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Past research

APPLICATION OF EVIDENCE BASED CLINICAL PRACTICE IN DIABETES CARE IN REMOTE NORTH QUEENSLAND INDIGENOUS COMMUNITIES

Funded by NHMRC $400,000

Prevalence of Type 2 diabetes is disproportionately high in Australian Indigenous people, yet access to quality diabetes care for Indigenous people is poor, especially in remote areas. A review of shared care programs concluded that the introduction of alternate care of diabetics was the key to improving outcomes, rather than rigid adherence to any particular imposed structure. The strength of this approach is that local providers can best design optimal and appropriate care planning (with the help of guidelines). This study aimed to determine compliance with current evidence-based guidelines for clinical management of diabetes in the primary care setting of 16 remote community health services in far north Queensland (Torres Strait and Cape York Health Districts). Negotiations with local care providers enabled appropriate plans for diabetes management which included (evidence-based) care plans for individuals, a significant role for health workers and a schedule for accessing support services as required. Evaluation of these interventions used a follow-up case note audit, a health worker survey and a survey of clients in the intervention and control communities. Over the long term (3 to 4 years), it is expected that better compliance with care guidelines will be reflected in reduced preventable hospital admissions among diabetics, for example, cellulitis, lower limb amputations and pneumonia.

WELL PERSON'S HEALTH CARE

The Well Persons Health Check was a community-based general wellness check for mainly indigenous people in remote north Queensland communities, run in partnership between Queensland Health, Apunipima Cape York Health Council and community organisations.

CIGUATERA POISONING IN NORTH QUEENSLAND

The Foundation, together with the University of Queensland's National Research Centre for Environmental Toxicology, commenced a ciguatera poisoning research project in 2001. Ciguatera poisoning poses a constant public health risk in the tropics. It is produced by the presence of ciguatoxin in the flesh of edible fish species, including coral trout and Spanish mackerel commonly caught by both recreational and commercial fishers in tropical waters. The presence of the toxin cannot be detected by taste, odour or visual means, and the toxin is not affected by freezing, cooking or curing. Affected fish are indistinguishable from safe fish, and no rapid, cost-effective procedure exists for determining its presence in fish at point of capture or sale.

The ciguatera toxin starts its life as a dinoflagellate called Gambierdiscus toxicus that colonises coral beds. The coral-grazing fish are the first in the food chain to be affected, with the toxin being passed up through the chain until it gets to the fish eaten by humans. Locally, this is likely to be reef fish and semi-pelagic saltwater species, such as red bass, snapper, Spanish mackerel, queen fish and coral trout. The affected fish-eater will begin to be aware of poisoning several hours later, with a sudden onset of gastrointestinal complaints such as nausea, vomiting and cramps. A common symptom is an altered sensation around the lips, throat and tongue, with reversed feelings of heat and cold. Ice applied to the lips will be interpreted by the sufferer as a burning sensation. Heaviness, weakness of the limbs, dizziness and other neurological complaints occur, and symptoms are intensified with the intake of alcohol. Ciguatera is usually self-limiting, lasting a few months. So far, attempted treatments have been generally disappointing. Immunity is not acquired after an attack, and if an individual is unlucky enough to eat poisoned fish more than once, a smaller dose of the toxin is required the second time around to produce similar symptoms. Although the death rate is low, any research that can contribute to the evaluation of risk of caught fish will be of benefit to the Far North Queensland community.

The initial aim of this project involved the validation of the CiguaCheck® test-kit developed overseas to test for the presence of ciguatoxins in fish. The test kit was particularly sensitive to storage conditions. A series of tests were performed on various fish species (over 120 samples), both those suspected of being toxic and non-toxic. Of fish suspected to contain ciguatoxins (implicated in cases of ciguatera fish poisoning or caught in known ciguateric areas), 95 per cent were positively identified. Investigations into compartmentalisation of ciguatoxins within fish flesh suggested no significant difference between fins, tail or gut regions in Spanish Mackerel. The intention is to test Coral Trout, Red Bass, Red Emperor, Spanish Mackerel and Cod.