Eradication of the commensal intestinal microflora by oral antimicrobials interferes with the host response to lipopolysaccharide.

The host components and commensal microorganisms of the intestinal microenvironment play roles in the development and maintenance of the host defence. Recent observations have suggested that toll-like receptors (TLRs) are involved in the recognition of innate immunity against intestinal microbes. However, little is known regarding the role of TLR in the maintenance of systemic host defence by intestinal microorganisms. We studied the expression and function of TLR4 and TLR2 on alveolar and peritoneal macrophages in mice after 3 weeks of oral administration of streptomycin and cefotaxime. After active treatment, the intestinal microorganisms were nearly completely eradicated, and the surface expression of TLR4 and TLR2 on the peritoneal macrophages was prominently downregulated. When the actively treated mice were challenged with lipopolysaccharide (LPS), a TLR4 ligand, the host response was markedly impaired. Our results suggest that the oral administration of antimicrobials downregulates the expression of surface TLR on the peritoneal macrophages and modulates the host immune responses against LPS by modifying the intestinal environment.

Effect of the preliminary hydration on gastric emptying time for water in healthy volunteers.

BACKGROUND: International guidelines allow healthy patients to drink clear liquid up to 2 h before general anesthesia. Recently, MRI measurements have been used for tracking gastric volume in humans. Hence, we used MRI to examine the gastric emptying rate of water in healthy volunteers with or without prior water loading. METHODS: Fifteen healthy volunteers were enrolled. The participants had MRI examinations on separate days under two different protocols: The preliminary hydration protocol (group H) and the water restriction protocol (group R). After the intake of water, MR imaging was performed every 10 min for 60 min. The gastric content was outlined as area of interest (AOI), and the AOI area of each slice was summated to calculate the volume of gastric contents. RESULTS: The 50% reduction time of gastric volume in group R and group H was 18+/-9 and 16+/-8 min (mean+/-SD), respectively. There were no significant changes between the two groups. CONCLUSION: The gastric emptying time for water evaluated with MRI was not affected by preliminary hydration, which shows the safety of repeated oral hydrations in the pre-operative period.

Cloning and expression of human B cell-specific transcription factor BACH2 mapped to chromosome 6q15.

The transcription factor Bach2, a member of the BTB-basic region leucine zipper (bZip) factor family, binds to a 12-O-tetradecanoylphorbol-13-acetate (TPA)-responsive element and the related Maf-recognition element (MARE) by forming homodimers or heterodimers with Maf-related transcription factors. Bach2 regulates transcription by binding to these elements. To understand the function in hematopoiesis, we isolated a cDNA clone for human Bach2 (BACH2) encoding a protein of 841 amino acid residues with a deduced amino acid sequence having 89.5% identity to mouse homolog. Among human hematopoietic cell lines, BACH2 is expressed abundantly only in some B-lymphocytic cell lines. RT-PCR analysis of hematopoietic cells revealed that BACH2 mRNA is expressed in primary B-cells. Enforced expression of BACH2 in a human Burkitt cell line, RAJI that does not express endogenous BACH2, resulted in marked reduction of clonogenic activity, indicating that BACH2 possesses an inhibitory effect on cell proliferation. By fluorescent in situ hybridization, the BACH2 gene was localized to chromosome 6q15. Because deletion of the long arm of chromosome 6 (6q) is one of the commonest chromosomal alterations in human B-cell lymphoma, we examined for the loss of heterozygosity (LOH) of the BACH2 gene in human B-cell non-Hodgkin's lymphomas (NHL). Among 25 informative cases, five (20%) showed LOH. These results indicate that BACH2 plays important roles in regulation of B cell development.

Progression from myelodysplastic syndrome with monosomy 7 to acute monoblastic leukemia with MLL gene rearrangement.

We report a case of myelodysplastic syndrome (MDS) with the 11q23 translocation at its leukemic transformation. Southern blot analysis demonstrated that the MLL gene on chromosome 11 was rearranged during the progression from MDS to acute leukemia. The clinical observation in this case supports the notion that leukemic transformation involves multiple cytogenetic evolutionary progresses, and that MLL gene rearrangement corresponds to the final step of leukemogenesis.

Socioeconomic factors and dental caries in developing countries: a cross-national study.

The purpose of the present study was to analyze statistically correlations between socioeconomic factors and the prevalence of dental caries in developing countries. The DMFT index, which evaluates the incidence of dental caries, showed a positive correlation (P < 0.01) with several socioeconomic factors, such as life expectancy, adult literacy rate, school attendance rate, population employed in the service sector, population aged 15-64 years, and urban population. According to multiple regression analysis, population aged 15-64 years, population employed in the service sector, and urban population were the most influential independent socioeconomic variables, in descending order, with a regression coefficient of 0.635 and a coefficient of determination of 0.404 (P < 0.001). This finding suggests that the prevalence of dental caries in developing countries increases with the degree of urbanization.

Leprosy elimination through integrated basic health services in Myanmar: the role of midwives.

Myanmar is one of the top 16 countries identified by WHO as being hyperendemic for leprosy. Multi-drug therapy (MDT) was introduced in 1988 as a vertical programme and gradually integrated into the basic health services (BHS), achieving 100% coverage over the registered cases by 1995. To achieve maximum coverage of and benefit for patients, both leprosy vertical staff and BHS staff were trained to implement MDT whilst performing routine BHS activities. This included a total of 8615 trained midwives who were mobilized for the nationwide leprosy elimination programme (LEP). They worked at village level in various parts of the country and were willing and able to carry out basic tasks in leprosy management, such as the implementation of MDT using blister-calender packs carrying a month's supply of drugs. This study was performed to assess the workload of midwives and their attitude towards LEP. The authors conclude that midwives in Myanmar show a high level of commitment and reliability, which are essential contributing factors to achieve the current goal of leprosy elimination by the year 2000. Along with the present trend of decreasing prevalence rate, leprosy could no longer be considered as a public health problem at national level by the year 2000 in Myanmar. However, because of its long incubation period, new leprosy patients may arise even after the elimination target is achieved, whilst many other patients may become disabled. A community-based sustainable approach for the post-elimination phase, after the year 2000, will be essential and the contribution of the midwives may be of considerable importance.

From 'culture of dehumanization of childbirth' to 'childbirth as a transformative experience': changes in five municipalities in north-east Brazil.

Brazil has become a country known as having one of the most extreme examples of the consequences of the hospital-based medicalization of delivery care, while a model of humanization of birth was developed in the State of Ceará in the 1970s. The Government of Japan, through the Japanese International Cooperation Agency (JICA), collaborated with the Federal Ministry of Health of Brazil and the Government of the State of Ceará, in implementing the Maternal and Child Health Improvement Project in north-east Brazil (1996-2001). This project focused on 'humanization of childbirth', with training based intervention activities. Behavioral changes among health professionals who received the project's participatory type of training were described using rapid anthropological assessment procedure (RAP) survey results. Changes from 'a culture of dehumanization of childbirth' to 'childbirth as a transformative experience' were observed.

Control of dengue fever with active surveillance and the use of insecticidal aerosol cans.

An interventional study was conducted in southern Vietnam to evaluate the feasibility and effectiveness of a new approach to control dengue fever. The approach consisted of active surveillance of dengue patients and the use of insecticidal aerosol cans. Febrile patients were tested serologically at local health centers and insecticidal aerosol cans were given to the family and employed in the neighborhood of dengue patients instead of ultra low volume (ULV) fogging with insecticide. The number of dengue IgM antibody positive cases among febrile patients, the number of reported dengue hemorrhagic fever patients and the total cost were compared in the 2 approaches (prompt focal ULV fogging and the use of insecticidal aerosol cans) in 1997. The aerosol cans were employed 5 times (in June, July, August, September and October) in the study area. ULV fogging in the control area was performed 5 times (in March, May, July, August and September). Twenty-two serologically positive cases were found in the study area which was about half that found in the control area (43 cases). A total of 16 dengue hemorrhagic fever patients was reported in the study area and 43 in the control area. Compared with the reported numbers of the previous year, the reduction rate in the number of dengue hemorrhagic fever cases was 71.4% in the study area and 51.7% in the control area. There were statistically significant differences in the morbidity of dengue fever and the reduction rate of dengue hemorrhagic fever. The cost of the insecticidal aerosol cans was US$393 which was lower than the cost of US$553 for ULV fogging. The findings suggest that insecticidal aerosol cans were effective and feasible for dengue fever control.

Knowledge, attitude and practice of smoking among university students of allied health sciences in Japan.

A study was conducted to determine the knowledge, attitude and practice (KAP) of cigarette smoking among freshman students of Tokyo Metropolitan University of Health Sciences. Students were categorized as 'ever-smoker' or 'nonsmoker'. 18.3% of the 356 subjects were categorized as 'ever-smoker'. The two categories were then compared to determine significant differences in health knowledge, attitudes towards health and smoking, smoking perceptions and preferences, knowledge on the economic impact of tobacco and attitudes towards tobacco control measures. In most cases, significant differences were found between the two groups. However, concerning knowledge on the economic impact of tobacco, the majority of both ever-smokers and nonsmokers had poor knowledge. Increased tobacco control education and related efforts are needed as is further research in determining the factors or influences that shape the significant differences found. Such information will be invaluable in formulating appropriate tobacco control measures for the future.

A new light on the community health fund--effective political support for a community essential drug project in Vietnam.

This report sheds new light on the development of a community health fund through the implementation of a community essential drug project, and its impact on the improvement of primary health care at the community level. The experience of community drug funds in Vietnam, supported by a strong government commitment, in which full delegation of authority on the management of drugs and finances is given to the community along with a measure for tax exemptions for drug fund revenues, provides a significant example of an autonomous community with active participation of people and effective resource mobilization, that is leading to the improvement of community health.

Cost analysis of malaria patients in Taikkyi Township Myanmar.

A hospital and clinic-based study was conducted in one malaria endemic area, Taikkyi Township, Yangon Division, Myanmar, for analysis of cost incurred by different types of malaria cases and the factors influencing the cost of illness from July to October 1995. A total of 100 patients admitted to hospital and 100 patients receiving ambulatory care from malaria clinics were interviewed using a structured questionnaire. Total cost of one episode of malaria was estimated to be kyats 559 for ambulatory care, kyats 2582 for an uncomplicated admitted case, kyats 4056 for one episode of cerebral malaria, kyats 4568 for one episode of other severe and complicated malaria and kyats 4758 for one episode of malaria with other disease. This study showed that the cost of illness for patients attending outpatient malaria clinics who received early diagnosis and prompt treatment was four to seven times cheaper than the cost of illness for hospitalized malaria cases. Multivariate analysis revealed the factors that contributed to high cost of care. Duration of illness before getting any type of treatment was the key factor that contributed to high or low cost of care. Long duration of illness before getting any type of treatment can lead to high malaria parasite density, long duration of actual illness and high total attendance cost. Therefore, it is recommended that people from malaria endemic areas should be informed to seek early treatment from health staff, and primary health care services should be made accessible to people who live in malaria endemic areas. The information obtained from this study will be useful in planning future malaria control programs and influencing policy makers to focus on timely and effective treatment of non-severe cases, which can save a large amount of economic loss due to treatment of severe malaria.

Should community-managed drug stores be phased out?

UNLABELLED: The existence of community-managed drug stores (CDS), operated by trained village health workers under the supervision of health officials, is under threat in the Philippines. This is to determine if there is an association between households' access to medicines and three types of CDS, namely, Botika Binhi (BB), Family Health Management By and For Urban Poor Settlers Pharmacy (FAMUSCY) and Botika ng Barangay (BnB) in selected urban and rural communities in a province where all three types operate. The study design was case-control using structured interviews and observations. A total of 1,710 households or 90% of the total were interviewed, and the medicines at home were inspected. Indicators for the five dimensions of access are affordability, availability, A1 quality, acceptability and appropriateness. The village with the longest-running CDS for each type was selected. RESULT: There is an association between the presence of any of the three CDS and villagers' perception of affordability of medicines, between FAMUSCY or BnB and availability of unbranded medicines at home as well as perception of counselling provided by prescribers and dispensers to be more than expected. On the contrary, there is an inverse association between the presence of FAMUSCY and availability of herbal plants at home, between BnB and percent of correct uses of medicines at home, and between either FAMUSCY or BnB and perceptions of availability of medicines and quality of services by dispensers at patronized drug outlets. CONCLUSION: Phasing out CDS should be weighed against the benefit of making medicines affordable at the village level, promoting the use of unbranded medicines and herbal plants with recognised therapeutic value, and keeping the clients informed through drug counselling provided by prescribers and dispensers.

Estimation of salt intake and recommendation for iodine content in iodized salt in Mongolia.

In 1996, the Mongolian Government pledged to eliminate iodine deficiency disorders by 2001 using salt iodization as its primary strategy. Iodine content in salt was set at 50 +/- 10 PPM based on an assumption of 5 g of daily salt intake. In 1998, the authors suspected that salt intake was more than 5 g and that pregnant women consumed more salt than non-pregnant women. Over 1,600 adults of both sexes were studied in five provinces. In this study we estimated salt intake based on urinary excretion of sodium and creatinine. A formula was used to calculate salt intake from excreted volumes of sodium and creatinine. Average values for pregnant women, non-pregnant women, and men, were found to be 15.6 g (n = 499), 12.6 g (n = 598), and 14.6 g (n = 571), respectively. We concluded that appropriate iodine content in salt should range from 20 to 40 PPM. It is recommended that health education regarding proper levels of salt intake be carried out with the general public, with emphasis on pregnant women.

Current status of iodine deficiency in Mongolia in 1998-1999.

In 1992, the Mongolian government conducted a nationwide palpation study of the thyroid glands, and the study showed an overall goiter rate of 30%. As a result of this, the Mongolian Government launched its Iodine Deficiency Disorders (IDD) Elimination Programme in 1996 and its primary strategy was salt iodization. In 1998 and 1999, we carried out programme monitoring studies in 11 provinces. The results showed: among schoolchildren, a goiter rate was 22.8% (n = 6,535), median values of urinary iodine excretion ranged from 11 micrograms/l to 256 micrograms/l (n = 1,930), and usage rates of iodized salt (> 20 PPM iodine content) in their households ranged from 3% to 82%. We concluded that severe iodine deficiency in 1992 was improved from moderate to mild severity a few years later by salt iodization. However, stronger official commitments and community participation are needed to improve the programme so that iodized salt will be made more widely available.

Subjective evaluation of chewing ability and self-rated general health status in elderly residents of Japan.

The purpose of the present study was to statistically analyse the relationship between subjective evaluation of chewing ability and self-rated general health status in elderly Japanese residents. Interviews were conducted with 1,544 respondents over 65 years of age in Yamanashi Prefecture, Japan. The interviews included questions concerning age, sex, health status, capacity to understand conversation, chewing ability, and ADL status. First, the age-adjusted odds ratio between subjective evaluation of chewing ability and self-rated health status was 2.242 (p < or = 0.01). Second, the age-adjusted odds ratio between respondentive evaluation of chewing ability and ADL status was 2.572 (p < or = 0.01). Third, the age-adjusted odds ratio between self-assessment of chewing ability and the degree of understanding conversations was 5.290 (p < or = 0.01). These results suggest that chewing ability is related to self-rated general health, ADL status, and the degree of understanding conversation among the elderly.

The role of AIDS volunteers in developing community-based care for people with AIDS in Thailand.

The present study analyses the effectiveness of AIDS volunteers in mitigating the stigma attached to People With AIDS (PWAs) within the context of developing community-based care (CBC) in Thailand. A total of 86 trained village health volunteers (T-VHVs) and 99 non-trained village health volunteers (N-VHVs) were enrolled in the study. In addition, 58 villagers in the T-VHV's intervention area and 72 villagers in the non-intervention area were also enrolled. Both T-VHVs and N-VHVs as well as villagers were assessed to determine their level of knowledge with respect to HIV/AIDS and attitudes toward PWAs. Furthermore, we also determined the village health volunteers' level of activity in distributing knowledge of HIV/AIDS in order to prevent and reduce stigma in the community. Although T-VHVs showed a greater depth of knowledge of HIV/AIDS than N-VHVs (p < 0.05), positive attitudes toward PWAs and the level of practice of village health volunteers did not differ significantly between T-VHVs and N-VHVs. While the level of health knowledge of villagers did not differ significantly between the T-VHV's intervention and control areas, a significant difference was observed between the two areas in terms of the villagers' attitudes towards PWAs (p < 0.01). Villagers in the intervention area attached less stigma to PWAs; therefore, T-VHVs played a role in providing basic information on AIDS to the villagers and in mitigating the stigma attached to PWAs. However, these volunteers need to undergo further training through a well-organized training programme in order to obtain a greater depth of knowledge. This is essential for the development of community-based care for PWAs.

[On line display of the reconstructed pressure waves of the radial artery from the monitored output pressure waves at the same site].

The input-output relationship of transducer and catheter system is described by linear, second-order differential equation with three coefficients: inductance (L), resistance (R), and capacitance (C). Once the natural frequency (fo) and the damping ratio (beta) of the monitoring system have been measured, three coefficients of the differential equation are uniquely obtained. We measured the frequency response of the monitoring system, which we usually use in our hospital, to obtain fo and beta, and reconstructed the original input arterial pressure wave from output signal on the display using the simple time-domain approach. The analysis of this linear, second-order differential equation, is applicable in on-line bedside monitoring, because the calculation of this equation is simpler than that using Fourier's translation. The pressure waves of the radial artery both monitored (output) and restored (input) were depicted on the same display at the same time. We can evaluate the changes in systemic circulation from the changes in the wave shapes of arterial blood pressure.