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Biomedical subjects

M Gracey

Publications and source records attributed to M Gracey.

At least 55 records · Page 3Linked to original sources
PubMed1994

Hospitalization of infants for infections in Western Australia, 1980-91.

Rates of hospitalization of Aboriginal infants in Western Australia from 1980 through 1991 for infections were much higher than for other infants and were consistently higher in rural areas than in metropolitan areas. There were substantial declines in rates of hospital admissions and bed occupancy of rural Aboriginal infants for respiratory and gastrointestinal infections during the study period; changes in rates for other infections were less marked and less consistent. Despite recent improvements, Aboriginal infants are hospitalized much more frequently and for longer than other infants because of these diseases. Hospitalization rates reflect many factors including disease incidence and severity but also are affected by isolation, climatic and physical conditions, and access to medical and nursing care. Preventive health programmes need to be maintained and intensified in order to improve health standards of young Aborigines and to lessen their need for hospital care.

Bed Occupancy↗
PubMed1993

The prevalence of Giardia and other intestinal parasites in children, dogs and cats from aboriginal communities in the Kimberley.

OBJECTIVE: To determine the prevalence of Giardia duodenalis and other intestinal parasites in children, dogs and cats from Aboriginal communities in the west Kimberley region of Western Australia. DESIGN: A four-year parasitological survey of faecal specimens from humans and faecal and intestinal specimens from dogs and cats. SETTING: Local hospital servicing Aboriginal communities surveyed in this study and the Veterinary School, Murdoch University. POPULATION: Children (under 14 years) and adults, as well as dogs and cats, from five Aboriginal communities. RESULTS: G. duodenalis was the most prevalent parasite in children and adults (32.1% in children, n = 361; 12.5% in adults, n = 24). Human infections with Hymenolepis nana (20.5%) and Entamoeba coli (13.0%) were also common. Ancylostoma duodenale (1.3%), Pentatrichomonas hominis (1.0%), Chilomastix mesnili (0.52%), Entamoeba hartmanni (0.52%), Sarcocystis sp. (0.52%), Trichuris trichiura (0.26%), Enterobius vermicularis (0.26%), Strongyloides stercoralis (0.26%) and Isospora belli (0.26%) were present at low rates. Dogs were most commonly infected with Ancylostoma caninum (51.1%) and G. duodenalis (17.0%). Cats were found to have a high prevalence of Ancylostoma tubaeforme (18.2%), Toxoplasma gondii (18.2%), Isospora felis (15.1%) and Spirometra erinacei (15.1%). CONCLUSIONS: This study has shown that children from Aboriginal communities in the west Kimberley region of Western Australia, particularly in the age group one to five years, are commonly infected with intestinal parasites. The dogs and cats in these communities are also infected. The high prevalence rates of Giardia and other enteric parasites in this survey are indicative of poor living conditions and low levels of hygiene. In addition, the high prevalence of hookworm and Giardia infection in dogs and hookworm and Toxoplasma infection in cats is of potential zoonotic significance for humans in these communities.

Adolescent↗
PubMed1993

Bacterial diarrhoea.

Diarrhoeal disease caused by enteric bacterial pathogens has become less prevalent in industrialized countries, but remains an important cause of morbidity and mortality in developing countries. Although better management of acute diarrhoeal episodes has led to more favourable outcomes, persistent diarrhoea remains a problem for which risk factors are being recognized and associated bacterial pathogens identified. Unusual or intractable diarrhoea should alert health workers to the possibility of impaired immune function, which is associated with a range of enteric pathogens and opportunistic infections. Improved microbiological methods have resulted in more frequent detection of pathogens in association with diarrhoea, as well as greater understanding of pathogenesis. Clinical features of diarrhoeal disease and mechanisms involved in pathogenesis are discussed in relation to specific bacterial enteric pathogens.

Bacterial Infections↗
PubMed1993

Diffuse and enteroaggregative patterns of adherence of enteric Escherichia coli isolated from aboriginal children from the Kimberley region of Western Australia.

Escherichia coli from 138 fecal samples from aboriginal children, in whom no other enteric pathogen was isolated (including enterovirulent E. coli), were examined for HEp-2 cell adhesion. Twenty-five (36.8%) of 68 children with diarrhea and 32 (45.7%) of 70 without diarrhea had diffusely adherent isolates, which were thus not associated with diarrhea (P > .25). However, after age stratification, children > or = 18 months showed a significant association of diffusely adherent E. coli with diarrhea (P < or = .05). Enteroaggregative E. coli were isolated from 12 children with diarrhea (17.6%) and 15 without diarrhea (21.4%); thus, there was no association with diarrhea (P > or = .5). Sixteen children with diarrhea (23.5%) and 6 without diarrhea (8.6%) carried isolates that caused detachment of the HEp-2 cell monolayer from the glass coverslip when examined in the adhesion assay and were significantly associated with diarrhea (P < or = .05). These isolates, termed cell-detaching E. coli, were different from all recognized classes of enterovirulent E. coli.

Age Factors↗
PubMed1992

Epidemiology and microbiology of diarrhoea in young Aboriginal children in the Kimberley region of Western Australia.

Infectious diarrhoea is common in young Australian Aborigines and is one of the main causes for their unsatisfactory health standards with consequent widespread failure to thrive and undernutrition. Most published reports relate to patients in hospital or to hospital admission statistics and give little indication of the extent or severity of diarrhoeal disease in children in Aboriginal communities. The present investigation involved more than 100 Aboriginal children up to 5 years of age living in remote communities in the tropical north of Western Australia who were studied prospectively over a 12-month period.

Bacterial Infections↗
PubMed1992

Virulence factors of enteric Escherichia coli in young Aboriginal children in north-west Australia.

Enterotoxigenic Escherichia coli (ETEC) were the most frequently identified enteric pathogens associated with diarrhoea in 0-5 year old Aboriginal children in tropical north-west Australia with an incidence similar to those from other tropical regions. Heat-stable toxin-producing (ST+) strains were associated with diarrhoea throughout the year but heat-labile toxin-producing (LT+) strains were more important in the monsoonal summer season. ST+ strains were commonest in children with diarrhoea between 6 and 18 months of age while LT+ strains were associated with diarrhoea in children aged 18-24 months. Vero-toxigenic E. coli (VTEC) which produced VT1, but not VT2, and enteroadherent (EAF+) E. coli were significant causes of diarrhoea, mainly in children below 18 months but without a seasonal pattern.

Australia↗
PubMed1992

Maternal and environmental factors associated with infections and undernutrition in young Australian aboriginal children.

Forty-eight Aboriginal infants in remote communities in north-west Australia were studied monthly from birth to 2 years. Birthweight and growth were positively associated with maternal health during pregnancy, regular antenatal supervision and lack of drinking alcohol or smoking tobacco as well as with personal and family hygiene. Impaired growth was associated with families which had more expensive consumer goods such as televisions, air conditioners, video cassette recorders and cassette tape players. Most children had impaired growth or frank failure to thrive which was associated with high rates of infections, particularly of the respiratory and gastro-intestinal tracts, and high rates of hospitalization.

Adult↗
PubMed1992

Diarrhoea in Australian Aborigines.

Infectious diarrhoea has been recognised as a serious public health problem for Aboriginal Australians, particularly infants and young children, for more than two decades. These diseases are caused by bacterial, viral and parasitic infections which are spread mainly by the faecal-oral route and which must be interrupted if prevention is to be effective. This paper reviews published reports on this subject and interventions which have been used elsewhere to reduce the incidence of infectious diarrhoea. These reports have important implications for Aboriginal health but interventions and strategies to overcome this problem must recognise the unique circumstances of Aboriginal people in Australia.

Child, Preschool↗
PubMed1992

Cryptosporidium in 100 Australian children.

Over a consecutive 36 month period, 100 patients out of 6,980 (1.4%) from whom stool samples were examined had oocysts of Cryptosporidium detected on fecal microscopy. Three patients were receiving cytotoxic chemotherapy and adequate clinical information was available from 84 of the remainder. Fifty per cent of patients were aged 1 to 2 years, 29% were less than 12 months and the rest were more than 2 years of age. More than one-quarter of the patients were Australian Aborigines. Isolations of cryptosporidia were most prevalent in late summer, autumn and early winter. Most patients (89%) had diarrhea, more than 75% had vomiting and 44% were dehydrated, mostly to a mild degree. Other symptoms included fever (11%) and abdominal pain (11%). Ten percent of patients were apparently symptomless. Cryptosporidium sp. is the second most commonly identified intestinal parasite, after Giardia intestinalis, in fecal specimens examined in our children's hospital. The high rate of isolation in Aboriginal children emphasized the importance of enteric pathogens in this group and the role of inadequate hygiene in relation to diarrheal disease in young Aborigines.

Child Nutrition Disorders↗
PubMed1991

Cytotoxic effects of children's faeces: relation to diarrhoea due to Clostridium difficile and other enteric pathogens.

Cytotoxicity of faecal extracts was demonstrated in 47 of 88 children (54%) referred for microbiological investigation of stools. Cytotoxic Clostridium difficile and vertotoxigenic Escherichia coli (VTEC) were the pathogens identified most commonly but cytotoxicity was also found in association with Campylobacter jejuni, Salmonella spp, Shigella sonnei, Giardia lamblia, rotavirus, adenovirus and poliovirus type 1 which had been acquired by oral immunization. In two patients, one of whom had cystic fibrosis, cytotoxicity of faecal extracts was associated with isolation of Pseudomonas aeruginosa. In five of 13 patients with diarrhoea and cytotoxic C. difficile, other pathogens were also present, in agreement with the view that C. difficile are more readily recovered when the intestinal flora have been altered by colonization with other micro-organisms. There was no correlation between previous treatment with antibiotics and isolation of C. difficile. Cytotoxicity neutralized by antitoxin, usually to C. sordellii, is used to detect cytotoxic C. difficile. We suggest that cytotoxicity not neutralized in this way should be an indication for further investigation of stools for the presence of other pathogens such as VTEC or viruses.

Adolescent↗
PubMed1991

Recent advances in childhood diarrhoeal diseases.

Over the past 20 years there have been many important advances in knowledge about diarrhoeal diseases of children. Of these, the development of oral rehydration therapy (ORT), has been outstanding. This is based on the observation that intestinal sodium transport is enhanced by glucose transport in the small intestine and that this sodium-coupled mechanism for glucose and water transport remains intact in the enterotoxigenic diarrhoeas despite the net secretory effects of bacterial enterotoxins on the small intestinal epithelium. The World Health Organisation has adopted ORT and strongly promoted its application for treatment of diarrhoeal diseases, particularly in developing countries. This has resulted in a drop in diarrhoeal disease mortality and the application of this treatment has been described in an Editorial in the Lancet as "potentially the most important medical advance this century".

Acute Disease↗