HIV Vulnerability in Out-of-School Adolescents and Youth in Yunnan, China

This study investigated multiple aspects of vulnerability to HIV in out-of-school adolescents and youth in Yunnan Province, a high HIV risk region in China. The findings show that socially disadvantaged adolescents and youth were overrepresented in the out-of-school young people in Yunnan. The out-of-school young people in Yunnan exhibited 1) limited knowledge about HIV transmission and prevention, 2) a high prevalence of unprotected sexual activity, 3) high exposure to illicit drugs and alcohol use and a high prevalence of drug use in themselves, and 4) limited access to health services. There is an indication of higher exposure to risk behaviours in the younger age group. The study population used multiple media, particularly television, internet and radio, to obtain information about HIV transmission and prevention, particularly in the younger age group. These media may be an effective way of reaching this population in future HIV education and prevention programs in the region.

1980—2001年澳大利亚西部土著与非土著婴幼儿死亡率模式、趋势以及种群差异增大现象的分析:群体数据库研究

Background: Since there are known disparities between Aboriginal and non-Aboriginal populations in Australia,trends in infant mortality rates can be used to assess the effectiveness of programmes designed to improve the health of Aboriginal populations. We have examined mortality rates in these populations in Western Australia.Methods: We used the most comprehensive and validtotal population data available for an Australian state to determine all-cause and cause-specific mortality for Aboriginal and non-Aboriginal infants born in Western Australia from 1980 to 2001. Findings: Overall, infant mortality rates fell in both populations, but less so in Aboriginal(from 25.0 in 1980-84 to 16.1 in 1998-2001) than in non-Aboriginal infants (from 8.4 in 1980-84 to 3.7 in 1998-2001) such that disparities between the two groups increased for all major causes of infant death. The relative risk for Aboriginal compared with non-Aboriginal infants rose from 3.0 (95%CI 2.5-3.6) to 4.4 (3.5-5.5), and there were significantly more potentially preventable deaths,such as those caused by infections (5.9 per 1000 livebirths vs 0.7 per 1000 livebirths, RR 8.5, 95%CI 7.1-10.2). Additionally, for Aboriginal infants, postneonatal mortality rates were higher than neonatal mortality rates (11.2 per 1000 livebirths vs 9.7 per 1000 livebirths), trend analyses showed that previous reductions in deaths due to pretermbirth (4.3 per 1000 livebirths-1.4 per 1000 livebirths from 1980-97) were not sustained in the most recent years studied (3.5 per 1000 livebirths), and rates of sudden infant death syndrome did not fall significantly (4.9 per1000 livebirths vs 4.7 per 1000 livebirths). Interpretation:These increasing disparities between Aboriginal and non-Aboriginal infants, especially in remote areas, demand immediate action in partnership with Aboriginal communities,focusing on both access to primary health care and better living conditions. Implementation and assessment of policies to reduce the continuing social and economic disadvantage faced by Aboriginal families are vital.

儿童手术前口服咪达唑仑对呼吸功能的影响

背景为了缓解焦虑、提高患儿配合度，临床上常在麻醉前给患儿服用咪达唑仑。然而咪达唑仑的肌肉松弛作用具有影响患儿呼吸功能的潜在风险。我们分别评估患儿清醒时以及手术前口服咪达唑仑（0．3mg／kg）20分钟后的功能残气量（functionalresidualcapacity，FRC）、通气协调性和呼吸力学特征，其中通气协调性以肺清除率指数（1ungclearanceindex，LCI）加以评价。方法18例3—8岁患儿口服咪达唑仑前后，采用六氰化硫（SF6）多次呼吸洗脱技术测定FRC和LCI，通过振荡技术获得输入阻抗，测定呼吸系统阻力与肺弹性阻力。结果麻醉前给予咪达唑仑导致患儿FRC均值降低6．5％，从25．0ml／kg降低至23．4ml／垤，该差异虽小但具有显著统计学意义，同时LCI由6．4增加至6．9，提高7．8％，这些都显示患儿的通气不协调性增加。此外，咪达唑仑导致患儿呼吸系统阻力增加了7．4％（从3．38±0．6到3．62±0．6cmH，0S／L，P〈0．001）．呼吸弹性阻力增加9．2％（48．8到52．9cmH2OS／L，P〈0．001）。FRC、LCI、肺阻力和弹性阻力等指标的变化具有显著相关性（P〈0．001）。结论手术前，给肺功能正常的患儿小剂量的咪达唑仑，短时间内呼吸参数改变较小。然而，麻醉医生应该意识到，对于存在呼吸系统并发症的高危患儿，咪达唑仑可能会明显抑制其呼吸功能。