Westernisation of gastrointestinal diseases in Asia.
Report on the Asia Pacific Congress of Gastroenterology Digestive Week, Singapore, 2003
Asia↗
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Outbreaks of avian influenza A (H5N1) in Asia and interim recommendations for evaluation and reporting of suspected cases--United States, 2004.
During December 2003-February 2004, outbreaks of highly pathogenic avian influenza A (H5N1) among poultry were reported in Cambodia, China, Indonesia, Japan, Laos, South Korea, Thailand, and Vietnam. As of February 9, 2004, a total of 23 cases of laboratory-confirmed influenza A (H5N1) virus infections in humans, resulting in 18 deaths, had been reported in Thailand and Vietnam. In addition, approximately 100 suspected cases in humans are under investigation by national health authorities in Thailand and Vietnam. CDC, the World Health Organization (WHO), and national health authorities in Asian countries are working to assess and monitor the situation, provide epidemiologic and laboratory support, and assist with control efforts. This report summarizes information about the human infections and avian outbreaks in Asia and provides recommendations to guide influenza A (H5N1) surveillance, diagnosis, and testing in the United States.
Animals↗
The burden and impact of COPD in Asia and Africa.
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. The World Health Organization (WHO) estimated that COPD is currently the seventh leading cause of death and disability worldwide, but will rise to the fifth position by 2020. The estimated prevalence of COPD worldwide in 2001 was 1013/100,000 population; it was highest in the Western Pacific Region and lowest in Africa. The mortality from COPD followed the same pattern. The prevalence of smoking is slowly decreasing in the industrialised world and rising in developing countries, especially in Asia and Africa. Cigarette consumption per adult has also decreased in the Americas, remained the same in Europe but increased in all other regions, especially the Western Pacific. Indoor air pollution from combustion of biomass/traditional fuels and coal, previous tuberculous infection, outdoor air pollution and childhood respiratory infections are other important risk factors for COPD in developing countries. The rise in morbidity and mortality from COPD will be most dramatic in Asian and African countries over the next two decades, mostly due to progressive increase in the prevalence of smoking. As developing countries can ill afford the added economic burden of COPD and other smoking-related diseases, there is an urgent need for multi-dimensional actions in reducing the main risk factor of cigarette smoking.
Adult↗
Water-related problems of central Asia: some results of the (GIWA) International Water Assessment Program.
This paper presents results of the research under the program Global International Waters Assessment (GIWA) for the Aral Sea basin (Subregion 24 of the GIWA program). These results show that the detemining factor for the region is freshwater shortage and the main issue is modification of stream flow. According to GIWA assessment estimations, freshwater shortage is responsible for about 70% of the developmental problems in the region. The current economy is developing under conditions of increasing water deficiency. In spite of increasing efforts by the governments of the countries in the region, and by the international community, the situation in regard to water supply and economic objectives in the countries of central Asia remains tense and shows clear tendencies towards aggravation and conflict. The main causes for this sharpening of ecological and socioeconomic conditions in the region are analyzed, and measures to mitigate stress in transboundary water-resources use are presented.
Asia↗
Management of chronic obstructive pulmonary disease in Asia and Africa.
This review examines whether the comprehensive programme recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), developed mostly by physicians in industrialised countries, can be applied in developing countries. In developing countries, there are several major limitations to the implementation of the programme. First, management of chronic obstructive pulmonary disease (COPD) patients is not a priority in competing for health care resources. Second, only major medical centres in developing countries have spirometers; the reliance on spirometric testing for diagnosis, staging and treatment options, as recommended by the GOLD guidelines, makes it almost impossible for the programme to be implemented. Third, in many Asian and African countries, regular monitoring is often restricted to patients with severe COPD who have frequent hospitalisations or clinic visits for exacerbations and complications. Fourth, the choice of therapy usually depends on the availability and cost of drugs. Finally, given the aetiological role of sequelae of lung infections, including tuberculosis, the appropriateness and safety of using intermittent courses of oral steroids during acute exacerbations and of long-term, high-dose inhaled corticosteroids for moderate to severe COPD in developing countries has not been evaluated. Developing countries in Asia and Africa may need to adapt the GOLD guidelines according to varying aetiology, local health care resources, socio-economic and cultural factors and development of health services. Prevention programmes, especially for tobacco control, are of paramount importance. National and international efforts must be directed towards controlling the tobacco epidemic in developing countries to reduce the burden of COPD and other tobacco-induced diseases.
Africa↗
[Simulation of effects to tropospheric ozone over South East Asia and south China from biomass burning].
The ozone variation led by biomass burning in Spring 2000 over South East Asia and South of China region was simulated with a combined regional climate model and atomospheric chemical model. It was found that ozone was added by the pollutant of biomass burning both over source area and down wind area. The ozone of lower troposphere was affected by the pollutant over source area, so did the ozone in middle troposphere over down wind area. An ozone increase of 9.0-12.0 x 10(-2) g/m2 over South of China was found. The range of ozone increase between 1000-900 hPa over source area was more than 36 x 10(-9) m3/m3.
Asia, Southeastern↗
Balamuthia mandrillaris meningoencephalitis: the first case in southeast Asia.
We present a case of 23-year-old man with acute meningoencephalitis, accompanied by inflammation of a nasal ulcer. He had been healthy until six months prior to admission to the hospital when he had a motorcycle accident. A star-shaped wound at his nose was incurred after falling into a swamp. A computed tomogram of the brain showed two nonenhancing hypodense lesions at the left caudate nucleus and the right parietal lobe, ependymitis and leptomeningeal enhancement. A skin biopsy showed chronic noncaseous granulomatous inflammation without demonstrated microorganisms. The patient did not respond to the empirical treatment with cloxacillin, ceftriaxone, and amphotericin B, and eventually died on the thirteenth day of hospitalization. At autopsy, hematoxylin and eosin-stained brain sections showed a chronic necrotizing inflammation with numerous amebic trophozoites and rare cysts. Definitive identification of Balamuthia mandrillaris was made by fluorescent immunohistochemical analysis. There were 10 Naegleria fowleri primary amebic meningoencephalitis, eight Acanthamoeba granulomatous amebic encephalitis, and three Acanthamoeba meningitis in Thailand. To our knowledge, this case is the first reported case of B. mandrillaris in Southeast Asia.
Adult↗
Eastern Europe and Central Asia: report identifies human rights gaps.
Criminalization and stigmatization of the high-risk behaviours that promote the spread of HIV are fuelling the HIV/AIDS epidemic in Eastern Europe and Central Asia and placing millions of people at risk. This is one of the findings of a report from the United Nations Development Programme released in February 2004. The report, which is the first comprehensive profile of the epidemic in the 28 countries of the region, includes a significant focus on human rights issues.
Asia↗
Progress toward sustainable measles mortality reduction--South-East Asia Region, 1999-2002.
Substantial progress has been made toward meeting the 2003 World Health Assembly goal to reduce measles deaths 50% by the end of 2005, compared with deaths in 1999. Although measles remains the leading cause of vaccine-preventable deaths among children, the World Health Organization (WHO) estimates that, during 1999-2002, global measles mortality decreased 29%, including a 19% decline among South-East Asia Region (SEAR) member countries. In June 2003, the SEAR Regional Technical Advisory Group on Immunization endorsed a Regional Strategic Plan for Measles Mortality Reduction (2003-2005). This report summarizes progress in measles control in SEAR during 1999-2002 and outlines plans for future activities in the region, which include strengthening measles surveillance, improving access to routine vaccination, and providing a second opportunity for measles immunization.
Adolescent↗
Learning of medical pharmacology via innovation: a personal experience at McMaster and in Asia.
Pharmacology, a discrete preclinical discipline of the traditional medical curriculum, identifies itself distinctly different from the other preclinical or clinical subjects in knowledge base as well as learning/teaching instructions. It exists in series with other pre-clinical courses (e.g., anatomy, biochemistry and physiology), and in parallel with other paraclinical courses such as pathology, microbiology and community medicine. Such arrangement makes learning of pharmacology rather difficult and deficient with regard to its therapeutic relevance and clinical application. In recent years, medical curricula based on clinical cases have emerged as a platform in which pharmacology is one integrated component in a holistic approach to medical education. In this problem-based learning (PBL) model, students learn, with teachers' facilitation, in a student-centered environment, based on self-directed, clinically relevant and case-oriented approach, usually in a small-group tutorial format. In PBL, pharmacology is learned in concert with other subject issues relevant to the case-problem in question, such as anatomy, physiology, pathology, microbiology, population health, behavior science, etc. Students learn via problem-evoked curiosity and motivation, in an environment which encourages free inquiries and intensive discussions in a cooperative rather than competitive atmosphere. Teachers facilitate students' learning objectives rather than deliver pre-packed knowledge and dictate what they think students should learn. A change towards PBL curriculum appears to be beneficial in better preparing the medical students as life-long learners capable of coping with changes in knowledge and skills associated with the progressive and dynamic social/economic transformation in the Asia-Pacific regions. Evidence is presented that this is indeed happening.
Asia↗
[Psychotic disorders. Higher incidence during travels in Asia].
Psychiatric disorders in French travellers accounted for 15 to 20 percent of medical repatriations arranged by medical assistance companies. The authors of this study dealt with the cases recorded during a 1-year period by one of these companies, and they analysed the psychiatric episodes in relation to the main features of the subject's journey. These episodes usually occurred in summer and affected young or middle-aged people. More than half of them were psychotic disorders which were significantly more frequent in Asia than elsewhere and were unrelated to drug addiction or anti-malarial prophylaxis. The management of these patients by the medical assistance company has been discussed.
Adolescent↗
Prospects of plasma immersion ion implantation and deposition (PIlI & D) in the biomaterials field in Malaysia and south East Asia.
One of the emerging technologies in the area of plasma processing is plasma immersion ion implantation (PSII). The paper addresses the merits offered by the PSII technique especially in the area of biomaterial processing. Worldwide development status as well as the drive towards commercial applications is elaborated in an attempt to draw the attention to the importance of the process for Malaysia as well as south East Asia.
Asia, Southeastern↗
Promoting road traffic injuries research in South Asia: capacity strengthening in health research.
Ideally, health policies should be based on valid scientific evidence and such evidence requires health research. Health research is also an essential tool for achieving equity in health and development. Although the need to carry out health research is noe well accepted, South Asia countries still lag behind and do not make any meaningful contribution to health research and development, This paucity in research work is due to a lack of incentives, shortage of skilled manpower, poor exposure and insufficient orientation to the methods and materials of biomedical research. Research capacity is a tool to help a country deal with it's national health problems in as effective and efficient a manner as possible. It is, therefore, part of the national health system ans should be integrated in a comprehensive national health plan for the promotion of health and the delivery of health services to the country. Capacity strengthening is recognized as a crucial step in the process of integrating the use od research doe decision-making in the health system of a country. This is especially true for conditions such as road traffic injuries, which present a new challenge for existing health systems.
Accidents, Traffic↗
Integrating strategies for combating vitamin A deficiency: successes in Asia.
Indonesia and Bangladesh were among the first countries to distribute vitamin A capsules (VAC) to underfives in the early 1970s. Since then, VAC coverage has increased very much. In Indonesia, VAC are now distributed to underfives in two special months. In Cambodia, VAC distribution started less than a decade ago and coverage is yet <50%. After being linked to National Immunization Days, it is now linked to Immunization Outreach, which seems a good strategy. Because VAC are only distributed to underfives and postpartum women, and because coverage is usually around 50-80%, other strategies are implemented simultaneously. Recent HKI-evaluations found that promotion of dark-green leafy vegetables and eggs in Indonesia increased their consumption and improved vitamin A status. In Bangladesh, underfives and women of households with a homestead garden and/or poultry had a lower risk of vitamin A deficiency. The HKI Homestead Food Production Program aims at improving homestead food production activities in order to increase production and consumption of vitamin A-rich foods. Food fortification in Indonesia reaches large parts of the population, while coverage is related to socio-economic status and urban/rural location. The successes in Asia emphasize the need for multiple strategies and integration with other health and agricultural programs.
Adult↗
Performance evaluation for screening laboratories of the Asia-Pacific region.
The Centers for Disease Control and Prevention (CDC) has a long history of involvement in quality assurance (QA) activities for support of newborn screening laboratories. Since 1978, CDC's Newborn Screening Quality Assurance Program (NSQAP), has distributed dried-blood spot (DBS) materials for external QA and has maintained related projects to serve newborn screening laboratories. The first DBS materials were distributed for congenital hypothyroidism screening in 1978 and by 2001, NSQAP had expanded to over 30 disorders and performance monitoring for all filter paper production lots from approved commercial sources. In 2001, there were 250 active NSQAP participants, 167 laboratories from 45 countries and 83 laboratories in the United States. Of these laboratories, 31 are from the Asia Pacific Region representing nine countries primarily for two disorders. In 1999, US laboratories had more errors for Performance Evaluation (PE) specimens than other laboratories; but in 2000, US laboratories had fewer errors. International laboratories reported 0.3% false-negative PE clinical assessments for congenital hypothyroidism and 0.5% for phenylketonuria (0.5%) in 2000. Paperless PE data-reporting operation using an Internet website has recently been implemented.
Asia, Southeastern↗
Universal neonatal hearing screening: applications for a developing country in the Asia-Pacific region.
Various centers around the world have implemented and evaluated universal hearing screening programs as a response to the US National Institute of Health policy statement on early identification of hearing loss. Several well conducted clinical trials have been devised to examine and evaluate various factors relevant to establishing a UNHS program. This paper aims to describe some of these factors and analyze their applications and implications for a UNHS program for a developing country in the Asia-Pacific Region. Specifically, three main issues will be discussed: hospital vs community based programs, choice of technology, and choice of screening protocol.
Asia, Southeastern↗
MS Across Continents: Challenging our Knowledge of MS in Asia and the Middle East. Report from the 2nd MS Forum Pan-Asian Conference, 19-20 November 2004, Ho Chi Minh City, Vietnam.
Multiple sclerosis in Asia and the Middle East shares many similarities with the disease seen in Caucasian populations, but there are notable and important differences. These need to be characterized and defined to enable correct diagnosis. Classifying and diagnosing MS in Asian and Middle Eastern populations were themes of the 2nd MS Forum Pan-Asian conference. Participants also discussed other 'hot topics', such as health economics and research outcome, diagnostic red flags and pitfalls with diagnostic imaging, early magnetic resonance imaging changes, pathology and axonal loss, neuroprotection and childhood MS.
Asia↗
[Polymorphism of CTG-repeats in the DMPK gene in populations of Yakutia and central Asia].
Allele frequency distribution of CTG-repeat in the 3'-flanking region of DMPK gene was analyzed in populations of Yakutia (three ethnogeographical groups of Yakuts, Evenks, Evens, Yukaghirs, Dolgans) and Central Asia (Kazakhs, Uzbeks, Uighurs). Frequencies of CTG alleles were found to be significantly different in two regions. Allele frequency distribution in populations of Yakutia was similar to Asian populations, whereas Central Asian populations showed similarity to European populations. The features of allele spectrum in Yakut populations were discussed in terms of high prevalence of myotonic dystrophy in Yakuts. Our result supports the hypothesis of founder effect in spread of myotonic dystrophy in Yakuts. The phylogenetic relationships between the investigated populations based on polymorphism of CTG-locus of the DMPK gene have been analyzed as well.
Alleles↗