新生儿早产、低出生体重及小于胎龄的危险因素

目的 研究早孕期相关暴露因素与新生儿早产、低体重及小于胎龄的关系。方法 选取“中国孕产妇队列研究·协和”项目于2017年7月25日至2018年7月24日入组并于2018年12月31日前分娩且符合纳入标准的3 172例孕妇为研究对象,使用二分类logistic回归分析对早孕期相关暴露因素与新生儿不良分娩结局的关系进行统计分析。结果 新生儿早产、低体重及小于胎龄的发生率分别为4.76%、3.53%、5.74%。在早产方面,北方孕妇和孕期增重是早产的保护因素,而胎膜早破、妊娠期高血压、1～3年内有口腔检查或治疗、家庭人口为3～4人是早产的危险因素。在低出生体重方面,孕期增重和食用奶及奶制品是低出生体重儿的保护因素,而胎膜早破、妊娠期高血压、工作久坐时间>6 h、1～3年内有口腔检查或治疗、被动吸烟等是低出生体重儿的危险因素。在小于胎龄方面,女婴、被动吸烟、食用花生油及口味偏淡是小于胎龄儿的危险因素,而补充叶酸是小于胎龄儿的保护因素。结论 新生儿早产、低体重及小于胎龄的影响因素是多因素的,应针对相关危险因素采取有针对的预防和干预措施以降低新生儿不良出生结局的发生风险。     

Cultural identification in Aboriginal and Torres Strait Islander AIDS education

Abstract: The emergence of the disease AIDS in the early 1980s has resulted in a unique response. Medical, sociocultural, political, sexual, moral and racial issues have all been raised. This paper examines the way in which participation of Aboriginal and Torres Strait Islander people has resulted in the culturally appropriate and distinctive approaches evident in health education materials produced in Aboriginal and Torres Strait Islander communities. Specific cultural issues relevant to AIDS education are considered, including: the use of visual and narrative communication for AIDS education; the significance of the specific concepts related to communication on sexual issues; perceptions of AIDS as alien and genocidal; the use of the Dreaming in AIDS educational resources; and implications for AIDS education.     

湖南省2011-2017年孕产妇HIV感染者早产、低出生体重和小于胎龄儿发生率及其影响因素分析

目的 了解湖南省孕产妇HIV感染者早产、低出生体重（LBW）和小于胎龄儿（SGA）的发生状况并探讨其影响因素。方法 以2011年1月至2017年12月湖南省预防艾滋病母婴传播管理信息系统报告的已分娩的孕产妇HIV感染者为研究对象,对其人口学特征、妊娠情况、抗病毒治疗（ART）、丈夫/性伴情况和妊娠结局等因素进行分析,分别计算早产、LBW和SGA发生率,采用多因素logistic回归分析其相关影响因素。结果 共纳入780例孕产妇HIV感染者,其早产率为7.9%（62/780）,LBW发生率为9.9%（77/780）,SGA发生率为21.3%（166/780）。孕产妇HIV感染者早产的危险因素包括妊娠期中重度贫血、妊娠期高血压疾病、<14孕周开始ART（与孕期未进行ART相比）和丈夫/性伴年龄>35岁（与26~30岁相比）,其aOR值分别为4.59（95% CI：1.51~13.95）、4.90（95% CI：1.56~15.46）、2.40（95% CI：1.26~4.56）和2.29（95% CI：1.21~4.36）。妊娠期中重度贫血、妊娠合并HBV感染和<14孕周开始ART（与孕期未进行ART相比）是LBW的危险因素,其aOR值分别为3.28（95% CI：1.13~9.54）、4.37（95% CI：1.42~13.44）和2.68（95% CI：1.51~4.76）。妊娠合并HBV感染和<14孕周开始ART（与孕期未进行ART相比）是SGA的危险因素,其aOR值分别为4.41（95% CI：1.43~13.63）和2.67（95% CI：1.51~4.73）。结论 早产、LBW和SGA是湖南省孕产妇HIV感染者常见的不良妊娠结局,受妊娠合并症、ART和丈夫/性伴的年龄等因素影响。     

Placing Aboriginal and Torres Strait Islander mortality in an international context

OBJECTIVE: To assess whether the patterns of mortality observed among Indigenous Australians were seen in other countries or sub-populations. Previous reports have indicated that the life expectancy of Indigenous Australians compares unfavourably with that of Indigenous groups in other developed countries, and is similar to that in some developing countries. However, in contrast to many developing countries, low life expectancy of Indigenous Australians is the result of relatively high and early adult mortality, rather than high infant mortality. METHODS: Using routinely available administrative data on age-specific mortality and estimated life expectancy at birth, we compared data for Indigenous Australians (from the Northern Territory, Western Australia and South Australia combined) with corresponding data for 200 countries world-wide, as well as for several population groups of interest, including African Americans, Native Americans, Canadian Natives and New Zealand Maori. RESULTS: Patterns of mortality among Indigenous Australians were markedly different to those of most other populations with available data, with the exception of the Russian Republic. The age-specific mortality rates for Russian males in 1990-95 were almost identical to those of Indigenous males in 1995-97. The similarities among females were less pronounced, but stronger than for any other country. CONCLUSION AND IMPLICATIONS: The dramatic fall in Russian life expectancy has been studied extensively and several important social and contextual factors have been identified. These factors are also relevant for the Indigenous population, and this may help to explain the similar mortality patterns of the two groups.     

Pre-pregnancy predictors linked to miscarriage among Aboriginal and Torres Strait Islander women in North Queensland

Objective : Identify preventable pre‐pregnancy risk factors that may affect the prevalence of miscarriage among a cohort of Australian Indigenous women. Methods: Data from 1,009 Indigenous women of childbearing age who participated in a 1999–2000 health screening program in far‐north Queensland were linked to Queensland hospitalisation data. Women who attended hospital after their health check (censor date: March 2008) for a pregnancy‐related condition were identified. Characteristics associated with becoming pregnant and subsequent miscarriage were analysed using generalised linear models. Results: After adjusting for age and ethnicity, women who became pregnant were more likely to be smokers and to have low red cell folate at baseline. The risk of miscarriage increased with age. Women who reported risky drinking or had elevated gamma‐glutamyl transferase were also at higher risk. After further adjustment for risky drinking, the presence of chlamydia or gonorrhoea before pregnancy was associated with miscarriage. The presence of both infections at baseline compared with women who had no infection, again after further adjustment for risky drinking, was strongly associated with miscarriage; these women had more than a four‐fold increase in risk (PR: 4.57 [2.21–9.46]). Elevated body mass index, high blood pressure and smoking were not statistically significantly associated with risk of miscarriage. Conclusions and implications: A high prevalence of pre‐pregnancy sexually transmitted infections and high rates of risky drinking are associated with miscarriage among young Indigenous women in rural and remote communities in north Queensland.     

Evaluation of a targeted immunisation program for Aboriginal and Torres Strait Islander infants in an urban setting

A conjugate pneumococcal vaccination program for Aboriginal and Torres Strait Islander children in an urban setting initially achieved poor uptake. A targeted intervention was developed to raise awareness among hospital staff, in general practice and in parents of eligible children. An evaluation of the intervention found moderate levels of increased awareness, use of promotional materials and an increase in vaccination. However, significant structural barriers remained.     

Risk factors for spontaneous preterm birth among Aboriginal and non-Aboriginal women in Manitoba

In the province of Manitoba, the incidence of preterm birth has been increasing and the rate is higher among Aboriginal than non-Aboriginal women. The purpose of this study was to identify risk factors for spontaneous preterm birth in Manitoba women, and to compare risk factors among Aboriginal and non-Aboriginal women. A case-control study was performed at two tertiary care hospitals in Winnipeg, Manitoba, Canada from October 1999 to December 2000. Cases delivered a live singleton infant at < 37 weeks gestation (n = 226; 36% Aboriginal), while controls delivered between 37 and 42 weeks gestation (n = 458; 38% Aboriginal). An interview was conducted with each subject on the postpartum unit, and information was collected from the health record. Using stratified analyses to control for race/ethnicity, several risk factors for preterm birth had a uniform effect measure across strata, while others demonstrated heterogeneity. After adjusting for other maternal characteristics in a multivariable logistic regression model, significant risk factors for all women included previous preterm birth, two or more previous spontaneous abortions, vaginal bleeding after 12 weeks gestation, gestational hypertension, antenatal hospitalisation, and prelabour rupture of membranes. In addition, potentially modifiable risk factors included low weight gain during pregnancy and inadequate prenatal care for all women, and high levels of perceived stress for Aboriginal women. These modifiable risk factors lend themselves to public health interventions, and should be targeted in future prevention efforts.     

Optimising Hepatitis C care in an urban Aboriginal and Torres Strait Islander primary health care clinic

Objective: Describe the sociodemographic and clinical characteristics of patients with Hepatitis C Virus (HCV) attending an urban Indigenous primary health clinic (IPHC) in Brisbane, Australia. Methods: A retrospective chart review of sociodemographic characteristics, presence of liver disease and treatments, lifestyle behaviours and comorbidities in patients with a HCV infection was conducted between October 2015 and March 2016. Results: One hundred and thirteen patients with confirmed HCV infection were aged between seven and 63 years; 66% were male, and 84% were Indigenous. Sixty‐nine per cent had been incarcerated; 41% had experienced conflict or domestic violence; 47% were injecting drugs; 72% had depression; and 61% had anxiety. Cirrhosis was present in 7/95 patients with adequate data and associated with age (p=0.02). Eleven patients had commenced direct acting antiviral (DAA) therapy in the 18 months that it had been available. Conclusions: The study highlights the opportunities for enhancing treatment of patients with HCV infection. Opportunities to improve treatment rates in an Indigenous primary healthcare include optimising diagnostic pathways, improving patient engagement, and general practitioner and peer worker participation. Implications for public health: HCV poses a serious threat to public health in Australia and IPHCs are key sites to addressing this for Indigenous people. Optimising care of patients with HCV attending IPHC requires recognition of the complex health needs and social context, to reduce the incidence and consequences of HCV infection.     

Breast screening attendance of Aboriginal and Torres Strait Islander women in the Northern Territory of Australia

Objective : To compare breast screening attendances of Indigenous and non‐Indigenous women. Methods : A total of 4,093 BreastScreen cases were used including 857 self‐identified Indigenous women. Chi‐squared analysis compared data between Indigenous and non‐Indigenous women. Logistic regression was used for groupings based on visits‐to‐screening frequency. Odds ratios and 95% confidence intervals were calculated for associations with low attendance. Results : Indigenous women were younger and had fewer visits to screening compared with non‐Indigenous women. Non‐English speaking was mainly associated with fewer visits for Indigenous women only (OR 1.9, 95%CI 1.3‐2.9). Living remotely was associated with fewer visits for non‐Indigenous women only (OR 1.3, 95%CI 1.1‐1.5). Shared predictors were younger age (OR 12.3, 95%CI 8.1‐18.8; and OR 11.5, 95%CI 9.6‐13.7, respectively) and having no family history of breast cancer (OR 2.1, 95%CI 1.3‐3.3; and OR 1.8, 95%CI 1.5‐2.1, respectively). Conclusions : Factors associated with fewer visits to screening were similar for both groups of women, except for language which was significant only for Indigenous women, and remoteness which was significant only for non‐Indigenous women. Implications for public health : Health communication in Indigenous languages may be key in encouraging participation and retaining Indigenous women in BreastScreen; improving access for remote‐living non‐Indigenous women should also be addressed.     

Coverage of Aboriginal and Torres Strait Islander nutrition in the Koori Mail

Objective : To examine the extent and nature of coverage of nutrition in the Koori Mail. Methods : Content and framing analysis were used to examine articles in the Koori Mail published between 2013 and 2017 that included the terms ‘nutrition?’, ‘diet?’, ‘food’, ‘eating’, ‘weight’, ‘tucker’ or ‘sugary drinks’. The analysis focused on the portrayal of Aboriginal and Torres Strait Islander people/communities, inclusion of First Peoples’ voices and the framing of nutrition issues. Results : A total of 102 articles were included. Most articles (88%, n=90) portrayed Aboriginal and Torres Strait Islander communities in a neutral or positive way and more than half (53%, n=54) included an Aboriginal or Torres Strait Islander voice. While nutrition was often framed as an individual or community responsibility, articles predominantly promoted programs or initiatives undertaken in local communities. Conclusion : Despite the limited prominence of Aboriginal and Torres Strait Islander nutrition in the mainstream media, the coverage of nutrition issues in the Koori Mail demonstrates the salience of this topic for local communities. This study highlights how journalism can better reflect the diversity and strengths of First Peoples. Implications for public health : Including more Aboriginal and Torres Strait Islander voices and using a strengths‐based approach in press releases may improve media advocacy.     

National trends in Aboriginal and Torres Strait Islander smoking and quitting, 1994-2008

Objective: To describe the trends in the prevalence of smoking, quitting and initiation among Aboriginal and Torres Strait Islander men and women aged 18 years and over. Methods: Analysis of responses to smoking questions in national Indigenous surveys in 1994, 2002, 2004 and 2008. Results: Male Indigenous smoking prevalence fell significantly from 58.5% in 1994 to 52.6% in 2008, an absolute decrease of 0.4 (CI 0.1–0.7)% per year, with the same decline in remote and non‐remote areas. Female smoking fell from 51.0% to 47.4%, with markedly different changes in remote and non‐remote areas. In non‐remote areas, there was an absolute decrease in female smoking of 0.5 (CI 0.2–0.9)% per year, but in remote areas, female smoking increased by 0.4 (CI 0.0–0.8)% per year. From 2002 to 2008, the percentage of ever‐smokers who had quit (quit ratio) increased absolutely by 1% per year in both men and women, remote and non‐remote areas. Results about trends in initiation were inconclusive. Conclusions and Implications: Health Minister Roxon has committed to halving the Indigenous smoking prevalence by 2018, and has dramatically increased Indigenous‐specific funding and activity in tobacco control. The reported historical trends in this paper are encouraging as they occurred at a time when there was little such tobacco control activity focused on Aboriginal and Torres Strait Islander people. However, to meet the Minister's goal, Indigenous smoking prevalence will need to fall more than six times as quickly as occurred from 1994 to 2008.     

Aboriginal and Torres Strait Islander smoke‐free homes, 2002 to 2008

Objective : To describe the social patterning of and trends in the prevalence of Aboriginal and Torres Strait Islander smoke‐free homes, and the association between these smoke‐free homes and smoking initiation, intensity and cessation. Methods : Analyses of responses to questions about whether any householders usually smoke inside in the 2004 National Aboriginal and Torres Strait Islander Health Survey, the 2008 National Aboriginal and Torres Strait Islander Social Survey, and in the comparable National Health Surveys in 2004 and 2007. Results : The proportion of Indigenous children living with at least one daily smoker who smokes inside declined significantly from 28.4% in 2004 to 20.8% in 2008, with significant improvements only detected among the most disadvantaged categories of Indigenous children. The proportion of Indigenous daily smokers who lived in multi‐person households where no daily smoker householder usually smoked inside increased significantly from 45.0% in 2004 to 56.3% in 2008. The absolute size of these changes was greater among Indigenous children and smokers than among all Australians. More disadvantaged Indigenous children were more likely to be exposed to secondhand smoke at home, and more disadvantaged Indigenous smokers were more likely to live in households where smokers usually smoked inside. Indigenous smokers in smoke‐free homes smoke significantly less cigarettes. Conclusions and Implications : The increases in Indigenous smoke‐free homes are encouraging, especially as they are from the period before recent increased attention to Indigenous tobacco control, which should accelerate these trends and their resultant health benefits for Aboriginal and Torres Strait Islander children and families.     

Substance use and socio-demographic factors among Aboriginal and Torres Strait Islander school students in New South Wales

OBJECTIVE: To estimate prevalence rates of substance use and associated socio-demographic factors among Aboriginal and Torres Strait Islander (ATSI) secondary students. METHOD: This paper presents ATSI data from population-based school surveys conducted in 1996, 1992 and 1989 in New South Wales and replicates identical analysis using the three datasets. RESULTS: The proportion of ATSI students in each survey ranged from 2.5% to 3.8%. After adjusting for age, gender and socio-demographic factors, ATSI students were more likely to smoke cigarettes, and to have tried cannabis and other illicit substances. CONCLUSIONS: This study suggests that Aboriginal and Torres Strait Islander students were more susceptible to, and maintained a higher rate of, substance use than non-Aboriginal and Torres Strait Islander youth. Socio-demographic differences between Aboriginal and non-Aboriginal students in age, rural/urban status, living with both parents, reporting poor school performance, low parental supervision and high school absenteeism remained significantly associated with Aboriginal status and substance use. IMPLICATIONS: This is one of the first studies examining substance use in a large and representative sample of in-school ATSI youth. These results provide information useful for public health advocates, and require policy changes more likely to reduce substance use among ATSI youth.     

Suicides in Aboriginal and Torres Strait Islander children: analysis of Queensland Suicide Register

Objective: Suicide rates among Indigenous Australian children are higher than for other Australian children. The current study aimed to identify factors associated with Indigenous child suicide when compared to other Australian children. Methods: Using the Queensland Suicide Register, suicides in Indigenous children (10–14 years) and other Australian children in the same age band were compared. Results: Between 2000 and 2010, 45 child suicides were recorded: 21 of Indigenous children and 24 of other Australian children. This corresponded to a suicide rate of 10.15 suicides per 100,000 for Indigenous children – 12.63 times higher than the suicide rate for other Australian children (0.80 per 100,000). Hanging was the predominant method used by all children. Indigenous children were significantly more likely to suicide outside the home, to be living outside the parental home at time of death, and be living in remote or very remote areas. Indigenous children were found to consume alcohol more frequently before suicide, compared to other Australian children. Current and past treatments of psychiatric disorders were significantly less common among Indigenous children compared to other Australian children. Conclusions: Western conceptualisation of mental illness may not adequately embody Indigenous people's holistic perspective regarding mental health. Further development of culturally appropriate suicide prevention activities for Aboriginal and Torres Strait Islander children is required.