The effectiveness of school educating program for betel quid chewing: A pilot study in Papua New Guinea

Background

To investigate the effectiveness of educating program among primary and secondary school students in Papua New Guinea, where has the highest incidence of oral cancer all over the world.

Iodine status of Tasmanians following voluntary fortification of bread with iodine

OBJECTIVE: To describe changes in the iodine status of Tasmanians following voluntary fortification of bread with iodine in October 2001. DESIGN AND SETTING: Post-intervention, cross-sectional urinary iodine surveys of Tasmanian schoolchildren aged 8-11 years were used to assess population iodine status. Participants were selected using a one-stage cluster sampling method. The sampling frame comprised classes containing fourth-grade children from all Tasmanian government, Catholic and independent schools. Results were compared with pre-intervention survey results. MAIN OUTCOME MEASURES: Median urinary iodine concentration (UIC) and percentage of UIC < 50 microg/L ascertained from spot urine samples. RESULTS: Median UIC was 75 microg/L in 1998, 72 microg/L in 2000, 105 microg/L in 2003, 109 microg/L in 2004 and 105 microg/L in 2005. Median UIC in post-intervention years (2003-2005) was significantly higher than in pre-intervention years. The percentage of UIC results < 50 microg/L was 16.9% in 1998, 18.7% in 2000, 10.1% in 2003, 10.0% in 2004 and 10.5% in 2005. CONCLUSION: Despite methodological differences between the pre- and post-intervention surveys, switching to iodised salt in bread appears to have resulted in a significant improvement in iodine status in Tasmania. Given iodine deficiency has been identified in other parts of Australia and in New Zealand, mandatory iodine fortification of the food supply in both countries is worthy of consideration. As voluntary fortification relies on industry goodwill, mandating fortification could be expected to enhance population reach and give a greater guarantee of sustainability in Tasmania.     

Birth defects: traditional explanations of causation recalled by medical and dental students in Papua New Guinea at the commencement of their preclinical education

Three intakes of medical and dental students to the University of Papua New Guinea were asked to recall traditional explanations of the causes of birth defects. Of 71 students who responded to the questionnaire 56% were from Papua New Guinea. The explanations were grouped into the principal categories of supernatural (39%), environmental (37%) and genetic (14%). The dominant themes were punishment, wrong foods, genetic faults, breaking of taboos, spirits, injuries, drugs, sexual misdemeanours, sorcery and illness. Health workers who counsel parents of babies with birth defects should bear these beliefs in mind and try to reconcile them with scientific explanations for birth defects, particularly as the aetiology of most defects is still unknown.     

Border testimonials: patterns of AIDS awareness across the island of New Guinea

This paper compares and contrasts two similar sets of data about AIDS (acquired immune deficiency syndrome) and AIDS awareness from the island of New Guinea. The goal of this comparison is to show that state policies and values can dramatically affect personal knowledge about safer sexual practices. One set was collected in 2001 in the Indonesian province of Papua, which is home to indigenous Papuans and many inmigrating Indonesians. The second set was collected in 1991-1992 in the independent state of Papua New Guinea (PNG). Papuans and Papua New Guineans share many sexual beliefs and cultural practices and have experienced similar effects of modernization, but we show that there are marked differences in public knowledge about AIDS and condoms. In general, Papuan respondents know less about condoms and use them less frequently than their PNG counterparts. We argue that a colonial form of government in Papua makes it more difficult to design culturally appropriate and effective programs.     

重庆市万州区2011—2018年学生肺结核疫情分析

目的 分析重庆市万州区登记的学生肺结核病例资料,了解肺结核流行特征,为制定防控策略提供参考依据。方法 采用SPSS18.0统计分析软件对该区2011—2018年登记的学生肺结核患者资料进行描述性分析。结果 万州区2011—2018年共登记学生肺结核患者712例,年均登记率为29.16/10万,登记率无明显变化,学生患者占全人群患者的7.58%。8年间每月均有学生患者登记,3—4月达高峰,共登记230例,占登记学生患者总数的32.3%。年龄主要集中在16~19岁,共472例,占登记学生患者总数的66.29%;各年龄段男生患者均多于女生,男女性别比1.62∶1;寄宿制学校登记率高于非寄宿制学校,民办寄宿制学校登记率高于公办寄宿制学校。就诊延迟率为66.01%。结论 重庆市万州区学生肺结核疫情形势严峻,建议将结核病防治知识内容纳入学校健康教育常规课程,加大校内结核病防治知识的宣传;争取财政经费支持,对疫情高的寄宿制学校的学生开展结核病筛查;加大对民办学校结核病防控工作的督导力度。     

Non-identical newborn twins with congenital adrenal hyperplasia.

Two neonates, one female and one male, with congenital adrenal hyperplasia due to 21-hydroxylase deficiency are described. The inheritance of this disease is autosomal recessive. It is of interest that these two babies were non-identical twins. 21-hydroxylase deficiency is briefly discussed and some relevant aspects of the hormonal control of the development of morphological or phenotypic sex are presented. Some of the difficulties encountered following the diagnosis of this condition in Papua New Guinea are mentioned.     

Therapeutic efficacy of chloroquine or amodiaquine in combination with sulfadoxine-pyrimethamine for uncomplicated falciparum malaria in Papua New Guinea

Resistance of Plasmodium falciparum to chloroquine is widespread in Papua New Guinea. At a meeting in Port Moresby in October 1997, it was decided to explore a possible change of the current first-line treatment of uncomplicated malaria with chloroquine alone (amodiaquine for children under five years) to chloroquine or amodiaquine in combination with sulfadoxine-pyrimethamine (S-P). To assess the therapeutic efficacy of the new drug combination in Papua New Guinea, a study was carried out in 1998-1999 at five hospital outpatient departments. From the 513 patients enrolled for the study, 95 defaulted from follow-up. Of the remaining 418, 399 (95.5%) had an adequate clinical response (ACR). Out of the 19 patients who did not have an ACR, 3 (0.7% of the total) developed severe signs in the first 24 hours and were treated in hospital; they were regarded as early treatment failures. The remaining 16 did not complete the study on the basis of various exclusion criteria but were not excluded from the analysis. From these results it was concluded that the combination was effective and a decision was taken in May 2000 to introduce the two-drug combination regimens as the standard first-line treatment of uncomplicated malaria, including falciparum malaria, in Papua New Guinea.     

Splenomegaly in Papua New Guineans and in Japanese living in Papua New Guinea: report of research and exchange program of Osaka University with the South Pacific region

Sizes of spleen and liver were studied by measuring spleen index calculated by multiplying the maximal length by the maximal width of the spleen and liver length at right mid-clavicular line below the costal margin using ultrasonography in 26 Papua New Guineans and in 25 Japaneses living in Papua New Guinea. In Papua New Guinean, spleen index and liver length were 77.4 +/- 9.9 cm2 and 5.4 +/- 0.7 cm, respectively. Their spleen index correlated inversely (p < 0.05) with hemoglobin level. In Japanese, spleen index and liver length were 24.5 +/- 2.1 cm2 and 0.8 +/- 0.3 cm, respectively and spleen index correlated positively with the duration of stay in Papua New Guinea (p < 0.05). These results indicate that the clinical and subclinical infections acquired in P.N.G. may play some role on the development of splenomegaly. Malaria is the prime suspect for the high prevalence of observed splenomegaly in both studied groups.     

Dental materials in Papua New Guinea: a survey of dental clinics

Questionnaires were distributed to 55 Public Health and Defence Force dental clinics throughout Papua New Guinea in order to ascertain storage and clinical conditions, as well as information related to the type, consumption and performance of alginate and elastomeric impression materials and composite restorative materials. Of the 39 respondents, representing a 71% return, few reported any problems with either of the two types of impression materials. However, complaints associated with the use of paste-paste composites, Adaptic and Concise, were a major concern. It was assumed that the problems were caused by exposure to excessively high temperatures during shipment, distribution and storage of these materials throughout Papua New Guinea. Alternative materials, which are less sensitive to heat, were proposed for use in Papua New Guinea. These were a light-activated composite (Durafill), a powder-liquid composite (Powderlite) and a powder-water glass ionomer (Chemfil II).     

Maternal death in Papua New Guinea, 1984-1986

The life-time risk of maternal death in the developing world is about 500 times that for women in developed countries. This disparity is wider than for any other public health statistic. The causes of 304 maternal deaths occurring in the period 1984-1986 are reported; this most likely represents only 10% of the total occurring in Papua New Guinea. The maternal mortality rate is estimated at 7/1000 for the period. Figures for Simbu Province are given in more detail than are available for other parts of Papua New Guinea.     

Obstructive sleep apnoea: a new disease for Papua New Guinea?

Obstructive sleep apnoea is a common disorder in western societies and has a strong association with obesity and alcohol use. The condition has not previously been recorded in Papua New Guinea. The clinical details of 2 patients from Papua New Guinea with obstructive sleep apnoea are described, and the principles of treatment of this condition are outlined. Sleep apnoea is likely to become an increasing problem in Papua New Guinea.     

Diethylcarbamazine in the control of bancroftian filariasis in the highly endemic Ok Tedi area of Papua New Guinea: phase 1

The effects of a well-spaced diethylcarbamazine (DEC) mass drug application in areas highly endemic for Wuchereria bancrofti in Papua New Guinea are not known. In 1986 a semi-annual single-dose 6 mg/kg body weight administration of DEC was initiated in the Ok Tedi area of Western Province, Papua New Guinea. The rate of bancroftian filariasis in the area was 39%. Within two years the rate of detectable microfilaraemia was reduced from 31% to 11% in the treated group. The mean blood density of the parasite was reduced from 79 to 19 microfilariae per 20 microliters. A survey of untreated villages in the immediate area (not surveyed before 1988) showed a filariasis rate of 39%. A 14-fold difference in the total microfilaraemia count was noted between the two groups when 1988 data were compared. A reduction in the annual rate of filariasis may be monitored through a well-established passive case detection program for malaria. The DEC treatment program was well accepted despite side-effects encountered in 20% of the treated population early on in the program. The success of the 2-year Phase 1 program has expanded into an annual single-dose administration of DEC over a larger area.     

Thiamine deficiency in patients with B-chronic lymphocytic leukaemia: a pilot study

Malignancy associated primary thiamine deficiency has been documented in several experimental tumours, sporadic clinical case reports, and in a number of patients with fast growing haematological malignancies. Thiamine status was assessed prospectively in 14 untreated B-chronic lymphocytic leukaemia (CLL) patients, and in 14 age matched control patients with non-malignant disease. Patients with any known cause of absolute, relative, or functional thiamine deficiency were excluded. High (>15%) thiamine pyrophosphate effect (TPPE), indicating thiamine deficiency, was found in five out of 14 CLL patients (35.7%) and in none of the controls (p=0.057). Mean (SD) TPPE in the thiamine deficient patients group was 21.6 (3.4)%. In all the patients, thiamine deficiency was subclinical. No correlates for the thiamine deficiency have been found save for an increment of more than 20% in the total leucocyte count over the preceding three months, which was found in all five thiamine deficient patients compared with only one of the nine non-thiamine deficient CLL patients. Thus, CLL patients may be prone to develop primary thiamine deficiency possibly promoted by the increased leucocytes span, which may increase thiamine consumption. Since even subclinical thiamine deficiency may be detrimental to the patient's clinical course, and in view of the theoretical danger of thiamine promoted tumour cell proliferation, further large scale studies are warranted to confirm this observation, and to elucidate the issue of thiamine supplementation to CLL patients.     

A serological survey of rickettsial infections in the Gazelle Peninsula, East New Britain and a review of the literature

Of the various rickettsial diseases, only scrub typhus has been well documented in Papua New Guinea. A review of the historical literature confirms this. A serological survey was conducted on 113 antenatal patients presenting to a district hospital in Kokopo, East New Britain. Results suggested that a spotted fever rickettsial infection is common in this area with a seroprevalence of about 17% in young women. There was no evidence of scrub typhus or murine (endemic) typhus in the population sampled. Clinical implications of these findings are discussed.     

Towards a malaria vaccine for Papua New Guinea

Malaria is a major problem in Papua New Guinea, where it accounts for a high proportion of sickness and death. In addition to the human suffering, malaria also puts severe stress on the health services, and may directly hinder economic growth. A malaria vaccine would be the best, most cost-effective and safest public health measure to reduce the burden of malaria. Though considerable technical challenges are present, much natural and scientific evidence suggests a vaccine is achievable. Through the malaria vaccine program at the Papua New Guinea Institute of Medical Research, Papua New Guinea is playing a significant role in the global effort to develop a malaria vaccine, and ensuring that the malaria patterns of the Asia-Pacific region figure strongly in vaccine development strategies. Discussed here are some of the major issues to be considered as we work towards a malaria vaccine for Papua New Guinea.     

Neonatal jaundice and glucose-6-phosphate dehydrogenase deficiency in Papua New Guinea.

Of 50 jaundiced neonatal patients studied at the Port Moresby General Hospital, 11 (22%) were found to be glucose-6-phosphate dehydrogenase-deficient. No apparent exogenous precipitating causes for the jaundice were noted. Serum bilirubin levels exceeded 20 mg/100 ml in seven of these glucose-6-phosphate dehydrogenase-deficient infants, and exchange transfusions were required for three subjects. Glucose-6-phosphate dehydrogenase deficiency must be considered in the differential diagnosis of neonatal jaundice in Papua New Guinea.     

The aetiology of severe anaemia among antenatal patients of the Port Moresby General Hospital

Between October 1998 and September 2000, 111 consecutive pregnant patients admitted to the Port Moresby General Hospital antenatal ward with a haemoglobin level of 6 g/dl or less were studied. The main causes of the severe anaemia were as follows: iron deficiency on its own or in combination with another factor 66%--iron deficiency on its own 43% and combined folate and iron deficiency 23%--and folate deficiency 18%. Malaria was a contributory factor in 13 patients (12%). A combination of blood film, bone marrow study, serum assays of ferritin, folate and vitamin B12, and mean corpuscular volume (MCV) was used to determine the cause of the anaemia. Ferritin levels on their own poorly correlated with the presence of iron in the bone marrow. A low MCV correlated well with iron deficiency anaemia while a high MCV was associated with folic acid deficiency. It would seem therefore that while a bone marrow study is mandatory to reach a definitive diagnosis of severe anaemia, MCV, in conjunction with the red cell morphology on blood film, would be a good marker for iron and folic acid deficiency anaemia, especially as we do not have serum assays readily available for folate, ferritin and vitamin B12 in Papua New Guinea.     

Amyloidosis: a global problem common in Papua New Guinea

The increase in different precursor proteins that have been shown to form amyloid fibrils and the identification of common properties have not yet led to any unifying theory or mechanism for the pathogenesis of amyloidogenesis. Papua New Guinea holds a unique place in the story of amyloidosis and in this article we review the current status of amyloidosis research indicating how this relates to those forms relevant to Papua New Guinea. This review concentrates on secondary reactive amyloid (AA), which is found in the highest frequency in the world in parts of Papua New Guinea, and kuru, in which the amyloid protein itself is infectious. The history, pathogenesis and future prospects for these diseases are discussed in the light of what is known about other forms of amyloidosis.     

In vitro susceptibility of Plasmodium falciparum isolates to halofantrine in the Central Province of Papua New Guinea

Halofantrine is a newer antimalarial drug which has not been approved for clinical use in Papua New Guinea. We assessed 21 Central Province isolates of Plasmodium falciparum for their in vitro susceptibility to halofantrine. The concentration required to inhibit 50% of parasite growth (IC50) ranged from 0.05 to 7.0 nM with a mean of 1.90 nM and a median of 1.50 nM. The minimum inhibitory concentration (MIC) values ranged from 2.5 to 50 nM with a median of 5.0 nM. All but one isolate had an MIC of 10 nM or less. These results indicate that halofantrine would be a suitable alternative for the treatment of P. falciparum malaria in the region in the future, if and when the need arises, provided that its use was carefully monitored.     

Trends in sexually transmitted disease incidence in Papua New Guinea

A retrospective study of gonorrhoea and syphilis from Health Department records was carried out in Papua New Guinea. During the ten-year period (1974-1983) 101,636 new cases of gonorrhoea and 34,422 of syphilis were reported among the general population of Papua New Guinea. The incidence of both sexually transmitted disease have significantly (P less than 0.005) increased over the decade despite the introduction and implementation of the National Sexually Transmitted Disease (STD) Control Programme. Some which contribute to the present increase in sexually transmitted diseases are segregation of health and non-health services, insufficient staff training and increased immigration to urban centres.