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Brodie T, Howard NJ, Pearson O, Canuto K, Brown A. Enhancement of scoping review methodology to reflect Aboriginal and Torres Strait Islander ways of knowing, being and doing. Aust N Z J Public Health 2023; 47:100096. [PMID: 37972493 DOI: 10.1016/j.anzjph.2023.100096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/01/2023] [Accepted: 09/08/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE This paper argues for the enhancement of scoping review methods to incorporate Indigenous ways of knowing, being, and doing for more effective understandings of evidence of importance to Indigenous populations. METHODS Scoping review methodology typically aims to understand existing evidence and support translation of evidence into practice. Levac and colleagues (2010) scoping review methodology stages: 1) Identify the research question; 2) Identify relevant studies; 3) Study selection; 4) Charting the data; 5) Collating, summarising, and reporting results; and 6) Consultation were considered from the perspective of Indigenous knowledges and adapted accordingly. RESULTS An enhanced method better aligns with Indigenous methodologies which are based on relationality, collaboration, partnership, reciprocity, and benefit. Consultation was redefined in this enhancement as partnership and integrated throughout scoping review stages, which are underpinned by key methodological principles. CONCLUSIONS Enhancement of scoping review stages with Indigenous ways of knowing, being, and doing has the potential to strengthen the utility of scoping review methods to better meet the needs of and ensure relevance for Indigenous populations. IMPLICATIONS FOR PUBLIC HEALTH These enhancements can increase the potential for knowledge translation and implementation of culturally relevant evidence-based approaches into practice for Indigenous populations and for other populations who experience health inequities.
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Affiliation(s)
- Tina Brodie
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.
| | - Natasha J Howard
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Odette Pearson
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Kootsy Canuto
- College of Medicine and Public Health, Flinders University, Darwin, Australia
| | - Alex Brown
- Professor Indigenous Genomics, Australian National University and Telethon Kids Institute, Adelaide, Australia
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Khurana I, Howard NJ, Maxwell S, Du Preez A, Kaipananickal H, Breen J, Buckberry S, Okabe J, Al-Hasani K, Nakasatien S, Himathongkam T, Cooper ME, Maple-Brown L, Thewjitcharoen Y, Brown A, El-Osta A. Circulating epigenomic biomarkers correspond with kidney disease susceptibility in high-risk populations with type 2 diabetes mellitus. Diabetes Res Clin Pract 2023; 204:110918. [PMID: 37748713 DOI: 10.1016/j.diabres.2023.110918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/05/2023] [Accepted: 09/21/2023] [Indexed: 09/27/2023]
Abstract
AIMS To investigate epigenomic indices of diabetic kidney disease (DKD) susceptibility among high-risk populations with type 2 diabetes mellitus. METHODS KDIGO (Kidney Disease: Improving Global Outcomes) clinical guidelines were used to classify people living with or without DKD. Differential gene methylation of DKD was then assessed in a discovery Aboriginal Diabetes Study cohort (PROPHECY, 89 people) and an external independent study from Thailand (THEPTARIN, 128 people). Corresponding mRNA levels were also measured and linked to levels of albuminuria and eGFR. RESULTS Increased DKD risk was associated with reduced methylation and elevated gene expression in the PROPHECY discovery cohort of Aboriginal Australians and these findings were externally validated in the THEPTARIN diabetes registry of Thai people living with type 2 diabetes mellitus. CONCLUSIONS Novel epigenomic scores can improve diagnostic performance over clinical modelling using albuminuria and GFR alone and can distinguish DKD susceptibility.
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Affiliation(s)
- Ishant Khurana
- Baker Heart and Diabetes Institute, Epigenetics in Human Health and Disease Program, Melbourne, Vic, Australia; Department of Diabetes, Central Clinical School, Monash University, Melbourne, Vic, Australia
| | - Natasha J Howard
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
| | - Scott Maxwell
- Baker Heart and Diabetes Institute, Epigenetics in Human Health and Disease Program, Melbourne, Vic, Australia; Department of Diabetes, Central Clinical School, Monash University, Melbourne, Vic, Australia
| | - Anelle Du Preez
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Harikrishnan Kaipananickal
- Baker Heart and Diabetes Institute, Epigenetics in Human Health and Disease Program, Melbourne, Vic, Australia; Department of Diabetes, Central Clinical School, Monash University, Melbourne, Vic, Australia
| | - James Breen
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT, Australia; Telethon Kids Institute, Perth, WA, Australia
| | - Sam Buckberry
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT, Australia; Telethon Kids Institute, Perth, WA, Australia
| | - Jun Okabe
- Baker Heart and Diabetes Institute, Epigenetics in Human Health and Disease Program, Melbourne, Vic, Australia; Department of Diabetes, Central Clinical School, Monash University, Melbourne, Vic, Australia
| | - Keith Al-Hasani
- Baker Heart and Diabetes Institute, Epigenetics in Human Health and Disease Program, Melbourne, Vic, Australia; Department of Diabetes, Central Clinical School, Monash University, Melbourne, Vic, Australia
| | | | | | - Mark E Cooper
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Vic, Australia
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Australia; Department of Endocrinology, Royal Darwin Hospital, Northern Territory, Australia
| | | | - Alex Brown
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT, Australia; Telethon Kids Institute, Perth, WA, Australia.
| | - Assam El-Osta
- Baker Heart and Diabetes Institute, Epigenetics in Human Health and Disease Program, Melbourne, Vic, Australia; Department of Diabetes, Central Clinical School, Monash University, Melbourne, Vic, Australia; University College Copenhagen, Faculty of Health, Department of Technology, Biomedical Laboratory Science, Copenhagen, Denmark.
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Dawson AP, Warrior E, Pearson O, Boyd MA, Dwyer J, Morey K, Brodie T, Towers K, Waters S, Avila C, Hammond C, Lake KJ, Lampard ‘UF, Wanganeen ‘UF, Bennell O, Bromley D, Shearing T, Rigney N, Czygan S, Clinch N, Pitson A, Brown A, Howard NJ. Exploring self-determined solutions to service and system challenges to promote social and emotional wellbeing in Aboriginal and Torres Strait Islander people: a qualitative study. Front Public Health 2023; 11:1206371. [PMID: 37809004 PMCID: PMC10556859 DOI: 10.3389/fpubh.2023.1206371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/28/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Many Aboriginal and Torres Strait Islander people living on Kaurna Country in northern Adelaide experience adverse health and social circumstances. The Taingiwilta Pirku Kawantila study sought to understand challenges facing Aboriginal and Torres Strait Islander communities and identify solutions for the health and social service system to promote social and emotional wellbeing. Methods This qualitative study applied Indigenous methodologies undertaken with Aboriginal and Torres Strait Islander governance and leadership. A respected local Aboriginal person engaged with Aboriginal and Torres Strait Islander community members and service providers through semi-structured interviews and yarning circles that explored community needs and challenges, service gaps, access barriers, success stories, proposed strategies to address service and system challenges, and principles and values for service design. A content analysis identified the breadth of challenges in addition to describing key targets to empower and connect communities and optimize health and social services to strengthen individual and collective social and emotional wellbeing. Results Eighty-three participants contributed to interviews and yarning circles including 17 Aboriginal community members, 38 Aboriginal and Torres Strait Islander service providers, and 28 non-Indigenous service providers. They expressed the need for codesigned, strengths-based, accessible and flexible services delivered by Aboriginal and Torres Strait Islander workers with lived experience employed in organisations with Aboriginal and Torres Strait Islander leadership and governance. Community hubs and cultural events in addition to one-stop-shop service centres and pre-crisis mental health, drug and alcohol and homelessness services were among many strategies identified. Conclusion Holistic approaches to the promotion of social and emotional wellbeing are critical. Aboriginal and Torres Strait Islander people are calling for places in the community to connect and practice culture. They seek culturally safe systems that enable equitable access to and navigation of health and social services. Aboriginal and Torres Strait Islander workforce leading engagement with clients is seen to safeguard against judgement and discrimination, rebuild community trust in the service system and promote streamlined access to crucial services.
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Affiliation(s)
- Anna P. Dawson
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Eugene Warrior
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
| | - Odette Pearson
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Mark A. Boyd
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
- Division of Medicine, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Judith Dwyer
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Kim Morey
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
| | - Tina Brodie
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
| | - Kurt Towers
- Division of Medicine, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Sonia Waters
- Aboriginal Services, AnglicareSA, Adelaide, SA, Australia
| | | | - Courtney Hammond
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
| | - Katherine J. Lake
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
- Indigenous Health Equity, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - ‘Uncle’ Frank Lampard
- Division of Medicine, Northern Adelaide Local Health Network, Adelaide, SA, Australia
- Executive Office, Kaurna Elder and Aboriginal Community Representative, Adelaide, SA, Australia
| | - ‘Uncle’ Frank Wanganeen
- Executive Office, Kaurna Elder and Aboriginal Community Representative, Adelaide, SA, Australia
| | - Olive Bennell
- Executive Office, Nunga Mi:Minars Inc., Adelaide, SA, Australia
| | | | - Toni Shearing
- Division of Medicine, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Nathan Rigney
- Aboriginal Health Promotion, Wellbeing SA, Adelaide, SA, Australia
| | | | - Nikki Clinch
- Statewide Operations, South Australian Department for Corrections, Adelaide, SA, Australia
| | - Andrea Pitson
- Aboriginal Education Directorate, South Australian Department for Education, Adelaide, SA, Australia
| | - Alex Brown
- Indigenous Genomics, Telethon Kids Institute, Adelaide, South Australia, Australia
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT, Australia
| | - Natasha J. Howard
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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McBride K, Howard NJ, Franks C, King V, Wade V, Dowling A, Rigney J, Burton N, Mitchell JA, Hillier S, Nicholls SJ, Paquet C, Brown A. Providing guideline-recommended preventive cardiovascular care to Aboriginal and Torres Strait Islander women: exploring gender differences with a medical record review in primary health care. Aust J Prim Health 2022; 28:498-507. [PMID: 35981938 DOI: 10.1071/py22064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 07/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND For Aboriginal and Torres Strait Islander women, the premature burden of cardiovascular disease is affecting their capacity to fulfil roles in society, and promote the health and wellbeing of future generations. In Australia, there is limited understanding of the difference in primary preventive cardiovascular care experienced by women, despite knowledge of sex and gender differentials in health profile and receipt of guideline-based acute care. This paper sought to explore the health profile and receipt of assessment and management of cardiovascular risk for Aboriginal and Torres Strait Islander women accessing preventive primary health care, and investigate gender differentials. METHOD Records of 1200 current clients, 50% women, aged 18-74years from three Aboriginal Health Services in central and South Australia for the period 7/2018-6/2020 were reviewed. RESULTS Twelve percent had documented cardiovascular disease. Compared with men, women with no recorded cardiovascular disease had a greater likelihood of being overweight or obese, a waist circumference indicative of risk, diabetes, and depression. Women were less likely to report being physically active. CONCLUSIONS The research concluded that gaps exist in the provision and recording of guideline-recommended primary preventive care regardless of sex. These are stark, given the evident burden.
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Affiliation(s)
- Katharine McBride
- Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia; and Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Natasha J Howard
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; and Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Christine Franks
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; and Aboriginal Women's Advisory Group, Adelaide, SA, Australia
| | - Veronica King
- Aboriginal Women's Advisory Group, Adelaide, SA, Australia; and Central Australian Aboriginal Congress, Alice Springs, NT 0870, Australia
| | - Vicki Wade
- Aboriginal Women's Advisory Group, Adelaide, SA, Australia; and Menzies School of Health Research, Casuarina, NT 0811, Australia
| | - Anna Dowling
- Aboriginal Women's Advisory Group, Adelaide, SA, Australia; and College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - Janice Rigney
- Aboriginal Women's Advisory Group, Adelaide, SA, Australia
| | - Nyunmiti Burton
- Aboriginal Women's Advisory Group, Adelaide, SA, Australia; and Ngaanyatjarra, Pitjantjatjara, Yankunytjatjara Women's Council, Alice Springs, NT 0870, Australia
| | - Julie Anne Mitchell
- Aboriginal Women's Advisory Group, Adelaide, SA, Australia; and The Heart Foundation of Australia, Woolloomooloo, NSW 2011, Australia
| | - Susan Hillier
- Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia
| | - Stephen J Nicholls
- Victorian Heart Institute, Monash University, Clayton, Vic. 3168, Australia
| | - Catherine Paquet
- Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia; and Faculté des Sciences de l'Administration, Université Laval, Québec, QC G1V 0A6, Canada
| | - Alex Brown
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; and Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
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Mansour A, Bentley R, Baker E, Li A, Martino E, Clair A, Daniel L, Mishra SR, Howard NJ, Phibbs P, Jacobs DE, Beer A, Blakely T, Howden-Chapman P. Housing and health: an updated glossary. J Epidemiol Community Health 2022; 76:833-838. [PMID: 35760516 DOI: 10.1136/jech-2022-219085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/15/2022] [Indexed: 01/10/2023]
Abstract
Recent crises have underscored the importance that housing has in sustaining good health and, equally, its potential to harm health. Considering this and building on Howden-Chapman's early glossary of housing and health and the WHO Housing and Health Guidelines, this paper introduces a range of housing and health-related terms, reflecting almost 20 years of development in the field. It defines key concepts currently used in research, policy and practice to describe housing in relation to health and health inequalities. Definitions are organised by three overarching aspects of housing: affordability (including housing affordability stress (HAS) and fuel poverty), suitability (including condition, accessibility and sustainable housing) and security (including precarious housing and homelessness). Each of these inter-related aspects of housing can be either protective of, or detrimental to, health. This glossary broadens our understanding of the relationship between housing and health to further promote interdisciplinarity and strengthen the nexus between these fields.
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Affiliation(s)
- Adelle Mansour
- Healthy Housing, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Rebecca Bentley
- Healthy Housing, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Emma Baker
- Australian Centre for Housing Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ang Li
- Healthy Housing, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Erika Martino
- Healthy Housing, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Amy Clair
- Australian Centre for Housing Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lyrian Daniel
- Australian Centre for Housing Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Shiva Raj Mishra
- Population Interventions, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Natasha J Howard
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Peter Phibbs
- Sydney School of Architecture, Design and Planning, The University of Sydney, Sydney, New South Wales, Australia
| | - David E Jacobs
- National Center for Healthy Housing, Columbia, Maryland, USA.,University of Illinois Chicago, Chicago, Illinois, USA
| | - Andrew Beer
- UniSA Business, University of South Australia, Adelaide, South Australia, Australia
| | - Tony Blakely
- Population Interventions, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Philippa Howden-Chapman
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
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McBride K, Nguyen J, Dowling A, Howard NJ, Franks C, Hillier S, Wade V, King V, Rigney J, Burton N, Mitchell JA, Nicholls SJ, Paquet C, Brown A. A systematic review on assessment and management of preventive cardiovascular care in primary health for Aboriginal and Torres Strait Islander women and men. Aust J Prim Health 2022; 28:179-199. [PMID: 35393010 DOI: 10.1071/py21219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/23/2021] [Indexed: 11/23/2022]
Abstract
In promoting positive cardiovascular health for Aboriginal and Torres Strait Islander peoples, there is a need to ensure provision of high-quality risk assessment and management in primary healthcare settings. There is some evidence of gender gaps for Australian women in the provision of cardiovascular risk assessment and management; however, there is little understanding of whether these gaps are also present for Aboriginal and Torres Strait Islander women. A mixed-method systematic review was utilised to synthesise existing evidence on the provision of assessment and management against guideline-recommended care for Aboriginal and Torres Strait Islander women, and determine whether gender disparities in provision of care exist for this population. Sixteen studies that report gender-specific data indicate there are significant gaps in the provision of assessment and management for Aboriginal and Torres Strait Islander women and men alike. There is no evidence of incorporation of social and emotional wellbeing into cardiovascular care and limited studies outlining the assessment and management of behaviours and factors that may be protective of cardiovascular health. Furthermore, little is known about the provision of care in mainstream primary health services for Aboriginal and Torres Strait Islander peoples.
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Affiliation(s)
- Katharine McBride
- Allied Health & Human Performance, University of South Australia, Adelaide, SA 5000, Australia; and Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Jayden Nguyen
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Anna Dowling
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia; and Aboriginal Women'¿s Advisory Group
| | - Natasha J Howard
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; and Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Christine Franks
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; and Aboriginal Women'¿s Advisory Group
| | - Susan Hillier
- Allied Health & Human Performance, University of South Australia, Adelaide, SA 5000, Australia
| | - Vicki Wade
- Aboriginal Women'¿s Advisory Group; and Menzies School of Health Research, Casuarina, NT 0811, Australia
| | - Veronica King
- Aboriginal Women'¿s Advisory Group; and Central Australian Aboriginal Congress, Alice Springs, NT 0870, Australia
| | | | - Nyunmiti Burton
- Aboriginal Women'¿s Advisory Group; and Ngaanyatjarra, Pitjantjatjara, Yankunytjatjara Women's Council, Alice Springs, NT 0870, Australia
| | - Julie Anne Mitchell
- Aboriginal Women'¿s Advisory Group; and The Heart Foundation of Australia, Woolloomooloo, NSW 2011, Australia
| | - Stephen J Nicholls
- Victorian Heart Institute, Monash University, Clayton, Vic. 3168, Australia
| | - Catherine Paquet
- Allied Health & Human Performance, University of South Australia, Adelaide, SA 5000, Australia; and Faculté des Sciences de l'Administration, Université Laval, Québec, QC, G1V 0A6, Canada
| | - Alex Brown
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; and Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
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Lake KJ, Boyd MA, Smithers L, Howard NJ, Dawson AP. Correction to: Exploring the readiness of senior doctors and nurses to assess and address patients' social needs in the hospital setting. BMC Health Serv Res 2022; 22:359. [PMID: 35300682 PMCID: PMC8932178 DOI: 10.1186/s12913-022-07758-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Katherine J Lake
- School of Public Health, The University of Adelaide, Adelaide, South, 5005, Australia
| | - Mark A Boyd
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, 5005, Australia. .,Northern Adelaide Local Health Network, Adelaide, South Australia, 5000, Australia.
| | - Lisa Smithers
- School of Public Health, The University of Adelaide, Adelaide, South, 5005, Australia.,School of Health and Society, The University of Wollongong, Wollongong, New South Wales, 2522, Australia
| | - Natasha J Howard
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, 5005, Australia.,Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South, 5000, Australia
| | - Anna P Dawson
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, 5005, Australia.,Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South, 5000, Australia
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8
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Lake KJ, Boyd MA, Smithers L, Howard NJ, Dawson AP. Exploring the readiness of senior doctors and nurses to assess and address patients' social needs in the hospital setting. BMC Health Serv Res 2022; 22:246. [PMID: 35197049 PMCID: PMC8867718 DOI: 10.1186/s12913-022-07642-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adverse social circumstances are a key factor in health outcomes. Hospitals are an opportune setting for assessing and addressing the unmet social needs of patients, however, the readiness of healthcare workers in hospitals to undertake such tasks requires further exploration in the Australian context. This study aimed to generate a theory of doctors' and nurses' readiness to assess and address patients' social needs in a hospital setting. METHODS A constructivist grounded theory methodology was applied, with purposive and theoretical sampling used to gather diverse perspectives of readiness during semi-structured interviews with twenty senior doctors and nurses from a variety of clinical specialties working in hospitals serving communities experiencing inequitable social and health outcomes. Line-by-line coding, memo writing, and diagramming were used in analysis to construct an interpretive theory of readiness. Application of constant comparison analytic processes were used to test the robustness of the theory. RESULTS The readiness of doctors and nurses varies across individuals and departments, and is founded upon a state of being comfortable and confident to assess social need as determined by a range of personal attributes (e.g. knowledge of social need; skills to assess social need); a state of being willing and prepared to assess and address social need facilitated by supportive environments (e.g. departmental culture); and enabling characteristics of the clinical encounter (e.g. time, rapport). CONCLUSIONS We found that the readiness of doctors and nurses is dynamic and impacted by a complex interplay of personal attributes along with contextual and situational factors. These findings indicate that any efforts to strengthen the readiness of doctors and nurses to assess and address social needs must target personal capabilities in addition to characteristics of the working environment.
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Affiliation(s)
- Katherine J Lake
- School of Public Health, The University of Adelaide, Adelaide, South, 5005, Australia
| | - Mark A Boyd
- Adelaide Medical School, Faculty of Health and Medical Sciences, Chair of Medicine, The University of Adelaide, Level 2, Women's Health Building, Lyell McEwin Hospital, Haydown Rd, Elizabeth Vale, SA 5112, Adelaide, South Australia, 5005, Australia. .,Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South, 5000, Australia.
| | - Lisa Smithers
- School of Public Health, The University of Adelaide, Adelaide, South, 5005, Australia.,School of Health and Society, The University of Wollongong, Wollongong, New South Wales, 2522, Australia
| | - Natasha J Howard
- Adelaide Medical School, Faculty of Health and Medical Sciences, Chair of Medicine, The University of Adelaide, Level 2, Women's Health Building, Lyell McEwin Hospital, Haydown Rd, Elizabeth Vale, SA 5112, Adelaide, South Australia, 5005, Australia.,Northern Adelaide Local Health Network, Adelaide, South Australia, 5000, Australia
| | - Anna P Dawson
- Adelaide Medical School, Faculty of Health and Medical Sciences, Chair of Medicine, The University of Adelaide, Level 2, Women's Health Building, Lyell McEwin Hospital, Haydown Rd, Elizabeth Vale, SA 5112, Adelaide, South Australia, 5005, Australia.,Northern Adelaide Local Health Network, Adelaide, South Australia, 5000, Australia
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Brodie T, Pearson O, Cantley L, Cooper P, Westhead S, Brown A, Howard NJ. Strengthening approaches to respond to the social and emotional well-being needs of Aboriginal and Torres Strait Islander people: the Cultural Pathways Program. Prim Health Care Res Dev 2021; 22:e35. [PMID: 34184630 PMCID: PMC8278791 DOI: 10.1017/s1463423621000402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/11/2021] [Accepted: 05/17/2021] [Indexed: 11/06/2022] Open
Abstract
Aboriginal and Torres Strait Islander holistic health represents the interconnection of social, emotional, spiritual and cultural factors on health and well-being. Social factors (education, employment, housing, transport, food and financial security) are internationally described and recognised as the social determinants of health. The social determinants of health are estimated to contribute to 34% of the overall burden of disease experienced by Aboriginal and Torres Strait Islander people. Primary health care services currently 'do what it takes' to address social and emotional well-being needs, including the social determinants of health, and require culturally relevant tools and processes for implementing coordinated and holistic responses. Drawing upon a research-setting pilot program, this manuscript outlines key elements encapsulating a strengths-based approach aimed at addressing Aboriginal and Torres Strait Islander holistic social and emotional well-being.The Cultural Pathways Program is a response to community identified needs, designed and led by Aboriginal and Torres Strait Islander people and informed by holistic views of health. The program aims to identify holistic needs of Aboriginal and Torres Strait Islander people as the starting point to act on the social determinants of health. Facilitators implement strengths-based practice to identify social and cultural needs (e.g. cultural and community connection, food and financial security, housing, mental health, transport), engage in a goal setting process and broker connections with social and health services. An integrated culturally appropriate clinical supervision model enhances delivery of the program through reflective practice and shared decision making. These embedded approaches enable continuous review and improvement from a program and participant perspective. A developmental evaluation underpins program implementation and the proposed culturally relevant elements could be further tailored for delivery within primary health care services as part of routine care to strengthen systematic identification and response to social and emotional well-being needs.
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Affiliation(s)
- Tina Brodie
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Odette Pearson
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Luke Cantley
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- Social Work Innovation Research Living Space, College of Education, Psychology & Social Work, Flinders University, South Australia
| | - Peita Cooper
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Seth Westhead
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Natasha J Howard
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
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Chakraborty A, Howard NJ, Daniel M, Chong A, Slavin N, Brown A, Cargo M. Prioritizing Built Environmental Factors to Tackle Chronic and Infectious Diseases in Remote Northern Territory (NT) Communities of Australia: A Concept Mapping Study. Int J Environ Res Public Health 2021; 18:5178. [PMID: 34068201 PMCID: PMC8152969 DOI: 10.3390/ijerph18105178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 12/31/2022]
Abstract
High prevalence of chronic and infectious diseases in Indigenous populations is a major public health concern both in global and Australian contexts. Limited research has examined the role of built environments in relation to Indigenous health in remote Australia. This study engaged stakeholders to understand their perceptions of the influence of built environmental factors on chronic and infectious diseases in remote Northern Territory (NT) communities. A preliminary set of 1120 built environmental indicators were systematically identified and classified using an Indigenous Indicator Classification System. The public and environmental health workforce was engaged to consolidate the classified indicators (n = 84), and then sort and rate the consolidated indicators based on their experience with living and working in remote NT communities. Sorting of the indicators resulted in a concept map with nine built environmental domains. Essential services and Facilities for health/safety were the highest ranked domains for both chronic and infectious diseases. Within these domains, adequate housing infrastructure, water supply, drainage system, reliable sewerage and power infrastructure, and access to health services were identified as the most important contributors to the development of these diseases. The findings highlight the features of community environments amenable to public health and social policy actions that could be targeted to help reduce prevalence of chronic and infectious diseases.
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Affiliation(s)
- Amal Chakraborty
- School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (N.J.H.); (M.D.); (A.B.); (M.C.)
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia
| | - Natasha J. Howard
- School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (N.J.H.); (M.D.); (A.B.); (M.C.)
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5000, Australia
| | - Mark Daniel
- School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (N.J.H.); (M.D.); (A.B.); (M.C.)
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT 2601, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Alwin Chong
- Australian Centre for Child Protection, University of South Australia, Adelaide, SA 5001, Australia;
| | - Nicola Slavin
- Environmental Health Branch, Department of Health, Northern Territory Government, Casuarina, NT 0810, Australia;
| | - Alex Brown
- School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (N.J.H.); (M.D.); (A.B.); (M.C.)
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5000, Australia
| | - Margaret Cargo
- School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (N.J.H.); (M.D.); (A.B.); (M.C.)
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT 2601, Australia
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Chakraborty A, Daniel M, Howard NJ, Chong A, Slavin N, Brown A, Cargo M. Identifying Environmental Determinants Relevant to Health and Wellbeing in Remote Australian Indigenous Communities: A Scoping Review of Grey Literature. Int J Environ Res Public Health 2021; 18:ijerph18084167. [PMID: 33920765 PMCID: PMC8071139 DOI: 10.3390/ijerph18084167] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/31/2022]
Abstract
The high prevalence of preventable infectious and chronic diseases in Australian Indigenous populations is a major public health concern. Existing research has rarely examined the role of built and socio-political environmental factors relating to remote Indigenous health and wellbeing. This research identified built and socio-political environmental indicators from publicly available grey literature documents locally-relevant to remote Indigenous communities in the Northern Territory (NT), Australia. Existing planning documents with evidence of community input were used to reduce the response burden on Indigenous communities. A scoping review of community-focused planning documents resulted in the identification of 1120 built and 2215 socio-political environmental indicators. Indicators were systematically classified using an Indigenous indicator classification system (IICS). Applying the IICS yielded indicators prominently featuring the "community infrastructure" domain within the built environment, and the "community capacity" domain within the socio-political environment. This research demonstrates the utility of utilizing existing planning documents and a culturally appropriate systematic classification system to consolidate environmental determinants that influence health and disease occurrence. The findings also support understanding of which features of community-level built and socio-political environments amenable to public health and social policy actions might be targeted to help reduce the prevalence of infectious and chronic diseases in Indigenous communities.
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Affiliation(s)
- Amal Chakraborty
- School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (M.D.); (N.J.H.); (A.B.); (M.C.)
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia
- Correspondence: ; Tel.: +61-(0)-422-473-881
| | - Mark Daniel
- School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (M.D.); (N.J.H.); (A.B.); (M.C.)
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT 2601, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Natasha J. Howard
- School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (M.D.); (N.J.H.); (A.B.); (M.C.)
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5000, Australia
| | - Alwin Chong
- Australian Centre for Child Protection, University of South Australia, Adelaide, SA 5001, Australia;
| | - Nicola Slavin
- Environmental Health Branch, Department of Health, Northern Territory Government, Casuarina, NT 0810, Australia;
| | - Alex Brown
- School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (M.D.); (N.J.H.); (A.B.); (M.C.)
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5000, Australia
| | - Margaret Cargo
- School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (M.D.); (N.J.H.); (A.B.); (M.C.)
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT 2601, Australia
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McBride KF, Rolleston A, Grey C, Howard NJ, Paquet C, Brown A. Māori, Pacific, Aboriginal and Torres Strait Islander Women's Cardiovascular Health: Where Are the Opportunities to Make a Real Difference? Heart Lung Circ 2020; 30:52-58. [PMID: 33162366 DOI: 10.1016/j.hlc.2020.06.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/27/2020] [Accepted: 06/15/2020] [Indexed: 11/30/2022]
Abstract
Māori and Pacific women in New Zealand and Aboriginal and Torres Strait Islander women in Australia are recognised as nurturers and leaders within their families and communities. However, women's wellbeing, and that of their communities, are affected by a high burden of cardiovascular disease experienced at a younger age than women from other ethnic groups. There has been little focus on the cardiovascular outcomes and strategies to address heart health inequities among Māori, Pacific, Aboriginal and Torres Strait Islander women. The factors contributing to these inequities are complex and interrelated but include differences in exposure to risk and protective factors, rates of multi-morbidity, and substantial gaps within the health system, which include barriers to culturally responsive, timely and appropriate cardiovascular care. Evidence demonstrates critical treatment gaps across the continuum of risk and disease, including assessment and management of cardiovascular risk in young women and time-critical access to and receipt of acute services. Cardiovascular disease in women impacts not only the individual, but their family and community, and the burden of living with disease limits women's capacity to fulfil their roles and responsibilities which support and sustain families and communities. Our response must draw on the strengths of Māori, Pacific, Aboriginal and Torres Strait Islander women, acknowledge health and wellbeing holistically, address the health and social needs of individuals, families and communities, and recognise that Indigenous women in New Zealand, Australia and across the Pacific must be involved in the design, development and implementation of solutions affecting their own health.
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Affiliation(s)
- Katharine F McBride
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia; Australian Centre for Precision Health, Cancer Research Institute, University of South Australia, Adelaide, SA, Australia; Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | | | - Corina Grey
- Auckland District Health Board, Auckland, New Zealand
| | - Natasha J Howard
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Catherine Paquet
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia; Australian Centre for Precision Health, Cancer Research Institute, University of South Australia, Adelaide, SA, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.
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Banham D, Roder D, Eckert M, Howard NJ, Canuto K, Brown A. Cancer treatment and the risk of cancer death among Aboriginal and non-Aboriginal South Australians: analysis of a matched cohort study. BMC Health Serv Res 2019; 19:771. [PMID: 31665005 PMCID: PMC6820943 DOI: 10.1186/s12913-019-4534-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 09/13/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander Australians have poorer cancer outcomes than other Australians. Comparatively little is known of the type and amount of cancer treatment provided to Aboriginal and Torres Strait Islander people and the consequences for cancer survival. This study quantifies the influence of surgical, systemic and radiotherapy treatment on risk of cancer death among matched cohorts of cancer cases and, the comparative exposure of cohorts to these treatments. METHODS Cancers registered among Aboriginal South Australians in 1990-2010 (N = 777) were matched with randomly selected non-Indigenous cases by sex, birth and diagnostic year, and primary site, then linked to administrative cancer treatment for the period from 2 months before to 13 months after diagnosis. Competing risk regression summarised associations of Indigenous status, geographic remoteness, comorbidities, cancer stage and treatment exposure with risk of cancer death. RESULTS Fewer Aboriginal cases had localised disease at diagnosis (37.2% versus 50.2%) and they were less likely to: experience hospitalisation with cancer diagnosis, unadjusted odds ratio (UOR) = 0.76; 95%CI = 0.59-0.98; have surgery UOR = 0.65; 95%CI = 0.53-0.80; systemic therapies UOR = 0.64; 95%CI = 0.52-0.78; or radiotherapy, UOR = 0.76; 95%CI = 0.63-0.94. Localised disease carried lower risk of cancer death compared to advanced cases receiving surgery or systemic therapies, SHR = 0.34; 95%CI = 0.25-0.47 and SHR = 0.35; 95%CI = 0.25-0.48. Advanced disease and no treatment carried higher risk of cancer death, SHR = 1.82; 95%CI = 1.26-2.63. CONCLUSION The effects of treatment did not differ between Aboriginal and non-Indigenous cohorts. However, comparatively less exposure to surgical and systemic treatments among Aboriginal cancer cases further complicated the disadvantages associated with geographic remoteness, advanced stage of disease and co-morbid conditions at diagnosis and add to disparities in cancer death. System level responses to improving access, utilisation and quality of effective treatments are needed to improve survival after cancer diagnosis.
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Affiliation(s)
- David Banham
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.
| | - David Roder
- School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, Australia
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, University of South Australia North Terrace, Adelaide, Australia
| | - Natasha J Howard
- School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, Australia
| | - Karla Canuto
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia
- Aboriginal Health Research Group, Cancer Research Institute, University of South Australia, Adelaide, Australia
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Wycherley TP, van der Pols JC, Daniel M, Howard NJ, O'Dea K, Brimblecombe JK. Associations between Community Environmental-Level Factors and Diet Quality in Geographically Isolated Australian Communities. Int J Environ Res Public Health 2019; 16:ijerph16111943. [PMID: 31159330 PMCID: PMC6603945 DOI: 10.3390/ijerph16111943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/24/2019] [Accepted: 05/29/2019] [Indexed: 11/24/2022]
Abstract
Remote Indigenous Australians experience disproportionately poor cardio-metabolic health, which is largely underpinned by adverse dietary intake related to social determinants. Little evidence exists about the community environmental-level factors that shape diet quality in this geographically isolated population group. This study aimed to explore the modifiable environmental-level factors associated with the features of dietary intake that underpin cardio-metabolic disease risk in this population group. Community-level dietary intake data were estimated from weekly store sales data collected throughout 2012 and linked with concurrent social, built, and physical environmental dimension data for 13 remote Indigenous Australian communities in the Northern Territory. Statistical analyses were performed to investigate associations. At the community level, store sales of discretionary foods were lower in communities with greater distance to a neighbouring store (r = −0.45 (p < 0.05)). Sales of sugar-sweetened beverages were lower in communities with higher levels of household crowding (r = −0.55 (p < 0.05)), higher levels of Indigenous unemployment (r = −0.62 (p = 0.02)), and greater distance to neighbouring stores (r = −0.61 (p = 0.004)). Modifiable environmental-level factors may be associated with adverse diet quality in remote Indigenous Australian communities and further investigations of these factors should be considered when developing policies to improve dietary intake quality in geographically isolated populations.
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Affiliation(s)
- Thomas P Wycherley
- Alliance for Research in Exercise, Nutrition and Activity; University of South Australia, Adelaide 5000, Australia.
- Wellbeing and Preventable Chronic Diseases Division; Menzies School of Health Research, Darwin 0810, Australias Division.
| | - Jolieke C van der Pols
- School of Exercise and Nutrition Sciences; Queensland University of Technology, Brisbane 4001, Australia.
| | - Mark Daniel
- Health Research Institute; University of Canberra, Canberra 2617, Australia.
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy 3010, Australia.
| | - Natasha J Howard
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide 5000, Australia.
| | - Kerin O'Dea
- School of Health Sciences, University of South Australia, Adelaide 5000, Australia.
| | - Julie K Brimblecombe
- Wellbeing and Preventable Chronic Diseases Division; Menzies School of Health Research, Darwin 0810, Australias Division.
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne 3800, Australia.
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Baldock KL, Paquet C, Howard NJ, Coffee NT, Taylor AW, Daniel M. Correlates of Discordance between Perceived and Objective Distances to Local Fruit and Vegetable Retailers. Int J Environ Res Public Health 2019; 16:ijerph16071262. [PMID: 30970565 PMCID: PMC6480361 DOI: 10.3390/ijerph16071262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/07/2019] [Accepted: 04/08/2019] [Indexed: 11/26/2022]
Abstract
Background: Perceptions of neighbourhood attributes such as proximity of food retailers that are discordant with objective measures of the same are associated with poor health behaviours and weight gain. Factors associated with discordant perceptions are likely relevant to planning more effective interventions to improve health. Purpose: Analysis of cross-sectional relationships between individual and neighbourhood factors and overestimations of walking distances to local fruit/vegetable retailers (FVR). Methods: Perceived walking times, converted to distances, between participant residences and FVR were compared with objectively-assessed road network distances calculated with a Geographic Information System for n = 1305 adults residing in Adelaide, South Australia. Differences between perceived and objective distances were expressed as ‘overestimated’ distances and were analysed relative to perceptions consistent with objective distances. Cross-sectional associations were evaluated between individual socio-demographic, health, and area-level characteristics and overestimated distances to FVR using multilevel logistic regression. Results: Agreement between objective and perceived distances between participants’ residence and the nearest FVR was only fair (weighted kappa = 0.22). Overestimated distances to FVR were positively associated with mental well-being, and were negatively associated with household income, physical functioning, sense of community, and objective distances to greengrocers. Conclusions: Individual characteristics and features of neighbourhoods were related to overestimated distances to FVR. Sense of connectivity and shared identity may shape more accurate understandings of local resource access, and offer a focal point for tailored public health initiatives that bring people together to achieve improved health behaviour.
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Affiliation(s)
- Katherine L Baldock
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.
| | - Catherine Paquet
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.
| | - Natasha J Howard
- Division of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia.
| | - Neil T Coffee
- Centre for Research & Action in Public Health, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ATC 2601, Australia.
| | - Anne W Taylor
- Population Research and Outcome Studies, Discipline of Medicine, The University of Adelaide, Adelaide, SA 5001, Australia.
| | - Mark Daniel
- Centre for Research & Action in Public Health, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ATC 2601, Australia.
- South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia.
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, VIC 3065, Australia.
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Dixit S, Arora NK, Rahman A, Howard NJ, Singh RK, Vaswani M, Das MK, Ahmed F, Mathur P, Tandon N, Dasgupta R, Chaturvedi S, Jethwaney J, Dalpath S, Prashad R, Kumar R, Gupta R, Dube L, Daniel M. Establishing a Demographic, Development and Environmental Geospatial Surveillance Platform in India: Planning and Implementation. JMIR Public Health Surveill 2018; 4:e66. [PMID: 30291101 PMCID: PMC6231830 DOI: 10.2196/publichealth.9749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/11/2018] [Accepted: 06/18/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Inadequate administrative health data, suboptimal public health infrastructure, rapid and unplanned urbanization, environmental degradation, and poor penetration of information technology make the tracking of health and well-being of populations and their social determinants in the developing countries challenging. Technology-integrated comprehensive surveillance platforms have the potential to overcome these gaps. OBJECTIVE This paper provides methodological insights into establishing a geographic information system (GIS)-integrated, comprehensive surveillance platform in rural North India, a resource-constrained setting. METHODS The International Clinical Epidemiology Network Trust International established a comprehensive SOMAARTH Demographic, Development, and Environmental Surveillance Site (DDESS) in rural Palwal, a district in Haryana, North India. The surveillance platform evolved by adopting four major steps: (1) site preparation, (2) data construction, (3) data quality assurance, and (4) data update and maintenance system. Arc GIS 10.3 and QGIS 2.14 software were employed for geospatial data construction. Surveillance data architecture was built upon the geospatial land parcel datasets. Dedicated software (SOMAARTH-1) was developed for handling high volume of longitudinal datasets. The built infrastructure data pertaining to land use, water bodies, roads, railways, community trails, landmarks, water, sanitation and food environment, weather and air quality, and demographic characteristics were constructed in a relational manner. RESULTS The comprehensive surveillance platform encompassed a population of 0.2 million individuals residing in 51 villages over a land mass of 251.7 sq km having 32,662 households and 19,260 nonresidential features (cattle shed, shops, health, education, banking, religious institutions, etc). All land parcels were assigned georeferenced location identification numbers to enable space and time monitoring. Subdivision of villages into sectors helped identify socially homogenous community clusters (418/676, 61.8%, sectors). Water and hygiene parameters of the whole area were mapped on the GIS platform and quantified. Risk of physical exposure to harmful environment (poor water and sanitation indicators) was significantly associated with the caste of individual household (P=.001), and the path was mediated through the socioeconomic status and density of waste spots (liquid and solid) of the sector in which these households were located. Ground-truthing for ascertaining the land parcel level accuracies, community involvement in mapping exercise, and identification of small habitations not recorded in the administrative data were key learnings. CONCLUSIONS The SOMAARTH DDESS experience allowed us to document and explore dynamic relationships, associations, and pathways across multiple levels of the system (ie, individual, household, neighborhood, and village) through a geospatial interface. This could be used for characterization and monitoring of a wide range of proximal and distal determinants of health.
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Affiliation(s)
- Shikha Dixit
- Research, SOMAARTH Demographic, Development and Environmental Surveillance Site, The INCLEN Trust International, New Delhi, India
| | - Narendra K Arora
- Research, Epidemiology, The INCLEN Trust International, New Delhi, India
| | - Atiqur Rahman
- Department of Geography, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi, India
| | - Natasha J Howard
- Sansom Institute for Health Research, Division of Health Sciences, University of South Australia, Adelaide, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Rakesh K Singh
- Research, SOMAARTH Demographic, Development and Environmental Surveillance Site, The INCLEN Trust International, New Delhi, India
| | - Mayur Vaswani
- Research, SOMAARTH Demographic, Development and Environmental Surveillance Site, The INCLEN Trust International, New Delhi, India
| | - Manoja K Das
- Research, SOMAARTH Demographic, Development and Environmental Surveillance Site, The INCLEN Trust International, New Delhi, India
| | | | - Prashant Mathur
- National Cancer Registry Program, National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bangalore, India
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajib Dasgupta
- Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India
| | - Sanjay Chaturvedi
- Department of Community Medicine, University College of Medical Sciences, University of Delhi, New Delhi, India
| | - Jaishri Jethwaney
- Department of Research, Indian Council for Social Science Research, New Delhi, India
| | | | - Rajendra Prashad
- Office of Chief Medical Officer, Department of Health, Palwal, India
| | - Rakesh Kumar
- Indian Council of Medical Research, New Delhi, India
| | | | - Laurette Dube
- McGill Center for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada
| | - Mark Daniel
- Centre for Research and Action in Public Health, Health Research Institute, University of Canberra, Canberra, Australia.,Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Melbourne, Australia
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Baldock KL, Paquet C, Howard NJ, Coffee NT, Taylor AW, Daniel M. Gender-specific associations between perceived and objective neighbourhood crime and metabolic syndrome. PLoS One 2018; 13:e0201336. [PMID: 30048521 PMCID: PMC6062143 DOI: 10.1371/journal.pone.0201336] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/13/2018] [Indexed: 12/02/2022] Open
Abstract
Much research has considered the relationship between neighbourhood crime and physical activity, but few studies have assessed clinical outcomes consequent to behaviour, such as cardiometabolic risk. Fewer still have simultaneously assessed perceived and objective measures of crime. Perceptions of crime and actual victimisation vary according to gender; thus, this study sought to assess: 1) correspondence between perceived and objective neighbourhood crime; and 2) gender-specific associations between perceived and reported crime and metabolic syndrome, representing cardiometabolic risk. The indirect effect of neighbourhood crime on metabolic syndrome via walking was additionally evaluated. An Australian population-based biomedical cohort study (2004–2007) collected biomedical, socio-demographic, and neighbourhood perceptions data from n = 1,172 urban-dwelling, adults. Area-level reported crime rates were standardised and linked to individual data based on participants' residential location. Correspondence between actual and perceived crime measures was assessed using Pearson correlation coefficients. Cross-sectional associations between crime and metabolic syndrome were analysed using generalised estimating equations regression models accounting for socio-demographic factors and area-level income. Correspondence between perceived and objective crime was small to medium among men and women (r = 0.17 to 0.33). Among men, metabolic syndrome was related to rates of violent (OR = 1.21, 95% CI 1.08–1.35) and total crime (OR = 1.17, 95% CI 1.04–1.32), after accounting for perceived crime. Among women, metabolic syndrome was related to perceived crime (OR = 1.35, 95% CI 1.14–1.60) after accounting for total reported crime. Among women, there were indirect effects of perceived crime and property crime on metabolic syndrome through walking. Results indicate that crime, an adverse social exposure, is linked to clinical health status. Crime rates, and perceptions of crime and safety, differentially impact upon cardiometabolic health according to gender. Social policy and public health strategies targeting crime reduction, as well as strategies to increase perceptions of safety, have potential to contribute to improved cardiometabolic outcomes.
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Affiliation(s)
- Katherine L. Baldock
- Centre for Population Health Research, School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
- * E-mail:
| | - Catherine Paquet
- Centre for Population Health Research, School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Natasha J. Howard
- Wardliparingga Aboriginal Research Unit, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Neil T. Coffee
- Centre for Research & Action in Public Health, Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Anne W. Taylor
- Population Research and Outcome Studies, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mark Daniel
- Centre for Research & Action in Public Health, Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
- Department of Medicine, St Vincent’s Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Baldock KL, Paquet C, Howard NJ, Coffee NT, Taylor AW, Daniel M. Are Perceived and Objective Distances to Fresh Food and Physical Activity Resources Associated with Cardiometabolic Risk? Int J Environ Res Public Health 2018; 15:ijerph15020224. [PMID: 29382169 PMCID: PMC5858293 DOI: 10.3390/ijerph15020224] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/19/2018] [Accepted: 01/25/2018] [Indexed: 12/13/2022]
Abstract
Perceived and objective measures of neighbourhood features have shown limited correspondence. Few studies have examined whether discordance between objective measures and individual perceptions of neighbourhood environments relates to individual health. Individuals with mismatched perceptions may benefit from initiatives to improve understandings of resource availability. This study utilised data from n = 1491 adult participants in a biomedical cohort to evaluate cross-sectional associations between measures of access (perceived, objective, and perceived-objective mismatch) to fruit and vegetable retailers (FVR) and public open space (POS), and clinically-measured metabolic syndrome and its component risk factors: central obesity, dyslipidaemia, hypertension and pre-diabetes/diabetes. Access measures included perceived distances from home to the nearest FVR and POS, corresponding objectively-assessed road network distances, and the discordance between perceived and objective distances (overestimated (i.e., mismatched) distances versus matched perceived-objective distances). Individual and neighbourhood measures were spatially joined using a geographic information system. Associations were evaluated using multilevel logistic regression, accounting for individual and area-level covariates. Hypertension was positively associated with perceived distances to FVR (odds ratio (OR) = 1.14, 95% confidence interval (CI) = 1.02, 1.28) and POS (OR = 1.19, 95% CI = 1.05, 1.34), after accounting for covariates and objective distances. Hypertension was positively associated with overestimating distances to FVR (OR = 1.36, 95% CI = 1.02, 1.80). Overestimating distances to POS was positively associated with both hypertension (OR = 1.42, 95% CI = 1.11, 1.83) and dyslipidaemia (OR = 1.25, 95% CI = 1.00, 1.57). Results provide new evidence for specific associations between perceived and overestimated distances from home to nearby resources and cardiometabolic risk factors.
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Affiliation(s)
- Katherine L Baldock
- Centre for Population Health Research, Sansom Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.
| | - Catherine Paquet
- Centre for Population Health Research, Sansom Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.
| | - Natasha J Howard
- Wardliparingga Aboriginal Research Unit, Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5001, Australia.
| | - Neil T Coffee
- Centre for Research & Action in Public Health, Health Research Institute, Faculty of Health, University of Canberra, Canberra 2617, Australia.
| | - Anne W Taylor
- Population Research and Outcome Studies, Discipline of Medicine, The University of Adelaide, Adelaide, SA 5001, Australia.
| | - Mark Daniel
- Centre for Research & Action in Public Health, Health Research Institute, Faculty of Health, University of Canberra, Canberra 2617, Australia.
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne 3065, Australia.
- South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia.
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Stankov I, Howard NJ, Daniel M, Cargo M. Policy, Research and Residents' Perspectives on Built Environments Implicated in Heart Disease: A Concept Mapping Approach. Int J Environ Res Public Health 2017; 14:E170. [PMID: 28208786 PMCID: PMC5334724 DOI: 10.3390/ijerph14020170] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/06/2017] [Indexed: 01/24/2023]
Abstract
An underrepresentation of stakeholder perspectives within urban health research arguably limits our understanding of what is a multi-dimensional and complex relationship between the built environment and health. By engaging a wide range of stakeholders using a participatory concept mapping approach, this study aimed to achieve a more holistic and nuanced understanding of the built environments shaping disease risk, specifically cardiometabolic risk (CMR). Moreover, this study aimed to ascertain the importance and changeability of identified environments through government action. Through the concept mapping process, community members, researchers, government and non-government stakeholders collectively identified eleven clusters encompassing 102 built environmental domains related to CMR, a number of which are underrepresented within the literature. Among the identified built environments, open space, public transportation and pedestrian environments were highlighted as key targets for policy intervention. Whilst there was substantive convergence in stakeholder groups' perspectives concerning the built environment and CMR, there were disparities in the level of importance government stakeholders and community members respectively assigned to pedestrian environments and street connectivity. These findings support the role of participatory methods in strengthening how urban health issues are understood and in affording novel insights into points of action for public health and policy intervention.
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Affiliation(s)
- Ivana Stankov
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA.
- Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.
| | - Natasha J Howard
- Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.
| | - Mark Daniel
- Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.
- South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia.
| | - Margaret Cargo
- Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.
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Carroll SJ, Paquet C, Howard NJ, Coffee NT, Adams RJ, Taylor AW, Niyonsenga T, Daniel M. Local descriptive body weight and dietary norms, food availability, and 10-year change in glycosylated haemoglobin in an Australian population-based biomedical cohort. BMC Public Health 2017; 17:149. [PMID: 28148239 PMCID: PMC5289014 DOI: 10.1186/s12889-017-4068-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 01/24/2017] [Indexed: 02/04/2023] Open
Abstract
Background Individual-level health outcomes are shaped by environmental risk conditions. Norms figure prominently in socio-behavioural theories yet spatial variations in health-related norms have rarely been investigated as environmental risk conditions. This study assessed: 1) the contributions of local descriptive norms for overweight/obesity and dietary behaviour to 10-year change in glycosylated haemoglobin (HbA1c), accounting for food resource availability; and 2) whether associations between local descriptive norms and HbA1c were moderated by food resource availability. Methods HbA1c, representing cardiometabolic risk, was measured three times over 10 years for a population-based biomedical cohort of adults in Adelaide, South Australia. Residential environmental exposures were defined using 1600 m participant-centred road-network buffers. Local descriptive norms for overweight/obesity and insufficient fruit intake (proportion of residents with BMI ≥ 25 kg/m2 [n = 1890] or fruit intake of <2 serves/day [n = 1945], respectively) were aggregated from responses to a separate geocoded population survey. Fast-food and healthful food resource availability (counts) were extracted from a retail database. Separate sets of multilevel models included different predictors, one local descriptive norm and either fast-food or healthful food resource availability, with area-level education and individual-level covariates (age, sex, employment status, education, marital status, and smoking status). Interactions between local descriptive norms and food resource availability were tested. Results HbA1c concentration rose over time. Local descriptive norms for overweight/obesity and insufficient fruit intake predicted greater rates of increase in HbA1c. Neither fast-food nor healthful food resource availability were associated with change in HbA1c. Greater healthful food resource availability reduced the rate of increase in HbA1c concentration attributed to the overweight/obesity norm. Conclusions Local descriptive health-related norms, not food resource availability, predicted 10-year change in HbA1c. Null findings for food resource availability may reflect a sufficiency or minimum threshold level of resources such that availability poses no barrier to obtaining healthful or unhealthful foods for this region. However, the influence of local descriptive norms varied according to food resource availability in effects on HbA1c. Local descriptive health-related norms have received little attention thus far but are important influences on individual cardiometabolic risk. Further research is needed to explore how local descriptive norms contribute to chronic disease risk and outcomes.
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Affiliation(s)
- Suzanne J Carroll
- Spatial Epidemiology and Evaluation Research Group, School of Health Sciences and Centre for Population Health Research, University of South Australia, IPC CWE-48, GPO Box 2471, Adelaide, South Australia, 5001, Australia.
| | - Catherine Paquet
- Spatial Epidemiology and Evaluation Research Group, School of Health Sciences and Centre for Population Health Research, University of South Australia, IPC CWE-48, GPO Box 2471, Adelaide, South Australia, 5001, Australia.,Research Centre of the Douglas Mental Health University Institute, Verdun, Québec, Canada
| | - Natasha J Howard
- Spatial Epidemiology and Evaluation Research Group, School of Health Sciences and Centre for Population Health Research, University of South Australia, IPC CWE-48, GPO Box 2471, Adelaide, South Australia, 5001, Australia
| | - Neil T Coffee
- Spatial Epidemiology and Evaluation Research Group, School of Health Sciences and Centre for Population Health Research, University of South Australia, IPC CWE-48, GPO Box 2471, Adelaide, South Australia, 5001, Australia
| | - Robert J Adams
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Anne W Taylor
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Theo Niyonsenga
- Spatial Epidemiology and Evaluation Research Group, School of Health Sciences and Centre for Population Health Research, University of South Australia, IPC CWE-48, GPO Box 2471, Adelaide, South Australia, 5001, Australia
| | - Mark Daniel
- Spatial Epidemiology and Evaluation Research Group, School of Health Sciences and Centre for Population Health Research, University of South Australia, IPC CWE-48, GPO Box 2471, Adelaide, South Australia, 5001, Australia.,Department of Medicine, The University of Melbourne, St. Vincent's Hospital, Melbourne, VIC, Australia.,South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia
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Sugiyama T, Niyonsenga T, Howard NJ, Coffee NT, Paquet C, Taylor AW, Daniel M. Residential proximity to urban centres, local-area walkability and change in waist circumference among Australian adults. Prev Med 2016; 93:39-45. [PMID: 27664538 DOI: 10.1016/j.ypmed.2016.09.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 08/24/2016] [Accepted: 09/19/2016] [Indexed: 10/21/2022]
Abstract
Consistent associations have been observed between macro-level urban sprawl and overweight/obesity, but whether residential proximity to urban centres predicts adiposity change over time has not been established. Further, studies of local-area walkability and overweight/obesity have generated mixed results. This study examined 4-year change in adults' waist circumference in relation to proximity to city centre, proximity to closest suburban centre, and local-area walkability. Data were from adult participants (n=2080) of a cohort study on chronic conditions and health risk factors in Adelaide, Australia. Baseline data were collected in 2000-03 with a follow-up in 2005-06. Multilevel regression models examined in 2015 the independent and joint associations of the three environmental measures with change in waist circumference, accounting for socio-demographic covariates. On average, waist circumference rose by 1.8cm over approximately 4years. Greater distance to city centre was associated with a greater increase in waist circumference. Participants living in distal areas (20km or further from city centre) had a greater increase in waist circumference (mean increase: 2.4cm) compared to those in proximal areas (9km or less, mean increase: 1.2cm). Counterintuitively, living in the vicinity of a suburban centre was associated with a greater increase in adiposity. Local-area walkability was not significantly associated with the outcome. Residential proximity to city centre appears to be protective against excessive increases in waist circumference. Controlled development and targeted interventions in the urban fringe may be needed to tackle obesity. Additional research needs to assess behaviours that mediate relationships between sprawl and obesity.
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Affiliation(s)
- Takemi Sugiyama
- Institute for Health and Ageing, Australian Catholic University, Melbourne, VIC, Australia; Spatial Epidemiology and Evaluation Research Group, University of South Australia, Adelaide, SA, Australia; Centre for Design Innovation, Faculty of Health Arts & Design, Swinburne University of Technology, Melbourne, VIC, Australia.
| | - Theo Niyonsenga
- Spatial Epidemiology and Evaluation Research Group, University of South Australia, Adelaide, SA, Australia
| | - Natasha J Howard
- Spatial Epidemiology and Evaluation Research Group, University of South Australia, Adelaide, SA, Australia
| | - Neil T Coffee
- Spatial Epidemiology and Evaluation Research Group, University of South Australia, Adelaide, SA, Australia
| | - Catherine Paquet
- Spatial Epidemiology and Evaluation Research Group, University of South Australia, Adelaide, SA, Australia; Research Centre of the Douglas Mental Health University Institute, Verdun, Québec, Canada
| | - Anne W Taylor
- Population Research and Outcome Studies, The University of Adelaide, SA, Australia
| | - Mark Daniel
- Spatial Epidemiology and Evaluation Research Group, University of South Australia, Adelaide, SA, Australia; Department of Medicine, The University of Melbourne, St Vincent's Hospital, Melbourne, VIC, Australia; South Australian Health & Medical Research Institute, Adelaide, SA, Australia
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Carroll SJ, Paquet C, Howard NJ, Coffee NT, Taylor AW, Niyonsenga T, Daniel M. Local descriptive norms for overweight/obesity and physical inactivity, features of the built environment, and 10-year change in glycosylated haemoglobin in an Australian population-based biomedical cohort. Soc Sci Med 2016; 166:233-243. [PMID: 27591806 DOI: 10.1016/j.socscimed.2016.08.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/17/2016] [Accepted: 08/19/2016] [Indexed: 01/17/2023]
Abstract
Descriptive norms vary between places. Spatial variation in health-related descriptive norms may predict individual-level health outcomes. Such relationships have rarely been investigated. This study assessed 10-year change in glycosylated haemoglobin (HbA1c) in relation to local descriptive norms for overweight/obesity (n = 1890) and physical inactivity (n = 1906) in models accounting for features of the built environment. HbA1c was measured three times over 10 years for a population-based biomedical cohort of adults in Adelaide, South Australia. Environmental exposures were expressed for cohort participants using 1600 m road-network buffers centred on participants' residential address. Local descriptive norms (prevalence of overweight/obesity [body mass index ≥25 kg/m(2)] and of physical inactivity [<150 min/week]) were aggregated from responses to a separate geocoded population survey. Built environment measures were public open space (POS) availability (proportion of buffer area) and walkability. Separate sets of multilevel models analysed different predictors of 10-year change in HbA1c. Each model featured one local descriptive norm and one built environment variable with area-level education and individual-level covariates (age, sex, employment status, education, marital status, and smoking status). Interactions between local descriptive norms and built environment measures were assessed. HbA1c increased over time. POS availability and local descriptive norms for overweight/obesity and physical inactivity were each associated with greater rates of HbA1c increase. Greater walkability was associated with a reduced rate of HbA1c increase, and reduced the influence of the overweight/obesity norm on the rate of increase in HbA1c. Local descriptive health-related norms and features of the built environment predict 10-year change in HbA1c. The impact of local descriptive norms can vary according to built environment features. Little researched thus far, local descriptive norms may play an important role in the evolution of HbA1c and thus cardiometabolic risk, over time. Further empirical research on local descriptive norms is necessary to understand how residential environments shape chronic disease risk.
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Affiliation(s)
- Suzanne J Carroll
- Spatial Epidemiology and Evaluation Research Group, Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
| | - Catherine Paquet
- Spatial Epidemiology and Evaluation Research Group, Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia; Research Centre of the Douglas Mental Health University Institute, Verdun, Québec, Canada.
| | - Natasha J Howard
- Spatial Epidemiology and Evaluation Research Group, Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
| | - Neil T Coffee
- Spatial Epidemiology and Evaluation Research Group, Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
| | - Anne W Taylor
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia.
| | - Theo Niyonsenga
- Spatial Epidemiology and Evaluation Research Group, Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
| | - Mark Daniel
- Spatial Epidemiology and Evaluation Research Group, Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia; Department of Medicine, The University of Melbourne, St. Vincent's Hospital, Melbourne, Victoria, Australia; South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia.
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Paquet C, Chaix B, Howard NJ, Coffee NT, Adams RJ, Taylor AW, Thomas F, Daniel M. Geographic Clustering of Cardiometabolic Risk Factors in Metropolitan Centres in France and Australia. Int J Environ Res Public Health 2016; 13:ijerph13050519. [PMID: 27213423 PMCID: PMC4881144 DOI: 10.3390/ijerph13050519] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/22/2016] [Accepted: 05/16/2016] [Indexed: 11/16/2022]
Abstract
Understanding how health outcomes are spatially distributed represents a first step in investigating the scale and nature of environmental influences on health and has important implications for statistical power and analytic efficiency. Using Australian and French cohort data, this study aimed to describe and compare the extent of geographic variation, and the implications for analytic efficiency, across geographic units, countries and a range of cardiometabolic parameters (Body Mass Index (BMI) waist circumference, blood pressure, resting heart rate, triglycerides, cholesterol, glucose, HbA1c). Geographic clustering was assessed using Intra-Class Correlation (ICC) coefficients in biomedical cohorts from Adelaide (Australia, n = 3893) and Paris (France, n = 6430) for eight geographic administrative units. The median ICC was 0.01 suggesting 1% of risk factor variance attributable to variation between geographic units. Clustering differed by cardiometabolic parameters, administrative units and countries and was greatest for BMI and resting heart rate in the French sample, HbA1c in the Australian sample, and for smaller geographic units. Analytic inefficiency due to clustering was greatest for geographic units in which participants were nested in fewer, larger geographic units. Differences observed in geographic clustering across risk factors have implications for choice of geographic unit in sampling and analysis, and highlight potential cross-country differences in the distribution, or role, of environmental features related to cardiometabolic health.
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Affiliation(s)
- Catherine Paquet
- Centre for Population Health Research, School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide SA 5001, Australia.
- Research Center of the Douglas Mental Health University Institute, Montréal, QC H4H 1R3, Canada.
| | - Basile Chaix
- Inserm, UMR-S 1136, Pierre Louis Institute of Epidemiology and Public Health, Nemesis Team, Paris 75012, France.
- Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1136, Pierre Louis Institute of Epidemiology and Public Health, Nemesis Team, Paris 75012, France.
| | - Natasha J Howard
- Centre for Population Health Research, School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide SA 5001, Australia.
| | - Neil T Coffee
- Centre for Population Health Research, School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide SA 5001, Australia.
| | - Robert J Adams
- Discipline of Medicine, The University of Adelaide, Adelaide SA 5001, Australia.
| | - Anne W Taylor
- Discipline of Medicine, The University of Adelaide, Adelaide SA 5001, Australia.
| | - Frédérique Thomas
- Centre d'Investigations Préventives et Cliniques, Paris 75116, France.
| | - Mark Daniel
- Centre for Population Health Research, School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide SA 5001, Australia.
- Department of Medicine, The University of Melbourne, St Vincent's Hospital, Melbourne, Fitzroy VIC 3065, Australia.
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Sugiyama T, Howard NJ, Paquet C, Coffee NT, Taylor AW, Daniel M. Do relationships between environmental attributes and recreational walking vary according to area-level socioeconomic status? J Urban Health 2015; 92:253-64. [PMID: 25604935 PMCID: PMC4411313 DOI: 10.1007/s11524-014-9932-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Residents of areas with lower socioeconomic status (SES) are known to be less physically active during leisure time. Neighborhood walkability has been shown to be related to recreational walking equally in low and high SES areas. This cross-sectional study tested whether associations of specific environmental attributes, measured objectively and subjectively, with walking for recreation were moderated by area-level SES. The data of the North West Adelaide Health Study collected in 2007 (n = 1500, mean age 57) were used. Self-reported walking frequency was the outcome of the study. Environmental exposure measures included objectively measured walkability components (residential density, intersection density, land use mix, and net retail area ratio) and perceived attributes (access to destinations, neighborhood esthetics, walking infrastructure, traffic/barriers, and crime safety). Participants' suburbs were categorized into low and high SES areas using an indicator of socioeconomic disadvantage. Low SES areas had lower scores in residential density, neighborhood esthetics, walking infrastructure, traffic/barriers, and crime safety. Recreational walking was associated with residential density, access to destinations, esthetics, traffic/barriers, and crime safety. Effect modification was observed for two attributes (out of nine): residential density was associated with walking only in low SES areas, while walking infrastructure was associated with walking only in high SES areas. The associations of neighborhood environmental attributes with recreational walking were largely consistent across SES groups. However, low SES areas were disadvantaged in most perceived environmental attributes related to recreational walking. Improving such attributes in low SES neighborhoods may help close socioeconomic disparities in leisure time physical activity.
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Affiliation(s)
- Takemi Sugiyama
- Spatial Epidemiology and Evaluation Research Group, Sansom Institute for Health Research & School of Population Health, University of South Australia, Adelaide, SA, 5001, Australia,
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Carroll SJ, Paquet C, Howard NJ, Coffee NT, Adams R, Taylor AW, Niyonsenga T, Daniel M. Contributions of local-area fast-food availability and area-based weight and dietary norms to 10-year change in cardiometabolic risk. Obes Res Clin Pract 2014. [DOI: 10.1016/j.orcp.2014.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Paquet C, Coffee NT, Haren MT, Howard NJ, Adams RJ, Taylor AW, Daniel M. Food environment, walkability, and public open spaces are associated with incident development of cardio-metabolic risk factors in a biomedical cohort. Health Place 2014; 28:173-6. [PMID: 24880234 DOI: 10.1016/j.healthplace.2014.05.001] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 05/01/2014] [Accepted: 05/05/2014] [Indexed: 11/17/2022]
Abstract
We investigated whether residential environment characteristics related to food (unhealthful/healthful food sources ratio), walkability and public open spaces (POS; number, median size, greenness and type) were associated with incidence of four cardio-metabolic risk factors (pre-diabetes/diabetes, hypertension, dyslipidaemia, abdominal obesity) in a biomedical cohort (n=3205). Results revealed that the risk of developing pre-diabetes/diabetes was lower for participants in areas with larger POS and greater walkability. Incident abdominal obesity was positively associated with the unhealthful food environment index. No associations were found with hypertension or dyslipidaemia. Results provide new evidence for specific, prospective associations between the built environment and cardio-metabolic risk factors.
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Affiliation(s)
- Catherine Paquet
- Spatial Epidemiology and Evaluation Research Group, School of Population Health, Sansom Institute for Health Research, City East Campus, University of South Australia, Internal Post Code CWE-48, GPO Box 2471, Adelaide 5001, SA, Australia; Research Centre of the Douglas Mental Health University Institute, Verdun, QC, Canada H4H 1R2.
| | - Neil T Coffee
- Spatial Epidemiology and Evaluation Research Group, School of Population Health, Sansom Institute for Health Research, City East Campus, University of South Australia, Internal Post Code CWE-48, GPO Box 2471, Adelaide 5001, SA, Australia.
| | - Matthew T Haren
- Spatial Epidemiology and Evaluation Research Group, School of Population Health, Sansom Institute for Health Research, City East Campus, University of South Australia, Internal Post Code CWE-48, GPO Box 2471, Adelaide 5001, SA, Australia.
| | - Natasha J Howard
- Spatial Epidemiology and Evaluation Research Group, School of Population Health, Sansom Institute for Health Research, City East Campus, University of South Australia, Internal Post Code CWE-48, GPO Box 2471, Adelaide 5001, SA, Australia.
| | - Robert J Adams
- The Health Observatory, Discipline of Medicine, The University of Adelaide, Adelaide 5005, SA, Australia.
| | - Anne W Taylor
- Population Research and Outcome Studies, Discipline of Medicine, The University of Adelaide, Adelaide 5005, SA, Australia.
| | - Mark Daniel
- Spatial Epidemiology and Evaluation Research Group, School of Population Health, Sansom Institute for Health Research, City East Campus, University of South Australia, Internal Post Code CWE-48, GPO Box 2471, Adelaide 5001, SA, Australia; Department of Medicine, The University of Melbourne, St Vincent's Hospital, Melbourne 3065, VIC, Australia; Discipline of Medicine, The University of Adelaide, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide 5001, SA, Australia.
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Sugiyama T, Paquet C, Howard NJ, Coffee NT, Taylor AW, Adams RJ, Daniel M. Public open spaces and walking for recreation: moderation by attributes of pedestrian environments. Prev Med 2014; 62:25-9. [PMID: 24518008 DOI: 10.1016/j.ypmed.2014.01.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/28/2014] [Accepted: 01/31/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined whether attributes of pedestrian environments moderate the relationships between access to public open spaces (POS) and adults' recreational walking. METHODS Data were collected from participants of the North West Adelaide Health Study in 2007. Recreational walking was determined using self-reported walking frequency. Measures of POS access (presence, count, and distance to the nearest POS) were assessed using a Geographic Information System. Pedestrian environmental attributes included aesthetics, walking infrastructure, barrier/traffic, crime concern, intersection density, and access to walking trails. Regression analyses examined whether associations between POS access and recreational walking were moderated by pedestrian environmental attributes. RESULTS The sample included 1574 participants (45% men, mean age: 55). POS access measures were not associated with recreational walking. However, aesthetics, walking infrastructure, and access to walking trail were found to moderate the POS-walking relationships. The presence of POS was associated with walking among participants with aesthetically pleasing pedestrian environments. Counter-intuitively, better access to POS was associated with recreational walking for those with poorer walking infrastructure or no access to walking trails. CONCLUSION Local pedestrian environments moderate the relationships between access to POS and recreational walking. Our findings suggest the presence of complex relationships between POS availability and pedestrian environments.
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Affiliation(s)
- Takemi Sugiyama
- Spatial Epidemiology and Evaluation Research Group, Sansom Institute for Health Research, School of Population Health, University of South Australia, Adelaide, Australia.
| | - Catherine Paquet
- Spatial Epidemiology and Evaluation Research Group, Sansom Institute for Health Research, School of Population Health, University of South Australia, Adelaide, Australia; Research Centre of the Douglas Mental Health University Institute, Canada
| | - Natasha J Howard
- Spatial Epidemiology and Evaluation Research Group, Sansom Institute for Health Research, School of Population Health, University of South Australia, Adelaide, Australia
| | - Neil T Coffee
- Spatial Epidemiology and Evaluation Research Group, Sansom Institute for Health Research, School of Population Health, University of South Australia, Adelaide, Australia
| | - Anne W Taylor
- Discipline of Medicine, The University of Adelaide, Australia
| | - Robert J Adams
- Discipline of Medicine, The University of Adelaide, Australia
| | - Mark Daniel
- Spatial Epidemiology and Evaluation Research Group, Sansom Institute for Health Research, School of Population Health, University of South Australia, Adelaide, Australia; Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Australia
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Carroll SJ, Paquet C, Howard NJ, Adams RJ, Taylor AW, Daniel M. Validation of continuous clinical indices of cardiometabolic risk in a cohort of Australian adults. BMC Cardiovasc Disord 2014; 14:27. [PMID: 24571233 PMCID: PMC3976083 DOI: 10.1186/1471-2261-14-27] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 02/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Indicators of cardiometabolic risk typically include non-clinical factors (e.g., smoking). While the incorporation of non-clinical factors can improve absolute risk prediction, it is impossible to study the contribution of non-clinical factors when they are both predictors and part of the outcome measure. Metabolic syndrome, incorporating only clinical measures, seems a solution yet provides no information on risk severity. The aims of this study were: 1) to construct two continuous clinical indices of cardiometabolic risk (cCICRs), and assess their accuracy in predicting 10-year incident cardiovascular disease and/or type 2 diabetes; and 2) to compare the predictive accuracies of these cCICRs with existing risk indicators that incorporate non-clinical factors (Framingham Risk Scores). METHODS Data from a population-based biomedical cohort (n = 4056) were used to construct two cCICRs from waist circumference, mean arteriole pressure, fasting glucose, triglycerides and high density lipoprotein: 1) the mean of standardised risk factors (cCICR-Z); and 2) the weighted mean of the two first principal components from principal component analysis (cCICR-PCA). The predictive accuracies of the two cCICRs and the Framingham Risk Scores were assessed and compared using ROC curves. RESULTS Both cCICRs demonstrated moderate accuracy (AUCs 0.72 - 0.76) in predicting incident cardiovascular disease and/or type 2 diabetes, among men and women. There were no significant differences between the predictive accuracies of the cCICRs and the Framingham Risk Scores. CONCLUSIONS cCICRs may be useful in research investigating associations between non-clinical factors and health by providing suitable alternatives to current risk indicators which include non-clinical factors.
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Affiliation(s)
- Suzanne J Carroll
- Spatial Epidemiology and Evaluation Research Group, School of Population Health and Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia.
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Howard NJ, Hugo GJ, Taylor AW, Wilson DH. Our perception of weight: Socioeconomic and sociocultural explanations. Obes Res Clin Pract 2013; 2:71-142. [PMID: 24351731 DOI: 10.1016/j.orcp.2008.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 03/12/2008] [Accepted: 03/12/2008] [Indexed: 11/18/2022]
Abstract
SUMMARY OBJECTIVE To compare self-reported perception of weight with biomedically measured body mass index in different socioeconomic and cultural groups. METHOD Of the original North West Adelaide Health (Cohort) Study (n = 4060) 68.5% (n = 2780) underwent a computer assisted telephone interview (CATI) answering additional questions related to their social and health status. The participants were asked "In terms of your weight, do you consider yourself to be… too thin, a little thin, normal weight, a little overweight or very overweight". The self-perception of weight was compared to biomedically measured BMI (body mass index). Binary logistic regression was used to compare those participants who were obese (BMI ≥ 30) with the self-perceived weight status of 'a little overweight'. The outcome measures included the Socioeconomic Indexes for Areas Index of Relative Socioeconomic Disadvantage (SEIFA IRSD), country of birth and household income. RESULTS Of those that were underestimating their obese weight status, 41.5% were male and 32.2% female. The highest misclassification was for those who considered their weight to be 'a little overweight', with 59.6% biomedically measured with a BMI of over 30. The odds of being biomedically measured obese (BMI ≥ 30) were compared to those who considered themselves to be 'a little overweight'. Those that misreported their weight status and were biomedically obese, were more likely to be living in the lowest quintile of disadvantage, have a household income of less then $20,000 or be born in Eastern or Western Europe. CONCLUSION There are psychosocial, sociocultural and social environmental influences related to the perception of weight status. Future research will need to understand the processes whereby people are not aware they have a weight problem.
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Affiliation(s)
- Natasha J Howard
- Discipline of Medicine, The University of Adelaide, Adelaide, SA, Australia.
| | - Graeme J Hugo
- Discipline of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Anne W Taylor
- Discipline of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - David H Wilson
- Discipline of Medicine, The University of Adelaide, Adelaide, SA, Australia
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Ngo AD, Paquet C, Howard NJ, Coffee NT, Adams R, Taylor A, Daniel M. Area-level socioeconomic characteristics and incidence of metabolic syndrome: a prospective cohort study. BMC Public Health 2013; 13:681. [PMID: 23886070 PMCID: PMC3733986 DOI: 10.1186/1471-2458-13-681] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 07/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The evidence linking socioeconomic environments and metabolic syndrome (MetS) has primarily been based on cross-sectional studies. This study prospectively examined the relationships between area-level socioeconomic position (SEP) and the incidence of MetS. METHODS A prospective cohort study design was employed involving 1,877 men and women aged 18+ living in metropolitan Adelaide, Australia, all free of MetS at baseline. Area-level SEP measures, derived from Census data, included proportion of residents completing a university education, and median household weekly income. MetS, defined according to International Diabetes Federation, was ascertained after an average of 3.6 years follow up. Associations between each area-level SEP measure and incident MetS were examined by Poisson regression Generalised Estimating Equations models. Interaction between area- and individual-level SEP variables was also tested. RESULTS A total of 156 men (18.7%) and 153 women (13.1%) developed MetS. Each percentage increase in the proportion of residents with a university education corresponded to a 2% lower risk of developing MetS (age and sex-adjusted incidence risk ratio (RR)=0.98; 95% confidence interval (CI) =0.97-0.99). This association persisted after adjustment for individual-level income, education, and health behaviours. There was no significant association between area-level income and incident MetS overall. For the high income participants, however, a one standard deviation increase in median household weekly income was associated with a 29% higher risk of developing MetS (Adjusted RR=1.29; 95%CI=1.04-1.60). CONCLUSIONS While area-level education was independently and inversely associated with the risk of developing MetS, the association between area-level income and the MetS incidence was modified by individual-level income.
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Affiliation(s)
- Anh D Ngo
- Social Epidemiology and Evaluation Research Group, Sansom Institute for Health Research, and School of Population Health, University of South Australia, Adelaide 5001, Australia
- Social Epidemiology and Evaluation Research Group, Sansom Institute for Health Research, and School of Population Health, University of South Australia, P4-18F, Playford Building, City East Campus, Adelaide 5000, Australia
| | - Catherine Paquet
- Social Epidemiology and Evaluation Research Group, Sansom Institute for Health Research, and School of Population Health, University of South Australia, Adelaide 5001, Australia
- Research Centre of the Douglas Mental Health University Institute, Verdun, Québec H4H 1R2, Canada
| | - Natasha J Howard
- Social Epidemiology and Evaluation Research Group, Sansom Institute for Health Research, and School of Population Health, University of South Australia, Adelaide 5001, Australia
| | - Neil T Coffee
- Social Epidemiology and Evaluation Research Group, Sansom Institute for Health Research, and School of Population Health, University of South Australia, Adelaide 5001, Australia
| | - Robert Adams
- Population Research and Outcome Studies, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Anne Taylor
- The Health Observatory, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Mark Daniel
- Social Epidemiology and Evaluation Research Group, Sansom Institute for Health Research, and School of Population Health, University of South Australia, Adelaide 5001, Australia
- Department of Medicine, The University of Melbourne, St Vincent’s Hospital, Melbourne, Victoria 3065, Australia
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Shanti B, Silink M, Bhattacharya K, Howard NJ, Carpenter K, Fietz M, Clayton P, Christodoulou J. Congenital disorder of glycosylation type Ia: heterogeneity in the clinical presentation from multivisceral failure to hyperinsulinaemic hypoglycaemia as leading symptoms in three infants with phosphomannomutase deficiency. J Inherit Metab Dis 2009; 32 Suppl 1:S241-51. [PMID: 19396570 DOI: 10.1007/s10545-009-1180-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 03/14/2009] [Accepted: 03/18/2009] [Indexed: 11/30/2022]
Abstract
We describe three patients with congenital disorder of glycosylation (CDG) type Ia, all of whom had persistent hyperinsulinaemic hypoglycaemia responding to diazoxide therapy as a common feature. The first patient, an infant girl, presented with recurrent vomiting, failure to thrive, liver impairment, hypothyroidism and a pericardial effusion. The second patient, also female, had a milder disease with single organ involvement, presenting as isolated hyperinsulinaemic hypoglycaemia, not associated with any cognitive impairment. The third patient, a boy presented with multi-organ manifestations including congenital hypothyroidism, persistent hyperinsulinaemic hypoglycaemia, coagulopathy, olivopontocerebellar hypoplasia and recurrent pancreatitis. All three patients had a type 1 serum transferrin isoform pattern, and were subsequently found to have low phosphomannomutase activity, confirming the diagnosis of CDG type Ia. Our findings emphasize that CDG should be considered as a differential diagnosis in patients with persistent hyperinsulinaemic hypoglycaemia and that it may even occasionally be the leading symptom in CDG Ia.
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Affiliation(s)
- B Shanti
- Genetic Metabolic Disorders Service, Children's Hospital at Westmead, Sydney, Australia
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Howard NJ, Taylor AW, Gill TK, Chittleborough CR. Severe obesity: Investigating the socio-demographics within the extremes of body mass index. Obes Res Clin Pract 2008; 2:I-II. [DOI: 10.1016/j.orcp.2008.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Revised: 01/14/2008] [Accepted: 01/14/2008] [Indexed: 01/22/2023]
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Cowell CT, Quigley CA, Moore B, Kirk JA, Bergin M, Jimenez M, Stevens MM, Howard NJ, Menser MA, Silink M. Growth and growth hormone therapy of children treated for leukaemia. Acta Paediatr Scand Suppl 2008; 343:152-61. [PMID: 3195330 DOI: 10.1111/j.1651-2227.1988.tb10816.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A total of 37 children (24 male, 13 female) who had been treated for leukaemia with chemotherapy and 24 Gy cranial irradiation, and who were disease free for at least 18 months, were commenced on somatrem at a mean of 7.6 years (range, 4.8-12.1 years) after leukaemia diagnosis because of growth rate below the 25th centile for bone age. Peak GH response to provocation (exercise, arginine, insulin hypoglycaemia) was less than 20 milliunits/litre in 27 children (deficient group) and 20 milliunits/litre or more in 10 children (non-deficient group). The mean height SD decrease from diagnosis of leukaemia to commencement of somatrem was 1.98, 86% of the children decreasing by more than 1 SD. Those who were tall for age at leukaemia diagnosis and females were more severely affected. Mean (+/- SD) height velocity increased on somatrem from 2.7 +/- 1.1 to 6.6 +/- 2.2 cm/year during the first 6 months (n = 25), and to 6.0 +/- 1.7 cm/year during the first 12 months (n = 19). No difference in growth response was seen between the sexes or between the deficient and non-deficient groups. Catch-up growth occurred for the first 6 months only. It is concluded that children with a low growth rate after treatment of leukaemia should be considered for GH therapy irrespective of the results of GH provocative tests.
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Affiliation(s)
- C T Cowell
- Institute of Endocrinology, Children's Hospital, Camperdown, Sydney, Australia
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Donaghue KC, Craig ME, Chan AKF, Fairchild JM, Cusumano JM, Verge CF, Crock PA, Hing SJ, Howard NJ, Silink M. Prevalence of diabetes complications 6 years after diagnosis in an incident cohort of childhood diabetes. Diabet Med 2005; 22:711-8. [PMID: 15910621 DOI: 10.1111/j.1464-5491.2005.01527.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To examine the prevalence of early diabetes complications 6 years after diagnosis of diabetes. The hypothesis that initial contact with a multidisciplinary team would be associated with a reduced risk of microvascular complications was tested in this cohort. METHODS Participants were recruited from an incident cohort of children aged < 15 years diagnosed between 1990 and 1992 in NSW, Australia. Initial management at a teaching hospital was documented at case notification. At 6 years, health care questionnaires and complications were assessed: retinopathy by 7-field stereoscopic retinal photography and elevated albumin excretion rate (AER) defined as the median of three overnight urine collections > or = 7.5 microg/min. Case attainment was 58% (209/361) with participants younger than non-participants and more likely living in an urban than rural location. RESULTS Retinopathy was present in 24%, median AER > or = 7.5 microg/min in 18%, and median AER > or = 20 microg/min in 2%. In multivariate analysis, initial management at a teaching hospital or consultation with all three allied health professionals combined with pubertal staging and cholesterol or HbA1c were all determinants of risk for retinopathy. CONCLUSIONS Early retinopathy and elevated AER are common in children 6 years after diagnosis. Initial allied health contact and management at a teaching hospital were associated with a reduced risk of microvascular complications in this cohort.
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Affiliation(s)
- K C Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, NSW, Australia.
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Fairchild JM, Ambler GR, Genoud-Lawton CH, Westman EA, Chan A, Howard NJ, Crock PA, Nunn EA, Silink M. Insulin lispro versus regular insulin in children with type 1 diabetes on twice daily insulin. Pediatr Diabetes 2000; 1:135-41. [PMID: 15016224 DOI: 10.1034/j.1399-5448.2000.010304.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare the clinical efficacy and safety of insulin lispro with regular insulin in 5- to 10-yr-old prepubertal children on twice daily insulin. RESEARCH DESIGN AND METHODS Thirty-five children (16 M, 19 F) completed an open-label randomised crossover study, with each child receiving insulin lispro for 3 months and regular insulin for 3 months in addition to their intermediate-acting insulin. Families were instructed to give regular insulin 30 min before meals and insulin lispro immediately before meals. Glycaemic control was monitored by eight-point blood glucose profiles and six weekly hemoglobin A1cs (HbA1cs) and the frequency and severity of hypoglycaemia was documented. RESULTS The endpoint HbA1c after 3 months on insulin lispro (8.33%, SD+/-0.89) was not significantly different to that on regular insulin (8.14%, SD+/-0.77). No significant differences were found in blood glucose levels before or after meals, 2-h postprandial glucose excursions or in blood glucose levels before bed between the treatments. However, blood glucose levels at 3 am were significantly lower on regular insulin than on insulin lispro (mean difference -2.35 mmol/L (95%CI: -3.98, -0.72, p=0.01). There was no significant difference in the frequency of hypoglycaemic episodes between the groups. CONCLUSIONS The main advantage of insulin lispro in children on twice daily insulin was found to be its greater convenience, this being achieved without a deterioration in glycaemic control. The higher 3 am blood glucose levels in those on insulin lispro could translate to reduced nocturnal hypoglycaemia in some individuals.
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Affiliation(s)
- J M Fairchild
- The Ray Williams Institute of Paediatric Endocrinology, Diabetes and Metabolism, The New Children's Hospital, Westmead, Parramatta, NSW, Australia.
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Abstract
OBJECTIVES 1. To determine the incidence of type 1 (insulin dependent) diabetes in children aged 0-14 years who were resident in the state of New South Wales, Australia over the period 1992-1996. 2. To analyse the trends in incidence over the period 1990-1996. METHODS Primary ascertainment of patients was performed using a prospective incidence register established in 1990. The secondary source of ascertainment was the National Diabetes Supply Scheme, a government subsidised scheme for diabetic supplies. RESULTS There were 1,230 patients identified over the five-year period. Using the capture-recapture method, ascertainment was estimated to be 99% complete. The lowest incidence occurred in 1992 (16.9 per 10(5) person years) and the highest incidence was in 1995 (21.7 per 10(5)). The crude incidence of IDDM from 1990-1996 was 17.8 per 10(5) and there was a statistically significant rise in the incidence of type 1 diabetes over this period (p=0.0003). The annual incidence has increased on average by 3.2% per year since 1990. CONCLUSION The incidence of childhood type 1 diabetes in NSW has increased significantly since 1990.
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Affiliation(s)
- M E Craig
- Ray Williams Institute of Paediatric Endocrinology, Diabetes and Metabolism, Royal Alexandra Hospital for Children, Sydney, NSW, Australia
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Abstract
Results are presented of diabetes complication screening in children and adolescents aged 6-20 years. Their diabetes duration was 0.02-18.4 yr and median HbA1c over the preceding 36 months was 8.4% [IQR 7.8-9.3]. Gradable retinal photographs were obtained in 937: 110 less than 11 years (< 11 yr Gp). Albumin excretion rate (AER) was obtained from 3 timed overnight urine collections in 691: 100 in < 11 yr Gp. Early retinopathy was found in 27% (9% in < 11 yr Gp). Microalbuminuria (AER > or = 20 micrograms/min) was found in 4%. Significant individual risk factors for both complications were higher blood pressure, cholesterol, HbA1c, pubertal staging, older age and longer diabetes duration. Using multiple logistic regression, significant risk factors for retinopathy were longer duration and older age and in addition higher HbA1c. Diabetes complication screening detected early subclinical disease in children and adolescents who may benefit from lowering blood pressure and improving metabolic control. Screening should commence after five years of duration in young children, and after two years of duration in adolescents.
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Affiliation(s)
- K C Donaghue
- Ray Williams Institute of Paediatric Endocrinology, Diabetes and Metabolism, Royal Alexandra Hospital for Children, Westmead, NSW, Australia
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Abstract
AIMS Limited joint mobility (LJM) in the foot has not been assessed in adolescents with Type 1 diabetes mellitus (DM) but is associated with neuropathic ulceration in adults. This study was designed to determine the presence of LJM in adolescents with Type 1 DM and its association with microvascular disease. METHODS The hands, feet and hips were examined in 302 diabetic adolescents and 51 nondiabetic controls (aged 11.5-20 years). LJM was defined as less than the fifth percent reference for controls. RESULTS Reduced motion was found in 35% of diabetic adolescents at the subtalar (ST) joint, 18% at the first metatarsophalangeal (MTP) joint, 26% at the fifth metacarpophalangeal (MCP) joint and 13% had limited passive extension of the interphalangeal (IP) joints of the hands. Limited passive IP joint extension of the hands was not present in the controls. Limited active IP joint extension, a positive 'prayer sign', occurred in 35% of diabetic adolescents and 14% of controls. Diabetic adolescents showing LJM in any of these areas, except the prayer sign, were more likely to have retinopathy (odds ratio 2.53, CI: 1.53-4.18). Those with LJM in the foot were more likely to have albumin excretion rates >7.5 microg/min (OR 2.06, CI: 1.16-3.68). CONCLUSION LJM in the feet of adolescents with Type 1 DM is associated with microvascular disease and is a useful routine clinical measure.
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Crock PA, McKenzie JD, Nicoll AM, Howard NJ, Cutfield W, Shield LK, Byrne G. Benign intracranial hypertension and recombinant growth hormone therapy in Australia and New Zealand. Acta Paediatr 1998; 87:381-6. [PMID: 9628291 DOI: 10.1080/08035259850156940] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Benign intracranial hypertension (BIH) is reported in three children from Australia and one from New Zealand, who were being treated with recombinant human growth hormone (rhGH). Three males and one female, aged between 10.5 and 14.2 y, developed intracranial hypertension within 2 weeks to 3 months of starting treatment. A national database, OZGROW, has been prospectively collecting data on all 3332 children treated with rhGH in Australia and New Zealand from January 1986 to 1996. The incidence of BIH in children treated with growth hormone (GH) is small, 1.2 per 1000 cases overall, but appears to be greater with biochemical GHD (<10 IU ml(-1)), i.e. 6.5/1000 (3 in 465 cases), relative risk 18.4, 95% confidence interval 1.9-176.1, than in all other children on the database. The incidence in patients with Turner's syndrome was 2.3/1000 (1 in 428 cases). No cases in patients with partial GHD (10-20 IU ml(-1)) or chronic renal failure were identified. Possible causative mechanisms are discussed. The authors' practice is now to start GH replacement at less than the usual recommended dose of 14 IU m(-2) week(-1) in those children considered to be at high risk of developing BIH. Ophthalmological evaluation is recommended for children before and during the first few months following commencement of rhGH therapy and is mandatory in the event of peripheral or facial oedema, persistent headaches, vomiting or visual symptoms. The absence of papilloedema does not exclude the diagnosis.
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Affiliation(s)
- P A Crock
- Department of Paediatric Endocrinology, John Hunter Children's Hospital, Newcastle, NSW, Australia
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Abstract
These are the baseline findings of a group of 68 prepubertal children enrolled in a longitudinal study of the development of early diabetes microvascular complications prior to gonadarche. The median age of the children was 9.8 years, the median diabetes duration 3.6 years and the mean HbA1c 8.4%. Mild nonproliferative retinopathy was present in 6 of 67 (9%) children, assessed by 7-field stereoscopic fundus photography. Those with retinopathy had higher total cholesterol (p < 0.05) and lower DHEAS (p < 0.01). Albumin excretion rate (AER) was calculated as the mean of three overnight consecutive urine collections. AER > 7.5 micrograms/min was present in 5 of 64 (8%), and one boy had a mean AER > 15 micrograms/min. Those with AER > 7.5 micrograms/min had higher diastolic blood pressure and diastolic blood pressure percentiles (p < 0.05). Longitudinal study of this cohort will establish which factors in the prepubertal years are important for the development of diabetes microvascular complications.
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Affiliation(s)
- K C Donaghue
- Ray Williams Institute of Paediatric Endocrinology, Diabetes and Metabolism, Royal Alexandra Hospital for Children, Westmead, NSW, Australia
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Donaghue KC, Fung AT, Hing S, Fairchild J, King J, Chan A, Howard NJ, Silink M. The effect of prepubertal diabetes duration on diabetes. Microvascular complications in early and late adolescence. Diabetes Care 1997; 20:77-80. [PMID: 9028699 DOI: 10.2337/diacare.20.1.77] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To define the significance of prepubertal diabetes duration in the development of diabetic microvascular complications in adolescents. RESEARCH DESIGN AND METHODS Study A compares complications in 38 prepubertal (PreP) and 140 pubertal (Pub) subjects of the same age (10-14 years) and diabetes duration (3-12 years) to determine if the absence of puberty itself confers a lower risk of complications. Study B examines the importance of prepubertal and pubertal diabetes duration in 193 older adolescents (ages 15-22 years) with prepubertal onset of diabetes. Retinopathy status was assessed using stereoscopic fundus photography of seven fields per eye. Albumin excretion rate (AER) was assessed by three consecutive overnight urine collections, using a polyclonal radioimmunoassay. RESULTS In study A, there were no significant differences between the PreP and Pub groups for retinopathy (27 vs. 29%, P = 0.8) or differences in elevated AER (17 vs. 31%, P = 0.1). In study B, longer prepubertal diabetes duration improved the prediction for retinopathy over postpubertal duration alone (P < 0.0005). No relationship with duration was found for elevated AER (> 7.5, > 15, and > 30 micrograms/min). CONCLUSIONS Prepubertal subjects with diabetes did not have less retinopathy or elevated albumin excretion compared with pubertal subjects of the same age. Prepubertal diabetes duration is significantly related to the presence of retinopathy in adolescents.
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Affiliation(s)
- K C Donaghue
- Ray Williams Institute of Paediatric Endocrinology, Diabetes and Metabolism, Royal Alexandra Hospital for Children, Westmead, Australia.
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Schwingshandl J, Donaghue KC, Fung AT, Pena MM, Bonney MA, Howard NJ, Silink M. Vascular responses by transcutaneous oximetry in adolescents with and without diabetes. J Diabetes Complications 1996; 10:18-22. [PMID: 8639969 DOI: 10.1016/1056-8727(94)00053-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The vascular response of the skin was evaluated by transcutaneous oximetry (TcPO2) in the forearm in 119 adolescents with type I diabetes aged 10.4-19.8 (median 15.3) years, with a duration of diabetes 0.7 to 18.3 (median 7.8) years, and 49 nondiabetic adolescents aged 11.3-18.8 (median 15.5) years. Two different vascular stimuli were used: heating of the probe to 43 degrees C and 5 min of ischemia. Baseline TcPO2 after 13 min of equilibration at a probe temperature of 43 degrees C, postischemic maximum TcPO2, and the postischemic TcPO2 increase were significantly lower in the diabetic group compared to the control group (p = 0.0001, p < 0.0001, and p = 0.0001, respectively). In both the diabetic and the control groups, gender differences were found for baseline TcPO2 (p = 0.0001 and p = 0.0009, respectively) and postischemic maximum TcPO2 (p = 0.0001 and p = 0.005, respectively), the girls having consistently higher values. After controlling for gender by multiple linear regression analysis, duration of diabetes showed a significant effect on postischemic maximum TcPO2 (R2 = 22%, p = 0.02). The postischemic TcPO2 increase was not affected by gender. Lower values for the postischemic TcPO2 increase were related to higher GHb values (R2 = 4%, p = 0.03). Abnormal values for oximetry were associated only with some autonomic nerve function abnormalities. Differences in the vascular response to heat and ischemia as measured by transcutaneous oximetry can be demonstrated between adolescents with type I diabetes and nondiabetic controls, as well as between girls and boys. Lower values in diabetic subjects are weakly associated with diabetes duration and metabolic control, independent of gender.
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Affiliation(s)
- J Schwingshandl
- Ray Williams Institute of Paediatric Endocrinology, Diabetes and Metabolism, Royal Alexandra Hospital for Children, Camperdown, Australia
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Abstract
Autonomic and peripheral nerve function were studied prospectively in 102 adolescents with Type 1 diabetes over a 5-year period. All adolescents were assessed three times; 54 were assessed four times. The median age at baseline was 14.5 (range 10.4-18.0) yr. The median diabetes duration at baseline was 6.8 (range 1.3-15.2) yr. Autonomic nerve function was assessed by measuring heart rate variation during deep breathing, valsalva manoeuvre, standing from a lying position (30/15 ratio), and the postural change in systolic blood pressure. Peripheral nerve function was assessed by determining the thermal threshold for heat and cold at the wrist and foot and the vibration threshold at the great toe and medial malleolus. At baseline, 29.5% adolescents had at least one abnormal autonomic nerve test and 28.4% had at least one abnormal peripheral nerve test. There was no significant increase in the number of abnormalities over the study period. Persisting abnormalities were present in only six individuals. Abnormalities were not related to age, diabetes duration or glycaemic control. In summary, a low rate of neurological abnormalities was found, suggesting that more than 3 years of follow-up is required to detect evolving neuropathy in this age group.
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Affiliation(s)
- K C Donaghue
- Ray Williams Institute of Paediatric Endocrinology, Diabetes and Metabolism, Royal Alexandra Hospital for Children, Camperdown, NSW, Australia
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Abstract
The aims of this study were to evaluate short-term changes in retinopathy in adolescents, and to examine the relationship of these changes to risk factors. Two-hundred and three adolescents, with a median age of 14.5 (range 10.4 to 20.6) yr and a median duration of diabetes of 6.6 (1.1 to 16.3) yr, were included in the study. Retinopathy was assessed on two occasions, using stereoscopic fundus photography; the median time between assessment was 1.3 (0.5 to 3.0) yr. At baseline, 41% of the adolescents had background retinopathy. When patients were stratified according to the median diabetes duration (DD) (6.6 yr) and glycaemic control over the 12 months prior to assessment (HbA1C) (8.4%), the percentage of retinopathy in each group was: lowDD/lowHbA1C 13%; lowDD/highHbA1C 40%; highDD/lowHbA1C 42%; and highDD/highHbA1C 72%. Using a 2-step criteria for stability or change in retinopathy, 11% of the 203 adolescents showed progression of retinopathy, 41% had stable retinopathy, 5% showed regression, and 43% had no retinopathy at either assessment. Change in retinopathy was related to age at baseline assessment (borderline significance, p = 0.06), diabetes duration (p < 0.001), glycaemic control (p < 0.001) and total cholesterol (p = 0.04), and was also related to DD/HbA1C group membership (chi 2, p < 0.001). This study highlights the combined adverse effect of long diabetes duration and poor glycaemic control on the development and progression of retinopathy during adolescence, and identifies a group that is likely to show progression over a relatively short period.
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Affiliation(s)
- M Bonney
- Diabetes Complications Assessment Service, Ray Williams Institute of Paediatric Endocrinology, Royal Alexandra Hospital for Children, Sydney, NSW, Australia
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Pena MM, Donaghue KC, Fung AT, Bonney M, Schwingshandl J, Howard NJ, Silink M. The prospective assessment of autonomic nerve function by pupillometry in adolescents with type 1 diabetes mellitus. Diabet Med 1995; 12:868-73. [PMID: 8846676 DOI: 10.1111/j.1464-5491.1995.tb00388.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The study aimed to compare the longitudinal assessment of automatic nerve function by computerized infrared pupillometry and standard cardiovascular tests in adolescents with diabetes. Adolescents (n = 150) were assessed at two time points (T1 and T2). The median time interval between assessments was 1.5 (range 0.9-3) years. At T1 the median age was 14.5 (range 8.3-19.5) years and the median duration was 6.5 (range 1.1-16) years. The pupillary variables assessed included the resting pupil diameter, the maximum constriction velocity, and the reflex amplitude of constriction. Heart rate reflexes were assessed in response to deep breathing, the Valsalva manoeuvre, and on standing from a lying position (30/15 ratio). Between visits there was a significant decrease in maximum constriction velocity (6.0 mm s-1 vs 6.3 mm s-1, p = 0.0001) and resting pupil diameter (6.2 mm vs 6.3 mm, p = 0.001). At reassessment pupillary abnormalities increased from 32 (21%) to 45 (30%), with 17 (54%) of the initial abnormalities persisting. Adolescents with abnormally slow maximum constriction velocity compared to those with normal maximum constriction velocity had a higher glycated haemoglobin (HbA1c%) at T2 (p = 0.02) and between assessments (p = 0.01). Cardiovascular test abnormalities did not increase between visits and the persistence of initial abnormalities was low (21%). In summary, pupillometry appears a more sensitive test of automatic nerve dysfunction in adolescents with diabetes than assessment of cardiovascular reflexes.
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Affiliation(s)
- M M Pena
- Ray Williams Institute of Paediatric Endocrinology, Diabetes and Metabolism, Royal Alexandra Hospital for Children, Camperdown, Australia
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Abstract
OBJECTIVE Previous reports of endocrinological profiles in children presenting with premature adrenarche have not shown consistent abnormalities. We therefore aimed to review the clinical and biochemical aspects of a large number of patients presenting with premature adrenarche without virilization and determine the relation between clinical and biochemical characteristics and the frequency of adrenal steroid disorders. DESIGN AND PATIENTS Eighty-eight patients presenting with adrenarche without virilization during 1985-1992 were retrospectively reviewed. There were 72 girls and 16 boys. All were normotensive and had either prepubertal breasts or testes < 4 ml. In patients with high adrenal androgen levels, adrenal tumours had been excluded by either adrenal ultrasound or CT scan. MEASUREMENT We recorded clinical manifestations, auxological data, bone age, biochemical results including basal 17OH-progesterone (b17OHP), dehydroepiandrosterone sulphate (DHEAS), androstenedione (delta 4A), testosterone, cortisol and stimulated 17OHP and cortisol. ACTH stimulation tests (using soluble Synacthen 250 micrograms intramuscularly and collecting blood at 0, 30 and 60 minutes) were performed when clinically indicated. 17OH-Pregnenolone (17OHPreg) was also measured during ACTH stimulation tests in 13 individuals to look for abnormalities of 3 beta-hydroxysteroid dehydrogenase (3 beta-HSD). RESULTS The age of onset ranged from 3 to 9.5 years (mean 6.8 +/- 1.3). There were no significant differences by sex for height SDS, weight SDS or % ideal body weight, but bone age advancement was greater in males (P < 0.02). The most common presenting clinical manifestation was premature appearance of pubic hair in 93.8%, the other 6.2% presenting with body odour, acne and/or hirsutism. Twelve patients had b17OHP > 6 nmol/l of whom 5 were diagnosed as having congenital adrenal hyperplasia (CAH) resulting from 21-hydroxylase deficiency after ACTH stimulation tests. A further 33 patients who had b17OHP < 6 nmol/l had normal 17OHP and cortisol responses to ACTH stimulation. Patients, after excluding those with CAH, were divided on the basis of their DHEAS levels into prepubertal (< 1.5 mumol/l), pubertal (1.5-6 mumol/l) and above pubertal range (> 6 mumol/l). The 8 patients with DHEAS values above the pubertal range were described as having 'exaggerated adrenarche'. There were no significant clinical differences between these 3 groups, but significant differences were found for bone age advancement and the steroids, b17OHP, delta 4A and testosterone. There was a strong correlation between DHEAS and delta 4A (r = 0.623, P < 0.001). The 'exaggerated adrenarche' group had higher 17 OHPreg/17OHP ratios at 60 minutes after stimulation but these were not diagnostic for 3 beta-HSD deficiency. CONCLUSION The value of assessing basal steroids in children presenting with premature adrenarche is demonstrated in this series with 5.7% being diagnosed with 21-hydroxylase deficiency and 9.1% with 'exaggerated adrenarche'. No relation was found between adrenal steroids and clinical features except for the acceleration of bone age. The relation between 'exaggerated adrenarche' and future ovarian hyperandrogenism needs further evaluation.
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Affiliation(s)
- S Likitmaskul
- Robert Vines Growth Research Centre, Children Hospital, Camperdown, NSW, Australia
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Abstract
OBJECTIVE To identify environmental factors involved in the etiology of insulin-dependent diabetes mellitus (IDDM). RESEARCH DESIGN AND METHODS An estimated 90% of all incident cases of IDDM in patients 0-14 years of age in New South Wales, Australia, were ascertained over 18 months. For each IDDM patient, two age- and sex-matched control subjects were randomly selected from the population. Past environmental exposures were determined with a questionnaire completed by the parents. Response rates were 92% for the IDDM patients (217 of 235) and 55% for the control subjects (258 of 470). The relative risk associated with each exposure was estimated with the odds ratio (OR) adjusted for confounding factors using multiple logistic regression. RESULTS The introduction of cow's milk-based infant formula into the diet before 3 months of age was associated with an increased risk (OR 1.52, 95% confidence interval [CI] 1.04-2.24). Exclusive breast-feeding for > or = 3 months was associated with a protective effect (OR 0.66, 95% CI 0.45-0.97). High dietary intake of cow's milk protein in the 12 months before the onset of diabetic symptoms was also associated with an increased risk (OR 1.84, 95% CI 1.12-3.00). A recent infection (during the 3 months before onset of diabetic symptoms) was more common in the patients than the control subjects (OR 2.92, 95% CI 1.96-4.35), as was day care attendance before the age of 3 (OR 1.73, 95% CI 1.00-3.00). When two age-groups, defined by the median age at onset of diabetes, were compared, the associations with early infant-feeding were stronger among the younger group (< 9.2 years), and associations with recent diet and recent infection were stronger among the older group (> or = 9.2 years). CONCLUSIONS These results indicate an increased risk of IDDM associated with early dietary exposure to cow's milk-containing formula, short duration of exclusive breast-feeding, high intake of cow's milk protein in the recent diet, recent infection, and early attendance at day care.
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Affiliation(s)
- C F Verge
- Ray Williams Institute for Pediatric Endocrinology, Royal Alexandra Hospital for Children, Sydney, Australia
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Verge CF, Howard NJ, Rowley MJ, Mackay IR, Zimmet PZ, Egan M, Hulinska H, Hulinsky I, Silvestrini RA, Kamath S. Anti-glutamate decarboxylase and other antibodies at the onset of childhood IDDM: a population-based study. Diabetologia 1994; 37:1113-20. [PMID: 7867883 DOI: 10.1007/bf00418375] [Citation(s) in RCA: 84] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Sera obtained at diagnosis from 273 children (0-14 years) with insulin-dependent diabetes mellitus (IDDM) were studied to compare different autoantibody levels. The subjects comprise 75% of all incident cases in New South Wales, Australia, for a 2-year period (ascertainment > 99% complete). Antibodies against glutamate decarboxylase were measured by radioimmunoprecipitation, insulin autoantibodies (on 176 sera collected within 4 days of initiation of insulin therapy) by radioimmunoassay, thyroid peroxidase and antigliadin IgA antibodies by enzyme-linked immunoassay, and anti-endomysial IgA and islet cell antibodies by indirect immunofluorescence. Reference ranges for anti-glutamate decarboxylase and insulin autoantibodies were determined in a group of non-diabetic children. Of the sera 69% were positive for anti-glutamate decarboxylase, 65% for insulin autoantibodies, 71% for islet cell antibodies (> or = 20 Juvenile Diabetes Foundation units), 10% for anti-thyroid peroxidase, 2.6% for antigliadin and 3.0% for anti-endomysial antibodies. Islet cell antibodies and insulin autoantibodies were both negative in 13.7% of the sera, while only 5.8% were negative for all three of islet cell antibodies, insulin autoantibodies and anti-glutamate decarboxylase. There was a higher frequency of anti-glutamate decarboxylase among girls than boys (75% vs 63%, p = 0.03) and a negative correlation between the level of insulin autoantibodies and age at diagnosis (r = -0.41, p < 0.0001). A higher frequency of antithyroid peroxidase was found with increasing age (p = 0.05). Higher titres of islet cell antibodies were associated with a higher frequency of both anti-glutamate decarboxylase (p < 0.0001) and insulin autoantibodies (p = 0.003).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C F Verge
- Ray Williams Institute for Paediatric Endocrinology, Royal Alexandra Hospital for Children, Sydney, Australia
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Abstract
OBJECTIVE To determine the incidence of insulin-dependent diabetes mellitus (IDDM) in children 0-14 years of age in the state of New South Wales, Australia, which has a total population of 5.73 million. RESEARCH DESIGN AND METHODS We established a prospective register, identifying 361 incident cases over a 2-year period (1990-1991) with two independent sources of case ascertainment. The primary source was the reporting of newly diagnosed patients by physicians and diabetes educators. The secondary source was a subsidized syringe scheme. RESULTS Using the capture-recapture method, ascertainment was estimated to be 99.4% complete. The age-standardized incidence rate was 14.5 per 100,000 person-years (95% confidence interval: 13.0-16.0). No significant differences were found when comparing the first and second years of the register, boys and girls, geographical areas, or Aboriginal and non-Aboriginal children. There was seasonal variation in the onset (with more cases in winter), which was evident in the 10- to 14-year age-group (P = 0.01), but not in younger age-groups. A first-degree relative was already affected in 6.9% of the cases. No significant difference was noted in the age at onset when comparing cases with and without an affected first-degree relative. CONCLUSIONS The incidence of childhood IDDM in New South Wales is similar to rates found in other predominantly Anglo-Saxon populations. IDDM occurs in Aboriginal children with a frequency comparable to that in the rest of the population.
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Affiliation(s)
- C F Verge
- Ray Williams Institute for Pediatric Endocrinology, Royal Alexandra Hospital for Children, Sydney, Australia
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Fairchild JM, Hing SJ, Donaghue KC, Bonney MA, Fung AT, Stephens MM, Mitchell P, Howard NJ, Silink M. Prevalence and risk factors for retinopathy in adolescents with type 1 diabetes. Med J Aust 1994; 160:757-62. [PMID: 8208191 DOI: 10.5694/j.1326-5377.1994.tb125943.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To establish the prevalence of, and risk factors associated with, diabetic retinopathy in an Australian adolescent diabetes clinic population. DESIGN A prospective longitudinal study; baseline findings. PATIENTS Two hundred and fifty-five patients with Type 1 (insulin-dependent) diabetes mellitus assessed by our service were studied. Entry criteria were: age 11.0-19.9 years; diabetes duration of at least two years; and gradable fundus photographs of at least one eye. MAIN OUTCOME MEASURES The presence and severity of retinopathy, as assessed by the grading of stereoscopic fundus photographs. Possible risk factors assessed were age, sex, diabetes duration, pubertal stage, blood pressure, glycaemic control and total cholesterol level. RESULTS The prevalence of retinopathy was 42%; all of those affected had mild background retinopathy. Highly significant associations were found with glycaemic control and both total and prepubertal duration of diabetes. No associations were found with age, sex, pubertal stage, blood pressure or total cholesterol level. CONCLUSIONS The high prevalence of early diabetic retinopathy in this group of Australian adolescents is comparable to recent reports from other centres. The significant associations with glycaemic control and duration of diabetes provide further strong evidence for the benefit of optimal glycaemic control during adolescence. Our finding that the prepubertal years of diabetes contribute to the development of retinopathy suggests that glycaemic control before puberty should also be optimised. The planned follow-up of this cohort will establish the risk of progression to vision-threatening retinopathy and allow risk factors to be further evaluated.
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Affiliation(s)
- J M Fairchild
- Diabetes Complications Assessment Service, Ray Williams Institute of Paediatric Endocrinology, Children's Hospital, Camperdown, NSW
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