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3.
Ann Rheum Dis ; 79(4): 536-544, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32114511

RESUMEN

OBJECTIVE: Gout is characterised by severe interleukin (IL)-1-mediated joint inflammation induced by monosodium urate crystals. Since IL-37 is a pivotal anti-inflammatory cytokine suppressing the activity of IL-1, we conducted genetic and functional studies aimed at elucidating the role of IL-37 in the pathogenesis and treatment of gout. METHODS: Variant identification was performed by DNA sequencing of all coding bases of IL37 using molecular inversion probe-based resequencing (discovery cohort: gout n=675, controls n=520) and TaqMan genotyping (validation cohort: gout n=2202, controls n=2295). Predictive modelling of the effects of rare variants on protein structure was followed by in vitro experiments evaluating the impact on protein function. Treatment with recombinant IL-37 was evaluated in vitro and in vivo in a mouse model of gout. RESULTS: We identified four rare variants in IL37 in six of the discovery gout patients; p.(A144P), p.(G174Dfs*16), p.(C181*) and p.(N182S), whereas none emerged in healthy controls (Fisher's exact p-value=0.043). All variants clustered in the functional domain of IL-37 in exon 5 (p-value=5.71×10-5). Predictive modelling and functional studies confirmed loss of anti-inflammatory functions and we substantiated the therapeutic potential of recombinant IL-37 in the treatment of gouty inflammation. Furthermore, the carrier status of p.(N182S)(rs752113534) was associated with increased risk (OR=1.81, p-value=0.031) of developing gout in hyperuricaemic individuals of Polynesian ancestry. CONCLUSION: Here, we provide genetic as well as mechanistic evidence for the role of IL-37 in the pathogenesis of gout, and highlight the therapeutic potential of recombinant IL-37 for the treatment of gouty arthritis.


Asunto(s)
Gota/genética , Interleucina-1/genética , Adulto , Anciano , Anciano de 80 o más Años , Animales , Estudios de Casos y Controles , Grupo de Ascendencia Continental Europea/genética , Femenino , Predisposición Genética a la Enfermedad , Gota/inmunología , Humanos , Técnicas In Vitro , Interleucina-1/inmunología , Interleucina-1/farmacología , Interleucina-1beta/efectos de los fármacos , Interleucina-1beta/inmunología , Interleucina-6/inmunología , Interleucina-8/efectos de los fármacos , Interleucina-8/inmunología , Leucocitos Mononucleares/efectos de los fármacos , Leucocitos Mononucleares/inmunología , Masculino , Ratones , Persona de Mediana Edad , Neutrófilos/efectos de los fármacos , Neutrófilos/inmunología , Grupo de Ascendencia Oceánica/genética , Polimorfismo Genético , Proteínas Recombinantes/farmacología , Ácido Úrico/inmunología , Ácido Úrico/farmacología
5.
Public Health Res Pract ; 30(1)2020 Mar 10.
Artículo en Inglés | MEDLINE | ID: mdl-32152618

RESUMEN

OBJECTIVE: The Live Life Well @ School program aims to establish, reinforce and support primary school students (aged 5-11 years) and their families to adopt healthy eating and physical activity behaviours through the implementation of an evidence-based program that focuses on the school curriculum, the school food and physical activity environment, and teacher professional development. This paper examines Live Life Well @ School monitoring data to provide practical insights into program adoption and changes in primary school environments across NSW, particularly in schools characterised as disadvantaged. Type of program: The Live Life Well @ School program provides a universally delivered, state-wide approach to childhood obesity prevention in the primary school setting. The program is a joint initiative between health and education sector agencies. METHODS: The program includes health promotion strategies for primary schools relating to physical activity and nutrition. Adoption of the program is indicated by achievement of evidence-based desirable practices, which are monitored routinely by local health promotion staff using a purpose-built online Population Health Information Management System. Monitoring data are used to provide feedback to schools and identify a staged approach to achieving more desirable practices. Health promotion staff tailor support locally to suit school and community needs, and have additional funding to support socio-economically disadvantaged schools. RESULTS: The program has achieved high reach to schools (82.7%percnt; of the 2570 schools in New South Wales, Australia). Adoption of desirable practices within schools participating in 2017 was 72.9%percnt;. Equitable reach was achieved for schools in areas of socio-economic disadvantage, schools in remote areas and schools with a high propotion of Aboriginal students, who are likely to have higher rates of childhood overweight and obesity. Curriculum-based strategies were more frequently adopted; environmental changes and teacher professional development components were less well adopted. LESSONS LEARNT: The desirable practice approach allows health promotion officers to tailor support by building on school strengths and taking a staged approach to change. Ongoing monitoring of the program provides useful insights that inform quality improvements to the program and implementation process, as well as information on progress towards outcomes. State-wide program targets were adjusted to strengthen impact and focus on desirable practices that were less well achieved. Intentional targeting and tailoring in areas of disadvantage are required to achieve equitable adoption of such a universal health promotion program. Strong relationships at the local level between school champions (teachers and principals) and health promotion staff characterise success.


Asunto(s)
Curriculum , Promoción de la Salud , Obesidad Pediátrica/prevención & control , Servicios de Salud Escolar , Niño , Femenino , Humanos , Masculino , Nueva Gales del Sur , Grupo de Ascendencia Oceánica , Obesidad Pediátrica/etnología , Evaluación de Programas y Proyectos de Salud
7.
N Z Med J ; 133(1511): 71-85, 2020 03 13.
Artículo en Inglés | MEDLINE | ID: mdl-32161423

RESUMEN

The hazardous and obesogenic food environment are major contributors to health loss in Aotearoa New Zealand. Here we consider the potential use of food taxes and subsidies to protect health in this country. We find that each one of the 14 recent systematic reviews on the tax and/or subsidy topic since 2015 in the scientific literature report that such interventions have favourable impacts from a health perspective. The New Zealand evidence we considered (n=12 studies since January 2010) is less definitive, but the pattern of results is consistent with the international evidence. Given this overall picture, the New Zealand Government should seriously consider such tax/subsidy interventions, potentially starting with a UK-style sugary drinks industry levy.


Asunto(s)
Alimentos , Legislación Alimentaria , Salud Pública , Bebidas Azucaradas , Impuestos/legislación & jurisprudencia , Bebidas , Grasas de la Dieta , Azúcares de la Dieta , Humanos , Nueva Zelanda , Grupo de Ascendencia Oceánica , Sodio en la Dieta
8.
Pediatrics ; 145(3)2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32094291

RESUMEN

OBJECTIVES: Investigate the relationship between maternal alcohol-use disorder and multiple biological and social child outcomes, including birth outcomes, child protection, justice contact, and academic outcomes for both Indigenous and non-Indigenous children. METHODS: Women with a birth recorded on the Western Australian Midwives Notification System (1983-2007) and their offspring were in scope. The exposed cohort were mothers with an alcohol-related diagnosis (International Classification of Diseases, Ninth Revision and International Classification of Diseases, 10th Revision) recorded in an administrative data set and their offspring (non-Indigenous: n = 13 969; Indigenous: n = 9635). The exposed cohort was frequency matched with mothers with no record of an alcohol-related diagnosis and their offspring (comparison cohort; non-Indigenous: n = 40 302; Indigenous: n = 20 533). RESULTS: Over half of exposed non-Indigenous children (55%) and 84% of exposed Indigenous children experienced ≥1 negative outcome. The likelihood of any negative outcome was significantly higher for the exposed than the comparison cohort (non-Indigenous: odds ratio [OR] = 2.67 [95% confidence interval (CI) = 2.56-2.78]; Indigenous: OR = 2.67 [95% CI = 2.50-2.85]). The odds were greatest for children whose mothers received a diagnosis during pregnancy (non-Indigenous: OR = 4.65 [95% CI = 3.87-5.59]; Indigenous: OR = 5.18 [95% CI = 4.10-6.55]); however, numbers were small. CONCLUSIONS: The effects of maternal alcohol-use disorder are experienced by the majority of exposed children rather than a vulnerable subgroup of this population. These findings highlight the need for universal prevention strategies to reduce harmful alcohol use and targeted interventions to support at-risk women and children.


Asunto(s)
Alcoholismo , Complicaciones del Embarazo , Efectos Tardíos de la Exposición Prenatal/epidemiología , Adulto , Australia/epidemiología , Niño , Preescolar , Femenino , Humanos , Grupo de Ascendencia Oceánica , Embarazo , Resultado del Embarazo , Efectos Tardíos de la Exposición Prenatal/diagnóstico , Adulto Joven
9.
Health Qual Life Outcomes ; 18(1): 43, 2020 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-32093749

RESUMEN

BACKGROUND: The oral health of Indigenous children in remote communities is much worse than other population groups in Australia. Providing and maintaining an oral health service is challenging due to the remoteness of communities, the associated high cost, and the low retention of clinical staff. An annual preventive intervention delivered by fly-in clinicians may be a more cost-effective way to manage this problem. In this analysis we estimate the cost-effectiveness of an annual professional intervention for the prevention of dental caries in children of a remote Indigenous community in Far North Queensland. METHODS: A cost-effectiveness analysis was conducted based on an annual preventive intervention protocol. This included treating all dental decay in those with disease, applying fissure sealants, a disinfectant swab, fluoride varnish and providing oral hygiene instructions and dietary advice to all participating school children. This study included an intervention group and a natural comparison group and both groups were followed-up for 2 years after the initial preventive intervention. A Markov model was built to assess the cost-effectiveness of the intervention compared with the usual care. Costs of treatment from the Queensland Department of Health were used and effectiveness was measured as quality-adjusted life years (QALYs) with the CHU-9D. One-way and probabilistic sensitivity analyses were conducted to identify key drivers and quantify uncertainty. RESULTS: The preventive intervention was found to be highly cost-effective. The incremental cost per QALY gained was AU$3747. Probability of new caries and seeking treatment were identified as the main drivers of the model. In probabilistic sensitivity analysis intervention was cost effective in 100% of simulations. CONCLUSION: An annual preventive intervention for remote Indigenous communities in Australia is a highly cost-effective strategy to prevent dental caries and improve the quality of life of children.


Asunto(s)
Caries Dental/terapia , Servicios de Salud del Indígena/economía , Salud Bucal/economía , Años de Vida Ajustados por Calidad de Vida , Estudios de Casos y Controles , Niño , Análisis Costo-Beneficio , Caries Dental/epidemiología , Femenino , Humanos , Masculino , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Queensland
10.
N Z Med J ; 133(1509): 28-38, 2020 02 07.
Artículo en Inglés | MEDLINE | ID: mdl-32027636

RESUMEN

AIM: To determine the contribution of smoking-related deaths to the life expectancy gap in both Maori and Pacific people compared with non-Maori/non-Pacific people in New Zealand. METHODS: Death registration and population data between 2013 and 2015 were used to calculate life expectancy. To determine the contribution of smoking to the life expectancy gap, population attributable fractions for all causes of death where smoking is a casual risk factor were calculated using age- and ethnic-specific smoking data from the 2013 New Zealand Census and relative risk estimates from the American Cancer Society Cancer Prevention Study II. Population attributable fractions were applied to all deaths registered in New Zealand for the 2013-15 period to estimate the number of deaths attributable to tobacco smoking. The life expectancy gap was decomposed using the Arriaga method. The gap was decomposed both overall and by specific smoking attributable causes of death. RESULTS: Between 2013 and 2015 an estimated 12,421 (13.4% of all deaths) were attributable to smoking. Nearly one in four (22.6%) deaths among Maori were attributable to smoking (2,199 out of 9,717 deaths) and nearly one in seven (13.8%) among Pacific people (512 out of 3,720 deaths). Among non-Maori/non-Pacific people, one in eight (12.3%) deaths were attributable to smoking (9,710 out of 78,759 deaths). Higher rates of smoking attributable mortality were responsible for 2.1 years of the life expectancy gap in Maori men, 2.3 years in Maori women, 1.4 years in Pacific men and 0.3 years among Pacific women. Cancers of the trachea, bronchus and lung, chronic obstructive pulmonary disease (COPD) and ischaemic heart disease were the leading smoking attributable causes of death contributing to the gap. CONCLUSION: Smoking is an important preventable risk factor contributing to ethnic inequities in life expectancy for Maori men and women, and Pacific men. Dramatic declines in smoking-attributable deaths can be achieved by reducing smoking prevalence rates. Preventing smoking initiation and increasing cessation rates must remain a top priority for the Ministry of Health and District Health Boards. Smokefree initiatives should be reoriented to be Tiriti o Waitangi (Treaty of Waitangi) compliant and better meet the needs of Maori and Pacific people who smoke. Addressing the residual risk in ex-smokers through equitable early diagnosis and treatment of smoking-related conditions will further assist a more rapid closing of life expectancy gaps for Maori men and women and Pacific men. The next five years provide the opportunity to demonstrate commitment to achieving a smokefree Aotearoa for all: an aspiration, based on the current trajectory, which is most probably out of reach.


Asunto(s)
Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Disparidades en el Estado de Salud , Esperanza de Vida/etnología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Fumar Tabaco/etnología , Femenino , Humanos , Masculino , Nueva Zelanda/epidemiología , Fumar Tabaco/epidemiología
11.
N Z Med J ; 133(1509): 47-57, 2020 02 07.
Artículo en Inglés | MEDLINE | ID: mdl-32027638

RESUMEN

AIM: To investigate the epidemiology of traumatic spinal cord injury (TSCI) in New Zealand over a 10-year period. METHODS: Ambispective data of all new patients admitted to New Zealand's two spinal rehabilitation units between January 2007 and December 2016 (n=929) were collated. Variables assessed included age at injury, gender, ethnicity, date of injury, aetiology, length of hospital stay, injury level, neurological status on discharge and discharge destination. RESULTS: The incidence of TSCI averaged 22 (95% CI 21-24) per million, increasing 6% a year. The average incidence for Maori (29 per million people (95% CI 25-34)) was 1.8 times higher than New Zealand European (16 per million people (95% CI 15-18)), and show an increase of 14% a year. The median age of TSCI increased from 43 to 48 years. Overall, falls (32%), transport (32%) and sports (22%) were the most common causes of TSCI. Cervical TSCI (54%) were most common, particularly in older adults (70% over 75 years) and Maori (61%) and Pacific Island (72%) patients. Surgical rates remained stable (77%) but length of stay in hospital decreased over the study period. CONCLUSIONS: The demographic of TSCI is changing in New Zealand. The median age of patients is increasing, as is the incidence, particularly for women, older adults and Maori patients.


Asunto(s)
Accidentes por Caídas/estadística & datos numéricos , Accidentes de Tránsito/estadística & datos numéricos , Traumatismos en Atletas/epidemiología , Traumatismos de la Médula Espinal/epidemiología , Violencia/estadística & datos numéricos , Actividades Cotidianas , Adolescente , Adulto , Distribución por Edad , Anciano , Vértebras Cervicales , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Humanos , Incidencia , Tiempo de Internación/estadística & datos numéricos , Vértebras Lumbares , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/estadística & datos numéricos , Nueva Zelanda/epidemiología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Sistema de Registros , Distribución por Sexo , Traumatismos de la Médula Espinal/etnología , Traumatismos de la Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/cirugía , Vértebras Torácicas , Adulto Joven
12.
N Z Med J ; 133(1509): 58-64, 2020 02 07.
Artículo en Inglés | MEDLINE | ID: mdl-32027639

RESUMEN

Staphylococcus aureus disease is associated with significant morbidity and mortality and of concern, it disproportionally affects Maori and Pacific Peoples. New Zealand has high rates of skin and soft tissue infection caused by S. aureus. Healthcare-associated S. aureus bacteraemia (HA-SAB) accounts for a significant proportion of all S. aureus bacteraemia events. Measurement of HA-SAB has been reported in New Zealand for over 20 years but it has not been linked to quality improvement interventions to reduce the rate. It has been used as an outcome measure for the Hand Hygiene New Zealand programme; however, a recent review of submitted data questioned the accuracy of it. This has been addressed. National programmes such as the Health Quality & Safety Commissions Hand Hygiene New Zealand and the Surgical Site Infection Improvement programme have led to reduced harm from healthcare-associated infections. Interventions targeted at reducing the HA-SAB rate, such as bundles of care for insertion and maintenance of vascular access devices and skin and nasal decolonisation of staphylococci prior to surgery, are urgently required.


Asunto(s)
Bacteriemia/prevención & control , Infección Hospitalaria/prevención & control , Control de Infecciones/métodos , Infecciones Estafilocócicas/prevención & control , Australia , Bacteriemia/etnología , Infecciones Relacionadas con Catéteres/etnología , Infecciones Relacionadas con Catéteres/prevención & control , Infección Hospitalaria/etnología , Grupo de Ascendencia Continental Europea , Humanos , Nueva Zelanda , Grupo de Ascendencia Oceánica , Paquetes de Atención al Paciente , Cuidados Preoperatorios/métodos , Infecciones Estafilocócicas/etnología , Staphylococcus aureus , Dispositivos de Acceso Vascular
13.
N Z Med J ; 133(1510): 35-44, 2020 02 21.
Artículo en Inglés | MEDLINE | ID: mdl-32078599

RESUMEN

AIMS: To determine whether glycaemic control and the prevalence of microvascular complications in Waikato children/youth with type 1 diabetes (T1D) has changed since 2003. METHODS: A retrospective review was performed of clinical records of children and youth with T1D who were under the care of the Waikato Paediatric and Young Adult Diabetes Services between March 2016 and March 2017. Comparisons were made to published data from the same service in 2003. RESULTS: Despite a more than two-fold increase in insulin-pump therapy since 2003, glycaemic control was not significantly improved in either children or youth. However, since 2003 there has been a significant reduction in the prevalence of diabetic retinopathy (24.6% vs 6.0%; P=0.003) and nephropathy (6.0% vs 25.4%; P=0.002), while symptomatic diabetic neuropathy remains rare. This reduction occurred despite a significant increase in obesity and hypertension, and no significant difference in the rates of dyslipidaemia or smoking. CONCLUSIONS: There has been a marked reduction in microvascular complications in Waikato youth and young adults with type 1 diabetes, but the reasons for the reduction are not clear given there has been no significant improvements in glycaemic control.


Asunto(s)
Diabetes Mellitus Tipo 1/complicaciones , Nefropatías Diabéticas/etnología , Neuropatías Diabéticas/etnología , Retinopatía Diabética/etnología , Grupo de Ascendencia Oceánica , Adolescente , Biomarcadores/sangre , Glucemia/metabolismo , Niño , Preescolar , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 1/etnología , Nefropatías Diabéticas/etiología , Neuropatías Diabéticas/etiología , Retinopatía Diabética/etiología , Femenino , Humanos , Hipoglucemiantes/uso terapéutico , Lactante , Recién Nacido , Masculino , Nueva Zelanda/epidemiología , Prevalencia , Estudios Retrospectivos
14.
N Z Med J ; 133(1508): 43-64, 2020 01 17.
Artículo en Inglés | MEDLINE | ID: mdl-31945042

RESUMEN

Maori are more likely than non-Maori to get cancer, and once they have cancer they are less likely to survive it. One frequently proposed explanation for this survival disparity is differences between these groups in terms of stage at diagnosis-whereby Maori may be less likely to be diagnosed at an earlier stage, when treatment is more feasible and outcomes are better for the patient. However, this simple explanation ignores the true complexity of the issue of stage at diagnosis as a driver of survival disparities, and makes critical assumptions about the quality of available staging data. In this manuscript we draw on New Zealand Cancer Registry and available clinical audit data to explore this issue in detail. We found that Maori are less likely than European/Other patients to have localised disease and more likely to have advanced disease for several commonly diagnosed cancers; however, we also found that this was not the case for several key cancers, including lung and liver cancer. There is evidence that Maori have more advanced disease at diagnosis for each of the cancers for which we currently have a national screening programme, reinforcing the importance of achieving equity in access to these programmes. Missing stage information on our national registry undermines our ability to both a) monitor progress towards achieving early diagnosis, and b) examine and monitor the role of stage at diagnosis as a driver of survival disparities for several important cancers for Maori, including lung, liver and stomach cancers.


Asunto(s)
Neoplasias Hepáticas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Neoplasias/diagnóstico , Neoplasias/etnología , Detección Precoz del Cáncer/métodos , Grupos Étnicos , Femenino , Disparidades en Atención de Salud , Humanos , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/etnología , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/etnología , Masculino , Tamizaje Masivo/métodos , Estadificación de Neoplasias/estadística & datos numéricos , Neoplasias/epidemiología , Neoplasias/patología , Nueva Zelanda/etnología , Grupo de Ascendencia Oceánica/etnología , Sistema de Registros , Análisis de Supervivencia
15.
PLoS Negl Trop Dis ; 14(1): e0008022, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31971951

RESUMEN

BACKGROUND: Chlamydia trachomatis is the most common bacterial sexually transmitted infection worldwide with some of the highest prevalence rates among Pacific Island Countries where syndromic management is practiced. However, little is known about the true prevalence and risk indicators for infection among neglected populations in these countries that suffer from health disparities. METHODOLOGY/PRINCIPAL FINDINGS: Consecutive sampling was used to enroll sexually active females, aged 18-40 years, attending 12 Fijian Ministry of Health and Medical Services Health Centers and outreach locations from February to December, 2018. A Behavioral Surveillance Survey was administered to assess risk indicators for infection. Signs and symptoms were recorded, and vaginal swabs were tested for C. trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Candida and bacterial vaginosis. Bivariate and multivariate logistic regression analyses were performed using R-Studio. Of 577 participants, 103 (17.85%) were infected with C. trachomatis of whom 80% were asymptomatic and only 11 met criteria for syndromic management; 38.8% of infected women were 18-24 years old with a prevalence of 30.5%. 91.7% of participants intermittently or did not use condoms. C. trachomatis infection was associated with iTaukei ethnicity (OR 21.41 [95% CI: 6.38-133.53]); two lifetime partners (OR 2.12 [95% CI: 1.08-4.18]); and N. gonorrhoeae co-infection (OR 9.56 [95% CI: 3.67-28.15]) in multivariate analyses. CONCLUSIONS: A disproportionately high burden of C. trachomatis is present among young asymptomatic women in Fiji of iTaukei ethnicity despite the low number of lifetime partners. Syndromic management and lack of barrier contraceptives contribute to hyperendemic levels. Strategic STI education and screening of at-risk adolescents, young women, and their partner(s) with appropriate treatment are urgently needed to control the epidemic.


Asunto(s)
Infecciones por Chlamydia/microbiología , Chlamydia trachomatis , Enfermedades Endémicas , Enfermedades de Transmisión Sexual/microbiología , Vaginitis/epidemiología , Vaginitis/microbiología , Adolescente , Adulto , Femenino , Fiji/epidemiología , Humanos , Grupo de Ascendencia Oceánica , Enfermedades de Transmisión Sexual/epidemiología , Adulto Joven
16.
Am J Gastroenterol ; 115(2): 262-270, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31985529

RESUMEN

BACKGROUND: We used data from the Fibrotic Liver Disease Consortium to evaluate the impact of ursodeoxycholic acid (UDCA) treatment across race/ethnicity, gender, and clinical status among patients with primary biliary cholangitis. METHODS: Data were collected from "index date" (baseline) through December 31, 2016. Inverse Probability of Treatment Weighting was used to adjust for UDCA treatment selection bias. Cox regression, focusing on UDCA-by-risk factor interactions, was used to assess the association between treatment and mortality and liver transplant/death. RESULTS: Among 4,238 patients with primary biliary cholangitis (13% men; 8% African American, 7% Asian American/American Indian/Pacific Island [ASINPI]; 21% Hispanic), 78% had ever received UDCA. The final multivariable model for mortality retained age, household income, comorbidity score, total bilirubin, albumin, alkaline phosphatase, and interactions of UDCA with race, gender, and aspartate aminotransferase/alanine aminotransferase ≥1.1. Among untreated patients, African Americans and ASINPIs had higher mortality than whites (adjusted hazard ratio [aHR] = 1.34, 95% confidence interval [CI] 1.08-1.67 and aHR = 1.40, 95% CI 1.11-1.76, respectively). Among treated patients, this relationship was reversed (aHR = 0.67, 95% CI 0.51-0.86 and aHR = 0.88, 95% CI 0.67-1.16). Patterns were similar for liver transplant/death. UDCA reduced the risk of liver transplant/death in all patient groups and mortality across all groups except white women with aspartate aminotransferase/alanine aminotransferase ≥1.1. As compared to patients with low-normal bilirubin at baseline (≤0.4 mg/dL), those with high-normal (1.0 > 0.7) and mid-normal bilirubin (0.7 > 0.4) had significantly higher liver transplant/death and all-cause mortality. DISCUSSION: African American and ASINPI patients who did not receive UDCA had significantly higher mortality than white patients. Among African Americans, treatment was associated with significantly lower mortality. Regardless of UDCA treatment, higher baseline bilirubin, even within the normal range, was associated with increased mortality and liver transplant/death compared with low-normal levels.


Asunto(s)
Afroamericanos/estadística & datos numéricos , Colagogos y Coleréticos/uso terapéutico , Cirrosis Hepática Biliar/terapia , Ácido Ursodesoxicólico/uso terapéutico , Adulto , Anciano , Alanina Transaminasa/sangre , Americanos Asiáticos/estadística & datos numéricos , Aspartato Aminotransferasas/sangre , Bilirrubina/sangre , Grupo de Ascendencia Continental Europea , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Cirrosis Hepática Biliar/sangre , Cirrosis Hepática Biliar/mortalidad , Trasplante de Hígado , Masculino , Persona de Mediana Edad , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Modelos de Riesgos Proporcionales , Tasa de Supervivencia
17.
Int J Equity Health ; 19(1): 8, 2020 01 13.
Artículo en Inglés | MEDLINE | ID: mdl-31931810

RESUMEN

BACKGROUND: Aboriginal women are frequently called upon to support their families and other community members. At times, such supporting roles can be burdensome for these women. Many Aboriginal women live with chronic conditions. We explored the ways in which the women's caring roles impacted on how they maintained their own health. METHODS: The aim of this manuscript is to explore the psychosocial factors associated with the management of health and chronic disease in Aboriginal women. An interpretive phenomenological approach was used for the analysis of 72 in-depth semi-structured interviews. These interviews were conducted in four community controlled Aboriginal health services, in urban, rural and remote settings, across two states and a territory in Australia. RESULTS: Women living with chronic disease experience multiple challenges while caring for family, such as intergenerational trauma, mental health issues relating to addiction, domestic and family violence and incarceration. When these women become ill, they also have to take care of themselves. These women provided informal and unfunded care in response to a range of complex family and community problems. This continuous caring for family affected the women's ability to maintain their health and manage their own chronic conditions. CONCLUSION: The caring roles and responsibilities Aboriginal women have in their community impact on their health. Aboriginal women provide much needed refuge and support to family and the wider community. Underfunded and over-burdened formal support services are not meeting the needs of many Aboriginal women. Improved culturally secure resources and social services are required within communities to support Aboriginal women to successfully manage their own health.


Asunto(s)
Enfermedad Crónica/etnología , Enfermedad Crónica/terapia , Grupo de Ascendencia Oceánica/psicología , Autocuidado/psicología , Adulto , Anciano , Anciano de 80 o más Años , Australia , Femenino , Servicios de Salud del Indígena , Humanos , Persona de Mediana Edad , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Investigación Cualitativa
18.
Aust N Z J Public Health ; 44(1): 59-64, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31535439

RESUMEN

OBJECTIVE: To assess the impact of an enhanced viral hepatitis surveillance program on data completeness and on epidemiological assessment of affected populations. METHODS: Notified cases of non-acute hepatitis B and C were analysed to determine demographic characteristics and risk factors during the period prior to July 2015-June 2016, and during enhanced surveillance of the period July 2016-June 2017, during which time doctors were contacted for information about new diagnoses. RESULTS: During the enhanced period, completeness for country of birth and Indigenous status doubled for both hepatitis B and hepatitis C, from 18-37% to 48-65%. The incidence ratio of hepatitis C among Aboriginal and Torres Strait Islander people increased from eight-fold to 11.4-fold, and the proportion of hepatitis B cases reported as born in China and Vietnam relative to other countries increased. New data fields identified that 12% of hepatitis C diagnoses occurred in a correctional facility, and 2% of hepatitis B cases were healthcare workers. CONCLUSIONS: Improved data completeness highlighted the underlying epidemiology of chronic viral hepatitis, demonstrating the increased burden of infection among specific priority populations. Implications for public health: Enhanced surveillance provides greater insight into the epidemiology of chronic viral hepatitis, identifying groups at risk and opportunities for public health action.


Asunto(s)
Hepatitis B Crónica/epidemiología , Hepatitis C Crónica/epidemiología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Vigilancia de la Población/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Niño , Preescolar , China/etnología , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Salud Pública , Factores de Riesgo , Victoria/epidemiología , Vietnam/etnología , Adulto Joven
19.
Support Care Cancer ; 28(1): 317-327, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31049670

RESUMEN

PURPOSE: The role of general practitioners in cancer care has expanded in recent years. However, little is known about utilization of primary health care (PHC) services by patients with cancer, particularly among socio-economically disadvantaged groups. We describe utilization of PHC services by patients with cancer, and the nature of the care provided. The study focuses on a disadvantaged group in Australia, namely Indigenous Australians. METHODS: A retrospective audit of clinical records in ten PHC services in Queensland, Australia. Demographic and clinical data of Indigenous Australians diagnosed with cancer during 2010-2016 were abstracted from patient's medical records at the PHC services. The rates of cancer-related visits were calculated using person years at risk as a denominator. RESULTS: A total of 138 patients' records were audited. During 12 months following the cancer diagnosis, patients visited the PHC service on average 5.95 times per year. Frequency of visits were relatively high in remote areas and among socioeconomic disadvantaged patients (IRR = 1.87, 95%CI 1.61-2.17; IRR = 1.79, 95%CI 1.45-2.21, respectively). Over 80% of visits were for seeking attention for symptoms, wound care, and emotional or social support. Patients who did not undergo surgery, had greater comorbidity, received chemotherapy and/or radiotherapy, and male gender had significantly greater rate of visits than their counterparts. CONCLUSION: The frequency of utilization of PHC services, especially by patients with comorbidities, and the range of reasons for attendance highlights the important role of PHC services in providing cancer care. The reliance on PHC services, particularly by patients in remote and disadvantaged communities, has important implications for appropriate resourcing and support for services in these locations.


Asunto(s)
Servicios de Salud del Indígena/estadística & datos numéricos , Neoplasias/terapia , Grupo de Ascendencia Oceánica , Médicos de Atención Primaria/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Auditoría Clínica , Femenino , Médicos Generales/normas , Médicos Generales/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/normas , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud del Indígena/normas , Humanos , Pueblos Indígenas/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Neoplasias/etnología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Pautas de la Práctica en Medicina/normas , Atención Primaria de Salud/normas , Queensland/epidemiología , Derivación y Consulta/normas , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos , Adulto Joven
20.
Ambio ; 49(1): 299-309, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30900080

RESUMEN

In this article, we focus on wellbeing as an important concept relating to bioenergy development in Canada. We use a three-dimensional or social approach to understanding wellbeing, which includes subjective and relational aspects in addition to the more traditional material dimension of wellbeing (e.g. financial resources, a healthy environment). Indigenous business leaders engaged in forestry, energy, and related resource sectors were recruited through our partner organization, the Canadian Council for Aboriginal Business, as a representative sample of key people to be engaged in the scoping of existing and future bioenergy partnerships in Canada. Participants often responded in ways that did not discretely fit into categories, but instead reflected a perspective on their own and their community's dimensions of social wellbeing, which we captured through open coding for emergent themes. Our findings on material wellbeing illustrate that relationships between different wellbeing dimensions need to be considered for community-appropriate bioenergy development.


Asunto(s)
Agricultura Forestal , Grupo de Ascendencia Oceánica , Canadá , Ambiente , Humanos
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