Changing patterns of mortality and hospitalized morbidity on the Navajo Indian Reservation.

This is the final report from the Navajo Area Indian Health Service (IHS) on mortality patterns and hospitalized morbidity on the Navajo Indian Reservation. The primary purpose of the study was to document changing causal patterns of morbidity and mortality of the Navajo in order to apprise the IHS of the types of services that are currently most needed, and of needs which may be projected in the near future. The data presented in this study was derived from three sources. The first came from the hospital discharge records of all Navajo patients seen in the IHS and IHS contract hospitals in the IHS Navajo, Phoenix, and Albuquerque Areas from 1972 to 1978. The second data set was population estimates of Navajos residing in different land management districts on the Reservation in 1975. The third set was economic data gathered from a random sample of households from each management district in 1974. The descriptive details of mortality and morbidity are presented in charts and graphic representations. The socioeconomic data were analyzed through multiple stepwise regression, and are presented in a set of regression tables. Relevant comparative and historic demographic data were drawn from the literature and presented in a series of charts and tables. The major findings of the study are as follows: 1) Navajo children\u27s physical health has improved since 1955; 2) the health of elderly patients has declined; 3) preceding observations may be explained as much by changing family, social, and economic patterns, as by any changes in the administration of Indian health care; 4) the incidences of infectious diseases has declined; 5) the instances of accidental death and injury, and mental health related problems have increased; 6) socioeconomic factors impact upon the Navajos in causal terms for most categories of disease or accident; and 7) these same factors affect the Navajo\u27s ability or inability to make themselves available to services. The authors suggest that services be expanded to provide care to the chronically ill and elderly both at home and in nursing homes. In addition, they recommend that IHS prepare to manage programs designed to provide services to children with behavioral, learning, and emotional problems. These children may be referred by families or the schools, which would require institutional linkages and community education programs. The report concludes by suggesting that the development of large scale extractive industries on the reservation increases the opportunity for occupational and environmental hazards, which may have direct impact on the health of the population

Dual Use of Veterans Health Administration and Indian Health Service: Healthcare Provider and Patient Perspectives

Many American Indian and Alaska Native veterans are eligible for healthcare from Veterans Health Administration (VHA) and from Indian Health Service (IHS). These organizations executed a Memorandum of Understanding in 2003 to share resources, but little was known about how they collaborated to deliver healthcare. To describe dual use from the stakeholders’ perspectives, including incentives that encourage cross-use, which organization’s primary care is “primary,” and the potential problems and opportunities for care coordination across VHA and IHS. VHA healthcare staff, IHS healthcare staff and American Indian and Alaska Native veterans. Focus groups were conducted using a semi-structured guide. A software-assisted text analysis was performed using grounded theory to develop analytic categories. Dual use was driven by variation in institutional resources, leading patients to actively manage health-seeking behaviors and IHS providers to make ad hoc recommendations for veterans to seek care at VHA. IHS was the “primary” primary care for dual users. There was little coordination between VHA and IHS resulting in delays and treatment conflicts, but all stakeholder groups welcomed future collaboration. Fostering closer alignment between VHA and IHS would reduce care fragmentation and improve accountability for patient care

The State Socialist Mortality Syndrome

Death rates for working-age men in European state socialist countries deviated from general improvements in survival observed in the rest of Europe during the 20th century. The magnitude of structural labor force changes across countries correlates with lagged increases in death rates for men in the working ages. This pattern is consistent with a hypothesis that hyper-development of heavy industry and stagnation (even contraction) of the service sector created anomic conditions leading to unhealthy lifestyles and self-destructive behavior among men moving from primary-sector to secondary-sector occupations. Occupational contrasts within countries similarly show concentration of rising male death rates among blue collar workers. Collapse of state socialist systems produced rapid corrections in labor force structure after 1990, again correlated with a fading of the state socialist mortality syndrome in following decades

Are hygiene and public health interventions likely to improve outcomes for Australian Aboriginal children living in remote communities? A systematic review of the literature

Background Australian Aboriginal children living in remote communities still experience a high burden of common infectious diseases which are generally attributed to poor hygiene and unsanitary living conditions. The objective of this systematic literature review was to examine the epidemiological evidence for a relationship between various hygiene and public health intervention strategies, separately or in combination, and the occurrence of common preventable childhood infectious diseases. The purpose was to determine what intervention/s might most effectively reduce the incidence of skin, diarrhoeal and infectious diseases experienced by children living in remote Indigenous communities. Methods Studies were identified through systematically searching electronic databases and hand searching. Study types were restricted to those included in Cochrane Collaboration Effective Practice and Organisation of Care Review Group (EPOC) guidelines and reviewers assessed the quality of studies and extracted data using the same guidelines. The types of participants eligible were Indigenous populations and populations of developing countries. The types of intervention eligible for inclusion were restricted to those likely to prevent conditions caused by poor personal hygiene and poor living environments. Results The evidence showed that there is clear and strong evidence of effect of education and handwashing with soap in preventing diarrhoeal disease among children (consistent effect in four studies). In the largest well-designed study, children living in households that received plain soap and encouragement to wash their hands had a 53% lower incidence of diarrhoea (95% CI, 0.35, 0.59). There is some evidence of an effect of education and other hygiene behaviour change interventions (six studies), as well as the provision of water supply, sanitation and hygiene education (two studies) on reducing rates of diarrhoeal disease. The size of these effects is small and the quality of the studies generally poor. Conclusion Research which measures the effectiveness of hygiene interventions is complex and difficult to implement. Multifaceted interventions (which target handwashing with soap and include water, sanitation and hygiene promotion) are likely to provide the greatest opportunity to improve child health outcomes in remote Indigenous communities

Socioeconomic disadvantage in childhood as a predictor of excessive gestational weight gain and obesity in midlife adulthood

BACKGROUND: Lower childhood socioeconomic position is associated with greater risk of adult obesity among women, but not men. Pregnancy-related weight changes may contribute to this gender difference. The objectives of this study were to determine the associations between: 1. childhood socioeconomic disadvantage and midlife obesity; 2. excessive gestational weight gain (GWG) and midlife obesity; and 3. childhood socioeconomic disadvantage and excessive GWG, among a representative sample of childbearing women. METHODS: We constructed marginal structural models for seven measures of childhood socioeconomic position for 4780 parous women in the United States, using National Longitudinal Survey of Youth (1979–2010) data. Institute of Medicine definitions were used for excessive GWG; body mass index ≥30 at age 40 defined midlife obesity. Analyses were separated by race/ethnicity. Additionally, we estimated controlled direct effects of childhood socioeconomic disadvantage on midlife obesity under a condition of never gaining excessively in pregnancy. RESULTS: Low parental education, but not other measures of childhood disadvantage, was associated with greater midlife obesity among non-black non-Hispanic women. Among black and Hispanic mothers, childhood socioeconomic disadvantage was not consistently associated with midlife obesity. Excessive GWG was associated with greater midlife obesity in all racial/ethnic groups. Childhood socioeconomic disadvantage was not statistically significantly associated with excessive GWG in any group. Controlled direct effects were not consistently weaker than total effects. CONCLUSIONS: Childhood socioeconomic disadvantage was associated with adult obesity, but not with excessive gestational weight gain, and only for certain disadvantage measures among non-black non-Hispanic mothers. Prevention of excessive GWG may benefit all groups through reducing obesity, but excessive GWG does not appear to serve as a mediator between childhood socioeconomic position and adult obesity in women

The Doctrine of Specific Etiology

Modern medicine is often said to have originated with nineteenth century germ theory, which attributed diseases to bacterial contagions. The success of this theory is often associated with an underlying principle referred to as the “doctrine of specific etiology.” This doctrine refers to specificity at the level of disease causation or etiology. While the importance of this doctrine is frequently emphasized in the philosophical, historical, and medical literature, these sources lack a clear account of the types of specificity that it involves and why exactly they matter. This paper argues that the nineteenth century germ theory model involves two types of specificity at the level of etiology. One type receives significant attention in the literature, but its influence on modern medicine has been misunderstood. A second type is present in this model, but it has been completely overlooked in the extant literature. My analysis clarifies how these types of specificity led to a novel conception of etiology that continues to figure in medicine today

Determinants of Infant Mortality in Older ASEAN Economies

Infant mortality in the Association of Southeast Asian Nations (ASEAN) has been declining, yet disparities remain between the nations. This paper therefore explores the determinants of infant mortality in the older ASEAN-4 economies, Malaysia, Thailand, Indonesia and the Philippines using an Autoregressive Distributed Lag (ARDL) Error Correction Model framework. The key findings of the study are: First, there is evidence of long-run relationships among infant mortality, education, female fertility, income and access to healthcare. Second, the determinants of infant mortality vary between countries. Female fertility emerged as the main determinant of infant mortality in Malaysia, while access to healthcare matter for infant mortality in Indonesia, and to a lesser extent for the Philippines. The income effect is significant for reducing infant mortality in Malaysia, while female education is important for Indonesia and Thailand. Third, the speed of adjustment of infant mortality rate is comparatively low in ASEAN-4