Cardiothoracic surgery in Papua New Guinea (PNG) was somewhat ad hoc prior to 1956 but later settled into an arrangement in which visiting teams from overseas selected mostly adult patients for a limited range of closed heart operations to be done locally or overseas. In 1978 the late Professor John Biddulph was instrumental in facilitating a more formal arrangement with the Royal Prince Alfred Hospital whereby patients were selected by a visiting cardiologist on an annual basis to be transferred to Sydney for cardiac surgery. This subsequently developed into a predominantly paediatric program based at the Royal Alexandra Hospital for Children in Sydney, which successfully ran until 1992. In 1993 a program began, based at the Sydney Adventist Hospital, in which a voluntary cardiac team has been visiting annually to perform both open and closed heart surgery. This program has proved to be very successful with a high output and a low mortality. Despite this long history of surgery for congenital heart disease in PNG, no definite long-term plans have eventuated. Because the financial situation of the country does not allow for a major cardiothoracic unit, the current arrangement whereby noninvasive investigation and some closed surgery are performed at Port Moresby General Hospital is appropriate for the foreseeable future.
Australia ; Cardiac Surgical Procedures - economics ; Cardiac Surgical Procedures - statistics & ; numerical ; Child Heart Defects, Congenital - surgery ; Humans ; Medical Missions ; Papua New Guinea

Objective：Tuberculosis (TB) poses a significant public health challenge in the 22 Pacific island countries and territories. Using TB surveillance data and World Health Organization (WHO) estimates from 2000 to 2013, we summarize the epidemiology of TB in the Pacific.

This was a descriptive study of incident TB cases reported annually by Pacific island national TB programmes to WHO. We counted cases and calculated proportions and case notification rates per 100 000 population. We calculated the proportion of TB patients who completed TB treatment and summed estimates of national incidence, prevalence and mortality, provided by WHO, to produce regional incidence, prevalence and mortality rates per 100 000 population.Results：Estimated TB incidence in the Pacific has remained high but stable from 2000 to 2013; estimated prevalence and mortality have fallen by 20% and 47%, respectively. The TB case notification rate increased by 58%, from 146 to 231 per 100 000 population in the same time period. In 2013, 24 145 TB cases were notified, most (94% or 22 657) were from Papua New Guinea. Kiribati had the highest TB case notification rate at 398 cases per 100 000 population. TB case notification rates were also high in Papua New Guinea, the Marshall Islands and Tuvalu (309, 283 and 182, respectively).Discussion：TB in the Pacific is improving in some areas; however, high rates affect many countries and the estimated regional incidence rate is stable. To further reduce the burden of TB, a combination of dedicated public health and system-wide approaches are required along with poverty reduction and social protection initiatives.

OBJECTIVETo study the nonbiologic risk factors of tuberculosis (TB) among adults.

METHODS1:2 matched case-control study was conducted. 158 new smear positive pulmonary TB patients with 25 - 60 years of age were notified and registered from three county anti-TB institutions in Henan from October 2002-March 2004, were selected as cases. Two healthy persons were selected to match each case, with the same sex and age group, from the nearest neighbors of the case as controls. Interview was carried out with a uniform designed questionnaire at the residence of the object. Univariate and multivariate condition logistic regression models were used.

RESULTSThe results of univariate analysis showed that marital status, education, self-employed occupation, smoking, out-migration for work away from hometown, household annual income level and household property were significantly associated with TB prevalence (P < 0.05); multivariate analysis showed that marital status, self-employed occupation, smoking, household economic condition and out-migration for work, away from home were also associated with TB (P < 0.05), and OR values were 2.826, 2.350, 1.536, 0.707, 2.096, respectively.

CONCLUSIONBeing single, smoking, self-employed occupation and out-migration for work were nonbiologic risk factors of TB while good household economic condition was a protective factor.

Adult ; Case-Control Studies ; China ; epidemiology ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Risk Factors ; Socioeconomic Factors ; Surveys and Questionnaires ; Tuberculosis, Pulmonary ; epidemiology

OBJECTIVETo investigate the long term survival of MDR-TB patients compared to non-MDR-TB in Henan province in 2010.

METHODSParticipants were randomly selected in 2010 from a dataset generated by an anti-TB drug resistance surveillance survey conducted by the Tuberculosis Control Institute, Henan Centre for Disease Control and Prevention in 2001, supported by the World Health Organization. Information on patient's demographic profile and medical records was extracted by trained doctors and nurses at local anti-TB dispensaries. Interviews were carried out using questionnaires to collect information on the socioeconomic features and survival status. Bivariate and multivariate with logistic regression were performed for data analysis.

RESULTSThe long term outcome of MDR-TB patients was much poorer when compared to non-MDR-TB patients. The case fatality was much higher among MDR-TB than non-MDR-TB patients (22.1% vs. 6.7%). The risk factors associated with the poorer outcome would include drug resistance status, disease relapse, hospitalization for treatment and long treatment period. Compared to non-MDR-TB, the survival time for MDR-TB was much shorter after having had the disease (6.7 years vs. 8.0 years).

CONCLUSIONMDR-TB patients had poor long term outcomes. As most of the cured TB patients were under productive age in the society, the high case fatality rate of MDR-TB would impose big burden on the related family and communities. Findings from this study suggested that the TB control programs should involve more efforts be paid on MDR-TB control, in order to reduce the burden of the disease.

Adolescent ; Adult ; Child ; China ; epidemiology ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Surveys and Questionnaires ; Survival Analysis ; Treatment Outcome ; Tuberculosis, Multidrug-Resistant ; mortality ; Tuberculosis, Pulmonary ; mortality ; Young Adult