Aboriginal Ethnicity Research Articles

Perinatal mortality among term births: Informing decisions about singleton early term births in Western Australia.

To minimise the risk of perinatal mortality, clinicians and expectant mothers must understand the risks and benefits associated with continuing the pregnancy. Report the gestation-specific risk of perinatal mortality at term. Population-based cohort study using linked health data to identify all singleton births at gestations 37-41 weeks, in Western Australia (WA) from 2009 to 2019. Lifetable analysis was used to combine the risk of each type of perinatal mortality and calculate the cumulative risk of perinatal mortality, termed the perinatal risk index (PRI). Rates of antepartum and intrapartum stillbirth and neonatal death, as well as the PRI, were examined for each gestational week at term by non-Aboriginal and Aboriginal ethnicity. For non-Aboriginal women, rates were also examined by time-period (pre- vs. post-WA Preterm Birth Prevention Initiative (the Initiative) rollout), primiparity, and obstetric risk. There were 332,084 singleton term births, including 60 perinatal deaths to Aboriginal mothers (3.2 deaths per 1000 births to Aboriginal mothers) and 399 perinatal deaths to non-Aboriginal mothers (1.3 deaths per 1000 births to non-Aboriginal mothers). For non-Aboriginal women, the PRI was at its lowest (PRI 0.80, 95% CI 0.61, 1.00) at 39 weeks gestation. For Aboriginal women, it was at its lowest at 38 weeks (PRI 2.43, 95% CI 0.48, 4.39) with similar risk at 39 weeks (PRI 2.68, 95% CI 1.22, 4.14). The PRI increased steadily after 39 weeks gestation. The risk of perinatal mortality was higher among Aboriginal women. The gestation-specific perinatal mortality rates were similar by the time-period, primiparity and obstetric risk. The gestational ages at term associated with the lowest risk of perinatal mortality reinforce that the recommendation not to deliver before 39 weeks without medical indication is applicable to both Aboriginal and non-Aboriginal women giving birth in WA. There was no increase in the perinatal mortality rate associated with the introduction of the Initiative.

P-758 Perinatal deaths to women dispensed clomiphene citrate: A study within a whole of population birth cohort

Abstract Study question Is the risk of stillbirth and neonatal death increased in pregnancies where clomiphene citrate was dispensed 3 months before or after time of conception? Summary answer The risk of stillbirth and/or neonatal death is 45% higher in pregnancies among women dispensed clomiphene citrate compared to unexposed women independent of confounders. What is known already Clomiphene citrate (CC) has been used for ovulation induction since 1967, despite prior evidence of fetotoxicity in humans and animals. CC has since been linked to fetal growth restriction, preterm birth, & congenital anomalies, which are independent risk factors for perinatal death. However, few studies have been large enough to provide data on infrequent adverse events. In high-income countries, maternal obesity is the greatest risk factor for perinatal death followed by advanced maternal age. These factors also contribute to infertility, but can be measured reliably and incorporated into safety studies to estimate patient and treatment effects. Study design, size, duration This is a whole of population cohort study involving 147,524 pregnant women and 242,079 births occurring from July 2003 to December 2015 in South Australia, assembled by linking records from the state-wide perinatal registry with Commonwealth government data on pharmaceutical dispensing. All post-20 week pregnancies have mandatory reporting. Clomiphene citrate dispensing by pharmacists resides in a single national database. Participants/materials, setting, methods Using de-identified pregnancy outcome data in South Australia, the prevalence of stillbirth (>20 weeks gestation) and neonatal death were examined in relation to clomiphene citrate exposure. Women were considered exposed if a prescription for clomiphene citrate was dispensed from three months before the conception window to end of first trimester. Dates for the conception window were derived from gestational age at birth (weeks), in turn based on date of last menstrual period and ultrasound scan. Main results and the role of chance There were 3,458 singleton pregnancies where women were exposed to clomiphene citrate, with 41 stillbirths and neonatal deaths recorded, a prevalence of 11.9 per 1000. For non-exposed pregnancies, the corresponding prevalence was 8.2 per 1000. In singleton pregnancies among women dispensed clomiphene citrate, compared to those without this exposure, stillbirth and neonatal death were increased by 45% (odds ratio (OR) = 1.45, 95% confidence interval (CI) 1.06 – 1.98). This association was strengthened after adjustment for maternal characteristics that were potential confounders: age, socio-economic status (based on postcode of residence), Aboriginal ethnicity, born outside Australia in low or middle income country, parity, smoking, pre-existing diabetes or hypertension, pregnancy-induced hypertension and pre-eclampsia (OR = 1.59, 95% CI 1.16 – 2.18). Obesity data was available from 2007 onwards and a restricted analysis including this variable saw an increased effect (OR = 1.79, 95% CI 1.19 – 2.72). It is implausible that a further unmeasured patient related factor could reverse this effect. The observed effect is also conservative as there were 200 multiple pregnancies in which women were exposed to clomiphene citrate, which were excluded as the number of deaths in offspring was too infrequent for robust stratified statistical comparisons. Limitations, reasons for caution Data reflect pharmacy dispensing, not consumption, although women are highly motivated to take this drug and over 5% of pregnancies were multiples, consistent with extensive use. Subfertility itself increases the risk of perinatal death and further analyses are underway to distinguish effects of the drug from indication for use. Wider implications of the findings Clomiphene citrate may not be as safe as presumed. This may partly be a consequence of variability in clinical prescribing and supervision, or the known variability in patient response to the drug. Our result is conservative as we excluded twins. It is supported by animal data and basic pharmacology. Trial registration number Not applicable

Effect of prior gestational diabetes on the risk of cardiovascular disease and death in women with type 2 diabetes: The Fremantle Diabetes Study Phase II

BackgroundTo examine whether prior gestational diabetes mellitus (GDM) is associated with prevalent coronary heart disease (CHD), cerebrovascular disease (CeVD) and peripheral arterial disease (PAD), and all-cause mortality, in community-based women with type 2 diabetes. MethodsBaseline prevalences of CHD/CeVD/PAD/prior GDM were determined in 718 females (mean ± SD age 65.5 ± 11.9 years) from the Fremantle Diabetes Study Phase II. Deaths between baseline (2008–2011) and end-2016 were ascertained. Cox regression identified predictors of mortality with GDM as a candidate variable. ResultsCompared to the 673 women without GDM, the 39 (5.4 %) with prior GDM were younger, more likely Aboriginal, smokers and obese, had longer diabetes duration and higher HbA1c levels, and were more dyslipidemic (P ≤ 0.046). Prevalences of CHD (24.6 versus 23.1 %), CeVD (7.5 % versus 2.6 %) and PAD (27.5 % versus 23.7 %) were not significantly different in those without versus with prior GDM (P ≥ 0.35). There were 116 deaths (16.2 %) during 6.8 ± 1.6 years of follow-up. Age, Aboriginal ethnicity, marital status, current smoking, heart rate, estimated glomerular filtration rate, CHD and PAD were independently associated with all-cause mortality (P ≤ 0.023); GDM status did not add to the most parsimonious model (P = 0.62). ConclusionsPrior GDM does not increase CVD risk or all-cause mortality in women with type 2 diabetes.

Cognitive and affective perspective taking amongst adolescent offenders with variants of callous–unemotional traits

Evidence suggests that associations between antisocial behaviour, callous–unemotional (CU) traits and cognitive empathy (e.g. perspective taking) vary depending on more fine-grained dimensions of these constructs. This study examined associations between adolescent antisocial behaviour and individual differences in cognitive and affective perspective taking ability. Based on current theory regarding distinct variants of CU traits, we further tested whether the correlates of CU traits differed amongst youth with high versus low levels of anxiety. Participants were 130 male adolescents (81 youth offenders; 49 non-offenders) aged 13–20 years, of predominantly Caucasian and Aboriginal Australian ethnicity. Perspective taking skills were indexed using performance-based testing, and self-report data was collected on CU traits and anxiety in a cross-sectional design. Offender status was associated with poorer cognitive and affective perspective taking. In addition, associations between CU traits and perspective taking skills were moderated by anxiety. Specifically, CU traits were associated with poorer skills for second-order cognitive perspective taking amongst high-anxiety youth, whereas CU traits were associated with better cognitive and affective perspective taking skills amongst low-anxiety youth. More fine-grained assessment of such factors stands to enhance understanding of, and effective intervention for, antisocial youth.

Improving equitable access to publicly funded bariatric surgery in Queensland, Australia.

BackgroundPeople living in regional Queensland, Australia, have less access to health care than their metropolitan neighbours; a gap that is wider if they are also of Aboriginal and Torres Strait Islander ethnicity. The Bariatric Surgery Initiative (BSI) aims to provide metabolic bariatric surgery as a public service accessible to all Queenslanders for patients with morbid obesity according to need, regardless of location or ethnicity.MethodsWe investigated the BSI's progress in closing the metro-regional gap by comparing the distribution of referrals for surgery with the geographic and ethnic spread of obesity across Queensland in 2017-2019.ResultsRegional Queensland is home to 59.8% of Queensland's individuals with obesity, whereas 40.2% live in metropolitan Brisbane. In contrast, 47.8% of referrals were from regional areas, with 52.2% received from Brisbane. We found that more patients from metropolitan than regional areas underwent metabolic bariatric surgery, probably due to a paucity of referrals from regional locations. Aboriginal and Torres Strait Islander peoples were able to access the service and all patients realised significant health benefits after surgery.ConclusionsThe BSI improved access to this service, and inequities in metro-regional access may depend on patient choice and healthcare provider awareness of the BSI.Trial registrationThis initiative was a quality improvement study focused on providing access to care rather than a clinical trial; as such it was not registered as a clinical trial.

P-767 Urogenital defects in live births to women dispensed clomiphene citrate: A study within a whole of population birth cohort

Abstract Study question Is the risk of urogenital defects increased in live births where clomiphene citrate is known to have been dispensed by a pharmacist to the individual? Summary answer The risk of urogenital defects is elevated in singletons, and approximately doubled in male babies among women dispensed clomiphene citrate, as compared to unexposed women. What is known already Clomiphene citrate (CC) has been used for ovulation induction since 1967 & is both inexpensive and largely effective. However, CC is a selective estrogen receptor modulator (SERM), which is a class of drugs with the potential for endocrine disruption during fetal development. The link between urogenital defects and CC has previously been reported by ourselves and others. Whether the link continues to exist where individual level pharmaceutical prescribing and dispensing patterns are clearly ascertained has not been determined. Secondly, the interaction of prescribed clomiphene citrate functioning as an endocrine disruptor by fetal sex has not undergone formal statistical testing. Study design, size, duration A population-based cohort study of South Australia was assembled by linking all records from the state-wide perinatal registry for births between July 2003 and December 2011, including defects coded to ICD9 and BPA, with Commonwealth government data on pharmaceutical dispensing in the national Pharmaceutical Benefits Scheme (PBS), which includes individual level prescribing and dispensing of drugs for ovulation induction, including clomiphene citrate. Participants/materials, setting, methods We analysed de-identified pregnancy outcome data for all births in South Australia, linked to individual level national prescription data, to examine the prevalence of urogenital birth defects (>20 weeks gestation) for births occurring between July 2003 and December 2011following clomiphene citrate dispensing, with 5-years follow-up for defect notifications. Multivariate analysis in STATA within a Secure Unified Research Environment (SURE) was used to calculate odds ratios, adjusted for maternal confounders and socioeconomic circumstance. Main results and the role of chance We examined 2,264 singleton live births where women were dispensed clomiphene citrate for infertility. Births among women dispensed clomiphene citrate, compared to those without this exposure, had increased urogenital defects (odds ratio (OR) = 1.73, CI = 1.34 - 2.24). This association was slightly reduced after adjustment for maternal characteristics that were potential confounders: age, socio-economic status (based on postcode of residence), Aboriginal ethnicity, born outside Australia in low or middle income country, parity, smoking, pre-existing diabetes or hypertension, pregnancy-induced hypertension and pre-eclampsia (OR = 1.66, CI = 1.28 -, 2.15). There was evidence of an interaction with fetal sex, such that males were at particular risk. Sex-by-clomiphene interaction Male 1.92 (1.47, 2.52) Female 0.88 (0.37, 2.14) Test for interaction χ2(1) = 2.72; p = 0.09 The observed main effects are unlikely to be due to chance, and the sex-specific effect is biologically plausible, but limited in power. Further, there were 280 babies from multiple pregnancies to women exposed to clomiphene citrate that were excluded due to statistical limitations. Limitations, reasons for caution Our data report pharmacy dispensing, but not observed consumption, although infertile women are highly motivated to take this drug and over 5% of pregnancies were multiples, consistent with extensive use. The analysis for interactions and for multiples is currently restricted by power, which may resolve as the cohort number increases. Wider implications of the findings Clomiphene citrate (CC) may be a potent endocrine disruptor inducing urogenital defects, particularly in males. This is important as CC continues to be a WHO essential drug and a first line treatment globally, but with largely unmonitored use and without any industry initiated prospective safety study. Trial registration number Not applicable

Prevalence of, and factors associated with, diabetes mellitus in people with severe mental illness attending a multidisciplinary, outpatient cardiometabolic health assessment service

IntroductionEvaluate the prevalence of, and factors associated with, diabetes in people with severe mental illness (SMI) attending the Collaborative Centre for Cardiometabolic Health in Psychosis (ccCHiP) tertiary referral clinics.Research design...

The cost of care for children hospitalised with Invasive Group A Streptococcal Disease in Australia

BackgroundInvasive Group A Streptococcal (iGAS) disease exerts an important burden among Australian children. No Australian hospitalisation cost estimates for treating children with iGAS disease exist, so the financial impact of this condition is unknown.AimTo determine the minimum annual healthcare cost for children (< 18 years) hospitalised with iGAS disease in Australia from a healthcare sector perspective.MethodsA cost analysis including children with laboratory-confirmed iGAS disease hospitalised at the Royal Children’s Hospital (Victoria, Australia; July 2016 to June 2019) was performed. Results were extrapolated against the national minimum iGAS disease incidence. This analysis included healthcare cost from the 7 days prior to the index admission via General Practitioner (GP) and Emergency Department (ED) consultations; the index admission itself; and the 6 months post index admission via rehabilitation admissions, acute re-admissions and outpatient consultations. Additional extrapolations of national cost data by age group, Aboriginal and Torres Strait Islander ethnicity and jurisdiction were performed.ResultsOf the 65 included children, 35% (n = 23) were female, 5% (n = 3) were Aboriginal and Torres Strait Islander, and the average age was 4.4 years (SD 4.6; 65% aged 0–4). The iGAS disease related healthcare cost per child was $67,799 (SD $92,410). These costs were distributed across the 7 days prior to the index admission via GP and ED consultations (0.2 and 1.1% of total costs, respectively), the index admission itself (88.7% of the total costs); and the 6 months post index admission via rehabilitation admissions, acute re-admissions and outpatient consultations (5.3, 4.5 and 0.1% of total costs, respectively). Based on a national minimum paediatric incidence estimation of 1.63 per 100,000 children aged < 18 (95%CI: 1.11–2.32), the total annual healthcare cost for children with iGAS in 2019 was $6,200,862. The financial burden reflects the overrepresentation of Aboriginal and Torres Strait Islander people in the occurrence of iGAS disease. Costs were concentrated among children aged 0–4 years (62%).ConclusionAs these cost estimations were based on a minimum incidence, true costs may be higher. Strengthening of surveillance and control of iGAS disease, including a mandate for national notification of iGAS disease, is warranted.Trial registrationThe current study is a part of ongoing iGAS surveillance work across seven paediatric health services in Australia. As this is not a clinical trial, it has not undergone trial registration.

Demographic and clinical characteristics of a population-based pediatric cohort of type 1 and type 2 diabetes in Western Australia (1999-2019).

To determine demographic and clinical characteristics of youth diagnosed with type 1 (T1D) or type 2 (T2D) diabetes aged ≤15 years from 1999 to 2019 in Western Australia, and examine time to first diagnosis of diabetes complications. A retrospective cohort study was conducted of patients identified from the population-based, prospective Western Australian Children's Diabetes Database and longitudinal data extracted for available demographic and clinical variables. Patients were followed from diagnosis to transition to adult services, death, or December 31, 2019. Cox proportional hazards regression models were used to analyse time to first diagnosis of hypertension, high cholesterol or microalbuminuria, after adjusting for sex, age at diagnosis, time period of diagnosis, hemoglobin A1c , and body max index Z-score. 2438 eligible patients were identified (2209 [91%] T1D: 229 [9%] T2D). The mean age at diagnosis was lower in patients with T1D (8.5 [±4.0] vs. 12.7 [±2.0] years). A higher proportion of patients with T2D were female (58% vs. 47%) and of Aboriginal ethnicity (59% vs. 2%). The median HbA1c (interquartile range) at diagnosis was lower 8.9% [6.7, 11.5] (74 mmol/mol [50, 102]) versus 11.6% [10.1, 13.3] (103 mmol/mol [87, 122]) and mean body max index Z-score higher (2.05 [±0.66] vs. 0.37 [±0.95]), in patients with T2D compared to T1D. Patients with T2D had a higher risk of hypertension, high cholesterol, and microalbuminuria (aHR 3.39 [95%CI:2.04, 5.63], 2.69 [95%CI:1.21, 5.98], and 19.79 [95%CI:10.99, 35.64] respectively).

P0512 / #1237: OPTIMAL SERUM VANCOMYCIN MONITORING IN CRITICALLY ILL CHILDREN WITH COMPLEX INFECTIONS: ARE WE REACHING RECOMMENDED THERAPEUTIC TARGETS?

Aims & Objectives: To evaluate the current prescribing, dosing and monitoring of Vancomycin in critically ill children reviewing effectiveness of current guidelines in reaching therapeutic trough target levels in the initial 48 hours of treatment. Methods: A single center retrospective chart review of children aged 1 month to 16 years admitted to the Pediatric Intensive Care Unit (PICU) and prescribed vancomycin therapy for ≥ 24 hours over 2 years. Results: 76% (46/60) of the participants were aged <5 years. Pneumonia was the leading primary admission diagnosis with infections of respiratory origin comprising 73.33%(44/60) of all cases requiring Vancomycin. Laboratory confirmed Methicillin Resistant Staphylococcus Aureus (MRSA) cases was 28% (17/60) with 70.58% (12/17) of these being children of Aboriginal or Torres Strait Islander (ATSI) ethnicity. The median serum Vancomycin plasma concentration (SVPC) fell below the therapeutic trough target of 15-20mg/ml for all dosing regimens. 8.33% (5/60) did not have Vancomycin levels taken and 54.54% (30/55) never reached the therapeutic targets. 20% (11/55) reached therapeutic targets in <48 hours and 23.6% (13/55) reached therapeutic targets in >48 hours.Conclusions: Current dosing regimens demonstrate efficacy in reaching therapeutic levels in initial 48 hours of treatment in 20% of cases and over half of the children prescribed Vancomycin never achieve the current therapeutic trough ranges currently specified. Further prospective investigation is needed with a view to use of Area under curve (AUC) and minimum inhibitory concentration (MIC) as markers of efficacy in our local population to determine if customised pharmacokinetic (PK) dosing models offer a better alternative.

Variability and trends over time and across centres in haemodialysis weekly duration in Australia and New Zealand.

Haemodialysis treatment prescription varies widely internationally. This study explored patient- and centre-level characteristics associated with weekly haemodialysis hours. Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data were analysed. Characteristics associated with weekly duration were evaluated using mixed-effects linear regression models with patient- and centre-level covariates as fixed effects, and dialysis centre and state as random effects using the 2017 prevalent in-centre haemodialysis (ICHD) and home haemodialysis (HHD) cohorts. Evaluation of patterns of weekly duration over time analysed the 2000 to 2017 incident ICHD and HHD cohorts. Overall, 12 494 ICHD and 1493 HHD prevalent patients in 2017 were included. Median weekly treatment duration was 13.5 (interquartile range [IQR] 12-15) hours for ICHD and 16 (IQR 15-20) hours for HHD. Male sex, younger age, higher body mass index, arteriovenous fistula/graft use, Aboriginal and Torres Strait Islander ethnicity and longer dialysis vintage were associated with longer weekly duration for both ICHD and HHD. No centre characteristics were associated with duration. Variability in duration across centres was very limited in ICHD compared with HHD, with variation in HHD being associated with state. Duration did not vary significantly over time for ICHD, whereas longer weekly HHD treatments were reported between 2006 and 2012 compared with before and after this period. This study in the Australian and New Zealand haemodialysis population showed that weekly duration was primarily associated with patient characteristics. No centre effect was demonstrated. Practice patterns seemed to differ across states/countries, with more variability in HHD than ICHD.

Diabetes during pregnancy and birthweight trends among Aboriginal and non-Aboriginal people in the Northern Territory of Australia over 30 years

BackgroundEarly-life risk factors, including maternal hyperglycaemia and birthweight, are thought to contribute to the high burden of cardiometabolic disease experienced by Indigenous populations. We examined rates of pre-existing diabetes in pregnancy, gestational diabetes mellitus (GDM) and extremes of birthweight over three decades in the Northern Territory (NT) of Australia. MethodsWe performed a retrospective cohort analysis of the NT Perinatal Data Collection from 1987 to 2016, including all births >20 weeks gestation, stratified by maternal Aboriginal identification. Key outcomes were annual rates of pre-existing diabetes, GDM, small-for-gestational-age, large-for-gestational-age, low birthweight (<2500 g), and high birthweight (>4000 g). Logistic regression was used to assess trends and interactions. Findings109 349 babies were born to 64 877 mothers, 36% of whom identified as Aboriginal ethnicity. Among Aboriginal women, rates of GDM and pre-existing diabetes, respectively, were 3 · 4% and 0 · 6% in 1987 and rose to 13% and 5 · 7% in 2016 (both trends p<0 · 001). Among non-Aboriginal women, rates of GDM increased from 1 · 9% in 1987 to 11% in 2016 (p<0 · 001), while pre-existing diabetes was uncommon (≤0 · 7% throughout). Rates of small-for-gestational-age decreased, while rates of large-for-gestational-age and high birthweight increased in both groups (all trends p<0 · 001). Multivariable modelling suggests that hyperglycaemia was largely responsible for the growing rate of large-for-gestational-age births among Aboriginal women. InterpretationThe burden of hyperglycaemia in pregnancy has grown substantially in the NT over three decades and is impacting birthweight trends. The prevalence of pre-gestational diabetes in Aboriginal women is among the highest in the world. FundingDiabetes Australia Research Program.

Incidence and factors associated with geographical relocation in patients receiving renal replacement therapy

BackgroundRenal replacement therapy (RRT) places a burden on patients, and geographical relocation for easier access to healthcare facilities is a necessity for some. Incidence and factors associated with relocation has not been comprehensively examined at a national level. We aimed to determine proportion, incidence, characteristics of RRT patients who relocate and relocation rate by remoteness of residence and dialysis modality.MethodsRetrospective cohort analysis using Australian and New Zealand Dialysis and Transplant Registry to examine RRT patients in Australia from January 2005 to December 2015. Relocation incidence was calculated for remoteness of residence and RRT modality as rate per 100 patient years. Factors associated with relocation were examined using competing risk regression models with death as a competing event.ResultsOf 24,676 incident patients on RRT, 5888 (23.9%) relocated with a median time of 1.6 years [IQR 0.7–3.4] years. Relocation incidence was 7.9 per 100 patient years and increased from major cities to very remote regions (7.2 to 48.8 per 100 patient years respectively, p < 0.001). Remoteness of residence was associated with geographical relocation in competing risk analysis especially in remote (SHR 1.20, 95%CI 1.01, 1.41 p = 0.034) and very remote regions (SHR 3.51 95% 3.05, 4.04 p < 0.001). Aboriginal or Torres Strait Islander ethnicity, compared to Caucasian, was independently associated with relocation (SHR 1.18, 95% CI 1.06,1.31, p = 0.002) while transplant patients were less likely to relocate compared to haemodialysis patients (HR 0.37, 95%CI 0.34, 0.39, p < 0.001).ConclusionsRelocation in patients receiving RRT is associated with remoteness of residence, RRT modality and ethnicity. Reasons for relocation and its impact on patient wellbeing and outcome should be further explored.

Hospitalizations due to unintentional transport injuries among Aboriginal population of British Columbia, Canada: Incidence, changes over time and ecological analysis of risk markers.

BackgroundWorldwide, Indigenous people have disproportionately higher rates of transport injuries. We examined disparities in injury-related hospitalizations resulting from transport incidents for three population groups in British Columbia (BC): total population, Aboriginal off-reserve, and Aboriginal on-reserve populations. We also examined sociodemographic, geographic and ethnic risk markers for disparities.MethodsWe identified Aboriginal people through BC’s universal health care insurance plan insurance premium group and birth and death record notations. We calculated crude incidence rate and Standardized Relative Risk (SRR) of hospitalization for unintentional transport injury, standardized for age, gender and Health Service Delivery Area (HSDA), relative to the total population of BC. We tested hypothesized associations of geographic, socio-economic, and employment-related characteristics of Aboriginal communities with SRR of transport injury by multivariable linear regression.ResultsDuring the period 1991–2010, the SRR for the off-reserve Aboriginal population was 1.77 (95% CI: 1.71 to 1.83); and 2.00 (95% CI: 1.93 to 2.07) among those living on-reserve. Decline in crude rate and SRRs was observed over this period among both the Aboriginal and total populations of BC, but was proportionally greater among the Aboriginal population. The best-fitting multivariable risk marker model was an excellent fit (R2 = 0.912, p<0.001), predicted SRRs very close to observed values, and retained the following terms: urban residence, population per room, proportion of the population with a high school certificate, proportion of the population employed; and multiplicative interactions of Aboriginal ethnicity with population per room and proportion of the population employed.ConclusionsDisparities in risk of hospitalization due to unintentional transport injury have narrowed. Aboriginal ethnicity modifies the effects of socioeconomic risk factors. Continued improvement of socioeconomic conditions and implementation of culturally relevant injury prevention interventions are needed.

Health-Related Quality of Life in an Inception Cohort of Children With Juvenile Idiopathic Arthritis: A Longitudinal Analysis.

To describe changes in health-related quality of life (HRQoL) over time in children with juvenile idiopathic arthritis (JIA), relative to other outcomes, and to identify predictors of unfavorable HRQoL trajectories. Children with JIA in the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) cohort were included. The Juvenile Arthritis Quality of Life Questionnaire (JAQQ, a standardized instrument), health-related Quality of My Life (HRQoML, an instrument based on personal valuations), and JIA core variables were completed serially. Analyses included median values, Kaplan-Meier survival curves, and latent trajectory analysis. A total of 1,249 patients enrolled at a median of 0.5 months after diagnosis were followed for a median of 34.2 months. The degree of initial HRQoL impairment and probabilities of reaching the best possible HRQoL scores varied across JIA categories (best for oligoarthritis, worst for rheumatoid factor-positive polyarthritis). Median times to attain best possible HRQoL scores (JAQQ 59.3 months, HRQoML 34.5 months), lagged behind those for disease activity, pain, and disability measures. Most patients followed trajectories with minimal or mild impairment; however, 7.6% and 13.8% of patients, respectively, followed JAQQ and HRQoML trajectories with persistent major impairment in HRQoL. JIA category, aboriginal ethnicity, and baseline disease activity measures distinguished between membership in trajectories with major and minimal impairments. Improvement in HRQoL is slower than for disease activity, pain, and disability. Improvement of a measure based on respondents' preferences (HRQoML) is more rapid than that of a standardized measure (JAQQ). Higher disease activity at diagnosis heralds an unfavorable HRQoL trajectory.

Differential prevalence of hematuria and proteinuria with socio-demographic factors among school children in Hualien, Taiwan

Pediatric hematuria/proteinuria is a risk factor for chronic kidney disease in later life, and school urinary screening can detect asymptomatic glomerulonephritis in the early stage. This study aimed to evaluate the prevalence of hematuria/proteinuria and its association with different socio-demographic factors among school children in 2013 in Hualien, Taiwan. A cross-sectional study was conducted among first, fourth, and seventh graders. Health examination results and urinalysis data were analyzed. Logistic regression models were used to the simultaneously analyze the association between the prevalence of hematuria/proteinuria and socio-demographic factors. A total of 9544 students were included. The overall prevalence of hematuria and proteinuria was 4.1% and 5.7%, respectively. Students who were females, of a high grade level, of aboriginal ethnicity, and living in rural areas had higher hematuria risk (all P<0.001) than other students. Underweight students had low odds ratio (0.53) of hematuria (P<0.001). Seventh-grade students had higher odds ratio (3.63) of proteinuria than first grade students (P<0.001). Students with both parents of aboriginal descent had lower odds ratio (0.81) of proteinuria than those with non-aboriginal parents (P=0.044). Only higher grade level students had significantly higher risk of combined hematuria and light proteinuria (odds ratio: 10.67) and heavy proteinuria with/without hematuria (odds ratio: 3.22) than first graders. Increased hematuria/proteinuria prevalence was noted in our county as compared to prior studies. Hematuria/proteinuria was significantly associated with gender, grade level, body mass index, ethnicity, and residence urbanization. Our data can be used for future longitudinal dataset collection to prevent pediatric renal disorders in Taiwan.

Human Immunodeficiency Virus Viral Load Rebound Near Delivery in Previously Suppressed, Combination Antiretroviral Therapy-Treated Pregnant Women.

To assess the stability of human immunodeficiency virus (HIV) viral load suppression within 1 month before birth in pregnant women receiving antenatal combination antiretroviral therapy (CART). This is a retrospective cohort study of a Canadian provincial perinatal HIV database from 1997 to 2015. Inclusion criteria were live birth and CART received for at least 4 weeks. Viral load rebound, defined as viral load greater than 50 copies/mL (or greater than 400 copies/mL for 1997-1998) and measured within 1 month before delivery, was identified in women who had at least one previous undetectable viral load during pregnancy. Logistic regressions were conducted to identify the risk factors for viral load rebound. Among the 470 women in the database, 318 met inclusion criteria. Viral load rebound was experienced by 19 women (6.0%, 95% CI 3.7-9.3%) with a mean log10 viral load near delivery of 2.71 copies/mL (=513 copies/mL). Six (32%) had a viral load above 1,000 copies/mL. The rebound was detected within 1 day before delivery in 50% of the women. Aboriginal ethnicity, cocaine use, and hepatitis C virus polymerase chain reaction positivity were significantly associated with viral load rebound. There were no HIV vertical transmissions. Even women attending for HIV care and achieving viral suppression in pregnancy can experience viral load rebound predelivery.

Bilirubin concentration is positively associated with haemoglobin concentration and inversely associated with albumin to creatinine ratio among Indigenous Australians: eGFR Study

Low serum bilirubin concentrations are reported to be strongly associated with cardio-metabolic disease, but this relationship has not been reported among Indigenous Australian people who are known to be at high risk for diabetes and chronic kidney disease (CKD).Hypothesis: serum bilirubin will be negatively associated with markers of chronic disease, including CKD and anaemia among Indigenous Australians.Method: A cross-sectional analysis of 594 adult Aboriginal and Torres Strait Islander (TSI) people in good health or with diabetes and markers of CKD. Measures included urine albumin: creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), haemoglobin (Hb) and glycated haemoglobin (HbA1c). Diabetes was defined by medical history, medications or HbA1c≥6.5% or ≥48mmol/mol. Anaemia was defined as Hb<130g/L or <120g/L in males and females respectively. A multivariate regression analysis examining factors independently associated with log-bilirubin was performed.Results: Participants mean (SD) age was 45.1 (14.5) years, and included 62.5% females, 71.7% Aboriginal, 41.1% with diabetes, 16.7% with anaemia, 41% with ACR>3mg/mmol and 18.2% with eGFR<60mL/min/1.73m2. Median bilirubin concentration was lower in females than males (6 v 8μmol/L, p<0.001) and in Aboriginal than TSI participants (6 v 9.5μmol/L, p<0.001). Six factors explained 35% of the variance of log-bilirubin; Hb and cholesterol (both positively related) and ACR, triglycerides, Aboriginal ethnicity and female gender (all inversely related).Conclusion: Serum bilirubin concentrations were positively associated with Hb and total cholesterol, and inversely associated with ACR. Further research to determine reasons explaining lower bilirubin concentrations among Aboriginal compared with TSI participants are needed.

Epidemiology, Clinical Presentation, and Prognosis of Posterior Circulation Ischemic Stroke in Children

BackgroundAnterior and posterior circulation strokes are often different in terms of presentation and recurrence risk, but there are few studies that focused on posterior circulation stroke. MethodsWe performed a longitudinal retrospective study of children, birth to 18 years, with posterior circulation ischemic stroke at the Children's Hospital Winnipeg from January 1992 to December 2012. Clinical and radiological features and outcomes were collected using standardized tools. ResultsOf the 158 children with arterial ischemic stroke, 23 (14.5%) children, 21 non-neonates, and 11 males were identified. For posterior circulation ischemic stroke, mean crude incidence of 0.38 and crude mortality rate of 0.11 per 100,000 person-years was estimated. The crude total period prevalence rate for the study period was estimated as 8.1 per 100,000 children. Nonspecific symptoms before stroke presentation were present in 38% and impaired consciousness in 71%. Identifiable risk factors were present in two thirds: vasculopathy 24%, infection 19%, trauma 14%, and congenital heart disease 9.5%. Average Pediatric National Institutes of Health Stroke Scale score at presentation was 11. Poor outcome was noted in 45%. Outcome did not change significantly between 12 and 24 months. Aboriginal ethnicity (P = 0.01), high Pediatric National Institutes of Health Stroke Scale score (P = 0.001), bilateral infarction (P = 0.001), and large caliber artery territory infarction (P = 0.02) predicted poor outcome. ConclusionsOur hospital-based incidence and outcome data provide valuable information to help direct treatment strategies and prognosticate children with posterior circulation ischemic stroke. Our study calls for close observation and early management of children with posterior circulation stroke, in particular with aboriginal ancestry and bilateral and large artery territory infarction.

Vitamin status of rural residents, living in Russian Arctic

The aim of this cross-sectional observational study was to estimate vitamin D, B2, A, E, β-carotene (BC) status in rural residents, living in Russian Arctic (Yamal-Nenets Autonomous Area). 216 healthy adults (166 women, 50 men, 45.4±0.8 years old; BMI 27.5±0.5 kg/m2), 76% aboriginal ethnicity and 24% non-aboriginals subjects have been surveyed in spring 2016. Nenets were 72% among the surveyed, Russians - 14%, other ethnic groups - 14%. A total of 69 and 78% of subjects had 25(OH)D and BC blood serum concentrations less than the recommended target threshold of 30 ng/ml and 20 μg/dL respectively. Deficiency of vitamins B2, A and E, when blood serum concentrations of riboflavin <5 ng/ml, retinol <30 μg/dL and tocopherols <0.8 mg/dL, were found in 34, 15 and 13% of participants, respectively. The indigenous population was better supplied with vitamins D and B2. The lack of these vitamins was detected 1.3 and 1.8 fold less often (p<0.05) than in the non-aboriginals; whereas non-aboriginals were better provided with vitamin A and BC: the deficiency of these micronutrients was detected 3.1 and 1.8 fold less often (p<0.05) than in the inhabitants. In general, only 2.4% of those surveyed were sufficiently supplied with all 4 studied vitamins and BC. The frequency of deficit of one or two vitamins was revealed in 62.2%, combined deficiency of 3 or more vitamins was detected in 35.4%. There were no statistically significant differences in the incidence of combined multivitamin deficiencies among the indigenous and non-aboriginals. High incidence of vitamin A deficiency in the indigenous female population (21%) along with insufficiency of vitamin B2 in female non-aboriginals (48%), the lack of vitamin E in men (22%) and vitamin D and BC in 70-78% of the surveyed dictate the need for targeted enrichment of the diet of people living in extreme conditions of the Russian Arctic with multivitamin complexes.