Indigenous people across the globe have generally had suboptimal access to quality medical care and effective prevention programs. The available programs that existed have generally been poorly funded and have primarily focussed on infectious diseases. More recent trends denoting significant rising morbidity and mortality of chronic diseases have brought some limited medical focus on cardiovascular diseases, their risk factors and their prevention. However, there is a growing body of evidence-published and unpublished-of developed and developing successful programs to provide culturally appropriate and sensitive treatment for cardiovascular diseases and prevention. Within this report, we aim to describe some of these programs in order to understand common approaches and links that make them successful. Once this survey is completed, a template for successful CVD programs can be created for the development of future programs.
We used several methods to gather information about successful Indigenous CVD programs: Pub Med search (keywords: Indigenous, native, First Nation, Aboriginal, cardiovascular, cardiac, etc.), online searches of government-based health programs (World Health Organization, Centers for Disease Control, etc.) and non-government health programs (World Heart Federation, Bill & Melinda Gates Foundation, etc.), and, importantly, personal communication with multiple thought leaders and program directors in the field of international CVD treatment and prevention.
Programs can be divided into: (1) epidemiologic programs, which focus on data collection, (2) focussed prevention programs and population approach to CVD prevention, and (3) clinical prevention and intervention programs.
Common themes that define successful Indigenous CVD programs include: dedicated focus on the Indigenous population, widespread community involvement within the Indigenous population, often through the use of Indigenous community health workers, a focus on high-risk individuals within the population and regularly scheduled contact between the program and participants. We recommend that these themes are incorporated during development of future CVD programs for Indigenous people.
The relevance of the study on the Gydansky Peninsula lies in poor knowledge and inaccessibility of the territory, planned intensive industrial development of the Gydansky Peninsula, in 2011 there were received licenses for the exploration of license areas at the peninsula up to 2031. Industrial development will inevitably lead to certain environmental shifts, emission of the harmful substances into biosphere, the accumulation of anthropogenic pollutants in soil and water sources. The proposed development of the territory of the Peninsula Gydan sets the task of assessment of the impact of gas and oil production in conditions of the far North on health, as well indigenous persons as employees recruited to this of the region. One of the informative approaches to the assessment of population health is the assessment of the cytogenetic status with the use of noninvasive analysis of buccal epithelium. The aim of the study is to determine the cytogenetic status of the inhabitants of the village of Antipayuta of the Yamal-Nenets Autonomous Okrug for the assessment of the impact of environmental factors on the health of the population at the present stage of the industrial development of the territory. Samples of buccal epithelium of 81 alien and indigenous people of the Yamal-Nenets Autonomous district were the object of the investigation. There was performed the analysis of indices of cells of buccal epithelium of the residents living in the village in comparison with the control group. The analysis of samples was performed on a Nikon Eclipse E100 microscope. For the assessment of the cytogenetic status of the individual there was used the proposed by Sycheva L. P. (2012-Index of accumulation of cytogenetic damages (Iac). It is shown that the frequency of occurrence of micronucleus and nuclear protrusions does not exceed the performance of the control group. The index of accumulation of cytogenetic damage for the population of the village is 0.78±0.07% and corresponds to a low level. The analysis of indices of buccal epithelial cells of residents living in rural areas was performed in the comparison with the control group The prevalence rate of cells with micronuclei and protrusions were shown to account of 14.6% andfail to exceed indices in the control group. Accumulation index of cytogenetic damages for the village population is 0.78 ± 0.07 % and corresponds to the low level. The amount of cells with micronuclei and protrusions in the current study is by 14.6% lower than the average of the control group. The intensity of proliferative processes and apoptosis in the comparison groups occurs evenly.
Alaska Division of Public Health, Section of Epidemiology, 3601 C St, Ste 540, PO Box 240249 Anchorage, AK 99524-0249, USA. scott_arnold@health.state.ak.us
Source
American Journal of Public Health. 2005 Mar;95(3):393-397
National fish consumption advisories that are based solely on assessment of risk of exposure to contaminants without consideration of consumption benefits result in overly restrictive advice that discourages eating fish even in areas where such advice is unwarranted. In fact, generic fish advisories may have adverse public health consequences because of decreased fish consumption and substitution of foods that are less healthy. Public health is on the threshold of a new era for determining actual exposures to environmental contaminants, owing to technological advances in analytical chemistry. It is now possible to target fish consumption advice to specific at-risk populations by evaluating individual contaminant exposures and health risk factors. Because of the current epidemic of nutritionally linked disease, such as obesity, diabetes, and cardiovascular disease, general recommendations for limiting fish consumption are ill conceived and potentially dangerous.
Notes
Comment In: American Journal of Public Health. 2005 Aug;95(8):1304; author reply 1304-1305
Centre for Research in Health and Social Care, Institute of Health and Social Care, Anglia Polytechnic University, Chelmsford CM1 1SQ. ddebell@compuserve.com
Norwegian surgeons provide for a wide range of modern surgical services with excellent results. With a thriving economy and a high standard of living and education, the major disease spectrum relates to cancer and cardiovascular diseases. Almost all types of surgery are performed in Norway. Improvements have been achieved through national programs and population-based registries have served as instrumental tools (eg, for cancer surgery). About 1 in every 5 general surgeons holds a PhD degree, with an even greater number for some subspecialties (30%-40% have PhD degrees). Trauma and acute care surgery is not a formal specialty, but a formal trauma system is likely to be established in the near future. Ring-fencing of elective surgical tasks from emergency surgery is increasingly being performed in surgical departments. Governmental coverage (85% of health care costs) and equal access to care have created waiting lists and given rise to private surgical outpatient clinics. The increase of women in medical school (>60%) has yet to be paralleled in most surgical specialists (eg, about 10% of general surgeons are women). Subspecialization, the 40-hour workweek, technical improvements (interventional and minimally invasive procedures), and quality demands have changed the surgical work scenario for both junior and senior staff members. Formal requirements in training duration and educational content are likely to change. Recruitment to surgery and ensuring continuity of patient care take surgery in Norway beyond the scalpel into the 21st century.