion across the application or complaints processes, and lack of resourcing and infrastructure to monitor ethical practice after approval.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Aboriginal and Torres Strait Islander people carry an important role and burden in the review of applications and monitoring of health research. However, Aboriginal and Torres Strait Islander people are not presently involved in all aspects of ethical research governance within current HREC structures, including the review and monitoring of approved research. Standardised processes and guidelines that uphold Aboriginal and Torres Strait Islander rights and expert knowledges are required.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 S2","pages":"S34-S41"},"PeriodicalIF":6.7,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52563","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To examine what ethics approvals are being sought for Aboriginal and Torres Strait Islander health and medical research, and to determine what proportion of this research upholds Aboriginal and Torres Strait Islander ethical governance via an Aboriginal and Torres Strait Islander community-controlled human research ethics committee (AHREC) by jurisdiction and funding body type.
Study design
Scoping review of all original, peer-reviewed health and medical literature published over a 5-year period (January 2018 to December 2022).
Data sources
Extending on a previous review, the search tool LIt.search was used to access all literature relating to Aboriginal and Torres Strait Islander health and medical research.
Results
589 eligible publications were included from the parent review, and a further 1703 publications were identified from the updated search. A total of 945 publications were included. A substantial number of ethics approvals were obtained from government-based ethics committees (394, 41.7%). More than half of the publications reported obtaining institutional ethics approval (514, 54.4%). Less than half (400, 42.3%) reported obtaining AHREC approval. Almost one-third of publications were on research that was conducted in states or territories where there is no AHREC (334, 35.3%). Publications did not always report obtaining AHREC approvals, including in jurisdictions where one operates.
Conclusions
We found a concerning lack of Aboriginal and Torres Strait Islander ethical governance reported in health and medical research. Acknowledging that Aboriginal and Torres Strait Islander ethics guidelines and AHRECs were established due to harm caused to communities, these results suggest a high risk, with research not consistently being deemed safe, respectful and beneficial with appropriate AHREC ethics review and approval. We join calls for the establishment of AHRECs in all jurisdictions and nationally. Furthermore, we urge funding bodies and institutions to uphold requirements for Aboriginal and Torres Strait Islander ethical governance in research and funding agreements, as well as institutional policies and procedures.
{"title":"Beyond ethical guidelines: upholding Aboriginal and Torres Strait Islander ethical governance in health and medical research. A scoping review","authors":"Felicity Collis, Kade Booth, Jamie Bryant, Michelle Kennedy","doi":"10.5694/mja2.52564","DOIUrl":"10.5694/mja2.52564","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To examine what ethics approvals are being sought for Aboriginal and Torres Strait Islander health and medical research, and to determine what proportion of this research upholds Aboriginal and Torres Strait Islander ethical governance via an Aboriginal and Torres Strait Islander community-controlled human research ethics committee (AHREC) by jurisdiction and funding body type.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Scoping review of all original, peer-reviewed health and medical literature published over a 5-year period (January 2018 to December 2022).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data sources</h3>\u0000 \u0000 <p>Extending on a previous review, the search tool LIt.search was used to access all literature relating to Aboriginal and Torres Strait Islander health and medical research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>589 eligible publications were included from the parent review, and a further 1703 publications were identified from the updated search. A total of 945 publications were included. A substantial number of ethics approvals were obtained from government-based ethics committees (394, 41.7%). More than half of the publications reported obtaining institutional ethics approval (514, 54.4%). Less than half (400, 42.3%) reported obtaining AHREC approval. Almost one-third of publications were on research that was conducted in states or territories where there is no AHREC (334, 35.3%). Publications did not always report obtaining AHREC approvals, including in jurisdictions where one operates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We found a concerning lack of Aboriginal and Torres Strait Islander ethical governance reported in health and medical research. Acknowledging that Aboriginal and Torres Strait Islander ethics guidelines and AHRECs were established due to harm caused to communities, these results suggest a high risk, with research not consistently being deemed safe, respectful and beneficial with appropriate AHREC ethics review and approval. We join calls for the establishment of AHRECs in all jurisdictions and nationally. Furthermore, we urge funding bodies and institutions to uphold requirements for Aboriginal and Torres Strait Islander ethical governance in research and funding agreements, as well as institutional policies and procedures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 S2","pages":"S42-S48"},"PeriodicalIF":6.7,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52564","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>It is well established that when “Indigenous people become the researchers and not merely the researched, the activity of research is transformed”.<span><sup>1</sup></span> But what happens when the researched actively seek to transform the system of research itself?</p><p>The <i>Murru Minya</i> project originated from the lead researcher's observations of the significant disparities between community conversations about their experiences of research and the narratives by researchers in academic literature. This raised questions about the conduct and application of ethical research practices in Aboriginal and Torres Strait Islander health and medical research. <i>Murru</i> (path) <i>Minya</i> (explain) is Wiradjuri language expressing a direct, true or straight way to explain this path we are on now, what is in the past to explain the path for the future.</p><p>We assert that there are clear distinctions between “ethics”, “ethical practice”, and “ethical processes”, and that these terms should not be used interchangeably. It is therefore pertinent to first explain our definitions of these key terms. Ethics broadly refers to a standard set of values and principles that guide our understanding of what is right and wrong. Ethical practice is concerned with how these standards and principles are implemented by researchers and their institutions through their behaviours, policies, and decision making processes. Ethical processes are the relative administrative duties required to be adhered to when seeking institutional ethical review and approval of research. These processes have been developed by Western-Eurocentric institutions and embedded in their systems to attempt to ensure that ethical research practice is upheld. This mechanism has limited accountability, monitoring, and reporting, making it difficult to ascertain whether ethical review and approval processes have resulted in the true application of ethical practices by researchers working with Aboriginal and Torres Strait Islander communities. Accordingly, it is vital to examine and evaluate the effectiveness of these frameworks and systems for and by Aboriginal and Torres Islander people.</p><p>This editorial was written by Michelle Kennedy, Wiradjuri woman, lead researcher and tobacco resistance expert, and Felicity Collis, Gomeroi woman and PhD Candidate, both currently working in the university and community-controlled research sector.</p><p>We do not assert that the <i>Murru Minya</i> project<span><sup>2</sup></span> is the first to explore ethical research principles, values, and guidelines in the context of Aboriginal and Torres Strait Islander health and medical research. Rather, we recognise the leadership of Aboriginal and Torres Strait Islander people and communities in the development, implementation, consultation, and revision of ethical research practice guidelines and frameworks.<span><sup>3-6</sup></span> The work by those before us has produced foundational knowledge to in
{"title":"Murru Minya: a national exploration of ethical research and research ethics in Aboriginal and Torres Strait Islander health and medical research","authors":"Felicity Collis, Michelle Kennedy","doi":"10.5694/mja2.52573","DOIUrl":"10.5694/mja2.52573","url":null,"abstract":"<p>It is well established that when “Indigenous people become the researchers and not merely the researched, the activity of research is transformed”.<span><sup>1</sup></span> But what happens when the researched actively seek to transform the system of research itself?</p><p>The <i>Murru Minya</i> project originated from the lead researcher's observations of the significant disparities between community conversations about their experiences of research and the narratives by researchers in academic literature. This raised questions about the conduct and application of ethical research practices in Aboriginal and Torres Strait Islander health and medical research. <i>Murru</i> (path) <i>Minya</i> (explain) is Wiradjuri language expressing a direct, true or straight way to explain this path we are on now, what is in the past to explain the path for the future.</p><p>We assert that there are clear distinctions between “ethics”, “ethical practice”, and “ethical processes”, and that these terms should not be used interchangeably. It is therefore pertinent to first explain our definitions of these key terms. Ethics broadly refers to a standard set of values and principles that guide our understanding of what is right and wrong. Ethical practice is concerned with how these standards and principles are implemented by researchers and their institutions through their behaviours, policies, and decision making processes. Ethical processes are the relative administrative duties required to be adhered to when seeking institutional ethical review and approval of research. These processes have been developed by Western-Eurocentric institutions and embedded in their systems to attempt to ensure that ethical research practice is upheld. This mechanism has limited accountability, monitoring, and reporting, making it difficult to ascertain whether ethical review and approval processes have resulted in the true application of ethical practices by researchers working with Aboriginal and Torres Strait Islander communities. Accordingly, it is vital to examine and evaluate the effectiveness of these frameworks and systems for and by Aboriginal and Torres Islander people.</p><p>This editorial was written by Michelle Kennedy, Wiradjuri woman, lead researcher and tobacco resistance expert, and Felicity Collis, Gomeroi woman and PhD Candidate, both currently working in the university and community-controlled research sector.</p><p>We do not assert that the <i>Murru Minya</i> project<span><sup>2</sup></span> is the first to explore ethical research principles, values, and guidelines in the context of Aboriginal and Torres Strait Islander health and medical research. Rather, we recognise the leadership of Aboriginal and Torres Strait Islander people and communities in the development, implementation, consultation, and revision of ethical research practice guidelines and frameworks.<span><sup>3-6</sup></span> The work by those before us has produced foundational knowledge to in","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 S2","pages":"S3-S5"},"PeriodicalIF":6.7,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52573","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michelle Kennedy, Kade Booth, Jamie Bryant, Felicity Collis, Catherine Chamberlain, Jaquelyne Hughes, Breanne Hobden, Kalinda E Griffiths, Mark Wenitong, Peter O'Mara, Alex Brown, Sandra J Eades, Kelvin M Kong, Raymond W Lovett
<div> <section> <h3> Objective</h3> <p>Describe perceptions of how well researchers conducting Aboriginal and Torres Strait Islander health and medical research apply ethical research practices.</p> </section> <section> <h3> Study design</h3> <p>Cross-sectional online survey.</p> </section> <section> <h3> Setting, participants</h3> <p>Researchers who included Aboriginal and Torres Strait Islander people or their data in their projects, and current or past members (previous 5 years) of a human research ethics committee that assessed Aboriginal and Torres Strait Islander research.</p> </section> <section> <h3> Main outcome measures</h3> <p>Researchers’ engagement with 15 ethical research practices (on a 5-point Likert scale, poor to excellent).</p> </section> <section> <h3> Results</h3> <p>561 participants (382 researchers [68.1%] and 179 human research ethics committee members [31.9%]) completed the survey. Across all research practices, a rating of excellent was least frequently endorsed, with the highest frequency being for employing Aboriginal and Torres Strait Islander team members (38 participants [6.8%]). A rating of poor was most common for enacting Indigenous data sovereignty and governance principles (156 participants [27.8%]). Aboriginal and Torres Strait Islander respondents had significantly lower odds of perceiving high levels of adherence to ethical principles than non-Aboriginal and Torres Strait Islander respondents for all ethical principles, except employing Aboriginal and Torres Strait Islander team members. In particular, Aboriginal and Torres Strait Islander participants had 65% lower odds of perceiving that researchers have high rates of adhering to disseminating results back to the community (odds ratio [OR], 0.35; 95% CI, 0.22–0.57), 56% lower odds of perceiving that researchers have high rates of adhering to engaging Aboriginal community in research implementation (OR, 0.44; 95% CI, 0.27–0.73), and 54% lower odds of perceiving that researchers have high rates of adhering to engaging Aboriginal community in developing research questions (OR, 0.46; 95% CI, 0.28–0.75).</p> </section> <section> <h3> Conclusion</h3> <p>Researchers are not consistently implementing all ethical practices outlined in guidelines for research involving Aboriginal and Torres Strait Islander people. We call for commitment from researchers, institutions
{"title":"How well are researchers applying ethical principles and practices in Aboriginal and Torres Strait Islander health and medical research? A cross-sectional study","authors":"Michelle Kennedy, Kade Booth, Jamie Bryant, Felicity Collis, Catherine Chamberlain, Jaquelyne Hughes, Breanne Hobden, Kalinda E Griffiths, Mark Wenitong, Peter O'Mara, Alex Brown, Sandra J Eades, Kelvin M Kong, Raymond W Lovett","doi":"10.5694/mja2.52572","DOIUrl":"10.5694/mja2.52572","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Describe perceptions of how well researchers conducting Aboriginal and Torres Strait Islander health and medical research apply ethical research practices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Cross-sectional online survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>Researchers who included Aboriginal and Torres Strait Islander people or their data in their projects, and current or past members (previous 5 years) of a human research ethics committee that assessed Aboriginal and Torres Strait Islander research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Researchers’ engagement with 15 ethical research practices (on a 5-point Likert scale, poor to excellent).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>561 participants (382 researchers [68.1%] and 179 human research ethics committee members [31.9%]) completed the survey. Across all research practices, a rating of excellent was least frequently endorsed, with the highest frequency being for employing Aboriginal and Torres Strait Islander team members (38 participants [6.8%]). A rating of poor was most common for enacting Indigenous data sovereignty and governance principles (156 participants [27.8%]). Aboriginal and Torres Strait Islander respondents had significantly lower odds of perceiving high levels of adherence to ethical principles than non-Aboriginal and Torres Strait Islander respondents for all ethical principles, except employing Aboriginal and Torres Strait Islander team members. In particular, Aboriginal and Torres Strait Islander participants had 65% lower odds of perceiving that researchers have high rates of adhering to disseminating results back to the community (odds ratio [OR], 0.35; 95% CI, 0.22–0.57), 56% lower odds of perceiving that researchers have high rates of adhering to engaging Aboriginal community in research implementation (OR, 0.44; 95% CI, 0.27–0.73), and 54% lower odds of perceiving that researchers have high rates of adhering to engaging Aboriginal community in developing research questions (OR, 0.46; 95% CI, 0.28–0.75).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Researchers are not consistently implementing all ethical practices outlined in guidelines for research involving Aboriginal and Torres Strait Islander people. We call for commitment from researchers, institutions ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 S2","pages":"S49-S56"},"PeriodicalIF":6.7,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52572","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kade Booth, Jamie Bryant, Felicity Collis, Catherine Chamberlain, Jaquelyne Hughes, Breanne Hobden, Kalinda E Griffiths, Mark Wenitong, Peter O'Mara, Alex Brown, Sandra J Eades, Kelvin M Kong, Raymond W Lovett, Michelle Kennedy
<div> <section> <h3> Objectives</h3> <p>To examine researchers’ reports of adherence to ethical principles in their most recent research project, including factors associated with higher self-reported adherence, and perceptions of how research conduct could be improved.</p> </section> <section> <h3> Study design</h3> <p>Online cross-sectional survey.</p> </section> <section> <h3> Setting, participants</h3> <p>Researchers who had conducted any health or medical research that included Aboriginal and Torres Strait Islander people or their data.</p> </section> <section> <h3> Main outcome measures</h3> <p>Researchers rated their adherence to 15 ethical principles extracted from ethical guidelines in their most recent research project on a 5-point Likert scale (poor to excellent), and reported what they believe is needed to improve the conduct of Aboriginal and Torres Strait Islander health and medical research.</p> </section> <section> <h3> Results</h3> <p>391 researchers completed the survey. Those with > 10 years’ experience in the field were significantly more likely to self-report adhering to all 15 key ethical principles compared with those with ≤ 5 years’ experience. Compared with those with ≤ 5 years’ experience, those with 6–10 years’ experience were significantly more likely to self-report adhering to: engaging community in identifying research priorities (odds ratio [OR], 2.05; [95% confidence interval (CI), 1.23–3.40]); engaging community in developing the research questions (OR, 2.16; 95% CI, 1.32–3.55); and engaging community in research implementation (OR, 2.10; 95% CI, 1.25–3.54). Aboriginal and Torres Strait Islander participants were significantly more likely to self-report adhering to the following principles than non-Indigenous participants: engaging community in identifying research priorities (OR, 1.90; 95% CI, 1.16–3.10); engaging community in developing the research questions (OR, 2.16; 95% CI, 1.30–3.61); engaging community in research implementation (OR, 1.92; 95% CI, 1.14–3.20); embedding Aboriginal governance, advisory and decision making on the project (OR, 2.10; 95% CI, 1.26–3.50); embedding opportunities in the research for capacity building for communities (OR, 1.70; 95% CI, 1.04–2.77); and enacting Indigenous data sovereignty and governance principles (OR, 1.67; 95% CI, 1.02–2.70). Open-ended responses indicated research conduct could be improved by recognition of community as experts, genuine partnerships and engageme
{"title":"Researchers’ self-reported adherence to ethical principles in Aboriginal and Torres Strait Islander health and medical research and views on improving conduct: a mixed methods study","authors":"Kade Booth, Jamie Bryant, Felicity Collis, Catherine Chamberlain, Jaquelyne Hughes, Breanne Hobden, Kalinda E Griffiths, Mark Wenitong, Peter O'Mara, Alex Brown, Sandra J Eades, Kelvin M Kong, Raymond W Lovett, Michelle Kennedy","doi":"10.5694/mja2.52570","DOIUrl":"10.5694/mja2.52570","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To examine researchers’ reports of adherence to ethical principles in their most recent research project, including factors associated with higher self-reported adherence, and perceptions of how research conduct could be improved.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Online cross-sectional survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>Researchers who had conducted any health or medical research that included Aboriginal and Torres Strait Islander people or their data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Researchers rated their adherence to 15 ethical principles extracted from ethical guidelines in their most recent research project on a 5-point Likert scale (poor to excellent), and reported what they believe is needed to improve the conduct of Aboriginal and Torres Strait Islander health and medical research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>391 researchers completed the survey. Those with > 10 years’ experience in the field were significantly more likely to self-report adhering to all 15 key ethical principles compared with those with ≤ 5 years’ experience. Compared with those with ≤ 5 years’ experience, those with 6–10 years’ experience were significantly more likely to self-report adhering to: engaging community in identifying research priorities (odds ratio [OR], 2.05; [95% confidence interval (CI), 1.23–3.40]); engaging community in developing the research questions (OR, 2.16; 95% CI, 1.32–3.55); and engaging community in research implementation (OR, 2.10; 95% CI, 1.25–3.54). Aboriginal and Torres Strait Islander participants were significantly more likely to self-report adhering to the following principles than non-Indigenous participants: engaging community in identifying research priorities (OR, 1.90; 95% CI, 1.16–3.10); engaging community in developing the research questions (OR, 2.16; 95% CI, 1.30–3.61); engaging community in research implementation (OR, 1.92; 95% CI, 1.14–3.20); embedding Aboriginal governance, advisory and decision making on the project (OR, 2.10; 95% CI, 1.26–3.50); embedding opportunities in the research for capacity building for communities (OR, 1.70; 95% CI, 1.04–2.77); and enacting Indigenous data sovereignty and governance principles (OR, 1.67; 95% CI, 1.02–2.70). Open-ended responses indicated research conduct could be improved by recognition of community as experts, genuine partnerships and engageme","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 S2","pages":"S16-S24"},"PeriodicalIF":6.7,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52570","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>The extraction and burning of oil, coal and gas is overheating our planet. The result is a changing climate that is becoming more extreme and less predictable. According to the Bureau of Meteorology (https://media.bom.gov.au/releases/1250/preliminary-summary-of-australias-climate-in-2024), for instance, 2024 was Australia's second hottest year on record. With intensifying climate events like extreme heat, drought, flooding and bushfires, as well as associated threats to biodiversity and food and water security, come myriad adverse impacts on health. Two articles in this issue of the <i>MJA</i> speak to the health implications of the climate crisis and the policy responses required to rise to this challenge.</p><p>Until recently, local transmission of Japanese encephalitis virus (JEV) in Australia was limited to the Torres Strait and Cape York. A widespread outbreak in 2022–23 in New South Wales, Queensland, Victoria and South Australia heralded that the country might be entering a new era in the epidemiology of this mosquito-borne virus. Indeed, at the end of last year, Victoria reported its first case of JEV since the last outbreak (https://www.theguardian.com/australia-news/2024/dec/31/japanese-encephalitis-case-found-in-victoria-prompts-high-risk-warning). Dowsett and colleagues (https://doi.org/10.5694/mja2.52550) explain how a changing climate could be contributing to the emergence and spread of JEV in Australia through increases in rainfall, temperature and levels of evaporation and humidity, which in turn affect the interactions between JEV vectors, hosts and the environment.</p><p>After reviewing Australia's JEV surveillance efforts to-date, Dowsett and colleagues conclude that “there is a pressing need to shift from a reactive ‘surveillance and response’ approach to a more proactive, comprehensive ‘predict and prevent’ strategy, particularly in regional areas of Australia where populations are at greater risk”. Key recommendations for action include developing comprehensive surveillance systems that target multiple diseases with overlapping ecology and transmission (such as JEV, West Nile virus, and Murray Valley encephalitis virus), utilising multidisciplinary One Health approaches, and the creation of a central data repository to assist in the rapid detection and containment of outbreaks, potentially led by the nascent Australian Centre for Disease Control (www.cdc.gov.au). These efforts should be complemented by enhancing research capacity for the diversity of vector-borne diseases that affect Australia and our region.</p><p>Recognising that our population is already experiencing the impacts of climate change on health and wellbeing, in December 2023, Australia launched its first National Health and Climate Strategy (https://www.health.gov.au/our-work/national-health-and-climate-strategy). Writing in the <i>MJA</i>, Beherns and their colleagues (https://doi.org/10.5694/mja2.52552) from the Australian Department of Health and Aged C
{"title":"Policy responses to climate crisis and health in Australia: a need for urgency","authors":"Elizabeth Zuccala","doi":"10.5694/mja2.52584","DOIUrl":"10.5694/mja2.52584","url":null,"abstract":"<p>The extraction and burning of oil, coal and gas is overheating our planet. The result is a changing climate that is becoming more extreme and less predictable. According to the Bureau of Meteorology (https://media.bom.gov.au/releases/1250/preliminary-summary-of-australias-climate-in-2024), for instance, 2024 was Australia's second hottest year on record. With intensifying climate events like extreme heat, drought, flooding and bushfires, as well as associated threats to biodiversity and food and water security, come myriad adverse impacts on health. Two articles in this issue of the <i>MJA</i> speak to the health implications of the climate crisis and the policy responses required to rise to this challenge.</p><p>Until recently, local transmission of Japanese encephalitis virus (JEV) in Australia was limited to the Torres Strait and Cape York. A widespread outbreak in 2022–23 in New South Wales, Queensland, Victoria and South Australia heralded that the country might be entering a new era in the epidemiology of this mosquito-borne virus. Indeed, at the end of last year, Victoria reported its first case of JEV since the last outbreak (https://www.theguardian.com/australia-news/2024/dec/31/japanese-encephalitis-case-found-in-victoria-prompts-high-risk-warning). Dowsett and colleagues (https://doi.org/10.5694/mja2.52550) explain how a changing climate could be contributing to the emergence and spread of JEV in Australia through increases in rainfall, temperature and levels of evaporation and humidity, which in turn affect the interactions between JEV vectors, hosts and the environment.</p><p>After reviewing Australia's JEV surveillance efforts to-date, Dowsett and colleagues conclude that “there is a pressing need to shift from a reactive ‘surveillance and response’ approach to a more proactive, comprehensive ‘predict and prevent’ strategy, particularly in regional areas of Australia where populations are at greater risk”. Key recommendations for action include developing comprehensive surveillance systems that target multiple diseases with overlapping ecology and transmission (such as JEV, West Nile virus, and Murray Valley encephalitis virus), utilising multidisciplinary One Health approaches, and the creation of a central data repository to assist in the rapid detection and containment of outbreaks, potentially led by the nascent Australian Centre for Disease Control (www.cdc.gov.au). These efforts should be complemented by enhancing research capacity for the diversity of vector-borne diseases that affect Australia and our region.</p><p>Recognising that our population is already experiencing the impacts of climate change on health and wellbeing, in December 2023, Australia launched its first National Health and Climate Strategy (https://www.health.gov.au/our-work/national-health-and-climate-strategy). Writing in the <i>MJA</i>, Beherns and their colleagues (https://doi.org/10.5694/mja2.52552) from the Australian Department of Health and Aged C","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 2","pages":"57"},"PeriodicalIF":6.7,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52584","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Louise Wilson, Tessa Copp, Martha Hickey, Bec Jenkinson, Susan J Jordan, Rachel Thompson, Gita D Mishra, Jenny A Doust
<div> <section> <h3> Objectives</h3> <p>To estimate the prevalence of heavy menstrual bleeding among Australian women from young adulthood to midlife (22–48 years) and investigate the characteristics of women who experience this condition; to investigate the relationship of heavy menstrual bleeding and health-related quality of life.</p> </section> <section> <h3> Study design</h3> <p>Longitudinal cohort survey study (Australian Longitudinal Study on Women's Health, ALSWH).</p> </section> <section> <h3> Setting, participants</h3> <p>Australia; baseline cohort of 14 247 women born during 1973–1978, recruited in 1996; eight post-baseline surveys undertaken at 3-year intervals, 2000–2021.</p> </section> <section> <h3> Main outcome measures</h3> <p>Self-reported frequency of heavy menstrual bleeding during the preceding twelve months (never/rarely, sometimes, often); frequency of heavy menstrual bleeding by socio-demographic, behavioural, health, and reproduction-related characteristics; mean physical and mental health-related quality of life scores (36-item Short Form health survey, SF-36) by frequency of heavy menstrual bleeding. Results are weighted to adjust for oversampling of participants from rural and remote areas.</p> </section> <section> <h3> Results</h3> <p>Data for 11 311 respondents to at least one ALSWH post-baseline survey were included in our prevalence analysis. The prevalence of sometimes or often experiencing heavy menstrual bleeding increased from 17.6% at age 22 years (124 of 691 respondents) to 32.1% at 48 years (359 of 1132 respondents); the proportion who reported often experiencing the condition increased from 6.1% (45 participants) to 12.1% (136 participants). The likelihood of often experiencing heavy menstrual bleeding increased with body mass index (40 kg/m<sup>2</sup> or greater <i>v</i> 18.5–24.9 kg/m<sup>2</sup>: risk ratio [RR], 2.27; 95% confidence interval [CI], 1.93–2.67), and was greater for respondents who reported low iron levels (RR, 2.26; 95% CI, 2.03–2.51) or endometriosis (RR, 2.29; 95% CI, 2.06–2.54). Similar associations were seen for sometimes experiencing heavy bleeding. Mean health-related quality of life scores for women who reported heavy menstrual bleeding were lower in all domains and for the summary mental health and physical health scores than for women who reported never or rarely experiencing the condition; the differences were greater for women who often experienced heavy menstrual bleeding.</p>
{"title":"Women who experience heavy menstrual bleeding: prevalence and characteristics from young adulthood to midlife, Australia, 2000–2021: a longitudinal cohort survey study","authors":"Louise Wilson, Tessa Copp, Martha Hickey, Bec Jenkinson, Susan J Jordan, Rachel Thompson, Gita D Mishra, Jenny A Doust","doi":"10.5694/mja2.52596","DOIUrl":"10.5694/mja2.52596","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To estimate the prevalence of heavy menstrual bleeding among Australian women from young adulthood to midlife (22–48 years) and investigate the characteristics of women who experience this condition; to investigate the relationship of heavy menstrual bleeding and health-related quality of life.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Longitudinal cohort survey study (Australian Longitudinal Study on Women's Health, ALSWH).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>Australia; baseline cohort of 14 247 women born during 1973–1978, recruited in 1996; eight post-baseline surveys undertaken at 3-year intervals, 2000–2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Self-reported frequency of heavy menstrual bleeding during the preceding twelve months (never/rarely, sometimes, often); frequency of heavy menstrual bleeding by socio-demographic, behavioural, health, and reproduction-related characteristics; mean physical and mental health-related quality of life scores (36-item Short Form health survey, SF-36) by frequency of heavy menstrual bleeding. Results are weighted to adjust for oversampling of participants from rural and remote areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data for 11 311 respondents to at least one ALSWH post-baseline survey were included in our prevalence analysis. The prevalence of sometimes or often experiencing heavy menstrual bleeding increased from 17.6% at age 22 years (124 of 691 respondents) to 32.1% at 48 years (359 of 1132 respondents); the proportion who reported often experiencing the condition increased from 6.1% (45 participants) to 12.1% (136 participants). The likelihood of often experiencing heavy menstrual bleeding increased with body mass index (40 kg/m<sup>2</sup> or greater <i>v</i> 18.5–24.9 kg/m<sup>2</sup>: risk ratio [RR], 2.27; 95% confidence interval [CI], 1.93–2.67), and was greater for respondents who reported low iron levels (RR, 2.26; 95% CI, 2.03–2.51) or endometriosis (RR, 2.29; 95% CI, 2.06–2.54). Similar associations were seen for sometimes experiencing heavy bleeding. Mean health-related quality of life scores for women who reported heavy menstrual bleeding were lower in all domains and for the summary mental health and physical health scores than for women who reported never or rarely experiencing the condition; the differences were greater for women who often experienced heavy menstrual bleeding.</p>\u0000 ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 4","pages":"191-197"},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52596","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Melanie Wong, Bradley Gardiner, Rob Stirling, Golsa Adabi, Brooke Riley, Jyotika D Prasad, GregoryI Snell
{"title":"Putting international practice into action: the first case of lung transplantation for COVID-19 in Victoria, Australia","authors":"Melanie Wong, Bradley Gardiner, Rob Stirling, Golsa Adabi, Brooke Riley, Jyotika D Prasad, GregoryI Snell","doi":"10.5694/mja2.52597","DOIUrl":"10.5694/mja2.52597","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 4","pages":"179-180"},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Programs for Aboriginal and Torres Strait Islander people for improving the modifiable risk factors of tobacco smoking, nutrition, alcohol consumption, physical activity, and social and emotional wellbeing can reduce the prevalence of chronic disease.<span><sup>1</sup></span> However, health promotion programs have typically focused on the individual level rather than broader actions, such as establishing supportive environments or reorienting health care services.<span><sup>1</sup></span> To facilitate health equity for Aboriginal and Torres Strait Islander people, these actions must take into account both the social and the cultural determinants of health and wellbeing.<span><sup>2</sup></span></p><p>In this issue of the <i>MJA</i>, Dissanayake and colleagues assessed the effects on chronic disease risk factors of a novel dietary and lifestyle program that incorporates traditional knowledge and practices, the Hope for Health program, in a single-arm trial in a remote northeast Arnhem Land Yolŋu community.<span><sup>3</sup></span> The program was co-designed with a group of senior Yolŋu women, and had been successfully piloted. Strong Aboriginal ownership, governance, and cultural approaches were apparent. At the start of the trial, the 55 adult participants were overweight or obese (based on their body mass index [BMI] or waist circumference); by the end of the four-month program, desirable changes in chronic disease risk factors had been achieved, including in anthropometric (weight, BMI, waist circumference) and some cardiometabolic health measures (reduced low-density lipoprotein cholesterol and glycated haemoglobin [HbA<sub>1c</sub>] levels). Median walking and moderate and vigorous physical activity also increased by more than 100 minutes per day for the 19 participants for whom analysable data were available. Some dietary improvements were also reported.<span><sup>3</sup></span></p><p>The single-arm design of the study by Dissanayake and colleagues was appropriate for the co-designed program. A recent review found that the number of experimental studies of diabetes interventions including Aboriginal and Torres Strait Islander participants was low.<span><sup>4</sup></span> However, the authors could report changes in diet, exercise, and metabolic biomarkers can only as being associated with the program; a direct causal effect cannot be assumed. Randomised controlled trials may not be the optimal study design for interventional research involving Aboriginal and Torres Strait Islander people because of problems related to bias, sample size, and ethics.<span><sup>5</sup></span> This view is consistent with decisions described by Dissanayake and colleagues that revised the study from a randomised controlled trial to a single arm format because of community concerns that participants allocated to the control arm could be at risk of health deterioration, and the desire for inclusive family participation.<span><sup>3</sup></span></p><p>A recen
{"title":"Embedding culture in co-designed chronic disease programs for Aboriginal and Torres Strait Islander people","authors":"Rona Macniven, Karla J Canuto","doi":"10.5694/mja2.52599","DOIUrl":"10.5694/mja2.52599","url":null,"abstract":"<p>Programs for Aboriginal and Torres Strait Islander people for improving the modifiable risk factors of tobacco smoking, nutrition, alcohol consumption, physical activity, and social and emotional wellbeing can reduce the prevalence of chronic disease.<span><sup>1</sup></span> However, health promotion programs have typically focused on the individual level rather than broader actions, such as establishing supportive environments or reorienting health care services.<span><sup>1</sup></span> To facilitate health equity for Aboriginal and Torres Strait Islander people, these actions must take into account both the social and the cultural determinants of health and wellbeing.<span><sup>2</sup></span></p><p>In this issue of the <i>MJA</i>, Dissanayake and colleagues assessed the effects on chronic disease risk factors of a novel dietary and lifestyle program that incorporates traditional knowledge and practices, the Hope for Health program, in a single-arm trial in a remote northeast Arnhem Land Yolŋu community.<span><sup>3</sup></span> The program was co-designed with a group of senior Yolŋu women, and had been successfully piloted. Strong Aboriginal ownership, governance, and cultural approaches were apparent. At the start of the trial, the 55 adult participants were overweight or obese (based on their body mass index [BMI] or waist circumference); by the end of the four-month program, desirable changes in chronic disease risk factors had been achieved, including in anthropometric (weight, BMI, waist circumference) and some cardiometabolic health measures (reduced low-density lipoprotein cholesterol and glycated haemoglobin [HbA<sub>1c</sub>] levels). Median walking and moderate and vigorous physical activity also increased by more than 100 minutes per day for the 19 participants for whom analysable data were available. Some dietary improvements were also reported.<span><sup>3</sup></span></p><p>The single-arm design of the study by Dissanayake and colleagues was appropriate for the co-designed program. A recent review found that the number of experimental studies of diabetes interventions including Aboriginal and Torres Strait Islander participants was low.<span><sup>4</sup></span> However, the authors could report changes in diet, exercise, and metabolic biomarkers can only as being associated with the program; a direct causal effect cannot be assumed. Randomised controlled trials may not be the optimal study design for interventional research involving Aboriginal and Torres Strait Islander people because of problems related to bias, sample size, and ethics.<span><sup>5</sup></span> This view is consistent with decisions described by Dissanayake and colleagues that revised the study from a randomised controlled trial to a single arm format because of community concerns that participants allocated to the control arm could be at risk of health deterioration, and the desire for inclusive family participation.<span><sup>3</sup></span></p><p>A recen","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 4","pages":"181-182"},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52599","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hasthi UW Dissanayake, George Gurruwiwi, J Dhurrkay, Josh C Tynan, Sabine Braat, Benjamin Harrap, Tim Trudgen, Sarah Hanieh, Bronwyn Clark, Michaela Spencer, Michael Christie, Emma Tonkin, Emily Armstrong, Leonard C Harrison, John M Wentworth, Julie K Brimblecombe, Beverley-Ann Biggs
<div> <section> <h3> Objective</h3> <p>To evaluate the impact of a 4-month dietary and lifestyle program co-designed and led by Aboriginal and Torres Strait Islander people on weight and metabolic markers, diet, and physical activity in overweight and obese adults in a remote Indigenous community.</p> </section> <section> <h3> Study design</h3> <p>Single arm, pre–post intervention study.</p> </section> <section> <h3> Setting, participants</h3> <p>Adult residents (18–65 years) of a remote Northern Territory community with body mass index (BMI) values of at least 25 kg/m<sup>2</sup> or waist circumferences exceeding 94 cm (men) or 80 cm (women).</p> </section> <section> <h3> Intervention</h3> <p>Hope for Health, a culturally sensitive 4-month program supporting self-managed health improvement based on dietary and lifestyle change, 1 August to 30 November 2022.</p> </section> <section> <h3> Main outcome measures</h3> <p>Weight loss of at least 5%; changes in BMI, waist circumference, other metabolic markers (blood pressure, biomarkers of metabolic health and inflammation), diet, and physical activity; participant perceptions of the program.</p> </section> <section> <h3> Results</h3> <p>We assessed outcomes for 55 participants who completed weight assessments at both baseline and program end (mean age, 42.5 years [standard deviation, 10.1 years]; 36 women [65%]). Forty participants lost and 15 gained weight; overall mean weight loss was 1.5 kg (95% confidence interval [CI], 0.5–2.4 kg), and ten participants (18%; 95% CI, 9–31%) achieved at least 5% weight reduction. The mean change in BMI (53 participants) was –0.60 kg/m<sup>2</sup> (95% CI, –0.93 to –0.27 kg/m<sup>2</sup>), in waist circumference (53 participants) –3.2 cm (95% CI, –4.7 to –1.7 cm), and in low-density lipoprotein cholesterol level (37 participants) –0.28 mmol/L (95% CI, –0.47 to –0.08 mmol/L); the relative decline in the HbA<sub>1c</sub> level geometric mean (50 participants) was 11% (95% CI, 6–15%). The intake of breads and cereals (median change, –1.5 [95% CI, –2.0 to –1.0] serves/day) and sugar-sweetened beverages (–0.6 [95% CI, –1.4 to –0.1] serves/day) declined; the amount of moderate and vigorous physical activity increased by a median of 103 min/day (95% CI, 74–136 min/day; 19 participants). The program focus on integrating healthy bodies and networks of kin, healthy governance,
{"title":"Improving cardiometabolic risk factors in Aboriginal and Torres Strait Islander people in northeast Arnhem Land: single arm trial of a co-designed dietary and lifestyle program","authors":"Hasthi UW Dissanayake, George Gurruwiwi, J Dhurrkay, Josh C Tynan, Sabine Braat, Benjamin Harrap, Tim Trudgen, Sarah Hanieh, Bronwyn Clark, Michaela Spencer, Michael Christie, Emma Tonkin, Emily Armstrong, Leonard C Harrison, John M Wentworth, Julie K Brimblecombe, Beverley-Ann Biggs","doi":"10.5694/mja2.52593","DOIUrl":"10.5694/mja2.52593","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the impact of a 4-month dietary and lifestyle program co-designed and led by Aboriginal and Torres Strait Islander people on weight and metabolic markers, diet, and physical activity in overweight and obese adults in a remote Indigenous community.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Single arm, pre–post intervention study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>Adult residents (18–65 years) of a remote Northern Territory community with body mass index (BMI) values of at least 25 kg/m<sup>2</sup> or waist circumferences exceeding 94 cm (men) or 80 cm (women).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Intervention</h3>\u0000 \u0000 <p>Hope for Health, a culturally sensitive 4-month program supporting self-managed health improvement based on dietary and lifestyle change, 1 August to 30 November 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Weight loss of at least 5%; changes in BMI, waist circumference, other metabolic markers (blood pressure, biomarkers of metabolic health and inflammation), diet, and physical activity; participant perceptions of the program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We assessed outcomes for 55 participants who completed weight assessments at both baseline and program end (mean age, 42.5 years [standard deviation, 10.1 years]; 36 women [65%]). Forty participants lost and 15 gained weight; overall mean weight loss was 1.5 kg (95% confidence interval [CI], 0.5–2.4 kg), and ten participants (18%; 95% CI, 9–31%) achieved at least 5% weight reduction. The mean change in BMI (53 participants) was –0.60 kg/m<sup>2</sup> (95% CI, –0.93 to –0.27 kg/m<sup>2</sup>), in waist circumference (53 participants) –3.2 cm (95% CI, –4.7 to –1.7 cm), and in low-density lipoprotein cholesterol level (37 participants) –0.28 mmol/L (95% CI, –0.47 to –0.08 mmol/L); the relative decline in the HbA<sub>1c</sub> level geometric mean (50 participants) was 11% (95% CI, 6–15%). The intake of breads and cereals (median change, –1.5 [95% CI, –2.0 to –1.0] serves/day) and sugar-sweetened beverages (–0.6 [95% CI, –1.4 to –0.1] serves/day) declined; the amount of moderate and vigorous physical activity increased by a median of 103 min/day (95% CI, 74–136 min/day; 19 participants). The program focus on integrating healthy bodies and networks of kin, healthy governance,","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 4","pages":"183-190"},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52593","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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