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.

Interfaces between cardiovascular and kidney disease among Aboriginal Australians

Rates of kidney disease among several indigenous groups have been shown to be substantially higher than corresponding non-indigenous groups. This excess has been clearly shown among Aboriginal Australians with respect to both end-stage kidney disease and early kidney disease. Rates of cardiovascular disease among Aboriginal Australians are also very high, as are rates of diabetes, smoking, and possibly overweight and obesity. These factors have been traditionally linked with cardiovascular and renal disease as part of a broader metabolic syndrome. However, the links and interfaces between cardiovascular and kidney disease in this environment extend beyond these traditional factors. The factors associated with atherosclerosis have expanded in recent years to include markers of inflammation, some infection, antioxidants, and other non-traditional risk factors. Given the high rates of acute infection and poor living conditions endured by many indigenous people, one might expect these non-traditional risk factors to be highly prevalent. In this review, we explore the relationships between markers of inflammation, some serological markers of infection, and other selected markers and both cardiovascular and renal disease. In doing so, we demonstrate links between kidney and cardiovascular disease at a number of levels, beyond the traditional cardiovascular/renal risk factors. Many of these factors are beyond the control of the individual or even community; addressing these issues a broader focus and biopsychosocial model. (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.

Strengthening cardiac rehabilitation and secondary prevention for Aboriginal and Torres Strait Islander peoples

This article summarises the findings of a project funded and supported by a principal committee of the National Health and Medical Research Council, the Health Advisory Committee, chaired by Professor Adele Green.

Locating whiteness in the academic production of "I Philosophy" in and of time and place

This review will critically evaluate two recent texts by white academics working across disciplines of cultural studies, history and anthropology and published by UNSW Press, which share a focus on the relationship between Aboriginality, Philosophy, Place and Time in Australia. I write from the position of a queer white academic committed to engaging politically and intellectually with the challenge of Indigenous sovereignties in this place while also aware that my position as a middle class white woman and intellectual imposes limits on what it is possible for me to know about Indigenous epistemologies (see Moreton-Robinson, 2000). In the course of this review I will demonstrate how anthropology's tendency to fix its objects of study within a circumscribed space of 'difference' limits the capacity of texts produced within this discipline to account for racialized struggles over sovereignty. While these struggles are equally embedded in the ethnographic context and the nation's constitution and political institutions, we will see that Muecke and Bird Rose confront problems in analysing the relationship between the intimate space of the 'field', in which one's research subjects quickly become one's 'friends' and/or 'classificatory kin'—on one hand—and the public space of the nation within which statements about Aboriginality by white academics circulate and are vested with an authority that escapes individual intentions and control—on the other.

Understanding Isolation and Change in Island Human Populations through a study of Indigenous Cultural Patterns in the Gulf of Carpentaria

This paper presents a set of hypotheses to explain the cultural differences between Aboriginal people of the North and South Wellesley Islands, Gulf of Carpentaria and to characterise the relative degree and nature of their isolation and cultural change over a 10,000-year time-scale. This opportunity to study parallelisms and divergences in the cultural and demographic histories of fisher-hunter-gatherers arises from the comparison of three distinct cultural groupings: (a) the Ganggalida of the mainland, (b) the Lardil and Yangkaal of the North Wellesley Islands, and (c) the Kaiadilt of the South Wellesley Islands. Despite occupying similar island environments and despite their languages being as closely related as for example, the West Germanic languages, there are some major differences in cultural, economic and social organization as well as striking genetic differences between the North and South Wellesley populations. This paper synthesizes data from linguistics, anthropology, archaeology, genetics and environmental science to present hypotheses of how these intriguing differences were generated, and what we might learn about early processes of marine colonization and cultural change from the Wellesley situation.