Indigenous child health: urgent need for improved data to underpin better health outcomes

Accurate data about Indigenous child health is vital to enable us to understand its current state, to acknowledge achievements, and to determine how to reduce inequalities between Indigenous and non-Indigenous children. We have identified a paucity of national, or nationally representative, data relating to Indigenous child health outcomes, and significant deficiencies in available data. A coordinated national approach will help address current data limitations, including lack of identification of Indigenous status, lack of currency, and lack of information about specific health disorders affecting Indigenous children. To ensure that health data collected are relevant and useful, Indigenous communities must have a role in data collection and management.     

Chronic diseases--facing a public health challenge

Middle income countries like those in the Caribbean can feel proud of their achievements in health care. There has been a dramatic fall-off in infant mortality and crude mortality rates along with significant improvements in life expectancy at birth. However, these countries now find themselves grappling with the burden of chronic non-communicable diseases such as heart disease, stroke, hypertension, diabetes mellitus and cancer. There are good data to support the view that some of these diseases, in particular diabetes mellitus, have assumed epidemic proportions and there is concern that this fact may have been missed by many because of the surreptitious onset, as is the nature of the chronic diseases. The impact of this epidemic may have suffered because of the higher profile of more topical issues like HIV/AIDS even though the former makes a larger contribution to morbidity and mortality statistics. It is now obvious that despite the impact of other factors, lifestyle changes are the major contributors to the epidemic. In populations of similar genetic stock, living in significantly different socio-economic circumstances, the impact of increased dietary salt, increasing obesity and decreased physical activity on the prevalence of hypertension, diabetes mellitus and lipid disorders is unequivocal. Data from the developed world, which has already been through this epidemic of chronic diseases, have shown that increasing technological advances in medical care is an inefficient way to respond to the situation. A multi-sectoral approach is required to tackle this epidemic, including the provision of incentives for healthy eating and widespread opportunities for increased exercise and other physical activities. Continued research into the evolution of the epidemic, including reliable estimates via surveillance methods is a necessary component of our response. The problems and the solutions are not only the responsibilities of the health officials but must involve education, agriculture and other sectors of the economy.     

The demise of a planned randomised controlled trial in an urban Aboriginal medical service

To fill a gap in knowledge about the effectiveness of brief intervention for hazardous alcohol use among Indigenous Australians, we attempted to implement a randomised controlled trial in an urban Aboriginal Medical Service (AMS) as a joint AMS-university partnership. Because of low numbers of potential participants being screened, the RCT was abandoned in favour of a two-part "demonstration project". Only 16 clients were recruited for follow-up in six-months, and the trial was terminated. Clinic, patient, Aboriginal health worker, and GP factors, interacting with study design factors, all contributed to our inability to implement the trial as designed. The key points to emerge from the study are that alcohol misuse is a difficult issue to manage in an Indigenous primary health care setting; RCTs involving inevitably complex study protocols may not be acceptable or sufficiently adaptable to make them viable in busy, Indigenous primary health care settings; and "gold-standard" RCT-derived evidence for the effectiveness of many public health interventions in Indigenous primary health care settings may never be available, and decisions about appropriate interventions will often have to be based on qualitative assessment of appropriateness and evidence from other populations and other settings.     

Long-term trends in Indigenous deaths from chronic diseases in the Northern Territory: a foot on the brake, a foot on the accelerator

OBJECTIVE: To examine trends in Northern Territory Indigenous mortality from chronic diseases other than cancer. DESIGN: A comparison of trends in rates of mortality from six chronic diseases (ischaemic heart disease [IHD], chronic obstructive pulmonary disease [COPD], cerebrovascular disease [CVD], diabetes mellitus [DM], renal failure [RF] and rheumatic heart disease [RHD]) in the NT Indigenous population with those of the total Australian population. PARTICIPANTS: NT Indigenous and total Australian populations, 1977-2001. MAIN OUTCOME MEASURES: Estimated average annual change in chronic disease mortality rates and in mortality rate ratios. RESULTS: Death rates from IHD and DM among NT Indigenous peoples increased between 1977 and 2001, but this increase slowed after 1990. Death rates from COPD rose before 1990, but fell thereafter. There were non-significant declines in death rates from CVD and RHD. Mortality rates from RF rose in those aged > or = 50 years. The ratios of mortality rates for NT Indigenous to total Australian populations from these chronic diseases increased throughout the period. CONCLUSIONS: Mortality rates from IHD and DM in the NT Indigenous population have been increasing since 1977, but there is evidence of a slower rise (or even a fall) in death rates in the 1990s. These early small changes give reason to hope that some improvements (possibly in medical care) have been putting the brakes on chronic disease mortality among Aboriginal and Torres Strait Islander peoples.     

Town or country: which is best for Australia's Indigenous peoples?

Some commentators suggest that the poor health of Australia's Indigenous population is due to misguided ideology-driven policy that has forced people to live in remote communities, preventing them from benefiting from the mainstream economy. The evidence shows that the poor health status of Indigenous people is found in all areas where they live and that, on some indicators, living in remote areas has health benefits. Government policies aimed at relocating Indigenous people from their traditional lands are not supported by evidence, and may further entrench Indigenous disadvantage.     

Preconception health and care (PHC)—a strategy for improved maternal and child health

Maternal health status before pregnancy is a decisive factor for pregnancy outcomes and for risk for maternal and infant complications. Still, maternity care does not start until the pregnancy is established and in most low-income settings not until more than half of the pregnancy has passed, which often is too late to impact outcomes. In Western societies preconception care (PCC) is widely recognized as a way to optimize women’s health through biomedical and behavioural changes prior to conception with the aim of improving pregnancy outcomes. But the content of PCC is inconsistent and limited to single interventions or preconception counselling to women with chronic illnesses. It has been suggested that PCC should be extended to preconception health and care (PHC), including interventions prior to pregnancy in order to optimize women’s health in general, and thereby subsequent pregnancy outcomes, the well-being of the family, and the health of the future child. With this definition, almost every activity that can improve the health of girls and women can be included in the concept. In the World Health Report of 2005 a longitudinal approach to women’s wellness and reproductive health was highlighted, and the World Health Organization has proposed a more comprehensive maternal and child health care, also including psychosocial issues and intimate partner violence. The present article gives an overview of the recent literature and discusses contents and delivery of PCC/PHC in Western as well as low-income countries. The article puts special emphasis on why violence against women is an issue for PHC.     

百色市2000～2010年妇幼卫生项目实施情况及工作效果回顾性统计分析

目的探讨利用妇幼卫生项目发展妇幼卫生事业的问题。方法采取回顾性调查分析的方法对2000—2010年百色市实施5个妇幼项目的项目管理、资金投入、基础建设、业务人员培训、健康教育宣传、项目资金监管等指标进行调查分析。结果（1）全市的主要指标：5岁以下儿童死亡率、婴儿死亡率、新生儿破伤风发生率、低出生体重发生率、孕产妇死亡率、5岁以下中重低体儿发生率、出生缺陷发生率等7个指标达到全国、广西和百色的“两纲”指标要求。（2）基础指标：农村儿童保健覆盖率、城市孕产妇保健覆盖率、农村孕产妇保健覆盖率、农村住院分娩率、农村高危住院分娩率、6个月内母乳喂养率、婴儿家长科学喂养知识普及率等7个指标达到全国、广西和百色的指标要求;住院分娩率达到广西、百色的“两纲”指标要求;住院分娩率、农村住院分娩率2个指标双双首次突破90％,达到历史新高。结论综合妇幼卫生项目在贫困地区的实施是成功的,是一种切实可行的妇幼卫生工作模式,可推动贫困地区妇幼卫生事业整体向前发展。     

Periodontal infections and cardiovascular disease: Is it a mere association?

The oral cavity is a major site of chronic infection and inflammation, particularly periodontal or chronic gum diseases. In recent years there has been increasing interest in the "periodontal systemic connection" between periodontal health parameters and risks of cardiovascular disease. Given that poor oral health and cardiovascular disease are major worldwide health problems, their association are potentially important. The article summarizes the evidences from epidemiologic studies and studies that focused on potential contributing mechanisms to provide an insight of this association.     

AIDS prevention: what are we talking about?

A psychiatrist from Calcutta objects to the colonial culture which still dominates India. Specifically the call for prevention of AIDS and the spread of HIV made by developed countries, yet socioeconomic conditions in India hinder any prevention efforts. India faces other more common and preventable fatal diseases. The basic needs (food, shelter, health, and education) of most people cannot even be met. Thus an AIDS prevention program is an expensive luxury and probably would not reach those whose needs are already not met. 65% of AIDS cases are in Africa especially central Africa and almost 90% of AIDS cases in developing countries are in the most productive age group (20-49 years). The HIV/AIDS epidemic is indeed dealing countries an economic blow. For example, in 1988, AIDS related medical costs in the US stood at US$8.5 billion; lost wages US$55.6 billion; and research, education, and blood screening US$2.3 billion. Developing countries cannot absorb such an economic impact. The AIDS epidemic can strain a developing country's health system such as Zaire. For example, the cost of providing proper care for only 10 AIDS patients is higher than the entire budget of the largest hospital. Yet this hospital's physicians diagnose as many as 15 new cases daily. Economic loss/year due to AIDS deaths in Zaire will equal 8% of the gross national product by 1995. The poor often do not have access to health services. illiteracy (88%) in Brazil impedes AIDS prevention messages from reaching remote rural populations. Brazil already faces a high infant mortality rate and 33% of the population has malaria. Health and social problems in developing countries are so common that AIDS is just 1 more disease. Another obstacle to AIDS prevention in developing countries is that the poor cannot afford to buy condoms. The root cause of AIDS in developing countries is poverty.     

医防结合构建慢性肾脏病三级防治新体系

近年来,慢性肾脏病已成为一个全球性的公共卫生问题,具有患病率高、知晓率低、预后差和医疗费用昂贵等特点。2015年上海市卫生和计划生育委员会批准"上海地区慢性肾脏病早发现和诊疗体系建设与示范"作为第四期公共卫生体系建设三年行动计划立项,项目实施3年取得了初步成效,应用医防结合构建了慢性肾脏病三级防治的新体系。项目的最终目标是实现上海市慢性肾脏病的早期发现、有效防控和规范诊治,降低发病率、致残率和病死率,为我国开展慢性肾脏病的防治作出示范。     

贵州省贫困地区农村居民医疗需要和卫生服务利用

目的 :了解贵州省贫困地区农村居民 ,尤其是其中的弱势人群医疗卫生需要量及卫生服务利用的基本情况和特点。方法 :通过多阶段分层整群随机抽样 ,访贵州省贫困地区农村居民 2 94 3人。结果 :慢性病患病率高于全国农村平均水平 (P <0 0 5 ) ,两周患病率是全国农村平均水平的 1 8倍 ,两周就诊率低于全国农村平均水平。婴幼儿、老年人及特困人口的医疗需要量高于其他人群。老年人相对于其高需要而言卫生服务利用率低 ;不同收入人群的卫生服务利用率非贫困人口最高 ,贫困人口次之 ,特困人口最低。结论 :与全国农村相比 ,贵州省贫困地区农村居民的卫生服务需求状况呈现出高需要、低利用的特点 ;老年人、特困人口是卫生服务的重点人群。     

沈阳市2007年-2015年其他感染性腹泻病流行特征分析

目的：掌握沈阳市其他感染性腹泻病流行特征。方法采样描述流行病学方法对沈阳市疾病监测信息管理报告系统的2007年—2015年其他感染性腹泻病病例进行分析。结果沈阳市2007年—2015年其他感染性腹泻病年均报告发病率为24.17/10万;男性年均报告发病率为28.16/10万,女性年均报告发病率为20.08/10万;3岁以下年龄组其他感染性腹泻病报告发病数占67.44%;散居儿童报告其他感染性腹泻病发病数占其他感染性腹泻病报告发病总数的72.60%;10月报告发病数最少占全年报告发病数6.15%,12月报告发病数最多占全年的报告发病数10.12%。结论3岁以下散居儿童是其他感染性腹泻病高发人群,季节高峰不明显。提示应加强卫生宣教工作;强化食品安全和饮水卫生监管工作,做好环境卫生整治;加强疫情报告及监测预警分析;做好应急处理,防止疫情扩散。     

Prevention and early detection of type 2 diabetes in children and adolescents

Type 2 ("adult-onset") diabetes in young adults and children has become increasingly common over the last 10 years, and has been described as an "emerging epidemic." The financial and societal ramifications of such a development are substantial and demand a prompt and aggressive public health response. Emphasis must be placed upon preventive behaviors and early detection, and creation of new public policy to address the related societal issues. Recommendations for prevention and screening of high-risk children and adolescents are provided.     

老年人牙周病430例临床分析

目的了解老年牙周病的发病率以提高对老年牙周病临床特点的认识。方法对门诊就诊的430例老年牙周病患者,检查确定牙周组织状况,并问诊患者的系统性疾病情况。结果老年牙周病发病率高,病因复杂,合并症多,老年人对该病的就诊意识较差。结论牙周病是慢性破坏性疾病,应该重视口腔卫生、保健、预防、治疗知识的宣传和普及。     

Women's groups' perceptions of neonatal and infant health problems in rural Malawi

Aims

To present the perceptions of women in rural Malawi regarding the health problems affecting neonates and infants and to explore the relevance of these perceptions for child health policy and strategy in Malawi.

Methods

Women''s groups in Mchinji district identified newborn and infant health problems (204 groups, 3484 women), prioritised problems they considered most important (204 groups, 3338 women) and recorded these problems on monitoring forms. Qualitative data was obtained through 6 focus-group discussions with the women''s groups and 22 interviews with individuals living in women''s group communities but not attending groups.

Results

Women in Malawi do not define the neonatal period according to any epidemiological definition. In order of importance they identified and prioritised the following problems for newborns and infants: diarrhoea, infection, preterm birth, tetanus, malaria, asphyxia, respiratory tract infection, hypothermia, jaundice, convulsions and malnutrition.

Conclusion

This study suggests that women in rural Malawi collectively have a developed understanding of neonatal and infant health problems. This makes a strong argument for the involvement of lay people in policy and strategy development and also suggests that this capacity, harnessed and strengthened through community mobilisation approaches, has the potential to improve neonatal and infant health and reduce mortality.     

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.     

Perspectives on nutrition needs for the new millennium for South Asian regions

South Asia is the most populated region of the world with several nutritional challenges. Though per capita food energy supply, child survival and life expectancy have improved, and even today large segments of the population are below the poverty line with high infant and maternal mortality rates. It is important to recognize the crucial role of nutrition throughout the life cycle-from conception to old age. It is very necessary now to move from food security to nutrition security and improve the quality of foods both in macro- and micronutrients in order to break the transgenerational effects of malnutrition. The key solutions to the problems should address the issue of social development, population stabilization, environmental degradation and inadequate health and nutritional services. Strategies for empowering women and actuating community participation as sustainable programmes for human development, measures to reduce underweight and stunting in children and prevention of micronutrient malnutrition across the population are required. Enhancing food and nutrition security through innovative diversified agriculture and dietary practices, prevention and control of infection, promotion of food safety and fortification of staples with appropriate attention on emerging chronic disorders are essential. Population control measures to stabilize the fertility rates, biotechnological approaches for genetically modified foods, nutrition surveillance based on assessment, analysis and action to address the logistic, technical and compliance issues with emphasis on promotion of breast feeding and complementary foods with adequate attention on the reproductive needs of adolescent girls, pregnant mothers and lactating women would eliminate low birth weight, stunting, and chronic energy deficiency in vulnerable groups. Focused studies on bioavailability of micronutrients and its enhancement, innovative horticulture interventions, fortifications, social marketing strategies would promote the intake of micronutrient and phytonutrient rich foods. In-depth epidemiological research, an insight into foetal origins of adult disease and nutrition-genes interaction and life style alterations will avert the emerging epidemic of chronic diet related disorders. An investment in preventing foetal malnutrition improves nutrition of women in reproductive age, infant and child nutrition and prevents the onset of chronic disease in adult life. Human resource development, IEC measures, technology transfer, operational and logistic research, building of databases, integrated, intersectoral, multidisciplinary plans and sound management information system and surveillance with net working and experience sharing in the region will help to overcome the common challenges and lay the foundation for a better scenario in these regions in the near future.     

轮状病毒及轮状病毒疫苗研究进展

［摘要］人轮状病毒（human rotavirus,HRV）自上世纪70年代初发现以来,至今仍然是世界范围内引起5岁以下婴幼儿腹泻的最主要病原体,每年约60万婴幼儿因轮状病毒感染导致严重脱水死亡。由于轮状病毒腹泻尚无特异性治疗药物,使用疫苗预防轮状病毒感染是目前有效手段．一种疫苗的研究往往涉及了多学科理论和技术,就轮状病毒流行情况、动物实验模型、机体感染后的免疫应答及疫苗研发使用等相关问题作一综述。     

中国鼠疫的疫情及防治进展

鼠疫是由鼠疫菌引起的烈性传染病,具有传染性强、传播速度快、病死率高的特点,严重危害人们的健康安全,甚至可能引发重大突发公共卫生事件。由于近年来我国仍有鼠疫病例报道,可见我国鼠疫防控形势仍然严峻,鼠疫的防治工作仍有待于加强。通过对1950—2019年全国鼠疫监测资料和21世纪以来报道的鼠疫病例的特征进行分析,进而了解我国鼠疫的疫情,探讨鼠疫的流行特点,提出相应的防控措施。新中国成立后,通过长期的防控,全国鼠疫疫情总体呈下降趋势,部分鼠疫自然疫源地已被消除;进入21世纪后鼠疫疫情呈现局灶性与散发性的特点,大多发生于西北地区和青藏地区,以青海省和西藏自治区较多,且主要与青壮年主动进入疫区或者接触鼠疫菌的宿主动物有关。应通过加大对疫区的监测,加强对人们的健康教育,正确诊断与高效治疗鼠疫患者,进而做好鼠疫的防治工作。     

Death, disease and diversity in Australia, 1951 to 2000

There has been a substantial decline in mortality in Australia during the 20th century, with a major improvement in life expectancy. There has been a broad "health transition", from a pattern of high mortality from infectious diseases to one of lower overall mortality from non-communicable diseases and injury. From 1951, trends in death rates from major causes were evident, with the rise and partial fall of two epidemics (coronary heart disease and stroke, and lung cancer). This overall picture masks significant inequalities in health for Indigenous people and the socioeconomically disadvantaged.