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      Knowledge interface co-design of a diabetes and metabolic syndrome initiative with and for Aboriginal people living on Ngarrindjeri country

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          Abstract

          Objectives

          This research program involves two phases to identify enablers and barriers to diabetes care for Aboriginal people on Ngarrindjeri country; and co-design a strength-based metabolic syndrome and Type 2 Diabetes (T2D) remission program with the Ngarrindjeri community.

          Study design

          A study protocol on qualitative research.

          Methods

          The study will recruit Aboriginal people living on Ngarrindjeri country above 18 years of age with a diagnosis of metabolic syndrome or T2D. Recruitment for phases one and two will occur through the Aboriginal Health Team at the Riverland Mallee Coorong Local Health Network. The lived experiences of T2D will be explored with 10–15 Aboriginal participants, through an Aboriginal conversational technique called ‘yarning’ (60–90 min) in phase 1. Elders and senior community representatives (n = 20–30) will participate in four co-design workshops (2–4 h) in phase 2. Qualitative data will be transcribed and thematically analysed (NVivo version 12). The analysis will focus on protective factors for the Cultural Determinants of Health. Ethics approval was obtained from Aboriginal Health Research Ethics Committee in South Australia (04-22-1009), and Flinders University Human Research Ethics Committee (5847).

          Results

          This work will be used to pilot the co-designed diabetes remission trial. Outcomes will be published in peer-reviewed journals, presented at conferences, focusing on following best practice guidelines from the Australian Institute of Aboriginal and Torres Strait Islander Studies and National Health and Medical Research Council. Research translation will occur through digital posters, manuals, and infographics.

          Conclusions

          The findings will be summarised to all Aboriginal organisations involved in this study, along with peak bodies, stakeholders, Aboriginal Services, and interested participants.

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          Most cited references10

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          Marked improvement in carbohydrate and lipid metabolism in diabetic Australian aborigines after temporary reversion to traditional lifestyle.

          K O'Dea (1984)
          The rationale for the present study was that temporarily reversing the urbanization process in diabetic Aborigines should improve all aspects of their carbohydrate and lipid metabolism that are linked to insulin resistance. Ten full-blood, diabetic Aborigines from the Mowanjum Community (Derby, Western Australia) agreed to be tested before and after living for 7 wk as hunter-gatherers in their traditional country in north-western Australia. They were middle aged (53.9 +/- 1.8 yr) and overweight (81.9 +/- 3.4 kg), and all lost weight steadily over the 7-wk period (average, 8 kg). A detailed analysis of food intake over 2 wk revealed a low-energy intake (1200 kcal/person/day). Despite the high contribution of animal food to the total energy intake (64%), the diet was low in total fat (13%) due to the very low fat content of wild animals. Oral glucose tolerance tests (75 g glucose) were conducted in the urban setting and repeated at the end of 7 wk of traditional lifestyle. The marked improvement in glucose was due to both a fall in fasting glucose (11.6 +/- 1.2 mM before, 6.6 +/- 0.8 mM after) and an improvement in postprandial glucose clearance (incremental area under the glucose curve: 15.0 +/- 1.2 mmol/L/h before, 11.7 +/- 1.2 mmol/L/h after). Fasting plasma insulin concentration fell (23 +/- 2 mU/L before, 12 +/- 1 mU/L after) and the insulin response to glucose improved (incremental area under the insulin curve: 61 +/- 18 mU/L/h before, 104 +/- 21 mU/L/h after). The marked fall in fasting plasma triglycerides (4.0 +/- 0.5 mM before, 1.2 +/- 0.1 mM after) was due largely to the fall in VLDL triglyceride concentration (2.31 +/- 0.31 mM before, 0.20 +/- 0.03 mM after.(ABSTRACT TRUNCATED AT 250 WORDS)
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            National analysis of the Modified Monash Model, population distribution and a socio-economic index to inform rural health workforce planning.

            To describe the population distribution and socio-economic position of residents across all states and territories of Australia, stratified using the 7 Modified Monash Model classifications. The numerical summary, and the methods described, can be applied by a variety of end users including workforce planners, researchers, policy-makers and funding bodies for guiding future investment under different scenarios, and aid in evaluating geographically focused programs.
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              Effect of nutrition interventions on diet-related and health outcomes of Aboriginal and Torres Strait Islander Australians: a systematic review

              Objective To review the literature on nutrition interventions and identify which work to improve diet-related and health outcomes in Australian Aboriginal and Torres Strait Islander people. Study design Systematic review of peer-reviewed literature. Data sources MEDLINE, PubMed, Embase, Science Direct, CINAHL, Informit, PsychInfo and Cochrane Library, Australian Indigenous Health InfoNet. Study selection Peer-reviewed article describing an original study; published in English prior to December 2017; inclusion of one or more of the following outcome measures: nutritional status, food/dietary/nutrient intake, diet-related biomedical markers, anthropometric or health measures; and conducted with Australian Aboriginal and Torres Strait Islander people. Data extraction and synthesis Two independent reviewers extracted data and applied the Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project. A purpose designed tool assessed community engagement in research, and a framework was applied to interventions to report a score based on numbers of settings and strategies. Heterogeneity of studies precluded a meta-analysis. The effect size of health outcome results were estimated and presented as forest plots. Results Thirty-five articles (26 studies) met inclusion criteria; two rated moderate in quality; 12 described cohort designs; 18 described interventions in remote/very remote communities; none focused solely on urban communities; and 11 reported moderate or strong community engagement. Six intervention types were identified. Statistically significant improvements were reported in 14 studies of which eight reported improvements in biochemical/haematological markers and either anthropometric and/or diet-related outcomes. Conclusions Store-based intervention with community health promotion in very remote communities, fiscal strategies and nutrition education and promotion programmes show promise. Future dietary intervention studies must be rigorously evaluated, provide intervention implementation details explore scale up of programmes, include urban communities and consider a multisetting and strategy approach. Strong Aboriginal and Torres Strait Islander community engagement is essential for effective nutrition intervention research and evaluation. PROSPERO registration number CRD42015029551.
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                Author and article information

                Contributors
                Journal
                Public Health Pract (Oxf)
                Public Health Pract (Oxf)
                Public Health in Practice
                Elsevier
                2666-5352
                16 April 2024
                June 2024
                16 April 2024
                : 7
                : 100496
                Affiliations
                [a ]Moorundi Aboriginal Community Controlled Health Service, Murray Bridge, Australia
                [b ]College of Medicine and Public Health, Flinders University, Adelaide, Australia
                [c ]Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
                [d ]Riverland Academy of Clinical Excellence (RACE), Riverland Mallee Coorong Local Health Network, South Australia Health, Australia
                [e ]Coorong Medical Centre, Meningie, Australia
                [f ]Southern Adelaide Diabetes and Endocrine Services, South Australia Health, Adelaide, Australia
                [g ]The George Institute for Global Health, University of New South Wales, Sydney, Australia
                [h ]School of Population Health, University of New South Wales, Sydney, Australia
                Author notes
                [* ]Corresponding author. Flinders University, Adelaide, Australia. courtney.ryder@ 123456flinders.edu.au
                Article
                S2666-5352(24)00033-8 100496
                10.1016/j.puhip.2024.100496
                11047281
                c44da037-d86c-415e-b3f7-208cd527541c
                © 2024 The Authors. Published by Elsevier Ltd on behalf of The Royal Society for Public Health.

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 26 October 2023
                : 29 February 2024
                : 4 March 2024
                Categories
                Original Research

                type 2 diabetes,diabetes remission,indigenous australians,community program,knowledge interface methodology,strength-based approaches

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