The Lancet Regional Health: Western Pacific最新文献_第3页

To what extent could eliminating racial discrimination reduce inequities in mental health and sleep problems among Aboriginal and Torres Strait Islander children? A causal mediation study 消除种族歧视能在多大程度上减少土著居民和托雷斯海峡岛民儿童在心理健康和睡眠问题上的不平等？因果中介研究

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2024-10-01 DOI: 10.1016/j.lanwpc.2024.101196

Background

Racism is a fundamental cause of health inequities for Aboriginal and Torres Strait Islander children. We estimated the potential reduction in inequities in Aboriginal and Torres Strait Islander children's mental health and sleep problems if interpersonal racial discrimination was eliminated.

Methods

We drew on cross-sectional data from the Speak Out Against Racism (SOAR; N = 2818) and longitudinal data from the Longitudinal Study of Australian Children (LSAC; N = 8627). The SOAR was completed in 2017 and the LSAC followed children from 2004 to 2014 in the kindergarten cohort and from 2008 to 2018 in the birth cohort. Exposure: Aboriginal and Torres Strait Islander status (Aboriginal and Torres Strait Islander/Anglo-European), a proxy measure of structural racism (SOAR: 10–15 years; LSAC: 4–5 years); Mediator: interpersonal racial discrimination (yes/no) (SOAR: 10–15 years; LSAC: 12–13 years); Outcomes: mental health problems (yes/no) and sleep problems (yes/no) (SOAR: 10–15 years; LSAC: 14–15 years). An interventional effects causal mediation approach was used.

Findings

Aboriginal and Torres Strait Islander children had higher prevalence of mental health problems (SOAR: 40.1% versus 13.5%; LSAC: 25.3% versus 7.6%) and sleep problems (SOAR: 28.5% versus 18.4%; LSAC: 14.0% versus 9.9%) than Anglo-European children. Hypothetical interventions eliminating Aboriginal and Torres Strait Islander children's experiences of interpersonal racial discrimination could reduce 42.4% and 48.5% of mental health and sleep inequities in SOAR (equivalent to 11.2% and 4.7% absolute reductions) and 25.6% and 1.6% of mental health and sleep inequities in LSAC (equivalent to 5.5% and 0.1% absolute reductions). Absolute remaining inequities were similar across both studies for both outcomes.

Interpretation

Targeted policy interventions that eliminate racial discrimination against Aboriginal and Torres Strait Islander children could have high potential to reduce inequities in mental health and sleep problems. Addressing racism and racial discrimination needs a multi-component and multi-level approach directed by Aboriginal and Torres Strait Islander communities.

Funding

National Health and Medical Research Council of Australia and Medical Research Future Fund of Australia.

背景种族主义是原住民和托雷斯海峡岛民儿童健康不平等的根本原因。我们估算了如果消除人际间的种族歧视，原住民和托雷斯海峡岛民儿童的心理健康和睡眠问题不平等现象可能会减少的程度。方法我们利用了 "大声反对种族主义"（SOAR；N = 2818）的横断面数据和 "澳大利亚儿童纵向研究"（LSAC；N = 8627）的纵向数据。SOAR于2017年完成，LSAC对2004年至2014年的幼儿园队列儿童和2008年至2018年的出生队列儿童进行了跟踪调查。接触：原住民和托雷斯海峡岛民身份（原住民和托雷斯海峡岛民/英裔欧洲人），结构性种族主义的替代测量（SOAR：10-15年；LSAC：4-5年）；中介：人际种族歧视（是/否）（SOAR：10-15年；LSAC：12-13年）；结果：心理健康问题（是/否）和睡眠问题（是/否）（SOAR：10-15年；LSAC：14-15年）。研究结果与英裔欧洲儿童相比，土著儿童和托雷斯海峡岛民儿童的心理健康问题发生率（SOAR：40.1%对13.5%；LSAC：25.3%对7.6%）和睡眠问题发生率（SOAR：28.5%对18.4%；LSAC：14.0%对9.9%）更高。假设采取干预措施消除原住民和托雷斯海峡岛民儿童遭受人际种族歧视的经历，可分别减少原住民和托雷斯海峡岛民儿童42.4%和48.5%的心理健康和睡眠不公平现象（相当于绝对减少11.2%和4.7%），以及25.6%和1.6%的心理健康和睡眠不公平现象（相当于绝对减少5.5%和0.1%）。在这两项研究中，剩余的绝对不平等在两项结果中都相似。解释有针对性的政策干预，消除对土著居民和托雷斯海峡岛民儿童的种族歧视，很有可能减少心理健康和睡眠问题方面的不平等。解决种族主义和种族歧视问题需要在土著居民和托雷斯海峡岛民社区的指导下采取多成分、多层次的方法。

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引用次数: 0

Efficacy and safety of visepegenatide as an add-on therapy to metformin in patients with type 2 diabetes: a randomised, double-blind, parallel, placebo-controlled, phase 3 study 维塞那肽作为二甲双胍附加疗法对 2 型糖尿病患者的疗效和安全性：一项随机、双盲、平行、安慰剂对照的 3 期研究

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2024-10-01 DOI: 10.1016/j.lanwpc.2024.101197

Background

Visepegenatide, a once-weekly glucagon-like peptide-1 receptor agonist injection, demonstrated effective glycaemic control and good tolerability without the requirement of dose titration in the two completed phase 2 studies. We aimed to evaluate the efficacy and safety of visepegenatide in Chinese patients with type 2 diabetes mellitus (T2DM) inadequately controlled by metformin monotherapy in this phase 3 clinical study.

Methods

This multicentre phase 3 clinical study included a 24-week, randomised, placebo-controlled, double-blind period followed by a 28-week open-label extended treatment period. Patients (N = 620) aged ≥18 and ≤75 years with glycated haemoglobin (HbA_1c) ≥7.0% and ≤10.5% [≥53.0 and ≤91.27 mmol/mol], were randomized in a 1:1 ratio to receive visepegenatide 150-μg or placebo once-weekly subcutaneous injection during the double-blind period. Subsequently, the patients in the placebo group were switched to visepegenatide treatment (placebo→visepegenatide group), and the patients in the visepegenatide group continued the same treatment during the open-label extended treatment period. The primary endpoint was the change in HbA_1c from baseline to week 24.

Findings

At week 24, the placebo-adjusted least squares mean (LSM) change of HbA_1c was −0.57% (95% CI −0.71 to −0.43) with visepegenatide (p < 0.001). The proportion of patients achieving HbA_1c < 7.0% and ≤6.5% [<53 and ≤ 48 mmol/mol] was higher in the visepegenatide group versus the placebo group (115 [40.5%] vs 50 [17.9%]; p < 0.001, and 60 [21.1%] vs 17 [6.1%]; p < 0.001). Visepegenatide demonstrated a significant reduction in fasting plasma glucose and 2-h postprandial glucose compared with placebo. Trends in the improvement of these variables were maintained during the open-label extended treatment period. No severe gastrointestinal adverse event or severe hypoglycaemia was reported during the 52-week study period.

Interpretation

Once-weekly injection of visepegenatide 150 μg as an add-on treatment to metformin therapy significantly improved glycaemic control and was generally well tolerated in Chinese patients with T2DM who were inadequately controlled with metformin monotherapy.

Funding

The study was funded by PegBio Co., Ltd, Suzhou, China.

背景在已完成的两项2期研究中，每周注射一次的胰高血糖素样肽-1受体激动剂维塞那肽显示出有效的血糖控制和良好的耐受性，且无需剂量滴定。这项多中心 3 期临床研究包括 24 周随机、安慰剂对照、双盲期和 28 周开放标签延长治疗期。年龄≥18岁和≤75岁、糖化血红蛋白（HbA1c）≥7.0%和≤10.5%[≥53.0和≤91.27 mmol/mol]的患者（N = 620）按1:1的比例随机分配，在双盲期每周一次皮下注射维塞那肽150微克或安慰剂。随后，安慰剂组患者转为接受维塞庚那肽治疗（安慰剂→维塞庚那肽组），维塞庚那肽组患者在开放标签延长治疗期内继续接受同样的治疗。研究结果第24周时，维塞那肽的安慰剂调整后最小二乘法均值（LSM）变化为-0.57%（95% CI -0.71至-0.43）（p <0.001）。与安慰剂组相比，维塞那肽组达到 HbA1c <7.0%和≤6.5% [<53 和≤48 mmol/mol]的患者比例更高（115 [40.5%] vs 50 [17.9%]；p <0.001；60 [21.1%] vs 17 [6.1%]；p <0.001）。与安慰剂相比，维塞那肽可显著降低空腹血浆葡萄糖和餐后 2 小时血糖。在开放标签延长治疗期间，这些变量的改善趋势得以保持。在为期52周的研究期间，没有严重胃肠道不良事件或严重低血糖的报道。解释作为二甲双胍治疗的附加疗法，每周注射一次150微克的维培那肽可显著改善二甲双胍单药治疗控制不佳的中国T2DM患者的血糖控制，且耐受性良好。

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引用次数: 0

RSV severity in New Zealand 2021 and 2022: applying the WHO severity assessment framework 新西兰 2021 年和 2022 年 RSV 严重程度：应用世界卫生组织严重程度评估框架

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2024-10-01 DOI: 10.1016/j.lanwpc.2024.101221

引用次数: 0

The impact of sodium glucose co-transporter 2 inhibitors and glucagon-like peptide 1 receptor agonists on insulin utilisation and costs in Australia: a national retrospective observational cross-sectional study 钠葡萄糖协同转运体 2 抑制剂和胰高血糖素样肽 1 受体激动剂对澳大利亚胰岛素使用率和成本的影响：一项全国性回顾观察横断面研究

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2024-09-24 DOI: 10.1016/j.lanwpc.2024.101207

Background

Global insulin requirements for type 2 diabetes were predicted to increase by more than 20% from 2018 to 2030. However, this did not anticipate the rapid increase in use of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors that has occurred over recent years. The current study aims to examine changes in insulin utilisation and costs in Australia from 2003 to 2023.

Methods

We conducted a large-scale observational study of national insulin utilisation and expenditure in Australia from 2003 to 2023 using the Australian Pharmaceutical Benefits Scheme. The proportion of insulin-treated people with type 2 diabetes between 2013 and 2023 was estimated using National Diabetes Services Scheme data. Joinpoint models and interrupted time series analysis were used to examine utilisation trends.

Findings

Insulin utilisation (units of insulin per person with diabetes) increased by an average of 2.71% per annum (95% CI 1.97, 3.73) from 2003 to 2015, then fell by 2.70% per annum (95% CI −4.55, −1.39) from 2015 to 2023. The proportion of insulin-treated people with type 2 diabetes increased by 1.00% per annum (95% CI 0.81, 1.25) from 2013 to 2020, then fell by 0.66% per annum (95% CI −1.62, −0.04) from 2020 to 2023. A 43% reduction in inflation-adjusted insulin expenditure was observed between 2015 and 2023 due to a combination of reduced utilisation and reduction in the price of insulin glargine.

Interpretation

Projected global insulin requirements and costs may be less than previously anticipated if reduced use of insulin in Australia is similarly observed in other countries.

Funding

No funding was received for this study.

背景据预测，从 2018 年到 2030 年，全球 2 型糖尿病的胰岛素需求量将增加 20% 以上。然而，这并没有预见到近年来胰高血糖素样肽-1受体激动剂和钠-葡萄糖共转运体2抑制剂使用量的快速增长。本研究旨在探讨 2003 年至 2023 年澳大利亚胰岛素使用情况和成本的变化。方法我们利用澳大利亚药品福利计划，对 2003 年至 2023 年澳大利亚全国胰岛素使用情况和支出进行了大规模观察研究。利用国家糖尿病服务计划数据估算了2013年至2023年接受胰岛素治疗的2型糖尿病患者的比例。研究结果胰岛素使用量（每位糖尿病患者使用胰岛素的单位）从2003年到2015年平均每年增长2.71%（95% CI 1.97，3.73），然后从2015年到2023年每年下降2.70%（95% CI -4.55，-1.39）。从 2013 年到 2020 年，接受胰岛素治疗的 2 型糖尿病患者比例每年增加 1.00%（95% CI 0.81，1.25），然后从 2020 年到 2023 年每年下降 0.66%（95% CI -1.62，-0.04）。由于使用量减少和格列卫胰岛素价格下降，2015 年至 2023 年期间，经通胀调整后的胰岛素支出减少了 43%。释义如果澳大利亚胰岛素使用量的减少在其他国家也出现类似情况，预计全球胰岛素需求量和成本可能会低于之前的预期。

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引用次数: 0

Heterogeneity of colistin resistance mechanism in clonal populations of carbapenem-resistant Klebsiella pneumoniae in Vietnam 越南耐碳青霉烯类肺炎克雷伯氏菌克隆群体对可乐定耐药机制的异质性

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2024-09-23 DOI: 10.1016/j.lanwpc.2024.101204

引用次数: 0

Population attributable fractions of depression and anxiety among Aboriginal and Torres Strait Islander peoples: a population-based study 土著居民和托雷斯海峡岛民中抑郁症和焦虑症的人口可归因比例：一项基于人口的研究

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2024-09-20 DOI: 10.1016/j.lanwpc.2024.101203

Background

Aboriginal and Torres Strait Islander peoples face an increased risk of common mental disorders, which may be associated with underlying socio-economic challenges, racism, and discrimination. This is the first study to calculate the population attributable fractions (PAFs) for depression and anxiety attributed to potentially modifiable risk factors such as health behaviour, social and cultural characteristics, and past adverse events among Aboriginal and Torres Strait Islander peoples aged ≥15 years.

Methods

This cross-sectional study examined the 2018–19 National Aboriginal and Torres Strait Islander Health Survey conducted by the Australian Bureau of Statistics. Logistic regression models were used to compute odds ratios (ORs). PAFs adjusted for communality were calculated using adjusted ORs and prevalence estimates for each risk factor.

Findings

This study included a weighted sample of 5362 individuals, with a mean age of 40.8 years (SD = ±17.2). Personal income below the national average (PAF = 13.4%; 95% CI: 12.4, 14.5), severed access to Indigenous cultural affiliations (PAF = 12.8%; 95% CI: 11.8, 13.8), central obesity (PAF = 7.2%; 95% CI: 6.4, 8.0), daily smoking (PAF = 5.9%; 95% CI: 5.2, 6.7) and severed access to Indigenous knowledge (PAF = 5.2%; 95% CI: 4.5, 5.8) were associated with 45% of depression cases. Personal income below the national average (PAF = 10.7%; 95% CI: 9.8, 11.7), limited access to Aboriginal Community Controlled Health Services (PAF = 10.6%; 95% CI: 9.7, 11.6), central obesity (PAF = 7.1%; 95% CI: 6.3, 7.9), severed access to Indigenous knowledge (PAF = 5.7%; 95% CI: 4.9, 6.4) and the experience of discrimination in the last 12 months (PAF = 4.7%; 95% CI: 4.0, 5.3) were associated with 39% of anxiety cases.

Interpretation

To reduce the burden of depression and anxiety disorder among Aboriginal and Torres Strait Islander peoples, addressing socio-economic and cultural harms that constrain healthy connections to people/kin, their rights, languages, land, and healthy food sources should be a priority.

Funding

This work was funded by a grant from the Commonwealth of Australia, represented by the Department of Health and Aged Care (Grant Activity 4-DGEJZ1O/4-CW7UT14).

背景土著居民和托雷斯海峡岛民罹患常见精神障碍的风险增加，这可能与潜在的社会经济挑战、种族主义和歧视有关。这是第一项计算年龄≥15岁的原住民和托雷斯海峡岛民因健康行为、社会和文化特征以及既往不良事件等潜在可改变风险因素导致的抑郁症和焦虑症人群可归因分数（PAFs）的研究。方法这项横断面研究考察了澳大利亚统计局开展的2018-19年全国原住民和托雷斯海峡岛民健康调查。采用逻辑回归模型计算几率比（ORs）。使用调整后的 ORs 和每个风险因素的患病率估计值计算出根据社区性调整后的 PAFs。个人收入低于全国平均水平（PAF = 13.4%; 95% CI: 12.4, 14.5）、与土著文化的联系被切断（PAF = 12.8%; 95% CI: 11.8, 13.8）、中心性肥胖（PAF = 7.2%; 95% CI: 6.4, 8.0）、每天吸烟（PAF = 5.9%; 95% CI: 5.2, 6.7）和与土著知识断绝联系（PAF = 5.2%; 95% CI: 4.5, 5.8）与 45% 的抑郁症病例有关。个人收入低于全国平均水平（PAF = 10.7%; 95% CI: 9.8, 11.7）、获得原住民社区控制医疗服务的机会有限（PAF = 10.6%; 95% CI: 9.7, 11.6）、中心性肥胖（PAF = 7.1%; 95% CI: 6.3，7.9）、无法获得土著知识（PAF = 5.7%；95% CI：4.9，6.4）和在过去 12 个月中遭受歧视（PAF = 4.7%；95% CI：4.0，5.3）与 39% 的焦虑病例有关。为减轻原住民和托雷斯海峡岛民的抑郁症和焦虑症负担，应优先解决制约与人/亲属、其权利、语言、土地和健康食物来源之间健康联系的社会经济和文化危害。

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引用次数: 0

Widening the lens for pandemic preparedness: children must be seen and heard 扩大防范大流行病的视角：必须看到和听到儿童的声音

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2024-09-18 DOI: 10.1016/j.lanwpc.2024.101205

引用次数: 0

Population-based prevalence of self-reported pediatric diabetes and screening for undiagnosed type 2 diabetes in Chinese children in years 2017–2019, a cross-sectional study 基于人群的2017-2019年中国儿童自我报告的小儿糖尿病患病率及未确诊2型糖尿病筛查的横断面研究

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2024-09-18 DOI: 10.1016/j.lanwpc.2024.101206

Background

The worldwide geographical and temporal variation in the prevalence of diabetes represents a challenge, but also an opportunity for gaining etiological insights. Encompassing the bulk of East Asians, a large and distinct proportion of the world population, China can be a source of valuable epidemiological insights for diabetes, especially in early life, when pathophysiology begins. We carried out a nationwide, epidemiological survey of Prevalence and Risk of Obesity and Diabetes in Youth (PRODY) in China, from 2017 to 2019, to estimate the population-based prevalence of diagnosed pediatric diabetes and screen for undiagnosed pediatric type 2 diabetes (T2D).

Methods

PRODY was a nation-wide, school population-based, cross-sectional, multicenter survey by questionnaire, fasting urine glucose test and simple oral glucose tolerance test (s-OGTT), among a total number of 193,801 general-population children and adolescents (covered a pediatric population of more than 96.8 million), aged 3–18, from twelve provinces across China. The prevalence of the self-reported pediatric diabetes, the proportion of subtypes, the crude prevalence of undiagnosed T2D and prediabetes in general juvenile population and the main risk factors of type 1 (T1D) and type 2 (T2D) diabetes had been analyzed in the study.

Findings

The prevalence of all self-reported pediatric diabetes was estimated at 0.62/1000 (95% CI: 0.51–0.74), with T1D at 0.44/1000 (95% CI: 0.35–0.54) and T2D at 0.18/1000 (95% CI: 0.13–0.25). For undiagnosed T2D, the crude prevalence was almost ten-fold higher, at 1.59/1000, with an estimated extra 28.45/1000 of undiagnosed impaired glucose tolerance (IGT) and 53.74/1000 of undiagnosed impaired fasting glucose (IFG) by s-OGTT screening. Maternal diabetes history is the major risk factors for all subtypes of pediatric diabetes in China.

Interpretation

The PRODY study provides the first population-based estimate of the prevalence of pediatric diabetes China and reveals a magnitude of the problem of undiagnosed pediatric T2D. We propose a practical screening strategy by s-OGTT to address this serious gap.

Funding

The National Key Research and Development Programme of China, Key R&D Program of Zhejiang, the National Natural Science Foundation of China and the Zhejiang Provincial Key Disciplines of Medicine, Key R&D Program Projects in Zhejiang Province.

背景全世界糖尿病发病率的地域和时间差异是一个挑战，但也是获得病因学见解的一个机会。中国是东亚人的聚居地，东亚人在世界人口中占很大的比例，因此，中国可以为糖尿病流行病学研究提供有价值的信息，尤其是在病理生理学开始的生命早期。我们于 2017 年至 2019 年在中国开展了一项全国性的流行病学调查--"青少年肥胖和糖尿病患病率及风险"（Prevalence and Risk of Obesity and Diabetes in Youth，PRODY），以估算已确诊小儿糖尿病的人群患病率，并筛查未确诊的小儿 2 型糖尿病（T2D）。方法PRODY是一项基于学校人群的全国性横断面多中心调查，通过问卷调查、空腹尿糖检测和简易口服葡萄糖耐量试验（s-OGTT）等方法，对来自全国12个省份的193,801名3-18岁普通人群儿童和青少年（覆盖儿科人口超过9,680万）进行了调查。研究分析了自我报告的儿童糖尿病患病率、亚型比例、普通青少年人群中未确诊的 T2D 和糖尿病前期的粗患病率以及 1 型糖尿病（T1D）和 2 型糖尿病（T2D）的主要危险因素。研究结果所有自我报告的儿童糖尿病患病率估计为 0.62/1000 (95% CI: 0.51-0.74)，其中 T1D 为 0.44/1000 (95% CI: 0.35-0.54)，T2D 为 0.18/1000 (95% CI: 0.13-0.25)。就未确诊的 T2D 而言，粗略患病率几乎高出 10 倍，为 1.59/1000，通过 s-OGTT 筛查，估计未确诊的糖耐量受损 (IGT) 和未确诊的空腹血糖受损 (IFG) 分别增加了 28.45/1000 和 53.74/1000。母体糖尿病史是中国所有亚型儿童糖尿病的主要危险因素。解读：PRODY 研究首次基于人群估计了中国儿童糖尿病的患病率，并揭示了未确诊儿童 T2D 问题的严重性。基金资助国家重点研发计划、浙江省重点研发计划、国家自然科学基金、浙江省医学重点学科、浙江省重点研发计划项目。

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引用次数: 0

Demographic disparities in the incidence and case fatality of subarachnoid haemorrhage: an 18-year nationwide study from New Zealand 蛛网膜下腔出血发病率和病死率的人口统计学差异：新西兰一项为期 18 年的全国性研究

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2024-09-17 DOI: 10.1016/j.lanwpc.2024.101199

Background

Although the incidence and case-fatality of subarachnoid haemorrhage (SAH) vary within countries, few countries have reported nationwide rates, especially for multi-ethnic populations. We assessed the nationwide incidence and case-fatality of SAH in New Zealand (NZ) and explored variations by sex, district, ethnicity and time.

Methods

We used administrative health data from the national hospital discharge and cause-of-death collections to identify hospitalised and fatal non-hospitalised aneurysmal SAHs in NZ between 2001 and 2018. For validation, we compared these administrative data to those of two prospective Auckland Regional Community Stroke Studies. We subsequently estimated the incidence and case-fatality of SAH and calculated adjusted rate ratios (RR) with 95% confidence intervals to assess differences between sub-populations.

Findings

Over 78,187,500 cumulative person-years, we identified 5371 SAHs (95% sensitivity and 85% positive predictive values) resulting in an annual age-standardised nationwide incidence of 8.2/100,000. In total, 2452 (46%) patients died within 30 days after SAH. Compared to European/others, Māori had greater incidence (RR = 2.23 (2.08–2.39)) and case-fatality (RR = 1.14 (1.06–1.22)), whereas SAH incidence was also greater in Pacific peoples (RR = 1.40 (1.24–1.59)) but lesser in Asians (RR = 0.79 (0.71–0.89)). By domicile, age-standardised SAH incidence varied between 6.3–11.5/100,000 person-years and case fatality between 40 and 57%. Between 2001 and 2018, the SAH incidence of NZ decreased by 34% and the case fatality by 12%.

Interpretation

Since the incidence and case-fatality of SAH varies considerably between regions and ethnic groups, caution is advised when generalising findings from focused geographical locations for public health planning, especially in multi-ethnic populations.

Funding

NZ Health Research Council.

背景虽然各国蛛网膜下腔出血（SAH）的发病率和病死率不尽相同，但很少有国家报告全国范围内的发病率，尤其是多种族人群的发病率和病死率。我们评估了新西兰（NZ）全国范围内蛛网膜下腔出血（SAH）的发病率和病死率，并探讨了性别、地区、种族和时间上的差异。方法我们利用全国医院出院和死因收集的行政健康数据，确定了2001年至2018年期间新西兰的住院和致命的非住院动脉瘤性SAH。为了进行验证，我们将这些管理数据与两项前瞻性奥克兰地区社区卒中研究的数据进行了比较。随后，我们估算了SAH的发病率和病死率，并计算了调整后的比率比（RR）和95%置信区间，以评估亚人群之间的差异。研究结果在7818.75万累计人年中，我们发现了5371例SAH（95%的敏感性和85%的阳性预测值），全国范围内的年度年龄标准化发病率为8.2/10万。共有 2452 名（46%）患者在 SAH 后 30 天内死亡。与欧洲人/其他人相比，毛利人的发病率（RR = 2.23 (2.08-2.39)）和病死率（RR = 1.14 (1.06-1.22)）更高，而太平洋岛屿族裔的SAH发病率也更高（RR = 1.40 (1.24-1.59)），但亚洲人的发病率较低（RR = 0.79 (0.71-0.89)）。按户籍地划分，年龄标准化SAH发病率介于6.3-11.5/100,000人年之间，病死率介于40%-57%之间。2001年至2018年期间，新西兰的SAH发病率下降了34%，病死率下降了12%。由于不同地区和种族群体的SAH发病率和病死率差异很大，因此在将重点地区的研究结果用于公共卫生规划时，尤其是在多种族人群中，应谨慎行事。

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引用次数: 0

Pathways to healthy ageing in Vanuatu: a qualitative evaluation of national policy priorities 瓦努阿图实现健康老龄化的途径：对国家政策优先事项的定性评估

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2024-09-16 DOI: 10.1016/j.lanwpc.2024.101178

Background

The Pacific Island country of Vanuatu is at the early stages of demographic ageing. The government is yet to develop a strategic approach to optimize the health and wellbeing of older indigenous Vanuatu residents (ni-Vanuatu).

Methods

Using policy mapping and semi-structured interviews with 42 ni-Vanuatu, this research aimed to explore the current policy context surrounding ageing in Vanuatu and the priorities of older adults to inform preliminary steps to develop a national response to healthy ageing. Analyses were grounded in the World Health Organization's Regional Action Plan on Healthy Ageing in the Western Pacific.

Findings

While the national policy context exhibited an indirect commitment to creating an environment conducive to healthy ageing, explicit policy commitments and monitoring indicators were lacking. Older persons reported numerous obstacles to healthy ageing, including financial insecurity, physical and psychological barriers to participation, and lack of community support.

Interpretation

Findings highlighted the need for policymakers and stakeholders to focus preliminary strategic efforts on select components of the Regional Action Plan: evidence generation, advocacy/awareness, financing, community engagement and coordination, and family-centred empowerment. To ensure acceptability and sustainability, it is vital that these leverage existing strengths of traditional community values and the prevailing role of faith and religion in the lives of older ni-Vanuatu.

Funding

This project was funded and supported by the World Health Organization (WHO) Regional Office for the Western Pacific (WPRO). Outcomes reflect the deliberations of authors and research partners.

背景太平洋岛国瓦努阿图正处于人口老龄化的早期阶段。本研究通过对瓦努阿图 42 名老年人进行政策调查和半结构式访谈，旨在探索当前瓦努阿图老龄化的政策背景和老年人的优先事项，为制定国家健康老龄化对策的初步措施提供信息。研究结果虽然瓦努阿图的国家政策背景显示出对创造有利于健康老龄化环境的间接承诺，但缺乏明确的政策承诺和监测指标。研究结果突出表明，决策者和利益攸关方需要将初步战略努力的重点放在《区域行动计划》的选定组成部分上：证据生成、宣传/提高认识、筹资、社区参与和协调，以及以家庭为中心的赋权。为确保可接受性和可持续性，这些内容必须利用传统社区价值观的现有优势以及信仰和宗教在瓦努阿图老年人生活中的普遍作用。成果反映了作者和研究合作伙伴的讨论。

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