Indigenous Health Research Program

Indigenous Health Research Program Gail Garvey Indigenous Health Epidemiology
Laboratory based studies of Indigenous Health
Promoting Science through Education
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Program Staff
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Indigenous Health Brochure
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Labhead: Associate Professor Gail Garvey

Overpowered by Cancer

Mission Statement

To promote improved health and wellbeing for Aboriginal and Torres Strait Islander peoples through health/ medical research and education.
To develop culturally appropriate reseach projects in partnership with Aboriginal and Torres Strait Islander peoples.
To cooperate with, and where possible assist, the work of other agencies to improve the health and well being of Aboriginal and Torres Strait Islander peoples.
To act as an advocate on issues related to the health and wellbeing of Aboriginal and Torres Strait Islander peoples.

This painting Overpowered by Cancer is one of a collection portraying Aboriginal women's perspective of cancer and its related treatment. The collection of artwork, prepared by Julie Rogers, contributed to the data that shaped a PhD thesis on Aboriginal women with cancer by Dr Deborah Prior.

Indigenous Health Epidemiology

CURRENT PROJECTS

Cancer treatment and health care services
Asthma
Bronchiectasis
Obesity, Metabolic Syndrome and Diabetes Type 2
Dementia
Lower Cancer Survival Rates

PAST PROJECTS

Indigenous Cancer Survival compared to non-Indigenous
Zinc and Vitamin A supplementation
Group B Streptococcus

A comparative study of treatment and health care services for Indigenous and non-Indigenous cancer patients in Queensland
PhD Candidate S Moore, Principle Supervisor: Prof A Green¹, Associate Supervisors: Dr P Valery¹, Assoc Prof G Garvey¹ and Assoc Prof M Coory².
¹ The Queensland Institute of Medical Research ²The University of Queensland
In Queensland, Aboriginal and Torres Strait Islander people have poorer survival and die more quickly than non-Indigenous people with cancer, now the second leading cause of death for Indigenous people. Cancer registry records indicate that although the incidence of cancer is no greater than that of the rest of the population, death rates are up to 45% higher. This is partly due to an elevated incidence of cancer types with higher case fatality rates such as cancers of the lung, cervix, oesophageus, mouth and pharynx, and also the later stage at diagnosis of cancer, when the disease is more difficult to treat. However, after adjusting for cancer stage and type, mortality is still higher for Indigenous compared to non- Indigenous Queenslanders, suggesting that outcomes from treatment are poorer.

The aim of the present study is to identify differences in cancer treatment between Indigenous and non-Indigenous Queenslanders diagnosed with cancer between 1998 and 2004, taking into account cancer stage, location of residence, co-morbidities, and other factors. Cases will be matched for age, sex, cancer type and location of residence and data will be obtained from medical records throughout Queensland. Patients, family members, Health Care Workers and clinicians, sampled for convenience, will also be invited to provide personal recounts of their experiences of cancer services in Queensland. Data collection is ongoing and analysis will be complete by December 2008.

The importance and urgency of this study is evidenced by the dearth of existing literature regarding cancer treatment for Indigenous Australians. The broader aim of this study is to inform future health initiatives in order to improve cancer outcomes for Aboriginal and Torres Strait Islander people in Queensland.

Asthma Education Intervention Study
PC Valery, V Clements, V Harrhy (QIMR), AB Chang, IB Masters, (Royal Children's Hospital), B Taylor (The Asthma Foundation of Queensland), Y Laifoo, (Thursday Island Primary Health Care Centre)

Ida Savage This project is conducted in collaboration with the Royal Children's Hospital, Asthma Foundation of Queensland and Torres Strait and Northern Peninsula Area District Health Service which was developed as a follow on to the 'short wind study' conducted in 1999..

The aims of the project are to:
1. Work towards recognition of local schools as an 'Asthma Friendly school'
2. Deliver Health Worker training - recognising and helping children with asthma in the Torres Strait communities.
3. Conduct Paediatric Respiratory specialist clinics.
4. Delivery and evaluation of culturally appropriate asthma education and asthma management support provided by a local Health Worker

The project commenced in 2005 with trips to Thursday Island twice a year. To date 500 hundred children have been seen in the Paediatric Respiratory specialist clinics and 60 health workers have been trained. Data collection is now completed and we are conducting data analysis.

Bronchiectasis in Indigenous Children
INTERNATIONAL COLLABORATION OF BRONCHIECTASIS NETWORK
Arctic Investigations Program - CDC, Alaska, US - R Singleton, T Thomas
Menzies School of Health Research, Darwin, Australia - P Morris, A Leach
Northern Territory Health Service, Alice Springs, Australia - R Roseby, A White
Queensland Institute of Medical Research, Brisbane, Australia - PC Valery, J Stirling
Starship Children's Hospital, Auckland, New Zealand - EA Edwards, CA Byrnes
Royal Children's Hospital, Brisbane, Australia - AB Chang, IB Masters, J Masel
Royal Darwin Hospital, Darwin, Australia - P Bauert
Royal Prince Alfred Hospital, Sydney, Australia - PJ Torzillo
University of Washington School of Medicine, Seattle, US - G Redding
Wellington School of Medicine and Health Sciences, Wellington, New Zealand - K Grimwood, J Murdoch, P Leadbitter
Chronic suppurative lung disease (CSLD) and bronchiectasis still contribute to the high burden of respiratory disease in Aboriginal Australians and Indigenous children worldwide. The risk factors associated with progression to bronchiectasis the clinical course and optimal treatment in this population is not known. Australian Aboriginal children have high rates of pneumococcal carriage, otitis media and Invasive pneumococcal disease. The significance of this in terms of the natural history of bronchiectasis is unknown. The high rates of CSLD among Indigenous populations in affluent countries have resulted in the first collaborative and international study (Aboriginal and Torres Strait Island, New Zealand Pacific Island and Maori and Alaskan Native people).

Two studies are proposed an observational study and an intervention study.
The aims of the observational study are to:
(1) define the natural history of chronic moist cough and bronchiectasis;
(2) identify the risk factors associated with progression to bronchiectasis

The aims of the intervention study are to evaluate maintenance azithromycin (30 mg/kg once a week) compared to placebo on:
(1) the prevention of pulmonary exacerbations
(2) pneumococcal and H. influenzae carriage and
(3) antibiotic resistance.

The study design is identical in the participating countries.
Observational: a prospective cohort study (2005-2010) of Indigenous children aged 6 months to 8 years with bronchiectasis or chronic moist cough (with and without CXR infiltrates).
Interventional: a randomised double-blind placebo controlled trial comparing maintenance azithromycin for 24 months versus placebo in Indigenous children aged 12 months to 8 years with bronchiectasis.
Primary outcomes are: number of pulmonary exacerbations and time to pulmonary exacerbation.

The Observational study has commenced in all sites; to date Australia and Alaska has enrolled 12 children; we expect to identify 100-150 eligible children. NHMRC funding has been approved to start the Australian Interventional study site in 2006. We expect to randomise over 100 children (including all sites).

This will be the first study to prospectively document the clinical course of chronic moist cough and bronchiectasis in Indigenous children. The associated clinical trial will provide urgently needed information about the potential benefits and harms of maintenance antibiotic treatment. The project has the potential to improve health outcomes for Indigenous children and other disadvantaged children with CSLD throughout the world.

Obesity, Metabolic Syndrome and Diabetes type 2 in children in the Torres Strait
PhD Candidate A Moloney (QIMR), P Valery(QIMR), A Green (QIMR), A Sinha (Qld Health), A Cotterill (Mater Children's Hospital)
One-quarter of Indigenous Australian adults are obese, one in eight have cardiovascular disease and 6% type 2 diabetes and usually at young ages. Indigenous people living in the Torres Strait, far north Queensland, have the highest prevalence of type 2 diabetes in Australia (26% of 15 years and older), obesity (51%) and cardiovascular risk factors (32% hypertensive, 33% hypercholesterolemic) are also highly prevalent.

We have conducted a cross-sectional study of school-age Indigenous children residing in the Torres Strait region of Australia. Our aim was to assess the prevalence of some key risk factors associated with cardiovascular disease and type 2 diabetes, namely excess weight, hypertension, insulin resistance and dyslipidemia in this population.

School aged children from four island communities participated in a face-to-face interview and had physical measurements and a conventional capillary fingerstick blood sample. Youth with a blood glucose level greater than 5.5 mmols/L or who were overweight or obese had fasting blood samples for glucose, insulin, C-Peptide, HbA1c and lipid measurements, and participated in an oral glucose tolerance test. Over 300 children were included in the study. Data collection is now completed and we are conducting data analysis.

Successfully ageing into the future: understanding dementia in Aboriginal and Torres Strait Islander communities (2007 ongoing)
Assoc Prof G Garvey, Assoc Prof P O'Rourke (QIMR), J Phillips, N Franks, B Meiklejohn (QUT), Assoc Prof D Gorman (USQ), V Curnow ( Alzheimer's Australia), Prof J Abbey, Dr S Sacre ( CRC Dementia)

Why is survival from cancer much lower for Indigenous people: gaining a better understanding of barriers and enablers
Assoc Prof G Garvey, Dr P Valery, Prof A Green, Ms S Moore (QIMR) Dr A Hawkes, C Jacka (Cancer Council Queensland) Dr D Prior (Queensland Health)

Past Projects

Cancer diagnosis, treatment and survival in Indigenous compared with non-Indigenous Australians treated in public hospitals
P Valery, J Stirling, A Green (QIMR) M Coory (University of Queensland)
Detailed data on cancer in Indigenous people have only been published for SA, WA and NT. Data on cancer in Qld are only available for selected rural and remote Indigenous communities. There is little information on stage of cancer at diagnosis and how Indigenous cancer patients are affected by co-morbidities. We have undertaken the first population-based comparative study of cancer in Indigenous and non-Indigenous public hospital patients in Qld, in particular exploring cancer stage at diagnosis and co-morbidities.

Indigenous people diagnosed with cancer between 1997-2002 were identified through the cancer registry and compared with selected non-Indigenous cases frequency-matched on age, sex, place of residence, cancer site and year of diagnosis. Treatment details were obtained from hospital medical records review.

The findings from this study indicate that more needs to be known about the identified health differential between Indigenous and non Indigenous cancer patients to resolve the problem.

Clinical trial of zinc and vitamin A supplementation in Australian Indigenous children with acute diarrhoea and pneumonia
P Valery (QIMR), A Chang (Alice Springs Division, Flinders University NT Clinical School), P Torzillo (RPAH Medical Centre), A Leach (Menzies School of Health Research), J Wakerman (Centre for Remote Health), and A White (Remote Health/Paediatrics/Medicine)
We evaluated the role of zinc and vitamin A supplementation in the clinical recovery of Aboriginal children hospitalised for diarrhoea and pneumonia through a randomised, controlled trial conducted at the Alice Springs Hospital in Central Australia. Participants were Aboriginal children with episodes of diarrhoea or pneumonia.

With regards to diarrhoea, overall, when all children in the supplemented groups were compared with non-supplemented, for both zinc and Vit-A comparisons, there was no significant effect on duration of diarrhoea and subsequent hospitalisation. A small non-significant positive effect of zinc and Vit-A was seen in the subgroup of stunted children. We concluded that Vit-A and zinc supplementation are not indicated in the acute management of hospitalised diarrhoeal disease in Aboriginal children living in remote areas. This finding may not apply to children with malnutrition where other studies suggest a benefit. Data on the Vit-A and Zinc status as well as nutritional status of study populations will be essential if future trials are to explain the different results in different populations.

With regards to pneumonia, there was no clinically beneficial effect of vitamin-A and/or Zn supplementation as adjunct treatment. Instead we found increased morbidity as children supplemented with Vit-A had prolonged hospital stay and those supplemented with zinc had increased risk of re-hospitalisation for pneumonia. This study does not support the use of Vit-A or Zn supplementation in the management of hospitalised ALRI episodes in Aboriginal children living in remote areas. Even in populations with high rates of ALRI and poor living conditions, vitamin-A and Zn therapy may not be useful and its effect may be dependent on prevalence of deficiency of these micronutrients in the population studied.

Group B Streptococcus rapid PCR test optimization and evaluation and Indigenous Non Indigenous Group B Colonisation/Prevalence Comparison Study
K Taylor (QIMR), C Knox (QUT), W Munckhof (PA Hospital), K Sriprakash (QIMR), P Valery (QIMR), J Stirling (QIMR)
Group B Streptococcus (GBS) can be found in a women's rectum and/or vagina without causing any harm. However, if she is pregnant, it can be transferred vertically during childbirth leading to neonatal morbidity and mortality. Treatment can be offered in a targeted manner if we know the GBS status of the expectant mother at the time of delivery. We have developed a test for this in the laboratory; we now propose to determine whether this test is applicable using clinical material. We are also going to compare colonisation/prevalence between Indigenous and non-Indigenous participants in the study. Data collection and analysis have been completed.

Laboratory based studies in Indigenous Health

Cooperative Research Centre for Aboriginal Health (CRCAH)
The CRCAH has identified the Healthy Skin program as one of its five research programs. Work in QIMR's Scabies, Molecular Immunology and Bacterial Pathogenesis Laboratories links into this program which aims to reduce the prevalence of scabies and skin sores in Indigenous communities and reduce the impact of associated chronic diseases including rheumatic fever and renal disease. QIMR has both "in kind" and CRCAH funded projects within this program.
CRC for Aboriginal Health

Scabies
This is a collaborative project with the Menzies School of Health Research. Scabies, a skin disease caused by a mite, is not only a very distressing disease, but it also leads to skin sores which become infected with streptococci. This in turn may lead to serious kidney damage. Scabies mites are often found in places where overcrowding occurs, and this is sometimes the case in Aboriginal communities. This project has a long term aim of developing a vaccine for scabies using molecular biology.
QIMR Scabies Laboratory

Rheumatic Fever and Rheumatic Heart Disease
Infection with group A streptococci (GAS) can result in a number of clinical manifestations including pharyngitis, skin infections, rheumatic fever (RF) and rheumatic heart disease (RHD). It is estimated that 12 million people are affected worldwide by RF and RHD with 380,000 deaths annually from RHD (WHO, 2000). These diseases are a major health concern in developing countries and indigenous populations, especially Australia's Aboriginal population of the Northern Territory who have the highest recorded incidence worldwide.

The primary aim of the Streptococcal Research Group, which includes members of the Molecular Immunology Laboratory, QIMR, and the Bacterial Pathogenesis Laboratory, QIMR, is the design and development of a vaccine to prevent GAS infection and GAS-associated diseases. Research in the laboratories is currently investigating different strategies for immunisation, vaccine design and delivery, the mechanisms responsible for eliciting protective immunity against GAS, and procedures for the identification of potentially novel vaccine candidates. In addition, research is also focussing on the contribution of specific virulence factors to GAS pathogenesis. More information about rheumatic fever and rheumatic heart disease research at QIMR is available from:
QIMR Molecular Immunology Laboratory
QIMR Bacterial Pathogenesis Laboratory

Promoting Science through Education

Spotlighting Careers in Indigenous Health and Science
Spotlighting Careers in Indigenous Health and Research is a week long hands on science experience, focusing on the importance of Indigenous health research and providing opportunities for students to gain an insight into the vast areas of health and science as a career.

School fun at QIMR
As an Institute our aim is to champion medical research as a career, provide work experience at several critical stages of this pathway and educate and mentor bright students and teachers from Queensland, interstate and overseas. Click here to find out what exciting opportunites we have to offer you as a student.

UQ Science and Engineering Camp
This is a UQ initiative in collaboration with QIMR.

Community Links

QIMR partners with a number of Aboriginal and Torres Strait Islander Community groups and organsiations across the Country. Our partners include:

WuChopperen Health Service, Cairns, North Queensland
Kambu Medical Centre, Ipswich
Queensland Aboriginal and Islander Health Council (QAIHC)
Thursday Island Primary Health Care Centre
CRC for Aboriginal Health, Darwin

Partnering Agreement with WuChopperen Health Service, Cairns

The Indigenous Health Research Program and WuChopperen Health Service have a "Partnering Agreement" between the two organisations. The agreement was developed after a period of building relationships and talking about how each organisation could benefit through a partnership which would bring together community controlled health service delivery and a large research institute.

The initial agreement was to work in the areas of Group A Streptococcus and the related diseases Rheumatic Fever and Rheumatic Heart Disease, with a view to expanding the research agenda in the future and the agreement was supported by funds provided to QIMR from the Indigenous Land Corporation to develop links between the scientists working in Group A Streptococcus research and Indigenous communities.

Photo (left): Professor Michael Good (Director of QIMR) with Ms Dallas Young, Chairperson of the Board of WuChopperen Health Service at the signing in Cairns.

Program Staff

Indigenous Health Program Coordinator
Assoc Prof Gail Garvey

Patricia Valery (23K)
Senior Research Officer
Dr Patricia Valery

Valerie Loga (23K)
Scientific Officer
Valerie Logan

Aletia Twist(23K)
PhD Student
Aletia Twist

PhD Student
Suzanne Moore

Vanessa Clements(23K)
Masters Student, Administrative Officer
Vanessa Clements

Lisa Whop(23K)
Cadet, Administrative Officer
Lisa Whop

Collaborators

Asthma Queensland
Cancer Council Queensland
CRC for Aboriginal Health, Darwin
CSIRO - Explore and Educate, Brisbane
Menzies School of Health Research, Darwin, Australia
Queensland Health - Epidemiology Unit
Queensland University of Technology - CRC Dementia
Royal Children's Hospital, Brisbane
Thursday Island Primary Health Care Centre
WuChopperen Health Service, Cairns, North Queensland
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Recent Publications

Valery PC, Chang AB, Masters IB, Stirling J, Laifoo Y, Twist A. Stability of prevalence of asthma symptoms in school children in the Torres Strait region. Respirology 2008; 13: 447-457.

Valery P, Wenitong M, Clements V, Sheel M, McMillan D, Stirling J, Sriprakash K, Batzloff M, Vohra R, McCarthy JS. Skin infections among Indigenous Australians in an urban setting in Far North Queensland Epidemiol Infect 2007; 1-6 [Epub ahead of print]

Valery PC, Coory M, Stirling J, Green AC. Cancer diagnosis, treatment, and survival in Indigenous and non-Indigenous Australians: a matched cohort study. Lancet 2006;367(9525):1842-8.

Chang AB, Torzillo PJ, Boyce NC, White AV, Stewart PM, Wheaton GR, Purdie DM, Wakerman J, Valery PC. Zinc and vitamin A supplementation in Indigenous Australian children hospitalised with lower respiratory tract infection: a randomised controlled trial. Med J Aust 2006;184(3):107-12.

Valery PC, Torzillo PJ, Boyce NC, White AV, Stewart PA, Wheaton GR, Purdie DM, Wakerman J, Chang AB. Zinc and vitamin A supplementation in Australian Indigenous children with acute diarrhoea: a randomised controlled trial. Med J Aust 2005;182(10):530-535.

Clements V, Evaluation Research on the Hearing Health Program - Aboriginal and Islander Health Worker Journal July/August 2005, Vol 29 - No 4

Valery PC, Torzillo PJ, Mulholland K, Boyce NC, Purdie DM, Chang AB. Hospital-based case-control study of bronchiectasis in indigenous children in Central Australia. Pediatr Infect Dis J 2004;23(10):902-8.

Valery P, Master I, Chang A. Snoring and its association with asthma in Indigenous children living in the Torres Strait and Northern Peninsula Area. J Paediatr Child Health 2004.

Valery PC, Purdie DM, Chang AB, Masters IB, Green A. Assessment of the diagnosis and prevalence of asthma in Australian indigenous children. J Clin Epidemiol 2003;56(7):629-35.

Valery P, Masters I, Chang A. Asthma is not Prevalent in Aboriginal and Torres Strait Islander Children: A Myth. J Paediatr Child Health. 2002 Feb;38(1):105-106. [letter to the editor]

Stirling J, Indigenous Health Research Program - The Queensland Institute of Medical Research, Aboriginal and Islander Health Worker Journal Nov/Dec 2002 Vol 26 - No 6

Valery P, Chang A, Shibasaki S, Gibson O, Purdie D, Shannon C, Masters I. High prevalence of asthma in five remote indigenous communities in Australia. Eur Resp J 2001;17:1089-1096.

Chang A, Shannon C, O'Neil M, Tiemann A, Valery P, Craig D, Fa'Afoi E, Masters I. Asthma management in indigenous children of a remote community using an indigenous health model. J Paediatr Child Health 2000;36:249-51.

Shibasaki S, Valery PC, Audera C, Gibson O. A guide to informing a community within the Torres Straits. Aboriginal and Islander Health Worker Journal 2000 24(4):15-16.

Chang AB, Shannon C, O'Neil MC, Tiemann AM, Valery PC, Craig D, Fa'afoi E, Masters IB. Asthma management in indigenous children of a remote community using an Indigenous health model. J Peadiatr Child Health 2000;36:249-251.

ABSTRACTS

The Thoracic Society of Australia and New Zealand Annual Scientific Meeting, Perth AUSTRALIA April, 2005. Valery PC, Singleton RJ, Redding GJ, Torzillo PJ, Butler J, LR Bulkow, Chang AB. Bronchiectasis in Alaska Native children and Indigenous children from Central Australia. Respirology 2005;10(suppl):A87.

The Thoracic Society of Australia and New Zealand Annual Scientific Meeting, Sydney AUSTRALIA March, 2004. Valery PC, Torzillo PJ, Mulholland K, Boyce NC, Purdie D, Chang AB. A hospital-based case-control study of bronchiectasis in Indigenous children in Central Australia. Respirology 2004;9(suppl):A56.

The Thoracic Society of Australia and New Zealand Annual Scientific Meeting, Sydney AUSTRALIA March, 2004. Valery PC, Singleton RJ, Redding GJ, Torzillo PJ, Butler J, Chang AB. Indigenous children with bronchiectasis: a comparison of similarities and differences between indigenous children living in central Australia and Alaska. Respirology 2004;9(suppl):A63.

The Thoracic Society of Australia and New Zealand Annual Scientific Meeting, Sydney AUSTRALIA March, 2004. Chang AB, Torzillo PJ, Boyce NC, White A, Wheaton G, Purdie D, Wakerman J, Valery PC. Randomized controlled trial of zinc and Vit-A supplementation in Australian Indigenous children with acute lower respiratory tract infectio. Respirology 2004;9(suppl):A63.

American Thoracic Society 96th International Conference. Toronto, Ontario CANADA May, 2000. Valery PC, Chang AB, O'Neil MC, Tiemann A, Shannon C, Fa'afoi E, Masters IB. Asthma in Indigenous children in Queensland, Australia. Am J Respir Crit Care Med 2000;291:A621.