Child growth and Type 2 Diabetes Mellitus in a Queensland Aboriginal Community

Globally, the prevalence of Type 2 diabetes is rising. The most affected populations are those that have undergone recent and rapid transition towards a Western lifestyle, characterised by energy-dense diets and physical inactivity. Two major hypotheses have attempted to explain the variation in diabetes prevalence, both between and within populations, beyond the contributions made by adult lifestyle. The thrifty genotype hypothesis proposes that some populations are genetically well adapted to surviving in a subsistence environment, and are predisposed to develop diabetes when the dietary environment changes to one that is fat and carbohydrate rich. The programming hypothesis focuses on the developmental environment, particularly on prenatal and early postnatal conditions: nutritional deprivation in utero and early postnatal life, measured by low birthweight and disrupted child growth, is proposed to alter metabolism permanently so that risk of diabetes is increased with subsequent exposure to an energy-dense diet. Both hypotheses emphasise discord between adaptation (genetic or developmental) and current environment, and both now put forward insulin resistance as a likely mechanism for predisposition.¶ Diabetes contributes significantly to morbidity and mortality among Australia’s Indigenous population. Indigenous babies are more likely to be low birthweight, and typical patterns of child growth include periods of faltering and rapid catch-up. Although there have been numerous studies in other populations, the programming hypothesis has not previously been tested in an Australian Indigenous community. The framework of the programming hypothesis is thus expanded to consider exposure of whole populations to adverse prenatal and postnatal environments, and the influence this may have on diabetes prevalence.¶ The present study took place in Cherbourg, a large Aboriginal community in southeast Queensland with a high prevalence of diabetes. Study participants were adults with diagnosed diabetes and a random sample of adults who had never been diagnosed with diabetes. Data were collected on five current risk factors for diabetes (general and central obesity, blood pressure, age and family history), in addition to fasting blood glucose levels. A lifestyle survey was also conducted. Participants’ medical records detailing weight growth from birth to five years were analysed with regard to adult diabetes risk to determine whether childhood weight and rate of weight gain were associated with subsequent diabetes. Adult lifestyle factors were also explored to determine whether variation in nutrition and physical activity was related to level of diabetes risk. ..

Collecting water : Shashemene, Ethiopia, November 2015

A water point was installed in 2012 as part of a biogas development initiative in an informal urban community of 200 households. The facility provides sanitation, gas for cooking, and organic fertiliser. It consists of four latrines and an inlet for animal waste, a fermentation chamber where the biogas (methane) is produced, and a communal kitchen with four stoves. The slurry byproduct is rendered safe by fermentation and used as fertiliser for the community garden.peer-reviewe

Type 2 diabetes and patterns of alcohol use in a Queensland Aboriginal community

Objectives To assess patterns of alcohol consumption in people with and without diabetes. Methods Location was a large Aboriginal community in southeast Queensland. Participants with diagnosed diabetes were identified through the hospital database (49 women, 38 men), and never-diagnosed participants recruited through random household sampling (62 women, 55 men). Alcohol consumption patterns were ascertained by questionnaire. Results Overall, 56% of participants consumed alcohol. On average alcohol was consumed only twice per week, but the number of drinks consumed per drinking day was high (17; range: 3.5-20). Compared with never- diagnosed participants, participants with diabetes were less likely to drink (women RR=0.3, 95%CI 0.2-0.5; men RR=0.7, 95%CI 0.5-0.9), drank less per week (ANOVA: women 9.4 versus 34.4, pConclusions People with diabetes are less likely than others to drink, and those who do drink consume fewer drinks on a day when they drink, suggesting they have modified their behaviour based on health advice. However, the overall quantity consumed in all groups remains high, at levels considered risky and high-risk in both the short- and long-term. Implications Given the diabetes and cardiovascular implications of heavy short-term and long-term alcohol use, specific patterns of alcohol use by people with diabetes should be assessed further to develop strategies to reduce the amount of alcohol consumed on a drinking day

Resource extractivism, health and climate change in small islands

Purpose – The extraction of natural resources has long been part of economic development in small islands. The damage to environment and health is extensive, even rendering once productive islands virtually uninhabitable. Rather than providing long-term benefits to the population or to the environment, the culture of “extractivism” – a nonreciprocal approach where resources are removed and used with little care or regard to consequences – has instead left many in far more fragile circumstances, increasingly dependent on external income. The purpose of this paper is to show how continued extractivism in small islands is contributing to global climate change and increasing climate risks to the local communities. Design/methodology/approach – Through a series of case studies, this paper examines the history of extractivism in small islands in Oceania, its contribution to environmental degradation locally and its impacts on health. Findings – It examines how extractivism continues today, with local impacts on environment, health and wellbeing and its much more far-reaching consequences for global climate change and human health. At the same time, these island countries have heightened sensitivity to climate change due to their isolation, poverty and already variable climate, whereas the damage to natural resources, the disruption, economic dependence and adverse health impacts caused by extractivism impart reduced resilience to the new climate hazards in those communities. Practical implications – This paper proposes alternatives to resource extractivism with options for climate compatible development in small islands that are health-promoting and build community resilience in the face of increasing threats from climate change. Originality/value – Extractivism is a new concept that has not previously been applied to understanding health implications of resource exploitation thorough the conduit of climate change. Small-island countries are simultaneously exposed to widespread extractivism, including of materials contributing to global climate change, and are among the most vulnerable to the hazards that climate change brings

Potential impact of AUSFTA on Australia's blood supply

• Australia is largely self-sufficient in its supply of safe, fresh blood products because of the goodwill of non-remunerated, volunteer donors, plus rigorous testing and processing standards. • CSL Limited is the sole provider of plasma fractionatio

Climate change could threaten blood supply by altering the distribution of vector-borne disease: an Australian case-study

BACKGROUND Climate change is expected to promote more intense and prolonged outbreaks of vector-borne disease, and alter the geographic boundaries of transmission. This has implications for the safety and supply of fresh blood products around the world. In Australia, a recent outbreak of dengue fever caused a prolonged regional shortage in the supply of fresh blood products. OBJECTIVE To highlight the potential for climate change to affect the safety and supply of blood globally through its impact on vector-borne disease, using the example of dengue in Australia as a case-study. DESIGN We modelled geographic regions in Australia suitable for dengue transmission over the coming century under four climate change scenarios, estimated changes to the population at risk and effect on blood supply. RESULTS Geographic regions with climates that are favourable to dengue transmission could expand to include large population centres in a number of currently dengue-free regions in Australia and reduce blood supply across several states. CONCLUSION Unless there is strong intergovernmental action on greenhouse gas reduction, there could be an eight-fold increase in the number of people living in dengue prone regions in Australia by the end of the century. Similar impacts will be experienced elsewhere and for other vector-borne diseases, with regions currently on the margins of transmission zones most affected. Globally, climate change is likely to compound existing problems of blood safety and supply in already endemic areas and cause future shortages in fresh blood products through its impact on transmission of vector-borne disease.This work was partially funded by the Australian Federal Government’s Garnaut Climate Change Review and the School of Medicine, University of Western Sydney internal grant scheme

Guest editorial : development and climate change in small island developing states

The evidence is increasing that Small Island Developing States (SIDS) will be heavily impacted by climate change (Nurse et al., 2014), especially among coastal communities (Formosa et al., 2017), and the challenge of fostering their development will be more difficult as a result. Many varied policy and practice responses to climate change have been proposed and critiqued, from migration, to physically engineering islands, to societal changes (Gerrard and Wannier, 2013; Yamamoto and Esteban, 2014), including emphasis on integration with sustainable development planning (Ayers and Huq, 2009). But what this means for specific island communities is still largely unknown (Nunn et al., 2007). Although attention toward the challenges faced by SIDS because of climate change, and because the social construction of climate change is gaining momentum (Kelman, 2014), lack of data and research capacity remains a major problem. This is especially true for the world’s most impoverished and vulnerable communities in SIDS, which paradoxically are frequently neglected even in research about SIDS’ climate change impacts and adaptation (Lewis, 1999; McCubbin et al., 2015). Furthermore, given the necessary interdisciplinary nature of dealing with climate change, there has not yet been a clear identification of methodological frameworks capable of operationalizing the required theoretical and practical aspects at the state/island and local levels. This too delays the comprehensive understanding of how specific development interventions can enhance adaptation, and how funds for addressing the negative effects of climate change are fairly and equitably distributed (Remling and Persson, 2015).peer-reviewe

Economic evaluations of the health impacts of weather-related extreme events : A scoping review. International Journal of Environmental Research and Public Health

The frequency and severity of extreme events is expected to increase under climate change. There is a need to understand the economic consequences of human exposure to these extreme events, to underpin decisions on risk reduction. We undertook a scoping review of economic evaluations of the adverse health effects from exposure to weather-related extreme events. We searched PubMed, Embase and Web of Science databases with no restrictions to the type of evaluations. Twenty studies were included, most of which were recently published. Most studies have been undertaken in the U.S. (nine studies) or Asia (seven studies), whereas we found no studies in Africa, Central and Latin America nor the Middle East. Extreme temperatures accounted for more than a third of the pool of studies (seven studies), closely followed by flooding (six studies). No economic study was found on drought. Whilst studies were heterogeneous in terms of objectives and methodology, they clearly indicate that extreme events will become a pressing public health issue with strong welfare and distributional implications. The current body of evidence, however, provides little information to support decisions on the allocation of scarce resources between risk reduction options. In particular, the review highlights a significant lack of research attention to the potential cost-effectiveness of interventions that exploit the capacity of natural ecosystems to reduce our exposure to, or ameliorate the consequences of, extreme events

Projecting the future of dengue under climate change scenarios: Progress, uncertainties and research needs.

BACKGROUND: Dengue is a mosquito-borne viral disease and its transmission is closely linked to climate. We aimed to review available information on the projection of dengue in the future under climate change scenarios. METHODS: Using five databases (PubMed, ProQuest, ScienceDirect, Scopus and Web of Science), a systematic review was conducted to retrieve all articles from database inception to 30th June 2019 which projected the future of dengue under climate change scenarios. In this review, "the future of dengue" refers to disease burden of dengue, epidemic potential of dengue cases, geographical distribution of dengue cases, and population exposed to climatically suitable areas of dengue. RESULTS: Sixteen studies fulfilled the inclusion criteria, and five of them projected a global dengue future. Most studies reported an increase in disease burden, a wider spatial distribution of dengue cases or more people exposed to climatically suitable areas of dengue as climate change proceeds. The years 1961-1990 and 2050 were the most commonly used baseline and projection periods, respectively. Multiple climate change scenarios introduced by the Intergovernmental Panel on Climate Change (IPCC), including B1, A1B, and A2, as well as Representative Concentration Pathway 2.6 (RCP2.6), RCP4.5, RCP6.0 and RCP8.5, were most widely employed. Instead of projecting the future number of dengue cases, there is a growing consensus on using "population exposed to climatically suitable areas for dengue" or "epidemic potential of dengue cases" as the outcome variable. Future studies exploring non-climatic drivers which determine the presence/absence of dengue vectors, and identifying the pivotal factors triggering the transmission of dengue in those climatically suitable areas would help yield a more accurate projection for dengue in the future. CONCLUSIONS: Projecting the future of dengue requires a systematic consideration of assumptions and uncertainties, which will facilitate the development of tailored climate change adaptation strategies to manage dengue