Hepatitis B:Epidemiology and prevention in developing countries

Hepatitis B virus(HBV)infection is a serious global public health problem.The infection may be transmitted through sexual intercourse,parenteral contact or from an infected mother to the baby at birth and,if contracted early in life,may lead to chronic liver disease,including cirrhosis and hepatocellular carcinoma.On the basis of the HBV carrier rate,the world can be divided in 3 regions of high,medium and low endemicity.The major concern is about high endemicity countries,where the most common route of infection remains vertical transmission from mother to child.Screening of all pregnant women and passive immunization with human hepatitis B immunoglobulin are not affordable for many developing countries.The infection rate can be reduced by modifying behavior,improving individual education,testing all blood donations,assuring asepsis in clinical practice and screening all pregnant women.However,availability of a safe and efficacious vaccine and adoption of appropriate immunization strategies are the most effective means to prevent HBV infection and its consequences.The unsolved problem for poorest countries,where the number of people currently infected is high,is the cost of the vaccine.A future challenge is to overcome the social and economic hurdles of maintaining and improving a prevention policy worldwide to reduce the global burden of the disease.

Hepatitis A:Epidemiology and prevention in developing countries

Hepatitis A is the most common form of acute viral hepatitis in the world.Major geographical differences in endemicity of hepatitis A are closely related to hygienic and sanitary conditions and other indicators of the level of socioeconomic development.The anti-hepatitis A virus(HAV)seroprevalence rate is presently decreasing in many parts of the world,but in less developed regions and in several developing countries,HAV infection is still very common in the first years of life and seroprev-alence rates approach 100%.In areas of intermediate endemicity,the delay in the exposure to the virus has generated a huge number of susceptible adolescents and adults and significantly increased the average age at infection.As the severity of disease increases with age,this has led to outbreaks of hepatitis A.Several factors contribute to the decline of the infection rate,including rising socioeconomic levels,increased access to clean water and the availability of a hepatitis A vaccine that was developed in the 1990s.For populations with a high proportion of susceptible adults,implementing vaccination programs may be considered.In this report,we review available epidemiological data and implementation of vaccination strategies,particularly focusing on developing countries.

Human papillomavirus and gastrointestinal cancer: A review

Human papillomavirus(HPV) is one of the most common sexually transmitted infections worldwide. Exposure to HPV is very common,and an estimated 65%-100% of sexually active adults are exposed to HPV in their lifetime. The majority of HPV infections are asymptomatic,but there is a 10% chance that individuals will develop a persistent infection and have an increased risk of developing a carcinoma. The International Agency for Research on Cancer has found that the following cancer sites have a strong causal relationship with HPV: cervix uteri,penis,vulva,vagina,anus and oropharynx,including the base of the tongue and the tonsils. However,studies of the aetiological role of HPV in colorectal and esophageal malignancies have conflicting results. The aim of this review was to organize recent evidence and issues about the association between HPV infection and gastrointestinal tumours with a focus on esophageal,colorectal and anal cancers. The ultimate goal was to highlight possible implications for prognosis and prevention.

Insulin-like growth factor-1, IGF binding protein-3, and the risk of esophageal cancer in a nested case-control study

AIM To assess the relationship between serum levels of insulin-like growth factor-1(IGF1)/IGF-binding protein-3(IGFBP3)and the risk of esophageal carcinoma.METHODS We assessed the relationship between the serum levels of these molecules and the risk of esophageal cancer in a prospective,nested case-control study of participants from the Japan Collaborative Cohort Study.A baseline survey was conducted from 1988 to 1990.Of the 110585 enrolled participants,35%donated blood samples.Those who had been diagnosed with esophageal cancer were considered cases for nested case-control studies.A conditional logistic model was used to estimate odds ratios for the incidence of esophageal cancer associated with serum IGF1 and IGFBP3 levels.RESULTS Thirty-one cases and 86 controls were eligible for the present assessment.The molar ratio of IGF1/IGFBP3,which represents the free and active form of IGF1,was not correlated with the risk of esophageal carcinoma.A higher molar difference between IGFBP3and IGF1,which estimates the free form of IGFBP3,was associated with a decreased risk of esophageal carcinoma(P=0.0146),and people in the highest tertile had the lowest risk(OR=0.107,95%CI:0.017-0.669).After adjustment for body mass index,tobacco use,and alcohol intake,the molar difference of IGFBP3-IGF1 was inversely correlated with the risk of esophageal carcinoma(P=0.0150).CONCLUSION The free form of IGFBP3,which is estimated by this molar difference,may be inversely associated with esophageal cancer incidence.

Seroprevalence of Cryptosporidium and risks of cryptosporidiosis in residents of Sothern Egypt: A cross-sectional study

Objective: To identify the serological epidemiology of Cryptosporidium infections and to follow up on the changes in the infection profile in Southern Egypt in order to establish a suitable scheme for control and prevention of cryptosporidiosis.Methods: A total of 1 912(960 from human and 952 from animals) stool specimens and sera were screened for Cryptosporidium species using modified Ziehl Neelsen technique and a newly-developed enzyme-linked immunosorbent assay(ELISA).Environmental risk factors and socioeconomic data were surveyed by questionnaire between September 2016 and December 2017.Results: Totally, 20.83% of the human subjects were positive for Cryptosporidium infection tested by ELISA.The seropositivity was positively correlated with age.The prevalence of Cryptosporidium infections in females was significantly higher than in males(P<0.05).The sensitivity and specificity of ELISA for Cryptosporidium were 99.06% and 88.88%, respectively.Furthermore, a high prevalence of Cryptosporidium in domestic animals(42.20%).Conclusions: The study observed that Cryptosporidium infections are common in the study area, with water sanitation, socioeconomic level; eating habits and hygienic status are considered the main risk factors for cryptosporidiosis.Therefore, environmental sanitation and health education will be useful in reducing the prevalence of infection.

Preventive Effect of Lactococcus lactis subsp. lactis JCM 5805 Yogurt Intake on Influenza Infection among Schoolchildren

Objective: A community-based intervention study was conducted to examine the effect of consumption of JCM 5805 yogurt on influenza incidence rates and the cumulative incidence rates among schoolchildren in Iwate Prefecture, Japan. Methods: Schoolchildren and their parents in Shizukuishi town were told of the purpose, frequency and duration of JCM 5805 yogurt administration. The number of elementary schoolchildren in Shizukuishi town was 780 while that of junior high school students in Shizukuishi town numbered 475. The number of elementary schoolchildren in neighboring town A was 208 and that of junior high school students in town A was 121. JCM 5805 yogurt was delivered three times a week to all elementary schools and junior high schools in Shizukuishi town from January 16 through March 18, 2015. The incidence rate was calculated every week as the maximum case number divided by the number of schoolchildren in each school. The cumulative incidence rate was calculated as the total case number during the period when JCM 5805 yogurt was delivered divided by the number of schoolchildren in each school. Results: JCM 5805 yogurt intake was associated with a two-thirds reduction in influenza incidence rates in Shizukuishi town schoolchildren compared with those of town A. Furthermore, the cumulative incidence rates of the elementary school and combined data from the elementary school and junior high school were significantly lower than those of neighbor town A. Conclusion: JCM 5805 yogurt intake reduced both the incidence rates and cumulative incidence rates of influenza.

Relationship of Mothers’ Food Preferences and Attitudes with Children’s Preferences

Because early childhood is the most important time for establishing eating habits, controlling the likes and dislikes of children is significant. This study investigated the relationship between mothers’ food preferences as well as their attitudes toward food and their children’s preferences. A questionnaire was answered by 244 mothers of children aged 3-5 years who attended a private kindergarten in Japan. The mothers were asked questions relating to their own current food preferences and those during their childhoods, their eating and cooking habits, and the likes and dislikes of their children. Multiple logistic regression analysis was used to assess the relative importance of mothers’ preferences and habits for their children’s likes and dislikes. The children’s preferences were significantly related to their mothers’ likes and dislikes during childhood, rather than to their current preferences, and to the children’s breakfast times during holidays and the frequency with which the mothers used takeout meals. This suggests that mothers’ likes and dislikes during childhood and their food habits affect their children’s preferences. Therefore, to improve children’s food preferences, mothers may need to improve their food habits and consider their own food preferences during childhood.

Development of simple HPLC/UV with a column-switching method for the determination of nicotine and cotinine in hair samples

Nicotine and cotinine in hair are good biomarkers for assessing long-term exposure to smoking. However, analytical devices such as GC/MS are associated with high cost and are not widely used. HPLC/UV is used widely in laboratories, but is unsuitable for measurement of minor constituents, except when using the column-switching method. Thus, we aimed to establish a simple, inexpensive and sensitive method based on HPLC/UV with column switching for measuring nicotine and cotinine in hair. First, we compared the presence and absence of a column selection unit. We then measured amounts of nicotine and cotinine in hair samples collected from the general population, and compared both the corresponding levels and the detection limits with those in previous studies. Finally, initial and running costs of HPLC/UV were compared with other analytical methods. As one of the results, the areas of nicotine and cotinine measured by HPLC/UV with column-switching method were 12.9 and 16.9 times greater, respectively, than those without the column-switching method. The amount of nicotine and cotinine in hair was significantly correlated to number of cigarettes smoked per day (r = 0.228, p = 0.040). In addition, the HPLC/UV method showed similar sensitivity and detection limit (nicotine, 0.10 ng/mg;cotinine, 0.08 ng/mg) as reported in previous studies. The cost of the HPLC/UV method is lower than that of other analytical methods. We were able to establish a low-cost method with good sensitivity for measuring nicotine and cotinine in hair. The HPLC/UV with a column-switching method will be useful as a first step in screening surveys in order to better understand the effects of smoking exposure.

Sensitivity and Specificity of a Short Questionnaire to Screen Frailty in the Community-Dwelling Older Population

Introduction. Frailty represents a major risk factor for death and Use of Hospital Services (UHS) among older adults. A simple tool to detect frailty might permit stratification of the community-dwelling older population according to the risk of negative outcomes. The present study aims at determining the sensitivity and specificity in predicting mortality and UHS of the Short Functional Geriatric Evaluation (SFGE), a short questionnaire to screen for frailty in community-dwelling older citizens. Methods. The study is a secondary analysis of all the data collected through an observational longitudinal cohort study carried out in Lazio region (Italy). The SFGE is compared with the Functional Geriatric Evaluation (FGE) questionnaire to define sensitivity and specificity for mortality and for UHS during the first year following its administration. Results. The SFGE classifies 36.3% of the respondents as frail and shows a sensitivity of 90.4% and a specificity of 78.3% compared to the FGE (area under the ROC: 0.928;CL95%: 0.910 - 0.947;p-value Conclusion. The SFGE identifies as frail a larger portion of the enrolled population than the FGE. Those people so identified show a high rate of UHS. Because of its easy and quick administration, it can be considered a useful primary screening tool but it must be followed up with a more extensive assessment of those identified as frail. The small time needed to fill in the tool and the possibility of administering it by telephone makes the SFGE a useful tool to screen for frailty and to plan the provision of care services at both individual and population level.

Genetic Polymorphisms in ADH1B and ALDH2 Are Associated with Colorectal Tumors in Japan: A Case-Control Study

Background: Unlike with esophageal cancer, acetaldehyde levels and genetic polymorphisms in alcohol dehydrogenase have not yet been shown to be contributing factors for colorectal cancer (CRC). This study aimed to clarify the mechanism of CRC development related to alcohol consumption and to the presence of genetic polymorphisms in the alcohol dehydrogenase, ADH1B and aldehyde dehydrogenase, ALDH2. Methods: This was a case-control study (221 cases and 179 controls) in patients with adenomas and intramucosal tumors who underwent endoscopic removal of all tumors. The amount of alcohol consumption was determined using a self-recorded questionnaire, and the tumor information was obtained from colonoscopy results. Blood samples were taken to analyze the following polymorphisms: ALDH2 Glu504Lys and ADH1B His48Arg. Results: The polymorphisms in ADH1B and ALDH2 had little influence on the development of colorectal adenoma or intramucosal cancer. Patients with ALDH2 (Glu/Glu) were more tolerant of alcohol than those with ALDH2 (Glu/Lys and Lys/Lys). Next, we examined certain combinations of the ADH1B genotypes. In the ALDH2 (Glu/Glu) group, an increased risk (OR = 3.4;95% CI 1.4 - 8.4;P = 0.009) was observed among moderate/heavy drinkers with ADH1B (His/His). In the ALDH2 (Glu/Lys and Lys/Lys) group, an increased risk (OR = 4.2;95% CI 1.1 - 16.7;P = 0.041) was found among moderate/heavy drinkers with ADH1B (Arg/His and Arg/Arg). Conclusions: ADH1B and ALDH2 activity may be involved in the development of CRC.

老年人功能评估简表对死亡率和住院率的预测效能研究

目的生物-心理-社会衰弱与死亡风险增加和医疗卫生服务利用有关。本研究旨在评估老年人功能评估简表(Short Functional Geriatric Evaluation,SFGE)对老年人死亡率和住院率的预测效能。方法采用回顾性队列研究对参与意大利“老年人长寿!”项目的人群进行分析。共纳入8561名75岁以上的意大利社区居民,平均随访时间516.6 d。计算老年人死亡率、住院率、养老机构入住率和SFGE评估的衰弱程度并进行分析。SFGE评分中社会经济相关条目占40%。结果与健康老年人相比,衰弱前期、衰弱和非常衰弱老人死亡(RR分别为1.40、2.78和5.41)、住院(OR分别为1.31、1.67和2.08)和养老机构入住(OR分别为3.63、9.52和10.61)风险显著增加。在仅纳入社会经济条目的模型中得到类似结果。衰弱预测死亡率的受试者工作特征曲线下面积为0.70(95%CI 0.68~0.72),敏感性和特异性分别为83.2%和40.4%。结论SFGE评分通过对老年人衰弱程度进行分层来预测死亡、住院和养老机构入住风险。该评估工具简短、包含社会经济变量等特征使之可作为公众健康大样本筛查工具,将衰弱作为社区老年人照护的核心。

Effects of the 23-Valent Pneumococcal Polysaccharide Vaccine on the Mortality of Pneumonia among Elderly over 70 Years Old after the Great East Japan Earthquake—PPV Vaccination Program in Iwate Prefecture, Japan

Objective: To estimate the efficacy of 23-valent pneumococcal polysaccharide vaccine (PPSV23) among the elderly, we analyzed the relationship between the mortality of the elderly for pneumonia and the vaccination rate of PPSV23 from 2008 to 2016 in Iwate Prefecture, Japan. Study Design: The present study was a retrospective, observational, database study adopting an ecological design. The mortality for pneumonia among the elderly over 70 years old from 2006 to 2016 in Iwate Prefecture was calculated based on the data from the Japanese Vital Statistics. We compared the mortality rate (MR) of pneumonia among the elderly over 70 years old between the low-vaccinated period (LVP) (2006-2010) and high-vaccinated period (HVP) (2012-2016) using a Poisson regression model. Results: While the vaccination rate of PPSV23 among the elderly over 65 years old was 3.3% in 2010, it increased rapidly up to 40.7% in 2012 and reached 66.4% in 2016. The MR ratio of the total population during HVP to the average MR during LVP was 0.749. The MR of the total population during HVP was significantly lower than that during LVP (p Conclusion: The increase in vaccination rate of PPSV23 during HVP (2012-2016) may contribute to the decrease in mortality for pneumonia among the elderly over 70 years old in Iwate Prefecture.

人小梁网的氧化DNA损害——与原发性开角青光眼患者的临床相关性

目的：评价氧化的分子损害的强度及其临床相关性：视野（VF）损害、眼压、年龄和病程长短。 方法：从17例行标准滤过手术的青光眼患者收集的人小梁网标本中提取DNA。与21只角膜移植收集的健康眼标本作对照。氧化DNA损害由测定8-羟基-2’-脱氧鸟苷（8-OH-dG）水平来估价。所有患者术前均经Humphrey 30-2视野检查和日间眼压测量。 结果：在青光眼患者和对照组中，DNA氧化损害的均数±标准差分别为8．51±5．44和1．75±1．80 8-OH-dG个分子／10。正常核苷酸。在人小梁网DNA氧化损害、视野损害和眼压之间发现了统计学上显著的相关性。没有发现其他统计学上的显著相关性。 结论：氧化应激在原发性开角青光眼代表着一个重要的致病步骤。因为它诱发了人小梁网的变性，有助于眼压升高。由此启动了青光眼的发病级联过程。

What factors are associated with premature death among professional baseball players in Japan?

The aim of this study is to clarify factors related to premature death among Japanese professional baseball players by a case-control analysis. The subjects are two matching groups of 622 Japan Professional Baseball (JPB) league players, those deceased and those surviving. Cases and controls are matched by birth year. All players debuted on the first string between 1934 and 2003, and are listed in The Official Baseball Encyclopedia of Japan. To compare means and frequencies of characteristics between deceased and surviving groups, t-tests and chi-square tests were used. A logistic regression analysis was assessed contributions of each independent variable on death. Significant differences between deceased and surviving players were observed in this study;deceased players had higher body mass indexes and longer careers. Furthermore, logistic regression analysis confirmed that body mass index and career length were statistically significant determinants of death for baseball players. This is the first report to examine factors of death for professional baseball players except employing data attained from Major League Baseball.

Antimicrobial Activities of Essential Oils against Common Hospital Fungi Species

Introduction: In hospitals and other healthcare settings the presence of airborne and sedimented fungi is an extrinsic risk factor for opportunistic infections involving both immunocompromised and non-immunocompromised persons. In hospitalized patients, it is estimated that 9% of hospital-acquired infections are caused by fungi. Lethality rate varies from 40% to 100% depending on the immunosuppression degree of stakeholders. To prevent healthcare-associated infections, the control of environmental fungal contamination through use of sanitizing/disinfecting practices is basic. However, the widespread use of common disinfectants could promote the growth of antibiotic-resistant superbugs and cause environmental harm. These aspects stimulated the search of new antimicrobial agents. The aim of this study was to evaluate the antimicrobial activity of essential oils of Mentha insularis Req., Mentha pulegium L., Mentha requienii Bentham, Artemisia caerulescens L. ssp. densiflora (Viv), Rosmarinus officinalis L. var. albiflorus, Rosmarinus officinalis L. var. lavandulescens, and Ocotea puchury major Mart. against fungi species frequently found in hospitals and potentially responsible for opportunistic mycoses. Methods: The essential oils’ antifungal activity was carried out by agar disc diffusion technique. Results: All tested essential oils are effective, though to a different degree, against both molds that yeasts assessed. The major antifungal activity was showed by Mentha oils. Particularly, Mentha requienii and Mentha insularis oils were active until 1:8 dilution against Rhodotorula spp. and 1:16 dilution against mixed molds, while M. pulegium was strongly active until 1:2 against both fungi. Conclusions: To the best of our knowledge, few or no data are available in literature on the activity of essential oils against hospital environmental isolates of fungi. Results suggest their potential application in sanitation procedures of the hospital, and in general, of the “care settings”.