Indigenous Health – Australia, Canada, New Zealand and the United States - Laying Claim to a Future that Embraces Health for Us All.

Improving the health of all peoples has been a call across the globe for many decades and unfortunately remains relevant today, particularly given the large disparities in health status of peoples found around the world. Rather than differences in health, or health inequalities, we use a different term, health inequities. This is so as mere differences in health (or inequalities ) can be common in societies and do not necessarily reflect unfair social policies or practices. For example, natural ageing implies older people are more prone to illness. Yet, when differences are systematic, socially produced and unfair, these are considered health inequities. Certainly making judgments on what is systematic, socially produced and unfair, reflects value judgments and merit open debate. We are making explicit in this paper what our judgments are, and the basis for these judgment

Safe levels of cadmium intake to prevent renal toxicity in human subjects

The present review attempts to provide an update of the scientific knowledge on the renal toxicity which occurs in human subjects as a result of chronic ingestion of low-level dietary Cd. It highlights important features of Cd toxicology and sources of uncertainty in the assessment of health risk due to dietary Cd. It also discusses potential mechanisms for increased susceptibility to Cd toxicity in individuals with diabetes. Exposure assessment on the basis of Cd levels in foodstuffs reveals that vegetables and cereals are the main sources of dietary Cd, although Cd is also found in meat, albeit to a lesser extent. Cd accumulates particularly in the kidney and liver, and hence offal contains relatively high amounts. Fish contains only small quantities of Cd, while crustaceans and molluscs may accumulate larger amounts from the aquatic environment. Data on Cd accumulation in human kidney and liver obtained from autopsy studies are presented, along with results of epidemiological studies showing the relationship between renal tubular dysfunction and kidney Cd burden. These findings suggest that a kidney Cd level of 50 mug/g wet weight is a maximum tolerable level in order to avoid abnormal kidney function. This renal Cd burden corresponds to a urinary Cd excretion of 2 mug/d. Accordingly, safe daily levels of Cd intake should be kept below 30 mug per person. Individual variations in Cd absorption and sensitivity to toxicity predicts that a dietary Cd intake of 30 mug/d may result in a slight renal dysfunction in about 1% of the adult population. The previous guideline for a maximum recommended Cd intake of 1 mug/kg body weight per d is thus shown to be too high to ensure that renal dysfunction does not occur as a result of dietary Cd intake

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

Health concerns associated with unconventional gas mining in Western Australia: A critical review

This paper examines the evidence available from peer-reviewed journal publications regarding the broad array of health concerns associated with unconventional gas mining and whether two Western Australian governmental reports used to contribute to policy decisions on unconventional gas, adequately and accurately address these health concerns. The reports are: • “Implications for Western Australia of hydraulic fracturing for natural gas” (Western Australian Standing Committee of Environment and Public Health Affairs, Report 42, 2015) • “Hydraulic fracturing for shale and tight gas in Western Australian drinking water supply areas: Human health risk” (Western Australian Health Department, June 2015). The literature review identified increasing evidence of multiple potential hazards and exposure pathways posing credible risks to human health, via air emissions, water contamination, psychosocial stress and climate change. Increasing numbers of published studies report associations between negative health and developmental outcomes and nearness of residence to and/or intensity of unconventional gas operations. These significant risks, combined with substantial gaps in understanding, prevent confirmation of the safety of the industry to health and the environment. Four main concerns emerged from the examination of the two Reports, which prevent them from adequately and accurately assessing the potential risks and benefits of the industry to the health and wellbeing of Western Australians, based on current knowledge. This paper concludes by urging the Western Australia government to conduct an updated and fully comprehensive review of the potential direct and indirect impacts of proceeding with an unconventional gas industry on human health and wellbeing, both now and in future. Six recommendations are made to maximize the value of such a review

Health concerns associated with unconventional gas mining in Western Australia: A critical review

This paper examines the evidence available from peer-reviewed journal publications regarding the broad array of health concerns associated with unconventional gas mining and whether two Western Australian governmental reports used to contribute to policy decisions on unconventional gas, adequately and accurately address these health concerns. The reports are: • “Implications for Western Australia of hydraulic fracturing for natural gas” (Western Australian Standing Committee of Environment and Public Health Affairs, Report 42, 2015) • “Hydraulic fracturing for shale and tight gas in Western Australian drinking water supply areas: Human health risk” (Western Australian Health Department, June 2015). The literature review identified increasing evidence of multiple potential hazards and exposure pathways posing credible risks to human health, via air emissions, water contamination, psychosocial stress and climate change. Increasing numbers of published studies report associations between negative health and developmental outcomes and nearness of residence to and/or intensity of unconventional gas operations. These significant risks, combined with substantial gaps in understanding, prevent confirmation of the safety of the industry to health and the environment. Four main concerns emerged from the examination of the two Reports, which prevent them from adequately and accurately assessing the potential risks and benefits of the industry to the health and wellbeing of Western Australians, based on current knowledge. This paper concludes by urging the Western Australia government to conduct an updated and fully comprehensive review of the potential direct and indirect impacts of proceeding with an unconventional gas industry on human health and wellbeing, both now and in future. Six recommendations are made to maximize the value of such a review

Mast cell hyperplasia in Opisthorchis viverrini-associated cholecystitis

Despite significant advances in understanding the role of the immune response in Opisthorchis viverrini-associated carcinogenesis, little is known about how infection induces gall bladder disease. This study investigated whether mast cells are activated in cholecystitis associated with O. viverrini, gall bladder specimens from ninety-two patients who had undergone cholecystectomy at the Khon Kaen Regional Hospital, Khon Kaen, Thailand. Two representative sections from the body of fresh gall bladder tissue were fixed in Carnoy’s solution and embedded in paraffin wax. The paraffin sections were stained for mast cells and IgE plasma cells by the double histochemical and immunohistochemical method. The cells in the epithelium, lamina propria, muscular layer, and subserosa were counted and expressed as cells per square millimeter. The gall bladder bile was examined for the presence of O. viverrini eggs. Significantly higher mean mast cell numbers were found in the lamina propria (221.41 ± 16.01 vs 116.97 ± 14.61 cells per mm2; P < 0.005) of egg positive compared to egg negative groups, respectively. No comparable differences in mast cell number were observed in other layers. IgE plasma cells were rarely seen. The results suggest that mast cell hyperplasia occurs during cholecystitis in association with opisthorchiasis and may play a role in the pathogenesis of the disease.</p

Formative Evaluation of Bourke and Brewarrina Healing Project for the Healing Foundation: Final Report

The Healing Foundation’s intergenerational trauma initiative is aimed at restoring and reaffirming Aboriginal and Torres Strait Islander children’s pride in their cultural identity. Following successful pilot projects at Brisbane’s Murri School and Darwin Aboriginal and Islander Women’s Service, the Healing Foundation entered into partnerships with Bourke High School (BHS) and Brewarrina Central School (BCS) in western NSW to develop healing programs in the two remote mainstream schools. Although they are being implemented independently, the two School Healing Programs (SHPs) are similar in overall approach. Both involve school and community partnerships and are intended to promote positive healing pathways for Aboriginal children, young people and their families. They aim to foster a whole-of-school understanding of trauma and the relationship between past policies and practices and the trauma that impacts Aboriginal children and families today, and to identify how the school community can support healing for Aboriginal children and families and the broader community. The formative evaluation covers the period 2015–2016. Primary data were collected through group discussions, interviews, questionnaires, observation and document review. Secondary data were also utilised. Findings were shared with program staff as they became available to support program implementation. This report presents the overarching insights from this work, a proposed evaluation framework and tools, and recommendations for the Healing Foundation. Site-specific findings and recommendations are provided in two stand-alone, supplementary reports. Implementation of a whole-of-school healing program within a mainstream educational facility has challenges at student, program, school and community levels, and takes time. The SHP is a good fit with the overall school strategies and their welfare/wellbeing cultures. Both schools now have a pool of staff with expertise in trauma-informed practice. Weekly yarning circles became a part of the curriculum for Years 7 and 8 but the other two program components—mentoring program and family camps—are still to be realised. Lessons learned involve both structural and relational dynamics. Despite their relatively close location, the many differences in context and capacity and challenges faced means a place-based approach and tailoring for local circumstances is essential. We recognise that the SHP is only one of many programs operating in BHS and BCS, as well as the influence of the broader social and cultural determinants of health on participants’ wellbeing. We also recognise that some students are better able than others to express how they feel about themselves and to talk about in their lives. Such issues pose difficulties for evaluation. In addition to an evaluation framework, which must be practical and meaningful to those involved, simple data collection tools are required that do not place unrealistic demands on the students or staff. Importantly, they should provide data about processes and outcomes, not only numbers of participants. The Bourke and Brewarrina SHPs constitute an innovative and nationally significant project under the Healing Foundation’s intergenerational trauma initiative. The past two years have provided an important foundation for the two schools. Based on our formative evaluation findings and understanding of the literature on intergenerational trauma and healing for Australia’s First Peoples, we make the following recommendations. Recommendations for the project overall: 1. Celebrate the project achievements and share the insights and learnings with national and state stakeholders and others who might be interested. 2. Commit to full implementation and evaluation of the SHPs in Bourke and Brewarrina, bringing in necessary expertise and seeking additional funding as required. Recommendations for program implementation: 1. Support each school to develop, and maintain, a locally-tailored toolkit for yarning circles containing lesson plans, exercises and activity sheets, as well as tools for other program components as they are implemented. 2. Give consideration to a system for regular exchange between the BHS, BCS and the Murri School in Brisbane, including tele/videoconferences and site visits. Recommendations for program evaluation: 1. Adopt BUILD PRIDE, an adult, empowering framework for learning, to guide ways of working. 2. Use the SHP-tailored version of the Growth and Empowerment Measure (GEM) to track change over time at the individual level. 3. Use the effectiveness and sustainability questionnaires from the Critical Success Factors: Program Quality Measurement Toolkit to track change over time at the program level. 4. Together with the schools, formally review the healing programs at the end of each year, seeking input from participants as well as other stakeholders

An investigation of hookworm infection and reinfection following mass anthelmintic treatment in the South Indian fishing community of Vairavankuppam

Hookworm infections, as assessed by counting worms expelled following anthelmintic treatment and by egg output, were found to be of low prevalence and intensity in a South Indian fishing community. The initial overall prevalence of infection in the community was 43 %, and the average burden was estimated at 2.2 hookworms per person. The age profiles of prevalence and intensity differed between males and females, with the latter harbouring significantly higher levels of infection. Children of both sexes under 10 years of age rarely harboured hookworms. Treatment with pyrantel pamoate was estimated to be 91 % effective in clearing hookworm infections. Egg counts made on stools collected during an 11-month period of reinfection indicated that female patients became reinfected soon after treatment, while little hookworm egg excretion was observed in males during the observation period following treatment. Females acquired a significantly higher number of worms during the reinfection period compared with males, although the average burden in females reached only 28% of the initial, pre-treatment level. The hookworm population consisted of predominantly Necator americanus, and less than 10% of Ancylostoma duodenale. The parasites were highly aggregated within the host population with 10% of the community harbouring over 65% of the total hookworms. Low values of the negative binomial aggregation parameter, k, (indicating extreme over-dispersion) were recorded in groups stratified by age and sex. Highly significant positive correlations were observed between the initial (pre-treatment) and reinfection worm burdens of female (but not of male) patients. It is suggested that occupational practices related to walking through areas contaminated with hookworm larvae play an important role in generating the observed patterns of infection within this community.</p

The importance of host age and sex to patterns of reinfection with Ascaris lumbricoides following mass anthelmintic treatment in a South Indian fishing community

Analysis of egg and worm counts of Ascaris recorded at various intervals following a mass anthelmintic treatment programme in a South Indian fishing community is presented. Three indices of infection in the community are compared, namely the prevalence and intensity of egg output (at 2, 6 and 11 months following treatment) and the number of worms expelled following an 11 month period of reinfection. Detailed examination of these measurements revealed significant associations with patient sex and age. The age-prevalence profile of Ascaris infection changed little over time (except immediately following treatment) with the peak prevalence found in the 5–9 year age group. Although 85% of both males and females harboured Ascaris initially, the prevalence following 11 months reinfection was decreased, due to a significantly lower proportion of males being reinfected. By the 11th month of reinfection, the age-intensity profiles of egg output were similar to those observed at initial treatment in the older age groups (10 years and above) and in male children (< 10 years). However, a dramatic increase in the egg output of female children, greatly exceeding the initial mean, was observed within a 6 month period of reinfection. The intensity of egg output did not accurately reflect the abundance of Ascaris recovered via drug-induced expulsion following an 11 month period of reinfection. Although the egg output attained pre-intervention levels, the average worm intensity reached only half the initial value. The trends in the sex- and age-intensity profiles were consistent at the two sampling dates and showed similar patterns to the egg output curves. The relevance of the results to helminth control and the monitoring of reinfection is discussed.</p