Frequent hospital admissions for bacterial infections among aboriginal people with diabetes in central Australia

OBJECTIVE: To determine hospital-based morbidity and mortality from bacterial infections among Aboriginal people with diabetes in central Australia. DESIGN: Examination of medical records on diabetic inpatients between January 1984 and December 1986. SETTING: Alice Springs Hospital in central Australia, covering an Aboriginal population of about 12,500 people. PATIENTS: Subjects admitted with a bacterial infection (n = 165) were selected from the database of all Aboriginal people known to have diabetes in the region (n = 374; all had non-insulin dependent diabetes). MAIN OUTCOME MEASURES: Number of admissions, type and site of infections, causative organisms, duration of hospital stay and cause of death. RESULTS: The 281 admissions for infections accounted for 4.6% of adult Aboriginal admissions to hospital. Thirteen patients died. Eleven patients required amputation of a digit or limb. In 1986, 13/200 patients admitted with diabetes had bacteraemia compared with 14/1885 patients who did not have diabetes. One patient had Fournier's gangrene, one had malignant otitis externa, one community acquired Acinetobacter pneumonia, one pneumonia with Succinivibrio spp. found in blood cultures, and one meningitis and transverse myelopathy with Streptococcus milleri found in blood cultures. CONCLUSIONS: The frequency, type and severity of infections in the relatively young patients result in high personal costs to the community and financial costs to the health care system. Standard preventive measures must be implemented to control severe bacterial infections among subjects with diabetes in this socially and economically marginalised population group.     

Prevalence of Helicobacter pylori in Indigenous Western Australians: comparison between urban and remote rural populations

OBJECTIVES: To determine and compare the prevalence of Helicobacter pylori in an urban and a remote rural Western Australian Indigenous community. DESIGN: Cross-sectional study of Helicobacter pylori status determined by urea breath tests between mid-January 2003 and the end of June 2004. PARTICIPANTS: 520 self-selected fasting participants, comprising 270 members of the Martu community at Jigalong, Punmu and Parnngurr in the East Pilbara region (129 men, 141 women; age range, 2-90 years) and 250 people from the Perth Indigenous community (96 men, 154 women; age range, 3-75 years. RESULTS: The overall prevalence of H. pylori was 76%, but the prevalence in the remote rural community was 91%, compared with 60% in the urban community. The odds of having H. pylori were six times greater for rural than for urban participants (odds ratio [OR], 6.34; 95% CI, 3.89-10.33). Further, the overall odds of H. pylori infection in males (rural and urban combined) were greater than for females (OR, 1.61; 95% CI, 1.02-2.54). In both communities, the prevalence of infection remained relatively constant after the age of 10. CONCLUSIONS: The prevalence of H. pylori in the two Indigenous communities was two to three times higher than that in the non-Indigenous Australian population and higher than that shown in previous studies in Indigenous Australians.     

城乡社区自杀死亡率前瞻性观察

目的研究城乡社区人群的自杀死亡率及其在不同人群中的分布特征,探讨自杀死亡原因和自杀方式.方法采用分层整群抽样方法,选择城乡8个观察区,自1988年至1992年对其自杀死亡状况进行5年前瞻性观察.结果观察区5年间≥15岁人群中共自杀死亡423例,5年的逐年自杀死亡率分别为10万分之17.75、27.29、25.26、18.31和22.96.年平均自杀死亡率为10万分之22.32.主要自杀原因为家庭纠纷、失恋和精神疾病,主要自杀方式为服毒和自缢.结论本观察区中的自杀死亡率、自杀原因和自杀方式与国内同类研究结果基本一致,与国外资料相比本观察区自杀死亡率处于中等或中等以上水平.     

城乡社区自杀死亡率前瞻性观察

目的：研究城乡社区人群的自杀死亡率及其在不同人群中的分布特征，探讨自杀死亡原因和自杀方式。方法：采用分层整群抽样方法，选择城乡8个观察区，自1988年至1992年对其自杀死亡状况进行5年前瞻性观察。结果：观察区5年间≥15岁人群中共自杀死亡423例，5年的逐年自杀死亡率分别为10万分之17．75，27．29，25．26，18．31和22．96。年平均自杀死亡率为10万分之22．32，主要自杀原因为家庭纠纷，失恋和精神疾病，主要自杀方式为服毒和自缢。结论：本观察区中的自杀死亡率，自杀原因和自杀方式与国内同类研究结果基本一致，与国外资料相比本观察区自杀死亡率处于中等或中等以上水平。     

Diabetes among aboriginal people in central Australia: a high prevalence based on health service attendance

The prevalence of diagnosed diabetes in Aboriginal people living in central Australia (population, 9983) was determined by collating data from the hospital, rural and urban health services, nursing homes and death registers. A total of 98 male and 183 female Aboriginal residents with diabetes attended health services in central Australia between January 1984 and December 1986. The point prevalence of diagnosed diabetes at the end of 1986 in the age group 25-34 years was 1.6% in men and 3.1% in women, and in those over 35 years, 8.8% and 14.1%, respectively. The true prevalence of diabetes (diagnosed and undetected) is likely to be at least twice this rate, and constitutes a major public health problem in central Australia. Diabetes and other disorders such as obesity, hypertension and ischaemic heart disease have common antecedents and outcomes. The control of these non-communicable diseases requires integrated and culturally appropriate educational, social and medical strategies.     

中国城乡青年女性自杀死亡比较研究

本文采用了全国人口普查资料（１９９０年）和中国预防医学科学院疾病监测点（１９８８－１９９２年）的部分资料，并进行横断面的分析，所得到的结果发现：农村青年女性自杀死亡率几科是城市青年女性的５倍，无论在农村还是在城市，青年女性自杀死亡的死因位置均居前列。随着整个医疗技术的进步，传染病以及慢性疾病等得到了很好的控制，而影响青年女性生命健康的自杀行为应该予以注意。     

吉林省长春市城乡社区老年人健康状况调查分析及比较

目的：通过调查长春市城乡社区老年人健康状况,分析其影响因素,为社区老年人疾病预防和社区卫生服务提供决策依据。方法：本次调查方法利用分层抽样和系统抽样相结合的方法对位于长春市朝阳区的桂林路社区、城乡结合处的净月开发区及德惠县三胜乡姜家村社区的600名老人进行问卷调查和体格检查。所有调查人员由经过严格培训的公共卫生学院研究生、护理学院的教师及学生组成。根据老年护理学日常生活能力表（ADL）和美国波士顿研究所的简明健康调查问卷（SF-36）自行设计老年健康状况调查表。调查表由人口统计学资料、身体健康状况、经济状况及社区卫生服务4部分组成。研究采取频数分布、率、构成比等描述性方法,统计分析采用SPSS13.0统计软件,比较长春市桂林路社区、城乡结合处净月社区及德惠三胜乡姜家村社区老人的健康状况。结果：本次调查老年人慢性病患病率为77.14%,城市、城乡结合部及农村慢性病患病率分别为87.36%、83.61%和71.22%;各种慢性病患病率依次为：心脏病51.43%,高血压36.96%,关节炎34.11%,脑血管病28.04%,呼吸系统疾病23.04%,白内障8.04%,恶性肿瘤3.92%,帕金森病1.42%,残疾0.53%。老年人患2种或2种以上慢性病的总患病率为67.30%。位于前4位的疾病为高血压、心脏病、脑血管病和关节炎,其患病率城市明显高于农村和城乡结合处(P<0.001)。结论：长春市城乡社区老年人慢性病患病率较高,应大力加强社区医务工作者对老年人的预防保健指导,提高老年人的健康水平。     

河南汉族城乡40岁以上高血压人群16项体质特征

目的了解河南汉族城乡40岁以上高血压人群的体质特征。方法运用分层和整群抽样方法调查河南汉族40岁以上人群个人基本情况,测量血压、身高、坐高、体重、肩胛下皮褶、髂前上棘皮褶、胸围、吸气胸围、呼气胸围、腹围、臀围、WHR、身体脂肪率、内脏脂肪率、BMI、基础代谢率、身体年龄。结果共调查高血压人群740人(城市290人,农村450人),正常血压840人(城市240人,农村600人)。高血压与正常血压人群在男性有WHR等10项有差异(P<0.05),女性有BMI等10项有差异(P<0.05)。城乡人群比较,有体重等10项有差异(P<0.05)。结论河南汉族40岁以上高血压人群体质指标中,身高、肩胛下皮褶、髂前上棘皮褶、腹围、臀围、身体脂肪率、内脏脂肪率、基础代谢率是高血压人群的重要特征,而体重、胸围、吸气胸围、呼气胸围不是该人群关联体质特征。     

Birth defects in the infants of aboriginal and non-aboriginal mothers with diabetes in Western Australia.

OBJECTIVE: Because of the high prevalence of non-insulin-dependent diabetes in Australian Aborigines, and a suggestion that the prevalence of birth defects was high in the infants of Aboriginal mothers with gestational diabetes, this study was undertaken to determine the prevalence of birth defects in infants of Aboriginal and non-Aboriginal mothers with insulin-dependent, non-insulin-dependent, and gestational diabetes mellitus. DESIGN: A retrospective cohort study of all births to diabetic and non-diabetic mothers in Western Australia, 1980-1984. MAIN OUTCOME MEASURE: Birth defects diagnosed at any time up to the age of six years. RESULTS: Compared with infants of non-diabetic, non-Aboriginal mothers, the prevalence ratio for birth defects in infants of non-Aboriginal insulin-dependent mothers was 2.08 (95% confidence interval, 1.2-3.7), and for infants of mothers with non-insulin-dependent diabetes the ratio was 3.64 (95% CI, 1.5-8.6). The corresponding ratios for infants of Aboriginal mothers were 4.85 (95% CI, 0.8-28.2) and 3.64 (95% CI, 1.3-10.4). For birth defects in infants of gestational diabetic mothers, the prevalence ratio was 1.07 (95% CI, 0.6-1.9) for the non-Aboriginal group and 3.65 (95% CI, 2.3-6.0) for the Aboriginal group. Diabetes could have accounted for 0.14% of birth defects in infants of non-Aboriginal mothers and for 4.62% in infants of Aboriginal mothers. CONCLUSIONS: The excess of birth defects in infants of Aboriginal women with gestational diabetes may be due to non-insulin-dependent diabetes that predates the pregnancy but is only diagnosed during pregnancy. For Aboriginal infants, maternal diabetes may be the single most common known cause of birth defects that is amenable to change.     

Hepatitis-B virus infection in rural and urban populations of eastern Nigeria: prevalence of serological markers

Hepatitis B virus markers were measured by radioimmunoassay in the sera of 804 rural and urban inhabitants and prisoners in Nigeria. Of these, 530 (66%) subjects had one or more serologic markers of HBV infection; 9.1% were HBsAg carriers, 47% had anti-HBs and 10.1% were positive for anti-HBc alone. Total HBV exposure rate, HBsAg carrier rate and previous exposure to hepatitis B virus measured by the frequency of anti-HBc alone were significantly higher in the rural population compared with the urban population (p less than 0.0001; p less than 0.03; p less than 0.01) respectively. It was observed that by the age of 40 years, 87% of the Nigerian population have at least one HBV seric marker. There was a higher incidence of HBsAg (p less than 0.0001) and anti-HBc alone (p less than 0.001) in prisoners than in any other group. HBeAg was present in 16.4% HBsAg positive individuals with no intersex difference. No positive correlation was found between the frequency of HBV markers in rural dwellers and the history of blood transfusions. These findings suggest that horizontal transmission aided by cultural or behavioural factors and clustering of carriers rather than transfusions is the main determinant of HBV prevalence in rural Nigeria.     

Severe traumatic brain injury in New South Wales: comparable outcomes for rural and urban residents

OBJECTIVE: To compare differences in functional outcomes between urban and rural patients with traumatic brain injury (TBI). DESIGN: A longitudinal, prospective, multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program (BIRP) for New South Wales, with follow-up at 18 months after injury. PARTICIPANTS: 198 patients (147 urban, 51 rural) with severe TBI from the 11 participating rehabilitation units. MAIN OUTCOME MEASURES: Demographic and injury details collected prospectively using a standardised questionnaire, and measures from five validated instruments (Disability Rating Scale, Mayo-Portland Adaptability Inventory, Sydney Psychosocial Reintegration Scale, Medical Outcomes Study Short Form and the General Health Questionnaire--28-item version) administered at follow-up to document functional, psychosocial, emotional and vocational outcomes. RESULTS: Demographic details, injury severity, lengths of stay in intensive and acute care wards were similar for both rural and urban groups. There were no significant group differences in functional outcomes, including return to work, at follow-up. CONCLUSIONS: Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents, and suggest that the integrated network of inpatient, outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live.     

城乡终末期肾病患者开始血液透析时的特征分析和比较

 目的 探讨城乡终末期肾病(end stage renal disease,ESRD)患者开始血液透析时的流行病学特征差异,为研究防治策略提供依据。方法 对2000年1月至2008年12月在复旦大学附属中山医院血液净化中心开始血液透析的ESRD患者流行病学资料进行横断面分析。结果 共928例患者,其中城市患者占69.61%,农村患者30.39%,农村患者平均年龄显著低于城市患者［(44.48±16.41) 岁 vs.(56.71±16.13) 岁,P=0.000］,透析前病程显著短于城市患者(28.5个月vs.51.5个月,P=0.000)。ESRD病因中农村患者慢性肾小球肾炎所占比例显著多于城市患者(67.38% vs. 48.76%,P=0.000),糖尿病肾病(8.51% vs. 13.47%,P=0.032)和高血压肾病(7.09% vs. 12.07%,P=0.023)显著少于城市患者。农村患者血液透析前估算肾小球滤过率(estimated glomerular filtration rate,eGFR)显著低于城市患者［(4.98±3.72) mL·min-1·1.73 m-2 vs. (5.48±3.04) mL·min-1·1.73 m-2,P=0.032),血压显著高于城市患者(154.73/89.55 mm Hg vs. 149.43/85.96 mm Hg,P<0.05,1 mm Hg=0.133 kPa),血红蛋白显著低于城市患者［(69.92±24.91) g/L vs.(74.60±25.64) g/L,P=0.001］。结论 终末期肾病患者进入透析前,农村患者较城市患者年轻、病程短,透析前肾功能更差,高血压和贫血等并发症控制较差;病因中慢性肾小球肾炎更多见,而高血压肾病及糖尿病肾病则相对比例较少。应加强农村肾病患者的早期防治,有效控制并发症,及时接受透析治疗。     

北京市城乡限定人群低视力与盲的患病率及其病因的调查

目的 研究北京市城乡≥40岁特定人群低视力、盲的患病率和病因。方法 对北京大兴区榆垡镇与城区北部5个干休所社区,用限定人群逐户上门登记的方法进行最佳矫正视力的检查。符合条件的人群进行系统的眼科检查。系统的眼科检查包括视功能检查和眼形态学检查。低视力和盲以WHO的标准进行统计。结果 5324人入选,实查4451人,农村应答率：79.37%,城市应答率：87.15%。低视力和盲的患病率分别为0.99%（95%CI：0.70-1.28)和0.39%(95%CI:0.21-0.57)。低视力的患病率女性（1.45%)是男性（0.65%)的2.23倍（OR：1.97,95%CI:1.00-3.95),农村（1.76%)是城市（0.61%)的2.89倍（OR：2.93,95%CI:1.43-6.11)。盲的患病率女性为0.64%,男性为0.37%(OR:1.55,95%CI:0.63-3.96),农村（1.06%)是城市（0.52%)的2.04倍（OR：3.77,95%CI:1.41-10.62)。导致盲的主要原因是白内障（37.50%)、青光眼（29.17%)、高度近视眼底病变（8.33%)、角膜病（8.33%)和其他眼底病变（16.67%)。各种病因的患病率农村明显高于城市。特别是白内障的患病率,农村（8/9,88.89%)明显高于城市（1/9,11.11%),24例盲中,农村女性占66.67%。结论 低视力和盲的患病率随年龄增长患病率增高。农村地区的低视力和盲的患病率高于城市。白内障、青光眼是致盲的主要原因。低视力和盲受年龄、地区、医疗保健水平、文化程度、经济状况、环境因素和性别的影响。