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The Chronicle – Publication of the Chronic Diseases Network
Volume 24, Issue 3, September 2012
IN THIS ISSUE ….
THE WISE GENERATION
CONTENTS
Cover Page:
Bowel Cancer Screening
No Smokes: It’s Deadly
Themed Articles:
The COTA Story
DRUID: follow up study
Rheumatic Heart Guideline Phone Apps
Asthma and Seniors
The Journey May Be Longer Than You Think
Physical Activity Recommendations for Older Australians
Home Dialysis Therapies
Regional Profile:
Reducing Tobacco-Related Harm in the Alice Springs Region
Creating Local Heroes at Ntaria Aged Care Centre
Frequently Asked Question
Regular Column:
NT CCPMS
General Articles:
Breastscreen NT
Library Resources and Mobile Apps: helping you keep up to date
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 NT
Cancer Council of the NT
Healthy Living NT
Heart Foundation – NT Division
Medicare Local NT
Menzies School of Health Research
NT DoH Allied Health/Environmental
Health
NT DoH Community Health
NT DoH Health Promotion
NT DoH Nutrition and Physical Activity
NT DoH Chronic Conditions Strategy Unit
THE CHRONICLE - CDN EDITORIAL COMMITTEE
CHRONIC DISEASES NETWORK
T: 08 8922 8280 / F: 08 8985 8177
E: [email protected]
www.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
memory
Contributions appearing in The Chronicle do not necessarily reflect the
views of the editor or DoH.
Bowel Cancer Screening
Jessica Alcorso, Health Promotion and Special Projects Officer
Cancer Council NT
Bowel cancer is the second most common form of cancer in Australia
with around 14 000 cases diagnosed each year, and approximately 80
deaths each week. If detected early bowel cancer can be treated
successfully, but currently less than 40% of bowel cancers are found
at an early stage.
The National Bowel Cancer Screening Program is the result of
recommendations from The National Health and Medical Research Council
that faecal occult blood test (FOBT) screening of average risk people
should begin at age 50 and continue every two years. It is encouraging
that the Federal Government has announced it will be expanding the
free screening program, initially only for people aged 50, 55 and 65,
to include all Australian’s turning 50, 55 and 60 in 2013, and 65 and
70 in 2015. People are sent free FOBT kits by mail.
It is important to encourage participation in screening even for those
who do not have any obvious symptoms, because it means bowel cancer
can be caught in its early stages. Doing a FOBT every two years can
reduce the risk of death from bowel cancer by up to one third1. People
who are not eligible for a free kit you can speak to their doctor
about purchasing a kit. Kits are available from GPs, chemists and
online through Bowel Cancer Australia.
For more information regarding screening for bowel cancer the Cancer
Council suggest speaking to a GP or calling the Cancer Helpline on 13
11 20.
For information on the National Bowel Cancer Screening Program, visit:
http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/bowel-about
Reference:
1.http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/bowel-about
NO SMOKES: IT’S DEADLY
Patricia Pinto, Team Member No Smokes Project
Menzies School of Health Research
Indigenous comedian on-the-rise Sean Choolburra, Bangarra dance troupe
performer Rarriwuy Hick, and hip hop singer Corey "Yung Nooky" Webster
are just three of the prominent Aboriginal Australians featured on the
new No Smokes website, which went live on World No Tobacco Day, 31st
May 2012.
No Smokes is an anti-smoking initiative designed especially for use by
young Indigenous people. It’s based on the understanding that social
marketing is at its most effective when it speaks the language of its
intended audience, when messages are delivered by people they look up
to, and when they can see something of themselves in the faces and
voices featured.
As Project Leader Dr Sheree Cairney explains:
“No Smokes is about providing positive role models for Indigenous
young people and helping them understand the detrimental physical
effects of tobacco.
Smoking causes one out of every five deaths among Australia’s
Indigenous population. More than half of Australia’s Indigenous people
smoke; compared to less than one fifth of non-Indigenous Australians.
It stands to reason therefore, that if we’re serious about ‘closing
the gap’ between the life expectancy of Indigenous and non-Indigenous
Australians, addressing smoking rates is a high priority.”
No Smokes is a project that has been two years in the making by Dr
Cairney and her team. Inspired by encouraging results from New Zealand
– where quit rates of 60% were achieved using multimedia strategies –
the researchers held extensive focus groups with young Indigenous
people, teachers and youth workers to discover what would work best
here.
Not surprisingly – and mirroring the New Zealand experience – the No
Smokes team found that Aboriginal and Torres Strait Islander young
people did not identify with most traditional anti-smoking campaigns
and therefore easily dismissed the campaign’s message.
Those Cairney interviewed found a much stronger pull to multimedia,
video, social networking, animation, music and mobile phones – media
is especially useful in overcoming language and literacy barriers. As
a result, No Smokes is rich with interactive content, including mobile
phone apps, links with social networking sites and a YouTube channel
‘No Smokes TV’.
“Participants said they wanted to see Aboriginal faces and messages
that mean something to them. We believe that with No Smokes we’ve
created the most relevant and effective site possible,” she says.
“We’re aiming to empower young people with knowledge – with clear
messages explaining the facts about smoking, and functions like an
animated brain that shows how tobacco addiction works – as well as to
entertain them with features like the hip hop dance-off that lets
users upload their own photos.”
The No Smokes website is now up and running and is well worth a look.
It features numerous video clips, the aforementioned brain animation,
interactive games and quizzes – all ‘on message’ about the dangers of
smoking and with some great support for smokers to quit and stay quit.
From a hilarious skit of comedian Sean Choolburra hamming it up in a
version of Beyonce’s ‘All the Single Ladies’ where he substitutes ‘All
the Cigarettes’ and concludes that ‘if you love it put a patch on it’
to a cheesy game show style quit quiz with a gold toothed Indigenous
compere walking players through a successful quit journey, No Smokes
is novel, fun and youth friendly.
No Smokes is also a great resource for teachers and health workers,
providing educational material, downloadable tools and fun interactive
activities. Designated teacher and health worker sections are going
live in the coming weeks.
The No Smokes site was developed with the help of a $700,000 grant
from the Australian Government Department of Health and Ageing.
Check out No Smokes at www.nosmokes.com.au It’s deadly!
The Groovy Grans
Dottie Daby, Coordinator
Groovy Grans
Groovy Grans is a Senior Linedancing Troupe. I am the Co ordinator,
organiser and teacher as well as a performer with the group comprising
of seniors from 60 years of age to 80 years of age. I guess we are
doing something right for each other and for ourselves.
We practise every Wednesday from 1pm-5pm; 1pm to 2.15pm is for those
seniors interested in public performances and depending on the space
at various venues the group could comprise of 6, 10 or 13 performers.
Public performers must be 60 years and over. We allow ourselves a 15
minute break and hit the floor again. From 2.30pm to 5pm we open the
class to anyone wishing to join us.
Most of the Groovy Grans are chronic sufferers including myself; we
suffer from diabetes, heart diseases, osteoporosis, blood pressure
problems, blood disorders and epilepsy. We also have cancer survivors
in our group - you name it we’ve got it, or had it!! The exercise
through dancing helps our way of life, gives us something to look
forward to doing and motivates us.
We dance for various senior groups and organisations and perform for
most of the Nursing Homes in the Northern Territory, especially at
Christmas time. We always endeavour to present a new act at the
Firie’s Pensioners Christmas party each year; this event is enjoyed by
approximately 600 people.
We did 25 public performances in 2011 and some of our performances
were:
for “Around Palmerston” at the Casino
the Royal Darwin Show for Darwin City Council
the Holiday Inn for the International Conference of the Bromiallad
Garden Club
NAIDOC Seniors dinner/dance at Tracy Village and St. Mary’s
We have even done a football show at Kantilla’s and although some
young footballers were present - we were a hit in our football
Guernseys, football shorts and long club socks - it was a scream
especially with the dances being performed to the football club songs!
All the shows we do are mostly on voluntary basis especially for the
Nursing Homes (we are even happy to perform for bikkies and a cuppa).
When we are presented with a donation, it is so exciting and eagerly
accepted. The big organisations always have us for a luncheon or a
dinner - we dance for our supper (as it were).
We haunt the Op shops for most of our outfits and the sleepless nights
of dreaming up the acts are worth every minute, especially to see the
enjoyment on everyone’s faces with all the toe tapping, hand clapping,
body swaying in seats and smiles all around! It is most rewarding and
we love every minute of it.
My interest in linedancing is to stay fit, active, and motivated and
this interest in the Groovy Grans is keeping “my ladies” fit, active
and motivated as well. Linedancing has given “my ladies” self esteem
and confidence, and is a pleasurable way of exercising to music.
I find that dancing helps me think of other things instead of on my
health problems. I would now like to share some of the other member’s
reasons for being part of the Groovy Grans.
Maureen Thomas says:
“I joined the Seniors Linedancing Troupe at Palmerston when it first
started approximately 8 years ago with Dottie Daby. My reason for
joining was to keep fit and healthy in my later years while enjoying
myself, and also to meet and socialise with other people. I had never
done line dancing before; I am now 75 years young and it certainly
keeps my mind active.
Pat Cook says:
“I have been a member of the Groovy Grans for 4 years and I enjoy the
social aspect as well as the fact that I get to exercise and have
company while doing so.”
Joan Carter says:
“I have been linedancing for a long time. It is so good that I can’t
remember! It keeps my brain working, I love the social interaction and
it is so much fun.”
Ruth Bishop says:
“I enjoyed 15 years of linedancing at Port Lincoln and since coming to
Darwin have been with the Groovy Grans for 3 years. I love the
exercise, the dancing and being part of the Groovy Grans which
provides us the opportunity to make friends and we enjoy each other’s
company.”
Marge Duminiski (Music Marge) says:
“I love the company and dancing but the best part is the “chardy
afterwards”.
The COTA NT Story
Robyn Lesley, Chief Executive Officer
COTA NT
Council on the Ageing (Northern Territory) Inc (COTA NT for short) is
a not for profit organisation. It was established in the NT in 1969 to
support and assist seniors in all aspects of life to live well, and
advocate for services and their appropriate delivery. COTA NT works
with its senior’s membership across the NT, organisations supporting
seniors and non members in the age categories of over 45 years for
Indigenous and over 50 years of non indigenous seniors.
COTA’s Darwin office is located at Spillett House, 65 Smith Street
where a variety of programs and projects are delivered including:
the Partners in Culturally Appropriate Care (PICAC)
Peer Education delivery of Beyond Maturity Blues and Quality Use of
Medicines
Computer Training Hub for seniors
Seniors Month Activity Program
Multicultural Affairs Sponsorship Program for Seniors
Independent Seniors Round Table
Policy Council
Information and referral services for seniors
Coordination of a wide range of information /workshop events targeting
seniors
Research and advocacy relevant to seniors as a method of supporting
effective and relevant decisions by the different levels of government
regarding seniors
COTA NT has two branches: Coomalie and Darwin – and links other
seniors in Katherine, Tennant Creek and Alice Springs via members.
These networks provide valuable resources for volunteers and social
engagement.
The five top priorities for NT Government action developed by COTA and
endorsed by the Independent Seniors Round Table during 2012 are:
Access to and design of housing for different cohorts of seniors
across the NT
Employment opportunities for seniors and how to address ageism in the
workplace
Appropriately designed public and private infrastructure which is
access friendly for all but considers the particular needs of seniors,
the disabled and mothers with young children
Consumer friendly service delivery
An integrated Transport service for vulnerable seniors within the
greater Darwin region (extending to other centres as the model is
developed and tested)
COTA NT has worked effectively with its State/Territory partners
through COTA Australia on the aged care reform agenda over the past
three years. As the Commonwealth rolls out the decisions arising from
the Productivity Commission’s report ‘Caring for Older Australians’,
the NT will be faced with the challenges of the fastest growing
population group being the over 50 years and the implementation of
seniors’ wishes aligned with Commonwealth policy to support “ageing in
place”. This means that service delivery methods will change. COTA NT
looks forward to working with service providers, governments and
volunteers to ensure we cope with the challenge of growth in the
numbers of seniors in the NT and quality in design and service
delivery to the home.
COTA NT can be contacted on Phone 08 89 411004, Monday to Friday
between 10am to 4pm.
Implications of an ageing population on health services in the
Northern Territory
Bhanu Bhatia, Research Assistant
Karen Dempsey, Senior Epidemiologist
Steven Guthridge, Director
Health Gains Planning, Health Protection Division
Australia’s population is ageing. This means that the proportion of
people in the 65 years and over age group is increasing. This group
comprised 13% of the Australian population in 2006,1 13.5% in 20102
and is likely to increase to 22.6% of the population by 2050.3 This
poses significant social and economic challenges including increasing
burden of disease and health care expenditure.4
In the Northern Territory (NT), the population has been comparatively
younger than in other States and Territories and consequently issues
related to population ageing have not been prominent. However, the
impact of ageing in the NT is changing. In 2006 only 4.6% of
Territorians were aged 65 years and over.5 Over the following four
years this proportion increased to be 5.5% in 2010.6 Even though the
proportion of older residents in the NT population is lower than the
national average, the rate of growth among this age group has been
higher.5 The ageing of the NT population is expected to continue
well into the future as illustrated in Figure 1, which shows that
while the projected proportions of children (0–14 years) and working
age persons (15–64 years) are set to decline; the proportion of older
persons (65 years and over) is expected to increase. By 2036, the
proportion of the NT Indigenous population in this older age group is
projected to be 8% and for the non-Indigenous 11.4%, which together
will be 10.3% of the total population.7
Making this demographic transition more challenging for the NT is the
relatively large Indigenous population, who have a much earlier onset
of disease and disability.8-9 The disease profile of middle-aged
Indigenous Territorians aged 50 to 64 years is similar to that of
non-Indigenous Territorians aged 65 years and over. An example of this
health differential is demonstrated by NT hospital admission rates.
The results in Table 1 display public hospital admission rates per
1,000 population for all-causes of disease and injury across
four-periods, spanning from 1992 to 2010. In each period the admission
rate of middle-aged Indigenous people (50–64 year olds) was marginally
lower than older non-Indigenous people (65 years and over) and the
growth in admission rates was similar. Admission rates doubled over
time for middle-aged Indigenous Territorians and almost doubled for
older non-Indigenous Territorians. Mortality rates are also presented
in the table and, for most groups, declined in each of the four 5-year
periods between 1986 and 2005.
While the ageing NT population signifies tremendous achievements in
improved life expectancy and a stabilisation of the out-migration of
older residents, it also raises challenges for the future. Ageing of
the population implies considerable growth in future health care
needs, in the face of already existing labour shortages in the health
care industry and an anticipated decline in the proportion of the
working-age population in the NT.7,10 There is, therefore, an urgent
need to moderate future health care demand, including through
investment in preventative health care measures that mitigate the risk
of diseases.10-11
References:
1. Australian Institute of Health and Welfare. Older Australia at a
glance: 4th edition. Cat. no. AGE 52. Canberra: AIHW, 2007.
2. Australian Bureau of Statistics. Population by age and sex, regions
of Australia, 2010. Cat. no. 3235.0. Canberra: ABS, 2011.
3. Treasury. Australia to 2050: Future challenges. Canberra:
Australian Government, 2010.
4. Productivity Commission. Economic implications of an ageing
Australia, Research Report. Canberra, 2005.
5. Australian Bureau of Statistics. Australian demographic statistics,
June 2009. Cat. no. 3101.0. Canberra: ABS, 2009.
6. Department of Health. Northern Territory resident population
estimates by age, sex, Indigenous status and health districts
(1971–2010). Health Gains Planning, file updated 01 Apr 2011, using
ABS Estimated Resident Population, 2011.
7. Northern Territory Treasury. Northern Territory population
projections 2009. Output file: Excel spreadsheet. Viewed 25 March
2010, .
8. Zhao Y, You J, Guthridge S. Burden of disease and injury in the
Northern Territory, 1999–2003. Darwin: Department of Health and
Families, 2009.
9. Li SQ, Pircher SLM, Guthridge SL, Condon JR, Wright AJ. Hospital
admissions in the Northern Territory 1976–2008. Darwin: Department of
Health, 2011.
10. Zhao Y, Goss J, Malyon R. What drives health spending in the
Northern Territory? Economic Papers 2010;29(3):292-300.
11. Zhao Y, Condon JR, Guthridge S, You J. Living longer with a
greater health burden - changes in the burden of disease and injury in
the Northern Territory Indigenous population between 1994–1998 and
1999–2003. Australian and New Zealand Journal of Public Health 2010;34
(S1):S93–98.

Darwin Region Urban Indigenous Diabetes (DRUID):
follow-up study
On behalf of the DRUID study investigators
Prof Joan Cunningham, Epidemiologist and Principal Research Fellow
Menzies School of Health Research
Dr Louise Maple-Brown, Endocrinologist and Senior Research Fellow
Menzies School of Health Research
Dr Elizabeth Barr, Research Fellow
Menzies School of Health Research
Mr Shaun Tatipata, Senior Program Officer
Fred Hollows Foundation
Associate Professor Terry Dunbar, Director
Australian Centre for Indigenous Knowledge and Education, Charles
Darwin University
Corresponding author
Dr Elizabeth Barr MPH PhD, Research Fellow
Menzies School of Health Research
Diabetes significantly increases the risk of cardiovascular disease
(CVD: disease of the heart and blood vessels)1, and both diseases
represent a serious public health problem in Aboriginal & Torres
Strait Islander Australians, and are major causes of death and
disability for Indigenous people aged 45 years and over.2 Two-thirds
of all deaths among Indigenous Australians occur before the age of 65
years which is vastly greater than the 20% of deaths experienced by
non-Indigenous Australians at the same age.2 Therefore, the
prevention of diabetes and CVD is important to reduce the
discrepancies in health status between Indigenous and non-Indigenous
Australians.
The Darwin Region Urban Indigenous Diabetes (DRUID) study was started
nine years ago to access the burden of diabetes, kidney disease, heart
disease and other health problems in Aboriginal & Torres Strait
Islander people in and around Darwin. DRUID included 1004 Indigenous
men and women volunteers aged ≥15 years (42% aged over 40 years), and
was conducted from September 2003 to March 2005. Details on the study
have been published3. Briefly, participants underwent a health
examination which involved blood and urine tests (including an oral
glucose tolerance test), clinical and anthropometric measurements, and
administration of questionnaires. Of those aged ≥55 years, half were
found to have diabetes. Even among younger people aged <35 years
without diabetes, 45% had at least two CVD risk factors, and very few
people had no risk factors.4 Thus, the future burden of CVD in this
population is great, and follow-up data on premature mortality, fatal
and non-fatal CVD and related conditions is now required.
In 2012, with funding from the Diabetes Australia Research Trust and
NHMRC program grant (#631947), the next phase -- the DRUID Follow-up
Study -- will look at how people’s health changes over time, and what
factors are important in predicting who gets diabetes, heart disease,
and other health problems, and who stays well. The study investigators
will work with the Indigenous Steering Group who will provide guidance
on the conduct of the study and dissemination of the study’s findings.
To capture as many outcomes as possible, both passive and active
follow-up methods will be undertaken. Passive follow-up will involve
data linkage of consenting participants (~90%) to the National Death
Index, Northern Territory and South Australian hospital databases, and
Northern Territory pathology laboratories. Active follow-up will
entail inviting participants who consented to be contacted again
(~90%) to answer a short questionnaire, and with permission,
participant’s medical records will be reviewed to verify self-reported
events.
The DRUID Follow-up Study aims to improve diabetes and CVD risk
assessment and advance our understanding on the links between diabetes
and related metabolic disorders, and CVD and mortality in urban
Indigenous Australians. Additionally, the influence of other factors
such as poverty and poor educational outcomes on these relationships
will be explored. We hope that this new information will assist health
workers to find and treat risk factors for diabetes and heart disease
much earlier and help keep people healthy and strong into middle age
and beyond.
References:
1. Barr EL, Zimmet PZ, Welborn TA, et al. Risk of cardiovascular and
all-cause mortality in individuals with diabetes mellitus, impaired
fasting glucose, and impaired glucose tolerance: the Australian
Diabetes, Obesity, and Lifestyle Study (AusDiab). Circulation
2007;116:151-7.
2. Australian Institute of Health and Welfare (AIHW). The health and
welfare of Australia’s Aboriginal and Torres Strait Islander people,
an overview 2011. Cat. no. IHW 42. Canberra: Australian Institute of
Health and Welfare; 2011.
3. Cunningham J, O'Dea K, Dunbar T, Weeramanthri T, Zimmet P, Shaw J.
Study protocol-diabetes and related conditions in urban indigenous
people in the Darwin, Australia region: aims, methods and
participation in the DRUID Study. BMC Public Health 2006;6:8.
4. O'Dea K, Cunningham J, Maple-Brown L, et al. Diabetes and
cardiovascular risk factors in urban Indigenous adults: Results from
the DRUID study. Diabetes Res Clin Pract 2008;80:483-9.

“Dry Mouth”: an often overlooked condition of the wise years
Dr Chris Handbury, Principal Dental Officer
Oral Health Services, Department of Health
One and a half litres of saliva: that’s how much the average healthy
person makes daily!!
One of the major oral problems encountered in the “wise years” is dry
mouth or xerostomia. The condition is unpleasant and often a major
complaint of older citizens. It can have the following complications:
Difficulty in swallowing
Difficulty with speech
A higher susceptibility to dental decay at the necks of teeth. This is
because saliva contains a number of antibodies, enzymes and fluoride
ions that assist in a constant battle against demineralisation of the
enamel and reducing the PH of the oral environment
It also changes dietary preferences: who wants to eat peanut butter or
vegemite with a dry mouth? It may alter the sufferer’s nutritional
status, causing vitamin deficiencies and caloric insufficiency
A number of factors contribute to this condition:
Sjögrens Syndrome
Sjögrens syndrome is a relatively common autoimmune disease that
mainly affects the eyes and salivary glands, but can also affect
different parts of the body. Immune system cells called lymphocytes
and auto antibodies attack the body’s moisture-producing glands. This
results in abnormal dryness of the mouth, eyes or other tissues.
The disorder may progress slowly, so the typical symptoms of dry eyes
and mouth may take years to show. However, rapid onset can also occur
with mild, moderate or severe symptoms, with progression often
unpredictable.
Drug induced xerostomia
Several hundred medications can cause or exacerbate xerostomia,
including antihypertensives, antidepressants, analgesics,
tranquilizers, diuretics, and antihistamines. These drugs affect the
saliva’s quantity and possibly quality, but usually the problem is
temporary or reversible.
Radiation
Irradiating to kill cancer cells in the treatment of oral carcinomas
requires dosages of between 40-60 Gys. Very significant permanent
damage can be done to both major and minor salivary glands. People
undergoing radiation need constant dental care prior, during and after
these treatments. There are a number of regimes that can assist with
their oral care.
What can be done to help reduce the symptoms of Xerostomia?
Sipping water or sucking on ice chips throughout the day may
moisturize the mucosa and possibly alleviate symptoms. If this is not
effective, artificially moisturizing the mucosa is a possible next
step. There are numerous types of saliva substitutes available
including; toothpastes, mouthwashes, chewing gum, spray and gels. They
are available in the oral care section of any pharmacy. They are best
used at bedtime and periodically throughout the day; their relief is
temporary and efficacy varies.
Oral pilocarpine, also a cholinergic agonist, is approved for salivary
gland hypofunction caused by radiotherapy for cancer of the head and
neck or in patients with Sjögren’s syndrome in the absence of
ophthalmologic and cardiorespiratory contraindications. It, too,
stimulates exocrine function. Side effects include sweating, nausea,
rhinitis, diarrhoea, flushing, and polyuria. Dose-related hypotension,
hypertension, bradycardia, and tachycardia can occur, as can blurred
vision. Patients must be able to increase fluid intake.
Conclusion
Dry mouth, especially when it is chronic, drastically alters patients’
lives. They will find that the sore mucous membranes and gums, cracked
lips and split corners of the mouth and a rough, painful tongue make
eating impossible. When teeth feel like razors, spicy foods set off
alarms, and sleep eludes them because they wake to sip water.
Xerostomia needs to be recognised and appropriate treatment options
commenced, as it significantly improves quality of life.
Rheumatic Heart guideline phone apps
Victoria Close, Marketing and Communications Unit
RHD Australia
A new iPhone, Android and iPad application will be available by the
end of June to assist with improving clinical practice and reduce
death and disability from acute rheumatic fever (ARF) and rheumatic
heart disease (RHD) throughout Australia.
ARF is a significant cause of disease among Indigenous children, often
leading to RHD, a chronic heart condition in which the heart valves
are damaged, which can lead to heart failure, strokes and premature
death.
Australia has amongst the highest recorded rates of RHD despite the
disease being almost eradicated in most developed countries during the
second half of the 20th century.
The apps are based on a new guideline; The Australian guideline for
prevention, diagnosis and management of acute rheumatic fever and
rheumatic heart disease (2nd edition).
Dale Thompson, Senior Manager of RHD Australia said the apps will be a
significant source of easily accessible information to doctors,
nurses, health workers and other clinicians working at the front line
of primary health care.
"Most doctors and nurses in Australia are trained in places where
rheumatic fever is rare, so when they come to rural and remote
settings where these diseases are common, they need easy ways to find
out about diagnosis and treatment. These apps make that information
easily accessible and should help ensure we deliver high quality
care," Dale Thompson said.
"These apps are particularly important for improving the quality of
health care for Aboriginal people and Torres Strait Islanders, who
bear the brunt of this disease in Australia."
Using the latest available evidence, RHD Australia (an initiative led
by the Menzies School of Health Research) undertook a comprehensive
update of the original 2006 guideline.
The revised guideline has expanded on the first edition to help
clinicians with additional information on preventative action,
diagnosis and management of ARF and RHD.
The evidence based guideline and information about the apps is
available online from www.rhdaustralia.org.au
Background
Rheumatic heart disease (RHD) is caused by one or more episodes of
acute rheumatic fever (ARF). These repeated episodes leave the heart
valves damaged so that they can no longer function adequately, leading
to heart failure and sometimes cardiac surgery or even death. ARF is
caused by the body's autoimmune response to an infection by the Group
A streptococcus germ, and is commonly seen in children from Indigenous
communities across northern and central Australia. ARF occurs mainly
in children aged between 5 and 14, and affects a number of areas of
the body, including the joints, brain, skin, and heart.
RHD Australia is Australia's national rheumatic heart disease
coordination unit and aims to reduce death and disability from acute
rheumatic fever and rheumatic heart disease. Funded by the Australian
Government Department of Health and Ageing RHD Australia is an
initiative of Menzies School of Health Research in partnership with
Baker IDI and James Cook University. The unit was established in 2009
as part of the National Rheumatic Fever Strategy.
Menzies School of Health Research is the national leader in Indigenous
and tropical health. The independent medical research institute aims
to improve and advance health; to break the cycle of disease and to
reduce the health inequities in Australia and the Asia Pacific region,
particularly for disadvantaged populations. Menzies sets its sights on
fostering excellence and leadership in scientific research and
education. The organisation has more than 300 staff working in over 60
communities in Central and Northern Australia, as well as the Asia
Pacific region.
Heartmoves has come to Alice Springs and it’s FREE!
Jess Karlsson, Director of Health and Wellness
YMCA of Central Australia
Lucinda Coobs, Healthy Communities Coordinator
Alice Springs Town Council
The National Heart Foundation’s Heartmoves is a gentle physical
activity program suitable for adults of all ages and is designed to be
safe for people with stable long term health conditions.
Five local health professionals have recently participated in
Heartmoves training to become accredited instructors. These
instructors are:
Pippa Tessmann, Physiotherapist, Alice Springs Physiotherapy & Sports
Injury Clinic
Jess Karlsson, Director, YMCA Health & Wellness
Jo Black, Registered Fitness Professional, YMCA Health & Wellness
Mitch Cameron, Development Officer, Alice Springs Town Council
Community
Lucinda Coobs, Healthy Communities Coordinator, Alice Springs Town
Council Community
Heartmoves is suitable for people with conditions such as asthma,
osteoporosis, arthritis, obesity, angina, lung conditions,
cardiovascular disease, chronic pain and muscle/joint problems.
Alice Springs Town Council’s Healthy Communities Coordinator, Lucinda
Coobs says:
‘Heartmoves is a fantastic low to medium intensity physical activity
program and is available FREE of charge to all adults in Alice Springs
for the duration of the ‘Active in Alice’ program. If you have
suffered a stroke, heart attack or heart surgery, Heartmoves is a
terrific follow on program after cardiac rehabilitation is completed’.
The benefits of participating in a Heartmoves program include:
maintaining a healthy lifestyle
social interaction and FUN
continued exercise after rehabilitation
lower blood pressure and improved cholesterol
weight management and diabetes control
prevention of falls from improved balance
Heartmoves sessions include:
warm up, cool down and stretching
aerobic and resistance training
balance, coordination and flexibility
Sessions are conducted by our accredited Heartmoves leaders and you
can attend one or all sessions currently being held at YMCA, Sadadeen
Road on:
Mondays 4:30pm
Wednesdays 12:00pm
Thursdays 10:15am
Heartmoves participant, 81 year old Ron Wallace of Alice Springs was
rushed to Adelaide with the Royal Flying Doctors Service suffering
tachycardia and returned with a pacemaker. Ron is now a regular member
of Heartmoves and the Heart Foundation Walking Group. Ron says:
‘The Heartmoves instructors are exceptional in their delivery of the
program, inspiring those within the class to work at their own fitness
levels’.
Ron believes the Heartmoves Program has provided him with numerous
benefits including ‘companionship, a feeling of wellbeing and having a
regular exercise regime’.
To register your interest please contact Lucinda Coobs, Healthy
Communities Coordinator on (08) 8950 0533 or email:
[email protected] OR you can start as early as today by arriving
at the YMCA ten minutes prior to class times to complete a
Pre-Exercise Questionnaire.
The Heart Foundation website at www.heartfoundation.org.au/heartmoves
is an excellent resource for further information on the history of the
Heart Foundation’s Heartmoves program.
Challenging Pain: a self-management course
Hilary Fowler, Secretary to the Arthritis & Osteoporosis Board
Arthritis & Osteoporosis NT
Pain is a factor of life for people with many different chronic
diseases. It can be very debilitating, both physically and mentally.
There are many conditions for which pain treatment is only partially
successful. In these cases the best alternative is learning to cope
with the pain so that life can continue as normally as possible.
‘Challenging Pain’ is a self-management course which aims to assist
pain sufferers in coping better with their pain. It is conducted over
two sessions of 2 ½ hours each one week apart. In both sessions
participants are asked to contribute both in pairs and in the general
group, and contributions are built on to develop techniques which can
be applied in everyday life.
In the first session pain is discussed and participants are asked to
assess the level of their pain. Reasons for challenging pain are
discussed, including the effect on activities and the negative
thoughts it generates. Conscious breathing techniques are practised
and gentle exercises introduced. Participants are asked to set
reasonable goals and ways of achieving them. Recognising and coping
with stress is addressed. Relaxation exercises are practised.
In the second session feedback from the goal setting of the previous
week is considered. The concept of diversion is discussed. The use and
side effects of medicines are considered. Positive and effective
communication is practised. The exercises and relaxation techniques
from the first session are practised and built on.
While some of this can be achieved by self-teaching with online
assistance, it has been found that the interactive group sessions are
very valuable for the participants. Meeting other people with similar
problems and discussing how they are coping and what they find helpful
can be of great assistance in managing the mental and emotional
aspects of pain.
A sufferer from osteoarthritis who attended the Challenging Pain
Course wrote 12 months later:
“Thanks to the management techniques I learned at the workshops I now
feel so much more in control. I can’t say I have no pain, however, by
following the guidelines I learnt, regarding exercise, diet and
attitude, my quality of life is much better and I am able to feel
confident that the crippling effects of the condition are
significantly reduced. I also use minimal pain killers as a result and
have an all-round healthy and pro-active approach. The best part is
that I am smiling and enjoying life again.”
In other states Challenging Pain has been offered to people waiting
for hip and knee replacement surgery. They have found that patients
who have completed the course recover more quickly from their surgery.
Challenging Pain is licensed from Arthritis Care UK and is currently
run by Arthritis & Osteoporosis NT (AONT) who will be conducting
training for presenters of Challenging Pain later this year. If you
are interested in doing the course please contact AONT on 89485232 or
email: [email protected]
If you would like to participate in Challenging Pain contact AONT as a
group of at least eight people is necessary to be viable.
Asthma and Seniors
Jan Saunders, Chief Executive Officer
Asthma Foundation NT
Asthma in older people is more common than previously understood. The
prevalence of asthma among middle-aged and older Australians is
approximately 15% as compared to the general adult population which is
estimated at approximately 10-12%. Emerging international evidence
suggests that the prevalence of both asthma and chronic obstructive
pulmonary disease (COPD) is increasing.
Asthma in seniors is often under-diagnosed due to:
lack of awareness of the possibility of new-onset asthma in seniors
respiratory symptoms being attributed to ageing or common diseases of
seniors
poor recognition of asthma symptoms by older people
associated co-morbidity which makes diagnosis difficult
Asthma is associated with significant disability, depression and
impairment of mobility in older people. The risk of dying from asthma
increases with age, with the majority of deaths occurring in people
aged 65 and over.
The diagnosis of asthma in seniors is based on:
history
physical examination
supportive diagnostic testing e.g. spirometry
Spirometry is an effective tool in the accurate diagnosis of asthma
and helps distinguish between asthma and COPD.
Managing asthma in seniors is similar to that in all age groups.
However, co-morbidities will influence the choice of delivery devices.
People who are frail, weak or have arthritis affecting their hands may
need to use additional aids or undergo a trial of various devices to
determine the best delivery method. Some people may require a carer to
help them use their puffers and spacers while others may require use
of a nebuliser.
Some points to consider in determining a delivery system for seniors
with asthma are outlined in the table below:
Older people with multiple co-morbidities may also experience
difficulties taking complex medication regimes correctly, so it is
important that administration of medications is kept as simple as
possible and reviewed each time they visit their doctor. Asthma
medications should also be monitored by the doctor for adverse effects
and potential interactions with drugs taken for other conditions.
It is important that asthma self-management not only includes
education to seniors with asthma, but also to family members/carers
and a personalised Asthma Action Plan is provided. An Asthma Action
Plan is a written set of instructions prepared by the doctor that
assists asthma management; providing clear information on how to
administer Asthma First Aid and when to call emergency services.
All people aged over 65years, particularly those with asthma should
have regular reviews with their doctor to ensure that they receive
annual influenza re-vaccinations and that initial pneumococcal
vaccination and subsequent re-vaccination occurs in line with current
recommendations. Vaccinations are important as elderly people with
asthma are at higher risk of complications if they get the flu.
National Asthma Council Australia. Asthma Management Handbook 2006.
Melbourne, 2006
The Journey May Be Longer Than You Think
Beth Amega, Renal Team Coordinator
Danila Dilba Health Service
Background
==========
End Stage Renal Disease (ESRD), diagnosed when the kidney function
drops below a glomerular filtration rate of 15mls/min, has two
management pathways:
Renal replacement therapy (renal dialysis or kidney transplant)
Conservative management
There is little evidence documenting ESRD conservative management.
General practice has often not referred clients to a nephrologist when
they are not seeking renal replacement therapy. Renal teams also have
not traditionally been actively involved in the conservative pathway
for end stage clients.
A renal case management program providing primary care for chronic
kidney disease (CKD) has provided the opportunity for the trajectory
of the disease to be mapped in an urban Aboriginal & Torres Strait
Islander population. As the program entered its third year a longer
survival time was noted amongst this distinct population.
Conservative management and the associated shared care between renal
and palliative care specialties has only been a recent development in
nephrology management in Australia and also around the world. In 2007
the Northern Territory renal services undertook a specific program to
look at this area of renal client care (Devitt, 2010).
In looking at survival times for persons managed conservatively with
ESRD there are two studies of relevance to this discussion. A UK study
on 69 ESRD patients who opted for conservative management rather than
dialysis was carried out and published in 2009 (Ellam et al, 2009). It
concentrated on the bio-physical factors of co-morbidity and
laboratory parameters. They showed there was a median patient survival
of 21 months and that early referral to a nephrologist and maintaining
serum albumin >35 were predicting factors for even longer survival
times. Their study concluded comorbidity and age did not predict
survival. Risk factors in the dialysis population such as
cardiovascular disease may not necessarily predict survival among
those conservatively managed.
Murtagh and others undertook a study (Murtagh et al, 2008) in the USA
of 74 persons with ESRD (mean age 81 ± 6.8 years); its objectives were
to determine trajectories of symptoms and wider health-related
concerns in the last year of life in people with ESRD, managed without
dialysis. They found that it was in the last two months of life that
patients had increasing symptoms. Their recommendations were that
healthcare professionals should be alert for this change in condition
which may indicate the patients are approaching death.
A retrospective analysis of all stage 5 clients managed conservatively
at a single Aboriginal medical service over a four year period (31 May
2008 – 31 May 2012).
18 clients mean age of 56.2 ± 24years (range 32-76) at the medical
service were diagnosed with ESRD over the four year period.
10 clients commenced renal replacement therapy, mean age of 51 ±
19years
8 clients have been managed conservatively,mean age 63 ± 12years
4 actively chose the conservative management pathway in consultation
with family and carers prior to reaching stage 5
2 clients were prepared for dialysis in stage 5 but then their
condition changed and they were recommended to take a conservative
approach
2 are undecided – not yet prepared for dialysis but also not actively
engaging in conservative management
The effect of case management
-----------------------------
At the commencement of the case management approach, ESRD clients’
survival time post diagnosis appeared to be less than 12 months.
Referrals to palliative care were being initiated at eGFR 20 prior to
reaching ESRD if they were identified early. With the survival time of
3-9 months, this appeared to be appropriate. During 2009 the clinic
had no CKD clients progressing to ESRD following a conservative
pathway. It was late 2011 when a couple of clients survived well into
their second year - this early referral to palliative care needed to
be reassessed and this retrospective analysis was undertaken. It was
found that those clients case managed with early referral to
nephrologist, survival rate without renal replacement therapy was now
well into their second year and some may even go into their third
year. This is comparable to the UK study even though the mean age
studied is some 18 yrs different.
Social determinants as factors
------------------------------
Accessing services was sometimes a problem. In the initial phase of
the renal care coordination program many clients were very hesitant to
access the services of the “kidney doctor”. Not only was it scary, but
it often meant sitting in cold waiting rooms. The re-establishment of
onsite nephrology clinic at the local AMS by 2009 resulted in 75-80%
completion of referrals (Amega, 2009). This allowed clients and
families to meet the multi-disciplinary renal team made up of
Aboriginal Health Workers, nurses, GPs and nephrologists to make
informed choices in a culturally safe environment, which can lead to
increased quality of life.
In the earlier case managed clients social determinates such a safety,
housing and family support were sometimes lacking and not enough time
was left to work with them through these issues to enhance their
quality of life. By initiating a case management approach some of
these social factors can be worked through and appropriate support
structures can be introduced early in the client’s journey. With
secure housing, food security and being allowed to remain within their
family and community it is being shown that conservatively managed
urban Aboriginal & Torres Strait Islander clients with ESRD may have a
comparable survival to those in other populations. Social determinants
were not discussed in either of the studies cited although low serum
albumin can be due to malnutrition and may indicate less than optimal
care.
Conclusion
The journey may be longer than you think. Initiating a palliative care
referral has often been done too early for those with ESRD in a stable
environment. Family meetings are an important factor in conservative
management:
A home medicine review is beneficial in conservative management
Nephrologist and multidisciplinary renal team input is important
A care co ordinated approach such as case management can ensure a
holistic approach to health to optimize outcomes.
References:
Devitt, J 2010, An evaluation report of the palliative care for renal
clients living at home initiative, Department Of Health and Aging,
Darwin
Ellam, T, El-Kossi, M, Prasanth, K, El-Nahas, M & Khwaja, A 2009,
'Conservatively managed patients with stage 5 chronic kidney disease-
outcomes from a single centre experience.' Quarterly Journal of
Medicine, vol. 102, pp. 547-54.
Murtagh, F, Murphy, E & Sheerin, N 2008, 'Illness trajectories: an
important concept in the management of Kidney failure', Neprology
Dialysis Transplantation, vol. Advance access October 2008
Amega, B & McGinness, P 2009, 'Building a CKD program from the ground
up', paper presented to Chronic Disease Network, Darwin, Sept 2009
Physical Activity Recommendations for Older Australians
It’s never too late to start becoming physically active, and to feel
the associated benefits.
“Too old” or “too frail” are not in themselves reasons for an older
person not to undertake physical activity. Most physical activities
can be adjusted to accommodate older people with a range of abilities
and health problems, including those living in residential care
facilities.
Many improved health and well-being outcomes have been shown to occur
with regular physical activity. These include helping to:
maintain or improve physical function and independent living
improve social interactions, quality of life, and reduce depression
build and maintain healthy bones, muscles and joints, reducing the
risk of injuries from falls
reduce the risk of heart disease, stroke, high blood pressure, type II
diabetes, and some cancers
There are five physical activity recommendations for older
Australians:
1.
older people should do some form of physical activity, no matter
what their age, weight, health problems or abilities
2.
older people should be active every day in as many ways as
possible, doing a range of physical activities that incorporate
fitness, strength, balance and flexibility
3.
older people should accumulate at least 30 minutes of moderate
intensity physical activity on most, preferably all, days
4.
older people who have stopped physical activity, or who are
starting a new physical activity, should start at a level that is
easily manageable and gradually build up the recommended amount,
type and frequency of activity
5.
older people who continue to enjoy a lifetime of vigorous physical
activity should carry on doing so in a manner suited to their
capability into later life, provided recommended safety procedures
and guidelines are adhered to.
Source :
http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines#rec_older
The EYEINFONET: An Indigenous Eye Health Resource
Avinna Trzesinski, Research Officer
Australian Indigenous HealthInfoNet
The EyeInfoNet (http://www.healthinfonet.ecu.edu.au/other-health-conditions/eye)
is a comprehensive web resource offering information and resources on
Indigenous1 eye health located on the Australian Indigenous HealthInfoNet
website.
Good vision and good eye health is important for a person’s physical
wellbeing and social and emotional health during all stages of life,
including the older years. Vision loss and blindness can have
significant negative impacts for individuals, families and
communities. Poor vision can increase the risk of injury and limit
opportunities in education, employment and social engagement, and also
be a reason for dependence on services and on other people .
Eye health problems can increase as we age. The number of Australians
over the age of 50 years is increasing, and it is estimated that the
number of people with visual impairment will double by the year 2030 .
Evidence suggests that even mild vision loss can increase the risk of
mortality by 2.6 times for Australians .
Although ageing is a risk factor for many eye conditions, it need not
lead to vision loss as it is almost entirely preventable, especially
if detected early . Regular eye checks can ensure good eye health into
the older years and current treatments - including visual aids and
surgery - are very successful and cost effective . Other risk factors
for eye conditions include genetics, premature birth, type 2 diabetes,
smoking, injuries, ultra violet (UV) exposure, and poor nutrition .
Indigenous people have poorer eye health outcomes than non-Indigenous
people. The frequency of eye diseases (with the exception of trachoma)
is similar between Indigenous and non-Indigenous people, but rates of
vision loss are three times higher, and rates of blindness are six
times higher for Indigenous people . Indigenous people are more than
three times more likely to report having type 2 diabetes ; a
contributing factor to diabetic retinopathy and cataract . Poor
hygiene and living conditions (which increases the risk of the
infectious eye disease, trachoma), is still found among some
Indigenous communities in Australia .
Another major factor for Indigenous people is access to eye health
services. More than one third of Indigenous people have never had an
eye exam, and are less likely to access eye health services . This can
be due to difficulty in accessing optometry or specialist
ophthalmology services locally that are affordable, coordinated and
culturally appropriate, living in a rural or remote area, or having a
lack of transport [10]. Providing quality eye services will be
essential to improving the health of Indigenous Australians in the
future [3].
1 The term Indigenous is used to refer generally to the two Indigenous
populations of Australia, Australian Aboriginal people and Torres
Strait Islanders.
Many health practitioners and organisations around Australia are
working to close the gap in eye health between Indigenous and
non-Indigenous people by providing quality eye health care service
delivery to Indigenous people, with the aim of reducing the prevalence
of eye conditions particularly cataract, diabetic retinopathy, and
trachoma.
The EyeInfoNet web resource can inform the health and policy workforce
of programs or projects, latest research, and health promotion
campaigns in Indigenous eye health. The EyeInfoNet provides
information and resources on the following areas:
policies and strategies – national and state-based, Indigenous and
mainstream
organisations – Australian organisations relevant to the eye health of
Indigenous people
health promotion resources – flipcharts, posters, pamphlets, DVDs,
online resources and practice resources for health professionals such
as clinical guidelines and toolkits
publications – details of journal articles, reports, books and book
chapters within a searchable bibliography
workforce – details of job vacancies, courses, conferences and funding
opportunities (such as scholarships or grant funding)
Contributions to the EyeInfoNet web resource are always welcome.
Feedback from our users helps to keep the EyeInfoNet web resource
relevant and current. Feedback is encouraged through an online form (http://www.healthinfonet.ecu.edu.au/contact).
Information-sharing is also supported through our free online yarning
place (electronic networks), the EyeInfoNetwork, which allows people
to share information, knowledge and practical experiences about
Indigenous eye health with other people from across the country (http://yarning.org.au/).
For more information, contact:
Australian Indigenous HealthInfoNet
Kurongkurl Katitjin: Centre for Indigenous Australian Education and
Research
Edith Cowan University
Phone (08) 9370 6336 / Email [email protected] / Website
www.healthinfonet.ecu.edu.au
References:
1. Access Economics, Clear focus: the economic impact of vision loss
in Australia in 2009. 2010, Vision 2020 Australia: Melbourne.
2. Foran, S., et al., Projected number of Australians with visual
impairment in 2000 and 2030. Clinical & Experimental Ophthalmology,
2000. 28(3): p. 143-145.
3. Taylor, H.R., et al., The roadmap to close the gap for vision:
summary report. 2011, Indigenous Eye Health Unit, the University of
Melbourne: Melbourne.
4. Australian Institute of Health and Welfare, Eye health in
Aboriginal and Torres Strait Islander people. 2011, Australian
Institute of Health and Welfare: Canberra.
5. Australian Bureau of Statistics. National Aboriginal and Torres
Strait Islander social survey, 2008. 2009 11 April 2011; Available
from: http://www.abs.gov.au/ausstats/[email protected]/mf/4714.0?OpenDocument.
6. Taylor, H.R., Eye Care for the future: the Weisenfeld lecture.
Investigative Ophthalmology and Visual Science, 2003. 44: p.
1413-1418.
7. Australian Bureau of Statistics, National Aboriginal and Torres
Strait Islander Health Survey: Australia, 2004-05. 2006, Australian
Bureau of Statistics: Canberra.
8. Taylor, H.R., et al., The roadmap to close the gap for vision: full
report. 2012, Indigenous Eye Health Unit, the University of Melbourne:
Melbourne.
9. World Health Organization, Trachoma simplified grading card. 2012,
World Health Organization: Geneva.
10. Taylor, V., et al., Review of the implementation of the National
Aboriginal and Torres Strait Islander Eye Health program. 2004, Centre
for Remote Health: Canberra.

Home Dialysis Therapies
Dorothy Brown, Renal Services Development Officer
Policy & Service Development Branch, Department of Health
It is no secret that renal disease is an important health issue in the
Northern Territory.
Australian and New Zealand data reports for 2010 and 2011 show that
the majority of new patients commencing dialysis are between 45 to 74
years old. This is an age bracket that includes the “wise generation”
– those elders and leaders in the community whose loss to the
community when they relocate to main centres for dialysis is
significant.
Home dialysis offers an alternative; enabling people with renal
failure to return to their community and perform self care dialysis
treatment closer to home. Northern Territory Renal Services is
committed to promoting self care dialysis.
What is dialysis?
Dialysis is a medical treatment that uses a semi-permeable membrane to
remove excess fluid, electrolytes and toxins from the blood of a
person whose kidneys have failed and can no longer perform this
function.
Unless kidney transplant is available, people with end stage renal
failure have to rely on dialysis to stay alive. There are two commonly
used types of dialysis treatment that are performed in the home or
shared facility setting in the community. These are Peritoneal
Dialysis and Haemodialysis.
Peritoneal Dialysis
Peritoneal dialysis is a gentle dialysis particularly suitable for
those patients who still have some renal function and are small in
body frame. Peritoneal dialysis aids in preserving residual renal
function; has a shorter training time (2-4 weeks) and gives greater
flexibility for travel. With time, the effectiveness of peritoneal
dialysis may be reduced and a patient may need to commence
haemodialysis. This is not to been seen as a failure but a progression
of needs. Peritoneal Dialysis uses the person’s own peritoneal
membrane (lining of the abdominal cavity and contents) as the filter
to remove unwanted fluid, electrolytes and toxins. In this treatment,
a specially formulated strength of dialysis fluid is drained into the
abdominal cavity through a surgically implanted catheter. The extra
fluid, electrolytes and toxins travel across the peritoneal membrane
from the person’s blood stream into the dialysis fluid and can then be
drained out. This treatment is conducted at home, every day, at least
four times a day and is known as Continuous Ambulatory Peritoneal
Dialysis (CAPD).
Another method of Peritoneal Dialysis is performed overnight using a
“cycler” machine that pumps dialysis fluid in and out of the person’s
abdomen numerous times while the person is asleep leaving their days
free for employment or other activities. This is known as Automated
Peritoneal Dialysis (APD).
Haemodialysis
Haemodialysis occurs by pumping the person’s blood through tiny
filaments in an “artificial kidney” (dialyser) which is bathed with a
specially formulated dialysis fluid. The filaments provide the
semi-permeable membrane that allows the unwanted fluid, electrolytes
and toxins to pass through to the dialysate side of the membrane but
does not allow blood to escape. Two needles are inserted into a
surgically made arterio-venous fistula, usually in the persons arm,
and blood is pumped from one needle through attached tubing to the
dialyser. The filtered blood is then returned through tubing and into
the patient’s body via the second needle. At the end of the treatment
the blood is flushed back using a saline solution, the needles are
removed and the blood lines and dialyser are discarded.
This treatment process continues for about five hours at a time and
must be performed at least three times a week for the person to stay
well. Dialysis following missed dialysis can be dangerous due to rapid
shifts in electrolytes. Home dialysis patients however do have some
flexibility to alter their dialysis days and times of treatment to
suit their activities.
Training time for self care haemodialysis varies with each patient but
usually takes about three to four months. Patients learn how to set up
the machine, work out how much fluid they need to take off each
treatment, monitor their blood pressure throughout the treatment, give
intravenous medication and take blood samples while on dialysis. In
addition, they learn how to “troubleshoot” when the dialysis machine
alarms.
Self care dialysis patients may have a machine in their own home if
there is suitable room space, giving them the opportunity to perform
nocturnal dialysis, a longer, slower dialysis that reduces the risk of
a sudden drop in blood pressure that conventional dialysis has.
Alternatively, they may share a machine in a multi-user facility or
renal ready room.
Home dialysis therapies not only benefits the patient with renal
failure but also gives them the opportunity to share their acquired
renal health knowledge with the younger generation and to be an
influence for change within their community.
Reference:
McDonald S. et al, Annual report 2010, 2011, Australian and New
Zealand Dialysis and Transplant Registry
Chronic Kidney Disease Detection & Management –
Guidelines for more precise intervention
Dr Marie Ludlow, National Medical Projects Manager
Kidney Health Australia
The new edition of Kidney Health Australia’s Chronic Kidney Disease
(CKD) Management in General Practice was launched earlier this year.
This guideline highlights the need for regular testing of all at-risk
patients and contains important updates on:
*
A revised staging system and treatment action plans matched to CKD
severity
*
Blood pressure targets
*
Testing for albuminuria
*
Age-related decision points
Early Detection is Essential
As many as one in ten people who visit their GP for any reason already
have a degree of kidney impairment. CKD claims more than 3300
Australian lives each year, a 23 per cent increase over the past 10
years.1 The new guidelines highlight the need to test annually for
kidney disease in patients with diabetes and hypertension, and every
two years in patients who are obese, have established cardiovascular
disease, smoke, have a family history of CKD or are Indigenous
Australians.
What’s New?
Staging System
A colour-coded staging system (in page 22) has been developed to
identify high, medium and low CKD risk, allowing for treatment to be
matched to the patient’s particular level of risk.
Importantly, the guidelines recommend that CKD staging should be based
on a combined measure of kidney function (measured or estimated GFR*),
kidney damage (albuminuria), and underlying diagnosis (e.g. Stage 2
CKD with microalbuminuria secondary to diabetic kidney disease).
Stage 3 CKD has been divided into Stage 3a (eGFR 45-59 mL/min/1.73m2)
and Stage 3b (eGFR 30-44 mL/min/1.73m2) to more accurately reflect
risk stratification.
The Elderly
Age greater than 60 years increases the risk of developing kidney
disease. It is now known that an eGFR <60 mL/min/1.73 m2 is very
common in older people, but it is nevertheless predictive of
significantly increased risk of adverse clinical outcomes, and should
not be considered physiological or age appropriate.
Controlling Hypertension
Patients with CKD should be treated with medication that consistently
lowers blood pressure to or below 140/90mmHg. If albuminuria is
present or the patient has diabetes, the target should be below 130/80
mmHg.
Detecting Albuminuria/Proteinuria
The preferred method of detecting albuminuria/proteinuria in patients
with or without diabetes is urinary albumin:creatinine ratio (ACR) as
it accurately predicts renal and cardiovascular risk. Dipstick for
protein in urine is no longer recommended.
Following diagnosis, most patients with an eGFR of between 30 and 60
can be effectively managed by their GP. However, referral to a
nephrologist is recommended when kidney function deteriorates rapidly
or eGFR levels fall to less than 30mL/min/1.73m2.
The revised guidelines have been endorsed by The Royal Australian
College of General Practitioners, The Australian College of Rural and
Remote Medicine, and the Australian and New Zealand Society of
Nephrology. Kidney Health Australia also provides accredited education
for health professionals through the Kidney Check Australia Taskforce
(KCAT) program. For further information please visit www.KCAT.org.au
Reference
1. Australian Bureau of Statistics. Causes of death, 2009, 2011
Central Inner West Regional Profile
Liza Shaw, CDN Coordinator
NT Department of Health
Location - Travelling west from Alice Springs, Ikuntji (Haasts Bluff)
is reached via the Namatjira Drive past Glen Helen Gorge, travelling
through the West MacDonnell National Park. From there a track leads to
Papunya and then Mount Liebig, where a small Aboriginal community sits
below a 1524 m high mountain with the same name. All this land is part
of Haasts Bluff Aboriginal Land Trust and permits are required to
visit.
A little south is the following communities, also in the Central Inner
West region:
Wallace Rockhole
Watarrka (King’s Canyon)
Haasts Bluff (Ikuntji)
Health - Each of the above communities has a Health Centre, and the
West MacDonnell Shire Council also provides services in many of these
communities. Other small communities without a health centre are also
scattered throughout this area.
Languages spoken in this region include Western Arrernte, Southern
Arrernte and Luritja.
Reducing Tobacco-Related Harm in the Alice Springs Region
John Bosco Odongo, Aboriginal Community Support and Education Officer
NT Department of Health
Tobacco use is the most common preventable cause of morbidity and
mortality throughout the world, especially among disadvantaged
populations. In Australia, tobacco use is the major risk factor for
cardiovascular disease and in 2003 was responsible for 15,511 related
deaths.(2) In addition, the Northern Territory has the highest smoking
rate in Australia with the prevalence of tobacco consumption amongst
its non-Indigenous population at approximately 25% and rates for the
Indigenous population at approximately 55%. This compares to a
national prevalence rate of approximately 17%.(1) Both the Australian
and State and Territory Governments have realised the economic and
health impact of tobacco use on the population and have taken steps to
address this problem head on.
The Northern Territory Government is tackling tobacco harm through its
2010 - 2013 Tobacco Action Plan which has been built on the National
Tobacco Strategy of 2004 - 2009 and the World Health Organisation’s
Framework Convention on Tobacco Control.(1) The aim of the NT Tobacco
Action Plan is to provide an effective, equitable and comprehensive
approach to tobacco in all areas of the Northern Territory.(1) However
the main target of the initiative remains the disadvantaged population
groups such as the Aboriginal and Torres Strait Islander peoples.
In addition the NT Government’s tobacco strategy has three clear
priority activity areas, namely, community interventions, health care
interventions and policy and legislation interventions. The aim of the
health care interventions is to improve access to tobacco prevention
and cessation treatment and services. At a community level the aim is
to improve awareness of the harm caused by tobacco use and increase
community action and local capacity to manage tobacco policy and
control measures. Meanwhile the third action area, policy and
legislation intervention aims at strengthening tobacco control
legislation (1).
In the Alice Springs region the Government has recruited Tobacco
Community Support and Education Officers who are based within the
Department of Health’s Alcohol and Other Drug Services Central
Australia (ADSCA). These workers focus their attention in remote
Aboriginal communities in the south and north of Alice Springs. Since
the start of their tobacco campaigns in Central Australia in September
2011 over 200 tobacco education activities have been completed, all
with the aim of minimising harms caused by tobacco use. This is being
achieved through raising awareness on the health risks and identifying
and supporting people who voluntarily agree to join a process of
quitting tobacco.
In the three months since commencing the implementation of the NT
Action Plans on tobacco in Ntaria and Papunya Aboriginal communities,
the focus has been on raising community awareness on the harm caused
by direct and passive tobacco smoke especially to pregnant women,
children, breast feeding mothers and their babies, and to those people
with lung and heart conditions.
In addition, continuous support and information has been provided to
community leaders to assist them in working towards achieving their
community’s identified goals and objectives around tobacco.
There has also been a concerted effort to provide assistance and
support to both individuals and groups of people who wish to quit
using tobacco. This has come in the form of offering advice;
information and personal support to assist potential quitters to
attend their community clinic.
Clients are medically assessed and offered counselling and prescribed
an appropriate nicotine replacement therapy (NRT) such as nicotine
patches or a pharmacotherapy such as Champix medication to suppress
the nicotine cravings. Those people in the process of quitting tobacco
have been encouraged to join the 100 Quit Club which gives them the
opportunity to interact with and receive support from their peers. In
addition the Tobacco Community Support and Education Officer continues
to personally monitor and provide advice, support and encouragement to
the 100 Quit Club members until they feel they’re in control of and
managing their tobacco withdrawal symptoms and have ceased smoking
completely.
The outcome of the tobacco control activities from January to end of
March 2012 indicates that when the harm reduction activities are
effectively carried out with the involvement of the target community
it can result in people making positive decisions about quitting
smoking tobacco. While some people are now on nicotine replacement
therapy the majority are still at the pre contemplation or
contemplation phase and will need comprehensive support, including
motivation, to move to their next phase of quitting.
A significant factor in decreasing rate of smoking in remote
communities is the development of community driven and managed tobacco
policy. The cornerstone of good social policy is the provision of
accurate information on prevalence, attitudes and understanding of
tobacco consumption.
ADSCA, in collaboration with Ntaria Community and Ninti One, the
Central Australian Research Centre are embarking upon a research
project that will provide that information to the community.
Ninti One employs local Ntaria residents who are trained researchers
and who will be active participants in the research design, conduct
and analysis of surveys.
Information on the prevalence of tobacco consumption and the attitudes
of tobacco users in Ntaria will provide the community with the tools
to make informed decisions about local tobacco policy.
In addition to prevalence rates, the research findings will also
provide an evidence-base that the community can use to better
understand the behaviour and attitude of tobacco users, to identify
high risk groups and to help with targeting of health promotion
programs.
There is reason for optimism regarding the challenge to close the gap
in the rate of tobacco use between the mainstream Australian
population and the Indigenous population as with continued effort,
culturally appropriate intervention methods, financial and material
resources, community involvement and participation, improved outcomes
will be realised.
References:
1. Department of Health and Families. Northern Territory Tobacco
Action Plan 2010 – 2013.http://www.health.nt.gov.au/library/ scripts
/objectify Media.aspx?
file=pdf/48/20.pdf&siteID=1&str_title=Northern%20
Territory%20Tobacco%20Action%20Plan.pdf. pp. 1-41. Viewed 7th June
2012
2. Cancer Council NSW. 2003 Statistics on smoking in Australia
http://www.cancercouncil.com.au/31901/reduce-risks/smoking-reduce-risks/tobacco-facts/statistics-on-smoking-in
australia/?pp=31901. Viewed 18th June 2012
Creating Local Heroes at Ntaria Aged Care Centre
Nina Bullock, Service Development Officer
Ntaria Aged Care Centre, Central Australia
Hermannsburg, or Ntaria, is a semi-remote central desert community.
Sweeping transformation in the past (Prime Minister’s Report, 2011)
has left Ntaria with a piecemeal understanding of Western concepts
such as ‘organisation’ and ‘health’ (Hagan, 2008). Equally, Westerners
often only have a superficial understanding of Indigenous cultural and
health practices (Dodson, 2010). The aim then, is to create an
organisational culture that enables the service to address chronic
conditions in a culturally appropriate and meaningful manner.
Ntaria Aged Care Centre (“the Centre”) is managed by MacDonnell Shire
and funded by the Northern Territory Government, Department of Health
to deliver Home and Community Care (HACC) services to twenty five
clients and by the Federal Government, Department of Health and Ageing
to deliver Community Aged Care Package (CACP) services to seven
higher-needs clients. A non-Indigenous Service Development Officer
supports four, soon to be eight, Indigenous staff to deliver these
services. 96% of clients and 80% of staff of the Centre live with at
least one chronic condition.
A typical day might proceed as follows:
8am - cook a nutritionist-approved meal
9am - transport interested clients to the Centre for breakfast,
shower, social interaction, craft, line dancing or respite
10am - advocate on behalf of client needs, for instance disability
access in a park project
11am - deliver meals-on-wheels to all clients, collate follow up
activities such as enquiries to Centrelink
1pm - staff meeting to provide input into the Ntaria Alcohol
Management Plan
2pm - staff mentoring: guide key staff through decision-making models
3pm - meet with Clinic staff to track client progress and needs
4pm - staff training; update client and service records
This timetable demonstrates the holistic nature of the Centre’s work:
education; networking; advocacy; role-modelling; reporting;
evaluating; and planning ways to achieve equity in health for our
clients. However, a large body of literature (Waddell, Cummings,
Worley, 2011) suggests that communities are much more likely to
achieve positive outcomes if strategies are driven from within or
‘below’. With this in mind, the emphasis at the Centre is on staff
empowerment, and the vision is towards self-management. That is, a key
strategy at the Centre to achieve equity in health is supporting local
staff to not only understand chronic conditions and the experience of
ageing, but to actively drive change to prevent and manage chronic
conditions.
Staff are thus being trained to create modified care plans for
clients. Creating a care plan is an extended conversation that allows
both client and service provider to share their story - an important
part of local culture. These care plans are conducted in the local
language, Arrernte where possible and incorporate images to ensure
shared meaning. Recently, with the assistance of the Dementia
Behaviour Management Advisory Service, the care plans integrated a
family tree and a strengths-based approach; that is, the plans
identify the skills and interests clients might be willing to share
with others and the attendant benefits of this process such as
building a positive sense of client capacity and the opportunity to
facilitate meaningful social interaction. The care plans also enable
staff with minimal literacy to contribute to the collective memory,
and the Centre is in discussion with the local Chronic Diseases Nurse
to share the care plans with the allied health community who already
provide indirect input to care plans via the Northern Territory Remote
Aged Care Assessment Teams.
Symbol-making is a consistent part of the Centre’s internal life -
language referring to our collaborative vision is used almost daily
and is supported with action:
staff are involved in human resource and leadership decisions where
possible
menu suggestions are incorporated where feasible
Key staff are mentored in models of decision making and engage in a
daily ‘handover’ which has more in common with storytelling than
traditional Western ‘action’ lists
‘Two-ways learning’ (Harris, 1990 cited in Living Knowledge, 2012) or
learning both Indigenous and Non-Indigenous ways of doing things, is
also integral to creating local heroes and an outward-looking
organisation. For instance, after some negotiation, the Centre
supports flexible work arrangements balanced with consistent
expectations around communication and forward planning. Creating a
learning organisation also keeps us visible, and helps information to
flow more readily between client, staff, and allied health services.
Of course, community Aged Care is not for everyone, and recruiting
appropriate people is a challenge across Australia. However, creating
a body of shared meanings, personalising staff development, engaging
staff in Centre processes and promoting our stories throughout the
community not only assists to build knowledge about chronic conditions
management and prevention but also serves to attract a sustainable,
talented workforce.
References:
Prime Minister’s Report (2011): “Closing the Gap: Prime Minister’s
Report, 2011”. Commonwealth of Australia, Attorney General’s
Department, Canberra
Hagan, S. (2008) Whitefella Culture. Australian Society for Indigenous
Languages, Alice Springs Australia. 4th edition
Dodson, M. (2010) “To the Front of the Bus” in Around the Globe,
Autumn 2010; pp.7-12
Waddell, D.; Cummings, T.; Worley, C. (2011) Organisational Change:
Development and Transformation. Cengage Learning, Melbourne Australia,
Asia Pacific 4th edition
Harris, S (1990) cited in Living Knowledge “About 'both ways'
education” at
http://livingknowledge.anu.edu.au/html/educators/07_bothways.htm
Australian National University, accessed 12 June, 2012
FREQUENTLY ASKED QUESTION
Dorothy Brown, Renal Services Development Officer
Policy & Service Development Branch, NT Department of Health
QUESTION:
“I am working in a health clinic on a remote community with an elderly
client who has Chronic Kidney Disease. She is not keen to leave her
community for dialysis. Should I try to convince her to get dialysis?
What are her other options?”
ANSWER:
A Matter of Choice
I don’t believe that you should try to convince this lady to “get
dialysis” but rather ensure that she has the information required and
a clear understanding of her options, in order to make a calculated
decision based on that knowledge. Her decision will also be influenced
by her goals and core values in life and by any co-morbid conditions
that may already compromise her quality of life.
The options for this lady are dialysis, renal transplantation or
conservative treatment and palliation. There is no cure for this
lady’s kidney disease. What a huge decision for this elderly lady to
make at a time in her life when she would be hoping to take life a
little easier.
The shock of finding out that to survive, she will need to have
dialysis and the implications of potentially having to relocate to a
city centre for dialysis treatment are enormous, not only for herself
but for her family and, if she is a significant community elder, for
community life as well.
The confusion caused by the need for these decisions and change may be
compounded by fear, her age and the uraemia (chemical waste in her
blood) due to her kidney disease. It is for these reasons that any
decision to commence dialysis should not be made hastily and education
about her treatment options should be commenced at an early stage and
progressively built onto as she moves towards the need for dialysis.
Though her decision should not be made under duress, after thorough
education and an understanding of her options is achieved, there is a
place for encouragement and guidance towards a particular mode of
dialysis based on her clinical suitability. Besides educational input
from chronic disease nurses in the community, attendance at a renal
outreach clinic will provide an opportunity for the lady to meet with
a renal physician, renal nurse and members of the renal allied health
team such as the renal social worker and dietician. The use of the
“Kidney Stories” DVD* and flip charts will provide further
opportunities for education and guidance to both the lady and her
family. It may also be helpful to have her talk with someone who has
already commenced dialysis especially if they perform self care
dialysis in the community. It would be negligent I believe, not to
give this advice however the treatment option chosen ultimately must
be what she decides is best for her and her family and she needs to be
supported in this decision.
The choice to commence dialysis does hold many positive possibilities
for this lady as
Dialysis will keep her alive and possibly provide the opportunity to
live many more years, thus giving her the opportunity to pass on the
wisdom and knowledge accumulated over the years to the next generation
of family
Lifestyle changes (e.g. diet, exercise, cessation of smoking) and
management of diabetes and hypertension may result in a delay in the
progression of her chronic kidney disease and the need for dialysis
The two types of dialysis, haemodialysis and peritoneal dialysis (into
the abdomen) both give options for self care dialysis in the community
With good planning, e.g. with AV fistula formation and buried
Tenckhoff catheter insertion ahead of time, a relatively smooth
transition to dialysis can be achieved
Peritoneal dialysis, though often having a limited time of
effectiveness, provides a much gentler dialysis; has shorter training
times and requires less technological knowledge than haemodialysis.
Peritoneal dialysis also gives greater flexibility for travel as it
does not require electricity or a large machine
Many communities have shared haemodialysis transportable or renal
ready rooms to enable self care dialysis within the community if the
patient is not able to accommodate a machine in their own home
Northern Territory Renal Services is committed to providing treatment
closer to home in line with national trends, and is endeavouring to
promote home dialysis therapies over dialysis in a satellite unit
Though it may be necessary to move to a city centre to commence
dialysis, this lady can be confident that endeavours will be made to
train her for self care dialysis as soon as possible enabling her to
return to her community. Training time for peritoneal dialysis usually
takes from two to four weeks and for haemodialysis one to six months
If home dialysis is not an option, there are increasing opportunities
e.g. through the mobile dialysis bus, for dialysis patients who have
relocated to cities to dialyse to return home for a week of nurse
assisted dialysis within their community
Many patients already have family members who are dialysing in city
centres so they are not necessarily without family support. In fact
some patients grow to like city life and its conveniences and grow to
enjoy the life style
In summary, dialysis offers the elderly lady an opportunity to extend
her life and does not necessarily exclude the possibility of her
living in her home community, especially if peritoneal dialysis is
used. To make an informed choice a thorough understanding of her
options is needed and clinical advice and guidance and encouragement
constitutes part of this. The choice to commence dialysis or not
however, must be ultimately hers and she should be supported in her
choice.
Combined Network Update
Liza Shaw, Chronic Diseases Network Coordinator
Department of Health
There is only one remaining Combined Network Meeting for 2012. This
meeting will be in Tennant Creek on the 13th of November, and more
details will be provided through the e-CDNews.
The Meeting will continue to feature speakers related to the
conference theme: ‘Promoting Healthy Childhood – Preventing Chronic
Conditions’.
The Combined Network Committee is currently looking for organisations
to join the committee. The purpose of the Combined Network Meetings is
to:
work in collaboration with other organisations to provide professional
development to the regional health workforce
support and facilitate networking across the regional workforce in a
geographical area
Anybody wishing to discuss this further should call 08 89228280 or
email: [email protected]
NT Chronic Conditions Prevention and Management Strategy Current
Update: Sneak Preview to our progress
Dr Laura Edwards and Dr Jacqueline Boyd, Public Health Registrars
Chronic Conditions Strategy Unit, NT Department of Health
The Chronic Conditions Prevention and Management Strategy (CCPMS) is
the current evidence-based framework to address Chronic Conditions in
the Northern Territory. It aims to use a systems-wide approach to
target chronic conditions, with an initial implementation plan for the
first 3 years. This plan is for a wide range of people working with
Chronic Conditions, including policy makers, primary health care
services, researchers and educators, Non-governmental services and
communities. The Implementation plan can be found on the internet at
http://www.health.nt.gov.au/Chronic_Conditions/NT_CCPMS/index.aspx
The annual report for 2011 is currently in draft form, being produced
by the Chronic Conditions Strategy Unit (CCSU). It will report on the
“Year 2 indicators” of the CCPMS Implementation Plan. The annual
report will be presented at the Chronic Diseases Network (CDN)
conference in September and is planned to be published around the same
time.
Of the 8 Key Action Areas (KAA), we have given a sneak peek into what
is currently happening under a selection of the year 2 indicators.
KAA 1: Social Determinants of Health
Awareness of the importance of the Social Determinants of Health is
increasing. The NT Early Childhood plan, developed in partnership with
a range of governmental and non-governmental organisations and in
consultation with communities across the NT in 2011, will soon be
released.
KAA 2: Primary prevention
NT Department of Health (DoH) has entered into a partnership agreement
with DoH South Australia to implement the Childhood Obesity and
Lifestyle (COPAL) Program, in the Palmerston community.
Talking About the Smokes, based at Menzies School of Health Research
was developed in 2011. It aims to understand which tobacco control
policies and programs are successful in reducing Indigenous smoking.
KAA 3: Early detection and Secondary Prevention
A number of three-day Preventable Chronic Disease short courses were
well attended by health care professionals, including Aboriginal
Health Practitioners, across the NT.
KAA 4: Self Management
The Chronic Conditions Self Management framework 2012-2020 has been
finalised and a detailed Implementation Plan being developed.
An NT Self Management network is being formed as a subgroup of the
CDN.
KAA 5: Care for people with Chronic Conditions
Many new positions have been created under the ‘Closing the Gap’
funding for Indigenous Care Coordinators across the Territory. Some of
these positions have enabled disease-specific care coordinators to be
appointed in Aboriginal Medical Services.
A framework describing Cardiac Rehabilitation Services in the Northern
Territory is currently being developed. There are many exciting
changes happening in this area, and it’s certainly a space to watch.
KAA 6: Workforce planning and development
A number of people took up new roles related to Chronic Conditions in
2011. This increase was most evident in the Aboriginal Community
Controlled Health Sector, where a team of dedicated Tobacco Action
Workers, Healthy Lifestyle Workers and Chronic Disease Care
Coordinators were employed throughout the Territory.
KAA 7: Information, communication and disease management systems
An area with many exciting changes happening, including the rollout of
the MyeHR (My Electronic Health record), aligning with the National
eHealth record system. This enables greater sharing of information
between health professionals, improving communication and patient
care.
Telehealth is in the process of being rolled out, enabling video and
expanded teleconferencing, improving access for those living in rural
and remote areas across the Northern Territory.
KAA 8: Continuous Quality Improvement (CQI)
With an increased focus on CQI activities, there are now approximately
16 dedicated CQI facilitators in Aboriginal Primary Health Care
Services working with both the DoH and ACCHOs to audit practices
through a combination of NT AHKPIs and one21seventy processes.
If you feel that you have something to add to the Year 2 indicators
for the report and haven’t as yet been contacted by CCSU, please email
[email protected]
Chronic Diseases Network (CDN) Conference aims to improve Aboriginal
health
Liza Shaw, CDN Coordinator
Department of Health
Rates of chronic conditions in the Aboriginal and Torres Strait
Islander population are high, and one of the aims of the conference is
to increase the capacity of the Aboriginal and Torres Strait Islander
workforce to improve the health of their own people.
The other aim of the conference is to be relevant to Aboriginal and/or
Torres Strait Islander staff, partly by ensuring a good proportion of
presenters are Aboriginal and Torres Strait Islander people working in
the field of chronic conditions. This year’s annual CDN conference
will take place on 20th and 21st September and hopes to deliver
information that Aboriginal and Torres Strait people working in the
area around chronic conditions can take away and use.
So far for this year’s conference, about one third of presentations
include speakers who have identified as either Aboriginal and/or
Torres Strait Islander. The program also includes plenary sessions,
workshops and concurrent sessions that address Aboriginal and Torres
Strait Islander health issues. A discussion forum is planned, where a
panel of experts in the field will discuss the topic “Promoting
Healthy Childhood – Achieving Aboriginal Health Equality”. The role
that child health promotion plays in closing the gap between
Aboriginal and non–Aboriginal health outcomes will be discussed, and
the audience will be encouraged to contribute to this discussion.
This year, the Office of Aboriginal and Torres Strait Islander Health
has generously granted $70,000 to sponsor Aboriginal and/or Torres
Strait Islander delegates to attend the conference, which has
traditionally had a high attendance rate by Aboriginal and/or Torres
Strait Islander delegates. Forty-six percent of delegates in 2011
identified as either Aboriginal and/or Torres Strait Islander, and
this year’s increased funding will continue to support Aboriginal
and/or Torres Strait Islander attendance. Evaluation forms from
previous years have shown that the conference is a valuable and much
appreciated professional development opportunity for Aboriginal and/or
Torres Strait Islander staff.
An Aboriginal and Torres Strait Islander reference group has been
meeting throughout the year to provide advice on conference plans, and
ensure relevance to the professional development and cultural needs of
Aboriginal and/or Torres Strait Islander delegates. The role of this
group also includes supporting Aboriginal and/or Torres Strait
Islander workers to present, by providing face to face support in
completing and submitting abstracts, co-presenting or supporting
people to present at the conference and “buddying” people attending
the conference.
The full conference program and registration details are available on
the conference website at: www.cdnconference.com.au
BreastscreenNT
Jessica Steele, Health Promotion Officer
Community Health Services, Department of Health
BreastscreenNT is a free cancer screening program that targets well
women aged 50-69 years to participate in breast screening every two
years. As 75% of breast cancers occur in women over 50, the main aim
of the program is to detect early breast cancer among the most at-risk
group (Cancer Australia, 2011). General Practitioners strongly
recommend women aged 50-69 years have a screening mammogram every two
years. With a current participation rate of 56% of Australian women
aged 50-69 years, a mortality reduction of 21-28% has been achieved
(Zorbas, 2011).
Cancer screening programs have played an integral role in rising
survival rates. Breast cancer now has a five year survival rate of 88%
with the greatest impact in the 50-69 age range. Thishas been
attributed to breast cancer screening programs (AIHW 2008).
BreastscreenNT has a permanent service located at the Casuarina Health
Services Centre, 9 Scaturchio Street, Casuarina, and Darwin. The
service also travels to other parts of the Northern Territory each
year. BreastscreenNT works closely with Women’s Health Educators,
Remote Outreach Midwives, Aboriginal Medical Services and health
personnel in each screening area to encourage women to commence
screening upon turning 50 and continue their participation in the
program.
Increasing equity of access for Indigenous and remote women
In October 2011, BreastscreenNT commenced screening at the Central
Australian Aboriginal Congress (CAAC) Alukura clinic. The service was
promoted by Alukura staff, in particular, Aboriginal Liaison Officers,
who used a grassroots campaign, paired with Aboriginal radio and
culturally suitable flyers. The five day service was delivered in an
all-female, culturally appropriate environment. The trial was deemed
successful with 105 women screened over five days; 87% of screened
women were Indigenous and 67% were new women to the program (internal
breastscreenNT data 2011).
BreastscreenNT looks forward to further expansion of the service to
several additional sites this year. Although Indigenous participation
has been rising in recent years, it is still much lower in the
Northern Territory at 26%, when compared with the national average of
approximately 38% (AIHW, 2009). This expansion of the screening
service into additional remote areas will enable more equitable access
for remote and Indigenous women to the program; a rise in the rate of
Indigenous participation is an expected outcome.
2012 Screening Calendar
Palmerston
When: 2nd-20th April 2012
Where: Palmerston Community Care Centre
Alice Springs
When: 8th May-15th June and 15th October-16th November 2012
Where: Eurilpa House, Todd Mall
Katherine
When: 2nd-27th July 2012
Where: Katherine District Hospital
Nhulunbuy
When: 13th-24th August 2012
Where: Miwatj Health Aboriginal Corporation
Tennant Creek
When: 1st-5th October 2012
Where: Tennant Creek Hospital
Congress Alukura
When: 8th-12th October 2012
Where: Central Australian Aboriginal Congress (CAAC) Alukura Clinic,
Alice Springs
References:
Cancer Australia. 2011. Breast Cancer.
http://canceraustralia.nbocc.org.au/breast-cancer/about-breast-cancer/breast-cancer-statistics
(accessed June 14, 2012).
Zorbas, H. 2011. BreastScreen Australia Evaluation: Achievements and
Challenges.
http://bsaconference.com.au/files/oral/saturday/b1/0900/0900_Zorbas.pdf
(accessed June 14, 2012).
Australian Institute of Health and Welfare (AIHW). 2008. Cancer
survival shows significant improvement.
http://www.aihw.gov.au/media-release-detail/?id=6442464771 (accessed
June 14, 2012).
Australian Institute of Health and Welfare (AIHW). 2009. Over 1.5
million Australian women screened through BreastScreen Australia.
Indigenous participation rates still lower.
http://www.aihw.gov.au/media-release-detail/?id=6442464832 (accessed
June 14, 2012).
Library Resources and Mobile Apps: helping you keep up to date
Marg Purnell, Clinical Librarian
NT Department of Health Library Services
Keeping up to date with the latest health/medical research in your
specialty area is an important component of best practice. This can be
a challenge when there are large amounts of research published every
year in a variety of journals. These journals are stored in searchable
health databases such as Medline. There are also summaries of this
research created for use at the point of care and compiled within
searchable tools such as DynaMed.
A key for busy health professionals is to be able to access this
stored information quickly and easily. There is a variety of ways to
access this information depending on your needs. This can be where the
NT Department of Health (DoH) Library Service can help.
If you have a favourite journal that you would like to receive the
table of content of the latest issue into your email inbox, then you
can set up an email alert for that journal. This feature is available
on most health/medical databases and journal websites. If you would
prefer not to have this come to your inbox, you can choose to receive
these latest articles as an RSS feed, but you will need to set up a
free tool such as Google Reader.
A number of these alerts can be set up through EBSCO, a large host
database that the Health Library subscribes to. Many journals such as
The Lancet, Australian and New Zealand Journal of Public Health and
Health Promotion Journal of Australia are indexed within EBSCO. You
can also search for a specific topic across Medline, CINAHL and other
health databases. You can then save this search and create a search
alert for when new information is published on that topic. For both
search alerts and journal alerts, you need to create a free account
within EBSCO that takes only a few minutes.
Librarians are aware of the growing importance of technology and the
huge growth in the mobile health field (O’Hagan, 2012). We are
continually investigating ways to keep up to date with the latest
technology to be able to pass this on to make your life easier.
The last year has seen a huge rise in the number of DoH staff using
smartphones, iPads or tablet PCs. The development of Library Services
is evolving as the number of users with mobile devices increase
(Cummings, Merrill and Borrelli, 2012). A number of the Health
Library’s resources are available either with a mobile-friendly
interface or can be installed on your device as an app: DynaMed is one
such example. It is a point of care tool that can be used on a mobile
device. You can search for a symptom or condition and the results are
displayed as a summary about the topic. This tool is especially useful
if you are working in a remote location, as once downloaded you do not
need to be connected to the Internet to search it. A serial number is
required from the Library for initial installation. Check out the
Health Library’s website (www.health.nt.gov.au/Library/eLibrary) for
other resources available in mobile format.
As well as the resources the Health Library subscribes to, there are a
large number of free health/medical resources and apps available via
the Internet through the App Store (for Apple) or Google Play (for
Android). Some are aimed at health professionals, others at consumers.
These include NEJM This Week, PubMed on Tap Lite, Medscape, Human
Anatomy!, Eye Chart Pro and Skyscape Medical Resources. If you want to
know more about the latest in medical apps there is a website you can
subscribe to called iMedicalApps (www.imedicalapps.com) where the
latest apps are reviewed and rated.
Accessing resources that the Health Library subscribes to requires you
to be working for the NT DoH, the NT Department of Children and
Families or be a member of one of our Memorandum of Understanding
organisations, such as GPNNT. If you need further assistance with
accessing the latest information give the Health Library a call on 08
89228961.
References
Cummings, J, Merrill, A & Borrelli, S. (2010). The use of handheld
mobile devices and their impact and implications for library services.
Library Hi Tech, 28(1), 22-40.
O’Hagan, E. (2012). Getting started with medical apps: Apps you should
know about. Journal of Hospital Librarianship, 12, 162-170.

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