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Biomedical subjects

M Gracey

Publications and source records attributed to M Gracey.

At least 37 records · Page 2Linked to original sources
PubMed1998

The pediatrician's role in the twenty-first century.

The world's children comprise: (i) those in wealthy, industrialized countries; (ii) those from rapidly industrializing countries; (iii) minority groups including recently arrived immigrants in otherwise affluent and healthy societies; (iv) previously traditional people in rapid transition to urbanized, Western lifestyles; and (v) many millions living in grinding poverty in overcrowded, unhygienic conditions where child mortality is high and often due to malnutrition and infections. Industrialization, affluence, better housing, hygiene and nutrition, better clinical care and disease prevention have helped enhance child health in many countries over the past century. However, this is being offset by obesity, smoking, alcohol and drug abuse and social disruption, mental disease and high rates of violence including homicide and suicide. These 'new morbidities' are worse among minorities and in populations undergoing rapid social change. Social pressures including unemployment, depression and family dysfunction are important. Pediatricians must become active in decisions about the use of public resources in disease prevention, health education and more rational and equitable use of high technology. They should also be active advocates for children and their rights and advise governments about all issues that affect child health, protection and well-being. This is particularly so in the poorest and developing countries. There is a need for better international collaboration, training and exchange programs involving the International Pediatric Association, United Nations International Children's Emergency Fund, World Health Organization and other local, national and regional organizations to help overcome these problems as the next century draws near.

Adolescent↗
PubMed1998

Seasonality of low birthweight in indigenous Australians: an increase in pre-term birth or intrauterine growth retardation?

We have analysed birthweights of 4,508 Aboriginal and Torres Strait Islander livebirths in the Kimberley region of Western Australia from 1981-93. Mean birthweight varied significantly according to month of birth (F(11) = 2.57, p = 0.003) and low birthweight babies were more common during the wet season. A significant increase in the proportion of very low birthweight (VLBW) babies was observed during the wet season compared with the dry season (OR 2.73; 95% CI 2.3-3.67; p < 0.001); whereas babies weighing 1,500-2,499 g were not significantly more common during the wet season (OR 1.06; 95% CI 0.96-1.17; p = ns). The results indicate that adverse environmental conditions may be associated with increased risk of VLBW. Since newborns weighing less than 1500 g are very likely to be pre-term (< 37 weeks' gestation), the findings also suggest that seasonality of birthweight may be due to an increase in pre-term births rather than an increase in intrauterine growth retardation. Further research is required to identify the underlying causes of an increase in VLBW babies during the wet season.

Birth Rate↗
PubMed1998

Differences in growth among remote and town-dwelling aboriginal children in the Kimberley region of Western Australia.

This paper documents the growth of Aboriginal children in remote communities and gazetted towns of the Kimberley region in the far north of Western Australia over the past 20 years. The study's specific aim was to compare the height and weight growth of children in different environments from birth to five years of age. From 1979 to 1983, children living in towns were significantly taller and heavier than their counterparts in remote communities. From 1984 to 1988 and thereafter, there were no significant differences in the growth patterns of children in towns and remote communities. Overall, weight-for-age and height-for-age of children in remote communities has improved since the 1970s relative to their town-dwelling counterparts. These changes in growth shed light on the quality of the social and physical environment over the past 20 years and may assist with the development of future programs for child health.

Birth Rate↗
PubMed1997

Fc epsilon R1-beta polymorphism and total serum IgE levels in endemically parasitized Australian aborigines.

Endemic helminthic infection is a major public-health problem and affects a large proportion of the world's population. In Australia, helminthic infection is endemic in Aboriginal communities living in tropical northern regions of the continent. Such infection is associated with nonspecific (polyclonal) stimulation of IgE synthesis and highly elevated total serum IgE levels. There is evidence that worm-infection variance (i.e., human capacity of resistance) and total serum IgE levels may be related to the presence of a major codominant gene. The beta chain of the high-affinity IgE receptor, Fc epsilon R1-beta, has been previously identified as a candidate for the close genetic linkage of the 11q13 region to IgE responses in several populations. We show a biallelic RsaI polymorphism in Fc epsilon R1-beta to be associated with total serum IgE levels (P = .0001) in a tropical population of endemically parasitized Australian Aborigines (n = 234 subjects). The polymorphism explained 12.4% of the total residual variation in serum total IgE and showed a significant (P = .0000) additive relationship with total serum IgE levels, across the three genotypes. These associations were independent of familial correlations, age, gender, racial admixture, or smoking status. Alleles of a microsatellite repeat in intron 5 of the same gene showed similar associations. The results suggest that variation in Fc epsilon R1-beta may regulate IgE-mediated immune responses in this population.

Alleles↗
PubMed1997

Hospitalization of aboriginal and non-aboriginal patients for respiratory tract diseases in Western Australia, 1988-1993.

BACKGROUND: Aboriginal people have lower health standards than other Australians. Respiratory tract diseases are prominent causes of high morbidity and mortality rates in the Aboriginal population. However, very little is known about the patterns of respiratory illnesses which affect these people. METHOD: This paper compares Aboriginal and non-Aboriginal age-specific hospitalization patterns for respiratory tract diseases from 1988 to 1993 in Western Australia (WA). RESULTS: Aboriginal people were admitted for respiratory diseases 2-16 times more frequently than non-Aboriginals of the same age with considerable discrepancies in hospitalization rates particularly in infants, young children and older adults. High admission rates for acute respiratory tract infections, pneumonia and asthma occurred in Aboriginal infants. Pneumonia was a disproportionately frequent cause of admissions in Aboriginal infants, children and adults. Pneumonia is a more frequent cause of admission among non-metropolitan compared to metropolitan Aboriginals. Asthma was a frequent cause of admissions of Aboriginal children and hospitalization rates for this disease were higher in non-metropolitan than metropolitan areas. Chronic obstructive airway disease and respiratory tract carcinoma were important uses of hospitalization in older Aboriginals. CONCLUSIONS: Admission rates for respiratory conditions were consistently higher among the Aboriginal population and in non-metropolitan areas. The overwhelming importance of infections among Aboriginal admissions has significant implications for the prevention and management of respiratory diseases among Aboriginal people.

Adolescent↗
PubMed1997

Environmental health conditions in remote and rural aboriginal communities in western Australia.

During 1994-1995 environmental health conditions of about 13,760 persons in 155 remote and rural Aboriginal communities in 20 local shires in Western Australia (WA) were surveyed. A semiquantitative questionnaire sought data about the communities and their services, including water supplies, power, sanitation and disposal of solid and liquid waste; a separate section dealt with conditions of individual dwellings. Data were recorded by experienced local workers. Thirty-five communities considered to have the worst conditions were evaluated on-site by a team of senior personnel in mid-1995. Environmental health problems were prevalent and often serious: over one-third of the communities had water supply or sanitation problems and 70 per cent had housing problems, with overcrowding and substandard housing being commonplace. Thirty-six per cent had difficulties with waste water disposal, 37 per cent had no rubbish disposal, and in others, the methods of disposal were often inadequate; pests were problems in 44 per cent of communities and the hygiene and maintenance of communal toilets was unacceptable in 25 per cent. Seventy-two per cent had no on-site environmental health worker and 44 per cent had no on-site or visiting medical, nursing or health worker personnel. An action plan was developed and the highest-priority communities were targeted in a program of major works (for example, housing, drainage and sewerage) and minor works, which have been commenced. The remote-area environmental health workers' program is being expanded. Increased intersectoral collaboration and enhanced community involvement in decision making have occurred as a result of this work.

Child Welfare↗
PubMed1997

Persistent growth faltering among aboriginal infants and young children in north-west Australia: a retrospective study from 1969 to 1993.

The objective was to examine long-term changes in the growth of Aboriginal infants and young children in the Kimberley region in the far north-west of Australia from 1969 to 1993. A retrospective analysis of anthropometric data (weight and length) routinely collected on 0-5-year-old children in 5-year cohorts from 1969 to 1993 was carried out. From 1974-78 to 1989-93 there has been a significant increase in mean birthweight (ANOVA p < 0.05). The percentage of low birthweight infants (< 2500 g) declined from 14% in 1979-83 to 10% in 1989-93 (p < 0.001). There were no consistent improvements in the growth patterns of infants from birth to 60 months. All cohorts displayed pronounced growth faltering in weight-for-age and height-for-age from 6 to 12 months of age and fell significantly below both the NCHS reference values and mean values for healthy breastfed infants. In conclusion, reductions in Aboriginal infant mortality and infectious disease rates over the past 20 years have not been accompanied by improved growth. The persistence of child malnutrition in these communities may warrant a shift in attention from disease treatment and prevention to a better understanding of nutritional influences, particularly weaning practices, during infancy and early childhood.

Analysis of Variance↗
PubMed1996

Risk factors for ill-health in a remote desert-dwelling aboriginal community in Western Australia.

BACKGROUND: Living in small, isolated groups may promote health for Aborigines if traditional lifestyles are followed, but overall health risks in such communities are inadequately documented. AIM: To document health status of a remote Aboriginal community with reference to nutrition, cardiovascular risks, renal disease and infections and to identify areas where health might be improved. METHODS: All residents of a small community in the Great Sandy Desert underwent medical examinations, anthropometry and measurement of blood pressure. Investigations included cholesterol, triglycerides, glucose, insulin, creatinine, lipoprotein (a), apolipoprotein E phenotype, angiotensin-converting enzyme genotype, urinalysis, stool microscopy (children), liver function tests and full blood examination. RESULTS: Children (n = 26) were undernourished while 14% of adults (n = 51) were underweight, 22% overweight and 40% of women and 13% of men were obese with central obesity in 90% of women and 48% of men. Fifteen per cent of the group were hypertensive. Insulin levels were increased in 55% of subjects, total cholesterol in 21% and triglycerides in 56%, while HDL was decreased in 78%. Angiotensin-converting enzyme and apolipoprotein E typing and lipoprotein (a) did not suggest increased cardiovascular risk. Proteinuria was present in 39% of subjects, haematuria in 49% and definite or possible urinary tract infections in 30%. Faecal parasites were prevalent and a history of infections, including sexually transmitted diseases, was common. CONCLUSIONS: Increased cardiovascular risk, nutritional disorders, renal disease and infections are major problems in this community which had relocated several years previously from a mission environment closer to western influences, including alcohol.

Adolescent↗
PubMed1996

Haemolytic-uraemic syndrome in Western Australia, 1980 to 1994.

A retrospective, population-based study of patients hospitalised with the haemolytic-uraemic syndrome in Western Australia from 1980 to 1994 was undertaken to describe the epidemiology of the disease in this state. We identified 41 patients. Episodes were commonest in children under five years of age (63.4 per cent) and were more frequent in females (58.5 per cent) than in males; only one Aboriginal patient was detected. More than 90 per cent of episodes had a gastrointestinal prodrome lasting from one to 22 days; in 47.6 per cent of these episodes patients had bloody diarrhoea. The average hospital stay was 26 days, and 63.4 per cent of patients required dialysis (mean 10 days). More than 20 per cent of patients developed chronic renal failure, 9.7 per cent died, two patients developed hypertension and one child became epileptic; three of the 10 patients over 16 years of age (30 per cent) died. The haemolytic-uraemic syndrome is potentially fatal, affects mostly young children, and is usually preceded by a gastrointestinal illness. Episodes can occur in common-source outbreaks but, with the exceptions of related cases in families, that appears not to have been so in Western Australia since 1980. There is a need for increased awareness of the haemolytic-uraemic syndrome to enhance prospects for earlier detection and better clinical outcomes. Improved public health surveillance is also needed to reduce the risks of the syndrome in the community.

Adolescent↗
PubMed1996

Deaths in Broome, Western Australia, 1883 to 1994.

We examined all records of deaths held in the Derby Courthouse (1883 to 1895) and the Broome Courthouse (from 1896). Records of 3409 deaths (2659 males, 750 females) were analysed. Race of origin was ascertained from > 99 per cent of records: 35.9 per cent of deaths were of Aboriginals, 42.8 per cent of Asians and 21.3 per cent were among other races. In the early decades (1880s to 1920s) most deaths were of young Asian males and related to deep-sea diving in the pearling industry; many other deaths were caused by homicide and suicide. Pearling deaths declined after World War I and the number of Aboriginal deaths increased. The 80 to 100 deaths caused by the Japanese air raid in March 1942 were not entered into the Broome register. After World War II deaths among young males and Asians decreased and reported Aboriginal deaths increased; many were of malnourished infants and young children with infections. In the 1970s and 1980s deaths of young adults in motor vehicle accidents and of young adults from homicide and suicide increased; some occurred in custody. The pearling industry caused hundreds of deaths in the late nineteenth century and in the first two decades of this century, particularly among young Asian divers. Many were recorded in the Derby and Broome Death Registries but others were not recorded. These official records show changing patterns of mortality, for example, mortality associated with violence, infection and undernutrition (in young Aboriginal children), and more recently, motor vehicle accidents.

Accidents↗
PubMed1996

Risk factors for diabetes and cardiovascular disease in young Australian aborigines. A 5-year follow-up study.

OBJECTIVE: To test the hypothesis that hyperinsulinemia and glucose intolerance are present at an early age in australian aborigines and can be used to predict the eventual development of NIDDM. RESEARCH DESIGN AND METHODS: Baseline anthropometric, pubertal stage, and blood pressure data were collected for 100 Australian aboriginal children and adolescents in 1989. Plasma concentrations of glucose, insulin, C-peptide, triglycerides, and LDL, HDL, and total cholesterol were measured before and during an oral glucose tolerance test. All measurements were repeated in 74 individuals from the original study population in 1994. Results were compared among hyperinsulinemic and normoinsulinemic subjects, and subjects with normal or abnormal glucose tolerance. RESULTS: The percentage of subjects who were overweight increased from 2.7% at baseline to 17.6% 5 years later. At a mean age of 18.5 years, 8.1% of the population had impaired glucose tolerance (IGT), 2.7% had diabetes, and 21.6% had elevated cholesterol concentrations in plasma. Dyslipidemia was particularly prevalent among male subjects in the population: 34.4% had elevated plasma cholesterol and 21.9% had elevated LDL cholesterol values. Of the eight subjects who had diabetes or IGT in 1994, four were classified as hyperinsulinemic in 1989 and four were not. CONCLUSIONS: The major finding of this study is the high prevalence of risk factors for NIDDM and cardiovascular disease in this population of aboriginal children and adolescents. Abnormalities of carbohydrate and lipid metabolism were well established by late in the second decade of life. Although many subjects had high insulin levels and there was evidence of insulin resistance in the population, hyperinsulinemia did not predict the development of abnormal glucose tolerance 5 years later.

Adolescent↗
PubMed1995

New World syndrome in Western Australian aborigines.

1. It has become clear over the past 25 years that Aborigines in Western Australia (WA) now experience very high rates of type 2 diabetes mellitus and its complications as well as hypertension and cardiovascular disease; these disorders are often associated with obesity and abnormalities of plasma lipids. 2. This experience is similar to that of Aboriginal people in other parts of Australia and to other previously traditional societies now in transition to an urbanized, Westernized existence; this is widely attributed to lifestyle factors and genetic susceptibility. 3. This so-called 'New World Syndrome' is responsible for disproportionately high levels of morbidity and mortality in the Aboriginal population of WA; prevention and improved methods of screening, detection and management are needed to reduce this problem.

Adult↗
PubMed1995

Comparative hospitalisation and mortality rates of aboriginal and non-aboriginal Western Australians in their sixth and seventh decades.

BACKGROUND: Aboriginals have higher hospitalisation and mortality rates and die, on average, about 15 years earlier than non-Aboriginals in Western Australia (WA). AIMS: To investigate Aboriginal morbidity and mortality rates in WA in comparison with the rest of the population, with particular reference to the ages of 50 to 65 years. METHODS: Mortality rates from 1983-1989 inclusive for Aboriginals and non-Aboriginals in WA were compared. Major causes of Aboriginal mortality in males and females were matched to the ages at which similar rates from the same causes occurred in non-Aboriginals. Rate ratios (Aboriginal:non-Aboriginal) for causes of death at ages 60-64 years were determined. Hospitalisation rates for Aboriginal and non-Aboriginal people aged 50-64 years in WA in 1988 were used to estimate hospitalisation rate ratios. RESULTS: Hospitalisation rates in WA were much higher among 50 to 64 year old Aboriginals than non-Aboriginals for most diseases, particularly for infectious and parasitic diseases, and injury and poisoning. Admissions for circulatory diseases were double to four times as frequent among Aboriginals. The main causes of deaths in Aboriginal males were circulatory diseases, injury and poisoning, respiratory diseases, neoplasms, and digestive diseases; in Aboriginal females the main causes of deaths were circulatory diseases, neoplasms, diabetes, respiratory diseases, and injury and poisoning. Except for neoplasms, deaths from these causes occurred among 50-54 year old Aboriginals at rates that were experienced by non-Aboriginal people ten to 30 years later in life. These results underline special needs of the Aboriginal population that have not been adequately met by appropriate services.

Aged↗
PubMed1994

Patterns of mortality in Western Australian aboriginals, 1983-1989.

The ratios of age-standardized mortality rates of Aboriginals to non-Aboriginals in Western Australia during the period 1983-1989 were 2.6 for males and 3.0 for females. Mortality rates experienced by Aboriginals were much higher in all age categories except 75+ years and for most major diseases except neoplasms. The peaks of all-cause age-specific mortality rate ratios (RR) for Aboriginal males and females were 10.2 (at 40-44 years) and 10.0 (at 35-39 years), respectively. These excess mortalities were mainly due to circulatory diseases, injury and poisoning, respiratory diseases and, in females, to digestive diseases and genitourinary diseases. The highest age-standardized, cause-specific RR for Aboriginal males were for mental disorders (10.3), injury and poisoning (8.9) and genitourinary diseases (8.6); for females the highest RR were for genitourinary diseases (16.9), endocrine, nutritional and metabolic (mainly diabetes mellitus) (12.3), and for infectious and parasitic diseases (7.5).

Adolescent↗