Does health assessment improve health outcomes in Indigenous people? An RCT with 13 years of follow-up

Objective: To examine the impact of a multi-component health assessment on mortality and morbidity in Kimberley Aboriginal residents during a 13-year follow-up. Method. A population-based randomised controlled trial using linked hospital, cancer and death records to evaluate outcomes in 620 intervention and 6,736 control subjects. Results: The intervention group had a higher rate of first-time hospitalisation for any reason (IRR = 1.37; 95 % Cl 1.25-1.50), a higher rate of injury-related hospital episodes (IRR = 1.31; 95 % Cl 1.15-1.48) and a higher notification rate of alcohol-related cancers. There was a smaller difference in the rates of multiple hospitalisations (IRR = 1.14; 95 % Cl 0.751.74) and no improvement in overall mortality compared with controls (IRR = 1.08; 95 % Cl 0.91-1.29). Conclusions: There was no overall mortality benefit despite increased health service contact associated with the intervention. Implications: Although not influencing mortality rates, multi-component health assessment may result in a period of increased health service use in Aboriginal and Torres Strait Islander populations, thus constituting an 'intervention'. However, this should not be confused with systematic and sustained interventions and investment in community development to achieve better health outcomes.

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.

Zinc and vitamin A supplementation in Indigenous Australian children hospitalised with lower respiratory tract infection: a randomised controlled trial

Objective: To evaluate the efficacy of supplementation with zinc and vitamin A in Indigenous children hospitalised with acute lower respiratory infection (ALRI). Design: Randomised controlled, 2-by-2 factorial trial of supplementation with zinc and vitamin A. Setting and participants: 187 Indigenous children aged < 11 years hospitalised with 215 ALRI episodes at Alice Springs Hospital (April 2001 to July 2002). Interventions: Vitamin A was administered on Days 1 and 5 of admission at a dose of 50 000 IU (infants under 12 months), or 100 000 IU; and zinc sulfate was administered daily for 5 days at a daily dose of 20 mg (infants under 12 months) or 40 mg. Main outcome measure: Time to clinical recovery from fever and tachypnoea, duration of hospitalisation, and readmission for ALRI within 120 days. Results: There was no clinical benefit of supplementation with vitamin A, zinc or the two combined, with no significant difference between zinc and no-zinc, vitamin A and no-vitamin A or zinc + vitamin A and placebo groups in time to resolution of fever or tachypnoea, or duration of hospitalisation. Instead, we found increased morbidity; children given zinc had increased risk of readmission for ALRI within 120 days (relative risk, 2.4; 95% CI, 1.003–6.1). Conclusion: This study does not support the use of vitamin A or zinc supplementation in the management of ALRI requiring hospitalisation in Indigenous children living in remote areas. Even in populations with high rates of ALRI and poor living conditions, vitamin A and zinc therapy may not be useful. The effect of supplementation may depend on the prevalence of deficiency of these micronutrients in the population.

Comparative susceptibility of indigenous and improved pig breeds to Classical swine fever virus infection: Practical and epidemiological implications in a subsistence-based, developing country setting

This study investigated the comparative susceptibility of indigenous Moo Laat and improved Large White/Landrace pig breeds to infection with classical swine fever virus (CSFV) under controlled conditions in the Lao People's Democratic Republic (Lao PDR). The Moo Laat (ML) and Large White/Landrace crossbreed (LWC) pigs were inoculated with a standard challenge strain designated Lao/Kham225 (infectivity titre of 10(2.75) TCID50/ml). The results demonstrated that both the native breed and an improved pig breed are fully susceptible to CSFV infection and the mortality rate is high. LWC pigs demonstrated lower (or shorter) survival times (50% survival time: 11 days), earlier and higher pyrexia and earlier onset of viraemia compared to ML pigs (50% survival time: 18 days). In the context of village-based pig production, the longer time from infection to death in native ML pigs means that incubating or early sick pigs are likely to be sold once an outbreak of CSF is recognized in a village. This increased longevity probably contributes to the maintenance and spread of disease in a population where generally the contact rate is low.

The promoter polymorphism -232C/G of the PCK1 gene is associated with type 2 diabetes in a UK-resident South Asian population

Background - The PCK1 gene, encoding cytosolic phosphoenolpyruvate carboxykinase (PEPCKC), has previously been implicated as a candidate gene for type 2 diabetes (T2D) susceptibility. Rodent models demonstrate that over-expression of Pck1 can result in T2D development and a single nucleotide polymorphism (SNP) in the promoter region of human PCK1 (-232C/G) has exhibited significant association with the disease in several cohorts. Within the UK-resident South Asian population, T2D is 4 to 6 times more common than in indigenous white Caucasians. Despite this, few studies have reported on the genetic susceptibility to T2D in this ethnic group and none of these has investigated the possible effect of PCK1 variants. We therefore aimed to investigate the association between common variants of the PCK1 gene and T2D in a UK-resident South Asian population of Punjabi ancestry, originating predominantly from the Mirpur area of Azad Kashmir, Pakistan. Methods - We used TaqMan assays to genotype five tagSNPs covering the PCK1 gene, including the -232C/G variant, in 903 subjects with T2D and 471 normoglycaemic controls. Results - Of the variants studied, only the minor allele (G) of the -232C/G SNP demonstrated a significant association with T2D, displaying an OR of 1.21 (95% CI: 1.03 - 1.42, p = 0.019). Conclusion - This study is the first to investigate the association between variants of the PCK1 gene and T2D in South Asians. Our results suggest that the -232C/G promoter polymorphism confers susceptibility to T2D in this ethnic group.

Water for the Wayuu: Procurement and maximization of a limited resource among indigenous pastoralists on the Guajira Peninsula of northern Colombia

For the Wayuu of the Guajira Peninsula of northern Colombia, water procurement has historically been challenging. The ancestral territory of this indigenous pastoral society is windy and arid, with low rainfall, high temperatures and an absence of perennial rivers or streams. In the past, the Wayuu adapted to these environmental conditions by practicing transhumance during the prolonged dry seasons, digging spring wells and artificial ponds and by following guiding principles for water usage. Since the 1930s, the government has made efforts to build additional wind-powered wells and ponds for a growing native population. Notwithstanding, these water solutions have only partly met the necessities; public water sources are limited or unreliable and few attempts are made to generate safe drinking water. Furthermore, the ubiquitous practice of animal husbandry places added pressure on existing sources; livestock consume more water than the human populations in the areas visited. Rapid assessments in four Wayuu areas on the peninsula were conducted by the author and an interdisciplinary team working for the Cerrejón Foundation for Water in La Guajira from 2010 to 2013. The assessments were part of a larger pilot project to design and implement a sustainability plan for reservoir-based water supply systems in the region. This study brings cultural practices and local knowledge to the forefront as key elements for the success of water works and other development projects carried out in Wayuu territory.

Atlantic Ais in the Sixteenth and Seventeenth Centuries: Maritime Adaptation, Indigenous Wrecking, and Buccaneer Raids on Florida’s Central East Coast

The Ais were a Native American group who lived along the Atlantic shoreline of Florida south of Cape Canaveral. This coastal population’s position adjacent to a major shipping route afforded them numerous encounters with the Atlantic world that linked Europe, Africa, the Caribbean, and the Americas. Through their exploitation of the goods and peoples from the European shipwrecks thrown ashore, coupled with their careful manipulation of other Atlantic contacts, the Ais polity established an influential domain in central east Florida during the sixteenth and seventeenth centuries. The pre-contact peoples of Florida’s east coast, including the ancestors of the Ais, practiced a maritime adaptation concentrated on the exploitation of their bountiful riverine, estuarine, and marine environments. The Ais then modified their maritime skills to cope with the opportunities and challenges that accompanied European contact. Using their existing aquatic abilities, they ably salvaged goods and castaways from the Spanish, French, English, and Dutch vessels dashed on the rocks and reefs of Florida’s coast. The Ais’ strategic redistribution of these materials and peoples to other Florida Native Americans, the Spaniards of St. Augustine, and other passing Europeans gained them greater influence. This process, which I call indigenous wrecking, enabled the Ais to expand their domain on the peninsula. Coastal Florida Native Americans’ maritime abilities also attracted the attention of Europeans. In the late seventeenth century, English buccaneers and salvagers raided Florida’s east coast to capture indigenous divers, whom they sent to work the wreck of a sunken Spanish treasure ship located in the Bahamas. The English subsequently sold the surviving Native American captives to other Caribbean slave markets. Despite population losses to such raids, the Ais and other peoples of the east coast thrived on Atlantic exchange and used their existing maritime adaptation to resist colonial intrusions until the start of the eighteenth century. This dissertation thus offers a narrative about Native Americans and the Atlantic that is unlike most Southeastern Indian stories. The Ais used their maritime adaptation and the process of indigenous wrecking to engage and exploit the arriving Atlantic world. In the contact era, the Ais truly became Atlantic Ais.

Impacts of newly established non-indigenous green crab (Carcinus maenas) on native fauna in Placentia Bay, Newfoundland

The recent invasion of the European green crab (Carcinus maenas) populations in Placentia Bay, Newfoundland and Labrador (NL) raises great concern about potential impacts on local fisheries and native biodiversity. Green crab are highly adaptable and in both native and invaded areas, green crab are well established predators that can outcompete other similarly sized decapods. The main objectives of this thesis were to: 1) identify the native species that green crab compete with for resources; 2) determine the depths and substrate types in which these interactions likely occur; 3) assess the indirect effects of green crab on native crustaceans and their changes in behavior; 4) assess the impacts of green crab on benthic community structure; 5) compare the NL population with other Atlantic Canadian populations in terms of competitive abilities; and 6) compare morphological features of the NL population with other Atlantic Canadian populations. I found that green crab overlap in space and diet with both rock crab (Cancer irroratus) and American lobster (Homarus americanus), potentially leading to a shift in habitat. Laboratory studies on naïve juvenile lobster also suggested shifts in behavior related to green crab, in that lobster decreased foraging activity and increased shelter use in the presence of green crab. Benthic community analyses showed fewer species in mud, sand, and eelgrass sites heavily populated by green crab compared to sites without green crab, although results depended on the taxa involved and I could not eliminate environmental differences through a short term caging study. Foraging ability of green crab varied in intraspecific competition experiments, with populations from NL and Prince Edward Island dominating longer-established populations from Nova Scotia and New Brunswick. Additional studies excluded claw size as a factor driving these results and behavioral differences likely reflected differences in invasion time and population genetics. Overall, green crab in Placentia Bay appear to be altering community structure of benthic invertebrates through predation and they also appear to indirectly impact native crustaceans through competition.

Changing times, changing stories: generational differences in climate change perspectives from four remote indigenous communities in Subarctic Alaska

Indigenous Arctic and Subarctic communities currently are facing a myriad of social and environmental changes. In response to these changes, studies concerning indigenous knowledge (IK) and climate change vulnerability, resiliency, and adaptation have increased dramatically in recent years. Risks to lives and livelihoods are often the focus of adaptation research; however, the cultural dimensions of climate change are equally important because cultural dimensions inform perceptions of risk. Furthermore, many Arctic and Subarctic IK climate change studies document observations of change and knowledge of the elders and older generations in a community, but few include the perspectives of the younger population. These observations by elders and older generations form a historical baseline record of weather and climate observations in these regions. However, many indigenous Arctic and Subarctic communities are composed of primarily younger residents. We focused on the differences in the cultural dimensions of climate change found between young adults and elders. We outlined the findings from interviews conducted in four indigenous communities in Subarctic Alaska. The findings revealed that (1) intergenerational observations of change were common among interview participants in all four communities, (2) older generations observed more overall change than younger generations interviewed by us, and (3) how change was perceived varied between generations. We defined “observations” as the specific examples of environmental and weather change that were described, whereas “perceptions” referred to the manner in which these observations of change were understood and contextualized by the interview participants. Understanding the differences in generational observations and perceptions of change are key issues in the development of climate change adaptation strategies.

Reduction of the “ngege”, Oreochromis esculentus (Teleostei: Cichlidae) populations, and resultant population genetic status in the Lake Victoria region

Ngege, Oreochromis esculentus, originally formed the mainstay of the Lake Victoria Region (LVR) fisheries. Together with its indigenous congener O. variabilis, it was displaced from Lakes Victoria and Kyoga of LVR and was found to survive as isolated small populations within the peripheral minor lakes and reservoirs around the two lakes. Displacement of the two LVR indigenous tilapiines was thought to be principally driven by changed lake environment and predation by the introduced Nile perch, but also competition and genetic swamping by the closely related introduced and comparatively more ecologically versatile tilapine species. In a study carried out in the LVR between 1993 and 2003, micro satellites and RAPD markers were used to analyse the remnant populations so as to establish the population structure and extant genetic diversity of O. esculentus. Analyses indicated that the surviving O. esculentus retained a high proportion of genetic diversity with high differentiation between units an indication of genetic exchange between indigenous and introduced Nile tilapia where the two forms co-existed. While this heightened concern for genetic swamping of the remnant population units by the introduced tilapiines it was noteworthy that in a few of the satellite lakes where the O. esculentus was dominant evidence for introgression was weak.

Triceps and subscapular skinfold thicknesses percentiles and cut-offs for overweight and obesity in a population-based sample of schoolchildren in Bogota, Colombia

OBJECTIVES: The aims of this study were to establish a Colombian smoothed centile charts and LMS tables for tríceps, subscapular and sum tríceps+subscapular skinfolds; appropriate cut-offs were selected using receiver operating characteristic analysis based in a populationbased sample of schoolchildren in Bogota, Colombia and to compare them with international studies. METHODS: A total of 9 618 children and adolescents attending public schools in Bogota, Colombia (55.7% girls; age range of 9–17.9 years). Height, weight, body mass index (BMI), waist circumference, triceps and subscapular skinfold measurements were obtained using standardized methods. We have calculated tríceps+subscapular skinfold (T+SS) sum. Smoothed percentile curves for triceps and subscapular skinfold thickness were derived by the LMS method. Receiver operating characteristics curve (ROC) analyses were used to evaluate the optimal cut-off point of tríceps, subscapular and sum tríceps+subscapular skinfolds for overweight and obesity based on the International Obesity Task Force (IOTF) definitions. Data were compared with international studies. RESULTS: Subscapular, triceps skinfolds and T+SS were significantly higher in girls than in boys (P <0.001). The median values for triceps, subscapular as well as T+SS skinfold thickness increased in a sex-specific pattern with age. The ROC analysis showed that subscapular, triceps skinfolds and T+SS have a high discrimination power in the identification of overweight and obesity in the sample population in this study. Based on the raw non-adjusted data, we found that Colombian boys and girls had high triceps and subscapular skinfolds values than their counterparts from Spain, UK, German and US. CONCLUSIONS: Our results provide sex- and age-specific normative reference standards for the triceps and subscapular skinfold thickness values in a large, population-based sample of 3 schoolchildren and adolescents from an Latin-American population. By providing LMS tables for Latin-American people based on Colombian reference data, we hope to provide quantitative tools for the study of obesity and its complications.

Phenotypic Characterization According to The Feather Color of Indigenous Muscovy Ducks Bred in The Back Yard in Brazzaville, The Congo

Abstract.  In Congo, waterfowl genetic resources are constituted by native population of Muscovy ducks that play an important role in food security. The present study aimed to identify and to characterize strains bred in the back yard in the households in Brazzaville. A sample of 154 households drawn over seven districts of Brazzaville was enrolled in the survey. Adults ducks found in the households were identified, pictured by a key of determination and then compared by using the multi resolution analysis image method. The survey recorded 13 strains in which four were considered as newly since they have never been reported elsewhere. These strains received temporally the name of the districts where they have been identified for the first time Makelékélé 1 (0.34%, n=6), Makélékélé 2 (0.11%, n =2), Poto poto 1  (0.28%, n=5) and in Poto poto 2 (0.11%, n=2). Finally, the survey reported nine classical  strains such as  black plumage, duclair, white, tortora, sepia, chocolate, lavender, grey and canizie. The apparent wide variation in plumage colors is an indication that the duck populations have not been ‘purified’ through selective breeding. In the context of the valorization of poultry biodiversity, this work represents a step toward a better knowledge of the production abilities of local ducks breeds in Congo. Key words: Muscovy ducks, color feather, strains, Congo. Abstrak.  Sumber daya genetik unggas air di Kongo mencakup populasi itik lokal yang memegang peranan penting dalam ketahanan pangan. Penelitian ini bertujuan mengidentifikasi dan menggolongkan jenis itik yang dipelihara di pekarangan rumah di Brazzaville. Sampel penelitian menggunakan 154 responden rumah tangga yang tersebar di 7 wilayah Brazzaville. Itik dewasa diidentifikasi dari pekarangan, dan dibandingkan dengan metode Analisis Multi Resolusi. Survey mencatat 13 jenis peranakan, 4 diantaranya dianggap baru karena belum pernah dilaporkan di studi manapun. Jenis ini sementara dinamai sesuai distrik tempatnya pertama ditemukan, yaitu Makelékélé 1 (0,34%, n=6), Makélékélé 2 (0,11%, n =2), Poto poto 1  (0,28%, n=5) dan di Poto poto 2 (0,11%, n=2). Berdasarkan survei didapatkan sembilan jenis klasik yaitu bulu hitam, duclair, putih, tortora, sepia, coklat, lavender, abu-abu dan canizie. Banyaknya ragam warna bulu adalah indikasi bahwa populasi itik belum “dimurnikan” melalui seleksi. Dalam konteks penetapan nilai keanekaragaman hayati unggas, penelitian ini mewakili sebuah langkah menuju pengetahuan yang mendalam akan kemampuan produksi itik yang berkembang di Kongo. Kata kunci: itik Muscovy, warna bulu, strain, Kongo