RESUMO
BACKGROUND: Lymphatic filariasis (LF), a mosquito-borne helminth infection, is an important cause of chronic disability globally. The World Health Organization has validated eight Pacific Island countries as having eliminated lymphatic filariasis (LF) as a public health problem, but there are limited data to support an evidence-based approach to post-validation surveillance (PVS). Tonga was validated as having eliminated LF in 2017 but no surveillance has been conducted since 2015. This paper describes a protocol for an operational research project investigating different PVS methods in Tonga to provide an evidence base for national and regional PVS strategies. METHODS: Programmatic baseline surveys and Transmission Assessment Surveys conducted between 2000-2015 were reviewed to identify historically 'high-risk' and 'low-risk' schools and communities. 'High-risk' were those with LF antigen (Ag)-positive individuals recorded in more than one survey, whilst 'low-risk' were those with no recorded Ag-positives. The outcome measure for ongoing LF transmission will be Ag-positivity, diagnosed using Alere™ Filariasis Test Strips. A targeted study will be conducted in May-July 2024 including: (i) high and low-risk schools and communities, (ii) boarding schools, and (iii) patients attending a chronic-disease clinic. We estimate a total sample size of 2,010 participants. CONCLUSIONS: Our methodology for targeted surveillance of suspected 'high-risk' populations using historical survey data can be adopted by countries when designing their PVS strategies. The results of this study will allow us to understand the current status of LF in Tonga and will be used to develop the next phase of activities.
Assuntos
Erradicação de Doenças , Filariose Linfática , Filariose Linfática/epidemiologia , Filariose Linfática/transmissão , Filariose Linfática/prevenção & controle , Humanos , Tonga/epidemiologia , Erradicação de Doenças/métodos , Vigilância da População/métodos , Masculino , Feminino , Wuchereria bancrofti , CriançaRESUMO
BACKGROUND: Type 2 diabetes (T2D) causes significant morbidity and is disproportionately prevalent in Pacific Island Countries (PICs). The socio-political demographics of PICs are rapidly changing, and health services must adapt to match the needs of their population. OBJECTIVES: The objective of this study was to review the literature published within the last 15 years relating to T2D prevalence, control, and management, with a specific focus on targetable areas for future funding and research projects. METHODS: This review was conducted using the PRISMA guidelines. Inclusion criteria were: discussion on T2D in the six PICs. Results were limited to those published between 1st January, 2006, and 27th July, 2023. RESULTS: A total of 6,640 publications were retrieved, and 110 met the inclusion criteria. Nineteen additional studies were identified through hand-searching. T2D prevalence differed between countries but was predicted to increase in the coming decades, with projections of up to 31.2% by 2030 in Tonga. Factors associated with T2D varied between countries, including Indian-Fijian ethnicity in Fiji and tuberculosis in Kiribati. Control was generally poor, with high rates of undiagnosed diabetes and microvascular complications. Epidemiological data was limited in some cases, as was information describing the structure and function of diabetes services. CONCLUSION: The prevalence, control, and management of T2D varied between Fiji, Kiribati, Samoa, the Solomon Islands, Tonga, and Vanuatu. Significant gaps remain in the data describing these domains; however, there are clearly targetable areas for future research and diabetes management programs.
Assuntos
Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Prevalência , Samoa/epidemiologia , Ilhas do Pacífico/epidemiologia , Fiji/epidemiologia , Vanuatu/epidemiologia , Melanesia/epidemiologia , Tonga/epidemiologia , Micronésia/epidemiologiaRESUMO
BACKGROUND: Cardiovascular disease (CVD) and diabetes mellitus are major health issues in Tonga and other Pacific countries, although mortality levels and trends are unclear. We assess the impacts of cause-of-death certification on coding of CVD and diabetes as underlying causes of death (UCoD). METHODS: Tongan records containing cause-of-death data (2001-2018), including medical certificates of cause-of-death (MCCD), had UCoD assigned according to International Classification of Diseases 10th revision (ICD-10) coding rules. Deaths without recorded cause were included to ascertain total mortality. Diabetes and hypertension causes were reallocated from Part 1 of the MCCD (direct cause) to Part 2 (contributory cause) if potentially fatal complications were not recorded, and an alternative UCoD was assigned. Proportional mortality by cause based on the alternative UCoD were applied to total deaths then mortality rates calculated by age and sex using census/intercensal population estimates. CVD and diabetes mortality rates for unaltered and alternative UCoD were compared using Poisson regression. RESULTS: Over 2001-18, in ages 35-59 years, alternative CVD mortality was higher than unaltered CVD mortality in men (p = 0.043) and women (p = 0.15); for 2010-18, alternative versus unaltered measures in men were 3.3/103 (95%CI: 3.0-3.7/103) versus 2.9/103 (95%CI: 2.6-3.2/103), and in women were 1.1/103 (95%CI: 0.9-1.3/103) versus 0.9/103 (95%CI: 0.8-1.1/103). Conversely, alternative diabetes mortality rates were significantly lower than the unaltered rates over 2001-18 in men (p < 0.0001) and women (p = 0.013); for 2010-18, these measures in men were 1.3/103 (95%CI: 1.1-1.5/103) versus 1.9/103 (95%CI: 1.6-2.2/103), and in women were 1.4/103 (95%CI: 1.2-1.7/103) versus 1.7/103 (95%CI: 1.5-2.0/103). Diabetes mortality rates increased significantly over 2001-18 in men (unaltered: p < 0.0001; alternative: p = 0.0007) and increased overall in women (unaltered: p = 0.0015; alternative: p = 0.014). CONCLUSIONS: Diabetes reporting in Part 1 of the MCCD, without potentially fatal diabetes complications, has led to over-estimation of diabetes, and under-estimation of CVD, as UCoD in Tonga. This indicates the importance of controlling various modifiable risks for atherosclerotic CVD (including stroke) including hypertension, tobacco use, and saturated fat intake, besides obesity and diabetes. Accurate certification of diabetes as a direct cause of death (Part 1) or contributory factor (Part 2) is needed to ensure that valid UCoD are assigned. Examination of multiple cause-of-death data can improve understanding of the underlying causes of premature mortality to better inform health planning.
Assuntos
Doenças Cardiovasculares , Diabetes Mellitus , Hipertensão , Feminino , Humanos , Masculino , Doenças Cardiovasculares/mortalidade , Causas de Morte , Atestado de Óbito , Diabetes Mellitus/mortalidade , Tonga/epidemiologiaRESUMO
BACKGROUND: In Aotearoa New Zealand (NZ), Pacific people have a higher prevalence of mental illness compared with the general population. Tongan people have high rates of mental illness and tend to not use mental health services. The risk for mental illnesses also differs between those born in Tonga and those born in NZ. AIM: This study presented the views of New Zealand-dwelling Tongan youth and mental health service users regarding the meaning of mental distress. METHODS: A Tongan cultural framework "talanoa" was used to inform the approach to the research. The youth talanoa group had seven participants and the service users talanoa group had twelve participants. Braun and Clarke's thematic analysis was used to analyse the data. RESULTS: Tongan youth and service users constructed mental distress from biopsychosocial perspectives and challenged traditional Tongan perspectives around being possessed by spirits, cursed and disruptions to social and spiritual relationships. CONCLUSIONS: The youth and service users construct mental distress from a biopsychosocial angle and there is a need for further information about Tongan perspectives of mental distress. This suggests that a biopsychosocial perspective is needed to ensure engagement by Tongan youth and service users in promoting mental health and alleviating distress.
Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Adolescente , Humanos , Transtornos Mentais/epidemiologia , Saúde Mental , Nova Zelândia/epidemiologia , Tonga/epidemiologiaAssuntos
Fatores de Risco de Doenças Cardíacas , Insuficiência Cardíaca , Obesidade Mórbida , Interação Gene-Ambiente , Predisposição Genética para Doença , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/prevenção & controle , Humanos , Obesidade Mórbida/complicações , Obesidade Mórbida/etnologia , Obesidade Mórbida/genética , Serviços Preventivos de Saúde , Tonga/epidemiologia , Estados Unidos/etnologiaRESUMO
BACKGROUND: Comprehensive vision screening programmes for children are an important part of public health strategy, but do not exist in many countries, including Tonga. This project set out to assess: (1) the functional vision of children attending primary schools in Tonga and (2) how a new recognition acuity test (The Auckland Optotypes displayed on a tablet computer) compares to use of a standardised eye chart in this setting. METHODS: Children from three Tongan primary schools were invited to participate. Acuity testing was conducted using a standardised recognition acuity chart (Lea symbols) and the tablet test displaying two formats of The Auckland Optotypes. Measures of ocular alignment, stereo acuity and non-cycloplegic photorefraction were also taken. RESULTS: Parents of 249 children consented to participate. One child was untestable. Only 2.8 per cent of testable children achieved visual acuity worse than 0.3 logMAR in the weaker eye. Results from the Spot Photoscreener suggested that no children had myopia or hyperopia, but that some children had astigmatism. The tablet test was practical in a community setting, and showed ±0.2 logMAR limits of agreement with the Lea symbols chart. CONCLUSION: The sample of children in Tongan primary schools had good functional vision. A modified version of the tablet acuity test is a promising option for vision screening in this context.
Assuntos
Ambliopia/diagnóstico , Instituições Acadêmicas , Estudantes , Acuidade Visual , Percepção Visual/fisiologia , Adolescente , Ambliopia/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Nova Zelândia/epidemiologia , Tonga/epidemiologiaRESUMO
Unhealthy food consumption is a key driver of the global pandemic in non-communicable diseases (NCDs). The Government of Tonga has prioritised NCD prevention due to the very high rates of NCDs in the Kingdom. This research examines the nature and context of the me'akai (food) consumed by Tongan children in Ha'apai using wearable cameras. Thirty-six randomly selected 11-year-old children used wearable cameras to record their lives for three days, as part of the wider Kids'Cam Tonga project. Images were analysed to assess the participants' food consumption according to a new data analysis protocol for Tonga. Core foods were defined as including breads and cereals, fresh fruit, vegetables, meat and alternatives, and staple vegetables. Non-core food types included confectionery, unhealthy snack foods, edible ices, and processed meat. Tongan researchers led the research in partnership with the Government of Tonga. Overall, children were observed to have consumed a mean of 4.5 (95% CI 3.3, 6.7) non-core and 2.3 (95% CI 1.8, 2.9) core foods per 10 h day, excluding mixed meals. Unhealthy snack foods, confectionary, and cookies, cakes, and desserts were the most commonly consumed non-core foods, and fresh fruit was the most frequently consumed core food. Snacking was the most frequent eating episode observed, with children snacking on non-core foods four times a day (95% confidence interval (CI) 2.5 to 6.2) compared to 1.8 (95% CI 1.3 to 2.6) core food snacks per day. Most commonly, children were observed eating at home, at school, and on the road while out walking. The most common sources of food were the home, other children, and the supermarket. On average, children consumed one purchased product per day, almost all (90%) of which were non-core. Children were also observed eating an average of just less than one mixed meal per day. Less than half (45.2%) of all mixed meals observed were traditional foods. This research illustrates the presence, and likely dominance, of energy-dense nutrient-poor (EDNP) foods in the diet of these Tongan children. It highlights a transition from a traditional diet and suggests that these children live in an obesogenic environment, one that promotes obesity as a normal response to an abnormal environment. The findings support efforts by the Government of Tonga for the implementation of a healthy School Food Policy, junk food taxes, and initiatives to ban the importation of EDNP foods. This study has relevance for other Pacific Island nations and all nations concerned with addressing obesity and other diet-related NCDs.
Assuntos
Fenômenos Fisiológicos da Nutrição Infantil , Dieta , Criança , Feminino , Alimentos , Humanos , Masculino , Fotografação , Tonga/epidemiologia , Dispositivos Eletrônicos VestíveisRESUMO
In Tonga, pneumococcal conjugate vaccine is not a scheduled immunization. We identified all children in Tonga with invasive pneumococcal disease from 2010 to 2013. The average annual invasive pneumococcal disease incidence rate was 113/100,000 (<2 years), 50/100,000 (<5 years) and 25/100,000 (<15 years). The case fatality rate (<5 years) was 25%. The incidence rate and high case fatality rate indicate the need for pneumococcal conjugate vaccine.
Assuntos
Infecções Pneumocócicas/epidemiologia , Streptococcus pneumoniae , Adolescente , Bacteriemia , Criança , Pré-Escolar , Hospitalização/estatística & dados numéricos , Humanos , Esquemas de Imunização , Incidência , Lactente , Recém-Nascido , Meningite Pneumocócica , Estudos Retrospectivos , Tonga/epidemiologiaRESUMO
INTRODUCTION: The South Pacific Medical Team (SPMT) has supported oral health care for Tongan juveniles since 1998. This voluntary activity, named the MaliMali ('smile' in Tongan) Programme, is evaluated in detail in this paper. METHODS: This evaluation was guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. The objectives were to explore: (i) whether the programme was accessible to Tongan schoolchildren (Reach); (ii) the impact of the programme on decayed, missing and filled teeth (DMFT) scores and toothbrushing habits (Effectiveness); (iii) factors that affected the adoption of the programme (Adoption); (iv) whether implementation was consistent with the programme model (Implementation); and (v) the long-term sustainability of the programme (Maintenance). RESULTS: The MaliMali Programme has grown into an international project, has spread countrywide as a uniform health promotion and is reaching children in need. Following implementation of this programme, the oral health of Tongan juveniles has improved, with a decrease in the mean DMFT index and an increase in toothbrushing. To provide training that will allow Tongans to assume responsibility for the MaliMali Programme in the future, dental health education literature was prepared and workshops on oral hygiene and the MaliMali Programme were held frequently. At present, the programme is predominantly managed by Tongan staff, rather than by Japanese staff. CONCLUSIONS: This evaluation found the MaliMali Programme to be feasible and acceptable to children and schools in the Kingdom of Tonga. The programme promotes oral health and provides accessible and improved oral health care in the school setting, consistent with the oral health-promoting school framework.
Assuntos
Educação em Saúde Bucal/métodos , Saúde Bucal , Higiene Bucal , Instituições Acadêmicas , Criança , Análise Custo-Benefício , Índice CPO , Cárie Dentária/epidemiologia , Cárie Dentária/prevenção & controle , Educação em Saúde Bucal/economia , Humanos , Cooperação Internacional , Prevalência , Avaliação de Programas e Projetos de Saúde , Tonga/epidemiologia , Escovação DentáriaRESUMO
Disparate population surveys of type 2 diabetes mellitus (T2DM) have been conducted in Tonga for 4 decades. This study standardizes these surveys to enable assessment of T2DM and obesity trends in Tongans aged 25 to 64 years over 1973-2012, and projects T2DM prevalence to 2020 based on demographic and population weight changes. Eight surveys were standardized to the nearest census to produce nationally representative estimates. Linear period trends and prevalence projections to 2020 were produced using random-effects meta-regression. Over 1973-2012, T2DM prevalence increased from 5.2% to 19.0% (1.9%/5 years) and obesity prevalence from 56.0% to 70.2% (2.7%/5 years). T2DM prevalence period projection to 2020 is 22.3%. Based on modeling using body mass index, T2DM prevalence in 2020 could have been 12.7% and 16.8% in 2020 had mean population weight been 1 to 4 kg lower than 2012 levels.
Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Obesidade/epidemiologia , Adulto , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Prevalência , Tonga/epidemiologiaRESUMO
OBJECTIVE: To explore the knowledge and attitudes underlying contraceptive use and non-use among Tongan adults and investigate the potential acceptability of contraceptive implants. METHODS: A mixed methods study was conducted that used two focus groups and a short self-completed survey (n=109). Participants were recruited from a Tongan non-governmental sexual and reproductive health clinic. RESULTS: Contraceptive method discontinuation was high among the study group, with reasons for discontinuation often relating to misconceptions circulating in the community about the side effects of contraceptives. A high proportion (38%) reported using 'natural' contraceptive methods. A total of 47% of survey participants reported having heard of implants and 37% indicated they would be willing to try them. CONCLUSION: Current Tongan contraceptive uptake and continuation is hampered by misconceptions about side effects of methods and their risks, particularly among long-acting and reversible methods. Contraceptive implants may be acceptable to Tongans given their arm placement, reversibility and long-lasting effect. IMPLICATIONS: Efforts to improve contraceptive continuation in Tonga should focus on improving counselling on potential side effects for all methods. The introduction of contraceptive implants as an additional long-acting reversible method should be considered.
Assuntos
Comportamento Contraceptivo/psicologia , Anticoncepção/psicologia , Anticoncepcionais Femininos/uso terapêutico , Implantes de Medicamento , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adolescente , Adulto , Comportamento do Consumidor , Anticoncepção/métodos , Comportamento Contraceptivo/etnologia , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Pesquisa Qualitativa , Tonga/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: We aim to report on the practice of psychiatry in the Kingdom of Tonga. METHOD: We provide a description of the findings from a visit to Vaiola Hospital and data provided by the chief psychiatrist of Tonga. RESULTS: The practice of psychiatry in Tonga reflects the difficulties of providing health care in a middle-income micro state. Interesting features include the use of kava as a calmative for some acutely disturbed and anxious patients, the high proportion of patients receiving treatment with fluphenazine decanoate and the possibility that the observed increase in psychosis among Tongan migrants to Australia is at least partly due to a high prevalence of psychosis in Tonga itself. CONCLUSIONS: A prevalence of psychosis study would need to be undertaken to confirm the report of a higher rate of psychosis in Tonga compared with that in Australia.
Assuntos
Flufenazina/análogos & derivados , Kava , Transtornos Psicóticos/epidemiologia , Flufenazina/uso terapêutico , Serviços de Saúde Mental , Tonga/epidemiologiaRESUMO
BACKGROUND: Mass drug administration (MDA) for lymphatic filariasis (LF) programs has delivered more than 2 billion treatments of albendazole, in combination with either ivermectin or diethylcarbamazine, to communities co-endemic for soil-transmitted helminthiasis (STH), reducing the prevalence of both diseases. A transmission assessment survey (TAS) is recommended to determine if MDA for LF can be stopped within an evaluation unit (EU) after at least five rounds of annual treatment. The TAS also provides an opportunity to simultaneously assess the impact of these MDAs on STH and to determine the frequency of school-based MDA for STH after community-wide MDA is no longer needed for LF. METHODOLOGY/PRINCIPAL FINDINGS: Pilot studies conducted in Benin and Tonga assessed the feasibility of a coordinated approach. Of the schools (clusters) selected for a TAS in each EU, a subset of 5 schools per STH ecological zone was randomly selected, according to World Health Organization (WHO) guidelines, for the coordinated survey. In Benin, 519 children were sampled in 5 schools and 22 (4.2%) had STH infection (A. lumbricoides, T. trichiura, or hookworm) detected using the Kato-Katz method. All infections were classified as light intensity under WHO criteria. In Tonga, 10 schools were chosen for the coordinated TAS and STH survey covering two ecological zones; 32 of 232 (13.8%) children were infected in Tongatapu and 82 of 320 (25.6%) in Vava'u and Ha'apai. All infections were light-intensity with the exception of one with moderate-intensity T. trichiura. CONCLUSIONS: Synchronous assessment of STH with TAS is feasible and provides a well-timed evaluation of infection prevalence to guide ongoing treatment decisions at a time when MDA for LF may be stopped. The coordinated field experiences in both countries also suggest potential time and cost savings. Refinement of a coordinated TAS and STH sampling methodology should be pursued, along with further validation of alternative quantitative diagnostic tests for STH that can be used with preserved stool specimens.
Assuntos
Anti-Helmínticos , Filariose Linfática/tratamento farmacológico , Filariose Linfática/epidemiologia , Helmintíase/epidemiologia , Helmintíase/transmissão , Anti-Helmínticos/administração & dosagem , Anti-Helmínticos/uso terapêutico , Benin/epidemiologia , Criança , Filariose Linfática/prevenção & controle , Inquéritos Epidemiológicos , Humanos , Projetos Piloto , Solo/parasitologia , Tonga/epidemiologiaRESUMO
OBJECTIVE: This study aimed to identify cultural-level variables that may influence the extent to which adolescents from different cultural groups are dissatisfied with their bodies. DESIGN: A sample of 1730 male and 2000 female adolescents from Australia, Fiji, Malaysia, Tonga, Tongans in New Zealand, China, Chile, and Greece completed measures of body satisfaction, and the sociocultural influences on body image and body change questionnaire, and self-reported height and weight. Country gross domestic product and national obesity were recorded using global databases. RESULTS: Prevalence of obesity/overweight and cultural endorsement of appearance standards explained variance in individual-level body dissatisfaction (BD) scores, even after controlling for the influence of individual differences in body mass index and internalization of appearance standards. CONCLUSIONS: Cultural-level variables may account for the development of adolescent BD.
Assuntos
Imagem Corporal/psicologia , Índice de Massa Corporal , Comparação Transcultural , Características Culturais , Produto Interno Bruto , Sobrepeso/psicologia , Satisfação Pessoal , Adolescente , Chile/epidemiologia , China/epidemiologia , Estudos Transversais , Feminino , Grécia/epidemiologia , Humanos , Malásia/epidemiologia , Masculino , Modelos Estatísticos , Nova Zelândia/epidemiologia , Obesidade/epidemiologia , Obesidade/psicologia , Sobrepeso/epidemiologia , Prevalência , Autoimagem , Autorrelato , Fatores Sexuais , Inquéritos e Questionários , Tonga/epidemiologiaRESUMO
BACKGROUND: The magnitude of the relationship between lifestyle risk factors for obesity and adiposity is not clear. The aim of this study was to clarify this in order to determine the level of importance of lifestyle factors in obesity aetiology. METHODS: A cross-sectional analysis was carried out on data on youth who were not trying to change weight (n = 5714), aged 12 to 22 years and from 8 ethnic groups living in New Zealand, Australia, Fiji and Tonga. Demographic and lifestyle data were measured by questionnaires. Fatness was measured by body mass index (BMI), BMI z-score and bioimpedance analysis, which was used to estimate percent body fat and total fat mass (TFM). Associations between lifestyle and body composition variables were examined using linear regression and forest plots. RESULTS: TV watching was positively related to fatness in a dose-dependent manner. Strong, dose-dependent associations were observed between fatness and soft drink consumption (positive relationship), breakfast consumption (inverse relationship) and after-school physical activity (inverse relationship). Breakfast consumption-fatness associations varied in size across ethnic groups. Lifestyle risk factors for obesity were associated with percentage differences in body composition variables that were greatest for TFM and smallest for BMI. CONCLUSIONS: Lifestyle factors were most strongly related to TFM, which suggests that studies that use BMI alone to quantify fatness underestimate the full effect of lifestyle on adiposity. This study clarifies the size of lifestyle-fatness relationships observed in previous studies.
Assuntos
Etnicidade , Comportamentos Relacionados com a Saúde , Estilo de Vida , Obesidade/epidemiologia , Tecido Adiposo , Adiposidade , Adolescente , Austrália/epidemiologia , Composição Corporal , Índice de Massa Corporal , Desjejum , Bebidas Gaseificadas , Criança , Estudos Transversais , Impedância Elétrica , Fiji/epidemiologia , Humanos , Modelos Lineares , Atividade Motora , Nova Zelândia/epidemiologia , Fatores de Risco , Inquéritos e Questionários , Televisão , Tonga/epidemiologia , Adulto JovemRESUMO
Over 200 million people worldwide live outside their country of birth and typically experience large gains in material well-being by moving to where wages are higher. But, the effect of this migration on other dimensions of well-being such as health are less clear and existing evidence is ambiguous because of potential for self-selection bias. In this paper, we use a natural experiment, comparing successful and unsuccessful applicants to a migration lottery to experimentally estimate the impact of migration on measured blood pressure and hypertension. Hypertension is a leading global health problem, as well as being an important health measure that responds quickly to migration. We use various econometric estimators to form bounds on the treatment effects because there appears to be selective non-compliance in the natural experiment. Even with these bounds, the results suggest significant and persistent increases in blood pressure and hypertension, which are likely to have implications for future health budgets given recent increases in developing to developed country migration.
Assuntos
Pressão Sanguínea , Emigração e Imigração , Hipertensão/economia , Hipertensão/epidemiologia , Modelos Econométricos , Adulto , Demografia , Feminino , Humanos , Masculino , Tonga/epidemiologiaRESUMO
OBJECTIVE: Obesity is a growing health concern in the Oceanic populations. To investigate the genetic factors associated with adult obesity in the Oceanic populations, the association of single nucleotide polymorphisms (SNPs) of the beta-2 adrenergic receptor (ADRB2) gene with obesity was examined in 694 adults living in Tonga and Solomon Islands. RESULTS: A screening for variation in 16 Oceanic subjects detected 17 SNPs in the entire region of ADRB2, of which nine SNPs including two non-synonymous ones, rs1042713 (Arg16Gly) and rs1042714 (Gln27Glu), were further genotyped for all subjects. The rs34623097-A allele, at a SNP located upstream of ADRB2, showed the strongest association with risk for obesity in a logistic regression analysis adjusted for age, sex, and population (P=5.6 × 10(-4), odds ratio [OR]=2.5, 95% confidence interval [CI]=1.5-4.2). The 27Glu was also significantly associated with obesity in the single-point association analysis (P=0.013, OR=2.0, 95%CI=1.2-3.4); however, this association was no longer significant after adjustment for rs34623097 since these SNPs were in linkage disequilibrium with each other. A copy of the obesity-risk allele, rs34623097-A, led to a 1.6 kg/m(2) increase in body mass index (BMI; defined as weight in kilograms divided by height in meters squared) (P=0.0019). A luciferase reporter assay indicated that rs34623097-A reduced the transcriptional activity of the luciferase reporter gene by approximately 10% compared with rs34623097-G. An electrophoretic mobility shift assay demonstrated that rs34623097 modulated the binding affinity with nuclear factors. An evolutionary analysis implies that a G>A mutation at rs34623097 occurred in the Neandertal genome and then the rs34623097-A allele flowed into the ancestors of present-day humans. CONCLUSION: The present results suggest that rs34623097-A, which would lead to lower expression of ADRB2, contributes to the onset of obesity in the Oceanic populations.
Assuntos
Havaiano Nativo ou Outro Ilhéu do Pacífico/genética , Obesidade/genética , Polimorfismo de Nucleotídeo Único , Receptores Adrenérgicos beta 2/genética , Adulto , Dioxigenase FTO Dependente de alfa-Cetoglutarato , Composição Corporal , Índice de Massa Corporal , Feminino , Predisposição Genética para Doença , Genótipo , Humanos , Desequilíbrio de Ligação , Masculino , Melanesia/epidemiologia , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/metabolismo , Fenótipo , Prevalência , Proteínas/genética , Receptores Adrenérgicos beta 2/metabolismo , Tonga/epidemiologiaRESUMO
Since 1998, the authors have been working to improve the oral health of children at kindergartens and primary schools in the Kingdom of Tonga (Tonga). Our primary activity has been a school-based fluoride mouth-rinsing (FMR) program. FMR is performed using 7-10 mL of a 0.2% NaF solution for 1 min once per week at each school. In the present study, we evaluated the effect of school-based FMR on dental caries incidence among Tongan schoolchildren. A total of 109 children aged 10 years were evaluated at six primary schools on Tongatapu Island. The FMR group comprised 46 children who had participated in the school-based FMR program for at least 5 years 6 months; the control group comprised 63 children who had participated in the school-based FMR program for 1 year or less. During standardized dental examinations, decayed, missing, and filled teeth were counted by a single dentist at each school. The school-based FMR program effectively decreased the number of dental caries. A school-based FMR program may thus be very beneficial in preventing caries among children in Tonga.
Assuntos
Cariostáticos/administração & dosagem , Cárie Dentária/prevenção & controle , Antissépticos Bucais/administração & dosagem , Serviços de Odontologia Escolar , Fluoreto de Sódio/administração & dosagem , Criança , Índice CPO , Cárie Dentária/epidemiologia , Cárie Dentária/etiologia , Humanos , Tonga/epidemiologiaAssuntos
Serviços de Saúde Comunitária , Obesidade/epidemiologia , Obesidade/prevenção & controle , Adolescente , Austrália/epidemiologia , Fiji/epidemiologia , Humanos , Estudos Multicêntricos como Assunto , Nova Zelândia/epidemiologia , Prevalência , Projetos de Pesquisa , Fatores Socioeconômicos , Tonga/epidemiologiaRESUMO
Policy makers throughout the world are struggling to find effective ways to prevent the rising trend of obesity globally, particularly among children. The Pacific Obesity Prevention in Communities project was the first large-scale, intervention research project conducted in the Pacific aiming to prevent obesity in adolescents. The project spanned four countries: Australia, New Zealand, Fiji and Tonga. This paper reports on the strengths and challenges experienced from this complex study implemented from 2004 to 2009 across eight cultural groups in different community settings. The key strengths of the project were its holistic collaborative approach, participatory processes and capacity building. The challenges inherent in such a large complex project were underestimated during the project's development. These related to the scale, complexity, duration, low research capacity in some sites and overall coordination across four different countries. Our experiences included the need for a longer lead-in time prior to intervention for training and up-skilling of staff in Fiji and Tonga, investment in overall coordination, data quality management across all sites and the need for realistic capacity building requirements for research staff. The enhanced research capacity and skills across all sites include the development and strengthening of research centres, knowledge translation and new obesity prevention projects.