Lack of medical resources and public health vulnerability in Mongolia's winter disasters.

INTRODUCTION: Many countries face the need to address medical resource shortages following various disasters. The dzud is a winter disaster that occurs in Mongolia following drought in dryland areas, and it leads to high livestock mortality. Affected provinces suffer increased mortality rates for children aged under 5 years. Using various factors, including medical resources, the present study aimed to evaluate the health risks for children during the dzud. METHODS: Data from all of Mongolia's 21 provinces and the capital of Ulaanbaatar were analyzed. The change in child mortality (CCM) was defined as the difference in the under-five mortality rate from 2009 to 2010. To determine the correlations, the CCM was compared with the urbanization rate (proportion of urban population), number of physicians and nurses (per 1000 residents), average temperature, total precipitation (October 2009 to February 2010), and declining rate in livestock numbers for 2009-10 (percentage livestock loss) in each province. RESULTS: The correlation coefficients between the CCM and each factor were as follows: number of physicians (r=−0.506, p=0.016), urbanization rate (r=−0.467, p=0.029), and percentage livestock loss (r=0.469, p=0.028). In the multiple regression analysis, the number of physicians was significantly negatively related to the CCM (standardizing coefficient −0.492, p=0.020). CONCLUSION: These results suggest that increased medical resources and infrastructure development have positive effects on child health - even in the setting where the dzud causes considerable damage to livestock.

Analysis of the Genetic Diversity Associated With the Drug Resistance and Pathogenicity of Influenza A Virus Isolated in Bangladesh From 2002 to 2019.

The subtype prevalence, drug resistance- and pathogenicity-associated mutations, and the distribution of the influenza A virus (IAV) isolates identified in Bangladesh from 2002 to 2019 were analyzed using bioinformatic tools. A total of 30 IAV subtypes have been identified in humans (4), avian species (29), and environment (5) in Bangladesh. The predominant subtypes in human and avian species are H1N1/H3N2 and H5N1/H9N2, respectively. However, the subtypes H5N1/H9N2 infecting humans and H3N2/H1N1 infecting avian species have also been identified. Among the avian species, the maximum number of subtypes (27) have been identified in ducks. A 3.56% of the isolates showed neuraminidase inhibitor (NAI) resistance with a prevalence of 8.50, 1.33, and 2.67% in avian species, humans, and the environment, respectively, the following mutations were detected: V116A, I117V, D198N, I223R, S247N, H275Y, and N295S. Prevalence of adamantane-resistant IAVs was 100, 50, and 30.54% in humans, the environment, and avian species, respectively, the subtypes H3N2, H1N1, H9N2, and H5N2 were highly prevalent, with the subtype H5N1 showing a comparatively lower prevalence. Important PB2 mutations such D9N, K526R, A588V, A588I, G590S, Q591R, E627K, K702R, and S714R were identified. A wide range of IAV subtypes have been identified in Bangladesh with a diversified genetic variation in the NA, M2, and PB2 proteins providing drug resistance and enhanced pathogenicity. This study provides a detailed analysis of the subtypes, and the host range of the IAV isolates and the genetic variations related to their proteins, which may aid in the prevention, treatment, and control of IAV infections in Bangladesh, and would serve as a basis for future investigations.

The Effects of Drought Severity and Its Aftereffects on Mortality in Bangladesh.

BACKGROUND: Drought has been a considerable problem for many years in northern Bangladesh. However, the health impacts of drought in this region are not well understood. METHODS: This study analyzed the impact of drought duration and severity on select causes of mortality in northern Bangladesh. Rainfall data from three meteorological stations (Rangpur, Dinajpur and Nilphamari) in northern Bangladesh were used to assess drought and non-drought periods, and the Standardized Precipitation Index was used to categorize mild, moderate, severe, and extreme drought. Mortality data from 2007 to 2017 for the three areas were collected from the Sample Vital Registration System, which is a survey of 1 million people. The generalized linear model with Poisson regression link was used to identify associations between mortality and the drought severity and 1-month preceding SPI. RESULTS: Only severe and extreme drought in the short-term drought periods affected mortality. Long-term drought was not associated with natural cause mortality in Rangpur and Nilphamari. In Dinajpur, mild and moderate drought was associated with circulatory- and respiratory-related mortality. CONCLUSION: The impact of drought on mortality varied by region. This study improves our understanding of how droughts affect specific causes of mortality and will help policy makers to take appropriate measures against drought impacts on selected cause of mortality. Future research will be critical to reduce drought-related risks of health.

The Influence of Income and Livelihood Diversification on Health-Related Quality of Life in Rural Ethiopia.

Examining health-related quality of life (HRQOL) in a rural setting can be beneficial for improving rural household policies and fostering public health promotion. The objective of this study was to measure the HRQOL and associated socioeconomic characteristics as well as test the reliability of the Amharic version of SF-8 (eight-item short form of HRQOL survey). A cross-sectional study was employed in three agroecologically different sites in rural Ethiopia, involving 270 household heads (218 male and 52 female) with a mean age ± standard deviation of 49 ± 12.88 years. The survey material consisted of a structured questionnaire for socioeconomic characteristics and SF-8 for HRQOL. The mean physical and mental component summary score of the whole sample was 30.50 ± 12.18 and 34.40 ± 7.26, respectively, well underneath the instrument average of 50. The SF-8 items showed excellent internal consistency in terms of both Cronbach's α coefficients and item-total correlation. In stepwise multiple linear regression, the low-income group had worse self-perceived physical health than the higher-income groups. Likewise, a diversified livelihood had a profound influence on positive self-perceived physical health. These findings imply that developing and distributing wide-ranging socioeconomic and public health policies is crucial for effective health promotion in rural communities.

Effects of a Self-efficacy Theory-Based Training Program for Peers of Patients with Type 2 Diabetes.

BACKGROUND: Training peer leaders to deliver patient education is expected to be a low-cost approach to providing healthcare in urban-poor areas affected by a shortage of healthcare professionals. The purpose of this study was to examine the effects of a training program on the self-efficacy and knowledge of peer leaders with type 2 diabetes. METHODS: A single-group longitudinal survey with baseline, intervention, and follow-up periods was conducted at a diabetes clinic in a small municipality in Metro Manila, Philippines. The intervention, a self-efficacy theory-based training program for peer-leaders of diabetic patients conducted in August 2017, comprised hands-on learning, demonstrations, quizzes, role-playing, group sharing, physical exercise, and a buffet lunch. The primary outcome was participants' self-efficacy for management of their diabetes. Secondary outcomes were participants' knowledge of diabetes and levels of emotional distress, motivation, and confidence for guiding their peers, satisfaction with the training program, hemoglobin A1c, and quality of life. RESULTS: At 12 and 18 months after the intervention, participants' knowledge of diabetes was significantly increased compared with baseline (both P < 0.05). At earlier time points, an increasing, but not significant, trend was observed. The change in knowledge of diabetes from baseline to 18 months after intervention tended to be positively correlated with the change in self-efficacy (r = 0.594, P = 0.054). No significant differences were observed for any of the other outcomes, although the descriptive statistics showed an increasing trend for all of the outcomes except motivation. CONCLUSION: The training program significantly improved participants' knowledge of diabetes at 12 and 18 months after the training programs compared with baseline. A positive correlation between the changes in the levels of knowledge and self-efficacy suggested that the observed improvement of self-efficacy was facilitated by the improvement of knowledge of diabetes.

Impact of Maximum Air Temperature on Ambulance Transports Owing to Heat Stroke During Spring and Summer in Tottori Prefecture, Japan: A Time-stratified Case-crossover Analysis.

BACKGROUND: The frequency and intensity of hot weather have increased. In Japan, there have been many studies of the relationship between ambulance transports owing to heat stroke (ATHS) and high air temperature in the summer season. However, there have been very few reports focusing on ATHS in spring. Therefore, we investigated the effect of the maximum air temperature on ATHS not only in summer but also in spring, to help with development of effective measures to prevent heat stroke. METHODS: We obtained daily ATHS and meteorological data from April to September in 2017 in Tottori Prefecture. We used a time-stratified case-crossover method for data analysis. RESULTS: A total 382 cases of ATHS were identified from April to September in 2017 in Tottori. The number of cases was highest in July, followed by August and May. Maximum air temperature was significantly linked to ATHS. The risk of ATHS was increased 1.13 times when maximum air temperature rose by 1°C. In summer, the risk on extremely hot days (maximum air temperature ≥ 35°C) increased by 5.55 times or more compared with that on days below 30 °C (< 30°C). The risk was approximately four times greater on hot days (≥ 30°C and < 35°C) than that on relatively cooler days (< 30°C) during the spring months of April through May. CONCLUSION: Maximum air temperature was significantly linked to ATHS. It is necessary to pay particular attention to heat stroke prevention not only on extremely hot days in summer but also on hot days in the spring.

A Conceptual Model for Quality of Life Among People with Type 2 Diabetes in the Philippines.

BACKGROUND: The increased prevalence of chronic diseases is a social issue in developing countries. METHODS: To create a conceptual model representing the quality of life of low-income people with type 2 diabetes in the Philippines, 117 low-income adult participants in a public support group were studied, and the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores on quality of life (QOL) were analyzed in terms of their relationships with the following factors: basic attributes, physical factors (glycated hemoglobin level, complications, comorbidities, and symptoms), social factors (support, education, and financial status), and cognitive factors (knowledge, attitude, self-efficacy, and self-management behavior). RESULTS: Based on correlation coefficients among variables and goodness-of-fit test results through a path analysis, 2 models representing causal relationships were created, both of which showed sufficient goodness-of-fit. CONCLUSION: Glycated hemoglobin levels, knowledge of blood glucose levels, self-efficacy, and self-management behavior (exercise) influenced PCS scores, while age, glycated hemoglobin levels, neuropathy, knowledge of insulin, self-efficacy, and self-management behavior (exercise) influenced MCS scores. The influence of self-efficacy was prominent in both cases, providing an important insight for healthcare professionals to develop effective support methods.

Association between dental caries indicators and serum glycated hemoglobin-levels among patients with type 2 diabetes mellitus.

Diabetes mellitus (DM) with poor glycemic control is often linked to oral manifestations. This study aimed to investigate the association between dental caries (DC) and glycated hemoglobin (HbA1c) among patients with type 2 DM (T2DM). A health center-based cross-sectional study was conducted comprising 91 eligible patients with T2DM (21 males and 70 females) with a mean age (± standard deviation) of 61.49 ± 9.71 years. A structured interview, screening for DM-related factors, and oral examination were performed. Serum HbA1c levels were used as an index for glycemic control. A comparison between patients with controlled T2DM, i.e., HbA1c ≤7.0% (n = 46), and uncontrolled T2DM, i.e., HbA1c >7.0% (n = 45), showed significant differences in mean values of decayed teeth (DT) (P = 0.045); missing teeth (P = 0.002); and decayed, missing, and filled teeth (DMFT) index (P < 0.001). Results of multiple linear regression analysis revealed that the number of DT was significantly correlated with serum HbA1c levels (95% confidence interval [CI] 0.173 to 0.972, P = 0.005). Furthermore, DMFT index values and serum HbA1c levels (95% CI 0.532 to 1.658, P < 0.001) showed a significant association. This study provides substantial evidence on the association between DC indicators and serum HbA1c levels.

Association between Asian Dust-Borne Air Pollutants and Daily Symptoms on Healthy Subjects: A Web-Based Pilot Study in Yonago, Japan.

During the spring, Asian dust (AD) repeatedly makes its way to Japan, originating from drylands. We evaluated the association between AD-borne air pollutants and daily reported subjective symptoms in healthy subjects. We constructed an Internet questionnaire on daily ocular, nasal, respiratory, and skin symptoms. Forty-two healthy volunteers residents of Yonago (mean age, 33.57) were selected from the self-reporting web-based survey and recorded their symptoms between 1 and 31 of March 2013. We also collected information on levels of suspended particulate matter (SPM), particulate matter < 2.5 µm (PM2.5), sulfur dioxide (SO2), and nitrogen oxide (NO x ) per hour on each of those days. SPM and PM2.5 were the dominant pollutants recorded throughout the month. A positive correlation was observed between SPM and ocular (r = 0.475, p < 0.01), nasal (r = 0.614, p < 0.001), and skin (r = 0.445, p < 0.05) symptoms. PM2.5 correlations were significant for ocular (r = 0.428, p < 0.05), nasal (r = 0.560, p < 0.01), and skin (r = 0.437, p < 0.05) symptoms. Our findings provide introductory evidence of AD-borne air pollutants and their association with several bodily symptoms in healthy subjects with the implementation of a self-administrated web-based survey application.

The Effect of Bamboo Leaf Extract Solution and Sodium Copper Chlorophyllin Solution on Growth and Volatile Sulfur Compounds Production of Oral Malodor Associated Some Anaerobic Periodontal Bacteria.

BACKGROUND: Bamboo leaf extract solution (BLES) and sodium copper chlorophyllin solution (SCCS) are known for their anti-oxidant activities. Oral malodor is often related with periodontal pathogens. The present study was undertaken to investigate the anti-bacterial effect of both BLES and SCCS on anaerobic periodontal bacteria producing oral malodorous volatile sulfur compounds (VSC). METHODS: Porphyromonas gingivalis W83 (PG), Prevotella intermidai TDC19B (PI), Fusobacterium nucleatum ATCC25586 (FN) and Prevotella nigrescence ATCC33563 (PN) were investigated as oral isolated bacteria. VSC production ability of the oral strains was investigated by gas chromatography. With serial dilution of BLES or SCCS, the strains PG, PI, FN or PN were cultured anaerobically with AnaeroPack at 37 ℃ for 3 days. For the determination of anti-bacterial action of BLES or SCCS, the inoculum was cultured with original concentrations of BLES 0.16% (w/v) or SCCS 0.25% (w/v). RESULTS: Gas chromatography exhibited that all strains, PG, PI, FN and PN were responsible for producing a high range of H2S and a moderate range of CH3SH. Anti-bacterial effect of BLES or SCCS on the strains was observed. Inhibition of BLES or SCCS on the strains was revealed as concentration dependent. BLES or SCCS inhibited bacterial proliferation at higher concentrations (PG; 0.04% BLES or 0.03% SCCS, PI; 0.002% BLES or 0.03% SCCS, FN; 0.005% BLES or 0.01% SCCS, PN; 0.01% BLES or 0.015% SCCS). No viable bacterial colony observed at original concentration of BLES 0.16% or SCCS 0.25%. Strain growth was eliminated from inhibition at lower concentrations (PG; 0.02% BLES or 0.015% SCCS, PI; 0.001% BLES or 0.015% SCCS, FN; 0.002% BLES or 0.007% SCCS, PN; 0.005% BLES or 0.007% SCCS). CONCLUSION: High concentrations of both BLES (0.16%) and SCCS (0.25%) show superior inhibiting capability on all four oral malodor associated periodontal anaerobes during testing, suggesting that these compounds might have a beneficial effect on oral health care.