Risk factors for renal disease and diabetes in remote Australia - findings from The Western Desert Kidney Health Project.

INTRODUCTION: The Western Desert Kidney Health Project (WDKHP) aimed to determine the prevalence of type 2 diabetes (T2DM), kidney disease and associated risk factors in Aboriginal and non-Aboriginal people in a remote area of Western Australia. METHODS: The project, featuring whole-of-community cross-sectional surveys and health assessments using point-of-care testing, was conducted in five small towns and six remote Aboriginal communities in the Goldfields of Western Australia between 2010 and 2014. Initial health assessments were completed by 597 adults (424 Aboriginal) and 502 children (393 Aboriginal). This included almost 80% of the Aboriginal population. All non-Aboriginal people residing in the six remote Aboriginal communities participated. RESULTS: Risk factors for renal disease and T2DM were present in participants of all ages, including children as young as 2 years. There was no significant difference between Aboriginal and non-Aboriginal children. Aboriginal and non-Aboriginal adult participants had twice the burden of T2DM than the standard Australian population. More than 12% of all children had elevated albumin-creatinine ratio (ACR). Adults had markers of kidney disease at higher rates than expected: 51% of Aboriginal adults and 27% of non-Aboriginal adults had at least one marker of kidney disease (haematuria, proteinuria or elevated ACR). Aboriginal women were the highest risk group (32% T2DM, 40% elevated ACR). Haematuria and low urine pH were common findings, 21% of people had haematuria (greater than trace) and 71% had urine pH of 6 or less; there was no difference in this finding between Aboriginal and non-Aboriginal people. CONCLUSION: The WDKHP found higher than expected rates of risk factors for T2DM and renal disease compared with Australian Bureau of Statistics rates for Australian Aboriginal and non-Aboriginal adults and children, with Aboriginal women the highest risk group. The rates for non-Aboriginal participants were higher than expected, suggesting exposures in common might be more important than ethnicity.The high prevalence of aciduria and haematuria found in both Aboriginal and non-Aboriginal participants in this study suggests that factors contributing to a chronic metabolic acidosis and inflammation or irritation of the urinary tract need to be explored. Drinking water quality in this remote area is known to be poor and may be an important contributing factor. Many of the contributing factors are potentially modifiable - such as water quality, food supply, exercise opportunities and living conditions - offering scope for interventions to reduce the risk and burden of these diseases.

Preparation of matrix-matched standards for the analysis of teeth via laser ablation-inductively coupled plasma-mass spectrometry.

Mineralised tissue such as teeth can serve as a retrospective, chronological bioindicator of past exposure to toxic metals. Laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) can be used to determine the presence and spatial distribution of toxic metals in teeth, giving a record of when an exposure occurred. Concentrations of these metals are often determined by a one-point calibration against NIST glass using an equation that requires an internal standard factor that accounts for differences in ablation behaviour between the glass and the tooth. However, an ideal external calibration would contain multiple matrix-matched standards to obtain a calibration curve. Here, we investigated optimal procedures for preparing synthetic hydroxyapatite (HA) doped with elements of interest as a calibration material. The materials were examined for homogeneity of metal incorporation, matrix-matched ablation characteristics, linearity, and limits of detection. A homogenised and pelleted HA was the most suitable material, providing improved ablation characteristics over previous HA materials and NIST glass for the analysis of teeth. An ablation yield of 1.1 showed its suitability to analyse teeth, the metals were homogeneously incorporated, and it produced excellent linearity with limits of detection ranging from 0.1-2 µg kg-1 for magnesium, aluminium, nickel, copper, zinc, cadmium, barium and lead. A juvenile incisor from a remote indigenous community in Australia and an adult molar from Sri Lanka were assessed for toxic metal exposure. The molar showed evidence of exposure to cadmium and lead. The synthetic HA material was straightforward to prepare, and will improve confidence in the analysis of teeth and other biomineralised material when assessing toxic metal exposure.

Positive community responses to an arts-health program designed to tackle diabetes and kidney disease in remote Aboriginal communities in Australia: a qualitative study.

OBJECTIVE: The Western Desert Kidney Health Project (WDKHP) is an innovative clinical screening, arts-health and community development program, staffed by Aboriginal health workers. The WDKHP is aimed at prevention and early detection, improving the chance of better management of kidney disease among people in 10 predominantly Aboriginal communities in rural Western Australia. This paper aimed to understand community responses to the WDKHP in three of these communities. METHODS: Interviews were undertaken with 26 Aboriginal people living in three remote communities. Community responses were analysed with attention to the social organisation of participants in each community and a focus on the perspectives of key groups, identified here as 'Community Leaders', 'Homelanders', 'Refuge Seekers' and 'Dislocated'. RESULTS: Participants from all groups reported that the WDKHP was highly acceptable, and an effective means of drawing attention to the need for prevention, early detection and management of diabetes and kidney disease. The integration of Aboriginal health workers to explain the project contributed to the high rates of participation in clinical screening. CONCLUSIONS: Outreach clinical services can be an appropriate method of engaging people in remote communities in addressing diabetes and kidney disease. IMPLICATIONS: The remote community setting can act as an 'enabler' of healthy lifestyle for Aboriginal people, particularly when augmented by well-designed outreach programs.

The Kalgoorlie Otitis Media Research Project: rationale, methods, population characteristics and ethical considerations.

Otitis media (OM) is one of the most common paediatric illnesses for which medical advice is sought in developed countries. Australian Aboriginal children suffer high rates of OM from early infancy. The resultant hearing loss can affect education and quality of life. As numerous factors contribute to the burden of OM, interventions aimed at reducing the impact of single risk factors are likely to fail. To identify key risk factors and understand how they interact in complex causal pathways, we followed 100 Aboriginal and 180 non-Aboriginal children from birth to age 2 years in a semi-arid zone of Western Australia. We collected demographic, obstetric, socio-economic and environmental data, breast milk once, and nasopharyngeal samples and saliva on seven occasions. Ear health was assessed by clinical examination, tympanometry, transient evoked otoacoustic emissions and audiometry. We considered the conduct of our study in relation to national ethical guidelines for research in Aboriginal and Torres Strait Islander health. After 1 year of community consultation, the study was endorsed by local committees and ethical approval granted. Fieldwork was tailored to minimise disruption to people's lives and we provided regular feedback to the community. We saw 81% of non-Aboriginal and 65% of Aboriginal children at age 12 months. OM was diagnosed on 55% and 26% of routine clinical examinations in Aboriginal and non-Aboriginal children respectively. Aboriginal mothers were younger and less educated, fewer were employed and they lived in more crowded conditions than non-Aboriginal mothers. Sixty-four per cent of Aboriginal and 40% of non-Aboriginal babies were exposed to environmental tobacco smoke. Early consultation, provision of a service while undertaking research, inclusion of Aboriginal people as active members of a research team and appropriate acknowledgement will assist in ensuring successful completion of the research.