Current Projects

Below are links to the information pages on the current KAMS and RCSWA research projects:

Aged Care

Health outcomes of older Indigenous Australians: a 5 year follow up study of a population at risk

Health outcomes of older Indigenous Australians: a 5 year follow up study of a population at risk

We have been involved in landmark research addressing dementia in older Aboriginal and Torres Strait Islander peoples since 2003. The initial development and validation of a culturally appropriate cognitive assessment tool (Kimberley Indigenous Cognitive Assessment- KICA)  facilitated accurate screening for dementia in Aboriginal and Torres Strait Islander peoples living in rural and remote areas, which was not previously possible. We completed a dementia prevalence study of 363 people over the age of 45 years in the Kimberley during 2004-2006, documenting levels of dementia at a rate of 12.4%, rates that are much higher than non Indigenous Australians.

In this project, which will be based in Derby, it is proposed that the participants of the initial prevalence study cohort of 363 people, who would now be 50 years and over, will be re-assessed. A new cohort of those aged between 45-50 years in the same communities will be reviewed, to allow comparison with the previous study and to determine new cases of dementia and other aged care conditions, such as falls, depression and incontinence, in a comprehensive and standardised manner. Risk and protective factors for ongoing morbidity, functional decline and death will be determined. In addition documentation of community service utilisation will be undertaken and the extent and causes of carer burden would be quantified. This data is required for adequate planning and service provision for the older Aboriginal population, and to improve knowledge on preventative strategies for Aboriginal Australians.

Publications:

LoGiudice, D. C.; Smith, K.; Atkinson, D.; Dwyer, A.; Lautenschlager, N.; Almeida, O. A.; Flicker, L. Preliminary evaluation of the prevalence of falls, pain and urinary incontinence in remote living Indigenous Australians over the age of 45 years  Intern Med J.  2012;42(6): e102-7

Smith K, Flicker L, Dwyer A, Atkinson D, Almeida OP, Lautenschlager NT, LoGiudice D.  Factors associated with dementia in Aboriginal Australians. Aust N Z J Psychiatry 2010;44(10):888-893

Researchers:

Dr Dina LoGiudice
Prof Leon Flicker
Prof David Atkinson
Dr Kate Smith
Vicki O’Donnell
Stephanie Waters
Ruth Crawford
Prof Osvaldo Almeida
Geraldine Shadforth

Diabetes

Investigation of the role of HbA1c in diabetes screening protocols in remote Aboriginal communities

Investigation of the role of HbA1c in diabetes screening protocols in remote Aboriginal communities

Type 2 diabetes and its associated complications are a significant health problem facing Aboriginal and/or Torres Strait Islander peoples in Australia. While early diagnosis and treatment of diabetes leads to improved outcomes this condition remains undiagnosed in up to 50% of people. Current screening methods are failing to detect people with diabetes in northern Australia. In December 2009 the American Diabetes Association updated their criteria for diagnosing diabetes to include glycated haemoglobin A (HbA1c) testing. Currently the use of HbA1c to diagnose diabetes is not part of the Australian guidelines

We will determine if it is feasible to translate existing findings regarding the potential utility of HbA1c as a diagnostic tool for diabetes, into everyday remote Aboriginal and Torres Strait Islander health service practice. We will be adding HbA1c to existing screening and assessing the benefit of this addition in terms of increased number of diagnoses, cost of testing and cost potentially saved from repeat visits if HbA1c were to be used instead of some or all of the existing somewhat complex screening pathway.

The aims of this project are:

  • To describe current pathways for, and outcomes of, screening for diabetes in Aboriginal and/or Torres Strait Islander peoples in the Kimberley region.
  • To evaluate the efficacy of incorporating HbA1c measurement into screening for diabetes in Aboriginal and/or Torres Strait Islander peoples living in the Kimberley region.
  • To test the accuracy / reliability of point-of-care HbA1c compared with laboratory testing as a screening tool for type 2 diabetes in a real world remote setting.
  • To determine the prevalence of risk factors for kidney, retinal and macrovascular disease in Aboriginal and Torres Strait Islander Australians with newly diagnosed type 2 diabetes.
  • To increase research interest and capacity among health staff, particularly Aboriginal and/or Torres Strait Islander staff, and to build skills in remote Aboriginal and Torres Strait Islander health service research.
  • To ensure that the project findings are generalisable to the broader remote Aboriginal and Torres Strait Islander primary health care environment, it will be carried out in a range of health care services across the Kimberley.

This project is a collaboration between The Rural Clinical School of WA, KAMSC and WA Country Health Services – Kimberley.

Publications:

Julia V Marley, May S Oh, Nyssa N Hadgraft N, Sally Singleton,David Atkinson. Cross-sectional comparison of point-of-care with laboratory HbA1c in detecting diabetes in real-world remote Aboriginal settings. BMJ Open 2015; 5:e006277.

Researchers:

  • Assoc Prof Julia Marley
  • Dr Kim Isaacs
  • Dr May Sian Oh
  • Dr Sally Singleton
  • Assoc Prof David Atkinson
  • Nyssa Hadgraft

ORCHID Study: Predicting gestational diabetes mellitus in rural communities

Optimisation of Rural Clinical and Haematological Indicators of Diabetes in pregnancy

Developing algorithms to improve predicting the development of and screening for GDM in rural communities

Gestational diabetes mellitus (GDM) is impaired glucose tolerance first detected in pregnancy. GDM is associated with a range of adverse neonatal and maternal outcomes. GDM is the commonest maternal antenatal abnormality in Australia. Screening is conducted in order to detect women at risk of disease, facilitating earlier management and treatment. Currently available evidence indicates that treatment of GDM with dietary modifications, glucose monitoring, and metformin and insulin (if needed) can significantly reduce the risk for adverse birth outcomes.

Current screening recommendations are for all pregnant women who are not known to have diabetes or GDM to have an oral glucose tolerance test (OGTT) at 24-28 weeks gestation. Women need to be fasted for this test and blood samples are taken immediately prior to consumption of a 75g glucose drink, and 1 and 2 hours later. Many women decline screening.

Alternative methods for diagnosing GDM or alternative methods for screening that lead to a reduction in the number of OGTTs required need to be found if we are to improve screening rates. We want to see if levels of glycation products such as HbA1c at first and third trimester antenatal visit predict the risk of developing GDM later in pregnancy or can be used instead of OGTT where an OGTT is difficult to achieve or refused by the patient.

The aims of this project are:

  • To determine at baseline the number of 24-28 week OGTTs completed on at least 100 antenatal patients in each study region expected to have had an OGTT.
  • To determine the relationship between first trimester antenatal information, including glycation products such as HbA1c, blood sugar levels, family history, obesity, maternal age, ethnic background, and 24-28 week glycation products, with 24-28 week OGTT.
  • To determine the proportion of women enrolled in the study requiring an OGTT who complete the OGTT at 24-28 weeks gestation.
  • To increase research interest and capacity among health service and RCSWA staff and students, and to build skills in rural and remote health service research.

To ensure that the project findings are generalisable to the broader regional, remote primary health care environment, it will be carried out in a range of health care services across Western Australia: Kimberley, Southwest, Greater South, Midwest and Goldfields.

This project is a collaboration between The Rural Clinical School of WA, KAMSC, WA Country Health Services – Kimberley, Harry Perkins Institue and is funded in part through an RCSWA Multi-site Project Grant.

Researchers:

  • Assoc Prof Julia Marley, RCSWA Broome
  • Kate Parrish, KAMS
  • Emma Jamieson, RCSWA Bunbury
  • Assoc Prof Andrew Kirke, RCSWA Bunbury
  • Assoc Prof Kylie Sterry, RCSWA Kalgoorlie
  • Assoc Prof Sarah Moore, RCSWA Bussleton
  • Assoc Prof Rebekah Adams, RCSWA Broome
  • Assoc Prof Carly Roxburgh, RCSWA Albany
  • Assoc Prof Susie Grainger, RCSWA Carnarvon
  • Dr Sally Singleton, KAMS
  • Dr Emma Griffiths, KAMS
  • Dr Cynthia Porter, GRAMS
  • Dr Jaye Martin, WACHS-K
  • Assoc Prof David Atkinson, RCSWA Broome
  • Prof Karen Edmond, UWA

Ear Health

Management of Otitis Media

Management of Otitis Media

It has been documented that clinicians poorly adhere to the best available evidence in the management of otitis media in Aboriginal populations and in adhering to culturally safe practices.

This proposed research will determine the barriers and facilitators that primary health care staff (AHW’s, GP’s and Nurses) based at KAMSC remote clinics face to adhering to evidence based recommendations in the management of Otitis Media and in implementing a culturally safe practice. This research will assess the policies and practices needed to address these issues.

This study will be a qualitative inquiry and will consist of open ended in-depth interviews with primary health staff, clinic managers and other relevant stakeholders at KAMSC and it’s remote clinics.

Researchers:

  • Mo Al-Timimie
  • Dr Lillian Mwanri, Flinders University

Kidney Disease

Clinical review of dialysis patients originating in the Kimberley region

Clinical review of dialysis patients originating in the Kimberley region

Over the past 20 years an epidemic of end-stage kidney disease (ESKD) has occurred among Aboriginal and Torres Strait Islander people in remote areas of Australia. The Kimberley Satellite Dialysis Centre (KSDC) was established in October 2002 in recognition of the growing need for dialysis in the Kimberley and after requests from patients to be able to dialyse in the region. Prior to this patients requiring haemodialysis either relocated to Perth for treatment or stayed at home to die.

Most reports on kidney disease in the Australian Aboriginal and Torres Strait Islander population in scientific journals describe the progression of kidney disease and treatment options prior to dialysis. There are very few published reports on health outcomes, including survival times for Aboriginal and Torres Strait Islander patients on dialysis.

The aims of this study are:

  • To determine the future need for dialysis in the Kimberley
  • To undertake a clinical audit of the implementation of best-practice guidelines for Kimberley clients with proteinuria and chronic kidney disease
  • To determine the outcomes of haemodialysis and peritoneal patients in the Kimberley

Researchers:

  • Assoc Prof Julia Marley
  • Assoc Prof David Atkinson
  • Dr Kevin Warr

Palliative care in end stage kidney disease: Are we meeting the needs of our Indigenous clients?

Palliative care in end stage kidney disease: Are we meeting the needs of our Indigenous clients?

Palliative care has been integrated into the kidney disease pathway care plan in the last few years. However no study to date has been done to ascertain if we are meeting the needs of our renal clients in their last days and weeks of life. As the burden of kidney disease has reached epidemic proportions in the Kimberley it is important to ensure that renal clients have an understanding of palliative care and the support it can provide. In order to deliver a quality service in line with the National guidelines it is imperative that we seek clarification from our Aboriginal clients on what their needs are in end of life care. This will help determine if we are meeting the needs of our Aboriginal renal clients.

We will conduct a twofold study to investigate this question further. Firstly a retrospective case note study from 5-10 renal clients who either opted to discontinue dialysis or renal replacement therapy was no longer an option. We will identify their use, if any, of palliative care and when discussions around end of life took place.

The second part of the project will be a qualitative investigation in the form of open ended interviews with a cohort of 10-12 renal clients. The participants will be from amongst the clients who attend the Kimberley Satellite Dialysis Centre. Questions will be aimed at learning end of life wishes, palliative care conceptions and when initial palliative care discussions first began and how these were perceived. This will give insight into the expectations of clients in their last days and weeks of life and their understanding of palliative care.

It is hoped that following evaluation of this research it will inform future program development and improve quality of palliative care service delivery for renal clients in a culturally appropriate and timely manner.

Researchers:

  • Jenny Costigan
  • Assoc Prof Julia Marley
  • Prof David Atkinson

Social & Emotional Wellbeing

Validating the Kimberley Mum’s Mood Scale

Validating the Kimberley Mum’s Mood Scale

Perinatal mental health is a major public health issue affecting 20% of Australian mothers within the first year post birth. Perinatal depression/anxiety is the most prevalent mood disorder associated with childbirth, with an incidence of 14% in Australia. The impact of perinatal depression/anxiety can be detrimental for the mother, her relationships and her developing infant. As a result of maternal depression/anxiety and stress, the increased level of maternal cortisol can threaten the developing foetal nervous system. This may result in poorer birth outcomes such as preterm delivery, small birth size and associated morbidity.  Long term effects include poorer learning outcomes, adolescent mental health issues and associated lifelong consequences.

Early identification, treatment and support helps women recover from postnatal depression. Recovery can lead to an enhancement of their life skills, emotional development and the rebuilding of relationships. However, despite the prevalence and consequences of antenatal and postnatal depression, most women do not seek and/or receive treatment. With so few Aboriginal And Torres Strait Islander peoples accessing mental health support until it is urgent, routine screening and effective early intervention for perinatal depression/anxiety in the Kimberley is critical.

The Kimberley Mums Mood Scale (KMMS) is an alternative to the Edinburgh Postnatal Depression Scale (EPDS) and screens for depression and anxiety. It has been collaboratively developed by health care providers and over 100 Aboriginal women from eight language groups throughout the Kimberley. KMMS is a cross sector collaborative project which is supported by WA Country Health Service – Kimberley, Boab Health Service, KAMSC and The Rural Clinical School of WA.

This project aims to validate the KMMS using a gold standard mental health assessment and assess its acceptability. Once validated the KMMS should ensure the culturally appropriate mental health screening of Kimberley Aboriginal women during the perinatal period.

Researchers:

  • Jayne Kotz
  • Sudha Coutinho
  • Dr Catherine Engelke
  • Assoc Prof Julia Marley
  • Meleseini Tai-Roche
  • Dr Stephanie Trust
  • Melissa Williams