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Will treatment of Helicobacter pylori infection in childhood alter the risk of developing gastric cancer?

Helicobacter pylori has been classified as a group 1 carcinogen for gastric cancer. It is estimated that there is between a two- and sixfold increase in the risk of developing gastric cancer among infected patients. Among different populations, the risk of H. pylori-infected individuals developing gastric cancer varies greatly. However, on a worldwide scale, gastric cancer is the second most common cause of cancer-related death. Therefore, H. pylori eradication could help prevent up to three to four million gastric cancer deaths per year. H. pylori is usually acquired in childhood. Because infected children have not harboured the organism for long enough to have developed precancerous lesions, childhood is theoretically an attractive time for H. pylori eradication and, thus, could help prevent gastric cancer later in life. However, as H. pylori prevalence and the incidence of gastric cancer are falling rapidly in developed nations, widespread population screening programs aimed at the eradication of H. pylori in these countries would be enormously expensive. Therefore, except in groups with a high risk for development of gastric cancer (eg, Japanese or those with a strong positive family history of gastric cancer), a population-based test-and-treat policy is not justified.

Asian People↗

Improved immunogenicity of a novel third-generation recombinant hepatitis B vaccine in patients with end-stage renal disease.

Hepatitis B (HBV) infection remains a significant epidemiological problem in the end-stage renal disease (ESRD) population. Vaccination programs using second-generation vaccines lead to effective seroprotection in only 50-60% of these patients. The purpose of this case series was to describe our experience with a novel third-generation vaccine, Bio-Hep-B, in ESRD patients who had not developed protective anti-HBs titers following a second-generation HBV vaccination protocol. Twenty-nine ESRD patients who had not responded in the past to a standard second-generation HBV vaccination protocol were included in this series. Each patient received 10 microg of Bio-Hep-B) intramuscularly at 0, 1 and 6 months. A month after completion of the vaccination protocol, anti-HBs antibody levels were measured. Following immunization, 25 of 29 patients (86%) developed seroprotective anti-HBs levels > or =10 mIU/ml. There was a significant difference in the titers of anti-HBs antibodies prior to and following vaccination (p < 0.0001). Statistical analysis of the variables age, gender, diagnosis, dialysis mode, weight, hemoglobin, albumin, and KT/V failed to detect predictors of antibody response. A retrospective analysis of the results of a second-generation vaccination program for the years 1999-2001 in our department showed that 19 of 36 (56.4%) ESRD patients developed seroprotection. In conclusion, the results of this study show that the third-generation HBV vaccine Bio-Hep-B is highly immunogenic in the population of ESRD patients who did not respond in the past to a second-generation vaccine. This enhanced seroprotection offers hope that the new vaccine will reduce the rate of non-responders and help to eliminate HBV infection from dialysis centers.

Adult↗

Promoting oral health: interventions for preventing dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. A report on recommendations of the task force on community preventive services.

The Task Force on Community Preventive Services (the Task Force) has conducted systematic reviews of the evidence of effectiveness of selected population-based interventions to prevent and control dental caries (tooth decay), oral (mouth) and pharyngeal (throat) cancers, and sports-related craniofacial injuries. The Task Force strongly recommends community water fluoridation and school-based or school-linked pit and fissure sealant delivery programs for prevention and control of dental caries. Using the rules of evidence it has established, the Task Force found insufficient evidence of effectiveness or ineffectiveness of the remaining interventions reviewed. Therefore, the Task Force makes no recommendation for or against use of statewide or communitywide sealant promotion programs, population-based interventions for early detection of precancers and cancers, or population-based interventions to encourage use of helmets, facemasks, and mouthguards to reduce oral-facial trauma in contact sports. The Task Force's finding of insufficient evidence indicates the need for more research on intervention effectiveness. Until the results of such research become available, readers are encouraged to judge the usefulness of these interventions by other criteria. This report presents additional information regarding the recommendations, briefly describes how the reviews were conducted, and provides information designed to help apply the strongly recommended interventions locally.

Athletic Injuries↗

Inbreeding of Wistar-Kyoto rat strain with hyperactivity but without hypertension.

A genetic inbreeding program using Wistar-Kyoto rat strains as progenitors was used to combine the hyperactivity trait of the spontaneously hypertensive rat (SHR) with the normotensive trait of the WKY genetic control strain. From an SHR X WKY cross we produced a gene-assorting F2 population from which selected brother-sister matings were carried out through seven successive inbred populations. This program produced a new strain of hyperactive rats with normotensive mean systolic blood pressure levels, and we have designated the new strain as the Wistar-Kyoto hyperactive (WK/HA) rat. Another behavioral characteristic of the SHR rat, poor habituation in a nonreinforcing novel environment, did not appear as a characteristic trait of the new strain of WK/HA rats, suggesting a separate underlying genetic basis for the two traits that had been apparently fortuitously fixed in the SHR genotype as a result of intensive inbreeding of that strain. The new WK/HA strain, together with the WKY control strain, is considered as more suitable for subjects in studying hyperactivity in rats than the original SHR strain with its concomitant hypertension and poor habituation traits.

Animals↗

Gender selection in China: its meanings and implications.

With the advancement of assisted reproduction technologies, people are offered wider choices to choose the gender of their offspring and to construct 'ideal-typed' families with specific gender structure. Gender selection is welcomed by many societies with gender-specific preference, especially those patriarchal societies such as Chinese communities. It is not only a medical procedure but also a social orientation, which reveals much of the underlying preference towards gender. This paper explores the cultural dimensions to gender selection and its psychosocial meanings and implications in Chinese societies, especially after the establishment of One Child Policy in China. Problems associated with son preference in the culture with strong gender stereotyping are addressed. We believe that gender selection for social reasons should not be allowed since undesirable outcomes will be resulted under such strict population control program.

China↗

Volume of screening mammography and performance in the Quebec population-based Breast Cancer Screening Program.

BACKGROUND: In the Quebec Breast Cancer Screening Program (Programme quebecois de depistage du cancer du sein [PQDCS]), radiologists' and facilities' volumes of screening mammography vary considerably. We examined the relation of screening-mammography volume to rates of breast cancer detection and false-positive readings in the PQDCS. METHODS: The study population included 307,314 asymptomatic women aged 50-69 years screened during 1998-2000. Breast cancer detection rates were analyzed by comparing all women with screening-detected breast cancer (n = 1709) and a 10% random sample of those without (n = 30,560). False-positive rates were analyzed by comparing the 3159 women with false-positive readings and the 27,401 others in the 10% random sample. Characteristics of participants, radiologists and facilities were obtained from the PQDCS information system. Data were analyzed by means of logistic regression. RESULTS: The rate of breast cancer detection appeared to be unrelated to the radiologist's screening-mammography volume but increased with the facility's screening-mammography volume. The breast cancer detection rate ratio for facilities performing 4000 or more screenings per year, compared with those performing fewer than 2000, was 1.28 (95% confidence interval [CI] 1.07-1.52). In contrast, the frequency of false-positive readings was unrelated to the facility's screening volume but was inversely related to the radiologist's screening volume: the rate ratio for readers of 1500 or more screenings per year compared with those reading fewer than 250 was 0.53 (95% CI 0.35-0.79). INTERPRETATION: Radiologists' and facilities' caseloads showed independent and complementary associations with performance of screening mammography in the PQDCS. Radiologists who worked in larger facilities and read more screening mammograms had higher breast cancer detection rates while maintaining lower false-positive rates.

Aged↗

Survey of the stray dog population and the health education program on the prevention of dog bites and dog-acquired infections: a comparative study in Nepal and Okayama Prefecture, Japan.

We estimated the number of stray dogs in Kathmandu, Nepal, where human rabies cases still occur, and in Shimotsui, Okayama Prefecture, Japan. In Kathmandu, the stray dog density was 2,930 stray dogs/km2, and the ratio of stray dogs to humans was 1:4.7. In Shimotsui, the density was 225 stray dogs/km2, and the ratio was 1:5.2. Since the stray dog population in Nepal is very large, one of the measures used to prevent dog bites and dog-acquired infections such as rabies is an effort to capture stray dogs. Another such measure is an effort to decrease the availability of food for stray dogs. We also organized health education programs in both Nepal and Okayama Prefecture, Japan, which involved a course on the prevention of dog bites and subsequent infections. After each course, a questionnaire survey was conducted. The results suggest that the course participants understood these important preventive methods. In addition to the measures mentioned above and the routine vaccination of dogs, this health education course is recommended as a long-term preventive program

Animals↗

HIV/AIDS education and prevention in Myanmar.

Myanmar has a diverse population, 70% of whom reside in rural areas. These factors, along with limited resources, create a challenge for monitoring and controlling the HIV/AIDS epidemic. The first HIV-infected individual was identified in 1988, and the first AIDS case was reported in 1991. The National AIDS Control Program and the National AIDS Committee were established in 1989. Sentinel surveillance was begun in 1992. A cumulative total of 45,968 HIV/AIDS cases have been reported through 2003. UNAIDS and the government of Myanmar estimated that there were 177,279 persons living with HIV/AIDS in Myanmar in December 2001. High prevalence rates of HIV have been identified in injection drug users (IDUs), commercial sex workers (CSWs), and men attending sexually transmited disease clinics. Levels of HIV in all groups appear to have leveled off, but the prevalence remains high in IDUs and CSWs. A 100% targetted condom promotion program was implemented in 2001. Political commitment to control HIV/AIDS has been established through the leadership of the government and establishment of AIDS committees extending down to the township and rural health center levels. An increased understanding of the problems that Myanmar faces in controlling HIV transmission and increased support from international agencies and nongovernmental organizations can play an important role in facilitating more intensive intervention activities.

Acquired Immunodeficiency Syndrome↗

HIV/AIDS epidemics in Vietnam: evolution and responses.

The goal of this study was to describe the evolution of the HIV epidemic in Vietnam and its responses. Surveillance was conducted in 8 provinces in 1994, expanded to 12 in 1995, 20 in 1996, and 30 in 2001. Sentinel populations were sexually transmitted disease (STD) patients, female sex workers (FSWs), injection drug users (IDUs), tuberculosis (TB) patients, antenatal women, and military conscripts. Vietnam is in the concentrated epidemic stage. HIV prevalence had increased significantly in all surveillance population groups in the 1990s. HIV prevalence in the south is higher than in other regions of the country. The national HIV prevalence increased from 10.1% in 1996 to 32% in 2002 among IDUs, from 0.6% in 1994 to 6.6% in 2002 among FSWs, from 0.4% in 1994 to 2.4% in 2002 among STD patients, from 0.03% in 1994 to 0.34% in 2002 among pregnant women, from 0% in 1994 to 0.7% in 2002 among army military recruits, and from 0.5% in 1994 to 3.6% in 2002 among TB patients. The government has a strong commitment to control the epidemic and has implemented many activities for HIV prevention and control. Vietnam's HIV epidemic is predominantly among IDUs. Current intervention activities have not been sufficient to reduce HIV transmission. Vietnam needs to strengthen responses by scaling up the best practices in the most affected population groups by implementing internationally recognised effective interventions appropriately.

Acquired Immunodeficiency Syndrome↗

The rationale for population-based surveillance for Haemophilus influenzae type b meningitis.

Although Haemophilus influenzae type b (Hib) conjugate vaccines have been spectacularly successful, nearly eradicating Hib disease in countries where used routinely, they are relatively expensive. In many countries the incidence of Haemophilus influenzae type b (Hib) disease is uncertain, and it is unclear whether the local burden of Hib disease warrants the costs of adding Hib vaccine to the routine immunization program. Population-based surveillance to assess the local burden of Hib disease can help decision makers with this process. Although pneumonia is more common than meningitis, surveillance for Hib meningitis and invasive disease is likely to be more feasible and efficient than surveillance for Hib pneumonia. Standardization of laboratory methods for the isolation and identification of H. influenzae from CSF specimens is essential to successful surveillance. Should a country decide to introduce Hib conjugate vaccine as a routine immunization, population-based surveillance data collected before and after the introduction of vaccine can be used to monitor its impact. Finally population-based surveillance for bacterial meningitis also can provide information on the incidence of pneumococcal and meningococcal infections and on serogroup or serotype distributions that will be important when evaluating the new vaccines for those pathogens that are being developed.

Child, Preschool↗

Effect of calcium on skeletal development, bone loss, and risk of fractures.

In assessing the role of calcium, it must be stressed that calcium is not the cause of bone health but simply a necessary condition for it. It is mechanical usage that is of primary importance for bone. In just the same way iron is essential for hemoglobin synthesis and protein is essential for muscle mass, but neither is sufficient by itself. What, then, ought we to expect from a high calcium intake? Can we prevent estrogen-withdrawal bone loss? No. Calcium is not a substitute for estrogen, anymore than it is a substitute for exercise. Will calcium slow the remodeling loss that occurs with aging? Yes, to some extent; as calcium slows remodeling, it will inevitably slow remodeling-related loss. But most importantly, a high calcium intake will prevent calcium-deficiency bone loss. The only question, therefore, is the extent to which calcium deficiency loss may contribute significantly to bone fragility in various populations. The bone loss and fracture data reviewed briefly here indicate that an important portion of the osteoporotic fracture burden is calcium-related. What that portion is will be a function of the fraction of the population with inadequate intakes in any given country. Better than half of all adult American women have calcium intakes less than 500 mg/day, whereas only a small fraction of Dutch or Danish women, for example, would be under that level. Hence, a population-wide program to increase calcium intake in the United States would be likely to yield a greater benefit than in either the Netherlands or Denmark. That does not mean, of course, that there could not be substantial benefit to individuals with low intakes in all countries. Calcium intakes of greater than or equal to 1,500 mg are both safe and natural. While not all bone loss and low trauma fractures are due to low calcium intake, some almost certainly are. Adaptation to low intakes does occur, but it is seldom sufficient to compensate for the low intake. We cannot easily distinguish those who need more calcium from those who need less, and for that reason it makes good sense to ensure an adequate calcium intake for the entire adult population. What should that intake be? During adolescence, 1,500 mg will come close to ensuring the achievement of genetically programmed levels of peak bone mass.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone and Bones↗

Diphtheria surveillance and control in the Former Soviet Union and the Newly Independent States.

The Newly Independent States (NIS) inherited a common approach to diphtheria control from the Soviet Union and maintained a centralized system of surveillance and control managed by Soviet-trained epidemiologists with a shared professional culture. This system had controlled a diphtheria resurgence in the 1980s. In response to the epidemic of the 1990s, NIS health authorities responded with a set of control measures based on the Soviet-era experience. These measures included intensified childhood vaccination, aggressive case investigation, widespread diphtheria screening in institutions, and vaccination of adults in high-risk occupation groups. These measures proved insufficient due to high levels of susceptibility among adults, excessive contraindications to childhood vaccination, and insufficient resources in many countries. After these initial delays in implementing effective measures in some countries, most of the NIS health authorities rapidly and successfully implemented mass immunization of the population against diphtheria once the strategy was adopted and sufficient vaccine was available.

Adult↗

Polygenic susceptibility to breast cancer and implications for prevention.

The knowledge of human genetic variation that will come from the human genome sequence makes feasible a polygenic approach to disease prevention, in which it will be possible to identify individuals as susceptible by their genotype profile and to prevent disease by targeting interventions to those at risk. There is doubt, however, regarding the magnitude of these genetic effects and thus the potential to apply them to either individuals or populations. We have therefore examined the potential for prediction of risk based on common genetic variation using data from a population-based series of individuals with breast cancer. The data are compatible with a log-normal distribution of genetic risk in the population that is sufficiently wide to provide useful discrimination of high- and low-risk groups. Assuming all of the susceptibility genes could be identified, the half of the population at highest risk would account for 88% of all affected individuals. By contrast, if currently identified risk factors for breast cancer were used to stratify the population, the half of the population at highest risk would account for only 62% of all cases. These results suggest that the construction and use of genetic-risk profiles may provide significant improvements in the efficacy of population-based programs of intervention for cancers and other diseases.

Breast Neoplasms↗

[Population policies and reproductive health in Paraguay]

The population's high growth rate, age profile, and geographical distribution have aroused increasing public concern in Paraguay. The country is involved in a moderate demographic transition, compatible with the consequences of modernity and the uneven rate of both social and economic changes. Reduction of mortality and the persistence of high birth rate patterns result in an age structure that consolidates demographic growth, with an increased focus on the dependent population. In the late 1960s the need for a systematic approach to population problems was perceived within the framework of economic planning. National governments had, and currently have, an ambivalent perception of this issue, since population growth is simply considered a positive factor. This concept results from an economic view of the consequences of a reduced domestic market in absolute terms. The lack of a Development Plan, the management deficit, and the shortage of training leave doubts as to the establishment of organically connected policies or programs concerning population.

Journal Article↗