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Changing phenotype and disease behaviour of chronic pancreatitis in India: evidence for gene-environment interactions. 印度慢性胰腺炎的改变表型和疾病行为:基因-环境相互作用的证据。
IF 1.9 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2016-10-18 eCollection Date: 2016-01-01 DOI: 10.1017/gheg.2016.13
P K Garg, D Narayana

Background: The idiopathic variety of chronic pancreatitis (CP) in India particularly in Kerala state was earlier called 'tropical pancreatitis' with peculiar features: early age of onset, severe malnutrition, diabetes and poor prognosis. A change in disease phenotype and behaviour has been observed recently.

Objective: To review the changing profile of CP in India and examine its relationship with environmental influences and socio-economic development.

Methods: Relevant studies on CP in India were reviewed along with social and economic parameters in Kerala over the past 4 decades.

Results: There has been a definite change in the phenotype of CP in India with onset in mid twenties, better nutritional status, and a much better prognosis compared with the reports in 1970s. Genetic susceptibility due to genetic mutations particularly in SPINK1, CFTR, CTRC, and CLDN2/MORC4 genes is the most important factor and not malnutrition or dietary toxins for idiopathic CP suggesting the term 'tropical pancreatitis' is a misnomer. We observed a close relationship between socio-economic development and rising income in Kerala with late onset of disease, nutritional status, and better prognosis of CP.

Conclusion: Changing profile of CP in India and better understanding of risk factors provide evidence for gene-environmental interactions in its pathobiology.

背景:印度特别是喀拉拉邦的特发性慢性胰腺炎(CP)早期被称为“热带胰腺炎”,具有特殊的特征:发病年龄早、严重营养不良、糖尿病和预后差。最近观察到疾病表型和行为的变化。目的:回顾印度CP的变化概况,并探讨其与环境影响和社会经济发展的关系。方法:结合喀拉拉邦近40年来的社会经济指标,对印度CP的相关研究进行综述。结果:与20世纪70年代的报道相比,印度CP的表型发生了明显的变化,发病年龄在20岁左右,营养状况更好,预后也更好。由于基因突变,特别是SPINK1、CFTR、CTRC和CLDN2/MORC4基因的遗传易感性是特发性CP的最重要因素,而不是营养不良或饮食毒素,这表明“热带胰腺炎”一词是用词不当。我们观察到喀拉拉邦的社会经济发展和收入增加与CP的发病晚、营养状况和预后良好密切相关。结论:印度CP的变化和对危险因素的更好了解为其病理生物学中的基因-环境相互作用提供了证据。
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引用次数: 7
Health insurance drop-out among adult population: findings from a study in a Health and demographic surveillance system in Northern Vietnam 2006-2013. 成年人口健康保险退出:2006-2013年越南北部健康和人口监测系统研究结果。
IF 1.9 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2016-10-14 eCollection Date: 2016-01-01 DOI: 10.1017/gheg.2016.14
Hoang Van Minh, Tran Quynh Anh, Nguyen Thi Thuy Nga

The coverage of health insurance as measured by enrollment rates has increased significantly in Vietnam. However, maintaining health insurance to the some groups such as the farmer, the borderline poor and informal workers, etc. has been very challenging. This paper examines the situation of health insurance drop-out among the adult population in sub-rural areas of Northern Vietnam from 2006 to 2013, and analyzes several socio-economic correlates of the health insurance drop-out situation. Data used in this paper were obtained from Health and Demographic Surveillance System located in Chi Linh district, an urbanizing area, in a northern province of Vietnam. Descriptive analyses were used to describe the level and distribution of the health insurance drop-out status. Multiple logistic regressions were used to assess associations between the health insurance drop-out status and the independent variables. A total of 32 561 adults were investigated. We found that the cumulative percentage of health insurance drop-out among the study participants was 21.2%. Health insurance drop-out rates were higher among younger age groups, people with lower education, and those who worked as small trader and other informal jobs, and belonged to the non-poor households. Given the findings, further attention toward health insurance among these special populations is needed.

以登记率衡量的医疗保险覆盖范围在越南显著增加。然而,向农民、边缘穷人和非正规工人等群体提供医疗保险是一项非常具有挑战性的工作。本文研究了2006年至2013年越南北部农村地区成人健康保险退出情况,并分析了健康保险退出情况的几个社会经济相关因素。本文使用的数据来自位于越南北部省份的城市化地区芝林区的健康和人口监测系统。描述性分析用于描述健康保险退出状况的水平和分布。采用多元逻辑回归评估健康保险退出状况与自变量之间的关联。共有32 561名成年人接受了调查。我们发现,在研究参与者中,健康保险退出的累积百分比为21.2%。在较年轻的年龄组、受教育程度较低的人、从事小商贩和其他非正式工作的人以及属于非贫困家庭的人中,医疗保险退出率较高。鉴于这些发现,需要进一步关注这些特殊人群的健康保险。
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引用次数: 9
The potential and value of epidemiology in curbing non-communicable diseases. 流行病学在遏制非传染性疾病方面的潜力和价值。
IF 1.9 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2016-09-09 eCollection Date: 2016-01-01 DOI: 10.1017/gheg.2016.10
A Patel, R Webster

Non-communicable diseases (NCDs) have reached pandemic levels globally and pose a major threat to social and economic development worldwide. The discipline of epidemiology has done much to bring this issue to the forefront of global health. Epidemiological approaches have broadened our understanding of the impact of NCDs in widening socioeconomic disparities. Over a number of decades, this discipline has also contributed to the development of many preventive measures and treatments of known efficacy and safety. However, epidemiology also has a critical role to play in better translating these discoveries into practice, through the new science of implementation. As we strive to achieve the "25 by 25" goal of a 25% reduction in premature mortality from common NCDs by 2025, the discipline of epidemiology will need to continuously evolve to remain an essential tool for public health action.

非传染性疾病(NCDs)在全球范围内已达到流行病的程度,对全世界的社会和经济发展构成重大威胁。流行病学学科为将这一问题推向全球卫生的前沿做了大量工作。流行病学方法拓宽了我们对非传染性疾病在扩大社会经济差距方面影响的认识。几十年来,这门学科还促进了许多已知疗效和安全性的预防措施和治疗方法的发展。然而,在通过新的实施科学将这些发现更好地转化为实践方面,流行病学也可以发挥关键作用。在我们努力实现到 2025 年将常见非传染性疾病的过早死亡率降低 25% 的 "25 by 25 "目标时,流行病学学科需要不断发展,以继续成为公共卫生行动的重要工具。
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引用次数: 0
Responding to health inequities: Indigenous health system innovations. 应对卫生不平等:土著卫生系统创新。
IF 1.9 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2016-08-22 eCollection Date: 2016-01-01 DOI: 10.1017/gheg.2016.12
J G Lavoie, D Kornelsen, L Wylie, J Mignone, J Dwyer, Y Boyer, A Boulton, K O'Donnell

Over the past decades, Indigenous communities around the world have become more vocal and mobilized to address the health inequities they experience. Many Indigenous communities we work with in Canada, Australia, Latin America, the USA, New Zealand and to a lesser extent Scandinavia have developed their own culturally-informed services, focusing on the needs of their own community members. This paper discusses Indigenous healthcare innovations from an international perspective, and showcases Indigenous health system innovations that emerged in Canada (the First Nation Health Authority) and Colombia (Anas Wayúu). These case studies serve as examples of Indigenous-led innovations that might serve as models to other communities. The analysis we present suggests that when opportunities arise, Indigenous communities can and will mobilize to develop Indigenous-led primary healthcare services that are well managed and effective at addressing health inequities. Sustainable funding and supportive policy frameworks that are harmonized across international, national and local levels are required for these organizations to achieve their full potential. In conclusion, this paper demonstrates the value of supporting Indigenous health system innovations.

在过去的几十年里,世界各地的原住民社区为解决他们在健康方面遇到的不平等问题而发出了更多的声音,也动员了更多的力量。在加拿大、澳大利亚、拉丁美洲、美国、新西兰以及斯堪的纳维亚半岛,我们与之合作的许多原住民社区都发展了自己的文化服务,重点关注本社区成员的需求。本文从国际视角讨论了土著医疗保健创新,并展示了加拿大(第一民族卫生局)和哥伦比亚(Anas Wayúu)出现的土著医疗系统创新。这些案例研究是原住民主导创新的范例,可为其他社区提供借鉴。我们所做的分析表明,当机会出现时,土著社区能够并且将会动员起来,发展由土著人主导的初级医疗保健服务,这些服务管理完善,能够有效解决健康不平等问题。这些组织要充分发挥其潜力,就需要国际、国家和地方各级协调一致的可持续资金和支持性政策框架。总之,本文证明了支持土著医疗系统创新的价值。
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引用次数: 0
Evolving perspectives on broad consent for genomics research and biobanking in Africa. Report of the Second H3Africa Ethics Consultation Meeting, 11 May 2015. 关于非洲基因组学研究和生物银行广泛同意的不断演变的观点。第二届h3非洲伦理磋商会报告,2015年5月11日。
IF 1.9 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2016-07-25 eCollection Date: 2016-01-01 DOI: 10.1017/gheg.2016.5
J de Vries, K Littler, A Matimba, S McCurdy, O Ouwe Missi Oukem-Boyer, J Seeley, P Tindana

A report on the Second H3Africa Ethics Consultation Meeting, which was held in Livingstone, Zambia on 11 May 2015. The meeting demonstrated considerable evolution by African Research Ethics Committees on thinking about broad consent as a consent option for genomics research and biobanking. The meeting concluded with a call for broader engagement with policy makers across the continent in order to help these recognise the need for guidance and regulation where these do not exist and to explore harmonisation where appropriate and possible.

2015年5月11日在赞比亚利文斯通举行的第二届h3非洲伦理咨询会议报告。这次会议表明,非洲研究伦理委员会在考虑将广泛同意作为基因组学研究和生物银行的同意选项方面取得了相当大的进展。会议最后呼吁与整个欧洲大陆的政策制定者进行更广泛的接触,以帮助他们认识到,在没有指导和监管的地方,需要有指导和监管,并在适当和可能的情况下探索协调。
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引用次数: 8
Sustainable development goals, universal health coverage and equity in health systems: the Orang Asli commons approach. 可持续发展目标、全民健康覆盖和卫生系统公平:土著人民共同做法。
IF 1.9 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2016-07-11 eCollection Date: 2016-01-01 DOI: 10.1017/gheg.2016.8
Y S Wong, P Allotey, D D Reidpath

Universal health coverage is a key health target in the Sustainable Development Goals (SDGs) that has the means to link equitable social and economic development. As a concept firmly based on equity, it is widely accepted at international and national levels as important for populations to attain 'health for all' especially for marginalised groups. However, implementing universal coverage has been fraught with challenges and the increasing privatisation of health care provision adds to the challenge because it is being implemented in a health system that rests on a property regime that promotes inequality. This paper asks the question, 'What does an equitable health system look like?' rather than the usual 'How do you make the existing health system more equitable?' Using an ethnographic approach, the authors explored via interviews, focus group discussions and participant observation a health system that uses the commons approach such as which exists with indigenous peoples and found features that helped make the system intrinsically equitable. Based on these features, the paper proposes an alternative basis to organise universal health coverage that will better ensure equity in health systems and ultimately contribute to meeting the SDGs.

全民健康覆盖是可持续发展目标中的一项关键卫生具体目标,具有将公平的社会发展和经济发展联系起来的手段。作为一个坚定地以公平为基础的概念,它在国际和国家各级被广泛接受,因为它对人口特别是边缘群体实现"人人享有健康"很重要。然而,实现全民覆盖一直充满挑战,医疗保健服务日益私有化也增加了这一挑战,因为它是在一个建立在助长不平等的财产制度基础上的卫生系统中实施的。这篇论文提出了这样一个问题:“一个公平的卫生系统是什么样子的?”而不是通常的“如何使现有的卫生系统更加公平?”作者使用人种学方法,通过访谈、焦点小组讨论和参与者观察探索了一个使用公地方法(例如存在于土著人民中的方法)的卫生系统,并发现了有助于使该系统本质上公平的特征。基于这些特点,本文提出了组织全民健康覆盖的替代基础,这将更好地确保卫生系统的公平性,并最终有助于实现可持续发展目标。
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引用次数: 14
An Australian model of the First 1000 Days: an Indigenous-led process to turn an international initiative into an early-life strategy benefiting indigenous families. 第一个1000天的澳大利亚模式:由土著居民主导的进程,将国际倡议转变为有利于土著家庭的早期生活战略。
IF 1.9 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2016-06-27 eCollection Date: 2016-01-01 DOI: 10.1017/gheg.2016.7
R Ritte, S Panozzo, L Johnston, J Agerholm, S E Kvernmo, K Rowley, K Arabena

Internationally, the 1000 days movement calls for action and investment in improving nutrition for the period from a child's conception to their second birthday, thereby providing an organising framework for early-life interventions. To ensure Australian Indigenous families benefit from this 1000 days framework, an Indigenous-led year-long engagement process was undertaken linking early-life researchers, research institutions, policy-makers, professional associations and human rights activists with Australian Indigenous organisations and families. The resultant model, First 1000 Days Australia, broadened the international concept beyond improving nutrition. The First 1000 Days Australia model was built by adhering to Indigenous methodologies, a recognition of the centrality of culture that reinforces and strengthens families, and uses a holistic view of health and wellbeing. The First 1000 Days Australia was developed under the auspice of Indigenous people's leadership using a collective impact framework. As such, the model emphasises Indigenous leadership, mutual trust and solidarity to achieve early-life equity.

在国际上,1000天运动呼吁采取行动和投资,改善从儿童怀孕到两岁生日这一时期的营养,从而为早期生命干预提供一个组织框架。为了确保澳大利亚土著家庭从这1000天框架中受益,开展了由土著主导的为期一年的参与进程,将早期生活研究人员、研究机构、政策制定者、专业协会和人权活动家与澳大利亚土著组织和家庭联系起来。由此产生的“澳大利亚第一个1000天”模式将国际概念拓展到了改善营养之外。澳大利亚的第一个1000天模式是通过坚持土著方法,承认文化的中心地位,加强和巩固家庭,并采用健康和福祉的整体观点来建立的。澳大利亚的第一个1000天是在土著人民的领导下利用集体影响框架制定的。因此,该模式强调土著领导、相互信任和团结,以实现早期生活公平。
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引用次数: 21
Women and global health: a personal view. 妇女与全球健康:个人观点。
IF 1.9 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2016-06-15 eCollection Date: 2016-01-01 DOI: 10.1017/gheg.2016.6
J A Whitworth
Women have been recognised as playing a central role in global health over millennia. Hygieia in both Greek and Roman mythology was the goddess of good health, cleanliness and sanitation, and her sisters Panacea, Acesco and Laso were goddesses of remedy, healing and recuperation, respectively. Florence Nightingale became a cult figure during the Crimean War and was a key figure in social reforms designed to improve health care across all levels of society. She is credited as the founder of modern nursing. More recently, a few women have made it to the top in global health, e.g. at international level Gro Harlem Bruntland and now Margaret Chan as Directors General of WHO, and at national level Dame Sally Davies as Chief Medical Officer of the UK (I was the Australian equivalent in the late nineties).
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引用次数: 4
Is there a role of pharmacogenomics in Africa. 药物基因组学在非洲有作用吗?
IF 1.9 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2016-05-27 eCollection Date: 2016-01-01 DOI: 10.1017/gheg.2016.4
A Matimba, M Dhoro, C Dandara

Pharmacogenomics has the potential of transforming clinical research and improving healthcare in sub-Saharan Africa (SSA). The role of African genome diversity and the opportunities for pharmacogenomics research are highlighted and will enable discovery of novel genetic mechanisms and validation of established markers. African genomics and biobank consortia will play an important role in building capacity for pharmacogenomics in SSA.

药物基因组学具有改变撒哈拉以南非洲(SSA)临床研究和改善医疗保健的潜力。会议强调了非洲基因组多样性的作用和药物基因组学研究的机会,并将有助于发现新的遗传机制和验证已建立的标记。非洲基因组学和生物库联盟将在非洲南部地区药物基因组学能力建设中发挥重要作用。
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引用次数: 8
Excess cost burden of diabetes in Southern India: a clinic-based, comparative cost-of-illness study. 印度南部糖尿病的过度成本负担:一项基于临床的疾病成本比较研究。
IF 1.9 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2016-05-13 eCollection Date: 2016-01-01 DOI: 10.1017/gheg.2016.2
K M Sharma, H Ranjani, A Zabetian, M Datta, M Deepa, C R Anand Moses, K M V Narayan, V Mohan, M K Ali

Background: There are few data on excess direct and indirect costs of diabetes in India and limited data on rural costs of diabetes. We aimed to further explore these aspects of diabetes burdens using a clinic-based, comparative cost-of-illness study.

Methods: Persons with diabetes (n = 606) were recruited from government, private, and rural clinics and compared to persons without diabetes matched for age, sex, and socioeconomic status (n = 356). We used interviewer-administered questionnaires to estimate direct costs (outpatient, inpatient, medication, laboratory, and procedures) and indirect costs [absence from (absenteeism) or low productivity at (presenteeism) work]. Excess costs were calculated as the difference between costs reported by persons with and without diabetes and compared across settings. Regression analyses were used to separately identify factors associated with total direct and indirect costs.

Results: Annual excess direct costs were highest amongst private clinic attendees (INR 19 552, US$425) and lowest amongst government clinic attendees (INR 1204, US$26.17). Private clinic attendees had the lowest excess absenteeism (2.36 work days/year) and highest presenteeism (0.06 work days/year) due to diabetes. Government clinic attendees reported the highest absenteeism (7.48 work days/year) and lowest presenteeism (-0.31 work days/year). Ten additional years of diabetes duration was associated with 11% higher direct costs (p < 0.001). Older age (p = 0.02) and longer duration of diabetes (p < 0.001) were associated with higher total lost work days.

Conclusions: Excess health expenditures and lost productivity amongst individuals with diabetes are substantial and different across care settings. Innovative solutions are needed to cope with diabetes and its associated cost burdens in India.

背景:关于印度糖尿病的直接和间接成本的数据很少,关于农村糖尿病成本的数据也很有限。我们的目的是通过一项基于临床的比较疾病成本研究来进一步探讨糖尿病负担的这些方面。方法:从政府、私人和农村诊所招募糖尿病患者(n = 606),并将其与年龄、性别和社会经济地位相匹配的非糖尿病患者(n = 356)进行比较。我们使用访谈者管理的问卷来估计直接成本(门诊、住院、药物、实验室和程序)和间接成本(缺勤或工作效率低下)。超额费用计算为糖尿病患者和非糖尿病患者报告的费用之间的差异,并在不同情况下进行比较。使用回归分析分别确定与总直接和间接成本相关的因素。结果:私人诊所患者的年度超额直接成本最高(19,552印度卢比,425美元),政府诊所患者的年度超额直接成本最低(1204印度卢比,26.17美元)。私人诊所的患者因糖尿病而旷工最少(2.36个工作日/年),出勤最多(0.06个工作日/年)。政府诊所的出勤率最高(7.48个工作日/年),出勤率最低(-0.31个工作日/年)。糖尿病病程增加10年,直接成本增加11% (p p = 0.02),糖尿病病程延长(p结论:糖尿病患者的过度医疗支出和生产力损失是实质性的,并且在不同的护理环境中存在差异。印度需要创新的解决方案来应对糖尿病及其相关的成本负担。
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引用次数: 17
期刊
Global Health Epidemiology and Genomics
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