Kidney and related chronic disease profiles and risk factors in three remote Australian Aboriginal communities

Morbidities and deaths from noncommunicable chronic diseases are greatly increased in remote Australian Aboriginal communities, but little is known of the underlying community-based health profiles. We describe chronic-disease profiles and their risk factors in 3 remote communities in the Northern Territory. Consenting adults (18+ years of age) in 3 communities participated in a brief history and examination between 2000 and mid-2003 as part of a systematic program to improve chronic-disease awareness and management. Participation was 67%,128%, and 62% in communities A, B, and C, respectively with a total of 1070 people examined. Current smokers included 41% of females and 72% of males. Most men were current drinkers, but most women were not. Parameters of body weight differed markedly by community, with mean body mass index (BMC) varying from 21.4 to 27.9 kg/m(2). Rates of chronic diseases were excessive but differed markedly; an almost threefold difference in the likelihood of any morbidity existed between communities A and C. Rates increased with age, but the greatest numbers of people with morbidities were in the middle-aged group. Most people had multiple morbidities with tremendous overlap. Hypertension and kidney disease appear to be early manifestations of the integrated chronic-disease syndrome, while diabetes is a late manifestation or complication. Substantial numbers of new cases of disease were identified by testing, and blood pressure improved in treated people with hypertension. Wide variations occur in body habitus, risk factors, and chronic-disease rates among communities, but an overwhelming need for effective smoking interventions exists in all. Systematic screening is useful in identifying high-risk individuals, most at early treatable stages there. Findings are very important for estimating current treatment needs, future burdens of disease, and for needs-based health services planning. Resources required will vary according to the burden of disease. (C) 2005 by the National Kidney Foundation, Inc.

Cost-effectiveness analysis of a kidney and cardiovascular disease treatment program in an Australian aboriginal population

The objective of the study was to assess, from a health service perspective, whether a systematic program to modify kidney and cardiovascular disease reduced the costs of treating end-stage kidney failure. The participants in the study were 1,800 aboriginal adults with hypertension, diabetes with microalbuminuria or overt albuminuria, and overt albuminuria, living on two islands in the Northern Territory of Australia during 1995 to 2000. Perindopril was the primary treatment agent, and other medications were also used to control blood pressure. Control of glucose and lipid levels were attempted, and health education was offered. Evaluation of program resource use and costs for follow-up periods was done at 3 and 4.7 years. On an intention-to-treat basis, the number of dialysis starts and dialysis-years avoided were estimated by comparing the fate of the treatment group with that of historical control subjects, matched for disease severity, who were followed in the before the treatment program began. For the first three years, an estimated 11.6 person-years of dialysis were avoided, and over 4.7 years, 27.7 person-years of dialysis were avoided. The net cost of the program was $1,210 more per person per year than status quo care, and dialyses avoided gave net savings of $1.0 million at 3 years and $3.4 million at 4.6 years. The treatment program provided significant health benefit and impressive cost savings in dialysis avoided. (C) 2005 by the National Kidney Foundation, Inc.

Database and narratological representation of Australian Aboriginal knowledge as information visualisation using a game engine

Current database technologies do not support contextualised representations of multi-dimensional narratives. This paper outlines a new approach to this problem using a multi-dimensional database served in a 3D game environment. Preliminary results indicate it is a particularly efficient method for the types of contextualised narratives used by Australian Aboriginal peoples to tell their stories about their traditional landscapes and knowledge practices. We discuss the development of a tool that complements rather than supplants direct experience of these traditional knowledge practices.

Performing traditional knowledge using a game engine: Communicating and sharing Australian Aboriginal knowledge practices

This paper challenges current practices in the use of digital media to communicate Australian Aboriginal knowledge practices in a learning context. It proposes that any digital representation of Aboriginal knowledge practices needs to examine the epistemology and ontology of these practices in order to design digital environments that effectively support and enable existing Aboriginal knowledge practices in the real world. Central to this is the essential task of any new digital representation of Aboriginal knowledge to resolve the conflict between database and narrative views of knowledge (L. Manovich, 2001). This is in order to provide a tool that complements rather than supplants direct experience of traditional knowledge practices (V. Hart, 2001). This paper concludes by reporting on the recent development of an advanced learning technology that addresses this.

Resource entitlements of indigenous minorities, their poverty and conservation of nature: Status of Australian Aborigines, comparisons with India's tribals, theory and changing policies globally

Considers the relevance of A.K. Sen’s theory of entitlements to the situation facing indigenous tribal people, its relationship to institutionalism, and to theories of property rights. Changing world views about the resource entitlements that should be given to local communities are outlined concentrating on the views expressed by the World Conservation Union (IUCN). These changing views have relevance for the resource entitlements of indigenous tribal communities and are reflected in differences in the policy approaches inherent in the Convention on International Trade in Endangered Species (CITES) and the more recent Convention on Biological Diversity. The latter embodies the view that provision of greater resource entitlements to local communities can provide economic incentives for nature conservation. There is a case for Indigenous Australians to be given greater rights to market the natural produce from their lands. Despite progress with land rights, they are not entitled to market much of the natural produce from their land. The socioeconomic status of Australian Aborigines is outlined. Their standard of living and their life expectancy are low by world standards and in comparison to other Australians. This is partly a result of historical events that have restricted their rights. These events are outlined briefly. Views differ about the appropriate development paths for Indigenous Australians and these are assessed. Concern on environmental and economic grounds is expressed about the view that the economic development of Australian Aboriginal communities would be accelerated by replacing their communal land titles by private land titles and encouraging Western-style agriculture and commercial development of their lands. Some comparisons are also made with the situation of India’s Tribals.

Changes in conceptions of learning for indigenous Australian university students

Background. Conceptions of learning have been investigated for students in higher. education in different countries. Some studies found that students' conceptions change and develop over time while others have found no changes. Investigating conceptions of learning for Australian Aboriginal and Torres Strait Islander university students is a relatively new area of research. Aims. This study set out to investigate conceptions of learning for Aboriginal and Torres Strait Islander university students during the first two years of their undergraduate degree courses in three Australian universities. Conceptions for each year were compared. Knowing, more about learning as conceived by this cultural group may facilitate more productive higher educational experiences. Sample. The sample comprised 17 students studying various degrees; Il were male and 6 were female. Ages ranged from 18 to 48 years; mean age was 26 years. Method. This was a phenomenographic, longitudinal study. Individual semistructured interviews were conducted each year to ascertain students' conceptions of learning. Conceptions for second year were derived independently of those From first year. A comparative analysis then took place to determine ally changes. Results. These students held conceptions of learning that were similar to those of other university students; however there were some intrinsic differences. On a group level, conceptions changed somewhat over the two years as did core conceptions reported by some individual students. Some students also exhibited a greater awareness of learning during their second year that resulted in three dimensions of changed awareness. Conclusions. We believe the changed conceptions and awareness resulted from learning at university where there is some need to understand and explain phenomena in relation to theory. This brought about new understandings which allowed students to see their own learning in a relational sense.

Gastrointestinal worm infections. The prevalence and treatment in Australia

BACKGROUND:Intestinal worm (helminth) infections occur in a large proportion of the world's population, often constituting public health problems, and are occasionally encountered by practitioners in urban Australia. Prevalence levels in some remote Australian Aboriginal communities compare with those in developing countries. OBJECTIVE: To provide general practitioners with a brief outline of the most common human intestinal helminthiases, their usual clinical presentations and how they are diagnosed and managed. DISCUSSION: The pinworm, Enteroblus vermicularis, occurs in all populations, and is the most common species of nematode encountered in suburbia. Eradication is impossible, but its numbers can be kept low in those children who seem predisposed to heavy, symptomatic infections. The other nematodes are prevalent in some remote Australian Aboriginal communities, and are encountered occasionally in travellers from overseas. These infections are often asymptomatic, they cannot spread directly to other people and so do not pose any public health threat to the general community under suburban living conditions. The tapeworms are encountered even less frequently, except for Hymenolepis, the dwarf tapeworm, which is prevalent in some Aboriginal communities.