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1.
MMWR Morb Mortal Wkly Rep ; 69(48): 1807-1811, 2020 Dec 04.
Artículo en Inglés | MEDLINE | ID: mdl-33270609

RESUMEN

By June 2020, Marshallese and Hispanic or Latino (Hispanic) persons in Benton and Washington counties of Arkansas had received a disproportionately high number of diagnoses of coronavirus disease 2019 (COVID-19). Despite representing approximately 19% of these counties' populations (1), Marshallese and Hispanic persons accounted for 64% of COVID-19 cases and 57% of COVID-19-associated deaths. Analyses of surveillance data, focus group discussions, and key-informant interviews were conducted to identify challenges and propose strategies for interrupting transmission of SARS-CoV-2, the virus that causes COVID-19. Challenges included limited native-language health messaging, high household occupancy, high employment rate in the poultry processing industry, mistrust of the medical system, and changing COVID-19 guidance. Reducing the COVID-19 incidence among communities that suffer disproportionately from COVID-19 requires strengthening the coordination of public health, health care, and community stakeholders to provide culturally and linguistically tailored public health education, community-based prevention activities, case management, care navigation, and service linkage.


Asunto(s)
/etnología , Brotes de Enfermedades , Hispanoamericanos/estadística & datos numéricos , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Adolescente , Adulto , Anciano , Arkansas/epidemiología , Técnicas de Laboratorio Clínico , Femenino , Disparidades en el Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
3.
Med J Aust ; 213 Suppl 10: S3-S31, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33190287

RESUMEN

■The RHD Endgame Strategy: the blueprint to eliminate rheumatic heart disease in Australia by 2031 (the Endgame Strategy) is the blueprint to eliminate rheumatic heart disease (RHD) in Australia by 2031. Aboriginal and Torres Strait Islander people live with one of the highest per capita burdens of RHD in the world. ■The Endgame Strategy synthesises information compiled across the 5-year lifespan of the End Rheumatic Heart Disease Centre of Research Excellence (END RHD CRE). Data and results from priority research projects across several disciplines of research complemented literature reviews, systematic reviews and narrative reviews. Further, the experiences of those working in acute rheumatic fever (ARF) and RHD control and those living with RHD to provide the technical evidence for eliminating RHD in Australia were included. ■The lived experience of RHD is a critical factor in health outcomes. All future strategies to address ARF and RHD must prioritise Aboriginal and Torres Strait Islander people's knowledge, perspectives and experiences and develop co-designed approaches to RHD elimination. The environmental, economic, social and political context of RHD in Australia is inexorably linked to ending the disease. ■Statistical modelling undertaken in 2019 looked at the economic and health impacts of implementing an indicative strategy to eliminate RHD by 2031. Beginning in 2019, the strategy would include: reducing household crowding, improving hygiene infrastructure, strengthening primary health care and improving secondary prophylaxis. It was estimated that the strategy would prevent 663 deaths and save the health care system $188 million. ■The Endgame Strategy provides the evidence for a new approach to RHD elimination. It proposes an implementation framework of five priority action areas. These focus on strategies to prevent new cases of ARF and RHD early in the causal pathway from Streptococcus pyogenes exposure to ARF, and strategies that address the critical systems and structural changes needed to support a comprehensive RHD elimination strategy.


Asunto(s)
Desarrollo de Programa/métodos , Fiebre Reumática/prevención & control , Cardiopatía Reumática/prevención & control , Adolescente , Adulto , Australia/epidemiología , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Sistema de Registros , Fiebre Reumática/complicaciones , Fiebre Reumática/epidemiología , Cardiopatía Reumática/epidemiología , Cardiopatía Reumática/etiología , Prevención Secundaria , Streptococcus pyogenes , Adulto Joven
4.
BMC Med Inform Decis Mak ; 20(1): 286, 2020 11 03.
Artículo en Inglés | MEDLINE | ID: mdl-33143691

RESUMEN

BACKGROUND: In Australia, health services are seeking innovative ways to utilize data stored in health information systems to report on, and improve, health care quality and health system performance for Aboriginal Australians. However, there is little research about the use of health information systems in the context of Aboriginal health promotion. In 2008, the Northern Territory's publicly funded healthcare system introduced the quality improvement program planning system (QIPPS) as the centralized online system for recording information about health promotion programs. The purpose of this study was to explore the potential for utilizing data stored in QIPPS to report on quality of Aboriginal health promotion, using chronic disease prevention programs as exemplars. We identify the potential benefits and limitations of health information systems for enhancing Aboriginal health promotion. METHODS: A retrospective audit was undertaken on a sample of health promotion projects delivered between 2013 and 2016. A validated, paper-based audit tool was used to extract information stored in the QIPPS online system and report on Aboriginal health promotion quality. Simple frequency counts were calculated for dichotomous and categorical items. Text was extracted and thematically analyzed to describe community participation processes and strategies used in Aboriginal health promotion. RESULTS: 39 Aboriginal health promotion projects were included in the analysis. 34/39 projects recorded information pertaining to the health promotion planning phases, such as statements of project goals, 'needs assessment' findings, and processes for consulting Aboriginal people in the community. Evaluation findings were reported in approximately one third of projects and mostly limited to a recording of numbers of participants. For almost half of the projects analyzed, community participation strategies were not recorded. CONCLUSION: This is the first Australian study to shed light on the feasibility of utilizing data stored in a purposefully designed health promotion information system. Data availability and quality were limiting factors for reporting on Aboriginal health promotion quality. Based on our learnings of QIPPS, strategies to improve the quality and accuracy of data entry together with the use of quality improvement approaches are needed to reap the potential benefits of future health promotion information systems.


Asunto(s)
Prestación de Atención de Salud/normas , Sistemas de Información en Salud/organización & administración , Promoción de la Salud/normas , Servicios de Salud del Indígena/normas , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Mejoramiento de la Calidad , Prestación de Atención de Salud/organización & administración , Promoción de la Salud/organización & administración , Humanos , Informática Médica , Northern Territory , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos
5.
N Z Med J ; 133(1525): 62-73, 2020 11 20.
Artículo en Inglés | MEDLINE | ID: mdl-33223549

RESUMEN

Acute coronary syndrome (ACS) is one of the leading causes of mortality in the renal replacement therapy (RRT) population. We aimed to understand the characteristics, trends and outcomes of ACS in our local RRT population as a means to improve care and outcomes for this high-risk population. Using the ANZACS-QI database, we conducted a retrospective analysis of all ACS occurring in RRT patients between 1 January 2010-31 December 2019 managed at Waikato Hospital (n=135 at index ACS). In our cohort made up predominantly of Maori (55%) and European (34%) patients, 58% had diabetic nephropathy as their primary disease. Twenty-seven percent presented atypically and 65% had a delay of >72 hours from diagnosis to angiogram. There was a 49% mortality rate at one year post-index ACS. Factors associated with mortality at one year included: atypical presentation (chi-square statistic (X2) 7.250; p=0.0071), troponin delta >20% (X2 5.682; p=0.0171), peak troponin (point biserial correlation; r=0.2086; p=0.0473) and no revascularisation (X2 5.2419; p=0.0221). The findings in our cohort reiterate that patients on RRT are a vulnerable population who have poor outcomes associated with ACS, driven by multifactorial delays in diagnosis and treatment.


Asunto(s)
Síndrome Coronario Agudo/epidemiología , Nefropatías Diabéticas/epidemiología , Terapia de Reemplazo Renal/estadística & datos numéricos , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Angiografía Coronaria , Bases de Datos Factuales , Nefropatías Diabéticas/terapia , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo
6.
BMC Public Health ; 20(1): 1752, 2020 Nov 23.
Artículo en Inglés | MEDLINE | ID: mdl-33225914

RESUMEN

BACKGROUND: A recent Royal Commission into the treatment of Australians living with disabilities has underscored the considerable exposure to violence and harm in this population. Yet, little is known about exposure to violence among Aboriginal and Torres Strait Islander people living with disabilities. The objective of this paper was to examine the prevalence, disability correlates and aspects of violence and threats reported by Aboriginal and Torres Strait Islander people living with disabilities. METHODS: Data from the 2014-15 National Aboriginal and Torres Strait Islander Social Survey were used to measure physical violence, violent threats and disability. Multivariable logistic and ordinal logistic regression models adjusted for complex survey design were used to examine the association between measures of disability and exposure to violence and violent threats. RESULTS: In 2014-15, 17% of Aboriginal and Torres Strait Islander people aged 15-64 with disability experienced an instance of physical violence compared with 13% of those with no disability. Approximately 22% of those with a profound or severe disability reported experiencing the threat of physical violence. After adjusting for a comprehensive set of confounding factors and accounting for complex survey design, presence of a disability was associated with a 1.5 odds increase in exposure to physical violence (OR = 1.54 p < 0.001), violence with harm (OR = 1.55 p < 0.001), more frequent experience of violence (OR = 1.55 p < 0.001) and a 2.1 odds increase (OR = 2.13 p < 0.001) in exposure to violent threats. Severity of disability, higher numbers of disabling conditions as well as specific disability types (e.g., psychological or intellectual) were associated with increased odds of both physical violence and threats beyond this level. Independent of these effects, removal from one's natural family was strongly associated with experiences of physical violence and violent threats. Aboriginal and Torres Strait Islander women, regardless of disability status, were more likely to report partner or family violence, whereas men were more likely to report violence from other known individuals. CONCLUSION: Aboriginal and Torres Strait Islander people with disability are at heightened risk of physical violence and threats compared to Aboriginal and Torres Strait Islander people without disability, with increased exposure for people with multiple, severe or specific disabilities.


Asunto(s)
Personas con Discapacidad/estadística & datos numéricos , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Abuso Físico/etnología , Adolescente , Adulto , Australia/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Encuestas y Cuestionarios , Adulto Joven
7.
PLoS One ; 15(10): e0239384, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33002023

RESUMEN

In recent decades, several studies have emphasized sense of personal control as a prominent aspect of Aboriginal health. However, one limitation is that instruments available to measure personal control were originally developed in western countries and validation for Aboriginal Australians has not been conducted. The aims of the current study were to evaluate whether the Sense of Personal Control Scale (SPCS) can be used to obtain culturally unbiased measurement of personal control across Aboriginal and non-Aboriginal Australians and to assess the psychometric properties of the SPCS for Aboriginal and non-Aboriginal Australian. METHODS: The current study utilized two Australian subsamples retrieved from the Teeth Talk Study (n = 317) and the National Survey of Adult Oral Health 2004-2006 (n = 3,857) in which the SPCS was included. Graphical Loglinear Rasch Models (GLLRM) were used to fulfill the aims of the study. RESULTS: The Perceived Constraints subscale fitted a GLLRM for Aboriginal Australians after the exclusion of three items, while fit to any Rasch model (RM) or GLLRM model could not be found in the non-Aboriginal sample. The Mastery subscale fitted a GLLRM in the non-Aboriginal sample after the exclusion of one item. In the Aboriginal sample, two items of the Mastery subscale fitted the RM, however, two items cannot be considered as a scale. CONCLUSION: In the present study, we showed that the development of new items is crucial before the revised SPCS might constitute a valid and reliable measure of sense of personal control in both Aboriginal and non-Aboriginal Australian populations, and it is possible to assess whether the SPCS can be measured without bias across these two populations.


Asunto(s)
Encuestas Epidemiológicas , Grupo de Ascendencia Oceánica/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Australia/etnología , Femenino , Servicios de Salud del Indígena/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Adulto Joven
9.
N Z Med J ; 133(1522): 30-41, 2020 09 25.
Artículo en Inglés | MEDLINE | ID: mdl-32994614

RESUMEN

AIM: Chronic respiratory diseases, such as chronic obstructive pulmonary disease, are a worldwide public health problem. Pulmonary rehabilitation is a gold-standard intervention for these diseases, yet attendance and completion rates are poor. Counties Manukau Health, in Auckland, New Zealand, has a high prevalence of chronic respiratory disease and a culturally diverse population, comprising large numbers of Maori and Pacific Island people, who are known to be disproportionately affected by chronic respiratory disease. The aim of this study was to investigate patient characteristics affecting engagement with the Counties Manukau Health pulmonary rehabilitation programme and identify factors predicting completion of the programme. METHODS: Investigators performed a retrospective analysis using routinely collected data of 2,756 patients invited to attend the pulmonary rehabilitation programme at Counties Manukau Health. Data were analysed to compare demographic and clinical outcomes of patients who completed, did not complete or did not attend the programme, and identified factors predicting completion. RESULTS: Significant differences were found between groups in demographic and clinical characteristics. Increasing age, higher six-minute walk test distance at programme commencement and European ethnicity were significant predictors of completion of the PR programme. CONCLUSIONS: Compared to European people, Maori were 52% less likely and Pacific Island people were 40% less likely to complete the programme. These findings are significant for the Counties Manukau Health population. Further work needs to focus on determining how to make programmes more engaging to different cultures and how we can aim to reduce health inequities in these populations.


Asunto(s)
Cooperación del Paciente/estadística & datos numéricos , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/terapia , Terapia Respiratoria/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Estudios Retrospectivos , Adulto Joven
10.
N Z Med J ; 133(1521): 40-54, 2020 09 04.
Artículo en Inglés | MEDLINE | ID: mdl-32994636

RESUMEN

AIMS: Ischaemic heart disease (IHD) mortality rates after myocardial infarction (MI) are higher in Maori and Pacific compared to European people. The reasons for these differences are complex and incompletely understood. Our aim was to use a contemporary real-world national cohort of patients presenting with their first MI to better understand the extent to which differences in the clinical presentation, cardiovascular (CVD) risk factors, comorbidity and in-hospital treatment explain the mortality outcomes for Maori and Pacific peoples. METHODS: New Zealand residents (≥20 years old) hospitalised with their first MI (2014-2017), and who underwent coronary angiography, were identified from the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry. All-cause mortality up to one year after the index admission date was obtained by linkage to the national mortality database. RESULTS: There were 17,404 patients with a first ever MI. European/other comprised 76% of the population, Maori 11.5%, Pacific 5.1%, Indian 4.3% and Other Asian 2.9%. Over half (55%) of Maori, Pacific and Indian patients were admitted with their first MI before age 60 years, compared with 29% of European/other patients. Maori and Pacific patients had a higher burden of traditional and non-traditional cardiovascular risk factors, and despite being younger, were more likely to present with heart failure and, together with Indian peoples, advanced coronary disease at presentation with first MI. After adjustment for age and sex, Maori and Pacific, but not Indian or Other Asian patients had significantly higher all-cause mortality at one year compared with the European/other reference group (HR 2.55 (95% CI 2.12-3.07), HR 2.98 (95% CI 2.34-3.81) for Maori and Pacific respectively). When further adjusted for differences in clinical presentation, clinical history and cardiovascular risk factors, the excess mortality risk for Maori and Pacific patients was reduced substantially, but a differential persisted (HR 1.77 (95% CI 1.44-2.19), HR 1.42 (95% CI 1.07-1.83)) which was not further reduced by adjustment for differences in in-hospital management and discharge medications. CONCLUSION: In New Zealand patients after their first MI there is a three-fold variation in one-year mortality based on ethnicity. At least half of the inequity in outcomes for Maori, and three-quarters for Pacific people, is associated with differences in preventable or modifiable clinical factors present at, or prior to, presentation.


Asunto(s)
Disparidades en el Estado de Salud , Infarto del Miocardio/mortalidad , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Infarto del Miocardio/prevención & control , Nueva Zelanda/epidemiología , Factores de Riesgo
11.
N Z Med J ; 133(1521): 69-76, 2020 09 04.
Artículo en Inglés | MEDLINE | ID: mdl-32994638

RESUMEN

Maori experience poorer health statistics in terms of cancer incidence and mortality compared to non-Maori. For prostate cancer, Maori men are less likely than non-Maori men to be diagnosed with prostate cancer, but those that are diagnosed are much more likely to die of the disease than non-Maori men resulting in an excess mortality rate in Maori men compared with non-Maori. A review of the literature included a review of the epidemiology of prostate cancer; of screening; of access to healthcare and of treatment modalities. Our conclusion was that there are a number of reasons for the disparity in outcomes for Maori including differences in staging and characteristics at diagnosis; differences in screening and treatment offered to Maori men; and general barriers to healthcare that exist for Maori men in New Zealand. We conclude that there is a need for more culturally appropriate care to be available to Maori men.


Asunto(s)
Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Disparidades en Atención de Salud , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Neoplasias de la Próstata , Adulto , Anciano , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/epidemiología , Neoplasias de la Próstata/etnología , Neoplasias de la Próstata/terapia , Factores de Riesgo , Factores Socioeconómicos
12.
N Z Med J ; 133(1521): 77-96, 2020 09 04.
Artículo en Inglés | MEDLINE | ID: mdl-32994639

RESUMEN

Cancer is an important cause of morbidity and avoidable mortality for Maori-and substantial disparities exist in cancer incidence, mortality and survival for Maori compared to non-Maori New Zealanders. In this viewpoint, we draw together cancer incidence, mortality and survival data from the previous decade, in order to provide clarity regarding the most important causes of cancer burden for Maori. Covering the decade 2007-2016, our manuscript directly leads on from the landmark Unequal Impact II report (which covered 1996-2006), and provides the most up-to-date record of this burden as is currently possible. While focusing on the absolute burden of cancer for Maori, we also compare this burden to that experienced by non-Maori, and consider how this relative disparity may (or may not) have changed over time. Finally, we discuss how to reduce the occurrence and the overall cancer mortality burden for Maori, with a focus on those cancers that confer the greatest burden.


Asunto(s)
Neoplasias/mortalidad , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Femenino , Humanos , Incidencia , Masculino , Neoplasias/epidemiología , Nueva Zelanda/epidemiología
13.
Artículo en Inglés | MEDLINE | ID: mdl-32981492

RESUMEN

Cumulatively to 13 September there have been 26,753 case notifications and 674 deaths. The number of new cases reported nationally this fortnight was 764, a 61% decrease from the previous fortnight (1,948). On average this represented 55 cases diagnosed each day over the reporting period, a decrease from 125 cases per day over the previous reporting period. 84% of all cases (640/764) were reported in Victoria, with a smaller number of cases reported from New South Wales (95), Queensland (22), Western Australia (4) and South Australia (3). In Victoria, 97% of cases (621) were locally acquired and were mostly reported from residential aged care facilities; and 3% of cases (19) were reported as under investigation at the date of extract this reporting period. Excluding Victoria, 124 cases were reported nationally, 32% (40) were overseas acquired; 65% (81) were locally acquired, predominantly in New South Wales (62); and 2% (3) of cases were under investigation at this time, all reported in Queensland. The continued decrease in new cases observed this fortnight in Victoria is likely associated with the enhanced public health measures that are currently in place in Victoria. Locally-acquired cases which were predominantly associated with several interconnected clusters continued to be reported in New South Wales. In Queensland, 82% of cases (18/22) were reported as locally acquired from two clusters associated with immigration centres or correctional facilities. A total of 6 deaths were reported from cases diagnosed in this reporting period-all from Victoria, all aged 50 years or older, three male and three female. Although testing rates have declined gradually over the past month they remain high at 14.5 tests per 1,000 population per week. The overall positivity rate for the reporting period was 0.13%. Victoria reported a positivity rate of 0.39% for this reporting period while in all other jurisdictions the positivity rate was 0.05% or lower. For this report, "In focus" is paediatric inflammatory multisystem syndrome temporally associated with SARS-COV-2 (PIMS-TS). A review of Australia's public health response to COVID-19 (as at 13 September 2020) is at Appendix A.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Síndrome de Respuesta Inflamatoria Sistémica/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Infecciones Asintomáticas , Australia/epidemiología , Betacoronavirus , Niño , Preescolar , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/transmisión , Femenino , Hogares para Ancianos , Hospitalización , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Nueva Gales del Sur/epidemiología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Neumonía Viral/transmisión , Queensland/epidemiología , Australia del Sur/epidemiología , Victoria/epidemiología , Australia Occidental/epidemiología , Adulto Joven
14.
N Z Med J ; 133(1521): 28-39, 2020 09 04.
Artículo en Inglés | MEDLINE | ID: mdl-32994635

RESUMEN

AIMS: There is limited evidence as to how clinical outcomes of COVID-19 including fatality rates may vary by ethnicity. We aim to estimate inequities in infection fatality rates (IFR) in New Zealand by ethnicity. METHODS: We combine existing demographic and health data for ethnic groups in New Zealand with international data on COVID-19 IFR for different age groups. We adjust age-specific IFRs for differences in unmet healthcare need, and comorbidities by ethnicity. We also adjust for life expectancy reflecting evidence that COVID-19 amplifies the existing mortality risk of different groups. RESULTS: The IFR for Maori is estimated to be 50% higher than that of non-Maori, and could be even higher depending on the relative contributions of age and underlying health conditions to mortality risk. CONCLUSIONS: There are likely to be significant inequities in the health burden from COVID-19 in New Zealand by ethnicity. These will be exacerbated by racism within the healthcare system and other inequities not reflected in official data. Highest risk communities include those with elderly populations, and Maori and Pacific communities. These factors should be included in future disease incidence and impact modelling.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/etnología , Grupos Étnicos/estadística & datos numéricos , Disparidades en el Estado de Salud , Esperanza de Vida/etnología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Neumonía Viral/etnología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Infecciones por Coronavirus/mortalidad , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Nueva Zelanda , Pandemias , Neumonía Viral/mortalidad , Tasa de Supervivencia , Adulto Joven
15.
Public Health ; 186: 35-43, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32768622

RESUMEN

OBJECTIVES: Although several studies have examined the gap in healthcare use between indigenous and non-indigenous people, empirical evidence on inequity in healthcare use within indigenous populations is limited. This study aims to fill this gap in the literature by investigating income-related inequity (unequal use for equal need) in healthcare use among indigenous Australians living in non-remote areas. STUDY DESIGN: This is a cross-sectional study. METHODS: This study used data from the Australian Aboriginal and Torres Strait Islander Health Survey, 2012-13. Logistic regression analysis was used to determine the association of income with the probability of a general practitioner (GP) visit, a specialist visit and inpatient admission. The horizontal inequity (HI) index and decomposition analysis were also used to quantify and explain inequity in healthcare use. RESULTS: No consistent association was found between income and the probability of GP visit or inpatient admission after controlling for health need. However, the likelihood of visiting a specialist was about three times (odds ratio = 2.96, P = 0.028) higher for the richest compared with the poorest population subgroups. The inequity index was 0.016 (P < 0.001), indicating a pro-rich inequity for the probability of visiting a specialist. Income inequality, unequal distribution of private health insurance and inequality in education were the main factors explaining the pro-rich inequity in specialist utilisation. CONCLUSIONS: Although there was no income-related inequity in GP visits or inpatient admissions, wealthier indigenous Australians had a higher probability of visiting a specialist than their poorer counterparts, after adjusting for need. Specific policies and initiatives are required to address the inequity faced by low-income indigenous people in Australia.


Asunto(s)
Disparidades en Atención de Salud/estadística & datos numéricos , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Australia/epidemiología , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Renta , Seguro de Salud , Masculino , Persona de Mediana Edad , Pobreza , Factores Socioeconómicos , Adulto Joven
16.
BMC Health Serv Res ; 20(1): 769, 2020 Aug 20.
Artículo en Inglés | MEDLINE | ID: mdl-32819360

RESUMEN

BACKGROUND: Sexually transmissible infection (STI) and blood-borne virus (BBV) diagnoses data are a core component of the Australian National Notifiable Diseases Surveillance System (NNDSS). However, the NNDSS data alone is not enough to understand STI and BBV burden among priority population groups, like Aboriginal and Torres Strait Islander people, because it lacks testing, treatment and management data. Here, we describe the processes involved in establishing a STI and BBV sentinel surveillance network representative of Aboriginal Community-Controlled Health Services (ACCHS)-known as the ATLAS network-to augment the NNDSS and to help us understand the burden of disease due to STI and BBV among Aboriginal and Torres Strait Islander peoples. METHODS: Researchers invited participation from ACCHS in urban, regional and remote areas clustered in five clinical hubs across four Australian jurisdictions. Participation agreements were developed for each clinical hub and individual ACCHS. Deidentified electronic medical record (EMR) data relating to STI and BBV testing, treatment and management are collected passively from each ACCHS via the GRHANITEtm data extraction tool. These data are analysed centrally to inform 12 performance measures which are included in regular surveillance reports generated for each ACCHS and clinical hub. RESULTS: The ATLAS network currently includes 29 ACCHS. Regular reports are provided to ACCHS to assess clinical practice and drive continuous quality improvement initiatives internally. Data is also aggregated at the hub, jurisdictional and national level and will be used to inform clinical guidelines and to guide future research questions. The ATLAS infrastructure can be expanded to include other health services and potentially linked to other data sources using GRHANITE. CONCLUSIONS: The ATLAS network is an established national surveillance network specific to Aboriginal and Torres Strait Islander peoples. The data collected through the ATLAS network augments the NNDSS and will contribute to improved STI and BBV clinical care, guidelines and policy program-planning.


Asunto(s)
/etnología , Redes Comunitarias/organización & administración , Servicios de Salud del Indígena/organización & administración , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Atención Primaria de Salud/organización & administración , Vigilancia de Guardia , Enfermedades de Transmisión Sexual/etnología , Adolescente , Adulto , Australia/epidemiología , Femenino , Humanos , Masculino
17.
Artículo en Inglés | MEDLINE | ID: mdl-32829699

RESUMEN

Confirmed cases in Australia: 12,636 notifications and 147 deaths as at 19 July 2020; during the latest reporting fortnight (6 to 19 July 2020) there have been 3,791 notifications and 37 deaths. The number of new cases reported nationally increased from 897 in the previous fortnight (22 June to 5 July) to 3,791 (6 to 19 July). The large increase in cases is due to multiple epidemiologically-linked outbreaks across a range of settings and locations in Victoria (94%; 3,575 cases), with very few cases reported by other jurisdictions (216) in this reporting period. Of the 3,575 cases reported in Victoria, all except one were reported as locally acquired. The majority of these cases were linked to several outbreaks. Of the 216 cases reported from other jurisdictions, approximately 55% (119 cases) were locally acquired. A total of 37 deaths were reported, all from Victoria. On average, 271 cases were reported each day over the reporting period, an increase from 54 cases per day over the previous reporting period. Testing rates have increased across all jurisdictions, predominantly in Victoria, with the nationwide cumulative positivity rate remaining very low at less than 0.5%. As at 19 July, a small proportion of cases have experienced severe disease, requiring hospitalisation or intensive care, with some fatalities. The cumulative crude case fatality rate amongst Australian cases is 1.2%. People who are older and have one or more comorbidity are more likely to experience severe disease.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Betacoronavirus , Niño , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/fisiopatología , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Mortalidad , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Pandemias , Neumonía Viral/mortalidad , Neumonía Viral/fisiopatología , Índice de Severidad de la Enfermedad , Distribución por Sexo , Victoria/epidemiología , Adulto Joven
18.
Artículo en Inglés | MEDLINE | ID: mdl-32829705

RESUMEN

Confirmed cases in Australia this reporting period (20 July to 2 August): 6,121 notifications, 71 deaths. Cumulative: 18,367 notifications, 240 deaths. Over the past fortnightly reporting period (20 July to 2 August), the number of new cases reported nationally increased from 3,462 in the previous fortnight to 6,121. The large increase in numbers is due to multiple epidemiologically-linked outbreaks across a range of settings and locations in Victoria (97%; 5,914 cases) with very few (207) cases reported by other jurisdictions in this reporting period. Of the 5,914 cases reported in Victoria, all were locally acquired. Of the remaining 207 cases nationally reported, only 23% were reported as locally acquired. ACT is the only jurisdiction reporting 0 cases, with its last case reported on 9 July. A total of 71 deaths were reported, all from Victoria. On average, 437 cases were reported each day over the reporting period, an increase from 247 cases per day over the previous fortnight. Testing rates remain high across all jurisdictions, with an overall positivity rate for the reporting period of 0.7%. Victoria reported a positivity rate of 1.7% for this reporting period; in all other jurisdictions the positivity rate was 0.07% or lower. Overall, syndromic surveillance of respiratory illness trends continues to show very low levels compared to previous years. 12% of cases have required hospitalisation or intensive care.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Betacoronavirus , Niño , Preescolar , Comorbilidad , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/fisiopatología , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Nueva Gales del Sur/epidemiología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Pandemias , Neumonía Viral/mortalidad , Neumonía Viral/fisiopatología , Índice de Severidad de la Enfermedad , Distribución por Sexo , Adulto Joven
20.
Aust N Z J Public Health ; 44(5): 397-403, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32776634

RESUMEN

OBJECTIVE: Smoking is a major cause of preventable illness for Aboriginal and Torres Strait Islander people, with most commencing in adolescence. Understanding trends in youth tobacco use can inform prevention policies and programs. METHODS: Logistic regression models examined smoking trends among Aboriginal and Torres Strait Islander and all students aged 12-17 years, in five nationally representative triennial surveys, 2005-2017. Outcomes measured lifetime, past month, past week tobacco use and number of cigarettes smoked daily (smoking intensity). RESULTS: Aboriginal and Torres Strait Islander students' never smoking increased (2005: 49%, 2017: 70%) with corresponding declines in past month and week smoking. Smoking intensity reduced among current smokers (low intensity increased 2005: 67%, 2017: 77%). Trends over time were similar for Aboriginal and Torres Strait Islander students as for all students (8-10% annual increase in never smoking). CONCLUSIONS: Most Aboriginal and Torres Strait Islander students are now never smokers. Comparable declines indicate similar policy impact for Aboriginal and Torres Strait Islander and all students. Implications for Public Health: Comprehensive population-based tobacco control policies can impact all students. Continued investment, including in communities, is needed to maintain and accelerate reductions among Aboriginal and Torres Strait Islander students to achieve equivalent prevalence rates and reduce health inequities.


Asunto(s)
Grupo de Ascendencia Oceánica/estadística & datos numéricos , Estudiantes/psicología , Fumar Tabaco/tendencias , Adolescente , Australia/epidemiología , Niño , Investigación Participativa Basada en la Comunidad , Femenino , Humanos , Masculino , Grupo de Ascendencia Oceánica/psicología , Estudios Prospectivos , Cese del Hábito de Fumar/estadística & datos numéricos
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