Topics

Summary

Space flight presents a set of physiological challenges to the space explorer which result from the absence of gravity (or in the case of planetary exploration, partial gravity), radiation exposure, isolation and a prolonged period in a confined environment, distance from Earth, the need to venture outside in the hostile environment of the destination, and numerous other factors.
Gravity affects regional lung function, and the human lung shows considerable alteration in function in low gravity; however, this alteration does not result in deleterious changes that compromise lung function upon return to Earth.
The decompression stress associated with extravehicular activity, or spacewalk, does not appear to compromise lung function, and future habitat (living quarter) designs can be engineered to minimise this stress.
Dust exposure is a significant health hazard in occupational settings such as mining, and exposure to extraterrestrial dust is an almost inevitable consequence of planetary exploration. The combination of altered pulmonary deposition of extraterrestrial dust and the potential for the dust to be highly toxic likely makes dust exposure the greatest threat to the lung in planetary exploration.

University of California, San Diego, La Jolla, CA, USA

Correspondence: kprisk@ucsd.edu

Acknowledgements:

Many of the studies were funded by the National Aeronautics and Space Administration (NASA) and the National Space Biomedical Research Institute under various contracts and grants. G Kim Prisk is currently funded by the National Institutes of Health under R01 HL119263.

Competing interests:

No relevant disclosures.

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Editorials

Preventing RhD haemolytic disease of the fetus and newborn: where to next?

James P Isbister and Amanda Thomson

Med J Aust 2019; 211 (6): . || doi: 10.5694/mja2.50325
Published online: 16 September 2019

ARTICLE
AUTHORS
REFERENCES

Non‐invasive fetal RhD genotyping will enable ethical and cost‐effective targeting of prophylaxis

There are many unique and inspiring aspects to the story of haemolytic disease of the fetus and newborn. This once common, mysterious, and potentially devastating disease has been known for centuries. It may have been the reason for the shocking obstetric history of Katherine of Aragon, the first wife of Henry VIII; the course of British history might have been very different had anti‐RhD been available in Tudor England.1

1 Sydney Medical School, Sydney, NSW
2 Australian Red Cross Blood Service, Sydney, NSW

Correspondence: james.isbister@sydney.edu.au

Competing interests:

James Isbister is a member of the Independent Advisory Committee of the Australian Red Cross Blood Service and Chair of the National Blood Authority Patient Blood Management Implementation Steering Committee. Amanda Thompson is a member of the National Blood Authority expert reference group for development of a clinical practice guideline on the use of RhD immunoglobulin in maternity care.

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Perspectives

Public health and economic perspectives on acute rheumatic fever and rheumatic heart disease

Jeffrey Cannon, Dawn C Bessarab, Rosemary Wyber and Judith M Katzenellenbogen

Med J Aust 2019; 211 (6): . || doi: 10.5694/mja2.50318
Published online: 16 September 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Cardiovascular diseases

Indigenous health

Health services administration

Environment and public health

With the care costs for the thousands of new cases predicted to occur by 2031, can we afford “business as usual”?

The group A streptococcus (GAS) bacterium causes possibly the most diverse range of diseases compared with any other pathogen. Resulting from an autoimmune reaction to GAS throat infection, and possibly skin infection, acute rheumatic fever (ARF) and its common consequence of rheumatic heart disease (RHD) have been described as “diseases of poverty” because they are highly prevalent in socio‐economic disadvantaged settings.1 Although there is a clear gradient between disease prevalence and socio‐economic disadvantage, ARF and RHD were once also prevalent in low and high socio‐economic settings, including in Melbourne, among non‐Indigenous Australians during the 1930s and 1940s.2 That ARF rarely, if at all, occurs in modern Melbourne is testament to the reality that ARF and RHD can be eliminated Australia‐wide, but what will elimination of ARF and RHD take and can we afford “business as usual”?

1 Telethon Kids Institute, Perth, WA
2 Centre for Aboriginal Medical and Dental Health, University of Western Australia, Perth, WA
3 George Institute for Global Health, Sydney, NSW
4 Western Australian Centre for Rural Health, University of Western Australia, Perth, WA
5 Group A Streptococcus and Rheumatic Heart Disease Research Group, Telethon Kids Institute, Perth, WA

Correspondence: jeffrey.cannon@telethonkids.org.au

Competing interests:

No relevant disclosures.

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Research

Paracetamol poisoning‐related hospital admissions and deaths in Australia, 2004–2017

Rose Cairns, Jared A Brown, Claire E Wylie, Andrew H Dawson, Geoffrey K Isbister and Nicholas A Buckley

Med J Aust 2019; 211 (5): . || doi: 10.5694/mja2.50296
Published online: 2 September 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Emergency medicine

Poisoning

Pharmaceutical preparations

Digestive system diseases

Mental disorders

Environment and public health

Abstract

Objectives: To assess the numbers of paracetamol overdose‐related hospital admissions and deaths in Australia since 2007–08, and the overdose size of intentional paracetamol overdoses since 2004.

Design, setting: Retrospective analysis of data on paracetamol‐related exposures, hospital admissions, and deaths from the Australian Institute of Health and Welfare National Hospital Morbidity Database (NHMD; 2007–08 to 2016–17), the New South Wales Poisons Information Centre (NSWPIC; 2004–2017), and the National Coronial Information System (NCIS; 2007–08 to 2016–17).

Participants: People who took overdoses of paracetamol in single ingredient preparations.

Main outcome measures: Annual numbers of reported paracetamol‐related poisonings, hospital admissions, and deaths; number of tablets taken in overdoses.

Results: The NHMD included 95 668 admissions with paracetamol poisoning diagnoses (2007–08 to 2016–17); the annual number of cases increased by 44.3% during the study period (3.8% per year; 95% CI, 3.2–4.6%). Toxic liver disease was documented for 1816 of these patients; the annual number increased by 108% during the study period (7.7% per year; 95% CI, 6.0–9.5%). The NSWPIC database included 22 997 reports of intentional overdose with paracetamol (2004–2017); the annual number increased by 77.0% during the study period (3.3% per year; 95% CI, 2.5–4.2%). The median number of tablets taken increased from 15 (IQR, 10–24) in 2004 to 20 (IQR, 10–35) in 2017. Modified release paracetamol ingestion report numbers increased 38% between 2004 and 2017 (95% CI, 30–47%). 126 in‐hospital deaths were recorded in the NHMD, and 205 deaths (in‐hospital and out of hospital) in the NCIS, with no temporal trends.

Conclusions: The frequency of paracetamol overdose‐related hospital admissions has increased in Australia since 2004, and the rise is associated with greater numbers of liver injury diagnoses. Overdose size and the proportion of overdoses involving modified release paracetamol have each also increased.

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1 NSW Poisons Information Centre, Children's Hospital at Westmead, Sydney, NSW
2 University of Sydney, Sydney, NSW
3 Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW
4 Royal Prince Alfred Hospital, Sydney, NSW
5 University of Newcastle, Newcastle, NSW
6 Calvary Mater Newcastle, Newcastle, NSW

Correspondence: rose.cairns@health.nsw.gov.au

Acknowledgements:

This study was supported by a National Health and Medical Research Council Program Grant (1055176). We acknowledge the Australian Institute of Health and Welfare for providing the National Hospital Morbidity Database data, and the National Coronial Information System (NCIS), managed by the Victorian Department of Justice and Community Safety, for providing the coronial data. We thank the staff of the New South Wales Poisons Information Centre for their contributions to the NSWPIC database.

Competing interests:

No relevant disclosures.

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19. The Acetaminophen Hepatotoxicity Working Group. Recommendations for FDA interventions to decrease the occurrence of acetaminophen hepatotoxicity [report]. Feb 2008. https://www.litigationandtrial.com/files/2011/12/2009-4429b1-02-FDA.pdf (viewed Nov 2018).
20. Gunnell D, Hawton K, Murray V, et al. Use of paracetamol for suicide and non‐fatal poisoning in the UK and France: are restrictions on availability justified? J Epidemiol Community Health 1997; 51: 175–179.
21. Australian Department of Health, Therapeutic Goods Administration. Paracetamol: changes to pack size [media release]. 26 Aug 2013. https://www.tga.gov.au/media-release/paracetamol-changes-pack-size (viewed July 2019).
22. Chiew AL, Isbister GK, Page CB, et al. Modified release paracetamol overdose: a prospective observational study (ATOM‐3). Clin Toxicol 2018; 56: 810–819.
23. European Medicines Agency. Modified‐release paracetamol‐containing products to be suspended from EU market [EMA/118413/2018]. 19 Feb 2018. https://www.ema.europa.eu/medicines/human/referrals/paracetamol-modified-release (viewed Nov 2018).
24. Australian Department of Health, Therapeutic Goods Administration. Interim decision in relation to paracetamol (modified release) [Interim decisions and invitation for further comment on substances referred to the March 2019 ACMS/ACCS meetings]. 6 June 2019. https://www.tga.gov.au/book-page/15-interim-decision-relation-paracetamol-modified-release (viewed July 2019).
25. New South Wales Poisons Information Centre. 2013 annual report. https://www.poisonsinfo.nsw.gov.au/site/files/ul/data_text12/4918535-NSWPIC_Annual_Report_2013.pdf (viewed July 2019).

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Research

The increasing use of shave biopsy for diagnosing invasive melanoma in Australia

Sara L de Menezes, John W Kelly, Rory Wolfe, Helen Farrugia and Victoria J Mar

Med J Aust 2019; 211 (5): . || doi: 10.5694/mja2.50289
Published online: 2 September 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Neoplasms

Surgical procedures, operative

Immune system diseases

General medicine

Abstract

Objective: To assess changes in the choice of skin biopsy technique for assessing invasive melanoma in Victoria, and to examine the impact of partial biopsy technique on the accuracy of tumour microstaging.

Design: Retrospective cross‐sectional review of Victorian Cancer Registry data on invasive melanoma histologically diagnosed in Victoria during 2005, 2010, and 2015.

Setting, participants: 400 patients randomly selected from each of the three years, stratified by final tumour thickness: 200 patients with thin melanoma (< 1.0 mm), 100 each with intermediate (1.0–4.0 mm) and thick melanoma (> 4.0 mm).

Main outcome measures: Partial and excisional biopsies, as proportions of all skin biopsies; rates of tumour base transection and T‐upstaging, and mean tumour thickness underestimation following partial biopsy.

Results: 833 excisional and 337 partial diagnostic biopsies were undertaken. The proportion of partial biopsies increased from 20% of patients in 2005 to 36% in 2015 (P < 0.001); the proportion of shave biopsies increased from 9% in 2005 to 20% in 2015 (P < 0.001), with increasing rates among dermatologists and general practitioners. Ninety‐four of 175 shave biopsies (54%) transected the tumour base; wide local excision subsequently identified residual melanoma in 65 of these cases (69%). Twenty‐one tumours diagnosed by shave biopsy (12%) were T‐upstaged. With base‐transected shave biopsies, tumour thickness was underestimated by a mean 2.36 mm for thick, 0.48 mm for intermediate, and 0.07 mm for thin melanomas.

Conclusion: Partial biopsy, particularly shave biopsy, was increasingly used for diagnosing invasive melanoma between 2005 and 2015. Shave biopsy has a high rate of base transection, reducing the accuracy of tumour staging, which is crucial for planning appropriate therapy, including definitive surgery and adjuvant therapy.

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1 Victorian Melanoma Service, Alfred Hospital, Melbourne, VIC
2 Monash University Central Clinical School, Melbourne, VIC
3 Victorian Cancer Registry, Cancer Council Victoria, Melbourne, VIC
4 Skin and Cancer Foundation, Melbourne, VIC

Correspondence: victoria.mar@monash.edu

Acknowledgements:

We acknowledge the staff at the Victorian Melanoma Service, Alfred Hospital, and the Victorian Cancer Registry for their support, which made this investigation possible.

Competing interests:

Victoria Mar received honoraria (speaker’s fees) from Bristol Myers Squibb and Merck in 2018 for work unrelated to this article.

1. Ng JC, Swain S, Dowling JP, et al. The impact of partial biopsy on histopathologic diagnosis of cutaneous melanoma: experience of an Australian tertiary referral service. Arch Dermatol 2010; 146: 234–239.
2. Cancer Council Australia; Melanoma Guidelines Working Party. Clinical practice guidelines for the diagnosis and management of melanoma. Updated Apr 2018. https://wiki.cancer.org.au/australia/Guidelines:Melanoma (viewed May 2019).
3. Swetter SM, Tsao H, Bichakjian CK, et al. American Academy of Dermatology. Guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol 2019; 80: 208–250.
4. National Institute for Health and Care Excellence. Melanoma: assessment and management [NICE guideline NG14]. July 2015; update 23 May 2019. https://www.nice.org.uk/guidance/ng14/evidence (viewed June 2019).
5. Kelly JW, Henderson MA, Thursfield VJ, et al. The management of primary cutaneous melanoma in Victoria in 1996 and 2000. Med J Aust 2007; 187: 511–514. https://www.mja.com.au/journal/2007/187/9/management-primary-cutaneous-melanoma-victoria-1996-and-2000.
6. Egnatios GL, Dueck AC, Macdonald JB, et al. The impact of biopsy technique on upstaging, residual disease, and outcome in cutaneous melanoma. Am J Surg 2011; 202: 771–777.
7. Mir M, Chan CS, Khan F, et al. The rate of melanoma transection with various biopsy techniques and the influence of tumor transection on patient survival. J Am Acad Dermatol 2013; 68: 452–458.
8. Zager JS, Hochwald SN, Marzban SS, et al. Shave biopsy is a safe and accurate method for the initial evaluation of melanoma. J Am Coll Surg 2011; 212: 454–460.
9. Hieken TJ, Hernandez‐Irizarry R, Boll JM, et al. Accuracy of diagnostic biopsy for cutaneous melanoma: implications for surgical oncologists. Int J Surg Oncol 2013; 2013: 196493.
10. Lowe M, Hill N, Page A, et al. The impact of shave biopsy on the management of patients with thin melanomas. Am Surg 2011; 77: 1050–1053.
11. Mills JK, White I, Diggs B, et al. Effect of biopsy type on outcomes in the treatment of primary cutaneous melanoma. Am J Surg 2013; 205: 585–590.
12. Mahul B Amin. American Joint Committee on Cancer. AJCC cancer staging manual. New York: Springer, 2017.
13. Long GV, Hauschild A, Santinami M, et al. Adjuvant dabrafenib plus trametinib in stage III BRAF‐mutated melanoma. N Engl J Med 2017; 377: 1813–1823.
14. Weber J, Mandala M, Del Vecchio M, et al. Adjuvant nivolumab versus ipilimumab in resected stage III or IV melanoma. N Engl J Med 2017; 377: 1824–1835.
15. Cancer Council Victoria. Victorian Cancer Statistics. http://vcrdata.cancervic.org.au/vs (viewed May 2019).
16. Saco M, Thigpen J. A retrospective comparison between preoperative and postoperative Breslow depth in primary cutaneous melanoma: how preoperative shave biopsies affect surgical management. J Drugs Dermatol 2014; 13: 531–536.
17. Farberg AS, Rigel DS. A comparison of current practice patterns of US dermatologists versus published guidelines for the biopsy, initial management, and follow up of patients with primary cutaneous melanoma. J Am Acad Dermatol 2016; 75: 1193–1197.e1.
18. Silverstein D, Mariwalla K. Biopsy of the pigmented lesions. Dermatol Clin 2012; 30: 435–443.
19. Lutz K, Hayward V, Joseph M, et al. Current biopsy practices for suspected melanoma: a survey of family physicians in Southwestern Ontario. Plast Surg 2014; 22: 175–178.
20. Troxel DB. Pitfalls in the diagnosis of malignant melanoma: findings of a risk management panel study. Am J Surg Pathol 2003; 27: 1278–1283.
21. Ng PC, Barzilai DA, Ismail SA, et al. Evaluating invasive cutaneous melanoma: is the initial biopsy representative of the final depth? J Am Acad Dermatol 2003; 48: 420–424.
22. Merck Sharp & Dohme Corp. Safety and efficacy of pembrolizumab compared to placebo in resected high‐risk stage III melanoma (MK‐3475‐716/KEYNOTE‐716). Clinicaltrials.gov; updated 14 June 2019. https://www.clinicaltrials.gov/ct2/show/NCT03553836 (viewed June 2019).
23. Patrawala S, Maley A, Greskovich C, et al. Discordance of histopathologic parameters in cutaneous melanoma: clinical implications. J Am Acad Dermatol 2016; 74: 75–80.
24. Karimipour DJ, Schwartz JL, Wang TS, et al. Microstaging accuracy after subtotal incisional biopsy of cutaneous melanoma. J Am Acad Dermatol 2005; 52: 798–802.

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Perspectives

Integrating palliative care and symptom relief into responses to humanitarian crises

Eric L Krakauer, Bethany‐Rose Daubman and Tammam Aloudat

Med J Aust 2019; 211 (5): . || doi: 10.5694/mja2.50295
Published online: 2 September 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Palliative care

The medical and moral imperative that palliative care be integrated into standard responses to humanitarian crises can be fulfilled by basic training and an essential set of medicines, equipment, social support and protocols

Humanitarian crises often cause both extensive loss of life and widespread suffering. Yet humanitarian crisis response virtually never fully integrates palliative care, the discipline devoted to preventing and relieving suffering. Recently, the World Health Organization (WHO) recognised the necessity of integrating palliative care and symptom relief into responses to humanitarian crises of all types and published a guide to this integration.1 In this article, we summarise the WHO recommendations, explain why inclusion of palliative care as an essential part of humanitarian response is medically and morally imperative, and describe how to ensure that palliative care is accessible for those affected by humanitarian crises.

1 Massachusetts General Hospital, Boston, MA, USA
2 Médecins Sans Frontières, Geneva, Switzerland

Correspondence: eric_krakauer@hms.harvard.edu

Competing interests:

No relevant disclosures.

1. Krakauer E, editor. Integrating palliative care and symptom relief into the response to humanitarian emergencies and crises: a WHO guide. Geneva: World Health Organization, 2018. http://apps.who.int/iris/bitstream/handle/10665/274565/9789241514460-eng.pdf (viewed July 2019).
2. United Nations Office for the Coordination of Humanitarian Affairs. World humanitarian data and trends 2018. Geneva: UNOCHA, 2018. http://interactive.unocha.org/publication/datatrends2018/ (viewed July 2019).
3. World Health Organization. WHO definition of palliative care. https://www.who.int/cancer/palliative/definition/en/ (viewed July 2019).
4. Smith J, Aloudat T. Palliative care in humanitarian medicine. Palliat Med 2017; 31: 99–101.
5. Schneider M, Pautex S, Chappuis F. What do humanitarian emergency organizations do about palliative care? A systematic review. Med Conflict Survival 2017; 33: 263–272.
6. International Committee of the Red Cross. Fundamental principles of the Red Cross and Red Crescent Movement. https://www.icrc.org/en/fundamental-principles (viewed July 2019).
7. Sphere Association. The Sphere handbook: humanitarian charter and minimum standards in humanitarian response. 4th ed. Geneva: Sphere Association, 2018. www.spherestandards.org/handbook (viewed July 2019).
8. Beauchamp TL, Childress JF. Principles of biomedical ethics. 7th ed. New York: Oxford University Press, 2012.
9. Holbrook TL, Galarneau MR, Dye JL, et al. Morphine use after combat injury in Iraq and post‐traumatic stress disorder. N Engl J Med 2010; 362: 110–117.
10. Joshi GP, Beck DE, Emerson R, et al. Defining new directions for more effective management of surgical pain in the United States: highlights of the inaugural surgical pain congress. Am Surg 2014; 80: 219–228.
11. Mollica RF. Invisible wounds: Medical researchers have recently begun to address the mental health effects of war on civilians. Sci Am 2000; 282: 54–57.
12. World Health Organization and International Committee of the Red Cross. WHO/ICRC technical meeting for global consensus on triage, 11‐12 January 2017. Meeting report. https://www.humanitarianresponse.info/sites/www.humanitarianresponse.info/files/documents/files/triage_2017_meeting_report-b.pdf (viewed July 2019).
13. Inter‐Agency Standing Committee. IASC guidelines on mental health and psychosocial support in emergency settings. Geneva: IASC, 2007. https://www.who.int/mental_health/emergencies/9781424334445/en/ (viewed July 2019).
14. World Health Organization and United Nations High Commissioner for Refugees. mhGAP humanitarian intervention guide: clinical management of mental, neurological and substance use conditions in humanitarian emergencies. Geneva: WHO, 2015. http://www.who.int/mental_health/publications/mhgap_hig/en/ (viewed July 2019).
15. World Health Organization, War Trauma Foundation and World Vision International. Psychological first aid: guide for field workers. Geneva: WHO, 2011. https://www.who.int/mental_health/publications/guide_field_workers/en/ (viewed July 2019).

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Perspectives

Adolescent immunisation in young people with disabilities in Australia

Jenny O'Neill, Fiona Newall, Giuliana Antolovich, Sally Lima and Margie H Danchin

Med J Aust 2019; 211 (5): . || doi: 10.5694/mja2.50293
Published online: 2 September 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

Mental disorders

Pediatric medicine

More research is needed to understand the barriers to optimal adolescent immunisation for students with disabilities

The benefits of immunisation in preventing or reducing the severity of vaccine‐preventable diseases and eliminating or reducing the risk of associated complications have been well documented. Importantly, immunisation is also a powerful means by which the inequity of poor health can be reduced, particularly in vulnerable groups that have a high burden of infectious diseases. This has been illustrated in immunisation research in refugees and other migrants, as well as in Aboriginal and Torres Strait Islander Australians, and in low income or resource poor settings.1,2,3,4,5 However, there is a paucity of research about immunisation for people with disabilities, another medically at‐risk and socially marginalised group.

1 University of Melbourne, Melbourne, VIC
2 Royal Children's Hospital, Melbourne, VIC
3 Murdoch Children's Research Institute, Melbourne, VIC
4 Bendigo Health, Bendigo, VIC

Correspondence: jenny.oneill@rch.org.au

Competing interests:

No relevant disclosures.

1. Crowcroft NS, Hamid JS, Deeks SL, et al. Human papillomavirus vaccination programs reduce health inequity in most scenarios: a simulation study. BMC Public Health 2012; 12: 935–943.
2. Batista Ferrer H, Trotter CL, Hickman M, et al. Barriers and facilitators to uptake of the school‐based HPV vaccination programme in an ethnically diverse group of young women. J Public Health 2016; 38: 569–577.
3. Barbaro B, Brotherton JM. Assessing HPV vaccine coverage in Australia by geography and socioeconomic status: are we protecting those most at risk? Aust NZ J Public Health 2014; 38: 419–423.
4. Abbott P, Menzie R, Davison J, et al. Improving immunisation timeliness in Aboriginal children through personalised calendars. BMC Public Health 2013; 13: 598–605.
5. Paxton G, Spink P, Casey S, Graham H. A needs analysis of catch‐up immunisation in refugee background and asylum seeker communities in Victoria. Melbourne: Victorian Refugee Health Network, 2014. http://refugeehealthnetwork.org.au/a-needs-analysis-of-catch-up-immunisation-in-refugee-background-and-asylum-seeker-communities-in-victoria/ (viewed July 2019).
6. Haider SI, Ansari Z, Vaughan L, et al. Health and wellbeing of Victorian adults with intellectual disability compared to the general Victorian population. Res Dev Disabil 2013; 34: 4034–4042.
7. Cobigo V, Ouelletee‐Kuntz H, Balogh R, et al. Are cervical and breast cancer screening programmes equitable? The case of women with intellectual and developmental disabilities. J Intellect Disabil Res 2013; 57: 478–488.
8. Cameron JC, Allan G, Johnston F, et al. Severe complications of chickenpox in hospitalised children in the UK and Ireland. Arch Dis Child 2007; 92(12): 1062–1066.
9. Public Health England. National congenital anomaly and rare disease registration service: congenital anomaly statistics 2016. London: PHE, 2018. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/751553/Congenital_anomaly_statistics_2016.pdf (viewed Mar 2019).
10. European Commission. EUROCAT data: prevalence charts and tables. https://eu-rd-platform.jrc.ec.europa.eu/eurocat/eurocat-data/prevalence; (viewed July 2019).
11. Sachedina N, Donaldson LA. Paediatric mortality related to pandemic influenza A H1N1 infection in England: an observational population‐based study. Lancet 2010; 376: 1846–1852.
12. Council of Australian Governments. National Partnership Agreement on Essential Vaccines. Canberra: COAG, 2009. http://www.federalfinancialrelations.gov.au/content/npa/health/_archive/essential_vaccines/national_partnership.pdf (viewed May 2017).
13. Australian Government Department of Health. National Immunisation Program Schedule: state and territory schedules. https://beta.health.gov.au/health-topics/immunisation/immunisation-throughout-life/national-immunisation-program-schedule (viewed July 2019).
14. Government of South Australia. Meningococcal B Immunisation Program. https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+topics/health+conditions+prevention+and+treatment/immunisation/immunisation+programs/meningococcal+b+immunisation+program (viewed July 2019).
15. Australian Bureau of Statistics. 4102.0 – Australian social trends, Jun 2012. Children with a disability. Canberra: ABS, 2012. https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features30Jun+2012#Children (viewed Dec 2016).
16. O'Neill J, Elia S, Perrett KP. Human papillomavirus uptake in adolescents with developmental disabilities. J Intellect Dev Disabil 2019; 44: 98–102.
17. O'Neill J, Newall F, Antolovich G, et al. The uptake of adolescent vaccinations through the School Immunisation Program in specialist schools in Victoria, Australia. Vaccine 2019; 37: 272–279.
18. Weinholz S, Seidel A, Michel M, et al. Sexual experiences of adolescents with and without disabilities. Results from a cross‐sectional study. Sex Disabil 2016; 34: 171–182.
19. Jones L, Bellis MA, Wood S, et al. Prevalence and risk of violence against children with disabilities: a systematic review and meta‐analysis of observational studies. Lancet 2012; 380: 899–907.
20. Servais L. Sexual health care in persons with intellectual disabilities. MRDD Res Rev 2006; 12: 48–56.

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Research

The Australian Aboriginal Birth Cohort study: socio‐economic status at birth and cardiovascular risk factors to 25 years of age

Markus Juonala, Pauline Sjöholm, Katja Pahkala, Susan Ellul, Noora Kartiosuo, Belinda Davison and Gurmeet R Singh

Med J Aust 2019; 211 (6): . || doi: 10.5694/mja2.50285
Published online: 26 August 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Cardiovascular diseases

Social determinants of health

Indigenous health

Pediatric medicine

Abstract

Objectives: To determine whether socio‐economic status at birth is associated with differences in risk factors for cardiovascular disease — body mass index (BMI), blood pressure, blood lipid levels — during the first 25 years of life.

Design: Analysis of prospectively collected data.

Setting, participants: 570 of 686 children born to Aboriginal mothers at the Royal Darwin Hospital during 1987–1990 and recruited for the Aboriginal Birth Cohort Study in the Northern Territory. Participants resided in 46 urban and remote communities across the NT. The analysed data were collected at three follow‐ups: Wave 2 in 1998–2001 (570 participants; mean age, 11 years), Wave 3 in 2006–2008 (442 participants; mean age, 18 years), and Wave 4 in 2014–2016 (423 participants; mean age, 25 years).

Main outcome measures: Cardiovascular disease risk factors by study wave and three socio‐economic measures at the time of birth: area‐level Indigenous Relative Socioeconomic Outcomes (IRSEO) index score and location (urban, remote) of residence, and parity of mother.

Results: Area‐level IRSEO of residence at birth influenced BMI (P < 0.001), systolic blood pressure (P = 0.024), LDL‐cholesterol (P = 0.010), and HDL‐cholesterol levels (P < 0.001). Remoteness of residence at birth influenced BMI (P < 0.001), HDL‐cholesterol (P < 0.001), and triglyceride levels (P = 0.043). Mother's parity at birth influenced BMI (P = 0.039).

Conclusions: Our longitudinal life course analyses indicate that area‐level socio‐economic factors at birth influence the prevalence of major cardiovascular disease risk factors among Indigenous Australians during childhood and early adulthood.

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1 Turun Yliopisto (University of Turku), Turku, Finland
2 Turku University Hospital, Turku, Finland
3 Murdoch Children's Research Institute, Melbourne, VIC
4 Research Centre of Applied and Preventive Cardiovascular Medicine, Turun Yliopisto, Turku, Finland
5 Menzies School of Health Research, Darwin, NT

Correspondence: mataju@utu.fi

Acknowledgements:

We acknowledge past and present study team members, particularly the late Susan Sayers AO, founder of the Aboriginal Birth Cohort study. We especially thank the young adults in the Aboriginal Birth Cohort and their families and communities for their cooperation and support, and all the individuals who helped in urban and rural locations. The investigation was supported by the National Health and Medical Research Council, the Channel 7 Children's Research Foundation of South Australia, the National Heart Foundation, a Northern Territory Government Research and Innovation Grant, the Juho Vainio Foundation, the Turku University Hospital, and the Finnish Foundation for Cardiovascular Research. The sponsors had no role in preparing the manuscript.

Competing interests:

No relevant disclosures.

1. Capewell S, O'Flaherty M. What explains declining coronary mortality? Lessons and warnings. Heart 2008; 94: 1105–1108.
2. Australian Institute of Health and Welfare. The health and welfare of Australia's Aboriginal and Torres Strait Islander Peoples: 2015 (Cat No. IHW 147). Canberra: AIHW, 2015.
3. Naska A, Katsoulis M, Trichopoulos D, Trichopoulou A. The root causes of socioeconomic differentials in cancer and cardiovascular mortality in Greece. Eur J Cancer Prev 2012; 21: 490–496.
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5. Diez Roux AV, Merkin SS, Arnett D, et al. Neighborhood of residence and incidence of coronary heart disease. New Engl J Med 2001; 345: 99–106.
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7. Kivimäki M, Vahtera J, Tabák AG, et al. Neighbourhood socioeconomic disadvantage, risk factors, and diabetes from childhood to middle age in the Young Finns Study: a cohort study. Lancet Public Health 2018; 3: e365–e373.
8. Sayers SM, Mackerras D, Singh G, et al. An Australian Aboriginal birth cohort: a unique resource for a life course study of an Indigenous population. A study protocol. BMC Int Health Hum Rights 2003; 3: 1.
9. Sayers S, Singh G, Mackerras D, et al. Australian Aboriginal Birth Cohort study: follow‐up processes at 20 years. BMC Int Health Hum Rights 2009; 9: 23.
10. Biddle N. Socioeconomic outcomes (CAEPR Indigenous Population Project 2011 census papers, paper 13). Canberra: Centre for Aboriginal Economic Policy Research, Australia National University, 2013. http://caepr.cass.anu.edu.au/research/publications/socioeconomic-outcomes (viewed June 2019).
11. Kakinami L, Serbin LA, Stack DM, et al. Neighbourhood disadvantage and behavioural problems during childhood and the risk of cardiovascular disease risk factors and events from a prospective cohort. Prev Med Rep 2017; 8: 294–300.
12. O'Neal DN, Piers LS, Iser DM, et al. Australian Aboriginal people and Torres Strait Islanders have an atherogenic lipid profile that is characterised by low HDL‐cholesterol level and small LDL particles. Atherosclerosis 2008; 201: 368–377.
13. McCarthy K, Cai LB, Xu FR, et al. Urban–rural differences in cardiovascular disease risk factors: a cross‐sectional study of schoolchildren in Wuhan, China. PLoS One 2015; 10: e0137615.
14. Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 2012; 70: 3–21.
15. Brimblecombe JK, O'Dea K. The role of energy cost in food choices for an Aboriginal population in northern Australia. Med J Aust 2009; 190: 549–551. https://www.mja.com.au/journal/2009/190/10/role-energy-cost-food-choices-aboriginal-population-northern-australia
16. Saiz AM, Aul AM, Malecki KM, et al. Food insecurity and cardiovascular health: findings from a statewide population health survey in Wisconsin. Prev Med 2016; 93: 1–6.
17. Shin JI, Bautista LE, Walsh MC, et al. Food insecurity and dyslipidemia in a representative population‐based sample in the US. Prev Med 2015; 77: 186–190.
18. Wycherley TP, Pekarsky BA, Ferguson MM, et al. Fluctuations in money availability within an income cycle impacts diet quality of remote Indigenous Australians. Public Health Nutr 2017; 20: 1431–1440.
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25. Emerging Risk Factors Collaboration; Di Angelantonio E, Sarwar N, Perry P, et al. Major lipids, apolipoproteins, and risk of vascular disease. JAMA 2009; 302: 1993–2000.

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Pulmonary challenges of prolonged journeys to space: taking your lungs to the moon

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Summary

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Preventing RhD haemolytic disease of the fetus and newborn: where to next?

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Public health and economic perspectives on acute rheumatic fever and rheumatic heart disease

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Paracetamol poisoning‐related hospital admissions and deaths in Australia, 2004–2017

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Abstract

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The increasing use of shave biopsy for diagnosing invasive melanoma in Australia

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Abstract

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Integrating palliative care and symptom relief into responses to humanitarian crises

Topics

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Adolescent immunisation in young people with disabilities in Australia

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The Australian Aboriginal Birth Cohort study: socio‐economic status at birth and cardiovascular risk factors to 25 years of age

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Adherence to screen time recommendations for Australian children aged 0–12 years

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Antibiotic use in animals and humans in Australia

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Pulmonary challenges of prolonged journeys to space: taking your lungs to the moon

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Preventing RhD haemolytic disease of the fetus and newborn: where to next?

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Do you have any competing interests to declare? *

Public health and economic perspectives on acute rheumatic fever and rheumatic heart disease

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Paracetamol poisoning‐related hospital admissions and deaths in Australia, 2004–2017

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Author

Comment

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The increasing use of shave biopsy for diagnosing invasive melanoma in Australia

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Abstract

Author

Comment

Do you have any competing interests to declare? *

Integrating palliative care and symptom relief into responses to humanitarian crises

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Author

Comment

Do you have any competing interests to declare? *

Adolescent immunisation in young people with disabilities in Australia

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Comment

Do you have any competing interests to declare? *

The Australian Aboriginal Birth Cohort study: socio‐economic status at birth and cardiovascular risk factors to 25 years of age

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Adherence to screen time recommendations for Australian children aged 0–12 years

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Antibiotic use in animals and humans in Australia

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Pagination