Suicide in Asia: opportunities and challenges

Asian countries account for approximately 60% of the world's suicides, but there is a great mismatch in the region between the scale of the problem and the resources available to tackle it. Despite certain commonalities, the continent itself is culturally, economically, and socially diverse. This paper reviews current epidemiologic patterns of suicide, including suicide trends, sociodemographic factors, urban/rural living, suicide methods, sociocultural religious influences, and risk and protective factors in Asia, as well as their implications. The observed epidemiologic distributions of suicides reflect complex interplays among the traditional value/culture system, rapid economic transitions under market globalization, availability/desirability of suicide methods, and sociocultural permission/prohibitions regarding suicides. In general, compared with Western countries, Asian countries still have a higher average suicide rate, lower male-to-female suicide gender ratio, and higher elderly-to-general-population suicide ratios. The role of mental illness in suicide is not as important as that in Western countries. In contrast, aggravated by access to lethal means in Asia (e.g., pesticide poisoning and jumping), acute life stress (e.g., family conflicts, job and financial security issues) plays a more important role than it does in Western countries. Some promising suicide prevention programs in Asia are illustrated. Considering the specific socioeconomic and cultural aspects of the region, community-based suicide intervention programs integrating multiple layers of intervention targets may be the most feasible and cost-effective strategy in Asia, with its populous areas and limited resources.     

Home-based mother's record: operational feasibility, understanding and usage in a rural community in Zimbabwe

Utilization of health services is variable but may contribute to the well being of women during pregnancy. If people understand when there is a risk of illness or death, they are likely to cooperate in reducing those risks and participate in their own care. In rural communities people need to be provided with simple but scientifically-sound technology adapted to their understanding and needs. One such technology is the home-based maternal record (HBMR). We assess the feasibility, understanding and usage of a locally adapted HBMR of the World Health Organization prototype in a rural community in Binga district, Zimbabwe.     

Plasma carotenoids,retinol, tocopherols,and lipoproteins in preeclamptic and normotensive pregnant Zimbabwean women

BACKGROUND: We examined the relationship between maternal plasma lipoprotein and antioxidant status with risk of preeclampsia among women delivering at Harare Maternity Hospital, Zimbabwe. METHODS: One hundred seventy-three pregnant women with preeclampsia and 186 controls were included in a case-control study. Maternal plasma total cholesterol, high-density lipoprotein (HDL), and total triglycerides were measured using enzymatic methods. Plasma carotenoids (alpha-carotene, beta-carotene, lycopene, lutein, beta-cryptoxanthin, zeaxanthin), retinol, and tocopherols (alpha-tocopherol and gamma-tocopherol) were determined using high performance liquid chromatography. We used logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Preeclampsia risk increased with successively higher quartiles of plasma triglyceride (OR: 1.00, 1.70, 2.00, 5.26, with the lowest quartile as referent; P for trend <.001). We noted an inverse association between preeclampsia risk and HDL cholesterol concentrations (OR: 1.00, 0.87, 0.66, 0.68, with the first quartile as the referent group; P for trend =.169), although the trend was not statistically significant. After adjusting for confounders, we noted decreases in preeclampsia risk with increasing concentrations of alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein, and zeaxanthin, respectively. Women with beta-carotene concentrations in the highest quartile, as compared with those in the lowest quartile experienced a 50% decreased risk of preeclampsia (OR = 0.50, 95% CI 0.25-1.00). There was no clear pattern of preeclampsia risk with lycopene concentrations or with concentrations of gamma- and alpha-tocopherol. CONCLUSIONS: Our results are consistent with some, although not all, previous reports. Prospective studies are needed to determine the temporal relationship between observed alterations in lipid and antioxidant concentrations in preeclamptic pregnancies.     

Decongestive lymphatic therapy for patients with cancer-related or primary lymphedema

PURPOSE: A prospective evaluation was undertaken to assess the efficacy of intensive, short-term decongestive lymphatic therapy coupled with focused patient instruction in long-term self-care for the management of lymphedema. METHODS: The therapeutic responses of 79 patients with lymphedema were analyzed prospectively. Each patient received intensive, short-term decongestive lymphatic therapy, with quantification of the extent and durability of the clinical response. Decongestive lymphatic therapy was performed by therapists trained in these techniques. The mean (+/-SD) duration of therapy was 8+/-3 days. Instruction in self-management techniques was incorporated into the therapeutic regimen by day 3 of the patient's treatment. The mean period of follow-up was 38+/-52 days. Changes in the volume of the affected limb were assessed with a geometric approximation derived from serial measurements of circumference along the axis of the limb. RESULTS: The mean short-term reduction in limb volume was 44%+/-62% of the excess volume in the upper extremities and 42%+/-40% in the lower extremities. At follow-up, these results were adequately sustained: mean long-term excess volume reductions of 38%+/-56% (upper extremities) and 41%+/-27% (lower extremities) were observed. CONCLUSION: Decongestive lymphatic therapy, combined with long-term self-management, is efficacious in treating patients with lymphedema of the extremity.     

Overlooking the abdominal X-ray --the peril of ascariasis

A young child presented with intermittent bowel obstruction. The abdominal X-ray was not closely examined, and a contrast study was performed that demonstrated multiple tubular filling defects indicative of worms. The patient was treated accordingly. Reviewing the abdominal X-ray demonstrated numerous serpigenous, tubular, soft-tissue densities in gas-filled bowel loops.     

Comparison of arthroplasty trial publications after registration in ClinicalTrials.gov

In 2005, the International Committee of Medical Journal Editors established a mandatory trial registration before study enrollment for publication in member journals. Our primary objective was to evaluate the publication rates of arthroplasty trials registered with ClinicalTrials.gov (CTG). We further aimed to examine the consistency of registration summaries with that of final publications. We searched CTG for all trials related to joint arthroplasty and conducted a thorough search for publications resulting from registered closed trials. Of 101 closed and completed trials, we found 23 publications, for an overall publication rate of 22.8%. Registration of arthroplasty trials in CTG does not consistently result in publication or disclosure of results. In addition, changes are frequently made to the final presentation of the data that are not reflected in the trial registry.     

Syncope as an initial manifestation of atypical lipomatous hypertrophy of the interatrial septum

Lipomatous hypertrophy of the interatrial septum (LHIS) is an incidental echocardiographic abnormality characterized by dumb-bell configuration of the interatrial septum from excess fat deposition. We report a case of syncope in a patient with LHIS obstructing the superior vena cava at the right atrial junction.     

Giant mesenteric fibromatosis: Report of a case and review of the literature

Mesenteric fibromatosis poses a diagnostic and therapeutic challenge.This paper presents a 35-year-old female complaining of vague abdominal pain of 2 mo duration.Her computed tomography scan and magnetic resonance imaging revealed a pelvi-abdominal heterogenous mass with significant displacement of the small bowel and urinary bladder.She underwent surgical excision of the mass with resection and anastomosis of the involved loop of the small intestine.Histological examination confirmed mesenteric fibromatosis without infiltration of the bowel.The patient remained well during the 6 mo follow-up.     

Genetic instability assessed by sister chromatid exchange analysis in the dunning R-3327 rat prostatic adenocarcinoma model and its relationship to metastatic potential

The original Dunning R-3327 tumor, described in 1961, has given rise to distinct sublines of different metastatic potentials. The different phenotypes cannot be explained by differences in chromosomal number, DNA content, or nuclear pleomorphism. Sister chromatid exchange is an interchange between two strands of DNA indicative of DNA damage. The frequency of sister chromatid exchanges is a well-accepted measure of genetic instability. To determine whether an assay of genetic instability could distinguish sublines capable of generating cells of the metastatic phenotype, cells from three sublines of low (<10%) metastatic potential and three sublines of high (>90%) metastatic potential were cultured in 10 μM 5-bromodeoxyuridine to label DNA. Chromosome preparations were made and sister chromatids were differentiated with Hoechst 33258 dye and Giemsa stain. Sixty metaphase spreads from each subline were scored for SCE and chromosome number. The low metastatic sublines G, AT-1, and AT-2 had 0.32 ± standard deviation 0.10, 0.38 ± 0.12, and 0.14 ± 0.05 sister chromatid exchanges per chromosome, respectively. The high metastatic sublines AT-3, MAT-Lu, and MAT-LyLu had 0.55 ± 0.17, 0.32 ± 0.1, and 0.33 ± 0.2 sister chromatid exchanges per chromosome, respectively. Subline differences in metastatic potentials cannot be explained by incidences of sister chromatid exchanges.