Exploring barriers to and enablers of adequate healthcare for Indigenous Australian prisoners with cancer: a scoping review drawing on evidence from Australia, Canada and the United States

Published: 3 May 2016Background: International frameworks supported by national principles in Australia stipulate that prisoners should be provided with health services equivalent to those provided in the general community. However, a number of barriers unique to the prison system may hinder the provision of equitable healthcare for this population. In Australia, Indigenous people carry a greater burden of cancer mortality, which the Cancer Data and Aboriginal Disparities (CanDAD) project is seeking to address. During the course of recruiting participants to the CanDAD study, Indigenous Australian prisoners with cancer emerged as an important, under-researched but difficult to access sub-group. Methods: This scoping review sought to identify barriers and facilitators of access to adequate and equitable healthcare for Indigenous Australian prisoners with cancer in Australia. This review demonstrated a lack of research and, as such, the scoping review was extended to prisoners with cancer in Australia, New Zealand, the United States and Canada. This approach was taken in order to summarise the existing body of evidence regarding the barriers and facilitators of access to adequate and equitable healthcare for those who are incarcerated and suffering from cancer, and highlight areas that may require further investigation. Results: Eight studies or commentaries were found to meet the inclusion criteria. This limited set of findings pointed to a range of possible barriers faced by prisoners with cancer, including a tension between the prisons’ concern with security versus the need for timely access to medical care. Conclusion: Findings identified here offer potential starting points for research and policy development. Further research is needed to better elucidate how barriers to adequate cancer care for prisoners may be identified and overcome, in Australia and internationally. Furthermore, given Indigenous Australians’ over-burden of cancer mortality and over-representation in the prison system, further research is needed to identify whether there are a unique set of barriers for this group.Jessica Olds, Rachel Reilly, Paul Yerrell, Janet Stajic, Jasmine Micklem, Kim Morey and Alex Brow

Effects of Early Childhood Intervention on Fertility and Maternal Employment: Evidence from a Randomized Controlled Trial

This paper presents the results of a randomized study of a home visiting program implemented in Germany for low-income, first-time mothers. A major goal of the program is to improve the participants' economic self-sufficiency and family planning. I use administrative data from the German social security system and detailed telephone surveys to examine the effects of the intervention on maternal employment, welfare benefits, and household composition. The study reveals that the intervention unintentionally decreased maternal employment and increased subsequent births. These results contradict those of previous studies from the United States, where home visiting programs successfully increased employment and decreased fertility. Analyzing the reason for the different results, suggests that the program interacts with low employment incentives and generous welfare state arrangements for disadvantaged mothers with young children in Germany

Does metformin improve vascular health in children with Type 1 diabetes? Protocol for a one year, double blind, randomised, placebo controlled trial

Background: Cardiovascular disease is the leading cause of mortality in Type 1 diabetes (T1D). Vascular dysfunction is an early and critical event in the development of cardiovascular disease. Children with T1D have vascular dysfunction therefore early interventions to improve vascular health are essential to reduce cardiovascular mortality in T1D. Metformin is an insulin sensitising agent which is known to improve vascular health outcomes in type 2 diabetes (T2D) and other individuals with insulin resistance. It has been used safely in children and adolescents with T2D for over 10 years. This study aims to assess the effect of metformin on vascular health in children with T1D. Methods/Design: This study is a 12 month, double blind, randomised, placebo controlled trial to determine the effect of metformin on vascular health in children (age 8–18) with T1D. The sample size is 76 with 38 children in the metformin group and 38 children in the placebo group. Vascular health and biochemical markers will be measured at baseline, 3, 6 and 12 months. Vascular function will be measured using flow mediated dilatation and glyceryl trinitrate mediated dilatation of the brachial artery and vascular structure will be measured with carotid and aortic intima media thickness, using standardised protocols. Discussion: This study will be the first to investigate the effect of metformin on vascular health in children with T1D. It will provide important information on a potential intervention to improve cardiovascular morbidity and mortality in this population at high risk from cardiovascular disease.Jemma Anderson, Alexia S Peña, Thomas Sullivan, Roger Gent, Bronwen D’Arcy, Timothy Olds, Brian Coppin and Jennifer Coupe

Parent wellbeing, family screen time and socioeconomic status during early childhood predict physical activity of Aboriginal and Torres Strait Islander children at ages 8–13

Objectives: Physical activity is holistically linked to culture and wellbeing among Aboriginal and Torres Strait Islander peoples, the First Nation Peoples of Australia. Socioecological correlates of high physical activity among Indigenous children include living in a remote area and low screen time but little is known about early life determinants of physical activity. This paper examines sociodemographic, family, community, cultural, parent social and emotional wellbeing determinants of physical activity among Aboriginal and Torres Strait Islander children. Design: Longitudinal cohort study. Methods: The Longitudinal Study of Indigenous Children, the largest First Nations child cohort study in the world, primarily collects data through parental report. Multiple logistic regression analyses examined Wave 1 (age 0–5 years) predictors of achieving ≥1 h/day of physical activity at Wave 9 (aged 8–13 years). Results: Of the 1181 children, 596 (50.5 %) achieved ≥1 h of physical activity every day. Achieving ≥1 h/day of physical activity at Wave 9 was associated with the following Wave 1 determinants: high parent social and emotional wellbeing (resilience; adjusted odds ratio 1.87 (95 % confidence interval: 1.32–2.65)), living in remote (odds ratio 3.66 (2.42–5.54)), regional (odds ratio 2.98 (2.13–4.18)) or low socioeconomic areas (odds ratio 1.85 (1.08–3.17)), main source of family income not wages/salaries (odds ratio 0.66 (0.46–0.97)), and if families played electronic games (odds ratio 0.72 (0.55–0.94)). Conclusions: To achieve high physical activity levels among Aboriginal and Torres Strait Islander children, high parental culture specific social and emotional wellbeing and low family screen time in early life may compensate for apparently low socio-economic circumstances, including living in remote areas

Lifestyle clusters and academic achievement in Australian Indigenous children: Empirical findings and discussion of ecological levers for closing the gap

© 2020 The Authors Participation in sport and physical activity can improve academic outcomes and has been identified as a potential mechanism for addressing educational disadvantage and ‘closing the gap’ in Australian Indigenous communities. To explore this possibility in relation to sport and lifestyle we performed a cluster analysis on data from the Footprints in Time study (also known as the Longitudinal Study of Indigenous Children), using data from Waves 3–6 (2010–2013, ages 5–9 years) of this cohort study. Cluster inputs were organised according to not only sports participation, but also screen time, sleep duration and unhealthy food intake, as reported in parent surveys. Associations between lifestyle cluster membership and academic outcomes from standardised tests from 2014-5 (Progressive Achievement Tests [PATs] for Maths and Reading, and National Assessment Program for Literacy and Numeracy [NAPLAN]) were examined using linear models. Analyses were adjusted for age, sex, remoteness and parental education. Three clusters were identified: Low Sport (36% of sample), characterised by low sports participation and low sleep duration; Junk Food Screenies (21% of sample), with high screen time and high intake of unhealthy foods; and High Sport (43% of sample), showing high sports participation and low screen time. Cluster membership was associated with academic performance for NAPLAN Literacy and Numeracy, and for PAT Maths. The High Sport cluster consistently performed better on these tests, with effect sizes (standardised mean differences) ranging from 0.10 to 0.38. We discuss the ecological dynamics potentially contributing to lifestyle cluster membership and ways in which policy can support healthier High Sport lifestyles associated with better academic performance

High levels of sewage contamination released from urban areas after storm events: A quantitative survey with sewage specific bacterial indicators

Background Past studies have demonstrated an association between waterborne disease and heavy precipitation, and climate change is predicted to increase the frequency of these types of intense storm events in some parts of the United States. In this study, we examined the linkage between rainfall and sewage contamination of urban waterways and quantified the amount of sewage released from a major urban area under different hydrologic conditions to identify conditions that increase human risk of exposure to sewage. Methods and findings Rain events and low-flow periods were intensively sampled to quantify loads of sewage based on two genetic markers for human-associated indicator bacteria (human Bacteroides and Lachnospiraceae). Samples were collected at a Lake Michigan estuary and at three river locations immediately upstream. Concentrations of indicators were analyzed using quantitative polymerase chain reaction (qPCR), and loads were calculated from streamflow data collected at each location. Human-associated indicators were found during periods of low flow, and loads increased one to two orders of magnitude during rain events from stormwater discharges contaminated with sewage. Combined sewer overflow (CSO) events increased concentrations and loads of human-associated indicators an order of magnitude greater than heavy rainfall events without CSO influence. Human-associated indicator yields (load per km2 of land per day) were related to the degree of urbanization in each watershed. Contamination in surface waters were at levels above the acceptable risk for recreational use. Further, evidence of sewage exfiltration from pipes threatens drinking water distribution systems and source water. While this study clearly demonstrates widespread sewage contamination released from urban areas, a limitation of this study is understanding human exposure and illness rates, which are dependent on multiple factors, and gaps in our knowledge of the ultimate health outcomes. Conclusions With the prediction of more intense rain events in certain regions due to climate change, sewer overflows and contamination from failing sewer infrastructure may increase, resulting in increases in waterborne pathogen burdens in waterways. These findings quantify hazards in exposure pathways from rain events and illustrate the additional stress that climate change may have on urban water systems. This information could be used to prioritize efforts to invest in failing sewer infrastructure and create appropriate goals to address the health concerns posed by sewage contamination from urban areas

The Rachel Carson Letters and the Making of Silent Spring

Environment, conservation, green, and kindred movements look back to Rachel Carson’s 1962 book Silent Spring as a milestone. The impact of the book, including on government, industry, and civil society, was immediate and substantial, and has been extensively described; however, the provenance of the book has been less thoroughly examined. Using Carson’s personal correspondence, this paper reveals that the primary source for Carson’s book was the extensive evidence and contacts compiled by two biodynamic farmers, Marjorie Spock and Mary T. Richards, of Long Island, New York. Their evidence was compiled for a suite of legal actions (1957-1960) against the U.S. Government and that contested the aerial spraying of dichlorodiphenyltrichloroethane (DDT). During Rudolf Steiner’s lifetime, Spock and Richards both studied at Steiner’s Goetheanum, the headquarters of Anthroposophy, located in Dornach, Switzerland. Spock and Richards were prominent U.S. anthroposophists, and established a biodynamic farm under the tutelage of the leading biodynamics exponent of the time, Dr. Ehrenfried Pfeiffer. When their property was under threat from a government program of DDT spraying, they brought their case, eventually lost it, in the process spent US$100,000, and compiled the evidence that they then shared with Carson, who used it, and their extensive contacts and the trial transcripts, as the primary input for Silent Spring. Carson attributed to Spock, Richards, and Pfeiffer, no credit whatsoever in her book. As a consequence, the organics movement has not received the recognition, that is its due, as the primary impulse for Silent Spring, and it is, itself, unaware of this provenance

Pointing effects and their consequences for Spitzer IRAC exoplanet observations

Spitzer observations of exoplanets routinely yield accuracies of better than one part in 10,000. However, there remain a number of issues that limit the attainable precision, particularly for long duration observations. These include initial pointing inaccuracies, pointing wobble, initial target drift, long-term pointing drifts, and low and high frequency jitter. Coupled with small scale, intrapixel sensitivity variations, all of these pointing issues have the potential to produce significant, correlated photometric noise. We examine each of these issues in turn, discussing their suspected causes and consequences, and describing possible and planned mitigation techniques

Prenatal Prediction of Poor Maternal and Offspring Outcomes: Implications for Selection into Intensive Parent Support Programs

This study examined the predictive ability of mother’s age, antenatal depression, education, financial difficulties, partner status, and smoking for a range of poor maternal and offspring outcomes assessed up to 61 months postnatally. Outcomes obtained from the Avon Longitudinal Study of Parents and Children (ALSPAC) were maternal postnatal depression at 8 weeks (n = 10,070), never breastfeeding (n = 7,976), feelings of poor attachment (n = 8,253) and hostility (n = 8,159) at 47 months, and not in employment, education or training (NEET, n = 8,265) at 61 months. Only a small proportion of women with each outcome were aged less than 20 years when they were pregnant. At least half of the women experiencing these outcomes, and up to 74.7% of women with postnatal depression, could be identified if they had at least one of the predictors measured during pregnancy (age < 20, depression, education less than O level, financial difficulties, no partner, or smoking). Model discrimination was poor using maternal age only (area under the receiver operator characteristic (AUROC) curve approximately 0.52), except for never breastfeeding (0.63). Discrimination improved (AUROC: 0.80, 0.69, 0.62, 0.60, 0.66 for depression, never breastfeeding, poor attachment, hostility and NEET, respectively) when all six predictors were included in the model. Calibration improved for all outcomes with the model including all six predictors, except never breastfeeding where even age alone demonstrated good calibration. Factors other than young maternal age, including education, smoking and depression during pregnancy should be considered in identifying women and their offspring likely to benefit from parenting support interventions