The Medical journal of Australia
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Biography Historical Article
The upsurge of interest in Indigenous health in the 1950s and 1960s.
During the 1950s and 1960s, there was a dramatic explosion in the number of letters to the editor about Indigenous health published in the MJA, reflecting increased reader interest. The letters from Barry Christophers were part of the Federal Council for Aboriginal Advancement's largely successful campaign for equal civil rights for Aboriginal and Torres Strait Islander people. His letters not only drew attention to discriminatory legislation and policies, but also emphasised the structural (especially economic) determinants of Indigenous ill-health, and the negative impact on Indigenous people of racist medical representations.
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Comparative Study
Diabetes care in remote northern Australian Indigenous communities.
To assess primary care processes and clinical characteristics of adults with diabetes in remote northern Australian Indigenous communities. ⋯ A high proportion of Aboriginals and Torres Strait Islanders requiring treatment for high blood pressure and proteinuria are receiving it. However, there is dissonance between the relatively high rates of routine checks and apparent lack of therapeutic action on glycaemia. More intensive management of glycaemia, including improved nutrition, exercise and (probably) insulin, is required to reduce microvascular complications.
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The concept of the Clinical Support Systems Program (CSSP) was transformed from an idea into reality through the efforts of representatives of the Australian Government Department of Health and Ageing and the Royal Australasian College of Physicians. This collaboration involved developing common ground between two different perspectives: those of the funder/policy/administrative sector and those of the clinical practice world. Bridging these differences to establish an agreed approach to moving forward was a lengthy and difficult process. ⋯ Compromise, persistence and commitment to the end-goal by the parties involved were important features in building and maintaining the momentum of the change process. Many of the difficulties experienced could be traced to differences in decision-making processes between the clinical and the administrative paradigms. Knowledge brokers can assist in bridging the different languages and perspectives of the groups involved.
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Androgen deficiency is a clinical diagnosis confirmed by hormone assays. Among younger men, androgen deficiency is usually due to underlying hypothalamopituitary or testicular disorders. ⋯ In the absence of characteristic underlying testicular or pituitary disorders, new diagnosis of androgen deficiency in older men is difficult because of the non-specific symptoms and the decline in blood testosterone levels seen in healthy ageing and chronic medical disorders. There remains no convincing evidence that androgen therapy is either effective treatment or safe for older men unless they have frank androgen deficiency.
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The Clinical Support Systems Program (CSSP) provided a mechanism for change from the existing entrenched structure and culture of patient care to one based on patient-centred, evidence-based care. The spectrum of change and improvement achieved by the CSSP was extensive, with support from government and active and enthusiastic involvement of clinical champions, practising clinicians, consumers and managers. ⋯ Many barriers to improvement in our complex healthcare system can be removed by recognising the need for accurate data recording and data systems, teamwork, and high-level organisational buy-in, with collaboration between teams and organisations trying to improve the quality of patient care. System-wide improvement has been stimulated and facilitated by the CSSP experience, with mutual flow-on benefits for the activities of the Australian Council for Safety and Quality in Health Care and the National Institute of Clinical Studies.