non-Aboriginal People Research Articles

“They just don’t like to wait”: A comparative study of Aboriginal and non-Aboriginal people who do not wait for treatment or discharge themselves against medical advice from rural emergency departments

Australian Aboriginals presenting to emergency departments are consistently over reported in urban data that looks at those people who do not wait for treatment, or who discharge against medical advice. To date, studies relevant to the way in which Aboriginal people interface with emergency departments have been conducted in large urban centres

Exploration of the beliefs and experiences of Aboriginal people with cancer in Western Australia: a methodology to acknowledge cultural difference and build understanding

BackgroundAboriginal Australians experience poorer outcomes, and are 2.5 times more likely to die from cancer than non-Aboriginal people, even after adjustment for stage of diagnosis, cancer treatment and comorbidities. They are also less likely to present early as a result of symptoms and to access treatment. Psycho-social factors affect Aboriginal people's willingness and ability to participate in cancer-related screening and treatment services, but little exploration of this has occurred within Australia to date. The current research adopted a phenomenological qualitative approach to understand and explore the lived experiences of Aboriginal Australians with cancer and their beliefs and understanding around this disease in Western Australia (WA). This paper details considerations in the design and process of conducting the research.Methods/DesignThe National Health and Medical Research Council (NHMRC) guidelines for ethical conduct of Aboriginal research were followed. Researchers acknowledged the past negative experiences of Aboriginal people with research and were keen to build trust and relationships prior to conducting research with them. Thirty in-depth interviews with Aboriginal people affected by cancer and twenty with health service providers were carried out in urban, rural and remote areas of WA. Interviews were audio-recorded, transcribed verbatim and coded independently by two researchers. NVivo7 software was used to assist data management and analysis. Participants' narratives were divided into broad categories to allow identification of key themes and discussed by the research team.Discussion and conclusionKey issues specific to Aboriginal research include the need for the research process to be relationship-based, respectful, culturally appropriate and inclusive of Aboriginal people. Researchers are accountable to both participants and the wider community for reporting their findings and for research translation so that the research outcomes benefit the Aboriginal community. There are a number of factors that influence whether the desired level of engagement can be achieved in practice. These include the level of resourcing for the project and the researchers' efforts to ensure dissemination and research translation; and the capacity of the Aboriginal community to engage with research given other demands upon their time.

“They just don’t like to wait”—A comparative study of Aboriginal and non-Aboriginal people who did not wait for treatment or discharged against medical advice from rural emergency departments: Part 1

Aboriginal people are consistently over reported in data looking at those who either did not wait or discharged themselves against medical advice from emergency departments. This study adds to current knowledge by providing a rural perspective on this problem. Methods This comparative descriptive study examines demographic patterns of people who utilise emergency departments in the North Coast Area Health Service of New South Wales in a 12-month period. Results Aboriginal people were 1.5 times more likely to leave emergency departments prior to being seen by the medical officer, and 2.5 times more likely to discharge against medical advice than non-Aboriginal people. Descriptive analysis revealed that those Aboriginal people who did not wait were more likely to be younger, female, arrived by ambulance, and present on a Monday, Tuesday, or Sunday in the early evening. A correlation between triage categories and did not wait revealed the majority of Aboriginal people who did not wait had been triaged to a category 4 or 5. Those triaged to category 4 were 4.5 times more likely to leave than those triaged category 5. Conclusion This study reveals the urban trend of rates for did not wait and discharged against medical advice for Aboriginal people is replicated in rural/regional areas in NSW supporting indirect evidence of service dissatisfaction for this group. Aboriginal people are consistently over reported in data looking at those who either did not wait or discharged themselves against medical advice from emergency departments. This study adds to current knowledge by providing a rural perspective on this problem. This comparative descriptive study examines demographic patterns of people who utilise emergency departments in the North Coast Area Health Service of New South Wales in a 12-month period. Aboriginal people were 1.5 times more likely to leave emergency departments prior to being seen by the medical officer, and 2.5 times more likely to discharge against medical advice than non-Aboriginal people. Descriptive analysis revealed that those Aboriginal people who did not wait were more likely to be younger, female, arrived by ambulance, and present on a Monday, Tuesday, or Sunday in the early evening. A correlation between triage categories and did not wait revealed the majority of Aboriginal people who did not wait had been triaged to a category 4 or 5. Those triaged to category 4 were 4.5 times more likely to leave than those triaged category 5. This study reveals the urban trend of rates for did not wait and discharged against medical advice for Aboriginal people is replicated in rural/regional areas in NSW supporting indirect evidence of service dissatisfaction for this group.

“They just don’t like to wait”—A comparative study of Aboriginal and non-Aboriginal people who did not wait for treatment, or discharged themselves against medical advice from rural emergency departments: Part 2

Summary Aboriginal people are consistently over-reported in data looking at those who either not or discharged themselves against medical from emergency departments. This study adds to current knowledge by providing a rural perspective on this problem. Methods This comparative descriptive study examines demographic patterns of people who utilised emergency departments in the North Coast Area Health Service of New South Wales in a twelve month period. Results Aboriginal people were 1.5 times more likely to leave rural emergency departments prior to being seen by the medical officer, and 2.5 times more likely to discharge against medical advice then non-Aboriginal people. Descriptive analysis reveals that those Aboriginal people who did not wait were more likely to be younger, female, arrived by ambulance, and present on a Monday, Tuesday, or Sunday in the early evening. A correlation between triage categories and did not wait revealed the majority of Aboriginal people who did not wait had been triaged to a category 4 or 5. Of concern the study uncovered a strong relationship between Aboriginal people triaged category 3 and did not wait or discharge against medical advice. Conclusion The study replicated urban trends for rates of did not wait and discharge against medical advice for Aboriginal people, supporting indirect evidence of service dissatisfaction for this group. Rural communities often provide limited or no choice for alternative after-hours health care arrangements, leading to potential adverse outcomes for this vulnerable group.

An increase in overseas acquired HIV infections among heterosexual people in Western Australia

There has been a recent increase in the number of heterosexually acquired HIV infections among non-Aboriginal people in Western Australia (WA), which has not been reported in other Australian jurisdictions. This report describes the epidemiological features of this increase. A descriptive analysis was conducted of newly diagnosed HIV infections among non-Aboriginal WA residents notified to the Department of Health from 2002 to 2006. Analysis outcomes included demographics, exposure categories, and place of HIV acquisition. From 2002 to 2006, 258 new HIV diagnoses were notified among non-Aboriginal WA residents. Over this period, the number of notifications increased from 41 cases in 2002 (2.2 cases/100 000 population) to 66 cases in 2006 (3.4 cases/100 000 population). Overall, 107 (42%) of the cases were heterosexually acquired, and the annual number increased threefold from 2002 to 2006 (12 to 36 cases, respectively). Of these cases, 64 (60%) were male and 43 (40%) were female. The majority (89%) of male cases acquired HIV overseas, mostly in countries other than their region of birth; South-east Asia was the most common place of acquisition reported. Over half (56%) of the female cases acquired HIV overseas, mainly in their region of birth (83%), and sub-Saharan Africa was the most common place of acquisition. There has been a recent increase in heterosexually acquired HIV infections among male and female WA residents, many of whom reported acquiring HIV overseas. Safe sex campaigns in WA should continue to reinforce safe sex messages among people travelling overseas.

Access to health care among status Aboriginal people with chronic kidney disease

Ethnic disparities in access to health care and health outcomes are well documented. It is unclear whether similar differences exist between Aboriginal and non-Aboriginal people with chronic kidney disease in Canada. We determined whether access to care differed between status Aboriginal people (Aboriginal people registered under the federal Indian Act) and non-Aboriginal people with chronic kidney disease. We identified 106 511 non-Aboriginal and 1182 Aboriginal patients with chronic kidney disease (estimated glomerular filtration rate less than 60 mL/min/1.73 m(2)). We compared outcomes, including hospital admissions, that may have been preventable with appropriate outpatient care (ambulatory-care-sensitive conditions) as well as use of specialist services, including visits to nephrologists and general internists. Aboriginal people were almost twice as likely as non-Aboriginal people to be admitted to hospital for an ambulatory-care-sensitive condition (rate ratio 1.77, 95% confidence interval [CI] 1.46-2.13). Aboriginal people with severe chronic kidney disease (estimated glomerular filtration rate < 30 mL/min/1.73 m(2)) were 43% less likely than non-Aboriginal people with severe chronic kidney disease to visit a nephrologist (hazard ratio 0.57, 95% CI 0.39-0.83). There was no difference in the likelihood of visiting a general internist (hazard ratio 1.00, 95% CI 0.83-1.21). Increased rates of hospital admissions for ambulatory-care-sensitive conditions and a reduced likelihood of nephrology visits suggest potential inequities in care among status Aboriginal people with chronic kidney disease. The extent to which this may contribute to the higher rate of kidney failure in this population requires further exploration.

Telling and Retelling Your Story in Court: Questions, Assumptions and Intercultural Implications

This article presents a sociolinguistic examination of the ways in which stories are told and retold in the criminal justice process, particularly in court. The main argument concerns the fundamental contradictions between everyday storytelling and retelling on the one hand, and the expectations and interpretations of storytelling and retelling in court on the other. Drawing on research on police interviews, lawyer interviews and courtroom talk, the article examines issues such as consistency and inconsistency, and the role of questions in shaping a person's story. While there are a number of distinctive assumptions and practices in the culture of the law which are not shared in the wider Australian community, there are particular implications for Aboriginal people, who are still 20 times more likely to come into contact with the criminal justice system than non-Aboriginal people. These implications are introduced and exemplified, and the article concludes by raising questions about alternative approaches to storytelling and retelling in court.

Emergency Department Presentations of Victorian Aboriginal and Torres Strait Islander People

This paper explains how routinely collected data can be used to examine the emergency department attendances of Victorian Aboriginal and Torres Strait Islander people. The data reported in the Victorian Emergency Minimum Dataset (VEMD) for the 2006/2007 financial year were analysed. The presentations of Aboriginal and Torres Strait Islander and non-Aboriginal people were compared in terms of age, gender, hospital location (metropolitan and rural) and presenting condition. Aboriginal and Torres Strait Islander people were found to attend the emergency department 1.8 times more often than non-Aboriginal people. While the emergency department presentation rates of metropolitan Aboriginal and Torres Strait Islander and non-Aboriginal people were similar, rural Aboriginal and Torres Strait Islander people presented to the emergency department 2.3 times more often than non-Aboriginal people. The injuries or poisonings, respiratory conditions and mental disorders presentation rates of the Aboriginal and Torres Strait Islander and non-Aboriginal population were compared. No previous studies have assessed the accuracy of the Indigenous status and diagnosis fields in the VEMD; therefore the quality of this data is unknown.

Improving the accuracy of Aboriginal and non-Aboriginal disease notification rates using data linkage

BackgroundRoutinely collected infectious disease surveillance data provide a valuable means to monitor the health of populations. Notifiable disease surveillance systems in Australia have consistently reported high levels of completeness for the demographic data fields of age and sex, but low levels of completeness for Aboriginality data. Significant amounts of missing data associated with case notifications can introduce bias in the estimation of disease rates by population subgroups. The aim of this analysis was to evaluate the use of data linkage to improve the accuracy of estimated notification rates for sexually transmitted infections (STIs) and blood borne viruses (BBVs) in Aboriginal and non-Aboriginal groups in Western Australia.MethodsProbabilistic methods were used to link disease notification data received in Western Australia in 2004 with core population health datasets from the established Western Australian Data Linkage System. A comparative descriptive analysis of STI and BBV notification rates according to Aboriginality was conducted based on the original and supplemented notification datasets.ResultsUsing data linkage, the proportion of STI and BBV notifications with missing Aboriginality data was reduced by 74 per cent. Compared with excluding notifications with unknown Aboriginality data from the analysis, or apportioning notifications with unknown Aboriginality based on the proportion of cases with known Aboriginality, the rate ratios of chlamydia, syphilis and hepatitis C among Aboriginal relative to non-Aboriginal people decreased when Aboriginality data from data linkage was included.ConclusionAlthough there is still a high incidence of STIs and BBVs in Aboriginal people, incompleteness of Aboriginality data contributes to overestimation of the risk associated with Aboriginality for these diseases. Data linkage can be effectively used to improve the accuracy of estimated disease notification rates.

Multidisciplinary treatment of diabetic foot ulcers in Canadian Aboriginal and non-Aboriginal people

Diabetic foot ulcers are a major cause of morbidity and mortality. This study evaluated the clinical outcomes in Canadian non-Aboriginal and Aboriginal diabetic patients with foot ulcers managed at a multidisciplinary, tertiary care diabetic foot clinic. A retrospective review of medical records was done for 325 patients receiving care during a 2-year period. All patients were followed at least 1 year after the initial visit. There were 224 (69%) non-Aboriginal and 101 (31%) Aboriginal patients with 697 foot ulcers. At the initial office visit, 204 (63%) patients had lesions in Wagner grades 2-4. At the most recent evaluation (average, 79+/-73 weeks after initial clinic visit), 190 (58%) patients were rated as having a good outcome (either healed or healing), but a poor outcome (static, progression, amputation, or death) was noted in 135 (42%) patients. At the most recent evaluation, the majority of the 697 ulcers that were noted at the initial or subsequent clinic visits were healed. Aboriginal patients had a shorter average time from initial clinic visit to major lower extremity amputation (Aboriginal, 50+/-64 weeks; non-Aboriginal, 62+/-56 weeks; P<0.01). Residence in a rural or reserve community also correlated with shorter average time from initial clinic visit to major lower extremity amputation (rural or reserve, 45+/-56 weeks; urban, 66+/-61 weeks; P<0.002). When controlled for non-urban residence, Aboriginal ethnicity was not associated with poorer clinical outcome. Earlier major lower extremity amputation was significantly associated with non-urban residence, Aboriginal ethnicity, and arterial insufficiency. Poor clinical outcome was significantly associated with being referred with a lesion present, age greater than 60 years, prior lower extremity amputation or revascularization, arterial insufficiency, more than one lesion on initial presentation, longer duration of type 2 diabetes, and a higher initial Wagner grade for the most advanced lesion. A multidisciplinary diabetic foot clinic may be successful in treating diabetic foot ulcers in Aboriginal and non-Aboriginal people. However, the frequency of poor outcome is high, consistent with the high prevalence of associated significant risk factors in this population.

Perinatal HIV transmission and pregnancy outcomes in indigenous women in Western Australia

Implementation of obstetric and neonatal interventions has reduced mother to child transmission of HIV. Health outcomes for Aboriginal people are often worse than for non-Aboriginal people; was this the case for HIV infection in pregnancy? To compare the management and outcomes of pregnancy in Aboriginal and non-Aboriginal HIV-positive women in Western Australia (WA). A retrospective study of all pregnancies delivered in WA to HIV-infected women from 1991 until 2005. Managed pregnancies were compared in Aboriginal and non-Aboriginal women. Outcome measures were HIV status of the babies, birthweight, rates of caesarean delivery and perinatal mortality. Fifty-six pregnancies occurred in 41 HIV-infected women resulting in 54 live births. Of the 41 women, 16 (39%) were Aboriginal. In regard to birthweight, perinatal mortality, rates of caesarean section and rates of HIV perinatal transmission, there was no significant difference between babies born to Aboriginal and those born to non-Aboriginal mothers. In contrast, of the eight pregnancies, with no contact with the multidisciplinary team, five babies (63%) were infected with HIV (2% vs 63%P = 0.001). There was no case of perinatal HIV infection in 22 pregnancies of the Aboriginal women that received care through the multidisciplinary team; perinatally acquired HIV occurred in the first pregnancy of one of these women before she was aware of her status when she was not managed by the team. Similar outcomes can be achieved in both HIV-positive Aboriginal and non-Aboriginal women, through intensive, culturally appropriate, multidisciplinary care and without elective caesarean delivery.

It's enough to make you sick: the impact of racism on the health of Aboriginal Australians

Experience of interpersonal racism has been neglected as a mechanism by which inequalities between Aboriginal and non-Aboriginal people are created and maintained. Cross-sectional survey of randomly selected residents of a rural Australian town (n=639). Interpersonal racism was measured by two questions on experiences in the past four weeks of negative racially based treatment that evoked an emotional or physical response. Health was measured with the mental and physical health component scores of the Short-Form 12 and self-reported fair or poor general health. Linear and logistic regressions modelled the effects of interpersonal racism on health, controlling for age, sex, socio-economic status and Aboriginality. The 183 Aboriginal respondents had lower health component scores, were more than twice as likely to report fair-to-poor general health (34% compared with 17%, p<0.001), and 2.6 to 5.0 times more likely to report negative racially based treatment. Demographic and socio-economic characteristics were not associated with reporting negative racially based treatment. After controlling for other variables, Aboriginal respondents who reported negative treatment were more likely to have poor health on all three measures. Non-Aboriginal respondents who reported experiencing negative treatment had lower mental health component scores. Experiencing racist treatment should be recognised as a social determinant of health. Improved health care and other initiatives may not eliminate health inequalities in the absence of fundamental changes in how non-Aboriginal people behave towards Aboriginal people.

Fallen between the Cracks: Conservation Linking Land and Sea

Fallen between the Cracks: Conservation Linking Land and Sea

HIV Risk, Systemic Inequities, and Aboriginal Youth

In Canada, Aboriginal people are overrepresented in the HIV epidemic and infected at a younger age than non-Aboriginal people. This paper discusses some of the ways Aboriginal youth in Toronto understand HIV/AIDS risk and the relevance of their comments for HIV prevention education. This research is part of a larger study conducted with Ontario youth through the Gendering Adolescent AIDS Prevention (GAAP) project. We conducted 11 GAAP focus groups with Ontario youth. This paper focuses primarily on the four groups of Aboriginal youth. A modified grounded theory approach guided analyses. Data were coded using Nud*ist qualitative data management software. Aboriginal youth were more aware of HIV/AIDS and the structural inequities that contribute to risk than their non-Aboriginal counterparts. In addition, they were the only group to talk about colonialism in the context of HIV in their community. Aboriginal youth were, however, more likely to hold a fatalistic view of their future and to blame their own community for high infection rates. We argue for incorporating structural factors of risk, including the legacy of colonialism, in HIV prevention programs for all youth. This may help to eradicate the stigma and self-blame that negatively impact on Aboriginal youth while allowing other youth populations to distance themselves from the disease.

Incidence and risk factors for newly acquired hepatitis C virus infection among Aboriginal versus non-Aboriginal Canadians in six regions, 1999–2004

The purpose of this study was to compare hepatitis C virus (HCV) incidence and recent patterns of transmission within Aboriginal and non-Aboriginal Canadians. Cases of newly acquired HCV infection (in patients > or =15 years) reported to the Enhanced Hepatitis Strain Surveillance System from six jurisdictions in Canada were analyzed. Information on demographic and clinical characteristics as well as risk factors for HCV infection was collected using standardized questionnaires. Univariate analysis showed Aboriginal patients to be significantly more likely than non-Aboriginal patients to report injection drug use (77.1% vs. 64.0%; p < 0.05), to be female (54.6% vs. 37.6%; p < 0.05), to report high-risk sexual behaviors (48.6% vs. 34.1%, p < 0.05), and to report drug snorting (45.7% vs. 32.7%, p < 0.05). The median age of Aboriginal patients was significantly younger than that of non-Aboriginal patients (31 years [range, 15-71] vs. 34 years [range, 15-81]; p < 0.05). The overall incidence of HCV infection per 100,000 people aged 15 years and older was 18.9 (95% confidence interval [CI] 15.5-23.1) in Aboriginal people and 2.8 (95%CI 2.6-3.1) in non-Aboriginal people. Poisson regression analysis revealed that Aboriginal Canadians were more likely than non-Aboriginal Canadians to develop acute hepatitis C (adjusted rate ratio 5.8, 95%CI 4.7-7.3). An appropriate and effective public health strategy that includes planned and implemented prevention programs in partnership with the Aboriginal community is needed.

The relationship between diabetes and tuberculosis in Saskatchewan: comparison of registered Indians and other Saskatchewan people.

Saskatchewan Aboriginal people are experiencing epidemics of both type 2 diabetes (T2DM) and tuberculosis (TB). The purpose of this study was to determine if a relationship exists between diabetes and TB in Saskatchewan and to establish whether there is a difference in the degree of any association between Aboriginal and non-Aboriginal people. Utilizing Saskatchewan Health databases, TB incidence (cases identified from 1986-2001) was compared between four subpopulations identified from 1991-1995: Registered Indians (RI) with and without diabetes, and other Saskatchewan people (OSKP) with and without diabetes. Diabetic women aged 20-59 years had higher average annual incidence rates of TB than non-diabetic women, but within-population rate ratios of TB in diabetic versus non-diabetic women were only significant in those aged 50-59 (2.7 [CI 1.28, 5.72] in RI and 3.9 [CI 1.58, 9.67] in OSKP). No other within-population diabetic subgroup had significantly higher rates of TB. The only male diabetic group that had a higher rate of TB were RI plus OSKP men aged 50-59 years. Overall, diabetes preceded TB in 87/111 individuals with both diseases (p < 0.0001). Our results suggest that T2DM is a predictor for TB in Saskatchewan women aged 20-59 but particularly in RI and OSKP women aged 50-59 years. This has implications for TB screening and prevention initiatives.

The Globalization of the Didjeridu and the Implications for Small Scale Community Based Producers in Remote Northern Australia

The didjeridu is a wind instrument which is traditionally made from hollowed Eucalyptus trees and used in various ceremonial situations Aboriginal people in Northern Australia. Today the didjeridu has become a globally recognized symbol of Australianna and is produced for personal use and sale by various groups of people including Aboriginal people in Central and Southern Australia and non-Aboriginal people within Australia and around the world. The globalization of the instrument has had many and varied effects on the Aboriginal people from which the instrument originated. On one hand it has allowed these economically and socially disadvantaged communities to supplement income and on the other they have seen their cultural and intellectual property exploited and their physical property stolen (poaching of tress from Aboriginal land). In this paper it is proposed that an economically viable model for a remote community based didjeridu industry, which maintains environmental and cultural integrity and improves social conditions, is possible. This is demonstrated through an analysis of existing production methods, costs and sales strategies. Target customer groups are identified through the examination of market research conducted in the Northern Territory, Australia and environmental sustainability is assessed by summarising ecological response of harvests. Finally recommendations are made for pursuit of a sustainably managed didjeridu industry in northern Australia.

The correlation between asthma control and health status: the GOAL study

The present study examined the association between guideline-derived asthma control and health-related quality of life, assessed using the Asthma Quality of Life Questionnaire (AQLQ), in patients with uncontrolled asthma whose treatment was directed towards achieving the highest possible level of control. The present randomised, double-blind, parallel-group study compared the efficacy of fluticasone propionate (FP) and salmeterol/fluticasone propionate combination (SFC) in achieving two composite, guideline-derived measures of control: total control (TC) and well-controlled (WC) asthma. Not achieving these levels was classed as not well-controlled (NWC). Doses were augmented until patients achieved TC or reached the maximum dose. This dose was maintained for the remainder of the study. AQLQ was assessed at baseline and at each clinic visit. AQLQ scores improved throughout the study, reaching near-maximal levels in patients achieving TC and WC, and 52-week mean scores in the three control groups were statistically significantly different. Clinically meaningful improvements (mean change from baseline) were: TC group (SFC 1.9, FP 1.8), WC (SFC 1.5, FP 1.5) and NWC (SFC 1.0, FP 0.9). In conclusion, the treatment aimed at controlling asthma improves the health-related quality of life to levels approaching normal. The difference in Asthma Quality of Life Questionnaire scores between total control and well-controlled confirms that patients distinguish even between these high levels of control.

Reduced nephron number and glomerulomegaly in Australian Aborigines: A group at high risk for renal disease and hypertension

Aborigines in remote areas of Australia have much higher rates of renal disease, as well as hypertension and cardiovascular disease, than non-Aboriginal Australians. We compared kidney findings in Aboriginal and non-Aboriginal people in one remote region. Glomerular number and mean glomerular volume were estimated with the disector/fractionator combination in the right kidney of 19 Aborigines and 24 non-Aboriginal people undergoing forensic autopsy for sudden or unexpected death in the Top End of the Northern Territory. Aborigines had 30% fewer glomeruli than non-Aborigines--202,000 fewer glomeruli per kidney, or an estimated 404,000 fewer per person (P=0.036). Their mean glomerular volume was 27% larger (P=0.016). Glomerular number was significantly correlated with adult height, inferring a relationship with birthweight, which, on average, is much lower in Aboriginal than non-Aboriginal people. Aboriginal people with a history of hypertension had 30% fewer glomeruli than those without--250,000 fewer per kidney (P=0.03), or 500,000 fewer per person, and their mean glomerular volume was about 25% larger. The lower nephron number in Aboriginal people is compatible with their susceptibility to renal failure. The additional nephron deficit associated with hypertension is compatible with other reports. Lower nephron numbers are probably due in part to reduced nephron endowment, which is related to a suboptimal intrauterine environment. Compensatory glomerular hypertrophy in people with fewer nephrons, while minimizing loss of total filtering surface area, might be exacerbating nephron loss. Optimization of fetal growth should ultimately reduce the florid epidemic of renal disease, hypertension, and cardiovascular disease.

Authentic Indians: episodes of encounter from the late-nineteenth-century Northwest Coast

In this innovative history, Paige Raibmon examines the political ramifications of ideas about “real Indians.” Focusing on the Northwest Coast in the late nineteenth century and early twentieth, she describes how government officials, missionaries, anthropologists, reformers, settlers, and tourists developed definitions of Indian authenticity based on such binaries as Indian versus White, traditional versus modern, and uncivilized versus civilized. They recognized as authentic only those expressions of “Indianness” that conformed to their limited definitions and reflected their sense of colonial legitimacy and racial superiority. Raibmon shows that Whites and Aboriginals were collaborators—albeit unequal ones—in the politics of authenticity. Non-Aboriginal people employed definitions of Indian culture that limited Aboriginal claims to resources, land, and sovereignty, while Aboriginals utilized those same definitions to access the social, political, and economic means necessary for their survival under colonialism. Drawing on research in newspapers, magazines, agency and missionary records, memoirs, and diaries, Raibmon combines cultural and labor history. She looks at three historical episodes: the participation of a group of Kwakwaka’wakw from Vancouver in the 1893 World’s Columbian Exposition in Chicago; the work of migrant Aboriginal laborers in the hop fields of Puget Sound; and the legal efforts of Tlingit artist Rudolph Walton to have his mixed-race step-children admitted to the white public school in Sitka, Alaska. Together these episodes reveal the consequences of outsiders’ attempts to define authentic Aboriginal culture. Raibmon argues that Aboriginal culture is much more than the reproduction of rituals; it also lies in the means by which Aboriginal people generate new and meaningful ways of identifying their place in a changing modern environment.