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Complete articles, Transnational Literature November 2017
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Social disparities in the prevalence of diabetes in Australia and in the development of end stage renal disease due to diabetes for Aboriginal and Torres Strait Islanders in Australia and Maori and Pacific Islanders in New Zealand
Get PDFThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background
Disparities in health status occur between people with differing socioeconomic status and disadvantaged groups usually have the highest risk exposure and the worst health outcome. We sought to examine the social disparities in the population prevalence of diabetes and in the development of treated end stage renal disease due to type 1 diabetes which has not previously been studied in Australia and New Zealand in isolation from type 2 diabetes.
Methods
This observational study examined the population prevalence of diabetes in a sample of the Australian population (7,434,492) using data from the National Diabetes Services Scheme and of treated end stage renal disease due to diabetes using data from the Australian and New Zealand Dialysis and Transplant Registry. The data were then correlated with the Australian Bureau of Statistics Socioeconomic Indexes for Areas for an examination of socioeconomic disparities.
Results
There is a social gradient in the prevalence of diabetes in Australia with disease incidence decreasing incrementally with increasing affluence (Spearman’s rho = .765 p < 0.001). There is a higher risk of developing end stage renal disease due to type 1 diabetes for males with low socioeconomic status (RR 1.20; CI 1.002–1.459) in comparison to females with low socioeconomic status. In Australia and New Zealand Aboriginal and Torres Strait Islanders, Maori and Pacific Islanders appear to have a low risk of end stage renal disease due to type 1 diabetes but continue to carry a vastly disproportionate burden of end stage renal disease due to type 2 diabetes (RR 6.57 CI 6.04–7.14 & 6.48 CI 6.02–6.97 respectively p < 0.001) in comparison to other Australian and New Zealanders.
Conclusion
Whilst low socioeconomic status is associated with a higher prevalence of diabetes the inverse social gradient seen in this study has not previously been reported. The social disparity seen in relation to treated end stage renal disease due to type 2 diabetes for Aboriginal and Torres Strait Islanders, Maori and Pacific Islanders has changed very little in the past 20 years. Addressing the increasing incidence of diabetes in Australia requires consideration of the underlying social determinants of health
Jane Austen's Songs of the Sea [Concert program]
No full textAmong the music in Jane Austen’s personal music collection are many songs about sailors and the sea. Britain was at war for most of Austen’s lifetime and two of her brothers were naval officers. The program includes songs about life at sea and coming home, songs about the wives and families left behind, sailors’ love songs, and songs about war and revolution. Many of the songs are drawn from the rich folk heritage of the period. Others are written by composers including William Shield, Samuel Arnold, Stephen Storace and the prolific Charles Dibdin, whose comic and sentimental songs Austen seems to have been especially fond of. There are arrangements of Haydn and Handel tunes, and there is even a love song written by Matthew Flinders – the colleague of Jane Austen’s younger brother
Occasional hybridization between a native and invasive Senecio species in Australia is unlikely to contribute to invasive success
Get PDFThis is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. For attribution, the original author(s), title, publication source (PeerJ) and either DOI or URL of the article must be cited.Background
Hybridization between native and invasive species can facilitate introgression of native genes that increase invasive potential by providing exotic species with pre-adapted genes suitable for new environments. In this study we assessed the outcome of hybridization between native Senecio pinnatifolius var. pinnatifolius A.Rich. (dune ecotype) and invasive Senecio madagascariensis Poir. to investigate the potential for introgression of adaptive genes to have facilitated S. madagascariensis spread in Australia.
Methods
We used amplified fragment length polymorphisms (141 loci) and nuclear microsatellites (2 loci) to genotype a total of 118 adults and 223 seeds from S. pinnatifolius var.pinnatifolius and S. madagascariensis at one allopatric and two shared sites. We used model based clustering and assignment methods to establish whether hybrid seed set and mature hybrids occur in the field.
Results
We detected no adult hybrids in any population. Low incidence of hybrid seed set was found at Lennox Head where the contact zone overlapped for 20 m (6% and 22% of total seeds sampled for S. pinnatifolius var. pinnatifolius and S. madagascariensis respectively). One hybrid seed was detected at Ballina where a gap of approximately 150 m was present between species (2% of total seeds sampled for S. madagascariensis).
Conclusions
We found no evidence of adult hybrid plants at two shared sites. Hybrid seed set from both species was identified at low levels. Based on these findings we conclude that introgression of adaptive genes from S. pinnatifolius var. pinnatifolius is unlikely to have facilitated S. madagascariensis invasions in Australia. Revisitation of one site after two years could find no remaining S. pinnatifolius var. pinnatifolius, suggesting that contact zones between these species are dynamic and that S. pinnatifolius var. pinnatifolius may be at risk of displacement by S. madagascariensis in coastal areas
Cybersecurity and medical devices: Are the ISO/IEC 80001-2-2 technical controls up to the challenge?
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This author accepted manuscript is made available following 24 month embargo from date of publication (Oct 2017) in accordance with the publisher’s archiving policyMedical devices, in the case of malfunction, can have tangible impact on patient safety. Their security, in a world where the Internet of Things has become a reality, is paramount to the continued safety of patients that are dependent upon these devices. The international standard ISO/IEC 80001 – Application of risk management for IT-networks incorporating medical devices presents a unified and amalgamated approach to the safety of medical devices connected to IT networks. Whilst this standard presents a guide for security and risk management in health delivery organisations, its effectiveness with regard to contemporary cybersecurity is unknown.
This research employed a structured review process to compare and analyse the ISO/IEC 80001 technical controls standards (ISO/IEC 80001-2-2 and ISO/IEC 80001-2-8), with contemporary cybersecurity best practice, guidelines and standards. The research deconstructed the technical controls and drew links between these standards and cybersecurity best practice to assess the level of harmonisation. Subsequently, a deeper analysis identified the areas of omission, coverage, addition or improvement that may impact the effectiveness of ISO/IEC 80001 to provide effective cybersecurity protection.
ISO/IEC 80001 aims to provide a minimal level of cybersecurity however this research demonstrates that there are deficiencies in the standard and identifies the important aspects of cybersecurity that could be improved. This situation has arisen due to the rapidly evolving nature of the cybersecurity environment and the protracted time to revise and republish international standards. This research identified several areas that require urgent consideration, including Emergency Access, Health Data De-Identification, Physical Locks on Devices, Data Backup, Disaster Recovery, Third-Party Components in Product Lifecycle Roadmap, Transmission Confidentiality, and Transmission Integrity. The research will provide health delivery organisations implementing ISO/IEC 80001, assurance as to the level of protection supplied by the ISO/IEC 80001 standard, and the areas that may need enhancement to increase cybersecurity protection and consequently increase in patient safety. Further, the outcomes are expected to influence development of the related international standard, as the findings from this research are being provided to the International Organisations for Standardisation, TC215 Health Informatics, Joint Working Group 7, to inform the review of ISO/IEC 80001 currently in progress
Pathophysiology of swallowing following oropharyngeal surgery for obstructive sleep apnea syndrome
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© 2017 John Wiley & Sons, Inc. All rights reserved.
This author accepted manuscript is made available following 12 month embargo from date of publication (Dec 2017) in accordance with the publisher’s archiving policyBackground
Uvulopalatopharyngoplasty (UPPP) and coblation channeling of the tongue (CCT) are oropharyngeal surgeries used to treat obstructive sleep apnea syndrome. The extent to which UPPP and CCT affect pharyngeal swallow has not been determined. We therefore conducted a novel case series study employing high‐resolution impedance manometry (HRIM) to quantify the swallowing‐related biomechanics following UPPP and/or CCT surgery.
Methods
Twelve patients who underwent UPPP+CCT or CCT only were assessed an average 2.5 years postsurgery. Swallow function data were compared with ten healthy controls. All patients completed the Sydney swallow questionnaire (SSQ). Pharyngeal pressure‐flow analysis of HRIM recordings captured key distension, contractility and pressure‐flow timing swallow parameters testing 5, 10, and 20 mL volumes of thin and thick fluid consistencies.
Key Results
Postoperative patients had more dysphagia symptoms with five returning abnormal SSQ scores. Swallowing was biomechanically altered compared to controls, consistent with diminished swallowing reserve, largely driven by elevated hypopharyngeal intrabolus pressure due to a reduced capacity to open the upper esophageal sphincter to accommodate larger volumes.
Conclusions & Inferences
Patients who have undergone UPPP and/or CCT surgery appear to have a deficiency in normal modulation of the swallowing mechanism and a reduced swallowing functional reserve. We speculate that these changes may become relevant in later life with the onset of age‐related stressors to the swallowing mechanism. This case series strikes a note of caution that further studies are needed to determine the role of preoperative swallow assessment in patients undergoing UPPP and/or CCT surgery
Physiological augmentation of esophageal distension pressure and peristalsis during conditions of increased esophageal emptying resistance.
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© 2017 John Wiley & Sons, Inc. All rights reserved.
This author accepted manuscript is made available following 12 month embargo from date of publication (Nov 2017) in accordance with the publisher’s archiving policyBackground
Abdominal compression has been implemented as a provocative maneuver in high‐resolution impedance manometry (HRIM) to “challenge” normal esophageal physiology with the aim of revealing abnormal motor patterns which may explain symptoms. In this study, we measured the effects of abdominal compression on esophageal functioning utilizing novel pressure‐impedance parameters and attempted to identify differences between healthy controls and globus patients.
Methods
Twenty‐two healthy volunteers (aged 23‐32 years, 41% female) and 22 globus patients (aged 23‐72 years, 68% female) were evaluated with HRIM using a 3.2‐mm water perfused manometric and impedance catheter. All participants received 10 × 5 mL liquid swallows; healthy controls also received 10 × 5 mL liquid swallows with abdominal compression created using an inflatable cuff. All swallows were analyzed to assess esophageal pressure topography (EPT) and pressure‐flow metrics, indicative of distension pressure, flow timing and bolus clearance were derived.
Key Results
The effect of abdominal compression was shown as a greater contractile vigor of the distal esophagus by EPT and higher distension pressure based on pressure‐flow metrics. Age and body mass index also increased contractile vigor and distension pressure. Globus patients were similar to controls.
Conclusions and Interferences
Intrabolus pressure and contractile vigor are indicative of the physiological modulation of bolus transport mechanisms. Provocative testing by abdominal compression induces changes in these esophageal bolus dynamics
Feasibility of a novel participatory multi-sector continuous improvement approach to enhance food security in remote Indigenous Australian communities
Get PDF© 2017 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/).Background
Food insecurity underlies and compounds many of the development issues faced by remote Indigenous communities in Australia. Multi-sector approaches offer promise to improve food security. We assessed the feasibility of a novel multi-sector approach to enhance community food security in remote Indigenous Australia.
Method
A longitudinal comparative multi-site case study, the Good Food Systems Good Food for All Project, was conducted (2009–2013) with four Aboriginal communities. Continuous improvement meetings were held in each community. Data from project documents and store sales were used to assess feasibility according to engagement, uptake and sustainability of action, and impact on community diet, as well as identifying conditions facilitating or hindering these.
Results
Engagement was established where: the community perceived a need for the approach; where trust was developed between the community and facilitators; where there was community stability; and where flexibility was applied in the timing of meetings. The approach enabled stakeholders in each community to collectively appraise the community food system and plan action. Actions that could be directly implemented within available resources resulted from developing collaborative capacity. Actions requiring advocacy, multi-sectoral involvement, commitment or further resources were less frequently used. Positive shifts in community diet were associated with key areas where actions were implemented.
Conclusion
A multi-sector participatory approach seeking continuous improvement engaged committed Aboriginal and non-Aboriginal stakeholders and was shown to have potential to shift community diet. Provision of clear mechanisms to link this approach with higher level policy and decision-making structures, clarity of roles and responsibilities, and processes to prioritise and communicate actions across sectors should further strengthen capacity for food security improvement. Integrating this approach enabling local decision-making into community governance structures with adequate resourcing is an imperative
Simultaneous Assessment of the Efficacy and Toxicity of Marine Mollusc–Derived Brominated Indoles in an In Vivo Model for Early Stage Colon Cancer
Get PDFCreative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-
NonCommercial 3.0 License (http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use,
reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).The acute apoptotic response to genotoxic carcinogens animal model has been extensively used to assess the ability of drugs and natural products like dietary components to promote apoptosis in the colon and protect against colorectal cancer (CRC). This work aimed to use this model to identify the main chemopreventative agent in extracts from an Australian mollusc Dicathais orbita, while simultaneously providing information on their potential in vivo toxicity. After 2 weeks of daily oral gavage with bioactive extracts and purified brominated indoles, mice were injected with the chemical carcinogen azoxymethane (AOM; 10 mg/kg) and then killed 6 hours later. Efficacy was evaluated using immunohistochemical and hematoxylin staining, and toxicity was assessed via hematology, blood biochemistry, and liver histopathology. Comparison of saline- and AOM-injected controls revealed that potential toxic side effects can be interpreted from blood biochemistry and hematology using this short-term model, although AOM negatively affected the ability to detect histopathological effects in the liver. Purified 6-bromoisatin was identified as the main cancer preventive agent in the Muricidae extract, significantly enhancing apoptosis and reducing cell proliferation in the colonic crypts at 0.05 mg/g. There was no evidence of liver toxicity associated with 6-bromoisatin, whereas 0.1 mg/g of the brominated indole tyrindoleninone led to elevated aspartate aminotransferase levels and a reduction in red blood cells. As tyrindoleninone is converted to 6-bromoisatin by oxidation, this information will assist in the optimization and quality control of a chemopreventative nutraceutical from Muricidae. In conclusion, preliminary data on in vivo safety can be simultaneously collected when testing the efficacy of new natural products, such as 6-bromoisatin from Muricidae molluscs for early stage prevention of colon cancer
Taste, choice and timing: Investigating resident and carer preferences for meals in aged care homes
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original work is properly cited and is not used for commercial purposes.There has been little empirical investigation of the preferences of people living in aged care
homes for food services. The aim of the present study was to elicit consumer preferences and
their willingness to pay for food service in aged care homes. Current residents or their family
members were invited to take part in the discrete choice experiment questionnaire administered
via interview. Of the 109 eligible residents and 175 eligible family members approached
for consent 121 (43%) participated, including 43 residents. Participant preferences were influenced
by food taste, choice in relation to serving size, timing of meal selection, visual appeal,
and additional cost. Participants indicated they would be willing to pay an additional 18.42) per week for food which tasted excellent and 6.14) per week to have
choice in serving sizes. The study found that respondents were willing to pay a premium to
receive food that met their expectations of taste, and for a high level of control over serving
sizes, which has implications for the funding and provision of food and dining in long-term care
in the future.This work was supported by the National
Health and Medical Research Council (NHMRC)
Partnership Centre on Dealing with Cognitive
and Related Functional Decline in Older People
(grant no.: GNT9100000)