Receiving essential health services on country: Indigenous Australians, native title and the United Nations Declaration.

OBJECTIVES: The aim of the study was to investigate the public health challenge to provide chronic disease management to Indigenous Australians who wish to remain on traditional lands and not cede tenure for health services. STUDY DESIGN: Within the context of the United Nations (UN) Declaration on the Rights of Indigenous Peoples (DRIP), this research is intended to reveal health aspects requiring holistic consideration and thus enhance the resilience of Australia's First Nations Peoples. METHODS: Lead authorship was by an Australian Aboriginal author, using methods of an information and literature review. A case study of chronic kidney disease illustrates the challenges remaining with native title land tenure. RESULTS: Despite continuing land tenure challenges, Indigenous Australians have demonstrated resilience and resourcefulness to engage and secure improvements in health and other basic services. CONCLUSIONS: The Australian Government needs to revisit its duty to respect, protect and fulfil its obligation to the country's First Nations people in a human rights-based approach towards improved, accessible and culturally appropriate health care for chronic diseases.

Evaluation of feedlot cattle working chute behavior relative to temperament, tenderness, and postmortem proteolysis.

The objective was to investigate if the association between working chute behavior and beef tenderness found in our previous study is related to protein degradation and calpain system activity. Crossbred steers (n=183) allotted to 16 pens were weighed every 28 d. Temperament was evaluated as exit velocity (EV), chute score (CS), and catch score (CAPS). Between 14 and 16 mo of age (606±52 kg), steers were harvested. Strip steaks were collected and aged for 14 d. Subsamples were collected at 36 h and 7d postmortem and analyzed for calpastatin activity, µ-calpain autolysis, and troponin-T degradation. Shear force (WBSF) was correlated (P<0.05) with calpastatin activity and measurements of troponin-T. Calpastatin activity, µ-calpain autolysis, and troponin-T measurements did not correlate with the measurements of EV, CS, and CAPS. Therefore, activation of the calpain system or differences in protein degradation did not appear to influence the differences in tenderness that are correlated with working chute behavior.

Leptin suppresses food intake and body weight in corticosterone-replaced adrenalectomized rats.

Intracerebroventricular (ICV) injections of leptin decrease food intake and body weight while increasing energy expenditure. Some of these effects are reportedly enhanced in bilaterally adrenalectomized (ADX) rats. The purpose of the present experiment was to establish the time course of the suppression in body weight and food intake after an ICV injection of leptin. We wanted to establish the effect of varying doses of corticosterone (CORT) on body weight and food intake suppression by using separate groups of ADX, ADX and corticosterone-treated and sham-operated Sprague-Dawley rats. All rats were implanted with cholesterol pellets that varied in CORT content. During the same surgical session, all rats were fitted with a cannula in the lateral ventricle. After recovering from surgery, each rat was administered a 5- micro g ICV injection of leptin. ADX rats that were treated with CORT replacement lost more (P < 0.05) weight and took longer (P < 0.05) to return to baseline body weight than sham-operated controls. Leptin injection decreased food consumption to a greater extent (P < 0.05) in the ADX groups treated with CORT than in the sham-operated controls. Plasma insulin increased in a dose-dependent manner in the ADX rats as a function of CORT replacement. The higher of the two CORT replacement doses used in this experiment restored circulating CORT to levels observed in sham-operated controls. Contrary to earlier reports, physiological doses of CORT appear to enhance leptin-induced weight loss.

Pharmacoepidemiology of urinary tract infections in Iowa Medicaid patients in urban long-term-care facilities.

OBJECTIVE: To describe the therapeutic management of Medicaid patients with urinary tract infections (UTIs) in urban long-term-care facilities (LTCFs) and to link individual therapies to patient outcomes. DESIGN: Retrospective review of medical records in LTCFs of patients who had documented UTIs. METHODS: Patient data were collected from 17 LTCFs in the Des Moines, IA, metropolitan area during a 1-year period starting January 1, 1995. Patients with UTIs were selected from the LTCF infection control logs. Data collected on patients included demographics, concomitant diseases, type of UTI (i.e., symptomatic, asymptomatic, catheter-related), process measures for management, UTI treatment, patient outcomes, and follow-up. Patient outcome data were defined as either cure or no cure. A UTI cure was defined as a negative urine culture while taking antibiotic therapy and/or complete resolution of signs and symptoms, as well as no further treatment given within 2 weeks after the end of treatment. RESULTS: Data were collected on 310 patients who had at least one UTI over the 1-year study period. Patients were primarily elderly (mean age 82.2 +/- 12.3 y), white (95.1%), and female (83.9%). Concomitant diseases were common and about one-fourth (23.0%) of the patients were catheterized. There were 536 UTI events (the unit of analysis) documented over the 1-year period, with about one-half (45.9%) being UTIs with symptoms consistent with uncomplicated lower UTI. Nearly two-thirds (62.3%) of the patients were cured, based on the study definition; there was no association between cure and type of antimicrobial therapy (p = 0.99). Over one-third (35.2%) of the UTIs were treated with a quinolone antibiotic. Others were treated with trimethoprim/sulfamethoxazole (24.4%), nitrofurantoin (13.9%), cephalosporin (10.4%), or ampicillin/amoxicillin (9.8%). Sixty-day follow-up showed no association between type of therapy and hospital readmission, physician follow-up visits, or subsequent UTIs. CONCLUSIONS: There were no differences in cure rates when comparing LTCF UTI patients receiving various regimens. With outcomes being the same, the clinician should closely consider costs of drug therapy in selecting a treatment preference.