Type 2 diabetes in young Indigenous Australians in rural and remote areas: diagnosis, screening, management and prevention

The burden of type 2 diabetes mellitus (T2DM) among Indigenous children and adolescents is much greater than in non-Indigenous young people and appears to be rising, although data on epidemiology and complications are limited. Young Indigenous people living in remote areas appear to be at excess risk of T2DM. Most young Indigenous people with T2DM are asymptomatic at diagnosis and typically have a family history of T2DM, are overweight or obese and may have signs of hyperinsulinism such as acanthosis nigricans. Onset is usually during early adolescence. Barriers to addressing T2DM in young Indigenous people living in rural and remote settings relate to health service access, demographics, socioeconomic factors, cultural factors, and limited resources at individual and health service levels. We recommend screening for T2DM for any Aboriginal or Torres Strait Islander person aged > 10 years (or past the onset of puberty) who is overweight or obese, has a positive family history of diabetes, has signs of insulin resistance, has dyslipidaemia, has received psychotropic therapy, or has been exposed to diabetes in utero. Individualised management plans should include identification of risk factors, complications, behavioural factors and treatment targets, and should take into account psychosocial factors which may influence health care interaction, treatment success and clinical outcomes. Preventive strategies, including lifestyle modification, need to play a dominant role in tackling T2DM in young Indigenous people.     

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。     

Diabetes in Indigenous Australians: possible ways forward

Reducing the burden of diabetes will require action well beyond the health service sphere.     

EBM and the health of Indigenous Australians

Implementing evidence-based medicine (EBM) in primary healthcare for Indigenous people will usually involve increasing services, particularly those for chronic conditions. As shown by the example of diabetes care, there are significant organisational, educational, economic, cultural and structural barriers to implementing EBM in many Indigenous communities. Many of these barriers could be reduced by better-organised service delivery systems at the community level, greater numbers of Indigenous health professionals and greater advocacy for healthy public policy by health services. There is evidence that delivering evidence-based primary healthcare, particularly for chronic diseases, can improve health outcomes in Indigenous communities. There is a need for more investment in strategies to implement EBM and evidence-based public health in Indigenous settings.     

Prevalence of Helicobacter pylori and parasites in symptomatic children examined for Helicobacter pylori antibodies,antigens, and parasites in Yemen

Objectives:

To estimate the prevalence of Helicobacter pylori (H. pylori) and parasites in symptomatic children examined for H. pylori antibodies, antigens, and parasites in Yemen.

Methods:

A record-based study was carried out at Specialized Sam Pediatric Center in Sana’a, Yemen for 3 years between 2011-2013. Out of the 43,200 patients seen for different causes through that period, 1008 (2.3%) (females: 675 [67%]; males: 333 [33%]) had gastric complaints, and were subjected to an examination of blood and stool for H. pylori and parasites. Data regarding age and gender was also collected.

Results:

The age of the patients ranged from 3-15 years. The prevalence of H. pylori among children examined for H. pylori was 65%, 30% of them were males, and 35% were females (chi square [I²]=142 p=<0.01]). The prevalence in the 6-8 years age group was 83%, and it was 52% in the age group of 12-15 years. The prevalence of giardiasis was 10%, and amoebiasis was 25%.

Conclusion:

Prevalence of H. pylori infection among children was high, and was more prevalent in the age group of 6-8 years than in the other age groups. Females were more affected than males. Parasites (amoebiasis and giardiasis) infestation was less prevalent.In countries with low socioeconomic status, co-infections involving several different pathogens commonly occur. Several studies from different locations have reported a possible connection between Giardia intestinalis and Helicobacter pylori (H. pylori).1,2 Both organisms inhabit the gastrointestinal tract (GI) in their human hosts within a close proximity, and both organisms are recognized to infect children at a high rate in low-income countries.3,4 The H. pylori is a common bacterial infectious disease whose manifestations predominately have an effect on the GI tract, a gram negative, spiral-shaped pathogenic bacterium residing in the mucosa overlying the epithelium of the gastric antrum was first isolated by Warren and Marshall in 1982.3 At first, this bacterium was classified as Campylobacter pylori but in 1989 it was included in a new genus, Helicobacter, and renamed Helicobacter pylori. It is among the most common bacterial infections in the world, and thousands of articles have been written regarding H. pylori.5The H. pylori is capable to live in the stomach acid because it releases enzymes that neutralize the acid; this allows H. pylori to make its way to the “safe” area - the protective mucous lining, which permits acid to get through to the sensitive layer below. Both the acid and bacteria irritate the lining, and cause abdominal pain, or ulcer.6 The method of acquisition and transmission of H. pylori is uncertain, even though the most probable method of transmission is fecal-oral, or oral-oral. Risk factors, such as low-income in childhood, or affected family members also influence the prevalence. All children infected with H. pylori develop histologic chronic active gastritis but often asymptomatic. Manifestation of H. pylori infection in children is abdominal pain or vomiting, less often, refractory iron deficiency anemia, or growth retardation. Chronic colonization with H. pylori will prompt children to a notably augmented risk of developing duodenal ulcer, or gastric cancer. The H. pylori is classified as a group 1 carcinogen by the World Health Organization (WHO).7 The prevalence and rate of acquisition of H. pylori infection in children from developing countries is higher than in developed countries.8 The prevalence is 3-10% of the population each year in developing countries, while in developed countries it is 0.5%.8 In a very attractive longitudinal study from the US-Mexican border, Cervantes et al9 demonstrated that a younger sibling was 4 times more liable to become infected with H. pylori if the mother was infected with H. pylori in contrast with an uninfected mother. Younger siblings were 8 times more liable to become infected if their older index sibling had persistent H. pylori infection.9 Crowding, poor living conditions, and poor personal hygiene may play a role as well.10 In Saudi Arabia, they found that there was a significant relation between H. pylori infection, and recurrent abdominal pain among students.11 Similarly, in Oman they found that H. pylori associated with active chronic gastritis is the most common form of stomach diseases. Particularly females, young, and middle ages group had the highest frequency of H. pylori organisms in gastric antrum.12 Regardless of the success in numerous diagnostic methods for the detection of H. pylori, such as endoscopy, urea breath test, stool and blood samples, and the enhancement in socioeconomic status, infection with H. pylori is still on rise, and physicians in many developing countries are facing the issues of availability and cost, to establish the diagnosis of H. pylori infection. Worldwide, non-invasive tests for active infection are preferred (such as, urea breath test, stool antigen test, and blood antibody test).13The results from many researchers depend on one or 2 tests only for the diagnosis of H. pylori, and any test that would give positive result for H. pylori was regarded positive for final diagnosis. However, every diagnostic method has a percentage of false positive or negative result, therefore, if at least 2 methods for H. pylori indicates positive result at the same time for the same patient, this indicates that the patient has really been infected with H. pylori.14,15 The aim of this study is to determine the prevalence of H. pylori, and parasites among symptomatic Yemeni children, and to identify the possible cause of the acquisition and transmission of H. pylori.     

When the tide goes out: health workforce in rural, remote and Indigenous communities

There is compelling evidence for the success of the "rural pipeline" (rural student recruitment and rurally based education and professional training) in increasing the rural workforce. The nexus between clinical education and training, sustaining the health care workforce, clinical research, and quality and safety needs greater emphasis in regional areas. A "teaching health system" for non-metropolitan Australia requires greater commitment to teaching as core business, as well as provision of infrastructure, including accommodation, and access to the private sector. Workforce flexibility is mostly well accepted in rural and remote areas. There is room for expanding the scope of clinical practice by non-medical clinicians in both an independent codified manner (eg, nurse practitioners) and through flexible local medical delegation (eg, practice nurses, Aboriginal health workers, and therapists). The imbalance between subspecialist and generalist medical training needs to be addressed. Improved training and recognition of Aboriginal health workers, as well as continued investment in Indigenous entry to other health professional programs, remain policy priorities.     

Suicide by aboriginal people in South Australia: comparison with suicide deaths in the total urban and rural populations

OBJECTIVE: To ascertain the number of recorded deaths by suicide of Aboriginal people and non-Aboriginals in South Australian urban and rural areas over the period 1981-1988. METHOD: The South Australian Coroner's records were examined by one of the authors and an Aboriginal research officer in consultation with members of the South Australian Aboriginal community (who identified Aboriginal suicides wrongly recorded as non-Aboriginal suicides). RESULTS: There was a major increase in suicide by Aboriginal people, both urban and rural, over that period, not marked by a similar increase for non-Aboriginal South Australians. CONCLUSIONS: A comparison can be drawn with reports of suicide by American Indians. It is possible that Aboriginal deaths by suicide can be ascribed to "anomie" (a concept first developed by Durkheim of social disintegration affecting tribal peoples under colonisation). The paper highlights the need for the development of successful intervention programmes in Aboriginal health.     

幽门螺杆菌感染与抑郁症的关联性研究

目的:探讨幽门螺杆菌(Hp)与抑郁症是否具有关联性,Hp根除治疗对抑郁症患者病情的影响。方法:抑郁症患者共131例,行14C-尿素呼气试验分为Hp感染组(101例)和未感染组(30例),使用汉密尔顿(HAMD)抑郁量表进行抑郁评分。Hp感染组随机分为试验组(55例)和对照组(46例),试验组进行规范Hp根除治疗,两组同时依病情使用SSR、ISNR I及NaSSA类抗抑郁药,4周后再次行HAMD抑郁评分。结果:Hp感染组与非感染组HAMD抑郁评分分别为26.55±5.94、17.90±5.65,t=7.085,P=0.000。试验组与对照组治疗前后HAMD抑郁评分差值分别为9.27±7.73、4.93±5.00,t=3.398,P=0.001。结论:幽门螺杆菌感染与抑郁症相关,Hp根除治疗对抑郁症患者的病情好转有显著促进作用。     

Nutrition-related disorders in Indigenous Australians: how things have changed

Awareness of a serious Indigenous health problem in Australia did not emerge until the 1960s and 1970s. Much attention was focused at the time on poor pregnancy outcomes, high infant and young child mortality rates, and childhood malnutrition and impaired growth, often associated with high infectious disease burdens. Although that situation has improved somewhat, Indigenous infant and child health is still poor compared with that of other Australian children. Over recent decades, there has been a rapid rise among Indigenous people of nutrition-related "lifestyle" disorders such as obesity, cardiovascular disease, type 2 diabetes mellitus and chronic renal disease and their complications. This epidemic of disabling and often fatal chronic diseases in Indigenous Australians is also occurring in disadvantaged groups in many other countries. Control of this potentially disastrous epidemic must become a much higher priority in Indigenous health programs. Governments must commit to this task in cooperation and collaboration with Indigenous organisations and communities.     

幽门螺杆菌与慢性胃炎病变的关系

0　引言　幽门螺杆菌 ( H elicobacter pylori,Hp)是慢性胃炎的病原菌 .近年来 Hp感染引起胃粘膜病变的作用引起了广泛重视 [1 - 3] .我们对 3 3 14例慢性胃炎的胃粘膜纤维内窥镜活检组织进行了 Hp检测 ,分析 Hp感染在胃粘膜病变形成中的作用 .1　材料和方法1.1　标本来源　取西京医院 1993 /2 0 0 0经纤维内窥镜活检并为病理诊断证实的慢性胃炎 3 3 13 (男 2 182 ,女 113 1)例 .平均年龄 5 3 .1( 2～ 81)岁 .组织学诊断根据 1980年全国胃癌协作组制定的标准 [4 ] .1.2　 Hp检测方法　纤维内窥镜钳取胃粘膜组织 ,取材部位为胃窦、胃体、…