An electronic publication from the Australian Indigenous HealthInfoNet
Issue 6, November 1999 : ISSN 1329-3362
Journal articles
Articles [I-Z]
|
articles
|
articles
|
|
[ A
- H ]
|
[ I - Z ]
|
|
Isaacs, D., & Royle, J.A. (1999). Objective: Early onset group B streptococcal (EOGBS) infection, the major neonatal infection in industrialised countries, can be prevented by intrapartum antibiotics, but population studies are lacking. This study aimed to determine the incidence of early onset infections caused by group B Streptococcus (GBS) and other organisms in Australia and to assess intrapartum antibiotic use. Design: Longitudinal, prospective surveillance of neonatal infections in Australian neonatal units from 1991 to 1997. Early onset infection defined as clinical sepsis in first 48 hours after birth, with positive cultures of blood or cerebrospinal fluid or positive urine GBS antigen detection. Results: The incidence of EOGBS sepsis fell from 2.0 per 1,000 live births (95% confidence interval, 1.4, 2.5) in 1991 to 1993, to 1.3 (1.2, 1.4) in 1993 to 1995, to 0.5 (0.4, 0.7) in 1995 to 1997 (P < 0.0001), The incidence in Aboriginal babies was 5.2 (1.8, 8.6) in 1991 to 1993, 5.1 (3.0, 7.2) in 1993 to 1995 and 1.8 (1.1, 2.5) in 1995 to 1997 (P < 0.05). The incidence of early onset infections caused by organisms other than GBS also fell, from 1.2 per 1,000 live births (0.8, 1.7) in 1991 to 1993, to 0.8 (0.7, 0.9) in 1993 to 1995 and 0.5 (0.3, 0.7) in 1995 to 1997 (P < 0.0001). In 1991, 3 of 9 study hospitals had a formal policy on intrapartum antibiotic use, whereas in 1997 all 11 hospitals had a formal policy (P = 0.002). Conclusions: A steady fall in EOGBS infections in
Australia from 1991 to 1997 has been associated with increasing
use of intrapartum antibiotics. Increased antibiotic use is probably
causal in the fall in GBS, because the incidence of early onset
infections caused by other organisms has also fallen.
Jackson, D., Teale, G., Bye, R., McCallum, J.,
& Stein, I. (1999). Many Aboriginal people reside in rural and remote
Australia. Aboriginal health workers were the informants in this
exploratory-descriptive study, which explored issues pertaining
to postacute care for older Aboriginal people. Qualitative analysis
of interview data revealed several issues were viewed as being
of crucial importance in the provision of effective post-acute
services to older Aboriginal people. These were: (i) identification
of Aboriginality; (ii) perceived racism and stereotypical attitudes
among hospital staff and healthcare workers; and (iii) effective
discharge planning. Other issues which were believed to impact
upon service use were identified as: (i) availability of services;
(ii) knowledge of services and level of use; and (iii) the notion
of mainstream versus Aboriginal-specific services. Findings are
discussed in relation to available literature. Implications for
further research are drawn from the findings of this exploratory
study.
Jackson, L.R., & Ward, J. E. (1999).
Johnston, F., Carapetis, J., Patel, M.S., Wallace,
T., & Spillane, P. (1999). Introduction: Outbreaks of acute post-streptococcal glomerulonephritis (APSGN) occur every few years in remote Australian Aboriginal communities. Intervention with benzathine penicillin G (BPG) to all children is effective in reducing streptococcal carriage in a community, but its effectiveness in arresting outbreaks of APSGN has not been established. Objective: To study nine recent community outbreaks of APSGN in Australia's Northern Territory and compare them with outbreaks reported in the literature to assess the impact of intervention with BPG. Methods: Because randomised controlled trials have not been conducted for this purpose, we assessed data from published observational studies and relevant experiences in the Northern Territory (NT). Eight of the nine outbreaks in the NT were studied prospectively. An outbreak was defined as two or more clinical cases of APSGN occurring within one week in a single community. Three intervention methods were used: intramuscular BPG to all children ages 3 to 15 years; BPG only to children with skin lesions; and BPG only to child contacts of clinical cases. The attack rates, number of clinical cases before and after the interventions were documented and the coverage of children with penicillin were estimated. Results: A review of the literature found very little evidence either for or against the effectiveness of intervention with BPG. In our study, four communities used the first method of intervention. The community with the lowest uptake of penicillin continued to have cases in untreated children for nine further weeks, two communities had no new cases from three weeks after the intervention and the fourth had a single further case after four weeks. The one community that used the second method had a high initial attack rate but no further cases from one week after the intervention. Three communities used the third method and in one community no intervention was attempted. Conclusion: Our observational study supports the
use of BPG in the community to prevent new cases of APSGN. It
suggests that targeted treatment of children with skin sores and
household contacts of cases, rather than attempted treatment of
all children in the community, could be an effective method of
intervention.
Kruske, S.G., Ruben, A.R., & Brewster, D.R.
(1999). Objective: To compare supervised vs unsupervised oral iron treatment in anaemic Aboriginal children living in a remote community with a 40% prevalence of iron deficiency anaemia. Methodology: A randomised unblinded clinical trial in children < 6 years presenting to a remote Health Centre with anaemia. Oral iron prescribed as a daily unsupervised dose (group A) was compared with twice weekly unsupervised administration (group B) over 12 weeks. Parenteral iron (group C) was reserved for failure of oral treatment. Results: Only 3 of 25 children in group A responded to treatment compared with 23 of 26 children in group B (odds ratio = 7.7, 95% confidence interval 2.6-25.0). After six weeks of treatment, the mean haemoglobin rise was 0.96g/L in group A compared with 10.9g/L in group B and 12.4g/L in group C. On entry to the study, 29.4% of subjects were underweight, 33.3% stunted and 35.3% microcephalic. The mean catch-up in weight/height on iron treatment over the study was only 0.28 (0.08,0.48) Z-scores. Conclusions: Oral iron as directly observed twice
weekly treatment is superior to unsupervised therapy. In view
of the poor compliance with unsupervised treatment and the high
prevalence of iron deficiency anaemia (along with stunting and
microcephaly) in Aboriginal children in northern Australia, we
propose to undertake in partnership with communities a nutritional
intervention program with a high energy weaning food fortified
with micronutrients (iron, vitamin A, zinc, folate) as the most
effective strategy to address these nutritional problems in the
weaning period.
Kukuruzovic, R.H., Haase, A., Dunn, K., Bright,
A., & Brewster, D.R. (1999). Background: Northern Territory Aboriginal children hospitalised with acute gastroenteritis have high rates of acidosis, hypokalaemia and dehydration. Aims: To determine whether Aboriginal children with and without diarrhoea have greater impairment in intestinal function than non-Aboriginal children, as assessed by increased permeability ratios. Methods: A descriptive study of 124 children (96 Aboriginal and 28 non-Aboriginal) hospitalised with and without diarrhoea. Intestinal permeability was assessed by the lactulose to rhamnose (L-R) ratio from a five- hour urine collection. Results: In Aboriginal children, mean L-R ratios (95% confidence intervals) were 18.3 (17.1 to 19.6) with diarrhoea and 9.0 (7.3 to 11.0) without diarrhoea, and in non-Aboriginal children they were 5.9 (2.8 to 12.3) and 4.2 (3.3 to 5.2), respectively. In patients with diarrhoea, L-R ratios were significantly raised when accompanied by acidosis (mean, 22.8; 95% CI, 17.0 to 30.5), hypokalaemia (mean, 20.7; 95% CI, 15.4 to 27.9), and greater than or equal to 5% dehydration (mean, 24.3; 95% CI, 19.0 to 29.6) compared with none of these complications (mean, 7.0; 95% CI, 3.5 to 13.8). Conclusion: The high incidence of acidosis, hypokalaemia
and dehydration in Aboriginal children admitted with diarrhoeal
disease is related to underlying small intestinal mucosal damage.
Larson, A., Shannon, C., & Eldridge, C.
(1999). Injecting drug use by Aboriginal and Torres Strait
Islander people has recently generated considerable concern in
communities and by public health services and planners. However,
there has been almost no research on the use of illicit drugs
by Indigenous people. This study is the first step in filling
this information gap. Through a process of extensive community
consultation the important issues were identified and a culturally
appropriate research method was developed. A questionnaire was
administered by peer interviewers to 77 Aboriginal and Torres
Strait Islander peoples who had injected an illegal drug in the
past 12 months and who lived in the Brisbane metropolitan area.
Amphetamine is the most commonly injected drug but 56% had tried
heroin and for about one-third of the sample it was the last drug
injected. Sharing injecting equipment is common in this group,
with 39% reporting that they had shared a needle in the past month;
among participants under 20 years old the percentage rises to
63. Youth and/or inexperience is also associated with unsafe needle
disposal and having never personally obtained injecting equipment
from a chemist or needle exchange. There is widespread ignorance
about safe procedures for cleaning needles. Knowledge about HIV/AIDS
is not universal and less than one-quarter personally know someone
living with HIV/AIDS; 67% rank their own chances of becoming infected
with HIV as very low or low. The results have been used to develop
programs and strategies for harm reduction locally.
Leemon, M., & Samman, S. (1999). Several studies in remote Australian Aboriginal
communities have identified impaired zinc status , which contributes
to poor growth, low immunity and recurrent episodes of diarrhoea
in children. Indigenous foods were identified for inclusion into
a community or household garden which would include fruit and
vegetables and lead to their availability, affordability, freshness
and quality. Suitable indigenous foods which provide zinc include
Brachychiton paradoxum (zinc 7.9mg/100g), Sterculia
quadrifida (zinc 6.5mg/100g), Portulaca oleracea/intraterranea
(zinc 6.5mg/100g), and Acacia coriacea (zinc 5.8 mg/
100 g). A brief review of the literature on zinc bioavailability
is presented and an attempt is made to estimate and improve the
bioavailability of zinc from these indigenous foods. This includes
food processing techniques which reduce the content of zinc inhibitors,
mainly phytate, and the consumption of zinc absorption facilitators
with meals. Concomitantly, adequate health and hygiene is suggested
in order to minimise the infection-malnutrition cycle that can
result from a reduced zinc status and recurrent episodes of infection.
An education program, including nutrition, gardening and cooking
skills could form the basis of a sustainable approach to combatting
impaired zinc status in this population.
Lester, S., Heatley, S., Bardy, P., Bahnisch,
J., Bannister, K., Faull, R., Clarkson, A. (1999). Background: The DD genotype of the angiotensin-converting enzyme (ACE) gene appears to be an independent risk factor for myocardial infarction, left ventricular hypertrophy and an increased incidence and rate of progression of renal disease. The high incidence of renal disease and end-stage renal failure in the Australian Aboriginal population has prompted investigation of ACE genotypes in these people. Methods: ACE genotypes were determined in four groups: (i) normal Australian Caucasian blood donors (n=100), (ii) Caucasian renal transplant recipients (n=173), (iii) normal Australian Aboriginals from a single tribe (n=184), and (iv) Australian Aboriginals included in the renal-transplant program (n=94). Findings: The D allele frequency in the normal Australian Aboriginal (3%) and Aboriginal renal patient group (14.4%) was significantly lower than both Caucasian groups. Interpretation: The D allele of the ACE gene has
little or no influence on the renal disease of Australian Aboriginals.
Martin-Iverson, N., Phatouros, A., & Tennant,
M. (1999). The Indigenous population of Australia constitutes
approximately 2 per cent of the total population. This group has
faced significant cultural, economic and health changes since
European settlement some 200 years ago. In this brief review some
of the health changes that have influenced the oral health status
of this community have been examined. Of major importance is the
dietary change that the once nomadic Indigenous community has
undergone. Today's Western diet, high in sugar and low in proteins
and vitamins, has resulted in a significant increase in the risk
(and prevalence) of caries and periodontal disease. In addition,
the high prevalence of diabetes also exacerbates the periodontal
of Australian Indigenous communities from modern health care services
and limited access to fluoridation increases the incidence of
oral disease. It is also noted that the incidence of rheumatic
heart disease is one of the highest in the world, thereby increasing
the risk of bacterial endocarditis. It is clear that Indigenous
communities have unique oral health needs but the extent of these
needs is not well documented. It is important that more research
be undertaken to assess these needs so that appropriate oral health
programs can be developed.
McGuire, K. (1999). The author discusses the development and accreditation
of a course in Aboriginal Social and Emotional Health Wellbeing
and her personal experience in undertaking the course.
Merritt, A., Symons, D., & Griffiths, M.
(1999).
Miller, P.J., Torzillo, P.J., & Hateley,
W. (1999). Objective: To evaluate the impact of a program to improve access to, and delivery of, diagnosis and treatment on prevalence of gonorrhoea and chlamydial infection in remote Aboriginal communities. Design: Analysis of cross-sectional data from annual age-based screening. Setting: Six remote Aboriginal communities and three homelands on the Anangu Pitjanjatjara Lands in the far north-west of South Australia, 1996-1998. Participants: All Aboriginal people aged 12-40 years listed on the Nganampa Health Council population register as resident on the Anangu Pitjanjatjara Lands. Main outcome measures: Prevalence of gonorrhoea and chlamydial infection, determined by urine polymerase chain reaction tests. Results: The prevalence of gonorrhoea in people aged 12-40 years almost halved, from 14.3% in 1996 to 7.7% in 1998 (test for trend: P<0.001). The fall in prevalence of gonorrhoea was comparable and statistically significant in both men and women. Prevalence of chlamydial infection also fell, from 8.8% in men and 9.1% in women in 1996 to 7.2% in both men and women in 1998, but this decline was not statistically significant (test for trend: P=0.174). Conclusion: This study documents a rapid reduction
in prevalence of gonorrhoea, probably reflecting reduced duration
of infectiousness due to advances in diagnosis, increased testing
activity and reduced interval to treatment rather than behaviour
change. These results demonstrate that, in remote communities,
even with a highly mobile population, it is possible to implement
effective control activities for sexually transmitted diseases.
Moor, P.E., Collignon, P.C., Gilbert, G.L. (1999). We used pulsed-field gel electrophoresis to study
the epidemiology and population structure of Haemophilus influenzae
type b. DNAs from 187 isolates recovered between 1985 and 1993
from Aboriginal children (n=76), non-Aboriginal children (n=106),
and non-Aboriginal adults (n=5) in urban and rural regions across
Australia were digested with the SmaI restriction endonuclease.
Patterns of 13 to 17 well-resolved fragments (size range, approximately
8 to 500 kb) defining 67 restriction fragment length polymorphism
(RFLP) types were found. Two types predominated. One type (n=37)
accounted for 35 (46%) of the isolates from Aboriginals and 2
(2%) of the isolates from non-Aboriginals, and the other type
(n=41) accounted for 2 (3%) of the isolates from Aboriginals and
39 (35%) of the isolates from non-Aboriginals. Clustering revealed
seven groups at a genetic distance of approximately 50% similarity
in a tree-like dendrogram. They included two highly divergent
groups representing 50 (66%) isolates from Aboriginals and 6 (5%)
isolates from non-Aboriginals and another genetically distinct
group representing 7 (9%) isolates from Aboriginals and 81 (73%)
isolates from non-Aboriginals. The results showed a heterogeneous
clonal population structure, with the isolates of two types accounting
for 42% of the sample. There was no association between RFLP type
and the diagnosis of meningitis or epiglottis, age, sex, date
of collection, or geographic location, but there was a strong
association between the origin of isolates from Aboriginal children
and RFLP type F2a and the origin of isolates from non-Aboriginal
children and RFLP type A8b. The methodology discriminated well
among the isolates (D=0.91) and will be useful for the monitoring
of postvaccine isolates of H. influenzae type b.
Morris, P.S. (1999). Objective: To describe the frequency and design of controlled clinical trials specifically addressing the health needs of Aboriginal Australians. Methodology: Electronic searching of Medline, the Australasian Medican Index, the Aboriginal and Torres Strait Islander health bibliographic database, and handsearching of Aboriginal Health: an annotated bibliography. Studies that met the following selection criteria were included: i) addressed an Aboriginal health problem, ii) had a formal description of methods and results, and iii) compared the health effects of an intervention with a concurrent control group. All summary data were extracted by a single author. Results: Only 13 studies were identified. Nine were randomised controlled trials and four were controlled trials but not randomised. Only one of these involved adults, which is unexpected. Although important Aboriginal child health issues were addressed in 12 of the 13 studies, most were undertaken many years ago and may not be familiar to Australian paediatricians. The majority appeared to be designed appropriately. Interestingly, the two studies not published in the medical literature had the largest sample size. There is no evidence that the number of published clinical trials involving Aboriginal Australians is increasing, or that long-term applied clinical research programs have been established. Conclusion: There is a profound lack of well-designed
studies assessing medical interventions. This is further evidence
that Australia has failed to develop a research infrastructure
able to inform health care in Aboriginal communities. Adults appear
especially disadvantaged.
Murphy, T.F., Sethi, S., Klingman, K.L., Brueggemann,
A.B., Doern, G.V. (1999). Non-typeable Haemophilus influenzae often
causes exacerbations of chronic obstructive pulmonary disease
(COPD), and these exacerbations are frequently treated with oral
antibiotics. The goals of this study were to determine the frequency
of the simultaneous presence of multiple strains of H. influenzae
in sputum and to measure the MICs of antibiotics for the isolates.
In a prospective study, adults with COPD were seen monthly. Sputum
cultures were obtained, and individual colonies were subjected
to genomic DNA typing and MIC determinations. Multiple strains
of H. influenzae were present simultaneously in the sputum
of 26.3% of adults with COPD. In 64.5% of these, MICs of greater
than or equal to 1 antibiotic varied by greater than or equal
to 4-fold among the strains. Therefore, multiple strains of
H. influenzae are frequently present simultaneously in the
sputum of adults with COPD, and the antimicrobial susceptibility
of different strains in the same sputum sometimes differs.
O'Connor, M.L., Parker, E., Meiklejohn, B., Oldenburg,
B., Alati, R. (1999). This article reports results of a survey and audit
of heart health education among Aboriginal and Torres Strait Islander
health workers. The study, conducted in Queensland during 1996
and 1997, analysed the quality of health promotional resources
to Indigenous communities. Results show that the health workers
assessed mainstream resources as inadequate. On the other hand,
educational materials specifically targeting Indigenous people
were rated as the most effective.
O'Donoghue, L. (1999). In this paper, the author discusses significant improvements in the health of non-Aboriginal urban Australians and compares this with the lack of improvement in Indigenous health. She acknowledges the major influences of diet, education, financial comfort, adequate housing, unpolluted environment and access to a range of goods and services on health status and identifies the need for a model of health that considers these factors. She also explains how the history of removal of children from families has had - and still has - a deleterious effect on families and communities. The author describes how remoteness contributes
to poor health, by the lack of specialist services and treatments,
general practitioners and hospitals, compounded by the fact that
many Aboriginal people do not own or have access to vehicles.
She states that geographical, environmental or socioeconomic factors
cannot be isolated from each other. She suggests that a range
of strategies should be used to deal with longstanding problems
in Indigenous communities, including school and university education,
health promotion and health worker education. Of paramount importance
is that there be self-determination, community control and involvement
at all levels. The author concludes that although progress is
slow, it is important to celebrate the small victories, breakthroughs
and lessons learned and to share these stories. Plummer, D., & Forrest, B. (1999). This study evaluates the potential of various service
models to deliver readily accessible, culturally appropriate,
socially relevant sexual health clinical services for Indigenous
Australians. A questionnaire on sexually transmitted disease control
strategies and sexual health clinical access was completed by
40 people working in Indigenous sexual health immediately before
the NSW Indigenous Sexual Health Workshop in Albury, October 1998.
The response rate was 93 per cent and responses represent more
than 90 per cent of the designated Indigenous sexual health positions
in New South Wales. Participants strongly supported a range of
special arrangements' to ensure Indigenous people have access
to sexual health clinical care. These include: more discreet clinic
signs; private entrances; unmarked cars for home visits and contact
tracing; assistance with transport to clinics; free diagnosis
and treatment; allowing false names; coding histories and test
requests; special arrangements for storing records; a working
partnership between sexual health and Aboriginal health staff;
expanded training for Indigenous and sexual health workers; greater
access to trained, same-sex, Aboriginal sexual health staff; regular
check-ups for all adults; and 'active outreach' in grassroots
settings. Improving access to Indigenous sexual health clinical
services is an urgent priority. Stigma and privacy profoundly
affect access, and special arrangements are essential to provide
relevant, accessible services. These arrangements differ from
conventional community health arrangements but these differences
must be understood and supported by 'mainstream' workers and planners.
Models for delivering Indigenous sexual health clinical services
are outlined.
Pollard, R. (1999). He only became involved in HIV/AIDS six months ago,
but already Robert Smith has made his mark on Indigenous health
and HIV in Australia.
Powell, J., & Dugdale, A.E. (1999). Antenatal, intranatal and postnatal features of
all Aboriginal women who lived at Cherbourg Aboriginal Community
and delivered during 1990, 1991 and 1992 were compared with all
non-Aboriginal women in the same rural area who delivered at Kingaroy
Base Hospital during 1991. Almost all the Aboriginal women also
delivered at Kingaroy. The data for 146 Aboriginal and 139 non-Aboriginal
women were taken from the hospital records. The Aboriginal women
were generally younger at delivery (Aboriginal 35% younger than
20 years vs. non-Aboriginal 12%), made their first antenatal visit
later (Aboriginal 49% after 20 weeks vs. non-Aboriginal 10%) and
made fewer antenatal visits (Aboriginal 43% < 4 visits vs.
non-Aboriginal 2% < 4 visits). They were more likely to be
anaemic (Aboriginal 65% < 110 g/L vs. non-Aboriginal 13% <
110 g/L), have a sexually transmitted disease (STD) (Aboriginal
13% vs. non-Aboriginal 2%) and drink alcohol (Aboriginal 54% vs.
non-Aboriginal 32%). After making an allowance for repeat Caesarean
sections, there was no significant difference in the proportion
of abnormal deliveries, but birthweights of Aboriginal infants
were lower. Postnatally, the only significant difference between
the two groups was a lower incidence of jaundice in Aboriginal
infants. Multifactorial analysis showed that birthweights were
significantly decreased by primagravidy, alcohol intake and STD.
It is likely that the effects of STD and alcohol on birthweight
were due to associated lifestyle factors. When these factors were
allowed for, Aboriginality had no significant effect on birthweight.
Smith, P.A., & Smith, R.M. (1999). The transition of Australian Aborigines from a diet
based on hunting and gathering to an essentially Western diet
has been proceeding for almost 200 years, but in some regions
was greatly delayed. In 1966-1967, Gould studied operational aspects
of hunting-gathering in desert regions of north-western Australia
and recorded sufficient quantitative and species-specific data
to allow definition of the diet over five months. By 1966, many
Aboriginal people in that region had been displaced from their
hunting grounds and were living in camps on cattle stations or
in missions. Aboriginal diets on cattle stations in the north-west
was studied in 1951 and shown to consist chiefly of fresh meat,
wheaten flour and sugar with small amounts of vegetables and dairy
products. With the granting of citizenship in 1967, most Aborigines
were dismissed from cattle stations and were moved first to town
camps and later formed remote Aboriginal communities. Studies
in the 1980s showed that the self-selected diet in such communities
reflected the station diet to a greater extent than the traditional
diet. Quantitative presentation of the above three diets, in terms
both of foods and of major nutrients, show that many of the dietary
inadequacies of the station diet identified in 1951 persisted
in self-selected Aboriginal diets in the 1980s. Comparison of
the three diets with a modern recommended diet supports the nutritional
adequacy of the hunter-gatherer diet. Traditional cultural values
assigned to food preferences continued to influence food choices
in all three diets.
Redd, A.J., & Stoneking, M. (1999) Abstract: We examined genetic affinities of Aboriginal
Australian and New Guinean populations by using nucleotide variation
in the two hypervariable segments of the mtDNA control region
(CR). A total of 318 individuals from highland Papua New Guinea
(PNG), coastal PNG, and Aboriginal Australian populations were
typed with a panel of 29 sequence-specific oligonucleotide (SSO)
probes. The SSO-probe panel included five new probes that were
used to type an additional 1,037 individuals from several Asian
populations. The SSO-type data guided the selection of 78 individuals
from Australia and east Indonesia for CR sequencing. A gene tree
of these CR sequences, combined with published sequences from
worldwide populations, contains two previously identified highland
PNG clusters that do not include any Aboriginal Australians; the
highland PNG clusters have coalescent time estimates of similar
to 80,000 and 122,000 years ago, suggesting ancient isolation
and genetic drift. 880-type data indicate that 84% of the sample
of PNG highlander mtDNA belong to these two clusters. In contrast,
the Aboriginal Australian sequences are intermingled throughout
the tree and cluster with sequences from multiple populations.
Phylogenetic and multidimensional-scaling analyses of CR sequences
and SSO types split PNG highland and Aboriginal Australian populations
and link Aboriginal Australian populations with populations from
the subcontinent of India. These mtDNA results do not support
a close relationship between Aboriginal Australian and PNG populations
- but instead suggest multiple migrations in the peopling of Sahul.
Ring, I., & Elston, J. (1999). In this editorial, the authors state that the gap
between the health of Australia's Indigenous and non-Indigenous
populations is widening rather than narrowing, in contrast to
the gains experienced by New Zealand's and the United States'
Indigenous people. They discuss how the history of previous Australian
governments has affected Indigenous life, controlling key aspects
of everyday life, and state that the Government's reconciliation
agenda needs to be seen as genuine by Indigenous people, and that
there are three essential actions that should be included. A campaign
informing the public of the need for reconciliation should be
the first action undertaken by the Government, followed closely
by an acknowledgement of past governments' wrongdoings, and finally
a commitment to 'righting the wrongs' and dealing with the consequences.
Within the area of health, the authors identify four specific
strategies as necessary in improving Indigenous health: namely
supporting community controlled health services; providing effective
and comprehensive health services; training Indigenous health
professionals; and achieving equity of funding.
Seow, W.K., Amaratunge, A., Sim, R., & Wan,
A. (1999). Purpose: This study investigated the prevalence and etiological factors associated with caries in a group of young Australian Aboriginal children from 1 to 3.5 years of age. Methods: One hundred and forty-seven healthy infants, aged from 1 to 3.5 years, attending a community health centre in Brisbane, a non-fluoridated State capital city, were randomly selected for the study. Results: The caries prevalence was 39% by subjects and 32% by the total number of teeth present. The mean number of decayed, filled teeth (dft) was 2.5 +/- 0.4, which is more than twice the figure for 3-year-old children in Australia. Furthermore, the filled (f) component represented only 1% of the total dft, suggesting very low treatment levels. Increased caries experience of the infants was strongly associated with high dental plaque scores, high levels of Streptococcus mutans infection, and sleep-time consumption of milk containing added sugar. Conclusion: The results suggest that urban Aboriginal
infants are at high risk for caries, and that preventive strategies
are urgently required.
Shaw, J.T., McWhinney, B., Tate, J.R., Kesting,
J.B., Marczak, M., Purdie, D., Gibbs, H., Cameron, D.P., &
Hickman, P.E. (1999). Objectives: To determine plasma homocysteine levels in Indigenous Australians living in urban areas, and the relationship of these levels with other risk factors in this population. Design: Cross-sectional study. Subjects and setting: 365 urban Indigenous Australian subjects, 153 men and 212 women, mean (SE) age 42 (1) years, ascertained without regard to history of atherosclerotic disease, in collaboration with community-based health centres in five Indigenous communities in south-east Queensland, 1997-1998. Main outcome measures: Plasma homocysteine levels, age, sex, smoking history, metformin therapy, history of atherosclerotic vascular disease, serum creatinine level, red cell folate and serum vitamin B12 levels. Results: 89 subjects (24%) had plasma homocysteine levels 15 mumol/L or above. Homocysteine levels were higher in men than in women (men: 14.4 mumol/L; 95% confidence interval [CI], 13.6-15.2; women: 11.9 mumol/L; 95% CI, 11.4-12.5) (P < 0.001); correlated with age (P < 0.001); higher in current smokers (P = 0.02); higher in subjects taking metformin therapy (P = 0.007); and higher in subjects with a history of atherosclerotic vascular disease (P < 0.001). Homocysteine levels were also correlated with serum levels of creatinine (P < 0.001), red cell folate (P < 0.001), and vitamin B12 (P < 0.001). Conclusions: These data indicate that the high plasma
levels of homocysteine of Australian Indigenous subjects are associated
with a history of vascular disease, and correlated with, among
other things, smoking, and folate and vitamin B12 nutritional
deficiency. These are potentially reversible risk factors, and
our data suggest that focusing public health initiatives on these
issues may reduce the high prevalence of cardiovascular disease
in the Australian Indigenous population.
Skull, S.A., Pearman, J.W., Krause, V., Coombs,
G., & Roberts, L.A. (1999). Introduction: Staphylococcus aureus invasive infection remains a serious condition associated with considerable morbidity and mortality. Following notification of five cases at Royal Darwin Hospital (RDH), we searched for related cases, determined their epidemiological characteristics and attempted to identify the source of this apparent cluster. Methods: We reviewed RDH microbiology records between June 1996 and April 1997 for S. aureus isolates with similar antibiograms to notified cases. We used antibiotic resistance patterns, bacteriophage typing and two molecular typing techniques to subtype implicated isolates. Hospital records were reviewed for admission details and associated costs were estimated. Results: Fifty-four cluster-related isolates occurred in 47 separate presentations. The peak incidence was in the wet season. The most important risk factor for staphylococcal invasive infection was the presence of skin sores/scabies in 17/54 cases (31%), followed by intravascular line use in 14/54 (26%), open trauma in 11/54 (20%), underlying end stage renal failure and alcoholism each in ten of 54 (18%). The mean admission length was 30 days and antibiotics were given for an average of 23 days. Death due to S. aureus infection occurred in eight of 47 (17%) presentations. S. aureus pneumonia was community acquired in 12/13 patients (92%) and six of 13 (46%) died. Ten of 13 (80%) pneumonia patients had at least one other focus of S. aureus infection. The cost of antibiotics and hospital bed per presentation was approximately $16,000. Presentations with skin sores/scabies cost considerably more ($31,000). No common epidemiologic features were found for community or hospital acquired cases. Conclusion: Considerable mortality and cost was
attributable to cases of S. aureus invasive infection during
this cluster; particularly those with community acquired pneumonia
or skin sores/scabies. Staphylococcal antibiotic cover should
be considered early for unwell patients presenting to hospital
with pneumonia and other signs of potential S. aureus infection.
It is appropriate to target public health efforts to prevent skin
sores and to provide adequate treatment when they occur.
Torzillo, P.J. (1999). In this paper, the author highlights the challenges
to health professionals when researching Aboriginal health issues,
stating that there are a wide range of problems requiring different
research methodologies. He explains some of the reasons that hinder
research results making a more valuable contribution, such as
lack of resources and infrastructure, problems with obtaining
adequate sample sizes and establishing appropriate endpoints for
studies, and inappropriate methodology for the research question.
He also argues that there may be wasted opportunities for research,
with a significant 'anti-research rhetoric' present in the Aboriginal
health scene. He discusses problems with funding initiatives that
have come about in the last few years and highlights, in particular,
the role of the National Health and Medical Research Council in
Aboriginal health research. In closing, the author identifies
several ways that research supports initiatives to improve Aboriginal
health.
Torzillo, P., Dixon, J., Manning, K., Hutton,
S., Gratten, M., Hueston, L., Leinonen, M., Morey, F., Forsythe,
S., Num, R., Erlich, J., Asche, V., Cunningham, A., & Riley,
I. (1999). Background: Aboriginal children in central Australia have attack rates for acute lower respiratory tract infection (ALRI) that are similar to those in developing countries. Although mortality rates are much lower than in developing countries, morbidity is high and ALRI is still the leading cause of hospitalisation. However, there are no data on the etiology of ALRI in this population. Methods: We prospectively studied 322 cases of ALRI in 280 Aboriginal children admitted to the hospital. Blood, urine and nasopharyngeal aspirate samples were examined for evidence of bacterial, viral and chlamydial infection. Results: The combination of blood culture, viral studies and chlamydial serology provided at least 1 etiologic agent in 170 of 322 (52.5%) cases. Assays for pneumolysin immune complex and pneumolysin antibody increased etiologic diagnosis to 219 (68.0%). Blood cultures were positive in 6% but pneumolysin immune complex and pneumolysin antibody studies were positive in one-third of cases. Evidence of viral infection was present in 155 (48%) of cases compared with 12% in controls (P < 001). There were only 7 possible cases and 2 definite cases of Chlamydia trachomatis and 3 cases of Chlamydia pneumoniae. Co-infection was common in these children. Conclusion: These findings have implications for
both standard treatment protocols and vaccine strategies. The
high rate of co-infection may make it difficult to develop simple
clinical predictors of bacterial infection. In the setting of
a developed country with efficient patient evacuation services,
management algorithms that focus on disease severity and need
for hospital referral will be most useful to health staff in remote
communities. Pneumococcal conjugate vaccines will be required
to reduce the high attack rate of pneumococcal disease.
Williams, R. (1999).
Wooldridge, M. (1999). The Federal Government has embarked on two major
projects of interest to Aboriginal and Torres Strait Islander
health workers aimed at improving the quality of service delivery
to communities. Federal Minister for Health and Aged Care, Dr
Michael Wooldridge, explains the projects are aimed at gaining
a complete picture of the current health workforce and meeting
the ongoing needs of health workers.
Working Group to Establish Guidelines for Interpreting
Indigenous Census Data. (1999). The most significant points from a workshop on the
use of Indigenous statistics from Census data are presented. Guiding
principles for interpreting Indigenous Census data are also presented.
Young, M., Fricker, P., Thomson, N., & Lee,
K. (1999). |
