Prevalence of plasmodium falciparum in active conflict areas of eastern Burma: a summary of cross-sectional data

Conflict and war have long been recognized as determinants of infectious disease risk. Re-emergence of epidemic sleeping sickness in sub-Saharan Africa since the 1970s has coincided with extensive civil conflict in affected regions. Sleeping sickness incidence has placed increasing pressure on the health resources of countries already burdened by malaria, HIV/AIDS, and tuberculosis. In areas of Sudan, the Democratic Republic of the Congo, and Angola, sleeping sickness occurs in epidemic proportions, and is the first or second greatest cause of mortality in some areas, ahead of HIV/AIDS. In Uganda, there is evidence of increasing spread and establishment of new foci in central districts. Conflict is an important determinant of sleeping sickness outbreaks, and has contributed to disease resurgence. This paper presents a review and characterization of the processes by which conflict has contributed to the occurrence of sleeping sickness in Africa. Conflict contributes to disease risk by affecting the transmission potential of sleeping sickness via economic impacts, degradation of health systems and services, internal displacement of populations, regional insecurity, and reduced access for humanitarian support. Particular focus is given to the case of sleeping sickness in south-eastern Uganda, where incidence increase is expected to continue. Disease intervention is constrained in regions with high insecurity; in these areas, political stabilization, localized deployment of health resources, increased administrative integration and national capacity are required to mitigate incidence. Conflict-related variables should be explicitly integrated into risk mapping and prioritization of targeted sleeping sickness research and mitigation initiatives.     

Community-based delivery of maternal care in conflict-affected areas of eastern Burma: Perspectives from lay maternal health workers

In settings where active conflict, resource scarcity, and logistical constraints prevail, provision of maternal health services within health centers and hospitals is unfeasible and alternative community-based strategies are needed. In eastern Burma, such conditions necessitated implementation of the “Mobile Obstetric Maternal Health Worker” (MOM) project, which has employed a community-based approach to increase access to essential maternal health services including emergency obstetric care. Lay Maternal Health Workers (MHWs) are central to the MOM service delivery model and, because they are accessible to both the communities inside Burma and to outside project managers, they serve as key informants for the project. Their insights can facilitate program and policy efforts to overcome critical delays and insufficient management of maternal complications linked to maternal mortality. Focus group discussions (n = 9), in-depth interviews (n = 18), and detailed case studies (n = 14) were collected from MHWs during centralized project management meetings in February and October of 2007. Five case studies are presented to characterize and interpret the realities of reproductive health work in a conflict-affected setting. Findings highlight the process of building supportive networks and staff ownership of the MOM project, accessing and gaining community trust and participation to achieve timely delivery of care, and overcoming challenges to manage and appropriately deliver essential health services. They suggest that some emergency obstetric care services that are conventionally delivered only within healthcare settings might be feasible in community or home-based settings when alternatives are not available. This paper provides an opportunity to hear directly from community-based workers in a conflict setting, perspectives seldom documented in the scientific literature. A rights-based approach to service delivery and its suitability in settings where human rights violations are widespread is highlighted.     

Prevalence and associated factors of female genital mutilation among Somali refugees in eastern Ethiopia: a cross-sectional study

Background  

Eastern Ethiopia hosts a substantial number of refugees originated from Somalia. Female genital mutilation (FGM) is a common practice in the area, despite the campaigns to eliminate it.     

Distinct haplotypes of dhfr and dhps among Plasmodium falciparum isolates in an area of high level of sulfadoxine–pyrimethamine (SP) resistance in eastern Sudan

Typing of polymorphic microsatellites that are linked to drug resistance genes has shed light on the origin and pattern of spread of some anti-malarial drugs. Recent surveys revealed spread of a high-level pyrimethemine resistant lineage of Plasmodium falciparum, of Asian origin, across Africa. Here, we examined mutations in dihydrofolate reductase, dhfr [chromsosome 4], the dihydropteroate synthase, dhps [chromosome 8] associated with resistance to sulfadoxine–pyrimethamine (SP), and neighboring microsatellites among P. falciparum isolates in Asar village, eastern Sudan. This area lies at the fringes of malaria endemicity, where the remote P. falciparum parasites have some distinct genetic characteristics. Overall, 89% (84/94) of the examined isolates carried double mutations at dhfr (N51I and S108N), but the 59R and I164L mutations were not seen. Similarly, the majority, 43% (35/81) of the isolates carried double mutations at dhps (437G, 540E). Analysis of neighboring microsatellites revealed one major dhfr haplotype with mutations (51I, 108N) and one dhps haplotype with mutations (436S, 437G, 540E). These haplotypes differ from the major ones thought to drive resistance to SP across Africa. The resistant haplotypes of dhfr and dhps, in Asar, share some microsatellites with the wild genotypes suggesting that they were generated locally. Among isolates successfully examined, 40% shared identical haplotypes of the 2 loci, comprising a dominant resistant lineage. Undoubtedly, this lineage plays an important role in clinical failure to SP in this area.     

Essential trauma management training: addressing service delivery needs in active conflict zones in eastern Myanmar

Introduction  

Access to governmental and international nongovernmental sources of health care within eastern Myanmar's conflict regions is virtually nonexistent. Historically, under these circumstances effective care for the victims of trauma, particularly landmine injuries, has been severely deficient. Recognizing this, community-based organizations (CBOs) providing health care in these regions sought to scale up the capacity of indigenous health workers to provide trauma care.     

Endogenous social capital and self-rated health: cross-sectional data from rural areas of Madagascar

The aim of this study is to analyse the pathways between income and self-rated health through the mediating role of social capital. Taking up recent criticisms on statistical approaches to social capital, we propose to endogenize this concept as an outcome of households' economic status and personal characteristics. In this way it becomes possible to analyse both the compositional effect of social capital and its mediating role in the income-health causal pattern. The originality of this work rests on the production of two kinds of variables of social capital: the probability a household gets involved in social activities according to its characteristics; and a residual variable of social capital that is not predicated by household characteristics. Based on cross-sectional data from five rural areas of Antsirabe (Madagsacar) in 2001, this work suggests that a high level of social capital--especially in collective actions and social networks--leads to better self-rated health.     

Prevalence of erectile dysfunction and active depression: an analytic cross-sectional study of general medical patients

Erectile dysfunction is a common problem, affecting more than half of all men between the ages of 40 and 70 years. The authors' goal was to quantify the prevalence of concomitant erectile dysfunction and active depression among patients seen in a general medical setting between September 1998 and September 1999. Simple random sampling techniques were used to select a subset of 334 patients from 73 general medical practices affiliated with an academic tertiary referral center in Pennsylvania. Of the 334 patients sampled, the authors received responses from 268 subjects (80.2%) and completed questionnaires from 199 subjects (59.6%) with a mean age of 59 years. The survey instrument consisted of three major sections: demographic and health history information, the Center for Epidemiologic Studies Depression (CES-D) Scale, and the five-item version of the International Index of Erectile Function Scale. The prevalence of moderate or complete erectile dysfunction in this sample was 36.4% (95% confidence interval (CI): 29.6, 43.1). The prevalence of current depression by CES-D Scale criteria was 12.1% (95% CI: 7.5, 16.7), and the prevalence of concomitant erectile dysfunction and depression was 5.1% (95% CI: 2.0, 8.1). Using logistic regression, the authors found that current depressive symptoms were not associated with moderate or complete erectile dysfunction (odds ratio = 1.3, 95% CI: 0.5, 3.1; p = 0.565). Concomitant erectile dysfunction and depression represent a significant public health problem.     

Diversity of the sarco/endoplasmic reticulum Ca-ATPase orthologue of Plasmodium falciparum (PfATP6)

The sarco/endoplasmic reticulum Ca(2+)-ATPase orthologue of Plasmodium falciparum (PfATP6) has been suggested to be involved in the mechanism of action and resistance to artemisinins, the main constituent of artemisinin-based combination therapy (ACT). In previous studies only six single-nucleotide polymorphisms (SNPs) have been described in clinical samples and field isolates. Our aim was to sequence a large number of clinical samples with different geographical origins to further explore the natural diversity of PfATP6. We sequenced three genetic regions of PfATP6 in 388 samples from 17 countries, mainly Zanzibar and Tanzania, and identified 33 SNPs, of which 29 were non-synonymous and 4 synonymous. To our knowledge 29 of these SNPs have not been described previously. Three mutations were found in high frequency in Zanzibar and Tanzania; E431K, N569K and A630S were present in respectively 31% (95% CI, 26-37%), 36% (95% CI, 30-42%), and 2% (95% CI, 1-5%) of Zanzibar samples and in 39% (95% CI, 29-51%), 29% (95% CI, 16-45%) and 7% (95% CI, 1-22%) of the Tanzania Mainland samples. No variation was found in position 263, suggested to be involved in artemisinin binding to PfATP6, or in position 769, proposed to be related to decreased sensitivity to artemether in vitro. A considerable difference in diversity was observed between the three genetic regions. In conclusion our findings show that PfATP6 is a more diverse gene than previously demonstrated. This natural variation may constitute a starting ground for artemisinin-driven progressive selection of resistant parasites.     

甘肃省重性精神疾病现况调查

目的 了解甘肃省重性精神疾病的患病率和分布构成特点,为进一步开展重性精神疾病的社区防治和康复工作提供基础数据。方法 采用线索调查与整群抽样相结合的方法,于2015年4-9月对甘肃省内常住居民按照村、居委会、小区逐个摸底和排查,以精神与行为障碍分类(ICD-10)和中国精神障碍分类与诊断标准第三版(CCMD-3)为诊断标准对排查出的疑似患者进行确定诊断,采用SPSS 19.0软件进行统计分析。结果 截至2015年9月30日,甘肃省重性精神疾病确诊病例共47 215例,时点患病率为1.832‰,精神分裂症患病率为1.339‰,各类型患病率差异有统计学意义(χ²=109 928.571,P=0.000);农村地区重性精神疾病患病率(2.483‰)高于城市地区(0.803‰)(χ²=9 441.793,P=0.000);总体上,男性患病率(1.877‰)高于女性(1.784‰)(χ²=30.250,P=0.000),其中男性精神发育迟滞伴发精神障碍和癫痫所致精神障碍患病率均高于女性(χ²=326.274,P=0.000; χ²=120.624,P=0.000),而女性双相情感障碍和分裂情感障碍的患病率均高于男性(χ²=24.590,P=0.000; χ²=30.218,P=0.000);重性精神疾病患者主要集中在46~55岁年龄段(27.1%),多为汉族(94.6%)、小学以下文化程度(44.1%)、已婚(55.9%)、农民(79.5%)。结论 精神分裂症是重性精神疾病的管理治疗重点,同时应针对不同人群特征采取不同的管理治疗措施,今后应进一步加强对农村地区重性精神疾病患者的政策帮扶。     

Prevalence of cardiovascular diseases in Punjab,Pakistan: a cross-sectional study

Aim

The purpose of the present study was to measure the frequency of CVDs and some of the risk factors and to familiarize people with information on the high rates of mortality and morbidity due to CVDs in the studied areas of Punjab, Pakistan.

Subjects

Cardiovascular diseases (CVDs) are the leading cause of sudden death. CVDs are a major health problem in Pakistan, and the number of patients is increasing daily.

Aim

The purpose of the present study was to measure the frequency of CVDs and some of the risk factors and to familiarize people with information on the high rates of mortality and morbidity due to CVDs in the studied areas of Punjab, Pakistan.

Method

A cross-sectional study was conducted to investigate the prevalence of cardiovascular diseases in the local population of 53 cities in Punjab, Pakistan. A total of 6351 individuals were contacted to collect data using a questionnaire from October 2014 to September 2015. Data were collected directly by meeting the participants or indirectly through relatives and friends.

Results

Of the participants, 49.2% (3127/6351) were male and 50.8% (3224/6351) female. The data showed that 17.5% (1109/6351) of the population had CVDs with 16.6% (519/3127) being male and 18.3% (590/3224) female.

Conclusion

This study concluded that CVDs are a serious problem for both genders and affected 17.5% of the studied population. Diseases are more common in females than males with young age of onset. An inactive lifestyle, low level of activity and family history of disease could be disease risk factors in the study area.

     

Some epidemiological data on leprosy collected in a mass survey in Burma

In the WHO Leprosy BCG Trial in Burma a mass survey was undertaken to determine whether children had been exposed to patients with leprosy and, if so, the form of the index case. This paper presents the most important epidemiological data collected in this survey. The prevalence rate was 31.6 per 1 000. It seems that even if the prevalence rate is very high the L rate does not increase accordingly. The high T rates in areas of high endemicity seem to be related mainly to the degree of spreading of leprosy, even to persons who react to lepromin. Comparison of the results with data available for the area before the survey was made shows that 87% of the L cases had already been detected and that 54% of the T cases had not. There was a tendency for high L rates to be associated with high prevalence rates. The results do not suggest that any particular age group has greater susceptibility or resistance; the prevalence rates seemed to be related mainly to the age when exposure occurred. A higher prevalence of leprosy in males started to appear in the 10-14-year age group, and after the age of 15 the difference became impressive. Biological, socio-economic, and environmental factors seem to be responsible for the level of endemicity, which does not seem to be essentially or primarily related to ethnic origin.     

Prevalence of malnutrition in free living elderly people in Iran: a cross-sectional study

INTRODUCTION: The elderly are a particularly vulnerable group. Malnutrition is common and increases an old person's vulnerability to disease. We determine the prevalence of malnutrition in free living elderly people and its relationship with nutritional status and some socioeconomic conditions. METHODS: Nutritional status and its relationship with socioeconomic conditions were evaluated using Mini Nutritional Assessment in free-living elderly people (n=1962 using cluster sampling, 917 male/1045 female, aged>60). RESULTS: Among the population, 42.7% were well nourished, 12.0% malnourished and 45.3% at risk of malnutrition. There was more malnutrition in females compared to males (13% vs. 10.8%; p<0.001), rural than urban (14.8% vs. 9.9%; p<0.001), non educated than educated (13.3% vs 6.9%; p<0.001), lonely than living with family (17.5% vs. 10.3%; p<0.001), unemployed than employed (13.3% vs. 6.3%; p<0.05), elderly on income support (Behsisty charity) compared with elderly on retirement salary, (41.7% vs. 3.3%; p<0.05). Total Mini Nutritional Assessment scores correlated significantly with length of education, age, waist circumference, and body mass index (r =0.426, -0.142, 0.355 and 0.269 respectively). CONCLUSION: This study revealed a 12% malnutrition prevalence in this elderly group, with higher percentages in special socioeconomic conditions. Health care providers need to be aware of this problem and its scope. These results reinforce the need to screen, monitor and support elderly people.     

用科学发展观探索流浪精神病的救助问题

  目的  分析流浪精神病患者肇事肇祸行为的临床特征及其相关因素,探索流浪精神病人救助管理新思路。  方法  将2008年1月 — 2014年12月南宁市社会福利医院收治的2 332例流浪精神病患者按其是否肇事肇祸分为研究组和对照组,并用SPSS 22.0软件对数据进行χ²检验和多因素logistic分析。  结果  2 332例流浪精神病人中肇事肇祸742例（31.8 %）,其中男性肇事肇祸发生率高于女性（P = 0.001）,外省患者肇事肇祸发生率高于南宁本市患者（P = 0.000）,离异患者肇事肇祸发生率高于已婚患者（P = 0.025）;肇事肇祸患者较非肇事肇祸患者更易出现骨折（P < 0.05）,流浪精神病人营养不良比例（70.9 %）较高,且传染病发病率（15.5 %）高于正常人群;肇事肇祸患者的主要精神病种为精神分裂症（75.9 %）,活性物质所致精神障碍患者肇事肇祸发生率54.4 %（37/68）、心境障碍患者肇事肇祸发生率52.4 %（22/42）,均高于精神分裂症患者肇事肇祸发生率43.9 %（563/1 283）（P < 0.05）;研究组出现妄想、幻觉、违拗、易激惹、被动性服从、情绪高涨等阳性症状多于对照组（P < 0.05）,情绪淡漠、思维贫乏、注意减弱、缄默等阴性症状低于对照组（P < 0.05）;多元回归显示,离异、无职业、精神分裂症、易激惹、幻觉、情绪高涨是肇事肇祸发生的危险因素。  结论  流浪精神病患者肇事肇祸有其明显的临床特征。肇事肇祸发生率较高;阳性精神症状促使其肇事肇祸;离异、无职业、精神分裂症患者更易肇事肇祸。建议加强流浪精神病患者家庭及社会支持,促进社会功能恢复,并将其救助工作纳入政府及相关部门的重要议程;救助医疗机构设立外科及传染病区等,提高综合救助力度。     

太原地区3 173名老年人睡眠障碍现况调查

目的 了解太原地区老年人各种睡眠障碍的流行病学特点及失眠的相关因素.方法 采用多级抽样方法,对太原地区3173名60～100岁的老年人进行人户调查,筛选出有睡眠障碍症状者,由专科医生复查并作出诊断.结果 (1)3173名老年人中,有各种睡眠障碍症状者2132例,患病率为67.2%;其中失眠症、多梦、习惯性打鼾、日间嗜睡的患病率均较高,分别为39.65%、38.58%、26.66%、34.32%.(2)随着年龄的增长,男性老年人早醒、起夜次数多、日间嗜睡、睡眠呼吸障碍及睡眠节律紊乱的患病率有明显上升趋势(P＜0.01);随着年龄的增长,女性老年人早醒、日间嗜睡及睡眠节律紊乱的患病率也有明显上升趋势(P＜0.01).(3)经logistic回归分析,独居、情绪障碍、躯体疼痛、夜尿次数多(P＜0.01)与男性老年人失眠的发病有关;独居及麻/瘙痒等感觉异常(P＜0.01)、情绪障碍(P＜0.05)与女性老年人失眠的发病有关.结论 太原地区老年人中各种睡眠障碍的患病率有上升趋势;应注重老年人情绪、躯体疾病对睡眠的影响.

Abstract：

Objective To investigate the prevalence rates of sleep disorders and the correlatives in the elderly from Taiyuan city.Methods All of the 3173 elderly (aged 60 years to 100 years) in Taiyuan city were investigated at home through questionnaires,regarding their sleep condition.Subjects with sleep disorders were then screened through questionnaires and reexamined/diagnosed by special doctors.Results (1) Among the 3173 elderly,2132 subjects complained of having sleep disorders.The total prevalence of sleep disorders was 67.2%.The prevalence rates of chronic insomnia,multi-dreams,habitual snoring and daytime drowsiness were 39.65%,38.58%,26.66% and 34.32% respectively.(2)In the male elderly,the prevalence rates of being awaken early,having more urination at night,daytime drowsiness,sleep-respiratory disturbance and indiscriminate sleep rhythm increased with age(P＜0.01).However,in the female elderly,the prevalence rates of being awaken early,having daytime drowsiness and indiscriminate sleep rhythm also had a tendency of increase (P＜0.01).(3) Living alone,emotional disorder,pain and nocturia (P＜0.01) were the risk factors of chronic insomnia in the male elderly while living alone,numbness/pruritus(P＜0.01),emotional disorder (P＜0.05),were the risk factors of chronic insomnia in the female elderly.Conclusion The prevalence rates of some sleep disturbances in the elderly in Taiyuan city were generally correspondent with prevalence rates reported elsewhere that called for more attention be paid to the effect of mood disturbance and diseases related to sleep condition among the eldexly.     

Physical activity and serum lipids: a cross-sectional population study in eastern Finnish men.

The authors studied the association of the type, amount, and intensity of physical activity with serum lipids in 2,492 randomly selected eastern Finnish men aged 42-60 years during 1984-1989, controlling for the major confounding factors. High density lipoprotein cholesterol (HDL cholesterol) and HDL2 cholesterol were associated positively and triglycerides inversely with total, occupational, and leisure time activity in a multivariate regression model (p < 0.001). HDL3 cholesterol was associated positively only with total activity (p < 0.001). The adjusted relative differences in HDL cholesterol, HDL2 cholesterol, HDL3 cholesterol, and triglycerides between extreme total (occupational, leisure time) activity quartiles were 10.7% (9.0%, 5.7%), 12.2% (10.3%, 9.5%), 5.9% (2.9%, 0%), and 22.7% (9.2%, 10.4%), respectively. HDL cholesterol and HDL2 cholesterol were the highest and triglycerides the lowest at a conditioning activity intensity of more than 6 metabolic units (p < 0.001). The strongest associations were found for the 24-Hour Recording, which suggests short-term effects of physical activity on serum lipids. The beneficial effects of physical activity on serum lipids appear to be mediated partially by a reduced serum insulin concentration and decreased body adiposity. These data provide further confirmation for the concept that both regular or at least moderate intensity leisure time activity and occupational physical activity have a favorable impact on serum lipids.     

基于区域卫生信息平台的疾病预防控制业务应用与数据共享

目的基于信息化多平台大数据分析,了解2017年以来上海市宝山区高血压、糖尿病患者健康管理数据的质量变化情况,进一步评估质控措施的效果,为开展慢性病防治和管理提供建议。方法抽取2017和2019年宝山区高血压、糖尿病在管患者不同数据来源的身高、体重、血糖及诊疗信息等数据,分析不同来源数据的一致性等情况。结果2019年同时患有高血压和糖尿病患者(简称“高血压糖尿病共患者”)体重不一致比例低于2017年(10.99%与18.72%,χ²=822.38,P < 0.001),2019年身高不一致比例低于2017年(0.86%与2.74%,χ²=347.03,P < 0.001),差异均具有统计学意义;2019年高血压建卡对象诊疗溯源异常比例高于2017年(12.67%与11.72%,χ²=4.01,P=0.045),差异具有统计学意义,在糖尿病建卡对象中也得到相似的结果;2019年我区糖尿病患者糖化血红蛋白值各末尾构成比的变异系数明显低于2017年(0.19与0.31),且2019年糖化血红蛋白值末尾值为0的比例(4 701例,12.72%)低于2017年(9 485例,17.14%),差异具有统计学意义。结论上海市宝山区高血压、糖尿病健康管理数据质量有一定提升,应综合运用信息化手段,推进技术标准化,继续加强技术培训、数据质量控制和效果评价。     

Prevalence of infertility in rural areas of Kafr El-Sheikh-Egypt: a community-based study

The current study was carried out in Desok district-Kafr El Sheikh province, to measure the prevalence of primary and secondary infertility among rural women and to study some risk factors as well. The study included 1125 married women between 15-49 years. The results of the study showed that; 7.9% reported secondary infertility 2.5% experienced primary infertility, the prevalence of primary infertility is higher among women under 30 years than older ages, and secondary infertility increases with advance in age. Both types of infertility were higher among women married under the age of 16 or above 30 years. There was an insignificant difference between fertile group and infertile groups regarding age at menarche. Irregular menses was significantly higher among infertile groups compared to fertile group. Secondary infertility group had significant higher abortion and difficult labor than fertile group. There was an insignificant difference between the study groups regarding illiteracy rate. Chronic illnesses of women as well as husbands were significantly more reported among women with secondary infertility. In conclusion, the overall prevalence of infertility is 10.4 %.