Indigenous health and environmental risk factors: an Australian problem with global analogues?

Strengthening Australia's Chemical Regulation

Humans are exposed to a myriad of chemicals every day, some of which have been established to have deleterious effects on human health. Regulatory frameworks play a vital role in safeguarding human health through the management of chemicals and their risks. For this review, we focused on agricultural and veterinary (Agvet) chemicals and industrial chemicals, which are regulated, respectively, by the Australian Pesticides and Veterinary Medicines Authority (APVMA), and the Australian Industrial Chemicals Introduction Scheme (AICIS). The current frameworks have been considered fragmented, inefficient, and most importantly, unsafe in prioritizing human health. We evaluated these frameworks, identified gaps, and suggested improvements that would help bring chemical regulation in Australia in line with comparative regulations in the EU, US, and Canada. Several weaknesses in the Australian frameworks include the lack of a national program to monitor chemical residues, slow pace in conducting chemical reviews, inconsistent risk management across states and territories, a paucity of research efforts on human health impacts, and inadequate framework assessment systems. Recommendations for Australia include establishing a national surveillance and chemical residue monitoring system, harmonizing risk assessment and management across jurisdictions, improving chemical review efficiency, and developing regular performance review mechanisms to ensure that human health is protected.

The prevalence of tuberculosis, malaria and soil-transmitted helminth infection in minority indigenous people of Southeast Asia and the Western Pacific: protocol for a systematic review and meta-analysis

BACKGROUND

Infectious diseases such as tuberculosis (TB), malaria and soil-transmitted helminthiasis continue to impose a significant global health burden and socio-economic impact. Globally, minority indigenous people are disproportionately affected by poverty and are shown to experience a disparate burden of disease and poorer health outcomes than the comparative majority population. Despite these inequalities, countries rarely systematically compile epidemiological data disaggregated by ethnicity to enable the extent of the differential to be quantified.

METHODS

The systematic review will be reported in accordance with The Preferred Reporting Items for Systematic Review and Meta- Analyses (PRISMA) guidelines. Systematic searches will be conducted in EMBASE, Medline, Scopus and Web of Science for studies reporting data which enable the prevalence of TB, malaria, and/or soil-transmitted helminth (STH) infections amongst minority indigenous populations within the Southeast Asia Region (SEAR) and Western Pacific Region (WPR) to be calculated. Where studies provide data on disease prevalence for both minority indigenous and other populations within the same study, a comparative analysis will be undertaken. In addition to a narrative synthesis, where sufficient data are available, a random-effects meta-analysis will be conducted to obtain a pooled estimate value for each disease/infection by country and mortality stratum. Heterogeneity between studies will be examined using the Cochran's Q test and quantitatively measured by the index of heterogeneity squared (I2) statistics. The methodological quality of the included studies will be assessed using a modified Newcastle-Ottawa Scale.

DISCUSSION

This systematic review aims to analyse the available data on the prevalence of TB, malaria and STH infections within minority indigenous populations of the SEAR and WPR.

REGISTRATION

Open Science Framework registration: osf.io/m6sqc.

Methodology to Investigate Indigenous Solid Waste Systems and Practices in the Rural Areas Surrounding Maseru (Kingdom of Lesotho)

Solid waste management (SWM) is the greatest challenge facing environmental protection and human wellbeing in the rural communities of Maseru (Kingsom of Lesotho). A lack of formal waste management (WM) systems in rural areas of Maseru have resulted in different indigenous systems and practices of SWM. Direct observation and descriptive designs will be employed. This is a mixed methods study of qualitative, quantitative and, non-experimental. We obtained data sets from existing official census and statistics of Maseru. We sampled 693 participants from total population of 6917. We received ethical clearance from Research Ethics committee of Health Sciences at the University of Johannesburg, we recruited six field workers. We have preventive equipment (sanitizers, masks, and sterile latex gloves) for COVID-19 infections in place; we have specific design on caps, masks and bags that will identify field workers as they collect data. We will train field workers, administer questionnaires, interview, and observe participants. STATKON will analyse data. The research will share the results with the Ministry of Environment and the community in Lesotho. The results will also be used to educate the rural communities on improved WM. Where weaknesses are identified, mitigation measures can be evaluated and implemented to rectify the negative aspects and improve the systems and practices. The rural communities face challenges such as waste collection services and sanitation facilities and this fact points out that there is a gap in SWM, which favours the existence of indigenous systems and practice of SWM.

Biomedical, Socioeconomic and Demographic Predictors of Heart Failure Readmissions: A Systematic Review

AIMS

To identify the biomedical, socioeconomic and demographic predictors of heart failure (HF) related readmissions in adult patients with HF.

METHODS

This systematic review was conducted in March 2020 using the databases EMBASE, CINAHL and Medline to identify publications between 2015-2020. The resulting articles were systematically reviewed according to the PRISMA guidelines.

RESULTS

Eighteen (18) studies were included in this review. Unemployment (HR=1.09; 95%CI=1.05-1.14; p=0.03) was the only socioeconomic factor predictive of HF-readmissions. Socio-Economic Indexes for Areas (SEIFA) scores did not predict HF readmissions in adults with HF (p>0.05). All patients included in the studies had pre-existing HF. Based on the included studies, Indigenous status was identified as a risk factor for HF readmissions in 1 study (p<0.05), and age or sex did not affect HF readmission patterns (p>0.05). New York Heart Association (NYHA) class, brain natriuretic peptide (BNP) levels, and heart rate were also predictive of HF readmission (p<0.05). Left ventricular ejection fraction and blood pressure, however, were non-significant risk factors of HF readmissions (p>0.05).

CONCLUSIONS

This review identified unemployment, Indigenous status, NYHA class, heart rate, and BNP levels to predict HF related readmissions in adult patients with HF. Adding demographic and socioeconomic variables to readmission risk models has the potential to more accurately target patients at risk of readmissions.

Protocol for a scoping review of the qualitative literature on Indigenous infant feeding experiences

INTRODUCTION

Prudent infant nutrition, including exclusive breastfeeding to 6 months, is essential for optimal short-term and long-term health. Quantitative research to date has documented that many Indigenous communities have lower breastfeeding rates than the general population and that this gap in breastfeeding initiation and maintenance may have an important impact on chronic disease risk later in life. However, there are critical knowledge gaps in the literature regarding factors that influence infant feeding decisions. Qualitative research on infant feeding experiences provides a broader understanding of the challenges that Indigenous caregivers encounter, and insights provided by this approach are essential to identify research gaps, community engagement strategies, and programme and policy development. The objective of this review is to summarise the qualitative literature that describes breastfeeding and other infant feeding experiences of Indigenous caregivers.

METHODS AND ANALYSIS

This scoping review will follow guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, the Joanna Briggs Institute and the methodological framework from Arksey and O'Malley. In October 2020, we will conduct an electronic database search using Medline, Embase, The Cumulative Index to Nursing & Allied Health Literature (CINAHL), PsycINFO, and Scopus, and will focus on qualitative studies. Publications that have a focus on infant feeding in Canada, the USA, Australia and New Zealand, and the Indigenous caregiver experience from the caregiver perspective, will be included. We will conduct a grey literature search using Indigenous Studies Portal, country-specific browser searches, and known government, association, and community websites/reports. We will map themes and concepts of the publications, including study results and methodologies, to identify research gaps, future directions, challenges and best practices in this topic area.

ETHICS AND DISSEMINATION

Ethical approval is not required for this review as no unpublished primary data will be included. The results of this review will be shared through peer-reviewed publications and conference presentations. This protocol is registered through the Open Science Framework (osf.io/4su79).

Screening-level microbial risk assessment of acute gastrointestinal illness attributable to wastewater treatment systems in Nunavut, Canada

Most arctic communities use primary wastewater treatment systems that are capable of only low levels of pathogen removal. Effluent potentially containing fecally derived microorganisms is released into wetlands and marine waters that may simultaneously serve as recreation or food harvesting locations for local populations. The purpose of this study is to provide the first estimates of acute gastrointestinal illness (AGI) attributable to wastewater treatment systems in Arctic Canada. A screening-level, point estimate quantitative microbial risk assessment model was developed to evaluate worst-case scenarios across an array of exposure pathways in five case study locations. A high annual AGI incidence rate of 5.0 cases per person is estimated in Pangnirtung, where a mechanical treatment plant discharges directly to marine waters, with all cases occurring during low tide conditions. The probability of AGI per person per single exposure during this period ranges between 1.0 × 10^-1 (shore recreation) and 6.0 × 10^-1 (shellfish consumption). A moderate incidence rate of 1.2 episodes of AGI per person is estimated in Naujaat, where a treatment system consisting of a pond and tundra wetland is used, with the majority of cases occurring during spring. The pathway with the highest individual probability of AGI per single exposure event is wetland travel at 6.0 × 10^-1. All other risk probabilities per single exposure are <1.0 × 10^-1. The AGI incidence rates estimated for the other three case study locations are <0.1. These findings suggest that wastewater treatment sites may be contributing to elevated rates of AGI in some arctic Canadian communities. Absolute risk values, however, should be weighed with caution based on the exploratory nature of this study design. These results can be used to inform future risk assessment and epidemiological research as well as support public health and sanitation decisions in the region.