Climate Change Impacts on Health in Remote Indigenous Communities in Australia.

Human-induced climate change in Australia is affecting the frequency and intensity of extreme events, including bushfires, cyclones and drought. Human health is affected by these climate impacts through direct impacts which include injuries and death from extreme events; indirect impacts through natural system changes such as impacts on water, food and air; and indirect impacts on human systems including mental health, productivity, and damage to housing and health-care facilities. Remote settlements are vulnerable to these climate impacts and associated health impacts due to isolated location, quality of the infrastructure, economic resources, limited transport, and existing health vulnerabilities that enable resilience or vulnerability. Remote Indigenous communities are particularly vulnerable. This research sought to identify vulnerabilities of human health of residents in remote Indigenous communities to human-induced climate change to contribute to adequate responses of prevention and preparation.

Five enablers to deliver safe water and effective sewage treatment to remote Indigenous communities in Australia.

CONTEXT: Safe drinking water and effective sanitation in remotely located Indigenous communities are essential services and their provision is a human right. Yet sustainable provision of these services can be challenging. Risks to human health from inadequate provision include transmission of hygiene-related infections from microbial contamination, and toxic chemicals that may cause kidney damage or dysfunction. This narrative review is conducted in the current context of the United Nations Sustainable Development Goal 6, the 'refresh' of the National Agreement on Closing the Gap in Indigenous inequity, and the 2020 Inquiry of the Australian Productivity Commission into the National Water Reform. ISSUES: Challenges to providing drinking water supplies in remote communities include biological contamination and chemical contamination from naturally occurring elements in groundwater. Monitoring regimes can be challenged by remote location, minimal and/or high turnover of staff and a lack of ongoing maintenance. Unpalatable water can shift consumption to purchased drinks such as sugar-sweetened beverages, with flow-on health impacts of diet-related chronic conditions such as overweight and obesity, and type 2 diabetes. LESSONS LEARNED: By analysing two effective programs from remote areas of New South Wales and the Torres Strait Islands in Queensland, Australia, five enablers were identified: people factors (support, training, cultural competence); cross-agency collaboration (regulators, funders, state and local government); technology that is fit for place, purpose and local people; funding that is sufficient and sustainable; and taking a systems view of water and sanitation.

Housing conditions and health in Indigenous Australian communities: current status and recent trends.

Ensuring sufficient and adequately maintained housing in Indigenous Australian communities remains an ongoing policy challenge for government, with major implications for the health of Indigenous Australians. This study sought to characterise the current status of housing conditions experienced by Indigenous Australians, with special reference to the Northern Territory. The assessment examined a range of indicators relating to crowding, dwelling condition, 'health hardware', and provision of maintenance and repairs. While acknowledging data deficiencies and inconsistencies, the analysis produced mixed results. There was evidence of a reduction in crowding but little observable improvement in the provision of maintenance and repairs. Some housing-related health outcomes have shown improvement, though these have tended to coincide with mass treatment campaigns. Achieving the goal of healthy homes - and ultimately closing the gap on Indigenous disadvantage - requires further investment in new houses that are appropriately designed and constructed, alongside an increased emphasis on cyclical maintenance.

Climate change and infectious diseases in Australia's Torres Strait Islands.

OBJECTIVE: This research seeks to identify climate-sensitive infectious diseases of concern with a present and future likelihood of increased occurrence in the geographically vulnerable Torres Strait Islands, Australia. The objective is to contribute evidence to the need for adequate climate change responses. METHODS: Case data of infectious diseases with proven, potential and speculative climate sensitivity were compiled. RESULTS: Five climate-sensitive diseases in the Torres Strait and Cape York region were identified as of concern: tuberculosis, dengue, Ross River virus, melioidosis and nontuberculous mycobacterial infection. The region constitutes 0.52% of Queensland's population but has a disproportionately high proportion of the state's cases: 20.4% of melioidosis, 2.4% of tuberculosis and 2.1% of dengue. CONCLUSIONS: The Indigenous Torres Strait Islander peoples intend to remain living on their traditional country long-term, yet climate change brings risks of both direct and indirect human health impacts. Implications for public health: Climate-sensitive infections pose a disproportionate burden and ongoing risk to Torres Strait Islander peoples. Addressing the causes of climate change is the responsibility of various agencies in parallel with direct action to minimise or prevent infections. All efforts should privilege Torres Strait Islander peoples' voices to self-determine response actions.

From "period poverty" to "period parity" to meet menstrual health needs.

Menstruation is a natural experience for most girls and women, yet it is often associated with socially imposed taboos and shame. "Period poverty" is a new term that has garnered the attention of media and politicians. It has articulated a public discussion of the menstrual health challenges that remain in many cultures.

What Contributions, if Any, Can Non-Indigenous Researchers Offer Toward Decolonizing Health Research?

Four non-Indigenous academics share lessons learned through our reflective processes while working with Indigenous Australian partners on a health research project. We foregrounded reflexivity in our work to raise consciousness regarding how colonizing mindsets-that do not privilege Indigenous ways of knowing or recognize Indigenous land and sovereignty-exist within ourselves and the institutions within which we operate. We share our self-analyses and invite non-Indigenous colleagues to also consider socialized, unquestioned, and possibly unconscious assumptions about the dominance of Western paradigms, asking what contributions, if any, non-Indigenous researchers can offer toward decolonizing health research. Our processes comprise of three iterative features-prioritizing attempts to decolonize ourselves, acknowledging the necessary role of discomfort in doing so, and moving through nonbinary and toward nondualistic thinking. With a nondual lens, working to decolonize ourselves may itself be seen as one contribution non-Indigenous researchers may offer to the collective project of decolonizing health research.

Menstrual health and hygiene among Indigenous Australian girls and women: barriers and opportunities.

Health inequities inhibit global development and achievement of the Sustainable Development Goals. One gendered health area, Menstrual Health & Hygiene (MHH), has received increasing attention in Low- and Middle-Income Countries as a barrier to health, wellbeing, and gender equity. Recent anecdotal evidence in Australia highlights that MHH also present challenges to High Income Countries, particularly among underrepresented populations, such as Indigenous Australian peoples, people from low socio-economic backgrounds, or communities that are remotely located. In this article, we chart the emergence of attention to MHH in the Australian context and highlight key considerations for the conduct of research with Aboriginal and Torres Strait Islander Peoples within the culturally- and gender-sensitive area of MHH. Further we draw on insights offered by a partnership between female Aboriginal and Torres Strait Islander leaders, NGO stakeholders, and non-Indigenous researchers. Through a convening (yarning circle) held in March 2018, the group identified multiple socioecological considerations for MHH research and practice, including: affordability and access to menstrual products, barriers to knowledge and culturally sensitive education, infrastructure and supply chain challenges, and the necessity of Indigenous-led research and community-driven data collection methods in addressing the sensitive topic. We draw together these insights to develop recommendations for future research, advocacy, and action in Australia.

Improving rural public health through 'best practice' water, sanitation and hygiene initiatives.

An understanding of best practice rural water, sanitation and hygiene (rWASH) and its associated indicators can ensure greater success and reduced failure of future projects. While numerous organisations have actively implemented rWASH projects since the early 1990s with donor reports, funding proposals and reviews frequently claiming best practice, there remains a paucity of information on what constitutes 'best practice' rWASH. A scoping review of qualitative and quantitative literature was done with six primary factors identified as key contributors to best practice rWASH: regulatory environment, community ownership, programme methodology, funding, technology and capacity. In the absence of standardisation, a benchmark of proven techniques may be used as an alternative to identify 'best practice' within the sector and propose minimum requirements for the development of best practice rWASH. Clearly defining best practice rural water, sanitation and hygiene is useful for governments, donor agencies and implementing organisations and those monitoring outcomes of programmes against national and global targets.

Health and the Sustainable Development Goals: Challenges for four Pacific countries.

Sustainable Development Goal 3 (SDG 3) focuses on health and well-being. To understand the in-country monitoring challenges for developing countries of reporting against SDG 3, this research sought published data for the four Pacific countries of Fiji, Papua New Guinea (PNG), the Solomon Islands, and Vanuatu-within a region with well-documented and significant health challenges. This research found that there are limited recent, comprehensive, and comparable data with identified sources against the SDG 3 outcome indicators at an in-country level. Without such data, there is a risk of relying on data that may be inaccurate because of aggregation, estimation, and modelling. The results from these data can influence the funding and other resources that could be made available to the Melanesian countries to address health inequities.

The Relationship between Infectious Diseases and Housing Maintenance in Indigenous Australian Households.

This research aimed to identify systemic housing-level contributions to infectious disease transmission for Indigenous Australians, in response to the Government program to 'close the gap' of health and other inequalities. A narrative literature review was performed in accordance to PRISMA guidelines. The findings revealed a lack of housing maintenance was associated with gastrointestinal infections, and skin-related diseases were associated with crowding. Diarrhoea was associated with the state of food preparation and storage areas, and viral conditions such as influenza were associated with crowding. Gastrointestinal, skin, ear, eye, and respiratory illnesses are related in various ways to health hardware functionality, removal and treatment of sewage, crowding, presence of pests and vermin, and the growth of mould and mildew. The research concluded that infectious disease transmission can be reduced by improving housing conditions, including adequate and timely housing repair and maintenance, and the enabling environment to perform healthy behaviours.

Global climate adaptation governance: Why is it not legally binding?

In the last decade, the United Nations Framework Convention on Climate Change has moved from a strong focus on mitigation to increasingly address adaptation. Climate change is no longer simply about reducing emissions, but also about enabling countries to deal with its impacts. Yet, most studies of the climate regime have focused on the evolution of mitigation governance and overlooked the increasing number of adaptation-related decisions and initiatives. In this article, we identify the body of rules and commitments on adaptation and suggest that there are more attempts to govern adaptation than many mitigation-focused accounts of the international climate regime would suggest. We then ask: to what degree are adaptation rules and commitments legalized in the United Nations Framework Convention on Climate Change? We examine the degree of precision and obligation of relevant decisions through an extensive analysis of primary United Nations Framework Convention on Climate Change documents, secondary literature on adaptation initiatives and institutions, interviews with climate change experts and negotiators, and participant observation at climate negotiations. Our analysis finds that adaptation governance is low in precision and obligation. We suggest that this is partly because adaptation is a contested global public good and because 'package deals' are made with mitigation commitments. This article makes a vital contribution to the global environmental politics literature given that adaptation governance is under-studied and poorly understood. It also contributes to the legalization literature by highlighting how contested global public goods may be governed globally, but with low obligation and precision.

Bactericidal function of alveolar macrophages in mechanically ventilated rabbits.

Protective ventilation strategies have been universally embraced because of reduced mortality. We tested the hypothesis that tidal volume (VT) in an in vivo model of mechanical ventilation would modulate bactericidal function of alveolar macrophages (AMs). Adult New Zealand White rabbits were mechanically ventilated for 4 h with a VT of 6 ml/kg (low) or a VT of 12 ml/kg (traditional), with each group receiving 3 cm H2O positive end-expiratory pressure with and without intratracheal lipopolysaccharide (LPS) instillation (20 mg/kg). AMs were isolated from bronchoalveolar lavage fluid taken from the whole left lung and used for bacterial killing assays. There were no significant differences in steady-state levels of nitrite or AM phagocytosis and killing of Klebsiella pneumoniae, although these values trended to be slightly higher in the traditional VT group. However, bronchoalveolar lavage fluid protein concentrations were significantly increased in traditional VT groups receiving LPS compared with animals ventilated with a low VT (1,407.8 +/- 121.4 versus 934.7 +/- 118.2; P < 0.001). Lung wet:dry weight ratio in the traditional VT group was increased when compared with the low VT group without LPS (7.3 +/- 0.4 versus 6.1 +/- 0.3, respectively; P < 0.05). Additionally, IL-8 expression was significantly greater under conditions of LPS treatment and mechanical ventilation at VT of 12 ml/kg. These results suggest that the traditional ventilator approach (12 ml/kg VT) in a model of in vivo mechanical ventilation results in lung pathology without affecting AM antibacterial function.

Prescription drug spending: contribution to health care spending and cost containment strategies.

Prescription drug costs have been the focus of much research in the health care economy, within managed care organizations, and hospital systems. Pharmacy costs are drivers of general health care spending, premium increases, and to a lesser extent, hospital spending. Factors contributing to increased prescription spending include increased prescription use, replacement of older, cheaper drugs with new and more expensive ones, and the costly prices of retail prescription drugs. In this article, we review the cost of prescription drugs as they relate to general health care costs and the costs associated with operating a hospital organization. We also address what is currently being done to control the cost of prescription drugs in the hospital setting.

ADAMTSL-3/punctin-2, a novel glycoprotein in extracellular matrix related to the ADAMTS family of metalloproteases.

The complete primary structure of ADAMTSL-3/punctin-2, a novel member of the family designated ADAMTSL (a disintegrin-like and metalloprotease domain with thrombospondin type I motifs-like), was determined by cDNA cloning from a human placenta library. The predicted open reading frame encodes a protein of 1690 amino acids that has considerable similarity to ADAMTSL-1/punctin-1. These multi-domain proteins lack both a protease domain and a disintegrin-like domain but are remarkably similar in their domain organization to the ADAMTS proteases, hence the name ADAMTS-like. Punctin-2 contains thrombospondin type 1 repeats (TSRs), a cysteine-rich domain and a cysteine-free spacer domain in the precise order in which they occur in the ADAMTS proteases. However, the number and organization of the TSRs in punctin-2 is unique with respect to the ADAMTS proteases. Punctin-2 contains 13 TSRs arranged in two arrays separated by a region containing three immunoglobulin-like repeats. Northern blot analysis of RNA from human adult tissues demonstrated that ADAMTSL3 is widely expressed, with highest expression in liver, kidney, heart and skeletal muscle, whereas it is expressed at low levels in mouse embryos. We characterized two punctin-2 polyclonal antisera. Using these and a monoclonal antibody to a C-terminal myc tag, we show that in transfected COS-7 cells, punctin-2 is expressed as a 210-kDa glycoprotein that is located in the extracellular matrix. The domain structure of punctin-2 and its matrix localization suggest that it might play a role in cell-matrix interactions or in assembly of specific extracellular matrices.

Chemistry and biology in the new age.

Ahmed Zewail won the 1999 Nobel Prize in chemistry for his visionary work in probing the motions of atoms at the femtosecond level. This pioneering research, a decade earlier, opened up a new frontier of scientific knowledge. Zewail and his multidisciplinary team at Caltech are now pushing further into the realm of molecular complexity, with the ultimate aim of exploring the global dynamics of biological systems at atomic resolution. This requires a new method of 'watching' reactions--ultrafast electron diffraction.