Associations of mortality and cardiovascular disease risks with diabetes and albuminuria in urban Indigenous Australians: the DRUID follow-up study.

AIM: To assess the relationships of diabetes and albuminuria with all-cause mortality and cardiovascular disease outcomes in a population without prior cardiovascular disease using data from the Darwin Region Urban Indigenous Diabetes (DRUID) study. METHODS: We conducted a prospective cohort study of 706 participants (aged 15-81 years, 68% women) without prior cardiovascular disease who underwent a 75-g oral glucose tolerance test. Deaths and fatal or non-fatal cardiovascular disease were determined over 7 years, and hazard ratios with 95% CIs and population attributable risks were estimated for baseline glycaemia and albuminuria. RESULTS: Compared with normoglycaemia and after adjustment for age, sex, hypertension, dyslipidaemia and smoking, known diabetes was associated with an adjusted hazard ratio of 4.8 (95% CI 1.5-14.7) for all-cause mortality and 5.6 (95% CI 2.1-15.2) for cardiovascular disease. Compared with normoalbuminuria, the respective adjusted risks for macroalbuminuria were 10.9 (95% CI 3.7-32.1) and 3.9 (95% CI 1.4-10.8). The Adjusted all-cause mortality and cardiovascular disease estimated population attributable risks for diabetes were 27% and 32%, and for albuminuria they were 32% and 21%, respectively. CONCLUSIONS: In our study population, the burden of mortality and cardiovascular disease was largely driven by diabetes and albuminuria. This finding on the influence of diabetes and albuminuria is consistent with reports in other high-risk Indigenous populations and should be better reflected in risk scores and intervention programmes.

Differing serologic responses to an haemophilus influenzae type b polysaccharide-neisseria meningitidis outer membrane protein conjugate (PRP-OMPC) vaccine in australian aboriginal and caucasian infants - implications for disease epidemiology.

This study compared Hib antibody responses to a single lot of PRP-OMPC vaccine given at 2, 4 and 12 months to 57 Aboriginal infants in rural areas of the Northern Territory and 56 Caucasian infants in Sydney, Australia. The Aboriginal infants had lower levels of antibody in cord blood (P>0.05), which were significantly lower (P<0.02) by 2 months of age. Antibody responses to one or two doses of vaccine, measured at 4 and 12 months of age, were similar but the geometric mean titre following the booster dose in Aboriginal infants was significantly lower (1.98 vs. 6.04 mcg/ml, P = 0.002). Low preimmunisation antibody is consistent with the early onset of Hib disease in Aboriginal infants before immunisation. Lower responses to boosting could correlate with persistence of Hib colonisation in indigenous populations.

Aboriginal perspectives of diabetes in a remote community in the Northern Territory.

This study explores the knowledge and beliefs of diabetes in a group of Aboriginal people from a remote community in the Northern Territory. Information was gathered from participants through a combination of group discussions, semi-structured interviews and informal conversations. The four themes of explanation of diabetes were: worry, food, family and infections. The most common means of preventing or treating diabetes were stopping worry and changing one's diet. Significantly, few of the participants believed that medication was effective, and weight loss and exercise were not mentioned. The results highlight the miscommunication about diabetes that has occurred in this population. For effective communication and management of diabetes, health information must incorporate the contemporary health beliefs of the clients.

Cold chain in a hot climate.

We monitored the temperatures of batches of vaccine during transport and storage from a national warehouse to five Northern Territory vaccination clinics. Electronic temperature monitors were placed with vaccines, and were programmed to record the temperature every 30 minutes for up to three months. A diary was attached to each vaccine batch to record each change in location. The temperature recordings covered 8369 hours. There were regular temperature deviations outside the recommended range. In the hot climate of the Northern Territory, freezing is the greatest threat to vaccine potency. Recommendations from the study include: routine use of cold chain indicators, increased vaccine turnover and storage of vaccines within an operational temperature range of 4 to 8 degrees C. Research is needed to investigate the efficacy of heat-stable vaccines when stored at ambient temperatures and in air-conditioned environments.

Evacuation of an Aboriginal community in response to an outbreak of blistering dermatitis induced by a beetle (Paederus australis).

OBJECTIVE: To describe an outbreak of dermatitis induced by the beetle Paederus australis and the public health measures implemented to control it. SETTING: A remote Aboriginal community in the Northern Territory of Australia. METHODS: Inspection of the community and interviews with residents to document skin lesions, sleeping locations and beetle activity. Samples of the beetle were collected for identification. RESULTS: The community was affected by a plague of beetles. All 40 residents reported painful, blistering, skin lesions. Four required hospitalisation for treatment of an extensive exfoliating and ulcerating dermatitis. The community was evacuated to allow skin lesions to heal and the beetle plague to decline. CONCLUSION: This is the first reported en masse outbreak of Paederus dermatitis in Australia. Paederus dermatitis should be considered as a differential diagnosis of vesicular dermatitis in tropical Australia.