Incidence of Dog Bite Injuries in American Samoa and Their Impact on Society

Introduction

In American Samoa, a US Territory in the South Pacific, over half of reported injuries are attributed to dog bites. Despite years of public outcry, little has been done to adequately address these preventable injuries that affect all age groups of both sexes.

Objective

To describe a serious public health hazard in American Samoa that may plague other jurisdictions that tolerate a significant free-roaming dog population.

Methods

A limited data set of outpatient records from 2004 through 2010 from the Territory''s only emergency department listing an ICD-9-CM E-code of E906.0 (“dog bite”) in the primary E-code field provided a record of dog bite injuries. A survey of 437 adolescents documented their experiences regarding unprovoked dog attacks during the 2010/2011 school year.

Results

The sex/age group with the highest incidence for dog bite treatment was males 55 to 59 years of age (73.1 per 10,000 population per year) followed closely by males 10 to 14 years of age (71.8 per 10,000 population per year). Males aged 5 to 14 years accounted for 23% of all emergency department visits for dog bites. About one-third of adolescents reported having been bitten by a dog between September 2010 and May 2011. About 10% of males and 16% of females attributed the fear of being bitten as a factor preventing them from getting more physical activity.

Conclusions

Children, adolescents, and the elderly are the most vulnerable to dog bite injuries. Emergency room records may reflect only about a quarter of all such injuries.

Implications

Unprovoked attacks by aggressive, free-roaming dogs degrade quality of life by placing an untenable burden on the health care system and imposing physical and psychological barriers toward a more healthful lifestyle that includes walking, jogging, and bicycling.     

Community Perspectives on Contraception in the Context of Zika Virus in American Samoa and the Commonwealth of the Northern Mariana Islands

The prevention of unintended pregnancy was identified as a primary prevention strategy to reduce Zika-related adverse birth outcomes during the 2016-2017 Zika virus outbreak. The Centers for Disease Control and Prevention in partnership with local health agencies conducted formative research to guide the development of culturally appropriate messages and materials to increase awareness of the prevention of unintended pregnancy as a strategy to decrease Zika-related adverse outcomes in American Samoa and the Commonwealth of the Northern Mariana Islands (CNMI). Nine focus groups (N=71) were conducted with women and men aged 18-44 years living in American Samoa and CNMI. Semi-structured interview guides were used to explore participants’ knowledge and perceptions of Zika, family planning, and contraception; barriers and facilitators to access contraception and use; and information sources and contraception decision-making. Trained staff from local organizations co-moderated each focus group. Thematic analysis was conducted with NVivo 10. Participants had mixed knowledge about Zika virus and its relation to pregnancy and birth defects. Women and men had varied knowledge of the full range of contraceptive methods available in their jurisdiction and identified barriers to contraceptive access. Social factors including stigma, gender roles, and religion often deterred participants from accessing contraceptive services. Participants highlighted the need for culturally appropriate and clear messaging about contraceptive methods. Results demonstrate the feasibility of conducting formative research as an effective strategy for understanding community perspectives on unintended pregnancy prevention in the context of the Zika virus outbreak to develop health communication materials.     

Insights in Public Health: A Tale of Two Polities: Health in Independent and American Samoa

Independent and American Samoa have a shared cultural, genetic, ethnolinguistic, and historical background but have been politically separated since 1899. In this essay, we examine the health of these two polities and identify two key health patterns that have emerged even as American Samoa has achieved a higher per capita income than Independent Samoa. Whereas the gender gap in life expectancy at birth has narrowed in Independent Samoa, this gap has not narrowed in American Samoa and its male life expectancy now lags behind that of Independent Samoa. Neonatal mortality rates in American Samoa are slightly higher than in Independent Samoa. These patterns may be linked to the higher rates of obesity and urbanization observed in American Samoa compared to Independent Samoa, as well as the differing political and institutional arrangements of the two polities. Limited data remains a persistent challenge to conducting analysis of public health in the Pacific islands, particularly in American Samoa.     

Seroprevalence of measles,mumps and rubella among children in American Samoa, 2011, and progress towards West Pacific Region goals of elimination

Introduction

In line with the global goals for measles elimination, countries in the West Pacific Region (WPR) have set a goal to eliminate measles by 2012. Due to its contagiousness, high population immunity is needed for achieving and documenting measles elimination. We assessed population immunity to measles, mumps and rubella among first grade children in American Samoa (AS) through a seroprevalance study.

Methods

Using commercial indirect enzyme-linked immunosorbant IgG assays (Wampole Laboratories, Cranbury, NJ) we determined IgG antibodies against the measles, mumps, and rubella (MMR) viruses in sera collected from first grade students in AS in April–May 2011. Vaccination status was retrieved from the immunization cards. Factors associated with seropositivity of measles, mumps, and rubella were analyzed separately.

Result

Among 509 first grade students, measles, mumps, and rubella seroprevalence were 92%, 90%, and 93%, respectively. The proportions of first grade students with documented one or two doses of MMR vaccine were 93% and 84%, respectively. The vaccination status of 6% of the first graders was unknown and 1% was unvaccinated. Receiving two-doses of MMR vaccines was associated with high measles and mumps seropositivity (p < 0.01).

Conclusion

The high measles seroprevalence among children shows the progress by American Samoa towards measles elimination. Achieving and maintaining high two-dose MMR vaccine coverage in all age groups will aid in attaining the measles elimination status and prevent transmission of measles from potential imported measles cases from other countries.     

玉树地震危重伤病员空运后送的组织实施

本文以玉树地震灾害医学救援实践为基础,根据危重伤病员空运后送的组织实施,总结六个方面的经验体会,为机动卫勤分队抽组训练和非战争军事行动卫勤保障能力建设提供借鉴。     

Dietary patterns of children in American Samoa: Multivariate analysis of food groups and household associations

The Winged Bean (Psophocarpus tetrogonolobus) is being widely promoted by development workers as an important new food crop. An examination of some of its simpler nutritional aspects shows it to have also many disadvantages which may outweigh its benefits. It is argued particularly that the problem of the need for prolonged cooking of the winged bean, due to its fibrous husk, will place so great a demand on fuel and time that it will adversely affect the household economy. The protein value (as NPU measured in rats) of the winged bean is shown to be lower than other legumes, though it is normalised by dehulling the beans or by germination. It is suggested that the lower protein value is a reflection of the chemical composition of the husk. The benefits to consumers as opposed to the scientists who have conducted research on the winged bean is questionable.     

The Exchange Coalition-Identifying and Addressing Structural Factors Affecting HIV Prevention in African American Women on a National Basis

ABSTRACT

Introduction: From 1992 to 2002, African American women accounted for almost 70% of all newly diagnosed cases of HIV among women (CDC, 2002). Systemic issues such as poverty, domestic violence, mental illness, and limited access to culturally competent HIV/health care services facilitate high infection rates among these women (OMH, 2005) and render many prevention/treatment messages ineffective. In response, Community Education Group (CEG) formed “The Exchange”-a national advocacy group comprised representatives from various organizations and agencies. To inform the groups formation CEG conducted a formative survey at three conferences to assess interest and need of such a group.

Methods: Using a convenience sample, CEG surveyed care providers, health specialist, and social/behavioral scientists from various organizations at three conferences about: (1) primary issues facing African American women at risk of and living with HIV/AIDS, (2) their interest in building a coalition with organizations with differing foci, and (3) what they believe to be the top health issues facing these women.

Results: Of the 1,186 surveys, 96.7% believed a coalition would provide effective advocacy, 77.3% were willing to build a coalition, and the top three issues affecting rates of infection were health care (62.8%), access to affordable treatment (50%) and unknown partner risk (47%).

Conclusion: Survey respondents felt that a coalition of organizations with differing foci to address the systemic conditions of African American women is needed if we are to have an effect on their rates of HIV/AIDS.     

电子伤票在战伤分类后送中的应用

现代战争条件下，伤员有数量多；时空分布复杂、区域性救治任务加大；重伤多、伤情复杂；出现新的伤类；战争的突发性强，使伤员发生地域难测等特点。对伤病员进行分类后送时，电子伤票作为记载和传输伤员救治信息的一种载体，其信息量大，省时、分类后送效率高，不易破损、丢失和被污染，便于携带等优势，已逐步在实战中试用，但是与任何新生事物一样，也存在一定的不足之处。     

A Multi-level Analysis of Factors Affecting Participation in Health Screenings in Korea: A Focus on Household and Regional Factors

ObjectivesThis study divided the factors that affect participation in health screenings into individual, household, and regional levels and conducted a multi-level analysis to identify the factors related to participation in health screenings.MethodsParticipants from the 2017 Community Health Survey were classified into 2 groups (under 40 and 40 or older). A multi-level logistic regression analysis was conducted to identify the factors that affected participation in health screenings.ResultsThe screening rate of the participants was 69.7%, and it was higher among participants aged 40 and older (80.3%) than it was among participants younger than 40 (49.8%). At the individual level, the factors that influenced participation in health screenings included age, economic activity, smoking status, physician-diagnosed hypertension, and a moderate or high physical activity level. At the household level, the odds ratio of participation in health screenings was high for participants who lived in single-person households, lived with a spouse, earned a high monthly household income, and were not beneficiaries of national basic livelihood security. At the regional level, the odds ratio at the 95% confidence interval level of participation in health screenings was high for participants who had trust in the local community and lived in an area with a proportionally high social welfare budget.ConclusionsThis study analyzed nationalwide data and confirmed that individual, household, and regional characteristics affected participation in health screenings. Therefore, policies that prioritize the improvement of regional level factors and especially household level factors are likely to be the most effective for improving the screening rate.     

美国骨科医疗风险影响因素研究述评

目的通过分析美国骨科医疗风险影响因素的分类方法,为我国骨科医疗风险因素分析和防范提供参考。方法使用Mesh及自由词,检索Pubmed、Embase等数据库以及相关官方网站,查找国外相关文献,并重点研究关国骨科医疗风险因素分析方法。结果美国建立了系统的多维的骨科医疗风险因素分类方法。骨科医疗风险主要存在于设备、沟通传达、用药及手术位置4个方面。结论美国骨科风险因素分析方法规范系统,有针对性,可有效发现医疗风险高发点,其为我国骨科医疗风险因素的分析和防范提供了借鉴和参考。     

A Community-Based Survey of Household Food Insecurity and Associated Sociodemographic Factors among 2–6 Years Old Children in the Southeast of Iran

Malnutrition remains a major public health issue in developing and transitional countries and food insecurity is a major indicator of the nutritional status in these societies. This research aimed to investigate the status of household food insecurity and sociodemographic factors affecting it among 2–6 years old children in an urban area in the southeast of Iran. A community-based survey was conducted from September to January 2018 on 421 children aged 2–6 years who were selected using stratified cluster random sampling. They lived in six different areas in an urban area in the southeast of Iran. Data was collected using the U.S. Department of Agriculture Food Security questionnaire and anthropometric measurements. Our study showed that the prevalence of food insecurity among children was 81.7% consisting of 2.6% with low food security, 9.2% with moderate food insecurity, and 69.9% with very low food security. The weight gain of those children who were in the low food security group, was 2.63 times lower than those children in the food security group. Moreover, the chance of weight gain in the low food security and in the moderate food insecurity groups was less as 1.91 and 1.41 times, respectively. Food insecurity in children aged 2–6 years is influenced by various sociodemographic factors including weight and height, mother’s education level, sanitation as access to water closet (WC). Policymakers should plan to improve the quality of life and health of the children through improving their food security.     

Environmental Factors That Impact the Eating Behaviors of Low-income African American Adolescents in Baltimore City

ObjectiveTo understand environmental factors influencing the food-related habits of low-income urban African American adolescents.DesignQualitative research was conducted between February and April, 2010, using in-depth interviews, focus groups, and direct observation.SettingThe study was conducted in low-income, predominantly African American neighborhoods of Baltimore City.ParticipantsA total of 20 adolescents were interviewed in 18 in-depth interviews (n = 13) and 2 focus groups (n = 7). Participants were recruited from Baltimore City recreation centers and were eligible if they were African American and aged 10–16 years.Phenomenon of InterestThe food-related habits of low-income, African American, urban adolescents and reported perceptions of their food environments.AnalysisInterviews were audio recorded, transcribed, coded, and analyzed for emerging themes.ResultsSix thematic categories emerged and were organized into 4 environmental contexts: the neighborhood context (accessibility of food and safety of neighborhood), the school context (school food environment), the family context (family health history, role modeling, and monitoring) and the peer context (peer behaviors).Conclusions and ImplicationsFuture efforts to reduce the obesity epidemic among low-income African American adolescents should address the social environment of the family; however, positive behavior change may not be sustainable without neighborhood or school food environment modifications.     

Social capital and immunization against the 2009 A(H1N1) pandemic in the American States

The objective of this paper was to investigate the association between contextual social capital and immunization coverage rates. A cross-sectional, ecologic study design was used. Three different estimations of contextual social capital in American states have been used. Data on immunization coverage rates at state level comes from Centers for Disease Control and Prevention. Correlation coefficients were calculated to investigate the bivariate association between the independent variable social capital and the dependent variable 2009 A(H1N1) immunization coverage rates. A multivariate OLS regression model was used to investigate the association between contextual social capital and immunization, under control for state-level health care spending per capita, state population, population per square mile, and median age in the American States. Results show that Social capital was strongly correlated with 2009 A(H1N1) immunization acceptance among American States. In a multivariate regression analysis, the association remains strong and significant also when controlling state-level confounders. In conclusion, social capital, at least in a U.S. context, is shown to be associated with the state-level uptake of vaccination against the 2009 A(H1N1) pandemic.     

体外受精/胞浆内单精子注射中异常受精的影响因素分析

目的：探讨体外受精（IVF）和胞浆内单精子注射（ICSI）后单原核和多原核受精卵生成的影响因素,为降低异常受精率探寻可行的方法。方法：选取2013年9月—2014年2月本中心2 229个周期[1 425个IVF周期和804个ICSI周期],共计25 160个卵细胞的临床资料,探讨其IVF和ICSI后异常受精的影响因素。结果：①IVF中单原核受精卵生成率与不孕类型、促性腺激素（Gn）剂量及使用时间无关,但IVF周期中女方年龄＞38岁组单原核受精卵生成率显著高于31～38岁组;②常规IVF周期中多原核受精卵生成率显著高于ICSI组;IVF周期中,当获卵数＞15个、取卵日血清雌二醇（E2）水平＞2 000 pg/mL及人绒毛膜促性腺激素（hCG）日E2水平与取卵日E2差值＞4 000 pg/mL者≥3个原核（3PN）形成率显著升高;ICSI周期中,随着女方年龄的增高,特别是女性大于31岁后多原核受精卵生成率显著增高;③采用多重线性回归分析,ICSI受精组中异常原核受精卵数与女方基础（月经周期第2～3天）的E2及黄体生成激素（LH）值、获卵总数呈线性相关,IVF组中异常原核受精卵数与基础（月经周期第2～3天）FSH及获卵总数呈线性关系,IVF组和ICSI组异常原核受精卵数与hCG注射日孕酮（P）/E2×1 000呈反向线性关系。结论：IVF/ICSI中异常受精生成的机制和影响因素不尽相同,临床工作中要针对不同不孕人群选择合适的受精方式,并在促排卵过程根据患者内分泌及卵泡数的变化情况及时更改用药剂量,有助于降低异常受精率。     

Physically Active,Low-Income African American Women: An Exploration of Activity Maintenance in the Context of Sociodemographic Factors Associated with Inactivity

Increasing physical activity among low-income African American women is an important target for addressing racial and economic disparities in chronic conditions and related risk factors. While barriers to physical activity for women have been examined empirically, successful strategies for navigating those barriers among physically active, low-income women have not been thoroughly explored. Informed by grounded theory, we conducted in-depth individual interviews between 2007–2010 with 14 low-income African American women who were physically active at nationally recommended levels for one year or more. We analyzed the data using thematic analysis techniques. Key themes emerged in three main categories: motivation for maintaining active lifestyle, strategies for maintaining physical activity, and challenges to maintaining physical activity. Important motivations included getting or staying healthy, social connections, and gratification. Two planning strategies emerged: flexibility and freedom. Critical challenges included financial constraints, physical strain and history of sedentary relapse. The motivations, strategies and challenges reported by low-income African American women who successfully maintained an active lifestyle provided important information for developing effective health promotion strategies for their inactive and underactive counterparts. A qualitative, asset-based approach to physical activity research contributes rich data to bridge the gap between epidemiological knowledge and community health improvement.     

美国新医改推进医疗信息化对我国的启示:基于《美国复兴与再投资法案》的分析

文章对《美国复兴与再投资法案》中关于美国新医改推进医疗信息化的内容进行了全面的翻译、梳理和总结,并在此基础上提出相应的政策建议,以期为我国医疗信息化改革工作提供参考。     

Adoption of preventive measures during and after the 2009 influenza A (H1N1) virus pandemic peak in Spain

Objective

This study describes the preventive measures adopted by the Spanish population towards 2009 influenza A (H1N1) virus and their associated factors.

Method

An anonymous computer-assisted telephone interview survey was conducted in Spain in December 2009 and February 2010. Respondents were asked about their perceptions of influenza A (H1N1) virus and the preventive measures adopted. Factors associated with the adoption of preventive measures were assessed by logistic regression analyses.

Results

Out of 4892 households approached, 1627 valid responses were obtained (response rate of 33.3%). The most commonly adopted preventive measures were respiratory hygiene and hand washing. Factors independently associated with the adoption of the preventive measures recommended by the Spanish Ministry of Health were female gender, higher educational level, size of municipality of residence > 50,000 inhabitants, high perceived susceptibility to infection, high perceived effectiveness of the measures and high perceived usefulness of the information provided by the government. The presence of school-aged children in household was associated with purchasing masks and hand sanitizer.

Conclusion

In addition to demographic factors, modifiable factors such as personal beliefs and expectations play a role in the adoption of preventive measures.     

河南省农村家庭经济条件与肺结核病之间的关系研究

目的：探讨农村家庭经济条件与肺结核发病的关系及在DOTS化疗管理、免费诊断和治疗策略下．肺结核对痛人家庭经济条件的影响。方法：首先．选取160例新发初治涂阳肺结核病人作为病例。每个病例选取2名与病例住所相邻、同性别和同年龄组的正常人作为对照组．采用发病前的家庭年收入与家庭财产2项指标衡量家庭经济条件。进行1：2配对病例对照研究；然后，对选取的所有病例进行随访收集有关费用；应用OR值及其95％的可信区间来估计其相对危险度：采用平均每例病人的家庭费用及其占家庭年收入的百分比来衡量结核病对家庭经济条件的影响。结果：160例肺结核病人发病前家庭年收入和家庭财产位于上等水平的分别占28．1％和25．6％．位于中等水平的分别占42．5％和35．6％，位于下等水平的分别占29．4％和38．8％，320例对照组同期的家庭年收入和家庭财产位于上等水平的分别占34．7％和37．2％．位于中等水平的分别占42．8％和33．1％。位于下等水平的分别占22．5％和29．7％：以上等水平作参照，单因素条件Logistie回归分析，家庭年收入的中等和下等OR值及其95％的可信区间分别为1．6（1．1-2．8）和2.3（1．2-4．4），家庭财产的中等和下等OR值及其95％的可信区间分别为1.7（1．1～2．8）和2．1（1.3～3．6），采用多因素条件Logistic回归分析后。家庭财产仍具有统计学意义，且OR值仍随着家庭经济条件水平的降低而增高，趋势性检验P值均小于0．05：肺结核病人家庭的直接费用平均为2772．0元．占平均病人家庭年收入的55．5％。我国结核病控制项目治疗下病人家庭的直接费用平均为2504．0元，占病人家庭年收入的50．1％：其他国家结核病控制项目治疗下病人家庭的直接费用平均为3360．0元，占病人家庭年收入的67.3％。结论：虽然，我国经济取得了快速发展．人民生活水平大幅度提高。但农村家庭经济条件差仍是肺结核病的重要危险因素．在实施DOTS策略及免费诊断和治疗策略下，肺结核病人家庭经济负担有所减轻，然而，肺结核病仍给病人家庭造成了沉重的经济负担．使原来本已贫困的家庭雪上加霜。