ATSI

Definition:

Preventative health screening for Aboriginal and Torres Strait Islander (ATSI) populations is aimed at early detection of health issues, to prevent or mitigate the impact of chronic diseases and other health conditions that disproportionately affect this group.

Aetiology/Causes:

Higher prevalence of chronic conditions such as cardiovascular disease (CVD), chronic kidney disease (CKD), diabetes, and mental health disorders are more prevalent in the ATSI population due to social determinants of health like overcrowded living conditions, limited access to healthcare, and poor health literacy.

Pathophysiology:

Chronic conditions in ATSI populations often result from a combination of genetic predisposition, environmental factors (e.g., overcrowding, poor sanitation), and limited access to healthcare services. Conditions such as CVD, diabetes, and CKD often develop silently over time, with risk factors such as hypertension, dyslipidaemia, and hyperglycaemia contributing to the disease process.

Symptoms:

Key symptoms to watch for in ATSI populations during screenings:

• Vision and hearing issues: Reduced vision or hearing loss, often due to untreated infections or trauma.

• Depression: Symptoms include prolonged sadness, irritability, withdrawal, and loss of interest in daily activities.

• Cardiovascular Disease: Symptoms may include chest pain, breathlessness, dizziness, and palpitations.

• Chronic Kidney Disease: Symptoms such as fatigue, swelling of the legs, and reduced urine output.

• Skin infections: Scabies and impetigo may present as rashes or sores on the skin, often due to overcrowded living conditions.

Differential Diagnosis:

• CVD Risk: Conditions like hyperthyroidism, anaemia, and sleep apnoea should be ruled out for unexplained cardiovascular symptoms.

• Chronic Kidney Disease: Other causes of kidney disease such as diabetes, glomerulonephritis, or dehydration should be considered.

• Hearing and Vision Impairment: Other causes could include age-related conditions, medication side effects, or neurological disorders.

Investigations:

• Vision and Hearing: Routine screening for hearing loss (audiometry) and vision impairment (ophthalmologic exams).

• Depression: Use of standardized tools such as the PHQ-9 (Patient Health Questionnaire-9) or K5 questionnaire for assessing depression.

• Cardiovascular Risk Screening (from 18 years):

  • Blood sugar level (BSL)

  • Lipid profile

  • Estimated glomerular filtration rate (eGFR)

  • Urine albumin-to-creatinine ratio (ACR)

  • Blood pressure (BP)

• Chronic Kidney Disease Screening (from 18 years): Regular testing of kidney function (eGFR, urine ACR).

• Immunisation History: Hepatitis A, B, Prevenar, and Bexsero. Bexsero can be given from 2 months of age.

Management:

• Health Worker Involvement: Ensure that a health worker is involved in screenings, education, and follow-up care, especially for those in remote or disadvantaged areas.

• Interpreter: Always offer an interpreter for non-English speaking ATSI patients to ensure effective communication.

• CVD Management: Lifestyle changes (smoking cessation, weight management, regular exercise), pharmacological treatments (antihypertensives, statins, etc.), and referral to specialists for advanced cases.

• Chronic Kidney Disease Management: Control blood pressure, manage diabetes, and use medications to prevent progression (e.g., ACE inhibitors).

• Mental Health: Provide psychological support, community services, and referrals for counseling and mental health services.

• Immunisation: Ensure timely immunisation for at-risk populations to prevent preventable diseases, particularly in areas with limited access to healthcare.

Complications:

• Unmanaged Chronic Diseases: Lack of management of conditions like CVD, diabetes, and CKD can lead to significant morbidity and mortality.

• Mental Health Issues: Untreated depression can lead to substance abuse, self-harm, and impaired daily functioning.

• Infections: Skin infections such as scabies and impetigo can lead to secondary complications if untreated, including abscesses and systemic infections.

Prognosis:

• CVD, CKD, and Diabetes: Early detection and treatment can significantly improve quality of life and life expectancy in ATSI populations. Management of risk factors is key to improving long-term outcomes.

• Mental Health: Timely intervention and culturally sensitive mental health support can lead to positive outcomes for those affected by depression and other mental health issues.

• Skin Infections: Early treatment of skin infections prevents long-term complications and improves community health.