[Epidemiology of influenza A/California/07/09 (H1N1) in foreign countries in 2009 - 2010 season]

AIM

Study of spread ofa new influenza variant A(H1N1) in the world in 2009.

MATERIALS AND METHODS

Analysis of WHO weekly situation reports on influenza epidemic in the countries of the Northern and Southern hemisphere.

RESULTS

The first laboratory confirmed cases ofA/California/07/09 (H1N1) were registered in the countries of the Northern hemisphere in 10 days, and in other continents--in 1 month after the increase of morbidity. In the countries of Northern hemisphere 2 increases of A/California/07/09 (H1N1) morbidity were present--spring and autumn, and in the autumn period an increase of population morbidity, rate of hospitalization and number of lethal outcomes was noted. Only in Canada autumn increase of morbidity was not accompanied by an increase in severe influenza cases. In the Southern hemisphere a single but longer increase of morbidity was registered during the summer period. In the South-eastern Asia 2 increases were mostly present with a higher level during the first one.

CONCLUSION

A significant increase in morbidity in the autumn periodand its decrease at the same time in the Southern hemisphere are determined by varying seasonality of influenza in the countries of Northern and Southern hemisphere. Spring increase of morbidity was of mixed etiology; and in the autumn period influenza A/ California/07/09 (H1N1) virus dominated in the etiology of diseases.

Surveillance of antibiotic resistance in Neisseria gonorrhoeae in the WHO Western Pacific and South East Asian Regions, 2009

Long-term surveillance of antimicrobial resistance in Neisseria gonorrhoeae has been conducted in the World Health Organization (WHO) Western Pacific Region (WPR) to optimise antibiotic treatment of gonococcal disease since 1992. From 2007, the Gonococcal Antimicrobial Surveillance Programme (GASP) has been enhanced by the inclusion of data from the South East Asian Region (SEAR) and recruitment of additional centres in the WPR. Approximately 8,704 isolates of N. gonorrhoeae were examined for their susceptibility to one or more antibiotics used for the treatment of gonorrhoea, incorporating External Quality Assurance controlled methods, from reporting centres in 21 countries and/or jurisdictions. A high proportion of penicillin and/or quinolone resistance was again detected amongst isolates tested in North Asia and the WHO SEAR. In contrast, from the Pacific Island states Fiji reported low penicillin and quinolone resistance, New Caledonia again reported no penicillin resistance and little quinolone resistance, Tonga reported no penicillin resistance and there was a continued absence of quinolone resistance reported in Papua New Guinea in 2009. The proportion of gonococci reported as 'decreased susceptibility' and 'resistant' to the third-generation cephalosporin antibiotic ceftriaxone varied widely but no major changes were evident in cephalosporin minimum inhibitory concentrations (MIC) patterns in 2009. Altered cephalosporin susceptibility has been associated with treatment failures following therapy with oral third-generation cephalosporins. There is a need for revision and clarification of some of the in vitro criteria that are currently used to categorise the clinical importance of gonococci with different ceftriaxone and oral cephalosporin MIC levels. The number of instances of spectinomycin resistance remained low. A high proportion of strains tested continued to exhibit high-level plasmid mediated resistance to tetracyclines. The continuing emergence and spread of antibiotic resistant gonococci in and from the WHO WPR and SEAR suggests that surveillance programs such as GASP be maintained and expanded.

Sleep disturbances among offshore fleet workers: a questionnaire-based survey

BACKGROUND. Shift work is related to fatigue and desynchronization with the external environment. This study investigates how 6-h shifts and 12-h shifts affects sleep and safety in workers onboard offshore supply vessels, and if any differences exist between the two working schedules. MATERIAL AND METHODS. A questionnaire study was carried out in the North Sea, Australia, Africa, South America, and the Far East, with 577 participants. The offshore fleet workers gave information on parameters related to sleep disturbances, causes of sleep disturbances, and safety. Regional differences in these parameters were also investigated. RESULTS. Workers on 6-hour shifts reported significantly more sleep problems than 12-hour shift workers did (p 〈 0.01). The 6-hour workers were more affected by noise (p 〈 0.01) and shift-work itself (p 〈 0.01). CONCLUSIONS. Those working 6-hour shifts suffer more from sleep disturbances than those on 12-hour shifts, but this is not reflected in the perception of safety within the individual. Noise and shift-work itself is more of a problem in the 12-hour workers. Differences in safety culture and work morale are likely to cause the differences between regions.

[Alcohol intake and stroke in Eastern Asian men:a systemic review and meta-analysis of 17 prospective cohort studies]

OBJECTIVE

To assess the dose-response relationship between alcohol intake and relative risk of stroke and all-cause mortality among Eastern Asian men.

METHODS

Potential prospective cohort studies were retrieved by searching Pubmed (1966 - 2000), OVID (1980 - 2009), Embase (1980 - 2009) and ISI Web of Knowledge (1986 - 2009) using Medical Subject Headings: alcohol drinking, ethanol, stroke, cerebrovascular disease, mortality, etc; and Koreans or Japanese or Chinese. From the relevant retrieved reports, 17 prospective cohort studies fulfilling the criteria were included into the study. Information on study design, participant characteristics, amount of alcohol intake, stroke and/or all-cause mortality outcomes, control for potential confounding factors and risk estimates was abstracted by a standardized protocol. For each study, relative risk (RR) and 95% confidence interval (CI) were extracted and pooled with either a fixed or random effect model according to the results of the test of heterogeneity.

RESULTS

As data available for women were too limited to be included into our meta-analysis, this study focused on male subjects, ranging from 1322 to 108 461 subjects among these 17 cohort studies. Compared with nondrinkers, the RRs of ischemic stroke for those drinking alcohol ≤ 20, 21 - 40, 41 - 60, > 60 g/d, were 0.85 (0.78 - 0.93, P = 0.0002), 0.94 (0.79 - 1.11, P = 0.46), 1.08 (0.86 - 1.37, P = 0.50) and 1.24 (0.96 - 1.59, P = 0.10) respectively. Similarly, RRs of hemorrhagic stroke were 0.92 (0.75 - 1.12, P = 0.46), 1.11 (0.96 - 1.28, P = 0.17), 1.20 (0.92 - 1.56, P = 0.18) and 1.74 (1.32 - 2.28, P < 0.01); and those of all-cause mortality were 0.83 (0.75 - 0.91, P = 0.01), 0.93 (0.87 - 0.99, P = 0.03), 1.01 (0.95 - 1.07, P = 0.86) and 1.32 (1.29 - 1.36, P < 0.01) respectively.

CONCLUSION

In Eastern Asian men, light alcohol intake (≤ 20 g/d) is associated with a lowered risk of ischemic stroke whereas heavy alcohol intake is associated with an elevated risk of stroke, particularly hemorrhagic stroke and all-cause mortality.

[Alcohol consumption and coronary heart disease in Eastern Asian men: a meta-analysis of prospective cohort studies]

OBJECTIVE

To assess the dose-response relationship between alcohol consumption and relative risk of coronary heart disease (CHD) morbidity, mortality and all-cause mortality among Eastern Asian men.

METHODS

Potential prospective cohort studies were retrieved by searching Pubmed (1966 - 2000), Biosis Previews (1980 - 2009), Embase (1980 - 2009) and ISI Web of Knowledge (1986 - 2009) using Medical Subject Headings alcohol drinking, ethanol, coronary heart (or artery) disease, myocardial infarction, mortality, etc; and Koreans, or Japanese or Chinese. From the 28 relevant retrieved reports, 15 prospective cohort studies met the criteria were included. Information on study design, participant characteristics, level of alcohol consumption, CHD outcome, control for potential confounding factors, and risk estimates were abstracted using a standardized protocol. For each study, relative risks (RR) and 95% confidence intervals (CI) were extracted and pooled with either a fixed effect model or random effect model according to the result of the test of heterogeneity.

RESULTS

Due to the limited available data for women, this study only comprised of 2406 cases of CHD among 177 723 male subjects. Findings were also pooled from 216 233 male subjects and 15 462 deaths from any cause. Compared with nondrinkers, the RRs on CHD morbidity for those who drank alcohol ≤ 20, 21 - 40, 41 - 60, > 60 g/d were 0.65 (0.34 - 1.23, P = 0.18), 0.48 (0.26 - 0.87, P = 0.02), 0.46 (0.32 - 0.67, P < 0.01), and 0.48 (0.29 - 0.78, P < 0.01) respectively; the RRs on CHD mortality were 0.98 (0.73 - 1.31, P = 0.87), 0.68 (0.58 - 0.79, P < 0.01), 0.64 (0.43 - 0.96, P = 0.03), 0.75 (0.54 - 1.03, P = 0.08); and on all-cause mortality were 0.83 (0.79 - 0.91, P < 0.01), 0.93 (0.87 - 0.99, P = 0.03), 1.01 (0.95 - 1.07, P = 0.86), 1.32 (1.29 - 1.36, P < 0.01).

CONCLUSION

Light-to-moderate alcohol intake was associated with decreased risk of CHD morbidity and mortality, while heavy alcohol intake was associated with increased all-cause mortality among Eastern Asian men.

Multiparasitism a neglected reality on global, regional and local scale

This review focuses on the issue of multiparasitism, with a special emphasis on its characteristics, its extent in eastern Asia and its significance for infectious disease control. Multiparasitism is pervasive among socially and economically disadvantaged or marginalised communities, particularly in tropical and subtropical areas. Intestinal parasites are the most numerous group, but an array of parasites is located elsewhere than in the human gastrointestinal tract. Although multiparasitism has been recognised for decades, in-depth studies are rare, and its public health and economic implications have yet to be fully elucidated. The assessment of multiparasitism is hampered by a lack of sensitive broad-spectrum diagnostic tools and the need to collect multiple biological samples for detailed appraisal. Non-specific symptoms and mainly subtle effects complicate the appreciation of its influence on cognitive and physical development, health, economic productivity and general well-being. Multiparasitism has been reported from virtually every eastern Asian country, and studies regarding the extent of multiparasitism and its effects on child health have been implemented in the region. However, new research is needed, as no comprehensive evaluations of multiparasitism in eastern Asia could be identified. Two case studies pertaining to multiparasitism at the local and regional scale are presented. Multiparasitism was rampant in an ethnic minority village in southern People's Republic of China where the challenges associated with its thorough evaluation are illustrated. The results from a cross-sectional survey covering 35 villages highlight the significance of its evaluation for the design of locally adapted and sustainable parasite control and poverty alleviation programmes. We conclude by listing a set of research needs for future investigations.

Income inequality and periodontal diseases in rich countries: an ecological cross-sectional study

There are adverse effects of income inequality on morbidity and mortality. This relationship has not been adequately examined in relation to oral health.

AIMS

To examine the relationship between income inequality and periodontal disease in rich countries.

PARTICIPANTS

Adults aged 35-44 years in 17 rich countries with populations of more than 2 million.

METHODS

National level data on periodontal disease, income inequality and absolute national income were collected from 17 rich countries with populations of more than 2m. Pearson and partial correlations were used to examine the relationship between income inequality and percentage of 35-44-year-old adults with periodontal pockets > or = 4 mm and > or = 6 mm deep, adjusting for absolute national income.

RESULTS

Higher levels of income inequality were significantly associated with higher levels of periodontal disease, independently of absolute national income. Absolute income was not associated with levels of periodontal disease in these 17 rich countries.

CONCLUSION

Income inequality appears to be an important contextual determinant of periodontal disease. The results emphasise the importance of relative income rather than absoluteincome in relation to periodontal disease in rich countries.

[Alzheimer's disease in Japan and other countries: review of epidemiological studies in the last 10 years]

Alzheimer disease (AD) is the most common type of dementia. In this review article, we summarized the current findings concerning the prevalence and incidence of AD in Japan and other countries; these findings were reported in the last 10 years. The prevalence of dementia among individuals aged more than 65 and more than 75 years was 2.4%-8.4% and 15.8%, respectively; this was determined according to the DSM-IV or DSM-III-R criteria. Further, the worldwide ratio of AD and vascular dementia (VaD) was 1.8-4.8, which was calculated according to the NINCDS-ADRDA and NINDS-AIREN criteria. In Japan, the prevalence of dementia among individuals aged more than 65 years was 3.8%-11.0%; this value was calculated according to the DSM-IV or DSM-III-R criteria. Further, the AD/VaD ratio among these individuals was 2.1-4.1, which was calculated according to the NINCDS-ADRDA and NINDS-AIREN. The prevalence of dementia and the AD/VaD ratios vary widely among the previous reports. The reasons for this are variations in the diagnostic criteria, epidemiological methods, demographics caused by the aging population, and mortality rate. It is necessary to establish a standard international epidemiological method worldwide. In addition, the diagnostic criteria of other types of dementias such as dementia with Lewy bodies and idiopathic normal-pressure hydrocephalus should be considered.

Timing of relapse in short-course chemotherapy trials for tuberculosis

We have reviewed the results from 15 tuberculosis treatment trials initiated by the British Medical Research Council between 1970 and 1983 in Africa and East Asia. Of 574 relapses, 447 (78%) occurred within 6 months of stopping treatment and 525 (91%) within 12 months. We suggest that investigators should consider terminating follow-up after the last enrolled patient completes 6 months following treatment, while continuing to follow patients enrolled earlier until that time. Compared to following all patients to 24 months, the total trial duration could be reduced by 18 months, with no increase in patient numbers in a non-inferiority design.

Comparison of incidence of intrahepatic and extrahepatic cholangiocarcinoma--focus on East and South-Eastern Asia

BACKGROUND

The term "cholangiocarcinoma" was originally used only for intrahepatic bile duct (adeno)carcinomas, but is now regarded as inclusive of intrahepatic, perihilar, and distal extrahepatic tumors of the bile ducts. A rise in incidence of intrahepatic cholangiocarcinoma has been recently reported in Western countries but comparatively little is known about recent cholangiocarcinoma incidence trends in East and South-Eastern Asia.

METHODS

We compared age-adjusted incidence rates of both intrahepatic and extrahepatic cholangiocarcinomas, as well as coding practices, using data from 18 cancer registries in Asia and 4 selected registries in Western countries. Intrahepatic cholangiocarcinoma incidence rates were calculated after reallocation of cases with unknown or unspecified histology among liver cancer cases.

RESULTS

Age-adjusted incidence rates of intrahepatic cholangiocarcinoma varied by more than 60-fold by region. The highest rates were found in Khon Kaen, Thailand, where 90% of liver tumors were cholangiocarcinomas. The next highest rates were found in the People's Republic of China, followed by the Republic of Korea. The highest age-adjusted incidence rate for extrahepatic cholangiocarcinoma was found in Korea. Coding practices for perihilar (Klatskin tumor) or unspecified sites of cholangiocarcinoma differed from one cancer registry to the other. The proportion of Klatskin tumors among cholangiocarcinomas was less than the one reported in clinical settings.

CONCLUSION

Developing a consistent and uniform topographical classification for acceptable coding practice to all health professionals is necessary. In addition, epidemiological research on risk factors according to anatomical location (intrahepatic versus extrahepatic) and the macroscopic appearance and/or new histological classification of cholangiocarcinoma is also needed.

[Prevalence of secondary deformities of dentition and diseases of temporomandibular joint in the population of Far East]

Epidemiological survey of 1161 indigenous people (I group) and 1000 people came (II group) of the population of Far East in the age over than 20 years was conducted. Established that the deformation of dentitions at diagnosis was found in 22.13% I group, 20.1% II group, reduced occlusion in 15.84% (I group) and 11.0% (II group). Pathology of the TMJ was defined at 8.68% of men and 26.15% of women in group I, 8.24% men and 30.04% of women in group II.

Controlling SARS: a review on China's response compared with other SARS-affected countries

OBJECTIVE

To summarise the major control measures implemented by severe acute respiratory syndrome (SARS)-affected countries and to compare distinctive features of the Chinese approach to other affected Asian countries and Canada.

METHOD

Literature review.

RESULTS

The realisation in March 2003 that SARS was spreading led affected countries to introduce measures such as rapid dissemination of information, early case detection and isolation, tracing and quarantining of SARS contacts, traveller screening, raising public awareness of risk and institution of stricter infection control in health care settings. SARS became a notifiable disease in China in mid-April 2003, after which introduction of efficient nationwide control measures led to containment within 2 months. Countries differed in the timeliness of implementing control measures, the mode and extent to which these were enforced and in the resources available to do so.

CONCLUSION

SARS challenged the political and public health systems of all affected countries. It demanded rapid and decisive action to be taken, yet the comparison shows how difficult this was for an unknown new disease. Guangdong reacted rapidly but this pace was not continued by China for some time, which facilitated national and international spread. Once the Chinese government changed its policy, it developed an impressive control strategy involving the public which culminated in containment. The significance of timely information was perhaps the main lesson which the SARS epidemic taught.

Proposal for a cooperative study on population-based cancer survival in selected registries in East Asia

Reliable population-based cancer survival data are essential for assessment of the effectiveness of cancer screening programs, distribution of cancer therapy and prevalent cancer cases. International comparisons are useful to allow societies, mass media and health authorities to gain a real appreciation of the cancer problem in their own country and provide an impetus to improve registration and cancer control planning. Since directly comparable survival data among East Asian countries are presently very limited, a comparative study on population-based cancer survival involving China, Indonesia, Japan, Korea, the Philippines and Taiwan, with Nepal as an observer, was proposed. At the 1st Working Group meeting in Tokyo on March 18th, 2009, it was decided to publish the present Commentary as a step towards realization of truly comparable cancer survival statistics in the region. Included are general information and quality of data of cancer registration at each participating registry and five-year relative survival rates of cancer of the stomach, colo-rectum, liver, lung, breast and cervix.

Genetic history of hepatitis C virus in East Asia

The hepatitis C virus (HCV), which currently infects an estimated 3% of people worldwide, has been present in some human populations for several centuries, notably HCV genotypes 1 and 2 in West Africa and genotype 6 in Southeast Asia. Here we use newly developed methods of sequence analysis to conduct the first comprehensive investigation of the epidemic and evolutionary history of HCV in Asia. Our analysis includes new HCV core (n = 16) and NS5B (n = 14) gene sequences, obtained from serum samples of jaundiced patients from Laos. These exceptionally diverse isolates were analyzed in conjunction with all available reference strains using phylogenetic and Bayesian coalescent methods. We performed statistical tests of phylogeographic structure and applied a recently developed "relaxed molecular clock" approach to HCV for the first time, which indicated an unexpectedly high degree of rate variation. Our results reveal a >1,000-year-long development of genotype 6 in Asia, characterized by substantial phylogeographic structure and two distinct phases of epidemic history, before and during the 20th century. We conclude that HCV lineages representing preexisting and spatially restricted strains were involved in multiple, independent local epidemics during the 20th century. Our analysis explains the generation and maintenance of HCV diversity in Asia and could provide a template for further investigations of HCV spread in other regions.

Equity, food security and health equity in the Asia Pacific region

What, and how much, people eat is a response to their socio-political, socio-economic, socio-environmental and socio-cultural environments. Good nutrition is central to good health. Globally, health has improved for many but not for everyone equally. That food and nutrition-related health is unequally distributed is a marker of societal failure. For some individuals, communities and even nations, it is a matter of not having enough food, of being unable to afford food and there being little nutritious food readily available. For others there is an over abundance of food but its nutritional quality is compromised, access to healthy food is poor and cost of food is high relative to other commodities. Human development and poverty reduction in the Asia Pacific region cannot be achieved without improving nutrition in an equitable way. There is no biological reason for the scale of difference in health, including diet-related health that is observed in the Asia Pacific region. That it exists is unethical and inequitable. Asymmetric economic growth, unequal improvements in daily living conditions, unequal distribution of technical developments and suppression of human rights have seen health inequities perpetuate and worsen, particularly over the last three decades. Addressing diet-related health inequities requires attention to the underlying structural drivers and inequities in conditions of daily living that disempower individuals, social groups and even nations from the pursuit of good nutrition and health. These are matters of economic and social policy at the global, regional and national level.

Improved food availability for food security in Asia-Pacific region

Food security requires that all people can access sufficient food for a healthy life. Enough food is produced to feed the global population, but more than 1.02 billion people are malnourished. Malnutrition and chronic food insecurity are widespread in some countries of the Asia-Pacific region; as much as 20 to 60 percent of the region's population lacks sufficient food to meet their minimum energy requirement. Food security greatly depends on food availability, although this alone is not sufficient to secure satisfactory nutritional status. Food security at the national level requires an effective framework of food, health, and economic systems coupled with awareness and consideration of environmental conditions. To improve food availability and security in the short term, lower income countries should focus on increasing productivity in the food system to generate higher incomes for workers on-farm and off-farm in the food chain. Over the long term, sustainable and small-scale farming based on ecologically viable systems should be the emphasis for agricultural development. Nutrition and health sectors should help promote food-based approaches that lead to diversification of crops, balanced diets, and ultimately better health.