Lipids and coronary heart disease in Asia

In Western countries, it has been shown that coronary heart disease (CHD) is related to high serum total cholesterol (TC) levels. In less developed continents such as Asia and Africa, serum lipid levels are low and CHD incidence is much lower as compared with Western countries. With growing urbanization and industrialization in Asia, it has been shown that there is a concomitant rise in the level of serum TC and with it a rise in CHD. In all the Asian countries, serum TC levels are also higher in the urban compared with the rural population. Singapore, the only Asian country which is 100% urbanized since 1980, showed a rise of serum TC similar to that seen in the US and UK from the 1950s to the 1980s followed thereafter by a fall. This is reflected in the trend (rise followed by a fall) of CHD morbidity and mortality as well. In spite of a declining trend in serum TC level, CHD morbidity and mortality are still high in Singapore and comparable to the Western countries. The rest of the Asian countries show a different pattern from Singapore. In general, there is still a rising trend in serum TC level and in CHD mortality in most Asian countries. However, Japan is considered an exception in having a decreasing CHD mortality in spite of an increasing trend in serum TC. This may be attributed to a better control of other CHD risk factors such as hypertension and smoking. The rising trend in serum TC level remains a cause for concern, as this will emerge as a major problem for CHD morbidity and mortality in the future.

Blood pressure indices and cardiovascular disease in the Asia Pacific region: a pooled analysis

This article aims to compare the importance of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP) as risk factors for stroke and ischemic heart disease and to assess whether the patterns are consistent by age and gender. Cox proportional-hazards regression, adjusted for cholesterol and smoking, was used to assess the associations of the 4 BP indices with stroke and ischemic heart disease by age and gender. The relative importance of individual indices was assessed with a hazard ratios for a 1-SD change in BP and by likelihood-ratio chi2 tests. The influence of >1 BP index in the Cox model was also estimated. The analyses demonstrated similar associations of SBP, DBP, and MAP with both fatal stroke and ischemic heart diseases, which were stronger than those of PP. Both SBP and MAP tended to be more important in the regression model than DBP or PP. In Cox models including DBP, addition of SBP improved the goodness of fit at all ages and for both genders. However, in Cox models including SBP, addition of DBP typically resulted in little incremental benefit over and above that of SBP alone. These data suggest that if time or resources are highly constrained, such as in much-needed epidemiologic surveys in developing countries, very little is lost from only measuring SBP.

[The biological characteristics of SARS virus and its related coronaviruses]

Cases of the life-threatening respiratory disease with no identified cause (designated as "severe acute respiratory syndrome", SARS, in March 2003) were first reported in late 2002 from Guangdong Province, China; they were followed by reports from about other 30 countries (or regions) such as Vietnam, Singapore, Thailand, Hong Kong (China), Canada, and USA etc. Because of its ongoing epidemic and high death rate, SARS has shined an intense spotlight all over the world. The World Health Organization (WHO) has promptly established a network of international laboratories consisting of 13 members around the 10 countries to facilitate the identification of the causative agent of SARS. A novel coronavirus, SARS virus, fulfilling all of Koch's postulates was announced to be the primary aetiological agent of SARS on April 16 by WHO shortly after the Canadian scientists released the full-length genome sequence of SARS virus (Tor2) on April 12. China is now facing a formidable task to fight SARS. In this article, we present a brief summary on the biological characteristics of coronavirus with its associated diseases, and make some suggestions on how to curb this outbreak and how to cure SARS disease based on the potential targets of this novel virus.

Are performance indicators generic? The international experience of the Quality Indicator Project

Performance indicators for healthcare organizations represent a strategy for accountability worldwide. A universal approach to either the design for indicators or their applicability to local needs remains a work in progress. The Maryland Hospital Association's Quality Indicator Project (QIP) is the only indicator-based performance measurement system used worldwide. This paper presents, for the first time in QIP's 17 years of existence, data showing why MHA's QIP may qualify as the most accepted generic methodology for healthcare performance measurement and evaluation.

Epidemiology of reflux disease and CLE in East Asia

Geoprevalence and chronoprevalence of reflux esophagitis were studied from a literature survey, which showed that the prevalence of reflux esophagitis seems to be correlated with economical development. In East Asia, prevalence of reflux esophagitis is between that of Western Europe and Africa. The prevalence of columnar-lined esophagus (CLE) was surveyed in East Asia and in Sendai, with reference to Helicobacter pylori infection. Prevalence of CLE was 0.9% in East Asia and 1.2% in Sendai, and H. pylori infection was 4% and 20%, respectively. Patient mean age was 63 years, and 73% were male. Endoscopic severity of esophagitis was mild. Adenocarcinoma of the esophagus has increased in Japan in the past 25 years, but the ratio to squamous cell carcinoma is low and no significant changes have been identified. Further observation is required because the prevalence of reflux esophagitis is increasing in Japan and East Asia.

Multicentre evaluation of the in vitro activity of linezolid in the Western Pacific

Multiresistance to antimicrobial agents is common in staphylococci and pneumococci isolates in the Western Pacific region. The activity of linezolid, a new oxazolidinone, was evaluated against a spectrum of Gram-positive species collected in the region. Eighteen laboratories from six countries in the Western Pacific examined the linezolid susceptibility of 2143 clinical isolates of Staphylococcus aureus, coagulase-negative staphylococci (CoNS) and Enterococcus spp. using broth microdilution or disc diffusion methodology. For Streptococcus pneumoniae (n = 351) and other streptococci (n = 83), Etest (AB Biodisk, Solna, Sweden) strips were used. Results were compared with other common and important antimicrobials. Linezolid-resistant strains were not detected among streptococci or staphylococci, including a significant proportion of S. aureus strains that were multiresistant. Almost all enterococci, including 14 vancomycin-resistant Enterococcus faecium, were linezolid susceptible. A small proportion of enterococci (0.8%) were intermediate to linezolid, and one strain of Enterococcus faecalis had a zone diameter of 20 mm (resistant). The linezolid MIC ranges (MIC(90)) of those strains tested by broth microdilution or Etest were: 1-4 mg/L (2 mg/L) for S. aureus, 0.5-4 mg/L (2 mg/L) for CoNS, 0.5-4 mg/L (2 mg/L) for Enterococcus spp., 0.12-2 mg/L (1 mg/L) for S. pneumoniae and 0.25-2 mg/L (1 mg/L) for Streptococcus spp. There was no difference in linezolid susceptibility between countries or between multiresistant and susceptible strains of each species monitored.

Recent outbreaks of foot and mouth disease in countries of east Asia

Japan regained the status of freedom from foot and mouth disease (FMD) without vaccination in September 2000 and the Republic of Korea likewise obtained this status in September 2001. However, new outbreaks of FMD caused by the pan-Asian topotype have occurred in pigs in the Republic of Korea since May 2002. Taipei China has not experienced an outbreak of FMD since February 2001 and the country is currently implementing an eradication programme. These countries had been free from FMD for many decades when in 1997, the FMD virus (FMDV) once again invaded the region, particularly in 2000; this resulted in widespread occurrence of the disease. The types of FMDV were investigated by genome analysis, and in each case the virus concerned was found to be a member of the pan-Asian O lineage. The authors present the recent situations and the characteristics of FMD in countries of east Asia.

Race/ethnicity and depressive symptoms: a cross-cultural/ethnic comparison among university students in East Asia, North and South America

To examine manifestations of depressive symptomatology among undergraduate students in East Asia, North and South America, responses to the Center for Epidemiologic Studies Depression Scale (CES-D) were compared across Japanese (n = 310), Anglo-American (n = 377), Native American (n = 353), and Argentinean (n = 110) undergraduate students. Japanese reported a significantly higher level of low positive affect, leading to significantly higher total CES-D scores, whereas their negative symptoms score was comparable to scores of Anglo-Americans and Argentineans. Although Native Americans were more likely to endorse negative symptoms, their low positive affect score was comparable to those of Argentineans. Argentineans appear to suffer less from depressive symptoms. Results from a Differential Item Functioning analysis, using Anglo-Americans as the reference group, indicated that: (1) the manifestation of depressive symptoms seemed to be similar for Anglo-Americans and Argentineans, except for low positive affect; (2) Native Americans tended to favor somatic symptoms over affective (depressive) symptoms; (3) responses to positive affect questions could possibly be biased not only for Japanese but also for people in North America; i.e., the expression of positive affect might be enhanced in North American culture, while inhibited in Japanese culture.

The molecular epidemiology of varicella-zoster virus: evidence for geographic segregation

Of 75 varicella-zoster virus (VZV) isolates obtained from patients in Africa, Asia, and the Far East, 74 (98.6%) were found to be positive for a BglI restriction site in gene 54. By contrast, <22% of strains from patients in the United Kingdom and in North and South America were positive for the BglI restriction site. Viruses positive for BglI were significantly more common in zoster occurring in patients of nonwhite origin (P<.05). Irrespective of the country in which the sample was obtained, 98% of strains positive for BglI clustered within a single phylogenetic group, which we termed "group A"; the exception was 1 strain that appeared to be recombinant genotype C/A. We used the BglI site to examine both the spread of type A viruses in the United Kingdom and the patterns of VZV infections within persons from different ethnic groups who grew up in the United Kingdom or abroad.

Cholangiocarcinoma: recent progress. Part 1: epidemiology and etiology

An attempt is made in this review to update the reader on recent developments and progress in the study of cholangiocarcinoma: a major primary carcinoma of the liver with a very poor prognosis. Knowledge of the cell biology and physiological functions of the cholangiocyte has recently so progressed that our understanding of cholangiocarcinogenetic mechanism is expected to follow. The first part of the review deals with semantic problems, temporal changes in the incidence of cholangiocarcinoma and geographic differences in epidemiology, etiologic factors (particularly opistorchiasis in Thailand and hepatolithiasis in the Far East), and discusses a recently disclosed role of hepatitis C virus infection (30% of cholangiocarcinoma patients have antibodies against hepatitis C virus in Japan).

Aplastic anemia in the Orient

Aplastic anemia (AA) is more common in Asia than in Europe or the United States. This may be due in part to the high incidence of hepatitis-associated AA in Asia. The management of AA has evolved rapidly in Japan during the last decade. Advances in the treatment of AA have largely been the result of prospective collaborative studies of immunosuppressive therapy and the large registry of bone marrow transplantation data. These studies have revealed several differences in clinical outcome between Western and Eastern patients, differences that may reflect the effects of genetic background on response to treatment or development of adverse effects.

[Possibilities of factor prognosis of the tick born encephalitis in the Primor'e region]

A technique of temporal factor prognosis of the tick born encephalitis infection during in real time has been elaborated and tested. High adequacy of prognosis for certain regions of the Maritime territory with the tick borne encephalitis foci has been achieved. This approach has a methodological and applied importance and may be used in medico-ecological and epidemiological investigations.

Taxonomy of trichodinids from the gills of marine fishes in coastal regions of the Yellow Sea, with descriptions of two new species of Trichodina Ehrenberg, 1830 (Protozoa: Ciliophora: Peritrichia)

Seven species of marine fishes from coastal regions of the Yellow Sea were examined for ectoparasitic trichodinids (Protozoa, Ciliophora). A total of seven species belonging to the genus Trichodina Ehrenberg, 1830, including two new species, occurred as gill parasites. These were T. rectispina n. sp., T. circinantis n. sp., T. frequentis Shtein, 1979, T. jarmilae Lom & Laird, 1969, T. hexagrammi Zhukov, 1964, T. minima Shtein, 1979 and T. ovonucleata Raabe, 1958. Each was investigated following silver nitrate and protargol impregnation. Morphometric data and comparative descriptions of these trichodinids are provided along with details of their prevalence and intensity of infestation.

[Some aspects of the resistance of natural foci of zoonosis infections with an example of the tick-borne encephalitis]

Epidermiological material reflecting some spatio-temporal aspects of the natural foci of tick-born encephalitis resistance has been analysed. The investigation carried out can used as a base for elaboration and realisation of factor prognoses concerning natural foci of zoonosis infection.

Global dissemination of the Mycobacterium tuberculosis W-Beijing family strains

A large, genetically related group of Mycobacterium tuberculosis strains, variously called W or Beijing, is distinguished by specific molecular markers and referred to as the W-Beijing family strains. Molecular epidemiological studies suggest that these strains are highly prevalent throughout Asia and the countries of the former Soviet Union and they have also been reported in several other geographical regions, including North America. Although the spread of W-Beijing family strains in diverse populations is well documented, the underlying host-pathogen factors accounting for their continued dissemination and burden of disease have yet to be determined.

Surveillance of antibiotic resistance in Neisseria gonorrhoeae in the WHO Western Pacific Region, 2000

A long-term program of surveillance of antimicrobial resistance in Neisseria gonorrhoeae isolated in the World Health Organization's Western Pacific Region (WHO WPR GASP) continued in 2000. About 11,000 gonococci were examined in 15 focal points. Widespread resistance to the penicillin group of antibiotics was confirmed. Resistance to quinolone antibiotics, already widely dispersed, increased further with a shift to higher levels of resistance in many centres. Gonococci with decreased susceptibility to third generation cephalosporins were observed in 5 centres. Spectinomycin resistance was infrequently encountered. Options for cheap and effective treatment of gonorrhoea in the WPR are increasingly limited.

Epidemiology of prostatic cancer in East Asia

Prostate cancer has become one of the most common malignancies in the world. The incidence of prostate cancer has rapidly increasing over the last decade in East Asia. In Japan, age-adjusted death rates due to prostate cancer rose from 4.4 to 8.6 per 100,000 between 1980 and 1998. Recent research has focused on age, race-related differences, patterns of familial aggregation, genetic factors, hormones, and diet. Epidemiological approach has identified several possible risk factors that may be useful for the prevention of prostate cancer and targeting high-risk individuals for early detection.

The incidence of vascular dementia in Canada: a comparison with Europe and East Asia

Vascular dementia (VaD) is the second commonest subtype of dementia after Alzheimer's disease (AD). However, its incidence has been studied much less extensively than that of AD. This article reviews the incidence data for VaD reported in the international literature. Results from 10 incidence studies are compared to those of the Canadian Study of Health and Aging using age-standardized incidence ratios (SIR). SIRs vary from 0.42 to 2.68, indicating that geographical variation is still present after taking into account the countries' differential age distributions. It is still unclear if these differences are due to genetic and/or environmental factors since a large part reflects methodological differences between studies.

Spondyloarthropathies in eastern Asia

The association between HLA-B27 and the spondyloarthropathies (SpAs) is so strong that it is supposed that the HLA-B27 molecule plays a pathogenetic role. In whites and Indonesians, the frequency of HLA-B27 is about 10%; in Chinese it is about 8%; and in Japanese it is only about 1%. The prevalence of SpA in the Chinese is at least 0.2%, but in native Indonesians, Philippinos, and Malaysians, SpA is rarely seen. Twenty-three subtypes (B*2701-B*2723) have been distinguished. These subtypes are not equally distributed over the world. In most countries the distribution of the subtypes among HLA-B27 SpA patients is the same as that among the normal HLA-B27-positive population. In China, the subtype B*2704 is frequent and the prevalence of SpA is high. Native Indonesians, however, mostly have subtype B*2706, and SpA is rarely seen in this population. It was shown that B*2706, probably like B*2709 in Sardinia, is not associated with SpA. The difference between the SpA-associated and non-SpA-associated subtypes is limited to only two amino acid residues (114 and 116) at the bottom of the peptide-binding groove of HLA-B27. This small difference between health and disease rewards studies for different peptide-binding capacities and may help us characterize the peptides that are involved in the pathogenesis of SpA. The differences in disease associations in these countries also have clinical implications. In Southeast Asia, HLA-B27 typing without subtyping has less clinical usefulness than in parts of the world where B*2706 is rarely seen. When native Indonesians, Malaysians, or Philippinos are suspected of having ankylosing spondylitis or a related SpA, it is worth asking if they had white or Chinese ancestors. If native HLA-B27-positive Indonesians (with subtypes other than B*2706) develop SpA, the clinical features are not different from those in other parts of the world. In the Chinese population on the mainland and in Taiwan, juvenile SpA is frequently seen. The onset is often a peripheral arthritis or enthesitis.

Epidemiology and epizootiology of hantavirus infection in Japan

Hantaviruses cause two severe human diseases: hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS). Various rodent species act as animal reservoirs for hantavirus. In Japan, urban rat- (Rattus norvegicus) and laboratory rat-derived human infections were reported during the 1960s and 1970s-1984, respectively. Although no human cases of infection have been reported since 1984, infected urban rats have been found throughout Japan, and infected grey red-backed voles (Clethrionomys rufocanus) have been identified in Hokkaido. These carriers can be considered to be potential sources of human infection. This review examines the epidemiology and epizootiology of this important zoonosis in Japan.