Perceived ill-health and health seeking behavior in two communities in the nam theun 2 hydroelectric project area in Lao Peoples Democratic Republic

Objective:To compare perceived ill-health and health seeking behavior between two communities affected by the large Nam Theun 2 hydroelectric project in central Lao People’s Democratic Republic(PDR).Methods: Two different affected areas;Nakai plateaubeing remote,sparcely populated and mountainous,and Xe Bang Fai lowland plains,more densely populated and comparatively affluent were included.Data were obtained from two cross-sectional household-based health and socio-economic surveys.Results:We found pronounced differences in the frequency of self-reported fever,cough,headache and myalgia according to location.On the Nakai plateau,45.1%of the individuals with ill-health report(recall period;2 weeks) went to a local health volunteer compared to only 7.2%in the Xe Bang Fai area(P 【 0.001 ).In Nakai,there were disproportionately more illiterates seeking help from local health volunteers when compared to those who attended at least primary schooling(49.2%versus 17.5%,P 【0.01 ).Self-medication with antimalarials was more common in Xe Bang Fai than on Nakai(32.3%versus 7.0%,P 【 0.001).The mean amount of money spent per health consultation was US $ 1.7 in Nakai and US $ 7.2 in Xe Bang Fai.Conclusion:The observed differences in self-reported ill-health and health seeking behavior among these two Lao communities need to be considered when implementing setting-specific mitigation measures as part of the public health action plan of the Nam Theun 2 hydroelectric project.

Parent and friend influences on the multiple health behavior of Pacific Islander adolescents

Youth obesity has increased dramatically in the United States, disproportionally affecting Hawaiian populations. The primary research objective was to describe the influence of parent and friends on the dietary, physical activity, and sedentary behaviors of Pacific Islander high school students. Data were collected from classrooms within a private high school on the Hawaiian island Oahu. Participants were Pacific Islander adolescents attending a high school in Hawaii. Participating adolescents completed a questionnaire, followed by a corresponding focus group;specifically reporting the social-level influences on their dietary and activity behaviors. Adolescents then interviewed their parent/guardian, asking questions relative to their perceived health-related influence. Participating adolescents (N = 60) were 53% female with a mean age of 16.93 (SD = 0.63), and their parents/guardians (N = 47) were 75% female with a mean age of 46.72 (SD = 5.11). Outcomes revealed parents/ guardians as the dominant influence on adolescents’ dietary behaviors, and time spent with parents was almost exclusively sedentary. In comparison, adolescents were more active with friends, but shared less healthy dietary habits. Results provide groundwork for similar examinations and culturally tailored interventions among similar adolescent populations.

The role of veterinarians in the One Health approach to antimicrobial resistance perspectives in Jordan

This study aims to evaluate the role of Jordanian veterinarians in terms of their knowledge,attitudes and common practices in combating antimicrobial resistance(AMR)and summarize the registered veterinary drugs between 20172020.Descriptive study data were collected using a standardized questionnaire that focused on the knowledge,attitudes,and practices of Jordanian veterinarians.The findings were analyzed descriptively;84%of the participants agreed with the statement on the definition of AMR.The majority(95.65%)of participants agreed that AMR is a challenge for the veterinary sector in Jordan and that it should be prioritized over other zoonotic diseases.Approximately 69%of the participants believed that the misuse and overuse of antimicrobials by unqualified,fraudulent,or unauthorized practitioners is the primary reason for the rise of cases associated with AMR and the challenges that accompany these.The most common practice among the respondents in this study was to recommend clients(e.g.,farmers and owners)to practice good animal husbandry(80.00%).The study also revealed that there was a significant difference(p=O.015)between attendance at AMR training sessions and the professional sector(private,public,and academic)of the veterinarians.This study underscores the importance of implementing a continuous education program on AMR so as to enhance the all-round knowledge of veterinarians and improve their advisory skills.In addition,laws should be enacted to ensure that veterinarians prescribe the correct antimicrobials and to improve surveillance systems for monitoring the use of antimicrobials in veterinary medicine.

Outcomes of nonresected main-duct intraductal papillary mucinous neoplasms of the pancreas

AIM:To compare characteristics and outcomes of resected and nonresected main-duct and mixed intraductal papillary mucinous neoplasms of the pancreas(IPMN).METHODS:Over a 14-year period,50 patients who did not undergo surgery for resectable main-duct or mixed IPMN,for reasons of precluding comorbidities,age and/or refusal,were compared with 74 patients who underwent resection to assess differences in rates of survival,recurrence/occurrence of malignancy,and prognostic factors.All study participants had dilatation of the main pancreatic duct by ≥ 5 mm,with or without dilatation of the branch ducts.Some of the nonsurgical patients showed evidence of mucus upon perendoscopic retrograde cholangiopancreatography or endoscopic ultrasound and/or after fine needle aspiration.For the surgical patients,pathologic analysis of resected specimens confirmed a diagnosis of IPMN with involvement of the main pancreatic duct or of both branch ducts as well as the main pancreatic duct.Clinical and biologic follow-ups were conducted for all patients at least annually,through hospitalization or consultation every six months during the first year of follow-up,together with abdominal imaging analysis(magnetic resonance cholangiopancreatography or computed tomography) and,if necessary,endoscopic ultrasound with or without fine needle aspiration.RESULTS:The overall five-year survival rate of patients who underwent resection was significantly greater than that for the nonsurgical patients(74% vs 58%; P =0.019).The parameters of age(< 70 years) and absence of a nodule were associated with better survival(P < 0.05); however,the parameters of main pancreatic duct diameter > 10 mm,branch ductdiameter > 30 mm,or presence of extra pancreatic cancers did not significantly influence the prognosis.In the nonsurgical patients,pancreatic malignancy occurred in 36% of cases within a mean time of 33 mo(median:29 mo; range:8-141 mo).Comparison of the nonsurgical patients who experienced disease progression with those who did not progress showed no significant differences in age,sex,symptoms,subtype of IPMN,or follow-up period; only the size of the main pancreatic duct was significantly different between these two sub-groups,with the nonsurgical patients who experienced progression showing a greater diameter at the time of diagnosis(> 10 mm).CONCLUSION:Patients unfit for surgery have a 36% greater risk of developing pancreatic malignancy of the main-duct or mixed IPMN within a median of 2.5 years.

The Quality of Medicines in Community Pharmacies in Riyadh, Saudi Arabia: A Lot Quality Assurance Sampling (LQAS)-Based Survey

Objectives: To classify community pharmacies (CPs) in Riyadh, Saudi Arabia, in terms of the quality of medicines sold by them, using?the lot quality assurance sampling (LQAS) technique with a predefined threshold. Methods: Riyadh CPs were divided into 2 categories (“lots” for the purpose of LQAS), i.e., chain and independent CPs. Upper and lower rate thresholds for CPs that sell low-quality medicines were predefined as 20% and 5%, respectively. Consumer and provider risks were predefined as 0.05 and 0.10, respectively. The calculated number of randomly selected CPs required in each lot was 36;then, sale of low-quality medicines in >3 CPs implies a prevalence of >20% of such CPs according to LQAS. A randomly selected brand of amoxicillin (selected as a quality indicator of medicines because it is both widely counterfeited and heat-sensitive) was purchased from each pharmacy by a “mystery shopper”, checked for authenticity, and analyzed for drug content and content uniformity using a validated HPLC method. Results: Substandard amoxicillin was purchased in 9 pharmacies (4 chains and 5 independent). Both lots were thus rejected as unacceptable, which may indicate that consumers in Riyadh are at risk of purchasing substandard medicines at CPs. Conclusions: The quality of medicines sold in CPs in Riyadh did not meet our acceptability criterion, and appropriate intervention by decision makers is recommended. LQAS proved to be a practical, economical, and statistically valid sampling method for surveying the quality of medicines. It should enable decision makers to allocate resources for improvement more efficiently.

Effectiveness of a home-environmental intervention package and an early child development intervention on child health and development in high-altitude rural communities in the Peruvian Andes: a cluster-randomised controlled trial

Background: Unsafe drinking water,poor sanitation and hygiene,exposure to household air pollution and low cognitive and socio-emotional stimulation are risk factors affecting children in low-and middle-income countries.We implemented an integrated home-environmental intervention package(IHIP),comprising a kitchen sink,hygiene education and a certified improved biomass cookstove,and an early child development(ECD)programme to improve children´s health and developmental outcomes in the rural high-altitude Andes of Peru.Methods: We conducted a one-year cluster-randomised controlled trial among 317 children<36 months divided into 4 arms(IHIP+ECD,IHIP,ECD,and Control)and 40 clusters(10 clusters per arm).ECD status(socio-emotional,fine and gross motor,communication,cognitive skills,and an overall performance)measured with the Peruvian Infant Development Scale and the occurrence of self-reported child diarrhoea from caretakers were primary outcomes.Secondary outcomes included the occurrence of acute respiratory infections and the presence of thermo-tolerant faecal bacteria in drinking water.The trial was powered to compare each intervention against its control arm but it did not allow pairwise comparisons among the four arms.Primary analysis followed the intention-to-treat principle.For the statistical analysis,we employed generalised estimating equation models with robust standard errors and an independent correlation structure.Results: We obtained ECD information from 101 children who received the ECD intervention(individually and combined with IHIP)and 102 controls.Children who received the ECD intervention performed better in all the domains compared to controls.We found differences in the overall performance(64 vs.39%,odd ratio(OR):2.8;95%confidence interval(CI):1.6–4.9)and the cognitive domain(62 vs 46%,OR:1.9;95%CI:1.1–3.5).Data analysis of child morbidity included 154 children who received the IHIP intervention(individually and combined with ECD)and 156 controls.We recorded 110,666 child-days of information on diarrhoea morbidity and observed 1.3 mean episodes per child-year in the children who received the IHIP intervention and 1.1 episodes in the controls.This corresponded to an incidence risk ratio of 1.2(95%CI:0.8–1.7).Conclusions: Child stimulation improved developmental status in children,but there was no health benefit associated with the home-environmental intervention.Limited year-round access to running water at home and the possible contamination of drinking water after boiling were two potential factors linked to the lack of effect of the home-environmental intervention.Potential interactions between ECD and home-environmental interventions need to be further investigated.

颈动脉粥样硬化对轻度认知功能损害的影响

目的探讨颈动脉粥样硬化对轻度认知功能损害（mild cognitive impairment，MCI）的影响。方法2006年11月至2007年9月单纯随机抽选1886名广州市50岁或以上，自报未患有脑卒中、心肌梗死、肺心病及恶性肿瘤等重大慢性疾病的相对健康的中老年人进行MCI测试和颈动脉彩色超声多普勒检查，以简易精神状态检查（Mini Mental State Examination，MMSE）及10个单词延迟记忆测试（10-word list learning task，CWL）得分和颈总动脉内膜一中膜厚度（IMT）作为评价指标。结果（1）本研究共检出MCI300例，患病率为15．9％。男女之间患病率差异无统计学意义。（2）CWI。得分随年龄、吸烟率、收缩压、腹围和低密度脂蛋白的升高而降低，随教育程度、体力活动和高密度脂蛋白上升而增加；而MMSE则与吸烟、体力活动、腹围和脂蛋白水平无明显相关。（3）在校正了多种潜在混杂因素后，IMT的增加均与CWL（β=-1．05，95％CI：-1．73～-0．36）和MMSE分数（p=-0．95，95％CI：-1．67～-0．23）的下降呈线性相关（P〈0．01）。（4）在校正了年龄、性别、教育、运动、吸烟、腹围、收缩压和高密度及低密度脂蛋白后，MCI患者相对非MCI者的平均IMT显著增加（0．76mm与0．74mm，F=6．9，P〈0．01）。结论颈动脉IMT增加与MCI的严重程度呈线性相关，与MCI的发生、发展关系密切。

不同检测方法对粪类圆线虫钩虫检出率的比较

目的用不同方法检查粪便中的粪类圆线虫和钩虫,掌握检测粪类圆线虫的方法。方法在云南省勐海县选择土源性线虫感染率相对高的自然村1个,以户为单位随机抽样,采用改良加藤法(Kato-Katz法)、Koga法和Baerm ann法3种粪便检查方法对粪样进行检查,每人送检粪样3次。结果粪类圆线虫阳性率Kato-Katz法为0,Koga法为11.72%,Baerm ann法为12.55%。钩虫阳性率Kato-Katz法为64.44%,Koga法为57.74%,Baerm ann法为4.60%。结论Baer-m ann法仅适用于粪类圆线虫检测,Koga法可用作钩虫和粪类圆线虫检测,而Kato-Katz法仅适用于钩虫检测。

广州市中老年人主动脉弓钙化的现患率及其相关特征

目的研究广州市≥50岁居民主动脉弓钙化（AAC）现患率及其相关特征。方法收集10413名年龄在≥50岁居民的一般资料，体格检查和实验室检查结果；用东芝KSO-15R型X光机拍摄10305名受检者胸部后前位X线平片，由2名高级放射科医师一起进行X线胸片AAC诊断，同时作独立阅片一致性可靠检验（Kappa值）。结果（1）2名高级放射科医师独立阅片对AAC诊断符合率为85．0％，一致性可靠检验Kappa值为0．68（P〈0．001），显示其AAC诊断一致性是可靠的；（2）10305名（男3064，女7349）受检者平均年龄男（640±6．0）岁，女（66．2±5．8）岁，文化程度以中学或以下为主，从事工人和农民职业占一半以上；（3）AAC检出率：为40．6％，女性（41．4％）高于男性（38．6％）；（4）AAC随年龄增加而明显增加（P〈0．001），但与职业无明显相关；（5）AAC主要发生于弓部（98．7％），长度〉10mm（57．6％）、宽度1～4mm（74．0％）占多数，提示≥50岁者AAC程度较为严重。结论广州市≥50岁者AAC检出率为40．6％，明显高于国外相关报道，程度也较严重，其原因及机理正在进一步探讨。

利用过程评价监测临床实践的质量

Richard J Lilford、Celia A Brown和Jon Nicholl称：生硬地用医疗的结局指标来评价其质量是不准确的。